HomeMy WebLinkAbout06 CLAIM OF DIANE HALE 12-04-06
AGENDA REPORT
Agenda Item
Reviewed:
City Manager
Finance Director
MEETING DATE: DECEMBER 4, 2006
TO: WILLIAM A. HUSTON, CITY MANAGER
FROM: RONALD A. NAULT, FINANCE DIRECTOR
SUBJECT: CONSIDERATION OF CLAIM OF LIBERTY MUTUAL AS SUBROGEE
FOR DIANE HALE, CLAIM NO. 06-31
SUMMARY:
The Claimant reported that while it was parked in front of 650 W. Main Street, their insured's
Hyundai Santa Fe was damaged by branches falling from a City tree. The cost to repair the
resulting dents and scratches on the vehicle was $788.48,
RECOMMENDATION:
That the City Council deny Claim Number 06-31, Liberty Mutual for Diane Hale, and direct Staff to
send notice thereof to the Claimant.
FISCAL IMPACT:
None.
DISCUSSION:
Staff has confirmed that the above City owned tree, which is a "Magnolia Grandiflora", is on a two
to three year trim cycle and was maintained timely on March 18, 2005 and September 15, 2006,
Also, there have been no prior complaints or incidents regarding this tree. While it could be that
the branches dropped because of the high summer temperatures, the exact reason is not known
and the event was not foreseeable. As this appears to be a case of no liability against the City,
the e 'm is being denied at this time.
ATTACHMENT: Copy of Claim No. 06-31
Consideration Of Claim Of Libert yMutuaI06-31. doc
CLAIM AGAINST THE CITY OF TU
(For Damages to Person or Personal
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Time Stamp:
Received Via:
o U.S. Mail
o Inter-Office Mail
[i}'bver the Counter
,,"'o"} r-,-' '1" 1 L
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Claim No: C'6 - 3/
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 hislher 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: l'\ 'G t! (t'l
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:
Post Office Address:
L :bect'l ,'Y'Iu{v,,1
5050 (,,0,
,~ \len+C:)0-JI\
If' >..J"af\( e. Telephone: l-get'). SJ./- ()'i'/p r Y/6
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3. The date, place and other circumstances of the occurrence or transaction from which the claim arises,
Date of Occurrence: 7/.111 0(0
Location: G, 50 C w ("(\ .:,,', '"
Circumstances giving rise to this claim:
\ (e t' OfC((\{ he<~
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St
Time of Occurrence:
Iv.~t,,, C A q ~ 7;'-0
c.,'50 P 1"\.00
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4.
General description of the indebtedness, obligation, injury, damage or loss incurred so far as you now know.
.set' <:i t\ur\\e A
:u 15S~. '1 ~
cienf ()/\ hood
<;"'(', /" tel: . r,
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Page 1 of 4
5. The name or names of the public employee or employees causing the injury, damage, or loss, if known.
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:
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 9
86.)
o Limited Civil Case
D Unlimited Civil Case
You are required to provide the Information requested above in order to comply with Government Code
S910. Additionally, In order to conduct a timely Investigation and possible resolution of your claim, the
Ci of Tustin re uests that ou answer the followln uestlons.
7. Name, address and telephone number of any witnesses to the occurrence or transaction from which the claim
arises:
.-k\\
T), C( ('. e \-\ cd e~
~OiVI +'-e e ~
So ,,\ ~~{ w
hit Cl't ("
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bcl\. l\che.s
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:
l" 'b;~i" rr,u-hlq\
Claimant(s) Auto Ins. Co.: I ~ e. I I \I
<:::t:ll\l\e n So. 0" ~~ 1-
Telephone:
Insurance~o.:
7.~ 8S ';Y~l-{>t) 0-:2.
Address:
Insurance Broker/Agent:
Address:
Telephone:
Claimant's Veh. Lic. No.: .
Claimant's Drivers Lic. No.:
Vehicle Make/Year:
Expiration:
:;'lZ'i. ,<;
ill'! }n.h ~
j <." ./-,'
, ..>ti..h{
fe,
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 corners. 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.
CURB ~
L
SIDEWALK
CURB -,.
PARKWAY
SIDEWALK
I
Warning: Presentation of a false claim is a felony (Penal Code 972). Pursuant to CCP 91038, 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:
~---- -- 3n~, r on maS f //J
fOr J. ,'beffY (htlft'q/
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Date:
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Page 3 of 4
~ libertY.
\p Mutual.
Liberty Mutual Fir ilsurance Company
5050 W Tilghman St Ste 200
Allentown P A 18104-9154
Tel: (610) 398-9800 / (800) 521-0986
Fax: (610) 336-0305
October 11, 2006
CITY OF TUSTIN CITY CLERK'S OFFICE
300 CENTENNIAL WAY
TUSTIN CA 92780
--'
"
.' ,
- i
>
.----
" )
OUR INSURED:
OUR CLAIM NUMBER:
YOUR INSURED:
YOUR CLAIM NUMBER:
DATE OF LOSS: 07/21/2006
PLACE OF 650C W MAIN ST
LOSS: TUSTIN,CA
DIANE L. HALE
PD660-0073 85686-0 1
CITY OF TUSTIN
.,,?
---~
Dear City Clerk:
Based on our investigation of this accident, we'believe your Insured to be responsible for the
damage to our Insured's vehicle. I have enclosed documentation to support the following
subrogation claim:
Amount we have paid
Salvage (if applicable)
Our Insured's deductible
Total amount of damages
$
$
$
$
583.48
0.00
100.00
788.48
Please include our claim number on your check for the total amount of damages shown above
and send your payment to my attention. If you have any questions, please contact me at the
number listed above, extension 416.
Sincerely,
SHARON MASTIN
Subrogation Department
Enclosure
Helping People Live Safer, More Secure Lives
SUBI27A
~ !:fALL DIANE - HALL DIANE 007385 -0001 DOL" 0712112006 Financial Summ I!!lIiIEJ
File Edit Toob Help
'--~-,-'"~"._,_._-,.,-,."~_._------.;,.-~-----,-
tr) I ~INext I
Amounts per Coverage:
Gross Expense; Paid to Date:
Net Expense; Paid to Date: '
Financial Transaction Histor}l;..
Name
INSURANCE COLLISION CENTER
INSURANCE COLLISION CENTER
~oiect New ProeetSl ,I .
1,'
..:J
Open New ProceSs.. ,
~
Disbursed
Reversed
583.48
583.48
08/10/2006
Ready
INSURM......tE COLLISION CENTER
5120 EAST LA PALMA AVE
ANAHEIM HILLS. CA 92807
(714) 777-1577 FAX: (714) 777-4712
CD LOG NO 180-1 DATE 08/09/06 REP.ORDER 400972
SHOP:
ADDRESS:
INSURANCE COLLISION CENTERS
5120 E. LA PALMA AVE
SUIT 103
ANAHEIM HILLS. CA
92807-
INSP DATE:
CONTACT:
PHONE 1:
PHONE 2:
FAX:
CITY STATE:
ZIP:
OWNER:
ADDRESS:
CITY STATE:
ZIP:
HALE. DIANE
HOME PHONE:
CELL PHONE:
CLAIM#: 007385686-01
INSURED: HALE.DIANE
LOSS DATE: 07/21/06
POINT OF IMPACT: 16
08/09/06
JOHN RUTHERFORD
(714) 777-1577
(714)777-1643
(714)777-4712
(
POLICY#:
TYPE OF LOSS: COMPREHENSIVE/DRP
DAYS TO REPAIR: 3
INS. CO:
ADDRESS:
CITY STATE:
ZIP:
EMAIL:
LIBERTY MUTUAL
1750 HOWE AVE. #400
SACRAMENTO. CA
95825-
SBALDWIN@ICCGROUPS.COM
PHONE 1:
FAX:
LIC#:
BODY COLOR: WHITE
CONDITION: GOOD
STATE:
VIN:
MILEAGE:
ACCTNG CTL#:
DRIVEABLE: YES
PROD. DATE: 11/04
VEH. INSP#:
PAINT CODE:
"=USER~ENTERED VALUE E=NEW PART
EC=QUALITY REPLACEMENT PART
UC=RECONDITIONED PRT UM=NEW DISCOUNT OEM PRT
EP=SEE QUAL. REPL. PRT. RPT.
PC=PXN RECONDITIONED PM=PXN REMAN/REBUILT
ET=LABOR/PARTIAL REPLACE IT=LABOR/PARTIAL REPAIR
L=REFINISH BR=BLEND REFINISH
CG=CHIPGUARD SB=SUBLET
RI=R&I ASSEMBLY P=CHECK
RP=RELATED PRIOR DAMAGE UP=UNRELATED PRIOR DAMAGE
(800)565-5505
(916)564-2007
10.243
ZZZZZZZZZ
NG=REPLACE NAGS
UE=DISABLED
EU=REPLACE RECYCLED
OE=DISABLED
TE=PART/PARTIAL REPLACE
I=REPAIR
TI'=TWO - TONE
N=ADDNL LABOR OPERATION
AA=APPEARANCE ALLOWANCE
PAGE 1
08/09/06
2005 HYUNDAI SANTA FE GLS 3.5 4DOOR WAGON
CD LOG NO 180-1 REP.ORDER 40f 2
( )
ALL SUPPLEMENTS REQUIRE PRIOR APPROVAL BY LIBERTY MUTUAL REPRESENTlVE.
PLEASE CONTACT LIBERTY MUTUAL'S SACRAMENTO CLAIMS CENTER AT 1-800-565-5505 FOR
ANY SUPPLEMENT REQUEST.
