HomeMy WebLinkAbout08 CLAIM #94-26 07-05-94 ,GENDA__-
NO. 8
7-5-94
DATE: ~ 21, 1994
Inter-Com
TO:
FROM:
SUBJECT:
HONORABLE MAYOR AND CITY COUNCIL
CITY ATTOR/~EY
CLAIMANT: KIM MORGAN; CLAIM NO: 94-26; D/L: 4/7/94; DATE FILED
W/CITY: 5/12/94; CARL WARREN FILE NO: S 78297 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.
Enclosure: Copy of Claim
cc:
Carl Warren & Co.
Finance Director
City Manager
City of Tustin
CI~IM AGAINST T~ CITY OF TUS~-K
(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~th~D 6 month~ after the incident or event occurred. Be
sure your claim is against the City of Tustin, not another public entity.
R~ere space is insufficient, please use additional paper and identify
information by paragraph nut,her. Completed claims must be mailed or
delivered to the City Clerk, City of Tustin, 300 Centennial Way Tustin,
California 92680 '
COMPLETING THIS FORM, PLEASE TYPE OR USE BLACE INK
~0 THE HONORABLE F~YOR AND CITY COUNCIL, City of Tustin, California:
The undersigned respectfully submits the following claim and information
relative to damage to person and/or property:
c. CITY/ZIP CODE:
d. TE~PHONE NO: ~ ~
e. DATE OF BIRTH: %~ /~% ~
2. Name, telephone and post office address to which claimant desires notices
to be sent (if other than above):
This claim ls submitted against:
a. X 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 City
of Tustin only:
Occurrence
b.
do
or event from which the claim arises:
PLAC-~J_kac~ and specific location): ~..
HOW and Under what c'~cum~-an~ ~ ~ ~ J (,O~ ~.,
the Da~ . - 1 ............. camage o~ injury occur? Specify
_ - =.cula= occurrence, event, act or ou~!SSlO~ you claim caused
the injury or damage (Use additional paper if necessary):
e. ~T particu!~ ction by the City, or employees, caused the
alleged damage oU inju.-y?
Give a description of the inju~', 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 ~employee(s) causing the damage or injury:
7. Name and address of any other person injured:
!0.
Name and address of the owner cr any damaged property:
Damages claimed:
a. ~umount claimed as of the date: ~C~ --~CD ~/~tl-~_~
b. Estimated amount of future costs: ~'
c. Total amount claimed: ~--~ "~'"'~-,L~ ~, ~,
d. Attach basis for computation of amounts claimed (include copies
all bills, invoices, estimates, etc.
Names and addresses of all witnesses, hospitals, doctors, etc.
of
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 tI-ue of my own knowledge, excepu as to those matters stated to be
upon information or belief and as %o such ma~ters I believe the same to be
t-~ue. I certify under penalty or perju~' ~hat the foregoing is TRUE AND
CORRECT.
Executed this % ~ day of ~
,19~ , at Tustin, California.
DATE FILED:
Ci~.I¥~AN~' S SIGNATU~/~
B!: CLFORM~
Revised 4/29/91
D~MAGE REPORT
~4/~6/94 at; ~R:48
ATT126933 ~'
FREFWAY AUTO
MORGAN
D.R. 1R504-00~1302
Est: D. TRIPLETT
ANA~ L ]f NC
28 AUTO C~NTER DR.
]'LISTIN, CA 92680-
(714) 544-?;~34-258
Address:
KlM MORGAN
[)ay Phone: (
Other ~'h: ( ) -
Deductible: $ N/A
Claim No.:
93 NISS ALTIMA GLE 4D SEO BLACK
V~n: License:
Phone:
Adj. :
4-2.41_-FI
Prod Date: 6/92; Odometer:
P'ower locks Power mirrors Body side moldings
Dual mirrors Air conditioning Rear defogger
Tilt wheel Cruise control Climate control
Theft deter/alarm Dr~ver airbag Positraction
Electric glass sunroof Cloth sc. ars Buc. ket seats
Recline/lounge seats Clear coat paint
-' REPR/ ~'ART LBR PAINT
NO. REP'L DESCRIR'T);ON OF ISAMAF*E [,,TY [:OST HRS HRS IqlSC
1 FENDFR & LAM~'S
2 Repl LT Wheel liner 1 29.00 0.4
3 Repl. LT Splash shield 1 19.84 0.3
4 CENTER PlI.I_AR & ROCKER ~'ANE
5* Refit, LT Otr rckr pr, 1 X, GX, (4L 1 1.3
6 Add for Clear Coat 1 0.5
?* COLOR SAND & BLIFF ] 5. ¢
8* DETAIL CAR 1 X
Subtotal s ---> 48. ~4 5.7 1.8
1
FREFwAY AUTO
28 AUTO CENTER DR.
TUSTIN, [:A 92680-
(714) 544-7:-~34-258
MORGAN
D.k. 1 R504-000130.:.
Est: D. TRIg'LETT
NE] I','1 E~ R
Parts (Subject to Ir, voice) 48.8~
Labor 5.7 hfs $ 30o00/hr
Paint 1. ~ hfs $
PA' 1. 8 hfs $ 18.00/hr 3'F.:.
~nt/Materia] s
Sub]et/Misc T5.0~:
~LIBTOTF~L
Tax on $ 81. 24 at
.............................................
GRAND TOTAl
............................................
l NSLiR~NC~ PAYS
$ 3.97. 5~
g'age: ;=;
· N_° 22821
ESTIMATE
N-E-~_---P .0_ R=T
3857 Birch St.. #530, Newport Beach, Catitornia, 92660
1 (800) 577-1376
NAME KIM MORGAN
ADDRESS
DATE LOCATION VEH . COLOR
I ~ODEL
o~/~5 /9~ ~o~ A~T~MA
REMOVE OVER
SPRAY DRIVER
SIDE
CASH
CHECK t# ]
VISA / MSTR.J
WASH
WS / WX
ENGINE
WS / INT
DETAIL
WHEELS
CARPETS
MISC.
REMOVE $ 300.0(
SUB-TOTAL
TOTAL
$300.0~
$ 300.p0
Thank You