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10 CLAIM 08-45 HAVLICEK 02-03-09
AGENDA REPORT MEETING DATE: FEBRUARY 3, 2009 Agenda Item 10 Reviewed: City Manager Finance Director N~o TO: WILLIAM A. HUSTON, CITY MANAGER FROM: KRISTI RECCHIA, DIRECTOR OF HUMAN RESOURCES SUBJECT: CONSIDERATION OF CLAIM OF STEVE HAVLICEK, CLAIM NO. 08-45 SUMMARY: The Claimant reported damage to his vehicle while it was parked at the City Yard as a result of being bumped by a blower or hedge trimmer, operated by SpectrumCare Landscape & Irrigation Management, Inc. RECOMMENDATION: That the City Council deny Claim Number 08-45, Steve Havlicek, and direct Staff to send notice thereof to the Claimant. FISCAL IMPACT: None. DISCUSSION: The City's Claims Administrator has found no fault attributable to the City of Tustin in this incident. The claim has been tendered to SpectrumCare Landscape & Irrigation Management, Inc. as the responsibility party for the damages. The City's contract with SpectrumCare Landscape & Irrigation Management, Inc. names the City of Tustin as an additional insured on their General Liability Policy. ~~VU~ ~ ~~l-tij~- Kristi Recchia Director of Human Resources ATTACHMENT: Copy of Claim No. 08-45 i ~ ~ ~~- '~~ C~AMII`AGAINST THE CITY OF TUSTIN ~ ~ (For Damages to Person or Personal Property) Received Via: ^ U.S. Mail ^~Inter-Office Mail [[~~ Over the Counter CIT~( Gtr= TU;~T1~d Time Stamp: 1^~~ t'?V 12 A 10~ 51 Claim No: ~g~ S PLEASE NOTE: A. Read entire claim before filing. B. Be sure your claim is against the Citv of Tustin, not another public entity. C. Claims for death, injury to person or to personal property must be filed no later than 6 months after the occurrence (Government Code § 911.2). D. Claims for damages to real property must be filed no later than one year after the occurrence (Government Code § 911.2). E. If additional space is needed to provide your information, please attach sheets, identifying the paragraph(s) being answered. F. A claim must be presented, as prescribed by the Government Code of the State of California, by the claimant or a person acting on his/her behalf and shall provide the information shown below and must be signed by the claimant or a person on his behalf (Government Code § 910.2). ~ , G. This form is for the convenience of those desiring to present claims against the city. Claimant is advised to consult a private attorney if legal advice is desired. No employee of the City may give legal advice to any claimant relating to private claims. H. Completed claims must be mailed or delivered to the City of Tustin, City Clerk's Office, 300 Centennial Way, Tustin, California 92780. 1. Name and Post Office address of the Claimant: Name of Claimant: ~j'r1EV ~ ~~~VLTGEK. Home Address: Home Telephone: Work Telephone: ~ 2. Post Office address to which the person presenting the claim desires notices to be sent: (If different from above) Name of Addressee: Telephone: Post Office Address: 3. The date, place and other circumstances of tqe occurrence or transaction from which the claim arises. Date of Occurrence: ~0 -Z7- d g Time of Occurrence: 12:0 Pm Location: i~~Z SEt~vZtf~ lZoµp, ~QRKs-~-6 I..o't" Circumstances giving rise to this claim: my TRH wAs PA~cEO ~ T~ PA~1~-~G 1.oT wK~2E E-u~~yB•oy 4 17A~t~S. Z w ~S_ ~7~~ac~s G nn~ L.u isC.b+ w t-f; ~ _ ~.saT~cGp Tfi~4rT ~`~GT~v~ ouf~ coNTRptc-rEV +-N~~srotPl:R~S' w~i~€ f3co~f 7~ A4~r~vt t.~7- c~-t~ BAc,(c PAc.~- t3t,aw ~ AKD ~6rL~ 7+t~rncni~, ?t`f~ I~i~G toT- C•~6tr5 Ca!-t~L~/ ~7!L~..~ ~juH1PE0 =T WLTl3 TNEIZ~ i4T Tl+~ B~o+.~F~ f~F~6~T' General description of the indebtedness, obligation, injury, damage or loss incurred so far as you now know. u~N~ 2 cArh>; ovr -~ MY -~ >~~N~ ~'p~ _ ~~~ ~ safir~q~c. 512,E DEn~T ©N TMI~ Dk3i~F.~S SsO~ , jA5~4rY,F~ RaoJ~ ~"N 13~~~i/ 7"~iE Daol~ ~iR~D+_€ Ar~D ~~ d,EO aF 7~' T~~-C-~~ ~T wA5 NAT T~lff~ fN Z ~ rr. ern r~sTrrv~ r~r' oN>` o~ S-~I~~S £,>"~ r~s /'lt~ ON ~b~~ON1`S ~l~'C.{Gi i/ ~:. T~a or~i>~of the public employee or employees causing the injury, damage, or loss, if known. Sim-T~~ r''~ t p~r~~c,~P~ V If amount claimed totals less than $10,000: Provide the amount claimed if it totals less than ten thousand dollars ($10,000) as of the date of your claim, including the estimated amount of any related potential future injury, damage, or loss, insofar as it may be known as of the date of your claim, together with the basis of computation of the amount claimed (include copies of all bills, invoices, estimates, etc.) Amount Claimed and basis for computation: If amount claimed exceeds $10,000: If the amount claimed exceeds ten thousand dollars ($10,000), do not provide a dollar amount in the claim. However, your claim must indicate whether it would be a limited civil case. A limited civil case is one where the recovery sought, exclusive of attorney fees, interest and court costs, does not exceed $25,000. An unlimited civil case is one in which the recovery sought is more than $25,000. (See CCP § 86.) ^ Limited Civil Case ^ Unlimited Civil Case You are required to provide the information requested above in order to comply with Government Code §910. Additionally, in order to conduct a timely investigation and possible resolution of your claim, the City of Tustin requests that you answer the following questions. 7. Name, address and telephone number of any witnesses to the occurrence or transaction from which the claim arises: ~_ }~T cP-~x~~~ y ~ ~e~l 8. If the claim involves medical treatment for a claimed injury, please provide the name, address and telephone number of any doctors or hospitals providing treatment: If applicable, please attach any medical bills or reports or similar documents supporting your claim. 9. If the claim relates to an automobile accident: Claimant(s) Auto Ins. Co.: S1ffT~ f~~ Telephone: 7/y ~q ~ ~~~ Address: qOD old ~i~elz mad , fir-~~~D G~L 331 1 _ d©o l Insurance Policy No.: Insurance Broker/Agent: 'f?yRtJ $->~~NS Telephone:"/~f G1G~ ~L(g~ Address: Claimant's Veh. Lic. No.: Vehicle Make/Year: ~~ f ZSo Loos"' Claimant's Drivers Lic. No.: ' -+ Expiration: ~~~ - ~ Z. If applicable, please attach any repair bills, estimates or similar documents supporting your claim. Page 2 of 4 READ CAREFULLY ~ ~ ,~~ ~ For all accident claims, place on following diagram name of City/Agency Vehicle; location of City/Agency vehicle at time of streets, including North, East, South, and West; indicate place of accident by "A-1" and location of yourself or your vehicle at the accident by "X" and by showing house numbers or distances to time of the accident by "B-1"and the point of impact by "X." street corners. If City/Agency Vehicle was involved, designate by letter "A" location of City/Agency Vehicle when you first saw it, NOTE: If diagrams below do not fit the situation, attach hereto a and by "B" location of yourself or your vehicle when you first saw proper diagram signed by claimant. `'~r Vv SIDEWALK CURB -~ Pte''(' f PARKWAY ~~~~~1_~~~1~1~1~1~1~1-~1~ ~`i'hy ~'IZ,x.~ WAS gAC.KiED sN i, ~ ~~=~t~ ~~~+~ ~ ny rrWtac ~_~'~ ~l Warning: Presentation of a false claim is a felony (Penal Code §72). Pursuant to CCP §1038, the ity/Agency may seek to recover all costs of defense in the event an action is filed which is later determined not to have been brought in good faith and with reasonable cause. Signature: Date: ~ ~ - ~ ~ d Page 3 of 4 CURB -7, ~~ '~'~ '~' ' ~ ~'' ~ IF LA IM: COMPLETE ITEMS 1- 9 AND THIS APPLICATION. ~ _ ~' ~ SIGN BOTH FORMS. ",~ r3 APPLICATION FOR LEAVE TO PRESENT A LATE CLAIM TO THE CITY OF TUSTIN The undersigned hereby applies for leave to present a late claim to the City of Tustin. This application is being made within a reasonable time, not exceeding one (1) year, after the accrual of the cause of action. Under some circumstances, leave to present a late claim will be granted (Government Code § 911.6). The reason for delay in presenting the claim is: ~ ~ IE~ L T I-F A~T N~P~= o~ C~ ShE~Twm G L. E r~ ~ ~4N ~ '1' 21~~ t3 ~ ry~E S RNu TREE s w 1-}=~£ tH~€ DHIZ~=NG LaT = S loo a\° ~u c,c,. ZS p~-r-t'`J~ ~~~, TI~~Y A~~ J~-~ST GUJ~'fza4NT~~ To Sc.