BOTH MATERIALS & LABOR FOR TINT COLOR AND COVER CAR ARE INCLUDED OPERATIONS
WITHIN ADP DATABASE
COPY OF APPRAISAL HAND DELIVERED TO VEHICLE OWNER
OLD DAMAGE; SCRAPE IN L SIDE OPF REAR BUMPER
2005 HYUNDAI SANTA FE GLS 3.5 4DOOR WAGON 6CYL GASOLINE 3.5
CODE: E7104B/E OPTNS D/2ABDERFVGHJSPQZ
OPTIONS:
TWO-STAGE - EXTERIOR SURFACES
DRIVER POWER SEAT
POWER DOOR LOCKS
REMOTE KEYLESS ENTRY SYSTEM
REAR WIPER
TRACTION CONTROL SYSTEM
ALARM SYSTEM
FRONT SIDE IMPACT AIRBAGS
BUMPER COVER MOUNTED FOG LAMPS
HEATED REMOTE CONTROL MIRRORS
ELEC REMOTE CONTROL MIRRORS
MOONROOF
ANTI - LOCK BRAKE SYSTEM
AIR CONDITIONING
CRUISE CONTROL
OP GDE MC DESCRIPTION
RI 0029
RI 0041
I 0083
L 0083
BR 0103
RI 0014
RI 1052
RI 1053
I 0209
I 0289
I 0341
I 0389
I 0479
SB M60
I M66
MFG.PART NO.
PRICE AJ% B% HOURS R
GRILLE ASSEMBLY R&I ASSEMBLY
HEADLAMP ASSY,BALOG LT R&I ASSEMBLY
PANEL, HOOD REPAIR
13 PANEL,HOOD REFINISH
2.9 SURFACE
O. 6 TWO STAGE SETUP
O. 6 TWO STAGE
FENDER,FRONT LT BLEND REFINISH
0.8 BLEND
O. 4 TWO STAGE
MLDG, FENDER LOWER L/R R&I ASSEMBLY
NOZZLE, W/S WASHER LT R&I ASSEMBLY
NOZZLE, W/S WASHER RT R&I ASSEMBLY
PNL,FRONT DOOR OUTE LT REPAIR
BUFF SCUFFS OFF ON DOOR & SIDE MOLDING
PNL,REAR DOOR OUTER LT REPAIR
BUFF SCUFFS OFF DOOR & SIDE MOLDING
PANEL, ROOF REPAIR
BUFF SCUFFS OFF L ROOF SAIL PANEL & LUGGAGE RACK
PANEL, QUARTER LT REPAIR
BUFF SCUFFS OFF QUARTER PANEL & GLASS
SHELL, TAILGATE REPAIR
BUFF SCUFFS OFF UPPER TAILGATE
HAZARD. WSTE. REM. SUBLET REPAIR 3.00 *
COLOR, SAND & BUFF REPAIR
HOOD & L FENDER
0.3 1
0.2 1
2.5*1
4.1 4
1.2 4
0.2 1
0.1 1
0.1 1
1.0*1
1. 0*1
1.0*1
1. 0*1
0.5*1
*1*
0.8*1*
PAGE 2
08/09/06
2005 HYUNDAI SANTA ~FE GLS 3.5 4DOOR WAGON
CD LOG NO 180-1 REP.ORDER 40 '2
15 ITEMS
MC MESSAGE(S)
13 INCLUDES 0.6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE
FINAL CALCULATIONS & ENTRIES
PAINT MATERIAL
PARTS & MATERIAL TOTAL
TAX ON PARTS & MATERIAL @
7.750%
137.80
137.80
10.68
LABOR
1-SHEET METAL
2-MECH/ELEC
3 - FRAME
4-REFINISH
5 - PAINT MATERIAL
LABOR TOTAL
SUBLET REPAIRS
TOWING
STORAGE
RATE
38.00
75.00
55.00
38.00
26.00
REPLACE HRS
0.9
REPAIR HRS
7.8
330.60
5.3
201.40
532.00
3.00
GROSS TOTAL 683.48
LESS: DEDUCTIBLE 100.00-
NET TOTAL 583.48
ADP SHOPLINK UR217 ES CD LOG 180-1 DATE 08/09/06 02:45:18PM R6.37 CD 07/06
PXN: Y/OO/OO/OO/OO/OO CUM 00/00/00/00/00 GEOCODE 92807
HOST LOG
(C) 1998 - 2006 ADP CLAIMS SOLUTIONS GROUP, INC.
1.6 HRS WERE ADDED TO THIS EST. BASED ON ADP TWO-STAGE REFINISH FORMULA.
--------------------------------------------------------------------------
THIS IS NOT AN AUTHORIZATION TO REPAIR.
NO SUPPLEMENT WITHOUT REINSPECTION BY THIS APPRAISER. ALL SUPPLEMENTS MUST BE
APPROVED PRIOR TO REPAIR.
COLLECT IN FULL FROM OWNER.
PLEASE SHOW ESTIMATE TO REPAIR SHOP.
YOUR VEHICLE. (SEE WARRANTY FOR COMPLETE TERMS AND EXCLUSIONS).
**** LOOK FOR THE CAPA SEAL ****
PAGE 3
08/09/06