Agenda 05/28/2019 Item #16E 1 (Risk Management Claims Report)05/28/2019
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 second 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 second 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 516-121650-645920 (Property and
Casualty Self Insurance Fund) and 518-121630-645928 (Workers’ Compensation Fund) for the payment
of claims and settlements. For the second quarter of FY 19, 89 files were closed with total expenditures of
$386,042.66. During the same period, 43 subrogation files were closed, and the Risk Management
Division recovered $386,972.97 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 ratifies the actions taken therein.
PREPARED BY: Jeff Walker CPCU, ARM, Division Director, Risk Management Division.
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05/28/2019
ATTACHMENT(S)
1. All Lines Closed Claim Report 2nd QTR FY 19 (PDF)
2. Subrogation Closed Claim Report 2nd QTR FY 19 (PDF)
3. Resolution 2004-15 PDF0001 (PDF)
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05/28/2019
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.E.1
Doc ID: 8862
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 second quarter of FY 19.
Meeting Date: 05/28/2019
Prepared by:
Title: Division Director - Risk Management – Risk Management
Name: Jeff Walker
05/02/2019 4:09 PM
Submitted by:
Title: Division Director - Risk Management – Risk Management
Name: Jeff Walker
05/02/2019 4:09 PM
Approved By:
Review:
Administrative Services Department Paula Brethauer Level 1 Division Reviewer Completed 05/07/2019 2:30 PM
Administrative Services Department Len Price Level 2 Division Administrator Review Completed 05/10/2019 4:56 PM
Office of Management and Budget Valerie Fleming Level 3 OMB Gatekeeper Review Completed 05/13/2019 2:08 PM
County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 05/15/2019 1:07 PM
Office of Management and Budget Laura Wells Additional Reviewer Completed 05/16/2019 7:42 PM
County Manager's Office Nick Casalanguida Level 4 County Manager Review Completed 05/19/2019 8:56 AM
Board of County Commissioners MaryJo Brock Meeting Pending 05/28/2019 9:00 AM
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Collier County Government
Closed Claim Report- All Lines
2nd QTR FY 2019
Valued as of:4/30/2019
Med/BI/Comp Expense Ind/PD/Coll Recovery Deductible Legal Other Total Inc
Claim Number Employee Name Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total Incurred Total
Division 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 Carrier Cause Employer Acc Desc.
Major Coverage: 10 - Workers' Compensation
1002271908856 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
ASAE 2/27/2019 2/27/2019 3/13/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1300 Employee tripped and fell on pavement while stepping out of Ambulance and injured back of head.
1003301807842 7,878.59 1,752.75 7,892.64 0.00 0.00 0.00 0.00 17,523.98
MHCP 3/30/2018 4/2/2018 3/12/2019 7,878.59 1,752.75 7,892.64 0.00 0.00 0.00 0.00 17,523.98
10 1500 Employee was locating valve boxes and injured right shoulder removing debris in the preserve area.
1002011908744 229.64 18.60 0.00 0.00 0.00 0.00 0.00 248.24
COAE 2/1/2019 2/1/2019 2/14/2019 229.64 18.60 0.00 0.00 0.00 0.00 0.00 248.24
10 1700 Employee was struck in the head by a phone receiver.
1003261908961 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
DASE 3/26/2019 3/26/2019 3/31/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1200 Employee was pre-medicating dog for surgery, and was bitten on left hand while removing the leash.
1011011808612 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
FMGE 11/1/2018 1/7/2019 2/13/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1900 Employee was sorting boxes to be scanned when he accidently poked himself in the eye with the edge of one of the boxes.
1010311808443 361.12 23.80 0.00 0.00 0.00 0.00 0.00 384.92
COAE 10/31/2018 11/8/2018 1/31/2019 361.12 23.80 0.00 0.00 0.00 0.00 0.00 384.92
10 1300 Employee tripped on carpet in lobby at work and is complaining of head, elbow hip, & knee pain.
1002221908834 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
COAE 2/22/2019 2/22/2019 3/29/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1300 Employee tripped and fell in lobby of Courthouse while walking back from lunch.
1003151908926 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
DASE 3/15/2019 3/15/2019 3/21/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1300 Employee slipped and fell on the grass, when the dog she was walking, pull on her and got away.
1001311908751 779.64 5.95 0.00 0.00 0.00 0.00 0.00 785.59
EMSE 1/31/2019 2/5/2019 2/28/2019 779.64 5.95 0.00 0.00 0.00 0.00 0.00 785.59
10 1300 Employee stepped on a storm drain causing her to fall to the gournd landing on lower arm.
1012271808592 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
EMSE 12/27/2018 12/27/2018 3/22/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1500 Employee felt a pop in lower back while moving a patient from the Ambulance stretcher to the hospital bed.
1010311808414 21,290.25 61.35 571.02 0.00 0.00 0.00 0.00 21,922.62
EMSE 10/31/2018 10/31/2018 1/31/2019 21,290.25 61.35 571.02 0.00 0.00 0.00 0.00 21,922.62
10 1300 Employee fell and landed face first on floor while working out on duty.
1001011908607 339.71 31.60 0.00 0.00 0.00 0.00 0.00 371.31
EMSE 1/1/2019 1/2/2019 2/26/2019 339.71 31.60 0.00 0.00 0.00 0.00 0.00 371.31
10 1500 Employee was running on treadmill when he began feeling severe pain in left knee.
1012041808524 1,886.95 31.60 373.54 0.00 0.00 0.00 0.00 2,292.09
EMSE 12/4/2018 12/4/2018 1/28/2019 1,886.95 31.60 373.54 0.00 0.00 0.00 0.00 2,292.09
10 1500 Employee was exercising when he lifted a heavy object and felt pain in lower back.
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Packet Pg. 991 Attachment: All Lines Closed Claim Report 2nd QTR FY 19 (8862 : Approval of Closed Claim Reports for
1007011708141 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CICE 7/1/2017 7/20/2018 2/26/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1900 Pain in wrists and hands from repetitive typing.
1005181706132 6,466.48 5,939.10 649.20 0.00 0.00 0.00 0.00 13,054.78
ORMD 5/18/2017 5/19/2017 2/1/2019 6,466.48 5,939.10 649.20 0.00 0.00 0.00 0.00 13,054.78
10 1300 Employee stepped over a plastic pool fence and his left foot became caught, causing him to fall and land on his left side.
1002141807714 5,285.83 339.00 0.00 0.00 0.00 0.00 0.00 5,624.83
INTE 2/14/2018 2/20/2018 1/28/2019 5,285.83 339.00 0.00 0.00 0.00 0.00 0.00 5,624.83
10 1500 Employee injured back moving 44 computers to Emergency Operation Center (EOC).
1010231808391 166.98 11.90 0.00 0.00 0.00 0.00 0.00 178.88
RMSE 10/23/2018 10/24/2018 3/22/2019 166.98 11.90 0.00 0.00 0.00 0.00 0.00 178.88
10 1700 The indiviual that was using the hammer missed the object and hit Joe on the top outside of his left foot just above the steel toe.
1011081707112 66,467.44 11,558.20 20,876.15 0.00 0.00 0.00 0.00 98,901.79
PURE 11/8/2017 11/8/2017 3/31/2019 66,467.44 11,558.20 20,876.15 0.00 0.00 0.00 0.00 98,901.79
10 1300 Employee fell on uneven pavement in front of the TAX Collector Bldg and hit the right side of face. Injury to face.
1010261808407 481.10 48.18 0.00 0.00 0.00 0.00 0.00 529.28
WWTE 10/26/2018 10/30/2018 1/31/2019 481.10 48.18 0.00 0.00 0.00 0.00 0.00 529.28
10 1100 Employee smashed left index finger picking up tubes off the Vactor and complaining of finger "locks up".
1011101808457 2,400.87 131.83 0.00 0.00 0.00 0.00 0.00 2,532.70
HURE 11/10/2018 11/13/2018 3/31/2019 2,400.87 131.83 0.00 0.00 0.00 0.00 0.00 2,532.70
10 1500 Employee stumbled backwards and fell while pulling on incoming access gate to the Museum.
1003141807777 6,557.21 49.74 0.00 0.00 0.00 0.00 0.00 6,606.95
EMSE 3/14/2018 3/15/2018 2/26/2019 6,557.21 49.74 0.00 0.00 0.00 0.00 0.00 6,606.95
10 1200 Employee punctured his left thumb while checking C-Collar bag during morning truck.
1012131808562 338.38 15.13 0.00 0.00 0.00 0.00 0.00 353.51
EMSE 12/13/2018 12/13/2018 2/26/2019 338.38 15.13 0.00 0.00 0.00 0.00 0.00 353.51
10 1000 Employee had blood splashed on arm from taking care of patient.
1012061808539 5,528.00 37.55 0.00 0.00 0.00 0.00 0.00 5,565.55
EMSE 12/6/2018 12/7/2018 1/31/2019 5,528.00 37.55 0.00 0.00 0.00 0.00 0.00 5,565.55
10 1400 Employee was involved in a motor vehicle collision and is complaining of contusion to chest.
1003271908965 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
WATE 3/27/2019 3/27/2019 3/31/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1200 Employee was nicked on back of right hand with barb wire while co-worker was cutting fence.
1001021908606 1,304.10 23.80 0.00 0.00 0.00 0.00 0.00 1,327.90
TXCE 1/2/2019 1/2/2019 3/18/2019 1,304.10 23.80 0.00 0.00 0.00 0.00 0.00 1,327.90
10 1300 Employee fell backwards into cabinets banging head and scraping left forearm and right uppper arm.
1002061908757 5,521.84 5.95 0.00 0.00 0.00 0.00 0.00 5,527.79
TECM 2/6/2019 2/6/2019 2/15/2019 5,521.84 5.95 0.00 0.00 0.00 0.00 0.00 5,527.79
10 1400 Employee was rear ended by another vehicle and is complaining of low back pain.
1002061908758 989.85 17.85 0.00 0.00 0.00 0.00 0.00 1,007.70
TECM 2/6/2019 2/6/2019 2/14/2019 989.85 17.85 0.00 0.00 0.00 0.00 0.00 1,007.70
10 1400 Employee was rear-ended by another vehicle and is complaining of lower back pain.
1003131908922 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
FMGE 3/13/2019 3/14/2019 3/15/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 1400 Employee was rear ended by another vehicle and is complaining of neck and back pain.
1002271908869 252.64 0.00 0.00 0.00 0.00 0.00 0.00 252.64
FMGE 2/27/2019 3/1/2019 3/22/2019 252.64 0.00 0.00 0.00 0.00 0.00 0.00 252.64
10 1500 Employee pulled muscle in left knee while installing railing.
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Packet Pg. 992 Attachment: All Lines Closed Claim Report 2nd QTR FY 19 (8862 : Approval of Closed Claim Reports for
1001221908696 352.53 27.01 0.00 0.00 0.00 0.00 0.00 379.54
LDSD 1/22/2019 1/23/2019 1/29/2019 352.53 27.01 0.00 0.00 0.00 0.00 0.00 379.54
10 1300 Employee injured left leg when he fell backwards off tractor.
1002081908779 322.50 0.00 0.00 0.00 0.00 0.00 0.00 322.50
MHCP 2/8/2019 2/11/2019 2/13/2019 322.50 0.00 0.00 0.00 0.00 0.00 0.00 322.50
10 1500 Employee felt sharp pain in neck while loading trimmings into dump trailer.
1001171908675 136.43 5.95 0.00 0.00 0.00 0.00 0.00 142.38
MHCP 1/17/2019 1/17/2019 2/13/2019 136.43 5.95 0.00 0.00 0.00 0.00 0.00 142.38
10 1300 Employee was playing with kids on the playground when he lost his balance and fell striking face.
1003051908882 242.16 0.00 0.00 0.00 0.00 0.00 0.00 242.16
MHCP 3/5/2019 3/6/2019 3/13/2019 242.16 0.00 0.00 0.00 0.00 0.00 0.00 242.16
10 1300 Employee slipped when he went to pick up trash from out of county vehicle and was struck in the chest by the door of vehicle.
1003071908890 252.35 13.75 0.00 0.00 0.00 0.00 0.00 266.10
MHCP 3/7/2019 3/7/2019 3/19/2019 252.35 13.75 0.00 0.00 0.00 0.00 0.00 266.10
10 1500 Employee was changing a sprinkler and while digging a hole with his shovel hit a tree root and felt pinching in right wrist.
1001311908740 370.35 20.33 0.00 0.00 0.00 0.00 0.00 390.68
ORMD 1/31/2019 2/1/2019 2/25/2019 370.35 20.33 0.00 0.00 0.00 0.00 0.00 390.68
10 1200 Employee was working with plywood and got splinter in right palm.
1002251908845 369.35 0.00 0.00 0.00 0.00 0.00 0.00 369.35
ORMD 2/25/2019 2/26/2019 2/28/2019 369.35 0.00 0.00 0.00 0.00 0.00 0.00 369.35
10 1300 Employee was pulling cart when she tripped and is feeling discomfort in left ankle and arch of foot.
1010101808354 2,638.48 87.24 0.00 0.00 0.00 0.00 0.00 2,725.72
PELB 10/10/2018 10/10/2018 1/24/2019 2,638.48 87.24 0.00 0.00 0.00 0.00 0.00 2,725.72
10 1400 Employee was driving a Kubota which was hit in the rear by another vehicle. Employee jolted forward and now complains of mild R lower back pain increased with certain movements.
