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INSURANCE CERTIFICATE REQUEST FORM
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When an Insurance Certificate is needed for a particular council function or for
your Parish Office at the beginning of each Fraternal Year, we need you to clarify
if it is for “Proof of Insurance” or if the venue is requiring to be named as an
“Additional Insured”!
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Please complete the form below and email it as an attachement to:
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Sheri Bardessono
Western States Insurance
Email: sbardessono@wsi-insurance.com
Fax: 509-786-2183
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And, if your council has a question or concern about coverages, just drop an email
to your State Secretary for clarification at wonkags@aol.com
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Liability Insurance Certificate
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