Holtville, CA · Imperial County
Liability Claim Form
This form lets a person or representative submit a claim for money or damages against the City of Holtville and provide information about the incident.
What this form is
Use this form to present a claim for money or damages against the City of Holtville. It asks for claimant and notice contact details, incident information, a description of the loss, and the amount or case type when applicable. It also requests details about witnesses and, when relevant, medical treatment or automobile insurance; supporting records and diagrams may be attached.
Who needs it
A claimant or a person acting on the claimant’s behalf uses this form to present a claim for money or damages against the City of Holtville.
How to submit it
File the completed claim with the City Clerk, City of Holtville, 121 West Fifth St., Holtville, CA 92250.
About notarization
This document is signed without a notary; the form asks the claimant to sign and date it, and does not identify any notarized attachment or related step.
How to submit this form
- 1
Download The Form
Download the City of Holtville Liability Claim Form.
- 2
Complete The Claim
Provide claimant and notice contact details, incident information, loss details, and other applicable information requested by the form.
- 3
Gather Supporting Materials
Attach additional sheets or applicable supporting records and diagrams as described on the form.
- 4
Sign And Submit
Sign and date the form, then file it with the City Clerk at 121 West Fifth St., Holtville, CA 92250.
Frequently asked questions
- Do I need a notary for the Liability Claim Form?
- No. The form asks the claimant to sign and date it, but does not include a notary block or identify a notarized attachment or related step.
- How do I submit the Liability Claim Form?
- File the completed form with the City Clerk, City of Holtville, at 121 West Fifth St., Holtville, CA 92250.
- What information does the Liability Claim Form request?
- It asks for claimant and notice contact details, the incident date, time, location and circumstances, information about the loss, and other details such as witnesses or medical treatment when applicable.
- Can I attach supporting documents?
- Yes. The form says to attach additional sheets if needed and requests supporting medical bills or reports, repair bills or estimates, and a signed diagram when the provided diagrams do not fit.