RPVCCA_SR_2010_01_19_04_Claim_CiottiCITY OF
MEMORANDUM
RANCHO PALOS VERDES
TO:HONORABLE MAYOR &CITY COUNCIL MEMBERS
FROM:GARY GYVES,SENIOR ADMINISTRATIVE ANALYST /JA-
DATE:JANUARY 19,2010
SUBJECT:CLAIM AGAINST THE CITY BY TAMMI CIOTTI
REVIEWED:CAROLYN LEHR,CITY MANAGER ~
RECOMMENDATION
Reject the claim and direct staff to notify the claimant.
BACKGROUND
The claimant allegedly damaged her vehicle while driving through a construction zone on
Hawthorne Boulevard.The alleged incident occurred on January 7,2010 and the claim was
filed on January 8,2010.
The City's Claims Administrator,Carl Warren and Company,has reviewed the-claim and
advised the City to reject the claim.
Attachment:
1)Claim
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"City 1LERKioFRCE CLAIM FOR UAMA\it:~
30940 HawthQrne Blvd..TO PERSON OR PROPERTY
Bancbo PalOIiJ lTeirdes,CA 90275
tl~cnvc:run r1Lo11'\OlI gl.....~l.-
CLAiM NO•.RfY 10 ''';''0 L
INSTRUCTIONS
1.Claims for death,Injury to person or to personal property must be flied not later than six
months afterth"occurrence.(Gov.Code Sec.911.2.)
2.Claims for damages to real property must be flied not later than 1 year after the occurrence.
(Gov.Code Sec.911.2.).
3.Read enUre claim form before filing.
4.See page 2for diagram upon which to locate place of accident.
S.This claim form must be signed on page 2 at bottom.
8.Attach separate aheets.if n~essary.to give full detal~SIGN EACH SHEer.
0:CITY OF Rangho Palos Verdes ..08
RECEIVED
CITY OF RANCHO PALOS VERQES
JAN 08 2010
CITY CLERK'S OFFICE
:I :•III.:It;t
lusln~ss Address of Claimant \l City and State::s Gto Yn.-'t':-~I
dState:,,:,:
---.~--..,---
lame of Clalmant....,-,
I tlml'Y\'
lome Address 0
~Ive address and telephone number to which you desire notices or communications to be sent
egardln this claim:
Nhen did DAMAGE or INJURY occur?Names of any city employees Involved In INJURY or DAMAGE
Jate /'7 ·/b Time 9:It"AJ\1,
If claim is for equitable Indemnity,give date claimant 'Served
Nlth the complaint:
Jate '
Nhere did DAMAGE or,INJURY occur?'Describe 'fully,and locate on diagram on reverse side of this sheet.Where appropriate,give street
lames and address and measurements from landmarks:1he pe~'-e.s CtlIwu..fh.n,n ~~W~~
£Or 1Ae...cr~<it\..l{~bV'M bL va.vJ~It..~C!-ov'>bfnA.-<.:ih::<.vn.IS b.e ~~I V.
See d'o.q'r"'Ut--1),.
Describe in detail each INJURY or DAMAQF
1h.t-'vJtnJs~ll>nolAl b~"h ..
SEE PAGE 2 (OVER)THIS 'CLAIM MUST BE SIGNED ON REVERSE SIDE
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..
GIIIUUII~\iIGIllIVU,Clill '",,,........_VI ....••_••_••_•••
,ages incurred to ~ate (exact).:.'.•
I rty':.',$Illt)61-amage to prope ,;'............ ..•.....J.:J~-
;xpenses for medical and hospital care $DolY
oss of earnings •.•.••.•••..••.:••••••••••••$ntSt\&
1peclal damages for ,$l\.6YY===
lsneral damages •.'••..•••••••••••.•••••••••$._
Total damages Incurred to date ••••.•••••:.•.$,_
II amount claimed as of date of presentation of this cJalm:
estimated prospeetlve damages as tar as Known;
Future expenses for medical and hospital c8re $--_.....,
Future loss of earnings •••:$----
Other prospective special damages •.••.•••••••$ _
Prospective general damages •.••.•••.•.•••.•.$ _
Total estimate prospective damages ••••••••~~$ _
$/4110-
s damage andlorlnJury I~vestlgated by police?Q()If8o,.whatcltY?_..;...._
re paramedics or ambulance called?.If 80,name city or ambulance'_
~ured,state date.time,name and'addres",of doctor of your first vislt --:-_
rNESSES to DAMAGE or INJU1BY:Ust all persons and addresses of persons known to have Information:
me ~Address PhonemeL7,r Address ....''Phone _
me .fl.z:~.:Address·Phone _
)croRS and HOSPITALS:
ISpital ~7!~-+-I'------AcIdress Date Hospitalized
lclar 7/-d--Address Date of 1teatment _IctdrJ~~Address Date of Treatment _
READ CAREFULLY
For all accident claims place on following diagram names of streelS.or your vehicle when you first saw City vehicle;locaUon of City vehicle
::Iuding North,East,South,and Westj Indicate place of accident by at time of accident by '~1"and location of yourself or your vehicle'at
e"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 Vehicle was Involved,designate by letter ''Au loCation of City NOTE:If diagrams below do not fit the situation,attach hereto a p'roper
.hlele when you first saw It,and by "B"location of yourself diagram signed by claimant.
-p 1~~l
SIDEWALK ~
CURB ~r\~~YV\..L
PARKWAY
SIDEWALK
...
Date:Typed Name:
's 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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