Certificate of Liability Coverage Request Form

Use this form to request a Certificate of Liability Coverage

Certificate of Liability Coverage (COLC) Request Form

  • Contact Information

  • The best number to contact you if we have questions.
  • Certificate Information

  • Those wishing to be listed as Loss Payee/Additional Insured on the Certificate (i.e. UDOT, Zions Bank etc.)
  • Address of the Loss Payee/Additional Insured on the Certificate
  • Please include name of event, description of activity.
  • Please include dates that coverage is requested.
  • Please enter any additional information/instructions here
  • Please upload any documents associated with the request for Certificate of Liability Coverage here:
    Drop files here or
  • Additional Persons Requesting Copy of Certificate

    Include anyone that would like a copy of the Certificate emailed to them.