HomeMy WebLinkAboutClaim No. 543 - QuinteroCITY OF PALM DESERT
COMMUNITY SERVICES DIVISION
CITY CLERK OPERATIONS
STAFF REPORT
REQUEST: CLAIM AGAINST THE CITY (#543) BY ERNESTO M. QUINTERO IN THE
AMOUNT OF $561.56
DATE: February 24, 2005
CONTENTS: I. Staff Report
II. Claim No. 543
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:
HELLE D. ASS N, CMC
CITY CLERK
Approved:
L.
A ER
EGA
A
CITY MAN
rd k
Attachment (as noted)
A
SHEILA R. GILLIGAN, C
ASST. CITY MANAGER
COMMUNITY SERVICES/P.I.O
H:1WPdata1WPDOCSICLAIMS1543-reject-staff report. wpd
CLAIM AGAINST THE CITY OF PALM DESERT
(For Damage(s) to Person(s) or Personal Property)
Received by:
CITY OF PALM DESERT
RECEIVED ASSIGNED CLAIM NO.
CITY CLERK'S OFFICE
PALH DESERT. CA
2005 JAN -4 PM 2: 49
via: U.S. Mail Interoffice Mail Over -the -Counter
A CLAIM MUST BE FILED WITH THE CITY CLERK OF THE CITY OF PALM DESERT WITHIN SIX
MONTHS AFTER WHICH THE INCIDENT OR EVENT OCCURRED. BE SURE YOUR CLAIM IS
AGAINST THE CITY OF PALM DESERT, NOT ANOTHER PUBLIC ENTITY. WHERE SPACE IS
INSUFFICIENT, PLEASE USE ADDITIONAL PAPER AND IDENTIFY INFORMATION BY
PARAGRAPH NUMBER. COMPLETED CLAIMS MUST BE MAILED OR DELIVERED TO THE CITY
CLERK, CITY OF PALM DESERT, 73-510 FRED WARING DRIVE, PALM DESERT, CA 92260.
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:
NAMEL4e5.(O
ADDRESS
PHONE NO.
SOCIAL SECURITY NO.
n L); N
2. Name, telephone number
sent, if o an above:
011/0_1/1/1 IOW
DATE OF BIRTH:
isr_imikDRIVER'S I EN E all..1111.
and post office address to which claimant desires notices to be
3. Occurrence or event from which the claim arises:
a. DATE: D ; b. TIME: r 0 d7 c. PLACE (exact and specific
location �,u� ,.. _coo
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.) 4,1/4,0+J..,- e«r ; ►,, (, ». o.t ,... -
e.
Page 1 of 2
What particular action by the City, or its employees, caused the alleged damage or
injury? IoJCV5®h(2. Qn'k S o,.I
Qv6Obr)Skrvc1',n tJ
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
s, state "no injuries":" fl() lfl Uj . "
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:
7. N e and address of the owner of any damaged propert : 6-ne,S1-cD f,., tv,,.A, t erc7
11111
8. Damages claimed:
a. Amount claimed as of this date:
b. Estimated amount of future costs:
c. Total amount claimed:
d. Basis for computation of amounts
estimates, etc.):
0,e N4CSo1'n1 /C' J4"1 o
$ t,Uj tnouo '3$1.6L Labv14) 8Q —
claim$ ea5QuIiClude copies of all bills, invoices,
Pc is
9. Names and addresses of all witnesses, hospitals, doctors, etc.:
(gv-9e5
10. Any additional information, including police reports, which might be helpful in considering
this claim:
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 to 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 day of De--/ , 20 o 5 at / = OP
SIGNATURE OF CLAIMAINT
Office of the City Clerk, Palm Desert, California
Page 2 of 2
1'1&.Sfr
E OF CLAIMANT
DOC. NO. DATE FILED