Request for General Liability Insurance Certificate Form

Please submit this completed form to the Greater Tampa Bay Area Council Service Center (13228 N. Central Ave, Tampa, FL 33612). The information provided will be treated with confidentiality and used solely for the purpose of evaluating the request for General Liability Insurance. Approval is subject to compliance with the Council's policies. Please allow up to 5-7 business days for proccessing and approval.

Unit Type and Number*
Charter Organization*
District*
Request Date*
MM slash DD slash YYYY
Event*
Event Date/Time*
Type of Event*
Name of Event Location*
Name of Event Organizer*
Address of Event*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Does this event holder require “ADDITIONAL INSURED”? If “YES”, please fill out the following section:*
- Yes
- No
Name of Additional Insured*
Additional Insured Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Please include any specific details/requirements*
Submission Information
Person Making This Request*
First Last
Email to Send Certificate*
NOTES
Consent
I agree to the privacy policy.
By submitting this form, I consent to the collection and use of the provided information by GTBAC, Scouting America for the purpose of obtaining General Liability Insurance coverage in accordance with applicable privacy policies and laws.
Name
This field is for validation purposes and should be left unchanged.

Have questions or feedback about this page? Last updated April 9, 2025

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Stephen McKellar

Marketing Specialist

Request for General Liability Insurance Certificate Form

Submission Information

Have questions or feedback about this page? Last updated April 9, 2025

Stephen McKellar