Get Broken Arrow Liability Protection Plan

The Broken Arrow Liability Protection Plan is essential for addressing claims related to personal injury and property damage. This guide provides clear, step-by-step instructions to help users fill out the form accurately and efficiently online.

Follow the steps to complete your claim form online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Begin by entering your full name in the 'Claimant' field, ensuring accurate spelling.
3. Fill in your date of birth in the designated field, using the format MM/DD/YYYY.
4. Provide your Social Security number in the specified section, entering the numbers without dashes.
5. Complete your address details, including the city, state, and zip code. If your mailing address is different, fill that in the provided space.
6. Enter your phone numbers, including home, work, and any other relevant contact information.
7. If applicable, input your spouse's name and Social Security number in the respective fields.
8. For juvenile claims, list the name of the custodial parent or guardian and their date of birth and Social Security number.
9. Specify the amount of your claim by entering values under the sections for personal injury, property damage, and other claims.
10. Indicate whether you have attached estimates, bills, or documentation to support your claim by selecting either 'Yes' or 'No.'
11. List all involved persons and property, detailing the nature of the injury or damage.
12. Record the date, time, and location of the incident thoroughly.
13. Describe the incident in detail, using additional sheets if necessary.
14. Include the name of any City employee or department involved in the incident.
15. List all witnesses or other individuals involved, including their addresses and phone numbers.
16. Clearly explain why you believe the City of Broken Arrow is responsible for your claim.
17. If there are special circumstances to be considered, indicate 'Yes' and provide further details.
18. Indicate if anyone else is authorized to settle the claim by selecting 'Yes' or 'No,' and provide relevant information if applicable.
19. Sign and date the form in the designated areas, ensuring all relevant signatures are provided.
20. Once completed, save your changes, and utilize any available options to download, print, or share the form as needed.

Complete your claim online today to ensure timely processing of your BROKEN ARROW LIABILITY PROTECTION PLAN.