Forms

This form is used to apply, change, remove, or reapply for coverage to participate in the Fire Department Insurance Program. Coverage begins when SRM approves the application. The review may include a physical inspection of the property, vehicles, and related records.

This form is uses to report any additions, deletions, or changes to building and/or contents covered by the property program. Make sure all items on form are complete.

This form is used to add, delete, or change a vehicle or vehicle equipment coverage listed under the APD program. When adding a vehicle, include proof of ownership.

This form is used to report any additions, deletions, or changes to vehicles listed under the liability program.

This form is used to add or delete Team Members. Team Members include members, officials, board members, dispatchers or volunteers of the organization acting in good faith within the duties or tasks lawfully assigned by the authority of the Fire Chief or other competent authority.

This form is used to report damage to the fire department’s property or vehicle in the event of a loss. A deductible will apply to this type of loss.

Keep the incident form with incident card in glovebox of all fire department vehicles. Review instructions to complete all steps. Submit incident form to SRM.

This form is used to describe what happened during the accident. There are different SLIR’s for different incident types: Vehicle & Other Property, Personal/Bodily Injury, and Employment Incidents.

This form is used to describe what happened during the accident. There are different SLIR’s for different incident types: Vehicle & Other Property, Personal/Bodily Injury, and Employment Incidents.

This form is used to describe what happened during the accident. There are different SLIR’s for different incident types: Vehicle & Other Property, Personal/Bodily Injury, and Employment Incidents.

This form is used to describe what job duty was being performed by the fire member at the time of the incident.

Keep the incident card with the FDIP incident form in the glovebox of all fire department vehicles. Give the card to the other driver in case of an incident so they can contact SRM with questions on how to file a claim. 

The contact form is added to the fire department file. This allows the FDIP to mail, call, email billing, survey and provide other program notices that require correspondence.

The contact form is to obtain all new fire chiefs' information and update new addresses, phone numbers, email addresses and alternate contact information. The form can be completed by any appointed administrator for the fire department.

The fire chief is to approve, sign and date all forms submitted to request vehicle, team member, address and email changes. 

This form is used to add, delete or change watercraft coverage listed in the WPD program