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HomeMy WebLinkAbout09 CLAIM #94-16 05-02-94AGENDA___. NO. 9 5-2-94 .)ATE: APRIL 22, 1994 inter-Com TO: HONOP~tBLE MAYOR ]%ND CITY COUNCIL FROM- CITY ATTORNEY SUBJECT: CLAIMANT= ROBERT BULOT~ CLAIM NO= 94-16~ D/L= 10-21-93 ~ DATE · FILED W/CITY= 04-11-94~ CARL WARREN FILE NO= S .78230 CLB 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. City ~Attorney Enclosure: Copy of Claim cc: Carl Warren & Co.' Finance Director City Manager City of Tustin CLAIM AGAINST THE CITY OF TUSTIN (For Damages to Persons or Personal Property) · The law provides generally t~at a claim must be filed with the City Clerk · the City of Tustin within 6 months after the incident or event occurred. ~ 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 FORH, PLEASE TYPE OR USE BI~CK INK' TO THE HONORABLE MAYOR AND CITY COUNCIL, city of Tustin, California: The undersigned respectfully submits the following claim and information relative to ~amage to person and/or property: . 1. a. NAME OF CLAIMANT: ROBERT BULOT · b. ADDRESS OF CLAIMANT:' .... c. CITY/ZIP CODE: d. TELEPHONE NO: (~ e. DATE OF BIRTH: f.. SOCIAL SECURITY NO: . ,. 2. Name, telephone and post office address to which claimant desires notic to be sent (if other than above): Law Offices of Brian Don Levy, 957 S. Village Oaks Dr., 2nd Floor, Covinar CA 91724-3617, (818) 960-3702 3. This claim is 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: 4. Occurrence or event from which the claim arises: a. DATE: 10-21-93 b. TIME: 7:25 p.m. c. PLACE (Exact an~.~pecific location): Jeffrey Road on-ramp to n~w-porto]a ~a_~a¥ ' d. HOW and under what circumstances did damage or injury occur? Specifk t occurrence,, event, act or omission yo injury or damage (Use additional o inadeauate liahtina conditions and nce of any warnin~ -or speed marR ramp to the new Portola Parkway- (a 15 mph turn), was unable to _ -reduce speed enough to negotiate the turn, causin~ his vehicle to leave the highway, flip over on the cement barrier and come to rest e. WHAT particul, action by the City, or $ employees, caused the alleged damage or injury? Failure to adecuatelv mark and licht the on-mm?, coupled with ~ comDlete failure to warn'of the reduced speed of the on-r~mD. 5. Give a description of the injury, property damag, e or loss so far known at the time of this claim. If there were no injuries, state "no injuries". P in insurance premiums and .emotional damages due to ~ever~ty of ~h~ accident. 6. Give the name(s) of the City employee(s) causing the damage or injury: Unknown .' 7. Name and address of any other person injured: N/A 8. Name and address of the owner or any damaged property: N/A 9. Damages claimed: a. Amount claimed as of the date: $.8~800.00 b. Estimated amount of future costs: S~j000____.00 c. Total amount claimed: $_!2_~~800-00 d. Attach' basis for computation of amounts c-~almed (include copies of' all bills, invoices, estimates, etc. · 10.' Names and addresses of all witnesses, hospitals, doctors, etc... . Howard Bovd ( -- -- 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 cert'ify under penalty or perjury that the foregoing is TR5~ ~D CORRECT. Executed this_tl~I_day of March .,1994 ., at Tustin, California. CLAIMANT S SIGNA~URE~ ' B1: CLFORM Revised 4/29/91