File original claim with the City Clerk's Office, P.O. Box 19575, Irvine, CA 92623-9575. Failure to provide sufficient information
may result in delays in claim processing.
1. Claims for death, injury to person or to personal property must be filed no later than six (6) months after
the occurrence (Government Code Section 911.2). This applies to occurrences after January 1, 1988.
2. Claims for damages to real property must be filed no later than one (1) year after the occurrence
(Government Code Section 911.2).
3. Review and complete entire Claim For Damages form before filing.
4. Attach separate sheets, if necessary, to give full details.
5. This form must be signed by the claimant or a person on his/her behalf (Government Code Section 911.2).
6. This form is for the convenience of those desiring to present claims against the City. Claimant is advised to
consult a private attorney if legal advice is desired. City employees may not give legal advice to any
claimant relating to private claims.
IF CLAIMANT WOULD LIKE NOTICES SENT TO AN
ADDRESS DIFFERENT FROM ABOVE, INDICATE BELOW:
IF CLAIMANT IS REPRESENTED BY AN ATTORNEY,
PROVIDE NAME AND ADDRESS: