HomeMy WebLinkAbout; ; Records Destruction Authorization Form-Risk Management; 2013-10-24 (2)Sbred- it .
3801 Ocean Ranch Blvd
Suite 101
Oceanside CA
920S6
Phone: 760- 598- 5700
SERVICE RECORD SUMMARY
CKRTIFICATE OF DKSTRUCTION
PLEASE KEEP THIS FOR YOUR RECORDS
(THIS IS NOT AN INVOICE)
Customer: 0011889293
CITY OF CARLSBAD- RECORDS .MANAGEMENT
5815 EL CAMINO REAL
CARLSBAD CA 92008- SSOl
Order #: 8009700753
Order Date: 24.10.2013
Service Type; SHRED - ON- SITE PURGE
Contact: PAT DOWNIE
Time In: 07:52 AM
Time Out: 10:49 AM
Material Collected
HANKERS/ARCHIVE BOX 141
FILE DRAWER 2
Total: 143
Service Time: 176 Min
Customer Signature: PAT DOWNIE
CSR Signature: RUBEN JACOBO
RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: j^ 1113 PAGE 1 OF 15
REQUESTING DEPARTMENT: RISK MANAGEMENT REQUESTER: TERIE ROWLEY
DESTRUCTION APPROVALS: /
We certify that the records listed below have been retained for the scheduled retention period, required audits have been
completed, and no pending or ongoing litigation or investigation involving these records is known to exist.
DEPARTMENT HEAD: RECORDS MANAGEMENT: CITY ATTORNEY:
BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS
PERIOD
SMEADSOFT BARCODE
(if applicable)
RM15 Risk Manager correspondence 2005-
2007
RM16 Incident Reports 2005-
2007 0120-23 CL+2
RM16 Vehicle Accident Reports 2006-
2007 0120-23 CL+2
RM16 Potential Claims 2007
RM16 Potential Loss Recoveries 2007 CU+2
RM16
-•
Facility Use Insurance Review
Requests 2007 0120-18 CL+2
2004-
2007
RKM19 Allen, Barbara - Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKIVI19 Angels Are From Heaven Closed
2005 0745-20 CL+5
To be filled out once records have been destroyed.
^YES • NO
SMEADSOFT BARCODES DELETED BY:
RECORD DESTRUaiON COMPLETED BY
CERTIFICATE OF DESTRUCTION?
DATE:
DATE: lO-^B'/^
^ CARLSBAD
This form documents tbe destruction of City records in accordance with the City of Carlsbad Records Management Program.
Revised: 7/31/2013
RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: PAGE 2 OF 15
REQUESTING DEPARTMENT: RISK MANAGEMENT REQUESTER: TERIE ROWLEY
DESTRUCTION APPROVALS:
We certify that the records listed below have been retained for the scheduled retention period, required audits have been
completed, and no pending or ongoing litigation or investigation involving these records is known to exist.
DEPARTMENT HEAD: RECORDS MANAGEMENT: CITY ATTORNEY:
BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS
PERIOD
SMEADSOFT BARCODE
(if applicable)
RKM19 Armstrong, Thomas-Claim, Other,
Violation of Due Process
Closed
2005 0745^ CL+5
RKM19 Bantoft, Christina - Claim, Other,
Dust due to blasting
Closed
2005 0745-20 CL+5
RKM19 Bellaver, John - Claim, Vehicle
Comprehensive
Closed
2005 0745-20 CL+5
RKM19 Beninatto and Spacinsky-Claim,
Tree branch fell
Closed
2005 0745-20 CL+5
RKM19 Bennett, Lindsay - Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM19 Berkuti, Marie - Claim, Tree Roots Closed
2005 0745-20 CL+5
RKM19 Bernard, Glenn - Claim, Tree Roots Closed
2005 0745-20 CL+5
RKM19 Bernard, Glenn - Claim, Tree Root
removal damaged mailbox
Closed
2005 0745-20 CL+5
RKM19 Bernard, Glenn - Claim, Trip and Fall Closed
2005 0745-20 CL+5
To be filled out once records have been destroyed.
RECORD DESTRUCTION COMPLETED BY:
CERTIFICATE OF DESTRUCTION?
SMEADSOFT BARCODES DELETED BY:
• YES • NO
DATE:
DATE:
This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
Revised: 7/31/2013
CARLSBAD
RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: PAGE 3 OF 15
REQUESTING DEPARTMENT: RISK MANAGEMENT REQUESTER: TERIE ROWLEY
DESTRUCTtON APPROVALS:
We certify that the records listed below have been retained for the scheduled retention period, required audits have been
completed, and no pending or ongoing litigation or investigation involving these records is known to exist.
DEPARTMENT HEAD: RECORDS MANAGEMENT: CITY ATTORNEY:
BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS
PERIOD
SMEADSOFT BARCODE
(if applicable)
RKM19 Besecker, Megan - Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM19 Bio-Hydration Research Lab-Claim,
Sewer/Water, Tree related
Closed
2005 0745-20 CL+5
RKM19 Blacic, Henrietta-Claim,
Sewer/Water, Tree related
Closed
2005 0745-20 CL+5
RKM19 Bray, Suzanne - Claim, Personal
Injury
Closed
2005 CL+5
RKM19 Broadway, Gwen - Claim, Other,
Emotional and Physical Distress
Closed
2005 0745-20 CL+5
RKM19 Budget Rent-A-Car - Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM19 Bujas, Ann - Claim, Law
Enforcement
Closed
2005 0745-20 CL+5
RKM19 C. San Dieguito Water Dist. - Claim,
Vehicle Collision
Closed
2005 0745-20 CL+5
RKM19 Carlsbad Comm. Church - Claim,
Sewer/Water, Tree related
Closed
2005 0745-20 CL+5
To be filled out once records have been destroyed.
RECORD DESTRUCTION COMPLETED BY:
CERTIFICATE OF DESTRUCTION? • YES
SMEADSOFT BARCODES DELETED BY:
• NO
DATE:
DATE:
This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
Revised: 7/31/2013 ,^<^N cn, o,
^ CARLSBAD
RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: PAGE 4 OF 15
REQUESTING DEPARTMENT: RISK MANAGEMENT REQUESTER: TERIE ROWLEY
DESTRUCTION APPROVALS:
We certify that the records listed below have been retained for the scheduled retention period, required audits have been
completed, ond no pending or ongoing litigation or investigation involving these records is known to exist.
DEPARTMENT HEAD: RECORDS MANAGEMENT: CITY ATTORNEY:
BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS
PERIOD
SMEADSOFT BARCODE
(if applicable)
RKM19 Clute, Mavis-Ciaim, Other,
Emotional Distress
Closed
2005 0745-20 CL+5"
RKM19 Colby, Aldon-Claim, Vehicle Collision Closed
2005 0745-20 CL+5
RKM19 Coobatis, Christy-Claim,
Sewer/Water, Tree Related
Closed
2005 0745-20 CL+5
RKM19 Coon, Kevin-Claim, Vehicle Collision Closed
2005 0745-20 CL+5
RKM19 Delaney, Zanita-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM19 Desai, Pragnya-Claim, Vehicle
Comprehensive
Closed
2005 0745-20 CL+5
RKM19 Di Landri, Garett-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM19 Dillon, Joseph-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM19 Dineen, Kristen-Claim, Vehicle
Collision
Closed
2005 - 0745-20 CL+5
To be filled out once records have been destroyed.
RECORD DESTRUCTION COMPLETED BY:
CERTIFICATE OF DESTRUCTION?
SMEADSOFT BARCODES DELETED BY:
• YES • NO
DATE:
DATE:
^ CARLSBAD
This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
Revised: 7/31/2013
RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: PAGE 5 OF 15
REQUESTING DEPARTMENT: RISK MANAGEMENT REQUESTER: TERIE ROWLEY
DESTRUCTION APPROVALS:
We certify that the records listed below have been retained for the scheduled retention period, required audits have been
completed, and no pending or ongoing litigation or investigation involving these records is known to exist.
DEPARTMENT HEAD: RECORDS MANAGEMENT: CITY ATTORNEY:
BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS
PERIOD
SMEADSOFT BARCODE
(if applicable)
RKM19 Endo, Kristina-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
^ RKM20 Farmers Ins. Nguyen-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM20 Favano, Daniel-Claim, Vehicle
Comprehensive
Closed
2005 0745-20 CL+5
RKM20 Flower Fields, LLC-Claim,
Sewer/Water-Tree related
Closed
2005 0745-20 CL+5
RKM20 Gil, Abraham-Claim, Vehicle Collision Closed
2005 0745-20 CL+5
RKM20 Gonzalez, Alvaro-Claim, Trip/Fall Closed
2005 CL+5
RKM20 Gonzalez, Martha-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM20 Gonzalez, Ruben-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM20 Green, Rick-Claim, Vehicle
Comprehensive
Closed
2005 0745-20 CL+5
To be filled out once records have been destroyed.
RECORD DESTRUCTION COMPLETED BY:
CERTIFICATE OF DESTRUCTION?
SMEADSOFT BARCODES DELETED BY:
• YES • NO
DATE:
DATE:
This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
Revised: 7/31/2013 CARLSBAD
RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: PAGE 6 OF 15
REQUESTING DEPARTMENT: RISK MANAGEMENT REQUESTER: TERIE ROWLEY
DESTRUCTION APPROVALS:
We certify that the records listed below have been retained for the scheduled retention period, required audits have been
completed, and no pending or ongoing litigation or investigation involving these records is known to exist.
DEPARTMENT HEAD: RECORDS MANAGEMENT: CITY ATTORNEY:
BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS
PERIOD
SMEADSOFT BARCODE
(if applicable)
RKM20 Greenland, Mark-Claim, Vehicle
Comprehensive
Closed
2005 0745-20 CL+5
RKM20 Heinz & Block, Jessica-Claim, Other,
Emotional & Physical Distress
Closed
2005 0745-20 CL+5
RKM20 Hjelt, John & Cathy-Claim, Other,
Damaged landscape
Closed
2005 0745-20 CL+5
RKM20 Ivanovich, Arso-Claim, Law
Enforcement - Property
Closed
2005 0745-20 CL+5
RKM20 Ivanovich, Arso-Claim,Law
Enforcement-Medical
Closed
2005 0745-20 CL+5
RKM20 Jamal & Desai, Hanif & Nilam-Claim
Vehicle Collision
Closed
2005 0745-20 CL+5
RKM20 Jordan, Toby & Brian-Claim, Vehicle
Comprehensive
Closed
2005 0745-20 CL+5
RKM20
Kaprielian, Gary & Dimitra-Claim,
Other, Property Damage and
Emotional distress
Closed
2005 0745-20 CL+5
RKM20 Kearns, Joseph-Claim, Trip & Fall Closed
2005 CL+5
To be filled out once records have been destroyed.
RECORD DESTRUCTION COMPLETED BY:
CERTIFICATE OF DESTRUCTION? • YES
SMEADSOFT BARCODES DELETED BY:
• NO
DATE:
DATE:
^ CARLSBAD
This form documents tbe destruction of City records in accordance with the City of Carlsbad Records Management Program.
Revised: 7/31/2013
RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: PAGE 7 OF 15
REQUESTING DEPARTMENT: RISK MANAGEMENT REQUESTER; TERIE ROWLEY
DESTRUCTION APPROVALS: ,
We certify that the records listed below have been retained for the scheduled retention period, required audits have been
compteted, and no pending or ongoing litigation or investigation involving these records is known to exist.
DEPARTMENT HEAD: RECORDS MANAGEMENT: CITY ATTORNEY:
BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS
PERIOD
SMEADSOFT BARCODE
(if applicable)
RKM20 Kelly, Colleen-Ctaim, Trip and Fall Closed
2005
0746
0745-2O CL+5
RKM20 Kent, Elizabeth-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM20 Knudsen, Frank and Judith-Claim,
Other, Emotional & Physical Distress
Closed
2005 0745-20 CL+5
RKM20 Kovsky, Gregory Alan-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
1/ RKM21 Laguna Terrace, Maggi Barboza-
Claim, Sewer/Water, Tree related
Closed
2005 0745-20 CL+5
RKM21 Lanphear, William-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM21 Launder, Diane-Claim, Tree, Other
than Sewer/Water related
Closed
2005 0745-20 CL+5
RKM21 Lawrenson, Kenneth-Claim,
Sewer/Water, tree related
Closed
2005 0745-20 CL+5
RKM21 Leader, Jeff-Claim, Other, Destroyed
tires
Closed
2005 0745-20 CL+5
To be filled out once records have been destroyed.
RECORD DESTRUCTION COMPLETED BY:
CERTIFICATE OF DESTRUCTION? • YES
SMEADSOFT BARCODES DELETED BY:
• NO
DATE:
DATE:
This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
cn.
^ CARLSBAD Revised: 7/31/2013
RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: PAGE 8 OF 15
REQUESTING DEPARTMENT: RISK MANAGEMENT REQUESTER: TERIE ROWLEY
DESTRUCTION APPROVALS:
We certify that the records listed below have been retained for the scheduled retention period, required audits have been
completed, and no pending or ongoing litigation or investigation involving these records Is known to exist.
