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MINUTES - 09101991 - 1.34
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 S e p t e m�10, 1991 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 belo!.-), given pursuant to Government Code Amount: $1 , 900.00 Section 9.13 and 915.4. Please note all "Warnings". CLAIMANT: ADDES , Shirley 01 ATTORNEY: �§N Cd\N \F•�kY Date received ADDRESS: GOJ�c���v BY DELIVERY TO CLERK ON August 5 , 1991 3065 Sylvia Court MPR Richmond, CA 94803 BY MAIL POSTMARKED: August 2, 1991 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 7, 1991 BY: Deputy 01 JA-00� , ZI. 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: I .� /J. 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 Order entered in its minutes for this date. 1 6L R Dated: S E P 1 0 1 1991 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 Noti to Claiman , addressed to the claimant as shown above. Dated: S F P 1 1 1991 BY: PHIL BATCHELOR byCL eputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS.TO CLAD%NT e 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 bepresented- not .later than six months after the accrual of thecause 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• 11 S• 1 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 COCA 0_� C6_S ) 'AN - 51991 Against the County of Contra Costa . ) or ) CLERK BOARD OF SUPER District) CONTRA COSTA CO. Fill in name ) The undersigned claimant hereby makes claim ainst the County of Contra Costa or the above-named District ,in`the, sum of $ 90 o and in support of this claim represents as °follows:_ ------------------------------------------------------------------------------------- 1. When did the ,damage, orinjury occur? (Give exact date and hour) 3 ------------------------------------------------------------------------------------ 2. Where did--the- damage or injury occur? (Include cit and county) o►� ���m load b �a�k-�� -�- hex cit and 3• How did the damage or injury occur?L� (Give full details;-use extra- paper- if' required) 1 Was dr�v� � in i'�,e. 1e + _IGhe - ova rim Roat�a� �2U�%^A) /m1 y Mouse. �40.n���✓ -owArr�S T''�- 1�ay �j�y}�W(ny �0, v+,�✓ o� ,��.- r�yk+ 5iae_: o% rr,� p,��; ,�u.Se�._.Vhi2 ^ anUl =Y�i¢_�n we„-�-. in o ---- - -- --------- - -� --------------------=-- -- --------- 4. What particular act or omission on the part of-,county or district officers,. ; servants, or employees caused the injury or..damage? o s� rocAs on Qawe RpbA (over) 7. what are the names of county or district officers, servants or employees causing - the damage or injury? r 5. What damage or injuries do you claim resulted?-- . (Give full extent of injuries or damages claimed'._ :Attach two estimates for auto damage-. --.{sem a f`Fu11ed 2..es¢,�.ate) t�NiGks i.r w�ti�5�i�1oQ y�ass. yO.Gusk: ,: AYV_,VL o +41-e- Sody o� *k,,,-ba.�k r�tif Z� Nick �nrn�} r,y�.� luw.pfb. NicV 7. =How was the amount claimed above computed? (Include .the est�imated'amount of any prospective injury or damage.) rocks �-{z,� curs see. e^ C_ --------------- ----------------------------------==--------------=--=---------- $. Names and addresses of witnesses; .do.ctors.and hospitals. " 9• List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 710-91 Tnp fr w. E7 S b(an+e tO D6"'WO^I (//Joc,�S Body Sk�p� 7 -7_17_qTrip �,ro-\ E) c1__(6n,,ks { Gov. Code Sec. �9i6:2 provides "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by someperson on his behalf." Name and Address of Attorney Claimant' Signature . 3 66,5 /V 6k ° GO AY_ _. (Address) - i G�vv o so Telephone No. NOTICE Section 72 of.the Penal• Code provides- "Every rovides"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 _($1,00.0),•_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. ` S ' Prct ADDENDUM TO THE- CLAIM OF r I In V1. tX2�S (Prin your full name) • �f ( 1) Do you use the roadway as part of• a daily -commute? Yes (X.) . No •( } ( 2) Were you aware that construction would be commencing on the roadway? Yes (X..)_ No ( ) ( 3) Was an alternate route available? Yes ( ) No ( X) ( 4) . . Did you read about the impending •resurfacing in the local newspaper? Yes.. ( � No (Y ) •Did,.you' see warning- signs advising of loose_' gravel and a 25 mile per hour advisory sign? 4 l , Yes (. } No (l ( 6,) Did the damage result from another`�dehiclg -ex e ding the 25?�mile per hour advisory? c ,-e . Yes (X ) No ,( ) (7) Did a` v6hicle traveling, in the same direction and exceedin� ) . the •25�mile,per hour advisory' sign attempt_ to vass vou? as Yes:.: ) :? No ( X) (8) Did a vehicle coming from the opposite direction cause gravel to be thrown onto your car? _ Yes ( ) No { X ) (9) was the vehicle located directly n front of you exceeding the speed advisory? ?� Yes ( �(.) No ( ) ( 10)- x1 Did; you travel the roadway more than once during the resurfacing prior to the damage sustained to your car? Yes .(X ) No ( ) ( 11) Did you obtain the identity of the car relating to questions .6. thru 9?.. Yes ( ) No ( ) -If yes, please provide identification below: ( 12) i'Please describe in your own words how the gravel caused damage to your vehicle and the angle the gravel was thrown onto the car, along with the specific. damaged parts on your vehicle. Glh2h I W0.5 Ariyzhq nn +1 e_ VAM Roan in 7^e' je:f ' Sack`i,-�l..- A- {Yu[.k we„ - by -me- LAE, riAkGni 1-AenWei Ih Fmv4 Q� m4e. , Oltiriry •AL3 +Tmer I hP_irA r,,-kSArG\"e_l swj Al Gar. I+ all koteghell so -�a54' rocats Zoravim, My Gar , bu4 S SurP kear11 t-kCm 1 i w�nA A i e-(d G [u53, .-J) as I^ koo d w e- ',ck y 6a5k ih o�rea olr, -�k, 6.1 Ove-, +AQ �iyl.�t bavlC WhQ�I . s i i h G ro mn etc re� r y f o4- 4- w i 5 t r , ( 13) Were you aware that using the road during the chip seal process might result in damage to your car? Yes (- ) No ( x) I, declare that the above information is true and correct under the penalty of perjury. u ( Si n ture) (Date) l , 4263 I Fe Q 0n MC31-0FZ 0-d--hFZ PR OF FINE EUROPEAN MOTOR CARS quo -7-)7-91 OF #AC101254 / 9829 BIGGE AVENUE OAKLAND, CA 94603 (415) 632-8901 E S T I M A T E # 4 2 6 3 by JAMES BROOKS AC101254 Time: 16:01 ATrD'ES;—S H'i K LEY-- F r•o Ins. U o`er 3065 SYLVIA CT. Remarks iCHAM/MET Adiuster; RICHMOND, CA 94803 License !2PUUL58 Appraise{ Home :223-2930 Ser # iWDBBA48D8KA104493 Claimant ; Rate Code: Insured i 90 MBZ 560S$L In/Out Mii8884 Policy #i Style i :Pt. : Deductibli $0.00 Claim .# # DESCRIPTION EST PRICE i LABOR PAINT --------------------------------------------------------------------------------------- --------------------------------- 60-1 R&I HOOD EMBLEM i i 0.2 2 R&I LLE 0.5 3 R&R GRILLE SEAL 12.00 4 R&I HOOD WASHER NOZZELS 0.4 ! 5 R&R RT VERTICLE W/SHEILD MLD 52. 74 b R&RR&I WF'f !SH �`"DM Z FACTORY) 55:5.80 5. 8 B R&I RT T/LAMP i 0.6 9 R&I RT BUMPER FILLER 0.5 10 R&I RT BUMPER END i 0.3 11 R&I GAS DOOR 0.6 12 R&I RT ROCKER MLD i i 0.4 i 13 R&R RT OUTER H./LAMPS -M i 24.00 ; 0.3 14 REPAIR DAMAGE IIS 15 REPAIR DAMAGE IN RT QTR i 0.4 t J 17 PAINT HOOD i i i 2. 9 i 18 PAINT RT OTR PANEL 2. 0 i 19 CLEAR COAT/URETHANE 2.0 20 FEATHER/MAST`/ACID PRIME 0. 51 i 21 BUILDING PRIMER/SLOG': i i 0.5 i 22 TINT COLOR FOR BLENDING 11 1.0 i 23 COVER VEHICLE COMPLETELY i 0.3 i 24 COLOR SAND AND RUB OUT i i i 0.5 i 25 CLEAN/DETAIL-D i i 0.2 i i --------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------- Continued an next page . . . F. ADDES, SHIRLEY 90 560SEL MBZ ESTIMATE # 4263 Page 2 --------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------- # DESCRIPTION EST PRICE ; LABOR ; PAINT --------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------- ESTIMATE SUMMARY Labor Descriptive Items FAINI LAB . ( @ 48. 0bS !TA= 644.54 BODY LAB 10.4 @ 48.00 499.20 ; REF MATERIAL 174.60 MECH LAB 0.3 @ 57. 00 17. 10 ; BDY MATERIAL 20.80 FRAME LAB 0.0 8 50.00 0.00 ; SUBLET 0.00 DETAIL/CL 0.2 8 59.00 11.80 ; TOW 0.00 0.0 @ 0.00 0.00 ; STORAGE 0.00 0.0 0 0.00 0.00 ; AUTO COSTS 0. 00 leo.6 Labor Mrs. Ifems Labor 993. 70 Subtotal 1 ,833.64 23 Grand Total 1 ,892.4 #f###########f#ff## Fart Prices Subject to Invoice #f#f#######f######### AUTHORIZED AND ACCEPTED: You are hereby authorized to make the above specified repairs. I understand that payment in full will be due upon release of vehicle, including additional sufFalemental damage charges, and hereby grant you and/or your employees, permission to operate the car, truck or vehicle thein described on street, highways or elsewhere for the purpose of testing and/or inspection. An express mechanic's lien is hereby acknowledged on above car, truck or vehicle to secure the amount of repairs thereto. You will not be held responsible for loss or damage to vehicle or articles left in vehicle in case or fire, 'theft, accident or any other cause beyond your control OLD PARTS ARE JUNKED UNLESS INSTRUCTED! �ff'^^y12) (e5timai�� ESTIMATE authorized by_ odln -s 6ro-ks _date` Thank you for coming to our shop for your repairs. 503007 NAME ' DATE _/O ZIRK PHONE OME PHONE ADDRESS CITY STATE ZIP YEAR MAKE a""'� MODEL �C� I.D.NO. PAINT CODE PROD.DATE TRIM MILEAGE LICENSE NO. DATE OF LOSS WRITTEN BY INS.CO. FILE NO. CLAIM NO. P.O.NO. ADJUSTER LIC.NO. PHONE Deductible/Betterment LINE RE- RE- DETAILS OF REPAIR PARTS INDEX NO. PAIR PLACE R=Repair S=Straighten A=Aftermarket N=New PI PARTS LABOR PAINT SUBLET/MiSC. R/C=Recycle/Rechrome/Recore U=Used R=Rebuilt 2 3 5 ✓ / ,�, 6 7 X 8 9 //� 1 10 1 G�. h a s `e d S fir' ^� �.rS 3 2 12 13 14 15 16 17 18 19 wt �� r;ltir remix 201m�� 21 oUte'-: 6'V 22 Ciro a or w,i$sk�I� 23 24 25 26 27 I hereby authorize the above work and acknowledge receipt of copy. TOTALS b PARTS Pr'c s sub' ct_to i oi�cQe $ Signed X Date LABO;� r hrs.Civ $ Shop Supplies $ PAINT hrs.@ $ �r �t�13� Paint Supplies $ o c= � Pp Towing/Storage $ 9317 East 12th Street Sublet/Miscellaneous $ Oakland, CA 1.94606 EPA/Waste Disposal Charge $ Phone (4 1p5�q ��g 0y{ $ B.A.R. Reg. No. ASf4�32 6 SUB TOTAL $ Jr_ • TAX ....................... $ TOTAL ©1988 HDIEIA inc.Form N�\\Jo.1002 I/DIE/,AL inc.,One I/D/E/A Way,Caldwell,ID 83,6005-6 _LL TOLL FRiowt /� .5''/ -�-Ir 9i Vl�e.�i, '{..._ 1/lc I11-i1 IFa 21.21, .�✓ 'tie�©'a I RECEIVED 51991 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. 946 A Q � cid vo M S 0l% Vi �.6 V V) s y. 0 o •- M $� 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 September 10, 1991 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) 750. 00 Sectio�n`vand 915.4. Please noteI � � D CLAIMANT: ALLEN, Mary Ann AUG 14 199 ATTORNEY: P� DaW �, CLERK BO RD Sl1PERVISORS 3630 Walnut Avenue ADDRESS: BY VERY TO CLERK ON A gus trnp+�aa IMAI -- Concord, CA 94519 BY MAIL POSTMARKED: August 5 , 1991 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: August 14 , 1991 EVIL DeputyLOR, Clerk 41 f.4 c7 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: Jq L91 BY: I Deputy County Counsel U1 I 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. 1 � 0 Dated: SEP 1 Q 1991 PHIL BATCHELOR, Clerk, By n 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 Not' a to Claimant, addressed to the claimant as shown 1 above. Dated: SEP 11 IM BY: PHIL BATCHELOR by o Deputy Clerk CC: County Counsel County Administrator' • r i Claim Vic: 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 onto 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. T1c 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 j Reeved yfr Cler ' fil' g t mn a►I'1v ' RECEIV 36.E L)A-lPJKt &6- (b®3 Against the County of Contra Costa ') AUG 141991 or ) , District) CLERK BOARD OF SUPERVISORS CONTRA COSTA Fill in name ) The undersigned claimant hereby makes claim aizainst the County of Contra Costa or the above-named District in the sum of $ `'' 10,7 and in support of this claim represents as',follows: ' ------------------------------------------------------------------------------------- 1. When did the damage or injury occur? (Give exact date and hour), `�J ---------------- 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)T,H t�A_lh,1 CX�i.t �,3 i,��l N Sr1 Rir - � F tjv 14. What particular act or omission on the part of county or district off vers, servants or employees caused the injury or damage? -7)qf � `r � o F TA (over) 5. What are the names of county or district officers, servants or employees causing the damage or injury? t)F--rf, (o E ,� CI �L 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. pzloc-� �j411 �j(�� _--------------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) � � moi, Q✓ . �� � 550, -P 12���La --------------------------------- �7-- _FL"o_- - LGL S--I------ 8. Names and addresses of witnesses, doctors and hospitals. bo 927A rvAMR LXJ, �o��d'J `��15J4 6E.B09M F�9y1Eje q27-tt 3 MOAN' 1�0, ���<'�J 9-15)5 TM IMA 4wl;6 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT a 1 * .i � !F it � iE * * * ��E��iIE �>1E �*��F * >lE >1E � !F 1I• iE * 1E >� !F � � * � � >1F ilf � ;l� # � >lE * >>E � Gov. Code Sec. 910.2 provides: " "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or_by some erson .on, his behalf." Name and Address of Attorney 14POE/0' Claimant's Signature 4O Address Telephone No. Telephone No 106 �6' 7�-V ! N0TIC-E Section 72 of the Penal Code provides: ' Every person who, ,with intent. to defraud,•,present&-for-allowance or for payment to any state board orofficer, .or to any county,`-city or district board or officer, 'authorized to'-alloW'or-.pay they 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)9 or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,0009 or by. -':both succi imprisonment and fine. i j��i G/�i� i�J�}iJ ►� �,�;�-,�l'I o��Lis�7' J��� G�}1-5 7 PA) ►' E`s s i Q /06 A?fid A-) p-f,,5��,J)0 )EbL`r AA-)Nt�' Alt bP��46b -1a ED BRASSFIELD t 1864 JACQUELINE WAY CONCORD, CALIFORNIA Telephone: 682-1572 PROPOSAL AND CONTRACT To Date _ �� y 19 yy . , P. U. Address— Telephone � Nr r, nnIX Job Address � f Q� l/L�%� d'�' BIk Tract Owner . Architect HIS PROPOSAL 1S VOID UNLESS ACCEPTED WITHIN THIRTY DAYS We propose to furnish all materials and labor necessary to perform the following f. a$ MrZ—MA-&* cC/fes / '- Z _� ..•-�, ��2 � n' c r �L all- sum of Dollars Payable OC' �" (U, DG�G'• , The entire amount of contract to be paid within _ days after completion. Any addition,alteration or deviation . from the above specifications will become an extra charge over the sum mentioned in this contract and owner shall pay for some weekly as such additional work, alteration or deviation progresses. Respectfully submitted, By You are authorized to furnish all materials and labor required to complete the work mentioned in the above proposol for which agree to pay the amount in said proposal, and according to the terms thereof. I have read the conditions of proposal and contract on the reverse side hereof and agree to some. ACCEPTED Date _ 19 ____ CONDITIONS of PROPOSAL and CONTRACT 1. MATERIALS: Unless otherwise specified to the plans and specifications. contractor shall have the right to select all materials. When specified materials are unavailable, contractor shall have the tight to substitute for such specified materills other materials of equal or better quality. 2. ADDITIONAL WORK: Additions. alterations. or deviations shall be charged to the owner at cost of labor and materials plus %. Labor shall be charged at S per hour and materials at published price without discounts plus sales tax. 3. CONTRACT PAYMENTS: The contractor shall not be required to proceed with the instal- lation of the work if the payments applying on same have not been made as specified in the contract. 4. UNAVOIDABLE INTERRUPTIONS: It is hereby mutually agreed that the contractor sha!I not be held responsible or liable fct any loss, damage or delay ca-.,sed by fire. strikes. civil or military authority. or by any cti.er cause beyond its control. 5. TRANSFER OF TITLE: If the customer shall enter into a sale or shall sell. all or any part of the premises herein involved. the full amount remaining unpaid on this contract becomes due and payable within 48 hours after date of such sale or agree..ent of sale at the option of the contractor. 8. In the event any process of lav: is resorted to by the contractor to collect any monies dueheieunder. the buyer agrees to pay all costs. interest. and attorney's fees incurred. 7. Title to any of the material sold or installed hereunder by the contraclot shall remain in the contractor until all. the terms hereof have been compiled with. and in the event such materials are affixed to realty it is expressly understood and agreed that they shall re- main personally subject to removal as hereinunder provided. and further that the owner and.or buyer.or customer hereby waives any and all claims for damage .o said realty or any par,hereof. S. Contractor reserves the right to adjust all prices for any materials !equired for the work to be done under this proposal and contract to its established prices in effect at the time of shipment or delivery of materials to the job (provided that such adjusted prices shall not exceed applicable maximum prices. if any. established by Government authority). Should construction labor rates be increased prior to or during the performance of any work under this contract. contractor reserves the right to charge and the owner or buyer nr e!tsInmer hereunder _,hal! pay for tho amount cf such inc.ensc. paid by conuaciot pius five per cent (Vo) for insurance. 9. It is further understood and agreed that this proposal and contract does not include any labor and materials not specifically mentioned here. 10. Requirements of Governmental Building Codes or Officials of Governmental Building Departments, not provided for in the plans and specifications. shall be considered as additional work and shalt be charged for as provided in paragraph 2 above. r /3y CLAIM s BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the. County, or District governed by) BOARD A�CTI the Board of Supervisors,.Routing Endorsements, ) NOTICE TO CLAIMANT Se p tem ��, x..9 1 and Roard 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 Am,)tjr) $237.09 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: BASTING, Karen E. ATTORNEY_ : Date received ADDRESS: 919 Brown Street BY DELIVERY TO CLERK ON August 9, 1991 Martinez, CA 94553 BY MAIL POSTMARKED: Hand delivered 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: August 9, 1991 JAIL BAATTCHELOR, Clerkuty e 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: `1 °fl 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 t5<r 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. 0 Dated: S E P 10 1991 PHIL BATCHELOR, Clerk, By v 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 J 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 11 1991 BY: PHIL BATCHELOR by 0Deputy Clerk CC: County Counsel County Administrator 2. 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-'befoee December, 31, 19$7; -must, be presented note later than{the '100th-day-after the 'ace'rual of the cause of action. Claims relating, to`-causes of action�for `death`-or for'injury to =person or to personal property or growing crops and which accrue on or after January. 1, - .- 1988, must be presented not later than six months after the accrual of the cause ,,...of.action. "Claims -relating-to any other cause •of action must be presented not later:,than one. year. after the •accrual)-)of, ,the cause of.act,ion.'`-- (Govt. -Code ,§911.2.) Be Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. �If.-claim is--against-. a district-,governed--'by'the Board`�of"Supervisors; rather than the County, the name of rthe<District'shduld be=filled fri. = - D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud,... See penalty -for -fraudulent,-.claims- Penal��Code"Sec-:`72 At'-the"end"bf 'this; form. 4. RE: Claim By ) Reserved for Clerk's filing stamp RECE1VFn,., Against the County. of Contra Costa ) or AUG 9 1991 _ ^_ District) CLERK BOARD OF SUPERVISORS Fill in name )_m ! CONTRA COSTA Co. The undersigned claimant hereby makes claim aanst the County of Contra Costa or the above-named District in the sum_of,_$, a 7 01 and in support of this claim-represents as« fol:ows: .:y� ---------------------------------------7------- -------------------- ------------- 1. When did the damage or .injury .occur? .(Give exact date and hour) f ------ -----------------------==-----=--------------------------- 2. Where did the damage or injury occur? (Include city and count ) ------- —=------------------------ - — 3. How did the damage or injury occur? (Give ' 1 details; use extra paper if required) e �-lot to -- -------_r -- 4., What particular act-or omission~on-t•the part .of'county orr'district=officers`, servants-.or,employees 'caused,the injury o damage?:%� D( -f k9 V DCO/�• �ks5 a0 l r Pu,�rtq c� LtUA -�0 0_ve QSv f y �� rte, �..�.�.Q-e- �✓�v�� ti �Ct�� > ��Q� �G75 l��t92� �( ver•) C �. wnaL, are the names of .county or district officers, servants or employees causing- the damage or injury?,. 4�4 5._. What 'damage or injuries do you claim- resulted?. :-(Give full extent-of. i juries or - -`==damages claimed. .: Attach-two-estimates-for-auto-damage. - -----_ wov ----- ---------- 7. How.was the:-amount •claimed above.'computed? :`(Include the estimated, amount of any prospective injury or damage.) --- ----- -- --------------------------------- --- -- -------------------------- $ Names and addresses :of witnesses, -doctors and .ho'spitals. - 9. List the expenditures you made on account of this accident or injury: - DATE ITEM AMOUNT if ii ii. r/ •C 'C ..; II if' T' it if li 7f ii 7f iC iC 7i. ]i A 1[ 7f i[ if 1f 7f ii Gov: Code: Sec.:91Q2 ,provides: - "The claim must be signed by the claimant SEND NOTICES TO: (Attorne ) or by some_person on his behalf." Name and Address of.-Attorney,- C aimantI Signa e } Address Telephone No. Telephone No. Ly/ 2 370'��p(� 5 NOTICE . t 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), on 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. ` ADDENDUM. TO THE CLAIM OF86aQ,✓eAgf (Print your full name) (1) Do you use the roadway as part of a daily-commute? Yes ( ✓) No - ( ) ( 2) Were you aware -that construction would be commencing on the roadway? Yes ( 3) Was an alternate route available? . Yes ( No ( ) ( 4) Did you read about the impending resurfacing in the local newspaper? 'Yes ( . ) No ( ✓) ( 5) Did-you see warning signs- advising -6f. loose gravel and a 25 mile per. hour ''advisory sign? Yes ( . .). No ( 6) Did the damage result from another vehicle exceeding the 25 mile . per hour "advisor Yes ( ) No ( ) _ (7) Did a vehicle ,traveling. in the same direction .and exceeding the 25mile per hour advisory sign attempt to pass you? - Yes ✓):-. No ( 8) Did a vehicle coming from the opposite direction cause gravel to be thrown onto your- car? Yes ( ) No { ✓) 19) Was the vehicle located directly in front of you exceeding the speed' advisory? Yes ( ) No ( ) , ( 10) Did you travel the roadway more than once during the resurfacing prior to the damage sustained to your car? Yes ( r/) No ( ) �,. ( 11) Did you obtain the identity of the car relating to questions 6 thru 9?. Yes ( ) No -If yes, please provide identification below: ( 12) Please describe in your own words how the gravel caused damage to your vehicle and the angle the gravel was thrown onto the car, along with the <specific. damaged parts on your vehicle. t �l - o-v u5-f" C ( 1.3} were you wareAtYiat using the road wring t e4chis�eal process might result in damage . to your car? Yes ( j No I declare that the. above information is true and correct under the penalty of perjury. ( Sig atur6) (Date) BAY CITIES GLASS iNvoicE P �� Remit to:Administrative Office The Bay Area's,Complete Glass Replacement Centers P.O.Box 2636,Castro Valley,CA 94546 Autos • Stores • Homes # 13561 (Formerly AA Gass) 1-(800) 358-4444 . _ REF. ANTIOCH CONCORD DUBLIN FREMONT HAYWARD LIVERMORE OAKLAND RICHMOND SAN JOSE SAN LEANDRO WALNUT CREEK P94 _ 757-2800 686-9792 828-3434 791-6464 481-7100 373-9900 451-1200 1 233-0313 286-7100 351-1275 944-9888 `- UCJ-T-EF ACCOUNT; AGENT `" ` PURCHASE ,DATE-p r y , E7RDER CUSTOMER STATE TAX OR EXEMPT NO. CUSTOMER FEDERAL TAX I.D.NO. ADV.CODE g4ESMAN I.D. gRgEH3AKo Py INSTALLED BY FEDERAL TAX I.D.N0.' 94-3036631 BILL TO: KAREN VAOTING 'SOLD TO: ..919 BROWN ST. MARTINEZ, CA 94553 INSURANCE PROOF OF LOSS BAY CITIES .GLA'SS-'-F REMONT INSURANCE CO. f �, n,r POLICY NO. INSURANCE CO. `4'`"� 76464. 1 PHONE NO. CLAIM NO. CAUSE& POLICY NAME H S LOSS LOCATION AGENT NAMEr _ VERIFIED BY 415 791. 646 AGENT PHONE DATE OF LOSS DEDUCTIBLE VEHICLE INFORMATION VEHICLE ODQMETER`„ RECEIVED AUG 9 1991 CLERK BOARD OF SUPERVISORS r CONTRA COSTA CO. _f �. j 0. LICPAY FRO CL.#46 M INVOICE - NO STATEMENT SENT.,'.' 8978 NOTICE. - "Under the Mechanic's'Lien,:Law(California Code of Civil.Procedure,Section 1181 atseq),any contractor sulicontractor,laborer, supplier or;other person who helps to improve your•property but is not paid for his work or supplies,.has a right to enforce a claim 4 L.rA against your property. This means that after a court hearing,your property could be sold by a court officer and the proceeds of the Subtotal '40. .1 sale used.to satisfy the indebtedness. This can happen even if you have paid your own contractor in full,it the subcontractor,laborer, B. ;D5% Tax 1 J. 69 or supplier'remains unpaid." . The above work has been done to my satisfactionby I HEREBY AUTHORIZE THE ABOVE REPAIR WORK TO BE DONE Bay Cities Glass and.payment,is to be made directly ALONG WITH NECESSARY MATERIAL AND I AGREE TO PAY FOR ALL is+ >• to them. CHARGES WHICH ARE NOT COVERED BY INSURANCE. �+� MS •—^.+o aav X By X LJi- i._EI'-I I k'HL I'IIJ. (JF-1L.Lli] 'I L !4!DIU-'Li e1Y NORtH IMIAIW ST. WAUWT 01t r.,�►r avi Libbey-Owens-Ford Co. I #AU43654 ON '' �� �3�1�05b6� ESTIMATE 2/212155855 Glass Centers WORK ORDER INVOICE r SALESMAN th') BILL TD; E S T I M A T E DATE 07/23/91 SOLDTO CASH-BAY ADDRESS MAKE MOD 84 PORSCHE 2D COUPE 924 9245, ADDRESS V.I.N•o CITY,ST LICENSE# MILEAGE CLAIMANT SPECIAL INST DATE TIME WORKPHONE 415933-2677 HOMEPH CUSTOMER# CASH INST b _ COMP.DATE TIME INS/PO# OUANTITY ITEM NUMBER DESCRIRTION LIST PRICE SALE PRICE TX 1 FCW36OPS FOREIGN WI,NDSHIELA 185. 98 TX 1 L.FW LABOR-FDREIGN WINDSHIE 25.100 1 KFW KIT FOREIGN WINDSHIELD 9. 95 TX ' RECEIVE® AUG 9 1991 CLERK BOARD,OF SUPERVISORS CONTRA COSTA CO. Paymt Reference Approval Date Amount Sub 22121. 93 ------ -------------------- ------ ------ ------ ----------- Tax 16. 16 Balance Total 237, 09 w*+� THIS IS NOT AN INVOICE - DO NOT PAY , *** 10 - - - - - - - - - - - - - - - - - - - - - - - - - -. - - - - - -.- - - - - - - - - - - -. - - - - - - - - - - - OLD TO: IM#AW-M INSURANCE COMPANY INFORMATION BELOW THIS LINE AGENT NAME NAME ADDRESS' ADDRESS ADDRESS ADDRESS CITY,ST i CITY.ST PHONE# FLEET>w PHONE# POLICY# CLAIM# INSURANCE DATE bici CAUSE OF VERIFIED BY LOSS LOS5 e • CLAIM "4 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. September 10, 1991 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: Estimated $256. 8900 Section 913 and 915.4. Please note all "Warnings CLAIMANT: BECKWITHI Scott`W' � ATTORNEY: Date received August 1 , 1991 ADDRESS: 402 Dale Road MP BY DELIVERY TO CLERK ON Martinez, CA 94553 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 7 19.91 ppHH1L BATCHELOR, Clerk 0_0Jo DATED: ' B : Deputy 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: I J _ ZZ�0__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 Order entered in its minutes for this date. q Dated: .S P ���` PHIL BATCHELOR, Clerk, By A^ 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: SEP 11 1991 BY: PHIL BATCHELOR b oRAAAJD Deputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF .CONTRA COSTA• COM&— 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 acc'r'ual of the cause of action. Claims relating•,,to,.eauses .;of action..for_death:or for injury to person onto 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:Ifilled, in. D. If the claim is against-more=-than-one -public entity, "separate claims must be filed against each public entity. - E. Fraud..., Seepenalty for fraudulent claims;..-Penal -Code Sec:' 72• at °the end of this form. ' . RE: Cla' By ) Reserved for Clerk's filing stamp .y0�- 1��/� RECE{VED . . Against the County of :Contra Costa ):: or �. Am - District) IIPIKROARDOFSUPERVISORS Fill in name ) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ . ' andin Supp t of �� F this claim represents as follows: > no f S" ------ .- �5 Time, 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or n y occu ? (Include pity and county) " -3. How did the damage or injury occur? (Give full details; use..extra paper if- required) use...extra 4. What -articular acth or.- on on .the : t.iof.cd ty or district-officers p . Imo' v ,servants or.employees caused,the injury or- damage? (over) 7. ft.,a'c are the names of county ,or district officers, servants or employees causing'- the damage or injury?,,. ra 5.. What ' ge or. injuries do you',claimr'resulted?s,-(Give full extent of injuries or damages claimed. Attach "two estimates for auto-damage. ----�---�.� ------ ----------- �- -��-�----L----- ----------------------- ------ 7. - How was the amount claimed above.'computed? .'(Include the estimated amount•of any prospective injury or damage.) ---------; --------------------I------------- - "-"=----- -=-----------=------=-------- $.: Names and addresses of. witnesses-, -doctors and hospitals. >: - - -------- - ----------------------------------------------------- 9. List the expenditures you made on account of this accident. or injury: DATE ITEM - s AMOUNT Gov`.''Code Sed.-. '9M.2 provides:. gfi "The claim must be signed-by the claimant SEND NOTICES TO: (Attorney or by some 'Person on is behalf." Name and Address;of;Attorney.ix j Claimant's Sigiiature Address• u Telephone No. I Telephone No:_ - Z- YrZ57 1 - * * , , * ,• Y X .fit..fit..*. A A- N 0 T I C E *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- Aperiod of«-not�more 'than one year, by •a 'fine,of not' excee8ing 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. ADDENDUM TO THE CLAZM•.OF ? -.(Print your full name) ( 1) Do you +use the roadway as part -ofa, daily commute? E Yes ( ) No ( ) ( 2) Were you aware that construction would be commencing on the roadway? " _ . _. Yes ( ) No (�) ( 3) Was an alternate route available? - Yes ( ) No (4) Did you, read about the .impending resurfacing -in the local newspaper? Yes ( _) No (X) ( 5) Did you see warning signs advising of_ loose.-gravel and a 25 mile per hour advisory sign? E .:77 Yes J( .._ No...(. ( 6) Did the damage result from another vehicle exceeding the - 25 mile per'hour advisory? _.- Yes ..i... _� No ) (7) Did a vehicle traveling -in the same .direction_.and exceeding �..,. the 25 mile - pe advisory, sign attempt to pass you? y r Yes `( )` No ( () (8) Did a vehicle coming from the opposite direction cause gravel to be: thrown.- onto your car!. `, Yes ( ) No (� ) ( 9j -',Was the- vehicle located directly in front of you exceeding the speed advisory? _ Yes ( ) No ) ( 10) Did you- travel' the_ roadway more than once during the resurfacing prior to the damage sustained to. your car? Yes ( ) No ) ( 11)* Did you obtain the identity of the car relating to questions �6 thru 9? Yes ( ) No X) If yes, please provide identification below: ( 12) Please describe in your own words how the gravel caused damage to your vehicle and the :angle the gravel was thrown onto the car, along with the'' specif'ic damaged parts 'on your vehicle. - r Iq Q, e, J A Co a , _ " 1 iZd A D Arid All a( el �C'`ll.tl? ( 13) Were you aware that using the road during the chip seal process might result in damage to your car? . . Yes (• ) No ) I declare that the above information is true and correct under the penalty of perjury. (signature) (Date) 'C®BEL GLASS, INC. Independently Owned & Operated 1-800-2-4-COBEL Servicing the ENTIRE Bay Area AUTO PLATE HOME RICHMOND OAKLAND HAYWARD / 1711 BARRETT AVE. 400 FRANKLIN ST, MOBILE SERVICE 232-1337 834-7841 . 276-3244 DUBLIN/ SAN LEANDRO PACHECO SAN RAMVI 1992 REPUBLIC AVE. 5292 PACHECO BLVD. MOBILE SERVICE MOBILE 2EOR02 357-0747 827-3900 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 September 10, 1991 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), gi ant to rr, e Amount: $11 , 296. 70 Section 913 and 915.4. PleaseR 1V Qgs CLAIMANT: BLUER, Joanne B. Fs14 �g�� At IG 1 41991 ATTORNEY: Susan G. Bluer, Esq . Pv�i Da.�e ed CLERK BOARD OF SUPERVISORS ADDRESS: 3500 Market Street CO , Y TO CLERK ON,_____Ad ,a A M S T4 Go 1 San Francisco, CA 94131 BY MAIL POSTMARKED: August 8 , 1991 Certified P 659 226 635 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. August 13, 1991 EVIL BATCHELOR,. Clerk DATED: BY: Deputy _ CL 0_w', V40 i 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: I Deputy County Counsel TT 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 Order entered in its minutes for this date. Dated: S E P .1 0 1991 PHIL BATCHELOR, Clerk, B 014Deputy 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 Noti to Claimant, addressed to the claimant as shown above. L Dated: SEP 11 1991 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator R • . August 7, 1991 ED AUG 9 Susan Frederick RN/NPM Merrithew Memorial Hospital CLERK BOARD OF SUPERVI 2500 Alhambra Avenue CONTRA COSTA CO. Martinez, CA 94553 Board of Supervisors Clerk's Office County of Contra Costa 651 Pine Street, First Floor Martinez, CA 94553 Office of County Counsel Clerk's Office County of Contra Costa 651 Pine Street, Ninth Floor Martinez, CA 94553 Re: CLAIM FOR DAMAGES TO PERSON OR PROPERTY PER GOVERNMENT CODE SECTION 911. 2 Dear Gentlepersons: Pursuant to Susan Frederick's request, I have completed and am enclosing a "Patient/Visitor Request for Personal Property Reimbursement" form, along with an appraisal, concerning a diamond ring which was stolen from me when I was admitted to the Emergency Room at Merrithew Memorial Hospital ("the Hospital") on or about February 14, 1991. The ring was a gift from my mother and, in addition to having great sentimental value to me, was worth in excess of $11, 000. While I am hopeful this matter will be resolved short of litigation, this letter also constitutes notice of my claim against the appropriate entity-- the Hospital, County Counsel, or County Board of. Supervisors-- pursuant to California Government Code § 911..2 . MY NAME AND ADDRESS: JOANNE B. BLUER 379 SCOTTSDALE ROAD PLEASANT HILL, CA 94523 . ADDRESS FOR FURTURE SUSAN G. BLUER, ESQ. NOTICES/CORRESPONDENCE 3500 MARKET STREET SAN FRANCISCO, CA 94131 (415) 495-4747 (office) Susan Frederick RN/NPM August 7, 1991 . Page 2 Circumstances of the Claim I was admitted to the Emergency Room of the Hospital on or about February 14, 1991, in a semi-conscious state resulting from a drug overdose. I noticed at the time of my arrival to the.' Emergency Room that the jewelry which I always wore on my hands .was present-- the subject diamond ring (on my left hand) , a simple gold ring and my watch (on my right hand) . However, I noticed after arriving at, the unit I was next taken to --Intensive Care (ICU) - - that only my simple gold ring and watch were on, and that my diamond ring had been removed by someone in the Emergency Room. I was very upset about the apparent loss of my ring and told one of the nurses in ICU "my diamond ring is gone! " Unfortunately, the nurse I spoke to ignored my concern and failed to do anything to determine who took, my ring. Incidently, the subject ring fit my finger very tightly and could not have fallen off. That next day, February 15, 1991, my sister, Bonnie Goodstein, called the Hospital to demand the return of my ring. She spoke to the nurses who were "on call" on February 14, 1991, including, among others, Tina in the Emergency Room, Beth Bautista and Delia Come in ICU, and Mary Alto, one of the nursing supervisors. These women reluctantly initiated an investigation for my stolen ring. Since my sister did not receive any word from the' Hospital regarding the return of my ring, my daughter-- Susan Bluer-- contacted the Hospital a day or two later and spoke to Mary Alto about.the status of the "investigation". During that conversation, Ms. Alto informed my daughter that the Hospital 's procedure mandated that upon admission to the Emergency Room, all valuables were to be removed and stored in the Hospital 's safe. Obviously, the nurse(s) in the Emergency Room on the date I was admitted violated this procedure. Later that day (February 16 or 17) , Ms. Alto directed my daughter to Susan Frederick, the nursing supervisor in ICU, the person who had taken over the "investigation" . On or about February 21, 1991, Ms. Frederick told my daughter the Hospital had completed its "investigation" and concluded the ring was not taken by anyone at the Hospital. Upon my daughter's request, Ms. Frederick sent her the enclosed claim form for completion and return to Ms. Frederick. Susan Frederick RN/NPM August 7, 1991 Page 3 General Description of my Stolen Ring The stolen ring was originally an anniversary gift from my father to my mother in approximately 1934. When he passed away in August of 1989, my mother gave me the ring to remember him by. On or about October 5, 1989, I brought the ring to Les Selan Jeweler, in Oakland, to have the ring sized and refinished. As you will note from the enclosed appraisal by David Rowley of Les Selan Jeweler, dated April 24, 1991, the ring had a large 11 .90 carat full cut round diamond set into the center of the ring, as well as assorted diamond melee" set in Platinum. The ring was appraised at $10, 510, plus applicable taxes of $786.70, for a total of $11, 296.70. Please see the enclosed appraisal for a further description of my stolen ring. Names of Public Employees Responsible for the Loss If I am forced to institute litigation, it will be my contention that the nurses identified above, their supervisors, the Hospital and the County are liable for, among other things: (i) conversion of personal property, (ii) negligent supervision, and (iii) negligence for failing to comply/enforce the Hospital ' s internal procedures for the safe handling of patient's valuables. Amount of Claim At this time, I demand the appraised value of my stolen ring, including applicable taxes-- $11, 296.70. If I. am forced to institute litigation, I intend to seek general damages for the emotional distress I have suffered as a direct result of the conversion, each defendant' s negligence, as well as the substandard nature of the Hospital ' s "investigation, " in an amount within the jurisdiction of the Municipal Court. Thank you for your prompt attention to my claim. I sincerely hope we can resolve this claim without the unnecessary time and expense of a trial . Very truly yours, .ts . JOANNE B. BLUER ` • CONTRA COSTA CONTY HEALTH SERVICES Policy No. 155aSeotenber, 1988 . MERRITHEW MEMORIAL HOSPITAL A CLINICS PATIENT/VISITOR REQUEST FOR PERSONAL PROPERTY REIMBURSEMENT xxxxxssxxxxxxxxxxxxxsxxsxxxxxxxxsssxxssasssszazrzrsxxxxxxssxxxxxaszssssssss--•----•--x-----xx---------_-_-_-__-_- This Section To Be Completed By Patient/Visitor Name: �a-h n� l / Patient Visitor Address: 3-7 CityFzjjj� Zip S'7� Telephone: (Home) &YQ 7 (Wor.k) q Describe the manner in which the loss or damage occurred: � 4 �{ c / L• V✓�S uNr7t. T� LM�ll 1� 0. �Wl ! GU�IJcIaK: �a�� -eSK ITIhqq rvn, rti v dlv w� - // J �' � • S ul� S l✓pQlln ��r)1,1'►Wr� Ih �?c 6j, (' 'L o L 1' C del Amount of Loss Claim(��� ��at : �� 2 ,Yi O Where purchaseds ®o�A'-�� n� � 1. d� Amount to repair damaged roperty S Date, purchased: ' jq IR�5 (attach invoice 8 actual repair) Original purchase price of article(s) S 4&rOk0 3, (attach sales slip on same) TY Signature � � Data s.==xxxxx--xxx•xx•s xxxs-•r-xxxss-s----•-xrxxss-•----•_s-r---x-ass-szzsszxsaszrssx-xs»ss---x•sssss-ass-x-xx•x This Section 10 Be Completed By Witness �c dpi �j Confirming statement by witness to incident: WALs V ohN1� w WhIC tp,all 4rk'15--rV- P4 kh 514C*-- hdSq s !'...,Witness Name (priWitness Signature Date sax_-x uxxx••xx-•r-•xxxssxssssszzsssrssssssrrazssrxs-sasssssarsssssrssssssssszsxsxsszsrx--eze-x-xxsssxxxx- This Section To Be Completed By Responsible Administrator. I recommend approval of this request because it masts the criteria for reimbursewent as outlined in MMH & C Policy "Compensation For Loss Or Damage To Hospital and Clinic Patient/Visitor Property, " as follows: I do not recommend approval of this request because it doss not met the criteria for reimbursement for the following reasons: rsxrssrsssarssssxsszzxsxzssss:saasassssssssasssssssasssssssssassassssssssasssssss:ssssssssassasssssszrsxs This Section To Be Completed By Hospital and Clinic Executive Director I do not authorize payment. I authorize payment to patient/visitor in the amount of f Signature Date Distribution: Original- Hoop. Administrator A-408 (1/88) fellow - Patient/Visitor P0 izv 'No. 155a SeotembPr,' 19P?- CONTRA COSTA COUNTY HEALTH SERVICES MERRITHEW MEMORIAL HOSPITAL b CLINICS PROPERTY DAMAGE RELEASE In consideration of the payment to me in the sum of , I, do hereby release Contra Costa County (print name) x and Merrithew Memorial Hospital and Clinics from any claims resulting from the loss or damage to my property occuring on . (date) It is further acknowledged that in the event I disagree with any dispute, disagreement or denial of reimbursement of loss or damaged property, I may for- mally present, a claim for damages to the Clerk of the Board of Supervisors. Signature Date r Witness Signature . Date Distribution: Original-Hosp. Admin. Yellow-Patient/Visitor A-407 (1/88) Les Selan aEWF_Lz% • 1635 Telegraph Avenue • Oakland, Calif. 94612 • Phone 444-5070 April 24, 1991 Susan G. Bluer 3500 Market St. Apt. 202 San Francisco, CA. 94131 Dear Susan; Thank you for asking our store to provide this estimate to replace your mother 's stolen ring. This appraisal will be based upon the information supplied to me by your mother as well as information that we noted on our work envelope when we repaired your mother ' s ring on October the fifth 1989. Before I give you the pertinent, information on the ring let me give you a little of my background. I 've been an appraiser for Les Selan Jeweler for approximately ten years. I have completed diamond grading courses from the Gemological Institute of America as . well as having attended numerous seminars and classes on appraisal arts and gemology. - I have been used as an expert witness in two court cases as well as . having done hundreds of appraisals in the -last ten years for both individuals and law firms. As I indicated before we did some repair -work on Joanne Bluer 's diamond ring which included sizing the ring to a size 72 as well as refinishing and rhodium flashing the ring. When we took the ring in for repair Mr. Selan wrote the following information on the repair envelope: Ladies Platinum diamond ring containing,' one approximately .90 ct. full cut round diamond set into the center of the ring, as well as assorted diamond melee. After questioning several members of the Bluer family I 've come up with a Les Selan aEweLEt. 1635 Telegraph Avenue Oakland, Calif. 94612 Phone 444-5070 more detailed approximation of the sizes. and shapes of the assorted melee. The top of the .ring has a horizontally situated oval shaped plate and has ten approximately .08 to .12 ct baguette cut diamonds set around the perimeter of the plate. There were also approximately twenty - four . 025 - . 05 ct. single or full cut -round diamonds set around the center diamond and between the baguettes . Assuming - the baguette and round - diamond melee are of excellent quality (. as is the case in most all -of the diamond platinum rings that I 've appraised) and the center is of medium high quality ( approximate clarity of VS1 , color of G- I, and good symmetry and finish) we can give a replacement cost ' of, $10,510.00 plus applicable federal, state, and local sales and excise taxes of $786.70. I didn't have a net weight for the ring mounting - so I used an. average price on platinum ring mountings of the type that the customer had. I also assumed' that the small round diamonds were single cuts and I used a recut formula to determine the price of the old European center diamond using national price guides and diamond broker price lists. This is only an estimate using both information obtained from the owners -as well as information noted on our job envelope. If my assumptions on the clarity, color, cut, etc. vary from the original the price may vary somewhat but I feel confident that they won 't stray too far from the price I 've given you. If you or your insurance company has any questions regarding this estimate please don't hesitate to call. Sin rely, David Rowley Authorized Appraiser a Manager -Les Selan Jeweler C5 h v cp G N cel ca A v / � t) oa 4A v Ul No oa) 0 01 01 m, N .4 . tl- r t i i CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Clam Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 10, 1991 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 Su ervisors (Paragraph IV below), given purl QtQdav�E[Yt Cod Amount: $11 , 296-. 70 Section 913 and 915.4. eas CLAIMANT: BLUER, Joanne B. RE6ENra AUG 144 1991 ATTORNEY: Susan. G. Bluer, Esq. 03 14 Date re i CpUNS� CLERK BOARD O IJPERVISORS ADDRESS: CONTRA COSTA CO. 3500 Market Street BY DELI 19 9 San Francisco, CA 94131 Au ust. 8 1991 BY MAIL POSTMARKED: g Certified . P 659 226 633 I. FROM: Clerk of the Board/of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PpHHIL BATCHELOR;. Clerk DATED:Al1ust 13 , 1991 BY: Deputy 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: Iq BY: J Deputy County Counsel I —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 (� 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. 0 V Dated: SEP 10 �ggi 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 Noti a to Claimant, addressed to the claimant as shown above. Dated: SEP 11 1991 BY:. PHIL BATCHELOR by 'L Deputy Clerk CC: County Counsel County Administrator • VICTOR J. WESTMAN CONTRA COSTA COUNTY COUNSEL TO a P.O. Box 69, Co. ADMIN. BLDG., �i MARTINEZ. CA 94553 i DATE SUBJECT Csa o I I I 1 1 f y r.0 4- August 7, 1991 %CEIVE® G Susan Frederick RN/NPM A.et' UNSF Merrithew Memorial Hospital 2500 Alhambra Avenue Martinez, CA 94553 Board of Supervisors Clerk's Office County of Contra Costa 651 Pine Street, First Floor Martinez, CA 94553 RECEI D Office of County Counsel Clerk' s Office 21991 County of Contra Costa 651 Pine Street, Ninth Floor Martinez, CA 94553 CLERK ONTRA OF SUPERVISORS Re: CLAIM FOR DAMAGES TO PERSON OR PROPERTY PER GOVERNMENT CODE SECTION 911.2 ' Dear Gentlepersons: Pursuant to Susan Frederick's request, I have completed and am enclosing a "Patient/Visitor Request for Personal Property Reimbursement" form, along with an appraisal, concerning a diamond ring which was stolen from me when I was admitted to the .Emergency Room at Merrithew Memorial Hospital ("the Hospital") on or about February 14, 1991. The ring was a gift from my mother and, in addition to having great sentimental value to me, was worth in excess of $11, 000. While I am hopeful this matter will be resolved short of litigation, this letter also constitutes notice of my claim against the appropriate entity-- the Hospital, County Counsel, or County Board of Supervisors-- pursuant to California Government Code § 911. 2 . _ MY NAME AND ADDRESS: JOANNE B. BLUER 379 SCOTTSDALE ROAD PLEASANT HILL, CA 94523 ADDRESS FOR FURTURE SUSAN G. BLUER, ESQ. NOTICES/CORRESPONDENCE 3500 MARKET STREET SAN FRANCISCO, CA 94131 (415) 495-4747 (office) Susan Frederick RN/NPM August 7, 1991 Page 2 Circumstances of the Claim I. was admitted to the Emergency Room of the Hospital on or about February 14, 1991, in a semi-conscious state resulting from a drug overdose. I noticed at the time of my arrival to the Emergency Room that the jewelry which I always wore on my hands was present-- the subject diamond ring (on my left hand) , a simple gold ring and my watch (on my right hand) . However, I noticed after arriving at the unit I was next taken to --Intensive Care (ICU) - - that only my simple gold ring and watch were on, and that my diamond ring had been removed by someone in the Emergency Room. I was. very upset. about the apparent loss of my ring and told one of the nurses in ICU "my diamond. ring is gone! " Unfortunately, the nurse I spoke to ignored my concern and failed to do anything to determine who took my ring. Incidently, the subject ring fit my finger very tightly and could not have fallen off. That next day, February 15, 1991, my sister, Bonnie Goodstein, called the Hospital to demand the return of my ring. She spoke to the nurses who were "on call" on February 14, 1991, including, among others, Tina in the Emergency Room, Beth Bautista and Delia Come in ICU, and Mary Alto, one of the nursing supervisors. These women reluctantly initiated an investigation for my stolen ring. Since my sister did not receive any word from the Hospital regarding the return . of my ring, my daughter-- Susan Bluer-- contacted the Hospital a day or two later and spoke to Mary Alto about the status of the "investigation" . During that conversation, Ms. Alto informed my daughter that the Hospital 's procedure mandated that upon admission to the Emergency Room, all valuables were to be removed and stored in the Hospital 's safe. Obviously, the nurse(s) in the Emergency Room on the date I was admitted violated this procedure. Later that day (February 16 or. 17) , Ms. Alto directed my daughter to Susan Frederick, the nursing supervisor in ICU, the -person who had taken over the "investigation" . On or about February 21, 1991, Ms. Frederick told my daughter the Hospital had completed its "investigation" and concluded the ring was not taken by anyone at the Hospital. Upon my daughter's request, Ms. Frederick sent her the enclosed claim form for completion and return to Ms. Frederick. Susan Frederick RN/NPM August 7, 1991 Page 3 General Description of my Stolen Ring The stolen ring was originally an anniversary gift from my father to my mother in approximately 1934. When he passed away in August of 1989, my mother gave me the ring to remember him by. On or about October 5, 1989, I brought the ring to Les Selan Jeweler, in Oakland, to have the ring sized and refinished. As you will note from the enclosed appraisal by David Rowley of Les Selan Jeweler, dated April 24, 1991,, the ring had a large 11 .90 carat full cut round diamond set into the center of the ring, as well as assorted diamond melee" set in Platinum. The ring was appraised at $10, 510, plus applicable taxes of $786.70, for a total of $11, 296.70. Please see the enclosed appraisal for a further description of my stolen ring. Names of Public Employees Responsible for the Loss If I am forced to institute litigation, it will be my contention that the nurses identified above, their supervisors, the Hospital and the County are liable for, among other things: (i) conversion of personal property, (ii) negligent supervision, and (iii) negligence for failing to comply/enforce the Hospital 's : internal procedures for the safe handling of patient's valuables. Amount of Claim At this time, I demand the appraised value of my stolen ring, including applicable taxes-- $11, 296.70. If I am forced to institute litigation, I intend -,to seek general damages for the emotional distress I have suffered as a direct result of the conversion, each defendant's negligence, as well as the substandard nature of the Hospital 's "investigation, " in an amount within the jurisdiction of the Municipal Court. Thank you for your prompt attention to my claim.. I sincerely hope, we can resolve this claim without the unnecessary time and expense of a trial.. Very truly yours, as . r JOANNE B. BLUER - � CONTRA COSTA CU1TY HEALTH SERVICES Policy No. 155aSeotenber; 1988 MERRITHEM MEMORIAL HOSPITAL & CLINICS PATIENT/VISITOR REQUEST FOR PERSONAL PROPERTY REIMBURSEMENT • xnannaaaas-_nonnnnancsossx saasssrnzssxassaxszrxrssssxssxssxss__szsz-:ssssss---------==snn rn=as=sn====°==== This Section To Be Completed By Patient/Visitor Name: �Q-h nv � / Patient Visitor �..� Address: •p-- (,,A City Zip Telephone: (Home) 6YO - 7 (Mork) Describe the manner in which the loss or damage occurred: n, 4 r / . o c / L, Y WAS �l(�Yh. � IL fMrLt n � 6n l — � ojC1f>K ,tat- reSK J•hh ' ��,� a w pUL'f�0�2 S vl�� W1� l✓2arin i�ow rh etc // Q[ 0 a , Amount of Loss ClsimC��K al S I4 2l(I� 'W-/here purchased: ®a�FMl� ice? "Mm 41 R ) Amount to repair dsmaged�operty S &1A rDate purchased: 1�f (attach invoiced actual repair) Original purchase price of article(s) S d,& # (attach sales slip on same) Signature 6 ' � � Date — This Section To Be Completed By Witness Confirming statement by witness to incident: 'L S P Avr Ywh �, W . �JZI nf' 5111�4i n Va +_0 awl- �5 r ; Witness Name (print)fj Witness Signature Date ansaxaaaars.nrssszssasxsxssssssssssrssssxxszssasrsszsxsrrssrasassasxssaazraxrssssxxxxssssssszsssaannss This Section To Be Completed By Responsible Administrator I recommend approval of this request because it meets the criteria for reimbursement es outlined in MMH A C Policy "Compensation for Loss Or Damage To Hospital and Clinic Patient/Visitor Property, " as follows: I do not recommend approval of this request because it does not meet the criteria for reimbursement for the following reasons: ssssss=zssxsasszsssssssssssssxssrsssszasasssssssasasssssssssassssssssssssssssssssassssssssssassaassassss This Section To Be Completed By Hospital and Clinic Executive Director I do not authorize payment. I authorize payment to patient/visitor in the amount of S Signature Date Distribution: Original- Hoop. Administrator A-408 (1/88) Yellow - Patient/Visitor Po I i cv- No.l. 155a SeDtembPr, 198¢ CONTRA COSTA COUNTY HEALTH SERVICES MERRITHEW MEMORIAL HOSPITAL b CLINICS PROPERTY DAMAGE RELEASE In consideration of the payment to me in the sum of S , - do hereby release Contra Costa County (print name) L and Merrithew Memorial Hospital and Clinics from any claims resulting from the loss or damage to my property octur-ing on (date) It is further acknowledged that in the event I disagree with any dispute, disagreement or denial of reimbursement of loss or damaged property, I may for- . malty presert. a claim for damages to the *Clerk of the Board of Supervisors. w' Signature Date Witness Signature Date Distribution: Original-Hosp. Admin. Yellow-Patient/Visitor A-407 (1/88) Les Selan F-weLt 1635 Telegraph Avenue Oakland, Calif. 94612 Phone 444-5070 April 24, 1991 Susan G. Bluer 3500 Market St Apt. 202 San Francisco, CA. 94131 Dear Susan; Thank you for asking our store to provide this estimate to replace your mother 's stolen ring. This appraisal will be based upon the information supplied to me by your mother as well as information that . we noted on .. our work envelope when. we repaired your mother ' s ring on October the fifth 1989. Before I give you the pertinent information' on the ringlet me give you a little of my background. I 've been an appraiser for. .Les Selan Jeweler for approximately ten years. I have . completed diamond grading courses - from the Gemological Institute of America as well as having attended numerous seminars and classes on appraisal. . arts " and gemology. I have- been used as an expert witness in two - court cases as 'well as having done hundreds of appraisals in the last ten years for both individuals. and. law firms. As I indicated before we did some repair work on Joanne Bluer 's diamond ring which included sizing the ring to a .size 72 as well as refinishing and rhodium flashing the ring. When we took the ring in for repair Mr. Selan wrote the following information on the repair envelope: Ladies Platinum diamond ring containing, one approximately .90 ct. full cut round diamond set into the center of the ring, as well as assorted diamond melee. After questioning several members of the Bluer family I 've come up with a rl.''B'4Gf1' Les Selan 9F-WF-LF-,t 1635 Telegraph Avenue Oakland, Calif. 94612 Phone 444-5070 more detailed approximation of the sizes and shapes of the assorted melee. The top of . the ring has a horizontally situated oval shaped plate and has ten approximately .08 to . 12 ct baguette cut diamonds set around the perimeter of the plate. There were also approximately twenty - four . 025 - .05 ct. single or full cut round diamonds set around the center diamond and between the baguettes. Assuming the baguette and round diamond melee are of excellent quality ( as is the case in most all of the diamond platinum _rings that I '.ve appraised) and the center is of medium . - high quality ( approximate clarity. of VS1 , color of G- I, and good symmetry and finish) .we can give a replacement cost of . $10,510.00 . plus - applicable_ federal, state, and local sales and excise taxes of $786..70. I didn't have a net weight for the ring mounting so I used an average price on platinum ring mountings of the type that the customer had. I also assumed that the small round diamonds were single cuts and I used a . recut formula to determine the price of the old European center diamond using national price guides and diamond broker price. lists. This is only an estimate using both information obtained from the owners as well. as information noted on our job envelope. If my assumptions on the clarity color, cut, etc. vary from the original the price may vary - somewhat but h feel confident that they won't stray too far from the price I 've given you. If you or your insurance company has any questions { regarding this estimate please don't hesitate to call. Sin rely, David Rowley Authorized Appraiser a Manager Les Selan Jeweler "—YM�Y Y'Y YYYYYYY c� ' c i CB Isl� R.x'37 r. 4-3 4-) )` O O �.;. LO LO ` ! 4J S4 -Pd' t� . O •U O 44 0 44 -U � a +-) w0 '-+ u wr, Oin (a f O U U i oa + rn I n ru 2 Er L CDo CL i i CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim ACainst the County, or District governed by) BOARD ACTION tine So,d of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 10, 1991 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 pursu% G6vernment Code Amotmt: Undetermined Section 913 and 915.4. PleaseqVd-ie all 11 �rnings". CLAIMAwI: BROWN, Theresa CpUN HT'iORNEY: Co Date received ADDRESS: 4176B San Pablo Dam Road BY DELIVERY TO CLERK ON August 6, 1991 g E1 Sobrante, CA 94803 .j BY MAIL POSTMARKED: Hand delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: August 7 , 1991 EVIL geputyLOR, Clerk a (IA^0-11 4, j II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. r ) 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: ( 15I BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrat (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present Q This Claim is rejected in-full. ( ) Other: I certify that this-is altrue and correct copy of the Board's Order entered in its minutes for this date. 9 0 Dated: SEP 1 O 1991 PHIL BATCHELOR, Clerk, By Op 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 No ti to Claimant, addressed to the claimant as shown above. Dated: SEP 11 1991 BY: PHIL BATCHELOR by—Q4,d, eputy Clerk CC: County 'Counsel County Administrator 1 I NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Teresa Brown 4176B San Pablo Dam Road E1 Sobrante, California 94803 Re: Claim of BROWN, Theresa Please Take Notice As Follows : The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code section 910 and 910 . 2, or is otherwise insufficient for the reasons checked below: 1 . The claim fails to state the name and post office address of the claimant. 2 . The claim fails to state the post office address to which the person presenting the claim desires notices to be sent . 3 . The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. 4 . The claim fails to state the name(s ) of the public employee(s ) causing the ,injury, damage, or loss, if known . x_5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ( $10, 000) . If the claim totals less than ten thousand dollars ( $10, 000 ) , the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ( $10, 000 ) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. 6 . The claim is not signed by the claimant or by some person on his behalf . ' 7 . Other: - VICTOR WEST County Counsel By: Deputy y Counsel CERTIFICATE OF SERVICE BY L \J C.C.P. 1012 , 1013a, 2015 . 5 ; Evid. C. §§ 641 , 664 ) My business address is the County Counsel' s Office of Contra Costa County, Co. Admin. Bldg. , P.O. Box 69 , Martinez, California, 94553, and I am a citizen of the United States, over 18 years of age, employed in Contra Costa County, and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non Acceptance of Claim by placing it in an envelope(s ) addressed as shown above (which is/are place(s) having delivery service by U.S. Mail ) , which envelope( s ) was then sealed and postage fully prepaid thereon, and thereafter was , on this day deposited in the U.S . Mail at Martinez/Concord, Contra Costa County, California . I certify under penalty of perjury that the foregoing is true and correct . Dated: y' 7 - 9� , at Martinez, California . cc: Clerk of the Board of Supervisors (ori al) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910 . 2, 920 . 4 , 910 . 8 ) Cli,-W-to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY h 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. ` y 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 61991 or or ) District) CLERK BOARD OF SUPEU-1 SO RS. Fill in name ) CONTRA COSTA The undersigned claimant hereby makes claim against he County of Contra Costa or the above-named District in the sum of $ Ad .4/l✓,l and in support of this claim represents as:,follows: ------------------------- ------------------------------------------------------------ 1. When did the damage or injury occur? (Give exact date and hour) ----CJ-' . / ----------------------------------------------------- 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 i - required) 6 fe -------------- -------------- ----------- .----------- 14. What particular act or omission on the part of county or' district officers, servants or employees caused the injury or damage? / y y (over) 5. What are the names of county or district officers, servants or employees eausjng the damage or injury? =------------ 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.) edk6 �G �D, s-a6 '8. Names and addresses of witnesses, doctors and hospitals. • �f4:�,�1y. ��- 3sa .moi� �Sdi��'?// 9. List the expenditures you made on account of this accident or injury: DATE ITEM / AMOUNT ` S * 1� •� !f IE � * � * !f �.,•,* !t �E�; ?,��k !F �E "�E �F �F �f 1F iF IE �E �E 9k �E �E �F �F IE # � �E � �E * �F iF �E 'Gov. Code Sec. 910.2 provides: The claim must be signed by the claimant SEND NOTICES TO: (Attorney) r ' ' " or by some person on his behalf." Name and Address of Attorney Claimant's Signature Address Telephone No. TPlenhone No..2Z2 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 ($10,0000 or by both such imprisonment and fine. 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 September 10, 1991 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: $224 .00 Section 913 and 915.4. Please note all "Warnings". VL CLAIMANT: CRUMES, Rufus J. ATTORNEY: ,p NSC Date received ADDRESS: 490 Canyon Oak Drive #HBY DELIVERY TO CLERK ON August 2, 1991 Oakland, CA 94605 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. EV BATCHELOR, Clerk p DATED: August 7 , 1991 BY: Deputy aA:�3dzo 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: J 191 BY: I JUL,_, 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 lam) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Or r entered in its minutes for this date. Dated: S E P 10 1991 PHIL BATCHELOR, Clerk, Byr1h, J.A ° 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 shownabove. Dated: S E P 11 1991 BY: PHIL BATCHELOR by A. Deputy Clerk CC: County Counsel County Administrator r; . .,. Ston Nar►a'l C�� Claim to BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY UG ® ` INSTRUCTIONS TO CLAIMANT Q J A. Claims relating to causes of action for death or for injury to Person .or to per--. sonal property,or1growing, crops-and-which ace'rue"on or before December 31',..1987, 'mustbe presented not later,than .the:-100th day after the accrual. of the cause of action. Claims relating•to:_causes of action, for'4&ath orifor injury to person or' td 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 ofaction must bejpresented not later than one"year,, after'-the-accrual''of, the amuse 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 4is _against .a district-governed',by° the,Board" of`Supervisors, rather, than., -County, the name ,of:,,.the.District.should befilled, 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, lPenal Code 'Sec. 72 at' the end of this - form. RE: Claim ByC ) Reserved for Clerk's filing stamp u s s , ru c� RECEIVED Against the .County.,of Contra 1991 or; _ CLERK BOAR } p OF SUPERVISORS' � �.. Districtj. oS ACo. CONTRA C Fill in name ) ; The undersigned `claim t hereby makes claim against the County of Contra Costa or the above-named Districtin- the 'sum of $ 07� and in support of this claim-represents.as. follows s_-: w A. - ------------------------------------------------------------------------------------- 1. When did the 'damage or injury occur? (Give exact date and hour) --------------- ------ -------- -- 2. ' Where' 2. ' Where did the damage or injury occur? (Include city and county) ki- R l!/.� -�- a-�- - ----�.ee-die -----N-e-e--N-s-N�rN.r-e--e----ee--- e --.�-e-- 3. How did the damage or injury occur? (Give full details; use extra paper if re uired) - /:4/ �f�N D-r�i Nr- a % X� � / /g Cliff 1/C'/ '�>:.�-A,, -e(--- N --- - - --e- ---a--e-- -e- N�e!.ee-ems-N e--a----- e- ---- -- e- l 4. 4hat particular act or.omission� on .the:part of�county or districf£officers, servants or ;employees. causedthe, injury:-:or: damages ~r • ', ,._..,,.. .,z. - Lposez 67rAvE � (over) 5. What areithel-names of county or district officers-, servants or employees causing,, the damage or injury?,, 5:r What damageror injuries do+you claim resulited? (Give full extent of injuries or damages4 claimed. . Attach two estimates for.-autodamage. s g/rte `qk �o.�cu+-� // ', :• moo,,u„�Tw,� �y2o c 3s- 6�.2 _7l3 / 7 How,was the' ,amountJ'claimed above _computed? °(Include the estimated amount of+any - prospective injury or damage.) -----= $ Names and addresses of witnesses; :doctors and'•hospitals. - _�-- - - r= . _�__� ______�_.�___-____�___--_ .--_-__-------------------- 9. List' the expenditures you made on account of 'this accident or .injury: DATE ;t ITEM. AMOUNT' _ 41 * * * * * * 4_4 * * * *-* V** *.* Gov.. Code Sec. 910:2 provides: . The claim must be signed :by the claimant SEND NOTICESY.µTQ:,.___(Attorne ) or -by some person on his behalf." Name and Address ofA;ttorney Cl mant's Signature ; Address- Telephone No. . Telephone No. 3 S Section 72'of the Penal .C*ode.,provides . t "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:i.mpri'sonmenti in the state' prison, by a fine, of not-exceeding .ten=thousand` dollars ($10,000, or by both such imprisonment and fine. ADDENDUM TO THE CLAIM OF (Print your full name) f (1) Do you use the roadway as part of a' daily-commute? Yes ( ri) No ( ) ( 2) Were you aware that construction would be commencing on the roadway? .._, , / Yes ( ) No ( ✓✓✓) ( 3) Was an alternate route available? Yes ( ) No ( ) (A) Did you "read about :the •impending .resur.facing, in the local newspaper? V4 Yes ( ) No ( lam ) ( 5) Did'..you see warning signs advising of loose gravel and a 25 "mile 'per hour advisory sign? r Yes N S ( 6) Did the damage result from another 'vehic.le exceeding the 25 mile per hour advisory? Yes ( V ) No ( ) (7) Did a vehicle traveling in the same direction and exceeding the 25 mile per hour advisory sign attempt to pass y u? Yes ( ) No ( . ( 8) Did a vehicle coming from the opposite direction cause gravel to be thrown onto your car? Yes' ( - ) No ( } (9). Was the vehicle located directly in front of you exceeding the speed advisory? Yes ( ) No ( 10) - Did you travel the .roadway more than once during the r' resurfacing prior to the damage sustained to your car? ' Yes ( ) No �,. ( 11) Did you obtain the identity of the car relating to questions 6 thru 9? Yes ( ) No ( ) -If yes, please provide identification. below: ( 12) Please describe in your own words how the gravel caused damage to your vehicle and the angle the. gravel was thrown onto the car., -along with the specific damaged parts on your vehicle. f�i, �o "��1� �ry � oma-����-,•:�� 'o,..� ,//�,��-- /3/v pis XF e_ ( 13)_ Were you aware that using the road during the chip seal process might result in damage . to your car? Yes (. ) No� ( } I declare that the above information is true and correct under the penalty of perjury. . ( Si nature) (Date) RECEIVED CLAIM ., BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CAL A aGI4 9 1991 ClaimAgainstthe County, or District governed by) MARNN' COUMORD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT Mt r 10, 1991 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: Uns p ecified Section 913 and 915.4. Please note all "Warnings". CLAIMANT: CURRY, Barbara Sue ATTORNEY: Peter W. Alfert Hinton & Al fert Date received ADDRESS: 1646 N. California Blvd. BY DELIVERY TO CLERK ON August 16, 1991 Suite 600 No envelope/From Risk Management Walnut Creek, CA 94596-4113 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. August 19, 1991 PpHHIL ATCHELOR, Clerk La DATED: BY: Deputy n...R , 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 Adminis rator (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. (1 0 Dated: S E P 10 1991 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. Dated: SEP 11 1991 BY: PHIL BATCHELOR by Loeputy Clerk CC: County .Counsel County Administrator NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM Peter W. Alfert TO: Hinton & Al fert 1646 N. California Blvd. Suite 600 W lnut Creek, California 94596-4113 Re: C�aim of CURRY, Barbara Sue Please Take Notice As Follows : The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code section 910 and 910 . 2, or is otherwise insufficient for the reasons checked below: X 1 . The claim fails to state the name and _post office address of the claimant. 2 . The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. 3 . The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. , 4 . The claim fails to state the names ) of the public employee(s ) causing the injury, damage, or loss, if known. X 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ( $10, 000 ) . If the claim totals less than ten thousand dollars ( $10, 000) , the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ( $10, 000 ) , the claim fails to state whether jurisdiction over the claim wouldrest in municipal or superior court. 6 . The claim is not signed by the claimant or by some person on his behalf . 7 . Other: VICTOR J. WEST ,County Counsel By: 1 9, Deputynty Couns u CERTIFICATE OF SERVICE BY MAIL C.C .P. 99 1012, 1013a, 2015 . 5 ; Evid. C . SS 641 , 664 ) My business address is the County Counsel 's Office of Contra Costa County, Co. Admin. Bldg. , P.O. Box 69, Martinez, California, 94553, and I am a citizen of the United States, over 18 years of age, employed in Contra Costa County, and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non Acceptance of Claim by placing it in an envelope(s ) addressed as shown above . (which is/are place(s ) having delivery service by U.S. Mail ) , which envelope(s ) was then sealed and postage fully prepaid thereon, and thereafter was , on this day deposited in the U.S. Mail at Martinez/Concord, Contra Costa County, California. I certify under penalty of perjury that the foregoing is true and correct. Dated: YA — / 9/ , at Martinez, California. cc: Clerk of the Board of Supervisors ( ginal) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C .§§ 910, 910 . 2, 920 .4 , 910 . 8) . JUUrE AUMOCK LAW OFFICES OF AUG 115 PETER J. HINTON ♦RR MSSIONAL COR-10N 1646 NORTH CALIFORNIA BOULEVARD PETER W. ALFERT SUITE 600 MICHAEL P. CLARK WALNUT CREEK, CALIFORNIA 94S96-4113 SHERRI J. CONRAD TELEPHONE (510) 932-6006 August 14, 1991 1F I SIMI E (,51A 51 932-3 2 t RECEIVE Contra Costa County AUG 1 61991 Municipal Risk Management Insurance Authority ?304, .^1% _ 651 Pine Street, 6th Floor CLERK BOARD OF SUPERVISORS Martinez, California 94553 CONTRA COSTA CO. Attention: Julie Aumock Re: Our Client: Barbara Sue Curry Your Principal: Contra Costa County Sheriff's Department Date of Incident: 6/7/91 Dear Ms. Aumock: Please be advised that this office represents Barbara Sue Curry, who was injured in an accident which occurred on June 7, 1991, at the intersection of Morello Avenue and Arnold Drive, Martinez. Ms. Curry was operating a vehicle which was struck by a Contra Costa County Sheriff 's Department vehicle being operated by David .Dunne Thys. Our investigation indicates that your principal is legally responsible in this matter. In the event that you have obtained a statement from our client, please provide us with a copy at your earliest convenience. If medical authorizations have been extended to you, please consider any such authorizations to be rescinded. We do not have sufficient medical information at this time to discuss settlement, but we would be pleased to do so when this information is available. Your anticipated cooperation is appreciated. Very truly yours, HINTON & ALFERT AA r avm L PETER W. ALFERT PWA:sm 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 September 10, 1991 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: $229. 71 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: DARCANGELO, Jill ATTORNEY: P\�� co BY received ADDRESS: j� �,� BY DELIVERY TO CLERK ON August 5 , 1991 2570 Monterey Avenu R�N Martinez, CA 94553 BY MAIL POSTMARKED: August 2,. 1991 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 7 , 1991 B1 : Deputy 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 (>4 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: SEP Q la�l PHIL BATCHELOR, Clerk, B 01 Al 0b 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 No i e to Claimant, addressed to the claimant as shown above. Dated: SEP 11 �g91 BY: PHIL BATCHELOR b C a Deputy Clerk CC: County Counsel County Administrator 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 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 J1 it arceJo RECEIVE®_ Y. A ainst the County#' ntra Cos ) ,AN — 51991 or ) District) CLERK BOARD OF S Fill in nameUP CONTRA COSTAIL)The undersigned claimant hereby makes claim against the County oftra Costa or the above-named District in the sum of $ �219.2/ and in support of .this claim represents as follows: - - ------------------------------------------------------------------------------------ 1. When did the damage or injury occur?. (Give exact date and hour) 7unG28, 1R9/ Ca : 3p a.rn ------------------------------------------------------------------------------------ 2. Where did the damage or injury occur? (Include city and county) ?Ie-asan`j- Hi 11 Rcgd /Taylar 31 vd, ?leosan* !-I ------------------------------------------------------------------------------------ 3. How did the damage or injury occur? (Give full details; use extra paper if required) 'Kead rerAsr cuo*-k .tias bcc�_Q1 4&rne.,•, 25 mfk 5+is we. p�s+c-d a�ovnd - GO rr.+r%4C-4*&-'► 4 r`e-0- ,. T -9ira c, ' U>*5 _0D 0 6 C-" OJO0� 2.'J rte° s6a+' past- mc, CaPpmx speea2 : 50 -Ga r'`� �� throw c�raVa at ---------------------------------------- 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury.or damage? ea v+nq I flo g rq ve,Q. a v. 't�+e., r 6&Z J vas assi�r�.d p,�c�s;e,►: Na +o ass ,mac, a\\ c arS (over) . 5. wnat 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.-- —T— "- -- - Cro►Ce a auto ------------------ '.007. How was the amount claimed above computed?. (Include the estimated amount of any prospective injury or damage.) z. ------------------------------------------------------------------------------------- 8. Names and addresses of witnesses, .doctors ,and hospitals. clon�- kay. -+� .S of Cw\,y W;41uSb e& . ---------------------------------------------.--------------------------------------- 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 Signature - Address .2 GAI : s Telephone No. Telephone Nc. L 2J Z Z� 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, bya 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. _ a y ADDENDUM TO THE CLAIM OF 1 r h o (Print yoO full name) (1) Do you use the roadway as part of a daily commute?? Yes ( ) No ( V ) ( 2) Were you aware that construction would be commencing on the roadway? ..Yes ( ). No vr" ( 3) Was an alternate route available? Yes ( No ( ) ( 4) Did you read about the impending resurfacing in the ocal newspaper? Yes ( ) No ( ) (5) Did you see warning signs advising of loose gravel and a 25 mile per hour advisory sign? Yes ( V ) No ( ) ( 6) Did the damage result from another vehicle exceeding the 25 mile per hour advisory? _ _ . Yes (✓) No ( ) (7) Did a vehicle traveling in the same direction and exceeding. the 25 mile per hour advisory sign attempt to pass you? Yes ( � No ( ) ( 8) Did a vehicle coming from the opposite direction cause gravel to be thrown onto your car? Yes ( ) No ( 1/� (9) Was the vehicle located directly in front of you exceeding the speed advisory? Yes No ( 10) Did you travel the roadway more than once during the resurfacing prior to the damage sustained to your car? Yes ( ) No (V ) ( 11) Did you obtain the identity of the car relating to questions 6 thru 9? Yes (� No ( ) -If yes, please provide identification below: ( 12) Please describe in your own words how the graver caused damage to your vehicle and the angle the. gravel was thrown onto the car, along with the specific. damaged parts on your vehicle. U) r&oc V,'2 -&r rr1 SueraQQ rz)ck- 5 hi i_ r )iyl dshi e l d an."-L- 0 O_' ra c k LA lass 4 3 00 _ y 5 4) -, rd aj_ s�.�aex_" ra C'CL U hds hi e l d , ( 13) Were you aware that using the road during the chip seal process might result in damage to your car? Yes ( ) No (� I declare that the above information is true and correct under the penalty of perjury. (Signat e) ( ate) QUOTE DATE: 7/20/91 QUOTE NUMBER: 0005210 COSTLITE AUTO GLASS 5011 BLUM RD.#2 MARTINEZ ,CA 94553 (415)372-4167 CUSTOMER: 0 SALES PERSON: ILL TO: SOLD TO: JILL DARCANGELO 229-1933 AGENT: POLICY: P.O.#: DATE OF LOSS: VIN: CC ($)CREDIT CARD,CHECKS 80 CELICA 2D COUPE ( 1980) CELICA CITY PART NUMBER DESCRIPTION BLOCK SIZE LIST AMOUNT 1 FCK KIT FOR FART FCW375 7.95 0.00 1 FCL LABOR FOR FCW•375 3.8 h0Urs 35.00 3-5.00 1 FCW375 S WINDSHIELD (ANT) 24.6X59.1 357.45 175. 15 LABOR TOTAL '5.00; SUBTOTAL 210. 151 TAX 14.45 "GIVE US A BREAK"and YOU WON' T GO BROKE ! TOTAL :24.60( PAYMENTS 0.100: AMOUNT DUE 224.60; FROM BEELINE GLASS B. 2. 1991 6:25 P. I 1210 W WINTON AVENUE 100102775 HAYWARD, CA 94545 PC BILL TO: E S T I M A T E 08/02/91 CASH 415-627-2042 CASH 1.00 FCW375T FOREIGN WINDSHIELD 334 .00 175.35 TY 1.00 LFW LABOR FOREIGN WINDSHIE 45. 00 1. 00 KFW KIT FOREIGN WINDSHIELD 0.00 0. 00 TY Paymt Reference Approval Date Amount Subtotal 220.35 ------ --------------- ------------- ----- ---------- Tax 14 .47 Cash DEDUCTIBLE 0.00 Total 234 .82 *** THIS IS NOT AN INVOICE - DO NOT PAY *** SOLD TO: JILL DARCANGELO ty .mac N C� .� f CO � i w O Cd u� tr G4 Op} ON aj N 44 � 0 0 v � x cc0 CC L ui(i S D ,peLL 0 ui aZ CD a J W oc " v � rR CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the ooa,•d cl Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 10, 1991 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 Am:)unr.: $Undetermined Section 913 and 915.4. Please note all "Warnings". C0TMQNT: . DUNAWAY, Shaun ¢� ,���VID Al TORNEY: ,G Da tepr�i�� i v d ADDRESS:. 901 Court Street col, TO CLERK ON August 2 , 1991 D Module Cell #5C N`P Martinez , CA 94553 BY MAIL POSTMARKED: August 1 , 1991 I, FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: August 7 , 1991 gqIL Dep�tyLOR, Clerk c� _ 3A44A 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.. "JThe 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: / 9 BY: S. /V Deputy County Counsel rI11. 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 j>Q This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Orde entered in its minutes for this date. n Dated: SEP 1 Q '� 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 ir, 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 Noti to Claimant, addressed to the claimant asshownabove. Dated: SEP 1 1 1991 BY: PHIL BATCHELOR by -('lLDeputy Clerk CC: County Counsel County Administrator RECEWED ------ ------- _ �'� A _ -__--CLERitBOARD OF_SUPERVi yy CONTRA COSTA CO. CJ - -- - i- ut,A-tom K- 3- tV�-lo c•- - = -- --- ------ 1 0- �/-a 6V-9- i r a p-e v.-A-�tv F u-5- -c)- cy u _ Gztp ,! CSC _to- -a o - ------ - Kt - tks PA —"m' _ _ -cin -- 14) kL Do-to- F -LcA- J � . y • - VO Ajt�- Co- F. --- cko uA t p t F l a owl _ 6.10 kw • vim_ ^ fi IIA rAy 5. 1 F s e{p� -D of -rte - U e kit LAJ' _l _l_ _ PCA /N L 5 Ik T- VVA-o'- rt v rt Y- t Ito Ca p. y - r F o- ---- -- - --- = --- -- -- ` a -t--- - "=t- - - -- ------ - -------- ------- � =� ®- --ivD•- NIPS -- -- -- -- - -- o N VJ i_N-t t- `t__f'® cf- a i -0 - � 4 --- - - �n ,Z CD z CLAIM BOARD OF SUPERVISORS.OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION . the ooa, c u° Supervisors, Routing Endorsements, } NOTICE TO CLAIMANT Septem e� 10, 1991 and Foard 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 Goverment Code $Undetermined Section 913 and 915.4. Please note all "Warnings". C!AIMoaT- DUNAWAY, Shaun ���;,� VD Al TORNE C\{` Date-It, ived ADDRESS: 901 Court Street VERY TO CLERK ON August 2, 1991 D .Module Cell #5C Martinez, CA 94553 BY MAIL POSTMARKED: August 1 , 1991 I. FROM: Clerk of the Board of Supervisors JO: County Counsel Attached is a copy of the above-noted claim. DATED: August 7 , 1991 EtlTl Deputy 0R, Clerk d a,4 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: 91 BY: :k_ ) . /J 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 aQ This Claim is. rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Ord e entered in its minutes for this date. 0 Dated: SEP 1 Q PHIL BATCHELOR, Clerk, By AAJ 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 Not' to Claimant, addressed to the claimant as shown above. Dated: SEP 1 1 199 BY: PHIL BATCHELOR by_J A 4Aeputy Clerk CC: County Counsel County Administrator s tsl . � Q ANN CO v�O� F ✓1�vo M a� 3 � N G O4-) V) W co ui � ce u Z 4 3 tvp o �N _ ty u LU 0 7lLU Cd Z Ll- uj z a Q .� C � u O > a � W ❑ 0 0 O n Y� O d C N v Z a c c �t 0 CLA IM RECEIVE BOARD OF SUPERVISORS` OF CONTRA COSTA COUNTY,da4FORNIA Claim Against the County, or District governed by) COUM', 199160ARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT*Rr/NEE��CO�Nsjeptember 10, 1991 and Board Action. All Section references are to } The copy of this document mahtyou 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: $374.59 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: EASTMAN, Kathleen L. ATTORNEY: Date received ADDRESS: 2356 Sweetwater Drive BY DELIVERY TO CLERK ON August 16, 1991 Martinez, CA 94553 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. August 19, 1991 EVIL BATCHELOR, Clerk DATED: BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors �(J } 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 Admin' trator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (>Q 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: SEP 10. 1991. PHIL BATCHELOR, Clerk, By4 AAAA I AA,, 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: SEP 11 1981 BY: PHIL BATCHELOR by v eputy Clerk CC: County Counsel County Administrator .���. e \ � \, - - , ! � . � . � y} ^ ° � ». �� < � � :� e\ . ,\��. . < < � � � xy� �� � , � � < \< ��i� \ . ^� � \2\\ � ` � � � ^ ~ /\ . � . . y . � � ° . � � <: < � � � � � s . ,//\ : ~ . � � � � � �� � >>yw �� % �� �\�� � y . �: . �«�% , . . . . - - - � ?< -ate/�/ \\yam^ � ±�3 �« ww. : � ©,/ � -§ � � ~i . . � . v\�� � � .��: � . . . . , :����� !«�a:.�: . -... . .w. , : ,w�& «, \ \ � , �� ����. � � -;- — - �, , ; , • .;� �. ' � .. �s 6 -.ti„�r` '`�. y 4`V �� �. <'. L , Ls V � �' :i � _ - � �„ "" _„ ,,� o "`,�� l q � --� �9a�1 1 1' 'K'�_T rF,. !1(/{ � Y. ..�_ ��� �.� �4 --- _._ lir. o ` , ��������� Via: f- -�; :;. � _ a �.. c � ._ �K K�.:. .'1 �' - �- v- _ r C " " - _ 1 33 � � � ...,Sac. �� N � r. �t� 'hk �� — ii�F _ � .. 9 �. if $ � _ 'S 1 �A�.# 4��� _ —__ ___�. � o t 0 0 �� 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-- 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 5911.2.) Be 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 KIClerk's filing stamp f+hlccfil �; �14S_rm1qQ ) • 2350 S��-���2. f��2 �1�z� . .. �� RECEIVED • Against the County.,of Contra Costa or . . . . . ) .. AUG 1 6..1991 District) . . ._ �. CLERK BOARD OF SUPERVISORS Fill• in- name) ).'�: CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the.,sum of., W and in support of this claim 'represents 'as follows: ----- ' ----------- ------------------------------------- 1'. , -When�did the damage_'or injury.occur? ,:.(Give-exact date and hour) --------------------- 2. Where did the damage or injury occur? .(Include city and county) ._TELJhCF_-_ iWd,� st 1,22 .6 ___ _�_ 3. How did the damage or injury occur? (Give full details;,.0 a extra paper if. required),R-� R. ., pass i,15 int Uian` o� 5�Aa �r oK -� ,,, °1 .050 'fry Ca`� s► tir e -t-o r w.-n o•��cfi� _\ . .�;�: 3°rt `f Cans ►�. >!to -oP �Kc.i rn �ndh;el ifi -V. e_2�. .m� SS'n� 4. What particular act or,-:omission on'the part of county, or district'officers,`. servants or -employees caused-ithe* in jury'or damages �o << cC�s��� �i�ro -- tom- C�� `'° �;os�. .� � � �• , 0 Ltr` -T G`'e� i2d UP „ _ _ Ujo\j no-f' }�a v2 �l he. inti�e SEah's'i 2P 64IX-.404a.s I� 51 , n y (over) 4J�'�- �b� �i1G-i�� ►S � `� Y�u�+ et- ' w�r►�S% �Ic�S . 7. What are the names of .county or district. -officers, servants or. employees causing the damage or injury?, 00 l�J .5.'- _What damage or injuries do you .claim resulted? ;;(Give full; extent of injuries or damages claimed. Attach two estimates, for. auto-_damage: ;, ' 451'1. 7. How was' the amount eTaimed above computed? .: (Include the-estimated amount of any, 'prospective injury or damage:) 8. Namd9�andraddresses 'of witnesses doctors-and- hos itals. f tri\.fto his bow w 9. List th6 expenditures'you made on account of this accident or injury: DATE ITEM AMOUNT av Gov. -Code Sec`.' 910.2".provides: "The claim must be signed',by the claimant SEND NOTICES TO: (Attorney ) or by s e person on his behalf." Name and Address of Attorney r - ' - Clai itts Signature Address - t Telephone 'No. Telephone No. Section 72 of the Penal Code providers - _ 'f l. "Every"person' who, 'with intent to defraud, presents for allowance or for payment to any state board or officer, on 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'iAtlier' by imprisonment in the county jail for a period.of..not more,rthan one.,year, by•,a'•fine-.of-not exceeding `. one thousarid` ($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, 6r 'b both such imprisonment and fine. ' _ ADDMMUM TO THE CLAIM OF: � � L �stw� (Print your full name) ( 1) Do you use the roadway as part of a daily commute? Yes ( ) No (�) ( 2) Were you aware that construction would be commencing on. the roadway?- Yes { .... )_ No ) ( 3) Was an alternate route available? —Yes {�.) No { ) (4) Did 'you -read about .the impending resurfacing in the local newspaper? . - Yes .( Y No (y) (;5,) Did you see warning signs advising of loose'-gravel and a 25 mile per-.'hour, advisory sign.? 5�-�-��-Yes (.�� No, ( 6,) . -Did the damage- result from another vehicle exceeding the 25 mile per'hour advisory? - _-U� <� Yes ( )_ No .(, ):.� (7.) Did a. vehicle traveling 'in the same directi_ on and exceeding the .25 mile per hour advisory' sigri .attempt to pass you? Yes ( ) No ( } (8) Did a vehicle coming from the opposite direction cause gravel to be thrown onto. your car? Yes ( ). No 0) Was the–vehicle located directly in f-r;.ont -.of_ you exceeding the speed advisory? _ Yes ( ) No ( ) ( 10) Did you_travel. the 'roadway more than once during the resurfacing prior to the damage sustained to your .car? Yes ( ) No E.. ( 11) Did you obtain the identity of the car relating to questions 6 .thru_ 9? Yes ( ) No -If yes, please provide identification below: q.. ( 12) Please describe in your own words how the gravel caused damage to your vehicle and the angle the. gravel was thrown onto the car, �along with the specificdamaged parts on your vehicle. o-C wWs1- 'AD Z4 Aron C o' hyo` s Op ou, } CaK CWM ( 13) -Were YoV aware that using the road duri g. the chip seal ? process might result in damage. to your car? �p I Oan Kt,J whQ 't�. ctiu p S-MV ( O tiS b Ye s ( ) No ( ) � T a �vo�iD dR� W y�� � n' i Mss �Ss not e�,l -- MM.sss�c�-1;( 11% acnes d- , TCp �� uf�uuSe �` � declare that the above information is true and correc $' .oJs under the ,penalty of. perjury. "` i � Gt o gr aS C'fhw�"-CJtsin- •�,�,� vSign�`� ature) N_,lqq. � (, Lai� (Date) G ;7 NAM /:� L �! �/ � � DATE ADDRESS PHONE � �J INSURED BY —ADJUSTER PHONE_ BELOW IS OUR ESTIMATE TO REPAIR YOUR VEHICLE: YEAR_ MAKE MODEJLICENSE N0, SERIAL NO. WIN NO.) AGE PART PARTS NECESSARY AND ESTIMATE OF LABOR REQUIRED PAINT LABOR COST PARTE ATET NUMBE ESTIMATE ESTIMATf ff3TIMATf Ile I . . of HAYWARD Parker Luciano Parts Manager - (415) 866-0777 ± 24895 Mission Blvd. • Hayward, CA 94544 _ SUB TOTALt�/ f' WRECKER SERVICE TAX TOTAL ESTIMATE The above le an esiiinate based on Our inspcetion and does not cover any SIGNED additional parts or labor which may be required after the work has been Opened up. Occesiomilly after the work has atortod damagod or broken parts are discovered which arc 4tvt evident on the first Inspection. BY AUTHORIZATION FOR REPAIRS YOU ARE HEREBY AUTHORIZED TO MAKE THE ABOVE SPLCIrICD REPAIRS. SIGNED DATE FORM ER•44 44.78) er' .W4A.,QWn 4an.40 ,a,.t, s .m•�. ,. �. ...u...4 .waei 4arN FORM ER-44 (4-79) 3 QTY. 100 (25-3-0) ." � r—untlnar ;'-4JCi-02-1'91 I4:36 FROH LOF ,EPJTRHL t',10. CHL.0[-1 TO P.02 i • hibbey-Owens Ford Co. ESTIMATE Glass Centers WORK ORGER INVOICE SALESMAN DATEI Vi E S T I M A T E ADDRESS MAKE MOD 90, ADDRESS v.r.N, CITY,ST LICENSE# MILEAGE CLAIMANT SPECIAL INST DATE TIME WORK PHONE HOME PH _ - - -• CUSTOMER# INST N COMP.DATE TIME INS JPO N QUANTITY IT M NUMBER DESCRIPTION LIST PRICE SALE PRICE TX 1 FCW641S FOREIGN WINDSHIELD 313, 00 TX 1 LFW LABOR-FOREIGN W I NDSH I E 25. 00 1 UFW U-KIT FOREIGN WINDSHIE 9. 95 TX i lymt Referlpnce Approval Date Am01Ant Sub 347. 95 ---- -------------------- ------------- ----- ---------- Tax 26. 64 Balance Total 374. 59 X x THIS IS NOT AN INVOICE -- DO NOT PAY X - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - INSURANCE COMPANY INFORMATION BELOW THIS LINE IMMM2. AGENT 4ME NAME 30RESS -2,356 ADDRESS )DRESS ADDRESS TY,ST tea'7 CITY,ST IONE M FLEET# PHONE# 1LICY N fcLAIm 0 3URANCE GATE OF RIFIED BY �l1gg I�.OS�S ,r � � _�. i� it t. 4 t i ;s �_ `t ,� t 5 � �jJ/'�J � r V �t � ri :�� {, � �-, 7 � � �? �' � -� �. � .� �- � S6, J Us,���o/b�S 0 J �����0�`ya��j .�1 �► �� y�. i ,�, �..: CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the 3oa,•d cf Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 10, 1991 and Roard diction. 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 Am!)ur!1 $486 .00 ���� Section 913 and 915.4. Please note all "Warnings". 4" CLAIMANT: FORAN, James Patrick ' ATTORNEY: 'i Co��,`F. - \NEti' Date received ADDRESS: 155 Haslemere Court 10-1 BY DELIVERY TO CLERK ON July 31 , 1991 Lafayette, CA 94549 BY MAIL POSTMARKED: July 30, 1991 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of 'the above-noted claim. ppHH gg r�AA44 4" DATED: August 7, 1991 BYIL DeputyLOR, Clerk �} II. FROM: County CounselTO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS t/comply substantially with Sections 910 and 910:2, and we are so notifying claimant. TheB and ca not 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 Order entered in its minutes for this date. Dated: SEP 10 1991 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 wantto 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: SEP 11 1991 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel. County Administrator 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- r sonal property, ogrowing 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- fo`r 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 act ion.'; . (Govt.. Code, §911.2.) B. Claims must be filed with the Clerk of.the Board of Supervisors at itsoffice in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C.I. If claim is against a district•-governed-by the •Board of Supervisors, -rather than the County, the name of the,District should b6-filled-'in. D. If the claim is against more than one publie .entity, separate claims must be filed against each public entity. E. Fraud. See penalty .for fraudulent claims;�-Pena1. .Code Sec. 72 at .the,end,of this form. RE: Claim By ) Reserved for Clerk's filing stamp RECENE® Against the .County of Contra Costa ) JUL 3 1 1991 -or. ) CLERK BOARD OF SUPERVIS ' District) CONTRA COSTA CO. Fill .in name The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named .District in the sum..ofy (b ssand .in support of this claim represents as follows:. -------------------------------------- ------ --------------------------------------- 1. When.did the. damage-,or injury occur?..-,(Give exact date and hour) r/ �;Z 10 C)o p M 4 -- -- --- ----------------------=---------------------------------------- 2. . Where did the damage or injury occur? (Include city and county) -'F_AyL_o9_ iP L-yb ($E'fu9I-vJ W iTr� �'6o e9)� I.AP'A`tCM CA .: COMTRA -OSI� - ------------------------------------------------=-----=---=--=-====-=--------------- 3.. How did the damage or injury occur? (Give full_ details; ,use extra, paper if -.- required)., ac � . ---- - ,. ..-------- - - - ------------------N-------------- 4. What particular act or omission 'on-the part ofcounty or district officers, servants .or employees caused•.L•the.in jury_or-'damage? a sp 4c, �5� c e 4, rye, U,,,;t; a r_Ute- o �rre��9aM� � wOD rat�cC A so -- (over) looses �a rv�ev�. 7. wna•t are the names of county or district officers, servants or employees causing the damage or injury? ; 5. rWhat'damage or ihjui^ies do+you claim resulted? (Give full extent of injuries or damages ,-claimed01 "Attach two estimates for ;auto damage:-_ ` .N r `�:> .,.,r � �• .'o,:,� � '6 0° � _:. 1 al�,a�, ..�SQ.s�.' a;r:�ac.tie.Z� .7. How was-the` amourit' claimed above computed. (Include the estimated amount of any. • prospective`injury or-damage.) . - --------- $: Names and addresses of witnesses., doctors and hospital`s. , t. . -----------------------------------N-------------_-N--_--------------'-------N----_ 9.- List t1i expenditures you made on account of this accident or injury:. \ DATE r _. ; ITEM , A q` d L4 8b�= 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 , •_ _ neo �4� �%� ---� u.•_'.., Claimant's Signature) . r. ._ Address Telephone No. Telephone No.l-Y� NOTICE Section 72 of the Penal Code, provides::...... .,. .._. "Every person"who, with intent to defraud, presents for allowance or'for```'t 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,pf_,not,more. than.one-year; -by a '-fine: of 'not-etceeding}i one`thousand "($1,,000),, or by both•;such;, impr:isoriment,and-fine, or by''impr i sonment 'in the state prison, by a fine` of not.-exceedingy=tcn:.thousand'dollars ($10,000, or"by both such imprisonment and ,fine. .^ ADDENDUM-TOTHE .,CLAIM OF "ATR 1 Ux �� (Print your full name) ( 1) Do you use the roadway as part of a daily commute? Yes ( ,X ) No ( ) ( 2) Were you aware that construction would be commencing on the roadway? _ .. .. _ Yes ( ) No (X ) ( 3) Was an alternate route .available?.... _ Yes (� ) No ( ) ( 4) • Did you read about .the impending resurfacing in the 'local newspaper? Yes ( ) No ( X ) . yoU see warning signs .advising of. loose gravel and a 25, mile per hour advisory sign? Yes (�(.) No ( ) (6) -Did the .damage result from':another -vehicle exceeding the 25 mile per hour advisory? Yes• ( ) No ( ) (7) Did a•vehicle traveling. in the same_,direction .and exceeding the 25 mile per hour. advisory sign attempt to pass 'you? - - Yes V'Y, No ( ) ( 8) Did a vehicle coming from the opposite direction cause gravel to be thrown onto your car? . Yes ( ) No (� ) (9) Was the vehicle located_ directly in front of you exceeding the speed advisory? _ . Yes (X ) No ( ) (10) Did you tr.avel' °the roadway more than once -during the - resurfacing prior to' the damage sustained to your car? Yes 0/1 No ( ) ( 11) Did you obtain the identity of the car relating to questions 6 thru 97 Yes ( ) No (X ) If yes, please provide identification below: t (12) Please describe in- your own words how the gravel caused damage to your vehicle and the angle the gravel was thrown onto the- car, along with,:the 'specific damaged: parts on`your vehicle., G�aNe�.��1 as `}•fr ow-ri- o�r`� yu,,,,y Ve,1.,tcQfc, �-.ti -�o � �cx c D• C',a, e .ca.w.as�- +�-��1 w i ga&kal L `5 c�r iv2Y- Sade C'xea n� o� loj]r'e_ c_rMil-�5� a,*--K m 0XVO S � v re rh u w•s� -b b�a�,,. I � '� -�.�. CL���f �Gi� ��. . �1 r 0�►.-2Q W C�.A �b SSk�� t.� C'�Oma'�( 1 w-t h y fired V �ao-2 or. ..4:R k aft VV :P a'O't a-,J_ t.4_s1 C. w-Q_.. U ( 13) W'er'e you aware that using the road during the chip seal process might result in damage to your car? . •. i^_, Yes No. ( }. 1,C)Ok C& a t OW o.,W o �t� -W - r)CQ� O a I declare that the above information is true and correct re under the penalty of perjury. r2pcA . �°Gz1z� ( Signature) 7 1,30 91 Date) 1, sa - 1 r .. RIT .- • •• 1 .• • . INVOICE NO. TOTAL III7�1;!& F1 I . + r I t 1 t t t �3 t t /=!. '.c. , t _u= •- :u• f•_ :uxYf;t•- iJ i :'!;5.. .i � ice'� t e•-^� t;tom_,.F.. t�t .;_u -Yref +u';ir,�f'-�_u..Yref•:�u�:,�l�f'.-, r" /. ����:./ �,•�Vii;../. �.,��: / �.,�� /;. =t'Yrer. :u= qtr _u� rtr.'. _u':Yrtr•- , f +u::,�;er. +u ,(,er ,y'Yr;r•_ ,y—,(feG•_ , /. C �!•JVr,� �i�.J. V•ice-% `'.,i�, r =t•,Y:ef =`t•,_�itf 'U'(::r'- -y'Yr:r'= ' r'Z'-y�:�(r;f' "r.=5, •'12;:` =rf.�, �7� :— 74 :L— 7 1#: DESCRIPTION ` 4 J. J ��'�/ �'.-.;i•`J ..ice.-J er �Y°er�•`?Yler•.� .x..;�rer ,V? rte.•_U:.-'�tr !_.i.: 32..751 60R hereby expressly disclaims all warranties,either ex- LA �O,TEIVIENT OF DISCLAIMER fill zo, PARTS AMOUNT The factory warranty constitutes all of the warranties •ef Ly?,art. _u. r!t' ,_s:. :r.• _u;, ��t':- :y=:' :f'- u?.: • i t 1with respect to the sale of this item/items.The Seller SUBLET AM press or implied, including any implied warranty of MISC. CHA46ES merchantability or fitness for a particular purpose. TOTAL CHARGES Seller neither assumes nor authorizes any other per- •ef. :u? ;.r °:u= y=r"+=s% ��f'_ sa ,.cf_ _u rer ar--,I��.� / yam LESS INS0 son to assume for it any liability in connection withURANCE the sale of this item ems. '1.• 1 1 '1.. s ?a, 1.. I 1 I PLEASE r�r. +u?.Yrer.•. _u?:�;eC' +u.:•ltt'-•_u.:' :r.'_ _`i r _ :y 1�►:�:..)J 1"::;.-,`)J 1 :►7J 1�►.,.,.)J 1-is ,)J-1�'r. ' STHIS AMO N IGNATUREAY ,tf '-U•,Y•.tr''- :U�Y::f.Z:u�'•(f:f''= U�'1(::r.': ur:' �C: u..i r r r _`trYi�r 1 r ,•)J=1 r ,•)J=A'r...,.)J 1'r..,.)J 1-r...,.)J'1�r: l-1�'-5:4��.yV�#:tic:. t�:L ?Ty:L�- . ���#:� ��t c�i!i C'.:�'•Y}•r'-;a':Yr,•r'_:u'itir �" r^ r', •:.•.�' a-=3'-�• rte. H :u? .et _u. Pref _u:: ref'. :u.: rpt'__ur: ret• :u�.: ����;!t.I �' i!:-J. V•ice:•J����!:,I ���!t. J Vii f[r. w�•�(�ef w.:���G''�_u.:,�r�t•-,_u.:���f'.r_u.:�ltr.•- _.1 »1�r: ,•)J':1 i`.•)J':1 r= �)J-:1 r.�;•)J-:ti i:�.-:)J' ►.�.-,• "A buyer of this product in California has the right to have this product serviced or repaired during the warranty period. The warranty, period will be extended for the number of whole days that the product has been out of the buyer's hands for warranty repairs. If a defect exists within the warranty period, the warranty will not expire until the defect has been fixed. The warranty period will also be extended if the warranty repairs have not been performed due to delays caused by circumstances beyond the control of the buyer, or if the warranty repairs did not remedy the defect and the buyer notifies the manufacturer or seller of the failure of the repairs within 60 days after they were completed. If, after.a reasonable number of attempts, the defect has not been fixed, the buyer may return this product for a replacement or a refund subject; in either case, to deduction of a reasonable charge for usage. This time extension does not affect the protections or remedies the buyer has under other laws." I. Customer is hereby notified that the said property is not insured or protected 7. Said Dealer is authorized to deliver the vehicle described herein or any of its to the amount of the actual cash value thereof, or otherwise, against loss contents to any person presenting this receipt. occasioned by theft, fire or vandalism while the property remains with the dealer. 8. In addition to any and all other legal remedies available, I authorize Said 2. Customer states no articles of personal property have been left in the vehicle Dealer to have a lien on the vehicle described herein for all charges for and dealer is not responsible for inspection thereof. repairs, including labor and parts, storage and/or towing, and to enforce such lien. Said Dealer is hereby expressly authorized to sell said vehicle at 3. The dealer is not responsible for unavailability of parts or delays in parts public auction after giving a twenty(20)day written notice by certified mail to shipment beyond dealer's control. the legal owner, registered owner, and Department of Motor Vehicles of 4. Due to the type of service requested some repairs must be sublet. intent to do so.On the sale date,the vehicle shall be sold to the highest cash bidder and the proceeds of sale must be used first to satisfy the lien plus 5. All charges for repairs including labor and materials furnished are due and storage costs and costs incident to sale,and the balance shall be forwarded payable simultaneously with the delivery of the within described vehicle or to the legal owner, or if none, to the registered owner, or if the address is prior to delivery upon the expiration of three (3) days after notice that the unknown, it shall be,forwarded to the Department of Motor Vehicles. repairs have been completed. Notice shall be deemed to have been given I upon the deposit in the United States mail, postage prepaid, of_written Said expenses for sale shall also include a reasonable attorney's fee,which notification to that effect addressed to the customer at.the address.given on may be necessarily.incurred. the reverse side hereof. ' y Y. 6. If the vehicle described herein is not called for within three:.(3) days after 9. If any such charges remain unpaid for thirty(30)days after such request for such notice is given,a storage charge of$5.00 p^3r day will be made for each payment, Said Dealer may also refer such charges to its attorneys for day thereafter.. collection and the customer will pay a reasonable attorney's fee. Retail customer labor charges are based on the minimum hourly rate indicated on the front of this repair order. Per hour charges for labor have no relationship to the hours actually worked by the technician except that the prices are established on the basis of the prevailing labor rate times the flat rate hours determined by us as the reasonable time required to perform each specific operation. Although in the case of a particular car it may take more or less Umroe. Any flat rate honors so determined to be reasonable which may be indicated on the repair order are for internal accounting purposes only and have no effect whatsoever on the prices being charged. LlMlTED WARRAMTV The only warranties applying 4o this par'Q(Warre those which may be offered) bthe"manufacturer. The selling deader hereby expressly disclaims all wafrrandas, either "'xprless or implied, including any implied warranties of merchantability or fitness for a particular purpose, and neither assumes nor authorizes any other person to assume for it any liability in connection with the sale of this 'art(s) and/or service. Buyer shall not be entitled to recover from the selling dealer any c6olsequential damages, damages to property, damages for loss of use, loss of time, loss of profits, or income, or ani other incidental damages. LIMITED WARRAMTV-PARTS & LABOR HAYWARD ACURA WARRANTS ALL PARTS& LABOR PERFORMED TO YOUR MOTOR VEHICLE AS SET FORTH ON THE REVERSE SIDE FOR A PERIOD OF ONLY'12 MONTHS OR 12,000 MILES, WHICHEVER OCCURS FIRST. THIS TIME PERIOD AND MILEAGE DETERMINATION SHALL COMMENCE FROM THE DATE THE PARTS & LABOR HAS BEEN COMPLETED. ALL WARRANTY WORK MUST BE PERFORMED BY HAYWARD ACURA AT QTS PLACE OF BUSINESS LOCATED AT 29000 MISSION BLVD., HAYWARD, CALIFORNIA. TO OBTAIN ANY WARRANTY WORK YOU MUST BRING,YOUR MOTOR VEHICLE TO THIS ADDRESS PRIOR TO THE EXPIRA7ON OF YOURA/VARRANTY. THIS WARRANTY IS EFFECTIVE ONLY IF THE MOTOR VEHICLE IS OPERATED IN A NORMAL AND ORDINARY MANNER. THIS WARRANTY IS NOT TRANSFERABLE AND MAY BE ENFORCED ONLY BY YOU SO LONG AS YOU OWN THE MOTOR VEHICLE TO WHICH THIS LABOR HAS BEEN PERFORMED. ANY IMPLIED WARRANTIES YOU MAY BE ENTITLED TO BY LAW SHALL BE LIMITED IN DURATION'TO THE DURATION OF THE ABOVE DESCRIBED EXPRESS WARRANTY. -"- IMPORTANT:NOTICE The price of installing an exchange rebuilt transmission and torque converter in your vehicle,excluding other hard parts, is$ The price of this same service if we rebuild your own transmission is$ Frequently, hard parts do not need to be replaced. The purpose of the teardown andinspection is to determine what hard parts are needed, if any. You have a Frequently, hard parts do not need to be replaced.The purpose of the teardown and inspection is to determine what hard parts are needed, if any.You have a right to: (A) the return of your replaced parts unless you are,informed otherwise; (B) know the maximum time in which the repair shop must reassemble and reinstall your transmission if you do not authorize the service the shop recommends; (C) have your transmission reassembled and installed for the price of the teardown; and (D) know the prices,terms, and conditions of all warranties if any. Check appropriate boxes below. ❑ Yes. Save my parts for inspection or return upon receipt of the vehicle or for days thereafter. ❑ No. I do not want to inspect my parts. ❑ Yes.I understand that my transmission will be reassembled and installed in my car within days of the date shown below if I choose not to authorize the service the shop recommends.This will be done for$ , the price of the teardown. ❑ Yes. I have read and understand the prices,terms,and conditions of all warranties provided. ic, r4 r-4 Vl 14 0 LO '44 14 0 W tll rj 44 00 4j V. Aj N ,:5 � 0 0 Lf) Ln CO Lw CD C4 U,-T, Uwe �LU Ce 0-0 Lw CD 0--e- • 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 September 10, 1991 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: Undetermined Section 913 and 915.4. Please note all "Warnings". CLAIMANT: GOLDEN, Michael ATTORNEY: Date received ADDRESS: 165 Jackson Way C ti� � ��F• BY DELIVERY TO CLERK ON July 31 , 1991 Pleasant Hill , CA �n�048523 BY MAIL POSTMARKED: Hand delivered 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted 'claim. EV BATCHELOR, Clerk DATED: August 7 , 1991 BY: Deputy - 0J,A 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: 1 BY: �_ J Deputy County Counsel . / -9 NJ 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 Order entered in its minutes for this date. Dated: SEP 10 1991 PHIL BATCHELOR, Clerk, By_(4wnDeputy 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. gc Dated: SEP -111991 BY: PHIL BATCHELOR by eputy Clerk CC: County Counsel County Administrator .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' ori or'before December 31, 1987, must .be presented,- not.dater 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 noV later than six months after the accrual .of the cause of action. Claims relating to any ;other cause of'aet on alust be presented not later,,.than one year. after the accruah of the cause of action:.. (Govt.. Code §911.2.) h . 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-fill 'l 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, PeriaT Code Sec.",.72 atY,the end of this.^ form. RE: Claim By ) Reserved for Clerk's filing stamp i►A,A Goldw RECEIVED Against the .County of Contra Costa:-, 1JUL 3 1 1991 or , ' CLERIC BOARD:OF SUPERVISORS District) Fill in name CONTRA COSTA CO. • )_.. ,. 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 followsr =----- -- ----------- -- - ..- ------------------------------ 1. When did the (damage r injury`occur. (Give exact date and hour) --1E��`--=`` _:. fir `�L t a q1 --- _ .. .., ..- 2. Where aid the damage or injury occur? (Include city and county) 3. How did the or injury occur? (Give full details; use extra _pa per, if,f required) 4. What .particular. act. or omi:ssion .on the part unty or df6triet'officers, servants or employees caused the 'injury:or- 4 +Q�y c�l/u iA 4v � e ° (over) "5. what are the names of :county or district officers, servants or employees ,causing the damage or injury' "x. ---- - -- -- - - -- - -------------------- r , r 5. :'What' or in3uries;do `y'ou claim resulted?., .(Give-'full extent of injuries or d imed: ' Attach.,' estimates_.for auto.-,.damage!. r amag ,,. t , ,3 ... 7. How,was the amount 'Claimed above computed N•(Include.the estimated Amount of any prospective injury or 'damage:) _ __ C�. y^f $. _Names and addresses' dryitnesses, .doctors.;and:*hospitals:A--b ` U . --------- ------------------= - ------------ --------- 9. List'the"expenditure's you `made on account of this accident or injury: DATE,. ITEM _ , AMOUNT ` -- 9F # # # W # Vik V_*W_*4- k t Gov. C"de Sec. 910:2 provides: "Th ' laim must be signed ;by the claimant SEND NOTICES TO:- (Attorney) b /some persQn on his behalf." Name and Address of.Attorney, Cl mant's Signature It k. .....-.._. _. .._. Address) Telephone No. Telephone No. NOTICE Section 72 of the Penal C ode_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 .impr sonment .in the state prison, by a fine of not-exceeding ten~..thousand` dollars''($10,000,'`or,by both such imprisonment and fine. .1 ADDENDUM TO -THE. CLAIM. OF. (Print your -full• -name) ( 1) Do you use the roadway as part of '.a,-daily commute? Yes (� ) No ( ) ( 2) Were you aware that construction would be commencing on the roadway? _ Yes ( -} No ( ) ( 3) Was an alternate route available? — _ Yes (� ) No ( ) ( 4) Divi you (read about the. impending resurfacing in` the local newspaperT Yes ( ) No ()4) ( 5) Did you see warning signs advising of loose gravel. and a - 2'S -mile per`hour advisory-sign?- _ _. _ •__w_ w �._ - Yes (lP ) No-, ( ) ( 6) Did the damage result from another-vehicle exceeding. the 25 'mule .per hour advisory? No ( ) (7) Did a vehicle traveling in the same direction and -exceeding - --the -25 mile`per'hour advisory sign attempt to pass you? Yes O No ( ) ( 8) Did a vehicle coming from the opposite direction cause gravel to be thrown •.onto your car? Yes ( ) No (�) .•(-9) Was',. the vehiele' located directly in.',front of you, ;exceeding the speed advisory? - _ Yes ( ) No ( ) c• t t+. ( 10) Did .you travel the roadway more 'than once during the r;esur.f.acing,.prior to the damage sustained to your car? Yes ( � ) No ( ) ( 11) Did you obtain the identity of the car relating to questions:%6 thrix. 9? .. . z s Yes ( ) No If yes, please provide identification below: (( • t, ( 12) Please describe in your own words how the gravel caused damage to your vehicle and the angle the gravel was thrown onto-•, the car,, along:.with..•the: specific damaged ,parts on your vehicle. 4�C✓' � �►cQ `WtlPu� fz�Je� V� era nj �no�Cs i TS 1 , f ( 13) Were you aware that using the road during the chip seal process might result in damage to your can ; < Yes'-( ..:, ). . No I declare that the above information is true and correct under the penalty of perjupy ignature) (Date) • 3890 *COOKS COLL X S XC)N FOR PEOPLE WIiO CARE 1414 PINE STREET WAL13Y25D93 - 4414596 DAMAGE REPORT # 3890 by RICK WOOD A(° C�r�LD5N MICHAEL Make J983 M1 2DR 3201 lress x 5 ACKSON WY Style DR 3 0 Qty St Zp ASAN�+ HILL 84523 License Ior�g P�tQt1� , 6278 Work: 9 1. H _,• Jux . .._.. # DESCRIPTION EST PRICE ; LABOR ; PAINT ; r�ccs:p.s.^===asa;==sa__Caass,ss=aaes:=ansa:s3aa=sC=aass�ssmasns=mssq��cansC=ssrs=s=saaa� NEW LBFT Foo LIGHT 51.72 0, 3 NEW FIONT NIND51lIEGD ! 38 :Z78 ! 2:4 ! f 4 NESE FRONT VINWIS0 VEATHERSTRIP � 53,85 ; 1 s-==:zc::_:suz,=_=aa_:�s=em�:_=aasss�sass��sa:asst_aaaoscsasan.o=ms_s=czaac�Ca=aaasC=aaa AMAG� R RT-5 r18: A Lab D rip iy-e It. FAINT—L' (jD�""" ���"'"'PAR�Y'E 'C`E� 4`67ff SUE LA 0: 118:88 ; s PPLIES$ .88 M H LA .pp ggpp. �.88 HAZARD WASTEpDi AIL LA 8.0 50. 0 � f SUBLET CHO � 0 8pp,p .Qpp pl TOWING CHO :8 ,80 0.8 ! GLASS PARTS , p p 0p9 4 STORAGE CHG CLEAN UP 8:8 :08 8: 1 rLLOWAH ANCES :N Labor rs. Labor ��70 Q raxotem 37.6 � Rt��........._.... PARTS PRICES SUBJECT TO INVOICE We oade a decision long ago that it would be better to explain price once than to apologise for quality forever If'yvu havo any q+sections about the repairs proposed for your vehicle, please feel free to ask. Oar staff can Wilt you in contacting your insurance ccapany. ASK ABOUT OUR LIFETINE GUARANTEE! a DAMAGE REPORT authorized by.,._—---—--------------------..---—----date-------_-------.---- WE ARE IN THE SERVICE BUSINESS, AND WE ARE HERE TO SERVE YOU! .................................. ::: 5903 CHtMU AWNIZ• FAST BAY PARK•'EKERYVtIl.E • CAUFORNIA•.94648 •415/65¢8284 ESTIMATE OF REPAIR COSTS NAME V'0Vfa' 6OW6�� DATE ADDRESS PHONE BELOW IS OUR ESTIMATE TO REPAIR YOUR AUTOMOBILE MORjL LI ENSC N . M R No. $ A N MILEAGE - 2J? a PARTS NECESSARY AND ESTIMATE OF LABOR REOUIREq LABOR COST PARTS COST ESTIMATE $TIMATE + !5& 100 1 i 1 f i SUBLET 171 0 a4 TOTAL. AX V AN T L ` �S PARTE AND BORE RA TOTAL '3,/ THE ABOVE 1$ AN ESTIMATE BASED ON OUR INSPECTION A S N T COV NY ADDITIONAL PARTS OR LABOR WHICH MAY BE REOUIR&D AP'rLR THE WORK WAS BEEN OPENED UP, OCCASIONALLY AFTER THE WORK HAS STARTED WORN PARTS ARE DISCOVERED WHICH ARE NOT EVIDENT ON THE FIRST INSPECTION. BECAUSE .. •................................................ ... .................................................................... TOTAL P. 02 ......................................... �y CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA ' v Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 10, 1991 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: Undetermined Section 913 and 915.4. Please note all "Warnings". CLAIMANT: GUY, Charles Sr. ATTORNEY: Date received August 7, 1991 ADDRESS: 1025 Ventura Drive BY DELIVERY TO CLERK ON Pittsburg, CA 94565 August 5, 1991 BY MAIL POSTMARKED: g 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 9, 1991 ��: Deputy CL a,44 a Z I1. 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: 1 9 t9l BY: I � 5. A Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County4inistrfor (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: SEP 1 Q PHIL BATCHELOR, Clerk, BY44 I J 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. D Dated: SEP 11 1991 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Charles Guy Sr. 1025 Ventura Drive Pittsburg, California 94565 Re: Claim of Charles Guy Sr. Please Take Notice As Follows : The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code section 910 and 910 . 2, or is otherwise insufficient for the reasons checked below: 1 . The claim fails to state the name and post office address of . the claimant. 2 . The claim fails to state the. post office address to which the person presenting the claim desires notices to be sent. X 3 . The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. X 4 . The claim fails to state the names ) of the public employee(s ) causing the injury, damage, or loss, ,if known. X 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10, 000) . If the claim totals less than ten thousand dollars ($10 , 000 ) , the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ( $10,000) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. 6 . The claim is not signed by the claimant or by some person on his behalf . 7 . Other: VICTOR J. WEST County Counsel f - By: i S- Deputy o my Couns 1 CERTIFICATE OF SERVICE BY MAIL C.C.P. S§ 1012 1013a, 2015 .5; Evid. C. 59 641, 664 ) My business address is the County Counsel's Office of Contra Costa County, Co. Admin. Bldg. , P.O. Box 69, Martinez, California, 94553, and I am a citizen of the United States, over 18 years of age, employed in Contra Costa County, and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non Acceptance of Claim by placing it in an envelope(s ) addressed as shown above (which is/are place(s ) having delivery service by U.S. Mail) , which envelope(s ) was then sealed and postage fully prepaid thereon, and thereafter was , on this day deposited in the U.S . Mail at Martinez/Concord, Contra Costa County, California . I certify under penalty of perjury that the foregoing is true and correct. Dated: at Martine , aliforni cc: Clerk of the Board of Supervisors iginal) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910 . 2, 920 .41 910 . 8) I -/47 VG il/6c h c c. 877 ' caa °-- ` ReCEIVED >`� _ I o - AUG 71991 f CLERK BOARD OF SUPERVISORS C7 CONTRA COSTA CO. • L "� r Richard K orone Contra - SHERIFF-C P.O. Box 391 Costa Ouayne l- Martinez. California 94553• AssistantSr. (.4151 372- 4495Warren E.R County Assistant Sr. Enclosed, is a County Clain Form. Please list the missing articles and their value, alone with any documents you may have, i.e., receipts etc. Be sure you have included pertinent dates that tie in with your loss. These dates should shout when you were brought here and when you left. Then you must return this form to Contra Costa County, Cleric of the Board, . 651 Pine -St. , Room-106, Martinez, CA 94553. � p "010�lr 1!5�0/c/ AN EOUAL OPPORTUNITY EMPLOYER • PROPERTY/CLOTHING RECEIPT CONTRA COSTA COUNTY , REC. NO15MOM I �"DATE: c �t HACK MDF° t .*IME: L c�►+soxx '>MCDf �. • 1 efloe sox` - 'WFC�� y Ctrs €>> .. NAME: UUP k ol OTHER BOOKING NBR: fr CASH DRESSariRT/BLOUSE �.} .COAT/JACKET _ 'TIE/SCARF# SHORTS/PANTiES JEWELRY- SOCKS/NYLONS EWELRY SOCKS/NYLONS S ATER/SWT SHIR ,�. /ATCH (PS ANT /SKIRT , SHOES/SOOTS - $ y T SHIRT/8RA . WALLET - HAT/PURK KE3�fS : r KNIFE. .; GLASSES_. ❑ OTHER C - 1{� i'a•. ti5 r. . i t _ :.BKG OFC_ - INMATE S . m s... - ,.. =# have received ali.� y per DATE: .$onal uoperty a„ ,dnthin REL OFC: X t#NiyJATi SIGNATURE '.. NFd�c4 y i �J� RECEIVED 3� CLAIM n BOARD .OF SUPERVISORS OF CONTRA COSTA AUFN,J 04L J COUNTY Claim Against the County, or District governed by) MARrINQCOUNSE BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT I CALIF, September 10, 1991 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: $400..00 ;t,,,,.: Sectior 913 and 915.4. Please note all "Warnings". CLAIMANT: HAISLEY, Curt ATTORNEY: Date received August 15, 1991 ADDRESS: 60 Morello Hts. Drive BY DELIVERY TO CLERK ON Martinez, CA 94553 August 9, 1991 BY MAIL POSTMARKED: g I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. IL BATCHELOR, Cler DATED: August 19, 1991 ��: Deputy OAmA I. 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 Adminis ator (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: SEp 1 o 191 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. Dated:—SEP 11 1991 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator plaim 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`ciuse of,action. . .(Govto 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/Py ) Reserved for Clerk's filing stamp RECEIVE® Against the .County off Contra. Costa 11991 or D ict) CLERK BOARD'OF.SUPERVISORS CONTRA COSTA CO, Fill in name The undersigned "claimant hereby makes claiminstQtthe County of Contra Costa or the above-named District yyin the sum. of $ 010 -� and in 'support of this claim represents asifoilows:. ` ----------------------- ----------------------------------------- ---------------- 1. When,did the damage_or-Jinjury occur? (Give exact date and hour) 59, --N---------. --------N---------------------- --, ------------------------------ 2. Where did the damage or injury occur? (Include city and county) �7' . --l------ ---------N---------------NMl-N-�N-OIN--NCO----N-----1----------- 3• How did the damage or injury occur? (Give full details; use extra paper if l required) lip 17 . ---- ---�-----�--. - ---------•�- ------ - -----1-----------'-- ----- 4. What particular act. or.;,omission,.on the -part bf -county or district officers, servants or employees -caused the injury;or damage0 ell. ? f (over) t. 5. . wnat are. the. names of county or district officers, servants or employees causing the damage or injury? ------ -- -------------.-----. -------------=-=----- -. - =-- -----�----a------ 5. ' •What 'damage or,.injueies do-you ,cla m_resulted? : (Give -full eztent_of injuries or damages claimed. "..'Attaeh two.:estimates for.auto:.,damage.� -- ---- -------------- ---- ------ ----------- ------------------------ 7. How`was -the amount "claimed ;above_computed? =,(Include the estimated-'amount--of any prospective injury or damage.) --o-------------- d addresses of witnesses; doctors and hospitals. 8.- Names-an 9: - List the expenditures you made on account of this accident or injury: DATE ITEM;: AMOUNT Gov: Code Sec. 910:2 provides:, • . � r "The claim must be signed.1by the claimant SEND NOTICES TO: (Attorney) or by s e Person.oh his behalf." Name and Address of Attorney - - Claimant's Si tore . ,.,: .. .. Address Telephone No. Telephoneo. NO :TILE ' 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.Rnot more,than-one-year•, by -a7,fine-of not exceeding one` thous--and ($1,000;),,, or .by both such .imprisonment' .and fin6; or by imprisonment- in the state prison, by a. fine of not:,exceeding�;.ten .thousand'-dollars ($10,000, or by both such imprisonment and fine. O CONCORD AUTO GLASS 1759 CONCORD AVE. CONCORD,CA (415) 685-3674 Jame Date7- written by \ddress Received Promised ;jty . Ins.Co.Phone come Phone Business Phone Claim No. Year Make Model ColorLicense Speedometer Vehicle I.D.N OPER. INSTRUCTIONS HOURS AMOUNT Se l) '909, --Lr 33 3.43- 25 -%a,4 . NOT RESPONSIBLE FOR ANY PERSONAL ITEMS LEFT IN CAR 1 hereby authorize the above repair work to be done along with the necessary materials.You and your empkryees may operate the above vehicle for purposes of testing,Inspection or delivery at my risk.An express mechanic's lien is, acknowledged on the above vehicle to secure the amount of repairs thereto.You will not be held responsible for loss or damage to vehicle or articles left in vehicle in ease of fire,theft,accident or any other cause beyond your control. STORAGE WILL BE CHARGED FORTY-EIGHT HOURS AFTER REPAIRS ARE COMPLETED, IN THE EVENT LEGAL ACTION IS NECESSARY TO PARTS Z�� 7 ENFORCE THIS CONTRACT, I WILL PAY REASONABLE ATTORNEY'S FEES AND COURT COSTS. LABOR 67, d SUBLET SIGNED X TAX ZZ. Terms:STRICTLY CASH Unless Arrangements Made TOTAL 79. f�� - � ° ^ . ` ' 1. J- � ^� \ EE-3,K.J 0"41 V 41%K_K_8-=.'`� F:�'C1 0::,;;-n B. A.R. LICENSE NO, AH126737 WE REPAIR ALL MAKES & MODELS 1260 Diamond Way Concord, CA. 94520 (415) 686-5007 ' 11,d' Ji ]L :D��mma��� �e 0JL1 .15,',1 by TOM CARVAJAL on 08-07-91 U.]! 3E f.31_E:`� 60 MORELLO HTS. DR. Style : F250 SUPER CAB Insurer o UNKNOWN Lic" Plate: 4C78297 Adjuster : MARTINEZ, CA 94553 Paint code: Appraiser: Phone: 228-2708 / Prod. Date: 6\90 Claimant : 90 FORD TRUCK FORD PICKUP Rate code : STANDARD Insured : VIN: 1FTHX2667LKB51456 Deductible: 0.00 Policy # : Mileage: 18090 Claim # : # Labor Op Description Price Labor Paint Labor Group Price Groupl RHV REP 6LASS5 WINDSHIELD 321.63 2.2 0.0 GLASS NEW 2 (SHADED) ' 3 KHV REP N\SHlEDLU KIT 20.0Vl TO V.V N EW / GLASS L 2@ 5100 11100 NEW 3U.0 T | ` Labor ( 2.2 hrs) 110.00 Material 0.00 Subtotal 451.63 ` «1l lFcs-t a-L 1. -14. 51 ~ ET JL #III Parts Prices Subject to invoice $*II* t SIGNIFIES, ESTIMATORS JUD6EHENT AUTHORIZED AND ACCEPTED; You are hereby authorized to make the above specified repairs l understand that payment io full will be he upon release of vehicle, iociudjng additional supplemental diamaUe charges` and hereby grant you aod/ur your employees, permission to opemLe the car` truck, or vehicle herein described on streets` highways, or elsewhere for the purpose of testing amKur inspection. An express mechanic's lien is hereby ackmwledyed on the above car` truck, or vehicle to secure the amount of repairs thereto. You wi|} out be held responsible for loss or damage to the vehicle or articles left in vehicle io case of fire` theft, accident or any other causo beyond your control. OLD PARTS 8EHOVEU F�KUM CAR WILL BE JUNKED UNLESS OTHERWISE lNSlRUCTEU. __________________________________________________________________ Authorizedby --------- -------------------------------------------- Date ____________ Thank you for coming to SUN VALLEY BODY SHOP! We appreciate your business! ` ° ' fa cj46 r i l �, + CL > ti A-�3 I a 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 $e p t e mb e r 10 199J . and Board Action. All Section references are to ) The copy of this document mailed tb you is your ndtice of California Government Codes. ) the-action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Undetermined ® Section 913 and 915.4. Please note all "Warnings". CLAIMANT: HAWTHORNE, Michael ATTORNEY: Philip T. Prince , E q Law Offices of Philireceived ADDRESS: 259 Oak Street BY DELIVERY TO CLERK ON August 1 , 1991 San Francisco, CA 94102 BY MAIL POSTMARKED: unreadable Cert . P 420 —2-7--0-37 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: August 7BH', 1991 EVIL DATCELOR, Clerk : eputy 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: JI /Jn 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 Order entered in its minutes for this date. 0 Dated: SEP 10 1991 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. 0 Dated:—SEP 11 199' BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator LAW OFFICES OF PHILIP T. PRINCE 259 OAK STREET SAN FRANCISCO, CALIFORNIA 94102 (415) 552-7707 RECEIVE® 1991 July 30, 1991 CLERK BOARD OF SUPFRV►; Board of Supervisors, CONTRA COSTA CO- Contra Costa County 651 Pine, Room 106 Martinez, CA 94553 Re: Michael J. Hawthorne v.. Contra Costa County, et al . Dear Sir : Please find enclosed an original and four copies of CLAIM FOR PERSONAL INJURIES in the above referenced matter . Two copies are provided to create file endorsed copies. Please use the enclosed envelope to return the file endorsed copies to our offices . Your professional cooperation and courtesy is appreciated . Very truly yours, LAW OFFICES OF PHILIP T. PRINCE G W. Dillon GWD:gwd Enclosures as stated. 1 2 . The names of the public employees causing Claimant' s injuries under the described circumstances are ROBIN MORAN and DOES 1 2 through 50, inclusive, all of whose identities are presently unknown . 3 3 . The injuries sustained by Claimant, as far as known, consist 4 of exposure to rabies vaccine, anxiety, depression, adverse physical and emotional reactions to the rabies vaccine, loss of 5 past and future income and/or wages, and pain and suffering. 6 4 . The amount of Claimant' s claim exceeds $25 ,000 (Twenty Five Thousand Dollars) and jurisdiction over the claim rests with the 7 Superior Court of California, County of Contra Costa. 8 5 . Witnesses to the incident and Claimant' s injuries, as far as are known are: 9 A) MELODY BOYD, 10 Contra Costa County, Animal Control Services; B) JAN JONG, 11 Contra Costa County, Animal Control Services; C) ROBIN MORAN, 12 Contra Costa County, Animal Control Services; D) Dr . NOE, 13 Contra Costa County, Animal Control Services; E) KEN POTTS, 14 Contra Costa County, Animal Control Services; F) RENEE BUTLER, D.V.M. 15 Clayton Valley Pet Hospital 4801 Clayton Road 16 Concord , CA 94521; G) Claimant; 17 H) FRANCINE WISE, Contra Costa County, Health Services Department; 18 I) JOSEPH BURGER, M.D. 2500 Alhambra 19 Martinez, CA 94523; J) HECTOR RIVERA, M.D. 20. Pittsburg , CA; K) JUDY BALTZO, 21 John F. Kennedy University Contra Costa County, •California; 22 L) Dr . BIGELOW Mt. Diablo Convelsent Care Center , Inc. 23 1520 Kirker Pass Road Clayton, California 94517 ; 24 M) Dr . SILVERI Merrithew Hospital 25 Martinez, California; N) Director of Personnel 26 Mountain Cascade, Inc. San Ramon, California; 27 0) MICHAEL MOURI , M.D. 28 Merrithew Hospital ; 2 1 P) Dr . BELLWOOD Martinez, California . 2 3 6) The amount of medical expenses to date are unknown. However , said expenses are continuing. Claimant has received medical and 4 related treatment and care from each of the various practitioners identified in Paragraph 6 , above, and has received treatment and 5 care at Merrithew Hospital located in Martinez, California and John Muir Hospital located at 1601 Ignacio Valley Road, Walnut 6 Creek, California. 7 Claimant has been disabled as a result of the incident as de- scribed in Paragraph 1, and consequently has been unable to work 8 since May 10 , 1991 at his job as a heavy equipment operator for Mountain Cascade, Inc. , located in San Ramon, California since 9 said date. The amount of Claimant' s past and future lost wages and income claims are unknown. However , said claims are continu- 10 ing . 11 7) All notices concerning this claim are to be sent to: PHILIP T. PRINCE, Esq. 12 LAW OFFICES OF PHILIP T. PRINCE 259 Oak Street 13 San Francisco, California 94102 14 15 LAW OFFICES OF PHILIP T. PRINCE 16 Dated: July.�La , 1991 by 17 PHILIP T. PRINCE 18 Attorney for Claimant MICHAEL J. HAWTHORNE 19 20 21 22 23 24 25 26 27 28 3 1 PROOF OF SERVICE VIA CERTIFIED MAIL 2 3 I hereby certify that I am a citizen of the United States, 4 that I am over the age of 18 , and am employed in San Francisco 5 County. My business address is 259 Oak Street, San Francisco, 6 California 94102 . I am not a party to the within entitled action 7 and on the date shown below, I served the attached : 8 CLAIM FOR PERSONAL INJURIES, (Triplicate) 9 10 in said cause, by placing a true and correct copy thereof en- 11 closed in a sealed envelope for certified mail , return-receipt 12 requested with postage thereon fully prepaid, in the United 13 States mail at San Francisco, California, addressed as shown 14 below: 15 Board of Supervisors , Contra Costa County 16 651 Pine , Room 106 Martinez , CA 94553 17 18 I declare under penalty of perjury that the foregoing is true . and 19 correct and that this declaration was executed at San Francisco, 20 California , on the date shown below. 21 —" 22Dated : July 30 , 1991 23 Gregaix. Dillon 24 25 26 27 28 f r 4 { r ru a3hv 0 0) C1 W y rioi f f i � p F--� rn tLi P- P) Ir8Q N (D C f-h n\j) t { coo f c) f-0 n P CD rt- 0 Z "3 Md r - m CIOW � 20 0 j�F ;i x .moi 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 September 10, 1991 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), gi en purer t% O o hent Coie Amount: $627 . 35 Section 913 and 915.4. Plea . l� ' CLAIMANT: HERNANDEZ Maria G. Jr, 141991 ATTORNEY: � �p 1 CLERK BOARD OF PERVISORS St. Mary' s College a e e� ed , ADDRESS: P.O. BOX 3316 Av�Y DEL �A� TO CLERK ONL"A'Ui_Z T A STA Moraga, CA 94575 cpv�v, sip. N$�� AIIL POSTMARKED: August 9 , 1991 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. August 13 1991 EVIL BATCHELOR, Clerk DATED: g BY: Deputy 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: �I� 191 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. 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: SEP 1 (3 1 PHIL BATCHELOR, Clerk, B 1 A,' ° 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 vile 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 claimantas shown 'above. Dated: SEP 11 `Ja� 0 BY: PHIL BATCHELOR by o Deputy Clerk CC: County Counsel County Administrator t✓Y"`U 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,:relatingGto. eauses bf Action--•for death ' ' for injury to.person or to personal property. on 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=acti�on.� ; .(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 ) .. :Against.the County of-Contra Costa ) rpistriet (Fi-11:, n name ).. The undersigned-ela'imarit:`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: 1. When did the damage or injury. occur? (Give exact date and hour) �Or��iOr�tirM�— -------------M�� 2. -Where-.did-';the. damage'br fnjury occur? (Inel'ude city and county) ---�r—N---�M------------.�—N--M---w—seas----M—M--w--M.---r�--�-------r---o�--r 3. How did the damage or injury occur? (Givecfull.,details ' use extra paper if required)_ ------N--N---N—MIS---sear--MMw—aa,�—NMN—�---N�rtr--N----------aM.----NN—ear—Ie, 4..,;:,What_-particular,act---pr-omission on the art-- f 'po -county_-or_d-istrict officers; servants-or--employeelFpaused-the--injury-or-damage? r (over) i a ' :Wnat are the names of. county,or. district officers, servants or employees causing the damage or injury? "J, • . r eee ��eNrrrreerrr�r----w-- -eer r-----L. —ereee rrr 5 '! What 'daaiage` or in juries,do'you-,-claim-resulted?... (Give •full. extent of injuries or damyages claimed. Attach two estimates for.auto damage.- j. ------------ -erre--r----erre--rrrr T: How was the amount claimed 'above computed? {Include the estimated amount of any prospective injury or damage.,) - rNeereeeerrNeN�sNNeeNe �rrere:tNeree�Mr ..• -��r�N...rrNeeere _ ereeeeeerrrrr $. Names and addresses. 'of• witnesses, doctors and hospitals. rereererr e reeereer reeNrrNreeereseNereeeererre eee—Ner rerrr erreereere—NeereNererr 9.. List the expenditures :you made: on �aeeount of this accident or' injury. DATE ITEM .,, AMOUNT Gov. Code See. 910:2 provides: "The claim must be signed .by the claimant SEND NOTICES TO: (Attorney) or ,,b ,.6ome�,_ erson on his behalf.'' . Name and Address of Attorney t n- 3 ^r -Claimant 1-s Signature). Address Telephone No. = Telephone No. - NOTICE . Section, 72. of thePenal•.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)9 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. ,. RE: Claim by RECEIVED } Dr. Maria G. Hernandez a resident of Contra Costa County j AUG 1 2 1991 Against the County of Contra Costa ) Public Works Department CLERK BOARD OF SUPERVISORS P ) CONTRA COSTA CO. _ The undersigned claimant hereby makes claim against the County of Contra Costa or the above named District in the sum of: 23 and in support of this claim represents as follows: -- 1. When did the damage or injury occur? Damage to the Petitioner's car was sustained on Tuesday July 2, 1991 at approximately 8:45 a.m. 2. Where did the damage or injury occur? The damage was sustained while driving south on Taylor Boulevard in Pleasant Hill close to the intersection of Pleasant Hill Road on a portion of road that was undergoing "chip seal process". 3. How did the damage or injury occur? The Petitioner was.driving on Taylor Boulevard and two very large pieces of gravel , that was being used for road work,were hurled at the Petitioner's car by other vehicles that passed by. 4. What particular act or omission on the part of County or district officers, servants or employees caused the injury or damage? The Petitioner contents that the County exercised poor judgement and neglected to do all or some of the following: a. use smaller sized gravel for repair work that would not have posed the threat of damage to vehicles using Taylor Boulevard b. provide at least one clear and safe lane of traffic;for vehicle use that could be used by motorists at normal speed during the time that repair work would be conducted; c. provide a flag man to warn vehicles of the upcoming danger that would better encourage drivers to observe a 25 mph warning. d. provide a warning to drivers that body damage could be sustained if they continued using the highway d. schedule repair work during times when Taylor Boulevard is less likely to be used by commuters than the morning rush hour 5. What are the names of county or district officers, servants or employees causing the damage or injury? The Department responsible for the road repair work on Taylor Boulevard is the Public Works Department. 6. What damage or injuries do you claim resulted? The damage sustained to petitioner's car is as follows: a. one cracked windshield Document Prepared/Updated on: 8/9/91 10:22 AM. Pagel cost of repair: $497.35 b. five hours of lost work time preparing complaint $25.00 per hour X 5 hours = $125.00 7. How was the amount claimed above computed? Item"a" was derived from the enclosed estimate issued by Acura of Concord. Item "b" is based on the amount of time Petitioner had to do all of the following: (1) Identify which County agency was responsible for road work. (2) Ask Office of Risk Management to provide needed paperwork (3) Identify a reputable body shop for repair work on Acura (4) Obtain car repair estimate from reputable repair shop (5) Answer claim form 8. Names and addresses of witnesses, doctors and hospitals. Although other vehicles were on Taylor Boulevard/Pleasant Hill Road at the time the damage occurred,it would be impossible to ascertain which exact vehicle was involved in thrusting the pebble up onto the Petitioners window or to determine which other driver saw the actual event. The petitioner's office staff member, Ms. Jean Purcel,who also uses Taylor Boulevard to reach Saint Mary's College,knew of the event and knew of the day my car was damaged. She can be reached at her place of employment by dialing 415:631-4349. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 7/26 cellular call to risk management(2min) $ .90 8/6 cellular call to Acura Dealer (4 min) $2.00 8/9 postage(estimate) $2.00 SEND NOTICES TO: Dr. Maria G.Hernandez Saint Mary's College aimant's Signature P.O. Box 3316 Moraga, CA 94575 Telephone: 415: 631-4357 SAINT MARY'S COLLEGE — OF CALIFORNIA Maria G.Hernandez,Ph.D. Assistant Dean for Special Programs Hispanic Student Programs Coordinator �/ P.O.Box 3316,Moraga,California 9457 415-631-4349 • FAX 415-376-1847 Document Prepared/Updated on: 8/9/91 10:22 AM Page2 ADDENDUM. TO THE CLAIM .OF 11P� �v/}IVD�Z-- r _ (Print your full-name) ( 1) Do you use the roadway as part of a daily commute? Yes (� ) No ( ) ( 2) Were you aware that construction would be commencing on the roadway? __ _- •, . _ ._ T Yes ( ) No (�) ( 3) Was an alternate route -available? Yes (X ) No ( . (4)- , Did .you ;read about:.the impending -resurfacing in. the ;'local newspaper? Yes ( ). No ,( 5) T:,.D d 'you see -warning.,, signs'advii rig..-of. 'loose gravel=='-and a 25 mile per hour advisory sign? Yes ':( X) No-•( )-t 154 Did the,;damage. result''from,arioth('' vehicle' exceeding the 25 mile per hour advisory? Yes No. (7) Did a vehicle traveling._in .the same- direction and exceeding the 25 mile per hour advisory sign attempt to pass you? Yes (Y\) No ( ) (8) Did a vehicle coming from the opposite direction cause gravel to be thrown onto your car.? Yes ( ) No ( �) (9) Was the vehicle located directly in front of you exceeding : the speed 'advi-sory? ' Yes ( ) No (x ) youtravel' the roadway more; than once during-,the -r,esurfacng:prior to the damage sustained to your car? Yes ( ) ;,No ( 11) Did you obtain the identity of the- car` r:elat ng to questions 6 Yes ( ) No O If .yes, please provide identification below: ( 121 Please' describe in`your own words how the gravel caused damage to your vehicle and the angle the gravel was thrown. .,.onto, the ,car,..along,.wth.•._the, specif is,-'damaged parts on your vehicle. - z ,. �- A ,At&e-- G�-P r c_2o ���7 Gctt/izGt�� AP �11a ( 13) Were you aware that using the road during the chip seal process might result in damage- to your car? ..W .. Yes ( ) No j( ) X I declare that the above information is true and correct under the penalty of perjury. (Signature) _ 1 , /99) —� (Date) .rr 7 861 RJI> CONCORD, CA 94520-4908 S LISTED FOR LABOR AND MATERIALS ESTIMATE OF REPAIR S VERBAL AGREEMENTS NOT BINDING(ESTIMATES FREE OWNER _ DATE ADDRESS ('HONE EST.NO. INSURANCE CO. : - - ORDER NO. ADDRESS - PHONE LICENSE NUMBER - -- ?. YEAR-MAKE MODEL MILEAGE MOTOR NO. SERIAL NO. 7 7 7`" ' 3. ;`:PART5 t?(ttCESASf>7 OtSttAN©ARC(CATAtLG PROCUItEM�tdTPR1C LtSt*�SUJET fiE7 CHA#dGE bbTTHOk1T P13T1C) '; TOTAL PROCUT}EMENi AtdO DELtY�RY CHARGES MAX�ACH3EQ POR SPEC[AL SERVECE C?N.f?EMS t*(f3F AVATlAt3CE LOCALLY : MATERIA L OLRPARSREMOVEDFR4AtCAR5W3LLBEJt3NKfDUf�f1E55OTtiiR1+J15E#NSTRUCTEf3INWRt7ING TOTAL LABOR ;THE ABK3VE+ts AN E5711+tAT€ BA5€D Of#OUR+i+fSP€C7+t3N ANt3 gOES NUT COVER ADLtf't;+t�fdR{.PRt2TS ;c3R LABOR WHTGH MAY F3E REOU+RE i TERTW WORK HAS BEEN OPEtTEq UP gCCA5tt3NALLY AFTER WG7RK HAS STAR'�EI?WCORN PARTtS E 0tsC + ' 1IVHTCH ARE NOT EVIRENT ON FtRs# iNSP[CTt4N TOTAL MATERIAL g; BECAUSE OFTfItS THE A;B©VEGUARANTEED ESTIMATE TAX ESTiMA'1"i=D 8Y .:: AT?PR05fED 6Y PAI DOUT-TOW&STORAGE SUBLET REPAIRS �Bll LiW1Vi^Ft ��•: . `CIR AGENT OATS 4H 429 RMFORM u +�' t cn � rA al \�tp.b�Yj 1rp W t`� 01 � • RECEIVED CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, 1931 Cla the County, or ict overned qWft the1BoardloftSupervisors, RouttingrEndorsements,by) NOTICE TO CLAIMANT� RtembeDlO, BOARD 1 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 bellow), given pursuant to Government Code Amount: Unspecified Section 913 and 915.4. Please note all "Warnings". CLAIMANT: HOL'LEMAN, Terri R. ATTORNEY: Date received ADDRESS: 4854 Northridge Rd. BY DELIVERY TO CLERK ON August 15, 1991 Martinez, CA 94553 BY.MAIL POSTMARKED: August 13, 1991 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. August 19, 1991 &pHHIL BATCHELOR, Clerk a DATED: BY: Deputy I1. 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: �j � �5 �(� BY: l Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Admi i r for (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present Vis) This Claim is rejected in full. t ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. 1 1 Dated: S E P 1 0 I991 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. Dated: S E P 11 1991 BY: PHIL BATCHELOR bye a Deputy Clerk CC: County Counsel County Administrator f .f NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Terri Holleman 4854 Northridge Road Martinez, California 94553 Re: Claim of HOLLEMAN, Terri R. Please Take Notice As Follows : The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code section 910 and 910 . 2, or is otherwise insufficient for -the reasons checked below: 1 . The claim fails to state the name and post office address of the claimant. 2 . The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. 3 . The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. 4 . The claim fails to state the name(s ) of the public employee(s ) causing the injury,, damage, or loss, if known . X 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ( $10, 000 ) „ If the claim totals less than ten thousand dollars ($10,, 000 ) , the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, .damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ( $10,000) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. 6 . The claim is not signed by the claimant or by some person on his behalf . 7 . Other: VICTOR J. WESTMAN, County Counsel i B y: •C..,,�t�l Deputyunty Cou Tj CERTIFICATE OF SERVICE BY MAIL C .C.P. SS 1012, 1013a, 2015 . 5; Evid. C. §9 641 , 664 ) My business address is the County Counsel's Office of Contra Costa County, Co. Admin. Bldg. , P.O. Box 69, Martinez, California, 94553, and I am a citizen of the United States, over 18 years of age, employed in Contra Costa County, and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non Acceptance of Claim by placing it in an envelope(s ) addressed as shown above (which is/are place(s ) having delivery service by U.S. Mail ) , which envelope(s ) was then sealed and postage fully prepaid thereon, and thereafter was, on this day deposited in the U.S. Mail at Martinez/Concord, Contra Costa County, California . I certify under penalty of perjury that the foregoing is true and correct . Dated: /99%, at Martinez, California. cc: Clerk of the Board of Supervisors (qginal) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910 . 2, 920 . 4, 910 . 8 ) Claim'to: - BOARD-OF ,SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLADIANT . 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.the100th 'day after the accrual of the cause of action. Claims relating to .causes of action for•death `or for injury to person on 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 oneyear after the accrual- of the cause bf 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 .publib entity, separate claims. must be filed against each public entity. E. Fraud. See penalty, for-fraudulent_claims, ,Penal. Code Sec.172 at the end of this form. RE: Claim By "" ) Reserved for Clerk's filing stamp ECLE ] Against the .County of Contra Costa )or DlstriCt)Flll in name )_.. _. . 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: l " -- ----------------------------- -- ------—------------------------------ -- When didthe damage or injury cur? (Give exact date and hour) �� ���aq _.�._c as!� - • - ..g ��� . 2. Where d the damage or injury occur? (Include city and county) -------- ---rrr----------------�--rrr-----rN-r-- ----�rr--Mr------�-r-----r----- 3. -How id the damage or injury occur? (Give -ful details; use extra paper if required) C asl: M,� ctS ctia; C a41e ,� 4s cUe �osd o . acv s �. mac'/ o� u:t�d s kd d bcf-' f6 o ;� ,� a c!,asr w1�dd�iu�d Z ---••----- �-.�.�---r ----•.e--r-.�rM..--r--r--ri..�.��e--r-- r-r-r -----r--�-. ----��- _ o !✓LU a.6� 4. What particular.act or omission on•..the..part of county or'. 'd°istrict;officers, / servants or employees-caused -the .;, damages f d r . / ��-' S``u� sial - � U (over) 7. wnat are the names of county .or district officers, servants or employees causing the damage or injury? ZC 0 LMA SW I�L) DO 5. - What; damage or injuries rdo you claim resulted? (Give full extent of injuriesor damagq claimed. ;. Attach two estimates for auto damage ' . Q il,�• �C�.ti( CJ1.0-G�S �O' �� Gv�i�G�;S�k �,(iL .. 1 . .-�� ,. . 7. How was' the amount- claimed above computed?.,-(Include'tthe estimated amount of any, prospective injury or damage.) 81 ` Names and'addres esJof witnesses, doctors" and 'hospitals: ------ --- -- ---- -- -- ---- ----------------------------------------------------- -- 9. List the expenditures,you made on account' of this accident or injury.: DATE ITEM4 AMOUNT e --- n Gov. Code Sec'': 12 p 910rovides: "The claim must be signed -by the claimant SEND NOTICES TO: (Attorney) or by some son n his behalf." Name and Address of Attorney:. r•- Cl t s Slimture 777 Address • Telephone No. Telephone No. . .- .. .. sva .r. . . _ ..- !., .- 0. , a.infl -,. .{ick • ,. „ .. ... _ .. NOTICE Section 72 of.,the- Penal,-Code provides: - - "Eyery 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 1period.of_:not•more-than-one'°year; by a' fine of,not exceeding one thousand• ($1,000:), ,or, by both. such impr.isorment`and fine; �or by;imprisonment in the state prison, by a fine of not:-.exceeding ten. th`ousaid dollars ($10,000, or by' both such imprisonment and fine. i y ADDENDUM TO THE CLAIM OF . (Print you full name) (1) Do you use the roadway as part of a daily commute? Yes ( ) No ( 2) Were you aware that construction would be commencing on the roadway? _ .._. .Yes ( ). No ( 3) Was an alternate route available? Yes ( ) No ( 4) Did you .read about .the. •impending resurfacing in the local newspaper? Yes ( ) No ( ✓ ) ( 5) Did you see warning signs advising of ' loose gravel and a 25, mile -per "hour advisory sign? _ . Yes ( ) No ( ) ( 6) Did the .damage result..from another vehicle' exceeding the 25. mile per hour advisory? Yes ( ) z No ( ) (7) Did a vehicle traveling in the same direction and .exQeedTng so -grr-attempt to pass you? Yes ( � ) No ( ) ( 8) Did a vehicle coming from the opposite direction cause gravel to be thrown onto your car? Yes (. ) No , '( 9) Was the vehicle located directly in front of you exceeding the, speed advisory? Yes ( ) No r ( 10) Did you travel the. roadway more than once during .the resurfacing prior to- the damage sustained to your car? Yes ( J ) No ( ) Did you obtain the identity of the car relating to ..questions 6 thru 9? Yes (✓ ) No ( ) -If yes, please provide identification below: ( 12) Please describe in your own words how the gravel caused damage to your vehicle and the angle the gravel was thrown onto the car,. along with the specific damaged parts on your vehicle. - ('i W (.�) ( or ( a� 5 ayved :5�4'4� "JW*4EA GQ� d ( 13) Were you aware that using the road during the chip seal process might result in damage . to your car? Yes'. ( ) No I declare that the above information is true and correct under the penalty. of perjury„ (Signature) Date) 4 IZa� v ZIP- LOP ✓. . rr Orr �.. Aeos�00O t 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 September 10, 1991 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: $287.56 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: MORI , Kelly E. ATTORNEY: Date received ADDRESS: 28 Driftwood Court BY DELIVERY TO CLERK ON August 8, 1991 Pleasant Hill , CA 94523 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. AuQust 9, 1991 PpHHIL BATCHELOR, Clerk v DATED: BY: Deputy 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: zz�,, Deputy County Counsel �J 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 C� 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: SEP 1 0 1991 PHIL BATCHELOR, Clerk, By c 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. 1 Dated: SEP 11991 BY: PHIL BATCHELOR by Deputy -Clerk CC: County Counsel County Administrator }Claim .to: BOARD--OF SUPERVISORS OFA 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, 198.79 -must .be presented- not-later than-the, 100th day after the accrual` of,the cause of: action.. -Claims relating to causes`of aetio. -`for"adath 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,,tban one-year -after the accrual of the-ca-Use,of". , (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 ln-," 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 RE: Claim By Reserved for Clerk's filing stamp Yl�.�y � w�Com,,. ) - ✓• RECEIVED Y. Against the.County of'Contra Costa ) i 8 i99f i-'District) ;, .,�,..., .., CLDiK BOARD OF SUPERVISORS Fill in name CONTRA COSTCO. �..- The undersigned.-claimant hereby-makes claim 11 against the County 'of Contra Costa or the above-named District in the stmt of $ ..N.rA S T 5-b and in support of this claim represents as follows: NNNIN- 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? " (Include city and' county) At=Py 7-rG .3. How did the damage or injury occur? (Give rfull 'details; use extra paper if required). G11� (?02. :T�6 .�V WC_, (?t ' S ��c r� :,,5p . rAA7 .. Nr- 4.: Wiiat:,part icular_ act oroomission--on the .part of-county or4disti ict `officers., servants orto ees ;caused the. in or=dams } 'C, y damage. H,SR .y LA_y<"- (over) 7, what are the names, of county_ - or, districtµofficers, servants or employees causing , the damage or injury? y wwwww "�`w "w.�wwNwwww,�ww..�wwwwwewwwwwwwww w..www..wwwwwwwwwwwwwwwwwwwwwww..w..ww... ,S 5. What'sai damage,or. injuries do_:you-claim=resulted?_. (Give .full extent of injuries or damages clmed,. Attach'.'two estimates _for.auto damage. C.-_-, ' wwwwwwwwwNwwNwwwwNwwrNwwwwwwwwwwwNwNNNSNN�NNwNwwNwwwwwwwNwwww.�wwwwwww ?. How was the amount claimed above computed? (Include the estimated amount of any prospective. injury or damage.) . wNwwwwwwwwwwNwwwwwNww wwNwwNww�wwA NN wwMwYwwwwNww wwwNwwrwr�NwwwNw wwwwwwww ww .hea+a � $. Names and addresses of witneyysses, doctors and hospitals. �. ... . _ t 1•.. � � .. ^'.! ` ,. } _.lam"y• . . - w,ww------------------—------- —— --------- ——--wwwwwwww9.' List, the,expenditures you made on .aecount of this accident or injury:,- DATE . .ITEM AMOUNT = - fW-0 0, !t !F :IF:':�t ,iF *.;* ' Gov. Code See. 910:2 provides: # "The claim must be signed_by the claimant SEND NOTICES:ITO: i�(, ttol ,) °�lt.. or !.by, somd,.person on his behalf." Name and-,Address of.`Attorney�._ ; _. w - Claimanf''s Signature (Address). -- p�_eQWcrlf 141 11.r C4 q 5a3 Telephone.No. ,. . - Telephone'-No =, :.;C4[5) 1-7S� 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 afine:of'not exceed ing one thousand ($1,000), or by both,.,:such—imprisonment and -fi.ne, °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. ADDENDUM TO :THE CLAIM:,OF { l ' Print"your Iull=name) { 1} Do you use the roadway as part of `a daily commute? . . Yes { ) No ( ) ( 2) Were you aware that. construction would be .commencing on the roadway? Yes { . } No { . ( 3) Was . an alternate route available? .___ . ... . .. - Yes V) NO (4) _ Did you read about- the -impending-'resurfacing in" the local newspaper? Yes ( ) No (X") ( 5) Did you see warning signs advising of loose gravel and a 25 'mile'per" hour advisory sign? Yes ( ) No ( ) (6) Did the damage result from anothe!r,.vehicle. exceeding the - 25 mile per -hour advisory? Yes �... +No* ..{ . (7) Did a vehicle traveling in the same. direction. and exceeding • --- the25 mile_ "per hour "advisory sign attempt to pass you? Yes { ) No (�) .(8) Did a vehicle coming from the opposite direction cause gravel to be thrown onto your car? Yes { ) No ( ) (9} ' Was the vehicle located directly- in front of you exceeding the speed advisory? Yes { } No ( �) . ( 10) Did you travel the roadway move than once`dur'ing_'the r.esurfacing. prior to the damage sustained to your car? Yes ( XI) No ( ) ( 11) Did you obtain the identity of the car. relating to questions. -6 thru4 9'? _ .� Yes ( ) No ( A If yes, please provide identification below: ( 12) Please describe in your own words how the gravel caused damage to your vehicle and the angle the gravel was thrown onto the car,,- along. with..the�.specific damaged parts7 on your vehicle. Y IkC:�c ',�� 1/11. ao 44-1 :gin £_ W dors n� ...��'1-�1 L't�.:� `-�i/� ' '�tt'�(�M•� l/Uf�-S ' 1`/L{+V t�t :t 1J (T f ` ( 13) Were you aware that using the road during the chip seal process might result in damage to your car? Yes. ( ».:) No O I declare that the above information- is true and correct under the penalty of perjury. : - ( signature) (Date) RAMS GLASS CO. P. ®. BOX 23674 TIME PROMISED Pleasant Hill, CA 94523-0674 DATES ACCT. NO. (415) 798-0306 (415) 930-0306 INSURANCE CO.NAME JOB SITE: AGENTS NAME NAME: �KF-WA I eei ADDRESS ADDRESS: CITY,PTATE PHONE: PHONE NO. INSURED'S NAME POLICY NUMBER CLAIM Thank you for allowing us to serve your glass needs!! DATE NUMBER ER , Loss MAKE A ///±±±N _�'/ MODEL �1 CAUSE YEAR Zq0 DOORS 999 �s•d LICENSE NUMBER 3 DEDUCTIBLE TERMS CUSTOMER P.O.NO. CUSTOMER R.O.NO. MILEAGE VIN NO. DATE SHIPPED QUAN. NAGS SIZE 1 DESCRIPTION LIST (COST{ ��� ��I l x X X X X e �lam$ ) X X X X X A xA . `art v I hereby Authorize the above repair work to be done along with necessary material and I agree to pay for all changes which are not covered by Insurance. BY: X .� .rte a ORIGINAL-White COMMERCIAL-Yellow INSURANCE-Pink CUSTOMER-Gold : - 4366 I S,s5-MARKET ST. GUNIC"OR®, CA 94520 AS FOR LABOR AND MATERIALS ESTIMATE OF REPAIRSVERBATLAGR EMENTSNOTBINDING ESTIMATES FREE OWNER DATE �. E Y q(( ADDRESS PHONE EST. NO. 22V 7(ZAsrwo©-z) INSURANCE CO. ORDER NO. Leers&A)T Lt c. ADDRESS PHONE LICENSE NUMBER I f\ YEAR-MAKE MOD L MILEAGE MOTOR NO. SERIAL NO. 'To 2a_CaL �Mv� all - DESCRIPTION OF LABOR OR MATERIAL PgRTS PRICES.BASED ON STANDARD CATALOG PROCUREMENT UBJ PRICE IiSTS SECT TO CHANGE WITHOUT NOTICE TOTAL PROCUREMENT AND DELIVERY CHARGES MAY BE ADDEb FOR SPECIAI SERVICE ON;;ITEMS NOT AVAILABif IOCAIIY. MATERIAL OlD PARTS REMOVED FROM CARS Wlll BE JUNKED UNLESS OTHERWISE.INSTRUCTED IN WRITING TOTAL LABOR 6 2 THE A6;OVE IS AN ESTIMATE BASED ON:OUR INSPECTION AND DOES NOT CdVER ADDITIONAL PARTS OR LABOR WHICH MAY BE REQUIRED AFTER THE WORK NAS BEEN OPENED UP OCCASIONALLY AFTER, W6RK-.HAS STARTED.WORN PARTS ARE DISCOVERED WHICH ARE NOT EVIDENT ON FIRST:INSPECTION. TOTAL MATERIAL `:'BECAUSE OF.THIS THE'AHOUE PRICES ARE NOT;GUARANTEED ESTIMATE �� TAX t .;ESTIMATED 8Y APPROVED EIY AUTH',ORIZE:D AND ACCEPTED PAIDOUT-Tow&STORAGE SUBLET REPAIRS BY OWNER OR AGENT DATE:` � 4H 429 REDIFORM 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 Secptember 10 11991 and Board Action. All Section references are to ) The copy of this document mad ' no ice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given purs,jant to Government Code Amount: $1-63. 88 rjS0 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: MURPHY, Wendy L. ATTORNEY: P\,o�N�y ,���p��F• Date received ADDRESS: 188 Miramonte Drive BY DELIVERY TO CLERK ON August 5 , 1991 Moraga, CA 94556 BY MAIL POSTMARKED: Hand delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: August 7, 1991 JVIL �ep�tyLOR, Clerk a 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: S. N 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 Order entered in its minutes for this date. Dated: SEP 10 1991 PHIL BATCHELOR, Clerk, By 0 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. SEP 11 1991 Dated: BY: PHIL BATCHELOR by .O Deputy Clerk CC: County Counsel County Administrator Chaim to BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO d ADAM 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 We b,l L. MuURV- RECEIVED Against the County- of Contra Costa ) AUG 5{1991 or ) i3OJ .0 a. CLERK BOARD OF.SUPERVIS ORS - District) CONTRA COSTA Co. Fill in name ) The undersigned claimant hereby makes claiainst the County of Contra Costa or the above-named District in the.sum of $ and in support of this claim-represents as ,follows: 1. When did the damage or injury occur? (Give exact date and hour) ------/l ----------- 2. Where did the damage or injury occur? (Include city and county) _ � As ►r� ------------------------------=------= 3. How did the damage or injury occur? (Give full details; use extra paper if./. required) _T W#,S IN Tib I r I_�£ 'OR/ 7AyZ0k- 3L�d Al -.A � 60- �c'' (( W�e” :A . P f er'e 48- g.1s�I CZ le Al �P ibv� Gtza�k� My l�rn►ds�,►�fd SHE 9r� L . , 14AS �i%o1�-t` /k See�'toA1. � f+�ve 1 A'r fls �OiU 7` l�2 $Gi�ct- . . 4. What particularactor omission on the part of-county or district officers, servants or;employees caused the in jury. or_ damage? ,[�eI -ilAT C'0VA1Ty W�� 14CY :b y le-AVW4. 11005E 9,-Av60 ( CAI `tHr `zflO W i+kov�- P;to d ids A 4 AAJ A f t-eP.fiJAI-r— (c o o iZ. (over) q J� s 7r wnat are the names .of county or district officers, servants or employees. causing the damage or injury? �ONA SM C�svn91 5. What damage or -injuries do you claim resulted? (Givel full extent- of injuries or d es claimed. Attach, two estimates: for auto damage: T4� ..: gNd51-►:eic� - My 1�8+ 7&Ymi 40 Intlins CdZ �� :4 - .. �_ 7. How was the`amount..clained above computed. . (Include the estimated amount of any prospective injury or damage.) - ----------------- - ---.. --- ---- ------ - - -�-- Bi Names and addresses of.witnesses, doetors'and-hospitals: q: `List the expenditures' you made on account of this accident or injury: DATE ITEM AMOUNT WEB` a Gov` Code Sec.: 910.2 provides':: } �,_?, Z ' "The claim must be signed by the claimant' SEND NOTICES TO _._(Attorney.),_...- or by someperson on his beha f." Name and Address ^of.`Attorney �4'°' ' Claimant's ' ure l /�)iZh 14't Address .- .. Mo)?_ tCA Telephone No. Telephone N0_ S # iF 9E ife 9E 9F $ �E �F iF...�E 9fr.. ..9E Mfr *-. f 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 .i.f.genuine, any false or fraudulent claim, bill, account; voucher, or writing, is punishable either., by imprisonment.,in.;,_: . _. the eounty. jail. for. a.per•iod.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..i_n the state prison, by a fine of not exceeding .ten `thousand dollars '($10,000, or by both such imprisonment and fine. .RECEIVE®. .... �. �. ADDMMUM TO THE CLAIM OF L yAj/u AUG 5 1991 (Print your full n me)CLERK BOARD OF'SUPERVISORS CONTRA COSTA CO. (1) Do you use the roadway as part of a daily commute? Yes ( ) No ( ) (2) Were you aware that construction would be commencing on . . the roadway? Yea ) No ( ) i ( 3)- ---Was an alternate ro� te ava�.lable? Yea ( ) No ( �) ( 4) Did you read about the impending resurfacing in the local newspaper? ( 5) Did you see warning signs advising of loose gravel and a 25 mile per hour advisory sign? ; Yes 06 No ( 6) : Did the damage result from another vehicle exceeding the 25 mile per`hour advisory? Yes ( ) No ( X ) (7) Did a vehicle traveling in the same direction and exceeding the 25 mile ,_per_ hour_--advisory sign-attempt-to---pass yOU?- - - .- - Yes ( ) No ( X) ( 8) Did a vehicle coming from the opposite direction cause gravel to be thrown onto your car? Yes ( ) No (X) (9) Was the vehicle located directly in front of you exceeding the speed"-advisory? Yes ( ) No ( ) j. I ( 10) Did you travel the roadway more than once during the resurfacing prior to the damage sustained to your car.2� o .}y_ Yes ( ) No (?Ct} ( 11) Did you obtain the identity of the car relating to, questions 6 thru 9? Yes ( ) No ( ). -If yes, please provide identification below: ( 12) .Please describe in your own words how the gravel caused damage to your vehicle and the angle the. gravel was thrown onto the car:, ,along with the specific damaged parts on your vehicle. �W1'q')Al6 IN THE R��!A7`" ZAAO5 onJ 27 A 7'►eco C - 9, 5:Z F/e hlyP A r r 71 E oe A,I,gL SeeM!e/ 70 die^49 57-RA z �� �i - 9��ty�� �� /moi�/ �i�f.�.✓- s__�s.� ( 13.) Were you aware that using the road during the chip seal process might result in damage. to your car? Yes ( ) No { X} I' declare that the above information is true and correct under the penalty of perjury. (Signa �a.5`A/ (Date) TI_IL-11-1991 0r9:59 FROM LOF CENTRAL NO. --AL.ON TO WALNUT CREEK P.01 zoos NORTH MAIN ST. WALNUT CRTC,CA"06 L6bbey-Owens-Ford Co. (415) 944-0112 ESTIMATE 202 154 Glass Centers BAR *AL143654 WORK ORDER R ID #34-1664 INVOICE SALESMAN -R I LL T-- - ---- ----� E O T I M R T E DATE SOLD TO ADDRESS MAKE/MOD * PICKUP. N50, RW; dCCRESS V.I.N.N Ic rr.5; LICENSE _ IMILEaGE_ CLAIMANT PECIAL INST OATS �'—f TIME WORK PHONE rte-; _ HOME PH CUSTOMER d4 CL� }a -- INST 0 COMP,DATE TIME—j , INS/PO# QUANTITY ITEM NUMBER DESCRIPTION LIST PRICE SALE PRICE TX 1 F'CW471S FOREIGN..-WINDSHIELD 1193 4 1 > 1 L,.FW LABOR-50FEIGN WINDSHIE 25. Q0 UFW if-1i'IT FOREIGN WIN1r SHIE 9, S THIS IS AN ESTIMA E' 'PbR CUSTOMER TO GIVE TO GOMPet!y ' N IBL.E POR DAMAGE. SHE WILL PICK THIS Ude 7-11 AFTERNOON RECEIVED . . AUG 51991 CLERKF SUPERV CBONTRAOCOSTA CO.SUPERVISORS F°aymt Reference AQproval I)atp Amount sm 1.54. 79 ------- --------------------- ------------- ----- ------------ Tg9. 09 nalaiiQe Totzal IGz. 98 THIS IS NOT AN INVOICE - DO NOT PAY- - - ^- -- - - - - - - - - - - - - - - - - - - - - - - - - = e -3-041L - - - - - - - - - _ - - - , �- SOLD TO: INS ,rc ft SURANCE COMPANY INFORMATION BELOW THIS LINE AGENT 1 NAME - v NAME ADDRESST' IADDRESS -- — — - ADDRES ADDRESS RAGA CITY,ST _=6— -- CITY.ST PHONE" —� FLEET'M 1'~ PtiOPdE# POLICY a CLAIM a �_ INSURANCE ,� _ DATE OF CAVS1 VERIFIED SY LOSS i 9SS 4 RErE [ WILD ROi;i 41 5 538 4757 117 '' 'BOULEVARD WAY . VALLEY: GLASS:. COMPANY =.6625 BRENTWOOD "BLVD: WALNUT 'CREEK.,:.. CA :. 4595` OD, CA 94'513 : BRENTWO: 933-2940...1: . 634.-51.55 ES.Z'SNiATE .BRBET DATE CONTR TO JOBSITE: ADDRESS— ADDRk&S.: PHON]F: PHONE: SIZE DE9CR�}P,TI - AMOUNT to RECEIVED CLERK BOARD OF. 7StJPFRVlS0Q4z CONTRA COSTA CO. PLEASE EXAMINE THIS ESTIMATE CAREFULLY. , AS WE AGREE TO FURNISH ONLY THE ARTICLES NAMED & DESCRIBED HEREON_ ALL AGREEMENTS CONTINGENT UPON STRIKES, ACCIDENTS, OR OTHER CAUSES OF DELAY BEYOND OUR CONTROL. TOTAL , 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 Sei) i tember 10 1991 and Board Action. All Section references are to ) The copy of this document mailed to you s ydur 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: $890.00 Section 913 and 915.4. Please note all "Warnings". f� ® CLAIMANT: �� NONATO, Elizabeth :ATTORNEY: Date received Nn coo6s, ADDRESS: 3442 Sanford Street BY DELIVERY TO WiN% August 2, 1991 Concord, CA 94563 BY MAIL POSTMARKED: Hand delivered via Risk Management I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: August 7 , 1991 gqIL �ep�tyLOR, Clerk (1,4AIA 49, I1. 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 ,C>< 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: SEP 10 1991 PHIL BATCHELOR, Clerk, By D Deputy Clerk 4 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: SEP 11 AMI BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Clai.m`to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY rveY INSTRUCTIONS,TO CLAIMANTRon Ha AUG 02 .1991 ; �� A. Claims relating Vta`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 riot later,thanthe'=100th day'After' the accrual' of, the'cause of action. Claims relating_;to}causes of adt on,'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 ofthe cause of-action. . Claims--rela • 3 acing 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 1060 County Administration Building, 651 Pine Street,, Martinez, CA 94553. C. .If claim .is against.-a- d�striet°governed, by,the Board` of Suoervisors,r 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 cla•ims,must,be filed against each public entity. - E.. .Fraud. -.. Seepenalty.-for -fraudulent claims•, Penal-Code: Sec:'''72;at-the"end"of'this . form. :}: . - - ..a1 7 RE: Claim By ) Reserved for Clerk's filing stamp NOAWc� .... , RECEIVES . Against the +:County of .Contra Costa ) AUG 2 1991 BOARD OF SUPERV-1so ' Fill in name ) CONTRA CO A CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 'meq 0 . (0 0 and in support of this claim"reoresent`s as- follows:'7 + 1. When did the damage or injury occur? _ (Give 'exact date and hour) --- _ -=---- ---- - —= v Pm-----------------=------------------- 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)., __--- 9--------------------- ---- 4. What partiqular.,act or omissioa.oncthe;part_-of county.'or district officers, servants,;or emoloyees caused :,the in jurylor.adamage? (over) 5. wnac are the names of county ordistrict officers, servants or employees causing the damage or injury?OfN- J;.. t `E� v r -777 t a ---------- (Give -- x ----- 5: ' What, damage or injuries do,;you ,claim (Givefull extent of Iinjures or damages claimed Attach two (estimates=for auto damage. "£ftom. „ .' re •�`f,t S.At e'. �. ,..fi. ..t t j 'y a '{` i 'j - 7. How was the ,amount claimed :above;computed? -;kInciude :.the, estimated amount• of any prospective injury or damage, • � .ss. x tr { d 1 � f..,fi ,•'r,``i t f .. t .. - _. w i - $. Names and"addresses of +witnesses.,, doctors .and .hospitals. .,. g: ..List the expenditures you made on.account of this-accident.. or injury: ro-i F ._k DATE . ._ ;. ITEM AMOUNTa - .: { i 4-c 4k i'i Ik-1 jj..P'T.a*F`rs 3•4' e 4 ....,.-m9.«..M...,... .., .n r.. ... ..»...w.. Govt: Code Sec. 910::2'provides. : s" '.. ,���� �. - �� � "The -claim must be signed .by the claimant SEND NOTICES TO: (Attorney,) 'or-by sow Person -oh his behalf." Name and Address of,Attorney +, mant Clai ' gnature (Address:), Telephone No. Telephone No. ywS_ ) . * * ,.' i * , ". .v,• .. ...... r.,_.Kra.v..e.e-5a ar-.nc. .r . s+._ - , - -Sect ion72 .of the PenalCode provides. - "Every person who, with intent !to defraud, presents yfor 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 ,.($1,00b), ,pr..b by,botht: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. ADDENDUM. TO THE CLAIM OF G(.it?iAi6 6 I d-4' N O ISI 4 ( 0 (Print your full name) ( 1) Do you use the roadway as part of a daily commute? Yes ( ) No W.) ( 2). Were you aware that construction would be commencing on the roadway? Yes ( ). No ( ) ( 3) Was an alternate route available? _ Yes ( ) No ( ✓) (4) Did you read about -the impending resurfacing . in the local .newspaper? Yes ( ) No---,( Did you see..war-ning signs advising of loo's'e' ', gravel and a 25 `,mile per -hour "advisory sign? , a �. . . . _ Yes No ( 6) Did,.the .damage ire'sult "from another ,vehicle exceeding the 25 mile per hour advisory? Yes ( ) No ( ) (7) Did a vehicle traveling in the same direction and..exceeding the 25 'mile per hour advisory sign .attempt. to pass you?, Yes ( ) No ( 8) Did a vehicle coming from the opposite direction cause : gravel to be thrown onto your car? r Yes ( ) No ( 9) Was the vehicle' located directly in front of you exceeding the .,speed adv-isory? ILI Yes ( ) No Didl you (travelthe, �;rbadway more. than once 'duri:ng- the resurfacing priorto the damage sustained to your, car? Yes ( } No Didyou obtain the identity of the car relating to questions 6 thru 97. } Yes ( } Nb -If yes, please provide identification below: 1 ( 12) Please describe in ;your own words how the gravel caused damage to your vehicle and the angle the. gravel was thrown onto, the .car,'-along. with the_ specific damaged ,parts on your vehicle. �',A-A A. ( 13) Were you aware that, using :the road during the chip seal process might result in damage. to your car? . . Yes (.. ) No I..declare that the above information is true and correct under the penalty of perjury.. . 4q - Q j ( Signature) (Date) i - AFMW 2938 E ST I -M A T E O F R E P A I R S 14� DATE ASIA & WEST 604 E. 1 Oth Street, BODY & FENDER Oakland, CA 94606 INS Co. EXPERT PAINTING & REPAIR (416) 839-9347 ADJUSTER PHONE OWNER A4El A �� INSURED PARTY ADDRESS, vsc>X DATE OF LOSS CITY �tiT' -(C ZIP �3k' CLAIM NO. HOME PHONE BUS."PHONE �� l COLOR CODE YEAR j MAKE MODEL BODY STYLELICENSE ODOMETER VEHICLE IDENTIFICATION NUMBER gg. !N�ss�.J ,S'c �eA ��c 2�� Hyp �t L4u�44�(R -733/ 1 QAJI PB92,V-4` ,Ja0,0_C C-7 'STA !REP DESCRIPTION G%IS i LABOR PARTS baa, 33 I /LU pi,20 i S DATE TIME DEALER PARTS MAN 4,•9— s TOTALS .- LABOR HRS, ,N PAINT/Material This jdamage,report-is based'upon our detailed Inspection of your vehicle and-does not Include repairs other than r ,tomizedebove. Occasionally.additional damage:will •be.discovered once the'work Is opened up, and additional PARTS .___.___ 3-3 iepairi;will be required O, Repairs will be made for you as owner, If.you do not Intend to pay with your own funds,please make certain TAX the insurance company can deliver their check to you In time to pick up your vehicle, All repairs murt be paid -"- ----' in full before the vehicle will be released, If i lienholder is named on the Insurance check their endoursament murt be obtained, SUBLET We=ara proud of our technicians and their superior quality craftsmanship, Thank you for letting us serve you. Authorization X' TOTAL $ 099 1`Y'' J & C BODYY SHOP, INC. Jack Armas �-� 2535 Monument Boulevard any rmas Concord, California 94520 825-3800 c Name `'i '� Phoney Address Insured by Year &Make ` ''SS9'A-� StylLicense for No. Serial No. Mileage Symb 1 FRONT Labor Parts Symbol LEFT labor Part. Symbol RIGHT Labor Park umper Bumper Brkt. Fender, Frt. Fender, Frt. Bumper Gd. Fender Shi*ldg V Fender Shi* Frt. System Fender Mldg. Fender Mldg. Frame Headlamp Heodksmp Cross Member Headlamp Door Headlamp Door Stabilizer - Seoled Beam Sealed Beam, Wheel Cowl Cowl A. Hub Cap Windshi*d Windshield Hub&Drum Door, Front Door, Front Knuckle Knuckle Sup. Door Hinge Door Hinge Lr. Cont. Arm•Shaft Door Glass Door Glass Ven#Glass Vent Glass Up. Cant.Arm-Shaft Door Mldgs. Door Mldg. Shock Door Handle Door Handle Spring Center Post Center Post Tie Rod Door, Rear Door, Rear Steering Gear Door Glass Door Glass Steering Wheel Door Mldg. Door Midg. Horn Ring Rocker Panel Rocker Panel Gravel Shield Rocker Mldg. Rocker Mldg. Park. Light Floor Floor From* Frame Rod. Grill* Dog Leg Dog Leg Quar. Panel Quar. Panel Quar.Midg. Quar.Mldg. Quor. Glass Quar. Gloss Fender, Rear Fender, Rear Fender Mldg. Fender Mldg. Fender Pad Fender,Pod Nam* Plate REAR MISC. Horn Bumper Inst. Panel Baffle, Sid* Bumper 8rkt. Front Seat Baffle, Lower Bumper Gd. Front Seat Adj. "o, Upper Grovel Shield Trim Lack Plate, Lr. Lower Panel Headlining Lock Plate, Up. Floor Tap Hood Top Trunk Lid Tire X Worn Head H*ne Trunk Light Tub* Hood Mldg. Trunk Handle Battery Ornament Tail Light Point Z%6 , Q Rod. Sup. Toil Pipe Undercoat Rad.Core Gas Tank 4PARTSI:� Anti Fr**z* Frame LABOR NOu /es Q40Rad. HosWheel6 Fan Blade Hub&Drum Fon Belt Ad* TAX Water Pump Spring TOTAL a1-`I 710 Molor Mts. Clutch Linkage ADVANCE CHARGE GRAND TOTAL$ A—Align N-Now ON-Overhaul S-Straighten or Repair E%- RC-R*throm* U-For Used Parts Signed: E ATE EXPIRES 30 DAYS FROM DATE RECEIVED CLAIM ((�� x BOARD OF SUPERVISORS OF CONTRA COSTA COUNT'Y,'RQQA iOR4901 cou" IVEL Claim Against the County, or District governed by) MARTINEZ�CALI. BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 10, 1991 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: $209.28 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: RI LEY; Matthew William ATTORNEY: Date received ADDRESS: 345 Gladys Drive BY DELIVERY TO CLERK ON August 15, 1991 Pleasant Hill, CA 94523 BY MAIL POSTMARKED: August 14, .1991- I. FROM Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: August 19, 1991 PeHHIL ATCHELOR, Clerk BY: Deputy 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 wa's .filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 19 l BY: I S. Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Admini ator (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. t Dated: SEP 10 1991 PHIL BATCHELOR, Clerk, By Q.11AAA 0 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. �Ep 11 1991 Dated: BY: PHIL BATCHELOR bvCJ01'.., ° Deputy Clerk CC: County Counsel County Administrator Claif to: BOARD OF SUPERVISORS OF CONTRA .COSTA COUNTY, INSTRUCTIONt-TO"CLAIMANT A. Claims relating to causes of action fdr 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 v RECEIVE® Against the County of Contra Costa F0151991 or CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. District) Fill in name )_ .. .The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the -sum of._$ __ L'y _� and in support of this claim represents-as follows: 1. When did the or-injury-.occu ..(Give exact date and hour) . . damaga- - r..?..- 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage .or injury. occur? (Give Hall de ails; .use extra paper if required)����eN :tie po�� ccs, "ve1_, :oN -t'� o�o. - S,,y .V a+ , igty E*CSm. RMbUti1�' 't' pNe. <r irw. ► Nd StweL_ 'WAS �ith�cy my,w�v� S�.�e19 vec y �ArC� �rcM C'i'rS �1J '�rON�. erF Mme. f�N4 thS I,kAi-e\rt-\\x- A)" 5Pox): P .b`. CPAt�_. 11-�' N% W iNO3�n1e a 4. What particular act::or -omission on `the part of county or district officers, servants or employees .caused the injury or damage? �R,1lrvC-� C.kCCfS&kQC 4tAo\jPTS (over) T t. what are the names oi' county'or district officers; servants or employees causing the damage or injury? poNN4W --e.�evr -------- --------------------------------------------------------------------------- 5: What damage or injuries do. you.claim resulted? (Give full extent of injuries or damages claimed: Attagh two est imat" s for auto. damage: c' rc1 ED wlo svie_ - -------------- ------------------ ----------- ---- -------- 74 How. was the amount claimed"above computed? (Include the estimated amount of any prospective injury or damage.) C 1��D W f�\,cw Bi.; Names and addresses of withes6esi -doctors and hospitals; -----------------=----------a_...._.. ..----------------------------------------------- 9. List the expenditures you made on account of .this accident or injury: DATE ITEMAMOUNT _ Gov. Code See. 910:2 provides "The claim must- be signed .by the claimant SEND NOTICES TO: (Attorney orby some person on his behalf." Name and Address-of Attorney-'-, Claimantsbre) S �1 � Add ss ` Telephone No. Telephone 'No." * ae * 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. ADDENDUM TO THE CLAIM OF t"1 � U�l Ill I�-V11� i' (Print your full name) ( 1) Do you use the roadway as part of a daily commute? Yes ( ) No ( ) ( 2) Were you aware that construction would be commencing on the roadway? Yes O NO ( ) ( 3) , Was an alternate route available? Yes ( ' ) No ( ) (4) Did you read about the impending resurfacing in the local newspaper? Yes ( ) No C ) ( 5) Did you see warning signs advising of loose gravel and a 25 mile -per hour advisory sign? Yes (X ) No ( 6) Did the damage result from another vehicle exceeding the 25 mile per hour advisory? Yes ( 1 No (X ) (7) Did a vehicle traveling in the same direction and exceeding the 25 mile -per hour advisory sign attempt to pass you? Yes l ) No ) (8) Did a vehicle coming from the opposite direction cause gravel to be thrown onto your car? Yes ( ) No (y) (9) Was the vehicle .located directly in front of you exceeding the speed advisory? Yes ( ) No ( ) (10) Did you travel the roadway .more than once during .the .resurfacing prior to the damage sustained to your car? Yes ( ) No O ' (11) Did you obtain the identity of the car relating to questions 6 thru 9? . Yes ( ) No ( ) If yes, please provide identification below: iCa.�e descr lbe 21s your Ci�Po�13 tivt u°S Liv N` .t13C gra ve.l. caused - - damage to your vehicle and the angle" the gravel was thrown onto the car, along with' the specific damaged parts . on your: vehicle. k)Q, �,J�aaA Fc. ts-s et wr,>- wQw s.0 iv oO"V, \,QUVA L �Ju �`� �Jo C� � SA�►.� . c� �`� J` t A� 1V"� ( 13) Were you aware that using the road during the chip seal process might result in damage to your car? Yes ( ) No O I declare that the above information is true and correct under the penalty of perjury, l (SignAfft5QJ �� (Date) albey,0wens-Ford Co. ESTIMATE aS Centers WORICORDER INVOICE SALESMAN B ILL TO _E S T I M A T E DALE GA_Sf4 BAY SOLD TO EM f1L'g41R96F=:F ADDRESS MAKE/MOD ADDRESS V.I.N.# CITY,ST LICENSE# MILEAGE CLAIMANT SPECIAL INST DATE TIME WORK PHONE HOME PH CUSTOMER*- MMSM INST# COMP.DATE TIME INS/PO# QUANTITY ITEM NUMBER DESCRIPTION LIST PRICE SALE PRICE TX 1 W665S DOMESTIC WINDSHIELD 115. 5 + TX 1 LDWCASH LABOR-DOMESTIC Wf5 c5. 00 Paymt Reference Pipproval Date Hmount bilb ', ------ -------------------- -------------- ----- ---------- Tax 9. 53 1 Balance Total 150.07 i * THIS IS NOT AN INVOICE DO NOT PAY , *** - - - - - - - - - - - - - - - - - --- - --- - --- -. - - - - - - - - - - - - - - - - - - - - - - - - - - -. - - - I Xx X X X 3Z X INSURANCE COMPANY INFORMATION BELOW THIS LINE INSURANCE CO. AGENT NAME NAME ADDRESS ADDRESS ADDRESS ADDRESS CITY,ST CITY,ST PHONE* FLEET# PHONE# POLICY I* CLAIM# INSURANCE DATE OF CAUSE QF VERIFIED BY LOSS LOSS RECEIVED FROM 415 538 4907 IV cc �OA- 0 co r e� SO O 4 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 September 10, 1991 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: $120.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: ROSS, David F. 10-0- ATTORNEY: PVG NS� Co�N��cAv Date received August 1 1991 ADDRESS: 517 Wilbur Drive * BY DELIVERY TO CLERK ON g Pleasant Hill, CA 94523 Hand delivered BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppHH gg DATED: Augur 7 _ 1 ()c31 BYIL DeputyLOR, Clerk 3 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: 1 BY: ,JlAnDeputy 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 Order entered in its minutes for this date. Dated: SEP 10 1991 PHIL BATCHELOR, Clerk, By AADeputy 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 16; 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 rp1 1 19 cl BY: PHIL BATCHELOR by a Deputy Clerk CC: County Counsel County Administrator V Claim to; BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT v 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 tollcau'ses W 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:month&-after the accrual .of the cause.. action..9<-Claims -relating' to any other cause of• action must-be presented, not Mater than.,one;.year after-•`the•�accrual'.of the-cause of action. (Govt.; Code, §911..2.) ,N 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. Supervisor s. rather than, the County, the name .of :the7..Di'strt should 1be fi led 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 Seca 72'at*the end of this form. RE: Claim By ) Reserved for Clerk's filing stamp 1 �•w►ar= Po-% � RECEIVED - A ainst the Count .of -. •, - } - g y Contra.Costa - ) ., AUG ' +or- District) CLERK BOARD OF SUPERVISORS Fill in name ) A coS A c0. 41 The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of ev and in support of this claim represents as'follows:..: - ---------------N------------ ----N-----------------------••-rte--� 1. When did the damage Yor�injuryg5 cur?.,:(Give exact date and hour) ------ 2. Wh re did the damage or injury occur? (Include city and county) A0? r 3. . How did the damage or injury occur? (Gi a � 1 details;., use extra paper if, required).; s.o s u/e ;�o % d+� 19 --------------- - ----------- --- :4. ,What„particular,act_or=,omissionaroa-the° part of-'county or district• officers, -, servants:or ;employees_caused', thei in jury`-or'•damage� � �e � . /ire /p/GG4Cv�t'iorl�. �e?�vS/�O r�! /NC c� //gr/o'✓r��� � CA�-,I A,e 1/41,,/ 4 3 14n/ eAll ��,SCC ��S�ftd/e,qe/J Ir�l�iicOl. A�. 1�5�,�;ny rr �11 vA rvor (over) 5. what are the.names ,of county or. district officers, servants-or'.employees: causing the damage .or injury? ; t ---••--- — — ..rr—r. --..r----------.•---r.ue—r--�.r— --r—r.. — ------ 1 1 6,' What damage''or in juries' do:. you.'&laimrresulted?•, ' (Give.t full extent-•6f in juries or damages ,claimed. Attach two estimates for,'auto:.damagei, -- - ------ -- 7. :How was the amount claimed above.computed?. (Include` the-estimated amount of any prospective in jury 'or::damage.) LomjO�'ee.?se - --------- r. ---- ----r--: -r-Y'-..--- 8'. Names- and` addresses of'witnesses, =doctors,,and ,-hospitals. " —.----------- r'-- -------- -- ——————- ---- � — '------- -------- — ----- 9, List the expenditures~you made on account of this accident or injury.: DATE ITEM • AMOj3NT 00 r r°� yy,, Y � y[ (( S! �in'7'L tS k�•w"4.Al(C s9s�iY '( r(..:Yu•n•..w-_ Yx+•....n.a.mgr.. Y.. .+.w.+YY .xrn Y' •: Y y 'lf if ' 7f ii `slst. yCyt4i]Y�' i_ ' )L '— if ii 7 V* )1 Gov. Code,Seco 910:2 provides: ' "The claim must be si ed�.b the claimant SEND NOTICES ,TO: r hi Y (Attorney) or by some person on his behalf." Name and Address; of, Attorney; r _. _._._ Claimant's Signature • ). a `s.t... r,. ...~ _ �F.4� . `' as •' K _ e l � )`r Address « rty .s, :, � ,1' =lam' t' Telephone No. Telephone No. 3O 5':I87— Sect ionP•2 of the na 7 e 1 Code.«,provides: "Every'peison. who, With intent to defraud, presents for allowance or f6' *" payment to anystate board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any falseorfraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county;fail for a period.of_not.more:than.-one y.ear,,'by a fine�•of not exceeding- one"thousand ($1;000), or ,by iboth such imprisonment:.and::fine, or by" imprisonment, in the state prison, by"a' fine` of notr,exeeeding.,ten) thousand: dolUirs•=($10,000; or by both such imprisonment and fine. y•_ ADDENDUM TO THE CLAIM OF s (Print your full name) ( 1) Do you use the roadway as part of' a daily commute? Yes No ( ) f ( 2) Were you aware that construction would be commencing on the roadway? Yes ( :"._ No ( ) ( 3) Was an alternate route available? Yes ( No ( 4) Did you read about -the.alimpending resurfacing• in the local newspaper? Yes ( ) No ( 5) Did you see warning signs advising of loose-gravel and a 25 mile per hour -'advisory sign? Yes (. ) . . No . Pre 100 Vr�ln�ed .n+NJ ,4r& en ( 6) Did the damage result from another vehicle .exceeding the '25 mile per hour -advisory? :Yes ( ) No (7) Did a vehicle_traveling in .the same direction and exceeding the 25 mile per hour advisory sign attemp o pass you? Yes ( No (8) Did a vehicle coming from 'the opposite direction cause gravel to be thrown onto your car? Yes ( ) No 1:9) ,.Was the•.vehicle located directly in: front 'of"you exceeding the speed advisory? Yes ( lam" No (10) Did you' .travelsthe roadway more than once. during the . :• resurfacing prior .to the damage sustained to your car? ; Yes ( No ( ) 1 --ma c' Ao r5 1 ( 1l) Did you obtairl the identity of the car re ating to, questions 6 thru,;, 9? - : Yes ( ) No -If yes, please provide identification below: ( 12) Please describe in your own words how the gravel caused damage to your vehicle and the angle the gravel was thrown onto; the car, -;along-with the specific damaged parts -on your vehicle. ra�e� lid; been' ovue So,;► ;'r r;� �:s�i�� �_. Gt r,4vd as n e v,0 Vie. .3 LIf . t;ile.t� Q�or/ ,N Wt n S ie .. !!!!�Vick 4001e A YC i" VeV t- it- ec.Ier fe, h� hr11 ( 13). Were you. aware that using the road during the chip se process might result in damage . to your car? Yes ( ) No I declare that the above information is true and correct under the penalty of perjury. (Signature) (Date) CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA a" Llaim Against the County, or District governed by) BOARD ACTION tie 3o `d of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 10, 1991 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice o California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount* $315 .07 Estimated Section 913 and 915.4. Please note all "Warnings". . CLAIMANT : SAITO, Cynthia ATTORNEY: Date received ADDRESS: 1467 Cedar Street �P BY DELIVERY TO CLERK ON August 1 , 1991 Berkeley, CA 94702 BY MAIL POSTMARKED: Hand delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. IL BATCHELOR, Clerk a DATED: August 7, 1991 �p: Deputy _ CL Ol't A I. 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: I 6A�4-----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. r ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated:—SEP 10 Iqg PHIL BATCHELOR, Clerk, By V 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 it 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 T 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 nd Notice to Claimant, addressed to the claimant as shown above. 0 Dated: SCEP 11 199 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator t Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT LA. 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.tocauses of-action for deatri-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 sixmonthsafter the accrual; of the..cause .,of,action., Claims-relating,-to any`other'cause of action -must' be presented�,nct 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 4should be'-filled 'in:- Do- 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-See. 72 at.the end of.this. . form. RE: Claim By � ' ) Reserved for Clerk's filing stamp RECEIVE® P.rA Against the .County of Contra Costa ) ' { FA )` -'- CLERK BOARD OR SUPERVISORS District) CONTRA COSTA CO. Fill in nameT 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•represerits'as-follows-: -..----------------------------- -------- ---- ...._-----_--__-----_-----------__-__- 1. When did the damage or injury occur.? (.Give exact date and hour). Tlgs/ --------- - -------------------------------------------------------- 2. Where did the. damage or injury occur? (Include city and county) g - injury �1`(�- Ql �,( e p 3. How did the damage oriur occur. (Give full deta is .,use axtraaper if, •� re fired) >>: zr �+zo� Aw p Pc�e 4. What.-particular actor o ssion on the par' of county or .district officers, servants or,,employees :caused' the:•injury `or damage So )r4pt L J\ 6y\ Yt lb a -c- wee ;�� . (over) y. What are the names of county or district .officers, servants or employees causing, the damage or injury?, - w., . ... ------------------------------------ --.. r.—_— -- _ -- -- ..,__—••_ .. 6. , What damage-,or` injuries do you claim .resulted?,. (Give,.full;extent of in juries or. damages"`c1 ' ed. Attach two'est mates for auto amage; r:i 'fit=ski:{ndo�J. ou' on' - :mks ' 7. How'was the'amount els irded' 'above eomputed� ,.:(Include the„estimated amount Y of' any .:prospect�i,nv}•e��"injury r--sw--------------------------------- --- —r------ —r— —�— y—_------------_--- : 8.:iN"Names• and addresses of witnesses, doctors..and hosp! also R`- ----------------r----------------- -------- --" —�'—_ __--------------- 9. ------- —9. List%the expend� tures'fyou made on' aecount of this accident or injury: DATE • • ITEM �, K AMOUNT - __._ _.:�:�=..R, �•m;er', ,rxx•<s.�.+amn�a-rte' -xsr.�;... . - - .�.e.b l+•.+Zs.?:gyp N r ,.; }:. :+...,a.,... ,.,. -,,,-,w.._ ......,.... -... 31 _ f-k:f i tGov., Code, Sec.` 910 2, providesi -' The. claim must be signed .by the claimant SEND NOTICES TO: .(Attorne .)w_. or by some erson on his .behalf.” Name and Address 4of - V. ClaimantIs Signature w 4. ZAddress `•. Telephone No. Telephone No 'WO TIC-E Section 72 of the Penal Code provides:. , - < "Every ,person who; with intent to defraud, presents for allowance or�fory' ` F 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«f ne-of "not exceeding one thousand"°($1 000):;.."or. 'by ,orsuch, imprisonment:.and "fine;=or^by' imprisonment in the state°=prison, by a fine of`hot .exceeding,ten ,thousand dollars ($10,000, or by both such imprisonment and fine. - CV WA ADDENDUM TO THE. CLAIM OF ,/ (.Print your full name) (1) Do you use the roadway as part of 'a daily commute? Yes No ( ) ( 2) Were you aware that construction would be commencing on the roadway? _ _ Yes X) No ( ) ( 3) Was an alternate route available? Yes ( ). No ( 4) ' Did you read about .t.he ,impending- resurfacing in the local newspaper? Yes ( ) NOCK) . ( 5) Did you see warning signs advising of.-,loose gra"vel . and a 25 mile "per hour "advisory sign? Yes O _ ..No ( ) (6) Did the damage result from another e icle exceeding.-the 25 mile per hour advisory?_ nr�sla� Yes ;) No ( ) (7) Did a vehicle traveling in- the same. direction - and_.exceeding - `--the 25- mile per hour advisory sign attempt to pass you? Yes (,... ) , No ( 8) Did a vehicle coming from the opposite direction cause gravel ,to -be thrown -onto your car? Yes ( ) N?,,K) (9) Was the vehicle located directly in front of you exceeding the speed advisory? i ' Yes ( ) No x) .Y ( 10) - Did you travel the roadway more than once during the ,resurfacing.'prior. to the damage sustained to your car? Yes ) No ( ) ( 11) Did you obtain the identity of the car relating to que,s.tons,.6 :thru. 9? Yes ( ) No % ) if yes, please provide identification below: ( 12) Please describe in your own words how the gravel caused damage' to your vehicle and the angle the gravel was thrown'' .onto , the car,::;along.-w'along.-with' the spec fic)damajged ,parts' ciri your vehicle. kJ o oo =f2a sr: ( 13) were you aware that using the road during the chip seal process might result in damage to your car? Yes DC') No' ( ) I declare .that the above information is true and correct .under the penalty' of perjury. (Signature) (. ! Mate)) Ep,cm E-STIMATE , JOB P".803 San n Pab!v Ave.' _EL CXJR,Rof?%r of v�lPIN,iA 0-45,30 cn� �'HONE � DATE �---JOB NAME/LOCATION' TO i \ 1 �l r��l 1 JOB DESCRIPTION: C - ESTIMATED / U THIS ESTIMATE IS FOR COMPLETING THE JOB AS DESCRIBED JOB COST ABOVE. IT IS: BASED ON OUR EVALUATION AND DOES NOT IN- CLUDE MATERIAL PRICE INCREASES OR ADDITIONAL LABOR AND MATERIALS WHICH MAY BE REQUIRED SHOULD UNFORESEEN PROBLEMS OR ADVERSE WEATHER CONDITIONS ARISE AFTER THE WORK HAS STARTED. ESTIMATED f BY ` 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 September 10, 1991 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 Amo-int: $2,000,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: SOUTHSIDE CENTER, INC. BOARD OF DIRECTORS: TROTTER, Frank, CLARK, B.F. NEWSON, James L. and Executive Director, FONG, Betty W. ATTORNEY: Melissa Newel , Esq. Brenda Harbin-Forte, Esq. Date received il�C�;� 1�`�1► ADDRESS: Thelen, Marrin, Johnson & Bridges BY DELIVERY TO CLERK ON August 12, 12J�W.y cnhw. Two Embarcadero Center ni • Suite 2200 BY MAIL POSTMARKED: San Francisco, CA 94111 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: August 23, 1991 JYIL BATCYELOR, Clerkepu o II. FROM: County Counsel TO: . Clerk of the Board of Supervisors \� .This claim complies substantially with Sections 910 and 910.2. A5 )\0 cc,.,. Acl ` J Ait-,5 o Nl\ ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and.we are so notifyin 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: 2-3, BYJ �- 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 Order entered in its minutes for this date. P. c1 Dated: `� P. 1 O 1991 PHIL BATCHELOR, Clerk, B I AliD 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 94;1.6. 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 lshown above. 0 L Dated: S E P 1 1 1991 BY: PHIL BATCHELOR by0Deputy Clerk CC: ,County Counsel County Administrator THELEN, MARRIN, JOHNSON & BRIDGES ATTORNEYS AT LAW LOS ANGELES TWO EMBARCADERO CENTER HONG KONG WASHINGTON, D.C. SAN FRANCISCO, CA 94111-3995 NEW YORK OAKLAND (415) 392-6320 HOUSTON ORANGE COUNTY SAN JOSE TELEX 34 0906 CABLE THEMAR FAX (415) 421-1066 MELISSA NEWEL .e RECEIVE ) August 20, 1991 :AUG::Zl991 BOARD OF SliFERVISORS Mr. Phil Batchelor 0-� -- Clerk of the Contra Costa County Board of Supervisors and County Administrator County Administration Building 651 Pine Street, Room 106 Martinez, California 94553 Re: Government Tort Claim of Southside Center, Inc. Dear Mr. Batchelor: This letter responds to the Notice To Claimant (Of Late-Filed Claim) sent by your offices on August 15, 1991 regarding the above-referenced claim. We hereby request that you withdraw the notice. Contrary to the indication in your notice, the claim is not grounded in tort. Southside Center, Inc. et al. (hereinafter "Claimants") asserts a claim for breach of contract against Contra Costa County arising out of the unlawful termination of the contractual relationship between the parties on August 10, 1991. The damages alleged all flowed from the breach of contract. Because the action is based on a breach of a promise made to the Claimants, the claim is considered contractual. Voth v. Wasco Public Util. Dist. (1976) 56 Cal. App. 3d 353, 356, 128 Cal. Rptr. 608. Moreover, even were it unclear whether the action sounds in tort or contract, a court would generally consider the action to be in contract rather than in tort. Id. at 357. As you are aware, a breach of contract claim is required to be presented within one year of the event or occurrence. Government Code Section 911.2 . The claim is deemed to have been presented and received at the time of deposit in the mail. Government Code Section 915.2. Here, Claimants presented their claim for breach of contract by mail on August 9, 1991. Because the date the claim was submitted was within one year of the event which gave rise to the claim, the claim must be considered timely. THELEN, MARRIN,JOHNSON&BRIDGES Mr. Phil Batchelor August 20, 1991 Page 2 You should also note that the claim asserts that the County's actions may subject Claimants to liability to the State for repayment of funds. That assertion sounds in equitable indemnity, a claim which cannot be barred at this time. People ex rel. Dept. of Trans. v. Superior Court (1980) 26 Cal. 3d 744, 163 Cal. Rptr. 585. In this regard, I have enclosed the claim submitted on August 9, 1991 for further review by the County Counsel. If you would like to discuss this matter by phone, feel free to contact me at the above number. Thank you for your anticipated cooperation. Very truly yours THELEN, MARRIN, JOHNSON & BRIDGES -•mac-yam e o- — Melissa Newel cc: Betty Fong Enclosure 1288N.A/6605-655 l I s C.JI rd u)1 0 -r•I .tib.:� r� w•C3 �r•/�� ��yy IP4 1:31 ',ti1V.; A f J✓ U 41 r i 0 -rq +) 0 :Jo U1O M �--i U U _ M �4 I cd 4J moi' O 4-y d rn d r-4 0NS4 ` (1) O P +► 4-) 4u0U) 0) U) -U Q) •r•I !~ P 4 rd4 > rI4-) U � +-) �4 U) a) b �-1 44 044 a) N rI O �J z a) a .'4 4Ja -1+ �4 44 0 4J • a) 00r-I �+ :E� U U - W V Q m a�j rmi a) E = Oz a 41 to a zm Z W Q O U — F tt w O O N ! w u Z ¢ U Fy O m OU rd F w " a y � 3 z z N w a w x . INSTRUCTIONS TO CLAIMAn •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 5911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office .in Room 106, C =ty 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 RE: Claim By Southside Center, Inc. Reserved for Clerk's filing stamp Board of Directors: Frank Trotter, R.F. Clark. James L. Newson and Execu- tive Director, Betty W. Fong. RECEIVED Against the County of Contra. Costa ) or ) p'JG I District) BQARD OF SUPERVISORS Fill In name) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $, - 2.000,000 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) The date of occurrence giving rise to this claim was August 10, 1990. �MMMM�M 2. Where did the damage or injury occur? (Include city and county), The place of the occurrence giving rise to this claim is the Belding School, .in Richmond, Contra Costa County, California. 3. How did the damage or injury 'oecur? (Give full details; use extra paper if . required) See Attached. 4. What particular act or emission cn the,part of oouhty or district officers, servants or employees caused the injury or- damage? See Attached. .(over) 5. •What ,are the names of c--mty or district officders sere%^ts or employees causing -the" aamage or injury? names o county or istfict c :vers, servants, public employee. or contractors causing claimants' injuries are JOAN SPARKS, SCOTT TANDY, JEFF LEE, .DONALD BOUCHET, PHIL BATCHELOR, MARGARET MYERKORTH, LOIS DESMOND, KENNETH J. CORCORAN, PAM SHAW, ALBERT PRINCE, TOM POWERS, SURE McPEAK, NANCY FAHDEN, TOM TORLAKSON and ROBERT SCHRODER. NN---------- 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. The injuries sustained by the claimants as of the date of presentation of this clsaim consist of the wrong- ful taking of personal property, loss of past and future nob earn:.ngs, lass nf state funds =_ a; r'-s; of r mbursina state funds, loss of cornia_Child_Care ??Howcwa tAmo°wti ° tpboveuted? comp (Include the estimated amount of any prospective injury or damage.) The basis of computation of the amount claimed above is that the amount reflects the damages sustained by claimants. 8. Names and addresses of witnesses, doctors and hospitals. 1. Betty Jones, 2831 Gaynor, Richmond, CA 94804 2. Jacqueline Tolbert, 989 18th Street, Richmond, CA 94804 3. Aurora Ruth, 1421 Langley Way, Suisun, CA 94585 !i---M--N---N-----NN-NNN--NNS--N-------NNNMN----NN------N----------- `9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 8/10/90-8/20/.90-,,, Bel J= Expenses $4,339.48 9/90-4/91 ' 'Coifs 1 Expanses $4,441.80 -9/90-present Cjperations ! $8,803.10 , i • iii i i i i i i i i # i i i # i i i i i i i i i i i i i iiiii iii • • i Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorne T or by some son on his behalf." FEWand Address of Attorney V� Q o . •�_ BRENDA HARBIN-FORTE, Esq. MELISSA NEWEL, Esq. (Claimant's Signature 7EELEN, MARRIN, JOHNSON & BRIDGES Brenda Harbin-Forte, Esq. Two Embarcadero Center Suite 2200 (Address) San Francisco, CA 94111 Thelen, Marrin, Johnson & Bridges ' Two Embarcadero Ctr. , Ste. 2200, San Francisco, CA 94111 Telephone No. (415) 392-6320 Telephone No. (415) 392-6320 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 offioer,, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any lake or fraudulent claim, bill, account, voucher, or waiting, 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 imprisormmt and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars (=10,000, or by Doth such imprisonment and tine. The circumstances giving rise to this claim are as follows: On and at the above date and place, Betty W. Fong, James L. Newson, Frank Trotter and B.F. Clark (hereinafter "Claimants") doing business as Southside Community .Center, were operating the Head Start, Child Care Food Programs and . Community Services Block Grant Contract, pursuant to a written contract then in effect with some or all of the public entities, public employees and/or agents, or independent contractors of the public agencies and employees of Contra Costa County, Contra Costa County Community Services Department and/or Richmond Unified School District. The Programs were being operated at the site of the Belding School pursuant to a written lease then in effect between Claimants and the Richmond Unified School District. At all times, Claimants were incompliance with their obligations under the Contract and Lease, except to the extent such compliance was excused by actions on the part of Contra Costa County. On and at the above-referenced date and place, Contra Costa County unlawfully terminated its contract with Claimants, appropriated Claimants' personal property, forcibly removed Claimants from the leased premises, caused the Lease to be terminated, accused Claimants of having misappropriated funds, . caused Claimant Betty Fong to lose her job as Executive Director of the Programs, caused Claimants to lose State funding for their Programs, placed Claimants at risk for having the State seek reimbursement of funding from Claimants, and caused shame and embarrassment to be felt by Claimants. C:3281N ell rA ata. .. A QrA �. N O O 0 O N A) to O i� cxy c N N rb ttl MA �+ OrA C. oo � �. .000 v� m m c� 1p Z i t . � i O a O m O r Z a O Q 3 a F� 4 N W . N THELEN, MARRIN, JOHNSON & BRIDGES ATTORNEYS AT LAW LOS ANGELES TWO EMBARCADERO CENTER HONG KONG WASHINGTON, D.C. SAN FRANCISCO, CA 94111-3995 NEW YORK OAKLAND (415) 392-6320 HOUSTON ORANGE COUNTY SAN JOSE TELEX 34 0906 CABLE THEMAR FAX(415)421-1068 MELISSA NEWEL August 23, 1991 RCEVED AUG 2 6 1991 Mr. Phil Batchelor CLERK BOARD O-SUPER I. Clerk of the Contra Costa County CONTRA COSTA CO. Board of Supervisors and . County Administrator County Administration Building 651 Pine Street, Room 106 Martinez, California 94553 Re: Government Tort Claim of Southside Center, Inc. Dear Mr. Batchelor: Enclosed is the completed claim form referenced in our letter of August 20. Please contact me if you have any questions. Thank you. Very truly yours THELEN, MARRIN, JOHNSON & BRIDGES Melissa Newel Enclosure 1288N.A/6605-655 y ir The Board of Supervisors Contra Cetrk fthe Bo Batchelor and County Administration Building Costa CountyAtlm-2371tor 646 tra(4t5) -2371 651 Pine St, Room 106 County Martinez, California 94553 Tom Powwa,tst District Nancy C.Fohden,2nd District Received TM1B Robert 1.Schrodw,3rd District Sunnt tNright MrPaak 41h District �.� AUG 191991 �:r4-.•. '... Tom ToAakaon,5th District � • r August 15, 1991 Southside Center, Inc. Board of Directors, et al 'Brenda Harbin-Fcrle, LEsq. Melissa Newel , Esq. Thelen, Marrin, Johnson and Bridges Two Embarcadero Center, Suite 2200 San Francisco, CA 94111 NOTICE TO CLAIMANT (Of Late-Filed Claim) The claim you presented to the Board of Supervisors of Contra Costa County, California as governing board of the County of Contra Costa and/or District, on August 12, 1991 has been reviewed by County Counsel and is being returned to you herewith because: Your claim for an injury to person or personal property which arose on or before December 31, 1987 was not presented within 100 days. after the event or occurrence as required by law. (See Government Code Sections 901 and 911.2.) X Your claim for an injury to person or personal property which arose on or after January 1, 1988 was not presented within six months of the event or occurrence as required by law. (See Government code Sections 901 and 911.2. ) Your claim relating to a cause of action other than injury to person, personal property or growing crops was not presented within one year after the event or occurrences as required by law. (See Government Code Sections 901 and 911.2. ) Because the claim was not presented within the time allowed by law, no action was taken on the claim. Your only recourse at this time is to apply without delay for leave to present a late claim. (See Government Code Sections 911.4 to 912.2 and 946.6. ) Under some circumstances leave to present a late claim will be granted. (See Government Code Section 911.6. ) You may seek the advice of an attorney of your choice in connection with this matter. If you desire to consult an attorney, you should do so immediately. PHIL BATCHELOR, Clerk of the Board of Supervisors and County Administrator By: Depu y trekk Clam 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 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 Toren. RE: Claim By Southside Center, Inc. Reserved for 'Clerk's filing stamp Board of Directors: Frank Trotter, B.F. Clark, James L. Newson and Execu- tive Director, Betty W. Fong. ) RECEIVED Against the County of Contra Costa ) or ) hUG District) FaMR OWD OF SUPERVISORS Fill in name) CXMCM COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 2,000,000 and in support of this claim represents as follows: ----------------------- ---------�_____ ��---------------------- 1. When did the damage or injury occur? (Give exact date and hour) The date of occurrence giving rise to this claim was August ld, 1990. ------------------ _� -------------- --- 2. Where did the damage or injury occur? (Include city and county) The place of the occurrence giving rise to this claim is� the Belding School, in Richmond, Contra Costa County, California. 3. How did the damage or injury occur? (Give full details; use extra paper if required) See Attached. 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? See Attached. (over) 5. What are the names of county or district trict offi ers .sere is or employees causing ' the damage or injury? The names ocounty or cdist ict o icers, servants, public employees or contractors causing claimants' . injuries are JOAN SPARKS, SCOTT TANDY, JEFF LEE, DONALD BOUCHET, PHIL BATCHELOR, MARGARET MYERKORTH, LOIS DESMOND, KENNETH J. CORCORAN, PAM SHAW, ALBERT PRINCE, TOM POWERS, SUNNE McPEAK, NANCY FAHDEN, TOM TORLAKSON and ROBERT SCHRODER. ---- -----------------------~--------------------------------- -------------- 6. What damage or injuries do you claim resulted? (Give ftull'extent ,of injuries or .damages claimed.. Attach two estimates for auto damage. The injuries sustained by the claimants as of the date of presentation of this claim consist of the wrong- ful taking of personal property, loss of past and future job,earn;.ngs, loss of state Z'censerdnd of ons rim ter-f re`mbursin2 state funds, loss of Cali.fornia_Child_C_are 7. How was the amount claim above computed? (Include the estimated amount. of any prospective injury or damage.) The basis of computation of the amount claimed above is that the amount reflects the damages sustained by claimants. 8. Names and addresses of witnesses, doctors and hospitals. 1. Betty Jones, 2831 Gaynor, Richmond, CA 94804 2. Jacqueline Tolbert, 989 18th Street, Richmond, CA 94804 3. Aurora Ruth, 1421 Langley Way, Suisun, CA 94585 ---------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT .expenses $4,339.48 9/90-4/91 c Expgnses $4,441.80 9/90-present 'Operatinrr5 $8,803.10 Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorne. � or some person on his behalf." Name and Address of Attorney ' ' BRENDA HARBIN-FORTE, Esq. Claimant' MELISSA NEWEL, Esq. s Signature) THELEN, MARRIN, JOHNSON & BRIDGES Brenda Harbin-Forte, Esq. Two Embarcadero Center Suite 2200 Address San Francisco, CA 94111 Thelen, Marrin, Johnson & Bridges Two Embarcadero Ctr. , Ste. 2200, San Francisco, CA 94111 Telephone No. (415) 392-6320 Telephone No. (415) 392-6320 IF F # # 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 ($10000), 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. The circumstances giving rise to this claim are as follows: On and at the above date and place, Betty W. Fong, James L. Newson, Frank Trotter and B.F. Clark (hereinafter "Claimants") doing business as Southside Community Center, were operating the Head Start, Child Care Food Programs and Community Services Block Grant Contract, pursuant to a written contract then in effect with some or all of the public entities, - public employees and/or agents, or independent contractors of the public agencies and employees of Contra Costa County, Contra Costa County Community Services Department and/or Richmond Unified School District. The Programs were being operated at the site of the Belding School pursuant to a written lease then in effect between Claimants and the Richmond Unified School District. At all times, Claimants were in compliance with their obligations under the Contract and Lease, except to the extent such compliance was excused by actions on the part of Contra Costa County. On and at the above-referenced date and place, Contra Costa County unlawfully terminated its contract with Claimants, appropriated Claimants' personal property, forcibly removed Claimants from the leased premises, caused the Lease to be terminated, accused Claimants of having misappropriated funds, caused Claimant Betty Fong to lose her job as Executive Director of the Programs, caused Claimants to lose State funding for their Programs, placed Claimants at risk for having the State seek reimbursement of funding from Claimants, and caused shame and embarrassment to be felt by Claimants. C:3281N CLAIM AUG 9 1991 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA COUNTY COUNSEL MARTINEZq CALIF. Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 10, 1991 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: $1,188.84 Section 913 and 915.4. Please note.all "Warnings". CLAIMANT: STRAUSE, Howard ATTORNEY: Date received August 8, 1991 ADDRESS: 22 Surmont Court BY DELIVERY TO CLERK ON Lafayette, CA 94549 BY MAIL POSTMARKED: August 7, 1991 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. August 9, 1991 PpHHIL BATCHELOR, Clerk DATED: 9 BY: Deputy 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 (Sec.tion 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 Order entered in its minutes for this date. QCT Dated: SEP 10 1991 PHIL BATCHELOR, Clerk, By 01 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 F P 11 199` BY: PHIL BATCHELOR by Deputy Clerk 404 CC: County Counsel County Administrator NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Howard Strause 22 Surmont Court Lafayette, California 94549 Re: Claim of Howard Strause Please Take Notice As Follows : The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code section 910 and 910 . 2, or is otherwise insufficient for the reasons checked below: 1 . The claim fails to state the name and post office address of the claimant. 2 . The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. X 3 . The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. 4 . The claim fails to state the name(s ) of the public employee(s ) causing the injury, damage, or loss, if known. 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ( $10, 000) . If the claim totals less than ten thousand dollars ($10, 000 ) , the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ( $10,000) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. 6 . The claim is not signed by the claimant or by some person on his behalf . 7 . Other: VICTOR J. WESTMAN, County Counsel By: Deputy OAdnty CounsN�J CERTIFICATE OF SERVICE BY MAIL C.C.P. 99 1012, 1013a, 2015 . 5; Evid. C. 99 641, 664) My business address is the County Counsel 's Office of Contra Costa County, Co. Admin. Bldg. , P.O. Box 69, Martinez, California, 94553, and I am a citizen .of the United States, over 18 years of age, employed in Contra Costa County, and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non Acceptance of Claim by placing it in an envelope(s) addressed as shown above (which is/are place(s ) having delivery service by U.S. Mail ) , which envelope(s ) was then sealed and postage fully prepaid thereon, and thereafter was , on this day deposited in the U.S. Mail at Martinez/Concord, Contra Costa County, California. I certify under penalty of perjury that the foregoing is true and correct. Dated: /��� , at Martinez California cc: Clerk of the Board of Supervisors iginal ) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910 . 2, 920 .4, 910 . 8) Claltri to: BOARD OF SUPERVISORS'OF ,CO?tRAI COSTA r; �, ',i°, ,` a„ INSTRUCTIONS TO-•CLAIMANT A. Claims gelating to causes of action for death or fors injury„to' person .or rta;.,per conalproper.,ty or :growing-crops and which accrue ;on `or'.befo a December.31,r' 19$7, ;a must be:presented not later:,than the -loath day after the accrual_'of 'the cause of , ,, action; { Claims' relating. to 'causes of action for, death; or for in, ury to `person or. to personal property ,or growing crops: and which accrue bn or 'after January! li, (:1988, must :be; presented not'.later� thani six months after the accrual of the of action. ;:Claims relating :to any other 'cause ofi, Emust be' presented not 4 later than one ,year after athepp accrual 'cif ithe cause of taction. (Govt. Coder§911.2.) ' .+ :, .:1, 4j� -5{i .; . �. .:"1 ! f r:� .'. � S �. ,+ r,f£.c}}..!) x, i 4p af,+ `I<`. .•. t'F .. B. Claims must,be filed,With .the Clerk.of the Soard.of Supervisors at Its, office in Room 106,:.`County Admir straticn' Building, ,651 Pine Street,;'Martinez,,`':CA , 553 u L' :, ,, j ,r. ,'•� i's.l4 7', .i.# ,:it t- } t i:'- t ;; i z i , C. If claim is _against ,,a district governed by the Board of Supervisors, rather-,than, the-,d6:Mty,_the .name'of the:District should be° f sled in. De If the claim is against more than o^e ,public entity, separate claims must be filed against ieach'publie entity. r. f E. Fraud. See - .malt fo p y raudulent claims, Pe 72 nal; Code Sec. at"the end�of this form. RE: Claim By ) Reserved .for Clerk's filing stamp i - ) jam. ♦ & '; Against the County of Contra Costa x - or,. s<� District) 'CLE �'eo�eab o uP Rvt Fill in. name CONTRA COSTA CO, T1undersigned claimant hereby makes claim aga st the County of C ra Costa or the above-named District in the. sum of $- , �' and in..support of this claim�-represents' as s: !p S"S 6 /�/�\+ 4 /����y/ty (/jam/.�/Q]�� •aw---r----- - ------------- �K riiw.r_r_w� ��r ' . wr r 1. When did the damage or in3ury occur? .._:CGive, enact date and hour --� - : 1r� '^t.0� 2. Where_did -the damage or injury occur (Include.c y and ountyy- �� $ Y wr—..rrww_r__rr-w�r—w�w.w_rr . �.nwwrww—r—wwrwrww.+rwr�w�r_—r�—w_w�i.��.rrw_w—rr�.._wwr 3. How did the ge or i ,jury occur? (G ve'.ful.l details; use extra paper if_ required) y J 4. What _ particular ,act �or omission =n,7the t of=count :par y, or district officers, `servants or,,, emp yees caused-the, injury or: damages e �,. /14 �� (over) i 7. what .are tris Haines of`county or district officers, servants or employees causing, the. damage or in4ury? w Y wY ww S 5. WY at damage ''or in uri`es do,you' claim,resulted? '(Givetfull extent of injuries or damages c aimed.{ Att eh ,two estimates for auto damage. 447. YYw w.siwww.rYwww�rYww www www Y wwYw Ywwwwrww..Ywwwrw r:r w wwwwwwww..rwY rw wY Y 7. How was the amount claimed `:above computed?;'. '(Include the estimated amount 'of any prospective injury or''damage.). - �Ywwwww�YY�w.wwYYw w Y YdIYY.Yw wwYw Yw � ..ww w wwwwwYw YYwYw w Y Yw..ww Y Y 3. `Names and addresses of; Vitnesses, doctors and:hospitals. k . ----------------------------- --------- - Ywt w Yw—Ywwwww-YYY---wwwwwws — YwwwYYws 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 claiivant, ' SEND NOTICES T0: " " (Att eY) orb some erson o ' his' 'behalf;. Name d Address of A orney . i . •Claimant's Signature) . y. : Address .:. C , p ._ Tele hone a: Telephone N 0 T I'C,E Section 72 of the Penal Code,_provides: ::- . Ever person who ith intent to de fraud presents f ' y s p " " , w ��� or ;allowance or .for'. payment to any state: board or. officer, onto any'county, city or dstrict •board_.or '. office r,: authorized .to allow_or pay, the same if, genuine, any -false. or'fraudulent claim, .bill,; account, :voucher,. or writing, is- punishable either by ,imprsonment in „. the county: jail,for a .period.of., lot..more,..than-ones year -by a fine "of not exceeding one thousand t$1,000}, or,by both such "imprisonment; and :fine;°or by imprisonment`in the state'° prison;,°by a' ,fine of:�at exceeding ten thousand dollars ($10,000, or" by both such .imprisonment and fine. f+1 t f ., rr �1� ) Ir �' �, y r r i� W4 ,...t�r 1: , '� 1 i ' �(I � ( 1 t i �• a � I , ' ( 10, , Did you; travel the, roadway more diifth than" once g:'the ' r;esirf acing prior to the damage sustained `to your . car;' 9r r Yes' ("6�} ;� No- - z' ( 11) ,Did you obtain,.'the; identity of :the .care relating, to '. questions .6 thrix, 9? If yes;, pleaseprovide. identification`below.' 12)' Please describe in your own words how the gravel caused damage .toIyour vehicle and the angle the gravel was thrown. onto*,the ,par ",,,Along' with' thea•"specif is damaged. parts on your .,veYicle. ze au y �- L ( 13) Were' you aware that using the road during . the chip seal process might result in damage to your car? _ No'.{ . .I declare, that the. above information is. true and correct under the' penalty of perjury. (Signature) (Date) ADDENDUM LL Ste: t . (.Print -your: full 'name) i (1) Do you 'use 'the roadwa as y part of a daily 'commute'? Yes { No ( ) t2} Were you aware that construction would be commencing on the roadway? Yes t } No Was an_ alternate route. availabl _. _ .__..._.. _ 00 Yes { l4) No { ) you` read about the.;impending, resurfacing in:the, local newspaper? Yes t ) No (5) Did you see warning signs advising of loose-gravel, and a .25 mile per hour' Advisory sign? ........... _.........:........_... Yes ( No ( ) (6) Did the damage result from another vehs.cle..._.exceeding the . .,. ..25_. mi-1•e_, per' hour"'advisory?_w. _.... .,...�......__..__..... . .. . . .. .._._....._ • _. . ._ Yes ,. .. .., . . Na { ) t'7) Did a vehicle traveling in the same direction_ and exceedin . , �.: _.....the.-25 -'mile _. ...., . . _ g per hour- advisory sign attempt to pass you? _ Yes { No { ) (8) Did a vehicle coming 'fromfthe opposite direction cause gravel to•,.be thrown onto your car? Yes (101 ) No ( ) (9) Was the vehicle located directly in front1of you exceeding the speed advisory? Yes ( No Damage Report 1766 08/02/91 Page 1 1-4IP4L-4!F1 3E MP°C3RT f-1U-1-'C:D 12LC:jIESNe T 1'1�m 1812 ARNOLD IND. PL. , CONCORD, CA 94520 (415) 676-1944 Vehicle Owner: Vehicle : Insurance : HOWARD STRAUSE 10 BMW 22 SURMOXj- C:T. 525 I LAF'AYETTE CASMER CA 94549 EPITOME Work : 937-6800 Mileage : 14805 Home : 939-5050 Vehicle ID Number Date of Loss : 0/00 WBAHD6313MBJ6O153 -------------------------------------------------------•-------_---------------- -- DAMAGE REPORT Written By TERRY HAWS -- ---------Labor-------,- Item Price Metl Mech Othr Faint ----------------------------------------------------------------------------------- C 1. Remove & Replace WINDSHIELD 4 421.54 2.8� C 2. Additional Paint Labor LEFT FRONT FENDER CHIP 0.6 C 3. Refinishing Requires LEFT FRONT FENDER 2.5 C 4. Remove & Re-Install FENDER MOULDING 0.3 C 5. Remove & Re-Install GRILLE 0.6 C 6. Remove & Re-Install FRONT BUMPER 0.6 C 7. Refinishing Requires CLEAR COAT PAINT 1.0 C 8. Additional Paint Labor MATCH PAINT 0.5 C 9. Additional Paint Labor COVERING THE CAR $ 6.00 0.6 C 10. Additional Paint Labor COLOR SAND & POLISHING 1.0 C 11. Remove & Replace TAPE STRIPE $ 12.50 0.8 NOTES: C = customer payable repair-item DAMAGE REPORT SUMMARY METAL LABOR $ 275. 40 . . . . 5. 1 hours @ $ 54. 00 per hour PAINT LABOR $ 334. 80 . . . . 6. 2 hours @ $ 54. 00 per hour PARTS $ 440. 04 PAINT MATERIALS $ 94. 50 . . . . 3. 5 hours @ $ 27. 00 per hour SALES TAX $ 44. 10 DAMAGE REPORT TOTAL $ 1, 188. 84 Insurance Payable Repair Total $ 0. 00 Customer Payable, including Deductible $ 1, 188. 84 ^ ` DIV.08RTB8BN INDUSTRIAL CD89UB&TIU0 8.&.8.# &D069602 645 EAST 11TH STREET 0431-4N1), CALIF. 94606 (416) 836-2672 (FAX) 836-6049 VISUAr— IDAMAOE REPORT # 5 3 9 4 by D-RIS ^ C t2�g-t-c3i meyir I ri:E c) ir m.-a t:. :L c3 ri V Ea li :L c= I ca I ri:E c) r-m.-a-t- :L c3 ri Name : Make : 1991 BMW 525 I Address : 22 SLlwOw CT. Style : 4 DOOR Cty,St,Zp : LAFAYETl��,CA. 94549 License : EPITOME H�� Ph # DESCRIPTIONEST PRICE | LABOR | PAINT | 1 REPAIR PAINT DEFECTS LT FRONT FENDER | | 1.0 | i 2 L FRONT F[NDEK,REFlNlS8 2.5 | 3 TINT COLOR | | 0.5 | | 4 BLEND REFINISH | i i 1.0 / 5 CLEAR COAT REFINISH | | 0.6 | 6 NEW LT F[N6[R TAPE STRIPE 24.74 0.4 | � 7 NEW FRONT SHADED WINDSHIELD 421.54 | 2.8 i � 8 INSTALLATION KIT | 25.00 | | | IYE-.-,M FfZS 0.0 @ 55.00 0.00 0.00 GLASS HRS 0.0 @ 49.00 0.(,V- - 0.00 0.0 @ 0.00 0.00 | GLASS PAV[S 0.00 Labor 471.20 ----- Grand Total $110M.QWS Part Prices Subject to Invoice AUTHORIZED AND ACCEPTED: You are hereby authorized to make the above specified repairs. l understand that payment in full will be due upon release of vehicle, including additional supplemeotal damage charVps' and hereby grant you and/or your employees permission permissioo to operate the car` truck o, vehicle hpreio dpscribed on stroet, highways or elsewhere for the purpose or testing and/or �osyedion. Ao expreso mechaoic's lien is herehy acknow�edVeU oo ahove car, truck or vehicle to secure the amount of reyaim �kereto. You will not he hold responsible tcn loss or damage to vehicle, or articles left in vehicle in case or, fire, theft` accident or any other cause beyond your control OLD PARTS ARE JUNKED UNLESS INSTRUCTED' ** VISUAL DAMAGE REPORT ** authorized by____ ----date --- THANK YOU FOR ALLOWING OUR FACILITY TO BO9&I8 YOUR VEHICLE ` C400 . LL oa r O � .4 3 N r.. CO o� � d � ar d U -0 cl L � o 01 d Lr)< U '- W cn U LU v � dG.�, -�X CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA x Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 10, 1991 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), iv v ode Amount: $500,000.00 Section 913 and 915.4. pl ;o �Ulb' �ings" 1© CLAIMANT: TURNER, Marvell Lee 4 1 AUG 1 41991 ATTORNEY: Curtis L. Johnson Curtis L. Johnson and Assoc. Dat , CLERK BOARD.OF UPERVISORS ADDRESS: 3240 Lone Tree Way, Suite 20 U �1@�l'E TO CLERK ON S CO. .1 Antioch, CA 94509 BY MAIL POSTMARKED: August 13, 1991 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PpHHIL BATCHELOR, Cler �.. DATED: August 14, 1991 BY: Deputy 11. FROM: County Counsel TO: Clerk of the Board of Supervisors N ) 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: S. / Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Adminis rator (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:S E P 10 1 q 991 PHIL BATCHELOR, Clerk, By 0 ° 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: SEP 11 1991 BY: PHIL BATCHELOR by a Deputy Clerk CC: County Counsel County Administrator 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`ofaction for death 'or= 7. what are the names of county,or district.officers; servants or employees causing the damage or injury? Contra Costa County. Jail ---=-------------------------------------==--=-------=------=---===-=---- ---------- 5.' What damage or `'injuries .do, you claim resulted?: (Give full extent of injuries or damages claimed. Attach \two estimates-.for auto:;damage. Humilation; .°Emotional'•Distr6ss ',:�Str,6 1! Aggravation ' ------•-r---- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective in or damage,) -Nrr.�------N----N-----rr--r-N-Nr�N-----�r�NNN-----N--NN---N----------r-- $. Names and addresses of.witnesses,. doctors and hospitals. Mrs Turner.,r, :.':: S40 Carpino Street . Pittsburg, CA 94565 �--rrrrNrrr-r-NNNNrrNr-rr-Mr-r.--Nrrrrrr./---rrrNrN-rrrNrr--- 9... List:the- expenditures -you made on account of this' accident or injury: DATE, ITEM ., :. AMOUNT - N/A 67 ' � if � R � N R R 7f .A 7f � 7[ � R R � 7C'� if if R � �. � �• if ���. � 7f if°7[;..if � if � R � � -if if Gov. Code S c. 910:2 provides: "The claim st be signed by the claimant SEND NOTICES TO: (Attorney) or b 'some erson on his behalf." . Name and Address of Attorney 4, . Curtis L. Johnson Curtis L: .•Johnson' &'A•ssociate-s * Cla is Signat%ure ,. A for for Claimant' 3240' Lorie -Tree, Way;. Suite 2.02 y Antioch, CA.' 945:09 . :.. , . . Address)-- - Telephone No... 41) 779-9A56. .. Telephone No. - •779-9456 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 wrting,' is punishable either by"imprisonment in ' the county. :jail for a period of.,,mot more ,than one year, by-.a Tine- 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. CONTRA COSTA DETENTION FACILITY i PROPERTY RECEIPT DATE: U t,f I):'i L1 1 REC: 3 29`J TIME: 1 U 13 FACILITY: 11L:)6= NAME: B U RIA a OAV I La t'lAWI BOOKING NBR: ITEM UNDER.COUNTER: Y -OR N 1 CASH: $ flu i JEWELRY: I;1 DESC: -WATCH: r4 : DESC: WALLET/PURSE: p.J KEYS: U GLASSES: ' {y BELT: Id KNIFE: IJ OTHER: SEALE=D BA0 t'l-I 'I BKG OFC: 'I U�3 U'3 PROPERTY BOX ASSIGNED: C 1 INMATE SIGNATU E J, vs DATE: I HAVE RECEIVED ALL OF MY PERSONAL PROPERTY. REL OFC: r' X" INMATE SIGNATURE .. .., -6 Attachment "A" This claim arises from an incident that occurred on September 12, 1989. Claimant's name was entered into a booking sheet because of inadequate booking procedures of the Pittsburg Police Department. Claimant was subsequently arrested one month later on a warrant which issued in his name for failure to appear in court. Claimant made repeated assertions that the department arrested the wrong person but his assertions went unheeded and unchecked. Claimant filed a claim against the City of Pittsburg as a result of this incident on February 16, 1990. The City settled with the claimant on February 22, 1990. On or about Friday, June 7, 1991, at approximately 5: 00 a.m. , claimant was arrested a second time at his home for violating his probation. The police officer handcuffed him and put him into a police car. Upon arrival at the Police Department they booked claimant as David Mack Burns. Once again, claimant made repeated assertions that they arrested the wrong person. Shortly after his arrival, Claimant was transported to the Contra Costa County jail. Upon arrival at the county jail, Claimant's property was taken from him. He was asked to sign the property receipt. The name on the property receipt was David Mack Burns. Claimant signed his own name, Marvell L. Turner. Claimant remained incarcerated until Monday, June 10, 1991. On this day he appeared. before a Judge. He explained the matter to the Judge beginning with the incident on September 12, 1989. He was re-incarcerated while the Judge verified the matter. Approximately 8.:30 p.m. on June li, 1991, claimant was released from jail. rA rA .� . 5 a A p .CA M N fs+ t3` o � N �yos� v %_o CV O NQ Z ra Q a 'r Z ��CO .r6,rt: iy�Q q0a 4 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 Setoo mb e r '10 1991 and Board Action. All Section references are to ) The copy of this document mailed t6 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: $327. 38 �®4s® Section 913 and 915.4. Please note all "Warnings". CLAIMANT: VAN BUREN, MC ATTORNEY: P .0\JoZY CpUN`� Z, 0' Date received ADDRESS: 2760 Sargeant Avenue BY DELIVERY TO CLERK ON August 1 , 1991 San Pablo, CA 94806 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. PPHH BB DATED: August 7 , 1991 JV DeputyLOR, Clerk a 0/. 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 la,te 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 Order entered in its minutes for this date. Dated: SEP 10 1991 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 No • e to Claimant, addressed to the claimant as shown above. DatedBY: PHIL BATCHELOR by 6P �_O/ Deputy Clerk CC: County Counsel County Administrator =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 1 growing crops and-,which•--acerue on-or tiefore"December 31, 1987, must be presented not later than:t2ie;-100th>day`After the'accrua1 of the cause of action. Claims relating+:.to causes,,of action for 'death a.or�for • njury to person or to personal propertyor 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 ofaction"must "be' presented hot" ". later. than`-one year. after- 'the accrual ofathe 'oause 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• a .C.--1f. claim is,.against. a-district governed• by the Board of "Supervisors,: rather than. the County, the name .of the,,District should be kfilled� 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 j-Penal. Code °Sec: 72-,,at 'the'end of this form. RE: Claim By ) Reserved for Clerk's filing stamp RE VE® Against the County. of Contra: Costa `` )f' AUG 1991 D1Strict) - CLERK BOARD-OF SU ORS CONTRA COSTA CO. Fill in�name CO Ce�c The undersigned claimant hereby makes claim. ai t th County of Contra Costa or the above-named District in the sum of $ 6 and in support of this claim represents as follows: ------------------------------------------------- ----------------------------------- 1. When did._the damage or. injury_occur?_ (Give exact date and hour) lbi -•//� a i �' 2. Where did the damage or injury occur? (Include city and county) -- `-=�- -a- 1�------co=------(°-°\r ' ?,_, -=Cas- ---=------------ 3. How did the damage or injury occur. (Give full details; use extra paper if, required), ,�- -eZ�,���:• l��-� Gv'� /1�����e_'�C� �-cJ�i:� 1�• Ccs� � - __ t'N�` �voCk��� 4..: What,.particular.;act or omissionrF..on the,.part`of-county`'or district officers-i- -servants fficers;-servants r,,employees.;eaused_r the ,injury or.:damage? (over) 5._ -What 'are the names of county or..-district officers, servants or employees causing 2 the damage or injurya,. l � k 5 .What damage or,in do. you claim,resulted? ..,(Give!full extent of injuries or :. . damages: claimed. :: Attach rtwo estimates. for :auto,�.damage,�` _---- ------- ---, — --- — -- ----------- -- ----- — —� �— -------- ----------- 7. Hord was the amount claimed :above computed? ~(Include W;the-estimated,�amount.'ofany prospective injury or damage. _ - a 8: Names an addresses of w�.tnesses', doctors and.hospitaTs. '.`• _- _ c : List the expenditures- ..� 9 you made on account of this accident., or injury: DATE ITEM AMOUNT .. !SU Gov".`: Code See._ 910.:2 provides': The claim must be signed,'by the claimant SEND NOTICES T0: (Attorr�ey,) w,,.,, orb some person on his behalf." a � x- Name and Claimant's Signature - { t r Address Telephone No: Telephone No. �� * ` ,. J f Vit.. ,*.. >._#,:., .- :,.* .# # NOTICE Section-72...of. the. Penal-Code, provi'des,: rt "Every person who, with intent to defraud, presents for allowance or "-for- a 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,jailr_for,a_period period, more- than, ear-, -by�a fine of-not exceeding ; one thousands ($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 ADDENDUM TO THE CLAIM OF (Print your full name) (1) Do you use the roadway as: part• of a da' ly-commute? Yes No ( 2) Were you aware that construction would e commencing on the roadway? Yes. . No ( ) ( 3) Was an alternate route available? . Yes ( ) No ,( ( 4) Did you read about the impending resurfacing in the local newspaper? l/ Yes ( ) No (5) Did. youl,see warning-,,signs advising of l ose ,gravel and a ` 25 mile `per 'hour advisory sign? . . .. - - Yes ( No ( ) ( 6) Did the damage result from 'anothe'r vehicle exceeding'' e 25 mile -per "hour � advisory? _ _. Yes ( ) No (7) Did a vehicle traveling in the same direction and exceeding the , 25•mile per hour advisory sign attempt to pass u? Yes ( ) No (.8) Did a vehicle coming from the .opposite direction cause , gravel to be thrown onto your car? Yes ( ) No ( ) ( 9) Was the vehicle located directly in front of you exceeding the speed advisory? Yes ( ) No :{ Did, you travel the .'roadway more than once -during the resurfacing pr-ior to the damage susta' ed to your car? Yes { ) : No { ) ( 11) Did you obtain the identity of the car relating to ,questions -,.6 thru 97, . Yes ( ) No If Vires, please provide identification below. ( 12) Please describe in your .own words how the gravel caused damage to your vehicle and the angle the gravel was thrown onto the :car,. along with the specific damaged .parts on your vehicle. S�►�.�`^ �C w 5,� i'nce)rr Pir t ae,�C �i� �-�,.�c, �-� • o� ray�rP C._. . �ow r� • �� e,-� CUA ^(`o h �- c�1 n c�6kj O�C yk W 1 ( 13) Were you aware that using the road during- the,chip seal process might result in damage to your . car? No I declare that the above information is true and correct under the penalty of 'perjury. ( ignature) z7 A (Date) CENTfFJLIIV 2000 J Q CONTINENTAL 4 FRAO,8&UNIBODY uMcNEVIN CADILLAC MEASURING SYSTEM --EQUIPPED ESTIMATE 1348 - 7TH STREET BERKELY, CALIFORNIA 94710 OF REPAIRS �� PHONE 527.4717 SHEET OF - SHEETS NAME _ /' Z14A DATE ADDRESS _t27(a D S C T �y-2 0 PHONE INSURED BY ADJUSTER PHONE BELOW: IS OUR ESTIMATE TO REPAIR YOUR MODEL ' LICENSE NO. MOTOR NO. SERIAL NO. MILEAGE 7 ed Z&0 - -rak-N, 'e., PARTS NECESSARY AND ESTIMATE OF LABOR REQUIRED LABOR PARTS PAINT TIME 777 77 v \ , \ v". \ q \\\ \ a a'? INSURANCE INSURANCE 0. .The above Is an estimate PATS 3 CO. PATS f NUMBER hood ea our Inspection end TOTALS deep Not .ewer any addl. ,,,„. ;„....�.m,..«.-:»,. Usual poet or labor whisk WRECKER ` may be required aner the 3 TOWING ¢ S I G N E D work hr been .peened do. „.. Oeeusaatly atter the work w has started demoted.or TAX Wage ova w OlsepvYpd which w pet oddeht onTOT '^ BY the oral laeoeetsn. AND TAAXIATL. AUTHO IZATION FOR REPAIRS e^— ^--•--r;,;� YOU ABC HERESTUT ORIZED TO MAKE THE ABOVE SPECIFIED REPAIRS GRAND 116NE0 DATE TOTAL AMENDED / 11 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Boar6 of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September .10, 1991 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), giv n pu Amount: $3080. 54 Section 913 and 915.4. Pleas s". CLAIMANT MITTELMAN, Mark R. R AUG 1 4199t ATTORNEYMark R. - Mittelman p` King, Shapiro, Mittelman eta odjl0le # ed CLERK BpAR OFSt1PERViSORS ADDRESS,: Lake Merritt Plaza, Suite 16O�yl�LIVERY TO CLERK ON CONTRA QS 1999 Harrison Street August 6 1991 Oakland, CA 94612 BY MAIL POSTMARKED: g I. FROM: Clerk of the Board of Supervisors TO: County .Counsel Attached is a copy of the above-noted claim. August 13 1991 BHHIL DATCHELOR, Clerk DATED: epuy a. InAA,. 0J 4, LI. 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 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: S E P 10 1991 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 9.13) 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. :14 Dated: SEP 11 1BY: PHIL BATCHELOR by ° Deputy Clerk CC: County Counsel County Administrator ,'=: �. - 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 341987, 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,---ratherthan 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. VA RE: Claim By AMENDED Reserved for Clerk's filing stamp Mark R. Mittelman [`)) RECEIVE® Against the County of Contra Costa .) 81991 -or ) + Cl EgRK-BOARD O SUPER 1 District) CONTRA:o STAi-C , oi Fill in name } The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum Of $ 3080.54 and in support of this claim represents as follows: --------------------------------------------------- 1. When did the damage or injury occur? (Give exact date and hour) 6/27/91 at 8:00 a.m. 2. Where did the damage or injury occur? (Include city and county) Taylor Boulevard, south of Grayson, Pleasant Hill, Contra Costa County --- 3. How did the damage or injury occur? (Give full details; use extra paper if required) Excess gravel dumped on road by Dept. of Public Works became projectiles while driving on road with other vehicles, causing paint damage to vehicle. It was almost raining gravel. 4. What particular act or omission on the part of county or district officers, - servants or employees caused the injury or damage Dept. of Public Works dumped excessive amounts of loose. gravel on .Taylor and allowed vehicles to traverse area, without taking any precautionary steps. On dap following incident, a street sweeper was used to remove excessive loose gravel in vicinity of incident, apparently after numerous complaints. On date of incident, I was advised that I was the fifth call so far concerning the gravel problem. (Over) 5. What are the name .I' county or. district officers, C.•vants or employees caul ing, •• the damage or injury? Dept. of Public Works, names unknown —..--..------------------------------------------- ...,...--------------- 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Paint damage to 1988 Lotus Turbo Espirit --------------------� �--�—��------------------------__....--- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) $2955.54 paint repair, plus: $125 car rental (5 days @..$25 per day) . s $. Names and addresses of witnesses, doctors and hospitals. Unknown at this time. -. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT None to date 'aJ Gov. Code Sec. 910:2 provides: "The claim must be.signed by the claimant SEND NOTICES T0: (Attorney) or by some ersori-on his behalf." Name and Address of Attorney C aimantls Signature 1048 Silverhill Drive Address -Lafayette, CA 94549 Telephone No.. Telephone No. 415/273-8833 * * * * 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 x 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 ($103,000, or by both such imprisonment and fine. �VS 3 sl 1 9 r t..ry ; i °,W.1 r t,!4, .:c - Syi 1` ro - i r ,t'c�' 1 s t r r ' )�J`it�'t 4 ,1} .� rt,t"xx`7'�tf i� t < ,,, L a ) �K," 23`2 w>•, 14L_i - i t:. }i 1 yfA,'J, Lid` _-ter,r{ij}. € ,� . . •'�. 4 } t ix) o- �.s�_y a ' "1� } �' * g , 1 r .r ' o-y " irxt i +. +:! Pl •}'L{1 q 'S.-,4 A i '` G r i,;-1 t t, �" t 7,, t:v}ih'r �,,��,F�..^a,'a tt, ;1'},i +� 1 t '' i1x '1A'. IZI4 t, { '�4 gyl ` i� i-! of-:r Y' t ext r`y. A, t'n ll \;.yf!{ t r 1:� ''Sr clot C`" r',iT,rc e.2 �x Jt,�:!,'V nX'ai-f F t : s r`r-Yn`aiwit-r�ltlt n1, k s.-. l.A F`t� a- t,-- Si ,t. rTY k't' Y i r, t 1, ,•: .I yl J i fi 4ti....} r 4., R ; r i .t °t i, fitr t ti Y i.y'>42 +�k,�- y�} w•k. I 'q•, , t} \tA'k,'i t'" e rr-# tr 1 T ,h f qur °y 1 a. Sric^�1 t of y 7 J'�[ht t. Yl �c•� , -.,+ t �:tIt. t, r.. ;tayA f ltt-4 i�rsA�1_-a y'E f.. 5r� t -,a, i1 S y ;1 t' ' �J S.Y.,..!�t' l �.' rtJ •-F.,t t i4K t t .. + tR '- tr". i .ti ' 6 t�. ^t3' {f:t i i L tat�i yi>' ' '—w ' : \!:�¢ ',,.At --M, r I y k 111 S 7} s r t r k. :s':§ - i n tt t tb p4 v ifH 1 i`{r ,+ a drat i t t -A 'y�iAry` 1 'rS tt . s-, s � ,ij2°t. IItf 4Yi�? -R;it f tr.`) >t'., 1Ar t §; � � � � Je)tk,r�� t,,t ' 41 � r�.. i ; \V- .1 y.... i. t..t; t 41.41,' ` .t,,�# V1, ,� �t�Ittlili. xF �1Aa'• t i+''5F:: \\ C.1 4 0 � : » \ 4 o � CG CT ,. 4 ® » 2 o 0 & A .,A U � . m � U - � * \ 0 tp 9 t ^ + b � d� 7z NX CP �d f \ 4 41 z I . $ . " � . % CLAIM BOARD OF SUPERVISORS OF.CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION tic,e Bo_j of Supervisors, Routing Endorsements, ) . NOTICE TO CLAIMANT September 10 1991 and Board Action. All Section references are to ) The copy of this document mailed to you is yours notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragr,:ph IV below), given pursuant to Government Code hmo`'nt Undetermined Section 913 and 915.4. Please note all "Warnings". CJ_ATMAN1 - MITTELMAN, Mark .R. AT'iORNEY: Mark Mittelman p Attorney at Law ���EL, �N�Date received ADDRESS: 1999 Harrison St . St11te 1600BY DELIVERY TO CLERK ON August 6, 1991 Oakland, CA 94612 BY MAIL POSTMARKED: August 5 , 1991 I. FROM: Clerk of the Board of Supervisors TO:. County Counsel Attached is a copy of the above-noted claim. , ultit -r- pHi� D eputLOR, Clerk DATED: yk 0J XW)-W, 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: /91BY: ( SA 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 Order entered in its minutes for this date. 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 ir, 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: BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Clain 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- sonaiproperty 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 "T _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'-'thari .the County , the name of the:,Distr•-ict: should be.filled in. D. hf 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 -f ` orm. RE: Claim By ) Reserved for Clerk's filing stamp ) Mark R. Mittelman ) ® WECE�L' Lill Against the County of -Contra Costa.. .- ..): - 6 1991 or . ) - DiStr'ict) CLERK BOARD OFSUR Fill in name ) CONTRA COSTA The undersigned claimant hereby makes claim against the County of o ra Costa or the above-named District in the sum of $ 3080.54 and in support of this claim,-represents "as,follows: ; ------------------------------------------------------------------------------------- 1. When did the damage or injury occur? (Give exact. date and hour) 6/27/91- at 8:00 a.m. --------------- -------- ------------- 2 - --- - - 2. Where did the damage or injury occur? (Include city and county) Taylor Boulevard, north of Grayson, Pleasant Hill, Contra Costa County -------' --------------------------------------- --------- 3. --- — a..------3. How did the damage or injury occur? (Give full details; use extra paper if required),. Excess gra_vel, dumped,.on road.by Deptof 'Pub 1ic•:morks- :became projectiles while driving on ,road with other-.vehicles, causing :paint;-damage to;-vehicle. It- was- almost raining..gravel. Y ------- ------ --- --- ---- -=----- ==------ --=---=------ 4. What particular act or omission on -the- part of county 'or district' officers, servants. or ,employees caused ahe injury or damage? _ .. Dept.. of,' Public'Works dumped excessive amounts ot, loose,. gravel on .Taylor and allowed vehicles to traverse area, without taking any precautionary steps. On dal following incident, a street sweeper was used to remove excessive loose gravel in vicinity of incident, apparently after numerous complaints. On date of incident, I was advised that I was the fifth call so far concerning the gravel problem. (over) 5. What are the names or county ordistrict officers, servants or employees causing the damage or injury.? Dept. of.Pub.lic Works, names .unknown.. . : 5,. What damage or..-injuries do you claim resulted? ('Give full extent'of injuries or :damages claimedi Attach. two- estimates for-autbdamage".- Paint damage .to 1988` -Lotus-3d Es.piri,t°. _- ,. H ow Was the amount,claimed above_computed?_ (:Include=the-esti:oated-amount of any - - prospective injury or damage.) $295. 54 ;paint repair, plus4125 car. rental :(5 days @` $,25 per. day), 1 - ------------------------------------------- ------------- 8. Names and -addresses of witnesses, doctors--andhospitals. ' - Unknown at t'h i s. time g. List the expenditures-you made on account of this accident or..injury: DATE ITEM AMOUNT None to date , � iF � � � � it � �F- � iF 9F iF 9E �F � �E * * �! �F � � �F �,.�F * � * * *, �E• *,iF *-�-.� *_.*, �_.* Gov:. Code'<'See. 910:2 provides:. The claim must be signed -by the claimant SEND NOTICES TO: (Attorney) - - orb some- erson on--hs-.behalf." � Name and Address of Attorney ' • - Claimant's Signature -"'-- fl1048 Silverhill Drive. y Address _. .tafayette_, CA 94549 Telephone No. Telephone No. 415/273-8833 * . _ •_ _ ._ 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 fora period of> not-more than one-year, by a fine' of not ekceeding one thousand, ($1;000);. or by,.both such imprisonment 'and fine'; or- by i�iprisonment in the state prison, by a fine of hot exceeding-ten thousand doll'ars! ($l0',000; or by both such imprisonment and fine.. ,a 1, • i C*,iC:.:.p Il:.._n.-..._ ::{L` ;=n 3: C3 ONQ i1"-.i r-T No T"IF--.'OR. F'.OR, # F3141063< 11.111-0 FaVET\11..jE 4�0- 2 K-1-5-7 Ery, E1C\i\1A Fi_I:T� Date! C=MT . a••. I u-u+ r--M•EX1 W_u_ C3r_h "',,+'lle:4�-i 1 c..IL Ir:' :IC a__•h-SF=Ccno-it n•6_=k`t--L r-h 141 t(riF? u MI"I'"1'1_1_a"s"Tl.l v."=s.-: �Pyp+l x' P PPPa r ;fit 1rJ lli U-7; li p �•"-(,� O U N � u CID 0 N bD r� q) 'd U] ' O O Cf) vo 6` O tn P+ co Z d I u m0 W W N Z r W N O �. N m N u 0 W ; m 0 Y Q Q x 1 Q. Q d I Z - '