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Home My WebLink About970616.tiff NOTICE OF CLAIM C:((: COLORADO GOVERNMENTAL IMMIIITITY ACT U -• 524-10-109, C.R.B. (a) The name and address of the claimant(s) and the name and address of his attorney, if any: (1) Poudre Valley Rural Electric Association, Inc. 7649 REA Parkway P. 0. Box 272550 Fort Collins, CO 80527-2550 (970) 226-1236 (800) 432-0123 FAX (970) 226-2123 (2) Randolph W. Starr, P.C. 150 E. 29th Street, Suite 285 P. O. Box 642 Loveland, CO 80539-0642 (970) 667-1029 FAX (970) 669-3841 (b) A concise statement of the factual basis of the claim, including the date, time, place and circumstances of the act, omission, or event complained of: (1) On December 10, 1996, near 25565 Weld County Road 47, Weld County, Colorado, in the vicinity of Kersey, Colorado, unknown employess of the Weld County Road and Bridge Department operated a vehicle that struck an electric power line of the claimant, Poudre Valey Rural Electric Association, Inc. , causing the line to break and require repair and replacement of the damaged electric facilities. (c) The name and address of any public employee involved, if known: (1) Weld County Road and Bridge Department. (2) names of other employees involved unknown. (d) A concise statement of the nature and the extent of the injury claimed to have been suffered: (1) damaged electric power line and appurtenances. (2) cost of repair and replacement of electric facilities (see copy of attached invoice) . (e) A statement of the amount of monetary damages that is being requested: (1) $124.21 (see copy of attached invoice) . (2) Attorney Fees and costs (unknown at this time) . DA 19— (,i� • > 970616 Dated March 5, 1997. POUDRE VALLEY RURAL ELECTRIC ASSOCIATION, INC. !1 'By:\ Randolph W. tarr, W. #3183 Attorney for Claimant 150 East 29th St. , Suite 285 P. O. Box 642 Loveland, CO 80539-0642 (970) 667-1029 FAX (970) 669-3841 pRRTTFTOAPR OF MATTJNf I do hereby certify that I have placed one true and correct copy of the foregoing document titled "Notice of Claim, Colorado Governmental Immunity Act, 524-10-109, C.R.S." with attachments in the United States mail, registered mail postage paid and addressed, and I als hand delivered a true and correct copy to the following on this V' day of March, 1997: Board of County Commissioners 915 10th Avenue Greeley, CO 80631 with an additional copy to: County Technical Services 1177 Grant Street Denver, CO 80203 Dennis Wacker Poudre Valley Rural Electric Association, Inc. P. O. Box 272550 Fort Collins, CO 80527-2550 Weld County Attorney 915 10th Avenue Greeley, CO 80631 c:\office\pvrea\claim.cou March 5, 1997 €B-21-97 FRI 10; 19 AN POUDRE VALLEY REA FAX NO. 970 226 2123 P. 11 �.. — _. _- ;-17 - �� County Technical Jervices, Inc_ tmcrantStreet.• Denver,Cobrado80203 February:20, 1997 Dennis Wacker Paudre Valley R.E.A. . P.O. Box 272550 Ft. Collins, CO 80527-2550 Our File Number : 96 WEL 066 CAPP Member : WeId County Loss Date . : 12/10/96 . . . Complainant. .._ PaudreAFaliey l�EA : : . .. Dear Mr. Wacker: . • We administer the loss function for Colorado Counties Casualty, and Property Pool (CAPP)of which the above captioned County is a participating member. This letter is being provided you on the basis that it is not to be construed as a waiver of any provisions of the Colorado Governmental Immunity Act, nor as a recognition that the notice provisions of that Act have been met.. Based on information available, on December 10, 1996, a Weld County John Deer 590 Trackhoe snagged and tore down a service line- The above County member would be accorded governmental immunity against:losses occurring from the operation of this type of equipment. , . . It is unfortunate. there is no basis by which we can pay.your loss___.... .. If you have any questions or wish to dice us this matter further, please call me. Ver tJ yam, ✓'illtam . Representatry lairs enclosure . cc Michelle Rainier, Weld County `.. . _ Adnwumaaon R toss P�ewM;on . . - . elai�ruteawite2 areepert _ . 303 861'0507 303�863�SO5;118C0.544.7868 . FEB-21-97 FRI 10: 15 AN POUDRE VALLEY REA FAX NO. 970 226 2123 P. 02 Poudre N R 1i POUDRE VALLEY RURAL E ELECTRIC ASSOCIATION , INC . Valley Ai 7649 REA PARKWAY • P.O.BOX 272550 FORT COLLINS • (970)226-1234 FORT COWNS,COLORADO 80527-2550 FAX NO. - (970) 226-2123 1-800-432-1012 3GN.0 •A Nt) iyQ 31 1101 January 24, 1997 Weld County Road & Bridge Department P. O. Box 758 Greeley, CO 80632 RE: DECEMBER 10, 1996 BOOM BACKHOE ACCIDENT Enclosed please find the bill concerning the above- mentioned incident which occurred when Poudre Valley 's overhead distribution facilities were damaged while you were operating at 25565 Weld County Road 47 west of Kersey, Colorado. The accident resulted in minor damages to our facilities . Please remit S124 . 21 payment in full, to my attention in the enclosed, self-addressed envelope . I need to receive your payment by February 24, 1997 . You should contact your insurance agent for possible coverage. If you have any questions feel free to contact me . DENN S WACKER - REPRESENTATIVE, EMPLOYEE/MEMBER SERVICES Enclosures • AN EQUAL OPPORTUNITY EMPLOYER • • • • • P T N .00 O .O -I Q CD .--I.O 1 eV S. ill en Y1 -4 7 Q 'C y LtO 0 2 to V U Ili 20 a o -I o¢ X }- a r1 ~ ar d e ue. U y z 0 o z oc- r p .T Z in1.0 N Z F a .. 0 N coI- N N W _ N f1 C 3tn `ow ' -1 a in w Q on CCN$ oo F1.1 . . • U > Nacw ¢ 2c 3 m ¢ U u2oo $ a 0 Z G ¢ mo . g b 0t� °- c J t U. a u J W UN o. yW W 0 d a .)\ ' s �`�is O Q .L O0 C.) 03 oCC m e Nbe en > i ri r a °° 7¢ 3 u\ co j o.�c o Q L n U ¢ 14 11 A LLI C W M 1,1 d X W 1D 1-1 m 1it'll _ .-1 r F1 v W ei a O Y O 7- = L3 °' ' .__I 0� v nt a a 6 • w.wrr r+.NVO/MAW° • r` . r'. £0 'd said 9ZZ 0L6 '0N Xdd 638 A311UA 38000d WV 91:01 I8d L6-18-93d FEB-21-97 FRI 10: 16 All POUDRE VALLEY REA FAX NO. 970 226 2123 P. 04 • POUDRE VALLEY REA 10/25/94 PROPERTY DAB= REPORT TOR» DtiE47-/O•9G TEE OF DAZ GE, //-'SD ?M TINE CALLS ZITO OEITCF, //.'3p @at, 7E0 C.�*.Le.D LY 1112Q.GE Mena-kIt/d to toad PERSON SPQR=r TO 'ZoivN s4 ?_n RESBONSZ3LE _CR DAMAGE ,n/r/J l .c!/QCZ - - 'zr 4" ALDIES S ?_Csz # NEC TOOL, IMPLEMENT, EQUIPMENT AND/OR ACTION CASED TEE D:-ya izes-yr— WEATTYR COYDITIONS Zr gEEICLE T2WCLVt: DRIVERS LIC $ Kat_^_,= SEX At_0 LIC i MAR M4.T= MODEL CRNER'S NAME & ADDRESS _ LAW ENFORCEMENT RESPONDING ✓ JCS BEING PE_SOE'C' WEEK DAM= as DONE C/e'a.nei Gri��c ?`SON IN CMIGE Wh.'_RE WAS 2E SCN IN CEASGEE WED DA?i'GE CC_ORRED W_TNESS'S JOB TITLE AmiurT wrisa2 LINE LOCATION GRID • ADDRESS W?? WAS DANAQ-D 3 EXTENT OF DAMAGE I I. UTILITY, WAS D:ZZTY LOCATE, YES, O DEPTH. OF UTILITY MIME OF OWNER(S) t GED ADDRWS EEC2G- NEAT STEPS WERE Tr_.i TO REPAIR DAMAGE lQd It pia Nu EC -cy --)se fM dawn C'kvn;M di.44Lfl DID raga RE2MR „vCC NO Is was, =aTALS US'zD ILSOd 2 6A <Me: (M hay Lagboe tag' to mes • - TL*a. R°an rnMPLE= • SIGEITOanr or PERSCS cc ,'FORM DA= /2- - lA SUP AVI_SOR'S SIGN;,.VM Li% DA / '�'/ �� 2 StManISOR'S COiesit5 Era COWIN S to f/`Mt•Spa v=C:'s WDE CUSS TO SAS OSt 3C Or S n MOAN • - . • 0 0 W W h` o 0o .NI c x r V .� D0 m b 13:1 IND- M i \ N Z 2 ....4t3 i ,........vk 1 1 itn t.: o c a 7 ¢ COr"- . z f 0 1 M W COII N C O W N ��} o t c 8 i 'lam_ 0 0 W 1 W I W .1a !1!W `•g S Vsj II�IIj 0 J ¢ V ` zits W v, W F �O "O Q Lsi enW _• I l 4 �•r 0 W W v ar.W \ dl ,,4 O .. ads 0 O In i W W c9 4 to� MM� , ` rn orr, � o 111 V O • Z v W tnl < CC �y 2 C ccv\ .a. O \ =1` en O YEtas U p \ �V Q O ` W { VV - C .1 � .y[y L�^j�J� { N 1 x Y vim, V < C� i WNW = a 0 /`y o—z C a .3 C V. �_ • .Zr WCCca�_02 .. .. • . SO id EZIZ 933 0L6 'ON Rd V3N A311VA 3N011Od WV 91:01 I8d L6-1?-83.d • FEB-21-97 FRI 10:17 AM POUDRE VALLEY REA FAX NO. 970 226 2123 P. 06 ? .11 ;:t ° 6 3o9- 7S? Grev_My et-, ?e6.32_ l -a1 �v-� f��-� d 0-r-tzt-t zsrc. c 11w(4'C _7r ,ths51y 61,1 zz -/o- & . (5 e5. 21) Fi /-AAA Liu. 0 427 Z86Se Z3•&7 • / .,. 0:4 -8/ 26 b'/ ti 2S !o'o /off /4z2 43 cz.O ti it s ill/tact-elf • Saa . ? !y, 1A4. • 14 . '} 5/b i1 • s't I! 7r4L /ati a 1 FEB-21-97 FRI 10:17 AM POUDRE VALLEY REA FAX NO. 970 226 2123 P. 07 FOOD-RE VALLEY REA TICKET NUMB EF 5M 5/94 `. MATERIAL TICKET' Na 4t c GISSUE RETURN 0 RETIREMENT 0 RECEIVING-P.O. DATE 101/210.9-6 DESCRIPTION k/CAy7 LOCATION INVENTORY LEDGER ACCOUNT NO.k WORK ORDER NO. .V3 od OMNIITY ITER CODE DESCRIPTION G/f ,va20 JtetvC 7_ 3 f66 al- .39 :Cap S./6 • • TRUCK A 3 ET at," 1 FEB-21-97 FRI 10; 18 AN POUDRE VALLEY REA FAX NO. 970 226 2123 P. 08 4 ,!—j County Technical Services. Inc ___ 1177Grant Street , Denver•Colorado 80203 February 7, 1997 Poudre Valley REA, Inc. P.O. Box 272550 Ft. Collins, CO 80527-2250 • Au: Dednis Wacker, Our File Number : 96•WEI_066 CAPP Membex : Weld Cotmiy Loss Date : 12/10/96 Complainant : Poudre Valley REA, Inc. Dear Mr. Wacker: We administer the loss function for Colorado Counties.Casualty and Property Pool(CAPP) of which the above captioned County is a participating member. This Ietterr is being provided you on the basis that it is not to be construed as a waiver of any provisions of the Colorado Governmental Immunity Act, nor as a recognition that the notice provisions of that Act have been met. Please complete and return the enclosed report form regarding,the above referenced accident A return envelope is provided for your convenience m this regard. Also, please yrovide us with two estimates of cost of repairs relating to the above captioned loss ':date. 4 Thank you for your anticipated cooperation and, upon receipt of the completed report form, we shall give our further consideration to your loss. . Thank.you,. C�l�j Wrlliam Fritz. . Representative-Claims enclosure . cc: :' Michelle Rainier, Weld County . ,. .: ..Adnunistration&[mSRfltfliCn .'. ebims(Cawetty&Prope.ty) . . -.'.. .. 303'.861'C 7 - : .3(13•863.•1505 • 1sa00•SA4,.7868.: ' ' :raz 303 861 2832. .. . :FCX 303 861'1022.. FEB-21-97 FRI 10: 18 AM POUDRE VALLEY REA FAX NO. 970 226 2123 P 09 STATEMENT OF CLAIM Claim No �L?.. ........_��E FOR INJURY TO PERSON OR DAMAGE TO PROPERTY (NOT ARISING OUT OF THE USE OF AUTOMOBILES) My Claim is against• Sa,.Ll�_ Y.ti.7�L l�o�ap:-=g;vD.....,t ., - ...» —�sAR. _T!+ SlT�. .. ...... �s..t rota u.t .esifffi NAME AND ADDRESS OF CLAIMANT Name . .JRr.SA.._YA.l•3?1t% QE. W AC. ge..._.. .._».Harried:.....-_........».Single.__...... Street ?.o. Tflxa7.a.SSo City.....FT• at (itss C:O {� A,,, G , cifLl. ........__.Phone._9710 - ZZfq-1a5:q. ,,, State............ ----OccvDation..... .�1.»R...ti.....� .».......... ......__..»» Do you have any insurance which would pay any part of this If 'Yes', list kind of insurance and name of company ............_.._................................ .. . TIME AND PLACE OF ACCIDENT Date of accident..._-__. 12/ I o(4Sp Time II ;2o AM Place Z55 Sa.S we ) Ce, 41 cWeasT o) „ttttT •se .ueecl oit ttua etf c...T.e I City hula .. State.._.-GO • THE ACCIDENT Describe carefully and in detail the manner in which the accident occurred. _......»»______»_-._..••_••••_.—••••-•••-••--- k1 11/4-is Ci—e a.lo %14•1 _tithe COuru'T..c ....._.... r.»_»..... Skate what defect, if any, In premises or machinery contributed to accident__ • WITNESSES NAME ADDRESS tTNy,.lsl Q a 4' 6Mt>rL.A.......w...t rs4 ' S - ) �sz.a27 ..1 !.[L r�--./.M...t`_►k FEB-21-97 FRI 10: 19 fill POUDRE VALLEY REA FAX NO. 970 226 2123 P. 10 COI". LEIF IF CLAIM INVOLVES IN, .Y TO PERSON . • Nature and extent of injuries — 4 If injured is a minor, give names and address of parents ------ ......-..... ..... was injured hospitalized/ Length of time. Name and address of Hospital.................. .................................... ........ ...... .......... ........ • Name and address of Doctor where is injured now? ly recovered7.----=:_....... was injured person employed at time of accident? If 'Yes°, state Fully work injured performing at time of accident Name and address of enip toyer . • How long In his employ? - IF INJURY OCCURRED IN RESIDENCE OR ON PREMISES OCCUPIED BY PERSON AGAINST WHOM CLAIM IS BEING MADE, ANSWER THE FOLLOWING: I. Was injured person REGULARLY residing on same premises? 2. Was injured person REGULARLY residing in same residence? 3. What is the relationship, if any, between injured person and person against whom claim is made? COMPLETE IF CLAIM INVOLVES DAMAGE TO PROPERTY Are you sole owner of .....If `No', give names and address of all co-owner Describe property and damage...—.6.17SPA.Sts..... Fix-c-‘1.5.--r ss cni .11/4 -freen tt.t..C. cis tiu Estimated amount of claim or loss...1.1221.1-a/.....-..-...Estimated value of ...... ............. Now was amount of loss determined? alik.A.:Ca.fiZa * w • ATTACH COPIES OF ESTIMATES OF REPAIR, REPLACEMENT OR OTHER VERIFICATION. I have read the above Statement of Claim, and the answers to each Question and the statements herein are try, and correct to the best of my knowledge. • SIGN WITH IRK OH LINE BELOW ciDa. . . Date of this Statement .. 1.12s/O_CIA-VA-u-t04:--"N Signature of Claimant (or f Parent or Guardian if Claimant is a Minor) • Hello