Item 12 - Rejection of Claim for Damages
AGENDA REPORT
CITY OF POWAY
This report is included on the Consent Calenc:l8r. 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 BY:
DATE:
Honorable Mayor and Members of the City Council
James L. Bowersox, City Man~
Susan M. Pulone, Director of Administrativ~S rVif~
Douglas A. Milton, General Services Manage ~. I
I
May 23, 1989 .
SUBJECT:
Denial of Claim for Damages - Gaylon Don Nixon
ABSTRACT:
On April 17, 1989 a claim for damages was presented to the City by
Mr. Gaylon D. Nixon. The amount of the claim, to date, is $210.03.
BACKGROUND:
Mr. Nixon claims that on March 11, 1989 his child, Jalene, fell on
Lingre Road in Poway, badly injuring her knees. The street was in
the process of being re-surfaced (sealed) by a contractor for the
City of Poway.
RECOMMENDATION:
It is recommended that the City Council deny this claim.
JLB:SMP:DAM:bs
Attachment
ACTION:
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231989 ITEM 12
City Of Poway
CLAIM AGAINST THE CITY OF'POWAY
Received by via
U.& Mail
Inter -Office Mail _
Overthe Counter
��rt if'-d54r
A claim'must +tie 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, notanother public entity. Where
space is, insufficient, pfease use additional paperand identify information by paragraph number. Completed
claims must be mailed or delivered 'to- The Of" of Poway, 13325 Civic Center Orive,Poway, CA. 92064 ( P.O.
Box: 769 ). Attn: 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
and /or personal property:
L. fi!! /anJ
1. Name of claimant 6 Di'J /01, A 01V
a. Address of claimant..
b. Phone No. a Date!of birth
d. Social Security No. e. Driver's Uc. 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 the claim arises:
a. Date -3—V49 b. Time S &V! c. Place ( exacb�and speciLc tocati09'
ii'Al i% 0 ni .0 o �~7 'A,07Y f>r;w C
d How and under -what circumstances did damage or injury occur? Specify the particular
occurrence, event; act or omission you claim caused the injury.or-damage (use
additional paperitnecessary ).
4),iv .00 r r r 4/,,J ./ dir✓
7:2.1 rr .41ei1 C'r+.1r 444(l .vor Ld.v
e. Whatparticularaction by the City, or its employees, caused the alleged damage or
injury?
!✓O>` 77 -e- i o /S IV)ZA / g ']pOL/l r- JIIIV111,icovt Fo.
T Jul u77, -(.
2 of 3
MAY 2 3 1989 ITEM 12
,
4. Give a,descripffon of thelinjury, property damage or loss; so far as is known at the time of this
claith. 'If.there wereno injuries, state "No Injuries."
.99 Tc <_si`Cti /. rY -r7r>1.T P /f/JT /C S:iL1lG�l7/ sv� //
5. Give name(s) of the City employees) causing the damage . or 'injury:
d°t �LC1 ✓i.G!
6. Name and address of any otherperson: injured:
7. Name and address of the owner oUany damaged property:
8. Damages claimed: 3
a. Amount claimed as of.this date $ a /L1 q
b. Estimated amount,of,future costs: $_
c Total amount claimed:
d. Basis for computatioWof amounts claimed ( include copies of. all bills,invoiees, estimates: etc)
_ 9. Names and addresses of all witnesses, hospitals,.doctors,,etc.
a. S o i/G C .`✓1 (I C'.9d ll y
b. 1�0PA4 itiac
C.
CL
10. Any additional rinformation, that might be helpful in considering this ctaft :
WARNING: IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM (Penal Code §72;
InsuYance Code ,§ 556.1
I have read the nianers;and statements made in;the above cW ft and Vknow the same to be true of my own knowledge,
except as to'thosermatters 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 /y day.of 19 , a2
Office of the City Cleiic Ctatm 's Signature
Poway,- Caiifomia
DOCUMENT NO. FILED
.3 of 3 MAY 23 1989 ITEM j G