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HomeMy WebLinkAbout04 CONS OF CLAIM 08-20 05-20-08AGENDA REPORT MEETING DATE: May 20, 2008 TO: William A. Huston, City Manager FROM: Ronald A. Nault, Finance Director SUBJECT: CONSIDERATION OF CLAIM OF THE HEIRS OF ESTEBAN SAMORA, CLAIM NO. 08-20 SUMMARY: The Attorney for the Claimants reported that there was an accident on the northbound I-5 freeway and one of the vehicles erupted into flames after the collision, causing fatal injuries to the driver. The Claim alleges negligence and negligent deployment of the City of Tustin Police and Fire Department, and failure to timely respond and provide life saving assistance upon arrival. RECOMMENDATION: That the City. Council deny Claim Number 08-20, Heirs of Esteban Samora, and direct Staff to send notice thereof to the Claimants' Attorney. The individual Claimants are listed as follows. Mary Campos (Mother of Esteban Samora) Tanya Gonzales, (Spouse of Esteban Samora) John Samora (Father of Esteban Samora) Tanya Gonzales (as Guardian Ad Litem for Minor Children) Esteban Samora, Jr. The Estate of Esteban Samora FISCAL IMPACT: None. DISCUSSION: This incident occurred within the city of Santa Ana and has been determined to be a case of no liability as to the City of Tustin. The two Tustin Police personnel involved were traveling on the freeway on City business when they came upon the accident scene with Mr. Samora pinned inside the burning truck. A Santa Ana Police Officer was already there, and the Tustin Officers assisted with traffic control and getting a fire extinguisher and first aid kit to the site. With the help of bystanders, the driver was freed from his vehicle and attended to before being taken to the hospital. The Tustin Officers left once the Santa Ana Fire Department and California Highway Patrol arrived. Ronald A. Nault, Finance Director ATTACHMENTS: Copy of Claim No. 08-20 ConsiderationOfClaimOfHeirsOfEstebanSamora. doc CLAIM AGAINST THE CITY OF TUSTIN For Damages to Person or Personal Property PLEASE NOTE: A. Read entire claim before filing. B. Be sure your claim is against the City of Tustin, not another public entity. C. Claims for death. injury to person or to personal property must be filed no later than 6 months after the occurrence (Government Code § 911.2). D. Claims for damages to real property must be filed no later than one year after the occurrence (Government Code § 911.2). E. If additional space is needed to provide your information, please attach sheets, identifying the paragraph(s) being answered. F. A claim must be presented, as prescribed by the Government Code of the State of California, by the claimant or a person acting on his/her behalf and shall provide the information shown below and must be signed by the claimant or a person on his behalf (Government Code § 910.2). G. This form is for the convenience of those desiring to present claims against the city. Claimant is advised to consult a private attorney if legal advice is desired. No employee of the City may give legal advice to any claimant relating to private claims. H. Completed claims must be mailed or delivered to the City of Tustin, City Clerk's Office, 300 Centennial Way, Tustin, California 92780. 1. Name and Post Office address of the Claimant: Name of Claimant: Home Telephone: Work Telephone: 2. Post Office address to which the person presenting the claim desires notices to be sent: Qf different from above) Name of Addressee: Post Office Address: 3. The date, place and other circumstances of the occurrence or transaction from which the claim arises. Date of Occurrence: Time of Occurrence: Location: 4. General description of the indebtedness, obligation, injury, damage or loss incurred so far as you now know. Page 1 of 4 5. The name or names of the~lic employee or employees causing the inju~amage, or loss, if known. 6. If amount claimed totals less than $10,000, Provide the amount claimed if ti totals less than ten thousand dollars ($10,000) as of the date of your claim, including the estimated amount of any related potential future injury, damage, or loss, insofar as it may be known as of the date of your claim, together with the basis of computation of the amount claimed (include copies of all bills, invoices, estimates, etc.) Amount Claimed and basis for computation: If amount claimed exceeds $10,000: If the amount claimed exceeds ten thousand dollars ($10,D00), do not provide a dollar amount in the claim. However, your claim must indicate whether it would be a limited civil case. A limited civil case is one where the recovery sought, exclusive of attorney fees, interest and court costs, does not exceed $25,000. An unlimited civil case is one in which the recovery sought is more than $25,000. (See CCP § ss.) ^ Limited Civil Case ~nlimited Civil Case You are required to provide the information requested above in order to comply with Government Code §910. Additionally, in order to conduct a timely investigation and possible resolution of your claim, the City of Tustin requests that you answer the following questions. 7. Name, address and telephone number of any witnesses to the occurrence or transaction from which the claim arises: 8. If the claim involves medical treatment for a claimed injury, please provide the name, address and telephone number of any doctors or hospitals providing treatment: Ifapplicable, please attach any medical bills or reports or similar documents supporting your claim. 