Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
MINUTES - 07222003 - C.11
CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JULY 22, 2003 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 a Pursuant to Government Code Section 913 and s. 915.4. Please note all "Warnings". AMOUNT: $30,000. CLAIMANT: JANE OVERTONt �< r `" ATTORNEY: JOHN C. FERRY DATE RECEIVED: JUNE 16, 2003 ADDRESS: LAW OFFICES OF JOHN C. FERRY BY DELIVERY TO CLERK.ON: JUNE 16 , 2003 100 PLEASANT VIEW DRIVE PLEASANT HILL, CA 94523 BY MAIL,POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JUNE 16 2003 JOHN SWEEzv—a--� Dated. 7 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 510.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Hoard cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was fled late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). ( ) Other: J 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: t 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: JULY 22, 2003 JOHN SWEETEN, CLERK, By , Deputy Clerk WARNING(Gov. code sectio 913) Subject to certain exceptions, you have only six (6) months from the date this ndtice 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: JULY 23, 2003 JOHN SWEETEN, CLERK.By Deputy Clerk Maim'to. BCPM OF StPMMMRS OF CONTRA CWTA CCJCTM 72�IMUCTIONS 710 alinwn A. Claims relating to causes of action for death or for injury to person or to per- zonal property or growing crops and which accrue on or before December 31, 19879 must be presented not later than the lDDth 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 gnawing 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 moat be presented not, later than one year after the ac erml. of the clause of action. (Govt. Cade 5911.2.) S. Maim moat be filed with the Clerk of the Board of Supervisors at its office in Room 106, City Adminiztration Building, 651 Pirie Strre*et, 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 tilled 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. fit at the end of this form. * * * * * i * * * * * * * * * * * * * * * * * * * * * * * * * • * * * * * * * * * * * REs Claim By Deserved for Clerk's filing st=p i a ti RECEIVED rp—rnsit t imty ntra Costa JUN 1) Ei X00 3 .N ._ o or rt } District) CLERK BOARD OF SUPERViS RS CONTRA M'ZTA CO. name.rrrri..n.1n n rr.w r.rri r.. -rwr) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of , � �, and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. Mmv did the damage or injury =ur? (Include city and county) ? . 3. Bow did the damage or injury occur? (Give full detailal use extra paper if required) 2 I V vm -1 Out i y) ell- MR � t 4. What particular act or mission on the part of county or district officers, servants or employees caused the injury or dwwge? (over) 5. What ar*e the names of county or district officers, servants or employees causing the damage or injury"? . V rt 6. What damge or injuries do you claim resulted? (Give full extent of injuries or damages ^claimed. Attach tuo estimates for auto damage. 7. Hou was the amount claimed above 000puted? (Include the estimated amount of any prospective injury or damage.) S. Hames and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DATE M • s e e e e e e e e e e • * s e e e e e e * f +� e r �r e e • e e * e e +� f e s e e e Gov. Code Sec. 910.2 provides: '"The claim Must be signed by the claimnt MZ NMCES TO: (Attorney) ory. some son on his behalf." Name an A dress o ttorn y �- f ��✓ ' (Claimant's gnaure LAW �O 10 Q ss 'Ll ea, OZA, -9 41 13 Telepha* No. l�'S � � � l� Telephone No. i a a ! ! ! a ! a a a 9 9 a W V ! NOTICE Sectien fit of the Pend Code provides: *Every person xho, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, amount, voucher, or writing, is punishable either by imprisonment in the county Jail for a period of not more thin one year, by a fine of wt exceeding one thousand W,tk?0), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not *xeceding tan thousand dollars ($10,0000 or by both such Imprisonment and fine. CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY \,1 BOARD ACTION: JULY 22, 2003 Claim Against the County, or District Governed by ) the Beard 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• $1 , 344 . 67 CLAIMANT: DWAYNE LYLE ATTORNEY: UNKNOWN DATE RECEIVED: JUNE 17 , 2003 ADDRESS: 714 THOMPSONS DRIVE BY DELIVERY TO CLERK ON: JUNE 17, 2003 BRENTWOOD, CA 94. 13 BY MAIL POSTMARKED: JUNE 12, 2003 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JUNE 17 JOHN SWEET N Dated: 2003 By: Deputy II. FROM: County Counsel TO. Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 9,10,2. { } 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: J 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: (X) 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: JULY 22.L 2003 JOHN SWEETEN, CLERK, By , Deputy Clerk WARNING(Gov. code secti 913) Subject to certain exceptions,you have only six (6)months from the date this ndtice 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: I LY 232003 JOIN SWEETEN, CLERK.By Deputy Clerk Y claim to.. BOARD OF Sick' VI"QRS OF CDNM COSTA COUNTY INMUCTIONS 1O CIATMANT A. Claims relating to causes of action for beach or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 193f, 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 amps and which accrue on or after .unwary 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Cleric of the Board *f Supervisors at its office in Roam 106,. County Administration Building, 651 Piste Street, Martinez, CA 94553. C. If claire is against a .district governed by tt.e Board of Supervisors, rather than the County, t?e name of the District should be filled in. U. 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 Agrary-Mt He- aunty of MR CoSt.3 A c District) f Fill in naw The undersigned claimant hereby mimes claim against the County of Contra. Costa or w the above-nad District In the sum of $ ���� and in support of this lira represents as follows- 1. When raid the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) t C�3 O, ���L fq ewA o `�3hu_ q .,rkl Oar4 o & ( �kJ � . � 3. How dial the damage or injury occur? (Give full details; use extra paper if required) C. 44/VU L C 4. What particular act or omission on the part of county or district officers, ` l'i servants or.employees caused. the.injury or,damage's 51 M44K, +111-04 L01 iN-9wJt�Nt�W ms I � 9F:60 �0 - F-AUW 2e'�J -(tii0i wnat are tie nacos of county or district officers, servants or employees causing the doge or injury? { t t 6. What damage or injuries do you claim resulted? Give full ext of injuries or damages claimed. Attach two estimates for auto damage. CN5 "��;a i 1 "-i Ccs toer nC €A {„rA I �: ..L UP—f:' ..0 a it 7. Howwas the amount claimed above computed? (Inalude the estimated amount of any prospective injury or damage.) AZ sc Olt a B. Names and addresses