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KITTITASCOUNTY
August 21, 2019
Mr. Chris Horner
Deputy Prosecuting Attorney
205 West 5s', Suite 213
Ellensburg, WA 98926
KZTTZTAIS COUNTY
DEPARTMENT OF PUBLIC WORKS
Mark R. Cook, PE Director
RE: Kittitas County Claim for Damages Number 201908120064
Dear Mr. Horner:
Public Works has reviewed the claim for damages submitted by Mr. David M. Paulsell
(08/12/2019 date stamp) and assigned number 201908120064. The results of our internal review
of the claim are listed below for your consideration.
• Public Works was engaged in gravel hauling operations on the date and time that Mr.
Paulsell's vehicle was damaged.
• The damage claimed is consistent with rock falling from a dump truck.
While we attempt to be diligent during gravel hauling operations, it is possible that a rock was
spilled onto a dump truck fender as was not noted by the driver. We cannot affirm that this was
or was not the case in this claim. I do believe, based on the fact pattern of the claim, that we
were more likely than not the cause of Mr. Paulsell's damage. I recommend payment of the
claim in the amount of the repair estimate: $489.99.
Sincerely,
EVEN �NOW
Mark R. Cook
Director
C: Mr. Jim Van de Venter, Maintenance Manager
Ms. Liz Remeto, Finance Manager
ATTACHMENT: Claim Number 201908120064
411 N. Ruby St, Suite #1 TEL (509) 962-7523
Ellensburg, WA 98926 FAX (509) 962-7663
Prosecutor fS� -
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0g8/12/2019 02:59:52 PM 201908120064
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KITTITAS COUNTY CLAIM FOR DAMAGES
Return to:
County.Auditor
205 W 5' Ave, Suite I05
Ellensburg, WA 98926
509-962-7504
Instructions:
Please read the entire form before completion. Fill out each question as completely as possible,
to the best of your ability. Do not hesitate to use the back side of this form if you need more than
the space provided. An incomplete response may delay the processing of your claim.
1. Name (Including spouse, if married): DAY 16 TA [ S E—L
2. Phone (Iiome):(204)5W?^9293 )(Work): 20i4mm,
Address (include former address if
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4. Date of Birth: 3! G/ f 9 67
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for less than 6 months):
5. Date and Time of Incident: M614ZAY a L y 242017 at f
6. Location of
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Kittitas County Claim for Damages Form
Revised 9/2012
Filed for kigtmd 0'02/2019 02 59:52 PM - Kittitas County, WA Auditor - 201908120064 Page 2 of 4
7. Describe in detail the defect which caused the injury: _
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8. Describe in narrative form and in detail exactly how the incident occurred:
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9. List the names of all persons involved and contact information, if kn wn.
10. Was claim investigated by a police officer? N Q
Sheriff State Patrol City Police
11. Description of claimant's vehicle: 06VRDLLT Make995Year
Model: !�2 0 VA O License No. A f)3$ q 4
12. Describe what you did after the accident
truck
13. Describe the conversations y u d 'f �ny� w, ith Co�pty personne unng or a er h9
ntoccurred: Z r" P KNi'r%ffl lAl7Mk i 1p. 0A A_lQ Sa
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14. Describe the damages or injuries which you sustained as a result of the incident:
2of3
Kitdtu County Claim for Damages Form
Revised 9/2012
Filed for Record 08!12/2019 02:59:52 PM - Kittitas County, WA Auditor - 201908120064 Page 3 of 4
15. What is the amount of damages claimed? (Include estimates and bills, if available):
*' 89.9° +4a * 53R.97
16.
17
List the names and addresses of all witnesses to the incident:
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18. Are yyou covered by insurance? If yes, who is your insurance agenticarrier?
6M ADIDQIP1
Dated this Day ofQUCTl1ST —,204.
Signature of Claimant
Subscribed and sworn (affirmed) to before me this --g day of/J¢_ 20/,0.
Seal Notary Public
State of Wasbi40SHI gtoa Nota c in and r the State of Washington
NICOLE MOSHIN 4) Notary
COMMISSION#205250 Residing at ^
My COMMISSION EXPIRES
November 24, 2022
3 of 3
Kiltlmas County Claim for Damages Form
Revised 92012
Filed for Record 08/12/2019 02.59:52 PM - Kittitas County, WA Auditor - 201908120064 Page 4 of 4
M Gmail
Regarding your estimate
1 message
D. M. Paulsell <dmpaulsell@gmail.com>
Safelite AutoGlass <noreply@t.safelite.com> Thu, Aug 8, 2019 at 10:46 AM
Reply -To: Safelite AutoGlass <reply-fe8f16787764037a73-516_HTML-597252669-7225942-4285@t.safelite.com>
To: DMPAULSELL@gmail.com
10 +wl
SafelfteeAutoGfass
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