City of Waco
Claim Information
ARTICLE XI SECTION 7 OF THE CHARTER OF THE CITY OF WACO REQUIRES
WRITTEN NOTICE BEFORE ANY CLAIM FOR INJURY OR DAMAGE MAY BE
CONSIDERED. THE CHARTER PROVISION IS QUOTED BELOW FOR
INFORMATION:
SECTION 7. NOTICE OF CLAIM
The City of Waco shall not be held responsible on account of any claim for da
mages to
any person or property unless the person making such complaint or claiming such
damages shall, within thirty days after the time at which it is claimed such damages were
inflicted upon such person or property, file with the City Secretary, a true statement under
oath, as to the nature and character of such damages or injuries, the extent of the same,
and the place where same happened, the circumstances under which happened, the
conditions causing same, with a detailed statement of each item of damages and the
amount thereof, and if it be for personal injuries, giving a list of the witnesses, if any
known to affiants, who witnessed such accident.
ACCEPTING THE FILING OF A CLAIM DOES NOT CONSTITUTE AN
ADMISSION OF LIABILITY BY THE CITY OF WACO.
THE CITY IS LEGALLY IMMUNE FROM LIABILITY, FOR MANY CLAIMS,
BY COMMON LAW OF THE STATE OF TEXAS.
File this claim within 30 (thirty) days of the injury or property damage with the City
Secretary.
If Mailing: If Delivering:
City Secretary City Secretary’s Office
City of Waco City Hall First Floor
P.O. Box 2570 300 Austin Ave.
Waco, TX 76702-2570 Waco, Texas
For follow-up contact:
Risk Management Department (254) 750-5730
P.O. Box 2570
Waco, TX 76702-2570
For Office Use Only:
CLAIM FORM
Personal Injury – Property Damage
RECEIPT OF THIS FORM BY THE CITY OF WACO IS NOT AN ADMISSION OR ACCEPTANCE OF LIABILITY.
(PLEASE PRINT IN INK)
Full Name: ___________________________________________ Home Phone: ______________________
Address: _____________________________________________ Work Phone: ______________________
City, State: ____________________________________________ Zip Code: ________________________
Location of incident: ______________________________________________________________________
Date of incident: __________________________________________Approx Time: _____________ AM/PM
***************************************************************************************
Describe in your own words WHERE, WHEN, and HOW the damage or injury occurred. Attach additional
pages if necessary. Give names and addresses of others involved if known.
***************************************************************************************
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
ALL OF THE STATEMENTS MADE IN THIS CLAIM ARE TRUE AND CORRECT TO THE BEST OF
MY KNOWLEDGE:
___________________________ _________________________________
Date Signature of Claimant
SWORN AND SUBSCRIBED BEFORE ME a Notary Public in and for the State of Texas, this_____
day of __________________________ 20______.
____________________________
Notary Public in and for the
State of Texas
File No. _____________
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome