COI Request Form | NGU Risk Management

Please use this form to request a Certificate of Insurance (COI) on your policy.

Entity Name*
Agent
Entity is a...*
- School District
- All Other Governmental Entities
COI Type Requested*
- Auto
- Liability
- Property
Property Description*

Ex. "Football Field at High School"
Property Address*
Street Address Address Line 2 City State ZIP Code
Mortgagee

Only if the property location has a mortgagee.
Mortgagee Address
Street Address Address Line 2 City State ZIP Code
Loss Payee / Certificate Holder*
Loss Payee / Certificate Holder Address*
Street Address Address Line 2 City State ZIP Code
Loss Payee
Loss Payee Address
Street Address Address Line 2 City State ZIP Code
Certificate Holder*
Certificate Holder Address*
Street Address Address Line 2 City State ZIP Code
Event Description*
Event Date*
Or First Day of Event
Last Day of Event
Only if Event is multiple days.
Additional Insured
Additional Insured Address
Street Address Address Line 2 City State ZIP Code
Vehicle Year*

Ex. "2005"
Make*

Ex. "Cheverlot"
Model*

Ex. "Impala"
VIN Number*

Ex. "1HGCM82633A004352"
Upload a File
Max. file size: 10 MB.
Please include any file relevent to this COI request.
Person Completing This Form*

Ex. "Your Name"
Your Email*

Ex. "you@email.com"
Additional Comments or Information
Include any additional comments or information, if needed.
Comments
This field is for validation purposes and should be left unchanged.