HomeMy WebLinkAbout; ; Records Destruction Authorization Form-Risk Management; 2006-11-27City Clerk/Records Management
Page 1 of8
Exhibit C - Onsite Records Destruction Form F005
ONSITE RECORDS DESTRUCTION LIST
Approved for Destruction 10/16/06
Department Head Date
- t>L
City Records Manager Date
o - i
City Attorney
Total of records approved for destruction:
Date
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.
This form documents the destruction of City records in accordance with the California Public Records Act.
Request by Originating Department:
RISK MANAGEMENT
Requested Date:
3/3/06
Originating Department Manager Initials:
Erin Letsch
Person's Completing Form: Erin Letsch - Risk Manager
No.
1
2
3
4
5
6
7
8
9
RECORDS DESCRIPTION
ALDRIDGE, Daniel - Hit Plant
Material Loss Recovery
ALVAREZ, Anulfo - Hit Traffic
Signal Loss Recovery
AYOUB, Daryl - Hit Light
Standard Loss Recvoery
BROWN, Debra - Hit Guard Rail
Loss Recovery
DAVISON, Philip -Hit Fire
Hydrant Loss Recovery
HAMIDEH, Jamil - Hit Traffic
Signal Loss Recovery
HARDING AUDITORIUM
DAMAGE - Damage due to fight
at party. Event insured through
Diversified Risk Loss Recovery
KOEHLER, Ray - Hit Street Light
Loss Recovery
LARSON, Gladys - Hit City
Vehicle Loss Recovery
DATE
Closed Date
8/6/96
Closed Date
10/28/96
Closed Date
10/28/96
Closed Date
7/10/97
Closed Date
5/7/97
Closed Date
1/22/97
Closed Date
5/27/97
Closed Date
2/28/97
Closed Date
8/6/96
BOX
No.
1095
1095
1095
1095
1095
1095
1095
1095
1095
RRS No.
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
RRS
Period
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
BARCOD
E
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
City Clerk/Records Management
Page 2 of 8
This form documents the destruction of City records in accordance with the California Public Records Act
Request by Originating Department:
RISK MANAGEMENT
Requested Date:
3/3/06
Originating Department Manager Initials:
Erin Letsch
Person's Completing Form: Erin Letsch - Risk Manager
No.
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
RECORDS DESCRIPTION
MESA DISTRIBUTING - Hit Fire
Hydrant Loss Recovery
NELSON, Ronda - Hit Guard Rail
Loss Recovery
ORTIZ, Jose - Hit City Vehicle
Loss Recovery
PEGG, Molly - Hit City Vehicle
Loss Recovery
PERRIS, Lawrence - Hit Plant
Material Loss Recovery
RILEY, James - Hit Street Light
Loss Recovery
STOCKHAM, Jerome - Hit Street
Light Loss Recovery
THORPE, Travis - Hit Light Pole
Loss Recovery
VAN PLEW, LISA - Hit City
Vehicle Loss Recovery
WEAR, Harry - Hit Traffic Signal
Loss Recovery
ANGEL, Josefina - Trash was not
picked-up by City's contractor for
3 months Claim
ARUGON, Joel - Vehicle Damage
Claim
BANTZ, Thomas - Vehicle
Damage Claim
BATT, Michael - Vehicle Damage
Claim
BATTAGLIA, Marylea - Vehicle
Damage Claim
BENTON, Stacy - Personal Items
Lost Claim
BICE, Barbara - Vehicle Damage
Claim
BICE, Barbara - Impound Fees
Claim
CICCARELLI, Joseph & Mary -
Damaged Property Claim
DATE
Closed Date
11/6/96
Closed Date
2/18/97
Closed Date
7/24/96
Closed Date
11/21/96
Closed Date
7/30/96
Closed Date
8/13/96
Closed Date
9/17/96
Closed Date
4/8/97
Closed Date
7/24/96
Closed Date
10/24/96
Received
5/3/96
Closed Date
11/26/96
Received
10/29/96
Closed Date
Received
7/22/96
Closed Date
8/20/96
Received
4/30/96
Closed Date
11/30/96
Received
5/22/96
Closed Date
11/26/96
Received
7/24/96
Closed Date
1/31/97
Received
1/2/96
Closed Date
7/31/96
Received
1/2/96
Closed Date
7/31/96
Received
6/24/96
Closed Date
8/16/96
BOX
No.
1095
1095
1095
1095
1095
1095
1095
1095
1095
1095
1095
1095
1095
1095
1095
1095
1095
1095
1095
RRS No.
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
RRS
Period
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
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
City Clerk/Records Management
Page 3 of 8
This form documents the destruction of City records in accordance with the California Public Records Act.
Request by Originating Department:
RISK MANAGEMENT
Requested Date:
3/3/06
Originating Department Manager Initials:
Erin Letsch
Person's Completing Form: Erin Letsch - Risk Manager
No.
29
30
31
32
33
34
35
36
37
38
39
40
41
42
RECORDS DESCRIPTION
C N A INSURANCE (Hall) -
Vehicle/City Vehicle Accident
Litigation
COHEN, Robert -Vehicle
Damage Claim
THE COLONY AT CALAVERA
HILLS - Damaged Irrigation Lines
Claim
COOPER, Alvin - Lost Property
Claim
DEFAGO, Ronald - Vehicle/City
Accident Claim
EHLERS, Wayne - Fire and
Excessive Water Use Claim
EKLAND, Arnold & Ann - Vehicle
Damage Claim
FARMERS (Blyth) - Vehicle/City
Vehicle Accident Claim
FARNUM, Melissa - Vehicle/City
Vehicle Accident Claim
FERGUSON, Wayde & Stacey -
City Vehicle Accident Claim
FIREMAN'S FUND (Angus
Asphalt) - Vehicle Accident Claim
GALAVIZ, Melissa - Police
Misconduct Litigation
GALINDO, Chris - Vehicle
Damage Claim
GRG MGMT., INC. (Hillgate) -
Damaged Water Pipe Claim
DATE
Received
1/28/91
Closed Date
4/18/97
Received
8/27/96
Closed Date
3/31/97
Received
5/31/96
Closed Date
7/2/96
Received
3/15/96
Closed Date
10/2/96
Received
1/8/97
Closed Date
2/6/97
Received
1/10/96
Closed Date
7/31/96
Received
12/10/96
Closed Date
6/27/97
Received
5/22/96
Closed Date
9/20/96
Received
3/13/97
Closed Date
4/18/97
Received
7/2/96
Closed Date
9/10/96
Received
2/21/96
Closed Date
10/25/96
Received
2/1/95
Closed Date
4/29/97
Received
8/19/96
Closed Date
3/31/97
Received
5/20/96
Closed Date
11/26/96
BOX
No.
1095
1095
1095
1095
1095
1095
1095
1095
1095
1095
1095
1096
1096
1096
RRS No.
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
RRS
Period
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
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
PDF APPROVED
By City Attorney
H=HOLD
City Clerk/Records Management
Page 4 of8
This form documents the destruction of City records in accordance with the California Public Records Act
Request by Originating Department:
RISK MANAGEMENT
Requested Date:
3/3/06
Originating Department Manager Initials:
Erin Letsch
Person's Completing Form: Erin Letsch - Risk Manager
No.
