CC – Item 4C – Staff Report Payment of Claim Against City-Gene Eastwood y 9
�yw.„ staff report
TO. HONORABLE MAYOR
AND MEMBERS
ROSEMEADyCITY COUNCIL
FROM: RANK G. TRIPEPI, CITY MANAGER
\
DATE: NOVEMBER 18, 1998
RE: PAYMENT OF CLAIM AGAINST THE CITY-GENE EASTWOOD
unt of$425.87 filed by a Mr. Gene
Attached
astwoo , 2433 yourN.
considerationd forism in the
Avenue. Mr.
was not aware of the damage to the curb until Mr. Eastwood came into to City Hall and filed his
claim. City inspectors confirmed the damaged curb and the County Public Works crew repaired it
that same day.
Pursuant to Council Policy, property damage claims under $500.00 can be settled by the City.
Attached is a copy of the claim with supportive documents.
RECOMMENDATION
It is Eastwood signs sadrthat the elease form as of
$425.87 provided that as appro ed by the City Attorney. Mr.
COUNCIL AGENDA
NOV 2 41998
1 ITEM No. GC
FILE WITH. CLAIM FOR DAMAGES RESERVE FOR FILING STAMP
CITY CLERK'S OFFICE r CLAIM ND.
-- TO PERSON OR PROPERTY
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.9112.)
2.Claims for damages to real property must be filed not later than 1 year after the occurrence.
(Gov.Code Sac 911.2.)
a Read entire claim form before filing.
4.See page 2 tor diagram upon which to locate place of accident.
5.This claim form must be signed on page 2 at bottom.
5.Attach separate sheets,it necessary,to give full details.SIGN EACH SHEET.
Date of Birth of Claimant
•
TO: CITY OF ROSEI.EAD, 8838 E. Valley Blvd. , Rosemead 91770
Occupation of Claimant
Name of Claimant_ P; y er
HGhf l- .571cD
Hom=Address o!Claimant City and Slate Home Telephone Number
�o5einec)7 Cc„ [(626.) ,;,2 Sig 30-1 6'
BCity and State Business Telephone Numbery33 N � I<ar�B aVG
Business Address of Claimant w I/ ,,2 G ) s73 .� ?Db)
57001 ��rvs y goSenmPr�J7
Give address and telephone number to which you desire notices or communications to be sent Claimant's Social Security No.
regarding this claim: y -67
When did DAMAGE or INJURY occur?3 . c p Names of any city employees involved in INJURY or DAMAGE
Date //- 7 — 'y Time
1f claim is for Equitable Indemnity,give date claimant served
with the complaint:
Daleappropriate,give street
Where did DAMAGE or INJURY occur?Describe hilly,and locate on diagram on reverse side of this sheet.Where rO� tre 5?/'C�'r
names/� and address and measurements iromlandmarhs: ,j} ,rhZ Che) e€ G- pr• ve Y r e
/rtri r•? y re5idencC ' 14e 54rtrt 114‘-rnc 15 6 He et-VC .
Describe in detail how the DAMAGE or INJURY occurred. j Wc5 pc-r A eµ APAI//, W5 I uJ'^'.S PAI I 4we-y
fiery r e Curb , a )7 rCe Cc thet Curl vat y ;tic in the 5u++rr tt. e
ire.i-h +arc rnr55 .,2 if bit* the Reek tm'ter h ,i lf" ) ] + bouren( eA off
1tiCtt 6" b ) h , t�+ ti grafi c;�rrf er el cf rnr Cc-r
/
Why do you claim the city is responsible? )? f1 LJCNid/ f1C+ hC"V d
-Ff the 5t7CeY WG-5 f Pc pe 11 )9741 I rJ_Iie`'I ) ><5 i
Describe in detail each INJURY or DAMAGE the tum e u,5 +CIC f0 itilC WI\I rStrmC er •
tie where Titan' er pcne/ hcs fti be Kciair,4 mot 'Tu5-F the desk
fhe CehCre>LL .LC 011 )n yCc-
THIS CLAIM MUST BE SIGNED ON REVERSE SIDE
SEE PAGE 2(OVER)
The amount claimed, as of the date of presentation of this claim,is computed as follows:
damages as lar as known:
Damages incurred to date(exact): 5 14
�- s
Etimated prospective
/i 7 Future expenses for medical and hospital care 55
Expenses
xp
Damage;toor medical
5 Future loss of earnings
Loss of eafngediral arW hospital care .. ...... $ Other prospective special damages 5
Loss of earnings O �r 5/00,0cli' Prospective general damages $
Special damages for .It r�'f� Total estimate prospective damages 5
General damages $
Total damages incurred to date $ $
Total amount claimed as of date of presentation of this claim:
If so,what city?
Was damage and/or ambulance
investigated by police? I I so,name city or ambulance
Were paramedics or time, a e called?
If injured,state date,time,name and address of doctor of your first visit
WITNESSES to DAMAGE or INJURY:List all persons and addresses of persons known to have information: Phone
Name Address Phone
Name Address Phone
Name - Address
DOCTORS and HOSPITALS: Date Hospitalized
Hospital Address Date of Treatment
Doctor Address Dale of Treatment
Doctor Address
READ CAREFULLY -
or your vehicle when you first saw City vehicle:location of City vehicle
For all accident as,South,place on Westfollow;ng indicatediagmm names ofof dents.
including North, Fast, and West; itnplace of accident by thet corners. at time off the accidentt by and location of yourof impad by"X?
self or your vehicle at
''X"Iantl shewiagnvo "uby letter locas to tion of City OfE:eI diagramsbeowbdo not fit the situation,1" and the attach hereto a proper
If Citye Vehiclehewas involved,tw designate diagram signed by claimant.
Vehicle when you first saw it, and by "B" location of yourself 9 g
I
7///7/
SIDEWALK / 1,
CURB CURB
/ PARKWAY
SIDEWALK
///J
Signature of Claimant or person filing on Typed Name: Date:
his behalf giving relationship to Claimant:
Gem-- fps
+W°CP Ir/47-98
NOTE:CLAIMS MUST BE FILED WITH CITY CLERK(Gov. Code Sec.915a). Presentation of a false claim is a felony (Pen. Code Sec n.)
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AMAGE REPORT EASTWOOD
1/09/98 at 11 : 04 D.R. 34185-0003982
B 006506 Est : L. SALGADO
EL MONTE FORD BODY SHOP
FAX : 626-443-8926
11401 GARVEY AVENUE
EL MONTE, CA 91732-
(626) 448-7681
wner: GENE EASTWOOD Day Phone: (626) 288-0716-
ddress : 2433 N. EARLE AVE Other Ph: ( ) - -
ROSEMEAD CA 91770 Deductible : $ N/A
nsurance Co. : Phone:
Claim No . : Adj . :
0 FORD MUSTANG LX 2D SED BLUE 4-2 .3L-FI
in: 1FACP40A3LF133948 License: 2RWR881 CA Prod Date : 12/89 Odometer: 99641
ower steering Power brakes Tinted glass
ody side moldings Dual mirrors Driver airbag
loth seats Bucket seats Recline/lounge seats
lear coat paint Metallic paint
PART
O. OP. DESCRIPTION OF DAMAGE QTY COST LABOR PAINT MISC
1 QUARTER PANEL
2* Repr RT Outer panel 1 1 5 2 .5
3 Add for Clear Coat 1 1. 0
4* PIN-STRIPE 1 X 20 00
5
6* BLEND ADJACENT PANEL 1 1 . 0
7* COVER CAR FOR OVERSPRAY 1 0 ,3 T 7 . 50
8* COLOR SAND & POLISH 1 1 .0
9* HAZARDOUS WASTE DISPOSAL 1 X 2 ,98
Subtotals =__> 0 . 00 3 . 8 3 . 5 30 .48
Page: 1
•
4MAGE REPORT EASTWOOD
1/09/98 at 11 : 04 D.R. 34185-0003982
B 006506 Est : L. SALGADO
EL MONTE FORD BODY SHOP
FAX: 626-443-8926
11401 GARVEY AVENUE
EL MONTE, CA 91732-
(626) 448-7681
Parts 0 . 00
Body Labor 3 . 8 units @ $30 . 00 114 . 00
Paint Labor 3 .5 units @ $30 .00 105 . 00
Paint 3 .5 units @ $20 .00 70 . 00
Sublet/Misc 30 .48
SUBTOTAL $ 319 .48
Tax on $ 77 .50 at 8 .2500% 6 .39
GRAND TOTAL $ 325 . 87
INSURANCE PAYS $ 325 .87
Estimate based on MOTOR CRASS ESTIMATING GUIDE. Non-asteriskl'1 items are derived from the Guide DR2JC85. Database Date 1008
Double asterisk)") items indicate part supplied by a supplier other than the oriuinal equipment manufacturer.
CAPA items have been certified for fit and finish by the Certified Auto Parts Association.
NAGS Parr Numbers, Prices and Labor Times are provided from National Auto Glass Specifications, Inc.
EZEst - A product of CCC Information Services Inc.
Page: 2
INSURANChEEIALIST
FF411k119
(626)280-9731 (o26) -11
(626) 443-1166
ESTIMATE # 18885 by MARCO MANRIQUE
_1•- ••: Tim. i1 •4 • ri •n 1 -1";
ros la e ns. o.
111 2emar s BLUE Aopua'luster
reuse ima�
Home insure #
0
•"r--0 1 MUSTANG ]n/Jut�11 $1 . 11 lIc r
I • P C•1 1
# DESCRIPTION EST PRICE 1 LABOR 1 PAINT
1 REPAIR RT QTR 2.0
CLEAR COAT
4 COLOR SAND BURP 1
1 .5
4 BLEND PAd PANELSD• ri i v- I :J 1
TIMATE MMAR 1 1 air gg((77 yy q
0A1 �ll • 1 HA AR AbSTE T. 10 1
1
It
11 II II I
I I1. II
1or nrs. ems (I.
a a:or• .1 I.
aX L . 1. b :.
r.n1 Tst. 1 $ 6 .
r*rrrr++rrr.r�rrrrrrr
AUTHORIZED
nDr AND ACCE Part Prices Subjecteato Invoice payment
willCbIZft AuD ACCEPTED: You are le, iy luding addito make the above rdamaued charges, I understand that want in full
wireleasell of rate the car, truckaorr vehicle herein t descri'bea ona streeet,?udhighways o anelsewhere/forYt e
ec ree the amountgofurf epairsathereto. An express
wills not be helds lien
sponsiblee for acknowledged
damage above
vehicle truck
articleshleft tin
o
vehicle in case or fire theft accident or any other cause beyond our control.
SLD PARTS REMOVED BROM CARS WILL BE SUNEED UNLESS OTBEP:ISE INSTRUCTED.
ESTIMATE autboiiaed by ate
Thank you for coming to our shop for your repairs.
Collision Shop iht Mitchell
International
yrgt1993 All Rights Reserved