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Risk Management Claim for Damage Form

Steps

  1. 1. Step One
  2. 2. Claim for Damage
  3. 3. Step Three
  4. 4. Step Four
  5. 5. Step Five
  6. 6. Step Six
  • Step One

    1. H2K_WF_City_Texas_TRANS_Tag_RGB
    2. CITY OF WICHITA FALLS CLAIM FILING PROCEDURES
    3. To file a claim against the City of Wichita Falls for Compensation of damages to your person or property, sufficient information is required. (City of Wichita Falls Code of Ordinances, Section 2.8)
    4. Any statements or promises made to you concerning your claim by any other city employee or agency are unauthorized and are not binding by the Risk Management or City Attorney’s Office.
    5. A claim can be considered only after it is filed in writing at the office of the City Clerk or the Risk Management office. By filing a claim you agree to allow the City or its agent to inspect your property or investigate the physical injury. Unreasonable refusal of such inspection or investigation will be grounds for denial of your claim.
    6. Filing a claim against the City does not automatically guarantee reimbursement from the City. However, the City examines each claim on an individual basis in determining if reimbursement is legally required.
    7. In order to obtain reimbursement for a claim against the City, you must prove that the City or its employees acted unlawfully or negligently.
    8. ACCEPTANCE OF THIS REPORT BY THE CITY IS NOT AN ADMISSION OF LIABILITY
    9. The following must be provided in letter form prior to the 45th day after the damages you incurred:
    10. ⦁ The time, date, and exact location of the reported incident.
    11. ⦁ As detailed a description as possible stating the nature and extent of the injury or damage. The manner in which the injury or damage occurred including the date, time, place, and a copy of any pictures taken.
    12. ⦁ The amount for which the claimant will settle.
    13. ⦁ Proof of the amount of the claim by means of either itemized receipts or two itemized estimates (If you are submitting two estimates, claims will not be processed unless they are itemized and provided from two separate agents, companies, or vendors).
    14. ⦁ Names and addresses of witnesses, if any, to the incident.
    15. ⦁ Police accident report or number, if any.
    16. ⦁ Be sure your name, address, email address, and telephone number are on your claim.
    17. This claim must be postmarked or hand-delivered to the following address within 45 days of the injury or loss:
    18. City Clerk
      Memorial Auditorium 1300 7th Street, Room 104
    19. PO Box 1431 Wichita Falls, TX 76307
    20. 940-761-7632
    21. city-clerk@wichitafallstx.gov