Get The Certificate Of Insurance Request Form Can Be ... - Teamusa.org

Completing the Certificate Of Insurance Request Form is essential for ensuring proper insurance coverage for your club's activities. This guide provides clear, step-by-step instructions to help you navigate the online form efficiently.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the 'Member Club Information' section, fill in the club name and membership number accurately. Provide the complete club address including street, city, state, and zip code.
3. Enter the club contact person's name and title. Include the primary and alternate telephone numbers, fax number, and email address. Optionally, add the club website if available.
4. Indicate the total number of club members and specify whether all members are also members of USA Field Hockey by selecting 'Yes' or 'No'.
5. Move to the 'Certificate Holder Information' section. Enter the certificate holder's name, street address, city, state, and zip code. Provide the contact person’s name and email address.
6. Fill in the main and alternate telephone numbers and fax number for the certificate holder. Indicate if the certificate holder requires additional insured status by selecting 'Yes' or 'No'.
7. Specify the role of the certificate holder by selecting the appropriate option provided in the form.
8. State whether there is an agreement or contract with the certificate holder that includes risk assumption or indemnity language. Answer 'Yes' or 'No'.
9. In the 'Sanctioned Event/Activity Information' section, indicate whether the certificate is for year-round club activity or a specific sanctioned event. If applicable, provide dates for the event.
10. Provide the name and brief description of the specific sanctioned event, including the estimated number of participants and spectators.
11. Review all entered information for accuracy and completeness. Once verified, submit the completed Certificate of Insurance Request Form via facsimile or email to the provided contact at USA Field Hockey.

Complete your documents online to ensure timely processing and coverage for your club activities.