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HomeMy WebLinkAboutMINUTES - 07272004 - C.14 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 'BOARD ACTION. JIILY 27, 200 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), give Pursuant to Government Code Section 913 and ' h 915.4. Please note all"Warnings". AMOUNT: $650.09k CLAIMANT: PEDRO ANDRADE C,01UNTY 00,1JNSEL MARTINEZ CALIPt ATTORNEY: UNKNNow1V DATE RECEIVED: JUNE 21, 2004 ADDRESS: 2830 11th STREET, BY DELIVERY TO CLERK.ON:JUNE 21, 2004 SAID? PABLO, CA 94806 BY MAIL POSTMARKED: JUNE 1812004 FROM: Clerk of the Beard of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEET , Ctarli- Dated: JUNE 21, 2004 By; Deputy II. FkOM: County Counsel TO: Clerk of the Beard of Sup cors (141"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: i---- t By: _ V4 "` >' 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 ORDER: By unanimous vote of the Supervisors present: ( ' This Claim is rejected in full. ( } Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated. + JOHN SWEETEN, CLERK, By , Deputy Clerk WARNING(Gov. code section 13) Subject to certain exceptions,you have only six(6) months from the date this notice was personally served or depositf 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 tunes 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: 1&-0JOHN SWEETEN, CLERK By DeputyCler: Claim to: BOARD OF SUIPERVISMLS OF C39MA COSTA Cl"i-f n4S7MC`IrIOHS TO aAnwrll r, Claims relating t".0 zauses of action for dea*.,h or for jnjur7 to p4.,rsor, or "o per- sor.sl prope--t'y or grox4lng crops and which accrue on or before Da,_-embev 31, 1987, must be presented not later than the 100th day after the accrual of the cause Of action. Claims Z*,Iating to causes of action fordeath or for iniury to person or to personal property or growing ;;,c;; and which ace_-rue on or afur January 1, 1986, must be presented not lata.' than six months after the accrual of the cause of action. Claims relating to any other cause of action =t. be presented not later � one year after the &=M-dl Of the cause of action. (Govt. code 591'.2=) B )Claims must be filed with the Mark of the Board of Supervisors at its .Offloe 11.1 I-'A1 ,1�/Ro= 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C:» T6f o�.aim is against a district governed by the Board of Supervisors, rathtr t'r= the County, the rwm of the District should be filled in. D. if the claim is against =re t�.n one public entity, separeate claims =t be filed against each public, entity. S. Fraud. See penalty for fraudulent' claims Peal:.. Code Sec. 72 at the end of this Tom Claim By Reserved for Clerk's filing s'v'=p R RELEXED, JUN j 1200 RA=0 rr__ME the =t)r of Contra CM J JUN 1 2004 go R =CL=ERJK.183AAr c T TA co ONTRA COSTA C 13111SORS ,,C District ON RA COS CELuin raw) tie undwsigned claimant hemby,=Kkas to t the County of Contra Costa or the Above-rimd District in the sum of C_)2 _ __ and in support of this claim --presents-as foll=: 2L LgL 1. When did the damage or injury occur? (Give emot date I and hour) N -7 A 2. Where did the damage or injury co*ur? (Include city azi County) -- A;Lz_V_ ,J ) 211�1')L zkc�, How did the damse or injury occur? (Give full details; use extra pager if ..w..�1.w...�r•..r � Y�� r�»w +»'M1�r3awr��i��aW'iY!�Wrr.�+r+++ +�r'+f+wa"""' _,. inn .r+rwww 4. khat parti=lar act or omission en the part of county or district officers,, sets car.employees c=ed.the.injury or dwzap? (�C\ !ZVI IN3X0RJW A618 _33--) VNZ—Lo—Nnf what ire Vie calms of counry or district officers, sevrvants or employees c ausirlg the age or in, =—I? �» injuries do �rou claim resulted? {Give full extend, of inJuries or Whatjdamage or da es claimed. At:aeh two estimates for auto damage. A: 1 t r 7. 1HOW was the amount claimed above om-puted? {%n-hide the estimated swunt of any prospective Injury,jury or damage..) Names and addresses o1 witnesses, doctors aril hospitals. 9. List the expenditures you made on sca=t of this aoaldent or injury: DkTu 1M. AM T Gov. Coda Sea. '0110i2 provides: "The claim mast, be signed by the claimant SD NMIMS TO- cr by eco ver'sor2 C7ri his behalf." Ram; EZ Address of Att nr wy Ciai taztt s Sx tuM • A ass Vk) C1 416'0 0 Telephone No. Telephcrlj�;10- 1 � NOTICE Sectio 72 of the Penal Cade provides: "Every person whop with intent to defraud, presents for allowanoe or for payment to any state bm"d or offf ioer, or to any county, city or district bo=-z d or of'fioer, authorized to allow ar pay the same if.genuine, any false or fraudulent olalm, bill, account, voucher, or urit.ing, is pmishable either by Imprisonment in the county Jai., for a period of not more tham ane.year, by a fine of not exoseding one th=and ($Jt000), or hy 'both sial Inorisornent and fine-,-or by imprisonment in the state prison, by a fine of not exceeding ten thousand .dollars {$10,000, or by. bath such i=prisorrnent and fine. 20`c T C V I 921� &E5 1N�W�JHh1bW I� ��� c t :S T hC�OG-L�-NC M HILLTOP , VICE CLINIC INSPECTION REPORT SICK 32-10 Autos Plaza. Richmond, C.A. 94806 • 510-222-4141 • Fax 758-8632 • F-mail - Internet@hilltopautos,cezn _ - r:c?- yo t,vOtlltlllued driving pleasure and Safety, one o"our certified technic arcs has performed the following rns" � coon f I on ,ow, vehicle. You are under no obligation to purchase any recommended repairs. We only wish to keep you � inforried of your vehicle's condition so that you may protect your investment. YEAR - k` t ;alis-EACE DATE r, w . SERVICI,", ADVISOR si3tTCs Needs ?Slifet- iEstimated ITEMS INSPECTED Attertin <t� '?'arts Labor ' G,v,x�: #C:� Cr F tires 2. Inspect condition olf rear tires 1 mspect a l iwnrn t tire wear f L....._....._�iiJoe':;,ioi1{.'aL+C.s.ra c':!Yi+".r f"i!er$m JiruT_j Inspect co nu,t.o: of rear shock absorbers iJsped adjis x ent o-AFbrake pedal _ _� m� -k•:•- i :iSj u'Ct condit o: 0:z". Ces 18, 8 .3✓Gct condition of brake 1wr ra+ui sr ilv i:. ("uIds visual c ocK of -_akeu_..r,._.,.__e,....�._.._..,�,.�....._�.«„�.,_..,�...>t......._........... `.,.�,,,.,_.��.,..._. , 4.< Sop o '3 ` S �l + � lhns!)--cl cos don oT ad)cEnnetst of Cis d t be t5� � .�..._ a w ___...... �/S (,✓f2 ...--"' i { � for^oSe + i itSC C# 0 .C£i o^ �� rad0 — t '_iSra ct co_d on vP1 eater boss / _--....._. . _..._._ -+5t^E.ct CofifAitio?1 ^r .....tCl" -_......_. ._.. ...___.__ .._.. .._...,,...___.. ._}..._._........_......_......_. ___.-jL .w,._._._..�..,�.__ .......�. i 120. Inspect operation of batteEZ cables i2i. inspect condition or fuel Filter -'2 Inspect condition of wiper blades -Y � -- "v. lns?ect o eration of headli hts 24. Inspect operation of stop,tail,turn signal lights 1 25. Ins ect restrain s stem 26. Road test 06115/2004 at 12 : 40 PM Job Number: 25244 BAST BAY BODY SHOP Federal ID # : 562401674 251. 24TH ST RICHMOND, CA 94804-1831 (510) 233-3233 Fax: (510) 233-9761 PRELIMINARY ESTIMATE Written By: LUIS HERRERA Adjuster: Insured: PEDRO ANDRADE Claim # Owner: PEDRO ANDRADE Policy # Address: Deductible: Date of Loss: Day: (510) 233-4985 Type of Loss: Point of Impact: Inspect Location: Insurance Company: Days to Repair 1998 CHEV M10 4X2 ASTRO 6-4 . 3L-FI 3D VAN Int: VIN: UNK Lic: Prod Date: Odometer: Air Conditioning Intermittent Wipers Dual Mirrors Clear Coat Paint Power Steering Power Brakes Anti-Lock Brakes (4) Driver Air Bag Passenger Air Bag Bucket Seats Rear Step Bumper - - - - __ NO. Off . DESCRIPTION QTY EXT. PRICE R. LABOPAINT - -_____ 1 FRONT DOOR 2* Rep! LT Mirror stationary power 1 183.22 1 . 0 0 . 5 3 Add for Clear Coat 0. 1 4* R&I LT R&I trim panel 0. 5 5* R&I LT Filler 0.2 6* Rept LT Window switch 1 61. . 46 0. 5 7 Repl LT Motor 1 137 . 86 0.5 -__----------------------_-__------------------------------------__----_--__--_------- Subtotals ==> 382 . 54 2 .7 0 . 6 Parts 382 . 54 Body Labor 2 . 7 hrs @ $ 66. 00/hr 178 . 20 Paint Labor 0. 6 hrs @ $ 66.00/hr 39. 60 Paint Supplies 0. 6 hrs @ $ 28 . 00/hr 16. 80 - - SUBTOTAL $ 617 . 14 Sales Tax $ 399. 34 @ 8 .2500% 32 . 95 1 06/15/2004 at 12 : 40 PM Job Number: 25244 PRELIMINARY ESTIMATE 1998 CHEV M10 4X2 ASTRO 6-4 .3L-FI 3D VAN Int: ----------------------------------------------------- GRAND TOTAL $ 650 . 09 ADJUSTMENTS: Deductible 0. 00 ---------------------------------------------------- CUSTOMER PAY $ 0 . 00 INSURANCE PAY $ 650. 09 FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM: ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. 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=D}AGNOSTIC 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 A/M=AFTERMARKET BLND=BLEND CAPA==CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY SNCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RELY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT W/ =WITH/ SYMBOLS: #=MANUAL LINE ENTRY *=OTHER tIE. .MOTORS DATABASE INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. MQVP=MANUFACTURER' S QUALIFICATION AND VALIDATION PROGRAM. Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise nested all items are derived from the Guide DRIGG85 Database Date 06/2004, CCC Data Date 06/2004, 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. Tilde sign (-) items indicate MOTOR Not-Included Tabor. operations. Non-Original Equipment Manufacturer aftermarket parts are described as AM, Qual Repl Parts or Comp Repl Parts which stands for Competitive Replacement Parts. Used parts are described as LEQ, Qual Recy Parts, RCY, or USED. Reconditioned parts are described as Recon. Recored parts are described as Recore. FAGS Part Numbers and Prices are provided by National Auto Glass Specifications, Inc. Pound sign (#) items indicate manual entries. CCC Pathways - A product of CCC Information Services Inc. 2 ' CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JULY 27, 2004 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 VF,,m� t Board of Supervisors. (Paragraph IV below), give: Pursuant to Government Code Section 913 and 915.4. Please note all"Warnings" law 's � s 1. f;.} AMOUNT: UNLIMITED CLAIMANT: CINDY ALLEN ATTORNEY: GARY GALLAWA DATE RECEIVED: JUNE 23, 2004 ADDRESS; GA11AWA BROWN KROESCH BY DELIVERY TO CLERK ON: JUNE 23, 2004 2207 J. STREET, SACRAMENTO, CA 95816-1050 BY MAIL POSTMARKED: JUNE 22, 2004 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETE C Dated: JUNE 23, 2004 By Deputy II. FkOM: County Counsel, TO: Clerk of the Board of Supervis s W"This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). ( ) Other. Dated: �: _° By: Deputy County Coun 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•,�. OARD ORDER: By unanimous vote of the Supervisors present: {V5 This Claim is rejected in full. ( ) Other: I certify that this is a true and corred copy of the Board's Order entered in its minutes for this date. Dated: JOHN SWEETEN, CLERK, By , Deputy Clerk WARNING(Gov. code sec on 913) Subject to certain exceptions, you have only six (6)months from the date this notice was personally served or deposit 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 ful' prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: +` OHN SWEETEN, CLERK By Deputy Cler Or-/22/2004 14:09 CONTRA CCSTA COUNTY CLERK OF THE 9191f4445921 NO.5G? POI Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSMCTIONS 10 CL.AZdA'�"f A. Claims relating to causes of action for death or-for injury to person or to pMOnal property or graving crops and which accrue on or before December 31, 1987, must be presented not later than the 1 Oar' day after the accrual of the cause ofacti+on. Claims rclating to =scs cif action for death or for injury to person or to pmonal property or growing crags and which accrue on or after January 1., 1999,must be presented not later than six months after the accrual of the rause of action- Claims relating to any ocher cause of action must be presented not later than one yw after the accrual of the cause of action. (Gov't Code 911.2), B. Claims must be filed with the Clerk ofthe Board of Supervisors at its officcin Roam 106, County Administmion Building, 651 Fine. Street,Martinez, CA 94553, C. Wclalm is against a district governed by the Board of Supervisors,rather than the County, the narne 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,Pcna.l Cade Sec.72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp CINDY ALLEN } Against the County of Contra Costa or ) J District} e� Xo 04 (Fill in name) } 0SrA C 1/12 ORS The undersigned claimant hereby makes claim against the County of Contra Cash or the above-named district in the sum of$,_mlimited and i,n support of this claim represents as follows: 1, When did the damage or injury occur?(Give exact date and hour) December 23, 2003 at approximately 1845 hours. ** PLE_ASE ALSO SEE ATTACHED ** 2. Where did the damage or injury occur? (Include city and county). Unincorporated Contra Crista County; near the city of Richmond. ** PLEASE ALSO SEE ATTACHED * 3. How did the damage or injury occur?(Give.full details;use extra paper if rerlukod) ** PLEASE SEE ATTACHED AND TRAFFIC COLLISION REPORT *� i5Gr22/2004 14:05 CONTRA COSt€; COUNTY CLERK Or THE 4 919IG4445521 Nth.Sri? 902 to Y H ~ f q. '4rt'k}at particular act or ornissitrn on the part of County or district officers, servants, as employees caused the injury or damage? Dangerous roadway. Particular acts or omissions unknown at this time. * '��E ALSO SEE ATTACHED S. What are the names of county or district afficers, servants, or employer:: causing the damage or injury? Unknown at this time. ** PLh4SE ALSO SEE ATTACHED ** 6. What damage or injuries do you.Claim resulted?(Give full extent of injuries or damages claimed, Aftach two estimates for auto damage.) Extensive Dhysical injury and total demolition of claimant's vehicle. Total damages unknown at this time. ** PLEASE ALSO SEF ATTACHED ** 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or da=age,) ** PLEASE SEF ATTACHED ** 8. Names and addresses of witnesses, doctors, and hospitals, Hosxpitalization at John Muir Medical_ Center in Walnut Creek, C.A. Treatment and rehabilitation are continuing. 9, List the expenditures you made on account of this accident or injury. DATE ME AMOUNT Treatment and rehabil.itation are continuing. *+F*�*r�wss�rs**Mkt**wrrrss�w.wtr*assww«+�tww*+ www**+�r�wwwws*wtww**+�**s+t*wswt*w�tsrr***w*s�**t*ss* Gov. Code Sec. 910.2 provides"The claim must be signed by the claimant or by some person on his behalf," N T (Anomty 'Larne and Address ofAttomey Gary Gallawa GALLAWA BROWN I RDESCH } ( f IC118t1t's esjgnat rG) 2207 J Street Gary Gallawa, Esq. by and :dor claimant CINDY ALLEA Sacramento, 'CA 9581.6-1059 Telephone: (916) 444-9364 (Address) Facsimile: (916) 444-5921 ) (see address and Rhone number to the left) Telephone Ado. �'f etephone No. NOTICE Section'f2 of the Penal Coda pmvides: EvtTy person who,with kaent to Mmud,prints for allowance or the payatatnt to any sute board or oM=,Or to atxy county,city,or district bm A or vMcer,sulhcrrL-wd w allow or pay the$ e if gaujne,any Nse or ftudulent claim,bill,amaunt, vmthrx,w wtitsng, is puni"ble eitber by impriso=ant In the county jail for a pmiod of that more than one Year,by a fate of not excer ding one thousand($1,000),or by bath sucb Lmpriso=em and fxue,or by imprisonment in the tete p650o,by a fiw of'"t e xmW4ng ten thouswd cholla or by both such imlorisata =t said fm. LAW OFFICES GALLAWA ' BROWN • KROESCH A PROFESSIONAL CORPORA'ITON WALTER E.GALLAWA 2247 i STREET DO(IGLAS A.KROESCH SACRAMENTO,CA 95816-4711 GARY GALIAWA TELEPHONE(916)444-9364 FACSIMILE(916)444-5921 Board of Supervisors Centra Costa County 551 Pine Street, Room 105 Martinez, CA 94553 Attention: Cleric of the Board TORT CLAIM AGAINST COUNTY OF CONTRA COSTA [Government Code Section 910 et seq] To the County of Contra Costa by and through its duly elected Board of Supervisors: Cindy Allen hereby makes a claim against the County of Contra Costa and makes the following statements in support of the claim: (1) Claimant's past office address is 530 Eagle River Court, Vacaville, CA 95688. (2) Notices concerning the claim should be sent to the Law Offices of Callawa- Brown. Kroesch, 2207 J Street, Sacramento, CA 95815. (3) The date, place and circumstances of the occurrence which clave rise to the claim asserted are as follows: (a) Claimant was involved in a two vehicle head on automobile collision which occurred on December 23, 2003 on San Pablo Dam Read, 0.5 miles east of Tri Lane, a two lane county road in the County of Contra Costa. LAW OFFIMS GALL.AWA • DROWN • KROESCH A PROFESSIONAL CORPORATION (b) A copy of the Traffic Collision Deport concerning the subject collision is attached as an exhibit hereto, for informational purposes. (c) Claimant was traveling eastbound on San Pablo Dam Road, approaching a southerly curve in the roadway. The adverse driver, Robert Acuff, Sr. was traveling westbound on the same road, reportedly within the posted speed limit. Mr. Acuff lost control of his vehicle, causing it to cross the center line of the roadway and directly into the path of claimant's travel. (d) Upon information and belief, claimant contends that the San Pablo Clam roadway and/or the surface of such roadway was in a dangerous condition at the time of the injury, that the dangerous condition caused or contributed to the accident, and that an accident of this nature was reasonably foreseeable under the circumstances. Claimant further alleges that the County of Contra Costa had knowledge of the dangerous condition and the foreseeable risk of accidents and the resultant injuries at the location of the subject accident. (4) Claimant suffered extensive injuries in the collision, including a shattered right ankle, a compound fracture of the right patella, a fractured pelvis, fractures in the lumbar spine from L1-L4,fractured left humerus with an open fracture of olecranon (left elbow) and several broken toes on her left foot. Claimant has been, and remains, totally disabled from the date of the accident to the present. (6) The name or names of the public employee or employees who caused or contributed to the injury, damage, or loss, are not presently known. (6) The claimant's claim as of the date of this claim is in amount that would place it within the jurisdiction of the Superior Court. The claim is based on extensive injury and damage and loss and an amount to proved later. The claim would be an unlimited civil case in the Superior Court. Dated: all w - Blown - Kroesch By Gary Gallawa on behalf of Claimant, Cindy Allen 2 S71.'E OF CALIRORNIA TRAFFIC COLLISION REPO T. CHP 555 Page (Rev.7-03) OPI 061 Page Of 5PWuwR �R�YO� CYECACONCfTONS 4R IaRUN D:STRT LOCAL REPORT NUMBER uep €ELNY I0 c , 7 i (i}NI1N.eER la:.:fif7 N-RUN R COUNTY RE?ORTING DISTRICT COLLISION OCCURRED ON �3 Mo. OAYYEA,A 7"1ME,(2470) NCIC A OFFICER 1.0. r ,} _ MILEPOST LNP'ORMkTION DAY OF WEEK TOW AWAY PHOTOGRAPHS BY' 'cam NONE ) # () FEETIMtL€S OF IS Mf W T F SIZYES 0 NO - �IARTY[g ' AT INTERSECTION VNTH STATE liYJ':'REL fff OR: a R1kLflMILES OF ! = �f-j, Yt5 NO DRIVER'S LICENSE NUMBER STATE CLASS AIR BAG SAFETY EGUfP. VEH.YEAR MACIs".JMODEUCOLOR LICENSE NUMBER STATE J _ . +�✓ry'} .64 DR; ER NAME(FIRpS7�WiODLE,U4S7) _ owiaERSNAME j SAME AS DRIVER PEDES. STREET ADDRESSTRIAN ElCr OWNER'SADDRESSSAMEASORIVER PARKED CTTYISTATFJZIP - VEHICLE �G f�� ` dL !; DISPOSITION OF VEHICLE ON ORDERS OF: .?,,�,?CFFICER�DRIVER�OTHER BfCY- SEX HAfR EYES HEIGHT 1N_E!GHT BIRTHDATE RACE ``?'''15 y.-�^ Iy ,I +� gJ�S LT Ma_ Day� Yaar Y�$ � T-_4+-...J velU"��.- .�1 g p r } � } f ...�7 �<"` j PRIORMECHANFCALOEFECTS: NONEAPPARENT REFFRTONARRATIVE OTHER HOM�.EP-��40NE +� BUSINESS PHONE VEHICLE TOEN2'IFiCATLON NUMBER J —Ag 441 VEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE IN:DAMAGED AREA INSURANCE CARRIER POLICY NUMBER 1]{.INK. NONE i_._t MINOR ' r MOD, MAJOR[]ROLL-OVER N2 OF TRAVEL CMF STREET OR HIGHWAY SPEED LIMIT ��t3 �t /� �'*, �� ISO' CA DOT/"" l ir' L-A �'" 2 'k,J' CAL•T —TCP/PSC MGMX_.- PARTY DRIVER'S LICENSE NUMBER STATE CLASS Rift BAG :SAFETY EQUIP, VEH,YEAR MAKEMOCEUCOLOR LICENSE NUMBER STATE 2 � L T DRIVER NAMEIFIR5T,AffDOLETLAS7) _ .�.�+ - - ..__-i_Y.. ___- -- - Y � OWNERS NAME [ `SAME AS DRfltlr`ER SAN STREETADDRESS L� ( 4 r l ; """r te OWNER'SADDRESS ttt---:::LII ' '� �" I�cyL SAME AS DRIVER PAPXED ClTYtS-ATE'tZtP . VEHICLE DISPOSITION of VEHICLE cu+ORDERS D,: OFFICER( DRIVER OTHER 81CY- 5f,X HAIR lryrs HEIGhT VJEIGMT BIRTHDATE TRACE ,+�'a'A } OUST ('� c T."' Ca.ifi'Si�"f,'.hJ 5',"u ; J _ a' l., �3 t g 1-7 - c,Mo. DayY7 PRIOR DEFecTs: NONE APPARENT REFERTONARRA1iVE OTHER HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER: y,,.qj_*y VEHICLE TYPE DESCRIBE VEHICLE DAMAGE - "SHADE IN DAMAGED IAREA INSURANtC€CARRIER POLICY NUMBER DUNK L_S NONE D MINOR L `�� T a TEG. Q//� DMOD, �AJORDROLL-OVER f IR aP TRAVEL TREEF OR HIGHWAY SPED LIMIT CA DOT ((f r+ C"31't Y✓i�'F q, r "�" CAI..T TCP/PSC MC/MX PA��RyTY DRIVER'S LWXNM NUMBER STATE CLASS AIR BAG :SAFETY EQUIP. VEH.YEAR'�MAKEWCOELICOLOR LICENSE NUMBER STATE DASVEA NAMEjI"IR5T,AIIDIILc,LA57J � -,___. -------------- ..____...._.,_. _ DOWNERS NAME SAME AS DRIVER PEDES- STREETAOORESS TRIAN . ' OWNER'S ADDRESS d SAME AS DRIVER PA RKED C,_YiSTAT&ZJP a + . IVEHICLE D ` DISPOSITION OF VEHICLE ON ORDERS OF: I I;—t OFFICER E DRIVER �OTHER BICY- SEX HAIR S HE.GW W8GHT ilRTHDTATE RACE LJ I CLLST Ma. Day Year PRIOR MECYAt fS AL DEFECTS; NONEAPPARENi REF RTO NARRATriJE OTHER HOME PHONE } BUSINESS PHONE VEHICLE IDENTIFICATION NUMOEFt, tttlll VEHICLETYPE DESCRIBE VEHICLE DAMAGE' SHADE:IN DAMAGED AREA NSURANC£CARRIER POLICY NUMBER �❑UNfC. �NCNE �MiNOR (((( MOD. ❑MAJOR[]ROLL-OVER ' O!R OF TRAVG' ON STREET OR HIGHWAY SPEED L?MLT c CA DOT t CAL-T - TCPIPSC MCpy ' jI PREPARER-S NAME ,r f OtSPATCH NOTIFIED REVIEWER'S NAME DATA REV0AIED I 33 F2:�_ YES E]NO NLA ! - CHF'555 Pgce ' (Pey.7-O3) OPi D61 - Page 04 RcC[AL..OMJ7fE.t4S ..._.�.__. [t 'wrt agUN /'� '".,�r .T`.' I JUDICIAL DISTRIC iltic, 1 LOCAL REPORT NU,sk ER izt , fEL6NY I 1 NU-TUA AXL C 4 HIT d AU 'COUNTY REPORTING DISTRICT 3Fii7 � w COL'=5'O*OCCu4RE3 ON .MJ DAY Y1cAR4WE'240M NCIC x 7------ld'#'n......'�•^_\.d f""ti:"' _.i "p.-t _..._.._._._._.�._y..__..�. { ,f, `y "'Y { 5"r }„" `'�tom' �"�if _ EPGST'.".>=CF;`.%ATFOhI 1 µDAY OP WEEK �TOW AWAY j1 a:*OTO^vRAPH5�6Y. '•!:vq;Nc'. EE IM;;SS OF ^�J i S j±)W T F S I JAI YES 1 1 NO { "••. .AT WTERSc..7;!.N WITH .� {STATE HW`f REL , t''�QM'?MiLEs ;,..�. OF ^r{f '',} i YES +i ItC R.AR Y�ORIVERC L- ti[SE:`1liMEER ' (STAT£, 4 jt-LASS �A!R SAG 'SAFETY ED /EN Yc, : i MAKEiMODEUCOLOR 'w iLiCcNSE ti.149i3cR -�^iVER NOME 1 RSY;,IDtJLE,L{.ST) t 1 r A OWNER'$NAME ( � 4fi -LM SAME AS DRIVER PSOSTREET ADDRESS TRIES- L� f 3.,.t o'�mER'S ADDRESS � .SAME AS DRIVER PARKED CITY/STATE/ZIP L EHIC1 F _ I I A ' - 1""'°��"F OfSPOSITIC14 OF VEHICLE ON ORDERS OF- -��... FFiCEFtDRIVER �I OTHER ,c- Si" HAIR IFYES HEIGHT WEIGHT BIRTHDATE IPACE - r r; �] /M0, Day Year '•` t _. # _$ x.�•i '�-t ",? -i, i. �Ji1 ! `'a # t,,.t.,.e°` FRIOR MEC-ANtCAL DEFECTS: �NONc APPARENT��RIFER 7q NARR.ATt4`E w.. ... POTHER HOivGE PHONE .n BUSINESS PHONE � VEHICLE tOENTiFICATICN NUMBER: i La _ VEHICLE TYPE DESCRIBE VEHICLE DAMAGE S-,AEE 1Ti frAMAGED AREA ry i INSURANCE CARRIER �j-�-•� POLICY NUMBER �UINK D NONE 'Ll MINOR MOD.K MAJOR[]f ROLL-OVER � IR OF TRAVEL JON STREET OR HIGHWAY SPEEr.D,,LIMIT CA `,,,'?``?_�:ll ^" 'c...=(Le✓ L,.f, 1,.7+,,,.w ,+w�ty...� CAI-Y _ _ TCF"/P5C,,.�.,_. �.�,..tCIMX ._...�..�..._..�� ., ,.,,,.� IPAR?'Y DRIVER'S LICENSE NUMBER ISTATE C',.ASS 'AIRBAG 'SAFETYEQUIP. VEH,YEAR MAffEr'MODeVCOLOR jLiOENSe`NUMBER i5TP7£ DRIVER NAME,FIRS7 MIDDLE,LAS t} f? f c �Y OWNER'S NAME SAME AS DRIVER `_ ! PEDES- STREET ADDRESSTWAN I Li t �,^y N 1 ;.;, ,{/ "'gypp s r•,,,;"'/ /� r OYvNER'SADDRESS , y ;y <x,!._>_,,,. `.,.-..., t -.._f( F t _ _ ,L SAME AS DRIVER {>ARKED cITYrSrrtTFizIP VEHICLE tt 1 ! 1" } ,t '� ..P• ., DISPOSITION OF VEHICLE ON ORDERS OF: �`� I-` t.�.UGrt ER 0 DReVE� El OTkER�f 1 3{f-ST SEX R EYES (WEIGHT BIRTHDATE RACE .. s )HEIGHT crem. Day (_Y-eaarr {�L 1 '�`4' f � � PRIOR MECHANICALDEFECTS.V — ONE APPARENT t �REFERTONARRA7NE� OTHER HpME PHONE jaUSINESS PHONE VEHICLE 0ENTtF'ICATION NUMBER: VEHICLE TYPE DESCRIBE VEHICLE DAMAGE .,HAOE IN DAMAGED AREA t ,AiSURA,NCE CARRIER POLICYNUMSER LINK NONE MINOR Lj }d . G3 tv '7 L DMOD. t YiAJOR ROLL-OVER f tOiR OF TRAVEL ION STREET OR HIGHWAY SPEED LIMIT GA OOT !I W CAL-T 7CPfPSO_ MC.'MY��..,._______.____, « Y I f�1y G �,tt t L. l iPARTY D'RIVER'S LICENSE NUMBER isYATE CLASS BAG ;SAFETY eCUiP, VEH.YEAR �MAKFJMOD°i1COLbR li.:.ENSE NUMBER ;S'ATc 1 j ttt 7 DaroER NAME(FIRS`xtiOCLG,LAST) t OWNER'S NAME SAME AS DRIVER f ON NER's ADaREss SAME AS GRiVER '•}eHfCLE! DISPOSITION OF VEHICLE ON ORDERS OF: ' < OFFICER If DRIVER OTHER j S'CY- SE1.' HAIR 'EYES IiE1GHT WEIGHT I eiR-DiDATE RACE CUS7 Mn. Day Year ! I ( ._.. - ).�.._._.._..—. ".._ .— PRIOR VECHANiw•AL DE isrs, NONE APPAP,EIl' !REEFTO NARRATIVE �..� 16 Ttirfl Itr1OMa."-_N:E^� L :SUStNESS PHONE LL VEHICLE IDENTIFICATION NUMBER �- --- !- = 'VI Vww`HICLE TYPE iDESCRIBE VEHICL<[7AMAGE >'�>~.E`u4�nGED A.tF?E a {INSURANCE CARFiiER POLICY NUMBER !�LINK. {NC3NE ;:UfNtSR I�MOC}. L_ej NSA,sOft� ROLL...OVER DIR OF:RAVEL'ON STRE5TOR HIGHWAY S'r «D,-urr I CA DOT_.�.. ...,..,-... -^--•- -, CAL' PREPARFR'S NAME INSPATCH NOT:FicD ffflRE R'S NA i iDASE REViE1,1iL 7 r 1 YES NO NIA 1 c.55 7U3.ha TRAFFiG COLUMN CODING 5-,"5 P-3-ac 2(Rev.7-03) OPI 061 p4tge Of WO DAY 'feAR} K1f,2dtl0) :NCka`.d i OFFICER 1.0. �1 OWNER'S NAME -_aNNER'S ADDRESS aTPie9 PROPERTY RFs NO DAMAGE lnEscRiRTION,FoAMAcE SEATING POSITION I SAFETY EQUIPMENT � WATTENTfON--ODES lv C.JPANTS L-AIR SAGDEPLOYED h I C 93CYCLE-HE MST A-CELLPIfONE HANOPELD fA NONE IN VEHICLE M-AIR BAG NOT DEPLOYED DRIVER PASSENGER S-CELLPHONE ,N SFREE / B UNKNOWN N-OTHER V-NO X-NO C-ELcC T RONIC GUtaME*iT C-LAP BELT USED P-NO, REQUIRED W-YES Y-YES p_RADIO I CD if _\ :D-LAP BELT NOT USED s=-SM DICING iC z ,-DRIVER I E-SHOJI-DER HARNESS USED F-EATING 2 TO 3-PASSENGERS jF-SHt7ULrER HARNESS 37QT 41SEpCHILD RESTFLAIN7 E ECTED FROt 4 VEHICLE v-CHILDREN 4 B 6 i 7-STATION WAGON.REAR I G-LAP/SHGULOtFR HARNESS USED 0-IN VEHICLE USED 0-NOT EJECTED H-ANIMALS t 9-REAR OCC TRK,OR VAN }H-LAPfSHOULUER HARNESS NOT USED R-IN VENICE NO`F USED 1-FULLY EJECTED i-PERSONAL HYGIENE 9-POSI`fON UNKNOWN J-PASSIVE:'RESTRAINT USED S-IN VEHICLE USE UNKNOWN 2-PARTIALLY EJECTED � J-REAC:NG \ I K-PASSIVE RESTRAINT NOT USED C-OTHER T-.N VEHICLE IMPROPER USE 3-UNKNiOVJN K-0 F c t i _ t _- U-NONE IN VEHICLE j i T EMS MARKED BELOW FOLLOWED BY AN ASTERISK{'}SHOULD BE EXPLAINED IN THE NARRATIVE. PRIMARY COL,LISll3N FACTOR i - TRAFFIC CONTROL DEVICES SPECIAL iNr'6RNIATiOet MOVEMENT PRECEDCNG t LIST NUMBER(#I OF PARTY A,FAULT 'I 1 2. � � �_� 2 � I COLLISION Se an nOu-e�. c!�n A CONTROLS FUNCTIONINGiA STOPP b S _ : I IA HAZARDOUS MA`ERIAL J J" $ CONTROLS NOT FUNCTIONING" IT. B CELL PHONE HANDHE D'N USE \ i $ PROCEEDING STRAIGHT�� CONTROLS OBSCURED " $OTHER IMPROPER DRIVING-: I C CEi L PHONE HANDSFREE IN USE I C CLAN OFF ROA _ _ D NO CON"ROL$PRESENT/FACTOR- rC?fid} D CELL PHONE NOT IN USE L r[3 MAKING RIGHT TURN C OTHER THAN DRIVER* � TYPE OF COLLISION i E SCHOOL BUS RELATED I E MAKING LEFT TURN s i E D UNKNOWN- A HEAD-ON F 75 T MOTORTRUCK COMBO i F MAKING U TUFti� $ SIDE SWIPEj G 32 F_T TRAILER COMBO }G BACKING _w- - REAR END #{ - ii# SLC?kVtNG f STf1P�i^!G i } WEATHER MARK 1, 70 2 MEMS D BROADSIDE - .`. } i SING OTHER VEHICLE A CLEAR J HIT OBJECT . ,1 CHANGING's.,4NEs ,: , CLOUDY F OVERTURNED ;K � K PARKING MANEUVER �y 1 RAINING _ IY VEHICLE/PEDESTRIAN 1 L EN,E 7 Nt TRAFFIC I? SNGWihCs H OTHER*: —1M 0,HER UNSAFE IE NTURNING GG"VISIBlL;TY FT. IN X1NG,NTOOPPOSING LAN= _S (F OTHER`, MOTOR VEHICLE INVOLVED WITH I 1{� Ii PARKED Wm G N0 'A NON-COLLISION }} .. ' _ l� I P MERGING LIGHTINGB PEDESTRIAN _t 1 �QTRSVELING WRONG N1A'f_ A DAYLIGHT C OTHER MOTOR VEHICLE1 2 31 OTHER ASSOCtgt C PACTOR(S iF ETHER sc2. DUSK CIAV^' D MOTOR VEHICLE ON OTHER ROADWAY ,MARK i TO 21TEhtS) C DARK STREETLIGHTS 7fE PARKED MOTOR VEHICLEvOsectlo wOLAT'ON; c;Tea —I { DARK NO STREET LIGHTS �F TRAIN �� J A � 7 a �� �qt YES 1s= DARK STR EF i LIGHTS NOT G BICYCLE B VCZMnakVlotanOW.. uric 0 YES ' FUNCTIONING' ANIMAL: Nd I i SOBRIETY-DR UGvC Sacl.;oN VOLATwN: cam_ ROADWAY SURFACE }{ r C eves 9 1 2 3 , PHYSICAL j A DRY I FIXED OSJECT: tN� 'MARK 7 7T 2ITEht Y S WET 4L3 '44:}t`1 HAD NOT BEEN DRINKING IC SNOWY ICY {j OTHER tCBJcCT: �TE VISION OBSCUREMENT! � � B HSI)-UNDER INFLUENCE � -I SLIPPERY(MUDDY,OILY,ETC.) F INATTENTION': C HED-NOT UNDER INFLUENCE` ROADWAY CONDITION{S} i I G STOP&GO TRAFFIC LD HBD-IMPAIRMENT UNKNOWN' i f!4tARK T 7O 2,:£WS) PEDESTRIAN'S ACTIONS 3 'H ENTERING 1 LEAVING RAMP6L1'G UNbER 17RUG iNFLUcNCE _1A HOLES,DEEP RUT' 7 A `d0 PEDESTRIANS INVOLVED I # I PREVIOUS COLLISIONlMPA RMENTB LOOSE MATERIAL ON ROACYVAY" B CROSSING IN CROSSWALK - J UNFAMILIAR WITH ROADIMPAIRMENT NOT K-iUWN �I UCTION.ON ROADWAYY- .AT'INTERSECTION 'IAC DEFECTIVE VEH.Eouip,: CITEDREPAIR ZONE CROSSING IN CROSSWALK-NOT CIYEsSLEEPY tFATIGUE[)- IE ATtGUEp'}E REDUCED ROADWAYWIDTH AT INTERSECTION C7�� } F PL{ODED" Cj CROSSING-NOT=N CROSSWALK I I.. UNINVC VED VEHICLE G OTHER E IN ROAD INCLUDES SHOULDER M OTHER- I _j X}H NO UNUSUAL CONDITIONS F NGT IN ROADAPPARENT - N NONE G AP.ROACHING I LEAVING SCHOOL BUS d RUNAWAY VEHICLE SKETCH `MISCELLANEOUS I ^p� i ?NDICATE.NORTH i ...�..--.w. DOT t OATCOFCO4 MON WO )AY YEAR] TIMk,(¢400) N!C=JAN-13-2004 13;2e CHF MARTTNEZ 9256464990 P.0 1/011 O�tCE�`— — e�a7z ' wi -EXTENT OF INJURY(-X"DNF—) j INjt; AS('W't NW, � } d.L'' SBX ..»......�.. S !�ARYYBciT R#R ��A�E't"!!I fJECY<. ONLY ONLY FAV L SEVERE OTHL Ji�i�L Cu i W t MW PCZ SAG �Gurr. !N.7Ua$Y ! iN: Y 04ju9Y OS pSlfil OkAftR i PASS. VIE0, �3JC'YcuE7 6T!mE _m o NAM9 t o a 1 tiSOR a C T6_&wH 51vE .&I - (!NJ(.,RED ONLY)-RAMBYTO: .. - _ - - •., --. TAKEN ViCd,ENT CRIM9 NOTIPWO NAM=! ,0 '4AAi..5O�Oe:R_ES..s—..r' TELEPHONE Al �- Z- SNJUREOONLYj TRkNSPrRTfOLY TAKEN TO' (,J VICTIM OF VIOLENT CRIME NOT,.ED f i# Ll I. NAME t D 0,A,1A00ROZ-5 fi-Ho e {!NJtJRSo ONLY)TRANSPonrco 8Y: ." - --^' TA"N TA, --- -m.�„ ._ •.•_•—.•....._........_s...,.. ,,,. (� V;CTIM OF VIOLehlr O21ME NOTIFIRD El 117-1 'EDr MAME D.0.S,i ADOMESg TEIEC'kgMe VWUR50 ONLY)Tf"NSPORTE= BY: tRRkk"i t7; VICTIM OF VIOLEN r CRIME NpTiFjeO twvnirMfD G B tA.CDHEw, TgLr.PHt'ita.E' , IINJUkED ons.YJ TFTAA+�:vOM7"cb�Y ._ TAkwN TO: .._ _ - -...... ..,, l5er3ORtbfIN.11iSii£5 .M ,._� - •• •,. •. __......_. .._ ,_ _. ..,,,._ L...J VIC'gM OP YICILENT CRIMIE NOTM5D RAW'0 0.8.,ADORM TELEPHONE (NJUREZ ONLY)TRAAWORTED BY - TAX414 TO; t' L i 41C.s)M OF uiOLENT CRIMIC NOME! PR£P,aR=Ern N,SME j,O.kUN6ER PAA. DAY YEAR REVIEWE-1 NAME NtO, OAY YEAR TOTPL P.01 FACTUAL DIAGRAM n page �of F-IP,055 P&gC-4fRev. 1-03) Cir i 061 ��O av� v=_.aR, t ,'ca G}�.____. *tGiC oi:FIGER i G. i NUhaER r-)r cm t .,'Y. 'a .. ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED {SCALE= ) l SAN INDICATE NORTH EIB IB 7ft. a 12 ft. I` —12 ft.— f ft. Double yellow fines Asphalt Roadway � �� ► � 1 Asphalt ShouFder — J i t Tri Lane v- , 1 t J I * NOT TO SCALE � f f n � , =Rr?AftED oY G NU41c R MO DAY YEAR REVIEWERSN.4:�Ti: 1:00, GAY Ye4R T_ STA:Fl OF C ALIFORI�U 1T t`EISUPPLEMENTALPAGE 5 OF " DATA- OF iNCIDENT TWE NCIC NUMBER _ - OFFICER I.D NUtt DER 2/2312003 1845 0320 016330 12-356 1 PHYSICAL EII3ElOrCE LEGEND. STATION LINE. 4 5 A station line was established along the north roadway edge lige_Station 0+00 was located .7 miles east of 6 Tri Ln. The station line increases as you proceed east. All rneasurements were taken. at right angles to the 7 station line. 8 9 VEHICLE POINTS OF REST. 10 11 '4_I LX TIRE was located 11 .feet right of station.0+05. 12 LIR TIRE was located 4 feet right of station.0+06. 14 V-2 LIF TIRE was located 26 feet right of station 0+57. 15 LIR"TIRE was located.32 feet right of station 0.4-56. 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 32 3.3 34 35 36 37 38 . 39 40 41 42 43 PREPARED 8Y LID. NUMBER DATE REVIEWER'S NAME DATE w J. GODMAN 016339 12!2312003 S' ="ti,-'E OF CA,It`'ORNMI.A RAGE b OF �DATE UE INCIDENT TIME NC?C NUMBER CiIrI=ICER I.D. 3vUN1BER 12/2312003 1845 9320 016339 12-356 FACTS: 2 3 NOTIFICATION: I was dispatched to a call of an injury traffic collision, with an ambulance 4 responding at 1848 hours. I responded from SR-4 at Cummings Skyway and arrived on scene at 5 1904 ho ars. All times, speeds and measurements in this investigation, are approximate. 6 Measurements were taken by rollrneter, except where otherwise indicated. 7 8 SCEN=E: At the scene of this collision, San Pablo Dam EZd. is a eastbound/westbound mountain 9 roadway consisting of two lanes. The roadway is curved and has a ascending grade as you proceed 10 east. The surface is composed primarily of asphalt. 11 12 PARTIES: 13 � 14 PARTY# 1 (Acuff)was located at the scene. P-1 was identified by a valid California driver's 15 license. P-1 was placed as a party by the following items: 16 17 -Driver statements 18 -giver location 19 -giver injuries 20 - Injuries to passengers 21 -giver is registered owner 22 -Driver seat adj astrnent 23 24 HYUN SONATA.Driver# 1's vehicle, was located on its wheels as shown on the diagram. V-1 25 sustained major damage to the entire vehicle due to the magnitude of the impact. 26 27 PAR'T'Y#2 (Allen) was located at the scene. P-2 was identified by a valid California. driver's 28 license. P-2 was placed as a party by the following items: 29 30 - Driver location 31 - Driver injuries 32 - Driver is registered owner 33 - Driver seat adjustment 34 35 HONDA ACCORD Driver#2's vehicle, was located on its wheels as shown on the diagram. V-2 36 sustained major damage to the entire vehicle dire to the magnitude of the impact. 37 38 PHYSICAL, EVIDENCE: 39 40 None. 41 42 43 PREPARED BY I.D.NUMBER DATE REVIEWER'S NAME DATE J. GODMAN 016339 12123/2003 STATE OF CA.a 3FC}c NIA DA` EE OF INCIDENT TIME NC1C NUMBER OFFICER T.—D—. NUMBER 12/23/2003 � 1845 9320 016339 12-356 1 S'+ATEMENT : 2 3 PARTY# 1 (Acuff) 4 1 was &.1ving westbound on San Pabio Darn Rd. at 50 miles per hour. while traveling through a left 5 hand curve in the roadway I lost control of my car and crossed the double yellowy lines, and hit the 6 white car head on. 7 8 PARTY# 2 �Allex) 9 leo statement was obtained clue to severity of injuries. 10 11 PASSENGER (Robert Acuff) 12 Was contacted at the scene and was determined to be to intoxicated to provide an adequate 13 staternent. 14 15 OPINIONS ANIS CONCLUSIONS: 16 7TJTN ARY: 18 P-1 was traveling westbound on San Pablo Darr:Rd. east of Tri Ln. at 50 miles per hour. P-2 was 19 traveling east on San Pablo Dam Rd.just east of Tri Ln. at an unknown speed.. For an unknown 20 reason P-1 allowed V-1 to travel across the solid painted double yellow lines into eastbound traffic 21 and directly into V-2's path. As aresult the front of V-1 struck the front of V-2. V-1 came to rest in 22 the Westbound lame of San Pablo Dam Rd. while V-2 came to rest on the south shoulder.After the 23 collision all the involved parties waited at the scene for emergency personnel to arrive. 24 25 AREA OF EVIPACT: 26 27 AOI# 1 (V-1 vs. V-2)was located .7 miles east of Tri Ln. and 14 .feet south of the north roadway 28 edge of San Pablo Dam Rd. 29 30 CAUSE; 31 P-1. caused this collision by crossing over the solid double yellow lines into oncoming traffic, a 32 violation of 2145(7 (a) VC. 33 34 RECOMMENDATIONS- 35 36 If any farther statements are provided by witnesses or involved parties that would change or alter the 37 outcome of this investigation they will be added in the form of a supplemental. 38 39 PREPARED By ;,D.NUMBER DATE— REVIEWER'S NAME DATE J, GODMAlwl 016339 12123!2003 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY ,,I • 'BOARD ACTION:JULY 27, 2004 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), give 'Pursuant to Government Code Section 913 and 915.4. Please note all"Warnings". AMOUNT: $10,000.00 4 CLAIMANT: CHRISTOPHER JONES ATTORNEY: uNKNowN DATE RECEIVED: JUNE 25, 2004 ADDRESS: 2991 GROOM DRIVE BY DELIVERY TO CLERK.ON:,JUNE 25, 2004 RICHMOND, CA 94806 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 S WE T rk Elated: JUNE 28, 2004 By: Deputy U. MOM: County Counsel. TO: Clerk of the Board of Sup rvisors ( yThis 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: Y/ tDated. By: Deputy County Coun4 r 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., CIARD ORDER: By unanimous vote of the Supervisors present: (, This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JOHN SWEETEN, CLERK,By ,Deputy Clerk WARNING(Gov. code sec on 9I ) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposits 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 full 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 Cler. Claim to: BOARD OF SUPERVISORS 4F CONTRA COSTA CM%TY 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 �fiich accrue on or before December 31, 1987, gust 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, persoral property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months, after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code B. Claims must be filed with the Clerk of the Board of Supervisors at its office in -�` Rim 106, County Administration Building, 651 Pine Street, Fartinez, 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 tha,r, one public entity, separate claims crust b-- filed rfiled against each public entity. E. ' Fraud. See pe-rialty for fraudulent claims, Fena?- Code Sec, i2 at the end of this form. RE: Claim By }j Rese.-ved for Clerk's filing stamp p J Rr * . � ) Ys Against the County of Contra costa ) F or JUS DistrictCkp (Fill In rmme The undersigned claimant hereby makes claim inst th county of Contra osta or the above-named District in the sum of � ��� and in support oy this claim represents -as fo11o•,rss: 1. When did the dAmage or injury occur? (Give exact date and hour) 2. Where did the die orn,�� occur? (Include city and county A. 3. How did the damage or injury occur? (Give full, details; use extra paper if required) PIC 4A 4. Khat particular act or omission on the part of county or district afficers, se-"vans or .employees caused.the. injury or damage? = _. - � � � a..ti- # ?„ _l ��_.. 5"c...-'1 5,i' ..F .h6 ..,:�- � 5e`: 4_.i$" ',•..... "„y a,,> �. W'I at ar¢ t:ze rames of county or district officers, servants or employees Causing the d2-mage or injury? 