Claim Form

CLAIM FORM

All official claims against the City shall be submitted to the City Clerk's office located within City Hall. Claim forms may be obtained from the City Clerk or downloaded below. The City will accept other formal methods of filing a claim providing the claim has the following required information:

  • Name and address of the claimant or the designated representative, where applicable.
  • Date, place, and circumstances of the occurrence.
  • A description of the indebtedness giving rise to the claim.
  • Name(s) of public employee(s) causing loss, if known.
  • Amount of claim, if known, at the time of filing.
  • Signature of claimant or representative.

The City's Risk Manager and the insurance agency will review and investigate your claim and issue a written recommendation for approval or denial.  This process takes an estimated six to eight weeks.  Claims must be filed no later than six months from the date of occurrence (state's statute of limitations).  For additional information please contact the City Clerk's office. 

TO SUBMIT A CLAIM:

  1. Download the City Claim Form.
  2. Submit your Claim Form and any attachments to the City Clerk's Office; 

By mail to:

1600 W. Beverly Boulevard, Montebello CA 90640; Attention: City Clerk's Office

OR in person during the following hours of operation:

Monday through Thursday: 7:30 AM - 5:30 PM. Closed every Friday.

CONTACT:
City Clerk's Office