INSURANCE DAMAGE REPORT
May 15, 2055
Reported by: [Your Name] Company Name: [Your Company Name] Approved by: Drake Feeney, Supervisor | Claim Number: BFI-789123 Policy Number: BFI-980765 Date of Incident: May 13, 2055 |
Time of the Incident: | | | | |
I. Incident Details
Type of Damage: Water Damage
Location of Incident: Orlando, FL 32801
Description of Damage:
On May 13, 2055, a heavy rainstorm caused flooding in the basement. Water entered through a broken window seal, damaging the flooring and several personal items. The water reached up to 2 feet deep in some areas.
II. Property Information
Property Affected | Basement |
|---|
Estimated Damage Amount | $8,000 |
Photographs Included | Yes |
Additional Documentation | Repair receipts and photos |
III. Witness Information
Witness Name: Lester Nolan
Witness Contact Information: (555) 987-6543
Witness Statement:
Lester Nolan, a neighbor, saw the water rising and immediately informed the homeowner. He helped move some personal belongings from the basement to prevent further damage.
IV. Actions Taken
Immediate Actions Taken:
Repairs/Replacement Needs:
Repair Needed | Action |
|---|
Flooring Replacement | Install new carpet and tiles |
Window Seal Repair | Permanent seal installation |
Electrical Inspection | Full inspection by a licensed electrician |
V. Additional Information
The homeowner has scheduled full repairs with a contractor and is awaiting approval from insurance to proceed.
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