Bainbridge Island, WA · Kitsap County
Claim for Damages
This form lets a person or authorized representative submit a claim for damages to the City of Bainbridge Island with supporting information and evidence.
What this form is
Use this form to present a claim for damages to the City of Bainbridge Island. It asks for claimant and incident details, information about injuries or property loss, the amount claimed, and supporting evidence; automobile claims have additional questions. Include available supporting documents, such as bills, records, photographs, or proof of property ownership, and sign and date the form.
Who needs it
A claimant, or an authorized representative listed on the form, uses this document to present a damages claim to the city.
How to submit it
Send the completed claim and supporting documents to City Clerk, City of Bainbridge Island, 280 Madison Avenue North, Bainbridge Island, WA 98110-1812, or email [email protected].
About notarization
This document is signed without a notary; the signer signs and dates it and declares the information true and correct under penalty of perjury.
How to submit this form
- 1
Download The Form
Download the Claim for Damages form.
- 2
Complete The Form
Type or print clearly in ink and provide the requested claimant, incident, and damages information.
- 3
Gather Supporting Documents
Include available evidence, such as bills, medical records, photographs, or proof of property ownership. Add sheets if needed.
- 4
Sign And Submit
Sign and date the claim, then send it with supporting documents to the City Clerk by mail or email.
Frequently asked questions
- Do I need a notary for the Claim for Damages?
- No. The form is signed and dated without a notary; the signer declares the information true and correct under penalty of perjury.
- How do I submit the Claim for Damages?
- Send the completed form and supporting documents to the City Clerk at the listed Bainbridge Island mailing address, or email them to [email protected].
- What information does the claim form request?
- It asks for claimant and incident details, information about injuries or property loss, the amount claimed, and supporting evidence. Automobile claims have additional questions.
- Who may sign the Claim for Damages?
- The claimant may sign, as may the listed authorized representatives, including a person with written power of attorney, an attorney admitted to practice in Washington State, or a court-approved guardian.