RPVCCA_CC_SR_2012_06_05_C_Claim_Against_The_City_By_Nora_LumCITY OF RANCHO PALOS VERDES
TO:
FROM:
DATE:
SUBJECT:
REVIEWED:
HONORABLE MAYOR &CITY C~~MEMBERS
CARLA MORREAlE,CITY CLERe
JUNE 5,2012
CLAIM AGAINST THE CITY BY NOR~~M
CAROLYN LEHR,CITY MANAGER QY--
RECOMMENDATION
.Reject the claim and direct staff to notify the claimant.
BACKGROUND
The claimant alleges that a branch from a City owned and maintained tree fell on the
claimant's parked and unoccupied vehicle,causing minor property damage.The
alleged incident occurred on March 21,2012 and the claim was filed on April 27,2012.
The City's Claims Administrator,Carl Warren and Company,has reviewed the claim
and advised the City to reject the claim.
Attachment:
Claim
C-1
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.
)FILE WITH:
CITY CLERK'S OFFICE (""""
City of Rancho Palos Verdes I,,,,
30940 Hawthorne Blvd.
Rancho Palos Verdes,CA 90275
CLAIM FOR DAMAGfiS
TO PERSON OR PROPER\,:·t
RESERVE FOR FILING STAMP
CLAIM NO.C1Dla·03
RECEIVED
CITY OF RANCHO PALOS VERDES
APR 27 2012
CITY CLERK'S OFFICE
TO:CITY OF RANCHO PALOS VERDES Date of Birth of Claimant
Occupation of ClaimantNameofClaimant
Home Address of Claimant
When did D~AGE or INJURY occur?Names 0 any city employees involved in INJURY or DAMAGE
Date J'1.rLL 20 I z..Time 1.,P,tyI •
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:
.,;,J f'fZ-'>tJ-r 0 f tn..Rlllj)",~.,J rO\J"hlo~e,),_~CH()rltvO!veJtJ)S(
Describe in detail how the DAMAGE or INJURY occurred.
;r.'Ir"t¥J1J My 2.-0 10 1:0'/0711 ffL'"if A.£.ON&,r#f.{1~f;e1 ~~8 t,J f-fLorJ7 of rrl~tJLIJJ}J)
v,f:NJ Toll1,J flo tv'G}.Irf1fst..fJ.-"'1'~UJJ~'To M 'f CIt fL.:x:.FolAW.D /Jr l.II-fl4e f/UJe
8t1tAJW-P1U>~A Cll''f O~W6!J ""~e It".}}PR~~rqJ J'rc,,{LDJJ nt'-(UJoF of hl'f CA-fl..
Why do you claim the city is responsible?
'(fA}b CA1'1 en1PW~~~J~"UlAPJM4 fVlAlflfflJlINU,ju.pet-W1e./fJ6#1 ehllv/D ~II/lP~o
CopJr;,.unf;.p 1'A'~~~witS 0"'1 owAl€P ..
,Describe in detail each INJURY or DAMAGE.
5fGf,A-11~CAl)~!J 90p~fJltof £:;$1',rtlf,t1e
This Claim Must Be Signed on Page 2
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General damages .••...•.••••..••.••.••$.-.-='7-.......-
Total damages incurred to date ...•.•••$,,,,.03
Total amount claimed as of date of presentation of this claim:
The amount claimed,as of;lte of presentation of this claim,is compur~sfollows:
Damages incurred to date ( .i):Estimated pr~"etive damages as far as known:
Damage to property ••••••.•..•••.•.••.•$'Cl'.o'Future expenses for medical and hospital care.$,_
Expenses for medical and hospital care •.•$Future loss of earnings •..'1'.i!ij.J ••V ...,..$,-=-...,...,..-..,...,:,"
Loss of earnings .•••.•.•••....•......•$Other prospective special d Ift'~g~§'~.•~~.••$2.£0 ,00
Special damages for ...•••••....•.•.••.$Prospective general damages ••£~.tfr'!-.~t.J1M.$1.f o.gO
Total estimate prospective damages $foo .00
Was damage and/or injury investigated by p.olice?M\)If so,what city?_
Were paramedics or ambulance called?HI)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 cersons known to have information:
NName ~trll {),,;::r,..Address-lf ;I~'11__Phon..e-;iiiiiiiliiiiliiii••=ame ~"'I I)P "'I:IF.....O Address'.I I ~Phon~
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.
CURBJ
Signature of Claimant or person filing on
his behalf giving relationship to Claimant:
PARKWAY
SIDEWALK
Typed Name:Date:
CURB.
Norq L\AVV)
NOTE:CLAIMS MUST BE FILED WITH CITY CLERK (Gov.Code Sec.915a).Presentation of a false claim is a felony (Pen.Code Sec.72.)
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~-CHI
OIIIcIal Body Shop
t-;;{l;:f
CHEVROLEt
IJUNNIN
OIIIcIaI Body Shop
·.
':;::.-.A'IIrM~g
N""........COWB/DN CENTERfp,R,D
OIIl!eShop Jimmy Portillo
jimmy@jimandjacks.com
E!Segundo Hermosa Beach
1605 E.Grand Avenue 555 Pacific Coast Highway
Tel:310.322.5733 www.jimandjacks.com Tel:310.322.9475
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Customer:LUM,NORA
JIM AND JACK'S HERMOSA('\CH
555 PACIFIC COAST HIGHWAY,HERMOSA BEACH,
CA 90254
Phone:(310)322-9475
FAX:(424)247-2399
Preliminary Estimate
Written By:Jimmy Portillo
Workfile 10:
Federal 10:
Federal EPA:
BAR:
a54c707e
95-3441830
CAD02813639
AB-076404
Insured:LUM,NORA
Type of Loss:
Point of Impact:
Owner:
LUM,NORA
Policy #:
Date of Loss:
Inspection Location:
JIM AND JACK'S HERMOSA BEACH
555 PACIFIC COAST HIGHWAY
HERMOSA BEACH,CA 90254
Repair Facility
(310)322-9475 Business
VEHICLE
Qaim#:
Days to Repair:5
Insurance Company:
Year:
Make:
Modei:
Color:
2010
TOYO
PRIUS
RED Int:
Body Style:
Engine:
Production Date:
COndition:
40 H/B
4-1.8L-G/E
6/2010
VIN:
License:
State:
Job #:
Mileage In:
Mileage Out:
Vehicle Out:
4 Wheel Disc Brakes
Air Conditioning
Aluminum/Alldy Wheels
AM Radio
Anti-Lock Brakes (4)
Automatic Transmission
Auxiliary Audio Connection
Bucket Seats
CD Player
Clear Coat Paint
4/20/2012 10:30:23 AM
Cloth Seats
Console/Storage
Cruise Control
Driver Air Bag
Dual Mirrors
FM Radio
Front Side Impact Air Bags
Head/Curtain Air Bags
Heated Mirrors
Intermittent Wipers
Message Center
Overhead COnsole
Passenger Air Bag
Power Brakes
Power Locks
Power Mirrors
Power Steering
Power Windows
Rear Defogger
Rear Spoiler
303974
Rear Window Wiper
Search/Seek
Stability Control
Steering Wheel Controls
Stereo
Telescopic Wheel
Tilt Wheel
Tinted Glass
Traction Control
Page 1
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Preliminary Estimate (~
Customer:LUM,NORA
Vehicle:2010 TOYO PRIUS 40 H/B 4-1.8L-G/E RED
Line Operation Description Qty Extended Labor Paint
Price $
1 WINDSHIELD
2 *Rpr Windshield Toyota wlo lane keepjng.wlo ayto
miITor(ROPE)
3 ROOF
4 R&I LT Roof molding black 0.4
5 PILLARS,ROCKER &FLOOR
6 *Rpr LT Hinge pillar (HSS)s s...a 1.4
7 QUARTER PANEL
8 Bind LT Quarter panel 1.5
9 R&I Fuel door 0.4
10 Bind Fuel door 0.2
11 ..REAR LAMPS
12 R&I LT Tail lamp assy 0.4
13 REAR BUMPER
14 R&I R&I bumper cover 1.3
15 MISCELLANEOUS OPERATIONS
16 #Color Sand and Buff 1 1.0
17 *Repl Cover car/bag 1 .1.O.JlQ 0.2
18 #Color tint,!Color match 1 0.5
19 #Hazardouse Waste 1 7.00 X
20 #Corrosion Protection Primer 1 10.00 0.5
SUBTOTALS 27.00 9.7 3.6
ESTIMATE TOTALS
Category Basis Rate Cost $
Parts 20.00
Body Labor 9.7 hrs @ $40.00 /hr 388.00
Paint Labor 3.6 hrs @ $40.00 /hr 144.00
Paint Supplies 3.6 hrs @ $32.00 /hr 115.20
Miscellaneous 7.00
Subtotal 674.20
Sales Tax $135.20 @ 8.7500%11.83
Grand Total 6B6.03
Preliminary estimate is based on visual inspection.
4/20/2012 10:30:23 AM 303974 Page 2
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Preliminary Estimate C·
Customer:LUM,NORA
Vehicle:2010 TOVO PRIUS 40 H/B 4-1.8L-G/E REO
THIS IS NOT AN AUTHORIZATION TO REPAIR ALTHOUGH IT IS AGREED BElWEEN THE REPAIR FAOLIlY AND
ESURANCE THAT THE ABOVE VEHICLE CAN BE REPAIRED BY THE REPAIR FAOLIlY FOR THE AMOUNT STATED IN THE
GROSS TOTAL SECTlON.ONLY THE VEHICLE OWNER CAN AUTHORIZE THE REPAIR OF THE VEHICLE AND ALL COSTS
OF REPAIR ARE THE SOLE RESPONSIBILIlY OF THE VEHICLE OWNER.
THIS APPRAISAL WAS BASED ON VISIBLE OR CERTAIN DAMAGES AT THE TIME OF INSPECTION.TO REQUEST A
SUPPLEMENT,PLEASE CALL (866)5144788.PLEASE FAX THE SUPPLEMENT AND ALL SUPPORTING DOCUMENTS WITH
CLAIM NUMBER TO (866)454 0890.THE REPAIR FACILIlY AND ESURANCE WILL REACH AN AGREED PRICE PRIOR TO
BEGINNING ANY OF THE SUPPLEMENTAL REPAIRS.THE REPAIR FAOLIlY WILL THEN SEEK AUTHORIZATION FROM
THE VEHICLE OWNER FOR THE ADDmONAL REPAIRS.NO SUPPLEMENTS WILL BE HONORED UNLESS APPROVED IN
ADVANCE BY ESURANCE.
REPAIR FACILITY MUST BE PROVIDED A COpy OF THIS ESTIMATE PRIOR TO COMMENCEMENT OF REPAIR.FAILURE
TO DO SO MAY SUBJECT THE VEHICLE OWNER TO ADDmONAL EXPENSE.
FOR YOUR PROTEcTION CAUFORNIA 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 GUlLTV OF A CRIME
AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON.
THE FOLLOWING IS A UST 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 PATHWAYS:ADJ=ADJACENT ALGN=AUGN A/M=AFTERMARKET
BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT
EST=EsnMATE EXT.PRICE=UNIT PRICE MULTIPUED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS
NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION
NO=UNE NUMBER QTY=QUANTITY QUAL RECY=QUAUTY RECYCLED PART QUAL REPL=QUAUTY REPLACEMENT PART
COMP REPL PARTS=COMPETmVE REPLACEMENT PARTS RECOND=RECONDmON 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/_=WITHL SYMBOLS:#=MANUAL UNE ENTRY *=OTHER [IE..MOTORS DATABASE
INFORMATION WAS CHANGED]**=DATABASE UNE WITH AFTERMARKET N=NOTES ATTACHED TO UNE.OPT
OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED
WITH SOME UNIQUE PRICING OR DISCOUNT.NWCPP=NATIONWIDE CRASH PARTS PROGRAM.
4/20/2012 10:30:23 AM 303974 Page 3
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Preliminary Estimate
Customer:LUM,NORA
Vehicle:2010 TOYO PRIUS 40 H/B 4-1.8L-G/E RED
Estimate based on MOTOR CRASH ESITMATING GUIDE.Unless otherwise noted all items are derived from the Guide
ARM8546,ctc Data Date 4/16/2012,and the parts selected 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 information provided by MOTOR may have been modified or
may have come from an alternate data source.Tilde sign (tv)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 AM.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 2012 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
complete 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=Diagnostlc labor category.E=Electricallabor category.F=Frame labor category.G=Glass labor category.
M=Mechanicallabor category.S=Structurallabor category.(numbers)1 through 4=User Defined Labor Categories.
OTHER SYMBOLS AND ABBREVIATIONS:
Adj.=Adjacent.Algn.=Align.ALU=Alumlnum.A/M=Aftermarket part.Blnd=Blend.BOR=Boron steel.CAPA=Certified
Automotive Parts Association.D&R=Disconnect and Reconnect.HSS=High Strength Steel.HYD=Hydroformed Steel.
Incl.=Inciuded.LKQ=Like Kind and Quality.LT=Left.MAG=Magnesium.Non-Adj.=Non Adjacent.NSF=NSF
International Certified Part.O/H=Overhaul.Qty=Quantity.Refn=Refinish.Repl=Replace.R&I=Remove and Install.
R&R=Remove and Replace.Rpr=Repair.RT=Right.SAS=5andwiched Steel.Sect=Sectlon.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
ESITMATING GUIDE:
BAR=Bureau of Automotive Repair.EPA=Environmental Protection Agency.NHTSA=National Highway Transportation
and Safety Administration.PDR=Paintless Dent Repair.VIN=Vehicie Identification Number.
4/20/2012 10:30:23 AM 303974 Page 4
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