JMU - Certificate of Coverage

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 Request:
Name of Person Submitting:
E-mail of Person Submitting:
MSC of Person Submitting:
Phone of person submitting:
Certificate Issued to (Name of Company/Medical Facility):
Attention:
Address Issued to:
City, State, Zip Issued to:

Coverage Period:	-
Purpose:

	Risk Management Building Coordinator List Certificate of Coverage Environmental Health Coordinator Safety Coordinator
	PUBLISHER: Office of Risk Management MSC 6703, Harrisonburg, VA 22807 PHONE: (540) 568-6495 FOR INFORMATION CONTACT: Yeevonne Riggleman Privacy Statement Last Modified: 6/26/2008