HomeMy WebLinkAboutPRR19344 metroreporting - 6-12-19 Highland Truck Bridge incident reportSASE,
!PLEASE RETURN THIS PORTION WITH REQUEST!
Account No. 05248
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
Request for a(n) FIRE
REPORT NUMBER
INSURED
DATE OF LOSS
LOCATION
DRIVER
OTHER DRIVER
CLAIM NUMBER
JAI -CA VM
WE REPRESENT Athens Insurance Serv.
As agent for the above insurance company
Report. Please return this form with report.
UNKNOWN
WALKER-LEWIS INC
06/12/19
HIGHLAND DRIVE
SAN LUIS OBI CA
DOB:
DOB:
AR195540
VEHICLE YEAR
2016
MAKE/MODEL
INTERNATI
DRIVER LICENSE#
VIN#
3HArMMML9GL007443
STATE
PLATE/TAG#
POLICE DEPARTMENT:
SAN LUIS OBISPO FIRE DEPT.
BARRACKS/PCT.#
DESCRIPTION
INSURED STRUCK A BRIDGE
INSURED STRUCK A BRIDGE
POLICY#: PRPKGO022802
!PLEASE RETURN THE BOTTOM PORTION WITH REQUEST!
0 Unable to Locate Report With Information Given
0 Loss Location Not In Our Jurisdiction. Try:
0 Log Entry Only, No Report Written. Please attach call sheet.
0 Not Releasable 0 Not Ready Reason:
[]If there is a charge for this service, please enclose your bill with
the report and our check will be issued promptly. 234 CA00000990
3330101406