Certificate of Insurance Request Form

This form is for Club Directors/Administrators ONLY. Insurance is only valid for events in which ALL participants are USAV members. Certificate holder is generally an entity, such as a school district, church, facility, etc. Individual schools that are part of a school district do not need to be listed, just the district name and the district office address. Turnaround time on COI requests is 3-5 days.
Club Name(*)
Invalid Input

Your Name(*)
Please let us know your name.

Your Email(*)
Please let us know your email address.

Your Phone Number(*)
Invalid Input

Club Address(*)
Please write a subject for your message.

Need by Date(*)
Invalid Input

Certificate Holder Name (i.e. school district, facility, etc):(*)
Invalid Input

Certificate Holder Address:(*)
Invalid Input

Certificate Holder email:(*)
Invalid Input

Certificate Holder email 2:
Invalid Input

Limits of Coverage Requested:(*)

Invalid Input

Insurance Coverage Requested For:(*)

Invalid Input

Notes
Invalid Input

Please type the letters you see on the right in the box below.(*)
Please type the letters you see on the right in the box below.
Invalid Input

Columbia Empire Volleyball Association
4840 SW Western Avenue, Suite 450
Beaverton, OR 97005

503-644-7468

region@cevaregion.org