Certificate of Insurance Request Form

Note: Requests will be processed on a first-come, first-serve basis. Processing may take 7-10 business days.

Requester First Name

Requester Last Name

Requester E-mail

Service Unit or Troop Number

SU/Troop E-mail

Activity Name

Activity Date(s)

Name of Facility Requesting GSEP Certificate

Address of Facility

Contact Name at Facility

Facility Contact E-mail

Facility Contact Fax Number

Additional Insureds (if required by facility)

Special Wording/Instructions