Arson Reward Program Application

Please use this form to nominate someone whose information has led to the conviction of an individual(s) responsible for arson.

Nominations can be made by fire and law enforcement personnel, prosecutors, and insurance industry personnel only.

Members of the Blue Ribbon Arson Committee, staff of the Ohio FAIR Plan Underwriting Association, insurance industry employees, prosecutors and public officials, fire and law enforcement personnel, and family members of any of these groups are ineligible for nomination.

You will be contacted to discuss the application before it is reviewed by the Committee. The Committee meets periodically throughout the year to review Reward Applications. Please be advised that the issuance of any Reward and/or its amount is at the discretion of the Committee. Rewards issued may vary in an amount up to $5,000. The Reward Program is voluntary, and the decision to participate is at the discretion of the nominator. Anonymity of a nominee may be protected if the nominator is willing to certify the circumstances and that the nominee is eligible for nomination.

Nominator

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Name

Role Law Enforcement Fire Department Prosecuting Attorney Insurance Representative

Email

Phone

Reward Applicant

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Applicant should remain anonymous*

Name

Age

Phone

*Anonymity of the nominee may be protected if the nominator offers an acceptable explanation to the Ohio Blue Ribbon Arson Committee Rewards Review Committee and is willing to make a sworn statement assuring Program Rules have not been violated.

Incident

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Date of Fire

Address of Fire

City

State Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code

Insurance Company

Insurance Company Contact

Insurance Phone

Estimated Value of Loss

$

Description of Incident

In the field below, please provide details about the incident and why the nominee should be considered for a Reward. In the details, please also include:

1. Which Blue Ribbon Arson Committee materials were used (if any)
2. Whether the nominee came forward with information before or after the materials were used
3. Whether the nominee has any association with the wrongdoer
4. Whether there were threats made against the nominee or other extenuating circumstances involved

Name of Wrongdoer

Date of Conviction

Details

Please provide details regarding the wrongdoer’s charges, conviction, and sentencing. Please also use this field to provide information if more than one wrongdoer was responsible for the incident.

Attachments

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