State of Wisconsin - Report of Shipment Request for Marine Insurance Coverage
BSRM Ref #
Agency/Institution
*
select
Administration, Department of
Aging & Long Term Care, Board of
Agriculture, Trade & Consumer Protection, Dept of
Arts Board
Child Abuse and Neglect Prevention Board
Commerce, Department of
Commissioners of Public Lands, Board of
Conservation Corps
Corrections, Department of
Credit Unions, Office of
District Attorneys, Dept of
Educational Communications Board
Educational Technology Board
Elections Board
Employee Trust Funds, Department of
Employment Relations Commission
Employment Relations, Office of State
Ethics Board, State
Financial Institutions, Department of
Government Accountability Board
Health and Family Services, Department of
Hearings and Appeals, Div of
Higher Educational Aids Board
Historical Society, Wisconsin
Investment and Local Impact Fund Board
Investment Board, State of Wisconsin
Judicial Commission
Judicial Council
Justice Assistance, Office of
Justice, Department of
Labor And Industry Review Commission
Land Information Board
Legislative Audit Bureau
Legislative Fiscal Bureau
Legislative Reference Bureau
Legislative Technology Services Bureau
Lower Wisconsin State Riverway Board
Military Affairs, Department of
National Community Services Board
Natural Resources, Department of
Office of The Lieutenant Govnr
Organization Test, Ben
Public Defender, Office of State
Public Instruction, Department of
Public Service Commission
Recycling Market Development Board
Regulation and Licensing, Department of
Revenue, Department of
Secretary of State, Office of the
Sentencing Commission
State Employment Relations, Office of
State Fair Park
State Treasurer, Office of
Statewide Utilization
Statutes Bureau, Revisor of
Tax Appeals Commission
Technology Educ Achievement Board
Tourism, Department of
Town of Delavan
Transportation, Comm of
Transportation, Department of
Trust Lands & Investment, Division of
UW Colleges
UW Eau Claire
UW Extension
UW Green Bay
UW Hospitals And Clinics
UW La Crosse
UW Madison
UW Milwaukee
UW Oshkosh
UW Parkside
UW Platteville
UW River Falls
UW Stevens Point
UW Stout
UW Superior
UW System Admin
UW Whitewater
UWC - Baraboo-Sauk County
UWC - Barron County
UWC - Fond Du Lac
UWC - Manitowoc County
UWC - Marathon County
UWC - Marinette County
UWC - Marshfield-Wood County
UWC - Richland County
UWC - Rock County
UWC - Sheboygan County
UWC - Washington County
UWC - Waukesha County
Veterans Affairs, Department of
Waste Facility Siting Board
Wisconsin Legislative Council
Wisconsin Legislature
Wisconsin Supreme Court
Wisconsin Technical College System Board
Women's Council
Workforce Development, Department of
State or University Owned Property
Yes
No
Department
*
Contact
*
Project
*
Phone
*
Declared Value
*
Shipment Destination
*
Property Description
1st Conveyance Carrier Information
Name of Carrier
*
Phone
*
Role
*
Vendor
Carrier
Broker
Forwarder
Earliest Departure Date
*
RadDatePicker
RadDatePicker
Open the calendar popup.
Calendar
Title and navigation
Title and navigation
<<
<
April 2024
>
<<
April 2024
S
M
T
W
T
F
S
14
31
1
2
3
4
5
6
15
7
8
9
10
11
12
13
16
14
15
16
17
18
19
20
17
21
22
23
24
25
26
27
18
28
29
30
1
2
3
4
19
5
6
7
8
9
10
11
Latest Departure Date
*
RadDatePicker
RadDatePicker
Open the calendar popup.
Calendar
Title and navigation
Title and navigation
<<
<
April 2024
>
<<
April 2024
S
M
T
W
T
F
S
14
31
1
2
3
4
5
6
15
7
8
9
10
11
12
13
16
14
15
16
17
18
19
20
17
21
22
23
24
25
26
27
18
28
29
30
1
2
3
4
19
5
6
7
8
9
10
11
1st Departure Point
*
Method of Transport
*
Air
Ship
Truck
Rail
Other
ADD ANOTHER CARRIER
Requesting Property Coverage at Destination? :
*
Yes
No
Coverage Date From :
*
RadDatePicker
RadDatePicker
Open the calendar popup.
