HomeMy WebLinkAboutAgenda Report - October 16, 1985 (54)a
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CITY OCUNC/ 1 n MWI
OBER 16, 1985
Following recam-endation of the City Attorney
and the City's Contract Administrator, Council
on motion of Council Member Olson, Snider second,
denied the following Claims and referred the same
back to L. J. Russo Insurance Services, Inc.,
the City's Contract Administrator:
a) Wilson/Moser - Date of Loss 9/5/85
b) Kathleen Gwin - Date of Loss 3/31/85
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2424 ARDEN WAY
BUILDING C-81
SACRAMENTO, CA 95825
916-920-5381
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MEN
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{{ LebnardjRusso
WCE M.
CITY CLERK CLAIMS
ADMINISTRATION SERVICE
t_ODt
CITYOF
June 18,
City of Lodi
P.O. Box 320
Lodi, CA 95241
Attn: Alice Reimche
r
Re: Insured:
City of Lodi _ =� �� ,.
;F
Claimant:
Kathl :•en Ann Gwin
Date of Loss:
85
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Our File No..
-2 48 , fit• '
,rte a`
Dear Ms. Reimche:
We have recently conferred with the Claimant,
Kathleen Ann Gwin
Mrs. Gwin advises us that after this
accident she experienced`-
high blood pressure which caused her
to lose the sight in one;''`-
$
eye. She is attributing her high blood
y g g
pressure to the � �
excitement caused by this accident.
She is presently being P ��
treated by Dr. Howen and Dr. Chen and
has incurred approximately
$500.00 in medical expenses to date.
She states that her eyesight
has been substantially recovered, but
she still has some minor
residual problems.Rrt;.`'
�y
Attached is a copy of my letter to Mrs.
Gwin which you will find
self explanatory.
f.
I am creating a bodily injury reserve
for Mrs. Gwin in the amount f=
X� a ~of $2,000.00. I'll keep you advised
of any further activity on
this claim.
very truly yours,
eY
Enclosure: Le ter to Claimant
CG/pw
2424 ARDEN WAY
BUILDING C-81
SACRAMENTO, CA 95825
916-920-5381
r
Le'onardfRusso
CLAIMS ADMINISTRATION SERVICE
Kathleen Ann Gwin
405 First Street
Lodi, CA 95240
Re: Our Principal:
Your Claim Of:
Our File No.:
June 18, 1985
City of Lodi
3-31-85
2748
Dear Mrs. Gwin:
This will confirm our telephone conversation of June 17, 1985.
As we discussed, I am attaching copies of medical reports
which should be completed by Dr. Howen and Dr. Chen, outlining
their treatment of your condition which caused you to lose,
temporarily, the sight in your eye.
When these have besn.returned to me with copies of the doctors'
bills, we will get back in touch with you regarding settlement
of your claim against the City of Lodi.
If you have any questions in the meantime, do not hesitate to
call me.
Very truly yours,
Chuck Gormley
CG/pw
Enclosures: Medical reports
'2
�Y
2424 ARDEN WAY
BUILDING C-81
SACRAMENTO, CA 95825
916-920-5381
i
;:CLA1'M FOR DAMAGES
'--,TO,PE'RSON OR PfIOPERTY
t
INSTRUCTIONS
I. Claims for death• injury to person of to personal property must be tiled not later than 100 days after the
• oceurante. (Gov. Code Sec. 911.2)
�. Claims for'&rriiges to real property must be filed not.later than I year after the occ urenoe: (Gor. God
a.:.
;1 Reahtntire claim before filing. 1 �M
z ;. See page 2 for diagram upon which to locate place of accident.
S. This claim form must be signed•on page 2•at bottom.
+ 6. *Attach separate sheets, ix:necessary• to give fu'lf details, S'IGN�EACH SHEET. .. i •' 3�a
7. Cliim must be filth with City Clerk (Gov. Code Sec. 91Sa) ' 01
ALI�F-.Mv
RF. IM • ; CITY - CLE RY,••� � 2s, •t; j,: . • Q;� �>�
221 W. Pine Street, Lodi, C`alifornii.' 95246��' ' N' ,• '•'
Address
' City and State` ; • nt•'
:;?: '
RESERVE FOR FILING STAMP
�ciAIM•�c�. __ . ,
• t • % ••
RECEWED
DATE: APR 24198so"
ALICE M REIME
CITT . RK
-JP
• v. :'�Df' isle..
Age of Claimant of natural pertun)
.HomeTelephone Nu»lbe;;f.•''�� �
., �.. i —L
Busfness Address of Claimant City and State ;; �� �u.iness Telephone Number
�fh^tf� G"11��� ...- '�l�i lett• • x'J":•'". rf;��_4--�s�.�� - _• .
Give address to whin you desire notices or communications to be sent regarding this claim.
A.
� 0��5 ries¢ Sf ... � _ . .., �.. - 1 .:,�:� xky�•
}low did DAMAGE or INJURY occur? Give full particulars. ` L• a t
b WrN OJE/�. ZL/!B h7ti'3�`1Q1�3'
f .mow J -4y 7 i�'E" Du,�: Z:DGt 0..01'-01 oL e r9yt
When did DAMAGE OR INJURY occur? Give full particulars, date, time of day: "-.
l'%%�9��% � � •• //�'f?�CbH, r �t�,C �¢- l.�.�' : /� !''/�I. fir'= ''
Where did DAMAGE or INJURY occur? Describe fytly, and locate on diagram on reverse side of this sheet, where appropriate, give street names and address f
and measurements from landmarks:
,What pa{ticular•ACT or OMISSION do you claim caused the injury or damage? Give names of City employees causing the injury or damage, if known... "Y
. � �•• C,l)(fC"l� •'�D/E'.. ''�`Ic • �� :t> bLE' �Irf ✓ k crL pl.f OiL)- Srd a�
t.
Yi'hzt DAMAGE of NJURIES•do you claim iesulted? Give�uil extent of injuries or damages iairned:• t
c RCfe cfu rT41e ,z;kwlal
7, (�L/7`i��/,O i.� !�'f i✓7 70"i L,. I4S !�i✓�i�i4i ,
What AMOUNT do you claim on account of each item.of injury or damage as of date of presentation of this claim, giving basis of computation.
L
Give ESTIMATED AMOUNT as far as known you claim on account of each item of prospective injury' or. damage, giving basis of computation.
AL
T h:
,I•
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•
$0.
;:CLA1'M FOR DAMAGES
'--,TO,PE'RSON OR PfIOPERTY
t
INSTRUCTIONS
I. Claims for death• injury to person of to personal property must be tiled not later than 100 days after the
• oceurante. (Gov. Code Sec. 911.2)
�. Claims for'&rriiges to real property must be filed not.later than I year after the occ urenoe: (Gor. God
a.:.
;1 Reahtntire claim before filing. 1 �M
z ;. See page 2 for diagram upon which to locate place of accident.
S. This claim form must be signed•on page 2•at bottom.
+ 6. *Attach separate sheets, ix:necessary• to give fu'lf details, S'IGN�EACH SHEET. .. i •' 3�a
7. Cliim must be filth with City Clerk (Gov. Code Sec. 91Sa) ' 01
ALI�F-.Mv
RF. IM • ; CITY - CLE RY,••� � 2s, •t; j,: . • Q;� �>�
221 W. Pine Street, Lodi, C`alifornii.' 95246��' ' N' ,• '•'
Address
' City and State` ; • nt•'
:;?: '
RESERVE FOR FILING STAMP
�ciAIM•�c�. __ . ,
• t • % ••
RECEWED
DATE: APR 24198so"
ALICE M REIME
CITT . RK
-JP
• v. :'�Df' isle..
Age of Claimant of natural pertun)
.HomeTelephone Nu»lbe;;f.•''�� �
., �.. i —L
Busfness Address of Claimant City and State ;; �� �u.iness Telephone Number
�fh^tf� G"11��� ...- '�l�i lett• • x'J":•'". rf;��_4--�s�.�� - _• .
Give address to whin you desire notices or communications to be sent regarding this claim.
A.
� 0��5 ries¢ Sf ... � _ . .., �.. - 1 .:,�:� xky�•
}low did DAMAGE or INJURY occur? Give full particulars. ` L• a t
b WrN OJE/�. ZL/!B h7ti'3�`1Q1�3'
f .mow J -4y 7 i�'E" Du,�: Z:DGt 0..01'-01 oL e r9yt
When did DAMAGE OR INJURY occur? Give full particulars, date, time of day: "-.
l'%%�9��% � � •• //�'f?�CbH, r �t�,C �¢- l.�.�' : /� !''/�I. fir'= ''
Where did DAMAGE or INJURY occur? Describe fytly, and locate on diagram on reverse side of this sheet, where appropriate, give street names and address f
and measurements from landmarks:
,What pa{ticular•ACT or OMISSION do you claim caused the injury or damage? Give names of City employees causing the injury or damage, if known... "Y
. � �•• C,l)(fC"l� •'�D/E'.. ''�`Ic • �� :t> bLE' �Irf ✓ k crL pl.f OiL)- Srd a�
t.
Yi'hzt DAMAGE of NJURIES•do you claim iesulted? Give�uil extent of injuries or damages iairned:• t
c RCfe cfu rT41e ,z;kwlal
7, (�L/7`i��/,O i.� !�'f i✓7 70"i L,. I4S !�i✓�i�i4i ,
What AMOUNT do you claim on account of each item.of injury or damage as of date of presentation of this claim, giving basis of computation.
L
Give ESTIMATED AMOUNT as far as known you claim on account of each item of prospective injury' or. damage, giving basis of computation.
AL
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'ESTIMATE for AIRS
YOSN MATAGA'S :,: ✓: -
BALDWIN OLDS, BUICK
216 S. Sacramento St: • P.O. Box 29 L. LOD1, CALIFORNIA 95240 Lodi: Phone 333-2233 L*J
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Stockton: Phone 943-6411
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NAM" ADDRESSCITY
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bloke Serioi No. Body Styled --Style Mo
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BY:
THIS CSTIMAT( IS SASCO ON OUR t"SPCCTION AND OO(S NOT COVER ADDITIONAL PARTS
OR LABOR WHICH
MAY BE R(DUIR[O A/TER TH[ WORK NAS BEC
N STARTED. A/TCR THE
'WORK HAS STARTCD. WORN OR DAM It PARTS WNICN ARE
NOT [V to CHT ON rIRSr
INSPCCTto" MAY BE
OISCOVCRE0' NATURALLY THIS ESTIMATE CANNOT COVER SUCH
CONING CNCI(S. PARTS PRICE SS US JECT TO CHANCE WIT KOUT NOT ICC. THIS [STIMATC
Is rOR IMMEO IATC ACCCPTANC(:
THIS WORK AUTHORIZED BY
--GRAND TOTAL..
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55"'. (Rev. 4-83) LIPD FORM Pio. 135 too sOITIOwi yMTIL vN rLE TfO
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MEMORANDUM, City of Lodi, Public Works Department
TO:
FROM:
DATE:
SUBJECT:
C O N F I D E N T I A L
Ron Stein, City Attorney
RECEIVED
1985 MAY - I PH jr-, 37
ALICE M. REIMCHE
CITY CLERK
CITY OF LOOI
Water/Wastewater Superintendent
April 30, 1985
Liability Claim of Kathleen Ann Gwin, D of L March 31, 1985 -
Per the request of the Public Works Director 1 have reviewed the attached
claim.
The manhole (your office has the original pictures from the prior claim)
described in the claim is a result of infrastructure failure of a 50-60 year
old facility.
It appears that due to a failing underground support structure of the manhole
the entire assembly shifted, causing the cover to pop out of the frame on
impact with front wheel of claimants vehicle and then back wheel dropped into
manhole causing tire to blow.
The damaged City structure was repaired to a proper condition by 3:00 p.m. on
April 1, 1985.
If you have any further questions regarding this subject, please contact me.
Fr n E. Fork
iter/Wastewater Superintendent
cc: Public Works Director
City Clerk .�.--
yy{(`PE,ED MEMO
FL�OYIGZYVLRuSSC.� INSURANCE SERVICES, INC.
■ r
Please reply to:Ir J4
li7%l! ,^rY''�►_�,�
INSURED/ACCOUNT
-.
CLAIM O OL CY NO
Z%'liC.J
DATE OF LOSS CLAIMANT
r.L OUR FILE NUMBER
DATE SUBJECT ,
IESSAGE:_
Ict
.00
IN
T of - +
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GNATURE r rte"
REPLY:�a. _.-.
r i
DATE SIGNATURE
_ .
RESERVE FOR FILING STAMP
CLAIM FQ R DAM�CLAIM No.
>rl�a
TO PERSON OR PROPERTY
i -(9$5 .SEP 23 AN 9- L
INSTRUCTIONS
1. Claims for death. injury to person or to personal property must be filed not later t� tit
���c
occurance: (Gov. Code Sec. 911.2)`"i t
2. Claims for damages to real property must be filed not later than 1 year after the occurrence. (Got-� OF L Off'
Sec. 911.2) ! '
3. Read entire claim before filing.
4. See page 2 for diagram upon which to locate place of accident.
5. This claim form must be signed on page 2 at bottom.
6. Attach separate sheets. if necessary, to give full details. SIGN EACH SHEET.
7. Claim must be filed with City Clerk (Gov. Cade Sec. 915x)
ALICE M. REIMCHE, CITY C_T,ERK
T0: .. . .
221 W. Pine Street, Lodi, California 95240
Name of Claim4nt — Ace of Claimant (if natural person)
Home Address of Claimant City and State Home Telephone Number
Business Address of Claimant City and State Business Telephone Number
N / A -
Give address to which you desire notices or communicaticns to be sent regarding this claim.
II „y
low did DAMAGE or 11
o K./' r f r' �� 1. '=? . i .-.2 y U
iKT occur! Citvelull particulars.
V
0
When did DAMAGE OR INJURY occur? Give full particulars, date, time of day:
s
Where did DAMAGE or INJURY occur? Describe fully, and locate on diagram on reverse side of this sheet, where appropriate, give street names and address
and measurements from landmarks:
t .1
What particular ACT or OMISSION do you claim caused the injury or damage? Gi a names of City employees causing the injury or damage, if known.
What DAMAGE or INJURIES do you claim resulted? Give full extent of injuries or damages claimed:
What AMOUNT do you claim on account of each item of injury or damage a; of date of presentation of this claim, giving basis of computation. '
Give ESTIMATED AMOUNT as far as known you claim on account of each item of prospective injury or damage, giving basis of computation.
N o 0 r
SEEPAGE 2 (OVER) 5-77-500 THIS CLAIM MUST BE SIGNED ON REVERSE SIDE
I 1. CASE NO. _
LOW 70LICE DEPAOT E AT
130 WEST RM STREET CONTROLLED DOCUMENT
IODI, CALIFORNIA 95140
RELEASED TO: 64 .moo"
STANDARD CREME RE-PORT II BY: ,�� DATE: '5F-157-8-r.
