HomeMy WebLinkAbout182 Harrison St Correspondence from Travelers - Claim Acknowledgement Claim Acknowledgment
CLAIM# LOSS DESIG. ADJ.OFFICE FIELD OFFICE NAME REPORTING STATE
F1S9249 � LR 028
CLAIM HANDLER PHONE NUMBER SUPERVISOR
CASEY LOWRY 1 (317) 740-2717 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
12/19/2024
TIME OF ACCIDENT CALLER PHONE NUMBER/EXT
P 0 BOX 1907
DATE REPORTED CALLER TYPE TWIN FALLS ID 83303
12/19/2024 3
DESCRIPTION OF ACCIDENT
SEWER WATERFLOODED MY BASEMENT . I MADE CONTACT WITH WASTE WATER, AND JUAN FROM
WASTE WATER DETERMINED THAT THE PLUG WAS CAUSED BY THECITY SEWER BEING BACKED UP.
P0016 8/2022
CLAIM # F1S9249
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 PRUDUC;I BE SEEN
CLAIMANT INFORMATION
NAME CLAIMANT NO. TYPE
ANGEL GONZALEZ 182 HARRISON STTWIN FALLSID83301 �01
DESCRIPTION
ATTORNEY
TOTAL CLAIMANTS: 1
P0016 8/2022