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/Risk Management representative 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 Robert Howerton in the Office of Environmental Health and Safety fifteen (15) working days prior to the effective date of coverage.

CSU Insurance/Risk Management representative shall forward the original certificate of insurance directly to the requesting party and maintain a copy in the Office of Environmental Health and Safety. The CSU Insurance/Risk Management representative will be provided a copy of the certificate of insurance upon request.

Download: PDF iconCertificate of Insurance Request Form 2017