Request a Certificate of Insurance

Name(Required)

First Last

Email(Required)

We'll send the certificate here.

Phone(Required)

Company / Organization(Required)

Start Date(Required)

The date the coverage is needed for.

End Date(Required)

The date the coverage is needed for.

Event / Artist Name / Project Name(Required)

Venue Name / Project Location (City, State)(Required)

This is the entity (usually the venue) that needs to be named on the certificate.

Certificate Holder — Legal Name(Required)

Exactly as it should appear on the certificate.

Certificate Holder — Mailing Address(Required)

Full address as it should appear on the COI.

Does the holder need to be named as Additional Insured?(Required)

Yes

Not sure — see attached requirements

Specific insurance requirements(Required)

Paste any coverage limits, endorsements, or wording your venue requires.

Needed by(Required)

When does the venue need the certificate?

Are you already booked with Pebble Rock?(Required)

Yes — project is booked

No — still planning

Anything else?(Required)

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