Certificate of Insurance Request – Rental Vehicle

Provides Coverage Limits as follows:

Liability $1,000,000
Comp & Collision $100,000

This form, completed with as much information as possible, is to be provided to the Risk Management Office, no later than 4 business days prior to the start of the rental period.

SPECIAL NOTE REGARDING ENTERPRISE RENTALS: Must be 21+ years of age to drive 12 or 15-passenger vehicles rented from Enterprise. URI Certificates of Insurance (COI) will be processed within 3 business days and will be emailed directly to the University member requesting the certificate.

DAMAGE TO RENTAL VEHICLES MUST BE REPORTED ASAP TO THE RISK MANAGEMENT OFFICE – 401-874-2591

URI Certificate of Insurance Request – Rental Vehicle

URI Department Name(Required)

Department Contact Person:(Required)

First Last

Department Email Address:(Required)

Vehicle Type(Required)

Car

Truck/Minivan

Utility Van / Box Truck

12 Passenger Van

15 Passenger Van (Van driver training is recommended)

Rental Begin Date:(Required)

Rental End Date:(Required)

Reason For Travel and Location Vehicle is to be Driven:(Required)

Name of Rental Agency:(Required)

Agency Address:(Required)

Driver's Name:(Required)

First Last

Is Driver(s) over 21+?(Required)

Yes

Phone

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