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Agenda 11/09/2021 Item #16E 3 (Property, Casualty, Worker's Compensation & Subrogation Claims)11/09/2021 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 fourth quarter of FY21. 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 fourth 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 fourth quarter of FY21, 67 files were closed with total expenditures of $245,317.29. Reinsurance recoveries for the fourth quarter of FY21 were $7,204.04. During the same period, 29 subrogation files were closed and the Risk Management Division recovered $90,163.43 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 16.E.3 Packet Pg. 1178 11/09/2021 RECOMMENDATION: That the Board of County Commissioners accepts the attached Settlement Report and ratifies the actions taken therein. PREPARED BY: Jeff Walker CPCU, ARM, Division Director, Risk Management Division. ATTACHMENT(S) 1. All Lines Closed Claim Report 4th QTR FY 2021 (PDF) 2. Subrogation 4th QTR FY 21 Closed Claim Report (PDF) 3. Resolution 2004-15 PDF0001 (PDF) 16.E.3 Packet Pg. 1179 11/09/2021 COLLIER COUNTY Board of County Commissioners Item Number: 16.E.3 Doc ID: 20422 Item Summary: Recommendation to ratify Property, Casualty, Workers’ Compensation and Subrogation claim files settled and/or closed by the Risk Management Division Director pursua nt to Resolution # 2004-15 for the fourth quarter of FY21. Meeting Date: 11/09/2021 Prepared by: Title: Operations Coordinator – Risk Management Name: Greily Gonzalez 10/18/2021 2:05 PM Submitted by: Title: Division Director - Risk Management – Risk Management Name: Jeff Walker 10/18/2021 2:05 PM Approved By: Review: Agenda Clerk Preview Geoffrey Willig Agenda Clerk Preview Completed 10/18/2021 4:15 PM Risk Management Sonja Sweet Additional Reviewer Completed 10/18/2021 4:17 PM Office of Management and Budget Laura Wells Level 3 OMB Gatekeeper Review Completed 10/18/2021 4:28 PM Office of Management and Budget Laura Wells Additional Reviewer Completed 10/18/2021 4:28 PM County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 10/19/2021 8:45 AM County Manager's Office Sean Callahan Level 4 County Manager Review Completed 11/01/2021 11:22 AM Board of County Commissioners Geoffrey Willig Meeting Pending 11/09/2021 9:00 AM 16.E.3 Packet Pg. 1180 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 26,978.86 262.90 735.67 0.00 0.00 0.00 0.00 27,977.43 12/4/2020 12/7/2020 8/31/2021 26,978.86 262.90 735.67 0.00 0.00 0.00 0.00 27,977.43 10 1500 551.85 13.75 0.00 0.00 0.00 0.00 0.00 565.60 7/14/2021 8/13/2021 8/26/2021 551.85 13.75 0.00 0.00 0.00 0.00 0.00 565.60 10 1300 413.84 0.00 0.00 0.00 0.00 0.00 0.00 413.84 9/13/2021 9/15/2021 9/30/2021 413.84 0.00 0.00 0.00 0.00 0.00 0.00 413.84 10 1300 468.33 0.00 0.00 0.00 0.00 0.00 0.00 468.33 8/19/2021 8/19/2021 9/30/2021 468.33 0.00 0.00 0.00 0.00 0.00 0.00 468.33 10 1200 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9/25/2021 9/25/2021 9/30/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10 1500 710.14 125.85 0.00 0.00 0.00 0.00 0.00 835.99 Major Coverage: 10 - Workers' Compensation 1003022111204 DASE Employee was getting dog ready for surgery, when the dog turned his head and bit her left hand pointer finger, towards thumb. 1009252111858 DASE Employee pulled lower back while emptying kiddie pool of water. 1009132111836 CBCE Employee fell while walking to the car after work in parking lot, and had contusion to left foot, and abrasion to right knee. 1008192111771 BPRI Employee was doing an inspection on a two story home, and he was walking downstairs and his foot slipped out from under him but was able to grab the safety rail and did not fall, but felt a twinge in his right shoulder. 1007142111760 BPRI Employee tripped and fell over a rebar at the permit box, and injured back, left pinky finger, left foot & left elbow. Division Carrier Accident Desc. Major Coverage: 10 - Workers' Compensation 1012042010926 Collier County Government Closed Claim Report- All Lines 4th QTR FY 2021 Valued as of:10/14/2021 Claim Number Claimant Name 16.E.3.a Packet Pg. 1181 Attachment: All Lines Closed Claim Report 4th QTR FY 2021 [Revision 1] (20422 : Ratification of Claims 3/2/2021 3/3/2021 8/31/2021 710.14 125.85 0.00 0.00 0.00 0.00 0.00 835.99 10 1200 1,673.87 37.74 0.00 0.00 0.00 0.00 0.00 1,711.61 11/18/2020 11/18/2020 7/19/2021 1,673.87 37.74 0.00 0.00 0.00 0.00 0.00 1,711.61 10 1200 1,117.30 23.80 0.00 0.00 0.00 0.00 0.00 1,141.10 6/28/2021 6/28/2021 7/31/2021 1,117.30 23.80 0.00 0.00 0.00 0.00 0.00 1,141.10 10 1500 393.00 46.60 0.00 0.00 0.00 0.00 0.00 439.60 6/25/2021 6/28/2021 7/26/2021 393.00 46.60 0.00 0.00 0.00 0.00 0.00 439.60 10 1500 311.50 11.90 0.00 0.00 0.00 0.00 0.00 323.40 6/15/2021 6/15/2021 7/22/2021 311.50 11.90 0.00 0.00 0.00 0.00 0.00 323.40 10 1500 668.19 0.00 0.00 0.00 0.00 0.00 0.00 668.19 8/24/2021 8/24/2021 8/31/2021 668.19 0.00 0.00 0.00 0.00 0.00 0.00 668.19 10 1200 1,335.99 35.70 0.00 0.00 0.00 0.00 0.00 1,371.69 6/2/2021 6/2/2021 8/27/2021 1,335.99 35.70 0.00 0.00 0.00 0.00 0.00 1,371.69 10 1500 238.85 20.95 0.00 0.00 0.00 0.00 0.00 259.80 8/3/2021 8/4/2021 8/11/2021 238.85 20.95 0.00 0.00 0.00 0.00 0.00 259.80 10 1900 4,220.96 5.95 0.00 0.00 0.00 0.00 0.00 4,226.91 7/22/2021 7/22/2021 7/31/2021 4,220.96 5.95 0.00 0.00 0.00 0.00 0.00 4,226.91 10 1900 162.35 5.95 0.00 0.00 0.00 0.00 0.00 168.30 7/22/2021 7/22/2021 7/30/2021 162.35 5.95 0.00 0.00 0.00 0.00 0.00 168.30 1007222111679 DASE MHCP Employee was traveling past a crew member blowing sand off the walkway, and caught a piece of dust in right eye. 1007222111673 MHCP Employee was working on an artificial turf fields, and experience symptoms of heat exhaustion. Major Coverage: 10 - Workers' Compensation 1006022111484 DASE Employee injured her ankle while walking a dog. 1008032111719 MHCP Employee was conducting swim lessons for pre-school, and a child jumped directly on right shoulder. 1008242111783 DASE Employee was boxing a cat up to have surgery, when it lunged and bit her on the right wrist, and back of palm. 1006252111582 MHCP Employee went to cut a limb with a machete, and felt a sharp pain in his right elbow. 1006152111534 EMSE Needle stick on right hand thumb after administering medication 1006282111585 MHCP Employee was lifting trash into the dumpster, and felt pain in lower mid back. EMSE Employee was scratched by a patient (Broke the skin) while transferring her to the hospital bed. Patient was covered in urine/feces. 1011182010886 16.E.3.a Packet Pg. 1182 Attachment: All Lines Closed Claim Report 4th QTR FY 2021 [Revision 1] (20422 : Ratification of Claims 10 1900 231.20 13.75 122.28 0.00 0.00 0.00 0.00 367.23 8/21/2021 8/22/2021 9/28/2021 231.20 13.75 122.28 0.00 0.00 0.00 0.00 367.23 10 1500 162.35 0.00 0.00 0.00 0.00 0.00 0.00 162.35 8/8/2021 8/11/2021 9/2/2021 162.35 0.00 0.00 0.00 0.00 0.00 0.00 162.35 10 1500 412.95 40.05 0.00 0.00 0.00 0.00 0.00 453.00 7/12/2021 7/13/2021 7/29/2021 412.95 40.05 0.00 0.00 0.00 0.00 0.00 453.00 10 1500 433.85 25.65 0.00 0.00 0.00 0.00 0.00 459.50 7/23/2021 7/25/2021 7/28/2021 433.85 25.65 0.00 0.00 0.00 0.00 0.00 459.50 10 1500 581.60 0.00 0.00 0.00 0.00 0.00 0.00 581.60 8/11/2021 8/11/2021 8/31/2021 581.60 0.00 0.00 0.00 0.00 0.00 0.00 581.60 10 1,847.75 167.86 0.00 0.00 0.00 0.00 0.00 2,015.61 7/8/2021 7/12/2021 9/14/2021 1,847.75 167.86 0.00 0.00 0.00 0.00 0.00 2,015.61 10 1500 851.32 11.90 0.00 0.00 0.00 0.00 0.00 863.22 8/3/2021 8/4/2021 8/13/2021 851.32 11.90 0.00 0.00 0.00 0.00 0.00 863.22 10 1500 2,223.51 159.10 0.00 0.00 0.00 0.00 0.00 2,382.61 6/10/2021 6/10/2021 7/23/2021 2,223.51 159.10 0.00 0.00 0.00 0.00 0.00 2,382.61 10 1300 RMSE Employee twisted her back while pulling a hose off of the water truck. 1006102111521 RMSE Employee stepped and fell through wooden board on trailer, and injured his knees, shin, upper right thigh and lower left leg abrasion. 1007082111641 PELB Employee reached down to pick up a piece of pipe, and felt pop in right hip and lower back. 1008032111718 EMSE Employee was lifting a patient, and suffered back pain. 1008112111750 FMGE Emploee was working with another employee moving a saw table. When placing the saw table down, the employee's right arm was cut (near elbow) from the table corner. Major Coverage: 10 - Workers' Compensation 1007122111648 MHCP Employee was lifting up tables and felt left shoulder pop. 1007232111688 EMSE Employee tweak his lower back in the car, while performing CPR when a woman husband was having a seizure. 1008082111749 EMSE Employee was walking down the stairs at the patients residence, when stepping down felt a crack with pain in left ankle. Employee was helping to contain a loose cat from a vehicle and a foreign body made its way into her right eye. 1008212111777 16.E.3.a Packet Pg. 1183 Attachment: All Lines Closed Claim Report 4th QTR FY 2021 [Revision 1] (20422 : Ratification of Claims 6,518.07 49.35 819.14 0.00 0.00 0.00 0.00 7,386.56 11/3/2020 4/19/2021 8/31/2021 6,518.07 49.35 819.14 0.00 0.00 0.00 0.00 7,386.56 10 270.30 0.00 0.00 0.00 0.00 0.00 0.00 270.30 8/24/2021 8/24/2021 9/1/2021 270.30 0.00 0.00 0.00 0.00 0.00 0.00 270.30 10 1200 681.57 23.80 0.00 0.00 0.00 0.00 0.00 705.37 7/28/2021 7/29/2021 8/16/2021 681.57 23.80 0.00 0.00 0.00 0.00 0.00 705.37 10 1500 468.10 37.41 0.00 0.00 0.00 0.00 0.00 505.51 7/8/2021 7/8/2021 7/15/2021 468.10 37.41 0.00 0.00 0.00 0.00 0.00 505.51 10 1500 201.00 0.00 0.00 0.00 0.00 0.00 0.00 201.00 9/15/2021 9/16/2021 9/27/2021 201.00 0.00 0.00 0.00 0.00 0.00 0.00 201.00 10 1900 348.50 11.90 0.00 0.00 0.00 0.00 0.00 360.40 8/5/2021 8/6/2021 8/23/2021 348.50 11.90 0.00 0.00 0.00 0.00 0.00 360.40 10 1700 359.75 11.90 0.00 0.00 0.00 0.00 0.00 371.65 7/8/2021 7/8/2021 7/16/2021 359.75 11.90 0.00 0.00 0.00 0.00 0.00 371.65 10 1000 1,257.15 23.80 0.00 0.00 0.00 0.00 0.00 1,280.95 7/13/2021 7/13/2021 9/23/2021 1,257.15 23.80 0.00 0.00 0.00 0.00 0.00 1,280.95 10 1400 RMSE Employee was driving a county vehicle, and stopped at light when he was rear ended by a private vehicle. No damage was reported on the vehicle and the employee suffered minor back pain. Employee was struck from behind by another vehicle, and banged left knee on metal pole computer stand. 1007082111630 WWTE Employee was cleaning a transducer out of a lift station when wastewater splashed into face and left eye. 1007132111653 WWTE Employee was collecting samples at the Golden Gate Wastewater Treatment Plant, and was stung by a wasp on her left ankle. Major Coverage: 10 - Workers' Compensation 1008052111728 WWTE 1007082111631 WATE Employee was cutting a pipe and removing valve, when he bent over, a wall of dirt fell on his neck. 1009152111839 WATE Employee was cutting a pipe with a saw, when the blade broke off, it hit left and right thigh. 1007282111703 WATE Employee was digging up a meter box with a shovel, and felt a strain to lower mid back. Major Coverage: 10 - Workers' Compensation 1011032011357 VSCE IEmployee was carrying a box into the office and hooked his right foot on a TV stand in full stride twisting knee. 1008242111785 Employee stepped and fell through wooden board on trailer, and injured his knees, shin, upper right thigh and lower left leg abrasion. 16.E.3.a Packet Pg. 1184 Attachment: All Lines Closed Claim Report 4th QTR FY 2021 [Revision 1] (20422 : Ratification of Claims 56,094.00 1,167.56 1,677.09 0.00 0.00 0.00 0.00 58,938.65 56,094.00 1,167.56 1,677.09 0.00 0.00 0.00 0.00 58,938.65 0.00 0.00 649.00 0.00 0.00 0.00 0.00 649.00 7/1/2021 7/8/2021 7/30/2021 0.00 0.00 649.00 0.00 0.00 0.00 0.00 649.00 22 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 7/11/2021 7/12/2021 7/21/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 21 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2/14/2019 8/21/2020 9/3/2021 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 4/6/2020 6/14/2021 9/17/2021 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 9/12/2021 9/16/2021 9/21/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 22 RMSE Citizen suffered an accident while riding his bike on Estero Parkway. 2209122111841 WILL, DYLAN RMSE Claimant was exiting parking area on the West side of Lakewood Blvd and as he attempted to turn north he crossed over the road and hit the concrete media, which caused damages to the vehicle tires. The Claimant's father, Douglas Smardz 2102141910563 SILBERHORN, MARJEAN RMSE Citizen was walking towards Lely Community Development when she was walking through the grass, and stepped in an unmarked and uncovered drainage/sprinkler hole that was covered by overgrown grass. Citizen broke her right fibula, just above the ankle Major Coverage: 20 - General Liability 2104062011527 GENDRON, GEORGE MHCP While on a field trip counselor, Renee Darroux, was dealing with a child having a tantrum "kicking and screaming." Her personal phone that was on her pocket was damaged. 2107112111640 RAMSDEN, VICKY RMSE Claimant was walking along the sidewalk on Plantation Circle outside of First Lakes Apartments when she tripped on an uneven sidewalk sustaining multiple injuries that includes: a fractured right wrist, spasms on her back, stiffness in right shoulder Employee was driving a county vehicle, and stopped at light when he was rear ended by a private vehicle. No damage was reported on the vehicle and the employee suffered minor back pain. Total by Major Coverage 31 Claims Major Coverage: 20 - General Liability 2207012111632 DARROUX, RENEE 16.E.3.a Packet Pg. 1185 Attachment: All Lines Closed Claim Report 4th QTR FY 2021 [Revision 1] (20422 : Ratification of Claims 0.00 746.73 0.00 0.00 0.00 22,248.05 0.00 22,994.78 11/7/2017 11/15/2017 8/25/2021 0.00 746.73 0.00 0.00 0.00 22,248.05 0.00 22,994.78 21 2050 0.00 746.73 649.00 0.00 0.00 22,248.05 0.00 23,643.78 0.00 746.73 649.00 0.00 0.00 22,248.05 0.00 23,643.78 60,000.00 689.94 0.00 0.00 0.00 13,696.00 0.00 74,385.94 3/30/2017 4/24/2017 9/16/2021 60,000.00 689.94 0.00 0.00 0.00 13,696.00 0.00 74,385.94 31 2450 0.00 0.00 2,371.34 0.00 0.00 0.00 0.00 2,371.34 6/29/2021 6/29/2021 8/12/2021 0.00 0.00 2,371.34 0.00 0.00 0.00 0.00 2,371.34 32 3000 60,000.00 689.94 2,371.34 0.00 0.00 13,696.00 0.00 76,757.28 60,000.00 689.94 2,371.34 0.00 0.00 13,696.00 0.00 76,757.28 384.96 0.00 0.00 0.00 0.00 0.00 0.00 384.96 9/9/2021 9/10/2021 9/16/2021 384.96 0.00 0.00 0.00 0.00 0.00 0.00 384.96 42 0.00 0.00 5,651.31 0.00 0.00 0.00 0.00 5,651.31 3/5/2021 3/5/2021 9/30/2021 0.00 0.00 5,651.31 0.00 0.00 0.00 0.00 5,651.31 41 3000 665.82 0.00 0.00 0.00 0.00 0.00 0.00 665.82 9/10/2021 9/10/2021 9/30/2021 665.82 0.00 0.00 0.00 0.00 0.00 0.00 665.82 42 4209102111826 Public Services PSVE Employee was cleaning back of the truck and placed 2x6 on tool box. 2 x6 fell over and hit back window and broke it. MHCP While driving southbound on Collier Blvd approaching the Shell Island Preserve a small piece of gravel hit the windshield. The gravel left a tiny chip in the glass on the lower center passenger side. Employee went directly to Fleet. 4103052111225 EMS EMSE While leaving the scene Collier County Truck 19 struck Marco Island Fire Truck 50. CMAO Ambulance rolled slowly into the back of landscape truck while sitting at traffic light. No damage found to landscape truck. Total by Major Coverage 2 Claims Major Coverage: 40 - Auto Physical Damage 4209092111824 Parks and Recreation Division 3103301706074 Cruz-Tapia, Jose TECM Employee was traveling east on Davis Blvd. when he failed to observe stopped traffic and struck the claimants vehicle, pushing it into the vehicle in front of the claimants. 4106292111601 Emergency Management Services 2111071707147 VAGNOZZI, ANITA RMSE Claimant was walking by herself going north along the sidewalk in the area of the tennis court when she stepped in a broken sidewalk and fell, hit her head, left side of body and broke her left wrist. Total by Major Coverage 6 Claims Major Coverage: 30 - Auto Liability 16.E.3.a Packet Pg. 1186 Attachment: All Lines Closed Claim Report 4th QTR FY 2021 [Revision 1] (20422 : Ratification of Claims 0.00 0.00 1,726.90 0.00 0.00 0.00 0.00 1,726.90 7/15/2020 7/15/2020 8/12/2021 0.00 0.00 1,726.90 0.00 0.00 0.00 0.00 1,726.90 41 3000 0.00 0.00 79.29 0.00 0.00 0.00 0.00 79.29 5/24/2021 5/24/2021 8/22/2021 0.00 0.00 79.29 0.00 0.00 0.00 0.00 79.29 41 3000 0.00 713.80 15,352.58 0.00 0.00 0.00 0.00 16,066.38 1/5/2021 1/5/2021 7/30/2021 0.00 713.80 15,352.58 0.00 0.00 0.00 0.00 16,066.38 41 3000 0.00 0.00 915.36 0.00 0.00 0.00 0.00 915.36 6/21/2021 6/22/2021 9/30/2021 0.00 0.00 915.36 0.00 0.00 0.00 0.00 915.36 41 3000 0.00 0.00 4,337.94 0.00 0.00 0.00 0.00 4,337.94 8/9/2021 8/9/2021 9/15/2021 0.00 0.00 4,337.94 0.00 0.00 0.00 0.00 4,337.94 41 823.58 0.00 0.00 0.00 0.00 0.00 0.00 823.58 9/1/2021 9/7/2021 9/15/2021 823.58 0.00 0.00 0.00 0.00 0.00 0.00 823.58 42 0.00 0.00 962.34 0.00 0.00 0.00 0.00 962.34 7/28/2021 7/28/2021 8/16/2021 0.00 0.00 962.34 0.00 0.00 0.00 0.00 962.34DASE 4209012111820 Pelican Bay Service Division PELB On the way back from dropping off a Bobcat UTV at Bobcat of Ft Meyers a rock got kicked up off the road and hit the windshield cracking it. It was taken strait to Fleet for inspection. Major Coverage: 40 - Auto Physical Damage 4207282111702 Domestic Animal Service WWTE Vehicle CC2-1324 pulled over in front of WW PS 181.00 to allow vehicles behind it to pass from the adjacent round-about; once the vehicles passed, CC2-1324 pulled forward to move further off the roadway and came into contact with a fire hydrant. 4108092111745 Water Division WATE Employee attempted to drive cc2- 1537 around the rear of a landscaping vehicle near 16767 Prato way. He instead struck the front right quarter panel of county vehicle against left rear bumper of landscaping vehicle removing the quarter panel from cc2-1537. Major Coverage: 40 - Auto Physical Damage 4101052111009 Road Maintenance Division RMSE CC2-2168 rear ended a Waste Management Rolloff truck. 4106212111559 Wastewater Division WATE Employee was operating Kubota tractor and struck his assigned work vehicle with it damaging the front bumper of the F450. 4105242111456 Water Division WATE While moving vehicles on job site one County vehicle struck a parked County vehicle. Employee was cleaning back of the truck and placed 2x6 on tool box. 2 x6 fell over and hit back window and broke it. 4107152010462 Water Division 16.E.3.a Packet Pg. 1187 Attachment: All Lines Closed Claim Report 4th QTR FY 2021 [Revision 1] (20422 : Ratification of Claims 40 0.00 0.00 313.68 0.00 0.00 0.00 0.00 313.68 2/24/2021 3/25/2021 8/30/2021 0.00 0.00 313.68 0.00 0.00 0.00 0.00 313.68 41 3000 1,874.36 713.80 29,339.40 0.00 0.00 0.00 0.00 31,927.56 1,874.36 713.80 29,339.40 0.00 0.00 0.00 0.00 31,927.56 355.59 0.00 0.00 0.00 0.00 0.00 0.00 355.59 8/6/2021 8/6/2021 9/17/2021 355.59 0.00 0.00 0.00 0.00 0.00 0.00 355.59 50 2900 1,700.00 0.00 0.00 0.00 0.00 0.00 0.00 1,700.00 3/1/2021 5/17/2021 7/31/2021 1,700.00 0.00 0.00 0.00 0.00 0.00 0.00 1,700.00 50 5900 535.90 0.00 0.00 0.00 0.00 0.00 0.00 535.90 3/3/2021 3/3/2021 7/31/2021 535.90 0.00 0.00 0.00 0.00 0.00 0.00 535.90 53 3000 616.10 0.00 0.00 0.00 0.00 0.00 0.00 616.10 3/8/2021 3/11/2021 7/31/2021 616.10 0.00 0.00 0.00 0.00 0.00 0.00 616.10 53 3000 1,246.46 0.00 0.00 0.00 0.00 0.00 0.00 1,246.46 3/15/2021 3/16/2021 7/31/2021 1,246.46 0.00 0.00 0.00 0.00 0.00 0.00 1,246.46 53 3000 9,955.00 0.00 0.00 0.00 0.00 0.00 0.00 9,955.00 11/11/2020 11/23/2020 7/22/2021 9,955.00 0.00 0.00 0.00 0.00 0.00 0.00 9,955.00 50 5400 0.00 0.00 0.00 7,204.04 0.00 0.00 0.00 0.00 CPPM Awning over cage was ripped during Tropical Storm Eta. 5004012111312 Traffic Operations vs Madison Delgado 5003152111258 Road Maintenance Division RMSE Traffic accident causing damage to a Collier County Guardrail. 5011112010893 Capital Project Planning Division RMSE Traffic accident caused damage to a Collier County guardrail. 5003082111248 Road Maintenance Division RMSE Traffic accident causing damages to a Collier County Guardrail. 5003012111427 Parks and Recreation MHCP Broken exterior window on community center building at Eagle Lakes Community Park. Unknown how the window was broken, suspected vandalism. 5003032111206 Road Maintenance Division Total by Major Coverage 11 Claims Major Coverage: 50 - Property 5008062111737 Facilities Management Division FMGE Roof leak at SOE. Water pouring into building. Damaged floors, drywall, and ceiling tiles. During a vehicle inspection Fleet noticed windshiled damage. The Division that owns the asset is unsured of when the damage happened. 4102242111289 DAS DASE Employee does not know exact time or day incident occurred. Vehicle was parked at approved parking location over weekend. When employee returned to work he noticed the dent in the right rear back back door on the back of the vehicle. 16.E.3.a Packet Pg. 1188 Attachment: All Lines Closed Claim Report 4th QTR FY 2021 [Revision 1] (20422 : Ratification of Claims 4/1/2021 4/1/2021 9/30/2021 0.00 0.00 0.00 7,204.04 0.00 0.00 0.00 0.00 50 3000 1,956.11 0.00 0.00 0.00 0.00 0.00 0.00 1,956.11 6/16/2021 6/17/2021 9/17/2021 1,956.11 0.00 0.00 0.00 0.00 0.00 0.00 1,956.11 50 5900 2,070.39 0.00 0.00 0.00 0.00 0.00 0.00 2,070.39 7/22/2021 8/6/2021 9/17/2021 2,070.39 0.00 0.00 0.00 0.00 0.00 0.00 2,070.39 53 5400 457.34 0.00 0.00 0.00 0.00 0.00 0.00 457.34 6/29/2021 6/29/2021 7/22/2021 457.34 0.00 0.00 0.00 0.00 0.00 0.00 457.34 51 5900 11,263.30 0.00 0.00 0.00 0.00 0.00 0.00 11,263.30 1/28/2021 1/29/2021 8/20/2021 11,263.30 0.00 0.00 0.00 0.00 0.00 0.00 11,263.30 50 3000 0.00 0.00 1,707.24 0.00 0.00 0.00 0.00 1,707.24 6/20/2021 6/21/2021 7/22/2021 0.00 0.00 1,707.24 0.00 0.00 0.00 0.00 1,707.24 52 5500 1,640.00 0.00 0.00 0.00 0.00 0.00 0.00 1,640.00 8/16/2021 8/17/2021 9/23/2021 1,640.00 0.00 0.00 0.00 0.00 0.00 0.00 1,640.00 50 3000 13,629.84 0.00 0.00 0.00 0.00 0.00 0.00 13,629.84 5/12/2021 9/8/2021 9/30/2021 13,629.84 0.00 0.00 0.00 0.00 0.00 0.00 13,629.84 50 5500 A contractor was granted access into administration building (building F) secure parking lot. While pulling through entry the gate came down on the delivery truck 2 times bending the pole twice. Vehicle was not damaged. 5005122111821 Facilities Management Division FMGE Landscaping company came to work and noticed all wires for the irrigation system were cut. FMGE Radio was stolen out of vehicle. Major Coverage: 50 - Property 5008162111768 Facilities Management Division FMGE 5001282111088 Traffic Operations TECM Street light pole down due to vehicle accident. 5006202111555 Facilities Management Division FMGE Lightning hit a flag pole. Lightning shot through the ground and blew out stucco and concrete through the CCSO sign. 5006292111600 Facilities Management Division FMGE Multiple fire alarm trouble signals were going off. Opened the module/control box to inspect, and noticed water dripping on the smoke evac modules. Water leak resulted in fried module. Leak is coming from the awning and roof. Contractor has been called. Major Coverage: 50 - Property 5006162111549 University Extension Services UESE Due to heavy rain the door and windows in the north hallway leaked and water poured into the building near the ground/window frames. 5007222111738 Facilities Management Division TECM Street light down due to car accident. 16.E.3.a Packet Pg. 1189 Attachment: All Lines Closed Claim Report 4th QTR FY 2021 [Revision 1] (20422 : Ratification of Claims 3,073.90 0.00 0.00 0.00 0.00 0.00 0.00 3,073.90 2/24/2021 2/24/2021 7/31/2021 3,073.90 0.00 0.00 0.00 0.00 0.00 0.00 3,073.90 51 3000 1,415.00 0.00 0.00 0.00 0.00 0.00 0.00 1,415.00 4/10/2021 4/12/2021 9/17/2021 1,415.00 0.00 0.00 0.00 0.00 0.00 0.00 1,415.00 50 3000 2,427.85 0.00 0.00 0.00 0.00 0.00 0.00 2,427.85 7/1/2021 7/1/2021 9/28/2021 2,427.85 0.00 0.00 0.00 0.00 0.00 0.00 2,427.85 51 5900 52,342.78 0.00 1,707.24 7,204.04 0.00 0.00 0.00 54,050.02 52,342.78 0.00 1,707.24 7,204.04 0.00 0.00 0.00 54,050.02 170,311.14 3,318.03 35,744.07 7,204.04 0.00 35,944.05 0.00 245,317.29 170,311.14 3,318.03 35,744.07 7,204.04 0.00 35,944.05 0.00 245,317.29Grand Totals: 67 Claims Major Coverage: 50 - Property 5007012111610 Fleet Management Divison FLME Employee was stowing boo on mower cc2-982 when it jerked forward and struck the 2 post lift damaging the hydraulic power unit. No damage to CC2-982 only the list asset # 20022689 Total by Major Coverage 17 Claims WATE The forklift driver was lifting a pump and was too close to the overhead awning. The forklift struck the awning breaking part of the frame and tore the canvas awning. 5004102111329 Paradise Coast Sports Complex COL Patron in can am spider (3 wheel vehicle) stroke a decorative fence and fence broke off the welds. The fence hit the fire riser causing damage to it. Valve and gauge stem broken and water was released. Sergeant Michael Chauncey filed report. Landscaping company came to work and noticed all wires for the irrigation system were cut. 5002242111180 Water Division 16.E.3.a Packet Pg. 1190 Attachment: All Lines Closed Claim Report 4th QTR FY 2021 [Revision 1] (20422 : Ratification of Claims -17- 10/14/2021 9:14:11 AM 16.E.3.a Packet Pg. 1191 Attachment: All Lines Closed Claim Report 4th QTR FY 2021 [Revision 1] (20422 : Ratification of Claims Collier County Government Subrogation Closed Claim Report 4th QTR FY 2021 Valued as of:10/14/2021 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 3,594.25 0.00 0.00 0.00 3,594.25 3,594.25 0.00 0.00Building Plan Review And Inspection Division v. Progressive Insurance 4103052111223 7/31/20213/5/2021 3/5/2021 0.00 3,594.25 0.00 3,594.25 3,594.25 0.00 0.00 0.00BPRI 41 3rd party vehicle disregarded stop sign and hit county vehicle in process of making a left turn. 3000 8,503.22 0.00 0.00 0.00 8,503.22 0.00 0.00 8,503.22Parks and Recreation v. Progressive Insurance 5003262111294 7/31/20213/26/2021 3/26/2021 8,503.22 0.00 0.00 8,503.22 8,503.22 0.00 0.00 0.00MHCP 50 Driver struck parking meter when attempting to maneuver his vehicle to launch his boat at Caxambas Boat Ramp. 3000 893.97 0.00 0.00 0.00 893.97 0.00 0.00 893.97Public Transit & Neighborhood Enhancement Department v. Liberty Mutual 5002162111151 9/24/20212/16/2021 2/16/2021 893.97 0.00 0.00 893.97 893.97 0.00 0.00 0.00PTNE 50 A black vehicle hit a electricity pole in front of the Cat Transfer Station. 3000 0.00 0.00 0.00 0.00 2,131.57 0.00 0.00 0.00Road Maintenance Division v. Argos 5003032111213 8/16/20213/3/2021 3/4/2021 0.00 0.00 0.00 2,131.57 0.00 0.00 0.00 0.00RMSE 50 Traffic accident, cement truck spill and clean up response. 3000 24,614.69 0.00 0.00 0.00 24,614.69 0.00 0.00 24,614.69Road Maintenance Division v. State Farm 5003022111203 7/31/20213/2/2021 3/2/2021 24,614.69 0.00 0.00 24,614.69 24,614.69 0.00 0.00 0.00RMSE 50 Traffic accident caused Irrigation Controller 20 to be completely damaged along with extensive landscape and irrigation damage. 3000 -1- 9:09:45AM 10/14/2021 16.E.3.b Packet Pg. 1192 Attachment: Subrogation 4th QTR FY 21 Closed Claim Report (20422 : Ratification of Claims Files Closed Collier County Government Subrogation Closed Claim Report 4th QTR FY 2021 Valued as of:10/14/2021 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 1,562.28 0.00 0.00 0.00 1,562.28 0.00 0.00 1,562.28Landscape Operations v. State Farm Insurance 5012152011017 7/31/202112/15/2020 1/5/2021 1,562.28 0.00 0.00 1,562.28 1,562.28 0.00 0.00 0.00RMSE 50 Traffic accident causing damage to Collier County landscape. 3000 5,769.85 0.00 0.00 0.00 5,532.85 0.00 0.00 5,769.85Traffic Operations v. Progressive Insurance 5011172010882 7/31/202111/17/2020 11/18/2020 5,769.85 0.00 0.00 5,532.85 5,769.85 0.00 0.00 0.00TECM 50 Pole with camera hit by car accident. 3000 40,219.84 0.00 0.00 0.00 25,000.00 0.00 0.00 40,219.84Traffic Operations v. Geico5004022010220 7/22/20214/2/2020 4/2/2020 40,219.84 0.00 0.00 25,000.00 40,219.84 0.00 0.00 0.00TECM 50 Signal went into flash at 1:05AM techs were paged at 1:47AM Mast arm was hit by car. Mast arm will need to be replaced. 3000 3,694.41 0.00 0.00 0.00 3,013.45 0.00 0.00 3,694.41Traffic Operations v. Progressive Insurance 5005112010332 7/22/20215/11/2020 5/15/2020 3,694.41 0.00 0.00 3,013.45 3,694.41 0.00 0.00 0.00TECM 50 Street light down due to car accident. 3000 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00Wastewater v. Private Contractor 5004112111432 9/28/20214/11/2021 5/18/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00WWTE 50 It appears that gravity main (GM10847 - 12"VCP) was damaged by a directional bore. 5900 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00Water Division vs Francisco Gasparrodas 5004242111793 9/28/20214/24/2021 8/27/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00WATE 54 Customer hit/ran over fire hydrant with vehicle. 3000 -2- 9:09:45AM 10/14/2021 16.E.3.b Packet Pg. 1193 Attachment: Subrogation 4th QTR FY 21 Closed Claim Report (20422 : Ratification of Claims Files Closed Collier County Government Subrogation Closed Claim Report 4th QTR FY 2021 Valued as of:10/14/2021 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 0.00 0.00 0.00 0.00Road Maintenance Division v. Mark Andrew Flanders 5004202111363 9/24/20214/20/2021 4/21/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00RMSE 50 Traffic accident caused guardrail damages. 3000 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00Transportation & Engineering Division vs Diego Ramirez Raymundo 5004292111627 9/24/20214/29/2021 7/7/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00TECM 53 Mast arm hit3000 0.00 0.00 0.00 0.00 6,799.98 0.00 0.00 0.00Road Maintenance Division v. Brinks Inc 5004122111339 8/23/20214/12/2021 4/13/2021 0.00 0.00 0.00 6,799.98 0.00 0.00 0.00 0.00RMSE 53 Traffic accident causing guardrail damage. 3000 0.00 0.00 0.00 0.00 1,823.54 0.00 0.00 0.00Traffic Operations v. Progressive Insurance 5005092111414 9/9/20215/9/2021 5/10/2021 0.00 0.00 0.00 1,823.54 0.00 0.00 0.00 0.00TECM 50 Street light pole was down3000 1,668.32 0.00 0.00 0.00 0.00 0.00 0.00 1,668.32Traffic Operations Division5004292111391 7/22/20214/29/2021 4/29/2021 1,668.32 0.00 0.00 0.00 1,668.32 0.00 0.00 0.00TECM 50 Ped pole and pull box damage due to car accident. 3000 0.00 0.00 0.00 0.00 1,405.35 0.00 0.00 0.00Road Maintenance Division v. National Liability & Fire 5002052111133 8/31/20212/5/2021 2/11/2021 0.00 0.00 0.00 1,405.35 0.00 0.00 0.00 0.00RMSE 50 Overturned dump truck clean up due to a traffic accident . 3000 267.46 0.00 0.00 0.00 198.86 0.00 0.00 267.46Traffic Operations v. Direct General Insurance 5001282111126 7/31/20211/28/2021 2/10/2021 267.46 0.00 0.00 198.86 267.46 0.00 0.00 0.00TECM 50 Sign down due to vehicle accident. 3000 -3- 9:09:45AM 10/14/2021 16.E.3.b Packet Pg. 1194 Attachment: Subrogation 4th QTR FY 21 Closed Claim Report (20422 : Ratification of Claims Files Closed Collier County Government Subrogation Closed Claim Report 4th QTR FY 2021 Valued as of:10/14/2021 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 0.00 0.00 0.00 0.00Landscape Operations v. National General 5006242010729 8/12/20216/24/2020 10/8/2020 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00RMSE 54 Vehicle damaged median plantings in traffic accident . 3000 0.00 0.00 0.00 0.00 189.55 0.00 0.00 0.00Transportation & Engineering Division vs Cynthia Thibodeau 5007242010728 7/13/20217/24/2020 10/7/2020 0.00 0.00 0.00 189.55 0.00 0.00 0.00 0.00TECM 53 Sign down in median3000 2,364.22 0.00 0.00 0.00 2,364.22 0.00 0.00 2,364.22Road Maintenance Division v. Permanent General Insurance 5011052010985 7/31/202111/5/2020 12/29/2020 2,364.22 0.00 0.00 2,364.22 2,364.22 0.00 0.00 0.00RMSE 50 TAR #3267 - Police Rept #20-428778 attached 3000 0.00 0.00 0.00 0.00 1,014.50 0.00 0.00 0.00Marco Island Tax Collector v . Anthony T Buckun 5011162010877 7/14/202111/16/2020 11/17/2020 0.00 0.00 0.00 1,014.50 0.00 0.00 0.00 0.00TXCE 50 Anthony T Buckun backed out of his parking spot and hit the railing on the handicap ramp. He broke the railing and damaged the concrete. He took off from the scene. I contacted MIPD we looked over video footage and found out that it was Anthony . 3000 0.00 0.00 0.00 0.00 815.41 0.00 0.00 0.00Marco Island Tax Collector v . Progressive Insurance 5012152010949 7/13/202112/15/2020 12/16/2020 0.00 0.00 0.00 815.41 0.00 0.00 0.00 0.00TXCE 50 Darlyne Carruthers hit the gas instead of the break, hopped the parking stop and hit our fence. MIPD was contacted. The police report should be ready in 3-4 days. The fence is on BCC property. 3000 -4- 9:09:45AM 10/14/2021 16.E.3.b Packet Pg. 1195 Attachment: Subrogation 4th QTR FY 21 Closed Claim Report (20422 : Ratification of Claims Files Closed Collier County Government Subrogation Closed Claim Report 4th QTR FY 2021 Valued as of:10/14/2021 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 77.49 0.00 0.00 0.00Traffic Operations v. USAA5004072111574 8/31/20214/7/2021 6/25/2021 0.00 0.00 0.00 77.49 0.00 0.00 0.00 0.00TECM 50 Sign damage due to vehicle accident. 3000 0.00 0.00 0.00 0.00 345.43 0.00 0.00 0.00Traffic Operations v. USAA5006122111575 8/11/20216/12/2021 6/25/2021 0.00 0.00 0.00 345.43 0.00 0.00 0.00 0.00TECM 53 Sign damaged due to single vehicle accident. 3000 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00Traffic Operations v. Federated Mutual Insurance Company 5009052010594 9/1/20219/5/2020 9/8/2020 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00TECM 50 Car accident hit street light.3000 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00Traffic Operations v. Allstate5009082010596 8/2/20219/8/2020 9/8/2020 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00TECM 50 Sign hit due to single vehicle accident. 3000 0.00 0.00 0.00 0.00 282.82 0.00 0.00 0.00Transportation & Engineering Division vs Geico 5006202111701 8/19/20216/20/2021 7/28/2021 0.00 0.00 0.00 282.82 0.00 0.00 0.00 0.00TECM 53 Signs down due to car accident3000 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00Traffic Operations v. Ally Insurance 5006012111483 7/26/20216/1/2021 6/2/2021 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00TECM 50 Car accident hit street pole number 129 also pull box cover damage. 3000 89,558.26 89,558.26 0.00 0.00 3,594.25 3,594.25 90,163.43 90,163.43 0.00 0.00 0.00 0.00 0.00 0.00 93,152.51 93,152.51Grand Totals: 29 Claims -5- 9:09:45AM 10/14/2021 16.E.3.b Packet Pg. 1196 Attachment: Subrogation 4th QTR FY 21 Closed Claim Report (20422 : Ratification of Claims Files Closed 16.E.3.c Packet Pg. 1197 Attachment: Resolution 2004-15 PDF0001 (20422 : Ratification of Claims Files Closed By The Risk Management Division) 16.E.3.c Packet Pg. 1198 Attachment: Resolution 2004-15 PDF0001 (20422 : Ratification of Claims Files Closed By The Risk Management Division) 16.E.3.c Packet Pg. 1199 Attachment: Resolution 2004-15 PDF0001 (20422 : Ratification of Claims Files Closed By The Risk Management Division) 16.E.3.c Packet Pg. 1200 Attachment: Resolution 2004-15 PDF0001 (20422 : Ratification of Claims Files Closed By The Risk Management Division) 16.E.3.c Packet Pg. 1201 Attachment: Resolution 2004-15 PDF0001 (20422 : Ratification of Claims Files Closed By The Risk Management Division) 16.E.3.c Packet Pg. 1202 Attachment: Resolution 2004-15 PDF0001 (20422 : Ratification of Claims Files Closed By The Risk Management Division)