About Us
Services

Careers
Portal (Coming Soon)

Contact Us

Skip to Content

About Us
Services
Careers
Portal (Coming Soon)

Contact Us

New Assignment Form

Please fill out the form below and click “Submit New Assignment” when complete. We will review immediately and dispatch to one of our Expert IAs as soon as possible, at which point you will receive a confirmation email with your Expert IA’s contact information!

"*" indicates required fields

Assignment Information

Claim Type*

Equipment/Specialty Assignment Type*

Equipment/Specialty Other Assignment Type

Property Assignment Type*

Property Other Assignment Type

Property Type*

Other Property Type

Equipment/Specialty Type*

Other Equipment/Specialty Type

Agreed Repair Estimate or Valuation Needed*

Yes

No

Client Information

Carrier/Client*

Staff Adjuster Name*

First Last

Staff Adjuster Phone*

Staff Adjuster Email*

Claim Information

Claim Number*

Policy Number*

Deductible*

Date of Loss*

MM slash DD slash YYYY

Other Property Loss Type

Insured Information

Business Name

Insured Name*

First Last

Insured Phone*

Insured Email

Insured Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Claimant*

Yes

No

Claimant Information

Business Name

Name*

First Last

Phone*

Email

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Loss Location

Business Name

Loss Location*

Same as Insured Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Coverage Information

Involved Coverages*

Coverage Category

Coverage Limit

RC/ACV

Other Coverage Information

Property Loss Type*

Cosmetic Exclusion*

Yes

No

Cosmetic Exclusion Information

Other Cosmetic Exclusion Information

Public Adjuster Retained*

Yes

No

Public Adjuster Information

Name*

First Last

Phone*

Email

Equipment/Specialty Claim Information

Unit Information*

Year

Make

Model

VIN/Serial/HIN

Click the blue "+" to the right to add multiple units under the same claim

Equipment/Specialty Loss Type*

Other Equipment/Specialty Loss Type

Drivable

Yes

No

Unsure

Total Loss Information

Total Loss Valuation Needed*

Yes

No

Total Loss Valuation Request Type*

Other Valuation Type Request

Salvage Bids Needed*

Yes

No

Salvage Bid Type*

Other Salvage Bid Request

Equipment/Specialty Location Information

Location*

With Owner

Salvage/Tow Yard

Workplace

Shop

Other

Shop/Yard Name*

Location Address*

Same as Insured Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supporting Documentation

Loss Description and Special Instructions

FNOL/Loss Notice

Max. file size: 50 MB.

Declarations Page

Max. file size: 50 MB.

Shop Estimate

Max. file size: 50 MB.

Contractor Estimate

Max. file size: 50 MB.

Receipts for Temporary Repairs

Max. file size: 50 MB.

Tow Bill

Max. file size: 50 MB.

Photos

Max. file size: 50 MB.

Email

This field is for validation purposes and should be left unchanged.

Δ

(270) 222-6711 or (864) 906-5188

admin@bluegrass.claims

117 E 18th St #101
Owensboro, KY 42303

Copyright ©2025 Bluegrass Damage Appraisal. All Rights Reserved. web design by sandlapper