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Risk Mgmt. Division
400 Yesler Way, Rm. 410
YES-ES-410
Seattle, WA 98104
Phone: 206-296-7432

Division director:
Jennifer Hills

Banner images: Bus, justice scales, damage forms, doorway arch, Yesler Building, and bus driver.

Claim for damages form

To file a claim against King County, a King County Claim for Damages form must be completed with the King County Clerk of the Council, per King County Code (4.12.070A) .

To obtain a King County Claim for Damages form you can download one of the versions below, or you can have us mail you a form. To obtain a King County Claim for Damages form by mail, please contact the Office of Risk Management at 206-296-7432 and have a mailing address ready.

Notice:   The King County Clerk of the Council cannot accept claim forms via e-mail or fax.   They must receive the form with your original signature.  You can complete this form electronically, however, you will need to print it and sign the copy that you send to the Clerks Office. Give specific details about your damage or loss. Include dates, times, witnesses and supporting documents.  Print the form, sign it and mail or deliver your claim submission to:

King County Clerk of the Council
Room W-1039
King County Courthouse
516 Third Avenue
Seattle, WA 98104

You can download and fill out a copy of the King County Claim for Damages form electronically. You will need to have a capable printer and PDF reader to view, fill out and print the form. 
KC_Claim_Form_Complete_Then_Print.pdf 506kb

If you have a slower internet connection you can download a smaller copy of the King County Claim for Damages form. You will have to print this version and fill it out manually as it is not a Fill-in form. You will need to have a capable printer and a PDF reader to view and print the form. 
KC_Claim_Form_Print_Then_Complete.pdf 19kb

Brightwater claim form
If you need to file a claim for damages related to a Brightwater Treatment System construction project, please use the following form. You will have to print this version and fill it out manually as it is not a Fill-in form. You will need to have a capable printer and a PDF reader to view and print the form. 
Brightwater_Claim_Form.pdf 32kb

If you need the free PDF reader software to view these documents [or files], visit the King County PDF help page.

Supporting documents

You may be asked to provide further documents supporting your claim. Since these documents may be required before a claim can be resolved, you may want to include them with your claim form.

Automobile accident report

You may be asked to provide more information or documentation supporting your claim. The Automobile Accident Report is used to record the details surrounding an automobile accident event. The form includes a second page with intersection and street diagrams to help you describe the event with a drawing.

You can download and fill out a copy of the King County Automobile Accident Report electronically. You will need to have a capable printer and Adobe Acrobat Reader to view, fill out and print the form.
KC_Auto_Accident_Report_Complete_Then_Print.pdf 1,702kb

If you have a slower internet connection you can download a smaller copy of the King County Automobile Accident Report. You will have to print this version and fill it out manually as it is not a Fill-in form. You will need to have a capable printer and Adobe Acrobat Reader to view and print the form. 
KC_Auto_Accident_Report_Print_Then_Complete.pdf 208kb

If you need the free PDF reader software to view these documents [or files], visit the King County PDF help page.

Repair estimates/receipts

Please document your claim. You may include estimates, photos, receipts or any other documentation to support your loss.

Pictures

Photographs supporting your claim may be included with your King County Claim for Damages form. Alternatively, you can submit digital photographs via e-mail to your assigned Tort Claims Investigator after the investigation has begun.

Other agency reports

If an accident report was filed with a local municipal Police Department you may want to request a copy to provide with your claim form directly from that agency.

If an accident report was filed by the Washington State Patrol, a copy can be requested on their web site,
W.S.P. Collision Report Request (external link).

Other forms

W-9

In order to comply with section 6109 of the Internal Revenue Code, King County requires that a W-9 form be completed before any settlement payments can be made.
Download a W-9 form at the IRS web site. (external link)