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Certificate of Insurance Request
Property Loss Report
Insurance
Property Loss Report
Employee’s Name
Required
Employee's Email
Required
Employee's Campus Phone Number
Required
Department Name
Required
Department Address
Required
Supervisor’s Name
Required
Supervisor’s Email
Required
Supervisor's Campus Phone Number
Required
Police or Fire Dept. Loss Reported to
Required
Location of Loss
Required
Detailed Description of Loss of Damage
Required
Including date and time of the incident, specific items damaged or lost, and identification of any witnesses.
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