Skip to content
Insurance & Risk Management
Emergency Preparedness and Strategic Initiatives
Toggle navigation
Home
Insurance
Property Insurance
Motor Vehicle Insurance
Liability Insurance
Business & International Travel
Other Insurance
Risk Topics
Animals on Campus
Camps
Drones
Events
TULIP – Tenant User Liability Insurance
Waivers – (password protected)
Origami Risk
Forms
Links
Contact Us
COVID-19 Insurance Implications
Search
Search for:
Search
Certificate of Insurance Request
Please complete the following to obtain a certificate of insurance (COI) to submit to a third party vendor/sponsor.
Type of COI requested
*
(You may select more than one type of COI if required)
General liability and/or workers’ compensation COI Request
Student Intern COI Request
Auto Liability COI Request
Certificate Holder (entity requesting the COI)
Certificate Holder Organization Name:
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Event or Activity:
*
Reason for COI
Event Start Date
*
MM slash DD slash YYYY
Event End Date
*
MM slash DD slash YYYY
Student Intern COI Request
Student Name
*
First
Last
Student Email
*
College
*
Department
*
Course Name / Number
Class of...
Sponsor Information
Sponsor Name
*
First
Last
Sponsor Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Sponsor Phone
Sponsor Email
*
Requester Information
Requester Name
*
First
Last
Requester Email
*