HomeMy WebLinkAboutCC 3 CLAIM #92-37 10-05-92A r,FIVnQ
CONSENT CALENDAR N0. 3
0-5-92
Inter -Com
DATE: SEPTEMBER 21, 1992
TO: HONORABLE MAYOR AND CITY COUNCIL
FROM: CITY ATTORNEY
SUBJECT: CLAIMANT: CLAUDIO CARVALHO; D/L: 02-11-92; DATE FILED W/CITY:
08-06-92; CLAIM NO: 92-37; CARL WARREN FILE NO: S 72725 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. �1j A Aft
JAMt0%/G401C6URKE1 City Attorney
^ JGRJab:091992(CL-9237 jab)
Enclosure: Copy of Claim
cc: Carl Warren & Co.
Finance Director
City Manager
City of Tustin
LM AGAINST THE CITY OF TII: d
(For Damages to Persons or Personal Property)
he law provides generally that a claim must be filed with the City Clerk of
she 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 INR
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:
1.
a. NAME OF CLAIMANT: CLA.UPTO Y. C ZA PI'AT,Nn
b. ADDRESS OF CLAIMANT:
C. CITY/ZIP CODE:
e. DATE OF BIRTH:
f. SOCIAL SECURITY NO:
— 2. Name, telephone and post office address to which claimant desires notices
to be sent (if other than above):
3. ThisX aim is submitted against:
a. 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 event from which the claim arises:
a. DATE: On or about Pebruary 11 , lgg
b. TIME: R-sn a rl
C. PLACE (Exact and specific location): Ion rPPt nor hw st of
Trvi nP rpn er D -rive Driveat its i ntPrsertion with JamhorPP Road _
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 paper if necessary):
Please see attached
On or about February 11, 1992 at approximately 8:50 a.m., I was traveling
northbound on Irvine Center Drive at its intersection with Jamboree Road in the
City of Tustin, California. When I just crossed the intersection about 100 feet
north of Edinger Avenue, I saw a trench which was normally filled with the dirt.
The trench was filled with water. Because of the heavy rain the dirt was soft and
loose. There was no signs, notices or warnings whatsoever about the trench or
the dangerous condition of the roadway. When I was able to see the depth of the
trench, I immediately stepped on the brakes. The car skidded to the left then it
fell on the trench hitting the bottom of the trench. The car went down to the
trench diagonally. Then the car lifted off from the trench and landed passing the
trench. I felt that all four wheels were in the air. The engine died immediately
and I maneuvered to stop the car on the muddy soft shoulder on the left side of
the road. At the same time, the City workers had just arrived there. One of the
City workers from the City truck bearing plate license number came
and helped me to find the emergency shut-off switch for the gas. Immediately
following this incident, my car started to make noise on the front right wheel
which was the one of the first wheels that went down on the trench.
• e. WHAT particul action by the City, or employees, caused the
alleged damage injury?
The City jailed to out any tunes of warninc-s or notices of the
dangerous condition of the roadway
-
5. Give a description of the injury, property damage or loss so far known at
the time of this claim. If there were no injuries, state "no injuries".
"No cl n 4- c.71Qoo l a n t e .
6. Give a name(s) of the City employee(s) causing the damage or injury:
7. Name0and address of any other person injured:
8. Name and address of the owner or any damaged property:
Claudio M. Carvalho, 15 Northwinds, Aliso Viejo, CA 92656
9. Damages claimed:
a. Amount claimed as of the date:
b. Estimated amount of future costs:
c. Total amount claimed:
d. Attach basis for computation of
all bills, invoices, estimates,
$542.50
None
$542.50
amounts claimed (include copies of
etc.
10. Names and addresses of all witnesses, hospitals, doctors, etc.
rTnna
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 2nd day of August ,19 92 , at Tustin, California.
DATE FILED:
CLAIMANT'S SIGNATURE
B1:CLFORM
Revised 4/29/91
CITY. PART NO. OR DESCRIPTIO►"
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SUBLET
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PARTS TOTAL
SUBLET TOTAL
+2
PRICE TUTTLE-CLICK FAD o
r BODY SHO TLE � CLICK ZO
-- 43 AUTO CENTE R. t,
�lJ IRVINE, CALIFORNIA 92718 t7R
(714) 472-5394
CAD 981978364 ! w
DATE:
B.A.R. NO. AH -80698
ADDRESS �+ CO
CITY / p DAY
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1 Ile,eny aumoiize nle .muve ,ena„ wu11. to be done along With In* necessary mna•nal, and Hereby qmm you andror your
er,nlnyees Ptnnlltslnn In 01w1.11- thn rnr, Irnck M vehicle hereon dr5rntwd On sheers%• h,011ways or Ma�wlllrw Ip the
pruptlss• of leMin,l n,„UOr „1'�cl�, An express mechanic s lien ,s heteby acknOwlnOge!1 On above car. truck a vM,cle Io
secure the amn„rll of repwos tlMrelo.
POWER Or ATTOfiNEV
Know :lir m•41 ny hint• presr•nr 11n1 lite 11010mmaned do, s hereby con -it' to- ,n,t nlgxnm TUTTLE CLICK TORO mvla
our true and I�winl n1lOrney In shin my name, place and stead at the undfwSioned tin any lnlurnrrce cnwcks o, Otahs Issued
by any ,n1t1r.111r.Y cr alpany cove,y/,1 any repairs td my lot ourl aulonlonae buthor17eA by myself (Of 011,sehves) ,n wharwver
mann, Is,{yfresenry In placeJ.thtirk no mall In a cashnble positron. CUSTOMER
I la w •,e1ebY ,nhly mWco ,rm wnnrevel action solid wnrltnay shall hos may PAYS
take by ,hue llerenf ,n 1 p ,roses.
� jSUCCRgqANCE
DATE �% B
SUPPLEMENT
�MAVE RECEIVED A COPY OF THE ESTIMATE
/ SUPPORMENI
> X s DATE BETTERMENT
r' N PER FLAT ORIGINAL ESTIMATE
LABOR RATE IS $ RATE HOUR PARTS & LABOR Q
$
(1) COLLECT ALL FROM CUST. REVISION 1
(2) COLLECT DEDUCTIBLE Date: Time:
Who contacted:
(3) SIGN INSURANCE CHECK Phoneiin Person $
H (4) SIGN INSURANCE PAY AUTH. REVISION 2
Date: Time: 1
(5) SIGN POWER OF ATTORNEY Who contacted:
t 16) SERVICE BILL ALSO Phone/in Person $
INSTRUCTIONS
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