Item 12 - Denial of Claim ~,AGENDA REPORT SUMMARY ~
~_.TO: Honorable Mayor and Members of the City Council
FROM: James L. B. owersox, City Man~;~nm~
INITIATED BY: Jp:hg~yD~. F lstt~hw,arAt~s iD~tr:~ttoCri gn~t~t ive (S_e rv i cers_~ ~9
Douglas A. Milton, General Services Manager<~'~/L_~'
DATE: April 25, 1995
SUBJECT: Denial of Claim for Damages - Steven M. Roberts
Denial of Claim for Damages - Brittany A. Roberts
ABSTRACT
1. A claim was received on March 21, 1995 alleging that Steven Michael Roberts
slipped and injured his mouth while climbing out of the Community Pool. The
incident occurred on October 24, 1994, and the amount of the claim is $282.00. It
is recommended that this claim be denied.
2. A claim was received on March 21, 1995 alleging that Brittany Ann Roberts slipped
and injured her mouth while climbing out of the Community Pool. The incident
occurred on October 18, 1994, and the amount of the claim is $507.00. It is
recommended that this claim be denied.
ENVIRONMENTAL REVIEW
This agenda item is not subject to environmental review according to CEQA guidelines.
FISCAL IMPACT
Unknown
ADDITIONAL PUBLIC NOTIFICATION AND CORRESPONDENCE
None
RECOMMENDATION
It is recommended that the City Council deny these claims.
ACTION
lo f9
APR 25 1995 rI'£M 12
- AGENDA REPORt"
CITY OF POWAY
This report is included on the Consent Calendar. There will be no separate discussion of the report pnor to approval by the
Cit~ C_ouncJi unless members of the Council staff or public request it to be removed From the Consent CaJendar and
discussed separately. If you ~vish to have this report puffed for discussion, please fill out a slip indicating t~e repo~ number
and give it to the Cit~ Clerk prior to the beginning of the City Council meeting,
TO: Honorable Mayor and Members of the City Council
FROM: James L. Bowersox, City Man'~
INITIATED BY: John D. Fitch, Assistant City Manager~
Peggy A. Stewart, Director of Administr%tive~ervices/
Douglas A. Milton, General Services Manager
DATE: April 25, 1995
SUBJECT: Denial of Claim for Damages - Steven M. Roberts
BACKGROUND
On March 21, 1995, a claim for damages was received from Steven Michael Roberts for
an injury sustained at the Poway Community Pool. The amount of the claim is
$282.00.
FINDINGS
The claim alleges that on October 24, 1994, Steven slipped and struck his mouth
while climbing out of the swimming pool. He was using the ladder.
ENVIRONMENTAL REVIEW
This agenda item is not subject to environmental review according to CEQA
guidelines.
FISCAL IMPACT
Unknown
ADDITIONAL PUBLIC NOTIFICATION AND CORRESPONDENCF
None
RECOMMENDATION
It is recommended that the City Council deny this claim,
Attachment: Claim for Damages - Steven Michael Roberts
.A. CTION:
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APR251995 ITEM !2
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a� ,D cary o� �o�vay � � i ,___
— � CW1+I AGAUJST TME CfTY � POWAY ' �,
- IYiY 0F FOI�Y lUNAGEMENf
�,S � by �.,.� �
��� �
,ver th� Counter . !� l r ` f y �-- o �� y
�•eWm must be,tUed wfa+ fi. Ctty CNrbror Rlsk IiAanaqer of:tho�Cily:of Pawq whtUn„6 monttu after,whleh.tht
hcident or ev�nt oeamed. 8a sure y.ourelaim is ap�inat,tho�1ty ot'Povr�y, tfot anoth�r p�ue eritlty. Wt�ere
tpa�e ts bs�uif+denL plaase usa �dditional paperand Infiortnatlon tiy paraqraph nur�sr. .Compleud
dalma must be malte0"or dei�verRd to The City at'Poway,13325 CMc Cinlar OrMs.Powsy. CA. 92064 (P.q.
Box.789 ). Aftr+:'Rlsk W
TO TFIE HONORABLE MAYOR ANG CRY'COUNCiL. TME CfiY OF AC7INAY C.'.1.1FGFVIA
..
The, understpned respecttuty svbmits the`fdiowinp eiaim �nil�iniormatton �taUvr tc dsmmpe to petsons
end/orpersonal propertY:
1. Wame Of deImant Steven Michael Roberts '_ (Brown) �
L �ddr�ss ot daimant
D. . Phane No. � c. Oat� ot;birtti -
r-
d Social Security No. e. D�iv�ert Ue. Plo.
:. Name, teiephone and post office sddress to whicl� Ctaimant desires flotices tD DQ sent M other
plan �bove:
3. Occurrence or eventtrom whicl� thr claim artse;: .
� . Data 10 / 24 / 94 b. Time e. �Itce (:6�caet sr+d sp�eNic location)
Powa� CommunitY. `Pool
d Naw`and unc•r wh?at aerumstar.�Q�:d!d riamaq� or'k�jury occurl SoeeHy the particular
oewRe,nce, ovent, act or.omisaion'you d�im cauaed t�e tnjury er damape'(use
add�ionaf paper'ii n�cssury ).
Steyen was; tak_ing, div,ing lessons. .As he was climb'ing ont of the
pool, his foot "sl'i p"ped ofE of the l,adder,• he fe;ll; hitting hie mouth
on the 'concrete. chiooine one of hic .fTnnr rn�nar�„ananr raPrt,_ HA
lso cut the ins-ide,of his mouth, skinned his knee, his chin and his
�orehead;:
e. W�.t,par�culu, action by'the Gry, or Its ert+ptoya�es, c�used tho all�yysd'dsmage or
injury?
3 of 9
. APR 2 5 1995 ITEII� 12
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4. C#Ivo a O�:diptlon ot'Ns.. �rY Pr'oP�nY demaee a�OSa. �o:4ar Is known at tha► tlmQ oftnis
,� �im. F! C►oFt rv�ro no fr�fiirtos. ffitste"WO �uri��' .
� Sxeven chipi�ed one' of.his unner front'pe�manent teeth cut the inside
� of his mouCh, �ki:}ned: his knee, his chin end hi:s forehead.
�a
J g, tiivo name(s) oi t�a GO� omploYee(a) causfng tA� d�ge or�(ury: -
. •
�.
. •
:: _
� 8. idamo �nd iddross et eny othfr'�rao� E��esd:
�
r
s .
s 7. Name and addross of;tht°wvnec of ar+y 6amsp�d DroPmrt�"• �
�
;
; 8. Damages dafined: . "
; a /lrnou"nt claimed �,t of ttits date �5n C� vfs�t �rto. t i� x-ruy�i; }.
- b. EaGrr�ted amount of futu� epstS; �
a Total amount daimed:
C. �asis !or oomput�boo 01 emounis dalmed ( Melude copima of a1t bitls.Invoic�s, lstimates, etc) :
�- '►�ai2in.eilt'oFSexv:rce. �
�. Pl es and_addreues all;wlb�oas�s, hos itals, docton':otc:.
a cU �t;�'�CQ- , � DD
c. — or
c _
d �
, 10. Any additional Intormation.that mip�t b� holptut In eona�der(rp thla daim:
s •
WARNINGe IT {S /S CRIMINAL OFFENSE TO F1LE A p�ALSE' CLAIMI (Penal Code g72;
�nsurarte� COd• $ 856.1 )
1'Mve road Vw rtsatters and ststarttiants:mtdo�in tM;aDove dalm ar�d,l know Vw �sme.fo;De:frue ot rtry:avn ki�owkG�e,
aapt as � C+ott,rttitttn`et$ied upon`IMortnation"or baGOt;ai to wch'rt�tsira"1 �6evo the aarra m' Da uve. I esrtAy unt�
p�naRy of�p�rJu .ry'that tnm bn:oinp Is"`TRUE anO;CORRECT. • •
SiOn�d:tAfs ��ay.of
� � -
. , . m
Otfioe ot s� �iy Clerk ,
PowY.,GaAfom;a .
OOCl1MEN7 NO: FlLED
4 of 9 APR 2 5 1995 ITEM 12
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� CITY OF POWAY '
w 60(�¢�tUNITY SExYICES OEPARTMENT .
ACCIDL•NT REEO[2T
Activity �'lli5�/�.�_.r . �..� i'•?.! �' ��
-' Date
Loca:Cion / ':� .:.J
Name of Injured Person SE!'EN i
, Address �
Tetephone gqe Sex /�c.:' �
. Date of ACCident /C'.�?:; j"�� Hour of Accident >•��
Na'ture of Injury t/ f'lU fc'T �i :-.rr i.:r/,r-i
� '-
Desczibe fn tull hocr the accident occurred fTE7ip✓ � LL>?: ��,��..,;,�.:c -, �.
'gF lllE"i� C"�» ..,�i 76/c !/�����`� ,C�-r� Ics�9i�J - L/e' ^tc� -
Li�r rL���J c� 7Gi� cA-�,-c.:•:; , �
Who was in Charge o� the proqrzm at time of ttie aecident? l�E' ��r�:�
What procedure xas folS.ov;? /�i-ri/�LC- �r: i� �-1:'��
Were first aid suppliss used? YG5 If so, vhat?_ LGC ���"'G� , G,4U �E i 1J�/�
�
Was-z physician calied? R-� IE so, name aad address
.
Names and addresses of wi.tnesses: '
Witness "�1: fSEJ�.''•t/!��Y �''�
Witness �2: _...
Work Oxder genera!ted:? Yes no ,� .
,Park Case Report generated?.� Y es no
� i!
Commen'E`s : /W� Gr, L��?r! %G�=� i: i`•'%' - � , .
� � , , _
,
5/90 \1�J pARK liANGER%RECREATION STAFF: ':� - i �`��
5 of 9 APR 2 5 1995 1TEIIA 12
�
- AGENDA REPOR
CITY OF POWAY
This report is included on the Consent Calendar. There will be no separate discussion of the report prior to approval by the
CiD/Council unless members of the Council. staff or public request it to be removed from the Consent Calendar and
discussed separately. [f you wish to have this report pulled for discussion, please fill out a slip indicating the report number
and give it to the C~ty Clerk pdor to the beginning of the CiD/Council meeting.
TO: Honorable Mayor and Members of the City Council
FROM: James L. Bowersox, City Manager
INITIATED BY: John D. Fitch, Assistant City Manager~-~)~
Peggy A. Stewart, Director of AdministrStive Services
Douglas A. Milton, General Services Manager
DATE: April 25, 1995
SUBJECT: Denial of Claim for Damages - Brittany A. Roberts
BACKGROUND
On March 21, 1995, a claim for damages was received from Brittany Ann Roberts for an
injury sustained at the Poway Community Pool. The amount of the claim is $507.00.
FINDINGS
The claim alleges that on October 18, 1994, Brittany slipped and struck her mouth
while climbing out of the swimming pool. She was using the ladder.
ENVlRONHENTAL REVIEW
This agenda item is not subject to environmental review according to CEQA
guidelines.
FISCAL IMPACT
Unknown
ADDITIONAL PUBLIC NOTIFICATION AND CORRESPONDENCF
None
RECOMMENDATION
It is recommended that the City Council deny this claim.
Attachment: Claim for Damages - Brittany Ann Roberts
.A. CTION:
6of 9
APR 2 5 1995 ITEM 12
.j
City Of Poway ^ D �
' f� 2'�� ��^5
CWM A�SAU�ISTT�iE CtTY,# P�NAY
_ : g;,
leatved by . � vta . ; _
I.S. Mall �' _ .
��-Olfieo'Mafl
A�� 1h� �Counti�r
l� � �" % � .03� J-
� etalm must.tis B1ed wl;h tho City C1erk.a FUsk Manager ot !t►e Cky:ot Pow�y �lhin i,°_e�ntM �r which t�f
+eident or ovent oewrrod Bm sure yourelatm'�is agatnsi 1hs�1�y of Paway,.r�ot.nolfiK pi�ik �ntlty: Where.
paeo Is I��CisnL pNsae usq �dQftlon�f,pspor dnd"Idon�fy iniortn�tlon by p�ra9rmph rwrtfber. Completed
iatn�t;muat.bo matled,or detivt�d to The:City'ot Poway� 99325 CMc C�tiUr,O�Ive.PoMrsy� Cil'92064 (`P.O.
bz 7@8 j: /1l7►: Filsk Manape .
"�TFifi HONORABGE MAYOR ANp CRY COUNClL, TNE CTf OF �OWAY CALfFORNiA , ..
�'ha unde(slgned rsspectfuiy subm3ts.tna tonowtne c�im anC inforr,�anc�� :osg�+�,to Car.�g: to aenons
ir�/orparaonal ProPertY: .
L Nstneo(d8lman! BrittanyAnn Ro6erts ($rown)
ps:. Add�sss or aaimant; .
b: Phone No. � c Oab ot'birtT. �
d Social Seairtty No. �. �rMrs�Ue. Plo_
�^ Name.:telephone and post oKce iddress to whicn dalmant desiresY.etolfeas to'D� sant M other
�han above:
3. Occvrrence oc event from whid��U�e.daim artsas: .
s . Due 10/18/94-b. Tfine t Plsce (`e�ct and �cHic lo�ton)
Poway Community,Eool
d How and=under wriat areumatanees Qd damap�.:or<injury xwr'1 Spedfy the particular
ocwRe`nce, event; acYOr"omission you claim eausQO tt+rtnjury�o� damapa (uie
aiidrtional paper i( ruussary ).
Brittany was taking swimming lessons. As she w as climbing; out of
the pooL her 'foot slipped on fihe rung• of the ladder and she hit , her
moufh on the concrete breaki:ng one of.:her permanent �front� teeth 3n
a an c, ipping.:t e ot er and cutt_ing- the inside of her moutti.
a. What parJcularaction tiy'th� City: or ks'etnployee3. causeC tlio altsged dama9e or
i,njury?
7 of 9
APR 25 1995 ITE1U1 1Z
6.. Givo a,:d�serlptlon ot.tt+m h, /, Pr'oPanY dart+ag� a loss. so 4�r a. s�kr+own at the !!mt of t�;s `. -.�
y d�}m. � lAsre w�r� no hiu+f�s. siate 'Alo tnjuries ' .
1 Brittany cfiipped her two fron[ permanent xeefh her mouth inside was
� bleeding :for._the;rest of the night and cut�the ineide,o£'her mouth.
r _
'- 8. �tvo t�sns(t} ot tla - .
C+ty �mp�oyo�(s) eauainp tho damape or�jury:
,
.
:
i 8. O+i�irsi sr�d tddr�at ot any �r�rson 6�u�d:
; 7. Namo and address oftho own�r of any damaqoQ prop�R�i; '
. .
e. D�n+�pes daimsd:
!1 Arf � ,'�,C .VfSli'3(0.'t If�1x-2tuJ•3l.
b. Estimmted: amoucrt ot tuNre costs; ��.
� • Totat amount�Gaimed: �
d. Basis ior eomputation o}:amounts daimed ( inck,dr eopiu�.o.t"afl=bipa:Irnroite;ees. fsUmases. e1c) :
�Slzc�{ern�;r' aP 4uvrcr... :cnC;ka.clic{��r
9. iVatns; ind eddrsssa oi �JI wltnesses-hps itals . .
a �'a C� 0. LLL/V(Lli'i �
+
a .
d . .
10. My additiona! information that mipht be}Aelpful �.eonsidering fhta daim:
' _ _ � _.� _ .
WARNING: IT IS A CRIMIN6,L .OFFENSE TO FILE A RALSfi' CIAfMf (Ommnal Cod� §72;
/naur6ne� Cotle f 556:1 )
1 havs esad'tta mattoes and statertants rtstd� In 1M:oDov� e�airn and,Pknow the �am�,b.brtruf ot my own knowled6e,.
�seopt�gs.to';ttrose maners fRatsd upon tnlomsstion or biGaf � to 'six�`mattars l'pa6ova tho gmma tp p� Uya. l uRity unde
penalty of'ptrfury thal ttw:bra,oirig is TpUE �:CORRECT. • •
� �, � �/
giGned,Ws . . � QaY,of '�. -1l1„�,� ,.
r..
• 's S+pnanrrt
Ot6o� oL� City'C�ak
Powy. c�a8fomla .
OOCtlMENT NO. �p-
S of 9 • APR 2 51995 ITEN1 1Z
--,,.__
' ^ CITY Of POHAY
� COMatUNITY SEecXICES DEPARTMENT .
ACCTDCNT REPORT
Itictivity 5��+...v�;p�..v.,H Da•te /)G-�- 1`r lY4Y
Location_ Qul�1'�\� �oD �
Name of Injured Person (� � i � a u:r\1 �' 1:,-r "'�S
Address
Tele�hone Age 'r Sex �
Date of Accident��$ �j�/ Hour of Accident �.fS
Nature of Injury '��ooi'� �, r=��e ��r ��nc�. a�i-�r� ,� ar �
�,_
�. re l,�„_{� Zr` , •
Describe in lull how the aecident occurred ' �-, f7}.acc�
D �Jn , .J l� � r f� ..� �: Y-. ��2'/ 'f�t.�/ e: o✓� Tti.{ � � Y /� �'� � V ��
.S��C� � � � � P� ,, i.. r..P �cnoLc�P.f
Who was in charge o° the ptogram at time of the aca.ident?
What procedcre vas follow? �` rp c � r r� ure ,, n n �: c� do 7L�
�;n �
, Were first aid suppiies used? If so, what2_ �cE: >�^c� (C
Was z physician ca1Ie�?_�O_ If so, name and address
Names and addres5es o£ vit'nesses:
�
Witness xY: v. � -
Witnes5 �2-
Work Order generated? �yes no ,� .
�Park Cas'e Repor`t geciera,ted:7. • __xes np
Comments • �P � L4 '�`l . y �
5/9G 9 of 9 tRK RAN6ER/RECREATION SrAFF: � �
APR 2 51995 AA 12