HomeMy WebLinkAbout14 CLAIM T.A. JOHNSON 11-03-97, ~/OODRUFF~ SPRADLIN & SMA
M E M ORA N D U M
TO'
Honorable Mayor and Members of the City Council
City of Tustin
FROM: City Attorney
DATE:
October 29, 1997
RE:
Claim of Todd A. Johnson; Claim No. 97-42
NO. 14
11-3-97
RECOMMENDATION_:
After investigation and review by this office and the City's Claims Administrator, it
is recommended that the City Council deny the claim and send notice thereof to the
claimant and the claimant's attorney.
DISCUSSION..:
The claimant alleges property damages in the amount of $1,500 to the front
suspension of his car. He claims that his car was damaged by the failure of a street crew.
to properly cover a manhole. A City contractor was working in the area and the Claims
Administrator intends to tender this claim to the contractor for independent evaluation by
the contractor and their insurance company.
.~,
~,-~/:-*.., ~, ...,.,£..t:.~:,;.~..~ ...-
LOIS E. JEFFRE._,,Y /
Enclosure
cc: William A. Huston, City Manager
1102-9742
54271_1
Office of the City Clerk
Carl Warren & Co.
P. O. Box 25180
Santa Ana, CA 92'799-5180
Re-
City of Tustin
Transmittal of Document
Claimant-
C1 aim No. -
Filed With City-
300 Centennial Way
nF~, ~ ,~ P- ,~ ~ ..~ ,~.~ Tustin. CA92680
~..i ':: '": :¢" · I.~ (714) 573-3026
.
FAX (714) 832-0825
i u !997
Todd Johnson Q:',---,.,.,rt;, -Si"~laU~,,i'i a ~mlART
97-42
10-8-97
Receipt of Claim/Summons and Complaint by the City Clerk's Office on
Date- 10-8-97 '
Time' 12-00 p.m.
By- ~ Personal Service upon the undersigned
~ Regular Mail
~ Certified/Registered Mail
· Int'erdepartment Del ivery
The enclosed Claim (or Application to File Late Claim) was presented to
this office as indicated above and has been referred to the appropriate
City department for its investigation and also to the offices of Woodruff,
Spradlin and Smart, Attn- Lois E. Jeffrey; City Attorney. By this letter,
you are authorized to comme, nce the necessary investigation of this claim
on behalf of the City.
We request that you give such notices as may be appropriate to the City's
insurance carrier(s) and further request that you submit your preliminary
and all subsequent reports to the City, with a copy to the City Attorney
and to the insurance carrier(s) if they so request. Upon receipt of
advice from the City Attorney, we will plan to present this matter to the
City Council and/or take such other steps as are directed by the City
Attorney.
__ Other-
A copy of this letter and enclosures were sent on ]0-9-97 to the City Attorney
and Department Head, and the original was forwarded to the Finance.Department.
S !.n~.erely,
Beverley Wh i~Xe/
Deputy City C'rerk
Enc [,osures
CITY OF TUSTIN
CL, Jl AGAINST THE CiTY O~ JSTI'N
(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
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 Claimant:
b. Address of Claimant:
c. City/Zip Code: '"/~_~-/-,%
d. Telephone Number:
e. Date of Birth: /
.
f. Social Security Number:
g. Driver License Number:
Name, telephone, and post office address to which claimant desires notices to be sent (if other
than above): ¢¢-.-~
.
This claim is submitted against'
a. .~ _ The City of Tustin only.
b. The following employee(s) of the City of Tustin only'
C.
The City of Tustin and the following employee(s) of the City of Tustin only:
.
Occurrence or event from which the claim arises'
a. Date: ~10¥ /(, ~r~ I-? lc;ct?
b. Time' . ?' ~' A~
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 damage (use additional
e.
What particular action by the City, or its employees, caused the alleged damage or injury?
--._ ~ ~ ~ ~
.
.
Give a description of the injury, property damage or loss so far known at the time of this claim.
If there were no injuries, state "no injuries".
Give the name(s) of the City employee(s) causing the damage or injury:
7. Name and address of any other person injured-
,
Name and address ofthe owner of any damaged property:
,
10.
Damages Claimed-
a. Amount claimed as ofthis date- s/Coo.-o
b. Estimatedamountoffuture-costs:
c. Total amount claimed:
d. Attach basis for computation of amounts claimed (include copies of all bills, invoices,
estimates, etc.)
Names and addresses of all witnesses, hospitals, doctors, etc.
~:,~/~ Zcf/~,~.. -~ %~ - , ~ -~
WARNINGi
IT iS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM
(Penal Code Section 72; Insurance Code Section 556.0)
I have read the matters and statements made in the above claim and I 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. ! certify under penalty of perjury that the foregoing is true
and correct.
Executed this ~ '~ day of ~:)~4Zob~; , 19 q7 ·
Date Filed.
2:CLAIM (7(96}
Summary Sheet
Claimanu [u ,ILl'(' TC)DD Jcbl rN.qt'i,q
Appraiser: Ix',~; lu:.nc'~ .~¥,,,
Estimate Copy m Owner
Locauort: Ht L¥1E
1:."] P:.qimate C:opy ~o Shop
Vehicle Dnvable .': Repairable
'" Agreed on .Price
A ppraiser Estimme
Shop Estimate:
..',,greed Ne~ Pric~: ~ 1.50:. la
QRP .c.-'arch
· · LKQ Sum'ch
R.-c,,'cled l'arr Supplier.~ C~Jled:
: Rt..ntal Vehicle
Days m Rep:dr:
:-.--' OIcl l)amag=
"-' Po.~.4bilivy or'
: l)raft Issued
:1, I ..',97.14
Repair Facility: H! I'~.c~ ^tJ'J(~ I-It.~lJY
Contact: I .I.SA
["; LKQ Applicable
.qupplier I' SAMS
Kcnta! Agency:
Supplier 2:
Conlact:
l-l, QRP Available
["' i LKQ Available
,x~.t.ti."~ > Supplier 3:
3OE Comtam:
Date' Started.:
Old Damage Amount:
Supplement Amount:
Betterment ToT. al:
Renr.,-I Period (Days):
Allowances:
Draft Number:
Regulation N umber:
Total Loss
_'Slock .X umber:
Dm: Contacted:
D..,.il.~ Storage Ram.
i . TLA Sent
To
l),ductible: t .N'I,,.."'qOV,,'.N
Net Total: $ I.$0'L t4
:.. Adjustor Notified I~ Pertnis~ion to Move Vehicle
7'1 'Vehicle Moved
SalYaga l,o:mion:
Sal',-age Value:
To,0Ang anti Storage:
(.,om m ~'nl..: ·
vi :ttlC!.l-; IM?At.' l'l'~l) ON ~[ ~(ONff ON ~E CROSS~IER. DA~{~IN(~ THE UR( )SS~Ib. MHER, RADIA~t)R 5L~)RT. & ~Oi.~' YR()NT
. .
~: ~5I'IiNSI{}N. I~.}SS~ll~ ~)D~I<)N.~- DAMAGE A[rIY~ }I~ARIX)A~, ANt) a I{ISSlIIlI.I'I'Y CJI:' 'I'ltAN.SNfl$SICt~' DAMAfiF:. I.IrlH'i' I'RI()R
I )AMAt',E TO ~ ~ CROSSI~¥~ NO O'11 UiR. I'R I()R I )AMOGE. Ct )PY '1'{ ) SH( ~P A~I) r~)RRO~C. .. ..
~g~zgEgglg'l~OI 01 N¥~£:B6 LB-IO-6I
_~ ! ION £ -
. . .... .~L'vD " ! ' 5
g 2.. O'; ':"tJN' o_-. t ',. , ..~., _:: r q',."~.:, ,1
· , ;'a 90{)28
H()L :.,Y.',':O0~, ....
(;S=~.) v~O-~03S F?,3" (8!~) ;90-'~09:'
ES T ikkkT E
:; 9- 33- }',' '2 ' 08 i:M
CLAIM !NFOP!-C'Ai ION
· .TiAiM .~ 970727619
,-.,' ·
... ~ ).-1 FAN Y
; N:.; l I R,.'..iD WF:.% FiNANC 7AL
P'.[i P,
102::. PA'YES
i NS PECi i ON
IY-'--:.~ iNDEPENDENT FIELD
APF'RAtSKR NAMF: 13ON BERG-,PJA
ON ., . : .....
WORK ~H I..: {'~1~) 7'~0-~09~
A~X)~;::;S 6201 SUNSH'r ~:LVD ~!4lb
CZT~ STATE IiOLLYWOOD
Z !:' 90028-
POLIC., '~
(..i.[.t4 REF/A{];N'I' C BYRON
WORK Pi[ONE (.
Ix)SS I)a'i'l-; 09-24-97
LOSS TYPE COLLISION
FiLE ~ '113146
AC. CT % ~¥
FAX (818) 790-8097
iNS~' DATE 09-30- 97
1,0CAT T ON HOMF.
CITY STATE TUST!N
CA
". .... ,.,Nr. (714) 5a7-5'12.:3
-r:,'"T;'i L'
V _.,"1 _ ....,., '-,
1990 HON{)A C~VIC
~C:'_. ...... (.,A,,OL-' "' !NE _.n
I.~X 4 I.}Ro."'KI)AN
<;.AR :N
CAR OUT
REPAIR
REG. ! D
AiR CONDiTIONiNG
'!'I..b't' :;TEF.:RINC WHEEL
5 DAY S
95-1986748
(7i4) 547-34;}1
BC:DY C. OLOR GREY MILEAGE 3 '17, 'I 1 ,'~
' ..
LICENSE i;TATE CA './F:H 'INSt.' ~
- ,'~¢'%.; '
CON'.- .....* ~..,',: k, RA(';I.".;
.."dqY R.'-:I-'I N [SH t Nt:.'LI. JUE:~ i TN'- ·
·
· .,-u-,,- - - .
_., -:.~ NOT ..'uN .,IUT:6ORIZ..%I 1 ()N F'OR R?;PA [ R
CALL,:' '.-'l ],F: HANI)I:.I';R / AD3USTER FOR CONFii-<M~./iON OF c.:Ov.'.-:RAG:-; AI'ql3
-1-
PAYMENT.
C!AiK. f 9707.'
'C'"' lq2 -:;
i ., % ol .
09-.30-97
.:'ART
FulD !AiOR SUP?DRT
r"I °1
%. !
Panel A:~::.e:ni:,t.y, R:-ic'~ Sup
,-"'. ,%1~.. T R'. T
>;.-$/qq'..,~-' A/W
FO,',~rq: :%IJ:~PgN:-'.. :'ON '
:":rm, i,owcr O)r, t roi R/F
513q5,''
...:,H3020
lj n,5 o. r,.-. O..% t i r, q
.-.~.....-.: ....... r, br. rUT. R/.'-"
~', !
c,' Front St' ,'ut .n_Ds RT
.... '' '- "'i ~/:
b 1 '_; 1 ,:].".- Ii 304 '3
A tm, Bad i :.: s R1
b!3b2SH3000
=;'=fl f~somb~ - '-
....... ._ =y,Axlc '.</,'
MANUAi, KN'I'R I
CO'_'=osion P£oLocL '_,'O:'~
Cc:vet Car
ALl C-N ' SUS FENS i ON
GDE O_='EFuIT I ON PR.I
0073 ,~ep:.=.i r
0073 ~<efini:~h
(3863 Reola. ce c'~lvagc
. ~-~ ,.~
M'.a ]-kUp
818-894-2820
0664 Reolace OEM
0M04 Rc.c, lace Economy
06o8 [Reol ace OEM
06'/1 Reu!a¢:e OHM
-
06'/6 Re,'.,l~.~ce OEM
--
06'18 R'eo!ace OEM
--
0684 Rep! ac.'o.
?.~'! rS kilo
M!4 R~.o! at:e
M'J7 Addiuiona! Lamor
20%
i 00.00"'
!33.2b
10.00'
99.95
47.7(.)
