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( 88|T0? +"///////$1h4j/u$$$/44e0;*;*;*$d48/;*$/;*;*,lb- P!h [%p:-n.\{000N-o4% o4(b-o4b- ##Lo#6;*#,#&######//)d######0$$$$ 444444 Your Agency:  FORMTEXT      Lease Number: FORMTEXT      Check One:  FORMCHECKBOX New Lease  FORMCHECKBOX Renewal Lease  FORMCHECKBOX Other - Describe:  FORMTEXT      Agency Contact Name: FORMTEXT      Contact Phone: FORMTEXT      Contact E-mail: FORMTEXT      Contact Fax:  FORMTEXT      Exact Street Address of leased premise :  FORMTEXT      Town:  FORMTEXT      Zip Code FORMTEXT       Check the type of construction that best describes the building:  FORMCHECKBOX  (1) Combustible (typically wooden buildings) FORMCHECKBOX  (2) Masonry structures with combustible frames or interiors FORMCHECKBOX  (3) Metal structures (all metal roof, frame and walls) FORMCHECKBOX  (4) Masonry structures with masonry or metal framing FORMCHECKBOX  (5) Buildings with a 1 to 2 hour fire resistive rating FORMCHECKBOX  (6) Buildings with a 2 or more hour fire resistive rating Year of construction of building (if known or best guess):  FORMTEXT       Number of floors (do not count unfinished basement and attic)  FORMTEXT       Is there an unfinished basement?  FORMCHECKBOX Yes  FORMCHECKBOX No Is there an unfinished attic?  FORMCHECKBOX Yes  FORMCHECKBOX No Approximate total area of building - do not include unfinished basement or attic:  FORMTEXT       sq. feet Of the total area, approximate area that your agency occupies with this lease:  FORMTEXT       sq. feet Number of elevators in building:  FORMTEXT       Does building have central air conditioning?  FORMCHECKBOX Yes  FORMCHECKBOX No If your agency does not occupy 100% of the useable space in this building, this section must be completed. Building Occupancy Type(s) - check as many as are applicable for this building:  FORMCHECKBOX Auditorium (18);  FORMCHECKBOX Classroom (2);  FORMCHECKBOX Day Care (33);  FORMCHECKBOX Dormitory (10);  FORMCHECKBOX Gym (12);  FORMCHECKBOX Laboratory (5);  FORMCHECKBOX Maintenance Shop (6);  FORMCHECKBOX Office (1);  FORMCHECKBOX Retail (29);  FORMCHECKBOX Staff Residence (11);  FORMCHECKBOX Storage (3);  FORMCHECKBOX Other - Describe:  FORMTEXT       Your agency s occupancy type (check one - only the most prevalent):  FORMCHECKBOX Auditorium (18);  FORMCHECKBOX Classroom (2);  FORMCHECKBOX Day Care (33);  FORMCHECKBOX Dormitory (10);  FORMCHECKBOX Gym (12);  FORMCHECKBOX L246@B`bvxz < > @ P v x   & ĐjXh-HUhRj1h-HUhjjh-HUjIh-HUjh-HUhCjth-HUjhkDUmHnHujh-HUhkDjhkDUh2h_2D`v Ukd$$Ifl\F?"*rj t 6P+644 la$$&P#$/Ifa$gdQ$&P#$/IfgdDEFF  8 $&P#$/Ifgd]kd$$Ifl0*$ t 6P+644 la& ( * 4 6 : Z \ p r t ~    4 6 8 B D F P T V j l n x z Ҽָҟ츛Ґ҅츁hjh-HUj|h-HUh Kjh-HUjh&0JUh{h&jh-HUj-h-HUhkDh hRjhkDUmHnHujhkDUjh-HU18 : Z |jjjj$&P#$/Ifgdkd@$$Ifl\T u * !  t 6P+644 la  F T | |jjjjjj$&P#$/Ifgdkd$$Ifl\u *  t 6P+644 la  ^ VTTTKK $IfgdkDkdh $$Iflֈu?"'*_k t 6P+644 la    . / 0 1 ] ^ _ m n o p     < > ? M N O P ߳ߡߏ}k#j hkDh-HCJUaJ#jC hkDh-HCJUaJ#j] hkDh-HCJUaJ#j hkDh-HCJUaJ#j hkDh-HCJUaJhDR;CJaJ#j hkDh-HCJUaJhkDCJaJjhkDCJUaJ hDR;>*hDR;hA* = > jEkd $$Ifl0n(r4 lal $IfgdkDEkdw $$Ifl0n(r4 lal "68:DFJ02NPRX^`b~ʺҨߤʔҨߤnjX#jhIh,#OJQJUhQ#jhIh,#OJQJUhIOJQJjhIOJQJUjhQ#hQ#>*Uh!#jhQ#hQ#>*UmHnHujhQ#hQ#>*UhQ#hQ#>*jhQ#hQ#>*UhDR;hDR;CJaJhkDCJaJjhkDCJUaJ J(><t===.?Ekd+$$Ifl0n(r4 lal "(@J *Zbyrn^yjhQ#h8>*Uh~ h8h8#jhQ#h8>*ԱQ#8>*Q#8>*Q#8>*!ٸ;>*ٸ;#,#ϴ#,#ϴϴϴ!$$&:<>HJP>?MNOa}rn}\ThDR;CJaJ#jh"|h-HOJQJUhEhEhECJaJhDR;#j/h"|h-HOJQJUhQ#jh"|h-HOJQJUh"|OJQJjh"|OJQJUhizh/#jhQ#hiz>*UmHnHujEhQ#hiz>*UhQ#hiz>*jhQ#hiz>*Uh! abpqr'ŽѧŽѧŽѧŽqŽ_Y hDR;CJ#jih4Dh-HOJQJU#jh4Dh-HOJQJU#j}h4Dh-HOJQJU#jh4Dh-HOJQJUhDR;#jh4Dh-HOJQJUh4DOJQJjh4DOJQJUhDR;CJaJ#jh"|h-HOJQJUh"|OJQJjh"|OJQJU"'()789DEFTUVeftuv~to_tj-h4Dh-H>*U h4D>*jh4D>*UhjCJaJ#jh4Dh-HOJQJU#jAh4Dh-HOJQJU#jh4Dh-HOJQJU#jUh4Dh-HOJQJUhDR;CJaJ#jh4Dh-HOJQJUh4DOJQJjh4DOJQJUhDR;!  &*>H ">@B^`b~{i#jhKh-HOJQJU#jhKh-HOJQJU#jhKh-HOJQJUhDR;CJaJ#jhKh-HOJQJUhKOJQJjhKOJQJUh~hDR;hizh~>*h4D hDR;>*4>*4>*Ա"<< <<<><@<B<j<l<n<<<<<<<<<<<<===6=8=T=ͻٹͧ͏}k#jhKh-HOJQJU#jShKh-HOJQJU#jhKh-HOJQJU hDR;CJ#jghKh-HOJQJUU#jhKh-HOJQJUhKOJQJhDR;hDR;CJaJjhKOJQJU#j{hKh-HOJQJU$aboratory (5);  FORMCHECKBOX Maintenance Shop (6);  FORMCHECKBOX Office (1);  FORMCHECKBOX Retail (29);  FORMCHECKBOX Staff Residence (11);  FORMCHECKBOX Storage (3);  FORMCHECKBOX Other - Describe:  FORMTEXT       Building is:  FORMCHECKBOX 100% Sprinklered  FORMCHECKBOX Partially Sprinklered  state %  FORMTEXT        FORMCHECKBOX Not sprinklered at all Building has a central station smoke detection system:  FORMCHECKBOX Yes  FORMCHECKBOX No Building has a central station security system:  FORMCHECKBOX Yes  FORMCHECKBOX No Building has an employee key card system:  FORMCHECKBOX Yes  FORMCHECKBOX No Replacement cost insurance desired: Contents $  FORMTEXT       Effective Date:  FORMTEXT       Questions? Call 287-3353. Either fax this form to 287-4008 or mail it to: State of Maine, Risk Management Division, 85 State House Station, Augusta, ME 04333-0085 FOR RISK MANAGEMENT DIVISION USE ONLYINSPBY:INSPDATE:  Post office boxes and rural route numbers are unacceptable. We need the 911 address assigned by the municipality in question.     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O _ w   4 @ F K [  ! 1 c s { 1FFG G G FFFFFFFFG G G G G G FFG G G G FFFG G G G G G G G G G G G G G FG G G G G G G G G G G G FG G FG G G G G G G FF8@0(  B S  ?1=Text5Text6Check1Check2Check3Text7Text8Text9Text10Text11Text12Text13Text14Check4Check7Check5Check8Check6Check9Check45Check46Check47Check48Check10Check11Check12Check13Check14Check15Check16Check17Check18Check19Check20Check21Check22Check23Text15Check24Check25Check26Check27Check28Check29Check30Check31Check32Check33Check34Check35Text16Check36Check37Text17Check38Check39Check40Check41Check42Check43Check441Rn .P _?Vo?b)Ff) L m  0 P x  4 L " d | 2  !"#$%&'()*+,-./0123456789:;<!Cb@b0oOfOr9Vv9 \ } # @ `  G \  2 t 20l( 1lrB2l<8E3l|7E4l|P 2U 2>*urn:schemas-microsoft-com:office:smarttags PostalCode8*urn:schemas-microsoft-com:office:smarttagsCity9*urn:schemas-microsoft-com:office:smarttagsState9*urn:schemas-microsoft-com:office:smarttagsplace tm  __aabbdeghjk-.2  __aabbdeghjk-.23!"0CQbn-@AOb0^o>OUfn>Oar(9EVev( 9 K \ l }  # / @ O ` w   4 G K \  ! 2 c t { D ]__aabbdeghjk!+-.2 __aabbdeghjk-.2XDfXDf 9XDf[9 vEE=XDfvn@XDf)SuXDf@hh^h`CJOJQJo(o@hh^h`CJOJQJo(o@hh^h`CJOJQJo(o@CJOJQJo(@hh^h`CJOJQJo(o@hh^h`CJOJQJo(o@hh^h`CJOJQJo(ovn@ 9EE=)Su[9=<E$M58NZ &i-Hs4k,#Q#1(/S/, 6:DR;S?B4DkDbWG KQlq"|&{7mOj(f:_]o*b/ ^I;t4DCizKRAD2!~#"0DE-AOcd^=> 2@  p 1`` `@````(@``<UnknownGz Times New Roman5Symbol3& z Arial;Wingdings"1h:F"f&& '  #Z4d 2QHX?!2 Your Agency: Patricia HaydenPPH(       Oh+'0  $ D P \ ht|Your Agency: Patricia Hayden Normal.dotPPH11Microsoft Office Word@r@~@Om#@p*h  ՜.+,0 hp  (State of fb88 Risk Management Division ' Your Agency: Title  !"#$%&'()*+,./0123456789:;<=>?@BCDEFGHIJKLMNOPQRSTUVWXYZ[]^_`abcefghijknRoot Entry F@&h pData -&1TableA4WordDocument8XSummaryInformation(\DocumentSummaryInformation8dCompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89qRoot Entry F`Jyh vData -&1TableA4WordDocument8X  !"#$%&'()*+,./0123456789:;<=>?@BCDEFGHIJKLMNOPQRSTUVWXYZ[]^_`abcut 4<H_AdHocReviewCycleID_NewReviewCycle_EmailSubject _AuthorEmail_AuthorEmailDisplayName 2*Please post revised forms on our web sitePatricia.Hayden@maine.govHayden, PatriciaSummaryInformation(\DocumentSummaryInformation8hCompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q՜.+,D՜.+,\ hp  (State of fb88 Risk Management Division ' Your Agency: Title H$,