Site MapContact Us
California Fair Services AuthorityAbout UsNews & EventsSelf InsuranceServicesSafetyAccountingComputerPurchasingPublications

Self Insurance
General Liability
Workers' Compensation
Revenue Protection
Summary of

Proof of Loss Form
Property Insurance Program
Special Events
Hazardous Special Events Protection




Home > Self Insurance > Revenue Protection > Proof of Loss Form
Revenue Protection Program:
Sworn Statement in 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 filing out this form, please contact Charlie Mitchell or Lianne Lewellen.


About Us / News & Events / Self-Insurance
Services: Safety / Accounting / Computer / Purchasing Publications / Contact Us / Site Map

Worker's Compensation
General Liability
Sign up for "fyi"
Win a t-shirt - Review our site
©2015 California Fair Services Authority. All rights reserved.