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HomeMy WebLinkAboutMINUTES - 07231996 - C12 r ! V CLA'M BOA' Or S.`icrK`Icr.c OC CONTR4 COSTA COUNTY, CA.' i;ORNIA July 2�, 1996 Claim A_airst the County, or District governed by) BOA:•D ACTION the Board of Supervisors, Routing Endorsements, ) N0710E 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: $723.16 Section 913 and 915.4. Please note all "Warninos". CLAIMANT: California State Automobile Association U 17—N703462 JUN 2 -7 1996 ATTORNEY: Tanya VanVliet Date received COUNTY COUNSEL ADDRESS: 1700 Somersville Rd BY DELIVERY TO CLERK ON June 26. 199. 6 MARTINEZ CALIF. Antioch Ca 94509-0951 BY MAIL POSTMARKED: Hand Delivered via Risk Management 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PpHHIL BATCHELOR,OR, Clerk DATED: eput �P _ T Y. 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. (x) 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 9.11.3). ( ) Other: Dated: ZJ3/l Cv BY: De;uty County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Acministrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARD ORDER: By unanimous vote of the Supervisors present (✓ ) This Claim is rejected in full. ( ) Other: 1 certifythat this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: a ( '4PHIL 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 warnino 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: 4 BY: PHIL BATCHELOR by, Deputy Clerk CC: County Co• sel County Administrator NOTICE OF INSI 1FFI IRN Y AND/OR NON-AC:C'F.PTANC'F. OF CLAIM TO:California State Automobile Association 17-N703462 1700 Somersville Rd. Antioch, California 94509-0951 RE: CLAIM OF: California State Automobile Association Please Take Notice as Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910.2,or is otherwise insufficient for the reasons checked below: 1. The claim fails to state the name and post office address of the claimant. 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [XX] 3. The claim fails to state the date,place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [XX] 4. The claim fails to state the name(s)of the public employee(s)causing the injury, damage,or loss, if known. 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars($10,000). If the claim totals less than ten thousand dollars($10,000),the claim fails to state the amount claimed as of the date of presentation,the estimated amount of any prospective injury, damage or loss so far as known,or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars($10,000),the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. 6.' The claim is not signed by the claimant or by some person on is behalf. 7. Other: VICTOR J. WESTMAN, County Counsel By: Jugl-4m AL4Y---5(� Deputy County Coun el Page 1 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 thereafter was,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 3, 1996 at Martinez,California. cc: Clerk of the Board of Supervisors(original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM:GOVT.CODE§§910,910.2,920.4,910.8) Page 2 -California State Automobile Association Inter- Insurance Bureau ORGANIZED 1914 June 21, 1996 1700 SOMERSVILLE RD.,ANTIOCH,CA 94509-0951 — /) (510)754-2210 fLc t tl RECEIVED .Julie Aumock, Contra Costa County. Risk Management "� 5`'° 651 Pine St,.6th Floor JUN 2 6 1996 Martinez, CA 94553 CLERK BOARD OF SUPE'VISORS ANTIOCH DISTRICT OFFICE CONTRA COSTA CO. Re: Our Insured: Vandenberg, John L. or Roberta Our Claim No.: 17-N703462 Date of Loss: 03-07-96 Your Insured: Contra Costa County, driver:Theresa Bird/95 Chevrolet Your Claim No.: Not Availble Dear Ms Aumock: This is notice of our subrogation interest arising from this loss. We have arranged settlement with our insured. Please make your payment directly to the California State Automobile Association Inter-Insurance Bureau (CSAA-IIB). Attached are itemized bills to substantiate our subrogation claim. Repair Bill 723.16 Loss of Use Tow/Storage TOTAL 723.16 Sincerely, Y Tanya VanVliet Claims Rep 510 754-2210 extension 244 1 7 0 0 SOMERSVILLE RD . ANTIOCH , CA 9 4 5 0 9 - 0 9 5 1 ( 5 1 0 ) 7 5 4 - 2 2 1 0 \ � Recycled Assignment of Claim and Subrogation Agreement o California State Automobile Association Inter-Insurance Bureau In consideration of the payment to the undersigned of fR the sum of ❑ a sum estimated to be Seven Hundred Twenty Three and 16/100**************************************•$723.16 Dollars, being the full amount of loss and damage insured against under an automobile insurance policy, number N703462 issued to the undersigned by the CALIFORNIA STATE AUTOMOBILE ASSOCIATION INTER- INSURANCE BUREAU, said loss and damage having occurred on or about the 7th day of March 19 96 , the said undersigned hereby assigns and transfers to said Bureau said claim in the above amount plus 0 additional claim for damage resulting from said accident, not covered under said policy of insurance, in the amount of $ 0 , constituting :U a total claim ❑ a total estimate in the amount of $ 723.16 Said Bureau is hereby subrogated in his 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 his name or otherwise. 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 posession, necessary for the proper prosecution of such claim. i Dated at Mthis day of 19 7 �. Qs�Pin E WITNESS" F1433(Rev.12-89) •= Assignment of Claim and Subrogation Agreement California State Automobile Association Inter-Insurance Bureau In consideration of the payment to the undersigned of Id the sum of ❑ a sum estimated to be Seven Hundred Twenty Three and 16/100**************************************$723.16 Dollars, being the full amount of loss and damage insured against under an automobile insurance policy, number N703462 issued to the undersigned by the CALIFORNIA STATE AUTOMOBILE ASSOCIATION INTER- INSURANCE BUREAU, said loss and damage having occurred on or about the 7th day of March 19 96 , the said undersigned hereby assigns and transfers to said Bureau said claim in the above amount plus 0 additional claim for damage resulting from said accident, not covered under said policy of insurance, in the amount of$ 0 constituting ;U a total claim ❑ a total estimate in the amount of$ 723.16 Said Bureau is hereby subrogated in his 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 his name or otherwise 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 hP will furnish to said Bureau any and all papers and information in his posession, necessary for the proper prosecution of such claim. Dated at this day of 19 WITNESS F1433(Rev.12-89) Assignment of Claim and Subrogation Agreement o California State Automobile Association Inter-Insurance Bureau In consideration of the payment to the undersigned of the sum of ❑ a sum estimated to be Seven Hundred Twenty Three and Dollars, being the full amount of loss and damage insured against under an automobile insurance policy,'number N703462 issued to the undersigned by the CALIFORNIA STATE AUTOMOBILE ASSOCIATION INTER- INSURANCE BUREAU, said loss and damage having occurred on or about the 7th day of March 19 % , the said undersigned hereby assigns and transfers to said Bureau said claim in the above amount plus U additional claim for damage resulting from said accident, not covered under said policy of insurance, in the amount of$ 0 , constituting R. a total claim ❑ a total estimate in the amount of$ 723.16 Said Bureau is hereby subrogated in his 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 his name or otherwise 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 haE not released or discharged any such claim or demand against such party or parties and that h® will furnish to said Bureau any and all papers and information in his posession, necessary for the proper prosecution of such claim. Dated at this day of 19 WITNESS G F1433(Rev.12-89) Assignment of Claim and Subrogation Agreement o California State Automobile Association Inter-Insurance Bureau In consideration of the payment to the undersigned of , the'sum of ❑ a sum estimated to be Seven Huudred Twonty Three and 16f 100>�t,���>a���,���aa������r�r�,ea�,�e�� ��►f�era��e��►*�723.I6 Dollars, being the full amount of loss and damage insured against under an automobile insurance policy, number N703462 issued to the undersigned by the CALIFORNIA STATE AUTOMOBILE ASSOCIATION INTER- INSURANCE BUREAU, said loss and damage having occurred on or about the 7th day of March 19 % , the said undersigned hereby assigns and transfers to said Bureau said claim in the above amount plus 0 additional claim for damage resulting from said accident, not covered under said policy of insurance, in the amount of $ ® , constituting ja a totalEltotal estimate claim in the amount of$ 723*16 Said Bureau is hereby subrogated in' his place and stead to the extent of the above amount of the said total claim and is hereby authorized and empowered to sue,compromise orsettle in bis name or otherwise 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 UP posession, necessary for the proper prosecution of such claim. Dated at V/' '�'�e© this n2l day of 19 . �\ gram de( WITNESS F1433(Rev.12-89) Photo Page > California State Automobile Association Inter-Insurance Bureau I NSD VEH I CLE VANDENBERG, JOHNI, L DR ROBE 1$�INSLIRED 17-1\170346-22 03-07-96 D CLAIMANT 05 GEO 92 4D HBK 2YZB260 ❑NEGATIVE 2ClMR646XN6767147 COL 00150 FILM ❑POLAROID LOSS—PAYEE ANT 17829 DATE M42 03'96 Tanya Van Vliet HOUR 0115— P. BY Tf LOCATION MAKE OF CAR—YEAR LICENSE NO. R:) DATE HOUR ❑A.M. ❑P.M. BY LOCATION MAKE OF CAR—YEAR LICENSE NO, DATE HOUR A.M.❑ BY L LOCATION ION MAKE OF CAR—YEAR LICENSE—NO F1440(ne,9-91) s _ _ ;j f _ ......... - -; -_ ,7 --- I�I --.1 I...I ,-- -.- - - - . 1. 11 I ;X A t _ >�r O p T :yt Ct tr 5 H K O s Viz. 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ANTENNA ❑ n ro 6CYL [] Clp Y' ISTD ❑ tS,SPD ❑ PB ❑ = TILT ❑ P LOCKS rirr xs VINYL ROOF ❑ l%�s�r QTHER 3 SPD ❑ AYC ❑ P WINDOW LJ ;. a .a,is. `• rr..� Y,.a:'.l.x i-.. +r.,,. _ Re Re , z { "t a DETAILS OF REPAIR ECYCLE �Y frame Eleit + Pai rtt' � NON par place 11SEDR`REPAIRT S STRAIGHTEN}RIC RlfiECHROMElRECORE r Value Farts ' OEAAr D t s� a,.; '- .,•, a VaWe !f ///�►� /� _ m 1 j `/�•-G� `-r/V� 'k -.�h � / � .. r � x rG� Cy '�� r D :x j «." ur*�•P.: ..sa g:.r r•r c '4'''t x..a^ ::x.. r c k+ a., .z -F^t.., •c' rEM F-.' • .,. 2 '•u, i; rz2 a `t. �z � t r���' ��• t- L �a >���a x",gag�'.>~�� sL �j a y �' �� �Vin.� � 1 3 /♦.�/.. �/ /�F�/rte /] H > r s r ro9- y ds ^e oy .� t t,,.f/C.J./C._C` <.K/`t`f rG�� •Vl.+'�y 1 3 ri-: ,F'r5 Y c.t ' ,§A a>• e„ .r.Jrsrr w•s x •.afia r- r ':F,t"(v -.y S- l; Nsa �L� ;? a 'e�v„'b - '�'.?" -ti ,� •,. � .�`. 4.5 ;�, t'e w'. -c''` .,`t*.}- � :-:' -r +ss,• 2 ,y '�' � -� Gj - %• /�_�< •_: aT rz• �'�• 4 h R j�':_ 1 cr`""'t t ...r _z jr•-,sem r ,.�< g .t- �r,= �� r 1� � e•'r�i�l �..` '°,v4 .5�• F ;f ! d -` �:� s+ sr ..5, --�..r -: ��..+./.s.2" '+IJ4...r'I"'ter.. 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Y�� fs •�i3:tcs Y• - '.•rii '€ �,•'' i .z�''.�.ar „.,�j -�. s,� =t1''' "t ri r _., ..: S ..••,� z a a < Y 'w s �y.xk�- y:l �0.r 1 `.:a �Z iF , j-- t _• _ _ : -' � - .`. q •_• ` } �Atatomobile -Damage Evalu-anon G A ® California State Automobile Association Inter-Insurance Bureau t = a Sure RESIDENCE PHONE E]baimant p.. y AEG TERED OWNER: BUSINESS PHONE ' I NSD VEHICLE v ;:VANDEbIBERG,JOHN, L OR - ROBE ,- LEGAL OWNER v f- 03-07-96 17 N7a346-2 °s MD YAR ID No. 4 05 GEO 92 4D HBK 2YZB260 j-� U � --JI(p77 MR646XN6767147 COL-'a015a '."CY/O•LO MODE �, LICENSE: # t. -a t� LO S PAYEE ANT 17829 4 if MILEA E OT INSPECTED AT NO•P OS IN BY- DATE INSPECTED � R Q^p Tan a" n Ulier MA . NO. REPL AEPR -,- DETAILS`.REPLACE%REPAIR,,; OR U d. sh't4 ,.� .r Bi3. �N LA ITS PAINT UNITS PARTS z SUBLET 2 2. _5 6 K 77 5 x.; E ' 10 12 '14 ;15: .1g -17 q - PRE EXISTING DAMAGE NOT.RELATED TO LOSS Labor Units. #@_ _$ Paint Units #@ _$ -r Paint Material - Parts Lessh% =$ Parts i tv f .�, Tax @ %on$ $ NOTE You have the right to select the facility where yourcar wel l be repaired.If you Sublet $ } have no preference,or would like a suggestion;please let your Claim Representative 'OtFfer $ know .. _ - Notes Total$ ' This'is not an authorization by;CSAA fo'r.repair Present this-estimate to'the repair Betterment$ s7hop'beforeyou authorize the repairs The labor-rate is atljustable#o the.shops Deductible.$ A hourly rate..AII supplements or changes must be approved by CS- A before repairs. _--- are started. ' • -' , � 'Net$ � F1725(Rev_10-94) n111/NGR/4uf1D.- _ California State Automobile Association Inter- Insurance Bureau ORGANIZED 1914 1700 SOMERSVILLE RD.,ANTIOCH,CA 94509-0951 (510)754-2210 f to Harvey 9''°obi�a`OC �O : YJ July 25, 1996 � ANTIOCH DISTRICT OFFICE Julie Aumock, Contra Costa County Risk Management Martinez, CA 94553 RE: Insured: John L or Roberta Vandenberg Claim No.: 17-N703462 Date of Loss: 03-07-96 Dear Ms Aumock: We received the "Notice of Insufficiency and/or Non-Acceptance of Claim". You have asked that we state the date, place and or other circumstances of the occurrence or transaction. You also asked us to state the name(s) of the public employee(s) causing the injury, damage or loss. The accident occured on March 7th,1996 at 3:00pm on State Route 4 Eastbound Railroad Avenue offramp in Pittsburg,California. Mr Vandenberg had stopped on the offramp to yeild to traffic on Railroad Avenue. There was a large truck obstructing his view, so he could not proceed further. He was then hit from behind by Theresa Joan Bird, a Contra Costa County Public Employee. r I believe I have submitted the correct information to you in order for you to process our claim. If you need additional information, please let me know . Sincerely, Tanya VanVliet Claims Representative 510 754-2210 extension 244 1 7 0 0 SO MERSVILLE RD . ANTIOCH CA 9 4 5 0 9 - 0 9 5 1 • ( 5 1 0 ) 7 5 4 - 2 2 1 0 F[t�»yol .� NOTICE. OF INSUFFICIENCY AN IOR NON-ACCEPTANCE, OF CLAIM TO:Cliforma State Automobile Association 1�-N703462 1 00 Somersville Rd. Antioch, California 94509-0951 RE: CLAIM OF: California State Automobile Association Please Take Notice as Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910.2,or is otherwise insufficient for the reasons checked below: 1. The claim fails to state the name and post office address of the claimant. 2. The claim fails to state the post office address to which_the person presenting the claim desires notices to be sent. [XX] 3. The claim fails to state the date,place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [XX] 4. The claim fails to state the name(s)of the public employee(s)causing the injury, damage,or loss, if known. 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars($10,000). If the claim totals less than ten thousand dollars ($10,000),the claim,fails to state the amount claimed as of the date of presentation,the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars($10,000),the claim fails,to state whether jurisdiction over the claim would rest in municipal or superior court. 6. The claim is not signed by the claimant or by some person on is behalf. ' 7. Other: VICTOR J. WESTMAN, County Counsel By: dz4&"- Deputy County Co el ,JUL 5 9�i Received Page 1 CLA:"' 2 1996 i of «.VI��-s cA:1 ro;%IA July N BOL ACTION Cia m,A;airst the C arty. Or pis• _Jgoverned by) ,. 'NO'??CF TO CLA,wC%T e heyB�a'a.of,Supe!1S r,S� R.rJt ng Ef�orsemerts.-.') F , :Land Boa*c fiction.', All -Section`references are 'to The'co,y Of-this docume••t mailed to you is your notice of Califonria G:'Ye�nre�► Codes. the, action taken on your claim by the Board of SuGerviscrs : Y " -.,.,_ (Parag•a,h:1V below), given pursuant to Government Code Ars.uni r„$723.16 of Grp Section 913 and 915.4. Please note all "Warnings"jam^ (�} CLAIMAAT: Califomia'�State-'Automobile 'Association 17—N703462.'_- JUN 2 , 1996 'ATTORNE'i:`. tTanya-Vanvhet Date received COUNTY COUNSEL ADDRESS: 1700 Somersville Rd BY DELIVERY TO CLERK ON June 26, 1996 MARTINEZ CALIF. Antioch Ca 94509=0951 —BY MAIL POSTMARKED: Hand Delivered via Risk Management 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is & .copy of- the above-noted claim. ppHHll BATCHELOR. Clerk n� DATED: B1: Deputy �a.�sG2G1. I1. FROM: . County Counsel 70. :Clerk of.the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. (x) 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 ( ) Claim is nct 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: 7/3 BY: De^,uty County Counsel III. fROM: Clerk of the Board TO: County Counsel (1) Coar,ty Acninistrator (1) { ) Claim wts .returned as .untimely with notice to Claimant (Section 911.3). IV. BOARD ORDER: by unanimous vote of the Supervisors present (� This Claim is rejected in full. ( ) Other: - I certify that this is a true and Correct Copy of the Board's Order entered in its minutes for this date. Dated: PHIL BATCHELOR, Clerk, 6y . Deputy Clerk \ s� . \� ƒ \/ fo o n \ to -)3 \ %} LIX 0 \ k� m ON & � \ o g\kL q , � 2 \\ � � �� �