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Notice of Claim
Home Human ResourcesNotice of Claim

Notice of Claim

Please submit the form below or if preferred, download a PDF fillable form from our website.

Notice of Claim

  • You may use this form to submit a claim against the City of Kingsville. Claims must be submitted within 180 days of the injury and or property damage as per the Texas Torts Claim Act.

  • Incident

  • :
  • MM slash DD slash YYYY

  • Statement

    Describe in your own words, where, when, and how the damage or injury occurred. Provide names, addresses, and phone numbers of others involved or witnesses of the incident, including which City department, City vehicle unit number and City driver/operator, if known.

  • Email additional information such as expanded statement, copies of any bills, estimates, photographs, medical reports, signed witness statements, etc. to hrsafety@cityofkingsville.com

    NOTICE: Any person who knowingly, and with intent to injure, defraud or deceive the City, files a statement of claim containing any false, incomplete, or misleading information is guilty of a felony.

    I hereby state all the information provided in this claim is true and correct.

  • MM slash DD slash YYYY
  • When completing this form electronically, it need not be signed. Instead, simply type your name.
  • You will be contacted by the City of Kingsville Human Resource Department within (5-10) business days of receiving your claim.

    When completed use the SUBMIT BUTTON to submit your claim for processing.

    If submitting electronically, you will receive an e-mail confirming that your notice of claim has been received. Be sure to check your junk mail before contacting our office.
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