Risk Management Forms

Public Injury/Property Damage

• UIC Report Form (PDF) [updated: 1/27/10]
  Form to be used on UIC campus to report incidents of public injury and/or property damage.
• UIS Report Form (PDF) [updated: 1/27/10]
  Form to be used on UIS campus to report incidents of public injury and/or property damage.
• UIUC Report Form (PDF) [updated: 1/27/10]
  Form to be used on UIUC campus to report incidents of public injury and/or property damage.

Gaming Liability Insurance

• 4-H Horse Gaming Liability Insurance Application - University Use Only  (Web Form)
• 4-H Shooting Sports Liability Insurance Application - University Use Only  (Web Form)

Academic Camp Forms

• UI Academic Camps Accident Insurance Enrollment Form - University Use Only  (Web Form)
• Camp Accident Claim Form - University Use Only  (MS Word) [updated: 11/29/07]

Transit Insurance

• Transit Insurance Request Form - University Use Only  (Web Form)

Evidence of Liability Insurance

In accordance with OBFS policy, the University Office of Risk Management is the only office permitted to issue evidence or proof of coverage. Requests from other contracting parties related to the University's insurance programs need to be directed to the University Office of Risk Management. To expedite requests please click on the applicable link. Should you feel none of these links apply to your particular request please call (217) 333-3113.

Insurance Certificate

Note: If the certificate holder requires that they be named an additional insured, a fully executed agreement is required before a certificate can be issued.

• Request for Proof of General Liability Coverage - University Use Only  (Web Form)
  Form should be used for contracts, department-sponsored events held at offsite locations, etc.
• Request for Proof of General Liability Coverage - University of Illinois Extension - University Use Only  (Web Form)

Request for Proof of Coverage

• Request for Proof of Medical Professional Liability Coverage (Web Form)
  To be completed when requesting proof of coverage for past and present medical professionals.
• Request for Proof of Medical Resident Liability Coverage - University Use Only  (Web Form)
  To be completed when requesting proof of liability coverage for current University of Illinois medical residents performing rotations outside the University. (If the individual is no longer a University resident and/or is seeking employment/credentialing outside of the University, please use the “Request for Proof of Medical Professional Liability Coverage” form.)
• Request for Proof of Student Liability Coverage - University Use Only  (Web Form)
  To be completed when outside entities request proof of liability coverage for students in approved practicums.

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Last Updated: May 9, 2012