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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"