HomeMy WebLinkAboutCC 6 CLAIM #88-11 06-06-88DATE: MAY 18, 1988
HONORABLE MAYOR AND CITY COUNCIL
FRO~:
CITY ATTORNEY
SUBJECT:
CLAIMANT: BARNETT, CARMEN;
W/CITY: 2/19/88; CLAIM NO:
NO: S530103PRC
D/L: 1/17/88; DATE FILED
88-11; CARL WARREN FILE
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 re3ection to the claimant and to the
claimant's attorney.
~istan% City Attorney '
JGR(F4.se)
Enclosure:
Copy of Claim
-CMIM ASAINS THE TUSTZN
('For Damages to Persons · Personal Property)
'eived by . via
~.a. Mail :..
Inter-office Mail
Over the-Counter
The l&w provides generally that a claim mus~ De filed with the City Clerk o~
the City of Tu~tin 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:
a. ADDRESS OF CLAIMANT. /~
b. PHONE NO: ( ~ c. DATE OF BIRTH: ~ -~
SOCI~ ~ ' ' DRIERS .
e. NO.
2. Name~. telephone and post office address to which claimant d.si=~s noti=~s
~o be sent, i~other than a~ve:
3. This claim is submitted against:
The City of Tustinonly.
The following employee(s) of the City of Tustin only:
The City of Tustin and the following employee(s)-of 'the
City of Tustin only:
Occurrence or even= from which ~he claim arises:
'and under what.¢ir=umstances did damage or injury occur? Specify
the particular occurrence, event, ac= or omission you claim caused
~he injury or ~amage, (Use additional paper if necessary).
eo Wha= par~icula= action ~y the City, or its employees, caused the
'5. -Give a description of une injury, property damage o~ loss so' far as is
nown at the time of this. claim. If there were no injuries, state "no
~njuries". . , ' . , - ~
6. .Give ~he n~e(s) of ~he City empl~ee(s) causing the d~age or inju~:
7. Name and address of any other person injured=
e
Name and address of the owner of any damaged propprty: ~_~CLt"',7-i~,,i,~ ~-
~mages ala~ed:
~: ~O~"~ claimed .. of this ~at.,
~ima~ed am~nt of future
C. Total ~oun= claimed:
d. Basis for c~tation of ~ounts claimed (inciude c~pies of all bills,
invoices., estimates, etc.:
10. Names and addresses of all witnesses, hospitals, doctors, etc.:
11. ~y additi0nal info~ation that might be helpful in consSdering this c%aim:
W;%RNING: IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIMI (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 penalty of perjury that the foregoing is TRUE AND CORRECT.
Executed this ~ day of , 19 ~ , at Tustin, California.
Oi e of the City Clerk,
Tum~ln, California
CLAIM NO:
CLAIMANT ' S SIGNATURE
Revised 8/05/81
JGa:se:R:8/5/81 (A)
"Since 1932"
P'. O. ~OX cea 700 WEST COMMONWEALTH
FULLERTON, CALIFORNIA 92~32
(7,14) 526-5501 Ext. 14 & 15
t7i
...... TO ,$vc Adv(sorl
quit C,IAL ,Jof~ OK O 8¥ .........................................
'.;*'. ' . .............. ~M Tree PM .... AMOUNT ....................
ESTIMATE OF ,REPAIRS
7~70
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-SANTA LINCOLN M RCU ¥
AOOlq~.q OWNER
iN~UI4~O IIY ~ "'- ~ POLICY NO
AOOAESS TEL.
1301 NORTH TUSTIN AVE · SANTA ANA, CA. 92701 · (714) 547-0511
ALL ~EPAIRS GUAF:IANTEE~_~,
ESTIMATED BY:
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WORK NO.,
~CLAIM NO.
ADJUSTER
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m$~ecl~o~ SUCH AODIflONAL LABOR AND MATERIAL WILL BE CHARGED FOR IN WAY AUTO BODY Insured s l]ower Of ~ltorne¥ lo sign or endorse SALESTAx $ / ~' '/'/5/
Deductible Portion of All Insurance Claims Must Be Paid Upon Delivery of Car.,, GRANDfoTAL $, /~,~/
TERMS :DATE
LITHO IN