Named Insured

Policy Number

Claim Number

Property Address

City

State

Zip Code

Date of Loss

Date of Discovery

Carrier Appraiser Tel #

Carrier Appraiser Email Address

Carrier Appraiser Assistant’s Email

Insured Appraiser

Insured Appraiser Tel #

Insured Appraiser Email

Insured Appraiser Assistant’s Email

Court Jurisdiction (if applicable)

Court Case Number (if applicable)

Assigned Magistrate (if applicable)

Assigned Judge (if applicable)

Requested Umpire Panel Pre-Inspection Conference

Requested Umpire Panel Meeting Dates (Please Discuss With Each Other)

Carrier Appraiser ESX

Insured Appraiser ESX

Demand Estimate & Pics

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Carrier FA Estimate & Pics

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Carrier Appraiser Estimate

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Insured Appraiser Estimate & Pics

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Insured Incurred Invoices

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Vendor Invoices (Tarp, EMS, Water Mit, Mold,, etc)

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Any Documents to be relied upon (Engineer, Plumbing, Expert, etc)

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Misc Documents.

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