CC - Item IV.CC-E - Authorization To Reject Claim Against City From Rose Marie CasarezCOUNCIL sDA
J U N! 27 2'000
TO: HONORABLE MAYOR
AND MEMBERS
ROSEMEAD CITY COUNCIL
iU
FROM: NANCY VALDERRAMA, CITY CLERK, CMC "
DATE: JUNE 21, 2000
RE: AUTHORIZATION TO REJECT CLAIM AGAINST CITY FROM ROSE
MARTS CASAREZ
The attached claim was received in this office on May 11, 2000. -A copy was sent to the City's
claims adjuster, Carl Warren & Company on the same day.
Carl Warren & Company sent a notice on May 22, 2000, recommending that the aforementioned
claim be rejected by the City.
Recommendation:
It is recommended that the City Council approve the rejection of this claim and authorize a letter
of rejection be sent to the claimant.
Attch.
!l.
staf epor
LAWYERS' GROUP, INC.
A PROFESSIONAL CORPORATION
ATTORNEY S AT LAW
4700 Teller Avenue, Third Floor
Newport Beach, CA 92660
Telephone (949) 261-7600
Fax (949) 261-7680
May 4, 2000
Rosemead Park
4;41 Encinita Avenue
Rosemead, California 91770
Re: Incident ofAnril 23. 2000
Our client: Rose Mane Casarez
To whom it may concern:
"r ."s'rte
CI-v r - cr=fi7
MAY 1 1 2000
C! T 1' CL=RK'z OFFICE
The above named client has consulted our law firm in regards to an incident which occurred
on April 23, 2000 involving your premises. Our client said that while walking towards her
vehicle she stepped in to a pathole, which caused her a `racture on her ankle. We are now in
the process of nvestigating the matter further.
Sometimes there are several versions as to what occurred and- before proceeding further,
we would lake to know your account of what happend. Please advise as to whether you feel
the incident was your fault or another partv's fault, the reasons for your belief, and also the
names and addresses of any other witnesses.
Please be certain to indicate the name of your insurance company on the enclosed form so
we can deal directly with them and minimize further inconvenience to you .also be certain
to give the arnount and type of coverage you have.
Thant: -tu for vnur coon-Tation and the courtesv of your prompt attention to this maner.
e jitruiv yours, 'L i
Sujey Flores
for Paul E. Lee
L!,VAIVERS GROUP- INC.
RE: Date of accident: April 23, 2000
Our client: Rose Marie Casarez
I wish to submit the following information in regards to the above referenced matter:
1. I xvas/am insured by:
2. Address of my insurance company:
6.
i.
S.
Policy number:
Type of coverage:
Liability, Property Damage, etc.
.Amount of coverage:
I was insured at the time of accident: Yes
I accept responsibility for the accident: Yes
my version of what occurred:
No
No
The above information is true and correct to the best of my knowledge and is given under
penalty of perjury.
Date: Signature.
LAWYERS' GROUP. Il'qC.
A PROFESSIONAL LAW CORPORATION
TO WHOM IT MAY CONCERN:
Date: I .h 1 J-1
I hereby appoint the LAWYERS' GROUP, Inc. (herein referred to as `the Firm') to represent me in
proceedings to which I am a party. (CDI Reg. §2695.2 (c)).
You are hereby authorized and requested to furnish the firm with any and all information or opinions its
attorneys may request.
This authorization also includes the release of all medical reports, diagnoses, prognoses, medical history,
notes, x-rays, photographs, prescriptions, charts, and other results of testing and bills.
This authorization also includes the release of findings, reports, notes, diagrams, surveys, photographs,
wage information, and any other information from police, administrative agencies, and any other person
or source, whether public or private.
This release is not restricted to time or subject matter.
You are further requested not to disclose any information concerning me to any insurance adjuster,
investigator, law enforcement officer, or any other person without my express written consent or that of
my attorney.
This release shall act as a revocation of any and all other release or authorization forms, which I
have signed prior to the effective date hereof.
1 am willing that a photocopy of this authorization has the same force and effect as the original.
J
NOTICE TO ALL MED-CAL PROVIDERS
Notice is hereby given pursuant to Welfare & Institution Code, Section 14124.791, of your eiigioiiiry to file a lien
For all costs for services provided to beneficiary against any judgment, award or settlement obtained by the
Beneficiary or director from a liable third party. A lien under this section must be filed with this office within
65 days receipt of this notice. Liens under this section should be sent registered mail. All liens will be subject to
off set for attorney fees and costs of litigation expenses. Proof of providers compliance with Medi-cal rules
regarding provisions of reimbursement is requisite for payment under this section.
SOUTHERN CALIFORNIA JOINT POWERS INSURANCE AUTHORITY
FROM: rD: Carl Warren & Co.
CITY OF ROSE?aAD
1801 Parkcourt.Pl• VIE-2-08
Santa Ana, CA 92701
OU=!JLL I : RLPORT ON 1'U I LNIAL CMAr- L ZU'J''J
- REPORT DATE y - ? 3
TIME OF REPORT 7,(-1 2- CAM Z"-PI
A. - COMPLETE FOR ALL ACCIDENTS
POLICE TO WHOM REPORTF1
DATE 6 TIME OF ACCIDENT I1{I,.L.~/OCA~TyION
MDAY Y A R TIMEG CAM P,-PM I✓T.. rV,.LuI~/•r
NO.
