By Michael Shemtoub, trial attorney, Beverly Law. Updated November 2026.
Filling out the City claim form?
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Where to get the City of Los Angeles claim form PDF
- PDF: Claim for Damages to Person or Property, Form Cont. 100-A (Rev. 12/18) on the City Clerk’s site. Page 2’s footer misprints it as “Form Count. 100-A”; it is the same form.
- Online: claims.lacity.org asks the same questions and lets you draw the diagram on screen.
- Spanish: spanish.claims.lacity.org.
- By mail: ask the City Clerk at (213) 978-1133 or clerk.cps@lacity.org.
The form does not ask for a Social Security number. It asks for City vehicle plates, not your own. There is no separate section for children; give the child’s information and sign as the person filing on the child’s behalf.
What the instructions at the top say
The form’s instructions repeat the deadlines (six months for death, injury or personal property, one year for anything else, citing Gov. Code § 911.2) and say:
- Complete every field marked with an asterisk. “THE FAILURE TO INCLUDE MANDATORY INFORMATION MAY RESULT IN YOUR CLAIM BEING RETURNED AS INSUFFICIENT.”
- If you need more room, attach separate sheets, write the section number on them and sign each sheet.
- Attach supporting documents or reports.
- Sign at the bottom of page 2.
- File only with the City Clerk: online, in person or by mail to 200 N. Spring St., Room 395. Faxed or emailed claims are not accepted.
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Field by field: what to write and common mistakes
| Field | What to write | Common mistakes |
|---|---|---|
| Claim No. and filing stamp box | Leave blank. The Clerk fills these in. | Writing in the box. |
| 1. Name* | Full legal name of the injured person or property owner. | Putting only a parent’s name when a child was hurt. |
| 1. Date of birth, email | Optional, but they help the City match records. | None serious. |
| 1. Phone number* and address* | A phone you answer and a mailing address where you get mail. | Leaving out an address. If the claim gives neither your address nor an address for notices, the City does not have to send a defect notice (Gov. Code § 911). |
| 1. Notices to someone else (checkbox) | If a lawyer or insurer represents you, check it and give their name*, relationship* and phone*. | Rejection letters going to an old address. The six months to sue runs from the mailing date. |
| 2. How did the damage or injury occur?* | What happened, in order, in plain words. Include every cause you know of. | One vague line such as “fell on sidewalk.” A later suit must rest on facts the claim reflected (Stockett). |
| 2. Date and time* | The exact date and approximate time. | A wrong date that conflicts with the medical records. |
| 2. Where did it occur?* | Closest street address or cross streets, side of the street, lane, direction of travel. | Naming only a long street, such as “Sherman Way.” |
| 2. Why is the City responsible?* | The reason in plain terms: the City failed to repair a hole it knew about, a City driver ran a red light, a City tree fell. | Only “it is a City street.” |
| 3. City employees, plates, department* | Names, plate numbers and the department, if known. If not, write “unknown at this time.” | Leaving a required field blank. |
| 3. Did you report it? | 311 service request numbers, LAPD report numbers, prior complaints and who took them. | Leaving out an earlier 311 report, which can help show the City knew. |
| 3. Witnesses, doctors, hospitals | Names and contact information. | Listing a doctor without contact details. |
| 4. What damage or injuries resulted?* | Every body part and every kind of loss: medical care, lost pay, car repairs, pain. | Listing only the main injury. You can amend before the deadline or before the City acts (§ 910.6). |
| 4. Total amount* and itemized damages | Less than $10,000, the amount. Over $10,000, no dollar figure; say whether it would be a limited civil case (§ 910(f)). | Guessing a number before treatment is finished. |
| 5. Insurance | Your insurer, the claim representative and any amounts it paid. | Leaving it blank when your insurer already paid for repairs. |
| 6. Accident diagram | Street names, nearest cross streets and an “X” where it happened. The online portal also asks for north. | No cross street, so the City cannot find the spot. |
| Signature*, printed name, date, relationship | Sign under the penalty-of-perjury declaration. If you sign for someone else, state your relationship. | Unsigned extra pages; the form says to sign each sheet. |
The amount of your claim and the $10,000 rule
Government Code section 910(f) says that if the amount claimed is more than $10,000, “no dollar amount shall be included in the claim,” and the claim must instead say whether it would be a limited civil case (Gov. Code § 910). The City form still has an asterisk on the total, so for an injury claim over $10,000, answer that field with the statement the law calls for instead of a number. Under $10,000, for example a single pothole repair, write the amount and itemize it. If you are not sure whether your case would be a limited civil case, ask a lawyer before filing.
Signing the claim, and the change on January 1, 2027
Today the law requires the claim to be signed by the claimant or someone on the claimant’s behalf (Gov. Code § 910.2). AB 2529 (Stats. 2026, ch. 618), approved September 27, 2026, amends section 910.2 starting January 1, 2027: the signer must also declare that, “upon information and belief, the contents of the claim are true and correct” (AB 2529, CalMatters Digital Democracy). The City’s form already ends with a declaration under penalty of perjury that the claim and its attachments are true and correct, so read it before you sign. If you file on a different form or a letter after January 1, 2027, include the new declaration.
The Penal Code 72 warning
The only warning printed on the form reads: “CRIMINAL PENALTY FOR PRESENTING A FALSE OR FRAUDULENT CLAIM IS IMPRISONMENT OR FINE OR BOTH.” Penal Code section 72 makes it a crime to present a false or fraudulent claim to a city with intent to defraud, punishable as a misdemeanor (up to one year in county jail, a fine of up to $1,000, or both) or as a felony (imprisonment under Penal Code section 1170(h), a fine of up to $10,000, or both) (Penal Code § 72). An honest mistake is not intent to defraud. Do not inflate amounts or list injuries you did not have.
Uninsured drivers and Prop 213 (Civil Code 3333.4)
The City form does not mention it, but Civil Code section 3333.4, adopted by Proposition 213, can limit a vehicle claim. In any lawsuit over the use of a motor vehicle, you cannot recover non-economic damages such as pain and suffering if you were driving uninsured, if you owned an uninsured vehicle involved in the crash, or if you were convicted of DUI for that crash (Civ. Code § 3333.4). You can still recover economic losses such as medical bills, lost wages and repairs. An uninsured owner hurt by a driver convicted of DUI is not barred. The rule applies “in any action,” so it covers suits against the City too.
If the City says your form is incomplete
If the City believes the claim leaves out required information, it has 20 days to send a written notice listing the defects, and then waits 15 days before acting (Gov. Code § 910.8). Correct the problems and send an amended claim to the City Clerk right away. If the City sends no such notice, it generally waives objections to those defects (§ 911). The California Supreme Court held that a medical-malpractice notice letter that left out the amount of damages still counted as a claim, because the public hospital district never sent a defect notice (Phillips v. Desert Hospital Dist. (1989) 49 Cal.3d 699). That does not make a bare letter safe; use the form.
Related pages
- How to file a claim against the City of Los Angeles
- How to file: online, mail or in person
- Documents checklist
- Deadline to file
- What happens after you file
- Claims for minors
- Pothole or dangerous road crash: can you sue?
- City or county vehicle hit me: what do I do?
Common questions
What is the City of Los Angeles claim for damages form called?
Claim for Damages to Person or Property, Form Cont. 100-A (Rev. 12/18). The City Clerk’s website calls it the Claim for Damages Form and posts it as a PDF. The same questions are on the online portal at claims.lacity.org.
Where do I download the City of Los Angeles claim form PDF?
From the Los Angeles City Clerk’s File a Claim page. You can also file online at claims.lacity.org or spanish.claims.lacity.org without the PDF, or ask the City Clerk at (213) 978-1133 or clerk.cps@lacity.org to mail you a form.
What amount should I put on a claim against the City?
If the claim totals less than $10,000, write the amount and itemize it. If it is more than $10,000, California Government Code section 910(f) says not to include a dollar amount and to state instead whether the case would be a limited civil case.
Who signs the claim form for a child?
A parent or guardian can sign as the person filing on the child’s behalf, giving the child’s name as the claimant and stating the relationship. The six-month deadline still applies to children’s claims.
Does the City of Los Angeles claim form have a Prop 213 warning?
No. The only warning on the form is the Penal Code section 72 false-claim warning. Civil Code section 3333.4 (Prop 213) still applies by law: uninsured drivers and owners, and drivers convicted of DUI for the crash, generally cannot recover pain and suffering in a vehicle case.
What changes on the claim form rules on January 1, 2027?
AB 2529 amends Government Code section 910.2 so that the person signing a claim must declare that, upon information and belief, its contents are true and correct. The City’s current form already includes a penalty-of-perjury declaration of truth above the signature line.
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Sources
- City claim form, Form Cont. 100-A (PDF)
- City of Los Angeles claims portal
- City of Los Angeles claims portal, Spanish
- City Clerk, File a Claim
- Cal. Gov. Code § 910
- Cal. Gov. Code § 910.2
- AB 2529 (Stats. 2026, ch. 618)
- Cal. Gov. Code § 910.6
- Cal. Gov. Code § 910.8
- Cal. Gov. Code § 911
- Cal. Gov. Code § 911.2
- Cal. Penal Code § 72
- Cal. Civ. Code § 3333.4
- Stockett v. Association of Cal. Water Agencies Joint Powers Ins. Authority (2004) 34 Cal.4th 441
- Phillips v. Desert Hospital Dist. (1989) 49 Cal.3d 699
Important: This page is general information, not legal or medical advice, and reading it does not create an attorney-client relationship. Every case is different; talk to a lawyer about yours. Texas cases are handled by the firm’s Texas-licensed attorneys, Joyce Ondich and John Efstathiou. Last reviewed: November 6, 2026.