CERTIFICATE OF INSURANCE REQUEST

Use this form for Fine Arts on loan to the University of Rhode Island, the completed and signed Fine Art Loan Agreement Form must also be on file and retained by the department receiving the loan. 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 Department Name*
Department Contact Person:*
First Last
Department Email Address:*
Art Ownership*
URI Owned Fine Art*
Artist Description Current Market Value
Fine Art on Loan to URI:*
Name of Lender Beginning Date of Loan Ending Date of Loan Display Location
Comments
This field is for validation purposes and should be left unchanged.

Risk Control and Insurance

Protecting the University community, by promoting a culture of compliance and shared responsibility

Artist	Description	Current Market Value

Name of Lender	Beginning Date of Loan	Ending Date of Loan	Display Location