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Claim Form

  1. Claims Notice

  2. Pool Member

  3. City of Highland Village

  4. Member Address

  5. 1000 Highland Village Road, Highland Village, TX 75077

  6. Check One

  7. Please attach Member's Notice of Claim Ordinance or provision and any written notice received from claimant.

  8. Time of Accident or Loss*

  9. Police Investigation/Report*

    If "Yes" Attach Report

  10. Any Other Insurance Coverage for this Claim?

  11. Car/Property Insured?

  12. Repair Estimate

  13. Prior Damage to Claimant Vehicle

  14. Claimant Related to Pool Member Employee?

  15. Please Attach Member Reports

  16. Texas Municipal League Intergovernmental Risk Pool

  17. Leave This Blank:

  18. This field is not part of the form submission.