HomeMy WebLinkAboutPRR26128 CA Fair Plan - 1811 Chorro Street fire report>Abl! /
!PLEASE RETURN THIS PORTION WITH REQUEST!
Please reference barcode number below:
PJ-ease Forward Response To:
Emaj-1 :
Metropolit,an Reporting BureauBox
VM
WE REPRESENT California Fair plan
As- agent for the above insurance companyTHIS REQUEST rS FOR TNSURANCE PURPOSES ONty
Report. Please return this form with report
POLICY#: CFP
CFP-CA
Request for a(n)
REPORT NUMBER
INSURED
DATE OF LOSS
LOCATION
LUCAS PIERCE
02/22/26 2:00 pM
18LL CHORRO STREEf
SAIV IJUIS OBI
OTHER
n
!
DRTVER
DOB:
OTHER DRIVER
CLATM NUMBER
DOB:: D2600987
VEHICLE YEAR :MAKE/MODEL :DRIVER LICENSE# :vrN# :
STATEPLATE/TAG#
=POLTCE DEPARTMENT: SAII IJUIS OBTSPO FIRE DEPT.BARRACKS/PCT.# :DESCRIPTION : A FTRE STARTED AT OUR INSURED'S HoME oN THE EXTERIA FIRE STARTED AT OUR INSURED'S HOME ON THE EXTERIOR OF THE PROPERTY BYTHE ATTIC. WE NEED THE FIRE DEPARTMENT REPORT.
!PLEASE RETURN THE BOTTOM PORTTON WITH REQUEST!
UnabLe to Locate Report, With Informat,ion Given
Loss Loeation Not In Our ,Jurisd.iction. Try:
Log Ent,ry on7y, No Report, writ,ten. please at,tach call sheet.
!*o, Releasable !*o, Ready Reason:
tl rt there is a-charge. fol tlig servj-ce, -please enclose your bil1 withthe report and our-check will be issued'pio*ptrvl-- 56 cAooo0oggo
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