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Make a Claim - Vallejo Flood & Wastewater District

  1. Emergencies

    If this is a medical emergency, please call 9-1-1.

  2. Making a Claim

    Use this form to make a claim for injury or property damage. This form is provided pursuant to state law (Government Code Section 910 et. seq.) and shall be used by any person presenting a claim to Vallejo Flood & Wastewater District under Government Code Section 810 et seq.

  3. Contact Information

  4. The date, place, and other circumstances of the occurrence or transaction which gave rise to the claim asserted:

  5. Would this claim be a Limited Civil case? ($25,000 or less)*

  6. Specify particular expenses, estimated prospective injury, damage or loss, general damages, and so on. Please attach copies of bills and/or estimates, as appropriate.

  7. Leave This Blank:

  8. This field is not part of the form submission.