Risk Management Vehicle Change Form First Name of Requester * Last Name of Requester * Requester Email Address * County/Entity Name * Effective Date of Change * Vehicle Choose One * Add Delete Existing Choose One * Liability & Physical Damage Liability Only Year * Manufacturer/Make * Model * Vehicle Identification No. (VIN) * Number of Passengers If this is a passenger transportation vehicle. For Ambulances and Fire Trucks Only If Replacement Cost coverage is desired, please indicate the Replacement Cost of the vehicle being added (4 years old or newer). plus1 Add Vehicle minus1 Remove Vehicle Department Name Special Instructions More Information For more information contact Underwriting at (919) 719-1170 or email [email protected]. Enter email address to receive an email copy of this form Submit