MCFRS Claims Reporting Form

If you are involved in a collision or received property damage with Montgomery County Fire and Rescue Service (MCFRS), the following information is provided for you to report to your Insurance Carrier:

MCFRS INSURANCE CARRIER: National Union Fire Insurance Company of Pittsburgh, PA

MCFRS INSURANCE CARRIER PHONE: 1-800-233-1957 (ask for claims support)

MCFRS INSURANCE CARRIER POLICY NUMBER: VFNU-CM-0014036-04

MCFRS recommends you report the incident to YOUR insurance carrier as soon as possible. MCFRS officials will report the claim to their insurance carrier. The claims support staff will be in contact with you as needed. Please be sure that a MCFRS official is provided with your name and contact information so the insurance claims support staff can reach you.

Thank you for your understanding.

Type of Damage:*

Vehicle CollisionProperty DamageBoth Vehicle Collision and Property Damage

Describe the Collision Damage*

Describe the Property Damage*

Fire Rescue Incident Number

Location of Incident*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date*

Date

Hour MinutesAM/PM Option

Police Report Number

MCFRS Unit Name*

MCFRS Unit Stock Number*

MCFRS Safety Officer*

MCFRS Safety Officer (Other)*

MCFRS Safety Officer Phone Number*

Please enter a valid phone number.

MCFRS Safety Officer (Other) E-Mail Address

example@example.com

MCFRS Safety Officer Phone Number

Civilian Driver's Name*

First NameLast Name

E-Mail or Text Delivery*

E-MailText

E-Mail or Text Delivery?

E-MailText

Civilian Driver's E-Mail Address*

example@example.com

Civilian Driver's Mobile Carrier

Civilian Driver's Cell Number for Text*