Item 17A - Rejection of Claim for Damages
f/
AGENDA REPORT
CITY OF POW A Y
(his report is included on the Consent Calendar. There will be no separate discussion of the report prior to approval by the
City Council unless members of the Council, staff or public request it to be removed from the Consent Calendar and
discussed separately. If you wish to have this report pulled for discussion, please fill out a slip indicating the report number
and give it to the City Clerk prior to the beginning of the City Council meeting.
SUBJ ECT:
Honorable Mayor and Members of the City Council
James L. Bowersox, City Man~ ~
Susan M. Pulone, Director of Administrativ:~ervi~~t7
Douglas A. Milton, General Services ManagejUV ~
January 30, 1990
Denial of Claim for Damages - Cassandra Kurfess
TO:
FROM:
INITIATED BY:
DATE:
ABSTRACT:
On November 1,1989, a claim for damages was
Kurfess. The amount of the claim is $500.00.
this claim be denied.
received from Ms. Cassandra
It is recommended that
BACKGROUND:
A claim for damages was received from Ms. Kurfess alleging that a block-
age in a City sewer main caused water to back up in her tub and shower.
FISCAL IMPACT:
Unknown
RECQItIIENDATION:
It is recommended that the City Council deny this claim.
JLB:SMP:DAM:bs
Attachment
ACTION:
1 of 3
JAN " 0 1990
City Of 'Poway
h- J- qo -a (%r
A clalm.must be filed with the City Clerk ' orRisk Manager of the,City of Poway within 6;months afterwhich!the
incident or,event occurred. Be: suresyour claim Is against the City of:Poway, not another public entity. Where
space is Insufficient, please use additional paper and Identify Information by`paragraph number., Completed
claims must be mailed or'de-livered to The City of Poway, 13325 Civic°Center Driive;Poway, CA. 92064 ( P.O.
Box 789 ). Attn: Risk Manager
TO'THE HONORABLE MAYOR AND'CITY'COUNCIL, THE ,CITY 'OF POWAY CALIFORNIA
The. undersigned: respectfully submits':the following claim and.information relative to damage to persons
and/or personal property:
1. Name of claimant C1ISAWAI34 KuRr-ESS
a. Address of claimant
F�
b. Phone No.
d. Social Security No.
c. Date °of:birth
e. Drivers Lie: No. '
2. Name, telephone and post,office.address to which claimant desires notices to be sent if other
than above:
3. Occurrence or event from which the claim arises:
a Date /D i3 89 b. Time 45?nw q rn C. Place ( exact and specific location)
d. How and under what circurnstances,did _damage or Injury - occur? Specify the particular
occurrence, event, act oromission you ciaim caused theinjury or damage (use
additional paperif necessary).
w4rEe 54c4W CAP /A/ AocuER, AA0 Iva.
CAuF�' Pi."8✓ R-. ATrFtnrrb uiJ9,Ur_CF PF'L1 4t_ 70 R-C* F
ULZAry ,ouT /.a C/ `f A.A- //V .,
e: What particular action by the City, or its employees, caused the alleged'damageor'
IVO Dr MA-&E :OR- S/aPPAGE rVUA/D CA/ OWAIEZZ :f P+QO6EZ7y
R0013 F4vA66 IN CG7y A4*t- I
2 of 3 JAN 3 0 1990 ITEM I7A
"`CLAIM AGAINSTTHE' CITY OF POWAY
Received by
U.SMail'
via
Inter -Office Mail
Over the Counter
h- J- qo -a (%r
A clalm.must be filed with the City Clerk ' orRisk Manager of the,City of Poway within 6;months afterwhich!the
incident or,event occurred. Be: suresyour claim Is against the City of:Poway, not another public entity. Where
space is Insufficient, please use additional paper and Identify Information by`paragraph number., Completed
claims must be mailed or'de-livered to The City of Poway, 13325 Civic°Center Driive;Poway, CA. 92064 ( P.O.
Box 789 ). Attn: Risk Manager
TO'THE HONORABLE MAYOR AND'CITY'COUNCIL, THE ,CITY 'OF POWAY CALIFORNIA
The. undersigned: respectfully submits':the following claim and.information relative to damage to persons
and/or personal property:
1. Name of claimant C1ISAWAI34 KuRr-ESS
a. Address of claimant
F�
b. Phone No.
d. Social Security No.
c. Date °of:birth
e. Drivers Lie: No. '
2. Name, telephone and post,office.address to which claimant desires notices to be sent if other
than above:
3. Occurrence or event from which the claim arises:
a Date /D i3 89 b. Time 45?nw q rn C. Place ( exact and specific location)
d. How and under what circurnstances,did _damage or Injury - occur? Specify the particular
occurrence, event, act oromission you ciaim caused theinjury or damage (use
additional paperif necessary).
w4rEe 54c4W CAP /A/ AocuER, AA0 Iva.
CAuF�' Pi."8✓ R-. ATrFtnrrb uiJ9,Ur_CF PF'L1 4t_ 70 R-C* F
ULZAry ,ouT /.a C/ `f A.A- //V .,
e: What particular action by the City, or its employees, caused the alleged'damageor'
IVO Dr MA-&E :OR- S/aPPAGE rVUA/D CA/ OWAIEZZ :f P+QO6EZ7y
R0013 F4vA66 IN CG7y A4*t- I
2 of 3 JAN 3 0 1990 ITEM I7A
4. dive a description of th
oi� Ifihiriwe-re.,fi-o':
5. Give name(s) of the C
/V
6. Name and address of
loss, so far as Is known at the time of this
V/Z-
causing the damage or Injury:
other person injured:
7. Name and address of the owner of any damaged property:
8. Damages claimed: $ to
a. Amount claimed as of thisdate
b. Estirnated4mount of future costs: $
C. Total amount claimed.- $ -'s-Do -x
d. Basls1or &omputatien of amounts claimed Include copies .of all bills,invoices, estimates, etc)
9- Names and addresses of all witnesses,; hospitals, doctors, etc.
a. 81u, ;4yvb C4SDfr40tZk
b. SR1hrV AM-b Jug CS RzWU4-
d
10. Any additional information that might be helpful' in considering this claim:
WARNING:! IT 15 A CRIMINAL OFFENSE TO FILE A FALSE CLAM (Penal Code §72;
insurance Code § M.1, )
I have re - ad the, matters and statemeritV me - de inthe.above claim and I know the'sae to be true of my own knowledge,
except as-461ho'se`rriatt-er's sita-itedupon iriforrnationor1ieliefis to such rhatters1 believe the same to be true. I certify under
penalty oUperjury that Itne1orogoing,is TRUE,and,CORRECT.
Signed this 50 77f day of 00MBEW- 19n at
Claimant's Signature
Office of the City Clerk
1vay, California
uJCUMENT NO. FILED
3 of 3 JAN 3 0 1990 ITEM 17A