CC - Item 4B - Reject Claim - Johnson Thai M
staff eport
TO: HONORABLE MAYOR
AND MEMBERS
ROSEMEAD CITY COUNCIL
FROM: NANCY VALDERRAMA, CITY CLERK
DATE: SEPTEMBER 9, 1999
RE: AUTHORIZATION TO REJECT CLAIM FILED AGAINST THE CITY BY
JOHNSON THAI
The attached claim was received in this office on August 16, 1999, on behalf of James Chow. A
copy was sent to the City's claims adjuster, Carl Warren & Company, on August 18, 1999.
Additional information (photographs)was forwarded to them on August 23, 1999.
Carl Warren & Company sent a notice on August 24, 1999, recommending that this 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. -
Attach.
COUNCIL AGENDA
SEP 141999
ITEM No. i- &a-4
2
�/
MAYOR. I Cif 1v
JVJV4Y
JOEDR. c �J `� l(
MAYOR PRO TEM. C
MARGARETCLARK
courvniveneExs 8836 E VALLEY BOULEVARD- R0. BOX 399
ROBERT W BrUEScn ROSEMEAD.CALIFORNIA 91770
JAY IMREFwL TELEPHONE (626)288-6671
GARY TABOR FAX(626)307-9218
.Aumast 16, 1999
Dwight J. Kunz •
Senior Account Manager
750 The City Drive, Suite 400
Orange, CA 92668
RE: JOHNSON THAI
Dear Mr. Kunz:
The attached Claim was received in my otnce on August 16, 1999. The City does not have any
prior information on this claim.
Please advise as to the steps you wish to take in this matter.
Sincerely,
NANCY VALDERRAMA
City Clerk
Attachment
cc: City Attorney
citsims:.aa_,t
•
FIL= WITH: CLAIM FOR DAMAGES RESERVE FOR FILING sAMP
CITY CLERK'S OFFICE 2" 7
TO PERSON OR PROPERTY
CLAIN ND.
_ INSTRUCTIONS
RELOENEP
1. Claims for death.injury to person or m pesonal pmpeny must be filed nol later than six CITY OF t.!/0 t;_j EF.D
months after the oosurrnn a (Gov.Code Set 9112) 't
2 Claims for damages to real pmparty must be filed not later than 1 year atter the o`turrenpe
AUG j 61993
(Gov.Code Sen 911.2)
a Read entin.laim fpm before fling.
<.See pane 2 Sar diagram upon which to lo=re plate o1 athierf_
CITY CLERK'S
) YCLERY,,S DYYICF
5.Ms claim form must be stoned on page 2 a;bottom.
a Math seoaate sheets,if necessary,to Dive full detais.SIGN EACH SHEET
Date o'Birth v:Caiman;
-ID: C]_5 O ROSL EA.D, BE36 E. Valley E]od. , Rosemead 9177D .`-11, ,T,. �l v=, 14l'il
C-.,=upation o1 Claimant
Name o;Clalmanl - S-`n^�Y
j_I y.,h L.c.1-...5 «i=.l
Cnyand Sate Home Telephone Number
Hume Addresd.0:aimanl /a UZU. x"11- 1��1
Aiir i =tnafl � AJCo--7= -arr. � Business Telephone Number
5usins Addr6 o.Claimant City and Sae
;live address and telephone number to+mi_h Cu Desire rutipes or=rmumi;aipns to be sure,
Gaimarc's Soria!Sesurlty'No.
re_pa:din[ms claim: L'SN. D;I?10 ill- 113 l =yam - Lam, C=✓
.Ja D� L'SI JU Y Arc P-1.=J,c A'�
Wnen dill DAMAGE Cr INJURY v-uR Names ot any city employees involved in INJURY or DAMAGE
Dale 10-`• Time
Y clam is for E uiahie Indemnity,oive Cale claimatt served
with the=mole's=
Date �_ toll and bate on diagram on reverse side of this sheen.Where appropriate.Dive street
Where did DAMAGE or INJURY of ur?Desctibe y.
names and address and measurements tram Iandmar's:
Da=ibe in Detail how the DAMAGE or INJURY o
"erred.
��=� H-COD e AO'J SHE pAgcCz ,S GC Cc-CU , :''vi- '.'1eS-1''2 W"'7.. 0 . ,> T, %
WnydD you carr..the Pty is responsiole? 1c-,C \t
G[cL_, - ,�I� i -7� Jam_ —J M - `-.4
i,-ti' i c— c ^-tt ,.I-kg4Y,,, VT H'' -
Desrroe'n de:ail each INJURY or DAMAGE e...c d.I J \ c.
