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HomeMy WebLinkAboutClaim No. 530 - B. SlaterCITY OF PALM DESERT COMMUNITY SERVICES DIVISION CITY CLERK OPERATIONS STAFF REPORT REQUEST: CLAIM AGAINST THE CITY (#530) BY BRANDON SLATER IN THE AMOUNT OF $940 DATE: May 13, 2004 CONTENTS: I. Staff Report II. Claim No. 530 Recommendation: By Minute Motion, reject the Claim and direct the City Clerk to so notify the Claimant. Background: Based on a review of the subject Claim and the recommendation of the Claims Adjuster, Risk Manager, City Attorney, and staff, it is recommended that the Claim be rejected. Discussion of this item should be held in Closed Session pursuant to Government Code Section 54956.9(b), potential litigation. Submitted by: RACHELLE D. KLASSEN, MC CITY CLERK Approved: CARLOS L. OR GA CITY MANAGER rdk Attachment (as noted) SHEILA R. GIL MC ASST. CITY MAN ` GE' FOR COMMUNITY SERA ES H:IWPdata\WPDOCSICLAIMS1530 reject staff rpt.wpd CLAIM AGAINST THE CITY OF PALM DESERT (For Damage(s) to Person(s) or Personal Property) CITY OF PALM DESERT ASSIGNED CLAIM NO.����._ ECEIVED CITY CLERK'S OFFICE PALM F DESERT. CA 7004 FEB -3 PM 5: 07 Received by: via: U.S. Mail Interoffice Mail Over -the -Counter A CLAIM MUST BE FILED WITH THE CITY CLERK OF THECITY EDROF PALM DE YRT WITHIN CLAIM IS SIX MONTHS AFTER WHICH THE INCIDENT OR EVENT OC AGAINST THE CITY OF PALM DESERTANOTHER. ANDBLIDENTIFY �I FORMATION IC ENTITYWHERE EBY IS INSUFFICIENT, PLEASE USE ADDITIONAL PARAGRAPH NUMBER. COMPLETED5CLAIMS MUST BE MAILED OR 10 FRED 'WAKING DRIVE, PALM DESERT,,CA 92260CITY CLERK, CITY OF .PALM DESERT, TO THE HONORABLE MAYOR AND CITY COUNCIL, City of Palm Desert, California: The undersigned respectfully submit(s) the following claim and information relative to damage(s) to person(s) and/or personal property: 1. CLAIMANT INFORMATION: NAME ADDRESS PHONE NO. .t _ SOCIAL SECURITY NO. 2. Name, telephone number sent, if other than above: DATE OF B.ITH: . allt DRIVER'S LICEN E NO. and post office address to which claimant desires notices to be 3. Occurrence or event from which the claim arises: a. DATE: f 1? ()Li b. TIME: 2 ` ©C ?'r'" c. PLACE (exact and specific Location} n 14o✓t EA 5T GooCar -rwE �•! 1 PrIr P o o oPt.si s d. How and under what circumstances did damage or injury occur? Specify the particular occurrence, event, act or ommission you claim caused the injury or damage. (Use additional paper if necessary.) 1'7, g.\v ‘ I,(., '_As-CC3060,11) l .4 3t \f„ C-Al ! "w/fie: " kAg�-� ® lt'tY�t �D�54.�(f 1 k - CA F `QoE? D Ok•st" ar 'C t `.k0L - A NID P-s ek 5 L & t r i ,C 1-2 D t alas Ag.0 K.i0 5T42.G.C. . LJ Cs vvr s S>tS7 mac - tiT v r.►--. c. et" L J AS "iv t- i-r e. What particular action by the City, or its employees, caused the alleged damage or injury? THE C. e4-e " sNth `C=-''C" o u T s t O C \-to 01 t- 0 P Pa v r (3 y t'r5 t.c Page 1 of 2 4. Give a general description of the indebtedness, obligation, injury, damage, or loss incurred so far as it may be known at the time of presentation of the claim. If there .were no injuries, state "no injuries": i kl . y Al Ca_ C t r A I a K , ,, H fY D . I teat) 1_ 1 0 e tt L is-lotki UgO PLv5 4,_. (A*0 -t-416, 02 'fib rTo-Tv1 L EstY.-‘,9-Cant /-wtioc yr t -+a„ ?YO, kf r 1 nl�T 5. Give the name(s) of the City employee(s) causing the damage or injury: . 6. Name and address of any other person(s) injured: 7C1 0 it/6_ 7. Name and address of the owner of any damaged property: p elz,J S— 3 4.17 c? A- ►/ t - Of e ✓A, 2 a2- o 8. Damages claimed: $ g 0 a. Amount claimed as of this date: _I b. Estimated amount of future costs: $ AlOAIC c. Total amount claimed: $ 9 / 0 d. Basis for computation of amounts claimed (include copies of all bills, invoices, estimates, etc.): y, S 1 .j--i'J e_ +4--C-C..- » f/li; C S 9. Names and addresses of all witnesses, hospitals, doctors, etc.: 10. Any additional information, including police reports, which might be helpful inconsidering this claim: tz-'12--'�- `.3 'r� Po Lt.( C= rz pc o�'r r( k ,(Z) t.-i t-r AA- e v p 6Ll c.c_ 63- .Per. WARNING:IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM[ (PENAL CODE 72; INSURANCE CODE 556.1). I have read the matters and statements made in the above claim, and I know the same tc be true of my own knowledge, except as to those matters 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 5 day of ( , 20 WI , at S1GNAT OF LAIMAINT SIGNATURE OF CLAIMANT Office of the City Clerk, Palm Desert, California Page 2 of 2 DOC, NO, DATE FILEB