DEPARTMENT HEAD: RECORDS MANAGEMENT: CITY ATTORNEY:
BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS
PERIOD
SMEADSOFT BARCODE
(if applicable)
RKM21 Levy, Bertha-Claim, Other, Plant
damage
Closed
2005 0745-20 CL+5
RKM21 Lewis, Thad & Mia-Claim, Tree,
Other than Sewer/Water Related
Closed
2005 0745-20 CL+5
RKM21 Licata, William-Claim, Vehicle
Comprehensive
Closed
2005 0745-20 CL+5
RKM21 Loughran, Chris-Claim,
Sewer/Water, Tree related
Closed
2005 0745-20 CL+5
RKM21 Lukas, Shari-Claim, Other, Drainage
Pipe
Closed
2005 0745-20 CL+5
RKM21 Marja Acres-Claim, Other, Water
run-off
Closed
2005 0745-20 CL+5
RKM21 Mason Jacquelyn-Claim, Trip & Fall Closed
2005 0745-20 CL+5
RKM21
Massery, George & Mary-Claim,
Tree other than Sewer/Water
related
Closed
2005 0745-20 CL+5
RKM21 McAnally, Tamara-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
To be filled out once records have been destroyed.
RECORD DESTRUCTION COMPLETED BY:
CERTIFICATE OF DESTRUCTION?
SMEADSOFT BARCODES DELETED BY:
• YES • NO
DATE:
DATE:
This form documents the destruction of City records in accordance with tbe City of Carlsbad Records Management Program.
Revised: 7/31/2013 CARLSBAD
RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: PAGE 9 OF 15
REQUESTING DEPARTMENT: RISK MANAGEMENT REQUESTER: TERIE ROWLEY
DESTRUCTION APPROVALS:
We certify that the records listed below have been retained for the scheduled retention period, required audits have been
completed, and no pending or ongoing litigation or investigation involving these records is known to exist.
DEPARTMENT HEAD: RECORDS MANAGEMENT: CITY ATTORNEY:
BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS
PERIOD
SMEADSOFT BARCODE
(if applicable)
RKM21 McComas, Audrey-Claim,
Sewer/Water Related
Closed
2005 0745-20 CL+5
RKM21 Mercury Insurance Co.-Clatm, Tree
Other than Sewer/Water related
Closed
2005 0745-20 CL+5
RKM2i Mertes, Robert-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM21 Montgomery, Ronatd-Claim, Tree,
Other than Sewer/Water related
Closed
2005 0745-20 CL+5
RKM21 Morgan, Bruce & Andrea-Claim,
Other, Property damage
Closed
2005 0745-20 CL+5
RKM21 Murrell, Teresa-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM21 Nakaji, Connie-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM21 Nash, Norman-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM21 Niemi, Jeff-Claim, Tree, Other than
Sewer/Water related
Closed
2005 0745-20 CL+5
To be filled out once records have been destroyed.
RECORD DESTRUCTION COMPLETED BY:
CERTIFICATE OF DESTRUCTION? • YES
SMEADSOFT BARCODES DELETED BY:
• NO
DATE:
DATE:
This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
4cAi<[sBAD Revised: 7/31/2013
RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: PAGE 10 OF 15
REQUESTING DEPARTMENT: RISK MANAGEMENT REQUESTER: TERIE ROWLEY
DESTRUCTION APPROVALS:
We certify that the records listed below have been retained for the scheduled retention period, required audits have been
completed, and no pending or ongoing litigation or investigation involving these records is known to exist.
DEPARTMENT HEAD: RECORDS MANAGEMENT: CITY ATTORNEY:
BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS
PERIOD
SMEADSOFT BARCODE
(if applicable)
RKM21 Obenberger, Bob-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM21 O'Donoghue, William-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM21 Olson, Lester-Claim, Tree, other
than Sewer/Water related
Closed
2005 0745-20 CL+5
RKM21 Palay, Susan & Elliott-Claim, Other,
Emotional and Physical distress
Closed
2005 0745-20 CL+5
RKM21 Peck, Edna-Claim, Tree, Other than
Sewer/Water related
Closed
2005 0745-20 CL+5
RKM21 Pelican Cove Inn B&B-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM21 Porter, Cynthia-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM21 Prentice, Angela-Claim, Vehicle
Collision
Cfosed
2005 0745-20 CL+5
RKM21 Rancho Carlsbad HOA-Claim, Other,
Defective Construction
Closed
2005 0745-20 CL+5
To be filled out once records have been destroyed.
RECORD DESTRUCTION COMPLETED BY:
CERTIFICATE OF DESTRUCTION? • YES
SMEADSOFT BARCODES DELETED BY:
• NO
DATE:
DATE:
4fc
This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
Revised: 7/31/2013 CARLSBAD
RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: PAGE 11 OF 15
REQUESTING DEPARTMENT: RISK MANAGEMENT REQUESTER: TERIE ROWLEY
DESTRUCTJON APPROVALS;
We certify that the records listed below have been retained for the scheduled retention period, required audits have been
completed, and no pending or ongoing litigation or investigation involving these records is known to exist.
DEPARTMENT HEAD: RECORDS MANAGEMENT: CITY ATTORNEY:
BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS
PERIOD
SMEADSOFT BARCODE
(if applicable}
RKM21 Robinson, Donna-Claim, Trip and Fall Closed
2005 0745-20 . CL+5
RKM21 Rogers, Christopher-Claim, Vehicle
Comprehensive
Closed
2005 0745-20 CL+5
RKM21 Ross, Kira-Claim, Vehicle Collision Closed
2005 0745-20 CL+5
RKM21
r ——
Rue, Allison-Claim, Other, personal
property destroyed
Closed
2005 0745-20 CL+5
/ RKM22 Salazar, Ernest-Claim Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM22 Salisbury, David-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM22 Saltz, Joel & L. Gayle-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM22 SDG&E-Claim, Tree, Other than
Sewer/Water related
Closed
2005 0745-20 CL+5
To be filled out once records have been destroyed.
RECORD DESTRUCTION COMPLETED BY:
CERTIFICATE OF DESTRUCTION?
SMEADSOFT BARCODES DELETED BY:
• YES • NO
DATE:
DATE:
^ CARLSBAD
This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
Revised: 7/31/2013
RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: PAGE 12 OF 15
REQUESTING DEPARTMENT: RISK MANAGEMENT REQUESTER: TERIE ROWLEY
DESTRUCTION APPROVALS:
We certify that the records listed below have been retained for the scheduled retention period, required audits have been
completed, and no pending or ongoing litigation or investigation involving these records is known to exist
DEPARTMENT HEAD: RECORDS MANAGEMENT: CITY ATTORNEY:
BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS
PERIOD
SMEADSOFT BARCODE
(if applicable)
RKM22 Sangster, Lolly-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM22 Schubert, Maureen-Claim, Vehicle
Comprehensive
Closed
2005 0745-20 CL+5
RKM22 Sheedy, Stephen-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM22 Sielaff, Donald-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM22 Silliphant, Jr., Donald C.-Claim,
Vehicle Collision
Closed
2005 0745-20 CL+5
RKM22 Singer, Ricardo-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM22 Singleton, Kerry-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM22 St. Austin, Bob & Judy-Claim, Other.
Emotional and Physical distress
Closed
2005 0745-20 CL+5
RKM22 State Farm Closed
2005 0745-20 CL+5
To be filled out once records have been destroyed.
RECORD DESTRUCTION COMPLETED BY:
CERTIFICATE OF DESTRUCTION? • YES
SMEADSOFT BARCODES DELETED BY:
• NO
DATE:
DATE:
^ CARLSBAD
This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
Revised: 7/31/2013
RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: PAGE 13 OF 15
REQUESTING DEPARTMENT: RISK MANAGEMENT REQUESTER: TERIE ROWLEY
DESTRUCTION APPROVALS:
We certify that the records listed below have been retained for the scheduled retention period, required audits have been
completed, and no pending or ongoing litigation or investigation involving these records is known to exist.
DEPARTMENT HEAD: RECORDS MANAGEMENT: CITY ATTORNEY:
BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS
PERIOD
SMEADSOFT BARCODE
(if applicable)
RKM22 Steers, Stephanie-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM22 Stevens, Scott-Claim, Tree, other
than Sewer/Water related
Closed
2005 0745-20 CL+5
RKM22 Stevenson, Debora-Claim, vehicle
collision
Closed
2005 0745-20 CL+5
RKM22 Steward Barbara-Claim, Vehicle
Comprehensive
Closed
2005 0745-20 CL+5
RKM22 Stovall, Jan & Roseanna-Claim, Tree,
other than Sewer/Water related
Closed
2005 0745-20 CL+5
RKM22 Straus, Judy Ann-Claim, Vehicle
Comprehensive
Closed
2005 0745-20 CL+5
RKM22 Stuempfig, J. David-Claim, Vehicle
Comprehensive
Closed
2005 0745-20 CL+5 -
RKM22 Sullivan, Edward-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM22 Tamagni, Charles-Claim, Vehicle
Comprehensive
Closed
2005 0745-20 CL+5
To be filled out once records have been destroyed.
RECORD DESTRUCTION COMPLETED BY:
CERTIFICATE OF DESTRUCTION? • YES
SMEADSOFT BARCODES DELETED BY:
• NO
DATE:
DATE:
^ CARLSBAD
This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
Revised: 7/31/2013
RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: PAGE 14 OF 15
REQUESTING DEPARTMENT: RISK MANAGEMENT REQUESTER: TERIE ROWLEY
DESTRUCTION APPROVALS:
We certify that the records listed below have been retained for the scheduled retention period, required audits have been
completed, and no pending or ongoing litigation or investigation involving these records is known to exist.
DEPARTMENT HEAD: RECORDS MANAGEMENT: CITY ATTORNEY:
BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS
PERIOD
SMEADSOFT BARCODE
(if applicable)
RKM22 Thomas, Bruce-Claim, Law
Enforcement
Closed
2005 0745-20 CL+5
RKM22 Thomas, Bruce-Claim, Other,
Requested Grant payout
Closed
2005 0745-20 CL+5
RKM22 Thomas, Bruce-Claim, Law
Enforcement
Closed
2005 0745-20 CL+5
RKM22 Thorogood, Scott-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM22 USAA, Crescini-Claim, Vehicle
Collision
Closed
2005 0745-20 . CL+5
RKM22 Van Sittert, Kelly-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM22 Violi, Joseph-Claim, Vehicle
Comprehensive
Closed
2005 0745-20 CL+5
RKM22 Webber, Micah-Claim, Vehicle
Collision
Closed
2005 0745-20 CL+5
RKM22 White, Scott-Claim, Vehicle Collision Closed
2005 0745-20 CL+5
To be filled out once records have been destroyed.
RECORD DESTRUCTION COMPLETED BY:
CERTIFICATE OF DESTRUCTION?
SMEADSOFT BARCODES DELETED BY:
• YES • NO
DATE:
DATE:
•A
This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
Revised: 7/31/2013 CARLSBAD
RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: PAGE 15 OF 15
REQUESTING DEPARTMENT: RISK MANAGEMENT REQUESTER: TERIE ROWLEY
DESTRUCTION APPROVALS:
We certify that the records listed below have been retained for the scheduled retention period, required audits have been
completed, and no pending or ongoing litigation or investigation involving these records is known to exist.
DEPARTMENT HEAD: RECORDS MANAGEMENT: CITY ATTORNEY:
BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS
PERIOD
SMEADSOFT BARCODE
(if applicable)
RKM22 Wilmott, Steve-Claim, Tree, Other
than Sewer/Water related
Closed
2005 0745-20 CL+5
RKM22 Wilson, Randy-Claim, Trip/Fall Closed
2005 0745-20 CL+5
RKM22 Wittkoski, Tom-Claim, Sewer/Water,
tree related
Closed
2005 0745-20 CL+5
RKM22 Wolinski, Marc-Claim, Vehicle
Comprehensive
Closed
2005 0745-20 CL+5
RKM22
World Savings Bank, Jennifer
Stinson-Claim, Other, Damaged
Landscaping
Closed
2005 0745-20 CL+5
RKM22 Zaplata, Mitch-Ciaim, Law
Enforcement
Closed
2005 0745-20 CL+5
To be filled out once records have been destroyed.
