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Endorsements

Please fill out and submit the form below for endorsements to General Liability policies.
Endorsement requests for other coverages, please contact Syreeta Brown at [email protected].

* required field
Name of Insured:* Policy Number:
Name of Business:
Insured Address: City:
State: Zip:
Type of Endorsement:

Certificate Holder Details

Is there a contract?  Yes  No 
First Name: Last Name:
Company:
Address: City:
State: Zip:
Project Location:
Job Description:

Broker Information

First Name: Last Name:
Company:
Address: City:
State: Zip:
Phone: Email:

Shield Commercial Insurance Services, Inc.
43-725 Monterey Ave, Ste A. Palm Desert, CA 92260
Tel: 760-345-9029 Fax: 800-345-4851
CA License Number: 0E67754
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