HomeMy WebLinkAboutCC 7 CLAIM #89-26 08-07-89TO:
FROM:
HONORABLE MAYOR AND CITY COUNCIL
SUBJECT:
CITY ATTORNEY
CLAIMANT: YACHI WEI; D/L: 6/12/89; DATE FILED
W/CITY: 7/11/89; CLAIM NO.' 89-26; CARL WARREN FILE
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.
City Attorney
JGR:D:7/24/89 (F4)
Enclosure: Copy of Claim
Rece.~iv~d by via
U.S. Mail
Inter-office Mail
Over the Counter
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 entJ
Where space is insufficient, please use additional paper and identify in~
tion by paragraph number. Completed claims must be mailed or delivered
City Clerk,, The'City of Tustin, 300 Centennial Way, Tustin, California 92
TO THE HONORABLE MAYOR AND CITY COUNCIL, City of Tustin, California:
The undersigned respectfully submits the follo%~ing claim and information
rive to damage to persons and/or personal property:
1. NAME OF CLAIMANT: ~_~
a. ADDRESS OF CLAIMANT: .-; ~ ._~~_'_~ ~ .- ~ ~ ~-~
b. PHONE NO: (- ) ~~-~_~~ c. DATE OF BIRT}{:
SOCIAL ~ ' ' DRIVERS
d. SECURITY NO: e. LICENSE NO:
2. Name, telephone and post office address to which claimant desires no
to be sent, if other than above:
3. This claim is submitted against:
a. Th~ City of Tustin only.
b. The following employee(s) of the city of Tustin only:
~ne 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 ' loca n): ~ y~~ ~ ~ ~~~ .~ r~.~
/
d. How and under what circumstances did damage or injury occur? SS
the particular occurrence, event, act or omission you claim caus
the injury or damage (Use additional paper if necessary)·
e. What particular action by the City, or its employees, caused th~
alleged damage or injury?
Give a descrlr~tlon o- -.e in]u-~y, F~uM=z~l ~ .....
known at the time of u..is claim. If there were
injuries" ~
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 ad'dress 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: ~ ~ 7.~. ~
d. Basis for computation of amounts claimed (include co-pies of all
invoices, es'timates, etc.:
and addresses of all witnesses, hospitals, doctors, etc. :.
b. ' ""'
C.
de
~1.. Any additional information that might be helpful in considering this cla
WARNING: 1T-IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIre'
.................. Section 72; Insurance Code Section 556.0)
(Penal Code
'I have read the ma{ters and statements made in the above claim and I know tf
same to be true of my own knowledge, except as to those matters stated to b~
upon information or belief and as to su-ch matters I believe the same to be t
I certify under penalty of perjury that the foregoing is TRUE AND CORRECT.
Executed this day of , 19 ~,~ , at Tustin, Californ'
Office of the City Clerk,
Tustin,' California
--
~AIM NO:
/~LAIMANT'S SIGNATURE
DATE FILED:
Revised 8/05/81
JGR:se :R:8/5/81 (A)
'OLD TO:
27942 Forbes Road, ~n,! A
Laguoa N,guet, CA 92677
(714) 364-3225
'~1 RES ~ WHEELS
SHOCKS
rSALESMAN:
QUANTITY
jP.O.: IS.O.: jw.c.:
DESCRIPTION
ITIME PROMISED:
UNIT PRICE EXTENSlC
TX
IL
tAL
A iA
It is agreed bet-~veen the Purchaser and TL~cker Tim Company that
the items listed above are sold on the following conditions. This is a
conditional sales contract and title remains in 'rbcker Tire Company
until paid in !u~l. This invoice is due and payable lOth o! the month
following purchase unless otherwise agreed. _
SALES TaX
LABOR
TOTAL
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