HomeMy WebLinkAboutCC 9 CLAIM #93-41 11-15-93CONSENT CALENDAR NO. 9
11-15-93
.~ATE:
NOVEMBER 8, 1993
Inter-Com
TO:
FROM:
SUBJECT:
HONORABLE MAYOR AND CITY COUNCIL
CITY ATTORNEY
CLAIMANT= WILLIAM TOOHEY; CLAIM NO= 93-41; D/L='09-01-93; DATE
FILED W/CITY= 09-14-93; CARL W]~RREN FILE NO= S ??8?2 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- G. ~~E, City Attorney
SGR:j~: 11 ~CL-9341 ~
Enclosure: Copy of Claim
cc: Carl Warren & Co.
Finance Director
City Manager
city of Tustin
CLAIM AGAINST THE CITY OF TUSTIN
(For Damages to Persons or Personal Property)
The law provides generally that a claim must be filed with the City Clerk ¢
the City of'Tustin within 6 moD~hs 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
WHEN COMPLETING THIS FORM, PLEASE TYPE OR USE BLACK INK
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:
b. ADD, SS OF C~I~T
c. CITY/ZIP CODE:
d. TE!.RPHONE NO:
e. DATE OF BIRTH:
f. SOCI~ SE~ITY NO
g. DRI~ LICENSE NO
2. Name, telephone and post office address to which claimant desires notice
to be sent (if other than above):
3. This claim is submitted against:
a. ~,- The City of Tustin only.
b. The following employee(s) of the City of Tustin only:
Co
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: ~_/- ~
b. TIME :.. . ~/'~, .
c. PLACE (Exact and specific location): ~:~ ~/~y/~---~_5 /~/;/f/U~ ,-)~ L~ ~
d. HOW and under what ~ircumstances did damage o~ inju~ occur? Specify
the particular occurrence, event, act or omission you claim caus~
the injury or damage (Use additional paper if necessary):
WHAT particular action by the City, or it-~ employee~, caused the
alleged damage or injury?
?
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".
o ,
6. Give the name(s) of the City employee(s) causing the damage or injury:
7. Name and address of any other person injured:
8. Name and address of the owner or any damaged property:_~/~ ~oF~__z~/
t /
9. Damages claimed:
a. Amount claimed as of the date: '~-~ ~. ~
b. Estimated amount of future cbsts: ~ ~
c. Total amount claimed: z~ ._~A .~. F~
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
,19 ~, at Tustin, California.
CLAIMANT ' S SIGNATURE ~
BI: CLFORM
Revised 4/29/91
( )
EXT:
( ) - EXT:
REFERRED BY: BILL MAXEY T
ESTIMATOR : ERIC W. DEBACA
INDEPENDENT :
INS. CONTACT:
ADJUSTER :
CLAIM No. :
~n~ - ( ) -
.~=....,-.!~-.- .. '7°.,.'
1988 TOYOTA
CAMRY GOLD
vLICENSE:
~PR. DATE: u
c PT. CODE: R
LTM. CODE: A
EBD STYL: 4 DR. LE N
C
MILEAGE: E
P.O. No:
UNIT No: 4 DAYS
FXT:
SEP 10. 1993
/ /
) -
POLICY No. :
CLAIM No. :
INSIDE ADJ. :
OUTSIDE ADJ.:
DEDUCTIBLE :
DATE OF LOSS:
PHONE No. :(
EXT. :
1
2
3
4
5
6
7
8
9
10
REPAIR/ALIGN LEFT QUARTER PANEL
REPAIR/ALIGN REAR DECKLID
Tape Pinstripe
DEDUCTION ALLOWANCE FOR PAINTOVERLAP
ADDITIONAL TIME ALLOTTED FOR 2 STAGE PAINT
HAZARDOUS WASTE REMOVAL
COLOR SAND AND RUB
R AND I PARTS FOR PAINTING
CAR BAG PROTECT FROM OVERSPRAY
TOTALS
15.00
24
2 4
-0.4
1.4
1.0
.. . .Oo ii6.~C i5.00' 8.5- 6.8 0.0
:..
CERT. # AB076318
Skdl Craft
' -Bo y Shop
· Inc.
..
;. . ~.~..:...~.' ·
17072 GOTHARD STREET
HUNTINGTON BEACH, CA 92647
(714) 848-2311
PARTS ~
PAINT/MISC -
SUBLET ["[ ~'' ~
BODY LABOR I ~.. O0
FRAME LABOR ~'~':. O0 "~"~';. 010
PAINT LABOR o O0 -1~+0~. 01:.)
MECH LABOR ['~0~, qO "~'~, 00
TOW . O0 '~_ ~'5C~. O0
STORAGE . O0
DAMAGE REP. -
01:)
TAX
6.8 0.0
TOTAL ~ (..'T~
DEDUCTIBLE ~'~ ~';'- ~
INS. PAYS
CUST. PAYS
PARTS PRICES SUBJECT TO SUPPLIES INVOICE.
Storage will be charged forty-eight hour~ attar repaim ere completed. In the event legal action le necessary to enforce this contract, I will pay reasonable a=a3mey's
tees end court costs.
I hereby authorize the below repair work to be done along with necessaJ7 materials. You and your employees may operate vehicle lor purposes of testing, insc~c~3n or
deliver/at my risk. An express mechanic's lien is acknowledged on vehicle to secure the amount of repairs thereto. You will not be held responsible for loss or ~a~age to
vehicle or articles lett in vehicle in case of fire, theft, accident or any other cause beyond your control.
· CUSTOMER IS RESPONSIBLE FOR PAYMENT OF ALL REPAIRS.
SIGNED X DATE
ALL REPAIRS MUST BE PAID FOR PRIOR TO PICK UP OF VEHICLE.
Notice: Due to many unforeseen circumstances in the repairing of automobiles we regret that we can ONLY ESTIMATE, NOT PROMISE a
completion time. Your understanding is greatly appreciated. No personal checks over $500.00.
Ail insured work that has a draft that has to be cleared with a bank or finance company also has to be paid under the above terms prior to ~ ut3 of the vehicle.
~ Assist the customer in expediting the payment of any repair work pedormed by Skill Craft Body Shop. Inc.. which repair work may be covered by mSUrance l~e ~lowing
5on must be completed at the ame of presenting the vehicle for repair work.
LABOR-LIMITED
WARRANTY
Skill Craft Body Shop, Inc. WARRANTS THAT ALL LABOR PERFORMED IN THIS SHOP WILL BE DONE IN A GOOD AND WORKMANLIKE MANNER. ANY ;~-FECT
IN SUCH LABOR WHICH OCCURS WITHIN 12 MONTHS AND. 12.000 MILES WHICHEVER COMES FIRST. WILL BE CORRECTED BY THIS SHOP AT NO Ci-~RGE.