Nirma Interact

To Submit Claim Forms

Click on the appropriate claim form below and fill in all information fields, following the sequential steps.  To retain a copy of the completed form for your records, print the document before submitting. 

General Liability Assignment Notice  (Events involving Motor Graders, Mobile Equipment or Premises Liability including County Roads)

Property Assignment Notice (Events involving damage to county owned buildings)

Auto Liability Assignment Notice (Events involving county owned or operated automobiles)

First Report of Alleged Occupational Injury or Illness (Events involving a job related injury or illness)