doc_id stringlengths 7 69 | category stringclasses 10
values | source stringclasses 2
values | original_format stringclasses 5
values | schema stringclasses 10
values | document stringlengths 175 4M | expected stringlengths 113 2.58k |
|---|---|---|---|---|---|---|
synth_coi_058 | insurance_certificates | synthetic | markdown | certificate_of_liability.yaml | # Certificate of Liability Insurance
Date (MM/DD/YYYY): 06/08/2025
---
## Producer
Summit Risk Advisors LLC
1200 Market Street, 4th Floor
Philadelphia, PA 19107
Phone: (215) 555-0188
## Insured
Westridge Concrete Foundations
3300 S. Figueroa Street
Los Angeles, CA 90007
## Insurers Affording Coverage
- Insurer ... | {"certificate_date": "2025-06-08", "producer_name": "Summit Risk Advisors LLC", "producer_phone": "(215) 555-0188", "insured_name": "Westridge Concrete Foundations", "certificate_holder_name": "Crossroads Commercial Properties", "policies": [{"policy_number": "CGL9965714", "coverage_type": "Commercial General Liability... |
fema_proof_of_loss_086 | insurance_claims | real | PDF (parsed via docling) | claim_form.yaml | ## DEPARTMENT OF HOMELAND SECURITY
## Federal Emergency Management Agency
## PROOF OF LOSS
OMB Control Number: 1660-0005
Expiration: 7-31-2020
Filing:
- [ ] Initial
- [ ] Additional
Name(s) of Insured:
Policy Number:
Address of Insured Property:
City:
State:
ZIP:
Date & Time of Loss:
Is there a mortg... | {"form_type": "Proof of Loss", "claimant_name": null, "employer_name": null, "date_of_loss": null, "description_of_loss": null, "body_part": null, "amount_claimed": null, "policy_number": null, "state": null} |
fema_proof_of_loss_hpcc | insurance_claims | real | PDF (parsed via docling) | claim_form.yaml | ## DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency
Hermit's Peak/Calf Canyon Claims Office
## PROOF OF LOSS
## TYPE OF PROOF OF LOSS
## AMOUNTS CLAIMED
## CLAIMANT CONTACT INFORMATION
Claim Number:
For verification purposes, please provide one or more of the following:
Tax Identification Num... | {"form_type": "Proof of Loss", "claimant_name": null, "employer_name": null, "date_of_loss": null, "description_of_loss": null, "body_part": null, "amount_claimed": null, "policy_number": null, "state": null} |
structural_loss_run_gap1_001 | insurance_claims | synthetic | markdown | claim_form.yaml | # Hartford Financial Services
## Loss Run / Claims History Report
Insured: Structural Test Corp 1
Policy: CGL-2867825 (General Liability)
Period: 01/01/2025 — 12/31/2025
As of: 07/15/2025
---
| Claim No. | Loss Date | Claimant Name | Description | Status | Reserve | Paid to Date |
|---|---|---|---|---|---|---|
| HF... | {"form_type": "Loss Run", "claimant_name": null, "employer_name": "Structural Test Corp 1", "policy_number": "CGL-2867825", "state": "TX"} |
structural_loss_run_gap1_002 | insurance_claims | synthetic | markdown | claim_form.yaml | # Zurich American Insurance
## Loss Run / Claims History Report
Insured: Structural Test Corp 2
Policy: CGL-6279418 (General Liability)
Period: 01/01/2025 — 12/31/2025
As of: 07/15/2025
---
| Claim No. | Loss Date | Claimant Name | Description | Status | Reserve | Paid to Date |
|---|---|---|---|---|---|---|
| ZA-2... | {"form_type": "Loss Run", "claimant_name": null, "employer_name": "Structural Test Corp 2", "policy_number": "CGL-6279418", "state": "CA"} |
structural_loss_run_gap1_003 | insurance_claims | synthetic | markdown | claim_form.yaml | # Liberty Mutual Insurance
## Loss Run / Claims History Report
Insured: Structural Test Corp 3
Policy: CGL-7264956 (General Liability)
Period: 01/01/2025 — 12/31/2025
As of: 07/15/2025
---
| Claim No. | Loss Date | Claimant Name | Description | Status | Reserve | Paid to Date |
|---|---|---|---|---|---|---|
| LM-20... | {"form_type": "Loss Run", "claimant_name": null, "employer_name": "Structural Test Corp 3", "policy_number": "CGL-7264956", "state": "NY"} |
structural_loss_run_gap1_004 | insurance_claims | synthetic | markdown | claim_form.yaml | # CNA Financial Corporation
## Loss Run / Claims History Report
Insured: Structural Test Corp 4
Policy: CGL-8999183 (General Liability)
Period: 01/01/2025 — 12/31/2025
As of: 07/15/2025
---
| Claim No. | Loss Date | Claimant Name | Description | Status | Reserve | Paid to Date |
|---|---|---|---|---|---|---|
| CNA-... | {"form_type": "Loss Run", "claimant_name": null, "employer_name": "Structural Test Corp 4", "policy_number": "CGL-8999183", "state": "FL"} |
structural_loss_run_gap1_005 | insurance_claims | synthetic | markdown | claim_form.yaml | # Erie Insurance Group
## Loss Run / Claims History Report
Insured: Structural Test Corp 5
Policy: CGL-3484601 (General Liability)
Period: 01/01/2025 — 12/31/2025
As of: 07/15/2025
---
| Claim No. | Loss Date | Claimant Name | Description | Status | Reserve | Paid to Date |
|---|---|---|---|---|---|---|
| EI-2025-6... | {"form_type": "Loss Run", "claimant_name": null, "employer_name": "Structural Test Corp 5", "policy_number": "CGL-3484601", "state": "IL"} |
structural_loss_run_gap2_001 | insurance_claims | synthetic | markdown | claim_form.yaml | # Liberty Mutual Insurance
## Loss Run / Claims History Report
Insured: PageBreak Industries 1
Policy: WC-7361002 (Workers Compensation)
Period: 01/01/2025 — 12/31/2025
---
| Claim No. | Loss Date | Claimant Name | Description | Status | Reserve | Paid to Date |
|---|---|---|---|---|---|---|
| LM-2025-98777 | 12/06... | {"form_type": "Loss Run", "claimant_name": null, "employer_name": "PageBreak Industries 1", "policy_number": "WC-7361002", "state": "OH"} |
structural_loss_run_gap2_002 | insurance_claims | synthetic | markdown | claim_form.yaml | # CNA Financial Corporation
## Loss Run / Claims History Report
Insured: PageBreak Industries 2
Policy: WC-9910914 (Workers Compensation)
Period: 01/01/2025 — 12/31/2025
---
| Claim No. | Loss Date | Claimant Name | Description | Status | Reserve | Paid to Date |
|---|---|---|---|---|---|---|
| CNA-2025-83259 | 10/... | {"form_type": "Loss Run", "claimant_name": null, "employer_name": "PageBreak Industries 2", "policy_number": "WC-9910914", "state": "PA"} |
structural_loss_run_gap2_003 | insurance_claims | synthetic | markdown | claim_form.yaml | # Erie Insurance Group
## Loss Run / Claims History Report
Insured: PageBreak Industries 3
Policy: WC-1486955 (Workers Compensation)
Period: 01/01/2025 — 12/31/2025
---
| Claim No. | Loss Date | Claimant Name | Description | Status | Reserve | Paid to Date |
|---|---|---|---|---|---|---|
| EI-2025-60968 | 06/22/202... | {"form_type": "Loss Run", "claimant_name": null, "employer_name": "PageBreak Industries 3", "policy_number": "WC-1486955", "state": "GA"} |
structural_loss_run_gap4_001 | insurance_claims | synthetic | markdown | claim_form.yaml | # Hartford Financial Services
## Combined Loss Run Report — MultiCov Enterprises 1
Prepared: 07/15/2025
---
## SECTION 1: GENERAL LIABILITY
Policy: CGL-2921542
Period: 01/01/2025 — 12/31/2025
| Claim No. | Loss Date | Claimant | Description | Status | Reserve | Paid |
|---|---|---|---|---|---|---|
| HF-2025-50768... | {"form_type": "Loss Run", "claimant_name": null, "employer_name": "MultiCov Enterprises 1", "policy_number": "CGL-2921542", "state": "NJ"} |
structural_loss_run_gap4_002 | insurance_claims | synthetic | markdown | claim_form.yaml | # Zurich American Insurance
## Combined Loss Run Report — MultiCov Enterprises 2
Prepared: 07/15/2025
---
## SECTION 1: GENERAL LIABILITY
Policy: CGL-7358385
Period: 01/01/2025 — 12/31/2025
| Claim No. | Loss Date | Claimant | Description | Status | Reserve | Paid |
|---|---|---|---|---|---|---|
| ZA-2025-13761 |... | {"form_type": "Loss Run", "claimant_name": null, "employer_name": "MultiCov Enterprises 2", "policy_number": "CGL-7358385", "state": "MA"} |
synth_claim_001 | insurance_claims | synthetic | markdown | claim_form.yaml | # WORKERS' COMPENSATION — FIRST REPORT OF INJURY
**State:** FL
**Report Date:** 08/17/2025
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Golden Gate Assurance Corp. |
| Policy Number | WC-707970 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Westri... | {"form_type": "Employer's First Report", "claimant_name": "Michael D. Baptiste", "employer_name": "Westridge Concrete Foundations", "date_of_loss": "2025-04-10", "description_of_loss": "Worker caught left wrist in conveyor belt mechanism.", "body_part": "left wrist", "amount_claimed": null, "policy_number": "WC-707970"... |
synth_claim_002 | insurance_claims | synthetic | markdown | claim_form.yaml | # FIRST REPORT OF INJURY
**State:** OK
**Report Date:** 04/24/2025
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Sterling National Insurance Co. |
| Policy Number | WC-505441 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Continental Scaffolding In... | {"form_type": "Employer's First Report", "claimant_name": "Brian K. Fontaine", "employer_name": "Continental Scaffolding Inc.", "date_of_loss": "2025-11-14", "description_of_loss": "Worker twisted left shoulder while stepping off truck bed.", "body_part": "left shoulder", "amount_claimed": null, "policy_number": "WC-50... |
synth_claim_003 | insurance_claims | synthetic | markdown | claim_form.yaml | # EMPLOYER'S FIRST REPORT OF INJURY OR ILLNESS
**State:** OK
**Report Date:** 07/28/2025
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Appalachian Fidelity Mutual |
| Policy Number | WC-571894 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Suncoast... | {"form_type": "Employer's First Report", "claimant_name": "Kathleen M. Beaumont", "employer_name": "Suncoast Roofing & Waterproofing", "date_of_loss": "2026-07-08", "description_of_loss": "Employee hyperextended right hand while reaching for overhead item.", "body_part": "right hand", "amount_claimed": null, "policy_nu... |
synth_claim_004 | insurance_claims | synthetic | markdown | claim_form.yaml | # WORKERS' COMPENSATION — FIRST REPORT OF INJURY
**State:** NY
**Report Date:** 11/03/2025
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Mountain West Casualty Co. |
| Policy Number | WC-845771 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Iron Ho... | {"form_type": "Employer's First Report", "claimant_name": "Robert T. Nakamura", "employer_name": "Iron Horse Steel Erectors Inc.", "date_of_loss": "2026-09-07", "description_of_loss": "Worker slipped on ice in parking lot, injuring lower back.", "body_part": "lower back", "amount_claimed": null, "policy_number": "WC-84... |
synth_claim_005 | insurance_claims | synthetic | markdown | claim_form.yaml | # EMPLOYER'S FIRST REPORT OF INJURY OR ILLNESS
**State:** IN
**Report Date:** 11/03/2025
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Midwest Indemnity Holdings |
| Policy Number | WC-407773 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Silverlin... | {"form_type": "Employer's First Report", "claimant_name": "Christopher S. Patel", "employer_name": "Silverline Electrical Contractors", "date_of_loss": "2025-06-18", "description_of_loss": "Employee cut right shoulder on exposed metal edge of equipment.", "body_part": "right shoulder", "amount_claimed": null, "policy_n... |
synth_claim_006 | insurance_claims | synthetic | markdown | claim_form.yaml | # FIRST REPORT OF INJURY
**State:** FL
**Report Date:** 06/20/2026
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Pinnacle Specialty Insurance |
| Policy Number | WC-559466 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Iron Horse Steel Erectors Inc... | {"form_type": "Employer's First Report", "claimant_name": "Michael D. Baptiste", "employer_name": "Iron Horse Steel Erectors Inc.", "date_of_loss": "2025-10-16", "description_of_loss": "Worker fell through unsecured floor opening, injuring left ankle.", "body_part": "left ankle", "amount_claimed": null, "policy_number"... |
synth_claim_007 | insurance_claims | synthetic | markdown | claim_form.yaml | # FIRST REPORT OF INJURY
**State:** TX
**Report Date:** 10/20/2026
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Keystone Indemnity Group |
| Policy Number | WC-382729 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Continental Scaffolding Inc. |
| ... | {"form_type": "Employer's First Report", "claimant_name": "Frank B. Estrada", "employer_name": "Continental Scaffolding Inc.", "date_of_loss": "2025-11-10", "description_of_loss": "Employee was operating forklift when sudden stop caused whiplash and injury to right knee.", "body_part": "right knee", "amount_claimed": n... |
synth_claim_008 | insurance_claims | synthetic | markdown | claim_form.yaml | # EMPLOYER'S FIRST REPORT OF INJURY OR ILLNESS
**State:** OR
**Report Date:** 06/21/2026
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Keystone Indemnity Group |
| Policy Number | WC-452230 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Redline Fir... | {"form_type": "Employer's First Report", "claimant_name": "Donna J. Bergstrom", "employer_name": "Redline Fire Protection Corp.", "date_of_loss": "2025-08-18", "description_of_loss": "Worker slipped on ice in parking lot, injuring lower back.", "body_part": "lower back", "amount_claimed": null, "policy_number": "WC-452... |
synth_claim_009 | insurance_claims | synthetic | markdown | claim_form.yaml | # EMPLOYER'S FIRST REPORT OF INJURY OR ILLNESS
**State:** LA
**Report Date:** 11/25/2026
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Pinnacle Specialty Insurance |
| Policy Number | WC-763991 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Atlas F... | {"form_type": "Employer's First Report", "claimant_name": "Mark A. Castellano", "employer_name": "Atlas Framing & Construction LLC", "date_of_loss": "2025-09-02", "description_of_loss": "Worker fell through unsecured floor opening, injuring lower back.", "body_part": "lower back", "amount_claimed": null, "policy_number... |
synth_claim_010 | insurance_claims | synthetic | markdown | claim_form.yaml | # WORKERS' COMPENSATION — FIRST REPORT OF INJURY
**State:** OK
**Report Date:** 10/23/2026
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Appalachian Fidelity Mutual |
| Policy Number | WC-685946 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Westri... | {"form_type": "Employer's First Report", "claimant_name": "Gary W. Ishikawa", "employer_name": "Westridge Concrete Foundations", "date_of_loss": "2026-05-27", "description_of_loss": "Employee was pinched between two heavy objects, crushing right wrist.", "body_part": "right wrist", "amount_claimed": null, "policy_numbe... |
synth_claim_011 | insurance_claims | synthetic | markdown | claim_form.yaml | # WORKERS' COMPENSATION — FIRST REPORT OF INJURY
**State:** FL
**Report Date:** 02/28/2025
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Pinnacle Specialty Insurance |
| Policy Number | WC-286488 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Tri-S... | {"form_type": "Employer's First Report", "claimant_name": "Laura C. Novak", "employer_name": "Tri-State Warehouse Solutions", "date_of_loss": "2026-03-16", "description_of_loss": "Employee was pinched between two heavy objects, crushing left knee.", "body_part": "left knee", "amount_claimed": null, "policy_number": "WC... |
synth_claim_012 | insurance_claims | synthetic | markdown | claim_form.yaml | # EMPLOYER'S FIRST REPORT OF INJURY OR ILLNESS
**State:** OR
**Report Date:** 09/04/2025
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Evergreen Mutual Insurance Company |
| Policy Number | WC-620340 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | N... | {"form_type": "Employer's First Report", "claimant_name": "Barbara J. Okafor", "employer_name": "Northern Star Telecom Services", "date_of_loss": "2026-06-13", "description_of_loss": "Employee hyperextended neck while reaching for overhead item.", "body_part": "neck", "amount_claimed": null, "policy_number": "WC-620340... |
synth_claim_013 | insurance_claims | synthetic | markdown | claim_form.yaml | # WORKERS' COMPENSATION — FIRST REPORT OF INJURY
**State:** WA
**Report Date:** 09/16/2026
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Keystone Indemnity Group |
| Policy Number | WC-165309 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Redline F... | {"form_type": "Employer's First Report", "claimant_name": "Brian K. Fontaine", "employer_name": "Redline Fire Protection Corp.", "date_of_loss": "2025-09-02", "description_of_loss": "Worker caught left elbow in conveyor belt mechanism.", "body_part": "left elbow", "amount_claimed": null, "policy_number": "WC-165309", "... |
synth_claim_014 | insurance_claims | synthetic | markdown | claim_form.yaml | # EMPLOYER'S FIRST REPORT OF INJURY OR ILLNESS
**State:** MN
**Report Date:** 08/25/2025
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Northern Lights Insurance Corp. |
| Policy Number | WC-916069 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Redl... | {"form_type": "Employer's First Report", "claimant_name": "Margaret A. Lindstrom", "employer_name": "Redline Fire Protection Corp.", "date_of_loss": "2025-09-25", "description_of_loss": "Worker strained neck while pulling heavy pallet across loading dock.", "body_part": "neck", "amount_claimed": null, "policy_number": ... |
synth_claim_015 | insurance_claims | synthetic | markdown | claim_form.yaml | # EMPLOYER'S FIRST REPORT OF INJURY OR ILLNESS
**State:** FL
**Report Date:** 09/27/2025
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Liberty Bell Underwriters |
| Policy Number | WC-356441 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Westridge ... | {"form_type": "Employer's First Report", "claimant_name": "Sandra L. Walsh", "employer_name": "Westridge Concrete Foundations", "date_of_loss": "2026-04-16", "description_of_loss": "Employee was pinched between two heavy objects, crushing left eye.", "body_part": "left eye", "amount_claimed": null, "policy_number": "WC... |
synth_claim_016 | insurance_claims | synthetic | markdown | claim_form.yaml | # EMPLOYER'S FIRST REPORT OF INJURY OR ILLNESS
**State:** MN
**Report Date:** 01/04/2025
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Golden Gate Assurance Corp. |
| Policy Number | WC-831323 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Granite ... | {"form_type": "Employer's First Report", "claimant_name": "Heather N. Ridgeway", "employer_name": "Granite Peak General Contractors", "date_of_loss": "2025-06-04", "description_of_loss": "Employee hyperextended left ankle while reaching for overhead item.", "body_part": "left ankle", "amount_claimed": null, "policy_num... |
synth_claim_017 | insurance_claims | synthetic | markdown | claim_form.yaml | # FIRST REPORT OF INJURY
**State:** IL
**Report Date:** 01/07/2025
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Pacific Crest Casualty |
| Policy Number | WC-220872 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Pacific Coast Cold Storage LLC |
| ... | {"form_type": "Employer's First Report", "claimant_name": "Christopher S. Patel", "employer_name": "Pacific Coast Cold Storage LLC", "date_of_loss": "2025-04-25", "description_of_loss": "Worker slipped on oily surface and landed hard on right eye.", "body_part": "right eye", "amount_claimed": null, "policy_number": "WC... |
synth_claim_018 | insurance_claims | synthetic | markdown | claim_form.yaml | # EMPLOYER'S FIRST REPORT OF INJURY OR ILLNESS
**State:** CA
**Report Date:** 08/14/2026
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Pacific Crest Casualty |
| Policy Number | WC-219639 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Northern Star... | {"form_type": "Employer's First Report", "claimant_name": "Matthew T. Ivanov", "employer_name": "Northern Star Telecom Services", "date_of_loss": "2025-12-04", "description_of_loss": "Employee fell from ladder approximately 8 feet, landing on chest.", "body_part": "chest", "amount_claimed": null, "policy_number": "WC-2... |
synth_claim_019 | insurance_claims | synthetic | markdown | claim_form.yaml | # FIRST REPORT OF INJURY
**State:** NY
**Report Date:** 02/19/2025
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Evergreen Mutual Insurance Company |
| Policy Number | WC-339199 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Northern Star Telecom S... | {"form_type": "Employer's First Report", "claimant_name": "Elizabeth R. Dominguez", "employer_name": "Northern Star Telecom Services", "date_of_loss": "2025-08-03", "description_of_loss": "Worker fell through unsecured floor opening, injuring right wrist.", "body_part": "right wrist", "amount_claimed": null, "policy_nu... |
synth_claim_020 | insurance_claims | synthetic | markdown | claim_form.yaml | # WORKERS' COMPENSATION — FIRST REPORT OF INJURY
**State:** IL
**Report Date:** 10/18/2025
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Atlantic Coast Mutual |
| Policy Number | WC-314250 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Riverside Fo... | {"form_type": "Employer's First Report", "claimant_name": "David C. Ramirez", "employer_name": "Riverside Food Processing Inc.", "date_of_loss": "2026-02-23", "description_of_loss": "Worker slipped on ice in parking lot, injuring right knee.", "body_part": "right knee", "amount_claimed": null, "policy_number": "WC-3142... |
synth_claim_021 | insurance_claims | synthetic | markdown | claim_form.yaml | # FIRST REPORT OF INJURY
**State:** OR
**Report Date:** 07/11/2026
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Continental Shield Insurance Co. |
| Policy Number | WC-831137 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Cascade Plumbing & HVAC I... | {"form_type": "Employer's First Report", "claimant_name": "Rebecca F. Salazar", "employer_name": "Cascade Plumbing & HVAC Inc.", "date_of_loss": "2025-08-08", "description_of_loss": "Worker slipped on oily surface and landed hard on right ankle.", "body_part": "right ankle", "amount_claimed": null, "policy_number": "WC... |
synth_claim_022 | insurance_claims | synthetic | markdown | claim_form.yaml | # WORKERS' COMPENSATION — FIRST REPORT OF INJURY
**State:** NY
**Report Date:** 05/07/2025
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Mountain West Casualty Co. |
| Policy Number | WC-250558 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Iron Ho... | {"form_type": "Employer's First Report", "claimant_name": "Brian K. Fontaine", "employer_name": "Iron Horse Steel Erectors Inc.", "date_of_loss": "2025-09-25", "description_of_loss": "Employee was operating forklift when sudden stop caused whiplash and injury to multiple body parts.", "body_part": "multiple body parts"... |
synth_claim_023 | insurance_claims | synthetic | markdown | claim_form.yaml | # FIRST REPORT OF INJURY
**State:** PA
**Report Date:** 09/05/2025
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Mountain West Casualty Co. |
| Policy Number | WC-190266 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Prairie Home Builders LLC |
| F... | {"form_type": "Employer's First Report", "claimant_name": "William K. Chen", "employer_name": "Prairie Home Builders LLC", "date_of_loss": "2025-10-22", "description_of_loss": "Employee cut left foot on exposed metal edge of equipment.", "body_part": "left foot", "amount_claimed": null, "policy_number": "WC-190266", "s... |
synth_claim_024 | insurance_claims | synthetic | markdown | claim_form.yaml | # EMPLOYER'S FIRST REPORT OF INJURY OR ILLNESS
**State:** IL
**Report Date:** 11/21/2025
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Golden Gate Assurance Corp. |
| Policy Number | WC-931405 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Pinnacle... | {"form_type": "Employer's First Report", "claimant_name": "Frank B. Estrada", "employer_name": "Pinnacle Manufacturing Group", "date_of_loss": "2025-01-13", "description_of_loss": "Employee fell from ladder approximately 8 feet, landing on lower back.", "body_part": "lower back", "amount_claimed": null, "policy_number"... |
synth_claim_025 | insurance_claims | synthetic | markdown | claim_form.yaml | # EMPLOYER'S FIRST REPORT OF INJURY OR ILLNESS
**State:** IL
**Report Date:** 02/10/2025
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Northern Lights Insurance Corp. |
| Policy Number | WC-120828 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Casc... | {"form_type": "Employer's First Report", "claimant_name": "Jeffrey D. Cranston", "employer_name": "Cascade Plumbing & HVAC Inc.", "date_of_loss": "2025-10-24", "description_of_loss": "Worker slipped on ice in parking lot, injuring left elbow.", "body_part": "left elbow", "amount_claimed": null, "policy_number": "WC-120... |
synth_claim_026 | insurance_claims | synthetic | markdown | claim_form.yaml | # FIRST REPORT OF INJURY
**State:** CA
**Report Date:** 08/09/2026
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Northern Lights Insurance Corp. |
| Policy Number | WC-787221 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Westridge Concrete Foundat... | {"form_type": "Employer's First Report", "claimant_name": "Jason R. Dietrich", "employer_name": "Westridge Concrete Foundations", "date_of_loss": "2026-07-11", "description_of_loss": "Worker slipped on oily surface and landed hard on right hand.", "body_part": "right hand", "amount_claimed": null, "policy_number": "WC-... |
synth_claim_027 | insurance_claims | synthetic | markdown | claim_form.yaml | # EMPLOYER'S FIRST REPORT OF INJURY OR ILLNESS
**State:** ID
**Report Date:** 03/07/2026
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Atlantic Coast Mutual |
| Policy Number | WC-700253 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Suncoast Roofi... | {"form_type": "Employer's First Report", "claimant_name": "William K. Chen", "employer_name": "Suncoast Roofing & Waterproofing", "date_of_loss": "2026-06-03", "description_of_loss": "Employee was struck by coworker's tool, impacting right elbow.", "body_part": "right elbow", "amount_claimed": null, "policy_number": "W... |
synth_claim_028 | insurance_claims | synthetic | markdown | claim_form.yaml | # WORKERS' COMPENSATION — FIRST REPORT OF INJURY
**State:** IL
**Report Date:** 04/18/2025
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Pacific Crest Casualty |
| Policy Number | WC-546622 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Granite Pea... | {"form_type": "Employer's First Report", "claimant_name": "Karen N. Blackwell", "employer_name": "Granite Peak General Contractors", "date_of_loss": "2025-03-06", "description_of_loss": "Worker fell through unsecured floor opening, injuring left hip.", "body_part": "left hip", "amount_claimed": null, "policy_number": "... |
synth_claim_029 | insurance_claims | synthetic | markdown | claim_form.yaml | # FIRST REPORT OF INJURY
**State:** FL
**Report Date:** 03/22/2025
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Keystone Indemnity Group |
| Policy Number | WC-324427 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Cornerstone Civil Engineering PC ... | {"form_type": "Employer's First Report", "claimant_name": "Timothy N. Reeves", "employer_name": "Cornerstone Civil Engineering PC", "date_of_loss": "2026-01-14", "description_of_loss": "Worker slipped on oily surface and landed hard on right eye.", "body_part": "right eye", "amount_claimed": null, "policy_number": "WC-... |
synth_claim_030 | insurance_claims | synthetic | markdown | claim_form.yaml | # FIRST REPORT OF INJURY
**State:** CO
**Report Date:** 06/07/2025
---
## Carrier / Insurer Information
| Field | Value |
|---|---|
| Insurance Carrier | Sterling National Insurance Co. |
| Policy Number | WC-701589 |
## Employer Information
| Field | Value |
|---|---|
| Employer Name | Westridge Concrete Foundat... | {"form_type": "Employer's First Report", "claimant_name": "Robert T. Nakamura", "employer_name": "Westridge Concrete Foundations", "date_of_loss": "2025-08-20", "description_of_loss": "Employee repetitive motion injury to right ankle from assembly line work.", "body_part": "right ankle", "amount_claimed": null, "policy... |
synth_claim_031 | insurance_claims | synthetic | markdown | claim_form.yaml | # PROOF OF LOSS
**Insurance Company:** Tidewater Surety & Casualty
---
## Policy and Claim Information
| Field | Value |
|---|---|
| Policy Number | FLD-157859 |
| Claim Number | CLM-840539 |
| Date of Loss | 12/28/2026 |
| Date Reported | 01/10/2026 |
## Insured Information
| Field | Value |
|---|---|
| Insured ... | {"form_type": "Proof of Loss", "claimant_name": "Angela M. Petrovic", "employer_name": null, "date_of_loss": "2026-12-28", "description_of_loss": "Wind-driven rain entered through damaged window seals, causing mold growth in walls and flooring.", "body_part": null, "amount_claimed": 14000, "policy_number": "FLD-157859"... |
synth_claim_032 | insurance_claims | synthetic | markdown | claim_form.yaml | # PROOF OF LOSS
