Certificate of Marine Insurance Template by eer13797

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									FY2007 INLAND MARINE TEMPLATE FOR ADDING OR DELETING ITEMS
Email completed template to: lkloewen@lcsc.edu
                                                                                                        FISCAL
                                                                                                          YEAR
                                                                                                       BILLING
                                                                                                       PERIOD:
                                    DIVISION NAME:                                  INSURANCE         Fill down for
  AGENCY NAME:           Fill   If applicable, fill down for    INSURANCE          COORDINATOR        each Inland
 down for Inland Marine item       each Division Inland      COORDINATOR NAME:       PHONE #:         Marine item
            entry.                  Marine item entry.         Only enter once.    Only enter once.        entry.
Lewis-Clark State College                              Lucy Loewen                208-792-2240           2007
G ITEMS


                                                            CERTIFICATE
                                                                              State Tag
           INSURANCE BEGIN                                   NUMBER:
                                    INSURANCE END                             Number:
                  DATE:                  DATE:             Fill down for each Fill down
          Enter date coverage to   Enter date to delete   item entered. Call for each
             begin for newly       Inland Marine items    332-1872 if you've    Inland  Serial Number: Fill
          acquired Inland Marine    from current FY06        forgotten your Marine item down for each item
                  items.                coverage.           agency's cert. #   entered.      entered.
                                             Replacement Cost
                                           (Cap each items value
                                             at $2,000 if actual
                                            replacement cost is
                                            higher)           Fill    NOTES TO RISK
State owned/leased Property Description:    down for each item       MANAGEMENT, IF
      Fill down for each item entered.          entered.               APPLICABLE

								
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