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HomeMy WebLinkAboutMINUTES - 08062002 - C25 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION. Aug 6,2002 Claim Against the County, or District Governed by } the Board of Supervisors, Routing Endorsements, JUL 202NOTICE TO CLAIMANT and Board Action. All Section references are to ) f'IARTII'-OfUNTYCpy of this document mailed to you is your California Government Codes. ) noTF6of 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: $11,451.28 CLAIMANT: 21"Century Ins/Robert Law Sr ATTORNEY: DATE RECEIVED: July5, 2002 ADDRESS: P.O. Box 4430 BY DELIVERY TO CLERK ON: _—_July 5. 2002 Woodland Hills, CA 91365 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim, JOHN SWEBTN �lerl ,> Dated: _. July 8,2002 By: Deputy ✓ " / i'< 11. FROM: County Counsel TO: Clerk of the Board of Supervisors {4° 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:�-'` '' 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). 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: 5JOHN SWEETEN, CLERK., By `_..�✓ �.�� `' � ��� '� c.' Deputy Clerk S WARNING(Gov. code section 91 1) 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: �'.✓ S� l 3 {$j �1 5._S. �e� •f ,Al�S �i P y 6 rUN-14-2002 IZ'-40 N! i I�1Hr tf-ii i �ttij: "��� �:� 1�e2 E=,t�2 Claim to: BOARD OF SUPRRVI= OF CONTRA CUS`f`A COUNTY ei INSMCrIONS TO CLA1r4Wr t A. Clai= relating to causes of action for death or for injury to person or to per- sonal property or mowing 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 Wury to person or to persvrral property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six moths after the accrual of the cause off'laht`on. Claims relating to any ether cause of action must be presented not later 0= one year after the accrual of the cause of action. (Govt. Code 5911.2.) B. Claims! t be tiled with the Clerk of the Board Of SuPervisoz-s at its office in Rom 166, County Administration Building, 651 Pine ,Street, Martinez, CA 94553• C. If claim is against a district governed by the Beard of Supervisors, rather, Char: the County, the name of the District should be filled in. U. If' thatclaim 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 ee � � e � eeee � eert � eee � eeeeeeeeee � � e * e * � ee � � � RE: Claim By Reserved for Clerk's filing s c `c` k— ) 2 Against the County or Contra Costa } or w F11, in The un4ers geed claimant hereby mattes claim instCounty of Centra Crista or the above-aimed District in the s= of$ !l 1• �; and in support of this dais represents -as follows 1. Whin d d the damage or injury occur? (Give exact date and hour) 2. Inhere did the damage or in occur'? (include city and county) :. 3• Row did ite damage or injury occur? (Give; full detail3s use extra paper if required) C.)n p�� f 4. Whativa rticulw act or omission cn the part of qty or district officers, servants or .employees caused. the-jnjury yr dame? I 9251421' _> 21ST CENTURY INS. ,TES.=818 7195040 06/14102 12:00 JLty- - 00 13 00 CSC RISK iACt �#T2 335 342 P.O3 'g v0nat 'ar„e the names of County or district officers, servants or ftployees causing i, the damage or injury? i 6. 14hat ,doge or injuries do you claim resulted? {Give full extent of injuries or es claimed. Attach taxa estimates for auto damage. t , 7» HOW was the a=unt claimed above computed? (Include the estimated amount of any Jrosjective injury- or damage.) and addresses of witnesses, doctors and hospitals. i t' 9. Ast the expendit•.ares you made on account of this accident or injury: .... ATEITEM AXZJNT Gov`. Codes Sec. 91U:2 j rovide s: "The claim mut be signed by the claimant ,was TO: (Attorney) or by amt px� on his. behalf." z ° Name . ddre33 of Attorney U^ i A Signature i t ' Address i t f Telephone No. Telephone No. iF a �t a * ! * aW I T F V 11 11 1 F r' N0T10E y.. Section 72 of the Penal Code provides: 4� "Every person who, with intent to defraud, presents for allowance or for is 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 claimm# 'bill, account, voucher, or writing, is punishable either by imprisoriwnt in the =unty jail.for a period of not more than one•year, by a fine of not exceeding one thousand ($1,400)t or by both such imri sonment and fine,`• car by imprisonment in the stAtAl prison, by a fine of not exceeding ten thousand dollars ($10,000, car by ' both p31101i Imprisonment and fine. _ F - ° TOTPL P.03 9253351421 => 21ST CENTURY INS. ,TEL.=818 7195040 06/14102 12:00 21stCENTURY INSURANCE 1.C= 1-800-211-SAVE P.O.Box 4430,Woodland Hills,CA 31365 office Number 1-800-322.8200 duly 2, 2002 CERTIFIED MAIL RETURN RECEIPT REOUESTED Centra Costa County Risk Management 9530 Arnold Dr. 140 Martinez, CA 94553 ATTENTION: Penny Bailey Your Insured : Contra Costa County Sherrifs Dept Your Claim/Policy No. : 50014 Date of Accident : 01/09/02 Our Insured Robert W. Law Sr Our Claim No. : 3882368-02 CS-47 Collision Payment $ 10,951.28 Rental Reimbursement $ N/A Deductible $ 500.00 Other Out-of-Pocket $ N/A Total Subro Claim $ 1.1,451.28 Dear Penny Bailey: We are enclosing documentation of our subrogation claim for your consideration and payment. The police officer went though the red light with out is siren on and struck our insured who was making a left turn on a green arrow. We have a police report citing your insured to be the proximate cause of the accident. Please make your check payable to 21st Century Insurance Company as subrogee for Robert W. Law Sr and include our insured's deductible and other out-of-pocket expenses as applicable. Please refer to our claim number when responding. Penny Bailey July 2, 2002 Page 2 Insured Law Sr Claim No. : 3882368.02 CS-47 Thank. you. Sincerely, jela Thomas 21st Century Insurance Company 1-818-71.9-5229 LL TCC-45 21stCENTuRyINSURANCE i21.CfJm 1-800-211-SAVE P.O.Box 4430,Woodland Hills,CA 39365 Office Number 1-800-322-8200 July 2, 2082 Contra Costa County Risk Management 9630 Arnold Dr. 1.40 Martinez, CA 94553 ATTENTION: Penny Bailey Your Insured Contra Costa County Sherrifs Dept Your Claim/Policy No. : 50014 Date of Accident : 81/09/02 Our Insured : Robert W. Law Sr Our Claim No. : 3882368-02 CS-47 Collision Payment $ 10,951.28 Rental Reimbursement $ NIA Deductible $ 508.00 Other Out-of-Pocket $ N/A Total Subro Claim $ 11,451.28 Dear Penny Bailey: Our insured's vehicle was a total loss. The following is a breakdown of the settlement with our insured: Total Loss breakdown ACU $ 12,561.00 Adjustment + $ 0.00 Adjustment - $ 0.00 Tax 8.25% + $ 1,036.28 ULA'/Registration + $ 87.80 SUBTOTAL $ 13,684.28 Deductible - $ 500.08 NET SETTLEMENT TO INSURED $ 13,184.28 Salvage Advance (Tow/Storage) + $ 240.08 Salvage Received - $ 2,473.00 TOTAL COLLISION PAYMENT $ 10,951.28 Rental Reimbursement + $ 0.00 Deductible + $ 500.00 Out-of-Packet Rental + $ 0.00 TOTAL SUBRO CLAIM $ 11,451.28 Please make your check payable to 21st Century Insurance Company as subrogee for Robert W. Law Sr and include our insured's deductible and other out-of-pocket expenses as applicable. Please refer to our claim number when responding. Penny Bailey July 2, 2002 Page 2 Insured Law Sr Claim No. . 3882368.02 CS-47 Thank you. Sincerely. Ange a Thomas 21st Century Insurance Company 1-818-719-5229 TCC-45 105086 CLAIM ADMINISTRATION 06/07/02 FHMG 1. 1 CHECK IMAGE 10:37:43 X 21ST CENTURY INSURANCE COMPANY CONTROL NUMBER CHECK NUMBER 21ST CENTURY CASUALTY COMPANY S 00752 7428070 CLAIM NUMBER DATE OF LOSS INSURED DATE OF ISSUE AP 3882368--02 01/09/2002 ROBERT W LAW SR 01/29/2002 HANDLING CONTROL VENDOR TAX-ID OFFICE DESK CODE MECHANICS BK 000000000 SJ 6MC PAYEE: MECHANICS BK AMOUNT ***10, 941.74 PAY: TEN THOUSAND NINE HUNDRED FORTY ONE AND 74/100 DOLLARS************************* FOR: TOTAL COLLISION LOSS F3=EXIT F12=CANCEL ENTER=CHECK STUB 105086 CLAIM ADMINISTRATION 06/07/02 FHMG 1. 1 CHECK IMAGE 10:37:48 X 21ST CENTURY INSURANCE COMPANY CONTROL NUMBER CHECK NUMBER 21ST CENTURY CASUALTY COMPANY S 00762 7428071 CLAIM NUMBER DATE OF LOSS INSURED DATE OF ISSUE AP 388236802 01/09/2002 ROBERT W LAW SR 01/29/2002 HANDLING CONTROL VENDOR TAX-ID OFFICE DESK CODE ROBERT W LAW 000000000 SJ 6MC PAYEE: ROBERT W LAW AMOUNT ****2,242.54 PAY: TWO THOUSAND TWO HUNDRED FORTY TWO AND 54/100 DOLLARS************************** FOR: TOTAL COLLISION LOSS F3=EXIT F12=CANCEL ENTER=CHECK STUB 105066 CLAIM ADMINISTRATION 06/07/02 FHMG 1. 1 CHECK IMAGE 10:37:53 X 21ST CENTURY INSURANCE COMPANY CONTROL NUMBER CHECK NUMBER 21ST CENTURY CASUALTY COMPANY . S 42746 7470536 CLAIM NUMBER DATE OF LOSS INSURED DATE OF ISSUE AP 3662368-02 01/09/2002 ROBERT W LAW SR 03/05/2002 HANDLING CON'T'ROL VENDOR TAX-ID OFFICE DESK CODE INSURANCE AUTO AUCTIONS 942866676 SJ 6ME PAYEE: INSURANCE AUTO AUCTIONS 11499 DOUGLAS RD RANCHO CORDOVA CA 95742 AMOUNT ******240.00 PAY: TWO HUNDRED FORTY AND 00/100 DOLLARS******************************************* FOR: SALVAGE ADVANCE PAYMENT F3=EXIT F12=CANCEL ENTER=CHECK STUB STATE OF CALIFORNIA TRAFF'.v COLLISION REPORT 4 0? CHP 555 CARS Paga I (Rev 8/98)OPI 442 MDQ. 1 10 ; BPGCyii,CONDtr10Ng ena+m wr&WJN. . ..CITY JUDICIAL DISTRICT LOCAL REPORT NUMBER 2 (" LAFAYETTE WALNUT CREEK MUNI mwim;Zamilm ZOUNTY REPORTING DISTRICT SEAT 1-102 L' 0 CONTRA COSTA 901 � COWS"OCCURRED ON: MO DAY YEAR TIME(2400) NCIC s - OFFICNA I.D. Z MT.DIABLO BOULEVARD 01109/2002 1009 9320 1 15576 MILEPOST INFORMATION: TOW AWAY PMIOTO7sRAPwD BY: NONE WEDNESDAYX YES 7 NO I ROLL C7 i,X.AT INTERSECTION WITH: STATE HWY REL � 'TOR: MOUNTAIN VIEW `�YES NO PARTY DRIVERS LICENSE NUMBER STATE CLASS SAFETY VFJI,YEAR J MAKE/MODEL!COLOR I.LICENSE NUMBER STAT'@ EQUIP. 83607101 CA C G 2001 FORD SEDAN WlU 1050148 CA 1 DRIVER NAMEtFIRDT.MIDDLE.LAST) ON DUTY EME LGENCY VEHICLE ---- ----------------- --------- __- I^ i KENNETH RAMIREZ OSAMER S NAME �SAME AS DRIVER TRRIAN STRUT ADDRESS, CONTRA COSTA COUNTY SHERIFF'S OFFICE (� 3675 MT.DIABLO BOULEVARD#130 SAME AS DRIVER PARKED VEHICLEODrv;STATE/ZIP 1980 MUIR ROAD,MARTINEZ,CA 94553 ( LAFAYEITE CA 94549 CIISPOSMON OF YENK'2.E ON ORDERS OF: FV-7 OFFICER rCANER ( OUST Y. -1 OTHERY• M HAIR rEs HEI sMnIT YVEIGrte B AMERICAN TOW (925)682-8122 u M SRN BRN 6-OZ 220 W PRIOR MECH.DEFECTS NONE APP. RULER TO NARRATIVE �) X I OTHER NOME PHONE $us#"PHONE VEHICLE IDENTIFICATION NUMBER: { (925)283-3680 (925)283-3680 CNP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE UNKNONE MINOR TtPY1LY SELF-INSURED 48 1X IMOD !MAJOR ROulOVER CtR Or TRAVELI ON MEET OR WaP=7 SPEW LIMIT CA DOT E MT.DIABLO 35 CAL-T TCP/PSC Mcm PARTY ORNER`S LICENSE NUMBER STATE CLASS SAFETY VEH.YEAR MAKE!MODEL 1 COLOR LICENSE NUMBER $TATE 2 D0687716 CA C G 1997 ORD SAN GLD 3 WAF976 CA DRIVER NAM£(MRST.MIDDLE.LAST') ---- ------------------- -E77 ROBERT WELLS LAW SR. OWNER'S NAME y]SAME AS ORNER TR" L^^JJ 3632 SICK.ERSTAF'F S TREET#D OWNER'S ADDRESS #y,SAME AS DRIVER CITY 1 STATE!ZIP Lnj VEHICLE LAFAYE=, CA 94549 DISPOSITION OF VEHICLE ON ORDERS OF: OFFICER DRIVER JHEIGHT �10TtiER CUSTsEx wAxR EYES wEK:Hr Mo lfiRT> 11 D" Year RACE LAMORINDA TOW-(925)284-7575 1 M GRY lHZL 5-11 195 0512211924 W PRIOR MECNANTCAL DEFECTS (v iNONE APP. f REFER TO NARRATIVE OTIltR HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER: F7, (925)283-8630 NONE CNP UDE ONLY DESCRIBE VVIICLE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE GUNK NONE jMINOR TOP YEV 21ST CENTURY 3882368 01 'IMOD R '�"IIROufaVER flIR OF TRAVEL ON STREET OR HIGHWAY SPEED LIMIT CA 00T j N {1bIOLN17AIN VIEW 25 CAL•T TCP/PSC MC1M% PARTY DRIVER'S LICENSE NUMEER STATE CLASS SAFETY VEw.YEAR MAIC!MODEL!COLOR LICENSE NUMBERS TATE DRIAM VER NE,rIRST.MIDOLA.LAST) ---_ ----------------- ---„----- OWNER'S NAME SAME AS DRIVER tTtLAN STREET ADDRESS L-1 1 OWNER'S ADDRESS (—]SAME AS DRIVER PARKED CITY 1 STATE/ZIP VEHICLE !V DISPOSITION OF VEHICLE ON ORDERS OF: OFFICER 'i IDRtVEA T'ti@tt ' DEX HAtR EYES lRgiGttT• VM-111 BIRTHDATE RACE CLISr Mo D" Ytv .1 1PRIOR MECHANCIAL DEFECTS NONE APP, f—t3EFM TO NARRATIVE OTHER MOMS PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER: 77. t - CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE UNK 7NONB 7MINOR IElmoo MAJOR - ROLL-OVER DNR OF TRAVEL ON STREET OR HIGHWAY SPEED LIMIT • CA D07 GAL-T TOP/P8C MD/My( PR&pAR€R'3 NAME -.. DCtI tSPATNOTIFIED REVIEWER'S NAME DAT'*y.REVD .. S.DESCHENES 15676 eASMS.- STATE OF CALIFORNIA TRAFFIC COLLISION' CODING CHP 555 CARS PSge2(8198)OPI 042 Peed 2 of 10 t . , �- -- -- 1 , i NUM 0#!0912002 1009 ' 9320 15fi75 1-102 E OTIFIED PROPERTY -7 -- —Y> S r7 NO DAMAGE DESCRIPTION OF DAMAGE SEATING POSITIONSAFETY EQUIPMENT OCCUPANTS MIC BICYCLE•HELMET L-AIR BACs DEPLOYED 0-NOT EJECT ED A& E A-NONE IN VEHICLE M-AIR BAG NOT DEPLOYED f-FULLY EJECTED S-UNKNOWN N-OTHER DRIVER 2-PARTIALLY EJECTED 12 3 1-DRIVER D-LAP BELT NOT USED P-NOT REQUIRED W YES 3-UNKNOWN 5 2 TO 6-PASSENGERS E-SHOULDER HARNESS USED CHILD RESTRAINT 7-STA WGN REAR F-SHOULDER HARNESS NOT USED D PASSENGER E-RR.OCC TRIC OR VAN G-LAP/SHOULDER FARNESS USED R-IN VEHICLE NOT USED X-NO f9.POSITION UNKNOWN H-LAP/SHOUL06R HARNESS NOT USED S-IN VEHICLE USE UNKNOWN Y-YES 0.OTHER J-PASSIVE RESTRAINT USED T-IN VEHICLE IMPROPER USE K-PASSIVE RESTRAINT NOT USED U-NONE IN VEHICLE ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK r)SHOULD BE EXPLAINED IN THE NARRATIVE.P0111Y 7=0115R FACTOR 3 MOVEMENT LIST NUMBER(4)OF PARTY AT FAULT TRAFFIC CONTROL Orvvlces 1 2 3 TYPE OF VEHICLE ! I COL!1S10N f A "E mcncN vKkA?lo' c4m XJA CONTROLS FUNCTIONING A PASSENGER CAR/STATION WAGON STOPPED NO CONTROLS NOT FUNCTIONING- PASSENGER CAR W 1 TRAILER X 2 PROCEEDING STRAIGHT 1 E OTHER IMPROPER DRIVING' IC CONTROLS OBSCURED MOTORCYCLE I SCOOTER RAN OFF ROAD UNSAFE SPEED 5 NO CONTROLS PRESENT/FACT OR- 5 PICKUP OR PANEL TRUCK MAKING RIGHT TURN OTHER THAN ORIVER- PICKUP/PANEL TRUCK WI TRAILER X r MAKING LEFT TURN UNKNOWN- A HEAD-ON IF TRUCK OR TRUCK TRACTOR MAKING U TURN >ELL ASLEEP` ts SIDE SWIPE TRUCK/TRUCK TRACTOR W/TRLFL SACKING REAR END i SCHOOL BUS SLOWING/STOPPING WEATHER ( t ) X 0 BROADSIDE OTHER BUS PASSING OTHER VEHICLE I CLEAR HIT OBJECT U EMERGENCY VEHICLE CHANGING LANES CLOUDY OVERTURNED K HIGHWAY CONST.EQUIPMENT PARKING MANEUVER RAINING I VEHICLE/PEDESTRIAN L BICYCLE L ENTERING TRAFFIC SNOWING H OTHER- OTHER VEHICLE OTHER UNSAFE TURNING FOG/VISIBILITY FT, I PEDESTRIAN XING INTO OPPOSING LANE OTHER:- MOTOR