COI Request
Please allow 5-7 business days. All COIs are valid July 1st of the current calendar year to July 1st of the following calendar year.
Is this request for a:
*
NEW COI (never requested before)
Renewed COI
Edit to current COI (please attach the COI that needs editing)
Name of person requesting the COI (Your name)
*
First Name
Last Name
Email of person requesting the COI (Your email)
*
example@example.com
When is the COI needed?
*
-
Month
-
Day
Year
Is this COI for a troop or a SU?
*
Please Select
Troop
Service Unit
Other
What is the troop # / SU name? Enter "NA" for "Other".
*
Name of certificate holder (IE: name of school, name of facility, name of church, etc)
*
Street Address of certificate holder
*
Town/City of certificate holder
*
State of certificate holder
*
Zip Code of certificate holder
*
Does the certificate holder need to be listed as "Additionally Insured"?
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Yes
No
N/A
What is the purpose of the COI? (IE: meetings, events, cookie booths)
*
Are there any other special instructions?
*
Please attach your supporting document here, if you have one.
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What is the name and email address of the contact at this location? (a copy of the COI will be sent directly to them and the email at the top of the form.)
*
First & Last Name
Email Address
Submit
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