HomeMy WebLinkAboutCC 4 CLAIM #83-8 06-06-83DATE:
TO:
FROH:
SUBJECT:
5/25/83
CONSENT C~T.~NDAR
Inter-Corn
HONORABLE MAYOR AND CITY COUNCIL
JA~S G. ROURKE, CITY ATTORNEY
CLAIMANT: BRUN, PATRICIA; D/L: 12/7/82; FILED W/CITY:
3/11/83; CLAIM NO: 83-8; CARL WARREN FILE NO: S 34209 CH
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:se
Enclosure
1. Copy of Claim
cc: OCCRMA
- RECEIVED
,.(FOr Damages to Person r Personal Property)
U.S. Mail
Inter-office Mail
The law provzdes generally =ha= a clalm must
~he City of Tus=in wi=bin 100 days after which =he incident ~= even= occurred.
~ sure your claim is against =he City of Tus=in, no= another public entity.
Where space is insufficAen=, please use additional paper and identify info~a-
~ion by ~aragraph n~be=. Completed claims must be mailed or delivered =o =he
City Clerk, The City of Tus=in, 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: Patricia Brun
a. ADDRESS OF CLAIMANT:
b. PHONE NO.: ( c. DATE OF BIRTH:
Name, telephone and post office address to which claimant desires notices
to be sent, if other than' above:
same
3. This claim, is submit:ted against:
a. X
b.
The city of Tu~tin mn!y.
The following'employee(s.) of the City of 'Tustin
The City of Tustin and the following employee(s) of t~e
City of Tustin only:
4. Occurrence or event from which the claim arises:
a. DATE: Dec.7,1982 b. 'TIME: 2:40 pm .c. PLACE (Exact
and specific location): Cross walk a= Holt and Irvine Blvd.
How and under what circumstances did damage or injury occur? 'Specify
the particular Occurrence, even=, act or omission you claim caused
the injury .or damage (Use additional paper if necessary).
Slipped on excessive ~ravel in the cross walk.
What particular action by.the City, or its employees, caused the
alleged damage or injury?
Me~elec~ o~ ~m~v~n~ ~v~] ~m ~ ~"=~ '-'~er~ they
be~n wor~ng.
Give a description of the injury, proper~y damage or aoss so far as is
known a= :he time of this claim. If there were no injuries, state "no
injuries".
Multiple bruise's leG, elbow, shoulder. Bursitis.
6. Give the name(s) of the City employee(s) causing ~he damage or injury:
7. Name and address of any other 9erson injured: None
8. Name and address of the owner of any damaged property: Hone
Damages claimed:
a. Amoun~ claimed as of this date: ~qT~ 7~
b. Estimated amount of f~ture costs: ,,,~~
c. To~al amount claimed: ~
d. Basis for computation of amounts claimed (include copies of all bills,
invoices, estimates, etc.:
10. Names and addresses of. all witnesses, hosgitals, doctors, etc.:
a. Dr. Barry Marfleet, 13372 Newl~ort Ave. ~F, Tustin, CA
Chris. Brun, son
c.
1i. Any additional information that might be helpful in considering this claim:
Snao shots ~aken. Available uDon request.
WARNING: IT ISA 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 :he same to be true'.
I certify under penalty of perjury that the foregoing is TRUE AND CORRECT.
Executed this 6th day of March , 19 83 , at Tus~in, California.
Office of ~he City Clerk,
Tustin, California
CLAZM NO: ~- ~
Revised 8/05/81
IR:se:R:8/5/81 (A)
PRESCalPT~0NS WILL ~ R~ ~(N YOU ARRIV~
THRIP
~0 ~ FIR~ STRE~
TUSTIN, CA 92~0 /
PRESCRIP~ON ~LLS ~7~
ALL O~ER ~LLS ~7~
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