of.witnesses, doctors and hospital ` }%~ )c_> �x f 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT f J Ct L4 Goy. Code Secy 910:2 provides: #The claim must be signed by the claimant SEM NOTICES M: (Attor M ) or by some person orvhis. if.n Dame and Address of Attorney K, ve LikaLJL�� ,S Si tura Address' Telephone No. Telephone No. NOTICE Sectio 72 of the Penal. Cade protides: "Every person who, with intent to defraud, presents for allowance or for payment to any state bard 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 imprisoriment in the county jail,.' for a period of not more that cne-year, by a fine of not exceeding one thous d ($1,000), or by-both such imoKsommt and fine;��or by imprisonment in the state prison, by a fine of not exoseditfig ten thousand dollars ($10t000, or by both such imprisonment and fine. 20 Id Tebz SEE SZ6 1N3WOUNHW >G I a 000 9Z:60 20aZ-?2-At 44 till" t ; ' It UF U ij 115 fit , a 1113 # tt3 113 13 t p ,i7 i pflsi;193�i !C�t7TS3: Pi$ t i #to o ,p ffi Ills! P 1 la I W � till utl waft 13 Disco Bay Detailing Estimate 6330 Brentwood Blvd. Brentwood, CA 94513 DATE ESTIMATE NO. 925-634-1883 5/22/2003 10352 NAME t ADDRESS Kelly Lyle :714 Thompsons Dr. Arent%ood,Ca.44.513 .925.316.6386 PROJECT DESCRIPTION CITY RATE TOTAL 2002 Chevy.sorb.Customer stopped by to see about removing tar 0.00 0.00 from tires.This cannot be done by any means at all..Only option is to mplacc with new all Four tires. I Questions`?Please Call,thank you,Carl TOTAL OT x L M S(l�.Ofi { b: 3: L 3 } , t _ _rr CLAIM i BOARDS OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JULY 22 , 2003 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". °x AMOUNT: $20 ,000-00 CLAIMANT: ROY SAVOY ATTORNEY: .JOHN L. TAYLOR DATE RECEIVED: JUNE 19 , 2003 385 GRAND AVE. SUI'T'E 300 ADDRESS: OAKLAND, CA. 94610 BY DELIVERY TO CLERK,ON: .JUNE 19 , 2003 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETE Dated: JUNE 19 , 2003 By: Deputy 'y H. FROM: County Counsel TO. Clerk of the Board of Supervise s }`?This claim complies substantially with Sections 910 and 510.2. d � { ) 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: a " : Dated:. , �z � B ( �` �� . 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: P 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: JULY 227 2003 JOHN SWEETEN, CLERK, By , Deputy Clerk WARNING(Gov. code secti 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: JULY 23, 2003 JOHN SWEETEN, CLERK By Deputy Clerk Clain to: BOARD OF SUPERVISORS OF CONTRA COSTA MINTY INSTRUCTIONS To CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January I, 1988, mint be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause,of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Superrvisom at its office in Roam 106p County Administration Building, 651 Fine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of' Supervisors, rather than the County, Whe 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 forma RE: Claim By ) Reserved for Clerk's filing stamp Against the County of Contra Costa ) � or JU"4' L 9 2003 District) CLERK Po Fill in name ) ; i, �CO. �S „ � . The undersigned claimant hereby rakes cla.i inst the County of Contra Costa or the above-named District in the sum of $ � ��.;, �� .Q and in support of this claim represents as follows: �` l.. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury sur? (Include city and county) 3. How did the damage or injury occur? (Give full details; use extra paper if required) 1t f:.�!!f�6��_� t•...P'i�j��8.',.,, �'s+F �L.r�.��C ��� ref.. ! .'GY' , -�a,.�.7 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? f � ................ ........... ....... 5. wnat are the names of county or district officers, servants or employees causing the damage or injury? 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. 7. How ,as the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) -—----------- Names and addresses of witnesses doators and hospitals. �At\ 9. A VA List the expenditures you made on account of this accident or injury-. DATE ITEM AMOUNT 4 ;7 V# Gov;. Code Sec. 910;2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on hi behalf." Name and Address of Attorney (Cya-t=trs signattxr) /4�.11l S74- (Addi Telephone No. Telephone i-N F N N N N X N V I V N I NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance lowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisoriment 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. .............................................................. ................�.-._.........._.................. ............. Date: 6/1410:3 04:04 PM Estirna a tt3: 2827 Estmele Verakrr: 0 Peary Proms 10: COLOMEX COLOMEX FRAME & BODY SHOP 22431 till"M fid.HWm ard,CA 94541 (510)24?- Foc (510)2477-93K38 BA€t. # AH17 9940 EPA GAL 0001 a 6604 FII} 94-3207431 FAX Sia 247-9306 t3emige By: Luh M"M Appvieed For T.J. IJeduC te: UNKNOWN Insurett: TAYLOR JHON &*d*#Seivuoe: slow De w*Wn: 1999 Fond Evkm Spod Body SW 2D LJ4 lUr WS Ddve Tnain: 4.OL 1r#8 Cy!4WD Vft 1FMY1t24E6XU841W6 Lkmww. 4GDV984 CA 437.000 Qpi : ALilWALLOY WHEELS,AIR CONDIT1C} ING,POWER WINDOWS,POWER DOOR LOCKS CRUISE CONTROL.,AUTOMATIC TRANSMISSION,AN" YER(SINGLE) All crash parts on this estimate ,are 'anew" original equipment manufacture parts,unless .Insurance company pays for used or recycling,aftermarket neaa parts,rechromed recorder remanufactured or reconditioned are considered rebuilt parts. Une Enby L*w Lrm#tit Part Tyw Ddw Lam Um Number Type OpWMW Part Number AmouM _ Unfs 1 AUTO St3'Y' OVERHAUL FRT BUMPER ASSY 0.7 Z 8133014 BOY REMOVEIREPLACE FRT BUMPER FACE BAR YL2217757 AAA 287.28 INC 3 MMM BOY RENME4052LAM R FRT 8U%#*R PACS XL2Z 17KW3 AA 81.17 INC 4 803019 BCY REMOVE PLACE FRT BUMPER UCENSE BRACKET XL2Z 17A38.5 AAAI 8.58 INC 5 804251 BOY REMOVEIREPLACE FRT BUMPER REINFORCEMENT Kt2Z 17#358 AA 234.00 INC 6 803023 REF REFINtSH GRILLE C 1.6 7 85335130 BOY REMOVEIREPLACE GRILLE HOER PANEL F87Z 8190 CA 14610 1.8 d# 8 AUTO FIEF REFINISH OPENING PANEL C 1.2 9 800022 BDY CHECKIAD UST HEADLAMPS 0.4 10 800025 BDY REMOVE/REPLACE R H& ASSEMBLY FSM 13008 A 1118.00 INC # 11 MOD41 ODY REMOVEIREPLACE R PARK1S1GNAL LAMP ASSEMBLY F67Z 13200 AA 37.20 0.1 12 800055 REF BLEND HOODOUTSIDE C 1.1 13 803227 BOY REMOVEIREPLACE R FENCER PANEL XL2Z IWW CA 239.40 3.0# 44 AUTO REF REFINISH R FEVER OUTSIDE C 2.5 15 AUTO REF REFINISH R FENDER EDGE C 0.5 16 80345`x7 BOY REMOVEIREPLACE R FSR LINER F67Z 16054 AA 35.13 0.3 # 17 WM89 BOY REMO VEANSTA.t L R FENDER WHEEL OPENING MLDG INC 18 OMM BOY REMOVEMEPLACE R FENS WHEEL OPENING MLDG XL2Z 1131}38 AAA 33.40 0.5 19 800448 GLS REMOVEIREPLACE WIS# IELD GLASS F57Z 780310D A 20063 22 # ESTIMATE RECALL NU0ABFA 6t14J0316:02: 3 2827 LWaUaft is a Trad&n rk of MkW toWnatexW Mtn Data Vavaln: Mok t_ h Com#(C)1994-2002 iVlitcW trdettoefioxad Pop 1 of 3 testate Vem§on: 4.13.012 AN tR DAA 611+ 3134:04 