HomeMy WebLinkAboutCC 3 CLAIM #83-2 03-21-83DATE:
March 3, 1983
CONSENT CAT.W. NDAR
No. 3
3-21-83
Inter-Corn
TO: .----h~f~ORABLE MAYOR AND CITY COUNCIL
FROM:
JAMES G. ROURKE, CITY ATTORNEY
SUB~JECT:
CLAIMANT: Douglas Teulie D/L: 11/21/82 FILED W/CITY: 1/13/83
CLAIM NO: 83-2 CARL WARREN FILE NO: S 33684 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
'~SkIM AGAINST THE CIT .... ~F TUSTIN
Damages to Persd or Personal Property)
Received by
u.s. Mail
Inter-office Mail
Over the Counter
via
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 ~ubmits the following claim and information rela-
tive to damage to persons and/or personal property:
NAME OF CLAIMANT: Douglas W. Teulie
a. ADDRESS OF CLAIMANT:
b. PHONE NO: ( c. DATE OF
SOCIAL DRIVERS
d. SECURITY e. LICENSE NO: ~
2. Name, telephone and post office address to which claimant desires notices
to be sent, if other than above:
W.L.McCAll, Attorney at Law, 2444 Wilshire Blvd ~414, Santa Monica CA 90304
~- 3. This claim is submitted against:
The City of Tustinfonly.
The following emplbYee(s) of ~he 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:
de
DATE:November 21. 1982b. 'TIME: 0925 c. PLACE (Exact
and specific location): on West side o~ MY~'UIiD STP~ET and 278 feet
SOUTH of BRYAN
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).
Claimant on bicycle ran into large pot hole in surface of street.
Claimant was thrown from bicycle onto pavement.
What particular action by the City, or its employees, caused the
alleged damage or injury?
Failure to repair and/or keep ~n repair ro~d ~r~
Give a description o~ uhe injury, property damage loss so far as is
known at the time of this claim. If there were no injuries, state "no
injuries".
Injuries: nasal fracture, severe facial lacerations, possible
damage to ~ee~h, 5ack anG neck sprain.
?roper~y ~ama§e: Dlcycie.
Give the name(s) of the City employee(s causing the damage or injury:
Presently unknown
7. Name and address of any other person injured: none
8. Name and address of the owner of any damaged property:
Douglas W. Teulie
Damages claimed:
a. Amount claimed as of this date:
b. Estimated amount of future costs:
(a) Medical $1426.19
(b) Property damage $830.94
Medical - $2500.00
c. Total amount claimed: $35.000 olus soecial damages.
d. Basis for computation of amounts claimed (include copies of all bills,
invoices, estimates, etc.: copies attached
10. Names a~d addre~ o~ ~11 witnesses, hospitals, doctors, etc.:
a. western ~e~lc~£ Center- 1001 W. Tustin Ave, Santa Aha, CA
b. C.H.,Turner, M.D.- 1401 Avocado Ave. New-port Beach. CA
c. Hoag ~osp~] - 301 New~ort Blvd. N~wpo~t B~ch, CA
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: rS- ~
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.
Newport
Executed this,/' 3rd day of ~' Oanuary , 19~$3 , at ~9~, California.
/ CLAIMANT ' S SIGNATURE
~ Douglas W. Teulie
Revised 8/05/81
JGR:se:R:8/5/81 (A)
DATE FILED: