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New Assignment for Phillips & Associates
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HI
IA
ID
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KS
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Insured's Information
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First Name:
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AA
AB
AE
AK
AL
AP
AR
AZ
BC
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
NB
NC
ND
NE
NF
NH
NJ
NM
NS
NT
NV
NY
OH
OK
ON
OR
PA
PR
QC
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
WY
YT
Zip:
Mortgagee:
Loss Location
Street Address:
Address 2:
City:
State:
AA
AB
AE
AK
AL
AP
AR
AZ
BC
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
NB
NC
ND
NE
NF
NH
NJ
NM
NS
NT
NV
NY
OH
OK
ON
OR
PA
PR
QC
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
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YT
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Claimant Information
(if applicable)
First Name:
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Phone:
Street Address:
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City:
State:
AA
AB
AE
AK
AL
AP
AR
AZ
BC
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
NB
NC
ND
NE
NF
NH
NJ
NM
NS
NT
NV
NY
OH
OK
ON
OR
PA
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QC
RI
SC
SD
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First Name:
Last Name:
Company:
Office Phone:
Cell Phone:
Street Address:
Address 2:
City:
State:
AA
AB
AE
AK
AL
AP
AR
AZ
BC
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
NB
NC
ND
NE
NF
NH
NJ
NM
NS
NT
NV
NY
OH
OK
ON
OR
PA
PR
QC
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
WY
YT
Zip:
Country:
Loss Information
Date of Loss:
Type of Loss:
ANIMAL DAMAGE
AUTO APPRAISAL
AUTO INVESTIGATION
AUTO LIABILITY
BUILDERS RISK
BURGLARY
BUSINESS INTERRUPTION
CARGO LOSS
COLLAPSE
CORO
EARTHQUAKE
Explosion
FALLEN TREE
FIRE
FLOOD
FOOD SPOILAGE
FREEZE
GARAGE KEEPERS
GENERAL LIABILITY
GUNSHOTS
HAIL
HEAVY EQUIPMENT
INLAND MARINE
CAT 34 - 4/4/08
IVAN - CAT 30 - 9/16/04
KATRINA - CAT 49 - 8/29/05
LIGHTNING
MEDIATION
MOLD
POWER SURGE
SETTLEMENT
SEWAGE BACKUP
SNOW COLLAPSE
THEFT
THIRD PARTY LIABILITY
TRUCK CALL OUT
VANDALISM & MALICIOUS MISCHIEF
VEHICLE DAMAGE TO PROPERTY
WATER
HOME DAMAGE
WIND
WATERCRAFT
WORK COMP
GUSTAV - CAT 58
CAT 99 04/24/2010
CAT 46 - 4/27/11
CAT 44 - 4/15/11
CAT 48 - 5/25/2011
CAT 59- 8/28/2011 (Irene)
CAT 87 ISAAC 8/29/12
CAT 93 - 3/18/-3/19/13
CAT 12/23/2014
CAT 12 - 12/23/15 - 12/24/15
CAT 1743 HARVEY
CAT 1744 IRMA 09/10/2017
CAT 1746 NATE 10/08/2017
CAT 1821 04/13/2018 - 04/14/2018
CAT 1828 ALBERTO 5/28/2018 - 5/31/2018
CAT 1851 GORDON 9/3 - 9/06/2018
CAT 18052 FLORENCE 9/14 - 9/16/2018
