HomeMy WebLinkAboutCC 4 CLAIM #90-04 03-19-9000 -ILI 10
DATE:
TO:
FROM:
SUBJECT:
March 2, 1990
HONORABLE MAYOR AND CITY COUNCIL
CITY ATTORNEY
CONSENT CALENDAR NO. 4
3-19-90
Inter - Com
CLAIMANT: MARYANN O'BRIEN; D/L: 01/04/90; DATE FILED
W/CITY: 02/08/90; CLAIM NO: 90-04 CARL WARREN FILE NO:
S 60181 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.
•, d
OURKE
City Attorney
JGR(F4)
Enclosure: Copy of Claim
;..Lt%11'1 1 -%V1 -11114J1 Ill" I.,11 L. vi iv" LA.<.
(For Damages to Pers( or Personal Property)
,
Received by
.U.S. Mail
iter -office Mail
ger the Counter
via
The law prove es generally that a claim must be filed 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
tive
1.
undersigned respectfully submits the following
to damage to persons and/or personal property:
NAME OF CLAIMANT : A I D;L f
a ADDRESS OF CLAIMANT:
b. PHONE NO - % c
SOCIAL
d. SECURITY NO: e.
claim and infFormation rela-
DATE OF BIRTH:
DRIVERS
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. X 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--flrom- which the claim a ffles :
a. DATE • f - b. 'TIME: (,�7 /S ?j --j -c . PLACE (Exact
and specific location) : n2o n F_ .0 r7 'A�-4/'A-
TLS 77/
d. flow 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).
-74
e. What particular action by the City, or its employees, caused the
alleged damage or injury?
%G �n�'/1 i 4C < 1� `'� ��11�� 1 <� �'�/
5.
0
7.
Give a description :he injury, property da e or loss so far a's��is
kncw n at the time of chis claim. If there weL_ no injuries, state no
injuries".
Give the name (s) of the City employee (s j causing the damage or injury:
Name and address of any other person injured:
Name and address of the owner of any damaged property: /-4Y-, .L -F-
9. Damages claimed:
G ��
a. Amount claimed as of this date
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.:
10. Names and addresses of all witnesses, hospitals, doctors, etc.:
a. IJ0rj
h_
c.
d.
1 Any additional information that might..be helpful in considering this claim:
WARNING: IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIPI! ( Penal Code
Section 72; Insurance Code Section 556.0)
o
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 of perjury that the foregoing is TRUE AND CORRECT.
Executed this � •n -t day of
office of the City Clerk,
T- -- "in, California
CLAIi1 NO:
Revised 8/05/81
,7GR: se : R: 8/5/81 (A)
19 QD at Tustin, California.
CLA/I(MANT 'S SIGNATURE
DATE FILED:
Skill Craft Body Shot. 1 17072 GOTHARD ST., HUNTI>N BEACH, CA 92647
. •,.._,�,`,^y`11� •�'.�'�' /'y, •l,!'..ii'� '.+ w.• �,.a'•,'.*.,.ji�'lt^7•„`r,`r i'I�l'''.i ,.'��!)�`••y��.''�,,"5 �(?ul'` a,�\• a�i4R'�,�iJ.":tl `''��•y/4:� +� �i•. �• ',Y ��`r:T� � +=1
a`_M�4• � t 1? ^ �A �I��� v�'t� ••? ii tiisl� Y ik x.^ ' �f4,,�rti+ 1N'yal� � � � 9:•.��t�l';1r�s�s,+�}i� 3. 1�(+t r Kl�� ":,,"
RY ANN O BRIAN JAN 17., 1990 R . 16793
'e56 CRAPS CYRTLE CIPv 1986 HOM
^
- BTT: PR,DATB: I
BTT: PT.CODE
REFERRED BY: UXKNC!Vl THC OD"EV
:
BSTIKATOP, TERP\T IDYNCH BD ST"L:
iTDYPBTDgxf ! KILEhGE: 64994
ITS, CONTACT: P.O. Fa:'
1.DJUSTER UNIT ho;
CLAiK No. :
I\ t� v'-:."4..�a"'��y�r�.''S )}})�,�F •''.%�ii'lSrirr3}Y.�v�.v�'�{ ,�a+�•Yti.1 ifiN �xi�i •"�,,VY T"�V,ra✓-.%t � '^../�i `'�•'S` y�a�� t��%
1, a /in .ft�r��lrw,�4�d�' �,�•�,��!df 31'�'�•��}r►�rf„•����' `t i �1•i� J` ra��*, i� ��,.•.�S
t.. .t. r.rJ t', y :n','...w�•44 wT` s.•tlArt.dt'Y,.F.•h,n ;L'n t•�r�. .'i'f�..^•',,y'•i�f'+'.!`'1":;J?t!t;
y:
POLICY No. :
CLAIM To.