43
44
45
46
47
48
49
50
51
52
53
54
55
56
RECORDS DESCRIPTION
HANDS, Camille - Vehicle
Damage Claim
HARRIS, Josephine - Vehicle
Damage Claim
HATEM, Cynthia -Vehicle
Damage Claim
HAZELTON, John W. -
Windshield damage Claim
HENNESSY, Evan - Vehicle/City
Accident Litigation
HENSON, James - Police
Misconduct Claim
HERMAN, Roxanne - Vehicle/City
Accident Claim
HOEFER, Don - Sewer Back-Up
Claim
HOOVER, Charles - Trip and Fall
Claim
HUGGINS, Catalina - Vehicle
Damage Claim
JACOBSEN, Kathleen -
Vehicle/City Accident Claim
JONES, Robert R. - Vehicle/Bike
Accident Litigation
KEATING, Nancy - Vehicle/City
Accident Litigation
KENT, John L. - Vehicle Damage
Claim
DATE
Received
7/15/96
Closed Date
1/31/97
Received
12/26/95
Closed Date
7/31/96
Received
4/22/96
Closed Date
11/26/96
Received
9/24/96
Closed Date
4/29/97
Received
2/23/95
Closed Date
9/25/96
Received
8/19/95
Closed Date
4/29/97
Received
10/30/96
Closed Date
11/22/96
Received
3/18/97
Closed Date
4/29/97
Received
9/25/96
Closed Date
4/29/97
Received
11/22/96
Closed Date
5/27/97
Received
3/14/97
Closed Date
3/31/97
Received
2/16/94
Closed Date
8/16/96
Received
12/1/95
Closed Date
2/26/97
Received
1/26/96
Closed Date
9/27/96
BOX
No.
1096
1096
1096
1096
1096
1096
1096
1096
1096
1096
1096
1096
1096
1096
RRS No.
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
RRS
Period
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
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
PDF APPROVED
By City Attorney
H=HOLD
City Clerk/Records Management
Page 5 of 8
This form documents the destruction of City records in accordance with the California Public Records Act
Request by Originating Department:
RISK MANAGEMENT
Requested Date:
3/3/06
Originating Department Manager Initials:
Erin Letsch
Person's Completing Form: Erin Letsch - Risk Manager
No.
57
58
59
60
61
62
63
64
65
66
67
68
69
70
RECORDS DESCRIPTION
KING, Kerry - Vehicle Damage
Claim
KNOX, Richard - Vehicle/City
Accident Litigation
LANGLOIS, Linda - Ambulance
Charges Claim
LATINO, Roc- Vehicle Damage
Claim
LEE, Jonathan - Vehicle/City
Accident Claim
LINDSAY MGMT. SVCS. - Water
Line Damaged Claim
LOPEZ, Richard - Glasses
Damaged Claim
MALINSKI, Edward - Vehicle
Damage Claim
MAY, Carole - Roof Damage
Claim
McDERMED, Paul - Vehicle/City
Accident Claim
McENTIRE, Charles -
Vehicle/City Accident Claim
METTEN, Stacey - Vehicle
Accident Claim
O'KEEFE, Dawna - Vehicle/City
Accident Claim
ORTEGA, Laura - Vehicle
Damage Claim
DATE
Received
4/19/96
Closed Date
11/26/96
Received -.
10/8/96
Closed Date
3/31/97
Received
5/28/96
Closed Date
7/3/96
Received
7/16/96
Closed Date
1/31/97
Received
1/16/97
Closed Date
Received
1/8/96
Closed Date
7/31/96
Received
12/26/95
Closed Date
7/31/96
Received
8/19/96
Closed Date
3/3/97
Received
1/16/97
Closed Date
6/27/97
Received
4/10/97
Closed Date
6/11/97
Received
8/30/96
Closed Date
11/18/96
Received
8/30/96
Closed Date
4/29/97
Received
7/8/96
Closed Date
8/21/96
Received
3/25/96
Closed Date
11/26/96
BOX
No.
1096
1096
1096
1096
1096
1096
1096
1096
1096
1097
1097
1097
1097
1097
RRS No.
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
RRS
Period
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
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
PDF APPROVED
By City Attorney
H=HOLD
City Clerk/Records Management
Page 6 of8
This form documents the destruction of City records in accordance with the California Public Records Act.
Request by Originating Department:
RISK MANAGEMENT
Requested Date:
3/3/06
Person's Completing Form: Erin Letsch - Risk Manager
No.
71
72
73
74
75
76
77
78
79
80
81
82
83
84
RECORDS DESCRIPTION
PACIFIC BELL (Clm. No. C0568)
- Indemnification Litigation
PACIFIC BELL (Clm. No. C9441)
- Cable Cut Litigation
PETERSON, Jerry - Vehicle
Damage Claim
RADSICK, Ronald - Vehicle
Damage Claim
RANCHO PONDEROSA HO
ASSOC. - Damaged Irrigation
Lines Claim
RICE, Gregory - Vehicle Accident
Claim
RICHMOND, Bill -Vehicle/City
Accident Claim
ROMERO, Leslie Ann - Trip/Fall
Claim
SCHUDEL, Conrad - Vehicle
Damage Claim
SEAHOLM, Dennis - Vehicle
Damage Claim
SILLEN, Connie- Indemnification
Claim
STATE FARM (Seaholm) -
Vehicle Damage Claim
STATE FARM (Van Dorn) -
Vehicle/City Accident Claim
SUN, Xiuying - Glasses Broken
Claim No Action Taken on Claim
DATE
Received
11/2/95
Closed Date
3/31/97
Received
7/15/94
Closed Date
1/31/97
Received
8/19/96
Closed Date
3/31/97
Received
3/25/97
Closed Date
5/6/97
Received
8/16/96
Closed Date
9/27/96
Received
9/9/96
Closed Date
3/31/97
Received
10/16/96
Closed Date
11/25/96
Received
1/29/96
Closed Date
9/27/96
Received
10/11/96
Closed Date
4/29/97
Received
8/22/96
Closed Date
4/29/97
Received
7/8/96
Closed Date
2/26/97
Received
10/28/96
Closed Date
4/29/97
Received
12/9/96
Closed Date
1/10/97
Received
10/5/95
Closed Date
12/26/96
BOX
No.
1097
1097
1097
1097
1097
1097
1097
1097
1097
1097
1097
1097
1097
1097
RRS No.
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
Originating Department Manager Initials:
Erin Letsch
RRS
Period
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
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
PDF APPROVED
By City Attorney
H=HOLD
City Clerk/Records Management
Page 7 of8
This form documents the destruction of City records in accordance with the California Public Records Act.
Request by Originating Department:
RISK MANAGEMENT
Requested Date:
3/3/06
Originating Department Manager Initials:
Erin Letsch
Person's Completing Form: Erin Letsch - Risk Manager
No.
85
86
87
88
89
90
91
92
93
94
95
96
97
98
RECORDS DESCRIPTION
20tn CENTURY - Vehicle/City
Accident Claim
TAGUE, Sarah - Vehicle Damage
Claim
TREASURES UNLIMITED -
Gasoline Pump Damaged Claim
TURNER, David - Harassment by
Police Claim
TURNER, David - False Arrest
Claim
TURNMIRE, Janeen - Trip and
Fall Litigation
USAA (J. Harris) - Vehicle
Damage Claim
USAA (R. Pegg) - Vehicle/City
Accident Claim
VAN DORAN, Elisabeth -
Vehicle/City accident Claim
VORCE, Cynthia - Vehicle
Damage Claim
VOLPE, Dennis - Vehicle
Damage Claim
WAWANESA (Knox) -
Vehicle/City Accident Claim
WOODS, Pamela - Vehicle
Damage Claim
XYZ SKATE SUPPLY - Inverse
Condemnation Claim
DATE
Received
5/7/97
Closed Date
5/13/97
Received
8/6/96
Closed Date
5/27/97
Received
4/23/97
Closed Date
6/11/97
Received
3/28/96
Closed Date
11/26/96
Received
3/28/96
Closed Date
11/26/96
Received
3/7/95
Closed Date
3/3/97
Received
12/14/95
Closed Date
7/31/96
Received
11/1/96
Closed Date
11/21/96
Received
10/11/96
Closed Date
12/24/96
Received
8/23/96
Closed Date
3/31/97
Received
3/4/96
Closed Date
9/26/96
Received
11/12/96
Closed Date
3/31/97
Received
12/10/96
Closed Date
6/27/97
Received
5/30/96
Closed Date
1/31/97
BOX
No.
1097
1097
1097
1097
1097
1097
1097
1097
1097
1097
1097
1097
1097
1097
RRS No.
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
RRS
Period
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
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
PDF APPROVED
By City Attorney
H=HOLD
City Clerk/Records Management
Page 8 of8
This form documents the destruction of City records in accordance with the California Public Records Act.
Request by Originating Department:
RISK MANAGEMENT
Requested Date:
3/3/06
Person's Completing Form: Erin Letsch - Risk Manager
No.
99
RECORDS DESCRIPTION
ZIE, Deborah. Candace & Ross -
Vehicle Accident Litigation
DATE
Received
5/31/97
Closed Date
10/8/96
BOX
No.
1097
RRS No.
0745-20
Originating Department Manager Initials:
Erin Letsch
RRS
Period
CL+5
BARCOD
E
Risk Mgmt
PDF APPROVED
By City Attorney
H=HOLD
~/mc£~ n fa/els
DOCUMENT DESTRUCTION WILL BE PROVIDED BY SJKWC^COMPANY, mobile paper shredding and recyclin
End of List
0 1 30-25/F005 F:\WORD\STORAGE\Riskmgm Des of 96-97files.doc
Exhibit C - Onsite Records Destruction Form F005
City Clerk/Records Management
Page 1 of 17
ONSITE RECORDS DESTRUCTION LIST
Approved for Destruction 10/16/06
Department Head Date
iQ-n-oc.
City Records Manager Date
Co - i % -
City Attorney
Total of records approved for destruction:
Date
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.
This form documents the destruction of City records in accordance with the California Public Records Act. (3^ -7^
Request by Originating Department:
RISK MANAGEMENT
Requested Date:
3/3/06
Originating Department Manager IniticHs:
Erin Letsch
Person's Completing Form: Erin Letsch - Risk Manager
No.
1
2
3
4
5
6
7
8
9
10
RECORDS DESCRIPTION
COAST WASTE MGMT. - Hit City
Vehicle Loss Recovery
EAGEN, Jeanne - Hit Traffic
Signal Box Loss Recovery
JANUZZI, Barbara - Hit Light Pole
Loss Recovery
LANE, Sharon - Hit City Vehicle
Loss Recovery
LATCHFORD, Peggy - Hit Traffic
Signs Loss Recovery
MIRAMAR BOBCAT INC - Hit
Plant Material Loss Recovery
PHILLIPS, Sarah - Hit City
Vehicle Loss Recovery
POOLE, Alan - Hit Plant Material
Loss Recovery
RAGIN, Veron - Hit Light Pole
Loss Recovery
ST. JOHN, Marley - Hit Light Pole
Loss Recovery
DATE
Closed Date
11/4/97
Closed Date
9/25/97
Closed Date
12/19/97
Closed Date
2/11/98
Closed Date
6/1/98
Closed Date
4/14/98
Closed Date
9/3/97
Closed Date
1/28/98
Closed Date
12/19/97
Closed Date
1/6/98
BOX
No.
1110
1110
1110
1110
1110
1110
1110
1110
1110
1110
RRS No.
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
RRS
Period
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
BARCOD
E
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
City Clerk/Records Management
Page 2 of 17
This form documents the destruction of City records in accordance with the California Public Records Act.
Request by Originating Department:
RISK MANAGEMENT
Requested Date:
3/3/06
Originating Department Manager Initials:
Erin Letsch
Person's Completing Form: Erin Letsch - Risk Manager
No.
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
RECORDS DESCRIPTION
SAMBI SEASIDE HEIGHTS - Hit
Construction Meter Loss Recovery
STEEN, Randall - Hit City Vehicle
Loss Recovery
UNITED VAN LINES/Sorensen
Moving - Hit Light Pole Loss
Recovery
USAA (Laurent) - Hit City Vehicle
Loss Recovery
ALLEN, Richard - Other Electrical
Surge at Work Damaged Personal
Property Claim
ALVAREZ, Louise - Vehicle
Comprehensive Claim
AUTO CLUB, Boss - Vehicle
Collision Subrogation Claim
AUTO CLUB, Dion - Other Wrong
Jurisdiction Sheriff Claim
BAIRD, William - Property
Damage Claim
BALDWIN, Wayne - Sewer/Water
Back-Up Claim
BALTIERRA, Andree - Vehicle
Collision w/City Vehicle Claim
BEAINY, Stanley -Vehicle
Collision Claim
BENHARROSH, Michel - Trip/Fall
Claim
BRACKEN, Stuart- Vehicle
Comprehensive Claim
BURNETT, Brian -Vehicle
Collision Claim
DATE
Closed Date
1/16/98
Closed Date
8/8/97
Closed Date
1/26/98
Closed Date
1/26/98
Received
3/9/98
Closed Date
6/8/98
Received
8/29/97
Closed Date
3/27/98
Received
10/15/92
Closed Date
8/25/97
Received
2/1/97
Closed Date
2/17/97
Received
8/13/97
Closed Date
10/1/97
Received
2/5/98
Closed Date
3/27/98
Received
1/10/97
Closed Date
2/9/97
Received
1/15/97
Closed Date
8/26/97
Received
3/10/97
Closed Date
10/28/97
Received
2/4/97
Closed Date
7/29/97
Received
6/11/97
Closed Date
12/19/97
BOX
No.
1110
1110
1110
1110
1110
1110
1110
1110
1110
1110
1110
1110
1110
1110
1110
RRS No.
0120-20
0120-20
0120-20
0120-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
RRS
Period
CU+2
CU+2
CU+2
CU+2
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
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
PDF APPROVED
By City Attorney
H=HOLD
City Clerk/Records Management
Page 3 of 17
This form documents the destruction of City records in accordance with the California Public Records Act.
Request by Originating Department:
RISK MANAGEMENT
Requested Date:
3/3/06
Originating Department Manager Initials:
Erin Letsch
Person's Completing Form: Erin Letsch - Risk Manager
No.
26
27
28
29
30
31
32
33
34
35
36
37
38
39
RECORDS DESCRIPTION
BURTSON, Jr., William - Law
Enforcement Claim
CAMINO HILLS H/O
ASSOCIATION - Sewer/Water
Claim
CAPEATCALAVERA-
Sewer/Water Claim
CARPENTER, Shande - Vehicle
Collision Claim
CHAFFEE, Katharine - Vehicle
Comprehensive Claim
CHRIST, Thomas - Other
Damage due to Fire Fighters
Battling Blaze Claim
DENNIS, Deborah -Vehicle
Collision Claim
DIAZ, Joanne - Vehicle Collision
Claim
DOBBS, Clayton - Other Personal
Vehicle Damaged during Working
Hours Claim
DYNES, Sean - Vehicle
Comprehensive Claim
ERBSEN, Loretta - Trip/Fall Claim
EXPLORER INSURANCE CO.
