CC - Item 4D - Staff Report - Authorization to Reject Claim Against City by Herman Miller M�
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puo stafte ort
TO: HONORABLE MAYOR
AND MEMBERS
ROSEMEAD CITY COUNCIL
FROM: NANCY VALDERRAMA, CITY CLERK
DATE: MARCH 17, 1998
RE: AUTHORIZATION TO REJECT CLAIM AGAINST THE CITY BY HERMAN
MILLER
The attached claim was received in this office on March 2, 1998, on behalf of Herman Miller. A
copy was sent to the City's claims adjuster, Carl Warren & Company on the same day.
Carl Warren & Company sent a notice on March 4 , 1998, 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.
:nv
.w.nsenaa COUNCIL AGENDA
MAR 2 4 1998
ITEM No.-✓ Le--D
— J
RECEIVED
OSEMEAD
�______ CITY OF 11998
�J//�J////�J////// MAR 1 i 1998
CITY CLERK'S OFFICE
GOVERNMENTAL ENTITY PRELIMINARY REPORT
TO:Carl Warren Company DATE: 03/09/98
750 City Drive, Suite 400 CLAIMANT: Herman Miller
ange, CA 92868 FILE NO: S 96924 DBK
D/EVENT: 02/22/98 FILING DATE: 03/02/98 SIX MOS.: YES
PRINCIPAL/CITY: CJPIA/City of Rosemead.
RECOMMENDED ACTION ON CLAIM: Rejection.
FACTS: The claimant's wife veered into a pole in the center median.
POSSIBLE CO-DEFENDANTS: None.
EVALUATION: Doubtful liability. The claimant's wife is at fault.
RESERVES TYPE OF CLAIM AMOUNT
I. Herman Miller LPD L 3.100.00
COMMENT/WORK TO BE COMPLETED: Diary for rejection from the City. Our
further report will follow shortly.
Very truly yours,
CARL ? r
& COPANY
go aDEboYah Been
cc: City of Rosemead, Attn. Nancy Valderama
cc: CJPIA - Attn.: Executive Director k
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)572-5900•Fax.(714)7409412
March 9, 1998
Herman ' ler
P.O. B 66113
Los . ngeles, CA 90066
RE: Principal CJPIA
Member City : Rosemead
Claimant Miller
D/Incident 02/22/98
Our File S 96924 DBK
Dear Mr. Miller:
As claim administrators for the self-insured City of Rosemead, we have made a careful
examination of the circumstances surrounding the captioned occurrence and feel we have
enough evidence to make a decision on your claim. After evaluating the facts, we have
reached the conclusion that our principal is not responsible for this occurrence. We are
sorry we are unable to recommend settlement of your claim to our principal.
This letter does not affect the notice that will be sent to you by the City of Rosemead
regarding disposition of your claim.
Very truly yours,
CARL WARREN & CO.
Deborah Been
cc: City of Rosemead
cc: CJPIA k
CARL WARREN & CO.
CLAIMS MANACEMENT•CLAIMS ADJUSTERS
750 The City Drive•Suite 400•Orange,CA 92668
Mail:P.O.Box 25180•Santa Ana,Ca 92799-5180
Phone:(714)740-7999•(800)572-6900•Fax (714)740-9412
C���
March 4, 1998
RECEIVE
CITY OF ROSEMEAD
MAR 91998
CITY CLERK'S OFFICE
TO: City of Rosemead
ATTENTION: Nancy Valderrama, City Clerk
RE: Claim Miller v. City of Rosemead
Claimant Herman Miller
D/Event 22-Feb-98
Rec'd Y/Office : 02-Mar-98
Our File S-9'(,924-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
41
Dwight J. Kunz
cc: CJPIA 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 92799-5180
MAYOR: �A,J eh, , A mead
MAYOR:
IMPERIAL
MAYOR PRO TEM: *AI'S
ROBERT N'.B UESCH•
ff* 8838 E. VALLEY BOULEVARD - P.O. BOX 399
M
ouRcaMEusERs: • ROSEMEAD,CALIFORNIA 91770
MARGARET RTTETORA TcTELEPHONE(818)288-6671
• MARGAL
JOE VASQUEZ TELECOPIER 8183079218
March 2, 1998
•
Dwight J. Kunz
Senior Account Manager
750 The City Drive, Suite 400
Orange, CA 92668
RE: HERMAN MILLER
Dear Mr. Kunz:
The attached claim was received in my office on March 2, 1998. The City does not have any
prior information on this claim other than the attached Sheriffs Department Accident Report.
Please advise as to the steps you wish to take in this matter.
Sincerely,
J )6
NANCY V ALDERRA VLA
City Clerk
Attachments
cc: City Attorney
sIailms:ak r:1
•
FILE WITH:
CITY CLERK'S OFFICE CLAIM FOR DAMAGES RESERVE FOR FILING STAMP
TO PERSON OR PROPERTY CLAIM NO.
_ INSTRUCTIONS RECEIVED
1.Claims br death,injury to person or to personal properly
must be filed not later than six CITY OF ROSEMEAD
months after the occurrence.(Gov.Code Sec 9112.)
2.Claims for damages to real property must Defiled not later than 1 year after the occurrence. MAR 21998
(Gov..Code Sec 911.2.)
3.Read entire claim form before fling.
4.See page 2 for diagram upon which to locate place of accident
S This claim form must be signed on page 2 at bottom. CITY CLERK'S OFFICE
&Attach separate sheets,if necessary,to give lull details.SIGN EACH SHEET.
Date of Birth of Claimar)1,�J
•
TO: CITY OF ROSEMEAD, 8838 E. ,Valley Blvd: , Rosemead 91770 � --/a? e.5 /
Name opfcl-aim�T;1 Occupationot Claimant
r M la-eti , c{l, GS
IJ,�eAddresso Claimant City and State Home Telepho a umber ^�� , FC�
Xo - AOC GG Fr tia4-- �f3-6
Bess Address ofarmft Cc City and State �fusiness Teljone Nuwbe,{ / .1
19, 4 d �1 j}J2�� d�3 Q d forv_
Give address and telephone number to which you desire notices or communications to be sent Clhimant's Social Security No.
�y�-- /5/
regarding this claim:
�� o vG /
U 1p
.'rj�y a
When did DAMAGE or JL)Rxgccur? L5--A.c./ Names of any city employees involved in INJURY or DAMAGE
Date 2��a tmeIf / / v �./�
Dclaim u fo E e: a Intlemniry,Dive dale claimant served R/
with the CO IS•1.'_,_;_j_,...,
Date — appropriate,give street
Where di aT r INJURY occur?Describe nilly,and lo/^�a.ta on diagram on r //rse�side of this sheeet/�Chere
names and address and measurements from landmarks: [:i es a v WA 'U Gj `� x.c uC U�ocL Cf
c- -e--- r C,F�
' o.vl v F �1cP �c As A regsf E �o, c' / e_ d
--‘l('cCc-c ) TRer i3 Lo 7 ETA 6Cmb I/ a'77Jc/
Describe in detail how the DAMAGE or INJURY occurred. �—`'reit / ' ' ?' fel &,r G 7C_
CEGCa 4 ryes 3 ci-'C Es
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Why do you claim the city is responsible? �r U iO ,c<
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Chow �, tiEs o ti ST
Cee% v�� � � T�sr ✓� �� � Cr �
roti G ass
Describe in detail each INJURY or DAMAGE U dr
EG -0 C..--/
/c & P _.,„o ��
LG pot- r 0, Ay /7 - NlE./CC) `JC r°
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): p HerEstimated prospective damages as far as known:
Damage to property S/900 0a Future expenses for me al d hosPia care $
Future loss of earnings Popoq.$s.a ><3c
Expenses for medical and hospital care $ pp $
Loss of earnings,•.::.:i.:.......... .. .. . _..$ /poo — Other prospective special damages
$ Prospective general damages 5
Special daltiag , . . - $
T — Total estimate prospective damages
General damages 1 6 Lk., J 7 $ �O-'
Total damages incurred to date $ 3o �`00 0( E� /� ) kYa9 f^1 I et>
Total amount claimed as of date of presentation of this claim: $ /\/' p/3ritS , P 1
o d�T�r ` /
Was damage and/or injury investigated by police? If so,what city? %ifEa' )
ff
Were paramedics or ambulance called? 22 If so,name city or ambulance j�
If injured,state date,time,name and address of doctor of your first visit
WIT -{g�GES to DAMAGE o INJURY/List all persons and addresses of persons known to have information: �'� 1 5-0q
Nank lKil sr,/ IGC S.2.7- #
Address tie.° Piga: 05 r .
Name Address Phone
Name Address Phone
DOCTORS and HOSPITALS:
Hospital Addr- - Date Hospitalized
Doctor -.dress Date of Treatment
Doctor Air Address Date of Treatment
READ CAREFULLY
oryour vehicle when you first saw City vehicle;location of City vehicle
For all accident, as, South,place on West:indicateng diagrzm namese al accidentdnbyts,
including and North, ngt, and esssplace streetr by theat time off accident by"A-1"and locationthe of yourselfpoint or your vehicle at
" If and by showing house designatesers or distances to not City NOTE:time diagrams the accidentldo"&tfi and ot impact to a)pC
If City Vehicle was involved, by letter"A"location of City If below not fit the situation,attach hereto a proper
Vehicle when you first saw it, and by "8" location of yourself diagram signed by claimant.
ff
SIDEWALK /
CURBS --, _:-- r
CURB
/ PAR
SID (AL1( ,,,_,
'ii/rr tai"'/ GQ �l A C cc/(- ----2
"
/!r 1 / '"l�r� l/ Date:
Signature of Claimant or person filing on Typed Name:
his behalf givin• elationship to Claimant ^ ^ t
NOTE: G •IMS MUST BE FILED WITH CITY CLERK(Gov. Code Sec 915a). Presentation of a false claim is a felony(Pen. Code Sec 72.)
C''TATE OF LWFOFNA
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PROPERTY "c)- -- F f P �SEMCIITO a3as Us<u e BBL-,-/c) , 1-o ScME3A ,CA .6417)
C0. 7)za 21J"
—DAMAGE Nmy,c,„II} 51e>N AHT.� 2 Nlm`A . (a-) -Tf-�S Ala'R-e,'. 10` V;lola-G S*CFre.r3� o(r
SEATING POSITION SAFETY EQUIPMENT _ EJECTED FROM VEHICLE
L.YR BAG DEPLOYEDilLCILLEAWILI
0-NOTEJECTED
/_ l A-NONE IN VEHICLE Y-AIR RAG NOT DEPLOYED DRIVER • I.FULLY EJECTED
S-UNKNOWN M-OTTER Y.NO 2-PARTIALLY EJECTED
�1 0-LAP BELT USED P-IIOT REQUIRED VI-YES S-UNKNOWN
I DRYER D•LAI BELT NOT USED
2 3 2 TO II.PASSENGERS E.SHOULDER HARNESS USED CHILD RF9TRAM PASSENGER
4 5 6 T-S1APON WAGON REAR F-SHOULDER HARNESS NOT USED K-Ip
2-REAR OCC.TRK OR VAN G.•LAP/SHOULDER HARNESS USED O-IN VEHICLE USED Y-YES
2-POSPDX UNKNOWN H.LAP/SMOULDER HARNESS NOT USED R-IN VEHICLE NOT USED
0-OTHER -PASSIVE RESIRMNT USED S-IN VEHICLE USE UNKNOWN
7 K-PASSIVE RESTRAINTNOT USED I•IN VEHICLE IMPROPER USE
L I RESTRAINTU-NONE IN VEHICLE
ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK I•1 SHOULD BE EXPLAINED IN THE NARRATIVE
PRIMARY COLLISION FACTORTRAFFIC CONTRCI DEVICES 2 'J TYPE OF YEHLLE 'j •J MOVEMENT PRECEDING
UST NUMBER (I) OF PARTY AT FAULT COWS'ON
Avc SECTION n ouTED: C'BDn ACONTROLS EUNCnOMNG SL APASSENGER CAR/STATION WAGON ASTOPPED
221 J
10c.. Es) B CONTROLS NOT FUNCTION/1G' BPASSENGER CAR W I TRAILER B PROCEEDING STRA)GHT
B OT RED IMPROPER DRIVING': C CONTROLS OBSCURED C MOTORCYCLE I SCOOTER C RAN OFF ROAD
�ONO CONTROLS PRESENT/FMM1' D PICKUP On PANEL TRUCK D MAKING RIGHT TURN
C OTHER THAN DRIVER• TYPE OF COLLISION ERLKUP/PANEL TRUCK W/TRAILER E MAKING LEFT TURN
D LINKOWN• AHEAD-ON F TRUCK OR TRUCK TRACTOR F MAKING U TURN
• EEELL ASL P BEDESWIFE GTRUCK/TRUCK TRACTOR W/TWA OBACKINO
1
C REAR END H SCHOOL BUS I'1 SLOWING/SWAPPING
WEATHER( MARK 1 TO 2 ITEMS) D BROADSIDE I OTHER BUS I PASSING OTHER VEHICLE
I ACLEAR X E FIT OBJECT J EMERGENCY VEHICLE J CHANGING LANES
Kr CLOUDY F OVERTURNED K HIGHWAY CONST.EQUIPMENT KPARKING MANEUVER
)/C RAINING G VEHICLE H PEDESTRIAN L BICYCLE L ENTERING TRAFFIC
D SNOWING H OTHER': MOTHER VEHICLE ?G MOTHER UNSAFE TURNING
E FOG/VIVWUTY FT. MOTOR VEHICLE INVOLVED WITH N PEDESTRIAN N XING INTO OPPOSING LANE
IF OTHER : ANON.COUIVON OMOPED ()PARKED
G WIND ti PEDESTRIAN P MERGING
LIGHTING C OTHER MOTOR VEHICLE 0TRAVEUNG WRONG WAY
A DAYUGM D MOTOR VEHICLE ON OTHER ROADWAY ' 2
,J OTHER ASSOCIATED FACTM(S) R OTHER•:
B DUSK-DAWN E PARKED MOTOR YENCLE IMARK I TOI ITELLS)
)CC DARK-STREET UGHTS yF TRAIN ARSSCIIN ROL/M 2
D DARK-MO STREET COMM y&CYGE DHo
EDARK-STREETUuHGSNOT HANWL: BvcAfcnoN aunt: Ovo
0
FUNCTDNNG• ❑ND SOBRIETY-DRUG
ROADWAY SURFACE RUED OBJECT: vuyi, D 1 2 3 PHYSICAL
TDRY I Tct S CYC NL wMARK HTO EREM )
TACCJJ(TA' lava
6 WET LJ OTHER OBJECT: ONO `HAD NOT BEEN DRINKING
C SNOWY-ICY D TBIBD-UNDER INFLUENCE
D SLIPPERY(MUDDY.OILY•ETC.) E VISION OBSCUREMENT: T)HBD•NOT UNDER INFLUENCE'
F INATTENOON DHBD-HYPMRYEM UNKNOWN'
ROADWAY CON
pTIOWS) G 5TOP i GO TRAFFIC
(MARK Hi021RY5) ^/` PEDESTRIANS INVOLVED HENiEPoNGILF/.WMG RAMP
)( E UNDER DRUG INFLUENCE'
A NO PEDESTRIAN INVOLVED / F IMPAIRMENT-PHYSICAL'
_IA HOLES.DEEP RUT' CROSSING IN CROSSWALK IPREVIWSCOWSION Irk S IMPAIRMENT NOT KNOWN
J UNFAMILIAR WITH ROAD
B LOOSE MATERIAL ON ROADWAY• BAT INTERBECRON )(OEFECVE VEILEQUIP.: D 111
C OBSTRUCTION ON ROADWAY' CROSSING IN CROSSWALK-NOT DNn NOT APPLICABLE
ISLEEPY/FATGUED
B A C ATIMERSECTION' G"" SPECIAL INFORMATION
' G REDUCED ROADWAY WIDTH D CROSSING-NOT IN CROSSWALK L UNINVOLVED VEHICLE AHAZARDOUS MATERIAL
E IN ROAD.INCLUDES SHOULDER MOTHER':
F NOT IN ROAD X N NONE APPARENT
>QH NO UNUSUAL CONDITIONS G APPROACH NG I LEAVING SCHOOL BUS 0 RUNAWAY VEHICLE I
:SKETCH ^I/ MISCELLANEOUS
T-W\1 110 = P/
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sHPASS PAGE 2( Rvv 141)0R 042
STATE OF CALIFORNIA
NARRATIVE/SUPPLEMENTAL GL
'CHP 556(Rev 7-90)ON 042 Page 3
DATE OF INCICENTKNUURRENCE TIME(24X/ NCC NUMBER OFFICER I.D.NUMBER !JUMPER
MPER53 9R-o53`}-26�
07_-22-`1a 25 no() -Poo3Z')
'K ONE 'S ONE TYPE SUPPLEMENTAL(A-APPLICABLE)
JSarrative ollision report 0 3A update ❑Fatal ❑Hit and run update
upplemental J Other: 0 Hazardous materials ❑School bus ❑Other:
CITYICOUNIYIJUDICLLLUSTHCTT PO
/, , n ,` REPORTING ISTRICTISEAT CITATION
Q-oSTTAeA / LAS KNC�E1t-.> / F-lo k't'ot-f00 o53"t 1553'-l-Aiv
LOCATON'SUBJECT /^� I STATE HIGHWAY RELATED KIND
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STATE OF CALIFORNIA •
NARRATIVE/SUPPLEMENTALPage �"
GNP 556(Rev 7-90)OPI 042 -- - - —'-
DATEOINCIDENLOCCURRENCE TIME(NM) - NCIC NUMBER
DATE
OFFICER ID.NUMBER NUMBER
0z -22-917 2.500 1900 Zcoo3Z'7 19g o3oCIA- o53`} -Z50
%'ONE 'Y ONE - TYPE SUPPLEMENTAL r%'APPLICABLE)
V ❑BA update ❑Fatal ❑Hit and run update
0 SuppnmOther:: report rd
❑COUNIVmemal ❑Otl,el' ❑Hazardous materials ❑School bus ❑OTIer_
REPORTING DISTRICT/BEAT CITATION NUMBER
Cf1YiLOUN1V/JUDICIALDISTHILT
STATE HIGHWAY RELATED
LOCATION/SUBJECT
/ ❑Yes El No
1. t . FACT'5 `ec`'T D-)
2. 3. MecsAiParFS
3. I . Amo, OF 3s^PHcrc
4.
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DATE: oZ- S
® THIS FILE TO STAND INACTIVE.
< > PROSECUTION TO BE SOUGHT AGAINST PARTY FOR VIOLATION OF
THIS FILE TO STAND INACTIVE.
< > PENDING RECEIPT OF WORKABLE INFORMATION, THIS FILE TO STAND
INACTIVE.
< > DUE TO LACK OF A WITNESS(ES) TO MAKE POSITIVE IDENTIFICATION OF
OF THE DRIVER OF VEHICLE #1, NO FURTHER ACTION TO BE TAKEN. THIS
FILE TO STAND INACTIVE.
< > THIS FILE IS UNDER INVESTIGATION. REPORT(S) TO FOLLOW. THIS REPORT
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< > PATROL ASSIGNMENT.
< >
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TRAFFIC INVESTIGATOR
ASSIGNED: TEMPLE STATION TRAFFIC