CAT 18057 MICHAEL
CAT 1916 02/22 - 2/25/2019 TORNADOS COLUMBUS
CAT 1923 - 4/12/2019 to 4/15/2019
CAT 1943 - BARRY - 7/10/19 to 7/14/2019
INVESTIGATION
EQUIPMENT BREAKDOWN
LIABILITY
TORNADO
CAT 1969 Tornadoes 12/16 - 12/17/19
CAT 2012 - tornadoes 1/10 - 1/12/2020
CAT 2014 - tornadoes 2/5/2020 - 2/7/2020
CAT 2016 - tornadoes/hail 3/02-04/2020
CAT 2019 - tornadoes/hail/wind 4/7/2020 - 4/9/2020
CAT 2020 - tornadoes/hail/wind 4/10 - 4/13/2020
CAT 2021 - hail/tornadoes/wind 4/18 - 4/20/2020
CAT 2022 - hail/tornadoes/wind 4/21- 4/24/2020
CAT 2050 - LAURA - 8/27/2020
CAT 2063 SALLY - 9/14 - 915/2020
CAT 2071 - HURRICANE DELTA - 10/9 - 10/10/2020
CAT 2074 - HURRICANE ZETA - 10/28/2020
CAT 2117 ICE STORM Feb 15 - 21 - 2021
CAT 2120 flood/hail/tornadoes/wind 3-17 to 3-18-21
CAT 2125 hail/tornadoes/wind 4/9 - 4/11/2021
CAT 2130 TORNADOES/WIND 05/03/2021
CAT 2138 - TS CLAUDETTE - 6/18 - 6/20/2021
CAT 2160 IDA 8/29 - 8/31/21
CAT 2220 - flood/hail/tornadoes/wind- 3/21 to 3/22
CAT 2221 3/30/2022 Wind
CAT 2223 4/06/2022
CAT 2225 - 4/14/2022
CAT 2226 - 4/16/2022 - HAIL
CAT 2270 - 11/29/2022 - 11/30/2022
CAT 2272 - 12/12/2022 - 12/13/2022
CAT 2273 - 12/26/2022 - 12/27/2022 - FREEZE
CAT 2312 - 1/12/2023
CAT 2316 - 1/24/2023
CAT 2332 - 3/23/2023 - 3/26/2023
CAT 2337 - 4/15/2023 - HAIL
CAT 2348 - 6/9/2023 - 6/14/2023
CAT 2349 - 6/15/2023 - 6/19/2023
CAT 2357 - 7/21/2023
CAT 2411 - 1/8/2024 - 1/10/2024
CAT 2431 - 4/6/2024 - 4/11/2024
CAT 2024-2474 - 9/11/2024 - HURRICANE FRANCINE
CAT - 10/5/2024 - 10/10/2024 - HURRICANE MILTON
Unit:
SELECT
AUTO - COMMERCIAL LINES
AUTO - PERSONAL LINES
CALL OUT
CARGO
FARMOWNERS
HURRICANE
INLAND MARINE
LIABILITY
MEDIATION
PROPERTY - COMMERCIAL
PROPERTY - RESIDENTIAL
WORK COMP
Type of Adjustment:
Limited
Full
Time and Expense
Hourly Rate
Flat Rate
Loss Description:
Characters left:
VIN #:
Deductible:
Wind Deductible:
Coverage A
MEDICAL PAYMENTS
AL -BI
AL-PD
GL-BI
GL-PD
LEGAL
EXCESS-AL BI
EXCESS-AL PD
EXCESS-LEGAL
EXCESS-GL BI
TRIDENT MED PAY
COMP - TTD
COMP - PPD
BUILDING
CONTENTS
Loss of Use
APD
ALE
ADJUSTING
TPA
Coverage B
MEDICAL PAYMENTS
AL -BI
AL-PD
GL-BI
GL-PD
LEGAL
EXCESS-AL BI
EXCESS-AL PD
EXCESS-LEGAL
EXCESS-GL BI
TRIDENT MED PAY
COMP - TTD
COMP - PPD
BUILDING
CONTENTS
Loss of Use
APD
ALE
ADJUSTING
TPA
Coverage C
MEDICAL PAYMENTS
AL -BI
AL-PD
GL-BI
GL-PD
LEGAL
EXCESS-AL BI
EXCESS-AL PD
EXCESS-LEGAL
EXCESS-GL BI
TRIDENT MED PAY
COMP - TTD
COMP - PPD
BUILDING
CONTENTS
Loss of Use
APD
ALE
ADJUSTING
TPA
Coverage D
MEDICAL PAYMENTS
AL -BI
AL-PD
GL-BI
GL-PD
LEGAL
EXCESS-AL BI
EXCESS-AL PD
EXCESS-LEGAL
EXCESS-GL BI
TRIDENT MED PAY
COMP - TTD
COMP - PPD
BUILDING
CONTENTS
Loss of Use
APD
ALE
ADJUSTING
TPA
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