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Claims related to injury to person or damage to personal property must be presented to the City within six months from the date of loss. Claims related to any other loss must be presented not later than one year from the date of loss. Answer all items fully and to the best of your knowledge and information. Failure to do so may result in your claim being found insufficient.
Be as specific as possible. Example: 5 feet east of west corner of Elmira Road and Peabody
I/We, the undersigned, declare under penalty of perjury that I/we have read the foregoing claim for damages and know the contents thereof; that the same is true of my/our own knowledge and belief, save and except as to those matters wherein stated on information and belief, and as to them, I/we believe to be true.
Person filing on behalf of claimant
Presentation for allowance or payment of a false or fraudulent claim, with intent to defraud, is a crime punishable as a felony under California Penal Code, Section 72, and Insurance Code, Section 1871.1.
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