HomeMy WebLinkAboutCC 6 CLAIM #89-20 07-17-89CONSENT CALENDAR
NO. 6
7-17-89
DATE:
JUNE 30, 1989
Inter -Corn
TO:
FROM:
SUBJECT:
HONORABLE MAYOR AND CITY COUNCIL
CITY ATTORNEY
CLAIMANT: CHRISTINE YORGA; D/L: 5/23/89; DATE FILED
W/CITY: 6/15/89; CLAIN NO: 89-20; CARL WARREN FILE
NO. S57912 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.
LOIS E. JEF/~R~.Y/
Assistant City~'Attorney
JGR/LEJ :D: 6/26/89 (F4)
Enclosure: Copy of Claim
CLAI'M AGAINST THE'CITY TUSTIN
('For Damages to Pers¢ or Personal Property)
Received by via
U.S. Mail
Inter-office Mail
Over the Counter ~!~- &~tO~
T~e 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 occurr~
Be sure your claim is against the City of Tustin, not another public entity
Where space is insufficient, please use additional paper and identify infor~
tion by paragraph number· Completed claims must be mailed or delivered to
City Clerk, The City of Tustin, 300 Centennial Way, Tustin, California 92681
TO THE HONORABLE MAYOR AND CITY COUNCIL, City of Tustin, California:
The undersigned respectfully submits the following claim and information re.
tire to damage to persons and/or personal property:
a. ADDRESS OF CLAIMA~T-,~O:_.. . .~' '
SOCIAL ..... " DRIVERS '
2. Name, telephone and post office address to which claimant desires notice
to be sgnt, if other than above:
o_./3G
3. This claim is submitted against:
a. / The City of Tustin ~hiy.
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:
and specif
How and under what circum~]~n~e~- ~'~X ~.
did damage or injury occur. Speci~
the particular occurrence, event, act or omission you claim caused
the injury.or damage (Us9 additional pape. r if necessary)· _
alleged damage.or injury?
Give a description the injury, pro__q~_e_r_ty d, te or loss so far as is
known at the time o~ ,his claim. If there were no injuries, state "no
injuries" .(!. ,,
Give ~be,name(s,) _o_f the, City employee(s) causing 'the damage or injury:
( '~../ ~:'~ ¥7./.~"/~ '
Name and address of any other person injured:
~. Nam>. /~./"'l_cr~'l/~and address,!./(,Q~X?.~_ Of the owner of any damaged property:
.. Damages claimed:
a. 'Amount claimed as of this date:
b. Estimated amount of future costs:
c. Total amount claimed :-:3. ~t~'~ -t)r't_'i.',>/~' ~>~,~ L;"t'~i-~ ~.~'~ ->t'~l~"~>.. ~>,_: <~},-'"(.~..",'j.>.¢~., ;.If.
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.:
a, ,
b.
Ce
Any additional ihformation that might be helpful in considering this claim
,~..-':' z:..~ c) foe ~ .u? I ~'0 ~ n.,Sf' .,p. ~ ~ ~/..~ ,.7.~ ~ ~ ~ /~ ~q~./ ~ ~ ~~ ~~
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
~me 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 beli,eve the same to be tru~
certify under penalty of perjury that the foregoing is TRUE AND CORRECT.
.~ecu ted this /.>~ ,.~..~ ~ ~.c~
day of ~...~/l , 19 , at Tustin, Cali-fornia.
ffice of the City .Clerk,
!stin, California
,IM NO:
.~vised 8/05/81
SR:se :R:8/5/81 (A)
CLAIMANT ' S
DATE FILED: