3927 University Ave.
Waterloo, IA 50701
Check the box below if your client requires
that they be named an Additional Insured. (Your client
will be covered under your policy for work you do on their
behalf.) Most clients do not need to be additional insureds
and simply want to be Certificate Holders. This should be indicated
in your client's contract.
Your Client's Name
(include address, city, state, zip)
Special Requests or Comments/ Project
Midwest Tech Insure is a service of PDCM Insurance