HomeMy WebLinkAboutCC 4 CLAIM #91-40 10-07-91AGENDA/6--, ,
TE- SEPTEMBER 11, 1991
TO: HONORABLE MAYOR AND CITY COUNCIL
FROM: CITY ATTORNEY
CONSENT CALENDAR NO. 4
10-7-91
SL1BJE: T: CLAIMANT: RICHARD DIAZ; D/L: 02-20-91;
ARL WARREN FILE
FILED W/CITY: pg -
20"91; CLAIM NO: 91-90;
------ ILE NO : S 66607 PRL
--- - -
After investigation and review it a
above -referenced claim be rejected and the Cit is recommended that the
give proper notice of the rejection to the cl Clerk directed to
claimants attorney. laimant and to the
Very tru ours
4JAMG K
City Attorney
J G R J-kb:091191(CL-9140. jab)
Enclosure: Copy of Claim
cc: Carl Warren & Co.
Finance Director
City Manager
City of Tustin
IM AGAINST THE CITY OF TU. d
(For Damages to Persons or Personal Property)
law provides generally that a claim must be filed with the City Clerk of
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 identif
information by paragraph number. Completed claims must be mailed Y
delivered to the City Clerk, City of Tustin, 300 Centennial wayor
California 92680 Y. Tustin,
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:
NAME OF CLAIMANT:
ADDRESS OF CLAIMANT:
CITY/ZIP CODE: .
TELEPHONE NO:
DATE OF BIRTH:
SOCIAL SECURITY NO:
DRIVERS LICENSE NO:
ra r�,
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. The City of Tustin only.
b. The following employee(s) of the City of Tustin only:
C • City 0' T ••�♦-; •, and the '
L:..�.. .,�.., ^g employee (s: of �'�e Cite
f �? ? ,.......
of Tustin only: 1
4. Occurrence or event from which the claim arises:
a. DATE:__2 -
b. TIME: p
C. PLACE (Exact and specific location :
d. HOW and under what circumst
the particular occurrence,
the injury or damage (Use
:ances did damage or injury occur?
event, act or omission you claim
additional paper if necessary):
Specify
caused
e. WHAT particul action by the City, or employees c
alleged damage or injury? Y aused the
5. Give a description of the injury, property damage or loss s
at the time of this claim. If there were no injuries t to known
injuries", no
6 - • • A&"AuC t 5 j ur Lne city employee (s) causing the damage or injury:
fury:
7. Name and address of any other person injured:
vre
S.
9.
Name and address. of the owner or anv damaged property:
Damages claimed:
a. Amount claimed as of the date: 4)H —7
b. Estimated amount of future costs:
c. Total amount -claimed:
d. Attach basis for computation of amounts claimedI
all bills, invoices, estimates, etc. (include copies of
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 an
d I same to be true of my own knowledge, except as to those matters stated
the
upon information -or belief and as to such matters I believe the s to be
tr''1'-' - I certify under penaltyor perjury same to be
CORRECT.
pe_�ur�� twat the foregoing is TRUE AND
Executed this �� day of
,19 � � at Tustin, California.
DATE FILED:
B1:CLFORM
Revised 10/23/90
4d. The damage occurred while driving east down Edinger. A
very large hole in the pavement was only partially covered.
Unfortunately I didn't notice the corner that was uncovered
which was well within my lane. The diagram below will show,
the approximate location of the cover and of the uncovered
section as well as my lane.
0
1
+------------------+ o
S
Cover +--+ t
1 O •
t t
'
Hole
, t
+--+ o
t ,
' 1 o
------------------+
i 1
Lane
o
o = orange cones
TRAFFIC COLLISION REPORT, TUSTIN POLICE DEPARTMENT
_
SPECIAL CONOmONf MMM$tR
!/
•AGE
AAT a RUN CTT
=104,0 FRONT
�3- ❑ TUSTI N
JUDICIAL DISTRICT
OF
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w f o ' MISC. um c°wm
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-�' ❑ ORANGE
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7JLUSON OCCURACO ON
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EDTAJGER AVG
MO. DAT YEAR TIME (U" NCtc• OFAC14L0.
Fo
�lVOSTtNFOAMATION --------- ---------------------.- bq ) 1610 3022 '72 g
OAT OF WEEK TOW AWAY PHOTOGRAPHS By:
SMT T F S
p
J
❑ AT MRCAStCTTON WfTN
❑ YEf ONO Jj x,45 IE L L Q
PARTY
OAr STATE H" AffiOIL.f ? vLEf OP E� ` P.4 G ? r 1 c E� L D R R. ❑ rd 21No
ORIv[A'i LtttNst NUM$EA XTATt
NONE
❑
1
CLASS SAFCTT vIK t
, QIL YAXC / Mood I COlOA
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RI
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NAM C tAw
AfT, OOlt. LASTS
�P �ISv8Is�1 ECc.IPsE /��
. . . . . /
. . . . . .
r
STREET ADDRESS
TRIAM
r
�SOWNER'S
wwt SAME Ai OAtvtR
OTT/STATEizw
VEHICLE
❑
OWNEA'f ADORES$ SAM[ AS DRIVER
MCT- SEX HAIR EYES H/ERCM wbC►R
cufT .M II L V $IATNOATt
�1 YQ
❑ L. 113 b
; 04= � O
I as.osnwN or VEHICLE oN CAotAt OP.. ❑ OPACCR ®O1rYEA ❑OTHER
� j
�l c.aBUSINESS
�
MCA ►MARE PHONE
PHONE
❑ (7 1 4) 19,111-6-N6 -7)'1
)'1 ��.� • 4913.3 MIO' YECNANICAL DEFECTS. NONE AMAmea RIPER TO NARRATIVE ❑
NSURAMCC CARRIER
POLICY NUM$ER
CNP uSt ONLY Cesca$E VCHICLt 0"ACE SHADE NI DAMAGED ARU
VENCIE TYPE
6
.4L LST.4 rE o d �r D g 86
❑WK
•
❑NONE
3"NOA
DIA OF ON STREET OR HIGHWAY
❑ MOD
❑
MAJOR ❑ TOTAL
i V L E
SPEED PCF
r�
ICC
•uc a
PARTYcHP
OIIVCR'f LICENSE NUM$C'
(3
STATE CLASSSAFETY
2
VEK rR MAXI/MODEL/COCOA
EOUIP, UCENSENUM$EA STATT
OAntR . t IARST. MIOOLC. LAST)
. . . . . . . .
PEDES. *TACIT ADDRESS
TRIAM
OWNER'S NAME ❑ SAME AS DRIVER
PARK t0 CITY / STATE A 21►
VE
0
OWNEA•S AGGRESS ❑SAME AS OIIV[A
EX
HAIR
ETES HEIGNr
WOCM
$IATDAY
�' � OAT ; YEAR
AACt OIiPOSRON OF VEHICLE ON ORDERS Of: ❑ OFFICER ❑ OA.vE' ❑OTHER
E PHONE $USWESS
PHONE ,
PRIOR MECHANICAL DEFECTS: NONE APPAA0.ff REFER TO NAAAATIVCCHP
AANCt CAAAIEA POUCTNUMSCA
IPARTY
VSE ONLY
VENCIE TYPE❑
OESCAIitVINCLE OAMACESHADE W OAYACtO YItA
UM[. ❑ NONE ❑ MINORMOO.
.OP
ONSTAIRORNIGONAT
❑MAJOR ❑TOTAL
SPCFVEL LIMIT
c
►
OER•s
UCINSE NUMSCA
uRP O
3
STATE
cuss
SAFETY VCKY0.
Iwo.
M"11MOCCLIColoA
uCENSI NUMSEA XTATT
OAIVEA NAME (RAST. YIoOLE. LAST)
. . .
. . . . . . . . .
. . . . . . . . .
. . . . . .
i KOCS. STRICT AOOAISf
AMOWNEA'f
NAME ❑ CAME AS DRIVER
jJ1
OWNER'S ADDAISS SAME AS CANER
4#A�AKC0CXTVlSTAT[/
hAAA
t/Ci NUGHfT WOGHfT
MATHOATT
YEARHONE
'Ac[ DISPOSITION OF VEHICLE ON OROCAS oF. ❑ OFFICER ❑ OA IVCA ❑ OTHCA
fuswtsf
PHWNt)
(
PRIOR MECHANICAL OCFECTS: NONE AMAAQNT ❑ RIFER TO NARAATIV[
Cl►oucr
UAANCI CAAAICR
NUY$c'
CHP Vat ONLY OISCNGI VEHICLE OAMACt
VEHICLE TTP[ SHADE W DAMAGED AA[A
❑ uH.l ❑ NONE
❑ MINOR
CIA.•
ON iTR[R OA HIGHWAY
❑MOO. ❑ MAJOR
❑ TOTAL
RA CL
TIIvtI
SOCIO
PCF
K:C C3 ,.
L*Ar
PUC
OAIPARE 'S NAME
CHP C3•
/
AtV1C WEA'$ NAME
OATS
vR[WC Y
0 H P 555 -Paget (Rev. 5-87) OPI 042
TRAFFIC COLLISION C001vt
DAr= of c
rima 1
ro. DAT O TEAR 4q ! ) 0
PROPERTY owa11RSNAM&.A00arSS
DAMAGE
9 i -01;z 6
PAGE Zi
EATING POSITION
I . DRIVER
2 To II . PASSENGERS
iZCCUPANTc SAFETY EQUIPMENT
A • NONE IN VEHICLE M I c FVCYC F
B • UNKNOWN L • AIR BAG OEPLOYEO
H ( MFT EJECTED FROM VEI
T •STA. WClL REAR
• - AA. DCI. TRK_ OR VAN
• •POSITION UNKNOWN
C . LAP BELT USED
0 •LAP BELT NOT USED
M . AIR BAG NOT DEPLOYED DRIVER
N •OTHER
V
0 . NOT EJECTED
1 • FULLY EJECTED
I 2 3 0.OTHER
E •SHOULDER HARNESS USED
F • SHOULDER HARNESS
P •NOT REOUTAED W- YES
2 • PARTIALLY EJECTED
3
456
NOT USED
G . LAP I SHOULDER HARK ESS USED
CHID RPtTR`INT PASSENGER
-UNKNOWN
7
H .LAP /SHOULDER HARNESS NOT USED
J • PASSIVE RESTRAINT USED
O. IN VEHICLE USED • 140R . IN VEHICLE NOT USED
K •PASSIVE RESTRAINT HOT USED
S . IN VEHICLE USE UNKNOWN Y • YES
T • IN VEHICLE IMPROPER USE
PRIMARY COLLISION FACTOR
UST NUM9ER Is1 OF PAATY AT
ITEMS MARKED BELOWw U • NONE IN VEHICLE
HlCH AAE FOLLOWED Br AN ASTERISK (•)SHOULD 8E
TRAFFIC EXPLAINED IN THE NARRATIVE
FAULT
CONTROL DEVICES
• 1 A vC SECTION VIOLATED: 080
�ra
A CONTROLS FUNCTIONING
1 Z 3 TYPE OF VEHICLE
MOVEMENT PROCEDING
' Z
"'0
B CONTROLS NOT FUNCTIONING*
A PASSENGER CAA /STA, WGN.
3 COLLISION
CONTROL= OBSC
B PASSENGER CA W /TRAILERC
A STOPPED
N DRIVER•
H�DU�NKNOWW
O Io+RaoLs PRESENT / TACTOR•
TYPE
MOTORCYCLE/SCOOTER
D PICKUP OR PANEL TRUCK
B PROCEEDING STRAIGHT
OFCOLUSIONIIIIIIIIII
A HEAD-ON
E PICKUP I PANEL TRK W / TLR.
