Filing a Claim

You may fill out and submit the form below or select the icon below the form to download and print a claim form. If you choose not to submit your claim form online using the form below, please submit the downloaded claim form either in person, by mail, or fax to the City Clerk’s Office. As with all claims, you should provide any information that you believe will support your claim (i.e., estimates, photographs and diagrams). There is no cost associated with the filing of a claim, but be sure to send your claim to the City Clerk's Office:

Town of Colma
Attn: City Clerk
1198 El Camino Real
Colma, CA 94014

FAX: (650) 997-8308

Our insurance company will move quickly to resolve your claim. State law allows a 45-day period to conduct the investigative process. As soon as the outside adjuster has all the necessary information, you will be advised if your claim is approved or denied.

Claimant Name * Required
First Middle Last
Claimant Address * Required
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone
Work Phone
Amount of Claim * Required

Please upload copies of bills/estimates
If amount claimed is more than $10,000, indicate where jurisdiction rests.
- Municipal Court
- Superior Court
Name to which notices are to be sent if different from the claimant
First Last
Address to which notices are to be sent if different from the claimant
Street Address Address Line 2 City State ZIP Code
Date of incident * Required
MM slash DD slash YYYY
Time of incident * Required

: Hours

Minutes

AM/PM AM/PM
Location of Incident * Required
Address, street name, cross streets, etc
Describe the accident or incident including your reason for believing the Town is liable for your damages. * Required
Describe all damages which you believe you incurred as a result of this incident. * Required
Names of Public Employee(s) causing the damages you are claiming
File
Drop files here or

Max. file size: 200 MB.
Please upload any supporting documents here
Signature * Required