'rt- -.14. -#:•:) r. 1-.0 -n
I++\S j.:.rit Yrs c^x ,e. ',rte -
X •-\ .�,Vwo - �- =C C5 a/2,I__r/( ,
_ _ THIS CLAIM MUST BE SIGNED ON REVERSE SC
SEE
The amount claimed, as of the date of presentation uahis claim,is computed as follows:
Damages incurred to date(exact): Estimated prospective damases as far 25 known:
Damage to property S Future expenses for medical and hospital care .. . .5
Expenses for mediml and hospital care S _ Future loss of earnings
Loss of earnings S other prospective special damaoes
Special damages for S Prospective general damaoes
-foal estimate prospective CamageeS
General damages S
Total canapes incurred to dale S
oat amount claimed as of dale of presentation of this claw: S
Was damage and/or injury investigated by police? Mn If so what city?
Were paramedh or ambulance called? tiri If so,comedy or ambulance
If injured_,sate date,lime,name and address of do_-wr of your fest
WITNESSES to DAMAGE-or INJURY:list all persons and addresses of persons laiavn 10 have information:
;:a.ra YE+k- '-AC P-VVIA `f'O Addams Prone ' 7 Li`
Name nA.lS5 1C-.1:-.1"-J>: Address Phone/.76 X 25-c
Name Address Phone
DDCTDRS and HDSPi iAS:
Hospital - __ Address Date Hospitalized
Do=r Address Date of Treatment
Doctor Address Date of Treatment
READ[AR PULLY
For all addem claims place on following diagram names of seeets, or your vehicle when you firs saw City vehicle;Ioalion of City vehi
including North,East,South, and West indicate place of=dent by at time of ardent by"'A 1"and location of yourself or your vehicle
"X" and by shaving house numbers Dr distances to street comers. the lime of the ac dem by"S-i" and the point of impact by"X"
If City Vehicle was involved,designate by letter A-loatan of City NTEIf diagrams below do not fd the situation.attach hereto a pro;
Vehicle when you first saw it, and by "B" location of yourself _ daoram signed by claimant.
. -
SIDEWALK
\ /
CURB-
CURE
PARKWAY r
SID_VJA!Y.
Signature of Claimant or person filing on Typed Name: _ - — Date:
his behaf divine relationship to Claimant:
NSE: CLAIMS MUST SE FILED WITH CITY CLERK(Gov Code Sec 9t5a). Presemation of a false claim is a felony (Pen. Code Sec 72.)
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" . . DESCRIPTIONOF DASAG- ?T1 COST TAROS _tAINT
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ATT-2 75-.)7A2 S
MAYOR tl[1 g/ y �V iJIIJZLlI4U
JOEAORSOUEC �./
MAYOR PRO TEM'.
M GARET C.ARK
couaniMEMBERs8838 E. VALLEY BOULEVARD P.O. BOX 399
ROBERT v:PRUESCn ROSE WEAD.CALIFORNIA 91770
JAVT IM^ERIAL TELEPHONE 1626(288-6671
GARY A TAYLOR FAX(626)387-9218
August 23, 1999
Dwight J. Kunz
Senior Account Manager
75D The City Drive, Suite 400
Orange, CA 92668
RE: JOINS ONTHAI
Dear Mr. Kurz:
The enclosed copy of photographs were received in my office today regarding Mr. Thai's claim.
The original claim was mailed to your office on August 18, 1999.
Please advise us as to the steps you -wish to take in this matter.
Sincerely,
NANCY VALDERRATZA
City Clerk
Cit • of Rosemead
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`�•//� August 24, 1999
RECEIVED
CITY n= ghEi-:D
AUG 2 61999
TO: City-of Rosemead
CITY CLERKS OFFICE
ATTENTION: Nancy Valderrama, City Clerk
RE: Claim Thai v. City of Rosemead
Claimant Johnson Thai
D/Event 12-Jul-99
Recd Y/Office : 16-Aug-99
Our File S-101299-DBK
We have reviewed the above captioned claim and request that you take the action indicated
below:
• CLAIM REJECTION: Send a standard rejection letter to the claimant
Please provide us with a copy of the notice sent, as requested above. If you have any
questions please contact the undersigned.
Very truly yours,
CARL WARREN& COMPANY
/,
Alr
Dwight J. Kunz
cc: DELA w/enc.
Attn.: Executive Director
CARL WARREN & CO.
CLAIMS MANAGEMENT•CLAIMS ADJUSTERS
750 The City Drive•Ste 400.Orange,CA 92868
Mail:P.O.Box 25180•Santa Ana.Ca 927935180
Phone:(714)7467999•(800)572-6300•Fax:(714)7469412