HomeMy WebLinkAboutCC 4 CLAIM 83-5 05-02-83~TE:
TO:
FROM:
SUBJECT:
APRIL 18, 1983
CONSENT C~.~..NDAR
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~ORABLE MAYOR AND CITY COUNCIL
JAMES G. ROURKE, CITY ATTORNEY
CLAIMANT: Cynthia Hilland D/L: 3/1/83 FILED W/CITY: 3/8/83
CLAIM NO: 83-5 CARL WARREN FILE NO: S 34175 AB
After investigation and review it is recommended
that the above-referenced claim be denied and the City ~lerk
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
"'C~AIM AGAINST THE CITY ~F TUSTIN
(For Damages to PersO or Personal Property)
Received by ',m~-~--, L.~ via
u.s. Mail ~ ~k,
Inter-office Mail
Over the Counter
RECEIVED
The law provides generally that a claim must be filed with' the ~itY ~lerk o~
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-
tire to damage to persons and/or personal property:
1. NAME OF CLAIMANT: ~%~kJr~ /~/Z-L~AJ~
a. ADDRESS OF CLAIMANT:
/,,~
Name, telephone and post office address' to which claimant desires notices
to be sent, if other than above:
e
This claim is submitted against:
a. ~. The City of Tustin only.
b. The following employee(s) of' the City of Tustin only:
Ce
The City of Tustin and the following employee(s) of the
City' of Tustin only:
4e
Occurrence or event from which the claim arises:
DATE: 3- /- ~5 b. 'TIME: '~=--r~'44/~ S'/-Efm c. PLACE (Exact
and specific location):
How and under what circ~stances did damage or injury occur? Specify
the particular occurrence, event, act or omission you claim caused
the inju~ or damage (Use additional paper if necessary).
What particular action by the City, or its employees, caused the
alleged damage or injury?
'5. Give a description of'the injury, property damage ~u loss so far as is
known at the time of this claim. If there were no injuries, state 'no
injuries'
· '.-~,~-~ ~/ ,' ," ~1. ~ ~' ~,u.'/~ ( '~-c .~ t- ~C '~%,'~ ~' ~: .'..
6. Give the n~e(s) of ~he Ci~ employee(s) causing the ~amage or inj~
7. Name and address of.any other person injured:
8. Name and address of the owner of any dama.ged property:
f~,.',~,-~4;.~ Wl, ~ ~.'.~ ('~.,~-,~- ~
9. ~mages claimed:
a. ~oun~ claimed as of this date:
b. Estimated amount of future costs:
c. Total ~mount claimed:
d. Basis for computation of amounts claimed (include copies of all bills,
invoices, estimates, etc.:
10. Names and addresses of all witnesses, hospitals, doctors, etc.:
11. ~y additional info~ation tha~ might, be helpful in considering t~is claim:
WARNING: 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 of perjury that the foregoing is TRUE AND CORRECT.
Executed this ~ day of /90~ , 19 ~-~ , at Tus~in, California.
Office of the City Clerk,
Tustin, California
CLAIMANT ' S SIGNATURE
Revised 8/05/81
JGR:se:R:8/5/81 (A)