PRESENTING A CLAIM TO THE CITY OF SAN RAMON
Please type or print clearly all of the information requested on the claim form.
You must complete each section or your claim may be returned to you as insufficient.
The following provides specific instructions for completing the claim form.
DOWNLOADABLE CLAIM FORM (PDF FORMAT)
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
State the full name and mailing address of the person/persons claiming damage or injury. Please include a daytime and evening telephone number.
WHEN DID THE DAMAGE OCCUR?
State the exact month, date, year, and appropriate time (if known) of the incident which caused the alleged damage/injury.
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?
Please explain the circumstances that led to the alleged damage or injury. State all facts that support your claim with the City and why you believe the City is responsible for the alleged damage or injury. If known, identify the name of the City Department(s) and/or City employees(s) that allegedly caused the damage or injury.
Provide the name, address and phone number of any witness to the incident.
What damage or injury occurred?
Provide in full detail a description of the damage/injury that allegedly resulted from the incident. (What specific damage or injury do you claim resulted from the alleged actions?)
State the specific dollar amount you are claiming as a result of the alleged damage/injury. If the damage/injury is continuing or is anticipated in the future, indicate with a "+" following the dollar figure if $10,000 or under.
HOW DID YOU ARRIVE AT THE AMOUNT CLAIMED?
Provide a breakdown of how the total amount that you are claiming was computed. You may declare expenses incurred and/or future, anticipated expenses. If you have supporting documentation (i.e. bills, payment receipts, cost estimates) please attach copies of them to your claim.
The claim must be signed by the claimant or by the attorney/ representative of the claimant. The City will not accept the claim without a proper signature. Government Code §910.02 provides "The claim shall be signed by the claimant or by some person on his/her behalf."
OFFICIAL NOTICES AND CORRESPONDENCE
Provide the name and mailing address of the person to whom all official notices and other correspondence from the City should be sent, only if other than the claimant. Please provide telephone numbers for the representative, if applicable.
SUBMIT COMPLETED AND RELATED DOCUMENTATION TO:
City of San Ramon
7000 Bollinger Canyon Rd
San Ramon, CA 94583
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.
You will receive a letter from the Risk Management Office indicating your claim has been received and is being investigated. You will receive an explanation of the investigation results within 45 days in most instances.
If, after reading these instructions, you have questions or need additional information regarding the filing of a claim with the City of San Ramon, please contact the City Clerk's office at (925) 973-2539 or firstname.lastname@example.org.