HomeMy WebLinkAbout06 CLAIM M ROMERO 02-06-06
AGENDA REPORT
Agenda Item ~
Reviewed: !!
City Manager
Finance Director
MEETING DATE:
FEBRUARY 6, 2006
FROM:
WilLIAM A. HUSTON, CITY MANAGER
RONALD A. NAULT, FINANCE DIRECTOR
TO:
SUBJECT:
CONSIDERATION OF CLAIM OF MARTY & MELBA ROMERO, CLAIM NO, 05-39
SUMMARY:
The Claimants stated that City of Tustin workers turned their water on and off - tDD much, too fast.
There was damage to their house supply line and water heater,
RECOMMENDATION:
That the City Council deny Claim Number 05-39, Marty & Melba Romero, and direct Staff to send
notice thereof to the Claimant.
FISCAL IMPACT:
None,
DISCUSSION:
City of Tustin personnel were working in the area at the time of the reported damage. The
Claimants submitted copies of invoices for repairs to their water line and replacement of a water
heater, to be reimbursed by the City. The City's Claims Administrator has asked the Claimants to
provide the name, address and telephone number of the company that performed this work so
they could break down the costs on the bills. Three letters were sent to the Claimants requesting
the information and there has been no reply. As it is not possible for evaluation of the claim to be
completed without their response, Staff is recommending denial of the claim at this time.
ATTACHMENT: Copy of Claim No, 05-39
U, I C LA 1M 51 Conslde,. lion OICI aim OIM a rly And Melba Romero. doc
CLAIM AGAIST THE CITY OF TUSTIN
(For DamagesUrsono; PersonalProperty)
Received Via: 'lrIGlii.fI1 ..'.,
0 U,S, Mali , iJt.ìl
.[J..lnter-Office Mail ..~
~ Over the Counter
CITY OF TUSTIN
Time Stzo'DS'ocr - 3 P /: LID
Claim No: Ð5-?¡q
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 Dr to personal property must be fiied 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 hisiher 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, Ciaimant is advised to consult a private
attorney if legai 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:
2,
Post Office address to which the person presenting the claim desires notices to be sent:
Name of Addressee:
Post Office Address:
Sa... '\'\\-'<-.
Telephone: ~~'-\ - \ ~ '\ '\
3.
The date, place and other circumstances r,f the occwrence or transaction from which the claim arises,
Date of Occurrence: ~ \ \ «) \ (j ~ Time of Occurrence: \ () " ~.
Location: ,
Circumstances giving rise to this claim:
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4.
General description of the indebtedness, obligation, injury, damage or loss incurred so far as you now know,
Page 1 of4
5.
The name or names of the public employee 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 thDusand
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,)
Amount Claimed and basis for computation:
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, exciusive 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.)
D Limited Civil Case
D 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
Cit of Tustin re uests that ou answer the followin uestions.
Name, address and telephone number of any witnesses to the occurrence or transaction from which the claim
a~~\~ <:3\ \\,~\ \.~ \.illR-\:..-I<-~~
7.
B.
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:
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--------------- ---- --------
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g.
If the claim relates to an automobile accident:
If applicable, please attach any medical bills or reports or similar documents supporting your claim.
Claimant(s) Auto Ins, Co.:
Address:
Insurance BrokeriAgent:
Address:
Claimant's Veh, Lic. No,:
Claimant's Drivers Lic, No,:
Page2of4
Telephone:
Insurance Policy No,:
Telephone:
Vehicle MakeiYear:
Expiration:
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 City/Agency Vehicle was involved, designate by
letter "A" iocation of City/Agency Vehicle when you first saw it,
and by "B" location of yourself or your vehicle when you first saw
CityiAgency Vehicle; location of CityiAgency vehicie 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.
--Jill I~ L
SIDEWALK
CURB --4"
CURB "+
W j¡/ PARKWAY in r
SIDEWALK
Warning: Presentation of a false claim is a felony (Penal Code §72), Pursuant to CCP §103B, the CityiAgency may seek
to recover all costs of defense in the event an action is filed which is later determined not to have been brought in good
faith and with reasonable cause,
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Date;
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