HomeMy WebLinkAboutCC 5 CLAIM #83-42 02-21-84 2-21-84
Inter-Corn
TO:
FROM:
SUBJECT:
HONORABLE MAYOR AND CITY COUNCIL
JAMES G. ROURKE, CITY ATTORNEY
CLAIMANT: CONNORS, CANDY ELAINE; D/L: 12/20/83; DATE
FILED W/CITY: 12/21/83; CLAIM NO: 83-42; CARL WARREN
FILE NO~ ~ 3C97~ CK
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
cc: OCCRMA
CLAIM AGAINST THE CI~Y-_OF TUSTIN
(Por'Damages tO Perso~ )~ personal Property)
Received by via
U.S. Mail
Inter-office Mail
Over the Counter
The law prov~es generally =ha= a claim must be filed wl=h the City Cler~ o:
the City of Tus=in within 100 days after which the incident or' event occurred.
Be sur~ your claim is against =he City of Tustin, not another public entity.
Where space is insufficient, please: use additional paper and identify info~a-
tion by' paragraph number.. Completed claims must be mailed or delivered' =o the
City Clerk, The City of Tustin, 300 Centennial Way, Tus=in, California 92680
TO THE HONORABLE MAYOR. AND CITY COUNCIL, City of Tustin, California:
The undersigned respectfully submits the following claim and information me!a-
tire to damage to persons and/or personal property:
CLA~MU%NT:
b. PHONE NO: (~/~) ~/_ ~/~/ c. DATE OF SIRTH: . ///~/~
2. Name, telephone and post office address to which claimant d~sires' notices
to be sent,, if other than above:
®.
This claim is submitted against:
a.. The City of Tus~in only.'
The following employee(s) o~ the City of Tus~in only:
The Ci=y.o~ Tus=in and the following employee(s)
City of Tus~in only:
Occurrence or event, from which the claim arises:
and s~ecific location): ~//~,'/' ~c~'~~--' ~ /~,'~ ~e~.
/
d. HOw and under what circ~stances did damage or inju~ occur? Specify
the pa~icula= occurrence, event, ac= or omission you claim caused
t~ injusy or damage (Use additional, paper if necessary).
-/
e. What- particular action by the CitY, or its employees, caused the
Give a description c,.. che injury, property damag- r loss so ~ar as is
known at the time of this claim. I~ there were no injuries, sta%e "no
injuries". V:, r~./'%.~< .~C ~) ~%', ~ ,':~- ~:~".~,~'~'.-~ ~,_:..'~_,~ "~dr,
6. Give the name(s) of the City employee(s) causing the damage or injury:
7. Name and address of any othe=- person injured:
9. Damages. claimed:. ~ / ~, ~
a.- A~oun~ claimec~ as,:' of' thiz date:
b. Em=~a~ed. ~oun~ o~ ~.r~ costs= ~
c. Total ~oun~ clawed: . t~. ~O
d. Basis for c~.=aUion o~ ~ounts claimed (include
Name~ and addressees o~ all witnesses, hospitals-, doctors
c.
Any additional inf~grmaCiou tha~ might.,be helpful in. considering' ~hi.s.'. claim=
W~ING: ~ IS A CRIMIN~ OFF,SE TO FILE A F~SE. C~IM! (Pena~ Code
~c.=ion 72; Instance ~de Sec=ion 556.0)
I have read the matter= and statements made in the. a~ove olaim and I know the
same to be true- of my own knowledge,, except as to those matters stated to be
upon in~ormat.ion or belief and as' to such matters I believe the same to be true.
I certify under' penalty o~ 9er._jury that the foregoing is TRUE AND CORRECT.
O~fice- o~ the City Clerk,
Tustin, California
c~,~ NO,. ?~-
CLAIMANT ' $ SIGNATURE
Revised 8105/81
JGR:se:R:8/5/8i (A)
~ ,,, L~.~ ~IA -~ ' ':: Petrolene Company
pT IS THE CUSTOMER'~ RES~ON$1-
81LITY TO CHECK TIGHTNESS OF LUG
NUTS ON CUSTOM WHEELS AFTER THE .
FIRST t00 MILES
AIR PRESSURE
ALIGNMENT. ALIGNMENT
L. CAM L. CAM
R. CA~, R. CAM.
L. c^sT._ ~ c^ST,
.. c~s?. .. CAS?.
TOE AO~
TOR. HT. TOR HT.
FEDERAL EXCISE TAX
WARRANTY PLUS
TUE~ES .
FEDERAL EXCISE TAX'-- TUBES
WHEEl- WEIGHTS~- -
WHEEL BALANCE. [r'lS"T^T~C ETOYNO /
RUBBER STEMS - ;- . -" ' /
SHOCKS t F R
STRUT CART { F - . I
28209
-,- 28154
28153
.' "28210'
.... 28311
28150
28152
29149 "
.... 28151
WHEELS FRONT '
WHEELS REAR
WHF-'EL LABOR
WHEEL ACCESSORIES
FF..AT REPAIRS
TIRE ROTATION
' ~0T~ LAeOR
· SNOW CHAINS SNOW CHAINS
TIRE AC)JUSTERS
~ I I I ~ CUSTOM WHEELS[]
ALIGNMENT' .~ m. . Lifetime P~lic¥
ALI GNMENT POLICY NO CHARGE
28212.
- 28213
2821A
.28215
28216
28217
2812~
.... 28131"
28133
WARRANTIES
I
I I I I I t I I I I I I I I I
TOTAL PARTS
SALES TAX
TOTALLAROR
GRAND TOTAL
THIS 15 YOUR RECEIPT AND WARRANTY, AND MUST ACCOMPANY ALL CLAIMS.
c. co= ( ....
gLAIM CHECK .or RESPONSIBLE FOR GOODS LEFT OVER 10 DAYS .
NOR FOR LOSS BY FIRE OR THEFT. CUSTOMER COPY