LOUISIANA STATE PROPERTY 1ST PARTY LOSSES BUILDINGS CONTENTS EQUIPMENT

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Louisiana State Property 1st Party Losses

Louisiana State Property 1st Party Losses

Buildings, Contents, Equipment Breakdown, Employee Bond and Crime Losses

In addition to the above FARA’s Property Claims Unit is responsible for Bridge Property losses and Fixed Marine Facility losses

Agency Name: Agency Location Code:

Agency Contact:

Name, Phone, Fax, and Email

Date of Loss: Time of Loss: Date reported to FARA:

State ID/Slab Building # (Facility Management#): S or L

Site Code #:

Location of Loss:

Street, City, Zip Code, Parish

Type of Loss: Fire Theft Lightning Hail Flood Wind Other

Explain Other:

Does this loss involve a hurricane? Yes No

If yes name of hurricane:

Estimated amount of loss to exceed $1,000.00? Yes No

Description of Loss & Damage:

Enclose all supporting documents of your loss, including any information on a 3rd party. Also, include asset management/LPAA print out sheet.

Contents/movable property list age or date of purchase:

Reported By: Phone:

After completion of this form please email directly to [email protected]

An adjuster will be assigned and your agency will receive an acknowledgement letter with the assigned claim number as well as the adjusters name and contact information.

Should you have any questions regarding completion of the form please contact Darrell Bizette at 225-448-0383.

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