HomeMy WebLinkAboutMINUTES - 09232003 - C.29 CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: SEPT. 23, 2003
Claim Against the County, or District Governed by )
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
and Board Action. All Section referenceaa_wq�tv ) _..z The copy of this document mailed to you is your
California Government Codes. { t ; notice of the action taken on your claim by the
} 3 Board of Supervisors. (Paragraph IV below), given
F` Pursuant to Government Code Section 913 and
915.4. Please note all"Warnings".
$1,095,213.99
AMOUNT: tai THIN":THE JURISDICTION OF tTH-E
SUPERIOR COURT - UNLIMITED
CLAIMANT: TIMARA RUTHI-AND, GEORGE O'DONNELL, AND
ESTATE OF JOSEPH JORDON O'DONNELL, DECEASED
ATTORNEY: LARRY E. COOK DATE RECEIVED: AUGUST 19, 2003
ADDRESS: CASPER MEADOWS & SCHWARTZ BY DELIVERY TO CLERK.ON: AUGUST 19, 2003
2121 NORTH CALIFORNIA BLVD., SUITE 1020 AUGUST 19, 2003
WALNUT CREEK, CA 94596 BY MAIL POSTMARKED: D BY
ONE HOUR DELIVERY
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
AUGUST 19 2003 JOHN SWE , Jerk
Dated: By: Deputyii�
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 AfB, Deputy County Couns(
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 GIRDER: By unanimous vote of the Supervisors present:
(V' This Claim is rejected in fall,
O
Other: '
I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date.
Dated: JOHN SWEETEN, CLERK,By , Deputy Clerk
WARNING(Gov. code sec ion 913)
Subjects o certain exceptions,you have only six(6)months from the date this notice was personally served or deposite
in the1 to file 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 per}ury 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 full}
prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above.
Dated: Q / JOHN SWEETEN, CLERK By Deputy Clerk
LARRY E. COOK, State Bar No. 122776 Ir-7r - -
CASPER, MEADOWS & SCHWARTZ
A Professional Corporation
2121 North California Boulevard, Suite 1020 I
Walnut Creek, California 94596
Telephone: (925) 947-1147 F_
Attorneys for Claimants
CLAIM AGAINST THE COUNTY OF CONTRA COSTA
TO Board of Supervisors
County of Contra Costa
651 Pine Street, Room 106
Martinez, California 94553
CLAIMANT'S NAME : Timara Ruthland, George O'Donnell, and
Estate of Joseph Jordon O'Donnell, deceased.
CLAIMANT'S ADDRESS : 310 Miner Avenue
Antioch, California 94509
CLAIMANT'S TELEPHONE : (925) 757-6945
AMOUNT OF CLAIM Within the jurisdiction of the Superior Court–
Unlimited Jurisdiction
ADDRESS TO WHICH LARRY E. COOK, Esq.
NOTICES ARE TO BE SENT : CASPER, MEADOWS & SCHWARTZ
A Professional Corporation
2121 North California Boulevard, Suite 1020
Walnut Creek, CA 94596
DATES OF OCCURRENCE : March 4th, Stn and 6t of 2003
PLACE OF OCCURRENCE Contra Costa County Regional Medical Center
Contra Costa County, California
- 1 -
HOW DID CLAIM ARISE:
This claim arises out of the negligent care and treatment given to claimants in
the managements of Ms. Ruthland's labor and delivery. As the result thereof, Joseph
Jordon O'Donnell sustained severe birth injuries which resulted in his death of April 6,
2003. A survivor action is claimed for the recovery of medical and related expenses
incurred and pain and suffering.
Claims of medical and professional negligence are based on healthcare
providers failure to properly manage Ms. Rutland's complicated labor including, but not
limited to, the failure to timely perform a cesarean section.
The names of the healthcare providers know to claimant are Contra Costa
County Regional Medical Center, Charles J. Berietti, M.D., Zenida Mendoza, M.D. and
Maura O'Leary, M.D. Other doctors and staff unknown to clients will be added when
ascertained.
The injuries sustained by Claimant as far as known as of the date of the
presentation of this claim consist of loss of future earnings and the loss of love, comfort,
society, and companionship.
Jurisdiction over the claim would rest in the Superior Court,
ITEMIZATION OF CLAIM;
General Damages $1,000,000.00
Including Loss of Love, Comfort, and Society
Medical Expenses $96,213.99
Dated: /,1-1
L4RAY E. COOK
CASPER, MEADOWS&SCHWARTZ
Attorneys for Claimants
- 2 -
1 PROOF OF SERVICE (C.C.P. §§1013, 2015.5)
2 RE: Rutland v. Contra Costa County Regional Medical Center, et al.
3
1 am a citizen of the United States and am employed in the County of Contra Costa,
4 State of California. I am over eighteen (18) years of age and not a party to the above-
entitled action. My business address is 2121 North California Blvd., Suite 1020,
5 Walnut Creek, CA 94596. On the date below, I served the following documents in the
6 manner indicated on the below-named parties and/or counsel of record:
7
8 CLAIM AGAINST THE COUNTY OF CONTRA COSTA
9
10
11 ❑ U.S. MAIL, with First Class postage prepaid and deposited in sealed envelopes
at Walnut Creek, California.
12
❑ FAcsIMILE TRANSMISSION from (925) 947-1131 during normal business hours,
13 complete and without error on the date indicated below, as evidenced by the
14 report issued by the transmitting facsimile machine.
15 ® Hand-Delivery Via Courier
16 ❑ Other:
17 Board of Supervisors
18 County of Contra Costa
651 Pine Street, Room 106
19 Martinez, California 94553
20
21
22 1 declare under penalty of perjury under the laws of the State of California that the
foregoing is true and correct and that I am readily familiar with this firm's practice for
23 collection and processing of documents for mailing with the U.S. Postal Service.
24
25
> y �n ,
26 Dated: �' i 61U
27 " HANNON M. BOWELS
28
CASPER,MEADOWS
&SCHWARTZ
2121 N.CALIFORNIA
BLVD.,#1020
WALNUT CREEK CA
94.5%
(925)947-1147
I
` 1 CA
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CLAIM .,
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: SEPT. 23, 200:3
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), giver,
Purpant to Government Code Section 913 and
{ 15,1 'lease note all "Warnings"
3
AMOUNT. $2,670.59 OR $2,556.74
s
> >
CLAIMANT: EDDIE TY
ATTORNEY: UNKNOWN DATE RECEIVED: AUGUST 20, 2003
ADDRESS: 6138 LA COSTA COURT, BY DELIVERY TO CLERK ON: AUGUST 20, 2003
VALLEJO, CA 94591
BY MAIL POSTMARKED: HAND DELIVERED
FROM: Clerk of the Beard of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN SWEET ,
Elated: AUGUST 20, 2003 By: Deputy
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
'JaThis claim complies substantially with Sections 910 and 910.2.
( ) This ClaimFAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The
Beard 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:
AA A
Dated: By LEW Deputy County Counse
III. FROM: rk 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: ' Ze - JOHN SWEETEN, CLERK, By _ , Deputy Clerk
WARNING(Gov. code secti 913)
Subject o certain exceptions, you have only six (6)months from the date this notice was personally served or depositec
in the 1 to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an
attorne. of your choice in connection with this matter. If you want to consult an attorney, you should do so
immedi�tel . *For Additional Warning See Reverse Side of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned,have been a citizen of the United
States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California,postage fully
prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above.
Dated: JOHN SWEETEN, CLERK By Deputy Clerk
Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT`
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be; presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for death or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1968, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
,later than one year after the accrual of the cause of action. (Govt. Code §911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in
Room 146, County Administration Building, 651 Pine Street, tib-rtinez, CA 94553.
C. If claim is against a district governed by the Board of Supervisors, rather than
the County, the name of the District should be filled in.
D. If the claim is against more than one public entity, separate claims must be
filed against each public entity.
E. Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this
form.
RE: Claim By } Reserved for Clerk's filing stamp
Ct € 1
Against the Munty of Contra Casts )
Fp$L
or } ,
vn 1
District}
Fi 1 in name
The undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $ 2—i 070 and in support of
this claim represents as follows: c ,
1. When did. the damage or injury occur? (Give exact date and hour)
2. 'inhere did the damage or injury occur? ('Include city and county)
3. How dial the damage or injury occur? (Give full details; use extra paper if
required)
4. What particular act or omission on the part of county or district officers,
servants or .employees caused. the injury or damage?
(over)
7. wnat are the nags 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.
to f 2 r � ,
Kt
9 3 {
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
:v a
$. 'Names and addresses of witnesses, doctors and hospitals.
o
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
Gov. Code Sec. 91M provides
"The claim must be signed by the claimant
SENT) NOTICES TO: (Attorney) or b so son on hi q- behalf."
Name and Address of Attorney .' -
Claimant's Slgnaturel
t C. S1 c
Address Vt�1--ull]
Telephone No. Telephone No.
� A `
* * *
NOTICE
Section 72 of the Penal. Code provides:
"Every person who, with intent to defraud, presents for allowance or for
payment to any state board or officer, or to any county, city or district board or
officer, authorized to allow or pay the sane if .genuine, any false or fraudulent
claim, bill, account, voucher, or writing, is punishable either by imprisonment in
the county jail for a period of not more than one year, by a fine of not exceeding
one thousand ($It000), or by both such imprisonment and fine;-- or by imprisonment in
the state prison, by a fine of not exceeding ten thousand dollars ($1010001 or by
both such imprisonment and fine.
_........................................................................................................................
�v�...t�tvly r�vu x �nvr
720 FLORIDA STREET VALLEJO,CA 94580
(707)644.4044
Fax: (707)644-4045
Tax ID: 68-0064378 BAR M AG164673
Damage Assessed By: JIMMY STEVENSON Appraised For: Linda Palmer
Type of Loss: Collision
Date of Loss: 6/7103
Payer: Insurance Deductible: 500.00
Claim Number: A046DO246101
Insured: EDDIE A,OR NOEMI TY
Address: 6138 LACOSTA CT.VALLEJO,CA 94581
Telephone: Home Phone: (707)554.2141
Mitchell Service: 910388
Description. 1997 Mitsubishi Montero Sport LS
Body Style: 4D Ut 107'WB Drive Train: 3.01-Inj 6 Cyi 4WD
VIN: JA4MT31P5VP021828 License: MRX0168
OEMIALT: O Search Code. None
Line Entry Labor Line Item Part Type/ Dollar Labor
Item Number Type Operation Description Part Number Amount Units
1 001231 BOY REMOVEIREPLACE ADD TO TRANSFER LIFTGATE GLASS 0;7
2 001233 BOY REMOVEIREPLACE LIFTGATE SHELL MR325733 591.67 4.0
3 AUTO REF REFINISH LIFTGATE C 2.3
4 AUTO REF REFINISH ADD FOR JAMBS 8'INSIDE C 1.0
5 001234 BOY REMOVEIREPLACE LIFTGATE WEATHERSTRIP MR242360 59.93 0.5
6 001785 BOY REMOVE/REPLACE LIFTGATE ADHESIVE NAMEPLATE MR300667 21.92 0.1
7 002020 BOY REMOVEIREPLACE R LIFTGATE ADHESIVE NAMEPLATE AMT7SL2E01 41.67
8 002028 BOY REMOVEIREPLACE R LIFTGATE ADHESIVE NAMEPLATE AMT7SL2E03 41.67
9 001461 BOY OVERHAUL REAR COVER ASSY 1.2
10 001482 BOY REMOVEIREPLACE REAR BUMPER COVER MR326890 314.90 INC
11 AUTO REF REFINISH REAR BUMPER COVER C 2.0
12 001465 BOY REMOVEIREPLACE REAR BUMPER REINFORCEMENT MR230301 108.00 INC
13 001466 BOY REMOVE/REPLACE REAR BUMPER STEP PAD MR230333 65.98 INC
14 001467 BOY REMOVEIREPLACE R REAR BUMPER BRACKET COVER MR230330 12.72 INC
15 001468 BOY REMOVEIREPLACE L REAR BUMPER BRACKET COVER MR230329 12.72 INC
16 001469 BOY REMOVE/REPLACE R REAR BUMPER BRACKET MB406419 0.88 INC
17 001470 BOY REMOVEIREPLACE L REAR BUMPER BRACKET M8406419 0.88 INC
18 001471 BOY REMOVEIREPLACE R REAR BUMPER REFLECTOR MR296011 7.18 INC
19 900500 REF* ADD'L LABOR OP FLEX ADDITIVE **Qual Repi Part 7.00* 0.0*
20 900500 BDY* ADD'L LABOR OP COVER CAR FOR OVERSPRAY Sublet 10.00* 0.3*
21 900500 FRM* REPAIR PULL FOR MASH Existing 4.0*
22 900500 FRM" ADD'L LABOR OP FRAME RACK SETUP Existing 2.0*
23 WITH COMPLETE DATA SHEET
24 001472 BOY REMOVEIREPLACE L REAR BUMPER REFLECTOR MR296611 7.18 INC
25 AUTO REF ADD'L OPR CLEAR COAT 1.7
26 AUTO REF ADD'L OPR FINISH SAND AND BUFF 1.3
27 AUTO ADD'L COST PAINT/MATERIALS 210.00
ESTIMATE RECALL NUMBER: 811110316:14:06 17387
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: JUL 03 A Copyright(C)1994-2002 Mitchell International Page 1 of 3
UltraMate Version: 4.8.012- All Rights Reserved
C -Included in Clear Coat Calc
Add'1
Labor sublet
1. Labor Subtotals Units Rate Amount Amount Totals If. Part Replacement Summary Amount
Body 6.8 86.00 0.00 10.00 462.00 Taxable Parts 1,294.30
Refinish 8.3 66.00 0.00 0.00 639.60 Sales Tax @f 7.376% 95.45
Frame 6.0 75.00 0.00 0.00 450.00
Total Replacement Parts Amount 1,389.76
Non-Taxable Labor 1,441.60
Labor Summary 21.1 1,441.60
Ill. Additional Costs Amount IV. Adjustments Amount
Taxable Costs 210.00 Insurance Deductible 600.00-
Sales Tax @ 7.376% 16.49
Customer Responsibility 500.00-
Total Additional Costs 226.49
1. Total Labor: 1,441.60
If. Total Replacement Parts: 1,389.76
Ill. Total Additional Costs: 226.49
Gross Total: 3,056.74
IV. Total Adjustments: 600.00-
Net Total: 2,566.74
This is a Preliminary estimate.
Additional changes to the estimate may be required for the actual repair.
Insurance Co: C F STATE OMOBILE ASSOC, S TTA - * A? 1�E.:s
Address: P.O.B
1183 ADM CAL !LANE
VAL ,CA 94590-0448
Telephone: (707)562-0592
Fax Phone: (707)668-8661
Body Shop: Solano Body Shop
Address: 720 Florida St
Vallejo,CA 94590
Work Phone: (707)6444044
Fax Phone: (707)644-4046
"All Crash parts on this estimate are "new" original equipment
manufacturer parts, unless otherwise specified. Parts described as
rechromed, recored, remanufactured or, reconditioned are considered
"rebuilt" parts. Crash parts described as "quality replacement part"
are non-original equipment manufacturer "aftermarket parts"
ESTIMATE RECALL NUMBER: 8111/0316:14-06 17387
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: JUL 03 A Copyright(C)1994-2002 Mitchell International Page 2 of 3
UltraMate Version: 4.8.012— All Rights Reserved
OEM= A new, Original Equipment Manufacturer part
AJM= A new, After-Market part: also known as a new, Ikon-OEM part
Used or LLQ= A used OEM part that has been reconditioned or
remanufactured..
Company Code:
Drop Off Date: 8111103 Time: 10:00 Repair Dates:
Promise Date: 8114103 Start Date: 8111/03
Is Vehicle Driveable(YIN)?: Y
Assisted With Rental(YIN)?: N
WARNING: Accidental air bag deployment is possible. Personal injury may result. Avoid area near steering wheel
and instrument panel even if air bags have deployed. Dual-stage air bag modules may be present that could
contain an undeployed stage. When disposing of a deployed dual-stage air bag,always treat it as a"live"module.
See appropriate MITCHELL®AIR BAG SERVICE&REPAIR MANUAL,or OEM information.
ESTIMATE RECALL NUMBER: 8111/03 10:14:06 17387
UltraMate is a Trademark of Mitchell international
Mitchell Data Version; JUL_03_A Copyright(C)1994-2002 Mitchell international Page 3 of 3
UltraMate Version: 4.8.012 All Rights Reserved
Date: 811910311:25 AM
Estimate ID: 6211
Estimate Version: 0
Preliminary
Profile ID: Service First
Klimisch's Inc II
1833 Soiano Avenue Vallejo,CA 94590
(707)645-7717
Fax: (707)645.7725
Tax ID: 68.0111339 BAR#: AK213264 EPA M CAL000170885
Damage Assessed By: JANICE STONE
Condition Code: Excellent
Deductible: UNKNOWN
File Number: P
Claim Number: NOME AT THIS TIME
Insured: ALEXANDER A TY
Address: 284 GLENVIEW CIRCLE VALLEJO,CA 94591
Telephone: Rome Phone: (707)554-2141
Mitchell Service: 910389
Description: 1997 Mitsubishi Montero Sport LS Vehicle Production Date: 4197
Body Style: 4D Ut 107"WS Drive Train: 3.01.Inj 6 Cyl 4WD
VIN: JA4MT31P5VP021828 License: MR X0168 CA
Mileage: 20,129
OEMIALT: O Search Code: None
Color: BLKIGOLD
Line Entry Labor Line Item Part Typel Dollar Labor
Item Number Type Operation Description Part Number Amount Units
T-
000778 BDY REPAIR FLOOR REAR CROSSMEMBER Existing 4.0*
2 900500 BOY* ADD'L LABOR OP TINT Existing 0.5*
3 ***GOLD***
4 900500 REF* ADO'L LABOR OP ADHESION PROMOTOR New 10.00* 0.3*
5 001233 BOY REMOVEIREPLACE LIFTGATE SHELL MR325733 591.67 4.0
6 AUTO REF REFINISH LIFTGATE C 2.3
7 AUTO REF REFINISH ADD FOR JAMBS&INSIDE C 1.0
8 001245 BOY REMOVE/REPLACE REAR LIFTGATE LICENSE BRACKET MR245969 14.38
9 002021 BOY REMOVE/REPLACE L LIFTGATE ADHESIVE NAMEPLATE AMT7SL2E01 41.67
10 002029 BOY REMOVEIREPLACE L LIFTGATE ADHESIVE NAMEPLATE AMT7SL2E03 41.67
11 002035 BOY REMOVE/REPLACE L LIFTGATE ADHESIVE NAMEPLATE AMT7SL2E05 41.67
12 AUTO BOY OVERHAUL REAR COVER ASSY 1.2
13 001462 BOY REMOVE/REPLACE REAR BUMPER COVER MR325890 314.90 INC
14 AUTO REF REFINISH REAR BUMPER COVER C 2.0
15 001465 BOY REMOVEIREPLACE REAR BUMPER REINFORCEMENT MR230301 108.00 INC
16 001466 BOY REMOVEIREPLACE REAR BUMPER STEP PAD MR230333 65.98 INC
17 001467 BOY REMOVEIREPLACE R REAR BUMPER BRACKET COVER MR230330 12.72 INC
18 900500 BOY* REMOVE/INSTALL SPARE TIRE Existing 0.5*
19 FOR REAR FLOOR REPAIR
20 001468 BOY REMOVE/REPLACE L REAR BUMPER BRACKET COVER MR230329 12.72 INC
21 936014 ADO`L COST FLEX ADDITIVE 7.00*
22 AUTO REF ADD'L OPR CLEAR COAT 1.7
23 933004 BOY ADD'L OPR UNDERCOATING 10.00* 0.3*
24 AUTO ADD`L COST PAINTIMATERIALS 219.00
25 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL 1.83
ESTIMATE RECALL NUMBER: 8/19103 11:24:04 6211
UltraMate Is a Trademark of Mitchell international
Mitchell Data Version: AUG 0_A Copyright(C)1994-2002 Mitchell International Page 1 of 2
UltraMat+e Version: 4.8.0_12 All Rights Reserved
Date: 8119/03 11:25 AM
Estimate ID: 6211
Estimate Version: 0
Preliminary
Profile ID: Service First
* -Judgement Item
C -Included in Clear Coat Calc
Add'I
Labor Sublet
1. Labor Subtotals Units Rate Amount Amount Totals If. Part Replacement Summary Amount
Body 10.5 60.00 10.00 0.00 640.00'—T Taxable Parts 1,255.38
Refinish 7.3 60.00 0.00 0.00 438.00 T Sales Tax @ 7.375% 92.58
Taxable tabor 1,078.00 Total Replacement Parts Amount 1,347.96
Labor Summary 17.8 1,078.00
Ill. Additional Costs Amount IV. Adjustments Amount
Taxable Costs 227.83 Customer Responsibility 0.00
Sales Tax @ 7.375% 16.80
Total Additional Costs 244.63
1. Total Labor: 1,078.00
it. Total Replacement Parts: 1,347.96
Ill. Total Additional Casts: 244.63
Gross Total: 2,670.59
IV. Total Adjustments: 0.00
Net Total: 2,670.59
This Is a preliminary estimate.
Additional chan"s to the estimate may required for the actual repair.
Points)of Impact
6 Rear Center{P)—
Insurance Co: Service First
WARNING: Accidental air bag deployment is possible. Personal Injury may result. Avoid area near steering wheel
and Instrument panel even if air bags have deployed. Dual-stage air bag modules may be present that could
contain an undeployed stage. When disposing of a deployed dual-stage air bag,always treat it as a"live"module.
See appropriate MITCHELL®AIR BAG SERVICE&REPAIR MANUAL,or OEM Information.
ESTIMATE RECALL NUMBER: 8119103 11:24:04 6211
UltraMate Is a Trademark of Mitchell International
Mitchell Data Version: AUG_03_A Copyright(C)1994-2002 Mitchell International Page 2 of 2
UltraMate Version: 4.8.012 All Rights Reserved
CLAIM ,.
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION:SEPT. 23, 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
r 915.4. Please note all"Warnings".
AMOUNT: $1,123.81
� 4ayb'
CLAIMANT: TERANCE LOW
ATTORNEY: UNKNowN STATE RECEIVED: AUGUST 22, 2003
ADDRESS: 2480 CANYON LAKES DRIVE BY DELIVERY TO CLERK.ON: AUGUST 22, 2003
SAN RAMON, CA 94583
BY MAIL POSTMARKED: AUGUST 21, 2003
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
Dated: AUGUST 22, 2003 JOHN SWEE , rk
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 PAILS 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 Cleric 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:
Dat MW ;' By: Deputy County Counsf
III, FROO Clerk of the Board TO: County Counsel (1) County Administrator(2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. ARD ORDER: By unanimous vote of the Supervisors present:
(Vj' This Claim is rejected in.full.
( ) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date.
Dated: JOHN SWEETEN, CLERK, By , Deputy Clerk
WARMING(Gov. code recti 913)
Subject o certain exceptions,you have only six(6)months from the date this notice was personally served or deposite
in the •1 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
immedi4ttely. *For Additional Warning See Reverse Side of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty of per ury 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: �. v JOHN SWEETEN, CLERK By Deputy Clerk
Claim to: BOAR! OF St ERMS'1M OF CL TIM COSTA COUNTY
I DZTH=0MS TO CLAD=
A. Claims relating to causes of action for death or for injury to pe $On or to per-
sonal property or grouting 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. Chris Mating to causm of action for Amth or for injury to person
or to personal property or growing crops and %h3ch a=,,%* 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 ether cause of actio must be presented most
later than one year after the acemal of the rarer of action. (Goo. Ocie §911.2.)
B. Claim must be filed with the Clens of the Board of Supervisors at its office in
Roam 106, County Administration Building, 651 Pin! Street, Martinez, Cit 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 Pilled in.
D. If the claim is against macre than one public entity, separate claims trust be
filed against each public entity.
E. - Fraud. See penalty for fraudulent claims, Penal, Code Se^r 72 at the end of Vnis
7corrm.
e � � aa � +� s � � � e ee �tattet# e �t � e � * � a4rt � • tt � a� � � � �t � � � � � � �
RE% Claim By Y Reserved for Cleark's filing stamp
mast nEW o sta , z
i003
District) C�Ai `
The undersigned claimant hereby makes claim araInst the County of Contra Costa or
the above--rte District in the sum of and in support of
this claim represents-as follows:
1. When dial the damage or injury occur? (Give exact date and hour)
2. Where did ihe damage or injury occur? (Include city and county)
3. Flaw did the damage or injury occur? (Give full details; use extra paper if
required)
4. Int Particular act or ad3sion on the part of county or district officers,
aer"vants or-employees causedx the_injury or damage
T0'd TZfrT SEE S?_6 LN3WE)UNUW ASId ODD 7_f7:2T 2002-TE-Wtf
5• wnat are the names of qty or district officers, aervants or employees causing
the damage or injury?
F
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 was the amunt claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
3. *fames and addresses of witnesses, doctors and hospitals.
., ,
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AM"T
e � a �t � a +� a �t .* e ■ e �t � �tae•e �.� a �t * �ea �r•sa �t � a �taaaa � * �,ae
C,oi. Code .Sec. '910.2 provides:
"The claim must be signed by the claimant
SM NDTI{ Tas <Att�►rt somas h13-behalf-10
Name and Address of Attorney
• t s 1gr�ature
Telephone No. .1 Telephone No.. !b '
N0TICE
Seotic a fit of the Penal Cade provides
"Every person who, with intent to defraud, presents for allowance or for
payment to any state board or officer, or to any county, city or district board or
officer, authorized to allow or pay the same if.genuine, any false or fraudulent.
claim, bill., amt, voucher, or writing, Is punishable either by imprisonment in
the: county Jail°for a period of not mere t hgn one•year, by a fine: of not exceeding
one thousand (*11 000), or by Meth such imprisarowt and f ine i or by imprisorment in
the state prison, by a fine of not exuding ten thousand .dollars ($100000, or by-
bath such imprisonment and fine.
c0"d i?ItrT SER 926 1N3W-q"W ASIN DOS
DIABL O LINCOLN -- MERCURY -- AUDI - KIA
r
�w Au61
2001 MARKET STREET — CONCORD, CA 94520
(925) 682-3150
I " # (925) 676-5619 t
DIABLO LINCOLN MERCURY INC. WILL ACCEPT PARTS FOR REFUND OR EXCHANGE PROVIDED THE PART IS A
1
NORMALCY STOCKED NON-ELECTRICAL PART PURCHASED WITHIN 20 DAYS AND IS ACCOMPANIED BY THIS
INVOICE.ALL PARTS ACCEPTED FOR RETURN MUST MEET THE MANUFACTURER'S CURRENT PACKAGE GUIDE-
LINES AND ARE SUBJECT TO A 20%RESTOCKING CHARGE. PURCHASES MACE BY CHECK WILL REQUIRE.A 10
DAY CLEARING PERIOD.SPECIAL ORDERED ITEMS NOT PICKED WITHIN 90 DAYS WILL BE RETURNED TO NORMAL
STOCK, i
t*f=ENTEREf] YOUR OFIE}ER NC}, C3ATE SH#PPEL? #NVC}tCE DATE INVOICE
MAY 03 NUMBER � 19086
**QUOTE**
o ACCOUNT NO. 1OX � Ill''1{ 1XE i OF 2
TERANCE LOW P
T T
0 0
d
SHIP VIA SLSM. H/L NO3 TERMS FO'B'POINT f
TC CASH ICONCORD,CA
ref7
PART NUMBER DESCRIPTION LIST NET AMOUNTLO
?
2 2 0 BGC-601-025-AD—lH7 RS4 17" 462. 15 462. 15 924.30
2 2 4 SILO-601-165-K-1 H7 WHEEL. CAP 56.93 56.93 113 x 86
I N V 0 1 C E 0 U 0 T E - DO NOT PAY
r
s
#
)s
i
1
7^a�+ Yxic as 3
R
i
%d-r–eturnsns on special car sere par
o return of electrical parts PARTS T ■
o returns an parts that are SUBLET i
installed or used. BEE ABOVE FRE#GKr
SALES TAX 85.65
1723.
E
CUSTOMER'S SIGNATURE
'
MAW:Any warant`,ae an the pMwts or perb sold weby ars rstaee made Satter fssrsby expressly&cls m nit www ttsa,aftrwomsad ori#ed.mdad'stg any jm'osd wwwly
Of rnereArAnbilty or tifneas Ior a Rat tsr purpose,and the S06F ftff r assumes nor aothaiM any Oft ps+W ft aasura for k 8N MWW to MWOM wkh ft seta Buyer atsea not ba an"ad to rm"t
from fhs wi!lg dealer any mrmg.le±Hlal damngas,damages to pmpfrtx dimwa for taxa of M.fora of tme,toss at pmff{s,bras of imams or arty cow hddereg damages
CLAIM e4 ! �
BOARD OF UPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTIONEF'T. 232 2003
Crim 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
x>, Board of Supervisors. (Paragraph IV below), given
Pursuant to Government Code Section 913 and
%s 915,4. Please note all"Warnings".
AMOUNT: $2,729.70
CLAIMANT: CALIFORNIA STATE AUTOMOBILE ASSOCIATION (CSAA)
BY: YET'UNDE OSIKOMAIYA
ATTORNEY: UNKNOWN DATE RECEIVED: AUGUST 19, 2003
ADDRESS. P.O. BOX 920 BY DELIVERY TO CLERK ON: AUGUST 19, 2003
SUISUN, CA 94585
HAND DELIVERED BY
BY MAIL POSTMARKED: RISK MANAGEMENT
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
Dated: AUGUST 19, 2003 JOHN SWEET N
By: Deputy
II. FROM: County Counsel TO: Clerk of the Board of Super-4sors
(This claim complies substantially with Sections 910 and 910.2.
( ) This ClaimFAILS 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 Cleric should return claim on ground that it was hied late and send warning of
claimant's right to apply for leave to present a late claim(Section 911.3).
( ) Other:
Date B( Deputy County Counse
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2)
{ } Claim was returned as untimely with notice to claimant(Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present: ,
(V)j 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: -48 JOHN SWEETEN, CLERK, By , Deputy Cleric
WARNING(Gov. code section 913)
Subjects o certain exceptions, you have only six(6)months from the date this notice was personally served or depositea
in the rr '1 to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an
attorney of youx choice in connection with this matter. If you want to consult an attorney, you should do so
immedi61y. *For Additional Warning See Reverse Side of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned,have been a citizen of the United
States, over age, 18; and that today I deposited in the United States Postal Service in Martinez, California,postage fully
prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above.
Dated; �. JOHN SWEETEN, CLERK By Deputy Clerk
JUL--02--2003 11:1i CCC R T SK i 1ANAGMENT 925 335 1421 P.02
C .iwlm .
Claim to: HOARD OF SWERVZORS OF CONTRA COSTA aXJNTY
JNTrRUCTIONS TO CT UiA fr
:, "« '.aL bS »4= -S {-y✓d .t.;e,rvl#r. L.d dew t torm Ja :.{-`x�y.<. 4i1 Sdti:. �.1:d i-�-
1 tea" growing GY`t �i ^_.d res"3 C ccl li or, o ` bi:ffore De,-;ember, 11.p .?08f r
must be presented not Later t= the "0 th dad after the accrual of the CaUSe O
action. Claims relating to causes of action for-death or for injury to person
or to personal property or growing craps and Mich 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 acral of the Douse of action. (Govt. Code §911..2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in
Boom 106, County Administration Building, 551. Pine Street, Martinez, CA 94553.
C. If claim is against a district governed by the Board of Supervisors, rather th,-Ln
the County,- the nate of the District should be filled in.
D. If the claim is against more than one public entity, separate claims dust be
filed against each public entity.
E. ' Fraud. See penalty for fraudulent claims, Penal. Code Sew. 72 at the end of this
fort.
RE: Claim By ) Reserved for Clerk's filing stamp
.. RECEIVED
Against the County of Contra Costa } AUG 151
CLAP i r SC}1S
District)
7M in nam
The undersigned alalant hereby mwm claim against the County of Contra Costa or
the above--ted District in the sum of � � _� �� ` �7 and in support of
this claire represents-as follows:
1. When did the damage or injury occur? (Give exact date and hour)
? tee.✓ -in+''...d-
2. Where did the damage or injury oca urt (Include city and county)
' Y6
s ��
3. How did the damage or injury occur'; (Give full details; use extra paper if
required) h
0C�i tt - t e" a � i t ,;� 0'Y\
4. Wrest particular act 6t-1omission cn.the 'part of county or district officers,
servants or.employees caused.the,..1nJwor.damage?
' JUL-02-2003 11:11 CCC RISK MANAGMEN T 925 335 2423 € .03
p
wci.t are the names of county or district officers, servants or employees musing
1C.he damage or in Jury?
}
What damage or injuries do you claim resulted? (Give full extent of injuries or
doges claimed. Attach two estimates for auto damage.
7. How the amount claimed above computed? (Tnc?ude the estimated amount of any
prospective injury, or damage.)
8. Names and addresses of.witnesses, doctors and hospitals.
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
Goi. Code See. '910;2 provides-
"The claim must be signed by the claimant
SM NOTICES TO: (Att rne ) or Dy sm person on his.behalf."
Name and Aridness of Attorney
Claimartt's tura
Ad ss
LIS -
Telephone No. Telephone No.
* eI T Iaware
NOTICE
Section 72 of the Penal Code provides-
"Every person who, with intent to defraud, presents for allowanee or for
payment to any state board or officer, or to any county, city or dJ'strict board or
officer, authorized to allow or pay the same if,genuine, any false or fraudulent
claimp bill, account, voucher, or writing, is punishable eitber-:..'by imprisorsaaent in
the co=ty Jail,feta" a period of not more than me-year, by a fine of not exceeding
one thousand ($1,000), or by both such impri.miumt 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.
TOTAL P.03
Jul . I. 2003 8:22PM L&S REPORT SERVICE 6022710161 No,8903 P 15/26
r �
J l
S r � e^»S..x�.0{.S yl � n�a y�n'X: �'�d y/ay5°�•`r �
R � ;.RYay qg
s
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V. S
3
1 Y:
V � � � 7'i`f�✓ t A� � '
5�. f
Jul . 7. 2003 8.23PM L&S REPORT SERVICE 6022710161 NoA 903 P. 16/26
.e
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E .C?"'M� g" &tt,NS1Ut>!6�}f:t Q DR�c _ • ..
} .4 ARMO NG p ? SME
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1 � .012 S6tN?itBD -r—
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'•r, s:
CLAIM .
BOAS SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION:SEPT. 23, 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„
AMOUNT: $3,922.30 ;
CLAIMANT: CALIFORNIA STATE AUTOMOBILE ASSOCIATION (CSAA)
BY: YEIME OSIKOMAIYA
ATTORNEY: UNKNOWN DATE RECEIVED: AUGUST 19, 2003
ADDRESS: P.O. BOX 920 BY DELIVERY TO CLERK.ON: AUGUST 19, 2003
SUISUN, CA 94585 HAND DELIVERED BY
BY MAIL POSTMARKED: RISK MANAGEMEN
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN WEETE C
Dated: AUGUST 19, 2003 By: Deputy
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
. This claim complies substantially with Sections 914 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:
' Deputy Count Counst
�` By:, - *
Dated: � y y
IIT. FROM: Jerk of the Board TO: County Counsel(1) County Administrator(2)
{ ) Claim was returned as untimely with notice to claimant(Section 911.3).
IV. OARD 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: 7' 45. ZOO& JOHN SWEETEN, CLERK., By , Deputy Clerk
WARNING(Gov. code secti n 913)
Subject p certain exceptions, you have only six(6)months from the date this notice was personally served or deposite
in the 1 to fele a court action on this claim. See Government Code Section 945.6. You may seek the advice of an
attorne .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 full',
prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above.
Dated: geTz. 4X JOHN SWEETEN,CLERK By Deputy Clerl
JUL-02-2003 11:11 CCG RISK MWAGMENT 925 335 1421 P.02
c c °
Claim to: BOARD OF SUPERVISORS OF CONTRA CC A COUNTY
INSTR MONS TO C A-XC
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 pr==ted not later than the I.QOth day after the accrual of the cause of
action. Claims relating to causes of actio for-death or for injury to person
or to personal property or growing amps 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 ether cause of action must be presented not
later than one year after the acannI of the cause of action. (Govt. Code §911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in
Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553.
C. If claim is against a district governed by the Board of Supervisors, rather than
the County,- the name of the District should be filled ,in.
D. If the claim is against more than one public entity, separate claims MISt be
filed against each public entity.
E. * Fraud. See penalty for fraudulent claims, Penal. Code ,Sec. 72 at the: end of this
form.
� � � � �F � � � * #t � * �t � � �F � � �t �t �► � � �t � aEitat * � � �Fit � �t #� ra � atat � � at
RE: Claim By ) Reserved for Clerk's filing stamp
`t om_ _ ) E "�
Against. the County of Contra Costa. � �-���r ��
ED
or
AUG 1�,4003
llistrict) V
Trill zz � z
The undersigned claimant hereby makes clad against the County of Cama costa or
the above-rte District in the sum of a f) and in support of
this claim represents-as follows:
1. When did the damage or injury occur? (Give exact date and hour)
2. Where did the damage or injury occur'? (Include city and county)
3. How did the damage or injury occur? (Give full details; use.:. extra paper if
required) 1 1.d i f1t � xat�r :
ve
4. What partioular act or omissr ora on-the part of county or district officers,
servants or.employees caused, the.injury cx'-dare? :t v e.;c- In 1 i e. u J,fc
JUL-02-2003 11:11 CCC RISK MANACMSFIT 925 335 1421 P.03
D• Wnat are the runes of county or district officers,rs, servants or employees causing
the doge or injury?
50 What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
7. How ams the want claimed above computed? (Include the estimated amount of any
prospective injury, or damage.)
LA
3. Names and addresses of.witnesses, doctors and hospitals.
f
06
9. List the expendi`ures you made on account of this accident or injury:
}ATE ITEM AMOUNT
Goi. Code Sec. '910;2 provides:
"The claim mast be signed by the claimant
SM NOT'lMa TO: Unr n ) or PX soft on his.behalf."
Rame azad Address of Attorney �
clairnt l s s tuts
Uddressi
Telephone No. Telephone No. � V& o �:�C'� P 1
NOTICE
Section 72 of the Penal Code provides: -
"Every person who, with intent to defraud, presents for allowance or for
Payment to any state board or officer, or to any county, city or district board or
offioert authorized to allow or pay the same if.genuine, any false or fraudulent
claim, bill., aictrot t, voucher, or writing, is punishable either by imprisoriment in
the county ,f ail•fOr a period *f not more than one-year, by a fine of rmt exceeding
one thousand ($1., 10}, or by-both such imorisaiment and Pixie,°`or by imprisonment in
the. state prison, by a fine of not e t sling tern thousand dollars ($10,000, or by
troth swh imprLsonment and fine.
TOTAL P.03