Please find enclosed the City of Columbus Claim form. Please complete the form,
sign in front of a notary and return the form to the proper department. It is important to note that the City will not open
a claim and an investigation will not begin until a completed claim form is received.
If a portion of the form does not apply to your particular situation, please write not applicable or n/a. All details,
dates, times and location provided must be accurate.
If you are not sure whether the City is liable for your injury or damage, please submit your claim to the City Department
in question and the Department will contact you.
Generally, the City of Columbus is not liable in damages in a civil action for injury, death, or loss to person or property
allegedly caused by any act or omission of the City or its employees. There are some exceptions. The City may be liable for:
(1) the negligent operation of a motor vehicle, unless police, fire or EMS are responding to an emergency; (2) the negligent
performance of proprietary functions; (3) the negligent failure to keep public roads in repair and negligent failure to remove
obstructions; (4) the negligence of its employees within or on the grounds of, and due to physical defects within or on the
grounds of, buildings; or (5) when the Ohio Revised Code imposes liability. If one of these exceptions applies, you must file
a claim with your insurance company first. The Ohio Revised Code limits the amount of money a city may pay. Any amount of
money you received, or should receive even if you haven’t, is deducted from the amount owed to you by the city. The City would
then be responsible for such items as your deductible.
Ohio Revised Code Section 2744.05 states that no insurer or other person is entitled to bring an action under a
subrogation provision of insurance or other contract against a political subdivision with respect to those benefits.
Attachment Checklist-Please read before submitting your claim. This information is necessary in order to open a proper
investigation. All of the above information is necessary to start the investigation. Liability cannot be determined until a
thorough investigation of your claim is completed.
If claiming vehicle damage, you need to provide:
Declaration Page of car insurance policy showing deductible, copy of title, registration or lease contract, two written
estimates, police report (if applicable), current mileage and photographs of vehicle damage. If you are claiming tire damage,
the age of the tire is required.
If claiming personal injury:
Copies of all medical reports including doctor bills, hospital bills and pharmacy receipts.
If claiming other property damage:
A copy of the homeowner’s insurance policy that includes the deductible amount is required. A separate itemized list of
property damages with a description of each item, serial number, quantity lost, purchase date or age and purchase price,
bills, receipts and estimates. If the damage was to a business you must submit proof of business ownership and/or lease
rights and responsibilities.
Once you have collected all of the required information and completed the claimant statement form, please forward the
information to the appropriate Department to begin the investigation process. If the City is liable, the City will issue
you a check. This process may take 4 to 6 weeks. You will be asked to sign a Release and Agreement and a W-9 form, and return
them to the City Department that is handling your claim.
With respect to any damage your vehicle may have sustained, we must inform you that the City, by statute, has certain
immunities from liability for damages of this nature. As stated above, Ohio Revised Code Section 2744.05 addresses these
immunities. In general, in order to recover in a suit involving damage proximately caused by roadway conditions, including
potholes, the party claiming damage must prove that either: 1) the City had actual or constructive notice of the pothole
and failed to respond in a reasonable amount of time, or responded in a negligent manner, or 2) that the City, in a general
sense, maintains its roadways negligently.
Hopefully, this has answered all of your questions; however, if you still need assistance, you can contact the City
Department that will handle your claim or the City Attorney’s office and speak to one of the individuals listed below.
If it is after normal working hours you may contact the 3-1-1 Call Center @ (614) 645-3111 or go to
The call center hours are Monday–Friday 7:00am to 6:00pm. If this is an emergency please dial 9-1-1 to contact the police.