Add Additional Insured / Change of Name

Please complete the following form

  • Policy Holder Information

    Please add your existing information

  • Changes in ownership will usually require a rewrite of the policy.

  • Please read and understand

  • By checking this box, I understand and agree that no coverage may be added, modified, deleted or otherwise changed until such request is received and approved by a staff member of Paul B Sullivan Insurance Agency. In order to expedite your request, please make sure all of the required fields are completed.
  • This field is for validation purposes and should be left unchanged.

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