HomeMy WebLinkAboutC.C. 09 CLAIM 92-06 02-18-92Iz
CONSENT CALENDAR NO. 9
2-18-92
� f
FEBRUARY 11, 1991 �-
HONORABLE MAYOR AND CITY COUNCIL
CITY ATTORNEY
_ .0 3. CLAIMANT: DONALD TURNER; D/L: 01-03-92; DATE FILED W/CITY: 01-
27-92; CLAIM NO: 92-06; CARL WARREN FILE NO: S 66948 PRL
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. _
JAME( /#nURKE, City Attorney
JGR: jab: 1):021192(CL-9206.jab)
Enclosure: Copy of Claim
cc: Carl Warren & Co.
Finance Director
City Manager
City of Tustin
LM AGAINST THE CITY OF Ti N
(For Da...ages to Persons or Personai 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 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: DONAT.n T) TTTRVER
b. ADDRESS OF CLAIMANT:
d. TELEPHONE NO: .(
e. DATE OF BIRTH:
f. SOCIAL SECURITY NO:
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:
b. TIME:6-10 P -M-
c. PLACE (Exact and specific location) : T_A rnT TNA ng k 'RAm nHylnnn
TUSTTN
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):
Traylina on La Colina Drive, Tustin Struck double dip, no warning
damage to
,�gn, natisi na dri ver to hattam alit car on gtrPet Sur
1188-r si dP of nar There ig a warning gign- pasted going Eqt on
e. WHAT particul -action by the City, or employees, caused the
alleged damac injury?
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".
RUPTURED 011,DAN (`RArygn RACK & PTmnM C ORF BRQKFN TAIL P
IRE
6. Give the name(s) of the City employee(s) causing the damage or injury:
7. Name and address of any other person injured:
i
8. Name and address of the owner or any damaged property:
DONALD
9. Damages claimed:
a. Amount claimed as of the date: $534 05
b. Estimated amount of future costs: 39 QC;
C. Total amount claimed: $574.00
d. Attach basis for computation of amounts claimed (include copies of
all bills, invoices, estimates, etc.
10. Names and addresses of all witnesses, hospitals, doctors, etc.
MRS- JANET ROCERS
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 77_ day of JANUARY ,19,.9.2_, at Tustin, California.
DATE FILED:
I S S ATURE
Bl:CLFORM
Revised 4/29/91
Le_____.___ .. o
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! CALDWELL'S
AUTO BODY & TOWING
Pay From This Invoice No Statement Will Follow
' (714) 554-3910 State #AL128978
1.519 N. Fairview Street
SANTA ANA, CALIFORNIA 92706
REO EO 8
P.
NAME ,�t �1 LQ { ' �t./� C..7 VC.J✓�_ _ __ _.._ f... . _...... _ _....._.
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I ADORE
MILEAGE SERVICE TIME EXTRA PERSON
' FINISH FINISH FINISH
'I
START START START •
TOTAL
TOTAL TOTAL
1 IOR DRIVER �
STATE UC. No. VD41 LE 1.0. NO.
SPECIAL EQUIPMENT
I ❑ SLING/HOIST TOW ❑ FLAT TIRE ❑ SINGLE LINE WINCHING
WHEEL LIFT C3 OUT LINE WINCHING OUT OF GAS ❑ SNATCH BLOCKS
! ❑ FLAT BED/RAMP ❑ WRECK
❑ SCOTCH BLOCKS
❑ START ❑ RECOVERY ❑ DOLLY
❑ LOCKOUT ❑ ❑
I VEHICLE TOWED TO
1
I REMARKS MILEAGE CHARG
i
TOWING CHARGE
LABOR CHARGE I
STORAGE CHARGE I
opowroRrs s+w.ATuRE IOTA
AUTHORIZED SIG"TURE
24670 road
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TO WHOM IT MAY CONCERN
ON JANUARY 3, 1992 AT APPROXIMATELY 6:30 P.M. I MADE A LEFT
HAND TURN OFF,TUSTIN RANCH ROAD ONTO LA COLINA DRIVE. AT THE
CORNER OF LA COLINA AND RANCHWOOD THERE IS A DOUBLE DIP.
THERE IS NO WARNING SIGNS POSTED ON LA COLINA FOR THESE DIPS.
THERE ARE WARNING SIGNS GOING EAST ON LA COLINA DRIVE TOWARDS
TUSTIN RANCH ROAD. WITH NO WARNING, THL,S CAUSED ME TO STRIKE
THE BOTTOM OF MY*CAR VERY HARD ON THE ROADS SURFACE, ALMOST
CAUSING ME TO LOSE CONTROL OF MY CAR. I THEN HEARD A LOUD
NOISE COMING FROM MY CAR. ALSO I WAS ABLE TO SEE A LARGE
AMOUNT OF OIL COMING FROM MY CAR. I MANAGED TO MAKE IT TO
THE NEAREST SERVICE STATION TO CALL MY PARENTS AND CALL FOR
A TOW TRUCK
DATE
A
County of Orvnye:
MAIL COMPLETED FORM TO:
CLAIM FOR MONEY OR DAMAGES
(File Original)
Clerk of the Board of Supervisors
Robert E. Thomas Hall of Admin. Bldg.
10 Civic Center Plaza, Room 465
Santa Ana, CA 92702
NAME OF CLAIMANT:
SEND REPLY TO:
DONALD D. TURNER
(Phone #)
r
DONALD D. TURNER
ADDRESS OF CLAIMANT:
DATE OF BIRTH:
BOOKING NUMBER
(If Applicable)
Exact date and time damage or injury occurred:
JANUARY 3, 1992 approximatel 6:30 P.M.
Exact place where damage or injury occurred:
LA COLINA DRIVE & RANCHWOOD, TUSTIN
What.particular ACT or OMISSION on,the part of the -County or County
Employees •cai.lsed the injury or damage: (Give exact and full details)
FAILURE TO POST WARNING SIGNS-FOR-DOUSLE DIP.
FAILURE TO POST REDUCE SPEED DUE TO DOUBLE DIP
AT LA COLINA DRIVE AND RANCHWOOD, TUSTIN
What damage or injuries do you claim resulted?
1. Rnptured oil pan
2. Cracked rack & pinon core
3. Broken tail pipe
(OVER)
What amount do you -,,aim for each item of injury or _ .gage?
(Show basis of computation of the amount claimed, such as the date an item
was purchased, amount of medical bills, etc.)
i / _ .3 7(:p __<3 ap c e-,. 2
0 /1 � a � /- 4/ _ ice. 4Y 2<, 21 r� o ele e-
0
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G[��Pf f ^�7 /p2 �3S/ �/ ouUot<<'� 'j�/ 77 eN
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74-gtZAAA: 67
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� `-s ot`�`w{i tnesses, doctors, and hospitals:
a' ��SV
Ms. JANET ROGERS
I swear or affirm that the above information is true and correct under
penalty of perjury.
Executed at
(Address) (City)
this
kg24
day of JANUARY
NOTICE
, 1992.
C aimant
Section 7Z of the Peiia l Code provides:
"Every person who, with intent to defraud,
presents for allowance or for payment to any state
board or officer, or to any county, city, or
district board or officer, authorized to allow or
pay the same if genuine, any false or fraudulent
claim, bill, account, voucher, or writing, is
punishable either by imprisonment in the county
jail or the state prison or by a fine of not
exceeding ten thousand dollars ($10,000.00)9 or by
both such imprisonment and fine."