HomeMy WebLinkAboutMINUTES - 08301988 - 1.1 (2) CLAIM A110
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT August 30' 1988
,
and Board Action. All Section references are to ). The copy of this document mailed to you is your notice of
California Government Codes. } the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: Unspecified Section 913 and 915.4. Please note all "WarniId0llnty Counsel
CLAIMANT: VALARIE I. BAKER '�ilr 3 19$$
4827 Appian Way #6
ATTORNEY: El Sobrante, CA 94803Date received Martinez, CA 94553
ADDRESS: BY DELIVERY TO CLERK ON August 2 , 1988
BY MAIL POSTMARKED: no envelope
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
BATCHELOR, Clerk
IL B
DATED: August 3 , 1988 EVIL Deputy
L. Hall
11. FROM: County Counsel TO: Clerk of the Board of Supervisors
(�) 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).
( ) 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:
Dated: BY; Deputy 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 0 ER: 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. L�
Dated: AUG 3 0 1988
PHIL BATCHELOR, 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 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.
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 7-Notice to Claimant, addressed to
the claimant�+ass shown above.
Datad: JLP119� BY: PHIL BATCHELOR by >9LI'Z�ty Clerk
CC: .County Counsel County Administrator
r -
Cai�m- to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for death or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. Code §911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in
Room 1069 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 name 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
To_rm
RE:. Claim By ) Reserved for Clerk's filing stamp
RECEIVED
Against the County of Contra Costa }
or ) ; iJ lJ i
District) a�P
Fill in name) o h
By .C.. 'y
The undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $ �)Y;y. and in support of
this claim represents as follows:
-------------------------------------------------------------------------------------
1. When did the damage or injury occur? (Give exact date and hour)
Q 1 y>�— C2_0-------
2. Where did. the damage or injury occur? (Include city and .county)
3• How did the damage or injury occur? (Give full details; u'se extra paper if
required)
4. What _�articular act or omission on the part of county or district officers,
servants or employees caused the -injury or damage?,
(over)
5.'� lihat are the names of county or district officers, servants or employees causing"
the damage or injury?
-- -- - d�__ --- - ----------- ------ ---------------------- -----
6. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
__
____________________________________
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
AIL
Names
8. Names and addresses of witnesses, doctors and hospitals.
--- 1L.1 ---- =1-=------ --- ------------------------------------------------
.9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
S07 47
Gov. Code.Sea.,'910.2 provides:
"The calai�/%i st"be signed/by.the cla' t
SEND NOTICES TO: (Attorney) orb om person on his- lf'."
. Name and Address of Attorney ! ��
.. v
Claimant's Signature
(AddressW i
Telephone No. Telephone No.
N O T I C E
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 anycounty, 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 ($1,000), 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.
HILL I UP FVKV �.�r1rvrr+r� yr n�rrr,rri.a
' 3280 Auto Plaza
_ - R.O. NO. =
Phone 222-4444
RICHMOND, CALIF. 94806
Complete Service All Makes of Cars
NAME r ADDRESS JD4M
14/y
MAKE OF VEHICLE Y TYPE L ASNa
EJMIILIAGVIN NO.) _
-
INSURED.BY ADJUSTER INSPECTOR PHONE J c_:. i ---.. HOME !3 J -
�.3"
..... � � _.... ... BUSINESS�al �•.'��:7.. -
SyY. Labor PARTS; SYI Labor PARTS SyM. Labor
Hours Hours Hours.::
Bumper Fender lFender
Bumper Rail Fender Ornament Fender Ornament
Bumper Brkt. Fender Shield Fender Shield
Fender Mldg. Fender Mldg.
Bumper Gd. Headlamp Headlamp .
Frt.System Headlamp Door Headlamp Door
Frame Sealed Beam ISealed Beam
Cross Member Cowl Cowl
Door, Front Door, Front
Wheel Door Lock Door Lock
Hub Cap Door Hinge Door Hinge
Hub&Drum Door Glass Door Glass
Knuckle Vent Glass Vent Glass
Knuckle Sup. Door Mldg. Door Mldg.
Lr.Cont. Arm-Shaft Door Handle Door Handle
License Frame-Brkt. Center Post Center Post
Up.Cont. Arm-Shaft Door, Rear Door, Rear
Shock Door Glass Door Glass
✓ Windahield ` Door Mldg. Door Mldg.
Rocker Panel Rocker Panel
Tie Rod Rocker Mldg. Rocker Midg.
Steering Gear Sill Plate' Sill Plate
Steering Wheel Floor Floor
Horn Ring Frame Frame
Gravel Shield Dog Leg Dog Leg
Park. Light Quar. Panel lQuar. Panel
Grille Quar. Mldg. Quar. Mldg.
Quar. Glass Quar. Glass
Fender, Rear Fender, Rear
Fender Mldg. Fender Mldg.
Fender Pad Fender Pad
Mirror linst. Panel
Horn Bumper Front Seat
Baffle, Side Bumper Rail Front Seat Adj.
Baffle, Lower Bumper Brkt. Trim
Baffle, Upper Bumper Gd. Headlining.
Lock Plate, Lr. Gravel Shield Top
Lock Plate, Up. Lower Panel Tire
Hood Top Floor ITube
Hood Hinge l Trunk Lid Battery
Hood Mldg. Trunk Lock Paint
Hood Letters Trunk Handle Undercoat
Ornament Tail Light Polish.
Rad.Sup. Tail Pipe Misc..Materials
Rad.Core I Gas Tank AUTHORIZATION FOR REPAIRS
Radio Antenna Frame You are hereby authorized.to:make the above
specified repairs.
Rad. Hoses Wheel Signed _
<,
Fan Blade Hub&Drum Labor L Hrs. -
Fan Belt Back Up Lite Parts g S `
Water Pump Wheel Shield Wrecker Service $
Motor License Frame—Brkt. Tax $ 7� e-
Sublet $
A—Align N—Now OH—Overhaul S—Straighten or Repair EX—Exchange RC—Rechrome U—Used $ —fes
This estim to is based on to est possible cost qr� isten� frith uality work, and as such, is TOTALS �.`•
guaranteed.Items not covere�by this estimate ornftltlt�on well be ad ltional.
FORM ER-1002-NC 14-791
US.PHON PHONE RES:_
SCCClTyw IP
YEARC MODEL
..E�� PROD.DATE—----TRIM —MILEAGE— LICENSE NO.
WRITTEN Y, 'NS.CO.----FILE NO. CLAIM NO. P.O.NO
ADJUSTER . LIC.NO......_.. PHONE .-.
No.
DESCRIPTION,OF DAMAGEPARTS I LABOR I PAINT I ALL OTHER
W M4
a■■ # Lff
4jal
46
JMWUMM
I ■■®® ■ ■�
®®®®®®��
BEIMo■�■®■.i
DIEi si®■®■®■
iiMININE
i ®s■®ii�■®�
MINIM ®® ■mm
MININ
IMININ
MIEN! �i■�ii®■��
MININEENNEEN �■■��■�■�■■
®moi ■sio®■'®■os■
®ice mmENEEMENEENE
■ E■ME1
®moi ■®■i■■■®■�■■
■■■■■■I■
oii ■®■i=iii®�=:
o■■ INGRENR®■INEM,:
I hereby authorize the above work and acknowledge receipt of copy.signed X
C LABORf 510.-1hrs.@$ $
Shop Supplies
MARTIN : BUICK�PONTIA
PAINT
r..
1 Auto Plaza Paint Supplies $
Towing/Storage $
Hilltop - Richmond, California 94806
Sublet/Miscellaneous. $
• _ (415) 222-4141 SUB
TOTAL
�i L1
:,,
CLAIM //D
P,0ARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT Augu s t 30, 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: Unspecified �e;�f Section 913 and 915.4. Please note all "Warnings"
County Counsel
CLAIMANT: RICHARD MURRAY
203 Mt . Wilson Place AUG U 3 1988
ATTORNEY: Clayton, CA 94517 Date received Martinez, CA 94553
ADDRESS: BY DELIVERY TO CLERK ON August 2, 1988
BY MAIL POSTMARKED: August 1 , 1988
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
��IL BATCHELOR, Clerk
DATED: August 3 . 1988 : Deputy i
L. Hall
I1. FROM: County Counsel TO: Clerk of the Board of Supervisors
VThis 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).
( ) 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:
i
Dated: BY: i Deputy 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. BOA7) This
DER: By unanimous vote of the Supervisors present
( Claim is refected 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. ape /
Dated: A U G 3 0 1989 PHIL BATCHELOR, Clerk, By ?� Q/ 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 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.-
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: S E P I 1988 BY: PHIL BATCHELOR by Depu y Clerk
CC: County Counsel County Administrator
. , y
Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for death or for injury to person
or to personal property or growing crops and which accrue on or after January l, ,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. Code §911.2.)
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 name 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.
RE: Claim By ) Reserved for Clerk's filing stamp
RECEIVED
Against the County of Contra Costa ) res-
or )
District) OSB PHI P
Fill in name ) By
The undersigned claimant hereby makes 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:
-------------------------------------------------------------;
When did the damage or injury occur? (Give exact date and hour)
. 2. Where di the damage or injury occur? (Include city and county)
-----------rl i_�� � �'___LCU�11r _C a� CU�✓z i�)
3. How did the damage or injury occur? (Give full details; use extra paper if
required) l woS �,Lfi,)'n rrnu, OCxZSUrI aLIOZ down Ki(KP(r P4SS rok ,l Gn T��
Grave` s J�S"I ee� la�� 1,, -T�� en-r1re_ f o� UUa-S CvueYeA .
inl+t fl�crH �hC
T L-VC_.S Tfe,�,VQ in �f(�►�oxeTO- yo MPH. THEQ& cvc,S c-V,0Tr- Ca.f-. i'n e-
4.
4. What particular act or omission on the part of county or district officers,M�5 winA%� el,�
servants or employees caused the injury or damage? cl-T I�tisT
I sry planes.-�,��i
-e r Pew f"OtO w aS 7-co )()(Ds-e a CSN Ps il, TV Z
/ Ie�T�roh�3.en�F
ccs,
Mev i 1_ S`�rlc� `t�n0.c� �('U
AUTO M bpi`es J (over)
5. What are the names of county or district officers, servants or employees causing-
the damage or injury?
-------------------------- ------------------------------------------------------
5. What damage or injuries do you claim resulted? (Give full_ extent of injuries or
damages claimed. Attach two estimates for auto damage.
-------------
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
r:�1�M0.1�e5
---------- --- - - - -- -- --- _- - ------ -== _-=- ------
8. Names.and addresses of witnesses, doctors and hospitals.
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
Gov. Code Sec. 910.2 provides:
"The claim must be signed by the claimant
SEND NOTICES TO: (Attorney) or by some person on his behalf."
Name and Address of Attorney
AAA
~ Claimant's Signatqtq
m ► Lu
(Address)
c)n CA 9 Y �/ "?
Telephone No. Telephone No. �- 5 � �.
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 ($1,000), 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.
MIKE ROSE'S AUTO BODY INC. DBA
DATE
MAK YEAR
� 1
tFb DY STYLE CO
OD
MILEAGE LICENSE
r' �T
SERIAL NO.
686 -1739
INSURANCE COMPANY CLAIM
2001 FREMONT ST.CONCORD,CALIF.94520
A COMPLETE QUALITY PAINTING & REPAIRING SERVICE ADJUSTER PHONE
T I N G FRAME STRAIGHTENING - EXPERT COLOR MATCHING
NAME HOME# 67D-Spffl
WORK#
REPAIR REPLACE / ESTIMATE F REPAIR COSTS PAINT BODY PARTS SUBLET
1.
Z
PARTS PRICES SUBJECT TO INVOICE
J ?� ALIGNMENT
HRS. C $ Per Hr. $ ` 1
CHARGE AIC
PARTS $
") AIM HIL
PAINT MATERIALS $ 100
�I
SUBLET-PARTS $ 2250
STRIPE
SUBLET-LABOR $
STORAGE/TOW $ COLOR MATCH
SALES TAX $���i TWO TONE.
TWO STAGE
GRAND TOTAL '. j RocKGuaRD
THIS ESTIMATE IS BASED ON OUR INSPECTION AND DOES NOT COVER ADDITIONAL PARTS OR LABOR
WHICH MAY BE REQUIRED AFTER THE WORK HAS BEEN STARTED. AFTER THE WORK HAS BEEN
STARTED. WORN OR DAMAGED PARTS WHICH ARE NOT EVIDENT ON FIRST INSPECTION MAY BEQ
DISCOVERED NATURALLY THIS ESTIMATE CANNOT COVER SUCH CONTINGENCIES. PARTS PRICES TOTAL
SUBJECT TO CHANGE WITHOUT NOTICE.THIS ESTIMATE IS FOR IMMEDIATE ACCEPTANCE.
J & C BODY SHOP, INC.
2535 Monument Boulevard Jack Ar .
Concord, California 94520 any rmas
825-3800
Name
�, Phone — Z Date 2–Z G
Address ZG� ' V 1 7 r �� /�i,� I l C( nf �1 Insured by
Year 8 Makez,� Style6_tjQ_!_License y Motor No. Serial No. Milli"&
Symbol FRONT Labor Parts Symbol LEFT labor Parts Symbol RIGHT labor Parts
BurrQer .
Bumper Brld. Fender, Fit. Fender, Frt.
Bumper Gd. Fender Shield Fender Shield
Frt. System Fender Mldg. Fender Mldg.
From* Heodlomp Headlomp
Cross Member Headlamp.Door Heodlamp Door
Stabiliser Sealed Boom Sealed Boom
Who*I P Cowl Cowl
Hub Cap Windshield AD 0W Windshield
Hub A Drum Door, Front Door, Front
Knuckle
Knuckle Sup. Door HingeDoor Hinge
Lr. Cont. Arm.Shah Door Glass Door.Glass
Vent Glasi Vent Gloss
Up. Cont. Arm-Shah Door Mldgs. Door Mldg.
Shock Door Handle Door Handle
Spring Center Foil Center Post
Tie Rod Door, Rear Door, Rear
Steering Gear Door Glosi Door Glass
Steering Wheel Door.Mldg. Door MWg.
Horn Ring Rocker Panel Reber Panel
Gravel Shield Rocker Mldg. Rocker MWg.
Park. Light Floor Floor
From@ Frame
Rad. Grille Dog Leg Dog Lag
Oucr. Panel Ouar. Panel
Ouar. Mldg. Ouor. Mldg.
Quor. Glois Ouar. Gims
Fender, Rear Fender, Now
Fender Mldg. Fender Mldg.
Fender Pod Fender Pod
Name Plate REAR MISC.
Horn Bumper Inst. Panel
Baffle, Side Bumper Erle. Front Seat
Wills, Lower Bumper Gd. Front Seat Adj.
Baine, Upper Grovel Shield Trim
Led Plate, Lr. Lower Panel Headlining
Lod Plate, Up. Floor Top
Hood Top Trunk Lid Two % Worn
Hood Hinge Trunk Light Tube
Hood Mldg. Trunk Handle Battery
Ornament Tail Light Point .�
Rod. Sup. Tail Pipe Underraot
Rad. Care Gas Tank
Anti Freese Frame LABOR HOU ;6 t,9d
Red. Hoses Wheal
Fon Blade Hub i Drum PARTS
Fon Bell Ade TAX a .2)
Water Puna Spring TOTAL t3
Motor Abs.
Clutch Linkage
ADVANCE CHARGE
GRAND TOTAL$
A—Align N-New- OH-Overhaul S-Straighten or it EX- nge RC-Rednome U-For Used Part
Signed:
EifMATE EXPIRES 30 DAYS FROM DATE
CLAIM �
BOARC• OF' SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Cla-im Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT August 30, 1988
and Board Action. All Section references are to ). The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $60. 00 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: . LAURENCE BAILEY County Counsel
247 Campbell Lane AUG U 3 1988
ATTORNEY: Pleasant Hill , CA 94523
Date receivedrtinez, CA 9455;
ADDRESS: BY DELIVERY TO CLERK ON August 2 , 1qfi
BY MAIL POSTMARKED: August 1 , 1988
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
August 3 , 19`88 PpHHIL BATCHELOR, Clerk
DATED: g BY: Deputy
L. Hall
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
(� 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).
( ) 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:
Dated: BY Deputy County Counsel
I11. 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
( 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.
Dated: A U G 3 PHIL BATCHELOR, Clerk, By
_W- (�(.. �(,.�� , 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 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.
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: S E P 1 198S BY: PHIL BATCHELOR byWx4ze-4�5.puty Clerk
CC: County Counsel County Administrator
„ CLAIM T0: BOARD -OF SUPERVISORS OF CONTRA CO
ur kllu application to;
L` yZ Instructions to Claim t Clerk of the Board
P.O.Box 911
A. Claims relating to causes of action for death or rtinez.Cu y to94�r}3-� '
person or to personal property or growing crops must be. presented
not later than the 100th day after the accrual of the cause of
action. Claims relating to any other cause of action must .be
.presented not later than one year after .the accrual of the cause
of action. (Sec. 911. 2, ,Govt. Code)
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 , California 94553.
C. If claim is against a district governed by .the Board of Supervisors ,
rather than the County, the name 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 end
of this form.
RE: Clam by ) Reserve ,p stamps
RECEIVED
Against the COUNTY OF CONTRA COSTA)
. ) i or DISTRICT) CSE ”
oas
(Fill in name) )
B y
. The undersigned claimant hereby makes claim against the-County of Contra
Costa or the above=named District in the sum of $ p , ®Q
and in support of this claim represents as follows : -7
----------=---------------------------- -
---- ---------
-----------------
1. When did the damage or injury occur- (Give exact date and hour) -
�� Z. L. I-
1N JRl` AT G �U �v— Fww. 0,y-,
\ (b-
�uGc� �ci�.lituJ .°,i��i ,
U k L. -4.1
------------------------------------------------------------------------
2. Where did the damage or injury occur. (Include city and county).
(A Q i i k C v� ci 'l' q
3. How did the damage or injury occur? (Give full details, use extra
sheets if required)
67 LIkk% ( d.i \ �t � Rte GLLCtid�(9
-- ---- --- --- -- -------- -- --- ---- -- ------ " —----—�'—
4 ---
.---What----partic-- ular—act—or—omission—on—the—part—of—county—or— district
officers , servants or employees caused the injury or damage?
V-d.lL l�
(over)
What, ar.e..the :names of county or district officers, servants or , .
�1� ! emYloyees:: ca sing the damage or injury?
R t F f �`i c'C:
--- ---------------------------
-----------------------------------------------
6. What damage or injuries .do you claim resulted? (Give. full extent
of injuries or damages claimed. Attach two estimates for auto
damage); «p� ,,
r'At)I�t��C. 1C t
��w{ia.?C.�'� 4 �o�\-- ' �l(Ji\�.A:N.ti� P.i.1, ,-tJiL\•.
7How was the amount claimed above computed? (I.nclude the estimated-.
amount of any prospective injury..or damage. )
i
-------------------------------------------------------------------------
8. Names and addresses of witnesses., doctors and hospitals.
-------------------------------------------------------------------------
9 . List the expenditures you made on account of this accident or injury: .
DATE.. ITEM AMOUNT
c�
1.*i. F•**•k*'�•'k**�•i.'k*T•�T**'k******�F**T *iC*•�** C�•k i 'is T C**********'k*ai�•�' C�is 7c**is 7f***'k
Govt; Code Sec. 91 .2 provides :
; -__-'7he; claim sed y e claiman
SEND NOTICES T0: (Attorney) or\ by some p son n is ehalf:
Name . and Address of Attorney
Claimant' s Signature
N Address
Telephone No. t ' 1 �, i r - 3. Telephone No.
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, town, city
district, ward or village board or officer; authorized to allow or pay
the same .if genuine , anv false or . fraudulent claim, bill , account , voucher
or' writing, is guilty of a felony.
PRISONER PROPERTY INVENTORY/RECEIPT
PLEASANT HILL POLICE DEPARTMENT
DATE OF ll�y7 CASE NO.
NAME
OTY:'• VTEAA d DESCRIPTION
1 RINGISI
WATCH / Lr
NECKLACE
EARRINGS `
GLASSES
/. BELT
v� PENS/PENCILS
COMB
PURSE
WALLET
/ DRIVER'S LIC.
S CREDIT CARD(S)
KEY(S) /
Ss s rl
P SO R'S SI GN AT URE
PHPD OFF.ICERS SIGNATURE
JAILOR'S SIGNATURE PROPERTY RECEIVED
PHPD 095 WHITE-PRISONER 6 CANARY-PHPO II PINK-JAIL .
CLAIM /x/07
BOARD OF SUPERVISORS OF. CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT Augu s t-. 3 0, 3 9 8
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $60. 00 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: ULLRICH WILLIAMS County Counsel
91 Bay View Avenue (,;�� �� J 1988
ATTORNEY: Pittsburg, CA 94565
Date received Martinez 04553
ADDRESS: BY DELIVERY TO CLERK ON August 1, 1988 hand de
BY MAIL POSTMARKED: no envelope
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: August 3, 1988 gy?L BATCHELOR, Clerk
eputy
L. Hall
. I1. FROM County Counsel TO: Clerk of the Board of Supervisors
(V 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).
( ) 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:
is
Gated: BY ( _LDeputy County Counsel
I11. 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
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. �
Dated: A U G 3 O 'J��pv PHIL BATCHELOR, Clerk, By tx — 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 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.
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 andotice to Claimant, addressed to
the claimant as shown above.
9ato�: SEP 1 1908
BY: PHIL BATCHELOR by D ty Clerk
CC: County Counsel County Administrator
^LAIM TC:: . BOARD OF SUPERVISORS OF CONTRA CO%TtA SSS It1a1 ,
e ur i i application t0.
Instructions to Claimant Clerk of the Board
P.0.Box 911
A. Claims relating to causes of action for death or tor injury
.person or to personal property or growing crops must be presented
not later than the 100th day after the accrual of' the cause of
action. Claims relating .to any other cause of action must be
presented not later than one year after the accrual of the cause
of action. (Sec. 911. 2, Govt. Code)
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 , California 94553.
C. If claim is against a district governed by the Board of Supervisors,
rather than the County, the name 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 end
of this form.
RE: Claim by ) Reserved for k' iling stamps
RECEIVED
Against the COUNTY OF CONTRA COSTA; lip 7 ur, 1 988
�.
or DISTRICT)
(Fill in name) ) CLEA A T E O bps
..
The undersigned claimant hereby makes claim a.1 n y�of Contra
Costa or the above-named District in . the sum of $ Zl.�.
o
and in support of this claim -represents as follows :
---- - - - ------------------------------------------
1. W-h----en d-id--the---d-amage------or---in--jury occur? (Give exact date and hour)
-- -- --�1- --- ------ ------ -- - -- -- ---- -- ---
2. Whe is theamage or injury occur? (Include city and county)
-
- - -� -- --
3. How did the damage or injury occur? (Give . ful details , se extra
sheets if required)
-----------= zird�t/or ------------------------- - ------
4 . WhatParti omission on the part of county or district
officers , servants or employees caused the injury or damage?
' ✓ate G'�u-/--rte` �G�il/ C'�',��
1
(over)
5..:,:• What- ar.e...the.:names of county or district officers, servants or
employees:: causing 'the damage or injury?
�._
=-e= �� -- - ! -----------
6. - ---
What damage or injurie4- oyo laim sulted? (Give full extent
of injuries or damages claimed. Attach two estimates for auto
damage)
-------------------------------------------------------------------------
7 . How was the amount claimed above computed? (Include the estimated
amount of any .prospective injury or damage. )
K. —Ram—es and addresses of witnesses, doctors and hospi, ls.
�
9 . Listlthe expenditures you made on account of this acc ent or injury:
DATE ITEM AMOUNT
01 00
sr;o vo
Govt. Code Sec. 910 . 2 provides :
The claim signed by the. claiman
SEND NOTICES TO: (Attorney) or by some person on his behalf. '
Name and Address of Attorney
C1 a.i;
1aim s igna ure
dress
Telephone No. Telephone No. 7 __I)
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, town, city
district, ward or village board or officer, authorized to allow or pay
the. same if genuine , any false or fraudulent claim, bill , account, voucher
or writing, is guilty of a felony. "
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT Augu S t 30, 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: Unspecified Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: CITY OF .SAN RAMON - JOHN KULAK County Counsel
2222 CaminolRamon
ATTORNEY: San Ramon, CA 94583-1350 AUG 0 5 1988
Date received MEO"Z, CA 94553
ADDRESS: BY DELIVERY TO CLERK ON August 5 ,
BY MAIL POSTMARKED: August 2 , 1988
I. FROM: Clerk of the Board of .Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
PpHHIL BATCHELOR, Clerk
DATED: August 5 , 1988 BY: Deputy
L. Hall
II. F7) This
County Counsel TO: Clerk of the.Board of Supervisors
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).
( ) . 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:
Dated: BY: Deputy 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
(/This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Board's rder entered in its minutes for
this date.
Dated: A U G 3 U 10 PHIL BATCHELOR, 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 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.
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 an .Notice to Claimant, addressed to
the claimant as shown above.
Dated: SEP 1 1988 BY: PHIL BATCHELOR by A-�y Clerk
CC: County Counsel County Administrator
t CONTRA COSTA MUNICIPAL RISK MANAGEMENT
t
LIABILITY/LOSS NOTICE FORM
Use this form to report any incident or verified claim in which the city may be liable
PERSONAL AND CONFIDENTIAL IN ANTICIPATION OF LITIGATION
FROM: City of San Ramon TO: CONTRA COSTA COUNTY
(city or town) MUNICIPAL RISK MANAGEMENT
CITY CLAIM # 01 /$$— -- — Insurance Authority
policy yr. log number
1415 Oakland Blvd. - #215
DATE &TIME OF LOSS July 29 , 1988 Walnut Creek, CA 94596
Attn: Claims Manager
DEPARTMENT LOCATION CODE P___a
(up to 5 tetters)
'If.one incident has multiple claimants, use same claim If, but add letter suffix and enter each in log, i.e. AL001(A).
—y COMMENTS TO ADJUSTER
City' s contract for Police services
_�A
p
CLAIMANT/INJURED'S NAME ADDRESS P PRD
G�
John Kulak
r
2 Hopyard #39 , Pleasant A By 846-1448
CLAIMANT'S ATTORNEY ADDRESS PHONE
WITNESS NAME ADDRESS PHONE
James Jacoby 7501 Interlachen San Ramon 828-0366
CITY EMPLOYEE INVOLVED/CONTACT DEPARTMENT PHONE
Officers Hill and Douglas Police 866-1400
LOCATION OF OCCURRENCE 7501 Interlachen, San Ramon
DESCRIPTION OF OCCURRENCE/DAMAGE. Car towed as ahandon -d vehicle of p-r he i ng
egged w/72 hour notice to remove.
POLICE/CHP REPORT# S88-18993. CITY VEHICLE/DRIVER #
for enter"none')
ENCLOSURES: VERIFIED CLAIM POLICE REPORT ® PHOTOS
• (check it rncluaea)
OTHER
DATE f 1 f AS SUBMITTED BY Marr S VA i 1 PHONE NO. 866-1400
DISTRIBUTION:
Original to Geo.Hills Co. BCJPIA-LLN-10
Yellow Copy to Risk Manager
Pink Copy to City Claimq File
r�
Date: August 1 , 1988 San Ramon
C A t i f 01.1 A
TO: City Attorney, City Manager, Police Services y`0;r0.A T t0
t:;Assistant City„-;Manager �
From: CITY CLERK
Attached is the following:
Claim No. 010.88
Claimant John Kulak
1302 Hopyard #39
Pleasanton, .CA 94565
Date Received: July 29, 1988
NOTE: Appropriate department (dept. which is named in claim) to ..
conduct an initial investigation and report to City Attorney and-
Assistant City Manager within l5_ calendar days. from the date of
this notice.
jjm/claimfor,
- 1 -
• RECEIVED
JUL 29 1988
CLAIM AGAINST THE CITY OF SAN RAMON City of Sail ['=01
(For Damages to Persons or Personal Property)
Claim No. 010.88
A claim .must be filed with the City Clerk of the City of San
Ramon, 2222 Camino Ramon, San- Ramon, California within six (6)
months after the incident or event causing the loss or damage
occ-»red.
Name of Claimant i- n -AU1
Address x.36) Z 1* rG, 3 one
Send Notices regarding this claim to 0 0 O 7Z re 14 C16-
Time and Date of Incident 0,,2
Place (specific location)_ 79�1
Circumstances (specify the act or omission upon which you base
this claim in as much detail, to include a copy of any police
report)
IClC.S /�'I 1� �, olJ9/Y X40 f�P/?
7111
rJ 5 C' QFC s� �i/"/ CSL-i�f�.Yj•P ---�'
%5' O/7�Oj/7�1 �� 1,;e All
mss/ ��r �cr�c�5 art cU�rr Sc_
(Add additional sheet if necessary)
Name(s) of�,�Public employee(s) causing injury, damage or loss, if
known 171,
d.
CONTRA COSTA COUNTY SHERIFF-CORONER ABANDONED, IMPOUNDED, RECOVERED
LAFAYETTE❑ DANVIL.LM SAN RAMON A ORINDA❑ `STORED OR RELEASED VEHICLE REPORT
CRIME i: !-..;,.s]-BEAT . DATE FCNN CASE FILE•
TYPE OF REPORT(CHECK ONE) IF A RFC VERED STOLEN VEHICLE,HAS NEIGHBORHOOD OR AREA BEEN CHECKED FOR
❑ABANDONED ❑IMPOUNDED. STORED LEADS OR CLUES?
13 ABATED ❑AECOVEAED RELEASED ❑YES ❑NO (LIST LEADS OR CLUES IN REMARKS OR SEPARATE SHEET)
PERSON REPORTING.00CURRENCE ADDRESS PHONETIME AND DATE
REPORTED
DESCRIPTION AND OWNERSHIP
YEAR MAKE MODEL BODY LICENSENUMBERIS) .. YEAR STATE COLOR(COMBINATION)
i
"
o oO 9
VEHICLE IDEFITIFICATION NUMBERS(VIN) _ DOES VIN COMPARE DOES VIN APPEAR IS VIN CLEAR IN LIC.NUMBER(SI ENGINE NUMBS ) - -
T WITH REG CARD? ALTERED? TEM? CLEAR IN SVS7
SYS _
.l :•y; '.
❑YES ❑NO ❑YES J��Q�NO YES ❑NO. YES ❑NO
�' •v`�" '/J •. •OD UNKNOWN
IF STOLEN NAME.DATE AND CASE NUMBER OF REPORTING AGENCY WAS AUTHORITY
VEH.RETURNED TO STORAGE AUORITY •.
t�> �.. ' r ''.. .:. .:•..:.:i .L :;i.-;'. �. OWNER?
� .. YE
v.
LOCATION TOWED FROM A. - ;.;.L A' ..r',::•. `WHERE STORED'1'• TIME AND DATE TOWED .
fi
3 i N1D
7 /q
4�
¢'...� NAMyE�OFGARAGE :..:.. i..., ;r.'.;!';C. r ,'L.f:, ADDRESS PHONE
ow. J� C w 6 ??8
REGISTERED OWNER ADDRESS PHONE ;s.,e
_ \ t. ..
SDI
•1�.
OWNER ADDRESS PHONE
4
CONDITION AND INVENTORY
C,DOLIETER READING DRIVEABLE1 WRECKED? STRIPPED?
I HAVE YOU ENTERED MISSING,IDENTIFIABLE
+ T1 ❑YES ❑NO UNKNOWN VES ❑NO ❑YES ONO PARTS IN SVS?
'0 YES 0 N
ITEMS YES NO ITEMS YES NO ITEMS YES NO ITEMS YES NO ITEMS CONDITION
(� T-mwwheeis
Seausr But►et Clock Engine TnnvnasronIle
Sea!tFronn Ignition KevCa,bwelorls) Y Autornatc I 1 116— Loll Front /J
Seal tRear. Reg.stralron Alternator v 3-Speed 1 1 Right Front r
1 '
Radio Ii Dr Lights 1• 1 V Generator 4-Speed Left Pear /
Tape Dec. S Muror(%I a ) ` Bauery Hub caps 1• 1 !/ Right Rear
Tapes la I Gnll Av ConOrtioner Mag Wheels SDare
LIST PROPERTY,TOOLS.AND DESCRIBE VEHICLE DAMAGE IN REMARKS SPACE
' REMARKS IIF ARREST MADE.INDICATE FULL NAMES.CHARGES AND WHERE DETAINEDI(USE ADDITIONAL BLANK SHEETS.IF REOUIREDI
711 e
`(
I '
OZL ') �g
L\
42�rAe
OFFICER ORDERING VEHICLE STORED REVIEWED BY /6 oopf
GABAOR AGENT =11TURE, TIME ANO DATE
FOR OFFICE USE ONLY APPRAISAL,R
RECOVERY TELETYPE(DATE AND REOUIRED NOTICES SENT TO REGIS- VEHICLECHECK/PARKING WARNING SAT
NUMBER) TERED&LEGAL OWNERS&GARAGE
(SEC 22952) 13 YES
❑NO
IF NO IS CHECKED.INDICATE REASON❑AVA PROGRAM DATE TIME n OILY OF%VEEK
t9
APPRAISED TIME AND DATE 'YE)RDE G 7 nAT>
VALUE OF APPRAISAL
APPRAISING OFFICER'S SIGNATURE I.D.NUMBER YF1W OF VLN. MAIC �J
SEC.22704 vC
+ RE95TERlTJ CjFh&OR LESSH
ROUTETO CRIME vs CORONER OTHER t
PERSONS. 1 AODfM OF OINMEA OR Ieeess57
CRIME vs SPEC SVCS PATROL
PROPERTY ` WCATIN OF W gCT 5►VIOLATED ,r
SEC, oMIL
PF-9 REV.1186 / 10 MO
S R.P D FOOL
R . ._. CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT August• 3 O, 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action. taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: Unspecified Section 913 and 915.4. Please note all "Warnings".
4JOUoty Counsel
CLAIMANT: KATHERINE D. NOBOA
22 Amador Ave. 5 1988
ATTORNEY: Oakley, CA 94561-1274
Date received i� .:: it18Z, CA 945:.
ADDRESS: BY DELIVERY TO CLERK ON August 4, 1988
BY MAIL POSTMARKED: August 3 , 1988
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: August 5 , 1988 RyIL BAATTCYELOR, Clerk
epuL. Hall
11. FROM- County Counsel TO: Clerk of the Board of Supervisors
( ) 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).
( } 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:
Dated: �" BY: Deputy 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 0 DER: By unanimous vote of the Supervisors present
( This Claim is rejected in full.
( ) Other:
1 certify that this is a true and correct copy of the .Board's Order entered in its minutes for
this date.
.-
AUG 3 0 198 � �
Dated- PHIL BATCHELOR, Clerk, By �beputy 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 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.
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. �f
Dated: SEP 1. 1988 BY: PHIL BATCHELOR by Gti _Deputy Clerk
CC: County Counsel County Administrator
Claim to' w BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. Claims relating to causes of action for death or.-for injury to person or to per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for death or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. Code §911.2.)
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 name 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.
RE: Claim By ) Reserved for Clerk's filing stamp
n
)
RECEIVED
Against the County of Contra Costa ) �o ki:"J
or )
Ko r! ��'s District)
AT ELO sons
Fill in name )
CLEn NTR
By ` poly
The undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $ �5 E E �t°s and in support of
this claim represents as follows:
-------------------------------------------------------------------------------------
1. When did the damage or injury occur? (Give exact date and hour)
----- ha i-� --1 �- -`� -------- = - -----------------------------------
2. Where di- the damage or injury occur? (Include city and county)
3. How did the damage or injury occur? (Give full details; use extra paper if
required)
.17LA.>Ck6 9a i nq c1o�c1 l�wy 4 �rorn Ou+c1�c� a Sher:-F'�S
wus ti n -the op�iS� �2 d�r�c�icbz YIJz 'hurrec} h;s I,gh-�� �hd I rem Go-)
Maw w:c3.� u-Ztira Sn Yn C G r
--- --�----s_sr_S�J� ---------
4. What particular act or omission on the part of county or district officers, w ds►,�cl
servants or employees caused the injury or damage?
whe.r� ! her made_ Ck v - �rN i -he c� r�t,,ej i n �1^ew
roc lc cx.� �"�� `�` cinrack.e d my u-, n G3A"o A
(over)
5. What are"the names of county or district officers, servants or employees causing
the damage or injury?
e1 ;d gea -��r.e rrne o �h� po1�c¢
con a CA-\\ 0.r d+ �� t� n0
wcx n 40n �r-�
5. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two esti tes for auto damage.
h�e1�
-------------------------------------------------------------------------------------
7. How was the amount claimed above computed? (Include the estimated amount of an
prospective injury or damage.) sD r Cv M �-'-
fjCE
-------------------------------------------------------------------------------------
8. Names and addresses of witnesses, doctors and hospitals.
p,ri e. M C-ay
------------------- ----------------------------
9. List .the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
c A-Cs Fy-' M 6A Rvsc 4- Sons
St lass C o
`^
Gov. Code Sec. 910.2 provides:
"The claim must be signed by the claimant
SEND NOTICES TO:- (Attorney) or by some person on his behalf."
Name and Address of Attorney ,
Claimant's Signature
- �� �►�,�,�.�� ��. ���� ahs ia-��
Address
�l�tele auSQ-I
Y�
Telephone No. Telephone No. �e.SS� t Yeo rtx-
�t
N 0 T I C E
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 ($1,000), 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.
17 Delta Glass
101 Railroad Avenue
Antioch, California 94509
(415) 757-5300
G
DATE O 19
NAME /�,Q 2 c. r. C. ,P�l✓�` y.�--
ADDRESS PHONE NO.
JOB LOCATION / PHONE NO.
INS. CO.
ON / DESCRIPTION AMOUNT
t,
i he, cl m5 k'-� 1 h;s
c.t.,:nc� SY��etc1,
And i�
NU)rnCLAC(,eCS
'T he A5 C O S
0 d
ESTIMATE
G. ROSE & SONS GLASS Co. Date.
. . . . . . . . . . . . . . . . . . .
230 Chestnut Street
Brentwood, CA 94513
(415) 634-5609
To Co
Address. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
•elm--
,2
/ 7, 77
r K 7. 4-4'42
Total Materials
ESTIMATES GOOD FOR 30 DAYS
Labor . . . . . . . .
Tax . . . . . . . . . .
TOTAL . . . . . . .
CLAIM 116
Or SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT August 30 , 1988
and Board Action. All Section references are to } The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $1, 009. 06 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: CSAA - CARL SERFASS county Counsd
P. O. Box 4019 !.:+1 ri U 5 1988
ATTORNEY: Concord, CA 94524
Date received Au ust 5 198g,l linez, CA 0455;
ADDRESS: BY DELIVERY TO CLERK ON g
BY MAIL POSTMARKED: August 4, 1988
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: August 5, 198$ PpHHIL BATCHELOR, Clerk '
BY: Deputy
L. Hall
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
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).
( ) 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:
Q i
Dated: U S BY:.41Deputy County Counsel SJ..0
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
( V 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.--
Dated: AUG
3 0 1986 PHIL BATCHELOR Clerk BX_ ,t ���' , 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 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.
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.
n SEP 1 IM BY: PHIL BATCHELOR by �A y Clerk
'J'�tp�:
CC: County Counsel County Administrator
Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO Q AIM1L
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before December 319 1987,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for death or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. Code §911.2.)
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 name 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.
it
RE: Claim By ) Reserved for Clerk's filing stamp
_L
Q Ck C
C� s_��� �AsS)
RECEIVED
Against the County of Contra Costa ) G �
or )
District) CLER NT AT OAS
Fill in name )
By .. .�.
The undersigned claimant hereby makes claim gainst0 the Pounty of Contra Costa or
the above-named District in the sum of $ and in support of
this claim represents as follows: �p"" �, I
----------------------------------!`W' '-�I- ------- --
1. When did the damage or injury occur? (Give exact date and hour)
--Q - fl O" ------CL ---Q_IIn aLn, --------------------
2. Where did the damage or injury occur? (Include city and county)
o.�0
r ----ab--- �- -�0�=--5 .11 -�--------
3. How did the damage or injury occur? (Give full details; use extra paper if
required) 0 U� V � he�,O �,b .Qjib
J ----------- ----
G1�n
Qc
u. What particular act or omission 'on the part of county or district. officers,
servants or employees caused the injury or damage?
(Jon
(over)
5. What are• the names of county or district officers, servants or employees causing
the damage or injury?
-------------------- -------------------------
5. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
---0,-IaA- n___Q
7. How was the amount claimed above computed? (Include the estimated- amount of any
prospective injury or damage.)
-- "-�--= =---�,-- ''-1----------- ------ ------ ----------------------
Names
----------- -----
Names and addresses of witnesses, doctors and hospitals.
9.- List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
�baSv•oma
Gov. Code Sec. 910.2 provides: .
"The claim must be signed by the claimant
SEND NOTICES TO: (Attorney) or by some person on his behalf."
Name and Address of Attorney
-CS 1kP
Claimant's Si ture
Address
cQ
Telephone.No. Telephone No.
N0TIC.'E.
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 ($1,000), 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.
C
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.:r'r
~~ . ESTIMATE OF REPAIF
i
' PARKER-ROBB CHEVROLET
1707 No. Main St: • Phone 934-4481
WALNQT CREEK, CALIFORNIA 94 96
ADDRESS PHONE GATE
YEAR MAKE MODELLICENSE NO. SPEEDOMETER SERIAL NO.(VIN NO.)
5430 EC09101
INSURANCE CARRIER ADJUSTER ,• PHONE VEHICLE LOCATED AT
OPERATIONS PARTS LABOR
i
i
S1 Df C' 9D
` - � �� iJc� C►I�7Vr�t ` � ,rI � 1� S 7 , �
SIL '� S
?
7v
t�-p A
tlg� ACa' a'
NA? A
Lr
TOTALS C�
INSURED PAYS $ INS.CO.PAYS R. 0. NO.
INS. CHECK PAYABLE TO-----
The
O The above is an estimate, based on our inspection, and does not cover additional parts or labor which TAX
may be required after the work has been opened up. Occasionally, after. work has started, worn,
broken or damaged parts are discovered which are not evident on first inspection. Quotations on
Darts and labor are current and subject to change.
TOTAL OF
:ST. MADE BY ESTIMATE 1
AUTHORIZATION FOR REPAIR. You are hereby authorized to make the above specified repairs to the vehicle described herein.
i C 'J
,IGNED DATE
8614637JER 811 NORICK
' . �.i.le�As p ,tan .2'0
Califorra State Automob ?-,
TE
OF LOSS
•�, �_.,y i':': ".: � in=:�. .�
KIND X
L.41 d-...
77
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F.
M.O.COPY ..
1
WE FEATURE FUTTD B 01HER FINE CARS TERWAY CAR RENTAL CONTRACT NO.
CUSTOMER COPY: IN Trucks a Pick-ups a 4-Wheel Drives RENTAL,INC.
7-12-15 Passenger Vans C 6 dba )%rCA;I,,: RENTAL
Make Nle VEHICLE UNIT NO. LICENSE NO. DATE DUE BACK CAR N1
TIME
1 _ i♦ DATE IN
Make Q VEHICLE UNIT NO LICENSE NO.
TIME
LESSEE NOTICE DATEOIJT. ;.
._; :.:. '.I•:�'.:.� .t"�'���...
t .
RENTER RESPONSIBLE MILES IN
L r j
HOME ADDRESS FOR ALL _
E f / :( PARKING TICKETS MILES OUT
CITY STATE 8 ZIP CODE PHONET
MILES
S / CAR#1
LOCAL ADDRESS, ,• CITY PHONE CAR N2
S TIME
I v'DATE IN
E DRIVER'S LICENSE NO. STATE EXPIRATION DATE TIRTHDATE '
TIME
E EMPLOYER——. PHONE — — DATE OUT .
IMPORTANT NOTICE."CDW'
CONDITIONAL COLLISION DAMAGE WAIVER MILES IN
T CO-LESSEE/ADDITIONAL DRIVER
C C.D.W.does not cover overhead damage(above cab
l.. level)on our parcel box vans and C.D.W.does not cover MILES OUT
O L. tire chain damage.You are fully liable for all collision
?IDOTIEn and/or comprehensive damage,loss of use and/or MILES
down time to our vehicle(unlimited),regardless of CAR#2
negligence.Said damages are calcalculated as agreed
L -- -- — on the reverse side of this agreement.You can reduce MILES '
CITY ,• ! 1 AtATE&ZIP CODE your responsibility totembynot violating this contract CAR 81
E
S -: and paying S .per day or traction MALES
DnivEn'S LICENSE tiO STATE therol.
S ; r OUR LIMITED COLLISION DAMAGE WAIVER ILY
_ ! IS NOT INSURANCE
E PROtdE' --'- :IQ
EXPIRATION DAT E BIRTHDATE I ACCEPT I DECLINE V WEEKLY
E
• ' X +` X ���- MONTHLY: ;.
[1ETE -D BY COMPANY YxES PERS014 OPTIONAL '
I I NO 'PERSONAL ACCIDENT COVERAGE(PAC)
By Initlals,renter declines or accepts P.A.C.11"Accept; MILES -+ ®„ I(V
LESSEE AND/OR CO-LESSEE ARE FULLY AND JOINTLY RESPONSIBLE FOR ALL CON- renter accepts coverage at rate shown and acknow- DRIVEN
TRACTUAL OBLIGATIONS SET FORTH IN THIS AGREEMENT INCLUDING BUT NOT LIMITED ledges to have read coverage document which Is OVERTIME
To ALL COSTS,CHARGES AND DAMAGES INCURRED UNTIL SAID VEHICLE AND KEYS written by an Independent Insurance company. PER HR.: $ /. ! ,•:
ARE RETURNED AND IN AVCAR RENTALS POSSESSION.I/WE AGREE TO RETURN VEHI• THIS IS NOT LIABILITY INSURANCE ��TIME AND
CLE BY DUE BACK DATE OR UPON DEMAND.VINE HAVE READ AND AGREE TO THE TERMS I ACCEPT 1 DECLINE MILEAGE CHARGE
ON BOTH SIDES OF THIS AGREEMENT.I AUTHORIZE THE USE OF MY CREDIT CARD TO
FULFILL MY CONTRACTUAL OBLIGATIONS. X r
LESSEE
X . SIGNATURE IMPORTANT NOTICE
1.All contracts subject to final audit. SUB TOTAL l(
CO-LESSEE 2•Vehicles must be returned m original landing office or a `
recovery fee will be charged. DROP OFF CHARGE
X SIGNATURE 3.All traffic violations are the responsibility of the rentet OR RECOVERY FEE
4.Mileage reading taken from factory Installed odometer.
CUSTOMER HAS S Clean-up charge on any vehicle brought back exceptional. CDW(Per Day)$
INSPECTED THE ly dirty. _
VEHICLE AND 6.You must gat our permission to make repairs,NO .
UPON EXCEPTIONS. PAC(Far Day)$•',
CO 00 ACCEPTANCE 7.Lessee Is responsible for theN and/or vandalism of
1ehlcle
ACKNOWLEDGES
a
THAT ALL Authorized drivers most M mu25 yre or older and have a valid8uldsnye
drivers license and be listed on contract. r
DAMAGES,IF 4 If you violate Nre contract your trrsurance win be primary. RATES DO NOT NO REFUND
ARE NOTED 10.All conlracts must be renvred and all vehicles m- INCLUDE GASOLINE off FU
HEREON. spected every 30 days with NO EXCEPTIONS.
00 QAS
^c" WARNING v.
�• 11 you do any of the mllowlnp you rill be In dolati n at Lets E F ,..
contract forfeiting all rights and coverage Including all op•
Ilonal coverage. NO •/
❑NO DAMAGE 1.Allow anyone not tullrmped by this contract to drive the CHECKS T CHARGE.
P.O NO. I DEPT. I PERSON vehlcle. '
2.Driving alter drinking ANY alcohol or taking ANY drugs. LESS DEPOSIT
3.Take the vehicle outside(his stale without written
4.JOB NO S DDriving the vehicle onsskly,Inc Includes speedon any unpaved surface,NO ing,reckless NET DUE TERWAY CAR
RENTAL INC. dba AVCAR RENTA
. -------.........
driving,etc _.
— --... - ..... .-............ . . .. _...... — !
6.Failure m promptly report(within b boon)andlai NET DUE LESSEE i" /•
T.A./T.P. cooperate with fusion,In Investigating accidents.
7.Failure to remove keys from the seated vehicle while CHARGED
snsttended by lessee.
CO. E Giving or leaving keys accessable to any unauthorized s
driver' pony VISA Check �aveler's
Co
ADDRESS WE SELL OUR VEHICLES eck
(415)459-5090 AM x Discover Diner's Carle
CITY 8 ZIP ..• Blanche BY
AVCar Offices ❑S.F.AUTO CENTER LJ NOVATO E BERKELEY/U.C. Cl SAN RAMON ,
16th a Bryant Streets (415)898-5600 Oxford E University DUBLIN/PLEASANTON/ THANK YOU FOR YOUR PATRONAGE
n S.F.DOWNTOWN (415)861.7866 (415)845.1306 552 Alcosta Mall
440 O'Farrell Street 0SANTA FIOSA/ AVCAR RENTAL INC.
(415)833.8601 s
(415)441-4779 J SAN RAFAEL SONOMA :1 j.OAktnp� P.O.Box 2339 San Rafael,CA 94912-2339
780 Andersen Drive 405 Sante Rosa Avefiue 3074 9Toadwa ❑VALLEJO/NAPA
Ll SOUTH OF MARKET (415)459.2700 (707)575-1600 (415)451.6333 1260 Georgia Street THIS NUMBER SHOULD APPEAR ON ALL
229.71h St. /. (707)648.1186 CORRESPONDENCE
(415)621-8989 ❑GREENBRAE/ LI BERKELgY 0 CONCORD/
CORTE MADERA 2nOO Fifth Strt2et WALNUT CREEK TT FAIRFIELD/VACAVILLE
I'LIVERMORE 2130 IledwOod Highway. (415)540-6920 1125 Detroit Avenue 1200 Oliver Road RENTAL
(415)449-6700 (415)461.4855 . . (415)671-3774 (707)42S-2522 CONTRACT 111062
TATE 0►CAUPORNIA ,
TRAFFIC COLLISION REPORT PAOE ZOF
SPECIAL CONDRIONB ' WL4rm MIT A RUN CITY K DISTRICT NUMBER ,
a Fc❑r � ,,
MO C � +f E R�Tp1Y i
_
COL N C l Am P w W-51
REfD DAr
_�_ ���_
Z _ _ ___ .
(POST INFORMATION D P WETOW A Y MM
OTOO /NS BY:
F
OF ME.EPOB7 S 1; E EK F S 1:1 YES NO
R'3T/MEEB
u
BIlk Rfl.a
oR: RETIi or rw NO NONE
)ARTY R�LIc S�NWBER / TE c B s ' v )R. '�RE/MoogL/00 0 EN NyY STATE
D '
I.MIgDDLLEE.Lag 5 ["�/{//��J . .
wa< - 4&i .
PFDES
ADOR
fT1 W LJ ES(IJ!.J/1 'I/ fJ / `{JB.f-yi O 'Eh7M �I06ZJAJ-r---1
TRAM
�A 1:1 ClTY' AT /21P /� �( O R'S E> r1 SAfA[AS WdVER
/ENICII[
BICY• SE N S M NT WW/((I/G\\1R RTM1DA MCE DISP�RIONJ/OF VEM`CLE(O/�N/pARDE'RS 0►: ❑OFFICERDNVFR ❑OTHER
CUSTOTHER HOME PHONE BU SS �J(J/� PRIOR MECHANICAL DEFECTS: NONE APPARENT REFER TO NARRATIVE
❑ �-t! 3� ' LJ F�� CHP USE ONLY DESCRIBE E E DAMAGE $MADE IN DAMAGED AREA
VEHICLE TYPE
NCE CARRIER. / UCY NlWBER /!\3 WK
LJ+ ❑ E MN011
Y0Q ❑MAJOR ❑TOTAL
D10.OOH R TOR WGHWAY SPE ICC ❑ '
YE u S n�rlL)40
\j sm PUC13
IgLTy ER5 LIC2 NUMBER
U � MODEL/ C� uS
LASS
E� ATE
2D IC
NEDRyR RMIS,LAS ` I /
,ffgbA
PEDES- ST ET AD ESS OWNER'S NAME ��SMAS AS DRIVER
o � 9"-18QJ4 yL7-
'ARKEO CRY7XAAATEE IZIP� /) / I l/�J�_` OWNER'S ADDRESS SAME AS DRIVER
EHci
ICIE �OJ.r�I V V I {�1..i!
SICY- g( R ES HECLIST IGHT W BIRTHDATE RACE DI ON FVEMC ON R MOF: ❑OFFICER DRIVER �OTHER
OTHER NDI�f �E ^ i ^ _4I W-r)
OyF� �(' PRIOR MECHANICAL DEFECTS: NONE APPARENT EFER TO DAMAGED
A
E�E{/•1}/.� C(X]/ —rfl�'�".lJ/ (xU/ '/1/ " CMP USE ONLY DESCRIBE VEHICLE DAMAGE 6MI1DE N OAMACED AREA
NSURANC RaIER POLICY NUMBER / VEHICIf TYPE
otik{,// lRK 1:1 NONE MINOR
,. a MOD. [:]MAJOR TOTAL
PCF ICC ❑
pR. '
VE IV 1 , r1 D J 1 PUC ❑ .
CNP [3
'ARTY DRIVER'S LICENSE NUMBER STATE fLA55 SAFETY EGMnP. VEM.YR. MAKE/MODEL I COLOR UCENSE NUMBER RAT[
3
. . . . . . . . . . . . . . . . . .; . . . . . . . . . . . . . .
DRIVER NAME(RBST.MIDDLE.LAST)
❑ I
PEDES- STREET ADDRESS OWNER'S NAME ❑SAME AS DRIVER
TRIAN
HARKED CITY/STATE/IIP OWNERS ADDRESSr'SAME AS DRIVER ,
/EMCLE u
BICY- SEK HAIR (YES HEIGHT WEIGHTBIRTHDATE YEAR RACE DISPOSITION OF VEHICLE ON ORDERS OF: ❑OFFICER _]ORIVER ❑OTHER
CLHIT MO. DAY
OTHER HOME PHONE BUSINESS PHONE, PRIOR MECHANICAL DEFECTS: NONE APPARENT ❑ REFER TO NARRATIVE ❑
( ) ( ) CHP USE ONLY DESC IEEE VEHICLE DAMAGE SHADE N DAMAGED AREA
VEHICLE TYPE
INSURANCE CARRIER .-POLICY NUMBER ❑UAL NONE ❑MINOR
❑MOD. O MAJOR .❑TOTAL
DMR.OF ON STREET OR.MIOMWAY SPEED PCF ICC ❑ '
TRAVEL LIMIT ❑
vuc
CHP ❑
@EP sNAM J� r DISPATCH NOIFIED REVIEwE AME JDATErR'EVIEWED
❑YES E3NO• WA �. '-i—� �
HP.555-Page 1 (Rev. 7-67)OPI 042
TRAF H C COL •ISION CODING- PAD. WV
)ATE oTIME I 1 �� GJ ` �4 .
YO. DAY 1•'Aq
El0tS�CftPTIO-:N:0:FDAM:AG
APROPERTYDAMAGE /
SEATING POSITIONOCCUPANTS SAFETY EQUIPMENT /cacyc�-NELMEi EJEQTED FROM VEH.
1-DRIVER A-NONE W VEHICLE L-AIR BAG DEPLOYED 0-NOT EJECTED
2 TO 6•PASSENGERS B-UNKNOWN M•AIR BAG NOT DEPLOYED DRIVER 1-FULLY EJECTED
7-STA.WGN-REAR C-LAP BELT USED N-OTHER V.NO 2-PARTIALLY EJECTED
•-RR.OCC.TRK-OR VAN D-LAP BELT NOT USED P-NOT REQUIRED W•YES S-UIOLNOWN
•-POSITION UNKNOWN E•SHOULDER HARNESS USED
1 2 3 0.OTHER F-SHOULDER HARNESS NOT USED CHILD RESTRAINT PASSENGER
4 5 6 G-LAP.ISHOULDER HARNESS USED Q•IN VEHICLE USED X-NO
N•LAP/SHOULDER HARNESS NOT USED R•IN VEHICLE NOT USED Y-YES
7 J•PASSIVE RESTRAINT USED S-IN VEHICLE USE UNKNOWN
K-PASSIVE RESTRAINT NOT USED T-IN VEHICLE IMPROPER USE
U-NONE IN VEHICLE
ITEMS MARKED BELOW WHICH ARE FOLLOWED BY AN ASTERISK(•)SHOULD BE EXPLAINED IN THE NARRATIVE
PRIMARY COLLISION FACTOR TRAFFIC CONTROL DEVICES2 3 TYPE OF VEHICLE 1 ,! 3 MOVEMENT PRECEDING
NUMBER I OF PARTY AT FAULT
6 VC ECiION\V/p_LAT o YES A CONTROLS FUNCTIONING A PASSENGER CAR/STA,WGK COLLISION
I�_JLp LJ 1._- B CONTROLS NOT FUNCTIONING , B PASSENGER CAR W/TRAILER A STOPPED
1 BOTHER IMPROPER DRIVING' C CONTROLS OBSCURED C MOTORCYCLE/SCOOTER
B PROCEEDING STRAIGHT
D NO CONTROLS PRESENT/FACTOR PICKUP OR PANEL TRUCK C RAN OFF ROAD
C OTHER THAN DRIVER• TYPE OF COLLISION &PICKUP/PANEL TRK W/TLR- D MAKING FIGHT TURN
D UNKNOWN' A HEAD-ON F LICK OR TRUCK TRACTOR E WAKING LEFT TURN
P E FELL ASLEEP' B SIDESWIPE G T K/TRK TRACTOR W/TLAF MAKING U TURN
C REAR END I I sdt400L BUS G BACKING
FATHER I MARK I TO 2 ITEMSD BROADSIDE I OT ER BUS H SLOWING/STOPPING
CLEAR E HT OBJECT J EMEVGENCY.VEHCLE I PASSING OTHER VEHICLE
B CLOUDY F OVERTURNED . K HWY. ST.EQUIPMENT J CHANGING LANES
C RAINING G VEHICLE/PEDESTRIAN L BICYCLE K PARKING MANEUVER
D SHOVING H OTHER': MOTHER VEHICLE L ENTERING TRAFFIC.
E FOG/VISIBILITY FT. MOTOR VEHICLE INVOLVED WITH N PEDESTRIAN. M OTHER UNSAFE TURNING
F OTHER': A NONLOLUSION O MOPED N XING INTO OPPOSING LANE'
G WIND B PEDESTRIAN O PARKED
LIGHTING C OTHER MOTOR VEHICLE P MERGING
A DAYLIGHT MOTOR VER ON OTHER ROADWAY OTHER ASSOCIATED FAC70R Q TRAVELING WRONG WAY
DUSK-DAWN E PARKED MOTOR VEHICLE 2 3 (MARK 1 TO 2ITEMS) R OTHER:'
C DARK-STREET LIGHTS F TRAIN A vc SECTION v1OLArmll- CITED
D DARK-NO STREET LIGHTS G BICYCLE DYE$
❑�
E DARK• STREET LIGHTS NOT H ANIMAL: B vc SECTION vlOunO►t CFTED
FUNCTIONING, ❑YES
ROADWAY SURFACE SOBRIETY-DRUG
G
I FIXED OBJECT: C VC SECTION MLATION: CITED 1 2 3 PHYSICAL
A DRY DYEa (MARK 1 TO 2ITEMS)
B WET J OTHER OBJECT: 0NO A HAD NOT BEEN DRINKING'
C SNOWY•ICY D
D SLIPPERY(MUDDY,OILY,ETC.) E VISION OBSCUREMENT: B HHBD-UNDER INFLUENCE
F INATTENTION- C HBD-NOT UNDER NFLU.'
ROADWAY CONDITIONS G STOP i GO TRAFFIC D FED-IMPAIRMENT LINK'
(MARK 170 2ITEMS) PEDESTRIANS ACTION E UNDER DRUG INFLU.•
Yf A NO PEDESTRIAN INVOLVED H ENTERING/LEAVING RAMP
F IMPAIRMENT•PHYSICAL•
A HOLES,DEEP RUTS- I PREVIOUS COLLISION
B CROSSING IN CROSSWALK J UNFAMILIAR WITH ROAD G IMPAIRMENT NOT KNOWN
B LOOSE MATERIAL ON RDWY' AT INTERSECTION H NOT APPLICABLE,
NOT SLEEPY I FATIGUED
C OBSTRUCTION ON ROADWAY' K DEFECTIVE VER EQUIP.:. �TTED
C CROSSING IN CROSSWALK- n3rEs I
D CONSTRUCTION•REPAIR ZONE AT INTERSECTION OP40 SPECIAL INFORMATION
E REDUCED ROADWAY WIDTH D CROSSING-NOT IN CROSSWALK L UNINVOLVED VEHICLE A HAZARDOUS MATERIAL.
F FLOODED' E IN ROAD-INCLUDES SHOULDER M OTHER-:
IG OTHER': F NOT IN ROAD IN NONE APPARENT
yj I1 NO UNUSUAL CONDITIONS G APPROACH/LEAVING SCHOOL BUS 10 RUNAWAY VEHICLX
SKETCH MSCELLANEOUS
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DATE o. 416'0. /� TIM[ yle Y) N y Q e w r. I Tu
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ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED ♦'SCALE -
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LNARRATIVE COIiJBION REPORT ❑ DA UPDATE 11 FATAL ❑ HIT E RUN UPDATE
❑ SUPPLEMENTAL LLLOLLL..11l���OTHER 0 HAZARD"MATERIALS D SCHOOL BUS ❑ OTHER:
CI TY/00LNT Y/JUDICAL DISTRICT REPORTING DDTR/CT/BEAT CITATIONNUMSER
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ATE OF CALIFOANIA
ARRATIVE/SUPPLEMENTAL PAGE
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NARRATIVE COLL00i4 REPORTElBA UPDATE ❑ FATAL HRBRUMUPDATE
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87 45312
TATFF ALIFGRNIA
JA�i ATIVE/SUP LEMENTAL PAGE
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87 45312
CLAIM
BOARD OF S`jPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
•
Claim Against .the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT Augu s t 30, 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $8, 331- 00 Section 913 and 915.4. Please note all "Warnings".
County Counsel
CLAIMANT: JAMES C. NUTTALL
1159 Discovery Bay Blvd. AUG U 5 1988
ATTORNEY: Byron, CA 94514
Date received Martinez, CA 94553
ADDRESS: BY DELIVERY TO CLERK ON August 3 , 1988
BY MAIL POSTMARKED: August 2 , 1988
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
IL gATCHELOR,,Clerk
DATED: August 5, 1988 ��: Deputy
L. Hall
II. FROM. County Counsel TO: Clerk of the Board of Supervisors
( -) 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).
( ) 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:
Dated: BY: Deputy 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
(Vhis 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. Q
Dated: AUG 3 0 1988 PHIL R BATCHEL / '/ r
0 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 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,
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: S E P 1 1988BY: PHIL BATCHELOR by ,{ -Clerk
CC: County Counsel County Administrator
�1
a. g t - r_ f r "'n n,r r` r 'n , `r,. nerson or to per'-
. ,... � �• ac -.,� c ea., � � ,
.. C�r.:.�� re--a ,.,r.. � ^.3.�ec?a . . . _ .. o:. a._�t,.`"V
nroperty or gra -.r-- or 1.,P?"(,re.
December 71! 1.98
7,
,f p.,jar' .,e a 1 rV'. p .� �.4.-r the accra?C ofthe,cause of
C? 'c..>. '`' ;1C� .oT `c- �,�*�1 or for _t1�L'''V fA .j?erS{YTl
J'' L rSo.'lci' p'^rJ'JF?••' Yr or grow;,,.':. _-!"ops 3rr: r*'_'.^' aecr`:e on or after January if
must �e presa^ �" -gat la`er t-awn six after the a,.crll l of the cause
of act _on. Claim. any other ca'',,Is ' o" action nr:s- be presented. not
"ate-. t'in one year a,^ter ,he accr iP..". o:" the. ca-''se 0*' act.-on. fGov`.. Code §411.2.,)
C?.a y 4 must. be ?.'.!'c' W=.th }hP Cler'I or the ?�Oa"C' of Supery;dors at its office in
• oCy". 'C,1cJ, {'.U'_?^..} j :.ni'?:.st! pit O^. "::.:!' 2'1 , fir. n:'.Tl�' St" e , Y+artinez, CA 94553-
C. ?F c,,,:.r. :Ci �.,•��.,t-.�.,n�. �' r1_C'Frt-f'*. goyrpy"."e ,,r 'F..=P 7(ti?re.. +0rather than .
tll ("ri,.-,!-fir !�'?t^ '"'•.::. 'p '�.' .`l'_^• r..S�T":_.. . c�!.o'.,.:.ri `` ._-___^ '•r.
TlTf the C"_?,-T^ t c^ ��_�L� �^(t�'C' 'tr. 1 one, oL+ _:.0 p? 'Spoara c aims must be
. 'raeP j}ar1c, _L, 4 rr r`rat2 'a"_e^t ^'_^ '....'} ¢r.,�.__ r ,4t+ . F_'C. 72 8` �:he en(. of. this
ar. # •'4 # � * � # # '1F x is �' ?t x +�'• iF � � � �• � +� � .'� �`' �'• �:' '� � # +E it * � �! iF 'it # !F # iF � '
,��J �. m 2• ',P;e.,y%tom a for _'�" ► fii'._2" stamp
,' . _. .. _y {' '
RECEIVED
!'Mtl BATCHELOR
.ti CLE K GO:,RU OF SUPERVISORS
/ n t ) �. ..,r -'�• _^�' - '1 c`. 'n:} CfJNTRA C0S1A CU
r •'r1n r a orTheaiaf*a �l ` s �' C*'o,-.m tti' nr _ . -o-et
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v.4:.s f`I-[a. 3 r, re.n.^e
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damages claimed. two estimates for auto dan2,ge.
--------------------- � ---- es/�Lc�.�_lf_''O _--- � -- �---------` ---------
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CLAIM
BOARD OF SUPER`!ISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Chaim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT Augu s t 30, 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $10, 000 - 00 Section 913 and 915.4. Please note all "Warn�%' "
�uhty Counsel
CLAIMANT: DEWAYNE STAUTINGER
901 Court St . AUG 0 5 1988
ATTORNEY: Martinez, CA 94553
Date received Martinez, CA 94553
August 4, 1988 Inter office
Au
ADDRESS: BY DELIVERY TO CLERK ON g
BY MAIL POSTMARKED: no postmark
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
IL gATCHELOR, Clerk
DATED: August 5, 1988 ��: Deputy
L. Hall
II. FROM:, County Counsel TO: Clerk of the Board of Supervisors
40
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).
( ) 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:
Dated: �� ' BY Deputy 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
( his Claim is rejected in full .
( ) Other:
I certify that this is a true and correct copy of the Board's rder entered in its minutes for
this date.
AUG 3 0 1988
Dated: PHIL BATCHELOR, Clerk, B) _ /, 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 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.
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 an Notice to Claimant, addressed to
the claimant as shown above.
SEP 1 n
Dated: 1988 BY: PHIL BATCHELOR byputy Clerk
CC: County Counsel County Administrator
C1Claim .< BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
'� :
INSTRUCTIONS TO CLAIMANT
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before December 31, 19879
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for death or for injury to person
. or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not .
later than one year after the accrual of the cause of action. (Govt. Code §911.2.)
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 name 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.
RE: Claim By ) Reserved for Clerk's filingstamp
Against the County of Contra Costa ) AUG 41988
or )
District) 7iU S '
Fill in name )
The undersigned claimant hereby makes clai against the County of Contra Costa or
the above-named District in the sum of $ !.�, U J:J• and in support of .
this claim represents as follows:
-------------------------------------------------------------------------------------
1. When did the damage or injury occur? (Give exact date and hour)
67.41 - `� -___
-
2. Where did the damage or injury occur? (Include city and county)Z.
— —
3. How did the fjdamag o� injury V�S 1 �,(Giv(Give de ail4�u7e bcurai,PaI r CoA4uq _"
re) uired) y s" tt--�� ,
lhE/ ' fi i SEAect-e.� til e .c'iA P5 I"e /�c/ �,.�� '�ec cVol ra"r4Zi �i.�) +]~Evi 1,;w* Hen I n. 5014,) /
Pe^d'.� .rr� f- ?Pt�•las.7� er o,C� /Jw aq •�!l rr� s�sof
4. What particular act or omission on the part of co y or d�istrict offic rs, ~
servants or employees cause the in jury�or e? j � �fnl(r'.� �a ^% ao"!�y
'� �i�.,,, �/�,/� S 2ca
�1y�Elidy��( patiS Nis �' S�vZ ss��uQ��f2� Ci�C r �A61n� AIA mr CIVIC es
1�Fy /�rAc� wed ��svif�y �;cic4SeiyS r-�y -c c,+. (/; ,rr lj' e2ir+5�.+5 �.• F C�rJ-�,zr-a�.o � d' ,
6 pr P/Ac- r'he. SoJ14-),ov 4Jy, V,6;,;
-roe- p4a; V^,
,J o ��5-J at�uc�,f i. -}��y E f u,. �' gg, ,
r
� ' Z S��c: P,F ,�1.� 4(e /zcsu sy �f vre ,a ;u+ � e� ��2� 5 (over)
.5. What are the names of county or district officeers, se vants o empl1,o� yees pausing
th damage or injury? 9.eAti,J5 0�(-{,Lr 56 �.Au/e� �Mp 77.03 caM* -Nee,»a P1 —
�,
ire, ti ?3 5-9„
5. What damage or injuries do you claim resulted? .(Give full:gxt'ent of injuries or
die clamed. Atach two estimates for auto 4
amage./��� S"'l
'rt� U• VP bf
. 7. How was the amount. claimed above conmuted? . (Include the estimated amount of any
prospective injury or damage.)
8. Names and addresses of witnesses," doctors and hospitals.
-------------------------------------------------------------------------------------
9. List the expenditures you made on' account of this accident or injury:
DATE ITEM -AMOUNT
Gov.. Code Seca 910.2 provides:
"The claim must be signed by the claimant
SEND NOTICES TO: (Attorney) or by some person on his behalf."
Name and Address of Attorney
Claimant's Signature
Address
Telephone No. I Telephone No. < C-
* * .
N. 0 T I C E
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 ($1,000), 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.
J J
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT Augu s t 30, 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors .
(Paragraph IV below), given pursuant to Government Code
Amount: $282 . 00 Section 913 and 915.4. Please note all "Warni6gs vllty Counsel
CLAIMANT: JOHN J. RANSON G u 5 1988
P .O. Box 4412
ATTORNEY: Camp Connell, CA 95223 w."arfinez, CA 94553
Date received
ADDRESS: BY DELIVERY TO CLERK ON August 4, 1988 Inter-office
BY MAIL POSTMARKED: no envelope
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim, ,
August 5, 1988 pHIL BATCHELOR, Clerk
DATED: g.. BY: Deputy
L. Hall
11. FROM: County Counsel TO: Clerk of the Board of Supervisors
(✓) 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).
( ) 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:
n A
Dated: D —� �g BY: PS1,6A puty County Counsel
I11. 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 0 'ER: 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.
AUG 3 0 1988 '
Dated: PHIL BATCHELOR, 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 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.
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 OrderkadNotice to Claimant, addressed to
the claimant as shown above.
SEP 1 1966 -�-! ,ty Clerk
De+°'�� BY: PHIL BATCHELOR by
CC: County Counsel County Administrator
CLAIM TO-wv : 75OARD OF SUPERVISORS OF CONTRA COR WKBppiication to:
Instructions to ClaimantVerk oithe Board
.0.Box911
Martinez,Calitomia94553
A. Claims relating to causes of action for death or for injury to
person or to personal property or growing crops must be presented
not later than the 100th day after the accrual of the cause of.
action. Claims relating .to any other cause of action must be
presented not later than one year after the. accrual of the cause
of action. (Sec. 911.2, Govt. Code)
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, California 94553.
C. If claim ..is against a district governed by the Board of Supervisors,
rather than the County, the name of the Distript 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 end
of this form.
RE: Claim by )Reserved for Clerk's filing stamps
p� � � �r �1 � �, �ur~, Gottticll CA 9S 3 RECEIVED
Against the COUNTY OF CONTRA COSTA; /. ,; 4 I���
or DISTRICT) C L
Fit in name ) YKA F P JeThe undersigned claimant hereby makes claim a "" Contra
Costa or the above-named District in the sum of $ �
and in support of this claim represents as follows:
�. When did the damage or injury occur'? ,.(Give exact date and hour]
G[a vi, �} r' ti i-`�.'. E � ��icaC. ca e v�.f �J V CA /� c e-CC -
�, FfAv
` A 1
�. Where did the damage or in1jury occur? (Include city and county)
3How did the damage or .injur
. y occur? (Give full cetails, use extra
sheets if rewired) _
a b
IPSO 1 5x r vA d�r G���t'/'} �� L tr��5 �C �A I 1 � !G�c f C cvu&A 4f \:
-T ----- -- -- ----------- --T --- ---
4. What particular act or omission on .the part ocounty or district
officers, servants or employees caused the injury or damage?
(over)
5. What are the names of county or district officers, :aervants or
employees causing the damage or injury?
ii .CG Nru rel S�"0.1`lj
1Mp.� Jc I VWA 0r ctE7:.
f�
6. What damage or 1n�urles do you claim resulted? Give full extent 111`
of .injuries of damaes claimed. . Attach two estimates for auto I
damage) 105 � r
__ --- - -- -- -- - -------------------------
7. How was the amount---claimed--- --above- --computed?--- ----- (Include the estimated
amount of any prospective ink ury or damage. ) ,
C\ w Ct A, �,}C;�. c}) C l t.J�E�� c.�►'l T
8. Names and addresses of witnesses, 'Andhospitals.
Pu r-Y �`r� ; as - {�rrrt moo k� �F fY ��o�2ouJ6,LL(
Y. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
JJ .JJ
1.6C c
U tH' c°P�D� 71S0c7
3 �.
a� cA4o o,
Govt. Code Sec, :9]]]31ffff�0+Y provides :
"The claim signed. by_ .be claimant
SE*7D NOTICES TO: (Attorney) or b some person on his behalf. "
Name and 'Address' of At�e
f
C I��►.����K
mant s Signature
'PO r3o�r�j�fl�dCA Ssff( ( ("4
.• rr M10 NQI tr � �
Telephone No. a,Ci' 7 C1 S a -i Telephone No.
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, town, city
district, ward or village board or officer', authorized to allow or pay
the same if genuine, any false or fraudulent claim, bill, account, voucher,
or writing, is guilty of a felony. "
CLAIM
BOARD OF SUP'tRVISORo OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ). NOTICE TO CLAIMANT August 30 , 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: Unspecified Section 913 and 915.4. Please note all "Warninc"vunty COUIISe)
CLAIMANT: RICHARD D. MALDONADO AUG U 5 1988
1315 Arnold Drive
ATTORNEY: Martinez, CA 94553 Martinez, CA 9455:
Date received
ADDRESS: BY DELIVERY TO CLERK ON August 5 , 1988
BY MAIL POSTMARKED: August 3 , 1.988
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
IL gATCHELOR, Clerk
DATED: August 5, 1988 �b: Deputy
L. Hall
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
( ) 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).
( ) 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:
Dated: BY: WJwe Deputy 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 ORDS-R: 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 rder entered in its minutes for
this date.
Dated: AUG 3. 0 1988 PHIL BATCHELOR, 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 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.
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.
Octed: j E P 1 . 1988 BY: PHIL BATCHELOR by C/ puty Clerk
CC: County Counsel County Administrator
Claiarito . - BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
` INSTRUCTIONS TO CLAIMANT
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before December'319 1987,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for death or for .injury to person
or to personal property or growing crops and which accrue on or after January 19
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must-be presented not
later than one year after the accrual of the cause of action. . (Govt. Code §911.2.)
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 name 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.
BE: Claim By ) Reserved for Clerk's f' p
RECEIVED
Against the County of Contra Costa__)
or )
/Z BATC OR g
District) CLERK B TR
Fill in e ) B e
By
The undersigned claimant hereby makes 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:
------------------------------------------------------------------------------------
I.- When did the damage or injury occur? (Give exact date and hour)
��--------------- =�7- --- --------------------------------
2. Where did the damage or injury occur? (Include -city and county)
----------------------
3. How did the damage or injury occur? (Give full details; use extra paper if
required)
----------------------------------------------------- --
---------------------------- -
4. What particular act or omission on the part of county or district officers,
servants or employees caused the injury or damage?
(over)
5. ' Wh%t are the names of county or district officers, servants or employees causing
the damage or injury?
-
5. -What damage or injuries do you claimresulted? (Give full extent .of injuries or
damages claimed. Attach two estimates for auto damage.
-----------------------------------------------------------------
7• How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
------------------ --
------------------------- ----------------------------------------
8. Names and addresses of witnesses, doctors and hospitals.
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT.
Gov. Code Sec. 910.2 provides:
` "The claim must be signed by the claimant
SEND NOTICES TO: . (Attorney) or by some person on his behalf."
Name and Address, of Attorney
Claimant's Signature
Address
Telephone No. Telephone No.
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. distriet 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 ($1,000), or by both such imprisonment and fine, or by imprisonment in
the state prison, by a fine of not exceeding ten thousand dollars ($10,00.0, or by:.
both such imprisonment and fine.
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CONCORD, CALIFORNIA 94520
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CLAIM
r
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT August 30, 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $10, 000 . 00 Section 913 and 915.4. Please note all "Warnings".
County Counsel
CLAIMANT: DORIS CROSLEY
180 Peppertree Way i-,d I G u D— 1988
ATTORNEY: Pittsburg, CA 94565
Date received Martinez, CdA �4�553
ADDRESS: BY DELIVERY TO CLERK ON August 3, 1988 han e
BY MAIL POSTMARKED: no envelope
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
PpHHIL BATCHELOR, Clerk
DATED: August 5 , 1988 BY: Deputy
L. Hall
I1. FRO County Counsel TO: Clerk of the Board of Supervisors
( ) 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).
( ) 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:
Dated: R BY: Deputy County Counsel
II1. 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
(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.
AUG 3 0 19e8 Dated: PHIL BATCHELOR, 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 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.
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.
9 IEP 1 199Q
Dated: BY: PHIL BATCHELOR byuty Clerk
CC: County Counsel County Administrator
ECEIVEDo rrl
1 CLAIM PHIL BATCHELOR
CLERK BOARD OF 9UPERV1SOfiS
CONTRA COSTA CO.
2 Claimant , DORIS CROSLEY ,. presents a .••f ...dam e,s
3 against CONTRA COSTA COUNTY in a sum in excess of $ 10 , 000 .00 and
4 within the jurisdisetion of the Supericr .Court .'
5 ' Claimant ' s Residence/Mailing Address is : 180 Peppertree
6 Way, Pittsburg, CA 94565 .
Date of Occurrence February 5 , 8 and 16 , 1988 .
8 Place of Occurrence : Contra Costa County , State of
9 California .
10 Said Claim Arises Out of the Following Circumstances :
11 Claimant was employed by CONTRA COSTA COUNTY as a family
12 support collection officer in the Family Support Division ,
13 District Attorney ' s Department , Contra Costa County. As a
14 result of the- .investigation of .Centra Costa employee's , including
1.'
5 but not limited to Rafael A . Hernandez of the Contra Costa
16 District Attorney ' s . Office , Claimant was wrongfully accused of
17 various dishonest acts, engaging in conduct tending to bring the
18 District Attorney ' s Office into disrepute, and various criminal
19 offenses. Said acts and offenses had not occurred , nor did said
20 individuals have reasonable cause to believe that the offenses
21 occurred , or. that Claimant had committed said off fenses . As a
22 result , a felony criminal complaint was field against Claimant
23 in the Municipal Court of . the State of California , County of
24 Contra Costa , Mt . Diablo Judicial District , on February 5 , 1988 ,
25 and Claimant was served with an order and notice of action.
26 dismissing her from her position on February 16 , 1988 , effective
27 February 8 , 1988. As:' a result of said negligent and intentional
acts of said employees, acting . in the course and scope. of
28
I
J.
1 employment , Claimant was libeled , slandered , wrongfully
2 terminated , from her position , falsely arrested , maliciously
3 prosecuted and suffered intentional and negligent infliction of
4 emotional distress .
5 Items , Nature and Extent of Damages or Injuries :
6 Claimant suffered wrongful termination with loss of wages
7 and benefits , severe emotional upset and distress , physical
8 . injury, attorney ' s fees, and other costs , the exact amount of
9 which is presently unknown .
10
11 DATED : c
DORIS CROSLEY
12 Claimant
13
14
15
-16 .
17
18
I
19
20
21
22
23 i
I
24
25
26
27-
28
2
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ). NOTICE TO CLAIMANT August "3 0, . 1 9 8 8
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $657 . 43 Section 913 and 915.4. Please note all "Warn ' tL�ntY Counsel
CLAIMANT: JOHN M. DICKEY AU G 0 5 1988
2 Del Cerro Court
ATTORNEY: Pittsburg, CA 94565 Martinez, CA 94553
Date received
ADDRESS: BY DELIVERY TO CLERK ON August 4, 1988
BY MAIL POSTMARKED: August 3, 1988
1. . FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
Au uSt 5 , 1988 pH IL BATCHELOR, Clerk
DATED: g BY: Deputy
L. Hall
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
( LlThis 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).
( ) 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:
Dated: �' BY. Deputy County Counsel
v
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 DER: By unanimous vote of the Supervisors present
7) 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 dateA.
�
Dated: ~UG 3 0 PHIL BATCHELOR, Clerk, By Ct- ��-7-9eputy 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 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.
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.
SEP 1
IgoeD�±`c': BY: PHIL BATCHELOR by - A4C-�—,A�uty Clerk
CC: County Counsel County Administrator
Clalm.-to t BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. Claims relating to causes of action for death or for injury to person 'or to per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for death or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action.' (Govt. Code §911.2.)
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 name 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
orm.
RE: Claim By ) Reserved for Clerk's filing stamp
RECEIVED
Against the .County of Contra Costa )
or LJ u 01y�e.
District)
Fill in name ) CLE F q ELOR
NT P SOAS
By
The undersigned claimant hereby makes claim against the C un y o Costa on
the above-named District in the sum of $ ('S7 S and in support of
this claim represents as follows:
-------------------------------------------------------------------------------------
1. When did the damage or injury occur? (Give exact date and hour)
Fi4/,Pi9 Y TvAv E a 17 're a- OD
-------------------------------------------_-----------------------------------------
2. Where did the 'damage or injury occur? (Include city and county)
------
,L167
.OA( T ' c�e if -51,06 ofG
,"FMO / //-E F;F0A? Ta--------------------------------
3.
, f � /��i4E1�CL`iPy/g,S.S (w/q
t------
� _ ___ _
3. How did the damage or injury occur? (Give full details; use
extra paper if
required) TyLc�E A16_, E 41A76-4=5- i40�iC�S JUST 6 e4 J/EL
S'FT eY TSE e-,PVN7X 414"S DEIPT. Aq� Th'e 4vW Y 0117-/A-'70
yE Ti�/9�f/< </9 ES, Tf1ERE !✓�9-s i9
,?O,%0 ('"l✓
a WNTi
4. What particular act or 'omission on the part of county or district officers, .
servants or employees caused the injury or damage?
�)
OBD S/DE) 4 T TW/S LATE /Y4U� BU7 T/yEI /yi9'ao
p� POSTED -S/6WS A1,11A2aA1FYM 7iy6fe 1119 S
/0 G✓i9 Y 7y1i9 T /9 TSU cX PR/VEA/ ,,'F y 9 100.6 ve S �i✓h'/L E 9A/
i'9�L YEE
ce
/iCOf 67Z EN/V M �TE,e C 0s , � � Eo
� oONE Of Mcse'f9e-T�Ar mvA1YJX0c�S. Niciyo
......�.,,�,.
5. %hat are the names of county or district officers, servants or employees causing
the damage or injury? r/yr R0�90 /�'��/NTEN/�N� �E/'�I� . ew2V
T 4qT GEfT �/YESE Li9,PGE Ro CA OPf IAI B 7h1
EffSTB04ND ZANES Of 1,1/,fA:o f �fYS.5 X011AD ON /?�8�
------------------------------------------------------------------------ ------=----
5. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto 'damage. p�/E (eam /4l pi4 JZ�
Of71, E �i<,ts ,yi7' /JY firOvT G✓/NDs/,�iE�D i9.vo �iY /T,
Uf FX047 7'/1V s TiP .3117 re VZP 41,07' -5;01JrAl6f9E
-------------------------------------------------------
D
7. How was the amount claimed above. computed? (Include the estimated amount of an ojt VDl-�*
prospective injury or damage.) O y 7' 0 E��/y�rES i9TT T
----------------------------------------------------------------------------------
8. Names and addresses of witnesses, doctors and hospitals.
:Tll' '06)1,0 e, . D,4/I/E� foiQ GLEN
- /t'J/I/�TEGL � s 0�; ,zNC• % /S/8 t o vE,q/D G E R�.
------------------------------------------------ -.rTs----��_
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
Gov. Code Sec. 910.2 provides: .
i "The claim must be signed by the claimant
SEND NOTICES ;TO: (Attorney) or by some person on his
/bbehalf."
Name and Address of Attorney
Claimant's Signature
Address
l/ U4,
Telephone No. Telephone No. �/S
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 ($1,000), 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.
LEHMER'S _
Aeaarl�e •1851 G.rl I.; .alindo.Street • P.O. Box 5398 983
s Phone 685-4481
DLIBiMDBItF .jeep
CONCORD, CALIFORNIA 94524
ESTIMATE OF REPAIRS AS LISTED FOR LABOR AND MATERIALS-VERBAL AGREEMENTS NOT BINDING—ESTIMATES FREE.
Owner Zi" Date. 'A L
Insp.
Address Phone By
Serial �f ( /2_Y3 2
Insurance Co. /Adj. y
Address Phone License
Number
Year
Make �!/L(�/ Model / � �' Mileage Nom
QUAN. DESCRIPTION OF LABOR OR MATERAL :... :.;.: PARTS..,` LABOR: SUBLET
9 d
.n .jeep GMC
OLDSMOBILE AL SWEENEY .
Body Shop Foreman
LEHMER'S
1851 Galindo Street WE CARE
Concord, CA 94520
Bus.. 685-4481 Direct Line 685-0615
'PARTS PRICES BASED ON STANDARD CATALOGUE PROCUREMENT PRICE LISTS SUBJECT TO CHANGE WITHOUT NOTICE.
PROCUREMENT AND DELIVERY.CHARGES MAY BE ADDED FOR SPECIAL SERVICE ON ITEMS NOT AVAILABLE LOCALLY.
Old parts removed from cars will be junked unless otherwise instructed in writing. �. .:•M1_ /
TOTAL LABOR (p
.The above is on an estimate based ori our inspection and does not cover additional parts or labor which may be required after the work PARTS
has been opened up.Occasionally after work has started worn parts are discovered which are not evident on first inspection.Because
.of this the above prices are not guaranteed.
PAINT MATERIALS
A-Align N-New OH-Overhaul S-Straighten or Repair EX-Exchange RC-Rechrome U-Used
TAX 2
REMARKS: PAID OUT-TOW a STORAGE
SUBLET
RR.0. TOTAL S y
.11986-01127 MORICK OKLAHOMA CITY aw++vi
• DUARTE &WITTING. IMC.
CHRYSLER — PLYMOUTH
825 FERRY STREET MARTINEZ,CALIFORNIA 04563 OWNERS
BODY SHOP:908 FERRY STREET—PHONE 228-0750—228-0768. BOB STEVENS
d1
GALIN FITZHUGH
ESTIMATE OF REPAIRS AS LISTED FOR LABOR AND MATERIALS - VERBAL AGREEMENTS NOT BINDING ESTIMATES
FREE
E )
NAME DAT
r —p /�
ADDRESS i1 D L CE�S'fs'l/ C-T / YO-CONE
MAKE MODEL 1 STYLE LICENSE_
SERIAL NO. MILEAGE
Symbol FRONT LaborHrs. Parts ISymbol LEFT LaborHrs . Parts Symbol RIGHT LaborHrs. Piirts
Bumper (U)Ex-Naw Fender 6 Ext. Fender 6 Ext.
Bumper Reinforcement Fender.Shield Fender Shield
Bumper Brkt. R L or ABS Fender.Orn.-Midg. Fender Orn..Mldg.
Bumper Gd. R L
Bumper Valance RL & CTR Headlamp Headlamp,
Frt.System Headlamp door. Headlamp door
Frame ( )Horn Seal Beam in-Out Seal Beam on-Out
Cross Member Cowl Post I Cowl Post
Wheel Front. Rear Door Front-Panel Door Front-Panel
Hub Cap-Sm. -Lge. Door Lock Door Lock
Knuckle Hub 6 Drum Door Hinge UP-Low Door Hinge Up-Low
Up. Cont.Arm-Shaft Door Glass- Reg. Door Glass-Reg.
Low. Cont.Arm-Shaft Door Mldp.—Stripe Door Mldg.—Stripe
Strut Rod Vent Glass-Channel Vent Glass-Channel
Stabaitzer Bar Door Handle Door Handle
Link Pkg. R L Center Post Center Post
Door Rear-Panel Door Rear-Panel
Steering Arm Door Midg.—Stripe Door Mldg..—Stripe
Steerirtg Wheel-Horn Ring Door Glass Door Glass
Steering Shaft -Jacket Rocker Panel - Rocker Panel
Drag Link Rocker.Mldg. Rocker Midg.
Tie Rod R L Sill Plat! SIII Plate
Floor Floor
Gravel Shield Quar. Inner Const. Quar. Inner Const.
Grille Ctr. Quar.- Ext. Quar.-Ext.
Grille Side R L Quar. Panel Quar.Panel
Grille Midg. Quer.Midg. —Stripe Quar.Mldg. —Stripe
Support R. L Cent. Quar.Glass- Reg. Quar.Glass- Reg.
Tie Bar Rear Fender Rear Fender
Park Lamp R L MISC.
Marker Lamp R L REAR Inst.Panel
Horn Bumper Ex-New Front Seat -Tracts
Bumper Rail Rear Seat
Air Cond. Core Bumper Brkt. R L Trim
Dehydrator Bumper Gd. R L Headlining
Recharge A/C Gravel Shield Top
Hood Lower Panel-Mldg. Tire %Worn
Hood Mldg Floor
Mood Orn.•Letters Trunk Lid-Hinges Battery
Hood Hinge R L i run_k Lock-Mldg. Antenna
Lock Plate Lower Ta.i Lamp R L Mirror
Lock Plate Upper Back Up Lamp R L Paint 6 Material
Rad.Sup. Tail Pipe-Muffler
Rad.Core Gas Tank-Neck.Cap SUMMARY
Fan Blade Frame.Crossmember I' (/v
y p�
Fan Clutch —Coolant Axle•Housing � Labor/ Hrs. _
Fan Shrowd Hub- Drum-Bearing Parts Less
Fan Belt. ( )Hoses Control Arms Paint Material =
Water Pump•Pulley Windshield (C) .( U I Tax 96 on :
Motor Mts. Ft. Rear Windshield Kit Sublet =
Trans. Linkage Windshield Midg. &ZZ7Advance Charges S '
Estimate 8 TOTAL S
OH REPAIR - OVERHAUL N NEW R.C. RECHROME
X ITEMS MISSED ON GARAGE EST. S STR. EX EXCHANGE CIRCLED ITEMS INDICATE OLD OR UNRELATED DAMAGE.
APPLICATION TO FILE LATE CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
BOARD ACTION
Application to File Late Claim ) NOTICE TO APPLICANT August 30, 1988
Against the County, Routing ) The copy of this document mailed to you is your
Endorsements, and Board Action.) notice of the action taken on your application by
(All Section References are to the Board of Supervisors (Paragraph III, below),
California Government Code.) ) given pursuant to Government Code Sections 911.8 and
915.4. Please note the "WARNING" below.
Claimant: CALIFORNIA STATE AUTOMOBILE ASSOCIATION
7035 Dublin Blvd. (Abel , Joseph) County Counsel
Attorney: Dublin, CA 94568-0769 Claim #06-757973-3
AUG 0 5 1988
Address: Claim rep : Taunna Nelson.
Martinez, CA 945
Amount: $250. 00 By delivery to Clerk on August 3 , 1988
Date Received:August 3 , 1988 By mail, .postmarked on August 2 , 1988
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above noted Application t ?i La a Claim.
DATED:-August 5 , 1988 PHIL BATCHELOR, Clerk, By C puty
L. Hall
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
( )) The Board should grant this Application to File Late Claim (Section 911.6).
(✓ ) The Board should deny this Application to File Late C i 91 .6).
11-0 1
DATED: VICTOR WESTMAN, County Counsel, Deputy
III. BOARD ORDER By unanimous vote of Supervisors present
(Check one only)
( ) This Application is granted (Section 911.6).
( �This Application to File Late Claim is denied Section 11.6 .
PP ( 9 )
I certify that this is a true and correct copy off the Board's Order entered in its
minutes for this date.
DATE: AUG 3 0 1988 PHIL BATCHELOR, Clerk, By Deputy
WARNING (Gov. Code §911.8)
If you wish to file a court action on this matter, you must first petition the
appropriate court for an order relieving you from the provisions of Government Code
Section .945.4 (claims presentation requirement). See Government Code Section 946.6. Such
petition must be filed with the court within six (6) months from the date your application
for leave to present a late claim was denied.
You may seek the advise of any attorney of your choice in connection with this
matter. If you want to consult an attorney, u should do so immediately.
IV. FROM: Clerk of the Board T0: 1 County Counsel 2 County Administrator
Attached are copies of the above Application. We notifed the applicant of the 1
Board's action on this Application by mailing a copy of this document, and a memo thereof
has ben filed and endorsed on the Boardts copy of this Claim in accordance with Section
29703.
SEP 1 1988
DATED: PHIL BATCHELOR, Clerk, syRuty
V. FROM: 1 County Counsel 2 County Administrator TO: Clerk of the Board
of Supervisors
Received copies of this Application and Board Order.
DATED: 'County Counsel, By
County Administrator, By
APPLICATION TO FILE LATE CLAIM
California State Automobile Association
Inter Insurance Bureau
7-1 r r
-RECEIVED
A,U G 3 19 Ull 8
rH!L BATCHELOR
LERK GOARD OF SUPERVISORS
-A CC)
Den.ly
r.
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7
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DATE: GJ/02;86
CLAIM NUMBER: 06-7574733
CALIF. STATE AUTO ASSN.
7035 DUBLIN BLVD. DUBLIN, CALIFORNIA 94568 -0764
1415) 8:4-2021
ESTIMATED BY JANINE BRANN
DEDUCTIBLE: 250.6
CUSTOMER NAME: . ABEL
ADDRESS:
iELEPHONE:
POLICY NUMBER:
TYPE OF LOSS: COLLISION
VIN: D E K,RIPT10N; 1976-61 HONDA ACCORD LICENSE: 932L'DE CA MILEAGE: 96.212
OEM/AFT:
LINE ENTRY LABOR .LAP01Fl, LINE ITEM PART TYPE/ DOLLAR LAPOF,
ITEM NUMBER TYPE OPERPT ION DESCRIPTION
PART NUMBER AMuUkT UNIT
1 000730 BODY REMOVE/REPLACE FACE BAR., FRONT BUMPER REMANUFACTURED 1.6
2 000770 BODY REMOVE/REPLACE END CAP, FRONT BUMPER LEFT 62516-6817-020 IRC
3 000840 BODY REMOVE/REFLACE REINFORCEMENT, FROST PUMPER REMA►1•JFACTLF:EG 60.00 + IS:L
.4 001310, BOGY REMOVEIREFLACE PANEL. GRILLE 62;01y-686-670 6J.4- 1.0
V
001380 BODY REMOVE/REPLACE MOULDING, GRILLE UPR 62'20-66E-671 48.59 IN'-L
6 001660 BODY CHECKIAyJUST HEADLAMPS, ADJUST ,5
7 001690 BODY REM0YEiREFLACE RETAINING RING, HE!wLAMP 33102-659-003 16.05
"r 001710 BODY REMOVE/REFLACE SEALED EEO. HEADLAMP OTR 33135-671-611 6.65 .2
9 001700 BDD'+. REMOVE/REPLACE rOUNTIN6 PANEL, HEADLAMP 33;01-611-003 24.2v
10 002(1 B0-'i RErOV'E;REFASSEKK f, MF,R}:ER LAMP LEFT 33650-671-671 29.96 i}+CL
11 0(1 2 (10 B'0 'i REPAIR 'ORE SUPFGFT, COOLING I.
12 0(2470 BODY REPAIR VALANCE PANEL., FRONT PUMPER ;+
13 004 SI B 0 D 1'. RCIYih FANEL, DODO
14 005250 ROD, REMOVE/FEPLACE PANEL, FEN'DEP LEFT 01612-671-67111.. 90.31 2.0
15 S}'.ik1 PANEL, fENDEP LEFT 61150-671-8:3 34.38 5
16 00`.•3E'. F0"f REMC�JEIkE.'rLACE SE;L. FROh? FENH-F 6^?14-65Y-00,; E.63 IRC
i1 9J30(K' REFIN AGI'L LAE_h GPS: CLEAR COAT 2,fyt
16 9"!J013 'REFIN ADi;'L LAB'-'; OPR ELGC} REFISIS� 7.1+
19 936005 A'u6'L COST PAINT/rATERIALS 149,22 ;
f ESTIMATOR'S JUDGEMENT
DATE: 03/02188
CLAIM NUMinER: 06-1579733
1. LABOR SUiTOTALS UNITS RATE TOTALS II. PARTS SUBTOTALS COS'5
--------------- ----- ---- ------ ---------------- -----
BODY TAXABLE
REMOVE1REPLAE 5.3 40.00 212.00 NEM :,5 .93
CHECK/ADJUST .5 40.00 20.00 REMANUFACTURED 123.00
REPAIR, 3.0 40.00 120.00 ------
REFIN SLIP TOTNL 474.93
ADD'L LABOR OPERATION 9.9 40.00 396.00 TAX @ 6.50X 30.87
TDTALS 18 .7 748.00 TOTAL 505.80
III. ADDITIONAL COSTS TOTALS IV. ADJUSTMENTS TOTALS
TAXABLE INSURANCE DEDUCTIBLE 250.00—
PAINT/MATERIALS149.22 ----------
------ TOTAL '150.00—
SUBTOTAL 149.22
TAX F 6.S0% 9.70
TOTAL 158.92
I. LABOR TOTAL 748.00
I1. PARTS TOTAL 505.80
III. ADD'L COSTS 158.92
GROSS TOTAL COST 1,412.72
IV. ADJUSTMENTS 250.00—
NET TGTAL COST 1,161.71.
THIS IS NOT AN AUTHORIZATION BY C.S.A.A TO REPAIR.
PRESENT THIS ESTIMATE TO THE REPAIR SHOP BEFORE YOU AUTHORIZE REPAIRt.
THE LAPOR RATE IS ADJUSTABLE TO THE SHOP'S HOURLY RATE. ASL SUPPLE!ENTS
OR CHANCES MUST BE APPROVED BY C.S.A.A. BEFORE REPAIRS ARE STARTED,
ESTIMATE RECALL W0iER,: 03/02/88 06-75791:: SUPPLEhENT NUMIER: Oi;C' FRSE: 2
COPYRIGHT 1921 MITCHELLMATIX INC.
ALL Ri6T5 RESERVED
c
caliiornia state automot,ile association _
1..10NTIA f."O 41:1 SETT T:?.? _.D.lr
NSURED
'95Z47 CC!i._
jL_ CLAIMANT IJ ,
0
FILM C NEGATIVE
E] POLAROID
DATE:
FEB 0 9'88 1. RRANN
HOUR A.M. P.M.
BY:
LOCATI N AND VIEW
IIS
MAK FCAR.—YEAR
LICENSE N
y
1
DATE
HOUR A.M. P.M.
BY:
LOCATION AND VIEW
MAKE OF CAR—YEAR
LICENSE NO.
DATE
HOUR A.M. P.M.
BY:
LOCATION AND VIEW
MAKE OF CAR- YEAR
LICENSE NO.
F1440 (1 1-8 1) .
FELONY JAN
RA �IC COLLISION REPORT �
.AGE / D.
NwEER HIT
iRUVCITY rJUDDAL DISTRICT NUMBER
-jr, FEarRAMOV Y ,4ZPA1V .XKa E` �
.
' ��L
UMBER / T i•RCOUNTY REPORTING DISTRICT {GT 12
1� ON7AA COST19 90/p
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COLUSIONOCCURAECON MO. DAY YEAR TIME I DI NCIC6 OFFICER l4
C Rofj c�NY011d Rb __ �c.5� �i ;/s 87 /pyo y320515-B
--------------------------------------- ------------.--
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MIL[/OST INFORMATION ` DAY OF WEEK TQW AWAY . PHOTOGRAPHS ST:
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S' AT OflERsamm WRN N PIO L L,.-y `, {TATE Mwr R[L
OR: PVTTI MILES OF (c I 1 ❑YQ ° I<rEf
PARTY DRIVERS LICENSE NUMBER STATE CLASS SAFETT VEM YR. Y KE I MODEL I COLOR LICENSE NUAISLR STATE
E095y695 CA 3 �. gy �R�jL7/�,H/7Z SIS�SYid cFr
DRIVER NAPE(FIRST.MIDDLE.LAST) t -
Plots. STREET ADDRESS OWN&"NAME AS DRIVER
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DINER MOPE F/gM1E _BUSINESS NqM[ ry' Mon MECHANICAL DEFECTS: NONE APPARENT '2; REFU1 TO N RRAT[V[ ❑
❑ / (4/S) Ego-/ //L CMI USE ONLY OEsCRIB[VEHICLE DAMAGE SMADE IN DAMAGED AREA
VEHICL.[TYPE
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DRIVER NAME(FIRST.MIDDLE.LAST) • • • • • • • "
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Plots. STREET AADDRESSC mor /�• OWNERj�S(NAJM(E\''�f��^/��1 J) 13 SAME AS DRIVER
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V EHICLE TYPE
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