RPVCCA_SR_2011_05_17_06_Claim_Against_City_RobertsfCrTYOF RANCHO PALOS VERDES
TO:
FROM:
DATE:
SUBJECT:
REVIEWED:
HONORABLE MAYOR &CITY COUNCIL MEMBERS
CARLA MORREALE,CITY CLER~
MAY 17,2011
CLAIM AGAINST THE CITY BY CAROLE ROBERTS
CAROLYN LEHR,CITY MANAGERc6L
RECOMMENDATION
Reject the claim and direct staff to notify the claimant.
BACKGROUND
The claimant alleges that a city owned water pipe broke and flooded the claimant's
property.The alleged incident occurred on May 27,2010 and the claim was filed on
July 27,2010.The City does not own or maintain the pipe.
The City's Claims Administrator,Carl Warren and Company,has reviewed the claim
and advised the City to reject the claim.
Attachment:
Claim
6-1
S tate Far min sur a nee Com pan i es
July 20,2010
Certified Mail-Return Receipt Requested
SrATI .ARM
A
INSUItANC~
Subrogation Services
PO Box 2375
Bloomington,IL 61702-2375
City Of Rancho Palos Verdes:City Clerk's Office RECEIVED
30940 Hawthorne Blvd CITY OF RANCHO PALOS VERDES
Rancho Palos Verdes,CA 90275
IJUL I 27 2010
CITY CLERK'S OFFICERE:Claim Number:
Our Insured:
Date of Loss:
Your Insured;
Your Claim Number:
Your Policy Number:
Loss Location:
Carole Roberts
May 27,2010
City Of Rancho Palos Verdes:City Clerk
Dear City Clerk:
Facts of Loss:Acity water pipe broke which caused water to run
down into the insured's home causing damage.
It is our understanding that you are self insured.Our
investigation indicates you are responsible for this claim.
Therefore,we are seeking recovery from you.This letter is to
notify you of our subrogation claim and request your cooperation
in settling this matter.
To assist you in your review,here is a breakdown of the amounts
State Farm paid by Cause of Loss:
Building/Structure
Contents/Personal Property
Additional Living Expenses
Other
Amount State Farm Paid
Insured Deductible
Total Claim Amount
$
$
$
$
$2,654.17
$1,000.00
$3,654.17
Based on the assessment of liability between the parties,State
Farm General Insurance Company is seeking %of the Total Claim
Amount listed above.The amount payable to State Farm General
Insurance Company for this loss is $3,654.17.
HOME OFFICES:BLOOMINGTON,ILLINOIS 61710-0001
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Page 2
July 20,2010
Please remit payment of this claim and include our claim number
on the payment.If you have any questions or concerns,please
contact me or a member of my team at the number listed below.
Thank you for your cooperation.
In order to assist you in evaluating and processing the
subrogation claim we are asserting,we may provide nonpublic
personal information about our customer.We are sharing this
in~rmation to effect,administer,or enforce a transaction
authorized by the consumer.However,you are neither authorized
nor permitted to:(1)use the customer information we provided
for any purpose other than to evaluate and process the
subrogation claim,or (2)disclose or share the customer
information we provide for any purpose other than to evaluate and
process the subrogation claim.
Sincerely,
Ned Beyer x5321
Claim Representative
(866)457-8276 Team 80
State Farm General Insurance Company
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07/13/2010 13:29 13105445291 RANCHO PALOS VERDES
CItY~=FACE CLAIM FOR DAMAGES
30940 Hawthorne Blvd.TO PERSON OR PROPERTY
aa~obo palQ~'~rdes"CA 90275
PAGE 02/03
RESERVE FOR FILING ~~
CLAIM No.~__
o INSTRUOTIONS
1.Claims for dMlh.Injury to peraon or 10 QeI'IOn8I property must be filed I"ot later than six
months after the occurrence.(Gov.Code Sec.911.2.)
2.Claims ror damagee to real property must be filed notlatar than 1 year.fter the occurrence.
(GCI¥Code sec.911.2.),
3.Read entire claim form before (IIIng.
4.se.page 2 for cllBgnlm upon which to Jogateplace of acioIdent.
6.Thle Claim form must be signed On page 2 at bottom •.
.6.Attach eeparale sheets,If neeeasary,to glve full details.SlGN EACtI SHEET.
RECEIVED 0
CITY OF RANCHO PALOS VERDES
JUL 27 2010
srrt CLERK'S OFFICE
10:CITY OF Rancho Palo;,verdes
Nam,of Claimant
City and State
Date of Blrth of Claimant
Claimant'.SOCl(ll8eCW1ly No.
Business Telephorie Nutnber
h Whe
~State
communlcaUOI'l$to be sentIt-'
Names of any city employesslnvolved In INJURY or DAMAGE
,• J •I .......'....I ••,_...:•II •,-~-~;•------__0'"
iI.o~-------.,~-
;)',-~--'~""'.~Describe In detllJl how thEt DAMAGE or INJUR'f D(:cur .f LCrt~,wM-e~L,6Ve..bf\ot<~a1l\CX.WftyC'r ROtIJ
home... .
When dld,.DAM.Al eOJ:~URV ocour?Date ~"'1~nme _
If claim it fot eqUitable Indemnity,give date claimant *erved
with the oomplalnt:
Date '
Where did DAMAGE!or INJURY OCClJr?Descrlbe'fully
names and acldl'llSS and measurement.'ro,m landmar
WhY de you claim th8 city Is responsible?
DescrIbe In detail eQl;h INJURY Dr DAMAGE D ,Cl £I __n
. .t.:>U t \<CI,OV5 (JJ.W'v-t.~~
S~E PAGE 2 (O~R)~~ISoCLAIM MUST BE SIGNEO ON REVERS~SIDE
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Generaldamages •••••••••••••••••••••••••••$~___
Total damages incurred to date •••.••••••:•••$_
.,"0101 amount claimed as of date of presentation of this claim:$
07/13/2010 13:29 13105445291 RANCHO PALOS VERDES PAGE e3/03
'he amount claimed,as of'the date of presentation of this claim,Is computed as follows:
hunages 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 ,0$Future loas of earnings $-_
Loss of eamlngs •.......,.•.•..:•••.••...., .$Oth.er pl'Olilpectlve SPllQlaI damages •••••••••.••$ _
Special damages for ,$Prospective general d~mages $_--...~_
1btal estImate prospective damages .••..••••.$,_
"'as damageandlor Injury Investigated by police?If sO,.what clly?_
/Vera paramedics or ambUlance calfed?If so,nllme city or ambulanc._-...-__~_
f injured.state date.tIme,name and address ofd~rofyour flrst v1slt:~
NITNESSes to DAMAGE or INJURY:Ust all persons and addresses of persons known to have information:
~ame Addr8&S ----------__---:Phone _
Name __Address Phone _
~ame Address Phone _
[,lOCTORS and HOSPITALS:Hospital --.-_~_Addreas Oate Hospllal1zed _
Doctor Address Oats of 1teatmenl _
Doctor AddrH8_'Date of 1I'eatme"t __~_
,READ CAREFULLY
For all accldont'clalms place on folloWing diagnun namee of streets.or your vehicle when you nlSt saw City vehicle;IOO8tlon of City vehicle
Deluding North,Eaot.South,and west;Indicate plac.e of accldem by 81 time of accident by "A-1"and location of yourself or your vehicle at
'X"and by showing house numbers or distances to street corners.the time of the aCCident by "B-1"and the point of Impact by "X:'
If City Vehlole was Involved,designate by letter ''A''loCation Of City NOTE:If diagrams below do not fit the situation,attach hereto a proper
iehicle when you first saw It.and by "B"loca110n of yourself diagram signed by claimant..
CURB
SIDEWALK
PARKWAY
SIDEWALK
Signature of Claimant or person filing on •
~~'
L ~_;-~---f
.;Y~T.",,:-.,-
"TYped Name:I ..
G!uAw.d C·~-ey~r
:r ...'".
LERK (Gov.CodQ Se.c.91Sa).Pr999ntatlon of a false claIm Is a felony (Pen.Code Sec.72.)
6-5
ITAII .A....
