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 Due to equipment issues, recyclables were not collected Tuesday, January 21, in some neighborhoods. Residents on Tuesday routes are asked to keep cans at the curb for Wednesday pickup. Thank you.

Claim Form

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Please correct the field(s) marked in red below:

1

 Name of Claimant(s)

 *
2

 Address of Claimant(s)

 *
3
Phone number of Claimant(s)
 *
4
Email address of Claimant(s)
 *
5

Nature of claim (property damage, bodily injury, and the like)

 *
6
Date, time and place of event on which claim is based
 *
7
Explanation of accident or event on which claim is based
 *
8
Amount claimed (please attach supporting documentation, if possible)
Amount claimed (please attach supporting documentation, if possible)
9
Reason for alleged Town responsibility (optional)
If claim involves property damage, please provide the following insurance information:
10
Name of Claimant's Insurance company
11
Address of Claimant's Insurance company
12
Claimant's Insurance policy number
  1. To receive a copy of your submission, please fill out your email address below and submit.