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Caption Error   Get Quote / Buy Online Select a Program Activity & Social Clubs Bands & Performing Groups Concessionaires, Exhibitors & Vendors Dance Instructors Dance Schools & Programs Entertainers & Performers Exercise/Personal Training Studio Fitness Instructors Health Clubs – Limited Services Martial Arts Schools & Programs Outfitters and Guides Insurance Short Term Special Events Sports Camps & Clinics Sports Instructors Teams & Leagues Tournaments & Events Walk/Run Events Yoga Instructors Youth Day Camps	DisplayTitle Welcome to Borden Perlman Phone ​1-609-482-2207 Fax 1-609-895-1468 Claims 1-800-237-2917 ProgramLinks     Ask us a Question/E-mail Policy Change Request Form   * fields are mandatory Current Information  *Named insured (as it appears on your certificate of insurance): Please enter field Invalid Characters  *Policy number (as it appears on your certificate of insurance): Please enter field Invalid Characters  * Contact first name:  * Contact last name: Please enter field Invalid Characters Please enter field Invalid Characters   Effective date of change(s): Please enter the correct date format (mm/dd/yyyy). That date entered must be today’s date or later.  * Phone:   Cell: Please enter field The information you entered is invalid, please try again. The information you entered is invalid, please try again.  * E-Mail: Please enter field Invalid email   Please indicate the type of change needed and complete the appropriate section Cancel coverage Limit of coverage Cancel/change event date Mailing address Certificate amendments and/or requests Named insured Contact name Phone, fax and/or e-mail Facility location Type of operation Other (please explain)   Please select   Please enter field     Note: Some changes may result in an increase of premium due and will be effective the day after receipt or a later date. Cancel Coverage *Effective date of cancellation: Please enter field The date entered must be tomorrow’s date or later. Please enter the correct date format (mm/dd/yyyy). *Reason for cancellation: (Refund Policy)   Invalid Characters Please enter field   Note: Coverage cannot be cancelled prior to K&K's receipt of this form. Change Limit of Coverage (an increase in liability limits will result in additional premium due)     *Type of coverage: Please enter field Invalid Characters *Current liability limit: *New limit requested:   Invalid Characters Please enter field   Invalid Characters Please enter field         Cancel/Change Event Date *Effective date of cancellation/change:   Please enter field The date entered must be tomorrow’s date or later. Please enter the correct date format (mm/dd/yyyy). *Reason for cancellation/change: (Refund Policy) Please enter field Invalid Characters Note: Request must be received by K&K prior to day of event. Named Insured, Contact Name, Mailing Address, Fax or E-mail Change Information   Only enter the fields to be changed.  *Named insured: Please enter field Invalid Characters  *Mailing address: Please enter field Invalid Characters   Invalid Characters  *City: Please enter field Invalid Characters  *State: Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Please select  *Zip: Please enter field The information you entered is invalid, please try again.   *Contact first name:   *Contact last name: Please enter field Invalid Characters Please enter field Invalid Characters   E-mail:   Cell: Please enter field Invalid email ID entered. The information you entered is invalid, please try again. Please enter field   Phone number:   Fax: The information you entered is invalid, please try again. The information you entered is invalid, please try again. Please enter field Please enter information for at least one change or change the type of change above.   Request Certificate *Type of request:  Please select Change/amendment request to a certificate already issued New certificate request Certificate of insurance request *This certificate is for our: Please select   Program coverage (commercial general liability) Equipments & contents coverage *Check the type of certificate you are requesting: (what's this?)  Please select   Additional insured Evidence of coverage Loss payee (Inland Marine/Equipments & Contents)   Certificate holder information * Entity name (as it should appear in the certificate): Invalid Characters Please enter field * Mailing address: Invalid Characters Please enter field Invalid Characters * City: Invalid Characters Please enter field * State: Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Please select * Zip Please enter field The information you entered is invalid, please try again. *Relationship to insured entity: Please select Owner/lessor of premises Sponsor Co-promoter Mortgagee Franchisor Event Organizer Lessor of Equipments and Contents Other (please identify/explain) Invalid Characters Please enter field If applicable Invalid Characters   Dates of events/activity: From To Please enter the correct date format (mm/dd/yyyy). Please enter the correct date format (mm/dd/yyyy).   Hours of events/activity: From HH 1 2 3 4 5 6 7 8 9 10 11 12 MM 00 15 30 45 AM PM To HH 1 2 3 4 5 6 7 8 9 10 11 12 MM 00 15 30 45 AM PM     Types of events/activity:   Invalid Characters   Name of events/activity:   Invalid Characters   Location of events/activity:   Invalid Characters   Need by date: Please enter the correct date format (mm/dd/yyyy). Special certificate language needed (please explain):   Invalid Characters   Add Another Certificate Information Do you want to delete the record?     Facility Location Change  *Select: Replacement facility location Additional facility location Delete facility location Please select  *Mailing address: Please enter field Invalid Characters     Invalid Characters    *City: Please enter field Invalid Characters    *State: Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Please select  *Zip: Please enter field The information you entered is invalid, please try again. Invalid Characters    *New facility square footage: sq. ft. The information you entered is invalid, please try again. Please enter field    *Was there a change in the insured's annual sales? Yes No Please select  *Provide the new annual sales:  $ Please enter field Invalid Characters  *Is there a change in total number of members? Yes No Please select    *Provide new total number of members:   Please enter field Invalid Characters   Type of Operation *Please provide the type of change:   Please enter field Invalid Characters Other *Please explain/describe change:   Please enter field Invalid Characters Document Delivery This certificate will be delivered based on the option you indicate below.  Please select   E-mail to: Attn: Invalid Characters Invalid email ID entered. Please enter field   Fax to: Attn: Invalid Characters The information you entered is invalid, please try again. Please enter field   Mail to:   Attn: Invalid Characters Mailing address: Please enter field Invalid Characters       Invalid Characters       City: Please enter field Invalid Characters     State: Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Please select     Zip: The information you entered is invalid, please try again. Please enter field   Please complete captcha question Caption Error
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