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HomeMy WebLinkAbout2009-01-13 City Council Agenda Item No. 4 CITY OF LAKE , LSINOR ,�- DREAM EXTREME REPORT TO CITY COUNCIL TO: HONORABLE MAYOR AND MEMBERS OF THE CITY COUNCIL FROM: ROBERT A. BRADY CITY MANAGER DATE: JANUARY 13, 2009 SUBJECT: CLAIM AGAINST THE CITY Background Claims filed against the City of Lake 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 claim has been recommended for rejection by Carl Warren & Company: CL# 2008 -34 — Junior Morford Fiscal Impact None. Recommendation Reject the claim listed above and direct the City Clerk's Office to send a letter informing the claimant of the decision. Agenda Item No. 4 Page 1 of 6 Claims Against the City January 13, 2009 Page 2 Prepared by: Jessica Guzma �� Office Specialist - "1 Reviewed by: Carol Cowley Interim City Cler Approved by: Robert A. Brady/,� City Manager it Agenda Item No. 4 Page 2 of 6 11Mil r ---------"‘ > December 17, 2008 � 1 � ee TO: The City of Lake Elsinore % ATTENTION: Jessica Guzman, Office Specialist RE: Claim : Morford vs. The City of Lake Elsinore Claimant Junior Morford D/Event 11/29/2008 Rec'd Y /Office : 12/5/2008 Our File : S- 1488385 -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 ,a. i---)/1„,...t....f.- Ri - d D. Marque cc: CJPIA w /enc. 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 Agenda Item No. 4 Page3of6 CITY OF LADE LSINORE -�% DREAM EXTREME December 15, 2008 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 5, 2008 from Junior Morford (CL #2008 -34). Please keep me advised of appropriate City Council Action. For further assistance, please contact me at (951) 674 -3124 ext. 269. Sincerely, IOU ES ICA GU '° OFFICE SPECIALIST CITY OF LAKE ELSINORE Enclosure 951.674.3124 130 S. MAIN STREET LAKE ELSINORE, CA 92530 WWW. LAKE-ELSINORE .ORG Agenda Item No. 4 Page 4of6 CITY OF .(...� 6 LSJNORE LAKE DREAM EXTREME, llov CLAIM AGAINST THE CITY OF LAKE ELSINORE (For Damages to Persons or Personal Property) Receiv •d by: ellAki ' `, /AM Time /Date Received: CI r ep .:tl RECEIVED A claim must. - iled with he Cit•'6J- e City of Lake Elsinore within six (6) months after the incident or event occurred. Be sure your claim is DEC 0 5 2008 against the City of Lake Elsinore, riot another public entity. Where space is insufficient, please use additionbl paper and identify information by paragraph number. Completed claims must be mailed or delivered to the CITY CLERKS OFFICE City Clerk, City of Lake Elsinore, 130 South Main Street, Lake Elsinore, CA 92530. The undersigned respectfully submits the following claim and information relative to damage to persons and /or personal property: 1. Name of Claimant // /Z!,./41" a. Address of Claimant: b. Phone No. M _ c. Date of Birth --allIllt d. Social Security No. jrnillinlig e. Drivers Lic. No. IIIIIIIIIIIII 2. Name, post offi, a address and tel ho e to whi claimant desires notices to be sent, if other than the above: + -S . /'AL y/ e( t/0 i/lq _•Up 0 r , 3. Occurrence or event from which this claim arises: a. Date: . / ��4 G j 0 Q b. T / � Op -1 1 c. Place (Exact and specific location) Di)'T'r 5 /-- 4c/0 5 0 S/4 ? kin X -X Fi r/ I.v. s d. How many! and under what circumstances did damage or injury occur? Specify the particular occurrences, event, act or omission you claim caused the injury or damage (use additional paper if necessary). �� _ /s/k/' / S e,/�'-/ -i c wit Jos i re' , r„ e. What particular action by the City of its emply� oes, ca sed the alleged damage or injury? f werC G /07A' / o f f S'4Y,4 `, 7p a17 c/ / - L ?/ I ,t) ,(e -1k � 4 cyvt, ' 1 kwe i ,A g e y a ItR e: 4 _ Z r / 5'C/Y . Z GA/or/ fr 47 >‘‘ Az a g / i 4. Were there any injuries at the time of this accident? If not, state "No Injuries." 5. Give the name s) of t public employee(s) causing the injury, damage, or Toss, if known. 6. Name anci'addres of any person injured: y'2/ 7. .Name and address of the owner of dam ged property: 8. Damages claimed: a. Amount claimed as of this date: $ '/59 b. Estimated amount of future costs: $ c. Total amount claimed: $ /5 d. Basis for computation of amounts claimed (include copies of all bills, invoices, estimates, etc.): 9. Names and addresses of all witne ses, hospital, doctors, etc: �� a. &.,C ©r'l / /W C' e/ - 1 /mi / / / r r b. �- I c. 6c, A /a5 c? 1./e 10. Any additional information that might be helpful in considering this claim: 04 r� ://Zo r o r �/� � 1( /0 ,lit/ eti iho Ao/e Warning: It is a criminal offense to file a false claim! (Penal Code 72 /Insurance Code 556.1) I have read the matters and statements made in the above claim and I know the same to be true of my own knowledge, except as to those matters state upon information or belief as to such matters, I believe the same to be true. I certify under penalty • •erjury that the foregoing is true and correct. Claimant's Signatu Z Date Agenda Item No. 4 Page 6 of 6