Farmington, MI · Oakland County
Liability Claim / Incident Report
This report documents a claim involving bodily injury or property damage, or an incident with potential for such harm, for a city department to forward.
What this form is
Use this report to document a claim that caused bodily injury or property damage, or an incident that could cause either. It asks for member and department details, claimant and incident information, witness details, supporting documents, and lawsuit service information when applicable. The form directs the completed report to MMRMA Claims.
Who needs it
A city department representative reports a bodily injury or property damage claim, or an incident with potential to cause either.
How to submit it
Forward the report to MMRMA Claims, 14001 Merriman, Livonia, MI 48154. The form also lists telephone (734) 513-0300 and fax (734) 513-0318.
About notarization
This report is signed and dated without a notary; it does not identify any attachment or related step that must be notarized or sworn.
How to submit this form
- 1
Download the Report
Download the Liability Claim / Incident Report PDF.
- 2
Complete the Report
Enter the member, department, claimant, incident, and supporting information that applies.
- 3
Gather Supporting Documents
Indicate whether photographs, supporting documents, or a police report are attached, if applicable.
- 4
Forward the Report
Forward the completed report to MMRMA Claims at the address shown on the form.
Frequently asked questions
- What is the Liability Claim / Incident Report used for?
- The report is used for a claim involving bodily injury or property damage, or an incident with potential to cause bodily injury or property damage.
- What information does the report request?
- It requests member and department details, claimant information, injury or property damage details, witnesses, supporting documents, and lawsuit service information when applicable.
- How do I submit the Liability Claim / Incident Report?
- Forward the completed report to MMRMA Claims, 14001 Merriman, Livonia, MI 48154. The form also lists a telephone number and fax number.
- Do I need a notary for the Liability Claim / Incident Report?
- No. The report is signed and dated without a notary, and it does not identify any attachment or related step that must be notarized or sworn.
Need something notarized?
This Liability Claim / Incident Report doesn’t need a notary — but Michigan residents can notarize other documents online with a commissioned online notary.