Insurance Certificate Request

Requestor Name*

Project Name*

Select or enter value

Project Specialist*

Select

Additional Insured Information

Please complete the following information for the “additional insured” party that has requested to be added to our policy or that requires evidence of insurance.

Name of Additional Insured*

Address*

City*

Province*

Postal Code*

Reason for Request*

e.g. Required for space rental or grant agreement. Or paste screenshot of insurance requirements from agreement

Location/Operation/Date of Event

N/A if insurance is required as part of grant agreement.

Comments/Special Instructions

Date Required (if applicable)

File Attachments (if applicable)

Drag and drop files here or

Send me a copy of my responses

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