HomeMy WebLinkAbout4.5 Industrial Indemnity Co. Claim f-7a � d
CITY OF DUBLIN
AGENDA STATEMENT
CITY COUNCIL MEETING DATE: May 11 , 1987
SUBJECT Claim Submitted by Industrial Indemnity Company on
April 28 , 1987 (No. 0014)
EXHIBITS ATTACHED Copy of Claim; Certificate of Insurance
RECOMMENDATION the claim and direct Staff to notify the
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claimant and the City' s Insurance Provider
FINANCIAL STATEMENT: Full damages are unknown, however, the Company
assesses a maximum value of $250,000
DESCRIPTION The City of Dublin received a claim requesting
subrogation for costs incurred by Industrial Indemnity Insurance Company on
behalf of Castle Construction.
The claim involves alleged damages when an employee of Castle Construction
was injured during his course of employment . The injury was alleged to have
occurred when the employee stepped into a depression between the unfinished
portion of the pavement and a manhole cover located on Iglacia Street . This
street is part of the subdivision improvements being constructed by Far West
Associates on the former Dolan School site. The improvements have not been
accepted by the City and are under the direct control of the developer. A
copy of the Developer ' s Certificate of Insurance is attached. The
description includes a statement that the construction company and
developer' s insurance is to be primary.
This claim has been reviewed by the adjustor for ABAG PLAN Corporation and
she has recommended a formal denial pursuant to the Government Code . Staff
would recommend that the City Council -deny the claim and direct Staff to
advise the claimant and the City' s insurance provider.
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COPIES TO: Claimant
Julie Aumock, George Hills Co.
ITEM N0. 4445,
ABAG PLAN Corporation
1 David W. Hughes R E C E I V E D
RAMOS, HERLIHY, BROADBECK
2 HEPLER & COCKLE APR 2 8 1987
101 California Street , Suite 1870
3 San Francisco, CA 94111 C rI C::
Telephone: (415) 986-1589
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Attorneys for Claimant,
5 INDUSTRIAL INDEMNITY COMPANY,
a corporation
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7 INDUSTRIAL INDEMNITY COMPANY, NO:
8 a corporation, as subrogee on
behalf of Castle Construction, CLAIM FOR DAMAGES
9 employer of Jeffrey B. Roy, (Government Code 5910)
10 Claimant,
11 VS .
12 CITY OF DUBLIN,
13 Defendants.
14 TO: CITY OF DUBLIN, 6500 Dublin Boulevard, Suite 205,
15 Dublin, California 94568.
16 INDUSTRIAL INDEMNITY COMPANY, a corporation,
17 as subrogee on behalf of Castle Construction, employer
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of Jeffrey B. Roy, hereby presents this claim for damages
19 pursuant to Section 910 of the Government Code of the State
20 of California, and makes the following statements in support
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of the claim:
22 1. The name and address of this claimant is
23 INDUSTRIAL INDEMNITY COMPANY, P.O. Drawer E, Walnut Creek,
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California 94596.
25 2. The address to which claimant desires notice
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to be sent is David W. Hughes , RAMOS, HERLIHY, BROADBECK,
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HEPLER & COCKLE, 101 California Street , Suite 1870, San
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Francisco, California 94111.
5X504 (4/84)
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1 3. The date and place of the occurrance giving
2 rise to the claim is on 'or about January 20, 1987 at the
3 Vista Green Housing Development, Dublin, California.
4 4. The circumstances giving rise to this claim
5 are as follows:
6 On or about January 20, 1987, Jeffrey B. Roy,
7 as employee of Castle Construction, was injured during
8 the course and scope of his employment. Mr. Roy stepped
9 into a depression between the unfinished portion of the
10 Pavement and a manhole cover located on Iglacia Street,
11 Dublin, California. Mr. Roy suffered a fractured ankle.
12 Mr. Roy ' s full name is Jeffrey B. Roy. He resides at 3488
13 Guthrie Street, Pleasanton, California 94566. His telephone
14 number is (415) 462-5158. His date of birth is December
15 31, 1955 and his social security number is 573-06-6664.
16 5. The full extent of the damages are not yet
17 known. For purposes of this claim, INDUSTRIAL INDEMNITY
18 COMPANY assesses a maximum value of $250,000.00, however,
19 the damages may be greater depending on Mr. Roy 's recovery.
20 6. The names of any public employees causing
21 the damages are unknown.
22 7. At all times herein mentioned, the City of
23 Dublin. negligently and carelessly owned, controlled, created,
24 maintained, inspected, warned and failed to warn of the
25 dangerous conditions in and about the subject manhole cover.
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5X504(4/84)
1 There may be additional theories of liability which the
2 claimant is unaware at this time.
3 DATED: April 28, 1987
4 kd \W . HY R EC ,
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6 BY
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7 Attorney for Claimant
INDUSTRIAL INDEMNITY COMPANY,
8 a corporation
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5X504 (4/84) '
V'ID DELIVERED
1 PROOF OF SERVICE
2 I am a citizen of the United States and ' a resident of the
3 County of San Francisco, California; I am over the age of eighteen
41 years and not a party to the within above-entitled action; my
5 business address is 101 California Street, Suite 1870 , San
6 ; Francisco, California, 94111.
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7j On April 28, 1987 I served by hand celivery,
6 personally, on the CITY OF DUBLIN, 6500 Dublin Boulevard, Suite
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c ; 205, Dublin , California 94568, a Claim for Damages, pursuant
10 ; to Government Code 5910.
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17 I, ��;, %/11f� �,�� /�/G declare under penalty of
18 perjury that the foregoing is true and correct.
19 Executed on April 28, 1987 at San Francisco,
20 California. /
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NAME AND ADDRESS OF AGENCY .:a:;r 4::,;ti:;+•>'"° - _ _
COMPANIES AFFORDING COVERAGES
C.`'Jenkins ..Insurance
P.O. 'Box.'5658 : '. Y
COMPANY A - : :Industrial 'Indemnity•• .
Concord; CA 94524 . LETTER
-:' _ COMPANY B : Employee Benef i ts'' -
LETTER
NAME AND ADDRESS OF INSURED
• ' ' COMPANY
..Castle-'Construction"Co.', Inc. LETTER , C'
: Far west Associates COMPANY D
2291 Via`de Mercados LETTER
Concord, CA 94520 ;• .: LETTER COMPANY E
a .i.. ..
This is to certify that policies of insurance listed below have.been issued to the insured named above and are in force at this time. Notwithstanding any requirement,term or condition
of any contract or other document with respect to which this certificate may be issued or may pertain,the insurance afforded by the policies described herein is subject to all the
terms,exclusions and conditions of such policies.
Limits of Liability in Thousands( )
COMPANY•' TYPE OFINSURANCE POLICY NUMBER EXPIRATION GATE EACH
' OCCURRENCE AGGREGATE
GENERAL LIABILITY
.:r 8/15/86.
BODILY INJURY f $
SG8572778
COMPREHENSIVE FORM
` '. - '•'
A :` ®
❑ =
PREMISES OPERATIONS PROPERTY DAMAGE f f
•;,'- EXPLOSION ANO COLLAPSE
r'• :{.HAZARD
UNDERGROUND HAZARD i"- st; •::::::
•
PRODUCTS/COMPLETED ` ':y\•
`^ •'OPERATIONS HAZARD BODILY INJURY AND _
E� C�CONTRACTUAL INSURANCE _ PROPERTY DAMAGE $500 S 500
•.:i; X BROAD FORM PROPERTY }.. :.:; ..' .. «'.:. - COMBINED _
DAMAGE
C�INDEPENDENT CONTRACTORS _
PERSONAL INJURY PERSONAL INJURY f 500
AUTOMOBILE LIABILITY BODILY INJURY
n : . ..... (EACH PERSON) $'
^A v COMPREHENSIVE FORM .,, SP8671487 " 8/15/86 BODILY INJURY $
OWNED (EACH ACCIDENT)
HIRED
PROPERTY DAMAGE S
BODILY INJURY AND
NON-OWNED•- - ,. - PROPERTY DAMAGE $500 - -
COMBINED
EXCESS LIABILITY
BODILY INJURY AND
A ❑ UMBRELLA FORM LC8572779 8/15/86 PROPERTY DAMAGE $10,000 $10,000
❑ OTHER THAN UMBRELLA
FORM COMBINED
WORKERS'COMPENSATION
. STATUTORY
B EMPLOYERS'LIABILITY 265101 1O/1/86 $ lOO
'[1CM.I:'CEhi7
OTHER
DESCRIPTION OF OPERATIONS&OCATIONSNEHICLES
The City of Dublin, its officers, agents and employees are included as Additional Insureds
as respects Liability coverages. This coverage is primary to any other coverage of the
City of Dublin.
Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the issuing com-
p (/f pany Ileln )()WX Xmail IQ days written notice to the below named certificate holder, but failure to
MA LO Nd mail such notice shall impose no obligation or liability of any kind upon the company.
co> `0
5 NAME AND ADDRESS OF CERTIFICATE HOLDER: 1/9/86 bp
IW Y--f V City of Dublin DATE ISSUED,.
P.O. Box 2340 "RIIE
Dubl in, CA 94568 NTA I VE
ACORD 25(1-791