HomeMy WebLinkAboutCity Council - 3891 RESOLUTION NO. 3891
A RESOLUTION OF THE CITY COUNCIL OF THE CITY
OF HUNTINGTON BEACH AUTHORIZING AN EXPENDITURE
OF FUNDS IN SETTLEMENT OF WORKMEN'S COMPENSA-
TION CLAIM NO. 70ANA31390
WHEREAS, claim has been filed against city in the sum
of Seven Thousand Five Hundred Fifty and no/100ths Dollars
($7500 . 00 ) plus Two Hundred Fifty and no/100ths Dollars
($250. 00) in attorney' s fees; and
Applicant has agreed to settle for the sum of Three
Thousand Seven Hundred Fifty and no/100ths Dollars ($3750 . 00 )
which sum includes attorney' s fees; and
City desires to reach amicable agreement in such matter,
and finds the Compromise and Release, copy of which is attached
hereto and by reference made a part hereof, in order,
NOW, THEREFORE, the City Council of the City of Huntington
Beach does hereby resolve that the said Compromise and Release
of Workmen' s Compensation Claim No. 70ANA31390 is approved;
that the Finance Director of said city is hereby authorized
to expend the sum of Three Thousand Seven Hundred Fifty and
no/100ths Dollars ($3750. 00 ) in settlement of said claim, filed
against city by Ervin J. Griffith; and that the City Attorney
is authorized and directed to execute said Compromise and Re-
lease.
PASSED AND ADOPTED by the City Council of the City of
Huntington Beach at a regular meeting thereof held on the 3rd
day of June, 1974.
Mayor
1.
DPB: ahb
ATTEST: APPROVED AS TO FORM:
City Clerk ' " Cit Attorne
APPROVED AS TO CONTENT
City Administrator
2 .
!
STATE OF VALIFORNIA
COMPROMISE AND RELEASE DEPARTMENT OF INDUSTRIAL RELATIONS ry^ 'T
DIVISION OF INDUSTRIAL ACCIDENTS CASE NO. y A"A �1390
PLEASE SEE INSTRUCTIONS ON WORKMEN'S COMPENSATION APPEALS SOARD �••—•�►
REVERSE OF PAGE a 89maz A j�
COMPLETING FORM. SOCIAL SECuhM NO. 532-09-136
SPo14?7
Ervin J. Griffith -�- 215 Crest, Huntington Beach, CA
Vs.
APIItO.».
City 9f Hun_ t ngto_Beach � ,~.P 0 Box 1.0, Huntington Beach, CA
ODOR=*NAME ev OMPLOTEN Ames"
.___. -
OOMMECT MAME OF 11600MANCC CAMIEM. no
The parties hereto,for the purpose of compromise only,hereby submit the following agreed statements Of faCt:
L __ ---_ Y 1+L. H._..._------------------- employee herein, born oa.-_ ceaber 20, 1919 .... ..
claims that he was employed an t>m.._19 b----day of.... Jjaae_----------- 15._ 4-at.___Hunt on Beach,___.. -_
/NONT.' (YEAR) • (O7Tr! WAVID
as a.miRs:hai ..__� _by_�_. __ L ' ''Q . t�hee insured as to
IOCOYPATIOM>. (MAME OF GNPLOT") -
Wprkmews liability bye' ,U--QQXEMAT;LQN-_I.N-4.UR CE.. F --and that
WAT*MAN!OP CAMNIp1 OM WNOTMEO OBLP."HINK OI
he sustained an injury arising out of and in the course of his employment as fo%ws:-T=k-- Urs Joded.._
inuring -head_ face, _fracturing_right arm and.cans in_g train damage.. It is
alleged that the employee was inured by reason of serious an , wilful m s::
ccn_duct of emplMer and/or his responsible representatives under the Labor
- ----------
IU actual weekly wages of the employee at the time of injury were$-__-�?-di��,while the avwage weekly WaW
were$._._-1n dJLp2ute ,
a The employao's present disability is ....___._.__in dispute__ ---- --_-_..___
has not (STATE PMEEs)IT DIEABILIrT M8WkTM0 F"M TNs IM.INRT)
and the employed.-_.../------._-jeturned to wo&---------------------------
rlP PO.ITATs WHOM)
4. (a) Temporary disability indemnity has been paid to the employee in the sum of$..6,425.73st$..BFx.5a-__-par wed
various periods beginning 6-11-69 through 9-27-TI
begmemg__.__�/----to and iududing.--_.,/-_._-------- The amount due and unpaid to the employee is
In, compliance with award and currently
(b) Permanent disability indemnity has been paid to the employee in the sutra of$---_-/eovwiug
!l. The parties hereby agree to settle any and all claims on amount of said injury by the payment of the sued of$...%-750..00_.
in addition to any sums heretofore paid by the employer or the insurer to the employee,said sum to be payable as follows:
To be paid _by_the.....imlo �g1 �Q � noun aud kd1W mi ficondLch
claims to _ ►.e._ � t _- c !A._fea,_,
6. Medical and hospital expenses have been paid$----JIQnC.._..by the employee and$5S[,929- the employer or carrier.
npaid bills amount to$.- .Future medical and hospital expense is estimated at$__ unknomm .unpaid and
Lure medical and hospital expense k to be assumed as followst-._- By By__-_the pp31r, - imless aDeaiif cal
x'paucat d Qr a ut ari zed by defenants�-----
DIA WCAS FORM III 1 PAs9 1 i 1 RIM.1.791
7. Name and address of employee's attorney, if any.....Mr....--Eugene...V --Barnes, .Attorney at .Law.---.--
12311 Chapman, Suite 2 f0�1p Garden arose,--CA
. Said attorney requests a fee of $................................... Amount of attorney fee previous! if any,$.....--.
Reason for Compromise SEE ATTACHED SU ET-- -------- •----------- - -�------
10 The undersigned request that-this Compromise Agreement and Release be approved.
11. Upon approval of this Compromise Agreement by the Workmen`s Compensation Appeals Board or a Refree, and
payment in accordance with the provisions hereof, said employee releases and forever discharges said employer and
insurance carrier from all claims and causes of action, whether now known or ascertained, or which may hereafter arise
or develop as a result of said injury, including any and all liability of said employer and said insurance carrier and e&&
of them to the dependents, heirs, executors, representatives, administrators or assigns of said employee.
. 11 It is agreed by all parties hereto that the filing of this document is the filing of an application on behalf of the employee,
and that the W.C.A.B. may in its discretion set the matter for hearing as a regular application, reserving to the parties
the right to put in issue any of the facts admitted herein, and that if hearing is held with this document used as an
application the defendants shall have available to them all defenses that were available as of the date of flung of this
document, and that the W.C.A.B. may thereafter either approve said Compromise Agreement and Release or disapprove
the same and issue Findings and Award after hearing has been held and the matter regularly submitted for decision.
I& For the purpose of determining the lien claim filed herein for the unemployment compensation disability benefits or
unemployment compensation benefits and extended duration benefits which have been paid under or pursuant to the
California Unemployment Insurance Code, the parties propose the following division of the sum agreed upon for
settlement and release of this case;
$-- ----..--•- --..-.-.for temporary disability covering the period------- ----- - ------.----- ----•---._:M.�. .......... ........•...-----•---
$----_--•----_____.---_.----__--for accrued medical expense paid or incurred by the employee.
-. .._....__ ._ ........for future medical care.
$..............................for permanent disability. NOT APPLICABLE
(The above segregation must be fair and reasonable and must be based on the real facts of the case. There shout be
no attempt pt�made to deprive the lien claimant of a reasonable recovery consistent with all the amounts involved.W.C.A.B.
Rule 10886 requires proof of service of a copy of this agreement on such Lien Claimant.)
Wrrwm the skmature hereof this ----------------- day of-------------------------------- -----t 1g---------'40--.....__..........................................- --
»._.
W.................-------.-._._....__ ........_ _---------.•_.-------- ---.._... ---------..... ..............
APPLICANT, �R�U'�N � `�'�li
- -» ---- -- --
WIT I tag*as
ATTORNEY -1!OR APPL4Alfi
TIiN#NAUNW APft14^NT'S 010HATUNS MUST 019 ATTSSTSN NY TWO JY
VOWTOWT.6L MM00*O Oi R ASNNOMLNDG20 NR,ONN A NOTA"OWNLNC.. --,CITY--OF HUNTINGTON. BEACH
STATE OF CAUFORNIA BY.
STATE--C4MPElJSA�'IU� --IN��RANC�--FUNS-----'--
......... ............. ........County of--------- .-•--- -------------
BY:
orney at rAW
onthis -- ------- day of---- --- --- -------- --•-------- ------,A.D. 19.- ---.., before tire,.-»_----------------- - _ ...._-----.......... -------,
a Notary Public in and for the said County and State, msiding therein, duly commissioned and sworn personalty appeared
------- -------------.... -•------ ---•- ------ ---
rto me to be the person whose game-------- --------- --- ----- ----------- --- -------- ----
bed to the within Instrument,and acknowledged to me that_---_he_.___-executed the same.
Wn?ms WHnnor, I have hereunto set my hand and aged my official seal the day and year in this Certi#vate first
above written.
----- . -------- -------- -------- .--------
Notwv Pubbe in end for add Cow*mid Sa+o #of Callornla
oeA wCA®Foes 15 (PLO[2) 4NKV.1.7a► m.*or
9. REi%SON FOR CONFROMISL:
A bonafide dispute exists as to whether the employer herein had
knowledge of the alleged safety orders through his managing
representatives and was employirg applicant in a serious and
wilful misconduct- manner. The applicant desires to avoid the
hazards of litigation; the defendants desire to buy their
peace• All parLies agree the amount is fair and reasonable.
Reference is made to all hearings, reports, and pleadings on
file. Settlement is expected to compensate for all aspects
of the said alleged serious and wilful misconduct claims on
account of the injury, whether filed or unfiled, as to all
future claims of serious and wilful misconduct arising out
of the alleged injury.
Payment of the compromise and release is to be made directly by
the employer, after approval order from the Workmen's Compensation
Appeals Board.
pp e" ness
Res. No. 3891
STATE OF CALIFORNIA )
COUNTY OF ORANGE ) ss:
CITY OF HUNTINGTON BEACH )
I, ALICIA M. WENTWORTH, the duly elected, qualified City
Clerk of the City of Huntington Beach, and ex-officio Clerk of the
City Council of said City, do hereby certify that the whole number of
members of the City Council of the City of Huntington Beach is seven;
that the foregoing resolution was passed and adopted by the affirmative
vote of more than a majority of all the members of said City Council
at a regular meeting thereof held on the 3rd day
of June , 19 74 by the following vote:
AYES: Councilmen:
Shipley, Bartlett, Wieder, Duke, Coen
NOES: Councilmen
None
ABSENT: Councilmen:
Gibbs, _Matney
A
City Clerk and ex-officio Clerk
of the City Council of the City
of Huntington Beach, California