Certificate of Liability Insurance Request Form
Please fill out this form completely.
You will receive a copy of the Certificate of Liability Insurance via email from Tresa Davis within 1 week of submission.
Date Requested
Date Required
Your Name
Email
Phone
School/Facility:
Select School/Facility...
Athey Creek
ArtTech High School
Boeckman Creek
Boones Ferry
Bolton
Cedaroak Park
Lowrie
Inza Wood
Meridian Creek
Rosemont Ridge
Stafford
Sunset
Trillium Creek
Willamette
West Linn High
Wilsonville High
District Operations Center
District Office
Group using Facility
Date of Use
# of Students & Staff
Name of Facility Requesting Certificate:
Street Address
City, State, Zip
Purpose of Use
Send Certificate to:
Fax Number
Phone Number
Company Email
Comments or Special Instructions