HomeMy WebLinkAbout435 Monroe Correspondence from Travelers - Claim Acknowledgement Claim Acknowledgment
CLAIM# LOSS DESIG. ADJ.OFFICE FIELD OFFICE NAME REPORTING STATE
F1S9169 � LR 028
CLAIM HANDLER PHONE NUMBER SUPERVISOR
ERIK SCHULZE 1 (630) 848-5804 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
12/14/2024
TIME OF ACCIDENT CALLER PHONE NUMBER/EXT
435 MONROE STREET
DATE REPORTED CALLER TYPE TWIN FALLS ID
12/14/2024 3
DESCRIPTION OF ACCIDENT
1 NOTICED A BAD SMELL, INVESTIGATED AND DISCOVERED SEWER FLOWING OUT OF A
BASEMENTRESTROOM. SEWER WAS FLOWING OUT INTO THE LARGE ROOM IN FRONT OF THE
RESTROOMS . I IMMEDIATELY CALLED THE TF CITY AND AND CONTACTED NATHANWITH TH
P0016 8/2022
CLAIM # F1S9169
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
RON PINKSTON 435 MONROE STTWIN FALLSID83301 �01
DESCRIPTION
ATTORNEY
TOTAL CLAIMANTS: 1
P0016 8/2022