SCI Exhibitor Request for Certificate of Insurance
Safari Club International Exhibitor Insurance
through T.H.E. Insurance Company
Las Vegas SCI 2012 Annual Hunter's Convention
(1/29/12 12:01 AM - 2/6/12 12:01AM includes set up and take down dates)
Exhibitor's Name :  Booth:
                                                                  (As it appears on your SCI booth application)
Is any other entity sharing booth space with you?        Yes       No
If yes, please provide their name:
                                                            (Note: they will have to provide a certificate of insurance or purchase SCI insurance)
Person Completing this form (Contact person):
Mailing Address:
City: ST/Province:
Zip/Postal Code: Country:
Daytime Phone: Evening Phone:
Fax Number: Website:
E-Mail Address for the person completing this form:

If you carry your own General Liability insurance that will provide coverage for your exhibiting at a trade show, please complete the following and send this form to your General Liability insurance carrier/agent. Your insurance carrier must provide us with a Certificate of Insurance naming the additional insured's listed below:

Only approved contracted exhibitors and others requiring insurance who are domiciled in the US or Canada may submit proof of insurance coverage from their own insurance carrier. All others must obtain insurance coverage through SCI and use the Exhibitor Insurance Application form.

This form can be faxed, scanned & e-mailed or mailed to your insurance carrier/agent. We must receive their certificate 45 days prior to the event dates.
TO: (Insurance carrier/agent)
FROM: (Exhibitors Name)

We are exhibiting at the SCI 2012 Annual Hunters Convention in Las Vegas and are required to have general liability coverage (premises only).

General Liability Insurance Requirements:
                                   For the Dates of:                                   1/29/12 12:01 AM - 2/6/12 12:01 AM
                                   Limit of Liability:                                  $1,000,000
                                   Please confirm that the policy does NOT contain a designated premises endorsement
The certificate must list as an additional insured using form: CG 2011 0196 or CG2026 0704

Safari Club International                                                                                                       Mandalay Bay Resort
c/o SIAI                                                                                                                                 3950 Las Vegas Boulevard South
1364 N. US 1, Suite 503                                                  And                                               Las Vegas NV 89119
Ormond Beach, FL 32174

Authorized Signature: Date: (mm/dd/yyyy)

Please fax, e-mail or mail the certificate of insurance to the appropriate address listed below.
Sportsman's Insurance Agency, Inc.    US Toll-Free - 1-800-925-7767
1364 N. US 1, Suite 503  Fax: 1-386-677-3292
Ormond Beach, FL 32174   Phone: 1-386-677-2588
Email: SCIexhibitors@siai.net  
   
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