HomeMy WebLinkAboutErik Jonsson - DOL 5_14_2024 Filed 10 2 2024 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:
Erik Jonsson
Physical Address
Street*
City* State* ZIP Code*
twin falls Idaho 83301
Have you lived at this address for at least 6 months prior to the incident date?
Yes No
My mailing address is different than my physical address
Phone Number* Email Address:
xxx-xxx-xxxx
INCIDENT INFORMATION:
......................................................... _ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ .........__
Date of Incident:*
05/14/24 10:05:00 AM
Location of Incident:*
738 Locust St
DESCRIBE IN DETAIL WHAT DAMAGE OR INJURY OCCURRED:
Received a phone call from tenant at 738 Locust stating the sewer had been backing up into the basement drain,shower drain and out the
basement toilet. Arrived and investigated,noted the manhole in the alley to the west of the house was half way up the tube with effluent.
When the drain is clear it flows at the bottom 2 inches of the channel. Called 311 for a sewerjet,which was accomplished shortly thereafter.
The main line was plugged in the alley somewhere between the two alley manlid access points.
Contacted a couple different restoration companies to have cleanup done and remove damaged flooring,sheetrock,paint and trim. Elite
restoration 14,639.54 bid numberJONSSON-T237-REP
Additional Files/Pictures:
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Cost of Property Damage or Bodily Injury:
$14,639.54
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*
10/2/2024
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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.