Lloyd S. Berkett Insurance Agency, Inc


	ABOUT US


	SPECIALTY PROGRAMS Religious Institutions Self Storage Industry


	BERKETT 24/7

*Name of business:

*Address:

*City:

*State:

*Zip:

Requested by:

Email address:

Business phone:

Fax:

Certificate Holder:

Name:

Address:

City:

State:

Zip:

Attn:

Business phone:

Fax:


Certificate Holder to be Named:
	Additional Insured	YES NO
	Loss Payee	YES NO
	Evidence of Property Insurance	YES NO
	Landlord	YES NO
	Mortgage	YES NO
Reason for Certificate: (description of activity, or property address):
Dates, Amount of People, Equipment:
Special Instructions:

Search:

11150 W. Olympic Blvd., Suite 1100 - Los Angeles, CA 90064 License # 0A96053
T: (310) 857-5757 - (800) BERKETT (800) 237-5388 - F: (310) 857-5750