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TatroClaimC

TatroClaimC

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Published by CalCoastNews

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Categories:Types, Legal forms
Published by: CalCoastNews on Feb 02, 2012
Copyright:Attribution Non-commercial

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11/07/2013

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CITYOFELPASODEROBLES-CLAIMFORM
PlEASEAEAO
iNirrdiw..,..rONS
ONentaRSlOEBEFOReCOMPI.!TIOff
I~~~
flrOd".~
CoOt,
cfeim.~to~~
of
Paso
RoI.'ief,
CaIifaT,ie,..
follows;]
Name
of
ClaimantJon
Tatro
(Hi'«
NarrHt)
(MIddle
InItJaI)
(lMt
Name)
Date
of81rth,_
~,-----------------
~------------~
ity.
State,
Zip
15821
Ventura
91'it(!.Suite615
MaillngAddrnS
Encino,
CA91436
(If
d"-'t
bM!
ebc:MI}
(SWet
addrWsJ
Daytime()905~OW1
CAOL#,_
e~~~~__
CellJPgr.__....L..._
Mi
Of
'QM
0Personal1nlurY
II
other
E!nPI
o)'!=E!
Itt
Reta!ia
t
i
O!'l
Whtndkl
Injury
or
damage
occur?__~':'::-.~~-;-~_~~,......_..,.....,.._-,-_
(Mooftllo.ylYesrJ
(Day
of
~J
(Time-
AM?
or
PM?i
C
Property.Oamage
0
PofIce;
Report
t,_
o
Indemnity-Date.
tompIaint
·sttVed,_
Whatil1j'"Yordamage
did
you
suffer?
See
attachedGovernmentClaim
.~)
State
the
amountdallMdfor:0
Per40nal
tnJvry
$
C
p~
Damage
$
I
NOT!:"_...,,;;
Gf;:;;;;:;;;;fwthe
IIIfIr1IItJP
fhIm«I
I
If
C1.AIM
RltAlBTOAN
AUTOM08IU!.
AeeIDIIHT.
PUMI!
MIMR
1'HII!fOL.L.CIWINO
i'ND
ATTACHPROOFOFINSURANCE
Please
cl?eck
here
if
there
was
no
In$.I.IrerICe
COIf$I'8ge
In
effect
at
timeof
il'\cident
0
InsuranceCOmpany,_
InsurallC4tBrokerfAgM.\.-_
~~~~~~~,~),------~------------------~----------------------
WARNtNG:
CaIlfomIa
Slate
Law
generally~
that
most
daIms
agaInSt
a
public~.
SUCh
as
lila
CI!y
of
Paso
RobleS.
be
jlIW8Il1lild
wtIhln
8fX
til
MONt1tI
from
h
a1e
of
the
ad!on
01'
Incident
gMng
liS&
10
lhe
dQIm,
Certain
ottIIIf
daims
must
11&
!lied~
0.
:I)
Y'EAI
from
Itle
acIIOn
01'~
You
should
dIec;k~
Cede
I()
deIeImine
MIst
flIW8ItI3tioI.
periOd
appI!es
In
youc
case,
~A//
2~.~,,~-.-,...
_/uJ,/_...
~
(;-n,
t:
t:Tff':'S
f)rf'Ic;;..·
I
 
CITYOFELPASODEROBLES-CLAIMFORM
H...
PLEASEREAD!NSTRUCTIONSONOTHERSIDEBEFORECOMPLETION
FOI'
official
USC
0Dly
PursuanttoSection910
of
theGovemmentCode,claim
is
presentedtothe
CityofPasoRobles,California,asfollows:
NameofClaimant.~J"...o_n~__..:T:..:a:..:t:..:r:..;:o:___
(First
Name)(MiddleInitial)(LastName)
HomeAddress
clo
Lipow
&
HarrisCity,State,Zip
15821
VenturaBlvd.
I
Suite
615
DataofSirth_SSN__MailingAddressEncino
l
CA
91436
(If
differentfromabove)(Streetaddress)
Daytime()
905-0507
(State)(ZipCode)
CADL#_Evening..__........--_CeU/Pgr.___...._
TYPE
OFLOSS
o
PersonalInjury
o
PropertyDamage
o
PoliceReport
#_
~OtherEmployrnentRetaliation~hendidi~uryordamageoccur?__~~~~~~~~~~~~__~~_~~~~_
(MonthIDay/Year)(Day
of
Week)(Time-AM?orPM?)
o
Indemnity-Datecomplaintserved_Wheredidinjuryordamageoccur?(street
address,intersecting
streets,
orotherlocation)
SeeattachedGovernmentClaimHowdidinjuryordamageoccur?
(describeaccidentoroccurrence)
SeeattachedGovernmentClaimWhatactionorinactionofCityemployee(s)causedyourinjuryordamage?SeeattachedGovernmentClaimWhatinjuryordamagedidyousuffer?SeeattachedGovernmentClaimNamesofanywitnesses~_
(Name)(Address)(PhoneNumber)(Name)(Address)(PhoneNumber)
NameofCityemployee{s)involvedSeeattachedGovernmentClaim
Statetheamountclaimedfor:
o
Personal
Injury
$_
o
PropertyDamage
$_
documentationfortheamountsclaimed
IFCLAIMRELATESTOANAUTOMOBILEACCIDENT,PLEASEANSWERTHEFOLLOWINGAND
ATTACHPROOFOFINSURANCEPleasecheckhereiftherewasnoinsurancecoverageineffectattimeofincident
0
InsurancePolicy#_InsuranceCompany_InsuranceBroker/Agent,_Address
(street,city,state,zip)_
WARNING:
CaliforniaStateLawgenerallyrequiresthatmostclaimsagainstapublicentity,suchastheCityofPasoRobles,bepresentedwithin
SIX
(6)
MONTHS
fromthedateoftheactionorincidentgivingrisetotheclaim.Certainotherclaimsmustbefiledwithin
ONE(1)YEAR
fromovemmentCodetodetenninewhatpresentationperiodappliesinyourcase.
RELATIONSHIP(Sel:attorney,guardian.etc.)DATERev
6/03
 
1~JEFFREY
A.
LlPOW(SBN82339)
KEVINSALUTE,(SBN173366)2L1POW
&
HARRIS15821VenturaBoulevard,Suite615
3
Encino,California91436Telephone:(818)905-05074Telecopier:(818)905-7868
5
AttorneysforClaimant6JONTATRO
7
8
91011
JONTATRO,
12
THESTATEOFCALIFORNIAFORTHECOUNTYOFSANLUISOBISPO
))
))GOVERNMENTCLAIMFORDAMAGES)PURSUANTTOCALIFORNIA
~GOVERNMENTCODE
§§905and910,
)etseq.
)
)
)
)
))Claimant,
1314
vs.CITYOFPASOROBLES;andDOES115through100,inclusive,
16
Respondents.
i718
19
20
PursuanttotheprovisionsofCalifornia
GovernmentCode
§§905and910
etseq..
demandisherebymadeagainstRespondentsinanamountinexcessofthejurisdictionallimitsoftheSuperiorCourtoftheStateofCalifornia.Insupportofsaidclaim,oninformationandbelief,thefollowinginformationissubmitted:
21
2223
24
25
26
..
I.
,..,1AlII.A
ie
IT·
'-1'-1""_'1"'"•.
JonTatro
clo
hisattorneysofrecordJeffreyA.LipowandKevinSalute,Lipow&Harris,15821VenturaBoulevard,Suite615,Encino,California91436,Telephone:(818)905-0507,Telecopier:(818)905-78685.
27
28
-1-
GOVERNMENTCLAIM

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