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:
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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?
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-
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)
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Street Address of certificate holder
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Town/City of certificate holder
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State of certificate holder
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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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Who should we send the completed COI to? (IE: Contact at the location-a copy will also go to the email at the top of the form.)
*
First & Last Name
Email Address
Submit
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