DEPARTMENT OF FINANCIAL SERVICES
Division of Risk Management
REPLACEMENT VALUE COMPUTATION
BUILDING CONTENTS
Agency Name:
______________________
Policy Number: ___________________
Insured Address:
______________________
Building Number: __________________
______________________________________________________________________________
Replacement Value – NON- Inventoried Contents Under $500
See Paragraph A, Contents Inventoried Instructions
A.
Section A-1
Inventoried Value
x
125% =
(factor)
______________________
Amount of Coverage
Replacement Value – NON- Inventoried Contents Under $ 500
B.
Section B-2
-
Number of Positions
x
________ =
(factor*)
_________
Section B-3
-
Number of Positions
x
________ =
(factor*)
_________
Section B-4.1
-
Number of Cells
x
= _______________
(value*)
Section B-4.2
-
Number of Bedrooms
x
= _______________
(value*)
Section B-4.3
-
Food Service Furnishing/Equipment
Section B-4.4
-
Number of CRT’s
= _______________
x
= _______________
(cost)
Section B-4.5
-
Other
=
____________________
Section B- 4.6 -
Other
=
____________________
Section B- 4.7 -
Other
=
____________________
Section B- 4.8 -
Other
=
____________________
Total B-2, B-3 and B-4
$
____________________
Total Inventory Over $500
$
____________________
Total of All Inventory-Amount for Coverage by
the Fund
$
____________________
Completed By:
____________________
Title:
____________________
*Factors and values are determined by the Budget Office of each agency.
DFS-D0-851
Revised 8/09
Rule 69H-1.003
Page 1 of 2
The Replacement Value Computation - Building Contents form is to be completed on each location where contents values are
reported for coverage. You will use either Section A or Section B, but not both.
A.
If you have a complete contents inventory based on acquisition costs by 25% ONLY on that part of your inventory
consisting of individual items having acquisition costs of under $500. This Computation will reflect the increase in value
from acquisition cost to replacement cost.
B.
If you chose the alternate method of evaluation for contents with a value of under $500, you will use Section B. Section
B is designed to give considerable flexibility in reporting so you should complete only those items that apply to your
operation at that individual location.
This form is to be completed in its entirety and mailed to:
Department of Financial Services
Division of Risk Management
Bureau of Loss Prevention
Larson Building
200 East Gaines Street
Tallahassee, Florida 32399-0337
DFS-D0-851
Revised 8/09
Rule 69H-1.003
Page 2 of 2