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Section 5: Premium Summary
Total Premium Due
Subtotal Premium Due:
(Please click on the box if you're from Florida) Florida applicants need to add a 1.3% state mandated Hurricane Catastrophe Fund Assessment fee to the amount due.
Florida Hurricane Catastrophe Fund assessment fee:
Section 5B: Certificate Requests
This certificate is for:
Evidence of Coverage
Relationship to insured:
If other, explain:
Special certificate language needed (please explain/attach):
Date certificate needed by:
If applicable: Date(s) of event/activity
Hours of event/activity
Type of event/activity:
Name of event/activity:
Location of event/activity:
Loss Payee:Type of equipment (please describe)
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