CC SR 20170606 F - Claim Against the City SokolRANCHO PALOS VERDES CITY COUNCIL
AGENDA REPORT
AGENDA DESCRIPTION:
MEETING DATE: 06/06/2017
AGENDA HEADING: Consent Calendar
Consideration and possible action regarding a claim against the City filed by Stephanie
Sokol.
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: Emily Colborn, City Clerk
REVIEWED BY: Gabriella Yap, Deputy City Manager. -
APPROVED BY: Doug Willmore, City Managervl"---,
ATTACHED SUPPORTING DOCUMENTS:
A. Stephanie Sokol claim (page A-1)
BACKGROUND AND DISCUSSION:
The claimant states that her vehicle was damaged when driving over a pothole while
driving east on Summerland Avenue. The alleged incident occurred on January 17,
2017, and the claim was filed on April 4, 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 incident occurred on
private property. Therefore, it does not appear as though the City has any liability for the
incident.
1
DILE WITH:
_ LERK'S GEEICE
City of Rancho Palos !Verdes
30940 Hawthorne Blvd.
Rancho Palos Verdes, CA 90275
CLAIM FOR DAMAGES
TO PERSON KIR PROPERTY
,tESERVE FOR
L � FILING STAMP
.
CLAIM NO.
I
TMEr -
r
IHSTRUCTIOHS
1. Claims for death, injury to person or to personal property must be filed not APR 0 4 2017
later than sir months after the occurrence. (Gob. Code Sec. 911.2.)
2. Claims for damages to real property must be filed not later than 1 year after
the occurrence. (Goes. Code Sec. 911.2.)I-� RK ®PEKE
3. Read entire claim form before filing,
.4. See Page 2 for diagram upon which to locate place of accident.
5. THIS CLIkfi FORM MUST BE SIGNED ON PAGE 2 AT BOTTOM.
6. Attach separate sheets, if necessary, to gibe full details. SIGN EACH SHEET.
5: CITY OF RANCHO E'ALOS VERDFS Date of firth of CIa;irna
;f r Annna n Occupation of Claimant —
Home Address of Claimant City and State
Business Address of Claimant City and State
address and telephone number to which you desire notices or
Business Telephone Number
Claimant's Social Security No.
When did DAMAGE or INJURY occur? Dames of any city employees involved in INJURY or DAMAGE
Date s / ( — Time � � ``._
If claire is for Equitable Indemnity, gibe date
claimant seabed with the complaint:
Date � jj q
Where did DAMAGE or INJURY occur? Describe fully, and locate on diagram on Mage 2. Where appropriate, gibe
street names and address and measurements from landmarks:
Describe in detail how the DAMAGE or INJURY occurred.
o V' KL Vl/ cel
Why do you claim the city is responsible?
Describe in detail each INJURY or DAMAGE.
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 .................... $ �g � - 4,9q Future expenses for medical and hospital care
Expenses for medical and hospital care ... $::=a— Future loss of earnings ..............
Loss of earnings ...................... $_ Other prospective special damages ... $
Special damages for ................... a— Prospective general damages ...............
Total estimate prospective damages......
General damages ......................
q
Total damages incurred to date ....... $ '�
Total amount claimed as of date of presentation of this claim:
Was damage and/or injury investigated by police? 00 If so, what city?_
t�ftre paramedics or ambulance caIIed?n_Q_ If so, name city or ambulance
If injured, state data, time, name and address of doctor of your first vizir ---
VM10ESSE S, to DA.MsAG3E or INJURY: List all persons and addresses of persons known to have information:
Name- 01——Address Phone
Name Address Phone
Name Address Phone
F,��e HOPPITAP S:
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
of streets, including North, East, South, and West; indicate
place of accident by "X" and by showing house numbers
or distances to street corners. If City Vehicle was
involved, designate by letter "A" location of City Vehicle
vvhen you first saw it, and by "B" location of yourself or
Signature of Claimant or person filing on
his behalf giving relationship to Claimant:
-pejjE-- j,-,
JIOIS MUST BE FILED WITH CITY CLERK (Gov. Code
L
your vehicle when you first saw City vehicle; location of
City vehicle at time of accident by "A-1" and location of
yourself or your vehicle at the firyie of the accident by
"B-1" and the point of impact by "X." NOTE: If diagrams
below do not fit the situation, attach hereto a proper
diagram signed by the claimant.
a
d Name:
Date:
CURB
See. 4al¢c clainni, --isa felonyTP"C-ode 'Sec. 72.)