182. U3
34.. !7
75.00'
1(].00'*' '
!0.00'
6(!.
'i 3 i TEMS
MC:
9'." :'-..TRUCTUk'~_~ PART AS
.
...
IDENT!F[ED BY
.r -CAP,
2 - 0U
·
1.6
1.6
2 . [)
O. 2
O. 2
0'.
RT
SM
RF
ME
ME
ME
ME
ME
SM*
:-.'.INAI, ':.:ALCULAI' iONS
:- A.-x i':-,
CROS:% FARTS
OTHER. PARTS
PAINT :..~.T E R iA_T.
: :,,., .:,: P.?:N'I':i;
L,!NE ITEMS
F'ARi'::: 'L'O'i'AJ~
TfuX ON
& ENT ii ]. ,71:':i
'" "t' ] s' I .
& MA'I',KR !' AT, @ 7 . 750%
1-SHEET METAL .$
, -Nr.t :i': / ELEC '-"
N/~.RKU P
S 35.00
,.-,~.T E RE ?kr~CE ERS
3Cl. 00 . 1.0
65.00 6.7
REPA.i R "'.'
4.5
49'i. 90
205.O0
'2(:,.
165.00
435.5O
'/b'/. 90
58.74
-2-
.2 !_.A- >: # '~ ..' ::: :' 22 d '! 9
..,.)(, ] :)2
-0
.S9-3'3-97 2- Sa ~X
..... ~-. r,')l z L
'fAX ¢.)N
SUBLET RE
'I',:')W I N('.;
' ..., .-L.&'.,
LEt:'-" NE'.!' l)~tt' ' ....
., ,Ur...' ; Rt ,1";
NET '['t'yl';~ t
$ B (). ".) ()
$ 6.30.50
$ 6 0.0 0
::; I, b()'i. 14
_::XN Y/00/0O/0O,':h0/00 ,--:t,~ 00/00/0O/00/00 Gcocodc:' 90028 [:;r..)C.:Ai,
· $?.?L Yes .::.;.eoc. o,Je' 90028 Sc) CA.I,
:,_,N:_'RO W0'330 --'q LOC-- 192 -0 09-30-9"/ g0-18'11 REL 3.30'CD 08/9'/
A?_;P "--' ' -- - - -
,'.:;(.)1,~'I~ ~GH'~', AU'I'OMA'i'IC DATA PROCE$:'IN¢4 .LN.q'. '1 99
, nA.:,r.l.; (_;N '['HE; U'"" O1-' (.RA::,H I'AR'i.:, ,:,~ Fp'[,T--'T~ BY
'['HItt I'::i;'I'~MA'I'?: k;k[.'-~ H.i-'.I-iN i,R.~lpARl.;l)" ""' . or., ---
- ,-,',,io~ ...... r,:' ...... r.. ,1.~.l',l'UrAC.t,,",.r,,'~ OF' YOL.,tR Moq'oR VF.;.'-IrCI',:',.
~ .::,.,,..~,..~ .... ~.-..-.R '1'NAN 'i'~" k .... :""' .... -' ANY WARR~JqTIES
.- o -r ., BY -'- I-~_NU_AC~'-:RER OR
.~_~_:-Li:£A.E' ..... U THESE REPLACEMENT '_--'7~RTS .z~RE _ROV_DED ,_h~ " '~' '-~'
· ·
D!SiRrBUTOR O-- THE PART"' F~THER THA2,~ ~'""' THE ORiGiNAL
V}:H ' C I,F.. _ ........ · .
O'J. W¥~[:68 LG-I8-OI
NO,hi