Non-Profit Insurance Claim
I. Claimant Information
Organization Name: | [Your Company Name] |
Contact Person: | [Your Name] |
Phone Number: | [Your Company Number] |
Email Address: | [Your Email] |
II. Incident Description
On the date of October 15, 2053, at approximately 2:30 PM, a severe storm caused significant damage to the roof of our community center located at [Your Company Address]. High winds coupled with heavy rain resulted in the partial collapse of the roof, leading to water intrusion into several rooms used for our outreach programs.
III. Damage Assessment
Roof: Severe structural damage and partial collapse.
Interior Walls: Water damage to drywall and insulation in multiple rooms.
Flooring: Water damage to carpeting and hardwood floors in affected areas.
Equipment: Damage to various pieces of electrical equipment including computers, projectors, and sound systems.
IV. Policy Information
Policy Number: | NP123456789 |
Insurance Provider: | Goodwill Insurance Co. |
Policy Type: | Comprehensive Property and Liability Insurance |
Coverage Period: | January 1, 2053 - December 31, 2053 |
V. Supporting Documents
Incident Report: A detailed report documenting the storm's impact, including the date, time, and nature of the damage. This report provides context and verification of the incident.
Photos of Damage: Visual evidence of the damage to the roof, interior walls, flooring, and equipment. These photos help illustrate the extent of the damage.
Water Damage Restoration Estimate: An estimate for restoring water-damaged areas, including the cost of drying, cleaning, and replacing affected materials.
Equipment Repair/Replacement Quotes: Quotes from service providers for repairing or replacing damaged electrical equipment, such as computers, projectors, and sound systems.
VI. Claim Amount
Roof Repair: | $25,000 |
Water Damage Restoration: | $15,000 |
Equipment Repair/Replacement: | $10,000 |
Total Claim Amount: | $50,000 |
VII. Declaration and Signature
I, [Your Name], hereby declare that the information provided in this claim is accurate and complete to the best of my knowledge. I agree to cooperate with Goodwill Insurance Co. and provide any additional documentation or information required during the processing of this claim.
[Your Name]
[Date Signed]
Claim Templates @ Template.net
