Safety & Loss Prevention
| FY__ LOSS RECONCILIATION REPORT | |||||
| UW- | |||||
| FY___ Receipts | Open Claims & 3rd Party Recoveries | ||||
| FY___ Carried Forward | to be carried forward to FY__ | ||||
| Disbursements | |||||
| Account Balance (6/30/___) | …… | ||||
| …… | |||||
| Less Open Claims | …… | ||||
| and 3rd Party Recoveries | |||||
| Equals Amount to Return | |||||
| to UWSA ULF | $0.00 | Total Open & 3rd Party Recoveries | $0.00 | ||
| Loss Control Summary | Explanation | ||||
| Deposits Date | Amount | ||||
| …… | |||||
| …… | |||||
| …… | |||||
| …… | |||||
| Total Deposits | $0.00 | ||||
| Expenditures | |||||
| …… | |||||
| …… | |||||
| …… | |||||
| …… | |||||
| …… | |||||
| …… | |||||
| …… | |||||
| …… | |||||
| Total Expenditures | $0.00 | ||||
| Loss Control Balance | |||||
| Third Party Recoveries | Explanation | ||||
| Deposits Date | Amount | ||||
| …… | |||||
| Total Deposits | |||||
| Encumbrances | |||||
| …… | |||||
| Total Encumbrances | |||||
| 3rd Party Recovery Bal. | $0.00 | …… | |||
Last Updated on 4/8/03