HomeMy WebLinkAbout4.09 State Farm Insurance Claim r '7o -( o
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CITY OF DUBLIN
AGENDA STATEMENT
CITY COUNCIL MEETING DATE: July 21 , 1987
SUBJECT Denial of Claim Submitted by State Farm Insurance
Received April 30, 1987 — #0008DU
EXHIBITS ATTACHED otice of Claim
RECOMMENDATION Deny the claim, direct Staff to notify the claimant
and the City ' s Insurance Provider.
FINANCIAL STATEMENT: Notice of Claim Form does not identify amount of
damages .
DESCRIPTION State Farm has submitted a Notice of Claim related to
vehicle damage caused to a vehicle driven by Mr. Peter Popp. The Insurance
Company claims that if they are called upon to make payment for Mr . Popp ' s
vehicle damage , they will seek reimbursement from the City .
Mr . Popp ' s vehicle was damaged in a minor traffic accident . The accident
involved a rented vehicle operated by Alameda County Sheriff ' s Department
personnel on official business pursuant to the City ' s agreement for Police
Services . The incident occurred on March 12 , 1987 in Walnut Creek. The
claim has been reviewed by ABAG PLAN Corporation and their adjusting firm.
The Adjustor is also notifying Alameda .County , since the accident involved
Alameda County personnel .
The adjustor has recommended that the City deny the claim, which will impose
the statutory timelines for proceeding . Staff recommends that the City
Council deny the claim and direct Staff to notify the claimant and the
City ' s Insurance Provider
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COPIES TO:
Claimant
ABAG PLAN Corporation
J. Aumock , George Hills Company
ITEM NO. �
fiAit /ARM x®STATE FARM MUTUAL -;.�' ❑STATE FARM LLOYDS
AUTOMOBILE INSURANCE'-`QPANY r r
,� ❑STATE FARM FIRE AND C. _TY COMPANY r❑STATE FARM COL.. MUTUAL M
INSURANCE INSURANCE COMPrrNY OF TEXAS
o
[:]STATE FARM GENERAL INSURANCE COMPANY
r ATE JOURINSURED ACCIDENT DATE CLAIM NUMBER
I 4 .29 87 Popp, William A. & Margaret hI 3 12 87 05 0203 190
RECEIYED
:APR -3 01991 '
From.
r City of Dublin CITY 0;. STATE FARM INSURANCE CLAIM OFFICE
P`.0. Box 2340 333 Civic Drive
Dublin, CA 94568 Pleasant Hill, CA
P.0. Box 4011
Concord, CA 94524
Steve Consalves - .
By:
Claims Representative .
Fold— Agent Code:
We are writing you about the accident in which you were involved with our insured on the date shown. Our, investigation
of this accident indicates that you are responsible for this accident.
2❑x Please accept this letter as notice of a claim we have for _
❑ Personal Injury Protection (PIP). ask Vehicle Damage.
❑ Medical Payments Coverage (MPC). ❑ Other:
-Qx Should we be called upon to make payment under our policy, we will be looking to you or your insurance company
for reimbursement.
❑ If you have insurance to protect you against such liability, please refer this letter to your insurance company.'
❑ Please send us the name of your insurance company,'its address, and your policy number.
❑ We have had no response to our previous letter concerning our claim. We assume you have overlooked writing us.
'Please let us hear from you at once.
❑ We have made the following payments and request reimbursement as shown below:
Net Vehicle Damage Other .
Name of Our Payee PIP/MPC Payment (Less Salvage) Payment/Expense*
$ $ $
$ $ $
Net Amount Paid Insured Vehicle
By Company,$ Deductible $ TOTAL
We enclose a return envelope for your assistance in replying.
(160)D 4376.5 REV.268 PRINTED IN U.SA t^S CI W t )
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