HomeMy WebLinkAbout17 CLAIM #95-19 07-03-95NO. 17
7-3-95
MEMORANDUM
TO:
FROM:
DATE:
Honorable Mayor and Members of the City Council
City of Tustin
City Attorney
June 27, 1995
Claimant: Anne Hsu; Claim No.' 95-19; D/L: 3/25/95;
Date Filed w/City' 5/30/95; Carl Warren File No.' S 84160 PRB
Recommendation:
After investigation and review it is recommended that the above-referenced claim be
rejected and the City Clerk be directed to give proper notice of the rejection to the claimant and
to the claimant's attorney.
Background:
This claim for $772.00 arose after unknown persons broke into Ms. Hsu's friend's
vehicle and stole Ms Hsu's luggage. The vehicle was owned by the Ehmson's (See Claim No.
95-17) and was parked at the Stevens Square Parking structure. The structure is not owned by
the City and there is no evidence of negligence by the City.
Enclosure' Copy of Claim
CC'
Carl Warren & Co.
Finance Director
City Manager
Lois E. Jeffrey:;/
1100-00022
14097 1
--
City of Tustin
AIM AGAINST THE CITY OF'~ ,TIN
(For Damages to Persons or Personal. Property)
The law provides generally that a claim must be filed with the City Clerk
the City of'Tustin withiD 6 months after the incident or event occurred. L
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: A
b. ADDRESS OF CLAIMANT: ~.~
c. CITY/ZIP CODE:
~
e. DATE OF BIRTH: ~
f. SOCIAL SECURITY NO:
g. DRIVERS LICENSE NO:
2. Name, telephone and post office address to which claimant desires notic~
to be sent (if other than above):
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: ~,~,~ ~ I9~S
b. TIME: ~,~ ~ :~ ?~
c. PLACE (Exact and specific location):
d. HOW and under what circumstances did damage or injury occur? Specify
the particular occurrence, event, act or omission you claim caused
the injury or damage (Use additional paper if necessary):
t · ! . t ~-- ~
e. WHAT particula, -~tion by the City, or ~,, 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".
IX/t>
6. Give the name(s) of the City employee(s) causing the damage or injury:
7. Name and address of any other person injured: ~J/D
8. Name and address of the owner or any damaged property:
9. Damages claimed:
a. Amount claimed as of the date: ~ qq~,o(?
b. Estimated amount of future costs: . ~ O.CO
c. Total amoUnt claimed: ~~.~0
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.
Vtt,-~ct.. ?~ g.te., ca q.z ~, (-.,'-7
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
CORRECT.
Executed this 2[ day of
DATE FI ]',F.D' 6'/~,/? 3'
,19 i9 , at Tustin, California.
CLAIMANT'S SIGNATURE
BI:CLFORM
Revised 4/29/91
Items lost in duffle bag
ITEM
Running shoes
Orthotics
Shoes
Martial Art Shoes
Sewing Scissors
white satin fabric
curling iron
blow dryer
dress
organizer
address book
jeans
vest
vest
skirt
blazer
shirt
shirt
shirt
brown belt
pajamas
shirt
shirt
tights
martial arts swords
toiletries.make-up
underwear/socks
plane ticket
sewing machine
ski pants
ski goggles
ski gloves
(2)
and backpack:
BRAND
Saucony
Esprit
Fiskars
vidal sass6on
vidal sassoon
Limited
Dayrunner
Old Navy
GAP
GAP
Honors
Honors
energi-e
Express
United (reissue
Kenmore
Smith
goretex
AGE
1 yr.
1 yr.
1 yr.
2 yr.
new
new
t yr.
2 yr.
1 yr.
6 mos.
2 yr.
1 yr.
new
2 yr.
2.yr.
2 yr.
2 yr.
1 yr
1 yr.
2 yr.
2 yr.
3 mos.
new
3 mos
2 yr.
fee)
10 yr
1 yr.
1 yr
2 yr
EST. PRICE
$45
$160
$35
$20
$15
$15
$15
$15
$35
$25
$15
$25
$20
$1o
$20
$20
$20
$15
$,:15
$25
$25
~0~ $20
$20
~ $6
$]00 (50 ea)
$2O
$2O
$150
$~00
$25
$25
ski gators
ski headband
scarf
glove liners
dorm key (cost of rekeying)
2 yr.
2 yr
2 yr
$25
$8
$3
$10