HomeMy WebLinkAboutPRR19418 - 1520 Froom Ranch Way FireSASE,
!PLEASE RETURN THIS PORTION WITH REQUEST!
Account No. 05575L NAT -OH 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) 34379047
www.metroreporting.com
Email: report@metroreporting.com
WE REPRESENT Nationwide Insurance Company
As agent for the above insurance company
Request for a(n) FIRE Report. Please return this form with report.
REPORT NUMBER
POLICY#:
INSURED SANTA MARIA BROADWAY PLAZA II
DATE OF LOSS 10/27/19
LOCATION 1520 FROOM RANCH WAY
SAN LUIS OBI CA
DRIVER
OTHER DRIVER
DOB:
CLAIM NUMBER 802361GJ
VEHICLE YEAR
MAKE/MODEL
DRIVER LICENSE##
VIN#
STATE
PLATE / TAG##
POLICE DEPARTMENT: SAN LUIS OBISPO FIRE DEPT.
BARRACKS/PCT.#
DESCRIPTION FIRE AT BUILDING
FIRE AT BUILDING
!PLEASE RETURN THE BOTTOM PORTION WITH REQUEST!
O Unable to Locate Report With Information Given
ElLoss Location Not In Our Jurisdiction. Try:
ElLog Entry Only, No Report Written. Please attach call sheet.
0 Not Releasable O 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. 310 CA00000990
5039314443