FORM Request For Certificate Of Insurance
User Manual: FORM-Request-for-Certificate-of-Insurance
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Request for Certificate of Insurance Please complete and forward 2 weeks before event to Council office: Fax: 717.394.7776 or email: leslie.rohrer@scouting.org Complete Shaded Areas Certificate Holder (Organization/Business) Organization/Business: Contact Name: Address: City, State Zip: Contact Telephone: Contact Email: Contact Fax Number: Amount Needed: Unit Type and Number: Start Date: End Date: Purpose: Requestor Information Name Telephone Email 630 Janet Avenue, Suite B-114, Lancaster, PA 17601 (717) 394-4063 Fax: (717) 394-7776
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File Type : PDF File Type Extension : pdf MIME Type : application/pdf PDF Version : 1.6 Linearized : Yes Author : Karen Glover Company : Created : D:20170119 Create Date : 2017:08:07 15:12:33-04:00 Last Saved : D:20170806 Modify Date : 2017:08:07 15:21:52-04:00 Source Modified : D:20170807191219 Has XFA : No Language : EN-US Tagged PDF : Yes XMP Toolkit : Adobe XMP Core 5.4-c006 80.159825, 2016/09/16-03:31:08 Metadata Date : 2017:08:07 15:21:52-04:00 Creator Tool : Acrobat PDFMaker 11 for Word Document ID : uuid:86691682-33fc-4b75-a275-b61b079ae611 Instance ID : uuid:b6fc4f23-51b2-445b-a6dd-8d7906b4ede4 Subject : 2 Format : application/pdf Creator : Karen Glover Producer : Adobe PDF Library 11.0 Page Layout : OneColumn Page Count : 1EXIF Metadata provided by EXIF.tools