CLAIM FOR DAMAGES
TO PERSON OR PROPERTY
INSTRUCTIONS
1. Claims for death, injury to person or to personal property must be filed not later than six (6) months after the occurrence. (Gov. Code Sec. 9112)
2. Claims for damages to realproperty must be filed not later than one (1) year after the occurrence. (Gov. Code Sec.91 1.2)
3. Read entire claim before filing. 4. See page 2 for diagram upon which to locate place of accident 5- This claim form must be signed on page 2 al bottom. 6. Attach separate sheets, if necessary, to give full details, SIGN EACH SHEET 7. Claim must be filed with City Clerk. (Gov.Code Sec. 915a) TO: CITY OF VERNON CITY COUNCIL
Name manl
Linea e Logistics Vernon CA
Home dress of C aimant a
Business Address of Claimant City and State
3200 E. Washington Blvd. Vernon CA 90058
RESERVE FOR FILING STAMP
CLAIM No.
REGEIVED
t ::.71, ?r,lx
CITY CLERK DEPARTMENT
ra person
ome ne m
Business Telephone Number
323-261-4500
ma
Give address to which you desire notices or communications to be sent regarding this claim:
3200 E. Washington Blvd. Vernon CA 90058
How did DAMAGE or INJURY occur? Give full particulars.
During the power outlage on 111712023 al around 9:31am, one of our refrigeration compressor panel shorted out due to the power outtage, this caused an alarm to our security monitoring alarm company. Our emergency generator tumed on powering on the facility and around 9:36am security moniloring company notified that the compressor power was not restored. After checking the power failure al the compressor, noticed that the panel was no longer wo*ing due to the power outtage.
When did DAMAGE or INJURY occur? Give full particulars, date, time of day, etc.:
January 17 2023 at around 9:31am
Where did DAMAGE or INJURY occur? Describefully, and locateon diagram on reverse side ofthissheet, where approximate, give street names and address and measurements from landmarks:
Compressor room located at the south/west of the building.
The provided diagram does not apply to our claim.
What particularACT oTOMISSION doyou claim causedlhe injury ordamage? Givenamesof Cityemployees, if any, causingthe injury or damage, if known:
A bad underground power cable that feeds the transformers.
What DAMAGE or INJURIES do you claim resulted? Give full extent of injuries or damages claimed:
A compressor panel shorted out.
WhatAMOUNT do you claim of each item of iniury ordamage as of date ot presentation of thisclaim, giving basisof computation:
$8,126.22
Give ESTIMATED AMOUNT as faras knownyou claim onaccount of each item of prospective injury ordamage, giving basisof computation:
$8,126.22
Were you insured at the time of the incident? lf so, provide narne of insuEn@ company, policy numbers and amount of insurance payments receivd:
Lockton lnsurance Brokers, LLC COI available upon request Expenditures made on account of accident or lnjury: (Date - ltem) (Amount) 0 Name and address of Witnesses, Doctors and Hospitals:
Saul Vaca 3200 E. Washington Blvd. Vernon CA 90058
Edwind Galvez 3100 E. Washington Blvd. Los Angeles CA 90023
READCAREFULLY
For all accident claims place on following diagram names oI slreeb, including North, Easl. South, and West: indicate place of accident by "X" and by showing house numbeG or dislances to stre€t comers. lf City Vehicle was lnvolved, designate by letter'A' localion of Cityvehicle when you first saw il,and by "8" localion ofyourself or your vahicle when you first saw City vehicle; location of City vehicle at time of accident by'A-1"and location of yourself or your vehicle at the time of accident by'8 1" and the point of lmpact by "x." NOTE lf diagrams do not fit the situalion, altach herelo a proper diagram signed by claitnant.
FOR AUTOMOBILE ACCIDENTS
FOR OTHER ACCIDENTS
SI DEWALK
CUBB 1
of ,
that the tn includi attachme is true and corect.
Date:
NoTE: ALL CLAIMANTS MAY BE REoUESTED TO BE EXAMINED AS TO THEIR CLAIM R OATH A FALSE CLAIM IS A FELONY (CAI.
CURB
I decla under na
Typed/Printed Name:
D
PAN WAY
Signature of Claimant or person filing on his/her behatf, giving relationship to Claimant:
PEN, CODE SEC,72). CLAIMS MUSTBE FILED WTTH Cfi CLERK (GOV CODE SEC,915a). STATE LAW PROVIOES THAT IF YOU ARE NOT NOTIFIEO OF ANY ACTION BY THE CrIY OF THIS CLAIM WTTHN 45 DAYS OF FILING THEN THE CLAIM E; DEEMED OENIED ISEE GOV. COOE SEC, 911.6 & 912.4) /) L_.t r_
7 i\V-7 ts t
11271202311t33i52 AM
lnltrll Co First to Last
Corporato Account ALL
Activity By Event Code
Sort.d By CS#
CS# 550405 to s59405
Event
1ol5
01117t23
01t17t23
01t17t23
01117123
01117t23
0111 23
01117 t23
01117t23
01117t23
01t17t23
01117t23
01117 t23
03;11:00
04r41:56
04:41:56
05:30r41
09:31:10
09r31:'10
09:31:12
09:32:'ll
09:U:11
09:34:05
09i35:13
09:36:11
New Alsrm Evont: 1GO
R401.1 ClR401 - Clo8o by Usor
8 CIRs7O - UNBYPASS
E401.1 CIE4O1 - OPEN BY USER
I ClR150 - RESTORE Alarm
14 SUB/HI - SupE vlsqy High Priorlty
45 SUPVHI - SupoNisory Hlgh Prlority
46 SUPVHI - Sup6Nlaory Hloh Prlodty
45 CIRlsO - RESTORE Alarm
44 ClR150 - RESTORE T{arm
AA - Alarm Accosssd
4OO4 - CONTACT REACHED
COOLER TEMPERATURE
SAUL VACA
POWER IS OUT PER SAUI
FSUP - FOLLOW-UP SUPERVISORY N6rv prlodty:1o1
SIGNAL
ADVISED SAUL PER ZONE 46 RESTORAL NEEDED / STATED POWER IS OUT RIGHT NOW / FOLLOW UP 44 SUPVHI . Supsrvi8ory Hlgh Prlortty COMPRESSOR 1 ALARM Prev Alsrm Dchy Ended
45 SUPVHI- SuporvBory Hlgh Priodty COMPRESSOR 2 ALARM
44 ClR150 - RE$TORE Alarm COMPRESSoR I ALARM
44 SUPVHI- SupErvlsory Hlgh Pdority COMPRESSoR 1 ATARM
44 ClRtso - RESTORE Alarm COMPRESSOR I ALARM
45 ClR150 - RESTORE Alsrm COMPRESSOR 2 ALARM
AA - Alarm Accassad
ZONDLY
Zone:Delay - 46;60
FC - Full Clear Full Clsar
New AlBm Event: 100
KW
SEE PREV
44 SUPVHI- Suparvlsory High Priorlty
45 SUPVHI - Supervlsory High Pdorlty
MV AA - Alsrm Acces8ed
MV 1999 - Contact Vo.lfled
44 ClR150 - RESToRE Alsrm
45 C|R15O - RESTORE Alarm
MV ONTEST - Plac€d On TeBt
Cat; CUST Expires: 011'122023 18:08:00 All Zones
MV FSUP . FOLLOW.UP SUPERVISORY
SIGNAL
oo tesl
COOLER TEMPERATURE
COMPRESSOR 1 ALARM
COMPRESSOR 2 ALARM
COMPRESSOR 3 AI.ARM
COMPRESSOR 2 ALARM
COMPRESSOR 1 AI-ARM
Drnas 1117 Do23 lo 111712023
1l:59:00 PM
Slte Loc.tlon First to Last
SAUL VACA
SAUL VACA
CH
CH
CH
CH
KW
KW
01/'17123 09:54:05
0111712309:540a
01i '17123 09:36:40
01 117 123 09:46112
01117123 W:46i22
01117123 09i46:24
01 I 17 123 09:46:26
01 117123 09t47 i'19
O'l l'17123 09:47 t33
0111 23 09:49128
01117123 09:54:05
01117123 1OiC5t33
01t17123 10:05:46
O1l17l2310t$st46
0111712310i06t51
0111712310107:14
01 h? D3 10:07:16
01/17123'10:07:35
COMPRESSOR 1 ATARM
COMPRESSOR 2 ALARM
COMPRESSOR 1 ALARM
COMPRESSOR 2 ALARM
'Test
01/17i23 10:10:13 New prlorlty:101 SAUL, VACA
11271202311:33:52 AM
Corporato Account# ALL
01117123 13142t09
Activity By Event Code
Sortod By
5ot5
cs#
cs# 559405 to 559405
Evonl
Dat,. 111712023 to 111712023
