NSA Certificate Request Form
Fill out this form to obtain a certificate of Liability insurance. Please note that Coverage is only valid for NSA Sanctioned Leagues and Tournaments. IF YOU ARE NOT NSA SANCTIONED WE WILL REVOKE ANY CERTIFICATE ISSUED
Name of League *
YOU MUST BE NSA SANCTIONED- use Name of Tournament if this is an NSA sanctioned tournament
Your answer
First and Last Name of League Contact *
Your answer
Full Address of the League including postal code *
Enter Full address or the certificate will be invalid
Your answer
Contact Phone Number including area code *
Your answer
Contact e-mail Address *
Toole Peet will e-mail the League Contact the Certificate of Insurance. We do not send certificates to the certificate holders or Third parties
Your answer
Name of Entity to be added as Additional Insured *
This must be a legal entity
Your answer
Full Mailing address of Additional Insured including postal code *
Enter the FULL mailing address or the certificate will be invalid
Your answer
Is this a FUNTASTIC Event? *
(Please note, Funtastic is an association, please only click yes, if this pertains to you).
Will you require any Liquor Liability coverage? *
Please note that under the NSA Insurance Liquor Liability is excluded - special requests can be made for Tournaments and Year End Banquets by completing the Liquor Liability Request Form
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