CC - Item IV.CC-C - Authorization To Reject claim Against City From Tao S. LauTO: HONORABLE MAYOR
AND MEMBERS
ROSEMEAD CITY COUNCIL
FROM: NANCY VALDERRAMA, CITY CLERK, CMC
DATE: APRIL 19, 2000
RE: AUTHORIZATION TO REJECT CLAIM AGAINST CITY FROM TAO S. LAU
The attached claim was received in this office on January 25, 2000. A copy was sent to the City's
claims adjuster, Carl Warren & Company on February 16, 2000.
Carl Warren & Company sent a notice on February 28, 2000, recommending that the
aforementioned claim be rejected by the City.
Recommendation:
It is recommended that the City Council approve the rejection of these claims and authorize a
letter of rejection be sent to the claimant.
COUNCIL F.C-EHV% A
APR 2 5 2000
ITEM No.TT d-L-:C
staf epor
MAYOR:
JOE VASOUEC
MAYOR PRO TEN!:
MARGARET CLARK
COUNCILMEMSERS:
ROBERT W S~-,IESCH
JAY T. 1AP[R:AL
GARY A, TAPLGR
oscsocad
8838 E. VALLEY BOULEVARD • P.O. BOX 399
ROSEMEAD, CALIFORNIA 91770
TELEPHONE (626) 288-6671
FAX(626)307-9218
'p-
February 16, 2000
Dwight J. Kunz
Senior Account Manager
750 The City Drive, Suite 400
Orange, CA 93665
RE: TAO S. LAU
Dear Mr. Kunz:
The attached claim was received in my office on January 25, 2000. The claim was forwarded to
the City Engineer's office to determine whose street project this is. The City Engineer determined
that the project and excavation was done by Pacific Bell. Photographs of the filled excavation are
attached.
Please advise us of the steps you wish to take in this matter.
Sincerely,
,,7
NIANCY VALDERRA to
City Clerk
City of Rosemead
Attachments
cc: City Attorney
FILE t^ CLAIM FOR DAMAGES
REoERVE ROR FILING STAI AP
clrY ct~~h'S OFFICE E
TO PEP.SON OR PROPERTY
CLAIM ND.
INSTRUCTIONS
r
'fLF
1. Claims for death, injury to person or to personal property must be filed not later than six
,
C 'TTY
months after :he occurrence. (Gov. Code Sec 911.2.)
- - T • "
2. Claims for damages to real property must be filed no: later than 1 year after the o_curren^_e
(Gov. Code Sec 9112.)
JAN 2 5 20DD
s Read entire claim form before filing.
a. See page 2 for diagram upon which to Ixale place of accident
5. This claim form must be signed on page 2 at bonom.
C: i v-";('J
E Attach separate sheets, if necessary, to give full derails. SIGN EACH SHEET.
Date o: Birth of Claimant
O: Ci=i OF ROSE?~ D, 663S V211e Si d. , Rosemead 1770 I
9
Name of Claimant .
I
Occupalion of Claimant
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T~ ~t~ r~05E.rn cs
an
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Home kddmss of Claimant City and Sate
Home Telephone Number
7.411 Ecr~e ~r~ Cry g
-
Business fadress of Claimant City and Sate I
Businss Telephone Number
41 1, 4 S-rt r1,, r . C I 9/irSt
C ib- ?cv 3~c
'
Give address and telep e number to which you desire notices gr communications to 5e sent
s Social Security No.
Claimant
re_carding this claim: / ]
y -JH~2 Ic"L C!//r 9/ 4n
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7 ~S'
When did DAMAGE or INJURY occur? Names of any city employees involved in INJURY or DAWAG--
Date r - %-1 - co Time ' 1;'-
If claim is for Equitable Indemnity, give date claimant served j ^
with the complaint: /T
Date
Where did DAMAGE or INJURY oc--ur? Describe rully, and locate on diagram on reverse side of this sheet. Where appropriate, give street
names and address and measurements from Iandmarim:
Des= ice in de:ail how the DAMAGE or INJURY occurred.
^ T ~iCKS ~ TiP rcr+Cr L,%
IL to
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Why do you claim the ciy is responsible?
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Describe in detail each INJURY or DAIJ.AGE
SEE PAGE 2 (OVER) THIS CLAItd MUST BE SIGNED ON REVEi45t SIUt
The amount claimed, as of the dale of presenlalion of this claim, is computed as follows:
Damages incurred to date (exact): Estimated prospective damages as far as known:
Damaoe to property S Future expenses for medical and hospital care S
Expenses for medical and hospital care .........5 Future loss of earnings .......................5
Loss of ea. nings S Other prospective special damages S
5
Special damages for ........................5 Prospective general damaoes.....
Total estimate prospective damages ..........S
General damages ...........................S
Total damages incurred to date S
Total amount claimed as of date of presentation of this claim: S
Was damage and/or injury investigated by police? f4c - If so, what city?_
Were paramedics or ambulance called? 1,t- If so, name city or ambulance
If injured, state date, time, name and address of doctor of your first visit W / A
WITNESSES to DAI✓,AGE or INJUP,Y: Lis all persons and addresses of persons known to have information.:
Name Address
Name
Name
DDr-7JRS and HOSPITALS:
Hospital
Do. or
Dr_ or
Date Hospitalized
Date of Treatment
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 a =ident 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 "&1" and the point of impact by "X:'
If City Vehicle was involved, designate by letter "A" location of City NOTE: If diaorams below do not fr, the situation, attach hereto a proper
Vehicle when you first saw it, and by "B" location of yourself diagram sioned by claimant.
CURB
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Cn_Ci:. W9EEL C LATERAL tl-,i
t,T 1S E: T;;LT i:;L =i1!1"' r=;.
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CITY n_ F?nc .y./cb`:~
FEB 2 8 2000
CITY C' .','S OFFICE
GOVERNMENTAL ENTITY PRELIMINARY REPORT
TO: Carl Warren & Coy DATE: 02/25/00
75/ranCA rive, Suite 400 CLAEMANT: Tao S. Lau
O92868 FILE NO: S 101939 DBK
D/EVENT: 01/22/00 FILING DATE: 01/25/00 SIX MOS.: YES
PRINCIPAL/CITY: CJPIA/City of Rosemead.
RECOMMENDED ACTION ON CLAIM: Rejection.
FACTS: The claimant alleges damaging his tire and wheel at an excavation site. The City
confirmed the excavator is Pac Bell.
POSSIBLE CO-DEFENDANTS: Pac Bell.
EVALUATION: Doubtful liability. The confirmed they were not a part of the excavation.
RESERVES TYPE OF CLAIM AMOUNT
1. Tao S. Lau LPD $300.00
COMMENT/WORK TO BE COMPLETED: Diary for a copy of the rejection letter to the
claimant, by the City. Our further report will follow shortly.
Very truly yours,
Wq Y c✓c: City of Rosemead, Attn. Nancy Valderama
cc: CJPIA - Attn.: Executive Director
CARS, 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
February 25, 2000
Tao S. Lau
2452 Earle /Avee
Rosemead, RE: Principal CJPIA
Member City
Rosemead
Claimant
Tao S. Lau
D/Incident
01/22/00
Our File
S101939DBK
Dear Mr. Lau:
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.
Our investigation reveals that Pacific Bell was conducting the excavation in the area of your
complaint. You may consider submitting your claim to Pacific Bell.
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,
cc: City of Rosemead
cc: CJPIA
CARL WARREN & CO.
Deborah Been
CARL WARRIE- & C®.
CLAIMS MANAGEMENT-CLAIMS ADJUSTERS
750 The City Drive . Suite 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
I
February 21, 2000
FEB 2 8 2000
- ~ oFr-icy
CITE, r
TO: City of Rosemead
ATTENTION: Nancy Valderrama, City Clerk
RE: Claim
Claimant
D/Event
Rec'd Y/Office
Our File
Lau v. City of Rosemead
Tao S. Lau
22-Jan-00
25-Jan-00
S-101939-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.
cc: CJPIA w/enc.
Attn.: Executive Director
Very truly yours,
CARL WARREN & COMPANY
Dwight J. Kunz
CAS WARREN & C®.
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. (80D) 572-6900. Fax: (714) 740.9412