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Private Property Damage Claim

What You Need to Know
City employees are not authorized agents for the City of Fairborn for claim settlement purposes. The City, along with other local municipalities, is a member of a nonprofit government risk pool. Public Entity Risk Services of Ohio (PERSO) administers the claims for the pool. A representative from PERSO is available at 1-866-907-3776 to clarify the claim process for damages incurred to private property.

The City of Fairborn will not assume liability for any damages prior to the completion of a full investigation conducted by city staff and the PERSO claims representative as to the cause of the damage to the private property.

Claimant Name*:

Claimant Address*:

Address Line 2:

City or Town:

Zip or Postal Code:

Claimant Phone Number*:


Date and Time of Incident*
Location of Incident*

Description of Damages and Cost Estimate*

Year, Make, and Model of Claimant's Vehicle (If Applicable)

Claimant's Auto Insurance Agent/Number (If Applicable)

City Vehicle Involved (If Applicable)

Year, Make, Model, Last Four Digits of VIN

Police Report Number (If Available)

Additional Information


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