|Claim Form Instructions|
PRESENTING A CLAIM TO THE CITY OF SAN RAMON
Please type or print clearly all of the information requested on the claim form.
You will need the Adobe Acrobat Reader to view and print a claim form. Click the button to get the Reader now! Otherwise, please contact the City Clerk's office at (925) 973-2539 or e-mail us at email@example.com.
We also encourage any visually impaired users who are unable to view the PDF documents to visit Access.Adobe.com, The site contains tools that can convert PDF documents into simple HTML or ASCII text which standard screen reading programs can then synthesize the HTML as audible speech.
NAME AND MAILING ADDRESS OF CLAIMANT
WHEN DID THE DAMAGE OCCUR?
Under State law, claims relating to causes of action for personal injury, wrongful death, property damage, and crop damage must be presented to the City of San Ramon no later than six months after the incident date. Please note that evidence of "presentation" includes a clear postmark date on an envelope or a certification of personal service.
When filing a claim beyond the six-month period, you must explain the reason the claim was not filed within the six-month period. This explanation is called "application for leave to present a late claim." In considering your claim, the City will first decide whether the late claim application should be granted or denied. (See Government Code §911.4 for the legally acceptable reasons why a claim may be filed late.) Only if your late claim application is granted will the City then consider the merits of you claim.
Claims relating to any cause of action other than personal injury, wrongful death, property damage, and crop damage must be presented no later than one year after the incident. (See Government Code §911.2).
AT WHICH LOCATION DID THE DAMAGE OR INJURY OCCUR?
Please include street address, city, county, intersection, etc. If possible, also include the Police Report number.
WHAT HAPPENED AND WHY IS THE CITY RESPONSIBLE?
What damage or injury occurred?
HOW DID YOU ARRIVE AT THE AMOUNT CLAIMED?
OFFICIAL NOTICES AND CORRESPONDENCE
SUBMIT COMPLETED AND RELATED DOCUMENTATION TO:
Personal service of claims can be accomplished during regular City business hours (8:30 a.m. to 5:00 p.m.) Monday through Friday (excluding City holidays).
If you wish to receive a stamped copy of your claim, submit a completed Claim Form to the City Clerk's Department with a cover letter, along with a stamped, self-addressed envelope informing the City of your request.