* CSSA *
Connecticut State Soccer Association

Certificate of Insurance Request Form

All files are in Microsoft Word for Windows and Macintosh formats. These formats can be imported into later versions of Microsoft Word for Windows and Macintosh.
CSSA Certificate of Insurance Request Form
 
CSSA Certificate of Insurance Request Form (302 KB) -- updated 03-Nov-2011
 
1. Click the form link above to download the form.

2. Please fill out the COI Request Form completely and accurately. Please make sure email addresses for both Team Managers and Facility Owner are included.

3. Unless you are only going to play on one field, please enter ALL FIELDS in "Facility Name," so you will be covered for all fields in that Town.

4. If there are several teams that play on the same fields, one COI can be issued for all teams, so, please group all teams to make things easier for everyone.

5. Email a copy of the form to
Marco Viola. His email address is at the top of the form.

6. Do
NOT send the form to the USASA.

7. Normal processing time for a COI is 7-14 days. PLEASE PLAN ACCORDINGLY AND SUBMIT WELL IN ADVANCE.

8. Expedited service (usually completed within 48-72 hours) is available for a processing fee of $50, in check form, payable to "CSSA, Inc." and mailed to:

Marco Viola
1200 East Putnam Avenue
Riverside, CT 06878