PBIA Digital Forms

Section 1 of 2

Additional Insured Request

Tell us about the project and share any requirement documents before we capture each Additional Insured.

Some clients, landlords, lenders, or business partners may require to be listed as an Additional Insured on your policy. Please provide the project details below before listing each Additional Insured.

Contractor's License Number

Email Address

Policy #

Physical Address of the Project

Has the project been completed prior to this request?

YesNo

What work is being performed?

What type of project? (Select all that apply)

CommercialResidentialCondominiumApartment

Choose all that apply. At least one project type is required.

If commercial, select the type of building

This is only required for commercial projects.

Uploaded Example Requirements (optional)

Upload any requirement examples. If attached, special wording fields can be left blank later.

Section 2 of 2

Additional Insured 1

Capture who needs to be added, how they relate to the project, and any special wording.

Name of Additional Insured (Individual or Business)

Street Address

City

State

ZIP/Postal Code

Who is the additional insured?

Description of Operations

Do you need any special wording or endorsements included?

If you uploaded example requirements, you can leave this blank and our team will review the attachments to determine endorsements.

Common example endorsements include:

CG 20 10 - Additional Insured - Ongoing Operations
CG 20 37 - Additional Insured - Completed Operations
Primary & Non-Contributory
Notice of Cancellation (10/30/60 days)
Per Project Aggregate

Would you like to add another Additional Insured?

YesNo