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CC 20170117 H Claim against the City HeynRANCHO 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 Udo Heyn. 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. Udo Heyn claim (page A-1) BACKGROUND AND DISCUSSION: The claimant states that his vehicle was damaged when driving eastbound on Miraleste Drive near Via Colinita through a construction area, alleging that something flew into the right rear-view mirror and thus damaging it. The alleged incident occurred on December 10, 2016, and the claim was filed on December 13, 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 Southern California Edison had control of the location at the time of the incident based on a copy of the encroachment permit. 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 n Business Address of Claimant RESERVE FOR FILING STAMP py CLAIM NO. ZO J RECEIVED CITY OF RANCHO PALOS VERDES DEC 13 2016 CITY CLERK'S OFFICE Date of Birth of Claimant 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 /a -(I! --'1e /6 Time 10 ' 40 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: 141 ralPs-k PI'. gov„� 644t, dear (�21l'vt11k, Describe in detail how the DAMAGE or INJURY occurred. ltl%nIEs/e ,fir, Ue /Ur, �,{ eVAj lr&aofC�vr w'l;�d�f se Yal�rle` Or ©r�i, g j�,�',� s 'I� ��i^ o4wff c 644 to a"l 01�►�P �ec�r�►-�e lD�e Jt'o,--(# kla6vw -(146 (1 ro a ce�r r 0� dlee g'' �w yr oho �r`0i 1l*2 ►'r^ ro r DF;ot ��s'�r®� �oC f �°c llolv is t Why do you claim the city is responsible? ' A,, , I V Cz7 rer�-,afflcowlef -- dIou d 4 ,54r e r ffle ;40W k a qe 4 btwel Describe in detail each INJURY or DAMAGE. ,�a p �!%r S'SP`i�pr�®Gotsi'ol�° ��rqr en,rror GCtvr1 ro PD[ ee fo�Co�oS' This Claim Must Be Signed on Page 2 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 ........ $l�h u p/ `C� Q Pt� /d p q Total amount claimed as of date of presentation of this claim: $ LH6,49 Was damage and/or injury investigated by police? ')70 If so, what city?_ Were paramedics or ambulance called? 11 o 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. CURB 11906? 'Af7#"e"41DEWALK -los;ce �If'rIie-0hfo 00ir ©k(o of /Q he, efivrz Signature of Claimant or person filing on his behalf giving relationshi to Claimant: SIDEWALK /o Typed Name: 1tdc A�y W CURBS Date: 1.? -r2 Z0/6 NOTE: CLAIMS MUST BE FILED WITH CITY CLERK (Gov. Code Sec. 915a). Presentation of a false claim is a felony (Pen. Code Sec. 72.) 0 - CUSTOMER # 763071<2j>, DCH TOYOTA / SCION ill TORRANCE UDO E HEYN *INVOICE* 2955 PACIFIC COAST HIGHWAY TORRANCE, CA 90505-6739 310-325-7602 PAGE 1 B CELL: SERVICE ADVISOR: 101459 Marvin cahrera : 15 1 i111";U_Lb 1 I 1L5 . UUI CASH OPTIONS: STK:531630 DLR:04078 ENG:IMZ-FE LINE OPCODE TECH TYPE HOURS LIST NET TOTAL :21 H .:. 0N'TDO.O M RRQ1 GUEST SOP `12.1D' SOP. REPLACED DRIVERSSIDE DOOR MIRROR .0:14:' 5 .' : 125:00 125A0 1 87910 -48160 -JO MIRROR ASSY, OUTER R 351.99 351.99 351.99 1. CDISP PA1�TS DISCOUNT ': 40:00 40.:00 40.00 PARTS 311.99 LABOR. 125.00 OTHER: 0.00 TOTAL LINE A: �6 99 B REPLACE ALL 3 WIPER INSERTS WrP;. R?CEI3 ALL 101495 CA 0.00 0.00 .14 3 L0.1 .Raii UBBER:; : WI PER BLADE " 9 5 7 9 .57: 9.57 1 85212 YZZ08 WIPER BLADE, U -HOOK, 19.99 19.99 19.99 ..1.:<8.5222;......y:ZZL2..WTPER:: BLADE; U:=HOQK:; 19:;99 19'.9.9 19.99 PARTS: 49.55 LABOR: 0.00 OTHER: 0.00 TOTAL LINE B: 49.55 EST 44.0. f3�. 131 EC16< D9 SA. 101459: I authorize DCH Toyota/Scion of Torrance to: contact. me. at my above noted__telephone number ori any matter coiicerring my �rehi.cle . . ko�° N� (V D ALL PARTS ARE NEW UNLESS SPECIFIED OTHERWISE. ORIGNIAL SERVICE DEPARTMENT HOURS: ESTIMATE MONDAY THROUGH FRIDAY 7:00 AM TO 7:00 PM 1 $ PARTS AND CASHIER HOURS: MONDAY THROUGH FRIDAY 7:00 AM TO 7:00 PM SATURDAY HOURS: 7:30 AM TO 5:00 PM BY APPOINTMENT ONLY ADDITIONS NOTICE TO CONSUMER PLEASE READ IMPORTANT INFORMATION ON BACK I acknowledge notice and oral approval of an increase in the original estimated price and authorize any additional warranty service. OUR CHARGES ARE NOT BASED ON ACTUAL TIME BUT ARE XESTABLISHED BY MULTIPLYING OUR RETAIL LABOR RATE BY INDUSTRY FLAT RATE ALLOWANCES OR OUR OWN EXPERIENCE OF THE AVERAGE REQUIRED TIME. BAR # ARD 169056 EPA # CAL 000325865 DESCRIPTION LABOR AMOUNT PARTS AMOUNT GAS, OIL, LUBE SUBLET AMOUNT MISC. CHARGES TOTAL CHARGES INSURANCE/DISCOUNTS SALES TAX CUSTOMER SIGNATURE PLEASE PAY THIS AMOUNT NG: Motor vehicles contain chemicals known to the State of California to cause cancer and birth defects or other reproductive harm. components and replacement parts, vehicle fluids, and paints and materials used to maintain vehkles, including, but not limited to, Ig weights. In addition, motor vehicles emit engine exhaust and fumes, and when serviced, cleaned, or maintained generate used oil, t Ates from comoonent wear, which contain chemicals known to the State of California to "use cancer and birth defects or other reorod� TOTALS are conta,r as, brakes, as, grease, ad in acco, U Mirror damage 1 Dec 12, 2016, 2:43:47 PM Udo Heyn DR. AND MRS.- "CYN LIDO U Mirror damage 2 Dec 12, 2016, 2:45:55 PM Udo Heyntt DR. AND MRS. UDp U Mirror damage 3 Dec 12, 2016, 2:47:57 PM Udo Heyn t U Mirror damage 4 Dec 12, 2016, 2:48:51 PM Udo Heyn DR. AND MRS. UD -0 "EYN AM U Mirror damage 5 Dec 12, 2016, 2:49:32 PM Udo Heyn \7 � La: Diff. AND MRS. UDO HLYN UH