CC SR 20190917 L - Claim against the City NiksefatRANCHO PALOS VERDES CITY COUNCIL MEETING DATE: 09/17/2019
AGENDA REPORT AGENDA HEADING: Consent Calendar
AGENDA DESCRIPTION:
Consideration and possible action regarding a claim against the City by Betsy Niksefat
RECOMMENDED COUNCIL ACTION:
1) Reject the claim and direct Staff to notify the claimant.
FISCAL IMPACT: None
Amount Budgeted: N/A
Additional Appropriation: N/A
Account Number(s): N/A
ORIGINATED BY: Emily Colborn, City Clerk
REVIEWED BY: Gabriella Yap, Deputy City Manager
APPROVED BY: Doug Willmore, City Manager
ATTACHED SUPPORTING DOCUMENTS:
A. Betsy Niksefat claim (page A-1)
BACKGROUND AND DISCUSSION:
The claimant alleges that she sustained damage to her vehicle after driving over a
pothole on Palos Verdes Drive South between Peppertree and Narcissa on July 29,
2018. Ms. Niksefat submitted her claim on January 3, 2019.
The City’s Claims Administrator, Carl Warren and Company, has reviewed the claim
and advised the City to reject it due to the determination that there was no previous
report of a pothole and as this roadway is known for frequent land movement with
appropriate warning signs posted.
1
FILE WITH:
CITY CLERK'S OFFICE
City of Rancho Palos Verdes
30940 Hawthorne Blvd.
Rancho Palos Verdes, CA 90275
CLAIM FOR DAMAGES
TO PERSON OR PROPERTY
'1. Claims for death, injury to person or to personal property must be filed not
later than six months after the occummce. (Gov. Code Sec. 911.:2.)
2. Claims tor 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. TliiS CLAIM FORM MUST BE SIGNED ON PAGE 2 AT BOTTOM.
e. Attach separate sheets, if necessary, to give full details. SIGN EACH SHEET.
A-
RESERVE FOR FILING STAMP
CLAIM NO. '2.01 'f -0 J
KC:t.;t:iVclJ
,]'fY OF RANCHO PALOS VERDE
JAN 0 0 2019
r'!TY CLERK'S OFFIC
N}A.
Claimant's Social Security No .
. When did DAMA or INJURY occur?
Date . Time 3 : 1 0 f \'VI
Names of any city employees involved in
if claim i for Equitable Indemnity, give date
claimant served with the complaint: N f fr
Date
Where did DAMAGE or RY occur? Describe fully, and locate on diagram on Page 2. Where appropriate, give
street names and address and measurements from landmarks:
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The amount claimed, as of the date of presentation of this claim, is computed as follows:
Damages incurred to date (exact): H t>-/' 91~ 2 Estimated prospective dam~ges as far as. known:
Damage to property .................... $":[ IL~· 7 Future expenses for medical and hosp1tal care.$ ___ _
Expenses for medical and hospital care ... $ Future loss of earnings ..................... $ ___ _
Loss of earnings ...................... $______ Other prospective special damages .......... $ ___ _
Special damages for ................... $--·---······· Prospective general damages ............... $ ___ _
Total estimate prospective damages ....... $. ___ _
Was damage and/or injury investigated by policn? N ° If so, what city? _____________ ......
Were paramedics or ambulance called?__J!_I} __ If so, name city or ambulance_
If injured, state date, time, name and address of doctor of your first visit------·
WITNESSES to DAMAGE or INJURY: List all persons and addresses of persons known to have information:
Name NQV\~ . _________ ., _____ Address. ____ .. ___ __Phone ________ _
Name Addmss ____ .. ___ ..................... _. __________ ........................... Ph one
Name Address ___________ .. ___ ..... ---------___ .. _____ ..Phone
----______ ., ____________ _
DOCTORS and HOSPITALS:
Hospital Y\ 11. V\ ,e_ ..... ___________ Address .... _____ _ __ Date Hospitaliznd ______ _
Doctor __________ , .. _ .. ____ Address_ .. -.............. --.. ----------.. Date 'of Treatment-------
Doctor ________ Address ___ .. _________ .......................... _,__________ Date of Treatmnnt
READ CAREFULLY
For all accident claims place on following diagram names
of streets, including North, East, South, and West; indicate
place of accident by "X" and by showing house numbers
or distances to street corners. If City Vehicle was
involved, designate by letter "A" location of City Vehicle
when you first saw it, and by "B" location of yourself or
your vehicle when you first saw City vehicle; location of
City vehicle at time of accident by "A-1" and location of
yourself or your vnhicle at the time of the accident by
"8-1" and thn point of impact by "X." NOTE: If diagrams
below do not fit the situation, attach hereto a proper
diagram signed by the claimant.
-------------------·-·· ... ·-.. ------..... -.... -.... --..... _, ___ ., .. ___________ .... --~---
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CURBJ
CURBw
JO{\fl!\WAY
SIDEWALl\
Signature of Claimant or person fi!in
his behalf
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A-2