Agenda 02/23/2021 Item #16E1 (Workers' Comp & Subrogation Claims)02/23/2021
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 first quarter of FY 21.
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 first quarter of FY 20
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 first quarter of FY 21, 93 files were closed with total expenditures of
$445,884.99. Reinsurance recoveries for the first quarter of FY 21 were $200,550.9 1. During the same
period, 22 subrogation files were closed, and the Risk Management Division recovered $63,899.79 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.1
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02/23/2021
Prepared by: Jeff Walker CPCU, ARM, Division Director, Risk Management Division.
ATTACHMENT(S)
1. All Lines Closed Claim Report 1st QTR FY 21 (PDF)
2. Subrogation Closed Claim Report 1st QTR FY 21 (PDF)
3. Resolution 2004-15 PDF0001 (PDF)
16.E.1
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02/23/2021
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.E.1
Doc ID: 14813
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 first quarter of FY 21.
Meeting Date: 02/23/2021
Prepared by:
Title: Operations Coordinator – Risk Management
Name: Greily Gonzalez
01/20/2021 4:27 PM
Submitted by:
Title: Division Director - Risk Management – Risk Management
Name: Jeff Walker
01/20/2021 4:27 PM
Approved By:
Review:
Risk Management Jeff Walker Additional Reviewer Completed 01/21/2021 7:31 AM
Administrative Services Department Paula Brethauer Level 1 Department Reviewer Completed 01/26/2021 10:36 AM
Office of Management and Budget Laura Wells Additional Reviewer Completed 01/28/2021 10:59 AM
Administrative Services Department Len Price Level 2 Department Head Review Completed 02/08/2021 4:09 PM
County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 02/10/2021 9:54 AM
Office of Management and Budget Debra Windsor Level 3 OMB Gatekeeper Review Completed 02/10/2021 11:07 AM
County Manager's Office Dan Rodriguez Level 4 County Manager Review Completed 02/10/2021 3:08 PM
Board of County Commissioners MaryJo Brock Meeting Pending 02/23/2021 9:00 AM
16.E.1
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Valued as of:
Med/BI/Comp Expense Ind/PD/Coll Recovery Deductible Legal Other Total Inc
Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Division 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
481.94 0.00 735.45 0.00 0.00 0.00 0.00 1,217.39
EMSE 11/15/2020 11/18/2020 12/17/2020 481.94 0.00 735.45 0.00 0.00 0.00 0.00 1,217.39
10 1500
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
EMSE 11/27/2020 11/28/2020 12/17/2020 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1500
2,254.57 29.75 0.00 0.00 0.00 0.00 0.00 2,284.32
WWTE 10/4/2020 10/5/2020 12/31/2020 2,254.57 29.75 0.00 0.00 0.00 0.00 0.00 2,284.32
10 1500
0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
EMSE 12/18/2020 12/18/2020 12/31/2020 0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
10 1300
1,402.67 11.90 0.00 0.00 0.00 0.00 0.00 1,414.57
TXCE 10/26/2020 10/26/2020 12/16/2020 1,402.67 11.90 0.00 0.00 0.00 0.00 0.00 1,414.57
10 1300
238.85 11.90 0.00 0.00 0.00 0.00 0.00 250.75
SOWE 10/4/2020 10/5/2020 10/12/2020 238.85 11.90 0.00 0.00 0.00 0.00 0.00 250.75
10 1900
630.54 69.49 0.00 0.00 0.00 0.00 0.00 700.03
RMSE 9/30/2020 10/7/2020 10/20/2020 630.54 69.49 0.00 0.00 0.00 0.00 0.00 700.03
10 1700
327.25 19.70 0.00 0.00 0.00 0.00 0.00 346.95
GMAO 10/29/2020 10/29/2020 10/31/2020 327.25 19.70 0.00 0.00 0.00 0.00 0.00 346.95
10 1700
0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
EMSE 10/23/2020 10/23/2020 10/31/2020 0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
10 1900
348.50 23.90 0.00 0.00 0.00 0.00 0.00 372.40
DASE 10/26/2020 10/26/2020 10/31/2020 348.50 23.90 0.00 0.00 0.00 0.00 0.00 372.40
10 1200
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
RMSE 12/9/2020 12/9/2020 12/16/2020 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1900
6,341.11 363.23 0.00 0.00 0.00 0.00 0.00 6,704.34
TECM 8/25/2020 8/25/2020 11/20/2020 6,341.11 363.23 0.00 0.00 0.00 0.00 0.00 6,704.34
10 1700
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
TXCE 11/17/2020 11/17/2020 11/30/2020 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1500
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
WATE 12/9/2020 12/9/2020 12/15/2020 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Employee was on a lengthy phone call, and when she hung up the phone,
she got a severe cramp on her neck, and her shoulder and arm felt ill.
1012092010934
1008252010571
Employee was at Fleet unloading his truck when another county vehicle
pulling a trailer ran over his left ankle with the trailer tires.
1011172010879
Employee was doing a meet and greet with member of the public's dog.
Employee ran towards the gate to close it when the dog chased her and bit
her behind the right knee.
1012092010931
Employee had an allergic reaction to his hands and wrist from a Royal Palm
tree berries.
1010232010774
Employee was on a 911 call when he became light headed and passed out
hitting his head.
1010262010780
Employee hit his right shin while removing a guardrail.
1010292010797
Employee was lifting an object off of the beach. When he lifted, one side of
the pole bounce back and hit his right wrist, thumb and then fell on right foot.
1010032010705
Employee felt sting on left groin causing swelling and cellulitis.
1009302010725
Employee tripped and fell forward coming down the stairwell on left elbow
and wrist. Employee has swelling to right eye.
1010262010781
Employee stepped down the stairs, and on the first step her left ankle twisted
landing on her left knee and left shoulder.
1010042010704
Employee was walking down the stairs and slipped after grabbing the railing;
causing pain to left shoulder.
1012182010956
Employee is complaining of left knee pain, when she and her partner were
taking a patient out of the ambulance on the stretcher, when it collapsed.
1011272010908
Employee states he injured/twisted his right knee when he was working out
practicing a new tactical fitness training.
Accident Desc.
