SAN FRANCISCO AND MARIN INTERGROUP
1821 Sacramento St.
San Francisco, CA 94109
Please complete ALL questions and submit this application to Central Office, together with the administrative fee of $50 payable to Intercounty Fellowship of A.A. Please note: this request form does not automatically bind coverage for the additional insured being requested.
You must have from the facility a written request
(or email) requesting insurance. We will submit the application and a Certificate will be sent directly to your landlord, with a copy to Central Office. The contact person listed on the application will be notified when the office has received the certificate.
It is the responsibility of each group to maintain a current contact with Central Office at all times. Updated information can be sent to email@example.com
with “Group Insurance” in the subject line. The administrative fee is $50 and is valid for the remainder of the term policy.