Burlington Claims - Hickok & Boardman Insurance Group

City of Burlington Claims Reporting: Property or Auto Loss Under the Deductible

Your Name*
First Last
Phone
Your email address*
Enter Email Confirm Email
Claim Contact Person
Name
First Last
Contact Phone
Dept Supervisor
First Last
Contact Email Address
City Department
Time & Place
Date of Loss or Accident
MM slash DD slash YYYY
Time of Loss or Accident

: Hours

Minutes

AM/PM
Location of Loss or Accident
Street Address Address Line 2 City State ZIP Code
Estimated Repair Costs
Auto and Equipment Info
Year
Make
Model
VIN or Serial Number
Description of Damaged City Property or Auto
Describe Cause of Loss
Additional Details
Robbery & Theft
Were Police notified?
- Yes
- No
Was Culprit Apprehended
- Yes
- No
Explain
Explain
Describe the situation below