Certificate Of Insurance Form - Alabama Secretary Of State printable pdf download

Certificate Of Insurance Form - Alabama Secretary Of State

ROM THE

FFICE OF THE

ECRETARY OF

TATE

HOME INSPECTOR

PROPERTY AND BODILY INJURY DAMAGE LIABILITY

CERTIFICA TE OF INSURANCE

Filed with:

ATTN HOME INSPECTORS REGISTRATION SECTION

OFFICE OF THE ALABAMA SECRETARY OF STATE

PO BOX 5616

MONTGOMERY AL 36103-5616

This is to certify that the __________________________________________________________________

(Name of Company)

(hereinafter called Company) of ____________________________________________________________

(Home Office Address of Company)

has issued to _______________________________ of ________________________________________

(Home Inspector's Name)

(Home Inspector's Address)

a policy or policies of insurance effective from _______________12:01

standard time at the address of the

insured stated in said policy or policies and continuing until canceled as provided herein, which, by attachment

of the Bodily Injury and Property Damage Liability Insurance Endorsement, has or have been amended to

provide bodily injury and property damage liability insurance covering the obligations imposed upon such

home inspector by the provisions of the home inspector law of the state of Alabama or regulations promul-

gated by the Office of the Secretary of State in accordance therewith.

Whenever requested, the Company agrees to furnish the Office of Secretary of State with a duplicate original

of said policy or policies and all endorsements thereon.

This certificate and the endorsement herein may not be canceled without cancellation of the policy to which it

is attached. Such cancellation may be effected by the Company or the insured giving thirty (30) days' notice

in writing to the Office of Secretary of State, such thirty (30) days' notice to commence from the date the

notice is actually received in the Office of the Secretary of State.

Countersigned at ________________________________________________________________________

(Street Address)

(City)

(State)

(Zip CODE)

this ____________________________________ day of _____________________ 19__________.

__________________________________

(Authorized Company Representative)

Insurance Company File No. _______________________

(Policy Number)

HI3 11/96

Certificate Of Insurance Form - Alabama Secretary Of State