THE FLORIDA ADVISORY COMMITTEE ON ARSON PREVENTION
SPECIFIC REWARD FUND CONTRIBUTION
The sum of ____________________________________________________________________
(______________) is hereby contributed to the Florida Advisory Committee on Arson Prevention for the creation of a Specific Reward Fund to be used for information leading to the identification, arrest, or conviction of the person(s) responsible for the fire incident identified below. This fund shall remain available until distributed in full by the Florida Advisory Committee on Arson Prevention, Reward Committee, or until this reward offer is revoked in writing.
| Location of Fire: ___________________________________
|
Date of Fire: _____/________/______
Time of Fire: _________ A.M. / P.M. |
Property Owners: ___________________________________ ___________________________________ ___________________________________ |
Law Enforcement Agency Involved: ___________________________________ ___________________________________ |
Insurance Company Name & Mailing Info: ____________________________________ ____________________________________ ____________________________________ ____________________________________ |
Claim Rep:/ Contact Name: (1st) ___________________________________ Contact Phone No.(_______) ___________ |
Claim No.:___________________________ Policy No.:___________________________ |
Claim Rep:/ Contact Name (2nd) ____________________________________ Contact (2nd) Ph. No.(_____) ____________ |
Submitted By:
Name (Printed): _____________________________________
Name (Signature):______________________________________
Date: _______/_______/_______
Check No.: __________________
Send To: FACAP Rewards Committee
C/O Gerald T. Albrecht, Chairman, FACAP Rewards Committee; One Harbour Place,
777 Harbour Island Blvd., Suite 500 Tampa, FL 33602
Telephone: (813)281-1900;
Fax: (813)281-0900
e-mail: galbrecht@butlerpappas.com .