File A Claim

“I state that my answers on this form are true and correct to the best of my knowledge. I also understand that submitting this form does not indicate that ITR Concession Co. LLC has accepted responsibility for this matter, and that responsibility will be determined after further investigation and analysis of the facts and circumstances relating to the incident. I further understand and agree that I am providing the requested information voluntarily in order to assist the ITR Concession Co. LLC to investigate the incident, and that, by completing the claims form, I hereby grant my permission to the ITR Concession Co. LLC to the information contained herein and that this form and any additional information may be sent to ITR Concession Co. LLC’s insurer or others investigating the incident"