Parking Lot Incident Reporting Form

Parking lot contractor employees are NOT authorized to accept claim presentations or to accept or deny responsibility for claims that could be presented against the City of Phoenix. This form is to be used for informational purposes only.

(Check All Appropriate Boxes)
Damage to Patron's Vehicle
Bodily or Personal Injury
Construction involved in occurrence?
Other
Police Responded
Name
Driver's License # and State
Address
City
State
Zip
Home Phone 
Work Phone 
Year
Make
Model
Color
License Plate and State of Issue
(Optional) Insurance Carrier and Policy
Insurance Phone 
WEG
T3 Garage
T4 Garage
High Profile Lot
W. Economy Lot
EEL Uncovered
EEL Garage A
EEL Garage B
44th St. Lot
Air Cargo Lot
T4RAC
Other
Level
Row
Entry DateTime
Exit DateTime
Description Of Incident* 
Description Of Damage* 
Witness 1 Name
Witness 1 Address
Witness 1 Phone 
Witness 2 Name
Witness 2 Address
Witness 2 Phone 
Exit Booth Location/Number
The file must not exceed 10MB in size.
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If the Patron feels that the City of Phoenix is responsible for the inquiry or damage, please refer then to the City of Phoenix Risk Management Division, at 602-262-5054 to request a liability clain form