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HomeMy WebLinkAboutCC 3 CLAIM #85-42 02-18-86TO: FROM: SUBJECT: HONORABLE MAYOR AND CITY COUNCIL/.' JAMES G. ROURKE, CITY ATTORNEY CLAIMANT: FIELD, ISOBEL; D/L: 08/30/85; DATE FILED W/CITY: 09/09/85; CLAIM NO: 85-42; 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 rejection to the claimant and to the claimant's attorney. JGR (F4.se) Enclosure: Copy of Claim ~LAIM AGAINST THE CITY OF TUSTIN (For Damages %o Persons or Personal Property) Received by .~ ~. u-)~-~-- - via U.S. Mail Inter-office Mail Over the Counter ~he law provides generally that a claim must De'~iied with the City Clerk o~ the City of Tustin within 100 da~s 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~ ~ion 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 submita the following claim and information rela- tive to damage to persons and/or personal property: 1. NAME OF CLAIMANT: ~C~ L_ ~, a. ADDRESS OF CLAIMANT: : b. PHONE NO: ( c. DATE OF BIRTH: SOCIAL DRIVERS d. SECURITY NO: ~-~&- e. LICENSE NO: Name, telephone and post office address to which claimant desires notices to be sent, if other than above: 3. This claim ia submitted against: a. b, The City of Tustin only. The following employee(s) of the City of Tustin on!y: The City of Tustin and the foliowing employee(a) of the City of Tustin only: Occurrence or event from which the claim arises: a. DATE: ~_~ '~o, tQp.~ b. 'TIME: I~'.C~©p~% c. PLACE (Exact 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;~he City, or i~s 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 injuries" ~ '. Give the name(s) of the City emp].oyee s) causing the aamage or in u : 7. Name and address of any other person injured: $. Name and address of the owner of any d, amaged property: 9. ~mages claimed: ~ ~5~ O~ a. ~ount claimed as of this date: · b. Estimated amount of future costs: c. Total amount claimed: ~ '~ ~'~' d. Basis for computation of amounts claimed (~nclude cop~es o[ all Dilis, invoices, estimates, etc.: 10. Names and addresses of all witnesses, hospitals, doctors, etc.: c. 11. Any additional information that might be helpful in considering this claim: WARNING: IT 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 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 5- day of ._~.. ~_.~ , 19 ~ ~ , at Tustin, California. CLAIMANT ' S SIGNATURE office of the City Clerk, Tustin, California Revised 8/05/81 JGR:se:R:8/5/81 (A) MIKE DAMMANN LANDSCAPE 14772 Briarcliff Place Tustin, Ca. 92680 (714) 544-7169 Customer Name Address Phone No. Res Work HARDSCAPE UNITS DESCRIPTION PRICE Concrete This [] Plain [] Broom [] Salt [] Burnt Edge Brick [] 8" Brick Ribbons [] 12" Brick [] Other Patio Cover [] 2 x 6 & 2 x 3 & 4 x 4 [] 2x8&2x3&6x6 [] Other Footings Drain [] 3" []4- Brick Steps [] 8" []12" Raised Deck Brick-porch [] Plain [] Herring Bone FEI~CING ¢s an estimate only- prices may vary depending upon quantity chosen