INSIDE ADJ. ;
OTJTSIDB ADJ.:
DEDUCTIELB :
DATE OF LOSS: ! I
PHONE Ro. ( j -
!IT.
r SKILL—CRAFT HONDA CAR SPECIALIST
r , ni' v tii, • 'C� :x'.iyi, .Y it�t iCs f t•i1• S4 =.w•k:'-�a��r•�:r,..�m'�-•�''�C��'i.��,:•�=J:V�fi+G �11��: •. ►'.!a.
r✓!�Y��.�� �. ��p,..� p:r°'\•t5:�+1q{kyr-nj �y��J ��ti�,�}��.c'�:�ih�M:''wl�iro�� �•�.�!'ST`yc .
f'��.+..►cis'-y�i�ie..]�.�2��G:i"�Y�r�• .'1�.
r' •
�j
1 REPLACE FRCRT ENGINE CROSSFEKBER
REPLACE FRONT ERGINE KOUNT
' PULL FRONT CORBSUPPORT TO ALIGN
ALIGN FRONT SUSPENSION
5 CUST NEEDS 10 TAKE CAR TO KBCE SHOP YOR OIL PAI
�r
L'
tir
(� DO .
TOTALS
229,16
53,12
40,0P
:P2.
2F 1 f -cle I 10.Oc I 0,C+�
2,
3.
Skill Cr' aft`
Body Shop
Inc.
17072 GOTHARD STREET
HUNTIN6TON BEACH, CA 92647
/7A A\ CA 71AA
CERT. # AB076318 �-� ���--••--5- W
sue o c.
PARTS ,N„ 0
MISC
SUBLET
BODY LABOR
FRAME LABOR
PAINT LABOR
MECH LABOR
TOW
STORAGE
DAMAGE REP
TAX
TOTAL ESTIMATE
DEDUCTIBLE
282.28
0,a0
40.00
�,tf3
a.aa
e.ae
290.40
a.ae
a.00
17.64
639,32
0.aa
•a' �'• • � j "r.. -C f 1- : 'r. 1 i �:14',.. J' (:. �`•''s �--~- ♦ '4L : •. y;a . - a'-.Ir_li,: n..ra ..� 4.-'l,('T� SIFT H:i" � .:`.'<`.tiK.i• -T c'a= J... - �., y s:W,L, ; -�. 5� �,L a,., �iC
:{ :_� ,: ✓t v� cS r�+t .2r ).' �raii�Y - {:) J'.,frY y+V. +L .�, a ' •nom,... ^: .' 4'�a:%-. t :ti �� =k1 P,;; rw�•t''r�,7 ^,.,:5.'• t+,... ,•k% J��n �7r r-r�"S �)�,�t1 =ay.,i+�s'i�yy��' Yi�r+'1v:�.%' r '�i<-:jtr,'5•.!t��'.+rr."�:._"�,j,�.11cjL'�,it� «:.� >' -�`.
.:.-:,.e-:�:w!.?a. r,,'�4•.-ftp'.•..<_,J•�rT_.. a r.`;".�:--ra,. ... ..,l.. ,
PARTS PRICES SUBJECT TO SUPPLIERS INVOICE.
-eight hours after repairs are compleied. In the event legal action Is necessary to enforce this contract, I will pay
Storage will be charged forty
reasonable attorney's tees and court costs.
' I hereby authorize the below repair work to be done along with necessary materials. You and your employees may operate vehicle for purposes
of testing, inspection or delivery at my risk. An express mechanic's lien is acknowledged on vehicle to secure the amount o` repairs thereto.
.,:• ,• You will not be held responsible for loss or damage to vehicle or articles left in vehicle in case of fire, theft, accident or any other cause beyond
your control.
'CUSTOMER IS RESPONSIBLE FOR PAYMENT OF ALL REPAIRS.
SIGNED X
DATE
S26 00
FS40,0Q
oS26.40
0$94.80
ALL REPAIRS MUST BE PAID FOR PRIOR TO PICK UP OF VEHICLE.
Notice: Due to many unforeseen circumstances in the repairing of automobiles we regret that we can ONLY
ESTIMATE, NOT PROMISE a completion time. Your understanding is greatly appreciated.
No personal checks over $500.00.
All insured work that has a draft that has to be cleared with a bank or finance company also has to be paid under the
above terms prior to pick up of the vehicle.
To assist the customer in expediting the payment of any repair work performed by Skill Craft Body Shop, Inc., which
repair work may be covered b.y insurance, the following section must be completed at the time of presenting the vehicle
for repair work.
Power of Attorney: The undersigned does hereby constitute and appoint Skill Craft Body Shop, Inc., a California
corporation, by its authorized officers or employees, my (our) true and lawful attorney to receive, endorse and deliver
.for payment and to sign the name, place and stead of the undersigned, on any insurance drafts or checks, issued by
(insurance company) made payable for the benefit of the
undersigned, and to do any and all things necessary to exercise these powers, covering any payment for the repairs to
my (our)
(vehicle year, make & VIN) authorized by myself (ourselves), which drafts or checks Skill Craft Body Shop, Inc. is hereby
empowered to apply towards any amount due and payable to Skill Craft Body Shop, Inc. for the repairs of my (our) auto-
mobile. This Special Power of Attorney expires upon payment in full by the above-named insurance company and the
insured for the repairs authorized by the undersigned.
(Insured)
DATED: (Insured)