Certificate of Insurance Request

Certificate of Insurance Request

A certificate of insurance is required for most events held at outside venues. Please secure your venue before requesting this certificate, as it is site-specific.
Current Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
- Name
  
  First NameLast Name
- Email
  yourname@ctk.church
- Has anyone asked to be additional insured?
- Additional Insured Named
- Event Name
- Campus
- Ministry
- Is there a charge for the event?
- Are you having food vendors?
- Please request a Certificate of Insurance from vendors for your records.
- Insurance Amount Requested
- Event Start Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Event End Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Estimated # of Attendees
- What ages will be attending?
- What kinds of activities will be happening at this event?
- Special Instructions, Details & Comments
- Has any special wording been requested? If so, please provide exact wording.
- Is there a written contract?
- Please attach the written contract in .PDF or .docx format:
  
  .PDF, .DOCX
  Cancelof
- How and to whom would you like to send the e-mail certificate?
- Venue Name
- Venue Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Delivery Method
- Venue Contact Person
  
  First NameLast Name
- E-Mail
  yourname@ctk.church
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Fax #
  Please enter a valid fax number.Format: (000) 000-0000.
- Should be Empty: