Revenue Protection Program: Proof of Loss Form
In the event of a covered Revenue Protection “occurrence:”
1. Notify Lianne Lewellen at California Fair Services Authority (CFSA), (916) 263-6145.
2. Complete the “Sworn Statement in Proof of Loss” form and have it notarized.
3. Document events (take pictures if applicable).
4. Obtain newspaper clippings or other written articles relating to loss.
5. Document extra (over and above normal) expenses paid to resume normal fairtime or covered interim event activities. Do not include hours normally worked.
What to include in a Revenue Protection claim:
1. Completed Sworn Statement in Proof of Loss.
2. Because claims are generally paid based on the average of the previous three years of the following fairtime or covered interim event accounts, please include revenue for the following accounts for the current year, plus the previous three years (don’t include sponsorships):
- Admissions (410)
- Concessions (420)
- Attractions (460)
- Miscellaneous (470)
- Other fairtime or covered interim event revenue generating accounts
3. Newspaper clippings or other articles verifying occurrence.
4. Accounting of extra expenses paid.
5. Send Proof of Loss statement and collateral to:
California Fair Services Authority
Attn: Lianne Lewellen
P.O. Box 15518
Sacramento, CA 95852-0518
If you have any questions about the Revenue Protection Program or about filling out this form, please contact Lianne Lewellen at (916) 263-6145 or firstname.lastname@example.org.