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HomeMy WebLinkAbout02/09/2006 CC Reports PACE__.~ OF \ PAGE \ ~~. OF -L-.... ~.J ~~U4'. ~ MINUTES SPECIAL CITY COUNCIL MEETING CITY OF LAKE ELSINORE 183 NORTH MAIN STREET LAKE ELSINORE, CALIFORNIA THURSDAY, NOVEMBER 17,2005 ************************************************************* CALL TO ORDER The Special City Council Meeting was called to order by Mayor Magee at 5:38 p.m. ROLL CALL PRESENT: COUNCILMEMBERS: BUCKLEY, HICKMAN, KELLEY, SCHIFFNER, MAGEE /""'"' ABSENT: COUNCILMEMBERS: NONE Also present were: City Manager Brady, City Attorney Leibold and Office Specialist ISoto. CLOSED SESSION A. CONFERENCE WITH LEGAL COUNSEL- ANTICIPATED LITIGATION - Significant exposure to litigation pursuant to subdivision (b) ofGov't Code S 54956.9: (1 potential case). B. PUBLIC EMPLOYEE PERFORMANCE (Government Code S 54957) - City Manager. Mayor Magee announced the Closed Session discussion item as listed above. r'- Agenda Item No. \ 0 page~ Of ")- Page Two - Special City Council Meeting Minutes - November 17,2005 ....." THE SPECIAL CITY COUNCIL MEETING WAS RECESSED TO CLOSED SESSION AT 5:40 P.M. THE SPECIAL CITY COUNCIL MEETING RECONVENED AT 6:38 P.M. CLOSED SESSION REPORT City Attorney Leibold announced the Closed Session Items as listed above. She noted tbat the City Council met in closed session with the City Manager to provide information and direction that the City Council deemed necessary and appropriate for the performance by the City Manager of his duties as they related to personnel matters affecting general City employees. She noted that there was no reportable action on Closed Session Item A. ADJOUNRMENT ~ THE SPECIAL CITY COUNCIL MEETING WAS ADJOURNED AT 6:50 P.M. ROBERT E. MAGEE, MAYOR CITY OF LAKE ELSINORE ATTEST: MICHELLE SOTO, OFFICE SPECIALIST I ......", Agenda Item No. \ Q Page ?- Of d-- ",..... MINUTES JOINT CITY COUNCIL/ PLANNING COMMISSION STUDY SESSION CITY OF LAKE ELSINORE 183 NORTH MAIN STREET LAKE ELSINORE, CALIFORNIA THURSDAY, NOVEMBER 17,2005 ************************************************************* CALL TO ORDER Mayor Magee called the Joint Study Session to order at 4:08 p.m. ROLL CALL CITY COUNCIL: ,-.- PRESENT: COUNCILMEMBERS: BUCKLEY, KELLEY, MAGEE, SCHIFFNER ABSENT: COUNCILMEMBERS: HICKMAN (Councilmember Hickman arrived at 4:17 p.m.) PLANNING COMMISSION: PRESENT: COMMISSIONER: FRANCIA, GONZALES, LARIMER, O'NEAL, LAP ERE ABSENT: COMMISSIONER: NONE Also present were: City Manager Brady, City Attorney Miles, Administrative Services Director Pressey, Information/Communications Manager Dennis, Community Development Director Preisendanz, City Engineer Seumalo, Senior Civil Engineer Basubas, Senior Planner Harris, Lake & Aquatic Resources Director Kilroy, Public Works Manager Payne ",..... and Office Specialist ISoto. ACENDA ITEM NO. \ b PA(j~OF J:s PAGE TWO JOINT STUDY SESSION MINUTES - NOVEMBER 17,2005 """" PLEDGE OF ALLEGIANCE The Pledge of Allegiance was led by Mayor Pro Tern Schiffuer. PUBLIC COMMENTS Michael Slavick, San Diego, commented that his family owned some lake-edge property. He stated that the City should look at sustainable economic opportunities. He stated he would like to see mixed-used development along the lake-edge area. Dennis Slavick, 129 Vista Valle, Palm Desert, commented that he and his family owned property within the City. He stated that he was concerned with economic development. He stated that he supported mixed-use development along the lake-edge area. Tim Fleming, ResidentJGPAC Member, gave an update on the progress of the ~ Committee. He noted several concerns of the committee that had to do with entitlement rights, the need for the Committee to be aware of all information impacting the City and the need for assurance from the City that the Committee is presented with all the facts. He noted that the lines of communication are imperative among the City Council, City Manager and the Planning Department to the Consultants. Hardy Strozier, Planning Associates, noted that MCA was a major tile manufacturer located on 146 acres on Walker Canyon Road. He noted that the City's consultant along with the GPAC requested that letters of recommendations be submitted to the Council and Commission. He requested that the land-use designation remain for MCA's property. DISCUSSION ITEMS 1. General Plan Update Mayor Magee introduced the item and deferred to City Manager Brady. '-' Agenda Item No. \ b page20f /3 r--- PAGE THREE JOINT STUDY SESSION MINUTES - NOVEMBER 17,2005 City Manager Brady gave a brief introduction on the item and deferred to Brian Mooney of Mooney, Jones and Stokes. Mr. Mooney introduced himself and Project Manager Claudia Unhold. Mr. Mooney noted that the General Plan was the constitution for future development. Mr. Mooney stated that his company started working on the project in February 2005. He indicated that there had been numerous GPAC meetings. Mr. Mooney noted that one of the key issues was the historic use of the specific plan area as a land use designation in the existing General Plan. He stated that had been a past problem with implementing planning programs. /"""', Mr. Mooney indicated that one of the key issues was the emphasis on enhancing Historic Downtown opportunities. Mr. Mooney gave an overview of real land use designations. He noted that they broke the City down into planning districts. Mr. Mooney indicated that the City had a variety of residential land uses. He noted density alternatives of 35 dwelling units per acre and 24 dwelling units per acre. He further noted that they had added in mixed-use designations. He stated that mixed-use commercial in the downtown area was very important. Councilmember Hickman noted his concern with the business district located near the outlet center. He requested clarification if the area surrounding the outlet was designated for light industrial. Mr. Mooney indicated that it was light industrial and they would be going with a land use designation that represented that land use. Councilmember Hickman inquired if there was a percentage of retail that could r-- be used in light industrial versus mixed use. Agenda Item No. \ b Page~Of /3 PAGE FOUR JOINT STUDY SESSION MINUTES - NOVEMBER 17,2005 "-'" Community Development Director Preisendanz indicated that limited manufacturing in the City's Municipal Code did not have a specific percentage for a retail use. He stated that the Planning Department had been using a15% allowance to control the amount of retail in an industrial area. He noted that the matter would be more definitive in the City's development code. Councilmember Hickman inquired if mixed used included industrial. Mr. Preisendanz confirmed. Councilmember Hickman inquired if an increase for retail allowance had been considered for light industrial. Mr. Preisendanz stated that he did not have a number that provided any sort of parameters; however, he noted that he tried to keep the retail allowance between 15-20%. .'-' Councilmember Hickman stated that he would like further consideration to increase the retail allowance in light industrial areas. Mr. Mooney indicated that one of the things that they were looking for in relationship to the lake edge on the north shore was the creation of a new circulation route. He noted the proposed location for the new road. He indicated that the new road would have a better interface with the lake. Mr. Mooney indicated that the highest density the City had was 24 units per acre. He noted that there were appropriate areas to go to 35 units per acre. He noted that those were issues that would be studied in the General Plan. Mr. Mooney gave an in-depth overview of Alternative No.1, 2 and 3 in regard to land-use designations for Historic Downtown area. He further noted the different scenarios that were available for land-use designation. Mr. Mooney gave an in-depth overview of Alternative No.1 and 2 in regard to land-use designations for Country Club Heights area. He further discussed the '-' Agenda Item No. \ h u 13 Page~ofL r' P ~GE FIVE JOINT STUDY SESSION MINUTES - NOVEMBER 17,2005 alternatives for the allowable number for dwelling units to be placed in that location. Mr. Mooney gave a brief overview of Alternative No. 1 and 2 in regard to land- use designations for Riverside/Lakeview area. Mr. Mooney gave a brief overview of Alternative No. 1 and 2 in regard to land- use designations for Riverview/Ballpark area. Mr. Mooney gave an in-depth overview of Alternative 1, 2 and 3 in regard to land-use designations for the Eastlake area. He noted that Alternative No. 1 reflected the Laing project and LUMOS project that had been approved. He noted that Alternative No.2 reflected an old plan that had been proposed previously. He further noted Alternative No.3 reflected a vast amount of open space and recreation area. ,.-- Mr. Mooney noted the 3 Special Treatment Areas that had been identified in the Planning Districts as Main Street, Country Club Heights and the Auto Mall. Mr. Mooney gave an in-depth overview of the proposed General Plan outline. Mr. Mooney addressed the steps in how to proceed. He stated that they were scheduled to be done with the General Plan in June 2006. He noted that the remaining budget was $340,000 out of a $775,000 budget. He noted that there would need to be testing for land-use plans through modeling for the circulation element, through market analysis and environmental impact reports. He stated the importance that Council believed they were headed in the right direction. Mr. Mooney noted issues that they had not anticipated. He noted that LAFCO indicated that there should be a larger area for the Sphere of Influence. Mr. Mooney noted that Senate Bill 18 was a new requirement by the State of California that the City consult with tribes related to scared resources within the City. He noted that there were 2 tribes that exclaimed they wanted to be ,-. consulted with. He further noted that the 2 tribes were Soboba and Pechanga. Agenda Item No. \ b Page \) orE PAGE SIX JOINT STUDY SESSION MINUTES - NOVEMBER 17, 200S ""-'" Mr. Mooney stated that after the General Plan was adopted, the City's Zoning Ordinance would need to be amended. Mr. Mooney noted that he was finished with his presentation and invited any feedback or questions that Council may have had. Mayor Magee thanked Mr. Mooney for his presentation. Mayor Magee deferred to Chairman Lapere and invited comments from the Planning Commission. Commissioner Francia stated that he has seen the progress that had taken place. He noted that he was involved in the community outreach and activities. He noted that mixed-use, circulation and the forming of districts was a very important. Commissioner O'Neal stated that the GP AC was moving along in an interesting w~. ""-'" Commissioner Gonzales stated that he like the idea of putting in a pier on the northern side of the lake edge. He inquired if putting in another pier on the southern side of the lake edge had been considered. Mr. Mooney indicated that they had not considered putting a pier on the southern side of the lake edge. He noted that the emphasis of the pier was its connection with Historic downtown. He inquired if that would be something that Mr. Gonzales would like for him to look at. Commissioner Gonzales confirmed that he would like to see a pier on the southern side of the lake edge considered. He noted that he thought the General Plan looked very good. Commissioner Larimer noted that she like the direction that Mr. Mooney and his company were going with for Historic Downtown. She inquired if that was the only area that had been targeted for higher density. ""-'" Agenda Item No. \ b page~Of }3 ~p AGE SEVEN JOINT STUDY SESSION MINUTES - NOVEMBER 17,2005 Mr. Mooney indicated that Historic Downtown and the Ballpark District were the two areas they were focusing on for higher density. Commissioner Larimer inquired if the same historic standard guidelines were being followed for Historic Downtown or if new guidelines had been implemented. Mr. Mooney indicated that they would have some form of design guidelines that would be new as part of the General Plan. Commissioner Larimer inquired if it was a part of the plan to remodel existing buildings in Historic Downtown. Mr. Mooney indicated that some of the buildings may be remodeled and ,-, buildings with important history would be preserved. Commissioner Larimer inquired if there were any plans for where Grand A venue and the Ortega Highway meet. Mr. Mooney indicated that a new road for that area was being considered. Chairman Lapere stated that Mr. Mooney was going in the right direction. He noted that he thought improving the downtown area with mixed use was a step in the right direction. He noted that tp improve the lake area as it related to mixed use was also a step in the right direction. He stated that higher density relative to the Ballpark was predicated on the flow of traffic and circulation. He noted that he liked the idea of using planning districts for land use. He noted his concerns for the Country Club Heights area. He stated that 15%-20% retail was accurate for light industrial areas. He further noted that he felt mixed use could be done in a tasteful manner. Mr. Lapere thanked Mr. Mooney for his presentati on. r- Commissioner Larimer requested clarification on what Mr. Mooney meant by different personalities of the community. Agenda Item No.\ b Page~Of jg P AGE EIGHT JOINT STUDY SESSION MINUTES - NOVEMBER 17,2005 ~ Mr. Mooney indicated that he had seen different personalities in the architecture, landscaping and related items in various parts of the City. He noted that creating community areas was a tool to shape different interests. Councilmember Kelley thanked Mr. Mooney for his presentation. She noted that she did like the idea of planning districts. She indicated that she like the proposed concepts for downtown. She noted that she did not oppose high density as long as the design standards were heightened. She noted her interest in traffic circulation. She requested that Council be given larger maps. Mr. Mooney indicated that larger maps would be available for the next meeting. Councilmember Buckley stated that downgrading of the specific plan concept was an excellent idea. He inquired if one of the performance indexes up to 35% or 40% could include affordability. Mr. Mooney indicated that he had been working with staff and it .could be architecturally based. He noted additional units could be obtained if the City was to allow 10% or 200/0 to be at an affordable rate for low to low-medium Income. ~ Councilmember Buckley inquired if the pier concept fit with the marina concept. He further inquired if the pier would be a more for entertainment or recreational use. Mr. Mooney indicated that they had not yet defined what kind of pier that would put in to the plan. He stated that he would give the concept to the economic consultant. Councilmember Buckley inquired if the pier would be competition for the manna. Mr. Mooney indicated that the idea for the pier would be part of an entertainment zone. ~ Agenda Item No. \ b Page f Of /3 ,.....-l> AGE NINE JOINT STUDY SESSION MINUTES - NOVEMBER 17,2005 Councilmember Buckley stated that he thought it was vital that the civic center should be Main Street. Mr. Mooney indicated that through the GP AC they have identified 3 locations for the proposed site. Councilmember Buckley requested clarification on variation of heights for higher density buildings in and around downtown. He noted that he would like to see 3 and 4-story buildings in the area. Mr. Mooney noted that they were very flexible with the concept. He noted that he thought higher densities were needed. Councilmember Buckley inquired if one-way streets had been considered for downtown. ~ Mr. Mooney noted that they were in the stage of focusing solely on land uses. He noted that after that stage they would speak to the traffic engineer who would then look at the possibility of one-way streets. Councilmember Buckley noted his concern with the appearance of buildings in Historical Downtown. Mr. Mooney indicated that they would be taking direction from City Council and the GPAC in regard to appearance. Councilmember Buckley stated that he thought residential hillside fit well for Country Club Heights fit well. He inquired about the concept of zoning. He noted that the city of Ventura changed their concept of zoning from use-zoning to building-type zoning. He inquired if building-type zoning was something that could be utilized for special treatment areas. Mr. Mooney indicated that it could be done. He noted that it was not a part of their contract to do the zoning ordinance. He noted that the concept of zoning /"'" Councilmember Buckley was speaking of was referred to as New Urbanism. Agenda Item No. \ b Page~Of 13 PAGE TEN JOINT STUDY SESSION MINUTES - NOVEMBER 17,2005 ~ Councilmember Buckley inquired on the subject that multiple hearings would be needed that was mentioned by Mr. Mooney. He further inquired if the meetings were study sessions, meetings or hearings. Mr. Mooney' indicated that multiple hearings would needed. Councilmember Buckley inquired if the meetings would need to be special meetings. City Attorney Miles indicated that the meetings could be special meetings. Councilmember Hickman inquired if there had been any thought given to traffic circulation and parallel roads on the 1-15 in case there is an emergency. Mr. Mooney indicated that they had been looking at frontage roads. He noted that there were frontage roads in the current General Plan but they had not been built. He noted that the next phase of the land-use stage would to have the "" traffic engineer review such items. Councilmember Hickman stated that he would like for there to be consideration of a river walk in Historic Downtown. Mr. Mooney stated that a river walk had been considered. He stated that idea was implemented in to the plan. He stated that he felt it would fit in perfectly. Mr. Hickman stated that he would like for there to be consideration for a park in Historic Downtown. Mr. Mooney indicated that the river walk would be a linear park. He noted that a public space in Historic Downtown would be considered. Mr. Hickman indicated that the felt it was a good idea for industrial areas to having living spaces on top of the buildings where the owners could stay. He indicated that he would like to increase retail higher than 15%. .....", Agenda Item No. \ b PageEOf /3 ,..--P AGE ELEVEN JOINT STUDY SESSION MINUTES - NOVEMBER 17, 1005 Mayor Pro Tern Schiffner indicated that he was interested in the fact that LAFCO had expressed a concern with the City expanding the Sphere of Influence. Mr. Schiffuer stated that was something he looked forward to. He indicated that he liked the idea of what had been proposed for the General Plan. Mayor Magee thanked the GP AC members for their hours of hard work and dedication that they have spent over the course of the last 10 months. He noted that their efforts had not gone unnoticed. He indicated that it was difficult to read the maps that had been provided for the presentation. He requested that that the maps be made available for the public at the front counter in addition to contact information for Mooney, Jones and Stokes so residents can better understand the process. He addressed the timeline that had been presented and inquired on the status of the Traffic Analysis with Urban Crossroads. r" Mr. Mooney indicated that they had completed a baseline inventory of all the issues. He noted that Urban Crossroads had done that baseline. He noted that all the problem areas had been identified. He noted that they had not proceeded for them to do the modeling on the land use. Mayor Magee inquired if the modeling to be received would include a menu board of things dealing with land use, density, service availability, circulation, economic viability and how all of those items interrelate based on which , alternatives are mixed and matched. . Mr. Mooney confirmed. He noted that they were currently working on the testing process. He noted that the two key areas of testing included traffic circulation and economic aspect. Mayor Magee inquired if Mr. Mooney would be able to meet for another update meeting at the end of January. Mr. Mooney stated that it would be possible to set up a meeting together for the end of January. ",,-.... Agenda Item No. \ D Page , I Of J s -- PAGE TWELVE JOINT STUDY SESSION MINUTES - NOVEMBER 17, 2005 ,...., Mr. Mooney indicated that staff would often get inundated with new applications. He noted that it was important for his company to understand what those applications were. He stated that if anybody was applying for anything it should be brought to his company and the GP AC for evaluation and to give their input. City Manager Brady stated that through the planning process, new applications could be conveyed to Mooney, Jones and Stokes in addition to the GPAC. Mr. Mooney indicated that the communication regarding new applications would be a big help. Chairman Lapere stated that anyone wishing to develop something in the downtown or lake area should not be held up any longer than necessary. He suggested that staff could include what was being discussed in a report to submit to the Commission. ...; Mayor Pro Tern Schiffner suggested that developers wishing to develop the downtown area should contact Mooney, Jones and Stokes to ensure that their plans fit with the General Plan. Councilmember Buckley stated that he strongly urged that information regarding the development of downtown, around the lake or any large project in the City be communication to the GP AC. ADJOURNMENT THE JOINT CITY COUNCIL/PLANNING COMMISSION STUDY SESSION W AS ADJOURNED AT 5:28 P.M. ROBERT MAGEE, MAYOR CITY OF LAKE ELSINORE ......" Agenda Item No. \ b Page ,')- Of ,~ r" PAGE THIRTEEN JOINT STUDY SESSION MINUTES - NOVEMBER 17, 2005 RON LAPERE, CHAIRMAN PLANNING COMMISSION Respectfully submitted, MICHELLE SOTO, OFFICE SPECIALIST I ATTEST: ~ FREDERICK RAY, CITY CLERK ,,-. Agenda Item No. \ b , page20f~ JANUARY 31, 2006 CITY OF LAKE ELSINORE WARRANT SUMMARY ~ FUND# FUND DESCRIPTION TOTAL 100 GENERAL FUND $ 1,803,175.46 101 SUPPLEMENT LAW ENFORCEMENT SERVCE FUND 23,658.01 105 MISCELLANEOUS GENERAL PROJECT FUND 609.28 110 STATE GAS TAX FUND 641.27 112 TRANSPORTATION/MEASURE A FUND 258.13 130 LIGHTING/LANDSCAPE MAINTENANCE FUND 48,005.12 150 C.D.B.G. FUND 67.86 201 STREET C.I.P. FUND 203.58 205 TRAFFIC IMPACT FEE FUND 1,696.50 221 PARK C.I.P FUND 5,200.00 231 LIBRARY C.I.P. FUND 269.38 254 89-1 RAILROAD CANYON IMPROVEMENT FUND 3,941.18 605 PUBLIC IMPROVEMENT TRUST FUND 1,261.72 608 TRUST DEPOSIT AND PRE-PAID EXPENSE FUND 20,136.60 620 COST RECOVERY SYSTEM 554.94 GRAND TOTAL $ 1,909,679.03 ~ r- 2/1/2006 Warrant 013106 1 of 1 AGENDA ITEM NO. 2. PAGE / OF q JANUARY 31. 2006 CITY OF LAKE ELSINORE CHECK# VENDOR NAME 84427 LAKE ELSINORE VALLEY CHAMBER OF COMMERCE 84532 VOID (COUNTY OF RIVERSIDE, BOB DOYLE, SHERIFF) 84574 WESTERN RIVERSIDE COUNCIL OF GOVERNMENTS 84575 JAIME'S MOBILE HOME SERVICE 84576 WESTERN RIVERSIDE COUNCIL OF GOVERNMENTS 84577 ARLINE GULBRANSEN 84578 UNION BANK OF CALIFORNIA 84579 AL TURA CREDIT UNION 84580 I.C.M.A. RETIREMENT TRUST 84581 CALIFORNIA P.E.R.S. 84582 CALIFORNIA JPIA 84583 INLAND VALLEY EXTREME 84584 MURRIETA MULlSHA BASEBALL CLUB 84586 VOID 84587-84590 A & A JANITORIAL SERVICE 84591 ACTION PARK ALLIANCE, INC. 84592 AFFORDABLE MAILING SOLUTIONS 84593 AMERICAN FORENSIC NURSES 84594 APPLE ONE EMPLOYMENT SERVICES 84595 ARTISAN GOLDSMITHS & AWARDS 84596 THE BAG LADY SANDBAGS 84597 BANNER MATTRESS 84598 BARRETT, LTD. 84599 BERRYMAN & HENIGAR, INC. 84600 CYNTHIA BLOOD-WILSON 84601 ROBERT BRADY 84602 THE BUSINESS PRESS 84603 C. R. & R. DISPOSAL, INC. 84604 CA ASSOCIATION OF CODE ENFORCE 84605 CA PARK & RECREATION SOCIETY 84606 CA RESOURCE RECOVERY ASSOCIATION 84607 CALIFORNIA BUILDING OFFICIALS 84608 CALIFORNIA MUNICIPAL STATISTIC 84609 CALIFORNIA TRAVEL INDUSTRY ASSOCIATION 84610 CANON FINANCIAL SERVICES, INC. 84611 JOHN CARLSON 84612 JORGE CERVANTES 84613 CITICORP VENDOR FINANCE, INC. 84614 CITY & COUNTY SOIL ENGINEERING 84615 CNH CAPITAL AMERICA, L.L.C. 84616 KIRT A. COURY 84617 CRAFCO, INC. 84618 CUTTING EDGE CONSTRUCTION 84619 CUTTING EDGE STAFFING, INC. 84620 D & SELECTRIC 84621 DAPEER, ROSENBIL T & LITVAK, L.L.P. 84622 BETH DE COU 84623 DISNEYLAND HOTEL 84624 DO IT CENTER 84625 CAROLE K. DONAHOE A.I.C.P. 84626 DORAL DESERT PRINCESS RESORT 84627 DOWNS COMMERCIAL FUELING, INC. 84628-84634 E. V. M. W. D. WARRANT liST AMOUNT $ 525.00 '-'" (5,786.46) 39,678.21 4,750.50 15,441.83 248.09 336,296.88 1,150.00 4,995.00 38,572.10 11,899.00 364.00 154.00 0.00 7,727.71 4,166.00 1,098.39 198.90 2,636.57 20.42 760.00 1 ,723.58 2,250.00 28,682.56 46.70 160.00 30.00 """" 170,489.74 65.00 80.00 186.00 330.00 400.00 520.00 1 ,038.96 421.87 500.00 770.41 1,126.00 3,251.42 6,162.96 1 ,440.60 92.00 1 ,065.00 7,413.75 1 ,755.49 200.00 365.70 317.09 3,168.60 619.96 2,203.14 23,784.15 ~ AGENDA ITEM NO. ? PAGE .;z OF '--} 2/1/2006 Warrant 013106 1 OF 3 JANUARY 31. 2006 CITY OF LAKE ELSINORE r--CHECK# VENDOR NAME d4635 EBERHARD EQUIPMENT,INC. 84636 ECONOLlTE CONTROL PRODUCTS, INC. 84637 ELITE ELEVATOR,INC. 84638 ELSINORE ELECTRICAL SUPPLY, INC. 84639 ELSINORE VALLEY RENTALS 84640 ELSINORE VALLEY YOUTH SOCCER 84641 EXECUTIVE EVENT SERVICES, L.L.C. 84642 TERI FAZZIO 84643 FEDERAL EXPRESS CORPORATION 84644 FERGUSON GROUP, L.L.C. 84645 FIRE ETC. 84646-84647 GREENSCAPE LANDSCAPE, INC. 84648 ARLINE GULBRANSEN 84649 LORENA HANCOCK 84650 IKON OFFICE SOLUTIONS, INC. 84651 INLAND EMPIRE LOCK & KEY 84652 INLAND INTERIOR CONTRACTING 84653 INLAND URGENT CARE 84654 INTERNAL REVENUE SERVICE 84655 INTERNATIONAL ASSOCIATION OF CHIEFS OF POLICE 84656 INTERNATIONAL CODE COUNCIL 84657 JEFF HAUSER MOBILE WELDING 84658 GENIE KELLEY 84659 KOBATA & ASSOC., INC. .r-"14660 L & M FERTILIZER, INC. d4661 LAKE CHEVROLET 84662 LAKE ELSINORE FORD 84663 LAKE ELSINORE GIRLS SOFTBALL 84664 LAKE ELSINORE TIRE & AUTO, INC. 84665 LAKE ELSINORE VALLEY CHAMBER OF COMMERCE 84666 LAKE ELSINORE VALLEY LITTLE LEAGUE 84667 NANCY LASSEY-HEFINGTON 84668 LEHMAN BROTHERS, INC. 84669 LIBRARY SYSTEMS & SERVICES, L.L.C. 84670 L1NKLlNE COMMUNICATIONS, INC. 84671 CHARLES MACKEY JR. 84672 ROBERT MAGEE 84673 THE MARK FISHER COMPANY 84674 MAYHALL PRINT SHOP 84675 LINDA M. MILLER 84676 MORROW PLUMBING, INC. 84677 MORROW PLUMBING, INC. 84678 MYRTLE A. THOMAS 84679 NELSON PAVING, INC. 84680 NEXTEL COMMUNICATIONS 84681 NORTH COUNTY TIMES 84682 OCB REPROGRAPHICS 84683 PHD PENSKE LEASING 84684 DANA C. PORCHE 84685 PREMIUM PALOMAR MT. SPRING WATER ~ 4686 PRO PET DISTRIBUTORS -- J4687-84689 PRUDENTIAL OVERALL SUPPLY 2/1/2006 Warrant 013106 20F 3 WARRANT LIST AMOUNT 85.50 3,993.22 312.00 958.64 1,239.16 500.00 284.00 160.00 248.64 6,000.00 16,636.60 10,168.00 85.25 3,768.00 137.41 42.86 1,465.00 258.00 37.90 100.00 100.00 120.00 160.00 10,120.00 187.37 1,457.10 121.71 500.00 120.00 125.00 500.00 64.54 4,948.13 269.38 47.28 5,269.88 160.00 8,822.00 407.17 3,410.00 95.16 176.63 16.24 3,195.85 1,532.23 79.73 168.36 898.58 78.23 425.15 478.50 472.44 AGENDA ITEM NO. .2 PAGE .3 OF L/ JANUAR Y 31, 2006 CITY OF LAKE ELSINORE W ARRANI' LIST CHECK# VENDOR NAME 84690 QUILL CORPORATION 84691 REBEL RENTS, INC. 84692 REDEVELOPMENT AGENCY FOR THE CITY OF LAKE ELSINORE 84693 REGIONAL PUBLIC SAFETY TRAINING CENTER 84694 RIVERSIDE COUNTY SHERIFF 84695 COUNTY OF RIVERSIDE, BOB DOYLE, SHERIFF 84696 ROTARY CLUB OF LAKE ELSINORE 84697 SCOTT FAZEKAS & ASSOCIATES, INC. 84698 SHERWIN-WILLIAMS CO. 84699 SILVER LEGACY HOTEL 84700 SIMPLOT PARTNERS 84701 SKILL PATH SEMINARS 84702 DAVID S. SOLOMON 84703-84707 SOUTHERN CALIFORNIA EDISON CO. 84708 SOUTHERN CALIFORNIA GAS CO. 84709 SPRINT 84710 STAUFFER'S LAWN EQUIPMENT 84711 BOB STOVER, INC. 84712 TEAM AUTOAID, INC. 84713 TEXTRON FINANCIAL CORPORATION 84714 TOP-LINE INDUSTRIAL, INC. 84715 TRI LAKES YOUTH FOOTBALL 84716 UNITED PARCEL SERVICE 84717 UNITED STATES POSTAL SERVICE 84718 VAN BLARCOM, LEIBOLD, MCCLENDON & MANN 84719 VAVRINEK, TRINE, DAY & CO., L.L.P. 84720 VENUS PRINTING 84721 VERIZON CALIFORNIA, INC. 84722 VERIZON EQUIPMENT SALES & SERVICE 84723 TOINI VUORI 84724 WEST COAST ARBORISTS, INC. 84725 ZEP MANUFACTURING COMPANY AMOUNT 317.19 ......., 194.20 773,617.50 299.00 5,188.80 34,436.36 80.00 23,184.26 435.57 339.29 506.43 399.00 3,257.28 34,419.88 669.27 241.71 58.19 4,931.10 331.17 987.13 330.68 500.00 198.19 2,521.20 35,043.84 2,000.00 1,341.55 ......., 907.33 491.73 36.09 6,091.40 89.57 TOTAL PIE DATE: $ 1,750,008.57 01/20106 01/20106 PAYROLL TAXES PAYROLL CASH 47,012.99 112,657.47 GRAND TOTAL $ 1,909,679.03 '-'" 2/1/2006 Warrant 013106 3 OF3 AGENDA ITEM NO. 2- PAGE tt OF Lf "....... CITY OF LAKE ELSINORE INVESTMENT REPORT OF POOLED CASH AND INVESTMENTS AS OF OCTOBER 31,2005 37,419,993.22 9,792.52 2,412,413.28 35,017,372.46 Cashier Drawers # I & #2 City of Lake Elsinore Petty Cash Fund 300.00 1,000.00 TOTAL POOLED CASH AND INVESTMENTS $35,018,672.46 I certifY that this report accurately reflects all pooled investments and it is in conformity with the investment policy as approved by the City Council on June 28,2005. A copy of this policy is available in the office of the City Clerk. The pooled investments shown above provide sufficient cash flow liquidity to meet the next six months estimated expenditures. Matt N. Pressey Director of Administrati I /f/ /fb Date "....... ACENDA ITEM NO. PAGE I '~ OF Cf FUND NO 100 . 101 102 103 104 105 106 107 110 112 115 130 135 140 150 201 204 205 211 221 231 232 254 257 259 351 352 353 356 357 358 359 360 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 604 605 606 608 610 611 616 620 650 CITY OF LAKE ELSINORE POOLED CASH AND INVESTMENTS BY FUND AS OF OCTOBER 31, 2005 FUND NAME General Fund Supplemental Law Enforcement Fund Local Law Enforcement Block Grant Fund Office of Traffic Safety Fund Traffic Offender Fund Misc. General Project Fund Affordable Housing In Lieu Fund Developer Agreement Revenue State Gas Tax Fund Transportation Fund Traffic Safety Fund Lighting & Landscape Maintenance Fund # 1 Lighting & Landscape Maintenance Fund Geothermal Fund C.D.B.G. Fund Street C.I.P. Fund Signal C.I.P. Fund Traffic Impact Fee Fund Storm Drain C.I.P. Fund Park C.I.P. Fund Library C.I.P. Fund City Fire Protection Fund AD 89-1 Railroad Canyon Rd. Improvement Fund CFD 90-2 Tuscany Hills CFD 90-3 Construction Fund AD 87-2 Debt Service Fund AD 86-1 Debt Service Fund AD 89-] Debt Service Fund AD 90-] Debt Service Fund CFD 2003-2 Canyon Hills CFD 91-2 Debt Service Fund CFD 90-3 Debt Service Fund AD 93-1 Debt Service Fund CFD 95-1(96 Srs.E) Debt Service Fund CFD 88-3/1997 Series F Debt Service Fund CFD 88-3 1Il B / ] 997 Series B Debt Service Fund CFD 98-1 Surnrnerhilllmprovement fund CFD 2004-] Debt Service Fund CFD 2005-3 Surnmerly / Laing CFD 2004-2 Vista Lago CFD 2004-3 Rosetta Canyon CFD 2005-x Camino Del NoTte CFD 2005-] Serenity CFD 2005-3 Alberhill Ranch CFD 2005-5 Wasson Canyon CFD 2005-4 Lakeview Villas CFD 2005-] D. Clurman CFD 2005-7 La Strada Endowment Trust Fund Public Improvement Trust Fund Mobile Source Air Polution Fund Trust Deposit & Pre Paid Expense Kangaroo Rat Trust Fund Developer Agreement Trust Fund Fire Station Trust Fund Cost Recovery System Fund CFD 2003-] Law & Fire Service Fund Total Pooled Cash & Investments AMOUNT $8,948,916.10 7,750.38 5,565.42 28,922.26 76, ]26.67 506,850.40 392,500.00 807,000.00 180,887.63 1,0]4,655.]4 ]74,795.67 (175,158.20) (2,897.95) 15,367.50 77,314.75 175,545.39 261,860.15 3,780,659.50 3,630,306.11 1,771,728.51 84],938.61 191,385.24 2,458,248.60 (23,325.00) 90,231.58 423,491.55 89,745.28 26],886.57 78,715.74 540,599.46 ],083,471.75 (48,729.00) 802,692.65 182,600.33 2,105,836.49 (1,299,821.58) (179,604.99) 4,373.45 18,983.92 9,850.00 (14,687.68) 30,165.30 18,225.]7 30,106.62 32,658.81 35,228.77 50,000.00 (6,000.00) 23,003.22 446,808.68 ] 18,386.41 2,293,661.29 30,599.56 1,043,290.00 119,554.02 1,441,495.78 14.910.43 $35,018,672.46 AGENDA ITEM NO. PAGE", ~ ~ ~ ~ :2-, OF 1 CITY OF LAKE ELSINORE "....., ANNUAL YEAR-TO-DATE INVESTMENT ACTIVITY SUMMARY FOR THE MONTH ENDING OCTOBER 31, 2005 Total outstanding investments as of June 30, 2005 PURCHASE MATURITY DATE DATE Investment Purchases: FHLMC FHLB FHLB FHLB FHLB FHLB 08/22/05 09/01/05 09/22/05 10/11/05 10/25/05 10/27/05 08/22/07 09/01/06 09/09/08 04/11 /08 04/25/08 10/27/08 Total Purchases Investment Maturities: r- Total Maturities Investments Called: Total Calls Net increase (decrease) in LAlF Total outstanding investments as of October 31, 2005 .r".. COUPON RATE 4.500% 4.125% 4.690% 4.560% 4.835% 5.000% $ 31,362,968.26 YIELD TO MATURITY COST 4.500% 4.125% 4.690% 4.560% 4.835% 5.000% 1,000,000.00 1,000,000.00 1,001,693.61 1,000,000.00 1,000,000.00 1,000,000.00 6,001,693.61 (3,584,563.92) $ 33,780,097.95 AGENDA ITEM NO. 3 PAGE 3 OF Cf g; ~ (") (") tl:I >-co> (")(")tl:I ~ ~ ~.... ... n d a (It e:'" > ~~~ ~ "8 g ~. g ~ ~ ~ (")a:::a::: z(")> a::: ~ ... ~ Po ~ Ft ~ 3 e. ~ >-l::I::a ~ ~ o' (")... g o r ~ .a ~ 0 Sl ::1 aa:::OQ ... 0 J11 z::1 ... o OQ (") ft&i 0 ;;'8 o .... '8 g- a t:l g' en"rj"rj ~Ff5 ,tl:Itl:I en' a ~ "Tj ... ... ... >-l!t!t ~ a a !)l ::I:: "tj f'i 0 !!l a ~ 3 (") a' b a g. ~ ~ tl:I tl:I ~ ~ ...., o ;: t""' t""' o (') e.. :> (JQ ~ "T1 "T1 "T1 "T1 "T1 ~.Q FJFJFJFJFJ~~ ttlttlttlttlttl()Cl> g Cl> a "T1 S Q.. 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'" ~ >-l ti !Jl ~ "'- '" '"0 ~ '" '"0 () ~ ~ ~ '" >-l ('5 '" o 'Tj ~ tI1 ~ ~ '" - CITY OF LAKE ELSINORE SUMMARY OF POLICY LIMITATIONS AS OF OCTOBER 31, 2005 ~ DESCRIPTION CURRENT PERCENTAGE BASED ON MARKET VALUE AS OF 10/31/2005 U.S. Treasury Bills 0.00% MAXIMUM PERCENTAGE UNLIMITED U.S. Treasury Notes 0.00% UNLIMITED Federal Agency Issues: FlCB FFCB FLB FHLB FNMA FHLMC LAIF (Local Agency Investment Fund) Current Balance 0.00% UNLIMITED 0.00% UNLIMITED 0.00% UNLIMITED 14.23% UNLIMITED 0.00% UNLIMITED 2.85% UNLIMITED 0.00% 40.00% 0.00% 25 ~ 0.00% 30.00% 0.00% 15.00% 0.00% 30.00% 0.00% UNLIMITED 0.00% 20.00% 82.91% UNLIMITED $ 29,039,197.49 Banker's Acceptances Certificates of Deposit Negotiable Certificates of Deposits Commercial Paper Medium Term Corporate Notes Repurchase Agreements Reverse Repurchase Agreements TOTAL 100.00% % of Portfolio Maturing within one year % of Portfolio Maturing or Callable within one year 85.20% 88.16% no less than 25% "'-"" AGENDA ITEM NO. 3 PAGE g OF q CITY OF LAKE ELSINORE PERCENT OF PORTFOLIO INVESTED IN FEDERAL AGENCIES JULY 2005 THROUGH OCTOBER 2005 ",--.. MONTH July 2005 August 2005 September 2005 October 2005 % OF PORTFOLIO BY AGENCY FFCB FHLB FHLMC FNMA 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 3.33% 0.000/0 0.00% 6.23% 3.12% 0.00% 0.00% 14.23% 2.850/0 0.00% AVERAGE 0.000/0 5.12% 2.33%' 0.00% ",--.. ",--.. TOTAL%OF PORTFOLIO IN FEDERAL AGENCIES 0.00% 3.330/0 9.35% 17.08% 7.44% 3 AGENDA1TEM NO. . q PAGE_ 9 OF_ ,- CITY OF LAKE ELSINORE REPORT TO CITY COUNCIL TO: MA YOR AND CITY COUNCIL FROM: ROBERT A. BRADY, CITY MANAGER DA TE: FEBRUARY 9, 2006 SUBJECT: PURCHASE OF STADIUM EQUIPMENT BACKGROUND On May 20, 1994, the Lake Elsinore Diamond Stadium was dedicated and the fIrst baseball game played. Since its inauguration, one cushman vehicle and the main stadium mower have been replaced. ~ DISCUSSION Staff has received three (3) bids to replace the two (2) remaining cushmans set into service in May of 1994. The two (2) new cushmans are available for immediate delivery and are 2005 models that meet the same specification as the unit purchased in August of 2005. The only changes are that these units have 48" boxes instead of 60" boxes and they have automatic transmissions. The bid submittals are as follows: Golf Ventures West H.V. Carter Co., Inc. Rocky Mountain Turf $31,215 $45,550 $46,087 Staff would also request an "Exception to Bid Procedures" as provided in Chapter 3.08.070 (F) of the Lake Elsinore Municipal Code which allows the City Council to authorize the City Manager or the Purchasing Officer to bypass the formal bid process required under this chapter for purchases greater than $15,000. r-- Staff is requesting that the City Council authorize the exception of the formal bid process (3.08.200) and allow staff to utilize the "Open Market" purchasing process AGENDA ITErvl NO. L\- PAC~~OF~ REPORT TO CITY COUNCIL FEBRUARY 9, 2006 PAGE 2 ""-'" (3.08.100) to expedite the purchase of these units. FISCAL IMPACT The funding for the purchase of these two (2) new units ($31,215) is available in the 2005-2006 adopted stadium budget. RECOMMENDA TION It is staff's recommendation that the Mayor and City Council grant the exception as per Chapter 3.08.070 (F) "Exception to Bid Procedures" for the purchase of two (2) new Cushman Turf Trucksters, Model 628 for maintenance and operations of the stadium. PREPARED BY: ......., OFCO~TYSERVICES APPROVED FOR AGENDA BY: ......., AGENDA ITEM NO.~ PACi: ~ OF q Date: 01/18/08 Go. Ventures West A ....1IIan~ . CITY OF LAKE ELSINORE STADlUM.OPERAnONS LAKE ELSINORE. CA 92531 DAVID SAPP 0 DAN GIBBONS 951-830-8531 ~---------- -- . . . ,,' ~ " i~:,":.:.'.-:,:.;,.." '. ':'. .~..; " .' =:-.~-~~~-'~~!--~ -~-~~~- ~,:-~~-'-.' , e '" ;' .... ': ',:' , , ..~-- -..~~ -..----. _...._~---"'--_. .: -. .'-- :..---. ~ ~---~........ - - . .. -.---- ..- -'"' r--- 898628 CUStWAN TURFTRUCKSlER. AUTO TRANS 32 hp oas,3 C)tnder,1iquid cooled engine. El8ctronic fuel injection. .. speed auto trans-- mfssion with high and low range speeds. A 4 wheel vehicle witt ... wheel hydraulic brakes. "'7" steel hydraulic cbnp box, vehicle rated at 28501bs. Full instrument8Ion, large turf tires and a flat bar tow hiIch. UNITS ARE 2005 PRODUC"IlON AND CALIF- ORNIA C..A.R.8. APPROVALS. TWO YEAR WARMHTY. SERVICE AND PARTS BY GV WESTICORONA. PRICE INCLUDES SET-UP AND DElVERY. 1 898628 CUSHMAN TURF TRUCKSTER, AUTO TRANS $15.248.00 SAME SPECS AS ABOVE. 2 898628 CUSHMAN TURF TRUCKSTER. AUTO TRANS SAlE SPECS AS ABOVE. $14,485.00 $28,970.00 3 UNITS AVAILABt.E, _MEDIAn: DELIVERY. Your Sales ReprUE..,1IatiYe is: GEOoII ". tares II........~ Dict Low ~1-a33f cell phone GoIfVentu... .... 1475 hmpeon Avenue Corona CA t287t Phone: 151-371-t888 Fax: 851.J71..1IU Sub- ToI8I s.tw Tax (7.71%) PLEASE ADD Total QIICl4H are firm for 30 days. /"""'" AGENDA ITEM NO._~. PACE 0 OF q """"Cu. '-v VV .I.It... v"'Tr' It'" '-'f'" I L...f' ,-,v. .&.....JL....J"'T"'T""'....JL..-..,IV ,.... ... I~rfvl \~'1~O ~ ~i:t11f> '..J,,'{'J~t' Ed. 19'7 Golf Course and Turf Equiprr:eni P.O. Box 2248, 94551-2248 4. 771 Arroyo Visla #C 0 Livermore. CA 94551-4X47 Phone (925) 443-5253 Fax (925) 443-5250 ParIs (l{OU) 443-5257 ........., The following quote is exclusively prepared for. ACCOUNT: CITY OF LAKE ELSINORE A TIENTION: DAVID SAPP ADDRESS: STADIUM OPERATIONS PHONE: CITY/ST./ZIP: LAKE ELSINORE, CA FAX: 951-471-1418 QTY. DESCRIPTION 2 JACOBSEN/CUSHMAN [GAS TRUCK, #898628 WITH 47" BOX, FLATBED AND TOW HITCH 20912 $ 41,824.00 LIMITED SUPPLY, SUBJECT TO STOCK ON HAND SUB-TOTAL: 41,824.00 " TERMS: NET 15 DAYS FIRM FOR THE NEXT 30 DAYS SALES TAX: PLEASE ADD FREIGHT: 450.00 TOTAl: $42,274.00 PLUS SALES TAX PREPARED BY: David Graves SIGNED: :~~~ DATE: 2D-Jan-06 SACRA:\iENTO P.O. nox 15117,95851 2309 Lexinl:ton St., CA 95lH5 Phone f9J{,) 927-3824 F:lx (916) 1)27.11(,~5 l'arts XOO-~.B-S257 ViSAUA 6(,78 Avenue 30-l. #A Visalia, CA 93291 .':!lI (209) (,S t-(I~.75 })a:-Is ~a)G-../.-13.!'Z57 RENO lJhon~ (775) 745-9\157 Fax (T15) 2(.7-1)382 Pilrh lirtll.~'B-5257 " Visit. nUT weh site: wn'\";~~l,".t~~irt;(.:r.:",'nJ1l ACENDA ITEM NO. L\ PAC;:~OF~ 19254435250 PAGE. 01 JAN 06 '06 23:55 JAN-l~-Uo lHU Uo:l1 rn ~I:$li/Knl tftK NU. tlUl~O~~tqU r--. Rocky Mountain Turf & Industrial 'Equipment QUOTATION January 19, 2006 City of Lake Elsinore Attn: ClaL\dia l~ax (951) 471~1418 ".-- . ~ :..\:>..s~J \t.\..... ... D CI d' . '~'~'~'~"';l!...,,, .\..' :".. '<':N 1t,:It; car au la: ,r s; !L'i~";c.~ <\';1,,1>,. ,.,,'1>;.~~ y~"....'t,;" ~, , rf ...! 'iT' )...:."~~': ;.roo.. ,..'(:oQ, ("."\ ~ !"-", ~ , ).."'-i9{ '/,':>.-1.< .,. :r;~~i- ~.I,,,,,,.,;:; ,:);:....,v,,'itt', " . .!.',' ~,\~'~:"" " H,,' ~P'~"<.':!~'Q~~;.. . V:t' ":r""N'Oo') ~.' '.t<.""... ..~, ~~i il" Thank,You for your i.ntr,~~.)~lrt'utilitY ve~~~l:~.,. ~ e would: lil{€~~)J~~mmend the followmg for your c~d.'St~ltton: / """F ........,. ~!l't~~\'.,---t. ~ )..~~~)~.,V' .., " .~'I>f5i--}~ 1 or 2 898628 .;~~an,utilitY vehicle complete with su,zuki 6~~!\\Et;! 21,336.00 ea )t'\~,':{.liqllid cOoled 32 hp gas engine, ~ speed mapual ~:~ . ~~.;{:;.~: transmission, 47'i~ox a~sAlnbly,~~nd tow hitch '~}~y~\ .'.....~\)... '.... .' "~ t..t:;,t '');:",:;,: · ,.~;{~...\t:~{~\~ ~;",(' : :'~'.~'" ~,~;'o~ y...,..... A .'''' ;.~.:.:-.:.'. f,~..~," ,.;' "~\.'~',~f.t~V1i.:'<~~ ~,"'" ' ~'~ ~.~ ,<' The above,price.is-.F9B:. Salt Lake qti~~~\~~~\~n~':-;~';" ;, ,,<:,~."'t.~ \ ".,' : 'rI:l..A'....~T\').;"),.l'';{'.l',~''''~,~t...'~, 'oJ ,', "/ ,.., . I . ....\~Il'r'~~~,~~"'~...(~s..Q",,.,.~.. i:l;:"T' ...\..... '" . " ". ,~.~~''''l:1;,~':''1\ .~ ':rW::Sl..~1,;W'~;"" ,,,.." Please calhfyou have any questlqfi$:.c<lt~'~~~~' 0i0~i,',f\r:-.,'(;~0, .' . .; ~rr~J~:.~r;o!A"1~~ (l~",,~:""I~~H':"'. ~\.'(:\r- ..; . .. ,~...:.r~'!Ir:.' ''4,l:!I..~.Ji>> :-\...~td'~~~'r"c.~;'~' '( . :.,' ,';,\j.;<.~<l0~~""",*"..t" ii,'lio~,/o ..'i:-~''t..:'':''''~ Sincerely, ." .' :..:~ ( .r (i)..... :1/ .c ;' l T ..,,~ ...., r ...." Rocky Mountain Turf _, 'J', '~ ,f <. .' ~" ~':,,, . / ,;\'l.::" _ :,':.'~" lK " i' "il,'1 ~','\~ / t .i"".'~~ nt ". " r Q~" r"Y'J" ,t ~ ): .'~~-'(.~, "', '-,..,. " .. .."... ,.. .,' Q,~~ ..";,;" ,I' it .. 0 .! .;"-'" ~'t '~';'~~'" 't ,.../ <..,;;-...... \~y" '~~,.'\ .: ~ ~ ":\ tor ,r:- !C(~~:t--~. :;.J:!:\~\.o '''..!^J",,_. ~(l:.(!-.. ....%.\.::r~. ..( ...f",.<~.. . , ,., . ." .............,._ ....~,.......... y.... ':'. -.::"1, I, "'..( 0 - ." .. ......,./'..... 0":" ...' !~.,~... ..' "Y ( Cindy Nlclse" . .' ,,:, ~\f.' .~~,'r'\'\'7tr", " "'~ ~"".tr \Y '-t~"'-\., / , '.., " . ,; -!':/~~ %~'i?J ~,;; <i".-"'i. '" 0 ~f\"~'\\ f:,~~ '~t, ",t..~">.." , Sales Coordinato C" ... 0:-'" . <,. ...... I.!l"'~ I)'t ~ (.. ~,11.\' "'$ r;:> .~\,~ ./ . r '.' ~',"',' ," f'f'J "",\....""0.<;, .~" ''- ';.1:'>.';. '(.."1' ,t>, ~~ '" 0 . ~)'"",' \~'l';,,' J;o.~, ""'~. ,'~ ... ~ ~~. .,. . ,. ,.: .t:~. ,;~~~'.~;i:&\:~"~;, ;:/~o ~;~,~~:!'~;.r.~-" ..... ........ -j"; .. .. ..... ........~... . ...:.' ~ .. . ... ;--. 4350 South 50 West, Salt Lake City, UT 84107 . (800) 733-7114 or (801) 262-0182 AGENDA ITEM NO. PACE (.5 r. Ul 4- OF_c1 JAN 06 '06 02:59 8012629740 PAGE. 01 v- W7 61/18/2666 16:56 9513721674 .~.I!rr,Y!~J.~~~. GOLF VENTURES WEST PAGE 63 CUSHMAN@ TURF-TRUCKSTER@ 'oJ, Q1) ~! Most-rugged, easiest~riding, best~equtpped turf vehicle. :i :: \: ;;: I' ,'I ":" i: ,h l~" ::;; ,,:.~; :;: i: , " .. 'ji'IGH'E'sT' hofUU'S'rRY' ':: ' PAYLOAD 2,850 lbs,; Steel or poly dumping beds ava1lable. 1'11'1"'''.... <1/' ",,,I. '::::::." ."hl " h CHOIcE OF ,:"".... :':';", '" TRANSMISSIONS Ind~try exclusive - automatic 3-speed , transm'$S'on available: D:Y.h'rilounted shitter for :l\Jtomatlc or 5.speed manual trMsmisslon. JAN 05 '06 02:59 " ,,-,.-,\ "":'.::, {:;'l~" .,~,:I~ ,. jill' "" ~OWER:FOR THE RUGGED ROAD AHEAD " ',: .::" ";" !,: :'~ ~ '" j' "",' , HYO'RA:OLlC DRiVE SYSTEM Auxiliary hydrauliCS corne standard; Optional high- output system. I'" ''''', ...il> ",..... -; 'L' " "A~efS'$o~iz~ FOR'::,: ,'::'" MAXIMUM PROPUCTIVrrv Heavy.dutY pro available; Many f)t~l' l)ption~ to ~uit YO\ll' Meds. Gas engines, Bvallable in 36-hp EFI; N~w 26-hp diesel ~n9Ine. '~:'_.. /1 " '." , , , ." WHEN PERFORMANCE IfATTERsr0: ~2005 Jacobse", It Textron Company. 1-888-922-lVRf or www.jacabsengolf.com ,ACEN6A ITEM NO. 4- PACE ~ OF --3 9513721074 PAGE. 03 Version 1.0 ~1/18/2~~o lo:5~ '.:1013 1:ll.l:U4 ~ULr VcNIU~C~ WC~1 I'"'/-\\:lt. 04 J .mm!.mg!;!!~ ,It!,i 0 ,,!~ I!: Ii W; l. - .i! ,.11 .11'.:' ~ ;.' :1_ l"J 36-HP GAS MODEL Engine Suzuki'" 660 EFI_ 3-cytinder. 4-cycle. 12-Yillve, liquid- toOl~. e\ectronic: fuel injection HorslL'power 36 hp (27 kW) (@",100 rpm) Torq~ (8 3.550 rpm) 44.7 tt.-lbs. Displacement Governor'T)'pe Afr Cleaner Lube Oll Filter : lubrtcatloll , Startln, System Fuel ,Type : ruel CaP~Ity Fultl F'lter DIESEl MODEL Engine ..so. I cu. In. (657 cc) ME:chanical centrifugal (Cushman'" ground speed !lovernor) Self.cleanlng centrifugal pre.cleaner with paper c:lrtricl!le Full flow with spln.on oil filter Full.pressure lubrication 12-volt staner Unleaded regular t:lsotine ~ .,. ". ""., -. 6.5 gal. 124.6 L) in pol}'olefln tank 30-mlcron IIre.f1Iter and 10'mieron final mter Perkins" "03C-11 dIesel. 3-cyllnder. 4.cycle. , liquid-cooled i, . Horsepower Z6.4 hp (19.7 kW) (~ 3.000 rpm) TCrqU9 (e 1,600 rpml "'9-" ft_-lbs. (67.0 N'm) Displacement 69 cu. In. 11.131 cc) 011 Capacity 3.7 qt. 13.5 L) Governor Type Mechanle:ll centrifugal Air Cleaner Ory.type with evacuator valve lu~ 011 Filter; Ful.1 flow wtth spln.on oil filter ,.\ lubrication ~ FUlI:,pressurc lubrication Starting Syst~m ' 12.volt starter Fuel Type F'u~( Capacity Fuel Filter , Diesel ASTM 1'0. 2.0. 45 minimum (etane , ., '"."' : 6.5 ~al. /24.6 L) in polyolefln ~nk Pr~.filt~r, water separator, final filter s; i~J I;::: I~:: .t~ ~;., jE :1::' .Ji~h -Ji l It]! fti~ ~:~ PAYLOAD CAPACITV Rated Capacity DRIVETRAIN Clutch EFI Model Transmission. ,Manual Transmission, Automatic Gear Selector ELECTRICAL SYSTEM 2.850Ibs. .',293 ki). Includes 200 lbs. (90.72 k~1 for each ope<Gtor; passen!ler and box 6.7 in. (170 mm), dl)t. Sinale disc and pressure plate, : 970 and Diesel Models 7.1 In. 1180 mm). Sln!lle disc Bnd pressure plate F1\o~.speed truck manual transmission wlth low.low (trl!eper) flrst !leer; synchronl%ed III aU forward gear; Three.speed .,utomotlve automatic W)n~mission wtth re~erse gear Dash.mounted. right.hand shlf~ www.JocobsenGolf_com WHEN PERfOR14ANCE HATTERsrllf CUSHMAN@TURF-TRUCKSTER'" "'" CHARGING Diesel/Gas Model, ! 55-amp. heavy-duty alternator L1ahts : 'lWo !lea led hi!h/low-beam headlights; stoplightl : taillight WBrnlnS Sys'em i Thermal sc:ns~-(lctlv:ltlng warning buzzer indicates : engine o~erheatlng ~ehtat D'esel Mo~I : Automatic lllow'plug activation before ignition; . : instrument panel light IndIcates when glow plugs are l heatln!l the combus,tlon ch:amber$',' " " Hydraulic System : 6.S gal. (25.7l) capacity; 25-mlcron, full-flow : filtration; bIodegradable flvld; oil cooler stllOdllrd STEERING Automotive power steering SUSPENSION Front Rear ! Double A-arm Independent suspension with spr1n~- ; over shock absorbers , Heavy.duty. multiplellr.tfsprings with shock sb~orbers 5EATS Two contoured, bucket-typ4I s.ats with hip restraints and hand.holds BRAKES Service TIRES Front Rear REAR AXLE Gas Models: Diesel Model: DIMENSIONS Ground ClearanGe Overall Hellht Over<'ltl He1ght with ROPS and Cab Overall Lensth O~rall Width Inside Clear"nc@ Circle Outside Clearance CIrcle WhClelbase Wheel Tread Front Rear Heavy.dut,y, hyclrlluUc.7.?, in. (29~ I'TJmI4uo:servo. . :.elf-adjuning b~l'lk~ on aiL \yheels,,,,ltl)'dual mll~ter cylinder and reniotetrunk~mount~d m~ter cylinder reservoIr '20 x 10-IG, 4-plyrfb tread '24 x 13-12. 4-ply turf tread 14.7.1:1 ratio. two. speed transBxle; 7.1.ln. (180 mml hypoid ring gear; beVel dIfferential !lears; : ; integral 3.2:1 auxiliary !ltar set; semi-floatIng axles: : wlth spllned five.bolt~hl!el hubS; heavy'duty i wheel bearin!l5. . . 11.16!1 ratio, two-sp~d transaxle; 7_111'1. (180 mm) hypoid ring !lear;bevel differential lears; integral 3.2:1 auxlllary g~ar set; semi~floatln!! ades with spllned fiVe'bolt wheel hubs; heavy. duty wheel bearin!ls .7.5 In. 1190 mm) I 50.5 in. 11.1 m) ,7"'.711\. (109m) , 114.2 In. 12.9 m) 63.5 In. 11.6 ml 41 in. (1 m) 20 ft. 2 in. 16.1 m) 88.2 in. 12.2 m) 50.6 in. 11.) m) -42 In. f1.1 ml 56 in. (1.3 m) AGENDA ITEM NO. L\ I. ,-~~ TO'" 01'" '0Ij::. OI~:OIOI 9513721074 PAGE_04 ~l/l~/~~~b Ib:~~ 'j~l.jILlt:J/~ UTIUlY VEHIClES ....u..u. '" ,....~.. ,#.", .....~&...u...... WEIGHT Gas, Manual Gas, Automatic DIesel PERFORMANCE 1.5n Ibs. (713 kg) 1,619 Ibs. (734 kg) 1.619 \l)s. (734 kg) In 1.6 (2.6) 5.0 (8.0) 2nd 2.7 (4.3) 8.5 (13.7) S-Speed Gas 4,100 rpm 3rd 4.2 (6.7) 13.5 (21.7) Manulll 4th 6.4 (10.3) 20.4 (32.8) 5th 8.1 (13.0) 25.8 (41.5) 1st 1.7 (2.8) S.S (8.8) 4~Speed Illd 3.2 (5.2) 10.3 (16.5) Diesel 3,000 rpm Manual 3rd 4.4 (7.1) 14.1 (22.6) 4th 6.3 (10.1) 20 (32.2) , 1st 2.5 (3.4) 8 (10.7) : l 3-Speed .-._.........,................ .... .. ..-..............-.....1 Gas 4,450 rpm __~~~....__4.:~ !6~_... . ..!~~_l!.~l....__: i Automatic 3rd 6.8 (11) 21.& (35.1) : ,......_~..... .....-._.~ . -. - _.- _.. -,.... ,..,......----"",....,..........-,.,...... _.*~..,._...._......._O'-'_. ..._ ltl iC .t,\ :;~: ,~:; ;c l~J( .77.: ,:~' {:;. .~; DEALER INSTAllED: C Al:ll'm. Baek-up Kit, Variable Patch o 'All Funetlon" Wire Harness (Use with lIJrf MMter) !.J Bar Set, OrB!! Mat (To be DIscontinued. Limited Availability) 8 Box Assembly. 47", SIdes and Thllgate with Automatic Tellgate Release (ReqUires 4r Flatbed) . tJ Box A$sombly. 60", Sides and Tailgate wIth Automatic Tail!ate Release (Requires 60" Aatbed) ~ Box A$sembly, Poly Boll W Box liner (For 47" Box Assembly) ;; Bumper. Front !..:; Conversion Kit to Mount Core Harvester (Mounts Old Core Harvester to New Truek) o Conver~lon Kit to Mount Top Dresser (Mounts Old Top Dresser To New 'Tl'uek) r', Conversion Kit to Mount Vicon Spreader !.: Core Harvester (Fits Old or New Truck), Polybox Requires Mounting Kit , (Requires One Box .A~sembly Option) . Black i o Door, Steel. Left Only. Green or Oranae (Requires R.O.P.S.) 'C:: Door, Steet, Right Only, Green or Orange lRequires R.O.P.S.) C Exhaust Spark Arrestor ~ Fifth Wheel Ball Hitch KIt (For Old 5th Wheel Kits to FIt New Truck). Includes Electric Brake Controller r'l Fifth WI'leel Ball Hiteh, lr\Clucles Electrt( Br:Ike Controller (Fits New Truek Only) : o Fifth Wheel Ball Hitch, Includes Electric Brake Controller (Fits Old Truete) ~ Hitch, Receiver Style with Drawbar (Male Insert 1-1/2') C Hltcn, Flat Bar Style ,..... Flatbed, 47" or 60". Quick Disconnect : :J Heater/Defroster (AI. Wheel) : [J Hydr3ulies. High/Low ~ Implemenllifl fA' Frame) ~: Mirrors. OutsIde (Left :ond Il.Is:ht) ::J Mounting KIt for Core Harvester, Poly Box ~ P.T.O., Hydraulic (RequIres Hydraulies) w'WW .Jocobsen"olf. com I;lUl...r v Co/'ll Ur::CO;:> WCO;:> I rf-ll;ll:. tJ'-' CUSHMAN@ TUItF~TRUt~Sl'ER."" ",. Q PoT-O.. Heavy-Duty. MechanIcal (Perkins Model Only) . i o QuIck Aerator (Includes Deep SUdnl Knives) . Black C] Ram Mount (Sprayer Control Mount) .., Itl).P'S. . Roll Over ProtectIon Structure (In<:lvdes Seat Beltsl STop Dresser 1500 (FIts Ol,d Dr New 1l'uck) ~xtured 'Creseent' ee.t with V l!ulde . Black . :::':;1lJrn Stglla's (Includes R.H. Tallll!lht) :.:.!Vlcon Hydrau\1c Power Kit (ReQuires HllLo Hyd,ralrllcs) :: Vlcon Mechanical Power Kit (Truclcster Requires PTO) :: Vlcon Spreader (Requires Power Kit) :':::W1ndow, Rear (RequIres R.O.P.5.) :::':;W1llclshleld with WIper (RequIres R.O.P.S.) ~J Dry Seal Coupler, 1 Set . ,_'... !"'""l Hl'adllner for R.O.P-S. (Standard wIth Cab) :: Dr~wbllr (Male Insert Only) (Requtres ReceIVer Style Hitch) r' ~Tjre. Spare 20.00 x 10.00 - 10, lUrf Rib . STlre, Spare 24.00 ic 13.00 - 12,1UrfTrdd MODIFICATIONS. FACTORY'NSTALLED !:: Cab. Installed (In~lucles R.O.p.S..Wlndshl'eldwtth WIper and Rea~Wi~do"":) !: Cratln! < ~:; Doors, Steel (Oran!e) :: Frame, GalvanIzed ("-Wheel) ~ Heater/Defroster ~ Hydraulics. High/Low (Diesel or Gas) ::.J Light. Dome (Requires Factory Installed Cab). .. :J P.T.O., Heavy Duty, HydraulIc (RequIres Hydratl\f~) :::.:: P.T.O. Heavy Duty, Mechanical (Perkins ModeIOn!>,) :J ItO.P.S. . Roll Over Protection Structure (Includes Seat Belts) ::! '1llrll Signals :J "All FunctIon" Wire Harness Ii Ram Mourit, Use wIth 'I\Irf Master lcan Not Be Used with lfeaterlDefroster) NOTE: SpecificatIons. while correct at tlll).pf Prlntlng,m!lY c:hanse :.'. r w1thout lIotlee. ThIs product has been wstecl and compiles wtth 8~.8 .1993 ANSI voluntary safl!'ty ~1ff~t1pn$fol'::c:ommerclalturfequlpment and also compllc:s with EU safety regulations. WHEN PERFORMANCE HATTERsr.. JAN 05 '06 03:00 AGeNDA ITEM NO. PACE ~ 9513721074 PAGE. 05 L\' r OF~ ~l/l~/L~~b Ib:~~ ':l:Jlj/L.l.~/q oULr V~NIU~~~ W~~, t""14UI:. t:J.L Golf Ventures West ^ WelbI\;on Q.mpllY I4'7S Sanapson Avenue Corona CA. 92879 Phone: 9SoS"S7-3UI Faxs 9SS-37z.S0'74 .. DM~6) F8JC 951-471-1251 ~ AXE]) I-I t)- OS- 10 A-M ,,-.. From: Dick low p....:z 0 Phone: Datec 1-18-06 R-= co o Urgent 0 For........ 0....... eon.n.nt 0....... Reply 0 ..... R~. ~ Dave and Dan: I think we have found the answer with this quote. This wilheJieve OV West of any liability of shipping non-approved C.A.R.B. Units into the state. Thete are no C.A.R.B. approved model 627 Cushman as we delivered to you last year. The only difference in the model 628, it full automatic trans, which could be operator friendly. It is fully speed governed like the 627. If the City purchases two units, you will be paying ~ the price of the auto trans option $765 x 2, which is the price difference between 2 - 627 manual trans units. This is a great chance for you to get 2 more Cushmans with auto trans at 2005 pricing! Give a call if this is going to work. Remember this is an alternative that we have worked for the City of Lake Elsinore Dick Low Go!fVentures West ",- .ACENDA ITEM NO. L\- PACE-1-0F~ JAN 05 '06 02:58 9513721074 PAGE. 01 r-. CITY OF LAKE ELSINORE REPORT TO CITY COUNCIL TO: MAYOR AND CITY COUNCIL FROM: ROBERT A. BRADY, CITY MANAGER DATE: FEBRUAY 9, 2006 SUBJECT: RESOLUTION OF INTENTION TO ESTABLISH COMMUNITY FACILITIES DISTRICT NO. 2006-2 (VISCAYA) AND RESOLUTION OF INTENTION TO INCUR BONDED INDEBTEDNESS BACKGROUND On March 9, 2004, City Council approved the tentative tract map for the Viscaya r--- development and on August 9, 2005, City Council approve the final map. The City's finance team has met with the developer and their financial consultants several times in the last two years to discuss the formation of a Community Facilities District for the project. This is the second formation process. The first formation process was canceled by the developer and a new deposit was provided for this second formation process. DISCUSSION The developer plans to build 168 single family homes. Special Tax The average residential special tax is estimated at $2,936. The annual CFD tax amount, when combined with all other property taxes applicable to the project, is estimated to be approximately 1.90%, which is within the 2% City CFD guidelines. The 1.90% tax rate includes the Police & Fire CFD and the proposed Parks, Open Space, and Storm Drains CFD for operation and maintenance. r- AGENDA ITEM NO. 5 PAGE J OF 41/- REPORT TO CITY COUNCIL FEBRUARY 9, 2006 PAGE 2 .."." Facilities The proposed facilities list is attached. The list totals $5,650,237. The list contains City facilities of$828,781, City fees of$I,869,901 including MSHCP fees of $201,422 and TUMF fees of $884,256. The list also includes $1,777,584 of EVMWD impact fees and $1,173,970 of improvements. Bond Issue In order to finance the facilities it is necessary to incur bonded indebtedness. The not to exceed amount is $7,000,000. FISCAL IMPACT The administrative cost to the City will be paid by the $65,000 deposit made by the developer. .."." Repayment of the bonds are secured by the special taxes levied on all property within the district, other than those properties that are exempt as provided in the rate and method of apportionment. The City will, however, be faced with a long-term obligation going forward to maintain the City public facilities constructed as part of the development. PROCESS The formation of the Mello-Roos Community Facilities District requires a specific process as outlined in the attached resolution to establish a CFD. The City Council will need to hold a public hearing on the formation of the District and for the approval of the bond documents. At the public hearing the participating property owner will have the opportunity to vote. The public hearing can be scheduled for March 28, 2006. ......, AGENDA ITEM NO. 5 PAGE 2- OF l/- L./- /'" REPORT TO CITY COUNCIL FEBRUARY 9, 2006 PAGE 3 RECOMMENDATION It is recommended that City Council: 1. Adopt Resolution of Intentions 2006 - J-i) to Establish CFD 2006-2 (Viscaya) and 2006 - ~ to Incur Bonded Indebtedness 2. Schedule the public hearing on the District Formation for March 28, 2006 PREPARED BY: MATT N. PRESSEY DIRECTOR OF INISTRATIVE SERVICES ,-.., APPROVED FOR AGENDA BY: ~ AGENDA ITEM NO. PAGE ~~ 5 OF L/- L/- PROPOSED BOUNDARY OF COMMUNITY FACILITIES DISTRICT No. 2006-2 OF THE CITY OF LAKE ELSINORE (V1SCA Y A) COUNTY OF RIVERSIDE, STATE OF CALIFORNIA ......" UNB DELr. LJ:NGf'H U _'/JJ Jr JOJ4./lO 12 6IrOtl J 6B.U' L3 38"6S'/JJ. Jr L4 6IrOtl'l'. 76.00' LIS Str63 /JJ Jr 106.00 UJ 63"06J, 1110.01 L7 Str63 61 Jr 106.00 UJ 63'06'1,. 806.00 LII N _ 61 Jr 40.00 63"06'1' 186.64 UJ N _'61. Jr /13." US 63"IHI 00 10.00 APN 378-2JO-04 US N_61 Jr 113.13 379-2JO-06 U4 N 63"06'1'. 44'1.00 378-2JO-08 UIl _'liS. _.311 378-2JO-Oll U, 63"06U &110. U'1 Il3"04lU 23'1.1lIl ctI1lVE JlADl(IS LJrNGf'H a 10.00 lU"30 Sf SO.11 CB 10.00 lU'3lI OJ SO.14 C3 630.00 C4 1l3O.00 03"fl' 3Il.1I1 CIl 1l3O.00 00'68 03 './lIl CfJ 4'/'0.00 ,J, C'1 100.00 4O"IllfU '11.4, ~ CfJ 41.00 24"00 .11 ell .00 ao 41.00 THE BOUNDARY OF lHE DISTRICT COINCIDES IIIlH THE BOUNDARY OF TRACT 32008 EXCLUDING LOts 169,170,A,M, Y AND Z. SCALE: 1.=200' F1LEO IN lHE OfFlCE OF THE CITY ClfRK OF lHE CITY OF LAKE ELSINORE lHlS ---PAY OF _2006. CITY a.ERK OF THE QTY OF LAKE ElSINORE I HERESY CERlIFY lHAT THE IIIlHlN /IN' SHOMNG THE PROPOSED BOUHOARIES OF COW/lUHITY FAClUlIES DISTRICT NO. 2006-2 (IolSCAYA), CITY OF lAKE ELSINORE. COUNTY OF RfIIERSIOE. STAlE OF CAUFORHIA WAS N'PROIIED BY THE CITY COUNCIl. OF THE CITY OF lAKE ELSINORE: AT A REGULARLY salEDlJLED llEETING tHEREOF, HElD ON THE _ DAY OF 2006. BY Its RESOlunON No. CITY ClERK OF THE CITY OF LAKE ELSINORE F1LEO lHlS _ DAY OF ~ 2006. AT THE HOUR OF O.CLOCK....../I. IN BOllK.- OF /lAPS OF ASSESSIIENT AND COIIWUN/TY FAaunES DISTRICts PAGE NDS...-lHROU_ AS INSTRUWENT NO IN THE OfFlCE OF THE COUNTY RECOROfR IN lHE COUNTY OF RI_SlDE. STAlE OF CAlIFORNIA. COUNTY RECORDER OF THE COUNTY OF R/\lERSlOE FEE L-- REFERENCE lHE R/\lERSlDE COUNTY ASSESSOR'S /lAPS FOR A DETAILED OESCRIPnON OF PARCEL LINES AND OIWENSlOHS PROPOSED BOUNDARY MAP ......" VICINITY MAP NO SCALE Wl.WIl D1S11l1CT IKlUNOARY _HARRIS & ASSOCIATES 34 Extc:uflvtl Pork. sw.. 1 so _irvine, CA 926t.4 (949) 655-J900 . fAX (9.9) 655-3995 Community FaclliUe. District No. 2006-2 01 the City 01 Lake Elsinore (Vi.cay.) County 01 mVAC!NM1T!M NO. _10'1 SCALE: l'-l4a' IN TI-E CITY Of LAKE ELSINORE, COUNTY Of RI vms I DE, SHEET 2 OF 7 SHEETS STATE Of CALIFORNIA TRACT 32008 PORTION OF LOTS 11 ANO 12, BLOCK "S" Of RANCHO LA LAGU-lA SUBDIVISION, IN THE CITY OF LAKE ELSII'mE, COCNTY Of RIVERSIDE, STATE Of CALIFORNIA, AS SHOWN SY lAAP ON FILE IN BOO< 8, PAGE 377, Of lAAPS, SAN DIEGO COUNTY RECORDS RENCIVIL - FEBRUARY 2004 .r" .r" f"ClH) t 1/2. I.P. Nn' FtUG ,. I.". TMlIED "IV1r' LfIIJIlL (tJI 0.5') MUP'JO) (FUJSH) .MXIP'JED AS M cA AS ll€ IE5TERl..Y alt. IF LOT INf. II'" IIIllOWlD 51llEET /IHJ It IN LIEU 0" 1 .-..... l.NCHl:R: DRIW: IN LIfU 0" l TAlilliED AlE 1211. PDt.. '9iI. ".U.. TAliIliED ACE 1211. 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WOWlO Sf 'HIEN 1& ItUC N31'55'05'"E AS - ~&ATM&R. ~l ~:c:s~~..:s~~~20" I /~U'IL"-'''''' =~~ 8lllMR~"RUT CM.maIJ.... -,- ~ t. ....................... t F2~..=r-D.E&: LoI'AA' f - 3. OIICUCATESSEll-IIDfPIPE'ITHPUSTIC I f'LUlil srMf'ED "'L.S. 7JI4-. a:NIEJLl~ ="y.=rn.., ~~I~.r.1CI 53 51L 1074,47 DEED TO .lACk W. WOCAIII AND . i- - =" ~ sr: ';"~::W = :,.m NIlH 1mIIID.. IMJI 2.1, ... ~~::::- I""" : I ~ - INPA'<<IENT UFN:E.. 1~~'7r JOI.53'&1~ 1074,50' =:ORUG 1t2.~ :,;:}} ~fllH) 4. ~IL:O!lET~,:a:=~'c:;:; '" ~ 38 L _J -'I: ,I 23'I~ \!-OI . ....._'... _nOllE M SIIlE LDJ LIIE IMLltu IE ",or-- -=-- ;1;;;' -;....; I,.., 32131 0029 28 11M""'" LDJ -..s.. I" -.... "'" , 39 371"" ""134 ,-PP-I T 21' '/ PL4STU: PUJO IT..... 'L.S.""" IIU.IIE lIET ro.N) 2- I,P. TtP" PIPE 2 - 5 ~ 111 ~ - ~~~~cn:-~~' ~:~ :'~~'l,. a ~ ~ <:;.. ee mEET 11lMA !laUHlUU.at... KlUNuu. urr 12. IN lIDJ Cf' 1Ji. 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Ie ../11 : 8...,.... 87 88 l:l2l'l3I34rJ5I38t17;:;-w ~ h8i · ~~n:;:,.~,'f~"". i ~I ~;~ 66 B9 fUoO,12912B 127/M 1251 ~.:.~: ri! - - _:~ -:,==,:::=;:. I 63-"'- fJ5 90 Y. ;,-, ~ r-- ~ ~ ~'~L~~'~~~~ I: .~. ;,.,. 6 li ...... ....,51: ....... ~ ..- .... -IIS~ _ f--- - 1Z, (R) lOOTES RADI...... EMI,. I _: ,2~ ;...: "' ,. IrJ 120 121122123 124 ~ 0 ~L ::::::::::::=..::::. f--- ).,~ ~"":f~ ~. LS-- in - ~ . 93 0 /Xl L~' ~ lD 112 ~'I~ KlJ 8 ~ 169 '~~II S- _ _ EASEMENT NOTES I '" jI\ k8 ;;: 62 ~ ;; ~ F'UTl.IiE ' if:,. UTILlTY-SllffiON SIrmAS POIIER : !L 0 '0 95 f 97 102 W 108 -J 1 lXUoERCi.... ~ ~"~~I~ ~~_ ! ...t\ J ~ 57.58 5ll~ J 96 101 liXl4 X)~ T..... r::~~ ~I - -l & ;~=~~~ ....' 2 I'" 99, fJO :JIIO.~ :f"g -.. JAHJARY 1, 1930 IN BOOK 838, PAGE I . 101 :3' 141. lfiDS : "'''I~''''''I",..T",~ ",~:'i.'1"!'F'I'I.I';;LaT' :. ~____.1 II 8 ~:~II~II~'I~I'~'I~II~II~ ~1~1~1~1~1~1t;1~IL_n-' ~ I. ::. : ! I I I 1 J I It ,aT, t=.=.:: "!ir:-i, "....IIM DfVVti -----I J.....,,1~.,2~ I I.J..:-rwr- .....1 O'53'5JL 1074.J,r"" '~FlJlN) ~~~~~ T~~~'2') _ 5Ii.......: S'!!!. ""---~.. ~~: IE ~;',")'" Ie '.... lOT ..12' N ~~ =,,::'~~":~. ! ~:,~:t':::"IE TMIliEDI.S 3HI PO,," SET i paM 1" lRDN ~IPE 'l.h'L.ASTIC fIt..UI; PU\€". 8~""'" LS7JI4. iI' t __ ! _ ::;'~~p~:: lE8UU ~=:::~:~ (r>>rt 0.25.) NXEP1tD /i5 M [N>>.J4'45~ ell INT. fF ltJVERSJlE DU\lE Nt) WAI.Jrrlff EJtlYE fER PM Jt'42- SURVEYOR'S NOTES ~ ,,-.., nut) ,- I.P. IIENI' !L1em..V, NOJ LDlIa.E ([If 0.;.1&') HI) flU. aT 0.1&'S. 0.11' . fT cA tNT r:F lMCEStOlE Ml\lE NO flWiEJt IJUVE I 1 I 1----, I ~ I I I J I / RI 1071.1,r 1014.05') 1074.12') rCll.Nl 1 ". I,P, NOT lDlJEl.E (ON 0.25') AIXI71ED AS M C/I.. IHr. " lJICE9fR: [lU\lE N{) Rl\IERSlrE DRIVE POt ,... '%2' '40 0 ~IIIIIII 140 280 420 1 GRAPHIC SCAL.E AGENDA ITEM NO. PACE 5 5 OF David Taussig & Associates, Inc. 12/02/2005 PROPOSED CITY OF LAKE ELSINORE CFD NO. 2006-2 CORMAN LEIGH COMMUNITIES (VISCA Y A) BOND FINANCED FACILITIES SUMMARY ...., Available Bond Financed Facilities [1] NA City of Lake Elsinore Facilities Storm Drain Improvements [3] Traffic Signal Improvements Lakeshore Drive Improvements [3] NA NA NA NA NA $5,234,791 $15,327 $1,869,901 $150 $18,300 $828 $101,023 $1,600 $195,200 $1,369 $167,018 $7,248 $884,256 $1,651 $201,422 $2,481 $302,682 NA $828,781 NA $449,344 NA $176,876 NA $202,561 $10,284 $1,777,584 ....." $5,429 $890,356 $4,855 $796,220 $23,979 $47,958 $8,610 $43,050 NA $1,173,970 NA $416,072 NA $757,898 $25,611 $5,650,237 NA ($415,446) City of Lake Elsinore Fees [2] Library Fee Master Plan of Drainage Park In-Lieu Fee Traffic Impact Fee Transportation Uniform Mitigation Fee Multiple Species Habitat Conservation Plan Fee Public Building Impact Fee NA 122 122 122 122 122 122 122 Elsinore Valley Municipal Water District Fees Water Connection Fee [5] Sewer Connection Fee [5] Landscape Irrigation Meters - 2" Landscape Irrigation Meters - 1" NA 164 164 2 5 Elsinore Valley Municipal Water District Facilities Sewer Improvements [6] Water Improvements [6] NA NA NA Total Fees and Facilities Bond Financed Facilities Surplus/(Shortfall) NA [1} Based on tax spread 20 utilizing a 1.90% Total E.T.R. and a 6.0% average coupon. [2} Excluding Phase 1 and Phase 2 units for which fees have already been paid, and 4 model units. [3} Project is substantially complete and has not been accepted by the City of Lake Elsinore. [4} Facility is being constructed with prevailing wage. [5} Excluding water and sewer connection fees that have already been paid for 4 model units. [6} Project is substantially complete and has not been accepted by the Elsinore Valley Municipal Water District. K:ICLlENTS2ICLCILake ElsinorelBudgetlBudget120205.123 '-' A~ENDA ITEM NO. PAGE h r-:::: . .0 OF cf 'f ~ ~ /"'"' - ~ ~ ~ ~ rI.l E M I \C ...... g=.. M rI.l .... CIJ ~ ~ .. ~ bE-< rI.l_ Q .~ CIJ rI.l ~ \C _ CIJ CIJ Q Q ;: r~ Q = .. ".J M 'r;] 13 '1:l th - ~ = Q liJ;1~~Q CIJ ~ M ~ E;'; ; ~ = ~ CIJ ~="t~ '0 6 = ti C6'g ~ .. Q _ .:!l UU~~ .. "'-.t ;;;J '" 1'; ~u 8~ 't;~ 0"'" Ill"'" III .... V .. ~~ 1'; ~u <A ov) ...0"'" "'0 =-0\ -.tv) ~..... I o III III .... <A .. "'M ;;;J '" 1!! ~u 0"'" "'0 v) "'0 ~tf ~..... I o III =- .... .. 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'" '" ., ] .D ., "0 ..s "0 ., "0 c: o III "0 ;j ~ E-< <; '0 ., 0. rn ] ~ .~ ~ c: o ~ '" '" III ~ ~ ACiENDA ITEM NO. PACE 1 :5 OF Iftf RESOLUTION NO. 2006- av ""'" RESOLUTION OF INTENTION OF THE CITY COUNCIL OF THE CITY OF LAKE ELSINORE, CALIFORNIA, TO ESTABLISH CITY OF LAKE ELSINORE COMMUNITY FACILITIES DISTRICT NO. 2006-2 (VISCA Y A) WHEREAS, the City Council (the "Council") of the City of Lake Elsinore (the "City") has received a petition (the "Petition") requesting the institution of proceedings for (i) formation of a community facilities district (the "CFD") pursuant to the Mello- Roos Community Facilities Act of 1982, as amended (the "Act"), (ii) authorization of issuance of bonds for the CFD, and (iv) establishment of an appropriations limit for the CFD; and WHEREAS, the Council has determined that the Petition complies with the requirements of Government Code Section 53318( c) and now intends to initiate such proceedings; and WHEREAS, it is the intention of the Council to finance parks, open space and storm drains maintenance services that are in addition to those provided in the territory within the CFD prior to the formation of the CFD and do not supplant services already available within the territory proposed to be included in the CFD through the formation of the CFD subject to the levy of a special tax to pay for such services, being approved at an election to be held within the boundaries of the CFD; and ....., WHEREAS, it is also the intention of the Council to finance the acquisition and construction of the Facilities (as defined below) or any combination thereof through the formation of the CFD, subject to the authorization of bonds and the levy of a special tax to pay lease payments, installment purchase payments or other payments, or principal and interest on bonds, being approved at an election to be held within the boundaries of the CFD. NOW, THEREFORE, THE CITY COUNCIL OF THE CITY OF LAKE ELSINORE DOES HEREBY RESOL VE, DETERMINE AND ORDER AS FOLLOWS: SECTION 1. The Council hereby determines to institute proceedings for the formation of a community facilities district under the terms of the Act. The exterior boundaries of the CFD are hereby specified and described to be as shown on that certain map now on file in the office of the Clerk entitled "Proposed Boundary of Community Facilities District No. 2006-2 of the City of Lake Elsinore (Viscaya)," which map indicates by a boundary line the extent of the territory included in the proposed community facilities district and shall govern for all details as to the extent of the CFD. ......, 45710630.1 c;;- AGENDA ITEM NO. ~ PAGE 5? OF If!/- CITY COUNCIL RESOLUTION NO. 2006-_ Page 2 of6 /"""". On the original and one copy of the map of such CFD on file in the City Clerk's office, the City Clerk shall endorse the certificate evidencing the date and adoption of this resolution. The City Clerk shall file the original of such map in her office and, within fifteen (15) days after the adoption of this Resolution, the City Clerk shall file a copy of such map so endorsed in the records of the County Recorder, County of Riverside, State of California. SECTION 2. The name of the proposed CFD shall be "City of Lake Elsinore Community Facilities District No. 2006-2 (Viscaya)." r-'"' SECTION 3. Except where funds are otherwise available, it is the intention of the Council to levy annually in accordance with procedures contained in the Act a special tax (the "Services Special Tax") sufficient to finance a portion of the cost of providing parks, open space and storm drains maintenance services (the "Services") that are in addition to those provided in the territory within the CFD prior to the formation of the CFD and do not supplant services already available within the territory proposed to be included in the CFD, the costs of administering the levy and collection of the Services Special Tax and all other costs of the levy of the Services Special Tax, including any foreclosure proceedings, legal, fiscal, and financial consultant fees, election costs, and all other administrative costs of the tax levy. The Services Special Tax will be secured by recordation of a continuing lien against all real property in the CFD. The schedule of the rate and method of apportionment and manner of collection of the Services Special Tax is described in detail in Exhibit A attached hereto and by this reference incorporated herein. The Services Special Tax is apportioned to each parcel on the foregoing basis pursuant to Section 53325.3 of the Act. SECTION 4. The facilities proposed to be financed by the CFD are public infrastructure facilities and other governmental facilities with an estimated useful life of five years or longer, which the CFD is authorized by law to construct, own or operate and that are necessary to meet increased demands placed upon the City as a result of development or rehabilitation occurring within the proposed CFD, including but not limited to City street and storm drain improvements, City Capital Facilities Fees, EVMWD Water and Sewer facilities, EVMWD Water and Sewer Capital Facilities Fees, and related costs including designs, inspections, professional fees, annexation fees, connection fees and acquisition costs (the "Facilities"). Such Facilities need not be physically located within the CFD. SECTION 5. Except where funds are otherwise available, it is the intention of the Council to levy annually in accordance with procedures contained in the Act a special tax (the "Special Tax") sufficient to pay for the costs of financing the acquisition and/or construction of the Facilities, including the principal of and interest on the bonds ,-.... 45710630.1 AGENDA ITEM No.5 PAGE q OF L/-4- CITY COUNCIL RESOLUTION NO. 2006- Page 3 of6 proposed to be issued to finance the Facilities and other periodic costs, the establishment and replenishment of reserve funds, the remarketing, credit enhancement and liquidity fees, the costs of administering the levy and collection of the Special Tax and all other costs of the levy of the Special Tax and issuance of the bonds, including any foreclosure proceedings, architectural, engineering, inspection, legal, fiscal, and financial consultant fees, discount fees, interest on bonds due and payable prior to the expiration of one year from the date of completion of facilities (but not to exceed two years), election costs and all costs of issuance of the bonds, including, but not limited to, fees for bond counsel, disclosure counsel, financing consultants and printing costs, and all other administrative costs of the tax levy and bond issue. The Special Tax will be secured by recordation of a continuing lien against all real property in the CFD. In the first year in which such a Special Tax is levied, the levy shall include a sum sufficient to repay to the City all amounts, if any, transferred to the CFD pursuant to Section 53314 of the Act and interest . thereon. The schedule of the rate and method of apportionment and manner of collection of the Special Tax is described in detail in Exhibit A attached hereto and by this reference incorporated herein. The Special Tax is based upon the cost of financing the Facilities in the CFD, the demand that each parcel will place on the Facilities and the benefit (direct and/or indirect) received by each parcel from the Facilities. The Special Tax is apportioned to each parcel on the foregoing basis pursuant to Section 53325.3 of the Act. In the event that a portion of the property within the CFD shall become for any reason exempt, wholly or partially, from the levy of the Special Tax, the Council shall, on behalf of the CFD, increase the levy to the extent necessary upon the remaining property within the CFD which is not delinquent or exempt in order to yield the required payments, subject to the maximum tax. Under no circumstances, however, shall the Special Tax levied against any parcel used for private residential purposes be increased as a consequence of delinquency or default by the owner of any other parcel or parcels within the CFD by more than 10 percent. Furthermore, the maximum special tax authorized to be levied against any parcel used for private residential purposes shall not be increased over time in excess of 2 percent per year. SECTION 6. The Council hereby finds that the proposed Facilities are necessary to meet increased demands put upon the City as a result of the new development or rehabilitation within the proposed CFD. SECTION 7. A public hearing (the "Hearing") on the establishment of the CFD and the proposed rate and method of apportionment of the Services Special Tax and the Special Tax shall be held on March 28, 2006, at 7:00 p.m., or as soon thereafter as practicable, at the chambers of the Council, 130 S. Main Street, Lake Elsinore, California 92530. 45710630.1 AGENDA ITEM NO. 5 PAGE /0 OF '-ILl ......" ....." ....." CITY COUNCIL RESOLUTION NO. 2006-_ Page 4 of6 ,..... SECTION 8. At the time and place set forth above for the hearing, any interested person, including all persons owning lands or registered to vote within the proposed CFD, may appear and be heard. SECTION 9. Each City officer who is or will be responsible for the Services and the Facilities to be financed by the CFD, if it is established, is hereby directed to study the proposed CFD and, at or before the time of the above-mentioned Hearing, file a report with the Council, and which is to be made a part of the record of the Hearing, containing a brief description of the Services and the Facilities by type which will in his or her opinion be required to adequately meet the needs of the CFD and his or her estimate of the cost of providing the Services and the Facilities. The City Manager is directed to estimate the fair and reasonable cost of all incidental expenses, including the cost of planning and designing the Facilities to be financed pursuant to the Act, including the cost of environmental evaluations of such facilities, all costs associated with the creation of the CFD, issuance of bonds, determination of the amount of any special taxes, collection of any special taxes, or costs otherwise incurred in order to carry out the authorized purposes of the City with respect to the CFD, and any other expenses incidental to the construction, completion and inspection of the authorized work to be paid through the proposed financing. ".....- SECTION 10. The City may accept advances of funds from any sources, including private persons or private entities, and is authorized and directed to use such funds for any authorized purpose, including any cost incurred by the City in creating the CFD. The City may enter into an agreement to repay all of such funds as are not expended or committed for any authorized purpose at the time of the election on the levy of the Services Special Tax and the Special Tax, if the proposal to levy such tax should fail, and to repay all of such funds advanced if the levy of the Services Special Tax and the Special Tax shall be approved by the qualified electors of the CFD. SECTION 11. The City Clerk is hereby directed to publish a notice ("Notice") of the Hearing pursuant to Section 6061 of the Government Code in a newspaper of general circulation published in the area of the proposed CFD. Such Notice shall contain information set forth in Section 53322 of the Act. Such publication shall be completed at least 7 days prior to the date of the Hearing. SECTION 12. The Clerk may send a copy of the Notice by first-class mail, postage prepaid, to each registered voter and to each landowner within proposed CFD as shown on the last equalized assessment roll. Said mailing shall be completed not less than fifteen (15) days prior to the date of the Hearing. ".... SECTION 13. Pursuant to Section 53344.1 of the Act, the Council hereby reserves to itself, in its sole discretion, the right and authority by subsequent resolution to 45710630. ] ACENDA 'TEM No.5 pAGE II OF 41./- CITY COUNCIL RESOLUTION NO. 2006- Page 5 of6 allow any owner of property within the CFD, subject to the provisions of Section 53344.1 of the Act and those conditions as it may impose, and any applicable prepayment penalties as prescribed in the bond indenture or comparable instrument or document, to tender to the CFD treasurer in full payment or part payment of any installment of the special taxes or the interest or penalties thereon which may be due or delinquent, but for which a bill has been received, any bond or other obligation secured thereby, the bond or other obligation to be taken at par and credit to be given for the accrued interest shown thereby computed to the date of tender. ..."", SECTION 14. The voting procedure with respect to the establishment of the CFD and the imposition of the special tax shall be by hand delivered or mailed ballot election. SECTION 15. This Resolution shall take effect from and after the date of its passage and adoption. . "-'" ......" 457] 0630.1 5 ACENOA ITEM NO. l./- pKk._I2- OF 4 CITY COUNCIL RESOLUTION NO. 2006- Page 6 of6 r" PASSED, APPROVED AND ADOPTED this 9th day of February, 2006. AYES: COUNCILMEMBERS: NOES: COUNCILMEMBERS: ABSENT: COUNCILMEMBERS: ABSTAIN: COUNCILMEMBERS: Robert E. Magee, Mayor City of Lake Elsinore ATTEST: ,r- Frederick Ray, City Clerk City of Lake Elsinore APPROVED AS TO FORM: Barbara Zeid Leibold, City Attorney City of Lake Elsinore ,r-, 45710630.1 AOENDA ITEM NO. PACE I S . 5 OF I../-l/- EXHIBIT A .~ RATE AND METHOD OF APPORTIONMENT ~ ~ 45710630.1 AGENDA ITEM NO. S ~ PACE / t./- OF tlLI-- FINAL /'"" RATE AND METHOD OF APPORTIONMENT FOR CITY OF LAKE ELSINORE COMMUNITY FACILITIES DISTRICT No. 2006-2 (VISCA Y A) A Special Tax shall be levied on all Assessor's Parcels in City of Lake Elsinore Community Facilities District No. 2006-2 (Viscaya) ("CFD No. 2006-2") and collected each Fiscal Year commencing in Fiscal Year 2005-2006, in an amount determined through the application ofthis Rate and Method of Apportionment as described below. All of the real property in CFD No. 2006-2, unless exempted by law or by the provisions hereof, shall be taxed for the purposes, to the extent and in the manner herein provided. A. DEFINITIONS The terms hereinafter set forth have the following meanings: "Acre or Acreage" means the land area of an Assessor's Parcel as shown on an Assessor's Parcel Map, or if the land area is not shown on an Assessor's Parcel Map, the land area shown on the applicable final map, parcel map, condominium plan, or other recorded County parcel map. "Act" means the Mello-Roos Community Facilities Act of 1982, being Chapter 2.5, Part 1, Division 2 of Title 5 of the California Government Code. .....-. "Administrative Expenses" means the following actual or reasonably estimated costs directly related to the administration ofCFD No. 2006-2: the costs of computing the Special Taxes and preparing the annual Special Tax collection schedules (whether by the City or designee thereof or both); the costs of collecting the Special Taxes (whether by the City or otherwise); the costs of remitting the Special Taxes to the Trustee; the costs of the Trustee (including its legal counsel) in the discharge of the duties required of it under the Indenture; the costs to the City, CFD No. 2006-2 or any designee thereof of complying with arbitrage rebate requirements; the costs to the City, CFD No. 2006-2 or any designee thereof of complying with disclosure requirements ofthe City, CFD No. 2006-2 or obligated persons associated with applicable federal and state securities laws and the Act; the costs associated with preparing Special Tax disclosure statements and responding to public inquiries regarding the Special Taxes; the costs ofthe City, CFD No. 2006-2 or any designee thereof related to an appeal ofthe Special Tax; the costs associated with the release of funds from an escrow account; and the City's annual administration fees and third party expenses. Administrative Expenses shall also include amounts estimated by the CFD Administrator or advanced by the City or CFD No. 2006-2 for any other administrative purposes ofCFD No. 2006-2, including attorney's fees and other costs related to commencing and pursuing to completion any foreclosure of delinquent Special Taxes. "Assessor's Parcel" means a lot or parcel shown in an Assessor's Parcel Map with an assigned Assessor's Parcel number. ./""' "Assessor's Parcel Map" means an official map of the County Assessor of the County City of Lake Elsinore Community Facilities District No. 2006-2 (Viscaya) January 30, 2006 Page 1 AGENDA ITEM NO. PAGE J 5' 5 OF Lttf designating parcels by Assessor's Parcel number. ......" "Assigned Special Tax for Facilities" means the Special Tax for Facilities for each Land Use Class of Developed Property, as determined in accordance with Section C.I.(b) below. "Authorized Facilities" means those authorized improvements, as listed in an exhibit to the Resolution of Formation. "Backup Special Tax for Facilities" means the Special Tax for Facilities applicable to each Assessor's Parcel of Developed Property, as determined in accordance with Section C.I.( c) below. "Certificate of Occupancy" means a certificate issued by the City that authorizes the actual occupancy of a dwelling unit for habitation by one or more residents. "CFD Administrator" means an official of the City, or designee thereof, responsible for determining the Special Tax Requirement for Facilities, the Special Tax Requirement for Services as determined in accordance with Section I below, and providing for the levy and collection of the Special Taxes. "CFD No. 2006-2" means City of Lake Elsinore Community Facilities District No. 2006-2 (Viscaya). "CFD No. 2006-2 Bonds" means any bonds or other debt (as defined in Section 533 1 7(d)of '-' the Act), whether in one or more series, issued by CFD No. 2006-2 and secured solely by the Special Tax for Facilities levy on property within the boundaries of CFD No. 2006-2 under the Act. "City" means the City of Lake Elsinore. "Council" means the City Council of the City of Lake Elsinore, acting as the legislative body of CFD No. 2006-2. "County" means the County of Riverside. "Developed Property" means, with respect to the Special Tax for Facilities, for each Fiscal Year, all Taxable Property, exclusive of Taxable Public Property and Taxable Property Owner Association Property, for which the Final Subdivision was recorded on or before January 1 of the prior Fiscal Year and a building permit for new construction was issued on or before May 1 of the Fiscal Year preceding the Fiscal Year for which the Special Tax for Facilities is being levied. "Final Subdivision" means (i) a final map, or portion thereof, approved by the City pursuant to the Subdivision Map Act (California Government Code Section 66410 et seq.) that creates individual lots for which building permits may be issued, or (ii) for condominiums, a final map, or portion thereof, approved by the City and a condominium ......" City of Lake Elsinore Community Facilities District No. 2006-2 (Viscaya) January 30, 2006 Page 2 AGENDA ITEM NO. PACE / ~ 5 OF tJ.l./- ,.-.. plan recorded pursuant to California Civil Code Section 1352 that creates individual lots for which building permits may be issued. "Fiscal Year" means the period starting July 1 and ending on the following June 30. "Indenture" means the indenture, fiscal agent agreement, resolution or other instrument pursuant to which CFD No. 2006-2 Bonds are issued, as modified, amended and/or supplemented from time to time, and any instrument replacing or supplementing the same. "Land Use Class" means any of the classes listed in Table 1 below. "Maximum Special Tax for Facilities" means the maximum Special Tax for Facilities, determined in accordance with Section C below, that can be levied in any Fiscal Year on any Assessor's Parcel. "Non-Residential Property" means all Assessor's Parcels of Developed Property for which a building permit permitting the .construction of one or more non-residential units or facilities has been issued by the City. "Outstanding Bonds" means all CFD No. 2006-2 Bonds which are deemed to be outstanding under the Indenture. ",-... "Property Owner Association Property" means, for each Fiscal Year, any property within the boundaries of CFD No. 2006-2 that was owned by a property owner association, including any master or sub-association, as of January I of the prior Fiscal Year. "Proportionately" means for Developed Property that the ratio of the actual Special Tax for Facilities levy to the Assigned Special Tax for Facilities is equal for all Assessor's Parcels of Developed Property. For Undeveloped Property, "Proportionately" means that the ratio of the actual Special Tax for Facilities levy per Acre to the Maximum Special Tax for Facilities per Acre is equal for all Assessor's Parcels of Undeveloped Property. The term "Proportionately" may similarly be applied to other categories of Taxable Property as listed in Section D below. "Public Property" means property within the boundaries of CFD No. 2006-2 owned by, irrevocably offered or dedicated to, or over, through or under which an easement for purposes of public right-of-way has been granted, to the federal government, the State, the County, the City, or any local government or other public agency, provided that any property leased by a public agency to a private entity and subject to taxation under Section 53340. 1 of the Act shall be taxed and classified according to its use. ,.-.. "Residential Floor Area" means all of the square footage of living area within the perimeter of a residential structure, not including any carport, walkway, garage, overhang, patio, enclosed patio, or similar area. The determination of Residential Floor Area for an Assessor's Parcel shall be made by reference to the building permit(s) issued for such Assessor's Parcel. City of Lake Elsinore Community Facilities District No. 2006-2 (Viscaya) January 30, 2006 Page 3 AGENDA ITEM NO. ~ PAGE / 7 OF L/tJ. "Residential Property" means all Assessor's Parcels of Developed Property for which a building permit permitting the construction thereon of one or more residential dwelling units has been issued by the City. .......,. "Resolution of Formation" means the resolution of formation for CFD No. 2006-2. "Special Tax" means any of the special taxes authorized to be levied by CFD No. 2006-2 pursuant to the Act. "Special Tax for Facilities" means the special tax to be levied in each Fiscal Year on each Assessor's Parcel of Developed Property, Taxable Property Owner Association Property, Taxable Public Property, and Undeveloped Property to fund the Special Tax Requirement for Facilities. "Special Tax Requirement for Facilities" means that amount required in any Fiscal Year for CFD No. 2006-2 to: (i) pay debt service on all Outstanding Bonds due in the calendar year commencing in such Fiscal Year; (ii) pay periodic costs on the CFD No. 2006-2 Bonds, including but not limited to, credit enhancement and rebate payments on the CFD No. 2006- 2 Bonds due in the calendar year commencing in such Fiscal Year; (iii) pay a proportionate share of Administrative Expenses; (iv) pay any amounts required to establish or replenish any reserve funds for all Outstanding Bonds; (v) pay for reasonably anticipated Special Tax for Facilities delinquencies based on the delinquency rate for the Special Tax for Facilities levy in the previous Fiscal Year; (vi) pay directly for acquisition or construction of Authorized Facilities to the extent that the inclusion of such amount does not increase the ..., Special Tax for Facilities levy on Undeveloped Property; less (vii) a credit for funds available to reduce the annual Special Tax for Facilities levy, as determined by the CFD Administrator pursuant to the Indenture. "State" means the State of California. "Taxable Property" means all of the Assessor's Parcels within the boundaries ofCFD No. 2006-2 which are not exempt from the Special Tax for Facilities pursuant to law or Section E below. "Taxable Property Owner Association Property" means all Assessor's Parcels of Property Owner Association Property that are not exempt pursuant to Section E below. "Taxable Public Property" means all Assessor's Parcels of Public Property that are not exempt pursuant to Section E below. "Trustee" means the trustee or fiscal agent under the Indenture. "Undeveloped Property" means, for each Fiscal Year, all Taxable Property not classified as Developed Property, Taxable Property Owner Association Property, or Taxable Public Property . ......., City of Lake Elsinore Community Facilities District No. 2006-2 (Viscaya) January 30, 2006 Page 4 AGENDA ITEM NO. r-; PACE J ~ O~ LJt.f- ~ /"'"' B. ASSIGNMENT TO LAND USE CATEGORIES Each Fiscal Year, all Taxable Property within CFD No. 2006-2 shall be classified as Developed Property, Taxable Public Property, Taxable Property Owner Association Property, or Undeveloped Property, and shall be subject to Special Taxes in accordance with this Rate and Method of Apportionment determined pursuant to Sections C and D below. Residential Property shall be assigned to Land Use Classes 1 through 4 as listed in Table 1 below based on the Residential Floor Area for each unit. Non-Residential Property shall be assigned to Land Use Class 5. With respect to Residential Property, the Residential Floor Area shall be determined from the most recent building permit issued prior to the issuance of a Certificate of Occupancy for such Assessor's Parcel. c. MAXIMUM SPECIAL TAX FOR FACILITIES ~ Prior to the issuance ofCFD No. 2006-2 Bonds, the Assigned Special Tax for Facilities on Developed Property (set forth in Table 1), and the Backup Special Tax for Facilities attributable to a Final Subdivision, may be reduced in accordance with, and subject to the conditions set forth in this paragraph. If it is reasonably 'determined by the CFD Administrator that the overlapping debt burden (as defined in the Statement of Goals and Policies for the Use of the Mello-Roos Community Facilities Act of 1982 adopted by the Council, the "Goals and Policies") calculated pursuant to the Goals and Policies exceeds the City's maximum level objective set forth in such document, the Assigned Special Tax for Facilities on Developed Property, and the Backup Special Tax for Facilities attributable to a Final Subdivision, may be reduced to the amount necessary to satisfy the City's objective with respect to the maximum overlapping debt burden level with the written consent ofthe CFD Administrator. The reductions permitted pursuant to this paragraph shall be reflected in an amended Notice of Special Tax Lien which the City shall cause to be recorded by executing a certificate in substantially the form attached hereto as Exhibit "A". 1. Developed Property (a) Maximum Special Tax for Facilities The Maximum Special Tax for Facilities for each Assessor's Parcel classified as Developed Property shall be the greater of (i) the amount derived by application of the Assigned Special Tax for Facilities or (ii) the amount derived by application of the Backup Special Tax for Facilities. (b) Assigned Special Tax for Facilities The Fiscal Year 2005-2006 Assigned Special Tax for Facilities for each Land Use Class is shown below in Table 1. ".... . City of Lake Elsinore Community Facilities District No. 2006-2 (Viscaya) January 30, 2006 Page 5 AGENDA ITEM NO. 5 PAliE ,q OF_ illf TABLE 1 ....., Assigned Special Tax for Facilities for Developed Property Community Facilities District No. 2006-2 Fiscal Year 2005-2006 1 Residential Property More than 2,349 sq. ft. $2,908 per unit 2 Residential Property 1,950 - 2,349 sq. ft. $2,711 per unit 3 Residential Property 1,550 - 1,949 sq. ft. $2,577 per unit 4 Residential Property Less than 1,550 sq. ft. $2,398 per unit 5 Non-Residential Property NA $29,060 per Acre ......" ....., City of Lake Elsinore Community Facilities District No. 2006-2 (Viscaya) January 30, 2006 Page 6 ACENDA ITEM NO. P) PACE 20 OF t.J lJ- ~ (c) Backup Special Tax for Facilities The Fiscal Year 2005-2006 Backup Special Tax for Facilities attributable to a Final Subdivision will equal $30,575 multiplied by the Acreage of all Taxable Property, exclusive of any Taxable Property Owner Association Property and Taxable Public Property, therein. The Backup Special Tax for Facilities for each Assessor's Parcel of Residential Property shall be computed by dividing the Backup Special Tax for Facilities attributable to the applicable Final Subdivision by the number of Assessor's Parcels for which building permits for residential construction have or may be issued (i.e., the number or residential lots). The Backup Special Tax for Facilities for each Assessor's Parcel of Non-Residential Property therein shall equal $30,575 multiplied by the Acreage of such Assessor's Parcel. If a Final Subdivision includes Assessor's Parcels of Taxable Property for which building permits for both residential and non-residential construction may be issued, exclusive of Taxable Property Owner Association Property and Taxable Public Property, then the Backup Special Tax for Facilities for each Assessor's Parcel of . Residential Property shall be computed exclusive of the Acreage and Assessor's Parcels of property for which building permits for non-residential construction may be issued. /"""" Notwithstanding the foregoing, if all or any portion of the Final Subdivision(s) described in the preceding paragraphs is subsequently changed or modified by recordation of a lot line adjustment or similar instrument, and only if the CFD Administrator determines that such change or modification results in a decrease in the number of Assessor's Parcels of Taxable Property for which building permits for residential construction have or may be issued within such Final Subdivision, then the Backup Special Tax for Facilities for each Assessor's Parcel of Developed Property that is part of the lot line adjustment or similar instrument for such Final Subdivision shall be a rate per Acre as calculated below. The Backup Special Tax for Facilities previously determined for an Assessor's Parcel of Developed Property that is not a part of the lot line adjustment or similar instrument for such Final Subdivision shall not be recalculated. 1. Determine the total Backup Special Tax for Facilities anticipated to apply to the changed or modified portion of the Final Subdivision area prior to the change or modification. 2. The result of paragraph 1 above shall be divided by the Acreage of Taxable Property which is ultimately expected to exist in such changed or modified portion of the Final Subdivision area, as reasonably determined by the CFD Administrator. /"*"" City of Lake Elsinore Community Facilities District No. 2006-2 (Viscaya) January 30, 2006 Page 7 ACENDA ITEM NO. PAGE ..;). I .5 OF ~lf 3. The result of paragraph 2 above shall be the Backup Special Tax for Facilities per Acre which shall be applicable to Assessor's Parcels of Developed Property in such changed or modified portion of the Final Subdivision area for all remaining Fiscal Years in which the Special Tax for Facilities may be levied. ....."" (d) Increase in the Assigned Special Tax for Facilities and Backup Special Tax for Facilities The Fiscal Year 2005-2006 Assigned Special Tax for Facilities, identified in Table 1 above, and Backup Special Tax for Facilities shall increase thereafter, commencing on July I, 2006 and on July 1 of each Fiscal Year thereafter, by an amount equal to two percent (2%) of the amount in effect for the previous Fiscal Year. (e) Multiple Land Use Classes In some instances an Assessor's Parcel of Developed Property may contain more than one Land Use Class. The Maximum Special Tax for Facilities levied on an Assessor's Parcel shall be the sum of the Maximum Special Tax for Facilities for all Land Use Classes located on that Assessor's Parcel. The CFD Administrator's allocation to each type of property shall be final. 2. Taxable Property Owner Association Property. Taxable Public Property. and Undeveloped Property ~ The Fiscal Year 2005-2006 Maximum Special Tax for Facilities for Taxable Property Owner Association Property, Taxable Public Property, and Undeveloped Property shall be $30,602 per Acre and shall increase thereafter, commencing on July 1, 2006 and on July 1 of each Fiscal Year thereafter, by an amount equal to two percent (2%) ofthe Maximum Special Tax for Facilities in effect for the previous Fiscal Year. D. METHOD OF APPORTIONMENT OF THE SPECIAL TAX FOR FACILITIES Commencing with Fiscal Year 2005-2006 and for each following Fiscal Year, the Council shall determine the Special Tax Requirement for Facilities and levy the Special Tax for Facilities until the amount of Special Tax for Facilities levy equals the Special Tax Requirement for Facilities. The Special Tax for Facilities shall be levied each Fiscal Year as follows: First: The Special Tax for Facilities shall be levied on each Assessor's Parcel of Developed Property in an amount equal to 100% ofthe applicable Assigned Special Tax for Facilities; Second: If additional monies are needed to satisfy the Special Tax Requirement for Facilities after the first step has been completed, the Special Tax for Facilities shall be levied Proportionately on each Assessor's Parcel of Undeveloped Property at up to 100% of the Maximum Special Tax for Facilities for Undeveloped Property; ....."" City of Lake Elsinore Community Facilities District No. 2006-2 (Viscaya) January 30, 2006 Page 8 AGENDA ITEM No.5 PACE 2z.. OF <.J l/- "..- Third: If additional monies are needed to satisfy the Special Tax Requirement for Facilities after the first two steps have been completed, then the levy of the Special Tax for Facilities on each Assessor's Parcel of Developed Property whose Maximum Special Tax for Facilities is determined through the application of the Backup Special Tax for Facilities shall be increased in equal percentages from the Assigned Special Tax for Facilities up to the Maximum Special Tax for Facilities for each such Assessor's Parcel; Fourth: If additional monies are needed to satisfy the Special Tax Requirement for Facilities after the first three steps have been completed, then the Special Tax for Facilities shall be levied Proportionately on each Assessor's Parcel of Taxable Property Owner Association Property and Taxable Public Property at up to 100% of the Maximum Special Tax for Facilities for Taxable Property Owner Association Property or Taxable Public Property. Notwithstanding the above, the Council may, in any Fiscal Year, levy Proportionately less than 100% of the Assigned Special Tax for Facilities in step one (above), when (i) the Council is no longer required to levy the Special Tax for Facilities pursuant to steps two through four above in order to meet the Special Tax Requirement for Facilities; (ii) all authorized CFD No. 2006-2 Bonds have already been issued or the Council has covenanted that it will not issue any additional CFD No. 2006-2 Bonds (except refunding bonds) to be supported by the Special Tax for Facilities; and (iii) all Authorized Facilities have been constructed and/or acquired. ,;--~ Further notwithstanding the above, under no circumstances will the Special Tax for Facilities levied against any Assessor's Parcel of Residential Property for which a Certificate of Occupancy has been issued be increased by more than ten percent as a consequence of delinquency or default by the owner of any other Assessor's Parcel within CFD No. 2006-2. E. EXEMPTIONS No Special Tax for Facilities shall be levied on up to 8.1 Acres of Property Owner Association Property and/or Public Property in CFD No. 2006-2. Tax-exempt status will be assigned by the CFD Administrator in the chronological order in which property becomes Property Owner Association Property or Public Property. However, should an Assessor's Parcel no longer be classified as Property Owner Association Property or Public Property, its tax-exempt status will be revoked. Property Owner Association Property or Public Property that is not exempt from Special Tax for Facilities under this section shall be subject to the levy of the Special Tax for Facilities and shall be taxed Proportionately as part of the fourth step in Section D above, at up to 100% of the Maximum Special Tax for Facilities for Taxable Property Owner Association Property or Taxable Public Property. F. MANNER OF COLLECTION r- The Special Tax for Facilities shall be collected in the same manner and at the same time as ordinary ad valorem property taxes; provided, however, that CFD No. 2006-2 may directly bill the Special Tax for Facilities, may collect Special Taxes at a different time or in a City of Lake Elsinore Community Facilities District No. 2006-2 (Viscaya) January 30, 2006 Page 9 " AGENDA ITEM NO. PAGE 73 of}lf.-'::: different manner if necessary to meet its financial obligations, and may covenant to foreclose and may actually foreclose on delinquent Assessor's Parcels as permitted by the Act. ~ G. PREPAYMENT OF SPECIAL TAX FOR FACILITIES The following additional definitions apply to this Section G: "Buildout" means, for CFD No. 2006-2, that all expected building permits have been issued. "CFD Public Facilities" means either $5,650,000 in 2005 dollars, which shall increase by the Construction Inflation Index on July 1, 2006, and on each July 1 thereafter, or such lower number as (i) shall be determined by the CFD Administrator as sufficient to provide the public facilities to be provided by CFD No. 2006-2 under the authorized bonding program for CFD No. 2006-2, or (ii) shall be determined by the Council concurrently with a covenant that it will not issue any more CFD No. 2006-2 Bonds (except refunding bonds) to be supported by the Special Tax for Facilities levy under this Rate and Method of Apportionment as described in Section D above. "Construction Inflation Index" means the annual percentage change in the Engineering News Record Building Cost Index for the City of Los Angeles, measured as of the calendar year which ends in the previous Fiscal Year. In the event this index ceases to be published, the Construction Inflation Index shall be another index as determined by the CFD Administrator that is reasonably comparable to the Engineering News Record Building Cost ~ Index for the City of Los Angeles. "Future Facilities Costs" means the CFD Public Facilities minus (i) public facility costs previously paid from the Improvement Fund, (ii) moneys currently on deposit in the Improvement Fund, and (iii) moneys currently on deposit in an escrow fund that are expected to be available to finance the cost of CFD Public Facilities. "Improvement Fund" means an account specifically identified in the Indenture to hold funds which are currently available for expenditure to acquire or construct CFD Public Facilities eligible under the Act. "Previously Issued Bonds" means, for any Fiscal Year, all Outstanding Bonds that are deemed to be outstanding under the Indenture after the first interest and/or principal payment date following the current Fiscal Year. 1. Prepayment in Full Only an Assessor's Parcel of Developed Property, or Undeveloped Property for which a building permit has been issued, may be prepaid. The obligation ofthe Assessor's Parcel to pay the Special Tax for Facilities may be permanently satisfied as described herein, provided that a prepayment may be made with respect to a particular Assessor's Parcel only ifthere are no delinquent Special Taxes with respect to such Assessor's Parcel at the time of prepayment. An owner of an Assessor's Parcel intending to prepay the Special Tax for ~ City of Lake Elsinore Community Facilities District No. 2006-2 (Viscaya) January 30, 2006 Page 10 ACENDA ITEM NO. 5 ~ PAGE 2t.j., OF _ tJlJ- ~ - ~ Facilities obligation shall provide the CFD Administrator with written notice of intent to prepay. Within 30 days of receipt of such written notice, the CFD Administrator shall notify such owner of the prepayment amount for such Assessor's Parcel. The CFD Administrator may charge a reasonable fee for providing this service. Prepayment must be made not less than 45 days prior to the next occurring date that notice of redemption ofCFD No. 2006-2 Bonds from the proceeds of such prepayment may be given by the Trustee pursuant to the Indenture. The Special Tax for Facilities Prepayment Amount (defined below) shall be calculated as summarized below (capitalized terms as defined below): Bond Redemption Amount plus plus plus plus less less Total: equals Redemption Premium Future Facilities Amount Defeasance Amount Administrative Fees and Expenses Reserve Fund Credit Capitalized Interest Credit Special Tax for Facilities Prepayment Amount As of the proposed date of prepayment, the Special Tax for Facilities Prepayment Amount shall be calculated as follows: ~. Paraeraoh No.: 1. Confirm that no Special Tax delinquencies apply to such Assessor's Parcel. 2. F or Assessor's Parcels of Developed Property, compute the Assigned Special Tax for Facilities and Backup Special Tax for Facilities. For Assessor's Parcels of Undeveloped Property for which a building permit has been issued, compute the Assigned Special Tax for Facilities and Backup Special Tax for Facilities for that Assessor's Parcel as though it was already designated as Developed Property, based upon the building permit which has already been issued for that Assessor's Parcel. 3. (a) Divide the Assigned Special Tax for Facilities computed pursuant to paragraph 2 by the total estimated Assigned Special Tax for Facilities for the entire CFD No. 2006-2 based on the Developed Property Special Tax for Facilities which could be levied in the current Fiscal Year on all expected development through Buildout of CFD No. 2006-2, excluding any Assessor's Parcels which have been prepaid, and (b) Divide the Backup Special Tax for Facilities computed pursuant to paragraph 2 by the total estimated Backup Special Tax for Facilities at Buildout for the entire CFD No. 2006-2, excluding any Assessor's Parcels which have been prepaid. 4. Multiply the larger quotient computed pursuant to paragraph 3(a) or 3(b) by the Previously Issued Bonds to compute the amount of Previously Issued Bonds to be retired and prepaid (the "Bond Redemption Amount"). ~ City of Lake Elsinore Community Facilities District No. 2006-2 (Viscaya) January 30, 2006 Page 11 AGENDA ITEM NO. -5 . PAGE 2~ OF t.J- If- - - 5. Multiply the Bond Redemption Amount computed pursuant to paragraph 4 by the applicable redemption premium (e.g., the redemption price-l 00%), if any, on the Previously Issued Bonds to be redeemed (the "Redemption Premium"). ....." 6. Compute the current Future Facilities Costs. 7. Multiply the larger quotient computed pursuant to paragraph 3(a) or 3(b) by the amount determined pursuant to paragraph 6 to compute the amount of Future Facilities Costs to be prepaid (the "Future Facilities Amount"). 8. Compute the amount needed to pay interest on the Bond Redemption Amount from the first bond interest and/or principal payment date following the current Fiscal Year until the earliest redemption date for the Previously Issued Bonds. 9. Determine the Special Tax for Facilities levied on the Assessor's Parcel in the current Fiscal Year which has not yet been paid. 10. Compute the minimum amount the CFD Administrator reasonably expects to derive from the reinvestment of the Special Tax for Facilities Prepayment Amount less the Future Facilities Amount and the Administrative Fees and Expenses (defined below) from the date of prepayment until the redemption date for the Previously Issued Bonds to be redeemed with the prepayment. 11. Add the amounts computed pursuant to paragraphs 8 and 9 and subtract the amount computed pursuant to paragraph 10 (the "Defeasance Amount"). """ 12. The administrative fees and expenses of CFD No. 2006-2 are as calculated by the CFD Administrator and include the costs of computation of the prepayment, the costs to invest the prepayment proceeds, the costs of redeeming CFD No. 2006-2 Bonds, and the costs of recording any notices to evidence the prepayment and the redemption (the "Administrative Fees and Expenses"). 13. The reserve fund credit (the "Reserve Fund Credit") shall equal the lesser of: (a) the expected reduction in the reserve requirement (as defined in the Indenture), if any, associated with the redemption of Previously Issued Bonds as a result of the prepayment, or (b) the amount derived by subtracting the new reserve requirement (as defined in the Indenture) in effect after the redemption of Previously Issued Bonds as a result of the prepayment from the balance in the reserve fund on the prepayment date, but in no event shall such amount be less than zero. No Reserve Fund Credit shall be granted if the amount then on deposit in the reserve fund for the Previously Issued Bonds is below 100% ofthe reserve requirement (as defined in the Indenture). 14. If any capitalized interest for the Previously Issued Bonds will not have been expended as of the date immediately following the first interest and/or principal payment following the current Fiscal Year, a capitalized interest credit shall be calculated by multiplying the larger quotient computed pursuant to paragraph 3(a) or ......" City of Lake Elsinore Community Facilities District No. 2006-2 (Viscaya) January 30, 2006 Page 12 AGENDA ITEM NO. .5 PACE 20 OF 4-4- "...... 3(b) by the expected balance in the capitalized interest fund or account under the Indenture after such first interest and/or principal payment (the "Capitalized Interest Credit"). 15. The Special Tax for Facilities prepayment is equal to the sum of the amounts computed pursuant to paragraphs 4, 5, 7, 11 and 12, less the amounts computed pursuant to paragraphs 13 and 14 (the "Special Tax for Facilities Prepayment Amount"). From the Special Tax for Facilities Prepayment Amount, the amounts computed pursuant to paragraphs 4, 5, 11, 13 and 14 shall be deposited into the appropriate fund as established under the Indenture and be used to retire CFD No. 2006-2 Bonds or make debt service payments. The amount computed pursuant to paragraph 7 shall be deposited into the Improvement Fund. The amount computed pursuant to paragraph 12 shall be retained by CFD No. 2006-2. The Special Tax for Facilities Prepayment Amount may be insufficient to redeem a full $5,000 increment ofCFD No. 2006-2 Bonds. In such cases, the increment above $5,000 or integral multiple thereof will be retained in the appropriate fund established under the Indenture to be used with the next prepayment of CFD No. 2006-2 Bonds or to make debt service payments. "...... As a result of the payment of the current Fiscal Year's Special Tax for Facilities levy as determined under paragraph 9 ( above), the CFD Administrator shall remove the current Fiscal Year's Special Tax for Facilities levy for such Assessor's Parcel from the County tax rolls. With respect to any Assessor's Parcel that is prepaid, the Council shall cause a suitable notice to be recorded in compliance with the Act, to indicate the prepayment ofthe Special Tax for Facilities and the release of the Special Tax for Facilities lien on such Assessor's Parcel, and the obligation of such Assessor's Parcel to pay the Special Tax for Facilities shall cease. Notwithstanding the foregoing, no Special Tax for Facilities prepayment shall be allowed unless, at the time of such proposed prepayment, the amount of Maximum Special Tax for Facilities that may be levied on Taxable Property within CFD No. 2006-2 (after excluding 8.1 Acres of Property Owner Association Property and/or Public Property in CFD No. 2006- 2 as set forth in Section E) both prior to and after the proposed prepayment is at least equal to the sum of (i) the Administrative Expenses, as defined in Section A above, and (ii) 1.10 times maximum annual debt service, in each remaining Fiscal Year on the Outstanding Bonds. 2. Prepayment in Part ,..-.. The Special Tax for Facilities on an Assessor's Parcel of Developed Property or an Assessor's Parcel of Undeveloped Property for which a building permit has been issued may be partially prepaid. The amount of the prepayment shall be calculated as in Section G.l; except that a partial prepayment shall be calculated according to the following formula: City of Lake Elsinore Community Facilities District No. 2006-2 (Viscaya) January 30, 2006 Page 13 r;=::... AGENDA ITEM NV. ~ ~ PACE ~ 1 OF LIt./- .. PP = [(PE - A) x F] + A --' These terms have the following meaning: PP = the partial prepayment. PE = the Special Tax for Facilities Prepayment Amount calculated according to Section 0.1. F = the percentage, expressed as a decimal, by which the owner of the Assessor's Parcel is partially prepaying the Special Tax for Facilities. A = the Administrative Fees and Expenses calculated according to Section G.I. The owner of any Assessor's Parcel who desires such prepayment shall notify the CFD Administrator of such owner's intent to partially prepay the Special Tax for Facilities and the percentage by which the Special Tax for Facilities shall be prepaid. The CFD Administrator shall provide the owner with a statement of the amount required for the partial prepayment of the Special Tax for Facilities for an Assessor's Parcel within 30 days of the request and may charge a reasonable fee for providing this service. With respect to any Assessor's Parcel that is partially prepaid, the Council shall (i) distribute the funds remitted to it according to Section 0.1, and (ii) indicate in the records ofCFD No. 2006-2 that there has been a partial prepayment of the Special Tax for Facilities and that a portion of the Special Tax for Facilities with respect to such Assessor's Parcel, equal to the outstanding percentage (1.00- F) of the remaining Maximum Special Tax for Facilities, shall continue to be levied on such Assessor's Parcel pursuant to Section D above. --' H. TERM OF SPECIAL TAX FOR FACILITIES The Special Tax for Facilities shall be levied for a period not to exceed forty years commencing with Fiscal Year 2005-2006, provided however that the Special Tax for Facilities will cease to be levied in an earlier Fiscal Year if the CFD Administrator has determined (i) that all required interest and principal payments on the CFD No. 2006-2 Bonds have been paid; (ii) all Authorized Facilities have been acquired and all reimbursements to the developer have been paid; and (Hi) all other obligations of CFD No. 2006-2 have been satisfied. I. SPECIAL TAX FOR SERVICES The following additional definitions apply to this Section I: "Developed Multifamily Unit" means a residential dwelling unit within a building in which each of the individual dwelling units has or shall have at least one common wall with another dwelling unit and a building permit has been issued by the City for such dwelling unit on or prior to May 1 preceding the Fiscal Year in which the Special Tax for Services is being levied. "Developed Single Family Unit" means a residential dwelling unit other than a Developed Multifamily Unit on an Assessor's Parcel for which a building permit has been issued by the """ City of Lake Elsinore Community Facilities District No. 2006-2 (Viscaya) January 30, 2006 Page 14 AGENDA ITEM NO. ~ q::. PACE 7g OF /"", City on or prior to May 1 preceding the Fiscal Year in which the Special Tax for Services is being levied. "Maximum Special Tax for Services" means the maximum Special Tax for Services that can be levied by CFD No. 2006-2 in any Fiscal Year on any Assessor's Parcel. "Operating Fund" means a fund that shall be maintained for CFD No. 2006-2 for any Fiscal Year to pay for the actual costs of maintenance related to the Service Area, and the applicable Administrative Expenses. "Operating Fund Balance" means the amount of funds in the Operating Fund at the end of the preceding Fiscal Year. "Service Area" means parks, open space, and storm drains. "Special Tax for Services" means any of the special taxes authorized to be levied within CFD No. 2006-2 pursuant to the Act to fund the Special Tax Requirement for Services. ,--. "Special Tax Requirement for Services" means the amount determined in any Fiscal Year for CFD No. 2006-2 equal to (i) the budgeted costs directly related to the Service Area, including maintenance, repair and replacement of certain components of the Service Area which have been accepted and maintained or are reasonably expected to be accepted and maintained during the current Fiscal Year, (ii) pay a proportionate share of Administrative Expenses, and (iii) anticipated Special Tax for Services delinquencies based on the delinquency rate for the Special Tax for Services levy in CFD No. 2006-2 for the previous Fiscal Year, less (iv) the Operating Fund Balance, as determined by the CFD Administrator. 1. Rate and Method of Apportionment of the Special Tax for Services Commencing with Fiscal Year 2005-2006 and for each subsequent Fiscal Year, the Council shall levy the Special Tax for Services on (i) all Assessor's Parcels containing a Developed Single Family Unit or Developed Multifamily Unit and (ii) all Assessor's Parcels of Non- Residential Property, up to the applicable Maximum Special Tax for Services to fund the Special Tax Requirement for Services. The Maximum Special Tax for Services for Fiscal Year 2005-2006 shall be $242 per Developed Single Family Unit, $121 per Developed Multifamily Unit, and $545 per Acre for each Assessor's Parcel of Non-Residential Property. On each July 1, commencing July 1, 2006, the Maximum Special Tax for Services shall be increased by two percent (2.00%) of the amount in effect in the prior Fiscal Year. 2. Duration of the Special Tax for Services ,--. The Special Tax for Services shall be levied in perpetuity to fund the Special Tax Requirement for Services, unless no longer required as determined at the sole discretion of the Council. City of Lake Elsinore Community Facilities District No. 2006-2 (VlScaya) January 30, 2006 Page 15 ACENDA mM NO. S 4- DACE ;;.q_ OF If --. 3. Collection of the Special Tax for Services The Special Tax for Services shall be collected in the same manner and at the same time as ordinary ad valorem property taxes, provided, however, that CFD No. 2006-2 may collect the Special Tax for Services at a different time or in a different manner if necessary to meet its funding requirements. J. APPEALS AND INTERPRETATIONS Any landowner or resident who feels that the amount of the Special Tax levied on their Assessor's Parcel is in error may submit a written appeal to CFD No. 2006-2. The CFD Administrator shall review the appeal and if the CFD Administrator concurs, the amount of the Special Tax levied shall be appropriately modified. The Council may interpret this Rate and Method of Apportionment for purposes of clarifying any ambiguity and make determinations relative to the annual administration of the Special Tax and any landowner or resident appeals. Any decision ofthe Council shall be final and binding as to all persons. K: ICLIENTS2\CLCILake ElsinorelRMA \ViscayaRMA _Final. doc Revised: 1/30/06 City of Lake Elsinore Community Facilities District No. 2006-2 (Viscaya) January 30, 2006 Page 16 AGENDA ITEM NO. PACE .~O ......" ......" ......" '5 OF 4-4-. ,"'-- EXHIBIT A CERTIFICATE TO AMEND SPECIAL TAX FOR FACILITIES ..-. ..-. ACENDA ITEM NO. .!:S PAGE 3/ OF #- ~ CITY OF LAKE ELSINORE AND CFD No. 2006-2 CERTIFICATE 1. Pursuant to Section C of the Rate and Method of Apportionment, the City of Lake Elsinore ("City") and City of Lake Elsinore Community Facilities District No. 2006-2 ("CFD No. 2006- 2") hereby agree to a reduction in the Assigned Special Tax for Facilities for Developed Property, and the Backup Special Tax for Facilities attributable to a Final Subdivision within CFD No. 2006-2: (a) The information in Table 1 relating to the Assigned Special Tax for Facilities for Developed Property within CFD No. 2006-2 shall be modified as follows: 1 Residential Property More than 2,349 sq. ft. $_ per unit 2 Residential Property 1,950 - 2,349 sq. ft. $ _ per unit 3 Residential Property 1,550-1,949 sq. ft. $ _ per unit 4 Residential Property Less than 1,550 sq. ft. $_ per unit 5 Non-Residential Property NA $_ per Acre ......, (b) The Backup Special Tax for Facilities attributable to a Final Subdivision within CFD No. 2006-2, as stated in Section C.l.(c), shall be reduced from $30,575 per Acre to $_per Acre. 2. The Special Tax for Facilities may only be modified prior to the first issuance ofCFD No. 2006- 2 Bonds. 3. Upon execution of the Certificate by the City and CFD No. 2006-2, the City shall cause an amended notice of Special Tax lien for CFD No. 2006-2 to be recorded reflecting the modifications set forth herein. By execution hereof, the undersigned acknowledges, on behalf ofthe City and CFD No. 2006-2, receipt ofthis Certificate and modification of the Rate and Method of Apportionment as set forth in this Certificate. CITY OF LAKE ELSINORE By: Date: CFD Administrator COMMUNITY FACILITIES DISTRICT NO. 2006-2 OF THE CITY OF LAKE ELSINORE '-' By: Date: AGENDA ITEM NO. 5 PAGE-A~z., OF tiLl /"'"' RESOLUTION NO. 2006- .'8..\ RESOLUTION OF INTENTION OF THE CITY COUNCIL OF THE CITY OF LAKE ELSINORE, CALIFORNIA, TO INCUR BONDED INDEBTEDNESS IN THE AMOUNT NOT TO EXCEED $7,000,000 WITHIN THE PROPOSED CITY OF LAKE ELSINORE COMMUNITY FACILITIES DISTRICT NO. 2006-2 (VISCA Y A) WHEREAS, the City Council (the "Council") of the City of Lake Elsinore (the "City") has heretofore adopted Resolution No. 2006- ~o , stating the Council's intention to form Community Facilities District No. 2006-2 (Viscaya) (the "CFD"), pursuant to the Mello-Roos Community Facilities Act of 1982, as amended, (the "Act"), to finance the purchase, construction, expansion or rehabilitation of certain real and other tangible property with an estimated useful life of five years or longer, including public infrastructure facilities and other governmental facil,ities, which are necessary to meet increased demands placed upon the City as a result of development or rehabilitation occurring within the proposed CFD (the "Facilities"); and /"'"' WHEREAS, in order to finance the Facilities it is necessary to incur bonded indebtedness in the amounts not to exceed $7,000,000, the repayment of which is to be secured by special taxes levied in accordance with Section 53340 et seq. of the Act on all property within the CFD, other than those properties exempted from taxation as provided in the respective rate and method of apportionment attached as Exhibit A to Resolution No. 2006- d-.'b . NOW, THEREFORE, THE CITY COUNCIL OF THE CITY OF LAKE ELSINORE DOES HEREBY RESOLVE, DETERMINE AND ORDER AS FOLLOWS: SECTION 1. The above recitals are true and correct. SECTION 2. It is necessary to incur bonded indebtedness within the proposed CFD in the amounts not to exceed $7,000,000 to finance the costs of the Facilities. SECTION 3. The indebtedness will be incurred for the purpose of financing the costs of designing, constructing and acquiring the Facilities, the acquisition of necessary equipment and property therefor and fulfilling contractual commitments and carrying out the powers and purposes of the CFD, including, but not limited to, the financing of the costs associated with the issuance of the bonds and all other costs necessary to finance the Facilities which are permitted to be financed pursuant to the Act. /"'"' SECTION 4. It is the intent of the Council to authorize the sale of bonds in one or more series, in the maximum aggregate principal amounts not to exceed $7,000,000 at 45710632.1 AGENDA ITEM NO.~ PACE 33 _OF J/!t CITY COUNCIL RESOLUTION NO. 2006- Page 2 of3 a maximum interest rate not in excess of 12 percent per annum or such rate not in excess of the maximum rate permitted by law at the time the bonds are issued. The term of the bonds shall be determined pursuant to a resolution of the Council authorizing the issuance of the bonds, but such term shall in no event exceed 40 years or such longer term as is then permitted by law. ..., SECTION 5. A public hearing (the "Hearing") on the proposed debt issue shall be held March 28, 2006 at 7:00 p.m. or as soon thereafter as practicable, at the chambers of the Council, 130 S. Main Street, Lake Elsinore, California 92530. SECTION 6. At the Hearing at the time and place set forth above, any interested persons, including all persons owning land within the proposed CFD, may appear and be heard at the Hearing. SECTION 7. The proposition to incur bonded indebtedness in the maximum aggregate principal amounts not to exceed $7,000,000 shall be submitted to the qualified electors of the CFD. A special community facilities district election shall be conducted on March 28, 2006. The special election shall be conducted by hand delivered or mailed ballot election. The ballots shall be .returned to the office of the election officer no later than 11:00 o'clock p.m. on March 28, 2006. SECTION 8. The Clerk is hereby directed to publish a copy of this resolution, ,....,. which shall serve as notice ("Notice") of the Hearing and the special bond election, pursuant to Section 6061 of the Government Code in a newspaper of general circulation in the proposed CFD. SECTION 9. The Clerk may send a copy of the Notice of the Hearing by first- class mail, postage prepaid, to each registered voter and to each landowner within the proposed CFD as shown on the last equalized assessment roll. SECTION 10. This Resolution shall take effect from and after the date of its passage and adoption. "'" c=-. AGENDA ITEM NO. __J ~ PACE... ~Lf OF ljcJ-- CITY COUNCIL RESOLUTION NO. 2006- Page 3 of3 ,'-' PASSED, APPROVED AND ADOPTED this 9th day of February, 2006. AYES: COUNCILMEMBERS: NOES: COUNCILMEMBERS: ABSENT: COUNCILMEMBERS: ABSTAIN: COUNCILMEMBERS: Robert E. Magee, Mayor City of Lake Elsinore ATTEST: ",..-.,. Frederick Ray, City Clerk City of Lake Elsinore APPROVED AS TO FORM: Barbara Zeid Leibold, City Attorney City of Lake Elsinore ~ AGENDA ITEM NO. ,5 PAGE,J r;-' OF # ~ ~ CI.l... ~-.b ~~ f;I;l~ !Q~ -;;- f;I;l........ .. ~u< = ~~~~... ~~~Ei ~~~~~ ~S~~l ~~~8~ ~~rj~~ ...i:~9i ...J z j ~ r <OJro..~'l:l ti~o=.!! ~0~8,g CI.lu_ - ~~u 'of. f;I;lf;l;l ... 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"" I ~~ ~ gi ~!lI!lI 0.1 .0("")0):2 ~<;i~glll) Nfil:glll. w ft ~..: '; I ~ ~ ~~~~l ~ ffi!z!z!z!z li3 ~~~~~ lli a: (I) (I) (I) (I) ~ lLWWWW :;) ;ia:a:a:a:. ! I=~N"'...il~ ffi(l)(I)(I)(I) ~ ~SSSS ~ wUuuu 0 a: .... ~ W lL o a: lL ~ ... Z W o 1ii w II: Z o Z ... z w ~ lL g ~ o .... .... :;) IL ~ II) W ~ ;i u W lL III o W z CI ii) (I) c ~: ~w w(!) ~~ u~ wO uu 5w a:u m~ I-W lD(I) W... OlD (l)W (1)0 0... _a:w s:(!)Z ......, ACENDA IlCM NO. ~ pAGE L). 4-- Of ~ ~ CITY OF LAKE ELSINORE REPORT TO CITY COUNCIL TO: MAYOR AND CITY COUNCIL FROM: ROBERT A. BRADY, CITY MANAGER DA TE: FEBRUARY 9, 2006 SUBJECT: PURCHASE OF LAKE PATROL VESSEL BACKGROUND On January 24, 2(>06 City Council adopted the FY 2005/2006 Mid Year Budget Adjustments. Funding for a new patrol boat was included as part of the budget adjustments adopted by City Council. DISCUSSION ,,-.... The new patrol boat will replace a 1986 Crystaliner that has been in continual use on the waters of Lake Elsinore since its purchase in 1986. Maintenance costs and down time of this vessel have increased dramatically the past few years. Replacement ofthe vessel will ensure the efficiency of our Lake Patrol Operations. The Lake Patrol Sergeant and City Mechanic were consulted to determine the specifications for a new patrol boat. Both agreed that a 21 foot fiberglass hull Boston Whaler vessel would be the best vessel for use on the waters of Lake Elsinore. Staff contacted Boston Whaler directly and Boston Whaler is willing to sell a vessel direct to the City. Boston Whaler agreed to sell the vessel at 24% below the retail cost of the vessel, a cost savings of approximately $15,000. Staff is requesting that the City Council authorize the exception of the formal bid process (3.08.100) and allow staff to utilize the "Open Market" purchasing process (3.08.100) to simplify and expedite the purchase of the patrol boat. FISCAL IMPACT ~, The funding for the purchase of the patrol boat ($65,000) is available as a result of the mid-year budget adjustments. AGENDA ITEM NO. (0 PAC'E-1- OF ,~ I REPORT TO CITY COUNCIL FEBRUARY 9, 2006 PAGE 2 RECOMMENDATION "" It is staffs recommendation that the Mayor and City Council grant an exception as per Chapter 3.08.070 (F) "Exception to Bid Process" for the purchase of a Boston Whaler patrol boat for use as a I enforcement vessel on the waters of Lake Elsinore. PREPARED BY: WILLIAM L. P A APPROVED FOR AGENDA BY: OF COMMUNITY SERVICES APPROVED FOR AGENDA BY: ACENDA ITEM NO. PACE cl - ~ .---, CO OF {p 1 210JC 1 21' JUSTICE BASE BOAT to include: $24,995 UNSINKABLE HULL WITH COMMERCIAL GRADE FIBERGLASS LAMINATE SELF BAILING HULL WITH SCUPPERS WHITE EXTERIOR / HAZE GREY INTERIOR GELCOAT HEAVY DUTY RUBRAIL BLACK IDENTIFICATION AND TRIM MARKINGS FIBERGLASS CONSOLE WITH STORAGE AREA, ELECTRONICS BOX, WINDSHIELD AND GRABRAIL ALUMINUM LEANING POST WITH DOOR, SHELF, AND GRABRAIL PADDED STAINLESS STEEL STEERING WHEEL WITH TILT HYDRAULIC STEERING BOW STORAGE LOCKER WITH FIBERGLASS COVER - ANCHOR LOCKER WITH FIBERGLASS COVER AND DRAIN (2) IN-DECK STORAGE LOCKERS WITH DRAINS BOWEYE / LIFTING EYE STERN EYES (6) 10" CLEATS NA VIGA TION LIGHTS FIRE EXTINGUISHER BILGE PUMP WITH AUTOMATIC FLOAT SWITCH SWITCH PANEL - BILGE / NAVIGATION LIGHTS / (4) AUXILIARY 119 GALLON BAFFLED ALUMINUM FUEL TANK 10 YEAR TRANSFERABLE LIMITED HULL WARRANTY 2 61520 1 RUBBING STRAKES - (1 per side) $843 3 60230 1 BW SUPPLIED ENGINE $0 4 9999 1 MERCURY 250XL VERADO 4-STROKE ENGINE $13,250 5 61601 1 TRIM TABS - ELECTRIC W/INDICATOR SWITCH PANEL $849 Quoted by: Don Ellingsen Phone: 850-539-9191 Fax: 850-539-7714 dellingsen@whaler.com NO. PART NO. QTY ,,-.,. BOSTON WHALER COMMERCIAL & GOVERNMENT PRODUCTS 420 Megan Ave., Edgewater, FL. 32132 QUOTATION Quoted to: City of Lake Elsinore Nicole Fields 521 North Langstaff Lake Elsinore, CA 92530 Phone: [1] 951-674-5170 nfields@lake-elsinore.org DESCRIPTION February 1, 2006 Quote #: 3 . Q-DNE-05463E PRICE Page 1 of3 AGENDA ITEM NO. lo PACE ( 3 OF f.rJ _. NO. PART NO. QTY DESCRIPTION PRICE 6 61440 1 PRE-RIG, SINGLE ENGINE, MERCURY VERADO: $2,839 INCLUDES: - FUEL! WATER SEP ARATOR(BOATS WITH BUILTIN FUEL TANK) - SMART CRAFT SC-I000 SYSTEM TACH/SPEED SINGLE ENGINE .....r1f/I GAUGE KIT - ELECTRONIC DIGITAL SHIFTffHROTTLE BINNACLE CONTROL - WIRING HARNESSES, KEY SWITCH & ALARM HORN - SHIFT AND THROTTLE CABLES 7 61401 1 SINGLE ENGINE INSTALLATION & PERFORMANCE VERIFICATION $479 8 61499 1 PROPELLER, STAINLESS V-6's $451 9 60614 1 G21 MEDlliM DUTY T -TOP W/RADIO BOX WITH LOCKABLE DOOR $4,793 10 61741 1 WHELEN 94 SERIES MINI-EDGE 28" LIGHT BAR W/SIREN, PA & $2,181 AMPLIFIER 11 62030 1 ENGINE CRASH RAIL - OUTBOARD $1,031 12 62020 1 TORSIONAL TOW BAR (may require alurnmum gunwale upgrade) $1,336 -BLACKPOWDERCOAT 13 61560 1 ALUMINUM GUNWALE UPGRADE $1,032 14 62302 1 72 QUART COOLER WITH CUSHION AND HOLDDOWN $286 15 60902 1 BATTERY SYSTEM FOR SINGLE ENGINE, ONE STARTING BATTERY $710 AND ONE AUX BATTERY , INCLUDES: - (2) ON/OFF BATTERY SWITCHES - (2) BATTERY BOXES AND TRAYS '" - BATTERY CABLES AND TERMINALS FOR ONE ENGINE AND TWO BATTERIES - ISOLATOR - SPLASHWELL RIGGING BOOT (WHERE APPLICABLE) 16 60925 1 MAINTENANCE FREE, WET CELL STARTING BATTERY, GROUP 24, $85 '1000MCA 17 60926 1 MAINTENANCE FREE, WET CELL DEEP CYCLE BATTERY, GROUP 27, $110 115 AMP HR 18 60737 1 EXTENDED SWITCH PANEL UPGRADE - BILGE/NA V/8 AUX $296 19 60740 1 12 VOLT OUTLET $52 20 62791 1 EZ Loader Trailer w/spare tire and carrier $3,765 21 9999 1 INSTALL CUSTOMER SUPPLIED AGENCY RADIO/ANTENNA $368 SUBTOTAL EX-WORKS EDGEW A TER, FLORIDA $59,751 '-' Page 2 on AGENDA ITHft NO. LD. - P' ~.- L!- IOr.:m I/J i'::''-..J~-r--- II-+-_ NO. PART NO. QTY DESCRIPTION PRICE SHIPPING TO CALIFORNIA $2,400 SHIPPING FUEL SUR CHARGE $375 ....... TOTAL $62,526 Comments and Special Instructions: CUSTOMER TO PROVIDE OFFLOAD OF BOAT AND TRAILER FROM DELNERY TRANSPORT CUSTOMER TO SUPPLY NEW RADIO/ANTENNA WITH LAY DOWN MOUNT FOR INSTALLATION AT PLANT. Terms and Conditions: 1. Payment Terms are NET 30 DAYS from invoice date subject to satisfactory credit approval at time of order placement. 2. Prices are guaranteed for 90 Days regardless of any Economic Price Modification to GSA Contract. 3. Brunswick Commercial and Government Products, Inc. reserves the right to modifY or discontinue models and equipment at any time without incurring obligation. GSA Contract Information: . GSA SCHEDULE TITLE: Small Craft and Marine Equipment FSC Group 19, Part 1, FSC Classes 1940 and 2010 . CONTRACT NUMBER: GS-07F-0011J CONTRACT PERIOD: 1011/98 through 09/30/08 . CAGE CODE: 1 C8W2 SIC: 3732 FEDERAL TAX ID#: 36-4083-000 'D~S:001012079 . PRICES ARE EX-WORKS EDGEWATER FLORIDA /"'"' ,.-.. Page 3 of3 AGENDA ITEM NO. PACi: ~ t) co OF If' HI ":IClt1~ ....., Open " . Dai1 LAKELAND /...;~=::=. = y ~AR~NE__ ~ (908) 878-4488 8-6 ~ Fax: (.09) 878-1232 Boals Sales, Service, Accessories & Rental · Mercwy OMC. Volvo oale;l.J~Llb 1...0 ,,~ 85 :" 0(' e...... (' '-' lsew "rEJCHAAoEI'" ACCt.,.. '""" I- wrl 1 " . .. . I ("'".....('0- "".I'll ,. : ...... v")'l- F II,' IT' ~ ... :'II['Q · M"I< ,: ~~ .. . . . . . , . . . . , : 30 DAY V.Y.AoWAY 100. DOwN PQ~] IN Rif:~ At' TAX: I~' 170 . Rcc'C1bv: .^ -, ,/ .\ . TOTAL: IJ7~ 13<<i "'" ACiEN9A ITEM NO.~ PACE. ~ OF-4L ~T_ .....Tc;c;t1""Y) CCTD7bbQ7Q bC:bD Daa7J~TJTa r-- CITY OF LAKE ELSINORE REPORT TO CITY COUNCIL TO: MAYOR AND CITY COUNCIL FROM: ROBERT A. BRADY, CITY MANAGER DA TE: FEBRUARY 9, 2006 SUBJECT: PURCHASE OF GENERATORS FOR CITY YARD BACKGROUND On January 24, 2006 City Council adopted the FY 2005/2006 Mid Year Budget Adjustments. As part of the budget adjustments adopted by City Council funding for two generators for use at the City Yard Facility were included. DISCUSSION --- The purchase of the two generators will provide electrical power to the City Yard during electrical power outages. Two generators are required, one for the Administration building and one for the Vehicle Maintenance Shop. It is important that the City Yard have a back up power source so that City services are not interrupted during emergency events. Providing the two generators will meet the City's goal of increasing our emergency preparedness. The attached information supports staffs recommendations and will allow the purchase of the generators through the informal process which was utilized in gathering the cost for mid-year budget consideration. Chapter 3 .08.070 (F) - Exceptions to Bid Procedures, allows City Council to authorize the City Manager or Purchasing Officer to bypass the bid process required under this chapter for purchases greater than $15,000. Staff is requesting that the City Council authorize the exception of the formal bid process (3.08.100) and allow staff to utilize the "Open Market" purchasing process (3.08.100) to simplify and expedite the pu:chase of the generators. r-- AGEN:;~, ITEM NO. PA('~ '1- OF & REPORT TO CITY COUNCIL FEBRUARY 9, 2006 PAGE 2 ...., FISCAL IMPACT The funding for the purchase of the two generators ($30,000) is available as a result of the mid-year budget adjustments. RECOMMENDATION It is staffs recommendation that the Mayor and City Council grant an exception as per Chapter 3.08.070 (F) "Exemptions to Bid Process" for the purchase of the two generators for use at the City Yard Facility. WORKS MANAGER D APPROVED FO AGENDA BY: ...., """" AGENDA ITEM NO. 4- PAC:: .~ OF 0 r" /"""""- "....... BID RESULTS CITY YARD GENERATORS 1) MQ Power - Carson California Bid = $26,830.26 2) B&G Services - Lake Elsinore, CA Bid = $28,740 862.20 = 3% pricing allowance due to being local vendor $27,877.80 = finial bid 3) Johnson rental Services- Temecula, CA Bid = $29,998.95 AGENDA ITEr'l! NO. PAC;; 8 ':t OF <p 1 ,) ~ POWER November 18, 2005 ;Ji Quotation TO: CITY OF LAKE ELSINORE ) ......, ATTN: NICOLE FIELDS FAX: QTY , DESCRIPTION NET PRICE EA. DELIVERY TIMES DCA-25SS12C $10,895.04 2-3 WEEKS TRLR-50XF $1;555.20 ,. SUB TOTAL $24,900.48 TAX 7.75% $1,929.78 TOTAL . $26,830.26 Exception INotes CA '-"" F.O.B. CARSON,CA This quotation is good for 30 days TERMS: ATTACHED SHEET Delivery: Quotation By: STEWART BRYAN MQ POWERCORP. A DIVISION OF MUL TIQUIP INC. POST OFFICE BOX 6254 CARSON. CA 90749 310-537-3700 OR 800-421-1244 FAX 310-632-2656 '-"" AGENDA ITEM NO. 1- . ,PAC::-LOF 0 /', '. "......... B&G SERVICES/GENERA TORS 18339 Pasadena Street Lake Elsinore, Ca 92530 (951) 674-3088 29 November 2005 Department of Public Works Lake Elsinore, Ca Attn: Gary Hufforth (951) 830-0406 We are pleased to quote on the following generators: # 1 Application: Office Building: One (1) each Mobil generator, trailer mounted. Iphase, 120/240V, diesel engine. Tank is sub-base with connector to match existing hubble cord connector. This is a 20 Kw unit. Mfgr. Is Wacker. Delivery: 10 days ARO. Or: One (1) each 25Kwtrailer mounted Multi-Quip Price............. .................. ....$14,780.00 "-'" Delivery: One week ARO Price...... .... ...................... ..$14,370.00 #2 Application: Shop Unit: One (1) each Mobil generator, trailer mounted, 20 Kw, 3-phase, 120/208V, reconnectable to other 3-phase voltages. Diesel engine, tank is sub-base connection. Wiring to shop not included in price. Manufacturer is Wacker. Delivery: 10 days ARO Price.............................. ....$14,370.00 , One (1) each 25K w, Trailer mounted -Multi-Quip Delivery: One week ARO Price... ............................ ....$14,780.00 Above items are FOB your site. Units will be ready to run.. Not included in above prices: sales taxes, on-site testing, wire to shop building, transfer switch And initial fuel. Manuals furnished at no charge. Prices valid for 30 days from date of this quotation. Terms: Net 30 days, max. AGENDA ITEM NO. PAC:':: 6 -=\. OF t.p I . JOHNSON RENTAL 'ERVICES www.johnson-rentalserVi.ce.com Riverside 800 E. La Cadena Drive Riverside, CA 92501 909.686.4560 Tel 909.n4.3273 Fax Victorville 11930 Mariposa Road Hesperia,CA 92345 760.947.0967 Tel 760.947.0978 Fax Fontana 14535 Rancho Vista Drive Fontana, CA 92335 909.574.6601 Tel 909.574.6606 Fax Temecula 41105 Raintree Court Murrieta, CA 92562 909.696.1063 Tel 909.696.9463 Fax ...., Name: City of Lake Elsinore Phone #: 951-674-5170 Date: 11110/05 Fax # : 951-471-1251 Attention: Nicole Fields SALES QUOTE EQUIPMENT TYPE SALE PRICE (2) Wacker G25 Generator Trailer Mounted With No Brakes $13, 548.00Each ,. , Sub-Total $27,906.00 Tax - at 7.50% $ 2,092.95 Grand Total $ 29,998.95 '-' SALES QUOTE IS VALID FOR 30 DAYS FROM DATE OF QUOTE Thank you for the opportunity to quote you on your upcoming Equipment purchase. We look forward to providing you with top quality, late model equipment and the best service in the industry. Please feel free to contact me if you have any questions or concerns. Thank you. Ben Bradshaw Johnson Rental Services TemecQ1a - 951.712.5981 bradshaw ben@johnson-rentalservice.com """"" AGENDA ITEM NO. PACE fe -=t OF {p I;,i ~ CITY OF LAKE ELSINORE REPORT TO CITY COUNCIL TO: MAYOR AND CITY COUNCIL FROM: ROBERT A. BRADY, CITY MANAGER DA TE: FEBRUARY 9, 2006 SUBJECT: CLAIMS AGAINST THE CITY BACKGROUND Claims filed against the CityofLake Elsinore are reviewed and handled by Carl Warren & Company, Claims Administrators. When received, each claim is logged in the City Clerk's Office and forwarded to this company for investigation. After initial review and investigation, direction is issued to the City to take one of several actions such as rejection, notification of late claim or reservation of action until further information is obtained. /"""' DISCUSSION The following claims have been recommended for rejection by Carl Warren & Company: CL#2005-05 - Pete Moreno CL#2005-31 - Bill Tiitto CL#2005-33 - Joseph Mauri CL#2005-34 - Kellie Mauri CL#2005-35 - Sheri Foster CL#2005-36 - Patricia Brown CL#2005-37 - Beverly Brown CL#2006-02 - Robert Seeley and Samuel Rizal Reference CL#2005-35 attachment for CL# 2005-36 and 2005-37. FISCAL IMPACT ~ None. AGENDA ITEM NO. PACE J 9 OF \ \..0:) REPORT TO CITY COUNCIL FEBRUARY 9, 2006 PAGE 2 ......, RECOMMENDATION Reject the claims listed above and direct the City Clerk to send letters informing the claimants of this decision. APPROVED FOR AGENDA BY: ......, ......, AGENDA ITEM NO. f) PACE '2- OF \ \.O~ ~ December 8, 2005 Pete More 1257 nestoga Street Co na, CA 92881 RE: Principal Member City Date of Incident Claimant Our File CJPIA Lake Elsinore 01/08/05 Pete Moreno 287761 DBQ Dear Mr. Moreno: ~, As claim administrators for the self-insured City of Lake Elsinore, we have made a careful examination of the circmnstances surrounding the captioned occurrence and feel we have enough evidence to make a decision on the 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 the claim to our principal. Our investigation reveals that the area is and was under the development by, Pardee Construction Company @ 10880 Wilshire Blvd., Suite # 2000, Los Angeles, CA 90024. The contact person is Ron Nugroho @ 31 0-475-3525. You may want to contact them on behalf of your client. This letter does not affect the notice that will be sent to you by the City of Lake Elsinore regarding disposition of your claim. Very truly yours, Deborah Been CARL WARREN & CO. ~ o \~ ..~ City of Lake Elsinore, Frederick Ray ".-, CARL WARREN & CO. CLAIMS MANAGEMENT.CLAIMS ADJUSTERS 770 Placentia Avenue, Placentia, CA 92870-6832 Mail: P.O. Box25180. Santa Ana, Ca 92799-5180 Phone: (714) 572-5200 . (800) 572-6900. Fax: (714) 961-8131 AGENDA ITEM NO. PAGE .?J ~ 4 OF l (t.to:S ~ December 8, 2005 ......, TO: The City of Lake Elisinore ATTENTION: Frederick Ray, Risk Management, Human Resources RE: Claim Claimant D/Event Rec'd Y /Office Our File Moreno v Lake Elsinore Pete Moreno 01/08/05 01/19/05 287761 DBQ 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, N & COMPANY CARL WARREN & CO. CLAIMS MANAGEMENT.CLAIMS ADJUSTERS 770 Placentia Avenue, Placentia, CA 92870-6832 Mail: P.O. Box 25180. Santa Ana, Ca 92799-5180 Phone: (714) 572-5200 . (800) 572-6900. Fax: (714) 961-8131 ......." AOENDA ITEM NO. <3 PACE L.\- OF 1\ 06, /"". ,,-., City of J}akE Et1-in.O'l-E cHOInE- of thE. !biamond ~tadium January 19,2005 Dwight Kunz Carl Warren & Company P. O. Box 25180 Santa Ana, CA 92799-5180 Dear Dwight: Enclosed for your handling are three recently received Claims received from Sharon Donovan(CL #2005-3), Darcie Grayum-Montano (CL #2005-4) and Pete Moreno (CL #2005-5). Please keep me advised of appropriate City Council action. It should be noted that Ms. Donovan's home was located in the County of Riverside; Ms.Grayum-Montano may have been on the County s.ide of the road; and in the case of Mr. Moreno, there are two fire stations on Grand A venue, one in the City and one in the County. As al ys if you have any questions or need additional information, please don' hesitate to call. KAS' ~CLERK CITY OF LAKE ELSINORE Enclosures cc: City Manager Finance AGENDA ITEM NO.~) R E OF 130 eSout~ c410ln eShut, 1'0" Et,'no<<, Cd! 92530 · fJdepfwnLC (909) 674-3124 ~~6 _ CLAIl\fAGAI lST THE CITY OF LAKE ELSINORE (For Damages to erSODS orPersoDalProperty) A.X~ City Representative ~ ~A~~~~~ [ ~ CIT\i9~f~~S OFFICI <TimelPateReceived) Received by: CL-41 Joos- S A claim must be flied with the City Clerk of the City of Lake Elsinore, within six (6)monthsaftertbeincident ore event occurred. Bt sure your claim is against the City of Lake Elsinore, not another public entity. Wherupace ,S insufficient, please use additional paper and identifyinfonnation by paragraphnurnber Completed dajms.mustbe ma,iledordeJivered to the Cit)'Clerk, Cit)' of Lake Elsinore, 130 South MainStTeet, Lake Elsinore, California:; 92530. TO THt HOSORABLE MAYOR AND CITY COUNCIL, CITY Of'LAKEELSINORE, CALtFORl\"lA: The undersigned respectfully subtnits the following claim andinfonnation relative to damage to persons and/or .personal property: . I. ~AMEOFCLAIMANT ?~ie hlMp'y' -eNd a. Address of Claimant 41 '!I/o Bl~e/rHt7L.A./75'a/:Vj-I(/' /~.~. /f1f.li&rU 725;"t, . ,. .. -. -, . b. Phone No. (<'If"!) h9cf, - f?p /fr Social Security No. ,'I J -J..<il- ~ 9'> if e. Date ofBinh It'.....).. () ...: 2-" Drivers Lie. No.V~~ 7f{/6f? ......, d. e. 2. Name, post office address and telephone to which claimant desires notices to be sent, ifothertban tbeabove: 3. Occurrence or evenrfrom which this claim arises: a. Date j- ~. - ).Ol/S" b. Time?,:,' "'I> P/1.....Jr;;,IN~;.,rJ' Place (Exact and specific location) . tJ'"h G..".. 11/1< d 1(1/.e C!y". a.1I).~,~f~~ c. ---------:. d. Howahd: under whatcircumstantes did dama,ge Of injury occur? SpeCifY the partieulat~utr~llee, event, actor omission you claim caused the injury or damage (use additional paper ifnec-essary). I lV~S dVH;V dN Gv- :/t./l./r./ ~J ~,';"'pjl-1 ~N~d WdS" ~~(:v?. 4-Y!/.L -'T~ .~ .C4 /:)p-j--J4j~ ...~/ ."7 A"./ .. t.V~'" r1J Ch'1 -doL ~/:/., .~bl JJ~ ~b~"4 f,;'~, e. What particular action by the City of its employees, caused the alleged damage or injury? ih/s irV"afT-h't' JrJ~JI-F-~-cnf f-/~~ Of ......, AO~;r; fa; \ lp:3 ~ 4. Were there any injuries at the time of this accident? lfnot, state ''No injuries". ~..(~~y I'.eS S. Give the name(s} ofthe City employee(s) causing the damage or injury; 6. Name and address of any person injured: /lioN\.( 7. N~m.eand~ddrr.ss~J lh.e ~W!l~LQr~Y9c!m!Aed pr..oyeny:.___ T'UI--L HI Mt:>y>eXIP ~/9ft'ej C!t'-j M~-nZ/~/. rltJfgl'Je c/ ~ '7 2.. l," c:. 2.. 8. Damages claimed: a. b. c. d. Amount claimed as Of this date $ . Estimatedamountoffuture costs $ .... . ~"..' . TotaJamount claimed $1~""V Basis for computation ofamounts claimed (Include copies ofall bills,invoices, estimates, etc): "....... 9. Kames and addresses of all wimesses,hospitals, doctors, etc: a. ...---.. b. r--' c. 10. Any additional information that might be helpful in considering this claim: WAR,~ING: IT IS A CRIMINAL OFFENSl: TOFlLE A FALSE CLAIM! (Penal code 72/JnsuranceCode ;;i;.i) I have read the manersand statements made in the above c:1aim and I know the same to be true of my own knowledge. except as to those maners state upon infonnation or belief as to such matters, I believe the same to be. true. 1 certify under penalty of perjul} that the foregoing is TRUE AND CORRECT. . ::::~A:;:~ l>AY.OF t. ..:O~AT.. ~~:t:f SIGNATUl<E: ~ ~ ..;:::. ...___ , CALIFORNIA. ~ AGENDA ITEM NO. R PAGE '=i OF \li ~ '" December 12,2005 TO: The City of Lake Elsinore ATTENTION: Frederick Ray, Risk Manager RE: Claim Claimant D/Event Rec'd Y/Office Our File Tiitto vs. The City of Lake Elsinore Bilfflitto 8/23/2005 10/24/2005 S-1397284-DBQ We have received and reviewed the above 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 ~.~ 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.Box25180.SantaAna.Ca 92799-5180 Phone: (714) 740-7999 Ext. 140 . (800) 572-6900 . Fax: (714) 740-9412 ."." AGENDA ITEM NO.~ PACE <6 _O~ City of LakE Ef1-ino7-E (( DnE. CitY'i got c/lI(O'l.E. II December 2, 2005 Dwight Kunz Carl Warren & Company P.O. Box 25180 Santa Ana CA 92799-5180 Dear Dwight: ~ Enclosed for yonr handling is a claim received on October 24, 2005 from Bill Tiitto (CL #2005-31). Please keep me advised of appropriate City Council Action. For further assistance, please contact me at (951) 674-3124 ext. 262. CK ,CITY CLERK CITY OF LAKE ELSINORE r-- 730 South diIIain Stud, l'ahe Ef,inou, Cd'! 92530 CJdepham (957) 674-3724 'Jax (957) 6?92 www.!akE-E[jino'tLo't:J AGENDA ITEM NO. ) r- PAGE~OF\\ O~ CLAIl\f AGAINST THE CITY OF LAKE ELSINO. (For Damages to Persons orPersonsl Property) o (g~(g"~.~ ~ CT %., 2Gu~ \.0 o ~I c\ {CLERKS OFFlCt' (TimelDate Received) Received by: . . . i City Representative A claim must be filed with the CityClerkofthe City of Lake Elsinore, within$ix (6)monthsafttr the incident ore hent occurred. Be sure your claim isal,gainst the City o(Lake Elsinore. not another pubJieentity.Wbere spaceisinsufficitnt, please use additiomil paper and identify information by paragraph;numberCompJetedelJims must be mailed or deUveredto the Cit)" Clerk, City of Lake Elsinore, J 30 South Main Street, Lake Elsinore, Califomia,92S30. TO THt HO~ORABLE MAVOR AND CITY COUNCIL, CITY OF LAKE ELSINORE, CALIFORNIA: The undersigned respectfull)' submhs the folJowin~ claim and information relative to damage to persons andlor personal property: 1. ~A~fEOFCLAIMANT ~\\o..~ -r-\ \T"TQ a. Address of Claimant ~.~ ~~(.. MA:<:-~"1)9 b. Phone No. (_. ~q>...q $O'S c. d. Social Securit). No."\.~ ~:'"~'" .. ~\ ~ 1 e. .~,-- .. ..\.." \(,aLS. .~()~C Date of Binh ;J. '2.. r ~~ ""'-" Drivers Lie. No. M 0 '-\3 ~\)j'" 2. Name, post office address and telephone to which claimant desires notices to be sent, jf oth.er than the above: ..-- 3. Occurrence or evenrfrom which this cJaim arises: a. A ~ .., '). c, Date. ... v".;;!""" 1~)~~<.\ S b. Time Place (Exact and specific location) L A\o4t;-<S ~~\\-t, \)'R,.. I :06 p~ (~~'.{rrA(.K..A ,..-;,:tt) c. d. How and under what circumstances did damage or injury occur? Specify the panicular occurrence, event, act or omission you claim caused tbe injury or damage (use additional paper ifnec:essary). H~-t () \\..~~ (. \(.~T C.~\H=.:(\.' l':> ,'& \J C'",,"'~A. 'vJ-..., ~q.~CN\ f"'I ~ ~\ ~>.~. \J, \ ~\\~~~t!t> v..Mt>iifl,~~~"H Cj\.,,-. . te' R,(b Q.,\ P ~.~.}(... n'~) l 'l) \~ ,"'~ 't>~t ~Ja \l.l4f l ~ee A 1\, \t.... ~ d...) e. What panicular action by the City of its employees, caused the alleged damage or injury? ~ ~~\cu.at -r"y ~E:~" \ '-it T~lt r~;"e c,..~ (6 ~ f;) =t '\ ~A, t'i c..\...'&~~. ~~\\jSl)J~'1 4-. ~"'G~vr~ ~\...A.fM 4 e.tJ~Y"). (. ~~ e ~~~A.) "f{,,"~"U ~ ~ Tt- ~<..~ .~ ""'-" A~ENDA ITEM NO. r:s PACE \0 OF ~ \'-0:3 /"'" . ..4. . ,', '\Wre there an)'injuries at the time of this accident? Ifnot, state "No injuries". :n ..,... \ V\ \ c.: 'r :~ 5. . Give the name(s) ofthc City empJoyc.e(s) causing the damage or injury: \AVt ~~Ov.\~ - . 6. Name and address of any person injured: ~~. 7. Name and address of the owner of any damaged property: ~~..."" 1"', \7.0 ~ -a,. ~ C. 'W"c.~4.~. ~"'t'; ~~'(,~ _\..'\lI.\o~ 8. Damages claimed: a. b. c. d. AmounrcJaimed as of this date $ .'a 'l~\ Estimated amount of futute costs $ .... Totalamountclaimed .. .. .. . $ . ...~.,. ~, Basis for computation ofarnounts claimed (lncludecopies ofall bills,invoices, estimates, etc): r" ~..... . n~~ ~I 9. Names and addresses ofall wimesses, hospitals, doctors, ett: N /", a. . b. c. 10. Any additional information that might be helpful in conSidering this claim: ~ -l\.(.A l \... At(~e"~ W ARNIl"G: IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM! (Penal code 72fJnsurance Code 556.1) I have read the maners and statements made in the above claim and lknow the same t(l be trUe of my own knowledge,except as to those maners state upon information or belief as to such maners, J believe the same lobe trUe. I cenify under penalt)' of perjury that the foregoing is TRUE AND CORRECT. SJGNED THIS ,"] DAY OF O(;r-oi1~ ,20!S.,A T\..." \(€ t:-U, ~c'"Ri\ CALIFORNIA. . CLAIMANT'S SIGNATURE: BJI ~:ttt? ,,-. AGENDA ITEM NO.~ PAGEJI _OF~ ~ ."" December 12, 2005 TO: The City of Lake Elsinore ATTENTION: Frederick Ray, Risk Manager RE: Claim Claimant D/Event Rec'd Y /Office Our File Mauri vs. The City of Lake Elsinore Joseph Mauri 5/2912005 11/2212005 S-1397280-CKQ We have received and reviewed the above 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 b 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.Box25180.SantaAna.Ca 92799-5180 Phone: (714) 740-7999 Ext. 140 . (800) 572-6900 . Fax: (714) 740-9412 ~ ACENDA ITEM NO. ~ PAOE1Q.. OF City of 1!akE Ef1-ino7-E ((,n /l J /7. _If 11 JJ l:...JnE- city 1. <::;Jot ClVIO'tE- December 2,2005 Dwight Kunz Carl Warren & 'Company P.O. Box 25180 Santa Ana CA 92799-5180 Dear Dwight: /""'. Enclosed for your handling is a claim received on November 22, 2005 from Joseph Mauri (CL #2005-33). Please keep me advised of appropriate City Council Action. For further assistance, please contact me at (951) 674-3124 ext. 262. sz F~ Y, CITY CLERK CITY OF LAKE ELSINORE ............. 130 South c;;Il;(ain St'tEd, 1!akE ED,ino'tE, Cc:/f 92530 CldEphonE (951) 674-3724 '3ax (951) 674-2392 wwwlakt:-dj.ino'tEoo't3AGENDA ITEM NO.~_ _._ PAGE I'~ y~ -- -------- ,/~ CLAIM AGAINST TliE CITY OF LAKE RT ..~ORE (I'or DaJlag.a t.o Peraona or Peraonal propert.y) fO) ~~~a~J~ ij ln1 2 2005 ......, CITY CLER}'\S OFFICE ..celnA bJ'~ ~ ~0 . t.y ..pr...nt.at. v. (!'ia./Dat. ..0.1..4) A claim IDU.t ))e filed with the City Cl.rk of the city of Lake Kl.inor., within.iz (6) month. after the incident or .v.nt occurr.d. Be 11\11". your cl.im i. .g.inat th. City of Lake Kleinor., not anoth.r public .ntity. Wher. .pac. i. inauffici.nt, pl.... ua. additional paper and identify information by paragraph number. COmpl.ted cl.i1D8 .u.t be aailed or deliver.d to the City Cl.rk, City of Lake Kl.inor., 130 South Ka1n Street, I~ ~!.!nor~. California 92530. _ !'O DB BOBOReLB XAYOR un CI!'Y COmlCIL, CIn 0., UK. aLlDIOJlB, caLl~1 The underaigned reepectfully .ubmita the. following cl.im and information r.lative to damage to peraon. and/or per.onal property: 1. KAME OF -C1AlMANT Joseph Mauri a. Addre.a of Claimant 29013 Coconut Way, Lake Elsinore, CA 92530 c. Dat. of Birth 10/6/84 .. Driv.r. Lic. No. 03926844 b. Phone No. (951) 285-3018 d. Social Security No. 602-32-8788 ~ . 2. Name, poet office addr... and telephone to which claimant d..ir.. notic.. to ))e .ent, if other than the above: - Keller. Fishback LLP, 28720 -Roadside Drive, Suite 201, Agoura Hills, CA 91301 3. Occurrence or .vent from which thie claim ari...: a. Date 5/29/05 b.Time 22:10 c. Place (Exact and .pecifie loc..t5.on~ Intersection of SR-74 and Riverside Street, lake Elsinore, CA d. How and under what circum.tance. did damage or injury occur? _ specify the particular occurrence, event, act or omi..i~n you cla~ cau..d the injury- or damage (u.. additional paper if n.c....ry). Claimant was driver of a vehicle traveling on SR-74 when a second vehicle pulled into its path while tumi~g from Riverside Street causing the two vehicles to collide. e. What particular action by the City or it. employ..., cau.ed th~ all8ged damage or lnjury? - . The roadway speed limitS, intersection, signals, signs, markings and/or other roadway warnings' and devices.; ~nd/or:jack the~eof, i~nd around !h.e a~~as ofth_~. SJJbject motor vel1icle accident were improper~ dangemus and/or defective at the time of the accidEt'lt. -- .~- ...-_ o. AGENDA ITEM NO. ~ PAOE~OF v:S ,,-.... .f. Were there any injurie. at tbetJ:.e of thi. hcident? If t:here were DO h:Jur1e., etate -110 Injurie.-. . . Injuries are ongoing and include multiple fractures requiring surgery and multiple lacemtions to his face and body, among others. 5. Give the n.....(a) of the City Mployee(a) cauaing the daaage or injurys Unknown 6. II... and addre.. of any other per.on injurec!. Kellie Mauri, 29013 Coconut Way. lake Elsinore. CA 92530 7. II... and .ddr.... of th. own.r of any damaged property. Joseph Mauri. 29013 Coconut Way. lake Elsinore. CA92530 8. . Damag.. cl.imed. ~ .. Amount claimed a. of this date b. E.timat.d amount of future co.t. c. Total amount Claimed d. Basi. for computation of amoumta claimed invoic.., .atimat.., .tC): Damages are continuing and ongoing and cannot be specifically determined at this time $ Unknown/ ConUnulng and ongolng $ UnknowtV Conlf!luiflQ and onQOing $ Unknownl i7 and rl1 (Incluc!. copie. 0 .1 111., 9. . Names and .ddre.... of all witn....., hospital., doctor., etcl a. Witnesses are listed. in the police report on file with the California Highway Patrol b. c. 10. Any additional information that might be h.lpful in eon..i.d.rin~ t.hf.~ "ld.'lU Investigation is ongoing W1RHING: IT IS A CRIKIBAL OFFENS. TO PIL. A PALS. ~J.I (P.nal Code 72/In.uranc. COde 556.1) I have read the matter. and .tatement. made in the above cl.im and I know the .... to be true of my own knowledge, exe.pt a. to tho.e matters .tated upon information or belief a. to auch mattera, I believe the .am. to be true. I c.rtify under penalty of perjury that the foregoing i. TRUE AND CORRECT. SIGNED THIS "l.<:? 0 S 2( DAY OF November , 1$- , AT Agoum Hills · CALIFO~Z P au - CLAIMANT'S SIGNATURE: ~, AGENDA ITEM NO.~ PACEJ ~ _OF~ '--' December 19,2005 TO: The City of Lake Elsinore ATTENTION: Frederick Ray, Risk Manager RE: Claim Claimant D/Event Rec'd Y /Office Our File Mauri vs. The City of Lake Elsinore KellieMauri 5/29/2005 11/22/2005 S-1397280-CKQ. We have received and reviewed the above 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 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.Box25180.SantaAna.Ca 92799-5180 Phone: (714) 740-7999 Ext. 140 . (800) 572-6900 . Fax: (714) 740-9412 ....., AGENDA ITEM NO. ~ PAGE \lo OF ()~ City of .-CakE Et~inottE 11,(\ /l J /2 _1111 " LJm:. city 1. '.:::lot ClV\o>te December 2,2005 Dwight Kunz Carl Warren & Company P.O. Box 25180 Santa Ana CA 92799-5180 Dear Dwight: /"". Enclosed for your handling is a claim received on November 22, 2005 from Kellie Mauri (CL #2005-34). Please keep me advised of appropriate City Council Action. For further assistance, please contact me at (951) 674-3124 ext. 262. Sincerel Y, CITY CLERK E ELSINORE ~K CITY OF LA /"" 130 ~outh cMain ShEd, ~afu Ef1.ino'tE, Cc/f 92530 C1dEphonE (951) 674-3124 ':lax (951) 674-2392 . www.fafn-Efj.ino'tE.o'fj AGENDA ITEM NO. b PACE ) q OF) l P =j " ~ f'- RECEIVED CLAIM AGAINST THE CITY OF LAKE ELSINORE (por Dalla;.. to per.on. or Per.oD&l Property) NOV.22 Z005 .""" CITY CLERKS OFFICE .ecd...s I>)'~ f:t. ~a . C ty ..pr..qta v. (~ta./Dat. "0.1..4) A elaim _.t be filed with the City Clerk of the Cit.y of LaJut .l.inora, within .ix (~) month. after the incident or event occurred. .. .ure your cl.iA i. av.in.t tM City of Lake El.inore, not .nother public entity. Where .pace i. in.ufficient, pl.... u.. .ddition.l paper and identify information by par.graph number. COmpl.ted cl.iAa 8Uat be aailed or delivered to the City Clerk, City of Lak. .l.inor., l30South Main Str..t~ t~ ~t.!nor.~; California 9~530. '1'0 HB BOllOR.ULB KAYOR U1) CITY COOltCIL, Cln 01' LaXB a.8DrOU,caLll'OJtIflAl The undereigned respectfully .ubmit. the following cl.im and information r.lative to d_ge to per80ne and/or per80nal propertYl . 1. NAME . OF CLAIMANT Kellie Mauri a. Addre8. of Claimant 29013 Coconut Way, Lake Elsinore, CA 92530 b. Phone No. (951) 285-3018 d. Social Security No. 951-285-3018 c. Date of Birth 10/31/1986 e. Driver. Lie. Mo. n/a "--'" . 2. Name, po8t office addre.s and telephone to which claimant de.ire. notice. to be .ent, if other than the above: Keller' Fishback LLP, 28720 Roadside Drive, Suite 201, Agoura Hills, CA 91301 3. Occurrence or event from which this claim ari...: a. Date 5/29/05 b.TiJDe 22:10 c. Place (Exact and specific loc.t~.on~ Intersection of SR-74 and Riverside Streetr Lake Elsinore, CA d. How and under what circumetance. did damage or injury occur1 -Specify .the particular occurrence, event, act or omi..i~n you claim cau.ed the injury or damage (uee additional paper if neee.eary). Claimant was a pasSenger in a vehicle traveling on SR-74 when a second vehicle pulled into its path while tuming.from Riverside Street causing the two vehicles to collide. e. ~hat particular action by the City or it. ~loy..., cau.ed th~ alleged damage or injury? The roadway speed limits, intersection, signals, signs, markings and/or other roadway wamings . and devices,; ~nd/o(jack thereof, i~~~round j~~ a~~as ofth~. SJ.Jbject motor vetlicle accident were improper, '-"" . ....:- danger.ous and/or defective at the time of the accidEt'1t. ~- .....-. ~- AGENDA ITEM NO. PAGEJ5 R OF \lo6 r" 4. Were there any injuri.. at the time of this incident? Xf ther. were DO injuie., Kate .110 Injuri.... Injuries are ongoing and include a fractured left wrist and other Internal injuries, among others, 5. Give the name(.) of tbe City .-ploy..(.) cau.ing tbe daaage or injuryr Unknown 6. .ame and addr... of any oth.r per.on injur.d. Joseph Mauri, 29013 Coconut Way, Lake Elsinore, CA 92530 7. .... and addr... of the owner of any damaged property. Joseph Mauri, 29013 Coconut Way, Lake Elsinore, CA 92530 8. Damage. claimed: ,r--- a. Amount claimed a. of this date $ Unknown/Conllnulngandongolng b. B.tilllat.d amount of future co.t. $ Unknown! Continulna and ongoing c. Total amount Claillled $ Un~~ngand" d. Basis for cqmputation of amoumt. claillled (Include copi.. 0 al111., invoice., e.t~t.., etc): Damages are continuing and ongoing and cannot be specified at this time. 9. , R~. and addre.... of all witne..e., ho.pital., doctor., atc: a . Witnesses are listed on the police report on file with the California Highway Patrol b. c. 10. Any additional information that might be hel~ful in eona.lderifl9 thi...- f,!him~ Investigation is ongoing WAJUfIlfG: IT IS A CRIXIDL OFF"S. TO I'lL. A !'ALS. c:r,~TIfI (P.nal COde 72/Insurance COde 556.1) I have read the .atter.. and .tatement. mad. in the above claim and I know the .ame to be true of my own knowledge, except a. to tho.e matter. .t.tad upon information or belief a. to .uch mattera, I believe the .ame to be true. I certify under penalty of perjury that the foregoing ia TRUE AND CORRECT. SIGNED THIS z. / DAY OF November . .~~ ~/ /~/ 2 <'pOj--- , 3.9_, AT AgouraHills CLAIMANT'S SIGNATURB: ,.-- AGENDA ITEM NO. R PAGE--1.9- OF \\JJ .~ IbK January 25, 2006 ....., TO: City of Lake Elsinore ATTENTION: Frederick Ray, City Clerk RE: Claim Claimant D/Event Rec'd Y /Office Our File Sheri Foster v. City of Lake Elsinore Sheri Foster 7/24/05 12/30/05 1400019 RQ 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 & CO. ~~ Richard Marque cc: CJPIA Attn\Executive Director \ CARL WARREN & CO. CLAIMS MANAGEMENT-CLAIMS ADJUSTERS 770 Placentia Avenue, Placentia, CA 92870-6832 Mail: P.O. Box 25180, SantaAna,CA 92799-5180 Phone: (714) 572-5200 . (800) 572-6900 . Fax: (714) 961-8131 ......" AGENDA ITEM NO. ~ PAGE ?C2 OF ') Robert E. Magee Mayor Robert Schiffner Mayor Pro Tern Thomas Buckley Councilman Daryl Hickman Councilman Genie Kelley Councilwoman Robert A. Brady . City Manager r"' ,-.. Cit}} of LakE Et~ino,[E ({Q)nc: Cit!/i got c!lI(ouJl January 19, 2006 Dwight Kunz Carl Warren & Company P.O. Box 25180 Santa Ana CA 92799-5180 Dear Mr. Kunz: Enclosed for your handling is a claim received on December 30, 2005 from the Law Offices of Michael H. Silvers on behalf of Sheri Foster (CL #2005-35). Please keep me advised of appropriate City Council Action. For further assistance, please contact me at (951) 674-3124 ext. 262. Sincerely, Enclosure cc: City Manager Finance 130 ~outh c!l1ain ~hut, -Lake: E[~dno'l.t:, (!df 92530 C"Jde:phone: (951) 674-3124 'Jax (957)~-2. 392 wwwla!n-dj.ino'te:.o'tJ AOENDA ITEM NO. PAce.2:L-OF . .-,- CLAIM AGAINSI' THE CITY OF LAKE EImNORE (:por Daaaq.. 'to Pft.ona or ~~.onal Proputy) /r/?~bJ "'-"" R.oaiv.4 by: City a.pr..antativa (Ttae/Date aeo.ived) A claim muat be fU.lS with the C1~y Cl~lc of i:b. Cii:y ot Lake .l..inor., wl~hin aix (6) -.ontu afte1' the incident or .vent occurred. Be aure your claim i. .9ain.tthe City of ~ Elainore, not ano~her public entity. Whare apaee i. inaufficieDt, pl.... vae .dditional paper and identify information ~y paragraph number. COmpleted cla~ ~~ be mail~ or dalivarad to the Ci~y Clerk, City of Lake El.inor., 130 South Main Street, Lake Slainore, California 92530. TO TIlE BONOJlA1lLB KAYOR AlfD CITY COWilC:IL, CITY 01' UIB a,8ROR.B, CJUa%J'ournl Th. under.ignad respectfUlly .ubmit. the foll~ing claiM and intormation relative to damaq. to per.oM and/or per.onal property: SHERI FOSTER 1. lWm OF CI..UMANT a. Addreaaofclaimant 195 Glynnshire Court, Covington, GA 30016 b. l'hona No. ( 7'10-385-864"5 d. Social security No. e. D~iv~. Lic. No. 12/24/70 GA-066723301 C~ Data of Birtb 2. N&me, post office addrells and tel8~hona t~ whieh Claimant d..1r.. nQtlc:e.. to be if other than the &bOVQl (310)551-05~1. LAW OFFICES OF MICHAEL H~ SILVERS ~~500 W9&t 01ymri~ Rlvo_ #322. Los Anqeles, California 90064 O~~rrencQQr..vent:fromwhich thi. claim ari...: ..nt, '-' 3. l. Date 7/")4/05 b.~ime 1400. C. PlAce (I~.a.ct and .pacific locAtion) Grape Street & Olive Street Riversjde, California d. Bow and 1,Inder what circ\UII.8tanc:ea did damag_ or injury occur1 _Specify the particular OCcurrence, .vent, act or omi.Bi~n you claim eau.ed the injury Dr dama9. (vae additional paper if necaaaary). ~RR J\'T''T':ll.C'HRD e. What particular action by the City or its ~loye.., Ca\1..0 tbe. alleged dama;e Or injury? SFR :aTT:a(,~ED t~ . . . .~ ..--.,. - ......" AGENDA ITEM NO._ S3y 1'3- PACE 2. Q.. OF ~ l (, ,,-.. .. Were there any 1njurie. at th. t~ of thh incic1ant:t If tbue were no injud..., rtate .No Injuri..... SEE ATTACHED 5. Give the name(.) of th. City employee(.) cau.lng the damag. or injury; Unknown at the present ti~e pendina fvrther investiaation & discovery are continuing. 6. lfaJlle anr1 ar1dr... of any ot.her per.on injur.dl Eleanor Gertrude Brown (D~ceased), Beverly Brown, Patricia Brown and Sheri Foster 1. RIUDI!l and addreu of th. owner of any ~ged prop.rty t Ele~nor Gertrude B~Qwn and Beverly Brown. Post Office Box 1152. Wildomar, CA 92595 8. pamages claimadr a. Amount claimed as of thi. date b. Estimated amount of future coat. c. Total amount Claimed d. BaaiB for computation of amoumt. claimed invoices, eBtimatee, .tC::)1 5rli:li: ATTA.c;'Mli:D' EXIHIHT "1\" $ 42 . 9 4 8 . 97 , $ TTT.J~ptprrni npd at $ pp'Q9t-a>'"fii %Id at (Include cop .. of a Ila, Present Pre'sent r-- }. N~.Band addreDDOD of. all witn...e8, ho.pitals, do~or., etel a. Jaotina U;1rie Carter 2119 Lomon Street, Ri~QrsidQ, CA b. c. 10. Any additional information that might be hQlpful in consid.ring thi_ claims SEE- ATTACHED QJUtIlIa: IT IS A ODllnL onuS!: TO 1'11,1 A I'ALaB l!T.,.Tllf (P8nal Code 72/In.urance Code 556.1) I have read the matters and .tatement. made in the above claim and I bow the .aIDe to be true of my own knowledg8, except .. to tho.e matter. .t:at.r1 upon i~ormatlon or ~liet .. to aueb IUttera, 1 believe the same to be true. 1 e.~U.fy under penalty of perjury that the foregoing b TRUE AND CORRECT. SIGNED THIS ?Qt-h DAY OF c.A1.!FORNIA. December , ~~, AT Los Angeles CLUKANT'S. BIGlfATtmB: /~ r~/ . r SHERI FOSTER I r-- ** TOTAL P~3 ** AGENDA ITEM NO. .3 -- PAGE?-.--~ OF~ From These AreAS c~u, (BOO) 775-'Z993 (n3) 269-7997 (408) 358-6080 (415) 255-0585 (510) 'Z68-88'Z0 (559) 738-9558 (562) 439-'Z26'Z (619) u.6-1336 (6'Z6) 403-0345 VIA FEDERAL EXPRESS Michael H. Silvers A Law Corporation 11500 West Olympic Blvd., Ste. 322 Los Angeles, Califomia 90064 Telephone: (310) 551-0551 Facsimile: (310)445-9623 michaelhsilvers.com '-'" December 29,2005 From Thue Are~. C~U, (650) 610-0344 (661) 'Z66-02U (714) 968-0802 (760) 256-3455 (805) 487-8176 (818) 785-0118 (909) 514-1889 (949) 725-0455 (951) 360-3207 City of Lake Elsinore Attn: City Clerk 130 South Main Street Lake Elsinore, California 92530 Re: Wrongful Death of Eleanore Gertrude Brown Our Clients: Beverly Brown, Patricia Brown, Sheri Foster Date of Loss: July 24,2005 Dear City Clerk: Enclosed please fmd an original and three copies of the Claims Against the City of Lake Elsinore forms to be filed on behalf of our clients Beverly Brown, Patricia Brown and Sheri Foster with regard to the above-referenced matter, along with a delineation of the accident facts and attachments. ....." I have enclosed a self-addressed stamped envelope for your convenience in returning the conformed eopies of the said filing to our offiCe. Please rde the enclosed claim feFDls immediately upon receipt. The statute of limitations in this matter runs on January 24,2006. Thank: you for your anticipated courtesy and cooperation in the handling of this claim. Sincerely, MICHAEL H. SILVERS ALA W CORPORATION De Reconnu, Paralegal to Michael H. Silvers :dr Encls: '-..i' ACENDAllEMNO.- ~'3 t'!'r;E 2.~ Of \ - From l1..... Azea. c.n: (800) 115-2993 (3231 269-7997 (408)358-6080 (415) 255-0585 (510)268-8820 (559)738-9558 (5621 439-2262 (619)266-1336 (626) 403-0345 Michael H. Silvers A Law Corporation 11500 West Olympic Blvd., Ste. 322 Los Angeles, Califomia 90064 Telephone: (310) 551-0551 Facsimile: (310)445-9623 michaelhsilvers.com ,,-... December 29, 2005 From ne... Azea. Call: (650)610-0344 (661)266-0224 (114)968-0802 (160)256-3455 (805) 487-8116 (818)785-0118 (909) 514-1889 (949) 725-0455 (951) 360-3207 VIA FEDERAL EXPRESS City of Lake Elsinore Attn: City Clerk 130 South Main Street Lake Elsinore, California 92530 RE: Wrongful Death of Eleanor Gertrude Brown Claimants: Beverly Brown, Patricia Brown Sheri Foster Date oflncident: July 24, 2005 ,-.. This letter will serve to advise you that we present the above named Claimants with regards to the Wrongful Death of Beverly Brown which occurred on July 24, 2005, as a result of an automobile verSus automobile accident which occurred at the intersection of Grape Street and Olive Street in the Unincorporated District, City of Lake Elsinore, California. Claimants Beverly Brown, Patricia Brown and Sheri Foster hereby submit the following claim for-damages: CLAIM FOR DAMAGES TO PERSON OR PROPERTY 1. NAME. ADDRESS AND TELEPHONE NUMBER OF CLAIMANTS: 1) Beverly Brown (spouse) Post Office Box 1152 Wildomar, California 92595 (951)471-3154 2) Patricia Brown (daughter) 21655 Sedco Heights Riverside, California 92595 (951)314-5327 3) Sheri Foster (daughter) 195 Glynnshire Court Covington, GA 30016 (770)385-8645 r' ACENDA ITEM NO.~ PACE ~~ Re: Beverly Brown, Patricia Brown and Sheri Foster Date of Incident: July 24, 2005 Page 2 ~ 3. OCCURRENCE OR EVENT FROM WHICH THIS CLAIM ARISES: a) DATE OF INJURY OR DAMAGE: July 24, 2005 - Time: 1400 b) LOCATION OF INJURY OR DAMAGE: Grape Street and Olive Street, Unincorporated Southwest Justice District, City of Lake Elsinore, State of California. d) HOW AND UNDER WHAT CIRCUMSTANCES DID DAMAGE OR INJURY OCCUR? SPECIFY THE PARTICULAR OCCURRENCE. EVENT. ACT OR OMISSION YOU CLAIM CAUSED THE INJURY OR DAMAGE (USE ADDITIONAL PAPER). The incident which is the subject of this claim occurred on or about July 24, 2005 at the intersection of Grape Street and Olive Street, in the City of Lake Elsinore, State of California. A copy of the complete police report is attached hereto as Exhibit "A." On July 24, 2005, Claimants' mother Eleanor Gertrude Brown was operating a 1996 Chevy Blazer bearing California license plate number 3TCT50 1 traveling east bound on Olive Street entered the intersection in a slow turn~ when the other party Brandon Ray Shade operating a 1998 Ford Ranger bearing California license plate number 6M30030 traveling south bound on Grape Street (a known narrow dirt and heavy weeded roadway) was unable to see the posted 35mph limit sign, as well as, an octagon red stop sign due to heavy weed and shrubbery, failed to stop at the stop sign and violently struck Eleanor Gertrude Brown (Decedent) with great force. As a result of the impact Eleanor Gertrude Brown was trapped inside her vehicle until paramedics were able to extricate her with the use of hydraulic equipment. Eleanor Gertrude Brown succumbed due to the severe injuries she sustained, which include but not are limited to: fracture skull, ruptured thoracic aeorta, pelvic and left hip fracture. Eleanor Gertrude Brown was pronounced deceased upon arrival to Inland Valley Medical Center. ...., e) WHAT PARTICULAR ACTON BY THE CITY OR ITS EMPLOYEES. CAUSED THE ALLEGED DAMAGE OR INJURY? The particular acts or omissions that caused the injury and damages are, among others: 1. Failure to install traffic control devices at the subject intersection; 2. Failure to adjust street marking/stripping given the ongoing signs at said intersection; 3. Failure to warn and/or prevent and/or correct a dangerous condition at or about the ...., AGENDA ITEM NO. ~ 3 PACE ? .11 OF ",- Re: Beverly Brown, Patricia Brown and Sheri Foster Date ofIncident: July 24, 2005 Page 3 subject intersection and adjacent thereto; 4. Failure to maintain the street surfaces at said intersection and areas adjacent thereto; 5. Failure to provide and/or maintain proper lane marking; 6. Failure to provide and/or maintain proper lighting at or about the subject intersection; 7. The creation of an uneven roadway surface and configuration that was unsafe and dangerous at the subject intersection and adjacent areas; 8. Failure to provide and/or maintain adequate traffic devices, including but not limited to stop signs, signals, devices, channelization, pavement, stripping and raised pavement markers; 9. Failure to adequately warn of dangerous condition as set forth above; 10. A combination of any of the above factor and/or factors are yet to be determine; "..-. The City of Lake Elsinore, its employees, agents, contractors, etc. and each of them, had actual and/or constructive notice of the dangerous condition as enumerated herein above, in sufficient amount of time prior to the accident to have taken measures to protect the public against said dangerous condition. As result of the above dangerous, defective, and hazardous conditions, and the negligence and carelessness of the City of Lake Elsinore, it agents, employees, contractors, etc. a substantial risk of injury was created to users of said public roadway including Claimants sibling Eleanor G. Brown (Decedent). The names of the particular employees, agents, and/or contractors of the City of Lake Elsinore and/or its department with specific responsibility for the occurrence are not presently known to Claimants, said names will be provided when they become known. The above, dangerous defective, and hazardous conditions, ofthe subject roadway, and/or the acts, and/or omissions of the City of Lake Elsinore, agents, employees and contractors, were a substantial cause ofthe death to Claimants sibling Eleanor G. Brown (Decedent). Claimant Beverly Brown Decedent's spouse has been deprived of a kind and loving spouse and of her care, comfort, society, companionship and protection. Furthermore, Claimants Beverly Brown, Patricia Brown, and Sheri Foster, have and continue to suffered emotional damages including but ",- not limited to anxiety, depression, post traumatic stress, etc. Claimants will require future psychiatrist consultation, and other such future treatment as may be determined to be necessary by their medical providers, pain and suffering and loss of comfort and society. ACENDA ITEM NO. h PACE 2":)- OF H O~i Re: Beverly Brown, Patricia Brown and Sheri Foster Date of Incident: July 24, 2005 Page 4 .""" 4. WERE THERE ANY INJURIES AT THE TIME OF TIDS INCIDENT? IF THERE WERE NO INJURIES. STATE "NO INJURIES." INJURIES AND DAMAGES SUFFERED As a result of Decedent Eleanor Gertrude Brown's death, Claimants, Beverly Brown is a surviving spouse of Decedent, Patricia Brown is a surviving daughter of Decedent, and Sheri Foster is a surviving daughter of Decedent are and will continue to suffer the loss of being deprived of a kind and loving mother and of her care, comfort, society, companionship and protection. As a further result of Eleanor Gertrude Brown's death, Claimants Beverly Brown, Patricia Brown, and Sheri Foster, have and will continue to suffered emotional damages including but not limited to anxiety, depression, post traumatic stress, etc. Claimants will require future psychiatrist consultation, and other such future treatment as may be determined to be necessary by their medical providers, pain and suffering and loss of comfort and society. Claimant Beverly Brown Decedent's spouse has been deprived of a kind and loving spouse and of her care, comfort, society, companionship and protection. Claimants Beverly Brown, Patricia Brown and Sheri Foster have incurred certain funeral and burial expenses, and medical bills in an amount undetermined at present pending further investigation and discovery which are continuing. S. GIVE THE NAME(S) OF THE CITY EMPLOYEE (S) CAUSING THE DAMAGE OR INJURY: .'" Unknown at the present time pending further investigation and discovery are continuing. 9. GIVE THE NAME(S) OF THE CITY EMPLOYEE(S) CAUSING THE DAMAGE OR INJURY: Justina Marie Carter 2119 Lemon Street Riverside, California 92595 (951)674-5332 Please refer to Exhibit "A" attached hereto. Discovery and investigation are continuing. Claimants reserve the right to amend and/or supplement this category. Dated: {2../y, IDS ~. Michael H. . ers, Esq. Attorney fo Claimants Beverly Brown, Patricia Brown and Sheri Foster, on behalf of Decedent Eleanor Gertrude Brown ~ AGENDA \TEM NO. LO PACE 7S-0f '" r" ",.- "..-. EXHIBIT "A" AGENDA ItEM NO. n ::; PACE L=LOF ~,:-D ~ WHC-BROWN, ELEANOR G-Enc nl07135915-0PT-ITR-7/24/2005 Face Sheet - 7/24/2005 - 1 pg k * * PATI ENT FACESHEET * SOUTHWEST HEALTHCARE S 'EMS PT NAME: 'lURS STA: ~OOM/BED: PT STATUS: 3SN: PREV NAME: Z\.DDRESS: BROWN ,ELEANOR G PT TYPE: HOSP SVC: EA MARITAL STS: 364-34-7649 SEX: T ITR M F AGE: 71 PT NO: 107135915 MED REC NO: 7056275 RACE: 2 REL: PRO BIRTHDATE: 03/09/1934 INFANT AGE: PHONE: 951 - 314-2598 DISTRICT CD: 32 ST: CA ZIP: 92595-0000 ......." PO BOX 1152 :::ITY: WILDOMAR E:MPLOYER: Z\.DDRESS: RETIRED 1998/ SPOUSE 1996 :::ITY: ST: ZIP: )CCUPATION: RETIRED PHONE: EXT }UARANTOR: BROWN ,ELEANOR ADDRESS: PO BOX 1152 GUAR SSN: 364347649 REL: S CITY: WILDOMAR ST: CA ZIP: 92595- accu: RETIRED PHONE: 951 - 314-2598 EXT GUAR EMPL: RETIRED 1998/ SPOUSE 1996 ADDRESS: PHONE: EXT CITY: ST: ZIP: EMER CONTACT: BROWN ,BEVERLY REL: U ADDRESS: PO BOX 1152 CITY: WILDOMAR ST: CA ZIP: 92595- HOME PHONE: 951 314-2598 WORK PHONE: EXT: NEXT OF KIN: PHONE: INSURANCE INFO: FC: A INS PL 1: Z61 AUTO INSURANCE POLICY #: 405307613 COB": 1 PAYOR ID: VERIFIED: Y GROUP #: MAIL TO: BROWN ELEANOR GROUP NAME: ADDRESS: PO BOX 1152 PHONE: 951 314-2598 ......." CITY: WILDOMAR ST: CA ZIP: 92595 UR PHONE: AUTH #: SUBSCRIBER NAME: BROWN ,ELEANOR INS PL 2: A85 MEDICARE B SECOND 05 POLICY #: 364347649 COB: 2 PAYOR ID: VERIFIED: Y GROUP #: MATL TO: MEDICARE GROUP NAME: ADDRESS: P.O. BOX 1602 PHONE: CITY: OMAHA ST: NE ZIP: 68101 UR PHONE: AUTH #: SUBSCRIBER NAME: BROWN ,ELEANOR INS PL 3: K29 TRICARE FOR LIFE POLICY #: 405307613 COB: 3 PAYOR ID: VERIFIED: Y GROUP #: MAIL TO: GROUP NAME: ADDRESS: PO BOX 7890 PHONE: CITY: MADISON ST: WI ZIP: 53707 UR PHONE: AUTH # SUBSCRIBER NAME: BROWN ,BEVERLY PREADM: REG/UPG: MUMFOS PREREG: ER REG: ANDRAL Z\.CC IND: H ACC DT/TM: 072405 00:00 ADM DT/TM: 07/24/05 14:52 Z\.CC LOC: ADM SOURCE: EO ADM PRI: X DSCH DT/TM: DISP: D7N ADM DR: 006213 PETERSON ROBERT REF DR: ATN DR: 020834 KIM STEVEN PROCEDURE: DIAGNOSIS: TRAUMA 934-05 :::LIN COMM: SURGERY DATE: PREV STAY: N PREV ADM DTE: PAM DR: PETERSON ROBERT 006213 PREV DSCH DTE: ~aDE ARRIVAL: EMS EMERGENCY MEDICA REL OF INFO: N )RGAN DONOR: LIV WILL/ADV DIR: Y LOCATION: HOME @X4 ......." AGENDA ITEM NO~_ PACE3::=) =-~ age 1 of 1 SOUTH"v cST HEAL THCAkc SYSTEM DIAGNOSTIC IMAGING REPORT r--- INLAN D VALLEY MEDICAL CENTER RANCHO SPRINGS MEDICAL CENTER 36485 Inland Valley Drive 25500 Medical Center Drive. Wildomar, CA 92595 Murrieta, CA 92562 PATIENT NAME: BROWN, ELEANOR G MRN#: 007056275 ACCT#: 107135915 BIRTHDATE AGE AT EXAM SEX VISIT TYPE 03/09/1934 71 F lED VDS # HIS ORDER # ORDER DATE LOCATION 07240500173 00007001 07/24/05 IAM-1 ADMITTING PHYSICIAN: KIM. STEVEN REQUESTING PHYSICIAN: PETERSON, ROBERT G CT CHEST W/CONTRAST HISTORY Trauma, chest pain. PROCEDURE Axial CT of the chest performed with intravenous contrast. ~ FINDINGS There is traumatic aortic tear and rupture of the descending thoracic aorta at the level of the carina with large 3.5 cm pseudoaneurysm-arising from the descending thoracic aorta and extending toward the right. There is a large am-ount-ofmediasUn-at1Tematoma. -large left pleural effusion .orhemothorax. Small right hemothorax or pleural effusion. Lungs are without pneumothorax. No significant pericardial effusion seen. Endotracheal tube and nasogastric tube in place. Endotracheal tube close to the carina. No osseous fracture seen. While the patient was still being scanned, I discussed these findings in person with trauma surgeon Dr. Jannakar by personal conversation. IMPRESSION Findings suspicious for traumatic aortic rupture injury with pseudoaneurysm with large amount of mediastinal hematoma and hemothorax. Endotracheal tube close to carina. DICTATED BY: KENNETH CHON ~ VERIFIED BY: KENNETH CHON DATE VERIFIED: 07-25-05 PATIENT NAME: BROWN, ELEANOR G Variable Text I\()EII~::.&=~~ o'A-: SOUTH'vv cST HEAL THCAkr= SYSTEM DIAGNOSTIC IMAGING REPORT INLAND VALLEY MEDICAL CENTER RANCHO SPRINGS MEDICAL CENTER 36485 Inland Valley Drive 25500 Medical Center Drive. """ Wildomar, CA 92595 Murrieta, CA 92562 PATIENT NAME: . BROWN, ELEANOR G MRN#: 007056275 ACCT#: 107135915 BIRTHDATE AGE AT EXAM SEX VISIT TYPE 03/09/1934 71 F lED VDS # HIS ORDER # ORDER DATE LOCATION 07240500172 00006001 07/24/05 IAM-1 ADMITTING PHYSICIAN: KIM, STEVEN REQUESTING PHYSICIAN: PETERSON, ROBERT G CT PELVIS W/CONTRAST HISTORY Trauma, pain. PROCEDURE A?<ial CT of the pelvis performed with intravenous contrast FINDINGS Foley catheter in bladder. Right common femoral approach catheter in place. There is a left femoral neck fracture with about 1 cm displacement and comminution and angulation. Nondisplaced fracture of the left upper anterior sacrum: There-is -a-fracture ofthe-pubic-symphysis--adjac-ent tcrtheright. superior pubic ramus displaced less than 5 mm. There is a nondisplaced fracture of the right inferior pubic ramus. 3 cm left pelvic side wall hematoma. Cannot exclude active bleeding within the left pelvis as there is an area of increased density. """ IMPRESSION Multiple pelvic fractures plus left femoral neck fracture. 3 cm left pelvic side wall hematoma. Cannot exclude active bleeding within the left pelvis as there is an area of increased density. DICTATED BY: KENNETH CHON VERIFIED BY: KENNETH CHON DATE VERIFIED: 07-25-05 PATIENT NAME: BROWN, ELEANOR G """ Variable Text ACENDA ITEM NO. 6 ":i:' PAGE ~ 2. OF \l .Q SOUTH\'"cST HEAL THCAk~ SYSTEM DIAGNOSTIC IMAGING REPORT r' INLAND VALLEY MEDICAL CENTER RANCHO SPRINGS MEDICAL CENTER 36485 Inland Valley Drive 25500 Medical Center Drive. Wildomar, CA 92595 Murrieta, CA 92562 PATIENT NAME: BROWN, ELEANOR G MRN#: 007056275 ACCT#: 107135915 BIRTHDATE AGE AT EXAM SEX VISIT TYPE 03/09/1934 71 F lED VDS # HIS ORDER # ORDER DATE LOCATION 07240500170 00004001 07/24/05 IAM-1 ADMITTING PHYSICIAN: KIM, STEVEN REQUESTING PHYSICIAN: PETERSON, ROBERT G CT BRAIN W/O CONTRAST HISTORY Trauma, head pain. PROCEDURE Axial CT of the head performed without intravenous contrast. /"'"'. FINDINGS This is a limited examination with small portion of the posterior skull and brain not visualized. The visualized portions of the brain and skull show no bleeding, hydrocephalus, infarction, or fracture. In the left occipital scalp, there is 2 cm 'softtissue-swelling or hematoma with 5 mm and- Y-'mrrr'suftlissue-forelgn-' bodies. IMPRESSION In the left occipital scalp, there is 2 cm soft tissue swelling or hematoma with 5 mm and 7 mm soft tissue foreign bodies. /"'"'. DICTATED BY: KENNETH CHON VERIFIED BY: KENNETH CHON DATE VERIFIED: 07 -25-05 PATIENT NAME: BROWN, ELEANOR G Variable Text AGENDA ITEM NO. ~. ; PAGE 3~ OF to.~! SOUTH"" cST HEAL THCA~c SYSTEM DIAGNOSTIC IMAGING REPORT INLAND VALLEY MEDICAL CENTER RANCHO SPRINGS MEDICAL CENTER 36485 Inland Valley Drive 25500 Medical Center Drive. ~ Wildomar, CA 92595 Murrieta, CA 92562 PATIENT NAME: BROWN, ELEANOR G MRN#: 007056275 ACCT#: 107135915 BIRTHDATE AGE AT EXAM SEX VISIT TYPE 03/09/1934 71 F lED VDS # HIS ORDER # ORDER DATE LOCATION 07240500169 00003001 07/24/05 IAM-1 ADMITTING PHYSICIAN: KIM, STEVEN REQUESTING PHYSICIAN: PETERSON, ROBERT G CT ABDOMEN W/CONTRAST HISTORY Trauma, pain. PROCEDURE Axial CT of the abdomen performed with intravenous contrast. FINDINGS Immediately anterior to the abdominal aorta at the region of the midpancreas, there i$ a 5 cm area of low density raising the possibility of mid pancreatic transsection or contusion versus bowel injury versus CT imaging artifact. There . i-s-a-Y--cmteft-retroperitoneal he-m-atoma or fluid coflectibh:d-Bc>lr'n<iCIfleys--C:fppear unremarkable without traumatic injury seen. The spleen appears unremarkable. In the liver, there are three hypodense lesions which may represent cysts. They range in size from 1 cm to 2 cm to 3 em. Nasogastric tube in stomach. The inferior vena cava is collapsed consistent with decreased intravascular volume. No fracture seen. '"'" IMPRESSION Possible 5 cm mid pancreatic transsection or contusion versus bowel injury versus CT imaging artifact. 7 cm left retroperitoneal hematoma or fluid collection. DICTATED BY: KENNETH CHON VERIFIED BY: KENNETH CHON DATE VERIFIED: 07-25-05 PATIENT NAME: BROWN, ELEANOR G ....." Variable Text AGENDA ITEM NO. 6 PACE..3d:-OF \lp 3 " SOUTHvv cST HEAL THCAkt: SYSTEM DIAGNOSTIC IMAGING REPORT /"" INLAND VALLEY MEDICAL CENTER RANCHO SPRINGS MEDICAL CENTER 36485 Inland Valley Drive 25500 Medical Center Drive. Wildomar, CA 92595 Murrieta, CA 92562 PATIENT NAME: BROWN, ELEANOR G MRN#: 007056275 ACCT#: 107135915 BIRTHDATE AGE AT EXAM SEX VISIT TYPE 03/0911934 71 F lED VDS # HIS ORDER # ORDER DATE LOCATION 07240500169 00003001 07/24105 IAM-1 ADMITTING PHYSICIAN: KIM, STEVEN REQUESTING PHYSICIAN: PETERSON, ROBERT G CT ABDOMEN W/CONTRAST Collapsed inferior vena cava consistent with decreased intravascular volume. /'"' PATIENT NAME: BROWN, ELEANOR G DICTATED BY: KENNETH CHON r" VERIFIED BY: KENNETH CHON DATE VERIFIED: 07-25-05 Variable Text AGENDA rTEM NO. h PAGE .~ OFJLQ 3 i - SQUTH\cST HEAL THeA' ~~ SYSTEM DIAGNOSTIC IMAGING REPORT INLAND VALLEY MEDICAL CENTER RANCHO SPRINGS MEDICAL CENTER 36485 Inland Valley Drive 25500 Medical Center Drive. Wildomar, CA 92595 Murrieta, CA 92562 "" PATIENT NAME: BROWN, ELEANOR G MRN#: 007056275 ACCT#: 107135915 BIRTHDATE AGE AT EXAM SEX VISIT TYPE 03/09/1934 71 F lED VDS # HIS ORDER # ORDER DATE LOCATION 07240500175 00017001 07/24/05 IAM-1 . ADMITTING PHYSICIAN: KIM, STEVEN REQUESTING PHYSICIAN: PETERSON, ROBERT G XR CHEST 1V HISTORY Trauma, pain. FINDINGS Portable chest 7-24-05 at 1520 hours. Nasogastric tube in stomach. Endotracheal tube close to carina could be pulled out 2 cm for more optimal positioning. The visualized lungs appear unremarkable. IMPRESSION Endotracheal tube close to carina could be pulled out 2 cm for more optimal positiening. ......" DICTATED BY: KENNETH CHON VERIFIED BY: KENNETH CHON DATE VERIFIED: 07-25-05 PATIENT NAME: BROWN, ELEANOR G Variable Text ...." AGENDA ITEM NO. B" ,", PACE., 3-D OF \ l 0 ~ r"', SOUTH\ ... cST HEAL THCAJ ,~ SYSTEM DIAGNOSTIC IMAGING REPORT INLAND VALLEY MEDICAL CENTER RANCHO SPRINGS MEDICAL CENTER 36485 Inland Valley Drive 25500 Medical Center Drive. Wildomar, CA 92595 Murrieta, CA 92562 PATIENT NAME: BROWN, ELEANOR G MRN#: 007056275 ACCT#: 107135915 BIRTHDATE AGE AT EXAM SEX VISIT TYPE 03/09/1934 71 F lED VDS # HIS ORDER # ORDER DATE lOCATION 07240500174 00008001 07/24/05 IAM-1 ADMITTING PHYSICIAN: KIM, STEVEN REQUESTING PHYSICIAN: PETERSON, ROBERT G XR PELVIS 1V-2V HISTORY Trauma, pain. FINDINGS One view. There is a fracture of the left femoral neck with angulation. There is a nondisplaced fracture of the right pubic symphysis adjacent to the right superior pubic rami. Right groin approach central catheter seen. /"'"'"' IMPRESSION Right pubic symphysis fracture. Left femoral neck fracture. 1""'. DICTATED BY: KENNETH CHON VERIFIED BY: KENNETH CHON DATE VERIFIED: 07-25-05 PA TrENT NAME: BROWN, ELEANOR G Variable Text ACENDA lTE.M NO.~: F'l<'\~E33:.-~ SOUTHV~ ~ST HEAL THCAK"': SYSTEM DIAGNOSTIC IMAGING REPORT . INLAND VALLEY MEDICAL CENTER RANCHO SPRINGS MEDICAL CENTER 36485 Inland Valley Drive 25500 Medical Center Drive. Wildomar, CA 92595 Murrieta, CA 92562 '-' PATIENT NAME: BROWN, ELEANOR G MRN#: 007056275 ACCT#: 107135915 BIRTHDA TE AGE AT EXAM SEX VISIT TYPE 03/09/1934 71 F lED VDS # HIS ORDER # ORDER DATE LOCATION 07240500171 00005001 07/24/05 IAM-1 ADMITTING PHYSICIAN: KIM, STEVEN REQUESTING PHYSICIAN: PETERSON, ROBERT G CT C-SPINE W/O CONTRAST HISTORY Trauma, neck pain. PROCEDURE Axial CT of the cervical spine performed from the base of the skull to the mid T1 vertebral body. Using E-film work station, I personally performed sagittal and coronal reconstructions. '-' FINDINGS Compared with lateral cervical spine x-rays 7-24-05. In the region of the tip of the -odontoid ,there-are multiple ossiftc-fragments.--These-may- represent fractures of the odontoid tip. Alternatively, these may represent dystrophic ossification and calcification outside the odontoid tip not representing fra~ture. Recommend clinical correlation. Remaining other cervical vertebral bodies are without fracture seen. IMPRESSION Multiple odontoid tip fractures versus dystrophic ossification or calcification. Recommend clinical correlation. DieT A TED BY: KENNETH CHON VERIFIED BY: KENNETH CHON DATE VERIFIED: 07 -25-05 PATIENT NAME: BROWN, ELEANOR G Variable Text '-' AGEtlOAITEMNO. ~ 3~ PACE ~Of j\.. 0 /"""' SOUTHV-ST HEAL THCAF : SYSTEM DIAGNOSTIC IMAGING REPORT INLAND VALLEY MEDICAL CENTER RANCHO SPRINGS MEDICAL CENTER 36485 Inland Valley Drive 25500 Medical Center Drive. Wildomar, CA 92595 Murrieta, CA 92562 PATIENT NAME: BROWN, ELEANOR G MRN#: 007056275 ACCT#: 107135915 BIRTHDATE AGE AT EXAM SEX VISIT TYPE 03/09/1934 71 F lED VDS # HIS ORDER # ORDER DATE LOCATION 07240500168 00002001 07/24/05 IAM-1 ADMITTING PHYSICIAN: KIM, STEVEN REQUESTING PHYSICIAN: PETERSON, ROBERT G XR CHEST 1V HISTORY Trauma, pain. FI NOI NGS Portable chest 7-24-05 at 1455 hours. Endotracheal tube close to the carina. Lungs appear clear. Cardiomediastinal silhouette unremarkable. /""'"' IMPRESSION Endotracheal tube close to carina. ",...... DICTATED BY: KENNETH CHON VERIFIED BY: KENNETH CHON DATE VERIFIED: 07-25-05 PATIENT NAME: BROWN, ELEANOR G Variable Text AOENDAITEMNO. 6 .."..': PAClEt:q OFJ t 0 6~ SOUTHvv cST HEAL THCAkt: SYSTEM DIAGNOSTIC IMAGING REPORT INLAND VALLEY MEDICAL CENTER RANCHO SPRINGS MEDICAL CENTER "-' 36485 Inland Valley Drive 25500 Medical Center Drive. Wildomar, CA 92595 Murrieta, CA 92562 PATIENT NAME: BROWN, ELEANOR G MRN#: 007056275 ACCT#: 107135915 BIRTHDATE AGE AT EXAM SEX VISIT TYPE 03/09/1934 71 F lED VDS # HIS ORDER # ORDER DATE LOCATION 07240500167 00001001 07/24/05 IAM-1 ADMITTING PHYSICIAN: KIM, STEVEN REQUESTING PHYSICIAN: PETERSON, ROBERT G XR C-SPINE HISTORY Trauma, pain. FINDINGS Two lateral views. This is an incomplete cervical spine examination. Endotracheal tube and nasogastric tube in place. Diffuse degenerative changes. On the lateral view, from base of skull to mid C7 vertebral body, no '-' fracture seen. C7 - T1 junction not well visualized. IMPRESSION tim-itedlateral cervical spine x-rays. DICTATED BY: KENNETH CHON VERIFIED BY: KENNETH CHON DATE VERIFIED: 07-25-05 PATIENT NAME: BROWN, ELEANOR G ~ Variable T exl AGENDA ITEM NO. 8 --) PAGElD.-OF \ CD WHC-BROWN, ELEANOR G-Enc #107135915-0PT-ITR-7/24/2005 Cumulative Laboratory Report - 7/25/2005 - 1 p~ SOUTHWEST HEALTH CARE SYSTEM ,....- INLAND VALLEY CAMPUS 36485 INlAND VALLEY DRIVE WILDOMAR, CA 92595 Patient: BROWN, ELEANOR G MR.#: 7056275 Account #: 107135915 DOK- 03/09/1934 Age: 71yr Sex: f Location:DIS RoomIBed: Admft PJrys.: PETERSON, ROBERT Ordering PJrys.: Additional Doctor: POIient's Facility: Inland Valley Campus Admit Date: 07/24/05 CLINICAL LABORATORY REPORT RANCHO SPRINGS CAMPUS 25500 MEDICAL CENTER DRIVE MURRIETA, CA 92562 MeolC3l Director: E. HoIburt,M.D. Co-Director: O.Vo M.D. Pathologist RVeve, M.D. CHEMISTRY Collection Date> lab Accession ,> 07124/05 15: 30 240176 e I I I I \ Creatinine I ~ Glucose,Blood \ Anion Gap(calc) laa . BUN/CreatRat io\ .Osmolality"calcl Calcium-blood I CPK (CKHI) Ib <;)::",B '. L CKHB Index I Troponin I Icc BASIC "ETAB PNl Sodium. Blood Potassium Chloride. Blood C02 BUN 141 I 1 I 1 I 1 I I I I I 1 . I.... ... .. f I 1136 . 144 ...1/l 13.6 . 5.1 ...1/L 1101 - 111 mollL In . 3Z IIIIOIIL 18 . ZO lIg/dl 10.4 . 1.1 IIgfdL 114 - 118 l19/dl 17.0 - 16.0 IIIIOl/l 16.0 . 10.0 Ins - 195 18.6 - 18.8 lIg/dl IZ6 . 140 U/l .Io.s . 5.0.ng/. 10.8 . 1.5 10.00 - 0.04 091.l 8.0 12.4 aa This lab uses the following formula for the Anion Gap calculation: Na-(Cl+C02) bb Called to & Read bact by: SERENA By:JORCUT 07/24/2005 ~ 16:28 cc Troponin value of 0.51 or greater is suggestive of M.I. l eQ~nd High -H low - l ~. BROWN. ELEANOR G Account #: 107135915 Printed Date/Time: 07/25/2005 @ 16:19 Page: 1 of 4 DISCHARGE CUMULATIVE REPORT c.aWl STa-r NOTHS: . ALL TESTING DONK AT PACILITY IN WHICH THE PATIBlfT WAS LOCATED WBEJf THE TEST WAS ORDBRED UHLKSS OTHERWISE HOTEl) .. ALL COLTORB TESTING DONE AT INLAND VALL.KY CJtM.PUS ge 1 of 4 AGENDA ITEM NO. ~ '3 PAGE~OF \LO j - -~-- ..-~--~....._......... ..........~ ........n ./L.-.&./.c.............. .....U.UU,A.....a.'-...Lv'C ~C1JJVLct.LULy KepOrC - IIL~/LUU~ - 1 p~ SOUTHWESTHRALTHCARESYSTEM INLAND VALLEY CAMPUS 36465 INLAND VALLEY DRIVE WILDOMAR. CA 92595 Patient.. BROWN, ELEANOR G M.R.#: 7056275 Accoum #:107135915 DaB: 03/09/1934 Age: 1Iyr Sex: f Location:DIS Room/Bed: Admit. Phys.: PETERSON, ROBERT Ordering Phys.: Additional Doctor: Patient's Facility: Inland Valley Campus AdmitDate: 07/24/05 CLINICAL LABORATORY REPORT RANCHO SPRINGS CAMPUS 25500 MEDICAL CENTER ORNE MURRIETA, CA 92562 '''; Medical Director: E. Holburt,M.D. Co-Director: D.Vo M.D. Pathologist: RVeve. M.D. CHEMISTRY Collection Date> Lab Accession ,> 07/24/05 15:30 240176 ld e Hhano 1 laa NO I "!l/dl ''-II' aa PLEASE READ THIS IMPORTANT NOTICE. THIS TEST IS FOR MEOICAL USE ONLY. THESE RESULTS SHOULD BE USED ONLY BY PHYSICIANS TO RENDER DIAGNOSIS OR TREATMENT OR TO MONITOR PROGRESS OF MEDICAL CONDITIONS AND NOT FOR ANY LEGAL PURPOSES. l eQf'nd Hjgh -H low . l BROWN, ELEANOR G Account. If: 107135915 Printed Date/Time: 07/25/2005 @ 16:19 CB..J$TI. Page: 2 of 4 DISCHARGE CUMULATIVE REPORT '-II' NOTBS: . ALL TESTING DONE AT FAClLITY IN WHICH THB PATIENT WAS LOCATED WHEN THE TEST WAS ORDEUD UNLESS OTHERWISE NOTED .. ALL COLTURE TESTING DOHR AT INLAND VALLBY CAMPUS ge 2 of 4 AOENDA ITEM NO. R PACE~OF \\..0 ~ J n___ __~____.. ________~ ~ __~~ ........... ~...........,-'........... ............ ........... 'I ~-"/~'VVJ \..,..UU....I....LCl\.....LVC UQ.UULC1LVLY rU::l1v1.L - II~jILUU'j - 1. p~ /"'" SOUTHWESTHEALTHCARESYSTEM INlAND VALLEY CAMPUS 36485 INlAND VAlLEY ORNE WllDOMAR. CA 92595 Medical Directoc E: Holburt,M.D. Co-Director: D.Vo M.D. Pathologist RVeve. M.D. Patient: BROWN, ELEANOR G M.R.#: 7056275 Account #: 107135915 DOB: 03109/1934 Age: 11yr Sex: F Location:DIS Room/Bed: Admil. Phys.: PETERSON, ROBERT Ordering Phys.: Additianal Doctor: Patient's Facility: Inland Valley Campus Admit Dote: 07/24/05 CLINICAL LABORATORY REPORT RANCHO SPRINGS CAMPUS 25500 MEDICAL CENTER ORNE MURRIETA, CA 92562 /"'" Collection Date> lab Accession ,> T CBC WBC RBC HGB HCT MCV MCH MCHC ROW Platelet Count MPV AUTO Dlff Neutrophil t lymphocytes.t Monocyte t Eosinophi 1 t Bilsophi 1% Abs.NeuLCt. NRBC Auto l~end High -H 07/24/05 15:30 240116 11 HEMATOLOGY 14.4 . 11.1 10.3tul 14.00 . 5.2510.6/uL 112.0 . 16.5 g/dL 136.0 . 46.0 I 180.0 . 100.0 fL (26.0 . 34.0 pg 131.0 . 37.0 g/dl 111.5. 14.5 I I ISO - 400 10.3/.l 17.4 . 10.4 Il 154.0 - 65.0 I (2$0,0 -.33.-0 I 13.0.7.0 I 11.0 . 3.0 I 10.0 . 0.8 I 110.3/ol 11100 \l8C ,r-. BROWN, ELEANOR G Account .: 107135915 .: 95.3 32.8 __H ~l 64.4 1 ~~.: 1.6 I 0.0 I 6.7 I o I low - l Printed Date/Time: 07/25/2005 ~ 16:19 Page: ] of 4 DISCHARGE CUMULATIVE REPORT NOTBS: * AL.L TBSTING DONE AT FAC'lLITY 1M WBICH TSI PATlEIIT WAS LOCATED WHEN THB TEST MAS ORDERIW UNLESS OTHBRWISE MOTBD . ALL CULTURE TESTING DONE AT UlLAND VALLEY CAJlPOS 1ge 3 of 4 ACENDA ITEM NO. P, lQ . PACE~OF \ 3 -------J -.-r....-.... .... t-'~ SOUTHWEST HEALTH CARE SYSTEM INLAND VALLEY CAMPUS 36485 INLAND VALLEY DRIVE WILDOMAR, CA 92595 PaTient.. BROWN, ELEANOR G MR.#.. 7056275 Account #.. 107135915 DOB-- 03/09/1934 Age: 71yr Sex.. F LocaTion:DIS Room/Bed: AdmiT. Phys.: PETERSON, ROBERT Ordering PJrys.: AddiTional DocTor: PaTienr's Facility.. Inland Valley Campus AdmiT DaTe.. 07/24/05 CLINICAL LABORATORY REPORT RANCHO SPRINGS CAMPUS 25500 MEDICAL CENTER DRIVE MURRIETA, CA 92562 ~ Medical Director: E. Holburt,M_D. Co-Director: DVo M.D_ Pathologist RVeve, M.D. COAGULA TION Collection Date> lab Accession ,> 07/24/05 15:30 240176 INR PH 1.4 19.7 - 11.3..c IL'!>-o - 34.0 seo ......, aa INR Theraputic Range Standard Dose 2.0-3.0 High Oose 2.5-3.5 INR values are relevant only for patients who are stabilized on oral anticoagulants bb >100 leae-nd High -H Low - l BROWN, ELEANOR G Account .: 107135915 Printed Date/Time: 07/25/2005 @ 16:19 COA9VUT.JO. Page: 4 of 4 DISCHARGE CUMULATIVE REPORT ~ NOTES: . ALL TESTING DOHB AT FACILITY 1M WHICH TRE PATIENT WAS LOCATBn lfHIlN THE TEST WAS ORDERED ONLIlSS OTHERWISJi. NOTED . ALL. CULTUae: TBSTING DONE AT IHLAND VALLBY CAMPOS 1ge 4 of 4 AGENDA ITEM NO~' PACEibL~ ."..... '- . .L..Io....'-'.."J.. , Advanced Directive - 7/28/2005 - 1 pg - v- "-iOHe It.LUIJ..>::>:>.J.::>-UPT-.J.TK- IIL4/LUU~ .a..:.L.J.a:.~.I." ..... ..... "'''-LJ.L L11L l'ER PATI.L._,.L~ S-ELF DETERMINATION RECORD BROWN 107135915 . ELEANoR G ooB, 03/09/193i 7} MRN, 7056275 SX, F rTR AD:>1/REG DT INLAND VALLEY M"Dr~' '07/2i/05 - '-"L Cf:NTER PT NAME: _pt' NO: _ATTN DR: ..MR NO: r' - - -- - - - - - - - ~ ~ - - ~ - - ~ - - - - _ _ -_ _ _ _ -c _ _ _ _ _..: _ _ _ _ _ :.. _ :. ~ _ _ _ _. _ _ _ _ _. _.,- __- '~ 3 PATIENT :IS IN~PABLE-.OF ANS.WER_ING TH;R FOLLpWrNg . QUESTIONS BECAUSE: DATE:-. . - " ; ..... T GNATr;ftE AND TITLE: f' . ~':l' 1. -- ---,,--___.---_-----:-----------_-------:--,.,_--------;..:---:--___--, ~ . . DO YOU, THE PATIENT, I!AVB AN ADVANCE. D1RBCTIVB?' Cy-iliJ ~'~'0 . IS THE ADVANCE D:rRRcri~!:A ~IVDlG-:WILL?_ .{Y~~l) ._ '__-:-' .'_, ,,';-: _. _,- IS THE ~ DIRECJ:IVE A DURAB~ -POWER OF ATT~'POR. m~?'{Y-N) ..R.T 2..c ---_u :._-.:.-----:---'---~--7J;.:-7=---...:--_____:_:,,:"'--,...-~~..:,,:-;!-.-'- ../ Lorna ,IS -YOuR'-APPODITEO HEALmcium_ SURROGATE' HAVING YO~'f>t:mAaIJi-PoloiER OF, ~~~~!i~ -,Q$,.~~1~~~t~b<.~ci. tTY W\ \dOvlf\.C\:r . ST: L/T . Z!P: ~t.,S'tS _ . DOES THIS PERSON XNow AND_ ~ TO ~E YOUR .amu.1'Ii~ ~TB? (Y-N) :J;F' THE. PEiI&>N NBITHB:R ~-'NOR.AGR:ImS TO J'JE YOOR HB1q.'l.'HC1mBSoRROGATB, 'Dd io~ STILL ~ISll,TO D~~GlllATB AN AL~ ~ stiRRoGATB?';.-rY-N) IF SO, WE HILL CON'17\:a'1' A HOSPITAL .REPRBSEl'I'.FAT~ TO vrSl:ryOU AND RECORD _ YOUR. ALTERNATE HBAL~ PRon jNpo~'1"IOIlt~- _ .. . . . u:!:SBNTAXIVR CONTACT ~: ,: U3SENTATIVBCONTAenm J1~-: . - , - , . . ~ 3. - -------___ _:-:-_'_..__...--:-~--;-------- ______.-----------'-___.,.___ WOULD ~ LI~ ~TION REGA$IDING 1\9 ADV1\lfc;B PIRB'~, SDJcR YOU DO NOT ~ o~~_!~~~~~.~ _~-----_-:.-:.-~'_-___-__~_ h~--.+-.--..:---~~--~~-h~ ._ LT-. _'HE- PATIEm' STATB--YGU'HAVB'jW ADVANCE- DI.RBcTIVB.: ..- . .'_ _ '. :>0 YOU ~VB Po COpy WITH ,YOU? CY -N) - -~; H ~.. '. . . )Il;:> THE:aOSPITAL STAFF PBRsON ~A COpy 'AND ATl'ACH.:rT-~,'liIi!r'QIJlRTi CY-::NJ -,1" ! ,.' .. ...... 5 - -: - ~_~::_:_~.~.-:-.~_~_::- =~___.___:-:7---.':'-'" - --,-.- -_-,-~_:----"7-:--------.:.~-~.~;;;.-- '+BNT-W'ANTS. .ADDITI~ INFOR~TION <?N. ~VANC;X PIRRCT~_ OU HAVE RECB~ INPoRMATION:REGARDING 'AN _ADVANCE D~IVE. CY-N) :>U :HAVE BBEN INFoRMED TO ADVISB YOUR 'NURSE -IF YOl,J WAN'!' TO . CREATH AN, . -. .. t. . , :>VANCE DIRECTIVE ~~~ - IN T1IB ~SPI~_ (Y-N) .. ' .,/. ) - -:.. - - --.,. ~ ~ -- ~-- ~ - --.:. -~- - ~-..!--: -- -0-.., - -- - - -,. - - -- -_:'-;-.c'-,_.: ___ :E YOU 00 NOT HA\tE_. A ~~ OP: ~ A!>.VANCE DIRBCTIVE,joU HAND, . WHERE IS' THE >N~E ~IREeTIVE- --!.9CATJID0' ~T.ION,' .__ _, ,- ~ ' 1St YPU HA~ A_COPY BR~:TOTHR.JI.~.Pt':r~~. (Y;-:-N) :'_ . BONE; quf BRING 'l'lm. CO.PY:. WHEN WILL THE Copy ElE DEL.IVBiuID TO YOUR NURSING DATE 'COPY wrJ"!>ARRI~; '09/00/0Q DA~ COPY RECEIVED: 00/0_0/0(1 - -,- '--- -- -.- - -- -. CONTENTs 0I1 ADVANCEr);fREt'!:IVE __ ____.: ______ :::A~~~~D=7 '.~ c(-QS=- HOSP:ITAL REi>; . -..l r- /""', AGENDA ITEM NO. ~ '?, PAGE ~<:; OF \\..0 ge 1 of 1 WHC-BROWN, ELEANOR G-Enc #107135915-0PT-ITR-7!24!2005 Blood Transfusion Reaction _ 7/24/2005 _ 4 pg KJ41257 07/23/05 1 B: 39 00000 CP \ ; I~~~;~;;:~;:;= umband, cornpanDility label end Ir8nsfusion record. W~ have compared the donor nwnbcr and blood Iypc on the unit label. comptltibility label. and lr.1Dsfusion record. All information in the .hove fidds lICe in agreement. ~ TAAlIMA, 13 TR13 ., ., EMERGENCY Ro0rf7 1071.35915 ~WN . ELEANOR G )B: 03/09/1934 71 SX: F ITR IT ABOIRH Uf: 1056275 ADM/REG DT: 07/24/05 INLAND VALLEY MEDICAL CENTER '~~;;~~!i?~f~;:,: ~:,",'.~7WW{~i~J::~;,,>, . DONOR UNITII II (Optjonal or D.O.B.) I ) 0 Informed Consent Documented Identification witnessed by: o Palient Consenl Signed Identification verified and transfusion initialed by: (MD. RN): YITALSIGNS AND TRANSFUSION OBSERV ATlON~ PRE 15MIN I HR 2 HR POST COMPONENT TIME VOLUME INITIAl Uncross.atched: KJ47251 Ordering Physician: ER, PHYSICIAN Special Instructions: TEMP. PULSE RESP BP S ecial Attributes: qIDI!1~Jt~_~_Ft~E'~S~;~;J;:-''':''''i,"c'' THE CONDmON OF THJS PATIENT JS SUFFICIENTLY CRITICAL AS TO DATE WARRANT THE IMMEDIATE RELEASE OF BLOOD WITHOUT TIfE CROSS MATCH PROCEDURE BEING COMPLETED. (FOR INTRAOPERATIVE TRANSFUSING VIT At SIGNS SEE ANESTHESIOLOGIST / PERFUSIONIST RECORDS) TIME STARTED TIME COMPLETED '-II PHYSJCJAN: ~~lt!5.:Sl6Ir0-*~~tU>]PJ((ijjIl0~~ 08/31/05 Return verification: 23:59 o Hypotension 0 Hypertension o Hematuria 0 Dyspoea OBaclcPain OOoziDgBIood OOl~NS Notes ~~1i<i(€jj--~~iI!~SI'iVS.lO~<iliI~J\f.:I~~r~ I. STOP TRANSFUSJON JMMEDIATEL Y, keep IV open wilb NS 2. Compare patienl's Blood Bank armband wilb blood bag label. 3. No1ify p&lient's physician STAT. MD Notiflcd: Notified by: Time: 4. Notify Blood Bank STAT. S. Order Transfusion Reaction Worlrnp. 6. Hold blood bag &: attacbed IV solutions It bedside (or lab tt:c:h.. 7. Send fust voided urine spc:cimal after mtction to Blood Bank. Tune Transfusioa Total Transfused: tIlDe Reslartcd (if Stopped: indicated): Ellpinlliou dale /time MRN: E. Holbun, M.D. Do. Vo, M.D. DlIIIIIIIIIIIR ~In l80055 TRANSFUSION RECORD .......... _ ~Wr ~ SOUTHWEST HEAlTHCARE SYSTEM INIJ.NO VALLEY MEDICAL CENTER RANCHO SPRINGS MEDICAL CENTER o INLAND V AllEY MEDICAL CENTER 36485 Indian Valley Or.. Wildomar. CA 92595 o RANCHO SPRINGS MEDICA'- CENTER 25500 M~jcal Center Dr.. Mwric<n. CA 92562 ACENDA ITEM NO. 8 PACE~OF\105 ......, SW118 (6104) lqe 1 of 4 WHC-BROWN, ELEANOR G-Enc #107135915-0PT-ITR-7/24/2005 Blood Transfusion Reaction - 7/24/2005 - 4 pg /""'. A PATiENT'S GUIDE TO BLOOD TRANSFUSIONS The Safest Blood is Your Own. Use it Whenever Possible. my surgeries do not reqUIre blood transfusions.. However. if you need blood, you have several opllonS. Allhough you have the right to refuse a blooc :nsfusiOn. this decision may hold life-threatening consequences. Please carefully review this brochure and decide with your doctor which options u prefer. .EASE NOTE~ Your options may be limited by lime and health factors, so il is Important to begin carryIng out your decision as soon as possible. The methods of using your own blood can be used independentty or together to eliminate or mfnimlze the need for donor blood, as well 8S virtually eliminate transfusion risks of infection and anergic reaction. ption ~E-OPERATIVE DONATION )naMa Your Own Blood Jloce SUr9elY AUTOLOGOUS BLOOD - USING YOUR OWN BLOOD Explanation The bIoOO bank Craws your blood and stores II until you need it, during or af\eJ surgery. For elective surgery only. Advantages Eliminates or minimizes the need for someone else's blood during and attar surgery. Disadvantages . ReqUlf8S advance planning . May delay surgt:ry · Medical condibons may prevent pre-operatrve donation. TRA-oPERATIVE JTOLOGOUS TRANSFUSION lCycling Yoor Blood During 'rgery Instead of ben1g discarded. blood lost during surgery IS Mered and put back ;010 your body during surgery. For electiVa and. emergency surgery. Elillllnates or minimizes the need for someone else's blood during surgery. Large amounts of blood can be recycled. . Not fOI" usa If cancer or iofection Is present. )ST-OPERATIVE JTOLOGOUS lANSFUSION !Cycling Your Blood After Ifgery ~.J"""'"" UTION )n~ four Own Blood uing Surgery. Blood lost aftel' surgery IS coRected. filtered r.nd returned. For elective and Offiel'gency 3l)fgery. Immediately before surgery, some of your blood Is taken and replaced willl I.V. fluids_ After surgery. your blood is Iiltercd and retumed 10 you. For eleclcV8 surgery. Elimtnates or minimizes the need lor someone else's blood after surgery. Eliminates or minunlzes the need lor . someone e1se's blood during and after surgery. o.lutes your blood So you lose less concentrated blood duriog surgery. .. Not for use II cancer or Infection is present. .. limited number of units can be drawn .. Medical conditions may prevent hemodDuUon. 'HERESIS l!:l_~mlliJ YQY[QW!lJ)I!!tft'~~ d Plasma B6lore surgery, your platelets and . pJasmawh'at..help ~top bleeding. are withdrawn. fiftered. and returned to you .,.-hen you need It For elective surgery. May eliminate the need for donor · Medical conditions may prevent platelets and.p1asma. especially-in .apheresls--.. -- -.-.. . .. H.__m_ high blood-loss proceduces. .. Procedure has hmlted application- In some cases. you may require more blood than anticipated. If this happens and you receive blood other than your own. there Is a possibility of complicatklns, such as hepatitis and AIDS. DONOR BLOOD - Using Someone Else's Blood Donor blood and blood products can never be absolutely 100% safe, even though tesllng makes the rISk very small. >tion Explanation Advantages Disadvantages lUNTEER BLOOD om the Community Blood ~ply BlOOcJ ancJ blood products donated by volurltC6r Oo'lOfS 10 a commurnty blood bank ReadIly available. Can be rife-saving when your own blood is nol available . . RIsk of disease transmission (such as hepatitis or AlDS)_ and alletgac reactklns. ITE: You may \o'oish to check v.'hel/ler donors are paId or volunteer. Since blood from commefcial {paid} donors may nol, m some cases. be as safe as'b100d !rom tJnleers . StGNATED DONOR BLOOD en Donors You Select Blood and blood donors you select who mllS! meet me same reqUIrements <as volunleer donors. You can select people wilh your own blood type you feel are safe donors. · Risk of dise<tse transmission (S\JCI\ as hepa!,li6 or AIDS). and allergic reactions. . May requlre several days 01 advanced dor:!tion. .. Not necess.'JflIy as ;ale nor safer than volunteer donor blood TE: Care should bo takerlln selecting donors. Donor!: Ghould never be pressured into donating Oonalions frorn certain iamily members may require irradJatlon 01 Dd J"""'"" lqe 2 of 4 ACENDA ITEM NO. e PACE.-Y:LOF 'lO~ 1"HIS :S NOT PART OF MEDICAL RECORDS ----- ---~A__~__~.....AA .....__................................. #I.L.'J~VV-' - ~ .P~ lR08831 , 01l23/U1S, 18 J 39 00000 CP 1 ,~ I :) o Informed Consent Documenled IdentiflC3tion witnessed by: Bc~ adminisrtrinl Ibis unit. """. Ihc undersigned h:lve compared !he polKnl - n>e<l;al .ecOld number and blood lxmk annband 11 on the blood b:mk annband. compatibility Iobel and IJ1lIlSfusion IttO"t We have eompamllhc donor I1UII1ber and blood Iype on Ihc unit label. eompatibility label. and InlnSfusion m:onl All information ;0 .he Bbove fields ate ill agrttmenl. ,.." TRAUMA, 13 TR13 BEDSIDE VERIFICATION l EMERGENCY ROOM I I o Patient Consent Signed 107135915 OWN , ELEANOR G 'B: OJ/09/1'}34 71 SX: F ITR N: 7056275 ADH/REG 00::07/24/05 INLAND VALLEY MEDICAL CENTER ; # (Optional or D.O.B.) >lIT ABOIRH IdentifICation verified and trnn.~fusion initiated by: (MD. RN): _':ur~l?~sYGNS:AND.:TRANSFUSION; :~. :S~~~~~~ '.:.OB8ERVATIONS . PRE 15 MIN I HR 2 HR POST lR08831 TIME COMPONENT VOLUME RED BlOOD CEllS 300.0 COMMENTS I SPECIAL INSTRUCTIONS Uncro s SI at ched : lR08831 Ordering Physician: ER, PHYSICIAN Special Instructions: INITIAL TEMP PULSE RESP BP r- ":"'. "."~ Special Attributes: It~EiN~ ReIW.&s~d~f~' THE CONDITION OF nus PATIENT IS SUFFIOENTLY CRITICAL AS TO DATE WARRANT THE IMMEDIATE RElEASE OF BLOOD WITHOUT THE CROSS MATCH PROCIIDlJRE BEING COMPLETED. (FOR INTRAOPERATIVE TRANSFUSING VITAL SIGNS SEE ANESTIfESIOLOGIST I PERFUSJONIST RECORDS) TIME STARTED TIME COMPLETED ~ Date ;":;6F' '<;, '!;;~;:mRANSFUSION:ASSESSMENT" o No ReactiOn--- - -- OTemp Rise >2"F 0 Hypotension 0 Hypertension o Chills 0 Hematuria 0 Dyspnea OBat:kPaia o Oozing Blood O~NS Notes . il1+..~~R~.$.~J}D~~o.~~~S.FUSIO~;REACflON: SI;1VS:S.ti!E.~~~_'~ 1. STOP TRANSFUSION IMMEDIATELY. keep IV open with NS Issued to: 2. Compete patient's Blood Bank armband with blood bag label. 3. Notify patient's physician STAT. MD Notified: Notified by: 4. Notify Blood Bank STAT. S. Order TransfllSion Reaetion Workup. 6. Hold blood bag &. allacbed IV solutions at bedside fur lab tech. 7. Scud fust voided urine specimen aller reaction to Blood Bank. TUDe Tnmsfusion Total Transfused: Time Restarted (if Stopped: indicated): Time: - ~Y-0..r Expiration dale hime 08/31/05 Return verification: 23:59 MRN: E. Holburl. M;D. Do. Vo, M.D. 11111111 alllll III U lBOO55 R. Veve. M.D. TRANSFUSION RECORD ............ _;W: ~ SOUTHWEST HEAlTHCARE SYSTEM INlAND V^,1.EY MEDICAL CENTER RANCHO SPRINGS MEDICAL CENTER o INLAND V ALLEY MEDICAL CENTER 36485 Indi:ill VaDcy Dr., Wildomac. CA 92595 o RANCHO SPRINGS MEDICAL CENTER 25500 Medical Cenler Ot _ Munie... CA 92562 """ SWl18 (6/04) AGENDA ITEM NO. ~ . PAGE~OF \lQ3 age 3 of 4 A P A TI. rs GUIDE TO BLOOD TRANSFU~ .iNS The Safest Blood Is Your Own. Use it Whenever Possible. ,,-..,. Oy !:1eries do not reqUire blood transfusions. However. if you need blood, you have severat options. Although ycu have the nght 10 refuse a blOO( rlsfusion, this decision may hold fife-threatening consequences. Please carefully review this brochure and decide wllh your doctor which options J prefeL EASE NOTE: Your options may be limited by time and health faclors, so it is important to begin callytng out your decision as soon as possible. The methods of using your own blood can be used in~pendently or together to eliminate or minimile the need for donor blood, as well as virtually eliminate transfusion risks of Infection and allergfc reaction. )tion AUTOLOGOUS BLOOD - USING YOUR OWN BLOOD Explanation Advantages Oisadvantag3s fE-OPERATIVE DONATION 'Ilating Your Own Blood fore Surgery The blood banlt draws your blood and store:; it unlil you need it. dUling or after surgery. For eIeclive surgery only. 8lminales or minimIzes the need for someone else's blood during and after surgery. . ReqUires :ldvance planning . May Ik'BY surgCty . Medical wndi!IOns may prevent pre-operat;':e donntioo. fAA.OPERATIVE JTOLOGOUS TRANSFUSION cyding Your 81000 During rgery Instead of being discarded. blood lost during surgery IS liltered and put Dack Into your body during surgery. For elective and emergem.y SUtgOry. 8Iminates or minimizes the need for someone else'!; b1000 during surgery. large amounls of b/oOd can be recycled. ~ Not for use if cancer or Infeclion is present. )ST.OPERATlVE JTOLOGOUS ANSFUSION cycling Your Blood Aller rge~ : . Blood IosI after surgery IS collected. filtered IUld returned. For elective 8I1d emergency surgery. Elimtoales or minimizes the need fOf someone else's blood atter surgEl/)'. . Not for UR'! if cancer Of iofeclioo Is present. :lI.lOOILUTION >or-your Own Blood ,rir gery. Immediately before surgery, some of your blood is taken and replaced with I.V. fluids After surgery. your blood Is flIIellld and returned to you. For electIVe surgery. Eliminates or ffilnimi.zes Ihe need for someone. else's blood during and after surgery. OiIules your blood so you lose less concentrated blood during surgery. . Umlted number of units can be dmwn . Meoical COIIdrtlons may prlM!l}t hernodllouon. 'HERESIS "E.'lI!l9Y~Qw~~t.eJ~~ d Plasma Before surgery. your p181elets and PlasmaL.!!'tbictLhQlp._S-top.J>teedlog. are withdrawn, filtered, and returned 10 you when you need it. For elective surger). May eliminate the need for donor · Mecical conditions may prevent .platelets and plasma. espectally in _ aphelesls high blOod-Joss procedures. · Procedure has limited appliealion In some cases, you may require more blood than anticipated. If tills happens and you re(;eive blood other than your own, there Is a possibility of complfcatJons. such as hepatitis and AIDS. DONOR BLOOD - Using Someone Else's Blood Donor blood and bl?Od products can never be absolutely 100% safe, even though tesling makes the fisk very small. )tion Explanation Advantages DisadVantages LUNTEER BLOOD m the Community Blood )ply Blood and b1oo..1 products donated by vOltlnteaf donors to a community blood bank. Readily available. Can be life-saving when your own bIoocI is not available. · Risk of disease transmission (sUch as t1epalills or AIDS) and allergic reaclions. TE: You may ",ish to check whether donors are paid or volunleer. since blood from commercial (paid) OOllOrs may nol. in some casas, be as safe as blood lrom Jnteers. SIGNATED DONOR BLOOD m DollorS You Select r'- Blood and ntood donors you select who must moat 1h6 same requirements as volooleer donors. You can select people with your own blOOd type you feel are safe donors. . Risk of diS8.lse transmission (sud\ as hepatrtis or AIDS). and allergic reacuons. ~ May require several days of . adltaoced donation . Not necessarily as 6afe, nor sale. than volunteer donor blood. Tf:.. ..e should be taken~' selecting donors Donors should never be pres5Ufed inlo donating DonallOns Irorn certain family manbers may require irradi;.tlon vt DO ige 4 of 4 noons IS NOT PART OF MEDICAL RECORDS AGENDA ITEM NO. f'-to PACE~OF\ '3~ ., -......, _..........Jo 4... 1:-"':1 1. CONSENT TO HOSPITAL ,WHCS) PROCEDURES: I conser. the medical and surgical procedures which may be performed during this hospitalization or on an outpatient basis, including emergency treatment or services. These may include but are not limited to laboratory tests, x-ray examination, medical or surgical treatment or procedures, anesthesia, or hospital services rendered to the patient under the general and special instructions of my physician or surgeon. -) ...." 2. RELEASE OF INFORMATION: To obtain payment for services, I hereby authorize the hospital/providerS/physicians giving medical services to me while I am a patient at (SWHCS), to disclose to my insurance carrier, health service plan or workman's compensation carrier, any and/all medical and billing records related to my admission. Upon inquiry. the hospital (SWHCS) will disclose to the public a one-word description about my condition; undetermined, good, fair, serious. critical. If I do not want. such information released I may make a written request for such information to be withheld. A separate form is available for this purpose upon request. ) 3. PROVIDERS NOT HOSPITAL EMPLOYEES: I understand that all physicians and surgeons furnishing services to me including the radiologist, pathologist, emergency physician, anesthesiologist and the like are Independent contractors and are not employees or agents of the hospital (SWHCS). The hospital (SWHCS) is not lIa~e;'r a~y acts or omissions made by any physician or in following the order of a.Physlclanr 8~ initial 4. INDEPENDENT CONTRACTORS WILL Bill SEPARATELY: Physicians are independent contractors, not agents or employees of the hospital (SWHCS). I understand and agree that each professional group or Individual practitioner which renders professional services to me will bill and collect for professional services separate and apart from the hospital's (SWHCS) billing and collections, but subject to the authorizations granted by me In accordance with this agreement. I have the right to reque an Ian on of the billing. Initial 5. ADVANCE DIRECTIVES: I have an advanced directive (I.e. Power of Attorney for .......) Healthcare): t:; o Yes (copy on chart) es ( requested to bring in) 0 No 0 Minor Child I have received written Information on y rights under California law an oSJ:f ai's (SWHCS) policies on- advancedirectives~-- ... m_ - - - - - --- ------.--Iolllal-- By signing I acknoV\(ledge that I have carefully read nd fully l:Jnderstand this patient consent/financial agreement and the patient bill of rights, (on the other side of this form), have received a copy hereof, and am duly authorized to execute the abo e and accept its terms. ~ &~ ,- DATE RElATIONSHIP TO PATIENT IF NOT PATIENT SIGNATURE _./------------ --. WITNESS CONDITIONS OF ADMISSIONS PATIENT IDE ION 11111111111/11 'I c00010 """ ~ SOUTHWEST HEALTHCARE SYSTEM INl^ND VAlLEY MEDICAL CENTER RANCHO SPRINCS MEDICAL CENTER 7 Bto ~07~359~5 DO. . ELE:ANoIl G ' M . 03/09/1934 7 , 7056275 1 SJ(, p ITIl \ 1NlJwo JU>>t/IlEG DT \ VALLEY MEDICA '07/24/05 -- L NTER ./ / ) SW244 (REV_ (5104) -___________ WHITE - MEDICAL RECORDS COpy YEllOW - PATIENT COpy PINK - FilE COPY ......, "lge 1 of 2 ACENOA rtEM NO. 6,' "";'\ ~OF \~o3 , WHC-~,RO~,r~.___ELE~l'lOR_ ,~~,I>'::C ~1.?~35ql,5-_~,P~!!~-7(24/2005 Consent Forms - 7/28/2005 - 2_pg >0 ASSIGNMENT OF BENEFITS: I or my agent, hereby authorize direct payment to the hospital/provider/physician, any insurance benefits payable to or in my behalf for this ,....b.Qspitalization or for these outpatient services, including emergency services jf rendered, at a e not to exceed the hospital's billed charges. It is agreed that payment to the hospital \vWHCS) by an insurance company shall discharge the insurance company of any and all obligations under a policy to the extent of such payment. I understand that I am financially responsible for charges not covered by this assignment. 7. FINANCIAL AGREEMENT: The undersigned agrees, whether he/she signs as agent or as patient, that in consideration of the services to be rendered to the patient, he/she hereby individually obligates himself/herself to pay the account of the hospital in accordance with the regular billed charges of the hospital and terms of the hospital. Should the account be referred to an attorney or collection agency for collection, the undersigned shall pay actual attorney's fees and collection expenses. All delinquent accounts shall bear interest at the legal rate. l. MEDICARE CERTIFICATION, AUTHORIZATION TO RELEASE PAYMENT INFORMATION AND PAYMENT REQUESl: I certify that the information given by me in applying for payment under title XVIII of the Social Security Act (Medicare) is correct. I authorize any holders of medical or other information about me to release to the social'security administration or its intermediaries' or carriers any information needed for this or a' related medicare claim. I request that payment of authorized benefits be made on my behalf. ~. GENERAL DUTY NURSING: I understand that the hospital (SWHCS) provides only general duty nursing care unless, upon orders of my physician I am provided more intensive n~rsing care. If my condition requires a special duty nurse, I agree that it must be arranged by myself or my legal representative. The hospital (SWHCS) will not be responsible 'for failure to provide the same and is released from any liability arising therefrom. ,,-.., It ~RSONAL VALUABLES: I understand that this hospital (SWHCS) maintains a safe for the safekeeping of money and other valuables, and that the hospital (SWHCS) shall not be liable for the loss of such valuables unless they are deposited with the hospital' (SWHCS) for safekeeping. Uability of the hospital (SWHCS) for loss or damage is limited by statute to five hundred dollars. I understand that I am responsible for all my personal effects, including personal grooming articles~']eweliy, c:Iottling, documents, mecJJcati6iis,'eyeglasses; -neanh~)' aIds, aentures~ali(j other prosthetic devices. 11.ASSlPMPTION OF RISK: Sh<;)Uld I leave the hospital (SWHCS) before being released or discharged by the physician attending me or should I fail to follow instructions given by the physician or other (SWHCS) healthcare professionals, I agree to assume all responsibility for any injury or damage suffered, and further agree to release and hold the physicians, their agents, the hospital (SWHCS), it's employees or agents harmless from any claims, demands or suits for damages from any complications arising therefrom. 12. PHOTOGRAPHY FOR PURPOSES OF DIAGNOSIS, TREATMENT OR PROFESSIONAL EDUCATION CONDUCTED BY THE HOSPITAL: I consent to the taking of pictures of my medical or surgical condition or treatment, and the use of the pictures, for purposes of my diagnosis or treatment or for education or training programs conducted by the hospital. 13.PATIENT COMPLAINTS: I understand I have the right and obligation to express any concerns about my care and treatment to a management representative. I have received a copy of my patient's rights and responsibilities. I ~N.SMOKING HOSPITAL: I understand that no smoking is permitted within the hospital . ~ NHCS). and will comply accordingly. ACENDA \TEM NO. 9-) . q..~"''': ,~E~OF \\..0"6, 'OP ? nf ? WHC-BROWN, ELEANOR G-Enc #107135915-0PT-ITR-7/24/2005 Consent Forms _ ~2812005 _ 1 pg 1. CONS~NT TO HOSPITAL (SWHCS) PROCEDURES: I consent to the medical and surgical procedures which may be performed during this hospitalization .or on an outpatient basis, including emergency treatment or services. These may include but are not limited to laboratory tests, x-ray examination, medical or surgical treatment or procedures, anesthesia, or hospital services rendered to the patient under the general and special instructions of my physiCian or surgeon. ......., ) 2. RELEASE OF INFOR~ATlON: To obtain payment for services, I hereby authorize the hospital/providers/physicians gMng medical services to me while I am a patient at (SWHCS), to disclose to my insurance carrier, health service plan or workman's compensation carrier, any and/all medical and billing records related to my admission. Upon inquiry, the hospital (SWHCS) will disclose to the public a one-word description about my condition; undetermined, good, fair, serious, critical. If I do not want such information released I may make a written request for such information to be withheld. A separate form is available for this purpose upon request. 3. PROVIDERS NOT HOSPITAL EMPLOYEES: I understand that all physicians and surgeons furnishing services. to me Including the radIologist, pathologist, emergency physician, anesthesiologist and the IIk~ are Independent contractors and are not employees or .agents of the hospital (SWHCS). The hospital (SWHCS) Is not- lIa~;'r ~ acts or omissions made by any physician or In following the order of.a'PhYSIClanr/:2rA. Initial 4. INDEPENDENT CONIRA~rQ~S WILl". BiLL SEPARATELY: . PhysicIans --are.. Independent Contractors, not agents or employees of the hospital (SWHCS)~ I understand and agree that each professional group o~ Individual practitioner .which renders professional services to me will bill ~nd coll~ .for professional services separate and apart. from. the hospftars (SWHCS) billing and collections, but sUbject. to.. the authorizations. 9nJnted by me In accordance with this agreement. I have the right to reque .an Ian on of the billing. . Initial . v 5. ADVAN.CE DIRECTIVES: I have an advanced . dlrectiv' (I.e. Power of Attorney. for Healthcare): ~ . Q Yes (copy an chart) EtS ( requested to brIng In) O.No 0 Minor Child I have re~lved ..:::~::::::~::::.L::g~:~::::: consent/financial agreement and the patient biJI of rights, (on the other side of this form), have received a copy hereof, and am duly authorized to execute the abo e and accept its terms. ..t ~Ory,,~ WITNES I~ RELATIONSHIP TO PATIENT IF NOT PATIENT SIGNATURE WITNESS CONDITIONS OF ADMISSIONS PATIENT IOENTfACATlON 11111111111",111 COOO10 ~ ~ SOUTHWEST HEALTHCARESYSTEM INLAND V,ULEY MEDICAL CENTER MNCHO SPRINGS MEDICAL CENTER BRONN 107135915 , E:l.E:ANoR G DOB: 03/09/193. HRH: 7056275 71 SX, F ITR INLAND VALLE:r~:E:G DT, 07/2./05 CAL CENn:R . SW244 (REv. 05/04) WHITE - MEDICAL RECORDS COPY YELLOW - PATIENT COpy '-'" Dt~'V r.. - ---.... ACENDA ITEM NO. ~ PACE5'.2.~ Ige 1 of 1 ---- - -' ' ~ ~ ::,- .- In_ 0= Ci)- ;0 !!!!!!!!!!!! ..- CIa_ c;- ii= === iiiiiiiiiiiiiii !!!!!!!!!!!!!!! ~8'" ~...~ -. .. :I: i.....oz ~ 0....- "'--... 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'"0 t;:) -0.0.0 -0 <: ~~~~~ · .0 en _. ,... o-i>-i~~ . ~"'CtIli: <l> iit~:; en 5.~ _0 (0 00 .' ~ ...... ~ 0> 00>00 *~ .33a.g- ~llO"'lIIa C :3 n o p ..... ~. <l> 0.. ~z'"Os-~ : ero c:f ~~ * D D aft>.... ~i.gi;l ..-....,5 _. tr tzj ;;. g ~ e- OCll~~iii'f>> Oo-i E D> g..g D>lloloCCSC D tll;;' e. 0.. ~ _. -:> 'E ......-< ....." - ;:s-- ~ - -- ID9 i3a <d "OlD & ......... o..~ < tD 3 qfD: 5".~ acs ....~ P:,< .., fig- "8D> CSQ. l; < !.~ .- .... ::r'< 1l!. tll-' a ~ ID'- ~lt ... tll I} t g I r:r -< 0.. <<5: ~ lD 3:8'" ~...~ .. .. x z <l> .... .... '" n .... (fl z :x: () . lP ~ :u :::0 0 z 0 z ~ - z 00 t"' tzj 00 c- ~ t<:l ~ 0 :u 0 Q :::0 I 00 :J 0 # I-' o -..l .... W lJ1 \0 .... lJ1 I o 'tl >-:l . H >-:l :u I -..l ........ I'J oJ> ~~ o ..... 0 ~m ...... 00 ~ () ::BQ - cn:u II> l.D ~ I-' rt l.D -..l 1>:1........ t~ Q ........ rl'J 1>:10 00 gm .,....._.llI_ -a .. '0 :::tQ o 00 I} (I) a cs ....- -< z ~ t;:) <: > t- t- t<:l >< ;So: t:<:l o C3 ~ t- o t:<:l Z >-3 t:<:l ~ 9 :- 0.. C n .- II> ~ g 3 "0 ;;; >< (I) lD aa&f20008y2X NBC-BROWN, ELEANOR G-Enc Itl07135915-0PT-ITR-7/24/2005 eCoding Summi3--' _ 3/5/200S _ 1 pg 15ya a&aOrOC a (SOp12hlOvOB INLAND VAllEY MEDICAL CENTER 36485 Inland Vallcy Drive Wildanar. CA 92595-9700 - ~~::- - -~. SOUTHVVEST tl~",,-q:.~~A.B!';n$_Y.~:H;M CODING SUMMARY REPORT '-'" PATIENT NAME: BROWN , ELEANOR G AGE: 71 S~: F ADMISSlONDATE: 07/24/05 DISCHARGE DATE: DISCHARGE STATUS: D7N OTHER DEA'TII, DRG ASSIGNMENT: MIDICAL RECORD NO.: 7056275 ACCOUNT NUMBER: 107135915 PATIENT LOS: FIN. CLASS: A COMMERCIAL NO AUIDPSY UPDATE BY: LEWISP DATE: 08/05/05 I':M PRINCIPAL DIAGNOSIS: CODE DESCRJP1l0N 901.0 'TIIORACIC AORTA INJURY SECONDARY CODE 862.29 868.03 959.01 820.8 805.6 808.2 V71. 4 E812.0 E849.5 DESCRIYIlON INfRATHORACIC INJ NEC-CL PERIroNEUM INJURY -CLOSED HEAD INJURY NOS CL FX NECK OF FEMUR NOS FX SACRUM/COCCYX -CLOSED FRAClURE OF PUBIS-CLOSED OBSERVATION ACCIDENT NEC MV COLLISION NEC-DRIVER ACC ON STREET/HIGHWAY '-"" . . PROCEDURES:-- -- .- .. -_._. . no.._h_... ..._.. ........ .... .. '..__n. -........ ._-. .--._- CODE DESCRIPTION DATE PHYSICIAN # PHYSICIAN NAME ~6.71 CONI' MECH VENT-<96 HOURS 07/24/05 009837 PILLAR EDlARD 96.04 INSERT ENDOTRAOiEAL TUBE 07/24/05 009837 PILLAR EI:MARD 99.60 CPR NOS 07/24/05 009837 PILLAR EDWARD 99.04 PACKED CELL TRANSFUSION 07/24/05 009837 PILLAR EI:MARD PHYSICIAN SIGNA TIJRE: qe 1 of 2 (SIGNATURE) ......, (DATE) 009837 PILLAR EDWARD 11a;;IVIIVV.~ . PACE<5?;_OF~ LJl=UtS/ u~i U~ ~~U= lo'M=NOPI"CL=p-ro=l ~AI:I';" 'I ~~I ~VVJ C~~U~U~ "'UllllllctLY - >:>{':>{L.UU':> - .1 pg r' ,-.... ,-.... 1ge 2 of 2 INLAND VAllEY MEDICAL CENTER. 36485 Inland VaDcy Drive Wildomar. CA 92595-9700 PATIENT NAME: AGE: SEX: ADMISSION DATE: DISCHARGE DATE: DISCHARGE STATUS: DRG ASSIGNMENT: PRINCIPAL DIAGNOSIS: CODE DESCRIPTION SECONDARY CODE DESCRlPTION PROCIDURES: CODE DESCRIPTION PHYSICIAN SIGNAlURE: u... - ~_r - -,..,:,"~ SQUTHVVEST J.-I"~I\.~ T"f:l<;./\~~_"~Y~TE."" CODING SUMMARY REPORT MEDICAL RECORD NO.: ACCOUNT NUMBER: PATIENT LOS: FIN. CLASS: DATE PHYSICIAN # (SIGNA'TIJRE) I~MI11<':: PHYSICIAN NAME (DATE) AGENDA ITEM NO. <() PACE~OF \lo'~ lHC-BROWN, ELEANOR G-Enc #10713colS-OPT-ITR-7/24/2005 ED Nursing FJ .heet - 7/24/2005 _ 1 pg EMERGENCY DEPARTMENT NURSING FLOWSHEET ..- '~ (Continuation Page ) IOATE: ' / ,2.l/1 0:> nme Bp P R T SPQz' 'Pain REASSESSMENT 1 INTERVENTION 1 RESPONSE '/ ~ t\-\~O~\V\~ \.\\fi 1:<\tr,\<S ~~ \~ / ~ ~ O()/-{~. \, L lh' L\L \t\v'l\O\ \.~ I / ~ V\-t~~nN/ \Oo...C\. (,'(l~\, C:t,'J~ ~"t \ ~o \~< ~\A-t ~ \ ~ .1\l t' lti\/\ , \ ~o t\\ \.1flf" '-V , \ ~I\I..~\(} ~Ntted ''In '-\ r~\:... ',(\ ,-/ n\l""<'<"' ' ../" ~lO "\It ' Yi) '\ . ~ \ Llt \~., \r:~~'r\ ~'{\OCnec' J ~ol\\-{()V\"'~ ~ ,,^(l ' II L//-;or1'\\~J ~V\ lJA'N\ J\\\! o1?'Y\ e 1. W\(_ ~ II \)y\\\:, (}t- 'o\.r jl' II\~ 'VQr 1a V ( Vl.\ VJl'~ Rb j I... n IJ~\ '( ,'\1\'\I\t. \. ~t\"t=v\\\~Q- E:V\. 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I~ ).JntAP ...1b~~ ~oHD ^->>7f--v h k -"-\-0 ~l\1).'-)).YJ( ) ~ / v " - . ~o / ~/ ~o /~ // ~ /' ~ ./ ~ / ~o I EMERGENCY DEPARTMENT NURSING PATIENT IDENTIFICATION FlOWSHEET ~..- ~.r ~ SOUTHWEST HEALTHCARE SYSTEM INlAND VAllEY MEDICAl CENTER ItANOfO SPRINGS MEDICAL CENTER e - ~ c. , 1(\ \) ,~ 'fJ .. \J .f\ .U} ~\ YJr \::J ,.. t"\ r ~I..) \. \j }J.... .,?V-- L..1' k\1 ~ '" r l' I~\P;V"" ..~ / I I 1/ , J / I e III 11111111111111111111 ER0050 SWl76 (4/04) ;:::ar'YO 1 ,....,F 1 ........, '-"" 107135915 BROwN . ELENlOR G sx. F 1 TR DOU, 0)/09/19)4 :~'R~ DT: 07/24/05 ~~, 1056215 D1CA~ CENTER INVoND VALLEY ME '-"" " AGENDA ITEM NO. 2) PACE(D0oF \lQ3 .'--/~--- ..... J:I:1 IIIIMIUIIIIIIIIII. EROO21 - ED Physician Record r'" -rClM /"'" . ., -', - m.ao.y .. I'IQIIaI DMe" Da.CliEum Onfer n.. 1'II,ydda'. 11.. Noted Ordw. 01/\ 9.. 11lAUMA I'A/'In . ) t;II(; aI6N 1 ANYlAsIi(AW) nPIT aA <EroJI) laINET_laaa 1M. o a::c ON....... , l..rlh......~ , "" - A__ - ,- \ 0 0 t ) :. 0 . t. 0 "\ i 0 ., - 0 tL ABG'I .. - 0 , . ", ......,-t- --"' - . - ., .... l(gaG / ..........-4"..1 , " f , , f " J . . . , - -. i , . ; o nlLlIEOIIIlIlNIUt . \ : 5 r-;.. .' o NG l1lIII: \ .' . " J .'.... .' ~ t~ ~ fA 11 .\./1\: . - . .~ 1- . .'"r'-_ _{.1. , o J'ClUY p ,.. ;- - -. i i1 '\ ~l \ )If/V lo JI~"\ , , ,,-...... ... UNELX-IlAYB: ; ..." I . . . i i i :J,,/, f[ , ,~ L (J ~CXTAIII.F.) 1 J', : A"\. r ,.;.-:. ! / 1.. : ; \ I'-" It'' '- J: ~'Jl U ., , ~ ~..:.J , .. : .. I C) . '-f" ..... . ~.c. "'... ~ ~ i . ' r " . .#' " I ., . A:. t .~ . " ( i . . . lY,' V"'IYlf "", . .:, ,. . .' . . I) '~:'" . . ~ . : : '-. .~ r :....:,.. :~ -, 0 . f. .." - 'l l. . "'V ~y , !' , . IE'" . .- ,.-\---l+.t... -- j \. ,. : . ._- ----. , ="-'~ i'" . _ 'n - , - I , I . ' 1 . I .1 0 f-.. -1 i I ~ . 1 . i hI tL I . ~. f 1 - .. -- ; o rAC_~ I , t . \1- I Y I o rAB_UoIla_ , I ! I : ! , r ~ H \ I ~i 7\ . ,I ~. 1- . f 'I \ I . l . ;. ;UI'}~ 1 ~ t- . I ~ \ i I ..... . . . ] 0 T.aU 1 I I. ; / V :\ .", . . o -J..rvra ,..--: (' '.1 . -... I ~~ ". -:. -~... .t ; i , ., l ( '\ \ f ./-{ \ , 1 ,) 0 \ j . : ,- .- ~~, ),. 0 IAlRGIlOI't C&l.UD(i ~\ DGDrtJCnoa '--.- /l " l(v ftlrllaQlaaJQUTUItE <<DOlII1"IO'IOfIll1.LUE: ~Ll7Jm JDPaaJJfft 0 lJIUT A IlD.&.\a 0 TItANaml 0 aallQJl 0 AN.\ 0 C()(X) 0 r AJII o CllJ1JCU. o AWIAlL4n 0 we 0 I:MJ 0 MEJIIC 0 a.rorw 0 IlDD 10MB O. ca 0 .tmGJ 0 J:Ump)8 0 t:nnvrw D C\JI.JIJID o fUI<<Pm1 ...... u:n~ I' PHYSICIANS DOCUMENTATION -TRAUMA If NLAND VALLEY MEDICAL CENTER .>648S 1nI_ VeIIey Driw WiIcIoRw. CA 925IIS EMERGENCY DEPARTMItNT PHYSICIAN TRAUIL\ RECORD IIP9 lO'JeOI 107135915 BROl\'If . EL&ANOR G . DOB: 03/09/U34 71 SX: f" ITR ~ 1IRN: 7056275 ADM/REG DT:4qo'!tNtrA ITEM NO, . INIAAD V"LLE"t MEDICAL c~1r : { r'"\ I , PACE~OF ' ,ge 1 of 2 WHC-BROWN, ELEANOR G-Enc #1071~~915-0PT-ITR-7/24/2005 ED Physiciar 'cord _ 7/24/2005 _ 2 P9 Name E 1e a:k...-6r .B~I-0t'\ Street Address City, State & Zip Code ~ Date of Admission .. Date of Death 1 Diagnosis -r NextofKln ~~e..-~~~~oW''1 Street Address~ 0 ~ I f ~ ~ Apt. No. CIty, SIaIe &2;pCojlo-l ~ ~ ~ s..r ~~ PIvJne i';~ 3/42S'i8 -~ ~ -~- ==--' 'fIJL_ Date"! 2- o't:;;;;;;-7?-~ -mUst DYos ,iNO 8i!J>aIure 4~~ . f To Family dl 0 To Safe 0 To Security 0 To Mortuary/Coroner Physi~~.~ +- rr:Trr~.~ When Notified Date Time By Date Last Seen by a PhysIcian ) , [ '8/POrgen llonaIion (Public law 99<;00) One Wgacy Contacted l-llOll-:l33-6112 0 Yos )( No ,,~ if- ~ 2 U <{.( CoronerNotified?\.fOO. ,1443-2300 tWos DNo '~~~~fl?U: /-oIH1_ ~\~CaseAccepted? ~YeS i!fIfHO,WaiifJ #-=:/::}2JB_ ~__.~ AutopsyRequested? DYes ONo (lfYes)PermitSlgned? DYes oNo e Permission is hereby granted for an autopsy on the body at Date Name of Deceased r/O~tD."2.~ MR# ,2000DOB J. , 20 os- Hour "-'" Phone No. ( Time '-" ~ ~ SKi*lURE 'l:/fl JsoIation.- RELAllOHSHP ..Type-'.. ~.A- Phone No, ( Ss-1 to to s. 3 0/2... ~n pemlsslon t)y TO >WlNESS Notified By to release the body at Disposition of Deceased D . Pickup by Mortuary )J Pickup by Coroner's l' Office Representative . MORIUARY SlGNAllJRE WITNESS DATE Dr ;1/o;E /q4/ TIME ID BA~ VERIAED PRIOR TO ,,^Yes PATIENT IDENTIACATlON e III 111110 II allll COOO5O ",A~ ~ SOUTHWEST HEALTHCARE SYSTEM INlAND VALLEY MEDICAL CENTER RANCHO SPRINGS MEDICAL CENTER 107135915 BROWN , EL&ANOR G sx: F I TR 008: 03/>>9/1934 ~/REG OT: o,J24JO~ t\RN' 70s62'~ MEDICAL CENTER . INLAND VAJ,LEY ACENDA ITEM HO,~ YEUOW-Molluary/Coroneo PACE( 02_~ '-" SW188 (4104) WHfIE - MedialI ReaJros PINK . NuoP-og 0Iflce - ~" ~ SuuTHWEST HEALTHCARE SYSTEM INLAND VALLEY MEDICAL CENTER 36485 Inland Valley Drive Wildomar, CA 92595 A.TE: 07/24/2005 I ME OF EXAMINATION: HI EF COMPLAINT: Jtor vehicle accident. ISTORY OF PRESENT ILLNESS: his 71-year-old female was brought in by the paramedics Code 3 after being T- JDed in the diver's side by a small truck reportedly traveling at a high ~te of speed. Bystanders apparently attempted to extricate the patient, Jwever, this was halted by prehospital personnel upon their arrival. The ~tient apparently suffered a respiratory arrest on scene for which she was ~gged and supported for approximately five minutes before regaining JDsciousness. Initially the patient's Glasgow Coma Scale was 3. The ~tient did require extrication. While en route the patient's Glasgow Coma ~ale improved but she was noted to be very combative and yelling ~coherently. The patient is unable to provide a history, rendering the ~mainder of the history of present illness, review of systems, past ~d~cal/surgical history, medications and social history unknown. 1YSICAL EXAMINATION: ~NERAL: Upon arrival the patient was combative, -as well as yelling ~coherently. She was moving all extremities well, requiring soft ~straints. VITAL SIGNS: The vital signs were difficult to obtain at this i~ PRIMARY SURVEY: AIRWAY: Intact. Gag is present. CHEST: Exam is in ~d secondary to the patient's combativeness, however, there is no flail ~glh~nt or chest wall instability noted. HEART: The heart sounds are ifficult to assess secondary to the patient's combativeness and yelling. [RCULATION: Radial pulses were weak but bilateral. NEUROLOGIC: Glasgow lma Scale was 3 for eye opening, 5 for motor and 2 for verbal. The patient lv-es all extremities-well-~ 'T-here- isn'o fo'cality not'ed' to the- patient's {amination. SECONDARY SURVEY: HEENT: The patient's occipital scalp lpears boggy. There is no racoon's or Battle's sign noted. There is lestionable hemotympanum. Dentition is intact without malocclusion. Mucous ~mbranes are moist. NECK: Collared. Trachea midline. No JVD. ABDOMEN: Ie abdomen is soft without guarding, rigidity, percussion tenderness or ~bound. There is no distention. PELVIS: Stable without crepitus. CTREMITIES: The patient's left hip appears to be swollen. There is some ~g shortening as well. There are multiple contusions and abrasions to the lwer extremity. Distal pulses are thready. BACK: Exam is deferred :-esently. 1ERGENCY DEPARTMENT COURSE AND PLAN: Lven the patient's mechanism of injury, Iready pulse the patient was emergently Iduction. inability to obtain vital signs and intubated using rapid sequence lOCEDURE NOTE - INTUBATION: Ie patient was hyperoxygenated with 100% oxygen. This was followed by ,docaine and then etomidate and succinylcholine. The reader is referred to Ie nurse's notes for routes and doses. A 7.5 mm endotracheal tube was lssed through visualized vocal cords on first attempt. Capnometry was >sitive. Breath sounds were heard equally in both axilla. There is no >r~rygmi in the epigastrium. Ii~ patient simultaneously to the rapid sequence induction had a second 1ge 1 of 3 ACENDA ITEM NO. PAGE (03 8 OF \\.1) .~ WHC-BP.OWN, ELEANOR G-Enc nl07135Q15-0PT-ITR-7(24(2005 eED Physician -~cord _ 7(24/2005 _ 1 pg ~rge bore IV established, well as central line place 't by myself. Her ~moCue was noted to be in t 7s and this prompted STAT negative blood 3fusion. A FAST scan performed by me revealed no obvious intra-abdominal Luid. . ~OCEDURE - CENTRAL LINE: ~ 3e patient's right inguinal area was prepped in the usual fashion with ~tadine. A triple lumen with Seldinger technique was placed in the femoral ~in. This was utilized for a rapid blood infusion. The patient tolerated Ie procedure well. This was done after a failed attempt at a subclavian by C". Junnarkar. Iortly after arrival and with the above mentioned measures we were able to nprove the patient's vital signs enough to send her to the CT scanner where r of the head revealed a scalp hematoma. CT of the C-spine revealed lltiple densities in the odontoid area suggesting possible fracture. CT of Ie chest revealed a traumatic aortic rupture of the descending thoracic )rta and carina with a large 3.5 em aortic pseudoaneurysm. Also mentioned 1S a large mediastinal hematoma and large left effusion. CT of the abdomen ~vealed a possible 5 em mid pancreatic contusion versus bowel injury versus r artifact, as per Dr. Ken Chon. There was also noted to be a large ~troperitoneal hematoma and fluid collection consistent with collapsed Iferior vena cava consistent with decreased intravascular volume. The ~lvic CT revealed a 3 em left pelvic wall hematoma, as well as a left ~moral neck fracture, as well as a nondisplaced left upper sacrum and right Ibic symphysis fracture. ie patient's husband, who arrived shortly after the patient, was brought itO the patient's care plan and resuscitation. He was made aware of the Itient's grave injuries and was updated routinely. Ultimately the patient ~ceived multiple units of 0 negative plood, as well as liters of crystalloid .uid. Upon knowledge of the chest CT I spoke to the husband and ~rangements were made to transfer to the patient to Lorna Linda University !dical Center. The husband was in agreement with this plan. I had spoke to Shawn Bush at Loma Linda who graciously accepted this patient in 'ansfer. Mercy Air was called and was en route when the patient's vital .gns began to degrade despite the above mentioned volume and dopamine Ifusion. Additional blood was infused, however, the patient's rhythm !graded to sinus brady, followed by QRS widening, followed by ventricular .brillation_ The patient then was additionally coded with utilizing .andard ACLSfo-r - vent.ricularfibri llat ion , however, des'pi 1:;-e"our--best efforts Ie patient succumbed. The patient's code was called at 1524 hours. Once rain, the husband was brought into the process. TIPS was notified and was 'esent during the majority of this patient's stay. '-" (PRESSION: Acute exam.to evaluate motor vehicle accident. Acute blunt chest trauma with ruptured thoracic aorta. Acute blunt abdominal trauma. Acute blunt pelvic trauma with pelvic fractures. Left hip fracture. Possible cervical spine fracture. Closed head injury. ITICAL CARE TIME: yen this patient's presenting symptoms and mechanism of injury, the patient quired 60 minutes of my undivided attention which included multiple serial aminations, accompaniment to the CT anner and conversations made on her behalf necessitating critical care me. """'" ---------------------------- Edward Pillar, D.O. ACENDA 'TEM NO. <23 PACE ( c4 ,-OF -.\ \. O"~ ,-.,..::. ..... _4= '") ~HC-BROWN, ELEANOR G-Enc "107135915-0PT-ITR-7/24/2005 eED Physician Record - 7/24/2005 - 1 pg )/MEDQ/135786185 D: 19202 07/2.i_V05 19:19:34 T: 07/25/200~ .4:11:03 JOB # /"'" PT NAME: BROWN, ELEANOR PHY: EDWARD PILLAR, D.O. MR#: 7056275 ACCT#: 107135915 REF PHY: IERGENCY ROOM REPORT /"'" /""'" AGENDA ITEM NO~~ PAGE(S_OF~ ge 3 of 3 REMS# 641782 ~~ Prim.lnc, .s ~1 OIherProvider(1D~ Lf/C/, Yot.. ~~?;i~~~/~ ~,,:JJ City l.~ Zone ~ o MEDICAL riJ- TRAUMA ". _'~.J.I~.""~.J.AI~JI..~~.:':s."';I.IlL1~__._ _ AMERIG . ~ 107135915 CARE ONo ONoCPR QCTz OModk:al OFO/BlS I BROWN . ELEANOR C PRIOR TOO AlS .. 0 None 0 law E-'~~ 0 ALS o Mn.D 0 MODERATE DOO~ 03/09/HH 7I SX~ F ITR.n ,."'_ S SEVERE 0 CPR' . ~ HRN~ 7056215 ADM/REG DT: 07/24/05 ARRIVAL lltJOIherBlS OOlher ' ---:J .. . L INLlUiD VALLEY loIEDlCAL CENTER TIME CODE ODOMETER NAME ~""'.a.1' fJ V' f~OL.> ,..., '. . , - - ,/ RECEIVED I. 'D R' 1 2 i! ADDRESS ft> M'X '\~L . lA.> ,.,J.e,,,,, /l../ ZIP =E ~' ,~ r.....-.. i- . . . PT. CONTACT Jj 'If/ Phone: ~\4. "2.':;<:Jg $ocialSecurityNo. 3.(.,~' 3~ 110</9, DEPART "~",, 1 2' AGe:]..l OOB .j /q /SI OM I3F =:-1'-'5 I~ ~er;.ll. (iI I r:D-L :::r. 'A.ld1f' ~, At ,.... - II. ........c<: ~~&__. oJr - ii. All; Ad 11 T~ s:-. H' l'.'.-I I~ ,1. t:i )~n 1(+...(":/.\ "'Ide (-/')', .~.A aF~' .'0 .1'" - J1!...~.J.J i-:! J::._ .c::..~-T MEDICAL Hx /]1\.\\-, "OiD...... v J 7tLAl) 1I..:.'h _ . ,=.. ,..~ 1....1 oC'::; ~ _) MEDICATIONS · No.. V' '" n,..J_ , ~.', _ J : /' ' It I . :-d h..J' 1../ o NKA Allergies , h... l-.. .,.) rr~\. Lo... r"MD 0 , SKIN COLOR MOISlURE SKIN TEMP. ~PUPILS CAP REFILL 12 1% 12 LR LR 12 12 o 0 Numt:lt Q 0 Normal f/ tJNor..... t;J F..q..... 0 0 Pinpoint ,..., l........u"'~ Q) 'tN.I1MI lD.Gi9'~ QQDI'}' <:JOtIQt a UD<qUai 1tr;fJUspoMJn 'lJdlIJday'" ~'ZJSltttno.. o 0 C~k R~tolsl a 0 c..... 00 Fix... 0 0 S1~ lit lit NuM 'lJ Rdnt<tl.~ (J 0 ........... tJ 0 I'Nfuse a 0 c.... <:J 0 Dilalrd a <:J C.1ancl, '!l Nonr 00 J....JNIInd TIME __ PULSE RaIe J DescrIption IYh-~........ ~to J.... -,;L "-' I 2 Ol\lfspotlla_ 1:!"'1I T.. Voic~ Ql CJ T" PlIitt IJIN_ I 1 I 1 lB liJ 0btdie1tI 111 al one.ed '3 CD ~ul ~ !O Co.......... 1IlINWI........w.. 1!)~~",. I!J IJJ FbioD m ........~ , ! 'ZJ &___ ., N.or ..Ilf!IJ~ JOULES EKG RHYTHM .~":I..() IRATE ~ ,?,... 7...... lung Sounds It jl.., TIME EKG RHYTHM ~ . '" l~.~ :;- -p<..~~.., '. ~ m1'IIIIIII'li t ER0120 - EMT Sheet WNl;Wi,hin Noml>! Limits ABN=AbnnnnaJ 0 tlo Aw:w.... Injuries ~ Endosed VdUcle ~. Se.1I1ld1 III Air B"ll 0 As>:>tdt 0 F.II WNL AON WNL.ABN ~ Pass. Spoc:e iDlnos 0 APJ":>s. i!'JPllCf sp<<ol 0 SUSI'OCTED 0 >21lfL or 0 !ill ~ A-...rv o Sunr. oC Fatal Ace: -..H"(;.J.. DOMESTICVIOI.E.\"CE 0 Elcclt;phoct ROO Faciul/Delll:ll o Ejc<lcd frotIl Vehide REVISI!b 0 GSW 0 HoURllI Es""". ADD Neck ..". 'Ii Ei:lnnJiojiltt\l"in:a TRAUMA 0 Stabbil1!: 0 'Thtnm/Bunl U 0 0 si..,..~' ..<-, __m "'n.,. ...-- o l'cd1Bike \'S. Vdtidc:} SCORE 0 OIl AccidtnaaJ 0 Spun, MOO CIto, o MU'"'':yddM"l''''' .' 0 OIl Inl<1ll;."",, 0 Wk Rc"''''' ADO Abc....ncn o V.. V~b 0 HdmcI 0 Other 0 Unknown 0 E Pdvi:, 7\. T . ~ .\ ~r- LL. ^ nME CARE REHDEREI> INIT I. Y. sra;JS1TP. RO\TTE DOSE RtsUlts "MEDICAL NFCR't<;ITY J"'l/ (I:\..:,:_.J -..; ., I ".lL:... ~ . '- a_ _ .t 0 - t :-=~ONORTRANS. k.~., /M. l)~ '.... lI...,.~A 'Oi..;L "{ '!c. "" I- 0 - ; UNCONCIOOSOR!'OS.SHOCK .- Ilh. 2. n _1.&#.' ~ 1M r_". '-. ;"'/ ~ t 0 OXYGENLPM: 2 .. (; . 10 '2~~ - IMMOOIU7.ATION J POS. FRACI1JRE /~~') n A 0' 19(1\.'\ A- It V -rk..1 L 0 - '.. !'OS. _ CVA nA MI J ,,? J - I . A.rJ'....^ J L" ~ IWI' 1. 0 HEMORRHAGE ''/ ..... 'd~C: 'w I' s......1. A-t i).' --, 1.0 BEDCONAN6DOUETO: I ..[.... I - ..... MOVE VIA STRETOfER ONLY '- i. '"7 ", -I":l.a: .- : - ~ 0, OTHER REASON: "al,~ "" 0.. 'lio r. .L - r .. () HOSP.CONTAcrm TIME .. .. C. .' L . .' - t 0 a ND Cnn'ac:t ~ VHI' 0 UHF 1$b0lt~ .dU-1 :. u~, C)J) - Ll""". - ':IBISINI'O ~.AIS'Nt-() OA..sCONSUI.TIORDER.'> If'>~ ^-," .0,... I .~ t:..... ,,' O-m r _ (""a 1. I. RECGSVC l\.,oIh t'! . , t. rJ . ";..- a CU)SEST ~UMA I;) ClUnCAL CARt: c.".L.AI'{" .....Q nud J...~~.,./.---.~"''''\ A>;,.., G.-....~..I;~i'OPTRF..QUY.ST C1MEDREQUEST QonJER I.., f"'. ,I. \.. _. -r...i - A~ttJ.lI : n ~ lrJ..ILIL J"/L,,Gllr t:. lr....,.. ..u.. It".) I~.rr 0 f.ln.~" m.c'. , -_ ~u.') /' - Le" ,.~"""4 -'0,,_.... ct~ "&AU....,/,hoJ n-r.;.n -r,..,......!....:;. -d:.L//nJ. :.,/~ J,,l _ 1141> ~71 ...cPJr/r 8/ ~L... t::-k,/~.r':'_ j~~I-~ A.I.....n 1..-/.' 1),/"""., "h_~,.. ~/L.. j .J{If'/J..,~ /:.1,0 ~ H^ I AI..,.:'U';{"r.,,_-L<..~ {...,ri-yrlJ....,. -r./.....- (J ..,l Ftl I.rc- '~'11._ v'~ · r ~-....,. /) - . :,,~~ IJ. /. 7/ / - ,_" .4 /t' C=kr .(-r.Jl. fA... b A "I....A "," L,,. Ji,.LJ) If',JA..-- ~~ /l JD c/c..t,tl,.,..;-I~ (,.1'fI ~ -./I E''1Hl<;k. I'!. br 'd gJ Z, atk--r ,(h-....; oU1lJ .~'Q~ 'r- p, L..i:J~. '-V ,. lu ~ ....rr~.... .JwbS . v~,,~".A.A . Jh// Urlf_../.'" .)re.~. rl .4 _ C' Q- I ;j luna Maahc-r.' Hame F Tt_Mcmllcr12~amc- J,"- ~ 1"""-': I o EMT.I ~ EMT-P D EMT-I l' EMT.P ~. EMT.' 0 EMT.P CI IS! Resp Q Othct ~)",/. 1/9ifT 7)" 'f ",JI,.IIJlk?7"[" CDr 0 TAAINEE REC'D B " .: ~~- . ~~. . ~~. MEDICAl. a~" a :ENDA IlEM NO.~;, ,:!;.rrnim"" ~ ige 1 of 2 PACE..!. l1 0 OF..\lO_ , .I. I..... ,...,- Q'1t.1 ,,,~'t""'" ,.. ) '" o 0 Genil:lllllutt. o 08act . on bn_~~. - I ("VM tr NEB --- '" CA EMER PHYS * INLAN .LLEY 1601 CUMMINS DR STE D-~3 MODESTO, CA 95358-6403 """""00 340-1321 lAX ID ACCOUNT NO. 000109806-01 ELEANOR BROWN PO BOX 1152 WILDOMAR, CA 92595 STATEMENT DATE 09/16/05 INSURANCE: **DUMMY INSURANCE KE POLICY ID: 364347649 BIRTHDATE: 3/09/34 DATE DESCRIPTION ---------------------------------------------------------------------------- AMOUNT PATIENT ICD9 --------------------------------------------------------------------------- 7/24/05 ELEANOR 99291/25 ATN DR: PILLAR , EDWARD, 7/24/05 ELEANOR 31500 ATN DR: PILLAR , EDWARD, ,.-.. ,.-.. CRITICAL CARE 30-74 MI D.O. REF DR: PILLAR, ENDOTRACHEAL INTUBATIO D.O. REF DR: PILLAR 4275 EDWARD, 4275 , EDWARD, TOTAL CURRENT 577.00 D.O. 265.00 D.O. $842-.00 AGENDA IlEM NO. ~ s: PACE (LI'lOF \. 0 ----------------------- SOUTHWEST HEALTHCARE SY~ ~M P. O. BOX 31001-0827 PASADENA CA 91110-0827 PHONE 909-694-31_~ TID# 23-3059262 FC : L PT: T PG# 1 DATE: 08/23/05 ACCT TYPE: 0 -------------------------------------------- ATIENT NAME: BROWN I ELEANOR G DMIT DATE: 07/24/05 DISCiARGE DATE: PATIENT NUMBER: 107135915 BIRTH DATE: 03/09/1934 '-'" ---------------------------------------------------------------------------- UAR: BROWN NFO PO BOX 1152 ELEANOR TOTAL CHARGES: 30537.11 PATIENT BALANCE: WILDOMAR CA 92595 ---------------------------------------------------------------------------- DATE DESC/QTY SVC CD INSl: Z61 BAL: I INS2: A85 INS3: K29 PATIENT ---------------------------------------------------------------------------- 072405 1 23 CT NONI 53414900 450.00 0.00 0.00 0.00 072405 1 23 VECURONI 54093612 147.00 0.00 0.00 0.00 072405 1 23 ETOMIDAT 54302534 68.00 0.00 0.00 0.00 072405 1 23 WATER 20 54306204 8.00 0.00 0.00 0.00 072405 4 26 .9% NACL 50524560 272.00 0.00 0.00 0.00 072405 4 26 LAC RNG 50524818 272.00 0.00 0.00 0.00 072405 1 30 AB RBC S 50300011 42.79 0.00 0.00 0.00 072405 1 30 ABO 50300094 41.01 0.00 0.00 0.00 072405 1 30 RHO (D) 50300102 26.31 0.00 0.00 0.00 072405 1 30 BMP 51000057 50.00 0.00 0.00 0.00 072405 1 30 ETHANOL 51002319 268.00 0.00 0.00 0.00 072405 1 30 CK/CPK 51003911 -87.00 0.00 0.00 0-.00 072405 1 30 CKMB - Q 51003937 89.00 0.00 0.00 0.00 072405 1 30 TROPONIN 51009041 133.00 0 . 00 0.00 0 .00 072405 1 30 CBC AUTO 51009579 87.00 0.00 0.00 0.00 072405 1 30 PT - PRO 51010320 41.00 0.00 0.00 0.00 '-" 072405 1 30 THROMBOP 51010437 38.00 0.00 0.00 0.00 072405 1 30 C/M INTE 51014223 104.00 0.00 0.00 0.00 072405 1 30 C/M INTE 51014223 104.00 0.00 0.00 0.00 0-7240-S- -1 - 30 C/M TNTE 51014223 104. ooo~oo - - --o-.()O- 0.00 072405 1 30 C/M INTE 51014223 104.00 0.00 0.00 0.00 072405 1 30 C/M INTE 51014223 104.00 0.00 O.QO 0.00 072405 1 30 C/M INTE 51014223 104.00 0.00 0.00 0.00 072405 1 30 SPEC COL 51018851 10.00 0.00 0.00 0.00 072405 1 32 CXR CHES 53202958 229.00 0.00 0.00 0.00 072405 1 32 CXR CHES 53202958 229.00 0.00 0.00 0.00 072405 1 32 XR C-SPI 53204103 318.00 0.00 0.00 0.00 072405 1 32 XR PELVI 53204756 274.00 0.00 0.00 0.00 072405 1 39 TRANSFUS 43024801 76.00 0.00 0.00 0.00 072405 1 39 PACKED R 50300565 155.00 0.00 0.00 0.00 072405 1 39 PACKED R 50300565 155.00 0.00 0.00 0.00 072405 1 39 PACKED R 50300565 155.00 0.00 0.00 0.00 072405 1 39 PACKED R 50300565 155.00 0.00 0.00 0.00 072405 1 41 VENTILAT 55000319 862.00 0.00 0.00 0.00 072405 1 45 ENDOTRAC 43016302 169.00 0.00 0.00 0.00 072405 1 45 INJECTIO 43021302 104.00 0.00 0.00 0.00 072405 1 45 CPR 43021500 1219.00 0.00 0.00 0.00 072405 1 45 LEVEL 6 43022656 4118.00 0.00 0.00 0.00 072405 1 45 INSERT T 43032515 56.00 0.00 0.00 0.00 072405 1 45 TRAUMA A 43033026 6655.00 0.00 0.00 0.00 ---------------------------------------------------------------------------- '-" AGENDA ITEM NO.~ PACE(~-OF~ -------~--------------_. ------------------------- SOUTHWEST HEALTHCARE SYSTEM P.O. BOX 31001-0827 ~~ENA CA 91110-0827 PHONE 909-694-3133 TID# 23-3059262 FC: L PT: T PG# 2 DATE: 08/23/05 ACCT TYPE: 0 ------------------------------------------------------------------------- ATIENT NAME: BROWN ,ELEANOR G DMIT DATE: 07/24/05 DISCHARGE DATE: PATIENT NUMBER: 107135915 BIRTH DATE: 03/09/1934 ---------------------------------------------------------------------------- UAR: BROWN NFO PO BOX. 1152 ELEANOR ACCOUNT BALANCE: ----------------------------- PATIENT BALANCE: WILDOMAR CA 92595 ---------------------------------------------------------------------------- DATE DESC/QTY SVC CD INS1: Z61 INS2: A85 INS3: K29 PATIENT BAL: I ---------------------------------------------------------------------------- 072405 1 45 INSERT N 43033075 1554.00 0.00 0.00 0.00 072405 1 51 CT BRAIN 53401709 1645.00 0.00 0.00 0.00 072405 1 51 CT CHEST 53403002 1463.00 0.00 0.00 0.00 072405 1 51 CT C-SPI 53403200 2310.00 0.00 0.00 0.00 072405 1 51 CT PELVI 53404208 2126.00 0.00 0.00 0.00 072405 1 51 CT ABOOM 53404505 2108.00 0.00 0.00 0.00 072405 1 68 ATROPINE 54006895 166.00 0.00 0.00 0.00 072405 1 68 SUCCI NYL 54085790 32.00 0.00 0.00. 0.00 072405 5 73 EKG TRAC 53500047 1450.00 0.00 0.00 0.00 072405 3 76 OUTPATIE 63890818 0.00 0.00 0.00 0.00 ",........ ~ ---------------------------------------------------------------------------- AGENDA ITEM NO.~ PAGE.0fLOF .ll.o3- WHC-BROWN. ELEANOR G-Enc #10713591S-0PT-ITR-7/24/2005 EMT Sheet _ 7!?4/2005 _ 2 pg ~ ~ ~ (I) Z o Cl.. ~ ~ \ DOCTOR PLEASE READ CAREFULLY, IF YOU DESIRE TO TAKE CHARGE OF THE ACCIDENTIILLNESS SCENE, YOU MUST: . . I. Show your current Cali~ornia Medical Dr. License to the Emergency Medical Personnel on the scene. . . - ~ 2. Agree 10 take full reponsibility for the car~ aod trealm.ent of the patient(s~ i~volved in Ihe accid~t. 3. Accompany the patienl(s) in the a!Dbulance to the medical facility most appropiate to receive the patient(s). 00 Z ~ U - 00 ~ PHYSJC~N'S SIGNATURE PROFESSIONAL LICENSE 11 "-" (PRINT NAME) * Paramedics: The Base Statiori must be notified that you have a pby.sician - on scene wisbing to take charge of the call. DATE Corona Regional Med. Clr. 120 Hemal HospIIaI 130 1nl8nd y8IIey Reg. Ned. C1r. 150 KaIser Riveislde 340 MenIIee Valley Med. Ctr. 320 Moreno Valley Conun. Hasp. 360 Palkview Coriun. Hosp. 160 RiwlIside Convn. Hosp 170 ~ 100 Desert 210 cJSenhower 250 KaI_ FonIana ..(). U. UMC Sharp Hospital MunIeta 420 ~~ ---""""'" S8 _~ ST _ T....,..... P51n/Pt.T '-~ T_ svr ~T_ P.oc __COol. AA. __ - -- lH8 ,...... 8Ioct. 2H8 __ DR~ IICr _ o...co.o AIlE __ AUl __ AlIt' "'- IlEN -,. IIIC. .._ - -""" DZ _ Olio __ EPt ~ GlI' __ COt. ~ tJ\S \MIll uo __ YS ~_ - ...... HTO ~Slnr VAl ".. \IER ""'- W LV.~ ULE OF NINES .(). 4 8 ..(). J -0- 76&-6461 677-0033 -0- 672-7190 672.719. ..(). -0- 243-2018 ..(). ..(). 688-8312 6 683-8671 7lJ8.32Oo 2 486-4137 486-5650 1 (760) 323-4723 a 323-62St 323-65., 3 (760) 561Ht91 773-122. ..(). -0- 427-552' ~41 766-6450 677-9712 353-3790 672.70.8 696-6061 :!HIt ~_ vr _Todl. I'IIC -__COol. VF. _fib. "'" -fIoyIhm 1IIJO "fItIt* AlIA ___ >St ".;- JB _~ Ptot _,..".,. PQ -~ - CAR ~ IlEF _ - >os _...... Dooo--... , TKO To Koop 0,- . WI) -0,- re _~I ~. :=-, PO .., ...... , NEB ~ . ET _~ so. ~ 1'9 l'IOII1- PR ,..,_ i!8l:l ZOJo ~ - - ~ ~:z: ~e. :: ~ PJo t-' ""0 to" ~~~~~ r: ~ow PI>> 01 ><>...0\0 3:0~ ..... l;~ 01 ..../:IO ~o~ to n~'IJ s: "'..... :U''"' "':u ... , o '" ,- PEDIATRIC . , , . Front Back Front Back Age in Years 0 5 10 1 /2 of head 9% 6% 5% 1/2 of olle.thlgh ~ 2% 4% 4% 1 J2 of one reg 2% 2% 3% Je 2 of 2 TOIaI REVISED TRAUMA SCORE Rap. Rate SYS. DIP GCS 10-29 .. >89n>m Hg 4 13-15 4 >29 3 >89 3 9-12 3 6-9 2 50-75 2 6-8 2 I-S I 1-49 I 4-5 I 0 0 0 0 >4 0 + + "\ I , APGAR -.....; I mln I.. I 5min SIGN A Color P Heart Rate I . GReflexes. . A Muscle Tone R Resp. Effort o Blue, Pale Absent - No-Aespon;... . Limp Absent 1 . Blue Ext. Below 100 .... 'Some'Motion $orne Rex. Slow, Irreg_ 2 All Pink Over 100 Vig; Cr. Active Crying .. , This assessment cfleckIisI should be done after trealmeot is initiated and !he patient is.enroute to the hospital. Transport should not be delayed. ~~~oo~~ ~ ~ 1. Chest pain (I (I 2. Onset within four (4) hours . ( . ( 3_ Hx 01 r~ bleeding episode (( . ( 4. .Documentation 01 hemoptysis, C .61 or ENT hemorrhage - . . 5. Hll of lnli-acraniaJ hernonttane 1 t (! 6. -file of recent stroke (wiIhin 6 months) ( 7. Hll of major surgety (within 2 weeks) {- {C -' 8. Hx 01 recent trauma, prolonged CPR 9_ HIe recent Head trauma., ()! 10. I.J. or subclavian venipuncture withip.2 weeks. ( I 11. Age greater than 80 years ( 12. SustainQd BP > 180 mmHg systolic . ( 13. HIe of previous lhromboIytiCS; Bleeding Disorder C I 14. Receot streploccoccallnfection . () 15. Severe diabetic retinopathy ( J ~ . ......., \ ~~-' '1'"'- PUPIL SIZE CHART , 2mm 3mm 4mm 5mm 6mm _7mm 8mm . · · · · ~eA~NO. c;;) - '-'ACE~OF \l O~ WHC-BROWN, ELEANOR G-Enc #107135915-0PT-ITR-7/24/2005 Insurance Car~ and 1D - 7/28/2005 - 1 pg \6,\ &~ . "... . ~7~'1 · SOUTHWESl HEALTHCARE Sy~ 107135915 INLANl> VALLEY MEO'CAlC BROWN . ELEANOR G RANCHO SPRINGS MEDICAL COB, 03/09/1934 71 SX, F ITR MRN: 7056275 ADM/REG OT, 07/24/05 INLAND VALLEY MEDICAL CENTER ,. EN HERE BEFORE:. YES NO P A~NTDEMOGKAr.t.U.L .udi'ORMATION PATIENT: FULL~ ~ E leClVl()( HOME ADDRESS: . (l. . f3 t7Y-~-) r-- CITY : ,.' COUNTY: PHONE: I MARTIAL STATUS (Cirt:1e One) a:z>.S STATE: ZIP: DATE OF BIRTII I w D . Other I 'SEX (CiTcle one) MALE ~ STATE ISSUED: {!. A RACE (Circle once) Whit~. Asian . HisPanic Other REASON FOR VISIT"\'YU () (h~ q .::/-1 . .... ~lJ~ f, b 6t>-JO" RELATI9NSIDP:WJ.-<.t1'n/A/ }-h( sh q /1& . . Pct'(j7Ci4 p~;:' ';J;;;;J'h-l,c;6 -3/t!- .f.3~ 7 CITY: SOCIAL SECURJTY NUMBER I DRIVER'S LICENSE NO: RELIGIOUS. pREFERENCE 'lJfKi.,t.;}; ~- PRIVATE PHYSICIAN ..' EMERGENCY CONTACT: .-. FULL NAME: Be \}t' f \\1 , . I ADDRESS: STATE: ZW: PHONE: - EMPLOYMENT INFORMATION: ~e.,L. EMPL-G-VER-NAME:"- . EMPLOYER ADDRESS: CITY: STATE : ZIP: PHONE NUMBER: OCCUPATION: INSURANCE INFORMATION: .: \ . ~ . J\' . ~C;\.--.. '- INSURANCE NAME:, 'fOe 00 Ca (e/.. P9LJCY#: - LfD5 3C:> 7wl3A . ~ ~<" '.- eDt<e- ~v' \..,Ae GROUP#: . SUBSCRIBER NAME: '&=> \X> ( \ I . e. ~v.r-- / SUBSCRIBER EMPLOYER: SUBSCRIBER DaB: LP ~ I L - ':J 7 SOCIAL SECURITY ~ER RELA TIONSIDP TO PATIENT: I \-' l1 ?bq nJ. I ".-. Do you have.. ADY ANCE DIRECTIVE... UVING TRUST? y~!; Are you a veteran? y f ~ If anyone calls to ask if you are here, can we say "MOT "NO"? AOENDA IT~M NO. 8 PAOE~OF.tlo'~ , - qe 1 of 1 SWHC-BROWN. ELEANOR G-Enc #107135915-0PT-ITR-7/24/200S Progress notp~ _ 7/24/2005 _ 1 pg e DATE PROGRESS NOTES I ~" J.tJ...--r c, ~ x'1~ ---1(,- ;t... "- ~ 7 J I "7& ~ "; r; '~j 'jf!'k- (/ ,. u-A- W? oJ. -.;> (/ - .. .-- ----'.--.-.------ _. --.. ... - .._.ow _.. -.....-. . . PROGRESS NOTES PAT'ENT IDENTIFICATION "A~ ~ .,' 107135915 BROWN . E~R G IIIIIIIIIIIIIII~ III SOUTHWEST OOB: 03/0'1/1934 71 SX: F ITR HEALTHCARE SYSTEM MRN: 7056275 ADM/REG Dr: 01/24/05 PNOO10 INLAND VALlEY MEDICAL CENTER II/LAND VALLEY NEDlCAL CENTER RANCHO Sl'RIN<",s MEDICAL CENTER AGENDA ITEM NO. SWl55 (1/04) . PROGRESS RECORD '-'If e '-'If e ....", lqe 1 of 1 PACE -=t.2'h ~ ~ I ~ >:: I ~ -IIIIIIIB ~ AEOO21 ~ Q I J ~ ') r- b1 .0. r') In C> C> N ........ .... N ........ I- Cl "" o U r..::I "" "" g,..,........ j H E-t Z r..::I :> :>0 "" o E-t ~ H Po U} r..::I "" ll) o o N ...... qo N ...... l- I "" f-t '-f . f-t ~ ::> I .n -f " .n "l' -f ::> -f It EST PASSED DATE: DATE: SIGNATURE: SERIAL NUMBER: TIME . ~ {to rl: I t:}1g: MODE rtG Au setl~~;rved ~ V / / // / // // /V ..Setl~~~erved (P2~'~;/ V/V/ /V // /!/ Fi02 %'. .l.O 1;0 PEEP/CPAP . (}j tJ Pressure Support fZ> (/) I, Flow LPM Co 0 fit) Sensitivity '1 /J cmH201LPM L - L- ~::~'::~u:: ~~ / LVi/VV /V /1/ / ~:~~~ rlr/ /I/VI/L( /1/ /V / Minute f) /l,- Ventilation }~ '-J Airway Temp IlAA€, I ,"IV:: 'Tn' II' 'v CatdiacRatePrelPost ~ .tn ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Breath Sounds 1:U{ I ~ t't1rWl< ~ NEBIMDL ..~ ..-=.. .. ~7 . .. Spa02 . ~ Skin Color ~ Hf ro --r - Patient Position ~ Fd,t.f' ALARMS HiA...ow Pressure V Low vt./Low VE High Rate Lovy Peep RCP 'N"'ALS Signature: Initials: Signature: Signature: Initials: Signature: 24 HOUR MECHANICAL VENTILATOR FLOWSHEET PATIENT IDENTIFICATION Initials: Initials: ~A~ ~ SOUTHWEST HEALTHCARE SYSTEM INtANO VAtlEY MEDICAL C&lTER RANOIO SPRINGS MEDICAL CENnR 107135915 BROWN . ELEANOR G DOS, 03/09/1934 71 SX: F ITR . MRN: 7056275 ADM/REG OT, 07/24/05 M INLAND VALLEY MEDICAL CENTER . ..... '- . . .AC;ENDAI1EMNO.~- : PAc;E~OF . ~ n1 $W51.. (03104) # ETT Taped @ cm HME Changed @ ...., Time err position changed: Cuff Press: Vent Tubing Change Due Date: I '- SXN Cath Changed @ e 01 0. l') II) o o N '- <I' N '- l'- ~ o U M ~ ~ o E-t .:( ..:J H E-t ;z; '" > '-" )-i :>: :::> ~ H :t. :J} il :>: n :> :> ~ '- .. ~ '- , >: ~ .... . .... 1. ::> . () ... " n .... ... :> ... t ~ a , , 0: ) ~ ~ :t ~ l071359:;EN:~~ 4 ; DROWN . ELEANOR G ~Flt DOB: 03/09/1934 71 SX: F ITR MRN: 7056275 ADM/REG DT: 07/24/05 INLAND VALLEY MEDICAL CENTER "-' o - ~ i N Q) tJl tU ~ If- lO rf\tC /Z~((_ - \ lol D cr-D/,O ~-O \{ 0l\T- \'L - \ ~l cJ ! \~t~ - \Jln\-- \1... g~ '2;&/ L~ . IllQl~~t\Q \5 f'l\\C 39JkY : - \~~ -~ ~G<:\-~,",-~~v -~ 'R>~Q. ; t ~ '( C <L ~ rY\~ C ~ C:SZCe-/~tL ~ ~ -\\"'Q- j . Hr- _ ! lCl ~l{ - ~e- \~ \\(\~ tm~~ ~-\--Cb\~) o f< ~- -- i lVLq - 6Llj:y::: \ffit- rz. \ lC:'>~ l/) C> C> N ~ . G2('lG \$-!\\- \1- \ \()L\~ f< H . ~ ICp33 - -lD/tp \jQ(t\--Q \ \O~t\-~ ! 1~4[ - Cr-~~ i <JlJ I\1rvP 1 Ur ~~ )1 ~ IIIIII1IIIII ~ RE0021- RESPlRATORYVENTllATOR ::r: ~ :J) 107135915 BROWN . ELEANOR G M DOB: 03/09/1934 71 SX: F ITR . HRNo 70S627S ADM/REG DTo 07/24/0S ~ INLAND VALLEY MEDICAL CENTER .-- M AC;EN~:C~:i~~\~3 E ;WHC-BROWN. ELEANOR G-Enc #1071~~91S-0PT-ITR"7/24/2005 Rhythm Strir ~cord.. 7/21/2005 _ 3 pg ,..." "-t~ .~ ~-~-= _~:"-'T1-:: --~~ -;. .. I '-' ~.. . -, -:-0:-- f - ~ ,. ~_J_' ,__'_'__1-: i --I. r. ~..: .L.i.. '. , · ' ~1 .~.t. ! -:1. .f:'" '. -r. : ': ./=::-:t:S . 0 : IJilii .. "...~-::- ~~ j Lr:;~! 1Tly"f :c;:; .'. :-:~:~_.~_. .._ u.. u. . "._-~~7:::- ---;'-=--1> I ii,l( -- ~WJL. . -=-=. J'--. -!..--t:..:.L~.+---"_' --~ ---...,-...- .. - .,_. '._-;-:-,- -+-:-1.- -'-....... .,..-.---t--.-:.{-:-.----o--t I:..~:. j-, . ~ ! i '--i"'.; , ' .. . ..: I';' " : 1 . . .I-i-.: \4:-:1 c-r- ~'-T-L:-t i ..' I , . -> -T--~-r----r-.- -J...-+'~-~-:r-7~-I\.1-.-__+_. .....,,--r-,...---l--r----.-:r- . . ":,.1,... .:: ~.'ft..: ..; .1'., :.:'..1:1,..1 ,',. :~,. ,! ,'.'.; ':. I' " , " -t--'--'--'-t--:t.... rT:.-_.~ r-~-'--<-- .'f.T~trt-. .-,.--... . , -...----,----->----t-:-r---<-:-'- \~ . ~ 'I -.... .. ! "..: -oJ. _" I _. 1- l. t' 1:-'-:-;'-, __ '.:':::1' ';'U' 1,.:1' .': ..,.. ::::~ ::: . ,-- ! ...: . I ,'I':..,_~!. '~~..l:.:...:L..;., . 'I,' :.. ,I '_'. '. . '., '.:'- ~RRYTH" f -.!.., - ____L. . ---,-.- - : I:': .r L , . 'liIT:- ~__u._'_. . : i*!!. .~.~~-:,~~:+t~ ,c+ :J., i,r-.--.__ +.~-- -... u' '~>-;'~;T "ill, I 'L i i\ i ".~. . '=~0, ; ~ ~:F-;':: .~~~~u::~-~~F,.:T=:2~-:-+' , .:'-d++i:t~ . :1~rt". ,. I I ~:'1 locrtt.. "F~ .LJb',-"-+~L+-!-c4~+-I~- t :.:.1d_~::.!--':i.:!_J1 ::-i:.li,Ll=:::k:L~~;, ;:::/-:: I::':: '~~::,:...:~::':, ~.i~l:..:...l~,~~~~ ',!.!...,~',~~~, I '- RHYTHM STRIP RECORD PATIENT IDENTIFICATION - HI rll~llllllIg.IIBIII CAOO70 .,,,~ ~ SOUTHWEST HEALTHCARESYSTEM INlAND VAUEY MEDICAL COlTER RANCHO SPRINGS MEDICAL CENTER '-'" SWS19 (4104) 107135915 BROWN . ELEMIOR G DOS' 03/09/1934 71 SX: F l~ 10~ HRN' 70S627~ ADK/REG 01': 07 · ~ ' INLl'JID VALLEY MED1'AGEN'f1A ITEM NO. PAGE~OF ___ ___~ .,__,__.....__ .......J...........~.. o,J&".-..........1-" .J.'\."-''-ULU - 'I.L.~/'VV=> - ~ PY' RHYTHM STRIP RECORD ~l " PlACE TOP OF REPORT "5 HERE tA" c:.J9L,..I;.c;nr""""-..-....----...__._ .JJlO :JIS3HOY.l tBS0dX3 HnDd tBA3lN3 3AJS3HOV 3sodX9 0l3i\0W3H HYD3d 30 m~ V, tt3NUdXi 'PONER LA GOMA DE PEGAR eNlEVER POUR EXPOSER L'AOHESlF REUOVETO EXPOSE ADHESIVE ourr.. .O!) V1 H3N0dX3 WVd W.1JIlO .:fJS:JHOV.ll13SOdX3 tmOd tBl\31N3 ~HOY 3S0dX3 Q13M)W3H IfYO; -.-.- -.-. -----. . -...... ~ oocnAD C:UI&:VJ<Q POUR EXPOSEAL'ADHESIF REIIOVE1OEXPOSE!' DIRECTIONS: Position forms to line at Jeft and above numerical order. PlACE TOP OF REPORT' 4 HERE ..~ DlIft..IQ u:r~ ...=- ENlEVER POUR EXPOSER L'AOHESIF REUOYETO EXPOSe ADHESIVE OUfTAR PARA EXPOHER LA GOMo' :IISiIHOV,' ISGOdX3 HOOd ~ 3AlS3HOY 3SOcfX3 013AO"3H HY03d :HI YftOO", H3N0dX3 ~ =n LA GOlIA DE PEGAR ENLEVER POUR EXPOSER L'ADHESJF REMOVE 10 EXPOSE ADHESIVE OUtTAF .--.- -- ---.. .---- ~... u:lC~n.n':a uno.. U:aA:ruG 3JUS3HQV:ISOdX3 OJ.3AOW3U ~ PlACE TOP OF REPORT '3 HERE sJEPEGAR EHLEVER POUR EXPOSERl.ADttIl:S. nc.uY"" "'""ArVOC .............. --.....-..--.-- ...-. ~ tnWnD :AIS3HOY.l tr:ISOcOOI HOOd tBAnH3 :JAJS3HOY 3SOdB 0l3AOl113U trm3d 30 VWOO Y1 tr: -4RA EXPONER LA GOlIA DE PEGAR ENLEVER POUR EXPOSER l'ADHESIF RBIOYElO EXPOSE ADHESIVE 10 YWOD Y1 tBNOcIX3 YHW W.uno :llS3HOV,' lBSOcfXa Hnod 1BAnN3 3AIS3HOY:ISOdX3 Ol~H DCUI"'IUIt' 'Tn r:l/. ~....: r-;r--.::r-:::-...:' - J .. .........ht.:2!= . ~. :;14 "+'~~ .': :~f.,,+-j~:q.::l:.t:-...:~ 1<1~'I: ::!~ '1' .I':.I::!: 'I~I':;.I . I.' '1. ':1.':../ r~:-J~t--T ---,.:....:.: ::t:++~__: . v.~ I. '::'.: :.: . .r btJt.. j"" ..!" r.l":;~' ....1 .; k I .:. ,I :.1 :" I~ ':. f": ~/ I ~1>GtL'" T.. r.:-r-r-ll": .::!.: 1=llt..t-f":,:. :.:: -::t:.-:-i7-:f:-:-:1--=-:fc.-.:..!: . "1:: .:;: .1 ::.. ;':H~ '1:. L- ". J~._:..~ -.--- .. I . -+--'-t- I I ',' I. ~, . . .::1... . I..J I I. ........ ~ '. I . I ", ~I . -+ t . ___li : I. .'; _~~__:-' ~_ ~ ;.(.., :J.' ::. ". ....1:: "'1-1": :.. : 1:.':1. 'f~~r-;:: .:1 . '. ; :~:: 1':! i. I . '. . ':1.. .::',. I ~ -t-+-1..--r--i-::-:-r-:-:-r_I~~~... . .!;:'.I '.. 1':./".: ":.! -i ::1 I. I ' . '. . ...1" t I. . . . ..~ " ..' I. . r. "1 . I I' 1 V:-:r::: ':.FL.. ! I:: ":1/':' '!'.: I. ; ".! I: OO-:-.) , +..-:+--'- 1'" I. .. ~n::'1 I----r-~~~_J. ' . ,':1' "'. , .: ::::~+8 ..... ;.r"---:--:f:-t"": =E+-i:i ..Ij : ,-:.1 ' ~__".1.4 -Pi F5~i.SS_6~ct~~~!3i+ifir~ RHYTHM STRIP RECORD PATIENT IDENTIFICATION . 111111111111111111 CA0070 ~ ~ SOUTHWEST HEALTHCARESYSTEM INI.ANO VALLEY MEDICAL CDlTER RANCHO SPRINGS MEDICAL CENTER 107135915 BROWN , ELEANOR G DOS, 03/09/1934 11 SX: F ITR MRN, 7056275 ADM/REG DT: 07/24/05 lNU.ND VALLEY M&DICJ\1. CENTER SW 519 (4/04) AGENDA ITEM NO,~ PAGE ~:t_OF~ age 2 of 3 ;WHC-BROWN, ELEANOR G-Enc 1I107135915-0PT-ITR-7/24/2005 Rhythm Strir "ecord _ 7/24/2005 _ 3 pg - \.~. ~ SOUTHWEST HEALTIlCARE SYSTEM .. - - INLAND VAlLEY MEDICAl CENTER . RANCHO SPRINGS MEDlCAt CENTER '-"" The original rhythm strip attatched to this encounter is stored in the .Health Jnfonnation Management (HIM) Department. . For review,. please -request through _ -HIM by either calling in or writing a request. , The foJJowing information is helpful in fulfilling your request:' Medicallecord Dumber /J') ') Account Dumber . . OJj ... I Lastand?mnameof~epatient j r ... ! Date of birth oftbe patient . . . ~ Thank you, Southwest Health Information MaJiagemen~ Department . . 11111111111. -Rbytbm Strip 107135915 BROWN . ELEANOR <> COB: 03/09/1934 71 sx: F ITR MRH: 7056275 ADM/REG DT: 07/24/05 IN!..AND VALLEY MEDICAl. CENTER .- "'-'" ::Je 3 of 3 AOINDA ITEM NO. ~ PACE.3CCJiF~ WHC-BROWN, ELEANOR G-Enc nl0713~q15-0PT-ITR-7/24/2005 Trauma Flow - et - 7/24/2005 - 4 pg e e :-~-~'_ __ -:l~; _ :'.. _ - TRAUMA FLOW SHEET ARRIVAl':1)ATE: \Z:.L\ -:- - .- _ARRlVAlTlME: -' ':--NAM~~ ~llF nil T A9ivation Time: o Crilical - CODE TRAUMA U MODERATE - Partial Ac;Uvalioft ,....... OM Arrival Mode mbulance DAir o Aulo o Walk in o Other PrebospitaJ Report @ 02 via: 0 tole 0 Mask t3'AGlMask JDtubationy DNasal DOni. ETT Size: 00/ ~JVN~ OMedsYTA ~ ~utions OSplint 0 Saeger o OlhcrIspccify INITIAL NURSING ASSESSMENT ~G'(:st+JA~IJ.~n(iigQj!~~i~~~dIr~~.SCiii GCS "- 5JoIeIk Bp 8. ..,. C Ere ~ D. VtrW Rnpe.- L M..... ..,... + 1 + I DI4-IS-. 0>\10-4 01D-n-4 D~ -4 O~ -S D~ -6 sm >20I(G C_bobNes IcIliId_, - Mechanism of Injury: Time ofJnjury: AUlO vs AulD 0 Aulo vs Pedestrian 0 Auro rollover Auto vs 8icyde 0 Motorcycle 0 Dirtbike 0 Bicyc:1e OMVI OSeatbeh OHdmd ODriva OPassenger o GSW 0 SCabbing 0 Crush Injury(J Bums o FaI. 0 Skyd' . Horse 0 I>rowDiRg o OtIIcr Specify: - 011-))-) ~\lO-) 025-)S-) OTo Vok. -) OC......... -4 o Pvrposclill -5 ~ IniIabkkrics 01-18-2 0~9-2., 0>)S-1 DTo..... -2 O~ -) o """'"h..-I -4 S7>-11P Cries to hio O.s.7-1 O<jO-1 ;1<10 - I -I 0_"""",_< -2 OfklUon -) eN>; Moano to pain - I~-~ rjND~ De -0 -1 MEDICAL HISTORY MEDICATIONS <14I1W I..... t1rl ~. ~ IF.TT. dC) ~ <,._1" 1-.....' CotnoIDoccft_ ChnedF_ llpctlIMuIlipk F. - M...C... ~ /'"' SKIN COLOR o NORMAL SKIN MOISTURE - 0 NORMAL SKIN TEMI'ERATUR!: o NORMAL . T...Jl.ctlvalfoll n....- BP RESPONSE N_ LMP u__ '_"____'" o FWSIJ TETANUSO>SY~O<SYRS . CHIEF COMPLAINT OIST 0 WARM o DIAPHORETIC o PRofusE NEURO: HEAD: NECK: CHEST: LUNGS: DJST AL PUlSES: BACK: REeT AL TONE 0 Y IIIII1IIIII1III EA0100 107135915 BROWN , ELEANOR G ITR 1 9/1934 71 sx, F OOB, 03 0 1 DT- 07/24/05 MRN- 7056275 ADM RL~ . -. - INLAND V"'LLEY MEDICAL CENTER ,....... SWS12 04104 INlAND VALLEY MEDICAL CENTER RANOIO SPRINGS MEDICAL CENTER POlite I of4 r T.lB~6A !reM NO. 8 ~ PACE -=l-9 OF \ ( 0 :s . OP 1 nf .4 ~<; (~ l> - "-..;J ~ e l II PUPILLARY CODE: 08 BRISK ~ MODERATE (J N NO REACTION (J S SWGCISH ....e... -'-II PUPIL SIZE: LEFT:~ RIGHT ~ I 1 J 4 .s 6 7 II ~ Ir- . -!\- r- --' , ~~ --- t~\-:rV -. 12 :f II":' LJ ~ ~\\ . f) I '\;j~1 Q- .. I--~ r:N" :~~ Rt:CORD OF INJURY A AbnoIoa AI' A..,..1IldoD AV AY1IbIoa 8 8.... C C.IIt...... -0 Crq>ftu. _. - .. D Pd-1tJ , LC [U..,..... t E~ : CF o.....r Frlld.n OF Opeu F"dun GSW Cu. SboI W...' 'R "-al_ L L8arudoII rw rltDctuR S 5,.. W.... RtspoDH: to MtdltlltlOD ~ ~ ......~ I-- ...... ~I f\ ~ ~ F ~ Ll.l j>R~~ .' TIME ~ULT MEVICATlONS 02@_LIMIN . /" ONe OMASK V- a BAGJMASK /' 1~~O~f!""} '1sc Sv.ec , rOOrn\ rv~ M ....,. ,~: c"....... ~~J...- ,,-;F- 0 -/ .J _ /'l _ DJa 0 LT Sj~1'b. } tJ5~ ~ '(}fA..,. 1St If~ Gla.--f..e.., 2l)~ k 1:" ( J" - ~. EKG_,rU~jj-:r;~ j'ldi>C;"Uhft "'C/A-I--.- ..~-~.. ;:l..~A ~ ____. ...... ANGIOGRAM ...-" ,~ )f() <. Ll12s;J -c: t/)~ ~\.--1. KJ 47257 ~ CT Ilt:1 b } of() r...- _ n b'b~1 '(., (F ~ '.J ./ ---=I .LR 08831 cVP UNElARTERIAL rJl. ~ .Jj ~ I) ~ ~ L~' '2 L B.. 1M ..1:...., )::..1/ PERITONEALLAVAGEI'1A t\' j 1"-'" ~) Fl CJb'" ~~ '1 ~,F u;t ~~ ~ FOLEVl . '" I I ~ J ^ n.A..h.1' 1, h R- 'Y\. ~ lh.. ~ :: lJ '-,t1 ~ ULTRASOUN1>.1<o. /' "VPJ..b- ~ (.0 r....^ I J ~ l.., J V SALEMSUMI'" ~ . ti2 'J ...lJ. ./ (7..t%e.-ab t7< - I -1--:-) ..J: J C-SPINECLEAREV I.. A ..( !I--'~Th ~ ')TDJ:J it'") . GH 55619 _ SAFETY - SIDE RAILS ~ UP AND LOCKED I Ao... ~.Jf11 W.. . -j:\' lJ"k "-'^ " n PIn. 1..... C 77556-; . . INTRAVENOUS nUll s._ V } BLOOD PROD~ . ..-r SOl.UJION AlIfT - ~ INFIlSED , TIME TYPE BLOOD NJJMfEa 1 SITE INFUSED ./ . / / .. ....7 /' ./ /' ~ l' V ./ 4 ./ PATIENT IDENTIFICATION TIME DRUG DOSE Roun: INITIAL SITE 'wi' " 1 nlltE 1 :I 4 5 6 I\. 7 SW5J2 0411)4 Poll< 2 of 4 107135915 BROWN . ELEJINOR G DOB, 03/09/1934 71 SX, F 1TR4 0> MRN' 70>6275 ADH/REG DT, 07/2 / . INLANO VAt.LEY MEDICAL CENTER ......" 11111111111110 EROl00 AGENDA IlEM NO. ~ PACE ~j oF\ { O~ '9 e 2 of 4 IHC-BROWN. ELEANOR G-Enc ffl071J5915-0PT-ITR-7/24/2005 Trauma Flow Sheet - 7/24/2005 - 4 pg I ,~,,[ f LEfT i~LI?;.~'t>CJ% '1>.th "q1O~'fI~ \lL.J2C'I0I3C -€7' RlGHT W .-2L t'l n 1"1 0 .. rll . n~ 7l.~. ~3 lot... I bt 'b3 -er RESPlRA lIONS ~ Q A" -\b\., -" I.P J..1 VU\. .ffMPERATURE Ir:' 1/ /" ~ 1/ pu~.OX V~ 1\ { 1 Cj' ,. V ~ f(, l- \...L-'tO! \A :r 0 /Vi/.V-. ~ '> ~ r J J t t I TIME Cardiac R!lyttun .!!! PULSE- PUPILS GCS Eyes Verbal Motor RTS PAIN (1-10 Scale) URJNE OUTPUT NG OlITPlIT Olest Tube Output ORAL FLUIDS /' GlIturaI ..e1i&ious .~... '>'&'V\ i ~ f ) I~ IlZTh ,I mOD I (oZO I ~?{ ... D I tAt I' I Vl,jAP ......--:- ......--: ~ -...-- ,--.---- / / / 7 ~ ~~.. 50cv Id J1V;\ -hAlo... ,1 J::Y' Zbf1. rOo AlA . /'4/A "Po / / / , I I - ., EDUCATIONAL BARRIER DYes DNo PsydIISocial D Yes a No Language Banier 0 Yes 0 No Readiness to Learn 0 Yes 0 No DYes ONo Coptive o Yes 0 No Physical Limila60ns 0 Ves 0 No Olher OVes aNo MUL TI-DISCIPUNARY PROBLEM LIST AND DOCUMENTATION L [tAirway Ckarance. ineffective 2. 0 Anxiety/Fear 3_ 0 siQlliiag-patiem. illeffective 4. OCardiat s. 0 Comfon. altem! 6. 0 Fluid Volume. defICit 7. D Fluid vOiume. eXCess 8. 0 Gas Exchange. impaired 9. a Hyperthermia 1!l,O_Hn9~JDia II. 0 IllfectiOll 12. 0 lIljury. poIelItiaJ IJ. a Knowledge deficit . J!' OM~I.s.!lIIlIS. aJJeml IS. a Mobility. impaimI 16. a Skin IlIlegrity. impaired Nsg Nwsiog Services Rad Radiology CoM. Case MIIIIIgUIICllI IC Inredion COIllrOI r . Muitk!iscl~!!N~~- __:': _'''''''0..,' .': . " lald.I.: y') uJ rJ~ 15V -' [} <of \ \Llr 1111 ('> 2-~ J& () r ~Dnrl\ ~6-- <t 1>(~ oM r ~ -+ r a~ .8.. -- ~(A.~c.t\ US" c~"ou (n~ - t..Jin t"'PoAntJ. U{\UV\n't- ro~'(lW -\n lt ~l ~,~V(,. L. ' r I.JA (,).'tl () J' ~ I '" 5 I1RftQff 1 0 '7,. '-I )( ^ 'I I J b- Ctrrk.Jp l P:PO'). T tI A r a.. P ~ p ~ ~ ~Lr......O' A- {)J>~~ (f JJ.lI,JI, 0--1^ rjl'//'l'/ n fL;,^_ ~f' 1.l1J'-'--yf ~ V ~ EMERGENCY DEPARTMENT \. PATIENTIOENTl1ttATION /""'. TRAUMA FLOW SHEET ~ SOUTHWEST 107135915 HEALTHCARE SYSTEM BRO~ . ELEANOR G INLANOVAllEY MEOICAl<ENTER DOB; 03/09/1934 71 :iX; F ITR 05 lIANCHOSI'RINGSMEOlCAtCENTElt cPl MJlN' 7056275 ADM/REG D'f; 07/24/ ...,.., WI . ,,,... vmE> ",D"AL ~EN:~:g ~o.~ DISC CODES: CP -cardiopulmonal)' PT PIlysical Thcmpy '\550 ~:11~', "Prob....;. Dlst. (OO'( 1(07 D (IJ_~ ~ ull 1 111111111I I EROl00 SW531 0410-4 age J of 4 ~HC-BROWN. ELEANOR G-Enc #10713591S-0PT-ITR-7/24/200~ Trauma Flow Shee~ - 7/24/2005 - 4 P9 Multl-tJhclpUoary N.?ln I - " IDo-pnA"", "^C) I ~A r~ 5'YU/~~t2~Jk ~ f-- 1.-'1r~ .' e.y\l .~ t3(P. TO. ex- ,.(,3 '/ riA -}~;;I/ P?7::n 1'\ 10 ,()/11 "eX/ ~lN>a... L4l g .) - >~~h ______~I . rf' 1-0 fSYJ\-.( C{)~.J<T" "to . CUll> 10 ~ f7J'{--a. [J ~ . )f --'11:T- U l (~U ~ l j7 ~ ~ Ar-.. 'tl) l?E" A 1;' j . SfD2... V~.-:t tUN ~ . J IF ~ a- (' rOA..( do PO d A fU 7L~ >. N..d tts f<..vt -. " \ D-61'dAM~ 0 /t.JJ:u ~ ()Dnt/~ !(y-7#r ^ '- ,--- r$.JL ~)O to' xtt ~ ~ol - ./~.e..,,' lV e.r-(/ fin I ") ~ n~ ;/ -> \ , ;pt-,l} Jk A -N: . ~~.. 0 ~ (J..et) a;. 0 \ · tJt?.b p/ C\ 4..Nk 1> 1 l >tV\. /~ 1>>" D /....11 fA ?P1 4 /I (AlA .)~ ~ Itd/ {>,/> A" c:L .lA-Oui rl" .-/ I~~ ~u:::tiA ~ PAJu A\- iA ~(2- , c:: ~ ~ '- ~lL..J . q 4.fir,/Y LI a.o JaA o. Ii" J.. rP 6... cPO I ) 1'11](. fA..)b:J.?A. JA ~ M...hQ A 0 ....~,n ~d-f- 7.c.;~ i~ '- ~rn,MJ _ ~.Ln .% A Jrodt ~ '<;: A~UITY LEVEl.@ DiSCHARGE I . 2 ) 4 I S U----- Time frobJl LDoS .~(o ~w . lle10 ~m) ,. . r'laL~ f./{J{ ~ ~c.t - . TOTALOUrfUT . URINE TOTAL INTAKE DIsc. - .Initial '-" CHEST TUBES '-" EMESIS NG IV'S BLOOD ORAL LAVAGE PATIENT DISPOSITION FAMILY/PATIENT ED~TlON Fa.iulynotified ;::ffn 0 No Plan of Care given 0 Yes 0 No IBEl~INGS la1ionu: wilb family OToRoom OToSafe' o Other ... . . ADMIT_Tu: OOR fJICU Qoou OnooR RM/I.. ~P-' .EQ-~@ /rfhd! ~~ @ ~~ -1M Tnnspoltvia: OGumey OW.C. ONurse OMonitur 002 [lfDeatbRerordcomp1eled Discharged: OAmbu!ale OW.c. OCustody C)Carried OEMT-P OEMT OAIR P1rele3Std:n/tUary Aftercare inslruclions given and lDIdastood. 0 PI. 0 Family 0 0thCt . . cr~~O Tnnsferrcd 10: .. . Time left E. t:-r:;)J- Time left ED: SIGNATURES: ~ "'~I'( , *~r~~ Signatures SIGNATURES: l.ill.Is PATIENT JDENTJFICA TION EMERGENCY DEPARTMENT TRAUMA FLOW SHEET ~~ II ~ !ll~lDllnllll'l SOUTHWEST HEALTHCARESYSTEM SW532 (4104) ....., 107135915 BROWN , ELEANOR G DOB: 03/09/1934 71 SX: F !TR MRN: 7056275 ADM/REG DT: JIlGJ:""A ITE ~. INLAND VALLEY MEDICAL CENTER M NO. . PAGEBr:z., OF' --.. Ot Page 4 of4 INl}IND VAlin' MEDlCl<l CENTEIl RANCHO SPRINGS MEOlCAl CENTER t -. l,p ~ ,... () v ~w ~ RECEIVED /.., 0 .Y NAME 6= -~- - - I ENROUTE /'Ie X- ADDRESS ft> Cffl)o,. \ \ ~ L <.u r -, d.eJ loA 1--/ ZIP ARRIVE I V /..~< PT. CONTACT It/,V Phone: ~\.... - '2..S '9 g Social Security No. .s. ~ ~ S <f " fa t.f ~ DEPART i Ivill 1 2 (I. AGe:l1- 008 3 JCi.M 0 M ~ F =~~. 14 S i b\ ~~~ fill 1 eLL ~:~:::T. i I..AI Y nt.. Au-,(' - LJ~c'v"'~ F'o. ~. vS: - 1~~.^._\'",:d~'(: Tf' ~f,'" hI d, I~".A-t-f:' r), (J}st'{ t-JCl.) J. J. ,(" (-t.) · n'7.^ (t r --r:.....lvh'.~ I~'h - P-v-.-1-1 l--''&o ,c:::x'-+ T '- MEDICAL Hx (~L"OW;'-'" .... j- MEDICATIONS '(~~I\OW-' o NKA i\IIergics ("" l<- A () { ...} SKIN COLOR MOISTURE SKIN TEMP. .2 12 12 a :.J Normal J 'J N.,,-....,I tJ '..IN..nnal '~AsIl~.. i~ oj I)ry oj d H... U U Cya_1c ~'" J 'J Cool :.:l '.1 flush<d U l.J I'rofus<" U Q Cold U '-' lauodkrd ,...... , V L. ~ ~~F--= - - l\'n:OICAL TRAUMA .~I:I:U".':.\'ft>>U:"'.'W-"~1;l.JilI-1~ AMERICAN MEDICAL RESPONSE / RIVERSIDE o MODER~ o CPR RI\TI~ I : IY""""'" ~ .tE PUPILS I. R J ..J I.jnpoint A./. Resp<>..-i n .J J SI"l!g.... :j :J Cal3racls CAP REALL 1. it '''/- Equal :~ IjD<'qllal 'j lJ Fixed lj W Dila'L-d Pmfl. Inc. #.;o7~ f::'..J) Olher Pro'lidere;<)~ <{,'~Z Dale _- /~ ( ~ ~ Uni' <f 1. J locatio. . _.f._ I (J,( "7";;' CilY / E Zone. /?. CARE DNO ONoCPRI~CTz OUedical OF~,jBLS PRIOR TO 0 AlS ! 0 None 0 Law Enlorce ; ] ALS ARRIVAL 'illOlher BLS i OOlner TIME CODE ODOMETEH I 2 l3 --- ty..\ - ~~.~ell- \It::t;A 5~i ~4 -) C'''';\t'<''~J~MD 1 Z I 2 (JLrtt Iml11~dial. t!I W-tl......a1 ~ :!1 D<-Ia)'cd ~'. ZI Shallo,,: !!J !!t .:"lfthe- oJ.) Rdract,,-e '!!i~ T WNLABN o 1l1~ ~ ROO Faciat'Denla' ~ g g ~:Idtr$ l\1 AD. O.0e!,1 - - ~. . - , o 0 Abdo",..'1I DO-Pelvis D. L.fr. \,~ /.I...J-b MEDICAL l--" EMERGENCY SITUATION OR TRANS. ~ RESTRAlNTS NEEDED _ UNCONCIOUS OR POS. SHOCK ...... OXYGEN LPM: 2 4 6 II 10 12 ~ IMMOB1UZATION I POS. FRACTURE POS. - CV A '01\ MI HEMORRHAGE BED CONFINED DUE TO: MOVE VIA STRETCHER. ONLY 01lIEJl REASON: HOsP. CONTAcrED .' V.N\(' TIME o No Contact Q VHF a UHF ;YPbone (J BLS INFO '1.ALS JNFO 0 AJ.s CONSUL T/ORDERS & . A L. I. _ .I. I { . I\..L. r . /. ..' I I REC'G SVC J, IN''h ~ "\..1 nMu..VJ}f' <- h'W i-........j,...,.Y7D /~ "-,, (...~.I\....1"..v&..1 \..lCLOSEST ~UMAJCltlnCALC^R.; ::'",.1..'N-~ ^ "'#<{.h, Ou\ I J",o r.\l:'\."... (: U :\ A>>.'h'-. <,;,..,., ;">,,;.....74 ~I'TREQUEST JMF..DREI){lr:~<;T :JOTHF.R ~ c.:u.~-'" G.,d, fff~~'f ~^ il., ,ir..,J[,1;f 7;..~/Zcj;u.: (., !<'''''/' &kf/"tJ I Lt:r; &s....,I 1') t')PfOA.sM~ ..; n'to.) (PH6AP.,e - v;lWfL") .Jo -t........ C~4~ EdI~" /.u-r 17,7V~ -rr/hi -I'l../u;.v' - ztf .f /~'r4''''' N/[i tI cJ.... r .- ~r;::f,::IJ~~: ;I:::~~ ;;'~7sd~::~;;:;~ l /J~~_~;:: ;;,::;~~~~~::t :;;' ~~~~~f 'tl~ '" r-xf /.?.J - \. - '.AA ~ ./,"11 / <'..7 A 1/ C',k/ SOn I; .s ~,b A J....." -I ik /..n(.. 11..... ,,1f;../J'1.'-' P: I JD d.c.-(,,,,",,:,.J'f t.:y ~ ~ E:. ..."tyk. ft. Or'd (/..J IV' al/&, ,d-f>---t ou...1 <'1 t24:I ,,::.... 'Jr- a, L4/0- -'-' L. Il6lf-rre~JriD-5 ~rC-e.d4 . ,-'iroN u/'7T p"f qJ k ...14,4 .4 - C' ()- ....00 Member ,. If""". r,'"... \"'..."" I! N",... .0<,.... Me".....r.' N",,,,' .' I~ d ~~M/T~.' '8 EM~~':,..,... ... ~..I 'r.~~n.f' ~"\lT.1 J r:o.H.1' r>...r J b,lk,,). J Ollltl ~__ -r.,.<J , ~~..,.. kJi.IN/<27"l. VUrJ TR"':-;rE REC'D B . N1ilk..c 'f (",'n"..,.., . c...."..<<. PROVIDER 'J R:-;. U I-1D AGENDA ITEM NO.1l n(~ I~') PAGE p)?-, OF \LO ~ TIM,:. _PULSE Ralt I Oeo.:ripbon !'I/I ~'...t ~ /Y'{.O ~") I {''Y ~ ,..(.-+0 Lung Sounds G:, '"7r-. 7,.., Ld'-o f" J-..L c..A f.- C:hl l 'f"2-~ L.I" __ ,-.. , ~osed Vehicle g Seal Bell rlJ Air B.g 0 As.......1I 0 Fall ~ Pl= Space Jntrus 0 AIf\"J' ",pact speed 0 SUS?ECTED 0 >2Of1. o SUIV. of Fa1ll1 Acc. , Ho',.. ~ a.. IJOMESTIC V10Lf~CE 0 E1tcllic sOOck o Ej<<1Cd (rom Vebicl~ RF.VI~ 0 GSW 0 Hazmal E.,,,,,,. ~ Eltlri<:ation RcquimJ TRAUMA 0 Stabbini! 0 Thermal Bum o PedlBike V$. Vehicle SCORE 0 00 Accidental 0 Sport.~ ...D JdJl!QIl:}'CJe/Moped . 0 OOlmcnliorlal 0 WI< Rd.iei!' o Vs. Veil 0 Helmet 0 0lIter 0 Unkoown TIME CARE RENDERED INIT J.V. SIZElSITE ROUTE DOSE l'I'Ic/ /1',,;..;~., _ ;] i ~ ,4v....~-nI....:. &~' '0./'"//9,, rJ.1 "J\. ~/.... 'o-i.-flJA (. '~L6~ f \h'_Z-- Q .f A.J- c.D I A '-"- '0... ,'-/ -r1<-a 1~?lJ n... f1t 0) I ~ fA..l A- /}....f '11<-,,) I "2./ ,. I r. ~, I /...V r...l"r'F" , Lt;::l,.c:; ft ., ", 0::;:- "'- ^ 'i-....,,~.... I '-i.,a:} .... ~ i '-I, '- ~o..... ro r.. ^.J... d ~ IU~ i6 Q ...r.A." ~ (:,I> - L4 ~ RrSllhs. .t 0 .. to.. ., 0 .. LO -'1..0 f-O t.-().. + 0 .. .0.. I 2 ~ iI/ Spontan...",. I!J '.liTo Voke ;:) '.;j Tn PaiR ~l!J~I)"t' 1 2 I 2 tI ~ Ohcdicnt 'iJ ~ ()r~.'''''' ~ .iJ IlourptlSCruJ :.!I;J c.lftr"~41 9 ]twilhdr:rw:r '~ ~pprepriatr .~;~ Fled.'1l -.:.J ~J~ ; :~ ~lI f=xt~nsjf)n '/J ill NoDr i .JJ :.u NOM TIME EKG RHYTHM JOllLE.<; EJ(G RHyr-iM .s::: ~ A. flu Lv^" ~ ~c.~ Jv fi)X -~ --- WNI.=Wilhin Normal Um;'" "nN=Abnorm.11 o No Apparent lnju'....~ WNL ABN o o o o C",nilal.llnn. o Back o Ex.rcmilics . .._-~ . - . L Nl.M JfT !'lEB ./ "'\ I ..h I '-.... <-../ MEDICAL TRAUMA .~ .f~u.,-,l". ...t~.Jl"'l"'..$.'1;l.h"""1=- Uale Locatior Volil ......, NAME ADDRESS .., ..... Phone: AGE-4--L- DOB ". ... -; i. '. ZIP / ,l i OM GF Social Security No. Approx. Appro". Weight Heighl_lilI~ l:D IlEDICARE # MEDI.CAll MIA # I PATIENrs 0 SPOUSE"S or 0 RESPONSIBLE PARTY.S EMPLOYER RELATIVE I FRIEND MPlOYER ADDRESS RELATIVE I FRIEND ADDRESS n-Y STATE ZIP CITY STATE ZIP ELEPHONE # TELEPHONE II ~SURANCE NAME NAME OF INSURED SS # RELA TION3HIP ~SURANCE ADDRESS POLICY # 1.0. I CERTIFICATE ,I ;ny STATE ZIP TELEPHONE II GROUP /I OTHER II OTHER # PART 1 - MASTER SIGNATURE STATEMENT I requBSl lhal payment of aulhol'lzed Medicare or OIher insurance benefits be made e;1Ilet' 10 me or on my behalf ro American Medical Response to< any amtlulal'lC& services and sop(>;es furnished 10 me by American Me<fical Response. I aUlhorize any hoIde. 01 mediCal inlormation about me 10 release 10 Ihe Cenlers lor Medicare and Medicaid Services (eMS) or any 01-",. third party payor and as agents and Carriers. as _ as American Medical Response. any inlormalion Of OOCumenlalion 10 their possesston neede" 10 <lelermine lhese benefits Of !lie benEfits payable '0' related senrices. now or in the luture. I agree 10 pay AMR aU charges that my ;nsura'lCe does not pay. except where othErw;se provided by Jaw. f haVtt been noltli&d by A "ofn that prior authorization may be required for this transport. If pto autho,ization was nol obtained. . aS$Utn& all I"es.pon$tbility to, any charges not paid by fny instwaoce C81"rifl....(s). fA 4:0P). of .his authorization may be used in place of the original). In ad<fdion..' acknowtedge that t was provided with. Of a reasonable attempt was made to provide me wilh. 8 copy of American Me<fIl""-aI RE:Sponse'S Notice ot Privacy Pracricp.s and rny rights In aCCOJdance with the Heafth Insurance PortllDilily and Accovnt..bi~ly Act 01.1996. also known as HIPAA. Signature of Beneficiary 1 ~ Oaled: Pallent is unable to sign because (stale reason) Dale: By: Signature of Patient Rept9$.entativo Relaliooship 10 Patient Address Of. for Facility Personnel. Name 01 Facility PAR~AnENT UNABLE TO SIGN I NO REPRESENTATIVE AVAILABLE iva is available/willing .' on beha~pat~ The signalure <loes nOl constihrte acknowledgement 01 llnane",1 responsibility 10. the s....".:es a-- ~ ~ ~ By: Srgnaluretrttle of Medical Transport Pe.sOnnel/Name 01 AMR Ope.al",ns Sile ADVANCE BENEFICIARY NOTICE Medicare rules and regulalions require us to notify you when se",ices prOvided or 10 be provided may nol be cO\IeI'ed by MedK:are. MedIcare. only pays IOJ services thaI it OOlcrm'''es to be reasonable and necessary under Section 1862 (a)(1) 01 the So::ral Securily Act" Medica.e delermines lhat a particular ser"ice. although il would otl>erwise be covered. is - '01 reasonable and necessary- under rile Med'lC8fe program standards. Medicare will deny paymenl lor mal sefVice. We believe that. lor the services provided 10 you or abOul fa be plOvideo to you by this ambvlance company. Medicare is likely 10 deny payment for Ihe following servicE?:: (Specify the services. lor example): ,. Base Rate 2. Mileage FOR THE FOLLOWING REASONS; (Check the reason(s)) 1. Medicare does not cover ambulance transportation 10 a physician's ollice. 2. Medicare does no! cover mileage for transportalion beyond !he nearest appropria'e 'ac,'ity. 3. Medicare does not COVQJ transportation Illaf is 10' Ihe convenience oIlhe palien' or physician. 4. Your physictan has not furnished or provided to AMR a signed Older 01 medlcat necossity reqUired for non.e1ne.rgency ambulance transpoltatfon. 5. Othe. Th8fefOfe. we ole required to give you this notice advising you that in the event Medicate defl:teS ~ymer'l. you will be ,rcSponsible '0' P3yment. P"~ase react thE- Sla.l~nlent beICf.aJ. $1911 it and retUln it to uS. I have been notified by Ambulance service that they believe that Medica.te is. likely to dEI-.y pilymc-nt lOt the ,1Ern~ 01 Set-oil(.€So ,ctc.nhliclf ;:)t".:.:v& for Ihe reasons Slaled. II MeOicare Oeme. payment. I agree 10 be personally and lully ,,,sponsi!>le 10' payment. ....., DATED: PATIENl'S SIGNATURE' J if patient signs with a ma,k (x}. the signature. relalionShip 10 pattent and addfess 01 a witness Int._st be provKted to Ihe space below the signature 'Ina. ....).I;i..1::11~ ;I""~. ':,::lj.SI AGENDA ITEM NO. PAGE ~ ~ OF\l () '6 Patient Contact ;ta iI Rivers~ . e Unit# ~')yee 1: Employee 2: Run# Assoc Run # Patient: Priority: Nature: Caller Location: Map Grid: Transport To: Cancel For: Medicare # Authorize: /""'" h .:g 1: Retleg 2: 4431 902682 903827 2275827 DAILEY. CRAIG HANSON, COURTNEY Not Captured A1 Trans Priority: ALS Emergency TCF FCDF*R6 CDF-WILDOMAR OLIVE ST -Rive/GRAPE ST -RivC 1 897A2 HINl-INLAND V 92595 # Transported: 1 Unit Exchanged. Original Unit 4410. Run Number 2275825 CALL DELAYED FOR CODE SU 'SECOND UNIT IN' (DNM) 431 REQ2NO -ENGINE AND UNIT (DNM) CAll DELAYED FOR CODE FF FIRE FIGHTERON BOARD (DNM) DELAY CODE CHANGED FROM CODE FF FIRE FIGHTER ON BOARD (ONM) TO CODE EC *EXTENDED ClEAN-UP (DNM) :~Illlllllllllllll~ 11111111111111111111111111111111111111 Sched Date: RUN CARD Received: Dispatched: Enroute: OnScene: Transport: Arrival: Available: Cancel Time: 7/24/2005 # 255 14:08:45 14:10:04 14:10:09 14:13:50 14:40:45 14:48:43 14:48:49 Start Miles: 0.1 End Miles: Total Miles: Wait Time: 5.0 4.9 0:26:55 AGENDA ITEM NO. 8 ~.. PAGE 2)S" OF'. I AMBPAC COLLECTPlUS TICKET, I 2275827 ZIP ---------------- ICo-9'S -------------__ ATIENT, BROWN, ELEANOR G I. 78609 DYSPNEA - B 3. E8129AUTO VS AU SOURCE, MC/PI CHG ZONE, RV 2. 78002 TRANSIENT A ~. 78603APNEA (3) CHARGES (FROM COLL+) CHARGEIOESCRIPTION IPROCEDUREIMOOIFIERIICD-9InUNITS AMOUNT IOK? (Y/N/D) , '-'" IALSE SPECIAL I A0~27 IMILE URBAN I A0Y25 I OXYGEN I A0Y22 SH SH SH I 6 I 8Y8.001 132.001 99.00/ AlSE MU OXY TOTAL, $1.079.00 ~ Americ3n Medical Response 20101 Hamilton Ave., Suite 300 Torrance, CA 90502 ....., AOENDA IlEM NO. ~. : PACE ao OF \ut'5 "'W/If AGENDA ITEM NO. 8 PACE ~ OF~ ~ ACENOA ''TEM NO. 9) PAGE ~OF.ll..D~ t , r ~. "-' ACENDA ITEM NO.----B-:' PACEC()_OF~ /"""' AGENDA ITEM NO. 8 3" " PACE L1 \ OF \t 0 - '-"" AGENDA ITEM NO. 0~ PACE 0')~ /"""'" AGENDA ITEM NO. ~C PAce C13 OF l.O~ ~ ....., AGENDA mM NO. ~ ~ PAGcill-OF ~ 0 r' AGENDA ITEM NO.~ PAGEqs_OF~ ......, AGENDA ITEM NO. ~ .. -. PACE C1l0 OF\\ C 3, , ~ CCC20050726185045_90640_770538L1+ZGJ+2740_001 018 Date: Estimate 10: Estimate version: commiUed profile 10: 7/28/2005 1:44:37 pm 7705381050726185045 o SHOP GMACINSURANCE PO BOX 3488 ONTARIO, CA 91761 (951) 201-1397 Fax:(951) 485-4836 . Dama9c A5~;eSSl~d.. By Appraised' For:-' DAYS TO~REPAIR_ conditiorlCode: Type of LOSS: collision Date 'ofJ-oss: 7/24/2005 Arri val Date: Contact Date: ACci dent Date: payer: claim Paid: policy No: 2542920A01 claim Number: 7705381050726185045 Deducti b 1 e: 100.00 Fil e Number: None OWner: ELEANOR BROWN Insured: ELEANOR BROWN ~ Claimant: Address: PO BOX 1152 WILDOMAR, CA 92595-115 Telephone:work phone': (909) 314-2598Home phone: JEREMY SPREITZER Mitchell service: Description Body Sty] ~:, VIN: License: OEM/ALT: 1996 chevrolet 40 Ut 107" WB TGNCs13wl-r2292212 CTC501 CA A 912493 Blazer Lsvehicle production Date: / DriveTrain: 4.3L Inj6 cyl 2WD Mileage: 141,598 search code: GCCAONTARI Color:WHITE Options: Air conditioning,power steering,power Brakes,power windows, power Door Locks,Tilt Steering wheel ,cruise Control,AM-FM Stereo cassette,Automatic Transmission,Deep Tinted Glass, luggage Rack,power Driver seat,Center console,passenger-Front Air Bag,power Remote Mirror,overhead conso1e,Driver-Front Air Bag,power Seats ESTIMATE RECALL NUMBER: 7/28/2005 13:44:36 7705381050726185045 ultraMate is a Trademark of Mitchell International copyright (c) 1994 - 2003 Mitchell International Mitchell Data version: JUl_05_V All Rights Reserved page 1 of 8 ultraMate version: 5.0.208 o Date: Estimate ID: Estimate version: committed profile ID: 7/28/2005 1:44:37 pm 7705381050726185045 o SHOP ~. page 1 AGENDA ITEM NO. 9) PAce9.:L.OF \! Q '~ CCC20050726185045_90640_7705381_1+ZGJ+2740_001 Line Entry Labor Line Item Dollar Labor CEG Item Number Type Op Description Amount Units Unit 1 700004 BOY RR REPLACE FRT SHEET METAL 1,500.00 Q*6.0 6.0T 2 AUTO REF RO FRONT SHEET METAL C5.2 5.2 3 AUTO REF RO ADD FOR EDGES & UNDERSIDE c2.0 2.0 4 LM LINE MARKUP %20.00 300.00 5 700324 BOY RR R HOOD HINGE Q O. 3 #0. 3T 6 700325 BOY RR l HOOD HINGE Q 0.3 #0.3T 7 700326 BOY RR HOOD INSULATOR Q 0.3 0.3T 8 700024 BOY RRR FENDER MOULDING Q 0.2 0~2T 9 700025 BOY RR L FENDER MOULDING Q 0.2 0.2T 10 700045 FRM RR REPLACE FRAME ASSY -F500.00 Q*25.625.0T 11 lM LINE MARKUP %20.00 100.00 12 700052 MCH RR ADD TO CLEAN/INSPECT/PAINT FRAME -M Q 2.5 2.5T 13 700138 B[}Y' RR L FRT REPLACE DOOR ASSY 300.00 Q*1.6 1.6T 14 AUTO REF RO l FRT DOOR C1.3 1.7 15 AUTO REF .RO l FRT ADD FOR JAMBS & INTERIOR C1.0 1.0 16' lM lINE MARKUP %20.00 60.00 1-7-- 700140 BOY RR l FRT W/POWER OPTION Q 0.4 OAT 18 . 700142 BOY RR l FRT DOOR LATCH Q 0.3 0.3T 19 , 700144 BOY RR l FRT DOOR GLASS Q 0.6 0.6T 20 700146 BOY RR lFRT DOOR REGULATOR Q O. 2 #0. 2T 21 700148 BOY RR l FRT DOOR MIRROR Q 0.3 0.3T 22 700212 BOY RR REPLACE REAR SECTION/ROOF 1,500.00 Q*26.5#26.5T 23 AUTO REF RO REAR SECTION/ROOF c11.812.0 24 AUTO REF RO ADD FOR EDGES & PILLARS C2.0 2.0 25 lM lINE MARKUP %20.00 300.00 26 700221 MCH RR FUEL TANK -M Q INC 1.8T 27 700266 BOY RR TAILGATE MOULDING Q 0.2 0.2T 28 *** END OF ATG SECTION *** 29 201805 MCH RR AIR BAG MODULE-DRIVER FRONT -M694.16 0.3 #0.3T 30 200785- MCH RR INST PANEL -MI75.00 Q*6.7 6.7T 31 LM lINE MARKUP %20.00 35.00 32 AUTO REF AO CLEAR COAT' 3.9 33 AUTO AC PAINT/MATERIALS 350.00 * T 34 AUTO AC HAZARDOUS WASTE DISPOSAL 3.00 1< ...., ..., * -judg-eine-nt~-fh~iri - # - Labor Note Applies Q - Quality Replacement Part ESTIMATE RECALL NUMBER: 7/28/2005 13:44:36 7705381050726185045 . UltraMate is a Trademark of Mitchell International copyright (C) 1994 - 2003 Mitchell International Mitchell Data version: JUl_05_V All Rights Reserved page 2 of 8 UltraMate version: 5.0.208 o Date: Estimate 10: Estimate version: committed Profile ID: C - Included in clear Coat calc 7/28/2005 1:44:37 pm 7705381050726185045 o SHOP 30 Qual Recycled Part 175.00 Recycler Information Section: Page 2 ..., AGENDA ITEM NO.~ PACECB_OF~ ~ CCC20050726185045_90640_770S381_1+ZGJ+2740_001 Riteway Auto Parts - RPN 15765 Arrow Hwy. Fontana CA 92335 909-350-2576;909-350-3497 1 1996 Chevrolet s10 pickup COMPLETE NOSE ASSY 17695 VA 1500.00 Description: -#5,CHR-GRL,PTD-FBR,RFF-BONDO,HOD-1 Ie: , CHEVROLET, w/o "zR2" OPT 10 1999 Chevrolet s10 Blazer FRAME ASSY 17833 VA 500.00 Description: 4X2, 4 Dr- OK IC: 4X2, 4 DR, 4x2, 4 DR , 13 1996 chevrolet S10 pickup . LEFT FRONT DOOR 18677 VA 300.00 Description: -LH-MIR-X MAN GRAY NO-MLDGS OK Ie: MANUA, MANUAL , 22 1997 Chevrolet 510 Blazer COMPLETE REAR CLIP ASSY 18686 VA 1500.00 Description: dropgate-(2 PIECE GATE), NO-QWNS IC: 4 0, 4 DR , Disclaimer: The price indications on recycled parts are real or composite values, based on the pricing option selected with QRP. Prices are the latest available at time of inventory download and are subject to change and availability. TO determine actual repairer net or wholesale price, call the automotive recycler of your choice. certain parts located for this quote are interchangeable but are not an exact match. call the automotive recycler of your choice. prior Damage N/A Remarks r' Add'l ESTIMATE RECALL NUMBER: 7/28/2005 13:44:36 7705381050726185045 UltraMate is a Trademark of Mitchell International . copyright (C) 1994 - 2003 Mitchell International Mitchell Data Version: JUL_05_V All Rights Reserved UltraMate version: 5.0.208 o page 3 of 8 Date: Estimate 10: Estimate Version: committed Profile 10: 7/28/2005 1:44:37 pm 7705381050726185045 o SHOP I. Labor Subtotals Body Bdy-S Refinish Glass Mechanical Frame Labor sublet units Rate Amount Amount Totals 37.4 36.00 0.00 0.00 1,346.40 0.0 36.00 0.00 0.00 0.00 27.2 36.00 0.00 0.00 979.20 0.0 36.00 0.00 0.00 0.00 9.5 65.00 0.00 0.00 617 . 50 25.6 50.00 0.00 0.00 1,280.00 Taxable Labor Labor Tax @ 0.000 0.00 Non-Taxable Labor Non-Taxable Labor4,223.10 Labor Summary 99.7 4,223.10 II. Part Replacement Summary Taxable Parts Parts Adjustments Glass Adjustments Sales Tax @ 0.000 @ 7.750 Page 3 Amount 4,669.16 795.00 0.00 423.47 ",.-. AGENDA IlEU NO. e~ PA(j~OF .~~3 CCC20050726185045_90640_7705381-1+ZGJ+2740_001 @ 7.750 0.00 Non-Taxable Parts parts Adjustments Glass Adjustments Total Replacement Parts Amount III. Additional Costs Taxable Costs sales Tax @ 0.000 Non-Taxable Costs Total Additional Costs IV. Adjustments Betterment Insurance Deductible Appearance Allowance Related prior Damage 0.00 0.00 5.887.63 @ 7~750 ..., 350.00 27.13 3.00 380.13 Amount 0.00 100.00- 0.00 0.00 ESTIMATE RECALL NUMBER: UltraMate Copyright Mitchell Data version: UltraMate version: o 7/28/2005 13:44:36 7705381050726185045 is a Trademark of Mitchell International (C) 1994 - 2003 Mitchell International JUL-05_V All Rights Reserved 5.0.208 Date: Estimate 10: Estimate version: committed Profile 10: Customer Responsibility Total Labor: Total Replacement Parts: Total Additional Costs: Gross Total: Total Adjustments: . Net Total: Related prior Damage I. II. III. IV. Labor Subtotals RL-Body RL-Refinish Units 0.0 0.0 Rate 36.00 36.00 RL Taxable Labor GST - E Tax @ 0.000 Labor Tax @ 0.000 Labor Tax RL-Non-Taxable Labor Related Prior Damage Labor Summary 0.0 Part Replacement Summary RL-Taxable Parts GST - E Tax @ Sales Tax @ 0.000 7.750 page 4 Page 4 of 8 7/28/2005 1:44:37 pm 7705381050726185045 o SHOP 4.223.10 5-.-887 ~63 380.13 10.490.86 100.00- 10.390.86 Totals 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Amount 0.00 0.00 0.00 ..., 100.00- ....., AGE.'lDA ITEM NO. B :2, PAGE \CD oF)\. 0 "....- CCC2005072618504S_90640_7705381-1+ZGJ+2740_001 Sales Tax @ 7.750 0.00 RL-Non-Taxable Parts 0.00 0.00 Related prior Damage parts summary Related prior-Total Labor: Related Prior-Total Replacement Parts: Related prior-Damage Total: 0.00 0.00 0.00 point(s) of Impact 11 Left Front Corner (p),15 Total LOSS (S) Insurance Co: GMAC Insurance Address: Telephone: Fax phone: ESTIMATE RECALL NUMBER: 7/28/2005 13:44:36 7705381050726185045 . UltraMate is a Trademark of Mitchell International copyright (C) 1994 - 2003 Mitchell International Mitchell Data version: JUL-05_V All Rights Reserved Page 6 of 8 UltraMate version: 5.0.208 o ,-, Date: 7/28/2005 1:44:37 pm Estimate 10: 7705381050726185045 Estimate version: 0 committed Profile 10: SHOP Body shop: Address: Telephone: Fax phone: State L;c. NO: cycle Time Information Drop off Date: Promise Date: pick up Date: Is vehicle Driveable (Y/N)?: Assisted with Rental (Y/N)?: Inspection site: COPART Address: 1203 S RANCHO AVE COLTON, CA Inspection Date: 7/28/2005 ALL PARTS REPLACEMENT ARE TO BE MADE WITH GENUINE FACTORY PARTS SOLD OR DISTRIBUTED BY THE MANUFACTURER UNLESS OTHERWISE STATED. Repair Dates: Start Date: completion Date: ~ THIS IS NOT AN AUTHORIZATION TO REPAIR. VEHICLE OWNER MUST GIVE PERMISSION FOR REPAIRS TO BEGIN. ALL SUPPLEMENTS NEED PRIOR APPROVAL Page 5 ACE."JDA ITEM NO.~ PAGE~()\_OF~ CCC20050726185045_90640_770538L-1+ZGJ+2740_001 BY JEREMY SPREITZER PHONE 951-201-1397 FAX 951-485-4836 ......" FOR YOUR PROTECTION UNDER CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM; .. ANY PERSON WHO KNOWINGLY PRESENTS A FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIMEAND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON." WE WILL ATTEMPT TO GET AN AGREED COST OF REPAIRS WITH THE SHOP OF YOUR CHOICE, HOWEVER IF THIS IS NOT POSSIBLE, WE WILL EXTEND TO YOU A FAIR AND REASONABLE OFFER TO REPAIR THE DAMAGE TO YOUR VEHICLE RESULTING FROM THIS LOSS BASED ON INDUSTRY REPAIR STANDARDS AND AVERAGE LOCAL RATES. IF THERE ARE DAMAGES RELATED TO THIS LOSS THAT WERE NOT VISIBLE AT THE TIME OF WRITING THE INITIAL ESTIMATE AND NOT INCLUDED IN THE ESTIMATE RECALL NUMBER: 7/28/2005 13:44:36 7705381050726185045 ultraMate is a Trademark of Mitchell International Copyright (c) 1994 - 2003 Mitchell International Mitchell Data Version: JUL_05_v All Rights Reserved Page 7 of 8 UltraMate version: 5.0.208 o Date: Estimate 10: Estimate version: Committed Profile 10: 7/28/2005 1:44:37 pm 7705381050726185045 o SHOP ORIGINAL ESTIMATE, THE ADDITIONAL DAMAGE WILL BE CONSIDERED FOR A SUPPLEMENTAL REPIAR ESTIMATE BASED ON INDUSTRY REPAIR STANDARDS AND AVERAGE LOCAL RATES. ....., ......" Page 6 AGENDA ITEM NO. ~ PACEJD2 OF ./""'"' ccc20050726185045_90640_7705381_1+ZGJ+2740_001 ESTIMATE RECALL NUMBER: UltraMate copyright Mitchell Data Version: UltraMate version: [J /'""" /""""' 7/28/2005 13:44:36 7705381050726185045 is a Trademark of Mitchell International (C) 1994 - 2003 Mitchell International JUL-05_V All Rights Reserved .Page 8 of 8 5.0.208 Page 7 AGENDA ITEM NO.~ PAGE )03.0F..\..UL:i. TRAFFIC COLLISION REPC'"'- CHP 555 CARS Pagel (Rev 1-03) OPI OE. ~-. SPECIAL CONOfrJQNS F);TAl z o I- <t: o o -.J COLUSIClN OCCURRED ON: GRAPE STREET MILEPOST INFORUA TJON~ ;.x' -; AT INTERSECTION WITH: i lOR: OLIVE STREET P ARTV DRIVER'S LICENSE NUMBER I D6756644 DRIVER NAME(FIRST. "'DOLE. LAST) )c. BRANDON RAY SHADE PEDfS. STREET ADDRESS TRIAN , , 24 120 CRAB HOLLOW CIR ; PARKED OTV I STATE / ZIP VEHICLE WILDOMAR 81CV. Q.lST sex THAIR M IBRN HOME PHONE TEVES IBm OTHER r--- , (951)471-10&4 INSURANCE CARRIER HUDSON INSURANCE PARTY DIR OF TRAVEL I ON STREET OR HlGHWAV S I GRAPE STREET DRIVER'S uCENSE NuMBER 2 N2049701 DRIVER NAME (FIRST. MIDDlE. lAST) iXl ELEANOR GERTRUDE BROWN PEDES- STREET ADDRESS T";"'N; 21655 SEDCO HEIGHTS ROAD t., .: PARKED VE!!'.f!.E , I . B!CVc CUST CITY / STATE / ZIP WlLDOMAR SE; I~:~' . IEVES IBm OTHER HOME PHOrJE i (951)471-3154 INSURANCE CARRIER GMAC cIa OF TRAVEL I ON STREET OR HlGP.WAV E I OLIVE STREET PARTY ORIVER"S LICE NSE Nl.IMBER 3 ORII/fR NAME (FIRST. "'DOlE. LAST) [-1 , PEDES. TRrAN STREET AOORESS PARKED VEHIClE ~ ! BICY. CllST f.] OTYI STATE J ZIP l-m rES SEx OTHER HOME PHONE ,'-, i I INSURANCE CARRIER OIR Of TRAVET ON STREET DR HIGHWAV PREPARfRS NAME B R. DEAN 10601 HEIGHT 5-08 I STATE CA HEIGHT 5-09 -,SlATE HEtGHl Page D .CITY SOUTHWEST JUSTICE Nt..fAER ~o I ..r &R\P" fao....w n UNfNCORPORA TED NUMBER KIlLED =:e~ COUNTY 1 T, RIVERSIDE '. J IS~A;E I C~ss I A':BAG T SAFETV~OlHP CA 92595 TR/.CE Vea< W WEIGHT BIRTHOA TE Mo Day 7/16/1985 160 BUSINESS PHONE (951)719-5157 POlICY NUMBER HSC 40511 65 TSPEED LIMIT 35 I ~ 1 AI~BAG 1 SAFE~EOlHP CA 92595 WEtGHT BIFUHOA1E Mo Oar 3/911934 [RACE Ve... W 145 BUSINESS PHONE NONE POlICV.......BER UNKNOWN 15P~~~ L~IT I CLASS I AIR BAG I SAfETY EOUlP. WEtGHT 1RACE Yea, Mo BIR1HOA1E lhy I BUSINESS PHONE POliCY NUMBER I SPHOttMn OtSPATCH NOTlflf.O 'X;YES I ' :-~NO t. ..i 01 JUDICIAl DISTRICT LOCAL REPORT NlJ>A!lER REPORTING OfSTRtCT BEAT 2005-07-0277 ......, AA() DAY 7/24/2005 VEAR TIME 124001 \400 NCJC >> J OFFICER J.D. I 10601 ; x: NONE 9685 DAY OF WEEK TOw AWAY [Xl YES flNO I PHOTOGRAPHS BV: SUNDAY STATE HWY REL n VES iX I NO VEH. VEAR MAKE I MOOE\./ COLOR 98 FORD RANGER P-UIRED LICENSE NUMBER 6M30030 STATE CA OW",ffR'S NAME iX, SAME AS IlR1VER L-' OWNER"S ADDRESS ! X ! SAME AS DRIVER ~ - DISPOSITION OF VEHICLE ON ORDERS OF: I X IOFFICER ODRI\IER U OTI-tER BROTHERS TOWING - (951)674-074(--' PRIORMEOt.DEfECTS :xlI>lONEAPP. r ; REfER TO NARRATIVE VEHlCt.E IOENTIFICATION-NUMBER: } FrZRl5X3WPA673 14 VEHlCl..E TYPE DESCRIBE VEHICLE DAMAGE SHADE .. DAMAGED AREA CJLINK nNONE OMJNOR fJE [XlMOD HMAJOR nROlL-DIIER ; DOT 1 . TCPIPSC UC/Ml( 1 22 I CA CAt.T VEl<. VEAR MAKE/MODEL/COLOR 1996 CHEVBLAZER WHT lICENSE NUUIlER 3TCT50\ STATE OWNER"S NAME ......, fXl SAME AS DRIVER L.....: OWNER'S ADDRESS 1)(1 SAME AS DRIVER L.i DISPOSITION OF VEHICLE ON ORDERS OF: ~OFFICER LJDRIIIER LOTHER BROTHERS TOW - (951 )674-074\ PRIOR MECHANICAL DEFECTS jXlNOHE APP. VEHICLE IDENTlFlCAnON~R: r REFER TO NARRATIVE VEHIClE TYPE DESCRIBE VEHlCt.E DAMAGE nUN!( L.J nMOD 07 I SHADE IN DAMAGED AREA LJNONE DMINOR D ~ nROlL-OVER . ' 1 ! MCtMx 1 '. CA CAl.T DOT TCPIPSC VEH. VEAR MAKE/MODEL/COlOR lICEHSE NUMBER STATE OWNER"S NAME C SAME AS DRIVER IXIJ,r. i,.--: ~ :: ...L~_, vv I ::....- ;'" <::.i") I j':': ::-:. . 'r':-:,. ,~.~ I ;, . .;:. t... c. . OISPOSITIONQF VEHQE ON ORDERS Of LJOFT~~ tJ~; ~~:~t PRIOR MECHANCIAt. DEfECTS 'lNOHE APP. ^ -,==reFER TO NARRATIVE OWNER"S ADDRESS nSAME AS DRIVER VEHICLE lOENTIf ICATION NUMBER: VEHICLE TYPE DE SCRfaf VE HIClE DAMAGE I DUNK n..oo SHADE INDAMAGEOAf...., P:;AcRlmJ&M NO.~ I I I , . PACE 'ID--\ OF CA CAl-T DOT TCPJPSC MC4I' REVIEWER'S NAME DAlE R{VIEWEO /? J Z~/JS ~NlA P.. e:n~::.~~E. # 143-19 CHP 555 CARSPage2 (Rev. 1-03)OPI 061 Page 2 01 I I~~~.I DA TE Of COLlIS.oN (uo. DAY YEAR. I .001 INC~' HIJUllER 7/24flO05 1400 9685 2005-07-0277 OWNER I OWNER ADDRESS I NOTifIED -.!:ROPERTY eVES ~NC 'lAMAGE DESCRIPTION OF DAMAGE SEATING POSITION SAFETY EQUIPMENT INATTENTION CODE OCCUPANTS L - AIR BAG DEPLOYED MlC BICYCLE - HELMET .... M - AIR BAG NOT DEPLOYED DRIVER PASSENGER A - CEU PHONE HANDHELD A - NONE IN VEHICL E B - CEll PHONE HANOSFREE B - UNKNOWN N - OTHER V.NO X-NO " P - NOT REOUIRED W-YES V-YES C - elECTRONIC EOUIPMENT C. LAP BELT USED D- RADIO/CO I 2 3 1 - DRIVER D - LAP BEL T NOT USED E . SMOKING 2 TO 6 - PASSENGERS E - SHOULDER HARNESS USED CHilD RESTRAINT EJECTED FROM VEHICLE F - EATING 456 7 - STA. WGN REAR F . SHOULDER HARNESS NOT USED o - IN VEHICLE USED G - CHILDREN o . NOT EJECTED 8 - RR. OCC TRK. OR VAN G - LAP/SHOULDER HARNESS USED R - IN VEHICLE NOT USED H.ANIMAlS H - LAP/SHOULDER HARNESS NOT USED 1 - FULLY EJECTED I - PERSONNEL HYGIENE 9 - POSITION UNKNOWN S . IN VEHICLE USE UNKNOWN 2 - PARTIALLY EJECTED 7 o -.OTHER J. PASSIVE RESTRAINT USED T . IN VEHICLE IMPROPER USE J - READING K. PASSIVE RESTRAINT NOT USED 3 - UNKNOWN U - NONE IN VEHICLE K - OTHER ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK (") SHOULD BE EXPLAINED IN THE NARRATIVE. PRIMARY COLlISIO.N FACTOR TRAFFIC CONTROL DEVICES I 2 3 SPE~INFORMATK}N I 2 3 MOVEMENT PRECEDING LIST NUM8ER 1'" OF PARTY AT F Aut.. T COllISION I VC SECTION VIOLATED: CITEOji?ES X A CONTROLS FUNCTIONING A HAZAR...."OUS MATERIAl A STOPPED A 22450A 1'40 B CONTROLS NOT FUNCTIONING" B CELL PHONE HANDHElD IN USE X B PROCEEDING STRAIGHT B OTHER IMPROPER DRMNG' C CONTROlS OBSCURED C CEll PHONE HANOSFREE IN USE C RAN OFF ROAD . o NO CONTROlS PRESENT / FACTOR" X X 0 Cell PHONE NOT IN USE o MAKIHG RIGHT TURN C OTHER THAN DRIVER" TYPE OF COLLISION E SCHOOl BUS RELATED X E MAKING LEFT TURN o UNKNOWN" A HEAD-Ol'f F 75 FT MOTORTRUCK COMBO F MAKING U TURN B SlOE SWIPE G 32 FT TRAItERCOMBO G BACKING C REAR END H H SlOWING/STOPPING WEATHER IMARK 1 TO 2 ITEMS) X o BROADSIDE I I PASSING OTHER VEHIClE A CLEAR E HIT OBJECT J J CHANGING lAHES X B CLOUDY F OVERTURNED K K PARKING MANElIVER C RAII'fIHG G VEHICLE / PEDESTRIAN L L ENTERING TRAFFIC o SNOWING H OTHER": M M OTHER UNSAFE TURNING ~ E FOG/VISIBILITY FT. N N XIHG INTO OPPOSING LAI'fE , OTHER:" MOTOR VEHICLE INVOLVED WITH 0 o PARKED IG WINO A NON - COLLISION P P MERGING LIGHTING B PEDESTRIAN Q Q TRAVELING WRONG WAY X A DAVLIGHT X C OTHER MOTOR VEHICLE I 2 3 OTHER ASSOCIATED FACTORS ROTHER": B DUSK - OAWI'f D MOTOR VEHIClE ON OTHER ROADWAY .IMARK 1 TO:z !lEMS) C DARK" STREET UGHTS . E PARKED MOTOR VEHIClE X A \Ie SfCTIONVlC\ATEO CItED nYES o DARK - NO STREET LIGHTS F TRAIN 22350 IEHO E DARK - STREET lIGHTS NOT G BICYCLE B \Ie SECTION VIOlATED. ono nves FUNCTIONING' H ANIMAL: HHO SOBRIETY - DRUG ROADWAY SURFACE C vc SEClKJN vtOl.ATEO OTED n"YES I 2 3 PHYSICAL X A DRY I FIXED OBJECT: tiN() (MARK 1 TO 2 ITEMS) B WET 01 ., .. .'. x X A HAD NOT BEEN DRINKING C 5NOWY.-ICY J OTHER OBJECT: E VISION OBSCUREMENT: B H80 - LINDER INFLUEI'fCE o SLIF1'ERY (MUDDY. OILY. ETC.) F INATTENTION': C HBO - NOT UNDER INFLUENCE ROADWAY CONOITION(S) G STOP & GO TRAFFIC o HBO - IMPAIRMENT UNKNOW" (MARK 1 TO 2 ITEMS) PEDESTRIAN'S ACTIONS H ENTERlNGIlEAVINGRAMP E UNDER DRUG INflUENCE" A HOLES. DEEP RUT- X A NO PEDESTRIANS INVOLVED I PREVIOUS COLLISION F IMPAIRMENT. PHYSICAL" B lOOSE MATERIAL ON ROADWAY" B CROSSING IN CROSSWALK J UNFAMILIAR WITH ROAD G IMPAIRMENT /'fOT KNOWN C OBSTRUCTION ON ROADWAY" AT INTERSECTION K DEFECTIVE VEH. EQUIP.: CITED H NOT APPLICABLE o CONSTRUCTION - REPAIR ZONE C CROSSING IN CROSSWALK - NOT g:s I SLEEPY/FATIGUED E REDUCEDROADVVAYWIDTH AT INTERSECTION F flOODED" o CROSSING - NOT IN CROSSWALK L UNINIIOL VED VEHICLE G OTHER": E IN ROAD - INCLUDES SHOUlDER MOTHER": X H NO UNUSUAL CONDITIONS F NOT IN ROAD X N NONE APPARENT G APPROACHING / LEAVING SCHOOl BUS o RUNAWAY VEHICLE SKETCH FOR SKETCH DIAGRAM, SEE PAGE 4 0 MISCelLANEOUS . .NDICAlE NORtH ~ AGENDA ITEM N~ PACE \ C~" OF STATE OF CALifORNIA INJURED I WITNESSES I PASSE.. CHP 555 CARS Pa J Rev l.03 OPI061 .5 DATE OF COllISION (MO. DAY YEAR) 7/24/2005 TIM~(2400) 1400 Page 3 01 NCICII 9685 OFFICER to. 10601 NUMBER 2005-1)7.0277 wtTNESS PASSENGER EXTENT OF INJURY("X" ONE) INJURED WAS ('X' ONE) 0Nt. Y AGE SEx PARTY SEAT AIR SAFETY ONLY EJECT FATAL SEVERE OTHER VJS'81..E COMPlAINT MJUBER pos. BAG EOUIP. INJURY INJURY DRIVER PASS. PEo. BICYClIST OT>iER INJURY OF PAIN ,-.# --. .----. f~ n r: n n . . 20 M . . ixi LXf ! '----l ~ i ~ u G L--' l G 0 NAME' D.O.B.' ADDRESS BRANDON RAY SHADE (0711611985) 24120 CRAB HOllOW ClR WILDOMAR CA92595 (INJURED ONLY) TRANSPORTED BY: AMERJCAN MEDICAL RESPONSE DESCRIBE INJURIES: LACERA T]ON TO ELBOW, RIGHT FOREARM TAKEN TO: TelEPHONE (951)47J-1084 INLAND VALLEY MEDICAL CENTER --# ; I !.-1 u VICTIM OF VIOLENT CRIME NOTIFIED () ELEANOR GERTRUDE BROWN (03/09/] 934) 21655 SEDCO HEIGHTS ROAD WllOOMAR CA 92595 (INJURED ONLY) TRANSPORTED BY: TAKEN TO: TELEPHONE (951)471-3154 AMERlCAN MED]CAL RESPONSE DESCRIBE INJURIES: INLAND VALLEY HOSPITAL SKULL FRACTURE, RUPTURED THORACIC AEORT A, PElVIC AND LEFT HIP FRACTURES, R1V. COUNTY CORONER CASE # 2005-4694/1 DEP. FERRlS .PRONOUNCED AT 1725 HRS, DR. PILLAR.- INLAND VAllEY HOSPITAL o VicTIM OF VIOlENT CRIME NOTIFIED .---, # J ;X: ~ NAME' D.O.B. I ADDRESS JUSTINA MARJE CARTER (0610711983) 21199 LEMON STREET WILOOMAR CA 92595 (INJURED ONLY) TRANSPORTED BY: TAKEN TO: TELEPHONE (951)674-5332 DESCRIBE INJURIES: ;--< # n VICTIM OF VIOlENT CRIME NOTIFIED - NAME ,o:O:aJilooREss (INJURED ONl V) TRANSPORTED BY: TAKEN TO: QESCRlBE INJURIES: ,--.# i ! LJ VICTIM OF VIOLENT CRIME NOTIFIED NAME' O.O.B.' ADDRESS (INJURED ONl V) TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: # o VICTIM OF VIOLENT CRIME NOTIFIED NAME I 0.0.8.' ADDRESS TElEPHONE (INJURED ONL Y) TRANSPORTED BY: TAKEN TO: "" DESCRIBE INJURIES: A PREPARER"S NAME B. R. DEAN 1.0. NUMBER 10601 MO. DAY YEAR REVlEWER"S NAME 7/2412005 11 L--.-l PAOEJCX .OOF~( Q '3 VICTIM OF VIOLENT CRIME NOTIFIED MO. DAY YEk ._ _ __ -;;L-- All ME-6:~UREMENTS ARE APPROXlMA Tf;' ANO_NO~_~~ ~CALE UNLE_S~.~~ ~~~~. ~SCAlE s__r _ _______u _h. /if~V' ' ...~~ ,- ~ r- . .._.:~~~-i..::-_ 6 flMt: : 51fl;E;,~ '.-:",_~:? p. _ ;- L.~.... -..... ..-. ~~.: ._~:_~:~~~~:; ""..- ~..- -. : Y' . ;--.;.r '--~-~ :- ":'.:t : _':'4 ~:-! - . : ----\ ---:- .. . '. r-- ., l~ lJl '}..-I .. r-- I Page &~ OfFICER 1.0 / D 0d I tUBER . .5 . 1'6 ~-'.- \2) IHOICATE NORTH .' / " " .' / - . / .,. -. ._/ :. -/~,- " ~,<- >.: i -' "'-J...\ ;.- .... ,_ .,;,c./ ,- -:-~ -.J- - . r ,. d(U~ j. ~ V"I \~ /}..-. DLwb &mct::."--- 51"or .r---.' ~ Ib' -~~:::~~~~l1'EMNO. :8. T "~E \ n-=t ~OF , \.0 3 j II '1 :3j: RE\J?ERS """'" J MO DAY Yf Sosp -.............. ~........'u.._ FACTUAL DIAGRAM CHP 555 PaQe 4(Rev. 1-03) opr 061 I DATE OF COluslON lMO, D"Y YEAR)' ItIUE 114001 . - L- '-f ~ ZOO-:;/ \.J-JU CJLP?;~ -0 (PO ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED /SCAlE = r-/5 I G flArE S,TI~E:l 1 :J I CD y \ \ @) y C{!' @ ~T , I ! ! dO..!S \<tr @J- U> -\ '2,-1 0 "3 -- W" '- ~ 0) ['6' -4 ~I Q) ,@ ".@ \ \ " @/ft v.l- (Q{') @ /\. \~ If\ 21 MO O.AY YEAR ~ \ ~. ~-,-_._-- Page 6'" of f (/i:) \ / '~ INDICATE NORTH ....., ......., /).,1 DL\ \If. & In c. E ,) AoeNDA ITE. M NO. ~"~ oJ' PAOE \~ OF i>-- @ IMO DAY VEAR :.;;.~: asP' 03 7S s.. _.- ...,~ "'-'-'~'->"'''''''''' P..c"lQ NARRATIVE/SUPPLEMENTAL -~:~.l o~'~':;:?c~.~Ty__iotJ\'rME,. ~ aU :.CIC""U"'n L1LP ~~,. fO::~I<' - INUM.'~ VOloo 11 """.O"'E. '.X'.O"'<< TY". .O""'~C"".""TAIL. C'.x.. "''''Llc...alL.':: -fARRATIVE ~Ot.L":ON REPORT o SA U~OATE o FATAL C HIT Be RUN- UPO"-TE CJ SU""'L~MENTAL o OT....ER. o HAl MATERIALS Q SCHOOl. BUS o OTHER: C.STY' JCOV""TY lJ.vOle."'\, 01 ST "ICT . 1"'" ,,,sY,,,CT/..,,. C.TATIO.. ...u....~R' :...OCATION/su.J.. CT sTATe ".C'MWAY -':\,..IOT o YES ~ NO LEX;END ... V Io-H I l'l.k' ()l? Q 1?C:rJl : ":Nl E mTNT Fl'. DIR. SECOND REFERENCE mINT i) Lu,jf. b(LAP~ !;~ 3 .s elD LlltJb UL , v-e Sl. f ( ( I '\ ) q $ \ '> ( '2,~ 5 ( '\ \l -b ,ll 5 L .,!j li"T' . n TR , R.~ I ,; C , L)~ O~ \rI'! , ftJl, O~ n~ ?. Lj f" 1.- t.- ~ '"l.. t. rl.. I 3" 5 J:\IIAT. ":VI ~~ A-5~A-M.-"\' f200.-DW~'1 (ft P6\~\' DC- fLm, \1;1 ..-.') IJ,(}:(' C M(.ttlNlL.M6Nl' J-\) VOI1\iT ~C:- a~ s\' V...-"2- 1'- (...) oP61\\ \) lrr- ~~eL-D (1 H 2.)- LoG\utrf:> \N\:.lUf.- 5,,-,~(. / S~ - GN~ ""-i) Y1=-ILDw DOll~l6 D\ VIJ)e1"2 L.~~ 3 'I LoL'l,t-i> w~VL ~\\) ~ I ~I~'" C;'No 6 "S'I\JbLt '1GWlL-l T)I \J\\)~7 Lt.u:fm 0 n.\JP:.~~ -h.(\.,i7 ~'\AM~ I- ~)~- ~1\Ji) 'F}, JP flltnn' I \Jt(l~l;;S.~o(> <"l {"N \H LOCATION OF ffiYSICAL EVIDENCE # Pr. DIR. REFERENCE mINT Fr. DIR SECOND REFERENCE POINT I tf W e...l ~ l-lN~ G(lf\P~ ~ 11., tJ tl b Lu)f; OLI \16- ST. 7..- ()N ~ r -~ ,5' 1..1 ,r f ? L G -- \ i I "L~ N \ ~ \ ~ to 6 J , ,S' kL / I I ~ ~ G { 11- N I \ CnD ~ I.. \i' -U ~ '\I '2~ ~ ........h ' ~~..~~...~ 'tv 17 '" r.-- JJ. \ ~1Jl. ) v l'_J\V C HP sse: tRev \ ].841 OPI -641 "Janal Mi'_ ?iJ_it&1..v,.-~~', M>ME _roo 0..... - Use- $He.VIO,-"S ~o.t;ons un6J depleted_ <I"- AGENDA ITEM NO. ~ 3:- PAGE \ c:B-OF J l D~_ STATE OF' CALIFORNIA NARRATIVE/SUPPlEI\t,cNT Al DATE OF INCIDENT TIME 07/24/2005 1400 NCIC NUMBER 9685 PAGE ~ OF .<1 OFFICER 1.0. NUMBER 10601 2005-07-0277 "-'" 1 FACTS 2 3 4 5 6 7 8 9 10 11 ALL TIMES, SPEEDS AND MEASUREMENTS ARE APPROXIMATIONS. 12 13 SCENE 14 T -C .occurred in the intersection of Grape and Olive Streets. At this location, Grape Street is a two 15 lane, asphalt surfaced roadway within the community of Wildomar, consisting of one SIB and one 16 NIB traffic lane, painted yellow divider line and the roadway is bordered by narrow dirt and weed 17 shoulders. Refer to the diagram for roadway design and measurements. 18 19 TRAFFIC CONTROLS 20 The intersection of Grape and Olive Streets is controlled by upright and visible stop signs and the 21 painted white limit lines in all four directions. SIB Grape Street is posted with a 35 mph speed 22 limit sign which is visible and located SI of the intersection with Railroad Canyon Road, which is.\wt1I 23 approx 1.8 miles NI of Olive Street. For SIB Grape Street, a large yellow cautionary sign, with an 24 octagonal red stop sign logo, is located approx 750 feet prior to the intersection with Olive Street, 25 warning SIB traffic of the upcoming stop-sign controlled intersection. 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 NOTIFICATION Received an injury accident call approx 1402 hrs. Responded from the office approx 1412 hrs, arriving approx 1427 hrs. Call was actual moderate to major injury accident, with the intersection blocked upon CHP arrival. Both vehicles were towed from the scene by Brothers Towing (951- 674-0741), with both drivers transported to Inland Valley Medical Center for treatment of injury. One. driver received fatal injuries as a result of the accident. Deputy Ferris responded to the hospital and took the incident report 00 the fatal party. VEHICLE #1 (FORD RANGER P-U) was found on its wheels, facing EIB across the NIB traffic lane on Grape Street. Damage toV-1 was major to the front end and towed from the scene by Brothers Towing. 0-1 was located in the intersection, identified by his statement, valid COl and as the R-O of V-1. Both air bags deployed in V-1 as a result of this accident. VEHICLE #2 (CHEVROLET S-10 BLAZER) was found on its wheels, facing SIB across the NIB traffic lane on <;3rape Street, having received major left side damage in this accident. D-2 was located inside V-2 and trapped in the drivers seat upon CHP arrival. 0-2 was receiving medical attehtion while trapped inside, and fire department personnel were in process of using hydraulic equipment to extricate 0-2 from V-2. 0-2 was identified by her drivers license and matching R-O information of V-2.. Family members were contacted at the hospital to confirm D-2's information. SAFETY RESTRAINT SYSTEMS Both drivers were wearing the three point safety belts at the time of the accident, with V-1 having both air bags deployed in this situation. """-'" PREPARED BY B. R. DEAN 1.0. NUMBER 10601 DATE 07/24/2005 REVIEWER'S NAME DATE AOENDA ITEM NO. ~ PAGE \ \rl OF l D.:..s STATE OF CALIFORNIA NARRA TIVE/SUPPLEMENT AL DATE OF INCIDENT TIME ~ 07/24/2005 1400 NCIC NUMBER 9685 . PAGE & OF ~ OFFICER LO. NUMBER 10601 2005-07-0277 1 STATEMENTS 2 0-1 was contacted at the scene, relating he was the driver and solo occupant in V-l at the time of 3 the accident. 0-1 related he was enroute home, to help his father with yard work at the time of 4 the accident. 0-1 related he was SIB on Grape Street, approx 60-70 mph, as he was SIB from 5 Railroad Canyon Road when the throttle linkage stuck on V-i. D-l related he had lifted his foot 6 from the pedal, but V-l failed to slow down as V-l continued up and down the rolling sections on 7 Grape Street. 0-1 related he tried to put his foot under the accelerator pedal, in an attempt to lift 8 and release the linkage, but to no avail. 0-1 related V-l might have accelerated up to 75 mph as 9 he approached the intersection when he began to panic. 0-1 related he tried to slow down and 10 finally hit the brakes hard as he approached the intersection. 0-1 related he noticed V-2 entering 11 the intersection at Olive and 0-1 tried to steer to the left to avoid V -2 but the front of V -1 impacted 12 the left side of V-2. 0-2 related he got out of V-l quickly and tried to find other motorists with 13 water or fire extinguishers, due to a small fire starting in the engine area of V -2. 0-1 related he 14 also tried to find people with cell phones to call 911. 15 16 0-2 was not able to provide a statement prior to succumbing to her injuries. 17 18 WITNESS CARTER (W-1) was contacted at the scene, relating she had been SIB Grape Street 19 approx 35-40 mph when she noticed V-l, also SIB, braking as it approa~hed the intersection at ,.-.:20 Olive Street. W-1 related she also noticed V-2 EIB on Olive Street in a slow turn, possibly for NIB ~1 on Grape Street when the front of V-1 impacted the left side of V-2. W-1 related she noticed V-2 22 had come from the direction of the freeway overpass, and that both brake lights worked on V-1 as 23 it approached the intersection. W-1 related she arrived at the scene and noticed 0-1, who was 24 the solo occupant in V-1, running around the intersection, asking if other motorists had a cell 25 phone or water, since there was a small fire starting in the~f)gine CPJDP;:trtment of V-2. W-1 26 related she went up to D-2, who had been wearing her seatbelt, and tried to offer comfort to 0-2. 27 W-1 related she noticed 0-2 was trapped in V-2, but that the fire had been put out. W-1 stayed 28 with 0-2 until paramedics arrived, and told other motorists not to try to move D-2 prior to the fire 29 departments arrival. W-1 related she is able to identify 0-1. 30 31 32 OPINIONS AND CONCLUSIONS 33 34 SUMMARY 35 Based upon statements and physical evidence, V-1 had been SIB Grape Street, approx 60-65 36 mph when 0-1 failed to notice the posted and visible stop-sign ahead advisory sign upon 37 approaching the intersection with Olive Street. 0-1 finally hit the brakes hard in V-1, leaving 38 approx 125 feet of locked wheel skid marks prior to impacting the left side and drivers door ofV-2. 39 V-2 had been EIB on Olive Street, approx 10-15 mph with 0-2 intending to proceed NIB on Grape 40 Street. The impact of V-1 into V-2 caused V-2 to rotate 90 degrees and stop in a SIB direction in 41 the intersection. The impact also caused the engine compartment to erupt into a small fire. 0-2 /",",,42 needed to be extricated from V-2 by fire department personnel. 3 44 PREPARED BY B.R.DEAN 10. NUMBER 10601 DATE 07/24/2005 REVIEWER'S NAME DATE AGENDA ITEM NO. ~} D4r.s: \, l OF \l D~ S1A TE OF CALIfORNLA NARRA TIVE/SUPPLEMENT AL DATE OF INCIDENT -rIME 07/24/2005 1400 NCIC NUMBER 9685 ~ q PAGE << OF ~ OFFICER LD. NUMBER 10601 2005-07-0277 '-" 1 2 3 4 5 6 ADDITIONAL INFORMATION 7 The accelerator pedal was checked through the interior of V -1, and appeared to be working 8 properly after the accident. The engine compartment was not accessible due to the damage 9 sustained in the accident. It is apparent, by the locked wheel skid marks left by V-1, the braking 10 system was functioning properly at the time of the accident. 0-1 related there was no previous 11 difficulty with the throttle IinkagiiinCe he had. purchased V-1 in June 2005. 0-1 related he only 12 had noticed the engine surgin 8lil . a while, but he did not get a maintenance agreement when 13 he purchased V-1 and did not v he money to fix the problem. 1~ 15 16 17 18 19 20 21 22 CAUSE 23 0-1 is in violation of 22450 (A) VC.- The driver of any vehicle approaching a stop sign at the 24 entrance to, or within, an intersection........ shall stop at a limit line, if marked, otherwise before 25 entering the crosswalk on the near side of the intersection. D-lis also inviolaUofl-oL22350 VC.- 26 No person shall drive a vehicle upon a highway at a speed greater than is reasonable or prudent 27 having due regard for weather, visibility, the traffi~ on, and the surface and width of, the highway, 28 and in no event at a speed which endangers the safety of persons or property. 29 30 RECOMMENDATIONS 31 Request OA prosecute 0-1 (BRANDON RAY SHADE, 7-16-1985) for 192 C-1 PC.- Vehicular 32 Manslaughter with Gross Negligence. 0-1 was driving V-1 approx 60-70 mph on a roadway 33 with a speed limit of 35 mph (posted approx 1.7 miles NI of the intersection with Olive Street), 34 failed to notice the stop-sign advisory sign and failed to stop at the posted stop sign and limit line 35 at Olive Street. The front of V-1 impacted the left side of V-2, causing fatal injuries to 0-2. 0-2 36 had stopped at the stop sign on E/B Olive Street prior to making the left turn for NIB Grape Street. 37 AREA OF IMPACT. AOI was located to be approx 15 feet NI of the center divider line on Olive Street and approx 1 foot EI of the center divider line on Grape Street. This location was based upon physical evidence and measured via pace. 0-1 related he had gone to the Irwindale races during the day, and then had gone up to Seal Beach to go grunion hunting from approx 11 :30pm until approx 3:00am. 0-1 related he had gone with his girlfriend and her mother, and had slept until10:00am. 0-1 related he had gone over to a friends (Ryan Keith) house to help wrap candy and almonds in small lace containers for an up- coming wedding. 0-1 left that house, which was NI of Railroad Canyon Road, and was. enroute to his house to help his father with some yard work when the accident happened. ......., ......., PREPARED BY B.R.OEAN 1.0. NUMBER 10601 DATE 07/24/2005 REVIEWER'S NAME DATE AGENDA ITEM NO. ~. PACE \ \ v2 OF l [J 6 ~ AGENDA ITEM NO. 8 PACE l \ ~ OF \ (..03 ....., AGENDA ITEM NO. ~ PACE~OF\Ci>~ ~...._-_. ._~...:..-/ .- .'" . " IF ~~~l ",-.... AGENDA ITEM NO. ~'\ PACE~OF \ "-03 ....., ACENDA ITEM NO. PACE' \(1) ~ OF \(j)~ ,-- AGENDA ITEM NO. e; PACE \ \ -=1 OF 100- ~ ACENDA ITEM NO. rc} PA.CE ~ \&~.OFJlQ3... /""'"' AGENDA ITEM ft.O. PAGE \ f-i ~ OF J l 0 3 ....., AOENDA '~M NO.~ PAGEJ '/r)_OP~ 1"'""" AOENDA ITEM NO Q ..., .,': PAGE \,2) ._o~J)LQ,~ 018 CCC20050726185045_90640_7705381_1+ZGJ+2740_001 Date: Estimate 10: Estimate version: Committed Profile 10: 7/28/2005 1:44:37 pm 7705381050726185045 o u SHOP GMAC INSURANCE PO BOX 3488 ONTARIO, CA 91761 (951) 201-1397 Fax:(951) 485-4836 Damage Assessed By Appraised For: DAYS TO REPAIR _ JEREMY SPREITZER condition Code: Date of ,"-oss: Contact Date: ACci dent Date: payer: claim Paid: Policy No: Deductible: OWner: Insured: Claimant: Address: 7/24/2005 Type of Loss: Collision Arrival Date: 2542920A01 100.00 ELEANOR BROWN ELEANOR BROWN Claim Number: 7705381050726185045 File Number: None PO BOX 1152 WILDOMAR, CA 92595-115 Telephone:Work Phone:(909) 314-2598Home phone: a Mitchell Service: Description 1996 chevrolet Blazer Body Style: 40 Ut 107" WB VIN: IGNCS13W7T2292212 License: CTC501 CA OEM/ALT: A 912493 LSvehicle production Date: / Drive Train: 4.3l Inj 6 cyl 2WD Mileage: 141,598 Search code: GCCAONTARI Color:WHITE Options: Air Conditioning, Power steering,Power Brakes,Power windows, Power Door Locks,Tilt Steering wheel,Cruise Control,AM-FM Stereo cassette,Automatic Transmission,Deep Tinted Glass, Luggage Rack,Power Driver Seat,center console,passenger-Front Air Bag,Power Remote Mirror,overhead Console,Driver-Front Air Bag,Power Seats ESTIMATE RECAll NUMBER: 7/28/2005 13:44:36 7705381050726185045 UltraMate is a Trademark of Mitchell International Copyright (c) 1994 - 2003 Mitchell International Mitchell Data version: JUl_05_v All Rights Reserved page 1 of 8 UltraMate version: S.0.208 o Date: Estimate 10: Estimate Version: Committed Profile 10: 7/28/2005 1:44:37 pm 7705381050726185045 o SHOP """ Page 1 AGENDA ITEM NO.~ PAGel. 2Q._OF~ /"'"" /"'"" CCC20050726185045_90640_7705381_1+ZGJ+2740_001 Line Entry Labor Line Item Do 11 a r Labor CEG Item Number Type Op Description Amount Units Unit 1 700004 BDY RR REPLACE FRT SHEET METAL 1,500.00 Q*6.0 6.0T 2 AUTO REF RO FRONT SHEET METAL C5.2 5.2 3 AUTO REF RO ADD FOR EDGES & UNDERSIDE c2.0 2.0 4 LM LINE MARKUP %20.00 300.00 5 700324 BOY RR R HOOD HINGE Q O. 3 #0. 3T 6 700325 BOY R~ L HOOD HINGE Q O. 3 #0. 3T 7 700326 BOY RR HOOD INSULATOR Q 0.3 0.3T 8 700024 BOY RR R FENDER MOULDING Q 0.2 0.2T 9 700025 BOY RR L FENDER MOULDING Q 0.2 0.2T 10 700045 FRM RR REPLACE FRAME ASSY -F500.00 Q*25.625.OT 11 LM LINE MARKUP %20.00 100.00 12 700052 MCH RR ADD TO CLEAN/INSPECT/PAINT FRAME -M Q 2.5 2.5T 13 700138 BOY RR L FRT REPLACE DOOR ASSY 300.00 Q*1. 6 1.6T 14 AUTO REF RO L FRT DOOR C1.3 1.7 15 AUTO REF RO L FRT ADD FOR JAMBS & INTERIOR C1.0 1.0 16 LM LINE MARKUP %20.00 60.00 17 700140 BOY RR L FRT W/POWER OPTION Q 0.4 O.4T 18 700142 BOY RR L FRT DOOR LATCH Q 0.3 0.3T 19 700144 BOY RR L FRT DOOR GLASS Q 0.6 0.6T 20 700146 BOY RR L FRT DOOR REGULATOR Q 0.2 #0.2T 21 700148 BOY RR L FRT DOOR MIRROR Q 0.3 0.3T 22 700212 BOY RR REPLACE REAR SECTION/ROOF 1,500.00 Q*26.5#26.5T 23 AUTO REF RO REAR SECTION/ROOF C11.812.0 24 AUTO REF RO ADD FOR EDGES & PILLARS c2.0 2.0 25 LM LINE MARKUP %20.00 300.00 26 700221 MCH RR FUEL TANK -M Q INC lo8T 27 700266 BOY RR TAILGATE MOULDING Q 0.2 0.2T 28 *** END OF ATG SECTION *** 29 201805 MCH RR AIR BAG MODULE-DRIVER FRONT -M694.16 O. 3 #0. 3T 30 200785 MCH RR INST PANEL -M175.00 Q*6.7 6.7T 31 LM LINE MARKUP %20.00 35.00 32 AUTO REF AO CLEAR COAT 3.9 33 AUTO AC PAINT/MATERIALS 350.00 * T 34 AUTO AC HAZARDO~S WASTE DISPOSAL 3.00 * ~ Judgement Item # - labor Note Applies Q - Quality Replacement Part ESTIMATE RECAll NUMBER: 7/28/2005 13:44:36 7705381050726185045 UltraMate is a Trademark of Mitchell International copyright (c) 1994 - 2003 Mitchell International Mitchell Data Version: JUL_05_v All Rights Reserved page 2 of 8 UltraMate version: 5.0.208 o Date: Estimate 10: Estimate version: committed profile 10: C - Included in Clear Coat calc 7/28/2005 1:44:37 pm 7705381050726185045 o SHOP 30 Qual Recycled Part 175.00 ~ecycler Information Section: page 2 AOENDA ITEM NO.-5..-. PAOE )2-~_O'~ CCC200S0726185045_90640_7705381-1+ZGJ+2740_001 Riteway Auto Parts - RPN 15765 Arrow Hwy. Fontana CA 92335 909-350-2576;909-350-3497 1 1996 Chevrolet S10 pickup COMPLETE NOSE ASSY 17695 VA 1500.00 Description: -H5,CHR-GRL,PTD-FBR,RFF-BONDO,HOO_1 IC: , CHEVROLET, w/O "ZR2" OPT 10 1999 Chevrolet S10Blazer FRAME ASSY 17833 VA 500.00 Descri ption: 4X2, 4 Dr- OK Ie: 4X2, 4 DR, 4X2, 4 DR , 13 1996 chevrolet S10 Pickup LEFT FRONT DOOR 18677 VA 300.00 Description: -LH-MIR-X MAN GRAY NO-MLDGS OK IC: MANUA, MANUAL , 22 1997 Chevrolet S10 Blazer COMPLETE REAR CLIP ASSY 18686 VA 1500.00 Description: dropgate-(2 PIECE GATE), NO-QWNS IC: 4 D, 4 DR , Disclaimer: The price indications on recycled parts are real or composite values, based on the pricing option selected with QRP. Prices are the latest available at time of inventory download and are subject to change and availability. To determine actual repairer net or wholesale price, call the automotive recycler of your choice. Certain parts located for this quote are interchangeable but are not an exact match. Call the automotive recycler of your choice. Prior Damage N/A Remarks ESTIMATE RECALL NUMBER: UltraMate Copyright Mitchell Data Version: UltraMate Version: o I. Labor Subtotals Body Bdy-s Refinish Glass Mechanical Frame Labor Summary II. "-" Add'l 7/28/2005 13:44:36 7705381050726185045 is a Trademark of Mitchell International (C) 1994 - 2003 Mitchell International JUL_05_V All Rights Reserved 5 . O. 208 "-" page 3 of 8 Date: Estimate ID: Estimate Version: Committed profile 1D: 7/28/2005 1:44:37 pm 7705381050726185045 o SHOP labor Sublet units Rate Amount Amount Totals 37.4 36.00 0.00 0.00 1,346.40 0.0 36.00 0.00 0.00 0.00 27.2 36.00 0.00 0.00 979.20 0.0 36.00 0.00 0.00 0.00 9.5 65.00 0.00 0.00 617.50 25.6 50.00 0.00 0.00 1,280.00 Taxable labor labor Tax @ 0.000 0.00 Non-Taxable Labor Non-Taxable labor4,223.10 99.7 4,223.10 Part Replacement Summary Taxable Parts Parts Adjustments Glass Adjustments Sales Tax Amount 4,669.16 795.00 0.00 423.47 "-' @ 0.000 @ 7.750 Page 3 AQENDA IT.EM NO. ~ .:2, ~ PAoej2:LOF { 0 /"""'" CCC20050726185045_90640_7705381_1+ZGJ+2740_001 @ 7.750 0.00 Non-Taxable Parts parts Adjustments Glass Adjustments Total Replacement Parts Amount III. Additional Costs Taxable Costs sales Tax @ 0.000 Non-Taxable Costs Total Additional Costs IV. Adjustments Betterment Insurance Deductible Appearance Allowance Related Prior Damage 0.00 0.00 5,887.63 @ 7.750 350.00 27.13 3.00 380.13 Amount 0.00 100.00- 0.00 0.00 ESTIMATE RECALL NUMBER: ultraMate Copyri ght Mitchell Data version: UltraMate version: o 7/28/2005 13:44:36 7705381050726185045 is a Trademark of Mitchell International (C) 1994 - 2003 Mitchell International JUl_05_v All Rights Reserved 5.0.208 ;---. Date: Estimate 10: Estimate Version: Committed Profile 10: Customer Responsibility I. II. III. Total labor: Total Replacement Parts: Total Additional Costs: Gross Total: Total Adjustments: Net Total: IV. Related Prior Damage labor Subtotals Rl-Body Rl-Refinish Units 0.0 0.0 Rate 36.00 36.00 RL Taxable labor GST - E Tax @ 0.000 labor Tax @ 0.000 labor Tax Rl-Non-Taxable Labor Related Prior Damage Labor Summary 0.0 /"""'" Part Replacement summary RL-Taxable Parts GST - E Tax @ Sales Tax @ 0.000 7.750 Page 4 Page 7/28/2005 1:44:37 pm 7705381050726185045 o SHOP 4,223.10 5,887.63 380.13 10.490.86 100.00- 10,390.86 Totals 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Amount 0.00 0.00 0.00 100.00- 4 of 8 ACENDA ITEM NO. e:> PACE \ 2S' 0' \ Lo :s ccc20050726185045_90640_7705381-1+ZGJ+2740_001 sales Tax @ 7.750 0.00 '-' RL-Non-Taxable parts 0.00 0.00 Related Prior Damage Parts Summary Related prior-Total Labor: Related prior~Total Replacement Parts: Related prior-Damage Total: 0.00 0.00 0.00 point(s) of Impact 11 Left Front Corner (P),15 Total LOSS (s) Insurance Co: GMAC Insurance Address: Telephone: Fax phone: ESTIMATE RECALL NUMBER: 7/28/2005 13:44:36 7705381050726185045 UltraMate is a Trademark of Mitchell International copyright (c) 1994 - 2003 Mitchell International Mitchell Data Version: J-ULOS_V All Rights Reserved Page 6 of 8 UltraMate version: 5.0.208 o Date: Estimate ID: Estimate version: committed Profi-l e ID: 7/28/2005 1:44:37 pm 7705381050726185045 o ......, SHOP Body shop: Address: Telephone: Fax phone: State Li c. No: cycle Time Information Drop off Date: Promise Date: pick Up Date: Is vehicle Driveable (Y/N)?: Assisted With Rental (Y/N)?: Inspection Site: COPART Address: 1203 S RANCHO AVE COLTON, CA Inspection Date: 7/28/2005 ALL PARTS REPLACEMENT ARE TO BE MADE WITH GENUINE FACTORY PARTS SOLD OR DISTRIBUTED BY THE MANUFACTURER UNLESS OTHERWISE STATED. Repair Dates: Start Date: Completion Date: THIS IS NOT AN AUTHORIZATION TO REPAIR. VEHICLE OWNER MUST GIVE PERMISSION FOR REPAIRS TO BEGIN. ALL SUPPLEMENTS NEED PRIOR APPROVAL page 5 ......, AGENDA ITEM NO. ~ PACE \?-J>> OF Q 3 ".- CCc20050726185045_90640_7705381_1+ZGJ+2740_001 3Y JEREMY SPREITZER PHONE 951-201-1397 FAX 951-485-4836 FOR YOUR PROTECTION UNDER CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM; .. ANY PERSON WHO KNOWINGLY PRESENTS A FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIMEAND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON." WE WILL ATTEMPT TO GET AN AGREED COST OF REPAIRS WITH THE SHOP OF YOUR CHOICE. HOWEVER IF THIS IS NOT POSSIBLE, WE WILL EXTEND TO YOU A FAIR AND REASONABLE OFFER TO REPAIR THE DAMAGE TO YOUR VEHICLE RESULTING FROM THIS lOSS BASED ON INDUSTRY REPAIR STANDARDS AND AVERAGE LOCAL RATES. IF THERE ARE DAMAGES RELATED TO THIS LOSS THAT WERE NOT VISIBLE AT THE TIME OF WRITING THE INITIAL ESTIMATE AND NOT INCLUDED IN THE ESTIMATE RECALL NUMBER: 7/28/2005 13:44:36 7705381050726185045 UltraMate is a Trademark of Mitchell International copyright (C) 1994 - 2003 Mitchell International Mitchell Data Version: JUL_05_v All Rights Reserved Page 7 of 8 UltraMate version: 5.0.208 o Date: Estimate 10: Estimate Version: committed Profile 10: 7/28/2005 1:44:37 pm 7705381050726185045 o SHOP ORIGINAL ESTIMATE, THE ADDITIONAL DAMAGE WILL BE CONSIDERED FOR A SUPPLEMENTAL REPIAR ESTIMATE BASED ON INQUSTRY REPAIR STANDARDS AND . AVERAGE LOCAL RATES. ~ ".- Page 6 AGENBA 'TEM NO.8. ~ PAGEJ 2-q OF ) lo ~L CCC20050726185045_90640_7705381_1+ZGJ+2740_001 ESTIMATE RECALL NUMBER: UltraMate Copyright Mitchell Data version: UltraMate version: o 7/28/2005 13:44:36 7705381050726185045 is a Trademark of Mitchell International (C) 1994 - 2003 Mitchell International JUl_05_v All Rights Reserved 5.0.208 Page 7 '-' page 8 of 8 ""-"" '-' ACENDA ITEM NO.~ PACEJ2B_OF~ ~ \() o o ('l .s 'V ('l >. ~ ...: {-. ~- ....-..'----- '. /"". ..e. .tIS 1 o ~ ~ ~ -< Q) ~ .gg ~ ~ ~ ..g ~ $Xl >- - t) < .~. ~. ~. ~.. .;.q'>~ ". . ....~.....>...'.......:...::!ol...."..I..'."....,:!"). ..'1.....; 'f;;fiS@''''';. .. ,," ..... c: ." .,S'.., "0.,. "*/;'.;.q Cl . ..:' .' ~: p.. ~ >< ~ ~ v -< :J ~ ~ ~ ~ ~ ~'.g ~ .~.ttl 8 ..:t: ... tIS ~ tn:: '''~<e~ ~:...'(i:i."" ~ .i: .a;. . fi1.i".f1: A~~ .8 " .::; 'u:l .. '" c:: 0 ~ b.O '" "':-' :::>.. .' - -~..'. - .~g' P'2'''':p <:> 8 .;; ~.. Z e'~, ~ ~8....g u t go .... 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IJ? .af. ,.,~ v ........ t'S ...... o Q) U) ~ c:: c-j ..r:: ~ ..... ~ ,U ~~ "" :3 ."...., s:: (V) C"'l CI) S ~ rh 0.... ~ (V) I V) (V) 00 CI) c: ro a o ~ ;.... s:J;.... s:: 000 g K 0 B ..g P ~" . b... ~, ] ii_ii(i'~ii~~ ~ .if" .....<'I.._'.D ~ ~!;~f;tr'~J~ ~i .. ......... ".. 1: : O} ttt '. "5 :: tro ~ <:t; a.. "::::s jo o ..c !--)f- c: o CI) CI) <1) .....J ....... ro <1) ;.... tJ ~ o r:: V n. CI) o tJ ~ bl) o - ::s u.l CI) s:: o ....... o <1) c;:: <1) ~ o @ c ::s E .~ ~ .D ::CO I,-. ..0 ,'::8 'ij 00 ro H ro .D ;.... ro t:q CI) "'0 s::: <1) ;E "'0 ~ ~ ] ~ ,.0 CI) ~ ;.... ro E <1) ~ <1) CI) 's o ;.... a.. c..-. o s::: 8 ~ r:: d ::: CI) ..... 0 ~- ;:r:u '. .' f- A r.a. ~ .~ E- :z ....... ~. ACENDA ITEM NO.~ PACE\-6'~ J AGENDA ITEM NO. R ...-;'.. PAGEl ''?>2 oFt\n~ .~~\. ~ .~...'."...........,.........'....."'" . "~". '. . " ':.: :.,.f ," " .. ....., 1.....'......11.'.' ~'~ r ACENDA ITEM NO. ~ACE1MoF ~~. January 25, 2006 TO: City of Lake Elsinore ATTENTION: Frederick Ray, City Clerk RE: Claim Claimant D/Event Rec'd Y/Office Our File Patricia Brown v. City of Lake Elsinore Patricia Brown 7/24/05 12/30/05 1400019 RQ 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 & CO. :-h1~ Richard Marque cc: CJPIA Attn: Executive Director CARL WARREN & CO. r--. CLAIMS MANAGEMENT.CLAIMS ADJUSTERS 770 Placentia Avenue, Placentia, CA 92870-6832 Mail: P.O. Box 25180, Santa Ana, CA 92799-5180 Phone: (714) 572-5200 . (800) 572-6900 . Fax: (714) 961-8131 AGENDA ITEM NO. ~ PAGEJ.3; OF ~ O~ Robert E. Magee Mayor Robert Schiffner Mayor Pro Tern Thomas Buckley Councilman Daryl Hickman Councilman Genie Kelley Councilwoman Robert A. Brady City Manager City of Lake ELj.ino7-e ff OnE- City ~got cilI(o'tE- JJ "" January 19,2006 Dwight Kunz Carl Warren & Company P.O. Box 25180 Santa Ana CA 92799-5180 Dear Mr. Kunz: Enclosed for your handling is a claim received on December 30, 2005 from the Law Offices of Michael H. Silvers on behalf of Patricia Brown (CL #2005-36). Please keep me advised of appropriate City Council Action. For further assistance, please contact me at (951) 674-3124 ext. 262. ......, Sincerely, / / ~ <<CITY CLERK CITY OF LAKE ELSINORE Enclosure cc: City Manager Finance .""""". 130 cSouth cMain cShEd) 1akE E[1.inou, CcI1- 92530 fJe[ephone (951) 674-3124 'Jax (957) 674-2392 wwwlake-E!1.ino7.E.o7.9 ACENDA ITEM NO. Y3 PACE ),,-3.QOF \ \O~ ./ /"'" CLAIM AGAlNSr THE crry OF LAKE ElSINORE (:For Da.aa.qe. "to Per.ou or Par.o~l Property) //30~s' lteoaive4 by: City a.pr..entative (Tiae/Date lecaived) A cla1.m m1ut bo fUel! with the City Clerk of the City ot Lake Zb.tno~e, whhin six (6) IIOntb8 after the incident or event occurred. Be sure your claiJa 1. a~ain.t tbe City of t.ak. Elsinore, not another public entity. Whare apaee i. in.ufflcient, ple... u.e addltLonal paper and identify information by paragraph nUlllbar. COmpleted clailu ~tt be JQil~ or dQl~vQrad to the City Clerk, City of ~ Sl.inor., 130 Soutb X.in Itr-.t, Lake il.inore, California 92530. TO THE RONORULB KAYOR Am) CITY CO'OJiCIL, CITY O~ UIB n8nrOU, QL:tJ'ODn. The underaigned respectfully .ubmits the following elaiM ~d information ~.l.tive to damag. to peraon. and/or peraonal property; PATRICIA BROWN 1. m.xE OF CUl.MANT a. AddreaaofClaimant 21655 Sedco Heights, Riverside, CA 92595 b. l>hono No. { 9 ~ 1 - 3 1 4 - 5 327 d. Social Security No. c. Dah of Birth - 1/27/6q e. Driver. 1.ic. Ho. rt;?28107 '-.2. Name, post offic~ Ilddre88 and- tlRlaphona to whieh cl.imant de.1r.. notlc:all t.o be ..nt, if other than thQ abOVQ l ( 3 1 0 ) 551 - Q 5 5 1 LAW OFFICES OF MICHAEL H. SILVERS - 11500 West Olyrnric Boulevard 8~~~8n~t2* . ~'l,~tA&&tT_t~rCh ~~.9 gPa~ aria..: 3. .. Date 7/24/0S b.'-ime 1..1QQ Grape Street & Olive Street c. l>lace (~~..~ and sPacific location) River~ide, California d. Bow and \lnder wh4t cirCWQtancea did dlllllage or injury occur7 _SP.c:1fy the particular oceurrence, event, act or oml.8i~n you claim eau..d the injury or damaQe (u.e additionlll paper if naeasaary). SEE ATTACHED e. ~ha.t particular action by the. City or ita BIploy..., cau.." tl).. alleQad damao. Or injury? SEE ATTACHED ., .~ - ...-" . /"'"'" '- AOENDA ITEM NO. ~ PAGE 12,-=t- OF \~ O.j, 4. Ware then anr 1njuri.. at the timlt of thh inci<1anU If t.here ~e DO injud..., Il1t&te -Ho Injuri..-. ~RR .ll.'T''T'2\{"llR~ ........, 5. Giv. the name{.) of the City ~ployae(.) e.~.in~ the d&ma~e or injuryl Unknown at the present time pending further investigation and discovery are continuing. 6. )f~ and adc;lr... of any other per.on injured; R1 ~1n~r c.:prtrnnp Brown ~ Der.pi'lRPn). ~hpri Fnc::h:"r Bl">vl">r11l Brown and Patricia Brown. 7. Hame a.nd addree. of thit DWner of any damaged property; Eleanor c.:l">rt-rnnl"> 'RrOlA7n rlnn 'Rl">v<=>r11{ Rrf"'\tA7n . P () 'Rnvl152. Wildomar. CA s. .Damages claimed; a. Amo~nt claimed a. of thi. date b. ~.tlmat.d amount of future ~0.t8 c. Total amount Claimed d. Bada forccmputation of UlOWIlta clailDltd invoicea, eBtimDtes, ate); ~RR 2\'P'1'2l("URD RYHTJ:l.TT "~" $ 42,948.97 $ fJnopt-prminpn at $ tlftdQt~""lrft~~ at (Include COP... 0" 1. h, Present Present 9. N~.e and addre.Dea o~ all witn....., ho.pital., do~ora, etCt ~ Justina Marie Carter- 2119 Lemon Streetf Riverside, CA b. ......., c. 10. Any additional info~tion that might be helpful in con.idoring thia ela~1 SEE ATTACHED' WAlUJIlfG: IT IS A CJWlDQL OnuSI '1'0 PILI >. pn8B ~... TN f (punal Code 72/Inaurance Code 556.1) I laVA r.ad the matters and .tlSt~nt. made in the above claim and r know the .... to be tru~ of my awn knowledge, .xoept .. to tho.. IIUltter. -tat.1;1 upon in:format1on Or belief... to auc:b matters, 1 bel.ieve the .JUDe to be true. 1 certify under penalty of perjury tbat tb. foregoing h TRUE AND CORRECT_ SIGNED THIS 29th DAY OF pl">r'pmnpr , CALIFORNIA. CLADUNT'8 ~-.A ~ BIGNATtTRB: // ~ ~ P ITRI CI A BR6wN 2005 , 19_, AT Los Anqeles, Cll ~ ~ 1- ** TOTRL PAc; 03 **. "....: ~G~NOA ITEM NO. \r;E \ ~ OF ~~ January 25, 2006 TO: City of Lake Elsinore ATTENTION: Frederick Ray, City Clerk RE: Claim Claimant D/Event Rec'd Y /Office Our File Beverly Brown v. City of Lake Elsinore Beverly Brown 7/24/05 12/30/05 1400019 RQ 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 & CO. ~~ Richard Marque cc: CJPIA Attn: Executive Director /'"'" CARL WARREN & CO. CLAIMS MANAGEMENT.CLAIMS ADJUSTERS 770 Placentia Avenue, Placentia, CA 92870-6832 Mail: P.O. Box 25180, Santa Ana, CA 92799-5180 Phone: (714) 572-5200 . (800) 572-6900. Fax: (714) 961-8131 ACENDA ITEM NO. ~) PAGE \,3l OF \ LD ~ Robert E. Magee Mayor Robert Schiffner Mayor Pro Tern Thomas Buckley Councilman" Dilryl Hickman Councilman Genie Kelley Councilwoman Robert A. Brady City Manager .~- City of Lake EL1-ino7-E "-" January 19,2006 ((,(\ /7 I /2 . _1111 1/ 'L.Jiu:. city.i '::::lot <::::::/vlo~e Dwight Kunz Carl Warren & Company P.O. Box 25180 Santa Ana CA 92799-5180 Dear Mr. Kunz: Enclosed for your handling is a claim received on December 30, 2005 from the Law Offices of Michael H. Silvers on behalf of Beverly Brown (CL #2005-37). Please keep me advised of appropriate City Council Action. For further assistance, please contact me at (951) 674-3124 ext. 262. Sincerely, '-"" ......, 730 .south cdl1ain .st'Cut} ..rake; ELj.inou, Cd! 92530 Clde;phone; (957) 674-3724 'Jax (951) 674-2392 wwwlake;-e.[j.ino7-e..o7-(/ TEM NO 9 ". ,. J ACENDA'.)- PACE \Lb OF lCO ~ . ~ Y, CITY CLERK CITY OF LAKE ELSINORE Enclosure cc: City Manager Finance -----" ,,-... ;LAIM AGAlNSI' THE CITY OF LAKE EImNORE (:tor Daaaq.. 1;0 ~er.oD.II or Par.onal Property) / ;r/3~J Jt.oeiv.4 by: city aepre.ent.t!ve (Tta./Dat. a.oelve4) A claim lIlu.t bo fUed with the C1.t.y Clerk of the City of Wlut Khine.., wi~hin d.x <') -.onth. After th. incident or event occurr.d. Be aur. your claJ..zai. aiain.t the City of ~tt Elsinore, not ano~h.r public entity. Where apace i. in.utficien~, pl.... u.. additional paper and iderttify information ~y paragraph n~r. COaIplatad cl.aima WNrt be m.ail~ or dRlivRrad to the Ci~y ClerK, City of Lake Elainore, 130 South Main Itreet, L~ .1.ino.e, California 92530. '1'0 THB JlONOIlULB KAYOR AND CI'1'Y COt7JilCI:L, CITY 01' UK. n8nroaz, CJU.%J'OUD., Th. under.ignad respectfully .ubmit. the following claiM and information relative to damag. to per.one and/or personal property: 1. NAME OF c:.t.A1MANT Beverly Brown A. Addreaaofclaimant Post Office Box 11S~;"~ildomar, CA 92595 6/12/27 c. Date of 8irth e. Driver. Lie. Ho. N2051459 b. PhonQ No. (9 5)1 - 4 71 - 3 1 5 4 ,-.. d. Soeial SQcurity No. Name, post office addrellB andtalaphonato whieh elaimant d..ir.. notlC:.1I to be ..nt, if other than thR abOVR t (31 0 ) 55 1 - 0 551 LAW OFFICES OF MICAHEL H. SILVERS 31500 West Olympic Boulevard, Suite 322, Los Angeles, CA 90064 3. Occurrencaorevent from whi.ch thi. clailllari...: l. Date 7/24/05 b.~ime 1400 c. Place (!:It.act and .peeifi~ loca.tion) Grape Street and Olive street Rive:r;~j,de. CA d. Bow and under wh.at eire\UD.tJtanc:e. did daJDage or 1njury oceur1 _Specify the particular occurrenco. evont, act or omi.8i~n you claim eau..d the injury or damaQ. (u.. additional paper if neee.aary). SEE ATTACHED e. ~ha~ particular ac~ion by the City or 1tl -=ploya.., e&u..~ th~ alleged damao. Or injury? gRE AT'I'AC~lID .;. " , .- ,-.. - ....,.-. AGENDA ITEM NO. PAGE \L\ \ 8 OF \ lO 2) .. Wer. there any inj~i.. at th. time of thb inc:ic1enU If there were no inj\U'!e., rtat. -Ho Ini\U'1.... S~E ATTACHED ....., 5. Give ~ha ftarM{a) (If the City employee(.) c.'U.ing the damage or injury, Unknown at the present time pending further investigation and disco.very are continuing.. 6. lfU* and .dlk... of any other per.on injure.dl E19:in9r ~~rt-rlln~ "Rr0wn (O,PCAi'iRP-n), Bpvprly Brown, Pi'itrieji'i Brown and Sheri Foster 7. Name and addr..e. of the tJWUer of any damaged propertyt Rl €,;:!Inor G9rtr1ld9Br.o,,,n. ;:!Inn "R~u~rl}t. "Rrnwn Post Office Box 1152, Wildomar, CA 92595 B. llamagea claimedt A. Amount claimed .. of thi. data b. Zatimated lUllOunt of futlU'e coat. c. Total amount Claimed d. Baei. for computation of amoumt. invoiee., e.timates, ete)l $ 42,948.97 $ UnQQtQrm;noQ at $ TT~09+-~r~ at {Inelude eop .. o. 1., Present Present claJ..JMd SEE ATTACHED EXHIBIT "An 9. N~.e and addrea8aa of. all witn...e., ho'pital., do~or., atCt a. Justina Marie Carter - 2119 Lemon street, Riverside, CA. b. '-'" c. 10. Any additional information that mi9ht be halpful in conaidaring thi. e1atml SEE ATTACHED WARNING: IT IS A caIKIDL OnuSI TO I'ILI ~ PALIK ~1"TVl (P8nal Code 72/Inaurance COde 556.1) I have r.ad the matters and atatement. IMde in the above claim and I know the .aIDe to be t:ru~ af my own lcnowlad98, .xaapt .. to tho.. matter. .t-ate" uJj>On in:format1on Or beliet .. to aucb matter., I believe the .ame to be true. 1 certtfy under penalty of P*rjury that the fore9oing b TRUE AND CORRECT. SIGNED THIS 29th December , i~05, AT Los Angeles, CA CLUlUNT'S. BIGDTtJRB: DAY OF CALIFORNIA. ~~ . Beverly~rown ( I r I ,...." ** TOTAL PAGE.03 ** AOENDAITE..MNO.~. . PAOE~OF -\lQ3:~ ~~A January 25, 2006 TO: City of Lake Elsinore ATTENTION: Frederick Ray, City Clerk RE: Claim Claimant DlEvent Rec'd Y/Office Our File Seeley v. City of Lake Elsinore Robert Seeley & Samuel Rizal Seeley 10/29/04 1/6/06 296448 RQ 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 & CO. :hl~ Richard 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. Box25180.SantaAna,Ca 92799-5180 Phone: (714) 740-7999 . (800) 572-6900. Fax: (714) 740-94]2 AGENDA ITEM NO. k PAGE \4 ~ OF ,- Robert E. Magee Mayor Robert Schiffner Mayor Pro Tern Thomas Buckley Councilman Daryl Hickman Councilman. Genie Kelley Councilwoman Robert A. Brady City Manager (lit!) of LakE EL1-ino7-E '-" I( <OnE. City ~ got c/lI(ou II January 23, 2006 Dwight Kunz Carl Warren & Company P.O. Box 25180 Santa Ana CA 92799~5180 Dear Mr. Kunz: Enclosed for your handling is a claim received on January 6, 2006 from Inglis, Ledbetter & Gower on behalf of Robert Seeley, and Samuel Rizal Seeley (CL #2006-2). Please keep me advised of appropriate City Council Action. ......., For further assistance, please contact me at (951) 674-3124 ext. 262. Sincerel , ~ FREDERI CITY OF Enclosure cc: City Manager Finance ......., 730 cSouth cJl1ain atud, LakE. E[1.ino7.E., Cc:If 92530 ClclE.phonE. (957) 674-3724 '3ax (957) 674-2392 www.fakE.'E.[1.ino7.E.07.Q ~ . J AGENDA ITEM NO. PAGE~OF Har 09 05 02:43p 1 19)46~~ 90~(g~n~~li ~n "~ U . 0 ~J . CLAIM AGAINST THE CITY OF LAKE ELSINORE ' (For Damages to PerIOD or Penonl Property) C\1Y CLERKS Off\CE arlene Best ",..-.-, . Received by: (TimelDate F .eoeived), City Representative A claim IIIUSt be filed with the City Clerk of the City of Lake EJsi.ooro, ymbin six (6) months after the iac.i Jeut ore event 0ClCUIRd. .Be.1U["C your daim i. apiaIl the City of Lab Elsinore, DOt IDOIbcr public eotity. Where IpICC is iDSUfticienr. plcue use additioaaI paper and identify intormatioa by pmsrapb lUmber Completed deimsmust be . led at delivered to 'the City acrt, City ofLate Elsinore. 130 South Main Street, Lake Elsinore. California. 92530. TO THE HONORABLE MAYOR AND CITY COUNcn., CITY 011' LAKE ELSINORE, CALIJi'ORNIA: The ~tnisned respectfully submits dte follOwing daim 8Dd iDfonnation ieIativc to dlmage to penoDI' fIIJIOl pcnoDIII pI'OIlCIty: a. Address ofClaimant 888 W. Phone No. (21t 627-6800 Robert Seeley, Samuel Rizal Seeley,c/o INGLIS, LEDBETTEI & GOwER. 6th. Street, Suite 800, Los Angeles, CA 90017 1. NAME OF CLAJMANT /""" b. cl. c. Date of Birth Socia) Sec:urity No. e. Drivers Lie. No. 2. Name. post office address and.tdephooe to wbicll elaimant desites DOtiees 10 be ICUl. if other tha.l the above: 3. ~ orcveat fiom which this daim arises; L Dlte October 29, 2004 b. Tunc approximately 10:00 a.m. c. Place (Exact and tpecifie Jocaaion) Lake Street and Mountain Street, Citv of Lake Elsinore, California d. How and under what circumstanceS did damage or inJury 0CQJt? Specify the particuJIr xcurrence.. evad, IICt or omissioo you claim aiuscd the jnjUl)' or ~ (uao edditioual papa. if~). At the time of the accident, the roadway was in a dangerous condition~. e. What particular ~ by the C'rty ofits ~yees. caused the alleged ctamase or iojur) 7 Roadway was dangerous and defendant had actual and/or constructive knowledge of the dangerous conditions. and sufficient time prior to /"""", the accident to have taken measures to correct the dangerous condition. AGENDA ItEM NO. ~ PACE~OF')lD~7 Mar 09 05 02:43p arlene Best 19)468-9044 p.3 '-' 4. Were there any injuries at the time of this llCCidcnt7 If DOt. state "No injuries-. . Yes S. OJ,,,, the oame(s) of the City employee(s) causing the daniage or injwy: 6. Name Uld addRiI of any penon injured: wrongful death of Wayne Romanski 7. Name and address of the owner of any damaged property: 8. Damages claimed: a. Amount daimed II of this date S b. ~ IIIlOUDt offuture costs S c.TotIJ amowit claimed S . d. Dais for computation of amounts claimed (:tocJude copies of all biDi, invoices, eitimat,.. de): . This is a claim for indemnity. declaratory relief and apportionier ': . raul1: . '-' . . 9. Names and 84dresses of aU witnesses. hospitals. doctors. de: .SEE ATTACHEDCOMFLAINT a. b. c. 10. Any additional information that might be helpful in CODSidering this c:IIim: wAilNING: IT IS A CRIMINAL OFFENSE TO FILE A FAlSE CLAIM! (PeDal code ~ Cod.e 556.1) I have read the matters and atatemeotJ made in the ebo"" claim IDd I bow the IIPICto botrue ofmy OWl! bowIecIse. except II to those matters .. upon infbrmation or belief II to such matten.1 believe the same to.be true. I eerily uocJer peoalty of perjury that the fOn:soiua ia TRUE AND CORRECT. ..SIGNED nus CLAlMANT'S SlGNATURE: aOO5.AT Los Angeles.. . CAUFORNlA. - ---------------~. ....., AGENDA ITEM NO.--B-- PAGEBto-OF .liJ3. "....... "....... r- ,'J. )./ t.I.d~ .ivvo J. J. ; .. ( l.::11b::l tsU<t:.N/KAI'::- 1~;C~7 2005 M t'~ 62/13 SUM-ita B Y: ______~..<<flfl'ClRtlJ&y (SOLO PAAA WO lie LA cottTr:) .::11 " ~ SUMMONS (CITACfON JUDICIAL) NOTICE TO DEFENDANT: (AVlSO AL DEMANDADO): .' CASTLE &.COOK ALBERHILL RANCH LIMITED PARTNERSHIP; ALTFILLISCH CONTRACTORS, INC.; CITY OF LAKE ELSINORE; COUNTY OF RIVERSIDE; STATE OF CALIFORNIA; SAMUEL RIZAL SEELEY; ROBERT SEELEY; and DOES 1 through 100/ Inclusive, ~J>>:- ~ dIU YOU ARE BEING SUED BY PLAINTIFF: (LO ESTA DEMANDANDO EL DEMANDANT~: . WAYNE ROMANSKI, SR. and SHERRI ROMANSKI, i i . I . ' ." I You have 30 CAlENDAR DAYS after thw summons and legal paper. are served on you to me a wri~n r..po.... at thIa court and have.. ; copyserwd on theplalnaff. A lea.r or phone.call will not protect you. Your wrttten ,..pon.e must.'" In pr~pet legal roms lfyolJ.WAnt the ; GOurt to hear your ~e. There may be a GOurt form thet you can use for your response. You can rmd these..court forma end more ..' information at the California Courts Online Self-Help Center (www.courtlnro.c:a.gov/selfhelp). your cOunty lew IlbrMY, 01' the -c:ourthouH . ne.feat ~u. ..11 ~u cennot pay the tmng fee. uk the court clerk for a fee waiver form. If you do not file your ruponM.on time, you may 10.. the case by default, and your wages, money, and property may b. tekenwiChout ~.r wamlng froIn t~ court. .. . Tti,,. ate om., legal requirements. You may want to call an attorney rlght.way. If you do not know an attOrney. you may went to qll an . attorney referral.ervice. If you cannot afford. an attorney, you may be eligible for free legal. services from a nonprofit legal aeMca . program. You cen I~te the.. nonprofit groups et the Cartfornia '-egal Services Web aite (www.lewhelpcallfomia.org), the CaDfomia Courte: Online Self-Help. Center (www.courtinfo.ce~QOvf.elfh.Ip); or by contacting yo..-Iocal court or Cflunty ...,.....ociation. . I r,.".3D olAs D~ CALENDARIO dup~. d. que I. enlreguen ute cilac16n y papele. legales pa,.' pre$enttu flna ruPfluta por ucdlo : en esCa corte, hacer.que se entrepe una eopia .1 de",.ndanee.Une carta o una Ilamada felef6n/c~ .no 10 pro""'" Su rupuut. por j osctI,o Ilene que urar en forma'o 1e0sl GO~o ~I de... que protuen su cuo en Ie eorte. Ell po$/ble que he,. un ronnulMlo que ua'ed puedaunr pan IIU./'NPU"". Pued. .neon".,...to. formu"". . Ie COlW Y inla Infonnad6n en ., Celtlro de Ayuda delu eo".. de CaUfom/a {www.coflrtlnlo.ea.govl.eHhelplecpanol/).en/ablbllot.ead.ley..deauCQndadooen/acorNq_lequedeml.cef.Ca.: . $1 no . puede ".gar" ClIO" dep,..."Cilt:l6n, pldll a/..ere"no fie ,. CQrte que I. 1M un fQnnfl"'r!a d. exenclOn de pqo de cllotN. SI no ptuenu j au fNpuesta a tI.,;,po,. pend. percI.r .1 cuo por Intumplimfento y" cOrte Ie podt'4qular su auoldo, dlnero y "lanes .In m" adv.rtonc/e. I Hfly o~ I'fIqulano. lega/...E. ,.r:omendeble q". "am. e rift abOt/ado Inm~.'.men", Sino cono~. un .bogado. pflede 'lemer a fin fttviclo de ,.",isl6n . abogados. SI no puede pellar aun .bog.do. es po$lI1la que cumplli eon '" reqillsno. peR obtener servlc/oa .I.l1a'" gratulto..de un pTOflrema de .ervlcloa legales 41n fin.. de IuClO. Puede enconlrar ..tOIl tJrUPN..'n II,... de Iucto on ., ..,Uo web d. California Legal Services, (www.l.whelpc8Ufomie.org). en eI Centro de Ayuda de /Q eortes de Ca/Homl.. www.coIittInfo.C8~ ov/Hlfhel ~ 41110 .0 oni6ndose en contllcto con la cO'" 0 eI col. 0 d. eb ed. 1oclI",.. The name arid .address of the court is: (EI nombre y cJirerx;i6n de. I. corle es):. RIVERSIDE SUPERIOR COURT. +() .>0 Mq,,, .s ,-- , /?,,ve..r-'Jde} ()4. 9 z50 I The name. address. and telephone number of plaintiff" attorney. orplelntlff without 81l attomey; .Is: - . {EI nombre, la dlreccl6n y el nOmero de te/efono del abogadO del demandante, 0 de/c1emllndaTJte que no tien. &bogedo, K}: .~atthewB.~. Biren, Esq. CSBfS6565 . (310t 476-3031 Btren. / Katzman ... . -11911 San V1cenLe Boulevard Brentwood, CA90049 OATE~ NOVO 2 2005. . Clerk. by (FechtJ) .. . . . .. (Secretariol .. (For prooto( seMce of this $um~f)$. U$9 Proof of Service of SlJRlmons (form POS-D10).) {Para pruebe de entrega de esta citati6n use e/ formiJlario Proof 01 Service of Summons. (pOS-010JJ. NOTICE TO THE PERSON SERVED: You are served ISE.-u 1. ~ as an individuat defendant . 2. D as the persoll sued under the fictitious name of (specify): . . I. SIRACUSA . Deputy {Adiunto) 3. 0 on behalf of (specify): under: 0 CCP 416.10 (corporation) 8 CCP 415.20 (deft.met corporation) CCP 416.40 (association or partnership) D other (specify): 4. ersonsl delive on 'date: P'etJ. ~ of ~ o CCP 41.6.60 (minor) o CCP 416.70 (conservatee) o CCP 416.90 (authorized person) """"....,.,....,...~u.e JUdICI"COUndI oIC--. SlJN.100 (lWv.-'-'Y 1. ZOO&I c;!~"pA rrEMfftJ.oI VVJ.a;~ACE. \L\ ~ OF \ \ . 0 ~ __ SS 412.20..46S SUMMONS I ..... ..., u,; !at.l:J. ~ ~ · &of I . . . . ..oJ -- \. .. . . . . . . ." . 1.1 "'J.b::>> tfJ.ItN/KA' ~ PAC:iI:::: 63/: ~1 MATmEWB.F. BIREN, ESQ.. CSB #56565 BIREN I KATZMAN 2 I 19 1 1 SAN VICENTE BOULEVARD. SUITE 140 BRENIWOOD. CALIFORNIA 90049-66.17 3 (310) 476-3031. FACSIMILE: (310) 471-3165 "" ~~ HOV0210D5 4. Attorneys for Plaintiffs 5 WAYNE ROMANSKI, SR. and SHERR! ROMANSKI.. 6 7 ... . . - 8 9. SUPERIOR COURT OF THE STAn OF CALIFORNIA FOR THE COUNTY OF RIVERSIDE .~ CASE NO. 439669 .COMPLAINT FOR WRONGFUL. DEATH DAMA(JES ANDREQtJEST FORJURY~ ... ... 10 11 WAYNE ROMANSKI, SR. and SHERR! ROMANSKI, z c( J: N. 13 f- .e( :It: 12 Plaintiffs, v. Z III a: - IG 14 CASTLE & COOK ALBERliILL RANcH 15 LIMlTEDPARTNERSHIP' . AL tFILLISCHCONTRACTORS, INC.; 16 CITY OF LAKE ELSINORE; COUNTY OF RIVERSIDE;, STATE OF .. 17 CALIFORNIA; ;:sAMUEL RIZAL . SEELEY; ROBERT SEELEY; and DOES 18 . 1 through 100, Inclusive, Defendants. eRe. .2005-. BY FAX ~ 19 20 21 Plairitiffs allege: 22 23 PRELIMIN:ARY ALLEGATIONS 24 L Wayne Romanski, Jr. (uJ;>ecedent'')-died on October 29; 2004 as a resWt of the 25 events alleged below; 26 2. Plaintiffs Wayne Romanski, Sr. and Sherri Romanski are Decedent's parents. 27 Pursuant to Code of Civil Procedure section 377.60(a), as pecedent'ssolelegal beirs, .....", 28. Plaintiffs are entitled to bring this action for the wrongful death of Wayne Romanski, Jr. 1 '-""I~p ..,...,.,.,... "''''P"\ br7""t7rr~r"D ""'DV'1".TJr~r ., . i . ~..' u,u "::ClClO il.: .. ( q t.l.:Slb:> tUt<tli/~ Wi t'Abt:. 64/ 3. At all relevant times, defendant Castle & Cook Alberhin Ranch ("Castle & Cook") was a limited partnership authorized to ~do and doing business in the Staie of California. 4. At all relevant times, defendant Altfillisch Contractors, Inc. was a coxporation authorized to do and doing business in the State, of California. . 5. The true names and capacities of Does I through 100, inc~ive, are currently unlolOWD to Plaintiffs who, therefore, sue said defendants by fictitious names. . . . 6. At all relevant times, each of the defendan1S was the agent or employee of eacl of the remaining.defendants an9 was. acting within the course and scope of said ageJ;icYaild employinent. 7. On or ab.out October 29, 2004, Decedent was a passenger in a 1994 Acwa . . . . . . . . Integra proceeding northbound onLak~ Streetin the vicinity of Mountain Street in the City of Lake Elsinore when the vehicle Was caused to overtum,fatal1r in~uring Decea~l 8. The accident oc~d in close proximity to a construction ptoject.located in ". . the 28300 block of Lake Street; 9. Prior to the .accident,gr~und water or rain water nmoff on the constluction .site eroded the roadway and shoul~er of adjacent Lake Street, creating a deep gully. . .. .- 1 Q. Additionally, prior to the accident, debris from the .construction' site was allowed to accumyJate on Lake Street. FIRST C~USE OF ACTION ON BEItA~F OF.BOTH . . . PLAINTIFFS AGAINST DEFENDANT CASTLE & COOK AND DOES 1 THROUGH 100.FOR PREl\fiSES N)tGLIGENCE 11. Plaintiffs reallege paragraphs 1 thrOligh 10 of the First. Cause-ofAction and incorporate the same herein by reference. 12. Defendant Castle & Cook was the owner of the real propenyori 'which the construction project was located (hereafter referred to as ';'the Premises"). :clit: 1200 . 773 2 AGENDA ITEM NO. rnMP1.-A TNT AND REOUEST FOR JURY TRIAL PAGE t . . :. t .1",/ ru./ ~t:It,:) ~~: q, t-'AC.:il:: 8511 '-' , . 1 2 3 4 5 6 7 8 9' 10 11 z 12 e( !: 13 N to- e( 14 ~ - z IS au -= 16 m 17 18 19 20 21 22 23 24 25 26 27 28 .:. /1.:Hb:> tW~N/KA, .N 13. Defendants had a duty to exercise reasonable care in the ownership, occupation, maintenance, management and control of the Premises. 14. Defendants negligently owned, occupied, maintained, managed and/or controlled the Premises, or otherwise negligently conducted themselves. 15. The accident occurred as a result of defendants' negligence. .. 16. As a result of defendants' conduct, Plaintiffs have'beenforeverckprived of the care, comfort, support and society of Decedent, to their general damages, as will be established at tbe time of trial. 17. As a result of defendants' conduct, Plainti~s' have incurred burial expenses, .to their damage, as will be established at the time of trial. 'wIJf SECOND CAUSE OF ACTION ON BEHALF ,OF BOrn PLAINTIFFS AGAINST DEFENDANT CASTLE &: COOK AND DOES 1 THROUGH 100 FOR NEGLIGENCE '-' 18. Plaintiffs reallege the. allegations set forth in paragraphs 1 through 10 of the First Cause of Actif?n and mcorporate the sam~ herein by reference. " 19. Defendant Castle & Cook also functioned as the genera) contractor Qfthe '. , construction project. 20. As the general contractor, defendants had the following non-exclusive duties: A. To supervise th~ subcontractors on th,e' Construction project. B.' To prevent the construction work from interfering with the public rig~t of way. C. To maintain the construction site so that debris from the site was not allowed to collect on adjacent Lake Street. 21. Defendants breached their duties by failing to supervise the subcontracto~ on the constrUction project, failing to prevent the construction work from interfering with the public right of way, and failing to remove construction debris from Lake Street, or othe~e negligently conducted themselves. 3 AOENDA ITEM NO. ~ PACE ~ OF, ,LP:~ .......C'r'tnn..._ "J'77~ PAGE 86/1: BIREN/KAT ,,. . . . 1~~~~~ 1-1:41 3 713165 .' ~ 1 2 3 4 5 6 7 8 9 10, 11 z 12 e( " 1: 13 r-..., l- e( 14 ~ z, 15 w 0::: 16 - aI 17 18 19 20 21 22 22. The accident occurred as a result of defendants' negligence. 23. Plaintiffs reallege the damage allegations set forth in para~hs 16 through 17 of the First Cause of Action and incorporate the same herein by reference. DflR:D CAUSE OF ACTION ONBJ}HALF OF BOTH PLAINTIFFS AGAINST DEFENDANT ALTFILLISCH ',CONTRACTORS. INC.: AND DOES 1 TIIROUGIJ ~OO lOR NEGLIGENCE 24. PlaiDtiffs reallege the allegations set forth in paragrap~ ..tthrough 10 :ofthe First Cause of Action and incorporate the same herein by reference~ . . 25. ' At all relevant times, .defendantAltfi.llisch Contractors, ~c.~ ~e.grading subcontractor on the construction project. 26. /t.:s the grading subcon~ctor, defendants bad a duty to.prevent. their work from interfermg with th~ public right of way on Lake Street. 27. Defc;ndants kneW or should baveknown that iftheir'work.interfered with the public right of way, it would pose a hazard to vehicles traveling on Lake Street. 18. The accident occurred as a result of 4efendants' negligence.. 29. Defendants breached their duty by negligently interfeiing with the~public right, of way on Lake Street, or otherwise negligently conducted themselves. . . '. . . 30. Plaintiffs reallege the damage allegations set forth in paragraphs 16 tb!ough 17 of the First Ga~e of Action and incorporate the same herein by re~erence~ III 23 III 24 ./11 25 1/1 ;;-... 26 1/1 27 //I 28 1/1 .~"....._^^~ ""......,'2 ". AG!;NDA ITEM N~: . 9 - ~IV~'= 15LOF \\..~ 3> ~ 4 . .u I tJ;l1 ~tJtJ~ 11 : 4 f .' - 1 2 3 4 5 6 7 8 9- 10 11 z 12. 4( % 13 N ... 4( 14 ~ z 15 au II: 16 - CD 17 18 19 2Q 21 22 23 24 25 26 27 28 3:'- '13165 BlREN/KAT: PAGE: 87/1: .' 31. FOURTH CAUSE OF ACTIOt{ ON BJ;HALF OF BOTH PLAINTIFFS AGAINST DEFENDAl'iTS Cl'IY O~ LAKE ELSINORE.. COUNTY OF RIVERSIDE AND ST A tt OF CALIFORNIA AND DOES 1 THROUGH 100 FOIl DANGEROUS CONDITIO]S OF GOVERNMENTAL PROPERTY Plaintiffs reallege the allegations set forth in paragraphs I-through 10 of the ~ 'f. First Cause of Action aDd incorporate the same bereinby reference~ 32. Plaintiffs timely fIled a governmental tort cl.aim against defendant City of Lake Elsinore which was denied less than six monthS. before the filing ofthi~ Complaint. 33. P]~intiffs timely filed a goven:unental tort claim against defendant County of Riverside which -was denied by operation .oflaw Jess than six m()Dths before ~e filing of thiS Complaint. 34. Plaintiffs filed an application to file a late (;laim againstdefendant State of " California which was gnin~ed on October 20, 2005. Defendant then denied the. late cl~m on _ . that same date. - 35. At the time of the accident, Lake Street, including the shoulder, in the vicinity . of Mountain Street (hereafter "the Roadway") was public property owned, maintained, managed and/or controlled by defendants. ~ 36. At the time of the acci4ent, the Roadway was. in a dangerous condition, as . . - - defmed by Goverriment Code sections 830 and 835,. for the following reasons: . A. The Roadway was dangerous due to the. presence of debris or other - foreign substance. B. The Roadway was dangerous because of inadequate precautionary devices warning drivers on the Roadway oftbe presence of severe erosion of the Roadway. C. Defendants had actual and/or cODs~ctive knowledge of tbe dangerou~ condition of the Roadway a sufficient time prior to the accident to have taken measures to ""'" correct the dangerous condition. 1':2 AGENDA \TEM NO. ~). - - PACe\SQ... _OF~\~~ 5 ;ijjcSI2005-2773 --. #^. ~.,.- .,- ...------ --- ---. --.. ~. .L.L, c.I"'.~c.lc.I;,.e J.J. : .. ( . . .:l (J.,j.Lb:J 1:UJ<t:,N/1<.A I '" PAl.:it:: eel 1 .' 37. The dangerous condition of the Roadway created a reasonably foreseeable risk of the kind of injury which was incurred. 38. The accident occurred as a result of the dangerous condition of the Roadway. 39.. . As a result of the dangerous condition, Plaintiffs have ~n forever deprived of the care, comfon, support and society of Decedents, to their general damages, as will be established at the time of trial. 40. . As a result of the dangerous condition, Plaintiffs have incurredbUrl81 expenses, to their damage, as will be established at the ~e of trial. FlFfH CAUSE OF ACTION ON BEHALF OF.BOTH PLAINTIFFS AGAINST DEFENJ}ANTS CITY OF ~ ELSINORE. coUNTY OF RIVERSIDE AND STATE OF C~IFORNIA AND DOES 1 TRROUGH.I00FOR mGLIGENCE 41. Plaintiffs reallege the allegations set forth in paragraphs.l through 10 of the First Cause of Action and paragraphs 32 through 35 of the Fourth Cause of Action and incorporate the same "herein by reference. 42. Defendants had a duty to inspect and maintain the.Roadway, inClUding the shoulder~ so that it did not pose adariger to other persons, including Deced~t. 43. Defendants and their employees breached their dutY by negligently inspecting . and maintaining the Roadway, or otherwise negligently conducting themselv~s. 44. . The accident occurred as a result of defendants' negligence: 45. Plaintiffs reallege the.damage allegationsset forth in paragraphs 16 through 17 of the First Cause of Action and incorPorate the same herein by. reference. III 11/ III III AGENDA 'TEM NO. .9) . ... PAGE_\>3..0F \l o~J1 :djt:5I2005-2773 6 ,...,.;..--- ._- .-- -...-.-- --- ------_.- .' J.f' ".G/.~"t:J::l U: '1/ t-'Abt:.. 89/13 .' .. '.. '-1 2 3 4 .:IJ . .1.:1.1b::l l:S.1to<t.N/KAJ~ . , SIXTH CAUSE OF ACTION ON BEjIALF OF BOTH PLAINTIFFS AGAINST DEFE:NJ)ANTS SAM\1J;L ,SEELEY AND ROBERT SEELEY AND DOES 1 " )'HRQUGH 100 FOR NEGLIG~NCE ''-/1f 5' 46. Plaintiffs reallege the allegations set forth in paragrap~ Lthrough 10 of the 6 First Cause of Action and mcorporate the same herein by reference. .... 7 47. At the time of the accident, defendant Samuel Seeley was the operator and 8 defendant Robert Seeley was the owner of the above-referenced vehicle Decedent was 9, withfu. 48~ Each of the de fend ants, including the defendants designated hereinfictitiou~1y. negligently owned, 'operated, entrusted,and maintained the above~referet1ced motor vehicle , ' andlor',otherwise negligently conducted himself, thereby causing the above-referenced accident. 49. Alternatively, e~ch of the fictitiously named defen~ts is liable to PlaintifThJ because said defendants 'negligently designed; manufac1:ll!ed, 'assembled and/or soJdthe ' 23 /1/ 24 III 25 /II 26 III 27 1/1 28 /11 :.tjt:5J200S-271J , ' ,vehicle that Decedent was within, or one or more of the component parts of that vehicle, or . ' . otherwise negligently conducted themselves,' 50. The accident occurred as a result of the negligent conduct of defendants. 51. Plaintiffs reallege the damage allegations set forth in paragraphs 16 through ,17 . ~ ~ of the First Cause of Action and incorporate the same herein, by reference. III " 11/ "will' AOENDA ITEM NO. ~ PAce\S-\ OF \ lO ':2, \ 7 rrllrpT A17\TT ~^,n RF.f">TlF..'\T ,..OR JURYTRJAL ~ 1.1I"~1 ~.,.,~ .U: 4 / ;J:' '1 ~lbo HJ.~/KAT7 't. PAl:it. 16/13 .' .. ,.- .' . WlIEREFORE, Plaintiffs pray for judgment against defendants as follows: AS TO AT .T. CAUSES Of ACTlQ~: . 1. General damages, as established at the time of trial; 2. Special damages, as established attbe time of trial; and, . 3. Cost of suit and such other further .relief as the Court deems appropriate. ~ DATED: November 2, 2005 . By: ~ WB.F.BlREN.. Attorneys for Plaintiffs . '. , WAYNE ROMANSKI, SR. and SHERR! ROMANSKI " AOENDA ITEM No.6 . PAGE1~ OF '\.03 8 :dit:5nOO5-2773 ...."..rnr . noM' HFn "l:'rJ"J:'~ r;orll' "my TRTAT. ~~/O~/~OO~ !!:q/ .'. .' .' --1 2 3 .:U l.:11b:l J:Uk'tN/KA I L! . PAGE . 11/13 . . '. '. REQuEsT FOR roRYTIUAL "'" Plaintiffs hereby request a jury trial. 4. DATED: No~ember 2, 2005 '5' 6 7 8 9. 10 oIl z 12 ~ :r;: 13 N l- e( 14 ~o z 15 III g:: 16 - - .- 17 .- 18 19 20 21 .. 22 .23 24 25 26 27 28 :djr:5l2D05-2i73 BIREN JKAT f.;. '. """ ~ ... .'. ......, . Ae~NDAITEMNO.~. - PAGEJSlp_~ . ... 9 rnVPT An./T A7V1> RF.OrTF.ST FOR JURY TRIAL ......, 'UL' LUU.). J.J....., ,:).1. v ".1. 0;) J:Ut<t:.N1 ~l a t'Abt:. 12/13 CM-010 :FOIt COURT USE OIf.Y r-- A11'ORNeY oil PISCN wm4()I)T ~TTORIEY l~ .... _",.,-r. and eddrw:.J: Matthew B.F. Biren, Esq.CSB156565 Biretl / Katzman 11911 San Vicente Boulevard Suite .140 Brentwood, CA 90049 TeLEf'HOtE NO.: ( 310) 476- 3 031 fAX 1'lO.: ,.,-, A SUPERIOR COURT Of e~ IFORtUAo COUNTY Of RIVERS! DE $TReeT~: -"loSt> /'*4#/4 . sr ~~= )3ye"...$/~ {}tI.. 9.25"0/ ~1WolE: CASENAME: ROMANSKI V. .CASTLE & COOK ALBERHtLI.. RANCH. L M T TN S I A CML CASE COVER SHEET . 00 Unlimited 0 Umited (Amount (Amount . demanded demanded is exceeds $25 000 525 000 ()I'less (Cal. Rules Of COUR. f\Ile 1811) . oeP'T.: All nve 6 items below must be com 19tGd see inStruciions on s e 2 . 1. Check one box below for the case type that best describes this case: Auto Tort Contract . D Auto (22). 0 Breactl of contrectJwarrarity (06) o Uninsured motorist (AG) D eoUecUons (09) Other PI/PDJWO (P....o~llnjury/Property. .0 lJ'\$urance coveRlge (18). Oam.gelWrongful Death) Tort . D . .... 7 Other contract (3 ) D. . Asbestos (04) . Real property . O Product liahDHv (24) . . .. .. wr'" . D emInent domain/lrwerse o MedIcal malpractic8 ("5) '. ~ndemnatiOn (14) . [i] Ott\etpl/POIWO(i3) D wrongful'evlctlon (33) Non.pI/PDIWD fOUler) Tort Dottier realpropel1y (26) o Business tort/unfair business practice (07) . . o ClvIIlights (08) Unlawful O.taln., D oefametion (13) 0 Commerclal (31) o Fraud (16) 0 Resldentiel(32) CJ Inteleclual property (10) 0 Drugs (38) o professional negligence .(25) Judldal RevIeW , o Other non-PIIPDIWO tort (35) . 0 Asset forfeiture (05) . . em loyment .. 0 Petition re: arbltretioo award (11) OWrongtul tennlnatlol\ (36) D Writ of mandate (02) o Othet employinen1 (15) 0 ()ther judicial revIeW @9) 2. This case 0 Is [i] Is not. cOmplex under rule 1800 of the California Rules of eouit. If~ case 1$ complex. mark the fa~or requiring exception~1 Judicial management . a:, 0 large number of 3eparately represented parties <<s.D Large number,of Wttne&$es b. 0 Ext~f\$ivo motion practice ra1singdlfflC?ult or novel e.D CoordInatlonwithrelatedactlonspendlnglnoneormoreeourt issues that win bedme-consuming to resolve . ~ otl)er counties. .states.or countrieS. or In a federal court c. CJ Substantial amount of doCumentary evidence 1. 0 Substantl~1 post-:ludgment judicial supervt&lon . · . 3. Type of remedies sought (che~ 8" that applY): a. CXJ monetary ~.D nonmonetary; declaratory orlnjuncliv~ relief 4. Number of cauSes of actiOn (specify): SIX 5. this ca~e 0 Is [X) is not a class a.ction suit. Date:November 2, 2005 ~atthew B.F. Biren. Eso. cSBi56565 4.39669 JUI)GE: (Cal Rulu of Court, rulea 1800-18 )'0. CJ AntItNSuTtade re~~) '. o cons. ~n defeW#) fl! 1/ D Mas tart (40) . .1lIl o SecuritJeslltlgation (28) . 8 envaronmentaVToxtc; tort (30) . .Insur8nce coVerage C1alms erlslng from the . above listed provisionally complex case typeS ("1 ) , Enfor"~.nt o' Judgment c:J EnfOrcement Of judgment (20) Mlace'''neo... Civil CompS-1nt o RICO (27) .. ., CJ Other C?O"'Plaint(not .peclf.edebove) (42) NlI.eelS-neous Civil Petition . . D PertnQrshlp end ccrPome govemerice (21) o Ott\er petition (not specJfIH ebove) (~) ""....-. NOTICE . PlaIntiff must file this cover sheet with the first paper filed In the actlon or proceeding (eXCQpt smaU elaims-cases or~ses tiled under the Probate, Fam")'. or Welfare end Institutions Code). (Cat. Rules of COurt. rule 201.8.) Failure to file may result in sanctions. . . File this cover sheet In addition to any cover sheet requirad.by local court nile. ' . If this.(;ase Is complex under rule 1800 et seq. of the California Rules of Court, you musts9IVe 8 copy of this toversheet on all other parties to the action or proceeding.. .. . . . UnleSs this is $ com lex case this cover sheet shall be used for statistical u oses on .p · 1 0' OIMa-lOIY CIVIL CASE COVER SHEET ~. .RUIeI. . (;oult.tuIetU.1800-te .IulIkMIc-dlofClllifOmlA ~..~.....1hltT.'t" cu.otO'(Aev. July 1. ZOO3). . DA ". tM N U. .. -4\ '.. . PACE l5 OF \ lO- """..., .......,4.U""'. D.LI'\CJ"l' fVot I~ rMl.:lt;. J.;J11.:J .' SUPERIOR COURT, COUNTY Of RIV~RSIOE, STATE OF CALIFORNIA o BANNING 155 e. Hays. 8aMlng. CA 92220 o BLYTHE 265 North ero.dwllY. B~. CA "2225 o HEMeT 880 N. S.. St., Hem.t. CA. 92~ , .0 .NDIO ....200 0.. St..1tldio. CA 92201 ' '0 MURRIETA 30755-0 Auld Road. MwrIet.t. CA 02583 ~IVERSID! 4050 t.46Jn'st.. Rlllemde. CA 92s0t o RIVERSIDE 4175 Main st., RivetSlde. CA~1 n TEMECULA 41002 County Center 0,_ ..,oo.T~.CA 12591 ........, Name and Address , Haithew a. F. Biren, Esq. Biren / Kattman 11911 San Vicente Boulevard suite 140 ' Brent~Ood, CA 90049 Attorney for praintift or Party without Attorney . (31()) 476-3031 CSB * 56565 ~~ NOY 022005' WAYNE ROOANSJ:<I, SR. and. SHERR! RO$NSK!, Plalntiff(s} ,~." 'CASENO. 439669: vs. CASTLE' COOK ALBERHILL RANCH LIMITED PARTNERSHIP, et al. . CERTIFICATE Of couNSa ......., Defendant(s CRe 2005 ~Y'FAX . . The undersignedcertifles that this metter should be tried or heard in the Ri "er$ide superior Court for the following reason: GO The action arose In this judicial district. . 0 The action concems real property located In this judicial district. o The defendant resides in this judlcfal district. Oa~: November 2, 2005 '~ren /~,,- '\. .. : '\, Signed by: ' . "'. Esq. ....., c-.7-'-) CERTIFICATE OF COUNSEL AGENDA ITEM NO. ~. . PAce\9'f3 OF\\Q3 RI-031 /'" SUPERIOR COURT OF CALIFORNIA COUNTY OF RIVERSIDE. . . . 4050 Main Street Riverside, CA 92501 NOTICE OF TRIAL DEPARTMENT ASSIGNMENT AND CASE MANAG~ CONFERENCE o. . ROMANSKI SR VS CASTLE & COOK ALBERHILL RANCH CASE NO. RIC439669 r-- The above entitled case is ASSIGNED to the HONORABLE Commissioner, JOAN F. BURGESS in Department 06 for ALL PURPOSES~ The Case Management Conference described in Rules of Court 212 is. scheduled for .06/30/06 at 8:30 am/pm in Department 06.. . The plaintiff/cross-complainant shall serve a copy of the Notice .of . Trial Department Assignment and Case Management ConferenceQnall.o . .. defendants/cross-defendants named or added to the complaint and file . . proof of service thereof. . Any challenge pursuant to Section 170.6 of the Civil. Code. of pr.ocedure. shall be made within twenty (20) days (15 days pursuant .to 68616(I)GC plus 5 days pursuant to 1013 (a). CCp) from the date of :this n9ti~ of assignment, or if the party has. not yet. appeared, then within fifteen (15) days after the party's first appearance. '.. 0 If this case has been assigned to a Judge Pro Tempore,. whose 0 appointment as Commissioner. is in accordance with Article Six, Section Twenty-two of the Constitution of this State and who. .has.been appointed as a Temporary Judge pursuant to an.order of. the Court uhder the authority. of Article Six, Section Twenty~one of the . Constitution and section 259 of the Civil Code of' Procedure; within ten (10) days of the date o.f this notice, the parties MUST file a Notice of Non-Stipulation if they do not stipulate to the hearing of pre-trial, trial and all subsequent post-trial law and motiQn matters. before the Commissioner. . ... . Failure to file such notice within (10) days shall be deemed acceptance of the assignment. DATE OF NOTICE: 11/02/05 CLERK'S CERTIFICATE I, Clerk of the above entitled Court, do hereby certify that on this< date; I provided the plairttiff(s) or plaintiffs' attorney of record with a copy of the foregoing NOTICE. .' Date: 11/02/05 by~LERK OF THE V ILZE SIAACS'SA AoENDA ITEM NO. ?J PAGE] ~ OF.. \\.1>~ r-- .'~ ~ .. . ...41 ~ . . SUPERIOR COURt.OF CALIFORNIA comITY OF~IDE ....., NOTICE OF CIVa. CASE MANAGEMENT RULES SERVICE: Unles~ otherwise pemritted by th~. court, the plaintiff mUSt. -- setve "each · defendailt with the complaint and a copy of this Notice of Civil caSe Management Rules, - . . .the Notieeof Assignment and the Alternative. Dispute Resolution (ADR) Packet. .fhe plaintiff must file-proof of servi~ within 60 days of the filing oftbecomplaint. "Ifthe complaint is amended to add anew defendant, the plaintiff must serve the dcfenn Rnt (as , described above) and subseq~t1y file proof of. service within ~ days of the fi1ip.g of the.am~c;i~(t~pl.F!R..i!i!_. ..... .... .--.::...........-.--.. .._..._-_.._~._.:.. . Upon the filing of a cross-complaint, the cross-complainant must serve~h nevYp~:: - with the cro~.-complaiDl and a copy of this Noti,CC? - of Civil Case Management - Rules, __ Notice of Assignment, and the Alternative Dispute Resolution (ADR) packet. The crpss- - """'" eomplainaDt must file proof of service ~thin 3{)days of the filing ()f the cross-' complaint. If a partyhBs previously appe8red -in: the action, a proof of serVice must- accompanytbecross-complaint at the time C?f:. filing. - . DEFAULT:Jf a responsive plearling is not filedand-sc:ved within the specified time, the plaintiff must :tile a Request for Entry of Default DO' later than 1 0 d~ys after - tbe . .responsive pleaaing was..due. - - . CASE MANAGEMENT . CONFERENCE: Parties must meet and confer, in penon or ... by telephone, at least 30 days before the Case Management Conference.: No later - tIiu 15dBys . prior to the .Case Management Conference. ~ party' must . me a Case M.8nagement Statement with the Court and serve it on all partieS in the action. Parties ere encouraged to file a joint Case Management Statement; in lieu of each party DI.ing a separatesratement. Parties must use the ri1andatory Case Management Statement _ (Judicial Council form CM-llO). Eachpaity who has appeared in the action must be - present at the Case Management Conference.., . -' . SANCTIONS: The Court may impose monetarysanctio~ ifaparty fails to comply with these requiTcrn.ents or any other state or local roles; : ......, 02103 AGENDA ITEM NO. ~ PACE I ( !t) OF ) LP '1; ~,. .... .- . . . . . ~ r" . . TH.E SUPERIOR. COURT OF CALIFORNIA . COUNTY .OF RIVERSIDE . . You Don1f Have to Sue. . ~ . . . . . . . . . . . . ..-. --~._.-....-.. --..-...-----..-- ...-' -- .-.-. -_.~...-._.-......-........:..._. .... .. ..;, .._ .. _.._c. ,,-.. . . . Rete ate Some Othet "'" .... . . .... .";.. . To Rest- I CiVl1 bi ... .,-- ACENDA~MNO...~' '. . '. . . PAOE_\ (0\ OFlLo3'. d '. . .. . " . Arbitration ....., In Arbi~tion, a neuual (the arbitrator) reviews evidence, hears arguments, and makes a decision (award) ~o resolve the dispute. This is very different from med~ation, where ~e mediator helps the parties reach their own resolution.. Arbitration nonnally is more infonnal, much speedier, and less expellSive than a lawsuit. Because of lhe large number of eases , awllitinguialin many couttS, a dispute nonnally can be heard much more quickly by an , atbitratorthan by a judge. . Often a ~e that may take a week to uy in court can be heard by , anatbitrator in a -matter of hours, because evidence can be submitted by.documents (like medcalreports and bills and business records), rather than by testimony. There ate two kinds of arbitration in Califoriria. Private .arbitration, by agreement of the parties involved in the dispute, ~6 place outside oftbe courts and, normally, is binding. In most cases, "binding" means that the arbitrato~s decision (award) is final and there win ~ot, be a t;tjai or an appeS1 of that decision. By contraSt, a decision by an arbitrator in .a case :retemd by the courts, lmown as "judicial arbiuation,'" is not binding, unless the parties agree to be bound. A party who does not like the award may"file a reqUest for triai-wu.h the 'Court within a specified time.' However, if that party does not do better in the trial than in arbitration, be or she may have to pay'a penalty. Arbittatio,i is:best for C3Bes whett the parties want a decision without the expense of a trial. ~bittation may be' better than DlematioD when~tbeparties 'ha.e liore1atiODship e~cep't"fot ' , thedilpute. Arbitration may not be a good idea when the parties want ~o resolve their dispute by themselves, or with the aid of a neutral ...., . SetdementCoIlferences , :.f In.a Settlement Conference :a' ileutt8J., -who conducts the conference, meets with both si des and confers' with each, often separately, to attempt to get the parties lOe'Valuate and re- , evJ~ItI~ their..case.80. as .to .achie;ve..aonegotiated settlement. Essentiany~ the neutral simply '.assists the parties-to negotiate a resolution. Settlement cOnferences may occur at any 'time 'in the course of the dispute' or litigation, and often are required as a case nears trial. Additional Information . ...