Self-Issue COI

Welcome, Kevin Kirkman

Note: Additional insureds are not automatically provided/issued per previous policy terms. You will need to request Additional Insureds that are needed for this policy term below.

Owners and/or Lessors Of Premises (Property Owners) and Sponsors of organizations are automatically endorsed onto the General Liability policy as "Additional Insureds."

Note: Do NOT list a person or business entity that is not a property owner or sponsor. Contact Sadler & Company, Inc. via email at sport9@sadlersports.com if you have questions about other types of additional insureds. It is the responsibility of the insured to make sure that the relationship listed is accurate in order to insure that coverage is available.

Do NOT list another team/league/instructor as an additional insured, if you have a need for this, please email sport9@sadlersports.com for clarification.

Please list only other entities below that require a certificate of insurance:

Select a Preset COI

Autofill information for frequently requested certificate holders by selecting from menu below: (automatically includes special wording and/or endorsements if required.)

Selecting from the list will autofill in your COI and the information entered below will be ignored.

OR complete the following

* Name of Entity Requesting COI

* Primary Location Address

Address 2

* City

* State

* Postal Code

* Relationship to the Named Insured Applying For Coverage (The system will produce all required documents based on the relationship.)

Property Owner/Lessor

Sponsor

Sports Governing Body

Tournament Host

Co-Promoter

* Other than being named on the certificate as an additional insured/certificate holder, does the entity require any special wording or endorsements?

Yes No

Special Coverage Required by Written Contract

(check all that apply)

WARNING: Don't check below options unless you are 100% sure they are required by written contract

Waiver of Subrogation

Does your written contract or lease agreement specifically require Form CG 20 11 to be included to name the property owner as an Additional Insured?
You will need to review your contract of lease agreement if you are unsure. If you are not able to review at this time, simply continue with the application. You will have the option to add this Additional Insured any time after the application is complete.

Yes - Require CG2011 Endorsement

**Special Wording (ONLY if required by written contract):

fill this out only when instructed by a Sadler employee

IMPORTANT! YOU MUST HIT "ADD CERTIFICATE" FOR EACH OF YOUR ADDITIONAL INSUREDS PRIOR TO HITTING "CONTINUE" IN ORDER TO RECEIVE YOUR CERTIFICATES.

List of previously added facility owners and sponsors

John Brown University - Property Owner/Lessor

2000 West University - - Siloam Springs, AR 72761

approval status: Approved