Before you begin
Is this for a Vehicle or Property Damage Claim?
Vehicle
Property
Personal Injury
Water and Sewer
If you believe that the InnServices has failed to maintain their water or sewer infrastructure, and you have incurred property damage as a result, you must
contact InnServices directly
.
If you believe that the Town of Innisfil has failed to maintain our facilities, roads, or trees, and you have incurred personal injury as a result, we recommend that you obtain independent legal advice or consult with your insurance company.
If you believe that the Town of Innisfil or InnServices has failed to maintain our facilities, roads, or trees, and you have incurred property damage as a result, you can submit a Statement of Damage claim. By accepting this form, the Corporation of the Town of Innisfil does not accept liability.
Step 1
Report the claim to your insurance company. Your insurer will review/process your claim. If the Town is legally at fault, they will collect from us.
Step 2
Complete this Property Damage Claim Form and submit it together with all supporting documentation to our Customer Service Department,
as soon as possible
. Customer Service will then log the damage claim into our tracking system, assign it a damage claim number and forward it to our Legal Services Department. Legal Services will conduct a fair and impartial investigation of liability on a without prejudice basis and respond within 90 days of receiving your claim. However, your claim may be assigned to a claims and risk analyst or the Town's insurer for handling
Before you fill in this form, please ensure you have the following documents prepared - they are required!
Photo of the damage
Photo of the location
Invoices or estimates for the repairs
Only damage claims that include all supporting documentation will be reviewed.
Please note:
This is an updated procedure - damage claims must be submitted through this online form (email submissions will not be accepted); only claims that include all supporting documentation will be reviewed, and all fields are mandatory unless otherwise stated.
If you believe that the Town of Innisfil has failed to maintain our roads, and you have incured vehicle damage as a result, you can submit a Statement of Damage claim. By accepting this form, the Corporation of the Town of Innisfil does not accept liability.
Step 1
Confirm that your damage is within the Towns jurisdiction
Road Jurisdictions - Town of Innisfil
.
Step 2
Report the claim to your insurance company. If the Town is legally at fault, they will collect from us.
Step 3
Complete this Vehicle Damage Claim Form and submit it together with all supporting documentation to our Customer Service Department
within 10 days
from the date of the incident. Customer Service will then log the damage claim into our tracking system, assign it a damage claim number and forward it to our Legal Services Department. Legal Services will conduct a fair and impartial investigation of liability on a without prejudice basis and respond within 90 days of receiving your claim. However, your claim may be assigned to a claims and risk analyst or the Towns insurer for handling
Before you fill in this form, please ensure you have the following documents prepared - they are required!
Photo of the damage
Photo of the location
Invoices or estimates for the repairs
Only damage claims that include all supporting documentation will be reviewed.
Please note:
This is an updated procedure - damage claims must be submitted through this online form (email submissions will not be accepted); only claims that include all supporting documentation will be reviewed, and all fields are mandatory unless otherwise stated.
Insurance and Warranty
Do you have any insurance or warranty of any type under which such damage may be recoverable?
Yes
No
Personal Information
Name :
Address, City, Postal :
Phone :
Email :
If you have already contacted the Town, please include a case number:
Incident Information
Incident Date :
Approximate Time :
--Please choose an option--
12AM
1AM
2AM
3AM
4AM
5AM
6AM
7AM
8AM
9AM
10AM
11AM
12PM
1PM
2PM
3PM
4PM
5PM
6PM
7PM
8PM
9PM
10PM
11PM
Road Name :
Nearest Intersection :
Precise Location or Landmark :
Damage to Vehicle
Description of Damage to Vehicle:
Year/Make/Model and Kilometers on Vehicle:
Reason for Damage:
Pothole
Debris on Road
Winter Maintenance
Construction
Other
Did the police attend the scene?
Yes
No
Schedule of Loss
Total Amount Being Claimed: (inclusive of taxes)
Breakdown of Claim Items:
Summary of Repairs or Replacement Costs:
Photos(s) of Damage:
Photos(s) of Area:
Receipts, Invoices, or Quotes:
Acknowledgment
I swear or affirm that the above information is true and correct to the best of my knowledge, information, and belief.
I understand that fraudulent claims cost all taxpayers and, for this reason, all fraudulent claims will be prosecuted to the full extent of the law.
I acknowledge that the Town's receipt and acknowledgement of this Form does not constitute acceptance of liability for any damage or loss sustained.
While investigating your complaint, in accordance with the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA), the Corporation of the Town of Innisfil (the "Town") will only disclose your personal information to staff and service providers who require the information to perform the investigation. Your personal information will not be shared with anyone else unless you provide written consent for such sharing or where the Town is compelled by law to do so. If you have any questions about the collection, use or disclosure, contact the Records Coordinator from Clerks Services at the Town of Innisfil.