Louisiana State Property 1st Party Losses Buildings Contents Equipment

louisiana state property 1st party losses buildings, contents, equipment breakdown, employee bond and crime losses in addition to the ab

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.