Certificate of Insurance Request Form

1 Applicant Information

Full Name * Please enter your full name.

USPS Certificate Number * Required.

Mailing Address * Required.

City * Required.

State * Required.

ZIP Code * Required.

Phone Number * Required.

Email Address * Please enter a valid email address.

Driver's License # * Required.

DL State of Issue * Required.

Date of Birth * Required.

⛔ Important Notice: The ABC|USPS Marine Liability policy does not cover instructors aged 80 or above. You are not eligible to be listed on this policy.

2 Training Activities & Background

1. What type of USPS on-water training/coaching/certification activities do you plan to do? *

Training using On-Water Guides Hands-On Training (HOT) Program Boat Operator Certification (BOC) Inland Navigator Coastal Navigator Advanced Coastal Navigator Offshore Navigator None

Please select at least one activity.

2. How long have you been boating? * Required.

4. How long have you been coaching/certifying? * Required.

3. What kind of boating do you currently do? *

Please select at least one.

5. What types of boats do you specialize in when coaching/certifying? *

Please select at least one.

6. USPS teaching, training/coaching, and certifications you hold — list all: * Required.

7. What body/bodies of water do you plan to teach/coach/certify on? List all: * Required.

8. Other licenses or certifications (e.g., USCG Captain's license)? List all: * Required.

9. Tickets, accidents, or violations ON OR OFF THE WATER? * Required.

10. Boating history / resume (paragraph): * Required.

3 Required Document Uploads

All items below must be uploaded before you can submit. Accepted formats: PDF, JPG, PNG.

A. Motor Vehicle Record (MVR) Release Form (signed) REQUIRED

📝

MVR Release Form (signed)

Drag & drop or click to browse · PDF, JPG, PNG

B. Driver's License — BOTH Front & Back REQUIRED

🪪 FRONT

🪪

DL — Front

JPG, PNG, or PDF

🪪 BACK

🪪

DL — Back

JPG, PNG, or PDF

C. USPS "All Completions" Certificate or Training History ONE REQUIRED

Access via the USPS Information Center → Find Members by Name or Certificate → Show Training History → Print an Eddept "All Completions Certificate"

OR

📋

All Completions Certificate

JPG, PNG, or PDF

📜

Training History

JPG, PNG, or PDF

⚕️ D. Medical Release Form REQUIRED — Age 65+

Because you are aged 65 or older, a completed Medical Release Form / Physician's Statement of Fitness is required annually. This can be the USPS form or your doctor's letter/form.

⚕️

Physician's Release / Statement of Fitness

JPG, PNG, or PDF

🚗 E. Motor Vehicle Record (MVR) Copy REQUIRED — CA & FL Instructors

Instructors licensed in California or Florida must provide an official copy of their Motor Vehicle Record. This is in addition to, not in place of, the MVR Release Form or driver's license.

🚗

Motor Vehicle Record (official copy)

JPG, PNG, or PDF

Package Submitted!