Damage Claim

State:

If you believe that Summit Utilities may have some responsibility for causing a loss you have experienced, or if you would like to report damage to Summit Utilities facilities, please use the form below to submit a claim.

When you file a claim, it will be assigned to a claims adjuster to conduct an investigation. As part of the investigation, your claims adjuster may request certain documentation to evaluate your claim.

Please allow up to 10 business days for us to review your submission.

NOTE: If you are reporting a gas blowing or any other emergency situation, please call 911.

Claim Information

Type of Claim

Type of Damages

Contact Information

First Name

Phone Number

City

Zip Code

Last Name

Address

State

Email Address

Incident Information

Date of Incident

City of Incident

Zip Code of Incident

Address of Incident

State of Incident

Brief Description of Incident

Property Damage Information

Damaged Item(s)

Brief Description of Damages

Auto Property Information

Vehicle Make

Vehicle Year

Vehicle Model

License Plate Number

Bodily Injury Information

Type of Injury

Brief Description of Your Injury

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