Additional Insured Certificate of Insurance

Welcome to the official home of the

E.D.G.E. & T.A.

Early Day Gas Engine & Tractor Association

Proof of Insurance Certificate/

Additional Insured Certificate

1. If a Land/Facility Owner requests a "Proof of Insurance" for a Branch Event, fill out the form below and submit.

2. If the Land/Facility Owner requires to be added as an "Additional Insured", check the "Additional Insured Certificate" box and fill out the form below and submit.

These certificates will be sent directly to the land/facility owners requesting the coverage.

Please submit both of these requests 30 days (not less than 10 days) prior to the date the certificate is needed by the landowner. The insurance agent needs time to process these requests. Requests made at the last minute may not be able to be processed by the time you need it! (see question 19 on the Q & A).

To send by Postal Mail, send to:	Rich and Cartmill, Inc. Carrel Sanders 4945 N. Towne Centre Dr. Ozark, MO 65721 (417) 581-4003 Phone (417) 581-4045 Fax

If you have any questions regarding our insurance, such as information on Insurance coverage, and requests, information on insurance non-coverage related questions, such as form submittal problems, or if you have problems resolving a problem with our insurance agent, contact:

Dick Tombrink 2250 North 12th Road Worden, MT 59088 (406) 967-6687 Voice (406) 967-6687 Fax E-Mail: dicknsue@nemontel.net	Larry Voris 2340 S Luster Springfield, MO 65804 (417) 882-7195 E-Mail: lgvoris@sbcglobal.net

For all requests for Proof of Insurance Certificates/Additional Insured Certificates, fill out and submit the above form. A copy will go to the insurance agent, and Dick Tombrink. For your information, if you wish to fax it, below is the insurance agent's name and fax number. They will not accept information by phone for your requests.

Rich and Cartmill, Inc. Attn: Carrel Sanders 4945 N. Towne Centre Dr. Ozark, MO 65721 (417) 581-4003 Phone (417) 581-4045 Fax

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