We are in the process of updating our facilities use online request system to meet the requirements of our insurance carrier. For those of you who already have requests in the system, please provide the now required documentation by April 30th. These documents can be sent to Lori Ehmer at Bloomfield High School. 

Through the link below you can access the district's Facilities Use Release Form. The responsible party/organization must sign and return this form before any facility use request can be approved. This form outlines the insurance requirements, responsible party and rules governing facility use. Please return the signed form to Lori Ehmer at Bloomfield High School. These forms will be kept on file with at least an annual update required beginning July 2019. 

Facilities Use Release Form

Through the link below you will find a sample Certificate of Insurance with Endorsement. This endorsement must stipulate Bloomfield CSD as an "additional insured on a primary and noncontributory basis". Please contact your insurance carrier for this required certificate. If you or your organization utilizes the facility over a season (i.e. April through July for summer soccer) you may ask your carrier to provide a certificate of insurance for a date range as long as your current policy covers those dates without renewal during that time. Certificates of Insurance must be updated at least annually; and will be reviewed prior to authorizing any specific facility use request to ensure the request occurs during the coverage period of the certificate on file and is in keeping with the parameters of that certificate. 

Sample Certificate of Insurance with Endorsement

Please feel free to contact us with any questions you may have. We appreciate your assistance as we update our files to meet the requirements of our insurance carrier. 

Guidelines For Facilities Use


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Lori Ehmer


585-657-6121 ext. 1004

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