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WHOLESALES TIRE DISTRIBUTORS

4490 Ayers Ave. Vernon, CA 90058    Tel.(887)449-4335    Fax.(714) 367-0300

Dear Sir / Madam:

Thank you for doing business with Katana Racing, Inc. dba Wholesale Tire Distributors (WTD).

Please complete the following with regard to your requirements for our Product Liability insurance:

    1. Each Occurrence Limit: $21,000.00
    2. Annual Aggregate Limit: $21,000.00
    3. Policy Form (Occurence, Claims Made, Either:)
    4. Certificate Holder Name (including any related subsidiaries Eg: Inc., Corp, LLC, Partnership, Sole Proprietor etc...)
* and its Subsidiaries, Affiliates, Agents, Successors and Assignees
  1. Certificate Holder Address, Email, Fax#: .
  2. Special Endorsement Requirements* .

*Should you require Additional Insured status, please sign and date below. Upon our receipt and approval, we will add our signature agreeing to provide such status on our General / Product Liability policy and will return the executed agreement of your records.


Vendor / Seller - Printed Name

Vendor / Seller - Date Signed


Katana Racing, Inc. - Printed Name

Katana Racing, Inc. - Date Signed

**This agreement shall remain in force until terminated by both parties in writing.**