HomeMy WebLinkAboutCC 4 CLAIM #81-23 09-21-81DATE:
TO:
FROH:
SUBJECT:
9/9/81
CONSENT C~ ?.~.NDAR
Inter - C om
HONORABLE MAYOR AND CITY COUNCIL
JAMES G. ROURKE, CITY ATTORNEY
CLAIMANT: WEISSGERBER, LEE ANN; D/L: 1979 to date;
FILED W/CITY: 8/20/81; CLAIM NO: 81-23; CARL WARREN
FI~ ~ 2~776 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
CLAIM AGAINST THE CITY OF TUSTIN
(For Damages to Persons or Personal Property)
U.S. Mail
Inter-office Mail
Over the Counter
The £aw provides generally that a c£azm must De [~led with the Czty C£er~ o[
the City of Tustin within 100 days after which the incident or event occurred.
B'e 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 ~YOR AND CITY COUNCIL, City of Tustin, California:
The undersigned respectfully submits the following claim and info~mation rela-
tive to damage to persons and/or personal property:
/
-7~13 b. PHONE NO: (?/¢) ~¢¢-/,~.~ c. DATE OF BIRTH: /~ ~'/
SOCIAL DRIVERS
2. Name, telephone and post office address to which claimant desires notices
to be sent, if other than above:.
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: c. PLACE (Exact
and specific location): /~z/'/ ~-~X~SW,~~/. ~%~'~
d. 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 i~ necessary).
e. ~at 9arti~lar action by the City, or its emgloyees, caused the
alleged damage or injury? -'
~/)
Give a description of the injury, property damage or ioss so far as is
known at the .time of this claim. If there were no injuries, state "no
injuries" .
Give the name(s) of the City employee(s) causing the damage or injury:
Name and address of any other person injured:
Name and address of the owner of. any damaged property:
/
Damages claimed:
a. Amount claimed as of this date:
b. Estimated amount of future costs:
c. Total amount claimed:
d. Basis for computation of amounts claimed (include copies of all bills,
invoices, estimates, etc.:
.0. Names and addresses of all witnesses, hospitals, doctors, etc.:
a.
b.
C.
Any additional' information that might be helpful in considering this claim:
~ ;-.~'~'/_. ;7- x'~ ~ ~¢"~/ ~ -'7-u%~'~,~.~ ,,F~$A~.~'~'L/r7
;ARNING: IT IS A CRIMINAL OFFENSE TO FILE'A FLASE 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
-~ame to be true of my own knowledge, except as to those matters stated to be
lpon information or belief and as to such matters I believe the same to be true
£ certify under penalty o~ perjury that the foregoing is TRUE AND CORRECT.
:xecuted this ~O day of /2Z~'~ -, 19. ~/ , at Tustin,
California.
~ CLAIMA~Tf ' S SIGNATURE
~3ffice of the City Cl~rk,
!ustin, California ..
N0: - o-Fl
Revised 8/05/81
.TGR: se: R:8/5/81 (A)