Skip Navigation LinksCIS Home > Underwriting > Property/Liability > Automobile Crash Report

  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
   LATEST NEWS
   UPCOMING EVENTS


Force Science Research Center / Force Analysis Seminar
May 20, 2010 - May 21, 2010
City of Medford

Risk Management Techniques To Manage, Maintain and Respond To Sewer Backups
Mar 19, 2010 - Mar 19, 2010
City of Springfield