5. What damage or injuries do you claim resulted? {Give full extent of injuries or 1 damages l �'. Attach two estimates for auto .9- -- T6 " °� Q 7. How was the amount c%aimed =)nnve cc uted? (include the estimated amount of any prospective injury ap damage.) IT I -a 3. -tames and addressl� of a wnessea, doctors and hospitals. 14 �.,': `fit', s y • '�' t" � �` ��°�-'§ S ---s f`' �,.,� �j '�.`.. �`���,a� � C`era,,.S„ t List the expenditure° you made on account of this accident or inj?L-I; DATE inss A��';3N �r A K ]C 7C R,i3 4C A' .ZC R A ii ]L' '�vf D[ i 7f iC A if 7f R F Ky. Gov.asCOde Se--. 910.2 provides: "ihe claim mist be signed by the cl airm.nt, SEM NOTICES '?'C: (Attorney) by some aerson on his. behal.'." Name and Address of Attorney J,-, - 4,- a` is Signature, l°'s dl f Address CT\ aS £ f Telephone too. Telephone No. � ;. 1 N 0 T I C E Section 72 of the Penal Code provides: "Eve-' y person who, with intent to defraud, presents for ;O owance or for payment to any state bca+^d or officer, or to any county, city or district board or officer, authorized to allow or pay the same if .genuine, any fa?se or fraudulent claim, bill. , aecourt, voucher, or writing, is punishable either by imp,%sdriment in the county Jail for a period of not more than cme-year, by a fine of not exceed Ing one thousand ( 1,000), or by both such imprisonment and fine,� or by imprisorLment in the state prison, by a fa ne of not exceeding ten thousand' dollars ;$lu?GCC, or by both suchimprison.-jent and fine. ............................................................_. CLAIM f ' BOARD OF UI'E VI ORS OF CONT CO T.A. COUZiT. t 'BOARD ACTION: ,IDLY 27, 2004 Clain 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), giver Pursuant to Government Code Section 913 and A 915.4. Please note all"Warnings". AMOUNT: $25,000.00 CLAIMANT: SHANTAYNE WESLEY ATTORNEY: UNKNOWN DATE RECEIVED: JANE 25, 2004 ADDRESS: 2991. GROOM DRIVE, BY DELIVERY TO CLERK ON: JUNE 25, 2004 RICHMOND, CA 94806 - 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 SWEET , Dated: JUNE 28, 2004 By: Deputy II. PROM: County Counsel TO: Clerk of the Board of Supervisors claim complies substantially with Sections 910 and 910.2. I } 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 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 claire(Section 911.3). } Other: Dated: $ By. Deputy County Coun 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). IOARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. { } Other: i 1 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 secti 913) Subject to certain exceptions, you have only six(6)months from the date this notice was personally served or depos 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 Unite( States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California,postage f l prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:Q�A ` JOHN SWEETEN, CLERK.By Deputy Cl Claim, to: BOARD OF SUPERVISORS OF CONt"RA COSTA CCtJM INSTRUCTIONS TO C LAIMAN7 A. Ciairn relating 1_0 "c—nuses Of action for death or for in-Jury to person or to per- sonal property or growing craps and whist accrue on or before December 31, 1Q87 , mast be presented not later than the 100th day after the ac-crual 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 xhich acc:-ue on or after January 1, 1088, must be presented not later than: six months after the accrual of the cause of action. Claims relating to any ether cause of action gust to pre«ented not Late." than one year after the accrual of the cause of action. (Govt. Code §911.2,-) B. must t, filed Room with the Clerk of the Board of Supervisors at its .office in Room 1061 Cot, Adm inistraticxf Building, 651 Bine Street, , *tinez, CA �?�55 3. C. if 'am is against a, district governed by the Boardof Supervisors, rat`ler thaan the County, the mme of the District should be filled in. D. If, the ,lama is against more than one public entity, separate ciai s cast b-- filed against each public entity. E. ' Fraud. See penity for fwaudu_l nt. claims, Penal. Code Sec. ' 2 at the end Of tti"form. RE: Claim By Reserved for Clerk's filing stamp REY Againstthe County of Contra Cris � or � N tm Eju cRD a �� � �d sDistrict} rill .n namCUM��T r . Me undersigned claimant hereby makes claim =inst the County of Contra Costs car the above-named Disyr ^t in the sum of ' 'and in support of this ,lair, represents as follows: - l . When did the die 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 fu11 details; case extra paper ifrequired.) ._ 4. What partiou,_,ar act or omission on the part of county or district officers, se--w-ts or .employees caused. the injury or damage? (v\ 5• wna% are t~e res of cOUnLy or district officers, servants or employees ca us, the damage or inJury? { - «. 5. What damage or injuries do you claim resulted?^ auto (Give full extent ofyin juries or dC� claimed..'. �. es claimed. .4lsC.ch two esti for or o da e. -2F5- 1 c 7. Hcq was the amount claimed above computed? (Include the estimated amount of arny� prospective injury or e.) and addresses of wi tnessei doctors and .jos .__ a - �. - 9. List the expenditures dites you made on accou*! of this accident or i ,irr�nj1M___ __ D=E iTT-74 AMOUNT ' - O �J lv�t` 21 Gov. Code Sec. 914;2 provides: "The claim roust be signed by the clai�r:t SEND NOTICES TO- (Attorr e ) or by someerson on :pis. b&.alf." Name and Address of Attorney - airz. }s a�3 i grat .t (Address) CO Telephone No. 1 Telephone No.- 11-1 f � ���'`��`7 a� T 9 9 T * # N O T I C E Section 72 of the Penal Cade provides; "Every person who, with intent to defraud, presents for allowance or for payment to any state board or cffl icr, or to any county, city or disvric , board or officer, authorized `o allow or pay the same if -genuine, any False or fraudulent" claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one-year, by a fine of not exceeding one thousand ($1,000), or by both such imbrisorment and fine;- or by imprisormnent in tyle state prison, by a fine o`' not exceeding ten thoLsand do",ars (t_10.1000, cr b_' both such i=risot_rL-u lst and fine. RICHMOND POLICE DEPT. 0710 MATE 401_-?71h StreefDOMESTIC VIOLENCE RELATED i CASE NO 2 IN �_ Y Richmond,California 94W4 VIC VIOLENT CRIME 60 OR OLDER, Ct3STC}DY , 6�" ���•`� � PAGE � OF 3-CODE SECTION 4 TITLE 6 U ���� a},.y.S-,�t�l�i�`•� MON, FELONY yLJ e� 3 '2-71 r< ` '�- _ ,y„ p. ,,.r-t '+ MISDEMEANOR 7 DATE 6 TIME OCCURRED•DAY $DATE b TfME REPORTED 5 WHERE OCC RED 10 VICTIM NAME-LAST,FIRST,MIODLE(��FIjk�— YL ��R�M IF BUSIN�EM 11-?RESIDENCE ADDRESS ) 12 RES PHONE g 13 OCCUPATION 16 D.D: .B - i5 SEX 16 AACE f7 AGE 18 BUSINESS ADDR£55tSCHOOI 19 BUS PHONE OR BP( > ,7- -2 > r COMPLETE IF PERSONAL 20 WHERE HOSPITAL{ZED 21 OATErrIME 22 ATTENOSNG PHYSICIAN 23 CHART NUMBER 24 NATURE OF INJURY INJURY OR RAPE vm INVL CODESVIC-VICTIM WIT-WITNESS RE P-REPORTING PARTY - 25 INVL 26 NAME•LAST.FIRST,MIDDLE (FfAM IF BUSINESS) 27 RESIDENCE ADDRESS 28 RES PHONE 6 29 OCC.UPAtiON 30 DO B 31 SEX 132 RACE 33 AG€ 34 BUSINESS ADOR£S �Tt. 35 BUS?HONE OR 8Pt u s r 35 INVL 37 NAM£-LAST FIRST.MIDDLE (FIRM IF BUSINESSI 38 RESIDENCE ADDRESS 39 RES ?HONE N zT 40 OCCUPAION at Q O B 42 5Ex a3 RACE +u AGE 45 BUSINESS ADDRESS HO L 46 BUS PHONE OR BPI F O 1I 47 INVL 48 NAME-LAST,FIRST WOOLE fFIAM IF BUSINESS, 49 RESIDENCE ADDQ 4-Lt, 50 RES PHONE 51 OCCUPATION 52 DOB STSEX- 54 RACE 15-.AGE 56 BUSINESS ADDRESS SCHvu, 57 BUS PHONE OR BP' 58ADDlTlONAL VICTm5151W;TNESS(E51' ❑ 59 5tJSPECt .1 LAST FIRST.MIDDLE, 60 NICKNAME AKA. 6t G08 62 SEX 63 RA's;, 6/AGE 65 HT 66 WT 67 HAIR 66 EYE: Aj 44 89 SUSPECT'S ADDRESS 70 CLOTHING DESCRIPTION .1 CITE - 72 ARREST a 73 MIRANDA ES ONO_'1 G- ls✓', t. !J P_!.t't t'r 'T 6G%�C, ..�� t"�" ' 0`'' x+1 1+,�. Y 74 SUSPECT -2 ILAST FIRST MIDOLE, 75 NICKNAME AKA `ti. Di;E 7 7 SEX 176 RACE 79 AGE 80 H- El 1'.7 82 HAJR 53 EYEf 84 SUSPECT'S ADDRESS 85 CLOTHING DESCRIPTION 56 CITE • 87 ARREST - 88 MIRANDA OYES ONO 89 9C 9+ 92 9' 9= 9? 96 SUSPECT SU1LD COMPLEXION HAIR STYLE HAIR LGTH"K FACIAL HAIR GENERAL APPEARANCE SPEECH DEMEANOR 1 2 SUSPECT 1 2 SUSPECT 1 2 SUSPECT 1 2 SUSPECT 1 2 SUSPECT 1 2 SUSPECT 1 2 SUSPECT 1 2 SUSPECT U ❑ ❑ Unknown. UK [DE] Unknown UNKN ❑EDUnknown UNK Q 0 Unknown UNKN [}❑ Un-nowrNK ❑❑ Unknown UNK ❑❑ UnknC,+- UNK 0 Unknown T ❑ ❑ Thin AC ,❑.,rD Acne AFRO ❑❑ Alto Nat BALD ❑❑ Balo CL SH ❑❑ Ciean Sha-e CS ❑ Consenaf,ee ACC ❑❑ ACcenl — ANG EJ Angry M 0 Muscutat QR JGi❑ Dirk BRAD ❑❑ Braided COLLA ❑❑ Conan PULE ❑ LD Fuh Beard OR� Drrry LSP 0 0 Lisps APO ❑❑ Apologetr( A jy-'�❑ AverEge K;!'❑❑ Freckled BUSH 0❑ Bushy LONG ❑❑ Long PUMA 0 ❑ FU MA,-,ch, DS ❑❑ Dtsgu!se LOU ❑❑ Loud CAL ❑❑ Caim H ❑ ❑ Haavy LT ❑❑ Oghl GRSY ❑❑ Greasy SHOU ❑❑ Shoulder GOAT ❑❑ Goatee FL 13.0 Plashy LOP ❑0 Low Pitched DSO ❑❑ D%0193no ME ❑❑ Meowm MILT ❑ ❑ Military SHOR;2-'0 Shon LOWL ❑❑ Lower Lip GL ❑❑ Good Looking HIP ❑❑ High Pitched IRR ❑❑ Inai!onal PA ❑0 Pate PONY ❑ ❑ Ponytail COAR 0 ❑ Coarse MUST ❑❑ Mustache ML ❑❑ Mortar' OFF 0 Otlenswe NER ❑❑ Ner OA PM E7❑ Pocked PROD ❑E7 Processed FINE ❑❑ Fine N FUZ.❑0 None Fuu UK 0 EDUnkempl NE-EJ❑ Non EngAs, POL 0❑ POit1e RU ❑❑ Ruddy STRA 0❑ Strmgh; THSC ❑❑ Thick SIDE ❑0 S!deourns UN 0❑ Unusua,Odo, Speaking PRO 0❑ Prole"O' SA ❑❑ Safle. WVCL 0❑ Wary Curly THIN ❑ ❑ Thinning UNSH ❑E) Unsr*a en WG ❑❑ Well Groomed NOM ❑0 Norrrthi STU 0❑ Stupor 7A ❑EDTannad WIG ❑ED Wig WiRY E]11Wiry VNQK 0 L3 Van Dyke CA ED EDTLK ❑❑ TElkani-e CbsuEi Vib ❑ ❑ V!okrtt OT ❑❑ Otnet CORN ❑❑ CO!n Rom SHAY ❑❑ Shaved OTHR ❑ RAP ❑ED Rapid Other CC ❑❑ Clean Cul NOR ❑❑ Normal CREW C1 Crew Cut ACHL ❑❑ ReCead,ng OT ❑❑ Other DIS ❑❑ oe;gwsed PFN ❑❑ Prdlane OTHR ClOther MED ED Mechurn SOF 0❑❑ Son EFF ❑ EDEflem. non NK E]Punk STU [3 Sturier 87 FURTHER SUSPECT DESCRIPTIDN ILL.GI ASSES.TATTOOS,TEETH.BIRTHMARKS.JEWELRY.$CARS.MANNERISMS,WEAPONS.CLOTHES,SHOES.MASKS,HATS,GLOVES.DEFORMITIES,ETC I SUSPECTI: 98 ADDITIONAL SUSPECTS LISTS n SUSPECT 2: OY€S 0Nb INVL CODES VIC=VICTIM SUS-SUSPECT OTH-OTHER 99 INVL i(J0 LSCENSE NUMBER 101 Lis i02 LIY103 V YR 10G V taA t05 V MO 106 V St 107 V CO ,p IDS TOWED-,0 IM HOLD 110 ADDITIONAL VEHICLE IDENTIFIERS fOAMAGE CHROME WHEELS VIN ETC; W '+ OYES O ONO 111 INVL 112 LICENSE NUMBER 113 LIS 11a LIy 1t5 v YR i16 V MA i17 V MO t18 V 5T 219 V CO W Y 120 TOWED TO 121 HOLD 122 ADDITIONAL VEHICLE IDENT1 )ERS(DAMAGE CHROME WHEELS VIN ETC) DYES ONO 123 ROUTING 124 REMARKS ROBBERY COM REL Z AT HOMICIDEPROPERTY STAT R FILE I �'• F {rY 1^t i-,•+i.•-y-� 9 ADM O JUV i VICE '�-� STATE TOTAL S 5 CAPT FRAUD C A CA ASSIGNED UNI CAPT CIS CAPT TRAFFIC I A �lt..n C RICHMOND POLICE DEFT. 0710 125 5W NO. - W-446-L r PAGE OF 1V INVASIIMATIVE AC'R4f17 s WAD •t2a PHYpCAL LVIDD CE 13L 0 BGGdrsalive ❑ 1 maied for LJ wft Q 6 Soars D*Fwrmd 0 12 Tach who? FP Q Fingsr Prints PJ ❑Pn*%A%mk"Yomsting ❑ 2 Taos Matti Pho opm had 7 Nr¢htcrs chocired 0 13 Det NOWW Who? OP 0 Otter flints CL 0 clothing ❑ 3 VatddrJStoe Tracks PhrMograyted 0 b Am C hecited C3 it onno Pmvanaon s xv.Y Canpteted WP ❑waatx,rt TT ❑Tire Tracks 0 !some Photographed Q S Arte Clashed ❑16 Tat.typa or BOL. TL Q Towmarwt to E3 inwation/Dust } D s victim Photographed Q 10 Wiaaa(aas c r aided G1 t6 Other VH 0 Vehicle PS 0 Paint Samples 2 0 71 Kictot(a)Cmtected PH 0 Ptrotos GL E3 Glan/Fragments HA 0 Hair DC ❑Documents ST Q Semen MS ❑Mua"I 1 `SOLVAS1LtYY SUSPECT CAN BE IDENTIFIED ❑STOLEN PROPERTY 15 TRACEABLE Q SUSPECT VEHICLE LICENSE IS KNOWN SUSPECT CAN BE NAMED Cl THERE IS A WITNESS TO CRIME C3 STOLEN PROPERTY CAN BE IDENTIFIED 0 SUSPECT VEHICLE CAN BE DESCRIBED .SUSPECT CAN BE LOCATED ❑THERE IS StGNIFiCANT M.O.PRESENT 13SERIAL NUMBERS ARE KNOWN 0 SUSPECT VEHICLE CAN BE IDENTIFIED SUSPECT CAN BE DESCRIBED d MAJOR PROPERTY LOSS($3,800 OR OVER) ❑ THERE is SIGNIFICANT PHYSICAL EVIDENCE 176 131 VICTIM VULNERABILITY VICTIM ACTIONS CONTINUED_ CONTINUED 1 2 VICTIM 1 2 VICTIM 1 2 VICTIM 1 2 VICTIM ELDER ❑ 0 Elderiy FROST 0 0 InvoWad with Prostitute INRES 0 0 In Restaurant BIKE D 0 Biking MENTL 0 0 Mental Disability ALONE 0 ❑Alone JOG ❑ ❑Jogging DIAD Q 0 Under We influence PHYOS ❑ a Physical Disability AWAY ❑ ❑Away From Scone of Gime PKLOT ❑ 0 In Parking Lot OTHER a Q Other YOUNG d ❑ Young/Smatt HITCH 0 ❑Hitch Hiking SLEEP 0 0 Sleeping WAIPT 0 0 Waiting for Public Transit FORGIN ❑ 0 Foreign WALK 0 0 Walking DRIVE ❑ Q Drlring PASPT Q ❑ Passangar, Public Transit Weapon Used Against Victim OYes 0 N MORE-• SHOP ❑ Q Shopping PASPV 0 0 Passenger,Private Vehicle 132 NARRATIVE 1 2 3 d 5 f 7 C 8 9 10 11 \J 12 l 13 16 is 16 tY 1B t4 t 20 ,TING OFFICER 130 i,D,k s3,y APPROVED BY: 136 DATE CPS334A-FORH i CASE.NO: RICHMOND POLICE DEPARTMENT 0710 04-48691 � Investigative Bureau 8uppfement PAGE No, CODE SECTION CRIMEICLASSIFICATION LOCATION 273.5 PC Corporal injury to a parent of a 100 37th Street child ViCTtM=S NAME-LAST,FIRST,MIDDLE(FIRM IF BUS.) DATE OF ORIGINAL WESLEY, Shantayne Marie 05/19/2004 On 05/1912004, at approximately 1435 hours, I was detailed to 3901 Macdonald Avenue for a