**Insurance Company:** Northern Lights Insurance Corp.
---
## Policy and Claim Information
| Field | Value |
|---|---|
| Policy Number | HO-899228 |
| Claim Number | CLM-993068 |
| Date of Loss | 07/15/2025 |
| Date Reported | 08/09/2025 |
## Insured Information
| Field | Value |
|---|---|
| Insur... | {"form_type": "Proof of Loss", "claimant_name": "Deborah L. Saddler", "employer_name": null, "date_of_loss": "2025-07-15", "description_of_loss": "Fire from faulty wiring in attic destroyed roof structure and caused smoke damage to entire residence.", "body_part": null, "amount_claimed": 41000, "policy_number": "HO-899... |
synth_claim_033 | insurance_claims | synthetic | markdown | claim_form.yaml | # PROOF OF LOSS
**Insurance Company:** Evergreen Mutual Insurance Company
---
## Policy and Claim Information
| Field | Value |
|---|---|
| Policy Number | HO-143907 |
| Claim Number | CLM-108781 |
| Date of Loss | 12/01/2025 |
| Date Reported | 03/25/2025 |
## Insured Information
| Field | Value |
|---|---|
| In... | {"form_type": "Proof of Loss", "claimant_name": "Margaret A. Lindstrom", "employer_name": null, "date_of_loss": "2025-12-01", "description_of_loss": "Burst pipe in second-floor bathroom caused extensive water damage to ceilings, walls, and flooring on first floor.", "body_part": null, "amount_claimed": 105000, "policy_... |
synth_claim_034 | insurance_claims | synthetic | markdown | claim_form.yaml | # PROOF OF LOSS
**Insurance Company:** Tidewater Surety & Casualty
---
## Policy and Claim Information
| Field | Value |
|---|---|
| Policy Number | FLD-433093 |
| Claim Number | CLM-455709 |
| Date of Loss | 04/12/2026 |
| Date Reported | 02/12/2026 |
## Insured Information
| Field | Value |
|---|---|
| Insured ... | {"form_type": "Proof of Loss", "claimant_name": "Linda M. Johansson", "employer_name": null, "date_of_loss": "2026-04-12", "description_of_loss": "Grease fire in restaurant kitchen caused hood system damage and smoke damage to dining area.", "body_part": null, "amount_claimed": 48500, "policy_number": "FLD-433093", "st... |
synth_claim_035 | insurance_claims | synthetic | markdown | claim_form.yaml | # PROOF OF LOSS
**Insurance Company:** Atlantic Coast Mutual
---
## Policy and Claim Information
| Field | Value |
|---|---|
| Policy Number | CPP-787834 |
| Claim Number | CLM-844599 |
| Date of Loss | 09/21/2025 |
| Date Reported | 04/25/2026 |
## Insured Information
| Field | Value |
|---|---|
| Insured Name |... | {"form_type": "Proof of Loss", "claimant_name": "Barbara J. Okafor", "employer_name": null, "date_of_loss": "2025-09-21", "description_of_loss": "Roof collapse under weight of accumulated snow and ice; interior water damage to all rooms below.", "body_part": null, "amount_claimed": 75000, "policy_number": "CPP-787834",... |
synth_claim_036 | insurance_claims | synthetic | markdown | claim_form.yaml | # PROOF OF LOSS
**Insurance Company:** Mountain West Casualty Co.
---
## Policy and Claim Information
| Field | Value |
|---|---|
| Policy Number | HO-446708 |
| Claim Number | CLM-267208 |
| Date of Loss | 04/06/2026 |
| Date Reported | 06/27/2026 |
## Insured Information
| Field | Value |
|---|---|
| Insured Na... | {"form_type": "Proof of Loss", "claimant_name": "Michael D. Baptiste", "employer_name": null, "date_of_loss": "2026-04-06", "description_of_loss": "Tornado damage to detached garage and partial roof loss on main structure.", "body_part": null, "amount_claimed": 70000, "policy_number": "HO-446708", "state": "WA"} |
synth_claim_037 | insurance_claims | synthetic | markdown | claim_form.yaml | # PROOF OF LOSS
**Insurance Company:** Tidewater Surety & Casualty
---
## Policy and Claim Information
| Field | Value |
|---|---|
| Policy Number | FLD-762317 |
| Claim Number | CLM-396715 |
| Date of Loss | 09/25/2025 |
| Date Reported | 05/24/2025 |
## Insured Information
| Field | Value |
|---|---|
| Insured ... | {"form_type": "Proof of Loss", "claimant_name": "Donna J. Bergstrom", "employer_name": null, "date_of_loss": "2025-09-25", "description_of_loss": "Sewer backup through basement floor drain damaged stored inventory and flooring materials.", "body_part": null, "amount_claimed": 95000, "policy_number": "FLD-762317", "stat... |
synth_claim_038 | insurance_claims | synthetic | markdown | claim_form.yaml | # PROOF OF LOSS
**Insurance Company:** Appalachian Fidelity Mutual
---
## Policy and Claim Information
| Field | Value |
|---|---|
| Policy Number | FLD-631063 |
| Claim Number | CLM-334287 |
| Date of Loss | 05/19/2025 |
| Date Reported | 04/08/2025 |
## Insured Information
| Field | Value |
|---|---|
| Insured ... | {"form_type": "Proof of Loss", "claimant_name": "Heather N. Ridgeway", "employer_name": null, "date_of_loss": "2025-05-19", "description_of_loss": "Burst pipe in second-floor bathroom caused extensive water damage to ceilings, walls, and flooring on first floor.", "body_part": null, "amount_claimed": 50000, "policy_num... |
synth_claim_039 | insurance_claims | synthetic | markdown | claim_form.yaml | # PROOF OF LOSS
**Insurance Company:** Compass Rose Specialty
---
## Policy and Claim Information
| Field | Value |
|---|---|
| Policy Number | HO-755909 |
| Claim Number | CLM-758001 |
| Date of Loss | 06/12/2025 |
| Date Reported | 11/09/2025 |
## Insured Information
| Field | Value |
|---|---|
| Insured Name |... | {"form_type": "Proof of Loss", "claimant_name": "James R. Henderson", "employer_name": null, "date_of_loss": "2025-06-12", "description_of_loss": "Smoke and fire damage from neighboring unit spread through shared wall in multi-family dwelling.", "body_part": null, "amount_claimed": 19500, "policy_number": "HO-755909", ... |
synth_claim_040 | insurance_claims | synthetic | markdown | claim_form.yaml | # PROOF OF LOSS
**Insurance Company:** Continental Shield Insurance Co.
---
## Policy and Claim Information
| Field | Value |
|---|---|
| Policy Number | CPP-128123 |
| Claim Number | CLM-358660 |
| Date of Loss | 07/01/2026 |
| Date Reported | 05/18/2025 |
## Insured Information
| Field | Value |
|---|---|
| Ins... | {"form_type": "Proof of Loss", "claimant_name": "Sandra L. Walsh", "employer_name": null, "date_of_loss": "2026-07-01", "description_of_loss": "Basement flooding from sustained heavy rainfall; sump pump failure led to 18 inches of standing water.", "body_part": null, "amount_claimed": 30000, "policy_number": "CPP-12812... |
synth_claim_041 | insurance_claims | synthetic | markdown | claim_form.yaml | # PROOF OF LOSS
**Insurance Company:** Tidewater Surety & Casualty
---
## Policy and Claim Information
| Field | Value |
|---|---|
| Policy Number | FLD-357558 |
| Claim Number | CLM-115461 |
| Date of Loss | 01/03/2025 |
| Date Reported | 12/27/2025 |
## Insured Information
| Field | Value |
|---|---|
| Insured ... | {"form_type": "Proof of Loss", "claimant_name": "David C. Ramirez", "employer_name": null, "date_of_loss": "2025-01-03", "description_of_loss": "Sewer backup through basement floor drain damaged stored inventory and flooring materials.", "body_part": null, "amount_claimed": 28000, "policy_number": "FLD-357558", "state"... |
synth_claim_042 | insurance_claims | synthetic | markdown | claim_form.yaml | # PROOF OF LOSS
**Insurance Company:** Appalachian Fidelity Mutual
---
## Policy and Claim Information
| Field | Value |
|---|---|
| Policy Number | CPP-219655 |
| Claim Number | CLM-207656 |
| Date of Loss | 02/14/2025 |
| Date Reported | 07/16/2026 |
## Insured Information
| Field | Value |
|---|---|
| Insured ... | {"form_type": "Proof of Loss", "claimant_name": "Jason R. Dietrich", "employer_name": null, "date_of_loss": "2025-02-14", "description_of_loss": "Vandalism to commercial property: broken windows, graffiti, and damage to interior fixtures.", "body_part": null, "amount_claimed": 21500, "policy_number": "CPP-219655", "sta... |
synth_claim_043 | insurance_claims | synthetic | markdown | claim_form.yaml | # PROOF OF LOSS
