Item 15 - Claim for Damages - Donald Lee MacFarlane, Jr.AGENDA REPORT
CITY OF POWAY
This 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.
TO:
FROM:
INITIATED
DATE
SUBJECT
ABSTRACT
Honorable Mayor
1:;;1;;;;
OF 01111
t�
,14 THE Co
and Members of the City Council,
James L. Bowersox, City Mana="
BY: Douglas A. Milton, Purchasing Manag
July 8, 1986
Claim for Damages
Donald Lee MacFarlane, Jr.
A claim for damages in the amount of $847.37 has been filed by
Mr. Donald Lee MacFarlane, Jr. on behalf of his 32 year old son,
Scott.
BACKGROUND
Mr. MacFarlane claims his 32 year old son climbed to the top of the
highest playing/climbing unit at Lake Poway, accidentally stepped
off the side and fell to the bottom. Mr. MacFarlane feels the City
is negligent; in that the structure is not safely designed, and that
the structure should have a railingto prevent such accidents.
RECOMMENDATION'
Carl . Warren f Company, insurance adjusters for the City of Poway,
has indicated no liability on the part of the City. It is
recommendedthat this claim be denied.
JLB:DAM:jt
Attachment
1. Claim for Damages
ACTION:
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JUL 81i8L ITEM
I
cm OF POWAY � y � �
C [.SAY 9 �8
CLAIM AGAINST THE CITY OF POWAY R E
.e
CITY OF POWAY
Received by via MY )986 CITY CLERKS Fc•
3
U.S. Mail 4. , •Ct;
Inter. -Off ice Mail --- C rk s Time Stamp
,Rt1NtlN SERV DEPS
Over the Counter
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A claire must be filed with the City Clerk of the City of Poway within 'i00 days aft
which the incident or event occurred. Be sure your claim is against the City Of
er
Poway, not another Y•
public entity. Where space is insufficient, please use additional
paper and identify information by paragraph number. Completed claims Host be mailed
or delivered to the City Clerk, The Cit of Poway,, 13325 Civic Center Drive
Y Y. 'Poway,
CA 92064 (P.O. Box 785). F
TO THE 'UNORABIE MYOR A CITY Coc =L. THE CITY OF POWAY CALIFORNIA
The undersigned resnectfLl�
_y sLbnits the following claim and information relative to
damage to persons and/or personal property;
1 NAME OF cumvkrrlee-
a.
ADDRESS OFCLAIMANr'. 1
a 142 5
b• PxcNE No c. DAA of BIxTxf/4r
S
d. SOCIAL SEOUP= NO.=e-7e. ,s LIC. No.�
2. Name, telephone and past office address to which claimant desires notices to be
°
sent if other than above:
e
3. Occurrence or event from which the claim arises;
a. DATE b,. TIME C. PLACE (exact andspecific location)
C - C r�
d. How and under what circumstances did da -mage or inur-y occur? Specify
particular occurrence, event, -act or omission you claim caused tthe t,
particular
injury or
dams a fuse additional paper if necessary)
r l� aU
r 7i�. ✓�; it e 0r_is��«�1
sir
a
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e. What particular action by the City, s, caused the a
or its employeell ed
damag er in Fury? A �
' �Y, de Sit r�C r ... % u
Y Jig �y =Cf 10A?�icl
a
2 of 3 JUL 8 1986 ITEM 15
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4. Give a descriptio?*,f the injury,, property damage a� loss, so far as is known at
the time of this df `r m. if therewere no injuries, , cafe "no injuries."
Y111,G /rC U�1�r n�c
"
S. Give name(s) of the City employees)causing the damage or injury:
nvnCl,
6. Name and address of any other person injured:
7. Nam and address of the owner of any damaged property;
8., Damages claimed:
a. Amount claimed as of this date:
b. E tir:�ae3 amour-It. of future costs: $ v a
C. Total amount claimed; $ 7 3 y
d. Basis for computation of amounts claimed (include copies of all bills,
invoices, estimates, etc. ) : s"� Q.-
9. Names and addresses of all witnesses, hospitals, doctors, etc.
f r - 'Z - & -
b.
ire
`.z j�llLl.l�pj1�! fel r�r �•
�.
d.
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10. An a itional information that mijgh t be helpful in considgring thip cl,aim•
OL
WARNIM: IT IS A CRIMINAL OF MSE TO FILE A FALSE CL,AII4i!Penal
( Code X72; Insurance
i
I have read the matters and statements made in the above claim and I know the same to
be true of my own knowledge, except as to those matters stated upon information or
belief as to such matters I believe the same to be true. I certify under penalty of
Perjury that the foregoing is TRUE and CORRECT.
Signed this day of , is�s6 , at. ®i a
:
Office of the City Clerk, Claimant's Signature
Poway, California
DOCUNSrA1T1 LSO.
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