Wisconsin Department of Administration                                                                                             Page 1 of 2
        Bureau of State Risk Management
        DOA-6084 (R07/2018)
        s. 16.865, Wis. Stats.
                                          Fiscal Year 2019 Property Value Inventory Summary
        Agency Name                                               Name of Person Completing Report
        Institution, Campus, Site       Address                              Phone                    Report Date (mm/dd/ccyy)
        Capital Content Level
                                                                                                                                      Total Value
        Fire Resistive (FIRE RESTV)
              Building                                                                                                         $ 
              Capital Contents                                                                                                 $ 
              Non-Capital Contents                                                                                             $ 
        Total Fire Resistive                                                                                                    $                                -   
        Ordinary Construction (ORD CONSTR) 
              Building                                                                                                         $ 
              Capital Contents                                                                                                 $ 
              Non-Capital Contents                                                                                             $ 
        Total Ordinary Construction                                                                                             $                                -   
        Frame Construction (FRAME CONSTR) 
              Building                                                                                                         $ 
              Capital Contents                                                                                                 $ 
              Non-Capital Contents                                                                                             $ 
        Total Frame Construction                                                                                                $                                -   
        Total Building Values                                                                                                  $ 
        Total Content Values                                                                                                   $ 
        Total Inland Marine*                                                                                                   $ 
            Property in the Open (INLAND MARINE PIO)                                                                           $ 
            Technical/Testing Equipment (INLAND TECHNICAL EQUIP)                                                               $ 
            Inland Marine Property (INLAND MARINE PROP)                                                                        $ 
           Contractors Equipment (INLAND CONTRACTRS EQUIP)                                                                     $ 
        Total Building, Content and Property in the Open                                                                        $                                -   
        Vehicle Comprehensive (VEHICLE COMP)                                                                                   $ 
        Vehicle Collision (VEHICLE COMP+COLL)                                                                                  $ 
        Total Vehicle                                                                                                           $                                -   
        *Inland Marine Definitions:
        Property in the Open (INLAND MARINE PIO): Property that is normally outside, permanent or semi permanent, and is not a 
        building.  Examples: Towers, Antennas, Pond Linings, Play Ground Equip, Storage Tanks, etc…
        Technical/Testing Equipment (INLAND TECHNICAL EQUIP): Mobile equipment used for montioring and testing. Examples: 
        Sensors, Transmitters, Samplers, Specialty Mobile Lab Equipment, etc…
        Inland Marine Property (INLAND MARINE PROP): Property that leaves the premise. Examples: Snowmobiles, ATVs, Boats, 
        Detached Snow Plows, Portable Tanks, Lawnmowers, Firearms, etc…
        Contractor's Equipment (INLAND CONTRACTRS EQUIP): Property that leaves the premise and is used for 
        maintenance/construction.  Examples: Excavation equip., Tools, Portable Welders, etc…
      DOA-6084 (R07/2018) pg 2 of 2
                                                                                             Total Value
      Fine Arts & Special Collectibles                                                        $ 
                                                                                             Total Value
      Business Interruption                                                                   $ 
      In the spaces below, please identify specialized vehicles with high equipment values (greater than $100,000); for 
      example, television trucks, mobile science labs, etc.
      Specialty Equipment 1
      Fleet Number            Year     Make & Model      Purchase Price    Replacement Cost  Equipment Value
      Purpose:
      Specialty Equipment 2
      Fleet Number            Year     Make & Model      Purchase Price    Replacement Cost  Equipment Value
      Purpose:
      Specialty Equipment 3
      Fleet Number            Year     Make & Model      Purchase Price    Replacement Cost  Equipment Value
      Purpose:
      Specialty Equipment 4
      Fleet Number            Year     Make & Model      Purchase Price    Replacement Cost  Equipment Value
      Purpose:
      Specialty Equipment 5
      Fleet Number            Year     Make & Model      Purchase Price    Replacement Cost  Equipment Value
      Purpose:
                         Send completed form by September 19, 2018 to: bradley.templin@wisconsin.gov