INSTRUCTIONS FOR FILING A CLAIM FOR DAMAGES
*PLEASE READ CAREFULLY*
The following form is fillable and printable only. Content cannot be saved or submitted online, so please gather all necessary information before beginning and complete the form in one sitting. If you choose to print a blank form to complete by hand, please print legibly in blue or black ink.
Please follow these steps for faster processing of your claim:
1) Complete the claim form on the following pages. Please provide as much detail as possible in the description section regarding the incident for which you are claiming damages. If all of the necessary information cannot be supplied in the space provided, please include additional pages. Attach any available documents or evidence supporting your claim, such as medical records or bills for personal injuries, photographs, proof of ownership for property damages, receipts for property value, etc.
2) Once the form is complete, print the form and have your signature notarized. Notary services for this specific purpose are available at Richland City Hall. The form must be signed by the claimant, the claimant’s attorney (or attorney-in-fact as authorized by a written power of attorney), or a court-approved guardian or guardian ad litem on behalf of a minor claimant. Only original signatures are accepted. Claim forms cannot be faxed or emailed to the City.
3) You must file your claim with the Richland City Clerk. Return the original, signed and notarized claim form and supporting documentation in person or via US Mail to:
City of Richland
City Clerk’s Office
Attn: Jennifer Rogers
625 Swift Blvd. MS-07
Richland, WA 99352
The City Clerk’s Office is located in Richland City Hall, which is open 8:00 a.m. – 5:00 p.m. Monday- Friday (excluding holidays). Documents will not be returned, so please consider keeping a copy of everything you submit.
After your claim has been submitted, you may receive notification from the City of Richland or the City’s risk pool, Washington Cities Insurance Authority (WCIA). Please promptly respond to any inquiries from either entity to ensure prompt review of your claim.
Claim Questions? If you have any questions regarding the enclosed claim form, or the status of a submitted claim, please contact Richland’s Risk & Safety Program Administrator at 509-942-7544.
Note: All documents submitted in connection with a claim for damages are subject to disclosure under the Washington Public Records Act (ch. 42.56 RCW).