Agenda 11/13/2018 Item #16E 411/13/2018
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 #
2004-15 for the fourth 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 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
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 fourth quarter of FY 18, 131 property and casualty files were closed
with total expenditures of $326,577.06. During the same period, 21 subrogation files were closed, and the
Risk Management Division recovered $127,510.62 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.
Prepared by: Jeff Walker CPCU, ARM, Division Director, Risk Management Division.
16.E.4
Packet Pg. 1884
11/13/2018
ATTACHMENT(S)
1. All Lines Closed Claim Report 4th QTR FY 18 (PDF)
2. Subrogation Close Claim Report 4th QTR FY 18 (PDF)
3. Resolution 2004-15 PDF0001 (PDF)
16.E.4
Packet Pg. 1885
11/13/2018
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.E.4
Doc ID: 7120
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 fourth quarter of FY 18.
Meeting Date: 11/13/2018
Prepared by:
Title: Division Director - Risk Management – Risk Management
Name: Jeff Walker
10/22/2018 9:46 AM
Submitted by:
Title: Division Director - Risk Management – Risk Management
Name: Jeff Walker
10/22/2018 9:46 AM
Approved By:
Review:
Administrative Services Department Paula Brethauer Level 1 Division Reviewer Completed 10/22/2018 2:21 PM
Administrative Services Department Len Price Level 2 Division Administrator Review Completed 10/23/2018 12:08 PM
County Attorney's Office Emily Pepin CAO Preview Completed 10/23/2018 2:09 PM
Office of Management and Budget Valerie Fleming Level 3 OMB Gatekeeper Review Completed 10/23/2018 3:19 PM
Office of Management and Budget Laura Wells Additional Reviewer Completed 10/24/2018 9:52 AM
County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 10/25/2018 9:26 AM
County Manager's Office Nick Casalanguida Level 4 County Manager Review Completed 11/04/2018 3:42 PM
Board of County Commissioners MaryJo Brock Meeting Pending 11/13/2018 9:00 AM
16.E.4
Packet Pg. 1886
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
381.52 50.90 0.00 0.00 0.00 0.00 0.00 432.42
4/9/2018 4/9/2018 7/23/2018 381.52 50.90 0.00 0.00 0.00 0.00 0.00 432.42
10 1500
1,338.22 98.00 0.00 0.00 0.00 0.00 0.00 1,436.22
9/6/2017 9/26/2017 7/24/2018 1,338.22 98.00 0.00 0.00 0.00 0.00 0.00 1,436.22
10 1300
5,256.42 23.39 0.00 0.00 0.00 0.00 0.00 5,279.81
8/9/2018 8/10/2018 8/15/2018 5,256.42 23.39 0.00 0.00 0.00 0.00 0.00 5,279.81
10 1700
1,379.51 23.80 0.00 0.00 0.00 0.00 0.00 1,403.31
5/30/2018 5/30/2018 7/24/2018 1,379.51 23.80 0.00 0.00 0.00 0.00 0.00 1,403.31
10
177.60 42.00 0.00 0.00 0.00 0.00 0.00 219.60
9/5/2017 10/12/2017 7/24/2018 177.60 42.00 0.00 0.00 0.00 0.00 0.00 219.60
10 1900
24,212.63 413.29 12,578.56 0.00 0.00 0.00 0.00 37,204.48
8/9/2017 8/9/2017 7/20/2018 24,212.63 413.29 12,578.56 0.00 0.00 0.00 0.00 37,204.48
10 1300
5,442.80 233.70 0.00 0.00 0.00 0.00 0.00 5,676.50
1/17/2018 2/5/2018 8/21/2018 5,442.80 233.70 0.00 0.00 0.00 0.00 0.00 5,676.50
10 1900
36,822.52 496.10 5,835.92 0.00 0.00 0.00 0.00 43,154.54
8/15/2017 8/15/2017 8/2/2018 36,822.52 496.10 5,835.92 0.00 0.00 0.00 0.00 43,154.54
10 1300 Employee fell off the bumper of a
truck and fell with his right arm
outstretched.
144610
Employee felt discomfort in groin are
while performing training for
revolutions.
1008151706370
233313
1008091706354
156344
Employee slipped and fell while
playing games with the Summer
Camp children.
1001171807478
163630
Employee was drilling out a stuck
bolt when the drill bit broke and went
into his right hand.
1009051706897
163620
Employee came in contact with
poison ivy while cutting trees down.
1008091808199
253214
Employee was struck with a pipe
wrench while pulling a well.
1005301808001
253215
Employee injured right ankle while
investigating meter box at customer
home.
1009061706609
233315
Employee tripped on a
housekeeping pad and fell to the
ground injuring his left wrist.
Cost Center
Carrier Employer Acc Desc.
Major Coverage: 10 - Workers' Compensation
1004091807866
Collier County Government
Closed Claim Report- All Lines
4th QTR FY 2018
Valued as of:10/12/2018
Claim Number Employee Name
1
16.E.4.a
Packet Pg. 1887 Attachment: All Lines Closed Claim Report 4th QTR FY 18 (7120 : Approval of closed claims by the Risk
3,131.72 2,998.37 0.00 0.00 0.00 0.00 0.00 6,130.09
12/29/2017 12/29/2017 7/20/2018 3,131.72 2,998.37 0.00 0.00 0.00 0.00 0.00 6,130.09
10 1300
23,055.80 243.40 11,923.43 0.00 0.00 0.00 0.00 35,222.63
5/16/2017 5/19/2017 7/24/2018 23,055.80 243.40 11,923.43 0.00 0.00 0.00 0.00 35,222.63
10 1500
1,094.40 37.80 0.00 0.00 0.00 0.00 0.00 1,132.20
10/29/2017 10/29/2017 7/24/2018 1,094.40 37.80 0.00 0.00 0.00 0.00 0.00 1,132.20
10 1700
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
9/17/2018 9/18/2018 9/30/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1700
252.00 26.25 0.00 0.00 0.00 0.00 0.00 278.25
8/2/2018 8/3/2018 8/17/2018 252.00 26.25 0.00 0.00 0.00 0.00 0.00 278.25
10 1400
263.05 17.85 0.00 0.00 0.00 0.00 0.00 280.90
5/22/2018 5/23/2018 7/23/2018 263.05 17.85 0.00 0.00 0.00 0.00 0.00 280.90
10 1400
7,699.39 170.95 0.00 0.00 0.00 0.00 0.00 7,870.34
7/3/2018 7/3/2018 8/31/2018 7,699.39 170.95 0.00 0.00 0.00 0.00 0.00 7,870.34
10 1500
3,059.74 297.49 0.00 0.00 0.00 0.00 0.00 3,357.23
10/27/2017 10/29/2017 7/6/2018 3,059.74 297.49 0.00 0.00 0.00 0.00 0.00 3,357.23
10 1700
660.63 70.99 0.00 0.00 0.00 0.00 0.00 731.62
12/6/2017 12/6/2017 7/23/2018 660.63 70.99 0.00 0.00 0.00 0.00 0.00 731.62
10 1100
90.00 5.95 0.00 0.00 0.00 0.00 0.00 95.95
4/9/2018 4/11/2018 7/23/2018 90.00 5.95 0.00 0.00 0.00 0.00 0.00 95.95
10 1500
1004091807871
156349
Employee dropped weight on left
pinky toe while cleaning weight
equipment
144610
Employee was spit in the face by a
patient considered to be positive for
Hep-C.
1012061707233
144610
Employee was exposed to blood
and bodily fluids while attending to a
patient.
1007031808096
253212
Employee felt pop in lower back
while installing a Bacteria Sample
Point.
1010271707074
157110
Employee was in a motor vehicle
accident and injured left elbow on
door.
1005221807984
138915
Employee was rear-ended in county
vehicle yesterday while stopped at
red light.
1009171808298
163630
Employee was struck in the face
while installing a street sign.
1008021808185
144610
Employee developed low back pain
while completing an obstacle course
at work.
1010291707072
144610
Employee was interacting with
combative patient and patient spit
on Paramedic's face, and saliva
made contact with eyes.
1012291707339
156314
Employee tripped while walking in
the Box Office at Sun-N-Fun and
injured her right knee.
1005161706135
2
16.E.4.a
Packet Pg. 1888 Attachment: All Lines Closed Claim Report 4th QTR FY 18 (7120 : Approval of closed claims by the Risk
0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
5/1/2018 5/2/2018 7/20/2018 0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
10 1400
178.98 0.00 0.00 0.00 0.00 0.00 0.00 178.98
8/30/2018 9/4/2018 9/13/2018 178.98 0.00 0.00 0.00 0.00 0.00 0.00 178.98
10 1300
1,120.92 103.32 917.00 0.00 0.00 0.00 0.00 2,141.24
7/16/2018 7/16/2018 8/31/2018 1,120.92 103.32 917.00 0.00 0.00 0.00 0.00 2,141.24
10 1500
0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
12/15/2017 3/27/2018 7/23/2018 0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
10 1900
2,318.04 580.44 727.02 0.00 0.00 0.00 0.00 3,625.50
6/29/2018 7/2/2018 9/30/2018 2,318.04 580.44 727.02 0.00 0.00 0.00 0.00 3,625.50
10 1500
261.95 31.69 0.00 0.00 0.00 0.00 0.00 293.64
7/11/2018 7/11/2018 8/17/2018 261.95 31.69 0.00 0.00 0.00 0.00 0.00 293.64
10 1300
182.14 0.00 0.00 0.00 0.00 0.00 0.00 182.14
8/28/2018 8/28/2018 8/31/2018 182.14 0.00 0.00 0.00 0.00 0.00 0.00 182.14
10 1200
693.06 5.95 0.00 0.00 0.00 0.00 0.00 699.01
9/14/2017 11/9/2017 8/21/2018 693.06 5.95 0.00 0.00 0.00 0.00 0.00 699.01
10 1000
253211
Employee stepped on nail clearing
scrap metal out of recycle dumpster
and punctured right foot.
1009141707121
233351
Employee was splashed with raw
wastewater in face during Hurricane
Irma disaster.
1007111808109
253212
Employee reports he was stepping
off a trailer which was approx. 3' off
the ground when his right foot
slipped off the rail. He had no pain
at the time and about 10 minutes
later while in vehicle he noticed a
pain in his right knee.
1008281808243
311111
Employee reported anxiety,
vomiting, nausea and abdominal
pain.
1006291808094
253215
Employee reports that while working
on 6/29/18 he was walking on soft
ground and felt his right knee
"buckle". Employee did not fall to
the ground.
1007161808123
122240
Employee was lifting a printing roll
when he felt a sharp pain in his
Right groin area.
1012151707807
138915
Employee was rear-ended while at
red light and is complaining of neck
and shoulder discomfort.
1008301808267
156363
Employee fell to hands/knees in
gravel lot, resulting in some slight
swelling and bruising to her left
knee.
1005011807937
3
16.E.4.a
Packet Pg. 1889 Attachment: All Lines Closed Claim Report 4th QTR FY 18 (7120 : Approval of closed claims by the Risk
318.04 25.17 0.00 0.00 0.00 0.00 0.00 343.21
12/6/2017 12/6/2017 7/24/2018 318.04 25.17 0.00 0.00 0.00 0.00 0.00 343.21
10 1700
148.48 25.48 0.00 0.00 0.00 0.00 0.00 173.96
4/24/2018 4/24/2018 7/23/2018 148.48 25.48 0.00 0.00 0.00 0.00 0.00 173.96
10 1900
3,996.31 303.90 0.00 0.00 0.00 0.00 0.00 4,300.21
3/1/2018 3/2/2018 8/31/2018 3,996.31 303.90 0.00 0.00 0.00 0.00 0.00 4,300.21
10 1300
10,872.80 392.83 0.00 0.00 0.00 0.00 0.00 11,265.63
3/5/2018 3/5/2018 7/18/2018 10,872.80 392.83 0.00 0.00 0.00 0.00 0.00 11,265.63
10 1500
1,356.56 52.77 1,515.55 0.00 0.00 0.00 0.00 2,924.88
6/1/2018 6/1/2018 7/20/2018 1,356.56 52.77 1,515.55 0.00 0.00 0.00 0.00 2,924.88
10 1500
457.67 43.53 83.28 0.00 0.00 0.00 0.00 584.48
6/1/2018 6/1/2018 7/24/2018 457.67 43.53 83.28 0.00 0.00 0.00 0.00 584.48
10 1500
1,033.39 63.63 0.00 0.00 0.00 0.00 0.00 1,097.02
7/20/2018 7/20/2018 8/10/2018 1,033.39 63.63 0.00 0.00 0.00 0.00 0.00 1,097.02
10 1500
427.17 26.32 0.00 0.00 0.00 0.00 0.00 453.49
8/6/2018 8/6/2018 8/29/2018 427.17 26.32 0.00 0.00 0.00 0.00 0.00 453.49
10 1500
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
9/18/2018 9/19/2018 9/30/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1000
Employee dropped a table on top of
right foot setting up for summer
camp.
156398
1009181808302
144610
Employee was possible exposed to
patient with possible meningitis.
1007201808142
155410
Employee right knee slammed into
the ground when trying to stop a
fight with another dog.
1008061808188
144610
Employee injured lower back after
lifting a patient out of an ambulance.
1006011808016
144610
Employee injured lower back after
lifting a patient out of an ambulance.
1003051807750
157470
Employee felt pain in left arm while
installing a new exhibit piece of
artwork in the Museum.
1006011808015
163620
Employee was working digging
holes to plant when he felt dizzy and
start to vomit.
1003011807741
156110
Employee fell forward when carrying
a table that slipped from her hands.
1012061707232
144610
Employee was exposed to blood
and body fluids while attending to a
patient.
1004241807913
4
16.E.4.a
Packet Pg. 1890 Attachment: All Lines Closed Claim Report 4th QTR FY 18 (7120 : Approval of closed claims by the Risk
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
9/4/2018 9/5/2018 9/24/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1200
137,683.46 6,932.76 33,580.76 0.00 0.00 0.00 0.00 178,196.98
137,683.46 6,932.76 33,580.76 0.00 0.00 0.00 0.00 178,196.98
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
8/9/2018 9/21/2018 9/26/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21
0.00 0.00 50.00 0.00 0.00 0.00 0.00 50.00
3/20/2018 3/21/2018 8/31/2018 0.00 0.00 50.00 0.00 0.00 0.00 0.00 50.00
22 5400
0.00 0.00 230.00 0.00 0.00 0.00 0.00 230.00
7/14/2017 7/21/2017 7/27/2018 0.00 0.00 230.00 0.00 0.00 0.00 0.00 230.00
22
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
1/26/2018 6/1/2018 9/19/2018 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
9/21/2017 5/15/2018 8/3/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 L360
RMSE
Letter from LSC Attorneys state-The
allegations of negligence that give
rise to the claim are: Negligently
maintained walk way and property
maintenance.
2209211707964 Georgetown HOA community within
Pelican Bay
RMSE
Neighbor/Board Member-Mike
Kitchen stated that the damage to
association grass area and retention
pond occurred due to flooding and
backup of storm drain starting at
Ridgeway Dr in front of Georgetown.
This damage is outside the gate of
Georgetown.
2207141706301 Enterprise Car Rental
156342
While driving from Immokalee, the
rental vehicle got a crack in the
windshield from a rock.
2101261808010 STENASON, LISA
163624
Mr. Ruiz stopped his vehicle at the
rest stop, and was viciously
attacked and shot via gunfire.
2203201807789 Culbert, Lawrence
108010
A tree limb from an Oak tree that is
on County property fell on
neighboring houses screen lanai.
155410
Employee was bitten by a cat in the
right hand on 9/4/18 at approx.
1745. The incident was reported on
9/5/18 while employee was already
at NCH downtown seeking
treatment following some swelling to
right hand.
Total by Major Coverage 36 Claims
Major Coverage: 20 - General Liability
2108091808312 RUIZ, LUIS
1009041808271
5
16.E.4.a
Packet Pg. 1891 Attachment: All Lines Closed Claim Report 4th QTR FY 18 (7120 : Approval of closed claims by the Risk
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
9/12/2017 9/15/2017 7/24/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
12/22/2017 3/15/2018 8/31/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 3200
0.00 0.00 250.00 0.00 0.00 0.00 0.00 250.00
4/14/2018 4/18/2018 8/3/2018 0.00 0.00 250.00 0.00 0.00 0.00 0.00 250.00
22 3000
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
3/17/2018 4/3/2018 9/5/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 5900
295.00 0.00 0.00 0.00 0.00 0.00 0.00 295.00
5/8/2018 5/8/2018 9/11/2018 295.00 0.00 0.00 0.00 0.00 0.00 0.00 295.00
22 3000
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
5/20/2018 6/1/2018 8/31/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 2450
233351
Vincente Sancho was backing truck
CC2-741 into a parking space and
struck a lamp post with the vehicles
hitch.
2205201808013 RUEL, RICHARD
163630
Mr. Rule was driving on 102nd WB
heavy rain, saw no stop sign, and
proceeded ran into another vehicle
on 6th heading SB. A previous
accident knocked the stop sign
down.
2203171807848 ELLEN, CULLEN
233351
The customer at 562 Bay Villas
Lane Naples called to report a
backed up toilet. The following
actions have occurred: A crew
arrived and verified the backup. A
camera truck was called and a
lateral line view was done.
2205081807949 Bayshore CRA
263613
On Friday December 22nd claimant
alleges he was following his
daughter who was driving my
Porsche as she turned left from
111th onto Vanderbilt Drive. She
ran over a small elevated man hole
or vent hole cover in the road.
2204141807900 ANDERSON, JENNETTE
EMSE
Crew unable to gain access to the
patient with stretcher because of the
layout of the house, stretcher was
staged in hallway. Neither crew
member recalls damaging wall.
2209121706463 HENDRICKX, WAYNE
138915
Employee experienced an
automobile accident in his personal
vehicle. Employee swerved to miss
a car that was running through an
intersection and hit a tree.
2212221707776 KORCHMAR, MICHAEL
6
16.E.4.a
Packet Pg. 1892 Attachment: All Lines Closed Claim Report 4th QTR FY 18 (7120 : Approval of closed claims by the Risk
0.00 0.00 1,734.75 0.00 0.00 0.00 0.00 1,734.75
7/19/2018 7/23/2018 8/16/2018 0.00 0.00 1,734.75 0.00 0.00 0.00 0.00 1,734.75
22
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
2/13/2018 2/21/2018 8/17/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 2150
0.00 3,130.00 0.00 0.00 0.00 0.00 0.00 3,130.00
9/10/2017 11/22/2017 9/19/2018 0.00 3,130.00 0.00 0.00 0.00 0.00 0.00 3,130.00
22 5400
0.00 0.00 1,265.53 0.00 0.00 0.00 0.00 1,265.53
1/8/2018 1/12/2018 8/6/2018 0.00 0.00 1,265.53 0.00 0.00 0.00 0.00 1,265.53
22 5900
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
5/31/2017 7/31/2017 8/8/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
6/4/2018 6/6/2018 8/1/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 3200
210155
Resident Jack Paul called the
project hotline on May 31, 2017 to
report that he hired a landscaper to
fix 3 broken sprinkles and paid
$95.17. The PIO advised him that
we do not reimburse because
sprinklers will be fixed by contractor.
2206041808027 MEANS, JOSEPHINE
163613
As claimant was exiting the
McDonalds located on Immokalee
Drive she turned right at the curve
and the rear passenger side tire fell
on a hole were a pipe is exposed.
Claimant alleges that his residence
had loss of structural support to the
NE corner of the foundation,
significant soil erosion, and seawall
collapse resulting from water runoff
caused by the blockage of storm
drains during a construction project.
2201081807378 BLUE SKY CO-OP, INC.
210116
Claimant states that due to repairs
being done to the county's lift station
located in the association's property,
their system was turned off to pump
out sewage. In the process the shaft
with the float on their line was
broken.
2205311706327 Jack Paul
210116
Claimant states that a county truck
working on Station 10404 ran over
one of the sprinkler heads on her
lawn.
2209101707172 KEATING, ROBERT
162542
2207191808145 FLINT, LONNIE
210116
Lonnie Flints Wife was driving to
work today(O'Connell Behavior
Services. 5432 Rattlesnake
Hammock Rd, Naples, FL
34112)when she was unable to
safely avoid some sort of lid/cover
for a hole in the street.
2202131807716 DELUCA, ARLENE
7
16.E.4.a
Packet Pg. 1893 Attachment: All Lines Closed Claim Report 4th QTR FY 18 (7120 : Approval of closed claims by the Risk
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
12/23/2017 7/23/2018 9/11/2018 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
6/2/2017 6/2/2017 7/27/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 5900
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
6/26/2018 7/6/2018 9/11/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
20 5900
0.00 0.00 195.00 0.00 0.00 0.00 0.00 195.00
11/28/2017 11/28/2017 7/31/2018 0.00 0.00 195.00 0.00 0.00 0.00 0.00 195.00
22 2000
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
9/12/2017 9/28/2017 8/8/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 2000
0.00 0.00 697.00 0.00 0.00 0.00 0.00 697.00
7/31/2018 8/23/2018 9/18/2018 0.00 0.00 697.00 0.00 0.00 0.00 0.00 697.00
22
122240
When trying to enter garage on
September 12th between 12 noon
and 1pm, the gate arms went up to
let me through, but closed on my car
as I was driving through and
scratched my paint all the way from
roof to tail of the vehicle.
2207311808235 Heinz, Beatrice
253215
A meter was changed out at this
address on 7-31-18. The customer
reported that her washing machine
was damaged by dirt/debris from the
work completed and required
repairs in excess of $600.
2211281707193 Poppert, Joel
210116
While removing debris from the
SCWRF Berm an employee backed
into a citrus tree breaking a branch.
The tree belongs to a resident living
on the other side of the berm.
2209121706667 FORESTER, DEBRAH
253215
Customer claims that his hot water
tank has damaged due to work
completed by the County per his
Plumber. Meter Operations team
replaced meter and old backflow
device on May 4th, 2017. No issues
noted on the work order with issues
from the customer.
2206261808099 JOHNSON, SUSAN
210116
Sewage backed up into the
claimant's bathrooms showers and
toilets.
2112231708146 RAMOS, LUCIA AND EDUARDO
163630
The driver of vehicle 1 stated her
light turned green and she made the
left hand turn onto Green Blvd.
Once on Green Blvd she was going
to make a left hand turn onto 39th
ST SW and head north. Driver of
vehicle 2 stated he came to a
complete stop.
2206021706174 RODRIGUEZ, GIOVANNI
8
16.E.4.a
Packet Pg. 1894 Attachment: All Lines Closed Claim Report 4th QTR FY 18 (7120 : Approval of closed claims by the Risk
0.00 0.00 1,075.00 0.00 0.00 0.00 0.00 1,075.00
11/9/2017 11/9/2017 7/31/2018 0.00 0.00 1,075.00 0.00 0.00 0.00 0.00 1,075.00
22 L105
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
8/10/2017 11/8/2017 7/2/2018 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
4/5/2017 5/5/2017 8/8/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 5300
295.00 3,130.00 5,497.28 0.00 0.00 0.00 0.00 8,922.28
295.00 3,130.00 5,497.28 0.00 0.00 0.00 0.00 8,922.28
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
3/26/2018 3/27/2018 7/13/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
32 3000
0.00 0.00 666.11 0.00 0.00 0.00 0.00 666.11
11/12/2017 11/12/2017 7/12/2018 0.00 0.00 666.11 0.00 0.00 0.00 0.00 666.11
32 2450
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
5/1/2018 5/1/2018 8/21/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
32
RMSE
Edna Benevidez vehicle was
damaged from a pothole on Costello
drive and US41.
3211121707128 APOSTOLIDIS, CHRISTINA
144610
Ambulance struck a vehicle while
responding to a call.
3205011807931 BENEVIDEZ, EDNA
Total by Major Coverage 26 Claims
Major Coverage: 30 - Auto Liability
3203261807808 GOEDKE, MARGARITA
138915
Vehicles were driving in opposite
directions, county vehicle hit
claimants side view mirror.
163613
Carolyn Jones presented a Workers
Compensation claim to her
employer Automotive Management
Services, Inc. for a slip and fall on
the sidewalk in front of the Acura
Dealer. Sedgwick is subrogating on
behalf of his client TT of Airport, Inc.
2204051706103 Simonelli, Suzanne
144610
Medic 48 ran a call at 2710 Cypress
Trace Circle and when leaving the
residence, they attempted to close
the screen door that was originally
propped open by the metal latch on
the shock absorber and the plastic
brace broke off.
2211091707123 SW Florida Water Management
District
163620
While employee was backing up
with roller # CC2-943 to turn around,
he had his hand in the lever control
for the back and forth motion of the
roller and he was trying to go
forward without realizing that he was
still in reverse.
2108101707116 SEDGWICK ON BEHALF OF, TT
OF AIRPORT, INC.
9
16.E.4.a
Packet Pg. 1895 Attachment: All Lines Closed Claim Report 4th QTR FY 18 (7120 : Approval of closed claims by the Risk
0.00 0.00 2,267.17 0.00 0.00 0.00 0.00 2,267.17
6/12/2018 6/13/2018 8/31/2018 0.00 0.00 2,267.17 0.00 0.00 0.00 0.00 2,267.17
32 3000
0.00 0.00 5,269.58 0.00 0.00 0.00 0.00 5,269.58
8/24/2018 8/24/2018 9/27/2018 0.00 0.00 5,269.58 0.00 0.00 0.00 0.00 5,269.58
30 3000
0.00 0.00 3,649.75 0.00 0.00 0.00 0.00 3,649.75
2/20/2018 2/20/2018 7/31/2018 0.00 0.00 3,649.75 0.00 0.00 0.00 0.00 3,649.75
32 3000
906.06 0.00 0.00 0.00 0.00 0.00 0.00 906.06
4/5/2018 4/6/2018 7/17/2018 906.06 0.00 0.00 0.00 0.00 0.00 0.00 906.06
30
0.00 143.10 0.00 0.00 0.00 0.00 0.00 143.10
9/30/2015 10/6/2015 9/11/2018 0.00 143.10 0.00 0.00 0.00 0.00 0.00 143.10
32 2450
0.00 122.00 75.00 0.00 0.00 0.00 0.00 197.00
11/6/2017 11/6/2017 7/12/2018 0.00 122.00 75.00 0.00 0.00 0.00 0.00 197.00
32 3000
163620
Employee was driving the Back Hoe
on 39th Ave NE east of Immokalee
Road. When he stopped at the stop
sign, he noticed some trucks turning
onto 39th Ave NE and he started to
back up to provide more room for
the trucks, but failed to look up
Inspector walked back to the truck
and saw a crack in the windshield.
3209301504504 MALDONADO, LISBETH
144610
Claimant was rear-ended by a
County vehicle when she slowed for
a traffic light turning red.
3211061707097 DUGGER, ALTON
144610
While responding to a call in Tk16
from Vineyards parking lot, driver
went around a car and clipped the
front of another vehicle in the
opposite lane with the back half of
the EMS truck. no injuries reported.
4204051807862 Building Review & Permitting
Inspection
138915
4108241808237 Wastewater
210116
Ron Jogee was on his way to a high-
level alarm on Friday night 8/24/18
with pumper truck CC2-197,
traveling eastbound on J&C Blvd.
The truck struck a low power line
that was downed due to a lightning
strike that fell on a tree.
3202201807715 GARCIA, NORMA
3206121808063 SUCEL, RODRIGUEZ
163624
County vehicle impacted private
vehicle in passenger rear bumper
area.
10
16.E.4.a
Packet Pg. 1896 Attachment: All Lines Closed Claim Report 4th QTR FY 18 (7120 : Approval of closed claims by the Risk
0.00 180.55 2,500.00 0.00 0.00 0.00 0.00 2,680.55
10/6/2017 10/6/2017 7/2/2018 0.00 180.55 2,500.00 0.00 0.00 0.00 0.00 2,680.55
32 2450
0.00 0.00 2,938.34 0.00 0.00 0.00 0.00 2,938.34
5/30/2018 5/30/2018 8/21/2018 0.00 0.00 2,938.34 0.00 0.00 0.00 0.00 2,938.34
32 3000
0.00 0.00 1,457.22 0.00 0.00 0.00 0.00 1,457.22
6/20/2018 6/20/2018 8/22/2018 0.00 0.00 1,457.22 0.00 0.00 0.00 0.00 1,457.22
32
0.00 157.84 1,277.72 0.00 0.00 0.00 0.00 1,435.56
2/12/2018 2/13/2018 7/13/2018 0.00 157.84 1,277.72 0.00 0.00 0.00 0.00 1,435.56
32 3000
906.06 603.49 20,100.89 0.00 0.00 0.00 0.00 21,610.44
906.06 603.49 20,100.89 0.00 0.00 0.00 0.00 21,610.44
0.00 0.00 540.64 0.00 0.00 0.00 0.00 540.64
3/20/2018 3/20/2018 8/14/2018 0.00 0.00 540.64 0.00 0.00 0.00 0.00 540.64
41 L105
Total by Major Coverage 13 Claims
Major Coverage: 40 - Auto Physical Damage
4103201807785 Emergency Medical Services
144610
Around 1508 employee was pulling
into the 7 Eleven at 31 Tamiami
Trail N in the city of Naples when
she ran onto the curb on the drivers
side of the vehicle, clipping the vent
on the rear of the box with a light
pole, it was very congested.
WATE
Employee pulled into parking space
and upon approaching the concrete
car parking stopper she noticed a
sound and attempted to back up,
and at that time her front bumper
was pulled off by the metal rebar
sticking up as it was not properly cut
off
3202121807599 MAUNZ, MARY
233351
Truck CC2-1038 hit the rear of
another car.
3205301808003 MCCUE, SEAN
SOWE
Mackenzie Pierre was turning right
(north bound) on U.S.41 from Collier
BLVD (south bound). The driver in
front of Mackenzie stopped to yield
to on coming traffic and Mackenzie
hit the left rear bumper of driver.
3206201808059 Water Department
3210061706810 ALPIZAR GOMEZ, PAULA
163611
Car accident at intersection of
Collier Blvd. and Golden Gate
Parkway. While performing
Hurricane Irma damage
assessment, Jim Zuver and
Shannon Bassett were southbound
on 951 at intersection and collided
with the other vehicle.
11
16.E.4.a
Packet Pg. 1897 Attachment: All Lines Closed Claim Report 4th QTR FY 18 (7120 : Approval of closed claims by the Risk
0.00 0.00 1,798.72 0.00 0.00 0.00 0.00 1,798.72
10/10/2017 10/11/2017 7/11/2018 0.00 0.00 1,798.72 0.00 0.00 0.00 0.00 1,798.72
41 5900
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
9/10/2017 9/16/2017 7/12/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
42 5400
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
9/10/2017 9/15/2017 7/12/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
42 5400
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
9/10/2017 9/15/2017 7/12/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
42 5400
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
9/10/2017 9/16/2017 7/12/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
42 5400
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
9/28/2017 9/28/2017 9/10/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41
0.00 0.00 666.45 0.00 0.00 0.00 0.00 666.45
2/12/2018 2/20/2018 8/31/2018 0.00 0.00 666.45 0.00 0.00 0.00 0.00 666.45
41 3000
5,726.43 0.00 0.00 0.00 0.00 0.00 0.00 5,726.43
6/29/2018 6/29/2018 9/30/2018 5,726.43 0.00 0.00 0.00 0.00 0.00 0.00 5,726.43
42 3000
210130
We were informed from Fleet that
there was front end damage to the
vehicle, Fleet asked us to prepare a
Stars report. We have no
knowledge of when the damage
occurred or where it occurred.
While closing the tailgate, the palm
of my hand pushed in on the area
between the tailgate handle and the
license plate, creating a dent.
4102121807713 Wastewater Division
233351
Truck CC2-1038 hit the rear of
another car.
4206291808085 Solid & Hazardous Waste Division
253212
Hurricane Irma
4109281706678 Wastewater Collection Division
233351
4209101706462 Water Distribution Division
253212
During hurricane, damage to the
vehicle occurred.
4209101706467 Water Distribution Division
253212
Hurricane Irma.
4209101706458 Water Distribution Division
253212
Hurricane debris fell on vehicle.
4110101706875 Capital Construction & Maintenance
Operations Division
163647
While getting out of the van on the
drivers side, a Semi truck passed
and the wind from the semi jerked
the door open and over extended
the door causing damage to the
door hinges.
4209101706469 Water Distribution Division
12
16.E.4.a
Packet Pg. 1898 Attachment: All Lines Closed Claim Report 4th QTR FY 18 (7120 : Approval of closed claims by the Risk
10,941.09 153.90 0.00 0.00 0.00 0.00 0.00 11,094.99
9/10/2017 9/17/2017 8/22/2018 10,941.09 153.90 0.00 0.00 0.00 0.00 0.00 11,094.99
42 5400
0.00 0.00 852.89 0.00 0.00 0.00 0.00 852.89
5/30/2018 5/30/2018 8/14/2018 0.00 0.00 852.89 0.00 0.00 0.00 0.00 852.89
41 3000
515.00 0.00 0.00 0.00 0.00 0.00 0.00 515.00
9/10/2017 9/26/2017 9/12/2018 515.00 0.00 0.00 0.00 0.00 0.00 0.00 515.00
42 5400
0.00 0.00 1,740.36 0.00 0.00 0.00 0.00 1,740.36
9/12/2017 9/26/2017 8/22/2018 0.00 0.00 1,740.36 0.00 0.00 0.00 0.00 1,740.36
41
0.00 0.00 1,175.32 0.00 0.00 0.00 0.00 1,175.32
12/9/2017 12/19/2017 7/17/2018 0.00 0.00 1,175.32 0.00 0.00 0.00 0.00 1,175.32
41
14,661.15 0.00 0.00 0.00 0.00 0.00 0.00 14,661.15
9/21/2017 10/11/2017 7/17/2018 14,661.15 0.00 0.00 0.00 0.00 0.00 0.00 14,661.15
42
0.00 0.00 1,294.82 0.00 0.00 0.00 0.00 1,294.82
2/1/2018 3/15/2018 9/26/2018 0.00 0.00 1,294.82 0.00 0.00 0.00 0.00 1,294.82
41 3000
182901
The vehicle's bed was damaged
from hauling hurricane debris
including large limbs.
4102011807768 Veteran Services
155230
Damage to Vehicle CC2-1524
resulting from the accident in claim
#31-02011807457. Volunteer driver
involved in accident in Miami while
transporting client for health
services.
4112091707318 Parks & Recreation Division
156332
Backed truck into tree with the
tailgate down.
4209211706890 Pelican Bay Services Division
163620
During Hurricane Irma, there is a
dent/hole in the passenger side of
the trailer and the aluminum
sheeting on the trailer side door was
torn off and other damage to the
door.
4109121706622 Parks & Recreation Division
156381
Asset #CC2-1430 was damaged
during the clean up of the storm. A
large tree was being loaded on the
dump trailer by use of the tractor.
The gate and the bumper were
damaged during this.
4105301808004 Solid Waste Division
SOWE
Employee was turning right
(northbound) from Collier BLVD
onto U.S.41 when the driver in front
of him stopped, Mackenzie could not
stop in time.
4209101706629 Road Maintenance Division
4209101706476 Solid & Hazardous Waste
Management Division
210106
During the hurricane, a large tree
branch fell on CC2-711 (Ford Truck)
and damaged the hood of the
vehicle and also damaged the
windshield.
13
16.E.4.a
Packet Pg. 1899 Attachment: All Lines Closed Claim Report 4th QTR FY 18 (7120 : Approval of closed claims by the Risk
0.00 0.00 1,296.21 0.00 0.00 0.00 0.00 1,296.21
3/28/2018 3/29/2018 8/14/2018 0.00 0.00 1,296.21 0.00 0.00 0.00 0.00 1,296.21
41 3000
0.00 0.00 3,650.00 0.00 0.00 0.00 0.00 3,650.00
4/17/2018 4/17/2018 8/14/2018 0.00 0.00 3,650.00 0.00 0.00 0.00 0.00 3,650.00
41 3000
892.11 0.00 0.00 0.00 0.00 0.00 0.00 892.11
3/9/2018 3/9/2018 7/17/2018 892.11 0.00 0.00 0.00 0.00 0.00 0.00 892.11
42 5900
882.55 0.00 0.00 0.00 0.00 0.00 0.00 882.55
7/31/2018 7/31/2018 8/21/2018 882.55 0.00 0.00 0.00 0.00 0.00 0.00 882.55
42
807.28 0.00 0.00 0.00 0.00 0.00 0.00 807.28
8/6/2018 8/6/2018 8/17/2018 807.28 0.00 0.00 0.00 0.00 0.00 0.00 807.28
42
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
8/29/2018 8/30/2018 9/27/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 L105
835.92 0.00 0.00 0.00 0.00 0.00 0.00 835.92
8/27/2018 8/27/2018 8/31/2018 835.92 0.00 0.00 0.00 0.00 0.00 0.00 835.92
42
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
12/21/2017 3/5/2018 7/13/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41
173410
Asset CC2-269 was involved in a
vehicle accident being hit by third
party that ran a light.
4208271808242 Traffic Operations
163630
Tossed jack stand in back of truck
CC2-1199 . It bounced off of traffic
cone and hit rear window of truck.
causing it to break glass.
4112211707747 CC v. Matthew A. Greene
156332
The windshield was cracked
(passenger side) upon inspection
this morning.
4108291808249 DAS
155410
At approximately 17:00 in attempt to
reposition the horse trailer to the
Sally Port for cleaning the interior. I
scraped the front right bumper on
the yellow fire hydrant.
4207311808173 Building Review & Permitting-
Inspection
138915
Inspector came out to his vehicle
and noticed a crack in his
windshield on the driver's side.
4208061808189 Parks and other property
156332
While lifting the bed on dump truck
the hitch and bed contacted, the bed
caught the ball hitch and bent the
bed from the back.
4203091807756 Building Review & Permitting
Division
138915
Employee noticed chip in
windshield, is not aware of when it
happened.
4103281807819 Parks and Recreation
156310
Mike noticed when he got into the
truck yesterday that there was
damage to the driver door.
4104171807895 Parks
14
16.E.4.a
Packet Pg. 1900 Attachment: All Lines Closed Claim Report 4th QTR FY 18 (7120 : Approval of closed claims by the Risk
0.00 0.00 2,698.42 0.00 0.00 0.00 0.00 2,698.42
7/5/2018 7/25/2018 9/11/2018 0.00 0.00 2,698.42 0.00 0.00 0.00 0.00 2,698.42
41 2150
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
6/8/2018 6/11/2018 7/17/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
42
0.00 0.00 376.50 0.00 0.00 0.00 0.00 376.50
6/12/2018 6/13/2018 8/14/2018 0.00 0.00 376.50 0.00 0.00 0.00 0.00 376.50
41 3000
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
5/17/2018 5/18/2018 7/16/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 3000
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
8/11/2018 8/11/2018 8/16/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 L105
413.09 0.00 0.00 0.00 0.00 0.00 0.00 413.09
9/10/2017 10/4/2017 7/17/2018 413.09 0.00 0.00 0.00 0.00 0.00 0.00 413.09
42 5400
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
7/3/2018 7/3/2018 9/28/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
42
144210
During Hurricane Irma , the driver's
mirror was broken out of the frame.
4207031808095 Facilities Management
FMGE
Van CC2-1315. Plastic cover on left
side mirror is making clicking sound
when door is opened.
4108111808206 PROPERTY MANAGEMENT,
MIRACLE
EMSE
While moving EMS Truck 19 on
scene of a medical call, MIFD FF
Yarnell scraped the passenger side
of the box against an aluminum
building extension.
4209101706745 Bureau of Emergency Services
Division
163624
County vehicle impacted private
vehicle in passenger rear bumper
area.
4105171807970 Emergency Medical Services
EMSE
Medic 2 backed into a concrete light
pole while trying to gain access to a
patients address.
4206081808035 Tax Collector
TXC
A pebble flew up from road and hit
windshield which caused a crack.
windshield needs to be replaced.
4106121808048 Road and Bridge FDOT
4107051808156 Distribution
253212
Unknown how the vehicle was
damaged. It is driven by several
different crews who were
questioned. Fleet found damage
when it went for an inspection.
15
16.E.4.a
Packet Pg. 1901 Attachment: All Lines Closed Claim Report 4th QTR FY 18 (7120 : Approval of closed claims by the Risk
4,401.99 0.00 0.00 0.00 0.00 0.00 0.00 4,401.99
9/14/2017 12/8/2017 7/12/2018 4,401.99 0.00 0.00 0.00 0.00 0.00 0.00 4,401.99
42 5900
0.00 0.00 3,471.62 0.00 0.00 0.00 0.00 3,471.62
11/28/2017 11/30/2017 7/12/2018 0.00 0.00 3,471.62 0.00 0.00 0.00 0.00 3,471.62
41 3000
0.00 0.00 554.80 0.00 0.00 0.00 0.00 554.80
7/12/2018 7/25/2018 8/21/2018 0.00 0.00 554.80 0.00 0.00 0.00 0.00 554.80
41 3000
796.17 0.00 0.00 0.00 0.00 0.00 0.00 796.17
7/24/2018 7/25/2018 8/23/2018 796.17 0.00 0.00 0.00 0.00 0.00 0.00 796.17
42 5900
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
3/6/2018 5/17/2018 9/28/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 3000
957.18 0.00 0.00 0.00 0.00 0.00 0.00 957.18
6/25/2018 6/26/2018 7/31/2018 957.18 0.00 0.00 0.00 0.00 0.00 0.00 957.18
42 5900
0.00 0.00 957.82 0.00 0.00 0.00 0.00 957.82
1/19/2018 1/22/2018 7/13/2018 0.00 0.00 957.82 0.00 0.00 0.00 0.00 957.82
41 2000
4101191807392 CC v. Janopoulos, Carole A.
163615
County vehicle was slowing down
for traffic in front of him and was hit
from behind.
FMGE
Employee backed into something
causing dent and scratch on right
rear of CC2-1615.
4206251808082 Wastewater Division
233351
Employee was doing truck
inspection in the morning and found
the front windshield has a crack.
On July 12th I came to work at 6:30
am and I found a dent on the left
fender.
4207241808154 Meter Operations
253215
Ricky Johnson parked vehicle CC2-
1201 at the Golden Gate Water
Plant at 4300 Golden Gate Pkwy at
the end of the day.
When he reported back to work he
noticed the rear window was broken
out with a rock.
4103061807968 Facilities Management
156332
While backing up, the trailer
(#970134) jackknifed and made a
dent on the bumper passenger side
and a dent on the fender wall of
Asset #CC2-1429.
4107121808155 Parks and Recreation
156310
4209141707250 Fleet Management Division
122410
Fleet loaner # CC2-1211 was on
loan to Everglades City for recovery
efforts. Damage was done to the
vehicle while being utilized by
Everglades City staff. Damages
span the entire length of the
passenger side of the vehicle.
4111281707207 Parks & Recreation Division
16
16.E.4.a
Packet Pg. 1902 Attachment: All Lines Closed Claim Report 4th QTR FY 18 (7120 : Approval of closed claims by the Risk
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
9/10/2017 9/24/2017 7/11/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
42 5400
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
9/10/2017 9/16/2017 7/12/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
42 5400
14,663.33 210.65 0.00 0.00 0.00 0.00 0.00 14,873.98
9/10/2017 9/13/2017 7/23/2018 14,663.33 210.65 0.00 0.00 0.00 0.00 0.00 14,873.98
42 5400
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
7/2/2018 7/11/2018 9/28/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 3000
56,493.29 364.55 21,074.57 0.00 0.00 0.00 0.00 77,932.41
56,493.29 364.55 21,074.57 0.00 0.00 0.00 0.00 77,932.41
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
12/16/2017 1/5/2018 8/17/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
53 2000
0.00 0.00 26,450.00 0.00 0.00 0.00 0.00 26,450.00
10/26/2017 10/26/2017 8/21/2018 0.00 0.00 26,450.00 0.00 0.00 0.00 0.00 26,450.00
56 5900
163630
A pedestrian crosswalk sign was
damaged by an unknown vehicle.
5610261707064 Ashbritt Inc.
233315
During the Hurricane IRMA
emergency generator deployment
one of Ashbritt's generators ended
up missing. The generator ended
missing somewhere between
9/18/17 and 9/29/17. The generator
was a GP 45KW with a serial #
WOP120759.
PUTD
Passenger rear wheel ran over
curbside causing a flat tire.
Total by Major Coverage 42 Claims
Major Coverage: 50 - Property
5312161707351 Traffic Operations
4209101706441 Airport Authority Division
192350
Flooding/surge likely 4-5 feet up
truck when stored in hangar during
Hurricane Irma.
4107021808111 Public Utilities
144610
Sometime during Hurricane Irma,
the retractable awning on the SRU
Trailer became detached. It appears
to have been ripped from the
brackets. The awning and most of
the associated framework was
discovered scattered throughout the
station's grounds.
4209101706468 Water Distribution
253212
Hurricane Irma.
4209101706578 EMS
17
16.E.4.a
Packet Pg. 1903 Attachment: All Lines Closed Claim Report 4th QTR FY 18 (7120 : Approval of closed claims by the Risk
683.92 0.00 0.00 0.00 0.00 0.00 0.00 683.92
2/9/2018 9/14/2018 9/30/2018 683.92 0.00 0.00 0.00 0.00 0.00 0.00 683.92
53
4,465.95 0.00 0.00 0.00 0.00 0.00 0.00 4,465.95
3/2/2018 7/24/2018 8/13/2018 4,465.95 0.00 0.00 0.00 0.00 0.00 0.00 4,465.95
53
724.72 0.00 0.00 0.00 0.00 0.00 0.00 724.72
4/19/2018 8/15/2018 8/31/2018 724.72 0.00 0.00 0.00 0.00 0.00 0.00 724.72
50
207.52 0.00 0.00 0.00 0.00 0.00 0.00 207.52
6/29/2018 8/15/2018 8/31/2018 207.52 0.00 0.00 0.00 0.00 0.00 0.00 207.52
53
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10/25/2017 11/14/2017 7/25/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
51
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
2/26/2018 7/16/2018 9/7/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
56 1100
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
9/18/2017 9/19/2017 7/25/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
52 5300
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
11/23/2017 11/27/2017 7/25/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
53
156363
Maintenance staff discovered wood
park sign, wood pilings supporting
the sign and adjacent landscaping
was struck and damaged by
unknown persons, the night before.
5209181706507 VAR Resources
144610
Lt. McColloch placed the EMS Lap
top on the back bumper of the
ambulance. The Lap top was found
on ST Road 951. South of Manatee
Road.
5311231707178 Parks and Recreation Division
121710
Back loading dock was hit by a
vehicle so hard that it caused
structural damage to where the
concrete and metal platform are
attached to one another. Unsure of
exactly when this occurred as there
were no witnesses.
5602261808121 Transportation Maint R & B
163620
Oil was observed leaking from the
CC2-983 on the morning of 2/26/18
and reported to fleet. The
equipment was last used on 2/22/18
on task RM29247. Fleet reported
the rear axle case was cracked and
attributed the damage to a strike of
some sort.
5306291808216 Traffic Operations
163630
Crew found down pedestrian pole
down in northbound lane.
5110251707140 Procurement Services Division
163630
I was sent an e-mail that street light
was down on Tamiami Trail.
5304191808217 Traffic Operations
163630
Pedestrian signal down. Bridge
damage as well.
5302091808288 Traffic Operations
163630
Pedestrian crossing signal
damaged.
5303021808149 Traffic Operations
18
16.E.4.a
Packet Pg. 1904 Attachment: All Lines Closed Claim Report 4th QTR FY 18 (7120 : Approval of closed claims by the Risk
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
2/5/2018 2/5/2018 7/27/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
53 3000
7,382.84 0.00 0.00 0.00 0.00 0.00 0.00 7,382.84
4/24/2018 4/24/2018 7/31/2018 7,382.84 0.00 0.00 0.00 0.00 0.00 0.00 7,382.84
56
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
12/26/2017 12/27/2017 7/27/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
52 5900
13,464.95 0.00 26,450.00 0.00 0.00 0.00 0.00 39,914.95
13,464.95 0.00 26,450.00 0.00 0.00 0.00 0.00 39,914.95
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
1/12/2018 1/24/2018 7/19/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
67
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
208,842.76 11,030.80 106,703.50 0.00 0.00 0.00 0.00 326,577.06
208,842.76 11,030.80 106,703.50 0.00 0.00 0.00 0.00 326,577.06
8:26:01 AM
6701121807404 MPBP 1 Enterprises ET. AL. v.
Collier County ET. AL.
138930
Claimant alleges that the defendants
refused to permit the use of a
statutory way of necessity across
the property described herein; grant
pedestrian and utilities access.
Total by Major Coverage 1 Claim
Grand Totals: 131 Claims
144610
After completing an interfacility
transport for AR#12807, M48 states
they obtained the nurse's signature
after transferring their patient at
NCH DT. They set the Toughbook in
the back of the truck and went
inside the hospital prior to clearing.
Total by Major Coverage 13 Claims
Major Coverage: 60 - Public Officials Errors and Ommissions
10/12/2018
While fixing signs on the median of
Vanderbilt beach Rd west of
Fontana Del Sol Way, Tony Barry
was backing up and didn't notice
that the box for the waste water
force main was there and struck the
water box. Box broke and waste
water came out.
5604241807916 Transportation Maint R & B
163620
Bomag Roller CC2-789 was
vandalized by others while staged
out in the field.
5212261707330 Emergency Medical Services
5302051807469 Wastewater Division
163630
19
16.E.4.a
Packet Pg. 1905 Attachment: All Lines Closed Claim Report 4th QTR FY 18 (7120 : Approval of closed claims by the Risk
Collier County Government
Subrogation Closed Claim Report
4th QTR FY 2018
Valued as of:10/22/2018
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 2,819.49 0.00 0.00 0.00CC v. SMITH, TENEQUA4110231707032
7/5/201810/23/2017 10/23/2017 0.00 0.00 0.00 2,819.49 0.00 0.00 0.00 0.00138911
41 Employee was driving vehicle
#CC2-1173 in the WaWa
parking lot when a parked
vehicle began backing out and
struck the right side of the
County vehicle. The other
vehicle involved had minor
damage to the rear bumper.
3000
740.65 0.00 0.00 0.00 762.91 740.65 0.00 0.00CC V Sedgwick4106071808030
8/31/20186/7/2018 6/8/2018 0.00 740.65 0.00 762.91 740.65 0.00 0.00 0.00138915
41 My vehicle was stopped at red
light, and I was rear ended by a
truck.
3000
933.93 0.00 0.00 0.00 973.68 933.93 0.00 0.00CC V. Julio Sierra4106061808031
8/31/20186/6/2018 6/8/2018 0.00 933.93 0.00 973.68 933.93 0.00 0.00 0.00138915
41 I was parked looking up my next
inspection. My vehicle was half
on road and half off road. A
vehicle with 20 wood pallets was
coming up behind me and I
noticed he wasn't planning on
stopping. I hit the gas to move
forward to minimize the impact.
3000
0.00 0.00 0.00 0.00 3,950.00 0.00 0.00 0.00CC v. Arcaim James Lallemand5305251807995
9/24/20185/25/2018 5/26/2018 0.00 0.00 0.00 3,950.00 0.00 0.00 0.00 0.00156332
50 A citizen driving a 2008
Volkswagen Jetta drove his
vehicle into the pedestrain
walkway located at the North
Gulf Shore beach Access.
Striking the pedestrain walkway
safety bollards.
3000
0.00 0.00 0.00 0.00 12,643.52 0.00 0.00 0.00MSTU VS. Allstate5305281808020
8/30/20185/27/2018 6/5/2018 0.00 0.00 0.00 12,643.52 0.00 0.00 0.00 0.00162524
53 A vehicle lost control hit the
planter and the decorative light
pole on the sidewalk.
-1-
7:41:43AM
10/22/2018
16.E.4.b
Packet Pg. 1906 Attachment: Subrogation Close Claim Report 4th QTR FY 18 (7120 : Approval of closed claims by the
Collier County Government
Subrogation Closed Claim Report
4th QTR FY 2018
Valued as of:10/22/2018
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 0.00 283.75 0.00 0.00 0.00Traffic Ops VS Allstate5305271808070
8/31/20185/27/2018 6/22/2018 0.00 0.00 0.00 283.75 0.00 0.00 0.00 0.00163630
53 A vehicle traveling west on west
main street SR 29 at
approximately 70mph in a
posted 35mph zone veered off
the roadway impacting Collier
Counties blue street light.
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00CC V. Bumper to Bumper
Naples Towing
4105021807954
8/24/20185/2/2018 5/9/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00253212
41 Truck had gotten stuck in ditch
while performing work.
Contacted fleet services and
they sent out Naples Towing to
pull the truck out. While pulling
the truck out, Naples towing bent
the rear bumper and ripped off
the driver side mirror.
734.66 0.00 0.00 0.00 734.66 734.66 0.00 0.00CC V. Louis Ochoa4106071808029
8/20/20186/7/2018 6/8/2018 0.00 734.66 0.00 734.66 734.66 0.00 0.00 0.00253215
41 While parked in front of 122
Royal Cove Lane the customer
struck vehicle CC2-1079 in the
rear drivers side bumper with the
boat he was towing while
entering the driveway.
3000
0.00 0.00 0.00 0.00 765.40 0.00 0.00 0.00CC v. Cacho Vasquez, Ricardo4102281807745
8/22/20182/28/2018 3/2/2018 0.00 0.00 0.00 765.40 0.00 0.00 0.00 0.00156332
41 While the employee was looking
for a parking space at Walmart,
another vehicle backed into the
county vehicle . The employee
honked and even tried to back
up but the patron still kept going
and struck the county vehicle.
3000
0.00 0.00 0.00 0.00 5,659.65 0.00 0.00 0.00CC V. Liberty Mutual5303101808197
8/20/20183/10/2018 8/9/2018 0.00 0.00 0.00 5,659.65 0.00 0.00 0.00 0.00163630
53 Light pole down due to car
accident. Pole number 68
-2-
7:41:43AM
10/22/2018
16.E.4.b
Packet Pg. 1907 Attachment: Subrogation Close Claim Report 4th QTR FY 18 (7120 : Approval of closed claims by the
Collier County Government
Subrogation Closed Claim Report
4th QTR FY 2018
Valued as of:10/22/2018
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 2,146.00 0.00 0.00 0.00CC v. Khadikova, Kristina5504161706085
8/20/20184/16/2017 4/27/2017 0.00 0.00 0.00 2,146.00 0.00 0.00 0.00 0.00163801
55 Valery Khadikov was traveling
south on St. Andrews Blvd, when
she went to light a cigarrette and
failed to maintain control of the
vehicle, colliding with a tree.
3000
0.00 0.00 0.00 0.00 10,000.00 0.00 0.00 0.00CC v. Valle Garcia, Erwin A.5301021807642
9/4/20181/2/2018 2/14/2018 0.00 0.00 0.00 10,000.00 0.00 0.00 0.00 0.00210125
53 A Vehicle was speeding and
veered off the roadway onto
grass and then back on to the
roadway striking an above water
backflow piping for Naples
apartment development.
2000
624.67 0.00 0.00 0.00 664.42 624.67 0.00 0.00CC v. Matesich, James4101031807344
8/31/20181/3/2018 1/3/2018 0.00 624.67 0.00 664.42 624.67 0.00 0.00 0.00253212
41 Employee was traveling east on
Vanderbilt Beach road when he
was struck from behind when
approaching the intersection of
Airport Road.
2450
0.00 0.00 0.00 0.00 599.60 0.00 0.00 0.00CC v. Matheson Tri-Gas Inc.5101101807363
8/20/20181/10/2018 1/10/2018 0.00 0.00 0.00 599.60 0.00 0.00 0.00 0.00EMSE
51 Damage done to NW ambulance
bay door at EMS10 when
Matheson Tri-Gas Inc oxygen
delivery truck backed into door.
No persons were injured in the
incident. Door remains
operational.
2000
-3-
7:41:43AM
10/22/2018
16.E.4.b
Packet Pg. 1908 Attachment: Subrogation Close Claim Report 4th QTR FY 18 (7120 : Approval of closed claims by the
Collier County Government
Subrogation Closed Claim Report
4th QTR FY 2018
Valued as of:10/22/2018
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
18,065.00 0.00 0.00 0.00 19,065.00 0.00 0.00 18,065.00CC v. Varian Construction Co.,
Inc. ($19,065.00)
5202081705845
7/24/20182/8/2017 2/9/2017 18,065.00 0.00 0.00 19,065.00 18,065.00 0.00 0.00 0.00138930
52 Varian Construction who was
hired by Collier County Growth
Management Department to
renovate office space in the
building hired a Sub-contractor
(Imperial Fire Protect Company)
to remove a spinkler head
causing flooding, and damage to
the office.
5100
0.00 0.00 0.00 0.00 1,630.53 0.00 0.00 0.00CC V. Carl Reichl4105011807930
9/12/20185/1/2018 5/1/2018 0.00 0.00 0.00 1,630.53 0.00 0.00 0.00 0.00156332
41 CC2-1800 drove from County
Barn Rd to Rattlesnake
Hammock Rd west with a green
light to make a left, the other car
did not stop at the red light and
hit the county vehicle.
3000
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00CC v. Ryan, Theresa M.5304191807918
7/27/20184/19/2018 4/25/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00163620
53 Traffic accident by third parties
caused 70 gallons of diesel fuel
to spill on the roadway and
caused damage to the
road.Road will need to be
repaved.
3000
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00CC v. Pro Lime5304131807875
9/24/20184/13/2018 4/13/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00210113
53 A Pro Lime truck piggybacked in
behind an employee; the gate
closed and the Pro Lime driver
moved forward damaging the
front gate of the South Regional
Water Treatment Plant.
2000
-4-
7:41:43AM
10/22/2018
16.E.4.b
Packet Pg. 1909 Attachment: Subrogation Close Claim Report 4th QTR FY 18 (7120 : Approval of closed claims by the
Collier County Government
Subrogation Closed Claim Report
4th QTR FY 2018
Valued as of:10/22/2018
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. Smith, Cory4106091706188
7/5/20186/9/2017 6/9/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00157110
41 The County vehicle was rear
ended while stopped on North
1st Street in front of the public
library waiting for the car in front
of them to turn.
3000
0.00 0.00 0.00 0.00 58,517.82 0.00 0.00 0.00CC v. The Warner Corporation5610101706870
9/19/201810/10/2017 10/10/2017 0.00 0.00 0.00 58,517.82 0.00 0.00 0.00 0.00163628
56 Unit CC2-900 was sweeping on
RSHR west of Grand Lely on
inside lane traveling at an
estimated speed of 4 mph.
White Toyota truck struck unit
from behind.
3000
0.00 0.00 0.00 0.00 6,294.19 0.00 0.00 0.00CC V. Progressive Insurance5304131808198
9/4/20183/13/2018 8/9/2018 0.00 0.00 0.00 6,294.19 0.00 0.00 0.00 0.00163630
53 A driver dosed off and the next
thing he realized his vehicle
impacted a street light and then
came to rest off the roadway
some distance away.
18,065.00
18,065.00
0.00
0.00
3,033.91
3,033.91
127,510.62
127,510.62 0.00
0.00 0.00
0.00
0.00
0.00
21,098.91
21,098.91Grand Totals: 21 Claims
-5-
7:41:43AM
10/22/2018
16.E.4.b
Packet Pg. 1910 Attachment: Subrogation Close Claim Report 4th QTR FY 18 (7120 : Approval of closed claims by the
16.E.4.c
Packet Pg. 1911 Attachment: Resolution 2004-15 PDF0001 (7120 : Approval of closed claims by the Risk Management Director for the 4th Quarter FY 18)
16.E.4.c
Packet Pg. 1912 Attachment: Resolution 2004-15 PDF0001 (7120 : Approval of closed claims by the Risk Management Director for the 4th Quarter FY 18)
16.E.4.c
Packet Pg. 1913 Attachment: Resolution 2004-15 PDF0001 (7120 : Approval of closed claims by the Risk Management Director for the 4th Quarter FY 18)
16.E.4.c
Packet Pg. 1914 Attachment: Resolution 2004-15 PDF0001 (7120 : Approval of closed claims by the Risk Management Director for the 4th Quarter FY 18)
16.E.4.c
Packet Pg. 1915 Attachment: Resolution 2004-15 PDF0001 (7120 : Approval of closed claims by the Risk Management Director for the 4th Quarter FY 18)
16.E.4.c
Packet Pg. 1916 Attachment: Resolution 2004-15 PDF0001 (7120 : Approval of closed claims by the Risk Management Director for the 4th Quarter FY 18)