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© 2004-2016 DKF Solutions Group All rights reserved. <br /> <br />City of Redwood City: Overflow Emergency Response Plan B-8 Sanitary Sewer Overflow/Backup Response Packet <br />Claims Submittal Checklist <br /> Complete this form if there is a Sanitary Sewer Backup into/onto Private Property <br /> <br />Public Works Supervisor <br />1. Complete the following information: <br />Title: <br />Name: <br />Phone: <br />Today’s Date: <br /> <br />2. Copy the items listed below and retain originals for internal archiving purposes. <br />3. Place the copies in the Backup Response Envelope and forward to the City Risk Manager: <br /> Form B-2: Start Time Determination Form <br /> Form B-3: Volume Estimation Forms (a, b and/or c) <br /> Form B-4: Sanitary Sewer Overflow Report <br /> Form B-5: Lateral CCTV Report <br /> Form B-7: First Responder Form <br /> Form B-8: Claims Submittal Checklist (this form) <br /> All photos taken: Check here if digital photographs will be forwarded separately ☐ <br /> Any other information you feel is important in this claim <br /> <br />4. Go to Regulatory Notifications Packet and make all appropriate notifications. <br />5. Complete Form BP-9: Collection System Failure Analysis <br /> <br />City Risk Manager’s Office <br />1. Verify claims packet is complete. <br />2. Notify Acclamation Insurance Management Services: <br />Ge’Nell Gary <br />Program Manager <br />(925) 246-2600 or (916) 563-1900 <br />ggary@aims4claims.com <br /> <br />P.O.Box 269120 <br />Sacramento, CA 95826 <br /> <br />www.aims4claims.com <br />6.2.A. - Page 150