RPVCCA_SR_2010_03_16_04_Claim_Randall_FleeceCITY OF
MEMORANDUM
RANCHO PALOS VERDES
TO:
FROM:
DATE:
SUBJECT:
REVIEWED:
HONORABLE MAYOR &CITY COUNCIL MEMBERS
GARY GYVES,SENIOR ADMINISTRATIVE ANALYST J\~
MARCH 16,2010
CLAIM AGAINST THE CITY BY RANDALL FLEECE
CAROLYN LEHR,CITY MANAGER C!9--
RECOMMENDATION
Reject the claim and direct staff to notify the claimant.
BACKGROUND
A tree branch fell on the claimant's fence during a recent storm.The incident allegedly
occurred on January 20,2010 and the claim was filed on February 3,2010.
The City's Claims Administrator,Carl Warren and Company,has reviewed the claim and
advised the City to reject the claim.
Attachment:
1)Claim
4 - 1
..''.~RKJS OFFICE
RESERVE FOR RUNG STAMP
C~M NO.fZ..Vtl II)~'()3
CItY CLERK10mCE CLAIM FUR UAMAGI:5
30~40 Hawthorne Blvd..0 SON OR PRO RTY
Rancho Palos llGrdes,CA 90275 1i PER PE
.'INSTRUCfIONS
1.Claims for death,injury to person or to personal property must be filed nollater than six
months after the ClCCurrence.(Gov.Code Sec.911.2.)
2.Claims for damages to real pioperty must be filed nollaler than 1 year after the occurrence.
(Gov.Code Sec.911.2.). .
3.Read entInJ claim form berore mlng.
4.See page 2for dfagram upon which to locate place of aCcident.
S.this Claim fOrm must be sIgned on page 2 at bottom.
&.Attach separale sheets.If necessary,to give iuD details.SIGN EACH SHEET.
,5'0
(JJ.f
~
Gt~
RECEIVED ((
CITY OF RANCHO PALOS VERDE,
FEB .03 2010
"
-
TO:CITY OF Rancho Palos verde,s
HomeAddr~====;;;;;;;;;;;:::;...-_,-:IFl_!P_V_C_l~_an_d~Sta_te -f-~
Busln~ss Address of C1a1manl City and State
alve address and lelephone number to which you desire notices or communications to be sent
regarding lhls dal~:S;4J-P1c:_.
When d!~AGEor INJURY occur?
Date 'L;7..!!JL!>Time 4l1ll~N
If claim Is for equitable Indemnity,give date claimant .rved •
with the complaint:
Dale '
Nhere did DAMAGE or INJURY occur?Deacrlb.ofully,and locale on diagram on reverse side of this sheeL Where appropriate,give street
1ames and address andmeasuremen~from landm~I?PV G-1 ~O;;,?S-
Jescrlbe In detaU how the DAMAGE or INJUR¥occurred.
WfNrl?-"J{N S~c.+«.J).Q...O Y'7t2-cl!:f-()Ctt-fe.o ~SldD,uNle-l=1t S~~t
~.81'~~~,.t!hv.o F~I!:)N ~FeNce ~eA4e.,o /IJr ~;PA.lJS!'~
,,
,
Yhy do you claim the city is responsible?
.:x.04u€AO I'CI.~L.ta (".(.,,~c...r oN /!:,S~CJ /M.()r.Jif;;J S4-/'c t.o
C¢wJ ~IN;f-No r'c.C-ou.;f CL4-t''Yf ~.77f;tI-i'""""()~~~l:
~-to /f.,t:J.t)~YJ'~p e-L~~()..eCJ4:{S ..
)escribe In detail each INJURY or DAMAGE.
~c.e-B~s ~·8"f'6~1 ~r~c;..~~:7l:~"...'\,)
Fe-v c:.e -~c..e S~~~(S /11~~~-.<:{q~•.::r:y.I ~·SWI'::!:1/~(J:..
~.+tV!>~W~/~1"'17:9~,;of-M-CI-;'N(J..()0-e.,,4.C;tk.t S"i'Vc;.IA/...:rc<-~.
3E'EPAGE 2 (OYER)THIS 'CLAIM MUST BE SIGNED ON REVERSE SIDE
4 - 2
images Incurred to .date (exact):
Damage to properly .•...••.•..••......••..••$_
expenses for medical and hospital care .•••.••••.$........
Loss of earnings •.•••.•••••.•••;••••••••••••$ _
Special damages for $,_
Grneral damages •••••••••••••••••••••••••••$,_
1blat damages Incurred to date ••••••••••~•••$,_
tal amount claimed as of date of presentation of this claim:$
Estimated prospecUve damages as far as known:-.Future expenses for medical and hospital care ••••$ _
Future loss of earnings •••~•••••••••••••••••.•$ _
Other prospective special damages •••.••••••••$ _
Pl'Ospeptive general damages ••••••••.••••••••$.:ft!!!'c!
1btal estimate prospectlve damages ••••.••.••$,_
as damage andlor InJury Investigated by police?If sO,.what cltY?-..:.-_---:_
Bre paramedics or ambulance called?If 10,name city or ambulanc8 _
rljured.state date,time.name and address of dOClor of your first vislt,_
ITNES§ES to DAMAGE or INJURY:Ust all persons and addresses of persons known to have Information:
Ime 1::!!::144c..Wi!>t2.!=-rS Address ~Phonec---_
Ime Address Phone _
sme Address·Phone _
>
JCIORS and HOSPITALS:3spltal Address,Dale H08pltallzed _
:»ctor Address Dale of lteatment _
,ctdr AddresI Date of lteatment _
READ CAREFULLY
For all accident claims place on following diagram names of streets,or your vehicle When you first law City vehlclei location of City vehicle
=Iudlng North.East,South,and west;indicate place of accident by at time of accident by 'Y\-1 1t and location of Yourself or your vehlcle'at
:"and by showing house numbers or distances to street comers.the time of the accident by "B-1"and the point of Impact by "X"
If City Vehicle was Involved.designate by leUer 'W'loedon of City NOTE:If diagrams below do not fit the situation,attach hereto a p~oper
Ihlele when you first saw It,and by liB"location of yourself diagram signed by claimant.
Date:Typed Name:
R ¥fJAt-t.,.l::...;::t....Eis:t::'JS.
---
SIDEWALK
PARKWAY
~.~.a"""~~••~..
SIDEWALK
CURB
~nature of Claimant or person fUing on
I behalf glvl
)TE:CLAIMS MOST BE FILED WITH CITY CLERK (Gov.Code Sec.915a).Presentation of a false claim Is a felony (Pen.Code Sec.72.)
4 - 3