Claim form - City of Lompoc 2026

1. Click ‘Get Form’ to open the claim form in the editor.
2. Begin by entering your personal information. Fill in your last name, first name, middle name, and date of birth. Ensure accuracy as this information is crucial for processing your claim.
3. Provide your home address, including city, state, and zip code. Include your CA Driver’s License number and the last four digits of your Social Security number for identification purposes.
4. Indicate how you filed the claim (e.g., personal delivery or US mail) and provide your contact numbers: daytime, evening, and cell phone.
5. Specify the type of loss by checking the appropriate box (personal injury or property damage) and describe when and where the incident occurred.
6. Detail how the injury or damage occurred. Attach any additional documentation if necessary to support your claim.
7. List any witnesses along with their contact information to strengthen your case.
8. If applicable, indicate whether the total amount of your claim exceeds $10,000 and provide specific dollar amounts for property damage or personal injury.
9. Finally, sign the form and include the date. Make sure to send it to the City Clerk’s Office as instructed.

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