Your Contact Info

Member Information

Member Name:

Main Phone:

Main Fax:

Website:

Mailing Address:

Physical Address:

Municipal Manager / Clerk / Attorney

Municipal Manager / Administrator

Name:

Title:

Email:

Phone:

Municipal Clerk

Name:

Title:

Email:

Phone:

City / Town Attorney

Receives correspondence from CIRSA’s Claims Department and assigned defense counsel on high profile and litigated claims. Provides input on behalf of member for claims which involve complex issues. One designated contact per member is recommended. Due to system limitations, only two city/town attorney contacts are permitted.

Name:

Title:

Email:

Phone:

Designated Primary Contact

Main point of contact for CIRSA correspondence; distributes information to appropriate member staff; maintains member contact information, website users, and system access. One designated contact per member is recommended. Due to system limitations, only two primary contacts are permitted.

Name:

Title:

Email:

Phone:

Designated Claims Contact

Receives correspondence from CIRSA’s Claims Department and CIRSA-assigned defense counsel; provides input on behalf of member on claims settlement and defense decisions; files claims and accesses claim reports. One designated PC and one designated WC contact is permitted.

Property/Casualty Claims

Name:

Title:

Email:

Phone:

Workers' Compensation Claims

Name:

Title:

Email:

Phone:

Designated Coverage Contact

Receives annual renewal application and workers’ compensation audit (if applicable), interacts with CIRSA’s Underwriting department on policy, coverage, and underwriting questions. One designated PC and one designated WC contact is recommended. Due to system limitations, only two PC and two WC contacts are permitted.

Property/Casualty Underwriting

Name:

Title:

Email:

Phone:

Workers' Compensation Underwriting

Name:

Title:

Email:

Phone:

Designated Training & Prevention Contact

Receives and distributes risk management and training materials, videos, posters, seminar notices, etc. Interacts with CIRSA’s Risk Control Department during property surveys, audits and other risk prevention activities. One designated contact per member is permitted.

Risk Control

Name:

Title:

Email:

Phone:

Designated Accounts Payable Contact

Receives all invoices from CIRSA’s Finance Department. One designated contact per member is recommended. Due to system limitations, only two accounts payable contacts are permitted.

Accounts Payable

Name:

Title:

Email:

Phone:

CIRSA Voters

Receives proposed CIRSA Bylaw amendments and notices of new members seeking CIRSA membership, unless waived. Attends and votes at the General Membership Meeting. Must be an officer or employee of the member.

Voter

Name:

Title:

Email:

Phone:

Alternate Voter

Name:

Title:

Email:

Phone:

Elected Officials

Receives invitations to public official trainings, Member Appreciation Lunches, General Membership Meeting, and notice of CIRSA’s Annual Report. If no email is on file, please leave these fields blank.

Member Information

Municipal Manager / Clerk / Attorney

Municipal Manager / Administrator

Municipal Clerk

City / Town Attorney

Designated Primary Contact

Designated Claims Contact

Property/Casualty Claims

Workers' Compensation Claims

Designated Coverage Contact

Property/Casualty Underwriting

Workers' Compensation Underwriting

Designated Training & Prevention Contact

Risk Control

Designated Accounts Payable Contact

Accounts Payable

CIRSA Voters

Voter

Alternate Voter

Elected Officials

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