REQUEST A CERTIFICATE

Use the form below to request a certificate of insurance for approved/insured activities. A list of club names as registered with USA Swimming will appear when you start typing the club or Local Swimming Committee name, city, or state code.

Please allow a minimum of 3-5 business days for review and processing of your request. Once reviewed and approved, you will receive a copy of the certificate at the email address you provided. We may also email to follow up for additional information to confirm the activity is covered under the insurance program. The request may also be denied if the activity is not insured under the program.

You will receive an email from SportsPortal@epicbrokers.com. Please be sure to check your Junk/Spam email folder for this email or add it to your contacts to prevent it being filtered.

If your request is urgent, please contact EPIC (USASWIMCOI@epicbrokers.com) for assistance.

Governing Body

Governing Body: USA Swimming, Inc. * Swim Club/Local Swimming Committee: * Type of Certificate: Select template... Class-1 (Proof of coverage only) Class-2 (Proof of coverage & Additional Insured) Class-3 (Additional Insured with Endorsement) Class-1 LSCs (Proof of Coverage) Class-2 LSCs (Proof of Coverage & AI)

Event Details

* Event Name: * Start Date: * End Date:

Certificate Holder

* Holder Name: * Address (1): Address (2): * City: * State: Select state... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia US Virgin Islands American Samoa Puerto Rico Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon France England United Kingdom * ZIP Code: * Certificate holder's interest: Select... Premises Owner/Facility Sponsor Other Additional request notes:

Swim Club Contact Information

* Contact Name: Contact Phone: * Contact Email:

Additional Notifications

If you have an additional contact who needs a copy of the certificate, please enter both the name and email below. Receiver Name: Receiver Email:

Request Attachments

If you need to submit documentation for your request, you can include up to three PDFs below. The total size of your attachments must be less than 10 megabytes.

Attachment #1:
Attachment #2:
Attachment #3: