File a Claim by Mail or Online

“I have suffered personal injury or property damage which I believe was caused by the RBRA or one of its staff. How do I go about collecting for my damages?

Claims for money are made by submitting a claim form to the Richardson’s Bay Regional Agency, located at the Marin County Civic Center, 3501 Civic Center Drive, Room 308, San Rafael, CA 94903.

The law regarding claims against public entities is complex and has relatively short deadlines. You should seek the services of an attorney for your own protection and you should present your claim without delay. [Government Code section 900, et seq.].

RBRA Claim Form

Name of Claimant: (required)

Address: (Street number, City, State, Zip) (required)

Phone Number(s)/Email: (required)

Mailing Address for all Notices: (if same as above, insert "same") (required)

Date of Injury, Damage or Loss: (required)

Place of Injury, Damage or Loss: (Exact Location) (required)

General Description of Injury, Damor or Loss and Circumstances: (required)

Why is the RBRA responsible for the alleged Injury, Damage, or Loss? (required)

Name(s) of RBRA employee(s) causing alleged Injury, Damage, or Loss, if known: (required)

Witness: (Name, Address, Phone, Email): (required)

Amount of Claim: $ (Attach supporting bills or basis of computation of amount claimed) (required)

Dated: (required)

Signed or printed name of Claimant: (required)

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