Item 21 - Denial of Claim .—�ENDA REPORT — oF o,�
G��� '�Y
CITY OF POWAY
This report is included on the Consent Calendac There will be no separate discussion of the report prior to approval by the T
Ciry Council unless members of the Council, sWff or public request it to be removed from the Consent Calendar and yF w s.�.� �
discussed separately.If you wish to have this report pulled for discussion,please fill out a slip indicating[he report number °iry �,\ rHE cp�"
and give it to the City Clerk prior ro the beginning of the City Council meeting.
Tp: Honorable Mayor and Members of the City Council
FROM: James L. Bowersox, City Mana�
INITIATED BY: Peggy Stewart, Director of,Administrative Services
Douglas A. Milton, General Services Manage�°-�
�.� �
DATE: May 5, 1992
SUBJECT: Denial of Claim for Damaqes - Rose La Chance
ABSTRACT:
A claim for damages was received from Ms. Rose La Chance on March 16, 1992.
The amount of the claim is $1535.41 . It is recommended that this claim be
denied.
BACK6ROUND:
Ms. La Chance claims that while she was driving on Poway Road in Poway she
unavoidably struck a "sprinkler box" that was lying in the street causing
severe damage to her vehicle.
FISCAL IMPACT:
Unknown
RECOhMENDATION:
It is recommended that the City Council deny this claim.
JLB:PS:DAM:bs
Attachment -
ACTION:
1 of 3 !YIAY 5 199[, f�t'�8h7 2.1
City 4f .�'oway " �i p `� `� `� ° � `� 0
` MAR I 6 I' ':;2
CIAIM AGAINST THE ClN OF POWAY .
;ceived;by �-e� via ���p����
S.:(vtail X=
:er-0ffice; Maii ,
�erfhe Counter �— `� I —� 2� C)3!
;
claim must be,fiied with the Ciry Cle�k or Risk Manager ofthe City'of Poway within.6 months after which the
ciiient or event`occurred. Be sure,your cla}m is 2gainst the City of Poway, not another public"entity. Where
sace is insutficient:"piease use additional';p2per and identify"intormation by paragr2ph number. Completed
=ims;must be mailed or delive�ed to The Ciry of Poway; 13325 Civic Center Drive,Poway, CA. 92064 ( P.O.
�x 789): Attn:'Risk Manager _
�TNE HONORABLE MAYOR AND CITY COUNCIL; THE GTY OF POWAY CALIFORNIA „
ne Jndersignsd respe���lly submits tt�e follovrirg ciaim 2rd info;maEion relaii�:e :o d2m2ge to per5on5
nii/orpersorial property: .
. Name of claimant 1��� l.A C' 1-N�I�_.
a Add�ess of claim2nt
b: Phone No. c. Date of bir;h —
d. Social Security N e. Drivefs Lic. No.
!. Name, telephone and post office add�ess fo which claimant desices notices to be.sent if oihen
Utian above:
3. Occurcence or event from which the claim arises:
2. D2tej],�,��1'L - b. Time J F� •��D lkM c. Place ( exact 2nd specific location)
�w'0.ti1 � `f� t � c.n La d n �`�; ✓!r� v � S-�' c"Yl (�0111^. �,I ACt,�
!
d, How and undar v,rh�t ci;c::ms,ances �id dam�3e oc in}ury occur? 8p°cifij !�e r2cticular
occurrence„event, act or omission you ci2im caused t7e injury or Camag= (use
additiond paper if �ecessary ).
i'i�';�c � �t- huand r^n ��u:t�y�� l h.cf a �/1n;�;hKli� hox c�u�n.v,
�.r �-drt �i� -�h��� � �a e�n�,. /h -�1 (tLf L�:u:P . ( e<:�a:s ru��hLt, �o a c
i� �'„• � �hl -lrc/��� r��,����/ r� T v u.>c� no o�-u i�
e, What,p2ricular action by the City, or its employees, caused the alleged d�nage or
injury?
T.�itd,_ ✓5 (1�1,i n �C!L�,s �x t,t1�J> l;t3i G vr c,l�i �vr �Gt � —
�
��ii..o� -
2 of 3 MAY 5 199Z IT�M 21
Give a descriptio� of the injur, roperty damage or.loss, so,far,as is 1ow dt the time Ot this
cta.imI. If'there were no in�unes state "No Inju�fes.' �' ��
�VD r ^ � � ��'� '�J '�{1 d' Ll!
Give nane(s) of the Gity empioyee(s) causing the d.amage or injury:
Narne and address of any otherperson:injured:
Name and address of the owner ot any=damaged property:
Q -- _
Damages cl2imed:
� a Amount ciaimed as of this date 5 i 5 35 •`�1
b. Estimated amount of futu�e cos�: S '— —
G Total anount cla,imed: $ —
tl, Basis for computa5on of amounts claimed ( include copies of all bilis,invoices, es:imztes, etc) :
I. N2mes and addresses ot a11 witinesses; hospitals, doctors, etc.
-- a
b. g
� —
d —
10. Any additional intormation that might be helpful.in considering this ciaim:
WARNING: .IT IS :A CRII!AINAL OFFENSE TO FILE A FALSE CLAIM! (Penal Code §7.2;
Insurance Code _§ 556:1 )
I have re2d the matters,and statementn"intormat on o bel et'as o s u hkmatte sel be eve het ame'to be true.r fcer ry unde
except as to those matters statzd;;upo
penalty of perjur��that�the foregoing is TRUE and CORRECT. //
� � day ot� 19 �oZ .2i�` �vn .�� C � C����
Signed this �_______.-- T i �'
L �
ClaimanYS-Slgrrature
C?ffice ofti�e City C1er1:
�uay. Califortu�
„OGUMENT NO. FILED
MAY 5 1932 ITE3lS 21
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