HomeMy WebLinkAboutCC 6 CLAIM #86-55 02-02-87 CONSENT
CALENDAR
· '3 ~" N0o 6
Inter-Corn
TO:
HONORABLE MAYOR AND CITY COUNCILjj
FROM:
CITY ATTORNEY'
SUBJECT:
CLAIMANT: ROBIN M. NEGENDANK; D/L: 10/21/86; DATE
FILED W/CITY: 11/21/86; CLAIM NO: 86-55; CARL WARREN
FILE NO: S49727CVH
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 ( F 4. se )
Enclosure:
Copy of Claim
CLAIM AGAINST THE CI~ 3F TUSTIN
('For Damages to Personm or Personal Property)
· Received b~ ' via '
U.S. Mail
Inter-office Mail
Over the Counter
The law provides generally that a claim must be filed with the City Clerk or
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 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 9268q
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:
SOCIAL DRIVERS
d. e. LIC SE NO:
2. Name, telephone and post office add~ess to which claimant desires notices
to be sent, if other than above:
.3.
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:
Occurrence or event from which the claim arises:
a. DATE: I~'~1-~e b. '_TIME: Z:~O ~/~ c. PLACE (Exact
and specific location): '/~dh(ll -t
d. How and under what circ~stances did damage o~ injury occur? Specify
the particular occurrence, event, act or omission you claim caused
t e ln' .'ury or da~a. ge (Us additional,paper if ~ecassary)
(~t~/~ :>~ ~,lll /~ ~/~ l~(~6'~ ~ ~ ~.~r
e. What particular action by =he C~ty, or its emgloyees, eause~ the
all~ge~ .Savage or ,~jur~?~ ""t' "
~'~%e a description of the injury, property damage or loss so far as is
known at the time of this claim. If t. here were no injuries, .state 'no
injuries'.
Give ~he n~e(s) of ~he City. employee(s) causing the aamage or inju~
0
Name and address of' the owner of any damaged property:
Damages claimed:
a. Amount claimed as of this date:
b. Estimated am.tnt of future costs:
c.
d.
Total amount claimed:
Basis for computation of amounts claimed (include copies of all ~11~..
invoices, estimates, etc.:
10. Names and addresses of all witnesses, hospitals, doctors, etc.:
a. ~ ~
¢®
11. Any~additional information, that might be helpful in .considering this claim:
· 7/~f~ ~(;5 PJ~k/ '/7'~d~l~-' &l<~/ PO YJgl/ -~P ~"6/d, ~/.'~l,'<~ d-t
WARNING: 1T 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 th~
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.
~ffice of the City Clerk,
us.tin, California
IMANT ' S SIGNATURE
P~vised 8/05/81
JGR:se :R:8/5/81 (A)