Agenda 03/12/2019 Item #16E103/12/2019
EXECUTIVE SUMMARY
Recommendation to ratify Property, Casualty, Workers’ Compensation and Subrogation claim
files settled and/or closed by the Risk Management Division Director pursuant to Resolution #2004 -
15 for the first quarter of FY 19.
OBJECTIVE: To settle routine, administrative and minor claims matters which promotes the efficient
use of resources and the efficient administration of the program; and allows for a timely response to
claimants and/or their representatives.
CONSIDERATIONS: Resolution 04-15 grants limited authority to the Risk Management Division
Director to settle certain damage claims against Collier County and to authorize the payment of
investigation and adjustment expenses as presented to the County’s Risk Management Program.
Authority is delegated as follows:
• Bodily Injury Liability- Premises, Auto, Operations: Non-litigated claims less than $50,000
• Property Damage Liability Claims- Premises, Auto, Operations: Non-litigated claims less than
$75,000
• Errors, Omissions, Professional Liability, Employment Practices Liability: Non-litigated claims
less than $50,000
• Property Losses to County Owned Property: Full authority
• Workers’ Compensation: Full authority subject to the provisions of F.S. 440 and subject to
approval by the Judge of Compensation as needed
• Employer’s Liability: Non-litigated claims less than $50,000
• Subrogation- Bodily Injury and Property Damage: Full authority to pursue non-litigated
subrogation recoveries
• Subrogation- Workers’ Compensation: Full authority to pursue non-litigated subrogation
recoveries.
Pursuant to the Resolution, claims are settled and paid according to the loss verification procedures
contained in the Resolution which include the completion of claim forms, documentation of evidence ,
valuation, and the determination of a finding of liability where applicable. Closed claim files are also
subject to review by the external auditor. A listing of claim files closed during the first quarter of FY 19
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 516-121650-645915 (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 19, 81 files were closed with total expenditures of
$239,650.01. During the same period, 12 subrogation files were closed, and the Risk Management
Division recovered $42,001.94 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, raises no legal
issue, and requires majority vote for acceptance of the Report. -JAK
RECOMMENDATION: To accept the attached Settlement Report and ratify the actions taken therein.
16.E.1
Packet Pg. 1104
03/12/2019
Prepared by: Jeff Walker CPCU, ARM, Division Director, Risk Management Division.
ATTACHMENT(S)
1. All Lines Closed Claim Report 1st Quarter FY 2019 (PDF)
2. Subrogation Closed Claim Report 1st QTR FY 2019 (PDF)
3. Resolution 2004-15 PDF0001 (PDF)
16.E.1
Packet Pg. 1105
03/12/2019
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.E.1
Doc ID: 8053
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 19.
Meeting Date: 03/12/2019
Prepared by:
Title: Division Director - Risk Management – Risk Management
Name: Jeff Walker
02/15/2019 7:45 AM
Submitted by:
Title: Division Director - Risk Management – Risk Management
Name: Jeff Walker
02/15/2019 7:45 AM
Approved By:
Review:
Administrative Services Department Paula Brethauer Level 1 Division Reviewer Completed 02/19/2019 9:16 AM
Administrative Services Department Len Price Level 2 Division Administrator Review Completed 02/20/2019 3:32 PM
County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 02/20/2019 3:37 PM
Office of Management and Budget Valerie Fleming Level 3 OMB Gatekeeper Review Completed 02/26/2019 5:08 PM
Office of Management and Budget Laura Wells Additional Reviewer Completed 02/27/2019 10:35 AM
County Manager's Office Leo E. Ochs Level 4 County Manager Review Completed 02/28/2019 4:09 PM
Board of County Commissioners MaryJo Brock Meeting Pending 03/12/2019 9:00 AM
16.E.1
Packet Pg. 1106
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 Risk Status Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
Coverage Cause
6,723.01 110.71 1,943.24 0.00 0.00 0.00 0.00 8,776.96
8/7/2018 8/7/2018 11/30/2018 6,723.01 110.71 1,943.24 0.00 0.00 0.00 0.00 8,776.96
10 1100
609.98 24.25 0.00 0.00 0.00 0.00 0.00 634.23
10/24/2018 10/24/2018 11/30/2018 609.98 24.25 0.00 0.00 0.00 0.00 0.00 634.23
10 1500
392.26 63.71 0.00 0.00 0.00 0.00 0.00 455.97
9/28/2018 9/28/2018 10/3/2018 392.26 63.71 0.00 0.00 0.00 0.00 0.00 455.97
10 1200
445.26 26.32 0.00 0.00 0.00 0.00 0.00 471.58
10/24/2018 11/7/2018 11/30/2018 445.26 26.32 0.00 0.00 0.00 0.00 0.00 471.58
10 1500
255.62 0.00 0.00 0.00 0.00 0.00 0.00 255.62
11/19/2018 11/19/2018 12/3/2018 255.62 0.00 0.00 0.00 0.00 0.00 0.00 255.62
10 1200
52,337.91 1,529.41 4,558.92 0.00 0.00 0.00 0.00 58,426.24
2/1/2017 2/7/2017 12/31/2018 52,337.91 1,529.41 4,558.92 0.00 0.00 0.00 0.00 58,426.24
10 1300
184.69 11.90 0.00 0.00 0.00 0.00 0.00 196.59
10/11/2018 10/12/2018 10/18/2018 184.69 11.90 0.00 0.00 0.00 0.00 0.00 196.59
10 1400
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
11/15/2018 12/4/2018 12/31/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1300 Employee slipped on wet floor in break
room and is complaining of back pain.
173439
Employee was in an auto accident and is
having abdominal pain.
1011151808522
313516
1002011705823
121165
Employee fell when her foot got caught in
the chair she was getting up from.
1010111808366
122240
Employee felt pain in left knee after
picking up cabinets at Home Depot for
Work Order.
1011191808488
163651
Employee cut left pointer finger on metal
bar while taking apart an old file.
1009281808331
182901
Employee stuck a needle nose pliers
through left third finger.
1010241808439
253211
Employee injured third digit finger and
left hand while working on a Plant Blower
Belt System.
1010241808393
121811
Employee was picking up trash and
injured her right hand causing pain and
swelling.
Cost Center
Carrier Employer Acc Desc.
Major Coverage: 10 - Workers' Compensation
1008071808192
Collier County Government
Closed Claim Report- All Lines
1st QTR FY 2019
Valued as of:2/14/2019
Claim Number Employee Name
1
16.E.1.a
Packet Pg. 1107 Attachment: All Lines Closed Claim Report 1st Quarter FY 2019 (8053 : Ratify Property, Casualty and
136.43 0.00 0.00 0.00 0.00 0.00 0.00 136.43
11/6/2018 11/6/2018 12/31/2018 136.43 0.00 0.00 0.00 0.00 0.00 0.00 136.43
10 1500
0.00 13.75 1,506.81 0.00 0.00 0.00 0.00 1,520.56
11/27/2018 11/28/2018 12/31/2018 0.00 13.75 1,506.81 0.00 0.00 0.00 0.00 1,520.56
10 1700
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
12/4/2018 12/5/2018 12/21/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1300
440.39 23.80 0.00 0.00 0.00 0.00 0.00 464.19
7/26/2018 8/3/2018 12/21/2018 440.39 23.80 0.00 0.00 0.00 0.00 0.00 464.19
10 1500
0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
12/16/2018 12/16/2018 12/21/2018 0.00 13.75 0.00 0.00 0.00 0.00 0.00 13.75
10 1900
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
11/30/2018 11/30/2018 12/12/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1700
4,674.02 2,424.74 0.00 0.00 0.00 0.00 0.00 7,098.76
4/26/2018 4/27/2018 12/21/2018 4,674.02 2,424.74 0.00 0.00 0.00 0.00 0.00 7,098.76
10 1300
190.71 0.00 0.00 0.00 0.00 0.00 0.00 190.71
11/13/2018 11/13/2018 11/30/2018 190.71 0.00 0.00 0.00 0.00 0.00 0.00 190.71
10 1500
0.00 0.00 209.15 0.00 0.00 0.00 0.00 209.15
12/6/2018 12/7/2018 12/31/2018 0.00 0.00 209.15 0.00 0.00 0.00 0.00 209.15
10 1400
182901
Employee twisted left ankle walking into
Maintenance Facility.
1012061808540
144610
Employee was involved in a Motor
Vehicle Collision while attending to a
patient and were T-boned by another
vehicle.
Employee struck head on a pole that was
in a vehicle not flagged in the front
parking lot and felt light headed and
bleeding.
1004261807925
138915
Employee tripped & fell on job site while
atteding to building nspection.
1011131808458
144610
Employee had a foreign object that
entered his eye during a call.
1011301808514
121155
1007261808183
138915
Employee did a foundation inspection and
the boot caught a wire and he fell and the
left thumb bent backwards.
1012161808565
163620
Employee was installing a Redhead bolt
to secure a handrail to concrete sidewalk
when the claw hammer chipped off and
went into arm.
1012041808525
138915
Employee tripped and fell and hit the
head of a raise nail and puncture his right
hand and pinky finger.
1011061808435
155410
Employee injured lower back while
opening the gate to Domestic Animal
Service. Gate has been broken since
10/18/18.
1011271808503
2
16.E.1.a
Packet Pg. 1108 Attachment: All Lines Closed Claim Report 1st Quarter FY 2019 (8053 : Ratify Property, Casualty and
225.05 0.00 0.00 0.00 0.00 0.00 0.00 225.05
11/6/2018 11/6/2018 11/30/2018 225.05 0.00 0.00 0.00 0.00 0.00 0.00 225.05
10 1200
20,373.16 569.99 7,066.25 0.00 0.00 0.00 0.00 28,009.40
5/22/2018 5/23/2018 11/29/2018 20,373.16 569.99 7,066.25 0.00 0.00 0.00 0.00 28,009.40
10 1500
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
12/5/2018 12/13/2018 12/31/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1500
86,988.49 4,812.33 15,284.37 0.00 0.00 0.00 0.00 107,085.19
86,988.49 4,812.33 15,284.37 0.00 0.00 0.00 0.00 107,085.19
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
6/2/2017 6/8/2017 11/2/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 5300
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
2/19/2017 3/13/2018 10/31/2018 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
9/10/2017 10/1/2018 11/2/2018 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
11/1/2018 11/8/2018 11/13/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 3200
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
7/24/2018 8/15/2018 12/6/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
20
2107241808220 KEITH, JOHN
156310
John and another student were playing
with a seat belt on the bus, the other
student let go of the belt and hit John in
the tooth, and chipped his tooth.
