HomeMy WebLinkAboutMINUTES - 09282004 - C.20 CLAIM �` I
BOARD 9F SC.EERVISORS OF CONTRA COSTA COUNTY V
BOARD ACTION:SEPT. 28, 2004
Claim Against the County, or District Governed by }
the Beard of Supervisors,Routing.Endorsements, } NOTICE TO CLAIMANT
and Board Action. All Section references are to ) The copy of this document mailed to you is your
California Government Codes. r, x notice of the action taken on your claim by the
Board of Supervisors. (Paragraph IV below), giver
Pursuant to Government Code Section 913 and
915.4. Please note all"Warnings".
AMOUNT: UNKNOWN
CLAIMANT: CAA ON BEHAVE OF
MARTHA CRUZ
ATTORNEY: UNKNOWN DATE RECEIVED: AUGUST 23, 2004
ADDRESS: 1002 STANTON AVENUE BY DELIVERY TO CLERK ON:AUGUST 23, 2004
SAN PAHLO, CA 94806
BY MAIL POSTMARKED: AUGUST 20, 2004
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN SW , Clerk
Dated: AUGUST 23, 2004 By: Deputy
11, FROM: County Counsel. TO: Clerk of the Beard of Su ervisors
{ } This claim complies substantially with Sections 914 and.914.2.
(•._,y'this Claire FAILS to comply substantially with Sections 914 and 910.2, and we are so noticing claimant. The
Berard cannot act for 15 days (Section 914.8).
{ ) Claire is not timely filed. The Clerk should return claire 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: . 2>t� Deputy County Counse
Ill. 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. ARD 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: f JOHN SWEETEN, CLERK., B , Deputy Clerk
WARNING(Gov. code section 13)
Subject to certain exceptions, you have only six(6)months from the date this notice was personally served or deposited
in the mail to file a court action on this claim, See Government Code Section 945.£. You may seek the advice of an
attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so
immediately. *For Additional Warning See Reverse Side of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United
States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully
prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above.
dly
Dated: "' ` JOHN SWEETEN, CLERK By Deputy Clerk
OFFICE OF THE COUNTY COUNSEL , SILVANO B.MARCHESI
fl
COUNTY OF CONTRA COSTA
COUNTY COUNSEL
Administration Building
651 Ping Street.9th doom d' , A -t�;a SHARON L. ANDERSON
Martinez, California 94553-1229 ` t CHIEF AssISTANT
�e3
(925) 335-1800ipoe:i k GREGORY C. HARVEY
i Lde fir, tf,�l b VALERIE J. RANCHE
(925) 646-1078 (fax) 5 3
a � AsslsrANrs
NOTICE OF INSUFFICIENCY
AND/OR
NON-ACCEPTANCE OF CLAIM
TO: Martha Cruz
1002 Stanton Avenue
San Pablo, CA 94806
RE: CLAIM OF: MARTHA CRUZ
Please Take Notice as Follows:
The claim you presented against the County of Contra Costa or District governed by the Board of
Supervisors fails to comply substantially with the requirements of California Government Code Section
910 and 910.2, or is otherwise insufficient for the reasons checked below:
[ ] L The claim fails to state the name and post office address of the claimant.
[X] 2. The claim fails to state the post office address to which the person presenting the claim desires
notices to be sent.
[ ] 3. The claim fails to state the date, place or other circumstances of the occurrence or transaction
which gave rise to the claim asserted.
[ ] 4. The claim fails to state the name(s)of the public employee(s) causing the injury, damage, or
loss, if known.
[ ] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000).
If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount
claimed as of the date of presentation, the estimated amount of any prospective injury, damage
or loss so far as known, or the basis of computation of the amount claimed.
[X] 6. The claim is not signed by the claimant or by some person on his or her behalf.
[ ] 7. You are required to submit your claim on the proper form, which is enclosed. Please resubmit
your claim on the enclosed form, including all the required information. Gov. Code, § 910.4.
Please be aware that you have only a limited period of time in which to file an amended claim.
See Gov. Code, § 910.6.
Page I
Martha Cruz
Re: Claim
Page Two
[ ] 8. Other:
SILVANO B. MARCHESI
COUNTY COUNSEL
Monika L. Cooper
Deputy County Counsel
CERTIFICA'T'E OF SERVICE BY MAIL
(Code Civ. Proc., §§ 1012, 1013a, 2015.5; Evid. Code, §§ 641, 664)
1 am a resident of the State of California, over the age of eighteen years, and not a party to the within action. My
business address is Office of the County Counsel, 651 Pine Street, 9th Floor, Martinez, CA 94553-1229. On
August 26, 2004, 1 served a true copy of this Notice of Insufficiency and/or Non-Acceptance of Claim by placing
the document in a sealed envelope with postage thereon fully prepaid, in the United States mail at Martinez,
California addressed as set forth above. I am readily familiar with Office of County Counsel's practice of
collection and processing of correspondence for mailing. Under that practice, it would be deposited with the U.S.
Postal Service on that same day with postage thereon fully prepaid in the ordinary course of business.
I declare under penalty of perjury under the laws of the State of California and the United States of America that
the above is true and correct. Executed on August 26,2004.. at Martinez, California.
Kathleen O'Connell
cc: Clerk of the Board of Supervisors(original)
Risk Management
Page 2
JUN--12-2003 09*3 CCC RISK MANAGMENT 925 335 2421 P.02
Claim to: BOOM OF MPERVI!SM OF aRM C{l5T'A CM
INSrMcfICNS IG CI.AIMA Z
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before: December 31, 1987,
most be presented not later than the 100th day atter the accrual of the ca=e: 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 atter January 1,
1988, must be presented not later than six manths after the accrual, of the rause
of action. Claims relating to any other Cause of action must be presented not
later than one year after the accrual or they cause of action. (Govt. Cade 5911-2-)
B. claims moist be filed with the Clerk of the 'Board of Supervisors at its office in
Room ZE6, 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 Pilled in.
D. If the claim is against more than one public entity, separate claims must, be
filed against each public: entity.
E.' Fraud. See penalty for fraudulent claims, Penal. Code See. 72 at the end of this
fC1rm.
ee � eee � �t e �teeeee � ee * ee
M. Claim By <:>-o � a1e3�ese=.rved foF�`k's,ung s
r
f AUG3
-Against y of Contra CosrA
.or laL
a a
District)
n
uorrsi hereby ake�s County of Contra Costa or
the above-named District in the sum of and in support of
this claim represents•as follows:
1. When did thetar in Jury occur? (Give exact date and hoar)
i •�� d
2. Whom 4id the damage or in occur? (Include city, and county)
3. How did the damage or injury* occur? (Give -full details, use extra paper if
required)
'V �-
A. int psrti.&alar act or cmisa «n. ori•the part of Mm'ty or district offiaers,
servants or,emplayef s caused..the.injury or. ?
JUN-ze--�--MS 05.23 CCC RISK Ma4r,�ENT 925 335 1421 P.03
7. writ are the names of county or district officers, servants or employees causing
the dame or injury?
n � ���
5. What damage or injuries do you Claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
7. Fmw was the am t claimed above computed? (Include the estimated amount of any
prospective injury or e.)
$. Names and addresses of.witnesses, doctors and hospitals.
9. Dist the expenditures you made on aaeount of this accident or injury:
DATE rM AN=
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provid
"The claim must be signed by the claimant
SEND NOTICES TO: (Attorne ) or ty some erson on his.behalf."
Name and Address of Attorney
Ma$2—E;3 Signature
Address
Telephone No. I Telephone No.
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N 0 T C8
Section 72 of the penal. Code providesx
"Every person who, with intent to defraud, presents for allowance or for
payment to any, state board or officer, or to any county, city or district board or
officer, authorized to allow or pay the same if.genuine, any false or fraudulent
claim, bill, account, voucher, or witing, is punishable either by impriso6 ent in
the county jail•for a period of not more than cne.year, by a fine of not exceeding
we thousand ($1,000), or by'both such iMprisodment and finer -or by imprisonment in
the state prison, by a fine of not exceeding ten thousand dollars {$lo,000, or by
both such imprisonment and fine.
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CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION:SEPT. 28 20D4-
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. >q* k ) F notice of the action taken on your claim by the
Board of Supervisors. (Paragraph IV below), giver,
Pursuant to Government Code Section 913 and
915.4. Please note all "Warnings".
AMOUNT: $996.86 0 0%N TYs NEL'.
CLAIMANT: GEICO INSURANCE/MORALES
BY: LYNNE LINDH/GEICO
ATTORNEY: UNKNot%}N DATE RECEIVED: AUGUST 23, 2004
ADDRESS: P.O. BOX 509090 BY DELIVERY TO CLERK ON: AUGUST 23, 2004
SAN DIEGO, CA 921.509090
BY MAIL POSTMARKED: ' AUGUST 19, 2004
FROM: Clerk of the Beard of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN SW E , Clerk
Dated: AUGUST 23, 2004 By: Deputy
eaffft
II. MOM: County Counsel, - TO: Clerk of the Board.of Supervisors
{t„,This claim complies substantially with Sections 914 and 910.2.
{ ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The
Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of
claimant's right to apply for leave to present a late claim (Section 911.3).
( } Other:
3 f,
Dated: -c><t. Bye...
$ .. % : Deputy County Counst
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. POARD ORDER: By unanimous vote of the Supervisors present:
(v)” 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 sectio 913)
Subject to certain exceptions, you have only six (6)months from the date this notice was personally served or depositec
in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an
attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so
immediately. *For Additional Warning See Reverse Side of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the'United
States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California,postage fully
prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above.
Dated: 02ACILIJOHN SWEETEN, CLERK By.--- Deputy Clerk
Claim to.. BOARD OF SMER SM OF CtU'f'RA COSTA COLAM
NSTRUCtIONS TO CLAIMT
A. Claims relating to causes of actio for death or for injury to person or to per-
sonal property
er-somalproperty or growing crops and which accrue on or before December 31, 1997,
tit be presented not later than the 1.00th day after the accrual of the rause of
actio.. Claims relating to caul of action for.death or for injury to person
or to personal property w.grvving crops and uhich accrue on or after January 1,
1988, must be presented not latter than six months after the accrual or the rause
of action. Claim's relating for any other c e of action must be presented not
later than one year after the accrual of the owe of action. (Govt. Code 5911.2,)
B. Claims sit be Mad with the Cly of the Board of &VWTi30r5 at Its Office in
Rom 106t County AdmInist tJc7t SuL1d r►g, 651 Pine Street, MIrtirJeZ, CA 94553.
C. If claim is against a distri
W nate are the nsemes of county or distridt officers, servants or employees causing
the damage or injury?
r
5. 'What damage or injuries do you claim resulted? give full extent of injuries or
damages claimed. Attach two estimates for auto damage,
7. Howe was the amount claimed. above computed?. (Include the estimated amount of any
prospective injury or e.)
" !L..`G'.�{ t°: � f i•may}° :`.✓ }` , Mi
3. Names and addresses of witnesses, doctors and h03pital3.
A)
9. List the: expenditures you made on ac=mt of this accident or injuryt
DATE M. 1#MOM
05a), 0
Gov. fide Sec. '910;2 provides;
"The claim must be signed by the claimant
SEND ACES TO: (At ) oron his,b�f.�
aZi eaui A of Atto:WY ,.� `t}
=aimantls Signature)
X A
4
++M
Telephone No. I Telephone leo.
if iF �F IF * * WIN WIMTVI I9F ik
NOTICE
Section 72 of the Perms. Codes providesz
"Every pion who, with intent to defraud, presents for allowance or for
payment to any, state board or officer, or to any qty, city or district beard or
officer, authorized to allow or pay the same if .genuine, any false or fraudulent
claim, hill., account, voucher* or uritinxg, is pudshabl.er either by impriso6ment in
the vrnmty Jail for a period of wt more than we-yeah* by a tine of not exceeding
one thousand ($1,000), or by,both such' izo sI t and finei"or by imprisonment in
tete states prison, by a fine of not exceeding eeding tat thousand dollars ($10,000, or
by -
'EIC
One GEICO West, P.O. Box 509090 N San Diego,CA 92150-9090
PAYMENT RECOVERY NOTICE
Date: 09/18/04
CONTRA COSTA RISK MANAGEMENT
2530 ARNOLD RD, SUITE 140
MARTINEZ, CA 94553 ATTN: FENNY DALY
Our Insured: ROSALINDA MORALES Our File# 0129589530101110
Your Insured/Driver: MICHAEL CHRISTIANSEN Your File# 56287
Your Vehicle: 00 FORD Tag: 4X 5Y887 CA
Our investigation shows your insured to be at fault in the above loss.
Payment for the repairs has been made. Documintation is attatched. Please honor our claim.
Property Damage
CO's Intrest $496.96 Supplement Insured's Deductiable $500.00
Rental Insured's out of pocket $ -
Less Salvage Total $ 996.86
Medical
Name Medical Payments Wage Payments NBA(Other)
k
Total $ - $ $
Total Medical $ -
Total Demand 1$ 996.86
Make checks payable to:
L-I GEICO Please include claim number on all checks
U GEICO Generaf Insurance Company Exam Lynne Lindh
GEICO Indemnity Company
Q GEICO Casualty
SignatLi �
1-800-654-5896 ext. 5357
Shareholder Owned Companies Not Affiliated with the U.S.Government
Pagel of 5
07/13/2004 AT 02:42 PM 0129589530101110-01
46093
GEICO
DIRECT
24HR CLAIM SERVICE 1-800-453-6494
P.O BOX 618
SUISUN CITY, CA 94585
(707) 688-3318 FAX: (707)429-2793
ESTIMATE OF RECORD
WRITTEN BY: JOSE LARA 07/13/2004 02:40 PM
ADJUSTER: A156 EXT: 6494 FCC:
INSURED: ROSALINDA MORALES CLAIM #0129589530101110-01
OWNER: ROSALINDA MORALES POLICY #0216644302
ADDRESS: DATE OF LOSS: 07/02/2004 AT 12:00 AM
TYPE OF LOSS: COLLISION
EVENING: POINT OF IMPACT: 6. REAR
BUSINESS:
INSPECT TRAVIS AUTO BODY DAY: (707)425-8848X0000
LOCATION: 1350 NORTH TEXAS ST DRIVE-IN
FAIRFIELD, CA 94535-0000
REPAIR TRAVIS AUTO BODY BUSINESS: (707)425-8848
FACILITY: 1350 NORTH TEXAS STREET 5 DAYS TO REPAIR
FAIRFIELD, CA 94533 LICENSE #
1996 GMC K1500 4X4 CLUB COUPE 8-5.7L-FI 2D LONG LT BLUE INT:GREY
VIN: 1GTEK19RXTE554919 LIC: 5E94331 CA PROD DATE: 07/1996 ODOMETER: 89894
AIR CONDITIONING REAR DEFOGGER INTERMITTENT WIPERS
TINTED GLASS DUAL MIRRORS CLEAR COAT PAINT
POWER STEERING POWER BRAKES POWER WINDOWS
POWER LOCKS AM RADIO FM RADIO
STEREO SEARCH/SEEK CD PLAYER
AIr7TI-LOCK. BRAKES (4) DRIVEN. AIR BAG AUTOMATIC TRANSMISSION
4 WHEEL DRIVE OVERDRIVE
-------------------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
-------------------------------------------------------------------------------
1 EXHAUST SYSTEM
N 2 REPL MUFFLER & PIPE 1 451.32 M 0.5 M
3 REAR BUMPER
4 O/H REAR BUMPER 1.2
N 5 REPL FACE BAR PRODUCTION CHROME 1 375.00 INCL.
BUMPER
--------------------------------------------------------------------------------
SUBTOTALS ==> 826.32 1.7 0.0
LINE 2 : NO BETTERMENT TAKEN RECENTLY REPLACED EXHAUST KIT.
LINE 5 CHEAPER TO GO OEM COMES WITH STEP PAD AND BRCKTS.
file://C:\Documents%20and%2OSettings\u79699\Local%2OSettings\Temp\pdi\01295895... 08/18/.2004
Page 2 of 5
1
07/13/2004 AT 02:42 PM 0129589530101110-01
46093
ESTIMATE OF RECORD
1996 OMC K1500 4X4 CLUB COUPE 8-5.7L-FI 2D LONG LT BLUE INT:GREY
--------------------------------------------------------------------------------
ESTIMATE NOTES:
OLD DAM
PARTS 826.32
BODY LABOR 1.2 HRS @$ 58.00/HR 69.60
MECHANICAL LABOR 0.5 HRS @$ 80 .00/HR 40.00
----------------------------------------------------
SUBTOTAL $ 935.92
SALES TAX $ 826.32 @ 7.3750% 60.94
----------------------------------------------------
TOTAL COST OF REPAIRS $ 996.86
ADJUSTMENTS:
DEDUC'T'IBLE 500.00
----------------------------------------------------
TOTAL ADJUSTMENTS $ 500.00
NET COST OF REPAIRS $ 496.86
THIS IS NOT AN AUTHORIZATION TO REPAIR
NO SUPPLEMENT WILL BE HONORED UNLESS
AUTHORIZED BY GEICO DIRECT
*
** FOR ALL SUPPLEMENT REQUESTS CALL ** 1-800-742-2347 **
*
"WE ARE PROHIBITED BY LAW FROM REQUIRING THAT REPAIRS BE DONE AT A SPECIFIC
AUTOMOTIVE REPAIR DEALER. YOU ARE ENTITLED TO SELECT THE AUTO BODY REPAIR SHOP
TO REPAIR DAMAGE COVERED BY US. WE HAVE RECOMMENDED AN AUTOMOTIVE REPAIR
DEALER THAT WILL REPAIR YOUR DAMAGED VEHICLE. IF YOU AGREE TO USE OUR
RECOMMENDED AUTOMOTIVE REPAIR DEALER, WE WILL CAUSE THE DAMAGED VEHICLE TO BE
RESTORED TO ITS CONDITION PRIOR TO THE LOSS AT NO ADDITIONAL COST TO YOU OTHER
THAN AS STATED IN THE INSURANCE POLICY OR AS OTHERWISE ALLOWED BY LAW. IF YOU
EXPERIENCE A PROBLEM WITH THE REPAIR OF YOUR VEHICLE, PLEASE CONTACT US
IMMEDIATELY FOR ASSISTANCE. "
NOTICE: NEW HIGH STRENGTH STEELS MAY REQUIRE THE USE OF MIG WELDER FOR PROPER
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Page 3 of 5
REPAIRS. NEW DESIGNS REQUIRE MEASUREMENT TO PROPERLY ALIGN THE VEHICLE. MAKE
SURE YOUR SHOP HAS THE RIGHT EQUIPMENT TO REPAIR YOUR
VEHICLE.
2
07/13/2004 AT 02 :42 PM 0129589530101110-01
46093
ESTIMATE OF RECORD
1996 GMC K1500 4X4 CLUB COUPE 8-5.7L-FI 2D LONG LT BLUE INT:GREY
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=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT
LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS:
ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLVD=BLEND CAPA=CERTIFIED AUTOMOTIVE
PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT
PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS
NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL
OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL
REPL=QUALITY REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS
RECOND=RECONDI'T`ION 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 [IE. .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 NOTED ALL
ITEMS ARE DERIVED FROM THE GUIDE DRlGH95 DATABASE DATE 05/2004, 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 LABOR OPERATIONS. NON-ORIGINAL EQUIPMENT
MANUFACTURER AFTERMARKET PARTS ARE DESCRIBED AS AM, QUAL REPL PARTS OR COMP
REPL PARTS WHICH STANDS FOR COMPE'T'ITIVE REPLACEMENT PARTS. USED PARTS ARE
DESCRIBED AS LKQ, QUAL RECY PARTS, RCY, OR USED. RECONDITIONED PARTS ARE
DESCRIBED AS RECON. RECORED PARTS ARE DESCRIBED AS RECORE. NAGS PART NUMBERS
AND PRICES ARE PROVIDED BY NATIONAL AUTO GLASS SPECIFICATIONS, INC. POUND
SIGN (#) ITEMS INDICATE MANUAL ENTRIES.
file://CADocuments%20and%20Settings\09699\Local%20Settings\Temp\pdi\01295895... 08/18/2004
Wage 4 of 5
CCC PATHWAYS - A PRODUCT OF CCC INFORMATION SERVICES INC.
3
07/13/2004 AT 02 :42 PM 0129589530101110-01
46093
ESTIMATE OF RECORD
1996 GMC K1500 4X4 CLUB COUPE 8-5.7L-FI 2D LONG LT SLUE INT:GREY
ALTERNA'T'E PARTS USAGE
AFTERMARKET PARTS
AFTERMARKET SELEC'T'ION METHOD: AUTOMATICALLY LIST
NO. OF TIMES USER WAS NOTIFIED THAT AN AFTERMARKET PART WAS AVAILABLE: 0
NO. OF AFTERMARKET PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0
file://C:\Documents%20and°l%24Settings\u796991Local%24Settings\Temp\pdi\01295895... 08/18/2004
07/06/04 10:19 !T510/242,+ 5852 ; � � CHEVRON B&S ,rf) {�
STATE OF MWORMA *✓�Lc r ) r 7 r L✓t f} o l �.
DEPARTTIENT"OFCAI.IFORNIAHIGHWAY PATROL
G/s i✓7 [t R.l (^
TRAFFIC COLLISION REPORT -Prop"Damage DnlY
CHP 555-03(Rev.9.99) OPl 061 Otighiel to Offf r,copy(ies)to involved Party{fes)
- s3PCCdhLCCNdS'ftOti6 WCfBRUtd OtTY JtXift'�4AtIIi8TRICT NUAdeER
. CoU,4 Y REPORT1Nb BISTRiCT SEAT REPORTM OFMC€R
wICA
'coLIAMON 00OURREM ON MO, DAY YEAR nMe(2+400) Ncle OMCER 14,
A'r NTeASQ=4014WITH; DAY O?V&eK TOW AWAY STATE.HI WWAY AMATED
r w Qw. of C 84-" V, d Yes QNo C} Yes No
r:;DRIVER'sUCEeJ3EMUMSm STAM cuss SAFETYS UTPM SHADE (ALLIED AGENCY USE ONLY)
h Ot L'sG3 t:w DAMAGED Report taken Yes C} No
NAME t Alt,,-AfrtME,L481.7 cet C�"�:tit 3- 2+�� AREAExchange of infomatlon Yes No
IL
pED SmE'T ADDRESS t'►.sii.'i .
p, SEX„ 81RThZATF MiAFAPOg CARRWR-.'
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i l i AGE SEX NAtatE A00RESS PHONE TdLNUR PARTY NO.
PROP,' N 4ME' ADDR£95 DAMAGED PROPERTY w.
IMPORTANT-READ CAREFULLY
K43p thlr irepart:"Phis is your'record of this accident. To compiywith California Vehicle Code'(VC)Section Of}0 (duty where
,Mperty damaged), you must either.
a.>Give#he'owner or person in charge of such property the name and address of the driver and owner of the vehicle; or in the
absence of the owner,
f"
b. leave a Wi.itten notice In.a conspicuous place on the ether vehicle or damaged property,giving the name and address of the
driver&hd owner of the vehicle involved and a statement of the circumstances.
This information is necessary for the completion of your state SR-1 Form, Report of Traffic Accident, and your insurance report.
VEHICLE CODE SECTION 'tSti O
The driver of a vehicle involved in an accident resulting in.damage to the property of any ONE party in excess of$500 or in the
injury or death of any person MUST submit a SR-1 Form to the California Department of Motor Vehicles within 10 clays, or as
soon as possible.
r Note. Failure to comply may result in suspension of your driver's license.
3
i' Form SRS l may be obtained from the Department of Motor Vehicles,the California Highway Patrol,any police station, motor
.> veh€cle club, insurance agent, or DMV Internet web site(SR-1A).
If city or state property is damaged, you will be contacted regarding possible liability.
t' taw enforcement reports do not satisfy the IMV report requirement.
CLAIM PAYMENT SCREEN REVERSE X
CLAIMJ. _ _LOSS_ ADJR TIME FCC _IRS FIELD ISSUED'
01.295895301.01110 07 02 04 A158 17544748 03 _ 07 13 04
CHECK # TYP ID CO CHECK AMT FEAT C S AMT_ EXP FEAT C S AMT EXP
058730807 C LP 13 496 . 86 01.COL Y-- 496 . 86- - -�
CLAIMANT
ROSALINDA MORALES USER ID
U79S66 IN PAYMENT OF
INSURED AG CNP TYPE COLLISION COVERAGE
ROSALINDA MORALES - _ --CNP- - - P/L LESS DEDUCTIBLE
PAY TO JAIME MORALES
ENCLOSURE
P=POLICE REP F=FORM LETTER
C=CORRESPOND L=PROOF/LOSS
MAIL TO ROSALINDA MORALES M=MISC. I=INVOICES
R=RELEASES
IN Nomm VECTORING IRAN; CL`Q
KEY: 0129589530101110.�
C1CC7L
CLAIM
BOARD OF UPERYISORS OF CONTRA COSTA COUNTY •
BOARD ACTION: SEPT. 28, 2004
Claim Against the County, or District Governed by )
the Board of Supervisors,Routing Endorsements, ) NOTICE TO CLAIMANT
and Board Action. All Section refere � " q Y_ " > The copy of this document mailed to you is your
California Government Codes. f, ° "
6 �) : notice of the-action taken on your claim by the
Board of Supervisors. (Paragraph IV below), giver
Pursuant to Government Code Section 913 and
915.4. Please note all"Warnings".
AMOUNT: $179,844.00 and $2,704.00 per month
CLAIMANT: MASOUD VAFAEI AND MITRA PE.JMAN
ATTORNEY: UNKNOTAN DATE RECEIVED: AUGUST 23, 2004
ADDRESS: 392 COVENTRY ROAD BY DELIVERY TO CLERK.ON: AUGUST 23, 2004
KENSINGTON, CA 94707
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 SWV"2erk
Dated: AUGUST 23, 2004 By�: Deputy
II. MOM: County Counsel. TO: Clerk of the Board of Supervisors
(t,) "This claim complies substantially with.Sections 910 and 910.2.
t
( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so noticing 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: y: �
- B ' ;;` �`,..�Q n Deputy County Counse
� ' �,
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2)
( ) Claim was returned as untimely with notice to claimant(Section 911.3),
IV. ARD 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: OHN SWEETEN, CLERK.,By , Deputy Clerk
WARNING(Gov. code secti 7n 913)
Subject to certain exceptions, you have only six(d)months from the date this notice was personally served or depositec
in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an
attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so
immediately. *For Additional Warning See Reverse Side of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United
States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California,postage fully
prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above.
Dated: ." JOHN SWEETEN, CLERK By Deputy Clerk
Claim ta: BOARD OF SUPERVISORS OF CONTRA COSTA CM`i"Y
INSTRUCTIONS TO CLAI.A.ANT
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not, later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for -death or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any ether cause of action must be presented not
Later than one year after the accrual of the cause of action. (Govt. Code §911.2.)
B. Claims must be filed with the Clerk of. the mrd of Supervisors at its office in
Room 1.036, County Administration Building, 631 Rune 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 Claus must be
filed against each, public entity.
E. ' Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this
form.
RE: Claim By } Reserved for Clerk's filing stamp
" Vk AA tJ'a }
}
r } �
Against the County of contra--costa ) ¢�
or } AUG 2
District) � :;; 4 €.
n
The undersigned claimant hereby makes claim against the County of Contra Costa or
the above--named District in the sum of $ - .1and in support of
this claim represents -as follows:
.._
1. When dial the damage or injury occur? (Give exact date and hour)
2. Where did the damage or injury occur? (Include city and county)
3. How did theamage or injury occur? (Give full. details; use extra paper if
required)
,J r. to 1A ��>�
A
-- -....__—_.......__._
4. What particular act or omission on the part of county or district officers,
servants or .employees caused. the.injury or damage?
Wnat are the names of county or district officers, servants or employees caus�rzg
the damage or injury?
5. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
d
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or die-)
S. ?dames and addresses of witnesses, doctors and hospitals.�._..._._..
9. List the expenditures you made on account of this accident or injury:
DATE AMOUNT
Gov. Code Sec. 910;2 provides:
"The claim must be signed by the claimant
SEND NOTICES TO: (Attorney) orbsome n his behalf."
Name and Address of Attorney
(Claimant b( Signat r
kAddre�s
Telephone No. Telephone No. �ie_Z�,/,_
NOTICE
Section 72 of the Penal Code provides:
"Every person who, with intent to defraud, presents for allowance or for
payment to any state board or officer, or to any county, city or district board or
officer, authorized to allow or pay the same if .genuine, any false or fraudulent
claim, bill, account, voucher, or writing, is punishable either by imprrisoriment in
the county jail for a period of not more than one-year, by a fine of not exceeding
one thousand ($1,000), or by both such' imprisonment and fine-,,-,or by imprisonment in
the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by
both such imprisonment and fine.
ATTACHMENT I
Item I. Response to Question#4:
The drainage system on Coventry and the cross section with Ocean view are mis-
designed, severely undersized and not well maintained. Over the past number of years,
numerous calls have been placed to the County Public Works Maintenance Division
informing and complaining about this drain system overflow and damage to out
properties. The County call log records illustrate those attempts.
The County maintenance personnel usually arrive at best a couple of days after a heavy
rainfall when the damage has already been done and all they have done thus far is to
clean the storm lines. An event that has to yet take place since the last heavy storm of
February 2004.
The County has been aware of this problem and has been informed of its severity
numerous times yet this problem has been ignored by the County officials. Currently, the
damage and mold growth in our house make it uninhabitable.
Item II. Response to Question#5:
The Contra Costa County Department of Public Works and Public Works Maintenance
Division have the responsibility for design and maintenance of this system and they have
severely been negligent in both of these responsibilities. The long term neighbors for
40+ years can attest to this fact.
Item III. Response to Question#6:
Damages are to our property and to our health and include the following:
1) Mold growth due to the moisture problem
2) Damage to the foundation and slab floor due to storm water flow causing
settlement
3) Damage to the wall structure due to dry rot in wood structure and plaster
4) We are investigating the role mold growth in our house has had on Lung and heart
problems and failure my wife, Mitra Pejman has experienced and sensitivities
both myself and my 3 year old son have been developing.
Please see Exhibit II, Forensic Analytical Mold Testing Report and
Exhibit III, Dan Szumski, P.E. Structural Report.
ATTACHEMENT II Continued.
Item IV, Response to Question#8.
1. Andy Spear, 384 Coventry Road, Kensington, CA 94707
2, Jeff Rhode, 388 Coventry Road, Kensington, CA 94707
3. Farid Dormishyon, 387 Coventry Road, Kensington, CA 94707
4. Leonard Brandi, 391 Coventry Road, Kensington, CA 94707
5. David Eicohn, 393 Coventry Road, Kensington, CA 94707
6. Dr, Teresa De Marco, M.D.
Professor of Clinical Medicine
Director, Heart Failure and Pulmonary Hypertension Program
Medical Director, Heart Transplantation
Cardiology Division
Moffitt Hospital, Room 1176, 505 Parnassus Ave., San Francisco, CA 94143-0124
ATTACIIEMENT I Page 2 of 2
Masoud Vafaei&Mitra Pejman Claim
Masoud Wild & Mitra pe'Innan
392 Coventry Road,Kensington,CA 94707
Celt: (510)406-601
Horne: (510)558-1119
Fax: (206)350-4789 4
rnasoudvafaei@yahoo.eom i V
June 16, 2004
Mr. Maurice Shiu, Director
Public Works Department
Centra Costa County
255 Glacier Drive
Martinez, CA 94553
RE: Inadequate Surface gain System on Coventry & Ocean View, Kensington
Dear Mr. Shiu,
I am a Professional Engineer and my wife Mitra Pejman is a Software Architect. We
reside at 392 Coventry Road in Kensington with our three year old son, Our health and
safety as a family are at risk due to the inadequacy of the street storm drain system on our
block. Annual surface drain backup flows through our property causing a serious moisture
problem leading to mold growth in the wall structures. This problem has caused damage
to the foundation and the structure of our building and is a continuous and serious health
hazard to our family.
Since we moved to this house over four years ago, my wife has been experiencing
progressive respiratory difficulties. Her lung and heart weakened quickly and led to
frequent hospitalization during the past:year. At age forty one, after months of stay in the
Intensive Care Unit at UCSF Hospital, Mitra received a heart transplant in February 2004.
She and a few other patients were the subj ect of a news report covered by The S.F.
Chronicle during that time.
Mitra was discharged from the hospital in mid-March 2004 with doctor's order to avoid
moldy environments. Therefore, she has not been able to live at our home awaiting
removal of moldy structure and correction of the street drainage system. Since mid-March
she has been staying with family and friends, further dividing and burdening our family
life.
We are awaiting a resolution to the street drainage problem and the removal of the rotted
and damaged structure of our house so that we can return to our home and live in a safe
environment.
M.vafaei&M. Neiman Page I of 3
Exhibit i shows the lot our house is situated on, lot#15 in the 300 block of Coventry
Read. The general slope of this area is Northeast-to-Southwest. Storm water
flows downhill on Ocean View Avenue southward and on Coventry
westward. Overflow occurs at the Northeastern corner(identified as "A") and
at the Northwestern corner(identified as"B") of this intersection. The drain
intakes at this intersection are not adequately designed to handle the high
velocity of storm runoff coming from Coventry and Ocean 'View. As a result
the majority of the water bypasses these intakes to the next smaller intakes at
point"C" and "D". The result is drain backup and water flow through our
property causing the mentioned damages.
Exhibit 2 through 9 are photographs taken at 9:47 A.M. on February 25, 2004
approximately 5 to 10 minutes after the rain storm subsided during the latest flood of 2004.
Please note that the massive water flow adjacent to our house shown in the attached
photographs shows a flow lower than the peak flow during this storm.
Exhibit"2" shows the flood water flowing against the side of our pause. This is fast
flowing water corning from uphill streets with a few hundred feet elevation
difference. This flow damaged our fence and entered the garage and the
lower living area of our house causing damage to our belongings.
Exhibit "3" shows the flooded sidewalk in front of our house looking westward on
Coventry.
Exhibit"4" shows Coventry westward with the backup flow at intakes "C"and "D"
Exhibit" " is taken at the intersection of Coventry and Ocean View looking westward
and showing flow bypassing intake "B"
Exhibit "h" is a closer look at intake "B".
Exhibit "7" shows intake"B" in dry conditions, not designed to accept a downhill fast
flow.
Exhibit "S" shows intake"A" in dry conditions.
I trust after viewing these photographs you can grasp the magnitude of this problem
reoccurring a number of tunes every winter. Other than the neighbors, I personally have
placed a number of telephone calls to the maintenance division of the Public Works
Department daring each flood and informed the County of the problem by discussing the
situation with the dispatch coordinator taking calls or by leaving detailed messages on the
Maintenance Message Line. The response has always been at the earliest a day or two
later, and all that the County has done thus far has been to occasionally clean the drain of
debris, an effort that has yet to take place this year since the subject storm in February.
About two weeks ago I called and explained this situation and nay complaint with Ms. Kim
Derryberry in the Maintenance Division of Public Works Department where she assured
me that she will pass my complaint to the responsible Civil Engineer and that the Engineer
will followup with me. To date I have not had any calls from the Public Works
Department.
M.'Vafaei&M.Pej nan Page 2 of 3
The inadequacy of this street storm drain system has significantly undermined the
structural integrity of our home and continues to be a health and safety hazard to our
family. This problem requires your urgent attention and the Department's expedited
correction efforts. We have the following requests:
1) Correct the drainage problem before the next rainy season.
2) Compensate us for the repair of the structural damage caused by this long neglected
problem.
We have pursued legal console regarding this problem and have been advised to directly
discuss this matter with yourself and seek a resolution before any formal legal proceedings.
Also, we are in the process of obtaining a structural damage assessment and repair costs
which will be available for you review at your request.
We hope that you can understand this extremely difficult situation and our distress and that
you would facilitate our requests so that we can return to our home without any further
health risks.
Thank you for your assistance in expediting this matter, please feel free to contact me on
my cell phone at(510)406-6010 if you need any further information or clarification.
Sincerely,
y
Masoud Max Vafaei, P.E. Mitra Penman
Cc: Mr, John Gioia, Contra Costa County Board of Supervisors, District One
Mr. James Carman,Chairman, Kensington Municipal Advisory Committee
M.Vafaei&M. Pejman Page 3 of 3
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MICROBIAL INVESTIGATION REPORT
Findings.... of Non-Viable Air Sampling
Site: Pejman Residence 1
392 Coventry Road
Kensington, California 94707
Subject: , Report on airborne fungal results.
__..._._.._._.._,. ......_.__....._.. ..._....... __ _._...._._.._......_.__...._...._....... _._.........._...__.........._............._...._..._..._1
Date: ; Nlarch 4,2004
__ .................. _ =::_-_---_.._-- _._.._.._.__.___.w. _,... _._____.......
.._ ....J.-:�
Prepared for: ' Mr. Masoud Pejman
392 Coventry Road !
!..._..__-.._ _. . ....._........,.. ._......_Kensington,-California 94707 - _. . _
j..::...........: ::. ... .._... ...__........._ .._..__.._.__.__._..__..._.. _.._ ._ W.__... .._-. ...
_.._ ....._...._......._._..............___...__._.... __......_....._.._._......_..........._......._.._._......._......_....__......._..._._......_....._.........._.....,. ..........
Prepared by: Kathleen Muntzel
Forensic Analytical Specialties, Inc. �
[,FASI Project#: RHE 100--11--.......... / HE 8682
................. ........... ...........
Contents
Introduction
Observations & Sampling
Conclusions & Recommendations
Limitations
Laboratory Report
Introduction
It was our understanding that rainwater entered into the garage of the residence and that existing microbial
growth was observed on the interior of the residence predominantly around the windows. We further
understand that the homeowner has covered the growth with clear tape and wanted to test the residence to
determine if there were airborne fungal spores present. At the request of Mr. Pejman, Ms. Kathleen
Muntzel of Forensic Analytical performed non-viable air sampling of the residence located at 392
Coventry Road in Kensington, California on March 2, 2004. This report contains the Endings of that
testing.
t)bservations & Samnling
Laboratory report is attached. Assessment findings are discussed below in Table 1.
Table 1 March 2,2004 Assessment Observations& Sampling Summary
Master Bedroom- isualf Findings— A paCch was observed under one of the windows. j
The room was reasonably iiee of visible mold growth, dust, and debris. j
Aires---Types of spores slightly different and concentration of spores substantially - X039793:
higher than outdoor controls (Stachybotrys). X444579
i;kf'1 "i"r1 1L:ISCC) " Los Angeles a Sacraimnto • Las Vegas * Chicago e rtris
Pejnian Residence
392 Coventry Road,Kensington,California
Garage�----Visual?�iadin�s---•S�gnifieant amount of contents pxevented observation of all
surfaces. The majority of wall surfaces were concrete.
Air Sarnl.e Types of spores approximately the same and concentration o spores slightly 1F03793:
544577
higher than outdoor controls (Sttachybotrys).
Moisture Findings-Selected building materials within normal ranges. 'M
I Kitchen,Family Room and Lining Room reasonably free of
visible mold growth, dust, and debris.
Composite Air Sample—Types of spares approximately the same and concentration of F039793:
j smoderately higher then outdoor controls (Stachybotrys)., 5485334
poae4
Second Bedroom—visual Findings—Minor amounts of microbial growth were observed
around the window. The homeowner had placed clear tape over the mold growth.
_...�... _._.... -- l"039793:
Exterior.---AilS<tm les----Two samples collectedd for use as control samples, one in the front 5478933
yard and one in the back yard. 5478346
L(1) Findings indicative of significant microbial growth/contamination listed in bold punt. Listed as"report#* sample W'
Conclusions cit Recommendations
Slightly to Substantially higher levels of Stachybotrys were detected in the residence indicating an indoor
reservoir source. Additional cleaning and/or removal are recommended.
Limitations
The above findings, conclusions, and recommendations are indicative of conditions that existed at the
time: of the investigation and are subject to the limitations and variability associated with the investigation
methodology. It should be noted that these conditions could change as a result of any number of factors,
including environmental parameters, fungal growth patterns, and activities in the area. In this case, the
limited number of samples only allows for large differences to be observed with any degree of
significance. In addition, the non-viable spore analysis cannot identify spores down: to the species level.
This report is not intended to guarantee that the subject site is or is not free from conditions that could
pose a threat to human health or safety. Commonly accepted guidelines in the industrial hygiene industry
maintain that the uncertainty inherent in microbial sampling precludes investigators from definitively
concluding or proving that an environment is"safe". However, these guidelines recognize that sampling
and inspection findings may be used to support the assumption that an environment presents conditions of
acceptable risk.
If you have any questions regarding this report, or require any additional information, please do not
hesitate to contact our office.
Respectfully,
FORENSIC ANALYTICAL
Kathleen Muntzel
Environmental Services Division
forensic Analyticat
�n 4�r;m isc�� + his Angelc s 0 5ikcl,111100to � i_ir;ifs}ar3s � Chicago m Portland
- Forensic AnalyticalFinal Report_._-_-_
Mon-Viable Air Fungal Analysis
Hayward ESD Residential Client 11): RHE100
Masoud Pe}man Report Number: F039793
392 Coventry Rd. FASI.Fob ID. HE8682
Date Received-, 03103104
Kensington,CA Date Analyzed: 03103104
Date Printed: 03103/04
Sample Type. Won Sampler First Reported: 03103/04
Analysis; Direct Microscopy,FASI Method IAO 101
Job ID i Site: 392 Coventry Rd.,Kensington 94707
Lab Number 40050733 40050234 44050235
Sample iD 5478933 5444579 $444577
Location Outdoors-front Indoors-master bedroom Indoors-garage
Sample Date 03102104 03102104 03102104
Volume 75,0 L 75.0 L 75.0 L
Organism Spores' °f. Lt3D SimiS ores % L D I Sim S res° % LOD Sims
Alternarla 1 5.9 52F'
Ascospores 2 1118 52 ; > 1 2.4 52 ,r:,' ` 1 1.2 52
Basidiospores 6 35.3 52 xF';' 22 52.4 52 � a _ 73 88.9 52
Cladosporium 4 23.5 52 4 9.5 52 3rsxyfi 5 6 52
Other coloriess
Cather dark 1 5,9 52h 1 2.4 52
Pe3nlclillurn 1 Aspergillus 3 17.6 52 _ ;' 8 19 52 ?s 3 3.6 52
Rustsismuts -
Stachybotrys 6 44,3 52 <; 2 2,4 52
s
5
s
1
2 1
Total 17 890 42 2,200 84 4,400
Particulate Density Minor Abundant Major
Comments
Page 1 of 3
;777 E7c poi Ito,ad, Suitor 401), tiaayw,al, Califor ii,a 941,45-276l •R4pphoiw:_i fO/887-88211 800/827-FASI rax:5 10/887-42 18
Forensic Analytical Final Report
Nan-Viable Air Fungal Analysis
Hayward ESD Residential Client 10: RHE100
Masoud Polman Report Number: E039793
392 Coventry Rd, FAST Job ID: HE8682
Date Received: 03/03/04
Kensington,CA Date Analyzed: 03103/04
Date Printed: 03103104
Sample Type: Zefon Sampler First Reported: 03/03/04
Analysis: Direct Microscopy;FASI Method IAQ 101
Jots ID/Site, 392 Coventry Rd,,Kensington 94707
Lab Number 40050236 40050237
:Sample ID 5478946 5485934
Location (Outdoors-track Composite sample lly./famd kit
Sample Date 03/02/04 03102/04
Volume 75,0 L 75.0 L
(Organism S es* % LOD Sim' S ores* % LOD 1 23tm' Spores* % LOD I Simil '
Alternarla - -
3'11!`' ��,� 1 2.9 52 �
Ascospores 6 7.5 52 1 2.9 52
basidiospores 55 68,8 52 a l z 8 23.5 52
Cladosporium 1 1.3 52 9 26.5 52
Other colorless 2 5,9 52
Cather dark 1 1.3 52 ; 1 1 2.9 52
Peniclillum t Aspergillus 17 21.3 52 ," k 3 8 23.5 52 r, ,
Rusts/smuts 52 `314 NU
Stachybotrys - - ', ..< 3 8.8 52
�i
n f MON
X°. tp c ,#je w, z -.5' .i^ c' +3 2yarrsy4
t` is r�tiIW fit:•.,: )/ a{.=,3:y
WA
4 � 3r
✓5 k��?`?Isi� � _.„,,`.?1���i,rj�h ,;y�ff rdxY s'rF,
� ,f
`` $ �tl�t..w �r .�h•V,fy`3t �sS 1 az` '.P(
Total 80 4,200 34 1,800
Particulate Density Minor Major
Comments Pollen and algae present
Page 2 of 3
3`/77 Telephone:Ctnaci, Suiir�409, 1 ltrywttrcl,C:�#iiforrua�34�i�1 -2761 *Telephone:510/887-8828 800/82 7-FASI l=ax:530/887-4 38
Forensic Analytical Final report
Non-Viable Air Fungal Analysis
Hayward ESD residential Client ID: RHE100
Masoud Paiman Report Number: F039793
392 Coventry Rd. FAST Job 10: HE8682
Date Received: 03/03/04
Kensington,CA Date Analyzed: 03/03/04
Date Printed. 03/03104
Sample Type: zefon Sampler First Reported: 03/03/04
Analysis: Direct Microscopy,FASI Method IAQ 101
Job ID t Site: 392 Coventry fid.,Kensington 94707
Explanations: Background inarticulate Density Estimated As Follows:
Spares' Actual number of spores counted In portion Trace Very little present
of sample examined Minor Present but not In large quantity
% Percent of Total Major Present in most of sample
LOD Limit of Detection Abundant Covering almost entire sample
Sim 3 Spores per cubic meter of air sampled Overloaded Covering entire sample
Spores/S Number of spores per sample
Not included In Totals Calculations
TNTC Too Numerous To Count
NO None Detected
Particulate Density Amount of background particulate present
Guidelines For interpretation,
No accepted quantitative regulatory standards currently exist by which to assess the health risks related to mold exposure. Molds have been
associated with a variety of health effects and sensitivity varies from person to person.0
0
Several organizations, including: the American Conference of Governmental Industrial Hygienists (ACGIH), the American Industrial Hygiene
Association (AIHA), the Indoor Air Quality Association(IAQA); the United States Environmental Protection Agency (USEPA), the Centers for
Disease Control (CDC), as well as the California Department of Health Services (CADHS), have all published guidelines for assessment and
Interpretation of mold resulting from water Intrusion In buildings.
Tara Dubey,Microbiology Laboratory Supervisor,Heyward Laboratory
Analytical results and reports are generated by Forensic Analytical at the request of and for the exclusive use of the person or entity(client)
named on such report. Results, reports or copies of same will not be released by Forensic Analytical to any third party without prior written
request from client.This report applies only to the sample(s)tested.Supporting laboratory documentation Is available upon request.This report
must not be reproduced except In full, unless approved by Forensic Analytical.The client is solely responsible for the use and Interpretation of
test results and reports requested from Forensic Analytical. Forensic Analytical Is not able to assess the degree of hazard resulting from
materials analyzed. Forensic Analytical reserves the right to dispose of all samples after a period of thirty(30)days,according to all state and
federal guidelines,unless otherwise specified.Unless otherwise noted, these samples were not blank corrected. All samples were received In
acceptable condition unless otherwise noted.
Page 3 of 3
3777 Df,pot Road, Suito 409, 1 hywwi, C,liforni�t 94545-"1.76'1 •lelerthono: 510/887.8828 80(1tR77_FAgt 4 ;If,No' ,11,
DAN SZUMSKI, P.E. C30167
CIVIL ENGINEER/STRUCTURAL DESIGN
August 2, 2004
Mr Masoud Vafaei
392 Coventry Road
Kensington, CA 94707
Re: Engineering inspection - 392 Coventry Road, Kensington, CA
Dear Mr Vafaei :
I have conducted an engineering inspection of the above
referenced property to assess drainage problems that occur during
large storms. My inspection included a visual inspection of the
home and its foundations, the back yard, and street drain inlets
in the home' s vicinity. This letter report provides a summary
report of my inspection findings, and my recommendations for
ramedi.at ion.
The homes is a one story wood framed structure that is :Located on
a slightly downsloping lot in an area of Kensington that is
underlain by clay soils . The home has a finished basement beneath
the back third of the structure, an attached garage with living
space above it at the south end of the west side, and a crawl
space beneath the front portion of the home.
I have reviewed the photographs of storm conditions that you took
last February 25 , 2004 during high volume rainfall events . These
photographs show water in the street gutter at the front of your
home.,_ and the .two homes tothe west . Water is shown rushing down
the driveway of 388 Coventry Road, and dawn your driveway. This
storm' s runoff had exceeded the capacity of the storm drain
inlets in front of your home, and caused water to run through
several yards on the downhill side of Coventry Road, and into
properties at the north side of Oak View Avenue.
I can see that this problem has a history; The unreinforced brick
wall in front of 388 Coventry Road appears to have been
constructed as a means of diverting water around that property. I
also noted the newer street storm drain inlets in front of your
neighbors to the gest, and across the street . These appear to
have been an attempt by the County to remediate this problem in
the past . The storm water catchment across the street intercepts
water and conveys it under the street to the drop inlet in front
of your neighbors property. It then flows eastward, probably to
513 F STREET 0 DWS, CALIFORWA 95616 + CELL: 510.41807155; FAX: 530+758.5832
the storm sewer running beneath the intersecti
foundation repair work and garage flood control structure, you
must be sure to complete at least the foundation project by the
time that next years floods occur. Having the homes on cribs with
so much water flowing to the site, could place the home in
jepordy. Also any new foundation would be at risk of being
damaged by future, large storm flows
This inspecti
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CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY �► •
BOARD ACTION:
Claim Against the County, or District Governed by )
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
and Board Action. All Section } {- ) The copy of this document mailed to you is your
fif `.' notice of the action taken on our claim b the
California Government Codes. �� ) 1 y y
Board of Supervisors. (Paragraph IV below), giver]
Pursuant to Government Code Section 913 and
915.4. Please note all "Warnings".
AMOUNT: t;stimated $170,000.00 - $200,000.00 or more
CLAIMANT: PAUL D. FORD AND JULIE A FORD
ATTORNEY: PAUL M. KOENIG DATE RECEIVED: AUGUST 24, 2004
ADDRESS: 1450 MARIA LANE, SUITE 400 BY DELIVERY TO CLERK.ON: AUGUST 24, 2004
WALNUT CREEK, CA 945:96
BY MAIL POS'T'MARKED: HAND DELIVERED
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN S
AUGUST 24 2004 WE T Clerk
Dated: By: Deputy
1I. FIROM: County Counsel TO: Clerk of the Board of Sup isors
(,-)"'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 Counse
111. FROM; Clerk of the Board TO: County Counsel (1) County Administrator(2)
( } Claim was returned as untimely with notice to claimant(Section 911.3).
1/OARD 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; '« 4—'JOHN SWEETEN, CLERK, By , Deputy Clerk
WARNING(Gov. code section 913)
Subject to certain exceptions, you have only six(6) months from the date this notice was personally served or deposite(
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
1 declare under penalty of perjury that 1 am now, and at all times herein mentioned, have been a citizen of the United
States, over age'18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully
prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above.
Dated: ' ' d JOHN SWEETEN, CLERK.By Deputy Clerk
BOARD OF SUPERVISORS OF CONTR k COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A A claim relating to a cause of action for death or for injury to person or to personal
property or growing crops shall be presented not later than six months after the
accrual cif the cause of action. A claim relating to any other cause of action shall be
presented not later than one year after the accrual of the cause of action.
(Gov. Code § 911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room
106, County Administration Building, 651 Pine Street, Martinez, CA 94553.
C. If claim is against a district governed by the Board of Supervisors, rather than the
County, the name of the District should be filled in.
D. If the claim is against more than one public entity, separate claims must be filed
against each public entity.
E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form.
a a a a a a a a a a a a a a a a a a a a a a a a a a a■■asaaaasasaasaasis•aaaaaaaaaaaaaaaaaaaaaaaaaaaaaa
RE: Claim By. Reserved for Clerk's filing stamp
ryt-u. r-:'eft b ',IVL 19 A . F4VtO
Against the County of Contra Costa or }
} AUG 2
District)
(Fill in the name) �-
��atf.
)
The undersigned claimant hereby makes claim against the County of Contra Costa or the
above-named district in the sum of$Pc, oe>v ..— and in support of this claim represents
as follows. y v 'o
1. When did the damage or injury occur? (Give exact date and hour)
2. Where did the damage or injury occur? (Include .pity and county)
3. How did the damage or injury occur? (Give full details, use extra paper if required)
0 ?1f11 tv ;�";X1+2y!?%,/Ppt �'6' 1eY 4 jPi � /rc�ls—
4. What particular act or omission on the part of county or district officers, servants, or
employees caused the injury or damage:'
c:. L�/D?5:5 !'r-A'a-?.,5 ' -''�C-r p�J,r,a,> r ry A 7-1 -9 C ,-J li Z) 4,
5 What are the names of county or district officers, servants, or employees causing the
damage or injury.? jv,.0,V k 1-:,e---,�-J
6. What damage or injuries do your claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.)
go t- P 1VO r'' A7 -r-6
7. How was the amount claimed ab6ve computed? (Include the estimated amount of any
prospective injury or damage.)
8. Names and addresses of witnesses, doctors, and hospitals.
9. List the expenditures you made on account of this: accident or injury.
DATE TIME AMOUNT
t3 ' t 3_7 j 1 ✓k J rte + z c, r ! e
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4
) Gov. Code Sec. 910.2 provides "The claim shall b er•-f u
)signed by the claimant or by some person on his
behalf." I Aqr`iih (3
SEND NOTICES TO: (Attorney] 1 � 1)� wsik3
Name and address of Attorney ) � {
. A/I G ems' Tye a-',,�r�.
(Claima is Signature) talc;"-~ 0 j-11.?,.9
A
�
(Address)
157 15,9
)
Telephone No. ,W ) Telephone No. ` `
is a a a a s srss■a:a■a ass aaaa/•ssis5 a a a sssss ass a a a a a■a r Garr■0■arrasaars as■ aaasssssa aaass
NOTICE
Section 72 of the Penal Code provides:
Every pet-son who, with intent to defraud, presents for allowance or for payment to any state
board or officer, or to any county, city, or district board or officer, authorized to allow or pay the
same if genuine, any false or fraudulent claim, bill, 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 dollars ($1,000.00), or by both such imprisonment and fine, or by imprisonment in the
state prison, by a fine of not exceeding ten thousand dollars ($10,000), or by both such imprisonment
and fine.
PAUL M. KOENIG,CSB No. 45453 "
1450 Maria Lane, Shite 400
Walnut Creek,California 94596
F6
Tel. No. (925)944-1960,Ext. 23 AUG 24
Fax No. (925)939-2219 ;�
E-mail Address: pmkoenig@pacbell.net s ,����.� ry`
Attorney for Claimants Paul Ford,Julie Ford,
Claim of PAUL D. FORD and JULIE A. } CLAIM FOR INJURY TO REAL AND
.FORD } PERSONAL PROPERTY AND FOR
PHYSICAL AND EMOTIONAL DISTRESS
Claimants, }
}
against }
THE CITY OF ORINDA,ORINDA CITY j
COUNCIL,ORINDA PUBLIC WORKS }
DEPARTMENT,ORINDA PLANNING }
DEPARTMENT,ORINDA }
ENGINEERING.DEPARTMENT, }
COUNTY OF CONTRA COSTA, }
CONTRA COSTA COUNTY BOARD OF }
SUPERVISORS,CONTRA COSTA }
COUNTY BUILDING INSPECTION }
DEPARTMENT )
Respondents. }
TO: CITY OF ORINDA,ORINDA CITY COUNCIL,ORINDA PUBLIC WORKS
DEPARTMENT, ORINDA PLANNING DEPARTMENT,ORINDA ENGINEERING
DEPARTMENT,COUNTY OF CONTRA COSTA,CONTRA COSTA COUNTY BUILDING
INSPECTION DEPARTMENT,and CONTRA COSTA COUNTY BOARD OF SUPERVISORS:
i. You are hereby notified that Paul D. Ford and Julie Ford, whose address is 549
Miner Road,Orinda, California 94563,claim damages from the City of Orinda,The City of
Orinda,Orinda City Council,Orinda Public Works Department,Orinda Planning Department,
Orinda Engineering Department,County of Contra Costa,Centra Costa County Building
Inspectidn Department,the Contra Costa County Beard of Supervisors,and all other relevant
agencies and entities of the City of Orinda and Contra Costa.County(hereinafter collectively
referred to as"Respondents")in an amount that exceeds$10,000 for damages to real and
personal property,and for physical and emotional distress.
2. Claimants are informed and believe and thereon state that the City of Orinda has
contracted with the County of Contra Costa for the county and county departments to perform
some of the City of Orinda's responsibilities relevant to the claims herein, including but not
limited to building inspection services.
3. Claimants do not know the names of the public employees who caused Claimants'
injuries and damages.
4. Jurisdiction over this claim would rest in the Superior Court in and for the County
of Contra Costa.
5. This claim is based on damages sustained on or about February 25, 2004,and
continuing thereafter to be sustained by Claimants arising out of and caused by acts and failures
of Respondents, including but not limited to as follows: failures to plan,construct and maintain
drainage systems,drain pipes,and other drainage components belonging to the Respondents or
either of them and/or Respondents,or either of them,have responsibility; the failure to address
concerns brought to the attention of Respondents or either of them relating to the inadequacy of,
recommended sizes of,and/or other recommendations regarding the drain system and drain
pipes;the failures of Respondents to protect persons and property, including Claimants persons
and property, from runoff and water-which is to be carried off through Its drainage system;
failures to properly maintain and keep clean and clear the drainage system and drain pipes in a
clean and clear condition;the failures to follow recommendations and procedures to maintain„
operate its drainage system and drain pipes; and failures and negligence in protecting the public
and property,including Claimants.
6. Claimants are informed and believe and thereon state that said acts of
Respondents were careless,reckless, in disregard of the safety of Claimants and their property,
and in violation of their responsibilities to individuals and their property.
7. As a result of Respondents failures and Respondents' negligence in carrying out
and perform their duties,Claimants have been damaged in that on or about February 25-,2604,
the drain system failed to properly drain water,such that the-eater overflowed and poured into
and onto Claimants' property,flooding and damaging their home,the real property, Claimants'
personal property,and causing severe physical and emotional distress. The exact amounts of
such damages are not known at this time,but exceed$10,000, exceed the amount for limited
civil cases, and therefore the claire would not be a limited civil case. Claimants are likely to
incur future and fin-Cher damages in an amount which is not known at this time,including for
further repairs to the property, for expenses to protect the property from further damage in future
rains, and to avoid damage as a result of the failure of respondents to perform their duties and
obligations.
i1
7
8. All notices or other communications with regard to this claim should be sent to
Claimants at 549 Miner Road, Qrinda,California 94563 and to their attorney,Pari M. Koenig,
1450 Maria Lane,Suite 400,Walnut geek,CA 94596.
z
Paul D. Ford
r Jure For
Paul M. Koenig, Attomey for PZI D. Ford
and Julia Ford