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Home My WebLink AboutAGENDA - 11042008 - C.14 (12) i ' AMENDED ---CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOA CTION; NOVEPIBER .04, 2008 Claim Against the County, or District Governed b the Board of Supervisors, Routing Endorsements,y ) 14NOTICE,TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to California Government Codes. D on is your notice of the action taken n your claim by the Board of OCT 0 6 2008 upervisors. (Paragraph IV below), given your to Government Code AMOUNT: $1,000.00 COUNTY COUNSEL Section 913 and 915.4. Please note all MARTINEZ CALIF. "Warnings", CLAIMANT: DANIEL T. BROWN, SR. ATTORNEY: UNKNOWN DATE RECEIVED: OCTOBER 06, 2008 ADDRESS: P.O. BOX 1104 BY DELIVERY TO CLERK ON: OCTOBER 06, 2008 PITTSBURG, CA 94565 BY MAIL POSTMARKED: OCTOBER 03, 2008 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. OCTOBER 06 2008 DAVID TWA, Cler Dated: By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors (k>",�hislaim 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). ( ) 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). O Other: Dated: ��7�� By: _ Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) O Claim was returned as untimely with notice to claimant (Section 911.3). IV. ,dOARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dateg Ldd.W DAVID TWA, CLERK, By ` Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mail to Me 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 This 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. Dated.//01J. !S' -AWd'DAVID TWA, CLERK, By puty Clerk f. This warning does ,nofapply to claims which R,a{. are not subject to the California Tort Claims Act such as actioris1-h-46'verse coindemnation, actions for specific relief such'as~m'andamus or injunction, or FederaliCivil RightsUaims. The above list is not exhaustive and legal consultation is essential-to_understand all the separate limitations periods 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 limitafions applicable to actions not subject to the California Tort Claims Act 44 i 1 f BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY i INSTRUCTIONS TO CLAUVLANT A. A claim relating to a cause of action for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the'accnial of the cause of action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) f B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street,Martinez, CA 94553: C. If claim is against a district governed by the Board of Supervisors, rather than the County, the ' naive 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 form. an MENSMEMEMBASMUNEW ■ ■t a a t a a a a a t a a a t a a a t a a a a a am ata an a a am a an a a a am an a a am a a a am ME a a l RE: Claim By: Reserved for Clerk's filing stamp MCONTRACOSTACO- The Against the County of Contra Costa or ) District) (Fill in the name) ) The undersigned claimant hereby wakes claim against the County of Contra Costa or the above-named district in the sum of$ " and in support of this claim represents as follows: 1. '\k lien did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur?. (Include city and county) ice ) L.t%T i(niYL[) N1:- t Sti �^C.-ups' 1it t^lPrT1.�.(> 3. How did the damage or injury occur? (Give full details;use extra paper f required) � � SAt��-o-�y �t- 1'�\04� gun_ � uJ-A� vN C;�i`� w�n �kv,�. sny c�n_ F►�•r•�x� V; �wravaSY:G. �' M ",A,) 'J)Mw� MvcLL, -W)N' w"nt S 6 P. Wr \kArro,-� p,tv`p Oy�,,,00sb ;;�?5D �i�ed �-�i.�k�� A C.1\ve;�.�1;�i �..� �� i,i-:G', )i �-�rn-i.�tt �.�F'1•/�.� �:�::; 4. What particular act or orrussion on the part of county or district officers, servants, or employees caused the injury or damage? a 'vJ+'N� Al}l `�`\1 v� \ati .� ��v , 5 What are the names of county or district officers, servants, or employees causing the damage or injury? i.�'' 6. WL-z.t.damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) ,,X,C;f� 7. How was the amount claimed above computed? (include the estimated amount of any prospective injury-or damage,) y Z:i:-O J_ 8. Names and addresses of Aritnesses, doctors, and hospitals: le C�- pv NG voa;f. `a`� SY�YF� Ut' V1'k, w�'5 t%L YAYVtyT �� 1=►�-►-1 \S Q�Si`;n;l-��'L.'o ( �,'�S�,.J—N�..E s.s�, F�t�"ltit l��U(—� �°-G'i..:T►�c�i •'.�ii� 9. List the e pees ydd'�mxa �`t agoku�i df this ace? r�ju DATE TIME AMOUNT `p • a ■• a a■■\a a••a■a unman MINES ■ t■■\■\.\■.[[\■.■■\\\■■[■■\\■•\\■■[.[■■.tat\■\ ■■ t•■■•a■a■•■1 ) .Gov. Code Sec. 910.2 provides "The claim shall be ) signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney) . 1 Name and address of Attorney ) N ) (Claimant's Signature) (Address) c ) Telephone No. N' ) T elephone N �aS> � 1f�� ■ a a a a a a a t a a a t a a a man Ma■■ a ■ a■ \a■a a a a a a t a a t a a a a t a a t a a a a t a a t a a a a a■a■t a a t[■t a\ ...[....t a a i 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, §§ 6500 at seq.) Furthermore, any attachments, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■ a t a t a a a a a I a a a a t 0 a a a a a a . ■ a\a t a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a t a a\a a a a a a a a a a a a a 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 imprisonrnent and fine. bYr- #AAJ Z,04,m /7 VA'A-) Vkn,-Qr,r- DOI\- C)LAI M r-4L-:: 'oj -L,) 4, v.,Vl NO REFUNDS ON DEPOSITS j �•� �•NES• OR SPECIAL ORDERS NATIONAL CUSTOMER SERVICE PHONE# 800 321-2446 CUSTOMER MUST PRESENT COPY OF INVOICE FOR ANY WARRANTY I:PIVO I:(.;E: Salesperson GIGO •TIRES h15011 501.1 Date/Ti.me07/24/20618 1.1:30 AM lOH ABITi 1500 NORTH I'Altl; BI_'JCi illvlire TIC), `''011-.t49`,6 PITTSBURG, CA ?',`6 ' Of 0-1, Ho, 1 E977 (425) /LI2--391).3 Cust: F!o, 5911-245757 i WIT BROWN EPA No. CA1-0U0224679 f;AR wii, tf"if{i)( t s3:S4 PO PDX 11.04 Vehicle .1946 DODGE TRICK. Be500 'JA11 PrTT T+I�r:,6;} rG 445E5 ! VJ N 4 F.11g].lie V9-31.9 :.cl_ !.litit; iE License CA EDOV754 Odometer 194037 Color I t Customer Instructions: None Parl, NI-other Descriptin;i Empl hill. 1)t , FEl Each Extended LAI+ FI I. FRONT END INSPECIT011 JE17F 1.00 a.0a 0.00 POPPING NOISE REC 10.1SLIS RECOMMEIII) ^IiSPFN51:011 lirl,IIr;^ JEFF 1,00 0.00 0.00 I RECOMMEND REPLACE UPPER BALL JOINF51 f'`t'Ifl .T 1)I I:"I gr;1115, D!iAG LINK, AND FROI'IT SHOUTS EST. $1371.06 W/1AX i • I I I I I I I. I ----•----•---•-----•----•------------•-----------•--•----- - -------•---•------------------------'-�._.._..---------------------------,---.--- -•------------0.00 ------ - --- 4 Thank. you. for being a valued cif- Im tt r Paid By: Invoice Totals Mechanic Cart_. Ilu. 'Type Amount Farts I -----------•-------•----------------------------------------•------'---------------------------- ---------------•--------------------' JEFF TNUMPSON FET' 0,00 Core Chg 0.00 Labor 0.00 Sery Agreement 0,00 Waste Disposal 0,00 Shop SLlpplies 0.00 Sales Tax 0.00 ------------------ .......................... ------ Total: $ 0.00 I ACKNOWLEDGE NOTICE AND ORAL APPROVAL OF ANY INCREASE IN THE ORIILGII$INAL ESTram PRI : X OF TERMS:ODI F NECESSARY 70 ENSTI�UTE EGX. UNLESS A OTHERWISE IEDJ,FP7�F 'C OF ERCENTAGE HE AMOUNT DUE T S AC10/9WLEDGED 8 REC eD ev UNDER THIS INVOICE,BUYER AGREES TO PAY ALL NTNECESS9AARY COSTS AND ATTORNEY'S FEES. /� �M TIRES WHEELS BRAKES ,' KS STRUTS ALIGNMENT I , N •: o v M f q � y f�a