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""<<KVVV.8<<VVVV<p0V0GV#(j#V#V\VC|%G#^ ~:  CERTIFICATE OF INSURANCE REQUEST FORM FIELDS WITH AN ASTERISK MUST BE FILLED IN AT ALL TIMES Please allow 7-10 business days for processing. * This is to certify to: (Name of the organization requesting a proof of insurance)* Address: that the following described policy(ies) or binder(s) in force at this date have been effected to cover as shown below: Name of Insured: HOCKEY CANADA 801 King Edward Avenue, N204, Ottawa ON K1N 6N5 Name of Insured: OTTAWA DISTRICT HOCKEY ASSOCIATION 1247 Kilborn Place, Suite D300, Ottawa ON K1H 6K9 * Name of Team / Association:Name of Contact:Phone Number:E-mail: *Description of Event(s):* Location of the event(s): (name and address)* Date(s): Type of insuranceInsurerPolicy N(Policy period* Limit of Insurance (canadian funds)Commercial Liability InsuranceChartis Insurance company of Canada0511578September 1st, 2010 to September 1st, 2011$_,000,000 General Liability Insurance Please check if Liquor Liability is required  FORMCHECKBOX ____ # of days for cancellation notice (if required) Please include a copy of your lease agreement. FORMCHECKBOX  Please check if a copy if the lease agreement is attached  FORMCHECKBOX  Please check if additional list attached * ADDITIONAL INSURED:1.4.2.5.3.6. THE ABOVE ENTITIES WILL BE ADDED TO THE POLICY AS ADDITIONAL INSURED BUT ONLY WITH RESPECT TO THE OPERATIONS OF THE NAMED INSURED DESCRIBED ABOVE. THE CERTIFICATE APPLIES TO THE MEMBERS AND AUTHORIZED PERSONNEL OF THE INSURED WHILE OPERATING WITHIN THE SCOPE OF THEIR DUTIES AND APPLIES ONLY TO THE DATES OF THE EVENT AS MENTIONED ABOVE. 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