HomeMy WebLinkAboutCC 4 CLAIM #92-47 02-01-93CONSENT CALENDAR NO. 4
`E N 2-1-93
.1 AT E:JANUARY 20, 1993 Inte r -Com %- �-11
V `•� V.
TO: HONORABLE MAYOR AND CITY COUNCIL
FROM: CITY ATTORNEY
SUBJECT: CLAIMANT: ROBBIN NILI; CLAIM NO: 92-47; D/L: 08-06-92 • DATE
FILED W/CITY: 10-20-92; CARL WARREN FILE NO: S 72845 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.
JAMES ROURKE, City Attorney
JGR. jab:012093(CL-9247. jab)
Enclosure: Copy of Claim
CC: Carl Warren & Co.
Finance Director
City Manager
. 1 0. 20. 9 2 1 1 9 AM _*S o .a c T h r i -f t & LO c n O 1
INFORMATION FACSIMILE....
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DATE'•,
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TO: i
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rocolnille Number: i }
SOUT11=1 PACIFIC THRIFT LOA11
FROM: •
OFFICE:
vARDE11 CROVE BRANCH: f�
Telept10ne Nurnber: (
716 Dyl,-73B�i
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�� �luitiUer: 7 14� a92 -73G4 .
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F-TOTAILPAGES INCLUDING COVER SHEET:
It eatlrelronsinisslon is not received, Please Cali:
Pa&,r, '/' phone: ( 714 ) 8
1 0 20. 92 1 1- �� AM �So.Pa c Th r i t & Loa n P 0 2
City of Tustin
CLAIX AaAJW2T TSM CITY OP TUB --N
spar Damages to persons or Personal Property)
The law provides generally that a claim must be =iled dent with
the CityoccuClerk of
Be
the City of Tustin n o s after the incl •sblia antit
sure your claim is against the City ofTustin,eiti nal not opaperther p and identify
where space is insufficient, please u
infoz'mation by paragraph number. Completed claims .must be mailed or
delivered to the City Clerk, City of Tustin, 15222 Del Amo Avenue, Tustin,
California 92680
XgEN COXPLETING THIS FORMi PL$ASE TYPE OR IIBE -BLACK THE
TO THE HONORABI.$ MAYOR ANd CITY COUNCIL, City of Tustin, California:
The undersigned respectfully submits the following claim and information
relatives to damage to person and/or property:
1.
a.
NAME OF CLAIM&
b.
ADDRESS OF CLX
c.
CITY/ZIP CODE:
d.
TELEPHONE NO:
e.
DATE OF BIRTH:
f.
SOCIAL SECURIT
g. DRIVERS LICENS
.
2. Name,telephone and post office address to which claimant desires notices
P
to be sent (if other than above):
1P. Wn i r� ar a d
3. This claim is submitted against:
a. .�~" The City of Tustin only.
be The following employee(s) of the City of Tustin only:
c.
The City of Tustin and the following employQa(s) of the City
of Tustin only:
4. Occurrence or event from which the claim a ices:
a . DATE: u
b . TIME: r+. °`,�•,`' _ �_
C. PLACE (Exact and specific location) : /I=l
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 aper inecessary) • f �
✓ 16k#A..
1 0. 20. 2 I,
1 I.M.Pa Th r i •` ' & Loan _ u3
amployees, caused the
•e. WHAT particular action by the C y,
alleged damage or in ury?
propertydamage or lose so tar known at
s. Give a description a thai nthere werninjuries, state "no injuries%,
the time c}f th s cls
r ► w r• ►"
6. Give the name(8) of the City employee(a) causing the damage or injurys
IV C
7. Name and address of any other person injured:
and addr ss of the owner or any damagad pro
s . Name perty:AA V,
A '
.0 •i /.0 �'
Q P Jr ,
ni li. . r
eloo"I
9. Damages claimed: 4K, a
A. Amount claimed as of the date: Q'
b. Estimated amount of future cost$:
c. Total amount claimed:
d. Attach basis for computation of amounts cla mad (include copies of
all bills, invoices, estimates, etc.
10.ames and addresses of all witnesses, h'.
oe itals�, •doctors, etc.
WARNING: IT I3 A CRIMINAL OFFENSE TO FILE A FALSE CLAM!1
(Penal Code Section 72; Insurance Code Section 556.0)
I have read the matters and statements made in the above
hers tat dote be
he
same'to be true of my awn knowledge, except as to these m
upon information or belief and as to such matters I believe the same to t,e
true. I certify under penalty or perjury that the foregoing is TRUE AND
CORRECT.
Executed this 11 - day of
,19l, at Tustin, California .
DATE FILED:
i
81:CLFORM
Revised 4/29/91
.' O. 20. 52 1 - A
` •Ciz Ia.t 19AM SMI, T SONS GLAM
Pon" 31150
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CARBO. _
REQUIRED
PROPOSAL
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PROPOSAL
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%W*t* To w ohm +e.- Med vs
Oats of Plans
city
Wa tWWM y propckas to /urrwr h tl�r-mater;-Is and aw fOl 11 %tM a_WC nscssaory far w oorrVNtwn Of
An fneww4W Is guaranteed to be we NPOOMML and the above work Vo be vw ft in - - - X dw vAth the dra w ngs and i
gper-lfl ptlons submitted for above wopk and completed in a substantial wcl-kmanlita sruAnsr- toy the sum at
%-
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with paymerus to be nada as *Xkr*4m: 4044
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wr.ir atirr+ra�s � er.�• 4orw eds�s �oMlaRio.e� r+LsMr� edrr� �%�i'/•-.
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�a C2=w o%vw and aro.. sw...s:r...o. wN
aver 40000,40000,48r oerarrwrLta aoe.s:nor+c
Loan srs "m6ft'• s• WMW aw �i 0-- o ear" are.ummme/ Orel oasrr e�ov �raiv awi0r Lo - a"— eOrrk- Wars-
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A EFTANCE OF PFK3P 15AL
The above prices. epecifiostow and pprLdltKw%= are satisfactory and arc h.raby acCAMS - You ere sutharlsd to do the work ss spoGifled.
Rsyrnner%t will be Rude ss nm+tLned atsr+e.
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