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Click ‘Get Form’ to open the 086 0 16 cause in the editor.
Begin by entering the NAME(S) OF INSURED and POLICY NUMBER at the top of the form. Ensure that this information is accurate as it identifies the insured party.
Next, provide the COMPLETE ADDRESS OF PROPERTY DAMAGED. This section is crucial for identifying where the loss occurred.
In the CAUSE OF LOSS section, check all applicable boxes that describe how the damage occurred. Options include improper diversion of water, negligent maintenance of sewer lines, and more. If 'ANY OTHER FACTOR' applies, explain in the space provided.
Identify any RESPONSIBLE PARTY by filling in their NAME and COMPLETE ADDRESS. Indicate whether they are insured and provide details if applicable.
Complete any additional sections regarding statutes or political subdivisions that may affect a tort action against them.
Finally, review your entries for accuracy before submitting. Attach any definitive materials as required.
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