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Home My WebLink AboutMINUTES - 09281993 - 1.13 10 V LIL- CLAIM PERVISORS OF CONTRA COSTA COUNTY CALIFORNIA Claim Againsgov ned by) BOARD ACTION the Board oforceaents. ) NOTICE TO CLAIMANT SEPTEMBER 28, 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: $1,030.63 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: FITCH, Nancy M. ATTORNEY: Date received ADDRESS: none given BY DELIVERY TO CLERK ON August 30, 1993 BY MAIL POSTMARKED: via Risk Management 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. pH DATED: August 31, 1993 IV BATCHy OR, Clerk3L22a� eput11. FROM: County Counsel TO: Clerk of the Board of Su visors k4 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: U�c �' 19�i 3 BY: Deputy County Counsel 111. 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: 9 8-cj 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 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: 10- Y-93 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Clair. to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Clai= 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 B ) Reserved fo 1 k's f' in Y 8 Against the County of Contra Costa ) AUG 3 0 1993 or ) CLERK BOARD OF SUPERVISORS District) CONTRA COSTA CO. ljy Fill in name ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ _4Q T69, 4:� 3 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) LIZ-. )_LL 2. Where did the damage or injury occur? (Include city and county 3. How did the damage dr injury occur? (Give full details; use extra paper if � required) F oz-eaz-7e,.; 4. What particular act or omission on the part of county or district offic s, servants or employees caused the injury or damage? .% Zae_- p � (over) p-,uJ C., sp..ih.,t. OLV O Lafayette Body & Paint Works % 3291 MT. DIARO BLVD, ESTIMATE OF REPAIR COSTS UVAYETM CAUFC)L4A Bumou of Automotive Repair Cutificete NoMM Tallephona, 283-3421 4ER DATE—_OWNER A f 2 Address City 2 MAKE -? YEAR ..............I LIC. NO. Z 1.D. NO. Insurance Co. STYLE--__. MODEL C—L�,/,:-,-, ATTN. Phone ADDRESS Mlleegt Paint No.—Trim No. POLICY NO. Claim NO. Symbc4 FRONT Labor Hre. Ports Symbol LEFT Labor Hre. Parts Symbol RIGHT Labor Hra. Parts Bumper Ex-New Fender Ext. FenderExt. C,L;sh;on Fender Shield Shield Bracket R L Fender Orn. - Mldg. Fender Orn. - Mldg. Reinforcement Energy-Absorber R L Headlamp Headlamp Guard/Pad 11 L Headlamp door Headlamp door Filler Seal Beam In-Out Seal Beam In-Out —Valance Cowl Cowl Gravel Shield Windshoeid (C) (T) Windshield Mldg. KA Front End Align Door Front-Panei00or Front-Panel Frame Door Lock Handle Door Lock Handle —Crossmember Door Hinge Uv-Low Door Hinge Up-Low Od Pan Door Glass - Avg. Frame Door Glass Reg. Frame W?-eel Front Rear R L Door Mldg. >Door Mldg__ Hub Cap/Wheel Gov. R L Center Post Center Post Knuckle Hub & Drum R L Door Rear-Panel Door Rear-Panel J-- Up. Cont. Arin-Shaft R L Door V.ld a -Door Mlig. Low. Cont. Arm-Shalt -R L Do-or Glass Aeg. Frame Door Glass Reg. Frame Strut Rod Shock R L Rocker Panel Rocker Panel Stabilizer Bar Link Pkg. R L Rocker_Mlo- sill Plate Rocker Mldg. Sill Plate --Steering Drag Link Floor Floor Tie Rod R L Quar. Inner Const. Ouar. inner Const. Quar. - Ext. Quar. - Ext. —Grille Ctr. Upper Lower Quar. Panel Quar. Panel ......grille Side R L Ouer. Mldg. _,,,,_Quar. Mldg. Grille Midg. Orn. Quar. Glass - Reg. Quar, Glass Reg. Support R L Center Rear Fender Skirt Rear Fender Skirt Grille Panel REAR Park Lamp R L Bumper Ex-New Marker Lamp R L Cushion Heater Housing Bracket R L Reinforcement A/C Condenser Energy-AbsortAr_R L Clear Coat A/C Receiver Guard/Pad- R L Undercoating Recharge/Freon Gravel Shield Valance Rustprooting A Lower Panel - Mldg._Orn. Pinstripes-Tape Hood Floor F,ller Color.Tint t,)od Orn. - Letters Midg. Trunk Lid - T Gate Hinge Car Exterior Hood Hinge R L Trunk Lock - midg. Orn. Set-up and Measure Fra-)= Lock Plate Lower Tail Lamp R L p d Color Sand and Buff 1 no Upper Back ULarn-, R L Lock Plate �.,n & Material - SC>eciaii. t- Rao Sup LIC. Light/Buil Stripe Kit -- Coolant Weather .1;trip Rad Cor��4oses- SUMMARY Fan Blade Clutch Back Glass Labor—'-7 ",Hr, Tail Pipe V.,*fler Ext Pars ./—L"- $ Fan Shrowd Gas Tank Neck Cap Sublet Hoses Frame - Cros-,member Tax on Water Pump - Pulley Axle H46using Advance Charges $ Motor Ft. Rear Hub -Drum - Bearing TOTAL S T,ans Linkage Clutch Control Arms Less Depreciation ..— $ THIS ESTIMATE IS VASCO ON OLIN INGOIECTIOW AND 0095 NOT COVER ADDITIONAL PARTS OR Notice: Less Deductible $ L so MAY Me REQUIRtO AFT THE WORK HAS SEEN STAPIT90. ArTEM �C WORK ftfU prices subject HAAS :TAWRITICCOM PIN on DAMAGED PARTS WHICH ARE NOT 9VIDENT � FIRST INSP""ION WAY to char"on invoice. TOTAL S .I . j WON S9 NATURALLY THIS ESTIMATE CANNOT COVER SUCH CONTIN09MC112. PARTS PRICES SkIIIIJECT To CHANCE WITH(XJY NOTIC,, 11.6 ESTIMATE 18 FOR IMMEDIATE ACCEPTANCE. THIS WORK AUTHORIZED By 5. wriat are the rooves of county or district officers, servants or employees cauging Lhe da,:.uge or injury? -��ilG-°�--- 5. at damage or injuries do you claim resulted? (Give fuel xte t of in ies or d es claimed. Attach two estimates for auto d e. a 7. How wa- the amount claimed above computed? (Include the esti ed amount of any prospective injury or damage.) $. Names and addresses of witnesses, doctors and hospitals. ------------------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or bv some person on his behalf." Name and Address of Attorney ; Clai s Signature Address Telephone No. Telephone No. i NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, 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.