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?
*
Please Select
Troop
Service Unit
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
Submit
Should be Empty: