Need a Certificate of Insurance for your Event?

Certificates of Insurance are issued by the Department of Enterprise Office of Risk Management when needed to verify that agencies are covered under the Self Insurance Liability Program (SILP) for a specific activity, lease or agreement. They are issued:

when evidence of coverage is requested by the owner, vendor or lessor of land, facilities, or equipment being leased, rented or used by an agency for its operations
when evidence of coverage is requested by another party for whom the agency employees perform services and/or activities as part of an agreement
when evidence of coverage is needed for general or vehicle liability covered by the Self Insurance Liability Program.

Fill out the form below and we will review your request as soon as possible.

Request for Proof of Insurance

Prepared by * Required
First Last
Phone Number
Email * Required
Date of Event - must be mm/dd/yyyy format
MM slash DD slash YYYY
Location of Event
Number of People Attending
Will Alcohol be Present?
- Yes
- No
Will Minors Be Present?
- Yes
- No
Reason for Certificate * Required
Please include as much detail as possible
Information for Entity Requesting Proof of Insurance * Required
Please include the following. Entity Name, Contact/Attn Name, Address, City, Zip, Fax, Email.