HomeMy WebLinkAboutCC 5 CLAIM #89-10 03-05-90w.,
DATE:
TO:
FROM:
SUBJECT:
HONORABLE MAYOR AND CITY COUNCIL
CONSENT CALENDAR NO. 5
3-5-90
Inter - Com
CITY ATTORNEY
CLAIMANT: DEBBIE ADLER; D/L: 3/29/89; DATE FILED W/CITY:
5/4/89; CLAIM NO: 89-10; CARL WARREN FILE NO: S 57822 NPB
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.
JJS4. ROURKE
City Attorney
JGR (F4)
Enclosure: Copy of Claim
CLAIM AGAINST THE CITY OF-TUSTIN _
10 (FQr Damages to Persons ", Personal Property)
Received by via
,S. Mail
.ter -office Mail
Uver the Counter
The law prove es generally that a claim must be..i ed with the City Clerk o
the City of Tustin within 100 days after which 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 informa.
tion by paragraph number. Completed claims must be mailed or delivered to th
City Clerk, The City of Tustin, 300 Centennial Way, Tustin, California 92680
TO THE HONORABLE MAYOR AND CITY COUNCIL, City of Tustin, California:
The undersigned respectfully submits the following claim and information rela-
tive to damage to persons and/or personal property:
.
1. NAME OF CLAIMANT: �8131 j aDLA
a. ADDRESS OF CLAIMANT: �
b. PHONE NO: ( ' C. DATE OF BIRTH:
SOCIAL DRIVERS
d. SECURITY NO: �'� - ( e. LICENSE NO: �
2. Name, telephone and post office address to which claimant desires notices
to be sent, if other than above:
.This claim is submitted against:
a. 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: 3-aq b. TIME: < < ; (� O Q, jam, c. PLACE ( Exact
and specific location) : 11_ nM i L)c RiUE uLbt- -hL%c nye?��ti�� ,
Arad Sk'aSuiAJK- b4 deesS Shoed su�'�Ne��� -,j�e 1 J
d. flow and under what circumstances �id damage or injury occur? Specify
the particular occurrence, event, act or omission you claim caused
the injury or damage (Use additional paper if necessary).
n av -�b r_ n1Q01z 1..1r• 1.n4- 1. -'Dom. +At -, +h' -[>P i► Pl
e.
-J'-0 2-.e-' l� -L& E 'Asa- d l g + MN � �} n � � . -!I-- v..) B -j, "D AR 14 St) 71.
see, So where X s`&-PP�d I%Xto sIf' I :� Lwjs d �^Y ,00 f k�k�
What particular action by the City, or its employees, caused'the�jeI-e
alleged damage or injury? Jg
+. .
Give a* description of injury, property damp r loss so far as is
known at the time of -s claim. If there were ,o -injuries, . state "no
injuries".
�Lu t i JE, Qe- S a A � ►a � f�N 1L ,j- Ari A � C � � �1; -� � -� = D � t� l t a � � 5
A K Lr-
• Give the name (s) of the City employee (s) causing the damage or injury:
/V
. Name and address of any other person injured:•
Name and address -of the owner of any damaged property: /vim -,vim
0.
Damages claimed:`
a. Amount claimed as of this date: 1 �00
b. Estimated amount of future costs:
c. Total amount claimed:
d. Basis for computation of amounts claimed ( include copies of all bills,
invoices, estimates, etc.: d t;
Names and addresses of all witnesses, hospitals, doctorsf etc •&
.
�
b .,-
C.
d.
my additional information that might be helpful in considering this claim:
vN 1✓%
T
�RNING : IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIPI! ( Penal Code
Section 72; Insurance Code Section 556.0)
have read the matters and statements made in the above claim and.I know the
ame to be true of my own knowledge, except as to those . matters stated to be
con information or belief and as to such matters I believe the same to be true.
certify under penalty of perjury that the foregoing is TRUE AND CORRECT.
xecuted this day of
19 at Tustin, California.
L AIMANT' S SIG14ATURE
rf ice of the City Clerk,
�.n, California
LAIM NO: DATE FILED:
avised 8/05/81
,jR: se : R: 8/5/81 (A)
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