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Home My WebLink About; ; Records Destruction Authorization Form-Risk Management; 2004-04-02CERTIFICATE OF DESTRUCTION E: This certificate is to certify that Shred-it destroyed confidential ESY information on-site for the above mentioned company by !lis3 TRUCK NO.: /ilp TRUCK NO.: TOTAL TIME HRS. MIN. '1 5 I- J ,4 MOBILE CUSTOMER SERVICE REP.: & /f CLIENT 4 t/ i, bwf$ .& < 2 * hi/ 'B&& ENVIRONMENTAL IMPACT Shred-it is committed to helping save the environment. All shredded material that is recyclable is brought to a recycling centre to be processed into recycled @ WE RECYCLE @ THIS YEAR YOUR FIRM'S SMR OF WQOD SAVED THROUGH SHRED-IT'S RECYCLING PRCKkAM AMOUNTS TO 0 TREES. THANK YOU FOR YOUR BUSINESS paper products. MISSION STATEMENT Shred-it is dedicated to being the World's leading Mobile Shredding and Recycling Company. We will achieve this goal on the strengths of our people. Shred-it will consistently deliver the greatest security, cost-effectiveness, convenience and environmentally-friendly service available. We will earn ;I fair return on the investment in our systems, our equipment and our people. Above all, we will earn the confidence of our clients through a continued commitment to total customer satisfaction. SECURING YOUR OFFICE AND THE ENVIRONMENT 0 PRiNTEO ON RECICLEO PAPER . Request by Originating Department: RISK MANAGEMENT 513 1 I02 Requested Date: 'Exhibit C - Onsite Records Destruction Form F005 Originating Department Manager Initials: Erin Letsch City ClerWRecords Management Page 1 of 8 ONSITE RECORDS DESTRUCTION LIST 10/22/02 ,*f0-p '. -- Date Jv A3 OF 547-83 Approved for Destruction c Department Head Date City Attorney Date Total of records approved for destruction: 5 Note: City records on Hold cannot be destroyed. 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. Person Completing Form: Erin Letsch Request by Originating Department: RISK MANAGEMENT Requested Date: 513 1 102 Erin Letsch Originating Department Manager Initials: 29 30 31 32 33 34 35 36 ALVAREZ, Jerry - Police Brutality Closed Date 991 0745-25 CL+5 Risk Mgmt Litigation 1 111 3/92 ARIZA, Abdiel - Missing Property Closed Date 991 0745-25 CL+5 Risk Mgmt Claim 1 1/20/92 BARRON, Robert & Rebecca - Closed Date 991 0745-25 CL+5 Risk Mgmt Vehicle/Bicyclist Accident 5/26/93 Litigation BERNSTEIN, Dan - City Vehicle Closed Date 991 0745-25 CL+5 Risk Mgmt Hit Mailbox Claim 812 1 I92 BISBING, Gretchen - Hit Pothole Closed Date 991 0745-25 CL+5 Risk Mgmt Claim 9/30/92 BRODSKY, Donna - VehiclelCity Closed Date 991 0745-25 CL+5 Risk Mgmt Accident Claim 9/9/92 BUCKLEY, Leif - Hit Manhole Closed Date 991 0745-25 CL+5 Risk Mgmt Cover Claim 1 111 8/92 CHAVEZ, Anthony - VehiclelCity Closed Date 991 0745-25 CL+5 Risk Mgmt Accident Claim 1211 5/92 - Citv Clerk/Records Management .Request by Originating Department: RISK MANAGEMENT 513 1 /02 Requested Date: Originating Department Manager Initials: Erin Letsch I RECORDS DESCRIPTION 54 No* I Back-up Claim HOOD, Gary - False Arrest Claim 37 -fzOLEMAN, Michele -Trip & Fall 992 992 I Litigation I COWIE. Marie - Vehicle/Citv 38 0745-25 CL+5 RiskMgmt 0745-25 CL+5 RiskMgmt I Accident Claim I CURRAN, Michael -Trip & Fall 39 I Claim I DAL CERRO, Gin0 - Vehicle 40 I Accident Claim I DAVIES. Richard -Tree Limb Hit 41 Vehicle Claim DAVIS, John - Rock Hit Windshield Claim ELLIOT, Henrv - Vehicle Accident I Litigation 44 I FLOWER FIELDS CONDOS - - 45 46 Damage Due to Forced Entry Claim FORD, John - Sewer Back-up Claim FORD, John - Sewer Back-up I Claim I GOENS, Troy -Tree Limb Hit 47 I Vehicle Litigation I HALL, Jay - VehicleICity Accident 48 I Litigation I HARTLEY, Kay - Vehicle/City 49 I Accident Claim I HAWKINS. Chad - Vehicle 50 I Accident itigation I HEIDEN, Ron & Denise - Sewer 51 - 52 53 - Back-up Claim HERNANDEZ, Daniel - Excessive Force Claim HEYLEK. Rav & Judi - Sewer I 55 1 HOSKINS, Timothv - Vehicle I Accident Litigation- I HUDSON, Linda - Limb Hit 56 I Vehicle Litigation I IMHOFF, Stefan, Alex & Tyler and 57 - 58 - 59 - HELLER, Peggy - False Arrest Litigation KEL-CAL - Inverse Condemnation, Denial of Due Process, Denial of Equal Protection, Deprivation of Civil Rights, Declaratory Relief and Injunctive Relief Litigation (Reserving Purposes Only) KELLY, Alicemae - Trip and Fall Litigation - DATE - Closed Date 211 6/93 Closed Date 1 1519 3 Closed Date 9/30/92 Closed Date 9130192 Closed Date 9130192 Closed Date 1 1/25/92 Closed Date 611 0193 Closed Date 10/13/92 Closed Date 9/30/92 Closed Date 9130192 Closed Date 8/20/92 Closed Date 811 3/92 Closed Date 3/5/93 Closed Date 6130193 Closed Date 6130193 Closed Date 9/28/92 Closed Date 1 /5/9 3 Closed Date 9130192 Closed Date 9/30/92 Closed Date 9/22/92 Closed Date 9/2 1 I92 Closed Date 7/24/92 Closed Date 1 011 192 !!: 1 0745-25 1 CL+5 1 RiskMgmt 1 1 I 0745-25 CL+5 Risk Mgmt 0745-25 CL+5 Risk Mgmt c Request by Originating Department: RISK MANAGEMENT 513 1 I02 Requested Date: City ClerWRecords Management Originating Department Manager Initials: Erin Letsch No. - 60 - 61 62 - 63 64 65 - 66 67 68 69 70 71 72 73 - - - - - - - 74 75 - 76 77 78 79 - - - 80 81 82 83 - - - 84 In Completing Form: Erin Letsch I Back-up Claim 1 1/8/93 ANDERSON, E. C., Re-issue Old Closed Date 993 0745-25 CL+5 Risk Mgmt Non-Cashed Checks Claim 711 9/93 * This . Req1 Pers 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 - - 103 104 105 106 107 108 109 110 I City ClerWRecords Management - City ClerWRecords Management , Request by Originating Department: RISK MANAGEMENT I Person Completing Form: Erin Letsch Requested Date: 513 1 102 Erin Letsch Originating Department Manager Initials: I - I RECORDS DESCRIPTION I DATE I BOX I RRSNo. I RRS I Road Claim I 10/13/93 I No* I I I Nom I - 138 139 I Period Accident Claim ' 2/7/94 MIJUSKOVIC, Ben & Ruth - Closed Date 994 0745-25 CL+5 Inverse Condemnation Claim 4/26/94 MILLER, Joseph & Crvstal- Closed Date 994 0745-25 CL+5 I I I I I I 1 136 I McFARLAND, Rene - Debris in I Closed Date I 994 I 0745-25 I CL+5 140 141 Vehicle Damage by Sim Jim 10/25/93 Claim MONREAL, Thomas - Driveway Closed Date 994 0745-25 CL+5 Damage Claim 511 6/94 Moulton, Lois - Sewer Back-up Closed Date 994 0745-25 CL+5 I Claim 3/3/94 143 144 145 Damaged by City Contractor 10/25/93 Claim MURPHY, Sharon - Civil Rights Closed Date 994 0745-25 CL+5 Violation Claim 6/29/94 MURPHY, Sharon - Wrongful Closed Date 994 0745-25 CL+5 Termination Litigation 5/26/94 NEFF, Raymond - Vehicle Closed Date 994 0745-25 CL+5 I Accident Information Only 1/2/92 I Claim I 4/26/94 I I 150 I PACIFIC BELL - Cable Cut I Closed Date I 994 I 0745-25 CL+5 146 I NIXON, Thomas - Forced Entrv I Closed Date 1 994 I 0745-25 CL+5 147 148 149 Claim 312 1 194 NOE, Robert - Police Brutality Closed Date 994 0745-25 CL+5 Claim 4/26/94 O'BRIEN, David - Bicycle Closed Date 994 0745-25 CL+5 Accident Litigation 5/31 194 OCHS, Clarence - Hit Pothole Closed Date 994 0745-25 CL+5 151 152 Litigation 1011 8/93 PACIFIC BELL - Indemnification Closed Date 994 0745-25 CL+5 Electrical Shock Claim 311 5/94 PACIFIC BELL - Line Severed Closed Date 994 0745-25 CL+5 153 154 1 I Claim 1 10/13/93 1 Litigation 111 3/94 PATTERSON, Sean - Single Closed Date 994 0745-25 CL+5 Vehicle Collision Claim 4/26/94 P.R.L. PROPERTIE SMGMT. - Closed Date 994 0745-25 CL+5 - BARCOD E - Risk Mgmt Risk Mgmt 155 156 Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Indemnification Vehicle Collision Claim REICH, Randy - Vehicle Damage Closed Date 994 0745-25 CL+5 Claim 3/3/94 REID, David, June & Stephen - Closed Date 994 0745-25 CL+5 3/3 1 194 Police Trespass and Assault 7130192 - APPROVED By City Attorney H=HOLD - 157 158 Claim ROADERICK, Marcia - Illegal Closed Date 994 0745-25 CL+5 Tow Claim 3/2/94 ROBERTSON. Nichole - Vehicle Closed Date 994 0745-25 CL+5 I Recovery Claim I 10/13/93 I I 159 I ROBINSON, Shawn - Police I Closed Date I 994 I 0745-25 CL+5 I Harassment Claim I 4/26/94 I 160 I ROCK, Michael - Bicvcle Accident I Closed Date I 994 I 0745-25 CL+5 -- . Request by Originating Department: Requested Date: RISK MANAGEMENT 513 1 102 City Clerk/Records Management 8of8 Originating Department Manager Initials: Erin Letsch VELASQUEZ, Leo - Hit Water Cap Claim WALKER, Jerry - VehicleICity No. - 161 162 163 164 165 166 167 168 169 170 - - - - - - - - - Closed Date 995 Closed Date 995 10/1 3/93 SUNSET PLACE HOMEOWNERS - Conduit cut I 6120194 Closed Date I 995 1 0745-25 I CL+5 175 176 177 178 179 I Claim 171 I TAMARACK POINT MASTER I Closed Date I 995 Accident Claim- 10/8/93 WARREN, William - Breach of Closed Date 995 Contract Litigation 5/24/94 WERNER, Michael - Police Closed Date 995 Brutality Litigation 3/3/94 WIEBOLDT, Wayne - Cracked Closed Date 995 Windshield Claim 10/1 3/93 WILLIAMSON, J. A. - Missing Closed Date 995 Property Claim 3/3/94 ZACHARY, Robert - Closed Date 995 MotorcycleICity Vehicle Accident 3/3/94 Litiaation 172 173 174 0745-251 CL+5 -1 CL+5 0745-25 CL+5 1 - BARCOD E - Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt Risk Mgmt - PDF - - APPROVED By City Attorney H=HOLD 3 I End of List DOCUMENT DESTRUCTION WILL BE PROVIDED BY SHRED-IT COMPANY, mobile paper shredding and recycling. I