ADDENDUM NO_1 PROPERTY _ LIABILITY INS_.pdf
PDF 111 KB Posted
- Attached to
- Property & Liability Insurance
- Solicitation number
- PE-77891-NONST-2024-000000023
- Issued by
- Columbia County, Georgia
About this file
This document is an Addendum to a county property and liability insurance contract opportunity. The contract is between Colquitt County and the Association County Commissioners of Georgia (ACCG), a statewide organization that provides risk management services to counties. The addendum provides detailed loss run reports for claims filed against the county's insurance policy from 2018 to 2024, covering incidents and losses across various county departments such as the Sheriff's Office, Public Works, and Landfill/Sanitation. The reports include information on the nature of the losses, claim numbers, dates, claimants, descriptions, payments, and incurred amounts. No new products or services are being requested, and the document does not indicate any upcoming bid, response, or award dates. The contract appears to be an ongoing renewal between the county and ACCG.
The addendum outlines the pricing and coverage terms of the county's property and liability insurance policy with ACCG. It shows the county's reimbursement for various claims, including vehicle accidents, property damage, and personal injury incidents. The reports do not mention any set-asides, incumbents, or specific funding sources, but they do provide insight into the county's risk management environment and the types of claims it experiences across its operations.
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Text version
ACCG
Report Name: Colquitt County Loss Runs
Report Name:
Thompson, JoeRun By:Template Name: ACCG2Line
Other Created By: Thompson, JoeReport Category:
Reset Page NumberPage BreakGroup TotalSort OrderGroupField
Sort Criteria:
NoNoYesAscYesDepartment1) NoNoYesAscYes2) Reinsurer Prop
Other Info:
Incurred Formula: Net Incurred
Prior Valuation: 4/23/2024
By Occurrence: No
Include Incidents: No
Include Voided Claims: No
STARS Client: IRMA
(Member [Claim, LocationID] equals Colquitt County and Loss Date [Claim, LossDate] is on or after Sunday, July 1, 2018 )
Selection Criteria:
8:53:17AM
4/23/2024
4/23/2024Valued as of :
Med/BI/Comp Ind/Pd/Coll Expense Deduc/Recov Total Net
CovLoss Date LocationClaimant NameClaim Number Examiner
Paid
Incurred
Paid
Incurred
Paid
Incurred Incurred
PaidPaid
Incurred
Description of Loss Report Date Cause Status Carr
Department: 1 - Sheriff's Office
Reinsurer Prop: 2018 - County Re
County, Colquitt 9/6/2018625004509402 1430 (IRMA) Adams, Melanie 53 0.00
0.00
1,295.00
1,295.00
0.00
0.00
1,295.00
1,295.00County vehicle and it's contents were damaged in a shootout.
9/10/2018 034 ACCG10/ 1/2018
0.00
0.00
County, Colquitt 6/26/2019625004701602 1430 (IRMA) Francis, Joann 31 0.00
0.00
610.00
610.00
0.00
0.00
610.00
610.00Member vehicle rear ended claimant vehicle 7/19/2019 080 ACCG8/14/2019
0.00
0.00
County, Colquitt 4/28/20196250046563 1430 (IRMA) Francis, Joann 33 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Member vehicle struck a deer 5/2/2019 019 ACCG8/26/2019
0.00
0.00
County, Colquitt 9/17/20186250045169 1430 (IRMA) Francis, Joann 31 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Other vehicle pulled out in front of member vehicle
9/21/2018 083 ACCG12/20/2018
0.00
0.00
County, Colquitt 9/6/2018625004509401 1430 (IRMA) Adams, Melanie 33 10,246.12
10,246.12
0.00
0.00
200.00
200.00
10,446.12
10,446.12County vehicle was shot during a shootout with suspect.
9/10/2018 034 ACCG12/12/2018
0.00
0.00
Total by Reinsurer Prop 5 Claim 10,246.12
10,246.12
1,905.00
1,905.00
200.00
200.00
12,351.12
12,351.12
0.00
0.00
Reinsurer Prop: 2019 - County Re
County, Colquitt 9/9/2019625004738301 1430 (IRMA) Francis, Joann 31 0.00
0.00
1,440.62
1,440.62
0.00
0.00
1,440.62
1,440.62Member vehicle backed into claimant vehicle 9/24/2019 081 ACCG9/25/2019
0.00
0.00
County, Colquitt 9/19/20196250047372 1430 (IRMA) Graham, Melanie31 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Member vehicle was rear ended 9/23/2019 083 ACCG11/ 1/2019
0.00
0.00
County, Colquitt 3/17/2020625004855001 1430 (IRMA) Francis, Joann 31 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Member vehicle backed into claimant vehicle 3/25/2020 081 ACCG3/30/2020
0.00
0.00
-2-
4/23/2024
8:53:16AM
https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=506544 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=515485 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=514046 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=506736 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=506543 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=516293 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=516265 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=519167
Med/BI/Comp Ind/Pd/Coll Expense Deduc/Recov Total Net
CovLoss Date LocationClaimant NameClaim Number Examiner
Paid
Incurred
Paid
Incurred
Paid
Incurred Incurred
PaidPaid
Incurred
Description of Loss Report Date Cause Status Carr
Department: 1 - Sheriff's Office
Total by Reinsurer Prop 3 Claim 0.00
0.00
1,440.62
1,440.62
0.00
0.00
1,440.62
1,440.62
0.00
0.00
Reinsurer Prop: 2020 - County Re
County, Colquitt 1/19/2021625005018101 1430 (IRMA) Wells, Bryan 31 0.00
0.00
20,709.43
20,709.43
200.00
200.00
20,909.43
20,909.43Member vehicle left roadway and drove through a fence
1/20/2021 092 ACCG10/21/2021
0.00
0.00
County, Colquitt 5/26/2021625005101101 1430 (IRMA) Dulaney, Ryan 31 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Member driver and another driver backed into each other
6/14/2021 081 6/23/2021
0.00
0.00
Chambers, George 1/19/2021625005018103 1430 (IRMA) Wells, Bryan 30 0.00
0.00
150.00
150.00
0.00
0.00
150.00
150.00Member vehicle left roadway and drove through a fence
1/20/2021 092 ACCG2/ 8/2021
0.00
0.00
Griffin, Darrell 1/19/2021625005018102 1430 (IRMA) Wells, Bryan 30 0.00
0.00
1,097.00
1,097.00
0.00
0.00
1,097.00
1,097.00Member vehicle left roadway and drove through a fence
1/20/2021 092 ACCG2/22/2021
0.00
0.00
Total by Reinsurer Prop 4 Claim 0.00
0.00
21,956.43
21,956.43
200.00
200.00
22,156.43
22,156.43
0.00
0.00
Reinsurer Prop: 2021 - County Re
County, Colquitt 2/9/20226250052305 1430 (IRMA) Dulaney, Ryan 31 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Member vehicle struck by another vehicle 2/18/2022 083 5/16/2022
0.00
0.00
Total by Reinsurer Prop 1 Claim 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Reinsurer Prop: 2022 - County Re
County, Colquitt 8/18/20226250053407 1430 (IRMA) Pye, Chesley 31 0.00
0.00
1,731.91
1,731.91
200.00
200.00
1,931.91
1,931.91Member vehicle damaged by tire from another vehicle
8/23/2022 083 2/21/2023
0.00
0.00
-3-
4/23/2024
8:53:16AM
https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523361 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525512 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523425 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523424 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=528809 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531560
Med/BI/Comp Ind/Pd/Coll Expense Deduc/Recov Total Net
CovLoss Date LocationClaimant NameClaim Number Examiner
Paid
Incurred
Paid
Incurred
Paid
Incurred Incurred
PaidPaid
Incurred
Description of Loss Report Date Cause Status Carr
Department: 1 - Sheriff's Office
County, Colquitt 8/15/20226250053408 1430 (IRMA) Pye, Chesley 31 0.00
0.00
4,862.44
4,862.44
200.00
200.00
200.00
200.00Another vehicle backed into member vehicle 8/23/2022 083 10/11/2022
4,862.44
4,862.44
County, Colquitt 8/22/2022625005345501 1430 (IRMA) Dulaney, Ryan 31 0.00
0.00
968.30
968.30
0.00
0.00
968.30
968.30Member rear-ended citizen's trailer 8/29/2022 080 9/12/2022
0.00
0.00
County, Colquitt 6/14/20236250055197 1430 (IRMA) Dulaney, Ryan 33 10,514.53
10,514.53
0.00
0.00
292.55
292.55
10,807.08
10,807.08Hail damaged vehicle 6/15/2023 035 9/20/2023
0.00
0.00
Total by Reinsurer Prop 4 Claim 10,514.53
10,514.53
7,562.65
7,562.65
692.55
692.55
13,907.29
13,907.29
4,862.44
4,862.44
Reinsurer Prop: 2023 - County Re
County, Colquitt 12/7/2023625005628802 1430 (IRMA) Dulaney, Ryan 31 0.00
0.00
14,496.00
14,496.00
330.55
330.55
14,826.55
14,826.55County vehicle struck claimant vehicle in rear 12/19/2023 080 ACCGOpen
0.00
0.00
Total by Reinsurer Prop 1 Claim 0.00
0.00
14,496.00
14,496.00
330.55
330.55
14,826.55
14,826.55
0.00
0.00
Reinsurer Prop: None
Chapman, Lawrence &
Pamela
9/9/2019625004738302 1430 (IRMA) Francis, Joann 30 0.00
0.00
1,383.73
1,383.73
200.00
200.00
1,583.73
1,583.73Member vehicle backed into claimant vehicle 9/24/2019 081 ACCG10/11/2019
0.00
0.00
Tuff, Albert 11/28/20186250047156 1430 (IRMA) Bergey, David 30 1,500.00
1,500.00
0.00
0.00
2,755.31
2,755.31
4,255.31
4,255.31Member vehicle was being worked on by inmate without parking brake engaged -vehicle fell on inmate while changing tire
8/12/2019 007 ACCG10/ 5/2020
0.00
0.00
Roberts, Rachel 1/18/20196250046778 1430 (IRMA) Graham, Melanie40 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Claimant alleges race discrimination 6/11/2019 059 ACCG12/28/2020
0.00
0.00
-4-
4/23/2024
8:53:16AM
https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531561 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531661 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=535828 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=538683 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=516292 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=515614 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=514658
Med/BI/Comp Ind/Pd/Coll Expense Deduc/Recov Total Net
CovLoss Date LocationClaimant NameClaim Number Examiner
Paid
Incurred
Paid
Incurred
Paid
Incurred Incurred
PaidPaid
Incurred
Description of Loss Report Date Cause Status Carr
Department: 1 - Sheriff's Office
Weeks, Amanda 6/4/2021625005285302 1430 (IRMA) Francis, Joann 35 0.00
0.00
0.00
0.00
60,000.00
44,058.58
60,000.00
44,058.58Plaintiff alleges sexual assault and mental anguish against a deputy
5/24/2022 070 ACCGOpen
0.00
0.00
White, Verna 1/25/20236250054539 1430 (IRMA) Phillips, Jeffrey 30 100,000.00
0.00
0.00
0.00
25,000.00
0.00
125,000.00
0.00Claimant alleges pursuit ended in accident of suspect hitting claimant resulting in fatal injuries
2/23/2023 005 ACCGOpen
0.00
0.00
Roberts, Lisa 4/12/2019625004644802 1430 (IRMA) Francis, Joann 30 100,000.00
100,000.00
0.00
0.00
15,634.07
15,634.07
115,634.07
115,634.07County Deputy turned into the claimant's vehicle.
4/12/2019 084 ACCG10/ 7/2022
0.00
0.00
Vanlandingham, John 8/22/20226250053457 1430 (IRMA) Dulaney, Ryan 30 0.00
0.00
962.82
962.82
0.00
0.00
962.82
962.82Member driver rear-ended claimant (minor) 8/29/2022 080 12/ 2/2022
0.00
0.00
Pascual, Juan 8/22/2022625005345502 1430 (IRMA) Dulaney, Ryan 30 0.00
0.00
1,149.92
1,149.92
0.00
0.00
1,149.92
1,149.92Claimant trailer was rear-ended by member vehicle
8/29/2022 080 10/25/2022
0.00
0.00
Solorio, Danael 3/17/2020625004855002 1430 (IRMA) Francis, Joann 30 0.00
0.00
926.54
926.54
200.00
200.00
1,126.54
1,126.54Member vehicle backed into claimant vehicle 3/25/2020 081 ACCG5/13/2020
0.00
0.00
Collier, Jessie 8/4/20206250049291 1430 (IRMA) Francis, Joann 20 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Claimant tripped and fell on member property 8/12/2020 028 ACCG8/26/2020
0.00
0.00
Roberts, Kevin 4/12/2019625004644801 1430 (IRMA) Francis, Joann 30 0.00
0.00
17,441.19
17,441.19
225.00
225.00
17,666.19
17,666.19County Deputy turned into the claimant's vehicle.
4/12/2019 084 ACCG3/16/2020
0.00
0.00
Johnson, Desmond 12/23/20216250052597 1430 (IRMA) Francis, Joann 30 500,000.00
500,000.00
0.00
0.00
35,928.38
35,928.38
535,928.38
535,928.38Claimant injured in accident with vehicle that was fleeing deputy
4/7/2022 005 ACCG2/ 6/2024
0.00
0.00
-5-
4/23/2024
8:53:16AM
https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=535665 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=534235 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=513732 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531663 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531662 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=519166 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=521108 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=513712 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=529524
Med/BI/Comp Ind/Pd/Coll Expense Deduc/Recov Total Net
CovLoss Date LocationClaimant NameClaim Number Examiner
Paid
Incurred
Paid
Incurred
Paid
Incurred Incurred
PaidPaid
Incurred
Description of Loss Report Date Cause Status Carr
Department: 1 - Sheriff's Office
Perez, Taimy 5/26/2021625005101102 1430 (IRMA) Dulaney, Ryan 30 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Member backed into Clmt 6/14/2021 081 7/16/2021
0.00
0.00
Meadows, John 12/7/2023625005628801 1430 (IRMA) Dulaney, Ryan 30 500,000.00
0.00
18,186.11
18,186.11
0.00
0.00
518,186.11
18,186.11County vehicle struck claimant vehicle in rear 12/19/2023 080 ACCGOpen
0.00
0.00
Daniels, Nicole 8/23/20236250056520 1430 (IRMA) Ducar, Mary 40 25,000.00
0.00
0.00
0.00
0.00
0.00
25,000.00
0.00Claimant alleges race discrimination, retaliation and wrongful termination.
2/6/2024 059 ACCGOpen
0.00
0.00
Waldorf, Jeremy 6/26/2019625004701601 1430 (IRMA) Francis, Joann 30 0.00
0.00
1,471.40
1,471.40
200.00
200.00
1,671.40
1,671.40Member vehicle rear ended claimant vehicle 7/19/2019 080 ACCG9/ 6/2019
0.00
0.00
Bo-O, Linda 1/10/20246250056441 1430 (IRMA) Dulaney, Ryan 30 0.00
0.00
8,226.06
8,226.06
314.25
314.25
8,540.31
8,540.31As county vehicle entered the lane, it collided with claimant's vehicle
1/24/2024 084 Open
0.00
0.00
Weeks, Amanda 6/4/2021625005285301 1430 (IRMA) Ducar, Mary 35 30,000.00
0.00
0.00
0.00
40,000.00
16,808.28
70,000.00
16,808.28Plaintiff alleges sexual assault and mental anguish against a deputy
5/24/2022 070 ACCGOpen
0.00
0.00
Enterprises, J Potter 7/25/2022625005327201 1430 (IRMA) Dulaney, Ryan 30 0.00
0.00
3,336.60
3,336.60
358.00
358.00
3,694.60
3,694.60Claimant vehicle rear-ended by member vehicle
8/1/2022 080 ACCG10/ 4/2022
0.00
0.00
Pierce, Albert 7/25/2022625005327202 1430 (IRMA) Dulaney, Ryan 30 15,000.00
15,000.00
0.00
0.00
0.00
0.00
15,000.00
15,000.00Claimant vehicle rear-ended by member vehicle
8/1/2022 080 ACCG5/31/2023
0.00
0.00
Total by Reinsurer Prop 20 Claim 1,271,500.00
616,500.00
53,084.37
53,084.37
180,815.01
116,681.87
1,505,399.38
786,266.24
0.00
0.00
Total by Department 38 Claim 1,292,260.65
637,260.65
100,445.07
100,445.07
182,238.11
118,104.97
1,570,081.39
850,948.25
4,862.44
4,862.44
-6-
4/23/2024
8:53:16AM
https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525511 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=538681 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=539294 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=515244 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=539090 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=530225 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531230 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=531235
Med/BI/Comp Ind/Pd/Coll Expense Deduc/Recov Total Net
CovLoss Date LocationClaimant NameClaim Number Examiner
Paid
Incurred
Paid
Incurred
Paid
Incurred Incurred
PaidPaid
Incurred
Description of Loss Report Date Cause Status Carr
Department: 10 - Water / Waste Water
