CERTIFICATE OF INSURANCE REQUEST

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 Department Name*
Department Contact Person:*
First Last
Department Email Address:*
Vehicle Type*
- Car
- Truck/Minivan
- Utility Van / Box Truck
- 12 Passenger Van
- 15 Passenger Van (Van driver training is recommended)
Rental Begin Date:*
MM slash DD slash YYYY
Rental End Date:*
MM slash DD slash YYYY
Reason For Travel and Location Vehicle is to be Driven:*
Name of Rental Agency:*
Agency Address:*
Driver's Name:*
First Last
Is Driver(s) over 21+?*
- Yes
- No
Phone
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