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If police responded, attach a copy of the police report or enter the name of the responding agency and the report number.
Attach a copy of any repair estimates you have received or enter any repair information.
I certify that all the statements contained herein and on any attachments hereto are true and that the injuries and/or damages reported were actually incurred. I also acknowledge that it is a misdemeanor to file a false claim with Knoxville Utilities
Board and/or the City of Knoxville and I understand that any claim will be evaluated by KUB pursuant to the terms and practices of the Government Tort Liability Act TCA 29-20-101 et seq.