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Home My WebLink AboutAGENDA REPORT 2002 0403 CC REG ITEM 11HTO: FROM: DATE: SUBJECT: CTTY OF MOORPARK, CALIFORNYA City Council Meeting of �nr 1 Ir , aU)a ACTION: QD'prYiveci i�ni� fea.)MMen)dF. MOORPARK CITY COUNCIL AGENDA REPORT Honorable City Council Walter Brown, City Engineer ull_� March 28, 2002 (CC Meeting of 4/03/02) Recognition Awards and ISO Rating for the Moorpark Building and Safety Division DISCUSSION Annually the Ventura chapter of the International Conference of Building Officials (ICBO) presents awards to individuals in the building and safety field who represent the top of their profession. This year two members of the Moorpark Building and Safety staff received the awards. Permit Technician, Leticia Alcozar, was presented the "Staff Person of the Year for 2001" award. Senior Building Inspector Ray Young, who holds an ICBO certification as Chief Building Code Official, received the "Building Inspector of the Year for 2001" award. We commend Leticia Alcozar and Ray Young to you as the best in their fields in Ventura County. In a second, and related matter, we are pleased to inform you that the Moorpark Building and Safety Division has received a Class 2 Building Code Effectiveness Grading Schedule ( BCEGS) rating from the Insurance Services Office, Inc. (ISO) . ISO is the organization that has graded the effectiveness of departments for many years. Their ratings are used by insurers in determining insurance rates for commercial property owners and homeowners. The BCEGS program assigns each municipality a BCEGS grade of 1 (exemplary commitment to building -code enforcement) to 10. ISO develops advisory rating credits that apply to ranges of BCEGS classifications (1 -3, 4 -7, 8 -9, 10) . Honorable City Council March 28, 2002 Page 2 The BCEGS program evaluates the effectiveness of local building - codes enforcement to help determine how well homes and commercial structures in a given community will hold up to hurricanes, earthquakes and other natural disasters. The rating weighed the building codes in effect in our community, the qualifications of our staff and how our community enforces its building codes, with special emphasis on mitigation of losses from natural hazards. This is the second consecutive Class 2 rating we have received. Our rating puts Moorpark in the top 2% of jurisdictions in the United States. With over 6000 rated, only 81 jurisdictions in the entire United States have received a rating of two or better. ISO ratings for jurisdictions in Ventura t,(_)uiiLy alc ISO Rating Standings - Cities in Ventura County Camarillo* 2 Fillmore Not Rated Moorpark* 2 Ojai Not Rated Oxnard 3 Port Hueneme 3 Santa Paula 3 Simi Valley 3 Thousand Oaks 4 Ventura 2 Ventura County 3 *Building and Safety ueparT-merru bt-_z V_L--cJ Abbott Associates Charles The concept of the ISO rating is that municipalities with well - enforced and up -to -date codes should experience lower insurance losses and that insurance rates can reflect that. The prospect of lessening catastrophe- related damage and ultimately lowering insurance costs provides an incentive for us to enforce building codes rigorously, especially as they relate to windstorm and earthquake damage. ISO gives insurers BCEGS classifications; BCEGS advisory credits, and related underwriting information. The rating we have received is significant to all residents and property owners in Moorpark. ISO ratings are used by insurance underwriters to determine local insurance rates. The rating achieved by our Building and Safety Division will result in lower property insurance rates for our citizens. �. Honorable City Council March 28, 2002 Page 3 STAFF RECOrMENDATION Receive and file. Attachment: ISO Report Rating Graph ^ 4�%4 —, -J, chart COUNTRYWIDE Distribution of Communities by BCEGS Class Number within Classification 1000 1600 1400 1'200 1000 800 600 400 200 0 1 3 4 5 6 7 6 9 111 The personal lines classification addresses building code adoption and enforcement for 1- and 2- family dwellings. The commercial lines classification is for all other buildings. http://1' sonittigation .conl/bcegscha /countrv�v.htmI Commercial Lines ElPersonal Lines Page 1 of I ., r , _,r ._• r 2'?8i02 111 NORTH CANAL STREET SUITE 950 CHICAGO, IL 60606 -7270 TEL: (312) 930 -0070 (800) 444 -4554 FAX: (312) 930 -0017 January 22, 2002 Mr. Steve Kueny City Manager City of Moo, park 799 Moorpark Avenue Moorpark, CA 93021 RE: Building Code Effectiveness Grading Schedule Moorpark, Ventura County, California Dear Mr. Kueny: We wish to thank you, Greg Robinson and Ray Young for the cooperation given to our representative, John Gorman, during our recent survey. We have completed our analysis of the building codes adopted by your community and the efforts put forth to properly enforce those codes. The resulting Building Code Effectiveness Grading Classification is 2 for 1 and 2 family residential property and 2 for commercial and industrial property. The Insurance Services Office, Inc. (ISO) is an insurer - supported organization with the primary mission of providing advisory insurance underwriting and rating information to insurers. There is no requirement that insurers use our advisory material. Insurers may have adopted, or may be in the process of adopting, an ISO insurance rating program that will provide rating credits to individual property insurance policies in recognition of community efforts to mitigate property damage due to natural disasters. These insurers may use the Building Code Effectiveness Grading Classification we have recently developed for your community as a basis for the credits used. While individual insurers may use different credits or different effective dates, the ISO program will apply credits to new construction within Moorpark that has been issued a Certificate of Occupancy in the year 2001 and forward. We have attached a copy of our report which provides additional information about our classification process and how we have graded various aspects of your community's building codes and their enforcement. We want to highlight the fact that the Building Code Effectiveness Grading Schedule is an insurance underwriting and information tool; it is not intended to analyze all aspects of a comprehensive building code enforcement program nor is it for purposes of determining compliance with any state or local law or for making property/casualty loss prevention and life safety recommendations. Mr. Steve Kueny January 22, 2002 Page 2 If you have any questions about the Classification that was developed, please let us know. Additionally, if you are planning on any future changes in your building codes or their enforcement, please advise us as these changes may affect our analysis and your community's grading classification. Sincerely, eodz D Building Code Department (800) 930 -1677 Ext. 6208 Enclosure cc: Greg Robinson, Building Official w /enclosure 18 High Street Moorpark, CA 93021 �...�vJ BUILDING CODE EFFECTIVENESS GRADING SCHEDULE INTRODUCTION The purpose of the Building Code Effectiveness Grading Schedule is to review the available public building code enforcement agencies and to develop a Building Code Effectiveness Classification for insurance underwriting information and rating purposes. The Schedule measures the resources and support available for building code enforcement. It also evaluates how those resources apply to the mitigation of the natural hazards common to the specific jurisdiction. These measurements are then developed into a Building Code Effectiveness Classification number on a relative scale from 1 to 10, with 10 representing less than the minimum recognized protection. The Schedule is an insurance underwriting information and rating tool. It is not intended to analyze all aspects of a comprehensive building code enforcement program. It is not for purposes of determining compliance with any state or local law or regulation, nor is it for making property /casualty loss prevention or life safety recommendations. It should not be used for purposes other than insurance underwriting information and rating. The Building Code Effectiveness Classifications developed through the use of this Schedule are only one of several elements used to develop insurance rates for individual properties. Other features specifically relating to individual properties such as construction, occupancy, and exposures have similar importance in the development of these rates. The Schedule is divided into 3 sections: Administration of Codes: This section evaluates the administrative support available in the jurisdiction for code enforcement. It looks for adopted building codes and modifications of those codes through ordinance, code enforcers qualifications, experience and education, zoning provisions, contractor /builder licensing requirements, public awareness programs, the building department's participation in code development activities and the administrative policies and procedures. Plan Review: This section assesses the plan review function to determine the staffing levels, personnel experience, performance evaluation schedules, review capabilities, and level of review of construction documents for compliance with the adopted building code for the jurisdiction being graded. Field Inspection: This section evaluates the field inspection function to determine the staffing levels, personnel experience, performance evaluation schedules, review capabilities, and level of review of building construction for compliance with the adopted building code for the jurisdiction being graded. The attached "Classification Details" identify the subject matter, maximum points achievable and the points obtained in the review of your community. This information is provided to you without recommendation and is for your use in understanding the details of the measurement of your building code enforcement activities in relationship to the Building Code Effectiveness Grading Schedule. Moorpark, CA SECTION I ADMINISTRATION OF CODES This section evaluates the administrative support for code enforcement within the jurisdiction -- the adopted building codes and the modifications of those codes through ordinance, code enforcers qualifications, experience and education, zoning provisions, contractor/builder licensing requirements, public awareness programs, the building department's participation in code development activities, and the administrative policies and procedures. The latest edition of the model codes should be adopted and enforced by the jurisdiction. Use of codes other than the model codes, the National Electric Code, or the CABO 1 & 2 Family. Dwelling Code may prorate the points available in Item 105. If the latest edition of the listed codes were adopted within 1 1/2 years of the published date, and the published date of the listed codes is within 3 years of the date of the grading Column A applies. If the above does not apply, or the previous edition of the listed codes is adopted, and the published date of the listed codes is within 5 years of the date of the grading, Column B applies. If the next previous edition of the listed codes is adopted, and the published date of the listed codes is within 10 years of the date of the grading Column C applies If an earlier edition of the listed codes is adopted Column D applies. CODES Points Possible Points Scored A C D Building 7.75 pts. 3.60 pts 1.70 pts 7.75 pts. Electrical 0.75 pt 0.30 pt 0.15 pt 0.45 pt. Mechanical /Gas 0.75 pt X4Opt 0.30 pt 0.15 pt 0.75 pt. Plumbing 0.75 pt 0.30 pt 0.15 pt 0.75 pt. I & 2 Family Dwelling 4.00 pts* 1.60 pts* 0.80 pt* 0.00 pt(s). * If a building code is adopted and enforced this value will equal 0.00 points. 1/222/2002 v� - .L- — a There should be no modifications to the structural design provisions of the adopted codes and referenced standards that would weaken the intent for construction mitigation of natural hazards as defined in the model codes and referenced standards. No proration is permitted in this item. ** Maximum allowable points = (points credited in item 105) x 0.1 x 5.0 Amount of expenditures for training equaling at least 2% of the annual operating budget for all building department related activities. 2 1/22/2002' Pts Poss. Scored 3.00 points _ 3.00 point(s) Each code enforcement person receiving the following amount of training per year: Pts Poss. Scored Administration 12 hours .. ............................... 1.25 points 0.94point(s) Legal 12 hours ... ............................... 1.25 points 0.94point(s) Mentoring 12 hours .. ............................... 1.25 points 1.07point(s) Technical 60 hours .. ............................... 4.25 points 3.08 point(s) Incentives provided by the jurisdiction for continuing education, outside training, certification and certification maintenance. Pts Poss. Scored Community paid certification exam fees 0.50 point 0.50 point Community incentive - outside training /certification 0.50 point 0.50 point Community paid continuing education 0.50 point 0.50 point Education of elected officials or governing authorities in building codes and building code enforcement a minimum of 3 hours per official per year. Pts Poss. Scored 0.50 point 0.00 point 2 1/22/2002' The credit for certification is as follows: Certification of code enforcement personnel (applicable to the position requirements) through a comprehensive examination representative of the performance area for which certification is sought. State or local jurisdiction mandated program for certification. Pts Poss. Scored 8.00 points 3.93 point(s) Pts Poss. Scored 1.00 point 1.00 point State or local jurisdiction mandated program of certification maintenance through continuing education at least once every 3 years. Pts Poss. Scored 2.00 points 2.00 point Program of employee certification in the field they are employed (prior to employment or within one year of date of hire or advancement). Pts Poss. Scored 1.00 point 0.64 point 1!22/2002 The following is reviewed: Licensed Architect or Engineer 4 1/22/2002 Pts Poss. Scored 0.60 point 0.00 point Certification as a building official Pts Poss. Scored 0.60 point 0.60 point High School diploma Pts Poss. Scored 0.10 point 0.10 point College degree Pts Poss. Scored 0.50 point 0.50 point Masters degree Pts Poss. Scored 0.40 point 0.00 point Construction related experience Pts Poss. Scored none 0.00 point less than 2 years 0.10 point or two to five years 0.20 point or more than five years 0.60 point 0.20 point Code enforcement experience Pts Poss. Scored none 0.00 point less than 2 years 0.10 point or two to five years 0.20 point or more than five years 0.60 point 0.60 point Building official experience Pts Poss. Scored less than 2 years 0.10 point or two to five years 0.20 point or more than five years 0.60 point 0.60 point 4 1/22/2002 The selection process for a building official is designed to select the most qualified candidate. Selection through examination. Selection through peer review. The credit for design professionals is as follows: Pts Poss. Scored 0.25 point 0.25 point 0.25 point 0.00 point If supervisory plan review staff are graduate or registered architects or engineers. Pts Poss. Scored 2.00 points 1.82 point(s) If non- supervisory plan review staff are graduate or registered architects or engineers Pts Poss. Scored 1.50 points 0.30 point(s) If supervisory field inspection staff are graduate or registered architects or engineers. Pts Poss. Scored 0.50 point 0.00 point Where possible, special (through ordinance or code amendment) zoning provisions that address mitigation measures for buildings subject to local natural hazards. 1/22/2002 Contractors/builders licensed and bonded to work in the jurisdiction being graded. The licensure dependence upon examination and experience. Licensing requirement for contractors and builders Pts Poss. Scored 0.10 point 0.10 point Licensing by examination Licensing by experience Bonding requirements for contractors Pts Poss. Scored 0.50 point 0.50 point Pts Poss. Scored 0.30 point 0.30 point Pts Poss. Scored 0.10 point 0.10 point Reporting of licensing violations in contract documents to the appropriate state professional licensing board. The amount of expenditures for public awareness programs equaling a minimum of 0.5% of the annual operating budget for all building department related activities. Pts Poss. Scored 1.00 point 1.00 point The amount of hours spent by code enforcers on public awareness programs, equaling a minimum of 3 hours per code enforcement employee per year. Pts Poss. Scored 1.00 point I 0.83 point 1/22/2002 The building department involvement in code development activities and associations with groups or organizations that assemble building enforcement personnel for the purpose of education and advancement of effective building codes. Participation in code change activities Pts Poss. Scored 0.25 point 0.25 point Participates in code association/chapter meetings Pts Poss. Scored 0.25 point 0.25 point The credit for "Policies and Procedures" is as follows: A formal appeal process that a contractor/builder or architect/design professional can utilize as recourse to a building official's interpretation of the adopted building code /zoning regulations. Pts Poss. Scored 0.30 point 0.00 point A policies and procedures guide for employees. Pts Poss. 0.10 point Scored 0.10 point The policies and procedures guide covers technical code requirements (such as approved products listings) that would assist a designer or builder. Pts Poss. Scored 0.05 point 0.05 point Publicizing the policies and procedures guide as available to the public. Pts Poss. Scored 0.05 point 0.05 point 7 1/22/12002 IR SECTION I1 PLAN REVIEW This section evaluates the plan review function to determine the following: Staffing levels Personnel experience Performance evaluation schedules Review capabilities, and level of review of construction documents for compliance with the adopted building code for the jurisdiction being graded Staffing levels sufficient to assure comprehensive reviews of construction documents for compliance with the adopted building codes. ** Maximum allowable points = points achieved in item 215 x item 205 points possible in item 215 5 years or greater experience in plan review of plan review staff. The credit for the comprehensiveness of plan review is as follows: Plan reviews conducted on all proposed 1 &2 family dwelling construction or dwelling additions /modifications. Note: When plan reviews are not being conducted, the community classification will be a Class 99 for and 2 family dwellings and the " Pts Scored" will default to the maximum possible in order to determine the community classification for commercial /industrial property. Pts Poss. Scored 5.00 points 5.00 point(s) Comprehensive review of plans performed even if they were prepared and sealed by a registered design professional certified in the appropriate field of work. Pts Poss. Scored 1.50 points 1.50 point(s) 1/22/2002 E' r, rp .� Structural plan reviews conducted for all proposed building construction or building additions /modifications including a review of engineering calculations. Pts Poss. Scored 2.00 points 2.00 point(s) A means to evaluate, or reference evaluation service reports, for substitute products and /or materials for conformance with the intent of the structural portions of the adopted building codes. Pts Poss. Scored 1.00 point 1.00 point A detailed checklist used with each plan review to assure all pertinent building code issues have been considered. Pts Poss. Scored 1.50 points 1.50 point(s) The checklist becomes a part of the permanent record of the project address. Pts Poss. Scored 0.50 point 0.50 point Credit for quality assurance programs for plan reviewers is as follows: Annual employee performance evaluations. Pts Poss. Scored 0.50 point 0.50 point "Follow -up" plan reviews by a different plan reviewer conducted semiannually_ Pts Poss. Scored 0.50 point 0.50 point 1/22,2002 �,' _., — J SECTION III FIELD INSPECTION This section evaluates the field inspection function to determine the following: Staffing levels Personnel experience Performance evaluation schedules Review capabilities and level of review of building construction Staffing levels sufficient to assure comprehensive reviews of building construction for compliance with the adopted building codes. 5 years or greater experience in field inspection. Pts Poss. 1.50 points 2 years or greater of construction related experience. Pts Poss. 1.50 points Scored 0.98 point(s) Scored 1.50 point(s) Building department authority to issue correction notices and stop work orders for non- compliant construction. A detailed checklist completed for each building construction project to assure that all pertinent building code issues have been considered. Pts Poss. Scored 1.50 points 1.50 point(s) 10 1,'22/2002 The checklist becomes a part of the permanent record of the project address. Pts Poss. Scored 0.50 point 0.50 point Where necessary to assure structural integrity, the building department requirement for special inspections for specific structural elements conducted by professional inspectors who have been certified for such work. When there are construction mitigation measures defined in the adopted building code for the natural hazard(s) peculiar to the area being graded, special inspections that focus on compliance with the provisions of the code. Final inspections performed on all buildings after the construction is completed and the building is ready for occupancy. Final inspections performed for I & 2 family dwellings. Pts Poss. Scored 1.25 points 1.25 point(s) Final inspections performed for all other buildings. Pts Poss. Scored 1.25 points 1.25 point(s) 11/22/2002 Pts Poss. Scored 0.75 point 0.75 point The certification being obtained by a combination of: Examination Pts Poss. Scored 0.25 point 0.25 point Experience in the field of inspection they will be performing Pts Poss. Scored 0.25 point 0.25 point An interview by the building official to assess qualifications Pts Poss. Scored 0.25 point 0.00 point When there are construction mitigation measures defined in the adopted building code for the natural hazard(s) peculiar to the area being graded, special inspections that focus on compliance with the provisions of the code. Final inspections performed on all buildings after the construction is completed and the building is ready for occupancy. Final inspections performed for I & 2 family dwellings. Pts Poss. Scored 1.25 points 1.25 point(s) Final inspections performed for all other buildings. Pts Poss. Scored 1.25 points 1.25 point(s) 11/22/2002 Certificates of occupancy issued by the building department after the construction is completed and prior to the building being occupied. Certificates of occupancy issued for 1 & 2 family dwellings. Certificates of occupancy issued for all other buildings. Pts POSS. Scored 1.20 points 1.20 point(s) Pts Poss. Scored 0.80 point 0.80 point Credit for quality assurance programs for field inspectors is as follows: Annual employee performance evaluations. Pts Poss. Scored 0.50 point 0.50 point "Follow -up" field inspections by a different field inspector conducted semiannually. Pts Poss. Scored 0.50 point 0.50 point 12 1/221/2002 F::j- urisdiction: Moorpark Total points: 85.28 tate: CA Classification: 1 & 2 Family Dwellings - 2 All Other Construction - 2 Survey Date: Nov. 15, 2001 FINAL SCORING Section 1 42.65 Section 2 22.93 Section 3 22.04 Subtotal 87.62 Item 105 9.70 The final score is determined by a relationship between Item 105 and the balance of the scoring. Points achieved in Item 105 [ {(Section I + Section II + Section 111) - Item 105} x Points possible in Item 105 1] + Item 105 [ {( 42.65 + 22.93 + 22.04) - 9.70} x (9.70 / 10.001 + 9.70 = 85.28 Classification Point Spreads Classification Point Spreads 1 93.00 - 100.00 6 51.00 - 60.99 2 85.00 - 92.99 7 39.00 - 50.99 3 77.00 - 84.99 8 25.00 - 38.99 4 69.00 - 76.99 9 10.00 - 24.99 5 61.00 - 68.99 ]0 0.00- 9.99 13 1/22/2002 Memo To: Joan Fretz, Human Resources Assistant From: Dallin Hutchinson, Crossing Guard Supervisor.: CC: Mike Mathews, Sr. Management Analyst Date: 08/23/02 Re: Home Address Confidentiality The California Vehicle Code provides public officers the option of requesting a confidential home address. CVC section 1808.4 says, in part: 1808.4. (a) The home address of any of the following persons, that appears in any record of the department, is confidential, if the person requests the confidentiality of that information: (19) Any active or retired city enforcement officer engaged in the enforcement of the Vehicle Code or municipal parking ordinances. The home address can then only be released to a court, law enforcement agency, State Board of Equalization, or any governmental agency requiring the City to release this information by law. The Department of Motor Vehicles will substitute my work address in place of my home address in their records. This memo will serve as my request to keep my home address confidential. • Page 1 Message Debbie Traffenstedt From: Mary Lindley Sent: Saturday, September 28, 2002 10:47 AM To: Debbie Traffenstedt Subject: RE: Claim Submitted By Moustafa Elgamiel There is a fence the length of the soccer field for that very reason. - - - -- Original Message---- - From: Debbie Traffenstedt Sent: Friday, September 27, 2002 11:10 AM To: Mary Lindley Cc: Steve Kueny Subject: Claim Submitted By Moustafa Elgamiel Mary, Page 1 of 1 Please review the copy of the claim form you received that was submitted by Mr. Elgamiel as a result of a soccer ball that hit his car as he was driving along Collins Drive adjacent to the City's park. Our claims adjuster has recommended that we reject the claim. John Hartnett confirmed that there were no park reservations for field use on the date of the incident (8/8/02). If there was a league making use of the field on that day, it was not a formal, scheduled game. For these reasons, the Council has been requested to reject the claim at the 10/2/02 meeting. However, you may want to look at whether or not a fence is needed to minimize balls hitting cars in the future. Debbie 9/30/2002 Message Debbie Traffenstedt To: Mary Lindley Cc: Steve Kueny Subject: Need Documentation for Roger Dixon Claim Page 1 of 1 A claim was filed on 9/26/02 by Roger Dixon pertaining to cement and rocks that hit his vehicle on 9/18/02 from a trailer being pulled by what Mr. Dixon thought was a City truck. Please review your copy of the claim form and provide a written response regarding whether any Community Services employees could have been involved in the incident. You verbally told me that they were at lunch at the time of the incident. Please provide this information in writing and verify whether there was any time on the morning of 9/18/02 that a Community Services truck might have been pulling a trailer that was hauling cement and /or rocks. Thanks. Debbie 9/27/2002 MEMORANDUM COMMUNITY SERVICES DEPARTMENT TO: Debbie Traffenstedt, ATCM /City Clerk FROM: Mary K. Lindley, Director of Community Services DATE: September 30, 2002 SUBJECT: Dixon Claim I do not believe the incident reported by Mr. Dixon involved any Community Services employee. On September 18, 2002, no employee in the Community Services department was either pulling a trailer or performing any concrete work. John Casillas and Rodrigo Ceja spent most of the morning working a Mountain Meadows Park. They left the Park in one vehicle and headed back to the maintenance yard at about 11:40 a.m. by way of Tierra Rejada Road, Gabbert Road and Poindexter Road — they did not use Spring Street or L. A. Avenue at that time. Once they got back to the yard, they both took lunch at around 11:50 a.m. using John Casillas' personal vehicle. At no time during the date of September 18 did either John or Rodrigo pull a trailer or work with concrete. Todd Henderson was on vacation that day. Neither Mark Westerline nor Loc Trans pulled a trailer on the date of September 30, 2002. They rarely, if ever, pull a trailer (although they have one), but they never work with concrete. No one at AVRC pulls a trailer and they never perform concrete work. MOORPARK 799 Moorpark Avenue Moorpark, California 93021 -555}� FORM #1 (FRON-T) FILE WITH: CLAIM FOR DAMAGES CITY CLERK'S OFFICE (Address] TO PERSON OR PROPERTY INSTRUCTIONS 1. Claims for death. injury to person or to personal property must be riled not later than six months after the occurrence. (Gov. Code Sea 911.2.) 2. Claims for damages to real property must be riled not later than 1 year alter the occurrence_ (Gov. Code See. 911.2.) 3 Read entire claim forth before firing. 4. See page 2 for diagram upon which to locate place at accident 5 This claim form must be signed on page 2 at bottom. 6. Attach separate sheets. if necessary, to give full details. SIGN EACH SHEET. TO: (Name of city) Name of Home Addrests of Ctaimant ��/— �'� -- -- �3l- urry� a' state Business Address of Claimant (tSVS) Z) I r-Dew RESERVE FOR FILING STAMP CLAr e Date of Birth of Claimant 0;? - /I - 4!e Occu atic o� �F t ^ G v LJ Home Telephone Number 7 Business Telephone Number Give address and telephone number to which you desire notices or communications to be sent t ia/tm7anz s aoua, ziw-w �r regarding thisclaim: Ir /nA, / LO, �j,r 6;,� %0 —6� When di 0 Ear INJURY ateuR is Names of any city employees involved in INJURY or DAMAGE Date ' D Time •r CVe, iZti dAl It claim is for Equitable Indemnity, give date claimant served with the complaint: uate Where did DAMAGE or INJURY o= r? Describe fully. and locate on diagram on reverse side of this sheet. where a and dress_ and measu0 ` ^ , ` e. i E a �Q (C/�[C.W Oescnbe in detail how the DAMAGE or INJURY occurred. Goa cA.Fil -re &`10 V-604 • t�"v+S CtR-�i T�+Qe t taF2 3 �r� -1�- -� ►-� � c',� l,J tw-v:s CA;-tit 'Dv-1, j 4iA � w E- Why do you claim the city is responsible? &-k-uc" N. Describe in 1ai1 each INJURY or DAMAGE re . (RpC,< Ca -Ae- -W PA) GJ //JDs 2• t�r►� z£ PAZ �5Po.9/ is -AZlG� DZ-. ( / yt0/ 4TE LIVIK f) SEE PAGE 2 (OVER) THIS CLAIM MUST BE SIGNED ON REVERSE SIDE FORM #1 (BACK) The amount claimed, as of the date of presentation of this claim, is computed as follows Damages incurred to date (exact): is irrat�ective damages as far as known: Oamage' to property ................. ....... S Future expenses for medical and hospital care .... 5 Expenses for medical and hospital care ...... _ . S Future loss of earnings ....................... $ Loss of earnings ............................ S Other prospective special damages ............ 5 Special damages for ........................ S Prospective general damages ................ Total e'st�imra�te estimate damages ......... S S l General damages .................. ......... S CA 6-L1 sr �>(- Total damages incurred to date .............. S M ftf k 4%'1 0 �1,r, 7v Total amount claimed as of date of presentation at this claim: S Was damage and/or injury investigated by poll a? D If so, what city? Were paramedics or ambulant La called? If so, name city or ambplance If injured. state date, time, name and address of doctor of your first visit WITNESSEI to DAMAGE or INJURY: List all persons and addresses of persons known to have information: Name Address Name Address Name address Phone Phone DOCTORS and OSPITALS: Hospital_ 71,1 Address Date Hospitalized Doctor Address Data of Treatment Doctor �_ Address Date of Treatment READ CAREFULLY For all accident claims place on following diagram names of streets, or your vehicle when you first saw City vehicle: location of City vehicle ,ncluding North. East, South, and West: indicate place of accident by at time of accident by "Art" and location of yourself or your vehicle at X and by showing house numbers or distances to street corners. the time of the accident by 84" and the point of impact by 'X' It City Vehicle was involved, designate by letter "A" location of City NOTE: It diagrams below do not fit the situation, attach hereto a proper Vehicle when you first saw it, and by "B" location of yourself diagram signed by Claimant. L6 CURB 9� 2 � SIDEWALK SIDEWALK C, ,., ,. P4 CA4 Signature of Claimant or erson filing on b�re tis behalf awtrtlation to Claimant: NOTE: CURB Date: CITY CLERK (Gov. Code Sea 9iSa). Presentation of a false claim is a felony (Pen. Code Sec. 72.) i —[