1002211908816 483.35 0.00 0.00 0.00 0.00 0.00 0.00 483.35
RMSE 2/21/2019 2/21/2019 3/31/2019 483.35 0.00 0.00 0.00 0.00 0.00 0.00 483.35
10 1500 Employee pulled muscle in lower back area while removing 4"x4"x10' tree support.
139,694.12 20,258.16 30,362.55 0.00 0.00 0.00 0.00 190,314.83
Total by Major Coverage 38 Claims 139,694.12 20,258.16 30,362.55 0.00 0.00 0.00 0.00 190,314.83
Major Coverage: 20 - General Liability
2101261708855 OWENS, CHELSEA 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
RMSE 1/26/2017 2/27/2019 2/28/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 Claimant stated she tripped over shattered and busted pieces of concrete from the sidewalk within Brittany Bay Apartment Complex.
2103021708471 NEUHAUSEL, HERBERT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
RMSE 3/2/2017 11/14/2018 2/22/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 1300 Received a public records request from Goldstein, Buckley, Cechman, Rice & Purtz, P.A. Attorneys At Law for a trip and fall accident.
2109171605515 HUSSEINI, FARRIS 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
MUSE 9/17/2016 9/30/2016 1/28/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 2050 Received notice from attorney that claimant allegedly "slippped on green mildew/mold/moss . . . on the walking path, which caused him to fall to the ground and suffer injuries."
2103211706128 SHLENSKY, JULIE 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
LIBE 3/21/2017 5/18/2017 1/30/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 2050 Claimant alleges she tripped over some raised pavers while walking out of the parking area of the Pelican Bay Library near The Inn at Pelican Bay Hotel.
2106041808017 DACHUK, STACY 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
UESE 6/4/2018 6/4/2018 1/31/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 1300 Claimant tripped over a broken broomstick in the parking lot and punctured her right hand on the palm and her wrist is splinted.
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Packet Pg. 993 Attachment: All Lines Closed Claim Report 2nd QTR FY 19 (8862 : Approval of Closed Claim Reports for
2212201808604 Nelson, Martha 0.00 0.00 1,093.00 0.00 0.00 0.00 0.00 1,093.00
WATE 12/20/2018 1/2/2019 1/31/2019 0.00 0.00 1,093.00 0.00 0.00 0.00 0.00 1,093.00
20 Customer reported that during a meter replacement sand entered the line causing damage to the shower valve and toilet valve and is seeking re-imbursement.
2201111908662 Claudine Auclair 0.00 0.00 243.36 0.00 0.00 0.00 0.00 243.36
FMGE 1/11/2019 1/16/2019 2/28/2019 0.00 0.00 243.36 0.00 0.00 0.00 0.00 243.36
22 Claimant went to the main campus to renew driver's license. When leaving the premises, a rod in the wheel stop ripped the rubber portion of their Ford Explorer bumper.
2205041807961 Andrews, Paul 0.00 0.00 1,144.77 0.00 0.00 0.00 0.00 1,144.77
WATE 5/4/2018 5/14/2018 2/15/2019 0.00 0.00 1,144.77 0.00 0.00 0.00 0.00 1,144.77
22 5900 Customer claims that due to a meter replacement on May 4th his washing machine was damaged beyound repair and he had it replaced.
2205111808323 James Carr 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
RMSE 5/11/2018 9/25/2018 1/31/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 The citizen that lives at 3062 Ponce De Leon Dr claims that swale maintenance caused his pavers to cave.
2211281808533 HOWELL, KENDRA 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
MHCP 11/28/2018 12/5/2018 1/31/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 Cameron Berrien was on the basketball court and threw a rock at a passing car.
2104201807953 SCHILLER III, JOHN 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
RMSE 4/20/2018 5/8/2018 2/15/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 3000 Claimant is alleging that he suffered serious permanent injuries as a result of a collier county employee not wearing a high visibility shirt/vest suddenly running out into traffic.
2107261808162 SANTIAGO-PETERSON, JORDANA 40,000.00 1,650.00 0.00 0.00 0.00 0.00 0.00 41,650.00
MHCP 7/26/2018 7/26/2018 1/28/2019 40,000.00 1,650.00 0.00 0.00 0.00 0.00 0.00 41,650.00
21 5900 Child was found unresponsive in the Eagle Lakes family pool.
2205151807980 MURPHY, BRANDON 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
RMSE 5/15/2018 5/21/2018 2/15/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
20 3200 Claimant was driving on far right lane, saw something in the road, ran over something and saw man hole spinning in middle of the road.
2202031908767 WOCHEK, WARREN 0.00 0.00 419.56 0.00 0.00 0.00 0.00 419.56
WWTE 2/3/2019 2/7/2019 2/28/2019 0.00 0.00 419.56 0.00 0.00 0.00 0.00 419.56
22 Customer called in backup. found roots coming in at connection 4" to 6". Called in emergency contractor to make repairs.
40,000.00 1,650.00 2,900.69 0.00 0.00 0.00 0.00 44,550.69
Total by Major Coverage 14 Claims 40,000.00 1,650.00 2,900.69 0.00 0.00 0.00 0.00 44,550.69
Major Coverage: 30 - Auto Liability
3201161908689 PUD Employee 0.00 0.00 1,429.95 0.00 0.00 0.00 0.00 1,429.95
FMGE 1/16/2019 1/22/2019 2/7/2019 0.00 0.00 1,429.95 0.00 0.00 0.00 0.00 1,429.95
32 Collier County Facilities Management vehicle accidently touched/bumped into a PUD employee's car while backing into a space.
3209201808306 Doherty, Stephanie 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
EMSE 9/20/2018 9/20/2018 3/13/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
32 3000 Paramedic Driver pulled onto Immokalee Rd southbound from EMS10 and struck vehicle travelling southbound on Immokalee rd resulting in minor damage to both vehicles.
3212221808589 NORTH COLLIER, FIRE RESCUE 0.00 0.00 334.19 0.00 0.00 0.00 0.00 334.19
EMSE 12/22/2018 12/22/2018 2/6/2019 0.00 0.00 334.19 0.00 0.00 0.00 0.00 334.19
32 3000 Medic 24 truck 29 struck North Collier Fire Departments engine 40 on scene of a medical call while trying to park.
3201171908671 JOHNSON, KATHRYN 0.00 0.00 1,725.76 0.00 0.00 0.00 0.00 1,725.76
ORMD 1/17/2019 1/17/2019 3/27/2019 0.00 0.00 1,725.76 0.00 0.00 0.00 0.00 1,725.76
32 3000 Inspector backed up and felt a bump. Back up sensors did not sound but inspector did not see the car in his rear view.
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Packet Pg. 994 Attachment: All Lines Closed Claim Report 2nd QTR FY 19 (8862 : Approval of Closed Claim Reports for
321011180836601 Almaral Pileta, Leosdan 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
SOWE 10/11/2018 10/11/2018 1/15/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
32 3000 CC2-843 and occupants were rear ended at the intersection of Davis Blvd and County Barn Rd's heading west, just where the left turn lane starts.
3203191908934 Michael Minatree 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
TECM 3/19/2019 3/19/2019 3/28/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
32 3000 Brakes failed at traffic light.
3212111808566 Pinero, Elvis 0.00 0.00 5,141.86 0.00 0.00 0.00 0.00 5,141.86
UOSD 12/11/2018 12/12/2018 1/31/2019 0.00 0.00 5,141.86 0.00 0.00 0.00 0.00 5,141.86
32 3000 County staff was exiting a parking spot going left and 3rd party driver made contact with front right bumper.
3201051807354 OIA Air Corp.0.00 0.00 1,098.00 0.00 0.00 0.00 0.00 1,098.00
OPRS 1/5/2018 1/6/2018 3/7/2019 0.00 0.00 1,098.00 0.00 0.00 0.00 0.00 1,098.00
32 Andrew was fueling a Citation Excel with the New Jet A Truck. When he finished fueling, he drove off but did not realize he forgot the Bonding cable on the aircraft.
3102011807457 Jennings, Denva Reamo 34,000.00 0.00 0.00 0.00 0.00 0.00 0.00 34,000.00
VSCE 2/1/2018 2/2/2018 2/20/2019 34,000.00 0.00 0.00 0.00 0.00 0.00 0.00 34,000.00
31 3000 While driving a Veterans Services Client to an appointment in Miami,a volunteer driver was involved in an accident with a non-motorist.
34,000.00 0.00 9,729.76 0.00 0.00 0.00 0.00 43,729.76
Total by Major Coverage 9 Claims 34,000.00 0.00 9,729.76 0.00 0.00 0.00 0.00 43,729.76
Major Coverage: 40 - Auto Physical Damage
4101041908609 EMS 0.00 0.00 26,859.99 0.00 0.00 0.00 0.00 26,859.99
EMSE 1/4/2019 1/5/2019 3/25/2019 0.00 0.00 26,859.99 0.00 0.00 0.00 0.00 26,859.99
41 3000 Medic 30 was transporting a patient nonemergency when a large animal believed to be a deer, ran out in front of the ambulance.
4101111908631 Fleet 0.00 0.00 2,190.30 0.00 0.00 0.00 0.00 2,190.30
FLME 1/11/2019 1/11/2019 2/11/2019 0.00 0.00 2,190.30 0.00 0.00 0.00 0.00 2,190.30
41 3000 Fleet vehicle CC2-1070 (white F-150) operated by employee, rear ended vehicle (blue BMW) at the intersection of Countybarn Rd and Davis blvd. around 10:00am this morning.
4106141808050 Distribution 1,994.00 0.00 0.00 0.00 0.00 0.00 0.00 1,994.00
WATE 6/14/2018 6/14/2018 2/28/2019 1,994.00 0.00 0.00 0.00 0.00 0.00 0.00 1,994.00
41 Employee reported scratch on vehicle CC2-1338 Drivers side rear utility door.
4112031808521 Building Review & Permitting Inspection 0.00 0.00 666.45 0.00 500.00 0.00 0.00 666.45
ORMD 12/3/2018 12/4/2018 2/28/2019 0.00 0.00 666.45 0.00 500.00 0.00 0.00 666.45
41 3000 Employee tapped the car in front stopped at a red light.
4111261808500 Building Review and Permitting 0.00 0.00 1,337.22 0.00 0.00 0.00 0.00 1,337.22
ORMD 11/26/2018 11/27/2018 1/31/2019 0.00 0.00 1,337.22 0.00 0.00 0.00 0.00 1,337.22
41 3000 We do not know when or how the damage occurred to this truck. It appears that someone backed into the truck and damaged the front bumper and front sidepanel.
4111091808460 Parks and Recreation 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
MHCP 11/9/2018 11/13/2018 2/28/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 L105 Employee hit the passenger door against one bollard(safety yellow pole)when he left the rich green memorial greenway.
4111131808466 Growth Management Division 0.00 0.00 8,447.04 0.00 0.00 0.00 0.00 8,447.04
GMAO 11/13/2018 11/13/2018 2/28/2019 0.00 0.00 8,447.04 0.00 0.00 0.00 0.00 8,447.04
41 3000 Traveling in the left lane at least 3 car lengths from the hit vehicle. The hit vehicle veered to the left as if to get into the turning lane but abruptly came back into the left lane.
4109261808332 Parks and Recreation 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
MHCP 9/26/2018 9/28/2018 3/13/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 3000 I was backing up to our back office, while a incoming car was going picking up a kid from the front when we both hit each other.
5
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Packet Pg. 995 Attachment: All Lines Closed Claim Report 2nd QTR FY 19 (8862 : Approval of Closed Claim Reports for
4101161908667 Meter Operations 0.00 0.00 1,252.83 0.00 0.00 0.00 0.00 1,252.83
WATE 1/16/2019 1/16/2019 3/13/2019 0.00 0.00 1,252.83 0.00 0.00 0.00 0.00 1,252.83
41 3000 Vehicle CC2-1840 was dropped off to Fleet for a bad tire. Fleet reported damage to the front bumper.
4112141808563 Distribution 165.79 0.00 0.00 0.00 0.00 0.00 0.00 165.79
WATE 12/14/2018 12/14/2018 1/18/2019 165.79 0.00 0.00 0.00 0.00 0.00 0.00 165.79
41 5900 While County vehicle was at job site a backflow device fell into the rear view window the vehicle.
4111271804008 Distribution 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
WATE 11/27/2018 11/27/2018 1/8/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 3000 Employee was turning north on to US 41 from Pine Ridge Road and struck vehicle ahead of him.
4112111808554 PUD 0.00 155.90 0.00 0.00 0.00 0.00 0.00 155.90
UOSD 12/11/2018 12/12/2018 1/31/2019 0.00 155.90 0.00 0.00 0.00 0.00 0.00 155.90
41 3000 County staff was exiting a parking spot going left and 3rd party driver made contact with front right bumper.
4211291808531 Domestic Animal Services 937.02 0.00 0.00 0.00 0.00 0.00 0.00 937.02
DASE 11/29/2018 12/5/2018 1/18/2019 937.02 0.00 0.00 0.00 0.00 0.00 0.00 937.02
42 5900 Cracked Windsheld, vehicle was parked under a tree, unknown reason for the cause of the damage.
4102091908782 Parks and Recreation 301.73 0.00 0.00 0.00 0.00 0.00 0.00 301.73
MHCP 2/9/2019 2/11/2019 3/14/2019 301.73 0.00 0.00 0.00 0.00 0.00 0.00 301.73
41 5900 Loading old ski equipment in back of truck and one piece of equipment slid and hit the rear windshield of the truck breaking it.
4112211808584 Building review and permitting-inspection 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
ORMD 12/21/2018 12/21/2018 3/12/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 3000 Employee( Vehicle 1) ran a red light causing vehicle 2 to hit the side of the county vehicle. Employee found at fault for running red light.
4101141908645 Traffic Operations 0.00 0.00 8,751.20 0.00 0.00 0.00 0.00 8,751.20
TECM 1/14/2019 1/14/2019 3/13/2019 0.00 0.00 8,751.20 0.00 0.00 0.00 0.00 8,751.20
41 3000 Traveling WB on Livingston Rd at the intersection of Livingston Rd and Pine Ridge Rd. Rear ended vehicle in front at light.
4101281908706 Traffic Operations 0.00 0.00 997.94 0.00 500.00 0.00 0.00 997.94
TECM 1/28/2019 1/28/2019 3/18/2019 0.00 0.00 997.94 0.00 500.00 0.00 0.00 997.94
41 3000 Was pulling off the roadway at 5400 Golden Gate Parkway South side and did not see fire Hydrant because it was around high grass.
3,398.54 155.90 50,502.97 0.00 1,000.00 0.00 0.00 54,057.41
Total by Major Coverage 17 Claims 3,398.54 155.90 50,502.97 0.00 1,000.00 0.00 0.00 54,057.41
Major Coverage: 50 - Property
5109101707711 Public Utilities Department, Wastewater Collections, Facility Storage Shed, Location #6110.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
WWTE 9/10/2017 2/16/2018 3/25/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
51 5400 325 sq ft storage shed in northeast quadrant damaged.
5309101707682 Public Utilities Department, Wellfield, SRO 3 & SRO 9 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
WATE 9/10/2017 2/16/2018 3/25/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
53 5400 Fence Damage, approx. 29 ft.
5309101707422 Public Utilities Department, Wellfield, Carica Booster Station 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
WATE 9/10/2017 1/31/2018 3/25/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
53 5400 Barbed wire and fence damages
5109101707650 Public Utilities Department, Wellfield, Raw Water Booster Station, Locatin #767 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
WATE 9/10/2017 2/15/2018 3/25/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
51 5400 Minor roof damage to Main Structure 424, utility locate pipe damaged, plumbing and foundation damage.
5611071808438 Parks and Recreation 0.00 0.00 2,942.03 0.00 0.00 0.00 0.00 2,942.03
MHCP 11/7/2018 11/7/2018 1/31/2019 0.00 0.00 2,942.03 0.00 0.00 0.00 0.00 2,942.03
56 L105 Spreading mulch on playground, tractor accidently ran into swingset.
6
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Packet Pg. 996 Attachment: All Lines Closed Claim Report 2nd QTR FY 19 (8862 : Approval of Closed Claim Reports for
5602091908794 Solid Waste 0.00 0.00 2,942.63 0.00 0.00 0.00 0.00 2,942.63
SOWE 2/9/2019 2/14/2019 3/31/2019 0.00 0.00 2,942.63 0.00 0.00 0.00 0.00 2,942.63
56 5900 Windshield of CC2-1346-(Bobcat) blew out while vehicle was in operation
5102071908766 North Collier Regional Park RecPlex facility 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
PSVE 2/7/2019 2/7/2019 3/13/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
51 Notified by a member that the mens restroom was flooding. I walked into the restroom and the 2nd toilet on the right side had a severely busted pipe which causedd flooding of the floor and hallway.
5212041707228 Solid & Hazardous Waste Mgmt.0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
SOWE 12/4/2017 12/5/2017 1/7/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
52 5500 CC2-1240 was dropped off at CarsMeds for repairs. We needed to access the vehicle and discovered it unsecured on two occasions and secured it when we left. Picked up and discovered the equipment missing.
5605041807945 Water Distribution Division 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
WATE 5/4/2018 5/4/2018 1/31/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
56 While unloading a 48" Adaptor from the Ferguson delivery truck the pallet collapsed and the adaptor was damaged.
5309191808301 Wastewater Collection 45,986.56 0.00 0.00 0.00 0.00 0.00 0.00 45,986.56
WWTE 9/19/2018 9/19/2018 3/7/2019 45,986.56 0.00 0.00 0.00 0.00 0.00 0.00 45,986.56
53 Damage was done to the lift station 313.15 panel and bollords that protect the station. a vehicle hit the panel and bollords. This was a hit and run, the police were unable to locate the vehicle that left the scene.
45,986.56 0.00 5,884.66 0.00 0.00 0.00 0.00 51,871.22
Total by Major Coverage 10 Claims 45,986.56 0.00 5,884.66 0.00 0.00 0.00 0.00 51,871.22
Major Coverage: 60 - Public Officials Errors and Ommissions
6703081705928 WANNAGOFAST, LLC 0.00 1,518.75 0.00 0.00 0.00 0.00 0.00 1,518.75
OPRS 3/8/2017 3/8/2017 1/16/2019 0.00 1,518.75 0.00 0.00 0.00 0.00 0.00 1,518.75
67 Claimant alleges breach of contract and/or misrepresentation
0.00 1,518.75 0.00 0.00 0.00 0.00 0.00 1,518.75
Total by Major Coverage 1 Claim 0.00 1,518.75 0.00 0.00 0.00 0.00 0.00 1,518.75
263,079.22 23,582.81 99,380.63 0.00 1,000.00 0.00 0.00 386,042.66
Grand Totals: 89 Claims 263,079.22 23,582.81 99,380.63 0.00 1,000.00 0.00 0.00 386,042.66
-21-
4/30/2019
3:51:07 PM
7
16.E.1.a
Packet Pg. 997 Attachment: All Lines Closed Claim Report 2nd QTR FY 19 (8862 : Approval of Closed Claim Reports for
Collier County Government
Subrogation Closed Claim Report
2nd QTR FY 2019
Valued as of:4/30/2019
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
Division
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
1,815.44 0.00 0.00 0.00 1,270.81 1,815.44 0.00 0.00CC v. Progressive Insurance4110051808397
3/4/201910/5/2018 10/26/2018 0.00 1,815.44 0.00 1,270.81 1,815.44 0.00 0.00 0.00LDSD
41 Was turning into driveway at
1011 22nd Ave NE, to turn
around. As i proceeded a black
vehicle passed me on the wrong
side of the road going around me
and both vehicles hit.
3000
2,606.95 0.00 0.00 0.00 2,646.70 2,606.95 0.00 0.00Parks and Recreation v.
Auto-Owners Insurance
4109061808275
3/6/20199/6/2018 9/6/2018 0.00 2,606.95 0.00 2,646.70 2,606.95 0.00 0.00 0.00MHCP
41 Truck was parked in parking lot
at Jason's deli, Patron pulled in
next to my truck and then
decided to move. when he pulled
out he turned right to early and
hit front end drivers side and
damged bumper of my truck. He
then came inside and found me.
3000
0.00 0.00 0.00 0.00 3,748.78 0.00 0.00 0.00Pelican Bay Services Division v.
Allstate
4110101808355
3/26/201910/10/2018 10/10/2018 0.00 0.00 0.00 3,748.78 0.00 0.00 0.00 0.00PELB
41 While County employee was
operating a sprayer, driving his
Kubota, CC2-1144, Jamie
Escobar side-swiped his Kubota
with Lexus SUV.
3000
0.00 0.00 0.00 0.00 446.22 0.00 0.00 0.00Pelican Bay Services Division v.
Allstate
5310101808362
3/26/201910/10/2018 10/11/2018 0.00 0.00 0.00 446.22 0.00 0.00 0.00 0.00PELB
53 While County employee was
operating a sprayer, driving his
Kubota, CC2-1144, Jamie
Escobar side-swiped his Kubota
with Lexus SUV.
3000
0.00 0.00 0.00 0.00 15,356.00 0.00 0.00 0.00Public Transit & Neighborhood
Enhancement Department v.
Bristol West
5309261808329
3/26/20199/26/2018 9/27/2018 0.00 0.00 0.00 15,356.00 0.00 0.00 0.00 0.00PTNE
53 CAT Shelter was hit by vehicle3000
-1-
3:47:43PM
4/30/2019
16.E.1.b
Packet Pg. 998 Attachment: Subrogation Closed Claim Report 2nd QTR FY 19 (8862 : Approval of Closed Claim Reports
Collier County Government
Subrogation Closed Claim Report
2nd QTR FY 2019
Valued as of:4/30/2019
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
Division
Cause
Date of Loss
Employer Acc Desc.
Date Report to RiskStatus Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
0.00 0.00 0.00 0.00 4,054.90 0.00 0.00 0.00Landscape operations v. Geico5401231808708
3/4/20191/23/2018 1/28/2019 0.00 0.00 0.00 4,054.90 0.00 0.00 0.00 0.00RMSE
54 There was a car accident which
damaged landscape materials
per police report.
3000
1,052.19 0.00 0.00 0.00 1,152.71 1,052.19 0.00 0.00CC v. Roman Roofing4106221808071
1/29/20196/22/2018 6/22/2018 0.00 1,052.19 0.00 1,152.71 1,052.19 0.00 0.00 0.00WATE
41 Employee was driving down road
(Los Altos Court) in Village Walk
when a truck driven by an
employee of Roman Roofing
pulled out of a driveway and
struck vehicle.
3000
0.00 0.00 0.00 0.00 8,108.65 0.00 0.00 0.00Landscape operations v.
Progressive Insurance & USAA
5402161808710
2/20/20192/16/2018 1/28/2019 0.00 0.00 0.00 8,108.65 0.00 0.00 0.00 0.00RMSE
54 There was a car accident which
damaged landscape materials
per police report.
0.00 0.00 0.00 0.00 2,661.79 0.00 0.00 0.00Landscape operations v. Infinity
Insurance
5405201808715
2/20/20195/20/2018 1/28/2019 0.00 0.00 0.00 2,661.79 0.00 0.00 0.00 0.00RMSE
54 There was a car accident which
damaged landscape materials
per police report.
0.00 0.00 0.00 0.00 3,165.50 0.00 0.00 0.00Landscape Operations v.
Progressive American Ins .
5403211808647
2/20/20193/21/2018 1/14/2019 0.00 0.00 0.00 3,165.50 0.00 0.00 0.00 0.00RMSE
54 There was an accident that
damaged landscaping materials
per the police report.
0.00 0.00 0.00 0.00 6,483.20 0.00 0.00 0.00Traffic Operations v. Geico5308181808663
2/7/20198/18/2018 1/16/2019 0.00 0.00 0.00 6,483.20 0.00 0.00 0.00 0.00TECM
53 Street light down due to car
accident.
3000
-2-
3:47:43PM
4/30/2019
16.E.1.b
Packet Pg. 999 Attachment: Subrogation Closed Claim Report 2nd QTR FY 19 (8862 : Approval of Closed Claim Reports
Collier County Government
Subrogation Closed Claim Report
2nd QTR FY 2019
Valued as of:4/30/2019
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
Division
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 7,278.84 0.00 0.00 0.00Traffic Operations v. Ocean
Harbor Insurance
5307111808626
2/7/20197/11/2018 1/10/2019 0.00 0.00 0.00 7,278.84 0.00 0.00 0.00 0.00TECM
53 Driver 1 advisded he was tired
and fell asleep behind the wheel,
drifted off the road and struck a
light pole.
0.00 0.00 0.00 0.00 6,757.05 0.00 0.00 0.00Traffic Operations v. Ocean
Harbor Insurance
5308081808666
2/20/20198/8/2018 1/16/2019 0.00 0.00 0.00 6,757.05 0.00 0.00 0.00 0.00TECM
53 Vehicle 1 jumped the sidewalk
curb and the front right bumper
stuck a light pole on the south
side of Pine Ridge Road.
3000
0.00 0.00 0.00 0.00 8,059.14 0.00 0.00 0.00Traffic Operations v. Progressive
Insurance
5309031808665
2/20/20199/3/2018 1/16/2019 0.00 0.00 0.00 8,059.14 0.00 0.00 0.00 0.00TECM
53 A vehicle jumped the curb and
the front right bumper struck a
light pole on the northwest
corner of Logan and Pine Ridge.
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00Airport Authority5311051808434
1/11/201911/5/2018 11/6/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00OPRS
53 Aircraft N9225G lost control
while landing on runway 09 and
the left horizontal stabilizer
impacted taxiway sign B2. Sign
was destroyed.
L105
0.00 0.00 0.00 0.00 1,608.08 0.00 0.00 0.00CC v. National Indemity Co Of
The South
4112271808591
2/15/201912/27/2018 12/27/2018 0.00 0.00 0.00 1,608.08 0.00 0.00 0.00 0.00ORMD
41 On Thursday Dec. 27, 2018 at
08:20 hours employee assigned
GMD North was struck by Veh#2
plate number D4115HY. County
veh number CC2-1160. (Fleet
and Risk) aware of incident
Sheriff on scene Aponte
(SH#3991)
3000
-3-
3:47:43PM
4/30/2019
16.E.1.b
Packet Pg. 1000 Attachment: Subrogation Closed Claim Report 2nd QTR FY 19 (8862 : Approval of Closed Claim Reports
Collier County Government
Subrogation Closed Claim Report
2nd QTR FY 2019
Valued as of:4/30/2019
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
Division
Cause
Date of Loss
Employer Acc Desc.
Date Report to RiskStatus Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
0.00 0.00 0.00 0.00 4,387.61 0.00 0.00 0.00Landscape Operations v. State
Farm Mutual
5407031808659
2/7/20197/3/2018 1/16/2019 0.00 0.00 0.00 4,387.61 0.00 0.00 0.00 0.00RMSE
54 There was a car accident which
damaged landscape materials
per the police report.
0.00 0.00 0.00 0.00 4,985.27 0.00 0.00 0.00Landscape operations v. State
Farm
5406251808718
2/7/20196/25/2018 1/28/2019 0.00 0.00 0.00 4,985.27 0.00 0.00 0.00 0.00RMSE
54 There was a car accident which
damaged landscape materials
per police report.
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00Landscape operations v.
Assurance America
5405191808714
2/1/20195/19/2018 1/28/2019 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00RMSE
54 There was a car accident which
damaged landscape materials
per police report.
0.00 0.00 0.00 0.00 1,262.41 0.00 0.00 0.00Landscape operatons v. Bristol
West Insurance
5411141808728
2/11/201911/14/2018 1/29/2019 0.00 0.00 0.00 1,262.41 0.00 0.00 0.00 0.00RMSE
54 There was a car accident which
damaged landscape materials
per police report.
3000
0.00 0.00 0.00 0.00 4,379.20 0.00 0.00 0.00Landscape operations v.
Thomas Lally
5403091808644
2/11/20193/9/2018 1/14/2019 0.00 0.00 0.00 4,379.20 0.00 0.00 0.00 0.00RMSE
54 There was a car accident that
damaged landscaping materials
per police report #18-82665.
3000
1,459.97 0.00 0.00 0.00 2,253.97 0.00 0.00 1,459.97Traffic Operations v. Ocean
Harbor Insurance
5308231808385
2/7/20198/23/2018 10/22/2018 1,459.97 0.00 0.00 2,253.97 1,459.97 0.00 0.00 0.00TECM
53 Vehicle 1 tried to make a right
turn onto Radio Rd and instead
hit the crosswalk illuminated
sign, then went airborne west
striking another illuminated
crosswalk sign and an electrical
pole.
3000
-4-
3:47:43PM
4/30/2019
16.E.1.b
Packet Pg. 1001 Attachment: Subrogation Closed Claim Report 2nd QTR FY 19 (8862 : Approval of Closed Claim Reports
Collier County Government
Subrogation Closed Claim Report
2nd QTR FY 2019
Valued as of:4/30/2019
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
Division
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 0.00 673.62 0.00 0.00 0.00Landscape Operations v. Geico5404271808682
2/15/20194/27/2018 1/22/2019 0.00 0.00 0.00 673.62 0.00 0.00 0.00 0.00RMSE
54 There was a car accident which
damaged landscape material per
the police report.
3000
0.00 0.00 0.00 0.00 825.10 0.00 0.00 0.00Landscape Operations v. State
Farm Mutual
5403291808646
2/7/20193/29/2018 1/14/2019 0.00 0.00 0.00 825.10 0.00 0.00 0.00 0.00RMSE
54 There was a car accident that
damaged landscape material
according to a police report.
0.00 0.00 0.00 0.00 1,172.02 0.00 0.00 0.00Landscape Operations v.
Allstate Ins.
5406071808653
3/15/20196/7/2018 1/15/2019 0.00 0.00 0.00 1,172.02 0.00 0.00 0.00 0.00RMSE
54 There was a car accident which
caused damage to landscape
materials per police report.
0.00 0.00 0.00 0.00 7,500.00 0.00 0.00 0.00Landscape operations v. Ocean
Harbor Insurance
5403051808643
3/15/20193/5/2018 1/14/2019 0.00 0.00 0.00 7,500.00 0.00 0.00 0.00 0.00RMSE
54 There was a car accident
according to police report
#18-77212.
0.00 0.00 0.00 0.00 4,442.51 0.00 0.00 0.00Landscape operations v. Geico5406071808717
3/18/20196/7/2018 1/28/2019 0.00 0.00 0.00 4,442.51 0.00 0.00 0.00 0.00RMSE
54 There was a car accident which
caused damaged to landscape
materials per police report.
3000
0.00 0.00 0.00 0.00 1,159.20 0.00 0.00 0.00Landscape v. Auto Owners
Insurance company
5401051808635
3/18/20191/5/2018 1/14/2019 0.00 0.00 0.00 1,159.20 0.00 0.00 0.00 0.00RMSE
54 There was a car accident per the
attached police report
#FHPF18OFF000975.
3000
0.00 0.00 0.00 0.00 700.00 0.00 0.00 0.00Landscape Operations v.
Progressive
5402141808673
3/22/20192/14/2018 1/17/2019 0.00 0.00 0.00 700.00 0.00 0.00 0.00 0.00RMSE
54 There was a car accident which
damaged landscape materials
per police report.
3000
-5-
3:47:43PM
4/30/2019
16.E.1.b
Packet Pg. 1002 Attachment: Subrogation Closed Claim Report 2nd QTR FY 19 (8862 : Approval of Closed Claim Reports
Collier County Government
Subrogation Closed Claim Report
2nd QTR FY 2019
Valued as of:4/30/2019
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
Division
Cause
Date of Loss
Employer Acc Desc.
Date Report to RiskStatus Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total Paid Total
0.00 0.00 0.00 0.00 6,224.58 0.00 0.00 0.00Traffic Operations v. Progressive
Insurance
5305201808622
1/18/20195/20/2018 1/9/2019 0.00 0.00 0.00 6,224.58 0.00 0.00 0.00 0.00TECM
53 Vehicle 1 rear ended vehicle 2
and both left the roadway,
vehicle 1 struck a light pole.
3000
0.00 0.00 0.00 0.00 8,037.00 0.00 0.00 0.00Traffic operations v. Progressive
Insurance
5307171808642
2/8/20197/17/2018 1/14/2019 0.00 0.00 0.00 8,037.00 0.00 0.00 0.00 0.00TECM
53 Street light damage3000
0.00 0.00 0.00 0.00 791.21 0.00 0.00 0.00Traffic Operations v. State Farm5312281808620
1/29/201912/28/2018 1/9/2019 0.00 0.00 0.00 791.21 0.00 0.00 0.00 0.00TECM
53 Car hit street Light and
landscape damage
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00CC v. Progressive Insurance5310061808376
3/8/201910/6/2018 10/16/2018 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00TECM
53 Vehicle 1 struck the traffic signal
pole that was on the southbound
right shoulder of Santa Barbara
Blvd.
L105
0.00 0.00 0.00 0.00 2,645.00 0.00 0.00 0.00Road Maintenance Division v.
State Farm
5410121608876
3/14/201910/12/2016 3/4/2019 0.00 0.00 0.00 2,645.00 0.00 0.00 0.00 0.00RMSE
54 There was a car accident on
Pine Ridge Road between Grand
Cypress Circle and Summerwind
Drive which damaged landscape
materials per the police report.
3000
0.00 0.00 0.00 0.00 3,904.25 0.00 0.00 0.00Road Maintenance v. State Farm5405181708840
3/4/20195/18/2017 2/26/2019 0.00 0.00 0.00 3,904.25 0.00 0.00 0.00 0.00RMSE
54 Vehicle 1 struck vehicle 2, after
impact vehicle 2 was propelled
into the landscape median.
3000
-6-
3:47:43PM
4/30/2019
16.E.1.b
Packet Pg. 1003 Attachment: Subrogation Closed Claim Report 2nd QTR FY 19 (8862 : Approval of Closed Claim Reports
Collier County Government
Subrogation Closed Claim Report
2nd QTR FY 2019
Valued as of:4/30/2019
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
Division
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 1,740.00 0.00 0.00 0.00Road Maintenance v. Pearl
Holding Group
5405021708839
3/22/20195/2/2017 2/26/2019 0.00 0.00 0.00 1,740.00 0.00 0.00 0.00 0.00RMSE
54 Vehicle 1 was east bound on
Tamiami Trail stopped for the
light at Palm street. When the
light changed the driver of
vehicle 1 accelerated, his vehicle
lost control on the wet roadway
and hit the median.
3000
0.00 0.00 0.00 0.00 120.75 0.00 0.00 0.00Road Maintenance Division v.
Geico
5406031708841
3/26/20196/3/2017 2/26/2019 0.00 0.00 0.00 120.75 0.00 0.00 0.00 0.00RMSE
54 Vehicle 1 hydroplaned off Pine
Ridge Road into the median.
3000
0.00 0.00 0.00 0.00 2,025.48 0.00 0.00 0.00Traffic Operations v. State Farm5309031808817
3/4/20199/3/2018 2/21/2019 0.00 0.00 0.00 2,025.48 0.00 0.00 0.00 0.00TECM
53 Vehicle 1 spun 360 degrees and
hit a light pole on Airport Pulling
Road.
0.00 0.00 0.00 0.00 2,052.00 0.00 0.00 0.00Landscape Operations v. State
Farm
5403061908909
3/22/20193/6/2019 3/13/2019 0.00 0.00 0.00 2,052.00 0.00 0.00 0.00 0.00RMSE
54 The vehicle crash occurred in
the left through lane on Davis
Blvd, West of Santa Barbara.
Vehicle 1 hit the curb and his
vehicle and became airborn and
landed in the median, hitting a
palm tree and several newly
planted bushes.
3000
0.00 0.00 0.00 0.00 243,522.17 0.00 0.00 0.00CC v. Accurate Drilling Systems
Inc; Mastec
5306291808789
3/19/20196/29/2018 2/12/2019 0.00 0.00 0.00 243,522.17 0.00 0.00 0.00 0.00UOSD
53 FCCI insured Accurate Drilling
was a subcontractor of MasTec
on behalf of FP&L. Although
locates were completed,
Accurate struck a Collier County
water main along Tamiami Trail
while boring.
5900
-7-
3:47:43PM
4/30/2019
16.E.1.b
Packet Pg. 1004 Attachment: Subrogation Closed Claim Report 2nd QTR FY 19 (8862 : Approval of Closed Claim Reports
Collier County Government
Subrogation Closed Claim Report
2nd QTR FY 2019
Valued as of:4/30/2019
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
Division
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 0.00Road Maintenance Division v.
Windhaven Insurance
5404291707136
2/27/20194/29/2017 11/14/2017 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00RMSE
54 Vanessa Beltran was traveling
west on Tamiami Trail when she
lost control of the vehicle and the
vehicle began to spin and struck
a median.
3100
0.00 0.00 0.00 0.00 1,592.75 0.00 0.00 0.00Road Maintenance Division v.
Allstate
5402151707134
3/26/20192/15/2017 11/13/2017 0.00 0.00 0.00 1,592.75 0.00 0.00 0.00 0.00RMSE
54 Austin Beach was traveling east
on Pine Ridge Road when his
vehicle hit standing water
causing him to lose control of the
vehicle. He swerved into the
median and struck a palm tree.
3100
0.00 0.00 0.00 0.00 7,778.50 0.00 0.00 0.00Transportation Engineering
Division v. USAA
5310291808849
3/4/201910/29/2018 2/27/2019 0.00 0.00 0.00 7,778.50 0.00 0.00 0.00 0.00TECM
53 cost center 163630 Traffic Ops
Car hit street light
3000
1,459.97
1,459.97
0.00
0.00
5,474.58
5,474.58
386,972.97
386,972.97 0.00
0.00 0.00
0.00
0.00
0.00
6,934.55
6,934.55Grand Totals: 43 Claims
-8-
3:47:43PM
4/30/2019
16.E.1.b
Packet Pg. 1005 Attachment: Subrogation Closed Claim Report 2nd QTR FY 19 (8862 : Approval of Closed Claim Reports
16.E.1.c
Packet Pg. 1006 Attachment: Resolution 2004-15 PDF0001 (8862 : Approval of Closed Claim Reports for 2nd Quarter FY 19)
16.E.1.c
Packet Pg. 1007 Attachment: Resolution 2004-15 PDF0001 (8862 : Approval of Closed Claim Reports for 2nd Quarter FY 19)
16.E.1.c
Packet Pg. 1008 Attachment: Resolution 2004-15 PDF0001 (8862 : Approval of Closed Claim Reports for 2nd Quarter FY 19)
16.E.1.c
Packet Pg. 1009 Attachment: Resolution 2004-15 PDF0001 (8862 : Approval of Closed Claim Reports for 2nd Quarter FY 19)
16.E.1.c
Packet Pg. 1010 Attachment: Resolution 2004-15 PDF0001 (8862 : Approval of Closed Claim Reports for 2nd Quarter FY 19)
16.E.1.c
Packet Pg. 1011 Attachment: Resolution 2004-15 PDF0001 (8862 : Approval of Closed Claim Reports for 2nd Quarter FY 19)