report of a domestic battery. On arrival I contacted Victim Wesley standing on the northeast corner of 39th Street. Upon contacting Wesley I noted her right cheek had a laceration with blood coming from the wound. I also observed lacerations to Wesleys' chest that had blood in the wounds. Wesleys' shirt was ripped and she was crying. I asked Wesley what happened, and she provided the following statement. Wesley said on 05/19/2004, at approximately 1420 hogrs, her three year cold sons' father Suspect Smith had physically attacked her. Wesley stated she arrived at 100 37th Street to meet Smith to discuss Smith visiting their three year old son Larry Darnell Smith Jr who is three years old. Wesley told me Smith asked her where their son was. Wesley said she informed Smith he was with a baby sitter. Wesley stated Smith asked her why he was not in school. Wesley told me she informed Smith that she needed to get a restraining order and custody order against him before he can see the child. Wesley said Smith became angry and said "Bitch, you hoe your boyfriend is a crack head. I will call child protective services on you. Bitch you aint shit my wife will have your son." Wesley stated she replied "Fuck you and your wife." Wesley told me Smith grabbed her shirt with his left hand. Wesley said Smith then started punching her in her head and face with his right fist. Wesley stated she fell down and her shirt ripped. Wesley told me as she was on the ground Smith kicked her three times in her right leg. Wesley said while she was on the ground she began kicking Smith hoping he would let her go. Wesley stated Smith let go of her shirt and she stood up. Wesley told me Smith then produced a knife and said, "Bitch I should stick you, but you aint worth it." Wesley said she then ran off towards 39th Street and called 911. Wesley stated she began a dating sexual relationship with Smith in June 1996. Wesley told me in 2000 they had their first child. Wesley said during their relationship there has been approximately ten domestic violence incidents, five of them had been reported to law enforcement. Wesley stated her and Smiths' relationship ended on 05115/2004, when he married another woman. Wesley said Smith was not under the influence of narcotics or alcohol during this incident. While I was interviewing Wesley, Smith was driving NIB on 39th Street and made a left hand turn onto W/B Macdonald Avenue. I entered my patrol vehicle and initiated a traffic stop of Smiths vehicles. Smith was taken into custody without incident. Officer R. Thomas transported Smith to the Hall of Justice while I completed my interview of Wesley. Wesley told me she would cooperate with the prosecution of Smith. REPORTINGOFFICERS TYPED BY DATE ROUTED BY Hall #1351 mh 05/19/04 Robbery — Com.Rei._ A.T. Homicide _ Property_ Stat Admin. J Juv. _ Vice _ Other; Assigned: `tate SS Capt. Fraud C.A. D.A. Patrol Capt.� CIB Capt _„ Traffic I.A. Other: Total DOMESTIC VIOLENCE REPORT-PC Section 93700 page t of MEDICAL TREATMIENT PARAMEDICSIEWiTs AT SCENE HOSPITAL None Company and unit No.: Name: XXWill seek own doctor Attending Physicians)/Nurse(s)(names): f• Name of Doctor: Names)/tD(s): • First Aid �._ First Aid rendered by others(names): ® Paramedics --- --- ___ D Hospital _ - 0 Refused medical aid Victim given. ALCOHOLISUBSTANCE ® DV phone number X—Yes t'] No Evidence of substancelchemicai abuse: 13 SWA phone number Yes D No Suspect 0 Yes Type: ® Case No, Yes 0 No victim 0 Yes Type: S.? MT. 4 G/t^✓ r PRASE DRAW ON DIAGRAM(S) 1 r •.,,% THE LOCATION AP ANY INJURIES., t � S.? ��s KT. l � AUTHORIZATION TO RELEASE MEDICAL RECORDS Having been advised of my right to refuse, I hereby consent to the release of my medical records to law enforcement and the District Attorney's Office of Contra Costa County. Date: Signature:' tS -a C 1 6'9.CASE NO. Ll_ �� ! ?O.COO$ SECTION ?I,CRIME f T2.CLASSIFIC&TIO (� s` ZltA T1 VICTIM-11NAME -LAST,FIRST,MIDDLE FIRM IF WS.) 7a.ADORE53 EStCtNCQ 1lUSI1fE53TS.PI4011C 14- k "i -A V#,A t v Q r- ° mn- S tC tit .v,J by `� �•. L L ':..'K..-«cwt �° � f c"c..f.s ' S CA le- l) I kkA� 0 P"r- C-t-k-e- it tdl— �'-Ql CA ie- j x REfCAtTiA1C F7C S RECORDtNS OFFICER TYPED By DATE AND TIME RCUTi:Sf�! ACTIONR YY3 TO: E;�O£TECtIYE CII j �-�ryf t l N4'! I 1 3WENlLE�[3 PATROL DIST.ATT%t OTHER S.O.itb. REVIErE;OICT DI►Tr OTME7I 69.CASE NO, 110-OWE SECTION ri.CRIME r2.CLASSIFICATION C, 5 � • i5T S TS VICTIM*S Rita£ LAST, IFIRST.IiIDO i IFIRM if U&) r4,Mm tktm*ENCd I iEUStM£53 IS.P!#CRE 21ILL RiORT a Of £RS RECORDING OFFICER TYPED ECY DATE AMC TIM£ RC74lTED In v ft33 ACTION SES TOFrIES DETECTIVE � CIt NO JUVENILE a 1 1 PATROL int C{ ;3 DIST,ATTtiF'ClL��OTMER i {SAJP.O. iC�^t# REVIEWED BY DATE t 1 nrMI7► i - CASE NO: RICHMOND POLICE DEPARTMENT 0710 04-48691 Investigative Bureau Supplement PAGE NO: l CODE SECTION CR#MEICLASSIFICATION LOCATION 273.5 PC Corporal injury to a parent of a 10037 th Street j child VICTIM-S NAME-LAST,FIRST,MIDDLE(FIRM IF BUS.) DATE OF ORIGINAL WESLEY, Shantayne Marie 05/19/2004 Wesley signed a R.P.D Citizens Arrest form in my presence. I transported Wesley to the Hall of Justice to have photographs of her injuries. Refer to C.S.I supplement. While at the Hall of Justice I provided Wesley with a S.T.A.N.D. business card and a R.P.D. resource guide for victims of domestic violence. On 05/19/2004, at approximately 1510 hours, I read Smith his Miranda Rights per my Contra Costa County District Attorney Issued Miranda Card, in the second floor holding cell. I asked Smith if he understood his rights. Smith said, "Yes." I asked Smith if he wanted to talk about why he was arrested. Smith said "Yes." Smith provided the following statement. Smith said on 05/1912004, at approximately 1400 hours, Wesley was suppose to come to 100 37th Street after he got off of work to let him see their three year old son, Smith stated he was with his. new wife. Smith told me around 1418 hours, Wesley had not shown up yet so he left and dropped his wife off at work. Smith said, Wesley called him at approximately 1438 hours, on his cellular phone and informed him she was at 100 37th Street waiting for him. Smith stated he arrived at 100 37th Street, but Wesley was not there. Smith told me he decided to leave and go home. Smith told me he then drove on 39th Street and saw me talking to Wesley. Smith said, he then decided to stop and see what happened. Smith stated he was then taken into custody. Smith told me he had not hit Wesley and had not seen her all day. Smith admitted to prior domestic violence incidents with Wesley, but said he had done nothing wrong today 05/19/2004. I booked Smith into the Richmond City Jail for 273.5 PC. At the time of booking Smith had no knives, and no visible defensive or offensive wounds. End of report. REPORTING OFFICERS TYPED BY DATE ROUTED BY Hall #1351 mh 05/19/04 Robbery _ Com.Rel. A.T. Homicide i Property_ Stat Admin. _ Juv, Vice _ Other: Assigned: State SS Capt. Fraud C.A. D.A. Patrol Capt.J, GIB Capt Traffic ___ LA. Other. Total DOMESTIC VIOLENCE REPORT-PC Section 13740 Page?of Domestic Violence reports can include,but are not limited to,the following Penal Code violations,if they meet the definition of Domestic Violence as aforementioned in this policy(PC 137110): 136.1, 145, 166.4, 187, 197`664,203,207,2361237,244,242,243(b),243(4),243(e),245(a)(1),262,273.5, 73.6,417,415,422,591, 597,602.5,646.5,647(f),653m, 12020(a), 12025(x),12031. SUSPECT$NAME(Last, First,Middle Initial) DOB CDUCID NO, PGCE DEPARTMENT: VICTIM'S NAME(Last,First,Middle initial) DOS CDUCID NO. CASE NO.: CONFIDENTIAL ADDRESS&TELEPHONE NUMBER(for victim contact) responded to a ca#I of '6,st -- at m l y found the victim ate. VICTIM SUSPECT ❑ Apologetic ❑ Bruise(s) ❑ Apologetic ❑ Bruise(s) ❑ Afraid XM#nor Cut(s) D Afraid ❑ Minor Cut(s) }e^Angry ❑ Laceration(s) Angry ❑ Laceration(s) ❑ Calm ❑ Fracture(s) Q Calm ❑ Fracture(s) ❑ Calmed Down Q Concussion(s) ❑ Calmed Down ( ❑ Concussion(s) [l�Tearful/Crying Red.Mark(s) ❑ Tearful/Crying # ❑ Red Mark(s) ❑ Hysterical Complaint(s)of Pain Q Hysterical ❑ Complaint(s)of Pain ❑ Emotional ❑ Other-Explain ❑ Emotional i ❑ Other-Explain ❑ Nervous ❑ Nervous ❑ Upset ❑ Upset ❑ Threatening ❑ Threatening -- -- - ❑ Other-Explain Q Other-Explain WITNESSESICHILRFDNg people victim may have told tocall fitness 1: Witness 2: !Witness 3: jWitness present during Domestic iolence? ❑ Apologetic Cj Apologetic 1 ❑ Apologetic j ❑ Yes 14 No ❑ Afraid ❑ Afraid 0 Afraid iStatement(s)taken? ❑ Angry ❑ Angry Q Angry j ❑ Yes /d No 0 Calm ❑ Calm Q Calm (Children present during domest�No iolence? ❑ Calmed Down ❑ Calmed Down ❑ Calmed Down i ❑ Yes ❑ Tearful/Crying Q Tearfui/Crying ❑ Tearful/Crying Statement(s)taken? ❑ Hysterical ❑ Hysterical ❑ Hysterical ' ❑ Yes No ❑ Emotional Q Emotional ❑ Emotional INames of all children: Ages ❑ Nervous ❑ Nervous ❑ Nervous ❑ Upset ❑ Upset ❑ Upset _ -- ❑ Threatening ❑ Threatening ❑ Threatening ❑ Other-Explain ❑ Other-Explain 0 Other.-ExplainPRIOR DOMESTIC VIOLENCE HISTORY RESTRAINING ORDER INFORMATION -�— i l Victim described rior history of violence? In force? ❑ Yes ❑ No Yes ❑ No ❑ Current ❑ Expired Have police Zena#led before? ❑ Not verified es Q N ❑ Acknowledged by suspect Number of pidents: Reported 5 Not Reported Type: 13 Emergency - Relationship between victim and suspect: ❑ Temporary ❑ Spouse ❑ Former Spouse ❑ Permanent Cohabitants ❑ Former Cohabitants Issuing Court: ❑ Dating 0 Formerly Dating Order or Docket No.: _ Q Engaged ❑ Formerly Engaged Copy attached with Proof of Service?. Q Yes ❑ No ❑ Same Sex ❑ Emancipated Minor ❑ EPO Issued Parent of child from ationship ❑ EDP Offered and Refused _ Length of Relationship: Year(s) Month(s) Q Issuing Judge: Week(s) Day(s) Notes: if applicable,date relationship ended: Reporting Officer: ID NO. Bate and Time.. Approved by: N DOMESTIC VI0LENCE REPORT---PC Section 13700 page CP o,-I— PARDLE/PROBATJON INFORMATION Date of parole/prchaticsn: Convicted of: county: 00m: D Crime Scene ❑ Hosp"rtai Weapon(s)used during incident(including suspect's shoes,rings,etc.)? ❑ Other-Explain D Yes ❑ No Type of wespon(s)used: i Photos: ❑ Yes ❑ No No.: Weapon(s)impounded? ❑ Yes ❑ No Type: 0 35mm Q Polaroid Firearm(s)impounded for safety? ❑ Yes ❑ No Describe all photographs: Copy of 911 tape collected? ❑ Yes ❑ No Photo(s)of victim's injuries? ❑ Yes ❑ No Suspect'sACctim's clothing collected ❑ Yes ❑ No Photo(s)of suspect's injuries? ❑ Yes d No (especially if torn,bloody,etc.)? Follow-up of victim's injuries? ❑ Yes ❑ No Scene diagram? ❑ Yes ❑ No Follow-up of suspect's injuries? ❑ Yes Cl No Case referred to Investigation/Detectives? ❑ Yes ❑ No Requested: ❑ Follow-up photos ❑ 911 tape(if not already requested) ❑ Prior incident reports, including requests for out-of-county reports ❑ Follow-up interview(s)with victim ❑ Follow-up interview(s)with witness(es) ❑ Follow-up interview(s)with suspect(s) ❑ Requested medical records DESCRIBE ALL CONDITIONS OBSERVED: PHYSICAL,EMOTIONAL,AND CRIME SCENE 1<moofl—onat a of vlcUWsuspecttwrtnes`s- Spontaneous statements of: Victim: Suspect: Eyewitness: Physical Injuries: ___... .. Physical condition of VictimlSuspect: Crime Scene Description: CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY (,;r BOARD ACTION: JM 27, 2 504 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), give Pursuant to Government Code Section 913 and 915.4. Please note all"Warnings". AMOUNT: $8,361.70 CLAIMANT: CALIFORNIA STATE AUTOMOBILE ASS. BY: CHRISTINE SAMPSON ATTORNEY: UNKNOWN DATE RECEIVED: JUNE 28, 2004 ADDRESS: P.O. BOX 920 BY DELIVERY TO CLERK ON: JUNE 289 2004 SUISUN CI'T'Y, CA 94585-0920 RECEIVED THROUGH BY MAIL POSTMARKED: INTEROFFICE MAIL FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWE Jerk Dated: JUNE-"-2004 By: Deputy II. MOM: County Counsel TO: Clerk of the.Board of Sup6visors (:) This claim complies substantially with Sections 910 and 910.2. ( } This Claim FAILS to comply substantially with Sections 91.0 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). ( ) Other: Dated: By: Deputy County Cour 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). Z. 3OARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. { ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JOHN SWEETEN, CLERK, By. , Deputy Clerk WARNING(Gov. code se on 91 5) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposit 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 arra 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: JOHN SWEETEN, CLERK ByZV� k Deputy Clet ,6/24/04 . 10:58 FAX 6765018 CSAA Z001 o CalTarnia State Autatnubtle Assodadon Inter-Insurance Bureau RO,Box 920 Suisun 0y,CA 94585-0920 May 14, 2004 Q25-335- 11+2—1 JtJIV 2 t 2004 Lafayette Risk M tut. S xi50RS 253 Arnold Drive#140 r.R �r: Tp0. Martinez,CA 94553 RE: Your Insured: City of Lafayette/driver:Marcus Morales Your Claim No.: 55296 Our Insured: Ronna J1Robert S Jones Weekly {Jur Claim No.: 07-D10916-0 Bate of Loss. 0212112004 Bear Lafayette Risk Mgmt.: This will confirm our subrogation interest arising from this loss. We have settled the claim with our insured and based on the following facts,request payment directly to California State Automobile Association Inter-Insurance Bureau (CSAA-IIB): Your driver ran the red light. Documentation to support our claim is enclosed. Please issue payment of$8,361.70 for the following expenses: Settlement $8,017.38 Less Salvage $558.00 Deductible $250.00 Loss of Use $652.32 Tow/Storage $0.00 Miscellaneous $0.00 TOTAL $8,361.70 Please be advised that any payment in an amount less than that set forth in this letter that is forwarded to CSAA without its prior authorization as described below will not constitute a full and f lnal settlement and will be accepted as partial payment only. Since payments received in the mail are processed by clerical staff and deposited as a matter ofcourse without examination,unauthorized payments for less than the full amount demanded may be processed inadvertently. Although such payments may be demarked as"payment in full"or have other words of similar meaning written on them, their processing will not constitute an accord and satisfaction,as CSAR has not agreed to acceptance of such payments. Only an authorized Subrogation Specialist may communicate,orally or in writing,CSAA's specific agreement to accept an amount less than that demanded in this letter. Sincerely, �TthL'��YGI+i �{I1J'7t �1'E+ Subrogation Specialist 888-222-1839 extension 5031 Enclosure F266K(Apr 2602) 06124/04 . 10:59 FAX 6765018 CSAA 2002 t as y rs s t� .. til. V& ntt f Of VJ1 Vut. 'Y' Claim:07-ID109190 Autosouroe Valuation 1894 Saguar M Vanden Pias 413 Sedan ADP Request:12432281 Autolsource Valuation Administrative Data 1994 Jaguar XJ6 Vanden Plas 4D Sedan': Chris Modic '.�"`✓# 1331# ; California State Auto Assoc. ICl st t Donna Weekiv U Sal-Hayward Branch 07-0109180 m' 1884 8a&e Street i'1 9 8s i 0212112004 ® Hayward CA 94545 Collision �> i-iINSOURCE Analysis 1994 Jaguar XJ6 Vanden Pins 4D SedanU u.r 94JKX174XRO893871 x:1994 Jaguar XJ0 Vanden Pias 40:sedan Deaodes Corr eatiy ;Ilii�l:ActiVtty'was reported a Autoeourc a Total Laos activity:(NONE). 13 Autotrok total to"activity:(NONE). a Audatox estimate activity: Reported by NATE FARM - SAN FRANCISCO on April 13, 1M, Call them regarding Claim:05-0372-30502.©GSE.,03111/95 with a primary Impact point of Right S1de. 13 Aud+ertax estimates activity: Fi*Wed by tJSERTY" MUTUAL. - SACRAMENTO an May 8, 1998. Call thorn regarding Claim:A06020 8190'1. DOL:OWGM with a primary Impact point of Right Silo. a Sales history activity: (NONE) ReportNICB .., Jaguar XJ6 Vanden Plas 4D Sedan S037 STATE FARM MUTUAL AUTOMOBILE INSURANCE 0MPANY fsl ff 05-0372-'SM02 03!11!95 ; # ESTIMATE :451+Mf i H0092288085 : I FI :RftlitE Right Side < 1 1 Iv4$kr#i LOQa LIBERTY MUTUAL INSURANCE COMPANY 's: lEii A800205318801 ; ( s 0212618 ; 3 ESTIMATE :: i HOM88885 trjW Right Side i >Ni; tt '!0001 CALIFORNIA STATE AUTOMOBILE ASSOCIATION INTER-INSURANCE A0001091808FX03 t ;0a/law ?t :f PROPERTYICASUALTY i i H0092288885 E>P�ift 0001 CALIFORNIA STATE AUTOMOBILE ASS0 AT#ON INTER-INSURANCE : i l l?p1091Q009 ''•:�r ' 108113102 PROPERTY/CASUALTY : li ?I"I H0092288685 0001 CALIFORNIA STATE AUTOMOBILE ASSOCIATION INTER-INSUIRANCE i hili OB-DJ09160 IIS #9 7 A8SIC91dMI NT H0092288%6 Version:2 Page 1 03100104 10:42 Ot,/24/04 ' .10:59 FAX 6765018 CSAA x}003 tu: 4r- mrr rar varuoP. It race c u Claim:07.01491eo Autoeouroe Valuation 1994 Jaguar X.JB Vanden blas 4t!Sedan ADP Request:12432281 Reported Phone Number Analysis •9: Jaguar XJ6 Vanden Plas 4D Sedan No Vehicles Advertised at (707)653-1495 Recall Bulletins 1994 Jaguar XJ6 Vanden PIOZ st Sedan No recall bulletins have been issued that apply to this vehicle Valuation1994 Jaguar XJ6 Vanden Pies EtSedan ► i$8,230 $8,230 i lli 6 Cvllnder4.0 6 Cvllnder 4.0 Speed Automatic 4 Speed Autorneltio ':Qow 18,048 Mi(TV foal} 165,138 M!(Actual •1,650 30 6,930 'TBfe.triiattlt. tit . df tt#f; # itit ;: 435 Totalr ► 7 365 tf akar; 7375% 543.1 7 The markt value d m�v not reflect the activity dete#ad bv 111W plya arretr>r NIC research. Plesse contact Client Services at 1-800-MI-3133 ori f review. . . . . ............... .............' 4 #ham:: Retail Asking Price Graph 1994 Jaguar XJ6 Vanden Pins 4D Sedan' The following Retall Asking Price Graph represents a market overview of potential repplacement vehicles that were advertised for sale In the state/province market area, during the Inst 90 days, originating from Zip Code 94590. All vehicles referenced are Identical to the year, make and model of the lose vehicle. While similar, some of these vehicles may be different In edition, mileer, e%ulpment and condition. The price distribution graph displays the average asking price range of all vehicles from the low of $3,200 to a high of $12,000. The vehicle quantity and average asking price are specific to vehicle edition and source, either dealer or private party. All stealer vehicles are displayed In capital letters and private party vehicles are displayed In lower case, .:.•• . 4I+�.`..,'.::a�;� ,:�:; CCC > .....:..::: 4 > ACCCCcc Amccccc :;%%;i:CCCCcccccc OCCCCCCCCCC ccccccccc ccs ILCC Version:2 Page 2 03108/04 10:42 0.6124/04 11:00 FAX 6765018 CSAA 11004 t ayc J a iw. 'rc nrr t rr uJruur . t ,Wm:07.8109160 Autosouroo Valuation 1984 Jaguar 7tJ6 Vanden Plan 417 Sedan ADP Request 12432261 Im A Vanden Plus 8 $$80,23 $$5019 5 $8,434 0 b Std C c JNot Indicated 68 $7,974 S 7,207 38 $8,580 75 07L71 32 $7,253 43 08,330 Vehicle Valuation Detail 1994 Y tVanden PlasJ Sedan The TYPICAL VEHICLE represents the average milese, condition, equipment level and estimated sellingprice of a vehicle of the same year, make, model, doors, edition, body and fuel type as the LOSS VEHICE and Is representative of the market area. 1 Ty ical vehicle Loss,VeNVICA Adjustment ;:moi;Vallejo Vallejo !?#i ' $8,230 $8,230 ii :fi¢ 1994 1994 ''f �Jaguar Jaguar '' Jf#G i 7G16 XJ6 ? i(00 Vanden Pias Vanden Plas ti©7 4D 40 Sedan Sedan 2WD 2wD Cylinder 4.0 8 Cylinder 4.0 0 ; tl ..... `' #si # itiji 4 Speed Automatic 4 Speed Automatic 0 > aj4 �Not Appfioable Green 118,048 Ml(Typical) 185,138 Mi(Actual) -1,850 43#ili :G� lte#;Automatic Dimming Mirror Automatic Dimming Mirror <:Air Conditioning Air Conditioning Rom Trunk-LIGats Rem Trunk-(}Gate Releaseeleas Power Antenna Power Antenna i Cruise Control Cruise Control Control ForAIC Climate Control For AIC ;Climate Rear Window Defroster Rear window Defroster Tilt StowingWheel Tit Steering Wheel .h...� t f o sit;#let.:Trip Computer Trip Computer Digital Clock Digital Clock : Canter Console Center Console Anti-look Brakes Anti-look Brakes i 115 Limited S Different al Fog Lights Fog Lights Headlight ht wa h s ers 35 Tinted Glass Tinted Glass Heated windshield 0 intermittent era Wipers Intermittent Wipers p Taohometer Tachometer Dual Airbags Dual Alrb s , #`�°,, to''.',�'KU Heated Power Mirrors Heated Power Mirrors Power Stakes Power Brakes Power Door Looks Power Door Looks Power Steering Power Steering Power Windows Power Windows Dual Power Seats Dual Power treats 3 #t ki Et #I tti i i t Compact Diso Changer 100 AMIFM Sterno Tape AMfFM Stereo Tape Theft Deterren em Y t Theft Deterrent System I Cellular Telephone 50 Power Sunroof Power Sunroof Leather Seats Leather Beats Heated Front Seats so Aluminum/Alloy wheels Aluminum/Alloy Wheels Version:2 Page 3 63ta6104 14:42 08/24J09 . 11:01 FAX 8785018 CSAA 2005 r oyer Y � iV• TG Y1lr S Jr Ua oWWIs 'T Claim:07-D109190 Autosouroe Valuation 1894 Jaguar XJ9 Vanden Plas 4D Sedan ADP Request 12432291 Ali Weather f'aoka e 0 i� 8,93© : :•::•:;i ii ::;;: t ;$ i:(:; 4:i iai;i'.;: :::>s;: .`, ; :.':::;:;:,;: ::;:;.:;•::::::::::::......................... 435 :.... gtai.Conditir�;Ott #ne313f'i iiwf;illtdl'.' Ittftt•£39# - - • r r iA 7. 91 Valuation Notes rrf Jaguar XJ6 VandenPla40 Sedan 13 Adjustrnenta►of Speolal Not* • An adjustment of $100 was made for the reported aftermarket Ccmpaot Diet Changer, The date of purchase was not provided. • An ad'ustment of$50 was made for the reported aftermarket Cellular Telephone. The date of purchase was not provided. • The following equipment: Limited Sip Differential, Headlight Washers, Heated Front Seats, does not have a manufacture cost associated with It; the adjustment was determined by using the average cost by vehicle year and category, Ci Information provided by Califomis State Auto Assoc. i Lose vehicle description was provided by California State Auto Assoc.. • All values are in U.S.dollars. e Lase vehicle was reported to have: o Aftermarket Compact Dlso Changer. o Aftermarket CeilulsrTelephone. fa Autosouroe Valuation Prooess * Over 2,000,000 vehicles are entered weekly into the database used for researching this value. This database includes dealer inspected, dealer inventory, dealer advertised, phone verified and adverild private party vehicles. r The originating search area for this valuation was Vallejo, California. s The VIN decoded correctly. . The tact' was calculated based on a date of lose of 02/21/2004 using zip 94590, In Vallejo, Solano County, Cal Ifornia,The city may vary from search area to reflect correct tax location. 13 Other Adjustments or Comments • Autosource has revalued the lose vehicle with revised conditions, as reported by Lisa Zook on 03/08/04. fndition Ad ustment Detail .,. Jaguar XJ6 Vanden Pine, .r Sedan Minor Wear Moderate Wear -170 Minor Wear Minor Wear i tSfl:Minor Damage Minor Damage t $S mood Good :Good Good : dy Minor Damage Minor Damage Moderate Damage Minor Wear 270 ritti'`:Minor Damapa Minor Damage Minor Wear Well Maintained 335 ri Minor Wear Minor Wear t3ood(30-79%Of Tread) Good(30-79%of Tread) Good t30-79%Of Trea Good 0-79%Of Tread yq�� 7 Varalon:2 Page 4 03109/04 10:42 0&/24/04 .11:01 FAX 6765018 ,.CSAA 2006 .ay.`'re. nae a ✓a w artourr -r Claim:07-DI 091M Aut000urae ValueUon 1994 Jaguat XJ®Vanden Plan 40 Sedan ADP Request:12432281 Odometer, equipment, trim level and condition must all be carefully considered on this vehicle. The average miles driven for this vehicle are 118,048.The expected vehicle condition would be aa follows: Minor Wear Stains.Seams wornArayed/strained.1-3 burn marks/holes. # ;Minor Wear Stains. 1-3 bum marks/holes.Light fadirtq.Wear under pada€s. Minor Damage Discolor€ng/scratches/small cracks. 1-2 knobsisWtohes pone. 4' Good No damage.1-3 small phs.L€ghi scratches on close inspection tiliftE good No darnage/fading/d€scoloring/lears.Soil removes with detai€. Minor Damage Multiple dings.Small non-collision dents.Surface rust. Moderate damage Oxidized.Extensive fading.Multiple scrapes.Poor repaint. tlhl:l Minor Damage Numerous oraoks,+dentstsorapea Cranked lens txwer.fVc emblems. Minor Wear Belt/accessories show wear/oorrosion.Minor oil/f€u€d leeks. T. Eli 2laadstftt Minor Wear Minor fluid leaks. Maintenance may not have been performed. Good(30-79°,6 of tread) Tires are in good condition,30-79%of tread remains, good(30 -79% tread) Tires are In good condition.30 79°!n of tread remains. Having a clean, well maintained vehicle will add to its market value. Prior body damage, rust, extensive Interior damage or mechanical problems will all decrease the market value of this vehicle. Replacement Vehicles 1994 Jaguar XJ6 Vanden Plas 40 Sedan The following replacement vehicles may Include a sampling of the actual vehicles used to calculate the selling price. The replacement vehicles represent vehicles that have recently been offered for sale In the marketplace. These vehicles have similar attributes and characteristics to the toted loss vehicle. Dealer Inventory Vehicles . Baen . 1994JaguarXJ4t - 850 80,0002 IleaDistance:21 Miles Sausalito,CA 8 Cylinder 4.0 Automatio ijiw:v,�Avenue Leasing Dual Power Seats Heated Power Mirrors (415)332-9474 Power Brakes Power Moor Looks Power Steering Power Windows Leather Sea is AM/FM Stereo Tape Theft Deterrent System Aluminum/Alloy Wheals Air Conditioning Automatic Dimming Mirror Climate Control For A/C Cruise Control Power Antenna Rear Window Defroster Rem Trunk-L)GateRelease Tilt Steering Wheel Anti-look Brakes Center Console Digital Clock Dual Airbags Fog Lights Intermltient Wipers X. Tachometer Tinted Glass XX Trip Computer Version:2 Page 6 0310€510410:42 1}6%24J04 .11:02 FAX 6765018 CSAA Z007 reeves n � xu; -rc Mn ros U.31 U01. It Crim:07•DI 09160 Autoaaurce Veduatlnn 1994 Jaguar Xis Vanden Plat 40 Sedan ADP Request:124=81 , t ,199L;•S .j:ur�rX,fB4E7;Sedan / ., •i" •t4 .�8 ,17170 Mlles lS st9 oe �'� ';Petaluma,loris C e Cylinder 4.0 4 Speed Automatic ?' tQi ? '•,British European Motors Dual Power seeds Bleated Power Mirrors '"`''' ��l��i�:{707 792-2737 :i Power Brakes Power Door Looks Power steering Power Windows Leather Seats Compact Diso Player Thea Deterrent system Aluminum/Alloy Wheels Air Conditioning Automatic Dimming Mirror Climate Control For A/C Cruise Control Power Antenna Rear Window Defroster Rem Trunk-trate Release 'lilt Steering Wheel Anil-look Brakes Center Console Digital Clook Dual Alrbags; Fog Light., tntcrrnittont Wipora Taohometer Tinted Glass Trip Computer Well E ut 21 Qi994�J6�t� Ji ?r( ni Dumiles, Distance:31 Miles blin-San Ramon CA B Cylinder 4.0 4 Speed Automatic �;Dealer is Due,Bower Seats Heated Power Mirrors i#1 (925)829-2421 Power Brakes Power Door Looks Power Steering Power Windows Leather Seats AM/FM;stereo Tape Thett.Deterrent System Aluminum/Alloy Wheels Air Conditioning Automatlo Dimming Mirror Climate Control For A/C Cruise Control Power Antenna Rear Window Defroster Rem Trunk-LiGate Release Til#Steering Wheel Anti-look Brakes Center Console Dipllal Clock Dual Alrbage Fog Lights Intermittent Wipers Tachometer Tinted Gass Trip Computer :: : :............... .; 994.! er XJ8 4t?'Sedan Q1%2N / 04 U :. Up Distanoe:22 Miles 8Cvl1nder4.0 ;:%i it4b;Oakland,CA Automatic Dual Power Seats i+? t:haler i.Heated Power Mirrors Power Brakes > s1 k? lulO.(510)437-1760 Power Door Looks Power;Steering Power Windows Leather Seats AM/FM Stereo Tape The Deterrent System Aluminum/Alloy Wheels Air Condlboning Automatic Dimming Mirror Climate Control For A/C Cruise Control Power Antenna Rear Window Defroster Rem Trunk-UGate Release Tilt Steering Wheel Antl-look Brakes Center Console Digital Clock Dual Atrbags Fog Lights Intermittent Wipers Tachometer Tinted Glass Trip Computer All Power Options Vera;nn:2 Page 6 03108/44 14:42 06/24/04 . 11:02 FAX 6765018 CSAA _ Zoos e U90 r 0 Av. ry fill s .ri v.OrWU* . V Claim 07.0106160 Autosouroe Valuation 1994 Jaguar XJ8 Vanden Plas 40,50dan ARF°Request 12452281 ry� •;: 1954 3agraaic XJB 40 Sedan Winder inder 4.0 . .. Berkeley,CA • Au#otnaticDual Power Seats Y tE Cli.i ;Johnny Delta Heated Power Mirrors Power Brakes 1 ; 1 ;(510)524-5870 Power Door Looks Power Steering Power Windows Leather Seats i Compact Disc Player Theft Deterrent System Aluminum/Al#oy Wheels Air Conditioning Automatic Dimming Mirror Climate Control For A/C Cru Ise Control Power Antenna Rear Window Defroster Rem Trunk-L/Gate Release Ti#t Steering Wheel Anti-look Brakes Center Console Digital Clock Dual,Arbags Fog Lights intermittent Wipam Tacharn ator Tinted Glass Trip Computer All PowerOotlons :::•:, :.:,, :•.;:::•: ii�iAi�ii ION Jo . . .. .. :-I `• n A : .•• Martie C Ernmedlate-�4reaCy <�k �#t?, � 4 Speed Automatfo Duaa Power Seats iiIii�;Dealer #loots(Power Mirrors Power Brakes (926)(925)228 6383 Power Door Look's Power Steering Power Windows Leather goats AM/FM Stereo Tape Theft Deterrent System Aluminum/Alloy Wheels Air Conditioning ;i Automatic Dimming Mirror Cilrnate Control For A/C .:Cruise Control Power Antenna Rear Window Defroster Rem`trunk-I.Mate Release Ttlt Steering Wheei Ant#-look Brakes Center Console Dialled Clock Dual Alrbaps Fop lights intermittentWlpers Taohomster Tinted Glass Trip Computer 11994 J Auar)Ufi,V Sedans i:ii 3 Ci$E;t f YtS4 t ?tiA t .800 •...•.....,,....;5 :j?i;iijij immediate Area" 5i. `i.`'>i? �i��'i'i;'t;?���,. 87,OOt Miley t?A:San Franal Ghroniofe 0 Cylinder 4.0 4 Speed Automatic i Vallejo,CA Dual Power Seats Neatest Power Mirrors ( (T07}647.7578 Power Brakes Power Door Looks Power Steering Power Windows i Leather Seats AM/FM Stereo Tape Theft Deterrent System Aluminum/Alioy Wheels i;Air Conditioning Automatic Dimming Mirror Climate Control For A/0 Cruise Control Power Antenna Rear Window Defroster Rem TrunkL/3ate Release T###Steering Wheel Anti-lark Brakes Center Console Digital Clock Dual Airbags Fog Lights Intermittent Wipers i Taohometer Tinted Glass Trip Computer ......Excellent Condition Verelan;2 Rage 7 03/08/04 10:42 0.6,/24/04 11:03 FAX 6765018 CSAR X009 raja 6 l3 Maim:07-D709180 Autoeouroe Valuation 1984 Jaguar XJ6 Vanden Pias 4D Sedan ADP Request:12432281 1994 Jaguar XJ8 40 `'fi3JtI4> 989 •'Sedan '''`�i"'•`` '�•�• .•'.�i . z s:,fnl„ • 14!04 ' a a `71,t}t2t Miles 8 Cylinder 4.0 Pleasanton Diablo Dealer Automatic Dual Power Seats Hayward,CA Heated Power Mirrors Power Brakes i888)248-2851 Power Door Looks Power Steering Power W€ndows Leather Seats AM/FM Stereo Tape Theft Deterrent System Aluminum/Alloy Wheels Air Conditioning Automatic Dimming Mirror Climate Control For A/C Cruise Control Power Antenna Bear Window Defroster Rem Trunk//Cute Release Tilt Steering Wheel AntHook Brakes Center Console Digital Clock Dual Airbags Fog Lights intonnittontWiporo Taohometor =;Tinted Mass Trip Computer All Powerrt" O wns p : ;3C�1 di#? � ': Xu�tr Sedan •. ��'i?21i4t1'M 128!03 800 a e8,800 Miles Distance:17 Mlles r" Greater "Area' ? , i G�eat r Bay+ Atdo Trader B Cylinder 4.0 4 ed Automatic #p ;t#�Berkeley,CA Dual Power Seats Heated Power Mirrors (510)UB-541 0 Power Brakes Power Boor tools Power Steering Power Windows Leather bate AM/FM Stereo Tape Thelt Deterrent System Alsmtinum/Alioy Whee€s Air Conditioning Automatlo trimming Mirror .l Cimale Control For AJC Cruise Control Power Antenna Rear Window Defroster Rem'Trunk-L4.1ate Release Flit Steering Wheel Anil-€cok Brakes Center Console Digital Clock Dual Airbags Fop Lights Intermittent Wipers Tachometer Tinted Glave Trip Computer Excellent Condition Kept.In Garage ......IM . Jag liar XJ6 asedan ::#ut 2t �tt3t:• 1 1 tJ0 . .'r' `: .• ...•.if: iw '�p'. 8 X00 M �st?€rrtanoe:`•1T•Ntiie$�. '�����i� Classified Flea Market B Cyfinder 4.0 d Speed Automatic #%:Berkeley,CA Dual Power Seats Heated Power Mirrors f ? ;(51D)847-0231 Power Brakes Power Door Looks Power Steering Power Windows Leather Seats AM/FM Stereo Tape Theft Deterrent System AluminumlAlloy Wheets Air Conditioning Automatic Dimming Mirror Ciima#a Control For ATC Cruise Control Power Antenna Rear Window Defroster Rem Trunk-L/Gate Release Tilt Stewing Wheel Ant 1-look Brakes Center Console Digital Ciook Dual Alrbags Fop Lights intermittent Wipers Tachometer Tinted Glass Tri Computer Excellent Condition Original Owner of Vehicle Version:2 Page 0 03ft/04 10:42 06/24/04 :11:04 FAX 67650.18 CSAA z O10 Claim;47-0109160 Autosouroe Valuation 1994 Jaguar 3Gl8 Vanden Pias 40 Sedan ADP Request 12432281 '011 [14 :St8t5at3 rig •.�,, �uerlGt64i2 •'i$=��'� .. F i• 71,000 Miles ♦ Distance:•21"Miles I XChronicle San Franc { 8 Cylinder 4.0 4 Speed Automatic Oakland,CA Dual Power Seats Heated Power Mirrors Power Brakes Power Moor Looks Power Steering Power Windows Leather Seats AMIFM Stereo Tape Theft Deterrent System Alum€numlAllcy Wheels Air Conditioning Automatic Dimming Mirror Climate Control For A/C Cruise Control Power Antenna Rear Window Defroster Rem Trunk-Li ate Release Tilt Steering Wheel Anti-look Braises Center Consols Digital Clock Dual Alrbags Fog Lighte Intarmittent Wipora Tachometer Ting!Glass =i Trip Computer Excellent Condition Will Appept Best Offer lit` 19514. ..tier XJt3 4€1$+adam:............... : ; . 10 988 .. d4'01/31/04 `n 12127113989 /0 finder .0 r Auto Trader > t3� :?��f#. ;Greater 8ay;�t'e�•A c'T st#e Automatic Dual Power Seats Sunnyvale,CA Heated Power Mirrors Power Brakes (800)850.2812 'Power Door Looks Power Steering Power Windows Leather Seats AM/FM Stereo Tape Theft Deterrent System Alum€numtAlloy Wheels Air Condllloning Automatic Dimming Mirror Climate Control For A/C Cruise Control Power Antenna Rear Window Defroster Rete Trunk UGate Release Tilt 5teerinp Wheel Anti-lock Brakes Center Console Digital Cloak Dual Alrbags Fop Lights .i intermittent Wipers Tachometer Tinted Mass Trip Computer All Power OP tlor>e :;:.:.:.,,:.,.,,,.:•:...:...:::.:.::. ,. 9 J.,auar XJ8 40 (Salt n:: 011/1204 900 ?41,000 Miles Distance:37 Miles )F San Francisco Chronicle 8 Cylinder 4.0 4 Speed Automatic it:Ban Mateo,CA Dual Power Seats Heated Power Mirrors ;; $trti ;(850)343-1533 Power Brakes Power Door Locks Power Steering Power Windows Leather Seats AMIN~M Stereo Tape Theft Deterrent System Aluminum/Alloy Wheels Air Conditioning Automatic Dimming Mirror Climate Control For AIC Cruise Control Power Antenna Rear Window Defroster Rein Trunk-UQate Release Tilt Steering Wheel Antl look Brakes Center console Digital Clock Dual Alrbage Fog Lights intermittent Wipers Tachometer Tinted Glass Trip Computer Version:2 Page 9 03/09/4410:42 06/24!04 . 11:04 FAX 6765018 CAA _ Z011 rays su J.u: YC I1n rat U.1I tsoI I. Y Claim:07-0109190 Autoeouroe Valuation 1894 Jaguar X,16 Vanden idea 4th Sedan ADP Aflquwr.12432261 aD:: :•: 1094 jeauar XIS 41)SedlitIrl 1'ib,DOO Miles Distance:63 Miles :;: Sacramento`Bee 8 Cyllnder 4.0 4 Speed Automatks t t;Saorarnento,CA Dual Power Seats Heated Power Mirrors fi (9116)83&4494 Power Brakes Power Door Looks Power Steering Power Windows Leather Seats AM/FM Stereo Tape .:Theft Deterrent System Aluminum/Ahoy Wheels Air Conditioning Automatic Dimming Mirror Climate Control For AJC Cruise Control Power Antenna Rear Window Defroster Ram Trunk-urate Release Tilt Steering Wheat Anti-took Brakes Center Console Digital Clock Dual Alrbaps Fog Lighto Intormittont Wiporo Tachometer Tinted Glass Trig computer Kept In Garage Original owner of Vehlole . . : i SSS 'i1 ?1 ;'# ,..4•�, C7CJ '1 , l:i• 199 .ua, .Vii, 9 9 $ 903 g9 1., �Of2t F..legit Market -:68,000 Miley Low'•Miiea..e, 11� Classified t7(stanoe:55 Mites 0 Cylinder 4.0 :San Jose,CA Automatto Dual Power Seats t BJ #t# (408)247 4101 Heated Power Mirrors Power Stakes Power Door mocks Power Steering Power Windows Leather Seats AM/FM Stereo Tape Theft Deterrent System AluminumlAiloy Wheels Air Conditioning Automfatio Dimming Mirror Climate Control For AJC Cruise Control Power Antenna Rear Window Defroster Rem Trunk UGate Release Tilt Steering Wheel Anti-back Brakes Center Console Digital Clog Dual Alrbags Fog Lights Intermittent Wipers Tachometer Tinted Glass Trip Computer Original * 1994JaguarXJ6 VandenPlasa * 0 Cylinder 4.0 STD ' 4 Speed Automatic STO i:.>?1i,..:.....'................... ... >: *t1SlV11E+1, ,.:�#1fd .:.; rip Anti-look Brakes STD $ Climate Control For AIC STD * Digital Clock STD * Air Conditioning STD Special Faototy Paint $1,500 * Automatic;Dimming Mirror STD * Center Console STD Power Antenna STD * !Dual Airbags STD * Cruise Control STD * Fog Lights STD Rear Window Defroster STD * Headlight Washers * Rem Trunk-Date Release STD * Heated Windshield * ;tilt Steering Wheal.:.:: . . . ..:::•;: ; ..,.,.... STO * intermittent Wipers STD ' + es, Limited Sip Differential * heated Power Mirrors STC) * Pachometer STD * Dual Power Seats am * Trip Computer STC? * Power Brakes STD * Tinted glass STD * Power Door Looks STD if tli (3461" l: fi i ............. Power Steering STO Compact D' l'w Player $725 Power Windows am * AMJFMt Se reo Tape STD Theft Deterrent system STO * Headed Front Seats Leather Sea T•' S O Seats Power SunroofT SD P * Aluminum/Alloy Wheels STD A � Version:2 mage 10 03)08X}4 10:42 - 06/24/04 11:05 FAX 6765018 CSAA " 0 012 sv. C. leer t .a* m.*ruvt . v a UND ss tit Clam:87-0109180 Autosovroe Valuation 1984 Jaguar XJ8 Vanden Pias 40 Sedan ADP Request;12432281 All Weather Package $800 1noludes:Power Headlight Washers;Heated Front Seats: Limited SOP Differential;Engine Block Heater;Heated Windshield. 69 9S 0 Mao Editions available for the same body style(€n order of original cost, Increasing); Std,;Vanden Plas *Indicates loss vehicle equipment. Vehicle Locator Service 1994 Jaguar M. Vanden Plas t.D Sedan'I After your claim Is settled,Autosource provides free assistance In locating your next vehicle. Call us Monday through Friday, between&00 AM and 5:00 PM, Pacific time, at (800)351-3133, ext 7428. Our specialists will work with you to find a new or used vehlrle In your area. Lose Vehicle Valuation 1994 Jaguar XJ6 Vanden Plas 4D Sedan Autoatourao has been chosen by Calffomla Stato Auto Acme.to assist In establishing a fair and reasonable market value for your vehicle.We are proud to offer you the most current and comprehensive automotive valuations available today. Your vehicle was inspected and/or described to Autosource by a trained representative of California State Auto Assoc.. Autosource has evaluated all aspects of your vehicle provided by California State Auto Assoc, as well as these features identified by the Vehicle Identification Number (VIN) or known to be standard equipment for your vehicle. The market value of your vehicle Is determined by comparing it to other vehicles In your area of similar make, model, equipment, mileage and condition that have been offered for sale or sold. The sources for this comparison Include new and used car dealers, newspapers, traders, specialty Journals and the Internet. Cour exclusive Dealer Access program provides us with electronic Inventories from thousands of affiliated dealers In North.America. Each week, over 2,000,E vehte f"are listed from these sources, representing over 100,000 dealerships and 3400 publications, making our database the larges In the Industry. We utilize the industry's largest electronic network and leading edge technology to provide you with the most current Inspected, surveyed or advertised market data. We will find the chest vehicle matches In the area nearest your home, Aboutw : 1994en .las s 4D Sedan This report contains proprietary Information of ADP and shall not be disclosed to any third party (other than the Insured or claimant) without ADP's prior written consent. if you are the Insured or claimant and have questions regarding the description of your vehicle, please contact the Insurance company that Is handling your claim, Information within VINaource/NICB Is provided solely to Identify potential duplicative claims activity. User agrees to use such information solely for lawful purposes. Copyright 02004 ADP Claims Solutions Group, Inc.All Rights Reserved, Version:2 Page 11 03108/0410:42 0:6/24/04 11.06 FAX 6765028 CSAA 013 Pagel of l A qp&Y' AV r I I n i"vw tt' Iq �� { 5; 1 t: 1 a File://C:\Program%20Files\CSAA—DMS_CACHE\47-D1O916-0\A_07-DlO9l6-0-01-COL—... 6/24/04 06/24/04 . 11.07 FAX 6765018 CSAR QtI014 Page 1 of 1 1 a� Y t.. i i F. M �Try r 3� t � �tt file://C:\Program%20Piles\CSAR DMS_CACHE\07-DIO91+6-0\A_07-D10916-0_01-COL—... 6/24/04 s � vs�^rv�� �r Xc}*y�•w �+} 4+t`h�y�Y -r�' �!� y''w 7�.rK✓ 4� re,�'J J' ^<" r`. y} 41,i•� � r a. of .vim ,.f "✓yy jd .�kr `��p )" .�^^:,U y`�� r` �'M .,� z w��r y'� ���A.�p a�''"�� yJ z .` F ' �' $4�rhe{ '.�,i r n •rypt c�' �5`;'� �`•�sT�`�j `•2"„ J}sem} r' '6�.,.All �s 'r +i�, k• 21 �p,�,-' � �e erre 94° � •.?s� �� ,� �,�. h +! f ? FF l t• f a t : S t �,,� t � 4N � � �� y"<V k �� .�i2 > y�" �+k S f t�-S�{ „„.�9h. �{•...�Y� � D f�.t'ti�"a�� ���, �� i�6 �' vb Wl I t V: —10 U Y+ `0'6/24/04 .11:12 FAX 6765018 CSAA - Z017 mage 1 of 1 2 ¢ ��N 2 P"A`l �Ste"' ` j {•:' a �••�.isk 5 �•a F 1 d file:/iC.Trogram°1o20Files»SAA DMS CACHE\07-D1091.5-0\A-07-D109i6-001-COLS.. /�4i0 — 06/24/04 11:14 FAX 6765018 CSAR Zola Page 1 of I y�' IMS 4 <c iR t�� v t rl fii _ a' f K 1 OR F F, £s,V file://C:\Program%20Files\CSAR DMS CAGE\07-D10916-OSA 07-D14916-0_OI-COL, .. 6/24/04 06/24/04 11:16 FAX 6765018 CSAR 0 019 Page 1 Of 1 1' P j7 � .rtr 1� <-�rs��r„��r tj?J.qt• � �'2.'.1 j t i' L }� t N %1 k' ��h t � u „z file://C:\Program%2OFiles\CSAR DMS_CACHE\07-DlO9l6-o\A-07-Dzo916-o_al-Coy,_... 6/24/04 . 06/24/04 11:18 FAX 6765018 CSAR — Q020 CHECK NO: 709 L339540-1—R � DATE: 04-08-2004 ILLI > NAME AND ADDRESS INFORMATION: U DR ROBERT S JONES 20 SANDY BEACH RD VALLEJO CA 94590 -- INSURED: WEEKLY,DONNA J/ROBERT S JONES PAYMENT INFORMATION/DESCRIPTION: DATE OF LOSS: 02-21-04 CLAIM NO, 07—D10916-0 CLAIMANT; WEEKLY,DONNA J/ROBERT S J PAYEE: DONNA J. WEEKLY & ROBERT S JONES AMOUNT: $8,017.38 IN PAYMENT OF: ACV LESS DEDUCTIBLE ADJUSTER: MARY ZOOK ADJUSTER NO.: 31210 KIND OF LOSS: COL 15/510702 DETACH AND RETAIN FOR YOUR RECORDS No. 709 L339540-9 -R DATE OF LOSSCLAEM INSUSED'S NADATE 02-21-04 07—D10918-0 WEEKLY,DONNA J/ROBERT S JONES O4-08-2004 POLICY TYPE KIND OF LOSS SUFFIX I CLAIMANT'S NAIVE PAY AUTO COL CIP WEEKLY,DONNA J/ROBERT S J $8,,017.38 D.O. ADJUSTER NO. IN PAYMENT OF TANK OF AMERICA 6L.421A SAL 31210 ACV LESS DEDUCTIBLE a:ak a1 AmaHca Curtam:r Connection all (lank of Amerka. N.A, Allatna, Rakdh COMM, GaurElla PAY *EIGHT THOUSAND SEVENTEEN 38/110041111 This check must be properly endorsed on the reverse aide by all payees. DONNA J. WEEKLY & ROBERT S JONES TO THE ORDER OF 06/24/04 .11:18 FAX 6765018 CSAR IM021 Cp4RT,!U1"O AUCTIONS Bate 4/30/04 1964 SABRE STREET HAYWAR.D, CA 94545 visit us at www.copart.com PHONE (510) 783-6511 TAX ID## 942867490 D'oft MAO ANTICIPATED SETTLEMENT STATEMENT U NO F PAY A101?302004 Copart Lot# 1829344 3 HAYWARD Lass Date 2/21/04 Called in 2/23/04 P/U Cleared 2/23/04 AWCR PIPS66A Pickup Date 2/25/04 LCRENZO REYNOSO Original Title 4/23/04 CALIFORNIA STATE AUTO ASN Trams 'Title 4/23/04 CALIFORNIA STATS AUTO ASSOC. 0 Sale Document 8687 WEY7 D AVENUE aLU Lose Type COLLISION SACRAMENTO, CA 95828 t Description 94 JAGLT VANDEN PLA GREEN ;w Vehicle ID## SAJKX174XRC693871. Claim# 07DIO916001 License /ST 4AH2849 CA Policy# Mileage 'UNREADABLE Voss Code Pickup From ORINDA TOW Reference# 41YYY 81 C NIORAGA WY Insured WEE LY/ROBERT JONES ORINDA, CA 94563 Owner WE3XLY/R0BERT+ JONES (925) 283-1.111 ADVANCE CHARGES PAID BY COPART '"ON SERVICE . . . . 130.00 S'TORtfF . . . . . . . . . . . . . . . . 200.00 TOTAL ADVANCE CHARGES . . . . . . . . . 330.00 COPART SERVICE CHARGES TITLE PROCESSING. . . . . . . . . . 15.00 SALVAGE CERTIFICATE PIP PROGRAM CHARGE. . . . . . . . . . . 147.00 T'OT'AL COPART SERVICE CHARGES. 152.00 TOTAL DUE COPART . . . . . . . . . . . . . . 492.00 PROCEEDS FROM SALE . . . . . . . . . . . . . 1050.00CR *Sold Via Internet Did* ------------ BAWNCE DUE SELLER . . . . . . . . . . . . . $ 558.00CR SALE INFORMATION Lot# 1.829344 Sold To 99869 SPECIALZBD BRITISH RECYYLIUG Sale Date 4/29/04 11315 DISMANTLE CT #2 Sale Amount 1050.00 RANCHO COR.DOVA, CA 95742 ACV 7365.00 (915) 638-7575 RES## SRKH97570271 Return 14.29W item# 125 Invoice Hate 4/30/04 Payment From Buyer Invoice Amount 558.00CR USD Resorted To NICE 4/29/04 .. 06/24/04 11:18 FAX 6765018 CSAA _ Z022 REMIT TO: Rental Areement No: A13756013 HERTZ LOCAL EDITION Invoice Bate: 2004-0408 PO BOX 266825 qpow Document: 609046582339 OKLAHOMA CITY, OK 73126-8825 LOCAL EDITION Account No. : 099075022188 HCC UNITED STATES ORIGINAL INVOICE Reservation ID: 037-3880951 v, CDP NO. : 1464607 TAX Id: 13-1938568 CDP Name: HLE CSAR FRP INSURE c� NO. I Club: OCALLAGHAN DANIEL CSAA FRP-INSURED *ATTR# CLAIMS DEPT PO BOX 920 SUISUN'CITY, CA 94586.0920 0 RENTAL DEIAILS RENTAL CHARGES Renter: ROBERT SHELDON JONES FRP 264.00 Car Description: CAVALIER 4ZRZ950 EXTRA DAYS 18 21.69 388.62 SUBTOTAL 652.62 Croup: Charged C Rented C FRP AMOUNT DUE 652.62 USD Reserved 99 Rate Plan In: CNVC Rate Pian Out: CNV TIME & MILEAGE -0.28 Rented On: 2004-02-21 11:57 CUSTOMER PAID(INCL TAX) -25.00 07375-01WALNUT CREEK, CA Returned On: 2004-04-08 17:5'5 07375.01 WALNUT CREEK, CA Miles In/Out/Driven: 15,507 0 13,092 = 2,415 Miles Allowed/Charged: TR-X Miles Driven: BILLINQ INFORMATION Claim No: 07-DIO916-0 Policy No: Date of Lass: 2004-02-21 Type of Lass: D Repair Facility: TOTAL LOSS - GLOBAL Authorized Rate: 25.00 Authorized Dans: 47 Adjuster: OCALLAGHAN DANIEL Insured: PAYMENT DUE !PON RECE 121 PER THE AGREEMENT BETWEEN HERTZ AND THE INSURANCE COMPANY, THE FLAT RATE AMOUNT DUE LISTED ON THIS INVOICE SUPERSEDES ANY DAILY RATE AMOUNTS CONTAINED IN THE ORIGINAL RENTAL AGREEMENT. AMOUNT DUE 662.62 USD THANK YOU FOR RENTING FROM HERTZ Billing Inquiries: Phone: 1-888-7773700 FAX: 405-775-6413 PLEASE PAY: 652.62 USD E-mail: CUSTOMERBILLINGNHERTZ.CM 46'/24f44 11:19 FAX 6765018 CSAR _ Z023 f CHECK NO.: 701 L358711-3—R m DATE: 04-17-2004 NAME AND ADDRESS INFORMATION: C) W HERTZ LOCAL EDITION ISO BOX 26882E5 OKLAHOMA CITY OK 73128-8825 INSURED: WEEKLY,DONNA J/ROBERT S JONES PAYMENT INFORMATION/DESCRIPTION: DATE OF LOSS: 02-21-04 CLAIM NO.: 07—D10818-0 CLAIMANT: WEEKLY,DONNA J/ROBERT S J PAYEE: HERTZ LOCAL EDITION AMOUNT: $831 .01 IN PAYMENT" OF: A13756013, ADJUSTER: GERTRUDE CLARK ADJUSTER NO.: 34874 KIND OF LOSS: XLU 18810702 DETACH AND RETAIN FOR Y" RECORDS No. 709 L.359711 -3-R DATE OF LOSS CLAIM INSURM'S NAME; DATE 02"21-04 07—DlOS18-�0 WEEKLY,DONNA J/ROBERT S JONES 04-17-2004 POLICY TYPE KkfD OF LOSS SLffI G CLAIMANT'S NAME PAY AUTO XLU 02F WEEKLY DONNA J/ROVERT S J $531 .01 010. AMUSTE R NO. IN PAYMEW OF BANK Of AWRfOA 61-.Ml; LRW 84874 A13755013, aank of Amartos Customer Connsotton all aattk of Artsef Ica.N.A. TIN: 13-1936558 Attsnte. Dakafp County,GsorBla PAY *SIX HUNDRED THIRTY ONE 01/11II001 HERTZ LOCAL EDITION This check must be properly endorsed on the reverse aide by all payees. TO THE ORDER OF APPLICATION TO FILE LATE CLAIM f + BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY CALIFORNIA E•� BOARD ACTION JULY 27, 2004 Application.to File Late 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 ITI, below), California Government Code.) 3 given pursuant to Government Code Sections 911.8 and 915.4. Please note the"WARNING"below. Claimant: ERIC A. MANDELL #2003014157 Attorney: UNKNOWN f � Address: 901 COURT STREET, T/25 MARTINEZ, CA 94553 JUNE 25, 2004 Amount: $70,000.00 By delivery to Clerk on: i Date Received: JUNE 252 2004 By mail,postmarked on: JUNE 24, 2004 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted Application to File Late Claim. i DATED: JUNE 25, 2004 JOHN SWEETEN,Clerk,By: DEPUTY 11. FROM: County Counsel TO: Clerlf of theiBoard of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6),. ( M. The Board should deny this Application to File Late Claim (Section 911.6). DATED: r } f tft . ria. SILVANO B.MARCHESI,County Counsel,By: � � a ,_4:� _ .,.-DEPUTY III. BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( ) This Application is granted (Section 911.6). ( his Application to File Late Claim is denied(Section 911.6). I certify that this a true and correct copy of the Board's Order entered in its minutes for this date. DATE: ���J�" JOHN SWEETEN,Clerk,By: 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 application 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: I JOHN SWEETEN,Clerk,By: DEPUTY V. F Bo O (1)County Counsel (2)County Administrator TO: Jerk of the rd of Supervisors Received copies of this Application and Board Order. DATED: County Counsel,By: County Administrator,By: APPLICATION TO FILE LATE CLAIM JUN 2004 _... _. �LERBt1A �F _.._._.. C IVTRR LiSTA C HS ......... ......... ................. y.. ._ ......_.... ___._-.......__...._.... _. t _ w.. ... .. t h: Y yt� �{ R�( c a•.• h S _ ........... _.._.. .. r s t , .................... 3 f ' ............ ........ . ............ _ _... .... ... _... _ Y ......... v t JJ � �• , 'u.- .. i Y F G z yy a ", c t.$ t ' { y ..♦ >-:. f ....... .......i .................. E _ .ww...... ....n.. ..... ------------- . 3 C $ .......... 3 t )S fi 4 .5 v c kk k G : v} : .: k•f ..:4::i. Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY E• R STRUCTICxs TO CLAD4ANT 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 10&day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov't Code 911.2.). B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors,rather than the County,the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed a cost public entity. E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end oft .19 RE Claim By Reserved for Clerks filing starn � �,� v } R Against the County of Contra Costa or } 'U40 ) } � 2004 District) CLERK BOARv1St1HSD OF st�pE� (Fill in name) } CON , CQStq co, The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of :t '';y < and in support of this claim represents as follows: 1. When did the damage or injury gccur?(Give exact date and hour) �< y t 2. Where did the damage or injury ocalr?(Include city and county) 3. Haw did the damage or injury occur?(Give full details,use extra paperrequrred) ' z` ' i., V a ...rS".v ... i r 4. What particular act or emission on the part of county or district officers, servants, or employees caused the injury or damage? S. What are the names of county or district officers, servants,or'employees causing e damage or injury? � :r. 6. What damage or injuries do you claim resulted?(Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) 3 { i 3 7. 146w Wvis"'the amount ctdarm11!4 ave, computed?`(Include the estimated amount of any prospective injury o damage.) $. 'Jq 's an addresses vfwifiicsses, dodo rs, 'and ho itals. 9. List the expenditures you made on account of this accident or injury. DATE TUNE AM(3TJN T } Gov. Code Sec. 910.2 provides"The claim must be } signed by the claimant or by some person on his behalf." SEND Nt3Tl E T Alt me Name and Address of Attorney s� v ( iatmant's Signature) (Address) 1 ) Telephone No.- Telephone No. NOTICE Section 72 of the Penal Code provides: Every person who,with inters to defraud,presents for allowance or the payment to any state board or officer,or to any county,city,or distract board or officer,authorized to allow or pay the same if genuine,any false or fraudulent claim,bill,account, voucher,or writing,is punishable either by imprisonment in the county jail for a period of not more than one year,by a fine of not exceeding one thousand(S 1,000),or by both such imprisonment and foe,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. j" ........... gid. ------- ik VCA ............. ......... ........... ---------- - ----- 4.......... ck l�q. ._�.1�'�t�t}__ C� � . 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