Item 17 - Rejection of Claim for Damages
.-GENDA REPORT ~
CITY OF POW A Y
This report. is included on the Consent Calendar. There will be no sepal1lte 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 Ma~
INITIATED BY: Peggy Stewart, Director of Administrative ~~
Douglas A. Milton, General Services Manage
DATE: April 16, 1991
SUBJECT: Denial of Claim for Damages - Paul Figueroa
ABSTRACT:
On February 20, 1991, a claim for damages was received from Mr. Paul
Figueroa. The amount of the claim is $1,123.11. It is recommended
that the City Council deny this claim.
BACKGROUND:
Mr. Figueroa claims that on February 8, 1991 he was driving south on
- 1-15 behnind a dump truck owned by the City of Poway. Mr. Figueroa
alleges that a piece of dry wall "flew" off the truck striking his
automobil e.
FISCAL IMPACT: Un known
RECOtfIIENDATION:
It is recommended that the City Council deny this claim.
JLB:PS:DAM:bs
Attachments
.'- ~
~
"\
ACTION:
-
l ./,
1 of 3 ITeM
u_ Art< 1 ti 1991 17
City Of Poway'
Ct.AIM AGAINST THE CITY OF POWAY
deceived by via
J:S. Mail �/
'nter- Office Mall'.
dyer the Counter
Stamp
4 daiffl must be filed with the City Clerk or Risk Manager of the City of Poway within 6 months after which the
ncident:or event occurred. Be sure yourdaltri is against the City of. Poway, not another public entity. Where
;pace Is Insufficient, please use additional paper;ancl Identify information by. paragraph number. Completed
;Iaims must be mailed or;delivered to, The City of Poway, 13325 Chic Center Drive,Poway, CA. 92064 ( P.O.
Box 789 ). Attn: Risk Manager,
,LOTTHE HONORABLE MAYOR AND CITY COUNCIL:, THE CITY OF POWAY CALIFORNIA
The undersigned respectfully submits the following olaftrl and information relative to damage to persons
and/or personal property,
Name of claimant
a. Address of
b. Phone No-
d. Social Security No e; Driver's'Lic. No.
2. Name;, telephone and post' office, address to which claimant desires notices to be sent if other
than above:
3. Occurrence or event from which the4 a+[N' arises:
a. Date Z/L /q/ b. Time 8r34on -f c. Place ( "exact and specific location)
d. How and under what circumstances did damage or injury, occur? Specify the particular
occurrence, event, actor omisston you dialm caused the injury or damage (use
additional paper If necessary ).
I
T .:,..r 1n:'.i .;c i�,^.0 . ;� cArtn Tn 17X Lrr-T oF- Pt .`Q'YCt%� Wf4`
�f'+rci �am 7tiE Ci'fY or owhY �, fyFtEn) Pr 3x3 PiErx :ar- bRY QfttL EyL-
-ri,/ --rn V 07,1 Z im,
e. ^What particular`action b e City, or its employees, caused the alleged damage or
mP�o`YEr s
RS �r i�S = tCNO
w e
FiL6UT -- 71 _
(VgeJ&+ri0tJ
C4*N Tt4I'CJK or iS
To R7&(9E
HAVE A- 606W
A , ro T,c.ti
Tn.,.Ir T W7LuGn T
Z)XR2.,3
,Ti?jm Ayf;v6 Dc'%
2 of 3 APH 1 6 1991 I1'tM 17
Give a description of the injury, property damage or loss, so far as is known at the time of this
claim. If there were no injuries,. state "No Injuries."
i{p IMT�2�ES "fHE f r GR+tt. 6,?iicfrE>'� Orf�ILuER� tDE PrRF $Rorlii 0AF
AND ;117- ON Low -Cr- 23 t(&./ •- SLR Qvfa7cON� >
Give name(s) of the City employee(s) causing the damage or injury:
T i; c wAmE /b edvtb +'oT sTbP ikE TWcr CrJ 'Tn€ M7
Name and address of any other person Injured:
it
e and address of the
Damages claimed:
a Amount claimed as of this date $
b, Estimated: amount offuture costs: . $
G Total amount claimed: $
d. Basis for computation of amounts claimed ( include copies of all bills,invoices, estimates, etc)
. Names and addresses of all witnesses, hospitals, doctors, etc.
a tiC Wi N '
C.
d
10. Any additional information that might be helpful In considering.this claim:
OA;OfPlD iv %hi8 er GlHlchr G/RS /�C,�Aefrr� fa¢rLL 4 >:6vHCK Cm 364irti
F} r y�ryA± -z i3Y o\'fp fft+E 6-441- - �/%fiSi Z WHK
-
Qr �' PIYEaVJf iw/c,ytisb> r{GV v r oTnb oN THE
Cc pf�T(IEa Tc n,B
MV / Ec rr
NcC3' 1Y1E �sDM 6 S/MVLt 1/+6lf&l/vE/NR 'TD /yAV//�/6.f0 -+TbP MY
WARMNG: IT IS A .CRIMINAL. OFFENSE TO FILE A FALSE CLAIM! (Penal Code §72,�� Xcc�n>
insurance Code § 556.1) mE
I hale read the matters and statements made in the above claim and'fknow the samevbe.true of my own knowledge,
except as to,,those.matters stated upon infomiationorbelief as to such matters l'belisve the same to be true. 1 certify under
penalty of perjury that the foregoing is TRUE and CORRECT.
Signed this day of_ 19' at
(yfice of the City Clerk
1 ray, Cafill
DOCUMENT NO. _
3 of 3
FILED
Claimant's Signature
Af R 16 1991 ITkM 17