Risk Management

SUBMIT A CLAIM

-- TYPE OF CLAIM

SELECT A CLAIM TYPE BELOW:

Property DamagePersonal Injury

-- TYPE OF CLAIM

NCLUDE A POLICE CASE NUMBER, IF KNOWN:

-- CLAIMANT ACKNOWLEDGEMENT

BY CHECKING THIS BOX

, I ACKNOWLEDGE

THAT I AM NOT UNDER THE EMPLOYMENT OF THE CITY OF MCALLEN AT THE TIME OF OCCURRENCE.

-- CLAIMANT INFORMATION

Title:

First Name:

M.I. :

Last Name:

Address:

City:

State:

Zip Code:

Email Address

Home Number

Cell Number

Other Number

* Please confirm the accuracy of these statements

-- CLAIM FOR INJURY / PROPERTY DAMAGE

Date of Ocurrance:

Time:

In the next section describe in your own words where, when, and how the damage or injury occurred. Attach additional pages if necessary. Give names and addresses of others involved and/or witnesses, if known.

Description Here

NOTE: If any additional documents (i.e., reports, invoices, photos) are in your possession, you may fax, mail or email the information to:

City of McAllen
ATTN: Risk Management
P.O. Box 220, 78505-220
McAllen, Texas 78501
(956) 681-1410

* Please Confirm the Accuracy of these Statements

BY CHECKING THIS BOX ,

I CONFIRM

that the statements above are true and correct to the best of my knowledge on this day of

Date:

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Risk Management

SUBMIT A CLAIM

-- TYPE OF CLAIM

SELECT A CLAIM TYPE BELOW:

-- TYPE OF CLAIM

-- CLAIMANT ACKNOWLEDGEMENT

-- CLAIMANT INFORMATION

* Please confirm the accuracy of these statements

-- CLAIM FOR INJURY / PROPERTY DAMAGE

In the next section describe in your own words where, when, and how the damage or injury occurred. Attach additional pages if necessary. Give names and addresses of others involved and/or witnesses, if known.

NOTE: If any additional documents (i.e., reports, invoices, photos) are in your possession, you may fax, mail or email the information to:

City of McAllen
ATTN: Risk Management
P.O. Box 220, 78505-220
McAllen, Texas 78501
(956) 681-1410

* Please Confirm the Accuracy of these Statements

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Contact Info

Yolanda Perez,
Director of Risk Management

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Download the 311 App

Risk Management

SUBMIT A CLAIM

-- TYPE OF CLAIM

SELECT A CLAIM TYPE BELOW:

-- TYPE OF CLAIM

-- CLAIMANT ACKNOWLEDGEMENT

-- CLAIMANT INFORMATION

* Please confirm the accuracy of these statements

-- CLAIM FOR INJURY / PROPERTY DAMAGE

In the next section describe in your own words where, when, and how the damage or injury occurred. Attach additional pages if necessary. Give names and addresses of others involved and/or witnesses, if known.

NOTE: If any additional documents (i.e., reports, invoices, photos) are in your possession, you may fax, mail or email the information to:

City of McAllen ATTN: Risk Management P.O. Box 220, 78505-220 McAllen, Texas 78501 (956) 681-1410

* Please Confirm the Accuracy of these Statements

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Contact Info

Yolanda Perez, Director of Risk Management

City of McAllen
ATTN: Risk Management
P.O. Box 220, 78505-220
McAllen, Texas 78501
(956) 681-1410

Yolanda Perez,
Director of Risk Management