HomeMy WebLinkAbout13 CLAIM NO. 96-33 09-16-96 LAW OFFICES OF
~VOODRUFF, SPRADLIN & SMA.
AG E NCD A
MEMORANDUM
NO. 13
9-16-96
TO:
Honorable Mayor and Members of the City Council
City of Tustin
FROM: City Attorney
DATE:
RE'
September 11, 1996
Claim of David Keen; Claim No. 96-33
RECOMMENDATION:
After investigation and review, it is recommended that the City Council deny the
claim and direct the City Clerk to give appropriate notice to the claimant and the claimant's
attorneys.
DISCUSSION:
This claim alleges property damage in the amount of $2,689.32. The claimant states
that the two left wheels of his car rolled over a manhole whose cover was ajar. According
to the claimant this resulted in damages to the rims, tires and axel of the vehicle. Our
preliminary investigation reveals no liability on the part of the City.
Enclosures
cc: William A. Huston, City Manager
Ronald Nault, Finance Director
1102-9635
35045_1
~ City of Tustin
CA ~M AGAINST THE CITY OF TU~_~N
(For Damages to Per~ons 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, 300 Centennial Way, Tustin,
California 92680'
WItEN COMPLETING THIS FORM, PLEASE TYPE OR USE BLACK INK
TO THE HONORABLF. MAYOR AND CITY .COUN'CIL, .City of Tustin, California:
The undersigned respectfully submits the following claim and information
relative' to damage to person and/or property:
b. ADDRESS OF CLAIMANT:
c. CITY/ZIP CODE: .
d. TELEPHONE NO: ~ ~---~,,¢~
e. DATE OF BIRTH: _ ~--
f. SOCIAL SECLrRITY NO: _
g. DRI~ LICENSE NO: _
2. Name, telephone and post office address to which claimant-desires notices
to be _sent (if other than above):
,
3. This claim is submitted against:
a. ' P/ The City of Tustin only.
b. The following employee(s) of the City of Tustin only:
Ce
The City of Tustin and the following employee(s) of the City
of Tustin' only:
e
Occurrence or event from which the claim ar's ' ~ . 1 es.
D. TiKE:
.c. PL~.CE · , _
..... ances d~d damage or
~e particular occu~ ............
~=..~=, =ven~, act or omission you claim 'caused
~e. ~nju~ o~ dam~ge'(Use additional paper if necessa~)- ·
e... WHAT particular iion by the city, or it
all~edtdamage c /_~njury?
~~~, ~. {
nployees, caused the
5. Give a description of the injury, property damage or loss so far known at
th,~e ti,m~-of, th~ claim, IfDther~ were no iDjuries, state "no injuries".
>-~" , ~,~~ !,'~ & ~K-. ~.~ ~'. ~ .r'_~_~ ~.~
~ ~ ~~ ~vo,'~,~. C ~o. d,~~,~.D' z
6. Give ~~ame (s, ~f the City employee(s, causing the damage or inju~:
7. Name and address of any other person injured:
8. Name~nd address of th? owner, or any damaged property-
.
9 Damages claimed:
a. 'Amount claimed as of the date:
b. Estimated amount of future costs: _
c. Total amount claimed: '~--~? ~F~o ~Z-
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
Z ld. w31 ,~'.. ~3:'1~ ~,,'1,"~ ' ~ ' '
· . ~,~.,,, '1~ ,~1 ~,~ ~z 70S-
WARNING: IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM! !
(Penal Code Section 72; Insurance Code Section 556.0)
etc. '-
[ have read the matters and statements made in the above claim and I know the
;ame to be true of my own knowledge, except as to those matters stated to be
~pon information or belief and ~s to such matters I believe the same to be
;rue. I certify under penalty or perjury that the foregoing is TRUE AND
2ORRECT.
~xecuted this
day of ,19
. , at Tustin, California.
FILED:
1: CLFORM
evised 4/29/91
Valerie Crabill ' '. -
Chief Deputy Cil7 Clerk-.-. '
· ,
City Of Tustin
·
!
300 Centennial Way Tustin, CA 92680
(714) 573-3025 FAX (714) 832-0825
, .----
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LOCAL ADDRES~ '.. - ' ~""~
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SOCtAL SECt, iRCFy · J EMPLOYER -- ' *" ° ' ' I
BILL ~ COUPANy r,,'...~ .~ '7 ; . , . ,
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PERSONA~.
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ADDITIONAL DI::~.,F~ NONE PERMi-i'iI~D WITHOUT ENTERPRISE'~-APPROVAL ,
/-~ . ~ATE - E~. I
i;'fw~ / ...... .'L_P,_ ....... ,o ~ " *'. ' I ."FAX ' ?..'75 I.
~RMI~;~IO'N GRANTED FIca ~ I ~.: '
VEHICLE TO LEAVE THE STATE.
... CHARGES
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DEPOSITS
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REFUNDS ·
6/!8/96 ": . J
·
· -.
694~-~
'i-fP~ DATE PD. AUTH ·
"-"1:--"'.'?~' H£ AUTH 6.'"!8 .h!
·
CHARGE
RESPONSIBLE FOR AND
)RIZES CHARGES TO THEIR
T CARD OR DEBIT CARD FOR '
lC VIOLATIONS AND HANDUNG
AND ANY CHARGES NOT PAID
~URANCE COMPANIES, BODY
;, AUTO DEALERSHIPS AND
-111=11'3 P A R'i'l~e
RECEIPT FOR CASH REFUND
DATE ' AMOUNT
· RECEIVED
BY X
.. ~.~!~,~"-~:..CLAIM INFO~MATI0N ..--.-i'::.
ADDmONAL INFORMATION:
· _ . _~,o. : .' ,-,D'
INVOICE