Eastern Charlotte, New Brunswick
· adopted 2023-02-15
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Snapshot 05564f6a19e0 · verified 2026-06-07 ·
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Liability and Damage Claims Policy (04-2023)
Page 1
POLICY 04-2023
LIABILITY & DAMAGE CLAIMS POLICY
The municipality of Eastern Charlotte works with citizens, businesses, and property owners to
determine the Municipality's liability as it applies to various claims. A damage claim can be filed
if it is believed that the Municipality has been negligent in its maintenance of facilities, roads,
trees and sewers causing bodily injury or property damage.
In the event of injury or property damage, we recommend consulting your insurance company
first, the Municipality is not your insurer and it is usually to your advantage to consult with your
own insurer. The responsibility to repair your damaged property is yours and if you need to
complete any emergency repairs to prevent further damage, it is your responsibility to do so and
keep receipts. If your insurer feels the municipality is responsible, they will pursue the munic-
ipality for reimbursement of your claim.
If you choose to submit a claim against the Municipality, it is important to know that any claim
will take time to investigate. The Municipality only pays when there is a legal obligation to pay,
for instance if the Municipality was negligent in their operations and not usually just due to
extreme weather. If the Municipality is found to be negligent, the amount paid is based on a
current value, not replacement cost. As an example, potholes are a way of life, are considered a
sudden unpreventable occurrence and the Municipality's liability only arises if the Municipality
fails to respond to the hazard in a reasonable time.
POLICY DETAILS & AUTHORITY
Liability & Damage Claims Policy (04-2023)
Reviewed by Committee on 07 February 2023.
This policy was adopted by Resolution of Council on 15 February 2023.
DAMAGE CLAIM FORM
EC Damage Claim Form - 02/23
1
Section 1: INCIDENT INFORMATION
Incident Date
Incident Time
Weather conditions at time of incident
Reporter Name
Reporter Address
Reporter Phone
Incident Address or Location
Describe what happened in as much detail as possible. Use a separate sheet if necessary. Please include relevant supporting photographs and documentation.
Check here if additional pages are provided. There are ____ additional pages attached.
Section 2: WITNESS INFORMATION
Are there any witnesses to the incident?
No Yes (Please complete witness information below)
Please attach a separate statement from each witness listed below, and have them sign at the end of this form.
Witness #1 Name and Phone)
Witness #2 Name and Phone)
Witness #1 Address
Witness #2 Address
How was this witness connected to the incident?
How was this witness connected to the incident?
Section 3: PERSONAL INJURY DETAILS
Check here if there were NO PERSONAL INJURIES resulting from the incident and continue to the next section.
Name of Injured Person
Home Phone
Date of Birth
Address
City/Town
Postal Code
Medicare #
Name of Insurer
Insurer Policy #
Insurer Case #
Part(s) of Body Injured (Specify Left/Right)
Have you missed any time from work,
beyond the day of the accident, due
to injury?
Yes No
Last Worked Date
Name of Employer / Supervisor
Employer Phone
Check here if injured party elected to forego medical treatment
Signature & Date
Name of First Doctor Seen
Doctor Phone
Date of First Examination
Medical Facility Name & Address
Medical Facility Address
Damage Claim Form, page 2
2
EC Damage Claim Form - 02/23
Section 4: PROPERTY DAMAGE DETAILS
Check here if there were NO PERSONAL INJURIES resulting from the incident and continue to the next section.
Type of Property (i.e. vehicle, house, fence, etc.)
Owner of Property (if different from Reporter)
Year of Make / Build
Prior Condition of Property
Property Insurer
Insurer Policy #
Insurer Case #
Have you obtained any quotes to repair/replace the damaged property?
No Yes (Please complete the following)
Quote Obtained From
Date of Quote
Quoted Cost of Repair/Replacement
Have you already made any repair to/replacement of the damaged property?
No Yes
If yes, please attach copies of all receipts and work orders.
Section 5: ADDITIONAL INFORMATION
Were Police/RCMP Contacted? No Yes
Date & Time of Contact
Police/RCMP File #
Was a Municipal vehicle or piece of equipment involved? No Yes
If Yes, Name of Operator
Section 6: REPORTER DECLARATION
By signing below, I certify all preceding information to be true and correct to the best of my knowledge.
I also give the municipality of Eastern Charlotte permission to contact the parties named above for the purpose of
investigating this claim.
If it should be determined the information in this claim is false, I release the municipality of Eastern Charlotte, its officers,
employees, agents and insurers from all claims of liability.
Signature
Date
Section 6: WITNESS DECLARATION
By signing below, I believe the facts stated in this claim and my attached witness statement to be true.
Printed Name (Witness #1)
Printed Name (Witness #2)
Signature (Witness #1)
Signature (Witness #2)
Date (Witness #1)
Date (Witness #2)