HomeMy WebLinkAbout04 CLAIM BONITA SQUIER 04-17-06
AGENDA REPORT
MEETING DATE: APRIL 17, 2006
TO: WILLIAM A. HUSTON, CITY MANAGER
FROM: RONALD A. NAULT, FINANCE DIRECTOR
SUBJECT: CONSIDERATION OF CLAIM OF BONITA SQUIER, CLAIM NO. 06-01
SUMMARY:
The Claimant slipped on the floor during a ballroom dance class at the Tustin Area Senior Center
and her wrist was fractured. The claim is for medical bills, physical therapy and any future
disability caused by the fracture fall.
RECOMMENDATION:
That the City Council deny Claim Number 06-01, Bonita Squier, and direct Staff to send notice
thereof to the Claimant.
FISCAL IMPACT:
None.
DISCUSSION:
An Incident Report was completed by the City's Parks and Recreation Department, where it was
noted by the class instructor that Ms. Squier over accentuated her steps and lost her balance.
The Claimant herself stated she does not know what caused her to fall and said she had fallen in
the same spot on a previous occasion but was not injured. The City's Claims Administrator was
advised by Staff that the floors are resurfaced annually and mopped five days a week by the City's
maintenance contractor. There does not appear to have been any prior complaints regarding the
floor nor any liability against the City of Tustin for the Claimant's fall. A dangerous condition has
not been established and Staff is requesting denial of the claim at this time.
ATTACHMENT: Copy of Claim No. 06-01
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CLAIM AGAINST THE CITY OF TUSTIN
(For Damages to Person or Personal Property)
Received Via:
o U.S. Mail
o Inter-Office Mail
'Ii Over the Counter
Claim No: 06-01
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 property must be filed no later than 6 months after the occurrence
(Govemment Code !i 911.2).
D. Ciaims for damages to real property must be filed no later than one year after the occurrence (Government Code!i 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 hislher behalf and shall provide the information shown below and must be signed by the claimant or a person on
his behalf (Govemment Code!i 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:
Social Security No.:
Post Office Address:
;:
2. Post Office address to which the person presenting the claim desires notices to be sent:
Name of Addressee: Rnrv I TA -X::. 5 c;:> U I Eic Telephone:
Post Office Address:
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3. The date, place and other circumstances of the occurrence or transaction from which the claim arises.
Date of Occurrence: 0 . S-
Location: /L>S 1-11\/ ....c, e.rv 10 fl.
Circumstances giving rise to this claim:
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Time of Occurrence:
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4. General description of the indebtedness, obligation, injury, damage or loss incurred so far as you now know.
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Page 1 of4
5. The name or names of the public employee or employees causing the injury, damage, or loss, if known.
& 11f<60 rv7 D,..,NCE' I.iJS~VC-+Df"'- ~ CAND';; DRv',)
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.)
Amount Claimed and basis for computation: C. u (c R. (' VI -(- fT IVI~ ~I" -f."
Fuf-u"'-p AN1()LJn+s tJNJ(NDLJ.,.)N' AI +in.S'
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If amount claimed exceeds $10,000: If thlil amount c1aimlild lilxClillilds tliln thousand dollars ($10,000), do not
providlil a dollar amount in thlil claim. Howlilvlilr, your claim must indicatlil whethlilr it would blil a limitlild civil caSlil.
A Iimitlild civil case is onlil where thlil rlilcovery sought, lilxclusive of attorney fliles, interest and court costs, does not
exceed $25,000. An unlimited civil case is one in which the recovlilry sought is more than $25,000. (See CCP !i
86.)
o Limited Civil Case
D Unlimitlild Civil Case
You are required to provide the information rlilquested above in order to comply with Government Code _
1910. 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 ciaim
arises: ()Cjhf? /OS- ~51-1t'J 5et-.JIO~'2 (f'V\t~~ &/IR.oCJrVl
"jahcpl ('",rA>) S-fuc:leh+S ~) Te:61CHE"'-L
8.
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71 -1..3'}- 12-12->
If applicable, pleaslil attach any mlildical bills or reports or similar documents supporting your claim.
9. If the claim rlillates to an automobile accident:
Claimant(s) Auto Ins. Co.:
Address:
Telephone: '
Insurance Policy No.:
Insuranclil BrokerlAgent
Address:
Telephone:
Claimant's Veh. Lie. No.:
Claimanfs Drivers Lic. No.:
Vehicle MakeNear:
Expiration:
Page 2 of 4
If applicab/e, please attach any repair bills, est/mates or similar documents supporting your claim.
READ CAREFULLY
For all accident claims, piace on foHowing 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 comers. If City/Agency Vehicle was involved, designate by
letter "AIt location of City/Agency 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 olthe 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.
CURB -4-
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SIDEWALK
CURB -..
PARKWAY
SIDEWALK
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Warning: Presentation of a false claim is a felony (Penal Code !l72). Pursuant to CCP !l1038, the City/Agency may seek
tD recover all CDstS of defense in the event an action is filed which is later determined nDt to have been brDught in gDDd
faith and with reasDnable cause.
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Signature: ~<~ ) ~ ~~-<-
Date: /J../ / I / 0 S-
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Page 3 of 4
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 late claim 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 will be granted (Govemment Code 9 911.6). The reason for delay in presenting the claim is:
~
Date
Signature of Claimant
Revised 12/2004
Page 4 of 4
1) Incident Type
A 0 Non~Jnj Acciqent
B ~ Jnjury Accident
C OSc;archlH.esr:uc
D 0 Disturbance
E OOth"
INCIDENT REPORT
City of Tustin Parks and Recreation Department
300 Centenrllal Wa ,Tustin CA 92780 (714 573-3326' FAX (7]4) 838-4779
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