You must have JavaScript enabled to use this form.Notice of ClaimContact Information Name First Name Last Name Company Name Address Mailing Address City/Town Province Postal Code Country Country - Select -AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua & BarbudaArgentinaArmeniaArubaAscension IslandAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia & HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCanary IslandsCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicCeuta & MelillaChadChileChinaChristmas IslandClipperton IslandCocos (Keeling) IslandsColombiaComorosCongo - BrazzavilleCongo - KinshasaCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d’IvoireDenmarkDiego GarciaDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard & McDonald IslandsHondurasHong Kong SAR ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao SAR ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorth MacedoniaNorwayOmanOutlying OceaniaPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSamoaSan MarinoSarkSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSt. BarthélemySt. HelenaSt. Kitts & NevisSt. LuciaSt. MartinSt. Pierre & MiquelonSt. Vincent & GrenadinesSudanSurinameSvalbard & Jan MayenSwedenSwitzerlandSyriaSão Tomé & PríncipeTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad & TobagoTristan da CunhaTunisiaTurkmenistanTurks & Caicos IslandsTuvaluTürkiyeU.S. Outlying IslandsU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis & FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsOther… Enter other… Primary Phone Number Secondary Phone Number Email Address Claim Information Claimant(s) Legal Name(s) Exact Location that the Damage Occurred Exact Date that Damage Occurred Exact Time Damage Occurred Type(s) of Claim Property Injury Was a vehicle damaged? Yes No Vehicle Year Vehicle Make Vehicle Model Are you the Registered Owner? Yes No The reason that I believe I have a claim against the City of Prince George is as follows: As a result of the circumstance described above, I suffered the following damage or injury(s) Estimated Cost to Repair Damage / Injury(s) Additional DocumentsPlease attach any relevant documents that will assist in processing your claim. Maximum 5 files.64 MB limit.Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.Agreement I fully understand that this official notice setting forth the time, place and manner in which I sustained damage must be delivered to the City Clerk or the Manager, Risk & Procurement in writing within two months from the date on which I sustained the damage. (Section 736 of the "Local Government Act", R.S.B.C. 1996, c. 323.) Important: I acknowledge that the City's receipt of this notice does not constitute its acceptance of liability for any damage or loss I sustained, nor has the City provided any advice to me regarding the adequacy of this notice. I acknowledge that the City is not prevented by receipt of this notice from arguing the adequacy of the notice.The personal information on this form is collected by the City of Prince George for the purposes of processing this application, under the authority of section 26(c) of the Freedom of Information and Protection of Privacy Act. If you have any questions about the collection of information, please contact the Manager, Risk and Procurement, at 1100 Patricia Boulevard, Prince George, BC, or by telephone 250-561-7600.Learn more information about the collection of personal information under the Freedom of Information and Protection of Privacy Act. AgreementI agree to and acknowledge all of the terms of this notice Applicant's Legal Name If you have any questions and concerns we can be contacted by phone at 250-561-7600, by email at claims@princegeorge.ca, or in person at City Hall ; 1100 Patricia Blvd ; Prince George ; BC V2L 3V9 CAPTCHA