Certificates of Insurance - Certificate Request Form
Certificate Request Form - Submit to CertificatesofInsurance@cfo.pitt.edu.
- Certificate requests will not be accepted directly from students. The appropriate advisor/department head must request.
- Please provide advance notice of at least ten (10) working days. Don't wait until the last minute. Either we or the brokers who issue the certificates may not be available or changes may be needed to the certificate issued. This could hold up activity from your end.
- Indicate if the contract is a multi-year agreement so that the certificate(s) can be automatically renewed.
- Additional Insured status MUST be supported by a signed contract. If Additional Insured status has been approved by Purchasing or the Office of General Counsel you must forward a copy of the signed contract along with your Certificate Request Form.
- Unlike General, Automobile and Excess/Umbrella Liability policies, in most cases, a third party CANNOT be named as Additional Insured on Medical Professional Liability insurance policies
- General Liability 'Waivers of Subrogation" cannot be agreed to in contracts. The University's Primary General Liability insurer does not allow waiving their rights to recover damages caused by another's negligence.
NOTE: The submit button on the Certificate Request Form will work for Adobe Acrobat Professional users only. Adobe Reader users will need to print/scan/email the request form to CertificatesofInsurance@cfo.pitt.edu.
- LICENSED DENTISTS ONLY: IF EVIDENCE OF YOUR INDIVIDUAL COVERAGE IS NEEDED, CHECK WITH THE APPROPRIATE ADMINISTRATORS IN THE SCHOOL OF DENTAL MEDICINE AS CURRENT CERTIFICATES OF INSURANCE HAVE BEEN PROVIDED.