HomeMy WebLinkAboutClaimC�SCAD[5
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KITTITAS C01 N 11
February 09, 2016
Mr. Christopher Horner
Deputy Prosecuting Attorney
205 West Fifth, Room 213
Ellensburg, WA 98926-3129
KITTaWA9 COUNTY
DEPARTMENT OF PUBLIC WORKS
Mark R. Cook, PE Director
RE: Claim No.: 201601250078
Dear Mr. Horner:
Public Works has reviewed the claim for damage (Exhibit 1) submitted by Puget Sound Energy
(PSE) (01-25-2016 No. 201601250079). We confirm that Public Works was engaged in road
operations on 06-18-2015 (Manastash Road shoulder rebuild). The damages listed are
consistent with our experience resulting from an elevated truck bed striking an overhead line.
Public Works immediately contacted PSE who responded repairing the damaged line. The
requested amount ($3,139.74) for replacing the damaged line and restoring electrical service to
eight (8) customers is consistent with our cost history. We find no reason to dispute the
narrative of the claim as submitted. We recommend that the Board of County Commissioners
favorably entertain the claim for damages.
Respectfully,
R�le
Mark R. Cook
Director/Interim County Engineer
Attachments: Exhibit 1 Claim No. 201601250078
C: Lisa Young, Risk Manager
411 N. Ruby St, Suite #1 TEL (509) 962-7523
Ellensburg, WA 98926 FAX (509) 962-7663
01/25/2016 04:51:36 PM 201601250078
Claims Against County/rls/miso PPROSECUTOR
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INSURANCE
KITTITAS COUNTY CLAIM FOR DAMAGES
Return to:
County Auditor
205 -W 5s' Ave, Suite 105
Ellensburg, WA 98926
509-962-7504
Instructions:
Please read the entire form before completion. Fill out each question as completely as possible,
to the best of your ability. Do not hesitate to use the back side of this form if you need more than
the space provided. An incomplete response may delay the processing of your claim.
1. Name (Including spouse, if married)
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2. Phone (Home): ( 1(Work): 1115 — (} >
3. Address (include former address if r ent dress.for less than 6 mon
Mailing
4. Date of Birth:
5. Date and Time of Incident:
6. Location of Incident: .
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1 of 3
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Kmitas County Claim for Damages Form
Revised 9/2012
Filed for Record 01/25/2016 04:51:36 PM - Kittitas County, WA Auditor - 201601250078 Page 2 of 4
7. Describe in detail the defect which caused the injury:
Describe in narrative form and in detail exactly how the incident occurred:
Q1
9. List the names of all persons involved and contact information, if known.
10. Was claim investigated by a police officer?
Sheriff State Patrol City Police
11. Description of claimant's vehicle: Make Year
Model: License No.
12_ Describe hat you did after the accident occurred: ,
arm
13. Describe the conversations you ha if any, with County personnel during or after the
incident occurred:
2of3
Kittitas County Claim for Damages Form
Revised 9=2
Filed for Record 01/25/2016 04:51:36 PM - Kittitas County, WA Auditor - 201601250078 Page 3 of 4
14.
or iniuries which you0hstained as a result of the incident:
15. Whakis` amount of aumages claimed? (Include estimates and bills, if available):
16. Ho -w dad you i
Kdentify the Countythe ariy re o ble for -pr dama
�—a.
17. List the names and addresses of all witnesses to the incident:
18. Are you covered by
who is your insurance agent/carrier?
Subscribed and sworn (affirmed) to before me this oda day of ��11 20�.
Seal
Notary blitin an�d�£or the State of Washin
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o NOTARY �N. a Kittitas County Claim for Damages Form
Revised 9/2012
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