Certificate of Insurance Request

University of Oregon
Office of Risk Management
Contact: Lisa Taylor, Insurance and Claims Coordinator
Email: riskmanagement@uoregon.edu

Please provide the information below to request a certificate of insurance. Certificates can typically be provided in 1-3 business days. If you have a rush request please complete this form and then email riskmanagement@uoregon.edu to notify.

Note: If this is for a practicum or medical liability please list the student or employee's name and title.

If there is no start date you may enter the policy year.

Note: Insurance renewals take place at fiscal year end. If this is a multi-year contract a new certificate of insurance will be provided once the new policy is in place.

This should reflect what you want to appear on the certificate. Example: University of Oregon will use facilities at _____ on ______ for ________.

Exact name as it should appear on the certificate.

What type of insurance is required? This is typically listed on the contract/facility use agreement under insurance. Select all that apply:

If vendor requires specific clauses, please indicate below.

If you selected Fine Arts or Property; please enter the total value of property being loaned or rented.

All contracts for events and activities at the University of Oregon (on & off campus) must be signed and approved through Purchasing & Contracting Services (PCS) or by another UO authorized signator.

Please attach a copy of the contract or agreement.

If you have special instructions for your request or need to indicate insurance requirements please explain below.

Powered by Smartsheet Forms
Privacy Policy   |   Report Abuse
Your submission is being processed. Please do not close this browser window until complete.