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Home My WebLink About2009-10-13 CC Item No. 4 Claims C 1 TY Q LA E LSINO U DREAM EXTREME REPORT TO CITY COUNCIL TO: HONORABLE MAYOR AND MEMBERS OF THE CITY COUNCIL FROM: ROBERT A. BRADY CITY MANAGER DATE: OCTOBER 13, 2009 SUBJECT: CLAIMS 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 claims have been recommended for rejection by Carl Warren & Company: CL# 2009 -17 - Sophia L. Martinez 2009 -18 - Gerald Patterson Fiscal Impact None. Recommendation Reject the claims listed above and direct the City Clerk's Office to send a letter informing the claimants of the decision. CC October 13, 2009 Item No. 4 Page 1 of 10 7AL.---7/0 September 30, 2009 D - E - 1:' Cc,", [ -, y 1 OCT 0 5 2009 TO: The City of Lake Elsinore ATTENTION: Jessica Guzman, Office Specialist CITY CLERKS OFFICE RE: Claim Martinez vs. City of Lake Elsinore Claimant : Sophia Martinez D/Event : 8 -26 -09 Rec'd Y /Office : 9 -2 -09 Our File : 1503335 -RWQ 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. Enc.: Copy of my letter to claimant. Very truly yours, 4 .'fir , N & COMPANY • o , Whang cc: CJPIA Attn: Paul Zeglovitch, Liability Claims Manager CARL WARREN & CO. CLAIMS MANAGEMENT•CLAIMS ADJUSTERS 770 S. Placentia Ave., Placentia, CA 92870 Mail: P.O. Box 25180 • Santa Ana, Ca 92799 -5180 CC October 13, 2009 Item No. 4 Phone: (714) 572 -5200 •'(800) 572 -6900 • Fax: (714) 961 - 8131 Page 3 of 10 CITY OF ins LA_E e a —, %r� DREAM EXTREME September 3, 2009 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 September 2, 2009 from Sophia Louise Martinez (CL #2009 -17). Please keep me advised of appropriate City Council Action. For further assistance, please contact me at (951) 674 -3124 ext. 269. Sincerely, P 7 — {{ 1 .SIC G ZM A ► , 0 ICE SPEC 1ST J T CI . Y OF A ' i +OR Enclosure 951.674.3124 130 5. MAIN STREET LAKE ELSINORE, CA 92530 WWW,LAKE- ELSINORE.ORG CC October 13, 2009 Item No. 4 Page 4 of 10 T CITY OF L.CA I(E elLsiptoikt ________, DREAM EXTREME... W CLAIM AGAINST THE CITY OF LAKE ELSINORE Pk ® mages to Persons or Personal Property) Receive by: ! ►._t Time /Date Received � � �: � 4 RECEIVE() A claim must be filed with the Cify Clerk .f the'.City of Lake Elsinore within six (6) months after the incident or event occurred. Be sure your .claim is S E P 1 2 REC against the City of Lake Elsinore, not another public entity. Where spaceis insufficient, please use additional 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- :foll"ow ng.cl°aim and informatll n• relative to damage to persons and /or personal property: 1. Name of Claimant 1 . !_ . .5 e z- a. Address of Clainiarit: b. .Phone Na.. c. Date of Birth d. Social Security No. e. Drivers Lic. No. 2. Name, post office address and- telepFone=to which claimant desires notices to be sent, if other than the above: 3. Occurrence or, event from which this claim arises: FC, a. Date: tJ; 1 ::, . b. Time: (7 ' -o c) — L 5c) c. Place (Exact and specific location) - l u) - +ex - Lst. or- d, How -many -sand 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). r *tea Q ± ` `v ari Like e d). e. What particular action by the City of its employees, caused the alleged damage or injury'? CC October 13, 2009 Item No. 4 Page5of10 4. Were there any injuries at the time of this accident? If not, state "No Injuries." --AK) ` ' k e , 5. Give the name(s) of the public employee(s) causing the injury, damage, or loss, if known 6. Name and address of any person injured: L/. 7. Name and, address of the ,owner of any damaged property: .41► i t & e kin '.2 i1 vy- 8. Damages claimed: a. Amount claimed as of this date: $ 5157.'19 b. Estimated amount of future costs: $ 5 1.5 ,+7'7 - c. Total amount claimed: $ tic5\ J 7 , 79 d. Basis-for cornputation of amduntslcIpimed (include.. copies- of .all bills, invoices, estimates, etc.) 9. Names and..addresses of all witnesses, hospital, doctors, etc: a. b. Ge I- r e -0.. C1 'a`c'l \- c c. 5\(\h «a�+ 10. Any additional information that might be helpful in considering this claim: 5r5r 0. , , A 6 '-dra, v 1--r€6:2 p■ris4 G. n l is 4,, lM , (la . r-6 TAx)71 u Warning: It is a criminal offense to file a false claim! (Penal Code 72/Insurance Code 556.1) have read the 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 ,inforrnation or belief as to such matters, I believe -, th same to be true. certify under penalty of perjury that the foregoing is true and correct. ,--- 1 A L. r ►d� elk, J -_61 Claimant' Signature Date CC October 13, 2009 Item No. 4 Page 6 of 10 September 20, 2009 TO: The City of Lake Elsinore ATTENTION: Jessica Guzman, Office Specialist RE: Claim Patterson vs. The City of Lake Elsinore Claimant Gerald Patterson D/Event : 8/13/2009 Rec'd Y /Office : 9/3/2009 Our File : S- 1503849 -SGQ 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, RL RREN & COMPANY 410 Richar• 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 CC October 13, 2009 Item No. 4 Phone: (714) 572 -5200 • (800) 572 -6901) • Fax: (714) 961 -8131 Page 7 of 10 : t CITY OF LADE L LS I NODE DREAM EXTREME September 10, 2009 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 September 3, 2009 from Gerald Patterson (CL #2009 -18). Please keep me advised of appropriate City Council Action. For further assistance, please contact me at (951) 674 -3124 ext. 269. Si9serely, :t CA U IAL :T IT OF LAKE L k • " Enclosure 951.674.3124 130 S. MAIN STREET LAKE ELSINORE, CA 92530 WWW.LAKE- ELSINORE.ORG CC October 13, 2009 Item No. 4 Page 8 of 10 CITY OF A -A-cN LAKE OLSINon DREAM EXTREME. CLAIM AGAINST THE CITY OF LAKE ELSINORE (For Damages to Persons or Personal Property) Received by: A - Age/ Time/Date Received City Representative 3 Fr C);( \// A claim must be filed with the City Clerk of the City of Lake, Elsinore within six (6) months after the incident or event occurred. Be sure your claim is against the City of Lake Elsinore, not another public entity. Where space is 1 SEP 0 3 2009 insufficient, please use additional paper and identify information by — paragraph number. Completed claims must be mailed or delivered to the City Clerk, City of Lake Elsinore, 130 South Main Street, Lake Elsinore, CA 92530. CITY CLERKS OFFICE The undersigned respectfully subrnitsthe %Hewing-claim and information relative to damage to persons and/or personal property: 1. Name of Claimant L9 / a. Address of Claimant: b. Phone No. b, Date of Birth 10111111 d. Social Security No. e. Drivers Lic. No. 2. -N'ame„post office ddFe6 tele060e to wbich,claiment desires notices to be sent, if other than the above: AO/VA 3. Occurrence or event from which this claim arises: a. Date: '//...3/09 b. Time: 67 /6 P/7 P. Plasa (?<9ct ad speqigc ,062 C..-AJTK.5e A 1/2- d. How many and undei liVhit'difcurifst6ntes 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). Otre TO &)m) A)064A 6t. V elie_ R (vs / 77) A) 1 9 A 2 e-7" ,(50077 /3)/7 s Ez-A- 7 S/)J7 s //t) 41_ FOue e. What particular action by the City of its employees, caused the alleged damage or injury? P0/1/4ie Ce 01P/w)T fe477.11.nc? CC October 13, 2009 Item No. 4 Page 9 of 10 4. Were there any injuries at the time of this accident? If not, state "No Injuries." NO r/\) Tc A/e_ S 5. Give the name(s) of the public employee(s) causing the injury, damage, or loss, if known CDUiti gn?1'C -TJQni . ,7/ 100`N 4' /9 I //v -6' 6. Name and address of any person injured: 60k) 1) 7. Name and address of the owner of any damaged property: 8. Damages ,claimed: a, Amount claimed as of this date: $ ./ 9 Y. 3 ? b. Estimated amount of future costs: $ c. Total amount claimed: $ 2/ 94. 37 d. Basis for computation of amounts claimed (include copies of all bills, invoices, estimates, etc ) quprzT 1914n ,PI R e SAN _ 9. Names and addressesofa:ll>witnesses, hospital, doctors, etc: a; t — b. c. 10. Any additional information that might be helpful in considering this claim '1.198 c Z A R6C6 /Z . C H1 of l: W.0 /A) C iA I /vspec77/ — Warning: It is a criminal offense to file a false claim! (Penal Code 72 /Insurance Code 556.1) I have read the matters acid °statemdPtts °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 of perjury that the foregoing is true and correct. 9 / . _ ' / f iii:# 4. ... C._) /io Claimant's Signature Date CC October 13, 2009 Item No. 4 Page 10 of 10