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#AdaptatHome COVID-19 Updates

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Request Certificate of Insurance

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Request Certificate of Insurance
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PLEASE SCROLL DOWN TO COMPLETE CERTIFICATE OF INSURANCE FORM

An entity or an individual such as a property owner, sponsor, service provider or event partner may contractually require that they be named as an additional insured and provided with a certificate of additional insurance. To request an additional insured certificate for the policies that your chapter carries through Disabled Sports USA dba Move United Group Insurance Program, please fill out the form below.

Before entering into any contract with an outside party, please review the insurance requirements and verify that your chapter’s insurance coverage meets them. If you have questions about whether or not the policies held through the Disabled Sports USA dba Move United Insurance Program will cover the requirements, please contact Ryan Semke (rsemke@moveunitedsport.org or 240.268.5370) before agreeing to the contract terms.

Below are instructions to ensure your Request for Certificate of Insurance is processed properly:

  • Submit the request for certificate of insurance AT LEAST 10 BUSINESS DAYS PRIOR to the date required by the requesting entity. This will ensure the paperwork has enough time to be processed. Move United cannot guarantee certificates for requests that are not submitted 10 business days prior to the date required by the requesting entity.
  • Fill out all required information within the form
  • Attach the contract/agreement/permit application that states the specific insurance requirements or provide a link to the document.

Click Here for the Basics of Certificates of Insurance Webinar

View a Sample Certificate of Insurance Form

Request Certificate of Insurance

  • The "Save & Continue Later" function can be found at the bottom of this report form. If selected, a pop-up notice will provide a unique URL which will allow you to access the form at a later time. The URL will also be sent via email to the Primary Contact listed. Please note before using this feature: DSUSA cannot access partially completed forms or the URLs associated with the forms. Not all browsers work with this feature. We recommend that you test the feature before completing the full form. Another recommendation is to back up your form to a Word Document before submitting.
  • Chapter Contact Information

  • Program/Event Information

  • Cannot Precede Today's Date
  • Date cannot be later than 11/30/2021
  • This name will be used on the certificate, so please type exact program name (i.e. Paralympic Snowboard Training, The Hartford Ski Spectacular)
  • (i.e. skiing, handcycling, camping, training clinic, fundraising)
  • Please list all safety equipment (i.e. helmets, lifeguards, personal flotation devices, protective eye wear)
  • Additionally Insured-Certificate Holder

  • (Should be listed exactly as required within contract)
  • (i.e. event site, service provider, sponsor, etc.)
  • Please provide name only. No contact information.
  • Drop files here or
    Accepted file types: pdf, doc, docx, jpg, gif, png.
    Accepted files are .pdf, .doc and .docx. jpg, gif, png If you have a link to the contract, please insert it in the additional comments box below.
  • Please enter any two digit number.
  • Thank You

    Please only click submit ONCE. Attachments may take 30-60 seconds to upload.
  • This field is for validation purposes and should be left unchanged.
Save and Continue Later

Move United is a nonprofit, tax-exempt charitable organization under Section 501(c)(3) of the Internal Revenue Code. Donations are tax-deductible as allowed by law.

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