HomeMy WebLinkAboutCC 5 CLAIM #91-42 10-07-91AGENDA/6,1 .,?/
'ATE: SEPTEMBER 26, 1991
TO: HONORABLE MAYOR AND CITY COUNCIL
FROM: CITY ATTORNEY
CONSENT CALENDAR NO. 5
10-7-91
SUBJECT: CLAIMANT: FRANK STRAWN; D/L: 03-07-91; DATE FILED W/CITY: 09-
06-91; CLAIM NO: 91-42; CARL WARREN FILE NO: S 66650 CLB
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.
VerWRKE
Very
i
1,4050,
Z
J
Ci Attorney
JGRJab(CL-9142 jab)
Enclosure: Copy of Claim
cc: Carl Warren & Co.
Finance Director
City Manager
,. City of Tustin p � l � U T � M
'M AGAINST THE CITY OF TU- N
(For D, .1es to Persons or Persona: ZOP ) SEP 61991
The law provides generally that a claim must be filed withOffki -1 M-ESt CM4ftfiffibf
V- City of Tustin within 6 months after the incident or event occurred. Be
your claim is against the City of Tustin, not another public entity.
%,Lore 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, 15222 Del Amo Avenue, Tustin,
California 92680
WHEN COMPLETING THIS FORM, PLEASE TYPE OR USE BLACK INK
TO THE HONORABLE 24AYOR 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 : FRMa S TRAWN through his agent KAY S'TRAM
b. ADDRESS OF CLAIMANT:
d. TELEPHONE NO: 1
f. SOCIAL SECURITY NO:
g. DRIVERS LICENSE NO: N/A
2. Name, telephone and post office address to which claimant desires notices
to be sent (if other than above):
SAME AS 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. X_ The City of Tustin and the following employee(s) of the City
of Tustin only:
OFFICER CT,F..SC RET
4. Occurrence or event from which the claim arises:
a. DATE: ,,4ar(,
_h 7P 1991
b. TIME: 9.0[) A_M_
C. PLACE (Exact and specific location) : 2245 Franzen Street, Apt. A
Santa Ana, CA 92705
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):
Officer Clesceri kicked FRANK STRAWN in the law causing the jaw to be broken.
The failure of the City of Tustin to provide FT-WX with treatment while he is in
!ail, As a result thereof.- FRANK is now in need of jaw reconstruction surgery.
alleged ... �� ___ �1 . 1 �.u�l✓iv�GGJ, CX LA.
l i1C
damage c� inj ury .
The fact that Of! Clesceri kicked FRANK STRAWN 'the jaw causing it to be
broken. No treat. _ _ ltwas given while FRANC was in .L 1 and as a result he now
needs Jaw reconstruction surcrery
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".
FRANK STRAWN is suffering frau a broken jaw.
6. Give the name(s) of the City employee(s) causing the damage or injury:
Officer Clesceri.
7. Name and address of any other person injured: NONE
8. Name and address of the owner or any damaged property: N/A
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,
N/A
$20,000.00
$100,000.00
amounts claimed (include copies of
etc.
10. Names and addresses of all witnesses, hospitals, doctors, etc.
KATHY ECtARD
ti .LING: 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 6th day of September , 19 91 , at Tustin, California.
DATE FILED:
'S SIGNA
B" ~LFORM
R sed 4/29/91
. _ _ iAcIMErrr TO CL A. -U -M AGAIIZT ME
OF TUSTIN FOR UAMACMS TO PERSON
DAMACMS c''7' ADIED :
d. BASIS FOR COMPUt'ATION OF AM MINT CLATVIED :
The amount claimed is based on the fact that FRANK STRAWN has a
broken jaw and the need for jaw reconstruction surgery.
SPECIAL POWER OF ATTORNEY
I, FRANK STRAWN, of
do hereby appoint KAY
STRAWN of
my true'and lawful attorney in fact,
for me and in my name, place, and stead, and for my use and benefit,
to ask, demand, sue for, collect, and receive all sums of money,
debts, personal property, or other obligations of any kind whatso-
ever which are now or shall hereafter become due, owing, or payable,
or otherwise belong to me, to settle and compromise any such debts
or obligations that may be due me and to indorse in my name any
check or note payable to me or my order given in payment of any such
other steps in connection with any such debt or obligation that he
may deem necessary and proper and in my name to execute and deliver
any receipts, releases, or discharges of any such debt or obligation
with the same effect as if such receipts, releases, or discharges
were executed by me personally.
I further give and grant unto my said attorney in fact full
power and authority to do and perform every act necessary and proper
to be done in the exercise of any o -f the foregoing powers as fully
as I might or could do if personally present, with full power of
substitution and revocation, hereby ratifying and confirming all
that my said attorney shall lawfully do or cause to be done by vir-
tue hereof.
Page 1 of 2
�1
• This power of attorney is granted for a period of one (1) y=ear
and shall become effective on June 12, 1991 and shall terminate
on June 12, 1992 .
Executed this J Z day ofj p , 1991 at-�'�'ri
C , A , California.
FRANK STRAWN
ACKNOWLEDGEMENT
State of California
County of Orange ]
On , 1991, before me, , a
Notary Public for the State of California, personally appeared
proven to me on the oath of
to be the person whose name is subscribed to the within power of
t
attorney, and acknowledged that he executed the same.
2
Notary Public for the State of California
My Commission expires , 19
Page 2 of 2
This power of attorney is granted for a period of one (1) near
and shall become effective on June 12, 1991 and shall terminate
on June 12, 1992 .
Executed this Z day of ; , p �, 1991 at
j %
-;.-I')'n
C , A California.
State of California
County of Orange
, -- On
FRANK STRAWN
ACKNOWLEDGEMENT
, 1991, before me,
Llotary Public for the State of California, personally appeared
, proven to me on the oath of
, a
to be the person whose name is subscribed to the within power of
CAT. NO. 4 TICOR TITLE INSURANCE
TO 1950 CAA (1 (11-1-84)
(Witness— Individual)
STATE OF CALIF?o
SS.
COUNTY OF ,
H
On .LC"-'—k/ZLb&�QAVA
me, the undersigned, a Notary Public in and for
said Sta , personally appeared
P known to me to be the person whose name is subscribed to the within Instrument, or proved to !ifornia
be such by the oath of a credible witness who is personally known to me, as being the subscribing Witness 19 ,
thereto, said subscribing Witness being by me duly sworn,
oscs ands s: T a this tncss resides in
d O i
Ian that id wit css present an aw CTi:iC;Al SEAL �
personally known to said witness to be the same person i� ,AT��•{ rL2::�- �.aL:: �-wiA
described in and whose name is subscribed to the within � / OPA-NGE c�TY
and annexed Instrument as a party thereto, execute and My CCMMMSION EXP AUG 25 1992
.� deliver the amt, and that affiant subscribed his/her
name to tV within Instrumcnf #Ls a Witness.
-VVITNES my a and off' i cal. `
e
� (This arca for official notarial xal)
Signed