CC 20170117 G Claim against the City BurackRANCHO PALOS VERDES CITY COUNCIL
AGENDA REPORT
AGENDA DESCRIPTION:
MEETING DATE: 01/17/2017
AGENDA HEADING: Consent Calendar
Consideration and possible action regarding a claim against the City by Scott Burack.
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 C�
REVIEWED BY: Gabriella Yap, Deputy City Manager
APPROVED BY: Doug Willmore, City Manager
ATTACHED SUPPORTING DOCUMENTS:
A. Scott Burack claim (page A-1)
BACKGROUND AND DISCUSSION:
The claimant states that his vehicle was damaged when driving over a utility cover near
the intersection of Silver Spur Road and Crenshaw Boulevard in the City of Rolling Hills
Estates. The alleged incident occurred on October 1, 2016, and the claim was filed on
October 7, 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
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.
Name of Claimant
AMMAN
usiness
Give address and telephone number to which you desire notices or
communications to be sent reaardina this claim:
RESERVE FOR FILING STAMP
CLAIM NO. 2 01 U - 5lp
----------------
RECEIVED
CITY OF RANCHO PALOS VERDES
OCT 0 7 2016
CITY CLERK'S OFFICE
ess
manrs
o.
When did DAMAGE or INJURY occur? Names of any city employees involved in INJURY or DAMAGE
Date fi _,_ '%gJ Time _J_Q = AA-
If claim is for Ec itable 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:�®®��,
Describe in detail how the DAMAGE or INJURY occurred. l
4z 0+ ccs
-Why d you claim th city is respo siu- i-----------------------------------------------------------------------
Why do you claim the city is responsible?
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S�," —% h—�� (Q.
-- -----------------------------------------------------
-Describe in detail each INJURY or DAMAGE.
AAJ V\
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--- ------------------------------------------------------------------------
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 .................... $`LSA' 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 damage for ..i.,Pe.. Prospective general damages ............... $_________
(` 4v-,(/w�% -- Total estimate prospective damages....... $_________
General damages ......................
Total damages incurred to date........ $_________ �� r
Total amount claimed as of date of presentation of this claim: $
Was damage and/or injury investigated by p lice?_ Y _&_ If so, what city?___L _c>p;k
Were paramedics or ambulance called?__,�E___ If so, name city or ambulanceIf injured, state date, time ame a ddress of doctor of our first visit_
/ _nAt,e� _ .vi AA,2 o�-z� . , riuf�a.r� �,� _ .� r -ter /� c�
WITNESSES to DAMAGE or INJURY: List all persons and addresses of persons known to have information:
Name__ _
- -
Address
Phone_
Name - ---AddressPhoneName
A
--------------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.
Signature of Claimant or person filing on
his behalf gi 'ng relationship to Claimant:
NOTE: CLAIMS MUST BE
Name:
C`0+t '61
CURB
Date:
l� .
y (Pen. Code Sec. 72.)
A-2
RE: Tesla Model S VIN #
1 message
Ricardo Caicedo <rcaicedo@tesla.com>
To:
Richard Caicedo I Service Advisor
5340 W Centinela Ave. I Los Angeles, CA 90045
p 310.649.5463 ext 73250 nl 310.867-1984 ( f 310.649.5563 Rcaicedo@teslamotors.com
Mon, Oct 3, 2016 at 3:52 PM
the con tent o f this message Is tike proprietary acid confidential property of "lesl<a Motors, and should he treated as such, if you are, not the, intended
recipient and have received this message in error, please delete this rnessage from your cornputer system and notify me Immediately by reply e-mail.
Any unauthorized ease or distribution of the content of this; nne x same is prohibited. I Dank you.
P Please consider the environment before printing this email.
From: Alejandro Melchor
Sent: Monday, October 03, 2016 3:28 PM
To: Ricardo Caicedo <rcaicedo@tesla.com>
Cc: LACentinela_Parts <LACentinela_Parts@tesla.com>
Subject: Tesla Model S VIN #
"'Tesla
. ................. .
Email Quotation Date: 10/3/2016
Thank you for your recent inquiry with Tesla Service. Below you find a price quote for the requested services/parts.
Service/Labor
Four Wheel Alignment - Check and Adjust (with Air Suspension)
Wheel - Rear - LH
FRT Hours FRT Price
1.3 175.00
0.7 175.00
Subtotal Labor Price: (USD) 350.00
A-3
Parts: Price
1030074-00-B - TIRE CONTINENTAL SPORT CONTACT5 (TESLA) P245/35/R21 375.00
1054044-00-B - TURBINE GRAY WHEEL - 21 X9 - KIT 1,150.00
1034601-00-B - TPMS CONTI ECU RECEIVER 433 MHz 25.00
Note: This is a quote on list price, actual prices may vary at the time of service.
Thank you for contacting Tesla Service,
Tesla Service Los Angeles-Centinela
Alejandro Melchor
310-649-5463
Subtotal Parts Price: (USD) 1,550.00
Subtotal Services and Parts: (USD) 1,900.00
Discount: (USD) 0.00
Shipping: (USD) 0.00
Estimated Tax: (USD) 139.50
Total Amount: (USD) 2,039.50
MA
0
your roadside incident
l
rnessage
Tesla <ServiceHelpNA@tesla.com>
To: Scott Burack
Scott,
Sat, Oct 1, 2016 at 12:25 PM
Thank you for reaching out to roadside assistance. I was happy to help you with your flat tire incident on
10/1 /2016. Please let me know if you need further assistance.
Sincerely,
Ivan I3ni, Bergman I Roadside Support Specialist
45.5(' , f'- re r,10F1t B I v d i r;eiiiont, CA 94 :s
1 ,f, k''i p, r �' , . r 1 - i ''i. A
�._
ServiceHelpNA@teslamotors.com
Model S video walkthrough
For s list of your local service centers, please press here:
The content of this message is the proprietary and confidential property of Tesla Motors, and should be treated as such,
If you are not the intended recipient and have received this message in error, please deletethis message trop, year
r ornpiiter system and notify me inirnediately by reply e-mail. Any unauthorized use or distribution of the content ofthis
nnessage is psz. hibited. Thank you,
Please consider the environment before printing this email
A-5
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Report Number
AA O A—St r&VC77041 /Slyt-
Classification of Incident
A I ,V
Date
Ail
Deputy's Name
JIM McDONNELL, SHERIFF
Los Angeles County Sheriffs Department
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Report
Information
County of Los Angeles
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SHERIFF'S DEPARTMENT
Jim McDonnell, Sheriff
DWAYNE O JAVIER
DEPUTY SHERIFF
Lomita
26123 Narbonne Ave.
Lomita, CA 90717
(310) 539-1661 FAX (310) 5340318
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�ihce 7850
dojavier@lasd.org
www.LASD.org
Station
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Report Number
AA O A—St r&VC77041 /Slyt-
Classification of Incident
A I ,V
Date
Ail
Deputy's Name
JIM McDONNELL, SHERIFF
Los Angeles County Sheriffs Department
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