Office of the City Clerk Timestamp
CLAIM AGAINST THE
CITY OF CITY OF SAN JOSE, CA
RECEIIET
SAN JOSE (For Damages to Persons or Personal Property)
SANAUSE CITY CLERK
CAPITAL OF SILICON VALLEY 2025 RUG 14 PM03:30
#_
Office of the City Clerk Received by: Milode
200 East Santa Clara Street Via: U.S. Mail
Tower 14" Floor
Interoffice Mail
San José, CA 95113
(Please do not write above this line - for City use only) Generally, a claim against the City of San José for damages to persons or personal property must be filed with the City Clerk of the City of San José within six months after the incident occurred. See Government Code 911.2. Completed claims must be mailed or delivered to: Office of the City Clerk, City of San José, 200 E. Santa Clara Street, Tower, 14* Floor, San José, CA 95113, telephone: (408) 535-1260. Attach copies of any receipts or other documentation to the original claim form.
TO THE CITY CLERK of the City of San José, California:
The undersigned respectfully submits the following claim and information relative to damage to persons and/or personal property:
NAME OF
CLAIMANT William Ek DATE OF BIRTH:
ADDRESS OF
CLAIMANT CITY San Jose STATE ZIP CODE
HOME WORK DRIVER'S LICENSE
PHONE PHONE ( STATE AND NUMBER
SEND NOTICES REGARDING THIS CLAIM TO: (List name, mailing address and phone number if not same as above.) LAST
Baler, CA
DATE OF INCIDENT PLACE (Exact and
specific location
CAUSING CLAIM See attached
CIRCUMSTANCES (Specify the occurrence, event, act, or omission which you claim caused the injury or damage for which you are submitting this claim. Where space is insufficient, attach an additional page with the claimant's name on the page.) See attached
CITY'S ACTION (Specify action by City or its employees which caused alleged damage or injury.) See attached
CITY EMPLOYEES' NAMES OR CITY DEPARTMENT INVOLVED IN ALLEGED ACCIDENT OR INCIDENT.
See attached and more individuals to be determined
CLAIM AGAINST THE
CITY OF SAN JOSE, CA
DESCRIPTION OF LOSS (Describe injury, property damage or loss, so far as is known at this time. If there were no injuries, state "NO INJURIES.")
See attached
OTHER INJURED PERSONS (list names and addresses)
OWNER OF PROPERTY DAMAGED (if different from claimant)
AMOUNT CLAIMED:
Amount claimed as of this date: $ 12,224.89
Estimated amount of future costs: Unknolo
Total amount claimed: $
Interne
base on Similar items
i SaW Many San Jor, CA 95110
18 - unhouse
WARNING! IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM (Penal Code Section 72) I have read the matters and statements made in the above claim and I know the same to be true of my own knowledge, except to those matters stated upon information or belief and as to such matters I believe the same to be true. I certify under penalty of perjury that the foregoing is TRUE and CORRECT.
14 dayor. August _. 2025
Signed this
Claimant's Signature
Revised 10/1/2015
Office of the City Clerk Timestamp
CLAIM AGAINST THE
CITY OF CITY OF SAN JOSE, CA
SAN JOSE (For Damages to Persons or Personal Property)
CAPITAL OF SILICON VALLEY
E CRY QUER
Office of the City Clerk Received by:'
200 East Santa Clara Street
Tower 14* Floor Via: U.S. Mail
Interoffice Mail
San José, CA 95113
Over the Counter
(Please do not write above this line - for City use only) Generally, a claim against the City of San José for damages to persons or personal property must be filed with the City Clerk of the City of San Jose within six months after the incident occurred. See Government Code 911.2. Completed claims must be malled or delivered Cy San s, 200. Santa Clara Street, Tower, 14" Floor, San José, CA 95113, telephone: (408) 535-1260) Attach copies of any receipts or other documentation to thé original claim form.
TO THE CITY CLERK of the City of San José, California:
The undersigned respectfully submits the following claim and information relative to damage to persons and/or personal property:
NAME OF
CLAMANT William FiL
DATE OF BIRTH
ADDRESS OF
CLAIMANT unhoused CITY Sar JOSISTATE C/ZIP CODE
HOME WORK DRIVER'S LICENSE
PHONE ( PHONE ( STATE AND NUMBER
SEND NOTICES REGARDING THIS CLAIM TO: (List name, mailing address and phone number if not same as above.) DATE OF INCIDENT PLACE (Exact and
CAUSING CLAM 10/21/25 spot in See attriched
CAUSING CLAIM of incident.)
CIRCUMSTANCES (Spedify the occurrence, event, act, or omission which you claim caused the injury or damage for which you are submitting this claim. Where space is insufficient, attach an additional page with the claimant's name on the page.) See attached
CITY'S ACTION (Specify action by City or its employees which caused alleged damage or injury.) see attached
CITY EMPLOYEES' NAMES OR C
, CLAIM AGAINST THE
CITY OF SAN JOSE, CA
JESCRIPTION OF LOSS (Describe injury, property damage or loss, so far as is known at this time. If there werd no injuries, state "NO INJURIES.")
see attached
OTHER INJURED PERSONS (list names and addresses)
OWNER OF PROPERTY DAMAGED (if different from claimant)
AMOUNT CLAIMED:
see attached
Amount claimed as of this date:
Estimated amount of future costs: §unknown
Total amount claimed: $
3asis for computation of amounts claimed (include copies of bills, invoices, estimates, etc.):
gas con -purchase price at Auto Zone where originl
enutional distress- per legal advice
puchaes
NITNESSES, HOSPITALS, DOCTORS, ETC. (list names and addresses):
around eight employees
from Arver
ADDITIONAL INFORMATION (List any additiopal information that might be helpful in considering your claim.): - ser attaches NARNING! IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM (Penal Code Section 72) have read the matters and statements made in the above claim and I know the same to be true of my own knowledge, except to hose matters stated upon information or belief and as to such matters I believe the same to be true. I certify under penalty of perjury that the foregoing is TRUE and CORRECT.
signed this 22 day of October, 20 25
Calmant's signature
DANNA AME
Office of the City Clerk Timestamp
CLAIM AGAINST THE
CITY OF CITY OF SAN JOSE, CA RECETUED
SAN JOSE (For Damages to Persons or Personal Property) SAN JOSE CITY CLERK 202:5 AUG 14 PM03:51
CAPITAL OF SILICON VALLEY
Office of the City Clerk Received by: M.Roche
200 East Santa Clara Street Via:
Tower 14 Floor U.S. Mail
Interoffice Mail
San José, CA 95113 Over the Counter
(Please do not write above this line - for City use only) Generally, a claim against the City of San José for damages to persons or personal property must be filed with the City Clerk of the City of San José within six months after the incident occurred. See Government Code 911.2. Completed claims must be mailed or delivered to: Office of the City Clerk, City of San José, 200 E. Santa Clara Street, Tower, 14* Floor, San José, CA 95113, telephone: (408) 535-1260. Attach copies of any receipts or other documentation to the original claim form.
TO THE CITY CLERK of the City of San José, California:
The undersigned respectfully submits the following claim and information relative to damage to persons and/or personal property:
CLAIMANT William Ek DATE OF BIRTH:
ADDRESS OF
CLAIMANT- CITY San Jose STATE CA ZIP CODE
HOME WORK DRIVER'S LICENSE
PHONE PHONE ( STATE AND NUMBER
SEND NOTICES REGARDING THIS CLAIM TO: (List name, mailing address and phone number if not same as above.) DATE OF INCIDENT PLACE (Exact and
CAUSING CLAIM OR OCCURRENCE July 16, 2025 specific location see attached of incident.)
CIRCUMSTANCES (Specify the occurrence, event, act, or omission which you claim caused the injury or damage for which you are submitting this claim. Where space is insufficient, attach an additional page with the claimant's name on the page.) see attached
see attach epiy action by chly or is employes which caused aloged damage or ijury.) CITY EMPLOYEES' NAMES OR CITY DEPARTMENT INVOLVED IN ALLEGED ACCIDENT OR INCIDENT. see attached and mare to be determined
CLAIM AGAINST THE
CITY OF SAN JOSE, CA
DESCRIPTION OF LOSS (Describe injury, property damage or loss, so far as is known at this time. If there were no injuries, state "NO INJURIES.")
see attached
OTHER INJURED PERSONS (list names and addresses)
OWNER OF PROPERTY DAMAGED (if different from claimant)
AMOUNT CLAIMED:
Amount claimed as of this date: $ 11719.37
Estimated amount of future costs: $ unknoun
Total amount claimed: $
WITNESSES, HOSPITALS, DOCTORS, ETC. (list names and addresses' other residnts - unhoused
ADDITIONAL INFORMATION (List any additional information that might be helpful in considering your claim.):
WARNING! IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM (Penal Code Section 72) I have read the matters and statements made in the above claim and I know the same to be true of my own knowledge, except to inose matters stated upon information or belief and as to such matters I believe the same to be true. İ certify under penalty of perjury that the foregoing is TRUE and CORRECT.
so is 14 artugust 2025
Revised 10/1/2015
Office of the City Clerk Timestamp
CLAIM AGAINST THE
CITY OF CITY OF SAN JOSE, CA
SAN JOSE (For Damages to Persons or Personal Property) RECEIUED
SAI JOSE CITY CLERK
CAPITAL OF SILICON VALLEY
2025 AUG 14 PM03:49
Office of the City Clerk Received by: MiRoue
200 East Santa Clara Street
Tower 14" Floor Via: U.S. Mail
Interoffice Mail
San José, CA 95113 Over the Counter
(Please do not write above this line - for City use only) Generally, a claim against the City of San José for damages to persons or personal property must be filed with the City Clerk of the City of San José within six months after the incident occurred. See Government Code 911.2. Completed claims must be mailed or delivered to: Office of the City Clerk, City of San José, 200 E. Santa Clara Street, Tower, 14" Floor, San José, CA 95113, telephone: (408) 535-1260: Attach copies of any receipts or other documentation to the original claim form.
TO THE CITY CLERK of the City of San José, California:
The undersigned respectfully submits the following claim and information relative to damage to persons and/or personal property:
NAME OF
CLAIMANT William Ek DATE OF BIRTH:
ADDRESS OF
CLAIMANT Kelly San dose STATE CA ZIP CODE 12433
HOME WORK DRIVER'S LICENSE
PHONE PHONE (• STATE AND NUMBER
SEND NOTICES REGARDING THIS CLAIM TO: (List name, mailing address and phone number if not same as above.) DATE OF INCIDENT PLACE (Exact and
OR OCCURRENCE
CAUSING CLAIM 04-15-25 spicientation, See Attached
CIRCUMSTANCES (Specify the occurrence, event, act, or omission which you claim caused the injury or damage for which you are submitting this claim. Where space is insufficient, attach an additional page with the claimant's name on the page.) See Attached
CITY'S ACTION (Specify action by City or its employees which caused alleged damage or injury.) See Attached
CITY EMPLOYEES' NAMES OR CITY DEPARTMENT INVOLVED IN ALLEGED ACCIDENT OR INCIDENT See Attached and more to be determined
CLAIM AGAINST THE
• CITY OF SAN JOSE, CA
DESCRIPTION OF LOSS (Describe injury, property damage or loss, so far as is known at this time. If there were no injuries, state "NO INJURIES.")
See Attached
OTHER INJURED PERSONS (list names and addresses)
OWNER OF PROPERTY DAMAGED (if different from claimant)
AMOUNT GLAMMED:
Amount claimed as of this date; $ 11,807.89
Estimated amount of future costs: $ unknown
Total amount claimed: $
Basis for computation of amounts claimed (include copies of bills, invoices, estimates, etc.):
internet searchis ond estimages base on
Similar items found in nearby stores
resilents
ADD ON NO ATON is any dina formation that might be heir in considering your cam,!.
WARNING! IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM (Penal Code Section 72) I have read the matters and statements made in the above claim and I know the same to be true of my own knowledge, except to those matters stated upon information or belief and as to such matters I believe the same to be true. I certify under penalty of perjury that the foregoing is TRUE and CORRECT.
14 dayor. August -. 20.25
Signed this
Claimant's Signature
Revised 10/1/2015
Office of the City Clerk Timestamp
CLAIM AGAINST THE SAN JOSE CITY CLERK
CITY OF SAN JOSE, CA 2025 JUL 23 A11:14
CITY OF
SAN JOSE (For Damages to Persons or Personal Property)
CAPITAL OF SILICON VALLEY
#_
Received by:
Office of the City Clerk Via: U.S. Mail
200 East Santa Clara Street Interoffice Mail
Tower 14" Floor
Over the Counter
San José, CA 95113
(Please do not write above this line - for City use only the City of San José within six months after the incident occurred. See Government Code 911.2. Completed claims must be Generally, a claim against the City of San José for damages to persons or personal property must be filed with the City Clerk of mailed or delivered to: Office of the City Clerk, City of San José, 200 E. Santa Clara Street, Tower, 14" Floor, San José, CA 95113, telephone: (408) 535-1260. Attach copies of any receipts or other documentation to the original claim form.
TO THE CITY CLERK of the City of San José, California:
The undersigned respectfully submits the following claim and information relative to damage to persons and/or personal property:
CLAIMANT Bobby Nunez DATE OF BIRTH:
ADDRESS OF CITY San Jose STATECA ZIP CODE 95112
San Fernando
DRIVER'S LICENSE
STATE AND NUMBER
SEND NOTICES REGARDING THIS CLAIM TO: (List name, mailing address and phone number if not same as above.) DATE OF INCIDENT PLACE (Exact and
OR OCCURRENCE Penitencia Creek
CAUSING CLAIM
CIRCUMSTANCES (Specify the occurrence, event, act, or omission which you claim caused the injury or damage for which you are submitting this claim. Where space is insufficient, attach an additional page with the claimant's name on the page.) CITY'S ACTION (Specify action by City or its employees which caused alleged damage or injury.) CITY EMPLOYEES' NAMES OR CITY DEPARTMENT INVOLVED IN ALLEGED ACCIDENT OR INCIDENT.
