HomeMy WebLinkAbout15 CLAIM 06-16 STRICKLIN 09-05-06AGENDA REPORT
MEETING DATE: SEPTEMBER 5, 2006
TO: WilLIAM A. HUSTON, CITY MANAGER
FROM: RONALD A. NAULT, FINANCE DIRECTOR
SUBJECT: CONSIDERATION OF CLAIM OF FRAN STRICKLIN, CLAIM NO. 06-16
SUMMARY:
The Claimant reported that her clothing was damaged when she sat on a recently painted bus
bench located on First Street in Tustin. She later noticed the Wet Paint sign but it was on the
sidewalk and not near the bench. She stated her pants, which cost $50.00, were ruined.
RECOMMENDATiON:
That the City Council deny Claim Number 06-16, Fran Stricklin, and direct Staff to send notice
thereof to the Claimant.
FISCAL IMPACT:
None.
DISCUSSION:
It has been confirmed by Staff that a Contractor was hired by the City of Tustin to paint the above
bus bench. This claim has been referred to the Contractor and/or their Carrier for handling. The
City's Claims Administrator finds this to be a no liability claim against the City and is requesting a
lelter of denial be sent at this time.
ATTACHMENT: Copy of Claim No. 06-16
ConsiderationOfClaimOfFranStrick/in.doc
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.Ot(IGlt~i1\L
CLAIM AGAINST THE CITY OF TUSTIN
(For Damages to Person or Personal Property)
, Rec;efved Via:
[]'U.S. Mall
o Inter-Office Mail
o ,Over the Counter
B ~~~DVllEil
~ JUN 0 6 2006 Y
CITY OF TUSTIN
Time Slamp:
ZOOb JUN -b A 8: , I
OlQ- \ lP
Clai1 No:
PLEASE NOTE:
A. Read entire claim before filing. OFFICE.TUSTIN CITY CLERK
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 ~ 911.2).
D. Claims for damages to real property must be filed no later than one year after the occurrence (Govemment Code ~ 911.2).
E. If addRional space is needed to provide your information, please attach sheets, identifying the paragreph\s) being answered.
F. A claim must be presented, as prescribed by the Govemment Code of the State of Califomia, by the clpiment or a person
acting on his/her behalf and shall provide the information shown below and must be signad by the claimlmt or a person on
his behalf (Government Code ~ 910.2).
G. This form is for the convenience of those desiring to present cleims egainst the city. Claimant is advised to consult a private
attomey if legal advice'is desired. No employee of the City may give legal edvice to any claimant relating to private claims.
H. Com plated claims must be mailed or delivered to the City of Tustin, City Clerk's Office, 300 Centenniel Way, Tustin,
California 92780.
1. Name and Post Office l!pdress of the Claimant:
. ~ . ~ .
Name of Claimant: /II
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Home Telephone: '
Work Telephone: Nt> N t.
2. Post Office address to which the person presenting the claim desires notices to be sent:
(If different from above)
Name of Addressee:
Post Office Address:
Telephone:
3.
The date, place and other circumstances of the occurrence or transaction from which the claim arises.
~ fU5t:
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4.
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Page 1 of4
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5. The name or names of the public employee or employees causing the injury, damage, or Ioss,if known.
UN J( A1(JWN
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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:
-r.--I- r.IJiflJ/J.obJIJR -fh€ OAtHS.
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If amount claimed exceeds $10,000: If the amount claimed exceeds ten thousand doHars {$10,OOO), 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 attorriey 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.)
o Limited Civil Case
o Unlimited Civil Case
You are required to provide the information requested above in order to comply with Government Code
fi910. 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:
Au!; [)P,;\/iER.
DI'J/../ 4- I( Al/) W )./1- M~ 0 I?
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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:
~ () "?1L->
If applicable, please attach any medical bilis or reports or similar documents supporting your claim.
9. If the claim relates to an automobile accident:
Claimant{s) Auto Ins. Co.: '111Y'r1..1V
Address:
Telephone:
Insurance Policy No.:
Insurance BrokeriAgent:
Address:
Telephone:
Claimant's Veh. Lic. No.:
Claimant's Drivers Lie. No.:
Vehicle MakeIYear:
Expiration:
If applicable. please attach any repair bills. estimates or similar documents supporting your claim.
Page 20f4
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READ CAREFULLY
For aU accident claims, place on following diagram name of
streets, jncl"ding North, East, South, and West; indicate place of
accident by "X" and by showing house numbers or distances to
street corners. If City/Agency Vehicie 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
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 o(;mpact by 'X:
NOTE: If diagrams below do not fit the situation, attach hereto a
proper diagram signed by claimant.
CURB ~
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SIDEWALK
PARKWAY
SIDEWALK
CURB .."
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Warning: Presentation of a false claim is a felony (Penal Code 972). Pursuant to CCP 91038, the City/Agency 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.
Signature: ,:,,
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Date: fJtnYIL 31 ()~
Page 3 of4
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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 lat~ claim will be granted (Government Code 9 911.6). The reason for delay in! presenting the claim is:
Date
Signature of Claimant
Revised 12/2004
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