HomeMy WebLinkAboutCC 3 CLAIM #85-21 05-20-85___ .~ . CL .ENT CALENDAR
TO:
FROH:
SUBJECT:
~E MAYOR AND CITY COUNCIL
JAMES G. ROURKE, CITY ATTORNEY
CLAIMANT: CHACONAS, JOHN; D/L: 03/01/85; DATE FILED
W/CITY: 04/01/85; CLAIM NO: 85-21; CARL WARREN FILE
NO: S41623CVH j
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
CLAIM AGAINST THE Y OF TUSTIN
('For Damages to ~Persons or Personal Property)
Received by ~F. ~
U.S. Mail
Inter-office Mail
Over the Counter
via
The law provides genera.lly that a clalm must be klled wlth the City Clerk o: .
the City of Tustin within 100 days afte~ 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 th,
City Clerk, The City of Tustin, 300 Centennial Way, Tustin, California 92680
TO THE HONORABL~ 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:
NAME. OF CLAIMANT: JOHN CHACONAS
a. ADDRESS OF CLAIMANT: c/o ~F~ invmnts, ~/~lu Newnope, ~zl~, ~'.v.
b. PHONE NO: ( c. DATE OF BIRTH:
SOCIAL DRIVERS
d. ,SECURITY NO: e. LICENSE NO:
2. Name, telephone and post office address to which claimant desires notices
to be sent, if other =hah above:
This claim is submitted against:
a. XX The City of Tustin only.
b. The following employee(s) of the City of Tustin only:
The City of Tustin and =he following employee(s) of the
City of Tustin only:
4. Occurrence or event from which the claim arises:
DATE: 3-1-85 b.
and specific location):
'TIME: AM
c. PLACE (Exact
15911 yr e, in parkway & front lawn
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).
Cit¥/Tustin while removin~ parkway tree dug under sidewalk hitting.
our property's water supply line causing it to gush ~n tne alr~
and water supply ~o the building turne~ o~ ~urlng two ~ay repair
e. What particular action by the City, or its employees, caused the
alleged damage or injury?
g tree removal equipment firstly; and,
secondly, ignorance per plumping repair on a nigh pre~=u~e
water line in their attempt to repair.
'5.
6o
So
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#' Mr. Hugh West, Maintenance for Tustin, instructed us to repair
the lea~lng water line ana Submit a claim as to the reimbursement o~ costs
involved in the repair.
Give the name(s).of the City employee(s) causing the damage or injury:
Unknown to us other than it was the subcontractor for the City of Tustin.
Name and address o'f any other pets'on injured:
See Claimant on front of this form
Name and ~ddress of the owner of any damaged property:
~ee Claimant on front of this form
e
10. Names and addresses of all witnesses, hospitals, doctors, etc.:
a. Mrs. Sue Jenkins,
Damages claimed:
a. Amount claimed as of this date: $ 382.98 Plumbinq repair
b. Estimated amount of future costs: ? Any excess water billing
c. Total amount claimed: ~oz.~ plus any excess water
d. Basis for computation of amounts claimed (include copies of all bills,
invoices, estimates, etc.: Dan Martinez Invoice No 9655
, Water bill for period not re-
ceived yet.
11. Any additional information that might be helpful in considering this claim:
The length of pipe removed by the plumber is in our Possession.
i= nas a Wvc coupllne [wnlc~ we ~ave not tampered with until
your claim oepartment see's ~t.
WARNING: IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM! (Penal Code
Sec=ion 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
h 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 , 19
, at Tustin, California.
Office of the City Clerk,
Tustin, California
CLAIM NO: ~
Revised 8/05/81
JGR:se:R:8/5/81 (A)
iNVOtC~' NO.
9655
STAT ZIP
7H 721 ·