HomeMy WebLinkAboutCC 4 CLAIM #93-52 01-17-94CONSENT CALENrDAR NO. 4
1-17-94
l nt e r- C o m
DATE:
DECEMBER 28, 1993
TO: HONORABLE MAYOR AND CITY COUNCIL
FROM: CITY ATTORNEY
_SUBJECT: CLAIMANT= UC VAN NGUYEN; CLAIM NO= 93-52; D/L= 10-27-93; DATE
FILED W/CITY= 11-03-93; CARL WARREN FILE NO: S ??935 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.
JAM] C~ity Attorney
JOR~b: 1 ~893(CL-9352 4'~
Enclosure: Copy of Claim
cc: Carl Warren & Co.
Finance Director
City Manager
City of Tustin '-
C_~IM AGAINST THE CITY OF TU~.IN
(For Damages to Person's or Personal Property)
The law provides generally that a claim must be filed with the City Clerk .
the City of'Tustin 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 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. NAME OF CLAIMANT: UC VAN NGUYEN
b. ADDRESS OF CLAIMANT:
c. CITY/ZIP CODE:
~. 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):
CARYN NGUYEN,
3. This claim is submitted against:
a. X The City of Tustin only.
b. -The following employee(s) of the City of Tustin only:
Ce
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:. 10/27/93
b. TIME: Approximately 1:30 a.m.
c. PLACE (Exact and specific location): 2021 Seminole, Tustin, CA
(claimant's residence)
d. HOW and under what circumstances did damage or injury occur? Specify
the particular occurrence, event, act or omission you claim caus
the injury or damage (Use additional %%%%r if necessa.ry):
The city's tree branches struck the of claimant's residence,
while other branches onto claimant's backyard.
e. ~-rLA~ par~icu, action by the City, or - e=ployees, caused the
alleged damage ~r injury?
The city-failed to maintain its trees (i.e., failure to trim the
branches) in a safe manner or condition.
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".
D~-maQe to claimant'-s roof, crushed plants and flQwers in claimant's
--
b=_ckyard. - -
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: UC VAN NGUYEN,
2021 Seminole, 'Tustin, CA 92680
9. Damages claimed:
a. Amount claimed as of the date: $886.00
b. Estimated amount of future costs: $250.00
c. Total amount claimed: $1136.00
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.
Dao Thi N~uyen,
Carvn Nquyen,
WAR~ING' IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM!!
(Penal Code Section 72; Insurance Code Section 556.0)
I h~age 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. _r certify under penalty or perjury that the foregoing is TRUE AND
CORRECT.
Executed this 2nd day of November
,19 93, at Tustin, California.
DATE FIi~?~D'
CLAI¥~tN? S SIG~.T~RE
B 1 ' C LFO
Revised 4/29/91
R. G. Smith COMPA qY
_
327 S. Archer street, Anaheim, CA 92804 * ( 714 ) 956-3344 *Lic. # 332274
Date: 10/28/93
Owner: Mr. Uc Nguyen
· .
Address:
Re' Roof repairs due to falling tree.
For estimate of roof repairs to damaged clay tiles.
Area: Scattered.
This roof repair would be guaranteed against leakage for one year.
Total $ 886.00
Robert G. Smith, owner