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CC - Item 4A - Staff Report Authorization to Reject Claim Against the City starteport TO: HONORABLE MAYOR AND MEMBERS ROSEMEAD CITY COUNCIL FROM: NANCY VALDERRAMA, CITY CLERK DATE: MAY 19, 1999 RE: AUTHORIZATION TO REJECT CLAIM AGAINST THE CITY- XING ZHEN MA, ET AL The attached five (5) claims were received in this office on May 11, 1999 for: Xing Zhen Ma, Kenny Liu, Robea Huang, Tony Huang, and Jeanne Liu. Copies were sent to the City's claims adjuster, Carl Warren & Company the same day. Carl Warren & Company sent notices on May 13, 1999, recommending that all five of the claims be rejected by the City. Also included is correspondence from Carl Warren & Company, the Claim for Damages forms, the City's Vehicle Accident Report, and the Sheriffs Traffic Collision Report. RECOMMENDATION It is recommended that the City Council approve the rejection of those claims and authorize a letter of rejection be sent to the claimants. :nv COUNCIL AGENDA agenda MAY 2 51999 ITEM No, CC -A it Clf/ RIECENFP May 13, 1999 CITY C'c: or;G._,r,,r_. .3 MAY 1 71999 CITY CLERK'S OFFICE TO: City of Rosemead ATTENTION:Nancy Valderrama, City Clerk RE: Claim Ma v. Rosemead Claimant Xing Zhen Ma D/Event 1/4/99 Rec'd Y/Office : 5/11/99 Our File S 100666 SWQ 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 Rechard'V. /V rga& Richard D. Marque cc: CJPIA 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 92799-5180 Phone:(714)740-7999•(800)572-6900•Fax:(714)740-9412 May 13, 1999 o P11c1:r:,,E. ,.3 MAY 1 71999 CITY CLERK'S OFFICE TO: City of Rosemead ATTENTION:Nancy Valderrama, City Clerk RE: Claim Liu v. Rosemead Claimant Kenny Liu D/Event 1/4/99 Recd Y/Office : 5/11/99 Our File S 100666 SWQ 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 RAchardD. Marque' Richard D. Marque cc: CJPIA Atm: 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 92799-5180 Phone'.(714)740-7999•(800)572-6900•Fax:(714)740-9412 May 13, 1999 C MAY 17 1999 CITY CLERICS OFFICE TO: City of Rosemead ATTENTION: Nancy Valderrama,City Clerk RE: Claim Huang v. Rosemead Claimant Robea Huang D/Event 1/4/99 Recd Y/Office : 5/11/99 Our File S 100666 SWQ 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 RGchard n Alairgl uei Richard D. Marque cc: CJPIA 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 92799-5180 Phone-(714)740-7999•(800)572-6900•Fax_(714)740-9412 May 13, 1999 OTY MAY 171999 CITY CLERK'S OFFICE TO: City of Rosemead ATTENTION:Nancy Valderrama,City Clerk RE: Claim Huang v. Rosemead Claimant Tony Huang D/Event 1/4/99 Recd Y/Office : 5/11/99 Our File S 100666 SWQ 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 Richard'V. /Varga& Richard D. Marque cc: CJPIA Attn: Executive Director CARL WARREN & CO. CLAIMS MANACEMENT•CLAIMS ADJUSTERS 750 The City Drive•Ste 400•Orange,CA 92868 Mail.P.O.Box 25180•Santa Ana,Ca 92799-5180 Phone'(714)740-7999•(800)572-6900•Fax (714)740-9412 LTJ/� May 13, 1999 RE CITY C; Bf) MAY 1 71999 TO: City of Rosemead CIIY'CLERK'S OFFICE ATTENTION:Nancy Valderrama,City Clerk RE: Claim Liu v. Rosemead Claimant Jeanne Liu D/Event 1/4/99 Recd Y/Office : 5/11/99 Our File S 100666 SWQ 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 Richar 'V• Marquez Richard D. Marque cc: CJPIA Ann: Executive Director CARL WARREN & CO. • CLAIMS MANACEMENT•CLAIMS ADJUSTERS 750 The City Drive•Ste 400•Orange,CA 92868 Mail:P.O.Box 25180•Santa Ana,Ca 92799-5180 Phone:(714)740-7999•(800)572-6900•Fax:(714)740-9412 E. •694J RECEPIFr aiv 'GF RG.: YF J Next Report Due: 7/15/99 MAY 17, 4. eR1'CLERK'S OFFICE May 12, 1999 NVESTIGATIVL tEPORT - •EPOR ; 2 Carl Wary-n and Company 750 Th- City Drive Suite 400 Oran-e, CA 92868 Attention: Richard Marque / Re: 0/Principal: CJPIA Member City: Rosemead Claimant: Zing Ma/Farmers Ins. Group D/Accident: 1-4-99 Our File No. : S 100666 SWQ Ladies and Gentlemen: PREVIEW: A City vehicle operator was involved in a motor vehicle accident. Farmers Insurance Group, the insurance carrier for the other motorist involved in the accident, has filed a subrogation claim. MEMBER CITY: City of Rosemead, 8838 E. Valley B1. , P.O. Box 399, Rosemead, CA 91770. Business phone number is (626) 288-6671. DATE, TIME, AND PLACE: This motor vehicle accident occurred on January 4, 1999 at approximately 2 :15 p.m. The collision occurred at the intersection of Hellman Avenue and Rockhold Avenue in the City of Rosemead, California. OWNERSHIP/CONTROL: Per discussion with Nancy Valderrama at the City of Rosemead, we have established that Silvia Llamas is an employee of the City of Rosemead. Furthermore, Ms. Llamas was operating a City owned and maintained vehicle within the course and scope of her employment when the accident occurred. GOVERNMENT CODE REOUIREMENTS: 1. Date Verified Claim Filed: The subrogation claim of Farmers Insurance Group was timely filed on april 20, 1999. CARL WARREN & CO. CLAIMS MANAGEMENT•CLAIMS ADJUSTERS 750 The City Drive - Suite 400 - Orange, CA 92868 Mail: P.O. Box 25180 - Santa Ana, CA 92799-5180 o......e niat 7a11.7999 • (8001572-6900 • Fax: (714) 740-7992 Page 2 S 100666 SWQ 2 . Action Taken by Public Entity: At the present time, the City of Rosemead has taken no action. 3. Statute of Limitations: 6 months from the date of denial or 2 years from the date of occurrence. FACTS ILRIEF: Silvia Llamas was traveling westbound on Hellman Avenue directly behind the claimant vehicle. The claimant apparently was initiating a left turn at the intersection of Rockhold and the City employee started to pass her on the right. As the City vehicle passed, the claimant made an abrupt right turn and impacted the City vehicle. PHOTOGRAPHS: Enclosed in this report are photographs taken of the accident intersection. These photographs are supplied with captions and are self explanatory. At an earlier date, the undersigned conducted a scene inspection and surveyed the area. Hellman Avenue is east/west traveling roadway which traverses a section of the City of Rosemead, California. It intersects Rockhold Avenue at approximate right angles. Rockhold Avenue, however, becomes staggered as it intersects Hellman Avenue in Rosemead, California. Hellman Avenue has no traffic controls at Rockhold except the posted speed limit. Hellman Avenue is one lane in each direction of travel and has no left turn pockets or right turn pockets available at or about the area of collision. In the westbound direction, Hellman Avenue is 16 feet 3 inches in width and in the eastbound direction, it is 15 feet 5 inches in width. Specifically speaking, this roadway in the westbound direction is capable of accommodating 2 westbound traveling vehicles. The roadways are straight, level, and flat. Lastly, we would like to make mention that the claimant apparently would have been turning into her residential property as she resides at 3403 Rockhold Avenue in Rosemead, California. POLICE REPORT: The City of Rosemead has supplied us with a copy of the Traffic Accident Report. We note that on the date of accident the weather was clear, the surfaces were dry and it was daylight outside. No unusual conditions existed. Motorist Ma was deemed to be the primary collision factor as she made a right hand turn from an improper position. Furthermore, she was deemed to be inattentive. No other causative factors were discussed. Page 3 S 100666 SWQ CITY MEMBER VERSION: Silvia Llamas, 9332 E. Valley Bl . , Rosemead, CA 91770. Ms. Llamas is employed by the City of Rosemead as a recreation leader. Date of birth: 2-18-77. In essence, this city employee will relate the following information: The collision occurred on January 4, 1999 at approximately 2:15 p.m. The accident took place at the intersection of Hellman and Rockhold in Rosemead, California. Ms. Llamas was driving a 9 passenger City van. Rudy Camacho and Diane Davila were also in the van. These 2 individuals are also City employees. She was driving the City vehicle within the course and scope of her employment. On the date of accident, the weather was clear and the surfaces were dry. The City employee was traveling westbound on Hellman approaching Rockhold. Hellman Avenue is one lane in each direction. The other vehicle involved in the accident was a Mazda family van. The Mazda was also westbound on Hellman directly ahead of the City vehicle. There was one adult and 4 children in the Mazda van. The driver was a female. The City employee first saw the van stopped on Hellman at Rockhold appearing to prepare to make a left turn. The City vehicle was traveling at approximately 10 to 15 miles per hour and was approaching from behind. The van had its left turn signal indicator activated. Ms. Llamas stopped behind the van. After being stopped for approximately 2 to 3 seconds, she attempted to pass the van on the right. The City employee activated her right turn signal indicator and started to pass to the right. While passing on the right at 5 to 10 miles per hour, the claimant started to make her left turn crossing the center median and then immediately started to make a right turn into the side of the City vehicle. The City vehicle operator swerved to the right to avoid the accident but was impacted anyway. The claimant vehicle's right side was impacted by the left front of the City vehicle. The collision occurred along the north curb line of Hellman Avenue. At the time of impact, the claimant vehicle would have been traveling at approximately 5 to 8 miles per hour. The City employee honked her horn to notify the claimant of her presence, all to no avail. The City vehicle was actually stopped along the curb line when it was impacted by the claimant vehicle. Although the parties in the City vehicle appeared to be stiff and sore after the accident, no one in the claimant vehicle appeared injured. There were no independent witnesses that viewed this accident. The police wrote a Traffic Accident Report. Both vehicles were driveable after Page 4 S 100666 SWQ the accident. Lastly, only the claimant driver was seat belted when the accident occurred. For further information, please refer to the enclosed written statement of Silvia Llamas. PROPERTY DAMAGE: Farmers Insurance Group, 117 E. Duarte Road, Arcadia, CA 91006. Farmers Insurance Group insures motorist Zing Ma. Apparently Farmers Insurance Group has paid for Ms. Ma's vehicular damages and has filed a subrogation claim with the City of Rosemead. The claimant vehicle sustained moderate damage to its right side in the amount of $6,076.73. Ms. Ma has a $500 deductible so the payment issued to Zing Ma by Farmers Insurance Group totals $5,576.73. Farmers Insurance Group's claim, however, is for the amounts of money paid and their insured's $500 deductible. Supporting documentation was supplied which includes the estimate, photographs of the damaged vehicle, etc. INJURIES: Zing Ma, 3403 Rockhold Avenue, Rosemead, California 91770. Contacts have been made with the City of Rosemead by John Wolcott, Attorney at Law, 3318 Del Mar Avenue, Suite 202, Rosemead, California 91770. Business phone number is (626) 288-1088. Mr. Wolcott has been mailed a claim form by the City as he apparently represents Zing Ma regarding her accident with the City employee. To date, however, it is our understanding that a claim has not been formally filed on behalf of Zing Ma. We would surmise, however, that this will be accomplished shortly. We will have more information regarding this in our next report. LIABILITY: This appears to be a claim of very questionable liability with regards to the City. It appears that the claimant vehicle was attempting to make a left turn at an intersection and the City vehicle was passing it on the right. For unknown reasons, the claimant vehicle initiated a right turn from the center of the roadway impacting the side of the City vehicle. The police report is adverse to the claimant vehicle operator and indicates that she made a right turn from an improper position on the roadway and that the claimant vehicle operator was also inattentive. In the absence of any independent witnesses, this appears to be a claim of extremely questionable liability with regards to the City. Page 5 S 100666 SWQ WORK TO BE COMPLETED: A. Investigation: atin: 1. Determine if the attorney that represents Zing Ma timely files a claim for injuries. 2. Determine if the City of Rosemead rejects the claim of Farmers Insurance Group. B. Claims Remaining Open: 1. Zing Ma - ABI. ENCLOSURES: 1. City employee statement. 2. Farmers Insurance Group's claim form and subrogation documentation. 3. Scene photographs. COMMENTS: Our handling of this matter continues. Our next report will follow upon receipt of additional information or on or about July 15, 1999. Very truly yours, C Aj2L WARREN &� CO. �� .��(�,ep�� L' p—�/�Q /✓ (iL SAW:ck S ephen A. White cc: CJPIA Attn: Executive Director (With copy of enclosures) . ". c: City of Rosemead Attn: Nancy Valderrama MAYOR, `AJ 9Rts,, inead toe vrsovec MAYOR PRO TEM. MO MARGARET CLARK 8838 E VALLEY BOULEVARD P.O. BOX 399 M RSSERRM 1 W B L R4 � ROSEMEAD,CALIFORNIA 91770 JAYT IMPERIAL TELEPHONE(626)28B-6671 GARY A TAYLOR "' FAX(6261307-921B May11, 1999 Dwight J. Kunz Senior Account Manager - 750 The City Drive, Suite 400 Orange, CA 92668 RE: XING ZHEN MA ET AL S 100656 SWQ Dear Mr_ Kunz: The following five claims were received in my office today. On February 17, 1999, I forwarded information to you regarding this incident which included the correspondence from the law firm to the City's employee, Rosemead's Vehicle Accident Report, estimates to fix the City van, and, the Sheriffs Report. A Claim for Damages form was mailed to the law firm on February 17, 1999, of which five were returned today- A separate claim involving the same accident was filed by Farmers Insurance on behalf of Jie Ying Huang (filed on 4/20/99), and, is scheduled to be considered at tonight's City Council Meeting. If the Council rejects the claim, then appropriate correspondence will be forthcoming. Please advise us of the steps you wish to take in this matter. Sincerely, NANCY VALDERRkM A City Clerk City of Rosemead Attachments cc City Attorney LAW arrICES Or Jom F. WOLCOTT 33113 OEL MAR AVENUE FAX SUITE 202 ROSEMEAD. CALIFORNIA DITTO CITY POST-' May 7 , 1999 MAY 1 1 1999 Cit_ of Rosemead 8838 E . Valley dl . Rosemead, CA 91770 CITYCLERK'SOFFICE Attn: City Clerk, Nancy Valderrama • RE: Claim No. Date of Loss : 1-4-98 Our Client : Xing Zhen Ma et al Your Employee: Silvia Llamas Dear Sir/Madam: Enclosed please find the Claim for damages and Injury forms regarding the above loss . Should you have any questions , please call the undersigned. Very truly yours , Wendy L✓ i Legal Assistant LAW OFFICE OF JOHN F . WOLCOTT • FILE WITH: CLAIM FOR DAMAGES RESERVE FOR FILING STAMP CITY CLERICS OFFICE C 0_3TO PERSON OR PROPERTY CLAIM NO. 7 / INSTRUCTIONS 1.Claims for death,injury to person or to personal property must be filed not later than six months after the occurrence.(Gov.Code Sec.9112.) 2.Claims for damages to real property must be filed not later than 1 year after the occurrence. (GLA.Code Sec 911.2.) a Read entire claim form before filing. 4.See page 2 for diagram upon which to locate place of accident 5.This claim form must be signed on page 2 at bottom. 6.Mach separate sheets,if necessary,to give full delails.SIGN EACH SHEET Dale of Birth of Claimant • TO: CITY OF ROSEMEAD, 8838 E. Valley Blvd. , Rosemead 91770 6-20-63 Name of Claimant XING ZHEN MA Occupation of Claimant HOUSEWIFE Home Address of Claimant City and State Home Telephone Number 3403 ROCKHOLD AVE. ROSEMEAD, CA 91770 626-572-3724 Business Address of Claimant City and State Business Telephone Number NONE NONE Give address and telephone number to which you desire notices or communications to be sent Claimant's Social Security No. regarding this claim: 3318 DEL MAR AV.#202 ,ROSEMEAD,CA 91770 605-34-9372 When did DAMAGE or INJURY occur? Names of any city employees involved in INJURY or DAMAGE Date 1 -4-99 Time 14 . 1S SILVIA LLAMAS If claim is for Equitable Indemnity,give date claimant served with the complaint: Dale Where did DAMAGE or INJURY occur?Describe Cully,and locate on diagram on reverse side of this sheet.Where appropriate,give street names and address and measurements from landmarks: HELLMAN AVE AND ROCKHOLD AVE. CITY OF ROSEMEAD,CA SEE THE DIAGRAM Describe in detail how the DAMAGE or INJURY occurred. AT ABOUT 19 : 15 , I , WITH 9 KIDS I PICKED UP FROM THE SCHOOL AT MARSHALL ST TO MY HOME AT 3903 ROCKHOLD AVE WHERE I HAVE BEEN LIVING FOR EIGHT YEARS . MY HOUSE IS AT THE CORNER OF ROCKHOLD AVE AND HELLMAN, BUT MY GARAGE IS ON HELLMAN,FACING HELLMAN AV. I WAS DRIVING W/B ON HELLMAN AVE. WHEN 100 FEET AWAY FROM THE GARAGE I TURNED ON THE RIGHT TURN SIGNAL. WHEN I WAS TO TURN, THE CAR BEHIND ME RUSHED UP AND HIT MY CAR ON MY RIGHT BOTH DOORS AREAS. WHEN THE IMPACT OCCURRED, MY CAR ' S FRONT PART AND FRONT WHEELS WERE ALREADY ON THE SIDEWALK.THE OTHER CAR'S FRONT RIGHT WHEEL Why do you claim the city is responsible? WAS ALSO ON THE SIDEWALK, I WAS DRIVING IN FRONT OF YOUR EMPLOYEE ' S CAR. I WAS MAKING A RIGHT TURN INTO MY GARAGE. ABOUT 100 FEET AWAY, I TURNED THE RIGHT TURN SIGNAL ON. YOUR EMPLOYEE HIT ME WHEN I TURNED. SHE WAS NOT PAYING ATTENTION TO THE TRAFFIC IN HER FRONT AND ALSO SHE WAS DRIVING TOO FAST AND FOLLOWED ME TOO CLOSE. Describe in detail each INJURY or DAMAGE PAIN AND STRAIN ON MY NECK, BACK SEE PAGE 2(OVER) THIS CLAIM MUST BE SIGNED ON REVERSE SIDE The amount claimed,as of the date of presentation of this claim,is computed as follows: Damages incurred to date(exact): Estimated prospective damages as far as known: Damage to property $ 7rC' Future expenses for medical and hospital care . . . .5 rli-CcLe" Expenses for medical and hospital care $ 3i00 Future loss of earnings 5 Xi-cote Loss of earnings $ N,on! Other prospective special damages S 11-4o'e Special damages for $ Prospective general damages 5 Total estimate prospective damages 5 ,14- General damages $ Total damages incurred to dale $ Total amount claimed as of date of presentation of this claim: $Zc OVc Was damage and/or injury investigated by police? 7i-e.5If so,what city? ,C°iE" di-r1 Were paramedics or ambulance called? fu' If so,name city or ambulance If injured,state date,time,name and address of donor of your first visit 1'v`.t K. be:--c IC . 6C>`L SG.-( 'L"vC 7Ltq /`'-ILn'a Leve an rniuGi te ('.S. L r . /S-j 5, ,'l,e rtNC Ai.e fife , /rr ted.:, G/� i/�9( , /k WITNESSES to DAMAGE or INJURY:List ali persons and addresses of persons known to have Information: Name FL* Address Phone Name Address Phone Name Address Phone DOCTORS and HOSPITALS: Hospital Address Date Hospitalized Donor L'I'e&TJcfred C(xry Mdressfn E. t' 'e Ork FFer "1,1-/4i--Zc-n, Date of Treatment 1-J---7 4 Doctor Address ' Date of Treatment READ CAREFULLY For all accident claims place on following diagram names of streets, or your vehicle when you first saw City vehicle:location of City vehicle including North, Fast, South,and West; indicate place of accident by at time of accident by"A-1"and location of yourself or your vehicle at "X" and by showing house numbers or distances to street corners the time of the accident by"B-1"and the point of impact by"XI' If City Vehicle was involved,designate by letter"A"location of City NOTE: If diagrams below do not fit the situation,attach hereto a proper Vehicle when you first saw it, and by "B" location of yourself fldiagram signed by claimant. / /citirc:. (if Cr.-e-lisji-K 7 — CURB CURB--'f & / / PARKWAY I \ / SIDEWALK Signature of Claimant or person filing on Typed Name: Date: Ms behalf giving relationship to Claimant t idz.-rftrLl ��nl hssil «;tiL1 ,FLcr, S`hn? r. (vlPc: - c l �-y t'_ / NOTE:CLAIMS MUST BE FILED WITH CITY CLERK(Gov. Code Sec. 915a). Presentation of a false claim is a felony(Pen. Code Set.72.) S \ NO toe_ A t a Pt-tHkkred 41± / -� 7 -r � te I I / m FILE WITH: CITY CLERK'S OFFICE CLAIM FOR DAMAGES RESERVE FOR FILING STAMP TO PERSON OR PROPERTY CLAIM NO. _ INSTRUCTIONS 1.Claims for death,injury to person or to personal property must be filed not later than six months atter the occurrence.(Goy.Code Sec.911.2.) 2.Claims for damages to real property must be tiled not later than 1 year alter the occurrence. (Gov.Code Sec.911.2.) 3,Read entire claim form before filing. 4.See page 2 for diagram upon which to locate place of accident. 5.This claim font must be signed on page 2 at bottom. a.Attach separate sheets,if necessary,to give full details.SIGN EACH SHEET. Date of Birth of Claimant • TO: CITY OF ROSEMEAD, 8838 E. Valley Blvd. , Rosemead 91770 )I' ZS-- Q 2- Occupation of Claimant Name of Claimant L L(_ �r i ant lr Hp City and State Home Telephone Numberq Home Address of Claim�antc (?fib (4 91 )7 p oa6 —2--?;?— E,�/ 3E al ufClaimant City and State Business Telephone Number Business Address of ito ),d,..0 Give address and telephone number to which you desirey� notices "or�communications to be sent Claimant's Social Security Na. regarding this claim:/?�_ p may�uvP Z J(11PUUu{ C0' 7/flu blq— e0—(731— When did DAMAGE or INJURY occur? Names of any city employees involved in INJURY or DAMAGE Date 1— 'f— 99 Time I47:ir If claim is for Equitable Indemnity,give date claimant served SrX vte L(--"t'-°-c with the complaint Daleive street Where did DAMAGE or INJURY occur?Describe Cully,and locate on diagram on reverse side of this sheet.Where appropriate,g names and address and measurements from landmarks: if (' V "tr liL 4 .--1 rc' t C*U t....-. 7?�"w Describe in detail how the DAMAGE or INJURY occurred. Why do you claim the city is responsible? Describe in detail each INJURY or DAMAGE p hetVt �2nv -c-1-12--y THIS CLAIM MUST BE SIGNED ON REVERSE SIDE SEE PAGE 2(OVER) l , ,t_ Yeanrt.e The amount claimed,as of the date of presentation of this claim,is computed as follows: Damages incurred to date(exact): LL'' Estimated prospective damages as far as known: Damage to property / S -71`o Future expenses for medical and hospital care . .. .s 5 Expenses for medical and hospital care S PTC Future loss of earnings S Loss of earnings S Other prospective special damages S Special damages for S Prospective general damages , Total estimate prospective damages S General damages S Total damages incurred to dale S Total amount claimed as of date of presentation of this claim: S ?fin) pp Was damage andlor injury investigated by police? ye.c If so,what city? l�npm l,*r, Were paramedics or ambulance called? ✓bc If so,name city or ambulance If injured,stale date,time,name and address of doctor of your first visit —5-99 f-,X;t 1--€1: Ae—rn— • y-6 times h,,r.a..:aj GtuK—u(' e,4 LXdM-Gutttivt . WITNESSES to DAMAGE or INJURY:List all persons and addresses of persons known to have information: Phone Name MA Address Address Phone Name Phone Name Address DOCTORS and HOSPITALS: Date Hospitalized Hospital Address /-4--«7 Doctor/.✓P �Jc/4b (1 0-At:, Address 7 =' L/c,E Ic/C Int qt'i. it cc. s_Date of Treatment Doctor Address Date of Treatment READ CAREFULLY location of Cityvehicle For all accident claims place on following diagram names of streets, or your vehicle when you first saw City vehicle; including North,East,South,and West:indicate place of accident by at time of accident by"A-1"and location of yourself or your vehicle at "X" and by showing house numbers or distances to street corners. the time of the accident by"B-1"and the point of impact by"XI' If City Vehicle was involved,designate by letter"A"location of City NOTE: If diagrams below do not fit the situation,attach hereto a proper Vehicle when you first saw it, and by "B" location of yourself diagram signed by claimant. / / (i--e--‘2- (411T-/C-Leks„.,_ SIDEWALK / \ CURB II CURB J PARKWAY �J / SIDEWALK Signature of Claimant or person filing on flil I Typed Name: Dale: p his behalf haH giving relationship ck-f to Claimant: a � Cteli tit[-vi c� .1'� I—- lti t�C c� eil NOTE:CLAIMS MUST BE FILED WITH CITY CLERK(Gov.Code Sec.915a).Presentation of a false claim is a felony(Pen. Code Sec.72.) • FILE WITH: CITY CLERK'S OFFICE CLAIM FOR DAMAGES RESERVE FOR FILING STAMP (Ye) _ST AMP TO PERSON OR PROPERTY CLAIM NO INSTRUCTIONS 1.Claims tor death.injury to person or to personal property must be filed not later than six months after the occurrence.(Gov.Code Sec.911.2.) 2.Claims for damages to real property must be filed not later than 1 year after the occurrence. (Gov.Code Sec 911.2.) 3 Read entire claim form before filing. 4.See page 2 for diagram upon which to locate place of accident_ 5.This claim form must be signed on page 2 at bottom. 6.Attach separate sheets,if necessary,to give full details.SIGN EACH SHEET. Dale of Birth of Claimant TO: CITY OF ROSEMEAD, 8838 E. Valley Blvd. , Rosemead 91770 4— h 88 Occupation of Claimant Name of ClaimantRnJ Lr'LC � i� Home Address of Claimant City and State Home Telephone Number i36( A1wsAl-vP_ csvh.L.n,cl SFJ /7 to 6 — z;8-6?7 z. Business Address of Claimant City and Slate Business Telephone Number Give address and telephone numberpto which you desire noticesp� or communications to be sent Claimant's Social Security No. regarding this claim: 33i�.p{ /�M 4t4`Ic2, p.cce,IF.4 cA `7/770 Gn 23/it When did DAMAGE or INJURY occuRNames of any city employees involved in INJURY or DAMAGE Date r-�-79 Time r �:Ir Sr'V'' LIVR/ru`S If claim o for Equitable Indemnity,give date claimant served with the complaint: Dateive street Where did DAMAGE or INJURY occur?Describe Tully,and locate on diagram on reverse side of this sheet.Where appropriate,g names and address and measurements from landmarks: reth .) F L �4rr Describe in detail how the DAMAGE or INJURY occurred.rr (�E It' riRk,l C`_Jl' e(.ii,,:.+� Why do you claim the city is responsible? /� !''4^ 4�C{.f G'l�' �'/� [.tel(<.c-Ft-c -1._ Describe in detail each INJURY or DAMAGE pk [_'_r( 11-rT'(rLt t2L SEE PAGE 2(OVER) THIS CLAIM MUST BE SIGNED ON REVERSE SIDE ./__q lit ft.+,t The amount claimed,as of the date of presentation of this claim,is computed as follows: Damages incurred to date(exact): / Estimated prospective damages as far as known: Po Damage to property $ 71�" Future expenses for medical and hospital care .. . .5 4..o--‘c$�' Future loss of earnings $ Expensesmedical and hospital care S—li4CC S h..°-r& Losss offrniearnings Other prospective special damages $ h��� Special damages for $ 7+ro^'� Prospective general damages Total estimate prospective damages S Y` 1k General damages $ Total damages incurred to date $ Total amount claimed as of date of presentation of this claim: $ N v'e'S If so,what city? P"`- r tl�` Was paramedics di or injury investigated by police? Were paramedics e,time, a called? If so,name city or ambulance Wit, -r t'“ If injured,state date,time,name and address of doctor of your first visit i"jK ' t" 7 ` )I`ve Ea.j_/e1 {' CS-lit-W. - IS1 E . L,Le CrLK Ove 4/of• AYc A. LA 9/cu WITNESSES to DAMAGE or INJURY:List all persons and addresses of persons known to have information: Phone Name "O Address Phone Name Address Phone Name Address DOCTORS and HOSPITALS: Date Hospitalized Hospital Address L£CrJt 1 I t QaT,[," Address 7( E.Live Pe-i<!'rVL%/ei 41 -- Date of Treatment 1-54--01 Doctor Date of Treatment Doctor Address READ CAREFULLY - For all accident claims place on following diagram names of streets, or your vehicle when you first saw City vehicle;location of City vehicle including North,East,South,and West;indicate place of accident by at time of accident by"A-1"and location of yourselfint oora youby r vehicle at of the accident by"B-1" ")If and shoagnvonumbers sletter distances location of City NOTE:to street corners. the time diagrams below do not fit the sitund theation,attach hereto a proper If City Vehicle was involved,wdesignateby diagram signed claimant. Vehicle when you first saw it, and by "B" location of yourself 9 9 by p q o GL (I ti'.,li..c.('�� — SIDEWALK / \ CURBS / CURB / PARKWAY --- .1SIDEWALK 7 Signature of Claimant or hip t0 filing on 11/P;at), Lt Typed Name: Date: his behalf giving relationship to Claimant j o'� J r" "` F. It'�u 4- • I (�—('Q Lc.1 Le ,-r.,� A t 5 s '�— �'� � // NOTE:CLAIMS MUST BE FILED WITH CITY CLERK(Gov.Code Sen 915a). Presentation of a false claim is a felony(Pen. Code Sec.72.) FILE WITH: CIN CLERK'S OFFICE CLAIM FOR DAMAGES RESERVE FOR FILING STAMP TO PERSON OR PROPERTY CLAIM NO. 92-03 P . _ INSTRUCTIONS 1.Claims for death,injury to person or to personal property must be filed not laser than six months after the occurrence.(Gov.Code Sec 911.2.) 2.Claims for damages to real property must be filed not later than 1 year after the occurrence. (Gov.Code Sec 911.2.) 3 Read entire claim form before filing. <.See page 2 for diagram upon which to locate place of accident 5.This claim form must be signed on page 2 at bottom. fl Attach separate sheets,if necessary,to give full details.SIGN EACH SHEET. Date of Birth of Claimant • TO: CITY OF ROSEIIEAD, 8838 E. _'alley Blvd. , Rosemead 91770 6—S r3 Occupation of Claimant Name of Claimant pp c N 41v1 P4,-/--Q 7 City and State Home Telephone Number la.c`- At Home Address of Claimant p Cel fr� o . z"� cs '27o (7- — /'Z. —f 7z City and State Business Telephone Number Business Address of Claimant 1ti-p Give address and telephone number to which you desire notices or communications to be sent Claimants Social Security No, agarcngtmadai351g/ 2-er47ar/419d 2_ /2,>0,.„22._„/ (A /14 77t, cE � tt 6 v When did DAMAGE or INJURY occur? Names of any city employees involved in INJURY or DAMAGE Date t — t I Time ITP✓ LLet/r•./�j If claim is for Equitable Indemnity,give date claimant sewed 5 - Y-& with the complaint: Dateve street Where did DAMAGE or INJURY occur?Describe Tully,and locate on diagram on reverse side of this sheet.Where appropriate,gi names and address and measurements from landmarks: .c4X5V2_ �-. jilt:P C:�✓^^ Describe in detail how the DAMAGE or INJURY occurred. I ✓ Why do you claim the city is responsible? - Describe in detail each INJURY or DAMAGE )✓E/ itstL • THIS CLAIM MUST BE SIGNED ON REVERSE SIDE SEE PAGE 2(OVER) )Till ll} The amount claimed,as of the date of presentation of this claim,is computed as lollows: Damages incurred to date(exact): / Estimated prospective damages as far as known: /' Damage to property $ 7 .-sii Future expenses for medical and hospital care .. . .5 Expenses for medical and hospital care 5 ;V Future loss of earnings $ Loss of earnings 5 Other prospective special damages 5 / Special damages for 5 Prospective general damages $ 1 Total estimate prospective damages 5 • General damages $ Total damages incurred to date $ Total amount claimed as of date of presentation of this claim: $ 70) Was damage and/or injury investigated by police?. vih If so,what city? SR4¢te-ft- Were paramedics or ambulance called? k-0 If so,name city or ambulance II injured,state date,time,name and address of doctor of your first visit f—c—q 1 (we ,Alfa cc.“-±, eiv. -.p awa 4,--,M,.-f t <e, WITNESSES to DAMAGE or INJURY:List all persons and addresses of persons known to have information: Name Address Phone Name L7L'd Address Phone Name Address Phone DOCTORS and HOSPITALS: Hospital Address Date Hospitalized Doctor L've e'LL A1r.-1 (['.Tr. Address ISI EL-ivt At"C hhp4/IiX 4>cr«{2a✓ Date of Treatment & --‘72 Doctor Address C 4 Date of Treatment READ CAREFULLY For all accident claims place on following diagram names of streets, or your vehicle when you first saw City vehicle;location of City vehicle including North, East.South,and West: indicate place of accident by at time of accident by"A-1"and location of yourself or your vehicle at "X" and by showing house numbers or distances to street corners the time of the accident by"B-I"and the point of impact by"X:' If City Vehicle was involved,designate by letter"A" location of City NOTE: If diagrams below do not fit the situation,attach hereto a proper Vehicle when you first saw it, and by "B" location of yourself g-44-X-C- signed by claimant. ,r .Nd/ -""C-eta SIDEWALK / CURB CURB PARKWAY _____J \ SIDEWALK 7 Signature of Claimant or person filing on Typed Name: _ Dale: his behalf giving relationship to Claimant: kI?t Z U L-t{1J rirtt. IT Cf. J .1 I— k-I,'Lc- .a NOTE: CLAIMS MUST BEV FILED WITH CITY CLERK(Gov.Code Sec.915a). Presentation of a false claim is a felony(Pen. Code Sec 72.) • FILE WITH: CITY CLERK'S OFFICE CLAIM FOR DAMAGES RESERVE FOR FILING STAMP TO PERSON OR PROPERTY CLAIM NO. I 03 INSTRUCTIONS 1.Claims for death,injury to person or to personal property must be filed not later than six months atter'the occurrence.(Gov.Code Sec 911.2.) 2.Claims for damages to real property must be filed not later than 1 year after the occurrence. (Gov.Code Sec.911.2.) 3.Read entire claim form before filing. 4.See page 2 for diagram upon which to locate place of accidenL i This claim form must be signed on page 2 at bottom. 6.Attach separate sheets,if necessary,to give lull details.SIGN EACH SHEET. Date of Birth of Claimant TO: CITY OF ROSEMEAD, 8838 E. Valley Blvd. , Rosemead 91770 j �5--y 2- Name Name of Claimant (Cued' H un„�. Occupation olC ant Q 4 Home Address of Claimant City and State Home Telephone Number 1 Ot Ro-c�� P e _ S< c.! 69/770 /2 —377- -372sz Business Address of Claimant City and State Business Telephone Number iced A+° Give address and telephone number to which you desire notices or communications to be sent Claimant's Social Security No. regarding this clairp: cA fie( // ors /4a � Pros:ot_sat c° 7;- 7/ 7A, 6111--.f-6—(F -7? When did DAMAGE or INJURY occur? Names of any city employees involved in INJURY or DAMAGE Date I— 4— it Cl lime I If claim a for Equitable Indemnity,give date claimant served Si—CN'1-e—L Lrt mcu j with the complaint: Date Where did DAMAGE or INJURY occur?Describe tully,and locate on diagram on reverse side of this sheet.Where appropriate,give street names and address and measurement from landmarks: Describe in detail bow the DAMAGE or INJURY occurred. Why do you claim the city is responsible? 74,t<L Describe in detail each INJURY or DAMAGE 1 V s nUj PQ-Y 1.e-- . SEE PAGE 2(OVER) THIS CLAIM MUST BE SIGNED ON REVERSE SIDE The amount claimed,as of the date of presentation of this claim,is computed as follows: Damages incurred to date(exact): Estimated prospective damages as far as known: Damage to properly S I Sti' Future expenses for medical and hospital care .. . .5 Expenses for medical and hospital care S y° Future loss of earnings S S Losss off earnings S Other prospective special damages /r. Special damages for $ Prospective general damages S - Total estimate prospective damages $ General damages $ Total damages incurred to date $ Total amount claimed as of date of presentation of this claim: $ -FCJ Was damage and/or injury investigated by police? city? I`f Se L1.1/'.2 Were paramedics or ambulance called? 11') If so.name city or ambulance If injured,state date,time,name and address of doctor of your first visit /-S--q`i L.-NC to-k met( C,,.it., _ E.Live &Je/k,,Q for /tr.-C(-r-i-e_ C4- ` /coo WITNESSES to DAMAGE or INJURY:List all persons and addresses of persons known to have information: Phone Name LT.-0 Address Name Address Phone Phone Name Address DOCTORS and HOSPITALS: Date Hospitalized Hospital Address Doctor 1„402 E.-It !Merl cj.,tt— Address IS- 1 E,(orf( flrE K 14Y'iro7./-)YT-d4. Date of Treatment /_r-rq Doctor Address Date of Treatment READ CAREFULLY For all accident claims place on following diagram names of streets, or your vehicle when you first saw City vehicle;location of City vehicle including North,East.South.and West;indicate place of accident by at time of accident by"A-1" and location of yourself or your vehicle at "X" and by showing house numbers or distances to street corners, the time of the accident by"B-I"and the point of impact by"XI' If City Vehicle was involved,designate by letter"A"location of City NOTE: If diagrams below do not fit the situation.attach hereto a proper Vehicle when you first saw it, and by "B" location of yourself diagram signed by claimant. /.....//// — — SIDEWALK / \ CURe-4 reLiBa / PARKWAY ___--J \ SIDEWALK _ Typed Name: n Date: Signature ehalf of ingimantupep to Claimant: on C r (vt-i d:4 t .P/ t n�eenaegmngrelatiananiptoaatmane (tirA�c,�t r L�t„0 r��'t� � J� � / 5 vii -ti ,." ar,,71,-e NOTE: CLAIMS MUST BE FILED WITH CITY CLERK(Gov.Code Sec.915a). Presentation of a false claim is a felony(Pen. Code Sec 72.) CH,. I I CITY OF ROSEMEAD — VEHICLE ACCIDENT REPORT DEPT. '7 Parks s Recreation - X CITY VEHICLE (5 PLPrmIT[ 1 veh�e le Lc No __ CON1RACT DIV. 3 Recreatro❑ -- _ - _ ..H's( CcSEPVICE yes R v VICE SECTION 4 _ J I:. N 937661 ._ t Ice uo _ _ _-. Na INCIDENT 9 an. — — DATE 1-4-98 FoJR 2 17 _ pm °oucE X_ Y, Po ICE AGrvrY REPORT ' Ni. REFIJDTINC TemLJle City— STATION _ __ CITY __Rosemead - PLACE INCIDENT HAPPENED OR AREA (STREET, ROAD, EIC.) l3ellman_Avan„e _ - DRIVER10 Silvia_Llamas- Joh Title 01 ecreati on Teader,e) s ❑c '40:B7078386.B7078386 �d Address: Homc _.9332_E.._Valley_BlTd,_Rosemead.,_ CA_ 91770 Phone (626) 780-4103 Lu Work Location __ 883.8_E, Valley_B1Vd;_Rosemead—Cis_.91770— Phone 162_61 2A8-6671 G x °J 199 VEHICLE Year 11 99_ Make :10 Ford Model o, Tyne r41 IIT __ } Paris Damaged 15 _Le ft_fetheT'/lightlleft t Har _o£_111u¢Fzer._ t- 0 Passenger Passenger I. Nome —Diana_Dassla____ 2. Nome _.FlldV ('am h Home Address_2417 G_ladyys, R93_emead Home Addre:s3338 Alanreed, ancamead CA ITYI Phone: Home 573-fig SI Business_ CI Phone: Home 288—MIL T) Busness ICI — r DRIVER Xing Zhen Ma . 9403 Rockhold AVenno . Rosemead CA 91770 'NAME) (ADDRESS) (CITY) ISTATEI (ZIP CODE) (PHONE) Lu DRIVER'S LIC. NO. A7522.629 INSURANCE COMPANY _Farmer's_ ITl"nra e Exchange J U 1 EMPLOYER - in )NAME OF PERSON. COMPANY OR ORGANIZATION) (ADDRESS( (C)TY) ISTATEI )ZIP CODE) (PHONE) ce VEHICLE '16 .1.3a7 ._Mazda MVP Mint Van veh. Lic. No. 3V5fl fR rA LU (YEAR( _MAKE) (MODEL OR TYPE? (YEAR) )NUMBER) ISTATEI H Pats Damaged 1,17 The right side O OWNER_ AM Ei — w OTHER PROPERTY DAMAGE 18 Yes Nal`, LOSS OR DAMAGE TO CITY AND/OR EMPLOYEE NON-VEHICLE, If yes, describe N/A EQUIPMENT OR PROPERTY? 59 Yes I I NoI I If yes, describe a 0 CCw = I- 0 O NAME.._ N/A _ ADDRESS K NATURE OF INJURY _ TAKEN TO = NAME N_/A ADDRESS NATURE OF INJURY . TAKEN TO DRAW A DIAGRAM AND SHOW HOW INCIDENT OCCURRED EXPLAIN clearly how incident occurred: SHOW the location and a sit)tn of Vehlc le(s) at point of impact � A left blinker The lady in the mazda had her SHOW your Vehicle as ! I _> ' � 'ihe other Vehicle os !1 �0 inker on � going to make SHOW :he none of the strati sl, .acarian as stop signs.Is(gnal.. dr) past left turn. I,: Silvia went NORTH on the right side going 1ft,(L�,c,/ .if el- i past her and all of a sudden i. _ a she made a right turn hitting E A the Van. s s T _ SOU H n 4�'�< �e,! ��� PRr✓c. If Additional Space Necessary, Use Blank Sheet. /.440.1 OVER . Leave no section blank. For (ince category, check iXI the ONE box .n each column INSTRUCTION: that best applies- Where there arc two colunns of Laves, the right hand column for vehicle c2. In the Linger Foxe. fill in the correct I.gores. 20 PERSONAL INJURIES 25 WAS YOUR VEHICLE LEGALLY PARTED AND UNATTENDED' o Yes 37 ROADWAY If No, complete the report. includira Col 2 3, and4. -J No I '_)( Straight I I xl None II Yes. Col. 2,3. and 1, o O bottom of page. — 2 2 _ Driver & Passengerigna e _ 2. Curve 3 3' Driver Only 26 LOCALITY 31 AMOUNT OF TRAFFIC 3 in Winding 4 n 4 7 Pa ssenger(s) only I ❑ Rural-Hwy Raodwc I ❑' I ���' N• a Other 51i T 5 C• ity -nP=ayee Not in Veh. 2 nResident's! — 38 TERRAIN 2[X. 21X1 Light 6' : 6i Pedestrian 3❑ Bminess',Sh-TWrig — III. Level 3 3' Freeway ❑ _ Medium _ 2 Upgrade 7' �' ]❑ O• mer 4 4 d, Heavy-flowing In—, 2. Total No. Injured 5❑ Motor Way (Mtn.) 5 . Congested 3'_I Downgrade IF-72i— Total No. Fatal 61 I Open Fiala J 5'❑ 4❑ Hill Crest 7P1 P• rivate R°ad32 SPEED(enter ESTIMATED mph) 5''❑ Dip 21 INVOLVING 8E7 O• ther r—I _ of Danger 1 � I ]— Sign 39 ROAD SURFACE I Non-City Vehmle D OPERATING AREA 2 L 1 21 1 Time of Impact 2E, Anafnar City Vehicle - Pasted 11II Concrete 11 1 Non-intersection 3'L-i-i 3_ I 2' Asphalt 3 Fixed Object (Other than 2❑ N• earing lntersec:ion _ 4'`, Moving Object Vehid`) 31 31 I In Intersection 33 CONTRIBUTING FACTORS 1 Oiled/Gravel 57 Pedesttla" 4E Unpaved 4 El L• eaving Intersection II ' I J Road or Vehicle Defects 6❑ Other Driveway — 5 J't Other 5n Entering 2'! 2 J Unsafe Passing 6I ii Leaving Driveway 3❑ 31 I Unsafe Lone Change 40 ROAD CONDITION V22 EHICLE DATIONOAMAGE 7 Construction zone 4 1 4pX t Improper Turn 1170 Dry I 1 ❑ Left side 8❑ Parking/Bus. Lot 5 5❑ Following Too Closely 2 n Wet 9• Other 61 1 61 1 Too Fast For Conditions J^, Muddy2❑ Leo Front 7❑ 7❑ V• iolated Sign/signal = 37 3 E Front 28 DIRECTIONe❑ 8❑ F• ailed to Yield Cr Wait 4'� Snowy or Icy 4 in a Right Front County Vehicle and other 97 5 1 Other Failure 5 D 5❑L' Right Side Vehicle or Pedestrian 41 NUMBER OF LANES 0❑ 0: II No Fault Your Side 6 6�'. R• ight Rear I . : Both Going Some Direction 71—I 7 Rear 2❑ Crossing in Opposite Direct_ 34 EVASIVE ACTION Opposing I 37 B7 Left Rear 3 Going in Opposite l Locked Brakes 9❑ 97 Other or Multiple 41— Not a Vehicle or Pedestrian 2❑ L❑ Hord Brakes 42 WEATHER 0• i 01iIx Clear None 29 MOVEMENT 3❑ 31❑ Slower/Stopped 2n Rain 23 NATURE OF 1 I, 11-1 Straight Ahead 4�i 4 Steered Away 3❑' Fog VEHICLE DAMAGE 2': 1 2• L_ Lane Change sl_� s__ Accelerated 3F oesty ❑ 31 3 Making Right Tum 6 _I 6'�, 3 and 4 Above 5❑ Snow 1 1 Bumper(s) 4❑ d Making Left lurn 7❑ 7111 4 and 5 Above 2 21 Door(s) Note: 67, Heavy Smog 3K 3_� Fender(s) Check 5❑ 5❑ Slowing, Stopping BF ED None 7 1 Other ❑ 6 6Standing 9L_ 9 1 Other 4L f 4 1 Frame all 71 1 7'❑' Parked d3 VISIBILITY 51 5❑ Grill that B❑ B❑ Backing 351 ❑-7 1,:J SKIDMARKS-(feet) 6 16❑ H• ood ApplyI ir Good 9 91 1 Rolling Back p❑ Fair ]}e' 1 7❑ Light(s) 0❑ 0 i Moving Unattended BI I BI 1 Radiator 36 DRIVER CONDITION 31-1 Pool 91 91 I Steering 30 TRAFFIC CONTROLS (Just prior to incident) 41 t Very Poor 101 110 ' Top 1 ❑ 1 D None Present 1y7 Good 111❑II D Trunk Deck/Lid 21 1 2 Green Signal 2 Weary 44 SAFETY BELTS 12712❑ Wheel(s)/Tlre(s) 3E 3❑ Yellow Signal 31_- Drowse 1I Installed. Not Worn 13❑)13❑ w• indshield/Windaw(s) 4D 41 1 Red Signal 4_'� Nervous 2� Installed and Worn 14IJ14❑ O• ther s*1 5•ri Flashing Signal 5'_ Worried 3❑ Not Installed 6 71 6• Stop Sign 6 Irritated 4_ Vehicle Unoccupied 24 VEHICLE DAMAGE (EST.) 71 1 71 1 Warning Sign 71 , In Pain I i 1rX Over $200.00 8 B Construction Sigr. 8 Illness 45 On emergency response] 21 12 t Under $200.00 9J( 9 Other 9i , Other Yes ❑ No ❑ Employee Namo© Silvia Llamas Age X411 21 n j II 1/��/ h SIG ATU RE Of SUPERVISOR tel- 161 Total Yrs.Priv.48._ oral ri Priv. City 149 2 Total Yrs. this Da Signature al Driver. r/ • • — Date�� 3. SIGNATURE O O REPRESENTATIVE AUTHORIZED Dole STATE OF CALIFORNIA ,J:, TRAFFIC COLLISION REPORT CHP SSE PAGE 1 (Rev 2-92) OPI 042 ,. ai , . ) . 6 C naaucwo,T,w. OnJI AL ET cr LOCAL n.ro,c.w... MR V"-r{+'D ID ti-anitc, 19S-Ovff 17 - .xLm .rt ""' ..r a533—,5 -7Z 75 LDS ' Lc n-r 7M OLwOAFaun=CA DAY nu l.ui�, Sac. O..ca,c f{a1L--/li Pi r-3 fW<NOc y� OCf I ia`�. ' iy�7A+3t2 19i. ND'756 x .. TOW 1AT...aama OK SO WTFS ❑.S RHO ❑DA n ROL C* Lb AvraJv n 1 PARTY . ,./ I EAS OREMW..A .r.,, ❑, f/JilC •®'97 Infl24, var! Oar & 3vsri tog nam a O` ko>kn, ,jp - 4: gl�7o o. . o,A. ® a 11 o❑ Y 81-11 3-14 ca 1- oCo t1-OMINTPCIAji (o`Vs O 9121r GN #4.A-( ❑C.Ac.A m.. Do.. ❑" (A26)�2.372 ( 0�1 g o . ALO rortAnA,.xri REFER Fawo...«..0 404 a,•< SrYc2 � O :EiREEMII .?frloLI L$ .: _,• . .c 0• aA DWI ❑Tor.. W EIMA wro .v eco Ccv ' PARTY .nv , .ALE .xuua" �O _ on an 2 3 0 8386. c4MIN 9`f �o�7ivP,?/.`3,1w� Emit 7..,4 cA Cy I ILVIA . . TEI 9 332_ & . v 4LLE Y 61- . TTY 0.........„vat 9/770 _ 9 _ �• 3$ E. ✓.r L.LY.3L. aysr..,esp cot . co ' 151:24.4 al., 503 79>' ft 0-wEr-i AwW( ❑O E., a. ❑0 ❑ (624.)z8a- '-1\03 (626 )288-6671 .<,..,. , ...R ..E.....,Dir. .,.<....bR .. ffi Oa MAJOR ❑S 1ti7 ileCcVLN -1 4V. • v E v v u i� PARTY OXY.,S PCAISER • � ,.. ,,00..,<o.o,® ... , x. . ,xA.r,.00..., .., ❑ 7O. .,A..:.00Aa,. O.x.A.NW. ❑.......o..., ..0.. o«x.",.<o,.a cr.... o^ <.. QC ®® .x< . . . S S ovn�<... OI OAA. .A: ❑oFRc.A ❑Aa..A ❑<,x.A ❑ �...). (wx ) ..OA..CA...CALD...Cn: xa.A...AAH.❑ x11,o.nTO xO.xR<ArVE lini • ®[[uw[. ®.E.[" Doi Krn..a.o D.icc❑C " Ov ALA / DISPATCH DTr.�Eo pE s T� - '-10736 oYEs 0 ND Donk DEP.D.MILLER#62322 c r • 1•wa /-15:-99 TRAFFIC COLLISION CODING _ „a, a �I la CAT <10 NO sioN nit DmD "1 . ! `� t5 N>2S . I�}oo `kJ i36'+ IL9i-0017&—s�'i —`17'2 OWNER S NUY/Atom. flooFou Q»o PROPERTY DAMAGE „a„,maw ouAN SEATING POSITION SAFETY EQUIPMENT EJECTED FROM VEHICLE /PAM L.MR BAG DEPLOYED D-NOT EJECTED -NONE.DACI • INVENaE N.AIR BAG NOT DEPLOYED DRIVER 1.FULLY EJECTED A B-UNKNOWN M-OTHER y.IKI 2.PARTIALLY EJECTED �', C•LAP BELT USED P"NOT REQUIRED W-YES U-UNKNOWN I DRIVER D-LAP BELT NOT USED i 2 'f E•SMOULDER HARNESS USED PASSENGER Z-S a TION WAGON RS fHl P RRSTRAIN[ 4 5 6 i-STATOR REAR F"$HdILDER HARNESS NOT I-NO OIN VEHICLE USED 9-REAR CI'C TRK OR VAN C•"LAP/SHOULDER HARNESS USED V-YES N-LAP/SHOULDER HARNESS NOT USED S-IX VEHCLE NOT USED G-POSITION UNKNOWN U PASSIVE RESTRAINT USED 5-IN VEHICLE USE UNKNO'ER WN USE \ 7 JD�OTNER K_PASSIVE RESTRAINT NOT USED 1-IN VE HOLE IMPROPER USE U-NONE IN VEHICLE ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK I'I SHOULD BE EXPLAINED IN TME NARRATIVE MARY COLLISION FACTOR DB MOVEMENT PRECEDING IIS:NUMBER (II) OF PARTY AT FAULT TRA FRC CONTROL DEVICES 1 213 TYPE OF VEHCLE 1 COLLUSION A'VC SE CnON AO-AHD: °Fin ACONTROLSFVNCnomNG APASSENGER CAR/STATION WAGON AsTOPPED I I 7200 1 , BCONTROLS ■ MOi FUNCTION B PASSENGER CAR WI TRAILER MN B PROCEEDING STRAIGHT RAN OFF ROAD A .S OTHER IMPROPER DRIVING': 30 URED - :■D MAKING RIGHT TURN 4 DHO FKICONTROLS PRESENT IFACTDII' DRORCKUPPANEL TRUCK ,: E MAKING LEFT TURN I L UNKNOWN THAN DRIVER' wYJNG U TURN •HEAD-dl F TRUCK/RUCU TK ACTOR W ■ BACKING pUNKHO WH' I I(j SCHOOL TRUCK TRACIOPWITPLP. 55 I REAR END . BUS SLOWING/STOPPING WEATHER I MARK I TO 2 ITEMS) AID BROADSIDE I OTHER BUS in I PASSING OTHER VEHICLE I A CLEAR E NT OBJECT J EMERGENCY VEHCLE ■■J CHANGNG LANES IB CLOUDY KNGHWAY CONST EOUIPEENT ■.K PARKING MANEUVER MICall L BICYCLE 5 L ENTERING TRAFFC MOTHER VEHICLE 5 MOTHER UNSAFE TURNING I D SNOW NG PI OTHER': , ■■ '. IIJIti INTO OPPOSING LANE I PO MOPED . •PARKED IF OIXEP'. A»GN-cowsON I. puERGING IMMIIIIIIMBIEZES OTHER MOTOR VEHCLE / IFJ LL St Zc J/iN 5 IrOAVEEUNG WRONG WAY B IB DUST(-DAWN .li. ID DARK-ND STREET LIGHTS lap55 E DARK-STREET LIGHTS NOT , Bvc.c��nLF yuuTNw: O SOggIET-OPUG NN�TOMNG' 1 2 3 PHYSICAL CNC sarnm munaY. fru (MARK 1 TO 2 ITEMS) IB WETOTHER OBJECT: Ow •HAD NOT BEEN DRINKING IC SNOWY-ICY J D Ar BHBD-UNDER INFLUENCE EVISIOI OBS UREUENT: HBD-NOT UNDER INFLUENCE'I. psUPPERYI MU•JDY,dLY.ETC.) I 5F INATTENTION': 5 BNBO-IMPAIRMENT UNKNOWN•1 ROADWAY CONATIONS) IG STOP&GO TRAFFIC ■ PEDESTRIANS INVOLVED FUNDER DRUG INFLUENCE' I wRK1TOZITEMS I �A»O PEDESTRIAN INVOLV[D i H EREVIOO.CoLlI TomNG IF IMPAIRMENT.PHYSICAL' /' I I PREVIOUS COLLUCN IYPYRMENI NOT KNOWN HOES,DEEP Fur' LR¢SLM MG IN CPSWALK I J UNFAYLAR WITH ROAD H NOT APPIICRBLE a LOOSE MATERIA:ONROADS'AY' 9 AT INTERSECTION K DEFECTIVE VEK EQUIP.: �� .. ISFEPY/FATIGUED IC OBSTRUCTION ON ROADWAY' GROSSINGIN CROSSWALK•NOT CONSTRUCTION REPAID ZOXE At INTERSECTION Db SPECIAL INFORMATION ID CONCROSSING.NOT IN CROSSWALK IL UNINVOLVED VEHICLE I I A HAZARDOUS MATERIAL REDUCEDIR aQ.Dwar vnorN IE ca r IF FLOODED IE INROAD KwDEs SHOULDER I IMNNOOTNE A : I qIv OTHER.: Ir NOT IN ROAD /1 IN NONE APPAaENr / 'H No UNUSUAL CTI IG APPROACNHG I LEAVING XHOOL BUS I I IO RUNAWAY VENCLE AKy^E11A.NcOUS sKETLh .1.-a,0Y--/ [ I ��bIrr �� Y'Z '". CLLN'T/tN A-./ CHP555 PAGES( Wv iaa)OPI042 STATE OF CALIFORNA INJURED / WITNESSES / PASSENGERS DATE i , (210L1DL . -yO.,�o} Ic-}I5 t}'2$- l\9oQ �7j6`Y 9qNUMSE�oon8-»,:3-1-172 EXTENT OF INJURY ( '% ONE INJURED WAS ( %uON6 ) „sty ally ONLY RDE 5: A1rpro: ,owe ""rm NU : or PON oxE'c a ❑` ❑ 3S F ❑ ❑ ❑ I� 2 ❑ ❑ ❑ ❑ I 16, o NAME oe,1e o MOORED ONLYp TRANSPORTED 10 -FAXEN 1-0 DESCRIBE S COryc�-EgNT O!- T1 nva -to 5.4c °r a2r.4< 0 NOF IOLENTCR�aEw„RSD ❑" rn ❑ ❑ ❑ ❑ DODD UI _ <DA tQrr�YoLIV RESS o'-I-Zc 7-�833eI Inu5 #7cU�fV rteat- n€r1D,`]'770 62b-E2& —6972 w MOORED OnTR.RSPORTtO Dv r....TO: DESCRIBE NJUMES 0 .,rna OR.,o.ERr cNNe wnnEO ❑" 12 G C ❑ ❑ ❑ ❑ DODO ❑ l S O 3 nrLpc 1 tutu , 3-3&1 nosab•E.L T.a /,O.2Ds . 'no 626-rEz� Fr-6472O.JURED ONLY)TR.,SPORTED 0 VIC,NDR.,OJENTCFEMEpnRED ❑" 7 "' ❑ ❑ ❑ ❑ 000991 gin o rose TELEPHONE YF\'n m o3- - a -7— I INJURED ONO,TRRa5PORTED8T. TAKEN To. COLOR SE HOMES 0 on S h ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ . 1D, o3 TR, 0 SA. o7— t4Jr1N�, O4.-x5-973 , r1 — I TELEPHONE "HIRED ONO°TR.NSPORTED BT: TRXEN TO. DE5C1UHE INJURIES 0 N ,.OF IO,Er,TON.E RDnRED ❑" 5F 23 r ❑ ❑ ❑ ❑ JOSE ❑ Z 3A O Diftba A-VILAre. z,-117GLADYS 4-V. eVknr iL-no 6zs.STS-ZS tar LNJURED ONLY)TRANSPORTED BY. 'FAXEN TO. IDE CFIBE INJURIES / ❑ Ncm Dr.a.ESJr CRRENDT�RED 7,p7 MA_ 73��F IZE 1•roMoOf p1� 44E R.jE"ERT:Nwz ao. DAY .EA, CNP 555-Page 3(Rev.7-87) DPI 042 s> 43cST STATE ORE.,.OR.R INJURED / WITNESSES / PASSENGERS DATE OF COLUSION TME RDoNUMBERFREER CD. O(— CH q47 I`{1S +RTS. �190a 407364 IQA an-72-.05-73-`172 woe. EXTENT OF INJURY ("X" ONE) INJURED WAS( "X" ONE) PARTY SEAT SAFFEI LyAGE SEX EJECTW NUMBER POS. SOLNI. ' TFATAL SEVERE . D. Lit X z2 m 00o ❑ SUDS S26, o MAME I 0.0 B.,ADDRESS ROIY? Z. AvhACAp 12 -o9-7(0 3338 AL✓ A eo AV, CLOS v.'2141),9,TR7 &z6-Z?F -'199 1 ..URED m.n TRANSPORTED BY: WREN TO. DESCRIBE INJURIES 0 v ,,.OFNOLE.T ...Eb1REO ❑° ❑ ❑ ❑ ❑ 010505 ❑ TELEPROTIE [NAMED OwYTRANSPORTED Dv: TAMEN TO. 0 .C,I.OR.,OLE.T L..E ROneED ❑a ❑ ❑ ❑ 1 ❑ ❑ ❑ ❑ ❑ ❑ ❑ • YELEESENE 0 PRJUREO ONLY;TRANSPORTED SY. TAXER TO. [WORSE TRIUNES pM r.OF\OLE.TCRIME.O1RED ❑° ❑ 0 Si ❑ ❑ DOSS ❑ (INJURED ONLY}TR.ISPORTEDBY: TAKEN TO DESCRIBE BRIURIES O r 11.,EYOLErC..ET.,,..ED ❑` ❑ ❑ ❑ ❑ ❑ 000 0 0 TELERBGNE ,INJURED WILY)TRANSPORTED ST. TANEN TO. DESCRIBE ImJURIES O .c .D. 1OLE4TC..E.OnREO ❑° ❑ ❑ ❑ ❑ ❑ [15550 TELEPSONE TRJURED own TRANSPORTED BY: T..E.TO. ❑ .On.D.D,OLwT"in ."RED ASEEASESS T zsa .J ro; <l p1 DAY 9.9R RE ,E.ER,R.E MO. DAY YEAS CHP 555-Page 3(Rev.7-67) OPI 042 R, TRW STATE OE CALIFORNIA NARRATIVE/SUPPLEMENTAL Page 7___ CHP 556(Rev 7-901 OPI 042 - - _ - ---. DATE OF INOIDENTCCCURRENCE TIME(2400) NCC NUMBER OFFCER t D.NUMBER 1 NUMBER 0t-o' �i 1- °L _ Wtil55, l9op ,-(07310`'/ lila -oon&-o S-33-'n2. 1-r ONE - TONE TYPE SUPREMENT.LL rr APPLCABLE) 2Narrative YNColliSIOn report ❑BA update ❑Fatal ❑Hit and run update o Supplemental ❑Other: - 0 Hazardous materials ❑School bus ❑Other: Ctyy.CDIAITY/JIWCILL DISTRCT _ REPORTING DISTRCT,EAT CHEAT/NNUMBER R eveyhe•440 / Los Angeles Into 4044 taD 47593-5-3r72/71 _. STATE HIGHWAY RELATED 3a NO IOCATOWSUBJECT JyJ t4- uJ✓/ ' Pry, ,20c.12 vu. A-v. Oyes 1. 1 . FACTS: -' 2. A. Scene: _ --- 3. 1 . Roadway # 1 : Name: 4-c't. J41 41. A. ()Q. Asphalt Surfaced ( ) Cement Surfaced ( ) Other : 5. ( ) Business/Commercial (Jt Residential ( ) State Hwy (S/R # ) 6. ( ) Private Property ( ) Parking Lot ( ) Other: 17. ($) Straight ( ) Curved oerLevel ( ) Incline ( ) Left Turn Bays 8. ( ) North/South Did East/West Divided By :'B✓10tt'�^) 4Aa-sunn Ltrof 9, Lanes in each Direction_ ) Additional Description: __.. 10. 'I.11. 12. 113. ._ _-I 14. 2. Roadway # 2 : Name : RQt. Lr4V 4". - - -j Its, OQ Asphalt Surfaced ( ) Cement Surfaced ( ) Other : -1I 116. ( ) Business/Commercial _ (...14 Residential ( ) State Hwy (S/R # ) 1 ; 17. ( ) Private Property ( ) Parking Lot ( ) Other: _ -11 Ia. (X) Straight ( ) Curved (,.)d Level ( ) Incline ( ) Left Turn Bays Hg. (J ) North/South ( ) East/West Divided By:92cIa 1#..-77-14,u0 Liner :20. Lanes in each Direction: 1 Additional Description: 21 _ _ __ _. • '22. _. - _ - __ • 23. _ _._ -.. • 24. _ _ _. 25. 3 . Traffic Controls : ( ) None ( ) Tr.-Phased ( ) Left Turn Arrows 26. _ (>Q Stop Signs ( ) Other Control (s ) : - . 27. Controls Located at : ( ) Four-Way : (:,, .__A›.4Other ;aPd42.t19s-D Ay. 28. - - -- 29. 30. 31. PREPARERS NAME AND I.D.NUMBER DATE REVIEWERS NAME 'DATE 2-e-reiat -1 Hn-734y-/ vi-o+419 _ TEM Use previous editions until depleted. w 5754r STATE OF CALIFORNIA NARRATIVE/SUPPLEMENTAL CHP 556(Rev 7-90)OPI 042 Page c DATE or WCY£NtOCCURRENCE TIME(NCO) NCC NUMBER DEFILER LD.NUMBER NUMBER 01-Pcd-1 `I(r +e. 19ff>U L:10-73 40-1 199=001-7$-o5-33-`472 -r DNE PONE TYPE SUPPLEMENTAL(YAPPLCTRLE) D Narrative El Collision report D BA update El Fatal D Hit and run update D Supplemental D Other: 0 Hazardous materials. D School bus D Other: CIIYCCUNTY/AOCLAL DISTRICT REPORTING DST-RCS/BEAT CITATION NUMBER / Los Angeles / LOCATONsua.4cT net HIGHWAY RELATED D yes D No 1. B. Measurements: Obtained By (>4') Pace ( ) Rol-A-Tape ( ) Other: 2. (All measurements are approximate & rounded to the nearest foot ) • 3. 4 1 . AOI # 1 : g'. Ft 't5 of the Curbline of r♦LZLdtB4ti A-V, • 5. 2- ( Ft W of the E Curbline of RDAK1{a"D A-V. 6. • 7. AOI # 2: Ft of the Curhli no of 8. Ft of the Curbline of 19. 10. AOI # 3: Ft of the Curbline of Iii. Ft of the Curbline of 12. I 13. I 14. 15. C. Physical Evidence: 16. 1 . Skid Marks: DNC SThZ.4R614T S IL T© 0114.1212 s-r Tk4- 1'41I'3 L(Wc I 17. p'er- 14-> 1-).wrr).-+ 4v, APPeac1m.crZ.V 2 rT �)4sT A- 4oS126/ , i).2= I IB. yDRr2iL O)% lP_Z S vetncL.c. J19. - I 20. I 21. 2. Debris : visa - 122 1 - 23. _ _ 124. .25. I • 26_ 3. Other: b., 01,-.312-- I 27 128. 29. 30. • 31. • PPEPAR:RS NAME AND L D.NUMBERDATE REVIEWERS NAME DATE ' TrHT« ' ''1a73S Ivro'-I-99 Use previous editions until depleted. 91:15754. STATE OF CALIFORNIA NARRATIVE/SUPPLEMENTAL CHP 556(Rev 7-90)OPI 042 _ Page 7 DATE OF INCWENT.CCCURRENCE TIME(2400) NCC NUMBER OFFICER ID.NUMBER NUMBER Gt • c 4! 1'415 *QS. LCiPO {o73�`f I -0O47&-O53v-Y72 T ONE -K ONE TYPE SUPPLEMENTAL(T AFWIKAecE) ❑Narafve El Collision report ❑BA update 0 Fatal ❑Hit and run update ❑Supplemental ❑Other: 0 Hazardous materials ❑School bus ❑Other: CITY/COUNTY/JUDICIAL DISTRICT REPORTING DISTRICT/BEAT CITATION NUMBER LOCATION/SUBJECT STATE HIGHWAY RELATED ❑Yes ❑ND - J 1..35. ST) 9- -w .&.-r'2 2. A . `rROrn -S 3. a. ?- ( Stn-ret SHa WrrD T QtiV��I.+t °11/3 /+mLtMw i4✓ s. ftPPaOA4+i AS 544- ,4PPoogq-4 l -711z- 6. .\^'neessLTJ.a of= h1t'L/.Mmra 1411 / oc.JZ71DL!) A✓. S/}.= 7. -rviaa,a0 or. (moi RI -r ' - SIha�F•i. A-A� 97'+4.2Tr�(� _ 8. �n •tV✓]N raj 6,i 47- \NTLI (+art !2<5? De- c E pt, -E-,elY �3ko3 l -).Lrny.a 467), As s) wri- -rvra�wl 24car+r 10. ?- Z I0vklo w)1-* *L SZ) ✓2i4 14111-1"14 '/a /-9\..-LLrnrA) 11. 5'j ert10•31 P- l , 912py 2 i3=nr4v.r-3 tom- f / r 71-4-e" ro02'rr 12. Gvr2C>LjNL= p1r7.LttN C.aLUO, c, r- VO fit+. 13. 7A,`�, eel4at2 S\Dz of 2-1.:S Vettt-• ice- t L--rwr j 14. -T741F1- 9CF '2c 5 ,mr"Qe -nit 12.11,t+T fir-1 vim, 15_ ri-a✓L t�vtkV&n ny1 7- /TZn ,r,t 16. ZOO Fr /#W r+A( t=rtgrn ('Ie2 (E/I3 Fa-On wkt '22" P- 17. N B45 Lo -6-) _ 18. 19. zo. -Z srt-r�o se-h� wr-25 Te ✓EL1NG T31'ii==2LMH+y N*.• 21. 14PP2ortC.tfIr.>e t2DUR091.-O R✓. t?- 1 t-A-5 fro• 22. r)wr i "that. pm ?- I fct+r) 23. FSTt'*et.-rIO'..) oP r' -Ld.rnit^?/4V ItaQC.I1.0pL,1> A¢6.1 {?- 24. 'TV✓��7S�..a r -2 LEF- 71.0.2.3 S4tNrFL \NI \LAT1,vg 25. I`7- ( WN-} ‘701r4 TO TL,vzi Ler.- )3) Or TD 26. 2.O iCWOLp Av, t4- f-- t ^7$c G✓a.1 To 'T/u21.1 27. ON-no -ocAtiVe-D 01-✓ Y- G 13 E 6 %-S 1'L7 Da-i v.0 SO-n •-,b 28. `I?-I 4,e7 3 Tv-It'C+J 7)-1 (4-0E::. -Whir e-kpi 1-L L tram C..1N Q 2W 1.4-ett ynr^-' Av. .�vsi f}SP-Z h/as mo✓wh !+\2ao.4t P- tom i 30. _? SV pO e cis rU P,-r' t.216,14--r t --> e-vs - - e -t _ 1. -Prn Tr W rOi .�� _L-rtt7 'T)+ Di24✓EW!.-1 - --II PREPARERS NAME AND ID.NUMBER 1DATE REVIEWERS NAME "I DATE r -t'es goe4 Use previous editions until depleted" - _ „57„7 STATE CC CALIFORNIA NARRATIVE/SUPPLEMENTAL CHP 556(Rev 7-90)OPI 042 Page DATE CF WCNENT/DODURRRENCE TIME RCA, NCC NUMBER °FACER I.D.NDMBBEI9) NUMBER pL- er-1 /. CA}13Hit I "CC, e{073/0 / L9j-ool7&-ofl3-Y72 TONE T DIE TYPE SUPPLEMENTAL(r A^PLCABLE) ❑Narrative ❑Collision report ❑BA update ❑Fatal ❑Hit and run update ❑Supplemental 0 other: ❑Hazardous materials ❑School bus 0 Other CIYCOUNTYAOCLLDLSTRCT REPORTING DISTRCT/BEAT CRATON NUMBER LOGTOWST$IECT STATE HIGHWAY RELATED Elves 0 N 1. A- . rF34''/2--ri j coer,, - 2. ?- I ? /2o`$ 12147l#r LN F✓aDN i ?-2 r 7-7 4. 44-Pflj-O }-al-4- ?2A-.le > r3v i -.-* ur44-31--e- "7l7 Q✓bl Q 5. �n LLI ANG+ i.rttn- 1. 6. 7. B.Jy.I,... O&tt IoNs AJ' CDD c1-O' O a S . 9. 4, Vnen As2`1 10. 11. c -s .0 Pot- PA-vancot*PLrb 12. X1114- m-/ (2/35.2 vol-ThDr-4S , IT 1 } rn °Pit. i -- 77-444- ' 13. CflLLIStION p cCo ora Wtf-c r-1 P- I , 1)/2.ti/ Lj 14. 1"J 1.11-514,-M At', vnl40C4 0-4 -"1-/-5.2.4.71>7- a/6tf-7- h}fWD 15. L_`l' or= 7-2 1-- kit -n'I2V6i H-r . 16. 7- ) t 4-' , M7412-'11/416 /9- La t 7 TZJI2a O..rt7 2QG411v[-0 4✓ 117. F.'s-cep-as - P-.7 =5 Lc rr -2-12d2,- C Cc-c fib_ G..T4-s o.>. `r>-2 !18. cOLLlD.CZ> L^."1- P- I . 119- 120. 21. le,. LJ 1aJSr. ._ 22. 23. 7j - 1 4L4v5 cot-1-1 k I.] 13`'{ rn.o4z-0 /7- 24. 25. IP r /l.t 'D -l..J d'.a 1=✓2vn- -+rte rnnP(o Pev Post • P- etc LNT1Ja or- 2z1O0(5) Vc•-) 26. 27. 128. _ Jai . 2c G'7mrncubA-T10rS 1129. X130. TJ OJT) 31. C�4S' . 2 J4C%r✓✓- / - ,S- 2 2 DEP.D.MILLER Y62322 ?PREPARERS NAME AND LD.NUMBER DATE REVIEWERS NAME DATE c-r-r-e-- e' yv /5(04 or-r-t'39 Use previous editions until depleted. F M F o 1'4 .72* st of -_ � f,eport TO: HONORABLE MAYOR AND MEMBERS ROSEMEAD CITY COUNCIL FROM: FRANK G. TRIPEPI, CITY MANAGELy7 DATE: MAY 18, 1999 RE: EXTENSION OF AGREEMENT WITH PEEK TRAFFIC/SIGNAL MAINTENANCE, INC. FOR TRAFFIC SIGNAL MAINTENANCE SERVICES Attached is a letter from Peek Traffic/Signal Maintenance, Inc. (SMI) requesting a one-year extension to its current agreement with the City. SMI is requesting a 3.0% increase in rates for the coming year. That request is in line with the most recent CPI report, which is attached for the Councils review. If approved,the rates paid by the City would be$59.60 per month per intersection, $47.68 per month for one flashing beacon near the Williams Elementary School, and $4.49 per month per location for insurance costs. SMI has maintained the City's traffic signals since 1981. Since then, the company has established itself as reputable and reliable contractor. Staff recommends that the City Council approve a one- year extension to the agreement. RECOMMENDATION It is recommended that the City Council approve a one-year extension to the City's agreement with Peck Traffic/Signal Maintenance, Inc. (SMI) effective June I, 1999 through May 31, 2000. ccmcmo sm199 j Is COUNCIL AGENDA MAY 2 5 1999 ITEM No. CG-B J PEEK TR A F FIC SiMi SIGNAL MAINTENANCE INC. Signal Maintenance Inc. Memorandum " 1 2283 Aha Re-Inn SI Arlal,emi Calilornm 92800. tl S.A. Telephone: 1714) 503-1000 Facsimile: p 111 563-3175 Date May 18, 1999 To: Mr. Jeff Stewart Fax: 926307-9218 • Front: Ken Hams. Re: Maintenance Contract As of May 31, 1999 our maintenance contrad will expire. We are requesting to renew this agreement with the City of Rosemead for another year. Along with this fax I have included the CPI for April 99 which we would like to add to the current prices. This would indicate a 3.0 %increase. Please contact me if there is any problem with this request. Sincerely PEEK TRAFFIC-SIGNAL MAINTENANCE, INC. Peal Is S Tn Hr mo Power cam "1F ZO ' d '1 TO 66-Si-Fei4 Page I of I CONSUMER PRICE I PACIFIC CITIES AND U. ALL STEPS I (1982-84=100 unless ot APRIL 19 ALL URBAN CONSUMERS PERCENT CHANGE Year 1 Month INDEXES ending ending MONTHLY DATA APR. MAR. APR. MAR. APR- APR. 1998 1999 1999 1999 1999 1999 M. 5. City Average 162.5 165.0 166.2 1 .7 2 .3 0.7 (1967=100) 486.8 494 .4 497. 8 - - - Los Angeles-Riverside-Orange Co161 .8 165.0 166.6 2 .2 3 . 0 1 .0 !1967=1001 478 .2 487.4 492. 1 - - - West 163.6 167.3 169. 0 2. 4 3 .3 1 .0 (Dec. 1977 = 100) 264.5 270. 5 273 .2 - - - West - A 164 .2 168.2 170.0 2 .7 3.5 1.1 (Dec. 1577 = 100) 267.8 274. 3 277 .2 - - - -Aest - E/C ' (Dec. 1996=100' 102.2 104 . 1 105. 1 1 . 3 2 . 8 1 .0 Year 2 Pontis INDEXES ending ending BI-MONTHL'Y DATA APR. FEB. APR. FEE. APR. APR. 1998 1999 1999 1999 1999 1999 San Francisco-Oakland-San Jose 1/ 164 .6 169.4 172.2 3 . 8 4 .6 1,7 11967-100) 505. 9 520 .7 529.4 - - - Seattle-Tacoma-Bremerton 1/ 166.4 170.6 172 .2 2.5 3 .5 0. 9 (1967-100) 507.1 520. 0 525 .0 - - - il Beginning with the 1996 CPI revision, indexes for San Francisco-Oakland-San Jo on a bimonthly Iasis. The Seattle-Tacoma indexes will no longer be published excl. Beginning/ with January 1999 data, both ot these urban areas will be published ti-m Oct, and Dec) . The next CPI All Items indexes for San Francisco and Seattle will Size classes: A = 1 ,500, 000 population and over, B/C = less than 1, 500, 000 populat Release dare May 14 , 1599. Next release date June 16, 1999. For more information Anchorage 1907) 271-2770 Los Angeles !310) 235-6884 San Diego Bonolulli 1808) 541-2808 Portland (503) 231-2045 San Francisco (ip://ftp.bls.goy/pub+special.requests/san francisco/pacities.txt 5718/99 Lo - d dos : TO 66-UT-KEW EXTENSION OF AGREEMENT THIS EXTENSION OF AGREEMENT is entered into effective the 1st day of June 1999,by and between the CITY OF ROSEMEAD,a municipal corporation (hereinafter"CITY"),and PEEK TRAFFIC/SIGNAL MAINTENANCE, INCORPORATED (hereinafter"CONTRACTOR"). WHEREAS,the parties have executed an Agreement dated March 1, 1981, in which CITY agrees to contract with CONTRACTOR for the performance of certain traffic signal maintenance and repair services; and WHEREAS, said Agreement is attached hereto, marked "Exhibit A" and incorporated herein by this reference; and WHEREAS,the Agreement of March I, 1981 provides for an annual extension of said Agreement for a period of one year; and WHEREAS, CONTRACTOR has thus far satisfactorily performed the services set forth in the Agreement dated March 1, 1981; and WHEREAS, CONTRACTOR has offered to perform the services required in the agreement for a period of one year with a 3.0% increase in the current rate for services. NOW, THEREFORE,the parties agree: I. That the Agreement of March 1, 1981 is hereby extended for an additional one-year period to May 31, 2000. 2. This EXTENSION OF AGREEMENT shall be effective as of June 1, 1999 and continue in full force and effect until May 31,2000. IN WITNESS WHEREOF,the parties have executed this EXTENSION OF AGREEMENT on the date set forth below. DATED: CITY OF ROSEMEAD MAYOR DATED: PEEK TRAFFIC/SIGNAL MAINTENANCE, INC. PRESIDENT • • 1'ROPCSPL FOR TRAFFIC SIGNAL MAINTENANCE FOR THE CITY OF ROSEMEAD, CALIFORNIA The undersigned declares that he has examined the signal locations contained herein ' and proposes to perform the following services for the unit prices as submitted. 1. DEFINITIONS a) . The worn "City Manager" shall mean the City Manager of the City of Rosemead, • acting personally or through his duly authorized agents, each agent acting only within the scope of authority delegated to him. b) The word "Police Chief" shall mean the Head of the City's Law Enforcement Agency of the City of Rosemead, acting personally or through his duly authorized agents, each agent acting only within the scope of authority delegated to him. ' 2_ AUTHORITY OF THE CITY MANAGER a) The City Manager shall. decide any and all questions which may arise as to the quality or acceptability of materials furnished and work performed, and as to the manner of peerformance and rate of progress of the work; all questions which arise as to the acceptable fulfillment of the Agreement on the part of the Company; and all questions as to claims and compensations. b) The City Manager's decision shall be final and he shall have executive authority to enforce and make effective such decisions and orders as the Company fails to carry out promptly. c) At no time will any changes in timing or progression of the signals be made • except under the direct supervision of the City Manager. 3. SERVICES Traffic Signals: Company shall service, maintain and overhaul, traffic signal devices; i.e. , electro mechanical and solid state type including type 170 controllers, fixed time, semi-actuated, fully actuated traffic signals, and at the locztions set forth on Exhibit "A", and at such other locations where such devices may from time to time be installed within the City. All said labor, services, materials and equipment shall be furnished and work performed and completed, subject to the inspection and approval of the City, the City Manager's Office, or inspectors or their representatives. When City desires to add traffic signal devices, to be serviced and maintained, it shall notify Company thereof at least fourteen (11) days in advance of the time such service shall commence. The services to be performed shall consist of a preventive maintenance program inslul ng, but not limited to, the following: 1. The inspection, cleaning and adjustment of each controller unit, and the repair and replacement of any and all defective par Ls; such inspection, cleaning and adjustment shall take place as to each unit at least once per calendar month. 2- The Commany 'shal.l. i amp on a group rclam tg basis The thlag shad shall be based on a depletion curve, not to escec3 twelve (12) months. Lamps shall he General Electric, Sylvania, Westinghouse or approved equal. 3. The replacement and/or repair of any and all defective parts of the controller mechanisms of any unit, or any part thereof, as may be necessary for the operation there, 4. The cleaning, polishing, and inspection of all lenses and reflectors in each • unit at the time the signals are relamped. All broken or deteriorated parts will be replaced or changed as necessary. 5. Daily visual inspections at intersections throughout the City to insure the prompt replacement of burned out lamps including highway safety lighting, illuminated str name signs, and repair of controller malfunctions, pedestrian push buttons, detectors, etc. , and to insure the traffic signal progression of all units according to timing relationships determined by the City Manager. ' • 6. The servicing of the signal systems on an emergency basis in the event of • malfunctions of the controller or signal systeM. 4. ANSWERING SERVICE CALLS Tho Company shall maintain a 24-hour emergency service so that he may be contacted at any hour of the day or night with no exceptions to holidays and weekends and will be required to answer different types of calls, as specified below, within certain time limits. The Company shall supply the City Manager and the Police Chief with a telephone number from which his radio operator may be contacted at all hours. If this telephone number is a toll number, the City will reverse the charges. a) Emergency Calls. Whenever the signal is malfunctioning in any manner, the Comoanc shall answer the call immediately, regardless of the fact that the controller may have been switched to flashing operation by the Police Department. The word "immediately" is construed to mean with all possible haste, and shall not exceed two hours. The above will also apply to any calls indicating the existence of danger to the motoring public caused by the signal control or the lack thereof. b) Light out calls. Two separate indications will be required for each direction of traffic at all times. When this number falls below two, or if one red indicator is out, the Company shall answer the light out call as soon es passible, not to exceed 2 hours, day or night. In the event a light out call is received with the report that two indicators are still remaining, the Company shall answer the call within 24 hours. c) Other emergency service. The services shall include, but not be limited to, part replacement or repair, including burned out lamps, lenses, reflectors, 'visors, light contacts, repairable relays, back plates, push button signs, controllers, coordinating units, interconnect units, time switches, head orientations, etc. d) Illuminated street name signs. The illuminated street name signs shall be serviced and maintained at locations shown in Appendix "B". Burned out lamps, and ballast shall be replaced within 72 hours, since the delivery of panels by the vendor requires 3-4 weeks, panel replacements shall be ordered by the Company within five (5) days. • c) ilighwny safety lighting. The highway safety lights shall be serviced and main- tained at 1.ocationn sho,m in Appendix "B". Burned out lamps and/or ballast shm be replaced within 72 hours. The luminaire reflector and/or refractor shall be cleaned at the time of lamp replacement. f) Equipment required. The Company shall be equipped with spare parts sufficient to place the signal back in operation for ordinary trouble calls. In those cases where a complex controller or component has to be repaired, the Company shall be required to furnish and install a substitute controller or component until the defective controller or component is repaired or replaced to its original condition as originally installed. The Company after performing any temporary emergency work shall have thirty (30) days in which to complete permanent repairs. All permanent repairs shall be to the level that existed ' prior to- the need of the emergency work. 5. EXTRAORDINARY MAINTENANCE Whenever any part of the signal system is damaged by, collision, Acts of God, or malicious mischief, excepting damage resulting from the negligence of the Com-,any while on the job, the repair of such damage will' be paid for as extraordinary maintenance. In addition to this, the replacement of vehicle detectors, pedestrian signal neon tubes and transformers, emergency service calls, flourescent street name signs, highway safety lights, or any revision work the City may request the Company to Perform will be paid for as extraordinary maintenace_ All extraordinary maintenan will be subject to the prior approval of the City Manager. If the Company receives a night call that requires the replacement of damaged equipment, he shall put the. signa in a temporary operating condition if damage is of a minor nature, otherwise the Company shall, if unable to restore temporary operation, place the signal on flashing operation if possible. If the signals arc damaged to the extent that they have to be shut down, the Company shall call the Police .Chief to provide traffic control until - the signal can be repaired. In no case will the Company perform extraordinary main- tenance without first obtaining the prior approval of the City Manager_ 6. COMPENSATION City shall pay to Company the sum of $92. 88 per month for each intersection as set forth on Iixhibit "A" for the traffic signal preventive maintenance program. Company shall be entitled to additional compensation for extraordinary maintenance. Billing for extraordinary maintenance shall include only the following: a) Company's invoiced material cost plus 15 per cent. b) Company's labor costs established as N/A per hour to be reviewedannually annual iy by the City Manager. Please see schedule A & B attached. c) Equipment rental to be revised annually by the City Manager. Upon receipt of each monthly invoice and certification by the City Manager, the City will, within thirty (30) days after receipt of such invoice, pay to the Company all certified sums. In addition, .the Company will furnish to the City a monthly summary of all work performed within the City, with the location of service, the day and approximate time, the reason for the service, whether routine or emergency, and the hours spent. • • 7. •Ix5upj.NCR REQUIREMENTS IN CASE OF A CONTRACT Company shall carry public liability and property damage insurance covering its operations and obligations hereunder in an amount not less than $1,000,000 for injuries, including accidental death, for any one person, and subirvt to the same limit for each person in an amount not less than $500,000, and pro:. Gty damage insurance in an amount not less than $100,000 per each occurrence. The Company shall also take out and maintain during the life of this contract, Workman's Compensation insurance covering all of his employees on the project, with a company satisfactory to the City and shall furnish to the City certificates issued by such companies showing that all of the above mentioned insurance has been issued and is in full force and effect prior to commencing work in accordance with this agreement. The Company shall he responsible for the insurance coverage as herein provided of all employees of said Company. Said insurance shall provide that the same in non-cancellable except upon ten (10) days' written notice to the City. In case any employee engages in hazardous work under this contract and is not protected under the Workman's Compensation Act, the Company shall provide or cause to he provided, appropriate insurance for the protection of all such employees not otherwise protected. The Company shall likewise'obtain public liability and property damage insurance to cover vehicles used or maintained by him in the performance of said work connected withthis Agreement, with liability limits of not less than • $300,000 for any one person, and $500,000 for any one accident, and property damage of $100, 000. If the Company fails to maintain such insurance, the City may obtain such insurance to cover any damages which said City or its principals may be liable to pay through any of the operations and deduct and retain the amount of the premiums for such insurance from any sums due. • Nothing herein contained shall be construed as limiting in any way the extent to which the Company may be held responsible for payment of damages to persons or Proper- resulting from his operations or any operations of any subcontractors under him. Company will be required to indemnify and hold harmless City and its officers and employees from any claims, damages or expenses, including attorney's fees and court costs, arising out of Company's performance. The City to be named as an additional insured on the Company's master policy. S. ASSIGNMENT Company shall not assign this Agreement or any portion hereof, without first obtaininc the written consent of City. If such assignment is made or attempted by Company, City, at its sole opton, may terminate this Agreement upon the giving of a 24-hour written notice to Company of such termination. 9- TERli This Agreement shall be in full force and effect for a period of one (1) year, and ray be extended upon mutual consent of both parties. 10. TAIG`'SNATION OF CONTRACT a) In the event that any of the provisions of this contract are vi.ol.ated by the Company, the City may terminate the Contract by serving wri ':ten notice upon the Company of its intention to terminate such Contract and, unless • within ten (10) days after the serving of such notice, such violation shall cease, the Contract shall, upon the expiration of said ten (10) days, cease and terminate. As to violations of the provisions of this Contract '-'hi& cannot he remedied or corrected within ten (10) days, said Contract shall be, at the option of this City, ceased and terminated upon the giving of like notice. In the event of any such termination of any of the reasons above mentioned, the City may take over the work and prosecute the same to completion by contract or otherwise for the amount and at the expense of the Company. b) If the Company should neglect to prosecute the work properly or fail to perform any provisions of contract, the City, after three (3) days' written notice to the Company may, without prejudice to any other remedy it may have, make good such deficiencies, and may deduct the cost thereof from the payment then or thereafter due the Company, provided, however, the City Manager of said City shall approve such action and certify the amount thereof to be charged to the Company. 11. NOT AN AGENT OF CITY It is expressly understood and agreed that the Company given the Contract will be responsible for furnishing all labor, service, materials and equipment and performing the work as provided for, is acting as an independent Company and not as an agent, servant or employee of the City of Rosemead. 12. STATEMENT OF QUALIFICATIONS The contractor must be highly skilled and specialized in traffic signal systems maintenance. Maintenance work should be the only business of the firm so that no business conflict will arise between maintenance and construction. The contractor must be familiar with a variety of equipment, have substantial parts inventory- and have sufficient equipment to adequately perform the contract_ This can best be assured by demonstrable past experience in the maintenance of traffic signal systems similar to Roseniead's. A positive answer to the following question should assure that this minimum requirement is met: Has your firm been engaged for at least three years solely in the maintenance of traffic signal systems in at least one jurisdiction with equal or greater numbers of signalinstallations than Rosemead? Answer: Yes X No if the answer is Yes, please list the following: • Total numer of years' experience: Eighteen (18) b • Jurisdiction Served No. of Fixed. No. of Actuated No. of Years Contract Time Signals Signals with this jurisdiction has been held — . Monterey Park 11 27 18 Years Montebello 22 35 16 Years Covina 7 22 16 Years 13. 'TOTAL BID PRICE FOR ORDINARY MAINTENANCE SHALL BE: • a) Traffic signals, 32 at $42. 88 per intersection, per month, for a total of $1, 372 .16 per month, as of the bid date. b) Safety lighting luminaires, at N/A , per luminaire, per month, for a total of N/A per month as of the bid date. c) Total per month (a and b) above N/A d) Total per hour labor for extraordinary maintenance, as of the bid date (Please see schedule A s B attached) /J Signed /G/�" r��'�^" • i mr/� Signal Maintenance, In C./ 2720 E. Regal Park Drive Anaheim, Ca. 92806 Date February 3, 1981