COI Request

COI Request

Please allow 5-7 business days. All COI's are valid January 1st thru December 31st of the current calendar year.
Name of person requesting the COI *

First Name Last Name
Email of person requesting the COI *
example@example.com
When is the COI needed? *

Month Day Year
Is this COI for a troop or a SU? *
What is the troop # / SU name? *
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"? *

Yes No N/A
What is the purpose of the COI? (IE: meetings, events, cookie booths) *
Are there any other special instructions? *
Who should we send the completed COI to? *

First & Last Name Email Address
Should be Empty: