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HomeMy WebLinkAboutMINUTES - 09192006 - C.34 1 C 130AItD OF SUPERVISORS OF CONTItA COSTA COUNTY BOARD ACTION: SEPTEMBER 19, 2006 Claim Against the County, or District Governed by MEW- Bciard of Supervisors, [touting Endorsemeiats, ) NOTICE TO CLAIN1AN'l' and Board Action. All Section references are to ) The copy of this document mailed to California Government Codes. ) you is your notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), jgiven Pursuant to Government Code AUG .14 2006 Section 913 and 915.4. Please note all A1\I.C)iJN"1': $6,760.07 "Warnings". C.I_,AJN/IANT: DEBORAH FOSTER COUNTY 11,�IARTINEZ CALIF. ATTOlt-NFY: UNKNOWN DATE R-ECEIVED: AUGUST 14, 2006 BY DELIVERY TO GLER.K. ON: AUGUST 14, 2006 ADDRESS: 277 COLIMA, PITTSBURG,. CA 94565 BY NIAIL POSTMARKED: HAND DELIVERED FRONa Clerk. of the Board of Supervisors ----TO: County Counsel - ------ Attached is a copy of the above-noted claim. JOAN CULLEN, r Dated: AUGUST'14, 2006 By: Deputy 1. FROM: County Counsel TO: Clerk of the Board of Supervisors ( fhis claim complies sa.abstantially with Sections 910 aiid .910.2. ( ) This Claiin FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 clays (Section 910.8). O Claim is not lively filed. The Clerk should return claim on grotllid that it was filed late and send warning of claimant's right to apply fir leave to present a late claim (Section 911.3). ( ) Other: ----- - - ----- ------- ---- --- - L)ated: By: M lleputy County Counsel Ill. FR.ONI: Clerk of the Board TO: County Counsel (1) County Administrator (2) O Claim was returned as untimely with notice to claimant (Section 911.3). IV I )A.R.D CM-13FIt: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. . I certify that this is a true and correct copy of the Board's Order entered in its minutes for. this date. Dated- _ 1fAW,9LJLLEN, CLERK, By Deputy Clerk WA_[tNIN(i (Gov. code section 913) - --- -- - --_- Suhimt to cerflain exceptions,you have only six(6)moullis from the date this notice was personally served or(leiaositetl in the mail to lile o court action on this claim.See Government Code Section 945.6.You may seek theadvice of an alto ney of your choice in connection with this matter: If you want to consult all atlorney,you should do so immediately. *.For Additional Warnurg See Reverse Side of ZLis Notice. AFFIDAVIT OF MAILING declare under penalty of per.iuiy that I am now, and at all times herein mentioned, have been a citizen (Qf the United States, over age l8; and that today .I deposited in (lie United Slates Pmgl:al ricui,icc in I\I:arlinez, Caaliforltia, Imsinge Ia►Ily. l►relmicl .1 certified cul►y of Ibis 13om d (Ji der :and Notice fo Cl:aimaual, :uldressed fo file Claimant as shon'n :above. 1.:►<ate�i ,�,�v e .�Id l 1.11_.I_.I:?I'J C L RT' D, - - - - -Deputy Cleik This warning dues nol apply I(► claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mantlamns or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be tiled may be shorter at- longer depending nn the nature of the claim. Consult the specific statti.tes and cases applicable to your particular claim. The County of Contra Costa does not waive any of i.ts rights under Califorui.i Tort Claims Act: nor sloes it waive rights antler the statutes of limitations applicable to actions not subject to the California Tort Claims Act BOARD OF SUPERVISORS OF CONTRA 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 of 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. No on REASON so noway no 0 me as a was a ago 5 0 9 RE: Claim By: Reserved for Clerk's filing stamp Deborairuste; -- ems N F�os���e RECEIVED 277 Colima Pittsburg California 94565 Against the County of Contra Costa or ) AUG 1 4 2006 West County DetP.ntaoa Fac#x Rirhmnnd District) CLERK BOARD OF SUPERVISORS (Fill in the name) Califom ) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ 6760.07 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) June 23,2006 8:00 p.m. 2. Where did the damage or injury occur? (Inclu+3e city and county) West County Detention Facility, Richmond California, Building 8 side A In the upstairs shower . 3. How did the damage or injury occur? (Give full details;use extra paper if required) After showering the show curtain fell,I was required to stand on a plastic chair to hang the curtain,The chair slipped and I fell to the floor. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? Being instructed to hang the shower curtains by standing on plastic chairs,Not having non-skid floors.Not having dry floors all the time, 5 What are the names of county or district officers,servants,or employees causing the damage or injury? Dputy Wong and every Deputy that works in building 8 A at the West County Detention Facility 6. What damage or�injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) Neck,Shoulders,Left and Right side.,Upper back,Middle Bade, Lower Back,Hip joint,Left and Right sides, Knees,Shins,and both Ankles, Bruised,muscles pulled,Sprained,Rotater cups wh�e damaged. 7. riow was. the amount claimed above computed? (Include the estimated amount of any prospective injury or.damage.) 6315.07 in Medical Bills 345.00 in prescriptions a copy of each is attached. 8: Names and addresses of witnesses, doctors, and hospitals: Dr.Danlel Ubke,Dr.Kellie Amador, Dr.Allen P.Drabinsky Mt.Diablo Medical Center 2540 East St. In to Monica IWmarez Concord California 94520 9. List the expenditures you made on account of this accident or injury:. DATE TIME AMOUNT 7/11/06 3:00 p.m. 555.Q93 ■.....r.■ 72006 ..........■ : .ii..................■■.sailr lri l ................ `/� "Alp.m. �'L .i pus 0 . r ) Gov. Code Sec. 910.2 provides"The claim shall be signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney) Name and address of Attorney (Claimant's Signature) } Pro/Per: Deborah Foster ) 277 Colima (_Address) Pittsburg California 277 Colima Pittsburg California 94565 94565 Telephone No. )Telephone No. p S .............215::0r5:Q3f¢..........................231 i7 91-MA........................... PUBLIC RECORDS NOTICE: Please be advised that this claim form,or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthermore, any attachments,addendums,or supplements attached to the claim form, including medical records,are also subject to public disclosure. 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 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. 1 .. MT. D IA B LO MEDICAL` CENTER Tek you for selecting John Muir-ML Diablo Health System for t your healthcare needs.Quality patient care and dedication to Jobn Muff'/Mt Diablo Htaltb Systtrri patient satisfaction are our highest priorities. PO Box 44000 Deparbrierd 44261 San Francisco,CA 94144-4261 Our records indicate that you have no insurance for the services 0000s-m,steer listed below.Please note the various payment options listed on the bade of the statement We also have added preventive healthcare and educational news. FOSTERHAMMOND,DEBORAH D We hope to serve you again if a health need arises. 41 HANLON PL PITTSBURG CA 94565-3507 Il�lrrrlrrl�lrl�mlt�rrl�lrmrllrrlrlrll�m�l�rmlrlrrlrrrllrrrlll Statement Date 07/15/06 DESCRIPTION AMOUNT Service Date(s) 07/11/06-07/11/06 PHARMACY ' 25.18 Patient Name DEBORAH D FOSTERHAMMOND EMERGENCY ROOM 530.75 Account Number H019685064 yeg-- - — - 550:93._ ~s pending with insurance 0.00 Total Insurance Payments/Adjustrrm is 0.00 What You Owe Now 555.93 Please confirm that information is correct Primary NONE ON FILE-Please call if you have Insurance insurance.or complete the back of this • Billing questions or changes in insurance coverage? Group(Plan statement and mail back to the hospital * ( 9-47-3336 �'to 4:15 pm weekdays John Muir/ML Diablo Health System Secondary Attn:Patient Accounts PO Box 44000 Insurance Department 44261 Group/Plan San Francisco.CA 94144-4261 Please Note: Your physician will bill separatel}for their professional sen-ices. �~ -- Statement Date:07/1: MT. D I A B LO MEDICAL CENTER Thank you for selecting John Muir-Mt. Diablo Health System for your healthcare needs.Quality patient care and dedication to Jobn Muir/Mc Diablo Health Systan patient satisfaction are our highest priorities. PO Box 44000 Department 44261 San Francisco,CA 941444261 Our records indicate that you have no insurance for the services OWW-r,313MI listed below.Please note the various payment options listed on the back of the statement We also have added preventive healthcare and educational news. We hope to serve you again if a health need arises. FOSTER DEBORAH D COMA PITTSBURG CA 94565-3650 ILLr�I�rL6L�ILrrlrlIrrl6gill rohill 11rdrrrllogo III III l Statement Date 0724106 DESCRIPTION AMOUNT Service Date(s) 0720/06-0720/06 PROSTHETIC DEV 120.75 Patient Name DEBORAH D FOSTER RADIOLOGY DIAG 399.75 Account Number H019722966 EMERGENCY ROOM 944.50 Total --- - 1465.00 What's pending with insurance 0.00 Total Insurance Payments/Adjustments 0.00 What You Owe Now 1465.00 Please confirm that information is correct Primary NONE ON FILE-Please call if you have Insurance insurance,or complete the back of this ' ins or changes in insurance coverage? (9925)M 947-3336 8:30 am to 4:15 pm weekdays Group/Plan int and mail back to the hospital a Witten con )ondence? John Muir/ML Diablo Health System Secondary Attn:Patient Acoounts PO Boot 44000 Insurance Department 44261 Group/Plan San Francisco,CA 94144-4261 Please Note: Yotvr physician will bill separately for their professional services. MT. D IA B LO MEDICAL CENTER Thank you for selecting John Muir-Mt.Diablo Health System for obn Muir/Mt Diablo Hrolth Systsm your healthcare needs.Quality patient care and dedication to J patient satisfaction are our highest priorities. PO Box 44000 I)Wrtment 44261 San Francisco,CA 94144-4261 Our records indicate that you have no insurance for the services 00W4.1,armor listed below.Please note the various payment options listed on the back of the statemenL We also have added preventive healthcare and educational news. We hope to serve you again if a health need arises. 95 CRIVELLEO AVE_ D BAY POINT CA 94565-1711 1Ills 11111rlrlr�lllr�rlr��ll���lll�lrr�irl�lrr�ll Statement Date 07/30/06 DESCRIPTION AMOUNT Service Date(s) 0726106-0727106 PHARMACY 14.08 Patient Name DEBORAH D FOSTER IV THERAPY 164.00 Account_Number....—__ H019.746478___.- __ LABORATORY 57.00 LAB%CFIEMISW Total Charges 4294.14 ~. Whars pending with insurance 0.00 DX X-RAY/CHEST 483.50 Total Insurance PaymentslAdjustments 0.00 EMERGENCY ROOM 2656.25 DRUGS REQUIRING DETAILD CODING 172.06 What You Owe Now 4294.14 EKG/ECG 475.50 Please confirm that irdomration is correct Primary NONE ON FILE-Please call if you have Insurance insurance,or complete the back of this ' Billing25) questions or cam to :1 pr n weeranm coverage? (925)947-3336 8:30 am to 4:15 pm weekdays Group/Plan sWtement and mail back to the hospital e Wtaten eorrespOniderice7 John Muir/ML Diablo Health System Secondary Attn:Patient Accounts PO Box 44000 Insurance Department 44261 Group/Plan San Francisco,CA 44144-4261 Please Note. Your physician will bill separately for their professional services. ..._...._.. .... RITE AID PHARMACY#5935 (925)458-0955 OAKHIUS SHOPPING CENTER Stm DEA:BT5236686 X not SW BAR"ROAD RPH:AYK .y become PmSBURG CA 94565 .reased. equine Rx 05935 0312301 Date Filled:07/27/2006 1increase )ersists or FOSTER-HAAMOND,DEBORAH Date of Birth: 01108/1963 (925)497-7553 277 COLDAA PmSBURG CA 94565 Inge I occur.If LORAZEPAM i MG TABLET DAW:0 NDC:00591-0241-10 QTY:7 DAYS SUPPLY:7 you is e serious DANIEL LIBKE MD Mects 2540 East ST . d manges CONCORD CA 94520 during NO REFILLS LEFT 3akness, STATS OF CAI WOI, U BENEFITS ID CARD-S N#610, ney GRP: CLM REF#: her effects o other ier aIle 'es: lly of:heart istructive 1 � 1lcohol On achinery. U&C: $9.99 ou are 14 of PAY: ntallmood i may not MEDICATION WARNINGS t for use Ys '....._ . ........:............ .. . ..:.................... this drug =.�•>- ' ;:�;z.:>H v 'usual �'�.:;..�.;�,.•�';=><:><�;«�:�'�>:.:;:-s:<:�:..,. details ........:,.:,::.�.,-.;,. infant. - ......... ;::•:`- a�'a,, )C@ GOIBtRTCFIRJJf7C7EHONilI�A1M43[::`:: ::.;y5 `::ax;,: ......... . T...0.> . . .......... :iii:y:-. :>v-.:.,...r. ............... 'Af arty hangethe ... sed with '.ctii. eeiisr►it'�" ,cybate +a�a,nuonr,o�: :'�.: .a i::_ _ •';:- :;; R�YYY�/i1i:::::.:::.::::::::::ii:iLi" ?\�{i ri::iii^::�i'•::::'.'i�'+�::: edlcatlon too .T. :.::.::.. ... :.. ...................... RITE AID PHARMACY/5935 (925)458-0955 OAKHEUS SHOPPM CENTER Stare DEA:BT5236696 580 BAR"ROAD RPM AYK PTI"I WMG CA 94565 Rx 05935 0311301 Date Filled:07/27/2006 FOSTER-HAMMOND,DEBORAH Date of Birth: 01/MI963 (925)497-7553 277 COLD&A PII TSBURG CA 94565 LORAZEPAM 1 MG TABLET DAw:0 NDC:00591-0241-10 QTY:7 DAYS SUPPLY:7 DANIEL LIBKE MD 2540 EAST ST CONCORD CA 94520 NO REFILLS LEFT STATE OF CALIFORNIA BBNSFITS ID CARD< WK10- GRP: CIM REF 0: U&C : $9.99 PAY: MEDICATION WARNINGS aio ?'?o'Y:'•.Y+`'iiF.::i':-.:x•::Y.,. iR.-. ................. .. .....:::::..,•:•:.:.,,:Lim;:•- ;...;: ;...:- OiflAfl.•r-flO�RIIOi6Tl7��IR�R7�61�T':<t';<::::::::: :}..............................:.:.:.::........... � y��� ?av?: °5> :�:sL+• :tit:...:..,, : .?'>::::;�>`:.:.'::;�::::':r: it�:i:s Jy:4} �'. 11eallMSfalp�sAM1F.411t�fPAid ::% :;;ii;•?:;^ �;. - - ::c-�:r:::v 1MiM .00EiONi1RRMUONtlSC:`:':":':?:;:.::':..,•:.:<.:: ?ii? ?�; ;fir»:; r:; a RnE AID PHARMACY N 5935 (925}458-1}5155 OAKHRIS SHOPPING CEN TER sist 580})ALLEY ROAD Stmt DEA:BTS236696 has PITTSWRG CA 94W RPB:AYK ie effects. 'or Rx 05935 0312.300 Date Filled:o712712{tt}6 reaming, ely if any of FOSS—RAI►t{MOND,DEBURAB ring Date of Birth OIAW1963 (925)497-7553 adult 277 COLD4A ce more MISBURG CA 44565 e.Tell your vere BYDROCODONV"AP 515M TAB DAW:0 rgic NDC:0006-0357-05 QTY.20 DAYS SUPPLY:3 symptoms cathing.N DANIEL URKE MD 250 EAST ST CONCORD CA 94520 Or to NO REFRIS IS LEFT ne , tion :iSTATE OF CAI.EWRNIA BENEFITS ID <M#610,CAR <M#610,ne spiratory GRP: CLM REF#: ,ious ;t your I., (e.g.. e.g., sease), )190sis),low ychiatric engaging beverages 1 ins - .�.�......a:w:: �. .. ten,-.. f41 Our ness,get up U&C: $14.99 pis drug in ,)e used PAY: anor unborrt elated NOWICAITON WARNINGS ansult x7101 t ua� 4i.r v :4i}rr �'y''?�: :�'^•-+t�;N::' -'�;t�:?itiiJ1'�:i,•.^::KFC'=.,s^i?;:i'?vi\r:-_:.!�':::::,_:.:fS;:::<:::5'is2:::::;:-:i:-�::3'::::�Y;f::::i::;:': interactions . + :���'•:':• _< it doctor :.,ineir<;> : z>::: . .,..:.,:bbl, .. •; Yw. :O r . Q mZx l.. ?: ha...v...{4..v Omer !y of. ......:........... _ _ e�r��,�►,a�,a�. -- .. .--•jam-� - .:.:..:-4+... ..........r_. ,, h't^='.tii�-::��_.'"_- ..r.,,:e•-:-�:::r2,.:,�'.'�.'�:-Y.''•��` 1R��IYrC':i: .�4 -.-h-_ u•:S 1z?ri r;>;:�';�:�<'>':�`:`:;`5:'%;�l;;isisi:.4-''i3:-Ji�'?.::•:�'2`i rye.that - SBFMOtISYI�IeR:I!R1?Ilk1116:`:_';;>:;`::::::;:;'...::;.,r. anxiety romazuter of yyyy �••h3iv\�•: 1/M - ............... i•1. v RITE AID PHARMACY N 5935 (925)458-0955 OAKHU IS SHOPPING CENTER Store DEA:BT5236686 580 BAR"ROAD RPH:AYK PITTSBURG CA 94565 Ra 05935 0312300 Date Filled 07m/2006 FOSTER-HAMMOND,DEBORAH Date ofBirtb: 01/08/1963 (925)497-7553 277 COIAM PTI I'SBURG CA 94565 HYDROCODONE/APAP 5/500 TAB DAW:0 NDC:00406-0357-05 QTY:20 DAYS SUPPLY:3 DANIEL LIBKE MD 2540 EASE ST; - CONCORD CA 9452D NO>REFILLS LEFT. .STATE OF•CAIWORNIA BENEFITS ID CARD-SIN#610- G?III:..:.x.: _. . . ... . .._.. CUM.REF;#:.. :- U&C;: 4.99 PAY: MEDICATION WARNINGS Ri T. .' .1.�161bK:'11L9 '�110►71E11 :::::: IYi11jfl ::.....:.:....::::.:: i�►11SE :: :is<:;:;:: PU111,p :4�k 'ti - so �7K11k>:: ..... f6I�f160CAK'AA1�1C1T :7A1{IN07RNi-<. sOiEyll!aRFaCt:;�?�<. -<:., ,, -;;.;:?L,-; -'::<:?-:<•x:?<.;:::.::•:.Y-;:....:':;..,..7MR'�i'?1ollos$�s�R IC' ................:................. .:i::: 5. �+,,,�? .r:• J:ti4:::i?-:�,:::.?n;.:ii-'{{•:vti•:J.i i;;r.i:i:i:.:iii?��i�':':'��?' - yy •r:}:i;:vi:i:4i:L:?v.`rin:::i.:?:j.v{}:r:-rV;i::.:'::::.i:'::::...:.: '... .. :'i:.�'.. �::ii��i::: :ai::is..... ..':: �yyy it:y%;: i\jj : :�':.: AlFAM1' JA��IR:RRIGJTIIIN1MR�i1fiRyMy11��.'MyyIR�wifRj':y.�i�:: ............... ari+sw..� r:t '::i:: :r:':;;i: ... ..r..r.. ........... .... .. . RITE AID PHARMACY#5935 (925)458-0955 OA8,ER S SHOPPING CENTER Stole DEA:BT5236686 580 RAMEY ROAD RPM AYK y YOU! Pn175BURG CA 94565 • ication ng this Rx 05935 031x302 Date Filled 07/27/2006 these FOSTER-HAMMOND,DEBORAH any of DateofBirth: OIAW1963 ;,lpn�/ (925)497-7553 nbness or 277 COLIMA .ek PITTSBURG CA 94565 dude: fisted PREVACID 30 MG CAPSULE DR DAW:0 NDC:00300-3046-13 QTY:20 DAYS SUPPLY:20 DANIEL LIBKE MD ►r to similar 2540 EAST ST icing this CONCORD CA 94520 disease, a more NO REFILLS LEFT ith STATE OF CALIFORNIA BENEFITS m CARD<Bnv#610- th trouble 'nedication GRP: CIM REF#: . benefits feeding ng. iteractions :r .tor or specially o this interaction ole may U&C: $123.99 or or ithout PAY om MEDICA77ON WARNINGS it6�IMrAt .:>;.;: : 22. :..:: r-? { ;i r performed - - d - �:{?: ...�.:..».,:.....r v�.�. .{tx'tC:%. ::'':t YAI i�9lRR :::::::::'::i::J:::•�: �:::::':::':'::_i:�:�:�...:....... ::.:. .. -.;,r.�.r - dose +c�.QQ totJJ� ::.:::.::::Yi:i-'•i::.v1--v:is-...:?.i::iii•?Tit'::. st e i :_ RITE AID PHARMACY#5935 (925)458-0955 OAKW c SHOPPM Cerfm Stere DFA:BT5236686 580 BAH"ROAD RPH:AYK PTTTSBURG CA 94565 Ila 05935 0312302 Date Filled:07/27/2006 FOSTER-HAMMOND,DEBORAH Daie ofBk&- OIAW1963 (925)497-7553 277 COLE" PITTSBURG CA 94565 PREVACID 30 MG CAPSULE DR DAw:0 NDC:00304-3046-13 QTY:20 DAYS SUPPLY:20 DANIEL LIBKE MD 2540 EAST ST WNCORD CA 94520 NO REFILLS LEFT STATE OF CALWORNMA BENEFITS ID CARD<M#610, GRP: CIM REF U&C: $123.99 PAY MEDICATION WARNINGS ONO vti'*Ti1ttti'•:::n:v�?{',:'>.'',xa>g}..•:-;t}�,:t:»•:::,y-'.x:<;.::_,..:,,..:.Y:o;;r.:a:;:::.:::._-�:::::,::,-:':::.,..-,::........ •i"::i_X:+J!v-ii'-::i�L?;':.••"$,:r v{-i:�:iiii'�?.�++,:�."4„i'::': A=,�:�i2 r--v.::.s::4:v?::✓,:•::.:v.:::::;1:.;:.!iii•::-":• +4. • ,Tn .. .............:.. ..... �:�::.:�.::..�:::'.may{: :ti:Xfv:v}?aJ}:A?:'?P.v�`,i'Y•-�Jv��.v;.J 1{�{iti:•i{v•>}X${:.,.:.;.5:.::._v.::.:::..:.::.�.. :}ii':i-0._::�:,.��::::.::::%:n1_^>.''.-:S�:C:�}n Jti't^iti4''�':::_.-::��:�::�::�:::�:::.:is��•;..;::::<:.::r;.'.,.:::;::.•::::i.::�i'�:�.�:�: .J•K;{n {i -fir. <.-'r'S�•~ - .lv. :;:ti:.::sri:-:--v viii:;::-}_,:-.}:._•.\i_i:-?:i-:-ti:�.::::,::;�'a} - i::\:.v 4 Sv :.\. •.�' vSht. r.\-n' RITE AID PHARMACY#,5935 {925)4S$-0955 OAKMLLs SHOPPING CENTER Stare DEA:BTS236655 I as 590 BAILEY ROAD ' RPH:LP7 PMSBMG CA 94565 lotion 19 this drug R:05935 0311989 Date Fined:070-3/2006 he risks and FOSTER—HAMMoNi),DEBomn :ts on a Date ofBitth 01,3$11963 (925)497-7553 277 COLiMA PIITSBURG CA 94565 especialy TRAMADOL HCL 50 MG TABLET DAW:0 NDC:00337$-4151-01 QTY:30 DAYS SUPPLY:5 'ors(e.g., chiatric ALLAN P DRABINSKY MD ,m), 2540 EAST.ST rich are also CONCORD CA 94520 gut doctor or NO REFILLS LEFT STATE OF CALIFORNIA BENEFITS w CARD<BIN#610, torn GRP: CLM REF M 22. s of thing, -sciousness, me for the Do not U&C: 525.99 degrees G) i ons out of PAY: all possible uses, MEDICATION WARNINGS as medical advioe 1r p?.....:.......# itMtaki +atsd :;:;::5>_".V"..rse:eM3W M1L A*rouR DWMR ON,.fR1AlOIAG£T�801fLip'M/.:Tt?TNEAT.'O— ...............::.. . .... - axve�scOYsnv±►T�oraSiuteloilgMa : :.:.::'..;:::::.::'.:: . :tl�l'if�f#�6Cf1at:W1pN�lIISI�Y��3�K�Itl4110!(, OPIdA'iMRi.�ttiBf�li1G@p0A1511►!gIMB:`.'::';�I�F�i'.,7,lf-1,�.f4�', TkIM::'+_S'='� ic:::=:5 .�xr'•' - ' :.:..:::.:::.:..:::...:�:'::':ter?::'r.}::�:;•...i}::? �.::';::;: :-.,:�.-.:;;.;s r:e : }:,.. Hl�J17118rti6.: ::i:':='-r:ti'v'ii:i }±.:+.:.:J:i:? RITE AID PHARMACY#5935 (925)458-0955 OAKHHl.S SHOPPING CENTER Stmc BEA:BT5236686 580 BAILEY ROAD RPI LP7 PITTSBURG CA 94565 Rx 05935 0311019 Date Fiffed:07123/2006 FOSTER-HAMMOND,DEBORAH Date ofBirtb: 0IM1963 (925)497-7553 60 DELTA DR PrrISBURG CA 94565 IBUPROFEN SW MG TABLET DAW:0 NDC:49884-X779-05 QTY:30 DAYS SUPPLY:10 KELLIE AMADOR 2540 EAST ST. CONCORD CA 94520 NO RFJU.LS LEFT STATE OF CALIFORNIA,BENERTS ID CARD<B1N##610, GRP: CIM REF#: U&C : $14.99 .PAY MEDICATION WARNINGS �t�in�a� lYaiiRi�iigE'�MR �'>:��>aorivruEoowe�Fooirr�,e+israor�ii;res:':: ...... . �:=��=rr�1'BTA!! .'ADNCE TAIOIW IIONz� .':::....'{i i:;}is i:j->`.i�+:=:^::•::::C-::;.;:...: :..i.}.. -...::?.�✓._:;sy+_::_;+Mi•`:i':%:moi::^.:::��: K����..•'R7�:::..�.:'...>.::':'? •�MOiTL1itE ..1I1!�QeABMiM CO4TAr116�;�.: <i,.,! - vnoax�e>l:wrnwerr�ee�ose.es�' ,.::.::.:.. .......:::.:�::.::...::.:'...:.::�y',:�:�:y:i::..:.v.:.r'::::::::::.::•:�'::.:i:�ii:ti'^:i^i:;:i'j`:v:i�:j4•!.i;:i.i'i �y�y�iJiF.T!FM)JR�#.TO�X.Y.�::;:•i::-:ii•i�J�v&:-::is�-+:>ij::..;.;�:.;..:.i�-.?:_::.i:��i.�,,•.;-r:::•::::•::. RITE AID PHARMACY#5935 (925)458--0955 Child's OAeHR. c SHOPPING CENTER Stone DEA:DT5236686 580 BAR"ROAD in Pn-mBURG CA 94W RPH I P7 take up to + - :re taking Rx 05935 0311019 Date Filled:07/23/2006 t medications has FOSTER-HAMMOND,DEBORAH tion for DatcofBirth 01A)8/1963 (925)497-7553 I your 60 DELTA DR ursetf or Pn'MBURG CA 94565 immediately or if new IBUPROFEN 800 MG TABLET DAW:0 mmended NDC:49884-0719-05 QTY:30 DAYS SUPPLY:10 KELLIE AMADOR 2540 EAST ST. ,owSiness, CONCORD CA 94520 fora NO RE LIL S LEFT Because the ;anon do side STATE OF CAL FORNIA BENEFITS ID CARD<BIN#1610, weight GRP: CLM REF#: kelt'but Sing or iighly tdache, ay rarely y unlikely rmacist illergic Symptoms ,athing. It t assppirin or U&C: $14.99 medication .ine, :itive PAY: n or other tour doctor MEDICATION WARNINGS )ort' , recurring pip :...Via::;"?'$:.:.,..:..:.9klod anemia0fantWY�>`<��:.`�:::;�: .:::ce�::: :.: 'f1 . 0<'<ler les iri .. •:,vae ......+ ............ .V. ionwawes . :<::>:>::::><:::::s<:° t alcoholic alcohol tobacco, .u:.:•g. .csiw�ooc�iiowc aOW. in 1oilifeiiiii[R:.,. - de etreoMuniasissoee ti bleed jWiicaar4Waas,osaunoN.: c more _ e ou : : :;:: ;:-; .:: ::tSin9 this ;:.:;. rug, ....... . ..... . ' n when ooMse�r. .row ly - tai.': , axon::.>,;: CLA INJ 130ARD OF SUPERVISORS OF CON'T'RA COSTA COUN'T'Y L� • BOARD ACTION: SEPTEMBER 19., 2006. Claim Against the Counly, or District Governed by --- the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMAN'l and .Board Action. All Section references are to ) 'fhe copy of this document mailed to California Government Codes. lgav� you is your notice of the action taken on your claim by the.Board of AgD� UG 1 4 2006 Supervisors. (Paragraph IV below), given Pursuant to Government Code COUNTY COUNSEL Section 913 and 915.4. Please (tote all ANII)UNC: $10,000,000 MARTINEZ CALIF. "Warnings". C I.A I I ANT: ROBERT DITI'MAN AND CHERYL DIT INAN ATTORNEY: SCOTT D. PEEBLES DATE RECEIVED: AUGUST 14, 2006 O'REILLY & DANKO AUGUST 14 2006 A.IX)RESS: 1900 O'FARRELL STREET, STE1:3`86'UELIVERY TO CLERK. ON: —_ ' _ SAN MATED, CA 944.03 BY MAIL POSTMARKED: AUGUST 11, 2006 FRONI. Clerk of the Board of Supervisors TO: County Counsel ------ Attached is a copy of the above-noted claim. JOHN CU.LLEN, C er Dated: AUGUST 14, 2006 13y: Deputy It. FRONI: County Counsel TO: Clerk of the:Board of Supervisors ( his claim.complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The .Board cannot act for 15 days (Section 910.8). ( ) ('faint is not tritely 171ed. The Clerk sliould 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: M C-4 Deputy County Counsel Ill. FRONT: Clerk of the Board TO- County Counsel (1) County Administrator (2) ( )-_ Claint was returned as untimely with notice to claimant (Section 911.3). - --- - IV. ROA-RD ORDER: lay unanimous vote of the Supe►visors present: (a,I' This Claim is rejected in full. ( ) Other: -- - - ----- - - ---- - - -- I certify that this is a true and correct copy oft lie Board's Order entered in its minutes for this date. Dated:C5�W7_, JOHN CULLEN, CLERK, By Deputy Clerk ---- — WARNING (Gov. code section 913) Subject to cerlaiu exceptions,you have only six(6)mouths frail the date this notice was personally served oj-deposited in the Intail to Men coutl action on this claim.See Govenuuent Code Section 945..6.You may seek the advice of m, attonicy of your choice in connection with this matten if you want to consult all. attorney,you shotdd do so immediately. *.For Additional Wanliug See Reverse Side of'Ibis Notice. AFFIDAVITOF MAILING ---- -- —�— -- 1 Ilechne miller penalty of per juiy 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 Suiles I'oslsal 53cuvicc in I1larlinez, C:alifornin, poslaage fully prepaid at certified copy or tills Boned Ill drr .anal Notice to (..:laaivaaraal, : iduessed to file ct.rinrarrl as sholvn .al,ove. LAW OFFICES OF O'REILLY & DANKO RECEIVED A PROFESSIONAL CORPORATION SCOTT D. PEEBLES 1900 O'FARRELL STREET, SUITE 360 AUG 14 2006 DIRECT DIAL (650) 358-5912 SAN MATEO, CALIFORNIA 94403 E-MAIL,speeblesCCoreillylaw.com TELEPHONE (650) 358-5901 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. FAX (650) 358-2575 www.oreillylaw.com August 11, 2006 Clerk of the Board of Supervisors Contra Costa County 651 Pine Street Rm. 106 Martinez, CA 94553 Re: Robert Dittman and Cheryl Dittman, parents of deceased, Brian Dittman Dear Sir/Madam: Robert Dittman and Cheryl Dittman hereby make claim against the County of Contra Costa, Contra Costa Regional Medical Center(aka Merrithew Memorial Hospital), for the sum of Ten Million Dollars ($10,000,000) and make the following statements in support of their claim: a. The address for claimant Robert Dittman is 2100 Rubye Drive, Antioch, California 94509. The address for claimant Cheryl Dittman is Windsor Manor Rehabilitation Center of Concord, 3806 Clayton Rd., Concord, California 94521. b. Notices concerning the claim should be sent to the law firm of O'Reilly&Danko, c/o Scott Peebles, Esq., 1900 O'Farrell Street, Suite 360, San Mateo, California 94403; telephone (650) 358-5901. c. The date,place, and description of the occurrence giving rise to this claim are that on or about February 14, 2006, Brian Dittman entered Contra Costa Regional Medical Center, Martinez, California, for medical care related to symptoms of alcohol abuse and/or alcohol withdrawal. At said time and place, agents failed to properly examine, diagnose, treat or otherwise tend to the condition of Brian Dittman, including the release of Brian Dittman from the Medical Center in a condition in which he posed a danger to himself and/or others, causing him injury or death. d. On or about the evening of February 14 or early morning of February 15, 2006, Antioch Police officers shot and killed Brian Dittman in response to a telephone call he made to Clerk of the Board of Supervisors August 11, 2006 Page 2 the Antioch Police Department in which he requested assistance with a danger he perceived existed from prowlers, vampires, and/or other trespassers. e. The true names and complete name or names of all public employees causing the injury, damage, or loss are not known at present. f. The amount of this claim is Ten Million Dollars ($10,000,000). The basis of the above amount includes loss of claimants' son, including grief, stress, anxiety, insomnia, and the loss of love, comfort, society, and companionship, and all damages as allowed by law. Enclosed is a check for$25, to cover filing fees. 4 Scott Peebles, Esq. On behalf of Claimants Robert Dittman and Cheryl Dittman N p O O N N� N VI N �� 1111 C� 4 a 1i+0vcno ..- %DQcc co or U u dNJ StT3.1lNSZ o 0 . 1 1 0.0010 cr C3 4A O y 0 ' Ln C3 6ti r. 2 da O a `+o8 © �kO Ilno C ry �, n Y Y i y F The Board of Supervisors Contra Joh oI„tlrn i'lcrk ofthe Board Costaand County Administration L3uildillg Comm :\dmiuistialm 651 PineStrect, Room I(.)() I.. i92 33;_1 XO Martinez. Califiornia 9-4553--4068 John Gioia,I)istriil I Ga,lr l3.•I�ilkrn,a,Lti.Uicl II 't-�'-” '-=�•'`' Man N. Piepho,Doncl III Mark I)rsaul„irr, I)islricl ;j - •' . Federal 11.C;lo,rr, I)isUirl\' rn'�-�' • �� ti COO . ALUXLISt 14, 2006 Mr. Scott Peebles, Esq. Law, Offices ol'O Reilly & Danko 1900 O'Farrell Street, Suite 360 San Mateo. CA 94403 Dear Mr. Peebles, I am returning herewith your check for $25.00, check no. 23549; representing your filing fees for the Tort Claim filed for Robert Dittman and Cheryl Dittman., We do not charge a Pilin- fee ou -Fort (.'aims. Sincerely Yours, lmy 1.. Sharp Deputy Clerk O'REIL.LY Sr DANKO. CALIFORNIA-BANK&TRUST. 23549 GENERAL OPERATING ACCOUNT SAN FRANCISCO MAIN OFFICE 1900 O'FARRELL STREET;SUITE 360 SAN FRANCISCO,.GALIFORNIA 84104 11-20411210 SAN MATEO,.CA 94403 :. .. . .. .. .8/1112006; PAY TO THE CONTRA.COSTA COUNTY BOARD OF SUPERVISORS � **25.00 ORDER OF Twcnty=Five and 00/100*****"************* DOLLARS. CONTRA COSTA COUNTY BOARD OF SUPERVISORS.. 651 PINE STREET. MARTINEZ,CA 94553 FILING EEE FOR CLAIM AGAINST COUNTY-DiTTMAN I150 23549i1' 1: 12 100 204 24 L0 100 i 2 i0 ill' O'REILLY&DANKO!GENERAL OPERATING ACCOUNT 23549 CONTRA COSTA COUNTY BOARD OF SUPERVISORS 8/11/2046 Date Type Reference Original Amt. Balance Due Discount Payment 08/11/2006 Bill DITTMAN 25.00 25.00 25,00 Check Amount 2.5.00 CLAIM WjkllD OF SUI'ERVISORS OF CON'T'RA COSTA COUNTY BOAR) Acuffi: SEPTEMBER 1.9, 2006 Claim Against the County, or District Governed by ) — - ---- -- —"— tile Board of Supervisors, Routing l ndOrsenrenls, ) NOTICE TO C1,A_1NIA.NT and Board Action. All Section references are to ) The copy of this document mailed to California Government Codes. I you is your notice of the action taken 5Q on your claim by the Board of Supervisors. (Paragraph IV below), AUG 14 2006 given Pursuant to Goverrunent Code Section 913 and 915.4. Please note till AN4Ot_tNT: $370.21 COUNTY COUNSEL "Warnings". MARTINEZ CALIF. Cl_,AINIANT.- LINDA ANDERSON ATTORNFY: UNKNOWN DA'FE RECEIVED: AUGUST 13, 2006 A-DI--)REBS: 16 SIMPSON DRIVE BY DELIVERY TO CLERK ON: AUGUST 13, 2006 WALNUT CREEK, CA 94596 -- — BY NIAIL POSTMNPKF.D. HAND DELIVERED FRONI. Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. AUGUST 13, 2006 JOHN CULLEN, CI rk Dated.- By: Deputy I I. [7110NI: Counly Counsel T0: Clerk of the Board of Supervisors ( his claim complies substantially with Sections 910 and 910.2. ( ) This Claim hA_iLS 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. "I'he 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: _�'� S-�D(o 13y: Deputy County Counsel 1I1. 17ROM: Clerk of the Board TO: Coulrty Counsel (1) County Administrator (2) O Claim was returned as untimely with notice to claimant (Section 911.3). lVOA.RD OR )FR: By unanimous vote of the Supervisors present: (� "I'his Claire is rejected in fall. l ) Other: -- --- ------- ------ —-------—--— — — — — I certify that this is a true and correct copy of the Board's Order entered in its minutes for this dale. Dated5O V" - AF 0-01-IN CU_L_LE_N,_CLER_K, Byeputy Clerk_ _ WA_ICNING (Gov. code section 913) Subject.to cerlain exceptions,you have only six(6)months fivin the[late this notice was persomally served or deposited in.the mail to file a coati action on this claim.See Govenrlrlent Code Section 945.6.You may seek the advice or sat attorney or your choice in couuectiou with this matter. If you want to consult tur altuntey,you should do so iuunetlintely. *For Additional Wanrutg See Reverse Side of this Notice- Al T ID A V IT otice.AITlDAVI"f OC MAILING — --- -------------- — I declare under penalty of per.jtii-y that I am now, and at all limes herein mentioned, have been a citizen of Ille Ulliied States, over age .18; and that today .1 deposited in the United Stales l'ostal Seri ice in I\Ial-linez, C::rlifornia, postage prepaid it certified cope of this 11varcl 1)rder- mid Notice to claimant, miduessed to the chlinuurl its shown above. l:rlEcl /• o 173}' ` JJN. 27: 2090 3'49PM CCC RISK UMEMEN- N4. 041 P. 2 BOARD CF qy���T,,7�P��E7'R�VISrC�.�yRRS QCF COMM CdSTA COUNTY �. O C—LAMM-1 A ciaim.rela*to a cause of action for'dmth or dor injury to person or-to person prop6i-�j ar g owing crops shall be presented not lafer .than six mos the after.the accrual of`she OR of action., 'A claim,relating to auy other cause of action shall be,presented not Iver than.G= yvar . after the accrual of the cage of action. (Gv. Code 3. Claimmust be tiled with. the Clerk of the Board of Supmdsors at its office in. Room 106, Coutity AaE in stat;on Building,. 651 Pi_ e Street,Ma ez,CA 94553. . C. Lf claim is against a district governed by the Board of Supervisors, rather than.the County, the Z ne of the District should be filled in. D. If the claim is against more th= one public ent, sepmme claims m,Lt be filed agaimt each public entity. E. Fraud. Soo penalty for fiautlulent claims,Pedal Cods Sec. 72 at:the end of this form.. Rzzzitzzzzzzzz z x Rz If z zz z z zNXgXXlrz c zzzR a zCJBJ1Xxz a zaFw tGzzzz It a alzz;Ktzczxtz*zt.zrl M: Claim By. Reserved foz Clerk's 1 hg,stamp A/V.04.AAQC-,& A RECEIVED CEIVED .-6A > ^ A � Agdwt the Cduaty of Coma Cosh,or AUG 1 3 2006 CLERK BOARD OF SUPERVISORS District) CONTRA COSTA CO. (Fill in the name) � The a dolrsigne's' claimant hr-,by malum claim aWast the Comfy of Contra Costa or the above=named district in the sum of 5- .174 , 0,j and in support of this claim represents as follows: 1. when did the damage or inury occur`! (C-ive-exact date and hour) ?. Where did the damage or injury occur? (Include city and unty) 3. flow did the damage or ir±iuurp cc `7 (Give full details; a extra aper if requ�ed) � �� u�7���-fie. c��r.�do f 4. ,that pazticul act ar omission on the part of ootu:tr or district ofacers, servants, or employees caused,the injury or damage?j/7J. �, cAevV 5 Vvhat are the names of co�. .ct o or employees dour' �� ty dim ffic=,Svmt; _ u damage or injury � Z� :r. JUN. 27, NOD' 3'49PM CCC RISK VANAG'"'MEC �- NO. 041 1. 3 6. VAmt damage• or injuries do your claim resulted? (Give fill extent of injuries or damages •claimed, A.=h-two estiraates--for auto damage.) .; any 7. Flow was the amount elaired above computed? (Include the estimate air o o prospective iajuiry or my 78 .E 8. `j"« 0449Names and addresses of witnesses,doctors; and hospitals: 9. list t7he expenditures you nnade-on account of•tbis accident or injury; • - DA.TE T&M -AMOUNT O� . Sol-awap F��" aaCtaff Kira In it me a ra[taa it Ka as of IF Crit ll[a It r[[ata19[a tIf[[a It aa!l la a a{al It x i f l{t a Z JC 1a1 .Gov.Code Seo, 970,2 provides"The claim shell be signed by the claimant or by some perzon on Us boo-Z." SEi`ID NOTICES TO: lAttomev) I Name and address of Attorney ) (Claimar 's Sigwture) (Address) TelephomNo. Telephone No. �"��j_�D 1614; A,ttkla■7 fa[Raa[[■a[[{.lalata■allk![1![[{[iLLlRalliaf�S.f'a rRr==f R�R1C■■YI!■1� k L[LtY1 PUBLIC RECORDS NOTICE: Please be advised that this claim form;or any claim filed with the County under the Tort Claims Act;is subj ect to public disrlasure under the California Public Records Act. (Gov. Code, 99 6500 et saq.) Furthermore, any attachments,addendums, or supplements atiarhed to file claim farm,including medical rezords,are also subject to publie disclosure. ■a[ta[FtY[a{Ra[a al 0 aa[kY awIaaRa{a aaaaaYlaaa ll[a■[a{a[a IN a a a a[a s F[L[a Y a a R it a a!■a A I M w a II NDTICE: Section 71 of the Penal Code pro des: kvery person who,with intent to defraud;prewits for allowance or for paymrmt to my state board or officer, or to eny coin; City, or dish t board or o:Ecer, mtharized to allow or pays the same if pu ino, any false or fraudulent claim,bill, account Voucher, or writing, is punishable either by imprisonwent in the Coimty jail for a pexiod of not more than one year, by a fine of not exceeding owe thousand dollars (S1,000,0a), or by both such imnnsoamwt asd nne, or by imprisonment in the state priso4 by a fine of not excea..di*tg ten thousand dollars ($10,000),or by both suah imprisonment wad nae. �• :1 ARMS - Automated Rental Management System (Patent Pending) Page 1 of 2 °�Y ca 0 Rental Company:ENTERPRISE RENT-A-CAR I� ® 1021ST CENTURY INS Invoice: D124531-2331 ,-j U G) Bill To: Billing Detail: l..) 21 ST CENTURY INS l�) ATTN:DEBORAH FENISON Rental Period: 7/10/06 to 7!14/06 (5 days) d) P.0.BOX 2252 Billed Period: 7/10/06 to 7/14/06(5 days) BREA, CA 92622 Description Rate: Amount: RENTER INFORMATION: 5 DAYS @ $24.99 $124.95 Renter: ANDERSON,LINDA 5 DAYS DW @ $8.99 $44.95 { 5 DAYS PAI @ $3,00 $15.00 c RENTAL INFORMATION: 1 SALES TAX% %8.25 $10.31 Rental Branch Location: ENTERPRISE RENT-A-CAR(2331) TOTAL CHARGES: $195.21. 1260 DIAMOND WAY Q CONCORD,.CA 945205226 Less Amount Received: $70.21 t� (925)674-1110 AMOUNT DUE.......... $125.00 hD. ADDITIONAL CLAIM INFORMATION: Claim Number:0000453665 !�1 Claim Type::lnsured r) Vehicle Condition:Driveable Date Of Loss:6120106 FO INDEXING PURPOSES ONLY Insured Name: PHILLIP ANDERSON Completed Mail Owner's Vehicle:2000 SAAB New Mail Additional Driver: .SPOUSE C] Repair Facility:. Loss Number DIRITO BROS CONCORD, CA DlvislonAdjust (925)825-2444 VEHICLES RENTED Effective Date and Time Year Make Model VIN Mileage 7110106 8:35 AM 2006 CHEV CORA 1GiAK55F467817473 135 D. FENISON Rental Invoice JUL 17 2006 Please Return This Portion with Remittance Make Payment To: Total Charges: $195.21 ENTERPRISE RENT-A-CAR(23CC) Less Amount Received: $70.21 2550 MONUMENT BLVD. Total Amount Due.................... $125.00 CONCORD„CA 945203107 Federal ID:36 3041733 Please include on your check: Invoice: D124531-2331 NOTEBOOK: 7/15106 4:01 AM R-Invoice received for an amount due of$125.00 7114/06 4:32 PM R-Ticket 124531 closed on 7/14/06 at 4:26 PM. 711110610:21 AM R-Ticket 124531 opened on 7110/06 at 8:35 AM. 7/10/0610:44 AM R-Authorization confirmed by Enterprise at 12:44 PM, 7110/06 10:44 AM R-Reservation number 047694. 7/10/0610:44 AM S-Authorization sent at 10:44 AM for 10 days at$25.00/day. https://www.enterprise.com/annsweb/payinvoice 7/17/2006 Estimate Screen Page 1 of 6 Estimate Data for Loss #0000453665 This data is current as of 08-07-2006 09:38:22Refresh Print 3375160 97655 21ST CENTURY INSURANCE COMPANY CONCORD FOR SUPPLEMENTS CALL 707.590.3274 1140 GALAXY WAY SUITE # 500 CONCORD, `-CA 94520 (707) 59073274 FAX: (707) 421-2667 ESTIMATE OF RECORD WRITTEN BY: LEWIS WILLIAMS 07/06/2006 08 :27 AM ADJUSTER: INSURED: PHILLIP ANDERSON CLAIM #3375160 OWNER: PHILLIP ANDERSON POLICY #1778774 ADDRESS: 16 SIMPSON DR DATE.OF LOSS: 06/20/2006 AT 11:2.; APS] WALNUT CREEK, CA 94596 TYPE OF LOSS: COLL ?NSP & PAY OTHER: (925) 930-7366 POINT OF IMPACT: 11. LEFT FRONT DAY: (925) 324-3489 INSPECT DRIVE-IN LOCATION: REPAIR DIRITO BROS. COLLISION CENTER BUSINESS: (925) 825-2444 FACILITY: 126 DIAMOND WAY 5 DAYS TO REPAIR CONCORD, CA 94520 LICENSE # 71-0967969 2000 SAAB 9-3 SE 4-2. OL-T 2D CNVT GRAY INT:BLACK VIN: YS3DF78K1Y7001930 LIC: 4YTAI-85 CA PROD DATE: ODOMETER: 122000 AIR CONDITIONING REAR DEFOGGER TILT WHEEL CRUISE CONTROL TELESCOPIC WHEEL INTERMITTENT WIPERS CLIMATE CONTROL THEFT DETERRENT/ALARM STEERING WHEEL CONTROLS BODY SIDE MOLDINGS DUAL MIRRORS FOG LAMPS CLEAR COAT PAINT POWER STEERING POWER BRAKES POWER WINDOWS POWER LOCKS POWER DRIVER SEAT POWER PASSENGER SEAT POWER ANTENNA POWER MIRRORS AM RADIO FM RADIO STEREO CASSETTE SEARCH/SEEK ANTI-LOCK BRAKES (4) DRIVER AIR BAG PASSENGER ASR BAG FRONT SIDE IMPACT AIR BAG 4 WHEEL DISC BRAKES LEATHER SEATS BUCKET SEATS AUTOMATIC TRANSMISSION OVERDRIVE ALUMINUM/ALLOY WHEELS ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT -----------------------------------------------------'-------------------------- 1 FRONT BUMPER 2 0/H BUMPER ASSY 2. 6 3 REPL BUMPER COVER 1 776. 00 INCL. 3.0 http://dilprod.20thcentins.com/pages/estimate.cfm?comparekey=3375160 8/7/2006 Estimate Screen Page 2 of 6 1 07/06/2006 AT 08 :28 AM 3375160 97655 ESTIMATE OF RECORD 2000 SAAB 9-3 SE 4-2.OL-T 2D CNVT GRAY INT:BLACK ---------------------------: OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT 4 ADD FOR-CLEAR COAT 1.2 5 REPL ABSORBER 1 163.00 INCL. 6 FRONT LAMPS 7 REPL LT SIGNAL LAMP 1 115.00 0.3 8# REFN COLOR MATCH 0.5 9# RPR COLOR. SAND AND BUFF 30% FULL 0. 9 REFINISH PANEL 10# REPL FELX ADDITIVE 1 8. 00 T 11# SUBL .HAZARDOUS. WASTE DISPOSAL 1 5. 00 X ------------------------------------------------------------------------------- SUBTOTALS =_> 1067 .00 3.8 4 .7 PARTS 1054 .00 BODY LABOR 3.8 HRS @$ 54 . 00/HR 205.20 PAINT LABOR 4 .7 HRS @$ 54 . 00/HR 253. 80 PAINT SUPPL.ES 4 .7 HRS @$ 24 . 00/HR 112. 80 SUBLET/MISC. 13.00 ---------------------------------------------------- SUBTOTAL $ 1638.80 SALES TAX $ 1174 . 80 @ 7 . 3750`?: 86. 64 ---------------------------------------------------- TOTAL COST OF REPAIRS $ 1725.44 ADJUSTMENTS: DEDUCTIBLE 300.00 -----------=---------------------------------------- TOTAL ADJUSTMENTS $ 300.00 NET COST OF REPAIRS $ 1425. 44 http://dilprod.20thcentins.com/pages/estimate.cfm?comparekey=3375160 8/7/2006 Estimate Screen Page 3 of 6 2 07/06/2006 AT 08:28 AM 3375160 97655 ESTIMATE OF RECORD 2000 SAAB 9-3 SE 4-2.0L-T 2D CNVT GRAY INT:BLACK "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. " FOR SUPPLEMENT CALL MY CELL NUMBER AND FAX MY NUMBER. FOP, CAR RENTAL, CLAIM QUESTIONS, PAYMENT QUESTIONS CALL .877.562.7865 -**NO SUPPLEMENTS WILL BE PAID WITHOUT PRIOR AUTHORIZATION*** INVOICES REQUIRED ON ALL SUPPLEMENTS BEFORE PYMT IS MADE] 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 BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT 0/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=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 ?IE. .MOORS DATABASE INFORMATION WAS CHANGED? **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. MQVP=MANUFACTURER'S QUALIFICATION AND VALIDATION PROGRAM. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. http://dilprod.20thcentins.com/pages/estimate.cfm?comparekey=3375160 8/7/2006 Estimate Screen Page 4 of 6 3 07/06/2006 AT 08:28 AM 3375160 97655 ESTIMATE OF RECORD 2000 SAAB 9-3 SE 4-2.0L-T 2D CNVT GRAY INT:BLACK ESTIMATE BASED ON MOTOR CRASH ESTIMATING GUIDE. UNLESS OTHERWISE NOTED ALL ITEMS ARE DERIVED FROM THE GUIDE ERK7315 DATABASE DATE 06/2006, CCC DATA DATE 06%2006, AND THE PARTS SELECTED ARE .OEM-PARTS MANUFACTURED BY THE VEHICLES ORIGINAL EQUIPMENT MANUFACTURER. OEM PARTS ARE AVAILABLE AT OE/VEHICLE DEALERSHIPS. OPT OEM (OPTIONAL OEM) PARTS ARE OEM PARTS THAT MAY PROVIDED BY OR THROUGH ALTERNATE SOURCES OTHER THAN THE OE/VEHICLE DEALERSHIPS. OPT . OEM PARTS MAY REFLECT SOME SPECIFIC, SPECIAL, OR UNIQUE PRICING OR DISCOUNT. 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 COMPETITIVE 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 BENCHMARK PRICES ARE PROVIDED BY NATIONAL AUTO GLASS SPECIFICATIONS. LABOR OPERATION TIMES LISTED ON THE LINE WITH THE NAGS INFORMATION ARE MOTOR SUGGESTED LABOR OPERATION TIMES. NAGS LABOR OPERATION TIMES ARE NOT INCLUDED. POUND SIGN (#) ITEMS INDICATE MANUAL ENTRIES. SOME 2006 VEHICLES CONTAIN MINOR CHANGES FROM THE PREVIOUS YEAR. FOR -THOSE VEHICLES, PRIOR TO RECEIVING UPDATED DATA FROM THE VEHICLE MANUFACTURER, LABOR AND PARTS DATA FROM THE PREVIOUS YEAR MAY BE USED. THE PATHWAYS ESTIMATOR HAS A COMPLETE LIST OF APPLICABLE VEHICLES. PARTS NUMBERS AND PRICES SHOULD BE CONFIRMED WITH THE LOCAL DEALERSHIP. CCC PATHWAYS - A PRODUCT OF CCC INFORMATION SERVICES INC. http://dilprod.20thcentins.com/pages/estimate.cfm?comparekey=3375160 8/7/2006 Estimate Screen Page 5 of 6 4 07/06/2006 AT 08:28 AM 3375160 97655 ESTIMATE OF RECORD 2000 SAAB 9-3 SE 4-2.OL-T 2D CNVT GRAY INT:BLACK ALTERNATE PARTS USAGE AFTERMARKET PARTS AFTERMARKET SELECTION METHOD: MANUF.LLY 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 http://dilprod.20thcentins.com/pages/estimate.cfm?comparekey=3375160 8/7/2006 Estimate Screen Page 6 of 6 5 http://dilprod.20thcentins.com/pages/estimate.cfnl?comparekey=3 75160 8/7/2006 C LA I11[ OARU OF SU11ERV[SORS OF CONTRA COSTA COUNTY BOAM) ACTION: SEPTEMBER 19, 2006 Claim Against the County, or District Governed by ) the Board of Supervisi�rs, Routing Endorsenrenls, ) NOTICETO CLAIMANT and Board Action. All Section references are to ) The copy of this.docurnent Mailed to California Government Codes. ) you is your notice of(lie action taken ou your claim by the Board of Supervisors. (.Paragraph IV below), given Pursuant to Government Code Ai�lOL1N l : $649.97 Section 913 and 915.4. Please note all - $1,230.33 DOES NOT "Warnings". INCLUDE PERSONAL TIME AS -NOTED CLA-1MANT: $100.00 ROBERT R. MARTINEZ I)ATE RECEIVED: AUGUST 17, 2006 AT�.fI)ItNF�': UNKNOWN — -.--_—_—.--.--.— ADDRESS: P.O. BOX 890 BY DELIVERY TO CLERK ON: AUGUST 17, 2006 RIO VISTA, CA 94571 BY MAIL POSTMARKED: HAND DELIVERED F RON, Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CU.LLEN ;I Dated: AUGUST 17, 2006 By: Deputy 11. FROM: Cot►n(_y Counsel TO: Clerk. of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FALLS to comply substantially with Sections 910 and 910.2, and we are so nolifying claimant. The Board cannot act for 15 days (Section 910.8). O Claint is not timely filed. The Clerk should return claim on ground that it was filets late and send warning of claimant's right.to apply 1c�r leave to present a late claim (Section 911.3). ( j Other: Dated: O '(�"�D By: _'r�� Deputy County Counsel III. )7R0I\-j: Clerk of the Board TO: Counly Counsel (1) County Administrator (2) O Claim was returned as untimely with notice to claimant (Section 911.3). (V. f )ARI) ORDI .R: By unanimous vote ofthe Supervisors present: (+ -Chis Claim is rejected in full. OOther: __.. .—_ — --- ---- ------- = — — -- 1certify that this. is a true and correct copy of the Board's Order entered in its minutes for this date. UatedF;;�e- 46< JOII_N_C_ULLEN,.CLERK, 13 Deputy Clerk WARNI G (Gov. code section 913) Suliject to cellain exceptions,you have only six(6)months fivin the(late this notice was personally served or deposited in lite mail to filen court action on'this claim.See Govenunent Code Section 945.6.You may seek the advice of an attorney of your choice ut counect.ion with this made► if you want to consult all atlor-itey,you should do so iuuuetlialely. *.For Additional Warnurg See Reverse Side Wilds Notice.— AF F 11)A V IT otice.—/AFFIDAVIT OF MAILING 1 declare tattler penally of pei juiy that I am now, find at all times herein mentioned, have been a citizen Of the United States, over age 1.8; antl that lotlay I deposiled in the United S(Mes I'ostaf Service in Mallirrez, Carlirorniaa, postage filly prepaid a certified copy or this floor d t)rder mid [Notice to Claimant, addressed to the claimant ars shown above. .lt::)Ill`J ('1.11.11?I'J, C'I.,I'It.l: I15� -- - _ - -- -I_)E:liuly l;lell•: AUG, 9. 2006 1 ;52FM CCC RISK MANAGEMENT - N0, 66 i P. 1 BOARD OF SUFFIRVISORS OF CONTRA COS A.COUNTY INSTRUCTIONS TO CLAIl 4,NT A clams relating to a cause of action for death or for injury to persoa or to personal property or gruiuin.g crops shall be presented not later than six months after the accrual of the cause of action_ A claim.relating- to any other cause of action shall be_presented nat lager than ane year . aftMr the accnml of the cause of action. (Gov. Code § 911.2.) Claims must be fled with the Clerk of the Board of Supervisors at its office in Room 106, Cotta-4T Administration BuUding, 651 Pine Street,Msrdnez, CA 94553. �— If claim is against a district governed by the.Board Df Supervisors, rather than the County, the :name of the District should be filled an.. Ff the claimis a,aft st more than one pubic D16LY, separate claims must be filed against each Public entity. ?. Fraud. Ser-penalty for fraudulent claims,Penal Code Sec.72 at the end of this form. ff f■fff ff or flf f f f f WNW a f t l i f.[Icf f asKKK Lf Lrrrffc■Riga wig ag,a Ica a Il rfiflf an as■ill CFf fl ZE, Claim By: Reserved for Clerk's filing stamp - against the Comte of Contra Costa or )District) gzv (Fill iathe nss=e) e� �� �� ) Co. Z L 3 tc `P64A — SSP• lcsa�K !r�� • 'Thr umd•ersiLmed elai==t hereby -makes claim against County of Contra Costa or tUe above-named district in the sum of S V and in,support of tid.claim represents as follows: ?230 31_ 'c�n€s' r��r /1,te1v4C_ kx-S uAt T7MV, et.S MV7T.0 1. 'When did theme or Nur),occur? (Give exact date and hour) ��p8/D�e /I :�O Q,r►. G�/1r+eDt 2. Where &lid the damage or injury occur? (Include city and county) �.S23 � C �F ok Si-F-E 'f•�tK,�v�i Carf --' CJ 3. How dime damage or injury occur` (Give M1&-tails;use extra aper if required) 4. What"particular act or omission on the part of ooThty or district of-n-cers, servants, or amployees caused the injury or dam ge? F'AI p ft C`1tcA. 6 oK ,GgC/�iu u�Q, 5 What are thp,names of county or district officers,serVMts. or emploY ees&akin-the. damage or injury? 5AMAVAJ �rISOM 4 - AUG, 9. 20106 1 ; 53PM CCC RISK MANAMENT N0. 661 P. 2 �T%7hat damage- or injuries do your claim resulted? (Give full extsnt of injuries or damages claimed. •A sclh-two estamatesfor auto damage.) � ..--,r v Clri 7. Hoer was the amount claimed above computed? (Include the estimated amount of ani' prospective injury or dauzage) C S4z"i f Q ftCA E 6 (Z-) 9. Names and addresses of witnesses, doctors, and hospitals: 106A Lo) A F ft,t (r1 ci a tut— 71J 14 w &Idd ya ' lie & S Ay`_ ZS�3 PAR� 9. List the expenditures you made•on account of this accident or injury: fTGtcow+L DATE TIME AMOUNT 611SIb L a■csReRraerreerasRReeaeeNNct<re�BEareR■ReseaaRRRRsraaaERsraaRaNRRRRrrNNraarcRRacacRr.e .Gov. Code Sec. 910.2 protides"The claim shalt be signed by the claimant or by some person on his bshalf-" SEND NOTICES TO: (Attorney) 1 1\Tarse and address of Attorney ) (G ain=fs Si ) A. (Addres5l* LA10k, CA. 9�s�1 Tel.ephoneNo. / '/o I Z�-7S�)Telephone No. 5"c- RE KKwxPVkzkRRKM "c-RRNR.RrrrrzkRRE■REENERRRNr a a NRararERMANNRRNa Es MEEK NICK■NNERRNta a sRR.aRR■■NE BENZ r ERE crz, PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act;is subject to public disclosure under*the C.alifarnia Public Records Act (Gov. Code, s§ 6500 et seq.) Furthermore, any attachments,addendums,or sapplemcnts attached to the claim form, including medical r•=ords,are also subject to public dbalomm. ■a a z IMIZIEK RE a a E R a r r s r N a■■R R INV a R R a R R R a R l as r N R a s t s R R N R■R I[E R N N r E R R R s N R RON a a R a E r Rik r a a z F �I NOTICE: Section 72 of the Penal Code provides: i Every psrsoa who, with intent to dafiaud,presents for allowance or for payment to any state board or officer, or to any county, alty, or dfstrlct board or o2cer, authorized to allow or pay the same if geavin.e, any false oz fraudulent claim,bill, account iroucher, or writing is punisbable either by imprisonment in tho County jail for a p=iod of not more than one year, by a fme of act exceeding one thousand dollars (51,000.00), or by both such imprisonment and fine, or by imp:isonment in the state prison: by a fine of not excec ng ten thousand dollars or by both such imprisonment and fine. VEHICLE AGc:IUM KEPURT DATE TIME ACCIDENT LOCATION 9�t c2�ciw� Lo' Vehicle Equipment No. Lic. Plate No. Year/Hake/Type County Driver: Other Driver: (veh%cic. l arvtb) NameName �abQc Mac��r�ez- Department Home Address. s-�3 cacuo.,e\ op Home Address I . Horse Phone i -xt�Li-­v-\yy Home Phone i /z ic�i WLk Zs! o Work Phone 1 s s work Phone i Driver's License f ��gb���B Driver`s License i �p o 4 Car: Year Make _aL,O Model If Personal or Rental Vehicle, Registered er ��� �u ne . Name & Address .of Agent "i 1A Address A< , Phone i License Plate Insurance Company Police Report Taken: Yes No x Address . Policy ( IC HNlS31_8 P+i 3 4-�9 q.L Police Dept. Agents Name •List InJured Parties . List Witnesses: 1.. Name N(r- 1. Name t-.-OA Phone i Phone i Address Address Street Street city State Zip Code city State 7ip Code 2. Name r.)} n 2. Name N�p Phone I Phone i Address Address Street Street —city State, lip Code —city State Zip Code 3. game rJ 1 3. Name �A Phone # Phone I Address Address .. - Street Street City State Ip Code . City State Zip de Seat Belt Worn By County Driver: 'Yes x No Damage -to County Vehicle novo �c'cx�l� Uccl\ DrpL�R � ty.:+mpcC Po�`C�ec� !l Damagp .to Other Vehicle �1" Si � L Date: 818/2006 01:55 PM Estimate ID: 932 ti Estimate Version: 0 Preliminary Profile ID: BAF COMPLETE CARE FRAME AND SUSPENSION EXPERTS FOR 30 YEARS B.A.F. AUTOBODY <bafautobody.corr>2218 MARKET ST SAN PABLO,CA 94806 (510)233-1448 Fax: (510)233-7531 Tax ID: #94-1649823 BAR#: #AK043701 EPA#: #CAL000023680 BAR # AK043701 FED # 94-1649823 Damage Assessed By: JR Stowell Deductible: UNKNOWN Insured: ROBERT MARTINEZ Mitchell Service: 912490 Description: 1993 Oldsmobile Eighty-Eight Royale Vehicle Production Date: 6/93 Body Style: 4D Sed • Drive Train: 3.81-Inj 6 Cyl AO VIN: 1G3HN53L8PH343996 License: 036TBW AZ Mileage: 94,842 OEM/ALT: O Search Code: None Color: TAN Options: ALUM/ALLOY WHEELS,AIR CONDITIONING,POWER STEERING,POWER BRAKES,POWER WINDOWS POWER DOOR LOCKS,TILT STEERING WHEEL,ELECTRIC DEFOGGER,AUTOMATIC TRANSMISSION PASSENGER-FRONT AIR BAG,POWER REMOTE MIRROR,4-DOOR,DRIVER-FRONT AIR BAG Line Entry Labor Line Rem Part Type/ Dollar Labor Rem Number Type Operation Description Part Number Amount Units 1 201450 BDY REMOVE/REPLACE GRILLE ORDER FROM DEALER 165.54 0.1 # 2 AUTO BDY OVERHAUL L HEADLAMP ASSY 0.5 # 3--.- 201780 BDY REMOVEIREPLACE L H/LAMP ASSEMBLY 16515619 GM PART 338.21 INC # 4 AUTO BDY CHECKIADJUST HEADLAMPS 0.4 5 201950 BDY REMOVEIREPLACE L H/LAMP HOUSING 26609335 GM PART 33.87 INC # #-Labor Note Applies ESTIMATE RECALL NUMBER: 8/8/200613:55:45 932 UltraMate is a Trademark of Mitchell International Mitchell Data Version: JUL—06— 6_V Copyright(C)1994-2005 Mitchell International Page 1 of 2 UltraMate Version: 5.0.215 All Rights Reserved Date: 8/812006 01:55 PM ' Estimate ID: 932 Estimate Version: 0 Preliminary Profile ID: BAF COMPLETE CARE Add'1 Labor Sublet 1. Labor Subtotals Units Rate Amount Amount Totals It. Part Replacement Summary Amount Body 1.0 68.00 0.00 0.00 68.00 Taxable Parts 537.62 Sales Tax @ 8.250% 44.35 Non-Taxable Labor 68.00 Total Replacement Parts Amount 581.97 Labor Summary 1.0 68.00 III. Additional Costs Amount N. Adjustments Amount Total Additional Costs 0.00 Customer Responsibility 0.00 1. Total Labor: 68.00 11. Total Replacement Parts: 581.97 111. Total Additional Costs: 0.00 Gross Total: 649.97 N. Total Adjustments: 0.00 Net Total: 649.97 This is a Preliminary estimate. Additional changes to the estimate may be required for the actual repair. ******************Parts Price's Subject To Change**************** All Workmanship is Guaranteed For As Long As You Own Your Vehecle. All Parts Guaranteed As Per Manufacturers Warranty. Any Additioal Repairs or Supplements Relation To This Loss Should be Brought To B.A.F. For Futher Repairs Or All Guarantees Are Void. I Authorize Any Additioal Parts And Labor Needed To Complete Repairs. Estimate Authorized By Date I AUTHORIZE ANY ADDITIONAL PART OR LABOR NEEDED TO COMPLETE. DUE TO MANY UNFORSEEN CIRCUMSTANCES IN THE REPAIRING OF AUTOMOBILES, WE REGRET THAT WE CAN ONLY ESTIMATE, NOT PROMISE A COMPLETION DATE AND TIME. ESTIMATE RECALL NUMBER: 818/2006 13:55:45 932 UltraMate is a Trademark of Mitchell International Mitchell Data Version: JUL_06_V Copyright(C)1994-2005 Mitchell International Page 2 of 2 UltraMate Version: 5.0.215 All Rights Reserved Date: 811612006 03:41 PM Estimate ID: 1327 Estimate Version: 0 Preliminary Profile ID: CUSTOMIZED Solano Collision Inc. 3267 Sonoma Blvd.Vallejo,CA 94590 (707)644-4044 Fax: (707)644-4045 Tax ID: 48-1299380 BAR M AF228086 EPA#: CAD981579832 I Damage Assessed By: DENNIS MURPHY Deductible: UNKNOWN Owner ROBERT MARTINEZ Address: PO BOX 890 RIO VISTA,CA 94571 Telephone: Home Phone: (510)374-7510 Mitchell Service: 912490 Description: 1993 Oldsmobile Eighty-Eight Royale Vehicle Production Date: 6193 Body Style: 4D Sed Drive Train: 3.8L Inj 6 Cyl AO VIN: 1G3HN53L8PH343996 License: 036 TBW Mileage: 95,268 OEM/ALT: O Search Code: None Color: BEIGE ** SPECIAL PART NOTE: All parts on this estimate are "NEW" parts (OEM) unless otherwise specified. Parts described as Rechromed, Recored or Remanufactured are either "Reconditioned" parts or "Rebuilt" parts. Crash parts described as "Qual Repl Part" are non-OEM aftermarket parts.** KEY TO PARTS ABBREVIATIONS: OEM= A new, Original Equipment Manufacutrer part A/M= A new, After-Market part; also known as a new, Non-OEM part Used or LKQ= A used OEM part that has been reconditioned or remanufactured. Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description _ Part Number Amount Units 1 201000 BDY OVERHAUL FRT BUMPER COVER ASSY 2.5 # 2 201042 BDY REPAIR FRT BUMPER COVER Existing 1.0*# 3 AUTO REF REFINISH FRT BUMPER COVER C 2.2 4 201160 BDY REMOVE/REPLACE FRT BUMPER LICENSE BRACKET 25606535 GM PART 21.07 INC 5 201450 BDY REMOVEIREPLACE GRILLE ORDER FROM DEALER 165.54 0.1 # 6 201480 BDY REMOVE/REPLACE GRILLE EMBLEM 25537292 GM PART 15.10 INC # 7 201500 BDY REMOVE/REPLACE CTR GRILLE BRACKET 25621829 GM PART 5.45 0.1 # 8 201520 BDY REMOVE/INSTALL GRILLE FILLER PANEL Existing 0.2* 9 201690 BDY CHECKIADJUST HEADLAMPS 0.4 10 AUTO BDY OVERHAUL L HEADLAMP ASSY 0.5 # 11 201950 BDY REMOVE/REPLACE L HILAMP HOUSING 25609335 GM PART 33.87 INC # 12 201970 BDY REMOVE/REPLACE L H/LAMP BRACKET 25535068 GM PART 3.84 INC # ESTIMATE RECALL NUMBER: 811612006 15:41:04 1327 UltraMate is a Trademark of Mitchell International Mitchell Data Version: JUL_06_V Copyright(C)1994-2003 Mitchell International Page 1 of 3 UltraMate Version: 5.0.215 All Rights Reserved Date: 8/16/2006 03:41 PM • Estimate ID: 1327 Estimate Version: 0 Preliminary Profile ID: CUSTOMIZED 13 202620 BDY ALIGN HOOD PANEL Existing 0.5* 14 200603 BDY REPAIR L FRONT BODY PANEL -S Existing 1.5* 15 AUTO REF REFINISH L RADIATOR SIDE PANEL 0.5 16 205630 BDY REMOVEIREPLACE FRONT BODY HOOD LATCH SUPPORT 25630768 GM PART 11.59 0.3 17 936012 ADD'L COST HAZARDOUS WASTE DISPOSAL 3.00* 18 AUTO REF ADD'L OPR CLEAR COAT 0.9 19 933003 BDY* ADD'L OPR TINT COLOR 0.5* 20 933018 REF ADD'L OPR MASK FOR OVERSPRAY 5.00* 0.2* 21 AUTO ADD'L COST PAINTIMATERIALS 115.20* 22 900500 REF * REMOVE/REPLACE FLEX ADDITIVE **Qual Repl Part 7.00* 0.0* 23 900500 BDY* REMOVE/REPLACE CORROSION PROTECTION **Qual Repl Part 10.00* 0.1* 24 .1 LABOR PER PANEL * -Judgement Item #-Labor Note Applies C -Included in Clear Coat Calc Add'I Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals Il. Part Replacement Summary Amount Body 7.7 70.00 0.00 0.00 539.00 Taxable Parts 273.46 Refinish 3.8 70.00 5.00 0.00 271.00 Sales Tax @ 7.375% 20.17 Non-Taxable Labor 810.00 Total Replacement Parts Amount 293.63 Labor Summary 11.5 810.00 III. Additional Costs Amount IV. Adjustments Amount Taxable Costs 115.20 Customer Responsibility 0.00 Sales Tax @ 7.375% 8.50 Non-Taxable Costs 3.00 Total Additional Costs 126.70 I. Total Labor: 810.00 II. Total Replacement Parts: 293.63 III. Total Additional Costs: 126.70 Gross Total: 1,230.33 IV. Total Adjustments: 0.00 Net Total: 1,230.33 This is a preliminary estimate. Additional changes to the estimate may be required for the actual repair. Point(s)of Impact 12 Front Center(P) THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR ESTIMATE RECALL NUMBER: 8/16/2006 15:41:04 1327 UltraMate is a Trademark of Mitchell International Mitchell Data Version: JUL_06_V Copyright(C)1994-2003 Mitchell International Page 2 of 3 UltraMate Version: 5.0.215 All Rights Reserved Date: 8/16/2006 03:41 PM • Estimate ID: 1327 Estimate Version: 0 Preliminary Profile ID: CUSTOMIZED VEHICLE. ANY WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OF THE PARTS, RATHER THAN BY THE ORIGINAL MANUFACTURER OF YOUR VEHICLE. ESTIMATE RECALL NUMBER: 8/16/2006 15:41:04 1327 UltraMate is a Trademark of Mitchell International Mitchell Data Version: JUL_06_V Copyright(C)1994-2003 Mitchell International Page 3 of 3 UltraMate Version: 5.0.215 All Rights Reserved