Please review the Risk Management webpage before submitting a claim.Please read the following carefully and keep the resulting document for your information and records.Personal information entered on this form is collected under the authority of Section 26(c) of the Freedom of Information and Protection of Privacy Act (FOIPPA) for the purposes of processing your input. If you have any questions or concerns about the collection of this information, please contact the City’s Records and FOIPPA Administrator at 604.927.5250 or [email protected].Below is an excerpt from the Local Government Act, RSBC 2015, c 1, explaining why you must provide written notice of your claim within two months of sustaining any damages. Your phone call or visit to the City Hall does not constitute notice under Section 736 of the Local Government Act unless notice of your intention to claim is also provided in writing.Notice requirement respecting damages sectionLocal Government Act Section 736A municipality or regional district is in no case liable for damages unless notice in writing, setting out the time, place and manner in which the damage has been sustained, is delivered to the municipality or regional district, as applicable, within 2 months from the date on which the damage was sustained.In case of the death of a person injured, failure to give the notice required by this section is not a bar to the maintenance of the action.Failure to give the notice required by this section or its insufficiency is not a bar to the maintenance of an action if the court before whom it is tried, or, in case of appeal, the Court of Appeal, believes There was reasonable excuse, andThe defendant has not been prejudiced in its defence by the failure or insufficiency.There are other limitation periods that apply to your claim.The information contained herein does not and is not intended to constitute legal advice .If you need legal help, you are advised to consult with legal counsel. Yes, I have read and agree with the above Notice and Immunity sections of this form.Notice of claim provided to:City of Port CoquitlamAttention: Claims - Purchasing DivisionPublic Works1737 Broadway StreetPort Coquitlam, BCV3C 2M9This online form is intended to provide notice to the above local government of my intention to bring a claim against it for the following: Claim Type Damage to my property Injury to my person Claimant's Contact Information Claimant's Name Email Phone Street Address City Province Postal Code Alternate Phone Alternate Phone Date and time damage sustained: Details of Claim Nature of damage or injury (include value of claim, if known): Reason why you feel the local government is at fault: Cause of the damage or injury and exact location (describe the hazard or event): If you are submitting this form more than two months from when the damage was sustained, please explain the reason for the delay: Supporting Photographs or DocumentationPlease attach supporting photos and/or documents to support your claim.Maximum 3 files.128 MB limit.Allowed types: pdf, jpg, jpeg, png, doc, docx. Declaration: By signing below and submitting this form, I, the claimant, acknowledge and agree I represent that I am the person who suffered the damage described above and that all the information provided in this form is true and accurate. Signature Please electronically sign. The current date and time will automatically be added to the completed form.