Major Coverage: 10 - Workers' Compensation
1011152010883
Collier County Government
Closed Claim Report- All Lines
1st QTR FY 2021
Claim Number Claimant Name
Page 1
16.E.1.a
Packet Pg. 1047 Attachment: All Lines Closed Claim Report 1st QTR FY 21 (14813 : Ratification of Claims Files Closed By
10 1900
2,627.61 58.91 0.00 0.00 0.00 0.00 0.00 2,686.52
DASE 10/13/2020 10/13/2020 12/8/2020 2,627.61 58.91 0.00 0.00 0.00 0.00 0.00 2,686.52
10 1500
427.75 31.40 0.00 0.00 0.00 0.00 0.00 459.15
COCE 10/8/2020 10/8/2020 10/20/2020 427.75 31.40 0.00 0.00 0.00 0.00 0.00 459.15
10 1300
454.09 17.85 0.00 0.00 0.00 0.00 0.00 471.94
CENE 10/22/2020 10/23/2020 10/31/2020 454.09 17.85 0.00 0.00 0.00 0.00 0.00 471.94
10 1400
293.89 0.00 0.00 0.00 0.00 0.00 0.00 293.89
WATE 11/2/2020 11/6/2020 11/16/2020 293.89 0.00 0.00 0.00 0.00 0.00 0.00 293.89
10 1500
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
BPRI 12/7/2020 12/7/2020 12/22/2020 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1200
0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
WATE 12/28/2020 12/30/2020 12/31/2020 0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
10 1900
247.37 39.21 0.00 0.00 0.00 0.00 0.00 286.58
EMSE 10/1/2020 10/1/2020 10/1/2020 247.37 39.21 0.00 0.00 0.00 0.00 0.00 286.58
10 1200
254.15 13.75 0.00 0.00 0.00 0.00 0.00 267.90
PUAO 11/12/2020 11/12/2020 11/30/2020 254.15 13.75 0.00 0.00 0.00 0.00 0.00 267.90
10 1300
699.17 66.21 0.00 0.00 0.00 0.00 0.00 765.38
EMSE 6/21/2020 6/21/2020 12/31/2020 699.17 66.21 0.00 0.00 0.00 0.00 0.00 765.38
10 1000
0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
EMSE 12/5/2020 12/8/2020 12/11/2020 0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
10 1500
17,029.46 812.20 735.45 0.00 0.00 0.00 0.00 18,577.11
17,029.46 812.20 735.45 0.00 0.00 0.00 0.00 18,577.11
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CMAO 5/4/2020 12/1/2020 12/28/2020 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 2200
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
WWTE 11/3/2020 11/3/2020 11/30/2020 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 5900
9,000.00 122.75 0.00 0.00 0.00 1,820.00 0.00 10,942.75
MHCP 7/31/2018 7/31/2018 12/31/2020 9,000.00 122.75 0.00 0.00 0.00 1,820.00 0.00 10,942.75
21 2050
4,500.00 0.00 0.00 0.00 0.00 1,140.00 0.00 5,640.00
MHCP 7/18/2017 7/18/2017 12/22/2020 4,500.00 0.00 0.00 0.00 0.00 1,140.00 0.00 5,640.00
21 5900
2107181706290 MCELDERRY, CARA
Per Cara McElderry: She was coming down slide 4. As she made it to the
final turn, her husband (Ryan McElderry), was behind her and slammed into
the right side of her upper back. Cara could not catch her breath after the
collison. (EMS denied)
While a county vac truck was cleaning the gravity line in front of a residence,
water was blown out of the toilet onto the walls and floor.
2107311808174 COLARIC, NICK
Nick was walking into Turtle cove and his heel caught the edge of the pool. I
went and looked at the area and found tiles to be missing.
2105042010913 MONGE, ASLAN
Cutting tool fell from A/C duct and caused laceration to the arm of a sub
contracted employee.
2211032010808 SABO, JOANN
1012052010928
Employee is complaining of right knee pain after working his 24hr shift.
Total by Major Coverage 24 Claims
Major Coverage: 20 - General Liability
Employee's chair moved out away from her and fell about 3" off the floor.
Employee complains of pain on tailbone, back, neck & shoulders.
1006212010416
Employee was transporting a patient and was spit on in the face by the
patient who stated he has Hepatitis.
1010012010691
Employee scratched right forearm with a piece of metal while checking
equipment under the bench seat of the Ambulance.
1011122010857
Employee was performing an inspection at 460 14th Ave NE when a dog
from the home bit him on the left wrist.
1012282010990
Employee was performing a new service installation in Fiddler's Creek and
was bitten by bugs on his lower right leg.
Employee was rear ended by another employee driving a County vehicle and
is experiencing mid and upper back pain.
1011022010817
Employee picked a 3" valve changing out a large assembly at when he
noticed a strain in his lower back. Employee did not want or seek medical
attention. Then employee went to a chiropractor on 11/5/20 for back pain,
and is now seeking medical attention.
1012072010922
Employee was walking up staircase going onto the 4th floor; as she opened
the door she fell on her right knee due to the floor being wet.
1010222010775
1010132010744
Employee was moving cattle panels and pulled a muscle in the right forearm
while setting up a pen for a large bull to be moved to the pasture.
1010082010730
Employee was cutting pipes, when particles flew in right eye causing some
discomfort.
Page 2
16.E.1.a
Packet Pg. 1048 Attachment: All Lines Closed Claim Report 1st QTR FY 21 (14813 : Ratification of Claims Files Closed By
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
WATE 10/2/2020 10/20/2020 12/31/2020 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 2150
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
RMSE 3/12/2020 10/20/2020 10/28/2020 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 2050
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
WATE 1/28/2020 1/29/2020 10/20/2020 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 2000
0.00 0.00 2,371.70 0.00 0.00 0.00 0.00 2,371.70
TXCE 11/6/2020 11/6/2020 12/28/2020 0.00 0.00 2,371.70 0.00 0.00 0.00 0.00 2,371.70
22 2150
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
MHCP 9/29/2020 9/29/2020 11/12/2020 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 2150
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
MHCP 7/5/2020 11/3/2020 11/25/2020 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 2050
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
RMSE 10/31/2019 9/29/2020 12/15/2020 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 2050
13,500.00 122.75 2,371.70 0.00 0.00 2,960.00 0.00 18,954.45
13,500.00 122.75 2,371.70 0.00 0.00 2,960.00 0.00 18,954.45
0.00 3,744.94 23,944.30 0.00 0.00 0.00 0.00 27,689.24
FLME 9/22/2020 9/22/2020 12/17/2020 0.00 3,744.94 23,944.30 0.00 0.00 0.00 0.00 27,689.24
32 3000
0.00 0.00 1,592.83 0.00 0.00 0.00 0.00 1,592.83
WATE 10/5/2020 10/6/2020 10/21/2020 0.00 0.00 1,592.83 0.00 0.00 0.00 0.00 1,592.83
32 2000
0.00 509.04 6,895.70 0.00 0.00 0.00 0.00 7,404.74
FMGE 11/13/2020 11/13/2020 12/16/2020 0.00 509.04 6,895.70 0.00 0.00 0.00 0.00 7,404.74
32 3000
0.00 0.00 3,034.98 0.00 0.00 0.00 0.00 3,034.98
EMSE 10/27/2020 10/27/2020 12/16/2020 0.00 0.00 3,034.98 0.00 0.00 0.00 0.00 3,034.98
32 3000
0.00 791.56 6,419.07 0.00 0.00 0.00 0.00 7,210.63
WATE 11/9/2020 11/9/2020 11/30/2020 0.00 791.56 6,419.07 0.00 0.00 0.00 0.00 7,210.63
32 3000
0.00 243.66 10,381.59 0.00 0.00 0.00 0.00 10,625.25
RMSE 9/24/2020 9/29/2020 10/19/2020 0.00 243.66 10,381.59 0.00 0.00 0.00 0.00 10,625.25
32 3000
3209242010682 Morales, Arturo
Employee encountered MOT setup by LCEC that was in the process of
transition. Employee stopped on Everglades Blvd and LCEC started to move
cones in front of Employee. He backed up and damaged a pickup truck.
Employee was operating ambulance #3 when she struck the rear bumper of
the third party claimant vehicle causing minor damage.
3211092010827 Fernandez, Joandia
Vehicle 3 stopped in traffic, vehicle 2 did the same, 1 could not. Vehicle 1-
(County Vehicle) rear ended vehicle 2, causing it to rear end vehicle 3.
3211132010865 Southern Striping Solutions
County vehicle crashed into third party vehicle.
3210272010786 Stearns, Constance
Erratic driver in roadway causing traffic to stop short. CC2-847 could not
stop in time and hit the rear of a county employee's personal vehicle.
3210052010712 MAZZOLA, TIM
Citizen driving in the middle lane of Airport Pulling Rd coming up to Pine
Ridge Rd, CC2-1345 in the left lane carrying a trailer with landscape debris,
and 50-rocks started flying out of county trailer striking citizens vehicle.
Minor suffered a laceration to his leg in a drainage ditch that is located on the
property of 102 Madison Drive Naples, FL 34110.
Total by Major Coverage 11 Claims
Major Coverage: 30 - Auto Liability
3209222010650 Schiller, Matt
2107052010809 LENDSEY, BEVERLY ANN
While in her wheel chair a citizen hit a bump on the park sidewalk and fell out
of the wheel chair onto her right shoulder.
2110311910683 Alonso, Adrian
Pulled into parking space at the Collier County main campus and lower front
bumper ran into parking stop that was out of place.
2109292010685 GARCIA, ANTHONY
Contractor of Wildcat Renovation, subcontracted by County contractor
Compass Construction, trapped under concrete slab, while working on
demolition of pedestrian bridge, at Sun N Fun Lagoon. Subject extricated
and transported to NCH-North by EMS.
2201282004023 FDOT(Contractor)
While performing a bore across Collier Blvd after receiving a locate from
Collier County Locate Team, a contractor working for FDOT struck the water
main. FDOT-(contractor) is claiming Collier County did not locate correctly.
2211062004040 SELIGSON, ZAK
Comcast is claiming water distribution damaged their cable on 10/2. Water
Distribution was on site 10/1 not 10/2 and there was no damage done to any
Comcast line while we were on site. We do not agree with the damage
assessment.
2103122010765 YOUNG, ALAN
Received notice of claim, citizen was walking on the sidewalk adjacent to
Livingston Road in Collier County and jammed his right toe against a piece of
raised concrete on the sidewalk. He received permanent injuries that
required medical care.
2210022010764 Comcast through Phoenix Loss Control
Page 3
16.E.1.a
Packet Pg. 1049 Attachment: All Lines Closed Claim Report 1st QTR FY 21 (14813 : Ratification of Claims Files Closed By
7,000.00 0.00 0.00 0.00 0.00 0.00 0.00 7,000.00
TECM 3/19/2019 3/19/2019 10/26/2020 7,000.00 0.00 0.00 0.00 0.00 0.00 0.00 7,000.00
31 3000
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
BPRI 8/3/2020 8/3/2020 10/21/2020 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
32 3000
7,000.00 5,289.20 52,268.47 0.00 0.00 0.00 0.00 64,557.67
7,000.00 5,289.20 52,268.47 0.00 0.00 0.00 0.00 64,557.67
0.00 0.00 636.72 0.00 0.00 0.00 0.00 636.72
WATE 8/3/2020 8/5/2020 11/30/2020 0.00 0.00 636.72 0.00 0.00 0.00 0.00 636.72
41 3000
0.00 0.00 522.72 0.00 0.00 0.00 0.00 522.72
WATE 8/4/2020 8/5/2020 11/30/2020 0.00 0.00 522.72 0.00 0.00 0.00 0.00 522.72
41 3000
0.00 0.00 392.50 0.00 0.00 0.00 0.00 392.50
MHCP 9/5/2020 9/12/2020 12/23/2020 0.00 0.00 392.50 0.00 0.00 0.00 0.00 392.50
41 3000
0.00 0.00 358.87 0.00 0.00 0.00 0.00 358.87
MHCP 12/11/2020 12/11/2020 12/28/2020 0.00 0.00 358.87 0.00 0.00 0.00 0.00 358.87
41 3000
0.00 0.00 2,946.20 0.00 0.00 0.00 0.00 2,946.20
PSVE 10/5/2020 10/6/2020 12/22/2020 0.00 0.00 2,946.20 0.00 0.00 0.00 0.00 2,946.20
41 3000
0.00 0.00 1,495.76 0.00 0.00 0.00 0.00 1,495.76
FMGE 7/6/2020 7/7/2020 10/29/2020 0.00 0.00 1,495.76 0.00 0.00 0.00 0.00 1,495.76
41 3000
805.48 0.00 0.00 0.00 0.00 0.00 0.00 805.48
SOWE 10/5/2020 10/5/2020 10/27/2020 805.48 0.00 0.00 0.00 0.00 0.00 0.00 805.48
42 3200
0.00 0.00 3,294.08 0.00 0.00 0.00 0.00 3,294.08
FLME 9/22/2020 9/22/2020 10/21/2020 0.00 0.00 3,294.08 0.00 0.00 0.00 0.00 3,294.08
41 3000
0.00 0.00 7,644.40 0.00 0.00 0.00 0.00 7,644.40
BPRI 8/3/2020 8/3/2020 10/1/2020 0.00 0.00 7,644.40 0.00 0.00 0.00 0.00 7,644.40
41 3000
0.00 0.00 217.00 0.00 0.00 0.00 0.00 217.00
FMGE 9/22/2020 9/22/2020 12/22/2020 0.00 0.00 217.00 0.00 0.00 0.00 0.00 217.00
41 3000
0.00 0.00 2,215.60 0.00 0.00 0.00 0.00 2,215.60
WATE 8/2/2020 8/5/2020 11/30/2020 0.00 0.00 2,215.60 0.00 0.00 0.00 0.00 2,215.60
41 3000
1,057.42 0.00 0.00 0.00 0.00 0.00 0.00 1,057.42
EMSE 9/18/2020 9/21/2020 10/29/2020 1,057.42 0.00 0.00 0.00 0.00 0.00 0.00 1,057.42
42 5900 Ambulance Strike Team was returning to Collier County from deployment, a
wheel simulator from TK-10 became dislodged bouncing off the pavement a
couple of times and eventually striking the windshield of Asset# CC-1632.
4108022010518 Water Division
On Call Truck utilized by a rotation of employees went to Fleet for PM work
and the driver side utility body was found to be damaged.
4209182010649 EMS
Inspector pulled in to Tallis Park drive around, and hit Fedex truck that was
parked.
4109222010652 Facilities Management Division
Employee reported to supervisor this morning about new unknown damage
to his vehicle. Employee inspected his vehicle, it looks like an object of some
sort struck the vehicle at a glancing blow.
4109222010651 Fleet Management
Erratic driver in roadway causing traffic to stop short. CC2-847 could not
stop in time and hit the rear of county employee's personal vehicle.
4108032010513 Building Plan Review & Inspection
Came to pick up car this morning and noticed a dent in the rear left door.
4210052010708 Solid Waste Division
Rock struck windshield of vehicle CC2-1540 while driving south bound on I-
75 near mile marker 106. Windshield is cracked and needs to be replaced.
Passenger in the vehicle was, new employee who was receiving training.
4110052010724 Parks and Recreation
Van CC2-1543 has roof damage across the top. Our vans have been
returned from Summer usage by other employee's not associated to Golden
Gate Community Center. The van went in with a recall on the brakes and the
damage was found by Ford Dealership.
4107062010449 Facilities Management Division
PR-525 while operating Unit CC2-1801 at 951 Boat Ramp, backed into a
park visitor's boat trailer rear light support damaging same, knowingly. The
visitor's trailer was sticking out into the traveled portion of the traffic way.
4112112010940 Parks and Recreation
While moving equipment around in the back of the truck the back window
was broken.
4108042010520 Water Division
Vehicle utilized as the on call vehicle and driven by the entire staff on a
rotating basis; upon being taken to Fleet left rear door damage was found.
4109052010620 Parks and Recreation
Total by Major Coverage 8 Claims
Major Coverage: 40 - Auto Physical Damage
4108032010521 Water Division
On Call Truck which is driven by all distribution staff on a rotating basis was
found to have right rear door damage when brought to Fleet for service.
Employee stated the county vehicles brakes failed at a traffic light causing
him to rear end the vehicle in front of him.
3208032010515 Fedex
Employee pulled in at Tallis Park roundabout with vehicle CC2-2318 and rear
ended a parked FedEx truck.
3103191904015 Michael Minatree
Page 4
16.E.1.a
Packet Pg. 1050 Attachment: All Lines Closed Claim Report 1st QTR FY 21 (14813 : Ratification of Claims Files Closed By
805.48 0.00 0.00 0.00 0.00 0.00 0.00 805.48
BPRI 10/6/2020 10/6/2020 10/26/2020 805.48 0.00 0.00 0.00 0.00 0.00 0.00 805.48
42 3200
805.48 0.00 0.00 0.00 0.00 0.00 0.00 805.48
BPRI 10/30/2020 10/30/2020 12/16/2020 805.48 0.00 0.00 0.00 0.00 0.00 0.00 805.48
42 3000
805.48 0.00 0.00 0.00 0.00 0.00 0.00 805.48
WATE 11/6/2020 11/6/2020 12/16/2020 805.48 0.00 0.00 0.00 0.00 0.00 0.00 805.48
42 5900
0.00 0.00 3,190.35 0.00 0.00 0.00 0.00 3,190.35
WWTE 8/13/2020 8/13/2020 10/29/2020 0.00 0.00 3,190.35 0.00 0.00 0.00 0.00 3,190.35
41 3000
0.00 0.00 698.15 0.00 0.00 0.00 0.00 698.15
MHCP 9/23/2020 9/23/2020 11/23/2020 0.00 0.00 698.15 0.00 0.00 0.00 0.00 698.15
41 3000
0.00 0.00 782.13 0.00 0.00 0.00 0.00 782.13
TECM 9/16/2020 9/16/2020 11/3/2020 0.00 0.00 782.13 0.00 0.00 0.00 0.00 782.13
41 3000
0.00 0.00 2,378.99 0.00 0.00 0.00 0.00 2,378.99
RMSE 11/2/2020 11/2/2020 12/31/2020 0.00 0.00 2,378.99 0.00 0.00 0.00 0.00 2,378.99
41 3000
0.00 0.00 806.26 0.00 0.00 0.00 0.00 806.26
BPRI 2/5/2019 2/6/2019 10/26/2020 0.00 0.00 806.26 0.00 0.00 0.00 0.00 806.26
41 3000
0.00 0.00 452.69 0.00 0.00 0.00 0.00 452.69
MHCP 9/4/2020 9/8/2020 11/23/2020 0.00 0.00 452.69 0.00 0.00 0.00 0.00 452.69
41 3000
4,279.34 0.00 28,032.42 0.00 0.00 0.00 0.00 32,311.76
4,279.34 0.00 28,032.42 0.00 0.00 0.00 0.00 32,311.76
9,460.00 0.00 0.00 0.00 0.00 0.00 0.00 9,460.00
MHCP 9/7/2020 9/8/2020 10/21/2020 9,460.00 0.00 0.00 0.00 0.00 0.00 0.00 9,460.00
50 3000
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
WWTE 9/20/2018 9/25/2019 10/23/2020 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
50 5900
6,725.39 0.00 0.00 0.00 0.00 0.00 0.00 6,725.39
TECM 9/18/2020 9/18/2020 12/11/2020 6,725.39 0.00 0.00 0.00 0.00 0.00 0.00 6,725.39
50 3000
1,051.33 0.00 0.00 0.00 0.00 0.00 0.00 1,051.33
OPRS 4/30/2020 5/1/2020 12/11/2020 1,051.33 0.00 0.00 0.00 0.00 0.00 0.00 1,051.33
50 2400
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
PAPM 2/11/2020 2/13/2020 11/3/2020 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
50 3000
Windsock pole frame located adjacent to runway 15 was sheared off its
mounting bracket due to high winds from thunderstorm. Damage beyond
repair. Replacement necessary.
5002112010094 Utilities Planning And Project Management Division
Wastewater Collections notified us that a car ran off the road and hit an Air
Release Valve recently and damaged a Telog recorder (SN 30192691).
5009182010641 Transportation Engineering Division
Employee was tasked to go out to program a message board that was not
communicating to the traffic center. When arrived he found Message board
CC2-365 damaged and facing the wrong direction.
5004302010293 Everglades Air park
Apparent vehicle damage done to Cocohatchee River Park boat dock
nearest to marina office, sometime between 6 pm Sep 6 and 6 am Sep 7.
Smashed deck boards, and moved piling and 4x10 support beams.
5009201809646 Wastewater Division
As a result of building health evaluation of NCWRF Operations Building, 2nd
floor, reported on 10.9.2018, there are several instances of Stachybotrys
Mold present in the inhabited spaces of this building. Please read the
attached summary report.
I noticed a dent in the side of the truck Friday morning.
Total by Major Coverage 21 Claims
Major Coverage: 50 - Property
5009072010599 Cocohatchee River Park
4102051908754 Building Plan Review And Inspection Division
On February 05, 2019 unit CC2-1236 was parked at 310 Alachua Street,
Immokalee FL 34142 " Collier County Growth Management Department
Building. Unit was damage by unknown vehicle or person. Damage to the
right rear passeger side of the truck.
4109042010595 Parks and Recreation
County vehicle rear ended vehicle 2 causing vehicle 2 to hit vehicle 3.
4111022010805 Road Maintenance Division
While driving on the sidewalk to locate irrigation for Sunshine 811, truck CC2-
1363 came into contact with passenger side front tire, fender, door and step.
4109232010664 Parks and Recreation
Employee attempting to make a right hand turn from Davis Blvd Eastbound
onto County Barn Rd. struck a third party vehicle.
4109162010626 Transportation Engineering Division
This morning vehicle had a small pin hole crack on windshield that has
gotten much bigger as day went on.
4108132010543 Wastewater Division
Employee driving vehicle into ms 312 to park for end of shift when gate
swung into passenger side of vehicle moved by strong gust of wind. Gate hit
into passenger corner post and damaged pillar and step.
A rock was kicked up by another vehicle as inspector was crossing the Ft.
Myers bridge and hit his windshield causing the crack. The inspector notified
us shortly after reporting the incident.
4210302010800 Building Plan Review And Inspection Division
When returning back to his vehicle, the inspector noticed a glimmer in the
winshield in the sunlight. Upon closer inspection it was a crack.
4211062010819 Water Division
4210062010714 Building Plan Review And Inspection Division
Page 5
16.E.1.a
Packet Pg. 1051 Attachment: All Lines Closed Claim Report 1st QTR FY 21 (14813 : Ratification of Claims Files Closed By
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
OPRS 8/12/2020 8/13/2020 11/3/2020 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
50 5900
4,799.37 0.00 0.00 0.00 0.00 0.00 0.00 4,799.37
RMSE 10/27/2020 10/28/2020 11/30/2020 4,799.37 0.00 0.00 0.00 0.00 0.00 0.00 4,799.37
50 3000
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
TECM 3/22/2020 9/16/2020 10/29/2020 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
50 3000
39,662.26 60.00 0.00 0.00 0.00 0.00 0.00 39,722.26
HDPE 9/10/2017 9/26/2017 12/11/2020 39,662.26 60.00 0.00 0.00 0.00 0.00 0.00 39,722.26
51 5400
3,052.92 60.00 0.00 0.00 0.00 0.00 0.00 3,112.92
LIBE 9/10/2017 9/26/2017 12/4/2020 3,052.92 60.00 0.00 0.00 0.00 0.00 0.00 3,112.92
51 5400
1,523.46 60.00 0.00 0.00 0.00 0.00 0.00 1,583.46
WWTE 9/10/2017 10/6/2017 12/4/2020 1,523.46 60.00 0.00 0.00 0.00 0.00 0.00 1,583.46
51 5400
4,826.92 60.00 0.00 72,402.12 0.00 0.00 0.00 4,886.92
WATE 9/10/2017 2/16/2018 10/14/2020 4,826.92 60.00 0.00 72,402.12 0.00 0.00 0.00 4,886.92
51 5400
0.00 128,148.79 0.00 128,148.79 0.00 0.00 0.00 128,148.79
MHCP 9/10/2017 7/31/2019 10/14/2020 0.00 128,148.79 0.00 128,148.79 0.00 0.00 0.00 128,148.79
135 5400
0.00 1,020.00 0.00 0.00 0.00 0.00 0.00 1,020.00
CCRD 9/10/2017 12/7/2018 11/19/2020 0.00 1,020.00 0.00 0.00 0.00 0.00 0.00 1,020.00
130 5400
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
PUAO 9/10/2017 10/16/2018 11/19/2020 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
130 5400
5,651.85 95.00 0.00 0.00 0.00 0.00 0.00 5,746.85
FMGE 6/18/2020 6/19/2020 10/31/2020 5,651.85 95.00 0.00 0.00 0.00 0.00 0.00 5,746.85
50 5900
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
EMSE 9/10/2017 9/19/2017 11/19/2020 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
53 5400
0.00 60.00 0.00 0.00 0.00 0.00 0.00 60.00
EMSE 9/10/2017 9/28/2017 10/27/2020 0.00 60.00 0.00 0.00 0.00 0.00 0.00 60.00
51 5400
684.00 60.00 0.00 0.00 0.00 0.00 0.00 744.00
51 9/10/2017 2/1/2018 11/10/2020 684.00 60.00 0.00 0.00 0.00 0.00 0.00 744.00
5400
15,160.00 60.00 0.00 0.00 0.00 0.00 0.00 15,220.00
MHCP 9/10/2017 10/12/2017 11/30/2020 15,160.00 60.00 0.00 0.00 0.00 0.00 0.00 15,220.00
53 5400
0.00 60.00 0.00 0.00 0.00 0.00 0.00 60.00
WWTE 9/10/2017 10/6/2017 11/10/2020 0.00 60.00 0.00 0.00 0.00 0.00 0.00 60.00
51 5400
0.00 60.00 0.00 0.00 0.00 0.00 0.00 60.00
WWTE 9/10/2017 2/12/2018 11/19/2020 0.00 60.00 0.00 0.00 0.00 0.00 0.00 60.00
53 5400
12,788.00 60.00 0.00 0.00 0.00 0.00 0.00 12,848.00
MHCP 9/10/2017 12/7/2017 10/28/2020 12,788.00 60.00 0.00 0.00 0.00 0.00 0.00 12,848.00
53 5400
SOWE
Antenna damage.
5309101707236 Parks & Recreation (N. Gulfshore Beach Access)
Hurricane Irma damaged the board walk, the wakways, and fences at the
beach access. Several trash cans have missing lids.
5109101706799 Mater Pump Station #306
Some tile and soffit damage caused by hurricane Irma.
5309101707584 Public Utilities Department, Wastewater Collections, PS 304.10
Gutter damage
5309101706905 Aaron Lutz Park (Grounds)
Fences damaged around tennis and basketball courts; concrete poles tilted
around tennis court, wood front sign cracked; 10 lights out of service and 3
lamps had fallen.
Picnic tables areas missing roof shingles.
5109101706672 Emergency Management Services (Station 32)
Access ramp dislodged, trailer skirts damaged, and ambulance bay ceiling
light fell during Hurricane Irma.
5109101707454 Public Utilities Department, Solid Waste Capital, Marco Island Recycling
Drop-off Center, Location #337
Power surge on main fire panel, rendering panel inoperable.
5309101706511 Emergency Management Services (Station 76)
Tree fell on vinyl fence during hurricane Irma
Due to the Hurricane Irma event employees were required to work overtime,
before, during, and after the storm resulting on additional cost incurred. Also,
a sign language interpreter was hired to provide the necessary
communication to the public.
1309101708373 Public Utilities Department (Contracted Labor - Extra Expense)
Due to the extensive damages caused by Hurricane Irma the county
contracted manual labor to assist with repairs.
5006182010415 Facilities Management Division
The impact of Hurricane Irma in our area caused several park facilities to be
closed which resulted in a Business Income Loss.
1309101708546 Communications & Customer Relations Division
5109101707699 Public Utilities Department, Wellfield, Tamiami Wellfield 18, Location #760
Roof damage - shingles and soffit. Large generator damaged.
1359101709428 Parks and Recreation Division (Business Income Loss)
Hurricane Irma winds blew off shingles from roof and metal soffits
5109101706818 Master Pump Station #318
Extensive roof damage to exterior, evidence of leaking at caulk lines of roof
from the interior. Some soffits missing.
5109101706617 Facilities Management Division (Bldg H)
Leak and damaged ceiling tile, wet carpet on stair well on the 3rd floor.
5109101706627 Library Division (East Naples Branch)
Damaged Guardrail due to unknown incident.
5003222010629 Traffic Operations
Street light down.
5008122004032 Marco Island Airport
Following multiple rain events, water intrusion has been observed in the new
terminal building (under construction).
5010272010787 Road Maintenance Division
Page 6
16.E.1.a
Packet Pg. 1052 Attachment: All Lines Closed Claim Report 1st QTR FY 21 (14813 : Ratification of Claims Files Closed By
28,358.36 60.00 0.00 0.00 0.00 0.00 0.00 28,418.36
MHCP 9/10/2017 12/11/2017 10/28/2020 28,358.36 60.00 0.00 0.00 0.00 0.00 0.00 28,418.36
53 5400
0.00 0.00 32,436.35 0.00 0.00 0.00 0.00 32,436.35
MHCP 9/10/2017 12/14/2017 10/9/2020 0.00 0.00 32,436.35 0.00 0.00 0.00 0.00 32,436.35
57 5400
0.00 60.00 0.00 0.00 0.00 0.00 0.00 60.00
WATE 9/10/2017 2/15/2018 10/27/2020 0.00 60.00 0.00 0.00 0.00 0.00 0.00 60.00
51 5400
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
PAPM 9/10/2017 8/21/2018 11/10/2020 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
53 5400
14,800.00 60.00 0.00 0.00 0.00 0.00 0.00 14,860.00
WATE 9/10/2017 10/9/2017 10/27/2020 14,800.00 60.00 0.00 0.00 0.00 0.00 0.00 14,860.00
51 5400
400.00 60.00 0.00 0.00 0.00 0.00 0.00 460.00
WWTE 9/10/2017 2/15/2018 10/27/2020 400.00 60.00 0.00 0.00 0.00 0.00 0.00 460.00
51 5400
148,943.86 130,103.79 32,436.35 200,550.91 0.00 0.00 0.00 311,484.00
148,943.86 130,103.79 32,436.35 200,550.91 0.00 0.00 0.00 311,484.00
190,752.66 136,327.94 115,844.39 200,550.91 0.00 2,960.00 0.00 445,884.99
190,752.66 136,327.94 115,844.39 200,550.91 0.00 2,960.00 0.00 445,884.99
Total by Major Coverage 29 Claims
Grand Totals: 93 Claims
1/20/2021
8:37:48 AM
Hurricane Irma winds caused damage to roof, window and screens; file alarm
system blown out.
5109101707666 Public Utilities Department, SCWRF Electric Service/Generator Building,
Location #634
Rain gauge on roof damaged.
5309101708231 Public Utilities Engineering & Project Mmgt. (Washout on Vanderbilt Dr.)
Hurricane Irma washed out the right-of-way and undermined the roadway
along Vanderbilt Drive between 101st and 107th Avenues North.
5109101706842 Public Utilities Department (Process Control Bldg)
Thirty-two (32) boats damaged due Hurricane Irma.
5109101707651 Public Utilities Department, Wellfield, Raw Water Booster Station, Location
#768
Minor roof damage to Pump House Structure 423, lightning detection system
damaged, copper pipe damaged, HVAC system damaged.
5309101707253 Parks & Recreation (Sabal Palm Elem. School)
Hurricane Irma damaged the back stop and fence around the field, and
beachers CC1-58 and CC1-59.
5709101707289 Parks & Reacreation Division (Boats)
Page 7
16.E.1.a
Packet Pg. 1053 Attachment: All Lines Closed Claim Report 1st QTR FY 21 (14813 : Ratification of Claims Files Closed By
Collier County Government
Subrogation Closed Claim Report
1st QTR FY 2021
Valued as of:1/20/2021
Total Inc Ind/PD/CollExpense RecoveryMed/BI/Comp Deductible Legal Other
Claim Number Claimant Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Coverage Carrier
Division
Cause
Date of Loss
Accident Desc.
Date Report to RiskStatus Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
1,835.67 0.00 0.00 0.00 1,835.67 1,835.67 0.00 0.00Building Plan Review v.
Progressive Insurance
4106242010428
10/20/20206/24/2020 6/25/2020 0.00 1,835.67 0.00 1,835.67 1,835.67 0.00 0.00 0.00BPRI
41 Driver was sitting at a red light
on the corner of Veronica
Shoemaker and Michigan
Avenue and got rear ended the
gentleman jumped out of his
vehicle looked at the bumper
and his front end and said "no
damage" got in his truck and
tried to drive away.
3000
1,515.00 0.00 0.00 0.00 3,030.00 0.00 0.00 1,515.00Paradise Sports Complex v.
Progressive Insurance
5007122010479
11/25/20207/12/2020 7/21/2020 1,515.00 0.00 0.00 3,030.00 1,515.00 0.00 0.00 0.00COL
50 Driver of a jeep lost control of
vehicle and went into the
retention pond. some
landscaping was damaged.
3000
0.00 0.00 0.00 0.00 2,195.16 0.00 0.00 0.00Road Maintenance Division v.
UAIC
5001222010280
10/20/20201/22/2020 4/27/2020 0.00 0.00 0.00 2,195.16 0.00 0.00 0.00 0.00RMSE
50 Single vehicle impact with
guardrail.
3000
9,604.41 0.00 0.00 0.00 0.00 0.00 170.00 9,434.41CRA v. Ocean Harbor Insurance5004182010269
12/14/20204/18/2020 4/21/2020 9,434.41 0.00 170.00 0.00 9,604.41 0.00 0.00 0.00CRAE
50 During a traffic accident light
pole #2A was knocked down in
Immokalee at First Street near
Eustis Avenue. A police report
was filed. Road Maintenance
and Traffic Ops secured the
area.
3000
-1-
8:33:43AM
1/20/2021
16.E.1.b
Packet Pg. 1054 Attachment: Subrogation Closed Claim Report 1st QTR FY 21 (14813 : Ratification of Claims Files Closed
Collier County Government
Subrogation Closed Claim Report
1st QTR FY 2021
Valued as of:1/20/2021
Total Inc Ind/PD/CollExpense RecoveryMed/BI/Comp Deductible Legal Other
Claim Number Claimant Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Coverage Carrier
Division
Cause
Date of Loss
Accident Desc.
Date Report to RiskStatus Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
41.28 0.00 0.00 0.00 0.00 0.00 0.00 41.28Traffic Operations v. Ocean
Harbor Insurance
5004182010277
12/14/20204/18/2020 4/24/2020 41.28 0.00 0.00 0.00 41.28 0.00 0.00 0.00TECM
50 Blue MSTU pole hit by car,
Traffic Operations made it safe .
Immokalee MSTU will replace the
pole.
3000
0.00 0.00 0.00 0.00 11,032.38 0.00 0.00 0.00Traffic Operations v. The
Standard Fire insurance
5007242010500
12/14/20207/24/2020 7/29/2020 0.00 0.00 0.00 11,032.38 0.00 0.00 0.00 0.00TECM
50 Light pole damage in car
accident.
3000
0.00 0.00 0.00 0.00 4,552.18 0.00 0.00 0.00Wastewater v. Progressive
Insurance
4107062010448
10/20/20207/6/2020 7/6/2020 0.00 0.00 0.00 4,552.18 0.00 0.00 0.00 0.00WWTE
41 County vehicle was rear ended
when trying to merge in a
construction zone on Vanderbilt
Beach Rd and Logan.
3000
0.00 0.00 0.00 0.00 1,327.90 0.00 0.00 0.00Wastewater Division v . Carter
Fence
5008142010544
10/20/20208/14/2020 8/14/2020 0.00 0.00 0.00 1,327.90 0.00 0.00 0.00 0.00WWTE
50 ARV was hit by Carter Fence
when they where working on
the School board fence.
Carter Fence Point of Contact is
Carson 239-571-0117
General Contractor Owens
Ames Kimball: Dylan
239-770-0017 or Shawn
239-834-8562
3000
0.00 0.00 0.00 0.00 37.58 0.00 0.00 0.00Traffic Operations v.
Progressive Insurance
5009012010585
12/8/20209/1/2020 9/1/2020 0.00 0.00 0.00 37.58 0.00 0.00 0.00 0.00TECM
50 Sign hit by car.3000
-2-
8:33:43AM
1/20/2021
16.E.1.b
Packet Pg. 1055 Attachment: Subrogation Closed Claim Report 1st QTR FY 21 (14813 : Ratification of Claims Files Closed
Collier County Government
Subrogation Closed Claim Report
1st QTR FY 2021
Valued as of:1/20/2021
Total Inc Ind/PD/CollExpense RecoveryMed/BI/Comp Deductible Legal Other
Claim Number Claimant Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Coverage Carrier
Division
Cause
Date of Loss
Accident 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 0.00 805.48 0.00 0.00 0.00Development Review Division v.
Haskins
4210212010771
12/21/202010/21/2020 10/21/2020 0.00 0.00 0.00 805.48 0.00 0.00 0.00 0.00LDSD
42 Employee was on site to
perform spot inspection of Lake
Excavation and while the
contractor was breaking rock
for removal, fragments of rock
flew approximately 75+ feet and
hit windshield of CC2-1081
causing a crack.
5900
0.00 0.00 0.00 0.00 153.89 0.00 0.00 0.00Traffic Operations v. Geico5007261910750
12/8/20207/26/2019 10/15/2020 0.00 0.00 0.00 153.89 0.00 0.00 0.00 0.00TECM
50 Sign down in median due to
single vehicle accident.
3000
0.00 0.00 0.00 0.00 1,681.41 0.00 0.00 0.00Facilities Management v. USAA
Insurance
4102042010049
10/1/20202/4/2020 2/4/2020 0.00 0.00 0.00 1,681.41 0.00 0.00 0.00 0.00FMGE
41 Employee was trying to get into
the turn lane to turn left on to
Collier blvd. Third party claimant
was driving in the emergency
lane before turn lane and rear
ended the Collier County vehicle.
3000
0.00 0.00 0.00 0.00 1,218.82 0.00 0.00 0.00Landscape Operations v. AAA
Insurance
5007042010777
12/31/20207/4/2020 10/23/2020 0.00 0.00 0.00 1,218.82 0.00 0.00 0.00 0.00RMSE
50 Vehicle accident damaging palm
tree and shrubs.
3000
-3-
8:33:43AM
1/20/2021
16.E.1.b
Packet Pg. 1056 Attachment: Subrogation Closed Claim Report 1st QTR FY 21 (14813 : Ratification of Claims Files Closed
Collier County Government
Subrogation Closed Claim Report
1st QTR FY 2021
Valued as of:1/20/2021
Total Inc Ind/PD/CollExpense RecoveryMed/BI/Comp Deductible Legal Other
Claim Number Claimant Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Coverage Carrier
Division
Cause
Date of Loss
Accident Desc.
Date Report to RiskStatus Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
9,939.39 0.00 0.00 0.00 19,530.70 9,765.35 174.04 0.00Development Review Division v.
Progressive
4102072010070
10/20/20202/7/2020 2/10/2020 0.00 9,765.35 174.04 19,530.70 9,939.39 0.00 0.00 0.00LDSD
41 County vehicle was heading
west on N horseshoe Dr. when
a vehicle on Collier way made a
left trying to get in front of
county truck and hit Miguel in the
right side bumper sending him
off the road into the street signs
that damaged left side and roof.
3000
0.00 0.00 0.00 0.00 586.72 0.00 0.00 0.00Parks and Recreation v. State
Farm Insurance
5007302010508
11/2/20207/30/2020 8/3/2020 0.00 0.00 0.00 586.72 0.00 0.00 0.00 0.00MHCP
50 Single vehicle accident damaged
fencing, landscaping and
boardwalk near new Vanderbilt
Beach restrooms. Driver
transported to hospital. CCSO
report number 20-296698
refers. Area caution-taped off.
3000
0.00 0.00 0.00 0.00 72.96 0.00 0.00 0.00Traffic Operations v. Allstate5010181910731
11/2/202010/18/2019 10/8/2020 0.00 0.00 0.00 72.96 0.00 0.00 0.00 0.00TECM
50 Sign down due to accident.3000
0.00 0.00 0.00 0.00 91.29 0.00 0.00 0.00Traffic Operations v. Hartford
Insurance
5005311910738
11/2/20205/31/2019 10/9/2020 0.00 0.00 0.00 91.29 0.00 0.00 0.00 0.00TECM
50 Sign hit in median.3000
0.00 0.00 0.00 0.00 211.85 0.00 0.00 0.00Traffic Operations v. State Farm
Insurance
5007302010526
11/2/20207/30/2020 8/6/2020 0.00 0.00 0.00 211.85 0.00 0.00 0.00 0.00TECM
50 Sign down due to accident.3000
-4-
8:33:43AM
1/20/2021
16.E.1.b
Packet Pg. 1057 Attachment: Subrogation Closed Claim Report 1st QTR FY 21 (14813 : Ratification of Claims Files Closed
Collier County Government
Subrogation Closed Claim Report
1st QTR FY 2021
Valued as of:1/20/2021
Total Inc Ind/PD/CollExpense RecoveryMed/BI/Comp Deductible Legal Other
Claim Number Claimant Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Coverage Carrier
Division
Cause
Date of Loss
Accident 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 0.00 562.79 0.00 0.00 0.00Road Maintenance v. Tow Safe5008112010536
11/23/20208/11/2020 8/12/2020 0.00 0.00 0.00 562.79 0.00 0.00 0.00 0.00RMSE
50 Tow company towing Collier
County owned lowboy tractor
and trailer backed into a yellow
safety pole and hit it with the
lowboy trailer (060098)
protecting gate key pad at 415
Sgt. Joe Jones Rd
3000
0.00 0.00 0.00 0.00 14,465.12 0.00 0.00 0.00Traffic Operations v. State Farm5007292004031
12/8/20207/29/2020 8/13/2020 0.00 0.00 0.00 14,465.12 0.00 0.00 0.00 0.00TECM
50 Street light down on Davis Blvd.3000
0.00 0.00 0.00 0.00 507.89 0.00 0.00 0.00Traffic Operations v. State Farm5009082010606
10/20/20209/8/2020 9/10/2020 0.00 0.00 0.00 507.89 0.00 0.00 0.00 0.00TECM
50 Sign down in Median from car
accident.
3000
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00Wastewater Division v . Cougar
Companies
5009222010661
11/19/20209/22/2020 9/23/2020 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00WWTE
50 While installing new storm
drains Cougar Contracting who
was sub-contracted by Wright
Construction Group hit an 8"
Irrigation Quality Main Line at
3307 Thomasson Dr.
2900
10,990.69
10,990.69
344.04
344.04
11,601.02
11,601.02
63,899.79
63,899.79 0.00
0.00 0.00
0.00
0.00
0.00
22,935.75
22,935.75Grand Totals: 22 Claims
-5-
8:33:43AM
1/20/2021
16.E.1.b
Packet Pg. 1058 Attachment: Subrogation Closed Claim Report 1st QTR FY 21 (14813 : Ratification of Claims Files Closed
16.E.1.c
Packet Pg. 1059 Attachment: Resolution 2004-15 PDF0001 (14813 : Ratification of Claims Files Closed By The Risk Management Director for 1st Quarter FY 2021)
16.E.1.c
Packet Pg. 1060 Attachment: Resolution 2004-15 PDF0001 (14813 : Ratification of Claims Files Closed By The Risk Management Director for 1st Quarter FY 2021)
16.E.1.c
Packet Pg. 1061 Attachment: Resolution 2004-15 PDF0001 (14813 : Ratification of Claims Files Closed By The Risk Management Director for 1st Quarter FY 2021)
16.E.1.c
Packet Pg. 1062 Attachment: Resolution 2004-15 PDF0001 (14813 : Ratification of Claims Files Closed By The Risk Management Director for 1st Quarter FY 2021)
16.E.1.c
Packet Pg. 1063 Attachment: Resolution 2004-15 PDF0001 (14813 : Ratification of Claims Files Closed By The Risk Management Director for 1st Quarter FY 2021)
16.E.1.c
Packet Pg. 1064 Attachment: Resolution 2004-15 PDF0001 (14813 : Ratification of Claims Files Closed By The Risk Management Director for 1st Quarter FY 2021)