Notice of Claim Against the City of Big Bear Lake Department of Water & Power – The City of Big Bear Lake, Department of Water & Power

Claims related to injury to person or damage to personal property must be presented to the City of Big Bear Lake, Department of Water and Power (DWP) within six (6) months from the date of loss (Government Code 910 – 935.9). Claims related to any other loss must be presented no later than one (1) year from the date of loss (Government Code 910 – 935.9). Answer all items fully and to the best of your knowledge and information. Failure to do so may result in your claim being insufficient.

Claimant Information

Claimant's Name(Required)

Representative's Name(Required)

First Last

Claimant's Relationship to BBLDWP(Required)

Phone(Required)

Email(Required)

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of Loss(Required)

Time of Loss(Required)

Claim Details

Location of Loss, specify in as much detail as possible (e.g., 5 feet east of west corner of Elmira Rd and Peabody Street):(Required)

Description of incident/accident that caused you to make this claim:(Required)

What specific injury, damages or other losses did you incur?(Required)

List financial damages incurred or anticipated:(Required)

Attach copies of receipts, repair estimates, bills, invoices, and any other documentation to prove your loss:

Drop files here or

Max. file size: 1 GB.

What is your basis for claiming that the DWP or its agents or employee(s) are the cause of your injury, damages or loss?

Please provide the name(s) of the employee(s) you have been in contact with regarding this claim:

(If unknown, write NA)

Name, address, and phone number of any witnesses who can substantiate your claim:

(If unknown, write NA)

Please include any additional information that you believe might be helpful to the DWP in considering this claims

Consent

WARNING: Penal Code 72 makes it a crime punishable by imprisonment to submit a “false or fraudulent claim” for payment to the city or public district, and Code of Civil Procedure Section 1038 authorizes the award of attorney fees against a claimant who brings a claim that is “not brought in good faith with reasonable cause.”