INSURANCE EXCEPTION REQUEST
Vendor / project: [Vendor and project]
Requirement: [Contract requirement]
Evidence submitted: [Actual evidence]
Gap and reason: [Difference and vendor explanation]
Work dates / exposure: [Scope and period]
Proposed controls or alternatives: [Controls]
Owner / upstream consent needed: [Consent requirement]

Decision: [Approve with conditions, decline or request more evidence]
Conditions: [Conditions]
Authorized approver / role: [Name and role]
Approval date / reference: [Date and reference]
Exception expires: [Date]
Review trigger: [Renewal, scope change or other trigger]
Follow-up owner: [Name]

Attach the supporting correspondence and retain the original unmodified insurance evidence.