~-ATGN~ 0~2 D~'T ~ e,~L2- o ~ T~~, ~T w av ~p ~}LM.a~T ~~ ZM.Pbs~l3t,£ /IJbT" 7~ G~n~c1~ ~ CaN?~ (.~~TH~ Soir-ti~`rf~,~yv 1T taovt.O ~~ ~ GooQ =~>~ Ta t,~T ~'j,I~S~ L~4+N6JSG~4~R-S w y-~}p„ r GL~EA~x7t.~ p~D 'T>~-~Mr-,.z~rG w~wLf~ B~ ~t.c3r ~f~S'zE2 wH~y -(H'~ PkR-ins G ~ a7 .~-S F~'-~ P'T}~ ~ ~ 'j/Y'~ / C oNT2N u To Wad wb~, ~ ~K~ c,oT .1-S w L ~ , TitiEi~€ Ws~ c.. l3~ /'1~0~ COr'IPLIa~, l1-~0~ Date Revised 12/2004 Si ure of Clai t Page 4 of 4 11/11/2.008 at 11:02 AM Job Number: 70951 .~ rt- ~+, "' r; ~; BO CRAFT COLLISION CENTER OF TUSTIN • Federal ID #:330899425 '~ FED.# 330899425 EPA.# 000191806 BAR.# AJ212767 28 Auto Center Drive Tustin, CA 92782 (714)368-3390 Fax: (714)368-3403 PRELIMINARY ESTIMATE Written By: JUAN ALBA Adjuster: Insured: STEVE HAULICEK Claim # Owner: STEVE HAULICEK Policy # Address: Deductible: Date of Loss: Day: Type of Loss: Point of Impact: 8. Left Qtr Post Inspect BODYCRAFT COLLISION CENTER OF TU Business: (714)368-3390 Location: 28 Auto Center Drive Tustin, CA 92782 Insurance Company: Days to Repair 2005 FORD F250 4X4 CREW CAB 10-6.8L-F 4D SHORT GRAY Int: VIN: Lic: CA Prod Date: 02/2005 Odometer: Intermitte nt Wip ers Dual Mirrors Clear Coat Paint Power Stee ring Power Brakes AM Radio FM Radio Stereo Search/Seek Anti-Lock Brakes (4) Driver Air Bag Passenger Air Bag 4 Wheel Di sc Bra kes Cloth Seats Rear Step Bumper Trailering Package 6 Speed Transmission 4 Wheel Drive Overdrive ---------- ------ ---- Styled Steel Wheels -------- NO. ---------- OP. ------ ---- -------------------- DESCRIPTION ------------------- ------------------------------- QTY EXT. PRICE LABOR PAINT 1 --------- REAR BUMPER ------------------------------- 2 R&I R&I bumper assy 1.0 3 REAR LAMPS 4 R&I LT Tail lamp assy 0.3 5 PICK UP BOX 6 Blnd LT Side panel 6 3/4 foot bed 1.5 sin gle wheel 7 R&I LT Splash shield single rear 0.3 whe el front 8 R&I LT Splash shield single rear 0.3 whe el rear 9* R&I LT Upper molding 6 3/4 foot 0.6 bed black 10# R&I Bed liner 0.5 11 Repl Set back box assy 1 1.5 1 (. 11/1'1/2008 at 11 _;,.02 AM Job Number • 70951 "~ ~ i : ,,,it., PRELIMINARY ESTIMATE `~0 ~5 FORD F250 4X4 CREW CAB 10-6.8L-F 4D SHORT GRAY Int: ------- NO. ------- --------- OP. --------- -------------------------------- DESCRIPTION ----------------- ----------------------- QTY EXT. PRICE LABOR -------- PAINT 12 --------------- REAR DOOR ----- --------- --------- -------- 13 Blnd LT Outer panel 1.2 14* R&I LT Belt w'strip 0.3 15* R&I LT Body side mldg from 0.3 12/23/02 dark gray 16# Clean and retape molding 1 2.00 0.5 17# Remove molding adhesive 1 0.4 residue 18 R&I LT Handle, outside shadow gray 0.4 19 R&I LT R&I trim panel 0.5 20 CAB 21 R&I LT Weatherstrip 0.5 22* Rpr LT Corner panel 7.0 1.2 23 Add for Clear Coat 0.5 24* R&I LT Roof molding paint to match 0.2 25 R&I LT Center plr trim pebble 0.7 26# Color Tint 1 0.5 27# Rpr Feather, Fill, Sand & Block 1.0 28# Mask Vehicle for Primer 1 10.00 T 0.3 29# Mask Vehicle Exterior for 1 10.00 T 0.3 Refinish 30# Color Sand & Polish 1 1.5 31# ------- --------- Hazardous Waste Disposal ----------------------- 1 6.00 X --------- Subtotals =_> ----- --------- 28.00 --------- 18.9 -------- 4.4 Parts 2.00 Body Labor 18.9 hrs @ $ 44.00/hr 831.60 Paint Labor 4.4 hrs @ $ 44.00/hr 193.60 Paint Supplies 4.4 hrs @ $ 34.00/hr 149.60 Sublet/Misc. --------------------- ---- 26.00 SUBTOTAL - --------- --------- $ -------- 1202.80 Sales Tax $ 171.60 @ 7.75000 13.30 GRAND TOTAL $ 1216.10 2