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County Technical Services, Inc.
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January 7, 1993
TO: CAPP Designated Correspondents
FROM: Louella Casias, Technical Assistant
RE: CAPP Service Providers
Please make the following corrections to your files:
Requests for Certificates of Insurance (form enclosed) should be directed to:
Rollins Hudig Hall
2180 South 1300 East, Suite 500
Post Office Box 526259
Salt Lake City, Utah 84152-6259
1/800-759-2001
FAX 801/488-2559
Vehicle Additions and Deletions (form enclosed) should be directed to:
Rollins Hudig Hall
2180 South 1300 East, Suite 500
Post Office Box 526259
Salt Lake City, Utah 84152-6259
1/800-759-2001
FAX 801/488-2559
Building and/or Contents Changes (form enclosed) should be directed to:
County Technical Services, Inc.
1177 Grant Street, Suite 200
Denver CO 80203
303/861-0507
FAX 303/861-2832
Questions concerning coverage, contributions, loss prevention, and general administration
should be directed to:
County Technical Services, Inc.
1177 Grant Street, Suite 200
Denver CO 80203
303/861-0507
FAX 303/861-2832
Questions concerning claims should be directed to:
Rollins Technical Services, inc.
1177 Grant Street,Suite 203
Denver CO 80203
1/800-544-7868
FAX 303/861-1022
Please contact me with any questions concerning this or any other CAPP matter
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1177 Grant Street, Suite 200 • Denver, Colorado 80203 • (303) 861-0507 • Fax (303) 861-2832
COLORADO COUNTIES CASUALTY AND PROPERTY POOL
BUILDING AND/OR CONTENTS CHANGE FORM
All information must be included to process this form. Use separate form for each building.
County: Date:
Location Address:
Type of Building:
(primary use)
Construction of Building:
(frame, masonry, brick, metal, etc.)
Square Footage: Average Height:
Number of Stories: Year Built:
Type of Heating/Cooling: Sprinklers: YES NO
Elevators: YES NO Number of Elevators:
Other Protective Safeguards:
Value of Contents: $
Mortgagee Loss Payee
Return form to:
Louella Casias
Casualty and Property Pool
1177 Grant Street, Suite 200
Denver, CO 80203
303/861-0507
FAX 303/861-2832
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COLORADO COUNTIES CASUALTY AND PROPERTY POOL
• CERTIFICATE OF INSURANCE REQUEST FORM
County:
Date of Request: Date Needed:
Coverage Requested (i.e. Property, General Liability, Automobile Liability, Automobile
Physical Damage):
Special Provisions to be shown on Certificate (i.e. Fair, Property Address, Description of
Vehicle and/or Mobile Equipment)
Loss Payee / Additional Insured / Mortgagee (circle which one's applicable):
Requested By:
Name and Phone Number
Return Form to:
Jess Hurtado
Rollins Hudig Hall of Utah
2180 South 1300 East, Suite 500
Post Office Box 526259
Salt Lake City, Utah 84152.6259
11-6
COLORADO COUNTIES CASUALTY AND PROPERTY POOL
VEHICLE OR MOBILE EQUIPMENT CHANGE FORM
All information must be included to process this form. Use separate form for each unit.
County:
Date of Request:
ADD DELETE
Vehicle Mobile Equipment
Description of Unit (i.e. heavy truck, automobile, bus, van, motor grader, compressor, etc.)
Year
Make
Model
Serial Number/VIN
Actual Cash Value
Loss Payee Additional Insured
Return Form to:
Jess Hurtado
Rollins Hudig Hall of Utah
2180 South 1300 East, Suite 500
Post Office Box 526259
Salt Lake City, Utah 84152-6259
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