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Submit a claim
This form is for our insured members only.  If you wish to file a claim against one of our insured members, please submit your claim in writing directly to the county, city or other special purpose district.  If you need further instructions on filing a claim, please visit the State of Idaho's website (www3.state.id.us) for Idaho Code Statutes.
Member Claim Submission

 1st Report of Damage to Your ICRMP Insured Property or Vehicle
Your Name:    Your Affiliation:

Your Phone:    Your E-mail:

Member Name:    Address:

Check here if you are the primary contact for this form.

Contact Person:    Contact's Affiliation:

Contact's Phone:    Contact's E-mail:

Incident Date:    Department Involved:


Details of Claim:


Description of Property Damaged & Location:

Make, Model & VIN# of Vehicle or Equipment Damaged:



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