A
RBZ0006S
date:07-20-10
~"1~~"'~W~1;,':'i..~~~~~~K.~.~~_
STATE FARM GENERAL INSURANCE COMPANY
page:1
FIRE PAYMENTS BY COL/LN
_:.u;r'lnr.
"named insured
ROBERTS,CAROLE
COL L:n.37 001
C denotes consolidated payment
E denotes EFT payment
number
date of loss
05-27-10
0.00 ex ense:
~payee
___CAROLE ROBERTS
dOr rcov:
issued
06-10-10
0.00
status trans pay code
PAID D 1
6-6
State Fann General Insurance Company
ROBERTS.CAROLE
Insured:
Propeny:
Home:
Type of Loss:
Deductible:
Date of Loss:
Date Inspected:
Water Damage
$1.000.00
5/2712010
61312010
Estimate:
Claim Number:
Policy Number:
Price List:.
Summary for Dwelling
•RcstorationlServiceIRemodel
F =Factored In.0 =Do Not Apply
Line Item Total
Material Sales Tax 9.7509&"601.50
3.237.11
58.65
Subtotal •
General Contractor Overhead @ 10.09&;It 3.295.76
,'.<.leneral C,pntractor Profit @ 10.0%;It 3.295.76 .
''''=-;;;ment ~ost Value (ln~luding General Contractor Overhea\and Profit)·'
Less Deductible
Net Payment
Garcia.Eva
? •
ALL AMOUNTS PAYABLE ARE SUBJECT TO THE TERMS,CONDITIONS AND
LIMITS OF YOUR POLICY.
This estimate was prepared by Claim Representative Annette Rodriguez
Date:611012010 5:02 PM
3,295.76
329.58
329.58
3.954.92
(1.000.00)
$2.954.92
Page:2
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State Farm General Insurnnee Company
ROBERTS.CAROLE
General
DESCRIPl'ION
0.00 SF Walls ..'f.,
0.00 SF Floor",.
0.00 SF Long Wall
0.00 SF Ceiling
(0.00 SF Shon Wall
QUANTlTI'
.
PjOO SF \\i'is &Ceiling
6>.00 LF Floor Perimeler
11.00 LF Cell.Fierimeter
UNIT COST RCV
9.Haul debris.per pJckup truck load·including dump fees
10.Cleaning Technician·per bour
Totals:General
LOOEA
4.00HR
Main Level
117.]9
35.31 D
117.19
141.24
258.43
~n ~.:.r i••i:r-.~;6~..;;j
•¥
to.I ••I
I "•I.....,.....-...---t
......',•....-01 "'-_'--""-·-1 ......-",..____
t---ro'--'""'--.'''---4..-P-----I ,-,-t-'-I ._-_
Exterior or Back House
'177.17 SF Walls
],663.00 SF Walls &Ceiling
157.17 LF Ceil.Perimeter
Height:8'
685.83 SFCeillng
685.83 SF Floor
140.17 LF Floor Perimeter
Missing Wall:1·5'X4'Opens into Exterior .
Missing Wall:1·17'X 6'8"Opens into E:rderior
Missing WaUl 1·S'X4'Opens into Exterior
Missing Wall:1·5'X4'Opens into Exterror
Missing Wall:1·5'X4'Opens Into Exterior
Missing Wall:I·5'5 112"X4'Opens Inlo Exterior
Missing Wllh 1·5'5"X4'Opeus inlo Exterior
Missing WIll:1·5'5"X 4'Opens into Exterior
Missing WIll:1.5'5"X 4'Opens Into Exterior
DESCRIPTION QUANTITY
1.Seal &paint stucco 977.17 SF
2.Stucco Inslaller •per hour 4.00HR
3.R&R Metal lath &stucco·StandlU'd grade
:;.Mask and prep for paint -plastic,paper.tape (per LF)
6.R&R Post &:rail fence·Split cedar -3 rail
7.R&R Welded-wire mesh fence·4'high -12 gauge
Date:6110120105:02 PM
90.00 SF
157.17LF
20.00LF
30.00LF
Ooes to neither Floor/Ceiling
Ooes to Floor
Goes to neither Floor/Ceiling
Ooes to neither Floor/Ceiling
Ooes to neitber Floor/Ceiling
Goes to neither Floor/Ceiling
Goes to neither Floor/CeJling
Goes to neitber Floor/CeUing
Goes to neither Floor/CeiUng
UNIT COST RCV
0.87 850.14
47.29D ]89.16
4.46 401.40
0.87 136.74
15.82 316.40
10.22 306.60
Page:3
.--
6-8
ROBERTS,CAROLE
State Fann General Insurance Company
CONTINUED·Exterior of Back House
..
•
DESCRIPTION
8.R&R Wood gate 3'·4'high.treated
QUANTITY
1O.00LF
UNIT COST
36.08
Rev
360.80
Totals:Exterior of Back House
Area Totals:Main Level
977.17 SFWalls
685.83 SF Floor
685.83 P100r Area
1,158.33 Eltterior Wall Area
Total:Main Level
Line Item Subtotals:75·MS89·373
Adjustments ror Base Service Charges
Fencing Installer
Painter
Stucco Installer
Total Adjustments for Base Service Charges:
UN!ITEM TOTALS:.,•••••
Grand Total Areas:
977.17 SF Walls
685.83 SF Floor
__685,:83 .Floor "'-ceq,
1,158.33 Exterior Wall Area
Date:61 IOI2{)IO 5:02 PM
685.83 SF Ceiling
738.67 Total Area
159.83 Exterior Perimeter
of Walls
685.83 SF Ceiling
_738.67 Total Area.
159.83 Exterior Perimeter of
Walls
2,56l.24
1,663.00 SF Walls and Ceiling
140.17 LF Floor Perimeter
157.17 LF Ceil.Perimeter
977.17 Interior Wall Area
2,819.67
Adjustment
127.44
100.84
189.16
417.44
3.237.11
l.663.00 SF Walls and Ceiling
140.17 LP Floor Perimeter
157.17 LF Ceil.Perimeter
_977.17 [nterior WmJ heea
Page:4
------------------_._--------------------------
6-9
,Trade Summary
Includes all applicable Ta~.GOIIeral CunlraCtDr CAP.and Bll$C Service Charles
DESCRIPTION LlNEITEM REPL.COST ACV NON-REC.MAXADDL.
QNT\'TOTAL DEPREC.AMTAVAIL.
CLN CLEANING
Cleaning Technician -per hour 4.00HR $169.49 $169.49 $0.00 $0.00
TOTAL CLEANING $169.49 $169.49 $0.00 $0.00
DMO GENERAL DEMOLITION
Haul debris -per pickup truck load -LOOEA $140.63 $140.63 so.00 $0.00
including dump fees
TOTAL GENERAL DEMOLITION $140.63 $140.63 $0,00 $0.00
FEN FENCING
R&R Welded-wire mesh fence·4'high -30.00LF $427.70 $427.70 $0.00 $0.00
12 gauge
R&R Post &rail fence -Split cedar - 3 rail 20.ooLF $433.93 $433.93 $0.00 $0.00
R&R Wood gate 3'·4'high -treated IO.OOLF $509.71 $509.71 $0.00 $0.00
TOTAL FENCING $1,371.34 $1,371.34 $0.00 $0.00
LAB LABOR ONLY
Stucco Installer -per hour 4.00HR 5305.63 5305.63 SO.OO $0.00
TOTAL LABOR ONLY $305.63 $305.63 $0.00 $0.00
PNT PAINTING
Mask and prep for paint·plastic.paper.157.17LF $185.10 $185.10 $0.00 $0.00
tape (per LF)
Seal &paint stucco 977.17 SF $1.142.69 $1,142.69 $0.00 $0.00
TOTAL PAINTING $1,327.79 $1,327.79 $0.00 $0.00
STU STUCCO &EXTERIOR PLASTER
R&R Metal lath &stucco -Standard grade 90.00 SF $640.04 $640.04 $0.00 $9.00
TOTAL STUCCO &EXTERIOR PLASTER $640.04 $640.04 $0.00 $0.00
TOTALS $3,954.91 $3t9S4.9Z $0.00 $0.00
Note:Slight variances may be found within report seciions due to rounding
Date:MOnOIO 5:02 PM Page:5
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