Item 14 - Claim for Damages - David Golokowwhich showered Mr. Gol
kow'`s vehicle and cracked the windshield.
t the incident occurred approximately l% miles
sway Road. In reviewing the location of this
Lned that it occurred outside the City limits
Dn. Carl Warren & Company', the City's insurance:
tenial of this claim.
-he City Council deny this claim
as filed by Mr. Golokow
APR 2 2
1986
ITEM
1
F,
CITY OF _ FOMY
CLATM AGAINST THE CITY OF PO4n3AY
f j , CdT 1 OF FOIAl:1Y
{ Received by via CITY CLERK'S Or�i%E
>,
U.S. Mall ;, �
Inter -Office Mail Clerk's Time Stamp ;
over the Counter
A. claim must be filed with. the City Clerk of the Cit of Poway which the incident or event occurred. y Y within 100 days after
Poway, net another Be sure your claim is against the Cat of
public entity. Where space .is insufficient., please use,additional
paper and identify infornnation b additional
y paragraph number, Completed claims must be mailed
or, delivered to the City Clerk, The City of Poway, 13325 Civic CA. 92064 (P.O., Box 785) . CCenter Driver pxiay,
TO THE HOMRABLE MAYOR AND CITY COUNCIL, THE CITY OF POWAX`
CALIFORNIA
f
n The undersigned respectfully submits t� fel .,
lama - 1.,�•zny claia. and it fornat on. relative to
damage to persons and/or personal property:
I •NAME of CLHIMAIIT
a. ADDRESS of CLAIMANT
�• �-
Ce DATE OF' BIRTH7401
- a d• S`J`.J.t'11J` SJMR; = Llai.! • ��� � / e • LRIVE't r y7 111C. L1i1d s
..
2• Nanm, telephone- and Post office address to which claimant
sent if other than above: desires notices to_ be
2 Occurrence. or event fr®m which the claim
arises:
a•DATE
- g (o be Tim.f�ri'Lk. /; o v e• PLACE
(exact and specific location)
u a�®/,Z
"" off' l
3
iLS'7cc 45
a• Bmnd_under what circumstances did damage or injuny cx�r�,�,-� c t. -_
p3rcicular occurrence,, event, act or arils- n you claim caused he�-injury he
damage (use addit
-M Ional.paper if necessary), °r
Ire 04:2-w
�
A -k-r- 7Z/ /,0- i� Z o vu� o V�,e
sic i �6,t/n1' Si yrs/
S Wttica-
CjZ K c`kE
e. What Particular action by the City, or its
ge or injury, employees, caused the alleged'
& 7- OF G -o oS C--- S77'0Ar4FC� /-'
4
A
3
�'