HomeMy WebLinkAboutCC 10 CLAIM #80-23 11-17-80L
DATE:
TO:
FROH:
SUBJECT:
CONSENT CAT~NDAR
NO. 10
11/3/80
HONORABLE MAYOR AND CITY COUNCIL
.]AMES 0. ROURI~E, CITY ATTORNEY
CLAIM OF 2ACIFIC TELE?HONE; CLAIM ~80-23
After investigation and review, it is recommended that the above-referenced claim
be denied and the City Clerk is directed to give proper notice of the denial to the
claimant and his attorney.
3OR:se
Enclosure
1. Claim of Pacific Telephone
October 22, 1980
Carl Warren & Company
1801 Park Court Place
Building E, Suite 208
Santa Ana, CA 92701
ATTENTION: L. Schellink
· RE: CLAIMANT: PACIFIC TELEPHONE
CLAIM NO: 80-23
Gentlemen:
The enclosed claim or' Application ho File Late Claim was
presented to this office this date and has been referred to
the appropriahe C~ty department for its investigation and
also to the offices of Rourke & Woodruff, Attention of
J~es G. Rourke, City Attorney. By this letter you are
authorized to commence the necessary investigation of this
claim on behalf of the City.
we would request that y.ou notify the excess insurance
carrier(s) for the City that you are commencing said
investigation; and would further request that you submit
your preliminary and all-subsequent' reports to the City,
',-;ith a copy to the City Attorney and to the insurance
carrier(s) if they so request. Pending advice from the
City A~:torney, we will plan to present this matter to the
City Council for denial at its next regularly scheduled
meeting.
Very truly yours,
~ ~lerk
City of Tustin
cc: ~L~ty Attorney
Department Head
Finance Department
(2)D:ll
FO~4 B
LETTER OF TRANSMITTAL OF CLAIM
OR APPLICATION TO FILE LATE CLAIM
City Center 300 Centennial
Tustin, California 92G80
(714) 544-8890
CITY OF TUSTIN
OFFICE OF THE CI FY CLERK
Claim No..
S&C No.'
The attached document was received
Received: Date: .October 22,-
T iriqe: 12: 45 o'clock
,19 80
P' .M-
Received
Personal service upon th~ Undersignmd
x Regular mail
Certified or regisLered mail
Signature
Mary E. Wvnn
(Print Naif,?)
City Clerk
Position
Copy to:
/ Carl Warren & Co. on
/ City Attorney on
"' DeparU-aent Head
/ Finance Deparkment
,19~O.
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,19 ~O
· 19 ~O
O-Z3
3.'A'R:~.2:D:2/12/79
3GR:se:2/!4/79
3GR:se:P.:3/20/79
3GR:se:R:4/2~4/79
Form A D:ll
FORM A
RECEIPT
(F o: Oamages to Persons or Personal ty)
',eceived By via Clerk's Time. Stamp
hr_er-of flee Mail
the Counter
the la~¥ 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 eve~[ occurred. Be sure your claim is. against the
City of Tustin, not another public entity. Where space if insufficient, piease use additiona! paper and
den[ify information by paragraph number. Completed claims must be mailed or delivered [o the City
Cjerk, The City of Tustin, 300 Centennial Way, Tustin, California 92680.
__TO THE HONORABLE MAYOFt AND CITY COUP4CIL, City of Tustin, California
Tha undersigned respectfully submits the following claim and information relative to damage to
__persons and/or personal property:
1. NAME OF CLAIMANT: ~/i. ~:~ ~6~~
~ a. ADDRESS OF CLAIMANT: ~¢ ~. ~z~.~F~Z</ ~F~N¢~ ¢~
b. PHONE NO: (~ ~//~ C. DATE OF BIRTH: ~
d. SOC~AL SECUR]TY NO: ~
e. DR[VE~% LICENSE NO: "' ....
_2 Name, t_~icohone and post office address to which claimant desires notices to be sent, if other
~ above:
Occurrence or event from which the claim arises:
a. DATE: .7-~'-_-~ b. ,TIME: z/,'Z~/C/r/ c. PLACE (exact and specific
d. How and Under what Circumstances did damage or injury oCCur? Specify the particuI~
occurrence, event, act or omission you claim caused.the injury or damage (use additional
p~per if necess~y).
What particular action by the City, or its employees, caused the alleged damage c
Give a descriptior~ of the injury, property damage or loss, so far as is known at the time of
this clai.rn. If there were no injuries, state "no injuries".
Give the name(s) of the City employee(s) causing the da,nags or injury:
Name and address of any other person injured:
¸7.
Name and .qddress of the owner of any damaged property: . ~- ~2 ~' ~ ,/ ~ ~- .
!0.
Damages claimed:
b.
d.
Estimatsd amount of future costs:
Total amount claimed:
Basis fo~ computation of amounts claimsd (ineluds ~opies of all bills, invoices~ estimates~
etc.):
Names end addre~es of all witness, hospitals, doctors, etc.
a.
b.
d.
Any ~dditional information that might be helpful in considering this claim:
WARNING: IT IS A CRIMINAL OFFENSE TO FILE A FALSE CCAIM! (Penal Code Section 72;
insurance Code Section
I have read tbs matters and statements made in the above claim and I know the same to be true' of m
own knowledge, excep~ as to those matters stated to be upon information or b~lief as to such matters
believe the same to be true. I certify under penalty of perjury that the foregoing is TRUE an
CO,~RECT.
Executed this ¢ day of ¢~% , 1~ ~r-~, at ¢~¢~ , California-
~laimant',~ture
.~ffiee of the City Clerk,
Tustin, California
CLAIM NO.
DATE FILED~-
~R:ss:D:2/5/80
. T/Claim Form D:ll