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COI Request
Please complete this form to acquire a Certificate of Insurance (COI) for your event. The COI will be emailed to you within 2 business days.
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* Indicates required question
Email
*
Your email
Other email you would like the certificate sent to (optional)
Your answer
Permit Holder's Name
*
Your answer
Permit # (If Applicable)
Your answer
Added Insured/Organization Name (i.e. Forest Preserve of Cook County)
*
Your answer
Event Address
*
Your answer
Event City
*
Your answer
Event State
*
Your answer
Event Zip Code
*
Your answer
Event Date
*
MM
/
DD
/
YYYY
Your Phone Number
*
Your answer
A copy of your responses will be emailed to the address you provided.
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