CMG Insurance Request Form

Insurance Request Form

To request a certificate of insurance for an event, follow these five easy steps.

1) Please copy everything below the dotted horizontal line into a fresh email.

2) Replace all of the red fields with your pertinent information. Delete the green notes that are there just to guide you.

3) In section 4, repeat the line as many times as needed for multiples. If only one, erase the (a) at the beginning.

4) Attach to that same email an electronic version of the paperwork from the event requestor, including the page
that shows the legal entity to whom the certificate is to be issued, as well as the page with the actual request.

5) Send the note to: VicePresident@theCMG.org ; he will forward it to the insurance people.

If you also need proof of us as a non-profit, you can either visit www.thecmg.org/proof-of-non-profit. (or you can go there yourself and copy the image into an email you send them). This is a separate issue from insurance, but some events require that we send them this as well.

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Hello! I am the current VP of the California Men’s Gatherings (CMG).

We have a need to show proof of “Additionally Insured” for an event.

Here is the information you should need.

1) The CMG event person involved in coordinating this is:

. Name: YOUR-NAME-HERE

. Best phone: YOUR-PHONE-HERE

. Email address: YOUR-EMAIL-HERE

2) General Info:

. Name of Event:

. XXXXXXXXXXXXXXXXXXXXXX

. Address of Event:
. XXXXXXXXXXXXXXXXXXXXXXXXX

. XXXXXXXXXXXXXXXXXXXXXXXXX

. Date(s) of Event: XXXXXXXXXXXXX

3) Minimum amount requestor requires: XXXXXXXXXXXXXXXXXXXX

4) Exact names of those needing to be shown as “Additionally Insured”:

. (a) XXXXXXXXXXXXXXXXXXXXX

. (b) XXXXXXXXXXXXXXXXXXXXX

. (c) XXXXXXXXXXXXXXXXXXXXX

5) Email address and phone of the requestor:

(“Requestor” is the agency you are working with, not you again; you can skip “phone” if you don’t have it):

. EMAIL-ADDRESS-OF-PERSON-YOU-ARE-DEALING-WITH-FOR-EVENT

. (XXX)THEIR-PHONE#

6) Physical mailing address of the requestor:

(even if it’s going to be emailed, it’s a requirement)

. XXXXXXXXXXXXXXXXXXXXXXX

7) Any additional comments from the CMG member or requestor:

. XXXXXXXXXXXXXXXXXXXXXXX

If you need additional information, please let me and the CMG event person know, not the requestor.

If you have all that you need to send the certificate of insurance, please email it directly to the email in section 5

with a cc to both the email in section 1 and VicePresident@theCMG.org.

Thank you!