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CC - Item 4C - Reject Claim - Roberto Gordon QF 1 ®®, � % staff, eport TO: HONORABLE MAYOR AND MEMBERS ROSEMEAD CITY COUNCIL �l FROM: NANCY VALDERRAMA, CITY CLERK DATE: APRIL 7, 1999 RE: AUTHORIZATION TO REJECT CLAIM AGAINST THE CITY -ROBERTO GORDON The attached claim was received in this office on February 2, 1999. 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 19, 1999, recommending that this claim be rejected by the City. RECOMMENDATION It is recommended that the City Council approve the rejection of this claim and authorize a letter of rejection be sent to the claimant. :nv i ..Rasta& COUNCIL AGENDA APR i 31999 ITEM No. T G FILE CITY CLERK'S K'SSOFFICE CLAIM FOR DAMAGES RESERVE FOR FILING STAMP TO PERSON OR PROPERTY CLAIM NO INSTRUCTIONS ^r r F e t ,r c t Claims for death,injury to person or to personal property must be filed not later than six ['t - months after the occurrence.(Ow.Code Sec 511.2) C!TY nit PI 2.Claims for damages to real property must be filed not later than 1 year atter the occurrence. .- (Soy.Code Sec 911.2.) FEB `Z a Road anile claim form before filing. 1999 <.See page 2 for diagram upon which to Ioa%e place of acident 5.This claim form must be signed on page 2 at banter. M' CLERK'S OFFICE S Ana:h separate sheet,it necessary.to pave full derails.SIGN EACH SHEET. Dale of Birtho'Claimant TO: C.P.' Or ROSE'EAD, 6536 E. l'zlley bh•d: , Rosewezd 91770 of'Claimant • Name of Claimant Occupation of Claimant /./ice/i 4Pir/4.-2 <� int 7/f .52245277C..."(7 Home Address of Claimant 9A78y Ci 'and Stale Home Telephone Number Business Address of Claimant Oily and State Business Telephone Number 9S5.-ts /1/4/Ay 41a/darr/ Asegn��a(7 ( 2&1 Zs8Z - Sh4. • Give address and ielephI number to which you desire notices or omrnuniations ID be sent 1 Claimant's Social Security No. regarding this claim: ✓1// S/ 2Gie t�J/6 / /��AIURY///fir 3-ci- 67-SAC/C. Wren did DAMAGE or INJURY occur? rd Names of any oily employees involved in INJURY or DAMAGE Date 4e'--2n ' r—fdt/ me -vs T,:.,- -L:. / II clam-1s auitable Indemnity,Dive date C /aiman?served //:,,vv,,.,-- with the nmptain:: Date Where did DAMAGE or INJURY Dourr?Describe roily,and loate on diagram on reverse side of this sheet.Where appropriate,give street names and address and measurements from landmarks: Qriinoyc C��,.,-p/ 0,,2 SSSS Ua/Zy e./v, 072 .741c- a /dC Lr/ofi a� //J,/ L24-c.7-4 / D=escribe in derail how the DAMAGE o'INJ;JRY occurred T// f-'fy /Gr Z- c/ GU,--i� //- s,/.«/_ O/// Cf:4ruc LI-/47.<j .ate /l/G/ Dov 6cC v' GC-a-7_!/C7J ZG /J/// !//iota• ,--‘22,-,--,,..4. 6 �GS G'l✓/7ovG s .y r/l�,/' .n /72,17 1/...--7.4-,-2C..,7,--ss e.I c% fr. � G'p-f a/y. //7,7 i cfi-f<.ri ,"sf� mos �me- ',7sczo --r.-7y �4as r'>.�� v;r _ _ d.ar the::t :5 sp s:DIe? <.i. /�"/ l%/ /S /GGiS_,I Z i<a< 1 .� �7C ./io %/'a/S .7C","-,-_ // 7,;(1, Gr ermoi.,, i/ G':-:% / q: /-;-‘7_<„,:-/ T:'' /s/- -rc' Y la/J �6� //7lo .rte /i7. —cam Des:rise in Derail each INJURY or DAMAGE izo.�;.==-""� (2-4"..--2./ 03"/ rio..n 9<- i27rfv/C j,----5..f GL.:/ C/Kt /'./i C 7-.- 42.-^,/ >Lys- , Gau Ccl/so ;// o - SEE PAGE 2 (OVER) TH!5 CLAIM MUST BE SIGNED ON REVERSE SIDE • The amount claimed,as of the dale of presentation of this claim,is computed as follows: Damages incurred to date(exact): Estimated prospective damages as far as known: Damage to pmpeny S /y0n Future expenses for medical and hospital care . .S (h Expenses tor medical and hospital care S Future loss of earninos S /X(-,e Loss of earrings S Other prospective special damages S dr Special damages for S (X Prospetiive general damages S or Total estimate prospective damaoes s General damages S /SOO Total damages incurred to dale S /706 Total amount claimed as of date of presentation of this claim: S /rO0 Was damage and%or injury investigated by police? de/r) If so,what city? Were paamediss or ambulance called? et/0 II so,name city or ambulance' ul If injured,state date,time,name and address of doctor of your hrsl visit N WITNESSES to DAMAGE or INJURY:List all persons and addresses of persons known to have information: Name %'illi, /i,'FR1--rT __Address 9 _/ed/,1/ & __ _Phone .z ' - -EftC Name ht N-1H77 LCA Address—9 -S8 VH-LL t� 6-2.vg"71- Phone —PV6 SY Name A" F.SF� Address �`ST ✓nuc! 6'I l'J Phone G2�"=F7-646Cs DDTORS and HOSPITALS: Hospital Address Date Hospitalized Docor Address Dale of Treatment 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 Nett,East, South, and West; indicate place of accident by at time of accident by"A l''and;oration 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"lo-.ation of City NSB If diagrams below do not fa the situation,attach hereto a proper Vehicle when you first saw it, and by "B" location of yourself diagram signed by claimant. //// SIDEWALK 2 \ N CURB ,A\) \ \D /// CGREn. I / PARKWAY C 1 .— I`� SIDEWALK T ossa or'I kj Sionature of Claimant or person filinc on Typed Name: Dale: his behalf of nc relationship to Clarma I: NSE CLAIMS MUST BE FILED WTH CITY CLERK (Gov. Code Sec 915a). Presentation of a false claim is a felony(Pen. Cod= Sec 724 noncni Vi BRJES;,v Yll Of es..c Ccad MAYOR PRO inM. !DE vpti0'JQ oonrvnuneueEas 8835 E.VALLEY BOULEVARD P.O.BOX 399 MARGAHEi CLARK ROSEMEAD,CALIFORNIA 91770 JAY 1.IMPERIAL `a TELEPHONE(626)208-6671 GARY A IAVLOR FAX(626)307-9218 February 2, 1999 Dwight 7. Kunz Senior Account Manager 750 The City Drive, Suite 400 Orange, CA 92668 RE: ROBERTO GORDON Dear Mr. Kunz: The attached Claim was received in my office today. The City does not have any prior information on this claim. Please advise as to the steps you wish to take in this matter. Sincerely, NANCY VALDERRAMA City Clerk Attachment cc: City Attorney ,.m... djlv5 a, • February 4, 1999 - rte .0:SL ._ D FEB_81999 TO: City of Rosemead • CITY CLERK'S OFFICE• ATTENTION: Nancy Valderrama, City Clerk RE: Claim Gordon v. Rosemead Claimant Roberto Gordon D/Event 2/2/99 Rec'd Y/Office : 2/2/99 Our File S 100616 RWQ We have reviewed the above captioned claim and request that you take the action indicated below: • TAKE NO ACTION: Defer any written response to the claimant pending our further advice. If you have any questions please contact the undersigned. Very truly yours CARL WARREN & COMPANY Reettetnd D. W re Richard D. Marque cc: SCJPIA w/enc. 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 Ext.140•(800)572-6900•Fax:(714)740-9412 `•��� �(• \ J _� March 15, 1999 REPORT kI--INVE GATION CARL W• • • & CO. ORANGE Alien on: Richard Marque RE: Principal CIPIA Member Rosemead Claimant Gordon D/Event 2/2/99 Our File S100616 Dear Mr. Marque: PREVIEW: Claimant's car was damaged when it bottomed out on sewer/gutter construction. OTHER INSURANCE: 1. Co-Defendant Damon Construction: Landmark Insurance (Commercial General Liability) and Fireman's Fund (any automobile liability). DATE, TIME & PLACE: Various dates, in 1999 at unspecified times in front of The Tin Shop at 9558 Valley Blvd., Rosemead CA. GOVERNMENT CODE REQUIREMENTS: 1. Date Claim Filed: 2-2-99 and timely. 2. Action By Public Entity: We recommended on 2-4-99 that No Action Be Taken, but I suggest rejection of this claim at this time. 3. Statute of Limitations: Six months from rejection notice mailing. CO-DEFENDANT: Damon Construction Co., 455 Carson Plaza Dr., Suite F„ Carson CA 90746-3216. Please see attached contract for indemnification, defense and hold harmless clause. CARL WARREN & CO. CLAIMS MANAGEMENT.CLAIMS ADJUSTERS 750 The Ctly Drive•Ste 400.Orange,CA 928E8 Mail:P.O.Box 25160•Santa Ma,Ca92799.516O Phone:(714)740-7 •(BOC)572-69J0•Fax:(714)740-9412 BRIEF DESCRIPTION OF INCIDENT: Claimant Gordon began working at The Tin Shop last December and soon thereafter, the city's sewer, gutter and parkway reconstruction project on Valley Blvd. reached the block where The Tin Shop is located. Gordon had had his pickup "lowered" he admitted, so that when he exited (more so than when entering) his employer's parking lot, the underside would contact the construction work zone. The transmission and exhaust system were damaged over a period of two weeks PRINCIPAL'S VERSION: The reconstruction project contract was signed with Damon Construction in June and the work on Valley Blvd. began on 7-15-98 and was continuing into January of this year. Also involved were the cities of San Gabriel and El Monte as well as Willdan Associates. CLAIMANT'S VERSION: Mr. Gordon denied being the cause of his damages, but did admit without elaboration that he had had his 1995 pickup lowered. He refused to acknowledge that he had possibly contributed to the "bottoming out" process when he exited from his em- ployer's parking lot. PROPERTY DAMAGE: No work or repair invoice was submitted with this claim and although Mr. Gordon alleges that he spent about $1450.00 to repair his pickup, he is claiming $1,400.00 WORK TO BE COMPLETED: I will tender this claim to Damon Construction. ENCLOSURES: 1. Contract between city and Damon Construction. COMMENT: I will close my file after I have secured the city's rejection notice and tendered this claim to the co-defendant. Very Truly ��y � Yours,. Cr i N CO. Cc.C�CJPIA i o�y/Whang \Attention: Executive Director(with enclosure cc). Cc: City of Rosemead .Attention: Nancy Valderrama, City Clerk Carl Warren & Co. CITv o ; March 19, 1999 d'1,4R 2¢ 1909 CITU CIfRK'S OFFICE. TO: City of Rosemead ATTENTION: Nancy Valderrama, City Clerk RE: Claim Gordon v. Rosemead Claimant Roberto Gordon D/Event 2/2/99 Reed Y/Office : 2/2/99 Our File S100616RWQ 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 Re-device D. 911a ae Richard D. Marque cc: CJPIA Atte: 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)572-8900•Fax-(714)740-9412 March 29, 1999 CITY r: DAMON ONSTRUCTION 455 Ca on Plaza, Suite F, ArR 0 D 19Sg Cars CA 90746-3216 CITY CLERKS OFF!Os ttention. Risk Manager RE: Principal CJPIA Member City Rosemead D/Event 2-2-99 Claimant Roberto Gordon Our File 5100616 Dear Gentlepersons: We are claims administrators for the self-insured City of Rosemead and have received the attached claim, which we believe is covered by the contractual agreement between you and the city, executed on 6-9-98. We are tendering this claim to you for transmission to your insurance carrier based on the indemnification and hold harmless clause of Article VI of the contract. Please confirm receipt of this claim by signing the acknowledgement block below and returning it to the undersigned. Very Truly Yours, CARL WARRE• & CO. •RoXhang ACKNOWLEDGED: - DATED: Enc: Copy of Claim and Reply envelope. Copy of contract. CARL WARREN & CO. CLAIMS MANAGEMENT•CLAIMS ADJUSTERS 760 The City Drive•Ste CO•Orange,CA 92868 Mail:P.O.Box 25180•Santa Ana,Ca 92i -5180 Phone:(714)740..S•_•(800)572-6900•Fax:(714)740-9412 •12.÷cc: City of Rosemead Attn: Nancy Valderrama, City Clerk cc: CJPIA Attn: Executive Director cc: Carl Warren& Co./Orange Atm: Richard Marque Carl Warren & Co.