Certificate of Insurance Request – Leased Equipment or URI Shipped Equipment/Property

Complete this form when requesting evidence of insurance to rent, lease or borrow equipment from a third party OR WHEN SHIPPING URI EQUIPEMENT. For leased Equipment, the certificate of insurance will provide the equipment owner evidence of the University’s General Liability Insurance coverage in case the equipment is lost, damaged or stolen. For Shipping URI Equipment, the COI will provide the URI Department Shipping the URI Owned Equipment with information of coverage for the listed equipment. 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 – Leased Equipment/Property

URI Department Name(Required)

Department Contact Person:(Required)

First Last

Department Email Address:(Required)

Description of Rental Equipment Or URI Equipment to be Shipped:(Required)

Reason for rental equipment or Reason URI Equipment will be Shipped::(Required)

If Shipping Equipment WHERE FROM:(Required)

If Shipping Equipment WHERE TO

Begin Date:(Required)

End Date(Required)

Value of Equipment Being Leased:(Required)

If Shipped Equipment – total value of Equipment in this one Shipment:(Required)

Certificate Holder Name & Address EQUIPMENT FOR SHIPPING CERTIFICATE HOLDER ALWAYS "SAMPLE":(Required)

File

Max. file size: 10 MB.

Name

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