Reinsurer Prop: 2021 - County Re
County, Colquitt 10/27/2021625005177801 1430 (IRMA) Penrod, Christina31 0.00
0.00
4,038.00
4,038.00
439.25
439.25
4,477.25
4,477.25Member failed to yield striking another vehicle 11/3/2021 084 7/ 6/2022
0.00
0.00
Total by Reinsurer Prop 1 Claim 0.00
0.00
4,038.00
4,038.00
439.25
439.25
4,477.25
4,477.25
0.00
0.00
Reinsurer Prop: None
Indian Lake, The Retreat 10/21/2022625005385802 1430 (IRMA) Francis, Joann 30 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Dump truck snagged a power line which damaged a sign
11/3/2022 082 ACCG1/19/2023
0.00
0.00
Communications, Windstream
10/21/2022625005385801 1430 (IRMA) Francis, Joann 30 0.00
0.00
0.00
0.00
570.00
570.00
570.00
570.00Dump truck snagged a power line which damaged a sign
11/3/2022 082 ACCG1/19/2023
0.00
0.00
McCall, Elisabeth 10/27/2021625005177802 1430 (IRMA) Penrod, Christina30 18,000.00
18,000.00
7,731.78
7,731.78
1,601.50
1,601.50
27,333.28
27,333.28Member driver failed to yield causing CLMT to strike front end.
11/3/2021 084 2/10/2023
0.00
0.00
Total by Reinsurer Prop 3 Claim 18,000.00
18,000.00
7,731.78
7,731.78
2,171.50
2,171.50
27,903.28
27,903.28
0.00
0.00
Total by Department 4 Claim 18,000.00
18,000.00
11,769.78
11,769.78
2,610.75
2,610.75
32,380.53
32,380.53
0.00
0.00
Department: 12 - Emergency Medical Services / 911
Reinsurer Prop: None
Caldwell, Nakeisha 11/23/20206250053660 1430 (IRMA) Ducar, Mary 40 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Claimant alleged employment discrimination based on race
9/29/2022 059 ACCG3/ 3/2023
0.00
0.00
Carmickel, Laura 7/22/20206250049967 1430 (IRMA) Ducar, Mary 30 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Claimant injured while passenger in emergency vehicle
12/9/2020 084 ACCG12/ 9/2020
0.00
0.00
-7-
4/23/2024
8:53:16AM
https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=527482 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=532598 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=532596 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=527481 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=532144 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=522843
Med/BI/Comp Ind/Pd/Coll Expense Deduc/Recov Total Net
CovLoss Date LocationClaimant NameClaim Number Examiner
Paid
Incurred
Paid
Incurred
Paid
Incurred Incurred
PaidPaid
Incurred
Description of Loss Report Date Cause Status Carr
Department: 12 - Emergency Medical Services / 911
Total by Reinsurer Prop 2 Claim 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Total by Department 2 Claim 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Department: 13 - Library System
Reinsurer Prop: None
McCombs, Laquittia 10/18/20186250046278 1430 (IRMA) Graham, Melanie20 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Claimant was bitten by insects in
Moultrie-Colquitt Library
3/15/2019 028 ACCG6/10/2019
0.00
0.00
Total by Reinsurer Prop 1 Claim 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Total by Department 1 Claim 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Department: 16 - Building Maintenance
Reinsurer Prop: 2021 - County Re
County, Colquitt 12/30/2021625005208302 1430 (IRMA) Ducar, Mary 52 0.00
0.00
3,185.46
3,185.46
0.00
0.00
3,185.46
3,185.46Storm damage at cabinet shop 1/5/2022 035 ACCG6/21/2022
0.00
0.00
County, Colquitt 12/30/2021625005208301 1430 (IRMA) Ducar, Mary 52 0.00
0.00
25,141.80
25,141.80
1,615.00
1,615.00
26,756.80
26,756.80Storm damage to rolling doors at Fleet maintenance shop
1/5/2022 035 7/25/2022
0.00
0.00
Total by Reinsurer Prop 2 Claim 0.00
0.00
28,327.26
28,327.26
1,615.00
1,615.00
29,942.26
29,942.26
0.00
0.00
Reinsurer Prop: 2023 - County Re
County, Colquitt 3/10/20246250056768 1430 (IRMA) Williams, Jeris 52 0.00
0.00
5,000.00
0.00
365.00
0.00
5,365.00
0.00A citizen lost vehicle controlled and hit county courthouse fence
3/25/2024 036 Open
0.00
0.00
-8-
4/23/2024
8:53:16AM
https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=513264 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=528291 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=528224 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=539965
Med/BI/Comp Ind/Pd/Coll Expense Deduc/Recov Total Net
CovLoss Date LocationClaimant NameClaim Number Examiner
Paid
Incurred
Paid
Incurred
Paid
Incurred Incurred
PaidPaid
Incurred
Description of Loss Report Date Cause Status Carr
Department: 16 - Building Maintenance
Total by Reinsurer Prop 1 Claim 0.00
0.00
5,000.00
0.00
365.00
0.00
5,365.00
0.00
0.00
0.00
Total by Department 3 Claim 0.00
0.00
33,327.26
28,327.26
1,980.00
1,615.00
35,307.26
29,942.26
0.00
0.00
Department: 19 - Public Works
Reinsurer Prop: 2018 - County Re
County, Colquitt 10/10/2018625004595101 1430 (IRMA) Ducar, Mary 52 0.00
0.00
8,063.89
8,063.89
4,187.20
4,187.20
12,251.09
12,251.09Structure at county parking lot was damaged during hurricane
1/23/2019 035 ACCG11/ 4/2020
0.00
0.00
Total by Reinsurer Prop 1 Claim 0.00
0.00
8,063.89
8,063.89
4,187.20
4,187.20
12,251.09
12,251.09
0.00
0.00
Reinsurer Prop: 2019 - County Re
County, Colquitt 10/29/20196250047657 1430 (IRMA) Graham, Melanie100 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Guard rail struck and damaged by private vehicle
11/6/2019 082 ACCG12/30/2019
0.00
0.00
Total by Reinsurer Prop 1 Claim 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Reinsurer Prop: 2022 - County Re
County, Colquitt 11/18/2022625005397402 1430 (IRMA) Dulaney, Ryan 100 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Member rear-ended by another vehicle that was rear-ended
11/28/2022 080 12/ 2/2022
0.00
0.00
HIghtower, James 2/6/2023625005456802 1430 (IRMA) Dulaney, Ryan 31 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Member driver rear-ended Member vehicle 3/2/2023 080 3/ 2/2023
0.00
0.00
County, Colquitt 2/6/2023625005456801 1430 (IRMA) Dulaney, Ryan 31 0.00
0.00
11,995.13
11,995.13
490.00
490.00
12,485.13
12,485.13Member driver rear-ended Member vehicle 3/2/2023 080 5/ 5/2023
0.00
0.00
-9-
4/23/2024
8:53:16AM
https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=508839 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=516999 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=532907 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=534315 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=534316
Med/BI/Comp Ind/Pd/Coll Expense Deduc/Recov Total Net
CovLoss Date LocationClaimant NameClaim Number Examiner
Paid
Incurred
Paid
Incurred
Paid
Incurred Incurred
PaidPaid
Incurred
Description of Loss Report Date Cause Status Carr
Department: 19 - Public Works
Total by Reinsurer Prop 3 Claim 0.00
0.00
11,995.13
11,995.13
490.00
490.00
12,485.13
12,485.13
0.00
0.00
Reinsurer Prop: 2023 - County Re
County, Colquitt 7/25/2023625005541302 1430 (IRMA) Dulaney, Ryan 51 0.00
0.00
2,783.66
2,783.66
585.00
585.00
3,368.66
3,368.66County motor grader damaged 7/26/2023 081 10/ 6/2023
0.00
0.00
County, Colquitt 7/25/2023625005541301 1430 (IRMA) Dulaney, Ryan 31 0.00
0.00
30,708.34
30,708.34
820.00
820.00
31,528.34
31,528.34County employee backed a motor grader into a truck
7/26/2023 081 Open
0.00
0.00
County, Colquitt 10/2/20236250055917 1430 (IRMA) Dulaney, Ryan 51 0.00
0.00
51,652.21
51,652.21
1,131.25
1,131.25
52,783.46
52,783.46CAT Mini excavator fell into a hole and sank 10/6/2023 092 1/17/2024
0.00
0.00
County, Colquitt 12/11/2023625005639501 1430 (IRMA) Dulaney, Ryan 51 0.00
0.00
84,660.01
84,660.01
1,015.00
1,015.00
85,675.01
85,675.01Mini excavator damaged 1/17/2024 036 4/ 2/2024
0.00
0.00
Total by Reinsurer Prop 4 Claim 0.00
0.00
169,804.22
169,804.22
3,551.25
3,551.25
173,355.47
173,355.47
0.00
0.00
Reinsurer Prop: None
Pineda, Narcisa 10/14/20196250047509 1430 (IRMA) Ducar, Mary 20 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Claimant was struck in the head by debris from county mower
10/15/2019 023 ACCG2/ 4/2020
0.00
0.00
Williams, Tiffany 8/27/20206250049403 1430 (IRMA) Dulaney, Ryan 30 5,500.00
5,500.00
554.90
554.90
0.00
0.00
6,054.90
6,054.90Member vehicle backed into claimant vehicle 8/31/2020 081 ACCG7/ 7/2021
0.00
0.00
Stripling, Eric 12/11/2023625005639502 1430 (IRMA) Dulaney, Ryan 20 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00County employee injured while handling equipment
1/17/2024 028 1/17/2024
0.00
0.00
Total by Reinsurer Prop 3 Claim 5,500.00
5,500.00
554.90
554.90
0.00
0.00
6,054.90
6,054.90
0.00
0.00
-10-
4/23/2024
8:53:16AM
https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=536423 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=536422 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=537674 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=538974 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=516638 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=521377 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=538973
Med/BI/Comp Ind/Pd/Coll Expense Deduc/Recov Total Net
CovLoss Date LocationClaimant NameClaim Number Examiner
Paid
Incurred
Paid
Incurred
Paid
Incurred Incurred
PaidPaid
Incurred
Description of Loss Report Date Cause Status Carr
Total by Department 12 Claim 5,500.00
5,500.00
190,418.14
190,418.14
8,228.45
8,228.45
204,146.59
204,146.59
0.00
0.00
Department: 2 - Road Department
Reinsurer Prop: None
Hall, Pamela 11/18/2022625005397401 1430 (IRMA) Dulaney, Ryan 30 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Member rear-ended by another vehicle that was rear-ended
11/28/2022 080 ACCG12/ 2/2022
0.00
0.00
Evans, Sharon 1/11/20216250051042 1430 (IRMA) Dulaney, Ryan 20 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Claimant alleges pothole cause damage 6/17/2021 028 ACCG6/21/2021
0.00
0.00
