Agenda 05/23/2017 Item #16E 205/23/2017
EXECUTIVE SUMMARY
Recommendation to ratify Property, Casualty, Workers’ Compensation and Subrogation claim
files settled and/or closed by the Risk Management Division Director pursuant to Resolution 2004-
15 for the second quarter of FY17.
OBJECTIVE: To settle routine, administrative and minor claims matters which promotes the efficient
use of resources and the efficient administration of the program; and allows for a timely response to
claimants and/or their representatives.
CONSIDERATIONS: Resolution 04-15 grants limited authority to the Risk Management Division
Director to settle certain damage claims against Collier County and to authorize the payment of
investigation and adjustment expenses as presented to the County’s Risk Management Program.
Authority is delegated as follows:
Bodily Injury Liability- Premises, Auto, Operations: Non-litigated claims less than $50,000
Property Damage Liability Claims- Premises, Auto, Operations: Non-litigated claims less than
$75,000
Errors, Omissions, Professional Liability, Employment Practices Liability: Non-litigated claims
less than $50,000
Property Losses to County Owned Property: Full authority
Workers’ Compensation: Full authority subject to the provisions of F.S. 440 and subject to
approval by the Judge of Compensation as needed
Employer’s Liability: Non-litigated claims less than $50,000
Subrogation- Bodily Injury and Property Damage: Full authority to pursue non-litigated
subrogation recoveries
Subrogation- Workers’ Compensation: Full authority to pursue non-litigated subrogation
recoveries.
Pursuant to the Resolution, claims are settled and paid according to the loss verification procedures
contained in the Resolution which include the completion of claim forms, documentation of evidence,
valuation, and the determination of a finding of liability where applicable. Closed claim files are also
subject to review by the external auditor. A listing of claim files closed during the second quarter of FY
17 is attached. The report may include claims and/or settlements previously approved by the Board of
Commissioners as well as litigated files with a final court determination.
FISCAL IMPACT: Funds are budgeted and available in Fund 516-121650-645920 (Property and
Casualty Self Insurance Fund) and 518-121630-645928 (Workers’ Compensation Fund) for the payment
of claims and settlements. For the second quarter of FY17, 90 files were closed with total expenditures of
$123,747.46. During the same period, 31 subrogation files were closed and the Risk Management
Division recovered $128,750.36 in funds owed the County.
GROWTH MANAGEMENT IMPACT: There is no growth management impact associated with this
item.
LEGAL CONSIDERATIONS: This item has been reviewed by the County Attorney, is approved as to
form and legality, and requires majority vote for approval. -JAK
RECOMMENDATION: To accept the attached Settlement Report and ratify the actions taken therein.
16.E.2
Packet Pg. 782
05/23/2017
Prepared By: Rebecca Collins, ARM, Manager, Risk Finance, Risk Management Division.
ATTACHMENT(S)
1. All Lines Closed Claim Report 2nd QTR FY 2017 (PDF)
2. Subrogation Closed Claim Report 2nd QTR FY 17 (PDF)
3. Settlement Authority Resolution (PDF)
16.E.2
Packet Pg. 783
05/23/2017
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.E.2
Doc ID: 3118
Item Summary: Recommendation to ratify Property, Casualty, Workers’ Compensation and
Subrogation claim files settled and/or closed by the Risk Management Division Director pursuant to
Resolution 2004-15 for the second quarter of FY 17.
Meeting Date: 05/23/2017
Prepared by:
Title: Manager - Risk Finance – Risk Management
Name: Rebecca Collins
04/28/2017 9:17 AM
Submitted by:
Title: Division Director - Risk Management – Risk Management
Name: Jeff Walker
04/28/2017 9:17 AM
Approved By:
Review:
Risk Management Jeff Walker Additional Reviewer Completed 04/28/2017 9:48 AM
Administrative Services Department Paula Brethauer Level 1 Division Reviewer Completed 05/01/2017 9:50 AM
Administrative Services Department Len Price Level 2 Division Administrator Review Completed 05/09/2017 4:21 PM
Office of Management and Budget Valerie Fleming Level 3 OMB Gatekeeper Review Completed 05/10/2017 10:06 AM
County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 05/11/2017 7:27 AM
Office of Management and Budget Laura Wells Additional Reviewer Completed 05/11/2017 9:14 AM
County Manager's Office Nick Casalanguida Level 4 County Manager Review Completed 05/14/2017 10:57 PM
Board of County Commissioners MaryJo Brock Meeting Pending 05/23/2017 9:00 AM
16.E.2
Packet Pg. 784
Collier County
Government Closed Claim Report- All
2nd QTR FY 2017
Med/BI/Comp Expense Ind/PD/Coll Recovery Deductible Legal Other Total Inc
Claim Number Employee Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Cost Center Date of Loss Date Report to Risk Status Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
Coverage Cause Employer Acc Desc.
Major Coverage: 10 - Workers'
Compensation
1001301705809 325.75 14.00 0.00 0.00 0.00 0.00 0.00 339.75
110434 1/30/2017 1/31/2017 2/28/2017 325.75 14.00 0.00 0.00 0.00 0.00 0.00 339.75
10 1300 Employee was walking down a flight of
stairs; fell and fractured her left foot.
1010241605564 3,517.65 56.00 0.00 0.00 0.00 0.00 0.00 3,573.65
233351 10/24/2016 10/27/2016 2/28/2017 3,517.65 56.00 0.00 0.00 0.00 0.00 0.00 3,573.65
10 1500 Employee's right elbow began to ache
while he was trying to loosen a
manhole with a sledge hammer.
1002121705852 320.00 13.75 0.00 0.00 0.00 0.00 0.00 333.75
144610 2/12/2017 2/12/2017 2/22/2017 320.00 13.75 0.00 0.00 0.00 0.00 0.00 333.75
10 1500 Employee strained his back while
lifting a life pack.
1001251705792 369.43 13.75 0.00 0.00 0.00 0.00 0.00 383.18
144610 1/25/2017 1/26/2017 1/31/2017 369.43 13.75 0.00 0.00 0.00 0.00 0.00 383.18
10 1900 Employee experiences an allergic
reaction after being exposed to
shellfish.
1003211705988 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
182901 3/21/2017 3/22/2017 3/31/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1900 Employee felt irritation in his right eye
after applying mulch then using a
blower when completed.
1003201705972 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
233312 3/20/2017 3/20/2017 3/24/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1900 Employee experienced tightness in his
chest, slight shortness of breath;
burning in his mouth and throat after
inhaling a Raid fogger that was set off
inside the building he was working in.
1001041705725 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
144610 1/4/2017 1/4/2017 1/5/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1400 Employee is complaining of right
shoulder pain after rear-ending
another vehicle.
1001031705718 237.72 27.75 0.00 0.00 0.00 0.00 0.00 265.47
121811 1/3/2017 1/3/2017 1/6/2017 237.72 27.75 0.00 0.00 0.00 0.00 0.00 265.47
10 1000 Employee burned his right hand after
losing his balance and falling into a hot
exhaust pipe.
1001191705771 464.43 27.75 279.88 0.00 0.00 0.00 0.00 772.06
122410 1/19/2017 1/20/2017 1/31/2017 464.43 27.75 279.88 0.00 0.00 0.00 0.00 772.06
10 1500 Employee felt a pull/strain in his right
groin area when he rose from a lying
position (mechanic).
1
16.E.2.a
Packet Pg. 785 Attachment: All Lines Closed Claim Report 2nd QTR FY 2017 (3118 : Closed Claim Reports)
1001121705759 1,672.81 65.20 0.00 0.00 0.00 0.00 0.00 1,738.01
182901 1/12/2017 1/17/2017 1/31/2017 1,672.81 65.20 0.00 0.00 0.00 0.00 0.00 1,738.01
10 1500 Employee strained his back when he
jumped out of a flatbed truck while
unloading shrubs.
1001131705752 215.07 0.00 0.00 0.00 0.00 0.00 0.00 215.07
144610 1/13/2017 1/13/2017 1/18/2017 215.07 0.00 0.00 0.00 0.00 0.00 0.00 215.07
10 1900 Employee had dust/debris fall from a
vent into his left eye.
1012291605728 458.75 0.00 0.00 0.00 0.00 0.00 0.00 458.75
156332 12/29/2016 1/5/2017 1/24/2017 458.75 0.00 0.00 0.00 0.00 0.00 0.00 458.75
10 1700 Employee was bit on the left wrist by
an unknown insect.
1012271605707 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
163620 12/27/2016 12/27/2016 1/5/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1500 Employee injured his right ankle when
he stepped out of a truck.
1001151705755 SMITH, DIANE 341.50 27.75 0.00 0.00 0.00 0.00 0.00 369.25
144610 1/15/2017 1/15/2017 1/25/2017 341.50 27.75 0.00 0.00 0.00 0.00 0.00 369.25
10 1500 Employee experienced pain in her
right hip while stepping into an
ambulance.
1012301605727 918.62 0.00 0.00 0.00 0.00 0.00 0.00 918.62
156395 12/30/2016 1/5/2017 1/26/2017 918.62 0.00 0.00 0.00 0.00 0.00 0.00 918.62
10 1500 Employee injured her shoulder while
lifting weights.
1001031705757 404.01 14.00 0.00 0.00 0.00 0.00 0.00 418.01
163620 1/3/2017 1/17/2017 1/25/2017 404.01 14.00 0.00 0.00 0.00 0.00 0.00 418.01
10 1700 Employee came in contact with poison
ivy on his right forearm.
1001101705740 245.10 14.00 0.00 0.00 0.00 0.00 0.00 259.10
156332 1/10/2017 1/11/2017 1/24/2017 245.10 14.00 0.00 0.00 0.00 0.00 0.00 259.10
10 1700 Employee was bit by an insect on the
right hand while moving
boxes/supplies.
1003221705986 0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
122240 3/22/2017 3/22/2017 3/31/2017 0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
10 1500 Employee was installing a cover for
the motors on an overhead door,
when he felt a strain/pull/pain in his
right elbow and forearm.
1003211705983 0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
144610 3/21/2017 3/21/2017 3/29/2017 0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
10 1700 Employee closed the ambulance door
on her left hand.
1003171705969 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
144610 3/17/2017 3/17/2017 3/31/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1900 Employee had a patient's saliva land
inside his mouth while performing an
interview.
1003281706002 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
163620 3/28/2017 3/28/2017 3/31/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1900 Employee had dust enter his left eye
while flagging for MOT.
1012141605680 658.78 14.00 0.00 0.00 0.00 0.00 0.00 672.78
122410 12/14/2016 12/14/2016 1/5/2017 658.78 14.00 0.00 0.00 0.00 0.00 0.00 672.78
10 1200 Employee lacerated his right index
finger while using a grinder.
2
16.E.2.a
Packet Pg. 786 Attachment: All Lines Closed Claim Report 2nd QTR FY 2017 (3118 : Closed Claim Reports)
1008291605447 4,719.04 240.64 8,034.68 0.00 0.00 0.00 0.00 12,994.36
144610 8/29/2016 9/2/2016 1/31/2017 4,719.04 240.64 8,034.68 0.00 0.00 0.00 0.00 12,994.36
10 1300 Employee lost her balance while in the
rear of an ambulance and fell.
1009111605467 1,381.18 42.00 0.00 0.00 0.00 0.00 0.00 1,423.18
144610 9/11/2016 9/12/2016 2/28/2017 1,381.18 42.00 0.00 0.00 0.00 0.00 0.00 1,423.18
10 1900 Employee had sweat cleaned off his
forehead by a patient's wife whose
hands were contaminated with fecal
matter.
1002071705832 570.09 14.00 0.00 0.00 0.00 0.00 0.00 584.09
155410 2/7/2017 2/7/2017 2/15/2017 570.09 14.00 0.00 0.00 0.00 0.00 0.00 584.09
10 1700 Employee was scratched on the right
hand by a cat.
1001231705782 286.59 14.00 0.00 0.00 0.00 0.00 0.00 300.59
163620 1/23/2017 1/24/2017 1/31/2017 286.59 14.00 0.00 0.00 0.00 0.00 0.00 300.59
10 1200 Employee's right index finger was
pricked by a spiked plant.
1009221605502 735.59 98.00 389.58 0.00 0.00 0.00 0.00 1,223.17
163673 9/22/2016 9/23/2016 1/31/2017 735.59 98.00 389.58 0.00 0.00 0.00 0.00 1,223.17
10 1700 Job bank employee fractured his foot
when the manhole cover he was
attempting to pull dropped on it.
1003061705919 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
156185 3/6/2017 3/6/2017 3/17/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1300 Employee fell while walking
backwards in the restroom.
1002011705819 310.07 0.00 0.00 0.00 0.00 0.00 0.00 310.07
233351 2/1/2017 2/6/2017 2/10/2017 310.07 0.00 0.00 0.00 0.00 0.00 0.00 310.07
10 1200 Employee was opening a valve with a
T handle when it fell, striking the
empolyee on top of head.
1003101705939 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
233351 3/10/2017 3/13/2017 3/24/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1200 Employee injured his right elbow on a
nail (puncture) while removing a shelf.
1003291706004 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
233351 3/29/2017 3/29/2017 3/31/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1300 Employee was pulling off a manhole
cover with a manhole hook; it slipped
and he fell to the ground, hitting his
right arm.
1003271705998 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
233351 3/27/2017 3/27/2017 3/31/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1500 Employee twisted his left knee exiting
a County truck.
1001271705797 692.37 0.00 0.00 0.00 0.00 0.00 0.00 692.37
253215 1/27/2017 1/27/2017 1/31/2017 692.37 0.00 0.00 0.00 0.00 0.00 0.00 692.37
10 1200 Employee lacerated the palm of his
right hand when the handle to a
backflow device he was turning broke.
1002021705835 91.07 0.00 0.00 0.00 0.00 0.00 0.00 91.07
253215 2/2/2017 2/8/2017 2/24/2017 91.07 0.00 0.00 0.00 0.00 0.00 0.00 91.07
10 1800 Employee experienced and allergic
reaction on his arms and stomach
while working in straw grass.
3
16.E.2.a
Packet Pg. 787 Attachment: All Lines Closed Claim Report 2nd QTR FY 2017 (3118 : Closed Claim Reports)
1002261604903 17,350.71 3,008.50 5,621.11 0.00 0.00 0.00 0.00 25,980.32
182901 2/26/2016 2/26/2016 1/31/2017 17,350.71 3,008.50 5,621.11 0.00 0.00 0.00 0.00 25,980.32
10 1600 Employee ran into a tree while
operating asset #CC2-1142 (Kubota).
1003011705904 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
253250 3/1/2017 3/1/2017 3/29/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1200 Employee was working with a glass
pipette when it broke and lacerated
her left hand.
1002071705834 175.07 0.00 0.00 0.00 0.00 0.00 0.00 175.07
138915 2/7/2017 2/8/2017 2/24/2017 175.07 0.00 0.00 0.00 0.00 0.00 0.00 175.07
10 1700 Employee was bit on the right arm by
a dog.
36,461.40 3,732.59 14,325.25 0.00 0.00 0.00 0.00 54,519.24
Total by Major Coverage 37 Claims 36,461.40 3,732.59 14,325.25 0.00 0.00 0.00 0.00 54,519.24
Major Coverage: 20 - General
Liability
2111101403746 EOVINO, TIMOTHY 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
000000 11/10/2014 12/9/2014 3/23/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 3200 Claimant was riding his bicycle on the
sidewalk and did not see an access
panel that had been removed. The
bicycle tire went into the hole and the
claimant alleges he went over the
handlebars.
2209071605598 CENTURY, LINK 0.00 0.00 2,302.54 0.00 0.00 0.00 0.00 2,302.54
163630 9/7/2016 11/9/2016 1/31/2017 0.00 0.00 2,302.54 0.00 0.00 0.00 0.00 2,302.54
22 5900 Received an invoice from third party
reporting damage to a 100 pair buried
cable.
2211081605643 CENTURY LINK (4470 58th Ave. NE.)0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
163620 11/8/2016 11/29/2016 3/8/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 5900 County employee(s) damaged a
buried Century Link cable at 4470
58th Ave., NE
2201111705742 ARRIAJA, NIEVES 0.00 0.00 1,190.14 0.00 0.00 0.00 0.00 1,190.14
163624 1/11/2017 1/11/2017 1/31/2017 0.00 0.00 1,190.14 0.00 0.00 0.00 0.00 1,190.14
22 2000 An employee was machete mowing
west bound on Golden Gate Blvd. It
appears that a piece of cut wood shot
into the west bound travel lane and
damaged a third party vehicles
windshield.
2212171605689 RUDAS, JUDITH 0.00 0.00 142.50 0.00 0.00 0.00 0.00 142.50
156310 12/17/2016 12/19/2016 1/31/2017 0.00 0.00 142.50 0.00 0.00 0.00 0.00 142.50
22 3200 Patron pulled into the handicapped
parking space at Tigertail Beach. She
stated she heard a noise, so she
backed up and saw that the rebar
poking out from the parking stop curb
had punctured her right front tire.
2111281403744 KANE, LORETTA 15,000.00 1,836.44 0.00 0.00 0.00 25.00 0.00 16,861.44
163620 11/28/2014 12/9/2014 2/24/2017 15,000.00 1,836.44 0.00 0.00 0.00 25.00 0.00 16,861.44
21 2050 Claimant alleges she tripped over a
lump of asphalt on the sidewalk at
Gulfshore Drive, causing her to fall.
4
16.E.2.a
Packet Pg. 788 Attachment: All Lines Closed Claim Report 2nd QTR FY 2017 (3118 : Closed Claim Reports)
2202051705869 GRISACK, DIANE 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
163620 2/5/2017 2/16/2017 2/28/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 2000 Claimant was driving through the
Waterside shops and struck the curb,
causing 2 flat tires.
2106011405282 ECHARTE ORTEGA, IVET 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
163630 6/1/2014 7/7/2016 2/24/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 2450 Claimant alleges she was driving east
on Davis Blvd., as she entered the
intersection of County Barn Road the
light was green light. At the same time
another vehicle crossed in front of her
vehicle, causing an accident.
2202021604878 HANS, LITERA 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
233351 2/2/2016 2/19/2016 1/23/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 5900 Customer called in a sewer backup.
2212011605802 KASSOLIS, PAUL 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
233351 12/1/2016 1/30/2017 3/13/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 5900 Customer reportied a sewer backup.
Crew did a dye test and found customer
flowing. Contractor was dispatched the
following morning to perform a lamping
view test. Tree roots were noted coming
in the County 6" cleanout from the
customers 4" cleanout.
2211011605583 Musse, Jonathan 0.00 0.00 656.68 0.00 0.00 0.00 0.00 656.68
PARD 11/1/2016 11/4/2016 3/13/2017 0.00 0.00 656.68 0.00 0.00 0.00 0.00 656.68
22 2000 Employee assigned to Growth
Management Department parked his
personal vehicle in the employee parking
lot in the rear of the building. Employees
vehicle was struck by flying object (patio
table umbrella).
2105111605141 KARACZUN, RUTH 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
155410 5/11/2016 5/16/2016 1/11/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 5900 Claimant was meeting with a cat that
she was interested in adopting; the cat
was sitting on her lap when another
cat approached - they hissed and the
cat bit the claimants’ arm.
2207221605375 BURDO, SIV 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
253215 7/22/2016 8/12/2016 2/28/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 5900 Customer returned home on 7/24/16
and claimed that after the county
completed a meter change-out on
7/22/16, she had a pressure problem in
her upstairs sink. She claims an
additional problem in her downstairs
kitchen sink.
2206071605250 GLAMYAN, ANI 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
233351 6/7/2016 6/27/2016 2/13/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 Claimant alleges her sewer backed up
as a result of the county conducting
repairs in her neighborhood.
15,000.00 1,836.44 4,291.86 0.00 0.00 25.00 0.00 21,153.30
Total by Major Coverage 14 Claims 15,000.00 1,836.44 4,291.86 0.00 0.00 25.00 0.00 21,153.30
5
16.E.2.a
Packet Pg. 789 Attachment: All Lines Closed Claim Report 2nd QTR FY 2017 (3118 : Closed Claim Reports)
Major Coverage: 30 - Auto
Liability
3207081605297 HALDIE, MICHAEL 0.00 0.00 1,520.44 0.00 0.00 0.00 0.00 1,520.44
163620 7/8/2016 7/12/2016 1/4/2017 0.00 0.00 1,520.44 0.00 0.00 0.00 0.00 1,520.44
32 2450 An employee was driving a collier
county utility truck in the parking lot of
Physicians Regional. The utility truck
grazed the bumper, tire, and rim of a
third party Dodge pickup.
3212241605705 Lee Memorial Hospital 0.00 0.00 1,704.92 0.00 0.00 0.00 0.00 1,704.92
144610 12/24/2016 12/25/2016 2/15/2017 0.00 0.00 1,704.92 0.00 0.00 0.00 0.00 1,704.92
32 3000 EMT employee drove ambulance #41
into the overhang at Lee Memorial
Hospital causing stucco damage to
the overhang.
3201191604760 Rinkenberger, Marcia 0.00 0.00 477.21 0.00 0.00 0.00 0.00 477.21
253215 1/19/2016 1/20/2016 2/24/2017 0.00 0.00 477.21 0.00 0.00 0.00 0.00 477.21
32 2450 While driving East on 951, West of I-
75, Asset # CC2-1079 was merging
from the left lane to the center lane.
At this time a third party vehicle
passed in the center lane; both
vehicles collided causing damage to
the third pa.
3210181605547 MCGILL, NATALYA OLEGOVNA 0.00 133.60 2,118.44 0.00 0.00 0.00 0.00 2,252.04
156363 10/18/2016 10/20/2016 2/28/2017 0.00 133.60 2,118.44 0.00 0.00 0.00 0.00 2,252.04
32 3000 A Park Ranger was backing County
truck #060023 out of parking lot at
Freedom Park. The Park Ranger
backed into a third party vehicle.
0.00 133.60 5,821.01 0.00 0.00 0.00 0.00 5,954.61
Total by Major Coverage 4 Claims 0.00 133.60 5,821.01 0.00 0.00 0.00 0.00 5,954.61
Major Coverage: 40 - Auto
Physical Damage
4111131605608 EMS 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
144610 11/13/2016 11/14/2016 1/30/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 3000 An EMT was operating ambulance
#41; while backing the ambulance up
it hit the bay door. Damage to
ambulance #41 roof antenna and
station 31 bay door are noted.
4201201705781 Growth Management Division 347.30 0.00 0.00 0.00 0.00 0.00 0.00 347.30
138930 1/20/2017 1/23/2017 2/15/2017 347.30 0.00 0.00 0.00 0.00 0.00 0.00 347.30
42 5900 On Friday, January 20, 2017 at
approximately 08:15am Staff
observed a dent on the rear driver's
side door. The vehicle paint was
scratched.
4112011605656 EMS 0.00 0.00 1,695.00 0.00 0.00 0.00 0.00 1,695.00
144610 12/1/2016 12/3/2016 3/31/2017 0.00 0.00 1,695.00 0.00 0.00 0.00 0.00 1,695.00
41 3000 Golden Gate Fire Fighter was backing
Truck #20 without a backer, while
paramedic was attending to a patient
inside the ambulance. The Fire Fighter
brushed the truck up against an
awning of a building at Cypress Gate.
6
16.E.2.a
Packet Pg. 790 Attachment: All Lines Closed Claim Report 2nd QTR FY 2017 (3118 : Closed Claim Reports)
4211171605625 Parks & Recreation Division 1,960.45 0.00 0.00 0.00 0.00 0.00 0.00 1,960.45
156332 11/17/2016 11/21/2016 1/31/2017 1,960.45 0.00 0.00 0.00 0.00 0.00 0.00 1,960.45
42 5500 Someone broke into the gated area of
maintenance and took the tail gate
from the truck
4111081605596 Facilities Management Division 0.00 0.00 1,805.00 0.00 0.00 0.00 0.00 1,805.00
122240 11/8/2016 11/8/2016 1/11/2017 0.00 0.00 1,805.00 0.00 0.00 0.00 0.00 1,805.00
41 3000 A vehicle was backing up and the
ladder on its roof struck the ladder
rack and ladder of another vehicle
damaging the ladder rack and
breaking the ladder.
Major Coverage: 40 - Auto
Physical Damage
4111221605632 Transportation Engineering &
Construction Management Division
0.00 0.00 2,763.19 0.00 0.00 0.00 0.00 2,763.19
163630 11/22/2016 11/22/2016 1/13/2017 0.00 0.00 2,763.19 0.00 0.00 0.00 0.00 2,763.19
41 3000 Employee was backing vehicle
#050725 and struck a tree.
4112021605655 Domestic Animal Services Division 0.00 0.00 1,683.00 0.00 0.00 0.00 0.00 1,683.00
155410 12/2/2016 12/2/2016 1/31/2017 0.00 0.00 1,683.00 0.00 0.00 0.00 0.00 1,683.00
41 2450 An officer was driving vehicle #CC2-
1137 in the parking lot. She was
struck in the front driver's side door by
an unknown person driving a Nissan
Murano. The driver of the Murano fled
the scene.
4111101605607 WHELAN, DAWN 0.00 0.00 683.20 0.00 0.00 0.00 0.00 683.20
110434 11/10/2016 11/14/2016 3/31/2017 0.00 0.00 683.20 0.00 0.00 0.00 0.00 683.20
41 3000 Employee was backing county vehicle
out of a parking spot, while another
vehicle was backing out at the same
time. Damage to vehicles noted.
4102111705851 EMS 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
144610 2/11/2017 2/11/2017 3/10/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 3000 Medic 48 (Truck #1) was responding
to a medical call and just passed the
location by a couple of feet. The driver
of Medic 48 backed up to make the
turn inside the community striking a
third party vehicle.
4101251705789 Water Distribution Division 0.00 0.00 932.30 0.00 0.00 0.00 0.00 932.30
253212 1/25/2017 1/25/2017 2/28/2017 0.00 0.00 932.30 0.00 0.00 0.00 0.00 932.30
41 2000 While operating a valve for a full bore
flush, the mirror on vehicle CC2-565
was struck and damaged by a semi
truck passing by. The truck did not
stop for the incident.
4111221605630 John Reyes 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
253212 11/22/2016 11/22/2016 1/5/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 3000 Employee was pulling out of the
garage in Vehicle CC2-1345, when he
struck the driver door of vehicle CC2-
331 that had the door open.
7
16.E.2.a
Packet Pg. 791 Attachment: All Lines Closed Claim Report 2nd QTR FY 2017 (3118 : Closed Claim Reports)
4202141705886 Wastewater Division 297.54 0.00 0.00 0.00 0.00 0.00 0.00 297.54
233315 2/14/2017 2/23/2017 3/17/2017 297.54 0.00 0.00 0.00 0.00 0.00 0.00 297.54
42 5900 Broken windshield noted on county
vehicle.
4102141705867 EMS Division 0.00 0.00 2,039.10 0.00 0.00 0.00 0.00 2,039.10
144610 2/14/2017 2/16/2017 3/17/2017 0.00 0.00 2,039.10 0.00 0.00 0.00 0.00 2,039.10
41 3000 Vehicle CC2-1135 was parked in the
parking lot of Medflight; an off duty
pilot was leaving the parking lot in his
personal vehicle. The off duty pilot
backed out of the parking space
hitting the side of CC2-1135. Damage
was noted to the driver's side door.
4112241605706 EMS 0.00 0.00 3,302.29 0.00 0.00 0.00 0.00 3,302.29
144610 12/24/2016 12/25/2016 1/31/2017 0.00 0.00 3,302.29 0.00 0.00 0.00 0.00 3,302.29
41 3000 An EMT driving ambulance #41 hit the
overhang at Lee Memorial Hospital,
resulting in damage to the roof and
antenna of ambulance #41.
4210131605540 Building Review & Permitting Division 331.50 0.00 0.00 0.00 0.00 0.00 0.00 331.50
138915 10/13/2016 10/14/2016 2/13/2017 331.50 0.00 0.00 0.00 0.00 0.00 0.00 331.50
42 5900 Inspector noticed a ding in his door.
4203201705979 University Extension Services Division 677.23 0.00 0.00 0.00 0.00 0.00 0.00 677.23
157110 3/20/2017 3/21/2017 3/31/2017 677.23 0.00 0.00 0.00 0.00 0.00 0.00 677.23
42 5900 Employee noticed a crack in the
passenger side windshield of Asset
#CC2-985.
4111251605637 EMS 0.00 0.00 2,220.46 0.00 0.00 0.00 0.00 2,220.46
144610 11/25/2016 11/25/2016 1/13/2017 0.00 0.00 2,220.46 0.00 0.00 0.00 0.00 2,220.46
41 3000 While turning into the Naples
Community Hospital breezeway, the
left of the ambulance struck the
building. Damage to the side of
ambulance box and AC exhaust
cover.
4212031605668 Solid & Hazardous Waste
Management Division
274.92 0.00 0.00 0.00 0.00 0.00 0.00 274.92
173435 12/3/2016 12/8/2016 1/24/2017 274.92 0.00 0.00 0.00 0.00 0.00 0.00 274.92
42 5900 Damage to driver side running board
was discovered.
4101111705743 Domestic Animal Services Division 0.00 0.00 1,792.34 0.00 0.00 0.00 0.00 1,792.34
155410 1/11/2017 1/11/2017 1/31/2017 0.00 0.00 1,792.34 0.00 0.00 0.00 0.00 1,792.34
41 3000 DAS Officer was pulling into driveway
of 2280 Della Drive and struck a
wooden 4x4 pole that was in the
ground at the foot of the driveway.
4211171605617 Parks & Recreation Division 0.00 0.00 2,648.60 0.00 0.00 0.00 0.00 2,648.60
156332 11/17/2016 11/17/2016 1/31/2017 0.00 0.00 2,648.60 0.00 0.00 0.00 0.00 2,648.60
42 5500 Tail gate was stolen off truck #CC2
1021
4112131605678 Capital Construction & Maintenance
Operations Division
0.00 0.00 310.98 0.00 0.00 0.00 0.00 310.98
163613 12/13/2016 12/14/2016 1/11/2017 0.00 0.00 310.98 0.00 0.00 0.00 0.00 310.98
41 2000 Windshield on Asset #010023 was
broken when debri flew from machete
mower #CC2-1105.
8
16.E.2.a
Packet Pg. 792 Attachment: All Lines Closed Claim Report 2nd QTR FY 2017 (3118 : Closed Claim Reports)
4202021705815 Solid & Hazardous Waste 276.40 0.00 0.00 0.00 0.00 0.00 0.00 276.40
178969 2/2/2017 2/2/2017 2/28/2017 276.40 0.00 0.00 0.00 0.00 0.00 0.00 276.40
42 2000 Appears rock hit front of windshield
bottom passenger side corner causing
a crack and indention in the
windshield glass.
4202111705862 Museum 135.00 0.00 0.00 0.00 0.00 0.00 0.00 135.00
157410 2/11/2017 2/15/2017 3/31/2017 135.00 0.00 0.00 0.00 0.00 0.00 0.00 135.00
42 5500 Museum truck was vandalized. Door
on drivers side was spray painted with
red paint and marked with a red X.
4203111705940 Wastewater Collections Divison 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
233351 3/11/2017 3/13/2017 3/17/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
42 5900 Field crew stopped for lunch; upon
returning to their truck CC2-454, they
found the driver's side mirror was
cracked.
4203101705971 Wastewater Division 260.92 0.00 0.00 0.00 0.00 0.00 0.00 260.92
233351 3/10/2017 3/20/2017 3/31/2017 260.92 0.00 0.00 0.00 0.00 0.00 0.00 260.92
42 3000 Employee approached stop bar at
Twin Eagle exit gate in vehicle
#060012; the stop bar hit vehicle
damaging the windshield.
4111221605631 Water Distribution Division 0.00 0.00 1,412.40 0.00 0.00 0.00 0.00 1,412.40
253212 11/22/2016 11/22/2016 1/31/2017 0.00 0.00 1,412.40 0.00 0.00 0.00 0.00 1,412.40
41 3000 While Asset #CC2-1345 was leaving
the garage, it struck the door of Asset
#CC2-331 that was open.
4103101705933 Water Distribution Division 0.00 0.00 62.39 0.00 0.00 0.00 0.00 62.39
253212 3/10/2017 3/10/2017 3/31/2017 0.00 0.00 62.39 0.00 0.00 0.00 0.00 62.39
41 3000 The streets in Naples Park are narrow;
while both vehicles were passing one
another, their mirrors hit.
4203081705926 Water Distribution Division 561.82 0.00 0.00 0.00 0.00 0.00 0.00 561.82
253214 3/8/2017 3/8/2017 3/31/2017 561.82 0.00 0.00 0.00 0.00 0.00 0.00 561.82
42 2000 Rock came off the back of a dump
truck while driving down Vanderbilt
beach Rd and hit front windshield of
County Vehicle CC2-1494. Unable to
get license plate of dump truck or
information. Noticed small chip (2cm-
3cm in the front window of the vehicle.
4211161605611 Water Division 0.00 0.00 414.20 0.00 0.00 0.00 0.00 414.20
253215 11/16/2016 11/16/2016 2/15/2017 0.00 0.00 414.20 0.00 0.00 0.00 0.00 414.20
42 5900 Vehicle taken to Fleet for service;
scratches were found in the
passenger's side door.
4101201705787 Clerk of the Cicuit Court - Internal Audit 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
311190 1/20/2017 1/25/2017 2/7/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 3000 Clerk of Courts employee was backing
in vehicle #010081 and struck a tree
damaging the driver's side rear tail
light.
5,123.08 0.00 23,764.45 0.00 0.00 0.00 0.00 28,887.53
Total by Major Coverage 30 Claims 5,123.08 0.00 23,764.45 0.00 0.00 0.00 0.00 28,887.53
9
16.E.2.a
Packet Pg. 793 Attachment: All Lines Closed Claim Report 2nd QTR FY 2017 (3118 : Closed Claim Reports)
Major Coverage: 50 - Property
5101171605402 Facilities Management Division 3,100.00 0.00 0.00 0.00 0.00 0.00 0.00 3,100.00
122240 1/17/2016 8/18/2016 1/9/2017 3,100.00 0.00 0.00 0.00 0.00 0.00 0.00 3,100.00
51 5400 Following a storm event, soffit
damage was discovered to the former
Juvenile Detention Center/Sheriff's
storage facility.
5310241605557 Library - North Collier 3,079.64 0.00 0.00 0.00 0.00 0.00 0.00 3,079.64
156100 10/24/2016 10/24/2016 1/31/2017 3,079.64 0.00 0.00 0.00 0.00 0.00 0.00 3,079.64
53 3000 A light post at the shared
headquarters Library and Collier
County Government Building parking
lot has been damaged. The light post
is hanging in tree limb and wires are
exposed.
5612301605714 Parks and Recreation Division 54.14 0.00 0.00 0.00 0.00 0.00 0.00 54.14
178987 12/30/2016 12/30/2016 1/24/2017 54.14 0.00 0.00 0.00 0.00 0.00 0.00 54.14
56 5500 Park Ranger discovered that the seats
on the John Deere Gator (CC2-944)
was missing off of an All-Terrain
Vehicle (ATV).
5101031705985 Parks and Recreation Division 1,140.00 0.00 0.00 0.00 0.00 0.00 0.00 1,140.00
156332 1/3/2017 3/22/2017 3/31/2017 1,140.00 0.00 0.00 0.00 0.00 0.00 0.00 1,140.00
51 5500 The exterior metal door to the
Electrical Room damaged; appeared
someone was trying to break in.
5101231705788 Parks and Recreation Division -
Barefoot Beach Preserve Park
5,859.00 0.00 0.00 0.00 0.00 0.00 0.00 5,859.00
156332 1/23/2017 1/25/2017 3/27/2017 5,859.00 0.00 0.00 0.00 0.00 0.00 0.00 5,859.00
51 5400 High winds and rain damaged
sections of the Chickee Hut Learning
Center at the Barefoot Beach
Preserve Park.
13,232.78 0.00 0.00 0.00 0.00 0.00 0.00 13,232.78
Total by Major Coverage 5 Claims 13,232.78 0.00 0.00 0.00 0.00 0.00 0.00 13,232.78
69,817.26 5,702.63 48,202.57 0.00 0.00 25.00 0.00 123,747.46
Grand Totals: 90 Claims 69,817.26 5,702.63 48,202.57 0.00 0.00 25.00 0.00 123,747.46
4/25/2017
2:22:21 PM
10
16.E.2.a
Packet Pg. 794 Attachment: All Lines Closed Claim Report 2nd QTR FY 2017 (3118 : Closed Claim Reports)
Collier County Government
Subrogation Closed Claim Report
2nd QTR FY 2017
Valued as of:4/25/2017
Total Inc Ind/PD/CollExpense RecoveryMed/BI/Comp Deductible Legal Other
Claim Number Employee Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Coverage Carrier
Cost Center
Cause
Date of Loss
Employer Acc Desc.
Date Report to RiskStatus Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
0.00 0.00 0.00 0.00 6,943.20 0.00 0.00 0.00CC v. CAT 5 Construction
Services LLC ($6,943.20)
5312011605660
1/31/201712/1/2016 12/6/2016 0.00 0.00 0.00 6,943.20 0.00 0.00 0.00 0.00121160
53 A third party company was
performing non BCC related
work on the NE corner of
Rattlesnake Road and 915. The
third party companies boring rig
struck an IT fiber optic cable,
damaging roughly 400 feet of
conduit.
2000
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00CC v. A+ Environmental
Restoration LLC
5312201605696
2/16/201712/20/2016 12/20/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00122240
53 Subcontractor damaged parking
curb near Building H.
2000
406.91 0.00 0.00 0.00 406.91 406.91 0.00 0.00CC v. New Line Trucking4101111705747
1/31/20171/11/2017 1/12/2017 0.00 406.91 0.00 406.91 406.91 0.00 0.00 0.00138915
41 Employees’ county vehicle was
struck by a semi truck on the
rear driver side; damaging the
tail light and denting the bumper.
2450
0.00 0.00 0.00 0.00 188.04 0.00 0.00 0.00CC v. Dolan, Kevin ($188.04)5309211605675
1/6/20179/21/2016 12/13/2016 0.00 0.00 0.00 188.04 0.00 0.00 0.00 0.00163630
53 Driver of Audi was traveling
north on Ridge Drive when a dog
allegedly ran out in front of the
vehicle. Driver swerved to avoid
striking the dog and collided with
a stop sign.
3000
0.00 0.00 0.00 0.00 427.16 0.00 0.00 0.00CC v. Ramirez, Marbin
($427.16)
5312181605702
1/30/201712/18/2016 12/22/2016 0.00 0.00 0.00 427.16 0.00 0.00 0.00 0.00163630
50 A perpetrator led deputies on a
high speed chase following an
attempted traffic stop. The
perpetrator ran off the road
hitting a stop sign, a fence, and
some bushes.
3000
-1-
9:32:11AM
4/25/2017
16.E.2.b
Packet Pg. 795 Attachment: Subrogation Closed Claim Report 2nd QTR FY 17 (3118 : Closed Claim Reports)
Collier County Government
Subrogation Closed Claim Report
2nd QTR FY 2017
Valued as of:4/25/2017
Total Inc Ind/PD/CollExpense RecoveryMed/BI/Comp Deductible Legal Other
Claim Number Employee Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Coverage Carrier
Cost Center
Cause
Date of Loss
Employer Acc Desc.
Date Report to RiskStatus Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
0.00 0.00 0.00 0.00 1,352.45 0.00 0.00 0.00CC v. Galvez, Eddy5312201605712
2/2/201712/20/2016 12/30/2016 0.00 0.00 0.00 1,352.45 0.00 0.00 0.00 0.00163630
53 Driver of an SUV was traveling
west on Davis Blvd. The driver of
the SUV attempted to make a
left turn onto Kings Way. The
SUV struck a vehicle heading
east causing it to run into a
pedestrian crosswalk signal.
3000
0.00 0.00 0.00 0.00 1,252.00 0.00 0.00 0.00CC v. Lindstrom, Susan5312181605701
2/7/201712/18/2016 12/22/2016 0.00 0.00 0.00 1,252.00 0.00 0.00 0.00 0.00163630
53 Driver of Lexis was traveling
west on Immokalee Road, when
she ran over a curb and struck a
light pole.
3000
0.00 0.00 0.00 0.00 3,634.76 0.00 0.00 0.00CC v. Fernandez, Osleidy5301051705751
3/7/20171/5/2017 1/13/2017 0.00 0.00 0.00 3,634.76 0.00 0.00 0.00 0.00163630
53 Driver of Nissan was traveling
west on Golden Gate Parkway.
Driver of Nissan failed to yield at
the light at 53rd Street SW
colliding with another vehicle
traveling east. Collision resulted
in damage to a power service
pedestal.
3000
686.70 0.00 0.00 0.00 686.70 686.70 0.00 0.00CC v. Dilks, David4101231705778
2/28/20171/23/2017 1/23/2017 0.00 686.70 0.00 686.70 686.70 0.00 0.00 0.00CENE
41 Employee was driving east in a
county vehicle on Capri Blvd. A
tan colored 1999 Lincoln sedan
backed out of driveway at 140
Capri Blvd. and struck the
county vehicle on rear
passenger side quarter panel.
3000
0.00 0.00 0.00 0.00 345.16 0.00 0.00 0.00CC v. Vatcky, Susan5301071705794
2/7/20171/7/2017 1/26/2017 0.00 0.00 0.00 345.16 0.00 0.00 0.00 0.00163620
-2-
9:32:11AM
4/25/2017
16.E.2.b
Packet Pg. 796 Attachment: Subrogation Closed Claim Report 2nd QTR FY 17 (3118 : Closed Claim Reports)
Collier County Government
Subrogation Closed Claim Report
2nd QTR FY 2017
Valued as of:4/25/2017
Total Inc Ind/PD/CollExpense RecoveryMed/BI/Comp Deductible Legal Other
Claim Number Employee Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Coverage Carrier
Cost Center
Cause
Date of Loss
Employer Acc Desc.
Date Report to RiskStatus Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
53 Driver of Ford Expedition was
turning onto Golden Gate
Parkway from Airport Road when
the vehicle hydroplaned and
struck the bridge.
3000
0.00 0.00 0.00 0.00 17,799.15 0.00 0.00 0.00CC v. Eash, Janet5301291705806
3/7/20171/29/2017 1/31/2017 0.00 0.00 0.00 17,799.15 0.00 0.00 0.00 0.00233313
53 A vehicle struck our assembly in
our NE intersection of Livingston
and Vanderbilt Beach Road
causing damage to our
assembly.
3000
0.00 0.00 0.00 0.00 13,025.17 0.00 0.00 0.00CC v. Danella Utility Const. /
ADS ($13,025.17)
5308151605393
2/7/20178/15/2016 8/16/2016 0.00 0.00 0.00 13,025.17 0.00 0.00 0.00 0.00233351
53 Subcontractor was boring and hit
the underground service
conductors (service lateral) at
497 Bayside Ave.
2000
0.00 0.00 0.00 0.00 2,916.25 0.00 0.00 0.00CC vs. R.A.W. Construction
($2,916.25)
5307081605294
2/7/20177/8/2016 7/11/2016 0.00 0.00 0.00 2,916.25 0.00 0.00 0.00 0.00233351
50 A Contractor was working in the
right-of-way, when they ran over
a wastewater air release valve
(ARV) with their vehicle.
2000
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00CC v. Smith, Brooke5311041605590
2/28/201711/4/2016 11/7/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00253212
53 A back flow device was struck
and damaged by a third party
vehicle.
3000
6,157.75 0.00 0.00 0.00 6,157.76 0.00 0.00 6,157.75CC v. Howison, Jack
($6,157.75)
5302021604820
2/7/20172/2/2016 2/2/2016 6,157.75 0.00 0.00 6,157.76 6,157.75 0.00 0.00 0.00LIBE
53 Third party driver confused the
gas pedal with the brake pedal;
knocking down a light pole on
the west side of the Library in the
parking lot. Shrubs were also
damaged.
3000
-3-
9:32:11AM
4/25/2017
16.E.2.b
Packet Pg. 797 Attachment: Subrogation Closed Claim Report 2nd QTR FY 17 (3118 : Closed Claim Reports)
Collier County Government
Subrogation Closed Claim Report
2nd QTR FY 2017
Valued as of:4/25/2017
Total Inc Ind/PD/CollExpense RecoveryMed/BI/Comp Deductible Legal Other
Claim Number Employee Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Coverage Carrier
Cost Center
Cause
Date of Loss
Employer Acc Desc.
Date Report to RiskStatus Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
8,624.98 0.00 0.00 0.00 6,784.26 8,480.33 144.65 0.00CC v. WEBB, TINA ($8,180.05)4105261605156
2/13/20175/26/2016 5/26/2016 0.00 8,480.33 144.65 6,784.26 8,624.98 0.00 0.00 0.00144610
41 Medflight Operations mechanic
was involved in MVA operating
county vehicle 040032 on
morning commute to work. He
was not at fault and was not
injured.
2450
0.00 0.00 0.00 0.00 453.17 0.00 0.00 0.00CC v. Schiavone, Joanna5304211605113
2/15/20174/21/2016 5/5/2016 0.00 0.00 0.00 453.17 0.00 0.00 0.00 0.00163630
53 Driver of third party vehicle
(Dodge Dart) was traveling north
on Airport Road when she
crashed into the rear of another
vehicle (Lexus). The Dodge Dart
veered to the left, hopped the
median and struck a "Do Not
Enter" sign.
3000
771.10 0.00 0.00 0.00 871.10 0.00 0.00 771.10CC v. Zuniga, Riadelfo5408161605427
2/14/20178/16/2016 8/29/2016 771.10 0.00 0.00 871.10 771.10 0.00 0.00 0.00156145
54 Several shrubs in front of the
library were damaged by a
vehicle and dry bags of cement
were left in the grass area as
well.
3000
0.00 0.00 0.00 0.00 5,775.30 0.00 0.00 0.00CC v. Koenig, Charles5308271605443
1/11/20178/27/2016 9/2/2016 0.00 0.00 0.00 5,775.30 0.00 0.00 0.00 0.00163630
53 Driver of third party vehicle was
traveling east on Immokalee
road when he fell asleep, striking
a street light.
3000
7,225.19 0.00 0.00 0.00 0.00 7,225.19 0.00 0.00CC v. Gomez, Marcos/Luiz, Joel
(SAO)
5303301201339
1/11/20173/30/2012 4/3/2012 0.00 7,225.19 0.00 0.00 7,225.19 0.00 0.00 0.00156343
-4-
9:32:11AM
4/25/2017
16.E.2.b
Packet Pg. 798 Attachment: Subrogation Closed Claim Report 2nd QTR FY 17 (3118 : Closed Claim Reports)
Collier County Government
Subrogation Closed Claim Report
2nd QTR FY 2017
Valued as of:4/25/2017
Total Inc Ind/PD/CollExpense RecoveryMed/BI/Comp Deductible Legal Other
Claim Number Employee Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Coverage Carrier
Cost Center
Cause
Date of Loss
Employer Acc Desc.
Date Report to RiskStatus Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
53 Perpetrator was fleeing from law
enforcement & ran a stop sign at
Roberts Ave. & N. 6th Street The
perpetrators’ vehicle crossed the
roadway & struck a chain link
fence and aluminum bleachers.
3000
0.00 0.00 0.00 0.00 5,328.15 0.00 0.00 0.00CC v. Rinella, Richard
($5,699.88)
5308251605429
3/14/20178/25/2016 8/30/2016 0.00 0.00 0.00 5,328.15 0.00 0.00 0.00 0.00163630
53 Driver of third party vehicle was
traveling east on Tamiami Trail,
when he lost control of his
vehicle. The vehicle damaged a
street light and palm tree.
3000
0.00 0.00 0.00 0.00 1,062.50 0.00 0.00 0.00CC v. Ventura, Santiago
($1,062.50) (CA)
5412031505450
3/15/201712/3/2015 9/6/2016 0.00 0.00 0.00 1,062.50 0.00 0.00 0.00 0.00163801
54 Third party vehicle was making a
u-turn and lost control of the
vehicle striking a tree.
3000
9,248.32 0.00 0.00 0.00 9,248.32 0.00 0.00 9,248.32CC v. Dworkin, Michael
($9,248.32)
5312131504677
3/31/201712/13/2015 12/14/2015 9,248.32 0.00 0.00 9,248.32 9,248.32 0.00 0.00 0.00156361
53 Third party vehicle struck a
concrete light pole, knocking it
down.
3000
0.00 0.00 0.00 0.00 1,527.59 0.00 0.00 0.00CC v. Broes, Guy5310041605818
3/30/201710/4/2016 2/3/2017 0.00 0.00 0.00 1,527.59 0.00 0.00 0.00 0.00163630
53 Driver of Chevy Passenger Van
was traveling south on 9th Street
NW and failed to yield the right
of way; resulting in a collision
with another vehicle and damage
to a stop sign and bike rack.
3000
0.00 0.00 0.00 0.00 5,829.86 0.00 0.00 0.00CC v. Alvarado, Juan5309231605527
3/30/20179/23/2016 10/11/2016 0.00 0.00 0.00 5,829.86 0.00 0.00 0.00 0.00163630
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9:32:11AM
4/25/2017
16.E.2.b
Packet Pg. 799 Attachment: Subrogation Closed Claim Report 2nd QTR FY 17 (3118 : Closed Claim Reports)
Collier County Government
Subrogation Closed Claim Report
2nd QTR FY 2017
Valued as of:4/25/2017
Total Inc Ind/PD/CollExpense RecoveryMed/BI/Comp Deductible Legal Other
Claim Number Employee Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Coverage Carrier
Cost Center
Cause
Date of Loss
Employer Acc Desc.
Date Report to RiskStatus Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
53 Driver of Dodge Ram pickup was
traveling north on Collier Blvd.
when he drove over a large
puddle of water. The driver
turned left onto the center
median; striking a street light
pole.
3000
0.00 0.00 0.00 0.00 2,468.12 0.00 0.00 0.00CC v. Omdoll, Melissa
($2,568.12)
5306291605326
3/30/20176/29/2016 7/26/2016 0.00 0.00 0.00 2,468.12 0.00 0.00 0.00 0.00163630
53 Third party vehicle (Kia) was
traveling west on Immokalee
Road when he drove onto the
curb, into the median, striking
several shrubs and a road sign.
3000
0.00 0.00 0.00 0.00 18,184.35 0.00 0.00 0.00CC v. Lee Drywall, Inc.
($18,184.35)
5310061605526
2/13/201710/6/2016 10/11/2016 0.00 0.00 0.00 18,184.35 0.00 0.00 0.00 0.00163620
53 A scissor lift being moved by a
third party's employee, resulted
in a spill of hydraulic fluid on the
roadway.
3100
2,662.54 0.00 0.00 0.00 3,038.22 2,520.14 142.40 0.00CC v. Paz, Mario4110191605546
1/6/201710/19/2016 10/20/2016 0.00 2,520.14 142.40 3,038.22 2,662.54 0.00 0.00 0.00253215
41 Employees’ county vehicle was
hit by third party vehicle.
Employee was at Vanderbilt
Beach Ext. and Collier Blvd.
traffic light when struck.
2450
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00CC v. Talarico, Katelyn5301011705991
3/24/20171/1/2017 3/24/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00163620
53 Driver of Chevy Aveo was
traveling east on Immokalee
Road when she failed to
maintain control of the vehicle,
crossed the raised median,
drove across all three lanes and
struck a guardrail.
3000
0.00 0.00 0.00 0.00 12,281.22 0.00 0.00 0.00CC v. Vanoy, Oliver (CA)5302281003493
3/3/20172/28/2010 3/3/2010 0.00 0.00 0.00 12,281.22 0.00 0.00 0.00 0.00163630
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9:32:11AM
4/25/2017
16.E.2.b
Packet Pg. 800 Attachment: Subrogation Closed Claim Report 2nd QTR FY 17 (3118 : Closed Claim Reports)
Collier County Government
Subrogation Closed Claim Report
2nd QTR FY 2017
Valued as of:4/25/2017
Total Inc Ind/PD/CollExpense RecoveryMed/BI/Comp Deductible Legal Other
Claim Number Employee Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Coverage Carrier
Cost Center
Cause
Date of Loss
Employer Acc Desc.
Date Report to RiskStatus Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
53 JE Auto accident on Golden Gate
Parkway, resulted in third party
damaging electrical box and
concrete light post.
2450
763.49 0.00 0.00 0.00 763.49 763.49 0.00 0.00CC vs. Gelco Fleet Trust
($763.49)
4106291605268
2/28/20176/29/2016 6/29/2016 0.00 763.49 0.00 763.49 763.49 0.00 0.00 0.00253215
41 Employees' county vehicle was
struck by third party; county
vehicle sustained damage to
right rear turn signal cover.
3000
16,177.17
16,177.17
287.05
287.05
20,082.76
20,082.76
128,750.36
128,750.36 0.00
0.00 0.00
0.00
0.00
0.00
36,546.98
36,546.98Grand Totals: 31 Claims
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4/25/2017
16.E.2.b
Packet Pg. 801 Attachment: Subrogation Closed Claim Report 2nd QTR FY 17 (3118 : Closed Claim Reports)
16.E.2.c
Packet Pg. 802 Attachment: Settlement Authority Resolution (3118 : Closed Claim Reports)
16.E.2.c
Packet Pg. 803 Attachment: Settlement Authority Resolution (3118 : Closed Claim Reports)
16.E.2.c
Packet Pg. 804 Attachment: Settlement Authority Resolution (3118 : Closed Claim Reports)
16.E.2.c
Packet Pg. 805 Attachment: Settlement Authority Resolution (3118 : Closed Claim Reports)
16.E.2.c
Packet Pg. 806 Attachment: Settlement Authority Resolution (3118 : Closed Claim Reports)
16.E.2.c
Packet Pg. 807 Attachment: Settlement Authority Resolution (3118 : Closed Claim Reports)