HomeMy WebLinkAboutCC 3 CLAIM #92-54 02-01-93AG Ef�DA_� 3
CONSENT CALENDAR NO. 3
2-1-93
.TATE: JANUARY 21, 1993 Inter -Com
TO: HONORABLE MAYOR AND CITY COUNCIL
FROM: CITY ATTORNEY
SUBJECT: CLAIMANT: SUSAN JONES -DE YOUNG; CLAIM NO: 92-54; D/L: 09-05-
92; DATE FILED W/CITY: 11-19-92; CARL WARREN FILE NO: S 72900
CLB
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.
JGR: jab:012193(C1. 9254 .•jab)
Enclosure: Copy of Claim
cc: Carl Warren & Co.
Finance Director
City Manager
City of Tustin
_SM AGAINST THE CITY OF TL ,N
(For Damages to Persons or Personal Property)
he 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 INF
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:
NAME OF CLAIMAN
ADDRESS OF CLAI
CITY/ZIP CODE:
TELEPHONE NO:
DATE OF BIRTH:
SOCIAL -SECURITY
DRIVERS LICENSE
2. Name, telephone .and post office address to which claimant desires notices
to be sent (if other than above):
11G/JC-
!,{
3. This claim is submitted against:
a. The City of Tustin only.
b. The following employee(s) of the City of Tustin only:
C.
111E Vl l.i Vl 1 LLj `.►tea Gama �a►E �v�lv� �.�. � .� ..� v� � � � ,� ,. _
of Tustin only:
4. Oc--urrence or event from which the claim arises:
a. DATE: F\±4 1)% 1:)F �-- n 1'C
b. TIME:
C. PI.AACE (Exact and specific locatio - d
T—
d. HOW"and under what cf rcumstanms did damage or in- u v occur? Specify
the particular occurrence, event, act or omissicn you claim caused
the iniury or damage (Use addi ti onn 7 nanPr if )
_ - , CJ .
e. WHAT particu' action by the City,
alleged damages or injury? r
14
or employees, caused the
t �
1
S cE' •� �� E 3 �•. � .
5. Give a description of the injury, property damage or(loss sd far known at -
.the
-.the time of this claim. If there were no injuries, state "no injuries".
%\ _ ..
6. Give the name(s) of the.City employee(s) causing the damage or injury:
7 . Name and address of any other person ynj ured : ,� �: !1 C.
S. Name and address of the owner or any damaged property: � e�
9. Damages claimed:
a. Amount claimed as of the date: co (, Q; ea 3 C a T
b. Estimated amount of future costs: C
C. Total amount claimed: -a '2 , r`
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.
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 is -, c,. '19 4 at Tustin, California .
DATE FILED:
CLAIMANT'S SIGNATURE"
B1:CLFORM
Revised 4/29/91
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- TUSTiN POLICE DEPARTMENT j 1353R5 -
NOTICE TO APPEAR = •=�
"DATE TWA �K TME O AM DAY OF I
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DRfVEA"S UC;Epdw NO. STATE WITHOATE O JUVENILEJTEL I
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SEX ( ►HJR EYES HEIGHT WEIGHT PARENT/G(►AROIAN NAME - h-'• . J
VEa uC_ O. , •-� STATE
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YR OF VEK MAKE MODEL BODY STYLE COLOR;
.0 H.M. (V.C_ 353) 't
REGSTEREO OWNER OR LESSEE E AS ORfVER
ADORESS = .. ,r: _ \ 4(�'".,r... E AS DRfVER
EVIDE"CE OF FINANCIAL RESPONSIBILITY O VALID O NONE O NO POOOF
ELCAkE FOR DISMISSAL (V•G- 406101 -_— _ _. b BOOKING REOUV4q,
Y� NO .::. VIOLATION(S) - CODE r� DESCRIPTION
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SPC -E: APossOX. I P f•/MAXJPOSTEDSAFE; RADAR DONT FORM N
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LOCA TON OF VIOLATION(S) •, ( - ACCIO[+r_ �E •++-
AT 0
WEAT-EF . - - ---SURFAC-- TRAFf1Z •• = ) LIGHT �+.,
CL-^,- C--c'—I:Q RN CX (Oaq, WE- I LIGHT MEO HEAV1 I OAWK DAv - DUSK NIGHT
�O�ERSS51 NOT COMMITTED W MY PRESENCE CERTIFIED ON INFORMATION AND BELIEF
• . CIEC.ArrE tsCE F •!MALTY D r t/OE11 TIE LAWS 00'?-* STAB OF CJLLOKWO a THAT T.4 FOAOOoO O TMA A&C CO�EC'f
DA _ / LssuING OFFICER(S) BADGE NO.(S) ••,, VAC. DATES
iii I �••� !'•! : 2 / � % .' V ,, ' . .r.i1►w'.:
NAM_ OF ARRESTING O*TiCERIINDIVIDUAL IF DIFFERENT FROM ABOVE BADGE NO•(S)
AL1 JUVENILES MUST APPEAR WITH PARENT/GUARDIAN _
Wrfl•OUT ADarfTT -LT. 1 PROMISE TO APPEAR AT THE TIME AND PLACE INDICATED BELOW •
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_ JUVE WLEE a,* r.o.nw to aPPOW at 301 Cry Erma Souan Cww". Juan..• L•ourt, rnan
."WIM an 0.40 ~.c.
APP.^..AR OPV` »•C C1 TIME 5z .i_- r M
i OF YOV MAY APPEAR aPRIOR TO YOUR COURT APPEARANCE DATE,
a- NtGMT COURT ON TUESDAY AT 4:x. PA,
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FOaM AY^raOVED BY THE JUDICIAL COUNM OF CALIFORNIA - SEE REVERSE c' -r
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2818 Sou'th lialla day Street -Santa Ana, 92705-
(714) 668-9766
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18812
DATE IN DATE OUTR G.- OWNER OR AGENT==
STREET
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UNDERSIGNED Do HEREBY CERTIFY THAT I AM LASOP
LEGALLY AUTHORIZEC AND ENTITLED TO TAKE POSSES
SOON OF THE VEHICLE CESCRjeEO ABOVE AND ALL PER DOLLY
ADV
PAYOUT
TOTAL 4
/ _
NOT RESPONSIBLE FOR DAMAGE TO VEHICLE
Fes
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A VISO-.
_ TRANSACTION RECORD
RENTAL NUMBER -w CAR NUMBER CAR GROUP
425560.74_4627,136�;';y }--
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CV CX4050189047815
OUT SNA 05SEP92/1634
IN SNA 08SEP9Z/ 1653
MI -OUT 5087 -MI -IN 5260
173 MI@ .00= -
- HR@ 14.97=
T 3 DY@ 44.90= 134.70
WK@ 314.30=
ONE WAY FEE/MISC=
�-NE T—T I ME -/MIL -- _ 134.70 -----
...REFUELING CHG = 32.17
TAXABLE SUBTOT = 166.87
TAX 7.750! = 12.93
LDW r
PAi/PEP/ALI =
AMOUNT DUB = 179.80
Ams features GM can.
C&dd1aC Sedan de Ville.
har&r,°
Your Avis transaction is now complete.
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RENTAL NUMBER -w CAR NUMBER CAR GROUP
425560.74_4627,136�;';y }--
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SUSAN
`'•
ES DEYOUNG-:. •.= ...
CV CX4050189047815
OUT SNA 05SEP92/1634
IN SNA 08SEP9Z/ 1653
MI -OUT 5087 -MI -IN 5260
173 MI@ .00= -
- HR@ 14.97=
T 3 DY@ 44.90= 134.70
WK@ 314.30=
ONE WAY FEE/MISC=
�-NE T—T I ME -/MIL -- _ 134.70 -----
...REFUELING CHG = 32.17
TAXABLE SUBTOT = 166.87
TAX 7.750! = 12.93
LDW r
PAi/PEP/ALI =
AMOUNT DUB = 179.80
Ams features GM can.
C&dd1aC Sedan de Ville.
har&r,°
Your Avis transaction is now complete.
Have a safe trip to your destination.
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_ TRANSACTION RECORD
RENTAL NUMBER -w CAR NUMBER CAR GROUP
425560.74_4627,136�;';y }--
!-
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SUSAN
`'•
ES DEYOUNG-:. •.= ...
CV CX4050189047815
OUT SNA 05SEP92/1634
IN SNA 08SEP9Z/ 1653
MI -OUT 5087 -MI -IN 5260
173 MI@ .00= -
- HR@ 14.97=
T 3 DY@ 44.90= 134.70
WK@ 314.30=
ONE WAY FEE/MISC=
�-NE T—T I ME -/MIL -- _ 134.70 -----
...REFUELING CHG = 32.17
TAXABLE SUBTOT = 166.87
TAX 7.750! = 12.93
LDW r
PAi/PEP/ALI =
AMOUNT DUB = 179.80
Ams features GM can.
C&dd1aC Sedan de Ville.
har&r,°
Your Avis transaction is now complete.
Have a safe trip to your destination.
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THIS IS YOUR CONTRACT
�.
READ TERMS CAREFULLY
•OMER'S MEMO
M x•' r� FOR BILLING INOUIRIES: 800-352.7900 O 5 1 1 jo Li
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SEND INOUIRIES TO: AVIS RENT A CAR SYSTEM, INC, A L /i+ / 0 �:� r i 9 2 L V
� R:. 4 1r�+�! (1j ' '• w� S U S A N J l J j -•+i , :.
JL'NP: WA'M',;E AF'CI
SANTA AtdA GA 9'•TCl7 U^.
t _ .+ 161 DRIVER'S LICENSE NUMBER
_:.,.�. (� kEN_TAL
A G R E E M E N t(31 RENTING LOC. (4) MVA NUMBER (S) OWN. LOT. 1 (7) RETURN LDWION 6
4455607 01 i_1 4 Gc 7 3 �G
rw •:. '= '; ^ (9) VEHICLE DESCRIPTION (10) LICENSE NUMBER III)AGREED RETURN LOCATION)N DAEIIME LOCATION(12) RETURN .
WH I CHEV LUM I 4DR -JOHN t+dAYNE AF'Q pP, C�?SEF'u� � 1?pp'"
-' __ (13) IMPRINT AREA (24A) AUTHORIZATION NO. OUT IAMOUNT (248) AUTHORIZATION NO INIAMOUNT
51 155 L
MILEAGE DETERMINED BY READING (25) ?IME-USED
..•�' r/,� i.''> >./.: 1 U , . , _ :' ',�, WIDRY INSTALLED 0000.OET7 y+-
- �_ 'j y.r i%ar.. -� � 1►ii .h:u.._:. r1 �:. 1...ln�+ ' •i.ii:i.__ �'i. '` {261 �^ :{.r... (27i DATEJ TIME IN ..- _ v.r ►:
Q eR w+ '.M",�+��>ii1ll Jk 7 t•w a MLSIKt,I$ i .?'1t •�,.!11 1 + 1': :n N 1(\:('+ !IF
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t - .. te' Ms..
:n.. " �, DATE/TIME OUTy.
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(outr;�1fb08 �Irez: �e u: 05 SEP9L'f,i:6341.
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DRIVEN _ t
RATE Cts W RA K 1 DON'T COMPLY WITH ALL RULES" A SPECIAL RATE. T FIAT FREE MLSIKMS • •...• . (;I) ADDS. MRS
"' s c • (141 L I- E U ;j TE IS VOID AN 1 WILL PAY A HIGHER RATI WHICH MAY U N L A s_ - �' �� �t� •1 ' i.� K
LLIDF MI AR Y ES
A DISC, ADO'L. HOURS DAILY RATE WEEKLY RATE AOO'L. DAYS MLSIKMS
- - I 1321 DAYS +
,;. 14 '� 44 . y C' 1 4 . 3 r1 SNL i
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:;-aie-.: ,1 •'' :I 1 DAY
MIN (33) WEEKS @ ,. _ + _
�_. is ) ap
•: °•�� �'":c (15) COUPON NUMBER 1(34) + lli
A REFUELING SERVICE CHARGE WILL BE APPLIED IF 1 CHOOSE TO RETURN THE CAR
- WITH LESS FUEL THAN WHEN RENTED. AS EXPLAINED ON REVERSE SIDE.
FUEL FUEL (16A) REFUELING SERVICE CHC,. 168) REFUELING SERVIC HU. (3S1 + (`
OUT IN I PER MILE I ' I E-. PER GAL 2.. E. i1
117) AP01TIONAL
. t'r INEORMATIO (36) _ _
f :!kit C t . ADJUST
gyp' (18) AWD NUMBER (19) FREQUENT FLYER NO. /REMARKS (38) ARC IIATA NOL _ /jNSUB TOTAL
terra.''' , - �. _ .. ',•1- •,�Y_ �.. -.i 1 ^ ' AUL (30) THRU (36) _. `' f'',•�:;il!•7
yJ (20)G.. 0 7 `• (21) (40) WlZARO NUMBER TA COM (39)DISC
n 4 0501 4 a '�.;� _ ,i
r Jt_IN DEYOUNG CUSAN - .. Y.: +� I
fit+1 D P E F: G F U R N T �` (42A) MI CHAR (411 TIME AND
U E MILEAGE CHARGE
^ems.., ": • -- _ ,
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,� — _ FUELING SVC
' • .Y- r- - •'•�,�'sC - (45A) (LDW) LOSS DAMAGE WAI1 PRE
cl-I . - - - ",
' 1 (TAXA + .
READ TERMS ON CTME%.SIDE BLE'
-.c t ArwEPT a'T aE° OA./ t 001;iA^rre• -
1151Ai(PAIS PERSONAL. A000ENTINSURA � I PEP ALL, + `_
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151CrA:IIADOITIONA: UAB! , INSUR "' TAX',
READ OTHERS D� -7.750
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Et
:53A1 DATE Of.PIFUH r'• ? c
u .1 N 1 RE
(NON-TAXA15LE,
'.. (53BI AD:.', CHARGE
1541 TIAL CHARGE I 1
(zz1 I ha"-- read and agree io the terms on both sides of this agreement. If I navy _ 1
resented a credit card for men;. all charges. including g Isn PREPA�M£hT N �• R 1=51 EX TME ROAD
Q Pic, g g parking titket� may be � EXPENSES I I
biked to the--mdit card and I signature w wit a considered to have been
de On jhe app(icabie credi' card watt/i // THIS RENTAL 1$ ((561 NET CHARGES I 1
/ BUSINESS PERSONAL11 it
_
I PREVIJUS MVA NUMoEn (71) ML-"MJ IN (Z)M:J kq� ' MlVth tib, NA v. Vtn;. 156) METMOD OF PAYMENT 11591 AMOUNT DUE
I , �XCHANGES ,
` (741 LASXEXCHANGE LOCATION` PS) EXCHANGE DATEITIME }J, (76)REFUELING SAYC 16,jj EXCHANGE RATE Al _
_ + f6A DUE CHE; KIN I 1
_ o _• CX1w I _
r t (77) ORIGINAL RENTAL LOC IBl) C7IHEA EXPENSE DEDU�, A.
- to �(7c) EXTENDED TO I (79) AGENT ID I (80! OATS I
.. tv I ! - FI1ZC1ECK•IN •62) SSM PFFUI�• EOUIY .- + i .. , _�•"
RENT'TYY CURF •1 w ,
; IIW: AZIUAI RETURN LOCATION I(641 RENTING.jwEN IO 1 (651 RET AGENT ID 166; Com.+ REFUND RECEIVED (167) J.°c`U++pREGD ( :� t'• ,.;:': ' '
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2818 South Halladay Street • Santa Ana. CA 92705_
= (714) 668-9766
INVOICE
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DATE IN, � -C7 � _ DATE OUT ,.//• �-
.:•�r ..
RM OWNER OR AGENT
_ - _s • - PHONE-
COLOR
�•♦a^ - a.
