2022-2023 IEA EVENT
INSURANCE REQUEST FORM

Insurance provided by Equisure, Inc.

*required fields

Coverage Info.

*Event Start Date:
Event End Date:	(if more than 1 day)
*IEA Zone:
*Submitted By:
*Email Address:
*Primary Hosting Team:
Cohosting Team 1
Cohosting Team 2

Insurance provided by Equisure Inc. and will include 2 Setup/take down days automatically.

*Competition Days:	($140 per day)

Certificate Requests

BEFORE MAKING YOUR CERTIFICATE REQUEST, PLEASE UNDERSTAND THE FOLLOWING DEFINITIONS:

Additional Insured means - By contract or other obligation, additional insured status will be added and I understand by picking this option, the entity shares in the policy limits and will be provided defense costs should a claim occur, possibly diluting your limits.

Proof of Insurance means- A certificate of insurance will be issued to the entity showing proof of insurance coverage only.

Certificate Requests: Landowner or Facility or Co-Hosting Team(s).
Horse Providers are automatically included so no need to list them.

Additional Insured 1 (optional)

Certificate Holder Name:
Attn:
Street Address:
City:
State
Zip:
Certificate Interest (check all that apply):	Landowner Facility
Certificate holder is (check one):	Additional Insured OR Proof of Insurance

Additional Insured 2 (optional)

Certificate Holder Name:
Attn:
Street Address:
City:
State
Zip:
Certificate Interest (check all that apply):	Landowner Facility
Certificate holder is (check one):	Additional Insured OR Proof of Insurance

Additional Insured 3 (optional)

Certificate Holder Name:
Attn:
Street Address:
City:
State
Zip:
Certificate Interest (check all that apply):	Landowner Facility
Certificate holder is (check one):	Additional Insured OR Proof of Insurance

Clear Form

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2022-2023 IEA EVENT INSURANCE REQUEST FORM

Insurance provided by Equisure, Inc.

Certificate Requests

2022-2023 IEA EVENT
INSURANCE REQUEST FORM