CC SR 20150721 D - Claim Against City Jaclyn TafollaCITYOF
MEMORANDUM
e
RANCHO PALOS
TO: HONORABLE MAYOR AND CITY COUNCIL MEMBERS
FROM: CARLA MORREALE, CITY CLER C
DATE: JULY 21, 2015
SUBJECT: CLAIM AGAINST THE CITY BY JACLYN TAFOLLA
REVIEWED: DOUG WILLMORE, CITY MANAGER A4A,>
RECOMMENDATION
Reject the claim and direct staff to notify the claimant.
DISCUSSION
The claimant alleges that on June 10, 2015, she was entering the plaza shopping center
located at Trudie Drive and Western Avenue and felt something scratch the underside
of her vehicle. She parked and noticed scratches on the left underside of her car
bumper.
The City's Claims Administrator, Carl Warren and Company, has reviewed the claim
and advised the City to reject the claim, as the incident occurred on private property and
the City's liability is doubtful. The claimant has been notified that the location is on
private property and that she may want to contact the owner of that property.
Attachment:
Claim (page 2)
1
FILE WITH:
CITY CLERK'S OFFICE
City of Rancho Palos Verdes
30940 Hawthorne Blvd,
12ancho P
CLAIM FOR DAMiAGES
INSTRUCTIONS
I. 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 I 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.
10: CITY OF RANC HO PAIUVEAM -'
e Address of Claimant
City and State
RESERVE FOR FILING STAMP 90C11.1
CLAIM NO.
RECE11,Y'Fr)
17'y OF RANCHO Ap,
JUN 15 2015
S
Date of
Occupation of Claimant
..............
Business Address of Claimant City and State I Business Telephone Number
Give address and telephone number to which you desire notices or Claimant's Social Security Ni
communications to be sent regarding this claim:
When did INJURY occ, Names o
f any city employees involved in INJURY or DAMAG
gate.,_ e Time
Eo[It claim it, for Eq itable Indetvrnity gi ate._
claimant served with the complaint:
Date
Where did CA GE -o 'r'- I -NJ UK —Yo—c-c" u fully, and locate on diagram on Page 2. Where appropriate, give
street names and address and measurements from landmarks:
J�J LUfti-1- '17M 1 W, SOW)'
Wi�p APE) PK6RAT &ttr- 00
Describe detail 4tfr
Why do you claim the city is responsible?
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Describe in det4ail each INJURY or DAMAGE,
1. IV
P*V&V --
The amount claimed, as of the date of presentation of this claim, is computed as follows:
Damages incurred to date (exact): I�Estimated prospective damages as far as known:
Damage to property .. _ .. , . . � � , � ...... / .7 Future expenses for medical and hospital care
Expenses for medical and hospital care . Future loss of earnings ................
Loss of earnings , , . . . . . ............... Other prospective special clamage!� ...
Special damages for ...... prospectivt general darnapps ........ ...... -------
Total estimate prospective damages, ......
General damages ........
Total damages incurred to date. .
Total amount claimed as of date of presentation of this clalwa $
Was damage and/or injury investigated by 11 So what city? .. . ... ......
. .......... . . ......
Were paramedics or ambulance called? If so, name city or ambulance . ... . ........... __'_ "', .. . ...... ....
if injured, stale date, time, name anti. address of doctor of your first vii . ...... ...
VVITNIEI,,E-" to oi- INJURY: List all porn,
Name Address
Name Address
DOCTORS and HOSPITALS:
Hospital .... ........ . . ........ . .... . ... . __Address
Doctor Address
Doctor Address
MMFTTR��
Date Hospitalized,
Date of Treatment
Date of Treatment
For all accident claims place on following diagram names your vehicle when you first saw City vehicle; location of
of streets, including north, Fast, South, and West; indicate City vehicle at time of accident by "A-V and location of
plzcc of accident by "Y" arid by shots vinq house rivrriburs yourself or your vehicle at the time of the accident by
or distances to street corners, If City Vehicle was "BA" 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.
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rs"PARIMM
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Signature of Claimant or person filing on i TypedI pate:
his behalf giving relationship to Claimant:
... ...... .... .. . .. . .. . ..... .......................
OfE: cLAmtg A6,0,5T BE FKA. D WITH CITY CLERK (Gov, Code Sea. 915a), Presentation of 8 false calm Is a felony (Pen. Code Sec. 721
; UTA CC I I
P.O. Box 802218
Houston, TX 77280
(713)973-8600
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Name: Long Beach BMW
Address: 2998 Cherry Ave, Signal Hill, CA, 90755
Owner Name:
Owner Address':
Date: 6/15/2015
Make: BMW
Model: 3 series
Year: 2013
Color: White
Mileage: ';'0
Tag #:
R.O. #:,
VIN #:
Stock #: df350581
Advisor:
Customer's Signature
Wheels Legend
LF RF None
LR RR
# Service Amount
1 Paint Bumper $600.00
REFINISH COMPLETE FRONT BUMPER
TOTAL: $600.00
0