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3/25/2009 - STAFF REPORTS - 00
LAW OFFICES OF WOODRUFF, SPRAOLIN & SMART A PROFr5510NAI. CORPORATION 555 ANTON E00LEVAR0, 311ITI[ 1200 COSTA MESA, CA 92626-7670 (714) 558-7000 DIRECT DIAL:(T14)415-1079 DRECT FAX:(714)415-1179 H•MA1L;danWu�(;ws,:•Imv.com MEMORANDUM FOR SETTLEMENT PURPOSES ONLY PIUVILEGED AND C0NFIDENTIAL HAND ]DELIVERED TO: City Council, City of Palm Springs("City") FROM: Diego Santana,Esq.,Deputy City Attorney DATE: March 11,2009 RE: Subrogation Claim of Enterprise Rent-a-Car CLAIM: On January 26, 2009, Enterprise Rent-a-Car ("Claimant") filed a claim in subrogation with the City Clerk alleging total loss of a vehicle as a result of a collision between Claimant's rental vehicle and a vehicle driven by Officer Mario Kasal while on duty with the Palm Springs Police Department. The collision occurred on North Indian Canyon Drive, 615 feet north of Racquet Club Drive on January 2, 2009. Claimant is seeking settlement of the damage claim in the amount of Sixteen Thousand Five Hundred Five Dollars and 85/100 ($16,505.85) (collectively, "Claim"). LIABILITY- Pursuant to the Traffic Collision Report issued by the California Highway Patrol (attached), Officer Kasai caused the collision by violating Vehicle Code § 22100(b)- Improper Position for Left Turn, Eased on the statements of the parties involved in the collision, Officer Kasal attempted to make a U-Turn in the middle of the street and collided with the vehicle in the oncoming lane. He was not involved in an emergency situation at the time of the incident. The City is liable for the negligent acts of the public employee acting within the scope of his employment pursuant to Government Code §§ 820 and 825. RECOMMENDATION: It is recommended that the City Council authorize a settlement payment to Enterprise-Rent-a-Car in the amount of Sixteen Thousand Five I•Iundred Five Dollars and 851100 ($16,505.85) in exchange for a full and final release of the subrogation Claim. Cc: Douglas C. Holland, Esq., City Attorney C., OSgm ITEM N0ZE�1 oA W27/2009 14:42 7602907039 CHP 111IDTO PAGE 03112 P1'ATk OF CALW'!IM[A dH�5GCOLLISION A�I1 I REPORT Cz6 A Ro RII ) NDG6WE I OF IR a1,,HN9 u19Q4 NB1111"H oOEuIYE6 £ )HT6F y5IC4C I"V"y"11j"A R"r"aA"v a F414TT M$p}1NGS DESRT(MA+lu0olr)lnu adTAMT L2PP0 A L RUV1o0(e6F 1NU1M An ,enITIRI%4a ePUNTT milp"YINa 916mcT POT MTUFV CM TmxI AY 0 ❑ Rmmor, FRIDAV u'Aa Nv N,INDIAN URANY HO p,Ar — rIbE115 Napa ""I'll" N,1NDIAN CANYON DRIVE 01/02J1007 0915 MII[e04TINp4RMATIOH, OM-4oum 1ATw PRPTOBPAPHR HI ©NOSS In11TUPE La4olluAR C.SMITIIN149I4 nr41ren\Pernu PATH. smTX HT+r nAL I1101TAL PR, 619 FEET NORTH OF RACQUET CLUB ROAD ❑vqa SC 1 n PARTY PRIYCA'A LICtlNa[NUNaIE[ aTATF 4LA'+1 Nn CAP aAFETTE9PIR. 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PRIMARY OOLLIMON FACTOR 1RAFyODpNTROLOVIGE9 12 3. entIALINFPRNATION t y 3 MDVEMdTT PREDEOINO 4NTNUMONR(fipPrARTYATPA,JLT COLLM10M VP SECTION MOLATRO,GTE Y% A C[NYTAOLT FUX4RIONpJO A NAZUWMUS MATERIAL A STOPPED I A xylxaL>5 NO p cONDioLV NDTPUNCT70NMO' B CpLLrNONR HAHDKELO IN deE D PRGVMP1M*aYRN0HT B OTHER IMPROP"PAMNG0 IQC0 PLBDe6C4Rw 10 OELLPHONENANDIFAEc1NUSE GRAN FROAD A HDCONTHOLSPRESENWIFAUTQfV 1, IS CRLLPMGNENOTINOSE D ANNGRIOMT'TUNl e OTHER TXAK DRIVER' TYPGOPCOLLIOIOH I I E SCHOOL BUD RRLgTYO E MAKINGLEFTYQRp b UNKNOWN' A HEAD•OH 1 IF 7AFTMOTCiRi1OOKCOME0 OUT NN S SIGESWIR 1 la 32PTTwL1MCOM9 G BACNWC RDMEND 1 114 OELL PHONE UHANOWN H 8LOWINol GTOFPMD WFATHEN (MAHKTT409MIME) b bKOAOS149 1 T PAMNUOTHERVEML— xAGLENS E EITODJECT U d UMANGMq LANES S CLOUDY F cVEA RNbD R K FAAWmaHANE6YEH O MmNt L EYIEPINO TFAFMC NG H O GR'I N A O UNBAPE:TOmRG p FOGIVAGIILITY rt Nmu INTO ORMIN LkNr— F MEN, MOTOHVMIPLE oLVRDYATN I aPARKEN D WIND JA KON-OOLLMON r I P MERGING QUIMNG 10 PIDCGTRIAN O O TRE"UNOWRON6 WAY A DAYLIQN7- 0 OTHER MOTO"VRHIOLE OTHER A6lPCpTeG PACYDRO R tlTHER': 4 SK-DAWN D NDTPRY O pONDTNCR ROADWAY 1 2131INARNITGAIT{V,T6) C DARK-ATRCL'TLIOHTD E PARKED MUMFUEHICLE q - A YeanrpNNLWIIR YP� I ARK. O6TRE LM+NTy r TRAIN .1 - Ng p DA -=EETLIQ iT0 G EICYCLS 1^■ w�1e YL I FUNPIRONINO' N ANMAU NS pOERIEII'-OaUv RDADWAY11URFADE LtiS G rcBmaRxeuta+ L q: ] 3 3 [MANX 1702 rtiMOj A * 1 PTKEv OE]eGTI L NI b 1vPT 1 ]( g A UAG DCO MKINO C 6NGNY-IDT VISION ORICUREMIN'r, 9TIOD- PTrRINFLQENCE b SLIPPERY(MUM,MY.EF F INATM"UM: I IC Ma .NOTUNGCNINI'I.Y nommYCGNVIMN(R( $$7OPi 0T 2 HUD -11,AtAH NKHPmM iNATIK T TO 71TEM0) MONST11FAMe AOT1ONE HENTORINGILEAVMC MAME p U Dpq ORW MFLDRiOG' A N0LE51 uvE.RUT' AND PCO M1 1 PNLVip HC L ON R FAMMENT-P Q, B WQSfMhTEMALOHAOAWPA7 B CROSIM0 IN CRdSSWALK N U PAMILIARIAMAQAQ a IMPAKMMW4TNOTN C OMTRU ONGNKDADWAT' ATIHTEREE0110N K OEFEMA VEH.EOIpF.1 CITL'P H bgTAPrLlOANLi G c4NgTRu1:TIpN-HSPAI [ON 0CRCK1 NQMCRMIYALK•NOT YAF SI.MKKTf PATIOPEP A RE D U 0-0 ROADWAY MDTN AT ERIE'MM No P FLODDEW DOROSNHO.NDYMORaaSWALK L ONMVCW00YENICIR P OTHEWI e N ROAD,MLYPR SHOULDER M DTXKW: X X O W HTUNS F NOTINRCAO x N NONEAPPARENT O APP PA 61LNA ECHOOL h., D UNA V6XIttE G%ETCH � M[40ELlANL',01 i , IuNCATE NDHTI REFER TO?AGE#4 i I 01/27/2009 14.42 7603607039 CHP INGIO PAGE 05/12 i"MTC OF OALIFORNIA , INJUREDIWrrNESSESIPASSENGERS CHP K CARS PAGE 31R'EV_7'�I161 OPI 066 _ Pace y op 16 DA19QPCOLLMN(Ma PAY YIIAM TIM911AN1 Me# DFFIaww. NUMBER UI102I2P01) n415 266WIf1011 ;011 "Na" ;XT6N7 oP INJCRY{'J(I LIVE) INJURCC WAS('X'ONE) EM1Y BUT Anlp LY4TAL eEYEnE eDILkVINIR aoMnuwTPPe,IkruRT Imfty INJuaY of PAIRGMNR vUP' PCO 81CYC111TxEA❑ An O! ❑ ❑ ❑ ® ® ❑ ❑ ❑ © I I M G 0 NAMI:fv,o,6,rAPDAEEs TELEPHONE MAR[4 W1LLIAM NASAL (1 W11975) 700 S.CIVIC CENTER DRIVE PALM SPRINGS CA 92262 (766)333RI16 (INJURED ONLY)YRAHAPORTED 9Y: TAKEN TO: AMR,AMBULANCE DESERTREGIONAI.MEDICAL CRN I'M nE§cR1opIHJURIEa: C6MPLAINTOBL'EPTJlIPANIILOWERBACKPAIN y1CPM op y1PL9NT PRIILE xpnmEo ❑£ © 33 M ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 0 ry RE/P.a.R.rannpvSE ' T(LEFNPRE CHRIS D£RGMAN 0710911l75 2QQ 3.crvrC C£NTT?R DBryL pA4M$YRDVC3 C.a 92262 60)323allo 1MJORED ONLYFTW3PDRTCD EYI TAKEN TO; PESOMEINJURILS: ViO'MI OF VIDILNTORIMp HDTIFlLD MIME I P.P.D.JAPDRe99 TELEPHONE (INJQRW 9NLYl TAANSROh"ol : TAKENTO= DESURMEINJURM: WOM OM VNJLEWQMMU N"FIEQ NAMEJn OA rADnITUR TELEPHONE 194JURDp ONLYNTHANEPDRTEu DYe TAKEN 701 PEDORMINJURME: NtiT1M OFVIOLlNY PRIME NDTIFlED ❑ ❑ 1 IOLL11 ❑ 1 ❑ Lo ❑ ❑ i ❑ LEYF71 -1 1 1 _ . NAMClO.O.:y.lAODAaaS TELEPHONE IINJURI:d ONLY)YNANSpDRTE6 aT: TAKEN To. UESCRIDC MUMS; VICTIM PRl'10404C CRID.E NOWWO HAMEID.P,8.10.PpRafE TELEPHONE (INJUREPONLYI TRANLPORTF.e 6Y: TAKEN TO: oEscmnclNJDRI[a: VICTIM OF VIOLT.NTCkIMR NDnMffg pRiAARGR'9 NAMD I.D,NDRBER MO. PAY YEAH RDyIWAR'SNAME MO. DAY YEAR 3,COLLINS UI6069 01/Q212QOp 01/27/2029 14:42 76036078$9 CHP INDIC PAQF a5/12 '8TA OTCAVPOFHA FAZT Ptica J(RaGRIJ1 OPr 061 - Y.pn OATG a`LWWpAo. DAY YGrzI TM6 k�W) NMI omeQflA nv1AeER �ra2'-o GYrs- ZdO�]QfOb1� AL4MFl UMMEMi8AREArRRO)aMATLANONOTT4ECALEVfV4G9.i GTATEU rSOALE • t �a' �.2' /a' 1e'• sk ETA � .• - Vh r {! a .. . .. . . . .. AWVLI ��W�•�I4� 1'IrpMOoo1' WNUdem Mo. WY yew g2bwrammO ma LAY Yenn oYTc67n 01127/2009 14:42 7603687639 CHP FN 10 PAGE 07/12 STATE OFO41FOW41A � TCSSU LI OPI US{ rero on'fsvFLW.140N IMD. DAY 7TNM 91Me(1/G11 Halo AFFICI,I D RD!lafR •n�o2a3 c*'j��r _ Z009�a�E]D1� T ALL MEASUUMUOTFAMAPPROMMA79ANDNu"C SCALE UNWD&5TA79D(8GLE )�/�r �D •��[_� �4sYw NI• i /� : : i. : i ! to ' � I ' I •,.: . I r ,..I it i I ftr•1J4?, •• ENig: ibS2�� • . I . . . TI - . : ii , l ! : ill � i.�... ��•�� r I III I II II f � 1 PR6Pnntl0 DT taxuNnm nm. tY.T YGAR AeY2Y1lR4tWAi Mu DnT Ycln �'G �•t7-f �y��Y c� aq erp QHPC$7Sl79 :. 3 01/27/2009 14:42 7603607839 CHP INDIO PAGE 6N/12 STATE OF CALIFORNIA NARRATIVEISUPPLEMf3N PAGE F 10 PATE��F 10C DENT T MWI NCIC 0M9ffR OFFICeR I D, NUMBER 01/02J2009 0935 Zi7ra 01Ooll 1 FACTUAL.DIAGRAM LEGEND: 2 3 STATION LINE: 4 6 A station line was established along the east road edge of N. Indian Canyon Dr. Station 0+00 was 6 established 575 feet north of the north road edge prolongation of Raquet(3ub dr. All 7 measurements were taken at right angles, Left (L) or Right(R)of the statil-,n line. All 8 measurements increase from south to north as you are standing at 0+00. 9 10 11 VEHI6LE POINTS OF REST: 12 18 Vehicle 1(V-1, Chev): 14 L/F was located 26 left of statiorf 0+89- 15 L/R was located 24Z feet left of station 0+79. 16 17 Vehicle 2(V-2, Chev): 18 L/F was located 67.7 feet left of station 1+03. 19 UP was located 58,5 feet left of station 0+97.5. 20 21 22 23 24 25 26 27 28 p 6Y I.A.NUMBPR DATE R'SN M.. D T �•�. n olglt j 01/02/2009 01/27/2009 14:42 7603607839 CHP'1NbI0 PAGE 09/12 STATE OF CALIFORNIA Up LMENTAL- Toy {o � OFFICER 1,13. NAFVTP TM 01/02/2009 091'S - Zfto°IDI co, 1 PHYSICAL EVIDENCE DESCRIPTION: 2 3 1-5 Tire friction mark from V-2. 4 6-10 Tire friction mark from V-2. 6 11. Miso- plastic debris from V-1 and V-2. 6 7 8 PHYSICAL EVIDENCE LOCATION: 9 10 1. Begin tire friction mark 25.3 feet left of station 0+28.5 11 2. Continuation tire friction mark 31.1 feet left of station 0+63. 12 3. Continuation tire friction mark 44.9 feet left of station 0+86. 13. 4. Continuation tire friction mark 55,6 feet left of station 1+01. 14 5. End tire friction mark 55 feet left of station 1+07.5. 15 B. Begin the friction mark 30.2 feet left of station 0+26.$, 16 7. Continuation tire friction mark 31 feet left of station 0+43. 17 8. Continuation fire friction mark 44.9 feet left of station 0+79. 18 9. Continuation tire friction mark 55.6 feet left of station 0+94. 19 10. End the friction mark 56.5 feet left of station 0+98. 20 11. Center of debris located 31 feet left of station 0+79. 21 22 AREA DETAILS: 23 24 A. Raised concrete curb edge. 25 B. Broken white line with raised pavement markers. 26 C. Solid/Broken yellow lines with raised pavement markers. 27 D. Asphalt center median. 28 P FP1 R0 BY I.O.N M R 6A REVIEWENS NAME DATP 0iggfq 01/02/2009 01/27/2009 14:42 7SNG07839 CHP 1NDI0 PAGE 10/12 ' STATE OF.CALIFORNYA NAIZRATIVEISUPPLEMENTAL PAGE s OF 14 DATE OF MIDENT TIME. NCIC NUM96 OFFICER I P. NUMBER 0 1 10 2/2 00 9 W15 2009010011 1 FACTS- 2 3 NOT1t 1CATION: 4 5 On 0110212009, at approximately 0925 hours, I received a call from CHP d spatch of a minor injury 6 traffic collision Involving the Palm Springs Police Dept. I responded from (Ilene Autry Trail, south 7 of 1-10, and arrived on scene at 0937 hours. All times,speeds, and dlstan :es are approximate. 8 Measurements were taken by roll meter. 9 10 11 SCENE DESCIRIPTION: 12 13 N. Indian Canyon Drive, at this location, is a two way, four lane(two southbound lanes and two 14 northbound lanes) straight,flat, north-south aligned, asphalt-concrete pave d highway located 15 within the city of Palm Springs, The northbound and southbound lanes arty separated by a two 16 way left tum lane. The traffic lanes are delineated by raised, circularshapod, white colored lanes 17 markers. N, Indian Canyon Drive is bordered on the east and west by concrete sidewalks 18 followed by apartment buildings. The speed limit is controlled by a posted .45 mph speed limit 19 sign. Traffic was light to moderate and the Weather was clear, calm, end n ilid. This collision 20 occurted during daylight hours and there were no visual obstructions notes or claimed, 21 22 2$ PARTMM 24 25 Party#1(Kasai)was located lying on a gurney inside the emergency room at Desert Regional 26 Medical Center. P-1 was identified by his valid CA driver's license and wa-, determined to be the 27 driver of V-1 by his statement and passenger(Bergman's) statement. 28 29 Vehicle#1(Chevy) was located resting on its wheels blocking the northbou 7d#1 IanQ of N. Indian 30 Canyon Drive. V,1 was facing in a northerly direction and sustained mode ate left front end body 31 damage. I visually inspected V-1's seatbelts and no defects were observe 1. No previous 32 mechanical defects were alleged or observed, 33 34 P_arty#2(Gouthier)was located standing next to Vehicle#2(Chevy). P-2 was identified by his 35 valid CA driver's license and was determined to be the driver of V-2 by his #rtement and rental 36 car agreement. 37 38 Vehicle#2(Chevv)was located resting on its wheels blocking the southbo4 nd#2 lane of N, Indian 39 Canyon Drive. V-2 was facing In a north-westerly direction and sustained i:taderate right front 40 side body damage. I visually inspected V-2a seatbelts and no defects wer,� observed. No 41 previous mechanical defects were alleged or observed, 42 PHEPARU)i3y 1,17.NUM13ER VATEVit NAM2 PATE J. COLLINS 015069 01/02/2009 01/27/2009 14:42 7603507839 CHP INDIC PAGE 11/12 ; STATE OF CALIFOUTA• NARRATIMSUPPI- MENTAL PAGE 9 OF 0 p OF INCIDENT T ME NOIC 0 IC- � . NUM E 01/02/2009 0915 20090100ll 1 PHYSICAL EVIlQFz(VCE: 2 3 Dual pre-impaetlpost-Impact tire friction marks from Vehicle#2(Chevy) be4iinning in the 4 northbound#1 lane of N. Indian Canyon Drive. (Refer to factual diagram k-y Officer C. Smith, 5 U1#14914). 6 7 a STATEMENTS: 9 10 party#1 f Kam related that he was traveling northbound on N. Indian Can Drive, in the#2 11 lane, slowing down to make a U-turn for a reason he couldn't remember. P-1 slowed to 12 approximately 10 mph and looked in his rear view mirror and saw vehicles behind him but they 13 were nowhere close. P-1 began to make his U-turn when he collided with Vehicle#2(chei y). P-1 14 didn't have any emergency lights activated at anytime before or during the initiation of the 15 attempted 0-turn- 16 17 ier related that he was traveling northbound on N. Indian C anyon Drive, in the#1 18 lane, at approximately 40 mph, Suddenly P-2 saw Vehicle#1(Chevy) com Fig Into his lane from 19 his right side_ P-2 didn't see V 1 until just prior to the collision and wasn't i ware if V-1 was first 20 stopped In the#2 lane or if it came rrom the right curb_ edge, 21 22 23 OPINIONS ADO CONCLUSIONS; 24 25 SUMMARY: 26 27 Party#1(Kasal)was driving Vehicle#1(Chevy) northbound on N, Indian Canyon Drive, north of 28 Racquet Club Road, In the 92 lane, at approximately 10 mph, Party#2(Gc athier)was driving 29 Vehicle#2(Chevy) northbound on'N. Indian Canyon Drive, north of Racquet Club Road, in the#1 30 lane, at approximately 40 n1ph. P-1 steered V-1 to the left in an attempt to make a U-turn from the 31 #2 lane, V-1 entered the#1 lane directly into the path of V-2. P-2 applied :he brakes of V 2 and 32 steered to the left In an attempt to avoid V-1. V-1 struck the right front of V-2 causing V-2 to veer 33 to the left across the two way left turn lane and both southbound lanes of A. Indian Canyon Drive 34 before coming to rest. The impact caused V-1 to veer back to the right bef:yre coming to rest in 35 the#2 northbound lane of N. Indian Canyon Drive, 38 37 M AREA OF IMEAGT: 39 40 The area where Vehicle#1(Chevy)struck the right front of Vehicle#2(Che,-y) occurred 24 feet 41 right of Station 0+43. The AOI was based on party statements, physical e%idence, and vehicle 42 damage. -PNVIYARED B7 Eri,NW10ft DA DATE J, OOLLINS 015069 01/02/2009 " 01/27/2009 14:42 7603607839 CHP INDIC PAGE 12/12 STATE OF CALIFORNIA NARRATIVEISUPPLEME AQE IoaF In IJA i E OF INCIDENT TIME CIC NUMBER{�I . N R 01/02/2009 0815 2009010011 1 CAUS;: 2 3 Party#1(Kasai) caused this collision by violating Vehicle Code section 22100(b).improper Position 4 for Left Tum. This section states: The approach fora left tum shelf be made as close as 5 practicable to the left-hand edge of the extreme left-hand lane orportion 0,-the roadway lawfully C available to traffic Moving In the direction oftravel of the vehicle. P-1 should have utilized thetwo- 7 way left turn lane to make the turn. The cause was based on party statem:mts, physical evidence, 8 and vehicle damage. e 10 ' 11 RECQMMENQ,ATIDNS: 12 13 None. PREPARE, I.U.NUAMM UAT REVI ER' M� DAM J. COLLINS 015069 011=2009 Reserved for filing siamp NAME Or=IMANT REc> iV Fr) ��cirY of Wr}Lti srl;lr 3, FIRST — 2009JAN 26 AN 814 HOME ADDRESS BUS. ADDRESS3•-(,\ �'tr� \Q� ( 2C7ab[+t JADES � F{(��1F150iL1 MNLTO FIOML4 ' CITY CLERK PH ONE on�c3- CLAIM NO. 6 ',o l�'� DAME OF PERSON INJURED l OR SUFFERING DAMAGES_, ADDRESS READ ENTIRE DORM � BEFORE COMPLETING � CITY OF PALM SPRINGS, CALIFORNIA CLAIM FORM Claims can be mailed or filed in person at: City ofPalm Springs City Clerk 3200 East Taliquitz Canyon Way Palm Springs,CA 92262 To the City Council,City of Palm Springs,California: The nndmigted hereby presents the following claim to the City of Palm Springs,in aceordaace with the laws of the State of Cnlifomw I. IS THE PERSON INJURED OR DAMAGED AMINOR7 YES ` NO IF YES,STATE CLAIMANT'S RELATIONSHIP TO THE.MINOR: BIRT14DATE OF MINOR:-- 2- NAME AND ADDRESS OF ATTORNEY,IF ANY; _NIA 3. '"OCCURRENCE OR TRANSACTION GIVING RISE TO TIIE CLAIM ASSERTED: PLACE �w �DATE HOUR 4. DAMAGES CLAIMED: OVERS10,0007 YES ANO IF OVER$10,000IN WHAT JURISDICTION DOES TI•IIS CLAIM REST7 MMCIPAL OR SUPERIOR COTURT INJURY OR PROPERTY DAMAGE: AMOUNT CLAIMED:$t/_/;,,94C 0 TOTAL INCURRED TO DATE$ G , Q +x s�n,000> NAMEANDADDRSSS 6E PHYSICIANS: NAMEAND ADDRESS OF HOSPITAL: NAMEANDADDRESS OF WITNESSES,(II7 ANY):,� Page 2 OTHER PERTINENT ORMATION AND BASIS OF COMPUTATION FOR THE AMOUNT CLAIMED: On'IIER THAN FOR INJURrJESORPROPERTYDAMAGKSTAT13 HOW CONTUTP,D: t"l oar„ Vry s(, 5- GENERAL DESCRIPTION OF INDEBTEDNESS,OBLIGATION,INJURY,DAMAGE,LOSS OR TRANSACTION(as far as it may pe known althe Gme of presentat on of this ola(m): . 7� r,ar ,s' Crw Y- \ \ - � ^' - • ACC y � C 6. COMPLETE ONE OF THE FOLLOWING,IF THE BASIS OF LIABILITY IS ALLEGED TO BE: AN ACT OR OMISSION OF A CITY *DANGEROUS OR DEFECTIVE *NEGLIGENCE ON THE PART OF OFFICER OR EMPLOYEE: CONDITION OF PUBLIC PROERTY THE CITY OR ITS EMPLOYEES: NAME OF SUCH OFFICER OR PUBLIC PROPERTY ALLEGED TO GENERAL STATEMENT OF HOW EMPLOYEE,IF KN N; BE DANGEROUS OR DEFECTIVE: ACCIDENT OCCURRED: r CLAIMANT'S STATEMENT OF THE CITY OFFICER HAVING PRIOR .BASIS OF SUCH OFFICER'SOR KNOWLEDGE OF SUCHCONDITMCM EMPLOYEE'S LIABILITY: IN WHAT WAY WAS THE CITY GENERAL STATEMENT OF HOW NEGLIGENT? ACCIDENT OCCURRED: * ATTACH, IF APPROPRIATE,ANY DIAGRAMS, PHOTOS, ESTIMATES, OR ADDITIONAL INFORMATION AS NEEDED TO FULLY DESCRIBE PHYSICAL CONDITIONS SURROUNDING THE OCCURRENCE,DUE TO WEATHER, ROAD OR TRAFFIC CONDITIONS,ETC. I declare under penalty of perjury that I have read the foregoing claim and the papers attached thereto, and that the same are true and correct to the best of my knowledge. II �9 DATE; PLACE: � �A�r ` J � L`'a _cc CUii OR T PRINTED NAM 62:41'" 01-fA-200D 114 a GA IM F60ftq 13,2009 Covel6n cWwa, M, NI& SAN&PSAROINOoCA,M412 RP: AgN6 law-,.b.sr: Memo., mat SKwalw, 6A lb,610ft"Wit fiavo;6601 pke l atgd ki usjiw jluuioir, sespops-$10fottliedauftc §51-343-79*4 -L)re T, -,31,1p'4 om Ow, AAOf�22RYQ OAR )aftAVq, AEIVX ,fw.s,t REP GP8,. r.n Ado; 000, MILEAGE: V1W j'ONQA2i3DI5IaSa1pY4,718q 11 1ILT: Zztt�z& sALO '�rh istd Ja 0111, ARc 'g.bhq APT14 *Ahj�T' A AFTHk MA�K�t 00i�T-� IkAfMi dikif 60 MODI;, HHFI AD r Q ME. uo NP,,',Ur THADMI 0 dog PUS ON."p, LTWW, ,� 160 O'.:OCr PAYMM: O(W, FlMt; .00 SELF Rur=' .00 OPTY" ZY; ZIP" F27PNW-IbUs car $ale FOrmrwX# F4-N%ompt 77. 951-sCs_gtlsd Une1 02:47"Aprm, 01_14-2g09 '3M oz�xa�zoo'ri xs:xs rr�x r�aax�arot , DR'OT144S.TOVOINO�!Fla; 3.01 09L SOS.,of fVt PAM OPAWOAu:tir`*91262� tlplTo•, � j. 6ec�ss�o.sPUXM4ye»ar aYa�iti� :ap6lsa ' �'� � 1 .:-v' fir$ s (.":i ..1iT,..i,,c .• .. .�N '} ['S rAR 3_.. 9@ iAG'.. :d7a219 :. urA :r srrso�t ' .�•f ;,,i 7. •� U�.. �16,, ... ,, � ,tz 0. 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