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This report is for:
-- SELECT A REPORT TYPE --
Public Facility Damage
Damage Report Type is required
Address is required
A number with five digits is required
Please describe the damage:
Please enter the following information if this is your property:
If this is Residential Damage, are the affected structures:
Do you have homeowner's insurance?
If you have homeowner's insurance, does your policy include flood insurance?
If you have homeowner's insurance, does your policy include earthquake insurance?
Is this a business?
If yes, enter the business name:
Please provide the following information about yourself:
Your First Name:
Your Last Name:
Your Phone Number:
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