Certificate of Insurance Request

Requester Information
This is the WELS representative requesting the Certificate of Insurance.
A field marked with a red asterisk is required.
Your name*
First Last
Your title / position
Your phone*
Your e-mail*
A confirmation e-mail will be sent to the e-mail provided.
Enter e-mail Confirm e-mail
Organization/Entity
This is the WELS entity requesting the Certificate of Insurance.
Organization/Entity name
Address*
Address line 1 Address line 2 City State Zip code
E-mail
Phone
Purpose*
Certificate Holder Information
This is the outside venue requesting proof of insurance.
Certificate holder/venue*
Contact name
Address*
Address line 1 Address line 2 City State Zip code
Phone
E-mail
Does the Certificate Holder need to be named as additional insured?*
- Yes
- No
Is this request for a special event?*
- Yes
- No
Special Event Information
Begin event date*
MM slash DD slash YYYY
End event date*
MM slash DD slash YYYY
City
State
Description of event*
Number of participants*
Are you renting a vehicle?*
- Yes
- No
Special wording or instructions
Include copies of any contracts or lease agreements
Allowed file extensions: doc, docx, pdf
Drop files here or

Accepted file types: doc, docx, pdf, Max. file size: 50 MB.
Data Privacy & Permission*
I AGREE with the terms of the WELS Privacy Policy.
NOTE TO EU CITIZENS, RESIDENTS, TOURISTS, AND OTHER PERSONS TEMPORARILY IN THE EU:

By submitting this form you consent to any and all information you provide and submit via the site being sent to the United States of America. The United States has not sought nor received a finding of “adequacy” from the European Union under Article 45 of the GDPR. WELS relies on derogations for specific situations as set forth in Article 49 of the GDPR. You are also informed that the United States presently does not have an adequate level of personal data protection as determined by the European Commission’s adequacy decision on October 6, 2015 (case c-362/14) and articulated in the European Union’s General Data Protection Regulation and has not received a similar designation of adequacy by any other foreign data protection authority. You agree to the transfer of your data and personal data to the United States, however, to be used in accordance with WELS Privacy Policy.
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Risk Management: [email protected] or 414-256-3260 | Privacy policy
Ref: Certificate of Insurance Request