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Home My WebLink AboutAGENDA - 11042008 - C.14 (11) . " CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY ti BOARD ACTION: NOVEMBER.04, 2008 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to j The copy of this document mailed to California Government Codes. you is your notice of the action taken on your claim by the Board of Jj C� Supervisors. (Paragraph IV below), QCT 0 1 2008 given Pursuant to Government Code AMOUNT: $159.84 Section 913 and 915.4. Please note all COUNTY COUNSEL "Warnings". MARTINEZ CALIF. CLAIMANT: RENE STOCKMAN ATTORNEY: UNMOWN DATE RECEIVED: OCTOBER 01, 2008 ADDRESS: 430 EDGEw00D LANE BY DELIVERY TO CLERK ON: OCTOBER 01, 2008 TRACY, CA 95376 RECEIVED FROM BY MAIL POSTMARKED: RTSu MANACFMFNT FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DAVID TWA, Clerk Dated: OCTOBER 01, 2008 By: Deputy II./FROM: County Counsel TO: Clerk of the Board of Supe isors QQ This claim complies substantially with Sections 910 and 910.2. /( `) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). O Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). . ( ) Other: Date I W v B County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( )/ Claim was returned as untimely with notice to claimant(Section 911.3). IV,! BOARD ORDER: By unanimous vote of the Supervisors present: (1/) This Claim is rejected in full. O Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated�a.. / 14'Be DAVID TWA, CLERK, By _Deputy Clerk WARNING (Go'v. code section 913) T� Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this matter.If you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side of Tbis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United.States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Datede� 4JWJV DAVID TWA, CLERK, By Deputy Clerk • 6' , +a This warning does not' „apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific rehef(suct ;as�mandamus or injunction, or Federal#Civil Rights claims. The above list is not exhaustive'-and legal consultation is essentialtoiund.erstand all the separate limitations period's that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of 'Iimif'ations applicable to actions not subject to the California Tort Claims Act BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY ESSTRUCTIONS TO CLAIMANT Pu /Oc GUCv�, A. A claim relating to a cause of action for death or for injury to person or to personal propertyor growing crops shall be presented not later than six months after the ac rual of the cause of action. A claim relating to any other cause of action shall be presented noV,,later than one year after the accrual of the cause of action. SFA �La (Gov. Code § 911.2.) �CP 2 B. Claims must be filed with the Clerk of the Board of Supervisors at its offiR&n Room 106, County Administration Building, 651 Pine Street,Martinez,CA 94553. C. If claim is against a district govemed by the Board of Supervisors, rather than the County, the nine of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each. public entity. E.' Fraud. See penalty for fraudulent claims; Penal Code Sec. 72 at the end of this f6rm. ■eaeeea eats■ee■tee■a■■NOR eaeeaeeceee■eseeuee■■eeeaREM KI RB: Claim By: Reserved for Clerk's filing stamp G G ia) RE EIVEIDOUN7Y I) Against the County of Contra Costa or j) OCT v 1 2008, `EP 2 3 20nA t,; F�R LERK'OARD OF SUVRI .,1 MANAGEMENT Distric CONTRA COS rA co. (Fill in the name) ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ /59 �`� and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) . . ,AUnv54-_ 22) 2008 01 :g0 AM 2. Where did the damage or injury occur? (Include city and county) M , �Sh Creciz Rd . 1/2 rr.; le be-Fore -v-t,e_ peer v(fA► Ict., 2d• �x� b• t <-cv-itw00o1 , CC)n+nrd CWn}j 3. How did the damage or injury occur? (Give full details;use extra paper if required) We- wcr(-- C6IICwi � 2 Ci � VUCk,-,s roC_V_ �eII- out. c�nd hc� S ({erccl 4 -)e "nc10W �ou� 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? worKers CCungl Ueh, Cie -yW1,O Were Shut n` GlCxcr� *1,� road . What are the names of county or district officers, servants, or employees causing the damage or injury? A b1 cyn d e mckr1 Who wc--\S Sf-L�r,06'1�) Wit h +h e y>o l o C c . He- -I-,b I of U5 -t) Cm ,-t c�k e-L -14-, e- CCLAn itl &-Rev- we_ eX01,�,nPd ccA��E . hc��p�nepl . �" � ,. �. � . � _ . . ,Y, 6�: -'.WL-at damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) Sk(Nl cr Pcl window (Sec regi 1pt 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) A-G-W c1 f CO S-e D F rc�y— S. Names and addresses of witnesses, doctors, and hospitals: tyk S+C)C k man 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT 012-5108 1-1 JA ! 5el No as a a a a a a ME i a am a a a s s a a a as f a to am a n t BE a a a as ass ME Kamm t a a on r a am mum a gala a a n a r a am a r a s a a a a ) .Gov. Code Sec. 910.2 provides "The claim shall be ) signed by the claimant or some person on his behalf." SEND NOTICES TO: (Attorney) ) Name and address of Attorney ) laimant's Signature) Ltzo t5 ;�Qoo-z w (Address) 1a AC�� CA 9 Telephone No. ) Telephone No. -LF+0 89 �9 MEN off m■am as a■■aacaa■n.asg■raaaaasmr■rrsgasasaasnaaa■■■ossaaansamsaaasaa■ ars a aaaaaast PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code, 55 6500 et seq.) Furthermore, any attachments, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. an gas mannas■■■a mama nota a a as mannum onsaonarna■■aaarnaaa as■mamas ugassgm■ no a■masssarl NOTICE: Section 72 of the Penal Code provides: Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city, or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account voucher, or writing, is punishable either by imprisonment in the County jail for a period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000.00), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000), or by both such imprisonment and fine. O 0000 . 06 �y N O 00 O p N00 6 CN } "i 77 C'1 m rn z: H N U v� W d A . p o H F�1 z ` A cs.. 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