Utah.gov
 
This form is to allow the user to request a Certificate of Insurance. Expect a reply from the Executive Secretary of Risk Management at 801-538-9560 within 5-7 days.
An "*" asterisk indicates a required field.

Certificate Requestor Information
* Your Name
* Organization:
* Address:
* City ,* State:
,
* Zip Code:
(5 digits)
* Phone Number:
000-000-0000
* Fax Number:
000-000-0000
* Email:
* Confirm Email:
Entity Requiring Proof of Insurance
* Name:
* Organization:
* Address:
* City ,* State:
 ,
* Zip Code:
(5 digits)
* Phone Number:
000-000-0000
* Fax Number:
000-000-0000
Email:
   
Coverage Requested
Government Liability Insurance only covers up to the current Government Immunity Limit (GIL).
Limits of Liability:
*
Standard Government Immunity Limits (GIL)
$

If you require Proof of Property insurance please check and fill in the amount.
$
 
Auto Comprehensive and Collision
Other Liability / Value
   
* Description:
Please describe the reason for the request. Be sure to include the dates the coverage is needed.