HomeMy WebLinkAboutCC 3 CLAIM #92-51 01-19-93CONSENT CALENDAR NO. 3
A G E N DA 1-157,3 1-19-93
:SATE: JANUARY 4, 1993 Inter -Com
TO: HONORABLE MAYOR AND CITY COUNCIL
FROM: CITY ATTORNEY
SUBJECT: CLAIMANT: GARY GREEN; CLAIM NO: 92-51; D/L: 6-2-92; DATE FILED
W/CITY: 11-2-92; CARL WARREN FILE NO: S 72882 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. ��p „
JA*W M"ROURKE, City Attorney
]GR:jab:123092(CL-9251.jab)
Enclosure: Copy of Claim
cc: Carl Warren & Co.
Finance Director
City Manager
City of Tustin
i AGAINST THE CITY OF TUr
(For Dal.._ges to Persons or Personal _operty)
law provides generally that a claim must be filed with the City Clerk of
't of Tustin within 6 months after the incident or event occurred.
Be
City of Tustin, not another public entity.
sure your claim is against the City and identify
Where space is insufficient,
please use additional paper
• paragraph number. Completed claims must be mailed or
information by P g Cit of Tustin, 15222 Del Amo Avenue, Tustin,
delivered to the City Clerk, Y
California 92680
WHEN COMPLETING THIS FORM, PLEASE TYPE OR USE BLACK INR
TO THE HONORABLE MAYOR AND CITY COUNCIL, City of Tustin, California:
respectfully
submits the following claim and information
res
The undersigned P ert
relative to damage to person and/or property:
OF CLAIr.ANT: Gary A. Green
1. a • NAME
e. DATE OF BIRTH. iii566-
g. DRIVERS LICENSE NO.
and ost office address to which claimant desires notices
2. Name, telephone P
to be sent(if other than above):
Same As Above
3. This claim is submitted against:
a• XX 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 event19r�2m which the claim arises:
a. DATE:
June 2,
b. TIME:8:�. Inters.Lo e�.port Ave. and
C. PLACE (Exact and specific location).
Irvine Blvd. (Northwest corner) . Specify
d. HOW and under what circumstances did damage orinjury
juryion you claim caused
the particular occurrence, event, onal t or aper if necessary)
the injury or damage (Use adds P
A
I drove over a re en
contain any cones or mparlz
the area neede be'
WHAT
tion by the City,
or it-- employees,
caused the
e. particular
' alleged damage
injury?
'^
. The Citv's failu.c
to F
��e
}�-}�e�•
5. Give a description of
' ro
the injury, property
p P Y
no
a or loss so
damage
g
far known at
•
the timef this claim.
The driver's side of my
If there were
car was sprayed with the
inj erlsuta e ed or stri ess„
hit paint
tite
e a
o the ctrnntc ThP T]ai
my car. Please see the
nt ravp-
attached photo as o f
City emplsoye� sg
of claim.
causing the damage or injury.
6. Give the name(s) of the
7. Name and address of any other person injured:
8. Name and address of the owner or any damaged property:
9. Damages claimed: 4 80.00 _..
a. Amount claimed as of the date. — i�un ntici ated
b. Estimated amount of future costs. �80.T_ p —�
c. Total amount claimed: / ies of
d. Attach basis for computation of amounts claimed (include cop
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
a the same to be
upon information or belief and as to such matte
the believe
is TRUE AND
true. I certify under penalty or perjury h
CORRECT.
Executed this 7 day of %vim L/ " ,19=, at Tustin, California .
SATE FILED: : /i / 1e9
CLAI T'SSIGNATURE
B1:CLFORM
Revised 4/29/91
D�T�: Q9/15/9Z J�C O7�47
4�%�09�3�084�4�
TU�TIN �UT0 �PK. IHC.
�501 NICCOK RD.
J�,
CL�8K ID
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. QUHN D[CCRIPT�UH
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T A
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AUTH HO
T"'TAi
4�6�1�63310�6�67 WI��
PIHIE : GHRY
- ' G RwC . '
'-'
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. Cafe Auto
Spa
1501 Nisson Road
10:4Gam
9-15-92
CAR# 62 SLSMN# 3484
____________________
Detail Shop
80.00
TOTAL:
80. 00
. . Vi sa
____-______________--
80.00
_
. THANK
YOU
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