HomeMy WebLinkAbout08 CLAIM 09-09, CICY SHEN/AAA 07-21-09Agenda Item - $
• Reviewed:
" AGENDA REPORT City Manager
.,
Finance Director N/A
MEETING DATE: JULY 21, 2009
TO: WILLIAM A. HUSTON, CITY MANAGER
FROM: KRISTI RECCHIA, DIRECTOR OF HUMAN RESOURCES
SUBJECT: CONSIDERATION OF CLAIM OF CICY SHEN/AUTOMOBILE CLUB OF SOUTHERN
CALIFORNIA, CLAIM NO. 09-09
SUMMARY:
The Claimant alleges that a City of Tustin police vehicle scraped the side of her car while passing
on a narrow street.
RECOMMENDATION:
That the City Council deny Claim Number 09-09, CiCy Shen/ Automobile Club of Southern
California, and direct Staff to send notice thereof to the Claimant.
FISCAL IMPACT:
None.
DISCUSSION:
The City's Claims Administrator, NovaPro, completed an investigation into this incident and
concluded that the City was liable for the damage sustained. The claim was filed by the
Automobile Club of Southern California (ACSC) on behalf of Ms. Shen. NovaPro has requested
documentation of the damages in order to resolve the claim, however, ACSC recently advised
that Ms. Shen has not taken her vehicle in for repairs and they have closed their subrogation
claim. Since the claimant has not repaired the damages sustained, staff recommends denial of
the claim.
Kristi Recchia
Director of Human Resources
ATTACHMENT: Copy of Claim No. 09-09
s:\general liability\claims\shen, cicy 09-09\shen, cicy -agenda report - gl claim denial 07.14.09.doc
CLAIM AGAINST THE CITY OF TUSTIN ,- . _ 1. ,,, .._ , , ,
(For Damages to Person or Personal Property) ~ ~ ' ' ! s
R eived Via:
U.S. Mail
^ inter-Office Mail
^ Over the Counter
T-rrtar,~ ~ I j ^ g' I b
Claim No: O 7 ' O
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
(Govemment Code § 911.2).
D. Claims for damages to real property must be filed no later Than one year after the occurrence (Govemment 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 Govemment Code of the State of Calffomia, by the daimant or a person
acting on hislher behalf and shall provide the information shown below and must be signed by the daimant or a person on
his behaff (Govemment 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 ff legal advice is desired. No employee of the City may give legal advice to any daimant relating to private claims.
H. Completed claims must be mailed or delivered to the City of Yustln, City Clerk's Office, 300 Centennial Way,_Tustin,
California 82780.
Name and Post Office address of the Claimant:
_Name of Claimant: ~ ~t ~ ~ ~1
Home Address:
2.
Name of Addressee: l ~t~A~~~~] ~~ .~_ 1~hi2Qn ~(A1~ Telephone: ~~~~~. ~~~~ X ~~"'~
Post Office Address:
Date of Occurrence: - Trme of Occurrence: ° r-r~
Location: ~`~ 'C~ ~,~(~~ '~~
Circumstances giving rise to this claim:
fin ~ V1C, ~~0 W Sir-~?+?~,~- C,vt cl Y ~,'~~~-} hP ~t f~.. --
4. General description of the indebtedness, obli anon, injury, damage or loss incurred so far as you now know.
f ~G rnC,Cte `~ ~~t t~~n ~ - 1~ 1~ ~.. ~ r~ ~ ~i~ s`~ r`~ _ hl -~-Ino ~,,1,~ ~n~ I u~, °- r~ 'r ~ v~n~l
Page 1 of 4
Post Office address to which the person presenting the claim desires notices to be sent:
(tf different from above)
The date, place and other circums#ances of the occurrence or transaction from which the claim arises.
5. The name or names of the public employee or employees causing the injury, damage, or loss, if known.
J ~ -
6. 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:
~-`~ ~'1(tP Irtc-~
ff 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 Civi{ 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.
Name, address and telephone number of any witnesses to the occurrence or transaction from which the claim
arises: ,
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.: ~~~ ~~. Telephone: y;Y~'~-~~.C~~` ~ ~~~
Address: ~~`~"-
-~(', ~~ ~~ ~ ~ V-Q ~~} Insurance Policy No.:
Insurance Broker//1~CCgent: ~ Telephone:
Address:
Claimant's Veh. Lic. No.: ~~ Vehicle MakelYear: "~L.-lU~
Claimant's Drivers Lic. No.: Expiration:
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
streets, including North, East, South, and West; indicate place of
accident by "X" and by showing house numbers or distances to
street comers. If City/Agency Vehicle was involved, designate by
letter "A" bcation of City/Agency Vehicle when you first saw it,
and by "B" location of yourself or your vehicle when you first saw
SIDEWALK
CURB ~
PARKWAY
SIDEWALK
City/Agency Vehicle; location of City/Agency vehicle at time of
accident by "A-1" and kxztion of yourself or your vehicle at the
time of the accident by "B-1"and the point of impact by "X."
NOTE: If diagrams below do not fit the situation, attach hereto a
proper diagram signed by claimant.
CURB -Z
Warning: Presentation of a false claim is a felony (Penal Code §72). Pursuant to CCP §1038, the City/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:
Page 3 of 4
~~
IF LATE CLAIM: COMPLETE ITEIb1S 1- 9 AND THIS APPLICATION.
SIGN BOTH FORMS.
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:
Date
Revised 12/2004
Signature of Claimant
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