HomeMy WebLinkAboutCC 5 CLAIM #86-15 05-19-86AGENDA
CONSENT CALENDAR
NO. 5
5-19-86
SUBJECT:
CLAIMANT: FRANCES M. WATTS; D/L-' 3/20/86; DATE FILED
W/CITY: 4/15/86; CLAIM NO: 86-15; CARL WARREN FILE NO:
45 903CVE
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
C~AIM AGAINST THE CI~ii'~~ F TUSTIN.
(For Damages tO Persons or Persona
I P~operty)
Received by 'via
U.S. Mail
Inter-office Mail
.Over the Counter
The law provxdes generally =hat a claim mus: Be ~iled wlth the City'ClerA o~
the City of Tust~n within 100 da--~ after which the incident or event .courts
Be' sure your claim is a.ga~nst t.e City of Tustin, not another public entity.
Where space is'insufficient, please use additiona~ paper and identify inform
tion by paragraph number.' Comp!.ted claims must be mailed or delivered to =
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 informa=ion tel
tide tO damage 'to persons and/or personal proper~y:
NAME OF CLAIMANT: Frances M. Wa£ts
a. ADDRESS OF CLAIMANT:.
PHONE NO: ( 71~ ) 552-2865
SOCIAL
d. SECURITY NO: 573-29-8356
Swan .Irvine. CA 92714
C. DATE OF BIRTH: I-~1'60
DRIVERS
e. LICENSE NO: N9220752
2. Name, telephone and poet office address to which claiman~ desires notice
to be sent, if other than above: N/A
3. This c~aim is submitted against:
The City of Tustin only.
The fo~lowing 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:
DATE: 3-20-86 b. 'TIM~: 7:30 A.M. c. pLACE (Exact
and specific location): C/Ol~edhill, and Ed~nser
d, How and under what circumstances did damage or injury occur? Speci~
~he particular occurrence, event, act or omission you claim caused
~he injury or damage (Use additional paper if necessary).
~h~le :rave~fl~ W/B ~ ~4~r in ~he #2 lane at approx. 10-15 MPH the right f
wheel of my 1981V~ Rabbit entered a hole in the pavement causin~ the trim tin
tn ~1] o~f -~& causin~ the ~h~,l t~ ~-~- Several ~av~ or,or there was ::
excessive rainfall which caused =he hole in =ha pay.pen:. (See attached pho~
e. What particular action by the City, or its employees, caused ~.he
alleged damage or injury?
· NeK~=ence on the Cit~vs ~arC to keep the street properly ,main=a~ne~..
~ ha: ~ole ~ ou~ £ w~£1 say ~fle no~c '
~ ~'~ k~ow how lone =
Was deed enou=h not to have occurred .Demi=hr.
Give a descriptlon 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". (Injuries) ? Property DamaEe: . Bent
tri~ rin~ and DOSS. suspension
Give =he name(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 of any damaged property:
R/O of the 1981 v~ Rab~itt is Jeffre7 L. Watts
Damages claimed: Unknown at =his time. To be determine~
a. Amount claimed as of this date:
b. Estimated amount of future 'costs: unknown ac ~nzs ~zme
c. Total amount claimed.: unknown ac =nls
d. Basis for computation of amounts claimed (include copies of all ~lls,
invoices, estimates, etc.: Unknown at this time.
10. Names and addresses of all witnesses, hospitals, doc=ors, etc.:
a. IIIIIIIIIIIII
¢o
d~
il. Any additional information =ha= might be helpful in considering this claim:
See attached phocos Of the hole
WARNING:-"' 1T IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM:
Sec=ion 72; Insurance Code Section 556.0)
(Penal Code
I-'have read =he mat=ers and statements made in the above claim and I know ~he
.... Same to be' true of my own knowledge, except as to those mat=ers stated =o be
upon information or belief and as =o such maC=ers I believe the same to be tru~
I certify under penalt~ of perjury =hat the foregoing is TRUE AND CORRECT.
Executed this 7. day of April , 19 86' , a= Tus=in, California.
CLAIItANT ' S SIGNkTURE
Office of the City Clerk,
Tustin, California
DATE FILED:
R~vised 8/05/81
_. JGR:se:R:8/5/81 (A)