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The following files must be completely filled out and returned to the USCA's insurance coordinator NO LATER THAN 30 DAYS PRIOR TO YOUR EVENT. REQUEST CERTIFICATE OF INSURANCE, ADDITIONAL INSURED, A LATE FEE CHARGE FOR PORCESSING. Request for additional insured certificate must be received at least 30 days in advance of an event date in order that the certificate of insurance may be processed and returned prior to the event date. if the post mark on the envelope is less than 30 days before the event, then a $25 late fee will be charged for the processing of addtional insured certificate.This insurance coverage is for $1,000,000 comprehensive commercial liability .


USCA's Insurance Coordinator

 Monday Through Friday From 9:00 A.M. to 5:00 P.M.

  Contact Virginia Migliaccio by:
 Phone: (516)-269-9696  Fax: (516)-269-9656


Jacka-Liquori Agency, Inc.

Attn: Virginia Migliaccio

121 East Northport road, P.O. Box 667

Kings Park, NY 11754

(1) Check List

(2) Request Form

(3) Request For Certificate Of Insurance

(Additional Insured)

(Read) Competition Guidelines

(Read) Non Competition Guidelines


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