Certificate of Insurance Request Form for Cornell internal use.

Please email the completed certificate request form and the supporting documents (i.e., permits/agreements) to both:

• Arthur J. Gallagher at certrequests@ajg.com
• Katherine Bisceglia at katherine_bisceglia@ajg.com

Please allow three business days for processing of certificates.

External entities that offer services or utilize university facilities must submit proof of their insurance by providing a Certificate of Insurance (COI). Cornell University its trustees, officers, agents, representatives, and employees, should be listed as Additional Insured on all liability policies, with primary and non-contributory. Such insurance shall provide a Waiver of Subrogation in favor of Cornell University. (Sample Certificate of Insurance)

If you have any questions regarding Cornell University’s insurance coverage, please contact the Office of Risk Management & Insurance at risk_mgmt@cornell.edu or call (607) 254-1575

Cornell Student Organizations please submit your request for a certificate of insurance through Campus Activities.