COI Request Form

Certificate of Insurance Request Form
Certificates of Insurance (COI) are issued upon request to companies/organizations providing the use of their
site to Girl Scout troops/groups for Girl Scout Activities. Many organizations/companies require a COI before
they allow a group to reserve their site.

COIs are valid for an entire calendar year. January 1st - December 31st. Multiple COIs are not needed for the same calendar year.

To request a Certificate of Insurance, complete the form below.

The certificate will be prepared and emailed directly to the insured organization/company as well as an email copy
sent to the person in charge of the activity.

Please allow 7-10 business days for processing.

Questions? Please call Customer Care (973)248-8200 or email customercare@gsnnj.org
Company/Organization Information
Company/Organization Name*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
Send to the attention of:*

First NameLast Name
Email*
example@example.com
For one time use or multiple uses?*
Automatically renew this company/organization for next year?*
Person Requesting Certificate

Please allow 7-10 business days for processing
Person in charge of activity:*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Service Unit*
Troop Number*
Which GSNNJ Service Center is nearest the above location. You will not need to pick up a completed COI as it will be emailed to you. Completing this form helps us to know where COIs are being requested.*

Paramus Service CenterRiverdale Service Center
Should be Empty:

Certificate of Insurance Request Form

Company/Organization Information

Person Requesting Certificate