Item 12 - Rejection of Claim for Damages
, - AGENDA REPORT SUMMARY -
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TO: Honorable Mayor and Members of the City Council
FROM: James L. Bowersox, City Man~
INITIATED BY: Peggy A. Stewart, Director of Administrative servicegY
,
Douglas A. Milton, General Services Manager~
~
DATE: October 6, 1998
SUBJECT: Rejection of Claim for Damages -- Dan S. Ervin
ABSTRACT
A claim for damages was received from Mr. Dan S. Ervin. Mr. Ervin alleges that his automobile
windshield was damaged when he drove through a construction area in Poway on August 19,
1998. The claim amounts to $430.65. The claim has been referred to the contractor doing the
work. It is recommended that the City Council reject this claim.
ENVIRONMENTAL REVIEW
This agenda item is not subject to environmental review.
FISCAL IMPACT
Unknown
ADDITIONAL PUBLIC NOTIFICATION AND CORRESPONDENCE
None
RECOMMENDATION
It is recommended that the City Council reject this claim.
- ACTION
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- AGENDA REPORT
CITY OF POW A Y
This report is included on the Consent Calendar. There will be no seperete discussion of the report prior to 21pprov211 by the
City Council unless members of the Council. staff or pUblic request It to be removed from the Consent Celender and
discussed separately. If you wish to have this report. pulled for discussion, pleese fill out ell slip Indicating the report number
and give It to the City Clerk prior to the beginning of the City Council meeting.
TO: Honorable Mayor and Members of the City Council
FROM: James L. Bowersox, City Mana~
INITIATED BY: Peggy A. Stewart, Director of Administrative S~
Douglas A. Milton, General Services Manager
DATE: October 6, 1998
SUBJECT: Rejection of Claim for Damages - Dan S. Ervin
BACKGROUND
A claim for damages was received from Mr. Dan S. Ervin. The claim is for windshield damage,
and the amount of the claim is $430.65. It is recommended that this claim be rejected."
FINDINGS
Mr. Ervin alleges that his windshield was damaged while he was driving through the
intersection of Espola Road and Twin Peaks Road during a period when that section of road
was under construction. At the time, a private contractor was working in the area. The claim
has been referred to the contractor.
ENVIRONMENTAL REVIEW
This agenda item is not subject to environmental review.
FISCAL IMPACT
Unknown
ADDITIONAL PUBLIC NOTIFICATION AND CORRESPONDENCE
None
ACTION:
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OCT 0 6 1998 1:1..
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Agenda Report
October 6, 1998
Page 2
RECOMMENDATION
It is recommended that the City Council reject this claim.
Attachment: Claim for Damages -- Dan S. Ervin
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City of Poway L COy Da.."""", -
CLAIM AGAINST THE CITY OF POWAY
Received by ~ ~ via ~fDl rn @ rn n r " ".,..-,.. '
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U.S. Mail ' . ., ~ . "
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A claim must be filed with the City Clerk or Risk Manager of the City of Poway within 6 months after which the incident or event
occurred. Be sure your 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 delivered to The City of
Poway, 13325 Civic Center Drive, Poway, CA 92064 (P.O. Box 789). Alln: 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 ancl/or personal
property:
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1. Name of claimant Frvl YJ
a. Address of claimant' P (9 8/JX /C;-63 Jt-( Ilqr; /'..q 97 I?~
b. Phone NO.! 760,) '7 -Rq Ylo '1r c. Date of Birth ?- "2.7-72
d. Social Security No. ~7 17 tin '7-:S e. Driver's lie. No. C9 ,;. L/ ZT -5'09 <: /
,
2. Name, telephone and post office address to which claimant desires notices to be sent if other than above:
Po 130-/ I~~ JW/rqf? CQ 9L05~
3. Occurrence or event from which the claim arises:
a.Date ?{- /0-9q( b.Time 10 ;OcJ I+/h
c. Place (exact and specific location) e.<?p/9/19 f/,(/"n"':5' /117 7h/i'Y} 'p""'akoi:
d. How and under what circumstances did damage or injury occur? Specify the particular occurrence, event, act of omission
you claim caused the injury or damage (use additional paper if necessary .
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W1t1I/,' '73 ~sr f(')y {_OJ.'] ~-fft:.({:r, '0 ~7 q/~
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4. Give a description of the injury, pro~ - damage or loss so far as is known at thE - e of the claim. If there were no injurie,
state "No Injuries." W/y-r;/C;~ ,e /d
Crqc. k-ec/
5. Give name(s) of the City employee(s) causing the damage or injury:
6. Name and address of any other person injured:
7. Name and address of the owner of any damaged property:
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7~ I {c,R'J 1"'9- 9t?CJ5/
8. Damages claimed:
a. Amount claimed as of this date $
b. Estimated amount of future costs: $ $~.r;
c. Total amount claimed: $
. d. Basis for computation of amounts ClaZed (include copies of all bills, invoices, estimates, etc.)
dJ-/1 :S I-o,/, G/c;55 tiV~77 779/ C)i(t~Py J JAD
9. Names and addresses of all witnesses, hospitals, doctors, etc.
a.
b.
c.
d.
10. Any additional information that might be helpful in considering the claim:
WARNING: IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM! (Penal Code !i72, Insurance Code !i 556.1)
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
pe~ury that the foregoing is TRUE and CORRECT.
Signed this ()~ day of 1/7 0<;-" $. 0(/
,19 :/, .at
Claimant's Signature ~~.--
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Office of the City Clerk
Poway, California
DOC 5 of 5 FILED
OCT () 6 1998 iTEM 1:2.