NOTICE

The Pennsylvania Department of Environmental Protection (DEP) has issued a drought watch that affects Allegheny County. At this time, residents and businesses may take voluntary actions to conserve water by cutting down on nonessential use. For more information, please visit: dep.pa.gov/Drought.

Report a Claim for Damages

This form is to report damages to private property or personal injury as a result of water leakage or other activities of the Pittsburgh Water and Sewer Authority.

Please note:

If you do not have available all the information requested, complete as much as possible at this time so that there will not be an unnecessary delay in the processing of your claim.
You must submit documentation to support your claim, such as photos, videos, witness statements, estimates, invoices, receipts, and homeowner’s, automobile, and renter’s insurance documentation. Please note that PWSA will not return any items submitted as part of a claim. Please keep duplicates for your records.
Any person who knowingly and with intent to injure or defraud any insurer, files an application or claim containing any false, incomplete or misleading information shall, upon conviction, be subject to imprisonment for up to seven years and payment of a fine up to $15,000.00.
Your claim will be investigated as soon as possible to determine if additional information will be required. During the course of the investigation, we may require further documents and will advise you accordingly.
By receiving your claim form, PWSA is not making an admission of liability nor does this mean PWSA will pay your claim. PWSA must investigate the circumstances surrounding your claim before it can be determined whether your claim will be denied or approved for payment.
PWSA is a political subdivision and is granted certain immunity under the Political Subdivision Tort Claims Act (PSTCA).

Submission

Please submit the webform below or print the Claim for Damages Form and deliver, mail, or email the completed form and attachments to:

Pittsburgh Water and Sewer Authority (PWSA)
ATTN: Claims Division
1200 Penn Avenue
Pittsburgh, PA 15222

Email: claims@pgh2o.com

Claim for Damages Webform

This form is to report damages to private property or personal injury as a result of water leakage or other activities of Pittsburgh Water.

Claimant Information

*Name

First

Last

*Email Address

*Home Phone

*Work Phone

*Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Incident Information

Attach additional information or documentation, if available.

*Date of Occurance

*Time of Occurrence

*Type of Incident

Water

Sewer

Auto

Personal Injury

Other

*Address of Occurrence

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

*Description of Damages

*Estimated Costs

Prior Incidents

*For a line break, are you aware of any prior line breaks in the vicinity?

Yes

No

If yes, give the date, location, and description of break:

Witnesses

Add witness names here and attach any witness statements in the File Upload section, if available.

Add witness names here and attach any witness statements in the File Upload section, if available.
	Add witness names here and attach any witness statements in the File Upload section, if available. Name Phone Address Address 2 City/Town State/Province ZIP/Postal Code	Item weight

more items

Property Owner Information

*Name

First

Last

*Phone

*Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Insurer Information

Notice: Your carrier must be notified as required by PA law (42 Pa.C.S.A. §8553)

*Is the property insured?

Yes

No

*Was the carrier notified?

Yes

No

*Company

*Policy Number

*Agent

*Phone

*Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

File Upload

You must submit documentation to support your claim, such as photos, videos, witness statements, estimates, invoices, receipts, and homeowner’s, automobile, and renter’s insurance documentation. Please note that Pittsburgh Water will not return any items submitted as part of a claim. Please keep duplicates for your records.

If your files are above the upload size limit, please email them to claims@pgh2o.com along with your name and a note explaining which claim they are for.

Unlimited number of files can be uploaded to this field.
14 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

Any person who knowingly and with intent to injure or defraud any insurer, files an application or claim containing any false, incomplete, or misleading information shall, upon conviction, be subject to imprisonment for up to seven years and payment of a fine up to $15,000.00.

*Signature

Sign above

*Signature Date

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