HomeMy WebLinkAboutMINUTES - 09182001 - C.10 CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: Sept 18, 2001
Claim Against the County, or District Governed by )
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
and Board Action. All.Section references are to ) The copy of this document mailed to you is your
California Government Codes. ) notice of the action taken on your claim by the
Board of Supervisors. (Paragraph IV below), given
-Vrsuant to Government Code Section 913 and
915.4. Pl9se note all "Warnings".
AMOUNT: $10,000 SEP Q 7 tUol
COUN1�1ART Nt:Z CgLIF L
CLAIMANT: Scott Wilbur
ATTORNEY: None DATE RECEIVED: September 5, 2001
ADDRESS: P.O. Box 859 BY DELIVERY TO CLERK ON: Semtember 5, 2001
Verdi, NV 89439-0859
BY MAIL POSTMARKED:
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN SWEET i er
Dated: September 6, 2001 By: Deputy `
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
(; his 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
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: JOHN SWEETEN, CLERK, By � puty 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, dressed tot e claimant as shown above.
Dated: I JOHN SWEETEN, CLERK By Deputy Clerk
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.
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 personal 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. (Gov't.
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 By Scott Wilbur ) (Reserved for Clerk's filing stamp)
Post Office Box 859 )
Verdi, NV 89439-0859 )
RECEIVED
Against the County of Contra Costa )
SEP 5 2001
CLERK BOARD OF SUPERVISORS
CONTRA COSTA CO.
)
The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district
in a sum of i n excess of $10, 000. 0 0, and in support of this claim represents as follows:
1. When did the damage or injury occur? (Give exact date and hour)
March 7, 2001, on or about 1 : 30 p.m. until April 18, 2001, on or about
9: 30 p.m.
2. Where did the damage or injury occur? (Include city and county)
1000 Ward St . (county jail) , Martinez, Contra Costa County, CA.
3. How did the damage or injury occur? (Give full details; use extra paper if required)
See attached.
4. What particular act or omission on the part of county or district officers, servants,'or employees caused the
injury or damage?
False imprisonment, and malicious prosecution.
5. Whatare the names of county or district officers, servants, or employees causing the damage or injury?
Susan Cruz, Superior Court Probation officer, Walnut Creek branch
Deputy District Attorney of record (name unknown to Claimant)
Merle Eaton, Superior Court Judge, Walnut Creek branch
Bruce Mills, Superior Court Judge, Martinez branch
Sheriff Warren Rupf, and his deputies in the county jail (names unknown
to Claimant) who came in contact with Claimant
6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach
two estimates for auto damage.)
See attached.
7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or
damage.)
See attached.
8. Names and addresses of witnesses, doctors, and hospitals.
Charles Dorsett, Jr. ; 400 W. 3rd St . , Santa Rosa, CA 95401
Elizabeth Grossman; 1510 Fourth St . , Berkeley, CA 94710
Michael Hardaway; 157 Village Circle, Morgan .Hill, CA 95037
9. List the expenditures you made on account of this accident or injury.
DATE TIME AMOUNT
See attached. .
******************************************************************************************
)Gov. Code Sec. 910.2 provides "The claim must be
)signed by the claimant or by some person on his behalf."
SEND NOTICES TO: }
(Name and Address of Attorney) ) (Claimant's Si ature&Address)
Scott Wilbur, in pro per )
Post Office Box 859 ) Post Office Box 859
Verdi, NV 89439-0859 ) Verdi, NV 89439-0859
Telephone No.: 775-772-4641 ) Telephone No.: 775-772-4641
NOTICE
Section 72 of the Penal Code provides:
Every person who,with intent to defraud,presents for allowance or the 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.
ATTACHMENT
General description of the loss, injury or damage suffered:
False imprisonment :
On the afternoon of 7 March 2001, the above-named employees of Contra
Costa County unlawfully caused Claimant to be arrested, and booked
into custody. The arrest, and imprisonment, was unlawful, was made
without probable cause, without reasonable cause to believe that a
public offense had in fact occurred, without reasonable cause to
believe that the arrest was lawful, and was not made pursuant to a
charge which was itself made upon reasonable cause and belief that
the Claimant had committed a felony or any other public offense.
Ms . Cruz, Judges Eaton and Mills, Sheriff Rupf and other individuals
whose identities are not yet known to Claimant are, and at all times
herein mentioned were, employees and agents of the county of Contra
Costa, and in doing the things herein alleged acted at all times
within the course and scope of their agency and employment.
Claimant was intentionally confined against his will for an
appreciable length of time. The employee/agents of Contra Costa
County acted without lawful privilege.
As a direct, proximate and reasonably foreseeable result of the
foregoing wrongful actions, Claimant was deprived of his liberty,
lost wages and his employment, was subjected to embarrassment and
damage to his reputation in the community, and suffered general
damages, all in amounts which are not stated here pursuant to the
provisions of Government Code section 910. The amount falls within
the jurisdictional limits .of the Superior Court, Unlimited Division.
The acts of the agents/employees, and each of them, as alleged herein
were willful, wanton, oppressive, and taken maliciously with a
specific purpose and intent to cause injury to the Claimant, and
Claimant is therefore also entitled to an award of punitive damages .
Malicious prosecution:
On 7 March 2001, the aforementioned agents/employees of Contra Costa
County wrongfully instituted a criminal proceeding against Claimant .
As described more fully above, the actions were taken against .
Claimant in the absence of probable cause and without any reasonable
belief that Claimant was guilty of any public offense. Furthermore,
the agent/employees were motivated by something other than the
bringing of a guilty person to justice. Said proceeding was
terminated in favor of Claimant .
Claimant suffered the same damages as a direct, proximate and
reasonably foreseeable result of the malicious prosecution as were.
suffered by reason of the aforementioned false imprisonment .
Specification of damages :
General damages for loss of liberty, emotional distress and damage to
reputation.
Special damages for loss of earnings and employment, and attorney
fees, all in amounts to be determined by the court and which are not
stated here pursuant to Gov. Code Sec. 910 (f) and Code Civ. Proc. Sec.
425. 10 (b) ; plus punitive damages in an amount to be determined by the
court [Civ. Code Sec. 3295 (e) ] .
Interest on awarded damages [Civ. Code Sec. 3287 (a) ; Code Civ. Proc.
Sec. 685. 010 (a) ] .
SILVANO S.MARCHESI _ DEPUTIES:
COUNTY COUNSEL ( PHILLIP S.ALTHOFF
—��
JANICE L.AMENTA
RAG.BARLOW
B.REBECCA BYRNES
SHARON L. ANDERSON : ANDREA W.CASSIDY
ASSISTANT COUNTY COUNSEL �\ MONIKA L.COOPER
C INTRA COSTA' UN
;!- s. VICKIE L.DAWES
GREGORY C.HARVEY OFFIC .OFT E-C .0 COUNSEL MARKES.ESTIS
ASSISTANT COUNTY COUNSEL 1r,1,, I iI .TtC�MB4l !,I JANLILLIANTFUJII
ETL.HOLMES
.... .
DENNIS C.GRAVES t KEVINT.KERR
STREET
/ BERNARD L.KNAPP
SENIOR FINANCIAL COUNSEL MAFaF=Z,:CALIF �9 229 EDWARD V.LANE.JR.
J V� BEATRICE LIU
GAYLE MUGGLI \� r MARY ANN MASON
OFFICE MANAGER �S•:=_-_-....__:_ PAUL R.MUNIZ
0 / VALERIEJ.RANCHE
PHONE (925) 335-1800 STEVEN P.RETTIG
F.
