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Complete one form for each building.

We recommend that you print this information before you send it to us.

Contact Information:

Name:

Title:

Telephone Nr:

Fax Nr.

E-mail address:

Building Location:

Building Id:

If one does not exist, assign a unique one. 

Location Id:

If one does not exist, assign a unique one.

 

If this is tenant information only, check here             Tenant Name:  

Furnishings and Fixtures

Is there a detail report for furniture and fixtures for this location? 

Yes   No

Is there a video tape documentation in a secure & fire proof location?  Yes   No

 

Is there any custom built furniture or fixtures? Yes   No

Do you wish to include a list of furniture or fixtures? 

Yes   No

If yes, please list in the box:

Records, Books, Documents and Valuables

Is there anyone in charge of stabilization, damage assessment, restoration and relocation of valuable books, documents, artwork or  records?    

Yes   No

If yes, name:  

Emergency Phone:

Is there a priority selection of these vital records, documents, books and artwork (including  collectibles):  Yes   No

Is there a list of these items:  Yes   No

If yes, please list in the box:

Production Equipment

List the location and square footage of areas that are defined as "Production Areas"  with machinery or equipment:

Who is responsible for maintaining and stabilizing this area in the event of a loss?

Name:   

Emergency Phone:    

Are there any hazardous materials in this department?

Yes   No

Is there a detailed report or list of production equipment?

Yes   No

If yes, please list in the box:

Computer and Audio Visual Equipment

Is all software backed up and in a secure, fire proof location? 

Yes   No

What is used for back up?  

Tape   Floppy disk    Optical/laser disk

Is any of the equipment leased?  Yes   No

If yes, leasing company:  

Emergency phone: 

Is there an alternate location for computer systems? 

Yes   No

If yes, where and with what company?

Is there a detail equipment report?  Yes   No

If yes, please list in the box: