HomeMy WebLinkAboutMINUTES - 07201993 - 1.14 1. 1
CLAIM JUN 2 1993
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA OOUNm 00%m
MARTKEEZ, MF:
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT JULY 20, 1993
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: $355.39 Section 913 and 915.4. Please note all 'Warnings".
CLAIMANT: WOODRUFF, Richard
ATTORNEY:
Date received
ADDRESS: 5 Rotherford Lane BY DELIVERY TO CLERK ON June 24, 1993 (via Risk Mamt)
Martinez, CA 94553
BY MAIL POSTMARKED:
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim, gg
DATED: June 28, 1993 ��IL DeputyLOR, Clerk
I1. FROM: County Counsel TO: Clerk of the Board of Sup rs
( L4 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:
Gated: �iQ 9 l x`13 BY: C a- Deputy County Counsel
I11. FROM: Clerk of the Board 70: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARDD ORDER: By unanimous vote of the Supervisors present
( y) 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: 3 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. *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: L/ Zq3 BY: PHIL BATCHELOR b Deputy Clerk
CC: County Counsel County Administrator
or
This warning does not apply to claims which are not
subject to the California Tort Claims Act such as
actions in inverse condemnation, actions for specific
relief such as mandamus or injunction, or Federal
Civil Rights claims. The above list is not exhaustive
and legal consultation is essential to understand all
the separate limitations periods that may apply. The
limitations period within which suit must be filed may
be shorter or longer depending on the nature of the
claim. Consult the specific statutes and cases
applicable to your particular claim.
The County of Contra Costa does not waive any of its
rights under California Tort Claims Act nor does it
waive rights under the statutes of limitations
applicable to actions not subject to the California
Tort Claims Act.
Clair,: 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,
19889 must be presented not later than six months after the accrual of the cause
of action. Claims relating to any,other bause '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 91553.
C. If claim is against a districtgoverned 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. She penalty for fraudulent claims, Penal. Code Sec. 72 at the end' of this
f orm.
Rte. Clai By ) Reserved for Clerk's filing stamp
�'k� ) ..,..;...:-- .RECEIVED
)
Against the County of Contra Costa ) ,0 Z 4 03
or )
District) CLFRKCDMRAD�ST��SORS
Fill in name )
The undersigned claimant hereby,makes claim against the County of Contra Costa or
the above-named District in the sum of $ s . 32 and in support of
this claim represents` as follows:
1. When did the damage or injury occur? (Give exact date and hour)
- n�. . _L9�3___ __� s -- ='----------------------
2.' Where did' the`damage or-injury occur? (Include city and county)
3. How did the damage or injury occur? (Give full details; use extra paper if
required)
4. What particular act or omission on the part of county or district officers,
servants or employees caused the injury or damage?
(over)
5. wnat are tne rke—,"s of county or district officers, servants or employees causing
the damange or injury?
A
4 / 7042--------
---TA --
a----- -
6. What damage or injuries do. you claim resulted?
ulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto:damage.
g cue
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 hospitals.
k-L C v4i�
_D42JOYMS --------
9. List the expenditures you made on "account- of this accident
acident or injury-.
DATE ITEM AMOUNT
f -y-
-0 #46 W"
C*
Gov. Code See. 910:2 provides;
ejG "The claim must be signed by the claimant
SEND NOT��O-,�� orby,,some person on his behalf."'
Name and Address dfAttorney
�Claimant's Sure)
Address)
or
-23
Telephone No. Telephone No. '3 2-0 V CI
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,I' 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.
INV.
# DATE
COSTLITE AUTO .GLASS
5011 BLUM RD.#2 COST. SALE
MARTINEZ, CA 94553 # TYPE
(510)372-4167 OUST. SOLD
P.O. BY
FED ID# 409-50-4828 FED.' INST'L
TAX,# BY
RICHARD WOODRUFF
11 0-27Q-2244
YEAR MAKE POLICY
#
MC TRUCKS
MODEL BODY AUTHOR-
STYLE pICK_Up (thrUMidIZED BY
LIC. CLAIM LOSS
# V.I.N. CODE DATE
A
HOMEBus. DAMAGE/
PHONE 10-370-2344 PHONE _ CAUSE OCK FROM VEHICLE 6 22 93
QT. PART DESCRIPTION BLOCK SIZE LIST PRICE TOTAL
1 DWO0847 SH Windshield (Ant). (Brkt) (88=7 -26x68 365.98 295.97 295.97
Labor (flat rate) 35.00
Urethane Kit Installation 0.00. 0.00 . 0.00
TOTAL LABOR NON-TAXABLE 35.00
SPECIAL INSTRUCTIONS SUBTOTAL 330.97
A ST 24..42
All material sold on this invoice is guaranteed to be as specified, and is not safety glazed material unless
so marked. It is sold with the understanding that this material will not be glazed in a "hazardous location"
as defined by the Consumer Product Safety Commission.
All merchandise returned for credit, refund or exchange must be in resaleable condition, authorized for
return, accompanied by this receipt, and may be subject to restocking fee.No returns will be authorized for
special orders or cut flat glass. Terms of payment are 30 days from invoice date. A service charge POTAL 355.39
of 2•0 % per month (24•0%annum) will be added to past due accounts.
ANCE 355-39
RECEIVED BY: The glass listed has been replaced/repaired with like kind and quality to my entire satisfaction,and
I authorize my Insurance Company to pay the"Above:named Repair/Glass Company"directly for the
glass and installation charges,or repairs.
I \
/ , . 1v
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 JULY 20, 1993
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: $1,663.46 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: FRIGON; Maurice or Carol (fig: 01=Fy5Z65-9
ATTORNEY: California State Automobile Association
Inter-Insurance Bureau Date received
ADDRESS: Attn: Cyndi Lusk BY DELIVERY TO CLERK ON June 18, 1993 (via Risk Mqmt)
P.O. Box 7
San Hablo, CA 94806 BY MAIL POSTMARKED:
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: June 18, 1993 gtIl Bep�tyLOR. Clerk
I1. FROM: County Counsel TO: Clerk of the Board of Sup isors
( ✓) 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: y - Z�� 9 3 BY: l_- Deputy County Counsel
U G1__
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
( Y) 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 fora-
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 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 warnina see reverse side of this notice.
AFFIDAVIT OF MAILING
1 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: 7aI 3 BY: PHIL BATCHELOR b Deputy Clerk
CC: County Counsel County Administrator
1
This warning does not apply to claims which are not
subject to the California Tort Claims Act such as
actions in inverse condemnation, actions for specific
relief such as mandamus or injunction, or Federal
Civil Rights claims. The above list is not exhaustive
and legal consultation is essential to understand all
the separate limitations periods that may apply. The
limitations period within which suit must be filed may
be shorter or longer depending on the nature of the
claim. Consult the specific statutes and cases
applicable to your particular claim.
The County of Contra Costa does not waive any of its
rights under California Tort Claims Act nor does it
waive rights under the statutes of limitations
applicable to actions not subject to the California
Tort Claims Act.
R.ECEIV D::_.�.�.
Claim For Damages .UN 18
Imm K BOA i
r In accordance with Section 910 of the California Government Code,this is to fo
of our subrogated claim for the loss described below.
Date: JUNE 4 19 93
CONTRA COSTA COUNTY RICHMOND
RISK MANAGEMENT DIVISION California
651 PINE STREET, 6TH FLOOR
MARTINEZ, CA 94553
Claim is hereby made and filed against the COUNTY OF CONTRA COSTA
as follows:
Insured/Claimant's: FRIGON,MAURICE S. OR CAROL
California State Automobile Association Inter-Insurance Bureau
Address of Claimant:
(Send notices to this address) P.O. BOX 7, SAN PABLO, CA 94806
Reference File
01—F45085-8
Date of Occurrence:
APRIL 26, 1993
Place of Occurrence:
TARA HILLS DRIVE AND KAVANAUGH, SAN PABLO, CA
Nature and Amount of Damages
RIGHT FRONT $1,663.46
Items Making up said Amount:
RIGHT FRONT CORNER, AND SIDE
Name of Public Employee(s)
causing said Damage(if known): AL PEREZ
Facts & Details:
OUR INSURED WAS ON TARA HILLS DRIVE, NO CONTROLS. YOUR INSURED RAN A STOP SIGN
AND HIT OUR INSURED'S VEHICLE DAMAGING RIGHT FRONT CORNER AND SIDE.
California State Auto m bile As o (on
Inter n rance Burea
By:
F1688(Rev.11-87) 7
DI7bEfK
assi nment of claim and
subrogation agreement
In consideration of the payment to the undersigned of ICI the sum of
❑ a sum estimated to be
ONE THOUSAND SIX HUNDRED SIXTY THREE & 46/00
Dollars,.being the full amount of loss and damage insured against under an automobile insurance policy, number
F45085-8 issued to the undersigned by the CALIFORNIA STATE AUTOMOBILE ASSOCIATION
INTER-INSURANCE BUREAU, said loss and damage having occurred on or about the 26TH day of
APRIL 19 93, the said undersigned hereby assigns and transfers to said Bureau HIS
said claim in the above amount plus HIS additional claim for damage resulting from said accident, not
a total
covered under said policy of insurance, in the amount of$ , constituting ❑ a total estimated claim
in the amount of $ 1.663.46
Said Bureau is hereby subrogated in MY place and stead to the extent of the above amount of the said
total claim and is hereby authorized and empowered to sue, compromise or settle in MY name or other-
wise to the extent of said total claim for loss and damage, and to endorse in my name any check made payable to
me therefor, and collect and receive any money payable thereby.
The undersigned covenants that HE has not released or discharged any such claim or demand against
such party or parties and that HE will furnish to said Bureau any and all papers and information in HIS
possession, necessary for the proper prosecution of such claim.
Dated at V\ this / day of 1g �
AL2 /f
WITNESS
F1433 (REV.7-77)
CLAIM FOR DAMAGE INSTRUCTIONS: Please read carefully the instructions on the reverse side and FORM APPROVE
supply information requested on both sides of this form. Use additional sheet(s) if 1 05-0 08
INJURY, OR DEATH necessary. See reverse side for additional instructions.
1. Submit To Appropriate Federal Agency: 2. Name, Address of claimant and claimant's personal representative, if any.
CONTRA COSTA COUNTY (See instructions on reverse.) (Number, street, city, State and Zip Code)
RISK MANAGEMENT DIVISION CALIFORNIA STATE AUTOMOBILE ASSOCIATION
651 PINE STREET, 6TH FLOOR P.O. BOX 7
MARTINEZ, CA 94553 SAN PABLO, CA 94806
3. TYPE OF EMPLOYMENT 4. DATE OF BIRTH 15. MARITAL STATUS 6. DATE AND DAY OF ACCIDENT 7. TIME(A.M. OR P.M.)
❑ MILITARY h CIVILIAN -- -- MONDAY, APRIL 26, 1993 1:35 P.M.
8. Basis of Claim(State in detail the known facts and circumstances attending the damage, injury, or death, identifying persons and property Involved, the
place of occurence and the cause thereon(Use additional pages if necessary.)
OUR INSURED WAS ON TARA HILLS DRIVE, NO CONTROLS. YOUR INSURED RAN THE STOP SIGN AND HIT
OUR INSURED'S VEHICLE DAMAGING RIGHT FRONT CORNER AND SIDE.
9. PROPERTY DAMAGE
NAME AND ADDRESS OF OWNER, IF OTHER THAN CLAIMANT(Number,street, city, State, and Zip Code)
FRIGON,MAURICE S. OR CAROL, 2838 TARA HILLS DR. , SAN PABLO, CA 94806
BRIEFLY DESCRIBE THE PROPERTY,NATURE AND EXTENT OF DAMAGE AND THE LOCATION WHERE PROPERTY MAY BE INSPECTED. (See Instructions
on reverse side.)
1985 CUTLASS, 4DOOR SEDAN, CALIFORNIA LICENSE PLATE 2NDN322, DAMAGE AMOUNT $1,526.55.
DAMAGE TO THE RIGHT SIDE.
10. PERSONAL INJURYIWRONGFUL DEATH
STATE NATURE AND EXTENT OF EACH INJURY OR CAUSE OF DEATH,WHICH FORMS THE BASIS OF THE CLAIM. IF OTHER THAN CLAIMANT,STATE
NAME OF INJURED PERSON OR DECEDENT.
N/A
11. WITNESSES
NAME ADDRESS(Number, street, city, State, and Zip Code)
N/A N/A
12. (See instructions on reverse) AMOUNT OF CLAIM(In dollars)
12a. PROPERTY DAMAGE 12b. PERSONAL INJURY 12c. WRONGFUL DEATH 12d. TOTAL(Failure to specify may cause
$1,663.46 0 0 forfeiture of your rights.)
$1,663.46
I CERTIFY THAT THE AMOUNT OF CLAIM COVERS ONLY DAMAGES AND INJURIES CAUSED BY THE ACCIDENT ABOVE AND AGREE TO ACCEPT SAID
AMOUNT IN FULL SATISFACTION AND FINAL SETTLEMENT OF THIS CLAIM
13a. SIGNATURE OF CLAIMANT(See instructions on reverse side.) 13b. Phone number of signatory 14. DATE OF CLAIM
(510) 233-8800 X 281 5-28-93
CIVIL PENALTY FOR PRESENTING CRIMINAL PENALTY FOR PRESENTING FRAUDULENT
FRAUDULENT CLAIM CLAIM OR MAKING FALSE STATEMENTS
The claimant shall forfeit and pay to the United States the sum of$2,000. Fine of not more than$10,000 or imprisonment for not more than 5 years
plus double the amount of damages sustained by the United States. or both. (See 18 U.S.C. 287, 1001.)
(See 31 U.S.C. 3 729.)
95.107 NSN 7540-00-634-4046 STANDARD FORM 95(Rev. 7-85)
Previous editions not usable. CSAR Form F1679 (Rev.8.89) PRESCRIBED BY DEPT. OF JUSTICE
28 CFR 14.2
PRIVACY ACT NOTICE
This Notice is provided in accordance with the Privacy Act, 5 U.S.C.552a(e)(3), B.Principal Purpose: The information requested is to be used In evaluating claims.
and concerns the information requested in the letter to which this Notice is attached. C.Routh7e Use: See the Notices of Systems of Records for the agency to whom you
A.Authority: The requested information is solicited pursuant to one or more of the are submitting this form for this information.
following: 5 U.S.C.301,28 U.S.C.501 at seq., 28 U.S.C. 2671 at seq., 28 D.Effect of Failure to Respond: Disclosure is voluntary. However,failure to supply
C.F.R.Part 14. I the requested Information or to execute the form may render your claim"invalid'.
INSTRUCTIONS
Complete all Items-Insert the word NONE where applicable
A CLAIM SHALL BE DEEMED TO HAVE BEEN PRESENTED WHEN A FEDERAL AGENCY
RECEIVES FROM A CLAIMANT,HIS DULY AUTHORIZED AGENT,OR LEGAL REPRESENTATIVE
AN EXECUTED STANDARD FORM 95 OR OTHER WRITTEN NOTIFICATION OF AN INCIDENT,
ACCOMPANIED BY A CLAIM FOR MONEY DAMAGES IN A SUM CERTAIN
FOR INJURY TO OR LOSS OF PROPERTY,PERSONAL INJURY,OR DEATH
ALLEGED TO HAVE OCCURRED BY REASON OF THE INCIDENT.
THE CLAIM MUST BE PRESENTED TO THE APPROPRIATE FEDERAL AGENCY
WITHIN TWO YEARS AFTER THE CLAIM ACCRUES.
Any instructions or information necessary in the preparation of your claim will be (b)In support of claims for damage to property which has been or can be
furnished,upon request,by the office indicated in item N1 on the reverse side. economically repaired,the claimant should submit at least two itemized signed
Complete regulations pertaining to claims asserted under the Federal Tort Claims Act statements or estimates by reliable,disinterested concerns,or,if payment has been
can be found in Title 28,Code of Federal Regulations,Part 14. Many agencies have made,the itemized signed receipts evidencing payment.
published supplemental regulations also. If more than one agency is involved,please
state each agency.
The claim may be filed by a duly authorized agent or other legal representative, (c)In support of claims for damage to property which is not economically repairable,
provided evidence satisfactory to the Government is submitted with said claim or if the property is lost or destroyed,the claimant should submit statements as to the
establishing express authority to act for the claimant. A claim presented by an agent or original cost of the property,the date of purchase.and the value of the property,both
legal representative must be presented in the name of the claimant. If the claim is before and after the accident. Such statements should be by disinterested competent
signed by the agent or legal representative,it must show the title or legal capacity of persons,preferably reputable dealers or officials familiar with the type of property
the person signing and be accompanied by evidence of his/her authority to present a damaged,or by two or more competitive bidders,and should be certified as being just
claim on behalf of the claimant as agent,executor,administrator, parent,guardian or and correct.
other representative.
If claimant intends to file claim for both personal injury and property damage,claim (d)Failure to completely execute this form or to supply the requested material
for both must be shown in item 12 of this form. within two years from the date the allegations accrued may render your claim"invalid'.
A claim is deemed presented when it is received by the appropriate agency,not when
The amount claimed should be substantiated by competent evidence as follows: it is mailed.
(a) In support of the claim for personal injury or death,the claimant should submit
a written report by the attending physician,showing the nature and extent of injury,
the nature and extent of treatment,the degree of permanent disability,it any,the
prognosis,and the period of hospitalization,or incapacitation,attaching itemized bills Failure to specify a sum certain will result In invalid presentation of your claim
for medical,hospital,or burial expenses actually incurred. and may result in forfeiture of your rights.
INSURANCE COVERAGE
In order that subrogation claims may be adjudicated,it is essential that the claimant provide the foliowing information regarding the insurance coverage of his vehicle or property.
15.Do you carry accident insurance? Yes,If yes,give name and address of insurance company(Number,street, city, State,and Zip Code)and policy number. 0 No
CALIFORNIA STATE AUTOMOBILE ASSOCIATION POLICY NO: F45085-8
P.O. BOX 7
SAN PABLO, CA 94806
16. Have you filed claim on your insurance carrier in this instance,and if so,is it full coverage or deductible? 17.If deductible,state amount
FULL COVERAGE $250.00
18.If claim has been filed with your carrier,what action has your insurer taken or proposes to take with reference to your claim? (it is necessary that you ascertain these facts)
CSAA HAS PAID FOR DAMAGES TO THE VEHICLE IN FULL, NO DEDUCTIBLE WAS PAID. $75.00, WAS FOR
CAR RENTAL AND THE REMAINING $61.90, OUR INSURED PAID DIRECT.
19.Do you carry public liability and property damage insurance? Cfk Yes.If yes,give name and address of insurance carrier(Number,street, city, State,and Zip Code) ❑ No
FULL COVERAGE WITH CALIFORNIA STATE AUTOMOBILE ASSOCIATION, P.O. BOX 7, SAN PABLO, CA 94806
e U.S.G.P.o.:i9ss-491-003/50508 SF 95(Rev. 7-85) BACK
Estimate Report 726568
NAME' j r%/v —DATE. WORK PHONE HCMG PHONE �� /� 1
ADDRES l �i/ c'L l // ✓' I S /✓.9js/ L
f— OJ2A ♦{{ —7F'l _CITrY STATE
YEAR " MAKE MODELS ( !D�NO. LL•��LTJ / �� / 1.�� J J I��
PAINT CODE PROD.DATE—TRIM—MILEAGE LICENSE NO.��-�-_3d[p,OF LOSS
i
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
N0. PAIR PUKE R=Repair S=Straighten A=Aftermarket N=New PI PARTS LABOR PAINT SUBLET:MISC.
Ri =Recycle/Rechrome//Recon U Used R=Rebuilt
1 �'i� d I I
2 ic
> —
3 i �
4 J U
5
7 -GGsL /
'�i Cy
9
10
12
13
I
14
15
16
17
18
19
20
21
22
23
Ir
I j
26
27
I hereby authorize the above work and acknowledge receipt of copy. I TOTA
Signed X Date
PARTS Prices subject to invo'ce S
ti LABOP;?-4 hrs.@ $
Shop Supplies $
MARTIN BUICK-PONTIAC PAINT hrs @ S
Paint Supplies $
3230 Auto Plaza Towing,,Storage $
A
Hilltop-Richmond, ^C94806
94806 AS �+ Sublet!Miscellaneous $
EPA:Waste Disposal Charge S
Phone (510) 222-4141 $
FAX # (510) 222-8016 SUB TOTAL $
S
TAX ......... ... ........... $
TOTAL $
^.town IIn IF re��� Cnrrn�In ,nn'f IIn/Cle inn n.,,.IIn ICin 1Al_.. !•_�..._iin nnrn�nnnn-..., .... �.,��.....-_
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:CaliforniaState Automobile Association Inter-Insurance Bureau : 030 ?1$051
0'30 L.?18051-0—R
DATE OF L CLAIM" +r - •• INSURED'S NAME - DATE
04-26.=.9 01-F45085-5 FR.IGON, MAURICE S; OR CAROL 04-29--93
POLICY TY KIND :• SUFFIX CLAIMANT' PAY m
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0
. "D.O. •. A0.1US E IN PAYM 11halk"of
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RF_P I �50. 00 DED amerlcaNrasA ':'.':. „-3s
: .:...-SPA. b4. ;::= A RS .LESS
............: ---:.;-. "... .. ,,.._. ...:; = I. Global Payments r1233 :- . 1210 Z
1850 Gateway BIW.
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MARTIN BUICK ::INC. - Cn
AND .hIAUR I CE ."FR I GON - m
TO. 3230, AUTO PLAZA AUTHORIZED SIGNATURE _ IG E
ORDER RICHMOND . CA 94806
OF NOT 'NECR BLE
- - ..
M.O. COPY
u2O30 7 LBO S Lu' 0: b 21,00,0 3. 86 .`b-2 3 30*1.90948x'
California State Automobile Association Inter-Insurance Bureau 030 718 310
.—.030 L718310-0--R
•(..=.�'.'+'. ATE OF LOSS - CLAIM INSURED'S NAME DATE
=26.-9 01=F45085-9 FR I GON, MAUR I CE S- OR CAROL. 05—OS—�73
POLICY-TYPE •:.KIND OF LOSS SUFFIX ,. CLAIMANTS NAME .. PAY 2
01 S FR I GON, MAUR I CE S; OR CARL $250. 00 g
r, `. ;D.O.�;-?• ::.++.r. ADJUSTER NO. IN PAYMENT OF: Through I m
,; :; ;;SPA 18557/12732 IVSD .:DED. BankoIAmerleaNTBSA 11-35 0
s?;:,?�•,�- - % Global Payments#1233 1210 O
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(. - Concord.CA 94520 _
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AND MARTIN BUICK . m
+� OR ED SIGNATURE _-
:. .;K.,2838 .TARA HILLS DR JESSE R PHILLIPS
;�aa4.:,' ORDER °i
of .., =; SyAN -PABLO cA :9480. NOT NEGOTIABLE
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RESPONSIBILITY'S �'X.• ':: U SEE REVERSE:THIS IS NOT INSURANCE X 1
WHL COVERS - :. RENTER DECLINES .:: _'IR RENTER REOIIESTS PERSONAL ACCIDENT INSUR ENTER _ _
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end I request Enterprise's permission to allaiv •�'D
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WHL COVERS _ ATE r:'AMOUNT a'� Pyy¢gY �'.f4EOATE PD. H e.-; CLOSED BY
OUT :E:Ys Yi 3S V2 % 34 T�.Fr RETURN k /_ 51):U() CA�Jhi. 5/
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,;••-DATE OF LOSS :.:�: ",: CUIM. :::.:... .....-•, :....: .:INSURED'S NAME DATE
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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 JULY 20, 1993
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: EAS, Francis and Janice
ATTORNEY:
Date received
ADDRESS: 597 La. Paloma BY DELIVERY TO CLERK ON June 18, 1993
El Sobrante, CA 94803
BY MAIL POSTMARKED:
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: June 18., 1993 JyIL DeputylOR, Clerk
II. FROM: County Counsel TO: Clerk of the Board of Supe visors
( ✓) 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: ` Z J� , f�3 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: `7 —cZo— q3 PHIL BATCHELOR, Clerk, 8y . 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. *For additional warnina 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: -7 /21 /q3 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-
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 whichaccrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action.. (Govt. Code §911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in
Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553.
C. If claim is against a district governed by the Board of Supervisors, rather than
the County, the name of the District should be filled in.
D. If the claim is against more than one public entity, separate claims must be
filed against each public entity.
E. Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this
form.
It * A It It
RE: Claim By Reserved for Clerk's filing stamp
RECEIV
Against the County of Contra Costa
or JW C 181993
C
District) SOARDOF 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 $ and in support of
this claim represents as follows:
1. When did the damage or injury occur. (Give exact date and hour)
. I
----—-—---------
2. Where did the damage or injury occur? (Include city and county)
3. How did the damage or injury occur? (Give full details; use extra paper if
required)
--—---------—---—---------— —---—-------------------------—---——-
4. What particular act or omission on the part of county or district officers,
servants or employees caused the injury or damage?
L
ad
5. Wnat are tne rip-tes of co=t.v or district officers, servants or employees causing
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.)
-—-------------------------- --_-MY___-_ _
3.
----------
6. Names and addresses of witnesses, doctors and hospitals.
441k \1(-N
-a------------------------------- ..-_-_-_.. —-----
9. List the expenditures you made on'account of this accident or injury:
DATE ITEM AMOUNT
;J) a-
GoV. Code See. 91002 provides:
✓ "The claim must be signed by the claimant
SEND NOTICES TQ-, ney).-r orb some personon his behalf."
Name and Address
qy-,)
�~Claimant ls Signature)
(Address)
C.CL.
Telephone No. Telephone No. S W A-a,3
T T V V 1 9 1 V V I T V
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.
CLAIM AGAINST CONTRA COSTA COUNTY_. Mav 30, 1993
RE: 609 LA PALOMA ROAD CLAIMANT: MR. STORM Q GORANSON, P.E.
EL SOBRANTE, CA 446 BEAVER STREET-
SANTA ROSA, CA 95404
(707) 575-5851
ITEM #3
NATURE OF DAMAGE
Background
. A portion of the western side of La Paloma Road, adjacent to 597
and 609 La Paloma Road, EI Sobrante, slipped in the wet weather season
of the winter and spring of 1992-93. This slippage was manifested
through the fracture of two different street side EBMUD water laterals,
and damage to both properties.
The substrata in this area has been identified by the U. S. Soil
Conservation Service as Los Osos Clay. The movement of these subsoils,
attributed to this slippage, adversely affected 609 La Paloma Road(hence
referred to as the subject site). This resulted in physical damage to the
existing exterior stairway, and also provided such a lateral movement
that a condition of instability was created in a portion of the existing
fence. A portion of this fence subsequently fell down.
This slippage was induced by the introduction of an inordinate
quantity ofstreet and surface water runoff which was directed along
the westerly face of La Paloma Road, on to the two adjoining parcels
for the very first time.
The term, "very first time", is intentionally used to denote the fact
that, historically, surface and street runoff emanating from above the
subject site was conveyed, westerly, down the driveway, located along
the northerly boundary of the subject site. The year 1992 was the first
year that this water was intentionally diverted into the westerly right
of way of La Paloma Road.
-1-
CLAIM AGAINST CONTRA COSTA COUNTY (continued) IMav 30, 1993 :
RE: 609 LA PALOMA ROAD CLAIMANT: MR. STORM C. GORANSON, P.E.
EL SOBRANTE, CA- 446 BEAVER STREET----
SANTA
TREET .SANTA ROSACA 95404
(707`) 575- 1
The point source of this runoff is a roadside ditch situate la Ong
the westerly portion of La Paloma Road, immediately northerly of the
subject site. The primary source of this runoff is that portion of La
Paloma Road located northerly of the subject site.
The County approved a three lot subdivision for the parcel to the
_rear of the subject site,.approximately five years ago. The construction
of this subdivision resulted in the development of the aforementioned
existing driveway. This driveway was transformed from one with a
simple aggregate base to one with an asphaltic base, curbs, and a
separate runoff structure intended to divert the runoff from the
driveway to the La paloma Road right of way. The original design for
this driveway, approved by the County,included a "valley drairnll to divert
surface runoff from the earlier mentioned roadside ditch, across the
rebuilt driveway, onto the County right of way, immediately easterly of
the subject site.
The runoff was then conveyed to a point where a roadside ditch
would have existed had there ever been one. Unfortunately,the existing
drainage way had evolved exclusively by conveying the runoff from the
immediate street. Consequently, it was only a few inches deep, and
virtually indistinguishable through much of its course. when the newly
inputed runoff was commingled with the historic runoff, this drainage
way was simply inundated. This water so overwhelmed the existing
"system" that the totality of the runoff flowed onto both properties.
Additional Damage
As stated previously, this slippage resulted in the shearing of two
EBMUD water laterals; one located at 609 La Paloma Road, the other
across the street and up one house from the subject site. The
-2-
I
M
CLAIM AGAINST CONTRA COSTA COUNTY (conthwed>< Mav 30, 1993
RE 609 LA PALOMA ROAD CLAIMANT: MR. STORK C. GORANSON P.E.
EL SOBRANTE, CA 446 BEAVER'STREET
SANTA ROSA CA 954M
(707x) 575-5851
destruction of the 609 lateral culminated in the flooding of the front
portion of the dwelling located on the property, as well as the flooding
of the basement. This free flowing water totally destroyed the dwellings
anteroom floor; and flooded .the basement, damaging the washing
machine, dryer, and personal items belonging to the tenant.
To date, there has been no effort to ascertain the extent nor total
effect of this movement on the subject site. Nor have on site mitigative
measures (eg, retaining structures) been studied.
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