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Agenda 09/14/2021 Item #16E 5 (Ratify Property, casualty, workers' comp and subrogation claim files09/14/2021 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 third quarter of FY 21. OBJECTIVE: To settle routine, administrative and minor claims matter 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 third quarter of FY 21 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 third quarter of FY 21, 89 files were closed with total expenditures of $220,253.58. There were no reinsurance recoveries. During the same period, 10 subrogation files were closed, and the Risk Management Division recovered $72,883.46 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 acceptance of the Report. -JAK RECOMMENDATION: That the Board of County Commissioners accepts the attached Settlement Report and ratifies the actions taken therein. 16.E.5 Packet Pg. 2669 09/14/2021 PREPARED BY: Jeff Walker CPCU, ARM, Division Director, Risk Management Division. ATTACHMENT(S) 1. All Lines Closed Claims Report 3rd QTR FY 21 (PDF) 2. Subrogation Closed Claim Report 3rd QTR FY 21 pdf (PDF) 3. Resolution 2004-15 PDF0001 (PDF) 16.E.5 Packet Pg. 2670 09/14/2021 COLLIER COUNTY Board of County Commissioners Item Number: 16.E.5 Doc ID: 17558 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 third quarter of FY 21. Meeting Date: 09/14/2021 Prepared by: Title: – Risk Management Name: Heidi Dareus 07/20/2021 4:43 PM Submitted by: Title: Division Director - Risk Management – Risk Management Name: Jeff Walker 07/20/2021 4:43 PM Approved By: Review: Agenda Clerk Preview Michael Cox Agenda Clerk Preview Completed 07/20/2021 5:01 PM Risk Management Jeff Walker Director Review Completed 07/21/2021 8:20 AM Office of Management and Budget Debra Windsor Level 3 OMB Gatekeeper Review Completed 07/21/2021 8:41 AM County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 07/21/2021 1:18 PM Office of Management and Budget Laura Wells Additional Reviewer Completed 07/22/2021 9:25 AM County Manager's Office Sean Callahan Level 4 County Manager Review Completed 09/07/2021 4:15 PM Board of County Commissioners Geoffrey Willig Meeting Pending 09/14/2021 9:00 AM 16.E.5 Packet Pg. 2671 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 Date of Loss Date Report to RiskStatus Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Coverage Cause 2,247.57 55.40 0.00 0.00 0.00 0.00 0.00 2,302.97 1/20/2021 1/20/2021 4/26/2021 2,247.57 55.40 0.00 0.00 0.00 0.00 0.00 2,302.97 10 1200 555.38 26.90 0.00 0.00 0.00 0.00 0.00 582.28 4/5/2021 4/5/2021 4/26/2021 555.38 26.90 0.00 0.00 0.00 0.00 0.00 582.28 10 1200 319.55 0.00 0.00 0.00 0.00 0.00 0.00 319.55 5/22/2021 5/22/2021 5/28/2021 319.55 0.00 0.00 0.00 0.00 0.00 0.00 319.55 10 1500 1,083.64 25.65 0.00 0.00 0.00 0.00 0.00 1,109.29 4/5/2021 4/5/2021 4/12/2021 1,083.64 25.65 0.00 0.00 0.00 0.00 0.00 1,109.29 10 1300 192.95 0.00 0.00 0.00 0.00 0.00 0.00 192.95 5/18/2021 5/18/2021 5/18/2021 192.95 0.00 0.00 0.00 0.00 0.00 0.00 192.95 10 1200 538.71 0.00 0.00 0.00 0.00 0.00 0.00 538.71 5/28/2021 5/28/2021 5/31/2021 538.71 0.00 0.00 0.00 0.00 0.00 0.00 538.71 10 1200 Collier County Government Closed Claim Report- All Lines 3rd QTR FY 2021 Valued as of:7/19/2021 Claim Number Claimant Name Division Carrier Accident Desc. Major Coverage: 10 - Workers' Compensation 1001202111063 BPRI Employee was performing a Site Inspection, when the garage door fell and hit his right hand middle finger. 1004052111316 WWTE Employee cut left hand fifth digit finger on the edge of a piece of polymer, while moving a piece of equipment. 1005222111451 WWTE Employee twisted left ankle when he stepped in a hole. 1004052111319 WATE Employee tripped and fell on a metal pipe, and hit his head working South Reverse Osmosis Well. 1005182111433 WATE Employee was picking up a chain from an equipment trailer when a small sliver of wood lodged into the skin under his right index finger. 1005282111477 WATE Employee was opening a package when knife slipped and cut his finger. 16.E.5.a Packet Pg. 2672 Attachment: All Lines Closed Claims Report 3rd QTR FY 21 (17558 : Ratification of Claim Files Closed by 0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75 6/3/2021 6/3/2021 6/15/2021 0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75 10 1900 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5/24/2021 5/24/2021 6/15/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10 1900 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6/15/2021 6/16/2021 6/16/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10 1000 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6/8/2021 6/9/2021 6/16/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10 1900 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6/27/2021 6/28/2021 6/30/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10 1200 238.85 16.10 0.00 0.00 0.00 0.00 0.00 254.95 11/10/2020 11/12/2020 4/28/2021 238.85 16.10 0.00 0.00 0.00 0.00 0.00 254.95 10 1500 414.80 31.60 0.00 0.00 0.00 0.00 0.00 446.40 4/26/2021 4/26/2021 6/16/2021 414.80 31.60 0.00 0.00 0.00 0.00 0.00 446.40 10 1100 1006032111499 WATE While excavating hole employee complained of chest pains and requested medical attention - EMS responded to the site. 1005242111454 WATE Employee felt chest pains and said he needed help as he was excavating a hole. 1006152111542 WATE Employee was cleaning out lime slaker, and received chemical burns to right elbow and wrist. 1006082111515 WATE Employee developed rash on lower left abdomen, and upper right arm while reading meters. 1006272111581 WATE Employee tripped and fell on a contractor fence, and cut finger. 1011102010839 TXCE Employee was stepping down from a high desk chair, and used the bar on the chair for assistance when her foot slipped and twisted left ankle. 1004262111381 TXCE Employee was leaning on a vehicle speaking to a driver, when a second vehicle approaching from the east struck the car behind him pushing the employee and temporarily pinning him between the vehicles causing him to his his head. 16.E.5.a Packet Pg. 2673 Attachment: All Lines Closed Claims Report 3rd QTR FY 21 (17558 : Ratification of Claim Files Closed by 248.60 0.00 0.00 0.00 0.00 0.00 0.00 248.60 6/3/2021 6/3/2021 6/30/2021 248.60 0.00 0.00 0.00 0.00 0.00 0.00 248.60 10 1300 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6/21/2021 6/21/2021 6/28/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10 1000 7.14 0.00 0.00 0.00 0.00 0.00 0.00 7.14 6/15/2021 6/15/2021 6/24/2021 7.14 0.00 0.00 0.00 0.00 0.00 0.00 7.14 10 1200 486.13 17.85 0.00 0.00 0.00 0.00 0.00 503.98 4/22/2021 4/22/2021 4/30/2021 486.13 17.85 0.00 0.00 0.00 0.00 0.00 503.98 10 1200 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6/28/2021 6/28/2021 6/30/2021 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 5/18/2021 6/4/2021 6/15/2021 0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75 10 1900 3,664.84 49.45 445.07 0.00 0.00 0.00 0.00 4,159.36 3/23/2021 3/24/2021 4/14/2021 3,664.84 49.45 445.07 0.00 0.00 0.00 0.00 4,159.36 10 1700 458.15 33.80 0.00 0.00 0.00 0.00 0.00 491.95 4/19/2021 5/3/2021 5/17/2021 458.15 33.80 0.00 0.00 0.00 0.00 0.00 491.95 10 1200 1006032111500 TXCE Employee tripped on raised bolts that attach hurricane shutters at the employee entrance. 1006212111553 DASE Employee was restraining a dog for sterilization surgery, and came in contact with pepper spray, and forearms are irritated. 1006152111533 DASE Employee was moving dog for surgery and dog jumped out of top kennel. Employee tried to catch dog and upon impact dog bit his left ring finger. 1004222111368 DASE A cat bit a volunteer on left forefinger. 1006282111591 EMSE Employee was standing up from the toilet stall, when he hit his head on an open cabinet door. 1005182111502 EMSE Previous Employee was diagnosed with a brain tumor May 18th, 2021. 1003232111281 EMSE Employee was rear ended by a pick up truck at a traffic light, and is complaining of back, neck and knee pain. She was transported to NCH ER 1004192111396 FLME Employee was working on a mower and scraped left ring finger near edge of fingernail, when reaching in engine compartment to loosen oil filter. 16.E.5.a Packet Pg. 2674 Attachment: All Lines Closed Claims Report 3rd QTR FY 21 (17558 : Ratification of Claim Files Closed by 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6/18/2021 6/21/2021 6/30/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10 1900 452.44 63.64 0.00 0.00 0.00 0.00 0.00 516.08 3/23/2021 3/23/2021 4/26/2021 452.44 63.64 0.00 0.00 0.00 0.00 0.00 516.08 10 1200 14,394.04 1,535.74 322.20 0.00 0.00 0.00 0.00 16,251.98 10/30/2020 10/30/2020 4/26/2021 14,394.04 1,535.74 322.20 0.00 0.00 0.00 0.00 16,251.98 10 1300 979.42 0.00 0.00 0.00 0.00 0.00 0.00 979.42 5/13/2021 5/13/2021 6/30/2021 979.42 0.00 0.00 0.00 0.00 0.00 0.00 979.42 10 1300 238.00 13.75 0.00 0.00 0.00 0.00 0.00 251.75 6/1/2021 6/1/2021 6/30/2021 238.00 13.75 0.00 0.00 0.00 0.00 0.00 251.75 10 1500 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6/8/2021 6/9/2021 6/24/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10 1900 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5/30/2021 6/8/2021 6/14/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10 1900 1006182111551 FMGE Employee left eye got irritated, when he scratched it from a lost bolt at the bottom of a compressor. 1003232111276 FMGE Employee was disposing an AC unit, and cut left 2nd index finger on box cutter. 1010302010803 LIBE Employee fell at the sidewalk pavers leaving the employee entrance area and injured left ankle. 1005132111421 MHCP Employee fell down from the bleachers and scuffed both knees, and complaining of lower back pain. 1006012111480 MHCP Haley was attending an LGI training (lifeguard Instructor) when she went to do a Rear Passive rescue. She went to roll victim onto the rescue tube, and she Quote " twisted wrong" Once staff got her out of the pool she stated she had lower back pains. 1006082111514 MHCP Employee came in contact with fire ants and poison ivy while trimming trees. 1005302111511 MHCP Employee was gathering trash and noticed red circles on back and arm area. 16.E.5.a Packet Pg. 2675 Attachment: All Lines Closed Claims Report 3rd QTR FY 21 (17558 : Ratification of Claim Files Closed by 230.35 13.75 0.00 0.00 0.00 0.00 0.00 244.10 6/1/2021 6/2/2021 6/10/2021 230.35 13.75 0.00 0.00 0.00 0.00 0.00 244.10 10 1300 238.85 11.90 0.00 0.00 0.00 0.00 0.00 250.75 4/15/2021 4/15/2021 4/28/2021 238.85 11.90 0.00 0.00 0.00 0.00 0.00 250.75 10 1200 3,142.89 140.45 0.00 0.00 0.00 0.00 0.00 3,283.34 2/4/2021 2/9/2021 6/18/2021 3,142.89 140.45 0.00 0.00 0.00 0.00 0.00 3,283.34 10 1500 162.35 0.00 0.00 0.00 0.00 0.00 0.00 162.35 3/24/2021 3/29/2021 4/30/2021 162.35 0.00 0.00 0.00 0.00 0.00 0.00 162.35 10 1900 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6/15/2021 6/16/2021 6/28/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10 1200 1006012111489 MHCP Employee was sitting on a bean bag chair in the Immokalee South Park Preschool room, and when she got up to ring bell for the kids to clean, her foot got tangled on iPad charger, causing her to fall on her knees and two hands. 1004152111352 MHCP Vincent was doing maintenance work , power washing next to dog park...using water from the dog park...upon entering the small dog park area to hook up hose...Vincent made several trips in and out the last time on way out he was attacked by dog. 1002042111122 PELB Employee was trimming shrubs and started feeling pain in left upper arm. 1003242111301 PELB Employee is complaining about chest pains, shortness of breath, and pain in both knees and was transported to Physicians Regional for medical treatment. 1006152111541 RMSE Employee was holding brush with left hand and struck his left thumb with machete while cutting the brush. He was wearing all the required PPE at the time. 16.E.5.a Packet Pg. 2676 Attachment: All Lines Closed Claims Report 3rd QTR FY 21 (17558 : Ratification of Claim Files Closed by 646.11 17.85 0.00 0.00 0.00 0.00 0.00 663.96 3/29/2021 3/29/2021 5/13/2021 646.11 17.85 0.00 0.00 0.00 0.00 0.00 663.96 10 1300 404.92 34.60 0.00 0.00 0.00 0.00 0.00 439.52 4/20/2021 4/20/2021 5/13/2021 404.92 34.60 0.00 0.00 0.00 0.00 0.00 439.52 10 1200 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3/15/2021 4/29/2021 4/30/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10 1700 273.70 11.90 0.00 0.00 0.00 0.00 0.00 285.60 4/22/2021 4/23/2021 4/28/2021 273.70 11.90 0.00 0.00 0.00 0.00 0.00 285.60 10 1700 419.65 5.95 0.00 0.00 0.00 0.00 0.00 425.60 5/8/2021 5/8/2021 5/31/2021 419.65 5.95 0.00 0.00 0.00 0.00 0.00 425.60 10 1100 1003292111303 RMSE While climbing out of the back of vehicle, right foot slipped off bumper causing right knee to hit against the bumper. Employee does not request medical attention at this time. 1004202111361 RMSE Mr. Martinez was trimming plants with a gas powered hedge trimmer when he lost grip of the hedge trimmer. When he lost grip with the one hand the hedge trimmer dropped striking him in the middle of his left upper thigh. 1003152111392 RMSE Employee reported to supervisor on April 25th, he climbed up on the Roller CC2-788 and hit his head on the steel top over a month ago and had brain surgery to remove blood from his brain. 1004222111372 RMSE Employees were securing a load to their truck when one of the crew members threw a ratchet strap over the truck, not realizing he was stepping on the slack. The buckle of the strap came back around and struck German H. in the side of the head. 1005082111412 SOWE Employee opened the roll off door, and right hand pinky knuckle area got pinned between the door pin and lever. 16.E.5.a Packet Pg. 2677 Attachment: All Lines Closed Claims Report 3rd QTR FY 21 (17558 : Ratification of Claim Files Closed by 326.60 0.00 0.00 0.00 0.00 0.00 0.00 326.60 5/25/2021 5/25/2021 5/31/2021 326.60 0.00 0.00 0.00 0.00 0.00 0.00 326.60 10 1500 302.60 5.95 0.00 0.00 0.00 0.00 0.00 308.55 5/7/2021 5/7/2021 6/14/2021 302.60 5.95 0.00 0.00 0.00 0.00 0.00 308.55 10 1400 32,668.23 2,139.73 767.27 0.00 0.00 0.00 0.00 35,575.23 32,668.23 2,139.73 767.27 0.00 0.00 0.00 0.00 35,575.23 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5/20/2021 5/20/2021 6/22/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 22 5900 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5/25/2021 5/25/2021 6/30/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 22 5900 0.00 0.00 1,200.87 0.00 0.00 0.00 0.00 1,200.87 3/2/2021 3/2/2021 4/26/2021 0.00 0.00 1,200.87 0.00 0.00 0.00 0.00 1,200.87 22 3000 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3/31/2021 4/1/2021 4/18/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 22 5900 1005252111459 SOWE Employee stepped up into trailer when left foot came down on right foot causing the knee to pop. 1005072111409 TECM Employee was parked at a dead end road, when another driver collided with the front driver side of County vehicle, and injured left wrist. Total by Major Coverage 40 Claims Major Coverage: 20 - General Liability 2205202111441 WENDY, MCKINNEY RMSE Citizens vehicle has rubber like paint damage due to driving over something on the road. 2205252111462 HMC Helicoper Service GMAO "I pulled away from the Bell Ranger III 206 Helicopter, ID# N206VL, with the bonding cable still attached. The cable pulled the stereo plug grounding port sideways and partially out of the right side of the helicopter. 2203022111201 Camden Lakes Homeowners Association WWTE The gate code for the community didn't work so the employee tried to follow another car through the gate and the arm came down on the truck. The gate arm broke off. There was no damage to the truck. 2203312111310 Marshall, Tyrone RMSE Turning on 16th place sw going south and 3rd party vehicle hit a pot hole. 16.E.5.a Packet Pg. 2678 Attachment: All Lines Closed Claims Report 3rd QTR FY 21 (17558 : Ratification of Claim Files Closed by 29,000.00 739.13 0.00 0.00 0.00 14,903.75 0.00 44,642.88 4/15/2018 2/13/2019 6/30/2021 29,000.00 739.13 0.00 0.00 0.00 14,903.75 0.00 44,642.88 21 2050 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5/6/2021 5/10/2021 5/20/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 22 3000 5,000.00 0.00 0.00 0.00 0.00 0.00 0.00 5,000.00 4/29/2020 5/6/2020 4/27/2021 5,000.00 0.00 0.00 0.00 0.00 0.00 0.00 5,000.00 21 2050 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4/26/2021 4/27/2021 5/3/2021 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 6/8/2021 6/9/2021 6/30/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 22 3000 2104151808790 FREY, PATRICIA RMSE Citizen took some type of fall on the sidewalk near the entrance to the Vanderbilt Gulfside Condos. 2205062111415 COTTO, MARISOL RMSE Driving down golden gate parkway in the left lane and ran over a tree branch that was in the road. 2104292010312 TAYLOR, CONNIE MHCP While standing on the boat ramp at Bayview Park, Ms. Taylor slipped when stepping backward and fell into the water. She received 7 stitches in her right knee, got road rash on her left leg and bruised inside the left leg. 2204262111384 Shawn Kingston WWTE Wastewater received an email about a backup at 1 Lanai Cir. County viewed line found roots in county / customer lateral. Dug up lateral and removed roots, installed county cleanout, and repaired line. 2206082111516 Wyndemere Homeowner's Association WATE On call technician was driving vehicle CC2-745 to a call inside the Wyndemere subdivision at 11:15pm on June 8, 2021. The gate arm struck the county vehicle. The gate had no reportable damage caused by our vehicle and our vehicle had no damage. 16.E.5.a Packet Pg. 2679 Attachment: All Lines Closed Claims Report 3rd QTR FY 21 (17558 : Ratification of Claim Files Closed by 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12/15/2020 12/15/2020 5/10/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 22 5900 34,000.00 739.13 1,200.87 0.00 0.00 14,903.75 0.00 50,843.75 34,000.00 739.13 1,200.87 0.00 0.00 14,903.75 0.00 50,843.75 0.00 0.00 858.68 0.00 0.00 0.00 0.00 858.68 4/13/2021 4/13/2021 6/17/2021 0.00 0.00 858.68 0.00 0.00 0.00 0.00 858.68 32 3000 32,000.00 0.00 0.00 0.00 0.00 0.00 0.00 32,000.00 2/28/2020 5/1/2020 4/18/2021 32,000.00 0.00 0.00 0.00 0.00 0.00 0.00 32,000.00 31 3000 1,966.00 0.00 0.00 0.00 0.00 0.00 0.00 1,966.00 9/22/2020 9/22/2020 4/30/2021 1,966.00 0.00 0.00 0.00 0.00 0.00 0.00 1,966.00 31 3000 0.00 0.00 2,124.88 0.00 0.00 0.00 0.00 2,124.88 11/9/2020 11/9/2020 6/17/2021 0.00 0.00 2,124.88 0.00 0.00 0.00 0.00 2,124.88 32 3000 33,966.00 0.00 2,983.56 0.00 0.00 0.00 0.00 36,949.56 33,966.00 0.00 2,983.56 0.00 0.00 0.00 0.00 36,949.56 2212152010945 CRAINE, NATHANIEL WWTE Collier county employee was driving county truck headed SW on Davis Blvd to intersection of Davis and airport pulling Road. When the vehicle behind him beeped and informed him that paint spraying from rear of county truck sprayed onto his vehicle hood. Total by Major Coverage 10 Claims Major Coverage: 30 - Auto Liability 3204132111341 Osselin, Frantzso BPRI Employee was driving between parking spaces and was attempting to back into a parking spot when another driver pulled beside going opposite direction stopped. Another vehicle pulled in behind him and he backed up and made contact with vehicle. 3102282004027 Bonar, Paula WATE Employee was driving a county vehicle and struck the rear end of another vehicle. 3109222004037 Schiller, Matt FLME 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. 3211092004041 Harris, Christopher WATE 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. Total by Major Coverage 4 Claims 16.E.5.a Packet Pg. 2680 Attachment: All Lines Closed Claims Report 3rd QTR FY 21 (17558 : Ratification of Claim Files Closed by 805.48 0.00 0.00 0.00 0.00 0.00 0.00 805.48 4/9/2021 4/12/2021 6/17/2021 805.48 0.00 0.00 0.00 0.00 0.00 0.00 805.48 42 5900 508.63 0.00 0.00 0.00 0.00 0.00 0.00 508.63 3/29/2021 3/30/2021 4/8/2021 508.63 0.00 0.00 0.00 0.00 0.00 0.00 508.63 42 3200 0.00 0.00 3.96 0.00 0.00 0.00 0.00 3.96 1/16/2021 1/16/2021 5/17/2021 0.00 0.00 3.96 0.00 0.00 0.00 0.00 3.96 41 3000 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1/6/2021 1/7/2021 6/22/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 41 2900 0.00 0.00 1,031.02 0.00 0.00 0.00 0.00 1,031.02 2/25/2021 3/1/2021 4/7/2021 0.00 0.00 1,031.02 0.00 0.00 0.00 0.00 1,031.02 41 3000 0.00 0.00 2,015.91 0.00 0.00 0.00 0.00 2,015.91 1/28/2021 1/29/2021 6/24/2021 0.00 0.00 2,015.91 0.00 0.00 0.00 0.00 2,015.91 41 3000 Major Coverage: 40 - Auto Physical Damage 4204092111328 Building Plan Review And Inspection Division BPRI Vehicle is at fleet now for general maintenance and notified the driver about the crack. Driver is unaware of how it happened. 4203292111304 Building Plan Review And Inspection Division BPRI While in for maintenance at fleet, we were notified of some small chips in the windshield that would eventually become a hazard. Upon advice of Fleet management were are requesting remediation. 4101162111059 EMS EMSE Truck was parked too close to the bay door of the garage and when the door was closed, it hit the front of the ambulance breaking 2- light covers & damaging the track of the garage door - no one was in the vehicle at the time of the incident. 4101062111034 Facilities Management Division FMGE When taking a railing out of his vehicle, Brian Haugrud noted a "ding" was left on his vehicle. 4102252111191 Coastal Zone Management GMAO Vehicle damaged in the Coastal Zone Management equipment storage parking area by Tiger Tail Beach. County staff never witnessed the vehicle being damaged. Discovered damage upon return to vehicle. 4101282111093 Parks and Recreation MHCP Backing out of shop and accidently hit a tree on the right side. 16.E.5.a Packet Pg. 2681 Attachment: All Lines Closed Claims Report 3rd QTR FY 21 (17558 : Ratification of Claim Files Closed by 4,000.00 0.00 0.00 0.00 0.00 0.00 0.00 4,000.00 3/3/2021 3/3/2021 6/24/2021 4,000.00 0.00 0.00 0.00 0.00 0.00 0.00 4,000.00 42 2350 0.00 0.00 2,434.02 0.00 0.00 0.00 0.00 2,434.02 11/13/2020 11/13/2020 5/17/2021 0.00 0.00 2,434.02 0.00 0.00 0.00 0.00 2,434.02 41 3000 0.00 0.00 760.01 0.00 0.00 0.00 0.00 760.01 2/18/2021 2/18/2021 4/7/2021 0.00 0.00 760.01 0.00 0.00 0.00 0.00 760.01 41 3000 0.00 0.00 809.11 0.00 0.00 0.00 0.00 809.11 1/26/2021 1/27/2021 5/6/2021 0.00 0.00 809.11 0.00 0.00 0.00 0.00 809.11 41 3000 0.00 0.00 3,048.11 0.00 0.00 0.00 0.00 3,048.11 5/25/2021 5/26/2021 6/30/2021 0.00 0.00 3,048.11 0.00 0.00 0.00 0.00 3,048.11 41 3000 0.00 0.00 373.80 0.00 0.00 0.00 0.00 373.80 4/15/2021 4/15/2021 6/23/2021 0.00 0.00 373.80 0.00 0.00 0.00 0.00 373.80 41 3000 0.00 0.00 1,657.48 0.00 0.00 0.00 0.00 1,657.48 3/31/2021 3/31/2021 6/17/2021 0.00 0.00 1,657.48 0.00 0.00 0.00 0.00 1,657.48 41 3000 4203032111207 Parks and Recreation MHCP A 4 Wheeler was stolen due to an employee keeping the gate unlocked by accident. 4111132010866 Parks and Recreation MHCP Trailer on rear of vehicle swung back around as vehicle was turning and hit rear of vehicle. 4102182111161 Parks and Recreation MHCP Passenger side of bumper struck a gate post on the way out of maintenance area. 4101262111084 Pelican Bay Services Division PELB While loading a UTV on a trailer the hitch came off the ball and hit the tail gate of CC2-2059 putting a small dent in it. Investigated cause found wrong size ball on truck. 4105252111465 PUD PUAO Collier County Employee Paul Carbone was traveling east bound on Radio Road at 2:15pm when just east of Devonshire Blvd when Leslie's car stopped abruptly before merging and Paul Carbone unable to stop hit the back of her car. 4104152111349 Public Utilities PUAO CC2-864 was discovered damaged due to an unknown incident. 4103312111308 Road Maintenance Division RMSE Passenger side front bumper of county vehicle hit the driver side rear bumper. 16.E.5.a Packet Pg. 2682 Attachment: All Lines Closed Claims Report 3rd QTR FY 21 (17558 : Ratification of Claim Files Closed by 0.00 0.00 667.13 0.00 0.00 0.00 0.00 667.13 4/16/2021 4/20/2021 5/31/2021 0.00 0.00 667.13 0.00 0.00 0.00 0.00 667.13 41 2150 0.00 0.00 3,439.14 0.00 0.00 0.00 0.00 3,439.14 4/14/2021 4/15/2021 5/17/2021 0.00 0.00 3,439.14 0.00 0.00 0.00 0.00 3,439.14 41 3000 0.00 0.00 2,544.03 0.00 0.00 0.00 0.00 2,544.03 1/22/2021 1/22/2021 6/17/2021 0.00 0.00 2,544.03 0.00 0.00 0.00 0.00 2,544.03 41 3000 0.00 0.00 833.32 0.00 0.00 0.00 0.00 833.32 5/25/2021 5/25/2021 6/30/2021 0.00 0.00 833.32 0.00 0.00 0.00 0.00 833.32 41 3000 0.00 0.00 5,461.01 0.00 0.00 0.00 0.00 5,461.01 10/12/2020 10/13/2020 6/22/2021 0.00 0.00 5,461.01 0.00 0.00 0.00 0.00 5,461.01 41 3000 0.00 0.00 517.12 0.00 0.00 0.00 0.00 517.12 11/24/2020 12/1/2020 6/17/2021 0.00 0.00 517.12 0.00 0.00 0.00 0.00 517.12 41 3000 0.00 0.00 251.39 0.00 0.00 0.00 0.00 251.39 12/1/2020 12/1/2020 6/17/2021 0.00 0.00 251.39 0.00 0.00 0.00 0.00 251.39 41 3000 4104162111360 Road Maintenance Division RMSE Dump truck bed raised while trailer attached causing damage to the tow pintle and frame 4104142111348 Road Maintenance Division RMSE Operator found a damage to the front passenger side bumper and front clip of his truck, but did not notice it until late in afternoon when he came back to the Davis facility. He does not know how it happened and thinks was at Airport & Domestic. 4101222111071 Transportation Engineering Division TECM Passenger side of county vehicle hit a pipe while driving. 4105252111458 Water Division WATE Vehicle returned to Fleet with damage to the rear of vehicle. 4110122010741 Water Division WATE Collier County employee attempted to drive in through a residents only gate by tailgating a car. The truck crashed into the gate damaging the County vehicle and destroying the gate. 4111242010911 Water Division WATE Truck taken to Fleet for normal maintenance and due to minor dents on the rear. 4112012010912 Water Division WATE Truck taken to Fleet for normal maintenance and due to minor dents on front. 16.E.5.a Packet Pg. 2683 Attachment: All Lines Closed Claims Report 3rd QTR FY 21 (17558 : Ratification of Claim Files Closed by 0.00 0.00 1,278.59 0.00 0.00 0.00 0.00 1,278.59 4/12/2021 4/12/2021 5/17/2021 0.00 0.00 1,278.59 0.00 0.00 0.00 0.00 1,278.59 41 3000 0.00 0.00 2,242.90 0.00 0.00 0.00 0.00 2,242.90 12/16/2020 12/18/2020 4/7/2021 0.00 0.00 2,242.90 0.00 0.00 0.00 0.00 2,242.90 41 3000 5,314.11 0.00 29,368.05 0.00 0.00 0.00 0.00 34,682.16 5,314.11 0.00 29,368.05 0.00 0.00 0.00 0.00 34,682.16 153.70 0.00 0.00 0.00 0.00 0.00 0.00 153.70 5/26/2021 6/1/2021 6/16/2021 153.70 0.00 0.00 0.00 0.00 0.00 0.00 153.70 50 3000 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11/16/2020 12/9/2020 6/7/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 50 5400 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11/12/2020 11/12/2020 4/30/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 50 5400 720.72 0.00 0.00 0.00 0.00 0.00 0.00 720.72 4/7/2021 4/8/2021 6/24/2021 720.72 0.00 0.00 0.00 0.00 0.00 0.00 720.72 50 3000 564.77 0.00 0.00 0.00 0.00 0.00 0.00 564.77 3/28/2021 3/29/2021 4/30/2021 564.77 0.00 0.00 0.00 0.00 0.00 0.00 564.77 50 2350 4104122111330 Water Division WATE As the light turned green the third party vehicle started to go then suddenly stopped causing the County vehicle to rear end it. 4112162010957 Wastewater Division WWTE CC2-2492 became wedged against a bollard while backing into an oil change bay. Total by Major Coverage 22 Claims Major Coverage: 50 - Property 5005262111481 Traffic Operations EMSE EMS Truck damaged a stop sign while trying to avoid making contact with a motor vehicle. 5011162010932 Library Division (Immokalee Library) LIBE Lost shingles at Immokalee Library due to TS Eta 5011122010859 Library Division (Headquarter Library) LIBE There is a leak coming from a light fixture in the back hallway by the loading dock. A bucket is set up to catch the drip. It was likely caused by storm damage. 5004072111324 Parks and Recreation MHCP Bollard, fencing, bicycle area damage from unknown car accident. 5003282111298 Parks and Recreation (Pelican Bay) MHCP Graffiti on racquetball wall at Pelican Bay. 16.E.5.a Packet Pg. 2684 Attachment: All Lines Closed Claims Report 3rd QTR FY 21 (17558 : Ratification of Claim Files Closed by 5,327.49 0.00 0.00 0.00 0.00 0.00 0.00 5,327.49 11/11/2020 11/12/2020 4/23/2021 5,327.49 0.00 0.00 0.00 0.00 0.00 0.00 5,327.49 50 5400 3,255.00 0.00 0.00 0.00 0.00 0.00 0.00 3,255.00 2/24/2021 3/9/2021 4/23/2021 3,255.00 0.00 0.00 0.00 0.00 0.00 0.00 3,255.00 50 2350 1,245.77 0.00 0.00 0.00 0.00 0.00 0.00 1,245.77 1/13/2021 1/14/2021 6/24/2021 1,245.77 0.00 0.00 0.00 0.00 0.00 0.00 1,245.77 50 3000 0.00 0.00 4,457.51 0.00 0.00 0.00 0.00 4,457.51 9/18/2020 9/23/2020 4/9/2021 0.00 0.00 4,457.51 0.00 0.00 0.00 0.00 4,457.51 50 3000 244.42 0.00 0.00 0.00 0.00 0.00 0.00 244.42 3/9/2021 3/9/2021 4/19/2021 244.42 0.00 0.00 0.00 0.00 0.00 0.00 244.42 50 3000 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5/23/2020 5/27/2020 5/19/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 50 5000 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4/3/2020 4/3/2020 5/10/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 50 5900 11,511.87 0.00 4,457.51 0.00 0.00 0.00 0.00 15,969.38 11,511.87 0.00 4,457.51 0.00 0.00 0.00 0.00 15,969.38 5011112010841 Parks & Recreation Division (Goodland Boat Park) MHCP Top of utility post between slips 8 and 9 at Goodland Boat Park was lost during Tropical Storm Eta. Exposed loose wires; have been wrapped up. 5002242111237 Veterans Park MHCP Tennis courts were vandalized from someone hitting golf balls off the courts ground. 5001132111051 Road Maintenance Division RMSE Guardrail damage from unknown incident. 5009182010659 Solid Waste Division SOWE Employee was preparing C&D material for transportation. A piece of furniture fell out of the container while prepping for transport and struck the windshield of the Bobcat and broke it. 5003092111239 Traffic Operations TECM Pedestrian pole down from an accident. 5005232010364 Building H FMGE Helmer refrigerator lost power, containing various pharmaceuticals and vaccine. Most of the pharmaceutical and vaccine products stored in the refrigerator was substantially damaged. Possible circuit failure. 5004032010228 Facilities Management Division FMGE Broken water line sprayed water all over local equipment (Building K main chiller controller, variable frequency drives, and pumps). Total by Major Coverage 12 Claims 16.E.5.a Packet Pg. 2685 Attachment: All Lines Closed Claims Report 3rd QTR FY 21 (17558 : Ratification of Claim Files Closed by 5,000.00 0.00 0.00 0.00 0.00 41,233.50 0.00 46,233.50 1/6/2020 5/6/2020 5/25/2021 5,000.00 0.00 0.00 0.00 0.00 41,233.50 0.00 46,233.50 65 5,000.00 0.00 0.00 0.00 0.00 41,233.50 0.00 46,233.50 5,000.00 0.00 0.00 0.00 0.00 41,233.50 0.00 46,233.50 122,460.21 2,878.86 38,777.26 0.00 0.00 56,137.25 0.00 220,253.58 122,460.21 2,878.86 38,777.26 0.00 0.00 56,137.25 0.00 220,253.58Grand Totals: 89 Claims -22- 7/19/2021 12:46:00 PM Major Coverage: 60 - Public Officials Errors and Ommissions 6501062010311 Petraitis, Michael RMSE Whistle Blower case, complaint filed for wrongful termination. Total by Major Coverage 1 Claim 16.E.5.a Packet Pg. 2686 Attachment: All Lines Closed Claims Report 3rd QTR FY 21 (17558 : Ratification of Claim Files Closed by Collier County Government Subrogation Closed Claim Report 3rd QTR FY 2021 Valued as of:7/19/2021 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 34,870.42 0.00 0.00 0.00 10,000.00 34,870.42 0.00 0.00EMS v. State Farm Insurance4105302010375 5/24/20215/30/2020 5/30/2020 0.00 34,870.42 0.00 10,000.00 34,870.42 0.00 0.00 0.00EMSE 41 MVA involving EMS Medic 60 Truck 28 - v/s Dark colored SUV - Crew was transporting a patient to the ER, when they crashed into the SUV. Damage to the front bumper of the ambulance with airbag deployment & driver's side damage to SUV 3000 1,280.00 0.00 0.00 0.00 0.00 0.00 0.00 1,280.00Facilities Management Division(Lake Trafford Gate) 5004092111327 5/24/20214/9/2021 4/12/2021 1,280.00 0.00 0.00 0.00 1,280.00 0.00 0.00 0.00FMGE 50 Someone tied open the gates with zip ties, and has pulled up the buried wiring from the ground and cut the connection from gate arms to motor. 2350 0.00 0.00 0.00 0.00 9,854.60 0.00 0.00 0.00Road Maintenance Division v. Continental Divide Insurance 5012022011013 4/30/202112/2/2020 1/5/2021 0.00 0.00 0.00 9,854.60 0.00 0.00 0.00 0.00RMSE 50 Traffic accident causing damage to a Collier County guardrail. 3000 1,068.12 0.00 0.00 0.00 0.00 0.00 0.00 1,068.12Traffic Operations v. Progressive Insurance 5012262010980 5/31/202112/26/2020 12/28/2020 1,068.12 0.00 0.00 0.00 1,068.12 0.00 0.00 0.00TECM 50 Traffic Management Center found a pedestrian signal pole knocked down. 3000 5,344.74 0.00 0.00 0.00 9,295.20 0.00 0.00 5,344.74Traffic Operations v. Hartford Insurance 5009252010671 5/13/20219/25/2020 9/25/2020 5,344.74 0.00 0.00 9,295.20 5,344.74 0.00 0.00 0.00TECM 50 Signal cabinet, Ups cabinet hit due to car accident. 3000 -1- 10:21:01AM 7/19/2021 16.E.5.b Packet Pg. 2687 Attachment: Subrogation Closed Claim Report 3rd QTR FY 21 pdf (17558 : Ratification of Claim Files Collier County Government Subrogation Closed Claim Report 3rd QTR FY 2021 Valued as of:7/19/2021 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 4,921.88 0.00 0.00 0.00Road Maintenance Division v. Progressive Insurance 5010071911219 5/24/202110/7/2019 3/5/2021 0.00 0.00 0.00 4,921.88 0.00 0.00 0.00 0.00RMSE 50 Single vehicle accident causing guardrail damage. 3000 0.00 0.00 0.00 0.00 1,915.90 0.00 0.00 0.00Traffic Operations v. Jose Degollado 5002182010100 5/26/20212/18/2020 2/18/2020 0.00 0.00 0.00 1,915.90 0.00 0.00 0.00 0.00TECM 50 Street light down from crash.3000 0.00 0.00 0.00 0.00 3,937.18 0.00 0.00 0.00Traffic Operations v. Progressive Insurance 5004192111358 5/12/20214/19/2021 4/19/2021 0.00 0.00 0.00 3,937.18 0.00 0.00 0.00 0.00TECM 50 Pedestrian pole down due to single vehicle accident. 3000 0.00 0.00 0.00 0.00 23,121.64 0.00 0.00 0.00Wastewater Division v . Pike Enterprises 5010142010746 5/25/202110/14/2020 10/14/2020 0.00 0.00 0.00 23,121.64 0.00 0.00 0.00 0.00WWTE 50 While performing gravity line maintenance in the MPS 308 basin area, the camera crew located a broken gravity line. FPL pole went through the 8" gravity line. 2150 0.00 0.00 0.00 0.00 9,837.06 0.00 0.00 0.00Traffic Operations v. Ocean Harbor Insurance 5011092010825 5/25/202111/9/2020 11/9/2020 0.00 0.00 0.00 9,837.06 0.00 0.00 0.00 0.00TECM 50 Street light crew found street light down on Collier Blvd due to a car accident. 3000 7,692.86 7,692.86 0.00 0.00 34,870.42 34,870.42 72,883.46 72,883.46 0.00 0.00 0.00 0.00 0.00 0.00 42,563.28 42,563.28Grand Totals: 10 Claims -2- 10:21:01AM 7/19/2021 16.E.5.b Packet Pg. 2688 Attachment: Subrogation Closed Claim Report 3rd QTR FY 21 pdf (17558 : Ratification of Claim Files 16.E.5.c Packet Pg. 2689 Attachment: Resolution 2004-15 PDF0001 (17558 : Ratification of Claim Files Closed by the Risk Management Director for Third Quarter FY21) 16.E.5.c Packet Pg. 2690 Attachment: Resolution 2004-15 PDF0001 (17558 : Ratification of Claim Files Closed by the Risk Management Director for Third Quarter FY21) 16.E.5.c Packet Pg. 2691 Attachment: Resolution 2004-15 PDF0001 (17558 : Ratification of Claim Files Closed by the Risk Management Director for Third Quarter FY21) 16.E.5.c Packet Pg. 2692 Attachment: Resolution 2004-15 PDF0001 (17558 : Ratification of Claim Files Closed by the Risk Management Director for Third Quarter FY21) 16.E.5.c Packet Pg. 2693 Attachment: Resolution 2004-15 PDF0001 (17558 : Ratification of Claim Files Closed by the Risk Management Director for Third Quarter FY21) 16.E.5.c Packet Pg. 2694 Attachment: Resolution 2004-15 PDF0001 (17558 : Ratification of Claim Files Closed by the Risk Management Director for Third Quarter FY21)