RISK MANAGEMENT 
REQUEST TO ADD INSURANCE -NON VEHICLE
*liability insurance is required for state various equipment https://legislature.maine.gov/statutes/14/title14sec8104-A.html

AGENCY:                             
ASSET:                             
YEAR:                                   
MAKE:                                  
MODEL:                               
VIN:                                       
COST NEW (not purchase price):                         
OWNED OR LEASED?                                              
INTENDED USE?                                                       
DESIRED EFFECTIVE DATE:                                     
**PHYSICAL DAMAGE COVERAGE Y or N?       
Person requesting insurance                             
Phone #                       Email                           
**physical damage insurance is optional; cost varies by asset/type

Questions? Call us 287-3351
Fax (287-4008) or email this form to 
       Jen Maddox Jen.Maddox@maine.gov