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Home My WebLink About06 CLAIM 07-05 SHAD 04-17-07/lf~. ,. .~ AGENDA REPORT Agenda Item Reviewed: City Manager Finance Director 6 MEETING DATE: APRIL 17, 2007 T0: WILLIAM A. HUSTON, CITY MANAGER FROM: RONALD A. NAULT, FINANCE DIRECTOR SUBJECT: CONSIDERATION OF CLAIM OF AZIN SHAD, CLAIM N0.07-05 SUMMARY: The Claimant reported she was driving near a construction zone in Tustin where there was a lot of debris, rocks and gravel on the street. A rock hit her car and caused a deep crack along the center of the windshield. She submitted an estimate of $1,153.64 to have the damage repaired. RECOMMENDATION: That the City Council deny Claim Number 07-05, Azin Shad, and direct Staff to send notice thereof to the Claimant. FISCAL IMPACT: None. DISCUSSION: The City's Claims Administrator views this as a case of no liability on the part of the City of Tustin. It has been confirmed by Staff that Vestar Development Company is overseeing the construction in the area where the Claimant's vehicle was damaged. There is no contract between Vestar and the City for the work being done, and the City had no prior notice of the debris at that location. Staff is recommending denial and the Claim has been referred to Vestar Development Company for consideration. Ron d A. Nault Finance Director ATTACHMENT: Copy of Claim No. 07-05 ConsiderationOfClaimOfAzinShad.doc CLAIM AGAINST THE CITY QF TUSTIN (For Damages to Person or Personal Property) Received Via: ^ U.S. Mail ^ Irrter-Office Mail ^ Over the Counter Time Stamp: Claim No~` PLEASE NOTE: A. Read entire claim lxfore filing. B. 8e sure your daim is against the Ci of Tusfin, not another pudic entity. C. Claims for death, injury to person or to personal propertyy must be filed no later than 6 months after the occurrence (Government Code § 911.2}. D. Claims for damages to real property must be filed no later than one year after the occurrence (Government Code § 911.2). E. If addt~onal space is needed to provide your information, lease attach sheefis, identifying the paragraphs} being answered. F. A claim must be presented, as prescribed by the Government Code of the State of California, by the daimant or a person acting on his/her behalf and shall provide the information shown below and mgt be signed by the daimant or a person on his behalf (Government Code § 910.2}. G. This form is for the convenience of those desiring to present claims against the city. Claimant is advised to consult a private attorney if leggy advice is desired. No em~oyee of the City may cave legal advice to any claimant relating to private daims. H. Completed daims must be mailed or delivered to the City of Tustin, City Clerk's Office, 300 Centennial Way, Tustin, California 92180. 1. Name and Pmt Office address of the Claimant: Name of Claimant:. ~Zi ~ ~ ~~~ Home Address: . ---- Home Telephone: ~.,~ ~ . ~~ ~. ~,~~, Work Telephone: ~ 2. Post Office ~Idress to which the person presenting the claim desires notices to be sent: (If different from above} Name of Addressee: Telephone: Post Office Address: 3. The date, place and other circumstances of the occurrence or transaction from which the claim arises. Date of Occurrence: ,~~~ ~,~ ~ ~j Time of Occurrence: ~„ : '~ p ~ Location: ~ ~,~q~, ~ ~.~ e.~ S~ ~- ~. ~~~l~ ~~,~ ~ ~ Circumstances giving rise to this claim: ~- ~r~l~. 4. General description of the indebted ess, obligation, injury, dams a or loss incurred so far as you now know. ~~ ~ ~~ Page 1 of ~ 5. The name or names of the puuiic employee or employees causing the injury, uamage, or loss, if known. 6. If amount claimed totals less than X10,000: Provide the amount claimed if it totals less than ten thousand dollars ($10,000} as of the date of your claim, including the estimated amount of any related potential future in~u , damage, or loss, insofar as it may be known as of the date of our claim t ether with th ~ ry Y , og a basis of computation of the amount claimed (include copies of all bills, invoices, estimates, etc. ) Amount Claimed and basis for computation: ~ ~ ~ 7. 8. 