COLORADO SCHOOL OF MINES
FIRST REPORT OF CLAIMS FOR DAMAGES / LOSS
PROPERTY, LIABILITY, AND AUTO CLAIMS
Kim Case , Account Executive , 970-506-3213 office
Email: KCase@floodpeterson.com
Fax: 970-506-6865
Today's Date:
Contact
Name:
Natalie Vega
Phone
Number:
303.273.3569
Email
Address:
nvega@mines.edu
Date of alleged loss
Time of
loss
Name of Claimant
Business Name (if applicable):
Colorado School of Mines
Address:1500 Illinois Street
Phone:303.273.3569
Description of loss:
Property Claim Information
Property Address:
Auto Claim Information
Insured Information:
Drivers Name:
Year, Make, Model:
Vin No.
Claimant Information:
Drivers Name:
Year, Make, Model:
Vin No. (if available)