A-2
Otto's Car Tech INVOICE
526 W 5th St 1767
San Pedro, CA. 90731
Phone: 310-833-5686 Fax: 310-833-3710 Org. Est. # 001797
ARD#00271091
INVOICE Vehicle Received: 01/18/2017 Invoice Date: 01/18/2017
Sakol, Stephanie 2015 Mercedes-Benz - C300 4Matic - 2L, In-Line4 (OCI) VIN
Lic #: Odometer In: 25718
VIN#:
Cust ID : 710
Part Description / Number Qty Sale Ext Labor Description Extended
NEW OEM STRUT ASSEMBLY 1.00 450.00 450.00 SUSPENSION NOISE,FRONT RIGHT STRUT LEAKS n/c
205320 OIL,
Shop Supplies 3.00 INSPECTION N/C
R/R FRONT RIGHT STRUT ASSEMBLY. 230.00
SUSPENSION LUBRICATE
FRONT WHEEL ALINGMENT 70.00
Org. Estimate 792.64 Revisions 0.00 Current Estimate 792.64
Labor: 230.00
Parts: 453.00
Sublet: 70.00
SubTotal: 753.00
Tax: 39.64
Total: 792.64
Payments - I I Bal Due: $792.64
1 hereby authorize the above repair work to be done along with the necessary material and hereby grant you and/or your employees permission to operate the car or truck herein described
on street, highways or elsewhere for the purpose to testing and/or inspection. An express mechanic's lien is hereby acknowledged on above car or truck to secure the amount of repairs
thereto. Warranty on parts and labor is one years or 12,000 miles whichever comes first. Warranty work has to be performed in our shop & cannot exceed the original cost of repair.
Signature Date Time
Page 1 of 1 Copyright (c) 2017 Mitchell Repair information Compan LLC invhrs 7.2.15d
A-4
Front right strut and alignment was needed due to pot hole in Rancho Palos Verdes.
$792.64 in damage was paid for the work
Otto's Car Tech
626 W. 5th st
A-5
QTTOS CAR TECH
526 A 5TH ST
SAN PE il-t:('), CA 90731
31W8 33-6686
SALE
iuU04975215
TID: 002 REF#: 00000003
Rank ID: 2648
018002 RRN: 056144429
61 14:41:29
i, t: 3
i_)DE !445
VISA
� Chip
**f**
Ali lrNT $792.64
Capital 01 -ie VlbO
AID: A00600000311010
TVR: 80 86 00 80 00
TSI: 68 00
Thank `.'au
Pleas,se Come Attain
CUS 0MER COPY
m
Ray Deeter Tire Town
1024 S. Pacific Ave
San Pedro CA, 90732
Phone Number: (310)833-4477
Fax Number: (310)833-5190
Customer:
Date: 1/18/2017 10:13 AM
Company:
VIN
License No:
Technician:
Odometer:
Order No.:
VEHICLE ALIGNMENT REPORT
MERCEDES -BENZ, 2015, 205 (W/S) 4-MATIC ECE/USA, 4WD, Standard Suspension, Code M005 + 485
Primary Angles
Initial
Specifications
Final
Min. Max.
Left
----
---- ----
----
Caster
Right
----
---- ----
----
Left
-0.80
---- ----
-0.9°
Camber
Front
Right
-0.80
---- ----
-0.70
Left
-0.400
---- ----
0.250
Toe Right
0.800
---- ----
0.200
Total
0.400
---- ---
0.45°
Left
-2.00
---- ----
-2.00
Camber
Right
-1.80
---- ---
-1.80
Left
0.100
---- ----
0.100
Rear
Toe Right
0.150
---- ----
0.150
Total
0.250
---- ----
0.250
Thrust Angle
0.00
-0.10 0.10
0.00
Secondary Angles
Initial
Specifications
Final
Min. Max.
Left
----
---- ----
---RiRight
SAI
t
----
---- ----
----
Left
----
----
Included Angle
.. Right
----
--- ----
----
Left
----
1.10 2.10
----
Toe Out On Turns
Right
----
1.10 2-10
----
Left
----
---- ----
----
Maximum Turns
Right
----
---- ----
----
Left
----
---- ---
----
Toe Curve Change
RiPht
----
---- ---
----
Front
0.0"
---- ----
0.1"
Setback
Rear
0.3"
---- ----
0.3"
Track Width Diff
1.1"
1.1"
Wheel Base Diff.
-0.3"
-0.1"
Left
----
0.4" 1.2"
----
Front Ride Height
Right
----
0.4" 1.2"
----
Left
----
0.6" 13"
----
Rear Ride Height
Right
---
0.6" 13"
----
Frame Angle
----
A-7
RECEIVED
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