| Risk Management |
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 Request for Certificate of
Insurance for University
employees and affiliates |
This form must be completed to receive a certificate of insurance from Risk Management when the Memorandum of Insurance is insufficient. Please fill out completely and return by fax or submit by email. Requests typically take 3-5 business days to process.
(NOT FOR FILM STUDENTS) |
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Property Loss/Damage Claim
Reporting form |
The Property Loss/Damage Claim form should be completed for occurrences involving loss or damage to University owned or leased property. Departments should document loss immediately and must report losses to Risk Management within 48 hours. Please document loss with photographs and police report. |
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| Vehicle Accident Report |
ALL MOTOR VEHICLE ACCIDENTS involving a Columbia University vehicle or employee travelling on University business must submit a completed form to Risk Mgmt within 24 hours of the incident. Submission should include photos of damage and police report (when available). |
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MV-104
(Component of Columbia
University accident reporting
procedures) |
This form must be completed and submitted to Risk Mgmt when a motor vehicle, boat, or trailer is involved in an accident in New York State. If the accident involves an injury or property damage over $1,000, the completed form must also be sent to the NYS DMV. |
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| New Vehicle Acquisition |
This form must be completed when a new motor vehicle, boat, or trailer is added to the Columbia University inventory through purchase, lease, or other transfer.
(You do not need to request a Vehicle Insur. ID card) |
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Duplicate Vehicle Insurance ID
Card Request
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Complete this form to request a lost or damaged proof of insurance for a motor vehicle, boat, or trailer. |
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| Vehicle Information Change |
This form must be completed when there is a major change in the status or information regarding motor vehicle, boat, or trailer; for example, when a new contact person begins handling a department's vehicle coordination or if there is a new account to charge for insurance premiums. |
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| Vehicle Disposal Report |
This form must be completed when a motor vehicle, boat, or trailer is transferred to another department, sold, or otherwise removed from Columbia University inventory. |
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FILM DIVISION FORMS
Initial film project declaration
Statement of Responsibility
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This form is for students in the Graduate Film Division at Columbia University's School of the Arts who are working on an authorized school film. A completely and executed form must be received by Risk Management before requests will be processed.
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Enrollment application for
Workers Compensation
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This form is for students in the Graduate Film Division at Columbia University's School of the Arts who are working on an authorized school film and wish to report cast, crew, and/or volunteers for Workers Compensation during the production.
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Certificate of Insurance
Request: Film Equipment
Rentals
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This form is for students in the Graduate Film Division at Columbia University's School of the Arts who are working on an authorized school film and wish to request insurance coverage for equipment that is rented, borrowed or loaned. |
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EXAMPLE of backup
information needed for film
equipment rentals from a
private party
(i.e. an individual) |
This form is an example of what a student in the Graduate Film Program at Columbia University's School of the Arts working on an authorized school film must provide if s/he wishes to request insurance coverage for equipment borrowed or loaned from an individual (not business). |
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Certificate of Insurance
Request: Location |
This form is for students in the Graduate Film Program at Columbia University's School of the Arts who are working on an authorized school film and wish to request General Liability insurance coverage for non-Columbia University owned location(s). |
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EXAMPLE of completed
Request for Certificate of
Location Insurance
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This form is an example of what a student in the Graduate Film Program at Columbia University's School of the Arts working on an authorized school film must provide if s/he wishes to request insurance coverage for locations where the production will shoot. |
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