Proof of Insurance Request Form Name of Insured: St. Thomas University, 16401 NW 37th Avenue, Miami Gardens, FL 33054 Full Name (required) Email (required) Phone (required) I would like to receive proof of insurance by: (Required) Standard 3-4 business daysEnd of todayRush Organization Requesting Proof of Insurance. Organization Name (Certificate Holder) (Required) Organization Address Organization Email Organization Phone Reason for the request (Required) Type of Coverage Requested (check all that apply): GeneralAutoWorkers CompensationProfessional Does the organization request to be listed as additional insured? YesNo If yes, please list additional insureds as required: Any additional details pertaining to this request:
