HomeMy WebLinkAboutCC 3 CLAIM #81-12 07-06-81DATE: 6/11/81
CONSENT CALENDAR
7-6-81
NO. 3
TO:
FROM:
JAMES G. ROURKE, CITY ATTORNEY
SUBJECT: CLA/M OF KAREN McCRAY, CLAIM NO. 81-12, ACCIDENT 5-5-81, FIIRD WITH
CITY 5-15-81, CARL WARREN FTT,E NO. 28986 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.
JGR:se
Enclosure
1. Claim of
Karen ~Cray
'-'~ :;" _7T~. C:LAIM AGAINST THE C.~OF TUSTIN ,
(For Damages to Persons or ~rt~'~¢. sonal Property)
ccived By
U.S. t~ait
Inter-office I~4ail
Over the Counter
via
Clerk's Time Stamp
-ny 1 :,i 198';
The law provides generally that a claim must be filed with the City Clerk of th% C;:'..,
of Tustin within 100 days after which the incident or event occurred. Be sure your claim is agairm~.
City of Tustin, not another public entity. Where space is insufficient, please use additional p~c-;er
identify information by paragraph number. Completed claims must be mailed or delivered to th~ Cit.,
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 relative to darr.:~g~ "
persons and/or personal property:
1. NAME OF CLAIMANT:
ADDRESS OF CLAIMANT: /'.~/ ~..~
b. PHONE NO: (7/'t) 5-dtj-~,~£/
d.
.,(-r
c. DATE OF BIRTH:
SOCIAL SECURITY NO:
DRIVEI~'S LICENSE NO: ?,'
2. Name, telephone and post office address to which claimant desires notices to be sent, if ot',,r.:
than above: ~'
Occurrence or event from which the claim arises:
location) ¢J//2:~/~¢6 .S'l/'/H /~¢ //'2¢7 ¢i /~/¢¢/~/~./ ,3z,'~P~ V ~ ....
/ /?:- ..., ...
d. How and under what circumstances did damage or injury occur? specify the
occur;ence~ event~ act or omission you claim caused the injury or damage (use
paper if necess~y).
eD
What part. icutar action by the City, or its employees, caused the all~ged damage
injury?
o
.Cive a description of t:~,~,,7..niury, proper[y damage or Joss, ~far
this claim. If there were no injuries, state "no injuries".
as is known at t
/
Give the name(s) of the City empioyee(s) (~ausing the damage or injury:
Name and addre% 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 af amounts claimed (include copies of all bills, invoices,
etc.):
~/: ~/6 7 Z>~ ~t,'~'r -/-'- ,:, ,-; /i/r/.~,.'/,': c'~ F ~(c, -:,f'~ :..~_!.__
Names ancC~ddresses of ali wltness~ hosptta~s, doctors, etc.
10. 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
Insurance Code Section 556.0)
I have read the matters and statements made in the above claim and I know the same to be .... * o;
own knowledge, except as to those matters stated to be upon information or belief as to such r,%-,tters
I certify under penalty of perjury that the foregoing is '/R'O~ r:~
believe the same to be true.
CORRECT.
Executed this."^? day of
office o'f the City Clerk,
Tustin~ California
CLAIM NO. ~'/~ /~-~
DATE FILED:
3CR:se:O:2/5/80
T/Claim Form O:ll