Instructions:
1. All fields marked with a red Asterisk (*) are mandatory to complete in order to submit the form.Notice Of Collection:
The City of Toronto's Insurance and Risk Management division collects personal information on this form under the legal authority of the City of Toronto Act, 2006, s. 8, 42(6), 137 and 138; Item No. 6, of Corporate Services Committee Report No. 4, adopted by City Council and confirmed by City of Toronto by means of By-law No. 229-1999 on April 13, 14 and 15, 1999, the City of Toronto Municipal Code, Chapter 169, Officials, City, Article 2, City Clerk, section 169-2.1; Article 3, Deputy City Manager, Corporate Services, Chief Financial Officer and Treasurer and Controller, section 169-3.2, and, Article 5, City Solicitor, sections 169-5.1, and 169-5.3. The information is used to receive; review; investigate; (including contacting and follow up with claimants) as well as determining eligibility with respect to and resolve (including the contesting of the validity of), claims made against the City of Toronto, (including but not limited to written notice of a claim, details of the occurrence, and injury complained of for purposes of s.42 of the City of Toronto Act, 2006). Information will be shared with City Divisions, various agents, consultants, experts and other third parties retained by the City based on the allegations made in the claim, or to undertake work or provide services in relation to the purposes noted above, as the City determines is appropriate. Questions about this collection can be directed to the Supervisor, Claims, Insurance and Risk Management, City Hall, 100 Queen Street West, 5th Floor, East Tower, Toronto, ON M5H 2N2 or by telephone at 416-397-4212.
