HomeMy WebLinkAboutCC 5 CLAIM #90-43 01-21-91DATE: JANUARY 10, 1991
CONSENT CALENDAR NO. 5
`1 -21 -L-
A.
Inter - Com
TO: HONORABLE MAYOR AND CITY COUNCIL
FROM: CITY ATTORNEY
SUBJECT: CLAIMANT: MARK D. EVANS; D/L: 11/21/90; DATE FILED W/CITY:
11/19/90; CLAIM NO: 90-43; CARL WARREN FILE NO: S 63997 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.
ROURKE
City Attorney
JGR:kbg(claim.frm)
Enclosure: Copy of Claim
City of Tustin
L IM AGAINST -THE CITY OF TL _N
(For Damages to Persons'or Personal Property)
---The law provides generally that a claim must be filed with the City Clerk of
he City of Tustin within 6 months after the incident or event occurred. Be
pure 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 INR
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: MARK D. EVANS
b. ADDRESS OF CLAIMANT: c/o KATHLEEN L. PRICE, ESQ., 714 N. Spurgeon
C. CITY/ZIP CODE: Santa Ana, CA 92701
d. TELEPHONE NO:
f. SOCIAL SECURITY NO:
g. DRIVERS LICENSE NO:
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. X The City of Tustin and the following employee(s) of the City
of Tustin only:
City of Tustin Police Department
4. Occurrence or event from which the claim arises:
a. DATE: July 21, 1990
b. TIME: Approximately 10:00 p.m.
C. PLACE (Exact and specific location): 300 Centennial Way, Tustin, CA
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):
As Mr. I"'vans got up from a bench in his holding cell to cross
to the cell door on his way to make a phone call, he slipped arid
-ell on a puddle of water on the cell floor_, Bitting his head on
the bench and hi.s Tac k on the floor.
F
e. WHAT particular ction.by the City, or i. employees, caused the
alleged damage or*injury?
_Failure to repair leaking water facilities and/or negligently
_allowing water to remain in a dangerous condition on the holding
cell floor.
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".
Fractured vertebrae - back injuries
6. Give the name(s) of the City employee(s) causing the damage or injury:
City of Tustin Police Department
7. Name and address of any other person injured:
None
8. Name and address of the owner or any damaged property:
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,
To be determined
Unknown
To be determined
None
amounts claimed (include copies of
etc.
10. Names and addresses of all witnesses, hospitals, doctors, etc.
Western Medical Center, 1001 N. Tustin Ave., Santa Ana, CA 92705
Western Medical Center, 1025 S. Anaheim Blvd., Anaheim, CA 92805
City of Tustin Fire Dept. Paramedics, Tustin, CA
Unknown name of Police Officer who witnessed Mr. Evans slip and fall.
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 16th
day of November
DATE FILED: / // `"i l(� 6)
CLAIMANT' SIGNATURE KiYEHLEEN L. PRICE
Attorney for Claimant,
MARK D. EVANS
Bl:CLFORM
Revised 10/23/90
Santa Ana
19 90, a t T�, California.