Environmental Health and Safety

Certificate of Insurance Request Form

Departments utilizing external entities who request a certificate of insurance from Cleveland State University prior to their use of facilities and/or properties need to provide CSU's Insurance Administration Consultant with a copy of the contract or agreement document and complete and submit the Request for Certificate of Insurance form.

The documents must be forwarded to the Insurance Administration Consultant fifteen (15) working days prior to the effective date of coverage.

Insurance Administration Consultant shall forward the original certificate of insurance directly to the requesting party and maintain a copy in the Insurance Administration Consultant's office. The CSU representative will be provided a copy of the certificate of insurance upon request.

Download: PDF iconCertificate of Insurance Request Form