HomeMy WebLinkAboutCC 8 CLAIM #88-15 06-06-88,..~ ~= ~.~' .'~ '.' L.),~~ .... -~ -~ -,~--_
DATE:: MAY 18. 1988
HONORABLE MAYOR AND CITY COUNCIL
FROM:
CITY ATTORNEY
SUBJECT:
CLAIMANT: JONES, ROBERT; D/L: 2/15/88; DATE FILED
W/CITY: 2/26/88;' CLAIM'NO: 88-15; CARL WARREN FILE
NO: S54563PRC
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.
Assistant City Attorney
JGR(F4.se)
Enclosure:
Copy of Claim
· CLAIM AGAINST THE CITY TUSTIN
('For Damages to Persons ~r Personal Property)
ReceiVed by
U.S. Mail
via
Inter-office Mail
Over the Counter
The law provides 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 your claim is against the City of Tustin, not another public entity.
Where space is insufficient, please use additional paper and identify informs
tion by paragraph number. Completed claims must be mailed or delivered to th
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
tire to damage to persons and/or personal property:
a. ADDRESS ?F CLAIMANT~r ¢~
b. PHONE NO. (!//) c. DAT~ OF BIRTH: '? -/-~-~
SOCIAL
d. SECURITY NO: .~ LICENsEDRI~RS NO:.~)--- ~ ~ ~/
2. 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:
The City of Tustin and the following employee(s) of the
City of Tustin only:
e
Occurrence or eve~nt from which the clai_~__~_~/?~n
a. DATE: ~--/~, ' ~ b. 'TIME: /~,'~?..~ PLACE (Exac~
and 'specific loc~tion):~1)~,/ ~1' ~2~ /~)~j~.
d. How and-under what circumstances did damage or injury occur? Specify
the particular occurrence, event, act or omission you claim caused
he injury or damag~ (Use additional paper if nesessary).
ee
What particular action by the City, or its employees, caused the
alleged damage or injury?
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
injur~ies" ~ .
6. Give the~n~me(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 o/~ any~d4maged property:
?,u )
9. ~mages claimed:
a. ~ount claimed as of this date:
b. Estimated amount of future costs:
c. Total amount claimed:
d. Basis for computation of amounts claimed (include copies of all bills,
invoices, estimates, etc.:
10. Names and %~esses ~f all witnesses, hospitals, doctors, etc.:
be
de
11. Any additio~nformation, that might be helpful in considering this claim:
WARNING:
IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM!
Section 72; Insurance Code Section 556.0)
(Penal Code
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.
day of
Executed this
~.ce.of the City Clerk,
California
CLAIM NO: 88-15
~ ~__ , at Tustin, California.
DATE FILED. { 2-26-88 .
Revised 8/05/81
JGR:se:R:8/5/81 (A)
Rddress.,
Customer's Rec'd
Order .No,
5L240/01240 RE[]FORN .