La Verne, CA · Los Angeles County
Claim for Damages Form
La Verne residents or other claimants use this form to describe and submit a claim for personal injury, property damage, or loss involving the City.
What this form is
The form lets a claimant report damage, injury, or loss and explain why they believe the City is responsible. It requests claimant contact details, incident information, a description of damages, cost estimates, and information about witnesses, medical care, and any police investigation. The form says claims for personal injury or personal property damage must be filed within six months, while real property damage and monetary claims must be filed within one year.
Who needs it
A person seeking damages from the City for injury, property damage, or another loss can use this form to present their claim.
How to submit it
File the signed form with the City Clerk's Office, City of La Verne, 3660 D Street, La Verne, CA 91750.
About notarization
This document is signed without a notary; the claimant or person filing on the claimant's behalf signs and dates the form.
How to submit this form
- 1
Download The Form
Download the Claim for Damages Form PDF.
- 2
Complete The Claim
Provide claimant details, incident information, damage or loss descriptions, and requested cost estimates.
- 3
Gather Attachments
Attach separate sheets if needed to give full details; sign each attached sheet and include a signed diagram if the provided diagrams do not fit.
- 4
Sign And File
Sign the form on page 2 and file it with the City Clerk's Office at 3660 D Street, La Verne, CA 91750.
Frequently asked questions
- What is the La Verne Claim for Damages Form used for?
- It lets a claimant describe damage, injury, or loss, explain why the City is responsible, and provide details such as costs, witnesses, and medical care.
- Do I need a notary for the Claim for Damages Form?
- No. This form is signed without a notary; the claimant or a person filing on the claimant's behalf signs and dates it.
- How do I submit the Claim for Damages Form?
- Sign the form and file it with the City Clerk's Office at 3660 D Street, La Verne, CA 91750.
- What information does the form ask for?
- It asks for claimant contact information, when and where the loss occurred, how it happened, why the City is responsible, damage estimates, and information about witnesses and medical care.