9. If the claim relates to an automobile accident: Claimant(s) Auto Ins. Co.: j fui n/ ~ f,j~ ji/2 ~ ~~c/s Telephone: Address: Insurance Policy No.: !3 UFO Gl? Z3/$ Insurance Broker/Agent: Telephone: Address: Claimant's Veh. Lic. No.: Vehicle Make/Year: Claimant's Drivers Lic. No.: Expiration: If applicable, please attach any repair bills, estimates or similar documents supporting your claim. Page 2 of 4 READ CAREFULLY For all accident claims, place on following diagram name of streets, including North, East, South, and West; indicate place of accident by "::" and by showing house numbers or distances to street corners. If City/Agency Vehicle was involved, designate by letter "A" location of City/Agency Vehicle when you first saw it, and by "B" location of yourself or your vehicle when you first saw SIDEWALK CURB CURB -y PARKWAY SIDEWALK Warning: Presentation of a false claim is a felony (Penal Code §72). Pursuant to CCP §1038, the City/Agency may seek to recover all costs of defense in the event an action is filed which is later determined not to have been brought in good faith and with reasonable cause. Signature: CirylAgency Vehicle; location of City/Agency vehicle at time of accident by "A-1" and location of yourself or vour vehicle at the time of the accident by "B-1" and the point of impact by "X.' ____ NOTE: If diagrams below do not fit the situation, attach hereto a proper diagram signed by claimant. Date: Page 3 of 4 DATE GF COLLISIOIJV(MO.,- DAY Ye'AR) TIME (2A00) ,. 13 , y~ ,~,v ~t-Zo:~~ ALL MEASURE -- ---- - - C~N<k ~C T11 JI f+Efi:. ~f~ rL. NC! /JG] l So y7rr ~oV,~J N L hn/ES /JG"T /avwni i IJCIC II OFFICER LD. ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED (S c C N --- T----~--~~ ---------- CoiJCZ_~7E iH;LF•/~L LG.~b!JLtEcR i IAO. DA.Y YEAP. P.EVIEVJEP.'S Nab/E NUMBER r -'- ,i C7 INDICATE NORTH SGC.ID wL!lTG_ "h^~r.•tn.A l INL ~! Syr/q_7 IvGV,. Lc2 A S C E,~,/ U l/'•/ G7 DINT L°Mrfa:o;ME~17- - tticor~N wane: Frt.-~E~LI rE: DA'. fEf;R -~ OAF 0~ 75E PLEASE NOTE. A. Read entire claim before filing. B. Be Sure your claim is against the City of Tustin not another public entity.~. Claims for deatf~~, iniurV to person or to personal property must. he hied na later than ~, months after the occurrence (Government Code § 911.2). C. Claims for death, injury to person or to personal pr property must be filed no later than one year after the occurrence (Government Code g 911.Zi. E. If additional space is needed to provide your information, please attach sheets, identirying ttie paragraphs} beino answered. F. A claim mtast be presented, as prescribed bV the Government i,ode of the State of California, by the claimant or a person acting on his/her behalf and shall provide the information sho~n~n below and rnrat be signed by the claimant or a perscn on his behalf (Government Code § 910.2). G. This fornT is far the convenience of those desiring to present claims against the city. Claimant is advised to consult a private attorney ir` legal advice is desired. No employee of the City may give legal advice to any claimant relating to private claims. H. Completed claims must be mailed or delivered to the City of Tustin, City Clerk's Office, 300 Centennial Way, Tustin, California 92780. 1. (Name and Post Office address of the Claimant: Name of Claimant: Home Address: Home Telephone: Work telephone: 2. Post Office address to which the person presenting the claim desires notices to be sent: If different from above) Name of Addressee: Telephone: Post Office Address: 3. The date, place and other circumstances of t'rTe occun~ence or transaction from wiTich the ciairn arises. Date of Occurrence:. Tune of Occurrence: Location: circumstances Giving rise to this claim: 4. General description of the indebtedness, obligation, injury, damage or loss incurred so far as you now know. Page 1 of 4 PLEASE NOTE: A. Read entire claim before filing. B. Be sure you, claim i ;against the City of Tustin, nat another public entity. C. Claims for death, iniury to person or to personal oreperty mr!si be flied na later than a months after the OCU!rranre (Government Code § 911.2). D. Claims for damages to real property must be filed no later than one year after the occurrence (Government Cade y 911.21. E. if additional space is needed to provide your information, please attach sheets, identifying tiie paragraph(s) being answered. F A. claim must be presented, as prescribed by the Government Code of the State of California, by tide claimant or a person acting on his;her behalf and shall provide the infcrmation sho~nm below and m~~st be sinned by the claimant or a persen or his behalf (Government Code § 910.2). G. This form is far the convenience of those desiring to present claims against the city. Claimant is advised tc consult a p;~ivate attorney ir` legal advice is desired. No employee of the City may give legal advice to any claimant relating [a private claims. H. Completed claims mus: be mailed or delivered to the City of Tustin, City CierR's O#~icp, 300 Cent~nr:iaP VUay, Tustin, Caiifoenia 9c7H0. 