HomeMy WebLinkAboutCC 9 CLAIM #90-34 12-17-90DATE: DECEMBER 5, 1990
TO: HONORABLE MAYOR AND CITY COUNCIL
FROM: CITY ATTORNEY
CONSENT CALENDAR NO. 9
12-17-90
Inter - Com
SUBJECT: CLAIMANT: GREG E. BARRON, M.D.; D/L: 9/30/90; DATE FILED
W/CITY: 10/11/90; CLAIM NO: 90-34; CARL WARREN FILE NO: S
63729PRL
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.
a4
AM G. ROURKE
City Attorney
JGR:kbg(claim.frm)
Enclosure: Copy of Claim
:ULAiM AUAINbl' 'frit, l..LTY yr 1'U�1'l1V
tz;ForDamages to Persor r Personal Property)
Received by via, _
U.S. Mail — -
Inter—office Mail
`ver the Counter
The law provides generally that a claim must be sled with the City Cler 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 informz
tion by paragraph number. Completed claims must be mailed or delivered to tl
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 CLAIMANT: 6Pe7 &- E • 'B&YZ-2;J , A4 .'D
a.. ADDRESS OF CLAIMANT: 2SQ7 1 PrV PrTAt e- , LJarL-SNA 1t t(--U.-eLA c 924;,7
b. PHONE NO: ( -71q ) 3611-63,(x` ' c.". DATE OF BIRTH: J
SOCIAL ,DRIVERS
d. SECURITY NO: 575-0 -?-'q - 2.ZZ-( e : LICENSE NO: 90
2. Name, telephone and post office address to which claimant desires notice:
to be sent, if other than above:
SaVyu C.'sg �oVe.
-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: b. TIME: 0 ' 00 vy\ c. PLACE ( Exact
and specific location) : RorS� GM100 u (2J,
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).
e.
What particular action by the City, or its employees, caused the
alleged damage or injury?
S. Give a description c ze injury, property dam, Dr loss - so far as is
known at the time of tais claim. If there were no injuries, state "no
injuries".
rr p
_ B try,-) n -�-i Y --L � b Y- o're L cJ o , �-ron T 2y� sc.
6. Give the name (s) of the City employee (s) causing the damage or injury:
7. Name and address of any other person injured:
8. Name and address of the owner of any damaged property: c5,�Z_
9. Damages claimed:
a. Amount claimed as of this date:
b. Estimated amount of future costs: V\.2.
c. Total amount claimed: F
d. Basis for computation of amounts claime(include copies of all bills,
invoices, estimates, etc:.:.' VptCe,
10. -Names and addresses of all witnesses, hospitals, doctors, etc.:
a. r\- o i csz CGS l--)cA+ c,.� e to 1 oQ Yl Y`P 01
b.
C.
d.
ll. -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) j.
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 day of aG`4}i 19�y at Tustin, California.
CLAIMANT ' S SIGNATURE
office of the City Clerk,
Tustin, California
7" IM NO: 90-34 DATE FILED:
Revised 8/05/81
JGR:se:R:8/5/81 (A)
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