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Michigan County Road Commission Self-insurance Pool
(800) 842-4971
417 Seymour Ave., Suite 2, Lansing, MI 48933
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Media Category: Third Party Loss

Instructions on how to use the above documents.

Third-Party Claim Form

(Fillable Adobe Acrobat PDF)

Customizable Instructions for Third Party Losses Against the Road Commission

Requires MS Word. Enter your RC information where indicated, then print/save as Adobe Acrobat PDF and send with the Third-Party Claim Form and MCL 691.1404 Statute below.

Michigan County Road Commission Self-Insurance Pool

(800) 842-4971

417 Seymour Ave., Suite 2, Lansing, MI 48933

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