HomeMy WebLinkAbout06 CLAIM #94-25 07-18-94AGENDA
NO. 6
7~. 9~4
Inter-Corn
DATE:
July 8, 1994
TO:
FROM:
SUBJECT:
HONORABLE MAYOR AND CITY COUNCIL
CITY ATTORNEY
CLAIMANT: R.D. EISZELE; CLAIM NO: 94-25; D/L: 4/20/94;
FILED W/CITY: 5/11/94; CARL WARREN FILE NO: S 78298 PRL
DATE
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.
In this case a Great Western Reclamation truck is alleged to
have damaged the claimant's driveway. This is not a case involving
potential City liability.
Lois E.
City Attorney
Enclosure: Copy of Claim
cc:
Carl Warren & Co.
William A. Huston, City Manager
Ronald Nault, Finance Director
City of Tustin ·
CLAIM AGAINST THE CITY OF TUBTIN
(For Damages to Persons or Personal Property)
The law provides generally that a claim must be filed with the city Clerk o.
the City of'T~stin 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, 300 centennial way, Tustin,
california 92680
WHEN COMPLETING THIS FOP. Mt PLEASE TYPE OR USE BLACK INK
TO THE HONORABLE MAYOR AND CITY COUNCIL, City of Tustin, california:
The undersigned respectfully submits the following claim
relative to damage to person and/or property:
and information
a. OF
b. ADDRESS OF CI2%IMANT:
C. CITY/ZIP CODE:
d. ~PHONE NO: (
e. DATE OF BIRTH:
f. SOCIAL SE~ITY
g. DRI~ LICENSE
2. Name, telephone and post office address to which claimant desires noti¢
e sen~ (if other than above):
This claim
b.
is submitted against:
The City of Tustin only.
Third, lowing/employee(s) of the City~ of T~sti~ only:
The City of ~stin and the following employee(s) of the City
of Tustin qnly:/
Occurrence
a.
b.
C.
or. event from which the claim arises:
TItlE: /z_ xJ ~p /t) .
PLACE (Exact a~nd specific_location): /? ;. ~/~_ ~ ~ ~L~ 0 ~
HOW and under what circumstances did damage or inju~ o~ur. Specify'
~e particular occurrence, event, act or omission you claim caur
~e inju~ or damage (Use additional paper if necessary):
' e. WHAT partlcu~_ '~ction by the City, c_ i' -- employees, 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".
6. Give t~e._name(s) of the City employee(s) causing the damage or injury:
7. Name[/N~-~gn~ ~j~dress of any other, person injured:
8. Name and address of,the oWner or an~damaged property: ~/~/~
9. D~ages claimed:
a. ~ount claimed as of ~e date: ~-/m -~
b. E~timated amount of fut~e costs: ~ ,
c. Total amount claimed: '~~D ~ +~1~ OJ~ % 77~
d. Attach basi~ fo~ computation'of amounts claimed (inclUde copies 6f.
all bills, ~nyo~ces, estimates, etc.
10. Names a~ 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
COP/AEC~.
EXecuted this /D day of
CLAIMANt'S SIGN%RE
,19 ~, at Tustin, California.
Bi:CLFORM
Revised 4/29/91
2 x
5'99
2 x
3'99
7'D8
1 '.; · 9 6
~ 5-'~ ? 017
05'11-94
NEWPORT 30 NIIN. FOTO
13842 NEWPORT AVE.
TUSTIN; CA 92680
/
L
WESTAR CONTRACTORS, INC.
General Engineering/Concrete
P.O. BOX 180
Tustin, CA 92681-0180
(714) 538-6027 Fax (714) 538-4564
/..Fo
· . ' i Tustin CA92681-0180
~": license No. 684584
WESTAI~ CONII~AClO~S, INC
Genoral Engineering/Concrete
JIM AEI~EOLA
P.O. Box 180
(714) 538-6O27
Fax (714) 538-4564