CSAC EXCESS
INSURANCE AUTHORITY
California Association of
Joint Powers Authorities
Accredited with Excellence
A Public Agency
December 20, 2012
Edward J. Guenette
P.O. Box 157 Hayfork, CA 9604-0157
RE:
Request for Documents
Mr. Guenette:
We are in receipt of your letter dated December 13, 2012, wherein you request a copy of the "CSAC
claim forms and written claim procedures." We are treating your letter as a request for documents
under the California Public Records Act, Government Code § 6250, et seq. While CSAC EIA does not
have the specific forms you requested, we are providing you with copies of documents we believe come
closest to your request, which consist of our Liability First Report form and our Claims Reporting,
Settlement, Reimbursement Procedures.
Please note the Liability First Report form is not a claim form for presenting a claim to a public entity.
Rather it is a form that only our insured public entity members use when reporting a large exposure loss
to CSAC Excess Insurance Authority. If you wish to present a claim to a public entity, you should contact
that public entity and obtain their claim form in order to file a claim with them.
Similar to the Liability First Report form, regarding the "claims procedures" request, we are providing
you a copy of the ElA's claim Reporting, Settlement, Reimbursement Procedures. Again, please note that
this form is for the instruction and use of our insured public entity members and is not intended to
provide instruction to you for the presentation and reporting of a claim to a public entity. You should
contact the specific public entity you wish to file a claim with and obtain their instructions for doing so.
Other than the documents provided, CSAC EIA has no other documents that we believe are responsive
to your request.
You may also review the above forms at our website, http://www.csac-eia.org/index.cfm.
Sincerely
Heather Fregeau
Senior Liability Claims Specialist
_____________ 75 Iron Point Circle,Suite 200 • Folsom, CA 95630 • 916.850.7300 » FAX 916.850.7800 • www.csac-eia.org __________________
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