City of Windsor Damage Claim Form

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Please Submit Only One (1) Form Per Incident
CLAIMANT DETAILS
















INCIDENT DETAILS






Please provide specific information regarding this incident.

Please specify whether you believe weather or other environmental conditions caused or contributed to the incident, and provide details of same.





ATTACHMENTS AND FILES
Please provide images in jpeg format.

Note: There is a 25 MB per file size limit and a 35 MB total file size limit per submission.













SUBMITTER DETAILS


If you believe the conditions giving rise to your claim pose an immediate threat to health and safety, please report to 311.

The personal information on this form is collected under the authority of the Municipal Act, 2001, s.10. The information is used solely for the purpose of processing the damage claim and will be supplied to the City of Windsor’s insurance adjuster and to those from whom the City is claiming contribution or indemnity. Questions about this collection of information can be made to the Supervisor, Information and Records, 519-255-6222 ext. 6214.