HomeMy WebLinkAboutClaim-Hitchen rcvd 1-23-231
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990 Palm Street. San Luis Obispo, CA 93401-3218
805. 781.7100
CLAIM PRESENTED TO THE CITY OF SAN LUIS OBISPO
PLEASE READ THE INSTRUCTIONS ON THE BACK BEFOR E COMPLETING.
Claimant's Name (please print)
Kevin Hitchen
Address
Day Phone Evening Phone
( (
Claim
No.
When did the damage or injury occur? Date and time
August 22, 2022 at 11 :30 am
Where did the damage or injury occur? San Luis Obispo
Police Report Number
Eastbound on Perfumo Canyon Road in San Luis Obispo NIA
What happened and why do you think the City is responsible?
Mr. Hitchen was riding his road bike eastbound on Perfumo Canyon Road in San Luis Obispo. Paving work was occurring on the
roadway. As Mr. Hitchen proceeded on the new pavement of the curbside lane, he suddenly hit an unexpected asphalt hump in the
pavement, which caused his front wheel to go airborne and turn spontaneously hard to the left. When his wheel came back to the ground,
it contacted a second hump, and Mr. Hitchen went over the handlebars of his bike, with his shoes still clipped in to his pedals. A large tree
casts a shadow over the area of the bumpy pavement where the fall occurred.
If applicable, identify the name and position of responsible City employee(s), if known.
Unknown to Mr. Hitchen at this time.
What damage or injury occurred?
Mr. Hitchen suffered a road rash over his hip, buttock, and back, head concussion, and hematoma on his left leg. There was also damage
to his bicycle and cycling gear.
Claim Amount If the amount exceeds$10,000, please check the court of
appropriate jurisdiction
$ only if less Municipal Court (claims up to $25,000) than $10,000 X Superior Court (claims over $25,000)
How did you arrive at amount claimed? Please attach documentation.
Medical bills, loss of earnings, loss of earning capacity, damage to bicycle and cycling gear
I declare under penalty of perjury under the law s of the State of Califor nia that the
following information is true and cor rect, and that this declaration was executed on:
�2_ 01/20/2023 Dana Point , California
Signature of Claimant or Representative Date Place
OFFICIAL NOTICE AND CORRESPONDENCE
If represented by an insurance company or an attorney, please provide the information requested below.
Name and Capacity (please print) Stephen N. Rosen, Esq.
Attorney for Kevin Hitchen
Address
ROSEN LAW OFFICES, 34118 Pacific Coast Highway, Suite 5, Dana Point, California 92629
Day Phone Evening Phone
(949)335-0020 (949)335-0020