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  Main Office
  1212 Court St NE
  Salem, OR 97301
  Phone: 503-763-3800
  Fax: 503-763-3900

  Claims Office
  PO Box 1469
  Lake Oswego, OR 97035
  Phone: 503-763-3875
  Fax: 503-763-3901

CIS is a member service of the League of Oregon Cities and Association of Oregon Counties


  
 
 
Automobile Crash Report
 
Use the form below to submit an auto liability or auto physical damage claim to our claims department.Required fields are in red.

Entity Name  
Contact Name  
Contact Phone  
Contact Email (Used to send copy of submitted form)
Date of Accident    
Location of Accident  
Date Reported to Entity  
Person Reported To
Driver of Entity Vehicle  
Vehicle Involved  
Auto Schedule / Item #
VIN #  
Description of Accident  
Other Vehicle Involved
License Plate #
Other Passengers Involved in Accident?  
How Many?  
Name of Other Driver
Address
Phone #
Injury
Witnesses
 

 
 
   FILING A CLAIM
Emergency Notification Process

Claims Contact Information

WC 801 Claim Form

WC Incident Report Form

Automobile Crash Report

General Liability Claim Form

Property Claim Form 
   LATEST NEWS
New Oregon Minimum Wage of $8.40/hr effective 1/1/2009

2009 Workers' Compensation Premium Assessment Rate effective January 1st

Workers' Compensation Pure Rates changes on 1/1/2009

STIPENDS paid to volunteer workers can be excluded from subject

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   UPCOMING EVENTS


Safety Committee Training
Sep 15, 2010 - Sep 15, 2010
Benton County