t 2. CODE SECTION
13. CRIME p
A. CLASSIFICATION p
S. REPORT AREA
6. DATE AND TIME OCCURRED - DAY 7. DATE AND TIME REPORTED 8. LOCATION OF OCCURRENCE
O ✓ .> �S // y� % fili/� iJ 94 3�,� // ,/9 /i' 9 Li/. % G /Ci� f ! �J � i
9. VICTIM'S NAME - LAST, FIRST, MIDDLE (FIRM IF BUSINESS) 10.
RESIDENCE ADDRESS
11. RESIDENCE PHONE
Culp- S�.J� E��T �t/G.y�
dao Lam• i ��! -s
12.OCCUPATION
13. RACE - SEX
14. AGE 15. DOB 16. BUSINESS ADDRESS (SCHOOL IF JUVENILE)
17. BUSINESS F'HO14E
ODES FOR V VICTIM W - WITNESS P - PARENT RP - REPORTING PARTY DC - DISCOVERED CRIME 1 - SPECIAL INTE2!ST
13. CHECK IF MORE
t BLOCKS 20 AND 30 D - DEFENDANT
NAMES IN
NARRATi VE
It. NAME - LAST. FIASt. MIDDLE
20. CODE
ADDRESS
22. RESIDENCE PHONE
121.RESfDENCE
-7
23. UP I >V
24. RAGE -SEX 25. AGE 26. DOB
27. BUSINESS ADDRESS (SCHOOL IF JUVENILE)
:9. lWSINESS PHCi4E
a 4?6 16 sf
29. NAME - LAST, FIRST, MIDDLE
30. CODE
131. RESIDENCE ADDRESS
32. RESIDENCE PHONE
33. OCCUPATION 34. RACE -, SEX 15. AGE 16. DOS 37. BUSINESS ADDRESS (SCHOOL IF JUVENILE) 3d. BUSINESS PHONE
#1 3?, VEHICLE USED - LICENSE NO. - ID NO. - YEAR MAKE •MODEL . COLORS (OTHER IDENTIFYING CHARACTERISTICS)
.. a
40. SUSPECTLA i, fiRSi, #AIDDLE) t1 RACE SEX I42.
�////1
AGE 43. HT.
44. WT.
45. HAIR 4e. EYES 47. tD NO. OR DOd
48. A CRESTED
YES ❑ NO ❑
! 49. ADDRESS, CLOTHING AND OTHER tn,NTIFYING MARKS OR CHARACTERISTICS
I
S0. NARRATIVE: �?
NE`/Gf�C- , Gc� / G Sa..J , N07 -
�.�L,.1-G•.��:.,�'%NG /��� %�c•,�2 G� %'/f�:•�c �-.. /i'7G.�:.c:: /.5���lEL•�-'� G✓/LSUnJ
IQ pt:-.P % OC.z'> C bur / L SG..� USU�LL y /5 OU: GF hl�,P
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/3EC-i LcZ') GviGSCI'r W qJ' /..i .vim) ai !7'� cf-' '- "10 0tsipeFD
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51 nroute Ttme 52. Investigation Ume
Minufts
%�
53. Date Wntttn or Recorded 54.
Time Written or Recorded 55. R.�(}orting O ryT 56. Em o. 57. Assisting Off. No.
0 3 9` -�.F (�-
Minu,ts--
Sd. PROCESSING
59. ATTACHMENTS 1
60. CASE ASSIGNMENT ' 11.fAL ROU
_14,ee.myy Info System Entry
Q Continuslion
❑ Tap^d NarrNwe
A Closed AChtef E C11 1
OfArPhoto - Copieir`7i
❑ Property Record
Detect.+e 8 Q- atrol F Q Si0 1 Q...
Q ......... ...............................
:l
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IM NO. L:12 (Revisal 3182) tno STANDARD CRIME REPORT 11' rj ii . `rn•
66. CASE NO,
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230 WEST ELM STREET CONTROLLED DOCUMENT
LODI, CALIFORNIA 95140
RELEASED TO:
SCR 11 NARRATIVE CONTINUATION
8Y: DATE:
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