Get Additional Insured Form

Filling out the Additional Insured Form online can seem daunting, but with clear instructions, you can complete it with confidence. This guide provides step-by-step directions to ensure you accurately fill out each section of the form.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to access the form and open it in your preferred online editor.
2. In the applicant information section, provide the name and address of the insured, and include contact details for the survey. Specify a phone number for reachable assistance.
3. Indicate if named insured status is requested for other entities. If yes, list the names, relationships, and operations of each additional insured.
4. If applicable, disclose whether the requested named insureds have any subsidiary or affiliated companies not listed earlier. If applicable, provide their names and operations.
5. In the operations section, check the appropriate boxes indicating the roles such as mine owner/operator, contract miner, or other roles as appropriate.
6. Move to the coverage requested section and choose between claims made and time element coverages. Specify the desired limits of insurance for each pollution incident and aggregate.
7. Complete the deductible amount requested, keeping in mind the minimum amount established.
8. Fill in the effective date and, if necessary, the retroactive date for claims made coverage. Attach prior evidence of claims made coverage if the retroactive date differs from the effective date.
9. Answer each question in the history section about previous coverage cancellations, environmental violations, and any pollution incidents over the past five years, providing detailed explanations as needed.
10. Indicate your current pollution or environmental insurance coverage, including policy number, period, and any special endorsements.
11. Provide site information, detailing the exact locations, minerals mined, and operations performed at each site, indicating any abandoned mines or previous operations.
12. In the additional information section, ensure you enter all required details truthfully, and be prepared to sign the declaration at the end of the form.
13. Review the completed form for accuracy, then save your changes, download, print, or share the form as needed.

Start filling out the Additional Insured Form online now to ensure you have the coverage you need.