C RAN OFF ROAD
A E FELL ASLEEP•
B SIDESWIPE
F TRUCK OR TRUCK TRACTOR
D MAKING RIGHT TURN
C REAR END
G TRK. IRK. TRACTOR w / TL:t
E MAKING LEFT TURN
WEATHER MARK I TO 2 ITEMS)
D BROADSIDE
H SCHOOL Bus
F MAKING U TURN
A CLEAR
EMT OBJECT
1 OTHER BUS
G BACKING
8 CLOUDY
F OVERTURNED
J EMERGENCY VEHICLE
H SLOWING I STOPPING
C RAINING
G VEHICLE / PEDESTRIAN
K HWY. CONST. EQUIPMENT
I PASSING OTHER VEHICLE
D SNOWING
H OTHER•'
L BICYCLE
J CHA ►rdING LANES
E FOC /VISIBILITY FT•
F HER*:
MOTOR VEHICLE INVOLVED WITH
MOTHER VEHICLE
N PEDESTRIAN
K PARKING MANUEVER
(, ENTERING 'TRAFFIC
G yNNO
APION-COLLISION
B PEOESTgIAN
O MOPED
M OTHER UNSAFE TURAYNG
UGHn;
A DAYLIGHT
C OTHER MOTOR VEHICLE
NXItIG INTO OPPOSING LANE
Q PARKED
B DUSK . DAWN
D MOTOR VEFL ON OTHER AOADWAr
P MERGING
ARK . STREET LIGHTS
E PARKED MOTOR VEHICLE
F TRAIN
OTHER ASSOCIATED FACTOR
(MARK 1 TO 2 ITEMS)
Q TRAVELING WRONG WAY
RK. NO STREET UGNTS
G ANIMAL -44%m
A ve vlouT,o/e e+Taa
R OTHER
EE
L OARIC • STRT LIGHTS NOT
FUNCTIONING
H ANIMAL:
Oras
ONo
ROADWAY SURFACE
B vc xcTlo" vaunoPr clrEa
A DRY
1 FIXED OILJECT:
❑Y[f
ONO
s0eRlETY40UG
B WET
C SNOWY .ICY
J O A OBJECT:
vc SCCnoN `VOLA .�;
C unto
Oras
PHYSIC �L
(MARK 1 TO AL,ITEMS)
D SLIPPERY ( MUDDY. OILY. ETC.)
rbT *I C-
p ❑►w
A HAD NOT BEEN DRINKING
ROADWAY CONDITIONS
MARK
E VISION OBSCUREMENT:
F INATTENTION•
B HBO . UNDER INFLUENCE
C HBO - NOT UNOEA INFLU.-
( 1 TO 2 ITEW
PEOMMAK9 ACTION
G STOP i GO TRAFFIC -
-. D HBO - IMPAIRMENT UNK•
A HOLES. DEEP PUTS,
A NO PEDESTRIAN INVOLVED
H ENTERING / LEAVING RAMP
E WIDE 'R DRUG INFLU.-
B LOOSE MATERIAL ON RDWY.•
B CROSSING IN•CROSSWALK
I PREVIOUS LISI
COLON
F IMPAIRMENT. PHYSICAL•
C Oe ON aoAowAM•
AT INTERSECTION .�
J UNFAMILIAR WITH ROAD
G lMPAlAMENT NOT KNOWN
STRUC IO
• D CONSTRUCTION .REPAIR ZONE
C CROSSING IN CROSSWALK . NOT
K DEFECTIVE VEH. EQUIP.: CITED
H NOT APPUCABLE
E REDUCED ROADWAY WIDTH
AT INTERSECTION
D CROSSING • )TI N CROSSWALK
❑mai
O�
I I I I SLEEPY / FATIG UED
F FLOOD ED•
G OTHER'-
E IN ROA -INCLUDES SHOULDER
UNI
L NVOLVED VEHICLE
SPEC IAL INFORMATION
A HAZARDOUS MATERIAL
H NO UNUSUAL CONDITIONS
F HOT IN a0A0
G APPROACH / LF-AVING
M OTHER•;
N NONE APPARENT
SCHOOL BUS
O RUNAWAY VEHICLE
/� Arac[LLrwEous
I
F.0?,v GE R
INOI C.�Tt
MOATM ,
l71 ���GL pAclFrc
&64 D R.
Pow WiT cg5h �, A4px ux.
s
n
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4� Gus,5b
1 IV v� W
CA 71 01
• . age ev - 042
NARRATIVEISUPPLEMENTAL PAGES
DATE Of INCIDENT i OCCURENCE
-q J
TIME (24001
NGC NUMBER
OFFICER 1.0.
1
NUMBER
')P ONE
gRATIVE
U SUPPLEMENTAL
X�ON,E/
1 COLLISION REPORT
/T
OTHER
TYPE SUPPLE MENTAL (X' APP%ICA"
❑ BA UPDATE 1:1 FATAL
a HAZARDOUS MATERIALS a SCHOOLBUS
❑ NIT i RUN UPDATE
❑ OTHER:
CITY/CGt.I+TYIJ.V0fCALOISTRIGT
REPORTING DIVA= BEAT
CITATION NUMBER
LOCATION I SUSACT
STA: E HIGMWAY RELATED
YES NO
t. AJ 0 r -t FSGQ TZ O N
•2.
3. EG S V C L -f D CAU TAG 17 tAJ -111 N
4. L A AvD R t S U
16 !'Y R,S ,4N
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7. DIV 07DrAhZeR,
8.
9.
10.
11.
12. S A :
13.
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11 P- J wAS 15AST SouQb oN EpSAIGER wNEAJ J41:S r -AR grr
15. W 4 v N
16. D.Q/p A G EN D AJ -r c .4 .DT C6
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18. 1406& 11+4 6t0t 1 v= lh/ - T009- Svc -Y AL PtfDroS OF-
7 4& %ate &177)-f•
19. A- 3 S'm m, CAm cS-. A-,Aj.6 foo/c--Q 7ti6 1 /r�j P/A-n Lk� Oq�4- AE✓6i�,0 i
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21. GiNCS) Cjk'
22.
23.
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25.
26. 7 AidRs -rH47, Due r6 R6Apw6PK1.
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27. JC65T w?D AND J AC46T LQAJC,N N R -04
28. A6
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29. A P A sgf6l o :6r6-rNe PAR7g,4 w Aj6T cayEgeop
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32.
_
PREO=tN/0r�REIEER'�4 ASwME
CA S?EC LQ NUMBER� -�1 1
MONiniOwrirEAA
T
CHP 556 (Rev. 7-87) OPI 042 U«pr.wu.4A.omw"d.v«.. 88 48U
STATE C01 CAUiOONIA
NARRATIVE/SUPPLEMENTAL
PAGE -1
DATE OF INCIO NT / g--uAENCE
QZ "�^l
T14E 12`x'/
1 t
NCIC NUTABER
�uZZ�
Off 1.0 M11 R
'�i�'
•7C ONE
Er-AiuTIVE
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WOKE
COLLISION REPORT
Q OTHER
TYPE SUPPL%MENTALr APPLJCABLZ)
a SA UPDATE a FATAL NIT i RUN LIPOATE
a NAZAROOUS MATERIALS Q SCHOOLOUS a OTHER;
•
CITY ICOUNTY /JUOICALOISTAICT
REPORTING OMTAICT/BEAT
CITATION NUMSEA
LOCATION ISUbJECT STA: E MIGHwAr AEUTEO
YES NO
CON7.
2•
3.
�}iv.� !.' iJ i o � . l T INKS tN ' F POATI orJ. d % Z �
' 4.
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19.
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25.
26.
27.
28.
29.
30,
_
31.
32.
