Incident Report • CampusOptics

Request for Certificate of Insurance

This form is used to gather information needed to issue Certificates of Insurance (COI) for Christopher Newport University activities. The COI will be emailed to the Christopher Newport University (CNU) contact submitting this form. The CNU contact will be responsible for sending it to the requesting organization. Please allow two weeks for processing.

**For location information, please indicate OFF SITE**

Reporter Info

Email* Required

Phone Number* Required

First Name* Required

Last Name* Required

Location

Campus, Building, or Outdoor Area* Required

Additional Location Details

Exact Location

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Who (organization, institution, or person) has requested the proof of insurance form Christopher Newport University?

Name* Required

Address* Required

What CNU group/department is being asked to provide proof of insurance?

Group / Department* Required

Contact Name* Required

Phone Number* Required

Email Address

Activity details

For what activity or event is the Certificate of Insurance being requested?* Required

Start date of the activity/event* Required

End date of the activity/event* Required

Where is the activity/event being held?* Required

Add Supporting Documents

Add files to upload as supporting documentation along with your incident report.