Loading
Form preview picture

Get WA General Claim Form - Clark County 2018-2024

STANDARD TORT CLAIM FORM General Liability Claim Form SF210 Pursuant to Chapter 4. 92 this form is for filing a tort claim against Clark County Washington. Information requested on this form is required by 4. 09. 100 and may be subject to public disclosure. Claim forms cannot be submitted electronically via e-mail or fax. PLEASE TYPE OR PRINT IN INK Mail or deliver Original claim To Clerk of the Board Board of Clark County Commissioners PO Box 5000 Vancouver WA 98666-5000 CLAIMANT INFORMATION 1. Claimant s name Last name First Middle Date of birth mm/dd/yyyy 2. Current residential address 3. Mailing address if different 4. Residential address at the time of the incident if different from current address 5. Claimant s daytime telephone number Home Business 6. Claimant s e-mail address INCIDENT INFORMATION 7. Date of the incident Time mm/dd/yyyy a*m* p*m* check one 8. If the incident occurred over a period of time date of first and last occurrences from Time a*m* p*m* check one to Time a*m. p*m* check one 9. Location of incident State and county City if applicable Place where occurred Name of street or highway Milepost number At the intersection with or nearest intersecting street 11. County agency or department alleged responsible for damage/injury 12. Names addresses and telephone numbers of all persons involved in or witness to this incident that have knowledge regarding the liability issues involved in this incident or knowledge of the Claimant s resulting damages. Please include a brief description as to the nature and extent of each person s knowledge. Attach additional sheets if necessary. 15. Describe the cause of the injury or damages. Explain the extent of property loss or medical physical or mental injuries. Attach additional sheets if necessary. 16. Has this incident been reported to law enforcement safety or security personnel If so when and to whom and billings. 18. Please attach documents which support the claim s allegations photos. police reports estimates etc*. 19. I claim damages from the Clark County in the sum of. This Claimant must sign this claim form unless he or she is incapacitated a minor or a nonresident of the state in which case it may be signed on behalf of the Claimant by any relative attorney or agent representing the Claimant. I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Signature of Claimant Date and place residential address city and county Records Request Authorization Form Claimant by signing below you are authorizing Clark County Risk Management or any of its representatives to request any and all information facts and particulars which may be requested during the Scope and Duration of time it takes to fully investigate the allegations made in your claim during. Failure to sign the form may adversely affect our ability to investigate the allegations made in your claim and bring your claim to a final conclusion* A copy of this form shall have the same effect as the original* Print Name Signature Date.

How It Works

washington general claim rating
4.8Satisfied
136 votes

Tips on how to fill out, edit and sign Ada online

How to fill out and sign Refasing online?

Get your online template and fill it in using progressive features. Enjoy smart fillable fields and interactivity. Follow the simple instructions below:

Are you searching for a quick and practical tool to fill in WA General Claim Form - Clark County at an affordable price? Our platform offers you a wide collection of forms that are available for completing on the internet. It only takes a few minutes.

Stick to these simple steps to get WA General Claim Form - Clark County ready for sending:

  1. Find the sample you need in our library of legal templates.
  2. Open the form in our online editor.
  3. Look through the instructions to determine which details you need to give.
  4. Click the fillable fields and put the required details.
  5. Put the relevant date and insert your e-signature when you complete all other boxes.
  6. Examine the form for misprints and other errors. If you need to correct something, our online editor along with its wide variety of tools are at your disposal.
  7. Save the resulting template to your computer by hitting Done.
  8. Send the e-document to the intended recipient.

Submitting WA General Claim Form - Clark County does not have to be stressful anymore. From now on easily get through it from your apartment or at your business office from your mobile device or desktop computer.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.

Keywords relevant to WA General Claim Form - Clark County

  • orm
  • milepost
  • Veh
  • Ifyou
  • HIV
  • NW
  • MMSEA
  • cms
  • ada
  • litem
  • reversibl
  • refasing
  • Lagman
  • SCHIP
  • yesd
If you believe that this page should be taken down, please follow our DMCA take down processhere.
Ensure the security of your data and transactions

USLegal fulfills industry-leading security and compliance standards.

  • 
                            VeriSign logo picture

    VeriSign secured

    #1 Internet-trusted security seal. Ensures that a website is free of malware attacks.

  • Accredited Business

    Guarantees that a business meets BBB accreditation standards in the US and Canada.

  • 
                            TopTenReviews logo picture

    TopTen Reviews

    Highest customer reviews on one of the most highly-trusted product review platforms.