HomeMy WebLinkAboutClaim #546 - SimsCITY OF PALM DESERT
COMMUNITY SERVICES DIVISION
CITY CLERK OPERATIONS
STAFF REPORT
REQUEST: CLAIM AGAINST THE CITY (#546) BY STEVEN L. SIMS IN THE AMOUNT
OF $10,000
DATE: March 10, 2005
CONTENTS: I. Staff Report
II. Claim No. 546
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. KLASSE'N, CMC
CITY CLERK
Approved:
CARLOS L. OR
CITY MANAGE
rd k
Attachment (as noted)
SHEILA R. GILL! AN, ST. CITY MANAGER
FOR COMMUNITY S; ICES/P.I.O.
H:IWPdataIWPDOCSICLAIMS1546-reject staff rpt.wpd
CITY OF PALM DESERT
CLAIM AGAINST THE CITY OF PALM DESERTIT Y CLER K SEOFFICE ASSIGNED CLAIM NO.
(For Damage(s) to Person(s) or Personal Property? A L t1 D E S E R T. CA
2005 FE8 16 PM 2: 20
Received by:
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 WAKING 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:
NAME
ADDRESS
PHONE NO. DATE OF BIRTH:
SOCIAL SECURIT NOIRW_-1111PDRIVER'S LI EN NO.41.1.11111.10.
2. Name, telephone number and post office address to which claimant desires notices to be
sent, i other than above:
1p�
3. Occurrence or event from which the claim arises:
a. DATE: (!, 2S f b. TIME:
location) lk-I-g;(ofQ4)
c. PLACE (exact and specific
(140K—
d. How and under what circumstances did damage or injury occur? Specify the particular
occurrence, event, act or ommission ou claim caused the injury or damage. Use
additional paper if_necessary.) �1 , ��
1F71 mac.- sIP 7 errki
T;�ff.. 2l 1:.
e. What partticular action by the City, or its employees, caused the
ali� m ge or
injury? 1 t/\ (_ ILi '�"K1
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 ' esen - tinn of th cl - 'm. If there were no
(Furies state ho 'uries": T' _ ,,-,, tiZ - , ►:.
rry • r
6. Name d address of any other person(s) injured:
7. A� � knokaddress of the owner of any damaged property:
8. Damages claimed: -M 4 f�a�t�C`,C� -
a. Amount claimed as of this date: T$�`w-uv�����'-�l fs f
b. Estimated amount of future costs: $
c. Total amount claimed:
d. Basis for computation of amounts claimed' include copies of all bills, invoices,
estimates, etc.):
9. Names and ad•
dresses o I witnesses, hos • itals, doctors, etc.:
�.-- 'S (lo t
tS e =,�
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 CLAM (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. r �-
Sign�:�9 � ay o
, 206, at i'2444Y\
Is161AINT SIGNATURE OF CLAIMANT
Office of the City Clerk, Palm Desert, California
Page 2 of 2
DOC. NO. DATE FILED