**Insurance Company:** Ironbridge Excess Carriers Ltd.
---
## Policy and Claim Information
| Field | Value |
|---|---|
| Policy Number | HO-461708 |
| Claim Number | CLM-114787 |
| Date of Loss | 10/07/2025 |
| Date Reported | 03/17/2025 |
## Insured Information
| Field | Value |
|---|---|
| Insur... | {"form_type": "Proof of Loss", "claimant_name": "Christopher S. Patel", "employer_name": null, "date_of_loss": "2025-10-07", "description_of_loss": "Accidental discharge from water heater flooded utility room and adjacent hallway.", "body_part": null, "amount_claimed": 31500, "policy_number": "HO-461708", "state": "WA"... |
synth_claim_044 | insurance_claims | synthetic | markdown | claim_form.yaml | # PROOF OF LOSS
**Insurance Company:** Sterling National Insurance Co.
---
## Policy and Claim Information
| Field | Value |
|---|---|
| Policy Number | CPP-556590 |
| Claim Number | CLM-472617 |
| Date of Loss | 03/10/2025 |
| Date Reported | 06/28/2025 |
## Insured Information
| Field | Value |
|---|---|
| Insu... | {"form_type": "Proof of Loss", "claimant_name": "Christine A. Holloway", "employer_name": null, "date_of_loss": "2025-03-10", "description_of_loss": "Burst pipe in second-floor bathroom caused extensive water damage to ceilings, walls, and flooring on first floor.", "body_part": null, "amount_claimed": 7000, "policy_nu... |
synth_claim_045 | insurance_claims | synthetic | markdown | claim_form.yaml | # PROOF OF LOSS
**Insurance Company:** Liberty Bell Underwriters
---
## Policy and Claim Information
| Field | Value |
|---|---|
| Policy Number | HO-182332 |
| Claim Number | CLM-692309 |
| Date of Loss | 04/12/2026 |
| Date Reported | 09/07/2025 |
## Insured Information
| Field | Value |
|---|---|
| Insured Nam... | {"form_type": "Proof of Loss", "claimant_name": "Gary W. Ishikawa", "employer_name": null, "date_of_loss": "2026-04-12", "description_of_loss": "Lightning strike caused power surge destroying HVAC system, appliances, and electronic equipment.", "body_part": null, "amount_claimed": 29500, "policy_number": "HO-182332", "... |
synth_claim_046 | insurance_claims | synthetic | markdown | claim_form.yaml | # PROOF OF LOSS
**Insurance Company:** Mountain West Casualty Co.
---
## Policy and Claim Information
| Field | Value |
|---|---|
| Policy Number | FLD-216938 |
| Claim Number | CLM-915164 |
| Date of Loss | 04/10/2025 |
| Date Reported | 06/20/2026 |
## Insured Information
| Field | Value |
|---|---|
| Insured N... | {"form_type": "Proof of Loss", "claimant_name": "Jeffrey D. Cranston", "employer_name": null, "date_of_loss": "2025-04-10", "description_of_loss": "Sewer backup through basement floor drain damaged stored inventory and flooring materials.", "body_part": null, "amount_claimed": 45000, "policy_number": "FLD-216938", "sta... |
synth_claim_047 | insurance_claims | synthetic | markdown | claim_form.yaml | # PROOF OF LOSS
**Insurance Company:** Mountain West Casualty Co.
---
## Policy and Claim Information
| Field | Value |
|---|---|
| Policy Number | FLD-155730 |
| Claim Number | CLM-234787 |
| Date of Loss | 12/15/2025 |
| Date Reported | 10/08/2026 |
## Insured Information
| Field | Value |
|---|---|
| Insured N... | {"form_type": "Proof of Loss", "claimant_name": "Sandra L. Walsh", "employer_name": null, "date_of_loss": "2025-12-15", "description_of_loss": "Sewer backup through basement floor drain damaged stored inventory and flooring materials.", "body_part": null, "amount_claimed": 58000, "policy_number": "FLD-155730", "state":... |
synth_claim_048 | insurance_claims | synthetic | markdown | claim_form.yaml | # PROOF OF LOSS
**Insurance Company:** Pinnacle Specialty Insurance
---
## Policy and Claim Information
| Field | Value |
|---|---|
| Policy Number | FLD-878365 |
| Claim Number | CLM-333494 |
| Date of Loss | 01/16/2026 |
| Date Reported | 08/22/2025 |
## Insured Information
| Field | Value |
|---|---|
| Insured... | {"form_type": "Proof of Loss", "claimant_name": "Thomas H. Fitzgerald", "employer_name": null, "date_of_loss": "2026-01-16", "description_of_loss": "Electrical fire in garage destroyed stored property and caused structural damage to attached wall.", "body_part": null, "amount_claimed": 27000, "policy_number": "FLD-8783... |
synth_claim_049 | insurance_claims | synthetic | markdown | claim_form.yaml | # PROOF OF LOSS
**Insurance Company:** Ironbridge Excess Carriers Ltd.
---
## Policy and Claim Information
| Field | Value |
|---|---|
| Policy Number | CPP-573722 |
| Claim Number | CLM-666204 |
| Date of Loss | 08/08/2025 |
| Date Reported | 11/02/2026 |
## Insured Information
| Field | Value |
|---|---|
| Insu... | {"form_type": "Proof of Loss", "claimant_name": "Gregory S. Huang", "employer_name": null, "date_of_loss": "2025-08-08", "description_of_loss": "Vandalism to commercial property: broken windows, graffiti, and damage to interior fixtures.", "body_part": null, "amount_claimed": 83500, "policy_number": "CPP-573722", "stat... |
synth_claim_050 | insurance_claims | synthetic | markdown | claim_form.yaml | # PROOF OF LOSS
**Insurance Company:** Mountain West Casualty Co.
---
## Policy and Claim Information
| Field | Value |
|---|---|
| Policy Number | HO-548958 |
| Claim Number | CLM-189706 |
| Date of Loss | 07/20/2025 |
| Date Reported | 05/06/2026 |
## Insured Information
| Field | Value |
|---|---|
| Insured Na... | {"form_type": "Proof of Loss", "claimant_name": "Cynthia D. Hartley", "employer_name": null, "date_of_loss": "2025-07-20", "description_of_loss": "Smoke and fire damage from neighboring unit spread through shared wall in multi-family dwelling.", "body_part": null, "amount_claimed": 47500, "policy_number": "HO-548958", ... |
synth_demand_001 | insurance_claims | synthetic | markdown | claim_form.yaml | # Northern Lights Insurance Corp.
**Subrogation Recovery Department**
Date: 01/28/2026
---
**VIA CERTIFIED MAIL**
Vanguard Maintenance Corp.
1650 Borel Place, Suite 200
San Mateo, CA 94402
**RE: Subrogation Demand**
**Our Insured:** Donna J. Bergstrom
**Claim Reference:** SUB-691137
**Policy No.:** AUT-657947
**D... | {"form_type": "Demand Letter", "claimant_name": "Donna J. Bergstrom", "employer_name": null, "date_of_loss": "2026-05-05", "description_of_loss": "On 05/05/2026, a fire originating at 600 N. Michigan Avenue, Suite 800, Chicago, IL 60611, owned or operated by Vanguard Maintenance Corp., spread to our insured's adjacent ... |
synth_demand_002 | insurance_claims | synthetic | markdown | claim_form.yaml | # Evergreen Mutual Insurance Company
**Subrogation Recovery Department**
Date: 05/09/2025
---
**VIA CERTIFIED MAIL**
Apex Transport LLC
2901 Gandy Boulevard
St. Petersburg, FL 33702
**RE: Subrogation Demand**
**Our Insured:** Steven R. Yamamoto
**Claim Reference:** SUB-797126
**Policy No.:** HO-896922
**Date of L... | {"form_type": "Demand Letter", "claimant_name": "Steven R. Yamamoto", "employer_name": null, "date_of_loss": "2026-02-03", "description_of_loss": "On 02/03/2026, our insured, Steven R. Yamamoto, was involved in a motor vehicle accident at the intersection of Broadway and Mill Road in Oklahoma City, OK. The responsible ... |
synth_demand_003 | insurance_claims | synthetic | markdown | claim_form.yaml | # Pinnacle Specialty Insurance
**Subrogation Recovery Department**
Date: 03/07/2025
---
**VIA CERTIFIED MAIL**
Alliance Building Services
221 Industrial Park Drive
Lakeland, FL 33805
**RE: Subrogation Demand**
**Our Insured:** Dorothy H. Kessler
**Claim Reference:** SUB-414546
**Policy No.:** HO-817904
**Date of ... | {"form_type": "Demand Letter", "claimant_name": "Dorothy H. Kessler", "employer_name": null, "date_of_loss": "2025-02-05", "description_of_loss": "On 02/05/2025, a fire originating at 600 N. Michigan Avenue, Suite 800, Chicago, IL 60611, owned or operated by Alliance Building Services, spread to our insured's adjacent ... |
synth_demand_004 | insurance_claims | synthetic | markdown | claim_form.yaml | # Compass Rose Specialty
**Subrogation Recovery Department**
Date: 07/27/2026
---
**VIA CERTIFIED MAIL**
Keystone Cleaning Co.
4500 W. Colfax Avenue
Denver, CO 80204
**RE: Subrogation Demand**
**Our Insured:** Angela M. Petrovic
**Claim Reference:** SUB-523586
**Policy No.:** CPP-766437
**Date of Loss:** 09/26/20... | {"form_type": "Demand Letter", "claimant_name": "Angela M. Petrovic", "employer_name": null, "date_of_loss": "2025-09-26", "description_of_loss": "On 09/26/2025, our insured, Angela M. Petrovic, was involved in a motor vehicle accident at the intersection of Elm Avenue and Oak Street in Oklahoma City, OK. The responsib... |
synth_demand_005 | insurance_claims | synthetic | markdown | claim_form.yaml | # Mountain West Casualty Co.
**Subrogation Recovery Department**
Date: 11/25/2026
---
**VIA CERTIFIED MAIL**
Riverside Construction Group
7700 Mineral Drive, Suite 200
Coeur d'Alene, ID 83815
**RE: Subrogation Demand**
**Our Insured:** Pamela E. Ogilvie
**Claim Reference:** SUB-570808
**Policy No.:** CPP-818292
*... | {"form_type": "Demand Letter", "claimant_name": "Pamela E. Ogilvie", "employer_name": null, "date_of_loss": "2025-04-03", "description_of_loss": "On 04/03/2025, a fire originating at 330 Madison Avenue, 12th Floor, New York, NY 10017, owned or operated by Riverside Construction Group, spread to our insured's adjacent p... |
synth_demand_006 | insurance_claims | synthetic | markdown | claim_form.yaml | # Pacific Crest Casualty
**Subrogation Recovery Department**
Date: 08/28/2025
---
**VIA CERTIFIED MAIL**
Pauline M. Chandra
700 Central Expressway
Santa Clara, CA 95050
**RE: Subrogation Demand**
**Our Insured:** Timothy N. Reeves
**Claim Reference:** SUB-318892
**Policy No.:** CPP-478795
**Date of Loss:** 06/13/... | {"form_type": "Demand Letter", "claimant_name": "Timothy N. Reeves", "employer_name": null, "date_of_loss": "2026-06-13", "description_of_loss": "On 06/13/2026, construction work being performed by Pauline M. Chandra at 2200 Market Street, Philadelphia, PA 19103 caused damage to our insured's adjacent property at 400 P... |
synth_demand_007 | insurance_claims | synthetic | markdown | claim_form.yaml | # Compass Rose Specialty
**Subrogation Recovery Department**
Date: 09/12/2025
---
**VIA CERTIFIED MAIL**
Pauline M. Chandra
5100 Port Road
Savannah, GA 31415
**RE: Subrogation Demand**
**Our Insured:** Frank B. Estrada
**Claim Reference:** SUB-389657
**Policy No.:** HO-589104
**Date of Loss:** 10/26/2025
**Amount... | {"form_type": "Demand Letter", "claimant_name": "Frank B. Estrada", "employer_name": null, "date_of_loss": "2025-10-26", "description_of_loss": "On 10/26/2025, a water leak originating from property owned or managed by Pauline M. Chandra at 90 State Street, Suite 700, Albany, NY 12207 caused extensive damage to our ins... |
synth_demand_008 | insurance_claims | synthetic | markdown | claim_form.yaml | # Sterling National Insurance Co.
**Subrogation Recovery Department**
Date: 06/26/2025
---
**VIA CERTIFIED MAIL**
Brightstar Property Management LLC
9800 Hillwood Parkway
Fort Worth, TX 76177
**RE: Subrogation Demand**
**Our Insured:** Dorothy H. Kessler
**Claim Reference:** SUB-726175
**Policy No.:** CGL-229664
... | {"form_type": "Demand Letter", "claimant_name": "Dorothy H. Kessler", "employer_name": null, "date_of_loss": "2025-11-18", "description_of_loss": "On 11/18/2025, our insured, Dorothy H. Kessler, was involved in a motor vehicle accident at the intersection of Pine Street and Mill Road in New York, NY. The responsible pa... |
synth_demand_009 | insurance_claims | synthetic | markdown | claim_form.yaml | # Compass Rose Specialty
**Subrogation Recovery Department**
Date: 12/23/2025
---
**VIA CERTIFIED MAIL**
Pacific Coast Moving & Storage
8200 Lehigh Avenue
Morton Grove, IL 60053
**RE: Subrogation Demand**
**Our Insured:** Steven R. Yamamoto
**Claim Reference:** SUB-367805
**Policy No.:** AUT-228897
**Date of Loss... | {"form_type": "Demand Letter", "claimant_name": "Steven R. Yamamoto", "employer_name": null, "date_of_loss": "2025-01-27", "description_of_loss": "On 01/27/2025, our insured, Steven R. Yamamoto, was involved in a motor vehicle accident at the intersection of Highland Avenue and Cedar Lane in Chicago, IL. The responsibl... |
synth_demand_010 | insurance_claims | synthetic | markdown | claim_form.yaml | # Midwest Indemnity Holdings
**Subrogation Recovery Department**
Date: 04/06/2025
---
**VIA CERTIFIED MAIL**
Edward P. Flanagan
221 Industrial Park Drive
Lakeland, FL 33805
**RE: Subrogation Demand**
**Our Insured:** Deborah L. Saddler
**Claim Reference:** SUB-588888
**Policy No.:** CGL-602612
**Date of Loss:** 0... | {"form_type": "Demand Letter", "claimant_name": "Deborah L. Saddler", "employer_name": null, "date_of_loss": "2025-01-05", "description_of_loss": "On 01/05/2025, construction work being performed by Edward P. Flanagan at 1800 N. Highland Avenue, Los Angeles, CA 90028 caused damage to our insured's adjacent property at ... |
synth_demand_011 | insurance_claims | synthetic | markdown | claim_form.yaml | # Tidewater Surety & Casualty
**Subrogation Recovery Department**
Date: 02/14/2025
---
**VIA CERTIFIED MAIL**
Alliance Building Services
450 Lancaster Avenue
Wayne, PA 19087
**RE: Subrogation Demand**
**Our Insured:** Maria L. Vasquez
**Claim Reference:** SUB-291211
**Policy No.:** CPP-570764
**Date of Loss:** 11... | {"form_type": "Demand Letter", "claimant_name": "Maria L. Vasquez", "employer_name": null, "date_of_loss": "2025-11-12", "description_of_loss": "On 11/12/2025, construction work being performed by Alliance Building Services at 1400 NW Compton Drive, Portland, OR 97209 caused damage to our insured's adjacent property at... |
synth_demand_012 | insurance_claims | synthetic | markdown | claim_form.yaml | # Sterling National Insurance Co.
**Subrogation Recovery Department**
Date: 12/10/2025
---
**VIA CERTIFIED MAIL**
Coastal Trucking Inc.
4400 Commerce Drive
Indianapolis, IN 46268
**RE: Subrogation Demand**
**Our Insured:** Matthew T. Ivanov
**Claim Reference:** SUB-698169
**Policy No.:** CGL-142154
**Date of Loss... | {"form_type": "Demand Letter", "claimant_name": "Matthew T. Ivanov", "employer_name": null, "date_of_loss": "2026-01-25", "description_of_loss": "On 01/25/2026, a water leak originating from property owned or managed by Coastal Trucking Inc. at 600 N. Pine Island Road, Fort Lauderdale, FL 33324 caused extensive damage ... |
synth_demand_013 | insurance_claims | synthetic | markdown | claim_form.yaml | # Compass Rose Specialty
**Subrogation Recovery Department**
Date: 06/11/2025
---
**VIA CERTIFIED MAIL**
Raymond K. Okonkwo
2901 Gandy Boulevard
St. Petersburg, FL 33702
**RE: Subrogation Demand**
**Our Insured:** Gary W. Ishikawa
**Claim Reference:** SUB-543706
**Policy No.:** AUT-802343
**Date of Loss:** 09/23/... | {"form_type": "Demand Letter", "claimant_name": "Gary W. Ishikawa", "employer_name": null, "date_of_loss": "2025-09-23", "description_of_loss": "On 09/23/2025, construction work being performed by Raymond K. Okonkwo at 1650 Borel Place, Suite 200, San Mateo, CA 94402 caused damage to our insured's adjacent property at ... |
synth_demand_014 | insurance_claims | synthetic | markdown | claim_form.yaml | # Continental Shield Insurance Co.
**Subrogation Recovery Department**
Date: 01/28/2025
---
**VIA CERTIFIED MAIL**
Douglas R. Wentworth
1800 N. Highland Avenue
Los Angeles, CA 90028
**RE: Subrogation Demand**
**Our Insured:** Frank B. Estrada
**Claim Reference:** SUB-366870
**Policy No.:** CGL-303354
**Date of Lo... | {"form_type": "Demand Letter", "claimant_name": "Frank B. Estrada", "employer_name": null, "date_of_loss": "2026-05-06", "description_of_loss": "On 05/06/2026, construction work being performed by Douglas R. Wentworth at 15200 NE 8th Street, Suite 300, Bellevue, WA 98007 caused damage to our insured's adjacent property... |
synth_demand_015 | insurance_claims | synthetic | markdown | claim_form.yaml | # Mountain West Casualty Co.
**Subrogation Recovery Department**
Date: 06/09/2026
---
**VIA CERTIFIED MAIL**
Douglas R. Wentworth
3200 Westheimer Road
Houston, TX 77098
**RE: Subrogation Demand**
**Our Insured:** Laura C. Novak
**Claim Reference:** SUB-360214
**Policy No.:** AUT-177950
**Date of Loss:** 10/18/202... | {"form_type": "Demand Letter", "claimant_name": "Laura C. Novak", "employer_name": null, "date_of_loss": "2025-10-18", "description_of_loss": "On 10/18/2025, a water leak originating from property owned or managed by Douglas R. Wentworth at 15200 NE 8th Street, Suite 300, Bellevue, WA 98007 caused extensive damage to o... |
synth_demand_016 | insurance_claims | synthetic | markdown | claim_form.yaml | # Mountain West Casualty Co.
**Subrogation Recovery Department**
Date: 06/12/2026
---
**VIA CERTIFIED MAIL**
Riverside Construction Group
9800 Hillwood Parkway
Fort Worth, TX 76177
**RE: Subrogation Demand**
**Our Insured:** Charles E. Gutierrez
**Claim Reference:** SUB-751216
**Policy No.:** CGL-900162
**Date of... | {"form_type": "Demand Letter", "claimant_name": "Charles E. Gutierrez", "employer_name": null, "date_of_loss": "2025-04-25", "description_of_loss": "On 04/25/2025, a tree located on property owned by Riverside Construction Group at 3200 Westheimer Road, Houston, TX 77098 fell onto our insured's property at 1650 Borel P... |
synth_demand_017 | insurance_claims | synthetic | markdown | claim_form.yaml | # Tidewater Surety & Casualty
**Subrogation Recovery Department**
Date: 08/12/2025
---
**VIA CERTIFIED MAIL**
Horizon Landscaping Services
3300 S. Figueroa Street
Los Angeles, CA 90007
**RE: Subrogation Demand**
**Our Insured:** Maria L. Vasquez
**Claim Reference:** SUB-538774
**Policy No.:** CPP-237997
**Date of... | {"form_type": "Demand Letter", "claimant_name": "Maria L. Vasquez", "employer_name": null, "date_of_loss": "2025-01-08", "description_of_loss": "On 01/08/2025, construction work being performed by Horizon Landscaping Services at 330 Madison Avenue, 12th Floor, New York, NY 10017 caused damage to our insured's adjacent ... |
synth_demand_018 | insurance_claims | synthetic | markdown | claim_form.yaml | # Compass Rose Specialty
**Subrogation Recovery Department**
Date: 04/23/2026
---
**VIA CERTIFIED MAIL**
Keystone Cleaning Co.
9800 Hillwood Parkway
Fort Worth, TX 76177
**RE: Subrogation Demand**
**Our Insured:** Angela M. Petrovic
**Claim Reference:** SUB-973217
**Policy No.:** HO-791606
**Date of Loss:** 03/23... | {"form_type": "Demand Letter", "claimant_name": "Angela M. Petrovic", "employer_name": null, "date_of_loss": "2025-03-23", "description_of_loss": "On 03/23/2025, a fire originating at 2700 University Avenue, Minneapolis, MN 55414, owned or operated by Keystone Cleaning Co., spread to our insured's adjacent property at ... |
synth_demand_019 | insurance_claims | synthetic | markdown | claim_form.yaml | # Tidewater Surety & Casualty
**Subrogation Recovery Department**
Date: 03/23/2025
---
**VIA CERTIFIED MAIL**
Coastal Trucking Inc.
90 State Street, Suite 700
Albany, NY 12207
**RE: Subrogation Demand**
**Our Insured:** Christine A. Holloway
**Claim Reference:** SUB-481084
**Policy No.:** CPP-698314
**Date of Los... | {"form_type": "Demand Letter", "claimant_name": "Christine A. Holloway", "employer_name": null, "date_of_loss": "2026-08-01", "description_of_loss": "On 08/01/2026, a water leak originating from property owned or managed by Coastal Trucking Inc. at 8200 Lehigh Avenue, Morton Grove, IL 60053 caused extensive damage to o... |
synth_demand_020 | insurance_claims | synthetic | markdown | claim_form.yaml | # Midwest Indemnity Holdings
**Subrogation Recovery Department**
Date: 04/13/2025
---
**VIA CERTIFIED MAIL**
Consolidated Freight Lines Inc.
600 N. Michigan Avenue, Suite 800
Chicago, IL 60611
**RE: Subrogation Demand**
**Our Insured:** Matthew T. Ivanov
**Claim Reference:** SUB-115251
**Policy No.:** HO-662294
*... | {"form_type": "Demand Letter", "claimant_name": "Matthew T. Ivanov", "employer_name": null, "date_of_loss": "2025-02-13", "description_of_loss": "On 02/13/2025, construction work being performed by Consolidated Freight Lines Inc. at 7700 Mineral Drive, Suite 200, Coeur d'Alene, ID 83815 caused damage to our insured's a... |
synth_demand_021 | insurance_claims | synthetic | markdown | claim_form.yaml | # Appalachian Fidelity Mutual
**Subrogation Recovery Department**
Date: 04/08/2026
---
**VIA CERTIFIED MAIL**
Douglas R. Wentworth
4500 W. Colfax Avenue
Denver, CO 80204
**RE: Subrogation Demand**
**Our Insured:** Nancy B. Stephenson
**Claim Reference:** SUB-165329
**Policy No.:** CPP-492708
**Date of Loss:** 02/... | {"form_type": "Demand Letter", "claimant_name": "Nancy B. Stephenson", "employer_name": null, "date_of_loss": "2025-02-03", "description_of_loss": "On 02/03/2025, a tree located on property owned by Douglas R. Wentworth at 1100 N. Meridian Street, Oklahoma City, OK 73107 fell onto our insured's property at 4500 W. Colf... |
synth_demand_022 | insurance_claims | synthetic | markdown | claim_form.yaml | # Golden Gate Assurance Corp.
**Subrogation Recovery Department**
Date: 06/22/2025
---
**VIA CERTIFIED MAIL**
Vanguard Maintenance Corp.
450 Lancaster Avenue
Wayne, PA 19087
**RE: Subrogation Demand**
**Our Insured:** Steven R. Yamamoto
**Claim Reference:** SUB-145006
**Policy No.:** CGL-631312
**Date of Loss:** ... | {"form_type": "Demand Letter", "claimant_name": "Steven R. Yamamoto", "employer_name": null, "date_of_loss": "2025-09-21", "description_of_loss": "On 09/21/2025, a water leak originating from property owned or managed by Vanguard Maintenance Corp. at 1025 Thomas Jefferson Street, Washington, DC 20007 caused extensive d... |
synth_demand_023 | insurance_claims | synthetic | markdown | claim_form.yaml | # Keystone Indemnity Group
**Subrogation Recovery Department**
Date: 06/11/2025
---
**VIA CERTIFIED MAIL**
John M. Castellano
600 N. Pine Island Road
Fort Lauderdale, FL 33324
**RE: Subrogation Demand**
**Our Insured:** Matthew T. Ivanov
**Claim Reference:** SUB-380229
**Policy No.:** CGL-299148
**Date of Loss:**... | {"form_type": "Demand Letter", "claimant_name": "Matthew T. Ivanov", "employer_name": null, "date_of_loss": "2025-03-02", "description_of_loss": "On 03/02/2025, our insured, Matthew T. Ivanov, was involved in a motor vehicle accident at the intersection of Main Street and Highland Avenue in Lakeland, FL. The responsibl... |
synth_demand_024 | insurance_claims | synthetic | markdown | claim_form.yaml | # Continental Shield Insurance Co.
**Subrogation Recovery Department**
Date: 03/09/2026
---
**VIA CERTIFIED MAIL**
Coastal Trucking Inc.
3200 Westheimer Road
Houston, TX 77098
**RE: Subrogation Demand**
**Our Insured:** Ryan P. Gallagher
**Claim Reference:** SUB-586914
**Policy No.:** AUT-213125
**Date of Loss:**... | {"form_type": "Demand Letter", "claimant_name": "Ryan P. Gallagher", "employer_name": null, "date_of_loss": "2025-11-04", "description_of_loss": "On 11/04/2025, construction work being performed by Coastal Trucking Inc. at 3200 Westheimer Road, Houston, TX 77098 caused damage to our insured's adjacent property at 5100 ... |
synth_demand_025 | insurance_claims | synthetic | markdown | claim_form.yaml | # Ironbridge Excess Carriers Ltd.
