Item 14D - Claim for Damages - Pacific Bell1 of 4
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damage. or.
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AUG 19 1986 ITEM 14D
Give a description 'f tine injury, property damage( ' loss, so far as is known at
the timeof this cint. : If users were no injuries, mate "no fn jUrfes,1°
Gi nameis) of the City employee(s) sousing the damage or injury..
Name and address of any other person injured:
Nam and address of the minis of any danageol property:
ges
a. Aaaount claimed as of this date:
b. P timatred anoint of future -a --- j
c. Total. amount clamed: $ r- . S'
d.- Basis for vac utation of amiunts clatred (incl. copies of all. bills,
invoices, test etc.
addresses of all witnesses, hosprta ,` doctors, etc.
b.
d.
10. fay additional information that might be
S helpful. in: considering this claim:
IT IS A CRIKENAL OFFENSE TO PILE A FALSE CIA1141
(Penal Oide 572; Insurance
5556.1)
have read the: natters and statements made in the above claim and 1 lasca# the sane. to .
be true of my own knowledge, edge, , except as to those matters stated' upon intonation or
belief as to such mattes. 1 believe the sane to be. true. " I certify under penalty of
perjury that the foregoing is TRIM and
.
Signed this E3 day of , 1914, at
Office of the City Cie -3:k,
Poway, California
DOCUMENT i1io.
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AUG 19 1986 ITEM 14
d,
04/24/M
REPORT JCWO14 PAGE,
20:15
ARC. --RPT; SOCAL PROGRAM
JOF71 .._.
WORK DETAIL FOR CWBO, 46006021.5 w
CITY OF POWAY
P 01 sox, 755
POWAY,; CA 9206
FOR THE COST. -OF REPAIR TO PACIFIC,BELL
PLANT FACILITIES DAMAGED AT
LO.CATrON :
a
RANCH HOLLOW RD / ORCHARD GATE POWY
DATEOF DAMAGE: 04/09/86
LABOVENGIN:EER:ING
w
D°A:TE..
RC FC REGULAR AND EXTRA: HRS HOURLY RATE
SUB -TOTAL
04009/86
4230 2.00 548.00
$96.00
0406%86
423a 4.00 548.0'®
LABOR/ENGINEERING, TOTAL
$2$8.00:
:MATERIAL
DATE
RC/'FC ` QUANT:ITY COST P/U' SUPPLY EXP
SUB--TOTALe--,.l
04/0s/86`
-450 25 .22 1.20000�.s
CA T 25x26
04/09/-86
45
$2x.64
MISCELLANEOUS MATERIAL
04009!86-
450
$3.92
MISCELLANEOUS MATERIAL
04f Q9�86
450
$30.28
MISCELLANEOUS MATERIAL
MATERIAL TOTAL
$:62.53
ADDITIONAL EXPENSES
04/09/86
41T TROUBLE REPORT HANDLING
$4.28
TOTAL AMOUNT DUE-
$354.91
AUG 19 1986:
ITEM 14
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