HomeMy WebLinkAbout1636 Harmon Park Ave Correspondence from Travelers - Claim Acknowledgement Claim Acknowledgment
CLAIM# LOSS DESIG. ADJ.OFFICE FIELD OFFICE NAME REPORTING STATE
F1S8783 � LR 028
CLAIM HANDLER PHONE NUMBER SUPERVISOR
ANDREW KUMRO 1 (630) 961-8782 RSV
ACCOUNT INFORMATION
PARENT COMPANY NAME IC'ITY
COUNTNAME
CITY OF TWIN FALLS OF TWIN FALLS
RISK LOCATION ADDRESS MAILING ADDRESS
321 2ND AVE E
ID 83301 TWIN FALLS ID 83301
LOCATION CODE
POLICY PROFILE
POLICY FORM POLICY NUMBER EFFECTIVE DATE
ZLP C 1 10/01/2024
LOSS ACCIDENT INFORMATION
DATE OF ACCIDENT CALLER NAME ACCIDENT LOCATION
11/30/2024
TIME OF ACCIDENT CALLER PHONE NUMBER/EXT
1636 HARMON PARK AVE
DATE REPORTED CALLER TYPE TWIN FALLS ID 83301
11/30/2024 3
DESCRIPTION OF ACCIDENT
OUR PRESSURE RELEASE VALVE WENT OUT AND WE HAVE BLONDE OVER 44 QUARTS OF WATER
OUT OF OUR WATER HEATER 2 DAYS IN A ROW. WE HAVE TO HAVE SOMEONE COME OUT AFTER
HOURS TO REPLACE THE PRESSURE RELEASE VALVE
P0016 8/2022
CLAIM # FlS8783
LIABILITY ACCIDENT INFORMATION
TYPE OF GL NOTICE
SUBSTANCE OR OBJECT CLAIMANT FELL ON
HOW OBJECT GOT THERE
HOW PRODUCT WAS BEING USED AT THE TIME OF THE ACCIDENT
MANUFACTURER NAME
MAKE/MOD EL/SIZE/STYLE
DAMAGE
WHERE&WHEN PURCHASED
WHERE CAN PRODUCT BE SEEN
CLAIMANT INFORMATION
NAME CLAIMANT NO. TYPE
TYLER JONES 1636 HARMON PARK AVETWIN FALLSID83301 �01
DESCRIPTION
ATTORNEY
TOTAL CLAIMANTS: 1
P0016 8/2022