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Home My WebLink About11 CLAIM R. TRUJILLO 06-02-97 LAW OFFICES OF ~TgOODRUFF, SPRADLIN & SMART A PROFESSIONAL CORPORATION MEMORANDUM NO. 11 6-2-97 TO: Honorable Mayor and Members of the City Council City of Tustin FROM: City Attorney DATE: May 28, 1997 RE: Claim of Richard "Mario" Trujillo; Claim No. 97-21 RECOMMENDATION: After investigation and review it is recommended that the City Council deny the claim and direct the City Clerk to send notice thereof to the claimant and the claimant's attorneys, if any. DISCUSSION' Claimant alleges that during a Little League ball game he was trying to avoid a pop fly ball and slipped on loose gravel on a cement surface. The claimant alleges that the loose gravel had been blown onto the cement surface by leaf blowers. Claimant is claiming injuries due to a multiple fracture of his left ankle in the amount of $14,107.09. It is anticipated that additional damages will be alleged after treatment is completed. At this point in time we have no information indicating that the City created a dangerou, s condition or otherwise failed to perform some duty owed claimant, or that any activity by the City caused claimant's injuries. Enclosure cc: William A. Huston, City Manager 1102-9721 46904 1 DESiGb-AT!ON OF R~PRES~f_AT1-VE PLrRSUD=N-T TO SECT__rON ' 2 5 ~ 5.7 OF arMS S~_-T~r_~ PR_%CTZC _~EGO-r_AT_rONS OD?,. CLi-_--NT - Richard Mario TRUJILLO YOuR ,_-NSo.~D - CITY OF TUSTIN Cr.~_ ~-__-~-Q -- UNKNOWN AT THIS TI.MP DATE OF LOSS ' 11/30/1996 DAT~ CITY OF TUSTIN '- CLA,,,. AGAINST THE CITY OF (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 sixl6) monThs aher 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 proper~y' . a. Name of Claimant: b. Address of Claimant: c. City/Zip' Code: d. Telephone Number: e. Date of Birth' RIC~,i~_RD "~RIO" TRUJILLO ( . Name, telephone, and post office address to which claimant desires notices to be sent (if other than above):" . This claim is submitted against: . a. xx 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' 11/30/96 b. Time: .APPROX. 02:52 P.M. c. Place (Exact and Specific Location)' TUSTIN SPORTS PARK (Jamboree & Robinson) 12850 Robinson Road, Tustin, CA 9278'2 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 · paper if necessary: WAS STANDING NEAR THE PARK DURING LI ~ LEAGUE BALL GAME. I W. FLYBAL.L ON THE CmMmNT SURFACE WHEN MY FEET GRAVEL THAT HAD BEEN BLOWN ONTO THE CEMENT 'T AT TUSTIN SPORTS · i'RYING TO AVOID A POP SLIPPED ON LOTS OF LOOSE SURFACE BY LEAFBLOWERS. e. What particular action by the City, or its employees, caused the alleged damage or injury? ~INTENACE PARK LEAFBLOWERS NEGLIGENTLY BLEW GRAVEL FROM GRASSY PARK ONTO CEMENT SURFACE. . 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". HULTIPLE FRACTURE OF L~'FT ANKLE . Give the name(s) of the City employee(s) causing the damage or injury' UNKNOWN .AT THIS TIME 7. Name and address of any other person injured: NON_-":. . Name and address of the owner of any damaged property: NONE . 10. Damages Claimed: a. Amount claimed as of this date' $14,107.09 b. Estimated amount of future costs: UNKNOWN c. Total amount claimed' UNKNOWN UNITL TREATMENT IS COMPLETED 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. WESTERN MEDICAL CENTER-P.O. BOX C-11912 SANTA AMA, CA 92711 DAVID M. DENENNY, MD.-845 W. LA VETA #104B ORANGE, CA 92668 DOCTOR'S AMBULANCE SERVICE-23091 TERRA DR. LAGUNA HILLS, CA 9'26'53 WARNING: 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. i certify under penalty of perjury that the foregoing is true and correct. ~ Claimant's Signature- ,,, Executed this '~ day of_ //~/~/~//...- , 19 ~,7. Date Filed' 2:CLAIM [7/96l .< UwMC HOSPITAL CO~P0RATION - SANTA ANA P.O. BOX C-t tgi'2 SANTA AMA, CA 927[1 TELEPHONE: (714) 56~-7200 JANUARY 8, 1997 GUARANTOR ~: 3279070 TRUJILLO, RICHARD H O000 PATIENT #- TRUJ[LLO, ~ICHARD M DATE OF ADMISSION: 11/30/96 DATE OF DISCH-"RGE: 12/01/96 DATE OF LAST PAYMENT: 12/2o/96 BALANCE DUEl 322.50 wE HAVE RECEIVED PAYMENT FROM YOUR INSURANCE COMPANY FOR THE ABOVE REFERENCED ACCOUNT, AND THE APPROPRIATE CONTRACTUAL ALLOWANCES HAVE BEEN APPLIED. AS DETERMINED ~Y YOUR INSURANCE COMPANY, THE ABOVE BALANCE IS YOUR PORTION DUE. YOUR PROMPT REMITTANCE OF THE BALANCE DUE IS APPRECIATED. THANK - YOU FOR USING wESTERN MEDICAL CENTER= PLEASE CONTACT THE BUSINESS OFFICE SHOULD YOU HAVE ANY QUESTIONS OR CONCERNS. SINCER£LY. UNITED wESTERN MEDICAL CENTERS CENTRAL BUSINESS OFFICE (714) 564--7200 HOURS: 9:00 AoNo TO 4:00 P.M. UNITED WESTERN MEDICAL CENTER A NONPROFIT HEALTHCARE CORPORATION DEDICATED TO COMMUNITY SERVICE 23091 Terra Drive, Laguna Hills. CA 92553 P HO N E :_(_7__14)-.95.1:.1701: FAX: (714) 951-289' OFFICE HOURS: 9 A.M. to 4 P.M. (Monday thru Friday) RICHARD TRUJ I LLO I ATIENTNAME: TRUJILLO, RICHARD DATE OF SERVICE: 11/30/96 · INVOICE ,,.: 214095 TIME: 14'52- '~ AUTH. BY: O~%NGE COUNTY FiRE AUTH (9!1) jAUTH.: FROM: IRVINE AT RONINSON FIELD # 1 WESTERN MEDICAL - SANTA ANA lCD-9 000! 0003 00!O CODE HCPS A0362 A0380 A0382 QTY DESCRIPTION BASE RATE' EHERG ENCY MILEAG;" BLS MiSC EXPENDABLE SUPPLIES DESCRIPTION SO WE MAY BILL YOUR INSURANCE, PLEASE FORWARD TO US A COPY OF YOUR INSURANCE CARD, FRONT AND REVERSE. IF YOU HAVE ANY QUESTIONS, PLEASE CALL: (714) 951-1708, MONDAY- FRIDAY, 9 AM TO 4-'PM. THANK YOU. MEDICARE # ZA375 · MEDI-CAL # 77773666Z · IRS # 95-3327978 Mail To: DOCTOR'S AMBULANCE SERVICE 23091 TERRA DRIVE LAGUNA HILLS, CA 92653 CHARGES 296.20 ~0 20 13.30 BALANCF 296.20 336.4O 349.70 ORIGINAL CHARGES ,=,- 349.70 DATE CREDITS BALANCE PAY THIS AMOUNT ,,',- 349 70 Subject to interest charge of 1.5% per month after 30 da~