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Home My WebLink About2021-10-19 CLAIM NO. 859-SANDY, MARGARET.pdf(ITT Of PRIM DESERT 73-510 FRED WARING DRIVE PALM DESERT, CALIFORNIA 92260-2578 TEL: 760 346-0611 INFO1A PALM-DESER'I'.ORG TO: CJPIA (c/o CARL WARREN & CO.), CITY MANAGER, CITY ATTORNEY, RISK MANAGER COPY: ASSISTANT CITY MANAGER, DIRECTOR OF DEVELOPMENT SERVICES, DIRECTOR OF PUBLIC WORKS. DIRECTOR OF ADMINISTRATIVE SERVICES, AND CITY CLERK. FROM: CORA L. GAUGUSH, MANAGEMENT SPECIALIST II DATE: October 19, 2021 SUBJECT: CLAIM NO. — 859-SANDY, MARGARET The attached Claim No. 859-SANDY, MARGARET is being transmitted to you for the following: or Information only. Please review and provide any recommendation you may have to the Risk Manager, concerning any action required by the City of Palm Desert. We would appreciate your report, if requested, by November 18, 2021, for timely response to the Claimant. Note: At your earliest convenience, please let me know if you have any information related to the incident giving rise to this Claim so that I may forward it to the City's third - party Claims Adjusters, Carl Warren & Company. Cora L. Gaugush Management Specialist II Attachment (as noted) RECEIVED f'ICE PALM DESERT CIA MS • 2021 OCT 18 AM 11: 03 CLAIM AGAINST THE CITY OF PALM DESERT For Damage(s) to Person(s) or Personal Property Received by. : U.S. MAIL ASSIGNED CLAIM NO. 859' Interoffice Mail Over -the -Counter A claim must be filed with the City Clerk of the City of Palm Desert within six (6) months after which the incident or event occurred. Be sure your claim is against the City of Palm Desert, not another public entity. Where space is insufficient, please use additional paper and identify information by paragraph number. Completed claims must be mailed or delivered to the City Clerk, City of Palm Desert, 73-510 Fred Waring Drive, Palm Desert, CA 92260 TO THE HONORABLE MAYOR AND CITY COUNCIL, CITY OF PALM DESERT, CALIFORNIA: The undersigned respectfully submit(s) the following claim and information relative to damage(s) to person(s) and/or personal property: 1. CLAIMANT INFORMATION NAME h a ,� & 4 . ADDRESS 7/SD � _ oH4 6r4i )).i»» I) •, .,/rr► )oLPrt. OW 9-*.2 O PHONE NO. (7lun ) .3 - c744 DATE OF BIRTH: g -iG - SOCIAL SECURITY NO.. 3h,v - feet, DRIVER'S LICENSE NO. 2-0 3.4 2. Name, telephone number and post office address to which claimant desires notices to be sent, if different than above: 3. Occurrence or event from which the claim arises: u'di'Gc a. DATE: 'S - 'I - b. TIME: ,� 4S Pk c. PLACE (Exact and sp cific location) Ain-drh P.t c-r PaaLi , i..? - {Ltn krre .. koCaoh 1 i ,, h t 5 C.. .• r/ dr. �r,.-r To i. ��sr� <✓ (QtirTS CTQpL nG w cy,r d. How and under what circumstances did damage or injury occur? Specify the particular occurrence, event, act or omission you claim caused the injury or damage. (Use additional paper if necessary.) 7-2. ' ,/7 ,Z,cjrpc-4, ' it c b, 1�e4',L.LIe ix» ,/L /7ptke d of 6,j// �l • e /al - L ! 4, al& h So, n T n. b 1 t 6 i4 ..i LA=Q Pa val C L i L,' " c Cu. rft-e4" ►tar k J 1 h 14-,11, ay.,‘. ,f C4.• fh .•-let ei tv% lU • e (h r'1.i /.er - l Lir. Z�,.tu.-r Nta .-11i. gS.p.h,, I/ — (Inn c A e. What particular action by the City, or its employees, caused the alleged damage or injury? Lei, ILA Q r0 rha tnTi-,i n / re, r t n oil QPIit17i!i 6 n tiY.ea— Ll), is Per lc, NCI Mt CLULL,' -t-rar 4-Cc4y r.,4„ Page 1 of 2 C. neIt) Rr,.mp ) Give a general description of theindebtedness, obligation, injury, damage, or loss;incurredso far` as' it may be known at the time of presentation of the claim. If there were no injuries,.state "no injuries": tVa /n3vizies, inn S0fr f a -In 1. Fe.,tei+L.( d6moy.a r.ibss n-F ' L' ��t,C.V.a'c-�-� Ghea[na.1 r[uCToVn•vr..S - --incs of ULA[ t.l..¢, 01-[1".[l Reins rl-,aA•.. `''= i - 5. Give the name(s) of the City employee(s) causing the *Page, or injury: '/P1,J- A20 net: 6G eh- 1 i2Olc. rk.ad Zvi fa hit ' 6. Na'e and address of'eny other person(s) injured: 91' �i'h -eec f h;) l//r ` " mG� 7. Name and'address ofthey owner of any damage pproperty: /Via P-�4- 4:_f;), 4+ t�/1(µ pq rirZ�j A p/I�S A �- - /4/nr,� i OrOrE ((/a 9 . e 4o 99 ., A. 8. DamagesClaimed: _ SQr a-[(��I ct a. Amount claimed as of this date: Sr Cost o (Za p[, c s Y , b. Estimated amount -of future costs: $1 • - �- } 3 e��cz c. Totaamount claimed' $ N4 ; QGn • 06 'f- COST- o T' nnpo rr s d. Basisii for computatlo of amounts claim'(n edcliide copies of all bills, mvo!oes, estirriates, etc,): hnJ. S 0 "'ue,i,as- s OGc nc., n'r5'r �oGTnm,etes -Cot,-,9_,, -l.'ns ..Do -Pi Mn7'rote 9. Names and ac?dress of all witnesses, hospitals, doctors, etc.: 10. Any additional informat!on,,including police repojts, which might be helpful in considering this claim: - • WARNING: IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM! (CALIFORNIA PENAL CODE 72 AND CALIFORNIA INSURANCE CODE) I have7ead-the-matters-and-statements-made-in-the-above-claim; and I know the same to be true of my own knowledge, except as to those matters stated upon information or belief as to such matters, I believe the same to be true. I certify under penalty of perjury that the foregoing is TRUE AND CORRECT. Signed this /.3 day of / SIGNAT cri OF CLAI ANT 20,a/ , at it6yeatt M SIGNATURE OF CLAIMANT Office of the City Clerk, Palm Desert, California DOC. NO. DATE FILED Page 2of2 CALIBER COLLISION CALIBER - PALM DESERT RESTORING THE RHYTHM OF YOUR LIFE 74818 Joni Dr, Palm Desert, CA 92260 Phone: (760) 346-7760 FAX: (760) 346-2395 Final Bill Workfile ID: Federal ID: State EPA: BAR: 956cb18b 33-0730794 CAL000440401 ARD292835 RO Number: 1146002819 Customer: SANDY, MARGARET 74049 OAK SPRINGS DR PALM DESERT, CA 92260 (760) 668-7794 Insurance: STATE FARM INSURANCE Adjuster: Phone: Claim: Loss Date: Deductible: Express Team U (855) 341-8184 Business 75-20G9-14Q01 5/27/2021 500.00 Estimator: Create Date: Frank Ciezenski 5/28/2021 2016 TOYO Tacoma SR5 Access Cab Automatic 4D P/U 4-2.7L Gasoline Sequential MPI GRAY VIN: License: State: STFRX5GNEGX067768 69114C3 CA Interior Color: Exterior Color: GRAY Production Date: 4/2016 Mileage In: Mileage Out: Condition: 86,747 86,747 Vehicle Out: 6/28/2021 Job #: Line Ver Operation Description Qty Extended Price $ Part Labor $ Type Paint Type 1 2 3 4 5 6 7 E01 E01 SO2 SO2 E01 E01 E01 Remove/Install Remove/Replace Remove/Replace Remove/Install Repair 8 E01 Remove/Install 9 E01 Remove/Install 10 E01 Repair 11 E01 Remove/Install 12 SO2 13 SO2 Remove/Replace 14 502 Remove/ Replace 15 SO2 Remove/Replace 16 501 17 502 Remove/Replace 18 SO1 19 E01 20 E01 Remove/Replace 21 E01 FRONT BUMPER R&I bumper assy LT Side retainer RT Side retainer GRILLE R&I grille assy Upper grille w/gray, w/o smoked finish gray Emblem Grille surround black Grille surround black Lower grille FRONT LAMPS LT Headlamp assy w/o LED NOTE: MATCH PART PRICE, AND PART # Aim headlamps RT Headlamp assy w/o LED NOTE: MATCH PART PRICE, AND PART # HOOD hood Overlap Major Non-Adj. Panel FENDER RT Fender w/o wheel opening molding Overlap Major Adj. Panel 1 1 31.61T OEM 31.61T OEM 1 362.00T Non OEM PER INVOICE 1 362.00T Non OEM PER INVOICE 1 1 430.00T RCY 311.04T OEM 64.00 Body 4.00 Body 0.00 Body 12.00 Body 40.00 Body 4.00 Body 8.00 Body 20.00 Body 12.00 Body 8.00 Body 20.00 Body 8.00 Body 24.00 Body 52.00 Body T = Taxable Item, RPO = Related Prior Damage, AA = Appearance .Allowance, UPC = Unrelated Pner Damage, POR = Paintfess Dent Repair, A/M = Aftermarket, Rechr = Rethromed, Reman = Remanufactured, OEM = New Onginal Equipment Manufacturer, Recor = Re -cored. RECOND = Reconditioned, LKQ = Like Kind Quality or Used, Drag = Diagnostic, Elec = Electrical, Mech = Mechanical, Ref = Refinish, Steuc = Structural 6/28/2021 3:22:27 PM 44.00 12.00 120.00 (8.00) 88.00 (16.00) Page 1 Final Bill RO Number: 1146002819 2016 TOYO Tacoma SRS Access Cab Automatic 4D P/U 4-2.7L Gasoline Sequential MPI GRAY 22 E01 Add for Edging 20.00 23 E01 Add for Clear Coat 4.00 24 E01 Repair LT Fender w/o wheel opening molding 120.00 Body 88.00 25 E01 Overlap Major Adj. Panel (16.00) 26 E01 Remove/Install LT Fender liner 12.00 Body 27 E01 Remove/Install RT Fender liner 0.00 Body 28 502 Remove/Replace LT Fender liner grommet 13 10.79T OEM 29 502 Remove/Replace LT Fender liner dip 10 13.20T OEM 30 502 Remove/Replace RT Fender liner dip 10 13.20T OEM 31 502 Remove/Replace RT Fender liner grommet 13 10.79T OEM 32 SO2 AIR CONDITIONER & HEATER 33 SO2 Remove/Replace Filter element 1 38.50T OEM 34 E01 WINDSHIELD 35 SO2 Sublet Windshield Toyota 1 172.32 Glass 36 502 LABOR 1 80.00T Other 37 E01 Sublet Urethane ICR 1 20.00 Sublet 38 E01 Remove/Replace LT Reveal molding 1 44.16T OEM 12.00 Body 39 E01 Remove/Replace RT Reveal molding 1 44.16T OEM 12.00 Body 40 E01 CAS 41 502 Repair Roof panel 440.00 Body 104.00 42 E01 Overlap Major Adj. Panel (16.00) 43 SO2 Repair RT Hinge pillar 300.00 Body 80.00 44 E01 Remove/Replace LT Side panel protector 1 14.57T OEM 12.00 Body 45 E01 Repair LT Hinge pillar 200.00 Body 80.00 46 E01 Overlap Major Non-Adj. Panel (8.00) 47 E01 Remove/Replace RT Side panel protector 1 14.57T OEM 12.00 Body 48 E01 Remove/Install LT Surround w'sbip 20.00 Body 49 E01 . Remove/Install RT Surround w'strip 20.00 Body 50 E01 Remove'Inslaii R&I headliner 100.00 Body 51 E01 Remove/Replace LT Drip molding 1 80.59T OEM 20.00 Body 52 E01 Remove/Replace RT Drip molding 1 80.59T OEM 20.00 Body 53 E01 ELECTRICAL 54 E01 Remove/Install Antenna 72.00 Body 55 E01 Remove/Install Deduct for Overlap (32.00) Body 56 E01 FRONT DOOR 57 E01 Repair LT Outer panel 80.00 Body 84.00 58 E01 Overlap Major Adj. Panel (16.00) 59 SO1 Repair RT Door shell 160.00 Body 84.00 60 E01 Overlap Major Adj. Panel (16.00) 61 502 Remove/Replace RT Mirror assy w/o blind spot w/o signal lamp 1 121.00T Non OEM 16.00 Body NOTE: MATCH PART PRICE, AND PART # PER INVOICE 62 E01 Remove/Replace Dis/reassmble to refn 16.00 Body 63 E01 Remove/Replace RT Mirror cover w/o signal lamp black 1 52.29T OEM 0.00 Body T = Taxable Ian, RPD = Related Rion Damage, AA = Appearance Allowance, UPD = Unrelated Rim Damage, PO0. = Paintless Dent Repair, NM = ARanarket, Redo = RedutnS, !Zeman = Remanufacored, OEM = New Original Equipment Manufacture, Res = Reined, RECOND = Reconditioned, LRQ = Like Kind Quality ar Used, Dag = Diagnostic, Eec = Electrical, Medi = Palmlike!, Ref = Refinish, Struc = SbumPal 6/28/2021 3:22:27 PM Page 2 Final Bill RO Number: 1146002819 2016 TOYO Tacoma SRS Access Cab Automatic 4D P/U 4-2.7L Gasoline Sequential MPI GRAY 64 E01 65 E01 66 E01 67 E01 68 E01 69 E01 70 E01 71 SO2 72 SO2 73 E01 74. E01 75 SO2 76 SO2 77 SO2 78 502 79 502 80 502 81 E01 82 502 83 SO2 84 E01 85 E01 86 E01 87 E01 88 502 89 E01 90 E01 91 E01 92 SO2 93 502 94 502 95 502 96 502 97 SO2 98 E01 99 E01 100 E01 101 SO2 102 502 103 502 Remove/Replace Remove/Install Remove/Install Remove/Install Remove/Install Remove/Install Remove/Install Remove/Replace Remove/Replace Remove/Install Remove/Install, Remove/Install Remove/Install Sublet Repair Repair Remove/Install Remove/Install Remove/Replace Repair Remove/Insiall Remove/Install Remove/Install Remove/Replace Remove/Replace Remove/Install Repair Repair Remove/Replace Remove/Replace matte RT Run channel 1 108.18T OEM RT Door glass Toyota RT Handle, outride w/o chrome accent, w/keyless entry super white RT R&I trim panel LT R&I mirror LT Handle, outside w/o chrome accent, w/keyless entry super white LT R&I trim panel RT Door w'strip Access cab 1 83.70T OEM LT Door w'strip Access cab 1 83.70T OEM REAR LAMPS High mount Tamp Access cab LT Tail lamp assy w/o LED RT Tail lamp as/ w/o LED PICK UP BOX R&Iboxassy BACK GLASS Bads glass Toyota 1 80.00 Glass REAR DOOR LT Outer panel Overlap Major Adj. Panel RT Outer panel Overlap Major Adj. Panel Clear Coat RT R&I him panel LT