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2. Notice

   Filing of this report does not indicate the City of Missoula acknowledges liability. This procedure allows anyone the opportunity to file a claim with the city through the Montana Municipal Interlocal Authority (MMIA), the city’s risk pool. MMIA will investigate all claims and determine the City’s liability, if any. At the end of its investigation, MMIA will contact you directly regarding the outcome of its investigation.

4. Claimant(s)*
5. Email
7. Date of birth
9. Mailing Address
11. City
12. State
13. Zip code
15. Home or cell phone
16. Work phone
18. Date of property damage
19. Time damage occurred
20. Address where property damage occurred
22. Describe property damage
24. Are you making a claim for injury or damage against the City of Missoula?*

    1. Yes
    2. No
26. Name of vehicle owner
27. Address
28. Phone
30. License plate number
31. Vehicle make and model
32. Year
34. Witness name
35. Witness address
36. Witness phone
38. Additional information
40. Signature field

    Enter your name here to sign the report

42. Attachments

    If you have pictures of the damage, witness statements, or estimates for damage, please attach. 

Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit Submit and Print

* indicates a required field