Charles River Insurance: Welcome

5 Whittier Street, Framingham, MA 01701
Main: 508.656.1400, Fax: 508.656.1499
Hours of Operation: M-F, 8:00 a.m. - 5:00 p.m. EST
Available weekends and nights by appointment
info@charlesriverinsurance.com

Report a Claim

	As our company grew, it was important to choose an insurance broker who had the knowledge and experience to provide complete, comprehensive insurance coverage for our specific needs. Charles River Insurance met all of these requirements. They are involved from the beginning stages of evaluating potential new building acquisitions to working with our lenders developing insurance solutions for each property’s unique risk. Working with Charles River Insurance continues to be one of our best business decisions.
	Brian Poitras, Principal Calare Properties, Inc.

Client Services

Commercial General Liability First Notice of Loss Report

The questions with asterisks (*) are required fields. We cannot process your claim without this information. If you do not have all of the information required for these fields, please call us at 508.656.1400. We are available to assist you from 8:00 am - 5:00 pm EST, Monday - Friday.

* Company Name:
* Policy #:
* Filing State:
* Preparer's Name:
* Email:
* Phone #:
* Date of Incident:
* Date Incident Was Reported to Insured:
* Claimant's Name:
* Claimant Address:

* City:
* State:	* Zip:
* Address Where Incident Occurred:

* City:
* State:	* Zip:
Again, if all of the required fields above are not filled in, we cannot process your claim and you will need to call 508.656.1400.
Account #:
Location Code:
Policy Exp. Date:
Company Address:

City:
State:	Zip:

Incident Information:

Time of Loss:	AM PM
Full Description of What Happened, Injury Type, Body Part, Cause or Property Damage:
What Authorities Were Contacted?

Claimant Information:

Phone:
Age:	Gender: Male Female
Social Security:
Claimant's Occupation:
Employer:
Address:

City:
State:	Zip:

For Product Liability, Complete the Following:

Type of Product that Caused the Injury:
Manufacturer's Name:
Address:

City:
State:	Zip:
Phone:
Name of Product that Caused the Injury:
Where Product Can be Seen, if it Has Been Discarded, Indicate So:

For Injury Complete the Following:

Name of Doctor or Hospital:
Address:

City:
State:	Zip:
Phone:
What Injured Was Doing & Description of Injury:

For Damaged Property, Please Complete the Following:

Description of Damaged Property:
Where Can Damaged Property Be Seen (i.e. claimant's possession, body shop)?
Estimated Amount of Damage to Claimant's Property:
Were There Any Witnesses?	YES NO If Yes, Complete the Following:
Name:
Address:

City:
State:	Zip:
Phone:
Name:
Address:

City:
State:	Zip:
Phone:
Name:
Address:

City:
State:	Zip:
Phone:

Coverage Information
(if available, complete only what applies to the loss):

Liability (BI):
Liability (PD):
Prod/Compl Opr:
Fire/Legal Liab:
Occur Lim:	Gen Agg (K):
Prod Compl Oper Agg (K):
Ded Amt:	Ded Cov:
Ext Cov Ded:	Liab Ded:
Ded 1:	Ded 2:
% Co Ins:	Coins Lim:
Forms and Endorsements:
Mortgagee 1:
Mortgagee 2:
Other Insurance-Specify:

Contact Person Regarding this Claim

Contact Person:
Address:

City:
State:	Zip:
Phone:
Comments:
IMPORTANT: Please take a moment to make sure, before hitting the SUBMIT button at the end of this form, that your entries are correct. You can do so by using the scroll bar to the right of this screen. Using the back button of your browser (because of varying browser configurations) may cause information to be lost.


	Claim Reporting Forms
	Commercial / Business General Liability Workers’ Compensation Property Claims Commercial Auto Claim (PDF) Personal Lines Home Personal Auto Claim

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