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Home My WebLink AboutCC 4 CLAIM #89-19 08-07-89h ;~ ~I ,~ .~ -~ ?;'~?i\ '"i ~''' ? "'"'~/i?~' ~'' -'--'- - --'-~ No,CON $ EI'I T4 CALE N BAR DATE: JULY 24, 1989 ~~~.~ B l'll.~" J ~i.. UIII [ ! JUL 2 7 1989 HONORABLE MAYOR AND CITY COUNCIL TO: FROH: CITY ATTORNEY SUBJECT: ., CLAIMANT: MICHAEL RAMOS; D/L: 3/25/89; DATE FILED W/CITY: 6/22/89; CLAIM NO: 89-19; CARL WARREN FILE NO. S57918 PRP 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. JAME~ %. ROURKE City Attorney JGR:D: 7/24/89 (F4) Enclosure: Copy of Claim · . Received by u.s. Mail Inter-office Mail Over the Counter · . via The law provides generally that a claim must be filed with the City.~Cler~ the City of Tustin within 100 days'after 'Which the incident or event occ~ Be sure your claim is against the City of Tustin, not another pUblic ent] ~ere space is insufficient, please use additional paper and identif~'inf tion by paragraph number. Completed'claims must be mailed or delivered City'Clerk, The City of Tustin,.300 Centennial Way, Tustin, Californi~ 'i~ THE HONORABLE MAYOR AND CITY COUNCIL, City of Tustin, California: The undersigned respectfully submits the following claim and information~ tire to damage to persons and/or personal property: a. ADDRESS OF CLAIMANT: ~ /~ ~'-~ b. PHONE NO: (~/~) ~' -~~-- c. DATE OF BIRTH: SOCIAL DRIVERS d. SECURITY NO: e. LICENSE NO: 2. Name, telephone and post office address to which claimant desires not to b~ 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..- · b. ~TIME: .~ c. PLACE (Exact and specific location):)~-~ ~/o~ A/o~~_-~-~__~ c~n ~v~ d. How and under what circumstances did damage or injury occur? Spe the particular occurrence, event, act or omission you claim cause the injury or damage (Use additional paper if necessary). e. What particular action by the City, or its employees, caused the a.lleged damage or injury? .' ' ' ' ~3- L) '-- (/ - · ' ~. u~v= Q u=~u~xpc~on o: ne zn]ury, proper~y aama¢' or loss so ~ar as is 'known at the time of this claim. If there were no injuries, 'state "no injuri'es". ' · Give the name'(s) of the City employee(s) causing the damage or inj.ury: · '7. Name and address of any other-person znjured: 8. Name and address of the owner of any damaged property: 9. Damages claimed: 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 bil~ invoices, estimates, etc.: 10 Names and addresses of all witnes.ses, nospz~azs, aoc~ors, etc.: · · b. Il. Co Any additional information that might be helpful in considering this cla WARNING: IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAI~{: (Penal Code Section 72; Insurance Code Section 556.0) I have read the matters and statements made in the above claim and I know 'th 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 t I certify under penalty of perjury that the foregoing is TRUE AND CORRECT. Executed this 25k\ day of _~~~m.__, 19 .~_!, at Tustin, Californi \/ CLAIMANT ' S SIGNATURE Office of the City Clerk, Tustin, California .-- AIM NO: DATE FILEb: Quality Auto 8ody I. ' · ,, 25721 Obrer, .va, Unit G / Mission Viejo, Califon. ~269I (714) 951-1321 -_::~-=__ ::: _-:- .:.. ...................................... . _ . ~: :_." REPAIRS · EXPERT BODY AND FENDER ESTIMATE. OF REPAIR CO .... --: R.O. No- ' REFINISHING Body Style...: :,~../~ · Trim No. '" .. ./ File No. ,_,¢'¢ Serial No. M.o~or NO., License No. Paint No. l~e Go Adjuster Phone No REPLACE ESTIMATE OF REPAIR COST LABOR HOURS PARTS MISC. · SUBLE , , , TOTAL ~,,'~d~gned agrees to complete the above repairs for $ )F ff~s emc~unt the above named insured is to pay Hrs. of Labor $ insurance deductible Parts depreciation work not covered by insurance Sublet AW, I:E~' aa-'#GRN parts removed from car will be junked unless owner instructs us otherwise in writing. - ~ F~I~: listed herein or required are NOT available, we reserve the right to R[PAIR such damaged r I~1'~. where possible, the CHARGE for which will be made on an actual time basis at our pre- · ear ra~e per hour. The above is an APPROXIMATE estimate of repairs required, based on the in- zet.,.~ mad~ AODITIONAL parts, or labor, ma,/ be required after the work has started, which were not ,eentt am me first inspection. SUCH ADDITIONAL LABOR AND MATERIAL WILL BE CHARGED FOR IN AOOI- ia~ ~ ~ MOVE. . . ~. . . .... L.; ~'- · - ~, . ' .... ' ' - . ; · -. GRAND TOTA~ . . .---. . .... : '"" .... ..:: ": _ _ '-:;,m,:'-~: :~. -~,,-:.- .::, ,.~ ' .... ' · .'.'.' .' ' ':. ':" .: · "(lelR'r~ PRICKS SU~JKC~T TO INVOIC~') "'. . '"". :' ~'-;' i'::-: .... ;'., .:: ......... --' · Per Hour Labor $ Dis. % Parts Misc. · Dis. % Sublet Sales Tax ESTIMATE TOTAL ADVANCE CHARGe. ~ Qual~t~'Auto Body (" ~,~,~ o~ · ., 25721 0to~ ~)r/ue, Unit G / M~sion Viejo, Cali/~ J 92691 ' SHEET (714) 951-132I . BODY AND FENDER REPAIRS · EXPERT REFINISHING ~"J~ ~ ~ - -- ~. ~ ~~,, ~Ser~l No. ~olor No. Bod~ SWIe - ~nl No. Trim No. I~$ur~nce ~o, __~hone No _F~le No. REPLACE ESTIMATE OF REPAIR COST LABOR HOURS PARTS MISC. SUF ~-'~~ ~' a ~ ~r~ ~ c' .......... ~ / TOTAL ~ , The u~de~'signeci agrees to complete the above repairs for $ (Df t~s amount the above named insured is to pay $' insurance deductible ~-~rs. of Labor @ S r.,~ 'y ~''~''~ Per Hour Labor Parts __.__ Dis. % Parts depreciation Misc. work not covered by insurance Sublet Dis. ~% Sublet '$ ~ ~' · O~ a~ WORN parts removed from car will be junked unless owner instructs us otherwise in writing. _ ;-/1 j/,~ ~'~..i..... ~-.,.. e ¢~ ,, ri,. I~W, I~g, TS.listed herein or required~ NOT availab.e, we reserve the right to REPAIR such ~maged /.~) -- -- 'tm Iza'ts, where possible, the CHAJi'GE for which will be made on an actual time basis at our pre- ,- ............ ~. labor' rate per hour. The above/Is an ~PROXlMATE estimate of repairs required, based on the in- - ~'bTIMATE/UIAL $ . .. _,,om, made. AOOITI.ONAL parts, or/la, r, W'~y be'.ceQuired after the work has started, which were not . ewdafltt a~ the first inspection. SUC~..kODJ13CiNAL LABOR AND MATERIAL WILL 8[ CHARGED FOR IN ADOl- ADVANCE CHAR6ES $ TIQ~ TO) 1;h'E A8OV[..,,/)'/~ - _ -/'//'// . /.~- . '.,, 2-~'~/~ GRAND TOTAL ISW.. ' ...... ":'/~/:.,/"' ~---Z- - ' ~ ' - ' . ' ' ' .-. ... · '-' '"'":'i.~'~:I:'''-: .~':-~'"-" ".:-": ':'~'''- ,,,,~, ..,c.. .u.,.~. '.o ,.Vo?,, .: ..... '. ......'. :--.:-.?'.'.':i":.i ::;:...'.~.. '~ ! ;TIME AM i NAME ? ~' " ~ AIRLINE ~,, - ~ FLIGHT NO OFFICE ,CIRCLEt -- ' ' WHO NOTIFIED I DATE PLACING ~ t I -~ ' ...... ** ' ...... I RES~R. I~ ) ' BILLING ADDRE~ CITY STATE ZIP ATTN: DIB I GPOR I CASH / AMT. t CREDIT CARD CREDIT CARD # EXP. DAT NOME ADDRESS CITY , EMPLOYER ADDRESS/CITY HOW MANY YEARS .o LISTED WITH DIRECTORY ASSISTANCE HOME ?_' YES WORK PH. # ~_ NO PH. # CO: ADJUSTER PHONE BILLING ADDRESS CITY ZIP CLAIM # DATE OF r- ACCIDENT LOSS ,'"THEFT ,.SURED ,S; I AUTHOR,ZED TAX 'I ................... I.OAYS AMT. FYEs_.o RR YR./TYPE OF CAR REPAIRING SHOP PHONE # APPROVAL I DEPOSIT INFO AMT. DATE APP. APP. ON ACTUAL NO. CR. CARD DEPOSIT DUE BACK DATE PER: WHO? RENTERS INS. AGENT PHONE# POLICY# COMP. COLLISION LIABILITY EXP. DATE, TRANSFER TO RENTAL VEHICLE EXTENSIONS REMARKS .Santa Ana 2202 East 1st Street Santa Aha, CA 92705 (714) 547-5717 DATE CAR # TYPE RENT DALLY WEEKLY CALENDAR DAY 31 ACCRUE AT -.. MONTHLY . - . ;- . . . RENEW DATE OF RENTAL CDW F'INC "E'YES ["NO DUE BACK