HomeMy WebLinkAboutCC 4 CLAIM #93-35 09-20-93AGENDA____
CONSENT CALENDAR NO. 4
9-20-93
Inter-Com
DATE:
SEPTEMBER 2, 1993
TO' HONORABLE MAYOR AND CITY COUNCIL
FROM: CITY /~TTORNEY
SUBJECT: CL]%IMANT: TONETTA TAMMARO; CLAIM NO: 93-35; 'D/L: 06-19-93
DATE FILED W/CITY: 08-12-93; C]~RL W]%RREN FILE NO: S77817 PRL
After investigation and review it is recommended that.the
above-referenced claim be rejected and the city Clerk directed to
$ive proper notice of the rejection to the claimant and to the
'~laimant's attorney.
~C~rty Attorney
JGR:~b:090293(CL-9335.~)
Enclosure: Copy of Claim
--c=:-- Carl warren & CO-.-
Finance Director
City Manager
city of Tustin -
C. ~AINST THE CITY OF TUH
(For Damages to Persons or Personal ~ perry)
The law provides generally that a claim must be filed with the City Clerk of
the City of Tustin w~thin 6 months after the incident or event occurred. B,
sure your claim is against the City of.Tustin, not another public entity.
Where space is insufficient, please use additional paper and .identify
information by paragraph number. Completed claims must be mailed or
delivered to the City Clerk, City of Tustin, 15222 Del Amo Avenue, Tustin,
califorDia 92680
WHEN COmPLETING THIS FORM, PLEASE TYPE OR USE BLACK INK
TO THE HONORABLE MAYOR AND CITY COUNCIL, city of Tustin, California:
The undersigned respectfully submits the following claim and information
relative to damage to person and/or property:
'' ' '
1 a. NAM~ OF CLAIMANT:-~-~~i
b. ADDRESS OF CLAIMANT:
L~,$,C)~_ ~ ~, ..~.
c. CITY/ZIP CODE: - ~_~
a. TE'r.[P~ONE ~0:
e. DATE OF ]~I~TH:
g. DRIVERS LICENSE NO:
2. 'Name, telephone.and post office address to which claimant desires notices
to be sent' (if other than above):
3. This claim is ~ubmitted 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 Cit~
of Tustin only:
4. Occurrence or event from which the claim arises:
a. DATE: ~C~q~
b. TIME: ._~'~'~_ ~ ~/~
c. PLACE (Exact and specific location): C~n ']~-Qi~ ~~~~ ~
d. HOW an~ 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):
e.
WHAT particul' ction bY the City, or ~ employees, caused the
alleged damage
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".
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. N_~ame and address of the owner or any damaged property:~-dD~~
9. Damages claimed:
a. ~ount claimed as of the date:
b. Estimated amount of future costs: I ~'/~
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.
WARNING:
IT IS A CRIMINAL OFFENSE TO FILE A FALSE Cf~kIM!!
(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 (~.'J%O~.~'-if'~
,!9q~ , at Tustin, California.
CLAIM3~NT ' S SIGNATURE
BI - CLFORM
Revised 4/29/91
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6'/0 i.]OR'i,'i B ~TAV'IA
OFC-~TGE, CZ,. 9 266~-
.(714) '/71-7107
BAR AG1357O2
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