HomeMy WebLinkAbout2023-08-22 Lua, Silvia1
Gloria Sanchez
From:Brendan B. Kearns <BKearns@rwglaw.com>
Sent:Friday, September 1, 2023 10:30 PM
To:Jessica Gonzales; Robert Hargreaves; Shawn Muir
Cc:Todd Hileman; Veronica Chavez; Isra Shah; Randy Chavez; Gloria Sanchez
Subject:RE: Notice of Claim & Tender of Claim Letter (Claim No. 901) [attorney client privilege]
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Jessica and Bob – I am inclined to follow the standard practice outlined by Bob. Let’s see how JPIA
responds.
Have a great 3-day weekend,
Brendan
Brendan B. Kearns
Shareholder
RICHARDS WATSON GERSHON
350 South Grand Avenue, 37th Floor
Los Angeles, CA 90071
T: 213.626.8484
E: bkearns@rwglaw.com
W: rwglaw.com
From: Jessica Gonzales <jgonzales@palmdesert.gov>
Sent: Friday, September 1, 2023 3:34 PM
To: Robert Hargreaves <robert.hargreaves@bbklaw.com>; Shawn Muir <smuir@palmdesert.gov>
Cc: Todd Hileman <thileman@palmdesert.gov>; Veronica Chavez <vchavez@palmdesert.gov>; Isra Shah
<isra.shah@bbklaw.com>; Brendan B. Kearns <BKearns@rwglaw.com>; Randy Chavez <rchavez@palmdesert.gov>;
Gloria Sanchez <gsanchez@palmdesert.gov>
Subject: RE: Notice of Claim & Tender of Claim Letter (Claim No. 901) [attorney client privilege]
Hi Bob,
Yes, typically that has been the process as I understand it. Just wanted to make sure if there was a need to respond at
all to RPM.
I have copied Gloria, she has forwarded the claim to JPIA.
Thank you.
2
Jessica Gonzales
Housing Manager
760.776.6410
jgonzales@palmdesert.gov | www.palmdesert.gov
73510 Fred Waring Drive, Palm Desert, CA, 92260
From: Robert Hargreaves <Robert.Hargreaves@bbklaw.com>
Sent: Friday, September 1, 2023 3:15 PM
To: Shawn Muir <smuir@palmdesert.gov>; Jessica Gonzales <jgonzales@palmdesert.gov>
Cc: Todd Hileman <thileman@palmdesert.gov>; Veronica Chavez <vchavez@palmdesert.gov>; Isra Shah
<isra.shah@bbklaw.com>; Brendan B. Kearns <BKearns@rwglaw.com>; Randy Chavez <rchavez@palmdesert.gov>
Subject: RE: Notice of Claim & Tender of Claim Letter (Claim No. 901) [attorney client privilege]
Jessica:
Typically, tender letters go out to everyone; and we let the various insurance agencies sort it out. Is the JPIA involved?
Any thoughts Brenda?
Bob
Robert Hargreaves
Partner
robert.hargreaves@bbklaw.com
T: (760) 837-1604
|
C: (760) 861-0347
bbklaw.com |
From: Shawn Muir <smuir@palmdesert.gov>
Sent: Friday, September 1, 2023 3:11 PM
To: Jessica Gonzales <jgonzales@palmdesert.gov>; Robert Hargreaves <Robert.Hargreaves@bbklaw.com>
Cc: Todd Hileman <thileman@palmdesert.gov>; Veronica Chavez <vchavez@palmdesert.gov>; Isra Shah
<Isra.Shah@bbklaw.com>; Brendan B. Kearns <BKearns@rwglaw.com>; Randy Chavez <rchavez@palmdesert.gov>
Subject: RE: Notice of Claim & Tender of Claim Letter (Claim No. 901) [attorney client privilege]
CAUTION - EXTERNAL SENDER.
Team,
The letter to WCA went out Wednesday for delivery today. I will let you all know of any updates.
Thank you,
Shawn
.
.
Shawn Muir
Community Services Manager
760.776.6481
smuir@palmdesert.gov | www.palmdesert.gov
73510 Fred Waring Drive, Palm Desert, CA, 92260
3
From: Jessica Gonzales <jgonzales@palmdesert.gov>
Sent: Friday, September 1, 2023 2:56 PM
To: Robert Hargreaves <robert.hargreaves@bbklaw.com>
Cc: Todd Hileman <thileman@palmdesert.gov>; Veronica Chavez <vchavez@palmdesert.gov>; Isra Shah
<isra.shah@bbklaw.com>; Brendan B. Kearns <BKearns@rwglaw.com>; Shawn Muir <smuir@palmdesert.gov>
Subject: FW: Notice of Claim & Tender of Claim Letter (Claim No. 901) [attorney client privilege]
Hi Bob,
As recommended, a tender letter was issued to RPM. We have received a rejection letter from RPM related to the Claim
No. 901, see attached.
On Thursday, August 30th, 2023, a call was made by Mr. Garibaldi requesting to have an impromptu meeting to discuss
the tender letter he received. Mr. Garibaldi requested a detailed step by step description of the incident. I informed
him that the was Teresa Vakili’s responsibility to provide. After she walked through the description, Mr. Garibaldi asked
if we had a contracted vendor to maintain the trees and palm trees and I confirmed we did.
I know Shawn was working on a tender letter to WCA but not certain if that has been issued.
Please advise on the next steps.
Thank you.
Jessica Gonzales
Housing Manager
760.776.6410
jgonzales@palmdesert.gov | www.palmdesert.gov
73510 Fred Waring Drive, Palm Desert, CA, 92260
From: Todd Hileman <thileman@palmdesert.gov>
Sent: Friday, September 1, 2023 2:27 PM
To: Isra Shah <isra.shah@bbklaw.com>; Veronica Chavez <vchavez@palmdesert.gov>; Jessica Gonzales
<jgonzales@palmdesert.gov>
Subject: FW: Notice of Claim & Tender of Claim Letter (Claim No. 901)
.
.
Todd Hileman
City Manager
760.776.6305
thileman@palmdesert.gov | www.palmdesert.gov
73510 Fred Waring Drive, Palm Desert, CA, 92260
1
Gloria Sanchez
From:Andrea Staehle
Sent:Friday, September 1, 2023 2:29 PM
To:Amber Molina; Gloria Sanchez
Subject:FW: Notice of Claim & Tender of Claim Letter (Claim No. 901)
Attachments:We sent you safe versions of your files; 2023.09.01 RPM Rejection of Lua claim
tender.pdf; Tender of Claim SILVIA FARIAS LUA - O.Q. Resident #2401 (Claim No. 901)
(002).pdf
FYI…
.
.
Andrea Staehle
Human Resources Manager
760.776.6337
astaehle@palmdesert.gov | www.palmdesert.gov
73510 Fred Waring Drive, Palm Desert, CA, 92260
From: Todd Hileman <thileman@palmdesert.gov>
Sent: Friday, September 1, 2023 2:27 PM
To: Andrea Staehle <astaehle@palmdesert.gov>
Subject: FW: Notice of Claim & Tender of Claim Letter (Claim No. 901)
.
.
Todd Hileman
City Manager
760.776.6305
thileman@palmdesert.gov | www.palmdesert.gov
73510 Fred Waring Drive, Palm Desert, CA, 92260
From: Todd Hileman <thileman@palmdesert.gov>
Date: Friday, September 1, 2023 at 2:27 PM
To: Isra Shah <isra.shah@bbklaw.com>, Veronica Chavez <vchavez@palmdesert.gov>, Jessica Gonzales
2
<jgonzales@palmdesert.gov>
Subject: FW: Notice of Claim & Tender of Claim Letter (Claim No. 901)
From: Julie Wood <juliewood@rpmcompany.com>
Date: Friday, September 1, 2023 at 2:09 PM
To: Todd Hileman <thileman@palmdesert.gov>
Cc: Jessica Gonzales <jgonzales@palmdesert.gov>, Teresa Vakili <TeresaVakili@rpmcompany.com>, Marilyn
Mack <marilynmack@rpmcompany.com>, Donnie Garibaldi <Donnie@rpmcompany.com>
Subject: FW: Notice of Claim & Tender of Claim Letter (Claim No. 901)
Mimecast Attachment Protection has deemed this file to be safe, but always exercise caution when opening files.
Mr. Hileman: We are in receipt of your attached Notice of Claim & Tender of Claim Letter (Claim No. 901). I am sending the attached response letter on behalf of Mr. Garibaldi. We have also sent a copy via Certified mail. Please let us know if you have any questions. Thank you
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Mr. Hileman:
We are in receipt of your attached Notice of Claim & Tender of Claim Letter (Claim No. 901). I
am sending the attached response letter on behalf of Mr. Garibaldi. We have also sent a copy
via Certified mail.
Please let us know if you have any questions. Thank you,
Best Regards,
Julie Wood
juliewood@rpmcompany.com
HR & Porƞolio Manager
RPM Company
Cell: (951) 990-6776
_______________________________________________
RPM Company
Lodi Office:209-333-3400
HR Fax:209-333-3407
1420 S. Mills, Suite M
Lodi, CA 95242
From: Jessica Gonzales <jgonzales@palmdesert.gov>
Sent: Tuesday, August 29, 2023 11:04 AM
To: Donnie Garibaldi <Donnie@rpmcompany.com>
Cc: Marilyn Mack <marilynmack@rpmcompany.com>; Teresa Vakili <TeresaVakili@rpmcompany.com>
Subject: Notice of Claim & Tender of Claim Letter (Claim No. 901)
Donnie,
3
You will be receiving a Tender of Claim Letter today. I apologize, the letter was sent without a copy of the claim and was
resent yesterday. The letter and a full copy of the attachments will be delivered tomorrow and a copy was attached for
your reference.
Thank you.
.
.
Jessica Gonzales
Housing Manager
760.776.6410
jgonzales@palmdesert.gov | www.palmdesert.gov
73510 Fred Waring Drive, Palm Desert, CA, 92260
1
Gloria Sanchez
From:Angelica Alcantara <aalcantara@wcainc.com>
Sent:Friday, September 1, 2023 10:26 AM
To:Janice Baluyut
Cc:Gloria Sanchez
Subject:RE: CJP-3049588 - City of Palm Desert - Request for maintenance records 72600 Fred
Waring Dr.
Attachments:We sent you safe versions of your files; One Quail Place LOT 294.pdf
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Good morning, Janice,
AƩached, please find the work records being requested.
Best Regards,
Angie Alcantara
Senior Claims Coordinator | West Coast Arborists, Inc.
Certified Treecare Safety Professional #05149
(714) 991-1900 Ext.117 Office | (888) 988-0192 Fax
aalcantara@wcainc.com | www.wcainc.com
From: Janice Baluyut <jbaluyut@carlwarren.com>
Sent: Thursday, August 31, 2023 3:43 PM
To: Angelica Alcantara <aalcantara@wcainc.com>
Cc: Gloria Sanchez <gsanchez@palmdesert.gov>
Subject: RE: CJP-3049588 - City of Palm Desert - Request for maintenance records 72600 Fred Waring Dr.
Hi, Angelica
May we please request the maintenance records for the subject tree below at the address of 72600 Fed Waring Dr.
If you don’t handle these requests, please let me know who to contact for the records.
Thank you
1
Gloria Sanchez
From:Gloria Sanchez
Sent:Tuesday, August 29, 2023 9:13 PM
To:Janice Baluyut
Subject:FW: CJP-3049588 - City of Palm Desert - Claim Against the City 901 - Lua, Silvia
Good morning, Ms. Baluyut:
Below in blue find staff responses to your quesƟons. AddiƟonally, the link below provides pictures taken by staff.
hƩps://cpdŌp.org/link/6A5es21LHGruabnhzIEE47
If you have quesƟons or need addiƟonal informaƟon, please do not hesitate to contact me.
Kind regards,
Gloria
From: Shawn Muir <smuir@palmdesert.gov>
Sent: Tuesday, August 29, 2023 4:05 PM
To: Gloria Sanchez <gsanchez@palmdesert.gov>
Cc: Randy Chavez <rchavez@palmdesert.gov>; Jessica Gonzales <jgonzales@palmdesert.gov>
Subject: RE: CJP-3049588 - City of Palm Desert - Claim Against the City 901 - Lua, Silvia
Hi Gloria,
Please see responses to the quesƟons below.
