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A Law that Impacts Presenting a Claim to the District 

RCW 4.92.100, requires citizens to present the Standard Tort Claim form with the government agency named in their claim.  The law also requires State and local government agencies to post the Standard Tort Claim form on their websites with instructions on how to complete the form.  In compliance with these requirements and for the convenience of citizens, The Washington State Office of Financial Management (OFM) developed a Standard Tort Claim Form Packet.  The Standard Tort Claims Form may be submitted directly to Northshore Utility District. 

Documents Contained in the Standard Tort Claim Form Packet (clickable links)

  1. Instructions for completing the Standard Tort Claim Form (Important: Read this first)
  2. Standard Tort Claim Form
  3. Medical Authorization
  4. Vehicle Collision Form (for tort claims involving vehicle accidents/collisions)
  5. Mandatory Medicare Beneficiary Reporting Form
  6. Release Form

Legal Requirements for Presenting Standard Tort Claim Forms

In order to verify the claim and additional supporting information, the law requires that the Standard Tort Claim form be signed by:

  • Claimant; or
  • Person holding a written power of attorney from the Claimant; or
  • Attorney in fact for the Claimant; or
  • Attorney admitted to practice in Washington State on the Claimant’s behalf; or
  • A court‐approved guardian or guardian ad litem on behalf of the Claimant

Present in Person or Mail the Standard Tort Claim Form and Supporting Documents to:

Attn: General Manager
Northshore Utility District
6830 NE 185th Street
Kenmore, Wa  98028

Business hours:

Monday-Friday 9:00 a.m. to 4:30 p.m.
Closed on weekends and official state holidays