HomeMy WebLinkAboutC.C. 04 CLAIM 92-1 02-03-92NDAa-J .v
A T_t: : JANUARY 21, 1991
TO: HONORABLE MAYOR AND CITY COUNCIL
FROM: CITY ATTORNEY
CONSENT CALENDAR NO. 4
2-3-92
I
Si�u►,�C�:
CLAIMANT: R.T. HARNEY;
D/L:
10-27-91; DATE
FILED W/CITY: 01-
02-92; CLAIM NO: 92-1;
CARL
WARREN FILE NO:
S 66887
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. _00 --AA 10
JAMES JAMES�RKE, City Attorney
Enclosure: Copy of Claim
cc: Carl Warren & Co.
Finance Director
City Manager
City of Tustin
IM AGAINST THE CITY OF TL N
(For Damages to Persons or Personal Property)
of
ovides enerally that a claim must be filed with the vent occurredrk Be
he law pr gdent or
she City of Tustin within 6 months after the
not another public entity.
sure your claim is against the City of Tustin ,
Where space is insufficient, please use additional paper be dmidentify ed o
information by paragraph number. Completed claims m
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 HON
ORABLE MAYOR AND CITY COUNCIL, City of Tustin, California:
ed respecsubmits the following claim and information
The undersign P
relative to damage to person and/or property:
NAME OF CLAIMANT.
ADDRESS OF CLAIMANT : �'
CITY/ZIP -CODE:
TELEPHONE NO:
DATE OF BIRTH:
SOCIAL SECURITY NO:
DRIVERS LICENSE NO:
2. Name, telephone and post office address to which claimant desires notices
to be sent (if other than above):
is submitted against:
The City of Tustin only.
The following employee(s) of the City of Tustin only:
The Cit of Tustin and the following emplovee(s) of the City
of Tustin only:
4. Occurrence or event from which the claim arises:
a. DATE: 7 «9 l
b. TIME: u i mo=o.
C. PLACE (Exact an.specific location) :
?Specify
d. HOW and under what circumstances did damage or injury you claim caused
the particular occurrence, event, act or omissi
the injury or damage (Use additional paper if necessary):
e. WHAT p articula action by the City, or employees, caused the
al l.eged damage injury?
• of the in • ury, property damage or loss so far knownat
5. Give a description � injuries, state no injuries".
the time of this claim. If there were no inj
• of the Cit employee(s) causing the damage or injury:
6. Giv the name(s) Y
7. Name and address of any other person injured:
: �1
s. Name and address of the owner or any damaged property:
C. �-i'tL.hf-11'-41vir
a es claimed: 44(.
�. lam g l7
a. Amount claimed as of the date: — 1
b. Estimated amount of future costs: L� 7
C. Total amount claimed:
d. Attach basis for computation of amounts claimed (include copies of
all bills, invoices, estimates, etc.
0. Names and addresses of all witnesses, hospitals, -doctors, etc.
1 �-
WARNING: IT IS A CRIMINAL OFFENSE TO FILE A FAe E CLAIM!!ction .0)
(Penal Code Section 72; Insurance Cod
ad the matters and statements made in the above claims and I know the
ed be
I have re except as to those matte
same to be true of my own knowledge, p
information or belief and as to such matters I believe thesame
to
oAbe
upon inform that the foregoing
true. ": I ND
certify under penalty or perjury
CORRECT. Dz�zen
Executed this
�� day of ,19 1 at Tustin, California.
DATE FILED: q
CLAIMANT'S SIGNATURE
B1:CLFORM
Revised 4/29/91
This at��chmn� relates to o�
+or� to w�ic� it �s aZiac�e�'
�7 1991 at C,
C..
�n the eof October ��' � n La Colina Dr at aoo�t 3^''
while dr�ving worr wes o , ine struc|thm pa,em*�nt
n�les per �ou� t�e bottom cf the car s eng
int�rss�tion witn R�nchwncd �d.
This mishap resulied �rom the following aciions or omisszons on
oa/t of Uhe C�cy of Tustin�
1. Poor �ighway design ol the intersection of
La Co�ina Dr. and Ranc�wood Rd'
2' uo pcs�e� sign warnir'g of the extremely sharp
djp .^7 the intersection with �anchwood Rd^
3. �o sp�ed limit sign on La Colina approaching Ranchwood.
4. No street lights at the intersection of La Colina and
RON. nchwood.
1 --owed to a repair shop for
Itwas necessary to ha«e the cat -h i estimates that
interim repairs to make it operable. The mec an �
a new engine �lock is needed to restore the car to its
pre -accident condition (see attached invoices).
/riL LOOL6 w3 Vd3WVW 'Cn3n3 5 OOL SVW-10.4Y19'03d5 iu3/cd N3 4313H
CD
N
d
i.
d
r
U
>
N Of
J N
Lo
an.
as
c
r
�d
i
,:
Acc
a
EazOzu
y
m
¢
C
w
i,• .sig
�+^:
N C
W r)
UAC
Sao
aC ap
W (��
w`
Y
ci
J
m
4'!
� 1!i
w
4 '
�, YI
" a
V `
— g
E N
1 � I
o °> 0 -
CD
d � d
aCL o
o E ro
1 3`0
gD
rE O Vl N
M w = y
> a Z R
¢6 p 0
0 CC
U) 0 cc X
H d o D 700
T CL S
a Qc U)
U iA Q ❑
.� h ;
8 -Sot t 8 N
V ! �
O, O � r
T
N
— O
cl
i A
J ccF—
fp
F- SL N 02
LL:
ui
W W m OU U' Ci C` �—
.-_
dW Go
8 : L i.- -.S: - - - '.
> U ag3s \J
.� -oQa ti
LL, m C13
Ali._`- - �•.n_ C w o o j
�44 ED
It ca 11IM-4
cc C V J `
vi w
SINU
ac
co
w
c cc
- 'p Y.
Q i g YSt
�►i '
M.
'►'�_ r _ Q
<.0
si3`�Y' Q
_Z.T.-
Yc
g
lj
N
d
d
r
U
>
N Of
J N
lj
Y
34183
KEEP THIS SUP FOR REFERENLt `
Tc sacs