2. Business Name*
3. Name of Person Submitting Proof of Insurance*
5. Business Address*
6. Upload Proof of Insurance*

   Upload a copy of the business's liability and casualty insurance listing the City of Coldwater as an additionally insured in an amount of $1,000,000 per occurrence and with an aggregate coverage of $2,000,000 for liability.

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8. 1. Receive an email copy of this form.
9. Email address

   This field is not part of the form submission.

10. Submit

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