Compliance & Risk Management > Risk Management > Certificate of Insurance Request Form

Certificate of Insurance Request Form





 








Select a date from the calendar.



Select a date from the calendar.

Include address if different from company/vendor location.

 NOTE: Please send a copy of the agreement or contract prior to signing.

 

Your Information

Certificate Holder

Event Details

Certificate Information

NOTE: Risk Management requires a copy of the written contract or agreement if the certificate holder (requestor) is requesting to be named as "additional insured," "loss payee" and/or "mortgagee."


If you have any questions please contact us at insurancecertificate@depaul.edu.

Before clicking the Submit button, please take time to review the accuracy of your COI Request.

Thank you,
The Risk Management Team​