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Home My WebLink About08 AGARWAL CLAIM 06-32 11-20-06 AGENDA REPORT Agenda Item Reviewed: City Manager Finance Director MEETING DATE: NOVEMBER 20, 2006 TO: WILLIAM A. HUSTON, CITY MANAGER FROM: RONALD A. NAULT, FINANCE DIRECTOR SUBJECT: CONSIDERATION OF CLAIM OF MERCURY INSURANCE AS SUBROGEE FOR ABHINAV AGARWAL, CLAIM NO. 06-32 SUMMARY: The Claimant reported that while traveling northbound on Browning Avenue at Irvine Blvd., their insured's vehicle dragged on the ground due to the higher road elevation across the intersection. The cost for labor and parts to repair the damages underneath the insured vehicle was $1,791.14. RECOMMENDATION: That the City Council deny Claim Number 06-32, Mercury Insurance for Abhinav Agarwal, and direct Staff to send notice thereof to the Claimant. FISCAL IMPACT: None. DISCUSSION: Staff and the City's Claims Administrator have determined that the area where the damage occurred to the Claimant/Insured's vehicle is in the jurisdiction of the County of Orange. The recommendation is to refer the Claimant to the County of Orange and to deny the claim at this time. Ron A. Nault Finance Director ATTACHMENT: Copy of Claim No. 06-32 ConsiderationOfC/aimOfMercurylnsurance06-32, doc --v--' ~..,~,~ "112. ~ 1"-:) ( ,.~,...,-...,,,,, l.~.. .. ~,.' '", ~ '().'1.,.! .~~!',., ~~_1', CLAIM AGAINST THE CITY OF TUS1.... (For Damages to Person or Personal Property) Received Via: ~U.S. Mail o Inter-Office Mail o Over the Counter Time'Stamo~uc'; ., "L I I i U r' I ...; I , 4 Z9J~i~02 Y' tt.- liJ:,-~-{) 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 9 911.2). D. Claims for damages to real property must be filed no later than one year after the occurrence (Government Code 9 911.2). 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 9 910.2). 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: Home Address: ?/Fe,...v- J1bh "OtJ!(" Ill! t;" / C...r:i/.+-r... ;:f,1o.A j" 1'-". I (,4 (/)---7 ) I ,'- 0'73,) Home Telephone: Work Telephone:"71 '--I- ..) c;c; 5'--'0 ) {',(J ..J- T , 2. Post Office address to which the person presenting the claim desires notices to be sent: (If different from above) Name of Addressee: Post Office Address: Telephone: 3. The date, place and other circumstances of the occurrence or transaction from which the claim arises. Time of Occurrence: J , I"' ) ,., tl/~}" ,,?/L VA\!J:{, In'itlL, l3)11/:{, ;<; III()}!C:>'~ LP {, I. r'h . !~{~-;,'})-l(~ij'l ,l/~'i-X_/')n ". . v I' , .. - , if -Iv. l n I",d . !/~p /1, l (~#- J;//'-C-'C f',tr! u.L :.( 1/, t lit &1. i (' I f j~ / '/7:;-(.d 'v) t},</ ! 0.:'0 f' d I/e' .".' V-th1.." t If. vcr-' I C~ 4. General description of the indebtedness, obligation, injury, damage or loss incurred so far as you now know. ~.ilP(l} (j /7~1(f: 'I~ a i J1A \if: I,;, L~. Page 1 of 4 5. The name or n~&es of the public employee or employees causing the injury, damage, or loss, if known. N/1 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: <g 11(.) F 't<'t:J 'Dr Y~' ~ It /'] (;// . I t.,! 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.) D Limited Civil Case o Unlimited Civil Case You are required to provide the information requested above in order to comply with Government Code ~91 O. Additionally, in order to conduct a timely investigation and possible resolution of your claim, the Cit of Tustin re uests that ou answer the followin uestions. 7. Name, address and telephone number of any witnesses to the occurrence or transaction from which the claim arises: MYf i ~ 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: N jJ If applicable, please attach any medical bills or reports or similar documents supporting your claim. 9. If the claim relates to an automobile accident: Telephone:7/' ,. ]5(; -[.> {;=)j (xl ;;."/7/ Insurance Policy No.:7f1 ,', r i~S 1...1.),__ '1 -; Insurance Broker/Agent: Address: Telephone: Claimant's Veh. Lic. No.: Claimant's Drivers Lic. No.: Vehicle Make/Year: ,.L.'I/ I Expiration: " . 'I t /!.J. ? ! '.."; ..'~:~.. . 1.~ ,.:.t...(:1(,...>.ft./ 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" location of City/Agency Vehicle when you first saw it, and by "B" location of yourself or your vehicle when you first saw City/Agency Vehicle; location of City/Agency vehicle at time of accident by "A-1" and location 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. 