Insurance Rate: $.86 per $100 value / Deductible $250.00 / World-wide Coverage
revised 7/6/2006
EQUIPMENT FLOATER
e-mail:
gashley@binghamton.edu
or FAX to:
607-777-4354
Date Received for Coverage:
Site Number:
020
Project:
Task:
Award:
Expenditure Type:
Organization:
Alternate Account (if necessary):
Project:
Task:
Award:
Expenditure Type:
GNS Insurance Equipment
Organization:
Customer:
Project Manager:
Equipment Type:
Brand Name:
Description:
Model Number:
Serial Number:
Decal Number:
Value:
P.O. Number:
Location:
Insurance Start Date:
Insurance End Date:
Your Name and Phone Number:
Notes: