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Flood and Storm Damage Report

Complete this form to report damage(s) due to flood and storm.

Your personal information is being collected under the authority of section 25 of the Local Authority Freedom of Information and Protection of Privacy Act. This information will only be used to administer the program/activity it was collected for. If you have any questions about the collection please contact the Office of the City Clerk at 780-875-6184 or email cityclerk@lloydminster.ca

Name:

Address:

City:

Province:

Contact Number:

Email:

Address of Concern:

Description of Concern: (please provide as many information as you can)

Have you reported the damage(s) to your insurance provider?:

YES, I have contacted my insurance provider.

NO, I have not (yet) contacted my insurance provider.

NO, I do not have insurance coverage.

Upload a Photo: (If applicable)

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Request for follow up?

YES, I would like to be contacted regarding my concern.

NO, I just want to report the concern.

Forms

Flood and Storm Damage Report

Thank you for submitting your report.