HomeMy WebLinkAbout04 CLAIM #94-12 04-19-94 ,GENDA
NO. 4
4-19-94
DATE:
APRIL 6,' 1994
Inter-Com
TO: HONORABLE MAYOR AND CITY COUNCIL
FROM: CITY ATTORNEY
SUBJECT: CLAIMANT= LEONARD NILES; CLAIM NO: 94-12; D/L: 031394; DATE
FILED W/CITY: 032194; CARL WARREN FILE NO: S 78177 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/G~ROURKE
City Attorney
IOR~b:O406~(CL-~ 12.~)
Enclosure: Copy of claim
cc: Carl Warren & Co.
Finance Director
City Manager
city of Tustin ~
CLAIM AGAINST THE CITY OF TU~'~'N
(For Damages to Persons or Personal Property)
The law provides generally that a claim must be filed with the City Clerk c~
the City of Tustin withip ~ 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 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.
ADDRESS OF CLAIMAN_T:
CITY/ZIP CODE:
DATE OF BIRTH:
SOC kL SECUR
LICZ SZ
2. Name, telephone and post office address to which, claimant desires noticr
to be sent (if other than above):
3. This claim is submitted against:
a. ~ The City of Tustin only.
b. The following employee(s) of the City of Tustin only:
Co
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: ~--/~ --~ ~
c. PLACE (Exact and specific location): ~ ~ WA/~ ~WE~fT'
d. HOW and under what circumstances did damage or inju~ occur? Specify
the particular occurrence, event, act or omission you claim caused
the injury or damage (Use additional paper if necessa~):
e. WHAT partic %action by the City, 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 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. Amount.claimed as of the date: ~ ~q~ Od~
b. Estimated amount of future costs: ~.
c. Total amount claimed: ~ ~~.~d)
d. Attach basis for computation of amounts 6'laimed (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 CLAIM! !
(Penal Code Section 72; Insurance Code Section 556.0)
I have read the matters andstatements 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 9nd as to such matters I believe the same to be
true. I certify under pengity or perjury that the foregoing is TRUE AND
CORRECT.
Executed this /~ day of
_
,19 q q, at Tustin, California.
DATE FILED:
Bi: CLFORM
Revised 4/29/91
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