HomeMy WebLinkAboutC.C. 03 CLAIM 92-22 06-01-92CONSENT CALENDAR NO. 3
AGENDA 6-1-92
Inter -Com
DATE: MAY 14, 1991
TO: HONORABLE MAYOR AND CITY COUNCIL
FROM: CITY ATTORNEY
SUBJECT: CLAIMANT: ALLSTATE INSURANCE (YVONNE HALES); D/L: 01-25-92;
DATE FILED W/CITY: 05-05-92; CLAIM NO: 92-22; CARL WARREN FILE
NO: S 72562 CLE
After investigation and review it is recommended that the
above -referenced claim be rejected and the City Clerk directed to
give proper notice of the rejection to the claimant and to the
claimant's attorney.
*IECS G. ROURKE, City Attorney
JGR: jab:051492(CL-9222. jab)
Enclosure: Copy of Claim
cc: Carl Warren & Co.
Finance Director
City Manager
City of Tustin
:M AGAINST THE CITY OF T� 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 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, 15222 Del Amo Avenue, Tustin,
California 92680
WHEN COMPLETING THIS FORM, PLEASE TYPE OR USE BLACK INR
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:,- Allstate Insurance Co. as Subrogee of Yvonne Hales
b. ADDRESS OF CLAIMANT: P.O. Box 2246
C. CITY/ZIP CODE: Tustin CA 92622
d. TELEPHONE NO: ( 714 ) 669-7749
e. DATE OF BIRTH: N/A
f . SOCIAL SECURITY NO: N/A SEE ATTACHED _
g. DRIVERS LICENSE NO: N/A
2. Name, telephone and post office address to which claimant desires notices
to be sent (if other than above):
N/A
3. This claim is submitted against:
a. X 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:
4. Occurrence or event from which the claim arises:
a. DATE: January 25 1992
b. TIME: 11:49 PM
c. PLACE (Exact and specific location) : Yorba St. North and Medford Ave.,
Tustin CA
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):
Property owned by the City and/or permitted and/or controlled by the City
obstructed both vehicle drivers view thereby causing or contributing to an
automobile accident.
e. WHAT particu? -%ction by the City, or - employees, caused the
alleged damac injury?
_City's action or lack of action permitting a dangerous and hazardous
condition to exist.
5. 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".
Undetermined Bodily Injury and Pro r�a rt Dare to Vro rty owned bv ales and
to the other driver and vehicle.
6. Give the name(s) of the City employee(s) causing the damage or injury:
Unknown
7. Name and address of any other person injured: Ines Casas Huttado,
17381 Delia Lane, Orange, CA 9266
8. Name and address of the owner or any damaged property: Pineda Sergio
Bareto 17381 Delia Lane Orange, CA 92669
9. Damages claimed:
a. Amount claimed as of the date:
b. Estimated amount of future costs:
c. Total amount claimed:
d. Attach basis for computation of
all bills, invoices,..estimates,
Undetermined
Undetermined
Undetermined
amounts claimed (include copies of
etc.
10. Names and addresses of all witnesses, hospitals, doctors, etc.
Undetermined
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 or perjury that the foregoing is TRUE AND
CORRECT.
Executed this �_ day of 19_x, at Tustin, California.
DATE FILED:
CLAIMANT'S SIGNATURE
B1:CLFORM
Revised 4/29/91
Allstate
April 27, 1992
CLAIM AGAINST CITY OF TUSTIN
Claim No. : 657 048 0175
Insured : Yvonne Hales
ALLSTATE INSURANCE COMPANY
MARKET CLAIM OFFICE
18302 IRVINE BLVD
TUSTIN CA 92680
714-832-0440
Paragraph 1 - There is the possibility of an Uninsured Motorist Injury
and Property Damage Claim against Allstate Insurance by their Insured and
this will be a subrogation claim against the City.
There is also an injury and property damage claim against Alls tate' s Insured
and Allstate will look to the City for contribution and/or indemnity.
Paragraph 7 - Additional Bodily Injury to Pineda Sergio Bareto, 17381 Delia
Lane, Orange, CA 92669.