HomeMy WebLinkAboutCC 4 CLAIM #88-8 06-06-88OAT~. D~¥ lB, lgBB
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HONORABLE MAYOR AND CITY COUNCIL
CITY ATTORNEY
CLAIMANT: CROSBY, LAURIE; D,/L: 2/9/88; DATE FILED
W/CITY: 2/16/88; CLAIM NO: 88-8; CARL WARREN FILE
NO: S53097PRC
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.
THOMAS
Assistant City Attorney
JGR(F4.se)
Enclosure'
Copy of Claim
('For Damagms to Perso~' . Personal Property)
:etved by
S. Mail
Inter-office Mail
Over the Counter
via
The law provides generally that a claim must he filed with the City Clerk o~
the City of Tustin within .100 da s after which the incident or event occurred.
Be sure your claim ls against t e 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
Cit~ Clerk, The Cit~ of Tustin, 300 Centennial Wa~, 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:
1. NAME OF CLAIMANT: IMANT:
a. ADDRESS OF CLA
b. PHONE NO: ) c.. DATE OF BIRTH:
SOCIAL DRIVERS
2. Name~. telephone and post office address' to which claimant desires notices
to be sent, if other than above:
3. This claim is submitted against:.
b.
The City Of Tustin only.
The following employee(s) of the City of Tustin only:
City of Tustin only:
4. Occurrence or event from which the claim arises:
: ·
PLACE
a. DATE:. ~ ~. 'TIME~ /,'~;V- c. _ .(Exact
and specific location) ~ ' ' '6~ ~'
d. How and under what circumstances did damage or injury occur? Specify
the particular occurrence, event, act_o~_q~sion you claim caused
~h? injury o~ damag? (Use ad=diti~nal ~1~ necessary). .,= __
What particula.r action by the City, or its employees, caused the
alleged damage or ' '
'5. Give a description of the injury, property damage or loss so far as is
mown at the time of this claim. If there were no injuries, stats "no
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=
o
Damages claimed= ~ / /
a. Amount claimed as of this date: . ~ /~
b. Estimated amount of future costs. ~. {~.. /. ~ ,~. ;~v.]._L
c. Total ~oun~ claimed= ~~~~ '~ TM
d. Basis for com~tation of amoun2s claimed (~nclude copies o~ all bills,
invoices, estimates, etc.=
10. Names and addresses of all witnesses, hospitals, doctors, etc.:
a.
b.
11. ~Any_ a~.it}onal i, nf_o~mpti.o,n,~h_a,t m!g~ht ,b.e, l f_ul in conside, ri. ng t,h%a claim:
#
........ " d ' '
WARNING= IT IS A CRIHINAL OFFENSE TO FILE A FALSE CLAI~I (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.t]{ of perjury that the foregoing is TRUE AND CORRECT.
r? :
Executed' this da~ o~ , 19 , at Tustin, California.
CLAIMANT ' S SI .~NAT URE
Ot ,e of the City Clerk,
Tubuin, California
CLAIM NO ~
DATE FILED:
P~vised 8/05/81
JGR:se:R:8/5/81 (A)