FROM: 
Your Firm's Name
    
Contact Person
    
Certificate Holder to Name on Form: 
Company Name
    
Attention
    
Address
    
City
    
State
    
Zip
    
Email
    
Coverage Info to Show : check the contract for the project for the following information : 
ALL ADDITIONAL INSURED
PROF LIAB WAIVER OF SUBROGATION
GEN LIAB X OUT "ENDEAVOR TO..." ETC
AUTO LIAB # DAYS NOTICE : (10 days is usual)
WORK COMP (some of the above items may not be available on all of your policies - we provide them where applicable or available)
EXCESS
OTHER

  

McLaughlin Brunson Insurance Agency
6600 LBJ Freeway, Suite 220, Dallas, Texas 75240
Telephone 214-503-1212
FAX 214-503-8899
McLaughlin Brunson Insurance Agency
2008 Huntington Ave., Oklahoma City, OK 73116
Telephone 405-620-4101
Fax 405-840-1462