Certificate of Insurance Request

Certificate of Insurance Request

General COIs are usually processed within a week or less. Anything that requires a waiver of subrogation will take 2-3 weeks for approval and processing from our insurance company.
Your Full Name*

First NameLast Name
Your SHP Email*
example@shpbeds.org
Your Chapter*
Is this a new request or a renewal?*

New RequestRenewal
Date(s) COI Needed*
What do you need the Certificate of Insurance for?*
Sponsor/Facility Name*
Facility Address*

Street Address

Street Address Line 2

CityState

Zip Code
Additional Insured Needed?*

YesNo
If we need to include any special wording, please explain below.
Please upload a copy of the requirements/agreement if necessary

Cancelof
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