Request Certificate of Insurance

Complete this form to receive a copy of your chapter's certificate of insurance.
Your Contact Information
Name
*
Chapter
*
Email
*
Phone
*
Event Detail
Name of Event
*
Describe Event
*
Requesting Party
University
IFC
3rd Party Vendor
Other
*
If other, please describe:
Representative
*
Email
*
Phone
*
None
Additional Insured ($250 additional charge to chapter by underwriters)
Primary Coverage ($500 additional charge to chapter by underwriters)
Other
*
If other, please describe:
Please attach formal document(s) which outline the insurance coverage requirements (Examples: Recognition statement, Student Organizational guidelines, Event requirements, Event contract/agreements, etc.)
*
Yes
No
I am not sure
*
If you have additional questions about where to find a particular resource, or what kind of resources are available, please contact pikeuniversity@pikes.org