HomeMy WebLinkAboutCC 3 CLAIM #90-33 11-05-90DATE: September 16, 1990
TO: HONORABLE MAYOR AND CITY COUNCIL
FROM: CITY ATTORNEY
' ONSENT CALI!VDAR NO. 3
_1-5-90
Inter - Com
SUBJECT: CLAIMANT: DENNIS BELANGER; D/L: SEPTEMBER 22, 1990; DATE FILED
W/CITY: SEPTEMBER 24, 1990; CLAIM NO: 90-33; CARL WARREN FILE
'LT^ e Q &13701A nn T
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.
it 0E SE
J ROURKE
City Attorney
JGR:kb9(c1aim.frm)
Enclosure: Copy of Claim
(c=r Damages to Persons or Personal Property)
Received by
U.S. Mail
Inter -office Mail
Over the Counter
via
ne 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 occurrec
Be sure your claim is against the City of Tustin, not another public entity.
Where space is insufficient, please use additional paper and identify informi
tion by paragraph number. Completed claims must be mailed or delivered to t}
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 relz
tive
to damage
to persons and/or personal
property:
1.
NAME OF CLAIPZANT:
T�7j`fNI� f`�C_ C-A,i,; r,
a . ADDRESS
OF CLAIMANT:
" (�
b. PHONE NO:
(
c. DATE OF
B RTH: ���-(�•- ;'
SOCIAL
DRIVERS
d. SECURITY
NO: (���, �(
e. LICENSE
NO:
2.
Name, telephone
and post office address
to which claimant
desires notice:
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. _ 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: 9-C-�),,�-"--)I u b. 'TIME: C. PLACE (Exact
and specific location) • l�`;r„,.,
d. flow and under what circumstances did damage or injury occur? Specify
the particular occurrence, event, act or omission you claim caused
_ tthe injury or damage (Use additional paper iIf' necessary).
l � �" _�")'� f"�;.i-� ; � �. tit' I %1..� •t •)�(/-•{ fJ f�'s'(,'( +'�/� 1' � t �'f� I,'.) .r` 1.=� \'� 2
e. What particular action by the City, or its employees, caused the
alleged damage or injury?
�.y /7i�f ./\� � 1 %I� -+ .'�- `��,.�'r .i f ( 1771 ' �• �'t ';%-�' f �r-�_�� `-.'� '��1' �/
5. GJ-�ye a description of 'he injury, property damages or loss so far as is
known at the time of s claim. If there were injuries, state "no
injuries"
6 Sive the name (s) of the City employee (s) causing the damage or injury :
7. Name and address of any other person injured: /�U��✓'�
8. Name and address of the owner of any damaged property:
(f 0 CIA_
9. Damages claimed:
a. Amount claimed as of this date: l�,Ajk-oC)("inJ
b. Estimated amount of future costs: ki (60 pUJ,J
C. Total amount claimed:
d. Basis for computation of amounts claimed (include copies of all bills,
invoices, estimates etc.: 11=Bf--E,
10. Names and addresses of all
% a.
�b
C.
d
witnesses, hospitals, doctors, etc.:
11. Any additional information that ,might be helpful in considering this claim:
�>or
1
WARNING: IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIPI! ( 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 of perjury that the foregoing is TRUE AND CORRECT.
Executed this 19 �l o
day of ,.,.r•�.� at Tustin., .California.
Off ice of the City Clerk,
Tustin, California
CLAIM NO:
R`.ised 8/05/81
JGR:se:R:8/5/81 (A)
CLAIMANT'S SI�NAT URE
DATE FILED: