As a professional courtesy, to the underwriters, please allow two weeks for processing a Certificate of Insurance for your event.

Please complete the following COI request and email to The Risk Management office at risk@lasierra.edu

• Who is the Certificate Holder:

  • Organization name
  • Address
  • City
  • State
  • Zip code
  • Contact Name
  • Phone number
  • Email address
• Event location: (if different from certificate holder)
  • Address
  • City
  • State
  • Zip code
• Activity Requiring Certificate (e.g., Filming activity: Name of film; Name of Student/ID number, phone number;)
• Beginning Date (MM/DD/YYYY)
• Ending Date (MM/DD/YYYY)
• Additional Insured: Yes or No  (select one answer)
• Specific Wording they Require
• Sponsored by (e.g., Your Department at La Sierra University)
• List email of recipient requesting certificate: (separate email addresses by semi-colon)
• Name and email address of the requester

Contractors/Vendors, need to complete one of the following agreements prior to the beginning of the contracted work or event/activity:

1. Contractor Agreement with Financial Administration
   • Contractor shall attach copies of licenses and permits to this Contract
   • Submit a Certificate of Insurance (COI)* with signed contract
2. Vendors Agreement with Financial Administration
   • Vendor shall attach copies permits and/or licenses to this Contract
   • Submit a Certificate of Insurance (COI)* with signed contract

* Please see the Certificate of Insurance requirement form prior to obtaining a COI from your insurance provider.

Please scan and submit all required documents to Financial Administration at finadmin@lasierra.edu

To obtain Professional Liablity insurance for student internships, you may find reasonable coverage at the following resource for education based programs by contacting the:

• American Professional Agency.
• For the Healthcare Professional please visit ProLiability Insurance.

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