Certificate of Insurance Request Certificate of Insurance Request Event:Event Date:Event Times:Jurisdiction:Chapter Name:Name of Venue:Address:City/State/Zip:Food or Beverage:ServedSoldIf sold what kind:Number of DeMolay:Number of Advisors:Choose One*Certificate HolderNamed Additional InsuredCertificate Holder is simply proof of insurance, where as Additional Insured status gives coverage and rights under your sub-contractors policy. Name:*Address:*Addl Address:City,State,Zip:*Name:*Address:*Addl Address:City,State,Zip:*Send Completed CertificateEmail CertificateMail CertificateEmail To:Mail To:Address:City,State,ZipSpecial Instructions:Additional EmailsAdditional EmailsAdditional EmailsAdditional Information