California Risk Management Authority
RCIC Form
Certificate of Insurance Request Form
7170 N. Financial Drive, Suite#130
Fresno, CA. 93720
559-476-2999
Fresno, CA. 93720
559-476-2999
Attn: Lisa Perez
Request for Certificate of Insurance Checklist
![Request for Certificate of Insurance Checklist icon]()
Request for Certificate of Insurance Checklisttitle
- Name, mailing address, contact name of certificate holder (party requesting proof of insurance
- Copy of contract/agreement stating insurance requirements from certificate holder
- (If this information is not on contract/agreement please request a copy in writing)
Date of event - Description of event (include organization/school participating in event)
- A two-week advance notice would be appreciated to process the paperwork.
No Certificate of Insurance and/or Additional Insured Endorsement will be issued until all the above information is received in our office.