Cupertino, CA · Santa Clara County
Claim Form
The Claim Form is used by people presenting a claim to the City of Cupertino and records information about the incident, alleged loss, and claimant.
What this form is
Use this form to present a claim to the City of Cupertino, except where the form’s stated Government Code exceptions apply. It asks for claimant and notice contact details, incident information, supporting facts, damages or injuries, and the amount claimed or case classification. Additional sections collect insurance details for motor vehicle claims and representative information when an attorney or representative files.
Who needs it
A person presenting a claim to the City of Cupertino should complete this form, including an attorney or representative filing on someone’s behalf.
How to submit it
Submit the completed form by personal delivery or U.S. mail, postage paid, to the City Clerk, City of Cupertino, 10300 Torre Avenue, Cupertino, CA 95014.
About notarization
This form is signed without a notary; no notarized or sworn attachment is identified, so the claimant or representative signs and dates it.
How to submit this form
- 1
Download The Claim Form
Download the City of Cupertino Claim Form PDF.
- 2
Complete The Applicable Sections
Provide claimant, notice, incident, loss, and claim information; complete the insurance or representative sections when applicable.
- 3
Attach Additional Sheets If Needed
Attach additional sheets if you need more space for required information.
- 4
Sign And Date The Form
The claimant or claimant’s attorney or representative signs and dates the form.
- 5
Submit To The City Clerk
Deliver it personally or mail it, postage paid, to the City Clerk at 10300 Torre Avenue, Cupertino, CA 95014.
Frequently asked questions
- Do I need a notary for the Claim Form?
- No. This form is signed without a notary, and no notarized or sworn attachment is identified. The claimant or representative signs and dates the form.
- How do I submit the Claim Form?
- Submit the completed form by personal delivery or U.S. mail, postage paid, to the City Clerk at 10300 Torre Avenue, Cupertino, CA 95014.
- What information does the Claim Form ask for?
- It asks for claimant and notice details, incident facts, damages or injuries, and claim amount or case classification. Motor vehicle and representative sections apply when relevant.
- Do I include the amount claimed?
- For a claim under $10,000, the form asks for the amount and its basis of computation. For a claim over $10,000, it asks whether the case is limited or unlimited civil.
Need something notarized?
This Claim Form doesn’t need a notary — but if you have another Cupertino form that does, a commissioned online notary can help.