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Home My WebLink AboutAssignment of Claim/Incident - OT General - 11/27/2006 (11/27/2006) lone Siegler- Itr 112706 clmt.doc Page 1 November 27, 2006 John Straatman PO Box 68 Lilliwaup, WA 98555-0068 RE: Our Insured: Mason County Date of Incident: 11/06/06 Our File Number: MCO0616 Dear Mr. Straatman: Please be advised that I am acting as adjuster on behalf of Mason County with regard to damages sustained to Building 3 on November 6,2006. Please find the enclosed estimate and glass replacement invoice supporting Mason County's claim of$587.35. If you are with benefit of insurance coverage for these reported damages, please turn this matter over to your carrier for consideration. I respectfully request reimbursement of$587.35 payable to Mason County. Please forward that payment to my attention in care of Premier Property Adjusters at 1910 Fourth Avenue East,PMB 113, Olympia, Washington 98506. Thank you for your attention to this matter. Please do not hesitate to contact me at(360)280- 3850 if you have any questions. Respectfully, Lyle Unwin Premier Property Adjusters LU:hs Enclosures (11/27/2006) lone Siegler-Itr 112706 clmt.doc Page 2 CC: Ione Siegler—Mason County Us Glass Company invoice 1714 Olympic I3'ighway North # Shelton, WA 98584-3054 Cate Invoice 11/6/2006 Bill To Ship To MASON COUNTY 426 W CEDAR AT TN:MRr,RUTTJ?R SIIELTON,WA.98584 P.O. Number Terms Rep Ship Via F.0.8. Project 11/&2006 Quantity Item Cade Description Price Each Amount 1 ReW 34 319 x 68 ]"OA 3/168116 CLEAR TtWERFD 390.00 390.00T 1 Retail LABOR 90.00 190.00T Sales Tax 8.30% 39.84 Total 8519.FA i r Premier Premier Property Adjusters, Inc. Proper Adjusters 1910 E 41h Ave,PMB 113 Olympia,WA 98506 Insured: Mason County Building#3 Business: (Building#3) Shelton,WA 98584 Estimator: Lyle Unwin Business: (360)280-3840 Business: PMB# 113 1910 41h Ave.E. Olympia,WA 98506 Claim Number Policy Number Type of Loss Deductible ????????? BLANKET Vandalism $0.00 Dates: Date of Loss: 11/06/2006 Date Received: 11/06/2006 Date Inspected: 11/08/2006 Date Entered: 11/12/2006 Price List: WAOL4S6D Restoration/Service/Remodel Estimate: BUILDING3 Premier Premier Property Adjusters, Inc. P,r 1910 E 4th Ave,PMB 113 Olympia,WA 98506 BUILDING3 Room: Entry/Foyer i N-- flm.l�yl. PmnMW DESCRIPTION QNTY REMOVE REPLACE TOTAL Door repair-(per EJ's Glass bid) 1.00 EA 0.00 480.00 480.00 General Demolition-per hour-County 2.00 HR 31.17 0.00 62.34 employee Additional labor to clean up glass and secure door for safe entry. Room Totals: Entry/Foyer 542.34 Line Item Totals:BUILDING3 542.34 Grand Total Areas: 0.00 SF Walls 0.00 SF Ceiling 0.00 SF Walls and Ceiling 0.00 SF Floor 0.00 SY Flooring 0.00 LF Floor Perimeter 0.00 SF Long Wall 0.00 SF Short Wall 0.00 LF Ceil.Perimeter 0.00 Floor Area 0.00 Total Area 0.00 Interior Wall Area 0.00 Exterior Wall Area 0.00 Exterior Perimeter of Walls 0.00 Surface Area 0.00 Number of Squares 0.00 Total Perimeter Length 0.00 Total Ridge Length 0.00 Total Hip Length BUILDING3 11/12/2006 Page: 2 I t Premier Premier Property Adjusters,Inc. Proper Adjusters 1910 E 4th Ave,PMB 113 Olympia,WA 98506 Summary for Vandalism Line Item Total 542.34 Sales Tax @ 8.300% x 542.34 45.01 Replacement Cost Value 587.35 Net Claim 587.35 Lyle Unwin BUILDING3 11/12/2006 Page: 3 Confidential—Attorney/Client Privileged ASSIGNMENT OF CLAIM/INCIDENT TO: Lyle Unwin,Premier Property Adjusters FAX NO: 360-252-6392 FROM: Ione Siegler,Risk Manager,427-9670 Ext.423 DATE: 11/6/06 INSURED: Mason County CLMT: John Straatman MASON COUNTY CLAIM NO. (No claim number) DATE OF LOSS: 11/6/06 No.Pages: 2(with this assignment) COMMENTS: Mr. Straatman,while conducting business with the Permit Assistance Center in Mason County Bldg.III, became very irate,slammed the door,and broke the glass in the door. The Permit Assistance Center has had prior problems with Mr. Straatman,and it is my understanding that a restraining order will be taken out to restrict Mr. Straatman's presence in county buildings. The City of Shelton Police Department was contacted and Patrol Officer C. Kostad responded(Case#06- 10835). Please investigate this incident and estimate the damages caused by Mr. Straatman's actions. We will want to collect for the damages from Mr. Straatman,but,at this time,I'm unsure whether or not it will be through normal collection activity or filing for restitution through the court system. Your contact person will be Mike Rutter,Facilities&Grounds Mgr.Mike can be reached by calling 360- 791-0996. Thanks. C: Mike Rutter,Emmett Dobey,Barbara Robinson,Monty Cobb,file PS I've attached information from Mike Rutter. a a i `B�v7d1w�Aw�e►.G�uvwlry C. Kostad . Police Qep ment Patrol Officer 525:W.sofa n St PO RoX'1610' . Shelton,WA 98584 tt (360)426-4441 I FAX(380)426-9..71 Fad vti� Oc> MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT SIGN IN SHEET DATE: bo — DEPARTMENT NVIRON. BUILDING PLANNING NA ME REASON FOR VISIT HEALTH00 \ 1.1 ( I YL L)<z 17 r et&� a-ALI to_ op 00, L cam..✓e.: !`rG�" ��"�' • ,� e 5cr Mason County Sheriff's Department Shelton, WA 98584 STATE OF WASHINGTON I COUNTY OF MASON Statement of � j.� _ beingfirst duly Y sworn on oath de oses and says. My name is 'S I am _YA _years of age and was born on at at I ancZrri ingle and reside at phone . I am employed by since This statement taken by ,— l at hours on �� "dl�p ,at RLb f iM � I certify under penalty of Perjury, under the laws of the State of Washington that Witness the foregoing statement is true and correct to the best of my knowledge Dated: At Maso 4( i' nt , WA Witness ) �� McsiPa Dales, �f-J mac 1 �I , Signed: u Mason County Sheriff's Department Shelton, WA 98584 Page __ of _ Statement of _ _F1*j4��t L�rrt . c b Aim, G��. L.�i u._. r4m 4ti'n-- J;2b tA-),i-( try Jail- �rt 1� 'f'�L_L_ Y7R� LJI44V Jvv t� a* ns mf*iz - I certify under penalty of Perjury, under the laws of the State of Washington that Witness the foregoing statement is true and correct to the best of my knowledge Dated: At Mason County, WA Witness Signed- •? Mcsm,(0+183) g Mason County Sheriff's Department L`Iae Shelton, WA 98584 1 STATE OF WASHINGTON 1 1 COUNTY OF MASON 1 Statement of�h 11 rt 1 4 being first duly sworn on oath deposes and says:: �ArAb My name is_ d I I I 1 U I am— 50 years of age and was born on 1 — , at I a married single and reside at �D In/ Ce � cy4 (/ L12�-f'(o7O Xn�- CQ I l4 I phone . I am employed by ��_SO ✓�� ,1�1`VI since t1, )Q� This statement taken by C at ) f11V, hours on NoJ-e M 6—,—'Z,V( 1 acoun a :00 Man4�►. �'1ou. (/ QY�v r� ►`an a � Q c�u+� y �� c;ry She�( Z7m s UA s � � c�h n S`�'af�"mun _ .� ►� �a.Y� 1'Vlr� �S--ta��an ass k X ll► 1� Ohl- d a�_ (I va-Q - bo Y a f__Oufvu-,� i rol� Adr)S, dr,) ovet� a a d i it boul ffl=n Cma4q no � _ u)h- Xm J was �-�- Was o wl �d araur� -fz :ffip cn.tn4 g s aa' I certify under penalty of Perjury, under the laws of the State of Washington that Witness the foregoing statement is true and correct to h best of my knowledge Dated: v oAt Mason ounty, WA Witness jv MCS/P4(04/83) Signed: lJ Mason County Sheriff's Department Shelton, WA 98584 Page of Statement of << ate, J: C&r1 - ce rn 2 rr,bA=r h►5 Var f ul()✓ds d A his A +1 K N-d 'JN,4,-a r) na d t:2JY-A I rRVAIdoor -'sk n I �Jp ull I shtlkz i-n a T 121 J O 1 � Aial-n t-tl�n I-►'1 S �1' YY� t Q--./ � a i \IJ Z horn, h�� nt��- c)(Th � 4�11 09f IWAt b& n h�V �s a/hLo LO; h; rf) as ca l ShAkl LOOUJ hA 4\3 dV JW_ G 1 nC� r�C� S np C&Irnt�AA OU)n hi kwq -4-'0 Ky-rVA 0 V-e ct 4;�'n 4u lAbi M�A kl� 4+�IA a , I �S&nt�man wy 11 k,n a Lv 6 wr. 6 4,cL — a�1 `kha r�T I -ens IoLr e_ I certify under penalty of Perjury, under the laws of the State of Washington that Witness the foregoing statement is true and correct to the best of my knowledge Dated: 11010 At Mason County,WA Witness Signed: jJ 4W�` (j— .