Certificate of Coverage Request Form

Use this form to request a Certificate of Coverage

Certificate of Coverage (COC) Request Form

  • Contact Information

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

  • Those wishing to be listed as the Certificate Holder (i.e. UDOT, Zions Bank etc.)
  • Address of the Certificate Holder
  • 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
    Max. file size: 100 MB.
    • Additional Persons Requesting Copy of Certificate

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