HomeMy WebLinkAboutCC 10 CLAIM #82-6 03-15-82DATE:
TO:
FROM:
SUBJECT:
3/1/82
CONSENT CALENDAR
No. ~0
3-15 82
lnter-Com
~RABLE MAYOR AND CITY COUNCIL
JAMES G. ROURKE, CITY ATTORNEY
CLAIMANT: OLIVARES, PETER: D/L: 12/6/81; FILED W/CITY:
2/11/82; CLAIM NO: -82-6;.CARL WARREN FILE NO: 31201 RR
After investigation and review it is recommended
that the above-referenced claim be denied and the City Clerk
directed to give proper notice of the denial to the claimant
and to the claimant's attorney.
(~Same Police Report as- Consent Calendar No. 8)
JGR:se
Enclosure
1. Copy of Claim
'cLAIM AGAINST TH~. CITY /- TUSTIN
' .(F°T Damages to Persons or Personal Property)
eceived by ~ ~. ~3 ~ via
U.S. Mail ~ . '~.'~-- FEB 1 i 1982
Inter-office ~ail
OL...a ,u~,,n Ci;~' C)erk
Over the Counter
The law provlQes generally that. a clazm must be tiled wltn the ~ty C]'er~ oz.
the City of Tustin within 100 days after which th~ in6ident or~ event occurred.
Be sure your claim is against the city of Tustin, no~ 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 Wa~, Tustin, California 92680
TO THE HONORABLE MAYOR AND CITY COUNCIL,-City of ~ustin, California:
The undersigned respectfully submits the following claim and information rela-
tive to damage to persons and/or personal property:
NAME OF CLAIJ~NT:
a. ADDRESS OF CLAIt~NT:
b. PHONE NO: ( )
SOCIAL
'd. SECURITY NO:
PETER OLIVARES
#
c. DATE OF BIRTH:
DRIVERS
e. LICENSE NO:
2. Name, telephone and post office address to which claimant desires notices
to be sent, if other than above:
GERALD H. NELSON,
· This claim is submitted against:
The City of Tustin only.-
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:
4. Occurrence or event ~rom which the claim arises:
a. DATE: 12-6-81 b. TIME: 3:42 p.m. c. PLACE (Exact
and specific location): Intersection of Sycamore & Newport Avenue
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)·
The injuries resulted from an automobile accident which was caused by
negligently designed intersection, inproperly placed stop s~s an~
improper maintenance of stop sign notices on the street.
What n caused the
alleged damage or inj
he negllg~n~]y d~ign~d intersection, improperly placed stop signs and
n~gl~ ~en~ly maintained ~+~p ~ g- nn~c~ ~
~'¥e a descr2~tlon of the inSu~, property damage or loss so =-
-t tn- -'m= of this claim. If the~= were no inSurles, state "no
Clue ~h5 z~me[s~ .......... ~= ~he City emm!cvee[=) -ausin? =~= damag_= cr _.,___: :~-4 ....
Name and address of any other person injured: Pearl Murray,
: Name and address of the owner of any damaged property:
J_e~uD_Ar~oyo, ,
Ro~er~ Seidlinger, Ca.
~ 2.a 3~s claimeo:
a. ~cunt claimed as of this date:
b. Essimated amount of future costs: $5,000.00
c. Total amount claimed: $105,000.00
d. 5asis for computation of amounts claimed
invoices, estimates, etc.: Injuries to mv he~d, neck, back ~d
body.
' ~. t~a~es an~ addresses of all witnesses, hospitals, doctors, etc.:
a. Pearl Murray,
c. R__obert Seidlinqer,
Tustin Commuhity Hospital, 14662 Newport Ave., Tustin, Ca. 92680
. .. _~n~,' additicnal information that might be he!ofu! in
__ IS A CRI~INAL OFFENSE TO F~E A FALSE
Section 72; insurance Code Section S56.0)
(Penal Code
have read %ne mauters and statemenus made mn the adore claim and ! know the
s~me 5o De %rue of my own knowledge, except as uo thcse matters auated to be
>on ~nfcrmation or belief and as to such matters I believe the same to be %rue.
ceruify under penalty of perjury that the foregoing is TRUE AND CORR
, 19 fA , at ~'.~s-{~, California.
~cu~ed
Cff'_ce of .--he Ci~v Clerk,
- :
A_:'.. NC: F~- ~
CLAiMA~f
D/o~
~GF,:se:R:~/5/81 (A)