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ENDORSEMENT
Endorsement request – INTERNAL FOR PPLS
Date Needed By
MM slash DD slash YYYY
Where should the COI needs to be sent to?
(Required)
Diana
Insured
Other
Email where the COI needs to be sent to:
(Required)
Insured's Name
(Required)
Upload Requirements Here:
Drop files here or
Select files
Max. file size: 128 MB.
GL A/I
_Carrier’s Default Blanket A/I Form included with the policy
CG 2026 – Designated A/I BLANKET
CG 2026 – Designated A/I – PRINTED ON FORM
CG 2010 11/85 – OWNERS, LESSEES OR CONTRACTORS INCL PROD/COMP OPS
CG 2010 04/13 – OWNERS, LESSEES OR CONTRACTORS EXCL PROD/COMP OPS
CG 2037 – A/I OWNERS, LESSEES OR CONTRACTORS COMPLETED OPS
CG 2033 OWNERS, LESSEES OR CONTRACTORS AUTOMATIC STATUS PER CONTRACT
Other
Include on the COI
Primary Wording
GL WOS per Blanket form
GL WOS Specific form
30-Day NOC
ADD CHECKBOX A/I on SAM
ADD CHECKBOX A/I on EXCESS
ADD CHECKBOX A/I on Hired/Non-Owned Auto
Other
If GL A/I Other – provide the info
If INCLUDE on The COI – "OTHER" provide the info
A/I Name and Address for Cert Holder Section
(Required)
A/I Wording Needed
(Required)