City of San Jose, City of San Jose Police Department, and others to be determined later. -
CLAIM AGAINST THE
CITY OF SAN JOSE, CA
DESCRIPTION OF LOSS (Describe injury, property damage or loss, so far as is known at this time. If there were no injuries, state "NO INJURIES.")
See attached.
OTHER INJURED PERSONS (list names and addresses)
OWNER OF PROPERTY DAMAGED (if different from claimant)
AMOUNT CLAIMED: $ 3,383
Amount claimed as of this date:
Estimated amount of future costs: $ TBD
Total amount claimed: $ 3,383
Basis for computation of amounts claimed (include copies of bills, invoices, estimates, etc.):
See attached.
WITNESSES. HOSPITALS, DOCTORS, ETC. (list names and addresses):
ADDITIONAL INFORMATION (List any additional information that might be helpful in considering your claim.):
See attached.
WARNING! IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM (Penal Code Section 72) I have read the matters and statements made in the above claim and I know the same to be true of my own knowledge, except to those matters stated upon information or belief and as to such matters I believe the same to be true. I certify under penalty of perjury that the foregoing is TRUE and CORRECT.
20th -, 20 25
Signed this day of _ July
Claimant's Signature
Revised 10/1/2015
Office of the City Clerk Timestamp
CLAIM AGAINST THE
CITY OF CITY OF SAN JOSE, CA
SAN JOSE (For Damages to Persons or Personal Property)
CAPITAL OF SILICON VALLEY RECENED
SAN JOSE CITY CLERK
#_ 2025 DEC 05 PM03:31
Office of the City Clerk Received by: D.VOELKL.B
200 East Santa Clara Street Via: U.S. Mail
Tower 14* Floor Interoffice Mail
San José, CA 95113 Over the Counter
(Please do not write above this line - for City use only) Generally, a claim against the City of San José for damages to persons or personal property must be filed with the City Clerk of the City of San José within six months after the incident occurred. See Government Code 911.2. Completed claims must be mailed or delivered to: Office of the City Clerk, City of San José, 200 E. Santa Clara Street, Tower, 14" Floor, San José, CA 95113, telephone: (408) 535-1260. Attach copies of any receipts or other documentation to the original claim form.
TO THE CITY CLERK of the City of San José, California:
The undersigned respectfully submits the following claim and information relative to damage to persons and/or persona property:
NAME OF
CLAIMANT Misela Galeana Duroz DATE OF BIRTH:
ADDRESS OF 18-5
CLAIMANT DITYsan Jose STATE ZIP CODE 95037
HOME WORK DRIVER'S LICENSE
PHONE PHONE (8 STATE AND NUMBER
- aW roundation it lIcan
CA 95113
CAUSING CRANE 8/27/25 specific location
CAUSING CLAIM of incident.) Columbur Park near baseball field CIRCUMSTANCES (Specify the occurrence, event, act, or omission which you claim caused the injury or damage for which you are submitting this claim. Where space is insufficient, attach an additional page with the claimant's name on the page.) See attached (double-sided)
CITY'S ACTION (Specify action by City or its employees which caused alleged damage or injury.) See attached
CITY EMPLOYEES' NAMES OR CITY DEPARTMENT INVOLVED IN ALLEGED ACCIDENT OR INCIDENT san cose touring Department & San ore contractirs
CLAIM AGAINST THE
CITY OF SAN JOSE, CA
DESCRIPTION OF LOSS (Describe injury, property damage or loss, so far as is known at this time. If there were no injuries, state "NO INJURIES.")
See attached
OTHER INJURED PERSONS list names and addresses
See attached
OWNER OF PROPERTY DAMAGED (if different from claimant)
AMOUNT CLAIMED:
Amount claimed as of this date: Jee attached
Estimated amount of future costs:
Total amount claimed: $
Basis for computation of amounts claimed (include copies of bills, invoices, estimates, etc.):
WITNESSES, HOSPITALS, DOCTORS, ETC. (list names and addresses) See attached
ADDITIONAL INFORMATION (List any additional information that might be helpful in considering your claim.):
WARNING! IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM (Penal Code Section 72) I have read the matters and statements made in the above claim and I know the same to be true of my own knowledge, except to those matters stated upon information or belief and as to such matters I believe the same to be true. I certify under penalty of perjury that the foregoing is TRUE and CORRECT.
Signed this day of. set 9 . 20 25
Claimant's Signature
Revised 10/1/2015