University Certificates of Insurance/Coverage

To provide an external party proof of University of Wisconsin–Madison insurance coverage.

The University can supply a certificate of coverage under many circumstances. The Risk Management office will review the coverage requested, the description of the activity to be covered, and the related contract or agreement documents (must be included with your request below) to determine whether or not it can be covered under the State Liability Program.

If it cannot be covered, we will contact you to discuss in more detail.
If it can be covered, a certificate will be generated, signed by the campus Risk Manager, and sent to you. Keep a copy of the signed form for your records and mail the signed form to the requestor.

Please allow up to 3 weeks for processing.

Note: Clinicians currently or previously employed by UW–Madison’s School of Medicine and Public Health (SMPH) seeking confirmation of liability insurance coverage for purposes of employment, licensure, or medical staff privileges, should email their request directly to UW SMPH Risk Management at smph-rm@med.wisc.edu. It generally takes 7-10 business days for SMPH Risk Management to provide its clinician confirmation of liability coverage letter.

Please provide us with the following information:

Company Name(Required)

Company Mailing Address(Required)

Type(s) of Coverage proof requested

General liability

Auto Liability

Worker's Compensation

Other

Please fill in other type of coverage(Required)

Begin date of activity to be covered(Required)

End date of activity to be covered(Required)

UW Employee Information

Employee Name(Required)

First Last

Employee Email(Required)

Employee Phone

Description of the activity being performed, and under which program/department’s authority(Required)

Upload contract or agreement documents

Please upload the corresponding contract agreement, facility use agreement, MOU, affiliation agreement, or other related documents which require UW–Madison to provide certificate or evidence of insurance. Missing documentation may cause delays in processing your request.

Drop files here or

Max. file size: 24 MB.