HomeMy WebLinkAboutCC 4 CLAIM 82-27 12-06-82C~TE:
TO:
FROM:
SUBJECT:
11/22/82
NO. 4
Inter-Corn
CONSENT CALENDAR
12-6-82
~__~QNORABLE MAYOR AND CITY COUNCIL
JAMES G. ROURKE, CITY ATTORNEY
CLAIMANT: Z.A. KAZARIAN; D/L: 7/26/82; FILED W/CITY:
10/19/82; CLAIM NO: 82-27; CARL WARREN FILE NO: S 32925 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.
JGR:se
Enclosure
1. Copy of Claim
cc: OCCRMA
(Fcr Damages to Person.. Dr Personal Property)
U.s.ReceivedMailbY ~a~-~l~[- x~.~--~v~a
Inter-office
3ver the Counter
OCT 1 9 1982
Orr'me- I u~1~n (~ty Cle;'k
By ~
The law provides generally that a claim must be filed with the City Clerk of
the City of Tustin within 100 days 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-
tion by paragraph number. Completed claims must be mailed or delivered to the
City Clerk, The City of Tustin, 300 Centennial Way, Tustin, California 92680
TO THE HONORABLE MAY~R AND CITY COUNCIL, City of Tustin, California:
The undersigned respectfully submits the following claim and information rela-
tive to damage to persons and/or personal property:
i. NAME OF CLAIMANT: ~. ~. ~RI~P~
a. ADDRESS OF CLAIMANT:I~
b. PHONE NO: ( ) c. DATE OF BIRTH: ~3~. I~9~--
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 than above:
3. This claim is submitted against:
a. /
b.
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:
Se
Occurrence or event from which the claim arises:
DATE: 7-~ ~ b. 'TIME: /~0~.]~:~)4~c. PLACE (Exact
and specific location): ~/%c~.~) ~ :~:LI~ /~,,~"rC-~T ~.~ ~US~I~ C~
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).
Give a description of ~e injury, property damagC r loss so far as is
known at the time of t _s claim. If there were n injuries, state "no
injuries".
6. Give the 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:
9. Damages claimed:
a. Amount claimed as of this date: ~ ~-
b. Estimated amount of future costs:
c. Total amount claimed: ~7'~ ~?
d. Basis for computation of amounts claimed (~nc±u~e copies of all bills,
invoices, estimates, etc.:
10. Names and addresses of all witnesses, hospitals, doctors, etc.:
a.
b.
d.
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)
Office of the City Clerk,
Tustin, California
CLAIM NO: ~-~
I have read the matters and statements made in the above claim and I know the
same to be t~e 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.
~ certi~ under penal~ of perjury that the foregoing is TRUE AND CORRE~.
Revised 8/05/81
JGR:se:R:8/5/81 (A)
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STATE OF CALIF()IU~IA, COUNTY OF
ann the , ___
and knoao the content~ tAcreo/; and I certily that tAe zam¢ i~ tr~e. oI my own knowledge, except o~ to those mattcr~ wAicA
are therein ~t,tgcd Itp,n m7 in[or;nation or bclie~, and o-~ go tho~e mntter~ I believe it to be true.
I decAt,e, under pcn,,hy o] perjut~/, that the/orcgolng ;* true and c,,,rect.
(date) (pt Joe)
........ Calitornla
PROOF OF SERVICE BY MAll, (Io13a, 2015.$ C C. P.)
STATE OF CALIFORNIA, COUNTY OF
I am a citizen o/ the (],,ired St.te~ anti a foci,lent o/ the county ./orezai~l; I am over the age o/ e~htccn yeat~ and not
a ~t~ty to the ~(hln entitled act~n; m~ b~in~J addre~ ~:
3~ Sparrowhawk
Irvl~e, Callf
O. October l~ .~_82 .t,e~dthe=ithl. CLAIM AGAINST '['HE
CITY OF TUSTIN
City Clerk
City of Tustln
300 Centenmlal Way
Tustln, CA 92680
I decLtte, un'er penalty o] perjury, that the ]oteg,,ing
~zecutedon October 16, 1982 ., N._ Hollywood
· C~di[orni~