Laserfiche WebLink
Address <br /> le il, <br /> ❑ Your Vehicle ❑ Other Vehicle ❑ Pedestrian Injured? ❑ Nol❑ Yes, Describe <br /> Name h. <br /> Phone No <br /> Address <br /> ❑ Your Vehicle ❑ Other Vehicle ❑ Pedestrian Injured? a No;o Yes; Describe <br /> Name Phone No _ <br /> f <br /> Address <br /> i� <br /> � ii 3 <br /> L' ❑ Your Vehicle o Other Vehicle.❑ Pedestrian Injured? ❑ No o Yes;'Describe <br /> Brief Descri tion of Photos Taken: <br /> E Use this paper to draw a schematic of the collision— indicate North ion schematic for reference <br /> Describe what happened below the schematic <br /> i! lis <br /> i. <br /> i. <br /> ii <br /> IF AN ACCIDENT OCCURS AFTER STANTEC'S NORMAL WORKING HOURS PLEASE REPORT <br /> YOUR CLAIM TO KIBBLE & PRENTICE INSURANCE AGENT, PHONE NO 425-454-2445, FAX NO <br /> 425-646-9616- AFTER HOURS PHONE N01,425-681-1349 <br /> i <br /> :j <br /> -SEE INSURANCE PAGE- <br /> i . <br /> ' Attachment 6 <br /> d a <br />