HomeMy WebLinkAbout2 Sirs Investments, LLC Tort Claim Claim for Property Damage or Bodily Injury
NOTE:This form is being provided as a courtesy to assist you in filing your claim.Providing this form to you is not an admission,nor shall it be
construed to be an admission,of liability or an acknowledgement of the validity of a claim by the political subdivision.Legal requirements for
filing claims can be found in Idaho Code:Title 6.Chapter 9.All claims must be filed promptly.
CLAIMANT INFORMATION:
......... ......... ......... ......... ......... ......... ......... ......... .........
First Name:* Last Name:*
2 Sirs Investments,LLC
Physical Address
Street*
City* State* ZIP Code*
Twin Falls Florida 83301
Have you lived at this address for at least 6 months prior to the incident date?
Yes No
Previous Address
Street*
City* State* ZIP Code*
Twin Falls Idaho 83303
My mailing address is different than my physical address
Mailing Address
Street*
City* State* ZIP Code*
Twin Falls Idaho 83303
Phone Number* Email Address:
xxx-xxx-xxxx
INCIDENT INFORMATION:
Date of Incident:
09/27/24 10:00:00 AM
Location of Incident:*
233 Walnut St,Twin Falls,ID 83301
DESCRIBE IN DETAIL WHAT DAMAGE OR INJURY OCCURRED:
We found the basement flooded on the morning of 9-27-24 during a routine check-in for the home,which is vacant and currently listed for
sale.We contacted our plumber,Danny Florinca,at Aquabest Plumbing.He contacted the city and discovered that the city sewer line had
backed up into our floor drain in the basement.I've attached a copy of the bill for the clean-up,removal,and carpeting that was replaced due
to the incident.
Don't hesitate to get in touch with me with any questions.
Thanks,
Ryan Higley
2 Sirs Investments,LLC
Additional Files/Pictures:
233 Walnut Carpet.pdf 1.171VIB
You may attach any other information or documentation you desire.
Cost of Property Damage or Bodily Injury:
$533.04
Property Damage or Bodily Injury:*
Property Damage
Bodily Injury
Property Damage and Bodily Injury
I hereby make a claim against the City of Twin Falls and I hereby certify that I have read the above information and it is true and correct to the
best of my knowledge.
Date* Signature
10/1/2024
Per Idaho Statute Title 41,Chapter 13:41-1331 -Any person who knowingly,and with intent to defraud or deceive any insurance company,files a
statement of claim containing any false,incomplete,or misleading information is guilty of a felony."Statement"includes,but is not limited to,
any notice,statement,proof of loss,bill of lading,receipt for payment,invoice,account,estimate of property damages,bills for services,
diagnosis,prescription,hospital or doctor records,x-ray test results,or other evidence of loss,injury,or expense.