PM Estknoft ICD: 2627 Eafiramte Verslon: 0 Preknkwy Prafle IC. COLOMEX 20 SUBJECT TO-44.0M SASS ADJUSTMENT 24 9031500 MCH* ADDIL LABOR OP 2 WHEEL ALIGNMENT Shat 49.95* 0.0* 22 WMS REF REFINISH R FRT DOOR OUtSIAE C 1A 23 840884 BOY REIuIOVE *TALL R FRT UPR W04DOW Ii LDL 1.1 � 24 800666 BOY REMOWJMTALL R FRT DOOR REAR MEW MIRROR Ems' trig 0.4`* 26 933002 REF AEVL OPR CLEAR COAT 1.5* 26 933W3 REF ADDIL t3PR TINT COLOR 0.3* 27 9=18 REF ADM OPR MASK FOR OVERSPRAY 5.00 28 AUTO ADDLCOST PAINTMA"I'I=RIALS 262.50 29 AUTO At'3D L COST HAZARDOUS WASTE DISPOSAL x.00" *-Judgement ftem #-Labor Note ApptiS C-Included it Char Coat Calc AdO Labor SubW 1. Labor SubtotWA Unft fb*e Amount Amount TO" U. Pwt Repleoa Aot Seamy Arrrtxanl BWY &4 EDO 0.00 0.00 502.20 Tax"Paas _ 4,484.89 R 10.5 62.00 5.00 4.00 66.00 Gins A4usbraftQ-40A)M 81.W Glias 22 62.00 0.00 0.00 136.40 Sales Tax C &250% 144.08 k4echofti 0.0 70.00 0.00 49,95 48.45 Total Rot Parts AmourA 1,4496.92 Nor-1 Labor 1,3444.55 Labor Sum 20.8 4,344..55 Ill. Addiftial C Rrr owt I. Adjwbmft Anvunt Tax"Csets 282,50 OAtworResporabW 0.00 Solea Tax 0 82w% 2t% Noo-Tamble Coft 5.00 Tried AddkkmW Coats 289.16 V ToW Labor 1,344.65 It. Total Reps Paris; 4,496.92 lit. ToWAddborialCosk. 289.16 Cara"Total: 3,13083 IV. ToW Adkustmen1a: 0.00 Nd Total: 3,430.63 7tft- jj a tdteft-k�.. This is your authority to repair my above mentioned vehicle for the cost of repairs and/or replacements as per estimate agreed upon. between. Co-lomex Frame and Body Shap and the representative of Insurance Company. My share of the cost of repairs is $ , the insurance company to pay the remainder of the agreed price direct to your company. Ir fiTIIat TE RECALL Nt#AWR; Bfi14M 31&02:W 2W is a Tradonark of Mkch&Intarrrs#kmw hWXW0gftVGr;jo": MAY 03�A COP}rrW(C)1904,2002 Ir r*WrW Pale 2 of 3 UlkavAkevask)w 4.8.012 AS R DOW 611 0*04 PM E$dn"Oe Versaar: 0 Pmft 0 COLOMEX It is understood by the undersigned that in carrying out these instructions you are acting solely for the undersigned and not for the Insurance Company or any of its representatives. Sinned Date CREDIT CARDS ARE ACCEPTED. ;ASH OK. INSURANCE CHECKS OR DRAFTS OK. SIGNED WARNING: W beg dept*msit a poswbi& Pecs ww h jW PW nnu t. Avid!arae nw sbwmv whee! wid3 mttwrrwrt peat owm 6 w begs hams d*kyed. Ouskitap w bag modWa mw be pts wt LW could Iain an unttepi Ad stva& WMn dq a vV of a air bV ~treat it as a"#"moftlik Sae appmpfte A+TCHELLO AIR BAG SERVICE&REPAIR MANUAL,or OEM k4ar w im. ESTIMATE RECALL NUMBER: W1 %VZ50 2627 WhOaft is a T d MJftW tftnetto" DaN'Vemidn: VARY 03,,A CaWg t(C)'t -2602 Mitchell Wwn4ong Pap 3 of 3 UWWASU VOW= 4.5,012 AN RWft Reswrec! 06/16/2303 at 03:10 PM Job dumber: 70409 A-1 MARTIN'S AUTOBODY REPAIR 6 FR14ME 1507 Market Ave San Pablo, CA 94606 (510) 233-0066 Fax: (510)233-0024 PRELIMINARY ESTIMATE Written by: EFRAIN MARTIN Adjuster: Insured: JOHN TAYLOR Claim # Owner: JOHN TAYLOR Policy # Address: P.O BOX 342 Deductible: PTTSBURG Date of Loss: Other: (925) 427-6490 Type of Loss: Point of Impact: 1. Right Front Inspect A--1 MARTIN'S AUTOBODY REPAIR & F Business: (510) 233-0066 Location: 1507 Market Ave San Pablo, CA 94806 Insurance Company: Days to Repair 1999 FORD EXPLORER 4X4 SPORT 6-4.OL--FI 2D UTV Int: 'YIN: 1FMYU24E6XUB41906 Lic: Prod Date: Odometer: Air Conditioning Rear Defogger Intermittent Wipers Rear Wiper Body Side Moldings Dual Mirrors Privacy Glass Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks Power Mirrors Anti-Lock Brakes (4) Driver Air Bag Passenger Air Bag 4 Wheel Disc Brakes Cloth Seats Bucket Seats Automatic Transmission 4 Wheel Drive Aluminum/Alloy Wheels ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1 FENDER 2 Repl RT Fender w%Sport 1 239.40 3.0 2.5 3 Add for Clear Coat 1.0 4 Add for Edging 0.5 5 Add for Clear Coat 0.1 6 Repl RT Fender brace to rad support 1 50.50 incl. 7 Repl RT Splash shield 1 10.08 Incl. 8* Repl RT Wheel opening 2 door black 1 79.68 0.4 0.0 9* Rpr RT Inner panel 2.0 1.2 i0 HOOD 11 Bind Hood 1.4 12 FRONT LAMPS 06/16/2003 at 03:1O PM Job Number: 70409 PRELIMINARY ESTIMATE 1999 FORD EXPLORER 4X4 SPORT 6-4.OL-FI 2D UTV Int: ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 13 Repl RT Headlamp assy 1 116.00 Incl. 14 Rep! RT Park/marker lamp 1 57.20 incl. 15 GRILLE 16 Repl Grille Sport, XL & XLT painted 1 1-91.52 Incl. 1.8 17 Overlap Major Non-Adj . Panel -0.2 18 Add. for Clear Coat 0.3 19 Repl Front panel 1 146.90 !.8 1.0 20 Overlap Major Adj . Panel -0.4 21 Add for Clear Coat 0.1 22 Deduct for Overlap -1.0 23 R&I Sight shield Incl. 24 FRONT BUMPER 25 O/H front bumper 1.8 26* Repl Bumper cover Sport 1 287.28 Incl. 0.0 27* Rpr Reinforcement 2.0 28 R&I License bracket 0.2 29 DOOR 3O Blnd RT Outer panel w/o keyless 1.3 entry 31 R&I RT Mirror w/power heated 0.6 32# Algn SET UP AND MEASURE 2.0 33# Subl ALL WHEEL ALIGNMENT 1 100.00 X 34# Refn COLOR, SAND AND BUFF 2.0 35# Rpr COLOR, TINT& BLEND 0.5 36# Algn PULL TO SQUARE 4.0 37# OPEN FOR 4 WHEEL NOT WORKING 1 ------------------------------------------------------------------------------- Subtotals _> 1278.56 17.3 12.6 Parts 1.178.56 Body Labor 17.3 hrs @ $ 64.00/hr 1038.00 Paint Labor 12.6 hrs @ $ 58.00/hr 730.80 Paint Supplies 12.6 hrs @ $ 26.00/hr 327.60 Sublet/Misc. 100.00 ---------------------------------------------------- SUBTOTAL $ 3374. 96 Sales Tax $ 1506.16 @ 8.2500% 124.26 ---------------------------------------------------- GRAND TOTAL $ 3499.22 ADJUSTMENTS: Deductible 0.00 2 06/16/2003 at 03:10 PM Job Number: 70409 PEtZLn411gAR C ZSTZK&TZ 1999 FORD EXPLORER 4X4 SPORT 6--4.OL-FI 2D UTV Int: ---------------------------------------------------- CUSTOMER PAY $ 0.00 INSURANCE PAY $ 3499.22 ? HEREBY AUTHORIZE THE REPAIR WORK TO BE DONE ALONG WITH THE NECESSARY MATERIALS. YOU AND YOUR EMPLOYEES MAY OPERATE VEHICLE FOR PURPOSES OF TESTING,INSPECTION OR DELIVERY AT MY RISK. AN EXPRESS MECHANIC'S LIEN IS ACKNOWLEDGED ON VEHICLE TO SECURE THE AMOUN OF REPAIRS THERETO. YOU WILL NOT BE HELD RESPONIBLE FOR LOSS OR DAMAGED TO VEHICLE OR ARTICLES LEFT IN VEHICLE IN CASE OF FIRE,THEFT,ACCIDENT OR ANY OTHER CAUSE BEYOND YOUR CONTROL. SIGNED DATE THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES: B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS: ADJ=ADJACENT ALGN=ALIGN AIM=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL• AU'T'O GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE' AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET G,T=LEFT W/O=WITHOUT W/—=WITH/— SYMBOLS: #=MANUAL LINE ENTRY *=OTHER [IE. .MOTORS DATABASE INFORMATION WAS CHANCED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide DR2MF95 Database Date 4/2003 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 Dual Repl Parts. Used parts are described as LKQ, Qua! 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 wORII; Gwac�I.l�ELEASE�A. CONTRA COSTA REGIONAL MEDICAL CENTER TIME OFF AUTHOR[ZED FRO WORK scI-Io EMERGENCY DEPARTMENT { ❑ ECHO � ❑ P.E. nor_ FOLLOW-UP INSTRUCTIONS I DUE To: ❑ 1INJURI ❑ ILLNESS s The care you received here has been given on an FROM: � emergency basis only. You may need further tests or care after your release from here. w� RETURN DATE: Xi RESTRICTIONS: If your condition worsens unexpectedly,return X here. If you feel your recovery is not preceeding as expected, contact your regular physician or call the Advise Nurse at 1-800-495-8885. FROM; Si su condici6n empeora regrese aqui. Si ciente ' ( SIG qL�e SLI reCllperacion no avanza como Se eXpecta SIG � NATI1#3i=: pongase en contacto con su doctor regular o flame a la enfermera de consejo 1-800-495-8885. E DATE: OTHER Py GIVEN: —— WORKING DIAGNOSIS. ❑DO I"*T11RIVE'. Ff;,)Mr E Hs{>0'I. PRINTED INSTRUCTION"WEN: L�WOUND CARE 0 SPRAIN 1 FRACTURE ❑VOMITING/DIARRHEA ❑UTI ❑ASTHMA I COPD 3_ � e r❑� £>� E�.d Sf.ac If✓�� HEAD INJURY ❑CASTS/SPLINTS ❑;i COLDS I FLULr }EARLY PREGNANCY ❑EAR INFECTION =is 'i#" •' (-32 f k#�k#ti, ,.R<, ss;# t_t EYN IURY 0—BACK I N —� NECK INJURY L 3 FEVER CONTROL ' L._I VAGINAL BLEEDING ❑ABOOMINALPA114 ❑ OTH INS.RUCTIONS. FOL -UP APPOINTMENTt. � ❑-:05NTACT APPOINTMENTS FOR FAMILY PRACTICE APPOINTMENT IN f" AYS EEKS RETL3RN EMERGENCY 15EPARTIkNT IN�DAYS APPOINTMENT SLIP GIVEN. ❑ SPECIALTY APPOINTMIENTS: MESSAGE LEFT AT APPOINTMENT UNIT. YOU WILL BE CONTACTED ABC1UTYOUR APPOINTMENT WITHIN TWO WORKING DAYS IF YOU HAVE 'CLINIC" DAYS/WEEKS NOT BEEN CONTACTED,CALLA.PPOINTMENT UNIT AT 800-495-8965. APPOINTMENT SCHEDULED 0 —7 NOSOTROS HEMOS DEJADO UN MENSAJE EN LA UNIDAD of C#TAS. CLINIC:PROVIDER SITE DATE TIME UD.SERA CONTACTADO DENTRO DE 2 BIAS HABILES.SI NO HA SIDO CONTACTADO,LLAMEAL 800455.9885.' PRfi3VIDER SITE DATE TIME 0 STAFF INITIAL SIGNATURE I UNE)ER STAN TIME PrTRUCTIONS(Patient Signature) 0 ❑ YOU NEED TO PICK UP REMAINDER OF lePRESCRIPTION A-- ........ M.DfFNP i TIME DISCH GED . ;` CONTRA COSTA REGIONAL MEDICAL CENTER EMERGENCY DEPARTMENT STRI TO DELIVER THE BEST0 CARE POSSIBLE,YOUR COMMENTS AND SUGGESTIONS ON OUR PATIENT SURVEY ARE APPRECIATED. YOUR PROVIDER TODAY WAS: 0 0G ❑ Joseph Barger,M.D. 0 Berard Bland,M.D. Nell Jayasekera,M.D. ❑ Herbert Slgmond,M.D. ❑ Christan Weinman,M.D. ❑ Jon Beauchamp,M.D. ❑ John I.Ellis,M.D. ❑ John Pabers,M.D. ❑ Alan Spain,M.D. 0 ® Fred Beck,M.D. ❑ Chris Famitano,M.D. ❑ David Reedy,M.D. 2t:Ad nson,M.D. 10 ❑Mod BeRwmnd,M.D. ❑ t�&Wd C thein,M-0- ❑ Sett Schn*k M.D. uchuw,M.D. 0 0 EMERGENCY DEPT.. DISCHARGE INSTRUCTIONS . . ..................................................................................................................................................................... ,ori . k .;: €� � T3:: T. #. ... �: . I `. � :' ; ..... ...... ..:. f �1�Af!df # 6tl�t?l ¢y + may .... ..":. :. - .. ..... #�C# � G AL f# ENT I�3�ENT . r� � f n # #0.any.. edice.f ��rr��#,'thel €di a b��#�e�# . i#3f3$d is ? tt tr #It t ;f f c rc� €r ,. i t st d r ,f Qn # r d.b1 tr ita.��r r� 0. c�sn d r fat r by the ## p #tsf r +# �r # u f 1' i of R'r jo I g ... p f d0. # d r d 't t + # f y t � d u€r f C � # ii r do r s � € #f rv + c cs# f�€I fdn TEA►G i f t i A Thi td r i t els. mat G z t a s i rzal;� d....... e r d Ga st .......................C alth xs a 1� u s azo :,� �..�€ s.�darea#ii .�t pa sxatx praf.....� , a b l dint r rut �i g z....... d,/, h Ith e.. �S�TT+�FkELf IfQI ClL LA►fEi ndd # ps��t Baca a..� e t r tea rr a v ©I :� g an d GsI a I att3 a#i i s rl t t V.P d Gai I bel tai G a Gi spa rvi s am t 1 a th a v tc: i s H r + f Au t o. w1 M- d' W �� r b I yr y ed eal s se K eit at a c a T� eve f b the 2vl�&GO pac: .> i l f L At F f»Ef{�f biT#T i I iso rz�> sr tit r irr�b s.e CO. my� t o to r a h ..a dJv e s c d d:ci tt t r tt w d. 6i-dw., Vis€# �: dzc €i lac; i� .. v.. ..air a�.... b.�Ize e..3 , s pixy c�tl a €e is comer,at the rat. Ij s # G st C a Bc. exp zp csr� T i as d mer gas a ..rages�� � aizt : ate $ a T .ci#t� .. �t� wl # e rtat this t�rel s e ecs ty u :ti tie ain t b IIS I i t e at b e B, d � .. f .. Tib ur x g e� *��W9 e stag l tats ,c ..tom f a a# #y 1� ag� ez i abd b r�di�Uzi . er.9 Ip s in h ire,as ,ae it s,a u x r e g d ab#hc�r ea ae l r€ A is t o tai r l� tts nt Gv r c al u e I .a€ s..� f mat € c Men" the fi fc� a � I k erg fit i dzrs #� y of .a z .k � ui t a ..�.e "� ��� t i ..cr au r b a e e tv F I f�e al u fb at i are a e t,inef d the � .. A atx1lf!� t}IwfET; tede ;: eterIia aet "a pat.� t, � ts� t Cpta a �y a� a z�etsstl € al tet IIs � atr crptala ar ctpae�ate , a e1 It rg s ?ice r der a i €t t dtI u ' reg eb t �. x�t a :� ion s�a�l b e t xe a ffectz aid x hW as n.� .. TI z rid g d t c3 es an. USC. aw e , adze tar, n ra � d rsrsr s.., ip ..car..rr ��si��b... a c z a sh e ei pa nt As a :elan r pis # i f �t# pact t i a a a � s� �a..slid ..�.. ce rt tb ss tal;>eare a s`Qr c�i {gent;s � , d ct i t? t f cl g I r .a it . .. as add pav tea# � %rect tait�atty tI u � tgs ���e�s�ass�gn�that apt C�intra G�ssta Gain t L A f» 1f� INFORM lllTft N f=t R 1 ' T1aeu der ttgree t t;t4;t� nt ie ary ta;c et�r�s l� xi1�t �dt ay t axsd tv talii re I ts�e it, �z a Gv to is i> a d Ic v est t M. #' r. . luc... ���u z� a l y tie r xs ,tv ax€ c n �d� c t v eb :; sa3� e lea l fe IN car�?�>��srt�rr��ftie I��.sf I..d bit�i�st li it°d tc � d e efl ane f Itb gaze vte la t g r rz erg' p t 4. or a.finers ei e :r �?r x zat at s sd .. T u + rtt #hit f 1 d hJ t ..r r.. a py #f r +f,a .the t t, # # I r C # fivef. r d f a tf tca CIS t € #ie ' +ex r I t to. trnr at ; .. �A 4 f S.MNATkn"ii'. + ENTtJ{S PATIS.<�ft P..fi�"i S}4:1A�( f.; {:: h3 { J y { f :::. .....::::: ..::. \,n: t v:..: ..... ..... t.:.... ::: .: .... ..... .... .... ...... ... w� �:: .::.. 4 TSV 3 7Qk3EC#t(R## 1FFf73Emro iEP#3,,., Dft"A'l�'1 r�",�3.A"z `f#kAT4P43f fd•. 51 atst�l ;tE1 zltftT A`1 :: 19ftT , 5.� Afi -4�1wf t ct 3 oll Ir m �TA 0 SV 95 ®R r '' ri 0 ' ' SS 49 to w W ._ s K OD m o w m �+ CD W O -.-Jrco �d G to y �N O G . N.CD (D W v 1. m N off . 0 'o CD 8 ° ro ,. n o xx CD 15 a -: CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JULY 22, 2003 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Beard 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 ;.,...;:.,.,.. CLAIMANT: KATHERINE STAUDT ATTORNEY: UNKNOWN DATE RECEIVED: JUNE 23, 2003 ADDRESS: 566 LA VISTA ROAD BY DELIVERY TO CLERK.ON: JUNE 23 , 2003 WALNUT CREEK, CA 94598 BY MAIL POSTMARKED: RECEIVED THRU FAX FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOIN SWEETE , C rk Dated: JUNE 23, 2003 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: 1kaXM 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: (X) 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: JULY 22, 2003 JOHN SWEETEN, CLERK., By , Deputy Clerk. WARNING(Gov. code section C3) 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: JULY 23, 2003 JOHN SWEETEN, CLERK.By Deputy Clerk 00/23/2003 14:33 FAX 925 934 8277- -----_ KIINK01 S 0002 " Claim to: BCI >of S�`FIt VJS0RS OF C 'A CGS—,A CLiU Ty INSTR CTIQNS TO CLAS X Claims relating to causes of action for dead/or for injury to person or to personal property or gnawing crops and which true on or before December 31, 1987,must be presented not later than the I OCO day after the accruai cf`the cause of action. Claims relating to causes of action for death Or for injury to person or to personal property or 9MVAP8 crops and which awe can Or after YanuarY 1, 1988; must be presented not later than six months after the accrual of the cause of action. Maims relating to any other cause oraction roust be presented not later than one year after the accrual of the cause of action. (Gov't Code 9l 1.2.) B. Claims must be filed with the Clerk of the Board of Supe cors at its owe ir, -0a , n oo, Cuur�vj Administration Building,651 Pine Streit,Martinez,CA 94553. C. if claim is against a district governed by t Beard of Sup isors,Ta ct than:he�'s�unty, the name of the Pistrict should be filled in. D. lfthe claim is against Moe 1hah Ght Public M ity, Wparate clam must be fled 000_%irs each public entity_ . F. Fraud. See penalty for fraudulent claims, penal Code Sec.72 at the end of this farm. +1#O+FRi#!44#!i#O#$##is�fa4$k#'#i+►iti*ii#f+►►1**#$iirk$i$i'#til#i$Fi#*i#!#dt#OYMIt$rti�+YiPRlw!##lilt#►i : Clai in By Reserved for Clerk's filing stamp Against the County of Coma Costa N 2 LUU Districc t) GLBRK BOAR'' OF SU (Fill IS�RS Gill in narrrey 'VON 7RAGOSTACO. The undersigued c#a D) I A i aeloy makes claim Inst the Cot.nty of Coma& eta or the above-nammed disl in the sum of$ ? and in support of Ns claim represents as follows. I. When did the damage or injury occur?(Clive Tract date and how) 2. What did the damage or injury occur?(include city WW county) 3. How did the damage or injury occur?Give full details,use extra paper if required) a. cam%ur^j%,J 06e_J,,re.J, tA10 4W, tMLZ. t. UU;51A, lC U C1Sr3�3,� iYtot4 Cak� 5 Q fid. dAA_ 1-0 z �_ Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAZIANT A. Claims renting 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 I Oe 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 ofBce.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 filler' 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. �**s*s*��*�+s*��#�**�*******•**�*Ott*�*«*�+*:*�*�*#*�s*�**#***�**.*��*«�*�**#****�*ss**�#* RE: Claim By Reserved for Clerk's filing stamp Against the County of Contra Costa or ) s District) (Fill in name) ) " The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the Burn of$ and in support of this claim represents as follows: 1. When did the damage or injury occur?(Give exact date and hour) 2. Where.did the damage or injury occur?(include city and county) kc)kl G�wvl-j Wo-Look Ctffz�, 041 Cc�-L6-4 3. How did the ffdamage or injury occur?(Give full details;use extra paper if required) -rj`t..- o-1 t 't V�'j f1J C1CGt✓Y U 'G @,q C✓1 i Zc t '.�✓ t L1SI`b'?� j' v 6� ic tcYr4c, Al Sc #Y`cc2 )e4 e'�A wt 's t c a E✓ `ry t c u J i�tj- dxu-e-- f-L) c�c -rr64VrYIt�: nr � i vt Set r Y' LA h cw— .^ 5 >f s r rx.!' c erg c va t e t 1�\ ) OY tct 4. 'What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage" ? j Y- , i n it as.c_ d-afak s r1 yr 5. What are the names of county or district officers, servants, or employees causing the damage or injury? (O uita. . cLP+!S¢, 5 vt .v►'SGY-6) Ak')c t1rd- Mal,&Lez A-K im'& cc, ( wt i--c 6. 'What damage or injuries do you claim resulted?(Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) _ t�.,6,45M dtaa4k 4 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses, doctors, and hospitals. 9. List the expenditures you made on account of this accident or injury. BATE IDE AMOUNT Vill Ict } Gov. Code Sec. 910.2 provides"The claim must be } signed by the claimant or by some person on his behalf.,, END NOTICES TO: Attorney Name and Address of Attorney ) (Claimant's Signature) (Address) Telephone No. )Telephone No 2, 9 NC YnCE Section 72 of the Penal Code provides: Every person who,with intent to defraud,presents for anoawc a 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 fiaudwent claire,bill, voucher,or writing, is punishable either by imprisonment in the oounty}ail for a period of nay[more than one year,by a fine of not exceeding one thousand(Sl,000�or by both such imprisonment and fine,or by imprisonment in the state prison,by a foe of exceeding ten thousand dollars(S 10,000),or by both such imprisonment and fine. `�:.. •;N `moi: k t� "y APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY CALIFORNIA JULY 22, 2003 BOARD ACTION Application to File Irate Claim ) NOTICE TO APPLICANT Against the County, Routing ) The copy of this document mailed to you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to ) the Board of Supervisors(Paragraph III,below), California Government Code.)_ ) given pursuant to Government Code Sections 911.8 and 915.4. Please note the"WARNING"below. Claimant: DENISE HUTSON Attorney: MATIHEW J. RINALDI Address: BOXER & CERSON 171 12th STREET, #100 Amount: OAKLAND, CA 94607 By delivery to Clerk on: JUNE 20, 2003 $200,000. Date Received: JUNE 20 2003 By mail,postmarked on: HAND DELIVERED I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted Application to File Late Claim, JUNE 20 2003 DATED: ' JOHN SWEETEN, Clerk_,By: DEPUTY II. FROM: County Counsel TO: Clerk of the,Boarcrof Supervisors { ) The Board should grant this Application to File Late Claim (Section 911.6). i The Board should deny this Application to File Late Claim (Section 911.6X el-7 ) DATE 4WVANO B.MARCHESI,County Counsel B UTY III. BOARD ORDEA By unanimous vote of Supervisors present (Check one only) { ) This Application is granted (Section 911.6). (X3 This Application to File Late Claim is denied (Section 911.6). I certify that this a true and correct copy of the BoarOWOrder entered in its minutes for this date. JULY 22 2003 DATER JbHN SWEETEN,Clerk,B a ��� DEPUTY WARNING(Gov. Code§911.8) If you wish to file a court action on this matter,you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4 (claims presentation requirement).See Government Code Section 946.6.Such petition must be filed with the court within six(6)months from the date your apication for leave to present a late claim was denied. 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. IV. FROM: Clerk of the Board TO: (1)County Counsel (2)County Administrator Attached are copies of the above Application. We notified the applicant of the Board's action on this Application by mailing a copy of this document, and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. DATED: JULY 23 2 2003 JOHN SWEETEN,Clerk,By: *AADEPUTY V. FROM: (1)County Counsel (2) County Administrator TO: Clerk of the Board of Supervisors Received copies of this Application and Board Order. DATED: County Counsel,By: t County Administrator,By: APPLICATION TO FILE LATE CLAIM j E E ; i MATTHEW J. RINALDI, State Bar No. 112011 2 ' BOXER& GERSON E 171 - 12th Street, Suite 100 Oakland, California 94607 Telephone: (510) 835-8870 4 Attorneys for Plaintiffs 5 ' f 6 I k i 7 8 SUPERIOR COURT OF CALIFORNIA, COUNTY OF CONTRA COSTA DENISE HUTSON, } CASE NO. CO3-01208 10 ) Plaintiff(s), } APPLICATION FOR LEAVE TO FILE A LATE CLAIM 11 vs.12 } LETANJA MITCHELL and DOES 1-20, ) �y�{{p�'' F -7 �'3 � Defendants. } LO�J 14 } JUN 2 0 i 15 CLERK SOAM OF SUPERVIS RS t 1, MATTHEW J. RINALDI, declare: CONTRACOSTACO. I 16 E I am an attorney duly licensed to practice before all the courts of the State of 17 California and am a member of the law firm of Boxer& Gerson, attorneys of record for 18 i claimant herein. 19 I We hereby apply for leave to file a late claim. Said claim is attached. The accident 20 I which gives rise to this claim occurred on July 31, 2002. We did not know, prior to the 21 € running of six months from the date of the accident, that the driver,Ms.Letanja Mitchell, 22 of the vehicle which hit our client, Ms. Denise Hutson,may have been in the course and 23 scope of her employment with Contra Costa College Police Department at the time of the 24 i accident. As set forth herein below, we have just acquired such information and 25 ; i 26 1 i DeclaraionofMaahew1.Rimldi ' 27 c 28 BOXER & GERSON �E s I i respectfully submit this application for leave to file a late claim. r i Ms. Denise Hutson became our client in December of 2002. Boxer & Gerson 3j agreed to represent her concerning a vehicular accident which injured Ms. Hutson while she was driving an AC Transit bus. i I was able to review materials provided by AC Transit, a true and correct copy of i 6 which is attached hereto as Exhibit A. 1 7 This material identified the driver of the vehicle which struck Ms.Hutson's bus as � I being Letanja Mitchell of 2355 Lancaster Dr., #21, Richmond, CA. After being retained by Ms. Hutson I wrote to Letanja Mitchell on December 11, 101 asked Ms. 2002, a true and correct copy of which is attached hereto as Exhibit B. '1 Mitchell to identify any insurance carrier which would insure her for liability for the 12 accident. Ms. Mitchell identified Farmers Insurance on Exhibit B. 13 ` On April 14, 2003, after numerous attempts at communication with Farmers, I i 14 finally received a letter confirming personal coverage for Ms. Letanja Mitchell. A true 15 and correct copy of the letter from Farmers' Insurance is attached hereto as Exhibit C. 16 I thereafter prepared a formal complaint against Ms. Mitchell which was filed in 17 Contra Costa Superior Court on May 13, 2003. E 18 When I sent the complaint our for service, I utilized both a processor server 19 company, D&T and a private investigator, Ms. Jae Scharlin dba J. Darling. 20 I The information I received from J. Darling indicated the possibility, not the 21 certainty, that Letanja Mitchell may have been in the course and scope of employment 22 with Contra Costa College at the time of the accident. Although it is clear that Ms. 23 Mitchell was not actually working at the time of the accident, there is the possibility that 24 she was just leaving work and may have technically still been on her employer's premises k 25 26 2 i Dec)aradm of Matthew J.Rinaidi 27 28 i `BOXER & GERSON i i i i } at the time of the accident. 2 Based on the information provided by Ms.Scharhn,I have attempted to contact AC 3 Transit but have been unable to speak with anyone. I also contacted Mr. Dale Wilson of 4 Farmers Insurance on June 19, 2003. Mr. Wilson was unable to clarify whether Ms. 3 5 ' Mitchell was in the course and scope of employment with anyone at the time of the 6 1accident which injured our client, Ms. Denise Hutson. In an excess of caution, we hereby submit an application for leave to file a late $ claim based on the facts learned by Jae Scharlin dba J. Darling on June 18, 2003, s I declare under penalty of perjury that the foregoing is true and correct and that this 10 1declaration was executed on June 20, 2003 at Oakland, California. 12 MATTHEW J.J. ALDI 13 ? i 14 15 16 s 17 18 19 20 21 22 23 24 25 i 26 3 fj Declaration ofMat&w J.Rlraldi 27 j 28 j' I BOXER 3 & GERSON 54 j` f SUPERVISOg'S-POST•ACCIDENT DRUGIALCOHOL TES REPORT POST-ACCIDENT Drug/Alcohol Testing1S REQ `J--� a death;�(2)the employee's performance was a„pon_1buti factor to the a idea a�divi as injured requiring transportation i to a medical facility for immediate treatment;or(b) any vehicle isp* f scene. B District revenue and non-revenue service vehicles are covered by Post-Accident Test'sng..If,the employee was not a contributing factor to the accident and no death occurred, NO TESTING OCCURS.If another Safety-Sensitive employee was a contributing factor to the acddent, that employee must also.be,tested: Name tfC 4«'t Badge1S`" Faun Division ' . Classification: Maintenance Operator Other C Day of Week: S, M, T, T, F, S (Circle One) Route Schedule ""' Coach # Time Started Work_ .. y Time Relieved of Duty Location Relieved of Duty ` t.Was there a fatality? (if yes, test.) §. .. YES C3 NO 2.Was the operator a contributing factor to the accident?. =YES (lf yes eXpI in below) Y a .. � k ,, ` i t'•� N` r ';^p, n .`5 • .. tM ..m r r. �ti '041 " 'tyf: ' .JY 3. Were there injuries requiring immediate medical tretment.away from scene? YES NO �- 4. Was a vehicle towed from scene? YES NO � It Answer to #2 YES,A14D either#3 or##4 is als6-YE8,thein a Post Accident Test is Required[ (!f alcohol test not completed within two (2) hours of accident,'explain]: (If alcohol test not completed within eight (8) hours of.accident, explain]: 5. Was employee sent for Drug/Alcohol screening? YES NO' L 6. Did employee refuse Drug/Alcohol screening? YES C3 NO E' 7. Was employee informed that he/she would be discharged for refusing to take a Drug/Alcohol Test? YES Nd C1 AMU Date Report Written: AC Representative: Print Name Job Title: j - SUPERVISOR'fo'i vn7iurn REPORT TO LE���� C}EPARTM�NT t . - F, AM1 E } Date:-2 A ._ `x Time: .r-- ` Schedule# Direction:District Vehicle *:—;4131 Weather Condition: lestd` Street Condition: J. Operator's Name QY7, 15G Badge No.: , Accident On: J i l� d CLUJBetween) ,f City: �.�'a n ,�'��� Number of bus passengers when you arrived:`_ Number of courtesy cards obtained:_ TRAFFIC ACCIDENT- INCIDENT- PERSONS INVOLVED:Check{4which one(•s) apply: C� Passengers (s) Vehicle Pedestrian 0 Between company vehicles Fixed object C] Others INTERSI CTIUPI, CONTROLLED BY: Check jq which.one(s) apply:oTraffic Li ht C9 Stop Sign C. lYleld sign LJ Between Intersections © Intersection has no controls lathers DISTRICT VEHICLE: ;'OTHER VEHICLE: Bus how far front curb: Front. Rear Number tri passengers in other vehicle: Point of contact:_ 12, 4:s 14,.- iJ r--r f1'imO .' Point of contatct: L e4k i9e .-M . 3 �-t���t7ar'r^lr�t Distance traveled after collision: - t.{.Yt V� , I t `,Distance traveled after collision: -t�. tt 6 Gd Extent of damage:_.. i ylo Y' � ;Extent of damage: r9�± `a, e r sxtos. LF Rt: LR PAsoros. LF 1tF, LA RR AFTER IMPACL BEFORE t�Acr 1V'2��1�. �1 t 51�i v At TER IMPACL CJwner_of vehicle or.o eot struck: e4-ot, V't ` .�-,• pyo� p� /� {y�y p /t Lit l ipe(•...{�'� j� ,/+/� ©rrver of other vehicle: cr_ ,L' (� a.- L)� j n$,J At tt ame r • �e � Address-- City Ltp Phone Driver's license no: '7 gate of Blah SSN qtr , Name and address of passenger in other vihlole and if injured what part R the body: t. . 2. 3. tt Name cess Zip i one Make and model of other vehicle.. 1tfl k �A � CCof' License no,4.XJ T3 olar W}t _*ear: ( Did,police Investigate: Owner Insured by: a ge no. Qlty Polley # BUS PASSENGER ACCIDENT-INCIDENT: Check (4 ) which one(s) apply (s). 0 Boarding � Alighting On board CD Front door 0 Rear door C7 W/C Lift 0 Other Name and address of bus passengers) 'rf injured or involved: E. I' f i d7 t 4'i —...o.� -� "la '•t�ma hr{rire�en !' ;t.. y:_ n..___ nrtin :Traffic diagram. tmportarl (Dri ;omplete Sagram of where and how acoi,• t happened using symbols below, shown street tames and kxEcating d•' on of-travel by 5ne or arrow of vehicles i }ved iniludwv lane mir-sings.) ius Mri.t t9tltrs Vai�imlr Prdrr!(!in !!ur atria P^JiRYa oa arLtv.ct iiiYiifiiOA Ca,YnniOl+s iy { {Pon tlth8+prt by SsS irasitt Gti+ a".oliti+ntt"to bus stow.il01.t;ew `U aymtsWlr sr nsutittsers,trornmr,ttur0.soot sttartea,std. lydlcst&rwnq show tri{fia pontfol,aWd mirk lsnytj%�deet!�ts++rr l"N"ns rtt factum. WM%an arrow '� � �. � •{ !! '"' M I...f�{syJ!�s,r � r ',«, .`.�•`tea• ' s .. ':., ; S. r i:- j .i Sn • j `' '�L�L..++'..�/wL�.��fF,.-!+- L�`�`N" S{Oii F .}: ..t 1 a . .rr• �• y�, ', c,Lr+a .r w ; ,n - r �.,3 �-a, r �. �.' • d*t��it�`�':. ; . . ; t �.: tom.. .,. +a i'#ur+ � Vis',""•; ...n� -c', m+e. :.wc � °j��,,, d �at�.y,F +s/..'"'� «, �{ ,y.i ,t. ���, ••i r t -s .* t „J..y c. _ - ! ' E .tf`4r I. r".'1' i RI- r r .... i.'r• { } }jyt a_ - } q -^v'r + L .L ! •y w..,� r.i.•:.} a �:`Y r ti 1 s # �` s''~�t� ,��,' �m �� , j,f h.. ,�:; �.� *.� .L � �' ? k' + .L k .��.•.3 w+-�.8 s TF f r.,r_ ,•'"• :`,t.;�..wve $R-rryw�r +.¢"••: P w.mu r ,y ti'ta+.�._r� a�r �j, rinS. � Jy t 4 r r•i � ^3'.' ,�t�y�,r,� � -y y'r,�r' r r : , �' e �.��ai�_a sr> Y p.,•..+., .L.' 'tlr.fJY• �,r%.Rt+.i,�!�.F}a.'-�I'�•., t i d i:+{ lis .g,'a p'`;r+G[,.L„r+. irl["" }.._ ¢ r..e.w j g-i i 2 :t •t "'i.!'a'. ''tt`' ` ::±'.. - ) j �t �P;PS:{1'. k w'.$..f t �P � ,_„r-,.i , ,L L.la,.-.•e-+.y."+A��r.�4.e., 'K.t S�.L.t fiLr.*•t+L � ,'4�. �x 1 l eL+! y,f � A 1 r ril.'t`m�y �'t- r� �ph.�r *: .. L } c•a -.i �t d /{� f �1�,�b' y���3• i r~ Y "'4�r�`,3 � ; 7"'t �:.�^..!'.��.�§ �+•.f,* p`ti.4. jJ�, a '� � Y t., x.., .�... .5,..� .0 i:F!t,a�iJ't`�fry �`iI••�ral+� �.w.(�„•i�-��' i{ x 'j a+9Y.s a,�tn eyr �iC r .r q._ .. vy y r. r •. « .. <...g,^++ r :fur `•. +V",' .r11+L z k 1. t�.'L�. T d.. �' i,J hd.L x 5 � ,"" ff'�+lfL,r'•4 ..L r e"` l 1 r or ry +at.W x "YSs t b ,P ..,, .a Y•.+` '�� a 'ty •.� !N X . �{a�. 3.,Nc�a eT '.ti rk rim•.. e. 4 t w,��.w G�- e -1wv, e +- �;,, :qR, .. .7a(}^ i ..p y,r{r p .wrW Tj_ti«, '.i•�.aL+tskK 3. r. t r,.l ,• ,K• , s-=t"# i Ya 1 C7 4 } L t k `} yi i t • _ �r'•�:�` G' � 'a.°C ,,� � � _'�"°` t 'Y; +• � o�� i «r •2:@•-�.� �..a , �^'!MY S,° 4 dL�TTSy °� t ! '� s �. � ... .o-.4 St..y«'#+.a. ver...i i �Y'h '�.,RC'E�•wr y ti''h'�'j{� �� F � 7 i-•�K «Y' } wr P t< Y�rni eY"• r t c � % .:•! ry a y x S t y ba } r ir> r n Y� MtF�;'..L4i �'t.•t.•�.�,+ry'F {rte 1.1�w4[�, r',4'�'�` 3 h 1' � ..� 1 � Se9 t ! t ° '. t. .4...'r yipxlrti 'f" .} ,q, R �+'..�. a.y S(a`�j��{,{♦ j/J 1.l F ai':1Y�•t ••r fYi.'�/^ri5 y'{ft i r' y .�•;•^ .re•,(`n f.. } ! br,r F, .,,. P e a )n `pa rd',� raa+^srJ¢ 'ri2�•"y`..s S".Q""�A uw YHF ..r r, .,..y. •,.a .+ i e 7-•-�Y�Ar. .,+!�.L��.J� J LG�lt".-.est t t L �h c F •� jt Y. v,� _ a .., .. �r•" .1 t ". ' ' � r .. ,!',e.. a �.,• .t• .t - 1�� •,.-jf�1 CJI' '+ M s • s •. e ,r F rt.4l,f�J �'w,�L�U►+J�'E.y..�,f,! � �#_./ -.�. .� ,a� � .i a � ' s.�,� :11�',/` .d !_ ..� �L MMWI /wf f .v! �' '�f _- F WW�.rf �.A1 � .� ♦ f ..+ JF� �.� � ,� .� f F,+A'}�� �./I��i9a.., /r .� _�..wla. -a�lwM� .5,�,/ M-1 VIAN MAUI IN ,t -a a w - - +fie-Ilaf♦ a..� -..~ Ism..M ---A �`� r —00.� wR aF :/ .�:•� �� 1-�I � — _ r � ..we. aitfR -"` .s.r °"I � O-J� "A� .a'...�tJ �/ �+f�,R �.ASR+I �GEi.P,f A.eA'!�'�� P `�'J� f %� Y' - - �•�„ /A I WINsI 'at RAW .J' . r_A.-t sl►; / - • f f aR MIF �10 '- / .` _ratio:t :., 6 R R r � •i..Yt�. /SRR��`-�+41F f tl yir'wrwi?Lltw S �e i « «�� [•i•��•15Hd�er;�� � • r .w•,. r, ....• .,. +�G.�rE.'1/ f ,tj��}..¢{_ .r `/. .L,e�,+l ` ._tiir��+:i ..�+...�, /�'_, r +►- s / ,fie r r. k j Tralsit SUPERVISORS REPORT - - .34, OP A' NS/s ER'WSION Cate: Operator:_ A dn ' lCet _�.._Badg U Coach t;Y:_ ✓' Run rK: � r Sched. ' Timer Weather: Locationa Direction: City: Invaived Veh.Make: Model: Year: Loc -Driver: A Owner- dress:. No.of Pass. Police Insured Sy: Involved Veh. Badge : ep�rt: ro m - r�+'d s/.fya�r.+,cam✓ "�'�`�",L�4 f Azz LIZ a All r/�` LI'�/t/C • 4'' All -_ Photos Frames: a""--------" " Camera ': �� Car : ® Supervisor: t B 0 E John M.Anton ATTORNEYS A T LAW Moira L. n guano Bert S.Arnold Julius Young Cherie Barnard* 171.12th itteet • Suite 100 • Oakland, CA 94607 Legal Assistants Stewart N.Boxer, Inc. Hillary A.Bryne Patricia A.Brown 514/835-$874 •TTY 530/98"t7691 Jan Krieger Michael C.Dolan Fax- 510/835.4415 (Workers Compensation) • 514/987.7690(Personal Injury/Emplayment Disctir�ination) Christine A.Mufioz Mark N. Dunning— Sharene V.Ross Michael G.Gerson,Inc. Maria Del Rosario Sanchez John M.Harrigan Direct Line : (5 10) 2 8 6—2 991 Howard G.Waters Jean K.Hyams 'Admittedto practice in Leslie B.Levy WisconsinRalph W.Mann. Matthew J.Rinaldi December 11, 2002 'fldmiaed topracrice Stanley E.Shields in N.Y.and Federal courrs Letanja Mitchell 2355 Lancaster Dr. , #21 Richmond, CA 94806 RE: Incident of July 31 , 2002 Dear Ms . Mitchell : This office represents Denise Hutson regarding an automobile accident in which you were involved on July 31, 2002 . If you were insured' for liability, please immediately forward this Letter to your insurance company and also advise us, on the enclosed copy of this letter, the name and address of your insurance carrier and policy number. If you .were not insured, please so indicate . California law requires that you provide the above-requested information. We thank you for your anticipated prompt cooperation. Very truly yours, BOXER & GERSON ANNE M. STR A.LY3 Assistant to Matthew J. Rinaldi /as (1) 1 was insured for liabilit � Carrier' s Name & Address : POLICY N©. : M-5-IS POLICY LIMITS (2) I was not insured at the time of the accident Web Site. http://www.boxerlarv.coni sa F A R M E R 11533 Dublin Canyon Road Pleasanton,CA 94588 Phone: (209)955-6804 .April 14, 2003 Pax: (209)955-7179 Email: dale.wilson( farmersinsuxance.corn Borer Gerson C e I V .0 Attorneys At Lav A PR 17 2003 171 12"' St. Suite 100 Oakland, CA 94607 RE: Insured: Letanja ?Mitchell r Claim Number: X15 151025 Policy Number: 96 145520827 Loss Date: 8/12/02 Your Client: Denise Hutson Dear Ms. Straub, I am in receipt of your retention letter For your client. Please direct all matters regarding this claim to my attention. Please advise me of the nature and extent of your client's injuries so that I may properly reserve our file. I look forward to resolving;this claim with you in the near future. Sincerely, Harmers Insurance FAchange Dale Wilson Claims Representative . ...... .............. ................................ . ..... .......... 2 3 DECLARATION OF JAE SCHARLIN dba I DARLING June 19, 2003 4 5 6 7I, Jac Scharlin dba J. Darling, declare: 8 i I am a licensed private investigator,have been a licensed private investigator since 9 1976, and do business under the fictitious name I Darling. My California private investigator's license is no. A6475, 10 I worked in insurance adjustment and investigations for a business named Black 12 and Bland in Oakland, California from 1976 through 1984. During that time, I had 13 extensive experience investigating the underlying details of claims for damages. 14 Since 1984 1 have continued to work as a licensed private investigator and have 1 5 frequently worked with the law firm of Boxer& Gerson. On Monday, June 16, 2003 1 was retained directly by Matthew J. Rinaldi, Esq. of 16 17 Boxer & Gerson to serve a Summons and Complaint on Ms. Letanja Mitchell of 2355 18 Lancaster Dr., #21,Richmond,California. As part of my routine, I requested from Boxer 19 & Gerson and obtained a copy of the report of the accident. 0 2 What I received was not a standard police report,but rather a report of the accident 21 filed by the injured person, Ms. Denise Hutson, with her employer, AC Transit. A true 22 and correct copy of that report is attached hereto as Exhibit A. 23 Upon reading the report,based upon my years of experience I concluded that there 24 were significant omissions in the report concerning the underlying facts of the accident. ii 25 Based upon my assignment as both a process server and a private investigator,I concluded 26 1 Declaration oche Scharlin 27 1 28 BOXER & GERSON ! ! in the report. i 2 On June 18, 2003 I traveled to 2355 Lancaster Dr.,#21, in Richmond, California i i and spoke with Ms. Letanja Mitchell who was at home in unit#21. j I learned that Ms. Mitchell had been served by D&T on June 17, 2003. Nevertheless, I determined that I still needed to speak with Ms. Mitchell. i On June 18,2003 I told Ms.Mitchell that I wanted to speak with her because there ! were some things that were not clear in the report I had seen about the accident. I 8 ! ! Ms. Mitchell spoke with me about the incident and, in the course of that ! I conversation, she informed me that she had been returning from work at the time of the 10 accident. I asked Ms.Mitchell who employed her on the day of the accident. She replied, 11 The Police Department." 12 I asked Ms. Mitchell"What Police Department?" Ms. Mitchell informed me that 13 she was leaving work from her capacity as an employee of the Contra Costa College 14 Police Department. I declare under penalty of perjury that the foregoing is true and correct and that this 16 declaration was executed on June 19, 2003 in Oakland, California. 17 18 JAEi SCHARLIN dba J. DARLING 19 20 ' 21 22 23 it 24 ! 25 I 26 € tbectaraiionoflaeSchatin 2 27 I 28 BOXER & GERSO 00P.54 Jun 19 l73 C : 51P Clerk of the Board 925 335 1913 P- 1 Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY RiSTRUCTTONS TO CLOT 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 100'h 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 206, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claire 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. B. 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 Denise Hutson ) Against the County of Contra Costa or Contra Costal College or Contra Costa College ;w � I Police Department District) z (Fill in name) ) 4v The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$200, 400 . and in support of this claim represents as foltows: (Unlimited jurisdiction) 1. When did the damage or injury occur? (Give exact date and hour) July 31, 2002; 4: 22 2, Where did the damage or injury occur? (Include city and county) Near the Contra Costa College Transit Center in the City of San Pablo, County of Contra Costa. 3. How did the damage or injury occur? (Give full details; use extra paper if required) Letanj,a Mitchell, driving a private vehicle, struck a bus being driven by claimant Denise Hutson. It is believed that Ms. Mitchell may be deemed to have been in the course and scope of- .her employment with Contra Costa College and/or Contra Costa College Police Department at the time of the accident. ,Jun 1,9' 03 o2:51p Clerk OP t h e 9 rd _ 925 335 1913 P- 2 4. What particular act or omission on the part of county or district officers, servants, or employees caused the an s o-damage? Letanja Mitchell drove her vehicle negligently, causing it to r e the bus being driven by Denise Hutson. 5, What are the names of county or district officers, servants, or employees causing the damage or injury? Letanja Mitchell 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) Personal injuries consiting of injuries to left shoulder, upper extremity and pelvis. Covered by workers' AC Transit.- compensation of 7. How was the amount claimed above computed?(Include the estimated amount of any prospective injury or damage.) A portion of lost wages and medical bills have been paid throuh the suffering and on workers' compensation system, Pain and ongoing medical care. going need Torg 8, Names and addresses of witnesses, doctors, and hospitals, Llua Juninqs, 207 S. 18th St. , Richmond, CA 94804; Sabrina McDaniel, 550 Key Blvd. , Richmond, CA 94508; Rateisha S. Brown, 534 Ohio St. , Richmond, C2 94804; Antonia Brown, 3035 Moyers Rpad, Richmond; CA 94806 9, List the expenditures you made on account of this accident or injury. PAIR- lam AMO Covered by workers , compensation; amounts currently unknown to plaintiff. Gov. Code Sec. 910.2 provides "The claim must be signed by the claimant or by some person on his behalf &E—N'D NQ110ESIO., - Attorne Name and Address of Attorney Matthew J. Rinaldi, Esq. BOXER & GERSON 171 12th Street, #Ioo Oakland, CA 94607 (Clai.;';��Vs Signature) (Address) TelephoneNo. (510) 286-2991 Telephone No. 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%Titing,is punishable either by imprisonment in the county jail for a period of not more than one year,by a I'me of not exceeding one thousand or by both such imprisonment and-fine,or by imprisonment in the state prison,by a fine of not exceeding ten thousand dollars(510,000),or by both such imprisonment and fine.