Certificate of Insurance Request

​A Certificate of Insurance is a document used to verify the university’s insurance coverage to outside parties. Risk Management provides the certificate as proof of insurance.

To request a COI, submit the following information to the Risk Management team at insurancecertificate@depaul.edu:

• A copy of the contract/agreement/invoice that requests proof of insurance.
• Contact information of the Certificate Holder requesting the proof of insurance.
• Date(s) of event or activity.
• Complete the form below.

  Smart Form Standard Web Part 2

Your Information

Name *

Phone *

Email *

Sponsoring Department *

DePaul Status * <Select One> Student Faculty Staff

Certificate Holder

Name of Requesting Company/Vendor *

Address *

City *

State *

Zip Code *

Contact Name *

Contact Phone *

Contact Fax

Contact Email

Certificate Due Date *

Date

Event Details

Is the certificate for an event?Yes
No

Event Type *

Event Name *

Event Description *

Event Date *

Date

Event Time *

Event Location *

Certificate Information

Purpose of Certificate *

Please note any insurance requirements, terms or specifics here.

Is there an agreement or contract? *Yes
No

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

Any other supporting documents? *Yes
No

Attachment

Before clicking the Submit button, please take time to review the accuracy of your COI Request. If you have questions, please email insurancecertificate@depaul.edu.