Liability Claim Form

  • To submit a claim to the City of Champaign, please provide the following information. Any claim submitted has to be investigated. You will be contacted to let you know if your claim has been accepted.
  • If you do not know the exact date of the incident, please pick the date closest to the incident.
    MM slash DD slash YYYY
  • Please be as specific as possible, giving information such as eastbound, southbound, lane nearest curb, etc.
  • Please provide as much information as possible.
  • *Indicates a required field