Agenda 02/13/2018 Item #16E102/13/2018
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 No.
2004-15 for the first quarter of FY 18.
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 evide nce,
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 18
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 18, 137 files were closed with total expenditures of
$212,650.55. During the same period, 24 subrogation files were closed and the Risk Management
Division recovered $127,694 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
Packet Pg. 1317
02/13/2018
Prepared by: Jeff Walker CPCU, ARM, Division Director, Risk Management Division.
ATTACHMENT(S)
1. Resolution 2004-15 PDF0001 (PDF)
2. All Lines Closed Claim Report 1st QTR FY 18 (PDF)
3. Subrogation Closed Claim Report 1st QTR FY 18 (PDF)
16.E.1
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02/13/2018
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.E.1
Doc ID: 4611
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 18.
Meeting Date: 02/13/2018
Prepared by:
Title: Division Director - Risk Management – Risk Management
Name: Jeff Walker
01/19/2018 1:47 PM
Submitted by:
Title: Division Director - Risk Management – Risk Management
Name: Jeff Walker
01/19/2018 1:47 PM
Approved By:
Review:
Administrative Services Department Len Price Level 1 Division Reviewer Completed 01/23/2018 9:33 AM
Administrative Services Department Len Price Level 2 Division Administrator Review Completed 01/23/2018 9:34 AM
County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 01/24/2018 9:05 AM
Office of Management and Budget Valerie Fleming Level 3 OMB Gatekeeper Review Completed 01/24/2018 11:09 AM
Office of Management and Budget Laura Wells Additional Reviewer Completed 01/26/2018 3:52 PM
County Manager's Office Leo E. Ochs Level 4 County Manager Review Completed 01/31/2018 11:29 AM
Board of County Commissioners MaryJo Brock Meeting Pending 02/13/2018 9:00 AM
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16.E.1.a
Packet Pg. 1320 Attachment: Resolution 2004-15 PDF0001 (4611 : Ratification of Closed Claim Report 1st QTR FY 18)
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Packet Pg. 1321 Attachment: Resolution 2004-15 PDF0001 (4611 : Ratification of Closed Claim Report 1st QTR FY 18)
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Packet Pg. 1322 Attachment: Resolution 2004-15 PDF0001 (4611 : Ratification of Closed Claim Report 1st QTR FY 18)
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Packet Pg. 1323 Attachment: Resolution 2004-15 PDF0001 (4611 : Ratification of Closed Claim Report 1st QTR FY 18)
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Packet Pg. 1324 Attachment: Resolution 2004-15 PDF0001 (4611 : Ratification of Closed Claim Report 1st QTR FY 18)
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Packet Pg. 1325 Attachment: Resolution 2004-15 PDF0001 (4611 : Ratification of Closed Claim Report 1st QTR FY 18)
Collier County Government
Closed Claim Report- All Lines
1st QTR FY 2018
Med/BI/Comp Expense Ind/PD/Coll Recovery Deductible Legal Other Total Inc
Claim Number Employee Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Cost Center Date of Loss Date Report to Risk Status Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
Coverage Cause Employer Acc Desc.
Major Coverage: 10 - Workers' Compensation
1009251706582 209.58 28.00 0.00 0.00 0.00 0.00 0.00 237.58
138930 9/25/2017 9/25/2017 12/28/2017 209.58 28.00 0.00 0.00 0.00 0.00 0.00 237.58
10 1300 Employee fell off the office chair when
she was moving towards the phone and
the wheels on the chair got stuck on the
plastic mat on the floor.
1012141707288 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
210153 12/14/2017 12/14/2017 12/28/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1300 Employee slipped on a paperclip when
she returned to her desk.
1012071605667 35,533.79 1,115.30 11,866.37 0.00 0.00 0.00 0.00 48,515.46
155910 12/7/2016 12/7/2016 10/30/2017 35,533.79 1,115.30 11,866.37 0.00 0.00 0.00 0.00 48,515.46
10 1300 Employee reported she fell when
entering door 213 into the Community &
Human Services Department. Her left
arm got caught in the door.
1007241706306 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
108010 7/24/2017 7/25/2017 10/30/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1700 Employee was administering a road test
and the citizens vehicle was struck by
another vehicle.
1007111706282 1,395.53 285.08 0.00 0.00 0.00 0.00 0.00 1,680.61
108010 7/11/2017 7/13/2017 10/30/2017 1,395.53 285.08 0.00 0.00 0.00 0.00 0.00 1,680.61
10 1600 Employee bumped her head on the
underside of a counter after she bent
down to pick up a pencil she dropped.
1
16.E.1.b
Packet Pg. 1326 Attachment: All Lines Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report 1st
1005171706138 1,733.14 3,041.36 0.00 0.00 0.00 0.00 0.00 4,774.50
138915 5/17/2017 5/22/2017 10/30/2017 1,733.14 3,041.36 0.00 0.00 0.00 0.00 0.00 4,774.50
10 1500 Employee injured her back kayaking 2
weeks ago then went to the ER on
5/11/17. Recently, she was at work
when she lifted a 50 pound object and
felt a pop in her lower back.
1010131706984 333.90 42.00 0.00 0.00 0.00 0.00 0.00 375.90
108010 10/13/2017 10/17/2017 12/31/2017 333.90 42.00 0.00 0.00 0.00 0.00 0.00 375.90
10 1400 Employee was out on the road for a
drivers license test, and was rear ended
by a vehicle.
1011071707107 151.20 13.75 0.00 0.00 0.00 0.00 0.00 164.95
138915 11/7/2017 11/7/2017 11/21/2017 151.20 13.75 0.00 0.00 0.00 0.00 0.00 164.95
10 Employee twisted his right ankle while
inspecting a dock off Heron Drive.
1009061706503 1,286.93 28.00 0.00 0.00 0.00 0.00 0.00 1,314.93
138930 9/6/2017 9/19/2017 10/30/2017 1,286.93 28.00 0.00 0.00 0.00 0.00 0.00 1,314.93
10 1600 In prepration for Hurricane IRMA,
employee injured left lower leg while
moving large picninc table at GMD.
1010191706992 242.08 28.00 0.00 0.00 0.00 0.00 0.00 270.08
163620 10/19/2017 10/19/2017 10/31/2017 242.08 28.00 0.00 0.00 0.00 0.00 0.00 270.08
10 1700 Employee was working on re-installing a
perimeter fence when a ladder fell on
him.
1011061707103 341.28 27.75 0.00 0.00 0.00 0.00 0.00 369.03
144610 11/6/2017 11/6/2017 11/14/2017 341.28 27.75 0.00 0.00 0.00 0.00 0.00 369.03
10 Employee twisted back while carrying an
unconsciouls patient down multiple
flights of stairs.
1011121707129 110.70 13.75 0.00 0.00 0.00 0.00 0.00 124.45
144610 11/12/2017 11/13/2017 11/30/2017 110.70 13.75 0.00 0.00 0.00 0.00 0.00 124.45
10 1500 Employee injured his back while lifting a
patient.
2
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Packet Pg. 1327 Attachment: All Lines Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report 1st
1009201706517 151.20 28.00 0.00 0.00 0.00 0.00 0.00 179.20
156332 9/20/2017 9/20/2017 10/30/2017 151.20 28.00 0.00 0.00 0.00 0.00 0.00 179.20
10 1700 Employee was moving a soccer goal.
The goal was stuck and when he moved
it, it came loose and struck him on the
right thigh.
1007211706305 1,297.71 55.75 407.49 0.00 0.00 0.00 0.00 1,760.95
156390 7/21/2017 7/24/2017 12/31/2017 1,297.71 55.75 407.49 0.00 0.00 0.00 0.00 1,760.95
10 1600 Employee bumped her left shin on a
bench.
1007261706314 273.97 56.00 0.00 0.00 0.00 0.00 0.00 329.97
156332 7/26/2017 7/26/2017 10/30/2017 273.97 56.00 0.00 0.00 0.00 0.00 0.00 329.97
10 1700 Employee was struck on the right ankle
by a wooden 6 x 6.
1009271706665 782.92 13.75 0.00 0.00 0.00 0.00 0.00 796.67
156332 9/27/2017 9/27/2017 10/30/2017 782.92 13.75 0.00 0.00 0.00 0.00 0.00 796.67
10 1200 Employee was cut on the right arm by
broken glass.
1009121706460 3,317.56 111.75 0.00 0.00 0.00 0.00 0.00 3,429.31
138915 9/12/2017 9/15/2017 10/30/2017 3,317.56 111.75 0.00 0.00 0.00 0.00 0.00 3,429.31
10 1700 Employee hit a tree going through the
intersection and swereved to miss
another vehicle that ran through the
intersection.
1009061706417 355.98 28.00 0.00 0.00 0.00 0.00 0.00 383.98
163620 9/6/2017 9/6/2017 10/30/2017 355.98 28.00 0.00 0.00 0.00 0.00 0.00 383.98
10 1300 Employee tripped on vines and his chest
area landed on a tree stump.
1012281707337 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
144610 12/28/2017 12/28/2017 12/31/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1500 Employee injured right knee while
exiting the Ambulance.
3
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Packet Pg. 1328 Attachment: All Lines Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report 1st
1012191707320 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
156363 12/19/2017 12/20/2017 12/31/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1200 Employee cut finger moving a parking
meter.
1009111706720 126.00 14.00 0.00 0.00 0.00 0.00 0.00 140.00
144610 9/11/2017 9/29/2017 10/30/2017 126.00 14.00 0.00 0.00 0.00 0.00 0.00 140.00
10 1200 Employee sustained small scratches on
her left arm, which later became
infected, while clearing debris.
1009291706700 CARSON-SMITH, CHRISTINA 166.67 14.00 0.00 0.00 0.00 0.00 0.00 180.67
155410 9/29/2017 9/29/2017 10/30/2017 166.67 14.00 0.00 0.00 0.00 0.00 0.00 180.67
10 1700 Employee had bleach splash into her left
eye.
1011291707196 0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
144610 11/29/2017 11/29/2017 11/30/2017 0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
10 1500 Employee rolled his right ankle while
taking a patient to an ambulance.
1011141707166 72.82 14.00 0.00 0.00 0.00 0.00 0.00 86.82
144610 11/14/2017 11/18/2017 11/30/2017 72.82 14.00 0.00 0.00 0.00 0.00 0.00 86.82
10 1500 Employee injured neck while unloading
a patient from the ambulance.
1011201707185 63.00 0.00 0.00 0.00 0.00 0.00 0.00 63.00
144610 11/20/2017 11/27/2017 12/19/2017 63.00 0.00 0.00 0.00 0.00 0.00 0.00 63.00
10 1500 Employee injured her right wrist while on
duty.
1008141706366 293.61 56.00 0.00 0.00 0.00 0.00 0.00 349.61
155410 8/14/2017 8/14/2017 10/30/2017 293.61 56.00 0.00 0.00 0.00 0.00 0.00 349.61
10 1700 Employee was bit on the left thumb by a
kitten he was trying to vaccinate.
4
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Packet Pg. 1329 Attachment: All Lines Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report 1st
1008041706339 580.57 84.00 0.00 0.00 0.00 0.00 0.00 664.57
163651 8/4/2017 8/4/2017 10/30/2017 580.57 84.00 0.00 0.00 0.00 0.00 0.00 664.57
10 1300 Employee slipped on water in front of an
ice machine and fell to the ground.
1009111706945 361.62 28.00 0.00 0.00 0.00 0.00 0.00 389.62
173410 9/11/2017 10/13/2017 12/19/2017 361.62 28.00 0.00 0.00 0.00 0.00 0.00 389.62
10 1700 Emploee was performing normal
working duties in the field and was stung
by a wasp in the neck area.
1009181706497 1,321.67 70.00 0.00 0.00 0.00 0.00 0.00 1,391.67
182901 9/18/2017 9/19/2017 12/19/2017 1,321.67 70.00 0.00 0.00 0.00 0.00 0.00 1,391.67
10 1700 Employee was cutting a limb with a pole
saw. While instructing a fellow
employee to keep his distance, the limb
fell on Jeovany's mouth & shoulder.
1009251706588 600.60 70.00 0.00 0.00 0.00 0.00 0.00 670.60
210151 9/25/2017 9/25/2017 10/30/2017 600.60 70.00 0.00 0.00 0.00 0.00 0.00 670.60
10 1300 Employee slipped on a bottlecap that
was on the floor near his desk and fell.
1010251707059 315.42 14.00 0.00 0.00 0.00 0.00 0.00 329.42
233351 10/25/2017 10/25/2017 11/21/2017 315.42 14.00 0.00 0.00 0.00 0.00 0.00 329.42
10 Employee strained back while clearing
up Lift Station 134.00.
1010171707006 942.27 42.00 0.00 0.00 0.00 0.00 0.00 984.27
233351 10/17/2017 10/20/2017 12/21/2017 942.27 42.00 0.00 0.00 0.00 0.00 0.00 984.27
10 1500 Employee was installing a pump, and
pulling the pump cable thru a conduit,
when he felt a twinge in his lower back.
1007251706311 244.68 28.00 0.00 0.00 0.00 0.00 0.00 272.68
253211 7/25/2017 7/26/2017 10/30/2017 244.68 28.00 0.00 0.00 0.00 0.00 0.00 272.68
10 1000 Employee had a caustic chemical leak
from a pipe onto his left thigh and right
abdomen.
5
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Packet Pg. 1330 Attachment: All Lines Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report 1st
1007051706256 2,159.91 70.00 0.00 0.00 0.00 0.00 0.00 2,229.91
253211 7/5/2017 7/7/2017 10/30/2017 2,159.91 70.00 0.00 0.00 0.00 0.00 0.00 2,229.91
10 1900 Employee was opening a compression
tank and inhaled chlorine gas.
1009201706542 471.60 42.00 0.00 0.00 0.00 0.00 0.00 513.60
253212 9/20/2017 9/21/2017 10/30/2017 471.60 42.00 0.00 0.00 0.00 0.00 0.00 513.60
10 1200 Employee was removing a tree and
received a scratch on his thumb. The
scratch became infected.
1009131706459 181.25 14.00 0.00 0.00 0.00 0.00 0.00 195.25
253212 9/13/2017 9/15/2017 10/30/2017 181.25 14.00 0.00 0.00 0.00 0.00 0.00 195.25
10 1700 Employee cut his arm while repairing an
RPZ.
1012151707300 0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
253212 12/15/2017 12/15/2017 12/28/2017 0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
10 1100 Employee crushed hand while removing
items from a trailer to a site.
1010301707079 1,075.34 0.00 0.00 0.00 0.00 0.00 0.00 1,075.34
313218 10/30/2017 10/31/2017 12/21/2017 1,075.34 0.00 0.00 0.00 0.00 0.00 0.00 1,075.34
10 1300 Employee was walking in parking garage
after work, and twisted her left foot.
1010161706973 234.17 28.00 0.00 0.00 0.00 0.00 0.00 262.17
PSAE 10/16/2017 10/16/2017 10/31/2017 234.17 28.00 0.00 0.00 0.00 0.00 0.00 262.17
10 1300 Employee fell on the step while coming
through the back door, and twisted her
ankle.
1004031706020 2,289.65 70.00 0.00 0.00 0.00 0.00 0.00 2,359.65
144610 4/3/2017 4/4/2017 11/30/2017 2,289.65 70.00 0.00 0.00 0.00 0.00 0.00 2,359.65
10 1700 Employee accidentally stuck her left
index finger with a used needle.
6
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Packet Pg. 1331 Attachment: All Lines Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report 1st
1012111707276 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
192370 12/11/2017 12/12/2017 12/28/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1300 Employee slipped while attempting to
pull off the cover of the alarm box.
1003041705917 849.99 84.00 0.00 0.00 0.00 0.00 0.00 933.99
144610 3/4/2017 3/5/2017 10/30/2017 849.99 84.00 0.00 0.00 0.00 0.00 0.00 933.99
10 1900 An angry and violent patient spit in
employee's face.
1007071706270 3,871.71 302.71 0.00 0.00 0.00 0.00 0.00 4,174.42
144210 7/7/2017 7/11/2017 10/30/2017 3,871.71 302.71 0.00 0.00 0.00 0.00 0.00 4,174.42
10 1500 Employee strained her back while
cleaning the inside of a Disaster
Response Unit (DRU).
1006271706237 559.85 56.00 0.00 0.00 0.00 0.00 0.00 615.85
156332 6/27/2017 6/30/2017 10/30/2017 559.85 56.00 0.00 0.00 0.00 0.00 0.00 615.85
10 1900 Employee was exposed to contaminated
water and developed a rash on his left
shoulder, left upper anterior chest, and
lower back.
1009271706639 4,572.87 140.00 0.00 0.00 0.00 0.00 0.00 4,712.87
163651 9/27/2017 9/27/2017 12/31/2017 4,572.87 140.00 0.00 0.00 0.00 0.00 0.00 4,712.87
10 1300 Employee lost her footing while stepping
over a guardrail and twisted her ankle,
fell on her back and hip.
1007101706271 4,074.68 42.00 0.00 0.00 0.00 0.00 0.00 4,116.68
156312 7/10/2017 7/11/2017 10/30/2017 4,074.68 42.00 0.00 0.00 0.00 0.00 0.00 4,116.68
10 1600 Employee struck his mouth on the edge
of a desk while bending down and broke
one of his front teeth.
1009071706419 1,338.34 84.00 0.00 0.00 0.00 0.00 0.00 1,422.34
163620 9/7/2017 9/7/2017 12/31/2017 1,338.34 84.00 0.00 0.00 0.00 0.00 0.00 1,422.34
10 1200 Employee walked up to a bay door that
was rolling down and it scratched his
right cheek.
7
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Packet Pg. 1332 Attachment: All Lines Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report 1st
1006271706238 1,962.05 238.00 0.00 0.00 0.00 0.00 0.00 2,200.05
156332 6/27/2017 6/30/2017 11/30/2017 1,962.05 238.00 0.00 0.00 0.00 0.00 0.00 2,200.05
10 1900 Employee was exposed to contaminated
water and developed a rash on his arms,
lower abdomen, and back.
1002091706400 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
144610 2/9/2017 8/30/2017 10/30/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1900 Employee contacted a contagious
disease.
1012111707266 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
138910 12/11/2017 12/11/2017 12/29/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1300 Employee fell from chair and hit the
back of her head.
76,247.81 6,548.45 12,273.86 0.00 0.00 0.00 0.00 95,070.12
Total by Major Coverage 50 Claims 76,247.81 6,548.45 12,273.86 0.00 0.00 0.00 0.00 95,070.12
Major Coverage: 120 - Pollution Liability
1211251707181 Parks & Recreation Division 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
156331 11/25/2017 11/27/2017 11/29/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
120 On November 25th at approx. 10:30
a.m. a neighbor came to tell me that he
thought Antifreeze had been spilled from
the dumpster into the parking lot at
Margood Harbor Park. I went to inspect
and found green liquid in the parking lot.
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Total by Major Coverage 1 Claim 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Major Coverage: 150 - Contingent Law Enforcement Liability
1511301304157 CENATUS, JOSHUA 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
106010 11/30/2013 6/12/2015 11/21/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
150 Claimant allegedly sustained injuries as
a result of the negligence and unlawful
actions of Collier County Sheriff's
officers.
1512191204212 ECKSTEIN, RICHARD 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
106010 12/19/2012 6/24/2015 11/21/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
150 Claimant was rear ended by a Collier
County Sheriff's vehicle on Oil Well
Road.
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Total by Major Coverage 2 Claims 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
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Packet Pg. 1333 Attachment: All Lines Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report 1st
Major Coverage: 20 - General Liability
2108161605592 WEATHERSPOON, MELANIE 11,250.00 0.00 0.00 0.00 0.00 0.00 0.00 11,250.00
000006 8/16/2016 11/7/2016 10/16/2017 11,250.00 0.00 0.00 0.00 0.00 0.00 0.00 11,250.00
21 Claimant alleges she tripped on a raised
paver and fell.
2208041504550 STIMOLO, MARIA 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
000006 8/4/2015 10/27/2015 11/21/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 2450 Notice of claim received from The
Pendas Law firm for damages resulting
from an accident with a CAT bus.
2209101706736 ANDERSON, CHARLES CRAGIN 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
163627 9/10/2017 10/3/2017 12/11/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 5400 Claimant alleges that the hurricane
stormwater which ordinarily would flow
on the north side of the wall at clam pass
eroded his property and damaged the
seawall because the clam pass wall had
been removed for replacement.
2209101707113 FOSTER, VERONICA 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
163627 9/10/2017 11/8/2017 12/1/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 5400 Seawall damage caused by winds from
Hurricane Irma. Seawal is compromised.
2107131605420 MEDINA, EDAMIS 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
163620 7/13/2016 8/24/2016 11/21/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 3100 Claimant alleges he suffered damages
resulting from an accident that was
caused by uneven roads.
2112061605903 JEROME, MARIE 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
138336 12/6/2016 3/1/2017 12/31/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 2200 Claimant alleges she sustained bodily
injuries while at the Collier CAT Station.
9
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Packet Pg. 1334 Attachment: All Lines Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report 1st
2108051706345 LIAS, MAECY 100.00 0.00 0.00 0.00 0.00 0.00 0.00 100.00
156314 8/5/2017 8/5/2017 10/18/2017 100.00 0.00 0.00 0.00 0.00 0.00 0.00 100.00
21 2200 The parents of Maecy lifted her out of
the water, Maecy put her knee down and
said "ow". They noticed an earring on
the ground right where Maecy had put
her knee down. They brought her right to
first aid.
2107111706315 BRIDGES, ROBIN 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
233351 7/11/2017 7/27/2017 11/7/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 2050 Claimant went to her neighbors house
(Mary Dwyer) to help her pick mangoes
from her tree. She alleges she stepped
in a hole, fell backwards, and fractured
her left wrist.
2209141706489 Jason Rummer 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
PUTD 9/14/2017 9/18/2017 10/25/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 2000 Resident at 653 107th Avenue North
alleges that his right front passenger
side tire went flat after hitting a
wastewater lateral clean out that was
protruding above ground near his
driveway. The clean out has been there
for about 1-1/2 months.
2210051706823 ARCHER, KEN 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
210116 10/5/2017 10/6/2017 11/30/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 5300 Claimant alleges that approximately two
weeks ago he started having issues with
his toilets getting clogged. He tried to fix
it until he realized that the problem was
a cracked lined.
2209261706620 Rebecca Erickson 0.00 0.00 225.00 0.00 0.00 0.00 0.00 225.00
122240 9/26/2017 9/26/2017 10/16/2017 0.00 0.00 225.00 0.00 0.00 0.00 0.00 225.00
22 1300 Employee tripped on raised area of
sidewalk and broke her Samsung
Galaxy phone. Would like it her
insurance deductible of $225
reimbursed.
10
16.E.1.b
Packet Pg. 1335 Attachment: All Lines Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report 1st
2209201706539 ABALOS, JOSE 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
210116 9/20/2017 9/21/2017 12/31/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 5400 Claimant alleges that water overflowed
out of the toilets, showers and bathtubs
of his home and got into his floors and
leaked into the guest bedroom
damaging the flooring, baseboards, and
walls. The bathrooms has damaged
vanities.
2112291405241 Encalada, Jose 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
163620 12/29/2014 6/23/2016 12/19/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 2450 Claimant was traveling north on
Corkscrew Road. He alleges several
racoons were crossing the road and he
swerved to the right, then overcorrected,
and the vehicle overturned.
2104151605063 MICHAELSON, HENRY 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
156313 4/15/2016 4/15/2016 11/17/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 2000 Claimant fractured his tibia after coming
down the water slide at the Golden Gate
Community Park.
2102251504005 RUBENSTEIN, SHARON 0.00 36.79 0.00 0.00 0.00 0.00 0.00 36.79
157470 2/25/2015 4/16/2015 10/25/2017 0.00 36.79 0.00 0.00 0.00 0.00 0.00 36.79
21 2050 Claimant allegedly slipped on pods that
fell from a tree in the Marco Island
Museum parking lot and broke her arm.
2209101706805 CAPUTO, JAMES JOSEPH 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
210116 9/10/2017 10/6/2017 10/16/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 5900 Claimant alleges that his bathrooms
flooded due to a sewer backup caused
by a pump failure.
11,350.00 36.79 225.00 0.00 0.00 0.00 0.00 11,611.79
Total by Major Coverage 16 Claims 11,350.00 36.79 225.00 0.00 0.00 0.00 0.00 11,611.79
Major Coverage: 30 - Auto Liability
3209071706474 Summers, Sharon 0.00 0.00 1,779.71 0.00 0.00 0.00 0.00 1,779.71
144610 9/7/2017 9/16/2017 12/31/2017 0.00 0.00 1,779.71 0.00 0.00 0.00 0.00 1,779.71
32 2450 Ambulance west bound on Davis at
Santa Barbara, left straight through lane,
signal light red. Employee began to
accelerate when he noted left turn traffic
moving. He looked down to console just
before striking vehicle in front.
11
16.E.1.b
Packet Pg. 1336 Attachment: All Lines Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report 1st
3205041706100 MILLER, Ben 0.00 0.00 227.07 0.00 0.00 0.00 0.00 227.07
144610 5/4/2017 5/5/2017 11/27/2017 0.00 0.00 227.07 0.00 0.00 0.00 0.00 227.07
32 2000 Patients walker was placed behind the
ambulance, when the door was opened,
the dump cycle started and the rear
passenger side door hit the edge of the
walker breaking the left front wheel.
3209131706485 LAMBERT, KOURTNIE 0.00 55.00 1,563.96 0.00 0.00 0.00 0.00 1,618.96
156332 9/13/2017 9/18/2017 11/20/2017 0.00 55.00 1,563.96 0.00 0.00 0.00 0.00 1,618.96
32 3000 Claimant was sitting at a stop sign at
Euclid Avene & Piper when a Collier
County vehicle that was in front of her
started in reverse and bumped into her
car.
3202111705850 KARAN, DARLENE 0.00 0.00 2,909.33 0.00 0.00 0.00 0.00 2,909.33
144610 2/11/2017 2/11/2017 11/27/2017 0.00 0.00 2,909.33 0.00 0.00 0.00 0.00 2,909.33
32 3000 On Feb. 11 Medic 48 (Truck #1) was
responding to a medical call and drove
just passed the location a couple of feet
and backed up to make the turn inside
the community, however there was
another vehicle behind them that was
not visualized and damaged.
3206141706249 SENESKI, BRIAN 0.00 0.00 692.63 0.00 0.00 0.00 0.00 692.63
155410 6/14/2017 7/5/2017 11/22/2017 0.00 0.00 692.63 0.00 0.00 0.00 0.00 692.63
32 2450 Claimant alleges his vehicle was struck
by a County vehicle. Employee states
he was struck by the claimant.
3209111706499 Perez, Lissette 0.00 0.00 978.34 0.00 0.00 0.00 0.00 978.34
253212 9/11/2017 9/19/2017 10/11/2017 0.00 0.00 978.34 0.00 0.00 0.00 0.00 978.34
32 3000 Anthony Lupo (Maintenance Specialist)
was driving down Rattlesnake Road to
isolate a water main that was flooding
the road when he had to back up due to
debris in the road way. He did not see a
vehicle that had pulled right up to his
bumper & struck it.
12
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Packet Pg. 1337 Attachment: All Lines Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report 1st
3209141706659 Schulze, Barbara 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
156100 9/14/2017 9/27/2017 10/31/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
32 3000 Employee's personal vehicle was
backed into while unoccupied by an
employee operating a County vehicle
(Asset#CC2-869).
0.00 55.00 8,151.04 0.00 0.00 0.00 0.00 8,206.04
Total by Major Coverage 7 Claims 0.00 55.00 8,151.04 0.00 0.00 0.00 0.00 8,206.04
Major Coverage: 40 - Auto Physical Damage
4109111706560 Communication & Customer Relations
Division
0.00 166.65 3,115.00 0.00 0.00 0.00 0.00 3,281.65
100130 9/11/2017 9/22/2017 12/31/2017 0.00 166.65 3,115.00 0.00 0.00 0.00 0.00 3,281.65
41 3000 The morning after the hurricane on my
way to the EOC, I hit a deer on I-75.
4108161706373 Wastewater Division 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
233351 8/16/2017 8/16/2017 12/4/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 3000 Employee was making a turn at Jackson
Ave. & Pine St. when his crane boom
wasn't secure. When he made the turn,
his crane boom hit the street sign,
breaking a cable on his truck CC2-1587.
Millard did not do his walk around his
truck before leaving job.
4207241706303 Domestic Animal Services Division 1,733.18 0.00 0.00 0.00 0.00 0.00 0.00 1,733.18
155410 7/24/2017 7/24/2017 10/19/2017 1,733.18 0.00 0.00 0.00 0.00 0.00 0.00 1,733.18
42 5900 Sometime in the past 6 months to a
year, the front bumper of CC2-344 was
damaged. This vehicle is driven by
many different officers and no one ever
reported the damage or stated how it
occurred.
4204191706091 Facilities Management Division 975.20 0.00 0.00 0.00 0.00 0.00 0.00 975.20
122240 4/19/2017 5/1/2017 12/5/2017 975.20 0.00 0.00 0.00 0.00 0.00 0.00 975.20
42 5900 Dings and dents were spotted on the
passenger side door of the vehicle.
4209101706512 Facilities Management Division 445.71 0.00 0.00 0.00 0.00 0.00 0.00 445.71
122240 9/10/2017 9/20/2017 12/31/2017 445.71 0.00 0.00 0.00 0.00 0.00 0.00 445.71
42 5400 Hurricane Irma. Tree hitting driver's
mirror and cargo trailer blown into back
of van.
13
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Packet Pg. 1338 Attachment: All Lines Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report 1st
4107261706321 Transportation Engineering and
Construction Management Division
0.00 0.00 1,118.21 0.00 0.00 0.00 0.00 1,118.21
163615 7/26/2017 7/28/2017 11/28/2017 0.00 0.00 1,118.21 0.00 0.00 0.00 0.00 1,118.21
41 3000 Rear bumper/ fender damaged by
backing into a parked vehicle on a
construction site.
4209101706482 Code Enforcement Division 508.21 0.00 0.00 0.00 0.00 0.00 0.00 508.21
138911 9/10/2017 9/18/2017 12/6/2017 508.21 0.00 0.00 0.00 0.00 0.00 0.00 508.21
42 5400 Hurricane Irma - Vehicle #CC2-1171
was parked at Cypress Palm Middle
School while employee Eric Short was
working at the shelter. During the
Hurricane Irma event, it is suspected
that a windborne object impacted the
driver side window.
4209101706479 Code Enforcement Division 489.85 0.00 0.00 0.00 0.00 0.00 0.00 489.85
138911 9/10/2017 9/18/2017 12/31/2017 489.85 0.00 0.00 0.00 0.00 0.00 0.00 489.85
42 5400 Hurricane Irma blew off the strobe
casing of the vehicle.
4205101706114 Building Review & Permitting Division 731.89 0.00 0.00 0.00 0.00 0.00 0.00 731.89
138915 5/10/2017 5/12/2017 12/6/2017 731.89 0.00 0.00 0.00 0.00 0.00 0.00 731.89
42 2000 Driving truck when driver heard a pop
and a crack formed on the windshield.
He pulled over and observed a small
rock on the windshield, he called his
supervisor. He then took it to Fleet.
4209101706490 EMS Division 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
144610 9/10/2017 9/18/2017 10/3/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
42 5400 Winds from Hurricane Irma approaching
pushed the side door to the patient
compartment open past its normal
opening width and broke the gas shock
bracket.
4110241707055 Emergency Medical Services 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
144610 10/24/2017 10/24/2017 11/7/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 5900 Tk28 sustained damage to mud flap
while attempting to get to a patient in the
Vineyards.
14
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Packet Pg. 1339 Attachment: All Lines Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report 1st
4209131706475 EMS Division 2,635.17 0.00 0.00 0.00 0.00 0.00 0.00 2,635.17
144610 9/13/2017 9/16/2017 11/30/2017 2,635.17 0.00 0.00 0.00 0.00 0.00 0.00 2,635.17
42 2400 Truck #34 backing while water covered
the road. This resulted in the truck
backing into a drainage ditch beside the
ride.
4207121706276 Parks and Recreation Division 488.28 0.00 0.00 0.00 0.00 0.00 0.00 488.28
156349 7/12/2017 7/12/2017 11/27/2017 488.28 0.00 0.00 0.00 0.00 0.00 0.00 488.28
42 5900 Rolled up driver's side window and was
caught on something on top of door and
glass broke.
4209101706508 Domestic Animal Services Division 885.46 0.00 0.00 0.00 0.00 0.00 0.00 885.46
155410 9/10/2017 9/19/2017 11/30/2017 885.46 0.00 0.00 0.00 0.00 0.00 0.00 885.46
42 5400 Vehicle CC2-1334 sustained damage to
the front windshield during the hurricane.
4106121706192 Parks & Recreation Division 0.00 0.00 1,648.04 0.00 0.00 0.00 0.00 1,648.04
156390 6/12/2017 6/12/2017 12/5/2017 0.00 0.00 1,648.04 0.00 0.00 0.00 0.00 1,648.04
41 3000 Backing out with the lawn mower (Asset
#051103) and struck the County pick up
truck (Asset #CC2-1465) on accident.
4203011706267 EMS 635.60 0.00 0.00 0.00 0.00 0.00 0.00 635.60
144610 3/1/2017 7/10/2017 11/29/2017 635.60 0.00 0.00 0.00 0.00 0.00 0.00 635.60
42 5900 Truck #11 went into Fleet for
preventative maintenance and fleet
personnel found scratches on the right
side of the roof.
4107071706259 EMS 0.00 0.00 4,273.01 0.00 0.00 0.00 0.00 4,273.01
144610 7/7/2017 7/7/2017 12/6/2017 0.00 0.00 4,273.01 0.00 0.00 0.00 0.00 4,273.01
41 2450 Medic 43 / Truck # 43 hit the right side of
a work van.
4208291706394 Fleet Management Division 362.96 0.00 0.00 0.00 0.00 0.00 0.00 362.96
122410 8/29/2017 8/30/2017 11/28/2017 362.96 0.00 0.00 0.00 0.00 0.00 0.00 362.96
42 2000 John Perry was driving asset #CC2-710
northbound on I-75 when a small pebble
was kicked up struck and chipped the
windshield.
15
16.E.1.b
Packet Pg. 1340 Attachment: All Lines Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report 1st
4109141706464 Parks & Recreation Division 0.00 0.00 4,426.90 0.00 0.00 0.00 0.00 4,426.90
156332 9/14/2017 9/15/2017 11/30/2017 0.00 0.00 4,426.90 0.00 0.00 0.00 0.00 4,426.90
41 3000 I was backing up and hit a stump.
4210051707286 Health Department 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
155810 10/5/2017 12/14/2017 12/31/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
42 5900 The door to Asset #060022 was opened
when the wind blew it past the 90 degree
point, damaging the front driver side
panel and hood.
4109291706716 Code Enforcement Division 0.00 0.00 1,138.15 0.00 0.00 0.00 0.00 1,138.15
138911 9/29/2017 9/29/2017 12/31/2017 0.00 0.00 1,138.15 0.00 0.00 0.00 0.00 1,138.15
41 2450 Employee was driving County vehicle
#CC2-121. While executing a left turn
from Airport Road to Corporate Flight Dr.
on a yellow flashing arrow, The County
vehicle was struck in the right rear
bumper by an oncoming third-party
vehicle.
4109131706746 Bureau of Emergency Services Division 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
144210 9/13/2017 10/4/2017 12/31/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 3000 Light trailer bounced off of trailer hitch
and damaged rear door of vehicle.
4103211705981 EMS Division 0.00 0.00 3,187.25 0.00 0.00 0.00 0.00 3,187.25
144610 3/21/2017 3/21/2017 10/31/2017 0.00 0.00 3,187.25 0.00 0.00 0.00 0.00 3,187.25
41 3000 At shift change 3-21-17 at 0700 Truck 6
at station 60 was pulled out of bay by
GNFR Scott Jacobs with the passenger
side transverse slide extended out. The
slide was severely bent, The bay door
track and a closet door were also
damaged.
4210041706943 Domestic Animal Services Division 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
155410 10/4/2017 10/13/2017 12/11/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
42 2150 Officer Bosch was exiting his vehicle
when the door covering the gas tank got
caught on his clothing. As he walked,
the door was damaged.
16
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Packet Pg. 1341 Attachment: All Lines Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report 1st
4209101707016 Traffic Operations Division 995.29 0.00 0.00 0.00 0.00 0.00 0.00 995.29
163630 9/10/2017 10/20/2017 10/31/2017 995.29 0.00 0.00 0.00 0.00 0.00 0.00 995.29
42 5400 Truck was parked during the storm
(Hurricane Irma) branch hit mirror, broke
plastic piece on the out side of mirror.
4203271705997 Transportation Engineering &
Construction Management Division
1,037.15 0.00 0.00 0.00 0.00 0.00 0.00 1,037.15
163630 3/27/2017 3/27/2017 11/28/2017 1,037.15 0.00 0.00 0.00 0.00 0.00 0.00 1,037.15
42 5900 While doing my normal walk through, I
noticed that my left rear quater panel on
my truck was hit by unknown vehicle. I
called my supervisor to inform him my
vehicle was hit while parked.
4105191706136 Traffic Operations Division 0.00 160.05 9,309.50 2,689.00 0.00 0.00 0.00 9,469.55
163630 5/19/2017 5/22/2017 11/30/2017 0.00 160.05 9,309.50 2,689.00 0.00 0.00 0.00 9,469.55
41 2450 Employee was exiting Speedway Gas
Station when he failed to yield the right-
of-way to an oncoming vehicle causing a
collision.
4109151706518 Transportation Engineering Division 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
163651 9/15/2017 9/20/2017 12/31/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 3000 Pulling truck into parking garage on
Horseshoe Drive, had to enter the "out"
lane due to power outage and driver
scraped the bollard with the passenger
side of the vehicle.
4103011705905 Conservation Collier 0.00 0.00 379.40 0.00 0.00 0.00 0.00 379.40
178987 3/1/2017 3/1/2017 12/5/2017 0.00 0.00 379.40 0.00 0.00 0.00 0.00 379.40
41 3000 Trailer came off hitch while loading
gator, popped up and scrached and
dented tailgate of Asset #CC2-1286.
4104211706079 Solid & Hazardous Waste Management
Division
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
210154 4/21/2017 4/25/2017 12/12/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 3000 Utilities Ordinance Education and
Compliance Investigator Chris Alcorn
was involved in a fender bender while
backing CC2-1244 causing minor
damage to the rear bumper.
17
16.E.1.b
Packet Pg. 1342 Attachment: All Lines Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report 1st
4.21109E+12 Public Utilities Engineering & Project
Management Division
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
210155 11/9/2017 11/9/2017 11/16/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
42 Someone broke the passenger window
with a large rock while parked overnight.
Minor interior damage to paneling.
Backpack was stolen with laptop, ipad,
and misc tools/cables.
4106051706176 Wastewater Division 0.00 0.00 2,317.42 0.00 0.00 0.00 0.00 2,317.42
233312 6/5/2017 6/5/2017 12/31/2017 0.00 0.00 2,317.42 0.00 0.00 0.00 0.00 2,317.42
41 3000 Employee was backing up the F-450 and
ran into the #4 pump building.
4209101706435 Wastewater Division 326.74 0.00 0.00 0.00 0.00 0.00 0.00 326.74
233315 9/10/2017 9/13/2017 12/14/2017 326.74 0.00 0.00 0.00 0.00 0.00 0.00 326.74
42 5400 Van parked at NCWRF was struck in
windshield by a roof tile from the Ops
bldg. during Hurricane Irma.
4109121706434 Wastewater Division 0.00 0.00 759.06 0.00 0.00 0.00 0.00 759.06
233315 9/12/2017 9/13/2017 12/31/2017 0.00 0.00 759.06 0.00 0.00 0.00 0.00 759.06
41 2450 Mr. Lawrence Sperling was involved in a
County vehicle accident with CC2-562.
Driving north bound on Airport-Pulling
Road near the intersection of Emerald
Lake Dr. when the vehicle in front of him
suddenly stopped resulting in an
accident.
4209101706730 Wastewater Collections Division 898.36 0.00 0.00 0.00 0.00 0.00 0.00 898.36
233351 9/10/2017 10/3/2017 11/30/2017 898.36 0.00 0.00 0.00 0.00 0.00 0.00 898.36
42 5400 Debris from Hurricane Irma broke the
windshield.
4209051706989 Wastewater Collections Division 627.91 0.00 0.00 0.00 0.00 0.00 0.00 627.91
233351 9/5/2017 10/19/2017 12/11/2017 627.91 0.00 0.00 0.00 0.00 0.00 0.00 627.91
42 2000 Crew was driving down Collier Blvd. past
Verona Walk when a rock struck the
driver's side upper windshield causing a
chip/small crack around it.
18
16.E.1.b
Packet Pg. 1343 Attachment: All Lines Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report 1st
4209101706498 Water Distribution Division 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
253212 9/10/2017 9/19/2017 10/30/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
42 5400 Hurricane Irma damaged vehicle.
4209101706645 United Rental 632.41 0.00 0.00 0.00 0.00 0.00 0.00 632.41
253212 9/10/2017 9/27/2017 11/30/2017 632.41 0.00 0.00 0.00 0.00 0.00 0.00 632.41
42 5400 During Hurricane Irma the windshield on
our rental water truck was broken.
4209101706496 Water Distribution Division 536.90 0.00 0.00 0.00 0.00 0.00 0.00 536.90
253212 9/10/2017 9/19/2017 12/11/2017 536.90 0.00 0.00 0.00 0.00 0.00 0.00 536.90
42 5400 Hurricane Irma damaged vehicle.
4211281707188 Water Distribution Division 22.49 0.00 0.00 0.00 0.00 0.00 0.00 22.49
253212 11/28/2017 11/28/2017 12/31/2017 22.49 0.00 0.00 0.00 0.00 0.00 0.00 22.49
42 2000 Passenger side window was hit by a
rock and has a crack in it. Identified first
thing this morning.
4208281706397 Airport Authority Division 686.56 0.00 0.00 0.00 0.00 0.00 0.00 686.56
192310 8/28/2017 8/30/2017 12/31/2017 686.56 0.00 0.00 0.00 0.00 0.00 0.00 686.56
42 5900 Vehicle was found to have a crack in the
windshield. It is unknown how or when it
happened, it was discovered this past
Monday, August 28, 2017.
4108021706336 Solid & Hazardous Waste Management
Division
0.00 0.00 314.86 0.00 0.00 0.00 0.00 314.86
210130 8/2/2017 8/2/2017 12/31/2017 0.00 0.00 314.86 0.00 0.00 0.00 0.00 314.86
41 5900 Employee was washing vehicle #CC2-
1240 at Fleet Car Wash. He was
spraying off vehicle when water hit
topper window and it shattered.
4209101706633 Growth Management Division 326.48 0.00 0.00 0.00 0.00 0.00 0.00 326.48
163620 9/10/2017 9/26/2017 12/31/2017 326.48 0.00 0.00 0.00 0.00 0.00 0.00 326.48
42 5400 Durring Hurricane Irma the roof vent and
rear top strobe light were ripped off.
19
16.E.1.b
Packet Pg. 1344 Attachment: All Lines Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report 1st
4209101706632 Growth Management Division 494.69 0.00 0.00 0.00 0.00 0.00 0.00 494.69
163620 9/10/2017 9/26/2017 12/31/2017 494.69 0.00 0.00 0.00 0.00 0.00 0.00 494.69
42 5400 During Hurricane Irma the roof vent was
ripped off the trailer.
4209101706630 Road Maintenance Division 567.07 0.00 0.00 0.00 0.00 0.00 0.00 567.07
163620 9/10/2017 9/26/2017 12/31/2017 567.07 0.00 0.00 0.00 0.00 0.00 0.00 567.07
42 5400 During Hurricane Irma, the roof vent was
torn off the trailer.
4209101706625 Growth Management Division 218.17 0.00 0.00 0.00 0.00 0.00 0.00 218.17
163620 9/10/2017 9/26/2017 12/31/2017 218.17 0.00 0.00 0.00 0.00 0.00 0.00 218.17
42 5400 During Hurricane Irma vehicle #CC2-415
had the drivers side front fender, mirror,
and bug shield broken.
4106201706223 Facilities Management Division 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
122240 6/20/2017 6/21/2017 12/31/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 3000 Employee backed #CC2-029 into the
front of Asset #CC2-1541.
4102161705870 Capital Construction and Maintenance
Operations Division
0.00 489.15 30,065.17 0.00 0.00 0.00 0.00 30,554.32
163620 2/16/2017 2/17/2017 11/2/2017 0.00 489.15 30,065.17 0.00 0.00 0.00 0.00 30,554.32
41 3000 County vehicle (060035) in front of
County vehicle #030781 stopped fast
causing a chain reaction involving two
County vehicles.
4101171705761 EMS 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
144610 1/17/2017 1/18/2017 12/8/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 3000 While reponding to medical call, the top
of the antenna on top of the ambulance
struck the outside facing or the Chalet
Building entrance underpass. Slight
damage noted at bottom of the entrance
where possible contact was made.
4205301706157 Transportation Engineering &
Construction Management Division
1,056.90 0.00 0.00 0.00 0.00 0.00 0.00 1,056.90
163630 5/30/2017 5/31/2017 11/27/2017 1,056.90 0.00 0.00 0.00 0.00 0.00 0.00 1,056.90
42 5900 Yesterday while doing a project on St.
Andrews, I went to load up on the truck
when I noticed the tailgate plastic step
was broken. Dont know how it
happened.
20
16.E.1.b
Packet Pg. 1345 Attachment: All Lines Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report 1st
4106011706166 Transportation Engineering &
Construction Management Division
0.00 0.00 730.62 0.00 0.00 0.00 0.00 730.62
163630 6/1/2017 6/2/2017 12/31/2017 0.00 0.00 730.62 0.00 0.00 0.00 0.00 730.62
41 3000 The tailgate was left down on Asset CC2-
968 with the trailer (#020145) attached.
Turned, and trailer struck tailgate.
Cracked plastic on tailgate.
4209271706683 Hazardous Waste Management Division 853.43 0.00 0.00 0.00 0.00 0.00 0.00 853.43
173410 9/27/2017 9/28/2017 11/27/2017 853.43 0.00 0.00 0.00 0.00 0.00 0.00 853.43
42 2000 Flying stone hit windscreen of CC2-1540
as it was being driven by Employee.
4106021706175 BROCK, KEVIN 0.00 0.00 2,139.88 0.00 0.00 0.00 0.00 2,139.88
122240 6/2/2017 6/2/2017 11/27/2017 0.00 0.00 2,139.88 0.00 0.00 0.00 0.00 2,139.88
41 3000 Employee was attempting to turn right
onto Vanderbilt Road from Livingston
Road while looking left and struck the
vehicle in front of him.
19,172.06 815.85 64,922.47 2,689.00 0.00 0.00 0.00 84,910.38
Total by Major Coverage 53 Claims 19,172.06 815.85 64,922.47 2,689.00 0.00 0.00 0.00 84,910.38
Major Coverage: 50 - Property
5303131706027 Traffic Operations Division 7,789.70 0.00 0.00 0.00 0.00 0.00 0.00 7,789.70
163630 3/13/2017 4/5/2017 10/23/2017 7,789.70 0.00 0.00 0.00 0.00 0.00 0.00 7,789.70
53 3000 A vehicle driven by an unknown person
struck and damaged a light pole at
Bayside Street and US41.
5310251707070 Traffic Operations 227.57 0.00 0.00 0.00 0.00 0.00 0.00 227.57
163630 10/25/2017 10/27/2017 12/31/2017 227.57 0.00 0.00 0.00 0.00 0.00 0.00 227.57
53 2400 Employee placed traffic counter in
median for traffic counts. We put it out
for aleast 24 hours to get traffic counts.
When he return the counter was beside
the median on roadway. It looked like a
car ran over it. Unable to find crash
report from SO.
5307311706329 Wastewater Division 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
233351 7/31/2017 7/31/2017 11/14/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
53 5400 Ted Shed at Shirley St. damaged by
Tropical Storm Emily's high winds. Roof
on shed was damaged.
21
16.E.1.b
Packet Pg. 1346 Attachment: All Lines Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report 1st
5208221706379 Distribution 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
253212 8/22/2017 8/23/2017 10/31/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
52 Ran over Asset No. CC2-1007725 Serial
Number 401A002229
Hand held radio that had been left on the
back of truck tail gate.
1204111706039 Airport Authority Division 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
AAUE 4/11/2017 4/12/2017 10/31/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
50 Petroleum Hydrocarbons identified in
geotechnical report; source unknown.
5308281706390 University Extension 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
157110 8/28/2017 8/28/2017 10/30/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
53 Our high tunnel was damaged some
time during the weekend storms - we put
a new top on it last Tuesday and it is
now destroyed. The cover is damaged
and the frame is twisted as well
throughout the entire structure.
5602171705871 Water Division 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
253211 2/17/2017 2/17/2017 10/18/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
56 5900 A break in the top right fender on the
Gator was discovered this morning. The
Gator was sent to fleet yesterday for
maintenance and only this morning was
the damage reported by SP staff.
8,017.27 0.00 0.00 0.00 0.00 0.00 0.00 8,017.27
Total by Major Coverage 7 Claims 8,017.27 0.00 0.00 0.00 0.00 0.00 0.00 8,017.27
Major Coverage: 60 - Public Officials Errors and Ommissions
6709011505044 Holtrey, Scott 3,500.00 1,334.95 0.00 0.00 0.00 0.00 0.00 4,834.95
156332 9/1/2015 4/8/2016 10/11/2017 3,500.00 1,334.95 0.00 0.00 0.00 0.00 0.00 4,834.95
67 Claimant alleges his personal medical
information was not kept confidential.
BCC approved settlement.
22
16.E.1.b
Packet Pg. 1347 Attachment: All Lines Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report 1st
3,500.00 1,334.95 0.00 0.00 0.00 0.00 0.00 4,834.95
Total by Major Coverage 1 Claim 3,500.00 1,334.95 0.00 0.00 0.00 0.00 0.00 4,834.95
118,287.14 8,791.04 85,572.37 2,689.00 0.00 0.00 0.00 212,650.55
Grand Totals: 137 Claims 118,287.14 8,791.04 85,572.37 2,689.00 0.00 0.00 0.00 212,650.55
1/16/2018
2:31:07 PM
23
16.E.1.b
Packet Pg. 1348 Attachment: All Lines Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report 1st
Collier County Government
Subrogation Closed Claim Report
1st QTR FY 2018
Valued as of:1/22/2018
Total Inc Ind/PD/CollExpense RecoveryMed/BI/Comp Deductible Legal Other
Claim Number Employee Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Coverage Carrier
Cost Center
Cause
Date of Loss
Employer Acc Desc.
Date Report to RiskStatus Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
7,826.98 0.00 0.00 0.00 7,831.13 7,826.98 0.00 0.00CC v. Zegarra, Ana ($7,831.13)4101251705786
12/4/20171/25/2017 1/25/2017 0.00 7,826.98 0.00 7,831.13 7,826.98 0.00 0.00 0.00122240
41 A vehicle driven by Ana Zegarra
pulled out in front of County
Asset #CC2-1058.
2450
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00CC v. North Collier Fire
Department
4112121605672
9/25/201712/12/2016 12/12/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00144610
41 Truck #37 was leaving the World
Tennis Center and was at the
light waiting to turn left onto
Airport Road. Fire Truck 47 was
behind our truck and decided to
go into the right lane. When
they switched lanes, the fire
truck hit the back of Truck #37.
2450
0.00 0.00 0.00 0.00 2,930.00 0.00 0.00 0.00CC v. Mitroff, Andrew5306191706219
9/20/20176/19/2017 6/20/2017 0.00 0.00 0.00 2,930.00 0.00 0.00 0.00 0.00156363
53 Andrew Mitroff was traveling
west on Vanderbilt Road and
crossed through the intersection
of Gulfshore Drive without
stopping for the stop sign and
struck the Vanderbilt Beach
baordwalk; broke right handrail,
hit conduit and brick pavers.
3000
0.00 0.00 0.00 0.00 554.92 0.00 0.00 0.00CC v. Sherman, Oswald
($554.92)
4109211605501
10/3/20179/21/2016 9/22/2016 0.00 0.00 0.00 554.92 0.00 0.00 0.00 0.00163624
41 Mark came to a complete stop at
the stop light. The car in front of
him went in reverse and hit the
vehicle he was in. The car went
forward and hit the car in front of
him then went in reverse and hit
Mark again. The police then got
called.
2450
-1-
6:48:42AM
1/22/2018
16.E.1.c
Packet Pg. 1349 Attachment: Subrogation Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report
Collier County Government
Subrogation Closed Claim Report
1st QTR FY 2018
Valued as of:1/22/2018
Total Inc Ind/PD/CollExpense RecoveryMed/BI/Comp Deductible Legal Other
Claim Number Employee Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Coverage Carrier
Cost Center
Cause
Date of Loss
Employer Acc Desc.
Date Report to RiskStatus Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
0.00 0.00 0.00 0.00 3,708.00 0.00 0.00 0.00CC v. One Stop Landscaping
LLC ($3,708.31)
5308301605480
9/6/20178/30/2016 9/14/2016 0.00 0.00 0.00 3,708.00 0.00 0.00 0.00 0.00163630
53 Sonia Valdes was traveling east
on Immokalee Road pulling a
trailer. As she approached a
yellow light, another vehicle
allegedly changed lanes &
stopped in front of her causing
her to slam on her brakes. She
struck crosswalk pole and
railing.
3000
0.00 0.00 0.00 0.00 5,178.45 0.00 0.00 0.00CC v. Deppen, Deanna5305171706164
9/21/20175/17/2017 6/1/2017 0.00 0.00 0.00 5,178.45 0.00 0.00 0.00 0.00163630
53 Deanna Deppen was parked at
Sandy's Cuban Cafe. She
backed the vehicle and struck
the brick flower bed in front of
the establishment then
accidentally hit the gas instead
of the brake striking a light pole.
3000
0.00 0.00 0.00 0.00 4,662.90 0.00 0.00 0.00CC v. Alpire, Hugo ($4,988.22)5305141706162
9/26/20175/14/2017 5/31/2017 0.00 0.00 0.00 4,662.90 0.00 0.00 0.00 0.00163630
53 Alexandra Alpire was traveling
north on Naples Blvd. when she
was involved in a verbal
argument inside the vehicle and
drove up onto to curb and struck
a light pole.
3000
0.00 0.00 0.00 0.00 1,584.20 0.00 0.00 0.00CC v. Dewitts, Bartholomew
($1,821.83)
5306231706320
10/3/20176/23/2017 7/28/2017 0.00 0.00 0.00 1,584.20 0.00 0.00 0.00 0.00163630
53 Bartholomew Dewitts was
making a u-turn when he alleges
another vehicle made a right
turn, causing him to swerve and
strike a stop sign and a light
pole.
3000
-2-
6:48:42AM
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16.E.1.c
Packet Pg. 1350 Attachment: Subrogation Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report
Collier County Government
Subrogation Closed Claim Report
1st QTR FY 2018
Valued as of:1/22/2018
Total Inc Ind/PD/CollExpense RecoveryMed/BI/Comp Deductible Legal Other
Claim Number Employee Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Coverage Carrier
Cost Center
Cause
Date of Loss
Employer Acc Desc.
Date Report to RiskStatus Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
0.00 0.00 0.00 0.00 6,732.81 0.00 0.00 0.00CC v. Betancourt Delgado, Ivette5303271706029
9/21/20173/27/2017 4/6/2017 0.00 0.00 0.00 6,732.81 0.00 0.00 0.00 0.00163630
53 Ivette Betancourt Delgado was
traveling north on County Barn
Road when she traveled to the
right and over the sidewalk
striking a guardrail, a tree, and a
light pole.
3000
0.00 0.00 0.00 0.00 4,344.38 0.00 0.00 0.00CC v. Olson, Jason $4,344.38)5304031706049
10/9/20174/3/2017 4/17/2017 0.00 0.00 0.00 4,344.38 0.00 0.00 0.00 0.00163630
53 Natalie Jo Hughes was turning
left onto Grand Lely Drive,
violating the right-of-way of an
oncoming vehicle, striking that
vehicle and sending it into a
street light pole.
0.00 0.00 0.00 0.00 98.68 0.00 0.00 0.00CC v. Burbage, John ($206.01)5303261706026
12/20/20173/26/2017 4/5/2017 0.00 0.00 0.00 98.68 0.00 0.00 0.00 0.00163630
53 George Bielat was traveling
north on Santa Barbara Blvd.
when he attempted to make a
lane change & struck another
vehicle. This collision caused
the other vehicle to leave the
roadway & strike a stop sign,
street locator sign, fire hydrant,
and a fence.
3000
656.25 0.00 0.00 0.00 656.25 656.25 0.00 0.00CC v. Ryder Truck Rental, Inc.
($656.25)
4208191605409
9/22/20178/19/2016 8/19/2016 0.00 656.25 0.00 656.25 656.25 0.00 0.00 0.00163647
42 Windshield on County vehicle
was cracked as the mulch
delivery truck was unstrapping
the load and the strap struck the
County vehicle.
2000
-3-
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16.E.1.c
Packet Pg. 1351 Attachment: Subrogation Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report
Collier County Government
Subrogation Closed Claim Report
1st QTR FY 2018
Valued as of:1/22/2018
Total Inc Ind/PD/CollExpense RecoveryMed/BI/Comp Deductible Legal Other
Claim Number Employee Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Coverage Carrier
Cost Center
Cause
Date of Loss
Employer Acc Desc.
Date Report to RiskStatus Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00CC v. Florida Safety Contractors,
Inc. ($12,814.50) (CA)
5305131605144
10/3/20175/13/2016 5/17/2016 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00210117
53 Florida Saftey Contractors Inc.
was demo-ing a signal arm base
to meet code and punctured the
12" IQ Raw Line feeding to
Pelican Bay.
0.00 0.00 0.00 0.00 25,869.78 0.00 0.00 0.00CC v. Standard Drilling Inc./Nova
Engineering ($29,552.08) (CA)
5311021605584
10/13/201711/2/2016 11/4/2016 0.00 0.00 0.00 25,869.78 0.00 0.00 0.00 0.00233351
53 Contractor doing a directional
drill hit Collier County"s 14"
forcemain causing damage.
Contractors name: Nova
Engineering @ 1226 Tech Blvd.
Tampa. Phone 954-424-2520 or
954-648-4969
2000
0.00 0.00 0.00 0.00 50,701.26 0.00 0.00 0.00CC v. CAT 5 Construction
($50,917.33)
5308121605389
11/30/20178/12/2016 8/15/2016 0.00 0.00 0.00 50,701.26 0.00 0.00 0.00 0.00233351
53 While boring, Cat 5 Construction
struck the gravity main in two
different spots.
2000
4,100.65 0.00 0.00 0.00 4,211.14 4,100.65 0.00 0.00CC v. Patterson, Shannon4109261707023
12/31/20179/26/2017 10/23/2017 0.00 4,100.65 0.00 4,211.14 4,100.65 0.00 0.00 0.00ORMD
41 County vehicle CC2-1084 was
rear ended at the fault of the
other driver.
3000
0.00 0.00 0.00 0.00 145.60 0.00 0.00 0.00CC v. Clairfeus, Severe
($145.60)
5905221403304
9/25/20175/22/2014 6/4/2014 0.00 0.00 0.00 145.60 0.00 0.00 0.00 0.00163620
59 Mr. Severe Clairfeus caused a
roll-over traffic accident and the
Sheriff's office requested County
employees to deliver oil dry to
the scene.
2450
-4-
6:48:42AM
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16.E.1.c
Packet Pg. 1352 Attachment: Subrogation Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report
Collier County Government
Subrogation Closed Claim Report
1st QTR FY 2018
Valued as of:1/22/2018
Total Inc Ind/PD/CollExpense RecoveryMed/BI/Comp Deductible Legal Other
Claim Number Employee Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Coverage Carrier
Cost Center
Cause
Date of Loss
Employer Acc Desc.
Date Report to RiskStatus Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00CC v. Honorat, Jean
($3,805.20)
5303191706075
11/7/20173/19/2017 4/24/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00163620
53 Jean Honorat was traveling
south on Collier Blvd. when she
sharply and drastically steered
left, drove over the raised
median and collided with a
guardrail.
3000
0.00 0.00 0.00 0.00 374.52 0.00 0.00 0.00CC v. Preferred Materials, Inc.5910201707102
11/22/201710/20/2017 11/6/2017 0.00 0.00 0.00 374.52 0.00 0.00 0.00 0.00163620
59 Rock from a Preferred Materials
truck spilled onto the road
requiring clean-up by County
personnel.
3100
0.00 0.00 0.00 0.00 773.18 0.00 0.00 0.00CC v. Palma, Dennis5310101707075
12/20/201710/10/2017 10/30/2017 0.00 0.00 0.00 773.18 0.00 0.00 0.00 0.00163630
53 Dennis Palma was traveling
north on Santa Barbara Blvd.
when another vehicle allegedly
came into his lane causing him
to swerve. He lost control of the
vehicle and struck a street sign,
then a light pole.
3000
0.00 0.00 0.00 0.00 60.19 0.00 0.00 0.00CC v. Viera, Maria ($60.19)5312121605700
10/3/201712/12/2016 12/22/2016 0.00 0.00 0.00 60.19 0.00 0.00 0.00 0.00163630
53 Jorge Caballero-Perez failed to
yield the right-of-way to another
vehicle while traveling west on
Golden Gate Parkway, causing a
collision and striking a stop sign.
3000
0.00 0.00 0.00 0.00 200.48 0.00 0.00 0.00CC v. Mattie, Ronald ($200.48)5312151605697
10/9/201712/15/2016 12/21/2016 0.00 0.00 0.00 200.48 0.00 0.00 0.00 0.00163630
53 It was reported that Ronald
Mattie struck and damaged a
road sign at Vanderbilt Road and
Tiburon Drive.
3000
-5-
6:48:42AM
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16.E.1.c
Packet Pg. 1353 Attachment: Subrogation Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report
Collier County Government
Subrogation Closed Claim Report
1st QTR FY 2018
Valued as of:1/22/2018
Total Inc Ind/PD/CollExpense RecoveryMed/BI/Comp Deductible Legal Other
Claim Number Employee Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Coverage Carrier
Cost Center
Cause
Date of Loss
Employer Acc Desc.
Date Report to RiskStatus Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
0.00 0.00 0.00 0.00 4,352.98 0.00 0.00 0.00CC v. Smith, Stephen5305221706139
10/31/20175/22/2017 5/23/2017 0.00 0.00 0.00 4,352.98 0.00 0.00 0.00 0.00182901
53 Damage to street light caused by
vehicle accident. CCSO case
#17-169773.
3000
0.00 0.00 0.00 0.00 2,723.28 0.00 0.00 0.00CC v. Mirenda, Anthony
($2,723.28)
5312071606483
12/4/201712/7/2016 9/18/2017 0.00 0.00 0.00 2,723.28 0.00 0.00 0.00 0.00253212
53 Anthony Mirenda was traveling
north on Glen Eagle Blvd. when
his right front tire went flat and
caused his vehicle to leave the
roadway, striking a fire hydrant.
3000
0.00
0.00
0.00
0.00
12,583.88
12,583.88
127,694.13
127,694.13 0.00
0.00 0.00
0.00
0.00
0.00
12,583.88
12,583.88Grand Totals: 24 Claims
-6-
6:48:42AM
1/22/2018
16.E.1.c
Packet Pg. 1354 Attachment: Subrogation Closed Claim Report 1st QTR FY 18 (4611 : Ratification of Closed Claim Report