Claims Form

The Town of Stony Plain will only consider legitimate claims where negligence on the part of the Town is demonstrated. 

In particular, the Town is not automatically liable for claims arising from:

  • Water damage resulting from the breaking or blockage of municipal water and/or sewer infrastructure; 
  • Property damage due to snow or ice related to snow clearing operations; 
  • Property damage and/or injury resulting from potholes

 

Incident Description:

Describe the incident causing your claim in as much detail as possible.

Remember to include all relevant information including but not limited to weather conditions, property damaged, direction of travel.

Upload any pictures and/or diagrams desired to support your claim.

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

By signing and submitting this claim, you confirm the facts and information submitted are all true. 

By signing and submitting this form, you give consent to the Town to share this information as required with the Town of Stony Plain representative, the Town of Stony Plain's insurer and adjuster(s) assigned to handle the claim, the RCMP or other law enforcement agency as required.

The information collected is strictly for the reporting and handling of the claim incident; general information may be retained as part of an incident reporting log and/or risk management processes.

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Protection of Privacy - The personal information requested on this form is collected under the authority of Sectiom 33(c) of the Alberta Freedom of Information and Protection of Privacy Act and will be protected under Part 2 of that Act. It will be used for the purpose of collecting information from this form for the Town of Stony Plain. Direct any questions about this collection to: FOIP Coordinator at the Town of Stony Plain 780-963-2151.

 Alberta FOIP Act