RPVCCA_CC_SR_2012_09_18_J_Claim_Against_City_Stephen_RicardCITY OF RANCHO PALOS VERDES
TO:
FROM:
DATE:
SUBJECT:
REVIEWED:
HONORABLE MAYOR &CITY COU~~MEMBERS
CARLA MORREALE,CITY CLERK \!I
SEPTEMBER 18,2012
CLAIM AGAINST THE CITY BY STEPHEN RICARD
CAROLYN LEHR,CITY MANAGER ~
RECOMMENDATION
Reject the claim and direct staff to notify the claimant.
BACKGROUND
The claimant alleges that he was driving on Western Avenue and a branch from a tree
hit the windshield of his car cracking the windshield and causing minor property
....damage.The alleged incident occurred on June 3,2012 and the claim was filed on July
26,2012.
The City's Claims Administrator,Carl Warren and Company,has reviewed the claim
and advised the City to reject the claim because the subject tree is owned and
maintained by Caltrans.
Attachment:
Claim
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INSTRUCTIONS
1.Claims for death,Injury to person or to pel'$onal properly must be filed It()t
later-than six months after the oecurrenee.(Gov.Co~e Sec.911.2.)
2.Claim",for dilmages to real property mU$t be flIed not later than 1 year after
the occurrence.(Gov.Code see.911.2.)
3.Read entire claim fonn before filing.
4.see Page 2 for diagram upon which to locate place of i1ecident.
5.THIS CLAIM FORM MUST BE SIGNED ON PAGE 2 AT BOTTOM.
6.Attach separate sheet$,if necessary,to give full details.SIGN EACH SHEET.
04/13/2031 07:10
FJLEWITH:
CITY CLERK'S OFFICE
City of Rancho Palos Verdes
30940 Hawthorne Blvd.
Rancho PalO$Verdes,CA 90275
CLAIM FOR DAMAGES
TO PERSON OR PROPERTY
#0188 P.001/005
RESERVE FOR FILING STAMP
ClAIM NO.6lt:1/0\-Q$
~vd "TIlL!t9..k;tltJ/~
VUt fYYl£UT--'
'To:CITY OF RANCHO PALOS VERDESN~~'-L\\epQDr~c..ai ------h~
Give address and telep one number to which you d_ire notices or
communications to be sent regarding thi$claim:
When did DAMAGE or INJURY occur?
Date <2k""03-1a Time ItJ·'Q..M
If c;laim is for Equitable Indemnity,9ive date'
claimant served with the.complaint:
Date
Where did DAMAGE or INJURY occur?Describe fully,and locate on diagram on Page 2.Where appropriate,give
~eet names and address and measul"$menfl?from landmark$~
\UC ~.4'0 0\)('\l-e..Y\\~(J~Yfed Of\~trarcnO '\b\05 \ferc\25 Brae~~Jf:i:liiY.~-e,,,~eJ~~'(N~6l>J\\1\0(\\~(\/
Describe in detail each INJURY or DAMAGE.
\t-t\\~\e\C\\NU5 ~e\L\OO~5ed,\N,,\~\tl yv'£lde OJ(te~~
~e~~V <iGt\\5.~ttx\-'\0 f?\le.D ~~w OCl\\,66*f\Kx\fl .-1()~~~\XOD\txn ~"ttr''6l\CLid.'«.t~n:{~rec\""VJ ~\\1 wOO t nQC\
~-¥:~'Oea\'f\C\\X\'\tM'{\e(t
This Claim Must Be Signed on Paae 2
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General damages ••••••••••••••••••••••$,,"="<"T"""l1:l'7-
Total damages incurred to date ••••••••~~
Total BmQUnt claimed as of date of presentation~im:
The amount claimed,as of the date of pruentation of this claim,i$computed as follows:
Damagos Incurred to date (exact):.MILl -Ill Estimated prospe<'4:lve damgges as far as known:
Damage to property ••••••••••••••••••••$~Future expens.for medical and hO$pitaJ care •$~_
Expenses for mediC$1 and hospital care $Futuro Ion of earnings •••••••_•••••••••••••$1.-_
Loss of earnings $Other prospective special damag8$$,_
Special damages for $Prospective general damag8$$._
Total estimate prospective damages ••••••.$,_
Was damage andlor injury investigated bY~Jee?Vr::;S If so,what city?--ib":Ql~iE~~~~~SJ!I:.J~~G
Were paramedics or ambulanc;;e called?.i1Sorname city or ambulance r-"l......u:e'::;-----------
If injured.state date,time,name ~,"d address of doctor of your finst visit -I~NJlJ:b:;L.-I.~ru~"cc:l~c;;;;,;5:L-----------
~~ES to DAMAGE or INJURY:Ust....
'II ~II IYo".~t i~
i 1lt'l'
W1TN
Name
Name
NaMe
DOCTORS and HOSPITAlS:jJ I~\JG \l'\\l""~~
Hospital l'AddreSs-'Date Hospital~,_~_Doctor -------~--....Address·--------~--~DateofTreatment _
Doctor Mdr,"Date ofT.-.atment _
READ CAREFULLY
For aJl 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 aceident by "A-1 M 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 comers.If City Vehicle was "B-1"and thEt point of impact by "X."NOTE:If dIagrams
involvtXf.designate by letter RAJ>location of City Vehicle below do not fit the situation,attach hereto a proper
when you first saw it,and by "S"location of yourself or diagram signed by the claimant.
PARKWAY
SIDEWALK
Signature of Claimant or pelSon filing on
his behalf giving relationship to Claimant:
TYJ*IName:Date:
NOTE:ClAIMS MUST BE RLED WITH CIlY CLERK (Gov.Code sec.915a).Presentation I!If a false claim is a felony (pell;.Code sec.72.)
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04/13/2031 07:11
AUTO GLASS 2.0 LONG .OCH
23272 ftlLL CREeK CR,SUITE 220
LAGUNA HILLS,CA UGiS
PH:(B88)88N28I FAX:(888)SOW'18
#0188 P.003/005
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Bill To:l(eTAiL
Oust Stzr...Tax 10,
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Sub Totat 5418.64
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07/26/2012 3:03PM (GMT-07:00)
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04/13/2031 07:11 #0188 P,004/005
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AUTO GLAst 2.0 LONG .BACH
23272 MILL CReEK DR.SUITE 220
LAGUNA HILLS,CA .28&S
PH:(888)818-1216 FAX:(888)i06-2~18
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tlcor Glau:Fr"'ll,lentiv,accidtJh1l5 invQlvlng the brealu\ge of dggr gl...alllo inwacts tn.functionality of ,
~l,llaflQlS or the ca!lbratlCl'l of .1li01S.hi.ttl...are Il'ld~ent gf the g1aiS p repair to ~UllltQtl and MI"IlIOf'S '
are I'ICt within the i!!IeclFO of gila5&'Ie!=llecement I~SDen oases,our technicians willll'lstall th~91..anc1 atempt
to eewre it in thlt fl.llll,;p position.In !'flInye."88tl.$Ol'i or re;ulatorS mety nMcl to be reealibrat~or "
i'8p1aced at a dtalttatJip •an a:iditional eost to tho l;uSmer,Any !r.cidental VtOrk or a~to rllpllk'
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durinG first 24 hours.
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1M lndle:ate$2012Q128 Retail A OE Pl'iOf:Lilt
?aymetlt TYIlII.Cr.oit C:.rd on ?jl~"
07/26/2012 3:03PM (GMT-07:00)J-9
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SHERlFF.'S STATIONS
. .in an emergency call 9-1 ..1
Attadeoa Station .....••......••.626-798.1131
780 E.Altadena Dr.,Altadena,CA 91001
Avalon Station ,310-510-0174
215 Sumner Ave.,Avalon,CA 90704
carson Station 31Q.S30-1123
21356 S.Avalon Blvd.,Carson,CA 90745
Century Station 323-568-4800
11703 Alameda St..Lynwood,CA 90262
Cerrttos Station ...•••....•••••••562-860-0044
18135 Bloomfield Ave.,ce~,CA 90703
Compton Station ......••••......310-605-6500
301 $.Willowbrook Ave.,Compton,CA 90020
Crescenta Valley$tation •....•.•..818-248--3484
4554 N.Briggs Ave.,La Cre:scent.a.CA 91214
East Lo5 Angeles Station ....•.••••323--264-41 $1
5019 E.3'"St.,east !.os Angeles,CA 90022
IndustJy Station 626-330-3322
150 N.Hudson Ave.,,City of Industry,CA 91744
Lakewood Station •.:............562-623-3500
5130 Clark Ave.,LakelNOOd,CA 90712
L.ancaster Station •.....••••.•....661-948-8466
~~.~~·.~~~.~3~=~1661~ne Ave ••L.omita,CA00717
Lost Hills Station .••••••...•....•818-878-1808
27050 AgOUIll Rd.,Agoura,CA 91301
Marina Del Rey Station ••••.•....•310-482-6000
13851 Fiji Way,Mtlina Del Rey,CA 90292
Norwalk Station .......••.••.....582-863-8711
12335 CMc center Dr.,Norwalk,CA 90650
Palmdale:Station .........•••...•61$1-272-2400
750 East Avenue Q,Palmdale,CA 93550
Pico Rivera Station .....•••••••••562-949-2421
6631 Passons SIvd.,Pica Rivera,CA 90660
san Dimas Station 909450-2700
270 S.Walnut Ave.,san Dimas,CA 91773
&lnta Clarita Valley Station ...•••••661-255-1121
23740 Magic Mountain Pkwy••Santi!CI~rit&,CA 91355
South \...0$AngeIE.il$Station ....•.•..323-820-6700
1310 Imperial Hwy.,lQ$Angeles.CA 90047
Temple Station ••...••.....•....•626-285-7171
883S Las Tunas Dr.,Temple City,CA 91180
WalnutlOiamond Bar station ..•...•909-595-2264-
21695 Valley Blvd.,Walnut.CA 91789
West Hollywood Station ...••,•.•..310-855-8850
780 S.San Vicente Blvd .•WeiSt Hollywood.CA 90069.
SH-R-404 (Revised 07/2011)
#0188 P.005/005
REPORT
INFORMATION
and
Victims'Bill of Rights
Date
[Iv cJ?'R-1lt:1 L(7.:r1 (2
Deputy's Name
L~Y D.BACA,SHERIFF
Los Angeles County Sheriff's Department
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