Item C31 BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: August 20, 2014 Division: Employee Services
Bulk Item: Yes X No _ Department: Risk Management
Staff Contact Person/Phone#:Maria L. Slavik X3178
AGENDA ITEM WORDING:Approval for Mayor to sign title transferring County Vehicle No.
3000-5684 to insurance company.
ITEM BACKGROUND: This vehicle has been declared a total loss by the insurance company due to an
accident on 4/23/14.
PREVIOUS REVELANT BOCC ACTION: N/A
CONTRACT/AGREEMENT CHANGES: N/A
STAFF RECOMMENDATIONS: BOCC approval to transfer title.
TOTAL COST: 10_ INDIRECT COST: BUDGETED: Yes X No
COST TO COUNTY: $0 SOURCE OF FUNDS: N/A
REVENUE PRODUCING: Yes_ _ No X AMOUNT PER MONTH Year
APPROVED BY: County A OMB/Pure asing Risk Management
X4 IL
DOCUMENTATION: Included X To Follow Not Required
DISPOSITION: AGENDA ITEM#
Revised 2/27/01
O ROE COUNTYL
TORT OF INCIDENT
FAX IMMEDIATELY
WORKERS COMP at 295-4301 (if employee injury) OR
RISK MANAGEMENT at 295-3179 (property damage or vehicle)
FAXED FROM: NUMBER:
❑ Employee Injury X❑ Vehicle Accident ❑ Other
WHO: En 'I eerin Car Phone: 295-4329
Name Judith Clarke JOB TITLE Director, Engineering
SUPERVISOR: Kevin Wilson Public Works/Engineering Works/Engineering Director
DEPARTMENT: Public Works/Engineering Vehicle ID#3000t5M
WHAT:TYPE OF ACCIDENT Vehicle accident.
IERE: LOCATION OF ACCIDENT Bin Coppitt K
Mile Marker 10
WHEN: DATE 04/23/2014 11:01 A
MO/ DAY/ YR TIME
DESCRIBE ACCIDENT
While traveling southbound, a car that was on the side of the
road me
rged back Int
o traffic and hit
the rear passanggr tire of the county vehicle. .
DESCRIBE INJURY OR The the was shredded and I believe the wheel mount was bent.
PROPERTY DAMAGE:
MEDICAL ATTENTION REQUIRED:
YES NO
If Personal Property Damage or Injury to the Public:
Name of Owner:
Address:
Phone*
FILL OUT ACCIDENT INVESTIGATION REPORT AND NOTICE OF INJURY(4 part form)(if employee
Injury)AND SEND TO YOUR DEPARTMENT HEAD FOR COMMENTS AND SIGNATURES
CC: DEPARTMENT HEAD via FAX oE counrrvsnF nFOW 1.30 UPDA'r 1OW4
MONROE COUNTY
VEHICLE ACCIDENT ADDITIONAL INFORMATION
COUNTY VEHICLE Engineering DATE April 23, 2014
MAKE Ford MODEL Taurus YEAR 2007 LICENSE NO: COUN42381
(COUNTY ID #.3000-5684 ESTIMATED REPAIR COST: Unknown
WHAT WAS THE VEHICLE BEING USED FOR? Return from Marathon BOCC
meeting.
WEATHER CONDITIONS:Clear
PRIVATE VEHICLES INVOLVED (if applicable)
MA KEAcura MODELMDX YEAR 2007 LICENSE NO: 145KMT
ESTIMATED REPAIR COST Unknown
OWNER: John J. Crowley
ADDRESS: 39 Cannon Royal Drive, Key West FL 33040
PHONE NUMBER:
DRIVER (if different from owner) Margaret E. Gardocki-Crowley
ADDRESS Same
PHONE NUMBER
INSURANCE COMPANY
CIRCLE INVESTIGATION TYPE SHERIFF FHP CITY POLICE OTHER
WHO WAS CHARGED WITH THE ACCIDENT? Gardocki-Crowley
ANY ARRESTS MADE? IF YES WHO?
DIAGRAM OF ACCIDENT:
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SIGNATURE ` ' . , } � ' NAME: Judith Clarke
MONROE COUNTY SAFETY OFFlCE FORM 1.2-C LST
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Insurance Compmw
July 9,2014 A tbmpany of Alrianz
Judith Clarke
1008 Belea Street
Key West, FL 33040
Re: Claim Number. 00514133214
Our Insured(s): JOHN J CROWLEY JR
Date of Loss: 4/23/2014
Vehicle Information:
Vehicle Make: Ford
Vehicle Model: Taurus
Vehicle Year 2007
Vehicle YIN: 1 FAFP53497A155335
Vehicle Mileage: 27,334
Dear Judith Clarke:
Your vehicle has been declared a total loss as a result of the above-captioned claim. Our settlement offer
Is as follows:
If you keep the selvage:
(See Addendum)
Market Value $7.606.50
Taxes+ $531.39
Selvage value- $1,156.49
TOTAL $6,981.40
If we dispose of the salvage:
Market Value $7.606.50
Taxes+ $531.39
TOTAL $8,137.89
Based on the documentation available to us,we feel our offer is fair and reasonable. If you disagree with
our offer, you will need to provide information or documentation that may support an increase in the
amount we would offer. When we get the information,we will review it and advise you of our position.
In addition, if your vehicle is Incurring storage charges and you have not granted us permission to move
your vehicle, please be advised that we will only consider payment of storage charges through
07/1012014.
1 have enclosed the following documents that you will need to sign exactly as your name(s)appear on the
title to the vehicle. In order to receive payment, these documents must be returned:
Power of Attorney
Unsigned title to the vehicle(if no lien holder)
1 Progress Pout Parkway
O'Fapon,NO 83366
Plane:(800)POMP
(800)67048S7XAM22
FaX (888)MI-1378
Affidavit of Correction
Release of Liability/Authorization to Pay
Adg2nduM
Please be advised we are required to inform you of your responsibility to comply with the provisions of the
Salvage Title Law. If you retain possession and ownership of your vehicle as part of a total loss
settlement we are required to notify the DW.
Your obligations are as follows: Return the unsigned title and enclosed documents for processing.Also if
the title is in a company name please provide the name and title of the person signing the documents.
Sincerely,
American Automobile Insurance Company
One of the Fireman's Fund Insurance Companies
Tovah Scott
Total Loss Adjuster
(800)870-8857x447722 E-mail: tovah.scott®ffic.com
Enclosure(s): Power of Attorney
Affidavit of Correction
Release of Liability/Authorization to Pay
Fraud Warring Enclosure