VEHICLE INVOLVED WITH 0 MOPED 7Y PARKED tN1N NON-COLLISION :# MERGING PEDESTRIAN TRAVELING WRONG WAY X A DAYLIGHT XC OTHER MOTOR VEHICLE Z 3 OTHER ASSOCIATED FACTORS ° I IR OTHER`. DUSK-DAWN MOTOR VEHICLE ON OTHER ROADWAY (MARK 1 TO 2 ITEMS) DARK-STREET LIGHTS PARKED MOTOR VEHICLE A "e m"vok"to creno YES DARK-NO STREET LIGHTS TRAIN �!N6 E DARK-STREET LIGHTS NOT ICYCLE $ VC=110NwotAMV: c"o y" FUNCTIONING` H ANIMAL: " SOBRIETY.DRUG G VC UCTION MLA120: CITED YES 1 2 3 PHYSICAL X A DRY I FIXED OBJECT: Np (MARK i TO 2 ITEMS) ti YvEI D X Xf JA HAD NOT BEEN DRINKING ic SNOWY-ICY J OTHER OBJECT: t VISION OBSCUREMENT: I BHBD-UNDER INFLUENCE I JU LI ( U ,C .) INATTENTtON': lu HBO-NOT UNDER INFLUENCE` ROADWAY CONDMON(S) U STOP 3 GO TRAFFIC D H$D-IMPAIRMENT UNKNOWN* (MARK I TO 2 ITEMS) PEDISIMM S ACTIO145 ENTERING/LEAVING RAMP ft UNDER DRUG INFLUENCE' JA HOLES:DEEP RUT X NO PEDESTRIANS INVOLVED I PREVIOUS COLLISION IMPAIRMENT-PHYSICAL' LOOSE MATERIAL ON ROADWAY' B CROSSING IN CROSSWALK fJ UNFAMILIAR WITH ROAD IMPAIRMENT NOT KNOWN OBSTRUCTION ON ROADWAY* I AT INTERSECTION DEFECTIVE VEH.EQUIP.: CITED IM NOT APPLICABLE CONSTRUCTION-REPAIR ZONE C CROSSING IN CROSSWALK-NOT YEB I SLEEPY/FATIGUED rz REDUCED ROADWAY WIDTH AT iNTERSECTION NoSrbULAL INFORMATION FLOODED- CROSSING-NOT IN CROSSWALK I UNINVOLVED VEHICLE y HAZARDOUS MATERIAL OTHER': IN ROAD-INCLUDES S14OULDER OTHER CELL PHONE IN USE X 1 NO UNUSUAL CONDITIONS NOT IN ROAD NONE APPARENT LL N IN USE I j APPROACHING I LEAVING SCHOOL BUS RUNAWAY VEHICLE �4 1 1 1IJ CELL PHONE NONEIUNKNOWN SKETCH FOR SKETCH DIAGRAM, SEE PAGE 4 0 MISCELLANEOUS f Q DOT INDICATE NORTH ��++��y}� t.i[NR 19C 'CHI` DA I STATS OF CALIFORNIA INJURED 1 WITNESSES I PASSENGEk Page 3 w 1 CHP 555 CARS Ps e 3(Rev 8l91 OPI 042 01/09/2002 1009 9320 15676 1-102 w"wassPASSEN£3 Si �, sEic EXTENT OF INJUIRY(7!CINE) INJURED WAS(W ONE) PARTY SEAT SAlFETY aJeCr>eff ONLY ONLY FATAL $� t}YN#Jat VIIItBt„E COMPtAN(i - NUMBER POa. NOW, INJURY INMY IKurf Of PAIN DRfl7�t PASS. PECi. B1CLYtii.tSf OTHER 26 M ❑ ❑ ❑ ❑ Q ❑ ❑ ❑ ❑ 1 1 G 0 NAME I Q.O.S.I ADDRESS TELEPHONE KENNETH RAMIREZ (07/13/1975) 3675 MT.DIABLO BOULEVARD#130,LAFAYETTE,CA 94549 (925)283-3680 (INJURED ONLY)TRANSPORTED BY: TAKEN TO: AMR AMBULANCE JOHN MUIR MEDICAL CENTER DESCRIBE INJURIES: NECK AND BACK.PAIN. BUMP ON HEAD. VICTIM OF VIOLENT CRIME NOTIFIED Ell ❑ 77 IM ❑ ❑ t� �1 �❑ ❑ ❑ ❑ 2 1 l IG 1 0 TELEPHONE ROBERT WELLS LAW SR. (05/22/1924 3632 BICKER.STAFF STREET#D,LAFAYETTE,CA 94549 (925)283-8630 (INJURED ONLY}'TRANSPORTED BY: TAKEN TO: WILL SEEK OWN MEDICAL AID DESCRIBE INJURIES: PAIN IN LEFT SHOULDER. f"l VICTIM OF VIOLENT CRIME NOTIFIED s ISO]F ❑ ❑ ❑ ❑ ❑ LEI I I-LI ❑ NAtdS 1 D.O.B,t ADDRESS TELEPHONE SUZANNE MARIE.MOORS 01/17/1951) 919 DEWING AVENUE,LAFAYETTE,CA 94549 925)962-0197 (INJURED ONLY}TRANSPORTED 8Y: TAKEN TO: E DESCRIBE INJURIES: 7- VICTIM OF VIOLENT CRIME NOTIFIED ; # 2 [ 38 F 71 ❑ ❑ ❑ ❑ ❑ ❑ NAME I D.O.B.t ADDRESS TELEPHONE: MARY FAITH PORCELLA (1212611963) PO BOX 1461,LAFAYETTE,CA 94549 (925)299-8995 (WJUR€D ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: i VICTIM OF VIOLENT CRIME NOTIFIED x,# 3 ❑ 144 F ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ NAME I D.O.B.I ADDRESS TELEPHONE INDU PAUL 02/{34/1957) 3651 MT.DIABLO BOULEVARD,LAFAYETTE,CA 94549 925)299-7930 (INJURED ONLY)TRANSPORTED BY: TAKEN TO: E DESCRIBE s . VICTIM OF VIOLENT CRIME NOTIFIED �# _J a _ J ❑ L I ❑ _! ❑ ❑ ❑ NAME 1 D.O.S.I ADDRESS TELEPHONE I t (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: VICTIM OF VIOLENT'CRIME NOTIFIED PREPARER'S NAME I.D.NUMBERMO. DAY YEAR REVIEWER'S NAME 7DAY Yam S.DESCHENE5 15676 01/09/2002 jj!"-76 ALL MiEASt PENISHTS r .APPROXIMATE AND f4CT TO ECALZ U"LZS5 TEST (SCALE _ } { ( t 1 �`I i.1 l ij 1 1 moi'"T`#� toot -Amp .ll�e INOICAYI 4 dA_ 0 elm boi >1 kq a r(, �t� t `�- CL EAR KEEP y. n s rs 37{ 13 —t GHP to it RY 3�7t .- won"eveous fbl"W"s umnl6 bt•itYtb . 14-47 ALL MS1ASUXMZMT$ '. ApS+ROXfMATE AND NOT TCS SCALE UNLESS t"SU#1BGALLC r } I ., I I l I I .... I so r 'fj�-TUG}C: x. o:41 K. PIWE t� � 1wn1e�•rr d 3 3 A . r elm t 1 KEEP a - V. s CMO! 43i {111ty 1-79} VENN•RUVIGUt SOM0000 UNTU.ourtar=D StAT't OF CALIFORNIA NAR ATIVEI UPPP.EEE TAL SAGE � OF�i� DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 011Ct9l2002 1009 9320 15675 1-112 1 LECENQ 2 VEHICLE POINT OF REST Vein. # Ft. Dir. Reference Point Ft, Dir. Second Reference Point V-1 LF Tire 5' E The west roadway edge of 24'4" N The south roadway edge of Mt. Mountain View Drive. Diablo Boulevard. LR Tire 9' W The west roadway edge of 21' N The south roadway edge of Mt. Mountain View Drive. Diablo Boulevard. V2 RF 1' E The west roadway edge of 36'9" N The south roadway edge of Mt. Mountain View Drive. Diablo Boulevard. RR 19'2" E The west roadway edge of 337 N The south roadway edge of Mt. Mountain View Drive. Diablo Boulevard. 3 PHYSICAL EVIDENCE A Tire friction mark from V-1's left front tire. B Tire friction mark from V-9's right front tire. 4 LQ ATICN CSF PHYSICAL EVIDENCE NO. Ft. Dir. Reference Point Ft. Dir. Second Reference Point A beg. 477" W The west roadway edge of Mountain View Drive. A end 2' E The west roadway edge of Mountain View Drive. B beg. 37*10' W The west roadway edge of Mountain View Drive. B end T E The west roadway edge of Mountain View Drive. 5 ORKEPA ED BY I.D.NUMBER DATE REVIEWER'S NAME NATE S, DESCHENES 15676 01/09/2002 SLATE OF CALIFORNIA NARRATIVE/SUPPLEMENTAL PAGE 7 Of IO DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.Q. NUMBER 01/0912002 1009 93201 15676 1-102 1 FACTS: 2 NOTIFICATION: 3 1 was dispatched to a call of an injury traffic collision, with an ambulance responding at 4 approximately 1010 hours. I responded from 1-680 SIB at SR-24, and arrived on scene at 5 approximately 1020 hours. All times, speeds and measurements in this investigation are 6 approximate. Measurements were taken by rollmeter, except where otherwise indicated. 7 8 SCENE: 9 The scene of this collision is the intersection of Nit. Diablo Boulevard and Mountain View 10 Drive. The intersection is controlled by three cycle traffic signals which were determined to 11 be in proper working order at the time of the collision. The surface is composed primarily 12 of asphalt. See diagram. 13 14 PARTIES: 15 Parley #1 (Ramimz) was located at the scene of the collision. P-1 was identified by his 16 statement. P-1 was determined to be the driver of V-1 based on his statement, and his 17 injuries. 18 VEHICLE #1 (Ford Police car) was located on its wheels, at its point of rest, as shown on 19 the diagram. V-1 sustained moderate damage to the front end as a result of this collision. 20 There were no known damage or defects to'V-1 prior to this collision. V-1 was removed 21 from the scene of the collision by American Tow pending a vehicle inspection. 22 Party #-2-(Law-Sr.) was located at the scene of the collision. P-2 was identified by a 23 California driver's license. P-2 was determined to be the driver of V-2 based on his 24 statement, he was the registered owner of V-2 at the time of the collision, and he was in 25 possession of the keys to V-2 upon my arrival. M 26 VEHICLE #2 Ward) was located on its wheels, at its point of rest, as shown on the 27 diagram. V-2 sustained major damage to the entire left side of the vehicle as a result of 28 this collision. Vere were no known damage or'defecrts to V-2 prior to this collision. PREPARED E3Y #.D.NUMB!`R -0A--TV REVIEWER'S NAME DATE S. DESCHENES 15676 01/09/2002 STATE OF CALIFORNIA NARRATIVEISUPPL»EMEN'TAL. PAGE 8 OF-ia DATE CP INCIDENT TIME NEI NUMBER WICER I.D. NUMBER 01/09/2002 1009 9320 15676 1-102 1 PHYSICAL EVIDENCE: 2 Vehicle paints of rest and locked wheel skid marks. See factual diagram and legend. 4 STATEMENT'S: 5 Party #1 (Ramirez] related that he was responding to a call of a bank robbery utilizing his 6 patrol vehicles overhead lights and siren. He stated he approached the intersection of Mt. 7 Diablo Boulevard at Mountain `thew Drive on a red light. He stated he was traveling at 8 approximately 30 MPH. He stated V-2 was facing N/B on Mountain View Drive with 9 another vehicle in front of it. The front vehicle pulled into the intersection, and completed 10 its left turn onto Mt. Diablo Boulevard. P-1 stated he made eye contact with P-2, and 11 assumed he was going to remain stopped prier to the intersection. P-1 stated he then 12 accelerated to clear the intersection, and then collided with V-2. He said he did not 13 remember seeing V-2 enter the intersection. 14 15 Party # 2 (La-r Sr.? related that he was stopped in V-2 on N/B Mountain View Drive at the 16 intersection with Mt. Diablo Boulevard. He stated he had stopped for a red light behind a 17 Porshe. He continued by stating the Porshe was the first vehicle at the intersection. When 18 the light turned green, the Porshe entered the intersection, and P-2 followed. P-2 stated 19 he then saw VA approaching from the left. He said it appeared that V-1 accelerated 20 toward him, and collided with the left side of V-2. P-2 stated he did not see the emergency 21 lighting, and did not hear the siren. He also stated that the emergency lighting was not 22 activated until after the collision. 23 24 WitnessAll-INIppre) was contacted at the scene of the collision. She related that she was 25 walking N/B on Mountain View Drive on the east side of the roadway. She stated she. 26 heard a siren,-and then saw V-1 enter the intersection. She stated she then saw and 27 heard the collision in the intersection. When asked, she did not notice the color of the 28 traffic signal light. PREPA-RED BY I.D.NUMBER DATE R VIEWER'S NAME DAfE S. DESCHENES 15676 01/09/2002 9tATE OF CALIFORNIA NARRATIVE/SUPPLEMENTAL, PAGE 9 OF"-10 DATE OF INCIDENT TIME NCIC NUMBER {OFFICER I.D. NUMBER 01/09/2002 1009 9320 15676 1-102 1 STATEMENTS CONTINUER: 2 Witness #2 (Porcella) was contacted at the scene of the collision. She related that she 3 was walking w1b on Mt. Diablo Boulevard. She stated she heard a siren, and looked up to 4 see V-1 with emergency lights on approaching the intersection of Mt. Diablo Boulevard and 5 Mountain View Drive. She stated she also saw V-2 entering the intersection from N1B 6 Mountain View Drive. She stated that the vehicles appeared to be attempting to avoid 7 each other. V-1 slowed down, and then accelerated again as the collision occurred. She 8 then stated that neither vehicle traveling at a very high rate of speed. 9 Witness #3 {Paul was contacted inside Baskin Robin's ice dream store at the comer of 10 Mt. Diablo Boulevard and Mountain View Drive. She related that she was inside the stare 1'I and observed V-1 drive by the window. She stated she did see emergency lights activated 12 on the vehicle, but did not remember if she heard the siren. She stated she then looked 13 away, and heard the collision. 14 15 OPINIONS AND CONCLUSIONS 16 SUMMARY. 17 P-1 was driving V-1 E/B on Mt. Diablo Boulevard approaching the intersection with 18 Mountain View Drive at approximately 30 MPH. The emergency lights and siren were 19 activated on the patrol vehicle. P-2 was stopped in V-2 on N1B Mountain View Chive at a 20 red light with one other vehicle between him and the limit line. The light for NfB Mountain 21 View Drive turned green. The first vehicle entered the intersection and completed a left 22 turn onto Mt. Diablo Boulevard. P-2 then entered the intersection.and began his left turn. 23 P-1 continued through the red light. The left front of V-1 collided with the left side of V-2. 24 25 AREA OF IMPACT: 26 A01 #1 was located approximately 5 feet 2 inches east of the west roadway edge 27 prolongation of Mountain View Drive, and approximately 19 feet 5 inches north of the south 28 road edge of Mt. Diablo Boulevard. P D BY l.#3.tVtlttf Eft DATE REVIEWERS NAME DATE S. DESCHENES 15676 01/0912002 SPATE OF CALIFORNIA NARRATIVEISUPPLEMENTALAEo ;o C7ATE OF INCIDENT TIME NCI NUMBER OFFICER I.D. NUMBER 01109/2002 1009 9320 15676 1-102 1 AREA OF IMPACT CONTINUED- 2 This area of impact was determined based on the points of rest of the vehicles involved, 3 and the skid marks made by V-1. 4 5 CAUSE: 6 P-1 caused this collision by driving through the intersection of Mt. Diablo Boulevard and 7 Mountain View Drive at a speed higher than that which is safe with lights and sirens while 8 cross traffic faces a green light. 9 10 This cause was determined based on the statements of the parties involved, and the 11 damage to their vehicles. 12 13 RECt3MMENDA71ON5 14 done. PEc BY a. UNER DATE REAM 'S Ai"E GATE S. DESCHENES 15676 01/0912002 STATE 6F CMYOF IA NARRATIVEISUPPLEMENTAL PAGE . tTA 5F INCI T7 E WIC SER t3FF3CEIt r D. 01/09102 1009 9320 015676 2002-1-102 r. Vehicle Lns �qn At the request of Officer S. Deschenes, #15671, 1 conducted a vehicle inspection on a 2000 Ford Crown Victoria which was involved in a traffic collision on Mout Diablo Boulevard at Mounttain. View Drive on January 9, 2002. On January 11, 2002 at 1000 hours'1 arrived at American Tow to perform the inspection. Lwat on American Tow 5017 `C' Forni Drive Concord, CA 94520 (925)682-8122 'C 6kle 2000 Ford, Crown Victoria, 4 door sedan Vin#2FAFP71 134X155492 Cal Plate#1050148 Odometer, 31,048 miles, 66.3 trip miles Iteter+ d mer Contra Carta County 2467 Waterbird Way Martinez, CA 94553 3'ItFPf ER'S NA�+tE Ida.NUNMER DATE lklff ER S NA3v1R HATE K GRIMES "" 010542 02104102 STATE OF CALIFORNIA NARRATIVE/SUPPLEMENTAL PAGE UAMTE OF INCIDENT TIME NCIC NUMBER OFFICER LD. NUMBER 01/09/02 I009 9320 415576 2002-1-102 } +Generalspetrtion The involved vehicle was a 2000 Ford Crown Victoria, 4 door, patrol vehicle. This Ford is a white rear wheel drive, patrol vehicle, with a 4.6 liter 8 cylinder engine and an automatic transmission. The Ford also has power assisted four wheel disc brakes, and power assisted . steering. There were lap/shoulder safety belts at the four perimeter seating positions. The safety belts are of a continuous web material applied by the person sitting in that position. The left front safety belt was examined for evidence of use. The safety belt was free of defects. The safety belt latched and released as required. There was no evidence of torsional loading on the belt webbing material, pivot points, or latch mechanism. The exterior of the Ford showed moderate damage consistent with a frontal impact. The damage indicated the Ford impacted an object across the front end of the vehicle and the principle direction of force (PDGF) was through the center of mass. Contact damage was observed to the across the front of the Ford beginning at the right front corner and continuing to the left front corner. Induced damage was observed to the remainder of the front end. PR.EPAR,ER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DA'T'E K GR.IH'S 010542 02104102 _. _ _ STATE 6F CAU'#FORNIA NARRATIVE/SUPPLEMENTAL PAGE . NAM of INCIr?Wr TIME NCIC NUIIM FFICER I.IS. NU?aER 01(09/02 1009 9320 015676 2002-1-102 Brakes Both the front and rear brakes are activated by foot pressure to the master cylinder through the vacuum power assist unit and brake pedal. The pressure applied to the mastei'brake cylinder by the brake pedal, pushes hydraulic brake fluid through the brake lines to the front and rear brake calipers, thereby activating the brakes. The master cylinder was located on the fire wall in the engine compartment. The composite design master cylinder was properly attached at the front shell of the vacuum power-assist booster. The master cylinder design included a cast aluminum body, primary and secondary piston assemblies with related seals and springs, plastic reservoir, reservoir cap and cap diaphragm seal. The fluid delivery lines were properly affixed between the .roaster cylinder and the combination valve. The lines of this location appeared to be free of visible defect or damage. The brake fluid was approximately .125 inches below the maximum level. The brake pedal was depressed and held for approximately 3 minutes. The brake pedal held firm, without fade. The power-assist function is achieved through use of a vacuum booster mounted to the engine compartment bulkhead. The booster unit uses intake manifold vacuum and atmospheric pressure to reduce braking effort. The Booster unit was a diaphragm, vacuum suspended unit. The booster was composed of front and rear shells, diaphragux(s), pushrod, and an air valve assembly. Vacuum is delivered to the power-assist booster from a vacuum outlet port located on the engine intake manifold. The delivery of manifold vacuum is conveyed through a molded rubber hose and an inline check valve. The,fron t brake calipers were of a single piston floating design. Each caliper was properly affixed to its respective carrier with mounting pins. The mounting pins and anti-rattle springs properly maintained the positioning of brake pads within the caliper assemblies. The steel caliper pistons were in an extended position, with the friction pad linings located in close proximity to the rotor surfaces The brake fluid delivery flex hoses were free of defect as were the rigid brake lines. The front brake pad friction li'ni'ngs were composed of a bonded, semi-metallic material. The friction lining contact surfaces were smooth and displayed indications of full engagement being made between them and the brake rotor surfaces during use. All four of the brake pad friction linings had approximately .37 inch of material remaining. The front brake rotors were a vented design. The outboard and inboard contact surfaces of both rotors were smooth and uniform. The rear brake calipers were of a single piston floating design. Each caliper was properly affixed to its respective carrier with mounting pins. The mounting pins and anti-rattle springs properly in ained the positioning of brake pads within the caliper assemblies. The steel caliper pistons were in an'extended position, with the friction pad linings located in close proximity to the rotor surfaces The brake fluid delivery flex hoses were free of defect as were the rigid brake limes. I'it PAIUR'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE K GRIMES 010542 02104102 STATE 6F CAUFORNtA NAI~ltkATIVEISUPPLEMENTAL PAM- DAf U UF"MriDerr TIME NCIC MER OFFICER M NUMER 01/09/02 1009 9320 015676 2002-1-102 The rear brake pad,friction hrungs were composed of a bonded, ;sena metallic material. The friction Doing contact surfaces were smooth and displayed indications of fill engagement being made between them and the brake rotor surfaces during use. All four of the brave pad friction linings had approximately .22 inch of material remaining. ,The rear brake rotors were of a solid design. The outboard and inboard contact surfaces of both rotors were smooth and uniform. The steering system is controlled by manual input through the steering wheel from the driver. This rotationalinput is transmitted to the steering box through a shaft which extends from the steering wheel through the fire wall to the frame mounted hydraulic assist steering boat. The rotational input into the box will push or pull on the steering arms, thereby turning the front wheels to either the left of the right. The power steering pump,belt,hoses,and power steering box appeared to be in good working order. The power steering fluid was approximately .25 inch below the full level. The left and right sides of the steering system showed no previous damage or defects. The remainder steering system showed no signs of prior defects or damage. The steering system would turn the front wheels to the left or the right in a jerky motion due to frame damage. Tires The tires on this Ford Crown Victoria were in good condition. The tires were Goodyear in model ,Eagle RSA. The tires were in size P225160 R.16. The tire tread depths and air pressures are as follows: 'fire Tread Depth Air Pressure Flight rear .22 inch 37 psi Flight front .20 inch 37 psi Uft front .31 inch 40 psi Left tear .19 inch 42 psi Throttle Sys#etrt The Ford Crown Victoria was equipped with a 4.6 liter 8 cylinder engine. The induction system was composed of port fuel injection with a cable controlled linkage, throttle return spring, and an accelerator pedal. The air intake hese was removed from the throttle housing to provide viewing of the throttle plate's positioning. The throttle plate was found established in the closed (idle) position. The control cable com=tions at the throttle linkage were maintained in their normally routed. . PREPARER's NA3v4E I.D.M MHER DATE REVIEWER'S NAME DATE K GAMES 010542 02104102 SY'ATE'OF CALIFORNIA NARfuxTIMMUPPLEMENTAL PAGE DXM OF OCIDENT TUM MEMOS 0MCBEM RU - 01149l42 1449 9324 415676 24421-142 ccnfigmt m The utile enols were properly conjoined at the hrkage cc>xibection points. The accelerator pedal was depressed and the throttle plate was rotated by hand. The throttle plate routed smoothly, without binding. The throttle rotated from an idle position to a full throttle position and retuned. C©ucludons A.ftr completing a medlianical inspection on the above vehicle, it is my opinion that there were not any prior reechamcal defects which would have caused or contributed to this incident. All damage observed during the inspection was determined to have resulted from the collision. No determination was made as to the use of the left front safety belt. PRVARWS NAME I.D.NUMHFR DATE REVIE110MF S NANM DATE K GRl1 S 010542 02104102 t SY{ 1N3URMCE AUTO AUCT:&.:N3 , . Pitt8b'iiI`g 1055 N. Parkside Drive INSURANCEPittsburg, CA 945655 No. 0330706614 wr.M Aum {.925}439-7Ci87 Detre: 05/09/02 J l re RepcSrt � 96 of � Saalvaga Zstfcr ca-ion ACV Acct of Sales IAA Stock No. 330-02001644 Sales.......................... $2,650.00 2 ..10 god. Tax I.D. 95-3790111 Coeatission.................. 159.40 1.27 ADJUSTIMt Chri.stino Rogers Title Fee..................... 3.00 0.02 POLICY HOLDXRs robart lax IAA VLF Processing Fee....... 15.00 0.12 TOTAL SAA CRARONS........... 177.00 1.41 CO. FILR: 3882368-1 �• IAA, R TMUr................. $2,473.00 19.69 POLICY$s 93D3IM,R1 1997 CROWN VICTO NXT REKZTT ................. $2,473.00 19.69 tMDC2 Left Side sa,ar�rerr,: { V.Z.3t.s 2FALP74WOV%178358 =='" ACV: $12.563. NXCD DATSs OS/08/02 -n Hi MMI BWOR AUTCUOTIVI 1 ADDSS': 101 U AvrrA W. 7 CITY',ST ZIP: Concord, CA 94820 � R'S b ` C... ...1 (_ wwwwrww Internet Bids wwww�ww twv J Contributed To Your Proceeds! ! MgRsed Deva► Aaaa:lvaais s Data of Nvent # of DAYS Lose 01/09/02 LZCNNSR RSYM CALCULATION Recovered IVA Refund Processed On 03/19/02 III Assigned 01/10/02 2 Year First Sold 2000 Released 01/10/02 1 License Axpires on 06/26/02 j Pickup 01/10/02 1 Claus of Vehicle DD Title Received 43/14/02 64 Refund Application Received On 03/19/02 Cert Received 05/03/02 51 DKV Refund $33.00 Auction Date 05/07/02 5 Lass •- DxV Charges 7.00 Salo 05/08/02 6 Not MM Refund $26.00 � Ranittanco 05/09/02 2 VLF to be paid directly from State - Rat Only Rlaipeod Totaal. Days: 121. Salvage Certificate Issued 05/03/02 Retain this portion for your records MORAQA :LAFAYB `x,ORINDA IN Mal {i m 24 HOURS 1029 Blackwood Lune•Lafayette,CA 94549 ? 284-7575 r- DARE. TIME REQUESTED BY CALL NO. LOCATION oil VEHICLE tus �. J YRAK MAKE x COLDR t10ENSE NO. STATE nz Lies-An h TOWED TO '' NAME PHONE Ra &u. b ADDRESS X ❑FLAT TIRE 0 STARE lYw a FRONT C REAR �1 CASH JCjFBECK R WHEEL LIFT 17 {/ } O BATTERY LOCCOtIT �;ARYtIER L,LOLLY + ' a M!C TRAILER £: C OAS a RECOVERY op.6MIDENT L7 CHARGE t x; a [. MILEAGE SERVICE TIME EXTRA MANPhW TRUCK FINISH FINISH FINISH START START START (` TOTAL TOTAL TOTAL Ro/Fo NO. YIN G ` BuTo ATTN: ADDRESS , C TOWING ROAD SERVICE MILEAGE I F lug V .�� h� �y......rw... �.. r ADVANCE CHARGES STORAGE KEYS 1w.0 YES HOLD:0 YES C3 NO TOTAL DRIVER? CK N0. i' F-. / CUSTOMER SIGNATURE 1 1 r INSURANCE AUTO .AUCTIONS Pre-Billing Invoice No: 635242 Pittsburg 1055 N. Parkside Drive Pre-ailiing :nvc.=e Date: 02/1.5102 ( Pittsburg, C.A. 94565 ` Tel . # (925) 439 -7087 Salvageee Report Salvage Information outstanding Charges: ACV IAA Stock No. 330-02001604 TOTAL{ IAA CHARGES. . . . . . . . . . . . . . . . . . . . . . . .00 Fees. Tax I.D. 953790111 ADJUSTER- Christine Rogers OUTSIDE CHARGES ADVANCED BY IAA: POLICY HOLDER:rohert law Paid Towing. . . . . . . . . . . . . . . . . . 100.00 Maid Storage. . . . . . . . . . . . . . . . . 140.00 CCD. FILE: 3882368 TOTAL OJS CHARGES. . . . . . . . . . . . . . . . . . . . 240.00 POL_CY#: NET DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . $240.00 VEHICLE: 1997 CROWN VICTORIA LX _-s UVDC: Left Side V.I.N. : 2FALP74WOVX178358 ACV: $0 r 91d Days Aaatlysis: -r r Fate of Nv'eut: # of Days Less 01109102 .Recovered NIA Assigned 01110102 2 tVENNOOR i��3�11.,fir. Released 01110/02 1 Fi ckz s 01110102 1 i,A - LO In�:oFe 02115102 37 n aW TratstZ Dais: 38 :� rM To ensure your payment is properly applied, please detach And mail the bottom stub With your check. hJ <-D.ETACH HERE DETACH HERE-> �. Pittsbur 1055 N. Parksi e Drive Pi t tsbur , CA 9456`5 Tel. # (925) 4.39-7087 j SALVAGE INFO MATTON t Co. File: 3832368 Policy Hldr: roberc law COL: 02109102 l IAA Stock#: 330-02001504 PRE-BILLING Fed. Tax X.Q. 95-3790212 DATE INVOICE NO AMOUNT DUE DUE DATE 02115102 635242 $240. 00 03102102 21st Century Ins 1102 P 63 O 1 Owen smo u th Woodland Hills, CA -91367 i 21S" -ENTURY INSURANCE COMPANY 1. 1AST HUNTINGTON1 DRIVE MONROVIA, CA 91016 (800) 443-3100 User id: 48330 Valuation - Request : 28706347 01/17/2002 15 : 15 *INSTANT* Aduster name: JOHNSON, A Less date: 01/09/2002 Appraiser ID: XXXXXXXXXX VIN: 2FALP74WOVX178358 Claim reference: 3882368 Claims class: Insured: LAS? Owner: LAW VINguard Insurer Description VINguard Analysis --______.._____________ Year 1997 1997 Make Ford Ford Model Crown Victoria LX Ltd Crown Victorialx P74 P74 Eddy style 4d Sed 4d Sed Engine 8-4 .61-Fi 8-4 . 61-Fi Trans Automatic Transmission Overdrive Restraints AIR BAGS (DRIVER+PASS. ) Air Bags (Driver+Pass, ) Odometer 43450 Note: 295 less than typical vehicle This vehicle was assembled in ST THOMAS, ONTARIO VINguard message (s) : VlNguard has decoded this VIN without any errors. ISO Vehicle History: ISO response indicates no history for this VIN. - C-71 t. Cn ..... Valuation ;equest : 2870634 ■%continued) 1997 FORD CROWN TORIA LX PAGE 2 , Ve :le Valuation Summary The current local market value was determined to be -_==> $12, 042 .00 _-� Includes adjustments for odometer and options; excludes condition, tax, title, and dealer prep. CCC pre-adjusted vehicle valuation amount : $ 12, 042 .00 Condition adjustment amount : f 519.00 Actual Cash Value $ 12, 561 . 00 Pretax amount $ 12, 561 .00 Adjusted vehicle valuation amount : $ 12,561 . 00 Vehicle Equipment Air Bag STD Air Conditioning STD A';.loy Wheels INC AM FM Stereo STD Anti-Lack Brakes (4) INC Automatic Transmission STD Body Side Moldings STD Bucket Seats INC Cassette INC CD Changer/Stacker INC Cruise Control INC Dual Mirrors STD Gauges STD Intermittent vipers STD Leather Seats INC Light Group STD Metallic Paint INC Moldings STD Overdrive STD Passenger Airbag STD Power Az:tenna INC Bower Brakes STD Power Driver Seat STD Power Locks INC Power Mirrors STD Power Passenger Seat INC Power Steering STD Power Windows STD Rear Defogger STD Reclining/Lounge Seats STD Search/Seek STD Tilt Wheel STD Tinted Glass STD 4-Wheel Disc Brakes STD Valuation Processing Notes Included in our backup aresimilar models to the loss vehicle. Proper adjustments were made for this valuation. Your primary valuation market selected for comparable vehicles is EAST BAY, CA We extended the search into surrounding markets for additional comparable vehicles . We have added the .following standard options to the loss veh: Disc Brakes, Dual Mirrors, Overdrive Uy 1 t'-f U ; 87f� ,,S• i H s, Valuation request : 28706347 ontinued) 19,97 FORD CROWN iORIA LX PAGE 3 Your valuation has been prepared according to Section. 790 . 03 (8) of the California Insurance Code. Any deductions from the value are meant to be discernible, measurable, itemized, and specified as well as appropriate in dollar amount according to the requirements of the Fair Claims Settlement Practices Reaulati.ons, Section 2695 . 8 et seq. (C) Copyright 2002 CCC Information Services Inc. All rights reserved. The trade names and/or trademarks used herein are owned by their respective trademark owners . Valuation Methodology CCC based the valuation of your 1997 Ford Crown Victoria LX on the local market of Lafayette, CA. CCC searched 2 local vehicle databases in the preparation of your valuation. The primary local vehicle database searched was East Bay, CA. In this area CCC maintains a database of 6, 383 inspected dealer vehicles located at 76 dealerships and 28, 770 advertised vehicles taken from 36 local newspapers and magazines. This local database also includes 9, 594 valuations recently completed in this area. The secondary local vehicle database searched was Bay Area, CA. In this area CCC maintains a database of 3, 045 inspected dealer vehicles located at 31 dealerships and 16, 729 advertised vehicles taken from 26 local newspapers and magazines . This local database also includes 5, 174 valuations recently completed in this area. CCC searched the above databases for comparable vehicles based on the year, make, model, body style and engine configuration of your vehicle. Adjustments were made to the value of each comparable vehicle to compensate for differences in year, model, body style, engine configuration, packages, options, and mileage. From these local databases CCC identified 4 dealer inspected vehicles as sufficiently similar to your 1997 Ford Crown Victoria LX to be considered as comparable vehicles. CCC selected 2 dealer inspected vehicles as the most comparable and used their values to determine your valuation. Your valuation was prepared automatically by our expert system. The valuation was based on dealer inventory. reale: inventory vehicles have been inspected by CCC to verify condition, mileage, packages, and options. Dealer inventory includes both recently sold and currently available vehicles . The valuation for your 1997 Ford Crown Victoria LX was adjusted to reflect the mileage, options, packages and condition of your vehicle. This information was provided as part of the request for valuation. Additionally, CCC decoded the Vehicle Identification Number (VIN) to verify that your vehicle is a 1-997 Ford Ltd Crown Victorialx 4 door sedan with a 8 cylinder 4 .6 liter engine. Valuation recruest : 2870634"" 'continued) 1997 FORD CROWN "-CTORIA LX .PAGE 4 Adjustment amounts are based on a combination of factors including the region of the country, the age of the vehicle, and the type of vehicle. Your vehicle has been valued in the Western region as a newer passenger car with 29% less than average mileage. The condition of key exterior, interior and mechanical components of your vehicle has been evaluated by your insurance adjuster and your valuation has been adjusted accordingly. The adjustment amount for each component is based on the age, class and value of your vehicle. CCC bases condition adjustment amounts on surveys of thousands of licensed dealerships nationwide. The following comparable vehicle (s) were selected and used to determine this valuation: Type Comparable vehicle Price Adj Val %Wt Inspected vehicle 1997 FORD Crown Victoria $9, 988 $12, 247 '61 Inspected vehicle 1997 FORD Crown Victoria $9, 900 $11., 725 39 CCC valuation amount: $12, 042 100 .All selected comparable vehicles were adjusted for differences in mileage, condition, model, options, and packages from the loss vehicle. Each comparable vehicle is considered when determining the final valuation amount. There are several factors which determine the exact amount that each vehicle contributes to the final valuation amount. These factors are outlined as follows: Vehicles whose year, model and body style match the loss vehicle contribute more than vehicles which differ. Vehicles with fewer differences in packages, options and mileage contribute more than vehicles with greater differences. Vehicles located closer to Lafayette, CA contribute more than vehicles which are farther away. Vehicle Condition Category Condition Adjustments MECHANICAL Engine Dealer ready $76 Appraiser comment : NC Transmission Dealer ready $54 Appraiser comment : NC Valuation request: 28706347 .Dntinued; 1997 FORD CROWN t 'ORIA LX PAGE 5 Vehicle Condition (continued) Category Condition Adjustments PAINT Dealer ready $54 Appraiser comment : NC TIRES Front Tires Major wear ($33) Appraiser comment : NC Rear Tires Normal wear $0 Appraiser comment: NC BODY/GLASS Dealer ready $162 Appraiser comment: NC INTERIOR Dealer ready $206 Appraiser comment : NC Total Adjustments : _ $519 Valuation request : 2870634' 4continued) 1997 FORD CROWN rTT�'TORIA LX PAGE 6 Vehicle Valuation Comparison ______________________-_ Lass Vehicle Inspected Vehicle Inspected Vehicle ---------------------------- ----------- ------------------- 1997 ------------------1997 Ford 1997 Ford 1997 Ford Crown Victoria Lx Crown Victoria Crown Victoria 4d Sed 4d Sed 4d Sed 84 .51-Fi 8 g Auto Trans-OD Auto Trans-OD Auto Trans-OD Air Conditioning Air Conditionina Air Conditioning AM/FM Stereo Seek AM/FM Stereo AM/FM Stereo Tape And Cd Changer With Tape Cassette With Tape Cassette Opts On Camp Veh: Privacy Glass Opts Not On Comp: Power Driver Seat Power Passenger Power Passenger Seat Seat Leather Seats Leather Seats Alloy Wheels Alloy Wheels Anti-Lock Brakes Anti-Lock Brakes (4) (4) Miles : 43,450 52, 231 57, 5037 Location: Sunnyvale Livermore Distance From:Lafayette 35 24 Dealer: Sunnyvale Ford Groth Bros . Chev Contact Person.: Jon Mitro Rich Madresa Phone Number: 408/738-1800 925/447-3190 VIN: 2FALP73W2VX131222 2FALP73W1VX226600 Stock# P0383 Stock# U9207 Recently Recently Avail.. $ 9, 988 Avail . $ 9, 900 Adjustments Madel/Year + 550 + 550 Radio Options + 300 + 300 Opts On Comp Veh: - 91 Opts Not On Comp: + 1, 178 + 1, 087 Odometer + 915 + 663 Condition - 684 - 684 %djusted Value $ 12,247 $W11, 725 Inspected Vehicles Dealer/Location/Yr-Model/ Compared VIN Stock# Color Phone/Odometer Price to Loss Sunnyvale Ford (408) 738-1800 $ 91988 $ 12,247 Valuation request: 2870534- rcontinuedi 1997 FORD CROWN VICTORIA LX PAGE 7 Inspected Vehicles (continued) Dealer/Location/Yr Model/ Compared VIN Stock# Calor Phone/Odometer Price to Doss -------------- -------- __ _____ Sunnyvale, CA. 36 Miles From Lafayette 1597 Crow:- Victoria 62, 231 2F'ALP73W2VX131222 Groth Bros. Chev (925) 447-3190 $ 9, 900 $ 11., 725 Livermore, CA. 24 Miles From Lafayette 1997 Crown Victoria 57, 507 2FALP73W1VX226600 Vehicle History The Crown. Victoria receives only slight changes for 1997, which include: updated power steering, a few new exterior calors, and the addition of a rear air suspension to the Handling Package. The Crown Victoria is offered in Base or LX trim levels .' There is also a special model offered to fleet buyers known as the Crown Victoria Commercial, and a special production Police version. All models get the same 4 .6-liter, V-8, with horsepower ranging from 190 to 210 depending on the model choice. The Crown Victoria and its Mercury Grand Marquis partner offer much more value than many of the compact and mid-sized cars available on the market . A fully loaded Crown Vic can be purchased for less money than a Toyota Avalon, or the even smaller Cary XLF. The Handling Package is recommended for improved ride and handling. 21s rntury Insurance Company (800) 443-3100 110 East Huntincdton Drive Monrovia, CA� 91015 DATE OF VALUATION: 01/17/2002 VALUATION#: 28706347 CLAIM REPRESENTATIVE: Johnson, a CLAIM #: 3882368 INSURED'S NAME: Law DATE OF LOSS: 01/09/2002 INFORMATION ABOUT YOUR VALUATION 21st Century Insurance Company has selected CCC Information Services to provide a fair and accurate market value for your 1997 Ford Crown Victoria LX 4 door Sedan. CCC provides local market values for over 1 . 7 million automobiles, trucks, recreational vehicles, heavy equipment, and marine craft each year. CCC' s values take into consideration all aspects affecting the value of a vehicle, including its age, mileage, options, and condition. Since its founding in 1990, CCC has valued over 25 . 0 million vehicles for insurance companies, banks, and government agencies. CCC establishes vehicle valuations by physically inspecting vehicles for sale at local auto dealers in your area., researching local newspapers and automobile publications and storing this information in a state-of-the-art database. This database allows CCC to continuously track the local market value of your vehicle. CCUs vehicle database contains specific local market information for more than 400 areas across North America. CCC" Field Inventory Representatives regularly inspect more than 600, 000 vehicles from over 4, 000 auto dealers while maintaining 2 .5 million vehicle advertisements published in more than 1, 500 newspapers and other local publications. CC^'s exclusive VINguard system utilizes the Vehicle Identification Number from your vehicle to accurately identify your vehicle. VINgua.rd has determined your vehicle to be a 1997 Ford Ltd Crown Victorialx 4 door sedan with a 8 cylinder 4 . 6 liter engine. The primary valuation database used for your valuation was East Bay, CA. CCC also searched 1 additional adjacent local market databases in your area. CCC maintains a database of inspected dealer vehicles from 107 dealers in your area, consisting of 9, 428 inspected dealer vehicles. CCC processes advertisements from 62 publications in your area including 45,499 locally advertised vehicles . Based on the information you provided to 21st Century Insurance Company, CCC has determined the fair market value of your 1997 Ford Crown Victoria LX 4 door Sedan in Lafayette, CA to be $12 , 042 . 00 . CCC' s inventory of cars can also help you locate your next vehicle . In your area, CCC maintains relationships with 107 dealers . once you have finalized your claim with 21st Century Insurance Company, please contact AutoSearch, at 1-800-633-7834 . our personal auto consultants can help you locate your next vehicle, FREE OF CHARGE. When contacting AutoSearch, please use the Valuation Request Number listed at the top of this page. - Your valuation has been prepared in accordance with the laws ofyour-state----- ------------------------------------------------------------------------------- Jan 15 €32 12: 29p SEL.MOS & RSSOC. RPPRR I SER 7074487503 P. 3 INSURANCE AUTO AUCTIONS FASTTRACK APPRAISAL SERVICES 1055 N. PARKSIDE DRIVE PITTSBURG, CA 94565 PHONE: 925-439-7087 CD LOG NO 483 -0 01-14-02 11:37 PM ESTIMATE CLAIM INFORMATION CLAIM 1, 3852368 POLICY # COMPANY 21ST CENTURY INSURANCE CLM REP/AGNT CHRISTINE ROGERS FAX WORK PHONE (925) 688-4721 INSURED ROBERT LAW LOSS DATE 01-09-02 CLAIMANT LOSS TYPE COLLISION FILE HNDLR FILE # 010025 INSPECTION TYPE DIRECT APPRAISAL PROGRAM APPRAISER NAME JEFF SELMOS WORK PHONE (707) 446-7507 FAX (707) 448-7503 ADDRESS P O BOX 5491 INSP nATF 01-14-02 CITY STATE VACAVILLE CA LOCATION STOCK# 02001604 ZIP 95696- CITY STATE PITTSBURG CA OWNER ROBERT LAW WORK# HOME# (925) 293-8530 REPAIR TOTAL LOSS CAR IN PITTSBURG CA REPAIR DAYS VEHICLE 1997 FORD CROWN VICTORIA LX 4 DR SEDAN 8CYL GASOLINE 4 . 6 OPTIONS TWO--STAGE - EXTERIOR SURFACES HEATED REMOTE CONTROL MIRRORS KEYLESS ENTRY SYSTEM POWER DOOR LOCKS HEATED BACK GLASS ANTI-LOCK BRAKE SYSTEM CALIFORNIA EMISSIONS CRUISE CONTROL DIGITAL INSTRUMENT PANEL PASSENGER SIDE AIRBAG BODY COLOR GOLD C/C MILEAGE 43, 450 CONDITION GOOD VIN 2FALP74WOVX178358 LICENSE * 3WAF 976 CODE P416 LICENSE STATE CA VEH INSP # REMARKS: VEHICLE IS A TOTAL L033- OP CODES : * = USER-ENTERED VALUE E = REPLACE OEM NG = REPLACE NAGS EC = QUALITY REPL. PART EU = LIKE, KIND & QUAL. PRT EP = QUAL_ REPL. PRT_ RPT -I- 7074487503 => 21st Century Ins. .TEL=626 3037480 01115'02 12:35 Jan 15 02 12: 55p SELMOS RSSOC. SPPRRISER '7074487503 p. 4 1997 FORD CROWN V'IC`F`ORIJ '. 4 OR SEDAN CLAIM # 3382368 LOC 483 -0 01-14-02 11:37 PM TE = PA.RTL REPL PRICE ET - PARTL REPL LABOR IT = PARTIAL REPAIR I = REPAIR L - REFINISH S8 = SUBLET N = ADDITIONAL LABOR RI R&I ASSEMBLY P = CHECK AA w APPEAR ALLOWANCE Ftp' : RELATED PRIOR UP = UNRELATED PRIOR OH GDE MC DESCRIPTION MFR.PART NO. PRICE AJ% HOURS R L- 0103 -- FENDER, FRONT LT REFINISH 3.7 4 SURFACE 2.6 TWO-STAGE 0.5 TWO-STAGE SETUP 0. 6 E 0147 MLDG, FENDER SIDE L/R F5AZ16037PTM 33 . 55 0.3 1 Fa 4163 PILLAR, HINGE LT F5AZ5402SA01A 877 .53 16.7 1 L 0163 PILLAR,HINGE LT REFINISH 3.2 4 SURFACE 2 .7 TWO-STAGE 0.5 E 4197 MLDC, RCKR PANEL FRONT LT F8AZ5410177AAA $9.40 INC 1 E 0201 DOOR SHELL, FRONT LT YW7Z5420125BA 565.40 5 . 9 1 L 4207 DOOR SHELL, FRONT T.T REFINISH 3.4 4 SURFACE: 2.0 EDGE 1.0 TWO-STAGE 0.4 E 4244 MLOG, F'RONT DOOR SIDE LT F5AZ5420879PTM 89.67 0 .3 1 E 0189 PILLAR,CENTER LT F2AZ54243A02A 1, 317. 58 6.0 1 L 0189 PILLAR,CENTER LT REFINISH 0.8 4 SURFACE 0 .5 EDGE 0. 2 TWO-STAGE 0.1 E 0287 DOOR SHELL,REAR LT F6AZ5424631AA 1, 134 .00 4 .4 1 L 0287 DOOR SHELL,REAR LT REFINISH 3.0 4 S'URF'ACE 1 . 7 EDGE 1.0 TWO-STAGE 4 .3 E 0323 MLDG, REAR DOOR SIDE LT F5AZ5425557PTM 85 .23 0 . 3 1 E 0341 PANEL,ROOF F2AZ5450202A 377 .87 21 . 0 1 L 0341 PANEL,ROOF" REFINISH 3 . 6 4 SURFACE 3.0 TWO-STAGE 0. 6 L 0389 PANEL,QUARTER LT REFINISH. 1 . 5*4 E 0421 MLDG, QUARTER SIDE L/F F5AZ5429077PTM 34 . 38 0.3 1 17 ITEMS FINAL CALCULATIONS & .ENTRIES PARTS GROSS PARTS Y 4, 604 .11 OTHER PARTS PAINT MATERIAL $ .350. 40 ** ADJUSTMENTS DISCOUNT MARKUP PARTS TOTAL $ 4, 954 . 11 TAX ON PARTS & MATERIAL a 8 .250% $ 408 .71 -2- 7074487503 -> 21st Century Ins. ,TEL=626 3037480 01/15`02 12:36 Jan 15 02 12: 29p SELMOS & RSSOC. APPRAISER 7074497503 P- 5 1997 FORD CROWN VICTORIA: 4 DR SEDAN CLAIM # 3882368 LOG 453 -0 01--14-02 11 :37 PM .LABOR RATE REPLACE HRS REPAIR HRS 1-SHEET ME'T'AL $ 58 . 00 55.2 $ 3, 201 . 60 2-MECH/ELEC $ 58 . 00 3-FRAME $ 58 . 00 4-REFINISH $ 58 .00 19.2 . $ 1 , 113 . 60 5-PAINT $ 24 .00 LABOR TOTAL $ 4, 315.20 TAX ON LABOR @ SUBLET REPAIRS TOWING STORAGE GROSS TOTAL $ 9, 678 .02 LESS: DEDUCTIBLE UNKNOWN- NET TOTAL $ 9, 678 . 02 TOTAL LOSS PXN No SPPL Yes Geocode: ADP PENPRO W0338 ES LOG 483 -0 01-14-02 23: 48 :51 REL 3.38 CD 10/01 COPYRIGHT, AUTOMATIC DATA PROCESSING, INC. 1999 ** USER-ESTABLISHED THRESHOLD FOR PAINT MATERIAL HAS BEEN REACHED AND CALCULATED IN THIS ESTIMATE. ANY ADDITIONAL MATERIALS MAY REQUIRE FURTHER APPROVAL. ** 3 . 0 HOURS WERE ADDED and THIS ESTIMATE BASED ON ADP' S TWO-STAGE REFINISH FORMULA : 20% OF REFINISH HOURS, AFTER OVERLAP, PLUS SETUP TII`'11E FOR THE FIRST MAJOR PANEL, WHERE NOTED. 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. ------------------------------------------------------------------------------- -3- 7074487'503 => 21st Century Ins. ,TEL=626 3037480 01/15 `02 12:36