Certificate of Insurance Request Form
Location
*
4000 - St. Anthony Parish, Inc.
4010 - San Luis Rey Parish, Inc.
4011 - Immaculate Conception Mission
4020 - Our Lady of Purification Parish, Inc.
4021 - San Isidro Mission
4030 - San Isidro Parish, Inc.
4031 - San Jose Mission
4040 - Our Lord Of Mercy Parish, Inc.
4041 - Our Lady of all Nations Mission
4042 - Our Lady of Guadalupe
4050 - San Jose Parish, Inc.
4060 - San Miguel Parish, Inc.
4061 - Our Lady of Perpetual Help Mission, Inc.
4063 - San Pedro Del Cerro Mission
4070 - Holy Cross Parish, Inc.
4071 - Las Cruces Catholic Schools, Inc.
4080 - Immaculate Heart of Mary Parish, Inc.
4090 - Our Lady of Health Parish, Inc.
4091 - Santa Rosa De Lima Parish, Inc.
4100 - St. Genevieve Parish, Inc.
4101 - St. Albert the Great Newman Parish, Inc.
4110 - San Albino Parish, Inc.
4111 - St. Joseph Mission
4120 - Shrine and Parish of Our Lady of Guadalupe, Inc.
4150 - Our Lady of Refuge Mission, Inc.
4160 - San Martin De Porres Parish, Inc.
4161 - Shrine of Mount Cristo Rey
4170 - St. Thomas More Parish, Inc.
4180 - St. John Paul II Parish, Inc.
4184 - Our Lady of Perpetual Help Parish, Inc.
4185 - St. Joseph Mission
4186 - San Lorenzo Mission
4187 - San Ignatius Mission
4188 - San Isidro Mission
4189 - San Miguel Mission
4190 - St. Gregory Mission
4191 - St. Jude Mission
4401 - SAN PATRICIO RETREAT CENTER
5000 - Immaculate Conception Parish, Inc.
5001 - Father James B. Hay School, Inc.
5002 - Our Lady of the Desert
5010 - St. Jude Parish, Inc.
5020 - St. Joseph Parish, Inc.
5021 - Our Lady of Guadalupe Mission-Bent
5030 - St. Francis De Paul Parish, Inc.
5031 - St. Patrick Mission
5040 - Our Lady of the Light Parish, Inc.
5041 - Sacred Heart Mission
5128 - Sacred Heart Mission
5129 - St. Rita Parish, Inc.
5160 - St. Eleanor Parish, Inc.
5161 - St. Joseph Mission
5162 - St. Jude Mission
6000 - Our Lady of Fatima Parish, Inc.
6001 - San Juan Mission
6002 - St. Anthony Mission
6003 - Holy Family Mission
6004 - San Lorenzo Mission
6005 - San Jose Mission-San Lorenzo
6010 - Santa Clara Parish, Inc.
6020 - Infant Jesus Parish, Inc.
6030 - St. Vincent de Paul Parish, Inc.
6031 - St. Isidor Mission
6032 - Holy Cross Mission
6040 - St. Francis Newman Center Parish, Inc.
6131 - St. Therese of the Little Flower Mission
6163 - San Ysidro Mission
6500 - Holy Family Parish, Inc.
6501 - Holy Family Mission
6510 - St. Ann Parish, Inc.
6520 - St. Joseph Parish, Inc.
6524 - St. Catherine Mission
6531 - San Felipe de Neri Mission
6532 - St. Jude Mission-Cotton City
6533 - St. Augustine Mission
7000 - Our Lady of Grace Parish, Inc.
7010 - St. Anthony Parish, Inc.
7020 - St. Edward Parish, Inc.
7021 - St. Edward School, Inc.
7030 - San Jose Parish, Inc.
7040 - St. Cecilia Parish, Inc.
7041 - St. Clare Mission
7050 - Our Lady of Grace Parish, Inc.
7051 - Cristo Rey Mission
7060 - St. Helena Parish, Inc.
7065 - St. Helena School of Hobbs, Inc.
7070 - St. Thomas Aquinas Parish, Inc.
7071 - Our Lady of the Rosary Mission
7080 - Our Lady of Guadalupe Parish, Inc.
7136 - Our Lady of Guadalupe Mission
7137 - St. Catherine Mission
7138 - Immaculate Conception Parish, Inc.
7165 - Assumption Parish, Inc.
7166 - All Saint's Catholic School, Inc.
7167 - St. Peter Parish, Inc.
7168 - St. John Parish, Inc.
Catholic Charities
Roman Catholic Diocese of Las Cruces
Location Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Location Contact
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Location Contact Email
*
example@example.com
Certificate Holder Information
Please complete the following for the entity requesting the certificate, NOT your location.
Name of Certificate
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Certificate Holder's Interest
*
Certificate Holder Only
Additional Name Insured
Loss Payee
Landlord
Bank/Lender
Reason for Certificate
*
Use of Facilities
Proof of Insurance
Leased Property
Other
Coverage Needed on Certificate
*
Property
General Liability
Automobile Liability
Worker's Compensation
Other
Recurring/One Time
*
Recurring
One-Time
Certificate Due Date
*
-
Month
-
Day
Year
Date
Event Dates and Use Description (if applicable)
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Submit
Should be Empty: