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Insurance Request Form
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* Indicates required question
Student Name
*
Your answer
Student ID
*
Your answer
Production Title
*
Your answer
Production dates (include rain dates)
*
(example: 1/15/15 - 1/20/15)
Your answer
Named Insured
*
(the property owner or rental facility requesting the insurance}
Your answer
Address of Named Insured
*
Your answer
"Additional Insured" wording
(if the insured requires specific wording, cut and paste it here)
Your answer
Any questions?
Your answer
Submit
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