CITY OF EMERYVILLE
CLAIM FORM
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City Attorney's Office, City of Emeryville
1333 Park Avenue Emeryville, Ca 94608
Phone: 510.596.4380 Fax: 510.596.3724
CLAIM AGAINST City of Emeryville
(Name of Entity)
Robert Speidel
Claimant's name
Claimant's date of birth Telephone#
Claimant's address
Address where notices about claim are to be sent, if different from above:
11/23/2024
Date of incident/accident:
Date injuries, damages, or losses were discovered: 11/23/2024 Near southwest corner of Powell St and Hollis St
Location of incident/accident:
What did entity or employee lo to cause this loss, damage, or injury Negligent restoration of pavement of a utility trench produced large and deep pot-holes, the work clearly did not meet specifications and standards (continued on next page) (Use back of this form or separate sheet if necessary to answer this question in detail.) What are the names of the cutty's omployees who caused this injury, damage, or loss (if know; Not known What specific injuries, damages, or losses did claimant receive Damages to vehicle inluding a ruptured tire and damaged wheel alignment.
(Use back of this form or separate sheet if necessary to answer this question in detail) What amount of money is claimant seeking, or which is the appropriate court of jurisdiction [Government Code 910(f)]? $388.57
How was this amount calculated (please itemize) $258.57 for replaced tire (receipt attached) $199.99 for wheel alignment diagnosis and adjustment (estimate attached) (Use back of this form or separate sheet if necessary to answer this question in detail) Date Signed: 12/10/2024 and olen delinen
Signature:
If signed by representative:
Representative's Names Address
Telephone #
Relationship to Claimant:
(Continued response from page 1)
The area where the pot-hole occured had been patched up to the pavement surface only with gravel and no asphalt material. This material had been ejected from the area of the pot-hole by regular traffic and recent rainfall. Large amounts of loose gravel that had been placed in the location of the pot-hole were present in the adjacent gutter.
Photos of the ruptured tire, the pot-hole, and the ejected gravel are attached.
Patching the pavement of a trench with gravel, particularly in such a high traffic road, is grossly negligent and should not have been allowed to happen. Other areas of the trench that were patched with proper asphalt material did not produce and pot-holes.
The location of this pot-hole was particularly hazardous, as it forced vehicles attempting to make the right turn to head south on Hollis St to maneuver back into the path of passing traffic heading east on Powell St. This occured to me specifically, and in order to avoid colliding with another car, I was forced to drive through directly through the pot-hole. I witnessed this same hazard occur multiple times at the location, just in the time I spent at the location taking photographs and measurments, in addition to witnessing multiple other vehicles hit the pot-hole and potentially incur damage to the tire or wheel of their vehicle. One car that hit the pot-hole broke a wheel cover and the wheel cover was ejected from the wheel of the vehicle.