1-General Liability Request for Certificate

Today's Date

AFT Local Name and Number

Your Name and Union Position

State

Your e-mail

Your best telephone contact info

Is this a NEW request or a renewal of a previous request?

New Request

Renewal Request

Is this certificate for an event (single or multiple days), for a landlord or for your local's records?

Event

Landlord

For Local Records Only

First Date needed (if needed for multiple consecutive days, see the next question)

End date needed if for multiple days or for a lease arrangement.

Date certificate is needed

If for an event, specify the type of Event (provide a short description, i.e., union meeting, rally, social event, etc.)

Will alcohol be served at the event or on the premises?

Yes

If alcohol will be served, will there be a charge for it?

Yes a charge

No charge

Unsure at this time

Who will serve the alcohol?

PLEASE READ: The certificate is typically written naming the entity wishing to ensure coverage - your landlord or an event location. This could be a hotel, a union hall, a conference center, a restaurant, etc. We will need the name and address of that entity. The next series of questions are about the "certificate holder" so please make sure you have that information. If you don't it may delay the completion. NOTE: once completed the certificate will be emailed to you in PDF format so you can deliver it to the Entity.

If you are simply wanting a certificate for your records then please indicate the name of your union and your mailing address on the next questions.

Name of the Entity requesting the certificate

Full address of the Entity including city and state.

Does the Certificate holder require any special language? If yes, please include the language below or simply say yes and we will ask for it in a subsequent message.

Is additional insured status needed? If yes, please provide additional information below.

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