1. Name and Post Office address of-the Clairnant: Name of Claimant: Home Address Horne Telephone: Work Telephone: 2. Post Office address to which the person presenting the claim desires notices to be sent: If different from above Name of Addressee: Telephone Post Office Address: 3. The date, place and oti~er circumstances of the occurrence or transaction frorT~ wl~rich tf~e ciairn arises. Date of Occurrence Time of Occurrence: E ~ f l7 ~~~ Location: Circumstances giving rise to this claim: 4. General description of the indebtedness, obligation, injury, damage or loss incurred so far as you now know. Page 1 of 4 PLEASE NOTE: A,. Read entire claim before filing. B. Be sure you; claim is againsi the City of Tustin, not another public entity!. C. Claims for deatl-r, iniury t.o person or to personal property must be filed nn later than a months after the acu~rrence Government Code § 911.2). D. Claims for damages to real property must be filed no later than one year after the occurrence (Government Code g 911.Zi. E. If additional spa!:e is needed to provide your information, please attach sleets, identifying the paragraph(.:) beincr answered. F. A claim must be presented, as prescribed by the Government Code of the State of California, by the clairrrant or a person acting on hislher behalf and shall provide the information shown below and rTiust be signed Cy the claimant or a person cr his behalf (Government Code § 910.2). G. This forn~r is far the convenience of those desiring to present claims against the city. Claimant is advised to consult a private attorney if"legal advice is dewed. No employee of the City may give legal advice to any claimant relatirry to private claims. H. Completed claims must. be mailed or delivered to the City ©f Tustin, City Clerk's QS~ice, 300 Centpnnia@ V~,fay, Tustin, Califrornia 92780. Name and Post Office address of the Claimant: Name of Claimant:-. Horne Address: Horne Telephone: Work Telephone: Post Office address to which the person presenting the claim desires notices to be sent: if different from above Name of Addressee: Telephone Post Office Address. The date, place and other circumstances of the occurrence or transaction from vvhich the clairn arises. Date of Occurrence Time of Occurrence: Location: Circumstances giving rise to this claim: Genera{ description or` the indebtedness, obligation, injury, damage or foss incurred so far as you now know. Page 1 of 4 PLEASE NOTE: A. Read entire claim before filing. B. Be sure your claim is against the Citv or Tustin, not another public entity. C. Claims for death, injury to person or to personal property must be filed no later than 6 months after the occuranc (Government Code § 911.2). D. Claims for damages to real property must be riled no later than one year after the occurrence (Government Code g 911.21. E. If additional spare is needed to provide your information, please attach sheets, identifying the paragraph(s) being anstverod. F. A claim must be presented, as prescribed by the Government Code of the State of California, by the claimant or a person acting on his/her behalf and shall provide the information shown below and must be signed by the claimant or a person on his behalf (Government Code § 910.2). G. This form is far the convenience of those desiring to present claims against the city. Claimant is advised to consult a private attorney if legal advice is desired. lVo employee of the City may give legal advice to any claimant relating to private claims. H. Completed claims must be mailed or delivered to the City of T€rstin, City Cferk's Ogiicp, 3Q0 Centpnniaf {(4fay, Tustin, Caiifornia 92780. Name and Post Office address of the Claimant: Name of Claimant: Home Address Home Telephone: Work Telephone: 2. Post Office address to which the person presenting the claim desires notices to be sent: If diflfrent from above Name of Addressee: Telephone Post Office Address: 3. The date, place and other circumstances of the occurrence or transaction from which the claim arises. Date of Occurrence: Tirne of Occurrence: Location: Circumstances giving rise to this claim: 4. General description of the indebtedness, obligation, injury, damage or foss incurred so far as you how know. PLEASE NOTE: A. Read entire claim before filing. B. Be sure your claim is against the Citv or Tustin, not another public entity. C. Claims for death, injury to person or to personal property must be filed no later than 6 months after the occuranc (Government Code § 911.2). D. Claims for damages to real property must be riled no later than one year after the occurrence (Government Code g 911.21. E. If additional spare is needed to provide your information, please attach sheets, identifying the paragraph(s) being anstverod. F. A claim must be presented, as prescribed by the Government Code of the State of California, by the claimant or a person acting on his/her behalf and shall provide the information shown below and must be signed by the claimant or a person on his behalf (Government Code § 910.2). G. This form is far the convenience of those desiring to present claims against the city. Claimant is advised to consult a private attorney if legal advice is desired. lVo employee of the City may give legal advice to any claimant relating to private claims. H. Completed claims must be mailed or delivered to the City of T€rstin, City Cferk's Ogiicp, 3Q0 Centpnniaf {(4fay, Tustin, Caiifornia 92780. Name and Post Office address of the Claimant: Name of Claimant: Home Address Home Telephone: Work Telephone: 2. Post Office address to which the person presenting the claim desires notices to be sent: If diflfrent from above Name of Addressee: Telephone Post Office Address: 3. The date, place and other circumstances of the occurrence or transaction from which the claim arises. Date of Occurrence: Tirne of Occurrence: Location: Circumstances giving rise to this claim: 4. General description of the indebtedness, obligation, injury, damage or foss incurred so far as you how know. Page 1 of 4