HomeMy WebLinkAboutCC 4 CLAIM #87-47 02-01-88· , .,,. ---, l I ~ ~ CONSENT CALENDAR
· NO. 4
~ATE: January 25, 1988 ' ~~~~~ ''''--' ------' ....
TO:
FROM:
HONORABLE MAYOR AND CITY COUNCIL
CITY ATTORNEY
CLAIMANT: DONALD E. JEFFERSON; D/L: 11/27/87; DATE
FILED W/CITY: 12/28/87; CLAIM NO: 87-47; CARL WARREN
' ~iL~. i40; ~S~-~J&L~ '
SUBJECT:
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
C.~ AGAINST THE C--'~' · TUSTIN -~, ·
· ~iFor Damages tO Per~ns ~r Personal Property).
~ceived by via
i. Mail
_,~ter-office Mail
O~.er the Counter ~ _
The law provides generally that a claim must be filed with the"Ci~y Clerk
the City of Tustin within 100 days after which the incident or event occurre¢
B~ sure your claim is against the City of Tustin, not another public entity.
Where space is insufficient, please use additional paper and identify inform~
tion by paragraph number. Completed claims must be mailed or delivered to 't~
C~:t'y Clerk, The City of Tustin, 300 Centennial Way, Tustin, California 92680
TI~:THE HONORABLE MAYOR AND CITY COUNCIL, City of Tustin, California:
T~e undersigned respectfully submits the following claim and information rel~
rive to damage to persons and/or personal property: ........ .
IL. NAME OF CLAIMANT: Donald E. ~effers0n
a. ADDRESS OF CLAIMANT:
b. PHONE NO: ( c. DATE OF BIRTH:
SOCIAL DRIVERS
d. SECURITY NO: e. LICENSE. NO:
Name,. telephone and post office address to which claimant desires notices
to be sent, if other than above:
,. This claim is submitted against:
a. The City of Tustin only.
b. The following employee(s) of the City of Tustin only:
c. 'XX
The City of Tustin and the following employee(s) of the
City of Tustin only:
Unknown p0l~ceman or p0lJcemen.
Occurrence or event from which the claim arises: :
a. DATE: 11-27-87 b. 'TIME: 2.15 A.M. c. PLACE (Exact
and specific location): Edin~er and Ross, Santa And, California
d. How and under what circumstances did damage or injury occur? Specify
the par.ticular occurrence, event, act or omission you claim caused
tional paper if necessary).
tin police were in pursuit of a stolen automobile which crashed at
location. I was the first person to the'-accident scene and the police thought
I may have 'been involved.
e. What part n by the City, or its emplOyees, .Caused, the
alleged damage or inju
I was hand cuffed and placed in roadway. Before _~i ce would listen, to me or
'5. Give a description of the injury, property damage or loss. sq far as is
-, known at the time of this claim.' If there were no injuries, state "no .'
,njuries". ' '
C~ts and scarrinq to the left side of my face and cheek,
6. 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 address of the owner of any damaged property:
9. Damages claimed:
a. A~nount claimed as of this date: 1,000.00
b. Estimated amount of future costs: --14,000.00
c. Total amount claimed: 15,000.00
d. Basis for computation of amounts claimed (include copies of all
invoices, estimates, etc.:
10. Names and addresses of all witnesses, hospitals, doctors, etc.:
a. Michael Flarity$
b. Car0]yn Butler;
c. Neal Weaver~
d. Verna Smith%
Debi Jefferson;
Any additional information that might be helpful in considering this clain'l:
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 bel.ieve the same to be true.
I certify under penal~y of perjury that the foregoing is TRUE AN9 CORRE~.
Executed this day of ... 19_, ., at Tustin, California.
Office of the City Clerk,
Tustin, California
./ CuAI~IANT . S S2fG~AT URE
Revised 8/05/81
JGR:se :R:8/5/8! (A)