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Home My WebLink About20161835.tiffDl Franklin D. Azar & Associates, P.C. 5536 Library Lane Colorado Springs, CO 80918 (719) 527-8000 Fax (719) 550-3926 www.fdazar.com June 8, 2016 VIA CERTIFIED MAIL/RETURN RECEIPT REQUESTED NOTICE OF CLAIM Notice is hereby given of the following claim: A. The name and address of the Claimant is: Derrick A. Polland 3755 Golden Eagle Dr. Dacono, CO 80514 B. The name and address of the Claimant's attorney is: Franklin D. Azar & Associates, P.C. 5536 Library Lane Colorado Springs, CO 80918 C. The basis of the claim is: RECEIVED JUN 09 2C3 WELD COUNTY COMMISSIONERS On May 10, 2016 at or around 3:35 p.m. Claimant was traveling Eastbound on Colorado State Highway 119 approaching the intersection with West County Road 7 in Weld County. At that time both lanes of Westbound Highway 119 were diverted into one of the Eastbound lanes of Highway 119 due to road work on Westbound Highway 119. Claimant had passed a Construction Zone postings but not yet reached the section of the road that was then changed to a one lane section for each direction of travel. Due to the construction and resulting congestion, Claimant was rear ended. The collision pushed Claimant's vehicle into the vehicle to his front and thus causing a second collision. The City of Firestone, the County of Weld and the State of Colorado created a dangerous condition that resulted in the above described collisions by failing to properly warn of the dangerous and atypical condition of that particular portion of roadway and Eramtukumfuniva) l.o-15-1lo e4„1-ite 2016-1835 DENVER, CO PUEBLO, CO TRINIDAD, CO also by substantially changing and restricting the normal pattern of traffic on the roadway. This failure to properly warn as well as the changing and restricting of the flow of traffic resulted in a dangerous condition that presented an unreasonable risk to the health or safety of the public. This dangerous condition physically interfered with the movement of traffic customarily used by motor vehicles on Highway 119 and similar sections roadways. Further, the existence of this dangerous condition was known to exist by the City of Firestone, State of Colorado and County of Weld, or should have been known to exist with the exercise of reasonable care. The dangerous condition of the roadway was proximately caused by the negligent act or omission of the City of Firestone, the County of Weld and the State of Colorado. Claimant sustained personal injuries and injuries to property as a direct result of the creation of the dangerous conditions as described above. D. The name of the public employee(s) involved is: Unknown E. Claimant has suffered injuries to his back, left leg and neck. F. The Claimant will seek damages to compensate him for the cost of medical treatment, prescriptions, and therapy for the severe pain and suffering resulting from the subject accident, loss of enjoyment of life, loss of earnings, and loss of property. G. The approximate amount of Claimant's injuries are anticipated to be in excess of $250,000.00. Dated this Sincerely, ay of June, 2016. FRANKLIN D. AZAR & ASSOCIATES, P.C. William 1GI Amato, #42665 Franklin D. Azar & Associates, P.C. 5536 Library Lane Colorado Springs, Colorado 80918 Phone: (719) 527-8000 ATTORNEYS FOR CLAIMANT CERTIFICATE OF MAILING I hereby certify that on the 8h day of June 2016, I deposited in the United States Mail, postage prepaid, certified mail/return receipt requested, a true and correct copy of the foregoing Notice of Claim to: Weld County Commissioners P.O. Box 758 Greeley, CO 80632 Shanelle"A. Arnold r DR 2447 (09/03/06) MAIL TO: STATE OF COLORADO COLORADO DEPARTMENT OF REVENUE MOTOR VEHICLE STATE OF COLORADO TRAFFIC ACCIDENT REPORT TRAFFIC RECORDS DENVER, CO 80261-0016❑ AMENDED/SUPPL. ❑ UNDER $1,000 El COUNTER REPORT 1:3 PRIVATE PROPERTY PAGE 1 of 3 PAGES COOT Code ■ INTERSTATE HWY HWY NUMBER1 1 9 DOR Code 1III1 05K 07K A01 © STATE HWY MILEPOINT I INN VIII IIIIIIIIIIII Case# III CITY ST/CNTY RD ❑ ❑ ID. • El 1603336 Date of Accident 5/10/2016 City Firestone Agency Firestone Police County Weld Count # 33 Time (24 Hr.) 1535 Officer Number 719 Officer Name T. Warren Signature Detail patrol L 03 Number Killed Number Injured Location Route, Street, Road Miles Feet N ■ S ■ © W ■ OF: L 03 B 07 0 0 Highway 119 © At: WCR 7 Date Report 5/10/2016 Latitude Longitude B 07 Agency Code Investigated Scene El Total Vehicles 3 District Number Public Property/ Employee El Photos Taken ID 27 Railroad Crossing Related El Const.Zone Related ID Highway Interchg. O Bridge Related O 01 M TraMc Unit# 03M B lnafncu## OVeh. ❑Parked ['Bicycle['Pedestrian❑NonVehicle ❑Non.Contacty zo ©Veh. ❑Parker! ❑Bicycle ❑Pedeselan ❑Non-Vebble ❑ Non -Contact veh. Last Name First MI Last Name First MI French Johnnie H Polland Derrick A Street Address 1600 Iron Horse Dr., #F102 Personal Phone (303) 332-4285 Street Address 3755 Golden Eagle Dr Personal Phone ( ) City Longmont State CO ZIP 80501 Bus. Phone ( ) city Dacono State CO ZIP 80514 Bus. Phone ( ) 35N Driver License Number 92-075-5784 CDL State CO Sex M DOB 7/30/1946 Driver License Number 92-183-8013 CDL State CO Si,x DOB 2/13/1959 35N Primary Violation w Primary Violation 03❑ DUI ❑ DUI IC Violation Code Citation Number Common Code Violation Code Citation Number Common Code P 35 Year 2008 Make Suzuki Model SX4 Body Type Hatchbaiy Year 2012 Make Chevrolet Model K3500 BodyT ►e 'RK 0 P License Plate Number State or Country Color License Plate Number State or Country Color D01 CO SIL L G O BLK Vehicle Identification Number Vehicle Identification Number JS2YB417285103344 1GC4K1C89CF171950 Vehicle Owner Last Name 0 Same First MI Vehicle Owner Last Name 0 Same First MI E 01 Address ID Same ... City State ZIP Address 0 Same City State ZIP Q 00 Towed Due to Damage 0 By: Elliott's Towing To: 5511 Colorado Blvd. Dacono, CO Towed Due to Damage Day: To: O 00 F 02 Trailer VIN# Trailer VIN# , , 2, I 1 I I 1 I 2' 1 I ,11 2 , 3 3 I I '' i- I i I' f i j i i r-- i i i i I I I I I I ----� IJ 2 ?-al-- I I I ---I j 1 1----1' 1 2 2 I I I _I I I --- U __ 1 -Slight r J -_. 1 -Slight ,-_ -- ___ -� --. 3 1 3 1 I 1 I ; ; 2- Moderate Undercarriage Undercarriage 3- Severe 2; I 1 I I I ; ;, Undercarriage __ Undercarriage 2- Moderate 3- Severe a _ 01 Insurance Company O None ❑ No Proof Exp. Date Insurance Company ❑ None O No Proof State Farm Exp. Date 7/5/2016 00R Esurance Insurance Company 7/23/2016 Policy Number PACO-001243572 Policy Number 228 2254 -A05 -06B 00 R H 01 Owner Damaged Prop. Last Name First MI Address City State ZIP Owner Damaged Prop. Last Name First MI Address Clly State ZIP 00 SAFETY SUSPECTED INJ. s T.U. POS. REST.ENDO MOP. AIR BAG EJECT ALCO DRUG SEV AGE SEX NAME /ADDRESS 01 01 00 00 B 101 I A 021 B 00 00 00 00 69 M Johnnie French 1600 Iron Horse Dr #F102 Longmont, CO s ■ 02 01 00 00 B1-011 A- 01TA 00 00 00 00 57 M Derrick Polland 3755 Golden Eagle Dr Dacono, CO 03 01 00 00 B 1011 A 01 A 00 00 00 00 54 M Michael Sargent 7470 Dakin St #1307 Denver, CO j I II I I I 00T I I I 00T ii I 'Approved By I.D. # I Date L GG GG GO L — Case # 1603336 DOR CODE Accident Date 5/10/2016 Agency Firestone Police Describe Accident Heavy traffic in EB Hwy 119 # lane approaching intersection with WCR 7. VEH1 strikes rear of VEH2 — and pushes VEH2 into VEH3. No injuries, but drivers of VEH1 & VEH2 transported for dizziness. _ i ____ _ Non -Injury Accident; f i ; i I I I DiagramNot L. ' , Required I I j -- I L i I 1 I I i I I ' i i I ' � i i i I i � I i. ! I i L j• } I ' t 1 ; i I I I I i ; i i Carrier Name US DOT a ICC D State DOT E H Address Carrier Identification # Carrier Name US DOT ICC State DOT m — Address Carrier Identification # 2 of 3 L. PAGES) HH HH KK _ NN J JJ ❑ AMENDED/SUPPL. 0 UNDER $1,000 0 COUNTER REPORT 0 PRIVATE PROPERTY DR 2447 (03/03/08) COLORADO DEPARTMENT OF REVENUE MAIL TO: STATE OF COLORADO MOTOR VEHICLE STATE OF COLORADO TRAFFIC ACCIDENT REPORT TRAFFIC RECORDS DENVER, CO 80261-0016 PAGE 3. OF PAGES 1 CDOT Code El INTERSTATE HWY HWY 1 NUMBER 1 9 DOR Code I IIIIIII IIIIII III IIIII IIIIIIIII II 07 K A01 Case# 1603336 0 CITY ST/CNTY RD El ❑ .1 ❑ Date of Accident 5/10/2016 City Firestone Agency Firestone Police County Weld Count 6 3 lime (24 Hr.) 1535 Officer Number 719 Officer Name T. Warren Signature Detail patrol 03 L Number Killed Number Injured Location Route, Street, Road Miles Feet N ❑ S ■ E © W ❑ OF: L B 07 0 0 Highway 119 © At: WCR 7 Date of Report 5/10/2016 Latitude Longitude B Agency Code Investigated @ Scene p Total Vehicles I District Number Public Employee Properly/ ❑ Photos Taken El 27 Railroad Crossing Related O Const. Zone Related ❑ Highway tnterchg. O Bridge Related O 03m Traffic 1 3 it E1 Veh. ['Parked ❑Bicycle ❑Pedestrian ❑ Non -Vehicle ❑Non-Contect Veh. z rak Unit*/eh. O Parked ❑Bicycle ['Pedestrian ❑ Non -Vehicle ❑Non contact Veh. e M Last Name Sargent First Michael MI J Last Name First MI Street Address 7470 Dakin St. #1307 Personal Phone (720) 723-0967 Street Address Personal Phone ( ) City Denver State -CO ZIP 80221 Bus. Phone ( ) City State ZIP Bus. Phone ( ) 35N Driver License Number 92-204-7010 CDL State CO Sex M DOB 2/23/1962 Driver Ucense Number CDL State Sex DOB N Primary Violation ❑ DUI Primary Violation ❑ DUI C 03 Moisten Code Citation Number Common Code Violation Code Citation Number Common Code P 0 Year 2000 Make Dodge Model RAM 1500 BodyTypa IRK Year Make Model Body Type p Ucense Plate Number 071QJT State or Count CO Color BLU License Plate Number State or Country Color 001 Vehicle Identification Number 3B7HF12Y6YG114764 Vehicle Identification Number Vehicle Owner Last Name x❑ Same First MI Vehicle Owner Last Name ❑ Same First MI E 01 Address 0 Same City State ZIP Address O Same City State ZIP 00Q 02 Towed Due to Damage I 1 By: Elliott's Towing To: 5511 Colorado Blvd. Dacono, CO Towed Due to Damage O By: To: Q Trailer VIN# Trailer VIN# 3 1 3 , , 2 , 1 , , , , , 1 , , 1 1 , ' 1 1 -- -"' fr _ 3_,rl-J i } ___-I I I I I i- l_ _J I j I--- 1 1 i I j I --- l� 1 [ r�� --=1 I I- 1 I I i__I 1--=1'u - I I I t 1 1 L� __ u 1 -Slight - ' - -Slight __ __ --- 3 ; 3 ; ; ; ; ; 2 Moderate Undercarriage Undercarriage 3- Severe ; ; ; ; , , 2- Moderate Undercarriage _ Undercarriage 3- Severe l� I01 __� Insurance Company ❑ None ❑ No Proof Insurance Exp. Date 9/29/2016 Insurance Company ❑ None O No Proof Exp. Date 0013Loya Policy Number 67 696649035 Policy Number R H 01 Owner Damaged Prop. Last Name First MI Address City State ZIP Owner Damaged Prop. Last Name First MI Address City State ZIP 00 T.U. SAFETY SUSPECTED INJ. AGE SEX NAME/ADDRESS s ■ # POS. REST-ENDO EOINP AIRBAG EECT�� DRUG SEV 01 01 00 00 B 1011 A 021 B 00 00 00 00 69 M Johnnie French 1600 Iron Horse Dr #F102 Longmont, CO s 02 01 00 00 B 101 I A 01 1 A 00 00 00 00 57 M Derrick Polland 3755 Golden Eagle Dr Dacono, CO ■ 03 01 00 00 B 011 A 01 A 00 00 00 00 54 M Michael Sargent 7470 Dakin St #1307 Denver, CO ' I I f I 00 T I- T 1IH Approved By I.D. # Date L I PAGE L OF L PAGES AA Case # DOR CODE Accident Date Agency 1603336 5/10/2016 Firestone Police HHj Describe Accident 1 AA Heavy traffic in EB Hwy 119 # lane approaching intersection with WCR 7. VEH1 VEH2 strikes rear of NH and pushes VEH2 into VEH3. No injuries, but drivers of VEH1 & VEH2 transported for dizziness. BB - — - - BB ,u CC - - -- - al cc I. IUD I I j : I NIn ob-jury Accident; Diagram,Not .I Required I KK I DD I I E- .: L_ LL I - , -- — I I i I I I EE j — !- --- LL i I j I � I FF I i I MM I — -- _.. ! FF I I MM L i i I I I H I I _L- _ I - --- - 1 -� ` GG I NN GG Carrier Name US DOT O ICC I State DOT NN III Address GG Carrier Identification # I—: NN Carrier Name GG US DOT ICC • State DOT In NN Address Carrier Identification # Hello