HomeMy WebLinkAboutCC 8 CLAIM 389-31 11-06-89CONSENT CALENDAR
P Inter- Corn
uATE: AUGUST 18, 1989
TO:
FROM:
SUBJECT:
HONORABLE MAYOR AND CITY COUNCIL
CITY ATTORNEY
CLAIMANT: SHIRLEY L~/IS; D/L: 8/1/89; DATE FILED
W/CITY: 8/21/89; CLAIM NO: 89-31; CARL WARREN FILE
NO. S,5986-~ Nr~
,J
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 a.nd to the
claimant's attorney.
City Attorney
JGR:D: 7/24/89 (F4)
Enclosure: Copy of Claim
CLAIM AGAINST THE CITY Om TUSTIN
('For Damages to Persons Personal Property)
Received by
U.S. Mail
' 'ret-office Mail
er the Counter
via
.,,e law provides generally ~ha: a claim must De fiied wi:h ~ne Ci~y. Cierk c
the City of Tustin within 100 da~s after which the incident or event occurred
'Be sure your claim is against the City of Tustin, not another public entity.
Where space is insufficient, please use additional paper and identify informa
tion by paragraph number· Completed claims must be mailed or delivered to tk
City Clerk, The City of Tustin, 300 Centennial Way, Tustin, California 92~S0
TO THE HONORABLE MAYOR .~ND CITY COUNCIL, City of Tustin, Caiifornia:
The undersigned respectfully submit~ the following claim and information
tire to damage to persons and/or personal property:
a ADDRESS OF CLAIMANT:
:
b. PHONE NO (?~)
SOCIAL
d. SECURITY NO: ,_ ~
2. Name, telephone and post office add,ess to which claimant desires notices
to be sent, if other than above:
' This claim is submitted against:
a ·
The City of Tustin o~_
The following _e__mp_l_o2~ee_(s_) of the City of Tustin..on!y:
~.' ;'" ~'." ~ ,' ~"'"T~_ _~-_- ,., -' .' ; ,' ...... r--
, ~ _'~'~:-- .- . ~ '-._ ...........
c. The City of Tustin and the following employee(s) of the../~.;.~
City of Tustin on!y:
· ·
....-,
'T'-~ i.- ...~.~'~ ., .. ~ ...-..,... .-~.., ..;a ..,', ,,, ~. ~ ~ .....
4. Occurrence or~ev~n~ from/which t'ne ~la~ ar_,ses: ~,.~,._'T~,..~,._~_..~,~
'/ ': /~. '&?/? ,~.-';1 ¢ Pr,ACE (~xact
a. DATE: . . b. 'TIME: ,:, ,. ,. ,. , .. .
and specific !ocati'gn): _i ~ r .... (. x~_.~ ..~
d. How and under what circumstances did damage or injury occur? Specif-.,'
the particular occurrence, event, act or omission you claim caused
the injury or damage (Use,additional pa_~E~.er if.necessary).
/~,: 2.,;:~ ~ ~':.- z,_.-,-.,_:
..~...~,~ .-~.~_~,... ~~. ,~ ~.~.,~.~ .D~" ~ -
e. W~ particular action by ~%~e/'C~ty, or its employees, caused the
ali~ damage or i~jury
~ '~ ~ ~'_ .~ r ._ _ ' -" -- ,- . ' , .... , - - /. -~ , . '- ' ..' , . .." ~ ~ _ :
.... ' '~,0 ~ ~ , _~,
~ z,~ '.. ,;~ q ~ ! ,,~ ~ , .~M ....... '- - -~ .... ' .... r '
'~.-~ ~~_.._ . , ~ _ _ .
'5. Give a description ¢ he injury, property dama dr loss so far as is
known at the time 'of _.~is claim. If there were . injuries, state "no
i .n_jur~es". ~ 1: '~ ; ' '
/'
6. Give the name(s) of the City employee(s)/ causing the damage or injury:
,,~-A':' .~~-~ ~, .~- 7-i3 13 .~ ,~~G~--~/ .... ,¢.:I ~ ~ ~' ~ ~
7. Name and address of any other person injured:
8 Name .and address of the owner of any_~ged proper~,y~: f, .~_~_.~ -">-'--~'~ ,': .
· ~ ~ .~- t' , ~I ' '" "~,~'~_
' 9. Damages claimed:~. ~ ~~ '
a. ~ount claimed as of this date:
b. Estimated amcun~ of future costs:
c. Total amoun~ claimed:
d. Basis for computation of amounts claimed (include copies of ail
invoices, estimates, etc.:
'10. Names and 9ddre.sses of all wi~gsses~¢ hospitals,~doctors: .e~c..:
b.
Co
de
An.y additional informs, tion that might ~._.be helpful in co~ns, ideri,~Ig this claim
,.~ ,~__,~_~, ..~_' ,, ". ~_ ~,~__ .;~ ~~.,.~_ .~ .~:,. ~_' ,~ ~~, ~,~1_ ..~ .,
.,'.~_~ ~.~. 4.: ?~: ~x_ .~ ~_~~~ ' ~~.
WARNING: IT IS A CRI~INAL OFFENSE T.O 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 the
same to be t~e 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 tru
I certi~ under penal~ of perjury that the~ foregoing is TRUE AND CORRE~.
Executed this ay of ~..~-$ , 19 ~ at Tus:in, Call orna
~ , . '/' ! ~ ·
Office of the City Clerk,
· :-~stin, California
_,AIM NO:
Revised 8/05/81
JGR:se :R:8/5/81 (A)
..,-7.,.CZ.~Z,"'tA~'~" S SiGNATURE
.,
DATE FILED: