NCSU Insurance & Risk Mgmt.

BUILDING & CONTENTS COVERAGE AND VALUE UPDATE

DEPARTMENT:

PHONE:

BUILDING:

CONTACT:

ASSET LOCATION [floor(s) and/or room(s)]:

ADDRESS [street, city]:

ASSET FUNDING IS (check one)

( ) GENERAL (G)

( ) SPECIAL (S)

( ) COMBINED (C)

COVERAGE DESIRED	FIRE	EC	BROAD FORM	ALL RISK
BUILDING (check ones you desire)
CONTENTS (check ones you desire)

ENTER WHICH CONTENTS VALUE TO BE USED (enter only one)

CAMS VALUE $_________

YOUR OWN ASSESSED VALUE $_________

EFFECTIVE DATE OF CHANGE (M-D-Y)

SIGNED:

DATE:

FORM IRM-02 (REV. 9/13/07)