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Home My WebLink About07 CLAIM WHEELOCK, 02-22-05 City Manager Finance Director Agenda Item Reviewed: AGENDA REPORT MEETING DATE: FEBRUARY 22, 2005 TO: WILLIAM A. HUSTON, CITY MANAGER FROM: RONALD A. NAULT, FINANCE DIRECTOR SUBJECT: CONSIDERATION OF CLAIM OF LAWRENCE CLEVE WHEELOCK, CLAIM NO. 05-05 SUMMARY: Staff is recommending denial of the claim. RECOMMENDATION: That the City Council deny Claim Number 05-05 and direct the Finance Director to send notice thereof to the Claimant. FISCAL IMPACT: None. DISCUSSION: The Claimant alleges property damage to his vehicle when his car drove over "improperly maintained or installed road work crossing" on Tustin Ranch Road, just south of Auto Center Drive. Staff has determined that the Irvine Ranch Water District was issued a permit for work in that area during the time of the reported damage. The claim has been tendered to Irvine Ranch Water District on February 4, 2005. Ronald A. Nault Finance Director ATTACHMENT: Copy of Claim No. 05-05 U : IC LAI M S ICons 1 de ration OIC I aim OILawre nceClava Wheelock. doc CLAIM AGAINST THE CITY OF TusA 01 (For Damages to Person or Personal PropeW 0, Gl' Atilt Received Via: CITY OF TUSTIN Time stamp:' "1'1 0 U.s. Mail ¡;;¡ Inter-Office Mall lDDS JAN 21 AID: 2- L¡ 'fJ Over the Counter Claim No: PLEASE NOTE: A. Read entire claim before filing. B. Be sure your ciaim is against the Citv of Tustin, not another public entity. C. Claims for death. Injury to person or to personai property 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 Califomia, 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 Ciaimant: Name of Claimant: Social Security No.: Post Office Address: - Post Office address to whic he person presenting the claim desires notices to be ¡ (11/ 3. The date, place and other circumstances of the occurrence or transaction from which the claim arises. Date of Occurrence: Location: Circumstances giving rise to this claim: ~-':'JV' \ I ~.~ --k, h ... e;{ ~( l t\, ,~II ~ I .CdX)~ 'V ij....).....~ -e( ~ k'1 f' C 1e.:G) 4. fJ ~ -* I{f~~ Lv~~w de..... (c- d ý. lAJ 0 (lL , damage or loss incurred so far as you now know. / -e/ l cV. T~ ~er. S(Yr(.page;~ tJ Q,~ W U v¡ f~~\ý~ce.. +y~e.. é).1> cJ<.Vveo[ 4 The name or names of the public employee or empioyees causing the injury, damage, or loss, if known. ~il A /-\ / -- 5 6. /--------..., / /' If amount claimed totals less than $10,000: Provide the amount ciaimed if it totals iess than ten thousand dollars ($10,000) as of the date of your ciaim, 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.) . Amount Claimed and basis for computation: --r-! ~ t L/lo:l- boO" ow&o\ If amount claimed exceeds $10,000: If the amount claimed exceeds ten thousand dollars ($10,000), do not provide a doilar amount in the ciaim. 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.) 0 limited Civil Case 0 Unlimited CIvil Case 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 Ci of Tustin re uests that ou answer the followin uestions. 7. Name, address and telephone number of any witnesses to the occurrence or transaction from which the claim arises: Nove ç.JC¡: \G...~I<" ~ ...---- '--- 8. If the claim involves medical treatment for a ciaimed Injury, please provide the name, address and telephone number of any doctors or hospitals providing treatment: Î"t'Ö- -- ~: Cc..l \'::-' II..\.....~-t. 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 Ins. Co.: Address: Teiephone: Insurance Policy No.: ~--- Insurance Broker/Agent: Address: Teiephone: Claimant's Veh. lic. No.: Ciaimant's Drivers Lic. No.. Vehicle MakelYear: Expiration: Page 2 014 If applicable, please attach any repair bills, estimates or similar documents supporting your claim. 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 CitylAgency Vehicle when you first saw it, and by "B" location of yourself or your vehicle when you first saw City/Agency Vehicle; location of City/Agency 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. 0/ j~ CURB --.J --(V-S..!-¡"v> ~V¡ 7J $1 ~( PARKWAY SIDEWALK () :::Çv-P--~SÇù~ ~ (b", T\Jùt,:-. 'Pcvt..... \2¿ ~~{ --'i ~"~ :~" ~:':"m :~:::":(~,,~, "" '"""'". coe ",},,'"'~'"~ m" ~ to recover all costs of defense in the event an action is filed which is later determined not to have been brou ht in good faith and with reasonable cause. ~ÍtÆe{cJ1"'ß.- Date J- I ð"- 0..:1 ---r~~Iè. )J I.,,-r- L-.reç...~ d ec('. ~~L uvt [A" S'U "'.5 f~O:-{ woI"" \1 . t &{,.oà r.r<Y-- -f ð ffiJ". LJ¡" 7, 'V '<:0:1- çJ~dJ d)rIVl'(j ~V~:t- CÝcÓ.!'& ~7 eelS Wi?("<!-Ij ~ do.~ -c4 d uc... 10 J 10 ~ ¿It fc.VIV eAeV~d-/;"1 ~-Wsif e -tl..l- y'ðaq V;:9?3~fl~ ~~ I'" .J.Le. '=+f: I hLf~. .J: ~ ~ rDV \ ~t<:c{ r'\L.-..¡ D v-!J\ ~ ~ 0...1 eQ..,. Signature: f'10d-O dl!!Cù~",--h ~~ Q,1Ac/ ðc.cle. j.c.t~ I-I-~- 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 appiies for ieave to present a late ciaim to the City of Tustin. This application is being made within a reasonable time, not exceeding one (1) year, after the accrual of the cause of action. Under some circumstances, leave to present a late claim wili be granted (Government Code § 911.6). The reason for delay in presenting the ciaim is: Q",OJorCl ('::'ç- ~7' { V tJ.. \ ( .:['c.CV\ C. (.A/,'I L c,x -rVÚI,)t~ Cc.., C!f; ~L ~;, s'-' 0(+ . '" I r: I .;., ::::I::" G;.\oV1 -~¡,k -1 0 ~ et7~ .~ :;;<70- 0'-/,-/0 CIv1/) r.. t 5' 9 J., '" e... ( c:.-J ~-1- -+~c.ed ..,,2,00"-1 3...rõ e- ft{ '1- C¡Y 9 ( Nl~~V¡) ./ WVI~,\ 'l\¡t... Vo \ K.- 1Ca.CI~/;, ð :(..." J)'-IVl I ~ J /7" .~? t (9 I Ie- 12ac. I ¡;, ~ Z /7-- \N1 l'f \.1 I ~~:Il\ cS F VJ\';V¡/~P if 91")\:)1.11 .s: ( v.7\!1 v1,>¡o J f f~ V , Date I-Ie'~ \J ~~ Signa ure of Claimant Revised 12/2004 Page 4 of 4