Request for Certificate of Insurance Request must be submitted AT LEAST TWO WEEKS PRIOR to the event/activity. Please enable JavaScript in your browser to complete this form.Requestor's Name *FirstLastRequestor's Email *Email of the person representing the scout unit or district making this request. The certificate will be sent to this email address.Requestor's District Name or Unit Information *Examples: Troop 123, Pack 123, Crew 123, or Aymaco DistrictEvent/Activity Information *Important: Submit to the Puerto Rico Council copies of any agreements, contracts, permits or application from the certificate holder indicating their insurance requirements, rules, and regulations. If this information is not provided or included the certificate cannot be issued.Date of Event or Activity *Specify the date or date range of the event or activity if it spans multiple dates.Location and Description of facilities used: *Provide the physical address of the location to be used in the event/activity and a brief description of the facilities.Limits requested *Specify limits if requested, otherwise enter N/A.Certificate holder/Organization Requesting Certificate (Complete name and address) *Specify the address and name of the organization requesting the certificate. Will you need the Hold Harmless and Indemnify Agreement? *YesNoHas the certificate holder requested to be listed as additional insured? *YesNoIf this request is for Scout meetings, does it need to be set up as a renewal?YesNoIf the certificate is for a unit activity, is the certificate holder the chartered organization for the unit involved? *YesNoFees required for services, use of property, etc. *Enter any additional comments deemed necessary.Submit