HomeMy WebLinkAboutPRR19364 - 830 Boysen Fire Report112031126
09/23/19
112031126
San Luis Obispo Fire Dept.
*** ten and 00/100 dollars *** $10.00
SAN LUIS OBISPO FIRE DEPT. 3330110620 r '
2160 SANTA BARBARA ST '
SAN LUIS OBISPO CA 93401-5240
AUTHORIZED SIGNATURE
NOT GOOD FOR MORE THAN $50.00
I I I I I I I I I I I I I I I I I I I I I I I VOID IF NOT PRESENTED WITHIN 180 DAYS
11°LL203LL2611° 1:03L0000531: 86L04L2439110
SASE,
!PLEASE RETURN THIS PORTION WITH REQUEST!
Account No. 06363 SGD-CA VM
Questions? Contact Metro's CALIFORNIA DEPARTMENT
Please Reply To:
Metropolitan Reporting Bureau
Box 926, William Penn Annex
Philadelphia, PA 19105-0926
Phone: (800) 245-6686
Fax No: (800) 343-9047
www. metroreporting.com
Email: report@metroreporting.com
WE REPRESENT Schifrin, Gagnon And Dickey
As agent for the above insurance company
Request for a(n) FIRE Report. Please return this form with report.
REPORT NUMBER
POLICY#: CMP003493-2
INSURED WESTERMAN LIVING TRUST
DATE OF LOSS 08/05/19
LOCATION 830 BOYSEN AVE. UNIT #3
SAN LUIS Oat CA
DRIVER
DOB'`:
OTHER DRIVER
DOB:
CLAIM NUMBER SO406512
VEHICLE YEAR
MAKE/MODEL
DRIVER LICENSE#
VIN#
STATE
PLATE/TAG#
POLICE DEPARTMENT: SAN LUIS OBISPO FIRE DEPT.
BARRACKS/PCT.# NEAL BERRY
DESCRIPTION UNIT NO. 3 KITCHEN FIRE
UNIT NO. 3 KITCHEN FIRE
!PLEASE RETURN THE BOTTOM PORTION WITH REQUEST!
O Unable to Locate Report With Information Given
O Loss Location Not In Our Jurisdiction. Try:
0 Log Entry Only, No Report Written. Please attach call sheet.
0 Not Releasable O Not Ready Reason:
H If there is a charge for this service, please enclose your bill with
the report and our check will be issued promptly. 266 CA00000990
3330110620