The URL can be used to link to this page

Home My WebLink About14 CLAIM OF JEANNIE L. GOSE 06-05-07Agenda Item ~_ Reviewed: ~~ City Manager "`~ -, -r ~, ~~~ Finance Director ~~.:_.-~ ..; MEETING DATE: JUNE 5, 2007 T0. WILLIAM A. HUSTON, CITY MANAGER FROM: RONALD A. VAULT, FINANCE DIRECTOR SUBJECT: CONSIDERATION OF CLAIM OF JEANNIE L. GOSE, CLAIM N0.07-12 SUMMARY: The Claimant has reported she was turning onto Irvine Boulevard when her car drove over a tem ora lane marker that was not properly secured. A bolt, a metal washer and a screw were p ~ ~ ~ - of 462.55. found embedded in the vehicle s rear tires, which both had to be replaced at a cost $ RECOMMENDATION: That the Cit Council deny Claim Number 07-12, Jeannie L. Gose, and direct Staff to send notice Y thereof to the Claimant. FISCAL IMPACT: None. DISCUSSION: The Cit 's Claims Administrator has determined this to be a case of no liability on the part of the Y Cit of Tustin. All American Asphalt was the contractor working on the rehabilitation project on Y Irvine Blvd. where the damage to the Claimant's vehicle occurred. This Claim has been referred to All American Asphalt for handling and Staff is recommending denial at this time. Rona'I~. Nault Finance Director ATTACHMENT: Copy of Claim No. 07-12 ConsiderationOfClaimOfJeannieGose.doc ~ ~ CLAIM AGAINST THE CITY OF TUSTIN RECEIVED =` (For Damages to Person or Personal Property) APR ~ a zo~~ eived Via: Time Stamp: U.S. Mail ' '~~~ $Y C1TY~ C. ~ 2~;~ ~~~~~ nter-Office Mail ~ R G ^ Over the Counter Claim No. PLEASE NOTE: A. Read entire claim before filing. B. Be sure your claim is against the City of Tustin, not another public entity. C. Claims for death, injury to person or to personal properly 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 additional space is needed to provide your information, please attach sheets, identifying the paragraph(s) being answered. F. A claim must be presented, as prescribed by the Government Code of the State of California, by the claimant or a person acting on his/her behalf and shall provide the information shown below and must be signed by the claimant 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 legal advice is desired. No employee of the City may give legal advice to any claimant relating to private claims. H. Completed claims must be mailed or delivered to the City of Tustin, City Clerk's Office, 300 Centennial Way, Tustin, California 92780. 1. Name and Post Office address of the Claimant: Name of Claimant: ~ ~~~,(E L, ~5 Home Home Telephone: ~ ~ Work Telephone: ~- --~~-~ 2. Post Office address to which the person presenting the claim desires notices to be sent: (If different from above) Name of Addressee: 3. 4. Telephone: Post Office Address. The date, place and other circumstances of the occurrence or transaction from which the claim arises. Time of Occurrence: ~ ; .Date of Occurrence: ~ ~ ~ ~ ~ Location: ~t b tlww ' ^• . -- _ _ - ~.. ...~~. ...~~ •w iL.iw w~wir.n• •_ /~ . . _ _ I ~ r ~ ~ ~_ ~JC .. t~ 1 ~ \ ~. General description. of the inde tedness, obi ation, injury, damage or loss incurred so far as you now know. (e~ ~~~ ~~~~p.¢-~-~~ Page 1 of 4 ~r ~ 5, The name or names of the public employ a or employees causing the injury, damage, or loss, if known. 6. If amount claimed totals less than $10,000: 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 injury, damage, or loss, insofar as it may be known as of the date of your claim, together with the basis of computation of the amount claimed (include copies of all bills, invoices, estimates, etc.) .-,~' sis for com utation: '~CQ ~ Amount Claimed and ba p ~,, -.~-fsts _ R.~.~rt you are required to provide the information requested above in order to comply with Government CodE ;910. Additionally, in order to conduct a timely investigation and possible resolution of your claim, the pity of Tustin requests that you answer the following questions. If amount claimed exceeds $10,000: If the amount claimed exceeds ten thousand dollars ($10,000}, do not provide a dollar amount in the claim. However, your claim must indicate whether it would 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 § 86.) ^ Limited Civil Case ^ Unlimited Civil Case 7. Name, address and telephone number of any witnesses to the occurrence or transaction from which the claim arises: 8, If the claim involves medical treatment for a claimed injury, please provide the name, address and telephone number of any doctors or hospitals providing treatment: If applicable, please attach any medical bills or reports or similar documents supporting your claim. 9. If the claim relates to an automobile accident: Claimant(s) Auto lns. Co.: Telephone: Address: Insurance Policy No.: Insurance BrokerlAgent: Telephone: Address: ._ Claimant's Veh. Lic. No.: Vehicle MakelYear: . Claimant's Drivers Lic. No.: Expiration: I~ applicable, please attach any repair bills, estimates or similar documents supporting your claim. Page 2 of 4 ~ ~ READ CAREFULLY For all accident claims, place on following diagram name of streets, including North, East, South, and West; indicate place of accident by "X" and by showing house numbers or distances to street corners. If CitylAgency Vehicle was involved, designate by letter "A" location of City/Agency Vehicle when you first saw it, and by "B" location of yourself or your vehicle when you first saw CURB -~ 7 CURB --3, Warning: Presentation of a false claim is a felony Penal Code §72). Pursuant to CCP §1038, the CitylAgency may seek to recover all costs of defense in the event an action is filed which is later determined not to have been brought m good faith and with reasonable cause. Signature' ~~ (~ ,. Date: '~~ ~ ~v, CitylAgency Vehicle; location of CitylAgency vehicle at time 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. Page 3 of 4 ' TUSTIN RA CH TIRE & AU C` TUSTIN RANGti 1IRE ill 2541 EL GAMING GOODYEAR DEALER, 2 541 EL GAMING REAL Tus1~IN, CA. 92762 TUSTIN, CA 9 2 7 8 2 714-573-2722 (714) 5 7 3- 2 7 2 7, BAR REG# AM19 7 5 8 5, I. D. CAL 0 0 0 0 3 3 2 9 0 Merchant ID: 8~8~42292 FEDERAL TAX ID# 3 3 0 3 8 8 2 41 Tern ID: 001054N0008~82~2<92d~ 04/23/07 04/23/07 ~~1~ zNVOicE T - 14 7 Li- 7 ~ ~ 0 7:21 AM 10:0 4 AM ~~~~~~~~~~~~~17 TERR: 7585 ~~r_~. n~ rnpv • n~ ~ NONSIG: 195945 jE~ E~1trY ~t'~ ~1R~d BILL T0: JEANNIE GOSE PHONE 1....... PHONE 2....... DATE REQUESTED TIME REQUESTED RETURN PARTS.. SALESMAN...... PRIOR INVOICE. ( 04/23/07 NO 050 / 050 NEW CUSTOMER Total. ~ ~2~~ 04i23i0Z 19,94.E Inu a; I per Code ~Z$84 VEH YEAR/MAKE . 03 NISSAN-DA d: Online VEHICLE MODEL. ALTIMA SE VEHICLE COLOR . BURCa C~to~r Coav LICENSE/STATE. T-wwc vou! ODOMETR IN/OUT 051230 / 051. VEHICLE INFO.. 3.5 SE ACCOUNT # COB TC CUST# TYPE/STATE AUTHORIZATION CREDIT CARD N0. 758500026 M 01 25849 0 CA 067884 3012 SLSM TECH PRODUCT CODE 8C QTY DESCRIPTION PARTS LBR/EXCISE LINE TOTAL 050 060 040- 204 R 2 TIRE DISPOSAL CHARGE 3.00 .00 6.00 050 060 041- 2.63 R 2 NEW VALVE STEM 3.00 .00 6.00 050 060 044- 263 R 2 WHEEL BALANCE -COMPUTER SPIN 2.95 10.00 25.90 050 060 046- 100 R 1 REPLACE REAR---AND ROTATE TO FRONT .00 .00 .00 050 660- 810-109-0 R 2 BRIDGESTONE 2155517 EL 42 93H 195.00. .00 390.00 660- 006-310-0 SERIAL#... FS038805 050 060 046- 100 R 1 ALIGNMENT DECLINED .00 .00 .00 050 .060 047 - 100 R 1 NOTE OLD TIRES WERE WORN DOWN NEAR I NDI CAT . 00 .00 .00 050 060 047 - 100 R 1 TORS AND HAD OBJECTS I N TREAD . 00 .00 .00 050 060 047 - 100 R 1 NO MILEAGE WARRANTY - - - . 00 .00 .00 050 060 046- 100 R 1 FREE TIRE ROTATE-WHEEL BALANCE AND FLAT .00 .00 .00 050 060 046- 100 R 1 REPAIRS ON TIRES PURCHASED HERE .00 .00 .00 CONTINUED NEXT PAGE TUSTIN RA CH TIRE ~ AU CTR GOODYEAR DEALER, 2541 EL CAMINO REAL TUSTIN, CA 92782 ''~ 714)573-2727, BAR REG# AM197585, I.D. CAL000033290 !~ ~,~,/~~ FEDERAL TAX ID# 330388241 INVOICE 04/23/07 04/23/07 T - 1 47470 07:21 AM 10:04 AM TERR: 7585 PAGE: 02 COPY: 02 NONSIG: 195945 SLSM TECH PRODUCT CODE BC QTY DESCRIPTION PARTS LBR/EXCISE LINE TOTAL PARTS: (ALL PARTS ARE NEW UNLESS OTHERWISE NOTED) WE WISH TO THANK YOU fOR YOUR BUSINESS JIM CROWELL ************** ALL TIRES ON SALE **********WITH PURCHASE QF 4 TIRES*********REC. 50~ OFF BALANCE & STEMS** WE HAVE ENGINE & ELECTRONIC DIAGNOSTIC AVAILABLE STARTING AT $90.00 IF APPLICABLE. I ACKNOWLEDGE .NOTICE AND ORAL APPROVAL OF AN INCREASE IN THE ORIGINAL ESTIMATE PRICE. SIGNATURE, PARTS TOTAL ........ 407.90 CHARGED AMOUNT 462.55 LABQR TOTAL........ 20.00 STATE TIRE FEE. 3.5Q SUB TOTAL.......... 427.90 ~_________________________________ TAXABLE AMOUNT 401.90 SALES TAX. ... 31.15 CUSTOMER AUTHORIZATION FOR TOTAL INVOICE TOTAL X462 _ S S AUTHORIZED BY . JEANN I E AUTH REC' D BY . JOHN M MANNER REC' D .. I N PERSON AUTH PHONE.... 000-0000 AUTH DATE..... 04/23/07 AUTH TIME..... 8AM REVISED TOTAL. 431.40 ADD'L AMOUNT.. 396.65 REPAIRS DESC.. TIRES SEE REVERSE SIDE FOR IMPORTANT SAFETY WARNING AND WARRANTY INFORMATION