HomeMy WebLinkAbout08- Risk Management CITY OF SAN BERN. IDINO - REQUEST F R COUNCIL ACTION
From: Victor Lorch Subject: Authorization for Mayor to sign
Dept: Director of Risk Management Proof of Loss statement.
Date: February 5 , 1993
Synopsis of Previous Council action:
Recommended motion:
That the Mayor be authorized to sign the attached Sworn Statement
in Proof of Loss relative to reimbursement for physical damage
to a City Refuse vehicle.
Sig'ncAure
Contact person: Victor Lorch Phone:
Supporting data attached: yes Ward:
FUNDING REQUIREMENTS: Amount:
Source: (Acct. No.)
(Acct. Description)
Finance:
Council Notes:
75-0262 Agenda Item No. _
CITY. OF SAN BERN...ADINO - REQUEST F.rR COUNCIL ACTION
STAFF REPORT
In accordance with Council Resolution #92-246, Establishment of a
Procedure to Approve and Accept Settlements for the City of San
Bernardino, recommend the Mayor be authorized to sign the attached
Proof of Loss in the amount of $44,737 . 66.
These monies are reimbursement from the City's Property Insurance
Carrier for physical damage to a City's Refuse Truck. The City has
a $25, 000 collision deductible on certain high value vehicles.
The attached subrogation receipt, allows the Insurance Carrier to
proceed against the party responsible for damages to our vehicle.
If they are successful in their collection, the City could recoup
its deductable, at no expense to the City.
75-0264
POLICY NO. - A. S. FILE NO.
SF ' 005975 +8731 -72253
AMOUNT OF POLICY AT TIME OF LOSS SWORN STATEMENT COMPANY CLAIM NO.
$ 5,000,000. 00 IN 50665
DATE ISSUED AGENT
04-30-92 PROOF OF LOSS FRANK B. HALL & CO.
DATE EXPIRES AGENCY AT
04-30-93 SAN BERNARDINO, CA
To the RLI INSURANCE COMPANY
of
At time of loss, by the above indicated policy of insurance, you insured—
CITY OF SAN BERNARDINO, ETAL
against loss by ALL RISK to the property described according to the
terms and conditions of said policy and of all forms, endorsements, transfers and assignments attached thereto.
TIME AND A COLLISION loss occurred about the hour of o'clock M.,
ORIGIN 24Tch AUGUST 92
y o 19 CITY REFUSE
on the f , the cause and origin of the said loss were:
TRUCK COLLIDED WITH ANOTHER TRUCK.
OCCUPANCY The building described, or containing the property described, was occupied at the time of the loss as follows, and for
no other purpose whatever: MUNICIPALITY
TITLE AND At the time of the loss, the interest of your insured in the property described therein was OWNER
INTEREST
No other person or persons had any interest therein or
encumbrance thereon, except: NONE
CHANGES Since the said policy was issued, there has been no assignment thereof, or change of interest, use, occupancy, posses-
sion, location or exposure of the property described, except NONE
TOTAL THE TOTAL AMOUNT OF INSURANCE upon the property described by this policy was, at the time of the loss,
INSURANCE 5,0 0 0,0 0 0. 00$ as more particularly specified in the apportionment attached, besides which there
was no policy or other contract of insurance, written or oral, valid or invalid.
VALUE THE ACTUAL CASH VALUE of said property at the time of the loss was . . . . $ NOT DETERMINE D
LOSS THE WHOLE LOSS AND DAMAGE was . . . . . . . . . . . . . . . $ 69,737. 66
AMOUNT CLAIMED THE AMOUNT CLAIMED under the above numbered policy is . . . . . . . _ $ 44,737. 66
STATEMENTS The said loss did not originate by any act, design or procurement on the part of your insured, or this affiant;nothing
OF INSURED has been done by or with the privity or consent of your insured or this affiant, to violate the conditions of the policy,
or render it void; no articles are mentioned herein or in annexed schedules but such as were destroyed or damaged at
the time of said loss;no property saved has in any manner been concealed, and no attempt to deceive the said company,
as to the extent of said loss, has in any manner been made. Any other information that may be required will be fur-
nished and considered a part of this proof.
The furnishing of this blank or the preparation of proofs by a representative of the above Insurance company is not a waiver of any
of Its rights.
State of X
County of
Insured
Subscribed and sworn to before me this day of 19
Form recommended by the X
American Insurance Association Notary Public _
GAB-765
SUBROGATION RECEIP'►
RECEIVED OF THE R L I _ INSURANCE CO.,
the sum of FORTY–FOUR THOUSAND SEVEN HUNDRED THIRTY– Dollars ($44,737. 66 )
SE EN AND ----------------------------
in full settlement of all claims and demands of the undersigned for loss and damage by COLLISION
occurring on the 24TH day of AUGUST A.D. 19-92 , to the property described in
Policy No. S F C 0 0 5 9 7 5 issued through the FRANK B. HALL & CO. Agency of said Company.
In consideration of and to the extent of said payment the undersigned hereby subrogates said Insurance Com-
pany, to all of the rights, claims and interest which the undersigned may have against any person or corporation
liable for the loss mentioned above, and authorizes the said Insurance Company to sue, compromise or settle in the
undersigned's name or otherwise all such claims and to execute and sign releases and acquittances and endorse
checks or drafts given in settlement of such claims in the name of the undersigned, with the same force and effect
as if the undersigned executed or endorsed them.
Warranted no settlement has been made by the undersigned with any person or corporation against whom a claim
may lie,and no release has been given to anyone responsible for the loss,and that no such settlement will be made
nor release given by the undersigned without the written consent of the said Insurance Company and the under-
signed covenants and agrees to cooperate fully with said Insurance Company in the prosecution of such claims,
and to procure and furnish all papers and documents necessary in such proceedings and to attend court and testify
if the Insurance Company deems such to be necessary but it is understood the undersigned is to be saved harmless
from costs in such proceedings.
I n W i t n¢S S W h¢r¢0 f_ ha hereto set hand and seal this
day of 19
WITNESS: X (L.S.)
BY
OFFICER
(Notarization to be completed on losses where local law requires it.)
FOR INDIVIDUALS FOR CORPORATIONS
STATE OF STATE OF
SS: SS,
COUNTY OF COUNTY OF I
ON THE DAY OF 19_. ON THE DAY OF 19_,
BEFORE ME CAME BEFORE ME CAME
TO ME KNOWN TO BE THE INDIVIDUAL DESCRIBED IN, TO ME KNOWN, WHO, BEING BY ME DULY SWORN, DID
AND WHO EXECUTED, THE FOREGOING INSTRUMENT, AND DEPOSE AND SAY THAT HE RESIDES IN ,
THAT HE IS THE OF
ACKNOWLEDGED THAT EXECUTED THE SAME. THE CORPORATION
DESCRIBED IN, AND WHICH EXECUTED, THE FOREGOING
INSTRUMENT; THAT HE KNOWS THE SEAL OF SAID COR-
PORATION;THAT THE SEAL AFFIXED TO SAID INSTRUMENT
IS SUCH CORPORATE SEAL; THAT IT WAS SO AFFIXED BY
ORDER OF THE BOARD OF DIRECTORS OF SAID CORPORA-
TION; AND THAT HE SIGNED H NAME THERETO BY
LIKE ORDER.
X
NOTARY NOTARY
Form 729(4/74)
1 RESOLUTION NO.
2 RESOLUTION OF THE MAYOR ANd COMMON COUNCIL OF THE CITY OF
SAN BERNARDINO ESTABLISHING A PROCEDURE TO APPROVE AND ACCEPT
3 SETTLEMENTS FOR THE CITY OF SAN BERNARDINO.
4 WHEREAS, from time to time settlements of lawsuits and
5 claims involving the City result in proposals to provide funds for
6 the City, and
7 WHEREAS, there is presently no authorized officer or body
8 other than the Mayor and Council who may accept and approve such
9 settlements,
10 NOW, THEREFORE, BE IT RESOLVED BY THE MAYOR AND COMMON
11 COUNCIL OF THE CITY OF SAN BERNARDINO AS FOLLOWS:
12 SECTION 1 . Subject to the provision of Section 3 below, the
13 City Administrator or his or her authorized representative shall
14 be empowered to accept all settlements of lawsuits and claims
15 involving the City upon the approval of the City Attorney where
16 the City is to receive money or other items of value, as long as
17 such settlement is in an amount which does not exceed Ten Thousand
18 Dollars ( $10, 000.00 ) .
19 SECTION 2. Subject to the provisions of Section 3 below,
20 the Claims Review Committee established by San Bernardino
21 Municipal Code §3 . 16.060 shall be empowered upon unanimous vote to
22 accept all settlements of lawsuits and claims involving the City
23 where the City is to receive money or other items of value, as
24 long as such settlement is in an amount in excess of Ten Thousand
25 Dollars ( $10, 000. 00 ) but does not exceed Twenty Thousand Dollars
26 ( $20, 000. 00 ) .
27
28
DAB/ses/Settleme.res 1 June 26. 1992
1 RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF
SAN BERNARDINO ESTABLISHING A PROCEDURE TO APPROVE AND ACCEPT
2 SETTLEMENTS FOR THE CITY OF SAN BERNARDINO.
3 SECTION 3 . Nothing in this Resolution shall be construed
4 to grant authority to any officer other than the Mayor and Common
5 Council to compromise a claim of the City in order to bring it
6 within the above specified settlement authority.
7 I HEREBY CERTIFY that the foregoing resolution was duly
8 adopted by the Mayor and Common Council of the City of San
9 Bernardino at a r&,u14V meeting thereof, held on the
10 day of __-5 J 992, by the following vote, to wit:
11
Council Members: AYES NAYS ABSTAIN ABSENT
12 ESTRADA
13 REILLY
14 HERNANDEZ X
15 MAUDSLEY x
16 MINOR
17 POPE-LUDLAM �c
13 MILLER x
19
20 City Clerk
21 The f rggoing resolution is hereby approved this �G�� day
of ut 1992.
22 /5
23 W. R. Holcomb, Mayor
City of San Bernardino
24 Approved as to
form and legal content:
25 JAMES F. PENMAN,
26 City Attorney
27 By
28
DAB/ses/Settleme.res 2 June 26. 1992