RECORD DESTRUCTION COMPLETED BY:
CERTIFICATE OF DESTRUCTION? • YES
SMEADSOFT BARCODES DELETED BY:
• NO
DATE:
DATE:
This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
CARLSBAD Revised: 7/31/2013
city of Carlsbad
Loss Ron Report
Date of
Ms Qosed between DI/QW
and 12/31/2D05
Date Date Date Loss Expense Loss Expense
ClaimName Loss Received Closed Cateqorv Litigate Reserve Reserve Payment Payment Incurred Status
1 ALLEN, BARBARA 01/14/2005 01/31/2005 08/31/2005 VEHICLE COLLISION 0.00 0.00 0.00 0.00 0.00 CLOSED
2 ANGELS ARE FROM HE 01/01/2005 06/20/2005 10/19/2005 OTHER 0,00 0.00 1,500,00 741 -40 2,241-40 CLOSED
3 ARMSTRONG, THOMAS 12/04/2000 01/02/2001 05/31/2005 OTHER 06/26/2001 0,00 0.00 3,205.00 23,135-20 26,340.20 CLOSED
4 BANTOFT, CHRISTINA 07/01/2003 06/17/2004 01/31/2005 OTHER 0.00 0.00 0,00 0.00 0,00 CLOSED
5 BELLAVER, JOHN 07/15/2004 08/02/2004 02/28/2005 VEHICLE COMPREHEN 0,00 0.00 0,00 0.00 0,00 CLOSED
6 BENINATTO AND SPACI 01/11/2005 02/16/2005 08/31/2005 TREE (OTHER THAN SE 0.00 0.00 0,00 0,00 0,00 CLOSED
7 BENNETT, LINDSAY 03/08/2005 03/17/2005 09/30/2005 VEHICLE COLLISION 0.00 0,00 0.00 0.00 0,00 CLOSED
8 BERKUTI, MARIE 09/24/2003 11/25/2003 09/30/2005 TREE (OTHER THAN SE 0.00 0.00 0,00 0,00 0,00 CLOSED
9 BERNARD, GLENN 05/14/2004 09/10/2004 02/28/2005jTREE (OTHER THAN SE 0.00 0,00 0,00 0.00 0,00 CLOSED
10 BERNARD/GLENN 12/01/2003 09/10/2004 02/28/2005|TREE (OTHER THAN SE 0.00 0,00 0,00 0,00 0,00 CLOSED
11 BERNARD, GLENN 08/28/2004 02/09/2005 09/30/2005 TRIP/FALL 0.00 0,00 0,00 0,00 0,00 CLOSED
12 BESECKER, MEGAN 01/17/2005 02/10/2005 09/13/2005 VEHICLE COLLISION 0,00 0,00 892,11 0,00 892.11 CLOSED
13 BIO-HYDRATfON RESE 09/06/2005 09/15/2005 10/19/2005 SEWER/WATER (TREE 0.00 0.00 180,00 0,00 180.00 CLOSED
14 BLACIC, HENRIETTA 01/02/2005 01/27/2005 02/28/2005 SEWERAWATER (TREE 0.00 0,00 5,130,86 0.00 5,130,86 CLOSED
15 BRAY, SUZANNE 12/16/2002 01/24/2003 03/03/2005 OTHER 11/21/2003 0.00 0,00 0.00 25,00 25.00 CLOSED
16 BROADWAY, GWEN 07/01/2003 06/29/2004 01/31/2005 OTHER 0.00 0.00 0,00 0,00 0-00 CLOSED
17 BUDGET RENTACAR 09/12/2005 10/21/2005 11/30/2005 VEHICLE COLLISION 0,00 0,00 2,897.80 0,00 2,897.80 CLOSED
18 BUJAS,'ANN 06/24/2004 07/14/2004 01/31/2005 LAW ENFORCEMENT 0.00 0,00 0.00 0,00 0.00 CLOSED
19 C. San Dieguito Water Di 06/10/2005 08/02/2005 08/23/2005 VEHICLE COLLISION 0.00 0,00 1,389.49 0,00 1,389.49 CLOSED
20 CARLSBAD COMMUNIT 11/23/2003 11/24/2003 11/30/2005 SEWERAft/ATER (TREE 0,00 0,00 6,911.20 500-00 7,411.20 CLOSED
21 CLARKE, CATHERINE & 08/08/2004 08/18/2004 10/27/2005 TREE (OTHER THAN SE 0.00 0,00 2,300.00 246-50 2,546.50 CLOSED
22 CLUTE, MAVIS 07/01/2003 06/29/2004 01/31/2005 OTHER 0.00 0.00 0,00 0.00 0,00 CLOSED
23 COLBY, ALDON 03/31/2005 03/31/2005 05/13/2005 VEHICLE COLLISION 0,00 0,00 1,456,02 0,00 1,456.02 CLOSED
24 COOBATIS, CHRISTY 05/07/2005 05/31/2005 08/23/2005 SEWERA/VATER (TREE 0.00 0,00 918,50 418,50 1,337.00 CLOSED
25 COON, KEVIN 03/03/2005 03/09/2005 09/30/2005 VEHICLE COLLISION' 0.00 0,00 0,00 0,00 0,00 CLOSED
26 DELANEY, ZANITA 04/02/2004 04/23/2004 05/31/2005 VEHICLE COLLISION 0.00 0.00 0,00 0.00 0,00 CLOSED
27 DESAI, PRAGNYA 10/07/2004 11/03/2004 05/31/2005 VEHICLE COMPREHEN 0.00 0.00 0.00 0,00 0,00 CLOSED
28 Dl LANDRI, GARETT 01/09/2005 01/18/2005 08/31/2005 VEHICLE COLLISION 0.00 0.00 0,00 0,00 0.00 CLOSED
29 DILLON, JOSEPH 01/07/2005 01/25/2005 08/31/2005 VEHICLE COLLISION 0.00 0.00 0.00 0,00 0.00 CLOSED
30 DINEEN, KRISTEN 07/05/2005 09/14/2005 10/19/2005 VEHICLE COLLISION 0.00 0-00 1,301,17 0.00 1,301,17 CLOSED
'3l| .D0RNICK; LESLIE-ASfG"" 03/25/2005 05/17/2005 12/30/2005 OTHER 0.00 0.00 0,00 0,00 0-00 CLOSED
32 ENDO, KRISTINA 04/05/2005 04/27/2005 05/24/2005 VEHICLE COLLISION 0.00 0.00 837,23 0,00 837.23 CLOSED
LossRunCiosed Monday, August 05, 2013
^^^7 i/Kv^r cWXd^ - U^va W^-NXO ^^V^
a Page 1 of 5
City of Carlsbad
Loss Run Report
CMS raised betw^ 0l/0V20ie
end 12/31/2005
Date of Date Date Date Loss Expense Loss Expense
33 FARMERS INSURANCE, 10/07/2004 12/14/2004 01/11/2005 VEHICLE COLLISION 0,00 0,00 3,960,25 0.00 3,960,25 CLOSED
34 FAVANO, DANIEL 09/29/2004 10/15/2004 04/29/2005 VEHICLE COMPREHEN
SEWERAWATER (TREE
0,00 0,00 0,00 0.00 0.00 CLOSED
35 FLOWER FIELDS LLC, 03/21/2005 06/13/2005 09/21/2005
VEHICLE COMPREHEN
SEWERAWATER (TREE 0,00 0,00 3,540.00 0.00 3,540,00 CLOSED
36 GIL, ABRAHAM 05/21/2005 06/03/2005 08/17/2005 VEHICLE COLLISION 0,00 0,00 1,029,90 0.00 1,029,90 CLOSED
37 GONZALEZ, ALVARO 08/21/2004 10/01/2004 04/29/2005 TRIP/FALL 04/11/2005 0,00 0,00 0,00 0.00 0,00 CLOSED
38 GONZALEZ, MARTHA 12/04/2004 12/15/2004 08/31/2005 VEHICLE COLLISION 0,00 0,00 0,00 0,00 0,00 CLOSED
39 GONZALEZ, RUBEN 05/02/2005 05/06/2005 06/07/2005 VEHICLE COLLISION 0,00 0,00 219.47 0,00 219.47 CLOSED
40 GREEN, RICK 09/20/2004 10/04/2004 04/29/2005|VEHICLE COMPREHEN 0,00 0,00 0,00 0,00 0,00 CLOSED
41 GREENLAND, MARK 05/28/2004 07/01/2004 01/31/2005 VEHICLE COMPREHEN
i\ II— /A-1-1 1 f--r-l 1 r, k 1
0,00 0,00 0,00 0,00 0,00 CLOSED
42 HEINZ AND BLOCK, JES 07/01/2003 06/17/2004 01/31/2005 OTHER 0.00 0,00 0-00 0,00 0,00 CLOSED
43 HJELT, JOHN & CATHY 02/19/2005 03/31/2005 10/31/2005 OTHER 0.00 0-00 0.00 0.00 0.00 CLOSED
44 HOUSTON, BRITTENY 11/01/2004 11/10/2004 06/30/2005 LAW ENFORCEMENT 0-00 0.00 0.00 0.00 0,00 CLOSED
45 HOUSTON,CASANDRA 11/01/2004 11/10/2004 06/30/2005 LAW ENFORCEMENT 0-00 0.00 0.00 0,00 0.00 CLOSED
46 HOUSTON, CLAUDIA 11/01/2004 11/10/2004 06/30/2005 LAW ENFORCEMENT 0.00 0.00 0,00 0-00 0,00 CLOSED
47 HOUSTON, JONES 11/01/2004 11/10/2004 06/30/2005 U\W ENFORCEMENT 0.00 0.00 0.00 0.00 0.00 CLOSED
48 IVANOVICH, ARSO 11/12/2002 06/17/2005 12/30/2005 LAW ENFORCEMENT 0.00 0,00 0.00 0.00 0,00 CLOSED
49 IVANOVICH, ARSO 11/12/2002 06/17/2005 12/30/2005 LAW ENFORCEMENT 0,00 0,00 0.00 0.00 0,00 CLOSED
50 JAMAL & DESAI, HANIF 07/09/2004 08/09/2004 02/28/2005 VEHICLE COLLISION 0,00 0,00 0.00 0,00 0,00 CLOSED
51 JORDAN, TOBY & BRIA 02/24/2005 03/03/2005 09/30/2005 VEHICLE COMPREHEN 0,00 0.00 0,00 0,00 0,00 CLOSED
52 KAPRIELIAN, GARY & D 07/01/2003 08/13/2004 02/28/2005 OTHER 0.00 0,00 0.00 0,00 0,00 CLOSED
53 KEARNS, JOSEPH -06/19/2003 08/29/2003 04/18/2005 TRIP/FALL 04/13/2004 0,00 0.00 9,999.00 24,588.78 34,587.78 CLOSED
54 KELLY, COLLEEN 12/26/2003 05/20/2004 09/22/2005 TRIP/FALL 11/17/2004 0,00 0,00 75,000.00 7,138-11 82,138,11 CLOSED
55 KENT, ELIZABETH 01/09/2005 03/08/2005 09/30/2005 VEHICLE COLLISION 0,00 0-00 0.00 0.00 0.00 CLOSED
56 KNUDSEN, FRANK AND
•ii.ir>u:u
07/01/2003 06/30/2004 01/31/2005 OTHER 0.00 0-00 0.00 0.00 0.00 CLOSED
57 KOVSKY, GREGORY AL
n k 1
02/21/2005 03/07/2005 09/30/2005 VEHICLE COLLISION 0.00 0,00 0.00 0.00 0,00 CLOSED
58 LAGUNA TERRACE HO
-Jl—luii-^fi I-, n r-tn/~--r A
09/22/2004 01/20/2005 02/28/2005 SEWER/WATER (TREE 0.00 0,00 1,798.00 0,00 1,798.00 CLOSED
59 LANPHEAR, WILLIAM 07/06/2005 08/05/2005 09/27/2005 VEHICLE COLLISION 0.00 0,00 545.44 0,00 545,44 CLOSED
60 LAUNDER, DIANE 04/14/2004 04/09/2004 07/12/2005 TREE (OTHER THAN SE 0.00 0,00 350.00 0,00 350,00 CLOSED
61 LAWRENSON, KENNET
L-l . .
06/08/2005 06/17/2005 07/27/2005 SEWERAWATER (TREE 0,00 0,00 205.00 0,00 205.00 CLOSED
62 LEADER, JEFF 06/22/2004 06/28/2004 01/31/2005 OTHER 0,00 0,00 0,00 0,00 0.00 CLOSED
63 LEVY, BERTHA 02/02/2005 03/09/2005 09/30/2005 OTHER 0,00 0.00 0.00 0-00 0.00 CLOSED
64 LEWIS, THAD AND MIA 12/31/2002 12/31/2002 01/31/2005 TREE (OTHER THAN SE 0,00 0.00 0.00 0-00 0.00 CLOSED
Monday, August 05, 2013 LossRunCiosed Page 2 of 5
City of Carlsbad
Loss Run Report
mvim
and 12/31/2005
ClaimName
Date of
Loss
Date
Received
Date Date
Litigate
Loss
Reserve
Expense
Reserve
Loss
Payment
Expense
Payment Incurred Status
65 LICATA, WILLIAM 06/18/2004 06/29/2004 01/31/2005 VEHICLE COMPREHEN 0,00 0.00 0.00 0.00 0,00 CLOSED
66 LOUGHRAN, CHRIS 02/10/2005 04/20/2005 05/13/2005 SEWERAWATER (TREE 0,00 0.00 335.00 0.00 335,00 CLOSED
67 LUKAS, SHARI 03/01/2005 04/06/2005 10/31/2005 OTHER 0,00 0,00 0-00 0.00 0,00 CLOSED
68 MARJA ACRES, 01/12/2005 01/12/2005 08/31/2005 OTHER 0,00 0.00 0-00 0.00 0,00 CLOSED
69 MASON, JACQUELYN 01/03/2005 02/01/2005 08/31/2005|TRIP/FALL 0,00 0,00 0-00 0.00 0,00 CLOSED
70 MASSERY. GEORGE & 08/01/2003 08/28/2003 08/29/2005|TREE (OTHER THAN SE 0,00 0.00 0.00 0.00 0,00 CLOSED
71 McANALLY, TAMARA 10/01/2004 11/04/2004 01/26/2005 VEHICLE COLLISION 0,00 0.00 1,175.47 0.00 1,175.47 CLOSED
72 MCCOMAS, AUDREY 03/01/2005 06/10/2005 07/12/2005 SEWERAWATER (TREE 0.00 0.00 340-00 0.00 340,00 CLOSED
73 MERCURY INSURANCE 09/12/2004 03/03/2005 04/18/2005|TREE (OTHER THAN SE 0.00 0.00 3,831.02 0.00 3,831.02 CLOSED
74 MERTES, ROBERT 09/15/2005 10/03/2005 11/30/2005 VEHICLE COLLISION 0.00 0.00 0.00 0.00 0,00 CLOSED
75 MONTGOMERY, RONAL 11/03/2004 01/20/2005 03/08/2005 TREE (OTHER THAN SE
OTHER
0,00 0.00 525.00 0.00 525.00 CLOSED
76 MORGAN, BRUCE & AN 12/01/2003 08/12/2004 02/28/2005
TREE (OTHER THAN SE
OTHER 0-00 0.00 0.00 0.00 0.00 CLOSED
77 MURRELL, TERESA 09/05/2004 01/03/2005 08/29/2005|VEHICLE COLLISION 0-00 0.00 0.00 0.00 0.00 CLOSED
78 NAKAJI, CONNIE 03/26/2005 05/10/2005 11/30/2005|VEHICLE COLLISION 0-00 0.00 0.00 0.00 0-00 CLOSED
79 NASH, NORMAN 01/09/2005 01/20/2005 08/31/2005 VEHICLE COLLISION 0.00 0.00 0.00 0.00 0.00 CLOSED
80 NIEMI, JEFF 01/11/2005 02/14/2005 08/31/2005 TREE (OTHER THAN SE
t IL tw— W-* A H t tk -i-w— W-* 1—11— • « -T-r- r-w
0,00 0,00 0.00 0.00 0.00 CLOSED
81 OBENBERGER, BOB 01/08/2005 02/01/2005 08/31/2005|VEHICLE COLLISION 0,00 0,00 0.00 0.00 0.00 CLOSED
82 O'DONOGHUE, WILLIA 04/11/2005 05/02/2005 11/30/2005 VEHICLE COLLISION 0,00 0.00 0.00 0.00 0.00 CLOSED
83 OLSON, LESTER 08/22/2005 08/24/2005 12/30/2005 TREE (OTHER THAN SE 0,00 0.00 2,396.27 0.00 2,396,27 CLOSED
84 PALAY, SUSAN AND EL 07/01/2003 06/30/2004 01/31/2005 OTHER 0,00 0.00 0.00 0.00 0.00 CLOSED
85 PECK, EDNA 04/10/2005 05/24/2005 06/28/2005|TREE (OTHER THAN SE
|i A II—r-i ft ft 1 A-T-l—n i-vr—1 A-rr—rs
0,00 0.00 4,660.75 0.00 4,660.75 CLOSED
86 PELICAN COVE INN B& 01/29/2005 05/02/2005 12/30/2005|VEHICLE COLLISION 0,00 0-00 0.00 0,00 0.00 CLOSED
87 PORTER, CYNTHIA 06/18/2004 12/03/2004 06/30/2005 VEHICLE COLLISION 0,00 0.00 0.00 0,00 0.00 CLOSED
88 PRENTICE, ANGELA 10/30/2004 11/10/2004 05/31/2005 VEHICLE COLLISION 0,00 0.00 0.00 0,00 0.00 CLOSED
89 RANCHO CARLSBAD 0 03/01/2005 07/29/2005 09/30/2005 OTHER 0,00 0.00 0.00 0,00 0.00 CLOSED
90 ROBINSON, DONNA 02/23/2004 07/07/2004 01/31/2005 TRIP/FALL 0,00 0.00 0.00 0,00 0.00 CLOSED
91 ROGERS, CHRISTOPHE 10/08/2004 10/19/2004 05/31/2005 VEHICLE COMPREHEN 0,00 0.00 0.00 0,00 0.00 CLOSED
92 ROSS, KIRA 04/27/2005 05/10/2005 11/30/2005 VEHICLE COLLISION 0.00 0.00 0.00 0.00 0.00 CLOSED
93 RUE, ALLISON 11/24/2003 08/13/2004 02/28/2005 OTHER 0.00 0.00 0.00 0.00 0,00 CLOSED
94 SALAZAR, ERNEST 01/21/2005 02/15/2005 03/28/2005 VEHICLE COLLISION 0-00 0.00 208.23 0.00 208.23 CLOSED
95 SALISBURY, DAVID 11/23/2004 03/11/2005 11/15/2005 VEHICLE COLLISION 0-00 0.00 160,089.19 9,512-34 169,601.53 CLOSED
96 SALTZ, JOEL & L, GAYL 01/01/2005 05/23/2005 12/30/2005 VEHICLE COLLISION 0-00 0.00 0-00 0-00 0,00 CLOSED
Monday, August 05, 2013 LossRunCiosed Page 3 of 5
City of Carlsbad
Loss Ron Report
(Mns Closed bstween 01/01/2005
and 12/31/2005
ClaimName
Date of
Loss
Date
Received
Date Date Loss
Resen^e
Expense
Reserve
Loss
Payment
Expense
Payment Incurred Status
97 SAN DIEGO GAS & ELE 07/01/2004 08/02/2004 02/28/2005|TREE (OTHER THAN SE
lAii—r-iBA*A-i-i—n 1—I r— i A -w-r—w-%
0.00 0,00 0-00 0.00 0.00 CLOSED
98 SANGSTER, LOLLY 09/30/2004 11/19/2004 06/20/2005 VEHICLE COLLISION 0,00 0.00 2,147,80 0.00 2,147.80 CLOSED
99 SCHUBERT, MAUREEN 09/24/2004 10/01/2004 04/29/2005 VEHICLE COMPREHEN 0,00 0-00 0,00 0.00 0.00 CLOSED
100 SHEEDY, STEPHEN 06/25/2004 08/23/2004 02/24/2005|VEHICLE COLLISION 0,00 0,00 0,00 0.00 0.00 CLOSED
101 SIELAFF, DONALD 01/08/2005 01/18/2005 08/31/2005 VEHICLE COLLISION 0,00 0,00 0.00 0-00 0.00 CLOSED
102
103"
SILLIPHANT, JR-, DONA 02/22/2005 04/12/2005 10/31/2005|VEHICLE COLLISION 0,00 0.00 0,00 0.00 0.00 CLOSED 102
103" SINGER, RICARDO 08/29/2004 08/31/2004 02/24/2005 VEHICLE COLLISION 0,00 0.00 0,00 0.00 0.00 CLOSED
104 SINGLETON, KERRY 11/13/2004 12/08/2004 06/30/2005 VEHICLE COLLISION 0,00 0.00 0,00 0.00 0.00 CLOSED
105 ST. AUSTIN, BOB AND J 07/01/2003 06/22/2004 01/31/2005 OTHER 0,00 0.00 0,00 0.00 0.00 CLOSED
106 STATE FARM, 01/17/2005 06/29/2005 08/23/2005 VEHICLE COLLISION 0,00 0.00 2,068.78 0.00 2,068.78 CLOSED
107 STEERS, STEPHANIE 03/06/2004 09/07/2004 06/30/2005 VEHICLE COLLISION 0,00 0.00 0,00 0.00 0.00 CLOSED
108 STEVENS, SCOTT 11/02/2004 11/10/2004 02/11/2005|TREE (OTHER THAN SE 0,00 0.00 2,600.00 617.28 3,217.28 CLOSED
109 STEVENSON, DEBORA 02/25/2005 06/01/2005 07/12/2005 VEHICLE COLLISION 0.00 0.00 69,98 0.00 69.98 CLOSED
110 STEWART, BARBARA 04/01/2004 07/08/2004 01/31/2005 VEHICLE COMPREHEN 0-00 • 0.00 0,00 0.00 0.00 CLOSED
11
12
STOVALL, JAN AND RO 01/11/2005 03/04/2005 09/30/2005 TREE (OTHER THAN SE 0.00 0.00 0.00 0.00 0.00 CLOSED 11
12 STRAUS, JUDY ANN 08/23/2005 08/30/2005 09/27/2005|VEHICLE COMPREHEN 0.00 0,00 151,00 0-00 151.00 CLOSED
13 STUEMPFIG, J. DAVID 12/08/2004 12/30/2004 08/31/20051VEHICLE COMPREHEN 0.00 0,00 0,00 0-00 0.00 CLOSED
14 SULLIVAN, EDWARD 11/02/2005 12/05/2005 12/27/2005 VEHICLE COLLISION 0,00 0.00 1,471,38 0-00 1,471.38 CLOSED
15 TAMAGNI, CHARLES 02/14/2005 02/18/2005 10/31/2005 VEHICLE COMPREHEN
LAW ENFORCEMENT
0,00 0.00 0.00 0.00 0.00 CLOSED
:i6 THOMAS, BRUCE 06/26/2004 10/08/2004 04/29/2005
VEHICLE COMPREHEN
LAW ENFORCEMENT 03/23/2005 0,00 0.00 0.00 0.00 0,00 CLOSED
THOMAS, BRUCE 11/18/2004 05/13/2005 11/30/2005 OTHER 0,00 0.00 0.00 0.00 0.00 CLOSED
|18 THOMAS, BRUCE 08/29/2004 09/17/2004 04/29/2005 LAW ENFORCEMENT 0,00 0,00 0.00 0.00 0.00 CLOSED
119 THOROGOOD, SCOTT 01/29/2005 05/24/2005 12/30/2005 VEHICLE COLLISION 0.00 0.00 0.00 0,00 0,00 CLOSED
120 [JSAA, CRESCINI 01/07/2005 04/25/2005 07/18/2005 VEHICLE COLLISION 0,00 0.00 7,027,04 0.00 7,027,04 CLOSED
121 VAN SITTERT, KELLY 01/02/2005 01/06/2005 08/29/2005 VEHICLE COLLISION 0,00 0.00 0-00 0-00 0.00 CLOSED
122 VIOLI, JOSEPH 02/13/2005 02/13/2005 08/31/2005 VEHICLE COLLISION 0,00 0,00 0.00 0.00 0.00 CLOSED
123 WEBBER, MICAH 01/22/2005 04/06/2005 10/19/2005 VEHICLE COMPREHEN
VEHTCLE COLLISION
0.00 0,00 823.19 . . 0.00 823,19 CLOSED
124 WHITE, SCOTT 08/24/2004 10/01/2004 04/29/2005
VEHICLE COMPREHEN
VEHTCLE COLLISION 0.00 0,00 0.00 0.00 0,00 CLOSED
125 WILMOTT, STEVE 05/27/2004 08/26/2004 01/11/2005 TREE (OTHER THAN SE 0.00 0,00 623.09 0.00 623.09 CLOSED
126 WILSON, RANDY 12/26/2003 04/06/2004 04/29/2005 TRip/FALL 10/15/2004 0.00 0.00 9,999.99 472.52 10,472,51 CLOSED
127 WITTKOSKI, TOM 07/07/2004 07/13/2004 01/31/2005 SEWER/WATER (TREE 0-00 0.00 0.00 0.00 0,00 CLOSED
128 WOLINSKI, MARC 10/15/2004 10/25/2004 05/31/2005 VEHICLE COMPREHEN 0,00 0-00 0.00 0.00 0,00 CLOSED
Monday, August 05, 2013 LossRunCiosed Page 4 of 5
City of Carlsbad IMeGlDSfid between 01/01/2005
and 12/31/2005
Date of Date Date Date Loss Expense Loss Expense
t29
1
WORLD SAVINGS BANK 08/16/2004 11/23/2004 05/31/2005 OTHER 0.00 0-00 0.00 0.00 0,00 CLOSED
130
1
ZAPLATA, MITCH 11/22/2004 12/17/2004 01/11/2005 LAW ENFORCEMENT 0,00 0-00 230,00 0,00 230,00 CLOSED
Totals 0,00 0.00 326.339,62 67,395,63 393,735.25
Monday, August 05, 2013 LossRunCiosed Page 5 of 5