PREPAAER-SNA I.0.N R MONTMIOAY/YEAA P"IEWERS NAME MONTM/ Y/YEAR
(115 1C'1r.l,ti Z -t
CHP 556 (Rev. -7 OPi 042 U"w*v4w&"won.I•so.Iw 88 4W41
Computation for amount claimed:
74.55 Rim
53.91 Hubcap
58.69 Alignment and Balance
7.00 Police report fee
194.17
Garden
Lirove mit
9898 Trask Avenue
GARDEN GROVE, CALIFORNIA 92644
(714) 636-6487
sunishi
DATE ENTERED
YOUR ORDER NO.
DATE SHIPPED
INVOICE DATE
INVOICE
02 APR 91
On HO PR 91
0 tlPR 71
NUMBER
D 91161 �
S ACCOUN r' 1'40& 71798,11 S PAGE 1 OF
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9898 Trask Avenue
GARDEN GROVE, CALIFORNIA -92644
(714) 636-6487
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15342 MARYKNOLL
WESMINSTER CA 92683
ALL PARTS ARE NEW UNLESS SPECIF
ORIGINAL ESTIMATE S
wEwSEO EST. DATE Turf ►E
s
REVISED EST. OATS . Time PEP40
MEANS OF CONTACTING M
0 IN PERSON 0 BY PHONE Or -
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Non. •r. or eftvm w. ow aw swr� of r•a•r maw
SUBJECT To CONOMONS ON REVERSE SIDE OF TM CONTRACT.
►LEASE READ REVERSE SIDE
Ctwrww Aanwrp.. wwwp M • Can I.w..E
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NOTICE TO ODNSINIER !LEASE READ s/ORTANT 000RIM110N ON BACK
in M r.wr rr yra. M emaw. w. rtaawa• Swaww.wA Mr M Ow wwrwn wllwl.aw w a tww w
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DUPLICATE 3 PAGE 1
TERMS: CASH OR CHECK
GARDEN GROVE MITSUBISHI BP.R#AA-122140
JyFr9AC �TkikFOLLOWING CREDIT CARDS:
GARDEN GREMJs Ff(3AAb • VISA
BRYAN SANDERS
y am.., . DATE $EADY STACK NO. VEIICLE IDENTIFICATION COST. NO. TAO NO. P.Q NO. MONTEo IMVOICE NO.
)MAY91 20MAY91 945780 T156 LOMAY91 22271'
TIME IN TIME READY YEAR MAKE A MODEL TELEPHONE NO:. ii_.. GATE aY filA
08509 15518 0 MITSUBISHI ECLIPSE 53.00 1MAR89 1 434
MILEAGE M MILEAGE OUT LICENSE NQ MISCELLANEOUS COMMENT ! LOCATION : •; , .•:. ?r.' �;+:
49720 49720
REPLACE RIGHT FRE7NT RIM
651 R/R RIM'
447 C 0.50 26.50 26.50
ALIGNMENT ( FRONT END ONLY
148 ALIGNMENT ( FRONT END ONLYIf -
372 r...L 0.00._ 0 0.0
23L WINSTON�
C 47.19
t! "
�,q s.a • :.it...• • �-i'y.. .. 'r r elF` nra •
DESCRIPTION 1 TOTALS
0 .00 The factory warranty constitutes all of the war-
ranties with respect to the sale of this
0.0 On item/iitems. The Seller hereby expressly
47.19 disclaim all warranties, either express or
0.00 Implied. Including any implied warranty of mer-
? 3.6 9 chanW Aity or fitness for a particular purpose.
Seger neither assumes nor authorizes any
15 . 0 0 other to assume for It any liability In
0.00 nn wi s this Item/items.
t
W SERVICE DEPT. HOURS
ARTING NOVEMBER 21 ST
NDAY THRU FRIDAY
30 AM TO 6:00 PM
a
Cityof Tustin
300 Centennial Way
Tustin, Cafifomia 92680
(714) 544-8890
DATE aJ ;L6 -�I
RECEIVED 6Y —1
CASH $
CHECK NO. 4-S �-
CHE
AMOUNT $ 7A
TOTAL $
mmmI
111—
imilm
TOTAL $