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)
CLAIMANT'S CONTACT INFORMATION
State the full name and mailing address of the person/persons claiming damage or injury. Please include a daytime and evening telephone number, and an email address if you have one.
DATE AND TIME INJURY, DAMAGE, OR LOSS OCCURRED?
State the month, date, year, and approximate time (if known) of the incident that 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 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).
SPECIFIC LOCATION WHERE THE INJURY, DAMAGE OR LOSS OCCURED?
Please include street address, city, county, intersection, etc. If applicable, also include the Police Report number in the top right of the form.
WHAT HAPPENED AND WHY IS THE CITY RESPONSIBLE?
A. Please explain the circumstances that led to the alleged damage or injury. State all facts that support your claim against the City and why you believe the City is responsible for the alleged damage or injury.
B. If known, identify the name of the City Department(s) and/or City employee(s) that allegedly caused damage or injury.
DESCRIBE THE DAMAGE OR INJURY THAT AROSE FROM THE INCIDENT
Provide in full detail with 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?
CLAIM AMOUNT
If under $10,000, state the specific total dollar amount you are claiming as a result of the alleged damage/injury. If the damage/injury is continuing or you anticipate future costs, indicate with a "+" following the dollar amount. If the total dollar amount exceeds $10,000, select the appropriate court jurisdiction for the claim.
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. You may redact bank, credit card, or other private information from any documents attached.
SIGNATURE
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
The claim must be signed by the claimant or by some person (i.e., an attorney or other representative) on behalf of the claimant per Government Code §910.2. The City will not accept the claim without a proper signature.
SUBMIT COMPLETED AND RELATED DOCUMENTATION TO:
By Mail to:
City of San Ramon City Clerk's Office
7000 Bollinger Canyon Rd
San Ramon, CA 94583
By email to: cityclerk@sanramon.ca.gov
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, return the form to the City Clerk 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 cityclerk@sanramon.ca.gov.