156332
Attorney for Robert Flick Trust called in
(Ellen Chadwell) stating a very large tree
has fallen off the bank of the canal, onto
Mr. Flicks lot, the canal was dedicated to
the public, so therefore they feel the
county should remove the tree.
2211011808442 PEREIRA, CAROL
163624
Went around a truck to get home, and
part of the road is missing, made left turn,
hit a pot hole and cracked the front right
rim.
2102191707762 RIDDLE, ANNIE
163613
Claimant was riding a scooter with her
grandaughter when she hit an uneven
sidewalk and was thrown out of the
scooter.
2209101708336 FLICK, ROBERT Trust
Total by Major Coverage 20 Claims
Major Coverage: 20 - General Liability
2206021706209 LIZAK, KATHERINE
163620
Claimant alleges she has white paint on
the drivers side of her red vehicle; she
stated that she knows she drove on
County roads where construction was
taking place.
163620
Employee injured left hip and lower back
removing a sign pole out of back of truck.
1012051808558
182901
Employee is complaining of right hand
pain while he was mowing.
1011061808432
155410
Employee was bitten by a dog in right
hand and is complaining of swelling and
pain.
1005221807986
3
16.E.1.a
Packet Pg. 1109 Attachment: All Lines Closed Claim Report 1st Quarter FY 2019 (8053 : Ratify Property, Casualty and
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10/1/2018 10/23/2018 12/20/2018 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
8/7/2018 8/9/2018 10/30/2018 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
11/3/2018 11/5/2018 12/31/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 2050
0.00 0.00 341.30 0.00 0.00 0.00 0.00 341.30
9/1/2018 10/5/2018 10/29/2018 0.00 0.00 341.30 0.00 0.00 0.00 0.00 341.30
22 L347
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
1/22/2018 9/10/2018 10/31/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22
0.00 0.00 477.59 0.00 0.00 0.00 0.00 477.59
7/28/2017 7/28/2017 10/31/2018 0.00 0.00 477.59 0.00 0.00 0.00 0.00 477.59
22 3000
Subrogation demand from Phoenix Loss
Control on behalf of Comcast is stating
Collier County or its Subcontractor did
damage to the Comcast cable while doing
work at 602 South 5th St. Immokalee, FL
34142.
2207281706319 100 Glenview Place, Parking Garage
144610
Medic 40/Truck #11 backed into the
parking garage roof at 100 Glenview
place, Naples FL 34108.
156332
While using the Collier Blvd boat ramp by
the Marco bridge, both of the claimants
driver's side trailer tires were pierced by a
piece of rebar sticking out under the water
on the ramp.
2201221808278 COMCAST, COMPANY
253212
2111031808431 Mary Totoro
156313
The patron had a fall in the ladies
restroom near the aquatic center. Floor
could of been wet from aquatic patrons
going in and out. A scrape was on her
nose as well.
2209011808345 DESEAR, JACQUELYN
156312
Maximilian Mazzone was running sprints
with his coach and team during basketball
practice on Monday October 1st and fell
backwards and broke his fall with his
hand and broke his right wrist.
2108071808195 CORTES, GABRIEL
156343
Child was playing a game, and in the
game he ran into another child and fell
over landed on his left wrist. first aid was
given ice for 10mins and rest and
repeated one more time, child said it hurt
but could move it. parent was notified at
pick up.
John and another student were playing
with a seat belt on the bus, the other
student let go of the belt and hit John in
the tooth, and chipped his tooth.
2110011808388 MAZZONE, MAXIMILIAN
4
16.E.1.a
Packet Pg. 1110 Attachment: All Lines Closed Claim Report 1st Quarter FY 2019 (8053 : Ratify Property, Casualty and
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
6/13/2018 6/13/2018 10/30/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 2200
0.00 0.00 196.86 0.00 0.00 0.00 0.00 196.86
11/22/2017 12/12/2017 10/19/2018 0.00 0.00 196.86 0.00 0.00 0.00 0.00 196.86
22 2150
1,000.00 0.00 0.00 0.00 0.00 0.00 0.00 1,000.00
12/11/2017 1/22/2018 10/8/2018 1,000.00 0.00 0.00 0.00 0.00 0.00 0.00 1,000.00
21 2050
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
11/6/2018 11/7/2018 12/31/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 635
1,000.00 0.00 1,015.75 0.00 0.00 0.00 0.00 2,015.75
1,000.00 0.00 1,015.75 0.00 0.00 0.00 0.00 2,015.75
12,000.00 0.00 0.00 0.00 0.00 0.00 0.00 12,000.00
5/19/2017 6/2/2017 10/31/2018 12,000.00 0.00 0.00 0.00 0.00 0.00 0.00 12,000.00
32
0.00 0.00 8,441.25 0.00 0.00 0.00 0.00 8,441.25
8/2/2018 8/2/2018 10/31/2018 0.00 0.00 8,441.25 0.00 0.00 0.00 0.00 8,441.25
32 3000
0.00 0.00 5,725.32 0.00 0.00 0.00 0.00 5,725.32
2/28/2018 2/28/2018 10/31/2018 0.00 0.00 5,725.32 0.00 0.00 0.00 0.00 5,725.32
32 91
3202281807765 ESPARZA, MIGUEL
RMSE
Truck CC2-1672 was making a right hand
turn into the turning lane making contact
with a vehicle that was at the rear of the
trailor. It is unclear if the vehicles were
committing a lane change at the same
time.
163630
Claimant was involved in a collision with
a County vehicle that failed to yield the
right-of-way as it was exiting a gas
station.
3208021804004 Anisladis Santos
157110
Employee was stopped at the stop sign of
39th Ave NE, & could not see NB traffic
due to two pickup trucks in the right turn
lane on Immokalee. Employee decided
to still enter the intersection and collided
with (V2) that was traveling NB on
Immokalee Rd.
253212
Distribution crew was on the street
performing a service break repair and had
idled the water main down. When break
repair was completed the main was
returned to normal pressure. Pipe inside
of customer's home then failed.
Total by Major Coverage 15 Claims
Major Coverage: 30 - Auto Liability
3205191706172 FRANCOIS, STEPHANY
2112111707395 LOHSE, ERIC
PBSE
Claimant tripped over a broken sprinkler
pipe that was stinking 6 inches above the
ground right at the edge of the walking
path.
2211061808437 CALDRIN, ANA
157710
Hector was swinging and a child next to
him took another swing and swung it
sideways striking Hector in the Right
Eyebrow area. Deep cut to eye area.
2211221707284 MILLER, RON
121650
Claimant was pulling away from a parking
stop and rebar caught the undercarriage
of his personal vehicle, pulling the front
bumper away from the fenders and the
grille.
2106131808047 ORTIZ, HECTOR
5
16.E.1.a
Packet Pg. 1111 Attachment: All Lines Closed Claim Report 1st Quarter FY 2019 (8053 : Ratify Property, Casualty and
0.00 0.00 3,743.14 0.00 0.00 0.00 0.00 3,743.14
11/3/2017 11/6/2017 10/31/2018 0.00 0.00 3,743.14 0.00 0.00 0.00 0.00 3,743.14
32
0.00 0.00 960.45 0.00 0.00 0.00 0.00 960.45
4/9/2018 4/10/2018 12/31/2018 0.00 0.00 960.45 0.00 0.00 0.00 0.00 960.45
32 3000
0.00 0.00 1,512.41 0.00 0.00 0.00 0.00 1,512.41
9/26/2018 9/28/2018 11/30/2018 0.00 0.00 1,512.41 0.00 0.00 0.00 0.00 1,512.41
32 3000
0.00 0.00 1,081.63 0.00 0.00 0.00 0.00 1,081.63
11/27/2018 11/27/2018 12/31/2018 0.00 0.00 1,081.63 0.00 0.00 0.00 0.00 1,081.63
32
12,000.00 0.00 21,464.20 0.00 0.00 0.00 0.00 33,464.20
12,000.00 0.00 21,464.20 0.00 0.00 0.00 0.00 33,464.20
0.00 0.00 16,359.08 0.00 0.00 0.00 0.00 16,359.08
8/2/2018 8/2/2018 10/18/2018 0.00 0.00 16,359.08 0.00 0.00 0.00 0.00 16,359.08
41 3000
0.00 0.00 1,112.68 0.00 0.00 0.00 0.00 1,112.68
4/2/2018 4/2/2018 11/9/2018 0.00 0.00 1,112.68 0.00 0.00 0.00 0.00 1,112.68
41 3000
157110
Employee was stopped at the stop sign of
39th Ave NE, & could not see NB traffic
due to two pickup trucks in the right turn
lane on Immokalee. Employee decided
to still enter the intersection and collided
with (V2) that was traveling NB on
Immokalee Rd.
4104021807845 Traffic Operations
163630
While working on sign repairs on
Livingston Rd Jimmy hit the fire hydrant
with vehicle # CC2-966 causing damage
to the left front bumper.
253212
Employee was turning north on to US 41
from Pine Ridge Road and struck vehicle
ahead of him.
Total by Major Coverage 7 Claims
Major Coverage: 40 - Auto Physical Damage
4108021808181 University Extension Office
Darlene Paskoll was making a right turn
on to Santa Barbara with a green light,
and then was struck by a collier county
vehicle-CC2-574.
3209261804006 Ariana Aguilar
156310
I was backing up to our back office, while
a incoming car was going picking up a kid
from the front, i was already in moving
motion while the car came in. I was
turning at a angle, thats when we both hit
each other.
3211271808499 Iyumva, Gratien
210130
Light changed to green, proceeded to go
and the car in front did not.
3204091807867 Paskoll, Darlene
253214
Truck CC2-1672 was making a right hand
turn into the turning lane making contact
with a vehicle that was at the rear of the
trailor. It is unclear if the vehicles were
committing a lane change at the same
time.
3211031707096 POMALESORBAN, JACQUELINE
6
16.E.1.a
Packet Pg. 1112 Attachment: All Lines Closed Claim Report 1st Quarter FY 2019 (8053 : Ratify Property, Casualty and
0.00 0.00 2,785.66 0.00 0.00 0.00 0.00 2,785.66
10/15/2018 10/15/2018 12/6/2018 0.00 0.00 2,785.66 0.00 0.00 0.00 0.00 2,785.66
41 3000
0.00 0.00 328.81 0.00 0.00 0.00 0.00 328.81
9/25/2018 9/25/2018 10/15/2018 0.00 0.00 328.81 0.00 0.00 0.00 0.00 328.81
41 3100
503.41 0.00 0.00 0.00 0.00 0.00 0.00 503.41
11/8/2018 11/8/2018 12/19/2018 503.41 0.00 0.00 0.00 0.00 0.00 0.00 503.41
42 629
0.00 0.00 111.05 0.00 0.00 0.00 0.00 111.05
10/3/2018 10/4/2018 10/15/2018 0.00 0.00 111.05 0.00 0.00 0.00 0.00 111.05
41 3000
0.00 0.00 905.70 0.00 0.00 0.00 0.00 905.70
10/30/2018 10/30/2018 11/29/2018 0.00 0.00 905.70 0.00 0.00 0.00 0.00 905.70
41 3000
0.00 0.00 1,750.64 0.00 0.00 0.00 0.00 1,750.64
7/9/2018 7/9/2018 10/29/2018 0.00 0.00 1,750.64 0.00 0.00 0.00 0.00 1,750.64
41 3000
0.00 0.00 4,828.27 0.00 0.00 0.00 0.00 4,828.27
8/15/2018 8/15/2018 12/6/2018 0.00 0.00 4,828.27 0.00 0.00 0.00 0.00 4,828.27
41 L105
4108151808223 Distribution
253212
Employee Eric Branch was pulling a Ford
F450 back into the garage at Water
Distribution. He turned too tight and struck
a parking bollard causing significant
damage to the passenger side of the
utility bin.
SOWE
Employee was driving trk#CC2-706
pulling trailer # 040574. The trailer came
off ball hitch landing on roadway causing
damage to truck and trailer.
4107091808105 Fleet Management
122410
Vehicle CC2-500 was parked in the
parking lot at Mcdonalds on Marco Island
while operator Tomas Rivera was using
the rest room. When he came out he
found the damage was done. Hit & Run
addident while parked.
4110031808342 Utilities
FLME
Dumping debris at the landfill and
accidently broke the fixed glass in the
back of the pickup truck.
4110301808408 Solid Waste
253215
While backing vehicle # CC2-1186 a
curbstop wrench struck and broke the rear
driverside window.
4211081808445 Collier County Appraisers
COL
Driving down the road and a rock hit the
windshield, and cracked the windshield.
4110151808368 Transportation
163651
Went to fix sign on 44th st sw Alley St and
while parking, I went over a rusted
decolored metal tube leaning toward the
ground. It impacted the right side of my
truck c22-969.
4109251808321 Meter Operations
7
16.E.1.a
Packet Pg. 1113 Attachment: All Lines Closed Claim Report 1st Quarter FY 2019 (8053 : Ratify Property, Casualty and
0.00 0.00 724.60 0.00 0.00 0.00 0.00 724.60
9/4/2018 9/4/2018 11/15/2018 0.00 0.00 724.60 0.00 0.00 0.00 0.00 724.60
41 3000
0.00 0.00 1,396.73 0.00 0.00 0.00 0.00 1,396.73
10/25/2018 10/25/2018 11/30/2018 0.00 0.00 1,396.73 0.00 0.00 0.00 0.00 1,396.73
41 3000
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10/1/2018 10/5/2018 11/19/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 3000
0.00 0.00 66.25 0.00 0.00 0.00 0.00 66.25
10/30/2018 10/30/2018 11/30/2018 0.00 0.00 66.25 0.00 0.00 0.00 0.00 66.25
41 3000
0.00 0.00 804.45 0.00 0.00 0.00 0.00 804.45
9/20/2018 9/20/2018 11/15/2018 0.00 0.00 804.45 0.00 0.00 0.00 0.00 804.45
41 L199
812.75 0.00 0.00 0.00 0.00 0.00 0.00 812.75
10/24/2018 10/25/2018 12/10/2018 812.75 0.00 0.00 0.00 0.00 0.00 0.00 812.75
42 629
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10/17/2018 10/17/2018 10/24/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 3000
CENE
While driving the right side mirror of the
county truck clipped the left side mirror of
a truck parked in the ROW. Tho other
truck mirror was built with a steel bar
around it and was very sturdy.
4210241808395 Public Utilities
PUTD
While the employee was driving Vehicle
number CC2-1176 a rock from a dump
truck struck the windshield. A minor crack
in the corner of the windshield was the
result.
4110171808377 LETOURNEAU, JEFFREY
SOWE
Employee was driving trk#CC2-706
pulling trailer # 040574. The trailer came
off ball hitch landing on roadway causing
damage to truck and trailer.
4109201808308 Meter Operations
253215
Kenny Alvarado reports that while
lowering the tailgate he noticed a crack in
the right rear taillight and a vertical dent in
the bumper of vehicle CC2-1764. He
notes that he is unaware of an incident
that would have caused the damage.
While backing vehicle CC2-1186 the
employee struck a mailbox causing a
scratch to the right quarter panel and
damaging the mailbox.
4110011808346 JUAN, VELAQUEZ
FMGE
When CPO Velazquez went to turn
around as he was backing up, he hit the
driver's side mirrior onto another county
vehicle. There was no damage to the
other vehicle involved. The damage to the
vehicle being operated was a cracked
driver side mirror.
4110301804005 Solid Waste
210130
A sign post in the median was not seen
by our driver when backing up to exit the
median.
4110251808396 Meter Operations
253215
4109041808269 Stake and Locate
8
16.E.1.a
Packet Pg. 1114 Attachment: All Lines Closed Claim Report 1st Quarter FY 2019 (8053 : Ratify Property, Casualty and
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
9/5/2018 9/5/2018 10/3/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41
851.88 0.00 0.00 0.00 0.00 0.00 0.00 851.88
11/15/2018 11/16/2018 11/30/2018 851.88 0.00 0.00 0.00 0.00 0.00 0.00 851.88
42 629
0.00 0.00 3,995.00 0.00 0.00 0.00 0.00 3,995.00
5/3/2018 5/10/2018 10/9/2018 0.00 0.00 3,995.00 0.00 0.00 0.00 0.00 3,995.00
41 3000
0.00 0.00 2,356.18 0.00 0.00 0.00 0.00 2,356.18
1/24/2018 1/24/2018 11/30/2018 0.00 0.00 2,356.18 0.00 0.00 0.00 0.00 2,356.18
41 3000
2,168.04 0.00 37,525.10 0.00 0.00 0.00 0.00 39,693.14
2,168.04 0.00 37,525.10 0.00 0.00 0.00 0.00 39,693.14
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
9/10/2017 9/29/2017 10/4/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
55 5400
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10/26/2017 2/7/2018 10/18/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
56 5900
5610261707538 Ashbritt Inc.
233315
During Hurricane Irma the County placed
an order for generators and female hard-
wired cables. Ashbritt sent the wrong
cables and their subcontractor Sun
Electric had to cut the cables in order to
accomodate the County's request.
Total by Major Coverage 20 Claims
Major Coverage: 50 - Property
5509101706712 Collier County Sheriff Office (District 7,
Carnestown Substation)
106010
Removal of tree knocked down by
Hurricane Irma.
PBSE
Employee driving a front end loader was
loading material into the bed of truck CC2-
629, and damaged the u-channel going
across the expanded metal (lattice-like)
top of the bed. Also, door frame needs to
be welded back.
4101241807402 Water Division
253212
Employee pulled onto the shoulder of
Capri Blvd. performing valve maintenance
duties. As he was pulling back into the
road, he struck a fire hydrant on the left
side of the truck. He called supervisor
immediately.
4211151808483 BRONSON, CARLTON
HHVS
Carlton was driving on County Barn Road
and a construction vehicle passed him,
going in the opposite direction. As the
vehicle passed, a rock flew up and hit the
windshield on the driver's side causing a
chip in the glass.
4105031807956 Pelican Bay Services
4109051808272 EMS
EMSE
Truck 31 (Medic 22) was driving on
Bayshore and at the intersection with
Barrett, they hit some debris in the road
(trash). There is no visable damage,
however they hear a faint "air leaking"
around the passenger rear wheel well.
Undetermined source.
9
16.E.1.a
Packet Pg. 1115 Attachment: All Lines Closed Claim Report 1st Quarter FY 2019 (8053 : Ratify Property, Casualty and
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
9/10/2017 9/29/2017 10/4/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
51 5400
4,895.00 0.00 0.00 0.00 0.00 0.00 0.00 4,895.00
8/30/2018 8/30/2018 12/31/2018 4,895.00 0.00 0.00 0.00 0.00 0.00 0.00 4,895.00
53
1,579.78 0.00 0.00 0.00 0.00 0.00 0.00 1,579.78
8/17/2018 8/28/2018 11/29/2018 1,579.78 0.00 0.00 0.00 0.00 0.00 0.00 1,579.78
51
9,296.50 0.00 0.00 0.00 0.00 0.00 0.00 9,296.50
11/10/2018 11/10/2018 11/30/2018 9,296.50 0.00 0.00 0.00 0.00 0.00 0.00 9,296.50
51 2400
5,159.99 0.00 0.00 0.00 0.00 0.00 0.00 5,159.99
10/3/2018 10/31/2018 12/18/2018 5,159.99 0.00 0.00 0.00 0.00 0.00 0.00 5,159.99
56 3000
2,443.34 0.00 0.00 0.00 0.00 0.00 0.00 2,443.34
7/29/2018 7/30/2018 10/31/2018 2,443.34 0.00 0.00 0.00 0.00 0.00 0.00 2,443.34
53 L314
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
9/10/2017 9/26/2017 11/20/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
53 5400
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
9/10/2017 9/26/2017 11/20/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
53 5400
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
9/10/2017 9/26/2017 11/20/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
53 5400
5309101706604 CAT (Bus Stop ID 419)
138336
Broken sign post.
138336
Bus stop sign down.
5309101706605 CAT (Bus Stop ID 4)
138336
Bus stop sign down.
5307291808172 Airport Authority
AAUD
Lighting storm damaged runway 09/27
and disabled multiple airfield lights.
5309101706606 CAT (Bus Stop ID 101)
156313
A water main broke at the Golden Gate
Park and Natural Resources Building,
flooding the building in ½” – 1” of water.
5610031808411 Road Maintenance and Stormwater
RMSE
Damage was discovered on the rear right
arm for the rear brush of CC2-900. How it
was damaged is unknown.
5108171808244 Communications
140480
Electrical servcie or generator transfer
switch was struck.
5111101808455 Natural Resources building
106010
During Hurricane Irma winds pushed in
metal wall allowing high water intrusion.
The carpet in one area has been
contaminated with brackish water from a
canal. Soffit & fascia damaged. Roof
damage.
5308301808250 Parks and Recreation
156315
Fire hydrant gate valve malfunctioned
from a lightning strike, blowout put sans
and waster all over parking lot and burnt
light controller in maintenance shop.
During Hurricane Irma the County placed
an order for generators and female hard-
wired cables. Ashbritt sent the wrong
cables and their subcontractor Sun
Electric had to cut the cables in order to
accomodate the County's request.
5109101706710 Collier County Sheriff Office (District
7/Carnestown Substation)
10
16.E.1.a
Packet Pg. 1116 Attachment: All Lines Closed Claim Report 1st Quarter FY 2019 (8053 : Ratify Property, Casualty and
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
9/10/2017 9/26/2017 11/20/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
53 5400
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
9/10/2017 9/26/2017 11/20/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
53 5400
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
9/10/2017 9/26/2017 11/20/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
53 5400
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10/12/2018 10/16/2018 10/29/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
53 2000
1,137.58 0.00 0.00 0.00 0.00 0.00 0.00 1,137.58
9/18/2018 10/10/2018 10/19/2018 1,137.58 0.00 0.00 0.00 0.00 0.00 0.00 1,137.58
50 L199
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
8/2/2018 8/3/2018 11/30/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
57 3000
32,879.54 0.00 0.00 0.00 0.00 0.00 0.00 32,879.54
6/28/2018 7/24/2018 10/31/2018 32,879.54 0.00 0.00 0.00 0.00 0.00 0.00 32,879.54
53 L314
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
9/10/2017 9/29/2017 10/4/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
53 5400
57,391.73 0.00 0.00 0.00 0.00 0.00 0.00 57,391.73
57,391.73 0.00 0.00 0.00 0.00 0.00 0.00 57,391.73
159,548.26 4,812.33 75,289.42 0.00 0.00 0.00 0.00 239,650.01
159,548.26 4,812.33 75,289.42 0.00 0.00 0.00 0.00 239,650.01
Total by Major Coverage 19 Claims
Grand Totals: 81 Claims
2/14/2019
12:54:34 PM
AAUD
Lightning strike disabled numerous
internal components on the Automated
Weather Observation System.
5309101706711 Collier County Sheriff Office (District
7/Carnestown Substation)
106010
Damage to fence during Hurricane Irma.
5708021808184 Pelican Bay Services
PBSE
While employee was operating our boat,
the bottom section of the boat motor was
damaged by concrete. Yamaha boat
motor on asset #CC2-1601
5306281808150 Airport Authority
PUTD
While leaving the facility the Synagro
driver ran into and damaged the entry
gate at the Golden Gate Wastewater
facility.
5309181808357 Wastewater-Reuse Section
233313
Truck backed into light pole.
5309101706600 CAT (Bus Stop ID 18)
138336
Bus Shelter panels loosened.
5310121808374 Golden Gate Wastewater Facility
138336
Broken sign post.
5309101706601 CAT (Bus Stop ID 152)
138336
Bike rack needs reinstallation after
Hurricane Irma.
5309101706603 CAT (Bus Stop ID 396)
11
16.E.1.a
Packet Pg. 1117 Attachment: All Lines Closed Claim Report 1st Quarter FY 2019 (8053 : Ratify Property, Casualty and
Collier County Government
Subrogation Closed Claim Report
1st QTR FY 2019
Valued as of:2/14/2019
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 23.85 0.00 0.00 0.00CC V. Geico4108151808222
10/1/20188/15/2018 8/15/2018 0.00 0.00 0.00 23.85 0.00 0.00 0.00 0.00144610
41 Paramedic M. Arvin was in
Vehicle CC2-1130 and was
stopped at a red light. When the
light turned green, the red
Hyundai Sonata in front of her
backed into her car for unknown
reasons.
3000
6,803.62 0.00 0.00 0.00 6,826.15 6,803.62 0.00 0.00CC V. Geico4104191807908
10/10/20184/19/2018 4/21/2018 0.00 6,803.62 0.00 6,826.15 6,803.62 0.00 0.00 0.00155410
41 We were driving down Tara Cir in
a apartment complex patrolling
for a stray dog. I was going 7-10
mph; unsure of exact speed. As I
passed, the gentleman backed
his vehicle out and hit me on the
right sliding door.
3000
591.00 0.00 0.00 0.00 1,254.65 0.00 0.00 591.00CC V Progressive Insurance5307071808163
10/31/20187/7/2018 7/27/2018 591.00 0.00 0.00 1,254.65 591.00 0.00 0.00 0.00163630
53 Vehicle struck a pedestrian
signal support.
L105
660.20 0.00 0.00 0.00 780.20 660.20 0.00 0.00CC V. Vernon Westfall4103211807787
10/9/20183/21/2018 3/21/2018 0.00 660.20 0.00 780.20 660.20 0.00 0.00 0.00FMGE
30 Carlos went to turn left and the
other car ran the red light and hit
him from behind.
3000
35.96 0.00 0.00 0.00 535.96 35.96 0.00 0.00CC V. Progressive Insurance4108141808224
12/10/20188/14/2018 8/16/2018 0.00 35.96 0.00 535.96 35.96 0.00 0.00 0.00155410
41 DAS Van CC2-871 was parked
on the side of the road as the
officer was completing a call for
service. The vehicle was side
swiped by a van driven by Nelsy
Avila-Caballero.
-1-
12:52:09PM
2/14/2019
16.E.1.b
Packet Pg. 1118 Attachment: Subrogation Closed Claim Report 1st QTR FY 2019 (8053 : Ratify Property, Casualty and
Collier County Government
Subrogation Closed Claim Report
1st QTR FY 2019
Valued as of:2/14/2019
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 0.00 821.60 0.00 0.00 0.00CC v. Gerard Pierre5405191707512
11/29/20185/19/2017 2/6/2018 0.00 0.00 0.00 821.60 0.00 0.00 0.00 0.00163647
54 Gerard Pierre was driving
southbound on Collier Blvd when
he applied his brakes to stop for
traffic, losing control of the
vehicle and crossing the median
into oncoming northbound traffic .
3000
0.00 0.00 0.00 0.00 52.52 0.00 0.00 0.00Traffic Operations V. Direct
General
5308311808287
10/17/20188/31/2018 9/14/2018 0.00 0.00 0.00 52.52 0.00 0.00 0.00 0.00163630
53 Car accident, a person hit a sign
and also landscape in the
median.
7,857.24 0.00 0.00 0.00 7,564.80 0.00 0.00 7,857.24Traffic Operations V. Allstate
Insurance
5306141808311
10/23/20186/14/2018 9/21/2018 7,857.24 0.00 0.00 7,564.80 7,857.24 0.00 0.00 0.00163630
53 UPS cabinet that was hit the
door and also corner was
damaged
0.00 0.00 0.00 0.00 559.78 0.00 0.00 0.00Traffic Operations VS.
Progressive Insurance
5310071808375
10/26/201810/7/2018 10/16/2018 0.00 0.00 0.00 559.78 0.00 0.00 0.00 0.00163630
53 After collision, vehicle 1 struck a
curb and traffic pole , vehicle 2
struck a curb and a traffic control
sign.
0.00 0.00 0.00 0.00 94.62 0.00 0.00 0.00Traffic Operations VS. Geico5310081808386
11/2/201810/8/2018 10/22/2018 0.00 0.00 0.00 94.62 0.00 0.00 0.00 0.00163630
53 Driver turning right onto
Outrigger Ln from Airport Rd
when he lost control and his
vehicle slid into a nearby stop
sign.
3000
-2-
12:52:09PM
2/14/2019
16.E.1.b
Packet Pg. 1119 Attachment: Subrogation Closed Claim Report 1st QTR FY 2019 (8053 : Ratify Property, Casualty and
Collier County Government
Subrogation Closed Claim Report
1st QTR FY 2019
Valued as of:2/14/2019
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 2,633.01 0.00 0.00 0.00CC v. USAA5308021808473
12/12/20188/2/2018 11/14/2018 0.00 0.00 0.00 2,633.01 0.00 0.00 0.00 0.00163630
53 Vehicle one drove southwest
after crossing the median into
the opposite travel lanes and
collided with a light pole on the
south grass area of Davis Blvd.
3000
0.00 0.00 0.00 0.00 20,854.80 0.00 0.00 0.00Traffic Operations VS.
Progressive Insurance
5307171808507
12/19/20187/17/2018 11/29/2018 0.00 0.00 0.00 20,854.80 0.00 0.00 0.00 0.00163630
53 Car accident at intersection one
of the cars hit signal and UPS
cabinet on corner.
3000
8,448.24
8,448.24
0.00
0.00
7,499.78
7,499.78
42,001.94
42,001.94 0.00
0.00 0.00
0.00
0.00
0.00
15,948.02
15,948.02Grand Totals: 12 Claims
-3-
12:52:09PM
2/14/2019
16.E.1.b
Packet Pg. 1120 Attachment: Subrogation Closed Claim Report 1st QTR FY 2019 (8053 : Ratify Property, Casualty and
16.E.1.c
Packet Pg. 1121 Attachment: Resolution 2004-15 PDF0001 (8053 : Ratify Property, Casualty and Workers' Compensation Claim File Closure)
16.E.1.c
Packet Pg. 1122 Attachment: Resolution 2004-15 PDF0001 (8053 : Ratify Property, Casualty and Workers' Compensation Claim File Closure)
16.E.1.c
Packet Pg. 1123 Attachment: Resolution 2004-15 PDF0001 (8053 : Ratify Property, Casualty and Workers' Compensation Claim File Closure)
16.E.1.c
Packet Pg. 1124 Attachment: Resolution 2004-15 PDF0001 (8053 : Ratify Property, Casualty and Workers' Compensation Claim File Closure)
16.E.1.c
Packet Pg. 1125 Attachment: Resolution 2004-15 PDF0001 (8053 : Ratify Property, Casualty and Workers' Compensation Claim File Closure)
16.E.1.c
Packet Pg. 1126 Attachment: Resolution 2004-15 PDF0001 (8053 : Ratify Property, Casualty and Workers' Compensation Claim File Closure)