(Lopez) - Vehicle Collision with
City Vehicle Claim
FAIRWAY SOUTH HOA -
Sewer/Water Claim
FOSTER, Cory - Vehicle Collision
Claim
DATE
Received
9/8/97
Closed Date
3/27/98
Received
2/23/98
Closed Date
4/1/98
Received
10/31/97
Closed Date
12/30/97
Received
8/20/97
Closed Date
3/27/98
Received
9/29/97
Closed Date
4/27/98
Received
4/21/97
Closed Date
12/19/97
Received
1/30/97
Closed Date
7/29/97
Received
3/19/08
Closed Date
6/26/98
Received
2/13/96
Closed Date
1/30/98
Received
2/4/97
Closed Date
6/26/98
Received
4/11/97
Closed Date
12/19/97
Received
3/9/98
Closed Date
6/8/98
Received
6/11/97
Closed Date
7/17/97
Received
9/10/97
Closed Date
12/30/97
BOX
No.
1110
1110
1110
1110
1110
1110
1110
1110
1110
1110
1110
1110
1110
1110
RRS No.
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
RRS
Period
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
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
PDF APPROVED
By City Attorney
H-HOLO
City Clerk/Records Management
Page 4 of 17
This form documents the destruction of City records in accordance with the California Public Records Act.
Request by Originating Department:
RISK MANAGEMENT
Requested Date:
3/3/06
Originating Department Manager Initials:
Erin Letsch
Person's Completing Form: Erin Letsch - Risk Manager
No.
40
41
42
43
44
45
46
47
48
49
50
51
52
53
RECORDS DESCRIPTION
FREDRICKS, Gloria - Vehicle
Comprehensive Claim
FULLMER, Orvis - Other Real
Property Damaged by Contractor
Claim
GAITAUD, Renee- Vehicle
Collision Claim
GOMBAR, John - Vehicle
Collision w/City Vehicle Claim
GONZALEZ, Federico - Vehicle
Comprehensive Claim
HALLSTROM, Ralph - Trip/Fall
Claim
HARLOFF, Jennifer- Vehicle
Comprehensive Claim
HERMAN, Tammy - Vehicle
Comprehensive Claim
HERNANDEZ, Paul - Vehicle
Collision with City Vehicle Claim
HIGGINS, E. Denise- Vehicle
Collision with City Vehicle Claim
HOWARD, Jennifer- Vehicle
Collision with City Vehicle Claim
HUNTINGTON, Sandra - Vehicle
Collision with City Vehicle Claim
JANICKI, Ed - Sewer/Water Claim
JENKINS, Andrew - Vehicle
Collision with City Vehicle Claim
DATE
Received
10/22/97
Closed Date
5/29/98
Received
5/8/97
Closed Date
12/19/97
Received
10/25/97
Closed Date
12/9/97
Received
3/16/98
Closed Date
6/8/98
Received
8/8/97
Closed Date
3/3/98
Received
1/24/97
Closed Date
12/30/97
Received
10/10/97
Closed Date
4/28/98
Received
4/29/97
Closed Date
12/19/97
Received
2/16/97
Closed Date
3/3/98
Received
9/15/97
Closed Date
5/29/98
Received
10/3/97
Closed Date
11/3/97
Received
8/8/97
Closed Date
10/2/97
Received
1/15/98
Closed Date
2/13/98
Received
8/5/97
Closed Date
10/2/97
BOX
No.
1110
1110
1110
1110
1110
1110
1110
1110
1110
1110
1110
1110
1110
1110
RRS No.
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
RRS
Period
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
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
PDF APPROVED
By City Attorney
H=HOLD
City Clerk/Records Management
Page 5 of 17
This form documents the destruction of City records in accordance with the California Public Records Act
Request by Originating Department:
RISK MANAGEMENT
Requested Date:
3/3/06
Originating Department Manager Initials:
Erin Letsch
Person's Completing Form: Erin Letsch - Risk Manager
No.
54
55
56
57
58
59
60
61
62
63
64
65
66
67
RECORDS DESCRIPTION
JONES, William - Vehicle
Collision Claim
KAIZA POINSETTIA - Other
Claim
KEHLER, Paul -Vehicle
Comprehensive Claim
KENT, John - Sewer/Water Claim
KOHN, David - Law Enforcement
Claim
LAMA, Bumtso - Vehicle Collision
with City Vehicle Claim
LEGLER, Wilma - Sewer/Water
Claim
LOPEZ, Jesus - Vehicle Collision
Claim
LOPEZ, Victoria - Vehicle
Collision Claim
MACDOUGALL, Joseph - Other
Claim
MALINSKI, Edward - Vehicle
Comprehensive Claim
MANTOR, Sheridan - Vehicle
Comprehensive Claim
MARINEZ, John - Tree Claim
MARTINEZ, Elias - Other
Personal Property Damaged
Claim
DATE
Received
7/17/97
Closed Date
3/3/98
Received
2/19/97
Closed Date
6/26/98
Received
9/30/97
Closed Date
4/28/98
Received
9/18/97
Closed Date
3/3/98
Received
8/12/97
Closed Date
3/27/98
Received
7/1/97
Closed Date
8/19/97
Received
1/30/98
Closed Date
3/3/98
Received
10/29/97
Closed Date
6/19/98
Received
10/29/97
Closed Date
6/19/98
Received
2/16/97
Closed Date
3/3/98
Received
7/14/97
Closed Date
3/3/98
Received
1/27/97
Closed Date
7/29/97
Received
5/12/97
Closed Date
9/19/97
Received
9/18/97
Closed Date
12/1/97
BOX
No.
1110
1110
1110
1111
1111
1111
1111
1111
1111
1111
1111
1111
1111
1111
RRS No.
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
RRS
Period
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
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
PDF APPROVED
By City Attorney
H=HOLD
City Clerk/Records Management
Page 6 of 17
This form documents the destruction of City records in accordance with the California Public Records Act.
Request by Originating Department:
RISK MANAGEMENT
Requested Date:
3/3/06
Originating Department Manager Initials:
Erin Letsch
Person's Completing Form: Erin Letsch - Risk Manager
No.
68
69
70
71
72
73
74
75
76
77
78
79
80
81
RECORDS DESCRIPTION
MC COMAS, Audrey - Tree Claim
MCINTOSH, Ron - Sewer/Water
Claim
MERCURY INSURANCE GROUP
(Richman - Vehicle Collision
Claim
MERCURY INSURANCE
(Estefani) - Vehicle Collision
Claim
MORGAN, Roy - Tree Claim
MULLEN, John -Law
Enforcement Claim
NOVELLA, April - Other Power
Surge Damaged Personal
Property Claim
NUZZI, Janet - Vehicle Collision
Claim
PACIFIC BELL - Other Cable
Damaged Claim
PERNELL, Jan - Sewer/Water
Claim
PHILLIPS, Nancy -Law
Enforcement Claim
POOLE, Geoffrey - Sewer/Water
Claim
PRICE, Robert - Vehicle Damage
Claim
QUITT, Walter- Vehicle Collision
Claim
DATE
Received
8/21/97
Closed Date
10/7/97
Received
2/11/97
Closed Date
2/13/98
Received
2/23/96
Closed Date
7/19/97
Received
9/15/97
Closed Date
5/11/98
Received
2/27/97
Closed Date
10/1/97
Received
4/21/97
Closed Date
12/19/97
Received
2/1 1/97
Closed Date
5/28/98
Received
2/15/97
Closed Date
5/28/98
Received
8/8/97
Closed Date
3/3/98
Received
2/5/98
Closed Date
3/27/98
Received
2/14/96
Closed Date
8/26/97
Received
7/15/97
Closed Date
3/3/98
Received
1/7/97
Closed Date
5/28/98
Received
2/19/97
Closed Date
3/3/98
BOX
No.
1111
1111
1111
1111
1111
1111
1111
1111
1111
1111
1111
1111
1111
1111
RRS No.
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
RRS
Period
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
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
PDF APPROVED
By City Attorney
H=HOLD
City Clerk/Records Management
Page 7 of 17
This form documents the destruction of City records in accordance with the California Public Records Act.
Request by Originating Department:
RISK MANAGEMENT
Requested Date:
3/3/06
Originating Department Manager Initials:
Erin Letsch
Person's Completing Form: Erin Letsch - Risk Manager
No.
82
83
84
85
86
87
88
89
90
91
92
93
94
95
RECORDS DESCRIPTION
RATCLIFFE, Martyn - Vehicle
Comprehensive Claim
ROSSALL, Barbara - Trip/Fall
Claim
SAAD, John - Vehicle Collision
Claim
SANBORN, Laurie - Vehicle
Collision Claim
SANDOR, Judith - Law
Enforcement Claim
SOUTHERN INSURANCE
(Burnett) - Vehicle Collision Claim
STRAUCH, Ken - Vehicle
Comprehensive Claim
TANNER, Carolyn - Other
Pushed by Patrons at Pool Claim
TITA, Heather -Vehicle
Comprehensive Claim
TOMPKINS, Karin - Law
Enforcement Claim
TRIPP, Chris - Vehicle
Comprehensive Claim
TUBBS, Evelyn - Trip/Fall Claim
VALENCIA, Erica - Vehicle
Collision Claim
VALLELY, Dwight - Vehicle
Comprehensive Claim
DATE
Received
3/19/98
Closed Date
6/2/98
Received
2/6/96
Closed Date
7/29/97
Received
2/22/97
Closed Date
6/23/98
Received
1/22/97
Closed Date
7/29/97
Received
9/19/97
Closed Date
4/28/98
Received
9/8/97
Closed Date
3/3/98
Received
10/23/97
Closed Date
4/28/98
Received
10/29/97
Closed Date
5/28/98
Received
10/7/97
Closed Date
4/28/98
Received
9/15/97
Closed Date
3/27/98
Received
1/28/97
Closed Date
8/26/97
Received
1/7/95
Closed Date
2/1/97
Received
6/24/97
Closed Date
7/17/97
Received
10/28/97
Closed Date
4/28/98
BOX
No.
1111
1111
1111
1111
1111
1111
1111
1111
1111
1111
1111
1111
1111
1111
RRS No.
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
RRS
Period
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
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
PDF APPROVED
By City Attorney
H=HOLD
City Clerk/Records Management
Page 8 of 17
This form documents the destruction of City records in accordance with the California Public Records Act.
Request by Originating Department:
RISK MANAGEMENT
Requested Date:
3/3/06
Originating Department Manager Initials:
Erin Letsch
Person's Completing Form: Erin Letsch - Risk Manager
No.
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
RECORDS DESCRIPTION
VAN LEUVEN, Audrey - Trip/Fall
Claim
WALLIEN, Ernest - Vehicle
Collision Claim
WISENER, Gail - Tree Claim
WORTH, Vicki - Vehicle
Comprehensive Claim
AHLES, Steven - Hit Plant
Material and Irrigation Equipment
Loss Recovery
ALCARAS, Armond - Hit Signs
Loss Recovery
ARIAS, Duran - Hit Street Light
Loss Recovery
BOLLINGER, Douglas - Hit Street
Sign and Pole Loss Recovery
BRUNNER, Kimberly - Hit Street
Sign Loss Recovery
BUFFINGTON, Doric - Hit Street
Light Pole Loss Recovery
BUNDY, Carol - Hit Street Sign
Loss Recovery
CABLE GRAFTERS CONST. - Hit
Fire Hydrant Loss Recovery
CARPENTER, David - Hit Fire
Hydrant Loss Recovery
CENTEX Golden Const. - Hit
Construction Meter Loss Recovery
CITY OF CARLSBAD - Stolen
Vehicle Loss Recovery from City's
Insurance Carrier
COBRA GOLF - Hit Fire Hydrant
Loss Recovery
CONTINENTAL EXPRESS - Hit
Street Signs Loss Recovery
COSTA, Raphael - Hit Signal
Control Box Loss Recovery
CUMMINGS, Katherine - Hit
Street Signs
DALEY CORP. - Hit Line Loss
Recovery Loss Recovery
EARTHBUSTERS & MTLS. - Hit
Fire Hydrant Loss Recovery
EDGE, Ulrike - Hit Signal Pole
Loss Recovery
DATE
Received
6/2/97
Closed Date,
7/17/97
Received
7/29/97
Closed Date
3/3/98
Received
2/16/97
Closed Date
1/27/98
Received
10/30/97
Closed Date
5/28/98
Closed Date
10/11/98
Closed Date
3/17/00
Closed Date
7/7/97
Closed Date
9/4/98
Closed Date
4/21/99
Closed Date
11/25/98
Closed Date
2/25/01
Closed Date
4/24/00
Closed Date
4/23/98
Closed Date
1/31/98
Closed Date
11/22/94
Closed Date
7/22/98
Closed Date
4/24/00
Closed Date
4/3/98
Closed Date
4/21/99
Closed Date
1/17/98
Closed Date
3/17/99
Closed Date
8/31/00
BOX
No.
1111
1111
1111
1111
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
RRS No.
0745-20
0745-20
0745-20
0745-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
RRS
Period
CL+5
CL+5
CL+5
CL+5
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
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
Risk Mgmt
Risk Mgmt
Risk Mgmt
PDF APPROVED
By City Attorney
H=HOLD
City Clerk/Records Management
Page 9 of 17
This form documents the destruction of City records in accordance with the California Public Records Act
Request by Originating Department:
RISK MANAGEMENT
Requested Date:
3/3/06
Originating Department Manager Initials:
Erin Letsch
Person's Completing Form: Erin Letsch - Risk Manager
No.
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
RECORDS DESCRIPTION
ELECTRIC CA WESTERN INC. -
Hit Overhead Signal Loss
Recovery
EVANS, Joe & ACME PALLET -
Hit Fire Hydrant Loss Recovery
FARR, Eric - Hit Fire Hydrant
Loss Recovery
FELICES, Raymundo - Hit Light
Pole Loss Recovery
GANAN, Kean - Hit Fire Hydrant
Loss Recovery
GENERAL INS. (Lalonde) - Hit
Street Light Pole Loss Recovery
GRIFFIN, Kenneth - Hit Fire
Hydrant Loss Recovery
HAMANN CONSTRUCTION - Hit
Construction Meter Loss Recovery
HANEY, Cherice - Hit Sign Loss
Recovery
HARPER, Mark - Hit Sign and
Pole Loss Recovery
HARRISON TRKG. (Robertson) -
Hit Signal Pole Loss Recovery
HAWTHORNE RENTAL - Diesel
Fuel Spill Loss Recovery
HESKETT, Virginia - Hit Sign
Loss Recovery
HIGANONNA, Alanna - Hit Light
Pole Loss Recovery
JERNBERG, Deborah - Hit Signs
Loss Recovery
JOHNSON, Celester- Hit Fire
Hydrant Loss Recovery
JONES, Heather- Hit Chain Link
Fence Loss Recovery
KOLL CONSTRUCTION -
Damaged Construction Meter
Loss Recovery
LAPORTE, Shirlee - Hit Plant
Material Loss Recovery
LESINSKI, Anthony - Hit Light
Pole Loss Recovery
LUCAS & MERGER DEV. -
Damaged Construction Meter
Loss Recovery
LUSARDI CONST. - Hit Fire
Hydrant Loss Recovery
M. L. BASHAW, INC. - Hit Water
Line Loss Recovery
MARIO, Badillo - Hit Fire Hydrant
Loss Recovery
MARKLEY, Ryan - Hit Plant
Material and Irrigation Line Loss
Recovery
DATE
Closed Date
11/13/00
Closed Date
6/23/97
Closed Date
1/31/98
Closed Date
5/11/97
Closed Date
8/13/98
Closed Date
9/16/98
Closed Date
4/24/00
Closed Date
12/22/99
Closed Date
10/8/99
Closed Date
12/13/98
Closed Date
4/10/00
Closed Date
19/9/98
Closed Date
3/17/00
Closed Date
8/31/00
Closed Date
5/21/99
Closed Date
1/21/98
Closed Date
11/7/94
Closed Date
3/6/00
Closed Date
11/23/00
Closed Date
11/21/97
Closed Date
1/31/98
Closed Date
2/28/99
Closed Date
9/24/98
Closed Date
4/24/00
Closed Date
10/29/98
BOX
No.
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
RRS No.
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
RRS
Period
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
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
Risk Mgmt
Risk Mgmt
Risk Mgmt
Risk Mgmt
Risk Mgmt
Risk Mgmt
PDF APPROVED
By City Attorney
H=HOLD
City Clerk/Records Management
Page 10 of 17
This form documents the destruction of City records in accordance with the California Public Records Act
Request by Originating Department:
RISK MANAGEMENT
Requested Date:
3/3/06
Originating Department Manager Initials:
Erin Letsch
Person's Completing Form: Erin Letsch - Risk Manager
No.
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
RECORDS DESCRIPTION
MARSH, Dale - Hit Signs Loss
Recovery
MARSHALL, Steven - Hit Light
Pole Loss Recovery
McCALL, Sarah - Hit Fire Hydrant
Loss Recovery
McNulty, Sheila - Hit Electrical
Sprinkler Boxes Loss Recovery
MERCURY INS. (Mercado) - Hit
Street Light Loss Recovery
MORENO, Daniel - Hit Plant
Material Loss Recovery
MORTIMER, Sandra - Hit City
Vehicle Loss Recovery
O. C. I. - Damaged Construction
Meter Loss Recovery
ORTEGA, Julio - Hit Street Signs
Loss Recovery
Possible 1/4/95 Storm Damage
Recovery from City's Insurance
Carrier
PACIFIC TREND PROPERTIES -
Damaged Water Service Line
Loss Recovery
PAREDES, Raul - Hit Irrigation
System Loss Recovery
PINEDA, Jesus - Hit City Vehicle
Loss Recovery
POHLMANN, Carl - Hit Street
Light Pole Loss Recovery
RADCLIFFE, Kevin - Hit Fire
Hydrant Loss Recovery
RAMIREZ, Juan - Hit Fire Hydrant
Loss Recovery
RICHER, John - Hit Fire Hydrant
Loss Recovery
RICHMOND AMERICAN -
Damaged Construction Meter
Loss Recovery
RANCHO SANTA FE SECURITY
- Hit Controller Cabinet Loss
Recovery
RODRIGUEZ, Luis - Hit Signs
Loss Recovery
SAFECO (Mulholland) - Hit Fire
Hydrant Loss Recovery
SALAMESSY, Aaron - Hit Light
Pole Loss Recovery
SHEA HOMES - Damaged
Construction Meter Loss Recovery
SHEA HOMES - Damaged
Construction Meter Loss Recovery
SIERRA CASCADE CONCRETE
- Damaged Water Service Line
Loss Recovery
DATE
Closed Date
3/17/00
Closed Date
3/17/00
Closed Date
4/23/98
Closed Date
11/5/00
Closed Date
1/17/98
Closed Date
12/1/96
Closed Date
3/15/96
Closed Date
12/22/99
Closed Date
4/24/00
Closed Date
11/6/95
Closed Date
3/26/99
Closed Date
12/21/00
Closed Date
11/1/01
Closed Date
8/31/00
Closed Date
1/16/99
Closed Date
11/15/96
Closed Date
12/22/99
Closed Date
12/22/99
Closed Date
11/13/00
Closed Date
4/9/99
Closed Date
4/24/00
Closed Date
2/25/00
Closed Date
1/31/98
Closed Date
12/22/99
Closed Date
5/9/99
BOX
No.
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
RRS No.
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
RRS
Period
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
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
Risk Mgmt
Risk Mgmt
Risk Mgmt
Risk Mgmt
Risk Mgmt
Risk Mgmt
PDF APPROVED
By City Attorney
H=HOLD
City Clerk/Records Management
Page 11 of 17
This form documents the destruction of City records in accordance with the California Public Records Act
Request by Originating Department:
RISK MANAGEMENT
Requested Date:
3/3/06
Originating Department Manager Initials:
Erin Letsch
Person's Completing Form: Erin Letsch - Risk Manager
No.
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
RECORDS DESCRIPTION
SMITH, Victoria L. - Hit City
Vehicle Loss Recovery
SNYDER, Ken - Hit Fire Hydrant
Loss Recovery
STAGECOACH PARK - Snack
Bar Fire Loss Recovery from
City's Carrier
20 r" CENTURY (Gordon) - Hit
City Vehicle Loss Recovery
TALLEY, Richard - Hit Street Sign
Loss Recovery
UDC HOMES INC. - Hit
Construction Meter Loss Recovery
VALENTINE, Thomas -Hit
Control Box Loss Recovery
VARDY, Katherine - Hit Light Pole
Loss Recovery
WESTERN PACIFIC HOMES -
Damaged Construction Meter
Loss Recovery
WHITMER, Rex - Hit Sign Loss
Recovery
ANGELINI, John -Vehicle
Collision Pothole Claim
AUTO CLUB (Ins. Ibbetson) -
Vehicle Collision w/ City Vehicle
Claim
AUTO CLUB (Ins. Paulin) -
Vehicle Collision Pothole Claim
BANTZ, Thomas - Vehicle
Comprehensive Substance Claim
BERGMANN, Rene and Anita -
Sewer/Water Back-up Claim
BLACKBURN, Dawn -Vehicle
Comprehensive Substance Claim
BRENNEISE, Dennis -
Sewer/Water Back-Up Claim
BROCK, Ronald -Vehicle
Comprehensive Vandalism Claim
DATE
Closed Date
2/9/95
Closed Date
6/25/00
Closed Date
12/12/97
Closed Date
1/29/00
Closed Date
4/16/99
Closed Date
12/22/98
Closed Date
2/25/00
Closed Date
4/21/00
Closed Date
12/22/99
Closed Date
2/25/01
Received
10/5/98
Closed date
04/26/99
Received
8/3/98
Closed date
12/23/98
Received
5/4/98
Closed date
10/30/98
Received
4/13/98
Closed date
10/30/98
Received
2/10/98
Closed date
04/09/99
Received
8/24/98
Closed date
10/27/98
Received
8/5/98
Closed date
06/07/99
Received
3/2/98
Closed date
10/30/98
BOX
No.
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
986
RRS No.
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0120-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
RRS
Period
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CU+2
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
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
PDF APPROVED
By City Attorney
H=HOLD
City Clerk/Records Management
Page 12 of 17
This form documents the destruction of City records in accordance with the California Public Records Act.
Request by Originating Department:
RISK MANAGEMENT
Requested Date:
3/3/06
Originating Department Manager Initials:
Erin Letsch
Person's Completing Form: Erin Letsch - Risk Manager
No.
186
187
188
189
190
191
192
193
194
195
196
197
198
199
RECORDS DESCRIPTION
CARLSBAD LODGE - Law
Enforcement Search/Entry
Property Damaged Claim
CARLSBAD RACEWAY -
Sewer/Water Shut Off Claim
CHAFEY, Kim - Law Enforcement
Claim
CHAFEY, Michael - Law
Enforcement Use of Extreme
Procedures Claim
CHAFEY, Sterling - Law
Enforcement Use of Extreme
Procedures Claim
CHILES, Olan and Carlene -
Trip/Fall Sidewalk Claim
DEGOUR, John & Lisa - Vehicle
Collision with City Vehicle Claim
DELONG, Larry -Vehicle
Collision with City Vehicle Claim
DEWHURST, Donald - Tree
Damaged Curb Claim
DONCO, Denise - Law
Enforcement Property Damaged
during Search Claim
DUNN, Daniel - Vehicle Collision
Pothole Claim
ESTEFANI, Ramon - Vehicle
Collision with City Vehicle Claim
FARIA, Sherie - Trip/Fall
Sidewalk Claim
FREEDMAN, Vanessa - Law
Enforcement Vehicle Tow Claim
DATE
Received
7/8/98
Closed date
02/01/99
Received
3/12/99
Closed date
05/11/99
Received
3/1/99
Closed date
05/28/99
Received
3/1/99
Closed date
05/28/99
Received
3/1/99
Closed date
05/28/99
Received
7/9/98
Closed date
02/01/99
Received
5/4/99
Closed date
06/30/99
Received
6/29/98
Closed date
07/29/98
Received
5/26/98
Closed date
02/01/99
Received
6/15/98
Closed date
01/06/99
Received
7/31/98
Closed date
02/01/99
Received
12/11/97
Closed date
10/14/98
Received
3/26/98
Closed date
09/29/98
Received
10/30/98
Closed date
05/28/99
BOX
No.
986
986
986
986
986
986
986
986
986
986
986
986
986
986
RRS No.
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
RRS
Period
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
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
PDF APPROVED
By City Attorney
H=HOLD
City Clerk/Records Management
Page 13 of 17
This form documents the destruction of City records in accordance with the California Public Records Act.
Request by Originating Department:
RISK MANAGEMENT
Requested Date:
3/3/06
Originating Department Manager Initials:
Erin Letsch
Person's Completing Form: Erin Letsch - Risk Manager
No.
200
201
202
203
204
205
206
207
208
209
210
211
212
213
RECORDS DESCRIPTION
GLOGER, Richard - Other
Damaged Sprinkles during
Replacement of Sidewalk Claim
GRACIANO, Rudy - Vehicle
Comprehensive Substance Claim
GRAY, Patrick & Vickie - Tree
Driveway Damage Claim
HUSTON, Chad - Vehicle
Collision With Hydrant Guard
Claim
IOZZIA, Jason - Vehicle Collision
Claim
IRVIN, William and Daurine -
Sewer/Water Double Payment of
Water Bills Claim
JIMENO, Frank - Other Electrical
Surge Claim
JINJA, Tamamitsu - Other Rental
Fence Damaged Claim
JOHNSON, Geneva -Trip/Fall
Sidewalk Claim
JOHNSON, Larry -Vehicle
Comprehensive Claim
JONES, Brande - Vehicle
Collision Claim
JUSTICE, Kathleen - Trip/Fall
Walking Claim
KAITANGIAN, Christine - Vehicle
Comprehensive Claim
KAKADELAS, Dana - Vehicle
Comprehensive Claim
DATE
Received
4/19/99
Closed date
05/11/99
Received
12/18/98
Closed date
05/28/99
Received
3/30/99
Closed date
06/29/99
Received
3/16/98
Closed date
09/28/98
Received
7/7/98
Closed date
02/01/99
Received
9/10/98
Closed date
01/25/99
Received
12/1/98
Closed date
01/26/99
Received
9/16/98
Closed date
11/23/98
Received
4/9/98
Closed date
12/14/98
Received
4/2/98
Closed date
10/21/98
Received
3/24/99
Closed date
05/07/99
Received
8/25/98
Closed date
03/25/99
Received
4/28/98
Closed date
12/14/98
Received
7/28/98
Closed date
02/22/99
BOX
No.
1113
1113
1113
1113
1113
1113
1113
1113
1113
1113
1113
1113
1113
1113
RRS No.
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
RRS
Period
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
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
PDF APPROVED
By City Attorney
H=HOLD
City Clerk/Records Management
Page 14 of 17
This form documents the destruction of City records in accordance with the California Public Records Act.
Request by Originating Department:
RISK MANAGEMENT
Requested Date:
3/3/06
Originating Department Manager Initials:
Erin Letsch
Person's Completing Form: Erin Letsch - Risk Manager
No.
214
215
216
217
218
219
220
221
222
223
224
225
226
227
RECORDS DESCRIPTION
KAKADELAS, Kevin - Vehicle
Comprehensive Claim
KRISTIANSEN, Trygve - Vehicle
Collision with City Vehicle Claim
LA COSTA 15, Jeanie S. Gott -
Law Enforcement Claim
LAKE, Donald - Law Enforcement
Claim
LARSON, Joseph - Vehicle
Collision Claim
LAS PLAYAS H.O. Association -
Trip/Fall Claim
LECHTMAN, Miles - Tree Claim
Walkway Damage
LEIGH, Laurie -Vehicle
Comprehensive Claim
LIEN, Richard - Law Enforcement
Claim
LUTHER, Ed - Vehicle Collision
Claim w/City Vehicle
MACMILLAN, John - Trip/Fall
Claim over manhole
MAFFETT, Erma - Vehicle
Comprehensive Claim
MAJORCA West HOA-
Sewer/Water Claim
MCLAUGHLAN, Brand! - Law
Enforcement Claim Personal
Property Missing
DATE
Received
7/23/98
Closed date
02/22/99
Received
5/17/99
Closed date
06/30/99
Received
11/20/98
Closed date
06/28/99
Received
3/2/98
Closed date
09/28/98
Received
6/29/98
Closed date
02/01/99
Received
8/24/98
Closed Date
04/26/99
Received
8/4/98
Closed Date
03/25/99
Received
10/28/98
Closed Date
05/28/99
Received
5/28/98
Closed Date
08/17/98
Received
9/21/98
Closed Date
03/09/99
Received
8/3/98
Closed Date
02/22/99
Received
1/20/98
Closed Date
08/31/98
Received
3/11/99
Closed Date
05/07/99
Received
9/14/98
Closed Date
03/25/99
BOX
No.
1113
1113
1113
1113
1113
1113
1113
1113
1113
1113
1113
1113
1113
1113
RRS No.
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
RRS
Period
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
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
PDF APPROVED
By City Attorney
H=HOLD
City Clerk/Records Management
Page 15 of 17
This form documents the destruction of City records in accordance with the California Public Records Act.
Request by Originating Department:
RISK MANAGEMENT
Requested Date:
3/3/06
Originating Department Manager Initials:
Erin Letsch
Person's Completing Form: Erin Letsch - Risk Manager
No.
228
229
230
231
232
233
234
235
236
237
238
239
240
241
RECORDS DESCRIPTION
MILLER, Tracy & Rick - Vehicle
Collision Claim w/City Vehicle
MONTOYA, Chris - Vehicle
Collision Claim
NARDELL, James Michael -
Vehicle Collision w/City vehicle
NOSSE, Stormy - Trip/Fall Claim
on Manhole Cover
NUGENT, Barbara -Trip/Fall
Claim Walking
ORTEGA, Henry- Vehicle
Collision Claim w/City vehicle
OWENS, Lynette - Vehicle
Collision Claim
PACIFIC BELL - Sewer/Water
Claim Cut Cable
PACIFIC BELL - Sewer/Water
Claim Cut Cable
PATT, Larry - Vehicle Collision
Claim w/City Vehicle
PEREZ AKA Angeles - Vehicle
Collision Claim w/Pedestrian
PRITTEN, Lew & Joan - Tree
Claim Walkway
RAKICH, Ron - Other Claim
Contractual
REMAS, Mark - Sewer/Water
Claim Back-Up
DATE
Received
12/2/98
Closed Date
01/26/99
Received
Closed Date
02/01/99
Received
7/10/98
Closed Date
08/27/98
Received
8/12/98
Closed Date
05/28/99
Received
4/1/98
Closed Date
10/30/98
Received
9/4/98
Closed Date
09/28/98
Received
9/17/98
Closed Date
03/25/99
Received
8/11/98
Closed Date
01/11/99
Received
10/23/98
Closed Date
09/11/98
Received
11/3/98
Closed Date
12/04/98
Received
2/20/98
Closed Date
08/31/98
Received
3/1/96
Closed Date
07/30/98
Received
1/5/98
Closed Date
08/31/98
Received
12/7/98
Closed Date
03/01/99
BOX
No.
1113
1113
1113
1113
1113
1113
1113
1113
1113
1113
1113
1113
1154
1154
RRS No.
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
RRS
Period
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
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
PDF APPROVED
By City Attorney
H=HOLD
City Clerk/Records Management
Page 16 of 17
This form documents the destruction of City records in accordance with the California Public Records Act.
Request by Originating Department:
RISK MANAGEMENT
Requested Date:
3/3/06
Originating Department Manager Initials:
Erin Letsch
Person's Completing Form: Erin Letsch - Risk Manager
No.
242
243
244
245
246
247
248
249
250
251
252
253
254
255
RECORDS DESCRIPTION
RIDER, Damian - Law
Enforcement Claim Brutality
RIDER, Marsha - Law
Enforcement Claim Brutality
RIDER, William - Law
Enforcement Claim Brutality
RIELA, Thomas - Vehicle
Collision Claim w/City Vehicle
ROGERS, Jennifer - Vehicle
Collision Claim w/Lid
ROLLER, Adolf- Other Claim
Personal Property Damaged
RUBENSTEIN, L. - Other Claim
Flowers Damaged
SEASHORE ON THE SEA -
Sewer/Water Claim Back-Up
SIGAFOOSE, NORINE -
Sewer/Water Claim Back-Up
SULLIVAN, Brian - Trip/Fall Claim
Bicycling on Street
TAHAJIAN, Roy -Vehicle
Collision Claim
THE PLAZA - Sewer/Water Claim
Leak
TOYOTA CARLSBAD - Vehicle
Comprehensive Claim
TRYGSTAD, Jean - Tree Claim
Damaged Driveway
DATE
Received
12/17/97
Closed Date
05/31/99
Received
12/17/97
Closed Date
05/31/99
Received
12/17/97
Closed Date
05/31/99
Received
10/21/98
Closed Date
12/04/98
Received
2/25/98
Closed Date
09/28/98
Received
6/6/99
Closed Date
06/30/99
Received
1/6/98
Closed Date
07/30/98
Received
3/9/99
Closed Date
05/11/99
Received
8/6/98
Closed Date
10/14/98
Received
12/1/87
Closed Date
07/30/98
Received
8/15/98
Closed Date
02/01/99
Received
1/21/98
Closed Date
07/30/98
Received
4/10/98
Closed Date
10/30/98
Received
11/25/98
Closed Date
05/28/99
BOX
No.
1154
1154
1154
1154
1154
1154
1154
1154
1154
1154
1154
1154
1154
1154
RRS No.
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
0745-20
RRS
Period
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
CL+5
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
PDF APPROVED
By City Attorney
H=HOLD
City Clerk/Records Management
Page 17 of 17
This form documents the destruction of City records in accordance with the California Public Records Act.
Request by Originating Department:
RISK MANAGEMENT
Requested Date:
3/3/06
Originating Department Manager Initials:
Erin Letsch
Person's Completing Form: Erin Letsch - Risk Manager
No.
256
257
258
259
260
RECORDS DESCRIPTION
VILLA LOMA APARTMENTS -
Sewer/Water Claim Back-Up
WRIGHT, Deborah - Vehicle
Collision Claim
YEATES, Lorraine - Personnel
Action
YOUNGKIN, Constance - Law
Enforcement Claim False Arrest
ZOOLAKIS, Kaye & Andrew -
Vehicle Collision Claim
DATE
Received
3/9/99
Closed Date
05/07/99
Received
2/5/98
Closed Date
08/31/98
Received
9/30/98
Closed Date
04/26/99
Received
3/5/98
Closed Date
10/30/98
Received
4/29/98
Closed Date
09/28/98
BOX
No.
1154
1154
1154
1154
1154
RRS No.
0745-20
0745-20
0745-20
0745-20
0745-20
RRS
Period
CL+5
CL+5
CL+5
CL+5
CL+5
BARCOD
E
Risk Mgmt
Risk Mgmt
Risk Mgmt
Risk Mgmt
Risk Mgmt
PDF APPROVED
By City Attorney
H=HOLD
DOCUMENT DESTRUCTION WILL BE PROVIDED BY SHREB-fTtTOMPANY.
0130-25/F005
11 fa I O
, mobile pape/shreddipapershredding and recyclr
jm^ \mm I ^^_ \" IMPSmxb FORCE
SECURE DOCUMENT DESTRUCTION
Client materials are to be destroyed off-site. Client will
receive official Certificate of Destruction upon completion
of service.
»This CERTIFICATE OF DESTRUCTION certifies the complete
destruction of all material contained as described below on the
date and at the time recorded herewith.
Date / Time of Pick up:__AM PM Date / Time of Destruction •//- 2'? -AM
Billing Address Service Address
Contact:Phone Number: r7<jS# )/
Type
Quantity
Service
Rate
Total
File Boxes
(Llo
•2^
?&^
Bankers
Boxes
ShredForce
Executive
100
ShredForce
250
Other
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sCft^"
/ ^
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Other Other
SHREDFORCE ID#:
Balance Due: $
Amount Paid: $
'T SHREDFORCE Signature:
Please Invoice Client
Authorized Representative:
Comments:
TB:Hours:Other:
09/05
SHREDFORCE D PO Box 891 D San Marcos, CA 92079 D (800) 444-6209