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INFORMATION REQUIRED TO INSURE RADIO TOWERS AND EQUIPMENT NORTH DAKOTA INSURANCE DEPARTMENT FIRE & TORNADO FUND SFN[removed]Complete one form for each tower location and attach photo of exterior items. If buildin
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Document Date: 2012-01-30 16:32:47

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File Size: 197,55 KB

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City

Ave. Bismarck / /

Currency

USD / /

Event

Natural Disaster / Man-Made Disaster / /

Facility

Policyholder Owned Self-Supporting Tower / If building / Building Application / Tower Replacement Cost Value / /

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Organization

Costs City Signature Date North Dakota Insurance Department / /

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ProvinceOrState

North Dakota / /

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