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Employee Portal
Join the Team
About Us
Who We Are
Our Team
Divisions
Asphalt
Roadway
Structures
Special Projects
Private
Projects
Careers
Work With Us
Open Positions
Internship Program
Resources
Credit Application
Hauler Application
Claims
Contact
Claims
Contact Information
First Name *
Last Name *
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Address Line 2
City *
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Incident Date & Time Information
Date incident occurred *
Date incident reported *
Time incident occurred *
Incident Location
Street Name, Hwy Name, and City
Which lane and direction of travel
Distance in relation to nearest intersection
Property Damaged
List or describe property damaged
(house, yard, or other property)
Vehicle Damaged
Year
Make
Model
VIN Number
Tag Number
Cause of the Incident
What caused the damage: (something in the roadway, a piece of equipment, or the construction in general)*
Accepted file types: jpg, tiff, png, pdf, gif, Max. file size: 50 MB.
Police Information
Was a police report written? *
Yes
No
Did you Contact any E.R. Snell Employee at the site of incident? *
Yes
No
Description
Description of how incident occurred *
Submit