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, please submit the form below.​​ Please note Environmental Health & Safety (773-325-3344) does not manage this process and any questions should be directed to insurancecertificate@depaul.edu​.

  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.

Click the Submit button one time to request your COI.

If you have questions, please email insurancecertificate@depaul.edu.