Orinda, CA · Contra Costa County
Notice of Claim Against the City
This form lets a claimant submit a notice of injury, loss, or damage to the City of Orinda and provide details supporting the claim.
What this form is
Claimants use this form to notify the City of Orinda of an accident or occurrence and describe resulting injury, loss, or damage. It asks for contact details, the date and place of the occurrence, witness and treatment information if applicable, the amount claimed, and how that amount was calculated. The form states filing periods for injury or personal property claims and other claims.
Who needs it
A person seeking to make a claim against the City of Orinda for an accident, injury, loss, or damage can complete and submit this form.
How to submit it
Return the completed form to the City Clerk, City of Orinda, 22 Orinda Way, Orinda, CA 94563. The form says to complete both sides and sign it.
About notarization
This document is signed without a notary; the claimant declares under penalty of perjury that the claim is true to their knowledge and belief.
How to submit this form
- 1
Download The Form
Download the Notice of Claim Against the City form.
- 2
Complete Both Sides
Provide the requested claimant, occurrence, witness, loss, and amount information. Complete both sides of the form.
- 3
Gather Supporting Documents
Attach copies of documents substantiating the claimed amounts, if available.
- 4
Sign And Return The Form
Sign the form and return it to the City Clerk at 22 Orinda Way, Orinda, CA 94563.
Frequently asked questions
- Do I need a notary for the Notice of Claim?
- No. The form has no notary block; the claimant signs a declaration under penalty of perjury that the claim is true to their knowledge and belief.
- How do I submit the Notice of Claim?
- Complete both sides, sign the form, and return it to the City Clerk, City of Orinda, 22 Orinda Way, Orinda, CA 94563.
- What information does the claim form request?
- It asks for claimant contact information, occurrence details, witness and treatment information if applicable, a description of the loss or injury, and the amount claimed.
- When does the form say a claim must be filed?
- The form states six months for claims related to injury to a person or personal property, and one year for claims related to any other cause of action.
Need something notarized?
This Notice of Claim Against the City doesn’t need a notary — but if you have another Orinda form that does, a commissioned online notary can help.