COL Mast

Insurance Request Form
Fields marked with * are required.
What Type of Event is it? 
Unit Type(e.g.Troop, Crew etc) and Number(if applicable)
What amount of Insurance is needed? 
If over 1 million dollars a copy of written requirements from the certificate holder will be required
Cradle of Liberty Council 1485 Valley Forge Rd Wayne, PA 19087
Has the requester asked to be listed as additional insured 
Are any fees required for services, use of property, etc? 
If the certificate is for a Unit Activity, is the Certificate holder the Chartered Organization for the unit involved? 


  Valley Forge Office | Rogers S. Firestone Center | 1485 Valley Forge Road | Wayne, PA 19087 |               610-688-6900


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