Clayton, CA · Contra Costa County
Claim Form
Use this form to present a claim to the City of Clayton for alleged damage or injury, providing incident details, claimed losses, and supporting documentation.
What this form is
The form lets a claimant explain an incident, why they believe the City is responsible, the damage or injury, and the amount claimed. The instructions describe different presentation periods depending on the type of claim and explain that a late claim must include an application for leave to present it. Attach supporting documentation for the claimed amount, and sign the form.
Who needs it
People seeking to present a claim to the City of Clayton for alleged damage or injury should complete and sign this form.
How to submit it
Submit the completed form and related documentation to the City Clerk of the City of Clayton. Personal service is available during the regular City business hours stated on the form.
About notarization
This document is signed without a notary; it includes a declaration under penalty of perjury, and the claimant or representative signs and dates it.
How to submit this form
- 1
Download The Form
Download the City of Clayton Claim Form PDF.
- 2
Complete The Form
Type or print clearly, complete each section, describe the incident and claimed losses, and sign and date the declaration.
- 3
Gather Supporting Documents
Attach documentation supporting the amount claimed, such as bills, receipts, or cost estimates.
- 4
Submit To The City Clerk
Submit the completed form and related documentation to the City Clerk of the City of Clayton.
Frequently asked questions
- Do I need a notary for the Clayton claim form?
- No. The form has no notary block; the claimant or representative signs and dates a declaration under penalty of perjury.
- How do I submit the Clayton claim form?
- Submit the completed form and related documentation to the City Clerk of the City of Clayton. The form also describes personal service during the stated regular City business hours.
- What information does the claim form ask for?
- It asks for claimant contact details, incident date and location, what happened, alleged damage or injury, the amount claimed, supporting documentation, and representative details if applicable.
- What documentation should I include?
- The instructions ask you to attach supporting documentation for the amount claimed, such as bills, payment receipts, or cost estimates.