CERTIFICATE OF INSURANCE REQUEST – LEASED EQUIPMENT/PROPERTY

Complete this form when requesting evidence of insurance to rent, lease or borrow equipment from a third party. 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. 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:*
Description of Rental Equipment:*
Reason for rental equipment:*
Begin Date of Rental:*
MM slash DD slash YYYY
End Date of Rental:*
MM slash DD slash YYYY
Value of Rental Equipment:
Certificate Holder Name & Address:*
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