8250 Woodfield Crossing Blvd, Suite 330 Indianapolis IN 46240 www.hjspier.com info@hjspier.com 317-815-2800 (Main Line)	Commercial Lines Claims: 317-815-2803 Personal Lines Claims: 317-815-2802 After Hours Emergency: 317-363-9774

PROPERTY LOSS NOTICE

Date of Loss:	Time Incident Occurred:
Name of Insured:
Telephone Numbers:	H)	C)	W)
Address:
Location of Loss (if different from above):
Description of Loss and Damage:
Emergency Repairs Made: Y N If Yes, Name of Restoration Company: Restoration Company Contact: Phone Number: Email: