Claim - Southern California Edison - 2013-03-07 CLAIM FORM
Please fill out,print and mail to:
Southern California Edison Company
P.O.Box 900 (800)251-3311 - Fax (626) 569-2573
Rosemead, CA 91770 Web Site: www.sce.com/claims
E-mail : claims @sce.com
SCE Customers ( Business)
If you are an SCE customer, please enter your Service Account number below. If you have multiple Service Accounts, please
select the one associated with this claim. If you don't know your account number,just select that option.
Service Account Number
r 3.031-8753-08 0 I don't know my account number.
Contact Information
Please enter the company name that appears on the bill. Please check your contact information below and make any updates
necessary. If we have any questions about your claim, we will use this information to reach you.
Company Name Costa Mesa Sanitary District
Contact First Name Scott Contact Last Name Carroll Position Title General Managr
Mailing Address 628 W. 19th Street Suite Number
City Costa Mesa State CA Zip Code 92627 Primary Phone# (949)645-8400
E-mail Address scarroll @crosdca.gov Alternate Phone# (714)800-3296
Company URL http://www.cmsdca.gov Fax Number Gt`E 5. -'226-
Non - SCE Customers
If you are not an SCE customer, you may still use this form to file your claim.
❑ I am not an SCE customer.
When did the incident occur?
Please tell us the approximate date and time of the incident.
Date 03/07/2013 Time 918 tJ am ()pm
Trouble Order or Sequence Number
Has SCE already provided a Trouble Order or Sequence Number? If so, please enter it here.
Trouble Order or Sequence Number
Location Information
Please enter the location where the incident occurred. If you're not sure about the exact location,just provide as much
detailed information as possible in the Incident Description area below.
❑ Same as Customer Contact Information.
Street Address 2401 23rd Street Apartment#
City Newport Beach State CA Zip Code 92660
Incident Description
Please tell us about what happened.You may also provide additional written documentation. For personal injury, business loss
or food loss claims, please enter those details here.
The Costa Mesa Sanitary District(CMSD)owns and operates twenty sewer pump stations. One of those pumping stations is located at 2401
23rd Street,Newport Beach,California. On March 7,2013,at approximately 9:18 am, CMSD's Supervisory Control and Data Acquisition
(SCADA)notified CMSD staff that the pump station at the referenced location did not have normal power(see Attachment A). One minute
later,at approximately,9:19 am, SCADA notified CMSD staff again to indicate the pump station has lost power(See Attachment B).
CMSD dispatched its pump station maintenance contractor,JIMNI Systems, Inc.,to assess and trouble shoot the power loss at this pump
station. The technician found that the power voltage suddenly increased from 243 VAC to 272 VAC. As a result of the extra voltage,a fuse
was blown out and damaged the motor saver to the point that it needed replacement. The technician spent three hours assessing and trouble
shooting the power loss at a cost of$439.00 to the District(See Attachment C).
A Southern California Edison(SCE)technician by the name of Troy contacted CMSD Maintenance Supervisor, Steve Cano,to inform him that
the LC feed voltage regulator on the SCE utility pole serving this area was somehow at full boost that impacted 3,000 SCE customers. (See
Attachment D).
On March 14,2013,JIMNI Systems installed a new motor saver at the referenced pump station at a total cost of$619.57.(See Attachment E).
The Costa Mesa Sanitary District is submitting this claim for$1,058.57.
Property Damage Information
If property has been damaged, please enter information about those items here.
Approximate Amount
Item Description Make Make/Model Number Dt Purchased of Purchase Repair Cost Replacement Cost
Three-Phase Motor Saver $459.00 $619.57
Witness Information
Please provide contact information for any witness to the incident. Witnesses are not required to file a claim.
Name Street Address,City,State,Zip Code Primary Phone No.. Alt.Phone No.. E-mail Address
Steve Cano 174 W.Wilson Street, Costa Mesa, (949)281-6785 (949)645-8400 scano @crosdca.gov
CA,92627
Tim Henson 174 W.Wilson Street, Costa Mesa, (949)200-2328 (949)645-8400 thenson @crosdca.gov
CA,92627
•
Tony Gomez 11161 Jeffrey Road, Irvine,CA (949)943-6608 (949)770-7654 tonygjimni@yahoo.com
92602 ) ( ) ygj @yahoo.com
Insurance Information
Please provide information about any insurance coverage you hold that relates to this claim.
Company Name No claim was submitted to CMSD's insurance company
Contact First Name Last Name
Contact Position Title Policy or Claim#
Mailing Address Suite Number
City State Zip Code Primary Phone#
E-mail Address Alternate Phone#
Additional Information
Please feel free to enter any additional information that will help us to process your claim.
Please Note
Acceptance of this form is not an admission of liability nor an indication that Southern California Edison Company is responsible
for your loss and/or damages. If SCE accepts liability for your property damage claim,we will reimburse you for either the repair
Cost, actual cash value, or the replacement cost,whichever is lowest.
► I Understand
Prepared By Scott Carroll Date 05/13/2013 Phone# (949)645-8400
Attachment A
Scott Carroll
From: Alerts @mail.m2mops.com
Sent: Thursday, March 07, 2013 9:19 AM.
To: Scott Carroll
Subject: Present Alarm: Costa Mesa - CMSD 23rd Street Pump Stat - Primary Power
Costa Mesa-CMSD 23rd Street Pump Stat
Present Primary Power alarm.
A value of Not Normal was reported for Power on 3/7/2013 9:18:31 AM PST
1
Attachment B
Scott Carroll
From: Alerts @mail.m2mops.com
Sent: Thursday, March 07, 2013 9:19 AM
To: Scott Carroll
Subject: Present Alarm: Costa Mesa - CMSD 23rd Street Pump Stat - Control Power Loss
Costa Mesa-CMSD 23rd Street Pump Stat
Present Control Power Loss alarm.
A value of Alarm was reported for Control Power Loss on 3/7/2013 9:19:07 AM PST
1
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*13 �o Attachment C Invoice
Pump and Control Specialists Date Invoice#
11161 Jeffrey Road I Irvine,CA 92602 3/11/2013 23682
T(949)770-7654 I F(949) 651-6043 -
Bill To
COSTA MESA SANITARY DISTRICT P E C F r ' y
628 W.19TH ST.
COSTA MESA, CA 92627 MAR 1 2 2013
ATTENTION:STEVE CANO GumA 5ANICARYOISTRIC1
Estimate# P.O.No. Rep Terms Due Date Date of Service Project
TIM HENSEN DB NET RECEIPT 3/11/2013 3/7/2013 23RD STREET
Hours-Qty Description Rate Amount
3 EMERGENCY CALL-LABOR RATE 153.00 459.00
ONE TECHNICIAN SAME DAY SERVICE.
FOUND INCOMING POWER VOLTAGE 272 VAC,NORMAL IS 243 VAC,
NO CONTROL PANEL
FOUND CONTROL POWER TO BE 138 VAC AND 10 AMP FUSE BLOWN;
FOUND NOT GETTING POWER TO#2 BLACK WIRE AT TERMINAL 8
IN MOTOR SAVER BASE.TECHNICIAN GOT CONTROL POWER BACK
WHEN MANUALLY PUSHING IN PUMP 1 START AND TURNED OFF
WHEN RELEASED.
MOVED#2 BLACK WIRE TO TERMINAL 1 WITH#1 BLACK WIRE,
BYPASSING MOTOR SAVER AND ALL CONTROL POWER WENT BACK
ON.PUMPS WORK IN AUTO,ALL ALARMS CLEARED.
) -"---agir— clalkAk
G.Acct
Cil Mot
-
Subtotal $459.00
Sales Tax(8.0%) $0.00
THANK YOU FOR THE OPPORTUNITY TO PROVIDE YOU EXCELLENT SERVICE. Total $459.00
Scott Carroll Attachment D
From: Steve Cano
Sent: Thursday, March 07, 2013 2:26 PM
To: Scott Carroll; robhamers
Subject: 23rd PS
SCE tech Troy called me and found out that the LC feed voltage regulator on the Edison pole was somehow at full boost
so not just our station was affected by this, but he said 3000 customers also was connected to this.The voltage coming
into our station was at 270, should be around 240. It was set back to 238 so we are good now.With the extra voltage,
the phase saver will not let the pumps come on. Right now, we had to jumper the phase saver and tomorrow Tony from
JIMNI will come and check the phase saver and see if it went bad due to the extra voltage.
Steve eaosa
Sewer Maintenance Supervisor
Costa Mesa Sanitary District
Phone(949) 548-7505
Cell (949) 281-6785
Fax (949) 515-1534
1
r
IMNI®Sy t.... �� Attachment E Invoice
Pump and Control Specialist Date Invoice#
11161 Jeffrey Road I Irvine,CA 92602 4/29/2013 23880
. T(949) 770-7654 I F (949) 651-6043
Bill To
COSTA MESA SANITARY DISTRICT
628 W. 19TH ST.
COSTA MESA, CA 92627
AT1 ENTION: STEVE CANO
Estimate# P.O.No. Rep Terms Due Date Date of Service Project
3798 TG NET RECEIPT 4/29/2013 3/14/2013 23RD STREET
Hours-Qty Description Rate Amount
2 LABOR RATE-ONE TECHNICIAN TO REMOVE THE FAULTY RELAY 170.00 340.00
AND INSTALL A NEW REPLACEMENT.THE TECHNICIAN WILL TEST
THE SYSTEM AND CONTROLS ONCE THE NEW MOTOR SAVER HAS
BEEN INSTALLED.
1 Three-Phase-MOTOR SAVER 136.20 136.20T
Voltage Monitor
Protects 3-Phase
Motors from:
•Loss of any phase
•Low voltage
•High voltage
• •Voltage unbalance
•Phase reversal .
•Rapid cycling
1 MOTOR SAVER 8 PIN SOCKET BASE 20.99 20.99T
1 COST OF OVERNIGHT SHIPPING/FRIG[-IT MATERIAL 60.00 60.00T
1 DESTINATION FEE-OC 45.00 45.00
Subtotal $602.19
Sales Tax (8.0%) $17.38
Total $619.57
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