HomeMy WebLinkAboutCC 3 CLAIM #81-4 04-06-81DATE:
March 26, 1981
CDNS~Z~T
No. 3
4-6-81
TO': HONORABLE MAYOR AND CITY COUNCIL
FROM: JAMES G. ROURKE, CITY ATTORNEY
SUBJECT: Claim of Lester Norton, Claim No. 81-4
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 his attorney.
JGR:se
Enclosure
1. Claim of
Lester Norton
'-,~ ~-'~ ' % ' CLAIM AC, Ail'db I. I i~b_ ~.~ ~ ¥ u~- I un ~ i,',~
~ '~F, or Damages to P~rsons or ~-sonal Property)
Rece]~e~ By ~3ttv ~er via
U.S. Mail
~nte~-office Mai[
C '~ the ~ouate~ X
Clerk's Time Stamp
The law provides generally that a claim must be filed with the City Clerk of the 'City
of Tustin within lOO 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 information by paragraph number. Completed claims must be mailed or delivered to the 2ity
Clerk, The City of Tustin, 300 Centennial V/ay, 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 damage to
persons and/or personal property: ';
1. NAME OF CLAIMANT:
a. ADDRESS OF CLAIMANT:
b.
d.
PHONE NO: (~ c. DATE OF BIRTH: . -'}'
SOCIAL SECURITY NO: /[,~'_,
~.~
2. Name, ~_:~phone and uest office address to which claimant desires notices to be sent, if other
~' n above:
O~cu,,~a-- or event ~ra,.~. which the claim arises:
a. DATE: ////..2 ~//~-r~ b. TIME: .~'25~.~f--
d.
c. PLACE (exact and specific
.Fo..,'/
How and under wh~t circumstances did damage or injury occur? Specify the parti2ular
occurrence, event, act or omission you claim caused the injury or damage (use additional
paper if necess~y). ,
What particular'action by the City, or its employees, caused {:he alleged damage or
injury?
Give a description of
t.hls clai.m. If there were no injuries, state "no injuries".
injury, property damage or los a far as is known at th,z time
Give the name(s) of the City employee(s) causing the damage or injury:
Name and address of any other person injured= ..-¢,,/¢,- ,.-v ,..':" .
Name and address of the owner of any damaged property:
6/)
Damages claimed:
a. AmOunt claimed as of this date:
b. Estimated amount ~f future costs:
c. To~a! amount claimed:
B~sis for computation af amounts claimed (include copies of att bills~ invoices~ estimates
etc.):
Names snd addre~es of eii witness~ hospit;als, doctors, etc.
d.
lO. Any -zd.~itional infoz~,~.a~.]cn that might be helpful in considering th~s claim:
WA~N[NG: IT IS A CR[~NA~ OV~ENSE TO ~[~ A FALSE ~A~ (Penal Code Section 72~
] have read Lhe ma~Le~ and statements made in Lhe a~ove claim and ~ ~no~ [he same Lo be true' of
own know]edge~ except as ~ those'matters staled Lo be upon [nfo~mation
believe Lhe ~am~ Lo be ~ru~. ] certify under pena]~y of perjury ~ha~
~OR~ECT.
Executed this ~ day of ~ ~ ~ , California.
~ffice of the City Clerk,
,stin, California
DATE F~LEO: /"-,~ I-
3GR:se:D:2/5/80
T/Claim Form D:ll
BOB'S PAINT 6 BODY
1~7 N. ,~PURG~ON ~,~NTA AUA, CA.
(~14 }. 547-0709
SHOP_
g~701
ESTI;,-~A]'E OF ~EPAI~5
.14122 Newport Avenue 838-5003
832-1468 ~uslJn, California 92680
-
24 Hour Towing . ComPlete. Automotive Repair
DATE
CASH CHARGE
P.O. # R.O.#
~$HERIFF OTHER
TIME IN TIME OUT
! sr lOW
?nd TOW
SE RVICE CALL
,t I st DOLl Y CHG.
2nd OOLLY CHg
MILEAGE
DBOP D~VE LINE
5TANO 8Y TIME
DRIVER - TRUCK - #
? FINISH
S~GNEO
STI~EE1 START
CITY ; .. TOTAL MILES
NOT RESPONSIBLE FOR DAMAGE TO VEHICLE