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 Latarsha Silver or call at 919-647-0065.

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

Indicates required field

Insured Name

Campus Name

Building Name

LEA/School Numbers

Type of change requested

Effective Date of Insurance coverage

Construction Type

(from construction plans)

Number of Floors

Building Has a basement

Yes

Building Has Sprinkler Protection

Yes

Building Has Burglar Alarm

Yes

Building Has Fire Alarm

Yes

Building Square Footage

sq ft

Building Value

(round up to whole numbers)

Content Value

(15% of bldg. value minimum)

Protecting Fire Dept

Address

City/Town

State/Province

ZIP/Postal Code

First

Last

Comments

(add additional information that would be helpful)