Sf 3164 Form PDF Details

When unfortunate events such as personal injuries, property damages, or the distressing loss of crops arise due to actions or negligence by city employees or operations, navigating the aftermath can be overwhelming. Here, the SF 3164 form serves as a crucial navigational tool for those affected. This form not only facilitates the process of claiming damages but also lays out the boundaries within which claims should be filed, guided by specific timelines outlined in the California Government Code Section 911.2. For incidents involving personal injury, property damage, or crop destruction, claims must be presented within six months following the cause of action. For all other causes, the window extends to one year. The document requires comprehensive details from claimants, including personal information, a thorough description of the incident, and the extent of the losses incurred. Additionally, the form demands transparency in listing potential future damages and the involvement of city employees, if any, in the incident. Filing this claim with the City of Fresno's Risk Management Department is facilitated by detailed instructions, ensuring claimants retain a copy for their records. Moreover, the inclusion of a stern warning about the felony charges associated with presenting false or fraudulent claims underlines the seriousness of the submission process. While the form may appear daunting at first glance, its structured approach provides a clear path for individuals seeking reparations for their grievances.

QuestionAnswer
Form NameSf 3164 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namessmall claims forem fresno ca, ca fresno form claim, city of fresno claim for damage form, fresno form claim

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CLAIM FOR DAMAGES

NOTE: A claim relating to a cause of action for death or for injury to person or to personal property or grown crops shall be presented not later than six (6) months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one (1) year after the accrual of the cause of action. (Refer to California Government Code Section 911.2)

INSTRUCTIONS: Deliver or mail the completed claim form to City of Fresno, Risk Management, 2600 Fresno Street, Room 1070, Fresno, CA 93721-3612. Retain the pink copy for your records. Sign and date all attachments to the claim form.

OFFICIAL USE ONLY

Name of Claimant (Injured or Damaged Party)

Birthdate of Claimant

Home Address of Claimant

City/State/Zip Code

Home Telephone Number

Business Address of Claimant

City/State/Zip Code

Business Telephone Number

Social Security Number of Claimant

CA Drivers License Number

Name of Person to whom any Notices concerning Claim should be sent (If different from above)

Relationship to Claimant

Address of Person to whom any Notices concerning Claim should be sent (If different from above)

Telephone Number

When did Injury, Damage or Loss occur? (Date and Time)

Police Report Number

Where did Injury, Damage or Loss occur? (Location Name, Street Address, Intersecting Streets, etc.)

How did Injury, Damage or Loss occur? (Provide full details - Use separate sheets, if necessary)

What did City or City Employee(s) do to cause the Injury, Damage or Loss? What are the name(s) of City Employee(s) who caused the Injury, Damage or Loss (If known)?

Describe the Injury, Damage or Loss claimed. (Provide full details - Attach any medical records and use separate sheets, if necessary.)

What is the amount of Injury, Damage or Loss claimed, including the estimated amount of any future Injury, Damage or Loss. (Itemize and attach medical bills, property damage estimates, etc.-Use separate sheets, if necessary). If the amount claimed exceeds $10,000.00, no dollar amount shall be included. However, you shall indicate whether the claim would be a limited civil case. (Refer to California Government Code Section 910[f])

Name, Address & Telephone Number of Witness(es), Doctor(s) and/or Hospital(s). (Use separate sheets, if necessary).

Signature of Claimant or Person acting on Claimant’s behalf

Date

PRESENTATION OF A FALSE OR FRAUDULENT CLAIM IS A FELONY (Refer to California Penal Code Section 72)

SF3164 (05/06)

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A way to prepare city of fresno claim form portion 1

2. Immediately after this array of blanks is done, go on to type in the suitable information in these - What did City or City Employees do, Describe the Injury Damage or Loss, What is the amount of Injury, Name Address Telephone Number of, Signature of Claimant or Person, Date, and PRESENTATION OF A FALSE OR.

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