HomeMy WebLinkAboutCC 5 CLAIM #90-02 03-19-90DATE: March 2, 1990
CONSENT CALENDAR NO. 5
3-19-90`
Inter - Com
TO: HONORABLE MAYOR AND CITY COUNCIL
FROM: CITY ATTORNEY
SUBJECT: CLAIMANT: CHARLOTTE EVANS; D/L: 11/23/89; DATE FILED
W/CITY: 01/18/90; CLAIM NO: 90-02 CARL WARREN FILE NO:
S 60151 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. A*
City Attorney
JGR(F4)
Enclosure: Copy of Claim
.,LAIM AGAINST THE CITY OF TUSTIN
(For'Damages to Person, r Personal Property)
Received by
.r Mail
er-office Mail
Over the Counter
via
The law provides 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 the
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: �a
a. ADDRESS OF CLAIMANT:
b. PHONE NO: ( C. DATE OF BIRTH: --
SOCIAL DRIVERS
d. SECURITY NO: � e. LICENSE NO:
2. Nacre, telephone and post office address'to which claimant desires notices
to be sent, if ocher 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: % 1,42 - 8 � b. 'TIME: c. PLACE ( Exact
and specific location) : /-77 % Q � b� ��� , 6 -
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 nec ssary).
e.
A n,rL 71-n ,bY-- /n " vLlP_ D .fir ('�. by AD_ / eJ`._ r,// /oLc./
A
What particular action by the City, or its employees, caused the
alleged damage or inlurv? • . A -
Give a description of e injury,
known at the time of L. --.s claim.
injuries".
Alf) A P< ty-.d IA ICA-VQs
property damp ,r loss so far
If there were injuries, stat _
Give the n,pe (s) of the ity employee (s) causing the damage or injury:
Name and add r ss_ of an other person injured:
�eqq� tvaS Ga�u� �d • ! �v �'
and ddress of the owner of any damaged property
Damages c 1 a imed : �-
a. Amount claimed as of this date: U�
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.:
_0. Names and addresses of all witnesses, hospitals, doctors, etc.: 1-%114--
a.
b.
.c
d.
_1. dditional information that might be helpful in considering this claim:
GJ f.
i c& 5 � ae.,Y)e, (�P,� to r I pu � h �I e. �-� - Al
h�P t46 Adve-,
5
?ARNING : IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM ( 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
:pon 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 19at Tustin, • California.
)f f ice of the City Clerk,
'ust-in, California
:LA. NO:
devised 8/05/81
JGR: se : R: 8/5/81 (A)
CLAMANT ' S SIGNATURE
DATE FILED:
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