1. Does the City own and maintain the tree?
The City does own the tree and maintains them.
2. Was the tree planted as part of the city’s overall beautification design?
The tree was planted as part of the City’s general landscape design and may have been
included as part of the landscape design for One Quail Place.
3. What type of tree is this?
Mesquite
4. What is the reasonable maintenance schedule for this type of tree?
Annual or bi-annual pruning.
5. What does staff believe was the cause of the failure?
Unknown.
6. When staff inspected the tree following the failure, was there any decay or structural weakness
noted? If so, was the decay/structural weakness visible from the outside?
City staff did not inspect the tree. The contracted arborist, WCA, was contacted to address the
broken branches and conduct inspection.
7. Were repairs to the adjacent sidewalk or street ever made in the past? If so, were any of the
tree’s roots pruned? Was an arborist consulted prior to the roots being pruned to evaluate
whether or not the structural integrity of the tree could be compromised?
In the recent past, there have been no repairs to the adjacent street or sidewalk have been
made. WCA is the City’s arborists consultant and maintains such as the root. The City does
not perform the actual maintenance.
2
8. Were there documented complaints about the tree? If so, what did the City do in response to
those complaints?
No, there were no documented complaints about the tree.
9. Have other trees of this type fallen in this neighborhood? If so, what was the cause of those
failures, if known.
No, there have not been other trees of this type fallen in this neighborhood that we are aware
of.
10. If it is a City tree, please provide the tree’s historical maintenance records, any incident report
or police report prepared by staff, and any photographs taken by staff.
The historical maintenance records are maintained by WCA. There were no incident reports or
police reports prepared by staff. Please take attached photographs by staff.
11. Please forward the maintenance records for the subject tree.
Please request these records from WCA.
12. If there are no maintenance records, please advise date of last trim?
N/A
.
.
Shawn Muir
Community Services Manager
760.776.6481
smuir@palmdesert.gov | www.palmdesert.gov
73510 Fred Waring Drive, Palm Desert, CA, 92260
From: Gloria Sanchez <gsanchez@palmdesert.gov>
Sent: Wednesday, August 23, 2023 10:43 AM
To: Shawn Muir <smuir@palmdesert.gov>
Cc: Randy Chavez <rchavez@palmdesert.gov>; Jessica Gonzales <jgonzales@palmdesert.gov>
Subject: FW: CJP-3049588 - City of Palm Desert - Claim Against the City 901 - Lua, Silvia
Importance: High
Good morning,
At your earliest convenience, will you please answer the quesƟons below. To easily disƟnguish your answers, please
change the font color.
Thank you and have a nice day.
M. Gloria Sanchez
Records Coordinator
760.776.6354
gsanchez@palmdesert.gov | www.palmdesert.gov
73510 Fred Waring Drive, Palm Desert, CA, 92260
From: Janice Baluyut <jbaluyut@carlwarren.com>
Sent: Wednesday, August 23, 2023 10:31 AM
3
To: Gloria Sanchez <gsanchez@palmdesert.gov>
Cc: Andrea Staehle <astaehle@palmdesert.gov>; Amber Molina <amolina@palmdesert.gov>
Subject: FW: CJP-3049588 - City of Palm Desert - Claim Against the City 901 - Lua, Silvia
Your attachments have been security checked by Mimecast Attachment Protection. Details of potentially unsafe files have been
attached.
Good morning,
Please provide us with the following informaƟon:
1. Does the City own and maintain the tree?
2. Was the tree planted as part of the city’s overall beautification design?
3. What type of tree is this?
4. What is the reasonable maintenance schedule for this type of tree?
5. What does staff believe was the cause of the failure?
6. When staff inspected the tree following the failure, was there any decay or structural weakness
noted? If so, was the decay/structural weakness visible from the outside?
7. Were repairs to the adjacent sidewalk or street ever made in the past? If so, were any of the
tree’s roots pruned? Was an arborist consulted prior to the roots being pruned to evaluate
whether or not the structural integrity of the tree could be compromised?
8. Were there documented complaints about the tree? If so, what did the City do in response to
those complaints?
9. Have other trees of this type fallen in this neighborhood? If so, what was the cause of those
failures, if known.
10. If it is a City tree, please provide the tree’s historical maintenance records, any incident report
or police report prepared by staff, and any photographs taken by staff.
11. Please forward the maintenance records for the subject tree.
12. If there are no maintenance records, please advise date of last trim?
Thank you.
Janice Baluyut
Claims Examiner
jbaluyut@carlwarren.com
Tel: (657) 622-4326 | Fax: (866) 254-4423
Carl Warren & Company, LLC
CA Entity License No: 2607296
www.carlwarren.com
PO Box 2411, Tustin, CA, 92781
Because Quality and Integrity Matter... please EMAIL my Supervisor about the service you received.
4
Important Notice: This email (including any attachments) is intended solely for the use of the individual or
entity to which it is addressed, and may contain information that is confidential, proprietary, non-public
and/or privileged. If you are not the intended recipient, you are hereby notified that any use, dissemination,
distribution, or copying of this communication is strictly prohibited. If you have received this email in error,
please delete it from your system and advise the sender immediately. Please be advised that we are unable to
bind, endorse or amend coverage via voicemail, email, or facsimile until confirmed in writing by an authorized
representative of this office. We accept no liability for any damage caused by any virus transmitted by this
email. It is your responsibility to check this email (including any attachments) for viruses.
From: Tim Varon <TVaron@carlwarren.com>
Sent: Wednesday, August 23, 2023 9:41 AM
To: Gloria Sanchez (gsanchez@palmdesert.gov) <gsanchez@palmdesert.gov>
Cc: Janice Baluyut <jbaluyut@carlwarren.com>; Andrea Staehle <astaehle@palmdesert.gov>; Amber Molina
<amolina@palmdesert.gov>
Subject: FW: CJP-3049588 - City of Palm Desert - Claim Against the City 901 - Lua, Silvia
Hi Gloria,
Please find aƩached a copy of our NoƟficaƟon LeƩer for your records.
Have a great day!
Tim
Tim Varon
Claims Supervisor
TVaron@carlwarren.com
Tel: (657) 622-4287 | Fax: (866) 254-4423
Carl Warren & Company, LLC
CA Entity License No: 2607296
www.carlwarren.com
PO Box 2411, Tustin, CA, 92781
Because Quality and Integrity Matter... please EMAIL my Supervisor about the service you received.
From: Gloria Sanchez <gsanchez@palmdesert.gov>
Sent: Tuesday, August 22, 2023 1:40 PM
To: PublicEntity Claims <PublicEntityClaims@carlwarren.com>; Todd Hileman <thileman@palmdesert.gov>; Isra Shah
<isra.shah@bbklaw.com>; Robert Hargreaves <robert.hargreaves@bbklaw.com>
Cc: Chris Escobedo <cescobedo@palmdesert.gov>; Andrea Staehle <astaehle@palmdesert.gov>; Anthony Mejia
5
<amejia@palmdesert.gov>; Tim Varon <TVaron@carlwarren.com>; Jessica Gonzales <jgonzales@palmdesert.gov>
Subject: CJP-3049588 - City of Palm Desert - Claim Against the City 901 - Lua, Silvia
Good aŌernoon,
AƩached for your review and appropriate acƟon is Claim No. 901 – Silvia F. Lua.
If you have quesƟons or need addiƟonal informaƟon, please do not hesitate to contact me.
Thank you and have a good day.
.
.
M. Gloria Sanchez
Records Coordinator
760.776.6354
gsanchez@palmdesert.gov | www.palmdesert.gov
73510 Fred Waring Drive, Palm Desert, CA, 92260
1
Gloria Sanchez
From:Tim Varon <TVaron@carlwarren.com>
Sent:Wednesday, August 23, 2023 9:41 AM
To:Gloria Sanchez
Cc:Janice Baluyut; Andrea Staehle; Amber Molina
Subject:FW: CJP-3049588 - City of Palm Desert - Claim Against the City 901 - Lua, Silvia
Attachments:2023-08-22 Lua, Silvia - 901.pdf; 20230823 Lua Palm Desert NOTIFICATION LETTER
3049588.pdf
Hi Gloria,
Please find aƩached a copy of our NoƟficaƟon LeƩer for your records.
Have a great day!
Tim
Tim Varon
Claims Supervisor
TVaron@carlwarren.com
Tel: (657) 622-4287 | Fax: (866) 254-4423
Carl Warren & Company, LLC
CA Entity License No: 2607296
www.carlwarren.com
PO Box 2411, Tustin, CA, 92781
Because Quality and Integrity Matter... please EMAIL my Supervisor about the service you received.
Important Notice: This email (including any attachments) is intended solely for the use of the
individual or entity to which it is addressed, and may contain information that is confidential,
proprietary, non-public and/or privileged. If you are not the in tended recipient, you are hereby notified
that any use, dissemination, distribution, or copying of this communication is strictly prohibited. If you
have received this email in error, please delete it from your system and advise the sender immediately.
Please be advised that we are unable to bind, endorse or amend coverage via voicemail, email, or
facsimile until confirmed in writing by an authorized representative of this office. We accept no
liability for any damage caused by any virus transmitted by this email. It is your responsibility to
check this email (including any attachments) for viruses.
2
From: Gloria Sanchez <gsanchez@palmdesert.gov>
Sent: Tuesday, August 22, 2023 1:40 PM
To: PublicEntity Claims <PublicEntityClaims@carlwarren.com>; Todd Hileman <thileman@palmdesert.gov>; Isra Shah
<isra.shah@bbklaw.com>; Robert Hargreaves <robert.hargreaves@bbklaw.com>
Cc: Chris Escobedo <cescobedo@palmdesert.gov>; Andrea Staehle <astaehle@palmdesert.gov>; Anthony Mejia
<amejia@palmdesert.gov>; Tim Varon <TVaron@carlwarren.com>; Jessica Gonzales <jgonzales@palmdesert.gov>
Subject: CJP-3049588 - City of Palm Desert - Claim Against the City 901 - Lua, Silvia
Good aŌernoon,
AƩached for your review and appropriate acƟon is Claim No. 901 – Silvia F. Lua.
If you have quesƟons or need addiƟonal informaƟon, please do not hesitate to contact me.
Thank you and have a good day.
.
.
M. Gloria Sanchez
Records Coordinator
760.776.6354
gsanchez@palmdesert.gov | www.palmdesert.gov
73510 Fred Waring Drive, Palm Desert, CA, 92260
PO Box 2411, Tustin, CA 92781
T: 657-622-4200 | F: 866-254-4423 | www.carlwarren.com
CA License #2607296
August 23, 2023
Silvia Farias Lua
72-600 Fred Waring Dr., Apt. #2401
Palm Desert, CA 92260
RE: Claimant : Silvia Farias Lua
Date of Loss : 7/14/23
Claim Filing Date : 8/22/23
Our File Number : 3049588 JBV
Carl Warren & Company is the claims management company for the City of Palm Desert. The
above-captioned claim has been assigned to Janice Baluyut for handling. Ms. Baluyut may be
reached at 657-622-4326.
When our investigation is complete, we will advise you as to whether or not we can recommend
settlement.
Very Truly Yours,
CARL WARREN & CO.
Timothy M. Varon
Timothy M. Varon
Claims Supervisor
cc: Member Agency: City of Palm Desert, attn:Gloria Sanchez
1
Gloria Sanchez
From:Gloria Sanchez
Sent:Tuesday, August 22, 2023 1:40 PM
To:Carl Warren & Co. (publicentityclaims@carlwarren.com); Todd Hileman; Isra Shah;
Robert Hargreaves
Cc:Chris Escobedo; Andrea Staehle; Anthony Mejia; Tim Varon; Jessica Gonzales
Subject:Claim Against the City 901 - Lua, Silvia
Attachments:2023-08-22 Lua, Silvia - 901.pdf
Good aŌernoon,
AƩached for your review and appropriate acƟon is Claim No. 901 – Silvia F. Lua.
If you have quesƟons or need addiƟonal informaƟon, please do not hesitate to contact me.
Thank you and have a good day.
n f" ~ ·•r::· -
_ ,,: /:: ... t'~ ~ .. ,,,.,CLAIM AGAINST THE CITY OF PALM DESERT 'SIT ( vL.:i' 1 J L 1 . ,..., At H E 5 ER T . c: Fo r Damage(s) to Pe rson(s) o r Personal Property
2 7 AUG 22 A II: 02 ASSIGNED CLAIM NO . 9 0 I /
Rece ived by : _____ _ Vi a: U.S . MAIL __ _ In t eroffice Mai l ___ Over-the-Counter /2
A cl a im mu st be filed with t he City Clerk of the City of Palm Desert within six (6) months
afte r whi c h th e inc id ent or eve nt occu rred. Be sure your claim is against the City of Palm
Des ert, not another pu blic entity. Where space is insufficient, please use additional paper
and id entify inform ation by paragraph number. Completed claims must be mailed
or de liv e red to the City Clerk, City of Palm Desert, 73-510 Fred Waring Drive,
Pa lm Desert CA 922 60
TO THE HONORABLE MAYO R AND CITY COUNC I L, CITY OF PALM DESERT, CALIFORNIA:
The undersign e d respectfu lly s u bmit(s) t he follow ing cla im a nd in formation relative to damage(s) to
perso n(s) and/or perso na l p rope rty :
1. CLA IM A NT INFO;ATION r 6 ,,.,
NAME '5.-~ '1j ,F:-·t:<-$. ~v
A DDRESS ~t ~o ~ ,:,:2 w:: lf Dr f) pt ,;; '/d71 G ia .De5,,i/ M
PHONE NO. ( </Lj~) s3 (2 :Z -f l 3 ?° DA E OF BIRTH : ~~?I ~-I ?6" /
DRIVER 'S LICEN S E NO . Q d-.,,<t)/t2 ?f" S/ i,~).,14/ yJJ1 # ~j .//t1ii~c tJ/Jtt
2 . Na me , telephone num be r a nd post office add ress to w h ich c la imant desires not ices to be sent, if
d iffe rent th an above :
3 . Occurren ce o r ev e nt from which the claim arises :
a. DAT E : 0 ,, I -0 ' b. Tl~E : ,-2,30 f:,,Lt . c. PLACE
d. How a nd und e r what c ircum st ances di d damage or injury occur? Specify the particular
occ urre nce , eve nt , act o r o mi ssio n y o u c lai m ca used the injury o r damage. (Use additional
pa pe r if ne ces sary.
Page 1 of 2
4. Give a general description of the in debtedness, obli gati o n, inj ury , damage , or lo ss incu r red so far as
it m½ be kno n at the-time of pr se nt t io n of the c l im. If t he re wer no inj uries , state "no ·nju~ies":
I~ · YI . ~ t7 . ~. SA#l;;X~:£:41JJ;!f!t7::};1[JJ?/
5 .
C qi/ s e. c;_n:;,q-J e.. .
Give the name(s) of the City employee (s) ca using the damage o r injury:
6 . Name and address of any other pe rso n(s) injured: _________________ _
7.
8 . Damages C laimed:
a. Amo un t claimed as of this date: $ ~ / tJ 7 , G 2-
b. Estimated amount of future costs : $ __________ _
c. Total amount claimed: $ , :5;. I &,?, 6"2,.
d . Basis for computation of amounts cl ai me d (include co pies of all bills , invoices , estimates, etc .):
!bcbded I
9.
~~~~~~~~~~~~~~~4 /
10 . Any additional info r mation, inc uding police reports, which m ight be helpful in c o ns ider ing t his c laim:
W AR NING: IT IS A CR IM INAL OFFENS E TO FILE A FALSE CLAIM! (CALI FORNIA PENAL
CODE 72 AND CALIFORNIA INSURANCE CODE)
I have read the matters and stateme nts made in the above claim, and I know the s ame to be true of my
o wn knowledge , except as to those matters stated upon information or b elief as to s uch matters, I believe the
sa me to be true . I certify under penalty of perj ury that the foregoing is TR UE ANO CO RRECT.
Signed this • day of 6jff&;r;/ , 20.,.2.J!, at ~ Jl,:,e?/ (!,j/
Office of the City Clerk , Palm Dese rt, California
Pa ge 2 of 2
SIGNATUR E OF CLAIMANT
DOC . NO. DATE FIL ED ------------
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