Certificate of Financial Responsibility Request Form

State entities may be requested to provide proof of liability insurance for its operations. This proof of insurance is generally known as a Certificate of Insurance. Because the Risk Management Fund is not an insurance company, it cannot issue Certificates of Insurance. Instead, Risk Management can provide a Certificate of Financial Responsibility for liability exposures it covers. Complete and submit this request form and Risk Management can issue the appropriate Certificate. Certificates will be provided by email.

Additional Insured Requests

"Additional insured" status requires that an insurer and/or an insured agree that a third party be entitled to coverage under an insurance policy. The Risk Management Fund is not an insurance policy and therefore, additional insured status is impossible. Further, claims for liability assumed under contract are excluded under the State Tort Claims Act, NDCC 32-12.2(3)(s)

Insured Information
Entity Requesting Certificate from the State
General Certificate Information