Certificate of Insurance Request – General Liability

Complete this Form when requesting evidence of insurance coverage for University of Rhode Island to provide to an individual or organization with whom the University has entered into a contract or agreement which requires proof of insurance. URI Certificates of Insurance (COI) will be processed within 3 business days and will be emailed directly to the University member requesting the certificate.

URI Certificate of Insurance Request – General Liability

URI Department Name(Required)

Department Contact Person:(Required)

First Last

Department Email Address:(Required)

Description of Activity:(Required)

Location of Activity:

If this is a field trip are all the participants URI student and URI employees?(Required)

Is this for Research/Study that includes Human Subjects? If yes, please see https://web.uri.edu/research-admin/office-of-research-integrity/human-subjects-protections/Untitled(Required)

Begin Date for Activity:(Required)

End Date for Activity:(Required)

Certificate Holder Name & Address? The Certificate Holder is the Party Requesting the Certificate from you.(Required)

Is Certificate Holder required to be named Additional Insured?(Required)

Yes

Additional verbiage to be included on form:

File

Max. file size: 10 MB.

Phone

This field is for validation purposes and should be left unchanged.