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Risk Management

Request for Certificate of Coverage

Please complete the below form to request a Certificate of Coverage. A certificate will be issued within five business days after receiving a properly completed form. It is the responsibility of the JMU department requesting the certificate to forward the certificate to the organization/business that needs the certificate. Please contact Yeevonne Riggleman riggleyy@jmu.edu 568-6495 with questions.

REQUEST OF CERTIFICATE OF COVERAGE

Date Of Service/Product/Event:
Name of Person Submitting:
E-mail of Person Submitting:
MSC of Person Submitting:
Phone of person submitting:



Certificate Issued to:
Attention:
Address Issued to:
City, State, Zip Issued to:
Coverage Period: -
Purpose: