Pico Rivera, CA · Los Angeles County
Claim Form
Claimants use this form to present a claim against the City of Pico Rivera for personal injury, property damage, indemnity, or another loss.
What this form is
This form presents a claim against the City of Pico Rivera for personal injury, property damage, indemnity, or another loss. It asks for claimant and incident details, the city employee involved if applicable, claimed amounts, witnesses, and contact information for notices. The instructions call for supporting records and, for automobile claims, proof of insurance; they also specify filing copies and the delivery address.
Who needs it
A person seeking to present a claim against the City of Pico Rivera for an injury, property damage, indemnity, or another loss needs this form.
How to submit it
File the original and one identical copy with one copy of all attachments at the City Clerk’s Office, City of Pico Rivera, 6615 Passons Bl., Pico Rivera, CA 90660. Retain one copy.
About notarization
This form is signed and dated without a notary; the instructions identify supporting records and automobile proof of insurance, but no notarized attachment or sworn step.
How to submit this form
- 1
Download the Claim Form
Download the City of Pico Rivera claim form PDF.
- 2
Complete the Form
Fill out the claimant, incident, loss, and contact information; print the form and sign and date it.
- 3
Gather Attachments
Include copies of supporting documentation for claimed amounts and, for an automobile accident, proof of insurance.
- 4
File With the City Clerk
Submit the original and one identical copy, plus one copy of all attachments, to the City Clerk’s Office at the address on the instructions.
Frequently asked questions
- Do I need a notary for this claim form?
- No. The form is signed and dated without a notary. Its instructions call for supporting records and, for automobile claims, proof of insurance, but identify no notarized attachment or sworn step.
- How do I submit the claim form?
- File the original and one identical copy, along with one copy of all attachments, with the City Clerk’s Office at 6615 Passons Bl., Pico Rivera, CA 90660. Retain one copy for your records.
- What documents should I attach?
- Attach copies of supporting documentation for the amounts claimed. If the claim relates to an automobile accident, the form also asks you to attach proof of insurance.
- When should I present a claim?
- The form warns that California law generally requires most claims against the City to be presented within six months, while certain other claims must be filed within one year. It advises checking the Government Code for the applicable period.
Need something notarized?
This Claim Form doesn’t need a notary — but if you have another Pico Rivera form that does, a commissioned online notary can help.