Request for Certificate of Insurance Checklist

1. Name, mailing address, contact name of certificate holder (party requesting proof of insurance
2. Copy of contract/agreement stating insurance requirements from certificate holder
3. (If this information is not on contract/agreement please request a copy in writing)
   Date of event
4. Description of event (include organization/school participating in event)
5. A two-week advance notice would be appreciated to process the paperwork.

No Certificate of Insurance and/or Additional Insured Endorsement will be issued until all the above information is received in our office.