CC 20161206 G Sherman Lee Claim Against the CityRANCHO PALOS VERDES CITY COUNCIL
AGENDA REPORT
AGENDA DESCRIPTION:
MEETING DATE: 12/06/2016
AGENDA HEADING: Consent Calendar
Consideration and possible action regarding a claim against the City by Sherman Lee.
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, Acting City Clerk
REVIEWED BY: Gabriella Yap, Deputy City Manager J-'
APPROVED BY: Doug Willmore, City Manager.1'1
ATTACHED SUPPORTING DOCUMENTS:
A. Sherman Lee claim (page A-1)
BACKGROUND AND DISCUSSION:
The claimant states that his vehicle's windshield was damaged when driving over an
area of the road that had recently been resurfaced. Debris left from the resurfacing
cracked his windshield. The alleged incident occurred on October 13, 2016, and the
claim was filed on October 25, 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 contractor responsible
for resurfacing the road should have cleared any remaining debris. Therefore, liability is
doubtful on behalf of the City.
1
FILE WITH: � P � _
CITY CLERK °5 OFFICE CLAIM R D I�
City of Rancho Palos Verdes
30940 Hawthorne Ted.
Rancho Palos Verdes, CA 00275
TO PERSON OR PROPERTY
IKISTRUCTIONS
9. Claims for death, injury to person or to personal property must be filed not
later than sirs months after the occurrence. (Gov. Code Sec. 3i 9.2.)
2. Claims for damages to real property mint be filed not later than `i year after
the occurrence. (Gov. Code Sec. g9 9.2.)
3. Read entire claim form before filing.
4. See Page 2 for diagram upon which to locate place of accident.
S. THIS CLAIM FORM MUST BE SIGNED ON PAGE ? AT BOTTOM.
6. Attach separate sheets, if necessary, to give full details. SIGN EACH SHEET.
7(IV: CITY OF RANCHO PALOS VERDES _— ------ — -----
S 4-E-P–m A`N LEG7
DESERVE FOR FILING STAMP
R
011-Y OF RANCHO ,
OCT, 2 5 2C-1uc
"ITY CLEF
Date of Birth of
W Occupation of Claimant
-YHome to dress of ClaimantCity and State Home Telephone Humber
Business Address of Claimant
City and Mate
Give address and telephone number to which you desire notices or
communications to be sent regarding this claim:
laimant's Social Security No.
When did AMAGE or INJURY occur? Names of any city, employees involved in INJURY or DAMAGE
Date ®/(- Time : ®S® eror4 .......
If claim is for Equitable Indemnity, give date g r
claimant served with the complaint: �9
Date
Where did DAMAGE or INJURY occur? Describe fully, and locate on diagram on Page ?. Where appropriate, give
street names and address and measurements from landmarks:
Describe in detail hogs the DAMAGE or INJURY occurred. 5 I pp
Ca- r
p 5 V I -'W 4e-
Describe in detail each INJURY or DAMAGE.
This Claim Must Be Signed on Page
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 ....................
$70
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
Total estimate prospective damages .......
$
General damages ...................... $
Total damages incurred to date ........ $-
Total amount claimed as of date of presentation of this claim: $ -74
Was damage and/or injury investigated by police? V 0 If so, what city?_
Were paramedics or ambulance called?_IV y 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 ------.-
Hospital Address Date Hospitalized_
Doctor Address Date of Treatment
Toctor A,;(sOes-c -6
READ CAREFULLT
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.
Signature of Claimant or person filing on
ee-dawb 1-(f
SIDEWALK
Typed Name:
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P- - A-
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NOTE.- CLAIMS MUST BE FILED WITH CITY CLERK (Gov. Code Sec. 915a). Presentation of a false claim is a felony (Pen. Code Sec.
A-2
LA CAR GUY BODY SHOP Workfile ID: 20cb9bf6
Federal ID: 39-2065116
8635 AVIATION BLVD, INGLEWOOD, CA 90301 Federal EPA: CAL000348620
Phone: (424) 207-2000 State EPA: CAL000348620
FAX: (424) 207-2093 BAR: ARD00260246
Preliminary Estimate
Customer: Lee, Sherman
Insured: Lee, Sherman
Type of Loss:
Point of Impact:
Owner:
Lee, Sherman
Written By: EDVARD AKHVERDYAN
Policy #:
Date of Loss:
Inspection Location:
LA CAR GUY BODY SHOP
8635 AVIATION BLVD
INGLEWOOD, CA 90301
Repair Facility
(424) 207-2000 Business
VEHICLE
2016 SUBA FORESTER AWD PREMIUM 4D UTV 4 -2.5L -FI grey
Claim #:
Days to Repair: 0
Insurance Company:
VIN: Interior Color: Mileage In: 18,209 Vehicle Out:
License: Exterior Color: grey Mileage Out:
State: CA Production Date: Condition: Job #:
TRANSMISSION
Air Conditioning
Search/Seek
Luggage/Roof Rack
Automatic Transmission
Intermittent Wipers
CD Player
Electric Glass Sunroof
4 Wheel Drive
Tilt Wheel
Auxiliary Audio Connection
SEATS
POWER
Cruise Control
Satellite Radio
Cloth Seats
Power Steering
Rear Defogger
SAFETY
Bucket Seats
Power Brakes
Keyless Entry
Drivers Side Air Bag
Reclining/Lounge Seats
Power Windows
Alarm
Passenger Air Bag
WHEELS
Power Locks
Message Center
Anti -Lock Brakes (4)
Aluminum/Alloy Wheels
Power Mirrors
Steering Wheel Touch Controls
4 Wheel Disc Brakes
PAINT
Power Driver Seat
Rear Window Wiper
Traction Control
Clear Coat Paint
DECOR
Telescopic Wheel
Stability Control
TRUCK
Dual Mirrors
Backup Camera w/Parking Sensors
Front Side Impact Air Bags
Rear Step Bumper
Privacy Glass
RADIO
Head/Curtain Air Bags
Power Trunk/Gate Release
Console/Storage
AM Radio
Communications System
Overhead Console
FM Radio
Hands Free Device
CONVENIENCE
Stereo
ROOF
10/24/2016 1:05:21 PM 055497 A-3 Page 1
Preliminary Estimate
Customer: Lee, Sherman
2016 SUBA FORESTER AWD PREMIUM 4D UN 4 -2.5L -FI grey
Line Oper Description Part Number
Qty Extended
Labor
Paint
Price $
1 WINDSHIELD
2 Repl Windshield Subaru w/o eyeview, 65009SG410
1 499.96
2.2
w/wiper deicer
3 # Glass Urethane Kit
1 25.00 T
SUBTOTALS
524.96
2.2
0.0
ESTIMATE TOTALS
Category
Basis
Rate
Cost $
Parts
v499.96
Body Labor
2.2 hrs @
$ 60.00 /hr
132.00
Miscellaneous
25.00
Subtotal
656.96
Sales Tax
$ 524.96 @
9.5000%
49.87
Grand Total
706.83
Deductible
0.00
CUSTOMER PAY
0.00
INSURANCE PAY 706.83
This estimate is based on a visual inspection only; it is valid for 120 days from date of origination, based on the
following contingencies. If, when the vehicle is torn down further damage is discovered, additional parts and labor
may be required. After the work has started, worn or damaged parts which were not evident on the first inspection
may be discovered. Naturally this estimate cannot cover these or any other unknown conditions. All prices are subject
to manufacturer and /or sublet supplier increases.
SIGN: DATE:
10/24/2016 1:05:21 PM
055497
Page 2
A-4
Preliminary Estimate
Customer: Lee, Sherman
2016 SUBA FORESTER AWD PREMIUM 4D UTV 4 -2.5L -FI grey
FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM: ANY PERSON
WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIME
AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON.
THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE
DONE OR PARTS TO BE REPAIRED OR REPLACED:
MOTOR ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART, A=APPROXIMATE PRICE. LABOR TYPES: B=BODY
LABOR, D=DIAGNOSTIC, E=ELECTRICAL, F=FRAME, G=GLASS, M=MECHANICAL, P=PAINT LABOR,
S=STRUCTURAL, T=TAXED MISCELLANEOUS, X=NON TAXED MISCELLANEOUS. CCC ONE: ADJ=ADJACENT,
ALGN=ALIGN, A/M=AFTERMARKET, BLND=BLEND, CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION,
D&R=DISCONNECT AND RECONNECT, EST=ESTIMATE, EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY,
INCL=INCLUDED, MISC=MISCELLANEOUS, NAGS=NATIONAL AUTO GLASS SPECIFICATIONS, NON-ADJ=NON
ADJACENT, 0/H=OVERHAUL, OP=OPERATION, NO=LINE NUMBER, QTY=QUANTITY, RECOND=RECONDITION,
REFN=REFINISH, REPL=REPLACE, R&I=REMOVE AND INSTALL, R&R=REMOVE AND REPLACE, RPR=REPAIR,
RT=RIGHT, SECT=SECTION, SUBL=SUBLET, LT=LEFT, W/O=WITHOUT, W/_=WITH/_ SYMBOLS: #=MANUAL
LINE ENTRY, *=OTHER [IE..MOTORS DATABASE INFORMATION WAS CHANGED], **=DATABASE LINE WITH
AFTERMARKET, N=NOTES ATTACHED TO LINE. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER
OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT.
10/24/2016 1:05:21 PM 055497 A-5 Page 3
Preliminary Estimate
Customer: Lee, Sherman
2016 SUBA FORESTER AWD PREMIUM 4D UTV 4 -2.5L -FI grey
Estimate based on MOTOR CRASH ESTIMATING GUIDE and potentially other third party sources of data. Unless
otherwise noted, (a) all items are derived from the Guide ARL7604, CCC Data Date 10/11/2016, and potentially other
third party sources of data; and (b) the parts presented are OEM -parts manufactured by the vehicles Original
Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM (Optional OEM) or ALT
OEM (Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the
OEM vehicle dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or
discount. OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle
dealerships. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor data provided by third party
sources of data may have been modified or may have come from an alternate data source. Tilde sign (—) items
indicate MOTOR Not -Included Labor operations. The symbol (<>) indicates the refinish operation WILL NOT be
performed as a separate procedure from the other panels in the estimate. Non -Original Equipment Manufacturer
aftermarket parts are described as Non OEM, A/M or NAGS. Used parts are described as LKQ, RCY, or USED.
Reconditioned parts are described as Recond. Recored parts are described as Recore. NAGS Part Numbers and
Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listed on the line.
.with
the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not included.
Pound sign (#) items indicate manual entries.
Some 2017 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated
data from the vehicle manufacturer, labor and parts data from the previous year may be used. The CCC ONE
estimator has a list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership.
The following is a list of additional abbreviations or symbols that may be used to describe work to be done or parts to
be repaired or replaced:
SYMBOLS FOLLOWING PART PRICE:
m=MOTOR Mechanical component. s=MOTOR Structural component. T=Miscellaneous Taxed charge category.
X=Miscellaneous Non -Taxed charge category.
SYMBOLS FOLLOWING LABOR:
D=Diagnostic labor category. E=Electrical labor category. F=Frame labor category. G=Glass labor category.
M=Mechanical labor category. S=Structural labor category. (numbers) 1 through 4=User Defined Labor
Categories.
OTHER SYMBOLS AND ABBREVIATIONS:
Adj.=Adjacent. Algn.=Align. ALU=Aluminum. A/M=Aftermarket part. Bind=Blend. BOR=Boron steel.
CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength Steel.
HYD=Hydroformed Steel. Incl.=Included. LKQ=Like Kind and Quality. LT=Left. MAG=Magnesium.
Non-Adj.=Non Adjacent. NSF=NSF International Certified Part. 0/H=Overhaul. Qty=Quantity. Refn=Refinish.
Repl=Replace. R&I=Remove and Install. R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched
Steel. Sect=Section. Subl=Sublet. UHS=Ultra High Strength Steel. N=Note(s) associated with the estimate
line.
CCC ONE Estimating - A product of CCC Information Services Inc.
The following is a list of abbreviations that may be used in CCC ONE Estimating that are not part of the MOTOR
CRASH ESTIMATING GUIDE:
BAR=Bureau of Automotive Repair. EPA= Environmental Protection Agency. NHTSA= National Highway
Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number.
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