Related:
Accident Coverage
Air Travel Insurance
Auto Insurance
Boiler Machinery
  Coverage
Fidelity Bond
  (Employee)
Fleet Manual
Liability Coverage
Malpractice Insurance
  (Students)
OSHA 300 Record
  Keeping
Property Coverage
Workers'
  Compensation

Contact:
Environmental Health
  and Safety
714 W. Lombard Street
Baltimore, MD 21201
410-706-7055
Fax 410-706-8212

Any damage to University property that may result in an insurance claim must be reported immediately to Risk Management Division as follows:

Risk Management Division
Environmental Health and Safety
3rd Floor EHS Bldg.
714 W. Lombard Street
Baltimore, Maryland 21201-1041
(410)706-8212 (fax)

Facilities Management will identify one individual to serve as the project administrator to coordinate necessary building repair. The FM Project Manager will initially provide :

A. brief statement detailing the incident, and if possible, identifying the cause of the incident.

B. A summary of the extent of the damaged property and attempt to estimate the cost to repair the property.

C. Immediately following the incident every attempt should be made to mitigate damage and reduce down time and inconvenience to the occupants of the area directly impacted by the incident

Each school or department impacted by the incident should identify one individual that can serve as the coordinator. The departmental coordinator will prepare a written inventory of equipment and supplies affected by the incident. This inventory should include the room number, items damaged, and replacement cost.

Where equipment is damaged, this list should include make, model and serial number as well as value.

SPECIAL NOTE: If the department has a current maintenance agreement on equipment that is damaged, they should immediately notify the company with the agreement and initiate a service call to inspect the damage. The service ticket should state the nature of the call, the finding of the technician, estimate to repair damage not covered by the maintenance agreement and, if the cost to repair the equipment exceeds replacement cost, to note this on the ticket.

For inspection and/or repair of equipment not currently on a maintenance agreement, the UMB Office of Procurement and Supply can provide the names of several local vendors qualified to inspect and repair the equipment. As with all insurance claim payments, purchase orders must be issued through the Office of Procurement and Supply and all original invoices related to inspection and/or repair must be forwarded to Risk Management Division, Environmental Health and Safety, 714 W. Lombard Street, Baltimore, MD 21201, for submission to the Claims Unit - Insurance Division for payment directly to the vendor by the Treasurer's Office. (SPECIAL NOTE: The Treasurer's Office will not reimburse the University for invoices paid in error.) Payment to the vendor will be made based on the total amount of the invoice. The claim deductible will be deducted at a later date from University funds.

REPORT OF INCIDENT INVOLVING STATE BUILDING OR EQUIPMENT

STATE INSURANCE TRUST FUND

University of Maryland, Baltimore _________________________ _________________ STATE AGENCY DEPARTMENT DATE OF INCIDENT ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ____ ____ ____ APPROPRIATION CODE FUND STATE WIDE SUB OBJECT (APPROPRIATION CODE, FUND & STATEWIDE SUB OBJECT IS YOUR AGENCY) Jeff Kiefer (410)706-7034 Name of Agency Insurance Coordinator Telephone Risk Management Div, 714 W. Lombard Street, Baltimore, Maryland 21201 AGENCY ADDRESS LOCATION OF INCIDENT (Building and Address) ____________________________ _____________________________________________________________________ DETAILED DESCRIPTION OF INCIDENT INCLUDING CAUSE (fire, wind, explosion, etc) _______________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ESTIMATE OF BUILDING LOSS $______________________ ESTIMATE OF CONTENTS LOSS $_____________________ POLICE OR FIRE DEPARTMENT TO WHOM REPORTED ______________________ POLICE OR FIRE REPORT NUMBER ______________________________________ _____________________________________________ ________________ SIGNATURE OF AGENCY INSURANCE COORDINATOR DATE Note: Attach additional information to this report if necessary. SEND ORIGINAL OF THIS FORM TO:

INSURANCE LOSS PROPERTY DAMAGE SUMMARY

CLAIM #:________________

DEPARTMENT :_______________________________

CONTACT PERSON :_______________________________

DEPT. ADDRESS : _______________________________ EXT.:____________

DEPT. SIGNATURE: _____________________________________

STATE PROPERTY

Description of equipment, materials, and/or supplies damaged:

SPECIAL NOTE: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company.