R&I him panel Cover Car for Overspray 1 5.00 Other Corrosion Protection Primer 1 8.00T Other Body Pull RT Door w'sbip LT Door w'strip RT Front w'sbip RT Surround w strip 1 20.34T OEM LT Surround w'strip 1 20.34T OEM LT Front w'sttip VEHICLE DIAGNOSTICS Pre -repair scan Post -repair scan INFORMATION LABELS Rpl Information labels Emission label 2.7 liter auto trans 1 1.29T OEM 12.00 Body 20.00 Body 12.00 Body 16.00 Body 12.00 Body 12.00 Body 16.00 Body 12.00 Body 12.00 Body 4.00 Body 8.00 Body 8.00 Body 100.00 Body 40.00 Body 80.00 Body 16.00 Body 16.00 Body 8.00 Body 8.00 Body 80.00 Body 8.00 Body 8.00 Body 8.00 Body 8.00 Body 8.00 Body 8.00 Body 32.00 Medi 32.00 Med% 12.00 Body 0.00 Body T = Tamale Item, RPD = Related Ma Damage, AA = Appearance Allowance, UPD = Unrelated Prior Danage, PDR = Painters Dent Repen, NM = ARetmarket, Redir = Redimmd, Roman = Rsnanufactured, OEM = New Original Equipment Manufacturer, R0a = Re -cored, RECOND = Racndit ,S, LKQ = LOre Kind Quality or Used, Dag = Diagnostic, Bac = 6atriml, Me31 = Mallaniml, Ref = Refinish, Struc = Structural 6/28/2021 3:22:27 PM 72.00 (16.00) 72.00 (16.00) 100.00 Page 3 Final Bill RO Number: 1146002819 2016 TOYO Tacoma SR5 Access Cab Automatic 4D P/U 4-2.7L Gasoline Sequential MPI GRAY 104 502 Remove/Replace AC label 1 2.30T OEM 0.00 Body 105 502 REAR BUMPER 106 502 Remove/Install Center support 36.00 Body 107 502 Sublet Urethane 10t bade glass 1 20.00 Sublet 108 SO2 DASH REPAIR/APPEARANCE 1 250.00T Other ALLOWANCE Estimate Totals Discount $ Markup $ Rate $ Total $ Parts (55.58) 106.00 Sublet/Miscellaneous 73.08 Labor, Body Labor, Refinish Labor, Mechanical Material, Paint E.P.C. 40.00 40.00 64.00 2,779.94 ' 365.40 2,476.00 924.00 64.00 450.00 3.50 Subtotal 7,062.84 Sales Tax 250.20 Grand Total 7,31.3.04. Deductible (500.00) Net Total 6,813.04 Estimate Version Total $ Original 5,997.18 Supplement 501 (556.54) Supplement 502 1,872.40 Insurance Total $: Received from Insurance $: 6,813.04 0.00 Balance due from Insurance $: Customer Total $: Received from Customer $: 6,813.04 5 0.00 Balance due from Customer $: NOTES 6/22/2021 10:10 AM Per: MARGARET Authorized additional repairs 501, additional repair lines: 1 112 Supplement amount of: 7577.27 Called Phone #: 7606687794 Gave Verbal Approval YES The New Target Date is:6.25 6/28/2021 11:42 AM number one vinyl does not repair dash. owner accepted appearance allowance for dash damage $250. 6/28/2021 03:13 PM Per: MARGARET Authorized additional repairs S02, additional repair lines: 1 108 500.00 T = Taxable Item, RPD = Reran Price Damage, AA = Appearance Allowance, UPD = Unrelated Prior Damage, PDR = Pamtless Dent Repair, NM = Aiberma,ket, Reda = R&uozn I, Raman = Re anufamnel, OEM = New Original Equipme,t Manufacturer, Rem = Reared, RECORD = Ramttioned, LXQ = Like and (panty or Used, Diag = Diagnostic, Elec = Electriosi, Mech = Mehanlol, Ref = Refinish, Struc = Structural 6/28/2021 3:22:27 PM Page 4