HomeMy WebLinkAboutCC 18 CLAIM #88-51 10-19-88 CONSENT CALENDAR
,~ ..~ ]~"'~ ~ ~1~ ,~ NO. 18
m. ~: !I~ ~.;..;~;.. 10-19-88
..
TO:
FROM:
SUEJECT:
I]ONORABLE MAYOR AND CITY COUNCIL
CITY ATTORNEY
CLAIMANT: WILLS, ELIZABETH/STATE FARM INSURANCE CO.;
D/L: 8/1/88; DATE FILED W/CITY: 9/14/88; CLAIM NO:
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 (F4. se)
Enclosure:
Copy of Claim
,;
CLAIM .AGAINST THE CITY' :' TUSTIN
('For Damages to Persons or Personal Property)
xeceived by
U.S. Mail
Inter-office Mail
Over the Counter
via
The law prov. ides generally that a claim must be filed with the City Clerk of
the City of Tustin within 100 days after which the incident or event occurred.
Be sure y~ur 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 the
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 rela
rive to damage to persons and/or personal property:
1. NAME OF CLAIMANT: ]' ,
a. ADDRESS OF CLAI~NT-: /.~O ~- Fx') -f,~,~ ~ / '~
b. ~o.~ .o: (7/4:) ~S."It~-~ c;- ~ o~
soc~: ~' -" o~v~s
d. SECURITY NO: e. LICENSE NO:
/
/
2. Name, telephone and post office address to which claimant desires notices
to be sent, if o~er than~abo~e: ~.., . ~.
~.~~. ~.~ '..,~.~ . I~.~.,..m~.~ _ ,~. ~.','-~ . ('~...,.~5..., ~ ~,~ ~/~,~,~;
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: / ~-~ ~/~/~ ~. PLACE (Exac__~t
and specific location):
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 additianal, ~-. "~ pap~.,, if necessary). . ~~
· ~ ~ ~ - ~ ~:~ ~ / ~ ....... .
e. What particular action by the City, or its employees, caused the
all,.eged damage o~ injury~ ' / "
<" :, /..,--~.-/.~,~.~ .~.. ~-~:~ ~-- ~.~.;/~ /.:~"~ //-'~_~' .~....~.~ _~.,:,/: ,,:,---- :. .~.¥,.
Give a description of .the injury, proper.ty damage or loss so far as is
known at the time of this claim. If there were no injuries, state "no
injuries".
6. Give the name(s)-of the City employee(s) causing the damage or inju~:
7. Name and address of any other person ?~:e~.lc,<. '~ - ~,~.('~/~"~'~!~J/~:~](r'f~'~ /~ ~:~
- ,' ,~ ~ . ~ ~ ; ' ,' : , . .... ~ ., _ ' . _ .-.' : ~
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
invoices, estimates, etc.:
claimed (inclUde copies, of all bills,
10. Names and addresses of all witnesses, hospitals, doctors, etc.:
~ ' ';, '- . ,,-, "f'~-, ~ ' ' ~,,'".~, K'- .,"P ~ ,'",~ :;.'/-'
a. .~.:,,-.,.~ vL_-4,.,,- _<.',',~.,~, ,.~,.-. ~ :-~,,-' · ;,'1..~
~. c~ ¥ r~l2- ,~.~? -~ ~,.,..~, zb,..,.,...-..
¢.
d.
·
Any 'additional information that might be helpful in considering this claim:
WARNING: IT IS A CRIMINAL OFFENSE T.O FILE A FALSE CLAIM! (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 tru~ 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 pe.n~lty of perjury that the foregoing is TRUE AND CORRECT.
Executed this /~~ay of
Office of the City Clerk,
Tu§tin, California
IM NO:
......... , at .T, ustzn, California.
t'l ,,
{ ' - - ~ CLAI]{ANT ' S SIGNATURE
DATE FILED:
Revised 8/05/81
JGR:se :R:8/5/81 (A)