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Request for Certificate of Insurance

The purpose of a Certificate of Insurance is to provide proof of coverage under Brown's insurance for University related events/activities. 

Please complete the form below, print a copy for your records, and email or fax any supporting document to 863-1566. Be sure to ask if there is a contract or rental use agreement when securing the location of your event.  Contracts need to be reviewed and signed by those who are authorized to do so.

This form serves as a formal request for a Certificate of Insurance from Brown University departments.  It is important that you fill out all of the fields on the form. If you have any questions regarding Certificates of Insurance, please contact the Insurance Office at 863-9481.

Please allow up to 1 week for processing.

Indicate any language that must appear on the Certificate of Insurance here.
For example: "Brown University's [department/event] to be held on [date] from [start time] to [end time] at [location]."

Please indicate the name and address exactly as it needs to appear on the Certificate of Insurance. Please note - this should not be a Brown University address. It should be an address for the outside party requesting the Certificate of Insurance.

If yes, please provide an email address in the field above.

If a party is asking to be named as additional insured, please indicate that below, and email or a copy of the contract showing the insurance requirement to 863-1566. If you are unsure, please check with the outside party.