Board of Commissioners of Cook County - File #: 16-5470

• File #: 16-5470
• Version: 1
• Type: Self-Insurance Claims General Liability
• Status: Approved
• File created: 9/21/2016
• In control: Finance Committee
• On agenda: 10/5/2016
• Final action: 10/5/2016
• Title: Department: Department of Transportation and Highways Claim Number: 201600311 Claim Payment: $759.58 Account Number: 490-826 Fixed Charges Department: 490 (Corporate) Claimant: Jeffrey Holdsberg Property Damage/Bodily Injury: 2007 Audi A6 Date of Accident: 06/04/2016 Location: Brinker and Otis Roads, Barrington Hills, IL Incident/Activity: Claimant was traveling near Brinker and Otis Roads in Barrington Hills and struck a pothole causing damages to his vehicle's tires. Investigated by: CorVel

Date	Ver.	Action By	Motion	Result
10/5/2016	1	Board of Commissioners	approve
10/5/2016	1	Finance Committee	recommend for approval	Pass

title

Department: Department of Transportation and Highways

Claim Number: 201600311

Claim Payment: $759.58

Account Number: 490-826

Fixed Charges Department:  490 (Corporate)

Claimant: Jeffrey Holdsberg

Property Damage/Bodily Injury: 2007 Audi A6

Date of Accident: 06/04/2016

Location: Brinker and Otis Roads, Barrington Hills, IL

Incident/Activity: Claimant was traveling near Brinker and Otis Roads in Barrington Hills and struck a pothole causing damages to his vehicle's tires.

Investigated by:  CorVel

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