EVA Certificate of Insurance Request Form

EVA Certificate of Insurance (COI) Request Form
Please provide the information below in order to request a Certificate of Insurance. Not all venues require a COI so be sure it is a mandatory. Only official Electric Vehicle Association chapter events can be issued a Certificate of Insurance. All requests will be verified that a current Chapter Affiliation form is on file. Please check your chapter's status before proceeding.
Name of EVA contact*

First NameLast Name
Phone number of EVA contact*
Please enter a valid phone number.
Email of EVA contact*
example@example.com
Chapter name*
Chapter president*

First NameLast Name
Chapter president email*
example@example.com
Has someone specifically requested a Certificate of Insurance for your event?*

YesNo
If they are not requiring a certificate of insurance, you do not need to proceed with submitting this form. You do not require a COI for an event being hosted by an EVA chapter to be covered under our policy. Please email admin@myeva.org for further clarificaiton.
EVA insurance coverage includes $1,000,000 liability per occurrence and $3,000,000 umbrella.

EVA DOES NOT CARRY ANY OTHER INSURANCE and will not be providing additional coverage if your event requires it. Chapters may source and purchase their own supplemental event insurance policy for additional coverage at their own expense if they so choose. If a venue is asking for more coverage than the EVA provides, always submit our coverage with its limits documented as we have found that most venues will opt to accept them.
Certificate Holder Information:
Venue Name*
Venue Contact*
Venue Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Venue Phone Number
Please enter a valid phone number.
Venue Email
example@example.com
Do they require a Waiver of subrogation?

YesNo
Do they require to be named as additional insured?

YesNo
If yes, what is the exact wording of those being named?
Most requesters have a sample COI they will provide. Please attach a PDF of their sample here in order to expedite your request.

Cancelof
Should be Empty:

EVA Certificate of Insurance (COI) Request Form

Certificate Holder Information: