South Gate, CA · Los Angeles County
Liability Claim Form
This form is for people submitting an injury or property damage claim to the City of South Gate and describing the incident and losses.
What this form is
This form lets a person report an injury or property damage claim to the City of South Gate. It asks claimants to describe the incident, injuries or damage, claimed expenses, witnesses, and relevant health care providers, and to sign and date the form. The form also asks for supporting records such as receipts, repair estimates, photographs, and medical bills.
Who needs it
Anyone seeking compensation from the City for personal injury or property damage may use this form to describe the incident and claimed losses.
How to submit it
Submit the completed form to the City Clerk’s Office, 8650 California Avenue, South Gate, CA 90280. Include supporting documents requested by the form.
About notarization
This form is signed without a notary; the claimant signs and dates it, and no notarized attachment or sworn step is identified.
How to submit this form
- 1
Download The Form
Download the City of South Gate Liability Claim Form.
- 2
Complete The Claim Details
Provide claimant information, incident details, injury or damage information, claimed expenses, and other requested details.
- 3
Gather Supporting Documents
Attach relevant records such as receipts, repair estimates, photographs, medical bills, and any additional sheets needed.
- 4
Sign And Submit
Sign and date the completed form, then submit it to the City Clerk’s Office at the address shown on the form.
Frequently asked questions
- Do I need a notary for the Liability Claim Form?
- No. The claimant signs and dates this form without a notary, and the document does not identify a notarized attachment or sworn step.
- How do I submit the Liability Claim Form?
- Submit the completed form to the City Clerk’s Office at 8650 California Avenue, South Gate, CA 90280. Include supporting records requested by the form.
- What documents should I attach to the claim?
- The form requests relevant documentation such as receipts, repair estimates, photographs, and medical bills. For property damage claims, it asks for at least two repair or replacement estimates.
- When does the form say a claim must be filed?
- The form states that claims for personal injury or property damage must be filed no later than six months after the occurrence.
Need something notarized?
This Liability Claim Form doesn’t need a notary — but if you have another South Gate form that does, a commissioned online notary can help.