School Insurance Fund Change of Coverage

Submitted by dclewis1 on Wed, 08/12/2020 - 10:57

If this is an addition to an existing building; give the name of the existing building as it appears on your insurance policy.

If you have any questions, please email Natalie Pollard or call at 919-647-0097.

Notes: Effective Date of Insurance coverage is subject to State Public Education Property Insurance Fund underwriter approval.

Indicates required field

Insureds Name

Type of change requested

LEA/CC Number AND site number if applicable

Site Number/Campus Name

Building Name

Address

City/Town

State/Province

ZIP/Postal Code

Effective Date of Insurance coverage

Note: effective date cannot be prior to today's date.

Construction Type

(from construction plans)

Number of Floors

Flood Zone

If building is in a flood zone, underwriter will add it to the endorsement.

Building Has Sprinkler Protection

Yes

Building Has Burglar Alarm

Yes

Building Has Fire Alarm

Yes

Building Square Footage

sq ft

If deleting building, square footage is 0.

Building Value

(round up to whole numbers) If deleting building, value is $0; if adjusting building, input the total value only. Ex: Increasing a $500,000 building to $1,500,000. Input $1,500,000.

Contents Value

(15% of bldg. value minimum) If deleting contents, value is $0; if adjusting contents, input the total value only. Ex: Increasing a $500,000 contents to $1,500,000. Input $1,500,000.

Protecting Fire Dept

First

Last

Comments

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