Request for Letter of Insurance

Submitted by admin on Wed, 07/02/2008 - 16:13.

Whenever you have a request from an outside organization for proof of insurance you need to complete the form below. If the request is part of a field trip we will need a copy of the CCF-798 in addition to this request. When you have completed the request form click the submit button. The original letter or insurance certificate will be mailed to the requesting organization. A copy will be emailed to you as well. If you have any questions please call 799-2967 x 5601.

Type of Insurance Required: *

Auto Liability

General Liability

Property

Workers Compensation

Check all boxes that apply

Name of Event: *

Description of Event: *

Give specific details regarding the event that requires proof of insurance.

Start Date of Event: *

Ending Date of Event: *

Date Insurance Letter Needed By:

Allow at least 48 hours to complete request.

Company Contact:

Company Contact Phone #: * (xxx) xxx-xxxx

Company Name: *

Company Address: *

City: *

State: *

Zip Code: *

CCSD Contact name: *

CCSD Contact Phone #: * (xxx) xxx-xxxx

CCSD E-mail Address (Interact): *

CCSD Location Name: *

Additional Comments:

Attachment - Required Documents:

Event information, Field Trip Form (CCF-798), etc.

Request for Letter of Insurance

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