-....... -_." .~-,.....:-..:........ There ale several other types of ADR besides mediation andaibitration. Some of these are , conciliation, case evaluation, fact finding, mini-tri,ak, and summarY jury trials. Sometimes , parties will try a combination of ADR types. ' The important thing is to try to find the type or _ -typeS'af ADR tbat--are .most likely" to reso.1Y~y()_ur dispute., The ,election of a neutral is 'an 'impoitantdecision. There is no legal requirement that tbeneuuafbc licensed ar hold any particular certificate. However, some programs have established qualification requirements for neutrals. You may wis~lO inquire about the qualifications of any neutral you are considering. Agreements'reached through ADR nonnally are putin writing by the neutral and, if the parties wish, may become binding contracts that can be enforced by a judge . You may wisbta seek the advice of any attorney as to your legal rights and other matters relating to the dispute. . spute Hesolution .. ' .......,-. AOENOA ITEM NO. ~ PACe' \( 02- OF \ c~~ ' ,:.. . , , .. . A TTORHEY OR PARlY WfTH()UT ATTORNEY tHeine 8I'ld__1 . FOR COURT USE eN. y "TT~ FOR ....".: SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE Street AddreSS: . Mailing ~ress: City and Zip Code: Branch Name: ". STIPULATION AND ORDER 'TO 1>>ARTICIPATE IN ARBITRATION CASE NUMBER: P\.AINTIFF : DEFENDANT: CASE MANAGEMENT CONFERENCE DATE (date): . . The parties in the above entitled action hereby stipulate to participate ,in arbitration proceedings, Each party having full authority to resolve the dispute agrees to be. adequately..prepared to meaningfully participate' in the arbitration process. and will fully cooperate with Hthearbitrator.in scheduling the arbitrationhearin.g. '.' . . ~mne of Paning Stipulating to Arbitration Print Name of Pany or Attorney , Plaintiff 0 Defendant 0 Other: Sign8tureof Party or ~ey Name of Parting Stipulating to ArbItration Print Name of Party or Attorney o Plaintiff 0 Defendant 0 Other: Signature of Party. orAttomeY. Name of Parting stipulating to Arblttation Pont Name 'Of Pany or Attorney o Plaintiff 0 Qefend8nt 0 Other: Sigmiture of Paity orAttol'liey . Name of Parting Stipulating to Arbitration Print Name of Pany or Attorney o. Plaintiff 0 [)efendal1t. 0 Other: Signature.of Party orAttomey Name of Parting Stipulating to Arbitration Print Name of Party or Attorney o.ptaintIff . ODefend8nt 0 0lbf1r:.. Signature of Party or Attorney IT IS SO' ORDERED: Arbitration to be completed by (date): Date: ~711a2 . CRC201.t(a) Judge of the Superior Court AGENDA IrEM NO. . ?) '-4"'1;:''-03 OF \l.Q~ ,-. CITY OF LAKE ELSINORE REPORT TO THE CITY COUNCIL TO: MAYOR AND CITY COUNCIL FROM: ROBERT A. BRADY, CITY MANAGER DATE: FEBRUARY 09, 2006 SUBJECT: AGREEMENT WITH HARRIS & ASSOCIATES TO PROVIDE ON-CALL PROFESSIONAL ENGINEERING SERVICES BACKGROUND /""" The Engineering Division of the City of Lake Elsinore, as a part of the development services, is required to review private development projects for compliance with City regulations, City Standards and the Subdivision Map Act. As a function of construction compliance, the Division also performs inspection services to ensure compliance with the approved plans. In order to maintain a high level of responsiveness, these services are contracted to Engineering firms that have the flexibility to provide a professional staff for a dynamic work load. DISCUSSION Harris & Associates is an established engineering firm with the ability to provide staff for a variety of tasks. The City has contracted with this firm for: Engineering plan checking for improvement plans, grading plans and final map projects; engineering design services; inspection services as well as Community Facility District work for several years with a high level of performance. Harris and Associates has the ability to provide services and supplemental staffing that the Engineering Division is currently experiencing. Providing plan check services since 1998, Harris and Associates has the local knowledge and experience to provide a high level of service to the Division as well as the development community. , .J ,.-- ACENDA 'TEM NO. q PAr;~ LOF \3 ~ REPORT TO CITY COUNCIL February 09, 2006 PAGE 2 ....., FISCAL IMPACT There is no direct financial impact to the General Fund as the services being provided by Harris and Associates are either funded by developer's plan check fees, inspection deposits or provided through the design budget of the Capital Improvement Program depending on the service being provided. RECOMMENDATION 1. Staff recommends that the City Council approve the Agreement withHarris and Associates. 2. Authorize the City Manager to execute the contract. PREPARED BY: KEN A. SEUMALO, CITY ENGINEER ~S ...., APPROVED FOR AGENDA BY: Attachment: Fee schedule of services ....., ,AOENDA ITEM NO. q PACE 2.. ~ AGREEMENT FOR PROFESSIONAL SERVICES I""""'" This Agreement for Professional Services (the "Agreement"), dated for identification purposes only as of February 09, 2006, by and between the City of Lake Elsinore, a municipal corporation ("City") and Harris & Associates ("Consultant"). RECITALS A. Consultant is specially trained, experienced and competent to perform the special services which will be required by this Agreement. B. Consultant possesses the skill, experience, ability, background, certification and knowledge to provide the services described in this Agreement on the terms and conditions described herein. C. City desires to retain Consultant to render professional consulting services and related work as set forth in this Agreement. AGREEMENT 1. Scope of Services. Consultant shall perform the serv~ces described on Exhibit A which is attached hereto and incorporated herein by reference. Consultant shall provide said services at the time, place, and in the manner specified in Exhibit A, subject to the direction of the City through its staff that it may provide from time to time. /"""- 2. Time of Performance. The services of Consultant are to commence upon execution of this Agreement and shall continue for a period of three (3) years, subject to annual review by the City Council. 3. Compensation. Compensation to be paid to Consultant shall be in accordance with the Schedule of Charges set forth in Exhibit B, which is attached hereto and incorporated herein by reference. In no event shall Consultant's compensation exceed $150,000 without additional authorization from the City Manager. Payment by City under this Agreement shall not be deemed a waiver of defects, even if such defects were known to the City at the time of payment. 4. Method of Payment. Consultant shall submit monthly billings to City describing the work performed during the preceding month. Consultant's bills shall include a brief description of the services performed, the date the services were performed, the number of hours spent and by whom, and a description of any reimbursable expenditures. City shall pay Consultant no later than 30 days after approval of the monthly invoice by City staff. 5. Extra Work. At any time during the term of this Agreement, City requests that Consultant perform Extra Work. As used herein, "Extra Work" means any work which is determined by City to be necessary for the proper completion of the Project, but which the parties did not reasonably anticipate would be necessary at the execution of this Agreement. Consultant shall not perform, nor be compensated for, Extra Work without written authorization from City. Extra work will be invoiced separately from services performed in accordance with the Scope of Services. /"""- 1 AGENDA ITEM NO. 9 r ~r:.E :3 OF ,~~ 6. Termination. This Agreement may be terminated by the City immediately for cause or by either party without cause upon thirty (30) days' written notice of termination. Upon termination, Consultant shall be entitled to compensation for services performed up to the effective date of termination. ......, 7. Ownership of Documents. All plans, studies, documents and other writings prepared by and for Consultant, its officers, employees and agents and subcontractors in the course of implementing this Agreement, except working notepad internal documents, shall become the property of the City upon payment to Consultant for such work, and the City shall have the sole right to use such materials in its discretion without further compensation to Consultant or to any other party. Consultant shall, at Consultant's expense, provide such reports, plans, studies, documents and other writings to City upon written request. City acknowledges that any use of such materials in a manner beyond the intended purpose as set forth herein shall be at the sole risk of the City. City further agrees to defend, indemnify and hold harmless Consultant, its officers, officials, agents, employees and volunteers from any claims, demands, actions, losses, damages, injuries, and liability, direct or indirect (including any and all costs and expenses in connection therein), arising out of the City=s use of such materials in a manner beyond the intended purpose as set forth herein. a. Licensing of Intellectual Property. This Agreement creates a nonexclusive and perpetual license for City to copy, use, modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property embodied in plans, specifications, studies, drawings, estimates, and other documents or works of authorship fixed in any tangible medium of expression, including but not limited to, physical drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared or caused to be prepared by Consultant under this Agreement ("Documents & Data"). Consultant shall require that all subcontractors agree in writing that City is granted a nonexclusive and perpetual license for any Documents & Data the subcontractor prepares under this Agreement. Consultant represents and warrants that Consultant has the legal right to license any and all Documents & Data. Consultant makes no such representation and warranty in regard to Documents & Data which were prepared by design professionals other than Consultant or provided to Consultant by the City. City shall not be limited in any way in its use of the Documents & Data at any time, provided that any such use not within the purposes intended by this Agreement shall be at City's sole risk. ......, b. Confidentiality. All ideas, memoranda, specifications, plans, procedures, drawings, descriptions, computer program data, input record data, written information, and other Documents & Data either created by or provided to Consultant in connection with the performance of this Agreement shall be held confidential by Consultant. Such materials shall not, without the prior written consent of City, be used by Consultant for any purposes other than the performance of the services under this Agreement. Nor shall such materials be disclosed to any person or entity not connected with the performance of the services under this Agreement. Nothing furnished to Consultant which is otherwise known to Consultant or is generally known, or has become known, to the related industry shall be deemed confidential. Consultant shall not use City's name or insignia, photographs relating to project for which Consultant's services are rendered, or any publicity pertaining to the Consultant's services under this Agreement in any magazine, trade paper, newspaper, television or radio production or other similar medium without the prior written consent of City. ......, 2 AGENDA ITEM NO. ~ PACE L-\ OF) .~ 8. Consultant's Books and Records. r-- a. Consultant shall maintain any and all ledgers, books of account, invoices, vouchers, canceled checks, and other records or documents evidencing or relating to charges for services, or expenditures and disbursements charged to City for a minimum period of three (3) years, or for any longer period required by law, from the date of final payment to Consultant to this Agreement. b. Consultant shall maintain all documents and records which demonstrate performance under this Agreement for a minimum period ofthree (3) years, or for any longer period required by law, from the date of termination or completion of this Agreement. c. Any records or documents required to be maintained pursuant to this Agreement shall be made available for inspection or audit, at any time during regular business hours, upon written request by the City Manager, City Attorney, City Auditor or a designated representative of these officers. Copies of such documents shall be provided to the City for inspection at City Hall when it is practical to do so. Otherwise, unless an alternative is mutually agreed upon, the records shall be available at Consultant's address indicated for receipt of notices in this Agreement. d. Where City has reason to believe that such records or documents may be lost or discarded due to dissolution, disbandment or termination of Consultant's business, City may, by written request by any of the above-named officers, require that custody of the records be given to the City and that the records and documents be maintained in City Hall. Access to such records and documents shall be granted to any party authorized by Consultant, Consultant's representatives, or Consultant's successor-in-interest. /""' 9. Independent Contractor. It is understood that Consultant, in the performance of the work and services agreed to be performed, shall act as and be an independent contractor and shall not act as an agent or employee of the City. Consultant shall obtain no rights to retirement benefits or other benefits which accrue to City's employees, and Consultant hereby expressly waives any claim it may have to any such rights. 10. Interests of Consultant. Consultant (including principals, associates and professional employees) covenants and represents that it does not now have any investment or interest in real property and shall not acquire any interest, direct or indirect, in the area covered by this Agreement or any other source of income, interest in real property or investment which would be affected in any manner or degree by the performance of Consultant's services hereunder. Consultant further covenants and represents that in the performance of its duties hereunder no person having any such interest shall perform any services under this Agreement. Consultant is not a designated employee within the meaning of the Political Reform Act because Consultant: a. will conduct research and arrive at conclusions with respect to hislher rendition of information, advice, recommendation or counsel independent of the control and direction of the City or of any City official, other than normal agreement monitoring; and r-- 3 AGENDA ITEM NO. q PACE Cj OF \ ~ b. possesses no authority with respect to any City decision beyond rendition of information, advice, recommendation or counsel. (FPPC Reg. 18700(a)(2).) 11. Professional Ability of Consultant. City has relied upon the professional training and ability """" of Consultant to perform the services hereunder as a material inducement to enter into this Agreement. Consultant shall therefore provide properly skilled professional and technical personnel to perform all services under this Agreement. All work performed by Consultant under this Agreement shall be in accordance with applicable legal requirements and shall meet the standard of quality ordinarily to be expected of competent professionals in Consultant's field of expertise. 12. Compliance with Laws. Consultant shall use the standard of care in its profession to comply with all applicable federal, state and local laws, codes, ordinances and regulations. 13. Licenses. Consultant represents and warrants to City that it has the licenses, permits, qualifications, insurance a)1d approvals of whatsoever nature which are legally required of Consultant to practice its profession. Consultant represents and warrants to City that Consultant shall, at its sole cost and expense, keep in effect or obtain at all times during the term of this Agreement, any licenses, permits, insurance and approvals which are legally required of Consultant to practice its profession. 14. Indemnity. Consultant agrees to defend, indemnify and hold harmless the City, its officers, officials, agents, employees and volunteers from and against any and all claims, demands, actions, losses, damages, injuries, and liability, direct or indirect (including any and all costs and expenses in connection therein), arising out of the performance of this Agreement or its failure to comply with any of its obligations contained in this Agreement, except for any such claim arising out of the sole negligence or willful misconduct of the City, its officers, agents, employees or volunteers. ,....., 15. Insurance Requirements. a. Insurance. Consultant, at Consultant's own cost and expense, shall procure and maintain, for the duration of the contract, the following insurance policies. i. Workers' Compensation Coverage. Consultant shall maintain Workers' Compensation Insurance and Employer's Liability Insurance for his/her employees in accordance with the laws of the State of California. In addition, Consultant shall require each subcontractor to similarly maintain Workers' Compensation Insurance and Employer's Liability Insurance in accordance with the laws of the State of California for all of the subcontractor's employees. Any notice of cancellation or non-renewal of all Workers' Compensation policies must be received by the City at least thirty (30) days prior to such change. The insurer shall agree to waive all rights of subrogation against City, its officers, agents, employees and volunteers for losses arising from work performed by Consultant for City. ii. General Liability Coverage. Consultant shall maintain commercial general liability insurance in an amount not less than one million dollars ($1,000,000) per occurrence for bodily injury, personal injury and property damage. If a commercial general liability insurance form or other form with a general aggregate limit is used, ~ 4 AGENDA ITEM NO. PAGE_ fJ) 0:..1 ,~ I OF l.:::s .,-..- either the general aggregate limit shall apply separately to the work to be performed under this Agreement or the general aggregate limit shall be at least twice the required occurrence limit. 111. Automobile Liability Coverage. Consultant shall maintain automobile liability insurance covering bodily injury and property damage for all activities of the Consultant arising out of or in connection with the work to be performed under this Agreement, including coverage for owned, hired and non-owned vehicles, in an amount of not less than one million dollars ($1,000,000) combined single limit for each occurrence. iv. Professional Liability Coverage. Consultant shall maintain professional errors and omissions liability insurance for protection against claims alleging negligent acts, errors or omissions which may arise from Consultant's operations under this Agreement, whether such operations by the Consultant or by its employees, subcontractors, or subconsultants. The amount of this insurance shall not be less than two hundred and fifty thousand dollars ($250,000) on a claims-made annual aggregate basis, or a combined single limit per occurrence basis. b. Endorsements. Each general liability and automobile liability insurance policy shall be with insurers possessing a Best=s rating of no less than A: VII and shall be endorsed with the following specific language: ,-..- i The City, its elected or appointed officers, officials, employees, agents and volunteers are to be covered as additional insureds with respect to liability arising out of work performed by or on behalf of the Consultant, including materials, parts or equipment furnished in connection with such work or operations. ii. This policy shall be considered primary insurance as respects the City, its elected or appointed officers, officials, employees, agents and volunteers. Any insurance maintained by the City, including any self-insured retention the City may have, shall be considered excess insurance only and shall not contribute with it. 111. This insurance shall act for each insured and additional insured as though a separate policy had been written for each, except with respect to the limits ofliability of the insuring company. iv. The insurer waives all rights of subrogation against the City, its elected or appointed officers, officials, employees or agents. v. Any failure to comply with reporting provisions of the policies shall not affect coverage provided to the City, its elected or appointed officers, officials, employees, agents, or volunteers. /"""' vi. The insurance provided by this Policy shall not be suspended, voided, canceled, or reduced in coverage or in limits except after thirty (30) days written notice has been received by the City. 5 AGENDA ITEM NO. l1 PN'l:~OFJ 3 c. Deductibles and Self-Insured Retentions. Any deductibles or self-insured retentions must be declared to and approved by the City. At the City's option, Consultant shall demonstrate financial capability for payment of such deductibles or self-insured retentions. d. Certificates of Insurance. Consultant shall provide certificates of insurance with original endorsements to City as evidence of the insurance coverage required herein. Certificates of such insurance shall be filed with the City on or before commencement of performance of this Agreement. Current certification of insurance shall be kept on file with the City at all times during the term of this Agreement. ......, 16. Notices. Any notice required to be given under this Agreement shall be in writing and either served personally or sent prepaid, first class mail. Any such notice shall be addressed to the other party at the address set forth below. Notice shall be deemed communicated within 48 hours from the time of mailing if mailed as provided in this section. If to City: City of Lake Elsinore Attn: City Manager 130 South Main Street Lake Elsinore, CA 92530 If to Consultant: Harris and Associates 34 Executive Park, Suite 150 Irvine, CA 92614-4705 17. Entire Agreement. This Agreement constitutes the complete and exclusive statement of Agreement between the City and Consultant. All prior written and oral communications, including correspondence, drafts, memoranda, and representations, are superseded in total by this Agreement. ....., 18. Amendments. This Agreement may be modified or amended only by a written document executed by both Consultant and City and approved as to form by the City Attorney. 19. Assignment and Subcontracting. The parties recognize that a substantial inducement to City for entering into this Agreement is the professional reputation, experience and competence of Consultant and the subcontractors listed in Exhibit D. Consultant shall be fully responsible to City for all acts or omissions of any subcontractors. Assignments of any or all rights, duties or obligations of the Consultant under this Agreement will be permitted only with the express consent of the City. Consultant shall not subcontract any portion of the work to be performed under this Agreement except as provided in Exhibit D without the written authorization of the City. If City consents to such subcontract, Consultant shall be fully responsible to City for all acts or omissions of those subcontractors. Nothing in this Agreement shall create any contractual relationship between City and any subcontractor nor shall it create any obligation on the part of the City to payor to see to the payment of any monies due to any such subcontractor other than as otherwise is required by law. 20. Waiver. Waiver of a breach or default under this Agreement shall not constitute a continuing waiver of a subsequent breach of the same or any other provision under this Agreement. ......, 6 AGENDA ITEM NO. C1 PACE B, OF \3 ~ 21. Severability. If any term or portion of this Agreement is held to be invalid, illegal, or otherwise unenforceable by a court of competent jurisdiction, the remaining provisions of this /" Agreement shall continue in full force and effect. 22. Controlling Law Venue. This Agreement and all matters relating to it shall be governed by the laws of the State of California and any action brought relating to this Agreement shall be held exclusively in a state court in the County of Riverside. 23. Litigation Expenses and Attorneys' Fees. If either party to this Agreement commences any legal action against the other party arising out of this Agreement, the prevailing party shall be entitled to recover its reasonable litigation expenses, including court costs, expert witness fees, discovery expenses, and attorneys' fees. 24. Mediation. The parties agree to make a good faith attempt to resolve any disputes arising out of this Agreement through mediation prior to commencing litigation. The parties shall mutually agree upon the mediator and share the costs of mediation equally. It the parties are unable to agree upon a mediator, the dispute shall be submitted to JAMSIENDISPUTE ("JAMS") or its successor in interest. JAMS shall provide the parties with the names offive qualified mediators. Each party shall have the option to strike two of the five mediators selected by JAMS and thereafter the mediator remaining shall hear the dispute. If the dispute remains unresolved after mediation, either party may commence litigation. 25. Execution. This Agreement may be executed in several counterparts, each of which shall constitute one and the same instrument and shall become binding upon the parties when at least one r' copy hereof shall have been signed by both parties hereto. In approving this Agreement, it shall not be necessary to produce or account for more than one such counterpart. 26. Authority to Enter Agreement. Consultant has all requisite power and authority to conduct its business and to execute, deliver, and perform the Agreement. Each party warrants that the individuals who have signed this Agreement have the legal power, right, and authority to make this Agreement and to bind each respective party. 27. Prohibited Interests. Consultant maintains and warrants that it has not employed nor retained any company or person, other than a bona fide employee working solely for Consultant, to solicit or secure this Agreement. Further, Consultant warrants that it has not paid nor has it agreed to pay any company or person, other than a bona fide employee working solely for Consultant, any fee, commission, percentage, brokerage fee, gift or other consideration contingent upon or resulting from the award or making of this Agreement. For breach or violation of this warranty, City shall have the right to rescind this Agreement without liability. For the term of this Agreement, no member, officer or employee of City, during the term of his or her service with City, shall have any direct interest in this Agreement, or obtain any present or anticipated material benefit arising therefrom. 28. Equal Opportunity Employment. Consultant represents that it is an equal opportunity employer and it shall not discriminate against any subcontractor, employee or applicant for employment because of race, religion, color, national origin, handicap, ancestry, sex or age. Such non-discrimination shall include, but not be limited to, all activities related to initial employment, upgrading, demotion, transfer, recruitment or recruitment advertising, layoff or termination. ",-.. 7 AGENDA ITEM NO. 9 p, ~..Cl__OF\~ Consultant shall also comply with all relevant provisions of City's Minority Business Enterprise program, Affirmative Action Plan or other related programs or guidelines currently in effect or hereinafter enacted. IN WIrnESS WHEREOF, the parties hereto have executed this Agreement on the dates set forth below. '~ "CITY" CITY OF LAKE ELSINORE, a municipal corporation Dated: , 2006 By: City Manger ATTEST: City Clerk APPROVED AS TO FORM: " Van Blarcom, Leibold, McClendon & Mann, P.C. Barbara Zeid Leibold, City Attorney "CONSULTANT" Dated: , 2006 By: Ed Edwards Attachments: Exhibit A - Scope of Services Exhibit B - Fee Schedule Exhibit C - Certificate of Exemption from Workers Compensation Insurance """ 8 ACENDA ITEM NO. PAGE \0 L1 OF\~ ~ --8...: ~ EXHIBIT "A" SCOPE OF SERVICES for CITY OF LAKE ELSINORE Harris & Associates shall perform the following tasks: 1. 2. 3. 4. 5. I""'"' II~ 1. (' I. DEFINITIONS As used in this Agreement,the following definitions shall be applicable: Harris. Consultant shall mean Harris & Associates, located at 34 Executive Park, Suite 150, Irvine, CA 92614-4705. Oient Client shall mean the City of Lake Elsinore, a municipal corporation, located at 130 South Main Street, Lake Elsinore, CA 92530. City Council. City Council shall mean the City Council of the City of Lake Elsinore. Services. Services shall mean the services to be performed by Harris pursuant to this Agreement Satisfactory. Satisfactory shall mean satisfactory to the City Manager of the City of Lake Elsinore or hislher designee. PLAN CHECK AND INSPECTION SERVICES Description of Services. CONSULTANT shall provide the following services: a. Shall provide plan check and inspections related to the residential and nonresidential buildings and development within the City of Lake Elsinore for compliance with applicable State and local codes. b. Shan. be available for information and consultation to City personnel and the public. AGENDA ITEM NO. q _ pACE q OF \::2 ~~JIJf EXHIBIT -B- ........" Civil Ensineerins Daisn and Public Works Services lob fitle Hourly R8te ProjeCt Director.......... ............ ........... ...................... ........$200 . Senior Project Manager ...............................:...................$175 Project Manager..... ...... ........................ ............... ............$150 Senior Civil Plan Check Engineer ...................................$150 Senior Map/Plan Check Engineer ...................................$150 Senior Project Engineer ...................................................$135 Civil Plan Check Engineer ..............................................$125 Project Engineer ......... .... .............. ........... ............ ............$125 Senior CADD Technician / CADD Manager ..................$115 CAD D Technician .... ......... ...... .......... ............ :.......... ......$1 05 Senior Design Engineer.. ....... .......... ........... ...... ...............$120 Design Engineer ........ .......... ........... .......... ............ ...........$1 05 Technical Support .... ....... .... ............ ........ ............. ..... ........$85 Administrative Assistant .... ....... ... .... ...... ..... .......... ..... ........$55 Civil Plan Chack and Map Chack Services ......" Services will be performed for a fixed fee that will be billed at percentage of applicable fee collected by the City Plan Check/Permit Fee Schedule/Other Fee Schedules/Grading Fee Schedule, Form No. 2002-03 revised April 24, 2002 as follows: Civil Improvement Plans....................................65% of City Fees Grading Plans.....................................................65% of City Fees Final Maps .........................................................75% of City' Fees A 5% surcharge fee shall be applicable for "fast track" plan checks. Notes: 1. These individuals include professionals and support personnel who might work on Harris projects. Support personnel include technicians and administrative staff. 2. These hourly rates will be held through December 31,2006. The hourly rates will increase thereafter by 5% on annual (calendar year) basis. 3. Unless otherwise indicated in the agreement, hourly rates include most direct costs such as vehicle usage and mileage, equipment usage (including computer and telephone), and printing and copying (except large quantities such as construction documents for bidding purposes). 4. Billing rates for independent contractors and hourly employees are determined on a case-by-case basis. 5. All subconsultant services are subject to a 10% markup. ACENDA ITEM NO._~ PAGE \2 ~ E I Hams & Assodates Page 48 \. On-Call Professional Services ~ Fea en fD a o :s \It The following rate table includes our proposed hourly rates, for the 2006 calendar year, to provide the wide range of services Harris & Associates is prepared to provide the City of Lake Elsinore. Although most services contemplated represent staff augmentation services at the indicated hourly rates, fees for Jther types of services would be as follows: " --- ( Buildinl " Safety Plan Check Services Harris fees wotild be on a percentage basis as described. Project Desiln Services Design projects are proposed to be negotiated individually based on hourly reates, not to exceed a specified lump sum price for the established scope of work. ~nstruction Management Services Third-party construction management services would be provided on an individual negotiated cost proposal basis. Standard Hourly Rate Schcclule Construction I Program Manag8.ent Job title Hourly Rate Project Director.. .... .......... ...... .................... .......... ........ ...$200 Project Manager ........ ...... ............... ...... ............. ........ ......$175 Senior Construction Manager .........................................$175 Construction Manager ....................................................$150 Senior Resident Engineer ....... .........................................$150 Resident Engineer ........ ....... ....... ................ ...... ...... .........$135 Construction Engineer. .................. ......................... ........$125 Scheduling Engineer ..... ...................... ..... ........... ............$125 Engineering Estimator... ......... ......... ......... ......... ..............$125 Senior Public Works Inspector...........................................$95 Prevailing Rate Inspector .............. ............ ........ ................ .$95 ",.- ublic Works Inspector .....................................................$85 Administrative Assistant .., .................. ... ..... ......... ..............$70 = I Hams & Assodates AGEND. Atla.llW. C".>j ; - : \ P''': .0-0F~\~ ' Page 47 r-- CITY OF LAKE ELSINORE REPORT TO CITY COUNCIL TO: MAYOR AND CITY COUNCIL FROM: ROBERT A. BRADY, CITY MANAGER DA TE: FEBRUARY 9, 2006 SUBJECT: RESOLUTION DECLARING WEEDS, RUBBISH, REFUSE AND DIRT A NUISANCE; PROPERTY OWNERS TO BE NOTIFIED BACKGROUND Pursuant to the City's Municipal Code, Chapter 8.32, Weed and Rubbish Abatement, the City is required to hold a hearing to adopt a resolution declaring weeds, rubbish and refuse on private properties a nuisance and order the abatement thereof. ~ DISCUSSION Weed abatement notices are being prepared for mailing to approximately 9,000 vacant property owners and will be mailed following the Council's adoption of the proposed - Resolution declaring weeds, rubbish, refuse and unpermitted dirt piles on private properties a nuisance. The Resolution also provides for a public hearing on April 11 th for the City Council to consider all objections to the proposed removal of weeds, rubbish, refuse and unpermitted dirt piles. Property owners will have until May 1, 2006, to abate their parcels. Should City staff abate a property beginning May 2, 2006, the owner will be assessed the cost of abatement at a rate of$0.02 per square foot plus a $306.00 administrative tee. FISCAL IMPACT None. All costs (including the administrative fee) will be recovered through a tax lien on the affected parcels. r-.. ACENDA ITEM NO. r~~ACE _\ Y2\ OF (() - . ~ . ..... REPORT TO CITY COUNCIL FEBRUARY 9, 2006 PAGE 2 ......, RECOMMENDATION Staff recommends that the City Council adopt Resolution No. 2006-.d2:. and direct staff to begin the abatement process for th' ear. CITY PREPARED BY: DA APPROVED FOR AGENDA BY: ......" ......" A6!NDA ITEM NO. 2 \ - ''''~I'~'\~ PAGE 2 0'_ c..o J "........ RESOLUTION NO. 2006-~ RESOLUTION OF THE CITY COUNCIL OF THE CITY OF LAKE ELSINORE, CALIFORNIA, ESTABLISHING WEED ABATEMENT ASSESSMENT LIENS AND DECLARING THAT CERTAIN WEEDS, RUBBISH, REFUSE AND DIRT AS DEFINED IN SECTION 14875 OF THE HEALTH AND SAFETY CODE OF THE STATE OF CALIFORNIA AND CHAPTER 8.32 OF THE LAKE ELSINORE MUNICIPAL CODE CONSTITUTE A NUISANCE AND REQUIRE A NOTICE TO BE GIVEN TO THE PROPERTY OWNER IN ACCORDANCE WITH DIVISION 12, PART 5, CHAPTER 2, OF THE HEALTH AND SAFETY CODE OF THE STATE OF CALIFORNIA AND CHAPTER 8.32 OF THE LAKE ELSINORE MUNICIPAL CODE AND PROVIDING FOR A HEARING ON OBJECTIONS, TOGETHER WITH FILING OF COST REPORTS AND ASSESSMENTS AGAINST ABUTTING PROPERTY OWNERS. WHEREAS, there exists in the City of Lake Elsinore, California,. on certain streets, sidewalks and on private property, weeds, rubbish, refuse and dirt as defined in Chapter 8.32 ofthe Lake Elsinore Municipal Code.; and r-- WHEREAS, said weeds, rubbish, refuse, and dirt constitute a nuisance that is a fire and health hazard; and WHEREAS, the City does designate the Parks and Open Space Division to enforce the provisions of Chapter 8.32 and the provisions of the Health and Safety Code of the State of California as hereinabove set forth; and WHEREAS, the City Manager has submitted a list of properties upon which there is upon the streets, sidewalks, and private property, weeds, rubbish, refuse, and unpermitted dirt piles, which constitute a nuisance by virtue of being a fire and health hazard; and WHEREAS, there is affixed hereto and made a part hereof by reference and marked Exhibit "A" a list of all properties within the City upon which said weeds, rubbish, refuse and unpermitted dirt piles exist and which exists by giving its assessors parcel number according to the official assessment for the City of Lake Elsinore. ,-- AGENDA ITEM NO. 2.\ :- PACE____2L.:=: OF ~ 0 . CITY COUNCIL RESOLUTION NO. 2006- Page 2 of 4 .....", NOW, THEREFORE, THE CITY COUNCIL OF THE CITY OF LAKE ELSINORE DOES HEREBY RESOLVE, DETERMINE AND ORDER AS FOLLOWS: SECTION 1. That pursuant to the authority granted to the City by virtue of Section 14875 of the Health and Safety Code of the State of California and Chapter 8.32 of the Lake Elsinore Municipal Code, weeds, rubbish, refuse, and unpermitted dirt piles upon or in front of the properties as described in Exhibit "A" are hereby declared to be a nuisance and shall be abated. (A) That notices will be sent out to the property owners as last shown upon the assessment rolls in accordance with the said Health and Safety Code, State .0fCalifornia, and of said Ordinance, City of Lake Elsinore, California. (B) That the said notices shall be in the form set forth in said Health and Safety Code and said City Ordinance and that said notices shall be sent at least five (5) days prior to the time of Hearing of objections. (C) That the list of all property owners to whom notices are to be sent, as well as the locations of the property are set forth in Exhibit "A" which is ..., attached hereto and made part hereof by reference. (D) That the City Council does hereby find and declare that the weeds, rubbish, refuse and unpermitted dirt piles on the specified parcels of property is recurrent and shall be abated in the manner provided for in Section 14900.5 of the Health and Safety Code of the State of California and in accordance with Chapter 8.32 of the City of Lake Elsinore Municipal Code. (E) That the City Council of the City of Lake Elsinore does hereby set the date of April 11, 2006, at the hour of 7 :OOpm in the Lake Elsinore Cultural Center, 183 North Main Street, in the City of Lake Elsinore, California, to herein consider all objections to the proposed removal of weeds, rubbish, refuse, and unpermitted dirt piles. (F) That hereafter if objections have not been made or the City Council has disposed of those made, the Parks and Open Space Division is ordered to abate the nuisances in accordance with said Health and Safety Code Section and said Ordinance of the City of Lake Elsinore, California. ..., AOENDA ITEM NO. Q. \ PACE L\ OF l(). - _ . r ~ ~~... CITY COUNCIL RESOLUTION NO. 2006- Page 3 of 4 ~ (G) The Parks and Open Space Division shall keep an account of the cost of the abatement in front of or on each separate parcel of land and shall render a written report showing such costs and shall cause said notice to be posted in accordance with law. (H) That the cost of the abatement in front of or on each parcel shall constitute an operational assessment against the parcel. After the assessment has been made and confirmed there shall be made a lien upon said parcel of property in accordance with said Health and Safety Code and the Ordinance of the City. SECTION 2. This Resolution shall take effect from and after the date of its passage and adoption. PASSED, APPROVED AND ADOPTED this by the following vote: day of , 2006, AYES: COUNCILMEMBERS: ",-... NOES: COUNCILMEMBERS: ABSENT: COUNCILMEMBERS: ABSTAIN: COUNCILMEMBERS: Robert E. Magee, Mayor City of Lake Elsinore ATTEST: Frederick Ray, City Clerk City of Lake Elsinore r' AOENDA ITEM NO. -:2 l PAGE 5 OF \.Q -~ CITY COUNCIL RESOLUTION NO. 2006- Page 4 of 4 APPROVED AS TO FORM: Barbara Zeid Leibold, City Attorney City of Lake Elsinore AOENDA ,reM NO.? \ PACE-lo OF1. (} ~ ~ ...." ~ ORDINANCE NO. 1168 AN ORDINANCE OF THE CITY COUNCIL OF THE CITY OF LAKE ELSINORE, CALIFORNIA, ACTING AS THE LEGISLATIVE BODY OF CITY OF LAKE ELSINORE COMMUNITY FACILITIES DISTRICT NO. 2003-1 (LAW ENFORCEMENT, FIRE AND PARAMEDIC SERVICES) AUTHORIZING THE LEVY OF A SPECIAL TAX WITHIN ANNEXATION AREA NO. 15 (LA STRADA) ANNEXED TO SAID DISTRICT WHEREAS, on December 13,2005, the City Council (the "Council") of the City of Lake Elsinore, California (the "City") adopted Resolution No. 2005-170 stating its intention to annex certain property ("Annexation Area No. 15 (La Strada)") into City of Lake Elsinore Community Facilities District No. 2003-1 (Law Enforcement, Fire and Paramedic Services) (the "District") pursuant to the Mello-Roos Community Facilities Act of 1982, as amended, (the "Act"); and WHEREAS, notice was published as required by law relative to the intention of the Council to annex Annexation Area No. 15 (La Strada) into the District; and ~ WHEREAS, on January 24, 2006 this Council held a noticed public hearing as required by law relative to the determination to proceed with the annexation of Annexation Area No. 15 (La Strada) into the District and the rate and method of apportionment and manner of collection of the special tax to be levied within Annexation Area No. 15 (La Strada) to finance certain public services; and WHEREAS, at said hearing all persons desiring to be heard on all matters pertaining to the annexation of Annexation Area No. 15 (La Strada) were heard and a full and fair hearing was held; and WHEREAS, the Council subsequent to said hearing adopted Resolution No. 2006-14 determining the validity of prior proceedings relative to the annexation of Annexation Area No. 15 (La Strada), annexed Annexation Area No. 15 (La Strada) into the District and authorized the levy of a special tax within Annexation Area No. 15 (La Strada); and WHEREAS, the Council subsequent to said hearing adopted Resolution No. 2006-15 which called an election within Annexation Area No. 15 (La Strada) for January 24, 2006 on the proposition of levying a special tax; and WHEREAS, on January 24, 2006 an election was held within each Annexation Area No. 15 (La Strada) in which the eligible electors approved by more than two-thirds ,r--. vote the proposition of levying a special tax. ACENDA ITEM NO. PACE \ ~\ OF t 0 CITY COUNCIL ORDINANCE NO. 1168 Page 2 of3 THE CITY COUNCIL OF THE CITY OF LAKE ELSINORE, ACTING AS THE LEGISLATIVE BODY OF CITY OF LAKE ELSINORE COMMUNITY FACILITIES DISTRICT NO. 2003-1 (LAW ENFORCEMENT, FIRE AND PARAMEDIC SERVICES), DOES ORDAIN AS FOLLOWS: ......, SECTION 1. A special tax is levied within the boundaries of Annexation Area No. 15 (La Strada) pursuant to the formula set forth in Exhibit "A" attached hereto and incorporated by reference in an amount necessary to finance a portion of the cost of providing law enforcement, fire and paramedic services that are in addition to those provided in the territory within Annexation Area No. 15 (La Strada) prior to the annexation of Annexation Area No. 15 (La Strada) into the District, periodic costs, and costs of the tax levy and collection. SECTION 2. This legislative body is hereby further authorized each year, by resolution adopted as provided .in section 53340 ,of the Act, to determine the specific special tax rate and amount to be levied for the next fiscat year, except that the special tax rate to be levied shall not exceed the maximum rate set forth in Exhibit "A." SECTION 3. All of the collections of the special tax shall be used as provided for in the Act and Resolution No. 2006-16 of the Council. SECTION 4. The above authorized special tax shall be collected in the same ,....", manner as ordinary ad valorem taxes are collected and shall be subject to the same penalties and the same procedure and sale in cases of delinquency and provided for ad valorem taxes. SECTION 5. The Mayor shall sign this ordinance and the City Clerk shall attest to such signature. The City Clerk is directed to cause the title and summary or text of the this ordinance, together with the vote thereon, to be published within fifteen (15) days after its passage at least once in a newspaper of general circulation published and circulated within the territorial jurisdiction of the City, and to post at the main office of the City a certified copy of the full text of the adopted ordinance along with the names of the Council Members voting for and against the ordinance. SECTION 6. If any provision, clause, sentence or paragraph of this Ordinance or the application thereofto any person or circumstance shall be held invalid, such invalidity shall not affect the other provisions of this Ordinance and are hereby declared to be severable. SECTION 7. This ordinance relating to the levy of the special tax takes effect and shall be in force from and after thirty (30) days after the date of its final passage. A copy of this ordinance shall be transmitted to the Clerk of the Board of Supervisors of Riverside County, the Assessor and the Treasurer-Tax Collector of Riverside County. ,....", AOENOA ITEM NO.-3.L PACE 2- _OFJ.lL: CITY COUNCIL ORDINANCE NO. 1168 Page 3 of3 ~ The City Clerk shall certify as to adoption of this Ordinance and cause this Ordinance to be published and posted in the manner required by law. INTRODUCED AND APPROVED UPON FIRST READING this 24th day of January, 2006, upon the following roll call vote: AYES: COUNCILMEMBERS: BUCKLEY, HICKMAN, KELLEY, SCHIFFNER, MAGEE NOES: COUNCILMEMBERS: NONE ABSENT: COUNCILMEMBERS: NONE ABSTAIN: COUNCILMEMBERS: NONE PASSED, APPROVED AND ADOPTED UPON SECOND READING this 9th day of February 2006, upon the following roll call vote: AYES: COUNCILMEMBERS: ~ NOES: COUNCILMEMBERS: ABSENT: COUNCILMEMBERS: ABSTAIN: COUNCILMEMBERS: Robert E. Magee, Mayor City of Lake Elsinore ATTEST: Frederick Ray, City Clerk City of Lake Elsinore APPROVED AS TO FORM: ,,--.. Barbara Zeid Leibold, City Attorney City of Lake Elsinore ACENDA ITEM NO. 8 \ PACE.3 OF \.j) ~ EXHIBIT A RATE AND METHOD OF APPORTIONMENT OF SPECIAL TAX "."", ......,. ......, AGENDA ITEM NO. 2> \ PAGE t..{ OF Lo .,--. NOTICE OF ADOPTION OF ORDINANCE NO. 1168 NOTICE IS HEREBY GIVEN that on January 24, 2006, at the Council Chambers of the City of Lake Elsinore, 183 North Main Street, Lake Elsinore, California 92530, the City Council of the City of Lake Elsinore, in its capacity as the legislative body of the City of Lake Elsinore Community Facilities District No. 2003-1 (Law Enforcement, Fire and Paramedic Services), held a public hearing and adopted Ordinance No. 1168. A summary of Ordinance No. 1168 follows and is marked as Exhibit "B". At said time and place the testimony of all interested persons or taxpayers for or against said ordinance was heard. Ordinance No. 1168 was adopted by the following vote: AYES: COUNCILMEMBERS: NOES: COUNCILMEMBERS: ABSTAIN: COUNCILMEMBERS: ABSENT: COUNCILMEMBERS: r-- CITY COUNCIL OF THE CITY OF LAKE ELSINORE, ACTING AS THE LEGISLATIVE BODY OF THE CITY OF LAKE ELSINORE COMMUNITY FACILITIES DISTRICT NO. 2003-1 (LAW ENFORCEMENT, FIRE AND PARAMEDIC SERVICES) Dated: ,2006 By Frederick Ray, City Clerk ;r- ACENDA ITEM NO. 31.- PAGE 5~ EXHmIT B ....,.; BEFORE THE CITY COUNCIL OF THE CITY OF LAKE ELSINORE IN ITS CAPACITY AS THE LEGISLATIVE BODY OF THE CITY OF LAKE ELSINORE COMMUNITY FACILITIES DISTRICT NO. 2003-1 (LAW ENFORCEMENT, FIRE AND PARAMEDIC SERVICES) IN THE MATTER OF Authorizing the Levy of a Special Tax Within Annexation Area No. 15 (La Strada) Annexed to City of Lake Elsinore Community Facilities District No. 2003-1 (Law Enforcement, Fire and Paramedic Services) ) ORDINANCE NO. 1168 SUMMARY ) ) ) ) ) ) The ordinance authorizes levy of an annual special tax within Annexation Area No. 15 (La Strada) annexed to City of Lake Elsinore Community Facilities District No. 2003-1 (Law Enforcement, Fire and Paramedic Services) (the "District"), collected in the same manner as ordinary ad valorem taxes, in an amount necessary to finance a portion .~ of the cost of providing law enforcement, fire and paramedic services that are in addition to those provided in the territory within Annexation Area No. 15 (La Strada) prior to the annexation of Annexation Area No. 15 (La Strada) to the District, which is necessary to meet increased demands placed upon the City as a result of development or rehabilitation occurring within Annexation Area No. 15 (La Strada). DA TED: , 2006 CITY OF LAKE ELSINORE By: Frederick Ray, City Clerk ......, AOENDA ITEM NO. <- =3 \ PAOE (n OF ( 0 - ~ ORDINANCE NO. 1169 AN ORDINANCE OF THE CITY COUNCIL OF THE CITY OF LAKE ELSINORE, CALIFORNIA, ACTING AS THE LEGISLATIVE BODY OF CITY OF LAKE ELSINORE COMMUNITY FACILITIES DISTRICT NO. 2003-1 (LAW ENFORCEMENT, FIRE AND PARAMEDIC SERVICES) AUTHORIZING THE LEVY OF A SPECIAL TAX WITHIN ANNEXATION AREA NO. 16 (TR 32129) ANNEXED TO SAID DISTRICT WHEREAS, on December 13,2005, the City Council (the "Council") of the Ciry of Lake Elsinore, California (the "City") adopted Resolution No. 2005-168 stating its intention to annex certain property ("Annexation Area No. 16 (TR 32129)") into City of Lake Elsinore Community Facilities District No. 2003-1 (Law Enforcement, Fire and Paramedic Services) (the "District") pursuant to the Mello-Roos Community Facilities Act of 1982, as amended, (the "Act"); and WHEREAS, notice was published as required by law relative to the intention of the Council to annex Annexation Area No. 16 (TR 32129) into the District; and ./""' WHEREAS, on January 24, 2006 this Council held a noticed public hearing as required by law relative to the determination to proceed with the annexation of Annexation Area No. 16 (TR 32129) into the District and the rate and method of apportionment and manner of collection of the special tax to be levied within Annexation Area No. 16 (TR 32129) to finance certain public services; and WHEREAS, at said hearing all persons desiring to be heard on all matters pertaining to the annexation of Annexation Area No. 16 (TR 32129) were heard and a full and fair hearing was held; and WHEREAS, the Council subsequent to said hearing adopted Resolution No. 2006-17 determining the validity of prior proceedings relative to the annexation of Annexation Area No. 16 (TR 32129), annexed Annexation Area No. 16 (TR 32129) into the District and authorized the levy of a special tax within Annexation Area No. 16 (TR 32129); and WHEREAS, the Council subsequent to said hearing adopted Resolution No. 2006-18 which called an election within Annexation Area No. 16 (TR 32129) for January 24, 2006 on the proposition of levying a special tax; and WHEREAS, on January 24, 2006 an election was held within each Annexation Area No. 16 (TR 32129) in which the eligible electors approved by more than two-thirds vote the proposition oflevying a special tax. ,,-. P.GENDA ~TE.;M. No,3~ta-"'''''i!i.H'. ' t'i"'F L OF '. ,"-v........ '_0_ _ .~.~~ CITY COUNCIL ORDINANCE NO. 1169 Page 2 of3 THE CITY COUNCIL OF THE CITY OF LAKE ELSINORE, ACTING AS THE LEGISLATIVE BODY OF CITY OF LAKE ELSINORE COMMUNITY FACILITIES DISTRICT NO. 2003-1 (LAW ENFORCEMENT, FIRE AND PARAMEDIC SERVICES), DOES ORDAIN AS FOLLOWS: '-"" SECTION 1. A special tax is levied within the boundaries of Annexation Area No. 16 (TR 32129) pursuant to the formula set forth in Exhibit "A" attached hereto and incorporated by reference in an amount necessary to finance a portion of the cost of providing law enforcement, fire and paramedic services that are in addition to those provided in the territory within Annexation Area No. 16 (TR 32129) prior to the annexation of Annexation Area No. 16 (TR 32129) into the District, periodic costs, and costs of the tax levy and collection. SECTION 2. This legislative body is hereby further authorized each year, by resolution adopted as provided in section 53340 of the Act, to determine the specific special tax rate and amount to be levied for the next fiscal year, except that the special tax rate to be levied shall not exceed the maximum rate set forth in Exhibit "A." SECTION 3. All ofthe ~ollections of the special tax shall be used as provided for in the Act and Resolution No. 2006-19 of the Council. SECTION 4. The above authorized special tax shall be collected in the same'-"" manner as ordinary ad valorem taxes are collected and shall be subject to the same penalties and the same procedure and sale in cases of delinquency and provided for ad valorem taxes. SECTION 5. The Mayor shall sign this ordinance and the City Clerk shall attest to such signature. The City Clerk is directed to cause the title and summary or text of the this ordinance, together with the vote thereon, to be published within fifteen (15) days after its passage at least once in a newspaper of general circulation published and circulated within the territorial jurisdiction of the City, and to post at the main office of the City a certified copy of the full text of the adopted ordinance along with the names of the Council Members voting for and against the ordinance. SECTION 6. If any provision, clause, sentence or paragraph of this Ordinance or the application thereof to any person or circumstance shall be held invalid, such invalidity shall not affect the other provisions of this Ordinance and are hereby declared to be severable. SECTION 7. This ordinance relating to the levy of the special tax takes effect and shall be in force from and after thirty (30) days after the date of its final passage. A copy of this ordinance shall be transmitted to the Clerk of the Board of Supervisors of Riverside County, the Assessor and the Treasurer-Tax Collector of Riverside County. '-"" ACENDA ITEM NO.--.32 PAOE '2 _o~ CITY COUNCIL ORDINANCE NO. 1169 Page 3 of3 ",...- The City Clerk shall certify as to adoption of this Ordinance and cause this Ordinance to be published and posted in the manner required by law. INTRODUCED AND APPROVED UPON FIRST READING this 24th day of January, 2006, upon the following roll call vote: AYES: COUNCILMEMBERS: BUCKLEY, HICKMAN, KELLEY, SCHIFFNER, MAGEE NOES: COUNCILMEMBERS: NONE ABSENT: COUNCILMEMBERS: NONE ABSTAIN: COUNCILMEMBERS: NONE PASSED, APPROVED AND ADOPTED UPON SECOND READING this 9th day of February 2006, upon the following roll call vote: AYES: COUNCILMEMBERS: /""""' NOES: COUNCILMEMBERS: ABSENT: COUNCILMEMBERS: ABSTAIN: COUNCILMEMBERS: Robert E. Magee, Mayor City of Lake Elsinore ATTEST: Frederick Ray, City Clerk City of Lake Elsinore APPROVED AS TO FORM: ",-. Barbara Zeid Leibold, City Attorney City of Lake Elsinore AGENOA ITEM NO.~ . . PAce3 OfZJJ2==, EXHIBIT A RATE AND METHOD OF APPORTIONMENT OF SPECIAL TAX ""'" ......" ""'" ACENDA ITEM NO. 3'2 PAOL4 _OF~ ",..- NOTICE OF ADOPTION OF ORDINANCE NO. 1169 NOTICE IS HEREBY GIVEN that on January 24, 2006, at the Council Chambers of the City of Lake Elsinore, 183 North Main Street, Lake Elsinore, California 92530, the City Council of the City of Lake Elsinore, in its capacity as the legislative body of the City of Lake Elsinore Community Facilities District No. 2003-1 (Law Enforcement, Fire and Paramedic Services), held a public hearing and adopted Ordinance No. 1169. A summary of Ordinance No. 1169 follows and is marked as Exhibit "B". At said time and place the testimony of all interested persons or taxpayers for or against said ordinance was heard. Ordinance No. 1169 was adopted by the following vote: AYES: COUNCILMEMBERS: NOES: COUNCILMEMBERS: ABSTAIN: COUNCILMEMBERS: ABSENT: COUNCILMEMBERS: ,-. CITY COUNCIL OF THE CITY OF LAKE ELSINORE, ACTING AS THE LEGISLATIVE BODY OF THE CITY OF LAKE ELSINORE COMMUNITY FACILITIES DISTRICT NO. 2003-1 (LAW ENFORCEMENT, FIRE AND PARAMEDIC SERVICES) Dated: ,2006 By Frederick Ray, City Clerk ,-.. AGENDA ITEM NO. PAOE CS ~() ~ EXHIBIT B ~ BEFORE THE CITY COUNCIL OF THE CITY OF LAKE ELSINORE IN ITS CAPACITY AS THE LEGISLATIVE BODY OF THE CITY OF LAKE ELSINORE COMMUNITY FACILITIES DISTRICT NO. 2003-1 (LA WENFORCEMENT, FIRE AND PARAMEDIC SERVICES) IN THE MATTER OF Authorizing the Levy of a Special Tax Within Annexation Area No. 16(TR 32129) Annexed to City of Lake Elsinore Community Facilities District No. 2003-1 (Law Enforcement, Fire and Paramedic Services) ) ORDINANCE NO. 1169 SUMMARY ) ) ) ) ) ) The ordinance authorizes levy of an annual special tax within Annexation Area No. 16 (TR 32129) annexed to City of Lake Elsinore Community Facilities District No. 2003-1 (Law Enforcement, Fire and Paramedic Services) (the "District"), collected in the same manner as ordinary ad valorem taxes, in an amount necessary to finance a portion ,..." of the. cost of providing law enforcement, fire and paramedic services that are in addition to those provided in the territory within Annexation Area No. 16 (TR 32129) prior to the annexation of Annexation Area No. 16 (TR 32129) to the District, which is necessary to meet increased demands placed upon the City as a result of development or rehabilitation occurring within Annexation Area No. 16 (TR 32129). DATED: , 2006 CITY OF LAKE ELSINORE By: Frederick Ray, City Clerk ~ ACENDA ItEM NO. o~' PACE (j) __ ",-.. CITY OF LAKE ELSINORE REPORT TO CITY COUNCIL TO: MAYOR AND CITY COUNCIL FROM: ROBERT A. BRADY, CITY MANAGER DA TE: FEBRUARY 09, 2006 SUBJECT: COMMERCIAL DESIGN REVIEW NO. 2005-07 - CARL'S JR. APPLICANT: LORENZO REYES, BKI INS., STAR GOALS, LLC., 1403 BATAVIA STREET, STE. 203, ORANGE, CA 92867 REQUEST The applicant requests approval of: ",-.., . Commercial Design Review No. 2005-07 BACKGROUND At their regular meeting of January 17,2006, the Planning Commission adQpted the following Resolutions based on the Findings, Exhibits and proposed Conditions of Approval: . Resolution No. 2006-05 approving Conditional Use Permit No. 2005-16; and . Resolution No. 2006-06 recommending to the City Council approval of Commercial Design Review No. 2005-07; DISCUSSION Items of discussion at the Planning Commission Hearing were relatively minor and related to the site design and architectural details ofthe proposed project. Overall, the Commission expressed satisfaction with the design and layout ofthe proposed project. Ultimately, it was the general consensus ofthe Planning Commission to accept staff's recommendation. I'"""' AGENDA ITEM NO. PACE I {)3 OF 3~ REPORT TO THE CITY COUNCIL FEBRUARY 9, 2006 Page 2 of2 ....." FISCAL IMPACT The development will have a positive fiscal impact to the community and the City. RECOMMENDATION The Planning Commission recommends that the City Council approve the following application based on the Findings, Conditions of Approval and Exhibits. 1. Resolution No. 2006-2J., approving Commercial Design Review No. 2005-07. PREPARED BY: KlRT A. COURY, PROJECT PLANNER CI "-tIll APPROVED FOR AGENDA BY: ATTACHMENTS 1. Vicinity Map. 2. City Council Resolution No. 2006~ approving Commercial Design Review No. 2005-07. 3. City Council Conditions of Approval. 4. Planning Commission Minutes, Staff Report, Resolutions, Conditions of Approval, and Exhibits from the January 17, 2006 meeting. 5. Full Size Plans. "-tIll ACENDA ITEM NO. 53 PACE l OF 3 fo 1"""'- RESOLUTION NO. 2006-21 RESOLUTION OF THE CITY COUNCIL OF THE CITY OF LAKE ELSINORE, CALIFORNIA, APPROVING COMMMERCIAL DESIGN REVIEW NO. 2005-07 FOR THE PROJECT KNOWN AS CARL'S JR. LOCATED ON PAD 7 OF PLANNING AREA 3 OF THE CANYON IDLLS MARKET PLACE WHEREAS, Lorenzo Reyes, BKI Inc., Star Goals, LLC, has initiated proceedings to approve Commercial Design Review No. 2005-07 for the property located on Pad "7" of Planning Area 3 of the Canyon Hills Market Place; and WHEREAS, the Planning Commission of the City of Lake Elsinore at a regular meeting held on January 17, 2006 made its report upon the desirability of the proposed project and made its recommendations in favor of the project by adopting Planning Commission Resolution No. 2006-06 recommending to the City Council approval of Commercial Design Review No. 2005-07; and r-- WHEREAS, public notice of said application has been given, and the City Council has considered evidence presented by the Community Development Department and other interested parties at a public hearing held with respect to this.item on February 9,2006. NOW, THEREFORE, THE CITY COUNCIL OF THE CITY OF LAKE ELSINORE DOES HEREBY RESOLVE, DETERMINE AND ORDER AS FOLLOWS: SECTION 1. The City Council has considered the proposed project prior to making a decision to approve Commercial Design Review No. 2005-07. The City Council finds and determines that the Addendum to the 1989 Final Canyon Hills Specific Plan Environmental Impact Report, which was prepared in accordance with Section 15164 of the State CEQA Guidelines, provides the necessary environmental clearances for the proposed application, based upon the following findings and determinations: SECTION 2. That in accordance with State Planning and Zoning law and the City of Lake Elsinore, the following findings for the approval of Commercial Design Review No. 2005-05 have been made as follows: 1. The project, as approved, will comply with the goals and objectives of the General Plan and the Zoning District in which the project is located. The proposed Commercial Design Review located on Pad '7" of Planning Area 3, of the Canyon Hills Market Place complies with the goals and objectives of the General r--. Plan, in that the approval of this "drive through" restaurant facility will assist in achieving the development of a well-balanced and functional mix of residential, AGENDA ITEM r~o. PAGE 3 ~3 OF 3 (.. CITY COUNCIL RESOLUTION NO. 2006- Page 2 of3 commercial, industrial, open space, recreational and institutional land uses as well as encouraging industrial land uses to diversify Lake Elsinore's economic base. 2. The project complies with the design directives contained in Section 17.82.060 and all other applicable provisions of the Municipal Code. The proposed Commercial Design Review located on Pad "7" of Planning Area 3, of the Canyon Hills Market Place is appropriate to the site and surrounding developments in that the proposed "drive through" restaurant facility has been designed in consideration of the size and shape of the property, thereby creating interest and varying vistas as a person moves along the street. Further the project as proposed will complement the quality of existing development and will create a visually pleasing, non-detractive relationship between the proposed and existing projects in that the architectural design, color and material and site designs proposed evidence a concern for quality and originality. 3. Subject to the attached Conditions of Approval, the proposed project is not anticipated to result in any significant adverse environmental impacts. The Addendum to the 1989 Final Canyon Hills Specific Plan Environmental Impact Report, which was prepared in accordance with Section 15164 of the State CEQA Guidelines, provides the necessary environmental clearances for the proposed applications. Accordingly, staff believes the proposed applications implement the land use objectives and requirements of the Specific Plan and finds that further environmental evaluation is therefore, unnecessary. 4. Conditions and safeguards pursuant to Chapter 17.82.070 of the Zoning Code, including guarantees and evidence of compliance with conditions, have been incorporated into the approval of the subject project to ensure development of the property in accordance with the objectives of Chapter 17.82. Pursuant to Section 17.82.070 (Action of the Planning Commission) of the Lake Elsinore Municipal Code (LEMC), the proposed Commercial Design Review located on Pad '7" of Planning Area 3, of the Canyon Hills Market Place has been scheduled for consideration and approval by the Planning Commission. SECTION 3. This Resolution shall take effect from and after the date of its passage and adoption. ACENDA ITEM NO. < ?;3 PACE 4 OF.3 10 "-'" ....., "-'" CITY COUNCIL RESOLUTION NO. 2006-_ Page 3 of3 ",-... PASSED, APPROVED AND ADOPTED this 9TH day of February, 2006, by the following vote: AYES: COUNCILMEMBERS: NOES: COUNCILMEMBERS: ABSENT: COUNCILMEMBERS: ABSTAIN: COUNCILMEMBERS: RobertE. Magee, Mayor City of Lake Elsinore ATTEST: Frederick Ray, City Clerk ",.--- City of Lake Elsinore APPROVED AS TO FORM: Barbara Zeid Leibold, City Attorney City of Lake Elsinore ",..- ACiENDA ITEM NO. 33 PACE ':> OF > (. .. M __~... ~~. ......, "~. II. 1-.' "" :0: "D" Z 0: ffi w m Q :::E 0: ;:) 0 z m l- t:: ," 0 z z '.', ~ Q ;:) ;:) ~ 0 C). () 0: 0: Z Z 0: 0: Z Z 0 0 z .z ~ z S S ~ 0.. 0.. , , . , . . I GO I , - , . , . , . , '" S 1&.1. ~ 0 ~ :::E 0: 0.. ~ If) la.I ~" t:: :z t! :z 1&.1 ;:) 0.. ";:) 0 8 Q () :z oJ '0: C) Z ~ :z :z i ~ ~ S :t S D.. . . ~ . .. . . . . . It + . . . . . . It . . . .. . . . . . . . . . . . . . .. . . .. . . . . . . . .. . . . OJ . . . '9 . . . . . . t . . ........ . . . . . .. . . . . . . . . . -: . . . ......, ACENDA ITEM NO. PACE (., 8~ OF .3 ~ r' GENERAL 1. The applicant shall defend (with counsel acceptable to the City), indemnify, and hold harmless the City, its Official, Officers, Employees, and Contract Agents from any claim, action, or proceeding against the City, its Official, Officers, Employees, Contract Consultants, or Agents to attach, set aside, void, or annul an approval of the City, its advisory agencies, appeal boards, or legislative body concerning the subject project located on Pad "7" of Planning Area 3, of the Canyon Hills Muket Place, which action is bought within the time period provided for in California Government Code Sections 65009 and! or 66499.37, and Public Resources Code Section 21167. The City will promptly notify the Applicant of any such claim, action, or proceeding against the City and will cooperate fully with the defense. If the City fails to promptly notify the Applicant of any such claim, or proceeding, the Applicant shall not, thereafter, be responsible to defend, indemnify, or hold harmless the City. PLANNING DMSION 2. Conditional Use Permit No. 2005-16 and Commercial Design Review No. 2005-07 approval for a "drive through" restaurant will lapse and be void unless a building permit is issued within one (1) year of the approval date. /'""'- 3. All construction shall comply with these Conditions of Approval and those provisions and requirements contained in the Canyon Hills Specific Plan and Municipal Code, prior to issuance of certificate of occupancy and release of utilities. 4. All site improvements shall be constructed as indicated on the approved building elevations and site plan for the "drive through" restaurant. 5. Future construction shall be consistent with these Conditions of Approval, those conditions approved with Canyon Hills Market Place, Planning Areas 3 and 4, and those provisions and requirements contained in the Canyon Hills Specific Plan and Municipal Code, subject to approval by the Community Development Director or designee. 6. Any revisions to approved site plans or building elevations shall be reviewed and approved by the Community Development Director or designee. 7. Materials and colors depicted on the materials board shall be used unless modified by the Community Development Director or designee. 8. The building addresses (in numerals at least four inches high) shall be displayed near the entrance and easily visible from the front of the unit and public right-of-way. The applicant shall obtain a street address prior to issuance of building permit. ~ 9. The applicant shall comply with all requirements of the City's Grading Ordinance. Construction generated dust and erosion shall be mitigated in accordance with the provisions of Municipal Code, AGENDA ITEM NO. 33 PACE_ 7 -=-OF ) c.. CONDITIONS OF APPROVAL Page 2 of 5 CONDITIONAL USE PERMIT NO. 2005-16 AND COMMERCIAL DESIGN REVIEW NO. 2005-07 '.....,f Chapter 15.72 and using accepted techniques. Interim erosion control measures shall be provided 30 days after the site's rough grading, as approved by the City Engineer. 10. The applicant shall comply with all applicable City Codes and Ordinances. 11. Trash enclosures shall be constructed per City standards as approved by the Community Development Director or designee, prior to issuance of building permit. 12. A cash bond of $1,000.00 shall be required for any construction trailers used during construction. Bonds will be released after removal of trailer{s), subject to the approval of the Community Development Director or designee. 13. The applicant shall pay school fees to the Lake Elsinore Unified School District prior to issuance of building permit. 14. The project shall connect to sewer and meet all requirements of the Elsinore Valley Municipal Water District (EVMWD). The applicant shall submit water and sewer plans to the EVMWD and shall incorporate all district conditions and standards. 15. The design and construction of the project shall meet all County Fire Department standards for fire protectIon. "-' 16. All mechanical and electrical equipment for the building shall be architecturally screened. All outdoor ground or wall mounted utility equipment shall be consolidated in a central location and architecturally screened along with substantial landscaping, subject to the approval of the Community Development Director, prior to issuance of building permit. 17. All exterior on-site lighting shall be shielded and directed on-site so as not to create glare onto neighboring property and streets or allow illumination above the horizontal plane of the fIxtUre. All light fixtures shall be consistent with the architectural style of the building. 18. All exterior downspouts shall be concealed or architecturally screened and painted to match the exterior color of the building as approved by the Community Development Director or Designee. 19. All building signage shall comply with the Sign Program submitted to the Planning Division. 20. All drive aisles and loading areas shall be kept and maintained free and clear of any materials/merchandise so as not to obstruct on-site circulation and deliveries. 21. Parking stalls shall be double-striped with four-inch (4") lines two feet (2') apan. 22. Provide a 12-inch concrete paver along the side of parking stalls that are adjacent to planters (paver to include curb width). 23. Applicant shall meet ADA (Americans with Disabilities Act) requirements. "-' AGENDA 'TEM NO. '-~ PACE f OF S l. CONDITIONS OF APPROVAL Page 3 of 5 r-- CONDITIONAL USE PERMIT NO. 2005-16 AND COMMERCIAL DESIGN REVIEW NO. 2005-07 24. No exterior roof ladders shall be pennitted 25. All service and loading doors shall be painted to match the building. 26. On-site surface drainage shall not cross sidewalks. 27. Comply with the Mitigation Monitoring Program that was prepared for the 2003 Addendum to the 1989 Final Canyon Hills Specific Plan EIR. 28. Three (3) sets of the Final Landscaping/Irrigation Detail Plan shall be submitted, reviewed and approved by the City's Landscape Architect Consultant and the Community Development Director or designee, prior to issuance of building pennit. A Landscape Plan Check & Inspection Fee will be charged prior to fmallandscape approval based on the Consultant's fee plus forty percent (40%) City fee. /""'. r" a) All planting areas shall have permanent and automatic sprinkler system with 100% plant and grass coverage using a combination of drip and conventional irrigation methods. Applicant shall plant street trees selected from the City's Street Tree List, a maximum of thirty feet (301 apart and at least twenty-four-inch (24") box in size. c) All planting areas shall be separated from paved areas with a six inch (6") high and six inch (6") wide concrete curb. b) d) Planting within fifteen feet (15') of ingress/egress points shall be no higher than thirty- six inches (36"). e) Landscape planters shall be planted with an appropriate parking lot shade tree pursuant to the LEMC and Landscape Design Guidelines. f) Any transformers and mechanical or electrical equipment shall be indicated on landscape plan and screened as part of the landscaping plan. g) The landscape plan shall provide for ground cover, shrubs, and trees and meet all requirements of the City's adopted Landscape Guidelines. Special attention to the use of Xeriscape or drought resistant plantings with combination drip irrigation system to be used to prevent excessive watering. h) All landscape improvements shall be bonded 100% for material and labor for two years from installation sign-off by the City. Release of the landscaping bond shall be requested by the applicant at the end of the required two years with approval/acceptance by the Landscape Consultant and Community Development Director or Designee. AGENDA 'TEM No._3~ PAGE_ C} _OF 3e-- CONDITIONS OF APPROVAL Page 4 of 5 CONDITIONAL USE PERMIT NO. 2005-16 AND COMMERCIAL DESIGN REVIEW NO. 2005-07 ~ ~ All landscaping and irrigation shall be installed within affected portion of any phase at the time a Certificate of Occupancy is requested for any building. All planting areas shall include plantings in the Xeriscape concep4 drought tolerant grasses and plants. j) Final landscape plan must be consistent with approved site plan. k) Final landscape plans to include planting and irrigation details. 29. . The applicant shall provide a landscaping hedge row of acceptable materials and spacing subject to the review and approval by the Community Development Director or designee. 30. Prior to issuance of any precise grading permit or building permi4 the applicant shall sign and complete an "Acknowledgment of Conditions" and shall return the executed original to the Community Development Department for inclusion in the case records 31. The Conditions of Approval shall be reproduced on subsequent building plans prior to issuance of building permit. 32. The applicant shall at all times comply with Section 17.78 (Noise Control) of the Lake Elsinore Municipal Code. 33. The applicant shall pay all appropriate City fees. ~ ENGINEERING DMSION 34. Comply with underlying Conditions of Approval. 35. Trash enclosure shall be situated such that trucks attempting to empty the bins do not block main drive isles. 36. Access routes from Rail Road Canyon Road to the restaurant shall be constructed pnor to occupancy. 37. Provide for compliance with the Santa Ana Regional Clean Water Run-off Permit. 38. Stacking for drive-through traffic on any pad shall not obstruct drive aisle circulation. 39. Pay all Capital Improvement and Plan Check fees (LEMC 16.34, Resolution 85-26), mitigation fees, area drainage fee, traffic impact fee (TIF), encroachment permit fees and inspection fees associated with the project and its development. 40. Submit a "Will Serve" letter to the City Engineering Division from the applicable water agency stating that water and sewer arrangements have been made for this project. Submit this letter prior to fmal map approval. ~ ACENDA ITEM NO. 33 PACE ) 0 OF ..5" CONDITIONS OF APPROVAL Page 5 of 5 CONDITIONAL USE PERMIT NO. 2005-16 AND COMMERCIAL DESIGN REVIEW NO. 2005-07 ,r--- 41. All compaction reports, grade certifications, monument certifications (with tie notes delineated on 8 ~" x 11" Mylar) shall be submitted to the Engineering Division before final inspection of public works improvements will be scheduled and approved. 42. Provide fire protection facilities as required in writing by the Riverside County Fire Department. 43. Applicant shall submit a traffic control plan showing all traffic control devices for the project. All traffic control devices shall be installed prior to final inspection of public improvements. 44. Apply and obtain a grading pennit with appropriate security prior to building pennit issuance. A grading plan signed and stamped by a California Registered Civil Engineer shall be required if the grading exceeds 50 cubic yards or the existing flow pattern is substantially modified as determined by the City Engineer. If the grading is less than 50 cubic yards and a grading plan is not required, a grading pennit shall still be obtained so that a cursoty drainage and flow pattern inspection can be conducted before grading begins. 45. Provide soils, geology and seismic report unless otherwise provided 46. Storm drain inlet facilities shall be appropriately stenciled to prevent illegal dumping in the drain system, the wording and stencil shall be approved by the City Engineer. ~ 47. Applicant will be required to install BMP's using the best available technology to mitigate any urban pollutants from entering the watershed. 48. Applicant shall obtain approval from Santa Ana Regional Water Quality Control Board for their storm water pollution prevention plan including approval of erosion control for the grading plan prior to issuance of grading pennits. The applicant shall provide a WQMP for post construction which describes BMP's that will be implemented for the development and including maintenance responsibilities. 49. Education guidelines and Best Management Practices (BMP) shall be provided to residents of the development in the use of herbicides, pesticides, fertilizers as well as other environmental awareness education materials on good housekeeping practices that contribute to protection of stormwater quality and meet the goals of the BMP in Supplement" A" in the Riverside County NPDES Drainage Area Management Plan. 50. Applicant shall provide first flush BMP's using the best available technology that will reduce stormwater pollutants from parking areas and driveways. 51. In accordance with the City's Franchise Agreement for waste disposal and recycling, the applicant shall be required to contract with CR&R, Inc., for removal and disposal of all waste material, debris, vegetation and other rubbish generated during cleaning, demolition, clear and grubbing or all other phases of construction. r' AGENDA ITEM NO. .3r3 PAGE If OF 3 (. PAGE 4 - PLANNING COMMISSIONMINlITES -JANUARY 17, 2006 6. Conditional Use Permit No. 2005-16: and Commercial Desie:n Review No. 2005-07 ......", Carl's Jr. (Canvon Hills Market Place). Chairman O'Neal opened the Public Hearing at 6:12 p.m. Community Development Director Preisendanz provided a brief overview of the proposed project and requested Project Planner Coury review it with the Commission and answer questions. Project Planner Coury noted that the project location was on pad seven of Planning Area 3 within the Canyon Hills Market Place shopping center. He indicated that the drive thru building occupied approximately eight percent of the total site area. He described the architecture and added amenities. He noted that the project was in conformance with the development standards ofthe Canyon Hills Specific Plan and the Lake Elsinore Municipal Code. John Murray, BKI Inc., agreed with the Conditions of Approval. Commissioner LaPere concurred with staff s recommendation. Commissioner Gonzales noted his support for the project. Vice Chairman Larimer concurred with staffs recommendation. "-" Chairman O'Neal had no comment. There being no further business, Chairman O'Neal closed the Public Hearing at 6: 15 p.m. MOVED BY LAPERE, SECONDED BY GONZALES AND PASSED BY A VOTE OF 4-0 TO APPROVE RESOLUTION 2006-05, A RESOLUTION OF THE PLANNING COMMISSION OF THE CITY OF LAKE ELSINORE, CALIFORNIA, APPROVING CONDITIONAL USE PERMIT NO. 2005-16 FOR THE ESTABLISHMENT OF A "DRIVE-THROUGH FACILITY" LOCATED ON PAD "7" OF PLANNING AREA 3, OF THE CANYON HILLS MARKET PLACE. MOVED BY LARIMER, SECONDED BY LAPERE AND PASSED BY A VOTE OF 4-0 TO APPROVE RESOLUTION 2006-06, A RESOLUTION OF THE PLANNING COMMISSION OF THE CITY OF LAKE ELSINORE, CALIFORNIA, RECOMMENDING CITY "-" AGENDA ITEM t~O. < '~ PAGE I ).. OF 3.c. PAGE 5 - PLANNING CDMMISSIONMINlITES -JANUARY 17, 2006 ,........ COUNCIL APPROVAL OF COMMERCIAL DESIGN REVIEW NO. 2005-07, FOR A "DRIVE-THROUGH FACILITY" LOCATED ON PAD "7" OF PLANNING AREA 3, OF THE CANYON HILLS MARKET PLACE Mitit!ated Net!ative Declaration No. 2005-05. Zone Chant!e No. 2005-02 and Tentative Tract Map No. 33486 O'Neal opened the Public Hearing at 6:15 p.m. Development Director Preisendanz provided a brief overview of the proposed quested Project Planner Miller review it with the Commission and answer Project Planner . ler noted that the proposed project was continued at the Planning Commission Mee on December 20,2005. She stated that the applicant was requesting to subdivide 23 acres i 83 lots. She noted that two lots would remain the same size and one lot would be used as a: tention basin. She detailed access streets. She noted that the location of the project an infilllot that had been vacant for more than ten years. She noted a revised condition approval with corrections provided to the Commission. ,r-. David Leonard, 1223 Univer Ave. #240, Riverside, noted that Corman Leigh Communities was the applican r the project. He stated that the applicant had been working with six different prope owners to consolidate the property into one land use plan. He noted compliance with the Gen 1 Plan. He detailed the layout of the project and added easement area. He indicated that a b k wall would be constructed at the rear of the property, 15 feet inside of that propert 0 retain 25 foot access. He addressed circulation and access from Terra Cotta. He detaile e circulation design to avoid high speed traffic through the area. He noted the applicant' tent to extend Clement in order to finish the street off in the northern boundary. He ad sed storms drains proposed from Clement to Machado. He addressed Condition No. 140 ge 15 of23 regarding a Mello Roos CFD. He requested clarification as to if a creation of ello Roos CFD would be formed for this project; or ifthe project being annexed into alar CFD in the area. He stated that he agreed with the remaining Conditions of Approval. e thanked staff for their efforts. Cliff Davidson, 15026 Zieglinde Dr., Lake Elsinore, addresse Cotta and the sizes of the homes. Condition No. 14 was to have a the applicant desired to join an nce with that. Engineering Manager Seuma10 noted that the intention mechanism for the landscape maintenance. He noted th existing CFD for that maintenance, staff would be in conc sements, access from Terra ,........ AGENDA ITEM NO. PAGE 13 ~~ OF .? Co Qty ofLakc E1sin<re Planning Diflis ion 130 S. MID Street Lake Elsnore, CA 92530 (909) 674-3124 (909) m-1419 fax PLANNING COMMISSION STAFF REPORT ....., I DATE: TO: FROM: PREPARED BY: PROJECT TITLE: APPLICANT: OWNER: PROJECT REQUEST January 17,2006 Chairman and Members of the Planning Commission Rolfe M Preisendanz, Director of Community Development Kirt A Coury, Project Planner Conditional Use Permit No. 2005-16; and Commercial Design Review No. 2005-07 - Carl's Jr. (Canyon Hills Market Place). Lorenzo Reyes, BKI inc., Star Goals, LLe, 1403 Batavia Street, Ste. 203, Orange, CA 92867. '-" Sudberry Properties, Inc., 5465 Morehouse Drive, Ste. 260, San Diego, CA 92121. A Conditional Use Permit and Commercial Design Review for the construction of a drive-through restaurant pursuant to Chapter 8.6 (G1 : Neighborhood Commercial District) of the Canyon Hills Specific Plan, Cbapter 17.38 (Non-Residential Design Review), Chapter 17.66 (parlcing Requirements), Chapter 17.66.060 (Drive- Through Establishments), Chapter 17.74, (Conditional Use Permits) and Chapter 17.82 (Design Review) of the Lake Elsinore Municipal Code (LEMq. ENVIRONMENTAL SETTING Project Vacant G2 (PA3) Canyon Hills Specific Plan Site North Vacant OS Can South Vacant OS Can East Vacant OS Can West Vacant G1 Can ....., AGENDA ITEM NO. 2i3 PAGE I ~ OF J f, ~ PLANNING COMMISSION STAFF REPORT JANUARY 17, 2006 Page 2 of 6 PROjECf TITLE: CONDITONAL USE PERMIT NO. 2005-16, AND COMMEROAL DESIGN REVIEW NO. 2005-07 CARL'S jR. (CANYON HILLS MARKET PLACE) /""' PROjECf LOCATION The .65 acre project site is located on Pad "7" of Planning Area 3 of the Canyon :Hills Market Place at the southwest comer of Railroad Canyon Road and Canyon :Hills Drive. Access to the project site will be provided from Railroad Canyon Road. PROjECf DESCRIPTION The proposed project is identified as Pad "7" of Planning Area 3, of the Canyon :Hills Market Place Shopping Center. The Shopping Center was approved by the Planning Commission in October, 2004. Approval was given for the site plan and parking layout. The project site was conditioned to submit applications for conditional use permits to allow for the drive-through establishments and design review for the building elevations. CONDITIONAL USE PERMIT NO. 2005-16 In compliance with the Conditions of Approval, the applicant is requesting the approval of a conditional use permit to allow for the establishment of a "drive-through" facility. The request for the "drive-through" facility is pursuant to Chapter 17.66.060 (Drive-Through Establishments). The proposed " Drive- Through" restaurant is anticipated to operate as a "24 hour establishment". Three (3) full time positions and 12 to 15 part time positions will be created by this facility. The "drive-through" portion of the restaurant will generate approximately sixty percent (60%) of traffic, with the remaining forty percent (40%) being generated by the dining room area. Parking for the proposed drive-through restaurant was analyzed accordingly. Finally, the stacking distance for the drive-through lane will accommodate eight (8) car lengths. COMMERQAL DESIGN REVIEW NO. 2005-07 ~hitecturaJ Design The applicant is proposing to construct a rectangular shaped "sand float" finish cement plaster building consisting of 3,198 square feet. The total land area is 39,156 square feet or .89 acres. The building will occupy approximately 8% of the total site area which complies with the Gty of Lake Elsinore's General Plan which allows a maximum of .40 Floor Area Ratio (FAR). The building will incorporate a pop-out tower elements for visual relief and shadowing along the north and east elevations of the building. The pop-out tower, as well as comer elements of the building will incorporate a decorative stone veneer ("Coronado Stone"). The stone veneer is also proposed as an accent treatment at the base of the porte-cochere element of the drive-through "pick-up" window. The building will include scored reveals, accent tiles, arch elements and decorative awnings over the windows, adding architectural interest and detail. "...... ACENDA ITEM NO. 33 PACE I '5 OF:3 ~ PLANNING COMMISSION STAFF REPORT JANUARY 17, 2006 Page 3 of 6 PROJECT TITLE: CONDITONAL USE PERMIT NO. 2005-16, AND COMMERQAL DESIGN REVIEW NO. 2005-07 CARL'S JR. (CANYON HILLS MARKET PLACE) ...." Finally, the roof line of the pop-out tower elements includes a decorative cornice cap and is approximately three feet (3') higher than the main building roof line, providing articulation and variation to an otherwise straight or flat roof line. ' Colors and Materials Finish materials for the building exterior include color treatments as well as score lines to create horizontal and vertical visual interest. The proposed building will incotpOrate anodized aluminum storefront windows. The maximum building height is twenty-four feet (24'), which will be compatible to adjacent commercial buildings. Building Location Material Color Building Walls Cornice Cap Accent Band/Wainscot Wmdow Awning Wall Mounted Lighting ANALYSIS The proposed drive-through establishment has been found in confonnance with all applicable development standards of the Canyon Hills Specific Plan, and the Lake Elsinore Municipal Code. In addition, the project has been designed with enhanced architectural characteristics such as raised parapets, varying color treatments and materials, and wall breaks to create interesting building elevations. Staff feels that the proposed project will compliment the existing and proposed development in the surrounding area. ENVIRONMENTAL DETERMINATION ~ment Plaster Ra:Ie'llLXXi Dark Gnm, Herbiwre, ani Haru:st Gdd Painted Foam Cornice Ha'fl'El'ffi Si/:lEr Stone Veneer Coronado S'tal! Verm- - Mountain Sunset Canvas Awning Canws Sunbrrila Jakey R<<i # 4603 Lighting Fixture ......" The Addendum to the 1989 Final Canyon Hills Specific Plan Environmental Impact Report, which was prepared in accordance with Section 15164 of the State CEQA Guidelines, provides the necessary environmental clearances for the proposed applications. Accordingly, staff believes the proposed applications implement the land use objectives and requirements of the Specific Plan and finds that further environmental evaluation is therefore, unnecessary. RECOMMENDATION It is recommended that the Planning Commission adopt Resolution No. 2006- _ approving Conditional Use Permit No. 2005-16, and Resolution No. 2006- _ recommending to the Gty Council approval of Commercial Design Review No. 2005-07. This recommendation is based on the following Findings, Exhibits, and attached Conditions of Approval. ......" AGENDA ITEM NO. 33 PAGE I & OF 3 ~ ~ ,-. ,-... PLANNING COMMISSION STAFF REPORT JANUARY 17, 2006 Page 4of6 PROJECf TITLE: CONDITONAL USE PERMIT NO. 2005-16, AND COMMERQAL DESIGN REVIEW NO. 2005-07 CARL'S JR. (CANYON HILLS MARKET PLACE) FINDINGS - CONDITIONAL USE PERMIT 1. The proposed use, on its own merits and within the context of its setting, is in accord with the objectives of the General Plan and the pmpose of the planning district in which the site is located. In order to aJiere a 'lll'il lxtlarml arxi Jiux:tional rrix if residential, cr>>17I1'1!1'Ci iHlust:ri4 cpen space, rrrreatimal ard institutimaJ larxJ uses, staff has t:hormgJy euzluatal the lard use cmpatihility, rKise, traffic arxi ether emirmnrntal hazards related to the -prrfJa<<i Onlitimal Use Pemit far the estahlishrmrt if a "Driw- 1'hra.t[/J FaaJitj' la:at<<l en Pad "7" ifPlanningA mt 3, if the ~Hills Market Place. A~ the -prrfJa<<i larxJ use is in an:urrerxE Wth the chj<<:tnes if the Gereral Plan ard the fJUl1Jae if the planning district in 7ihUh the site is kx:ataJ. 2. The proposed use will not be detrimental to the general health, safety, comfort, or general welfare of persons residing or working within the neighborhood of the proposed use or the Gty, or injurious to property or improvements in the neighborhood or the Gty. In aaard Wth the fJUl1Jaes if the Oxtpter 17.74 (Onlitimal Use Pemits) if the Lake Elsimre Muniapal Ode, the City rraliz<<i that the -prrfJa<<i Onlitimal Use Pemit far the estahlishrmrt if a "Driw-1'hra.t[/J FaaJity" kxatRd en Pad "r if Plarrning A mt 3, if the ~ Hills Market Place mry haw a pcrential to ~ inpaa the uelfare if pemn res~ or wnkin6 Wthin the ndg,barIxxxl or the Cit)l Onidering this, staff has substantiaud that all ttpplimJle City DepartrrEn/s arxi A wries haw b?en afforded the cpportunixy far a t:haraIgJ miew if the use ard haw inx>>porated all applU:ahle canrrEJ1/S arxl/ or anlitims rr:lat<<l to instttllation arxi mtintemra if larx!capirT& street da1icatUn, ~ if pcinJs if uhiaJa:r ingress arxi tgress ard cmtrd if pcrential nuisarm, so as to elininate any ~ inputs to the WUallxulth, safety, corrfort, or wual71Ilfare if the s~ ndrjJborlxxx1 or the City. 3. The site for the intended use is adequate in size and shape to accommodate the use, and for all the yards, setbacks, walls or fences, landscaping, buffers and other features required by TIde 17 of the LEMC The -prrfJa<<i Onlitimal Use Pemit for the estahlishrmrt if a "Driw-1'hra.t[/J F aaJity" la:at<<l en Pad "r if Planning A mt 3, if the ~ Hills Market Place has b?en desigJRl in anideratim if the size ard shape if the prrpert:y, thereby s~ ard enharring, the inmxIiate camEYCial area. Further, the prrjer:t as -prrfJaed, WlJ cmplenrnt the quality if existing ~ ard WlJ create a Usually pleasin& rK>>detracti7E relatimship leturen the -prrfJa<<i ard existing prcjeds, in that the prt:1Ja<<i use has b?en redeutrl to ensure adtquate prorisim if s~from the puhlic riWts-if-7mJ or adjt<<EJ1t prrperties. 4. The site for the proposed use relates to streets and highways with proper design both as to width and type of pavement to carry the type and quantity of traffic generated by the subject use. The -prrfJa<<i Onlitimal Use Pemit for the estahlishrmrt if a "Driw-1'hra.t[/J F aaJity" 1a-at:<<J en Pad "7" if Plarrning A mt 3, if the ~ Hills Market Place has b?en reriew?d as to its rr1atim to the Wdth arxi type if paW1'Ef1l ~ to carry the type ard quantity if traffic wuat<<l, in that the City has a&:quately euduated the pcrential inputs associated Wth the -prrfJa<<i uses prior to its appraud ard has anIitUnd the prqer:t to /;e AGENDA ITEM NO. PAGE /1 ScS OF "3 c.. PLANNING COMMISSION STAFF REPORT JANUARY 17, 2006 Page 5 of 6 PROJECT TITLE: CONDITONAL USE PERMIT NO. 2005-16, AND COMMERQAL DESIGN REVIEW NO. 2005-07 CARL'S JR. (CANYON HILLS MARKET PLACE) serurl by roWs if ~ capaaty ani di5i[!/1 starxlards ro prucide reascmable aaI!SS by car, trude, transit, arxl bU:yie. 5. In approving the subject use located on Pad "7" of Planning Area 3, of the Canyon Hills Market Place there will be no adverse affect on abutting property or the pennitted and nonna! use thereof. The ~<<i use has hEn tharatgJly ~ arxl cax:IitU:rmJ by all applicalie City lJepart:rrmts ani adside Awm, elinirtatUg the paential far any ani all adrerse if[eas 00 the abuttingprrperr:y. 6. Adequate conditions and safeguards pursuant to Section 17.74.50 of the LEMC have been incOlporated into the approval of the Conditional Use Pennit to insure that the use continues in a manner envisioned by these findings for the term of the use. PUlSuant ro Seaioo 17.74.050 (Aaioo if the Planning C'nmiss~ if the Lake Elsimre Muniapal 0Je (LEMq, the ~ad 0n:Iitimal Use Pemit far the estahlishrmTt if a "Driw- ~ FaaJit;I' kratRd 00 Pad "1" if Planning A ml 3, if the Gt~ Hills Market Place has hEn schedukd far anideratim ani appruud if the Planning Camissim FINDINGS - DESIGN REVIEW 1. The project, as approved, will cornplywith the goals and objectives of the General Plan and the Zoning District in which the project is located. The ~<<i Cnrrnm:ial Desi[!/1 RedewkratRd 00 Pad "1" if Planning A ml 3, if the Gt~ Hills Market Place amplies Wth the gds arxl chjeJ.tires if the Gerrral Plan, in that the appruud if this "time thrrMjp" restaurant faGlity W1J assist in adiecing the deuJqmrnt if a 'liIil-b:1larnd ani./Untim:d rrix if residential, camrrr.:iaJ, inlustrial, qxn space, m:JPatia1al arxl institutimallarxJ uses as 'liIil as erxxMYagjng inlustrialland uses ro dicersify Lake E lsimre's errn:nic Me 2. The project complies with the design directives contained in Section 17.82.060 and all other applicable provisions of the Municipal Code. The ~<<i Cnrrnm:ial Desi[!/1 Redew kratRd 00 Pad "1" if Planning A ml 3, if the Ompz Hills Market Place is apprrpriate ro the site ani srmamding dere/qmrnts in that the ~<<i "time thrrMjp" restaurant faGlity has hEn di5iwxl in anideratim if the size arxl shape if the prrperty, thereby ueating interest arxl mrying'listas as a persoo 11VU?S akng the strret. Further the prrj<<t as ~<<i W1J cmp/enrnt the quality if existirlg deuJqmrnt ani W1J CYPdte a 'lisually pleas~ rm-detraaite relationship betutm the ~ad ani existirlgprrjeas in that the arrhitatural di5igp, cdar ani rmterial am site di5igns ~<<i eritlem? a anem far quality arxl migjnality. 3. Subject to the attached Conditions of Approval, the proposed project is not anticipated to result in any significant adverse environmental impacts. The AddetrJmn ro the 1989 Final Ompz Hills Sprojic Plan Emi:rarnrntaJ Inpaa Report, uhUh 'UJlS prepami in aaurdarKT! Wth Seaioo 15164 if the State CE QA Guidelin5, pruddes the rm5sary emi1Wl7l!J1tal ckararm far the ~ad applications. A cr:ardirWY, stt1ff Wieu:s the ~ad applications inplenrnt the larxl AGENDA ITEM NO. 38 PACE__L~OF J (. ~ ~ ~ ,-... ,,-- ,,-- PLANNING COMMISSION STAFF REPORT JANUARY 17, 2006 Page 6 of 6 PROJECT TITLE: CONDITONAL USE PERMIT NO. 2005-16, AND COMMERQAL DESIGN REVIEW NO. 2005-07 CARL'S JR. (CANYON HILLS MARKET PLACE) use chjtxticPs and nquirenwts if the Speaji4 Plan and fin1s that finther emirrrrnrntal euduatim is thenfure, Uf/1'XJJ!Ssary. 4. Conditions and safeguards pursuant to Chapter 17.82.070 of the Zoning Code, including guarantees and evidence of compliance with conditions, have been incorporated into the approval of the subject project to ensure development of the property in accordance with the objectives of Chapter 17.82. Pursuant to Soctim 17.82.070 (Actim if the PIarrning Cnmiss~ if the Lake Elsimre Mtmifipal 0Je (LEMC), the ~<<i Carm?rrial DesiWZ Redew krated en Pad "7" if PIarrning A 1m 3, if the ~ Hills Market PlatE has ~ scJ.xrluled fur coosideratim and appraud by the Planning Camissim. Prepared by: Kirt A Coury, Project Planner Reviewed And Approved by: Rolfe Preisendanz, Director of Community Development . EXHIBITS Exhibit 'A' Exhibit 'B' Exhibit 'G Exhibit 'D' Exhibit 'E' Exhibit 'F' Exhibit 'G" Exhibit 'ff Exhibit 'I' Location Map Overall Site Plan (for portion of Canyon Hills Market Place shopping center) Site Plan Floor Plan Building Elevations Full Size Exhibits Colored Site Plan (presented at hearing) Colored Elevations (presented at hearing) Color and Materials Board (presented at hearing) ACENDA ITEM NO. PACE 11 ~33 . OF 3 c.. ~. ......... RESOLUTION NO. 2006- 05 A RESOLUTION OF THE PLANNING COMMISSION OF THE OTY OF LAKE ELSINORE, CALIFORNIA, APPROVING CONDITIONAL USE PERMIT NO. 2005-16 FOR THE ESTABLISHMENT OF A "DRIVE-THROUGH FAOLITY" LOCATED ON PAD "7" OF PLANNING AREA 3, OF THE CANYON HILLS MARKET PLACE. '-" WHEREAS, Lorenzo Reyes, BKI inc., Star Goals, lie, has initiated proceedings to request the approval of Conditional Use Pennit No. 2005-16 for the establishment of a "Drive- Through FacilitY' to be located on Pad "7" of Planning Area 3, of the Canyon Hills Market Place; and WHEREAS, the Planning Conunission of the Gty of Lake Elsinore has been delegated with the responsibility of approving Conditional Use Pennits; and WHEREAS, public notice of said application has been given, and the Planning Conunission has considered evidence presented by the Connnunity Development Department and other interested parties at a public hearing held with respect to this item onJanuaty 17,2006. NOW TIiEREFORE, the Planning Conunission of the Gty of Lake Elsinore DOES HEREBY RESOLVE as follows: SECTION 1. The Planning Conunission has considered the proposed Conditional Use Pennit 2005-16 prior to approval. The Planning Conunission finds and detennines that the Addendum to the 1989 Final Canyon Hills Specific Plan Environmental Impact Report, which was prepared in accordance with Section 15164 of the State CEQA Guidelines, provides the necessary environmental clearances for the proposed application, based upon the following findings and detenninations: ......, SECTION 2. That in accordance with State Planning and Zoning law and the Gty of Lake Elsinore the following findings for the approval of Conditional Use Pennit No. 2005-16 have been made as follows: 1. The proposed use, on its own merits and within the context of its setting, is in accord with the objectives of the General Plan and the pwpose of the planning district in which the site is located. In order to adiece a uel1 balarml ani./imcticnal nix if residential, cumrrcial, industrial, cpen sptuE, nrreatimal ard institutUntllard USfS, stajfhas t:haratgJly euduat<<l the lard use rorrpatibility, nise, traffic ani ether emirmm:ntal hazards related to the J11r1Jald Onlitianal Use Pernit far the fStablishnrnt if a "Driw- 'IbratgJ F aciliJ:y" la:aud on Pad "1" if Planning A mt 3, if the ca~ Hills Market Plaa? A crorrlinJy, the J11r1Jaed larrJ use is in cxn:J./l7'efKE Wth the dJjertiu:s if the Gen!ral Plan ani the ~e if the planning district in uhUh the site is la:ataJ. 2. The proposed use will not be detrimental to the general health, safety, comfort, or general welfare of persons residing or working within the neighborhood of the proposed use or the Gty, or injurious to property or improvements in the neighborhood or the Gty. ......, AGENDA ITEM NO. <~ PAGE Z 0 OF J J. /""'. /""'" ,-., PLANNING COMMISSION RESOLUfION FOR CONDITIONAL USE PERMIT 2005-16 Page 2 of3 In tU1XJlTi Wth the pttrpacs if the C1Japter 17. 74 (O:nliti.mJ Use Perrrits) if the Lake E lsirvre M uniapal 0xJe, the CiEy mdiz<<l that the ~<<l 0:nliti.mJ Use Pemit far the establislmmt if a "IJme. ~ F acilirj' la:at1:d an Pad "r ifPlarrning A n>a 3, if the Cany:nHills Market Pku:e mry hallE a pctential to ~ inpaa the wJfare if persans residing or 7JJJtIeing Wthin the nifPbarhaxi or the City Ons~ this, staff has substantiatai that all applicahle CiEy DepartrrEnts arx1 A pies haw lren affarrhl the cpportunixy far a ~ rer.iewif the use arx1 haw in:orporated all applicahle a:JfmE11/s arrl/ or anIitUns reIatRd to installatim am mtintenarxE if lands~ strret rkdimtims, ~ if JXints if uhiaJar ingess arx1 tgress arxl a:ntrd if pctential nuisarm, so as to elininate any ~ inpads to the wrral health, safety, anfart, or wrral7ielfare if the surran/ing niiJbarhaxl or the City 3. The site for the intended use is adequate in size and shape to accommodate the use, and for all the yards, setbacks, walls or fences, landscaping, buffers and other features required by TIde 17 of the LEMC The prcpa<<l 0:nliti.mJ Use Pemit far the cstdhlislmmt if a "IJme. ~ F aciliEy" la:at1:d an Pad "r if Plarrning A n>a 3, if the Cany:n Hills Market Pku:e has lren design:d in cmsideration if the size arx1 shape if the prrperty, thereby strenf!hening arx1 enharring the immliate ammzrrial arra. Further, the prcjoct as prcpaal, Wll cwplemnt the qualiEy if existing der.ekprrrnt arxl Wll create a Usually plmsi1r& rKn-detradi7.e relatimship /::Jeturen the prcpa<<l arx1 existing prrj<<ts, in that the prcpa<<l use has lren recieuPd to ensure ad<<juate prmisim if screeningfrrm the public rig,rs-cf'lmj or adjarent prcperties. 4. The site for the proposed use relates to streets and highways with proper design both as to width and type of pavement to carry the type and quantity of traffic generated by the subject use. The prcpa<<l 0:nliti.mJ Use Pemit far the cstdhlislmrnt if a "Driw- ~ F aciliEy" la:at1:d an Pad "7" if PlarrningA n>a 3, if the Cany:nHills Market Pku:e has lren recieuPd as to its relation to the Wdth arx1 type if pa'lErfl?l1t rm1ed to carry the type arx1 quarrtiEy if trajfk wrratlXi, in that the Oty has ~ euduated the pctential inpads associated Wth the prcpa<<l uscs prior to its approud arx1 has anlitiam the prrjoct to k serux/ by muls if ad<<juate capacity am desigrz starr1arrJs to prudde rrasooahle aaISS by car, trude, transit, arx1 bic;de 5. In approving the subject use located on Pad "7" of Planning Area 3, of the Canyon Hills Market Place there will be no adverse affect on abutting property or the pennitted and nonnal use thereof. The prcpa<<l use has lren ~ly rer.ieutxi arxl anlitiam by all applicahle Oty Departm?ntS arx1 aaside Apies, elinimting the pctential far any am all adterse effim an the ahuttingprrpen:y. 6. Adequate conditions and safeguards pursuant to Section 17.74.50 of the LEMC have been incorporated into the approval of the Conditional Use Pennit to insure that the use continues in a manner envisioned by these findings for the term of the use. Pursuant to Soctian 17.74.050 (Action if the Plarrning OmnissU:q if the Lake Elsirvre Muniapal Oxie (LEMC), the ~<<l 0:nliti.mJ Use Pemit for the cstdhlislmmt if a "Dme- ~ FaciliEy" la:at1:d an Pad '7" if Planning, A n>a 3, if the Cany:n Hills Market Pku:e has lren schedulai far cmsideration arx1 approud if the Plarrning Camissim. AGENDA ITEM NO. 33 PACE_ 21 _OF 3 C- PLANNING COMMISSION RESOLUTION FOR CONDITIONAL USE PERMIT 2005-16 Page 3 of3 ....., NOW, TIiEREFORE, based on the above findings, the Planning Commission of the Gty of Lake Elsinore DOES HEREBY APPROVE Conditional Use Permit No. 2005-16. Michael O'Neal, ClIairrnan Lake Elsinore Planning Commission I hereby certify that the preceding resolution was adopted by the Planning Commission at a meeting thereof conducted on January 17,2006 by the following vote: AYES: Commissioners: O'NEAL, LARIMER, GONZALES, LAPERE NOES: Commissioners: ABSENT: Commissioners: ABSTAIN: Commissioners: '-" ATTEST: Rolfe M Preisendanz, Secretary to the Planning Commission '-" ACENDA ITEM NO. ,~.:::' PACE 1- 2. OF } (, ~ RESOLUTION NO. 2006- 06 A RESOLUfION OF THE PLANNING COMMISSION OF THE CITY OF LAKE ELSINORE, CALIFORNIA, RECOMMENDING CITY COUNCIL APPROVAL OF COMMERCIAL DESIGN REVIEW NO. 2005-07, FOR A "DRIVE-THROUGH FACILITY" LOCATED ON PAD "7" OF PLANNING AREA 3, OF THE CANYON HILLS MARKET PLACE WHEREAS, an application has been filed with the Gty of Lake Elsinore by Lorenzo Reyes, BKI inc., Star Goals, LLC., to request a Commercial Design Review No. 2005-07 for a "drive through" restaurant building totaling 3,198 square feet on .89 acres of vacant land; WHEREAS, the Planning Commission of the Gty of Lake Elsinore has been delegated with the responsibility of making recommendations to the Gty Council pertaining to the Design Review of commercial projects; and WHEREAS, public notice of said application has been given, and the Planning Commission has considered evidence presented by the Community Development Department and other interested parties at a public meeting held with respect to this item on January 17, 2006. NOW 1HEREFORE, the Planning Commission of the Gty of Lake Elsinore DOES ~ HEREBY RESOLVE as follows: SECTION 1. The Planning Commission has considered the proposed request for the Commercial Design Review No. 2005-07 prior to making a decision to recommend that the Gty Council approve the proposed "drive through" restaurant facility. The Planning Commission finds and determines that the Addendum to the 1989 Final Canyon Hills Specific Plan Environmental Impact Report, which was prepared in accordance with Section 15164 of the State CEQA Guidelines, provides the necessary environmental clearances for the proposed application, based upon the following fmdings and determinations; SECTION 2. That in accordance with Chapter 17.82 (Design Review) of the Lake Elsinore Municipal Code the following findings for the approval of have been made as follows: 1. The project, as approved, will comply with the goals and objectives of the General Plan and the Zoning District in which the project is located. The prrpaed ~ Design Redewla:ated 00 Pad "7" if Planning A mt 3, if the Gt~ Hills Market Place cmplies Wth the [pJls am chjff.ti'U!S if the General Plan, in that the appruutl if this "drire tbrati/' restaurant fadJity Wll assist in aUJiedng the dec.eIqmrnt if a 'lilil-Wlamrl ani furx:tUnd rrix if residential, carTJrEYCial, inJustrial, q;en spatE, recreatimal ani institutianallam uses as 71Pl1 as etratra~ inJustriallani uses to dicersify Lake E lsimre's ~ b1se 2. The project complies with the design directives contained in Section 17.82.060 and all other applicable provisions of the Municipal Code. r---- ACENDA ITEM No.3?::/. ~ PACE~ 3 _OF.-.J t. ~ PLANNING COMMISSION RESOLUTION FOR COMMERQAL DESIGN REVIEW NO. 2005-07 Page 2 of3 ~ 1heprrpa<<1 ComnmialDesi[!!lRedewla:ated 00 Pad "7" ifPlanningA1m 3, if the Gt~Hills Market Plare is apprrpriate to the site am s~ deu:/qJrrFnJs in that the propa<<1 CC dYne thrrHjJ" rrstaurant fadli1:y has /:xen dtsi~ in anideratioo if the size am shape if the prrperty, therWy creating interest and ut~ 'listas as a pmoo 1WU!S along the strret. Further the prrjoct as propa<<1 WJl arrplenrnt the quali1:y if existing dec.elqmrnt am WJl create a 'lisually pleasin& rul-detraai7.e rriat:icnship betut:en the propa<<1 am existingJ>>riocts in that the arrhit<<tural dtsi[!!l. cdar and rmteriaJ and site dtsigps propa<<1 eridm:e a aJfXEm far quali1:y and origjmlit)! 3. Subject to the attached Conditions of Approval, the proposed project is not anticipated to result in any significant adverse environmental impacts. 1he Adderxlum to the 1989 Final Gt~ Hills Spetific Plan Ernirrnnwtal Inpaa Report, 'lIhUh ws prepami in aaxmiarKe Wth S<<tim 15164 if the State CE Q4 Guide1in:s, pruriJRs the rm:ssary ernircnmntttl deararm far the propa<<1 applications. A a:ordinJy, staff klieu:s the prrpa<<1 applications inplenrnt the land use dJjecti'U'S and raplirerrrnts if the Spetific Plan and finis that.finther emi~ eznluatim is therifare, u:nn:assary. 4. Conditions and safeguards pursuant to Chapter 17.82.070 of the Zoning Code, including guarantees and evidence of compliance with conditions, have been incorporated into the approval of the subject project to ensure development of the property in accordance with the objectives of Chapter 17.82. Pursuant to S<<tim 17.82.070 (Actim if the Pla1'll1inJ Camissw,y if the Lake Elsimre Municipal 0xIe (LEMC), the propa<<1 Comnmial Desi[!!l Redew Ia:ated 00 Pad ccr if Pla1'll1inJ A 1m 3, if the ~ Hills Market Plare has /:xenschet1ukd far anideratioo am appruwJ by the Pla1'll1inJ Camissm '-" NOW, lHEREFORE, based on the above Findings, the Planning Commission of the Gty of Lake Elsinore DOES HEREBY RECOMMEND TO lHE an COUNaL APPROVAL of Design Review for Commercial Project No. 2005-07. Michael O'Neal, Cbairman Lake Elsinore Planning Commission I hereby certify that the preceding resolution was adopted by the Planning Commission at a meeting thereof conducted on January 17,206 by the following vote: '-" ACENDA ITEM NO. . ~ .6 ___"" PACE 2-4 OF J (, . ..~. ~ '"""" r'- ,/'"' ,/'"' PLANNING COMMISSION RESOLUTION FOR COMMERQAL DESIGN REVIEW NO. 2005-07 Page 3of3 AYES: Conunissioners: O'NEAL, LARIMER, GONZALES, LAPERE NOES: Conunissioners: ABSENT: Conunissioners: ABSTAIN: Conunissioners: ATTEST: Rolfe M. Preisendanz, Secretary to the Planning Co~sion AGENDA ITEM NO. :.:::r.3 PACE 1.-> OF} (. ......, GENERAL 1. The applicant shall defend (with counsel acceptable to the Gt)?, indemnify; and hold harmless the Gty, its Official, Officers, Employees, and Contract Agents from any claim, action, or proceeding against the Gty, its Official, Officers, Employees, Contract Consultants, or Agents to attach, set aside, void, or annul an approval of the Gty, its advisory agencies, appeal boards, or legislative body concerning the subject project located on Pad "7" of Planning Area 3, of the Canyon Hills Market Place, which action is bought within the time period provided for in Gilifomia Government Code Sections 65009 and! or 66499.37, and Public Resources Code Section 21167. The Gtywill promptly notify the Applicant of any such claim, action, or proceeding against the Gty and will cooperate fully with the defense. If the Gty fails to promptly notify the Applicant of any such claim, or proceeding, the Applicant shall not, thereafter, be responsible to defend, indemnify, or hold harmless the Gty. PLANNING DIVISION 2. Conditional Use Pennit No. 2005-16 and Commercial Design Review No. 2005-07 approval for a "drive through" restaurant will lapse and be void unless a building pennit is issued within one (1) year of the approval date. 3. All construction shall comply with these Conditions of Approval and those provisions and requirements contained in the Canyon Hills Specific Plan and Municipal Code, prior to issuance of certificate of occupancy and release of utilities. "-'" 4. All site improvements shall be constructed as indicated on the approved building elevations and site plan for the "drive through" restaurant. 5. Future construction shall be consistent with these Conditions of Approval, those conditions approved with Canyon Hills Market Place, Planning Areas 3 and 4, and those provisions and requirements contained in the Canyon Hills Specific Plan and Municipal Code, subject to approval by the Connnunity Development Director or designee. 6. Any revisions to approved site plans or building elevations shall be reviewed and approved by the Connnunity Development Director or designee. 7. Materials and colors depicted on the materials board shall be used unless modified by the Connnunity Development Director or designee. 8. The building addresses (in numerals at least four inches high) shall be displayed near the entrance and easily visible from the front of the unit and public right-of-way. The applicant shall obtain a street address prior to issuance of building pennit. 9. The applicant shall comply with all requirements of the Gty's Grading Ordinance. Construction "-'" generated dust and erosion shall be mitigated in accordance with the provisions of Municipal Code, ACENOA ITEM NO. 33 PAC - ~OF-.!!. - CONDITIONS OF APPROVAL Page 2 of 6 "".-... CONDITIONAL USE PERMIT NO. 2005-16 AND COMMEROAL DESIGN REVIEW NO. 2005-07 Chapter 15.72 and using accepted techniques. Interim erosion control measures shall be provided 30 days after the site's rough grading, as approved by the Gty Engineer. 10. The applicant shall comply with all applicable GtyCodes and Ordinances. 11. Trash enclosures shall be constructed per Gty standards as approved by the Comnmnity Development Director or designee, prior to issuance of building pennit. 12. A cash bond of $1,000.00 shall be required for any construction trailers used during construction. Bonds will be released after removal of trailer(s), subject to the approval of the Community Development Director or designee. 13. The applicant shall pay school fees to the Lake Elsinore Unified School District prior to issuance of building permit. 14. The project shall connect to sewer and meet all requirements of the Elsinore Valley Municipal Water District (EVMWD). The applicant shall submit water and sewer plans to the EVMWD and shall incorporate all district conditions and standards. ,-. 15. The design and construction of the project shall meet all County Fire Department standards for fire protection. 16. All mechanical and electrical equipment for the building shall be architecturally screened. All outdoor ground or wall mounted utility equipment shall be consolidated in a central location and architecturally screened along with substantial landscaping, subject to the approval of the Community Development Director, prior to issuance of building permit. 17. All exterior on-site lighting shall be shielded and directed on-site so as not to create glare onto neighboring property and streets or allow illumination above the horizontal plane of the fixture. All light fixtures shall be consistent with the architectural style of the building. 18. All exterior downspouts shall be concealed or architecturally screened and painted to match the exterior color of the building as approved by the Community Development Director or Designee. 19. All building signage shall comply with the Sign Program submitted to the Planning Division. 20. All drive aisles and loading areas shall be kept and maintained free and clear of any materials/ merchandise so as not to obstruct on-site circulation and deliveries. 21. Parking stalls shall be double-striped with four-inch (4") lines two feet (2') apart. 22. Provide a 12-inch concrete paver along the side. of parking stalls that are adjacent to planters (paver to ,- include curb width). ACENDA ITEM NO'-L 3~~ "" .'" PACE 27 OF> (. ---4. ~'i: .~~~ CONDITIONS OF APPROVAL Page 3 of 6 CONDITIONAL USE PERMIT NO. 2005-16 AND COMMERQAL DESIGN REVIEW NO. 2005-07 -.."" 23. Applicant shall meet ADA (Americans with Disabilities Act) requirements. 24. No exterior roof ladders shall be permitted. 25. All service and loading doors shall be painted to match the building. 26. On-site surface drainage shall not cross sidewalks. 27. Comply with the Mitigation Monitoring Program that was prepared for the 2003 Addendum to the 1989 Final Canyon Hills Specific Plan EIR 28. Three (3) sets of the Final Landscaping/Irrigation Detail Plan shall be submitted, reviewed and approved by the Oty's Landscape Architect Consultant and the Community Development Director or designee, prior to issuance of building permit. A Landscape Plan Clleck & Inspection Fee will be charged prior to final landscape approval based on the Consultant's fee plus forty percent (40%) Oty fee. a) All planting areas shall have permanent and automatic sprinkler system with 100% plant and grass coverage using a combination of drip and conventional irrigation methods. b) Applicant shall plant street trees selected from the Otis Street Tree List, a maximum of thirtyfeet (30') apart and at least twenty-four-inch (24") box in size. ""'" c) All planting areas shall be separated from paved areas with a six inch (6") high and six inch (6") wide concrete curb. d) Planting within fifteen feet (15) of ingress/egress points shall be no higher than thirty- six inches (36"). e) Landscape planters shall be planted with an appropriate parking lot shade tree pursuant to the LEMC and Landscape Design Guidelines. f) Any transformers and mechanical or electrical equipment shall be indicated on landscape plan and screened as part of the landscaping plan. g) The landscape plan shall provide for ground cover, shrubs, and trees and meet all requirements of the Oty's adopted Landscape Guidelines. Special attention to the use of Xeriscape or drought resistant plantings with combination drip irrigation system to be used to prevent excessive watering. h) All landscape improvements shall be bonded 100% for material and labor for two years from installation sign-off by the Oty. Release of the landscaping bond shall be requested ~ ACiENDAITEM NO. 33____.___ PACiE_ 2 r _OF _ J..k ~_.. CONDITIONS OF APPROVAL ,,-. Page 4 of 6 CONDITIONAL USE PERMIT NO. 2005-16 AND COMMEROAL DESIGN REVIEW NO. 2005-07 by the applicant at the end of the required two years with approvaV acceptance by the Landscape Consultant and Community Development Director or Designee. ~ All landscaping and irrigation shall be installed within affected portion of any phase at the time a Certificate of Occupancy is requested for any building. All planting areas shall include plantings in the Xeriscape concept, drought tolerant grasses and plants. Final landscape plan must be consistent with approved site plan. j) k) Final landscape plans to include planting and irrigation details. 29. . The applicant shall provide a landscaping hedge row of acceptable materials and spacing subject to the review and approval by the Community Development Director or designee. 30. Prior to issuance of any precise grading permit or building permit, the applicant shall sign and complete an "Acknowledgment of Conditions" and shall return the executed original to the Community Development Department for inclusion in the case records 31. The Conditions of Approval shall be reproduced on subsequent building plans prior to issuance of ~. building permit. 32. The applicant shall at all times comply with Section 17.78 (Noise ControQ of the Lake Elsinore Municipal Code. 33. The applicant shall pay all appropriate Gtyfees. ENGINEERING DIVISION 34. Comply with underlying Conditions of Approval. 35. Trash enclosure shall be situated such that trucks attempting to empty the bins do not block main drive isles. 36. Access routes from Rail Road Canyon Road to the restaurant shall be constructed prior to occupancy. 37. Provide for compliance with the Santa Ana Regional Oean Water Run-off Permit. 38. Stacking for drive-through traffic on any pad shall not obstruct drive aisle circulation. 39. Pay all Capital Improvement and Plan Clteck fees (LEMC 16.34, Resolution 85-26), mitigation fees, area drainage fee, traffic impact fee (TIF), encroachment permit fees and inspection fees associated with the project and its development. /"""" ACENDA ITEM NO. 3:3 PACE 2- q OF ":;'t:-- ..,~ .,~ CONDITIONS OF APPROVAL Page 5 of 6 CONDITIONAL USE PERMIT NO. 2005-16 AND COMMERQAL DESIGN REVIEW NO. 2005-07 ......", 40. Submit a "Will SelVe" letter to the Gty Engineering Division from the applicable water agency stating that water and sewer arrangements have been made for this project. Submit this letter prior to final map approval. 41. All compaction reports, grade certifications, monwnent certifications (with tie notes delineated on 8 ~" X II" Mylar) shall be submitted to the Engineering Division before fmal inspection of public works improvements will be scheduled and approved. 42. Provide fire protection facilities as required in writing by the Riverside Qmnty Fire Department. 43. Applicant shall submit a traffic control plan showing all traffic control devices for the project. All traffic control devices shall be installed prior to fmal inspection of public improvements. 44. Apply and obtain a grading permit with appropriate security prior to building permit issuance. A grading plan signed and stamped by a California Registered Gvil Engineer shall be required if the grading exceeds 50 cubic yards or the existing flow pattern is substantially modified as determined by the Gty Engineer. If the grading is less than 50 cubic yards and a grading plan is not required, a grading permit shall still be obtained so that a cursory drainage and flow pattern inspection can be conducted before grading begins. 45. Provide soils, geology and seismic report unless otherwise provided. .......", 46. Storm drain inlet facilities shall be appropriately stenciled to prevent illegal dumping in the drain system, the wording and stencil shall be approved by the Gty Engineer. 47. Applicant will be required to install BMP's using the best available technology to mitigate any urban pollutants from entering the wate~hed. 48. Applicant shall obtain approval from Santa Ana Regional Water Quality Control Board for their storm water pollution prevention plan including approval of erosion control for the grading plan prior to issuance of grading permits. The applicant shall provide a WQMP for post construction which describes BMP's that will be implemented for the development and including maintenance responsibilities. 49. Education guidelines and Best Management Practices (BMP) shall be provided to residents of the development in the use of herbicides, pesticides, fertilizers as well as other environmental awareness education materials on good housekeeping practices that contribute to protection of stormwater quality and meet the goals of the BMP in Supplement "A" in the Riverside County NPDES Drainage Area Management Plan. 50. Applicant shall provide first flush BMP's using the best available technology that will reduce stormwater pollutants from parking areas and driveways. """'" ACENDA ITEM NO. 3~ PACE 3 o' OF 1 <- CONDITIONS OF APPROVAL ~ Page 6of6 CONDITIONAL USE PERMIT NO. 2005-16 AND COMMERQAL DESIGN REVIEW NO. 2005-07 51. In accordance with the Gty's Franchise Agreement for waste disposal and recyt:ling, the applicant shall be required to contract with CR.&R, Inc., for removal and disposal of all waste material, debris, vegetation and other rubbish generated during cleaning, demolition, clear and grubbing or all other phases of construction. .t'" t'" AGENOA lTEM NO. .;S~ ", 0" J (. PAGE_:> _ r_ f5 f5 ID 0 ::E 0: => 0 Z ID l- t:: Z z 0 0 ;:) ;:) ~ ~ (!). () 0 0: 0: Z Z Z Z 0: D:: Z Z 0 0 :5 :5 ~ z :i 0.. 0.. , I , I I . . GO . , - , , I . ....., . I = , 0 . '""" ~ ~ I- Z ~ III. III S ::E 0 ~ 0... ~ 0: II) III d ~ ~ :z ~ t:: III ';:) 0 :z D- 8 ;:) 0 () () ~ .0: Z Z ~ III ~ z i ~ z ~ j 0.. . ;r....... . . ] . . . . . . . . . . . . . . .. .. . .. . .. . . . . ......... \ . . . . . .. .. . . . . . . .. ... . OJ . .. . . . . . ,- . . . ....... . .. . . . . . . . . .. . . . . - -:"t '-"" ~...: ACENDA ITEM NO. 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