HomeMy WebLinkAboutCC 7 CLAIM #81-21 08-03-81DATE:
8- 3-81
7/~/81 ~~~ Inter-Corn
TO:
FROM:
SUBJECT:
................-.~ '" ~*mv COUNCIL
JAMES G. ROURKE, CITY ATTORNEY
CLAIMANT: BRIDENBECKER, FRANCES; D/L: 6-17-81;
FILED W/CITY: 7-10-81; CLAIM NO: 81-21; CARL WARREN
FILE NO: 2q~ql AB
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.
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JGR: se
Enclosure
1. Copy of Claim
'" CLAIM AGAINST THE ( Y OF TUSTIN
(For Damages to Persons. or r-ersonal Property) ;:l];: ';' ..: '"' "!iT :;!;. ~"::
R-ecei red By ,~'~ .¢ /
l ' Mail
I~%~r-office Mail
Over the Counter
Clerk's Time Stamp
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 Tustln, not another public entity. Where space is insu~%elc~ent:, please use additional pal3e~' afld
identify information 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 respectful]y submits the folio.wing claim and information relative to damage to
persons and/or personal property:
1. NAME OF CLAIMANT: -7~J~_~
a. ADDRESS OF CLAIMANT:
b. PHONE NO: ( ¢ ~- ~ ~¢~ c. DATE OF BIRTH:
d. SOCIAL SECURITY
e. DRIVE~% LICENSE NO:
Name, telephone and post office address to which claimant desires notices to be sent, if other
than above:
Occurrence or event from which the claim arises:
a. DATE: (/Z)~'/L) - ~-7~/~'/~/¢~> TIME: ~',%~ c. PLACE (exact and specific
location) ~ ~ ~,~ ~ / ~ ~
d. How and under what circumstances did damage or injury occur? Specify ~he particular
occurrence~ event, act or omission you claim caused the injury or damage (use additional
paper if nece~y).
e®
What particular action by the City, or its employees, caused the alleged damage or
injury?
· Give a description of the injury, property damage or loss, 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: '~'~c
Damages claimed:
a. Amount claimed as of ~his date: ~, ~;-~ ~,~-
b. Estimated amount of future costs:
c. Total amount claimed: ~.~'Z~ ~-
d. Basis for computation of amounts claimed ~include copies of ail bills, invoices, estlmates~
Names and addresses of all witness, hospitals, doctors, etc.
b.
10.
WARNING:
Any additional informa~tion that might be helpful in considering this claim:
IT I~ A CRIMINAL Off~ENSE T~ ~ILK A ~A~SK CLAIMI (~nal C~d~ ~etion 72;
I~urance Code Section 556.0)
! have read the matters and statements made in ~he 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 as to .such matters ]
believe the same to be true. [ certify under penalty of perjury that the foregoing is TRUE ant
CORRECT.
Executed this .~.7~ day of
ffice-of the City Clerk,
Tustin~ California
CLAIM NO. ~'~/'- ~ /
.3GR:se:O:2/5/80
T/Claim Form D:ll
DATE FZLED: ' //-.), /~ f
, / /
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