FAX (925)646-1078 DAVNAJ.SILVERDT
September 13, 2001 JACQUELINE Y.WOODS
PAMELA J.ZAID
Scott Wilbur
PO Box 859
Verdi, Nevada 89439-0859
Re: Government Tort Claim of Scott Wilbur
Dear Mr. Wilbur:
We are in receipt of your government tort claim, and it is being processed. If your intent
was to file a claim against the Superior Court of California or one of its employees, please be
aware that the Contra Costa County Clerk of the Board is not the proper entity to serve. Any
claims against the court or its employees should be directed to:
The Superior Court Executive Office
649 Main Street, Suite 103
Martinez, California 94553.
Attn: Superior Court Executive Officer
Thank you for your attention to this matter.
Very truly yours,
SILVANO B. MARCHESI
COUNTY COUNSEL
By:,--n�6�IuL L/6-6
Monika L. Cooper
Deputy County Counsel
cc: Ken Torre
1:\TORT\RISK-MGT\CLAIMS\Superior Court ClaimAletter re court claims.wpd
C.;0
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: Sept 18, 2001
Claim Against the County, or District Governed by )
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
and Board Action. All Section references are to ) The copy of this document mailed to you is your
California Government Codes. D ) notice of the action taken on your claim by the
Board of Supervisors. (Paragraph IV below), given
��� Pursuant to Government Code Section 913 and
SFP O C 915.4. Please note all "Warnings".
AMOUNT: $175 4jg9T�,C 90, ?001
CLAIMANT: Dennis Mc Namee
ATTORNEY: NONE DATE RECEIVED: August 31, 2001
ADDRESS: 14 Center Ct BY DELIVERY TO CLERK ON: August 31, 2001
Walnut Creek, CA 94595
BY MAIL POSTMARKED: Auzust 30, 2001
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN SWEE EN � �/,'
Dated: August 31, 2001 By: Deputy
Il. FROM: County Counsel TO: Clerk of the Board of Supervisor
01
( its 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: S —d/ 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).
I 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 itsinutes r this date.
Dated: 0/1 U JOHN SWEETEN, CLERK, By t� 7 , 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
rq
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, dressed to the claimpt as shown above.
Dated: ( JOHN SWEETEN, CLERK By MI / Deputy Clerk
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.
DATE No.
V ORDER NO..
NAME
ADDRESS7
.
SOLD BY E]CASH' E]C.O.D. ❑PAID OUT
❑:CHARGE E]MERCHANDISE RETURNED
• • •
W, r)E
t�c�cti c�w CC' S
IriAdams a
NC2581 SIGNATUR
ALL CLAIMS AND R URNED GOOUS MOST BE ACCOMPANIED BY THIS BILL.
GENERAL PURPOSE
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 personal property or growing crops
and which accrue on or before December 31, 1987, must be presented not later than the 1001h 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. )
--')P 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 945,53.
C. If Claim is against a:district gpverneil'by ,Ihe 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 filedagainst each public entit!�
E. Fraud. See penalty for fraudulent claims. Penal Code Sec 72 at the end of this form.
�N�m e e ) \
RE: Claim by Reserved for Clerk's Filing Stamp
- e�ivi s 1M , , .
RECE!1 '�'
W,#Auut G2eeIC CA `tgs95) 2001
Against the County of Contra Costa AUG 31
or CLERK BOARD OF SUPERVISORS
•.•:.: . . t':,�, - TCO.
Disthicto
(Fill in Mame)
The undersigned claimant hereby makes claim against the County of Contra Costa or the above named
District in the sum of$ rl-5 `L0 and in support of this claim represents as follows:
1. When did the damage or,injary.•occur? (Give exact Date and Hour)
J—�ly 30th $: ao P
______
2. Where did-the dama,!e or injury occur? 'Include City and Counny)
JP
3. Hoid rhe daw' dm 'ry �. • t t- t i quired
:l�e•OIRIUI�' OCCUr? (Give full�etaiis: use extra paper if re }`
e 24,9 of u/AS Re -6,0.• e W, �O 'Id.v fV'Ii a -/A e S U e 4 C e c✓A S .���
eo0,7 w4 s
4. What particular'act.or omission-.on the,part;of county,or district officers, sen.ants:-or-employees causeq,the;
injury or damage?
(Over)
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CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: Sept 18, 2001
Claim Against the County, or District Governed by )
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
and Board Action. All Section references are to ) The copy of this document mailed to you is your
California Government Codes. ) notice of the action taken on your claim by the
Board of Supervisors. (Paragraph IV below), given
D FE II i, M Pursuant to Government Code Section 913 and
915.4. Please note all "Warnings".
AMOUNT: Unknown SEP 0 5 2001
COUNTY COUNSEL
MARTINEZ CALIF.
CLAIMANT: Steve Kaspar
ATTORNEY: NONE DATE RECEIVED: September 4, 2001
ADDRESS: #29 Goree Ct BY DELIVERY TO CLERK ON: September 4, 2001
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.
JOHN SWEEJI��"&./
Dated: September 4, 2001 By: Deputy
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
( 04his 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: e-J0y 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 ertify that this is a true and correct copy of the Board's Order entered in its mi utes for this date.
Dated: JOHN SWEETEN, CLERK, By % eputy 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: JOHN SWEETEN, CLERK By ' Deputy Clerk
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.
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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 personal property or growing crops
and which accrue on or before December 31, 1987, must be presented not later than the 1001h day after the
accrual of the cause of action. Claims relating to causes of action for death or for injurti to person or to
personal property ore owing crops and which accrue on or after January 1, 1988. must be presented not later
than sig 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 3911.:. )
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 that one public entity,separate claims must be filed against eaeh'public entity. .
F. Frand._-See.nenalty for fratidulent...claims. Penal-Code Sec..7 2 at the end-of this form.
' JI' JF �f 1t * Jk Yf * :t * Y[ :C * IF % * * Yf �f '�• �C Yf :t * * * t * YC Y[ * * * � * * � * �t * * :t * * S * * * � * * :k YC jf �[
RE: Claim by. ) Reserved for Clerk's Filing Stamp
)
RECEIVED
SEP 42001
kuainst the Count' of Contra Costa
lli. e �t� CLERK BOARD OF SUPERVISORS
or
t �� �` CONTRA COSTA CO.
�.? District )
.(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 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 injure occur:' (include Cite and County 1
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(! ' I13
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: Sent 18, 2001
Claim Against the County, or District Governed by )
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
and Board Action. All Section references are to ) The copy of this document mailed to you is your
California Government Codes. ) notice of the action taken on your claim by the
Board of Supervisors. (Paragraph IV below), given
D 6 II�
I ursuant to Government Code Section 913 and
15.4. Please note all "Warnings".
AMOUNT: $6,500 SEP 0 7 2001
COUNTY
CLAIMANT: Reginald Johnson
ACOUNSEL
MARTINEZ CALIF.
ATTORNEY: None DATE RECEIVED: September 6, 2001
ADDRESS: 2817 Parker Rd BY DELIVERY TO CLERK ON: September 6, 2001
Richmond, Ca 94806
BY MAIL POSTMARKED:
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim. ,
JOHN SWEET e
Dated: September 6, 2001 By: Deputy '
II. 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: 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 Ord<2ntered in its minutes for this date.
Dated: JOHN SWEETEN, CLERK, By puty 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 ertified copy of this Board Order and Notice to Claiman dressed to the c 'imant s shown above.
Dated: JOHN SWEETEN, CLERK By Deputy Clerk
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.
-A
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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 Mich 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
orm.
* • * * f * * f * * * * * * * * * f f f f f * f f f * f f f f f f * f * * * * f f * * .
RE: C1 m By ) Reserved for Clerk's filing stamp
RECEIVED
Against the County of Contra Costa ) SEP 6 2001
or )
CLERK BOARD OF SUPERVISORS
District) I CONTRA COSTA CO.
Fill in name ) ,
The undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $ (oi _S-oD. oo and in support of
this claim represents as follows:
1. When did the damage or injury occur? (Give exact date. and hour)
7/ 0 Sq
or
0 VF+end MA t}ne P12MM&A nr irn iiit+v �v+cn�r?__f Tnnl_�vlo. ni.f., ov%A
5. `WHat are the names of county or district officers, servants or employees causing
the damage or injury?
rJ k[JowtJ SEE P446(t J I�i c�4maod ?o(I-cE rEpo+,
Iso sacOAJ41-a COS4 _Sh&r-e D60 cas C --t-1- ol— x-671
6. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage. SE, 'p,01, por�- AaD
40
7. How was the amount claimed above computed? (Includ the estimated amount of any
prospective injury or damage.) SEC ::I- p.-{A,--A,4 rsAwia-f6-f
8. Names and addresses of witnesses, doctors and hospitals.
CbP"fl� ocJ� �� lb -2r,'" Vr-D 12�,�.v�a„c��I Ctv qq� 66 (�10aa-3 - g7 '�S
��� 2-x-3 ` 49 3.g
�hom�s TO P,4 c� a-q O3 �i r�r{�ti�i . ;��,�,oN�, cup ���o� C�
..9. List the expenditures.-you..made on account of this accident or injury:
DATE N , ITEM AMOUNT
7-)-)4-01 1_0
.f.._::,�r Com' Soo.o v
Gov. Code Sec. 910.2 provides:
"The claim must be signed by the claimant
SEND NOTICES TO: (Attorney) or bv some Derson on his be
Name and Address of Attorney —
EGJckNSOAJ .
Claimant's Si�gnat I
SS Address rl /
I
\S y (0?7y2,7ggq
STAM OF CALIFORWA �\. ✓� :. ': D �� VI+
TPAFFIC OOLLISION REPORT
CHP•S55 PAGt 1 (Rev MZ1 ORI 042 92 63763 p µ y.' '' PAGE of
i
SPECIAL CONDITIONS NUMBER NRA RUN .CITY ... .IUOICIALDISTRICT LOCAL REPORT NUMBER
INTFELONY R�I
• ❑ �I. Aj� �17AdUNi n
NUMBER HR A RUM COUNTY REPORTING DISTRICT BEAT
KILLED 050.
r�ti2�2,4 t;2S � -
COLLISION OCCURRED ON MO. DAY YEAR . TIME(2400) NCIC 1 OFFICER L 0.
Z T Ae4L:� � �_-- ��/2 6 0� �7l1 �
P6 -----------------------------------==-='- -------
O MILE ST SIFORM'T N U).. � OAYOFWEEX TOW AWAY PHOTOGRAPHS BY:
F
U FEETIMI�LES OF
T W T F S YEs ❑� ('CSo 5�7'
T INTERSECTION WITH /S LLJR✓►�Jn�iJ,/J�
f/� ❑ ❑
FEET/MILES OF ' YES
PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEIL YEAR MAKE/MODEL/COLOR, 104E NUMBER ST TE
EQUIP.
DRIVER NAME(FIRST.MIDDLE,,LAST)
0 DES- STREET ADDRESS OWNERS NAME , 1❑SAYE AS DOVER
rA❑ C--PH LC
PARKED CITY/STATE/LP OWNER•B ADDRESS J El AS DRIVER /� v/�/ ,J
VE❑E ! i �C ��i w"10 L `7 too
BICY- SEX HAIR EYES HEIGHT WEIGHT BIRTHDATE RACL DISPOSITION OF VEHICLE ON O BOERS O F: OFFICER ❑DRIVER [:]OTHER
CUST MO. DAY YEAR 5L
44
OTHER MOME PHONE BUSINESS PHONL
❑ � � / �� � � POOR MECHANICAL DEFECTS: NONE APPARENT❑ REFER TO NARRATIVE❑
CMP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA
INSURANCE CARRIER POLICY NUMBER VEHICLE TIPS
OLNK []NONE OYINOR
0M00. R DOTAL
D10.OFTRAVr ON STREET OR HIGHWAY SPEED PCF DOT13 CA O 1 O PUC O
OIFL
4- C-1
2ND Z 77-:3. �S
PARTY DRIVER'S UCENSE N MBER STATE CLASS SAFETY VEIL YEAR MAKE MODEL/COLOR LICENSE NUMBER STATE
2 SOUP. r ,iF eq - L}+
q -TyY�7-I� c!(�- . . . . .
'I?RIVER NAME(FIRST, DOLE,LAST),
a
PEDES STREET ADDRESS OWNERS NAME ❑SAME AS DRIVER
TRIAN
11
PARKED CITY/STATE/ZIPNER'B ADDRESS ❑SAME AS DRIVER
VEMICLE
y1L�-1) 217 ILi_•� le�
BICY- SEX I HAIR EYES N WEIGHT SIRTHOATIE RACE DISPOSITION Of VEHICLE ON ORDERS OR ❑OFFICER ODOVER &TITER
CLIST 00. DAY I YEAR / V
OTHER HOME PHONE BUSINESS P
HONE POOR MECHANICAL DEFECTS: NONE APPARENT REFER TO NARRATIVE❑
❑ ( > / CMP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA
INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE
DUNK. Cl- OYNOR
T TOTALcz'-6 C y
DIP-OF JONSTREETORMIG MVAV SPEEOPCF DOT E3 CA 13 I 13 PITC C
TRAVELPIOK& U.IT
PARTY D ER'S UCENSE NUMBER .STATE CLASS SAFETY VEIL YEAR MAKE/YODEL/COLOR CENSE NUMBER STATE
3 EQUIP.
DRIVER NAME(FIRST, LE,LAST) GANGS
❑ i .T
PEDES STREET S E!22GANII
S'TATE TDTAL
TRMA CO OLLNOT.TNalzEDDOCUMENT i �':��,TV 1131 Ic .S.L,. AMANFft
pPARKED CITY/STATE/ P. !1 'DA M AS
VEHICLE Il TO:BICY- SEX MAIR,V, EYES M �HT r0* RACEON Of VEHICLPtr((�DyiOE;.•� ❑OFFICER []DRIVER ❑OTHER
CLIST -. Y qQJ,� YEAR
❑
OTHER HOME PHONE Idu N S ) PRIOR MECHANICAL DEFECTS: NONE APPARENT❑ REFER TO NARRATIVE❑
❑ ( ) CHP USE ONLY DESCRIBE VEHICLE DAMAGE SMADE IN DAMAGED AREA
VEHICLE TYPE
INSURANCE CARRIER POLICY NUMBER
DUNK. ❑NONE 011NOR
0000. ❑MAJOR ❑TOTAL
DIR.OF ON STREET OR HIGHWAY SPEED PCF. OT CA 0 ICC r PUC 13
TRAVEL OMIT ® -
PREP Efl'S NA E DISPATCH NOTIFIED REVIEWER'S NAME GATE REVIEWED
av/ ❑YES ❑ NO ❑ N/A
STATE.OF CALIFORNIA -
TRAFFIC COLLISION CODING
PAGE
CA:'E OF COLLISION / , TWE 11�g7 NGC N^UY-i'E/R OFF.CER I.[D/ NWiYER A 7
MO. DAY YEAR v ( I• ?C Ll 1 1 O
OWNER'S NAME;ADDRESS NOTIFIED
PROPERTY ❑rES ONO
DAMAGE DESCRIPTION OF DAMAGE
SEATING POSITION SAFETY EQUIPMENT EJECTED FROM VEHICLE
OCCUeANTS L-AIR BAG DEPLOYED M/C RICYCI F.HEI MET
0-HOT EJECTED
A-NONE IN VEHICLE M-AIR BAG NOT DEPLOYED DRIVER 1-FULLY EJECTED
B•UNKNOWN N-OTHER V-N O 2-PARTIALLY EJECTED
C-LAP BELT USED P•NOT REQUIRED W-YES 3-UNKNOWN
1•DRIVSR D-LAP BELT NOT USED
1 2 3 2 TO 6-PASSENGERS E-SHOULDER HARNESS USED PASSENGER
4 5 6 T•STATION WAGON REAR F-SHOULDER HARNESS NOT USED
CHILD RESTRAINT X-NO
8-REAR OCC.TRK.OR VAN G-LAP/SHOULDER HARNESS USED 0•IN VEHICLE USED Y•YES
0-POS(770N UNKNOWN H-LAP/SHOULDER HARNESS NOT USED R-IN VE14CLE NOT USED
7 0•OTHER J-PASSIVE RESTRAINT USED S-IN VEHICLE USE UNKNOWN
K-PASSIVE RESTRAINT NOT USED T•IN VEHICLE IMPROPER USE
U-NONE IN VEHICLE
ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK(•)SHOULD BE EXPLAINED IN THE NARRATIVE-
PRIMARY
ARRATIVEPRIMARY COLLISION FACTOR TRAFFIC CONTROL DEVICES 1 2 3 TYPE OF VE}iCLE 1 2 3 MOVEMENT PRECEDING
UST NUMBER (0) OF PARTY AT FAULT COLLISION
X AVC SECTION VIOLATED: a�°Eg ACONTROLS FUNCTIONING APASSENGER CAR/STATION WAGON ASTOPPED
Z=7�Zl V C, B CONTROLS NOT FUNCTIONING• BPASSENGER CAR W I TRAILER B PROCEEDING STRAIGHT
r B OTHER IMPROPER DRIVING C CONTROLS OBSCURED C MOTORCYCLE/SCOOTER C RAN OFF ROAD
NO CONTROLS PRESENT;FACTOR• D PICKUP OR PANEL TRUCK D MAKING RIGHT TURN
C OTHER THAN DRIVER' TYPE OF COLLISION I 1EPICKUP/PANEL TRUCK W/TRAILER E MAKING LEFT TURN
D UNKNOWN• HEAD-ON IFTRUCK OR TRUCK TRACTOR F MAKING U TURN
r E FELL rSLEE B SIDESWIPE I IGTRUCK/TRUCK TRACTOR W I TRLR. G13ACKING
REAR END I IHSCHOOLBUS HSLOWING I STOPPING
WEATHER( MARK 1 TO 21TEMS) - ADBROADSIDE I OTHER BUS I PASSING OTHER VEHICLE
ACLEAR E NIT OBJECT I Ij EMERGENCY VEHICLE J CHANGING LANES
B CLOUDY F OVERTURNED I IKHIGHWAY CONST.EQUIPMENT KPARKING MANEUVER
C RAINING GVEHICLE I PEDESTRIAN I IL BICYCLE L ENTERING TRAFFIC
D SNOWING H OTHER': I IMOTHER VEHICLE M OTHER UNSAFE TURNING
E FOG/VISIBILITY FT. MOTOR VEHICLE INVOLVED WITH I INPEDESTRIAN N XING INTO OPPOSING LANE
F OTHER•: ANON-COLLISION MOPED OPARKED
JGWIND B PEDESTRIAN P MERGING
LIGHTING C OTHER MOTOR VEHICLE QTRAVELING WRONG WAY
A DAYLIGHT D MOTOR VEHICLE ON OTHER ROADWAY OTHER ASSOCIATED FACTOR(S) R OTHER•:
B DUSK-DAWN E PARKED MOTOR VEHICLE 1 2 3 (MARK 1 TO 2ITEMS)
C DARK-STREET LIGHTS F TRAIN. Avc SECTION VIOLATION: CITED
D DARK-NO STREET LIGHTS GBICYCLE ❑YES
❑NO
E DARK.STREET LIGHTS NOT ANIMAL: B VC SECTION VIOLATION: CITED
FUNCTIONING• H ❑YES
SURFACE NO SOBRIETY•DRUG
ROADWAY
FIXED OBJECT: ❑ PHYSICAL
A DRY . I C vc SECTION VIOLATION: gOYES 1 2 3 (MARK 1 TO 2ITEMS)
B WET OTHER OBJECT: []NO HAD NOT BEEN DRINKING
CSNOWY-ICY J D
D SUPPERY(MUDDY.OILY,ETC.) IEVISION OBSCUREMENT:
B HBO•UNDER INFLUENCE
HID-NOTUNDERINFLUENCE'
IFINATTENTION•: D HBD-IMPAIRMENT UNKNOWN'
ROADWAY CONDITION(S) PEDESTRIAN'S INVOLVED IGSTOP 6 GO TRAFFIC E UNDER DRUG INFLUENCE'
(MARK 1 TO 2 ITEMS)
,IANO PEDESTRIAN INVOLVED 1HENTERING/LEAVING RAMP F IMPAIRMENT-PHYSICAL-
A HOLES,DEEP RUT• CROSSING IN CROSSWALK I PREVIOUS COLLISION IMPAIRMENT NOT KNOWN
B LOOSE MATERIAL ON ROADWAY• B AT INTERSECTION UNFAMILIAR WITH ROAD H NOT APPLICABLE
C OBSTRUCTION ON ROADWAY' K DEFECTIVE VER EQUIP.: cep SLEEPY/FATIGUED
CROSSING IN CROSSWALK ❑rEa
D CONSTRUCTION-REPAIR ZONE AT INTERSECTION ❑NO SPECIAL INFORMATION
E REDUCED ROADWAY WIDTH D CROSSING-NOT IN CROSSWALK L UNINVOLVED VEHICLE I I JAHAZARDOUS MATERIAL
F FLOOD IN ROAD-INCLUDES SHOULDER OTHER
IGOTHER-: ---- - FHOT IN ROAD NONE APPARENT
,IIH NO UNUSUAL.CONDITIONS- GAPPROACHING/LEAVING SCHOOL BUS 1 10RUNAWAY VEHICLE '
SKETCH MISCELLANEOUS
UiDICATi NORTH .
CHP 555 PAGE 2( Rev 1-98)OPI 042 .
STATt OF CALIFORNIA
INjUREU / WITNESSES / PASSENGERS PAGE
DATE OF COLLI ON� TIME(25 ) NCIC NUMBER OFFICER I.D. NUMBER
�f eta - y�� 3
EXTENT OF INJURY ( "X" ONE ) INJURED WAS ( "X" ONE )
WITNESS PASSENGER AGE SEX PARTY SEAT SAFETY EJECTED
ONLY ONLY FATAL SEVERE OTHER VISIBLE COMPLAINT NUMBER POS. EQUIP.
INJURY INJURY INJURY OF PAIN DRIVER PASS. PED. BICYCLIST OTHER
❑ ❑ ❑ ❑ ❑ ❑ 1711 ❑ I ❑ 10 . .....
NAME;D.O.B.I ADDRESS ���_TE,LEPHONE
(INJUREDONLY)TRANSPORTED BY j TAK TO:
� ,
DESCRIBE INJURIES � � � � `' �n i
7/ VICTIM OF VIOLENT CRIME NOTIFIED
I ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑
/ADDRE� ��- �- 1 � �f � L� TELEPHONE
(INJURED ONLY)TRANS R ED BY: 5 TAKENp6:
DESCRIBE INJURIES
❑ VICTIM OF VIOLENT CRIME NOTIFIED
❑# ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑
NAME 1 D.O.S./ADDRESS TELEPHONE
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
DESCRIBE INJURIES
VICTIM OF VIOLENT CRIME NOTIFIED
❑# ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 0.. FEI
.
NAME/D.O.B.I ADDRESS TELEPHONE
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
DESCRIBE INJURIES
VICTIM OF VIOLENT CRIME NOTIFIED
❑# ❑ ❑ ❑ ❑ ❑ 1010101
NAME;D.O.B.:ADDRESS - TELEPHONE
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
DESCRIBE INJURIES
VICTIM OF VIOLENT CRIME NOTIFIED
❑# ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑
NAME/D.O.B./ADDRESS TELEPHONE
(IN.URED ONLY)TRANSPORTED BY: TAKEN TO:
DESCRIBE INJURIES
VICTIM OF VIOLENT CRIME NOTIFIED
PREPARER'S NAME I.D.NUMBER MO. DAY YEAR REVIEWER'S NAME MO. DAY YEAR
CHP 555-Page 3(Rev.7-87) OPI 042
87 43637
STATS OF CALIFORNIA
NARRATIVE/SUPPLEMENTAL
CHP 556(Rev 7-90)OPI 042 Page '
DATE OF INCIDENT/OCCURRENCE TIME(2400) NCIC NUMBER OFFICER I.D.NUMBER NUMBER
"X"ONE "X'ONE 'TYPE SUPPLEMENTAL('X-APPLICABLE)
' I
arrativeCollision report ❑ BA update ❑ Fatal ❑Hit and run update
L .Supplemental ! J Other: ❑ Hazardous materials ❑School bus ❑Other:
1 CITY/COUNTY/JUDICIAL DISTRI T REPORTING DISTRICT/BEAT ]7NUMBER
LOCATION/SUBJECT STATE HIGHWAY RELATED
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STATE OF CALIFORNIA
NARRATIVE/SUPPLEMENTAL
CHP 556(Rev 7-90)OPI 042 Page
LATE OF INCIDENT/OCCURRENCE TIME(2400) NC;C NUMBER OFFICER I.D.NUMBER NUMBER
ONE "X"ONE TYPE SUPCILEMENTAL('X'APPLICABLE)
F-
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CENTRAL IDENTIFICATION SERVICES FINGERPRINT EXAMINATION REQUEST AND RESULTS
Forensic Services Division Office of the Sheriff-Contra Costa County 925-646-2460
rn
INSTRUCTIONS: TYPE OR PRINT LEGIBLY.FILL OUT THIS PORTION OF THE FORM EXCEPT THE SHADED AREAS
FILL!)UT THE"PERSO(S TO BE COP;IFA..RED"PORTION P,TIGiJ IN THE SAME M1.4AIJfJER.
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lrilri?stet)3a ';t;np.t1 •:t.=.l i 011ense(sj by Code Number — -— Dale(s)Examined .
work. :-EvniL:ale iiaarhed latents compare oitacheo talents l 4utomaied Latent Print System Search(ALPS) Verily/Establish Identity
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Description of Evidence: C•on-o:ele nes,,iplinn of ev rence ann'ecorfi ilr;t ernlln!taros if submilied.
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Evidnni:e Received From
Received , Date
Pei Iresl
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Results of i Latent Fillgeiprints nt Value Latent Palm Prints of Value i Lalenl(s)are Insufficient Evaluated By
Evaluation i. +�:P:;ssible''!allre or Possible Value for Comparison
Evaluation for Laiertl Finge'p•rinti.$)are Sl ilab:e Latent F r erprni(s)afp•Insuliicienf latent Palm Pring Title Date
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Comparisons -_-._ (Ejlim'l;arirl' Date:of Birin ALPS Manual (2)Unavailable for Comparison
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•,Disposifion of Unidentified ALPS Duality Latent Fingerprints F I I:alent(s)searched and not identified.These latent(s)were registered to the unidentified latent data base for further searching.
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Col-npallson By Tide - Date
ADpro'ved By-----....------ — - Title .. Date
I
�istr: i+tir:n To L:ih F:le 1 To Re..nr;ost:n.;A-Iant;y 7.Rerores ni!r'.au F]DA's Office — _ -`- ❑ Other
08/31/2001 at 04:07 PM Job Number:
35392
SAN PABLO AUTO BODY
2031 RUMRILL BLVD, #11
SAN PABLO, CA 94806
(510)231-0722 Fax: (510)215-9110
PRELIMINARY ESTIMATE
written by: Marco Aguilar #123
Adjuster:
Insured: REGINALD JOHNSON Claim #
Owner: REGINALD JOHNSON Policy #
Address: 2817 PARKER RD Deductible:
SAN PABLO, CA 94806 Date of Loss:
Evening: (510)758-8366 Type of Loss:
Business: (510)864-3100 Point of Impact: 3. Right T-Bone (R
Inspect
Location:
Insurance
Company: Days to Repair
1997 TOMO COROLLA DX 4-1.8L-FI 4D SED RED PL Int:
VIN: 1NXBB02E9VZ601768 Lic: Prod Date: 03/1997 Odometer:
Rear Defogger Intermittent wipers Tinted Glass
Body Side Moldings Dual Mirrors Clear Coat Paint
Power Steering Power Brakes Driver Airbag
Passenger Airbag Cloth Seats Bucket Seats
Recline/Lounge Seats Automatic Transmission
-------------------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
-------------------------------------------------------------------------------
1 FENDER
2 Blnd RT Fender US built 1.2
3 R&I RT Body side mldg body color 0.1
4 FRONT DOOR
5 Repl RT Door shell w/molding 1 509.69 3.5 3.2
6 Add for mirror 0.3
7 Repl RT Body side mldg black 1 45.53 0.3
8 Repl RT Handle, outside body color 1 76.74 Incl .
9 REAR DOOR
1
08%31/2001 at 04:07 PM Job Number:
35392
PRELIMINARY ESTIMATE
1997 TOYO COROLLA DX 4-1.8L-FI 4D SED RED PL Int:
-------------------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
------------------------------------- I-----------------------------------------
10 Repl RT Door shell sedan, power win 1 418.46 3.5 3.0
11 Overlap Major Adj . Panel -0.4
12 Repl RT Body side mldg body color 1 50.24 0.3
13 Repl RT Moveable glass NAGS sedan 1 214.85 Incl .
14 Repl RT Handle, outside body color 1 76.74 Incl .
15 Repl RT Lock manual locks US built 1 87.89 Incl .
16 Repl RT Hinge upper 1 34. 52 0.3 0.3
17 Repl RT Hinge lower 1 34. 52 0.3 0.3
18 QUARTER PANEL
19 Blnd RT Quarter panel 1.0
20 PILLARS, ROCKER & FLOOR
21 Repl RT center pillar outer 1 101.06 s 4.5 1.0
22 Repl RT Rocker panel outer 1 82.28 s 6.0 1.0
23 overlap Major Adj . Panel -0.4
24 Deduct for Overlap -1.0
25 ROOF
26* Rpr Roof panel w/o sunroof 4_0 3.0
27 Overlap Major Non-Adj . Panel -0.2
28 REAR BUMPER
29 O/H rear bumper sedan 1.8
30 Repl Bumper cover 1 112.56 Incl . 2.3
31 Add for Clear Coat 0.9
32 WINDSHIELD
33 Repl windshield TOYOTA 1 308.50 3.5
34 Repl Reveal molding US built 1 60.07 Incl .
35# ADD FOR FRAME SET UP 1 1.0
36# ADD FOR PULL RT CENTER 1 2.0
37# Color tint 1 0.4
38# Cover for overspray 1 8.00
39# Hazardous waste Disposal 1 3.00
40 Clear Coat 2.5
-------------------------------------------------------------------------------
Subtotals =_> 2224.65 30.4 19.1
2
08/31/2001 at 04:07 PM Job Number:
35392
PRELIMINARY ESTIMATE
1997 TOYO COROLLA DX 4-1.8L-FI 4D SED RED PL Int:
Parts 2224.65
Body Labor 30.4 hrs @ $ 55.00/hr 1672.00
Paint Labor 19.1 hrs @ $ 55.00/hr 1050. 50
Paint Supplies 450.00
----------------------------------------------------
SUBTOTAL $ 5397.15
sales Tax $ 2674.65 @ 8.0000% 213.97
----------------------------------------------------
GRAND TOTAL $ 5611.12
ADJUSTMENTS:
Deductible 0.00
----------------------------------------------------
CUSTOMER PAY $ 0.00
INSURANCE PAY $ 5611.12
The estimate of repair includes parts, labor, and diagnosis. If on further
inspection, additional parts or repairs are needed, you will be contacted for
authorization. we are not responsible for lost or stolen valuable item left in
your vehicle while its being repair.
Authorized signature: Date:
Estimate calculated using a preset user threshold amount for the paint and
material cost.
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from
the Guide ARM8425 Database Date 5/2001 and the parts selected are OEM-parts manufactured by the
vehicles Original Equipment Manufacturer. Asterisk (*) or Double Asterisk (**) indicates that the
parts and/or labor information provided by MOTOR may have been modified or may have come from an
alternate data source. Non-original Equipment Manufacturer aftermarket parts are described as AM
or Qual Repl Parts. Used parts are described as LKQ, Qual Recy Parts, RCY, or USED. Reconditioned
parts are described as Recon. Recored parts are described as Recore. NAGS Part Numbers and Prices
are provided from National Auto Glass specifications, Inc. Pound sign (#) items indicate manual
entries.
Pathways - A product of CCC Information Services Inc.
3
AJ' S. AUTO CLINIC BODY PAINT & REPAIR
5512 MARTIN LUTHER KING, JR WAY
OAKLAND, CA 94609
(510) 601-5000 FAX: (510) 601-5199
CD LOG NO 2791-1 DATE 09/04/01
SHOP: A. J. ' S AUTOCLINIC INSP DATE: 09/04/01
ADDRESS: 5512 MARTIN LUTHER KING JR CONTACT: WALTER JOHNS
CITY STATE: OAKLAND, CA PHONE 1 : (510) 601-5000
ZIP: 94609- FAX: (510) 601-5199
OWNER: JOHNSON, REGINALD HOME PHONE: (510) 758-8366
ADDRESS: 2817 PARKER RD. WORK PHONE: (510) 864-3100
CITY STATE: SAN PABLO, CA
ZIP: 94806-
POINT OF IMPACT: 12
LIC# : 3TYF845 STATE: CA VIN: 1NXBBO2E9VZ601768
BODY COLOR: RED MILEAGE:
CONDITION: FAIR ACCTNG CTL# :
DRIVEABLE: YES VEH. INSP# :
PROD. DATE: 03/97 PAINT CODE:
*=USER-ENTERED VALUE E=REPLACE OEM NG=REPLACE NAGS
EC=REPLACE ECONOMY EU=REPLACE SALVAGE EP=REPLACE PXN
TE=PARTL REPL PRICE ET=PARTL REPL LABOR IT=PARTIAL REPAIR
I=REPAIR L=REFINISH BR=BLEND REFINISH
TT=TWO-TONE CG=CHIPGUARD SB=SUBLET
N=ADDITIONAL LABOR RI=R&I ASSEMBLY P=CHECK
AA=APPEAR ALLOWANCES RP=RELATED PRIOR UP=UNRELATED PRIOR
NEEDS RENT-A-CAR ✓
POSSIBLE HIDDEN DAMAGE V"'
ALL WORKMANSHIP, INCLUDING REFINISHING, WARRANTEED, FOR ONE YEAR FROM DATE OF
COMPLETION OF REPAIRS .
1997 TOYOTA COROLLA DX 4DOOR SEDAN 4CYL GASOLINE 1 . 8
CODE: Y1164B/E OPTNS F/24J
OPTIONS:
TWO-STAGE - EXTERIOR SURFACES TWO-STAGE - INTERIOR SURFACES
POWER STEERING
OP GDE MC DESCRIPTION MFG. PART NO. PRICE AJo B% HOURS R
-- --- -- ----------- ------------ ----- --- -- ----- -
E 0959 COVER, FRONT WHEEL RT 4260202050 68 . 52 1
E 0961 COVER, REAR WHEEL RT 4260202050 68 . 52 1
N 0974 SUSPENSION ALIGN, FRT ADDNL LABOR OPERA 1 . 2 2
SB 0143 WINDSHIELD,TINTED SUBLET REPAIR 275. 00* 1
I 0188 07 PANEL, ROCKER RT REPAIR 3 . 0*1
L 0188 09 PANEL, ROCKER RT REFINISH 2 . 8 4
PAGE 1
'1997 TOYOTA COROLLA DX-A DOOR SEDAN
CD LOG NO 2791-1
E 0208 01 DOOR SHELL, FRONT RT 6700102100 509. 69 4 . 8 1
L 0208 DOOR SHELL, FRONT RT REFINISH 3. 4 4
E 0255 01 MLDG, FRONT DOOR SID RT 7573102060 45. 53 0. 2 1
E 0224 CYL, FRONT DOOR LOCK RT 6905112360 46. 34 1
E 0228 01 HANDLE, FRONT DOOR 0 RT 6921002020G2 78 . 72 1
E 0200 07 REINF, CENTER PILLAR RT 6134112090 19. 43 1 . 0 1
L 0200 REINF, CENTER PILLAR RT REFINISH 0 . 2 4
E 0177 07 PILLAR, INNER CENTER RT 6134312090 24 . 78 2 . 5 1
L 0177 PILLAR, INNER CENTER RT REFINISH 0 . 4 4
E 0249 07 PILLAR, INNER CENTER RT 6103712050 101. 69 1 . 0 1
L 0249 PILLAR, INNER CENTER RT REFINISH 0 : 5 4
E 0288 01 DOOR SHELL, REAR RT 6700302090 418 . 46 4 . 5 1
L 0288 DOOR SHELL, REAR RT REFINISH 3. 0 4
E 0328 MLDG, REAR DOOR BELT RT 7573012170 59. 79 1
E 0324 01 MLDG, REAR DOOR SIDE RT 7574112840 29. 98 0 . 2 1
E 0296 GLASS, REAR DOOR T RT 6810312350 61 . 43 1
I 0341 PANEL, ROOF REPAIR 4 . 0*1
L 0341 PANEL, ROOF REFINISH 3 . 4 4
I 0390 PANEL, QUARTER RT REPAIR 4 . 0*1
L 0390 PANEL,QUARTER RT REFINISH 2 . 3 4
I M14 CORROSION PROTECTION SUBLET REPAIR 10 . 00* 4
I M17 COVER CAR EXTERIOR SUBLET REPAIR 5. 00* 4
I M18 SET-UP & MEASURE REPAIR 1 . 5*3
I M60 HAZARD. WSTE. REM. SUBLET REPAIR 3 . 00* 1
I M66 COLOR, SAND & BUFF REPAIR 0 . 5*4
SB RE KEY FRT DOOR CYL SUBLET REPAIR 25 . 00* 1*
I PULL TO SQR ROCKER SUBLET REPAIR 3 . 00* 1*
BR RT FENDER BLEND REFINISH * 1 . 0*4*
34 ITEMS
MC MESSAGE (S)
O1 CALL DEALER FOR EXACT PART NUMBER / PRICE
07 STRUCTURAL PART AS IDENTIFIED BY I-CAR
09 INCLUDES 0 . 6 HOURS MAJOR PANEL TWO-STAGE ALLOWANCE
FINAL CALCULATIONS & ENTRIES
GROSS PARTS 1, 532 . 88
PAINT MATERIAL 350 . 00**
PARTS TOTAL 1, 882 . 88
TAX ON PARTS & MATERIAL @ 8 . 000°% 150 . 63
LABOR RATE REPLACE HRS REPAIR HRS
1-SHEET METAL 60. 00 14 . 2 11 . 0 1, 512 . 00
2-MECH/ELEC 60. 00 1 . 2 72. 00
3-FRAME 60 . 00 1 . 5 90 . 00
4-REFINISH 60 . 00 17 . 0 0 . 5 1, 050. 00
5-PAINT MATERIAL 26. 00
LABOR TOTAL 2, 724 . 00
TAX ON LABOR @ 0. 000%
SUBLET REPAIRS 321 . 00
TOWING
STORAGE
PAGE 2
'1997 ' TOYOTA COROLLA DX %4DOOR SEDAN
CD LOG NO 2791-1
GROSS TOTAL 5, 078 . 51
NET TOTAL 5, 078 . 51
ADP SHOPLINK U3674 ES CD LOG 2791-1 DATE 09/04/01 11 : 36: 35AM R6. 2 CD 08/01
PXN:N/00/00/00/00 CUM: /// HOST LOG
COPYRIGHT 2000, AUTOMATIC DATA PROCESSING, INC.
**USER-ESTABLISHED THRESHOLD FOR PAINT MATERIAL HAS BEEN REACHED AND CALCULATED
IN THIS ESTIMATE. ANY ADDITIONAL MATERIALS MAY REQUIRE FURTHER APPROVAL.
3. 1 HRS WERE ADDED TO THIS EST. BASED ON ADP TWO-STAGE REFINISH FORMULA.
ADP TWO-STAGE EXTERIOR THRESHOLD OF 2 . 5 HOURS WAS CALCULATED IN THIS ESTIMATE.
--------------------------------------------------
THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A
SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES
APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR
DISTRIBUTOR OF THE PARTS, RATHER THAN BY THE ORIGINAL MANUFACTURER OF YOUR
VEHICLE.
PAGE 3
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CLAIM
? BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: Seat 18, 2001
Claim Against the County, or District Governed by )
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
and Board Action. All Section references are to ) The copy of this document mailed to you is your
California Government Codes. ) notice of the action taken on your claim by the
Board of Supervisors. (Paragraph IV below), given
R
�6 II�� suant to Government Code Section 913 and
R4. Please note all "Warnings".
AMOUNT: $1,000,000 SEP 0 7 2001
COUNTY COUNSEL
MARTINEZ CALIF,
CLAIMANT: Alexia Hensley
ATTORNEY: Thomas Greerty DATE RECEIVED: September 6, 2001
ADDRESS: 917 Las Juntas St BY DELIVERY TO CLERK ON: September 6, 2001
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.
JOHN SWEET e
Dated: September 6, 2001 By: Deputy
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
( �his 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: 9,//-0/ By: ��(y-�� 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 c rtify that this is a true and correct copy of the Board's Orde entered in its minutes for this date.
Dated: JOHN SWEETEN, CLERK, By , /� , Deputy Clerk
WARNING (Gov. code section 13)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited
in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an
attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so
immediately. *For Additional Warning See Reverse Side of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United
States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully
prepaid a rtified copy of this Board Order and Notice to Claimant dressed to the claima t as shown above.
i
Dated: JOHN SWEETEN, CLERK By Deputy Clerk
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.
t.
I , Clain n 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 personal 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.
(Gov't 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 By Reserved for Clerk's filing stamp
Alexia Hensley, by and through her RECEIVED
grandmother, Deborah Hensley
SEP 6 2001
Against the County of Contra Costa or )
CLERK BOARD OF SUPERVISORS
District) CONTRA COSTA CO.
(Fill in name)
The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district
in the sum of Sl,000,00.0Uand in support of this claim represents as follows:
1. When did the damage or injury occur? (Give exact date and hour)
Between April 20, 2001 and April 24, 2001 while Alexia was staying.with her father
2. Where did the damage or injury occur? (Include city and county)
City and County of San Mateo
3. How did the damage or injury occur? (Give full details; use extra paper if required)
Alexia was abused sexually by her father.
I
.•4.: hat particular act or omission on the part of county or district officers, servants, or employees caused the
`
injury or damage?
t The county failed to prevent the abuse from occurring in spite of the information they
possessed which was sufficient to prevent it..
5. What are the names of county or district officers, servants, or employees causing the damage or injury?
Personnel at the Social Services Department
6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach
two estimates for auto damage.)
Very significant trauma and injury to the minor physically, emotionally and
psychologically
7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or
damage.)
Cost of future medical and psychiatric care; pain and suffering
8. Names and addresses of witnesses, doctors, and hospitals.
Patricia Mackay Turnin Point Counseling, 1399 Ygnacio Valley Rd. Walnut Creek, CA 94598
Sharon Reposa, Lma Visa Center, 1266 San Carlos Ave. , Concord, CA 94518
Dr. Kenneth Saffer, Pittsburg Health Center, 550 School St. , Pittsburg, CA 94565
9. List the expenditures you made on account of this accident or injury.
DATE ME AMOUNT
Unknown
******************************************************************************************
) Gov. Code Sec. 910.2 provides "The claim must be
) signed by the claimant or by some person on his behalf."
SEND NOTICES TO: (Attorney
Name and Address of Attorney )
THOMAS P. GREERTY )
Attorney at Law )
917 Las Juntas Street ) (Claimant' ignature)
Martinez, California 94553 )
705 Treasure Dr.
(Address)
Bay Point, California 94565
Telephone No. 925-370-8400 )Telephone No. 925-458-3260
NOTICE
Section 72 of the Penal Code provides:
Every person who,with intent to defraud,presents for allowance or the 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(S 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 I
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: Sept 18, 2001
Claim Against the County, or District Governed by )
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
and Board Action. All Section references are to ) The copy of this document mailed to you is your
California Government Codes. ) notice of the action taken on your claim by the
Board of Supervisors. (Paragraph IV below), given
uant to Government Code Section 913 and
o �6 IId4. Please note all "Warnings".
AMOUNT: $10,000 SEP 0 6 2001
COUNTY COUNSEL
CLAIMANT: Michael Tamborini MARTINEZ CALIF.
ATTORNEY: NONE DATE RECEIVED: September 5, 2001
ADDRESS: 306 E. Berna Ave BY DELIVERY TO CLERK ON: September 5, 2001
P.O. Box 5861
Napa, CA 94581 BY MAIL POSTMARKED: September 4, 2001
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN SWEETE ,
Iylk,�.
Dated: September 5, 2001 By: Deputy
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
( his 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: Q� By: L1062 ( '( T 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: JOHN SWEETEN, 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: ,Sa
I JOHN SWEETEN, CLERK By i Deputy Clerk
i
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.
i
I
I
i
RECEIVED
Michael Tambornini
306 E. Berna Avenue SEP 5 2001
P.O. Box 5 861 CLERK BOARD OF SUPERVISORS
Napa, California 94581 CONTRA COSTA CO.
August 31, 2001 ^
CLERK OF THE BOARD OF SUPERVISORS
County Administration Building
651 Pine Street, Room 106
i,'Sartinez, CA 9455.3
Re: Claim of Michael J. Tambornini under Government Code § 910 et seq.
Dear Sir or Madam:
This is a claim by Michael Tambornini against the County of Contra Costa(the Sheriff's
Department and the individual Deputy Sheriffs; Jason Vorhauer; D. Cushman, Westhorpe, and
Sergeant Kollo and unidentified jailors. The claim against Contra Costa is a claim in the amount
in excess of$10,000.00. The injury occurred on April 15, 2001 in the evening hours. The injury
occurred in the City of Crockett and continued while Michael Tambornini was in the custody of
the Sheriff's Department all injuries occurred in the County of Contra Costa.
County of Contra Costa law enforcement officers arrested Michael Tambornini without
probable cause and then used excessive force on Michael Tambornini and caused him injury and
deprived him of his constitutional rights. Mr. Tambornini sought and was denied immediate
medical treatment for his injuries when in custody. He was detained longer than was appropriate.
The Sheriff's Department constructed an inaccurate written police report, Contra Costa
cu rn ;► b�, r. r C' '680^
011cii , J Department nuns e 'DR No. ,-. 4.
Mr. Tambornini sustained injuries to his head, neck and torso and was treated in the
medical facility and by a private physician.
Mr. Tambornini claims medical treatment expenses. Mr. Tambornini's treatment
continues and damages cost. He seeks compensation for deprivation of his constitution rights,
and mental and emotional anguish and pain.
CLERK OF THE BOARD OF SUPERVISORS
Re: Claim of Michael J. Tambornini Under GC § 910 et seq.
August 31, 2001 Page Two
This matter is property within the jurisdiction of an unlimited jurisdiction court. All
correspondence regarding this matter should be directed to the letter head address.
Claimant
��
Michael Tambomini
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tCYL"AIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: Sept 18, 2001
Claim Against the County, or District Governed by )
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
and Board Action. All Section references are to ) The copy of this document mailed to you is your
California Government Codes. ) notice of the action taken on your claim by the
Board of Supervisors. (Paragraph IV below), given
Pursuant to Government Code Section 913 and
915.4. Please note all "Warnings".
AMOUNT: Unknown SEP 13 2001
COUNTY COUNSEL
CLAIMANT: Steve Kaspar MARTINEZ CALIF.
ATTORNEY: NONE DATE RECEIVED: September 11, 2001
ADDRESS: #29 Goree Ct BY DELIVERY TO CLERK ON: September 11, 2001
Martinez, CA 94553
BY MAIL POSTMARKED: 1
1
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN SWEEE 1
Dated: September 12, 2001 By: Deputy
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
(v)'fhis 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:
GI% es/- ol
Dated: fBy: L'1�E'"a� 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).
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: (� JOHN SWEETEN, CLERK, By i puty 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 Claim , dressed to the claimant as shown above.
Dated: �� JOHN SWEETEN, CLERK By Deputy Clerk
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.
Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
LNSTRUCTIONS TO CLAIMANT
A. 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 before December 31, 1987, must be presented not later than the 1001' 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 ore owing 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.'_. )
-;7 B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, Countv
l Administration Building,651 Pine Street. vlartinez. CA 94=53.
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 eaeh public entity.
E. Fraud: Sea nenslty for fnimiulent c!aims. Penal Code Sec. 72 at the end,of this form.
RE: Claim by )l Reserved for Clerk's Filing Stamp
� ) RECEIVED
SEP
4200
_ ,-,ainst the County of Contra �`Coosta
or l�i✓D�►e. SIO 1/t� CLERK BOA RD'OF SUPERVISORS
CONTRA COSTA CO.
District )
.(Fill in dame).
The undersigned claimant herehv makes claim against the County of Contra Costa or the
�D
District in the sum of 5 and in support of this claim represents as follows:
SEP 112001
1. When did the damage or injure occur? (.Give exact Date and Hour)
AvPCox wy- �k Vr�fv�e � { CLERK A OF TISORSCONTRA COSTA CO. .
'_. Where did the damage or in
jun' occur.' (Include City and Counn 1
jn�ressc�t;.�.., e� P,�G►,� o��.,a. �,.� Go�et �:� G> a �sr�-�. Ce-.
--- ------- -------------------- -------------------------------- -------------------- ---
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WHEEL DAMAGED AND REPLACEMENT IS REQUIRED.
Part #/Labor Code Description __---_-_- Src Cat Tech Hrs/Qty Total
Farts 36,312314912 SPK. WHL FRT. BET; BNP 1 691. 95
Labor_ REMOVE AND REINSTALL TIREUA . Z) 3-6.010
INSTALL NEW WHEEL UA . 50 36. 01
Job Subtotal f 763. 91
Job Parts Labor Sublet Other
Breakdown_--> ----h5i.y--_--�-- �I
'� Q) -•-_--------.-:���_----- —. Oki Total of all Jobs
i= 1MiaC4RE GOOD FOR 7 D H r Before Tax Total
WE i1ILL Fi!'iEN PRICE-3 A5 W', RECEIVE NEWFF,Ii=E &00i�1' !=ROS: Sales Tax
Repair Order Total 81. . 9
Diablo Kawasaki-BMW In
1255 Parkside Dr. Ticket Number: 2013619
Walnut Creek,CA 94596
925-938-8373
Salesperson: Richard Williams
Cashier: Richard Williams
Sold To: Date: 8/30/2001
Kaspar,Steve
29 Goree Ct
Martinez,CA 94596
925-228-8748
Sold S/0 Lay P/Ll PartNumber Src Cat Description Price Sold Now Bin
1 0 36312314912 BM BHP SPK.WHL FRT. $691.85 $691.85
Sit
6 0 LABOR4 DI SHP Shop=$60.00/Hour $6.00 $36.00
$0.00
Sub-Total $837.70
Taxable Subtotal $801.70
Sales Tax $64.14
Non-Taxable Subtotal $36.00
Invoice Total $901.84
Total Amount Due $901.84
Check(ck#1752) $901.84
20%RESTOCKING FEE ON ALL RETURNED MERCHANDISE
NO PARTS ARE RETURNABLE AFTER 15 DAYS
NO RETURNS OR REFUNDS WITHOUT THIS INVOICE
NO RETURNS ON ELECTRICAL PARTS
NO REFUNDS ON SPECIAL ORDER PARTS
THANK YOU
8/30/2001 11:05:20 AM Page 1