9. If amount claimed exceeds $10,000: If the amount claimed exceeds ten thousand dollars x$10,000 , do not provide a dollar amount in the claim. However our claim ~ y must md~cate whether ~ wou~ be a limited civil case. A limited civil case is one where the recovery sought, exclusive of attorney fees, interest and court costs does not exceed $25,000. An unlimited civil case is one in which the recovery sought is more than $25,000. See CCP 8G.) ~ § ^ Limited Civil Case ^ Unlimited Civil Case You are required to provide the information requested above in order to com I with Government Code PY §910. Additionally, in order to conduct a timely investigation and possible resolution of our claim the City of Tustin requests that you answer the following questions. Y _~______ Name, address and telephone number of any witnesses to the occurrence or transaction from which the claim arises: , ~' ~~~~ ~~ If the claim involves medical treatment for a claimed injury, please provide the name address an d telephone number of any doctors or hospitals providing treatment: If applicable, please attach any medical bills or reports or similar documents supporting your claim. If the claim relates to an automobile accident: Claimants) Auto Ins. Co.: Address: Insurance Policy No.: Insurance BrokerlAgent: Address: Telephone: Telephone: vian ~ IQI It ~ V CI I. LIL. IVV.. Claimant's Drivers Lic. No.: Vehicle Make/Year: Expiration: if applicable, please attach any repair bills, estimates or similar documents supporting your claim. m iY" Ak.lr~av i Page 2 of 4 READ CAREFULLY For all accident claims, place on fallowing diagram name of streets, including North, East, South, and V11est; indicate place of accident by "X" and by showing house numbers or distances to street comers. If City/Agency Vehicle was involved, designate by letter "A" location of City/Agency Vehicle wl~n you first saw it, and by "B"location of yourself or you- vehicle when you first saw ~~ CURB -~ ~) ~o /~ City/Agency Vehicle; location of City/Agency vehicle at lime of accident by "A-1" and location of yourself or your vehicle at the time of the accident by "B-1"and the point of impact by "X." NOTE: If diagrams below do not fit the situation, attach hereto a proper diagram signed by claimant. SIDEWALK ~rY~~ ~...,• .r ~...... CURB Z ~_ SIDEWALK rY 5 ~ - w Warning: Presentation of a false claim is a felony (Penal Code §72). Pursuant to CCP 1038 the Ci / en to recover all costs of defense in the event an actin § ty ~g cy may seek n is filed which is later determined not to have been brought in good faith and with reasonable cause. Signature: Date: ~ / ~ / Q ~-- Page 3 of d IF LATE CLAIM; COMPLETE ITEMS 1- 9 AND THIS APPLICATION. SIGN BOTH FORMS. APPLICATION FOR LEAVE TO PRESENT A LATE CLAIM TO THE CITY OF TUSTIN The. undersigned hereby applies for leave to present a fate claim to the City of Tustin. This a lication is bein wrthin a reasonable time, not exceeding one (1) year, after the accrual of the pp g made leave to present a late claim will be ranted Gove cause of action. Under some circumstances, g ( rnment Code § 911.fi). The reason for delay in presenting the claim is: f~ ~, ~ ~ a ~" ~ 1 , ~~' Date Revised 12I2o04 Signature laimant Page 4 of 4 uestions # 3 - :Descri Lion of darns a and how it occurred: As I was driving on Barranca past Jamboree towards Von Karman Ave. on Thursd ay, January 25, 200 at 2:30PM, near the construction zone where work is bein don f g e or The District, a rock hit the windshield of my 2007 Lexus IS250 and caused a dee r p c ack slang the center of my windshield. There was a lot of ravel an ` g d debris along Barranca at the tune when this occurred. ~~rnl ~~~~~ ~' ~r~1 ~ . ~, .~ 39C1'~ MACARTHUFt BLVD. ~lEVIlPORT BEACH, CA 92660 {949} 4T7-7Q0~ P~~ ~tE~~~fC~S UNL~S~ A~C~~IMPANIEb ~~ THIS IN~'~l~ raoruc~ ~a ~c~~~u~~~; ~-~~~~~ ~~ ~~~~r~r~~r ~~s~~~c~~ ~ ~~~~~ ~~~ ~s~~~»a~~ ~~ ~~~n~s Thy seller h~r~by expr~l~ ~fiai~Xrs aim w~rt,~~#i~~: ~it~r ~x~~ ~~ 1~-1pli~~i, l~i~l~n~ ~~~ im~lind w~rr~n~+ ~~ m,~rc.~t~b~l€t~ ~~ ~tr~~ fit l~rfi~~sl~t ~u~~,, ~~~ i~ifif~t ~m ~i0~ ~~~ ~~~ ~t~ peg t~ ~~ ~~r ~ ~~~ li~i~y ~ t~lftt~~t~?~~! ~ 4~ ~~ ~~d pr~du~, B.A.Q. # ~p~ # CAL040~Q7515 x 1~ivr~uen ~~1~~/2~~~ 1~ :19F~M mmiiai~niinn~u~~~num~~iimiinomnnnunuitiiun timm~murn~i