Certificate of Insurance Request

Certificate of Insurance Request

A certificate of insurance is required for most events held at outside venues. Please secure your venue before requesting this certificate, as it is site-specific.
Current Date

MonthDayYear
Date

Submitter Info
Name*

First NameLast Name
Email*
yourname@ctk.church
Has anyone asked to be additional insured?*

YesNo
Additional Insured Named

Event Info
Event Name*
Campus
Ministry*
Is there a charge for the event?

YesNo
Are you having food vendors?

YesNo
Please request a Certificate of Insurance from vendors for your records.
Insurance Amount Requested*
Event Start Date*

MonthDayYear
Date
Event End Date

MonthDayYear
Date
Estimated # of Attendees*
What ages will be attending?*
What kinds of activities will be happening at this event?*
Special Instructions, Details & Comments

Certificate Information
Has any special wording been requested? If so, please provide exact wording.
Is there a written contract?*

YesNo
Please attach the written contract in .PDF or .docx format:

.PDF, .DOCX
Cancelof

Venue (Certificate Holder) Information
How and to whom would you like to send the e-mail certificate?
Venue Name*
Venue Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Delivery Method*

PhoneFaxE-Mail
Venue Contact Person*

First NameLast Name
E-Mail*
yourname@ctk.church
Phone Number*
Please enter a valid phone number.
Fax #
Please enter a valid fax number.
Should be Empty: