CC SR 20170321 E - Claim Against the City IliasRANCHO PALOS VERDES CITY COUNCIL
AGENDA REPORT
AGENDA DESCRIPTION:
MEETING DATE: 03/21/2017
AGENDA HEADING: Consent Calendar
Consideration and possible action regarding a claim against the City by Cherry Ilias.
RECOMMENDED COUNCIL ACTION:
1) Reject the claim and direct Staff to notify the claimant.
FISCAL IMPACT: None
Amount Budgeted: N/A
Additional Appropriation: N/A
Account Number(s): N/A
ORIGINATED BY: Teresa Takaoka, Deputy City ClerkCD
REVIEWED BY: Gabriella Yap, Deputy City Manager.:+.,,
APPROVED BY: Doug Willmore, City Manager J1- fru
ATTACHED SUPPORTING DOCUMENTS:
A. Cherry Ilias claim (page A-1)
BACKGROUND AND DISCUSSION:
The claimant states that her vehicle was damaged by a tree that had fallen into the
roadway and hit her windshield. The alleged incident occurred on February 3, 2017,
and the claim was filed on February 6, 2017.
The City's Claims Administrator, Carl Warren and Company, has reviewed the claim
and advised the City to reject it, due to the determination that the tree is/was privately
owned. Therefore, it does not appear as though the City has any liability for the
accident.
1
FILE WITH:
CITY CLERK'S OFFICE
City of Rancho Palos Verdes
30940 Hawthorne Blvd.
Rancho Palos Verdes, CA 90275
CLAIM FOR DAMAGES
TO PERSON OR PROPERTY
INSTRUCTIONS
1. Claims for death, injury to person or to personal property must be filed not
later than six months after the occurrence. (Gov. Code Sec. 911.2.)
2. Claims for damages to real property must be filed not later than 1 year after
the occurrence. (Gov. Code Sec. 911.2.)
3. Read entire claim form before filing.
4. See Page 2 for diagram upon which to locate place of accident.
5. THIS CLAIM FORM MUST BE SIGNED ON PAGE 2 AT BOTTOM.
6. Attach separate sheets, if necessary, to give full details. SIGN EACH SHEET.
TO: CITY OF RANCHO PALOS VERDES
RESERVE FOR FILING STAMP
CLAIM NO. 2-0 ! l% 03
RECEIVED
O MM
w �.
Name of Claimant _.�" Occupation of Claimant
Business Address of Claimant
City
Give address and telephone number to which you desire notices or
communications to be sent regarding this claim:
Claimant's Social
No.
When did DAMAGE or INJURY occur? Names of any city employees involved in INJURY or DAMAGE
Date �.: � .. � �J Time \2_0'1, 0
If claim is for Equitable Indemnity, give date GLV\� �'� �� VA A ``
claimant served with the complaint:
Date
Where did DAMAGE or INJURY occur? Describe fully, and locate on diagram on Page 2. Where appropriate, give
street names and address and measurements from landmarks-
�1 Ck\ 0
Describe in detail how the DAMAGE or INJURY occurred. ,qt
Why do you claim the city is responsible?
Describe in detail each INJURY or DAMAGE.
k t
This Claim Must Be Signed on Page 2
A-1
The amount claimed, as of the date of presentation of this claim, is computed as follows:
Damages incurred to date (exact):
Estimated prospective damages as far as known:
Damage to property ....................
$ Future expenses for medical and hospital care.
$
Expenses for medical and hospital care ...
$ Future loss of earnings .....................
$
Loss of earnings ......................
$ Other prospective special damages ..........
$
Special damages for ...................
$ Prospective general damages ...............
$
Total estimate prospective damages.......
$
General damages ...................... $
Total damages incurred to date ........ $
Total amount claimed as of date of presentation of this claim: $ ON\ )1k0 �
Was damage and/or injury investigated by pof�ca?�j — If so, what city?_
Were paramedics or ambulance called? .4 0 If so, name city or ambulance
If injured, state date, time, name and address of doctor of your first visit
WITNESSES to DAMAGE or INJURY: List all persons and addresses of persons known to have information:
Name Address Phone
Name Address Phone
Name Address Phone
DOCTORS and HOSPITALS:
Hospital Address Date Hospitalized
Doctor Address Date of Treatment
Doctor Address Date of Treatment
READ CAREFULLY
For all accident claims place on following diagram names your vehicle when you first saw City vehicle; location of
of streets, including North, East, South, and West; indicate City vehicle at time of accident by "A-1" and location of
place of accident by "X" and by showing house numbers yourself or your vehicle at the time of the accident by
or distances to street corners. If City Vehicle was "B-1" and the point of impact by "X." NOTE: If diagrams
involved, designate by letter "A" location of City Vehicle below do not fit the situation, attach hereto a proper
when you first saw it, and by "B" location of yourself or diagram signed by the claimant.
SIDEWALK
CURB--+
PARKWAY
SIDEWALK rF
Signature of Claimant or person filing on Typed Name: Date:
his behalf giving relationship to Claimant: ry /ry
NOTE: CLAIMS MUST BE FILED WITH CITY CLERK (Gov. Code Sec. 915a). Presentation of a false claim is a felony (Pen. Code Sec. 72.)
A-2