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2. Claims for Damages Due to ROADWAY DEFECTS

   The City Clerk's Office will accept claims for property damages or personal injury caused by a roadway defect and will forward them to MIIA, the City's insurance company.   MIIA requires sufficient time to complete an investigation of your claim.

   Claims for damages or personal injury caused by roadway defects must be filed within 30 days of the incident.  Claims are subject to investigation to determine whether the City had prior knowledge of the defect and failed to fix the defect within a reasonable amount of time.   The insurance company may factor in weather or other elements when determining what is reasonable.

6. Damage Type caused by Roadway Defect*

   Please Select only one:

   1. Property Damage
   2. Personal Injury
   3. Personal Injury & Property Damage
8. CONTACT INFORMATION

   Please include accurate contact information if we have any questions.

10. First & Last Name*
12. Phone Number*
13. Email Address
15. Street Address
16. Apt #
18. City, State, Zip code
22. Describe What Occurred*

    Please include explanation of the incident including damages or injuries suffered.

24. Date and Time of Incident*
    Date and Time of Incident

    Date and Time of Incident
25. Exact Location Where Incident Occurred*
29. Upload Receipt(s) or Quotes
30. Upload Photos of damaged property or Injury.

    Provide pictures of damages or of roadway defect.

31. Upload Supporting Documents (Police Reports or other evidence)
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit Submit and Print

* indicates a required field