Community Disaster Insurance Claim
Claimant Information
Full Name: [Your Name]
Community ID: 789012
Date of Birth: March 10, 2030
Address: 101 Future Circle, Harmony Town, FL 32003
Phone Number: (555) 321-0987
Email: [Your Email]
Community Information
Community Name: Harmony Town Community Association
President Name: Robert Brown
Community Address: 202 Harmony Avenue, Harmony Town, FL 32003
Community Phone Number: (555) 432-1098
President Email: robert.brown@harmonytown.org
Disaster Information
Type of Disaster: Hurricane
Date of Disaster: August 15, 2051
Time of Disaster: 3:00 PM
Location of Disaster: Harmony Town, FL
Description of Disaster: Hurricane Delta caused severe flooding and structural damage to numerous homes and community facilities.
Damage Details
Property Affected: Community Center
The extent of Damage: Roof collapse, water damage to the interior, electrical system failure
Estimated Repair Cost: $150,000
Additional Expenses: $10,000 (temporary relocation of community activities)
Total Claimed Amount: $160,000
Additional Notes: A temporary community center was set up at a local school. The expectation of full restoration within six months.
Emergency Response Information
Date of Initial Emergency Response: August 15, 2051
Emergency Services Contacted: Harmony Town Fire Department, Red Cross
Description of Immediate Actions Taken: Evacuation of community members, temporary shelter provided, initial assessment of damage by fire department.
Claim Information
Claim Number: 345678901
Insurance Policy Number: HT-2051-34567
Insured Property: Community Center, Harmony Town
Policy Coverage Details: Full coverage for natural disasters, including structural repairs and relocation expenses
Additional Notes: The community is prioritizing safety and rapid restoration to normalcy.
Signature and Acknowledgement
We hereby certify that the above information is true and accurate to the best of our knowledge. We understand that providing false information can result in denial of our claim and potential legal action.
[Your Name]
[Community President's Name]
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