Item 11A - Rejection of Claim for Damages
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.~GENDA REPORT -
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CITY OF POW A Y
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: Honorable Mayor and Members of the City Council
FROM: James L. Bowersox, City Man~
INITIATED BY: Peggy Stewart, Director of Administrative Servic~
Douglas A. Milton, General Services Manager~
DATE: March 19, 1991
SUBJECT: Denial of Claim for Damages - Mary Taylor
ABSTRACT:
A claim for damages was received from Ms. Mary Taylor on February 20, 1991.
The amount of the claim is unknown, at this time. It is recommended that
the City Council deny this claim.
BACKGROUND:
Ms. Taylor claims that her automobile and truck were damaged by the resi-
due of sandblastin9 being performed in the area by Plaza Landscape, Inc.
FISCAL IMPACT: Unknown
REC(MIIENDATION:
It is recommended that the City Council deny this claim.
JLB:PS:DAM:bs
Attachments
ACTION:
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1 of 3 Mril< ll:l 1991 IT t.M
J ~ A-
=REGEIVED City Of PowaV
CLAIM AGAINST THE,CITY OF POWAY
��-�L
deceived by Al �r/.ts.. via _
is. Mail
;nter -Office Mail
'fiver the Counter 4 d
:1 claim must be filed with the City Clerk orRlsk Manager of the City of Poway within 6 months after which the
ncident or event occurred. Be sure your claim is against the
City, of ;Poway, not another, public entity. Where
.pace is insufficient, please use additional paper and idenfify. Inform_afion bylparagraph number. Completed
ilaims must be mailed, or delivered to The City of "Poway, 13325 Civic Center Drive,Poway, CA. 92064 ( P.O.
3ox 789 ). Attn: Risk Manager
rO THE HONORABLE MAYOR AND CITY COUNCIL, THE CITY OF POWAY CALIFORNIA
rhe undersigned respectfully submits the following claim and information relative to damage to persons
intl/or personal property
3.
Name of claimant
a. Address of
b. Phone No. C. Date of birth _
d. Social Security N e. Driver's.Lic. No.
Name, telephone and post office address to which claimant desires no to be sent if other
than above:
Occurrence or event from which the'claim arises:
a.
is
Ail
c. Place (exact and specific location)
d. How and under what, circumstances did damage or injury occur? Specify the particular
occurrence,event, act oromisslon you claim caused the injury or damage (use
additional paper if necessary ).
e.
/vl
�'
What particular action by the City, or its employees, caused the alleged damage or`
iniurv?
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Mate 19 1991 ITEM 17/4
4. Give a description of the :inju:ry;;, property c
claim. if there were no Injuries, state "No
5. Give Nme(s) of the:City emplgyee(sl cat
3
7. Name and
addrev ss of any
or doss, so ^far.as is known at the time of this
the da "e or injury:
Injured:
S. Damages claimed: ��•�. /
a. Amount claimetas of this date
b. Estimated amount of future costs: $
G Total amount claimed: $
d. Basis for computation of amounts claimed ( Include copies:of'all bills;invoices, estimates, etc)
9. Names and addresses of all witnesses; hospitals, doctors, etc.
a
T
C.
CL
10. Any additional information that might be helpful in considering 1his claim:
WARNING: IT IS A• CRIMINAL OFFENSE TO FILE A FALSE CLAIM[ (Penal Code §72;
Insurance Code;§ 556x1 +),
I have read, the?matterstand :statements made in therabove 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!! believe the. same tol be true: I certify under
penalty:of perjury thattheloregoing is TRUE and CORRECT.
Signed this day.ot
Claiman ignature
,Office of tihhwCity Clerk
P" - y,.California
DuCUMENT NO.
3 of 3
FILED
MAtt 1 y 1991 ITEM 1V