HomeMy WebLinkAboutCC 11 CLAIM #88-23 06-06-88HONORABLE MAYOR AND cITY COUNCIL
F~OM:
CITY ATTORNEY
SUBJECT:
CLAIMANT: BERGFORD, KRISTIN; D/L: 2/19/88; DATE FILED
W/CITY: 3/29/88; CLAIM NO: 88-23; CARL WARREN FILE
NO: S54639PRS
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
-~LAIM AGAINST THE CIT%..F TUSTIN
· ('For Damages to Perso~s, -r Personal Property)
Received by Elizabeth Barter via
-',S. Mail
~ter-office Mail
Over the Counter X
The law provides generally that a claim must be file~ with the City Clerk o~
the City of Tustin within 100 days after which the incident or event occurred.
Be sure your claim is against the City of Tus'tin, 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 Tus~in, California:
The undersigned respectfully submits the following claim and information rela-
tive to damage to persons and/or personal property:
PHONE NO: (-~% DATE OF BIRTH:
SOCIAL DRIERS
d. SECURITY NO:
e. LICENSE 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:
4. Occurrence or event from which the claim arises: :
a. DATE. -IC -85 b.
- ~a& a~ and specific location): ~S Co--~~70~ ~ag Pt3%a ~9~
~ w~,z d. How and under what circumstances did damage or injury occur? Specify
the particular occurrence, event, act or omission you claim caused
the injury or damage' (Use additional paper if necessary).
e. What particular action by the City, or its employees, caused the
alleged damage or injury?
'5. Give a description of u e injury, .property damage : loss so far as is
known at the time of this claim. If there were no injuries, state "no
;,njuries't, . · . ~ ~'
6, Give the name(s) of the City employee(s) causing the damage or inju~:
7. Name and address of any other person injured:
'8. Name and address of the owner of any damaged property:
9. ~amages claimed:
a. Amount 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 addresses of ali witnesses, hospitals, doctors, etc.:
1- .my additional info~ation that might be helpful in considering this claim:
WARNING: 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 ~c ~R , 19~.C? , at Tustin, California.
Office of the City Clerk,
Tv 'n, California
CLAIM NO: ~ --,2-3
CLAIMANT ' S S~NATURE
DATE FILED:
B~vised 8/05/81
jGR:se:R:8/5/81 (A)
1578299
79!
! i
j
TOTALS
the a~3ove work and acknowledge recmg! of coOV. s~ne<l X
AUTO COLLISION & FRAME, ]NC.
3400 West Westminster Avenue
Santa Ana, California 92703
Phone (714) 554-0313
PARTS P~ce$ suOject to ¢nvo~ce
LA80R hr$.(~ $ ~
Shoo Supoii~
PAINT hts,~ S ~
Towing / S forage
SUB TOTAL
TAX
TOTAL ESTIMATE
' .EWPOR'r. AUTO'cENTE .
15622 Moshe~:'Street · Tustin,'California 92680
' Phone (714) 259-0381
Car,~OOwner ~ ~'~
Make
Mileage
m'surance Co.
Ye~,~"~ Serial NO.
Ucen~e No.
--.Adjuster ' .
no~ .... - Biter enter~ our p~smiaes or after co
rg~lS~Ola tot' IOSa or damage to car8 or · mplele
Motor No.
Paint No.
Phone No.
LABOR
Body Style
Trim No, ' ·
_ File No.
PAR~S UST SUBLET-NET.
& PAINT
above Is an estimate based on our inspection and does not cover any additional
s or labor which may be required after work has been started, Also the above estimate (st Sublet. (EX) Exchange,
bject tO parts price increases ceyond our control. In addition, this estimate ~s SUbject to (ut used. IR) Rebuilt, etc.
~ion in the event of a clerical error and or misinterpretation of the above said OPEN ITEMS
marion. If when you present this to.,your insurance company, and they feel that any
~gsc a'~eded, you should have ~hem contacl NEWPORT AUTO CENTER as soon
ossi~
e~:imate~w~lPbe~e~n-'oo~files ~or 60 days, Thank you.
k.~ ~ ~"*" ~;',,~,~sy....,~
-tORIZA~'ION FOR ~EPAIRS: You are hereby authorized to make the above specified
's to the car described herein.
INSURANCE DEDUCTIBLE MUST BE
PAID BEFORE CAR IS RELEASED.
~t..- lABOR
(net) PARTS
PAINT MAT'L
SUBLET NET
SALES TAX .. _~,
ESTIMATE TOTAL
Adv, Charges