HomeMy WebLinkAbout012 - Claims for Damages less than 500 ADMINISTRATIVE ORDER NO . 12
( Rescinds Administrative Order No . 12 dated April 2 , 1979 )
TO : All Department H ads/Division Heads February 10 , 1989
FROM : Gary Crutchfiel i y Manager
SUBJECT : CLAIMS FOR D G S AGAINST CITY
I . PURPOSE : This Adminis ative Order is issued to implement
a revised system for the handling and reporting of Claims
for Damages against the City . The procedures outlined in
this Order are intended to :
A , Assure that potential claimants are given uniform
information regarding the submittal of claims ;
B , Assure that the City Risk Manager ( City Attorney ) is
appraised of potential claims and handles their
administration ; and
C . Assure that the City Manager receives a suitable
reporting of claims filed and their history upon
• resolution .
II . FORMS : Claims should be submitted to the City on the 3 -part
NCR form , a copy of which is attached hereto as Attachment
"A" . A written explanation of the claim ' s procedure should
be provided to potential claimants on the form titled
" Information for Claimant" , a copy of which is attached
hereto as Attachment " B " .
III . PROCEDURE :
A . Form Distribution , The written explanation of the
claim procedure , " Information for Claimant "
(Attachment " B" ) , shall be available in all
departments . This form should be provided to a
potential claimant when an inquiry is made about the
City ' s claim procedure . The actual claim forms ,
however , shall be available only in the Risk Manager ' s
Office .
B . Risk Manager ' s Responsibilities . The Risk Manager
shall :
1 . Distribute the claim forms to potential claimants
upon request .
Administrative Order No . 12 ( R) - Page 1
i .
2 . Accept completed claim forms for filing with the
City .
3 . Upon the filing of a completed claim form shall :
a . Determine what level of staff investigation is
required ;
b . Gather pertinent records , photos and other
evidence ;
c . Send a copy of the completed claim form and
accompanying documents with his recommendation
to the WCIA , Department Head and City Manager ;
d . Record the claim ' s filing in the micro computer
data bank ;
e . Upon disposition of the claim , notify the
Department Head and City Manager ;
f . Submit a monthly report of new claims to the
City Manager ; and
g . Submit a copy of the WCIA quarterly report on
claims to the City Manager ,
Co Department Responsibility . In addition to providing
potential claimants a copy of Attachment " B "
( " Information for Claimant" ) , employeess ( and
Division/Department Managers in particular , shall
assist the Risk Manager as necessary in the
investigation of claims filed with the Risk Manager .
IV . EFFECTIVE DATE : This Administrative Order is effective
immediately .
• Administrative Order No . 12 (R) - Page 2
CITY OF PASCO
CLAIM FOR DAMAGES
This form must be filled out and signed before a notary public .
All expenses must be documented ( attach copies of receipts ,
repair estimates , pictures , etc . ) . The following statements are
true and made under penalty of perjury if Falsely made :
1 . The injury/damage for which ,I claim damages occurred
on the day of 9
2 . The place of the injury/damage was/
3 . The location and des ipt�on of the defect which
caused the injury/damage are
\ `
49 The injury/damai is described'- as follows
5 . he amount of damage claimed is as follows
i 6 . actual residence at the time of presenting and
filing this claim is
7 . My elephonq number is (home )
/ ( work)
i�
Signature of Claimant
• STATE OF WASHINGTON )
/ : ss
County of )
On this day of 19 , before me ,
the undersigned Notary Public in and for said County and State ,
personally appeared , known to me
to be the person whose name is subscribed to the foregoing
instrument , who acknowledged to me that signed same as _
free and voluntary act and deed , for the uses and purposes
therein mentioned . ,
WITNESS MY SEAL .
Notary Public for Washington
Residing at
Commission Expires :
FILE THIS FORM IN THE CITY ATTORNEY ' S OFFICE .
1st Risk Manager's Copy 2nd Claimant's Copy 3rd WCIA Copy
ATTAf HMF.NT "All
• Information for Claimant
SUBMITTING A CLAIM FOR DAMAGES
If you or your property has been damaged , and in your opinion ,
you believe the City of Pasco may have a responsibility to you , a
Claim for Damages form can be obtained from the Risk Manager in
the City Attorney ' s Office ( 545 - 3406 ) .
Submittal of a Claim for Damages does not guarantee payment by
the City . An investigation by a Claims Adjuster will be made
into the incident to determine if the City has any liability .
If it is determined that the City has a responsibility to you ,
the amount of claim payment is based on the level of City
liability , the level of your liability ( if any ) , and the
depreciated value ( not replacement value ) of the property
damaged .
Investigations into Claims for Damages are usually conducted by
City personnel and Claims Adjusters representing Washington -
Oregon Claims Service . Please excuse the number of possible
interruptions during the investigation period .
If you have contacted the City in an emergency , AS A PUBLIC
SERVICE , the Public Works crew or other City employees may have
assisted you in minor clean-up . This assistance does not
constitute an admission of liability on the part of the City .
For further information , contact the City ' s Risk Manager at
545 -3406 .
ATTACHMENT " B"