Risk Transfer Request

Please Note:

We can only review indemnity and hold harmless provisions.

We CANNOT review insurance requirements. The Sterling Insurance Team is responsible for reviewing insurance

Requestor

Your Name

Your Email Address

Need by date:

Email(s) of other Sterling employee(s) that should be notified regarding this request?

Client Details

Client Name

Epic ID:

Annual Account Revenue

What is the client's role in the contract?

Please specify the reason for and exception to the $10,000 Revenue cutoff:

Explain Other:

Request Details

Attach full copy of contract

If a contract doesn't exist, you must attach a page containing an explination of why it does not.

Identify the page or clause where indemnity of other risk transfer language appears:

Please describe specifically what you need:

Attach any other supporting documentation:

Supporting Document

Description

Please tell us anything else that we may need to know: