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HomeMy WebLinkAboutMINUTES - 09121995 - C47 APPLICATION TO FILE LATE CLAIM C ' q 7 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 12, 1995 BOARD ACTION Application to File Late Claim ) NOTICE TO APPLICANT Against the County, Routing ) The copy of this document mailed to you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to ) the Board of Supervisors (Paragraph III, below), California Government Code.) ) given pursuant to Government Code Sections 911.8 and 915.4. Please note the "WARNING" below. Claimant: Gary D. Mosbarger and Cynthia Lee Ginn Attorney: Address: 901 Court St. Martinez, CA 94553 Amount: $5 Million By delivery to Clerk on A„e,�r �, 7995 Date Received: August 3, 1995 By mail, postmarked on August 1, 1995 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted Application to File Late Claim. DATED: Aumzst 4. 1995 PHIL BATCHELOR, Clerk, n Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6). (� The Board should deny this Application to File LateClaim ( tion 911.6). DATED: VICTOR WESTMAN, County Counsel, By eputy III. BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( ) This Application is granted (Section 91.1.6). (+✓� This Application to File Late Claim is denied (Section 911.6). I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. i DATE: 9'/� -9�' PHIL BATCHELOR, Clerk, Deputy WARNING (Gov. Code 3911.8) If you wish to file a oourt action on this matter, you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such petition must be filed with the court Within six (6) months from the date your application for leave to present a late claim was denied. You may seek the advise of any attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. IV. FROM: Clerk of the Board 70: 1 County Counsel 2 County AdmInIstrator Attached are copies of the above Application. We notifed the applicant of the Board's action on this Application by mailing a copy of this document, and a memo thereof has ben tiled and endorsed on the Board's copy of this Claim in accordance with Section 29703. DATED: 9-/3 -?,; PHIL BATCHELOR, Clerk, Byy le-A Deputy V. FROM: 1 County Counsel 2 County Administrat TO: Clerk of the Board of Supervisors Received copies of this Application and Board Order. DATED: County Counsel, By County Administrator, By APPLICATION TO FILE LATE CLAIM RECEIVED AUG 319A6 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. 1 G CL c-'( �, vt% 6% b� r 2 c �� �, hve, 1c� (' � V� 3 4 q 5 \ ►1 EZ -S53 6 y 8 . 10 � � rs G' �'; 11 12 13 C,L� e . 14 I� j �, Y�1DS �a t' y L I 04 ! -r -c � I'S c\,) v:]AVN.,ct � i n� a p p I i c 4 V^� cam, 16 aPpl,c�; y,�s 17 Q 'For 18 \ l-� 19 �v U © � ��1� rA. cc L Vk1 20r QM� U� $uc•�� �rvtil� 21 mid AcG ( � �� �;c� ,�;; �5� Cc�� � S� `� 1 � • �'�ro h 22 q-{ htc�ra �ti,�Z � ►L p� 1 a y 'S 23 � ��- C ylp� }��pw rt c�-� �� -` '�' R ,p► � 24 25 To !..)d a,,d � � ,�Ura `�` 1�d SC.� .�` �;� `�.•�-� 26 CU J), nsic 37 28 + 3 OF k ff 4 r IL 6 7 v U G.�'li - o C.rj o if Wl fit" ('O 9 10 12 ( i 1� ` t 13 r1 �'�J �'1 ��� " t' lt1� JCC` u �'l 14 OlAli 1818 C 17 W / t7 L1►' 19 20 21 22 23 )Day 24 V��( 199 25f rYtR C'a 26 _ 28 c 1 ��^ C.•U til �' �" ���"> !''S c: '� 'f P �••'�d..� c:� �7-��.y,�}'t�'t � � 2 �.� • 5 v F Gov * ro V% C� Y-t t 4 { J ` s kAg 6 1_ 7 0-e a C'IC F c U f sr\ fo r '1 9 10 1 I �� >< ��� � � �� .y , t�� S •. � f`�s�t L.+1 i at-�:.� a�. r-e�c�,� 12 �- ,nom a� �- �, v r2 - , �R 4 , ,r,-- iy t a 13 wec5 4V-k A-0 VVN, S�-a�-.� _ vctot VQ 'r O."lC.¢. , 5 vpri 14 16 ! 5b jai( C. 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Code i,�,� t io4-o LQ o�„� t v A-0 s-(� 12 YZ Ckc v-e+(` 1 _ C ta'►^ -2 S � � n � �XcvSabi� ✓fsP97.e�f'� . . 13 14 tTeviC {� r t5 16 d v., S Ll 7 iiwrl:, 17Q y,-e� 18 �`' 'lQ `, f i e ( Sl.�,���c '� G nU �r I 20 �e SYF4- o 21 0. �- � �y C t4�owe /ql r ��CQ1� F s 1.0 �, v �s u c,.,, .1 o G1.k Bole 6 � 22 _ 23 1 24 ell -7t 25 26 � �• ��.-�.' ' C' 27 C ct ` D-P c", 2 3 a we b-- s 7 � �c `,er,� 8 9 u lo Gr CIct. ( wtib,� j . 10 C 1 11 ct y4T�1 R y�t .. ( 't C? j S �Q 4-6o-c4- 12 t- €€ __ 13 �.s, e. JCC.nI,( LACE"{ 14 i • t5 16 .. ria �t1y1 '� j� ��•( t+��} *}-�..C_. PC) i"A�-�� �... ct caL c,; 17 ' �.0 o 18 19 '�!�'ta� �� �� L. :�� r'�r�j' a ►�1 �`�ck ��.:�;�--rte E'er s�� �'U��'�,� 20 21 ar v-PS Y2 d ' Q� t`Sr 1 vt C V ✓�'�0.' t � 22 15 23 24 _/-E?C f Vit, E c �5 25 26 acs �r�e�` t.,►���°-�. �"�.,c� �-�-f �-F' �'�v r"� �,,,�.�,t 4-6 28 e ckY TO: Gary Mosbarger and Cynthia Lee Ginn MDF 901 Court Street . Martinez, CA 94553 NOTICE TO.. CLAIMANT (Of Late-Filed -Claim) (Government Code Section 911.3) The claim you presented to the Board of Supervisors of Contra Costa County, California, as governing body of the County of Contra Costa and/or District, on July 6 , 1995 has been reviewed by County Counsel and is being returned to you herewith because: Your claim for an injury tc 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 as to those events occurring between October 15, 1994 and January 6, 1995. (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 that portion of 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) NOTICE OF LATE CLAIM You may seek .t e ,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: — Dqfkty Clerk 4-7 Dated: Les, / Enclosure 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 Postai Service in Martinez, California, postage fully prepaid, a copy of the above Notice to Claimant (of Late submitted Claim) , addressed to the claimant as shown above. 1 Date.: Mr By Phil Batchelor by U 6F Deputy erk NOTICE OF LATE CLAIM VERIFICATION OF PROOF OF'P b*RSONAL SERVICE 2 1 am a citizen of the United States -and a resident of the county of 3 Co w-�ra e¢ti 54g, ; I am over the'age_of.eighteen years of age and not a parry to 4 the within cause of action ; that my address is : 5 go ( �'� r S_-- "AO, v.k-z ?LJSS That I personally 6 served the within cl,v ' 01-4 L-CCC r 0-,, ro r .a.0,V_tL' 7 Cc 6 1360,C to d f= So Pa AV•S v rs fa t;� t",1-Vy 9 on the c),jvt k vCry ..� e 1, �Ca 4��► in-said action by personally 10 delivering same to the aforementioned and/or his/her agent at the address of 11 6vF sop V5V-' Cyc olo f� �� cLo�w•:� A-rki- . s+ 2,K. t c� ( V"a r n'e Z 12 CC) Jvl�y �cJ CV rc 13 fcR Tg5S 5 14 about the 5 day of �v S=, 199__S_at the approximate time of . 15 16 17 1 declare under penalty of perjury that the foregoing is true and correct, except as 18 to matters stated upon Information and belief, and as to those matters I do believe them 19 a` to be true. Executed this t S day of uG V-5 '� 199_ . at 20 'ha r rte.Z- California pursuant to provisions of California Code of 21 22 Civil Procedures, Sections 446 and 2015.5. 23 24 25 DECLARANT 26 ,72 - w.e18z1 JJ V LLT cc)'ey mouy-�-� 2 4 5 6 7 8 9 . 1 11 C3 ( + `i.r ` S 1213 � 14 f5 16 17 18 19 �l 20 21 r� 22 23 24 25 26 27 28 Y Y s- 1 k �vo � Y , r'' CLAIM .. BOARD OF SUPERVISORS OF CON'RA COSTA COUNTY, CALIFORNIA AMENDED September 12, 1995 C 41 Cna;^st the County, or District governed Dy) - BOARD ACTION Cc;, S;:;ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT (. � 7 crid oLr,c Action. All Section references are to ) The copy of this document mailed to you is your notice of Califcrnia Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $1,574.89 Section 913 and 915.4. Please note all •Warnings". CLAIMANT: State Farm Insurance Companies 05-6778-623 ATTORNEY: Karen Jones Date received ADDRESS: PO Box 2357 BY DELIVERY TO CLERK ON July 31, 1995 Antioch CA 94531-2357 BY MAIL POSTMARKED: Hand Delivered via: Risk Mgmt. I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppHH BB DATED: August 2, 1995 BYIL DeputyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors (i/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: s Dated: �,� 8Y: y County Counsel 11I. 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 Superviscrs 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: m - q S 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: 9 —1,3 — 5.5' BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator qo3 i STATE FARM State Farm Insurance Companies ®® RECEIVED ,NSURANC® 1901 West 10th Street July 27 , 19 5, _J1 3 + 1995 Antioch,California 94509 Uz'' / Mail:P.O.Box 2357 CLERK BOARD OF SU ERVISORS Antioch,California 94531-2357 CONTRA COSTA CO. o I Phone:(510)779-2900 CONTRA COSTA COUNTY ,1 RISK-MANAGEMENT P.O. BOX 69 i MARTINEZ, CA 94553 ****IMPORTANT**** _ PLEASE WRITE OUR- _ CLAIM NUMBER* ON YOUR REPLY OR PAYMENT THANK YOU RE: Claim Number : *05-6778-623 Date of loss : 07-20-1995 Our Insured Roy E. Woodhouse Dear Victor J. Westman County Counsel: State Farm State Farm Mutual Auto Insurance Co. Insurance Company on behalf of Subrogee, Roy E. Woodhouse hereby makes claim for $1, 574 . 89 and makes the following statements in support of claim: 1. Notices concerning this claim should be sent to State Farm Insurance Companies, P.O.Box 2357 Antioch, CA 94531-2357 2 . The date and place of the accident giving rise to this claim are; on 07-20-1995 at Hwy. 4 E/B Pt. Chigo/Will 3 . The circumstances giving rise to this claim are as follows: Obj . flew from County Veh. hitting#1 4 . The injuries reported consisted of NONE. 5. Our total claim is as follows: Company's Net Payment $1, 539 . 34 Insured's Deductible Interest $35. 55 Rental Total Property Damage $1, 574 . 89 ta HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001 Page 2 July 27, 1995 NOTICE: This form is to provide notice of our claim for damages in accordance with the six (6) month statute. If this form is not acceptable for compliance with the statute, please rush the necessary form to my attention for proper filing. DATED: BY: Ken Joe Claim Specialist (510) 779-2935 State Farm Mutual Automobile Insurance Company KJ/hcb Encl: Supporting Documents cc: Roy Woodhouse 05-2791 CLAIM No 05-6778-623 POLICY No 6923-740-05M�;k, LOSS DATE 06/20/95 DRAFT No 1 02 433381 DATE 06/23/95 PAYEE ROY E WOODHOUSE AMOUNT $*******40.0, 107'BEGONIA CT A;�MzriMARTINEZ CA 94553-5035 � COVERAGE TIN �������� RENTAL REIMBURSEMENT _ 501-1 $40.00 REMARKS 4 DAYS LOSS OF USE AT $10 PER DAY. 1995 I CREATED BY Vicki Williams ANT ,;C :9__ IMS I,A„IAN STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY 1NORTHER02 433381 J ROHNERTNPARKCALIFCANIA OFFICE CUSTOMER BANK OF ASERVICENAMERICAS11233/1210' ” ,,�—,, ; DATE 0 6/2 3/9 5 IN{YAANC� Antioch 02-124 CONCORD, CA "' • t �"' COVERAGE RENTAL REIMBURSEMENT CLAIM NO 05-6778-623 POLICY NO 6923-740-05M CLAIM UNIT 501-1 $40.00 i is LOSS DATE 06/20/95 7 iw'q ' INSURED WOODHOUSE, ROYr f t rrr**,r **r *r t****,r*r*rrr,r,ta*,►rt,r t+t,±t*****r*r**,t,t*,t**k***,t*r**,r r*r,r**r**r*EXACT Y F 1k:dF#< 7 'lltih>k`?• Y> L FORTY AND 00/100 DOLLARS 'rh Pay to the �, ,c-.•r �a��e, ��`��'^`�'` Order a ROY E WOODHOUSE� F 107 BEGONsIA CT� TIN MARTINEZA 94553-5035 RUTH VWIL APPROVED BY CLAIM NO 05-6778-623 POLICY NO 6923-740-05MR LOSS DATE 06/20/95 DRAFT NO 1 02 433380 PAYEE ;r � v a DATE 06/23/95 BERNAL AUTO BODY INC .& ROY E WOODHOUSE AMOUNT $****1, 4 7 5.3, 406-N BUCHANAN CIR I�" PACHECO CA 94553-512 A. 0 A�� "' , COVERAGE TIN 05-680044723 COMPREHENSIVE - FWT, CAC, OR LOMV s tag r OUTGOING390-1 $1,475.34 REMARKS N JUN.2*3 1995 CREATED BY Vicki Williams w0f, ANTIOCH CLAIMS STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY 1 '02 433380 J NORTHERN CALIFORNIA OFFICE BANK OF AMERICA NT & SA 11-35/1210 ° ROHNERT PARK, CA CUSTOMER SERVICE AMERICAS 1233 + DATE 06/23/95 IMf Y.AN C. " ' ® Antioch 02-124 CONCORD, CA COVERAGE COMPREHENSIVE - FWT, CAC, OR LOMV CLAIM NO 05-6778-623 POLICY NO 6923-740-05M CLAIM UNIT 176 ° 390-1 $1,475.34 LOSS DATE 06/20/95 , x " f INSURED WOODHOUSE, ROY , ' a'� * X AND *:`�k iii:'*i >>j:` % :s;..<:'•''•'E>'"' 5 � ',*EXACTLY ONEsTHOUS FOUR HUNDRED'SEVENTY-FIVE AND 34/100 DOLLARS $,..:.... :. ..,:_ ,, .e «;y .4 ` e k Pay to the #F „Y, w '•.< Order of. BERNAL AUTO BODY INCROW-",ROY E WOODHOUSE 406 N BUCHANAN PACHECO CSA .94553-5120 TIN 05-680044723 AUTH VWI L APPROVED BY CLAIM NO 05-6778-623 POLICY NO 6923-740-05M LOSS DATE 06/20/95 DRAFT 140 1 02 433967 PAYEE DATE 07/13/95 ROY E WOODHOUSE 107 'BEGONIA CT AMOUNT $ 2 4. 0 MARTINEZ CA 94553-5035 COVERAGE TIN MA",I_L E D RENTAL REIMBURSEMENT 501-3 $24.00 REMARKS BALANCE DUE RENTAL ' .I U 1V3 1995", CREATED BY Helene C Boersig AN I IOVfl CLAMS STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY 1 02 433967 J NORTHERN CALIFORNIA OFFICE BANK OF AMERICA NT & SA 11-35/1210 ROHNERT PARK, CA CUSTOMER SERVICE AMERICAS 1233 DATE 07/13/95 IN{V��NC� Antioch 02-124 CONCORD, CA ..,x COVERAGE RENTAL REIMBURSEMENT CLAIM NO 05-6778-623 POLICY NO 6923-740-05M CLAIM UNIT 176 501-3 $24.00 LOSS DATE 06/20/95 INSURED WOODHOUSE ROY *EXACTLY TWENTY-FOUR AND 00/100 DOLLARS *ait+ ;,,.>:,: :...,•;.: Yt Pay to the }¢ Order of.- ROY E WOODHOMtl,11,1�1 .107 BEGONIA f'°x MARTINEZ` CA 94553-5035 TIN ONE APPROVED BY =NT.ERFRISE RENT—A—CAR LOM ANY OF SAN FRANCISCO MO 7:3i� 6:OOP TO 7.3()A 6.0�P 1260 n I AMC)taD 4!A'r '511:x—•6'14-1110 WE 7:30A— 6:O P T'H 7:30— 6:00P CONCORD CFS i. . i20--jr_'.26 22331 FR 7:30A— :OOP SA 9:OOA-12,OOP rlAv j -- YEAR RENTAL SOURCE I I.D. I, N TYPE • D 14�L;[i 1 YEAR U RENTER MILES s• t.10 CtIARC7E i A GES F 1 FERENY ' ADDRESS HOME PHONE c - ORIGINAL'VEHICLE city, STATE ZIP OFFICE PHONE 55.. — _ COLOR LICENSE NO. LOCAL ADDRESS PHONE aqm ', GALE t-IDAR DAY SCAR I DRIVER'S LICENSE .STATE EXPIRES .HOURS d 'c- .-t•�--. MILE• IN D1S�•' HEIGHT WEIGHT 1vtS RAIR DAYS AGE OUT F r_ WRY 22.99 OCTAL ITY I EM1500YER DRIVEN BILL ..GMPANY ' CONDITION AGREED TO x TO REN R TO �p }��'� y �. JE 8 'S C Y STATE 21P _ r F f A N: PHON EXT. ! �wfA.lJ FI C EPT9 E RENTER REQUESTS DAMAGE WAIVER(DW(AT RENTER- p JV YYY��� DAMAGE DAILY FEE SHOWN IN ADJOINING COLUMN.SEE T� O RESPONSIBILITY RE VERSE.THIS IS NOT INSURANCE. Gl.99/DAY`, ,... RENTER DECLINESTE RENTER REOUESTS PERSONAL ACCIDENT INSUn. RENTER PERSONAL ANCE(PAI)AT DAILY FEE SHOWN IN ADJACENT - OUT E t/a '/4 Ve / % S/4 7/aF ACCIDENT INSU N COLUMN AHD HAS KAD THE POLICY CERTIFICATE. X 2.w/DAY RENTER DECLINES R RENTER REOUESTS OPTIONAL SUPPLEMENTAL RENTER IN E '/a 'h a/e '/z a/a a/4 % F OPTIONAL SUPPLEMENTAL LIABILITY PROTECTION (SLP) AT DAILY RATE y LIABILITY PROTECTION(Sl SHOWN IN COLUMN.SEE REVERSE. X SLP 5.99DAY. ADDITIONAL DR — N PERMITTED WITHOUT ENTERPRISE'S APPROVAL. REPLACEMENT. HICLE` I request Ente rise's permission to allow • AGE LICENSE NO. q TP A D STATE• EXP. /�VV tT]� -.�• TU OR LICENSE NO. E T Who Is under my control direct ve I nled.vehicle for me and in my behalf. I am responsible. TAA FUEL CHARGE �� / for their acts While they' ddvin I fulfil to s aril conditio of this agreement. E ECAR III :..:_.1••99/GALLON BY E'S REP MILE- IN -" RMISSION NTED FOR VEHICL TO LEAVE THE TATE. AUTH.BY RTES AGE OUT YES NO ENTERPRISE'S PEP DRIVEN TOTAL CHARGES <;1 X NO OTHFR STATE PERMIT'T'ED CONDITION AGREED TO NO GASOLINE REFUND DAY MINIMUM - R ACKNOWLEDGMENT OF - .CONDITIONS O RENTER. HAVE ..AND A •THE TERMS AND CONDITIONS ON BOTH SIDESOF THIS AGREEMENT.MY SIGNATURE BELOW IS CONSIDEPIL, rO HAVE BEEN MADF ON ANY APPLICABLE CREDIT CARD VOUCHER AND I AUTHORIZE . .. ... r-'� DEPOSITS ENTEHPRISE TO PROCEIsS SUGII VOUCHER r(`,R ADVANCE DEPOSITS AND CHARGES gTHIRD INCLUDING PAY- • r• RESTRICTIONS. REFUNDS DO � RENTERD E T-1/77 �rrr or r. J'LLr—__—JJJI A7BY REP X l r. c• -I WILL DATEMME ORtG. AMOUNT PD BY TYPE DATE PD. AUTH Is CLOSEDOUr E '/a '/� �/a '/: a/e 'h T/e F RETURN ,,,�� , DEP. 1, . rn-JAR BYIN E '/6 '/4 % '/7 a/a /4 "A F EXT. ADDrL - PAID CR.CARD Cl,w TO DEP. BY EXT. ADDTL RECEIPT FOR CASH REFUND. TO DEP. EXT. ADDTL DATE AMOUNT BY P. RECEIVED TO DEX EXT. ADDTL CLAIM INFORMATION TO DEP. ADDITIONAL INFORMATION: POL.OR CL k INSD.SAME LOSS DATE THEFT_ACcinEHT-_. .. _ PHONE NAME —_ VTER RESPONSIBLE FOR AND REPAIR SHOP fHORIZES CHARGES TO THEIR RERNALS AUTO BODY —.. _DIT CARD FOR TRAFFIC TYPE CAR LATIONS INVOICE D045041 ON FILE 0/23/g5 at 09:25 File X710174-00OZ914 hl STAT F_: _T1\XSLJRAN'CE: COMT-�ANZE;S LIKE A GOOD NEIGHBOR, STATE FARM IS THERE E ;• 1901 W. . 10TH STREET l EANTIOCH, CA..94509 {51,0} 779-2900 FAX: .{510} 779-2905 1 , ESTIMATE OF RECORD Written By: H. :VASQUEZ . 06/23/95 '09:25 a.m. Claim Rep: KAREN JONES # (510) 779-2935 Insured: ROY. E. WOODHOUSE Claim #05-6778-62301 Policy 4/ Address: 107 BEGONIA CT MARTINEZ, CA 94553-5035 Date of Loss: 6/20/95 at 8:40 Day: . (510) 757-6600 Type of Loss: COMPREHENSIVE Other: (: „ ) 686-1330.- Point Of Impact: 16 NON-COLLISION Inspect, �. Locations Drive-In : Repair' BERNAL AUTO BODY (510) 689-0360 Facility: 406 NORTH BUCHANAN CIRCLE .PACHECO, CA . 94553 License "/i 93 LEXU LS 400 4D SED 8-4.OL-FI VIN: JT8UF11E3P0159894 Lic.#: 3DBE548 CA ` Prod. Date:" 0/0 Mileage: 40667 Automatic transmission Power driver seat Power passenger seat Bucket seats Leather seats Recline/lounge seats Power steering Tilt. wheel Telescoping . . Power brakes:. . 4 wheel,-disc brakes Tinted glass Rear defogger. . Power windows Intermittent wipers Alloy wheels. Power locks A/c fCruise contol Driver airbag Climate control } Power mirrors Special -mouldings Theft, deter/alarm Keyless entry Dual mirrors 2-tone paint Clear coat paint ------------------------- ------------------------_ REPR/. PART LBR PAINT {, N0. REPL DESCRIPTION OF DAMAGE QTY COST HRS HRS MISC } --------- ---------------------------------- ----------- ---------- 1 FRONT-BUMPER „ -- --- 2 R&I Front Bumper 1 0.00 2,0 0.0 3* Repr, Cover 1 0.00 1 ,5 2.5 4 Add, for .Clear Coat 1 0.00 0.0 1 .0 5 Repl 'Mo_lding 1 87.62 0.50.0 6* R&I LAMPS & TRIM 1 0.00. 0.b 0.0 7 HOOD & GRILLE 8 Repr Hood : 1 0.00 2.5 4.0 Page: 1 1 . - Vb/Li/vD au vv:LD C11e viui /4-vuuzv14 Li ^��T.'ATF' L�ARM SN'SURAIVCF_; CC:�MI-'A1�7=F;`. Claim #: 05-67.78-62301 �t.• fi 93 LEXU:LS 400 AD SED 8-4.0L-FI m -- ------ ---- ---------- ---- - - - ----- n-- CREPR/ PART LBR PAINT r N0 REPL DESCRIPTION OF DAMAGE QTY COST HRS HRS MISC m ----------------------- --------------------- ----------------- -------- -- 9 Overlap Major.Adjacent Panel 1 0.00 0.0 -0.4 3 10 Add ,for Clear Coat 1 0.00 ' . 0.0 0.7 11 Repl Grille. assy 1 267.84 0.7 0.0 D 12* R&I WASHER NOZZLES 1 0.00. 0.2 0.0 13* Repr . COLOR TINT 1 0.00r0.5 0.0 14* Repr COVER.CAR1 0.00 0.5 0.0 T 0.00 m 15* Repr COLOR SAND & BUFF 1 0.00 0.6 0.0 m --- -----------------------------------------------------.---------------- ----- z-- z Subtotals. ___> 355.46 . 9.6 7.8 0.00 m t t W D D m D n ' D s S m -rt m u, 1'. m z x.1 m l m� Co i r; rr z z: Page, 2. c: x rt. rt v: 3* ri e o. ` rlie 9f1V1 /4—VVVZV14 G1 '�"S r. rF Ly.ARM x__I\r IJRANCF.: C©1�9T7AN=F::3 Claim #: 05-6778-62301 ` 93 LEXU LS 400 .4D. -SED 8-4-OL-FI . a : 2 u z. R C' r r rt z a rt rt z r — rt. Parts 355.46 Labor 9.6 hrs $ 52.00/hr 499.20 Paint 7.8 hrs $ ,52.00/hr 405.60 Paint/Materials—_7_8—hrs�$. '22_ --- 00/hr171_60 SUBTOTAL $ 1431:86. $ 527.06 at 8.2500% 43.48 Tax on � --------------------------------------------- . D TOTAL COST OF REPAIRS . $ 1475.34 r -----.------------ ---------------------- --- m NET COST OF REPAIRS D r ALL, S)PP1AlQ1f5'RUN Pw.APP'fI]I&By A S1A9E HN EHMTM. C r D Estimate based on tM CWM BTIti?tT1lG GUIDE. 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I .. . � . .....: -, � .--- �. . 1� - ".. � :-.-............-- � ..".1 . .i..- ,. m ��--.. .. ��.... w -...:: �.- . .1. ��i:: . -- . - -� . I .... . ... ... . - . . . - . - --. -f R�; � ---I x.--- .. �� �. , , , . ,I . ! i i i : : ------------- .-...l.- ---.- ,=,,=&gre-,2z�K' ,'-- �.,, �.'�,� --- ----zj,��=%-�k--a�------ I-- . - .a,�.., �. -- . .. � - � CLAIM C► BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 12, 1995 Cl?;m oar4rst the County, or District governed by) BOARD ACTION 2::-' S::,ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT acid SLcrc Action. All Section references are to ) The copy of this document mailed to you is your notice of Califcrria Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Mount: $25,000.00 + Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Sandra Ruffen ATTORNEY: AllanM. Tabor 11 Embarcadero West, Ste. 130 Date received ADDRESS: Oakland, CA 94607 BY DELIVERY TO CLERK ON August 3. 1995 BY MAIL POSTMARKED: August 2, 1995 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. eeHH gg � DATED: August 4, 1995 BrIL DeputyLOR, Clerk 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( loKThis 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: dq Dated: — ?— 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 Superviscrs 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: 9-1A - 95 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. Or For Additional Warning 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 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: 4 /3 —gS BY: PHIL BATCHELOR by &,,'_�_&_JDeputy Clerk CC: County Counsel County Administrator RECEIVED AU6 3 10 1 RYAN & TABOR ALLAN M. TABOR CLERK BOARD OF SUPERVISORS 2 STATE BAR NO. 52846 CONTRA COSTA CO. 11. Embarcadero West, Suite 130 3 Oakland, CA 94607 Telephone (510) 444-5350 4 Attorneys for Claimant 5 6 CLAIM 7 SANDRA RUFFEN. 8 Claimant, VS. 9 CITY OF RICHMOND, COUNTY OF 10 CONTRA COSTA, NEVIN HOUSE/PHOENIX PROGRAM, 11 Respondents. 12 A. Sandra Ruffen lives at 3215 Nevin Avenue, Richmond, CA 13 94804 . .• . 14 B;,� .Notices in this matter are to be sent to Ryan & Tabor, 15 11 Embarcadero West, Suite 130, Oakland, CA 94607 . 16 C. On May 5, 1995, Sandra Ruffen was attacked, beaten and 17 injured by a resident. At all times herein mentioned, Respondents 18 who owned, operated and maintained the Nevin House, negligently 19 failed to supervise and maintain the premises, proximately causing 20 the injury to claimant as hereinafter described. 21 D. Injuries: Claimant sustained injury to her low back and 22 head. 23 E. Damages with respect to this claim. The jurisdiction 24 rests properly in the Superior Court and exceeds $25,000.00. 25 F. Names of public employees: Aaron Wright. 26 DATED: July 31, 1995 RYAN & T R 27 28 BY RYAN&TABOR ALLAN M. TABOR ATTORNEYS AT LAW PORTOBELLO SQUARE 11 ENIBARCAOERO WEST,SUITE 130 &4 , OAKLAND,CA Iii Mal"AAL14sn 3 � ! - � . _ . v� ƒ . m = / % ¥ ~ m � /� \ � \ \ %M < » q » O ` mm m . /w Qro \ E , §g � = 4-) Q # rMew oo@ % \ Q m @ x � 2 r q m @ % ® . � M t r-q Q ru q 0 CL R 0\ \ ( � ƒ 0 . $ ) dE / 220 < \ o a . CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 12, 1995 CIp:m a^ei^st the County, or District governed by) -- BOARD ACTION C, 4-7 2:--1 :` ,ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Eucrd Action. All Section references are to ) The copy of this document mailed to you is your notice of Califcrria Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $1,020.00 Section 913 and 915.4. Please note all 'Warnings". CLAIMANT: Kadeth Pozzesi ATTORNEY: Date received ADDRESS: 2031 Date St. BY DELIVERY TO CLERK ON August 1, 1995 Concord, CA 94519 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 2, 1995 JAIL BATCHELOR, Clerk ., 11. FROM: C y 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: Z Jr 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). 1V. BOARD ORDER: By unanimous vote of the Superviscrs present ( This Claim is rejected in full. ( ) Other: 1 certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: PHIL BATCHELOR, Clerk, By ( !sa_p,�� , Deputy Clerk 44 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 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 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: g- /a _ BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Ciaim' to:. BOARD OF SRERVISORS QF CON'T'RA CDSTA COUNTY INSTRUCTIONS 'M CLADAANT 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. 7 C. If claim is against a district governed by the Board of Supervisors, rather than the County, the na=e 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 enrity. E. Fraud. See penalty for fraudulent claims, Penal_ Code Sec. 72 at the end of this Form. R£: Claim By ) Reserved for Clerk's filing stamp Knoet-h PvzzeG i RECEIVE® �" i�P,✓ Against the County of Contra Cosh � ) Y�Q�,,, I or. ) N�tt� District) CLERK 80ARD OF SUPERVISORS Fill in namee ) 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) 2. Where did the damage or injury occur? (Include city and county) aa� 'lar V► �c_ Rd. 5J-�srm otr kii) ►'rl S -r��- �n�, s P,�1�4-sbu. , CFS"ggsC,2S ih A-C>A-- o,P 1 DL1JS� cc�5 r�- cawn c, 3. How did the damage or injury occur? (Give full details; use extra paper if required) 1 pe,clled u.p _I-o (Jexr-k �'V1 C.on�- o� rnY ^i'ertd,s hocese . 17'lY 1eG-I- •�-ron4- .ire_ cross2(4 over- 44ne Skov rn dr-c O-)) 4%.e 54-orrrn draii i odro-+-p- moue_l -�rward C•o{•44, m y wheel,, OAd rn y 4_e- 4, l e4 f,-0.174 .0-Ac-4 4S11.1yi,10 �41e. h o% 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? 5+0rrn drain was no-l- Properly M0.614CLlned: -i-ke_ ;Z bol--S W�I'C-k 4�tX 1'4- ih place we're. Vni'Ss191 0ACIWIV9 _41a P6J_,_0A?rC4e 40 moue . t ?, anaL are the names of county or district officers, servants or employees causing `..he -a:---ge or injury? 1 UOIJ tU o �.erson Cs) we,�. n ecl. y 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for 49uta e. lej4 C,—cY% - louse-v- Ce-^d-e,- 4er4ed . Lem- deA4d j deep scrr.,-4-c� iik #DaI*n1-. EEu.mpQL-- p"U ed aud- o.(^-cx11' nmer� 6.i\'q(t,4- 6Ooc`J&4- cic`-"e , See esA;-" des L:.211-110 41r" , 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Tangy god y 5lnops 4✓ est+'rnc_4e s Made Ca!Is re and j'n !���' L - C,R d�:v S. >�c r: es � S Ct v c ld is shop - 8. Names and addresses of witnesses, doctors and hospitals. C,610.J vs g -9t3 9 e ro\4 '7�zo r oto Mar U4Sk- -P-a w�`�neSeSed Cjr►i -eeir -0o23i w4nessed G'ctr r-h hole t� R#sbur,,� C.A ggS19 a4ei`cieA4- coNed 4.- assridz,"ce A 4.a 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT S/rn t een 4,me-1 (4AIKIOy14N t see cz2�c ' b�►22 its - ' �'R' _ Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Ator by some person on his behalf." Name and Address of Attorney 4tr 44 4" 5 Claimara Signature /U©-� relores.en led 11 "Y o d 31 Address Telephone No. Telephone No. (S/off (o 3`7- 5 -72 N O T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, cityy 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 ($10,000, or by both such im-prisonment- and fine. t , VEHICLE DAMAGE REPORT— ESTIMATE •>VRICIS BODY SHOP n® � NAME 2535 MONUMENT BLVD. ADDRESS o�0 3 l o�CL� S CONCORD,CA 94520 >� (510) 682-3250 FAX. (510) 682-9829 CITY C¢>✓ L / / "Specialists in Uni-body repair" flomQ �C Date -7 � featuring Phone�j 'S'77a— Ins.Co. CAR BUNCIi—the Ultimate Unibody Repair System LIC. . tour Wheel Alignment 8t Precision Color Matching Business. Phone Adjuster Engine Other Claim N Trans. Date of loss W.0. Paint Code Odometer �`'$'—►r�, �rTSMAN'� 5.,.n.or<�wno�n.ro..fw.wra. IRAINEB 1ECIINICIAN MEMBER MEMBER Trim Code Year � Make .--- � Model ' % VIN � � Uj ¢ o i z z q DESCRIPTION PARTS m� t¢ ¢Co w¢ w5z 4z w-a ' ZZ Lfi az o This damage report Is based upon our detailed Inspection COLUMN TOTALS of your vehicle and does not include repairs other than ilernized above. Occasionally additional damage will be BODY Hrs. a C) PARTS discovered once the work is opened up,and additional repairs Sub eet to Invoice will be required. TOTAL Our parts prices are from Mitchell's Manuals.Any rise In PAINT Hrs. p�`� 03o LABOR i cost must be supplemented to us by owner or Insurance I company. FRAME I-Irs. 0SUBLET Repairs will be made for you as owner. 11 you do not Intend CHARGES to pay with your own funds, please make certain the MECH. Firs. Qu SUBTOTAL Insurance company can deliver their check to you In time to pick up your vehicle. All repairs must be paid In full before the vehicle will be released. SUBLET SALES TAX It a lienholder Is named on the Insurance check, their endorsement must.be obtained. PAINT & i We are proud of our technicians and their superior quality MATERIALS d I craftsmanship.Thank you for letting us serve you. WRITTEN BY TOTAL j 11769 JIM'S CAL AUTO BODY, INC. 2520. MONUMENT BOULEVARD CONCORD, CA 94520 (510) 689-6117 Fax: (510) 689-7836 Visible Damage Quotation #11769 by TOM on 08-01-95 KA DET►f CADETH POZZESI 2031 GATE ST. Style 4DR Insurer DATE Lic. Plate: 898 CVU Adjuster : CONCORD, CA 94519 Paint Code: GRN Appraiser: Phone: 687-5772/ Prod. Date: Claimant : 71 FORD MAVERICK Profile STANDARD Insured VIN: Deductible: 0.00 Policy # : Mileage: 0 Claim # Options: # Labor Op Description Price Labor Paint Labor Group Price Group 1 REPAIR FRT VALANCE PANEL 0.00 2.5* 1.6* BODY * EXISTING 2 REPAIR L ROCKER PANEL 0.00 3.5* 1.8* BODY * EXISTING 3 ADL LABOR TINT COLOR 0.00 0.5* 0.0 BODY 4 ALIGN FRT SUSPENSION 0.00 1.0* 0.0 BODY * EXISTING * Judgement Item Summary BODY 7.5@ 54.00 405.00 PAINT MATERIALS 74.80T REFINISH 3.4@ 54.00 183.60 Non-Taxed Labor 588.60 Taxed Costs 74.80 Tx 8.250% 6.17 Labor ( 10.9 hrs) 588.60 Add'l Costs/Materials 74.80 Tax 6.17 Grand Total 669 .57 UNDER CALIFORNIA CODE OF REGULATIONS, TITLE 10, CHAPTER 5, SUBCHAPTER 8, SECTION 2695.8.D.2C., YOU ARE ADVISED, THAT YOU HAVE THE RIGHT TO HAVE ANY REPAIR FACILITY OF YOUR CHOICE TO DO THE REPAIRS TO YOUR VEHICLE. HOWEVER, YOUR INSURANCE COMPANY CAN REASONABLY ADJUST ANY WRITTEN ESTIMATE PREPARED BY THE REPAIR SHOP OF YOUR CHOICE. IF YOUR CHOOSE TO USE A REPAIR FACILITY SUGGESTED BY YOUR INSURANCE COMPANY, THEY WILL GUARANTEE THE DAMAGE VEHICLE TO BE RESTORED TO ITS PRE-LOSS CONDITION AT NO COST TO YOU OTHER THAN AS STATED IN THE POLICY (I.E. POLICY LIMITS OR DEDUCTIBLE) OR ALLOWABLE DEPRECIATION. ESTIMATE RECALL NUMBER: 08-01-95 09:26:52 EstiMate Plus is a trademark of Mitchell International Copyright 1991-1995 All Rights Reserved a ' 3-72- To 72- 1 o qlua.re n-�-e �, o�c. �rolo � iil - � ("39-76 S> 3 : 9 . o3 675 519 � co . 50 - c -- l e e t -)o-Y was Cis ren o rte , 1090 =� 014 q CS I C, (,2S7r s � `7/ Farm ffictuer,,c,k— bL VW 1k-52L1sq�K(08 (SU-- S i r t C�oDd II ori 4 C� irf{Sy1 ��..:c. ,Iq %3'-..�.�'���.e�r�y�'�a��?r.}-"�, -,+�?c=- ,„ ii`....=gL+.•w„�.'`itx.--.'=k a:-r•. „-,r;..,:�.z�`•� '+',-��r .�,.._, 4 < VISA (AT00))) , TOWING AND RECOVERY 2655"R"CLOVERDALE AVE", CONCORD.CA 94518. ` HOLD:. YES (510)827-1860 ,,. 24 HOUR'SERVICE s -CASE NO" . DATE 19 ` k' NAME' 8'l "/r (/� �-u S/ ADDRESS, CITY 6 STATE ZIN PHONE;_ TOW REQESTED:.BY CU� TIME YEAR [ MAKE IC.NO: > Ck COLOR V.I.N.NO. CASH CHARGE ON ACCT. FOR Jt= " REPORTED TO TOW. FRONT - REAR DOLLY NMEELLffT.� CARR9iRM 1049 10.97 10.99 �£ . _ snow. 2W Tow trotma START WEN.. COMPLETE UEN ADVANCED CHOS.OR ADM:FEES: ' STORAGE.Two W TO:,- TOTAL DAYS,,-•- , - RELEASE OF PERSONALPROPERTY. PHONE NO. mc •TOTAL' • • •- • • • . ACCOMPANIEDALL CLAIMS MUST BE • BY THIS BILL WITHIN 5 DAYS R.O. . . ` P.O. EXP RATION DATE" _ NEMBERSNIP No.OR DRIVERS UC.NO. WE CHARGE 1.5% MONTHLY ON UNPAID BALANCE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 12, 1995 Cip;m Gnainst the County, or District governed ny) BOARD ACTION S;:porvisors, Routing Endorsements, ) NOTICE TO CLAIMANT C` 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: $1,435.30 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Maurice Playberry ATTORNEY: Date received ADDRESS: 2911 Mary Anne Lane, 4125 BY DELIVERY TO CLERK ON July 28, 1995 Bay Point, CA 94565 BY MAIL POSTMARKED: July 27, 1995 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppHH gg DATED: July 28, 1995 BYIL DeputyLOR, Clerk II. FROM: unty 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: 4/ S 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 (v'l This Claim is rejected in full. ( ) Other: 1 certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: Q-/a_gS PHIL BATCHELOR, Clerk, By ^ Q Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately, * For Additional Warning 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: !I-13- BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator U Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIOIJS 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 5911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 146, 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 f orm. RE: aim By ) Reserved for Clerk's filing stamp 12 0 RECEIVED } Against the County of Contra Costa ) JUL 2 8 IM or } CLERK BOAR©OF SUPERVISORS District) CONTRA COSTA CO. Fill in name } The undersigned claimant hereby makes claim against the unty of Contra Costa or the above-named District in the sum of $ Z and in upport of this claim represents as follows: •�� � 1. When did the damage or injury occur? (Clive exact da and our) 2. Where d d the a or injury occur? (Include city and county) i - ► � �' ; 3. How did tbq damage or injury OC c (Give full�dgtai s, u ext paper if red ired)M� aaur. ►12 Q c� _440 4. What particular act or omission on the part of county or district officers, se_^vant , or loyipes caused the injury or,damage? 5. wnaL are �ne na.,Des of county or district officers, servants or employees causing the -damage or injLx� 5. What damage or inJ �ies do you claim resulted? (Give Hull extent of injuries or damages claimed. Attach two estimates for auto damage. Zt� E. 7. How was the amount claimed above computed? (Include the estimated amount of an prospective injury or damage.) 2-LW $. Names and addresses of witnesses, doctors ar, hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ___ITEM_... AMOUNT Gov. Code Sec. 91D.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or some person his behalf." Name and Address of Attorney Claimant's gnature aC-I� 1 Addre C� STelephone No. Telephone No. LO ,I�,�� N O T I C E Section 72 of the Penal. Code provides: "Every person who, with intent to defraud, presents for allowance or for Payment to any state board or officer, or to 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 imprisonrjent and fine. ' e > 4 E J r r C�;,Vo \l r 110 ll� LP � J .9 CLAIM .. BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 12, 1995 Clp4m aaei.nst the County, or District governed by) BOARD ACTION C . y --' S:;;ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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: Unknown Section 913 and 915.4. Please note all "Warnings". .CLAIMANT: Jim Boner ATTORNEY: Date received ADDRESS: 2441 Warren Road BY DELIVERY TO CLERK ON July 27, 1995 Walnut Creek, CA 94595 BY MAIL POSTMARKED: Hand Delivered via: Risk Mgmt. I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppHH BATCHELOR, DATED: July 28, 1995 BYIL Clerk 11. FROM: C unty 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 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: qs 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: 9—/3 _ qs BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Ciai- to: BOAM) 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 na•ne 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 for=. RE: Claim By �- ) Reserved for Clerk's filing stamp le � RECEIVED JUL 2 719�i Against the County of Contra Costa ) or ) J LQ; CLERK BOARD OF SUP RVISORS District) CONTRA C ACO. � Fill in n ) ' _- �c The undersi fined claimant hereby makes claim ago 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) 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 particul act or omission on the part of county or district officers, servants or employees caused the injury or damage? Cv�.r j a. WnaL are the names of counLv or district officers, servants or employees causing the da:a---ge 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.) 6. Names and addresses of witnesses,. doctors and hospitals. AV 9. List the expenditures you made on account of this accident or injury: DATE AMOUNT N - !.,-.'Gov,. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some Doson on his behalf. Name and Address of Attorney aimant Signature (Address) Telephone No. Telephone No. W 1 9 V 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 i%prisonment- and fine. CLAIM September 12, 1995 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA - E . 47 CIA;rm aneinst the County, or District governed by) BOARD ACTION ?c_-2 S;:;ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Soard 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 Govet nment Code Amount: $122.03 Section 913 and 915.4. Please note all "War ings". CLAIMANT: Stacy Adams ATTORNEY: Date received ADDRESS: 20 Roberts St. BY DELIVERY TO CLERK ON July 26, 1995 Bay Point, CA 94565 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. PPHH gg DATED: July 27, 1995 JY DeputyLOR, Clerk 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. (This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: [ —a?- ( 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 ( v) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: 9L 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 /_� , /gg,T" BY: PHIL BATCHELOR by ;4.,4jDeputy Clerk CC: County"Counsel County Administrator OFFICE OF COUNTY COUNSEL DEPUTIES: CONTRA COSTA COUNTY PHILLIP S. ALTHOFF �i SHARON L. ANDERSON »•r,. ANDREA W. CASSIDY COUNTY ADMINISTRATION BUILDING VICKIE L. DAWES P.O. BOX 69 MARKE S. ESTIS MICHAEL D. FARR MARTINEZ, CALIFORNIA LILLIAN T. FUJII VICTOR NTJ. WUNSEL 94553-0116 DENNIS C. GRAVES COUNTY COUNSEL GREGORY C. HARVEY SILVANO B. MARCHESI TELEPHONE (510) 646-2074 KEVIN T. KERR ARTHUR W. WALENTA, JR. FAX (510) 646-1078 EDWARD V. LANE, JR. ASSISTANTS MARY ANN M. MASON PAUL R. MU&IZ July 27, 1995 VALERIE J. RANCHE DAVID F. SCHMIDT DIANA J. SILVER VICTORIA T. WILLIAMS NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Stacy Adams 20 Roberts St. Bay Point, CA 94565\ RE: CLAIM OF: Stacy Adams 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. [x] 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 ,y 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. [x] 6 . The claim is not signed by the claimant or by some person on is behalf. [ ] 7 . Other: VICTOR J. WESTMAN, County Counsel By: Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a, 2015.5; Evidence Code §§ 641, 664) I declare that my business address is the County Counsel's Office of Contra Costa County, 651 Pine Street, Martinez, California 94553; 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 addressed as shown above, sealed and postage fully prepaid thereon, and thereafterlwas, deposited this day in the U.S. Mail at Martinez, California. I certify under penalty of perjury that the foregoing is true and correct. Dated: July 27, 1995 at Martinez, California. cc: Clerk of the Board of Supervisors (original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOVT. CODE SS 910, 910.2, 920.4, 910.8) =" Clai 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 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, 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 fcr=. R£: Claim By ) Reserved for Clerk's filing stamp C n-S ) RECEIVED Tic ��t i� �/S—I-( ) �" O( cut f Against the County of Contra Costa ) s or ) C� ZZDistrict) C BOARD OF SUPERVISORS Fill in n?me TT'" ) CONTRA COSTA CO. The undersigned claimant hereby makes nst the County of Contra Costa or the above-named District in the sum of a r and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) ( 00 — 2. Where did the damage or injury occur? (Include city and county) 3• How did the damage or injury occur? (Give flill details; use extra paper if required) ? _I _ 4. What part cular act or omission on th part of county or district officers, ,,U se-rvants or employees caused the injury or damage? ;c j°j�^�� e ��; l fca I.A , Re, 06S 0l� nkv, VAS �j� bU/,- oke t.uC. wnat are �ne na-mes a1' county or district officers, servants or employees causing r 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.) 8. Names and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury; DATE. ITEM AMOUNT Gov. Code Sec. 910:2 provides: Ow^AM,Mmen The claim must be signed by the claimant SEND NOTICES TO ° ('Attaffne )"—'�—--- or py some erson on his behalf." Name and Address of Attorney Claimant's Signature Address, Telephone No. Telephone No. * * I W-W 9- V V I V N O T I C E Section 72 of the Penal Code provides: z "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 imrrison,)ent and fine. INVOICE NO. ` �51305 • • - • NAMEVg e NAME ti x ADDRESS ' " ADDRESS CITY STATE ZIP CITY STATE CUSTOMER NO.` SOLA BY TERMS SHIPPED VIA - FOB DATE - 1 Y • yy DESCRIPTION UNIT PRICE AMOUN'l' X e 7 V R gL 21 i 1 o2LL 1 i I 1 mni 1 m pp 1 I aLco IM TOTAL �GO } }'•:. .gym - - .z 4