Certificate of Insurance Request
If your local LWV is under our 501c3 umbrella your LWV is incorporated into our general liability insurance. If you need a certificate of insurance for an event, please use this form and LWV Minnesota will contact our insurance agent for the certificate.

If your local LWV is not listed, you are not under our 501c3 umbrella and are responsible for your own general liability insurance.

Email address *
Local LWV *
Date of Event *
If requesting for an ongoing or repeating event, please make note of the duration or frequency of repetition in the notes space below.
MM
/
DD
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YYYY
Notes for Ongoing or Repeating Events
Your answer
Name of Location *
Your answer
Location Address *
Street address, city, and zip - FULL ADDRESS IS NEEDED OR A CERTIFICATE CANNOT BE MADE
Your answer
Does the location request proof of any specific coverage? Or need an event name listed?
Your answer
Date you need certificate by:
MM
/
DD
/
YYYY
Submit
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