**Subrogation Recovery Department**
Date: 06/19/2025
---
**VIA CERTIFIED MAIL**
Pacific Coast Moving & Storage
5100 Port Road
Savannah, GA 31415
**RE: Subrogation Demand**
**Our Insured:** Mark A. Castellano
**Claim Reference:** SUB-781688
**Policy No.:** CGL-763696
**Date of Los... | {"form_type": "Demand Letter", "claimant_name": "Mark A. Castellano", "employer_name": null, "date_of_loss": "2025-11-05", "description_of_loss": "On 11/05/2025, our insured, Mark A. Castellano, was involved in a motor vehicle accident at the intersection of Pine Street and Mill Road in Houston, TX. The responsible par... |
synth_demand_026 | insurance_claims | synthetic | markdown | claim_form.yaml | # Pinnacle Specialty Insurance
**Subrogation Recovery Department**
Date: 02/09/2025
---
**VIA CERTIFIED MAIL**
Elena V. Marchetti
90 State Street, Suite 700
Albany, NY 12207
**RE: Subrogation Demand**
**Our Insured:** Sandra L. Walsh
**Claim Reference:** SUB-464543
**Policy No.:** AUT-720096
**Date of Loss:** 08/... | {"form_type": "Demand Letter", "claimant_name": "Sandra L. Walsh", "employer_name": null, "date_of_loss": "2026-08-03", "description_of_loss": "On 08/03/2026, a tree located on property owned by Elena V. Marchetti at 4500 W. Colfax Avenue, Denver, CO 80204 fell onto our insured's property at 9800 Hillwood Parkway, Fort... |
synth_demand_027 | insurance_claims | synthetic | markdown | claim_form.yaml | # Ironbridge Excess Carriers Ltd.
**Subrogation Recovery Department**
Date: 12/13/2026
---
**VIA CERTIFIED MAIL**
Pacific Coast Moving & Storage
3200 Westheimer Road
Houston, TX 77098
**RE: Subrogation Demand**
**Our Insured:** Elizabeth R. Dominguez
**Claim Reference:** SUB-914087
**Policy No.:** HO-579853
**Dat... | {"form_type": "Demand Letter", "claimant_name": "Elizabeth R. Dominguez", "employer_name": null, "date_of_loss": "2026-05-21", "description_of_loss": "On 05/21/2026, construction work being performed by Pacific Coast Moving & Storage at 5100 Port Road, Savannah, GA 31415 caused damage to our insured's adjacent property... |
synth_demand_028 | insurance_claims | synthetic | markdown | claim_form.yaml | # Liberty Bell Underwriters
**Subrogation Recovery Department**
Date: 11/12/2026
---
**VIA CERTIFIED MAIL**
Sterling Property Holdings LLC
5100 Port Road
Savannah, GA 31415
**RE: Subrogation Demand**
**Our Insured:** Andrew J. Callahan
**Claim Reference:** SUB-173976
**Policy No.:** CPP-472544
**Date of Loss:** 0... | {"form_type": "Demand Letter", "claimant_name": "Andrew J. Callahan", "employer_name": null, "date_of_loss": "2026-01-03", "description_of_loss": "On 01/03/2026, our insured, Andrew J. Callahan, was involved in a motor vehicle accident at the intersection of Main Street and River Road in Philadelphia, PA. The responsib... |
synth_demand_029 | insurance_claims | synthetic | markdown | claim_form.yaml | # Midwest Indemnity Holdings
**Subrogation Recovery Department**
Date: 02/05/2025
---
**VIA CERTIFIED MAIL**
Summit Contracting Inc.
1100 N. Meridian Street
Oklahoma City, OK 73107
**RE: Subrogation Demand**
**Our Insured:** Jason R. Dietrich
**Claim Reference:** SUB-971681
**Policy No.:** HO-168195
**Date of Los... | {"form_type": "Demand Letter", "claimant_name": "Jason R. Dietrich", "employer_name": null, "date_of_loss": "2025-05-27", "description_of_loss": "On 05/27/2025, our insured, Jason R. Dietrich, sustained injuries in a slip-and-fall incident at 9800 Hillwood Parkway, Fort Worth, TX 76177, a property owned or managed by S... |
synth_demand_030 | insurance_claims | synthetic | markdown | claim_form.yaml | # Liberty Bell Underwriters
**Subrogation Recovery Department**
Date: 04/27/2025
---
**VIA CERTIFIED MAIL**
Apex Transport LLC
1400 NW Compton Drive
Portland, OR 97209
**RE: Subrogation Demand**
**Our Insured:** Matthew T. Ivanov
**Claim Reference:** SUB-818379
**Policy No.:** HO-561133
**Date of Loss:** 08/01/20... | {"form_type": "Demand Letter", "claimant_name": "Matthew T. Ivanov", "employer_name": null, "date_of_loss": "2025-08-01", "description_of_loss": "On 08/01/2025, a fire originating at 3200 Westheimer Road, Houston, TX 77098, owned or operated by Apex Transport LLC, spread to our insured's adjacent property at 2200 Marke... |
synth_loss_run_001 | insurance_claims | synthetic | markdown | claim_form.yaml | # Erie Insurance Group
## Loss Run / Claims History Report
Insured: Atlas Framing & Construction LLC
Location: 221 Industrial Park Drive, Lakeland, FL
Policy: AUT-5445135 (Commercial Auto)
Period: 01/01/2024 — 12/31/2024
As of: 07/05/2024
---
| Claim No. | Loss Date | Claimant Name | Description | Status | Reserve ... | {"form_type": "Loss Run", "claimant_name": null, "employer_name": "Atlas Framing & Construction LLC", "policy_number": "AUT-5445135", "state": "FL"} |
synth_loss_run_002 | insurance_claims | synthetic | markdown | claim_form.yaml | # Employers Holdings Inc.
## Loss Run / Claims History Report
Insured: Meridian Mechanical Services Inc.
Location: 4400 Commerce Drive, Indianapolis, IN
Policy: GLO-908551 (General Liability)
Period: 05/10/2025 — 05/10/2026
As of: 09/25/2025
---
| Claim No. | Loss Date | Claimant Name | Description | Status | Reser... | {"form_type": "Loss Run", "claimant_name": null, "employer_name": "Meridian Mechanical Services Inc.", "policy_number": "GLO-908551", "state": "IN"} |
synth_loss_run_003 | insurance_claims | synthetic | markdown | claim_form.yaml | # LOSS RUN REPORT
## Policy Information
- **Insurance Carrier:** Markel Corporation
- **Named Insured:** Silverline Electrical Contractors
- **Mailing Address:** 1800 N. Highland Avenue, Los Angeles, CA
- **Policy Number:** AUT-1715845
- **Coverage Type:** Commercial Auto
- **Effective Date:** 08/02/2024
- **Expirati... | {"form_type": "Loss Run", "claimant_name": null, "employer_name": "Silverline Electrical Contractors", "policy_number": "AUT-1715845", "state": "CA"} |
synth_loss_run_004 | insurance_claims | synthetic | markdown | claim_form.yaml | # Zurich American Insurance Company
# Loss Run — Multi-Year Claims History
**Policyholder:** Brookfield Property Management Group
**Address:** 350 Madison Avenue, 8th Floor, New York, NY
**Policy No:** GL-2099485
**Line of Business:** General Liability
**Reporting Period:** 02/07/2023 to 02/07/2024
**Date Prepared:*... | {"form_type": "Loss Run", "claimant_name": null, "employer_name": "Brookfield Property Management Group", "policy_number": "GL-2099485", "state": "NY"} |
synth_loss_run_005 | insurance_claims | synthetic | markdown | claim_form.yaml | # Erie Insurance Group
## Loss Run / Claims History Report
Insured: Clearwater Environmental Solutions
Location: 600 N. Pine Island Road, Fort Lauderdale, FL
Policy: AUT-6679335 (Commercial Auto)
Period: 03/20/2025 — 03/20/2026
As of: 08/25/2025
---
| Claim No. | Loss Date | Claimant Name | Description | Status | R... | {"form_type": "Loss Run", "claimant_name": null, "employer_name": "Clearwater Environmental Solutions", "policy_number": "AUT-6679335", "state": "FL"} |
synth_loss_run_006 | insurance_claims | synthetic | markdown | claim_form.yaml | # Liberty Mutual Insurance Company
# Loss Run — Multi-Year Claims History
**Policyholder:** Granite Peak General Contractors
**Address:** 7700 Mineral Drive, Suite 200, Coeur d'Alene, ID
**Policy No:** CP-6767991
**Line of Business:** Commercial Property
**Reporting Period:** 10/25/2023 to 10/24/2024
**Date Prepared... | {"form_type": "Loss Run", "claimant_name": null, "employer_name": "Granite Peak General Contractors", "policy_number": "CP-6767991", "state": "ID"} |
synth_loss_run_007 | insurance_claims | synthetic | markdown | claim_form.yaml | # Employers Holdings Inc.
# Loss Run — Multi-Year Claims History
**Policyholder:** Suncoast Roofing & Waterproofing
**Address:** 2901 Gandy Boulevard, St. Petersburg, FL
**Policy No:** BAP-5386932
**Line of Business:** Commercial Auto
**Reporting Period:** 11/15/2023 to 11/14/2024
**Date Prepared:** 08/20/2024
---
... | {"form_type": "Loss Run", "claimant_name": null, "employer_name": "Suncoast Roofing & Waterproofing", "policy_number": "BAP-5386932", "state": "FL"} |
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