(0us3) Mason County Sheriff's Department Shelton, WA 98584 STATE OF WASHINGTON ) COUNTY OF MASON ) Statement of being first duly sworn on oath deposes and says: j� My name is r Y �-- s 1.l Y n i 5 o h I am _ 69 years of age and was born on tf at I am married single nd reside at woa-e phone 3� 7—��`�� I am employed by 01-7 �l _— , since This statement taken by at hours on at Af W/ I I certify under penalty of Perjury, under the laws of the State of Washington that Witness the foregoing statement is true and correct to the best of my knowledge Dated://-G G At Mason County, WA Witness MCS/P4(04/83) Signed: Mason County Sheriff's Department Shelton, WA 98584 Page of Statement of / S �u1�/'� e, Adz z zzuv zel X�11 L I certify under penalty of Perjury, under the laws of the State of Washington that Witness the foregoing statement is true and correct to the best of my knowledge Dated:/!G At Mason County, WA Witness Signed: Mason County Sheriff's Department l� Shelton, WA 98584 STATE OF WASHINGTON I COUNTY OF MASON I Statement of being first duly sworn on oath deposes and says: My name is Al (2 HR,,S&WS&A J I am years of age and was born on //,g/67 at �i�Y dh d 4V,,V-- I am arrie / single and reside at /405 RC-11&V1e4,f &&E b'C2DcFA) W,f 4.q S 2-0 phone eu o) 53 51 8 3 Z I am employed by /YJ�}SDiI C�CJry," since This statement taken by at hours on at -Z- ivAs ewlle `fD Jcron7l Cy �rke c4d 8:'367-AM -ro // 1,e 2 AA V A M OU,) 77, -/- W 4 5 r u 5--r a- 4-r-d RV w/�� ►� Foe �� / M4M& To BE e4f/EO Fo- ,e /yE�f' z<J Leh he Gr/A s Asked h c cA v !3c he%eFa 17V <C<'rn , AT" �-ti ,-s ,mac 1jE w4l'k-ed' VZ 44-1Q SOX F A, P-0 l Tk \,/e 1Zu Lq`y o 'To v- w, r►•."" 1.0o krd /n Sell' ,:�-teom aJAe-,e n * -7?3 - h a C'o U y74,e w` 4N o y+S ke u 4,* 7o Ua le e � ,vo w4A e 4 ti zt h e 6 I certify under penalty of Perjury, under Qi the laws of the State of Washington that Witnlx/�, the foregoing statement is true and correct to the best of my knowledge Dated: At Mason County,WA Witness MCS/P4(04/83) Signed: -* Mason County Sheriff's Department Shelton, WA 98584 Page Z of 2— Statement of _ be i h 9 /c�S�ue,�•8i'b l e )on- (Jp rL y 400.p , Ae (241 v)n d poi A P 1-io 4- ��11 , Se WC CAA RE P � V.EO pr2o f=A !J' e I°r _7-74ern_S A /4 5; b e am-S V�//•'�� 7`/*-/- I bee-44,5,e /'::--ed A;,W7 (Alo /, f10c2 S y4 R-y 1-40,0 7e#5 6r a"OFA-�v�'�� ro Z C-Ave cu, Ile <f fie. '!� / Wit' 4-Le 45d odL- a�� 9lASS oL4- /'V// y U fad d dleeI 2. 14Av0 1- 4ap_k 1elIV tj&g-/- 7-Z) He Aar 7'a L' i54vc k- f4- -fA I`5 `Ti w► h Ge/ 5 rd w i ng i S 1�eS l� s* 0 -r4 Cdjem �l Gv,� 5 bo •e l w n� ►�, �i ��s 3 d' K (« �E 11 e d e o No '-7 Leo/e, OA-) ,A-N o pr eked de a �T74-cwv --I446,-4- h-e h,u c,+ h okv-e eza P PieJ A0o cJeit4- 'tO A "s CA-0— I certify under penalty of Perjury, under the laws of the State of Washington that Witness the foregoing statement is true and correct to the best of my knowledge Dated: At Mason County,WA Witness Signed:(W83) iviabon %,,uunty 3nerut s lie artment Shelton, WA 98584 V� STATE SHINGTON ► I COUNTY OF MASON ► Statement of _ being first duly sworn on oath deposes and says: My name is�,A `I �}y I am y Years of age and was born on 10 ZS L at -r&60waL we,C11 r, I am a rie /single and reside at 9 7 X6 Phone I am employed by `Vl 4 50" 60r~N 4 l/ �G 0 since 7�� This statement taken by at hours on at R:od AM I/V101(" �7T�'�� 0 my ACV— , LT h,eu1-1� Q Cus�y Cc� coN*�'�� cry IJar� �s J t'kr fo go 7`0 (4ll�tG✓L 1� Qerw►�� *Clk �n►f►�c,G�lG� !�� Gs1L,'nr� 1 qv td (),-ems dF (0"v)tC2 SGw A 4120 �,Ovrel", US7o1--cre-- le'd l:°Q� ��.'I�1'� 01L4 t,�1lr-- (I ems. TlAt- GttisZyMe✓ -�1 Wus T✓y,.�y �y col I�rf s a►��i'. S VW(4 Cod 44't7�_-Wj, Spa� � musk bar 14 q o I certify under penalty of Perjury, under the laws of the State of Washington that Witness the foregoing statement is true and correct to the best of my knowledge Dated: At Mason County, WA Witness MCSIP4(04�83) Signed: Mason County Sheriff's Department Shelton, WA 98584 Page of Statement of i n-f c) �/l i S tar. �l�°yi Lu wC� 7`o I�d w we Q n J kx, K"Y�t C LI s-ty A-Y—r2 IN - �Qc �� 7� �� e� O� p��►cps (r�ti..e,vt f}l D �i 72D ' G(lam �Q �'✓l . pct,il� �' ` 1 ✓l tl wr►^y 4S � Sl�'UGa It- - I certify under penalty of Periury, under the laws of the State of Washington that Witness the foregoing statement is true and correct to the best of my knowledge Dated: At Mason County, WA Witness MOSM4(ous3) Signed: Mason County Sheriff's Department b(r- 17, 7 Shelton, WA 98584 STATE OF WASHINGTON 1 i COUNTY OF MASON Statement of 1 , ! l rkAi jj� � �. being first duly sworn on oath deposes and says: My name is rq l '.--��d: J �s I am years of age and was born on �—n TL , at Vag C �✓'�✓� 1J�.7�F I am married/ single and reside at Cl:�)CQ LC ) ftCLeA V IVA phone Qt:)D =R�O��> I am employed by U)Url;� since This statement taken by at a hours on L\ ] l� . C at tkli— gtcpyn C.% U-)e V4 �ir'• V l_ LsLc � w =bcx V - -,L U0 ��nU) �30\x n,% 4-vbyu CL CL 0A -t -\ C- Lkca ) J I certify under penalty of Perjury, under the laws of the State of Washington that Witness the foregoing statement is true and correct to the best of my knowledge Dated: At Mason County, WA Witness MCS/P4(04/83) Signed: r Mason County Sheriff's Department Shelton, WA 98584 Page of Statement of _ ,/" ry-Z qnU-0— Oss I certify under penalty of Perjury, under the laws of the State of Washington that Witness the foregoing statement is true and correct to the best of my knowledge Dated: At Mason County, WA Witness Q;Cv„,.A. Mason County Sheriff's Department Shelton, WA 98584 STATE OF WASHINGTON I COUNTY OF MASON Statement of being first duly sworn on oath deposes and says: ,C �k My name is �> I am �. years of age and was born on sill ' at I am arrie / single and reside at Aphone �� '` X (I am employed by , ! l(L-- J ` since ( aws This statement taken by at hours on n at L�t °NJAlit WAAMAM-q- P-m-na WN k ( JAIDbo d&M ft d,-,, LAS "a6o& 1k3a�1 tw "AlAIPA 4 X AS / l� I certify under penalty of Perjury, under the laws of the State of Washington that Witness the foregoing statement is true and correct• Lest my knowledge Dated: ason County,WA Witness MCS/P4(04/83) Signed: N-L � r Mason County Sheriff's Department Shelton, WA 98584 Page of Statement of L"I&M �J&A C,o nJ —IAIArr�- %41 MkNw)*� (,h t Oh B'th� kfl� /a 6"At N LU A-AA 9L4 q- Y d(d DAJ�I) a UU AA 0,< db�ffil -Aw�=2' )tk (, W , wts4rfl JkL SA� U , Kk(�) DWAn ta JdA 'J 45 J4 ie -t� I certify under penalty of Perjury, under the laws of the State of Washington that Witness the foregoing statement is true and correct t th b st of my knowledge Dated:+ t�Mason County, -WQA Witness Signed MCSfP4(04/83) I II .�.6 �:.. • A «'' �' � '� _ ,_ � � y � w �� .� . '��r •I .. 1' .1 .:� i�' 'I �` i ;S' � M j 4r�~ "h r � - e� � - j �, ��j• � - 4 - - k i r November 6,2006 ■ s a 7 pEMPT wDEIARTOUMTT 1EMT rr,rrrlrr l �r