Calendar
Title and navigation
Title and navigation
<<
<
April 2024
>
<<
April 2024
S
M
T
W
T
F
S
14
31
1
2
3
4
5
6
15
7
8
9
10
11
12
13
16
14
15
16
17
18
19
20
17
21
22
23
24
25
26
27
18
28
29
30
1
2
3
4
19
5
6
7
8
9
10
11
Coverage Date To :
*
RadDatePicker
RadDatePicker
Open the calendar popup.
Calendar
Title and navigation
Title and navigation
<<
<
April 2024
>
<<
April 2024
S
M
T
W
T
F
S
14
31
1
2
3
4
5
6
15
7
8
9
10
11
12
13
16
14
15
16
17
18
19
20
17
21
22
23
24
25
26
27
18
28
29
30
1
2
3
4
19
5
6
7
8
9
10
11
Location :
*
Who is your Risk Management Contact?
*
select
ADMINISTRATION - ANDREW EISLER
ADMINISTRATION - Bradley Templin
ADMINISTRATION - DAWN RINGELSTETTER
ADMINISTRATION - Shari Hillery
AGRICULTURE (DATCP) - LISA BRODERICK
CHILDREN & FAMILY SERVICES - TROY SYVERUD
CIRCUS WORLD - SCOTT MAU
CORRECTIONS - TRACIE NINEDORF
DFI - DAWN OASHGAR
DHS - BRENDA CLIFTON
DNR - SIERRA STORKEL
DOJ - JODI GORSKI
DOT - TRENT RITZENTHALER
DPI - MICHELE MCGAFFIN
DWD - KAREN MOORE
ECB - JEFFREY OHNSTAD
ELECTIONS - SHARRIE HAUGE
ETF - MIKEY JARLSBERG
MILITARY AFFAIRS - JESSICA WAGNER
PUBLIC DEFENDER - TERI TOBIAS
REVENUE - LAURIE GRAMS
SAFETY & PROFESSIONAL SERVICES - BRIAN BELL
STATE FAIR PARK - ADAM HEFFRON
STATE HISTORICAL SOCIETY - SCOTT MAU
SWIB - PAIGE EMMRICH
TOURISM - ANNE SAYERS
TREASURER - JOHN LEIBER
UW EAU CLAIRE / BARRON COUNTY - BRIAN DROLLINGER
UW GREEN BAY / MANITOWOC, MARINETTE AND SHEBOYGAN - CHRIS PAQUET
UW LACROSSE - SPENCER GREEN
UW MADISON / COOP EXTENSION, WI PUBLIC MEDIA AND CONF CTRS - UW MADISON RISK MANAGEMENT
UW MILWAUKEE / WASHINGTON CO AND WAUKESHA - JIM OLSON
UW OSHKOSH / FOND DU LAC AND FOX VALLEY - MICHELLE BOGDEN MUETZEL
UW PARKSIDE - BOB GRIESHABER
UW PLATTEVILLE / BARABOO SAUK COUNTY AND RICHLAND CO - CHASE ROSSNER
UW RIVER FALLS - JEANNA HAYES
UW STEVENS POINT / MARSHFIELD AND WAUSAU - MELISSA VERGARA
UW STOUT - JIM UHLIR
UW SUPERIOR - JEFF KAHLER
UW SYSTEM DIRECTOR / EXTENDED CAMPUS - ANGELA RYAN
UW WHITEWATER / ROCK COUNTY - LANCE FREDRICK
VETERANS AFFAIRS - AL HOFFMANN
WERC - ELENA LUGO
Who Else Should Receive a Copy of this Request?
Verification Text:
*
Page not valid. The code you entered is not valid
Type the code from the image