Certificate of Insurance Request Form

This form is used if a vendor or site you are working with requires a Certificate of Insurance from the council. For online facilities use websites (i.e. Civic Permits and Facilitron), email your request to insurance@girlscoutsnorcal.org directly. Certificates are mailed directly to the Certificate Holder by the insurance company and should be received within 7-10 business days.

You should expect to hear back on your submission within 3-10 business days.  If you would like to follow-up please email:  insurance@girlscoutsnorcal.org

Person Making Request:

Certificate Issued To:

Is this request for: *
Certificate is proof of insurance for: *
Is Certificate Holder required to be named Additional Insured? *
Certificate Holder must be named Additional Insured because of a:

Electronic Signature


Published April 14th, 2014

* Please Note: Once you submit this form, you'll have the option to print the form contents on the following page.
Girl Scouting builds girls of courage, confidence and character that make the world a better place.  2014 Girl Scouts of Northern California