Ruhl & Ruhl Insurance - Certificate of Insurance

Submit to:

Name

Address

City

State

Zip code

Phone Number

Insured's Name

Requested by

Certificate Holder's Name & Address

Regarding: (description of operations/locations/vehicles/special items)

Does the certificate holder need to be named as an additional insurred?
yes no
If so, what is their interest?

Special Instructions

If certificate needs to be faxed, what is the name of person and fax number?

Name

Fax