Notice Of Tort Claim (Page 7 of 8) in pdf

Notice Of Tort Claim Page 7

damages claimed herein? _________ If so, describe details of agreement.

10.

The following items must be submitted with this notice or your claim may be

rejected as incomplete:

(A) Copies of itemized bills for each medical expense and other losses and

expenses claimed.

(B) Full copies of all appraisals and estimates of property damage claimed by

you.

physicians.

(D) A letter from your employer verifying your lost wages. If self-employed,

a statement showing the calculation of your claimed lost income.

11.

Please specify, if known, whether the claim arises out of any of the following

activities of:

(A) Any construction project. _________________________________________

(B) Any demolition project. __________________________________________

(D) Other. _________________________________________________________

12.

State whether the incident has occurred on any sidewalk, street or bridge

located in the City of Atlantic City.

13.

If yes, please give exact location.

Provide a list of your expert witnesses and their reports or statements relating to the

claim.

Please be advised that the City of Atlantic City may require you to submit to a

physical or mental examination by a physician employed by the City of Atlantic City

and you may be required to permit the City of Atlantic City to inspect all appropriate

records relating to your claim for liability and damages including, but not limited to,

income tax returns, hospital records, medical records and employment records subject

to Attorney General rules and regulations regarding same.

I, hereby certify, that the foregoing statements made by me are true, that the attached

Notice Of Tort Claim Page 7