Walker, Jake 6/15/20236250056428 1430 (IRMA) Ducar, Mary 20 50,000.00
0.00
0.00
0.00
0.00
0.00
50,000.00
0.00Claimant alleges improper repair/maintenance of roadway that was eroded or washed out resulting in injury to claimant on an ATV
1/22/2024 028 ACCGOpen
0.00
0.00
Woodward, Lewis 7/11/20226250054023 1430 (IRMA) Francis, Joann 20 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Claimant alleges poor road conditions led to collision
12/5/2022 021 ACCG12/20/2022
0.00
0.00
Tyson, Sarah 9/27/20196250047408 1430 (IRMA) Wright, Nia 30 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Debris from member vehicle damaged claimant vehicle
10/1/2019 022 ACCG10/ 1/2019
0.00
0.00
Total by Reinsurer Prop 5 Claim 50,000.00
0.00
0.00
0.00
0.00
0.00
50,000.00
0.00
0.00
0.00
Total by Department 5 Claim 50,000.00
0.00
0.00
0.00
0.00
0.00
50,000.00
0.00
0.00
0.00
Department: 23 - Court Services
Reinsurer Prop: None
-11-
4/23/2024
8:53:16AM
https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=532896 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=525588 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=539057 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=533033 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=516378
Med/BI/Comp Ind/Pd/Coll Expense Deduc/Recov Total Net
CovLoss Date LocationClaimant NameClaim Number Examiner
Paid
Incurred
Paid
Incurred
Paid
Incurred Incurred
PaidPaid
Incurred
Description of Loss Report Date Cause Status Carr
Department: 23 - Court Services
Pinion, Marvin 7/30/20186250044891 1430 (IRMA) Dulaney, Ryan 20 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Cut left elbow and forehead when he slipped on wet stairs during storm entering county building.
8/9/2018 028 ACCG8/21/2018
0.00
0.00
Kennedy, Sarah 10/18/20196250047539 1430 (IRMA) Francis, Joann 20 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Claimant slipped and fell on curb outside of county building
10/18/2019 028 ACCG10/27/2019
0.00
0.00
Williams, Traci 9/1/20236250056320 1430 (IRMA) Francis, Joann 40 25,000.00
0.00
0.00
0.00
0.00
0.00
25,000.00
0.00Claimant alleges discrimination based on race, sex and promotion
12/27/2023 059 ACCGOpen
0.00
0.00
Total by Reinsurer Prop 3 Claim 25,000.00
0.00
0.00
0.00
0.00
0.00
25,000.00
0.00
0.00
0.00
Total by Department 3 Claim 25,000.00
0.00
0.00
0.00
0.00
0.00
25,000.00
0.00
0.00
0.00
Department: 29 - Prison Operations
Reinsurer Prop: 2021 - County Re
County, Colquitt 10/11/2021625005169703 1430 (IRMA) Dulaney, Ryan 31 0.00
0.00
5,555.19
5,555.19
200.00
200.00
5,755.19
5,755.19Member vehicle damaged during accident 10/20/2021 084 ACCG4/ 4/2022
0.00
0.00
Total by Reinsurer Prop 1 Claim 0.00
0.00
5,555.19
5,555.19
200.00
200.00
5,755.19
5,755.19
0.00
0.00
Reinsurer Prop: None
Hendrixson, Hayley 10/11/2021625005169701 1430 (IRMA) Dulaney, Ryan 30 72,500.00
72,500.00
19,581.78
19,581.78
1,752.00
1,752.00
93,833.78
93,833.78Claimant vehicle struck by member -transported to ER
10/20/2021 084 ACCG7/25/2022
0.00
0.00
Mayerhofer, Michael 10/11/2021625005169702 1430 (IRMA) Dulaney, Ryan 30 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Passenger in claimant vehicle transported to
ER
10/20/2021 084 ACCG5/25/2022
0.00
0.00
-12-
4/23/2024
8:53:16AM
https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=506065 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=516705 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=538751 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=527336 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=527302 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=527303
Med/BI/Comp Ind/Pd/Coll Expense Deduc/Recov Total Net
CovLoss Date LocationClaimant NameClaim Number Examiner
Paid
Incurred
Paid
Incurred
Paid
Incurred Incurred
PaidPaid
Incurred
Description of Loss Report Date Cause Status Carr
Department: 29 - Prison Operations
Matthews III, Joseph 10/25/20196250054956 1430 (IRMA) Francis, Joann 40 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Claimant alleges discrimination due to disability
5/3/2023 059 ACCG11/20/2023
0.00
0.00
Total by Reinsurer Prop 3 Claim 72,500.00
72,500.00
19,581.78
19,581.78
1,752.00
1,752.00
93,833.78
93,833.78
0.00
0.00
Total by Department 4 Claim 72,500.00
72,500.00
25,136.97
25,136.97
1,952.00
1,952.00
99,588.97
99,588.97
0.00
0.00
Department: 31 - Administration
Reinsurer Prop: None
McCalley, William 9/17/20196250047497 1430 (IRMA) Ducar, Mary 100 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Former county attorney claims retirement benefits were not honored by county
10/15/2019 062 ACCG9/ 8/2020
0.00
0.00
Bullington, David 1/19/20236250055301 1430 (IRMA) Francis, Joann 100 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Claimant injured while on a Colquitt County
Board of Education school bus involved in an accident
7/5/2023 082 ACCG7/21/2023
0.00
0.00
Furney, Charlotte 8/25/20206250049843 1430 (IRMA) Francis, Joann 100 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Claimant tripped and fell on hospital property 11/16/2020 028 ACCG12/ 2/2020
0.00
0.00
Jeffery, Matthew 9/14/20236250055868 1430 (IRMA) Dulaney, Ryan 100 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Claimant injured at school 9/28/2023 028 ACCG9/29/2023
0.00
0.00
Jenkins, Byron 10/18/20236250056910 1430 (IRMA) Francis, Joann 100 0.00
0.00
100.00
0.00
0.00
0.00
100.00
0.00Claimant alleges that Board of Education driver struck claimant vehicle in rear
4/22/2024 065 ACCGOpen
0.00
0.00
Total by Reinsurer Prop 5 Claim 0.00
0.00
100.00
0.00
0.00
0.00
100.00
0.00
0.00
0.00
-13-
4/23/2024
8:53:16AM
https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=535232 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=516616 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=536098 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=522509 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=537541 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=540342
Med/BI/Comp Ind/Pd/Coll Expense Deduc/Recov Total Net
CovLoss Date LocationClaimant NameClaim Number Examiner
Paid
Incurred
Paid
Incurred
Paid
Incurred Incurred
PaidPaid
Incurred
Description of Loss Report Date Cause Status Carr
Total by Department 5 Claim 0.00
0.00
100.00
0.00
0.00
0.00
100.00
0.00
0.00
0.00
Department: 7 - Jail Operations
Reinsurer Prop: 2018 - County Re
County, Colquitt 10/10/2018625004595102 1430 (IRMA) Ducar, Mary 52 0.00
0.00
6,728.00
6,728.00
0.00
0.00
6,728.00
6,728.00Structure at county parking lot was damaged during hurricane
1/23/2019 035 ACCG10/ 6/2020
0.00
0.00
Total by Reinsurer Prop 1 Claim 0.00
0.00
6,728.00
6,728.00
0.00
0.00
6,728.00
6,728.00
0.00
0.00
Reinsurer Prop: 2021 - County Re
County, Colquitt 12/30/2021625005208303 1430 (IRMA) Ducar, Mary 52 0.00
0.00
416.84
416.84
0.00
0.00
416.84
416.84Storm damage 1/5/2022 035 ACCG5/ 3/2022
0.00
0.00
Total by Reinsurer Prop 1 Claim 0.00
0.00
416.84
416.84
0.00
0.00
416.84
416.84
0.00
0.00
Reinsurer Prop: None
Williams, Robert 3/7/20196250046384 1430 (IRMA) Ducar, Mary 20 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Inmate allegedly slipped and fell in county jail 4/2/2019 028 ACCG6/10/2019
0.00
0.00
Jordan, Ted 6/13/20206250048968 1430 (IRMA) Graham, Melanie35 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Inmate committed suicide in county jail 6/15/2020 008 ACCG11/ 6/2020
0.00
0.00
Ellerson, Bobby 6/27/20206250049074 1430 (IRMA) Ducar, Mary 35 50,000.00
50,000.00
0.00
0.00
1,737.50
1,737.50
51,737.50
51,737.50Alleged excessive use of force on inmate 7/6/2020 003 ACCG6/29/2022
0.00
0.00
Fender, Kirby 3/13/20206250049073 1430 (IRMA) Ducar, Mary 35 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Alleged excessive use of force on inmate 7/6/2020 003 ACCG8/10/2022
0.00
0.00
-14-
4/23/2024
8:53:16AM
https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=509001 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=528292 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=513526 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=520234 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=520512 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=520511
Med/BI/Comp Ind/Pd/Coll Expense Deduc/Recov Total Net
CovLoss Date LocationClaimant NameClaim Number Examiner
Paid
Incurred
Paid
Incurred
Paid
Incurred Incurred
PaidPaid
Incurred
Description of Loss Report Date Cause Status Carr
Department: 7 - Jail Operations
Disciplina, Catrina 2/14/20206250048208 1430 (IRMA) Graham, Melanie35 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Inmate died in custody 2/14/2020 073 ACCG8/19/2020
0.00
0.00
Valdez Flores, Jose 1/29/20216250050248 1430 (IRMA) Wells, Bryan 35 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Inmate committed suicide 2/2/2021 008 ACCG9/27/2021
0.00
0.00
Pace, Willie 8/3/20226250055306 1430 (IRMA) Ducar, Mary 35 0.00
0.00
0.00
0.00
3,666.00
3,666.00
3,666.00
3,666.00Pro se inmate alleges denial of medical care 7/6/2023 009 ACCG3/14/2024
0.00
0.00
Total by Reinsurer Prop 7 Claim 50,000.00
50,000.00
0.00
0.00
5,403.50
5,403.50
55,403.50
55,403.50
0.00
0.00
Total by Department 9 Claim 50,000.00
50,000.00
7,144.84
7,144.84
5,403.50
5,403.50
62,548.34
62,548.34
0.00
0.00
Department: 9 - Landfill / Sanitation / Recycling
Reinsurer Prop: 2018 - County Re
County, Colquitt 8/15/20186250044937 1430 (IRMA) Francis, Joann 31 0.00
0.00
7,297.70
7,297.70
0.00
0.00
7,297.70
7,297.70Member driver backed into a tree 8/15/2018 081 ACCG9/12/2018
0.00
0.00
County, Colquitt 5/23/2019625004665701 1430 (IRMA) Francis, Joann 31 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Member vehicle backed into claimant vehicle 5/23/2019 081 ACCG5/23/2019
0.00
0.00
Total by Reinsurer Prop 2 Claim 0.00
0.00
7,297.70
7,297.70
0.00
0.00
7,297.70
7,297.70
0.00
0.00
Reinsurer Prop: 2019 - County Re
County, Colquitt 6/30/20206250049070 1430 (IRMA) Francis, Joann 31 0.00
0.00
5,853.67
5,853.67
0.00
0.00
0.00
0.00County garbage truck was rear ended 7/6/2020 083 ACCG8/17/2020
5,853.67
5,853.67
-15-
4/23/2024
8:53:16AM
https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=518454 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=523552 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=536128 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=506178 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=514366 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=520501
Med/BI/Comp Ind/Pd/Coll Expense Deduc/Recov Total Net
CovLoss Date LocationClaimant NameClaim Number Examiner
Paid
Incurred
Paid
Incurred
Paid
Incurred Incurred
PaidPaid
Incurred
Description of Loss Report Date Cause Status Carr
Department: 9 - Landfill / Sanitation / Recycling
County, Colquitt 6/25/2020625004904601 1430 (IRMA) Francis, Joann 31 0.00
0.00
2,279.40
2,279.40
439.25
439.25
2,718.65
2,718.65Member vehicle pulled out in front of claimant vehicle
6/29/2020 084 ACCG8/24/2020
0.00
0.00
Total by Reinsurer Prop 2 Claim 0.00
0.00
8,133.07
8,133.07
439.25
439.25
2,718.65
2,718.65
5,853.67
5,853.67
Reinsurer Prop: 2021 - County Re
County, Colquitt 11/10/2021625005191801 1430 (IRMA) Dulaney, Ryan 31 0.00
0.00
2,941.83
2,941.83
530.00
530.00
3,471.83
3,471.83Member truck rear-ended by another vehicle 12/1/2021 080 8/ 8/2022
0.00
0.00
Weldon, Michael 11/10/2021625005191802 1430 (IRMA) Dulaney, Ryan 30 0.00
0.00
0.00
0.00
25.25
25.25
25.25
25.25Member truck rear-ended by another vehicle 12/1/2021 080 ACCG9/26/2022
0.00
0.00
County, Colquitt 12/2/20216250051975 1430 (IRMA) Dulaney, Ryan 51 0.00
0.00
79,705.53
79,705.53
1,015.50
1,015.50
80,721.03
80,721.03Equipment got stuck while cleaning retention pond
12/13/2021 036 3/29/2022
0.00
0.00
Total by Reinsurer Prop 3 Claim 0.00
0.00
82,647.36
82,647.36
1,570.75
1,570.75
84,218.11
84,218.11
0.00
0.00
Reinsurer Prop: None
Vizcarrondo, Joseph 11/12/20186250045928 1430 (IRMA) Adams, Melanie 30 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00Claimant ran stop sign into the path of member garbage truck
1/17/2019 083 ACCG1/30/2019
0.00
0.00
Key, Matthew 2/7/2024625005654201 1430 (IRMA) Dulaney, Ryan 30 0.00
0.00
12,000.00
5,624.31
365.00
0.00
12,365.00
5,624.31County vehicle was reversing, claimant didn't notice this and got backed into by county vehicle
2/9/2024 081 Open
0.00
0.00
Barber, Mary 6/25/2020625004904602 1430 (IRMA) Francis, Joann 30 2,500.00
2,500.00
2,756.90
2,756.90
2,486.48
2,486.48
7,743.38
7,743.38Member vehicle pulled out in front of claimant vehicle
6/29/2020 084 ACCG3/18/2022
0.00
0.00
-16-
4/23/2024
8:53:16AM
https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=520415 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=527836 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=528477 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=527979 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=508773 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=539342 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=520414
Med/BI/Comp Ind/Pd/Coll Expense Deduc/Recov Total Net
CovLoss Date LocationClaimant NameClaim Number Examiner
Paid
Incurred
Paid
Incurred
Paid
Incurred Incurred
PaidPaid
Incurred
Description of Loss Report Date Cause Status Carr
Department: 9 - Landfill / Sanitation / Recycling
Mumbray, Autumn 1/16/20196250046134 1430 (IRMA) Francis, Joann 30 32,500.00
32,500.00
1,915.64
1,915.64
200.00
200.00
34,615.64
34,615.64Member rear ended other vehicle 2/22/2019 080 ACCG1/15/2020
0.00
0.00
Key, Tyler 2/7/2024625005654202 1430 (IRMA) Dulaney, Ryan 30 3,500.00
3,500.00
0.00
0.00
0.00
0.00
3,500.00
3,500.00County vehicle was reversing, claimant didn't notice this and got backed into by county vehicle
2/9/2024 081 ACCG4/12/2024
0.00
0.00
Kailing, Jessica 5/23/2019625004665702 1430 (IRMA) Francis, Joann 30 0.00
0.00
5,173.43
5,173.43
200.00
200.00
5,373.43
5,373.43Member vehicle backed into claimant vehicle 5/23/2019 081 ACCG7/ 1/2019
0.00
0.00
Total by Reinsurer Prop 6 Claim 38,500.00
38,500.00
21,845.97
15,470.28
3,251.48
2,886.48
63,597.45
56,856.76
0.00
0.00
Total by Department 13 Claim 38,500.00
38,500.00
119,924.10
113,548.41
5,261.48
4,896.48
157,831.91
151,091.22
5,853.67
5,853.67
Grand Totals: 99 Claim 1,551,760.65 488,266.16 207,674.29 2,236,984.99 10,716.11
821,760.65 476,790.47 142,811.15 10,716.11 1,430,646.16
-17-
4/23/2024
8:53:16AM
https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=509302 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=539839 https://www.riskonnectclearsight.com/enterprise//pass.cmdx?packagename=&domainname=STARS.Claim&entitykeys=514364
File details come from the government source that posted it. Updated .