File a Claim for Damages

If you believe that the City is liable for damages to you or your property, you must complete a Claim for Damages Form within three years from the time of the incident, or if a minor at the time of incident, before you reach the age of 21. Due to City Hall closure, staff are not currently available for notarizations. 

Online

Step 1.Download a Claim for Damages form

Step 2.Fill out completely

  • Type or print legibly.
  • Submit any available documents or evidence supporting your claim.
  • If the requested information cannot be supplied in the space provided on the form, use additional blank sheets or word documents.

Step 3.Notarize

  • Must be notarized before submitting.
    • Staff will be able to assist with notarizations, free of charge.

Step 4.Submit to City Clerk's Office

  • City Hall has a drop box outside the North Entrance for form submittals during closed business hours.
  • Bring into City Hall during business hours, submit to front desk staff, who will transfer to the City Clerk's Office.
  • Mail with completed notarization to 123 5th Ave, Kirkland, WA 98033.  
  • Electronic or faxed copies will not be accepted.

Step 5.Process of the claim 

  • The claim will be sent to the city's Human Resources Coordinator.
  • The claim is then sent to WCIA for investigation to determine the City's responsibility.
  • WCIA will contact you with next steps.

Phone/Email

Step 1.Obtain a Claim for Damages form

  • Call the City Clerk's Office or Human Resources Division to receive a form by email. If leaving a voicemail please include a valid email, mailing address, or phone number to reach you.

Step 2.Fill out completely

  • Type or print legibly.
  • Submit any available documents or evidence supporting your claim.
  • If the requested information cannot be supplied in the space provided on the form, use additional blank sheets or word documents.

Step 3.Notarize

  • Must be notarized before submitting.
    • Staff will be able to assist with notarizations, free of charge.

Step 4.Submit to City Clerk's Office

  • City Hall has a drop box outside the North Entrance for form submittals during closed business hours.
  • Submit to front desk staff, who will transfer to the City Clerk's Office.
  • Mail with completed notarization to 123 5th Ave, Kirkland, WA 98033. 
  • Electronic or faxed copies will not be accepted.

Step 5.Process of the claim 

  • The claim will be sent to the city's Human Resources Coordinator.
  • The claim is then sent to WCIA for investigation to determine the City's responsibility.
  • WCIA will contact you with next steps.

In Person

Step 1.Obtain a Claim for Damages form from the Customer Service Desk at City Hall

  • The Information Desk will have forms available.

Step 2.Fill out completely

  • Type or print legibly.
  • Submit any available documents or evidence supporting your claim.
  • If the requested information cannot be supplied in the space provided on the form, use additional blank sheets or word documents.

Step 3.Notarize

  • Must be notarized before submitting.
    • Staff will be able to assist with notarizations, free of charge.

Step 4.Submit to City Clerk's Office

  • City Hall has a drop box outside the North Entrance for form submittals during closed business hours.
  • Submit to front desk staff, who will transfer to the City Clerk's Office.
  • Electronic or faxed copies will not be accepted.

Step 5.Process of the claim 

  • The claim will be sent to the city's Human Resources Coordinator.
  • The claim is then sent to WCIA for investigation to determine the City's responsibility.
  • WCIA will contact you with next steps.

Contact Us

Phone

425-587-3190

Alternate Phone

425-587-3210

Email

CCO@kirklandwa.gov

Location

City Hall
123 5th Ave
98033
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