CLAIM FOR DAMAGES
AGAINST THE CITY OF DIAMOND BAR, CALIFORNIA
(Government Code § 910, 910.2)
INSTRUCTIONS (Please read carefully):
• Claims related to injury to person or damage to
sonal property must be presented to the City
within six (6) months from the date of loss.
• Claims related to any other loss must be presented
later than one (1) year from the date of loss.
• Answer all items fully and to the best of your
knowledge and information. Failure to do so may
result in your claim being found insufficient. If more
space is needed to provide requested information,
please attach additional pages identifying
agraphs(s) being answered. Please click in t
rey text fields to type requested information.
Date/Time Received by the City Clerk
[City Use Only]
Pursuant to Government Code § 915a, please file your claim with the City Clerk.
TO: City Clerk
City of Diamond Bar
21810 Copley Drive
Diamond Bar, CA 91765
1. Claimant's Name:
rimary Phone Number: Claimant’s Date of Birth:
laimant's Mailing Address:
Street Number – Street - Apt No. – City – State – Zip
te/Time of Loss:
4. Location of Loss (Specify in as much detail as possible)
Description of incident/accident that caused you to make this claim: