HomeMy WebLinkAboutCC 6 CLAIM #93-50 11-01-93AGENDA____
CONSENT CALENDAR NO. 6
11-1-93
DATE:
OCTOBER 22 t 1993
lnter-Com
TO- HONORABLE MAYOR AND CITY COUNCIL
FROM: CITY ATTORNEY
SUBJECT: CLAIMANT: SHIRLEY LOECHNER; CLAIM NO: 93-50; D/L: 09-25-93;
DATE FILED W/CITY: 10-04-93; CA~L WARREN FILE NO: S ??896 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
~ty Attorney
..
JOR:jnb: ~ ~93(CL-9350.~b)
Enclosure: Copy of claim
cc: Carl warren & co.
Finance Director
City Manager
City of Tustin ~
CLAIM AGAINST T~E CITY OF TUSTIN
(For Damages to Persons or Personal Property)
The law provides generally that a claim must be filed with the City Clerk of
the City of Tustin w~thin 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, 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:
Shirley A. Loechner
1. a. NAME OF CLAIMANT:
b. ADDRESS OF CLAIMANT:
d. TELEPHONE NO: (
e. DATE OF BIRTH: -
2~ Name, telephone and'post office address to which claimant desires notices
to be sent (if other than above):
3. This claim is submitted against:
a. X The City of Tus~in only.
b. The fol. lowing enployee(s) of the city ~of Tustin only:
' - .. ' , .._ -. "~'~.. _. .. · "'' ? - ~ ": '~ :.i~'i ..-.
I. _ . :,. . .~ · ~
..
-
c. The City of Tuszin and the following employee(s) of the City
of Tustin only:
4. Occurrence or event from which the claim arises:
a. DATE: ~ep%ember
b. TIME: Appro× 1'00 - 1' 50 ~,m,
c. PLACE (Exact and specific location): Columbus Tustin rark
rrospect ~nd 4th
d. HOW and under what circ'~stances did damage o
the injury or damage (Use
~ee attached
e. WHAT pa~icula mc. ~n by the City, or i
~ alleged damage ur injury?
mployees, caused the
Baseball kit ou~ of p~_rk
5. Give a description of the injury, property damage or loss so far known at
the time of this claim. I~ there were no injuries, state "no injuries".
]~o :njuries - hood of car dented by baseball
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:
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 amounts claimed (include copies of
all bills, invoices, estimates, etc.
10. Names and addresses of all witnesses, hospitals, doctors, etc.
rassen~er in car with me' Ardene B&y.c.e, .
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 cf 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 ls- day of October
,1993 , at Tustin, California.
DATE FILED:
CI.~I~T ' S ~GNA.~'3RE
.-
~1 ' CLFORM
{evised 4/29/91
t'",~ I 11¥t/'-{ I r-
STONE & VAN DYKE INC.
1101 East 3rd Street
SANTA ANA, CA 92701
(714) 542-4387- 542-3739
i .,
STREET
8'7
-~E GLSTRAT3ON NO.
~SURANCE CO.
MODEL
ESTIMATE PREPARED BY
REPLACE
REPAIR
J i
i
.i
DESCRIPTION
i
'1
1
I ' TOTALS
I
PARTS
LABOR
/.O
f.,
REFINISH
SUBLEi
The above is an estimate :ased on our .USPec:~3n and does not cover
any additional Darts or laD:r which may be reD.red after the work has
oeen started. Occasionally..yom or damaged Dam are discovered which
may not be evident on ti'e. f~s! inspectio~ Be:~se of this. the above
~ices are not guaranteecL ~uotations on parts a~cl labor are current and
subject to change.
ALLT..HORIZATION FOR REPAIR. You are he-eoy authorized to meke
')ye reos."s:
SIGNED
DATE
TOTAL PARk's ......................................$
· o~~o,..~..D...~F~...~.~,.~)..o. ..... s
· OT,,~ ,~,~,~..~.,.3.~..2.~,.~.~) ...... s
TOTAL SUBLET ..................................... S
TAX .................................................. $
S
TOTAL .............................................. $
',,'vh~-e,er G .":,~3 .-~c_. 1982
F R~-EWAY AU-FO BODY
28 AU=O CENTER DRIVE
TUSTIN, CA 92680
(7'4) 544-3111
Fax: ~?14) 544-8674
si bl e Damage Quotst i on #4534
I RLEY LOECHNER
-
:
_~l
]ICK ELFCTRA/PARK AVE
tgel 0
(FWD)
Style : 4DR
Lic. Plate:
Paint Code:
Prod. Dates
Profile : STANDARD
Deductible: 0.00
Labo~ Op Description
RF~IR HOOD I:~EL
R & I HOOD
·
MAb~ & ~VER FOR OVErlY
~E~ & !~CT FOR ~IV~RY
~.DR ~0 &-~F
A~ (~R ~AR ~T
~ Judgement Item
by MIKE MURILLO on 10-01-93
Insurer : FARMERS INSURANCE ORA
Adjuster :
Appraiser:
Claimant :
Insured
Policy # :
Clai~ # :
Price Labor' Paint Labor Group
8. 00* ]. ~ .~. 4 BODY
10. ~* 0. 5. 0, 0 ~Y ·
I~, 8.8
8.~ 1.8. 8~8 "~Y
8.~ 1.4 8.0 ~INI~ ,
Price G~oup
EXISTING
EXISTING
NEW *
~ed tabor ~. ~
MATERIALS 86.48T ~W
I-P-=:RDOUS ~TE 8.48
i;,eo Costs 86.40
Tx 7. ~Jt% 6.70
No.--iaxed C~sts 2.48
10. ~T
Taxed Parts 18. N
Tx 7.750% 8.78
Labor ( 8.6 hfs)
Add'l Costs/~laterials
Part s
Tax
258.00
88.80
10.00
7.48
Grand"' Tot a i
'[NJ FOR COMING TO SAN~fl ANA LINCOLN-MERCURY ANO FREWA~.' AUTO BODY. WE_ APPRECIATE YOUR BUSIhE:~S)
EstiMate CZ is a tr~emark of Mitchell Inte~ational
Copyright 1991, :lC2 All Rights Reserved
DAMAGE QUOT -ION -. 818722
I I
sY~ ~~ ~s. co. ~E ~. ~ C~U NO. ,, P.O.
WReN
..... D~N~ OF REPAIR. P~S ~D~
~E ~' ~ · R - Rear S = S~llghten ' A = Affie~ N - New PI PARTS ~BOR PAINT .¥ ~/MI~.
NO. P~;~ "R~C ~ ~ycM~Re~e/R~Me U = U~ R = Rebui~
1 '~'
_/. -~ ..............__//---,-~ ":~' ..... : .:--; .:.;,:. ...~.~ .
2
.... _ _;... . / -- /_~ .............
~ /~b ..
8 -z ..}: ~: .... ; '~':' " ' -':- - .-..'-.. . ~- "' . -
' . ~
.
: . . . . - .. . -: . -
· . :. .-.. . . -.. . · ,,.. ;:,:~-.; ..:-~:~'~ ::/ , ..
..... ... . . · .... ..... :~. ;:--' . .... .:~:~.. ..
. ... . . ._ .
:..I ......... ':':' "-"- ..... : ......... ~' '~' ~': ........ ~'~.'~"~:~.. .- ................................
18
I
.
,
_. . ~':'.~.~: ~'....~g.~:.f_: :::., ;;.'.::. 'C.: -:::..
20 .:- -
21 ......
- . . . · . .
2z ..:.~-;'.,-::. . ....... . .... .~ · -..:.;~::.:~:.-:::: ~::"-. - ..
.. · . . .. --:: : .'.. ._ _
23
2~ . --' . .... :~.... ..... .:~.-;...~-..' '.?. :.-.-- . ~', rZ<-~ ~77::"=7::.~ :: ............. "~'
.... .~ ,,
25
P~TS Prices subje~ to in.ce
Signed X Date
L~OR ~s. ~ $
Shop Supplies
P~ hrs. ~
.. .
A C E
AUTO COLLISION PERTS
'~ Sublet I Miscellan~us
BODY & PAINT ~.~,w..,.~,.~o.,~,~.
~5 N. M~n S~ * Or~, CA ~~ sub TOTAL
~4) ~2~5~ ~
T~X ....................... S
TOTAL s
':. 19~.~. i.'3/~JA ,nc I:o~m NO 1C~03 IIDIE]A ,nc. One IIO/FJA Way. Catowefl. ID 83605-6.(302 - CALL TOLL FREE
~ & M, AXE MCX)C-L BODY STYLE
DATE
~.0. ~
B~. RES.
~E P~E
A~.
OWNER
PAYS $
LICENSE
MOTOR
' ' S T; ~ AT.E BY SHOP # . _ _ CITY ~'~/'/~' ~'~F~/~" NOT AN INVOICE
3 Synthetic Plus 1, Exclusive Activator, 12 Month Warran~
4 A~c Plus 2, A~lic Additives Plus Silicone Sheen, 24 Mon~ Waffan~
5 Polwrethane Plus 3, Polyurethane ~itives Plus Sili~ne Sheen, 36 Month Warranty
~0
I ,.
~ (SI ~ (E~ Em~. ~'
~ARTS PRICES b~ on Stan0ar0 Catal~ue. & Price CHANGES WITHOUT INSURANCE DEDUCTIBLE MUST BE I PAINT /~0
3TICE. Se~e C~es may be a0~ed lot special items not available Io~lly.
.................................... ~ ....... I P~n~ when nr~er is PAID BEFORE CAR IS RELEASED ~ PRFP.
-:PLACED PARTS J'JNKEO. unless Owner as
~ceci. Above estimate =~aseC on tn,s inspection. Additional Parts. or Labor. may be
~uired atter me worn ~'.as ooenec~ uo c~amage previously obscured.
ESTIMATE EXPIRES 30 DAYS AFTER DATE.
My car will be clrive- 13y your emoloyees to make required tests at my risk. An
3tess mechanic's ~,e~ is nereOy acKnowleOge0 on aDove vel3icle to secure tl3e
-~ount Of repairs the?tc. I hereOy wa,ye the $;atute of Limital~°ns and if any action
t,"tts account reou,,es emo4oymen; of an a~orney I agree to pay 1'4% interest 13er
3n~. which is annus ~)ercentage rate ol 18% from date. reasonable attorney'S lee
court costs.
~ave rea{3 the al:)o,~: rece,ved a cody. and above worV, 13ereOy aulnorizecl.
-n, ner, Agent) By Date
* This charge is not imposed by any govern-
mental agency but is usecl by 1-Day to
offset the consiclerable costs incurred in
complying with local, state and Federal
environmental regulations.
SUBLET NET
BODY MAT'L
cO
ENVIRONMENTAL
COMPLIANCE CHARGE' 8i O0
/ o/
_