Midland Park, MT · Bergen County
Tort Claim Form
Claimants use this form to notify Midland Park and the Bergen County Municipal Joint Insurance Fund of a claim involving an incident.
What this form is
The form collects information about the claimant, incident, alleged injury or property damage, and the basis for the claim. It also requests supporting documents and includes authorizations for employment and health records. The instructions say to file a completed form with the municipality within 90 days after the incident; questions should be answered under oath, and nonapplicable sections may be marked accordingly.
Who needs it
A person filing a tort claim against Midland Park should complete the form and provide the requested information and supporting documents.
How to submit it
Return the completed form and requested documents to the Borough of Midland Park, 280 Godwin Avenue, Midland Park, NJ 07432, and Bergen JIF Claims LLC, 373 Kinderkamack Road, Westwood, NJ 07675. The form also lists [email protected].
About notarization
This document has no notary block and is signed without a notary; its instructions say answers are to be provided under oath, and the signer certifies the information is truthful and complete.
How to submit this form
- 1
Download the Form
Download the Tort Claim Form PDF.
- 2
Complete the Questions
Answer the applicable questions with the information available; mark sections that do not apply as instructed.
- 3
Gather Supporting Documents
Include the documents requested in your answers and any applicable property damage materials.
- 4
Return the Form
Send the completed form and requested documents to the Borough of Midland Park and Bergen JIF Claims LLC using the listed addresses.
Frequently asked questions
- Do I need a notary for the Midland Park Tort Claim Form?
- No. The form has no notary block. Its instructions say answers should be provided under oath, and the claimant signs a certification.
- How do I submit the Midland Park Tort Claim Form?
- Return the completed form and requested documents to the Borough of Midland Park and Bergen JIF Claims LLC at the addresses listed in the form. It also lists an email address.
- What information does the tort claim form request?
- It asks for claimant and incident details, information about alleged injuries or property damage, the claim basis, and supporting documents. Additional sections cover employment and health records.
- When does the form say to file a tort claim?
- The instructions state that timely notices of claim must be filed within 90 days after the incident giving rise to the claim.
Need something notarized?
This Tort Claim Form doesn’t need a notary — but if you have another Midland Park form that does, a commissioned online notary can help.