HomeMy WebLinkAboutCC 3 CLAIM #83-31 11-21-83DATE:
11/ /s3
CONSENT C~ ~.W. NDAR
NOo 3
11-21-83
Inter-Corn
TO:
FROM:
SUBJECT:
HONORABLE MAYOR AND CITY COUNCIL
JAMES G. ROURKE, CITY ATTORNEY
CLAIMANT: OLSON, TERESA JOE; D/L: 6/14/83; DATE FILED
W/CITY: 9/12/83 ; CLAIM NO: 83-31; CARL WARREN FILE NO:
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 CITY OF TUSTIN
(~or Damages to Pers(~ 9r Personal Property)
Received by via
U.S. Mail
Inter-office Mail
Over the Counter
"1983
$EP 1 ,::
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 MAYOR 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:
NAME OF CLAIMANT: TERESA JOE'OLSON
a. ADDRESS OF CLAIMANT:
b. PHONE NO: ( c. DATE OF BIRTH:
SOCIAL DRIVERS
d. .SECURITY NO: e. LICENSE NO: None
2. Name, telephone and post office address to which claimant desires notices
to be sent, if other than above:'
t
This claim is submitted against:
a. x The City of Tustin only.
b. 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 from which the claim arises:
a. DATE: June 14, 1983 b. 'TIME: 12:15 a.m. c. PLACE (Exact
and specific location): N/B Moulton Parkway, North of ttarvard
de
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).
Throuqh the imorooer maintenance of the roadway r~y ~ll~-nrnnh~ ]~
struck a ~ard rail on northboun~ r,~n,]~nn p~r',-w~y mn,~ng tb~
automobile to careen off th~ roadway and mi~rim~ m ?~r~ p~m ,+il~+y pO_
ee
What particular action by the City, or its employees, caused the
alleged dama~ge or injury? .
'Negligen orthbound on 14oulto
pproximately 100 vards north of iloward
'5. ~ Give a description~ ahe injury, property dam r loss so far as is
known at the time of this claim. If there were no injuries, state "no
injuries"
Crushed pelvis resulting in surgery necessitating implant of 21
screws and tour plates in pelvis.
6. Give the name(s) of the City employee(s) causing the damage or injury:
Unknown at this time
7. Name and address of any other person injured: None
8. Name and address of the owner of any damaged property:'
Anthony L. Curiale, 324 S. Brea Blvd., Brea, CA 92621
9. Damages claimed:
a. Amount claimed as of this date: $75,000.00
b. Estimated amount of future costs: $25,000.00
c. Total amount claimed: $100,000.00
d. Basis for computation of amounts claimed (include copies of all bills,
invoices, estimates, etc.: Medical bills are not in my possessio
They are in hands of treating hospitals & physicians
10. Names and addresses of all witnesses, hospitals, doctors, etc.:
a. Western Medical Center, Tustin, CA'
b. U.C.I.. Medical Center, Orange
c. Dr. Robert Baird, 4950 Barranca, Suite 105,' Irvine
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 Secti.on 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 to those matters stated to be
upon information or belief and'as to such matters I believe the same to be true.
I certify under penalty Of perjury that the foregoing is TRUE AND CORRECT.
Executed this ~5~. day of September , 19 83 , at Tustin, California.
Office of the City Clerk,
Tustin, California
Revised 8/05/81
JGR:se :R:8/5/81 (A)
CL~/~NT ' S SIGNATURE
DATE FILED: ~ /~,