HomeMy WebLinkAboutCC 3 CLAIM #93-39 10-04-93 GENDA
CONSENT CALENDAR NO. 3
10-4-93'
,.)ATE:
SEPTEMBER 23, 1993
Inter-Com
TO: HONORABLE MAYOR AND CITY COUNCIL
FROM: CITY ATTORNEY
SUBJECT: CLAIMANT: MARY BRANDELLI;,, CLAIM NO: 93-39; D/L: 08-06-93; DATE
FILED W/CITY: 09-08-93;-CARL WARREN FILE NO: S 77850 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
City Attorney
JGR:jab: 092393(C~9339 Sab)
Enclosure: Copy of Claim
cc: Carl Warren & Co.
Finance Director
City Manager
City cf.Tustin -
CLAIM AGAINST ~ 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 within 6 months afte'r 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, C~ty 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: MARY BRANDELLI
b. ADDRESS OF CLAIMANT:
d. TELEPHONE NO: (
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. This claim is submitted against:
a. xx The City of Tustin only.
b. The following employee(s) of the City of Tustin only:
Ce
The City of Tustin and the following employee(s) of the City
of Tustin only:
4. Occurrence or event from which tine claim arises:
a. DATE: 8/6/93
b. TIME: 7:12 A.M.
c. PLACE (Exact and specific location): 22 Freeway, near 57 off ramp,
headinq West
d. HOW and under what circumstances did damage or injury occur? Specif~
the particular occurrence, event, act or omission you claim caused
the injury or damage (Use additional paper if necessary):
As my husband and I were auDroaching_, an overpass we noticed a
city emDloyee spray painting over some graffiti on the side of
the overpass. As we went under the overpass our car was sprayed
with uaint.
e. ~q{AT particula action by the City,
alleged damage or injury?
See
employees, caused the
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".
The frontr hood and roof of my car was sprayed with paint, as well as
the wfndshield.
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. A~ount claimed as of the date: $50.00
b. Estimated amount of future costs:
c. Total amount claimed: $50.QQ
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.
A1Brandelli, address same as above
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 4th day of September
,1993 , at Tustin, California.
DATE FI_~,F.D:
Bi:CLFORM
Revised 4/29/91
MA~=NOLIA CAll W~
(714) ~Z9-76~1
417363
DE~CRIPTION
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