HomeMy WebLinkAbout PRR23194 LexisNexis - 1233 Southwood Fire Reportr
LOxisNexls�
P.O. BOX 740167
ATLANTA,GA 36
678.924.4900 FA
BaniC of America.r�
74-0167
,V00.934.6449 ,.
j PAY TEN DOLLARS ANID NO CENTS
PAY TO SAN LUIS BISP F�TT
E DEF
THE FIRE RECO ❑S E
ORDER OF 2160 SANTA A B A ST
SAN LUIS OBE P 93401
DATE 7/5/23
111'2209796061111 1:0611127881: 3360213 7820
5.1907
2209796061
$ 10.00
AMOUNT
AFTER 18 MONTHS j
a-
1 QVIINIGTI IRF
TRAN: 2209796061
I REPORT REQUEST
' LexisNexis-
Agency Info
P.O.BOX740167
g y
ATLANTA,GA 30374-0167
6/23/23 00:00
II
I
I
TOLL FREE PHONE
Date of Occurrence
1.800.934.9698
TOLL FREE FAX
Report/Case #
1.800.934.6449
Type of Report Fire Building
EMAIL cru.incom ng@I eiREPORTS
risnexiisrisk.comm
Agency Name SAN LUIS OBISPO FD
Vehicle
Info
Precinct or District UNKNOWN
VIN
City of Loss SAN LUIS OBISPO
Car Tag
Tag State.
County of Loss SAN LUIS OBISI@Qte
CA Make
Year _
Location of Loss 1233 SOUTHWOOD DR UNIT 11
Additional Info
Involved Parties
Insured Party__ WILLIAM
Date of Birth
below and Return This Form)
Repot Attached.
Report Cost I # of Pages (Including this sheet)
�r ke)
O No Rebrt Found'
O No Report Written - Log entry only/Driver Exchange
O Not Releasable / Not Ready
O Unable to locate Report in our Jurisdiction*
Suggest you try:
O Comments
"This request may include confidential information. As an entity authorized to receive this information you agree that after responding to
LexisNexis you will appropriately protect this information against any unauthorized reading, distribution, copying or other use. If you do
not have a report for this request, please return this form to LexisNexis and then immediately destroy any copies.
LexisNexis Internal Use Onlv Below This Line
Client 7126 Claim # 015907104
Division CAH-UNIT-ONE
AR Page 1 of 1
Claims AdjusterROBIN MEBANE
1111 DIANA GARCIA
7/5/23 T 5.1907
LexisNexis-
P.O, BOX 740167
ATLANTA,GA 303'�
678.924.4900 FAX
PAY
PAY TO
THE
ORDER OF
TEN
ff BankafAmerica,��
167 I
SAN LUI
FIRE RE
2160 SAN
SAN LUIS
u
PO F I f7 E
� DEP
ISPO,CA-
DATE 7/6/23
5.1907
$ 10.00
AMOUNT
VOID AFTER 18 MONTHS
AUTHORIZED SIGNATURE
TRAN: 2209796912 REPORT REQUESTLexisNexis®
Agency Info
Date of Occurrence 6/23/23 00:00
Report/Case # 230623050 _
Type of Report _Fire Building
Agency Name SAN LUIS OBISPO FD
Precinct or District BRANDON TYLER
City of Loss SAN LUIS OBISPO
County of Loss SAN LUIS OBISR_(j1,te CA
Location of Loss-1 233 SOUTHWOOD DR UNIT 11
P.O.BOX 740167
IIATLANTA,GA 30374-0167
TOLL FREE PHONE
1.800.934.9698
TOLL FREE FAX
!� 1.800.934.6449
I EMAIL REPORTS TO
cru.incoming@lexisnexisrisk.com
Vehicle Info
VIN
Car Tag
Make
Tag State
Year
Additional Info
Outcome Of Search (Mark below and Return This Form)
Involved Parties
)(Report Attached:
WILLIAM Cost v# of Pages (Including this sheet)
Insured Party 7^T_
O No Report Found
Date of Birth SS#__ O No Report Written - Log entry only/Driver Exchange
Driver's License License State O Not Releasable / Not Ready
Driver #2 O Unable to locate Report in our Jurisdiction*
Suggest you try:
Driver #3 O Comments
*This request may include confidential information. As an entity authorized to receive this information you agree that after responding to
LexisNexis you will appropriately protect this information against any unauthorized reading, distribution, copying or other use. If you do
not have a report for this request, please return this form to LexisNexis and then immediately destroy any copies.
LexisNexis Internal Use Only Below This Line
Client 7126 Claim # 015907104 Claims AdjusteROBIN MEBANE
Division CAH-UNIT-ONE
1111111 III DIANA GARCIA
AR Page 1 of 1 7/6/23 T 5.1907