11:59:00 PM
8lt Locltlon Flr8t to LaBt
01117123
01117 t23
01t'\7t23
01t17t23
01117t23
01117t23
13:43:40
1e:22115
'16:22i26
'16122126
16i22134
16122i36
0'111 2310i54t07
01117n311136t33
01117123 11:40t30
01117123 13142t03
46 0E602
42 38OO . LATE RESTORAL ALARM
SUPVHI - Sup6rvisory High Prionny
20 - TIMER TEST
TCV - Two Csll Verificatioo
CIR'150 - RESTORE Alarm
ClR150 - RESTORE Alsrm
SUPVHI - Sup€rvisory High Priority
SUPVHI - SupsMsory Hlgh Priority
ClR150 - RESTORE Alarm
SUPVHI - Suporvlsory Hlgh Prlodty
TCV . Two Call VerlflcaUon
ClR150 - RESTORE Ala.m
ClR150 - RESTORE Alsrm
TCV . Two Call Verlflcation
ClR150 - RESTORE Alam
853923 - Explrod Ta8t
Cat: CUST Prev Alarm Doley Ended
AC AA - Alarm Acc68s6d
AC ZONDLY
Zone:D6lay - 45:18900
AC FC - Fullcloat
Nsw Alsrm Ev€nt 1 00
7 SUPVHI - Supervlsory High Prlortty
AG AA - Abrm Accrssed
AG AA - Alarm Accessrd
AG FSUP . FOLLOW-UP SUPERVISORY
SIGNAL
'T68l COMPRESSOR 3 AI-ARM
'T€8t DOCK TEMPERATURE
'Teat zone: 0
'ToBt ELECTRICAL RoOM ENTRY
24HR
'To6t ELECTRICAL ROOM ENTRY
24HR
'TeEt OOCK TEMPERATURE
'TeBt COMPRESSOR 1 ALARM
'ToBt COMPRESSOR 2 AI-ARM
.To8t COMPRESSOR 1 ALARM
.Te9I COMPRESSOR 1 ALARM
'TeEt ELECTRICAL ROOM ENTRY
24HR
'Tosl ELECTRICAL ROOM ENTRY
24HR
'TeBl COMPRESSOR 1 ALARM
'T€sl COMPRESSOR 2 ALARM
'ToEi ELECTRICAL ROOM ENTRY
24HR
"Test ELECTRICAL ROOM ENTRY
24.HR
'ToBt ELECTRICAL ROoM ENTRY
24HR
'Te8t ELECTRICAL ROoM ENTRY
24HR
42 7
44 45
44 44
42 42
44 45
42 42
42 42
O1l1123 16:22:48
01117/23'16t22154
01h712316125:24
ClR150 " RESTORE Alarm
ClRl50 - RESTORE Alarm
TCV - Two Call Vorlfication
01117123 16:22140
01117123 16128:59
01h712316t30152
01 117 123 16i31 101
01/17123 18:06;05
0'l/17123 18:0Bil9
01117123 'l8i06t19 Full Clear
0111 23'l9io2t45 OOCK TEMPERATURE
01117n319.02:47
01117123 191O4t30
011171231910436 Now prlorlty:101
lnstall Co First to Last
9111712318,06:01
v^4,
P.O. Box 8142
La Veme, CA 91750
Ligue # 92364GCA
l4 Hour Emergencl- Sen icc
Tel. (626) 602-6014
Offce (909) 392-0381
Fax (909) 392-0382
Iatlt'nry 25,2023
Lineage Logisflcs
3200 E. Washlngton
LosAngeles, CA
Attention: Saul
JC's Mechanical Inc. is pleased to provide the following investigation and proposal to r€move and replace Gforce processor on compressor C3 at Lineage Logistics,3200 E. Washington Blvd, -Los Angeles, CA .
Scooe Ofworh:
1. Will remove damage processor on comprcssor C3
2. Will install new Gforce processor on compressor C3
3. Start up Compressor C3 and check that all parameter rcading are correct
4. Will calibrate compressor motor amps and slide valve if needed.
5. Check all operations and make sure all is running to manufacture specs.
Total price including labor, equipmenl and tox $ 8,126.22 Please allow 10-12 weeks for delivery ol para
General Conditions:
Controctor ldtial. Cuslomer lniiials
L AII work is to be completed in a workmanlike rnanner and according to standard practices.
2. All agreements contingent upon strikes, accidents or delays beyond our control.
J. We have only included one (l) mobiliution any other mobilizatioos will be at an additional cost to customer.
4 All other wort not mentioned in this pmposal shall be excluded.
5. JC's Mechanical Inc based this pmposal on given requirements and specifications by Lineage Logistics and/or their representative(s).
6. If the City of Los AngeleVlos Angeles County Building/Health inspecto(s) requires us to upgrade any Utilitieystructural supports, such work shall alter the proposed price.
7. Any alterations, delays caused by others, acts of God, muddy, windy, or advene weather conditions, andlor deviations shall affect the quoted amount.
8. All material is guaranteed to be as specified. All work is to be completed in a workmanlike manner and according to standard practices.
9. Customer to have area ready before work is to commence and there will be a stand by time of $l10.00perhour per man if area is not rcady.
I0. Remove debris, clean off job site, and dispose of in customen trash bin.
All work to be completed during daytime regular working hours, any overtime would be an additional cost to the above quotation and addressed with an approved sigrred change order.
NOTE.'lhis proposal is based on general construction practices within the industry. JC's Mechanical Inc Reserves the right to modify this proposal upon the final engineering and approval by all Govemmental aqencies.
No provisions have been made to upgrade, remove, and/or relocate any and all utilities.
Any City-permits, utility and govemment agency fees shall be invoiced at cost plus 15% (contracton) markup.
Cancellation: In the event the purchaser cancels this order, seller may charge and purchaser agrees to pay a cancellation charge or either fifteen percent (15%) of the sales price or altematively, seller's accrued costs of the order plus forty percent (40%), whichever is sreatcr.
Seller's cancellation fee will in no way be construed or interpreted to be a penalty, and is established solely for the purpose of determining with reasonable certainty seller's out-of-pocket costs and expenses which would otherwise be difficult to determine.
Contrrctor I{itials --Eii6iiiiiliiis
Exclasions: Pemrits, fees, drawings, engineering, foaming machines, chiller machine, zurveying" Restroom and/or ADA improvements, plumbing/or water supply, painting, Rubber/PVC roofmg, or any other specialty rcofing, gutters, down spouts, mechanical, Title-24 documents, HVAC Work, Freon/Ammonia leak detection systern, electrical, controls or control wiring, telecommunication(s) or related wiring, alarm systems or wiring, structural supports, fire protection, seismic upgrades, disabled access upgndes, protection bollards, racks, doors, door bucks, windows, over deck insulation, floor inzulation, Batt insulation, wall or ceiling vapor barrier, concrete./asphalt work, demolition, dumpster or trash removal, travel, per diem, additional specialty insurances, aesthetic screening, landscaping, unforeseen conditions above or below floor, unforeseen conditions above or below rorof or ceiling and walls, removal or disposal of contaminated materials, utility consumption or intemrption during construction, soils test, soils report, performance or payment bond, prevailing wages, mad improvements, asbestos testing, asbestos abatement, concrete testing, deputy inspection fees. Any costs connected with handling or abatement of hazardous materials or contaminated earth or materials. ADA Documentation, Handicap Documentation, Restroom Documentation and or Design, Site Plan, Parking analysis and or design, Califomia Green Building Code Compliance Any cost due to unforeseen underground obstructions (i.e. utility lines, concrete mass over 8" thick. Obstructions in area of construction, any alterations, delays caused by others, acts of God, or muddy or advene weather conditions, adverse weather related costs, and/or any deviations from the original scope of work, and any other work not herein specified above shall affect the quoted amount.
Terms and Conditions: This proposal is subject to change and may be withdrawn if not accepted within (30) thirty days of the above date. Upon acceptance of the contract a deposit of 50%;o of the contract amount is required prior to commencement of the work. Schedule of payments to follow after contract is signed. Payment in full is due upon receipt of invoice. Any unpaid balance after 30 days will be charged a 5.5Yo late charge compounded per day. JC's Mechanical Inc reserves the right to collect attomey's fees and costs incurred related to payment of any moneys owed.
This proposal and contract accepted on the day of 2023
Accepted By
Lineage Logistcs @LEASE SIGN AND PRINT)
Submitted By:
JC's Mechanical lnc
C!"tr*to. tniri"ls Customer lnitials