NISL Facility Insurance Request Form

Insurance Request Form

A Certificate of Insurance details your limits and coverage's, and you’re likely to need a copy for more than your own information. Organizations request your Certificate of Insurance as proof of your coverage in instances like field rental applications or equipment rental, any situation where a third party may end up invested in what happens at yours or their property. You’ll also likely be asked for a Certificate of Insurance whenever you host an event (Tournaments, Tryouts, etc) at an off-site venue. The N.I.S.L. is happy to provide exactly what you need, by filling this form.
We require a minimum of two weeks’ notice prior to the event for any Certificate of Insurance or Event Review requests.

* Click on Calendar

*Indicate the date that you need your COI.
Please indicate date needed *

Month Day Year
Choose a date 2 weeks from today's date
Club Information
Club requesting certificate: *
Name if your Club
Club ID #: *
ie. SKPL followed by NIS 4333
If you do not know your Club Code, please click here.
Club Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Contact Person: *

First Name Last Name
Phone Number *

Area Code Phone Number
Contact Person Title: *
Email: *
example@example.com
Is your Request a?:

Tournament Insurance Facility Insurance
Tournament Name:
Full Name of the tournament
Facility Name:
Full Name of the Facility
Starting Date: *

Month Day Year
From
Ending Date: *

Month Day Year
To
Type of certificate?: *

Named Insured Additional Insured
Facility Details: *

Indoor Outdoor
Named Insured - members of NISL (carded players and staff). This certificate lists the club as a named insured in its description of operations and as Certificate Holder.
Additional Insured - not members of NISL. These are typically the field/facility owners, and are listed along with the club on the certificate. If this coverage is for other than field/facility owners, please specify why you are requesting this certificate.
Field Owner's Legal Name: *
Field Owner's Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Field Owner's Phone Number *

Area Code Phone Number
Endorsement Needed?:

Yes
Please specify what you are requesting for your endorsement.
Should be Empty:

Insurance Request Form

Club Information