HomeMy WebLinkAboutItem 3.5 Carolyn Jean Smith Claim / 101- � o
CITY OF DUBLIN
AGENDA STATEMENT
CITY COUNCIL MEETING DATE: March 26 , 1984
SUBJECT Claim of Carolyn Jean Smith, 9943 Mangos Drive, San
Ramon
EXHIBITS ATTACHED Claim
RECOMMENDATION Deny claim and notify claimant and insurance company
FINANCIAL STATEMENT: Total claim in the amount of $113 . 90
DESCRIPTION On March 8 , 1984 , the City received a claim from
Carolyn Jean Smith, 9943 Mangos Drive, San Ramon,
California , for property damage to her car as a result .
of allegedly hitting a pothole on a City street . It
is recommended that the City Council deny the claim
and notify the claimant and the City ' s insurance
carrier .
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COPIES TO: Carolyn Jean Smith
Ben Fernandez
ITEM NO. (s5. Q5 City Attorney
C E I \1 E D '-T.,AIM AGAINST THE CITY OF DUBT `
Control No.
-
(Office e
!tdaress of Claimant:
Clund Notices to: '6' Ja a a -A --(I All IvW *722U&6.
1) y
U"Lu and (rime of occurrence;
Place of Occurrence-: .(Provide detailed diagram describing exact location,
including physical landmarks or distinguishing land features, if appropriate . , '
��A A7/AbA -2
U
ZL'J'W4 A,-2
o'
Circum' stances of Occurrence: (If an accident, describe physical conditions
surrounding occurrence, such as weather, road and traffic conditions, etc. )
?2 /9 3Z At
r
List names, addresses and phone numbers of any witnesses;
V
Doscription of Damage or Loss:
qamc and Department of Involved City Employee (if any) .
Ootal Amount Claimed: Breakdown of Amount Cl'aimed:
rt
)a ted:
Signed;
V
oLe. Acclaim relating to a cause of action for death or for injury to person or to personal
roperty or growing crops shall be presented not later than the 100th clay after the accrual
f the cause of action. A claim relating to any other cause of action Shall be presented not
)ter than one (1) year after the accrual of the cause of action.
W= a claim_that is-required-t6-be presented-not�ter than the ibbth &y after the
:crual of the Cause of action is not presented within such time, a written application rDay
In,
Adc to the City Council for leave to Present such ciaijh:-,na application shall be pre-
!nted within a UJW not to exceed one (1) year
after the accrual of the cause
action and Wi&U state the reason for the delay in presenting the claim. 7he proposed
aim shall be attached to the application.
• F: � alt` f� i :•t� - ti�� z t � k i
'COOPER:McKENZI E MURPHY,
"P. 0. BOX 1030 voua ndePenaenl " • '
4< :'PLEASANTON, CA::.94566 �ns�FOp�+AGENT �' 0
. ,,. tom•` ' 7,
DATE: 3/8/84
REFERENCE
ATTENTION:
Paul Rankin
NAMED
INSURED City of Dublin
COMPANY&
POLICY NO.
City of Dublin FILENO. Claimant: Carolyn Smith
TO: 6500 Dublin Blvd. Suite 101 Date of Loss 12/27/83
Dublin, Calif. 94568
CHECK HERE
FOLD
THE ENCLOSED DRAFT IS PAYMENT FOR YOUR CLAIM. WE SINCERELY HOPE THE SETTLEMENT IS COMPLETELY SATISFACTORY.
YOUR INSURANCE COMPANY HAS SETTLED YOUR CLAIM AND PAYMENT HAS BEEN MADE IN THE AMOUNT(S)SHOWN BELOW. '
PLEASE COMPLETE, SIGN AND RETURN THE ENCLOSED FORMS.
SIGNATURE MUST BE NOTARIZED SIGNATURE NEED NOT BE NOTARIZED
IN ORDER TO PROCESS YOUR CLAIM, WE WILL NEED THE ITEMS SHOWN BELOW.
SEE MESSAGE BELOW.
,1 .•ATTACHED ARE THE ITEMS SHOWN BELOW.-:
PLEASE ADVISE STATUS OF-THIS CLAIM IN THE SPACE BELOW.
T ELOW
[` .SEE•MESSAGE B
L" - ~
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' f. .57 -,. +' 2iv,�;� e24:.*A', "^"'a.�,�*t' Lam.' `+`a`i4°6.0. ?�r
" WE HAVE RECEIVED A
, REPORT•INDICATING THAT.YOU WERE INVOLVEDIN AN ACCIDENT--WITH OUR INStU�RED IN ORD'ERTHAT`.WE `
i ,t SMAY_.PROPERLY.SEVICE THIS LOSS WE ARE,ASKING THAT. I
FOLD
N
THE INFORMATION SHOWN BELOW i��ITHE INFORMATION REQUESTED-'ON THEATTACHED FORMS)
1;WILL YOU PLEASE.COMPLETE SIGN AND1RETURN THIS ENCLOSED FORM SO THAT WE MAY PROCESS THIS
1 , o
iSEE MESSAGE BELOW T' c j
Hi Paul,
Enclosed is the material which I discussed with you
on the telephone today. Thanks for your help.
r`•:MESSAGE'=>`.�
M
DATE � SIGNED
SAVE envelope addressing•fold at arrows to fit standard#10 window envelope•THE OHIO ENVELOPE COMPANY•CINCINNATI,OHIO 45219 CAT.NO.541
0 Copyright MCMLXXVI by Ohio Envelope Company.Reproduction of this form by any means is strictly prohibited by law.Vrolators will be severely prosecuted.
t BLACK K &. BLAND
_._. ._.__ --___ ___
INSURANCE • INVESTIGATORS - A_DJUSTERS______. _.
5 2 7 6 COL L E G S A V E N U E
OAKLAND , CALIFORNIA 94. 618
LICENSES : A - 5508 • B - 967 BRUCE B. BLACK
DAY OR NIGHT ( 415 ) 652- 5526 ROBERT J.CONOVER
March 5, 1984
Cooper-McKenzie-Murphy
78 Mission Drive., #C
Pleasanton, :CA. ,.94566
.:=Attention: Mr. ,Ben Fernandez
Ins ured . >{' County of -Alameda
._. , Claimant , .z -Smith; Carolyn
Date of Loss 12/27/83
Our File # VAL-36453
Dear Mr. Fernandez:
We are enclos-i.ng a claim recently filed against Alameda County that
may involve the Ci.ty of Dublin. The claimant, Carolyn Smith, contacted
our office -today and was advised that your office would be handling this
matter.
If I. can answer any questions for you, please feel free to contact me.
Sincerely,
VALERI WHITE
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MEMBERS:CALIFORNIA ASSOCIATION OF INDEPENDENT INSURANCE ADJUSTERS
CALIFORNIA ASSOCIATION OF LICENSED INVESTIGATORS • AFFILIATED ADJUSTERS
COUNTY OF ALAMEDA
►- :.., PUBLIC WORKS AGENCY
399 Elmhurst Street • Havxvanl, CA 94544-1395
(415) 881-6470
P ..i
esources
February 23, 1984
Mr. Robert J . Conover - -
Black & Bland '
5276 College Avenue
Oakland, CA 94618
Dear Mr. Conover: . . .. _
Re: Claimant: SMITH, Carolyn
Date/Loss: 12/27/83
Your File: YAL 36453
Enclosed,-:with reference to the above claim, is a copy of the request
for service -to.-repair.-the -pothole on Dougherty Road in -the City of Dublin,
that was mentioned in the claim, together with the picture of the damaged
wheel that was mentioned. —
Enclosed also is a copy of the current agreement the County has with
the City of .Dublin for services that the County provides the City. .
In regard to road related claims, a procedure should be established
whereby -the claims -on -City of Dublin streets-tan 'be-transmitted directly -:
to the City for their action. - Please call and let me know_ your thoughts
in this 'regard: _ .
r'Very .trulyyouurs,' -
RONALD.;F:' SORENSEN t xr
-- CHIEF,`ROAD DEPARTMENT
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609.2.248 PUBLIC WORKS AGENCY NO.
ROAD DIVISION
ROUTINE ❑ COUNTY OF ALAMEDA
DATE
URGENT REQUEST FOR SERVICE
EMERGENCY ❑ TIME �� G� �`���,t�s
REQUESTED BY: /"��S S��'�h Telephone No. 8z8
ADDRESS 99 43 ypal wo/?
ROAD or STREET
EXACT LOCATION - /
NATURE OF REQUEST —!?O�e O�7 / Y_ fw ,
REQUEST RECEIVED VIA: yp�lor�e-
,C pp TELEPHONE,PER ONAL CONTACT,OR OTHER —EXPLAIN
R EC'D.BY / UD/Y��S ASSIGNED TO /-32 DATE /Z Z�
ACTION TAKEN OR WORK PERFORMED
COMPLETED tom, (-0 DATE Z 8 CHECKED BY
.c%le X1,/%ZW 7k 1410 /COX- P%,< o,e don�aycc�arc s,�L A. 'n%m eQ`/es's p/arc dam. . -
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