Certificate of Coverage

The Office of Administration and Finance prepares and signs all certificates of coverage. The certificate of coverage states coverage limits set under the State Risk Management Plan.

Please complete the form below at least TWO weeks in advance to request a certificate of coverage. Once the information has been received it will be reviewed by the Office of Administration and Finance. The requester will receive the certificate of coverage once it is ready.

Certificate of Coverage Request Form

UMW Employee Requesting the Certificate * Required
First Last
Department * Required
Email * Required
Event or Purpose for the Certificate * Required
Name of Organization as it Should Appear on Certificate * Required
Organization Contact Name * Required
Address of the Organization * Required
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Coverage Period * Required
Attach Signed Contracts & Facility Rental Agreement (if applicable)
Drop files here or

Accepted file types: pdf, doc, jpg, gif, Max. file size: 5 MB.
Description/Additional Information * Required

Certificate of Coverage

Certificate of Coverage Request Form

Risk Management

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