Risk Management Equipment Change Form First Name of Requester * Last Name of Requester * Requester Email Address * County/Entity Name * Effective Date of Change * Equipment Choose One * New Change Delete Equipment Description * ID Number Year Manufacturer Model Value of Equipment plus1 Add Item minus1 Remove Item Department Name Special Instructions More Information For more information contact Underwriting at (919) 719-1170 or email [email protected]. The County/Entity will receive an endorsement as confirmation of all changes. Enter email address to receive an email copy of this form If you are human, leave this field blank. Submit
