NCSBT Members

Automobile/Inland Marine Fund

The following forms should be used to notify NCSBT of automobile accidents or losses, inland marine losses, or vehicle schedule changes.

Automobile Loss Notice Form:  This form must be completed and submitted to NCSBT promptly following an automobile accident or loss, along with a written statement from the driver of the member vehicle describing the accident or loss and a copy of the police report and any complaint, petition or other pleading filed in court as a result of the accident or loss.

Vehicle Change Request Form:  This form must be completed to make an addition, deletion, or change to your vehicle schedule.

Inland Marine Loss Notice Form:  This form must be completed and submitted to NCSBT promptly, or in any event within fifteen (15) days of discovery of the loss.  Please also attach a copy of any incident report prepared, and a copy of the receipt, purchase order, or invoice for the covered property.

Inland Marine Change Request Form:  This form must be completed to make additions or deletions to your scheduled inland marine equipment as set forth on the form.

Errors & Omissions/General Liability Fund–Drone Liability Coverage

The following form should be used to create or modify a member’s drone schedule on file with NCSBT.

Drone Liability Schedule Change Request

Errors & Omissions/General Liability Fund—Medical Payments Coverage

The following forms should be used when filing a claim or submitting information related to a claim under NCSBT’s no-fault medical expense coverage.

Medical Expense Certificate:  The Medical Expense Certificate, along with all requested documentation, must be completed and submitted within one year of an accidental injury.

Supplement to Medical Expense Certificate:  The Supplement to the Medical Expense Certificate, along with all requested documentation, may be completed and submitted within fourteen (14) months of an accidental injury.  It should only be used to supplement a previously completed Medical Expense Certificate that was submitted within within one year of an accidental injury.

Risk Management
Richard Bostic Assistant Director of Governmental Relations 919.747.6677
Sam Thorp Staff Attorney 919.747.6706
Tanya Giovanni Staff Attorney 919.747.6701
Chelsea Sutton Legal/Policy Assistant 919.747.6713
Donna Lynch Litigation Counsel 919.747.6685
David Byrd Claims and Risk Services Consultant 919.747.6683
David Palo Data Analyst 919.747.6687
Carlisha Parker Claims Adjuster 919.747.6682
Melody Coons Litigation Assistant 919.747.6684
Lee Adams Claims Assistant 919.747.6707
Helen Gelb Claims Assistant 919.747.6712
Rachel Vachon Legal/Policy Assistant 919.747.6694
Debbie Shinbara Legal Assistant 919.747.6698
McKenna Osborn Policy Consultant 919.357.6277
Jim O’Rourke Staff Attorney 919.747.6711
Cynthia Moore Policy/Editorial Assistant 919.747.6696
Scott Murray Staff Attorney 919.747.6708
Nancy Black Staff Attorney 919.747.6693
Kathy Boyd Senior Staff Attorney 919.747.6695
Janine Murphy Assistant Legal Counsel 919.747.6699
Allison Schafer Director of Policy/Legal Counsel 919.747.6700
Sean Holmes Governmental Relations Research Specialist 919.747.6688
Bruce Mildwurf Associate Director 919.747.6692
Leanne Winner Director 919.747.6686
Sherry Cariss Accounting Technician 919.747.6689
Chadae Lewis Membership Services Assistant 919.747.6675
Angela Dillingham Information Specialist 919.747.6678
Dana Roberts Director of Finance 919.747.6690
Ramona Miller Board Development & Technology Manager 919.747.6676
Patsy Clack Executive Assistant 919.747.6680
Ed Dunlap, Jr. Executive Director 919.747.6679
Christine Scheef Assistant Litigation Counsel 919.747.6681