CC SR 20160719 D - Leona Nagusugi Claim against the CityRANCHO PALOS VERDES CITY COUNCIL MEETING DATE: 07/19/2016
AGENDA REPORT AGENDA HEADING: Consent Calendar
AGENDA DESCRIPTION:
Consideration and possible action regarding a claim against the City by Leona
Nagasugi.
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: Carla Morreale, City Clerk
REVIEWED BY: Same as above
APPROVED BY: Doug Willmore, City Manager
ATTACHED SUPPORTING DOCUMENTS:
A. Leona Nagasugi claim (page A-1)
BACKGROUND AND DISCUSSION:
The claimant states that she sustained a fall due to a raised portion of sidewalk. The
alleged incident occurred on August 16, 2015, and the claim was filed on February 9,
2016.
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 incident occurred
outside of the City's jurisdiction. Therefore, it does not appear as though the City has
any liability for the accident.
1
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FILE WITH:RESERVE
CLAIM FOR DAMAGES
FOR FILING STAMP
CITY CLERK'S OFFICE
City of Rancho Palos Verdes TO PERSON OR PROPERTY
30940 Hawthorne Blvd.
CLAIM NO. cZi(�//
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Rancho Palos Verdes, CA 90275
RECEIVED
INSTRUCTIONS
1. Claims for death, injury to person or to personal property must be filed not
CITY OF RANCHO PALOS VERDE
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.)
FEB 0 9 2016
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.
CITY CLERK'S
6. Attach separate sheets, if necessary, to give full details. SIGN EACH SHEET.
OFFICE
TO: CITY OF RANCHO PALOS VERDES
Date of Birth of Claimant
Name of Claimant
Occupation of Claimant
Leona Nagasugi
Home Address of Claimant City and State
Home Telephone Number
Business Address of Claimant City and State
Business Telephone Number
Give address and telephone number to which you desire notices or Claimant's Social Security No.
communications to be sent regarding this claim:
When did DAMAGE or INJURY occur? Names of any city employees involved in INJURY or DAMAGE
Date 08/15/15 Time 9:15 a.m.
Not applicable
If claim is for Equitable Indemnity, give date
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:
Sidewalk adjacent to baseball field on Silver Spur, near parking lot of Peninsula High School
Describe in detail how the DAMAGE or INJURY occurred.
Fall due to raised portion of sidewalk. See attached photos.
Why do you claim the city is responsible?
Sidewalk not maintained.
Describe in detail each INJURY or DAMAGE.
Left radius neck fracture, nondisplaced.
This Claim Must Be Signed on Page 2
A-1
:S
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 ...
$ Unknown
Future loss of earnings .....................
$
Loss of earnings ......................
$ approz 3,000.00
Other prospective special damages ..........
$
Special damages for ...................
$
Prospective general damages ...............
$
Total estimate prospective damages.......
$ unknown
General damages ...................... $
Total damages incurred to date ........ $ unknown
Total amount claimed as of date of presentation of this claim:
Was damage and/or injury investigated by police? No If so, what city?
Were paramedics or ambulance called? Ho If so, name city or ambulance
If injured, state date, time, name and address of doctor of your first visit Kaiser, Harbor City (copy of records attached)
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 Kaiser, Harbor City 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.
See photos.
PARKWAY
SIDEWALK
Signature of Claimant or person filing on Typed Name:
his behalf giving relationship to Claimant: Leona NagaSUgi
Date:
02/08/16
CURB
BE FILED WITH CITY CLERK (Gov. Code Sec. 915a), Presentation of a false claim is a felony (Pen. Code Sec. 7
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