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2. Only one COI request per form. Do not combine multiple COI requests into one submission. You will be asked to resubmit them separately.

4. Request Deadline

   You must submit this request at least 10 or more business days PRIOR to the reservation date. For rush requests, please complete this form AND contact Linda Cooper at 301-600-1177 or Lauren Vandergrift at 301-600-1357.

6. Rec Council Insurance FAQ's
   FAQ's

   Please read the FAQ's at the link above prior to submitting this form.

8. Name of organization requesting COI (Certificate Holder)*
10. Address of Organization requesting COI (Certificate Holder Address)*
12. Name of Event and/or Description*
14. Location(s) of Event*
16. Date(s)*
18. Does the Certificate Holder request to be an Additional Insured? *

    1. Yes
    2. No
20. Will this certificate be needed every year or is this a one-time event? *

    1. Annual Event
    2. One-Time Event
22. Name of Recreation Council*
24. Name of Recreation Council Contact*
26. Council Contact Phone*
28. Council Contact Email *

    Where COI will be emailed. You may have up to 3 emails. Please separate the emails with a comma.

30. Attach Document

    Attach either a Rental Agreement or Rental Application. Failure to provide it with the initial request will only delay the process

Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit Submit and Print

* indicates a required field