The URL can be used to link to this page

Home My WebLink AboutClaim No. 541A - James A. CollingsCITY OF PALM DESERT COMMUNITY SERVICES DIVISION CITY CLERK OPERATIONS STAFF REPORT REQUEST: CLAIM AGAINST THE CITY (#541A) BY JAMES A. COLLINGS IN THE AMOUNT OF $676.25 DATE: January 13, 2005 CONTENTS: I. Staff Report II. Claim No. 541A Recommendation: By Minute Motion, reject the Claim and direct the City Clerk to so notify the Claimant. Background: Based on a review of the subject Claim and the recommendation of the Claims Adjuster, Risk Manager, City Attorney, and staff, it is recommended that the Claim be rejected. Discussion of this item should be in Closed Session pursuant to Government Code Section 54956.9(b), potential litigation. Submitted by: RA HELLE D. SE , CMC CITY CLERK Approved: CARLOS L. ORT CITY MANAGER rdk Attachment (as noted) SHEILAR. GILLIGAN, CMC ASST. CITY MANAGER FOR COMMUNITY SERVICES H:1WPdata\WPDOCSICLAJMSl54IA-reject-stall report.wpd RECEIVED CLAIM AGAINST THE CITY OF PALM DESERTI T Y CLERK'S OFFICE (For Damage(s) to Person(s) or Personal Property A L H DESERT, C A 2004 DEC 16 AM 8: 52 Received by: via: U.S. Mail Interoffice Mail Over -the -Counter CITY OF PALM DESERT ASSIGNED CLAIM NO. A CLAIM MUST BE FILED WITH THE CITY CLERK OF THE CITY OF PALM DESERT WITHIN SIX 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 damages) to person(s) and/or personal property: 1. CLAIMANT INFORMATION: NAMEaVOes ADDRESS �. PHONE NO. F -, ., _ z DATE OF BIR H: SOCIAL SECURITY NO. ____ - - OW DRIVER'S LICENSE NO. aigimme 2. Name, telephone number and post office address to which claimant desires notices to be sent, if other than above: 3. Occurrence or event from which the claim arises: a. DATE: /v - U t( b. TIME: Li N( location) 2 i ci i ry h r i-1 irk e e �-- :r d. How and under what circumstances did damage or injury occur? Specify the particular occurrence, event, act or ommission you claim caused the injury or damage. (Use additional paper if necessary.) �'< r k a c i, C E. v lit,- 04.3,-'t; 'rte. 2-it, rr- cL t i,I it_ t '. '2 CiAt4ip {� rz kid% Tf-u t Tit 11 c. PLACE (exact and specific e. What particular action by the City, or its employees, caused the alleged damage or injury? L L� ; w . w t. 3 ) ► t Cz[ i-csf%- Page 1 of 2 4. Give a general description of the indebtedness, obligation, injury, damage, or loss incurred so far as it may be known at the time of presentation of the claim. If there were no injuries, state "no injuries": 4, e r - +' A J• I. OP 5. Give the name(s) of the City employee(s) causing the damage or injury: 6. Name and address of anyother person(s) injured: X4) , k - rc 7. Name and address of the owner of any damaged property: 8. Damages claimed: A10 a. Amount claimed as of this date: b. Estimated amount of future costs: c. Total amount claimed: d. Basis for computation of t.'7 C - _ — l� L 4k_ - t 74? - Li amounts claimed (include copies of all bills, estimates, etc.): C j4., wrot.qqf�, �� '4 r J 3-�-..`ram%' �:`/1 .L.��,��_.� -4' 9. Names and addresses of all witnesses, hospitals, doctors, etc.: /!/..: invoices, 10. Any additional information, including police reports, which might be helpful in considering this claim: nA../c. C'V LI � 1 \ % h' SL. (.' WARNING:IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM! (PENAL CODE 72; INSURANCE CODE 556.1). I have read 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 !J day of ce , 20 c at Pt:- (L4,-L 'tsOr f. SIGNATURE OF CLAIMAINT Office of the City Clerk, Palm Desert, California Page 2 of 2 SIGNATURE OF CLAIMANT DOC. NO. DATE FILED N 0303PM 11/26/04 ENTERPRISE RENT -A -CAR COMPANY OF LOS ANGELES .\` '--~- CATHEDRAL CITY 24'�NOUR DAY RENTAL TYPE B SOURCE C80112 .` ' - �^' - owswo FLAG ` �*,�cum+/ ��`' =^'^' NIT 1 !NIT # LA6402 IC# 5FLA149 |ODEL CAVA ,OLOR WHITE N 15436 �UT 15278 VAIM INFO 'OSS DATE 'HEFT ACCIDENT RENTER LOCAL DR. LICENSE 4000000000000 STATE CA EXPIRE DOB MMNM001 HT WT EYES HAIR S.S.# EMPLOYER BILL TO N CUST # CUSTOMER PAY/ONE WEE[,` ADDITIONAL DRIVER NO OTHER DRIVER PERMITTED PERMISSION TO LEAVE STATE YES NO X CUSTOMER SIGNATURE ON FILE PAYMENT INFORMATION AMOUNT PD.BY TYPE DATE AUTH 676.25 MC SALE 11/26/04 055654 '~ _---_'.- - O14 RENTAL AGREEMENT D81213? PAGE I OF I SUMMARY OF CHARGES DAY = 24 HOUR PERIOD MILES NO CHARGE 150 MI FREE/DA 1050 MI FREE/WK 5 DAYS @ 40.00 2 WEEKS @ 239.99 LESS DISC% 10.00 TOTAL CHARGES 2O0.00 479.98 67.99 15.62_ 676.25 676.25 �HOP HONE AME CLOSED TICKET PAYMENT INFO OPENED BY #9556W EDWIN P RADTKE CLOSED BY #9556W EDWIN P RADTKE fp AUTO PLAZA ar,e,. M111410IBS BUICK PONTIgc GMC 68-111 Highway 1I1 Cathedral City, California 92234 Cadillac / Saab / Hummer PHONE(760) 328-2571 FAX (760) 321-4570 Buick / Pontiac / GMC Truck PHONE (760) 328-9999 FAX (760) 321-4630 BAR# AA000856 www.jessupautoplaza.com YOUR FULL SERVICE OM STORE SINCE 1938 �' B 305 Owe #EsuiCK' If PONTIAC GI111S Ooodwfe▪ ldl OPERATION 01OLZINSERT OPERATION nCtfl,JMMtINIL)CLJ JttiVll,;t5 _ MO/MI TOTAL DESCRIPTION I MO/MI MO TOTAL 31.95 OPERATION OPERATION DESCRIPTION REPLACE WIPER INSERT K!'l 1 /MMHNI IL FIr kIC CDf' Ill Df1Jt 'ln1 DATE --....v REPAIR ., ...,,,,..I rsv+r �v I .7 1.4•..1 iMtUM 4INGIO NL`fOVII.t 10/06/04 04/13/04 10/23/03 05/16/03 02/28/03 ORDER 201511 8 18488 18488 164493 158700 I MILEAGE 17466 15850 14187 12466 11486 . —..:'-_— I ADVISOR 31 31 31 31 56 — TECHNICIAN 704 704 600 600 98 600 TYPE C C W C W C OPERATION O16UZZLOF 01 BUZZLOF 50BUS 01BUZZLOF 07BUZ1 N 01 BUZZLOF I OPERATION DESCRIPTION LU:E • LOBE OIL & FILTER CAMPAIGN LUBE OIL & FILTER POWER WINDOWS LUBE OIL & FILTER ithdIGGstrmEnU.nul c[ 7 t rrinr....-. TERMS CASH 0 CREDIT CARD CHECK PRIOR APPROVAL) OTHER SAVE REMOVED PARTS FOR CUSTOMER 0 YES 0 NO APPOINTMENT ❑ Yes �I NO 1 x • LE1D. JAMES A COLLINGS RESIDENCE PHONE BUSINESS PHONE TIME RECEIVED 08:20am B O D Y YEAR/MAKE/MODEL 01 /BUICK/LESABRE/4 DOOR SEDAN 10/26/04D 05:00pm LABOR RATE ORIGINAL CUSTOMER ESTIMATE: OTAL 2821.79 COMMENTS : REAR & RT 1/4 DAMAGE C 7OBUZ1 METAL BODY REPAIR AS PER ESTIMATE C 70BUZ2 REFINSH REFINISH AS PER ESTIMATED C.4.e— e_ 5 x 2 a 11111111111111111111111111111111I IIIII111111i11f IIIII IIIII Iiii (I1 II 01J203050 PAGE 1 OF 1 REPRIN 1 TECHNICIAN COPY CUSTOMER NO. SERVICE CONTRACT 70501I COBLUE/ TURBO M/MC z I AIR CO; D. PRODUCTION DATE 11/22/00 CONTRACT NO. P. S.v TRAAS I MILEAGE1 ,643 STOCK NO. DELIVERY MIL E6 EXPIRATION DATE AD4y NO. UCENSE NO. SELLING DEALER NO. 1 EXPIRATION MILES 15kg764 _ & RT CERDA JR I HEREBY AIZE THE REPAIR WORK TO SE DONE ALC JG VMH THE UP EMPLOYEES PERMISSION TO OPERATE THE VEHICLE HEREIN DESCRIBED ON STREETS. HIGHWAYS OR ELSEWHERE FOT NECESSARY PURPOSE OF (ESTINGBANC O4R NSPECT10N, AU. LABOR CHARGES ARE FIXED PRICES. AND BEAR NO RELATIONSHIP TO ACTUAL HOURS OF LABOR PERFORMED. ALL REFERENCES HEREIN OF OTHERRSSE, INCLUDING ANY POSTING OF LABOR RATES OR FLAT RATE LABOR HOURS ARE FOR INFORMATICS ' ONLY TO INDICATE TO THE CUSTOMER THE BASIS UPON WHICH THE FIXED PRICES WHERE ESTABUSHED BUT NEITHER SUCH REFERENCES OR POSTING NOR THE FA Err THAT THE ACTUAL HOURS OF LABOR PERFORMED MAY BE MORE OR LESS THAN 111E INDICATED RAT RATE HOURS SHA - HAVE ANY EFFECT WHATSOEVER ON 18 FIXED PRICES SO CHARGED. MARE DIRE ORNERY ATES ARE FOR LABOR AND PARTS. STORAGE WILL BE CHARGED 48 HOURS AFTER REFAIRS ARE COMPLETED. NOT RESPONSIBLE �)fi7rr,�.• CLFS LEA IN CARS IN CASE OF RITE, HEFT, ACCIDENT Ca ANY OTHER CAUS E BEYOND OUR CONTROL PLEASE READ REVERSE SIDE ER ACKNOWLEDGES RECEIPT OF A COPY HEREOF S't t F cat 6 !ice 2 J uc� 7' ORIGINAL ESTIMATE S REVISED ESTIMATE S ADOITIO(JAL COST S REASON CONTACTED BY AUTT1OR12ED BY ESTIMATES DO NOT INCLUDE SALES TAX ❑ PERSON O PHUNE a 2ND REVSED ESTIMATE S DATE ADDITIONAL COST TIME REASON CONTACTED BY AUTHORIZED BY PERSON ❑ PHONEa I DATE TIME IMPORTANT: REMOVE ALL PERSONAL PROPERTY AND VALUABLES FROM YOUR VEHICLE. WE DO NOT ASSUME RESPONSIBILITY FOR LOSS OR DAMAGE FOR ARTICLES LEFT IN YOUR VEHICLE. TEARDOWN ESTIMATE: I understand :hat my vehicle will be reassembled within days of t`.e date shown Ebove if1 choose not to authorize the services recommended. "By law, you may choose another licensed Smog Check facility to perform any needed repairs or adjustments that the Smog Check test indicates are necessary." POWEROF ATTORNEY The undersgned. hereinafter called 'Insured', for the consideration of repairs made to "Insured's' automobile, does hereby ga nt to said JESSUP AUTO PLAZA, Insured's power of attorney to sign or endorse any checks and/or drats made payable to Insured, and any releases thereto, as settlement for Insured's Gan for damages to tle above described automobile COMMENTS 7Y- 5 7