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Home My WebLink About16 CLAIM #98-1 04-06-98 LAW OFFICES OF ~;OODRUFF~ SPRADLIN & SMART AGENDA TO: FROM: DATE: RE: MEMORANDUM Honorable Mayor and Members Of the City Council City of Tustin City Attorney April 1, 1998 Claim of Gordon Alan Smith; Claim No. 98-1 NO. 16 4-6-98 RECOMMENDATION: After investigation and review by the City's claims' administrators and this office, it is recommended that the City Council deny the claim and direct the City Clerk to send notice thereof to the claimant and to the claimant's attorneys. DISCUSSION: The claimant alleges damages in the amount of $263.69 due to a fall he took while roller blading eastbound on Santa Clara street. The City's investigation shows that this accident happened outside the City's boundaries in the unincorporated area. The claimant was notified in writing of this fact. We will ask the City's claims administrators to send another letter warning the claimant of the City's rights to recover its fees and costs should he pursue the claim, as the accident took place outside the city. LOIS E. JEFFRE(~ ~ ~/ u Enclosure CC: William A. Huston, City Manager 1102-9801 60866._1 city of Tustin £M AGAINST THE CITY OF TIN (For Damages to Persons or Personal Property) The law provides generally that a claim must be filed with the City Clerk of the City of Tustin within 6 months after 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 infol]~,ation by paragraph number. Completed claims must be mailed or delivered to the City Clerk, city of Tustin, 300 Centennial Way, Tustin, California 92780 W-~EN COMPLETING THIS FORM, PLEASE TYPE OR USE BLACK INK TO THE HONORABLE MAYOR AND CITY COUNCIL, City of Tustin, California: The undersigned respectfully submits the following claim and information relative to damage to person and/or property: b. ADDRESS OF CLAIMANT: ~ d. TELEPHONE NO: ( ~ ) ~-~ e. DATE OF BIRTH: ~-~ - ] 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. .~ 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: ~ b. TIME: ~30 ~,~, ~;~7'~ c. PLACE (Exact and specific location): d. HOW and under ~hat 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 necessa~): Wq~AT particul :ion by the City, or- alleged damage ~ ~njury? , er, ployees, caused the 5. Give a description of the injury, property damage or loss so far known at the time of this claim. If there were no 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 or any damaged p~operty: 9 o a. Amount claimed as of the date: b. Estimated amount of future costs: /~-- c. Total amount claimed:. ~.~q d. Attach basis for computation of amounts claimed (include copies of all bills, invoices; estimates, etc. 10. Names and addresses of all witnesses, hospitals, doctors, etc. y¢~.~t~ J')/41~Y--~ h'lf..D~CRJ..61~l~ ,.g..~-ol ~ . C~l~l~lSN /¢V~, O~'c~ W~Z~NING: IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM! ! (Penal Code. Section 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 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 or perjury that the foregoing is TRUE AND C0~RECT. Executed this ~ day of b~d~l'~%~- ,19 ~7, at Tustin, california. DATE FILED: Bi:CLFORM Revised 8/96 December 18, 1997 I Gordon A. Smith have a formal complaint. I was roller-blading home from work at Dairy Queen located on Tustin and Santa Clara on 11/20/97 and had an accident. A portion of the street was not finished. I have pictures of a rec- tangular hole in the street. I also have pictures of my right arm and shoulder. The scrapes have healed but my wrist has not been the same. My shoulder which took most of the impact does not rotate like it should. I ,,vas on the side walk when I came across new wet cement so I moved on to the street and into the bike lane. This is where I came across the rectang-ular hole. The only reason why I am bringing this to your attention is because I was thrown into the street by this hole and almost hit by a car. Because of this accident I couldn't go to work the next day and my employer required a doctors release for me to return. The visit to Yorba Park Urgent Care cost me over $200.00. They required ex-rays oi: my shoulder and an office visit, and a prescription for antibiotics for infection from the scrapes. I need these bills paid for. The area in the bike trail was not marked as a hazardous area like the sidewalk was and should have been. I/:edit is the city's responsibility to pay for my medical expenses and lost wages: I have included the photographs of the street, my arm and shoulder and copies of the bills. Thank you for your attention to this matter. Please make payment out to: Gordon A. Smith Phone # $157.00 Ex Rays $47.00 Dr. Visit $24.69 Antibiotic $35.00 Lost Wages Total $263.69 z:~ c~-~ O~ ~.'.'=:: 125967 P =~,sE 01 YORBA PARK MEDICAL GROUP, INC. 2501 EAST CHAPMAN AVENUE ORANGE. CALIFORNIA g26~9-3288 (714) 633-1011 NEWADDRESS: , ..; ,.-_ BALANCE 157.00 125967 CORDON SMITH IMPORTANT! SEE REVERSE SIDE YORBA PARK MEDICAL GROUP, INC. 2501 EAST CHAPMAN AVENUE · ORANGE. CALIFORNIA 92669-3288 IRS ~ 33-0667389 PHONE # (714) 633-1011 CORDOH SMITH .1/21/97 GORDON 1/21/97 CORDDN 1/21/97 CORDON 1121/97 CORDON 1/21/9Z ~ORDON 00107 NEW PATIEHT(MAIL/APUERT) O0 DR. TUUERA 99201 PROBLEM FOCUSED NEU PAT O0 DR. TUUERA 959.2 71101 X-RAY EXAM OF RIBS, CHES O0 DR. TUUERA 959.2 ?]0)0 X-RAY SHOULDER MIN 2 UWS O0 DR. TUUERA 959.2 PAYMENT-~HE~K CLOSING DATE 11/]0/97 1259G7 0.00 47.00 92.00 ~5.00 47.00 WE WILL ACSEPT PAYMENT BY MASTERCAR~ AH~ UISA FOR YOUR CONUENIENC~. :re of Last P~gae~t 11/21/97 157.00 I 0.00 '.:' O.Oq