Certificate of Insurance (COI) Request

Certificate of Insurance (COI) Request
A Certificate of Insurance (proof of liability insurance) is a possible requirement for a site use when hosting a Girl Scout event. Examples include: schools, churches, community centers and park & rec buildings.

To request a Certificate of Insurance, please complete the form below.
TROOP#/CAMP/SERVICE UNIT

(if applicable)
TROOP# SERVICE UNIT# CAMP NAME/OTHER
Name:

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Event description or purpose for use of site:
Example: Troop meeting, cookie booth, money-earning activity, etc.
Site Name
Site Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Site Contact

(if available)
Contact Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Does the site above need to be listed as a certificate holder?

YESNONOT SURE
Does the site above need to be listed as additional insured?

YESNONOT SURE
Please list any additional requirements or attach site agreement below for reference.
File Upload

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