CICP Contractor's Theft and/or Vandalism Report

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**REPORT ALL LOSSES IMMEDIATELY**
Answer every question on this form. All losses are important, even small ones. CICP needs the information in tracking crime patterns, establishing victims to match with hotline calls, and recoveries. For questions call (503) 618-8871

Contractor Information
Contractor Name:
Report Preparer:
Phone Number:
Incident Information
Street Address:
City of Incident:
State of Incident:
Date and Time Noticed:	January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 1 2 3 4 5 6 7 8 9 10 11 12 0102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 a.m. p.m.
Reported by:
When crime occured:
Witnesses:
How site was entered:
Estimated value of stolen/damaged property:
Describe In Your Own Words What Happened:
Law Enforcement Information
Law Enforcement Agency Notified:
Date of Notification:	January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Officer Name:
Report Number:

Property Loss Information
Items Stolen/ Vandalized	Year/ Make/ Model	Serial/ Pin/ Vin #	Value	Owner Applied #	Unique Identifiers