Attachment 3 Damage Claim.pdf

This is a Damage Claim Form 2062 (Revised 01/2014) issued by the South Carolina Department of Transportation for processing claims related to property damage or personal injury. The form is designed to capture comprehensive information about incidents involving registered vehicles or other damages potentially attributable to state transportation infrastructure or operations. Claimants must provide complete information including incident date and location, vehicle details (tag number and state), insurance information, and a detailed description of the incident including cause and type of damage or injury. All applicable fields must be completed, and the claim must be substantiated with supporting documentation such as two repair estimates or paid invoices for vehicular damage, or appropriate documentation of losses for personal injury or non-vehicular claims.

The form requires claimant signatures to be properly notarized through an affidavit process, wherein the claimant swears under oath that the claim is true and just and that no compensation has been received from other sources for the damages claimed. The notary public must provide their printed name, signature, commission expiration date, and state of commission. This documentation requirement ensures the legitimacy and accuracy of all submitted claims before the South Carolina Department of Transportation processes payment or denial of the damage claim.