City of Burlington Claims Reporting: Property Your Name First Last PhoneYour email address* Enter Email Confirm Email Claim Contact PersonContact Name First Last Contact PhoneContact Email* Enter Email Confirm Email Dept Supervisor First Last DepartmentAirport TerminalAirport ParkingAirport Industrial ParkAirport Other BuildingsAirport AirfieldBED: General Manager Executive SecBED: Customer Energy ServicesBED: Finance AccountingBED: Risk Management Gov't AffairsBED: EngineeringBED: Operations - LinecrewBED: Operations - MeteringBED: Operations - TechsBED: Operations - TbshooterBED: Operations - DispatchBED: McNeil Station - Aux OperatorBED: McNeil Station - Shift SupervisorBED: McNeil Station - Station OperatorBED: McNeil Station - YardworkerBED: McNeil Station - MaintenanceBED: McNeil Station - MiscCity Hall: CEDOCity Hall: MayorCity Hall: Clerk/TreasurerCity Hall: Planning ZoningCity Hall: AttorneyCity Hall: ITCity Hall: AssessorDPW: Admin EngineeringDPW: SidewalkDPW: RecyclingDPW: Right of WayDPW: TrafficDPW: WaterDPW: WastewaterDPW: Equipment MaintenanceParking: 47 S Winooski AveParking: 60 College StreetParking: 45 Cherry Street (Lakeview)Parking: Westlake Garage (attached to Lakeview)Station #1: 136 South Winooski AveStation #2: 132 North AveStation #3: 20 Mansfield AveStation #4: 1397 North AveStation #5: 23 Ferguson AveAdministration: 1 North AveLibraryMarketplaceHuman ResourcesFirehouse BuildingParks & Rec: Bldg Maintenance, 645 Pine StreetParks & Rec: Parks Maintenance, 645 Pine StreetParks & Rec: Cemetary: LakeviewParks & Rec: Cemetary: ElmwoodParks & Rec: Cemetary: Green MountainParks & Rec: North BeachParks & Rec: Oakledge ParkParks & Rec: Leddy ParkParks & Rec: Calahan ParkParks & Rec: Schifilliti ParkParks & Rec: Schmanska ParkParks & Rec: Community BoathouseParks & Rec: Arborist StaffPolice Dept: CivilianPolice Dept: SwornTelecomTime & Place of Accident or LossDate MM slash DD slash YYYY Time : Hours Minutes AM PM AM/PM Location Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Estimated Repair CostsBuilding and / or ContentsDecribe Cause of LossAdditional DetailsBoiler & MachineryDescribe Details of LossRobbery & TheftWere Police notified? Yes No Explain Was Culprit Apprehended Yes No Explain Decribe the situation belowNameThis field is for validation purposes and should be left unchanged. Δ