HomeMy WebLinkAboutCC 3 CLAIM #87-35 01-04-88HONORABLE MAYOR AND CITY COUNCIL`/'
FROM:
S UBJ ECT:
CITY ATTORNEY
CLAIMANT: Carl Harry Martin; D/L.- 6/17/87; DATE FILED
W/CITY: 9/18/87; CLAIM NO: 87-35; CARL WARREN FILE
NO: S52720 CLH
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)
via
Received by
U.S. Mail ·
Inter-office Mail
Over the Counter "
·
The law provides generally that a claim must be ~iled with the City Clerk
the City of Tustin Within 100 days 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 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-
tive to damage to persons and/or personal property:
b. PHONE NO: (~) ~ ~ c. DATE 'OF'BIRTh: /~-?-( - _'
.
2. Name,. =elephone and post office address =o which clakmant desires notices
=o be sent, i~ o=her =han above=
3. This claim is submitted against:
The City of Tustin only·
The following_em.?loyee(s) of the City of Tustin only:
C·
The City of Tustin and the following employee(s) of the
City of Tustin only:
·
:.
Occurrence or event from which the claim arises:
a. DATE: '~%1~' !-~.-~ b. 'TIME: 1~OO-- I,~..~'O .. :. , PLACE (Exact
and specific location): ~,9~ ~
d. How and under what circ~stances did damage or injury occur? Specify
the particular occurrence, event, act or omission you claim caused
the in'ury or damage (use additional p~er if necessary)·
e. Wh~t particular action by the C~ty, or ~ts employees, caused the
alleged damage or injury?
.
'5. Give a description of the injury, property 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~mployee(s)~ causing the damage or injury:
7. Name and address of any other person injured=
8. Name and address of the owner of anY'damaged property.- ~.,~?t. t?!,k.?,~,~
a. ~ount claimed as of ~his da=e:
b. Estimated amount of future costs: ~5=,= ~)~~,~,~ oC~W~/~ - '
c. To~al ~oun= claimed: OU~ ~ ~'o, f)Or~ ' '.
d. Basis for computation of amounts claime~ (ihclude copies o~ all
10. Names and addresses of all witnesses, hos~'=als, doc:ors, e=c.:
.1. ~y a~di=ional in[o~a=io~ that ~igh= be helpful i~ considering this'claim:
WARNING: IT IS A CRIMINAL OFFENSE TO 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 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 true.
I certify under penal~y of perjury that the foregoing is TRUE AND CORRE~.
:
Executed this if day of ~t~"- , 19 ~? , at Tustin, California.
Office of the City Clerk,
Tustin, California
Revised 8/05/81
JGR:se:R:8/5/81 (A)