1'" \ , '(;;R\1 v;t ,,'I \p:., I\. 1'- &~ '.' ,", \ Y SIDEWALK CURB ---4' 11 I PARKWAY SIDEWALK CURB -" I Warning: Presentation of a false claim is a ~ to recover all costs of defense in the event faith and with reasonable cauge. 1// ~ I 7 Signature; ", LA ',>>, (Penal Code 972). Pursuant to CCP 91038, the City/Agency may seek .' ction is filed which is later determined not to have been brought in good -----. ,...../ Date: Page 3 of 4 Date: 10/11/2006 10:52 AM Estimate ID: Z0905542-9700101 Estimate Version: 1 Supplement: 1 (F) 10/11/2006 10:49:5, Profile ID: CUSTOMIZED ********************************************************************** NO SUPPLEMENTS WILL BE HONORED WITHOUT PRIOR INSPECTION OR APPROVAL ********************************************************************** ***************CALL FILE ADJUSTER TO CONFIRM COVERAGE**************** MERCURY INSURANCE COMPANY 555 W. IMPERIAL HWY., BREA, CA 92822 (714) 671-6700 Damage Assessed By: DAN LAM #2344 Adjustor: KRISTINE GRAJO (888) 263-7287 Supplemented By: DAN LAM #2344 CONTACT# 714 671 6700 x1078 FAX # 714 671 4645 Type of Loss: Date of Loss: Contact Date: Deductible: Policy No: Insured: Owner: Address: Telephone: Description: Body Style: VIN: Mileage: OEM/ALT: Color: Options: Line Entry Labor Item Number Type 1 201497 MCH 2 200454 MCH S1 3 900500 MCH* Collision 8/13/2006 8/28/2006 500.00 AP27370581 Claim Number: Z0905542-9700101 ABHINAV AGARWAL ABHINAV AGARWAL 13881 TUSTIN EAST DRIVE # 149, TUSTIN, CA 92780 Work Phone: (541) 221-1768 Home Phone: (714) 368-7418 Mitchell Service: 912287 2001 Mercedes-Benz SLK230 2D Cony WDBKK49F71F183833 66,416 o blue LEATHER SEATS, AUTOMATIC TRANSMISSION Vehicle Production Date: Drive Train: License: 4/00 2.3L Superchg Inj 4 Cyl 5A RWD 5PRF225 CA Search Code: BREA Operation REMOVE/REPLACE REMOVE/REPLACE REMOVE/REPLACE Line Item Description ENGINE OIL PAN -M ALTERNATOR -M CORE CHARGE FOR ALTERNATOR Labor Units 6.5* 2.0* 0.0* Part Type/ Part Number 111 010 10 13 009 1547602 New Dollar Amount 390.00 * 360.00 * 84.00 * * - Judgment Item This estimate has been re-calculated with a modified profile. ESTIMATE RECALL NUMBER: 8/28/200610:31:11 20905542-9700101 UltraMate is a Trademark of Mitchell International Mitchell Data Version: AUG_06_A Copyright (C) 1994 - 2005 Mitchell International UltraMate Version: 6.0.017 All Rights Reserved Page 1 of 2 Date: 10/11/2006 10:52 AM Estimate ID: Z0905542-9700101 Estimate Version: 1 Supplement: 1 (F) 10/11/200610:49:5 Profile ID: CUSTOMIZED 1. Labor Subtotals Mechanical Units Rate 8.5 105.00 Add'l Labor Amount 0.00 Sublet Amount 0.00 Totals 892.50 II. Part Replacement Summary Taxable Parts Sales Tax @ 7.750% Amount 834.00 64.64 Non-Taxable Labor 892.50 Labor Summary 8.5 Total Replacement Parts Amount 898.64 892.50 III. Additional Costs Total Additional Costs Amount 0.00 IV. Adjustments Insurance Deductible Amount 500.00- Customer Responsibility 500.00- I. II. III. Total Labor: Total Replacement Parts: Total Additional Costs: Gross Total: 892.50 898.64 0.00 1,791.14 IV. Total Adjustments: Net Total: Less Original Net Total: Net Supplement Amount: 500.00- 1,291.14 1,200.63 90.51 Sl: DAN LAM #2344 90.51 Insurance Co: Mercury Insurance Company Address: 555 W IMPERIAL HWY BREA, CA 92822 Work Phone: (714) 671-6700 Inspection Site: FLETCHER JONES COLLISION CENTER Address: 3300 JAMBOREE RD. NEWPORT BEACH, CA Inspection Date: 8/25/2006 Body Shop: FLETCHER JONES COLLISION CENTER Address: 3300 JAMBOREE RD. NEWPORT BEACH, CA 92660 Work Phone: (714) 833-9300 THIS IS NOT AN AUTHORIZATION TO REPAIR. THE UNDERSIGNED REPAIR FACILITY AGREES TO REPAIR THIS VEHICLE USING INDUSTRY ACCEPTED EQUIPMENT AND METHODS, AND TO COMPLETE AND GUARANTEE SAFE REPAIRS AT A PRICE OF $ , INCLUDING ALL CHARGES. NO SUPPLEMENTS WILL BE HONORED WITHOUT PRIOR APPROVAL. SIGNED: This estimate has been re-calculated with a modified profile. ESTIMATE RECALL NUMBER: 8/28/200610:31:11 Z0905542-9700101 UltraMate is a Trademark of Mitchell International Mitchell Data Version: AUG_06_A Copyright (C) 1994 - 2005 Mitchell International Ultra Mate Version: 6.0.017 All Rights Reserved Page 2 of 2