HomeMy WebLinkAboutMINUTES - 08041992 - 1.16 RECEWD
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA J UL a
Claim Against the County, or District governed by) BOARD
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT August 4, 1992
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: Unspecified Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: EATON, Marie
ATTORNEY: The Ohio Casualty Group
Ray Horton, Claims Manager Date received
ADDRESS: P.O. BOX 5126 BY DELIVERY TO CLERK ON July 2, 1992 (via Risk Mgmt)
Concord, CA 94524
BY MAIL POSTMARKED:
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
�qIL BATCHELOR, Clerk
DATED: July 6, 1992 : Deputy
1I. FROM: County Counsel 70: Clerk of the Board of Supervisors
\( ) This claim complies substantially with Sections 910 and 910.2.
�N ) 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:
f/
Dated: 2 BY: 1 _ ' 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. [�
9
Dated: �{�1 Z PHIL BATCHELOR, Clerk, By , Deputy Clerk
WARNING (Gov. code sec - 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.
FOR ADDITIONAL WARNING SEE REVERSE SIDE OF THIS NOTICE.
AFFIDAVIT OF MAILING
''I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant as shown above.
Dated: tq—,5 —q;-- BY: PHIL BATCHELOR by Deputy Clerk
CC: County Counsel County Administrator
NOTICE OF INSUFFICIENCY
ANDZOR
NON-ACCEPTANCE OF CLAIM
TO: The Ohio Casualty Group .
Ray Horton, Claims Manager
P.O. Box 5126
Concord, CA 94524
Re: Claim of Marie Eaton Claim No: OAK-1 GFL 92-46 55 40 W
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.
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 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
( $10,000) , the claim fails to state whether jurisdiction
over the claim would rest in municipal or superior court.
6 . The claim is not signed by the claimant or by some person on
his behalf .
7 . Other:
VICTOR J. WEST , County Counsel
By:
Deuty" Coil6ty Counsel
CERTIFICATE OF SERVICE BY MAIL;
C.C.P. SSS 1012, 1013a, 2015.5: Evid. C. §§ 641, 664 )
My business address is the County Counsel's Office of Contra Costa
County, Co. Admin. Bldg. , P.O. Box 69, Martinez, California, 94553,
and I am a citizen of the United States, over 18 years of age,
employed -in Contra Costa County, and not a party to this action. I
served a true copy of this Notice of Insufficiency and/or Non
Acceptance of Claim by placing it in an envelope(s) ,addressed as shown
above (which is/are place(s) having delivery service by U.S. Mail) ,
which envelope(s) was then sealed and postage fully prepaid thereon,
and thereafter was, on this day deposited in the U.S. Mail at
Martinez/Concord, Contra Costa County, California.
I certify under penalty of perjury that the foregoing is true and
correct.
Dated: July 7, 1992 at Martinez, Californi
cc: Clerk of the Board cf Supervisors ( iginal )
Risk Management
(NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§S 910, 910. 2, 920.4, 910. 8 )
. 0 The OCasualty Groupof Insurance Companies
CLAIM OFFICE: P.U. Box 5126,Concord,California 94524-Telephone: 5101825-4552 FAX:
119 i�ECEIV
RAYMOND D. HORTON Claims Manager June 22 , 1992 Oil, R cis k- 5
Kenneth Kooper,Claims Supervisor s' A 2
Contra Costa County R0 �COSTA CO$
Risk Management Department
651 Pine Street, 6th Floor �vN Q1gg2
Martinez, CA 94553
Attn: Ron Harvey
Re: Claim No OAK-1 GFL 92-46 55 40 W
Insured Oakley Water District',-,
Loss Date 10/23/91
Claimant Marie Eaton
Project Utility Adjustment Agreement
for Empire Avenue
Dear Mr. Harvey:
It is my understanding that the county entered into an agreement
with the Oakley Water District to do street improvement and improve
their water line at the same time. Attached is a copy of my
initial letter of May 20, 1992 directed to Rob Tavenier.
I'm attaching a copy of the notice from the attorney Scott Dunning
of the Law Firm of Arnold Laub and a copy of the agreement between
the water district and the county. Also attached is a copy of the
police report.
Please acknowledge receipt of these items and advise us that you
are prepared to protect us under the terms of the indemnity
agreement.
If you have any questions, please to not hesitate to call .
Regards,
WESTINSURANCE COMPANY
Ray rort�on
Claims Manager
RH: sep
cc: HO
OAK
'The Ohio Casualty Insurance Cori-Tpany-VYest American Insurance Cornpany-American fire& Casualty Company
fhe Ohio Liie Intsurance Company-Ohio Security Insurance Company-Ocasco l3udgel, Inc.
Police Report No.
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Date of Loss
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INSURED VER. MAKE
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(10 The Ohio Casualty Groupof Insurance Companies
CLAIM OFFICE: P.O. Box 5126, Concord, California 94524-Telephone: 510/825-4552 FAX: 510/825-4153
RAYMOND D. HORTON,Claims Manager May 20! 1992
Kenneth Kooper,Claims Supervisor
Contra Costa County Public Works Department
. 255 Glacier Drive
Martinez, CA 94553
Attn: Rob Tavenier, Design Engineer
Re : Claim No OAK-1 GFL 92-46 55 40 W
Insured Oakley Water District
Utility Adjustment Agreement
for Empire Avenue
Claimant Marie Eaton
Loss Date 10/23/91
Dear Mr. Tavenier:
This will confirm our telephone conversation of May 19 , 1992
regarding the above-captioned matter.
You acknowledged that you received a letter of April 27 , 1992 from
Mr. Leonard Celoni, General Manager of Oakley water District. A
claim is being made against them by Marie Eaton through her
attorney, Scott Dunning of the Law Offices of Arnold Laub . At the
time of our conversation, you had not passed this letter on to the
county' s legal department .
As a claim has been made against the Oakley Water District, and
based on the terms of the Hold Harmless Agreement under Project No.
0662-6R4032-89 , we request that you handle the matter and hold the
Oakley Water District harmless of any cost or expense arising out
of the matter. It is our understanding that the accident occurred
between a vehicle operated by an employee of a subcontractor to the
general contractor hired by the county in this matter.
You may well be tendering this matter onto the general contractor
and/or his subcontractor. However, we need written assurance that
the matter is being resolved and that the county acknowledges its
responsibility under the contract so that it does not cause the
Oakley water District nor its insurance carrier to expend funds for
which it would need to seek reimbursement under the Hold Harmless
Agreement .
The Ohio Casualty Insurance Company-West American Insurance Company-American Fire&Casualty Company
The Ohio Life Insurance Company-Ohio Security Insurance Company-Ocasco Budget, Inc.
If you have any questions, please do not hesitate to contact me
directly. We await your written response.
Regards,
WEST AMERICAN INSURANCE COMPANY
Ray Horton
Claims Manager
RH: sep
cc : HO
OAK
,., 1 Scott Dunning
Law Offices of Arnold Laub
2 A Professional Corporation
43 Panoramic Way
3 Walnut Creek, CA 94595
(510) 938-4400
4
5 .
6 MARIE EATON, }
} NOTICE OF CLAIM
7 Claimants, }
}
8 VS. }
9 THE OAKLEY WATER DISTRICT. }
}
10 }
Defendants . }
11
TO : THE OAKLEY WATER DISTRICT:
12
PLEASE TARE NOTICE OF THE FOLLOWING CLAIM:
13
Name and address ,of Claimants:
14
Marie Eaton
15 1847 Walnut Grove Ct.
Oakley, CA 94561
16 (510) 625-4218
SSN# 555-55-4218
17 D.O.B. 01/18/64
18 Send all Notices to:
19 Scott Dunning
Law Offices of Arnold Laub
20 A Professional Corporation
43 Panoramic Way
21 Walnut Creek, CA 94595
(510) 938-4400
22
23 Date of Accident: 10/23/91
24 Place of Accident: On Gateway Drive, near Empire Avenue in the.
25 City of Oakley in Contra Costa County-
26 //
1 Circumstances of Accident:
2 Ms. Eaton collided with a Water Truck owned by the Ken '
3 Jones Water Truck Service, operating under contract with a
4 contractor who was contracted by the Oakley Water District
5 The accident was investigated by officers from the
6 California CHP collision report Number 10-300 lists Ken Jones
7 Water Service truck driver as the cause of the collision.
8 Injuries/property damage:
9 Ms. Eaton suffered soft tissue injuries to her neck and
10 back. The extent of their injuries as well as their general and
11 special damages are continuing to accrue.
12 Ms. Eaton's vehicle sustained heavy property damage
13 totalling over $3, 000. 00; ,
14 Jurisdiction: .
15 Superior Court Jurisdiction.
16
17 Dated: �-2-1 .222—"
Scott Dunning
18 Law Offices of Arn ld Laub
19
20
21
22
23
24
25
26
UTILITY ADJJUSTHHNT AGRI RKENT
PROJECT NO. 0662-684032-89
1. Parties: Effective on November 27, 1990, pursuant to
Government Code sections 6500-6520, the COUNTY OF CONTRA
COSTA, a political subdivision of the State of California,
hereinafter referred to as "COUNTY," and the Oakley Water
District, a California special district, hereinafter
referred to as "UTILITY, " mutually agree and promise as
follows:
ti
2. Purpose and Scope of Work: The COUNTY is performing a
project known as the Empire Road Widening Project,
Project No. 0662-6R4032-89. In connection with such
project, the UTILITY is required to relocate at its own
expense certain utility facilities.. To improve project
coordination and to expedite project completion, the UTILITY
has requested the COUNTY to include as part of the project
construction work, the utility modification work
(hereinafter referred to the "work") described in attached
Exhibit "A. "
3. County Responsibilities: The COUNTY shall perform the
following activities:
1. Act as lead agency.
2. Perform design engineering for the project, excluding
the work.
3. Prepare contract plans and specifications for the
project, including incorporation of contract plans and
specifications provided by UTILITY.
4. Advertise and award a contract for project construction
to the lowest responsible bidder.
5. Administer and inspect the project construction, except
as otherwise provided in section 4.
4. Utility Responsibilities: The UTILITY shall perform the
following activities:
1. Perform design engineering for the work.
2. Provide the COUNTY with contract plans and
specifications for the work in a form suitable for
incorporation in the plans and specifications for the
project.
3. Inspect the work, excluding trench backfill and paving.
4. Review shop drawings for the work.
5. Accept the work upon completion of the project.
i
5. Financial Responsibility: The estimated cost of the work is
$20,900, as detailed in attached Exhibit "A. " All costs of
the work shall be paid for by the UTILITY. The total costs
for the work shall include, but not be limited to, the work
bid item amount(s) of the construction contract awarded by
COUNTY, change orders and construction claims pertaining to
the work, and compensation to COUNTY for incorporation of
UTILITY contract plans and specifications into contract
documents, contract administration, construction .1
engineering, inspection, overhead and incidental costs.
Compensation to the COUNTY shall be 10.0% of total amount
paid to the contractor for the work. The COUNTY agrees to
pay all other costs of the project.
6. Deposit and Adjustment: The UTILITY, no later than three
weeks prior to the COUNTY advertising for construction bids,
shall deposit with the COUNTY the sum of $20,900 as the
UTILITY's share of the estimated cost of the work. As soon
as possible after determination of final cost for the work
the UTILITY shall either be reimbursed for any excess sum
owing it from its deposit, or the UTILITY shall pay promptly
to the COUNTY any additional sum that may be due and owing
the COUNTY over and above such deposit.
7. hold Harmless: A. The UTILITY shall defend, indemnify,
save and hold harmless the COUNTY, its governing board,
officers, agents and employees from any and all claims,
demands, suits, costs, expenses and liability for any
damages, injury, sickness or death, including liability
for inverse condemnation, nuisance or trespass, arising
directly or indirectly from, or in any way connected with,
the design, construction, installation, inspection,
operation, maintenance or repair of the utility facilities,
except for liability arising through the sole negligence or
willful misconduct of the COUNTY, its officers or employees,
and shall make good to and reimburse the COUNTY for any
expenditures, including reasonable attorney's fees, the
COUNTY may make by reason of such matters, and if requested
by any of the indemnitees, shall defend such suits at the
sole cost and expense of the UTILITY.
B. The COUNTY shall defend, indemnify, save and hold
harmless the UTILITY, its governing board, officers, agents
and employees from any and all claims, demands, suits,
costs, expenses and liability for any damages, injury,
sickness or death, including liability for inverse
condemnation, nuisance or trespass, arising directly or
indirectly from, or in any way connected with, the design,
construction, installation, inspection, operation,
maintenance or repair of the road improvements, except for
liability arising through the sole negligence or willful
misconduct of the UTILITY, its officers or employees, and
shall make good to and reimburse the UTILITY for any
expenditures, including reasonable attorney's fees, the
UTILITY may make by reason of such matters, and if requested
by any of the indemnitees, shall defend such suits at the
sole cost and expense of the COUNTY.
C. The COUNTY shall include in the contract for project
construction provisions regdiring the contractor to provide
indemnification and liability insurance naming the UTILITY,
?r
the COUNTY, their governing boards, officers, agents and
employees.
D. Nothing in this Agreement is intended to affect the
legal liability of either party to third parties by imposing
any standard of care respecting work performed hereunder
different from the standard of care imposed by law.
8. Acceptance: The UTILITY shall accept the work performed by
the contractor when it has determined, upon recommendation
by the COUNTY, that the work has been satisfactorily
completed. The UTILITY shall not unreasonably withhold its
acceptance of the work.
9. Accountability: Each party is strictly accountable for all
funds and must report all receipts and disbursements.
10. Restrictions: In performing this Agreement, the powers of
the parties shall be subject to the restrictions upon the
manner of exercising the power of the COUNTY.
11. Term of Agreement: Except for thIe provisions of section 7,
which shall survive the expiration of this Agreement, this
Agreement shall expire upon acceptance of the project
construction as complete by�the Board of Supervisors and the
payment of all sums required herein by the parties from one
to the other.
12. Agreement Modification: This Agreement shall be subject to
modification only.,with the written consent of both parties.
Neither party shall unreasonably withhold its consent to the
implementation and accomplishment of the overall purpose for
which this Agreement is drawn.
t
COUNTY OF CONTRA COSTA " OAKLEY WATER DISTRICT
By, '�' / u�vi By:
Chairpe on,
Board of Supervisors ' Name:V. Wallace Allen
Position:President, Board of
Directors
ATTEST: ATTEST;
Phil Batchelor, Clerk of the By: ��.
Board of Supervisors and
County Administrator Namei Leonard Celoni
. n
By: j��. JQ /�� elf Position: General Manager
Deputy
RECOMMEND FOR APPROVAL
J. Michael Walford
Public Works Director
By: c /�
Deputy Public Works Director
FORM APPROVED
Victor J. Westman
!i County Counsel
Deputy County Counsel
MLFi:RT:drg
c/UAAl,owd
10/30/90
I
EXHIBIT"A"
UTILITY ADJUSTMENT
SCOPE OF WORK AND ESTIMATE OF COST
PROJECT NO.: 0662-6R4032-89
Scope of Work:
The work will consist of adjusting the water main in Empire Avenue between
Gateway Drive and Hemlock Drive, along with adjusting all valve covers and water
meters within the project limits as requested by UTILITY.
Estimate of Cost:
Contract item Estimated Estimated
of Work Quantity/Unit Unit Price Extension
Relocate 12"
Water Main 1 Lump Sum $19,000.00
Contract Total $19,000.00
10.0% Engineering and Overhead $ 1,900.00
TOTAL ESTIMATE OF COST $20,900.00
MLH:RT:drg
cluaal.owd
10/30/90
w .
vo
-
� �
� ,a
/40
CLAIM - JUL O `' 1992
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
COUNTY COUNSEL
Claim Against the County, or District governed by) "M QWkON
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT August 4, 1992
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: CURTIS, Scott
1688 Countrywood Ct.
ATTORNEY: Walnut Creek, CA 94598
Date received
ADDRESS: BY DELIVERY TO CLERK ON July 1, 1992
BY MAIL POSTMARKED: June 30, 1992
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: July 2, 1992 VIL BATCHELOR. Clerk
eputy11. FROM: County Counsel TO: Clerk of the Board of rvisors
r �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: Deputy County Counsel
'U
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 ORD : 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: 2-y-42 PHIL BATCHELOR, Clerk, By Deputy Clerk
WARNING (Gov. code sect 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.
FOR ADDTTTONAL WARNING SEE REVERSE SIDE OF THIS NOTICE
AFFIDAVIT OF MAILING
I -declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant as shown above.
Dated: ;L- BY: PHIL BATCHELOR by 54_5Deputy Clerk
CC: County Counsel r County Administrator
Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA OOUNTY
:;- INSTRUCTIONS m 6 AIMANT
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on ,or before December 31, 19879
must be presented not later than the 100th day after the accrual.' of the cause of
action. Claims relating to causes of action for death or for injury to person
or `to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of ,action. (Govt.. Code §911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in
Room 1069 County Administratim 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
filedaagainst each public entity.
E. Fraud. See, penalty for fraudulent claims, Penal Code Sec. 72 at the end of this
form.'
ee * eeeeeeaas �i * eee �"e � * • � * aseees * eaaeeaaee * ea
RE: Claim By ) Reserved for Clerk's filing stamp
C E fir
.�._.�
Against the County of Contra Costa j JUL 1
or
192
District) CLER CON RABOARD C OSSSUPERVISORS
CO ISORS
Fill in name ) .
The undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of.$ S7E.E e_inn^nA've:S and in support of
this claim represents as follows:
1. When did the damage or injury occurT (Give exact date and hour)
2. Where did 'the damage ,or injury occur? (Include city and o=ty)
(e7 �!Aoct
3. How did the damage or injury occur? (Give full details; use extra paper if
required)
exp Go,a rz Pa c.=STA C 0L3t4,r,/ --rQ_0C_t •ir- 648`ELS
a nl� baos Lc D 04;r;- -rk-W7 R-oRO. "i—t 4V\-1 mac!,rt 0--st-h ea-D AND
4. What particular act or omission on the part of county.or district officers,
servants or employees caused the injury .or damage?,
i LO NX IE_, U—_-=�L LA
':1�t,S "'r-"ek- t--,F- '-tom
'JnoCL ArN►D Zr=Ar2 GartiPA� EtIT v�lP�1.S Q�S�P��� cc7ctiP� �e_��
1AP i Y t NG, IN, LiZtai� M"Vc,VArT (over)
5. What are the names of county or district officers, servants or employees 'caus? ig, , ,
the damage or injury?
GE1i.1�'TYL A CGF��Ac COLS
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.)
8. Names and addresses of witnesses doctors and hospitals.
C-'Q.a�5 208. 100
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
Gov. Code Sec. 910.2 provides:
"The cl be s y the claimant
SEND NOTICES TO: (Attorney) or some n is half."
Name and Address of Attorney
iS Signature
i Lo$$ Coynl-r2�/ bc� cY-t-,
Ad
Telephone No. Telephone No. (5 L Q) 9 3 o• Cp 5`7`'E'
`NOTICE
Section 72 of the Penal Code provides:
."Every,personawho, with.intent to, defraud, presents for allowanee.or for
payment ,to any state.board,or officer, or to anyrcounty, 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 'e' xeee'ding ten thousand' dollars ($10,000," or''by
.both such imprisonment and ..fine: ._ .
Ij
ry / cobel glass, inc. WHEN PAYING BY
mewled CHECK,PLEASE INCLUDE
(510)834-7841 THIS INVOICE NO.
REMIT TO: � 'INVOICE NUMBER
P.O. BOX 657 Stud 4)0-3-893
OAKLAND, CALIFORNIA 94604
-X.**** WORK ORDER FEDERAL TAX NO.
SCO"fT CURTIS � SCOTT CURTIS
CASH SALE
J SCHEDULE DATE:
CASH CHARGE CREDIT ' WHSLE RETAIL WPU DEL INSTIL MOBILE M T W TH F S AM PM TIME
X X X
DATE ACCOUNT NUMBER P.O. POLICY NUMBER CLAIM NUMBER SALESMAN WORK ORDER PHONE NUMBER
06-a9--•92 0 01 _
DATE OF LOSSTYPE OF DAMAGE CAUSE AUTHORIZED BY DEDUCTIBLE AGENT
YEAR' MAKE MODEL BODY'BTYLE •V.I.N. STOCK NO. LICENSE # INSTALLED BY
PLYM IVOYAGER MINI-VON
CUSTOMER' S PHONE 1. )
QTY. PART NO. DESCRIPTION CTL LIST PRICE TOTAL
1 W963 S WINDSHIELD (WINDSHIELD) X M 399. 65 1213. B9. 123..81)
1 LABOR . 45. 00 45. 00
***THANK YOU FOR CHOOSINS CO EL GL-ASS, II`3C.
SPECIAL INSTRUCTIONS
SUB: 26E]. Ei9
TOTAL
LOCATIONS: CONTRACTORS LICENSE NO.374138 SALES TAX .10
❑ 400 FRANKLIN STREET, OAKLAND, CA 94607• (510)834-7841
❑ 1992 REPUBLIC AVE., SAN LEANDRO, CA 94577• (510 357-0747
( 1090C DETROIT AVE., CONCORD,CA 94520• (510)827-3900 RECD BY TOTAL 1'79. 11
❑ 1711 BARRETT AVE., RICHMOND, CA 94806• (510)232-1337
NOTICE:"Under the Mechanics Lien Law(California Code of Civil Procedure,Section 1181 at seq.)arty contractor,subcontractor,laborer,supplier pr orothhewho
helps t a court officer your 171.g B 1
property but is not paid for his work or supplies has a right to enforce a claim against your property.This means that alter a court hearingyour property
could be
and the proceeds of the sale used,to satisfy the indebtedness.This can happen even if you have paid your own contractor in full,it the subcontractor,laborer or supplier remains unpaid"
CONDITIONS OF CREDIT TERMS—A FINANCE CHARGE IS COMPUTED ON A PERIODIC RATE OF 11x%PER MONTH WHICH IS AN ANNUAL PERCENTAGE RATE OF 18%ON
ANY PREVIOUS BALANCE NOT PAID WITHIN 30 DAYS.All accounts,industrial,corporate,and private are included.
UC)`rI
SAFELITE AUTOGLASS CORP. QUOTE #c 6365 ORB DATE: 06--29-92
BAR:N.- AA 1 ,7967 06-P9-92 1:3 s 15 BD
2098 MARKET S1- h
CONCORD, CA. 94520 INSURED SCOTT CURT I S
510 687--2150 1688 COUNTRY WOOD CT
WALNUT CREEK, CA 94596
P.''HONE1 � 510--934--4a44
PHONE::2„
'CASH—OAKLAND Pot-ICY *k
PO BOX 182:278. CLAIM #n
COLUMBUS, OH 43272 6867 AUTH/VER: /
PO#/REF° _
LOSS LOC:
800 835--2092 �. LOSS I7ATE/GAlJSF:v
5.�L�B�+t�1 l_iliO�`i�7i�r,�8$k�+CJ 1 ��+�1f�E' 1*
3^ YEARi MAKE MODEL. � MILEAGE. L I CENSE STATE VEI--I I C.LE�ID NUMBER
198'4 PLYMOUTH VOYAGER
_ .... M-INI VAN_.. _ ____._._._......._......_._STK
_.#»... _w»_,_.__..___..._.. ..__»�».._._...»._W........._..�.._....»_.____.�__.»..�._.� _..�......
CITY. P<W # LIST SELLING LABOR KIT MATERIAL EXTENSION
1 W963--B 399. 65 177. 84 49. 00 9. 95 236. 79
n., SHADED WINDSHIELD 0
O
1 WFS463--N 14. 52 14. 52 14. 52.
84--89 TDODGVN W/'SFILLSTRP O
® t1
� O
O
g
THIS IS A QUOTE ONLY. PART SUB TOTAL 202. 3
DO NOT PAY FROM THIS DOCUMENT. LABOR, SUB TOTAL.; � ��.'3. 0�1
SUB TOTAL1. 31
SALES TAX 1.6. t19
TOTAL ESTIi4ATE 268.00
THANI-', YOU FOR CHOOSING SAFELITE FOR YOUR AUTOGLASS NEEDS
IN—STORE NOT SCHEDULED I
ADDRESS d I
CITY . I
WINDSHIELD REPAIR POSSIBLE YES _ NO _ I
OUST INITIALS ACCEPTED � DECLINED
GMT c *
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