B.- COMPLCTE ONLY IF CITY CAR OR EOUIPMENT 15 INVOLVED
PERMISSION YES:.: NUJ
C. - COMPLCTE ONLY IF OTHER PROPERTY IS DAMAGED
H
E- -COMPLETE FOR ALL ACCIDENTS
IOESCRIBC INCIDENT - STATE FACTUAL POINTS ONLY- DO NOT GIVE OPINIONS AS TO FAULT, NEGLIGENCE OR LIAbi L1TY
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DESCRIBE -
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ADDRESS PHONE NO.
L~Y~i~ III--S 2, qn -41ziz7
WAS CLAIMS ADMINISTRATOR NOTIFIED 7 =YES W40 BY WHOM 7
DATE
l
REPORT PREPARED BY
USE ADDITIONAL SHEETS IF NEEDED.
TIME
O.' COMPLET E ONLY IF SOMEONE 15 INJURED
idhat steps were Laren to prevent a sam=iar occurrence?
Date of Repo=t:
Reviewed by:
__me of Report
Lirecto=:
S; ry--~ct~=e
Si:3^!Z^ THIS
FDR.,
TO T, x r;J OFF, C=
I,= r:: 2.1 !TOURS OF :,CCs DE7:^
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Date:
Date
What treatment was Given - describe in detail first-aid administered and by whom.
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MAYOR:
MARGARET CLARK
MAYOR PRO TEM:
JAY T IMPERIAL
COUNCILMEMBERS:
ROBERT W. BRUESCH
GARY A. TAYLOR
JOE VASOUE2
May 11, 2000
Vi 11' c~ ~ ~ S~2C 8(~
8838 E. VALLEY BOULEVARD • P.O. BOX 399
ROSEMEAD. CALIFORNIA, 911770
TELEPHONE (626) 569-210D
FAX (526) 30792118
D,Ai¢ht I. Kunz
Senior Account Manager
Carl Warren & Company
750 The City Drive, Suite 400
Or:mr_e' CA 92665
Rte: ROSE 1v1ARIE CASAREZ - NEW CLAJI ,I
Dcar \1r. Kunz:
The a_tached claim was received in my o icc today. Enciosed zre the City's Report on Potential
Claim and photographs taken by staff of the alleged incident site.
Please advise us of the steps you wish to take in this matter.
Sincerely,
,7/ -7,
NANCY VALDEP~ ANNA
City Clerk
C;:) :OSCnI :i
Encl.
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VI! 7: 7 :7 :7 .-AD
MAY 2 2 ZOuD May 14, 2000
C:Ty C_.-RY =i
T0: Citv of Rosemead
ATTENTION: Nancy Valderrama, Cite Clerk
RE: Claim Casarez y. Citv of Rosemead
Claimant Rose Marie Casarez
D/Event 23-Apr-00
Recd Y/Omce I 1-Mav-00
Our File S-108208-GMQ
We have reviewed the above captioned claim and request that you take the action indicated
below:
• TAKE NO ACTION: Defer any written response to the claimant pending our
further advice.
if you have any questions please contact the undersigned.
Vern truly yours.
CARL WARREN' & CO7 P,kNY
i
Dwieht J. Kunz
cc: CJP1A ti/enc
Attn.: Executive Director
CARL WARREN & CO.
CLAIMS MANAGEMENT-CLAIMS ADJUSTERS
aJ The City Drive . Stems • Orange. CA 92859
rv.ait P.O. Box 2.51 so • Santa Ana, Ca 92799 5180
Phone: (714) 743-7939 • (BDD) 572-e930- Fax: (714) 7414: 2
ED
MAY 2 IS
20D0
CITY CLEDW; O-=ICE
TO: Carl 'Warren &,Company
750 The City Drive, Suite 400
Orange. CA 92868
DATE: 05/16/00
CLAIMANT: Rose Marie Casarez
FILE NO: S 108208 GJIQ
D/EVENT: 4..-23-00 FILING DATE: 5-11-00 SIX MOS.: YES
PRINCIPAL/CITY: CJPIA/City of Rosemead
RECOMMENDED ACTION ON CLAIM: REJECT in 15 days unless claimant attorney
files an amended claim
FACTS: Claimant tripped and fell as a result of a hole at Rosemead Park..
POSSIBLE CO-DEFENDANTS: Deferred pending scene inspection.
EVALUATION: Deferred pending scene inspection.
RESERVES TYPE OF CLAIM AMOUNT
1. Rose Marie Casarez LBI S10-000
COMMENT/VVORK TO BE COMPLETED: InSD°Ct scene and statement from
claimant. Interview witness Casillas. Our further reportwill follow shortly.
-=cc: City of Rosemead, Attn. Fancy Valderrama. City Clerk
cc: CJPI_A - .Attn.: Executive Director
CARL WARREN & CO.
CLAIMS MANAGEMENT-CLAIMS ADJUSTERS
750 The City Drive • Ste 400 • Orange, CA 92858
Mail: P.O. Box 25180 • Santa Ana, Ca 92799-518D