Risk Management

1. Department to complete all fillable fields in the form(s) with the event/activity information.
2. Department to provide the form(s) to all participants and/or chaperones to review, complete, and sign prior to the start date of the event/activity.
3. Once all forms are completed and signed, scan all forms into one PDF file and send the file to Insurance@ccsu.edu. five (5) business days before the start date of the event/activity.

Note: For efficiency purposes, only one PDF file submission shall be accepted per event/activity.

4. Department shall maintain original form(s) with the department’s files as required per the Records Retention policy.
5. Fiscal Affairs / Risk Management will review the form(s) and securely store the file in Secure Apps (P drive).

Assumption of Risk and Release (fillable): Required for completion by Central students, Central faculty and staff, and non-Central participants attending Central sponsored programs, trips, events, and activities. (Note: formerly the Central Waiver Form.)

Chaperone Agreement (fillable): Required for completion by non-Central employee participants attending Central sponsored programs, trips, events, and activities.

Certificate of Insurance Request Form (fillable)

• When are Assumption of Risk and Release forms required?
  • Forms are required for completion by Central students, Central faculty and staff, and non-Central participants attending Central sponsored programs, trips, events, and activities.
• When are Chaperone Agreements required?
  • Required for completion by non-Central employee participants attending Central sponsored programs, trips, events, and activities.
• What is a Certificate of Insurance?
  • A certificate of insurance provides evidence to the certificate holder (the party to whom the certificate is issued) that the State of Connecticut carries insurance to satisfy various obligations, such as liability or loss or damage to property. The certificate of insurance shows the amount and type of insurance provided.
• When do I need a Certificate of Insurance?
  • When there are contractual or statutory requirements that require evidence of insurance.
• How can I obtain a Certificate of Insurance?
  • State agencies are occasionally requested to furnish proof of insurance for liability or property coverage to satisfy leasing/rental companies or other parties. The process for obtaining a Certificate of Insurance is as follows:

You can obtain a Certificate of Insurance by completing the Certificate of Insurance Request Form. You can then email the form to Insurance@ccsu.edu a minimum of two (2) weeks prior to the event, camp, or sports clinic start date.

• Do I need a Certificate of Insurance if I am using another state facility?
  • It is not necessary for a state agency to get a Certificate of Insurance to use another state facility, since the State of Connecticut is protected by governmental immunity.
• What is an additional insured?
  • An additional insured is an entity other than the named insured (State of Connecticut) who is protected under the terms of the insurance policy. Additional insureds are identified by name in the description section of the Certificate of Insurance.

Any additional insured request shall require State Insurance and Risk Management Board (SIRMB) approval prior to issuance of Certificate of Insurance.

• How do I request insurance coverage for programs, trips, events, and activities involving non-Central minors?
  • Please contact Insurance@ccsu.edu a minimum of sixty (60) days prior to program, trip, event, and activity start date.

• How do I request insurance coverage for a sports clinic?
  • Complete a Certificate of Insurance Request Form and email to Insurance@ccsu.edu a minimum of two (2) weeks prior to the sports clinic start date.
• Incident and Claims Reporting Procedures

• Jon Martin, jmartin1@ccsu.edu (860) 832-2551
• Amy Lopez, lopeza@ccsu.edu (860) 832-2534
• Insurance@ccsu.edu: For priority requests, please submit the Certificate of Insurance Request Form to Insurance@ccsu.edu and follow up with a telephone call to x22551 so that we can attempt to expedite.

Forms are required for completion by Central students, Central faculty and staff, and non-Central participants attending Central sponsored programs, trips, events, and activities.

Required for completion by non-Central employee participants attending Central sponsored programs, trips, events, and activities.

A certificate of insurance provides evidence to the certificate holder (the party to whom the certificate is issued) that the State of Connecticut carries insurance to satisfy various obligations, such as liability or loss or damage to property. The certificate of insurance shows the amount and type of insurance provided.

When there are contractual or statutory requirements that require evidence of insurance.

State agencies are occasionally requested to furnish proof of insurance for liability or property coverage to satisfy leasing/rental companies or other parties. The process for obtaining a Certificate of Insurance is as follows:

It is not necessary for a state agency to get a Certificate of Insurance to use another state facility, since the State of Connecticut is protected by governmental immunity.

An additional insured is an entity other than the named insured (State of Connecticut) who is protected under the terms of the insurance policy. Additional insureds are identified by name in the description section of the Certificate of Insurance.

Please contact Insurance@ccsu.edu a minimum of sixty (60) days prior to program, trip, event, and activity start date.

• Complete a Certificate of Insurance Request Form and email to Insurance@ccsu.edu a minimum of two (2) weeks prior to the sports clinic start date.