Contents Reporting Form Office of Risk Management USE THIS FORM TO ADD MOVABLE PROPERTY (CONTENTS) VALUES FOR BUILDINGS NOT ALREADY INDICATED ON THE PROPERTY EXPOSURE REPORT, INCLUDING THE NOTE CONTENTS OF NEW LEASED BUILDINGS. DO NOT USE TO INSURE ACTUAL BUILDING STRUCTURE. AGENCY NAME AGENCY ISIS CODE ORM LOCATION CODE CONTACT NAME PHONE NUMBER DATE EMAIL ADDRESS BUILDING INFORMATION (ALL FIELDS REQUIRED) BUILDING ID NUMBER LEGACY BUILDING ID NUMBER (NEW FORMAT: SITE CODE/ BLDG #) (SLABS #) OWNER OF BUILDING BUILDING NAME (IF STATE OWNED, INDICATE (IF APPLICABLE) WHICH STATE AGENCY) PHYSICAL STREET ADDRESS CITY, STATE, ZIPCODE (NOT P. O. BOX) GROUND FLOOR SQUARE SQUARE FOOTAGE OCCUPIED FOOTAGE OCCUPIED IF THIS IS A LEASED SPACE, YES LA GOV BUSINESS LA GOV FUND IS IT PROCESSED THROUGH LA GOV FUND NO AREA FACILITY PLANNING AND CENTER CONTROL? CONTENTS VALUES (INCLUDE THE TOTAL OF STATE OWNED AND NON-STATE OWNED; ROUND TO WHOLE NUMBERS) GENERAL GENERAL CONTENTS COMPUTER EQUIPMENT MOBILE EQUIPMENT FINE ARTS FENCES MEDICAL EQUIPMENT SIGNS LIVESTOCK OTHER OUTDOOR PROPERTY MOBILE STRUCTURES LPFA/3RD PARTY FINANCING BOATS BUSINESS INCOME RETURN COMPLETED FORM TO THE OFFICE OF RISK MANAGEMENT UNDERWRITING SECTION, POST OFFICE BOX 91106, BATON ROUGE, LOUISIANA 70821-9106 – FOR ORM USE ONLY PS NUMBER Revised 3/2016 RS NUMBER
Contents Reporting Form Office of Risk Management NOTE USE THIS FORM TO ADD MOVABLE PROPERTY (CONTENTS) VALUES FOR BUILDINGS NOT ALREADY INDICATED ON THE PROPERTY EXPOSURE REPORT, INCLUDING THE CONTENTS OF NEW LEASED BUILDINGS. DO NOT USE TO INSURE ACTUAL BUILDING STRUCTURE. AGENCY NAME AGENCY ISIS CODE ORM LOCATION CODE CONTACT NAME PHONE NUMBER DATE EMAIL ADDRESS BUILDING INFORMATION (ALL FIELDS REQUIRED) BUILDING ID NUMBER (NEW FORMAT: SITE CODE/ BLDG #) LEGACY BUILDING ID NUMBER (SLABS #) BUILDING NAME (IF APPLICABLE) OWNER OF BUILDING (IF STATE OWNED, INDICATE WHICH STATE AGENCY) PHYSICAL STREET ADDRESS (NOT P. O. BOX) CITY, STATE, ZIPCODE SQUARE FOOTAGE OCCUPIED GROUND FLOOR SQUARE FOOTAGE OCCUPIED IF THIS IS A LEASED SPACE, IS IT PROCESSED THROUGH FACILITY PLANNING AND CONTROL? YES NO LA GOV FUND LA GOV FUND CENTER LA GOV BUSINESS AREA CONTENTS VALUES (INCLUDE THE TOTAL OF STATE OWNED AND NON-STATE OWNED; ROUND TO WHOLE NUMBERS) GENERAL GENERAL CONTENTS COMPUTER EQUIPMENT MOBILE EQUIPMENT FINE ARTS FENCES MEDICAL EQUIPMENT SIGNS LIVESTOCK OTHER OUTDOOR PROPERTY MOBILE STRUCTURES LPFA/3RD PARTY FINANCING BOATS BUSINESS INCOME RETURN COMPLETED FORM TO THE OFFICE OF RISK MANAGEMENT – UNDERWRITING SECTION, POST OFFICE BOX 91106, BATON ROUGE, LOUISIANA 70821-9106 FOR ORM USE ONLY PS NUMBER RS NUMBER Revised 3/2016
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