Current day and time:

This form was created to aid in the processing of loss claims submitted to A TO Z MANAGEMENT, INC.  All losses are reviewed and then directed for consideration under our General Liability coverage, and processed.   Please follow instructions outlined below thoroughly for the prompt processing of your claim.

Procedure:

    1. Fill out this Incident Report Form stating the nature of  loss below.   Reporting can also be made by requesting a LOSS PROCESSING FORM by calling our Office of  Risk Management at (773)283-1518 or emailing your request to: RiskDept@AtoZManagement.com  

    If you wish to mail your claim in, please write to: A TO Z MANAGEMENT, INC. - Risk Management Dept. - 6154 West Belmont Avenue - Chicago, Illinois 60634.

    2. Please contact Risk Department , Claims Manager at (773)283-1518 to discuss the incident report, case, claim specifics or to address any other questions or concerns you may have.  Also, please remember to FAX a hardcopy of the "Incident Report" to (773)685-1271 to expedite the filing of your claim.

When you are finished, just click on the (send) button below the form.  A confirmation of receipt will be emailed to your mailbox.  


Your Name:
Company:
Address:
City, State:
Your Telephone:
Your Email Address:

Input relevant case loss information here and include the following:

-  Individual's Name

-  Date of Loss

-  Time and location of incident

    (i.e., Bakery, Restroom, Aisle #, etc.)

-   Briefly Describe what happened.

 

Note:  Please FAX a hardcopy of the STORE

"Incident Report" to the Claims Department

at (773)685-1271

 

 


         


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