HomeMy WebLinkAboutAGENDA REPORT 1998 1104 CC REG ITEM 11ETO:
FROM:
DATE:
RE:
CITY OF MOORPARK
CITY COUNCIL AGENDA REPORT
Honorable City Council
aao.A(�Zq
ITEM 1.1 • 6 •
01 V OF MOORPARK, CALIFOR1NIA
City Council Meeting
of—
Ark i'i)N:
Af F r o vac!
BY
John E. Nowak, Assistant City Manager PN
October 19, 1998 (Council meeting of 11/04/98)
CONSIDER REJECTION OF CLAIM AGAINST CITY - ALICE
ROWAN
Discussion: On October 5, 1998 the City received a Claim
for Damages from Alice Rowan of 15750 E. Los Angeles
Avenue, #90, Moorpark seeking damaged as a result of a
determination by the Assistant City Manager that the rent
increase on her mobile home space was permitted under the
Moorpark Municipal Code and the Public Housing Assistance
Payment contract. The amount of damages sought is $61.80
for past rent increases and $15.45 per month beginning
October 1, 1998.
This type of claim is not covered under the Joint Powers
Insurance Authority.
Recommendation: The City Council is requested to reject
the claim for damages filed by Alice Rowan.
Attachment: Claim form
000456
CLAIM FOR DAMAGES
TO PERSON OR PROPERTY
REiI -� ED
OCT 0 5 1998
CiT / rT i_r, T
�.:1 Y`l!L .Y1�1'V 1L j�. >:�i•
Name of Claimant
Date of Birth of Claimant
Home Address of ClaitKant
City & State
Home Telephone Number
IS-7 5 G , �° a� �,
�eue. % D �'j r,�
S o s- 5 1 1- 3 6 /
Business Address of Claimant
City & State
Business Telephone Number
Give address & telephone number
to which you
Claimant's Occupation
desire notices or communication
to be sent
regarding this claim:
Ste,
L j - a 9 - a 0/
�
->-,� , �� 9 3oa 1
Claimant's Social Security
�bg_
When did DAMAGE br INJURY-occur?
Date: `��
Names of any City employees involved
in INJURY or DAMAGE:
Time:
where uiu uanalwL or iNjuKY mcuK7 Describe fully, and locate on diagram on attached diagram.
Where appropriate, give street names and addresses.-4nd measurements for landmarks:
Describe in detail how DAMAGE or INJURY occurred:
'
Why do ou c aim the CITY is responsible?
uasc:rtue iu ue[aii each iviuKY or DAMAut:
IL1!i c,
Was damage and /or injury ivnestigated by police or sheriff or California Highway Patrol?
Name of agency that investigated: Pig-
Were paramedics or' ambulance called?
If so, name County or City ambulance:
If injured, state date, time, name and address of doctor of your first visit:
Hospital
Address Phone
Doctor Address
Doctor Address
Phone
Phone
Page 000457
9t'XNESSES TO DAMAGE OR INJURY: List names and addresses of all persons known to have
information:
Name Address w( -7 &u� ,%CC�- .(.L�. Phone,5-9V O 56 /
Name '%7;► (, GCS G {JCe�iy�, ,. - C e'— / 7 Y q
Address /,3Q ��� i4 ' �& Phone- 1/k76531
Name_ Ce/oJ�iiyvy Address Ll 00 1- -18.60
✓ZI - Phone rvo
t o s azJl - i 3.
The amount claimed, as of the date of presentation of this claim, is computed as follows:
Damages incurred to date (exact):
Damages to property..
Expenses for medical and/or . hospital •care ........................ $
Loss of earnings .. ........................ ............................:$$
Special damages for
General Damages ........................... ..............................$ `�
Total Damages to Date .............. ...............:..............$ jv l• D
Total amount claimed as of presentation of this claim ..............
Estimated prospective damages as far as known:
Future expenses for medical and hospital care ...........................$
Future loss of earnings.. .$
Other prospective special damages ...... .$
Prospective general damages.....
Total estimated prospective damages ..............................$ GLn /�ir�c4cvy�i
READ CAREFULLY
SHOW the location and position of vehicle(s) at
SHOW your vehicle as Cl , the other vehicle
SHOW the name of the street(s), location of stop
�u
point of impact.
as �? � I ,
sig s, ss gnals.
INDICATE
NORTH
I-
I declare the claim, under California Government Code Section 910, to be true and correct,
under penalty of perjury of the laws of the State of California, this J`✓�- day of
GCr-� -c t� 19 q�
Type or Print Name of Claimant Signature of Claimant
000438