PAYOUT '
TOTAL
.�.� smart0 .- — .. :I •J -
{'"' NOT RESPONSIBLE FOR DAMAGE TO VEHICLE
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1318 S. FALLPr+pi STF, T" • ��'
E41TA Ate, CA X35
- 7.14 668
9766
E."140104101720
-ITEM: 248 SAE
ACCT: 48581M7815 1192
REP: _ ALrrWTKT W146
I AG= TO PA'r TiE� AME
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Fy cor;t AGAIN'
147
` STATE OF CAUFOANIA—BUSINESS, TRANSPOK.—t ION AND HOUSING AGENCY
. DEPARTMENT OF MOTOR VEHICLES
' ...-a1• F`��.... l�'�'i tib'" w . I_
y;; ,.' • (916) .. 6 5 7-6 6 7.7 . PLEASE ADDRESS CORRESPOtlGEfr-E T,
l Tom" ,tea• •. _-_ �_ ~'
"' '�! :,e„���Vj :.'.•_ r r DIV. OF HEADQUARTERS CPERATZOtZ
ORDER OF SUSPENSION ; P. 0. Box 94''8/34
• ►. i mow. ^ `
SACRAMENTO, CA. 94284-0001
«�= �;•. ""' PLEASE SHOW T
-r-.;r«'I'�•� "�"''"c i HESE tJL"•>f3ER5 ON •YL
Y�:• CORRESPONDENCE
`!�.�'�%•••� JAMES ALLEN DEYOUNG
DRIVERS LICENSE N0.
- CASE N0. 92-03-60249
. � ��h�ss�s-• _ tai..'; �'
�z THE`DEPARTMENT HAS RECEIVED INFORMATION THAT YOU WERE THE DRIVER OR OWNER OF'A VEHICLE Fir'
•'•" ,INVOLVED IN . AN ACCIDENT THAT RESULTED IN -DAMAGES OVER $500 AND/OR RESULTED IN AN INJURY
•.:�-'.OR -DEATH. '
DATE JUL 24, 1992 LOCATION (IN OR NEAR): LONG BEACH
"J-OURRECORDS INDICATE YOU HAVE NOT FILED A DMV REPORT -OF TRAFFIC ACCIDENT OR PROVIDED
EVIDENCE OF LIABILITY COVERAGE FOR THE VEHICLE INVOLVED IN THE ACCIDENT AS REQUIRED BY
* VEHICLE CODE SECTIONS 16004(A) AND -16070.
FAILURE TO REPORT AND PROVIDE EVIDENCE OF FINANCIAL RESPONSIBILITY WILL RESULT IN THE
-SUSPENSION OF YOUR. DRIVING PRIVILEGE EFFECTIVE AUG 29, 1992. THE SUSPENSION 14ILL NOT
'•'-AFFECT YOUR PRIVILEGE TO DRIVE VEHICLES OWNED BY YOUR EMPLOYER DURING THE COURSE OF YOUR
EMPLOYMENT.
-�-
`-TF YOU WERE INSURED= CALL US TOLL FREE AT (800) 521-4368 FROM 7:00 A.M. — 9:00 P.M.,
MON. — FRI., OR COMPLETE AND RETURN THE ENCLOSED INSURANCE INFORMATION FORM SR1A(E). UPOIJ
.= RECEIPT OF ACCEPTABLE INSURANCE INFORMATION, THE PENDING SUSPENSION WILL BE CANCELLED.
�' ''=• IF YOU WERE NOT INSURED: YOU MAY QUALIFY TO APPLY FOR A RESTRICTED LICENSE DUPING THE
FIRST YEAR OF SUSPENSION (SEE ENCLOSED RESTRICTED LICENSE INFORMATION AND PROOF FILI14G
INSTRUCTIONS), OR YOU CAN REMAIN SUSPE14DED FOR ONE YEAR. AFTER AUG 29, 1993, YOUR DRIVING
PRIVILEGE MAY BE FULLY RESTORED BY FILING AND MAINTAINING PROOF WITH THE DEPARTMENT
THROUGH AUG 28, 1996.
YOU MAY REQUEST A HEAPING TO SHOW YOU WERE NOT THE DRIVER. OR OWNER. OF THE VEHICLE INVOLVE%
IN THE ACCIDENT OR THAT THERE WAS NO DAMAGE OVER $500 TO ANY SINGLE PROPERTY AND 140
INJURIES OR DEATHS. TO RECEIVE A HEARING, YOU MUST COMPLETE AND RETURN FORM FR:, PART A
AND B, BEFORE THE SUSPENSION EFFECTIVE DATE.
:IF YOU FEEL THIS NOTICE IS IN ERROR, PLEA SE CALL (916) 657-6677 OR WP,:TE TO THE ABOVE
..Q.•� �•„ • mar •"f �^—.i:� � ..- -
�'`"`•DATED AUG 14, 1991DEPARTMENT OF MOTOR V'HI..ES
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ENCLOSURES
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