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Item C08
BOARD OF COUNTY COMMISSIONERS AGENDAITEMSU~RY Meeting Date: August 16.2000 Bulk Item: Yes X No Division: Management Services Department: Human Resources/Risk Management AGENDA ITEM WORDING: Approval for Mayor to sign title transferring County Vehicle No. 1005- 107 to insurance company. '" ITEM BACKGROUND: This vehicle has been declared a total loss by the insurance company due to an accident on 7/18/2000. PREVIOUS RELEVANT BOCC ACTION: NIA STAFF RECOMMENDATION: BOCC approval to transfer title. TOTAL COST: $0 COST TO COUNTY: $0 REVENUE PRODUCING: Yes No X AMOUNT PER MONTH YEAR APPROVED BY: County Atty _ OMBlPurChasinJ.ll- Risk Management_ DIVISION DIRECTOR APPROVAL: ~~ James L. Roberts BUDGETED: Yes No X DOCUMENTATION: Included: ~ To Follow: _ Not Required: _ DISPOSITION: Agenda Item #: l:L5 . Government Employees Insurance Company . GEICO General Insurance Company . GEICO Indemnity Company . GEICO Casualty Company ONE GEICO PLAZA. Washington, D.C. 20076-0001 GEICD Washington, D.C. . ::~~ . . . Date: -, -d.~-OO Accident Date: "I - \ g - 0 O~ Claim Number: O} 0 Lf- S4 02,;;1. ~ 3 DI 0 -10 I Z . Dear This is a brief explanation of your claim settlement: . Agreed value of vehicle $ (Q/Add State Sales Tax $ o Misc. Fees & Adjustments $ TOTAL $ Less deductible amount (if any) $ Less net value of salvage you retained $ Less payment to lienholder $ Amount to you (Payment enclosed) $ Additional Payments $ NOTICE: I ) I J ~ 5 . 00 744.90 II J CfO 9 .90 Draft Number I L 9()9,90 . Draft Number Draft Number State law requires that owners of Total Loss or Salvage motor vehicles apply for a Salvage Certificate within 10 days after a Total Loss Settlement. D Does apply ~ Does not apply Any State Sales Taxes due the Owner through Replacement of the vehicle will be considered when Notice is given and Purchase Invoice Presented. Adjuster S c.. 0 ++ Lu d. \ 0 '-'\J Telephone No. '36'5 - f)l>9 - I 5 I 5 Customer's Signature Please Refer to Our Claim Number When Writing or Calling About This Claim MEMBER NATIONAL INSURANCE CRIME BUREAU Shareholder Owned Companies Not Affiliated with the U.S. Government CL-30 (7-96) FROM : CODE ENFORCEMENT PHONE NO. : 305 853 7324 Jul. 15 2000 10:S6AM P1 ~ dlqS- q6(gLj~ Q3!10/19~3 IG:J~ 305:9:5~~1 rLCO 1,,~r.~T ':;EF",'j'.I:>. Pi4?E (I: -' - ~~~ ". :'"."''::'"~, .~.~^ /'~i/JI,::-~, ~ ___..,.. '\ 11'-;''' '....,.- -- ~...:". .. -r:r.""' -~ FAX COVER SHEET ~~:~~;T~- .~\ . ..,.... Ill" So ,....". ;' -"~ ~,. 11 ~~ ,~"'l'~~ (, :.~. ... . ..-:-:1 MQNROE COLJt.fL'L_ ,,- .. -~.I '.- -. .. .. . ._~ -- \. ~ .... ..-/ - '=d~rRST REPORT OF ~CCIDEN]~;' FAX IMMEDIATELY TO: EMPLOYEE B'ENEFITS at - 295~301 (if employee InJury) OR RISK MANAGEMENT at - 292-4564 FAXED FROM: PIC.. (1,r)e,~eJ'l NUMBER: rs3--732.~ j -- \ - -~jEMP~ ;~~E INJU~y -~E~iCLE ;cU~~~ ,,-,IOTHER -- - - WHO: 'T1lc"-lAS Stfv?HDtv5 C€:>oe eN~r NAME E"rl'-E'J employee or public JOB TITLE it employee SUPERVISv~ :1'"'1 '1 M~ 61t1'1JLy TELEPHONE: .;J..'ff9-d.SIC; OEPARTMENT: G>7Leu>HA.. J.-i~i: Hf::;7IVT WHAT: ~MO& L t:- TYPE OF~CCiDENT WHERE: M/w1 q~ ~{UcYL U$I ! JoJ~ l.OC':'-:ON OF ACCIDENT 7- WHEN: ~L-_I /15 ! 001 . AM62..l60 DATE ~~o OAY YJi . .. . TIME WHY~ "CA1L F11-cM bt7J..'!? k!nA!{) r?v ~L ElJ IN FvOiUT OESC~'BE ACCIDENT J 1._ . _ ._.' _/2'f=:_.Cbv~"1<1 ~-1I1G~ f. ._~ _._~ .OESt,,~BE INJURY ;-GAMAGE'rO PROPERTY - .~;,--'-"" : r I tv' ' NO ! Y'-.. I I . 0((\Q 0'0 ()..cO Fill OUT ACCH)ENT INVESTIGATION REPORT AND NOTICE OF INJURY (if employee) AND SEND -0 YOUR OEPARTMENT HEAD FOR COMMENTS ANO SIGNATURES cc:'OeDartment Hea 'i via...fAX 07/24/2000 15:42 305-289-2309 'lORlDA TRAFFIC CRASH REPORT LONG FORM 0 SHORT FOAM TO: DEPT. ~ HIGHWAY SAFETY & MOTOR VEHIClES TRAFfIC CIlASH AEOOROS TALl.AHAS&. FWRIIA 323545IlO F'HP MARATHON PAGE 02 ~c..~"i.:I:!JI!E~",': . ., _~ ._ _ I ~-r i~~. O'~. T.~9 n.o,j:;"", I~ :~~..~i~~;'- ....,-.114:11.=5.1 IMlI5a...1 U' (,lc;"1 Iwl}'llll -- "III "la1I.....LlI.I L1 I ~..,a r'~'':;!if:i:>..~.,.r::,,::.~~I'?;'i .-e,: A~ ;!!.~(lIlTOlWl '.\";f~=(:'~:;.;." ~ "'~O .;,!c,;~-..~t"l!~.~..:. :.:.....:.. '.' '.1" .. . .. ." . .m-/..iJ:s RgIICCENO. -....;,:,' .]III).QF IlIWIII8l 011. oIJ .i~::':::;;';A"':':' ;:-:..;: .1 . .~n 2 . ..... ~ ~ I ~ -- ..cs .... a ~~~~,~~iM>~~~:C n ,- -- rg~:~~:,~ . 11-- ~It~ r-,.- 011 · fJ()f&- cis 1,~NJj";.A^= 11, ~::... t .,.>j:'...:....:;..;"".'::.; :Mm....,.... 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I/o.-- 7_ __(,IMI, ,. 1 .. ~ ..... 07/24/2000 15:42 305-289-2309 F'HP MARti Tl-()N PAGE 03 ~ FLORIDA TRAfFIC CRASH REPORT :__.................ooo............"..,............._____.___....__._..__-......--........--....--., 1WIM1M'_ ! DO NOT WflITE IN THIS SPACE I MAL TO: DEP1'. OF HIGHWAy wen' a MOTOR VEHIClES } i TIW'I'IC ~ Il!CllflO9 I l T~ Fl.ONOA 3239800500 ;.-..............-...................;........,.............-..........---..--...-...--................----............: PM 1WI_ IlOlIAED __fIIoor,'''' ... oJ '*~ 07/24/2000 15:42 305-289-2309 F'H" MARA TI-Ol PAGE 05 i; I j,'J,;;:,}t~~~L;; _llWlIPOIllIlI ., '~... . ". . :.: ~ : ,.':~;.' .'.::" :,,:' ltllWllIo"'_ llIlooOl___ ,.~ aCllillllllFtl_VtIiIIIt .~-- .... . ...... " .0....... , . ~IZJ ,. .' ~'." ':'''' , , ,'~,"'., ...cL1S'fD1ilIUCl1Dlll OI~_ I 2 , i_ t r :=='~!ill~ if: [!][I] :~ ::e:.. :1......= 1/ ..-._ -,-YIfl. . ...., ".- - - . 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I..... , Cod ClTl11II , IIllIllC:lllOl 01 lOt D*II .. --,-..... ===-.1- . -..-.lIAIl4oo'.... :-I~--flIoo .==-- 77 .....lIlilIIIIII II fit CInII n fit _ ....1IM " .II CIlIr II _..... I:j1 :== EJ_=llIM r7I :GIIoorm.... JL,J _l'MI!IIfltl/-r... '~ ,.---L-_1-,.. 07/24/2000 15:42 DIAGRAM .vor 305-289-2309 PAGE 04 FHP MARATHON (B INDICATE NORTH WITH NW1N f'ZS1 I I I I ~ "- I .m ~ .~ Sf< S 1./ r SOcJr~ ~ ",;0,. Jo.J.~'" I4J II 'f TO .seA ,-I:::: ..--1LClI~'" FROM CODE ENFORCEMENT PHONE NO. 1. 0 LAW ENFORCEMENT SHORT FORM REPORT 2. g ORIV~ ~EPORT OF TRAFFIC CRASH 3. ~ ORNER EXCHANGE OF INFORMAnON Jul. 15 2000 10:56AM P2 "'.'~c9~ .i;;~",;~;aO)5.ft;:;~.M4~~~~.. L................. ................ ................. .,........... . .......F.~.:".. .~9.Q..9......... RePORT h\IMllER 30sLJ 305 853 7324 S e l: t i o n nME OFFICER NOT1l'IfD B~ , ~::'it;"L"E,:j.,( FeelOt ' ,~.-O:J,Od::J;e: A(/' 1 CJ 2 CJ, FI'lOM NOllf NO. NEXT 1 S ~~1 e 'C t i 0 n 2 s' , G T i o n PW:Y NO. 3 I. ,......,w 0 I. ,..__ ,,-.- ZP COOl AGE VIOlATOR Fl S'rAl\ITI! 1'UIIlER ~, CITATION . NAIE AllllAESS . NuIdltt and SlNIl ClIy I SIa 11lp >,\.;;:(~,~~\,..I~,:;};, : 7," .., :.",',' HSMV 9000ll (I\Iw. 11/981 $ G' MUSl' READ AND CCIFlY WITH M lNSTRIJCTlOI'iS ON THE IW:K Of' 1lflS FORM .. ,~_~:~~"~f!!!D.BY~'}~~"~'~~'~~;~;~~':~Y:':"'" ::';.~' . ...' ,'.