HomeMy WebLinkAboutCC 6 CLAIM #91-08 06-03-91-4GEND
( -3 -91
1ATE: MAY 20, 1991
TO: HONORABLE MAYOR AND CITY COUNCIL
FROM: CITY ATTORNEY
CONSENT CALENDAR NO. 6
6-3-91
Inter -Gofer
SUBJECT: CLAIMANT: DANIEL ARMSTRONG; D/L: 1-18-91; DATE FILED W/CITY:
2-14-91; CLAIM NO: 91-08; CARL WARREN FILE NO: S 64188 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.
1
V y ,- : UAY Yo s
G. ROURKE
City Attorney
JGRJab:5-20-91 (CL-9jab)
Enclosure: Copy of Claim
City of Tustin
AGAINST THE CITY OF T1
(For Damages to Persons or Personal Property)
`,he law provides generally that a claim must be filed with the City Clerk of
ie 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:
Tyle undersigned respec.Viuiii% sZ;w�+uai�..s t:;� `�� ��='=--:� =� ?'-"' ?nd information
relative to damage to person and/or property:
1. a. NAME OF CLAIMANT: Daniel Michael Armstrong
b. ADDRESS OF CLAIMANT:
d. TELEPHONE NO:
e. DATE OF BIRTH:
2. Name, telephone and post office address to which claimant desires notices
to be sent (if other than above):
3. This claim is submitted against:
a. XX 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: 1%1.8/91
b. TIME: 6:10 A.M.
C. PLACE (Exact and specific location): 5 Freeway north bound between_
Jaboree and Red Hill
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):
Oil pan to automobile (Large concrete block that fell from
hill that was placed y contruction workers that are working on
construction of freeway See phi t s- 'QnCQ QSeri
Severe rlamaxrP to lender carriage
�:. WHAT particuli r •tion by the City, or !mployees, caused the`' .,
alleged damage .,r injury? ��`'
Concrete blanks 6hau d have beemere _a
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".
Severe damage to oil pan on automobile., also sPVPrP dmmngP
under car. No personal 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: Nn P-
8. Name and address of the owner or any damaged property:
Dani P1 Ml i rhnPl Armctrnng A„tamobi le
9. Damages claimed:
a. Amount claimed as of the date:
b. Estimated amount of future costs:
C. Total amount claimed:
d. Attach basis for computation of
all bills, invoices, estimates,
$254.62
-k-
amounts
amounts claimed (include copies of
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 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 g- day of February f 199 , at Tustin, California.
DATE FILED: 1/19/91
CLAIMA SIGNAT RE
BI:CLFORM
Revised 10/23/90
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2001 E. SeventE
(714) 558-781.1 P.O: Boz 10079'.
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0 DANNY ARMSTRONG H
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ADVISOR -JI, SALFSMAW
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