File #: 16-4225    Version: 1 Name:
Type: Self-Insurance Claims General Liability Status: Approved
File created: 6/29/2016 In control: Finance Committee
On agenda: 7/13/2016 Final action: 7/13/2016
Title: Department: Department of Transportation and Highways Claim Number: 97012813 Claim Payment: $100.00 Account Number: 490-826 Fixed Charges Department: 490 Claimant: Mark Snow Property Damage/Bodily Injury: 1997 BMW 328I Date of Accident: 12/05/2015 Location: Quentin Road- North of Route14, Palatine, IL Incident/Activity: Claimant was travelling southbound on Quentin Road, north of Route 14 in Palatine and struck a pothole causing damages to his vehicle's back tire and wheel. Investigated by: CorVel

title

Department: Department of Transportation and Highways

Claim Number: 97012813

Claim Payment: $100.00

Account Number: 490-826

Fixed Charges Department:  490

Claimant: Mark Snow

Property Damage/Bodily Injury: 1997 BMW 328I

Date of Accident: 12/05/2015

Location: Quentin Road- North of Route14, Palatine, IL

Incident/Activity: Claimant was travelling southbound on Quentin Road, north of Route 14 in Palatine and struck a pothole causing damages to his vehicle's back tire and wheel.

Investigated by:  CorVel

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