OFM, Risk Management Division - Master Property Policy Form

MASTER PROPERTY POLICY CHANGE REQUEST

(fields with an asterisk (*) are required)

ADD       DELETE

*Agency:

*Effective Date:

*Requestor:

*Phone:

Email:

Location of Property:

*Street address:

*City:

*State:
*Zip Code:

*Type of Property:        *Value:

Property is: Owned Leased

*Description of Property:
(for building, please list year built, SF area, type of construction...)

Comments/Additional Information:

ADD DELETE
*Agency:
*Effective Date:
*Requestor:
*Phone:
Email:
Location of Property:
*Street address:
*City:
*State:	*Zip Code:
Type of Property: Value:
Property is: Owned Leased

Description of Property: (for building, please list year built, SF area, type of construction...)*
Comments/Additional Information: