HomeMy WebLinkAbout12 CLAIM GEICO INSUR. 04-16-01'AGENDA RE" ...... '3R'T
No. 12 ·
04-16-01
I ILIIll I I I I I II I I II III I I I _ I I II
MEETING DATE'
APRIL 16, 2001
180-10
TO:
HONORABLE MAYOR AND MEMBERS OF THE CITY COUNCIL
FROM'
SUBJECT:
CITY ATTORNEY
CLAIM OF GEICO INSURANCE; CLAIM NO. 01-14
SUMMARY:
The City Attorney is recommending that the City Council reject Claim No. 01-14, GEICO
Insurance.
RECOMMENDATION'
After review and investigation by the City's Claims Administrators and by this office, it is
recommended that the City Council reject the claim and direct the City Clerk to send
notice thereof to the claimant and the claimant's attorneys.
FISCAL IMPACT:
There is no fiscal impact with this action.
BACKGROUND:
This claimant indicates that a piece of metal fell off of a police vehicle being driven
along the I-5 freeway, striking the claimant's vehicle, causing damage. City inspection
after the incident failed to disclose that the vehicle was missing any parts nor was the
metal piece identified or recovered. The facts are therefore in dispute.
ATTACHMENTS'
Claim
34540\1
FEEI-2~-200J. EIg: 1:2
"IT'/' OF' TUSTIN ' " '7:1.4 832 G:3Et2
·
CiTY OF TUSTIN ' )'
C~,AIM AGAINST THE CITY OF TUSTIN
(For Damages to Persons or'Personal Property)
o
P. 02/03
The law provides genemll~ that a claim must be filed with the City Clerk of the City of Tustin within ~.i~ (,6)
moCt.h.$ affer.th.e In¢ldent or evont o~curred.' Be sdre your claim'is against the Clty of Tusfin, not anothar
public entity,' Where space Is Insufficient, please use additional, paper and Identify Information by
paragraph number. Completod claims mu~t ~e mailed or dellYerod to.the City Clerk, Cily of Tusfln, 300
· Centennial Way, Tustln, California 92780. · ·
WHEN COMPLETING THIS FORM' PLEASE TYPE OR USE BL~CK_ IN!~
To the Honorable'Mayor and City Council, City of Tustln, Califomla:
·
·
·
The undemigned mspec~ully submits the following claim and information relative to damage to per, on
,nd/or prop,try: · ·
1, a, Name of Claimant:_.
b. ' Address of C!almanti
c. Cify~pCode:_,.~,~~i
d,. Telephone
e," Date of Bi~: / .- ~ ~.' '~ - . ........
.... "
. f. Social Sorer umbe~ .....
g. Driver Lbense Numben· ,
..
2. Name, t,[~phone,'and po~ offi~ address to ~hlch claimant desires noilces 1o be sont (~ o~er than
3, ~is claim ts ~ubm~ed agaln~t: '
a. ~" ~e Ci~.of Tu~tln only.
b. ~'~.- j'. ': Tho followin~ ~m~loy~(~) of th, C~ of Tu~tin' only::
Ce ·
'Tl~e Ci~f Tusfi~' and th~ follOWlrig eml~'ioyee('s) ol~ th~ Clty-~f TUsti~ only:
e
Occurrence or event from which the claim artses:
a. Date:~ j O.- J 'o - ...~. C~xD ............... · __. ..... ...... ..: ,- .......
b. Time: ._ I 1.7~.~- ~'c' ~...
c. Place (Exact and Specific LoCationi:
·
d. H~w and ~noi'r' what C~lrcumStancds did-damage 0i ihjury <~ccur? Speci~ the PaAicular
occurrence, event, act or omission you claim ,aused the Injury or damage (use additional
5~
e,. What particular action by the C!t~, _or lt.s 'employees, caused the alleged damage or Injury?
.
_
o
_ _ ·
· - ,. .~ - . . _. -- -.,~,, .- ,,, - . . ·.
-_ i - -- -_ _ ~ _ _ - ..... · ........ ~ ._
GNe a de~dption of the Inlu~, property damage or loss' so f~r known at ~e t!mp of this claim. If
them were no Injuries, State "no Injuries".
L'o ' ..
·
·
- _ -- - ._ . t .. -~ ~'-~ · --~- - ~ - - -~ ' '- ' n ..
_.
1
9~
10.
Give the name(s) of the City employee(s) c~uslng the damage or Injury:
.. ~, ~-- ..
.- ........... '.,, .- .- . v -.,., ~ ...
.... x ~, · ..... .__,~ ..... _ , · ......
Name and address of any other pars,on injured:. 1~o~ ¢ _
· ·
~- - · -- - - · -'- - - / - . -- ~* '~ t - _ ..........
Name and address of t. he owner of a.ny damaged property:_ ~._.~ .% Q.~_ ~ _~. -~ .~,~_. ....... ..
, . ~ - v-,~ ...... ~ -, ~ ._ ~ ...... ~,. .
Damages Claimed:' ." /~' ~c~~ .
a Amount claimed as of this date:
b. Estimated amount offu~re
c. To~l amount claimed:
d; AUach basis for mm~~tion "of .amOunts claimed' '(include &ple~ o~'~ii'-bili~; invoi'ces~
e~mates, et~.) ~ ~[ ~~%.~ ~ ~~~~~~ '~~~ L~'{'~. .
Names and addresses of all wimps~es,' hospitals, d~ctom,
'. ' ~ - ~ ~ ~ x
' - ~ ' ~- ~- - - .... r- - /
._ t ~ - . ~ -~- _ y ~; ~ .... ; ....
_
WARNING: IT IS A CRIMINAL OFFENSE TO FILE A FAL;~E dLAIM
(Penal Code Section 72; InsumnOe Code. Section 5~6.0)
I have mad the matter, and st~toment$ made 'in the al:~Vo claim and I kno~ the'same to 15o true of my
own knowl,dg~, ~xmpt
believe the same to be ~ue, I certify under penalty of perjury that tl,,e foregoing ~ ',¢je ar~ rrect.
Clbimant'$ Signature: __~Lf.~~..O.~..._~.._i0~...~
Executed this ,. ~ ('~._ .....
d,7 ._, · .20 ol .
TOTAL P. 03