CS # 05
CLAIM AGAINST THE CITY OF ANAHEIM
(FOR DAMAGES TO PERSONS OR PERSONAL PROPERTY)
Received by ___ via
U.S. Mail 0
Inter-Office Mail D CLERK'S TIME STAMP
Over the Counter D
A claim must be filed with the city clerk of The City of Anaheim within 6 months after which the incident or event occurred. Be sure your claim is against The City of Anaheim, 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, The City of Anaheim, City Hall, P.O. Box 3222, Anaheim, CA 92803.
TO THE HONORABLE MAYOR AND CITY COUNCIL, The City of Anaheim, California The undersigned respectfully submits the following claim and information relative to damage to persons and/or personal property:
1 SRB Management, LLC ("SRB")
NAME OF CLAIMANT: ___________________________ _
2850 W. Horizon Ridge Parkway #200, Henderson, NV 8 9052 a. ADDRESS OF CLAIMANT: ________________________ _
STREET ADDRESS CllY, STATE
b. PHONE NO. (917) 941-6209
ZIP CODE
c. DATE OF BIRTH __ N_IA _______ _
2. Name, telephone and post office address to which claimant desires notices to be sent if other than above:
Copy to Allan Abshez, Esq., Loeb & Loeb LLP, Two Embarcardero Center, San Francisco, CA 94111
3. Occurrence or event from which the claim arises:
N/A a. DATE: ______ _ b N/A . TIME: ______ _ c. PLACE (exact and specific address/location):
d. How and under what circumstances did damage or injury occur? Specify the particular occurrence, event, act or omission you claim caused the injury or damage (use additional paper if necessary):
SRB is entitled to recover its "Transaction Costs," in the amount of $5 million, as a result of the City of Anaheim's repudiation of the transaction contemplated by the Amended and Restated Purchase and Sale Agreement between SRB and the City ("Amended and Restated PSA"). SRB's claim is pursuant to Section 12.1 of the Amended and Restated PSA for the City's default. "Transaction Costs" are defined in Section 4.15 of the Amended and Restated PSA. e. What particular action by the City, or its employees, caused the alleged damage or injury? N/A
AISKIM-1549 6/04