RPVCCA_CC_SR_2011_08_16_F_Claims_Against_The_City_Rochelle_KriegerCITY OF RANCHO PALOS VERDES
TO:
FROM:
DATE:
SUBJECT:
REVIEWED:
Staff coordinator:
HONORABLE MAYOR &CITY CO~L MEMBERS
CARLA MORREALE,CITY CLER~
AUGUST 16,2011
CLAIM AGAINST THE CITY BY ROCHELLE KRIEGER
CAROLYN LEHR,CITY MANAGER a9-
Teresa Takaoka,Deputy City Clerk(jA--'
,
RECOMMENDATION
Reject the claim and direct staff to notify the claimant.
BACKGROUND
The claimant alleges that a flickering street lamp caused her to fall and sustain injuries.
The alleged incident occurred on December 8,2010 and the claim was filed on May 9,
2011.The City does not own or maintain the street light.
The City's Claims Administrator,Carl Warren and Company,has reviewed the claim
and advised the City to reject the claim.
Attachment:
Claim
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~qeSERVE FOR FILING STAMP
(".CLAIJ\.W &0''-OS .
City ~=~FRCE (~LAIM FOR DAMAGES
30940 Hawthorne Blvd."'/TO PERSON OR PROPERTY
Rancho Palos Ve;rdes,CA 90275
INSTRUCfIONS
1.Clai~s for death.injury to person or to personal property must be flied 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.
.30,
pore
wL
RECEIVED'~
CITY OF RANCHO PALOS VERDES~
MAY 09 2011 ~
CITY CLERK'S OFFICe-
10:CITY OF Rancho Palos Verde,S
Name of Claimant
ROCHELLE I.KRIEGER
Occupation of Claimant
OFFICE MANAGER
Home Telephone NumberCityandState
RANCHO PALOS VERDES,CA 90275
Home Address of Claimant
Business Address of Claimant ~~~~~~~CJ!Y~t ~a~n~d7St~a::te-=::::-_-Jf~~~~~~=~:i:"-__"':'-'"....~is -.
-G-Ive-a""":d'":'"dress and telephone number to which you desire notices or communications to be sent Claimant's Social Security No.
regarding this claim:.
HOME lWDRES S
Names of any city employees involved in INJURY or DAMAGEWhendidDAMAGEorINJURYoccur?
Date 12/8/10 Time 10·45 pM
If claim is for Equitable Indemnity.give date claimant served
with the complaint:
~~:re did DAMAGE or INJURY occur?Describe·fully.and locate on diagram on reverse side of this sheet.Where appropriate.give street
names and address and measurements from landmarks:
SIDEWALK IN FRONT OF ••••••••••RPV,CA 90275
Describe in detail how the DAMAGE or INJURY occurred.
I PARKED THE CAR IN THE GARAGE,WENT TO GET THE MAIL OUT OF THE·MAIL BOX,SAW THE LIGHT
FROM ACROSS THE STREET FLICKER AGAIN,LOOKED UP TO SEE IT,FELL IN SIDEWALK,FLEW,HIT
MY FACE AGAINST A ROCK AND LANDED WITH MY FACE IN THE DRIVEWAY.
I BROKE MY FRONT TOOTH,GLASSES AND HAD BADLY SCRATCHED BY FACE AND HURT ,MY LIP.
I HAD PREVIOUSLY REPORTED THE FLICKERING LIGHT TO THE EDISON COMPANY TWO TIMES BEFORE
THIS ACCIDENT HAPPENED AND IT NEVER GOT FIXED UNTIL I GOT HURT AND REPORTED IN AGAIN.
Why do you claim the city is responsible?
I FELL IN THE SIDEWALK BECAUSE I LOOKED UP AT A FLICKERING STREET LIGHT THAT I HAD ALREADY
REPORTED FOR REPAIRS TWO TIMES.
Describe in detail each INJURY or DAMAGE
MY FACE HIT A LARGE ROCK WHEN I FELL.I THOUGHT MY NOSE WAS BROKEN.I WAS CUT.I WAS
BLEEDING.MY GLASSES FLEW OFF.THEY WERE BENT OUT OF SHAPE AND I LOST SOME OF THE
DECORATION ON THE GLASSES.MY FRONT TOOTH WAS CHIPPED BADLY.I CRIED,BUT WAS ABLE TO
GET UP.MY SHOES HAD FLOWN OFF,I SCRAPED MY CLOTHiNG AND WAS DRIPPING WITH BLOOD.MY
EYE HAD SOME GRAVEL IN IT FROM THE ROCK.IT DIDN'T COME OUT UNTIL THE NEXT DAY.
SEE PAGE 2 (OVER)THIS CLAIM MUST BE SIGNED ON REVERSE SIDE
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$
"eamount claimed,as of'the date of presentar on ot tnls Clatm,IS compUl80 U IU\lUVVl2.
amages incurred to dale(e~ct):..Estimated prospective dr',,\ges as far as known:
.>[)BlIlage to property .., ,....., ,..,.....'..., .Future expenses for medt\#at and hospital care •...$----
Expenses for medical and hospital care .'.,..',,-$464 Future loss of earnings •.,••.....•........., , .$,----
Loss of earnings,.., . ,.., , ,:.•.........,$Other prospective special damages ,..$ _
.Special damages for ,,.,,$Prospective general damages.,,..$ _
Total estimate prospective damages : '$ _
I HAVE A RETURN VISIT TO THE DENTIST SCHEDULE
BECAUSE TOOTH NEEDS FURTHER REPAIR COST????
I NEED _TO REPLACE MY GLASSES.COST'APRROX'$50
General damages ...,...•'.....,........•..•$ _
Total damages incurred to date .....••...:..,$:4"""'64.......__
bml amount claimed as of date of presentation of this claim:
Vas damage and/or Injury Investigated by pollee?NO If sO,what cltY?_..;....~!:___..:-_
Vere paramedics or ambulance called?Nn If so,name city or ambulance -,-._
f injured,state date,time,name and address of doctor of your first visit 12/9/10 11•30AM DR ROBERT JUITOBE
NITNESSES to DAMAGE or INJURY:Li,t ~ll persons and addresses of persons known to have infotmatlon:
\lame .Address ---:Phone _
\lame Address '\..,.Phdhe _
i\lame 1'.-;.Addl-ess·Phone _
..
DOCTORS and HOSPITALS:
Hospltal Address Date Hospltalized _
Doctor DR.ROBERT AUTORE Address 1350 W.7TH ST.SAN PEDRO,CA Date of Treatment 1219/10
Doctor DR.KEN MILLER ,Address 1360 W.6TH ST.SAN PEDR~M~~Date ofTreatment 12/9 /l 0
READ CAREFULLY
For all accident claims place on following diagram names of streets,or your vehicle when you first saw City vehicle;location of City vehicle
including North,East,South,and West;indicate place of accident by...at time of accident by "A·1"and location of yourself or your vehicle at
"X"and by showing house numbers 0'tlistarices to street corners.the time of the accident by "8-'"and the point of impact by "X:'
If City Vehicle was involved,designate by letter 'W'location of City NOTE:If diagrams below do not fit the situation,attach hereto a proper
Vehicle when you first saw it,and by "8"location of yourself diagram signed by claimant.
SIDEWALK
PARKWAY
SIDEWALK
Signature of Claimant or person filing on
his behalf giving relationship to Claimant:
Typed Name:
ROCHELLE I.KRIEGER
Date:
5/1/11
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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