HomeMy WebLinkAbout09 CLAIM RANDI SHAPIRO 09-05-00AGENDA
NO. 9
REPORT 09-06-00
MEETING DATE: SEPTEMBER 5, 2000
TO:
FROM:
SUBJECT:
HONORABLE MAYOR AND MEMBERS OF THE CITY COUNCIL
CITY ATTORNEY
CLAIM OF RANDI SHAPIRO; CLAIM NO. 00-28
SUMMARY:
The City Attorney is recommending that the City Council reject Claim No. 00-28, Randi
Shapiro.
RECOMMENDATION'
After review and investigation by the City's Claims Administrators and by this office, it is
recommended that the City Council reject the claim and direct the City Clerk to send
notice thereof to the claimant and the claimant's attorneys.
FISCAL IMPACT:
There is no fiscal impact with this action.
BACKGROUND:
The claimant alleges damages to his automobile while he was traveling east on Walnut
due to sewage spilling in the street. The amount of damages is not specified. The City
is aware of a spill by Waste Management on Walnut and Waste Management cleaned
up the spill. The claimant has been notified that Waste Management is responsible for
any debris falling from their vehicle. There is no City liability for this incident.
ATTACHMENTS'
Claim
CITY OF TUSTIN
CL_ ,IM AGAINST THE CITY OF-, JSTIN
(For Damages to Persons or Personal Property)
The law provides generally that a claim must be filed with the City Clerk of the City of Tustin within six (6)
months after the incident or event occurred. Be sure your claim is against the City of Tustin, not another
public entity. Where .space is insufficient, please use additional paper and identify information by
paragraph number. Completed claims must be mailed or delivered to the City Clerk, City of Tustin, 300
Centennial Way, Tustin, California 92780.
WHEN COMPLETING THIS FORM, PLEASE TYPE OR USE BLACK INK
.
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To the Honorable Mayor and City Council, City of Tustin, California:
The undersigned respectfully submits the following claim and information relative to damage to person
and/or property:
1. a. Name of Ciaimant: ~¢---.~C~i' ,...~kG~-~.c_..,r',f,~ .
b. Address of Claimant: .
c. City/ZipCode: '~ /
d. Telephone Number:
e.' Date of Birth: ,,//'-/./¢'¢'. _
f. Social Security Number:
g. Driver License Number:
Name, telephone, an.d post office address to which claimant desires notices to be sent (if other than
This c[ai, i:n is submitted against:
a.,)( The City of Tustin only.
b. // The following employee(s) of the City of Tustin only:
The City of Tustin and the following employee(s) of the City of Tustin only:-
Co
.
Occurrence or eveqt from which the claim arises:
a. Date:
b. Time:
c. Place (Exact and Specific Location):
.d.
How and under what circumstances did damage or injury occur? Specify the particular
_~.occurrence, event, act or omission you claim caused the injury or dam. age (use additional
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What__particular ~lc_tion ?y/the Ci,ty, or its employees, caused the alleged damage or injury?
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Give a description of the injury, property damage or loss so far known at the time of this claim. If
there~e no injuries, state "no injuries". '-
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Give the name(s) 9fthe qty, employee(s)causing the'damage or injury:
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Name and address of any other person injured:
.
Name and address of the owner of any damaged property:
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10.
Damages Claimed:
a. Amount claimed as of this date:
b. Estimated amount of future costs:
c. Total amount claimed:
d. Attach basis for computation of amounts claimed (include copies of all
estimates, etc.)
bills, invoices,
Names and addresses of ali ~.bcsp. itals, doctorS, etc.
WARNING:
IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM
(Penal Code' Section 72; Insurance Cede Section 556.0)
i have read the matters and statements made in the above claim and ! know the same to be true of my
own knowledge, except as to those matters stated to be upon information or belief and as to such matters I
believe the same to be true.,.J-c, ertify
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Executed this day of ,20~
Date filed this day of , 20, ~
2:CLAIM (1/00) '
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