HomeMy WebLinkAbout08-25-09 CC Item 05CITY OF ^nir-~q
LAKE C09LSIIYQRIE
I7REAM EXT[tEME
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REPORT TO CITY COUNCIL
TO: HONORABLE MAYOR
AND MEMBERS OF THE CITY COUNCIL
FROM: ROBERT A. BRADY
CITY MANAGER
DATE: AUGUST 25, 2009
SUBJECT: CLAIM AGAINST THE CITY
Backqround
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 fufther information is
obtained.
Discussion
The following claim has been recommended for rejection by Carl Warren & Company:
CL# 2009-15 - Nicholas Gonzales
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.
CC August 25, 2009 Item No. 5
Page 1 of 6
Claim Against the City
August 25, 2009
Page 2
Prepared by: Jessica Guzman~
Office Specialist
Reviewed by: Debora Thomsen Q~
City Clerk
Approved by: Robert A. Brady~
City Manager
CC August 25, 2009 Item No. 5
Page 2 of 6
August 10, 2009
TO: The City of Lake Elsinore
AT"I'ENTION: Jessica Guzsnan, Office Specialist
RE: Claim
Claimant
D/Event
Rec'd Y/Office
Our File
Gonzales vs. The City of Lake Elsinore
Nicholas Gonzales
7/1/2009
8/3/2009
S-1501262-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
Marque
cc: CJPIA w/enc.
Attn.: Executive Director
CARL WARREN & CO.
CLAIMS MANAGEMENT CLAIMS ADJUSTERS
770 Placentia Avenue, Placentia, CA 92870-6832 O(,~` AU USt 2rJ, 2009 Item No. 5
Mail: P.O. Box 25180 - Sanp Ma, Ca 92799-51 SO 9
Phone: (714) 572-5200 •(S00) 572-6900 • Fax: (714) 961-8131 Page 3 of 6
C I T Y OF
LAKE ~ LSIIYOIZE
DREAM EXTREME
. "
August 5, 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 August 3, 2009 from N:ichoPas
Gonzales (CL #2009-15). Please keep rne advised of approp,riate City Council Action.
rt (951) 674:-3124 ext. 269.
;
CC August 25, 2009 Item No. 5
Page 4 of 6
Enclosure
~
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B
o E c C~aMF" AuG 0 3 240a
CITI° C.LERKS OFFIGE
CLRIM AZAfNST 1'M C1TY Of LAFCE ELSINORE
~For Darnages to Perso6s or Persorial Propertq)
Received by: ~AU I Time/Date Received:
A claim must be filed w~th the Crty Clerk qf the City of lakg ~;IginntV ryi,(hin..
six (6) months aker the tpcident or event occurred. Be sure yAUi elaim Is
against the City of LakeElsv.nore not anattxer public,entitp. Wheve.spfiCe-is
insuffici,ent, PleaSe usa:atipifinoak.pa{a:ef and -ideafi4y mfors.aakiorn,.:by
paragraph number. Complete'd claims must be mailed or deliveretl to the
City Clerk, City of Lake EI'sina{e, 130 SoaEh"Main $trvet, 1,akE' Elsiavre,
AUG 0 3 209
BYf~~_~,r_Q.~-_~_----_~~ 05~.,
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The undersigned respectfuPly submits th'e fcafdaVui4g claim and informatictn relative 4b d"amage to persons and/or
personai praperty:
1. Nam~ Qf~f~imant
a, P;cJftsb
b. Phaiae..No. _ E. Bate-of,~irth
d. Social Security No. - e: : Qrimgrs Lic, No, MOM
2. Name, post offtce ~RziclCess arid.teJephone ta whiCh claimant desires not3ces Eo be sent, if other than
the above;
3. Oceurren:c.e or event frorn vi(hicM this ciairri arises:
a. Date: _ ~ - % f~ 4 • r _ . > ;b.:-: - Ti;me:
c. Place (Exact.anc1 speEific locatron) f~./ ,30a ,f} c-CTo C-45(-) 'r-r~lc- !3 Y2
A-2-~.(,uG- k-o T . F~r✓ r n F P~ 9--y 3
d. How-m:any-an"d-under wLhat eirctarlS6ncest7id dam age or injury occur? Specify the particular
z° acourrences, evenf, acG.or omissian you claim caused the injury or damage (use additional
a) aper'ifnecessary). ~F',~,0 Q 1.e ~ ,vC>
o, 1ltJ U uU /f ,e
°
~~o
N 4- ~ ~LQac.~ ~ ~ ,rrc "1'7J Y A' ~ 's-C._.4-4 S f=5
N~ e. U~h`a# p~icular acFion by~e C$y of its emplbpees, caused the alle ed damage or injury?
~
u-) /h T79-LC C-!L r¢ ~ ~'-G~-~ F-
ao ar
a C U~J 7~r~-~ T~F ~J rD
l4 /7L .4-x°7 146 'q-c'C_i./al=vTL~~
-S 6 1,r~ cq~ 7- CL. 4 . 4 , %i ~
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4. Were there any injuries aY tho-time of this aecident? ff not, state "Np bpjurles."
. _ . _ n r . . . .
5. Giva trie rrame(s) o#tfie publicemployee(s) causingthe inJ.ary, damage, or loss, if known.
~F 75 - 7- 7 '3 Q9 r-
6. Name and address of any persan ii*ure r_= ,e s L
d: D Ne-y `
7
8.
Name and address of"the (iwner o# any d'amaged property:
a: Amount p1aimed.ap,n.f t#a(s -t~at~:
b. EsHmaYed arnount of Puture eosts:
c. Tatal amsru.nt c(aime.tt: .
d.. Basis fior compuYation of amounts°clat€ned (incl,udp cctpies pf,aA :bEps, tnu.aica~, est*ates, etc.):
.Z 3
4f5~~.~ ~
$ ~
$ !
w
G'
9
N_atne5 and:addeesses of;alleWttnesses, hospital, doctors„:efc:
a.
b. 1 -75 7 s- 3 ar/
C.
XF/-
10. Any addition.,ad i.rtfo,rmation Ytrat migh44be hetpfui incarrsi~e~irag.this::elaim:
.Tf~i~ j-z r3
j ,r/ FK.<-~ IeE 42. -f- , Gr1 4S F r-`c 49 ~
,
S /F
r
Warning: It is a crirninal offerrse to filea false claimd (Penat Code 72flnsura,nee Code 556.1)
I have read the mattors anti' stateri!P#nYS ri7ade in tFie abAve c12i'tn anei'f know 1he same to be true of my
owrt knowledge,.p
, ccept as.to thas,e matter.s state upon_#nforrnitkpn ar.belisR as to such mptters, I believe
the same to be frue. I certify u.ndQr penafty°pf perjury that the~foregoing is true and eorre:ct.
-7 CIaF,_ nYs Signature
D'ats
CC August 25, 2009 Item No. 5
Page 6 of 6
Damages clairsa`etl-.
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