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MINUTES - 07222008 - C.34
l - CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION. Z � Claim Against the County, or Disti-ict Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT z, ) grid 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 13 D on your claim by the Board of JUN 1 9:ZOOS Supervisot•s. (Paragraph IV below), given Pursuant to Government Code AMOUNT: COUNTY ART N �COUNSEL FL Section 913 and 915.4. Please note all n "Warnings". CLAI.MANT:3 -� T—orm JLf`I•a0U4,/-a 4/ rte: +5erine411 VIC' ATTORNEY: j'l/a.) DATE RECEIVED: td'( jt, 1`3 ADDRESS: p o, Box BY DELIVERY TO CLERK ON: 1 CCS (�Co oow',�'> � BY MAIL POSTMARKED: JLuI-e-,. toWWI- A31/ FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN CUL N, Clerk Dated:Ni w, c( By: Deputy � I,ejle, �r af�(a i1. FROM.: County Counsel TO: Clerk of the Board of Supervisors (VY--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). O 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 Counsel III. FROM.: Clerk of the Board TO: County Counsel (1) County Administrator(2) O Claim was returned as untimely with notice to claimant (Section 91 1.3). IV BOARD ORDER: By unanimous vote of the Supervisors present: (l 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. Date •2.2 �i�"bd60HN CULLEN, CLERK, By eputy Clerk WA IN (Gov. code sections 913) Subject to certain exceptions,you have only six(6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of'your choice in connection wide this nnatter. If'you want to consult an attorney,you should do so immediately. *For Additio+ial Warning See Reverse Side ofThis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that .l. ann now, and at all times herein mentioned, have beew a citizen of the United States, over age 18; and that today l .deposited in the United States Postal Service in- [Wartinez, California, postage fully prepaid a certified copy of•.this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: �'�'��JOHN CULLEN, CLERK By eputy Clerk 1 ;• STATE FARM State Farm Insurance Companies i INSURANCE State Farm Insurance Subrogation Services June 6, 2008 PO Box 2371 Bloomington, IL 61702-2371 Certified Mail-Return Receipt Requested Contra Costa County Clerk Of The Board Of . Supervisors 651 Pine St . RECEIVED Martinez, CA 94553 JUN 1 3 2008 CLERK BOARD OF SUPERVISORS _ RE: Claim Number: 05—BO84-180 CONTRA COSTA CO. Our Insured: Kenneth Vogel Date of Loss : May 15, 2008 Your Insured: Contra Costa County Your Insured Driver: Andre Moses Your Claim Number: Your Policy Number: Dear Sir/Madam: It is our understanding that you are self insured. Our investigation indicates you are responsible for this claim. Therefore, we are seeking recovery from you. This letter is to notify you of our subrogation claim and request your cooperation in settling this matter. To assist you in your review, here is a breakdown of the amounts State Farm paid by Cause of Loss : 041/045 - Uninsured Motorist BI $ 042 - Uninsured Motorist PD $ 300 series/400 - Comp/Collision $1, 695 . 38. . 501 - Rental/Loss of Use $ 600-050 - Med Pay/PIP $ Other $ Salvage Recovery $ Amount State Farm Paid $1, 695 . 38 Insured Deductible $500 . 00 Total Claim Amount $2 , 195 . 38 Based on the assessment of liability between the parties, State Farm Mutual Automobile Insurance Company is seeking 1000 of the Total Claim Amount listed above . The amount payable to State Farm Mutual Automobile Insurance Company for this loss is $2,195 . 38 . HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001 Page 2 June 6, 2008 Please remit payment of this claim and include our claim number on the payment . If you have any questions, please call 877-457-8276 and any member of Team #60 .may assist you. Thank you for your cooperation. In order to assist you in evaluating and processing the subrogation claim we are asserting, we may provide nonpublic personal information about our customer. We are sharing this information to effect, administer, or enforce a transaction authorized by the consumer. However, you are neither authorized nor permitted to: (1) use the customer information we provided for any purpose other than to evaluate and process the subrogation claim, or (2) disclose or share the customer information we provide for any purpose other than to evaluate and process the subrogation claim. Sincerely, S egraf Claim Proce o (877) 457-8276 , Team 60 State Farm Mutual Automobile Insurance Company Enclosure (s) z� .�. _;:�- 4 r�' ,. .. � g v#-�a "� •` yy F �i�)� F4' �" M 9'f V - �� E — u h ��� _ ��1 a ' ,ASM RBZ00032 date : 06-06-08 time : 08 : 13 AM STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY VEHICLE DAMAGE REPORT .................................... ...... c1a :;ru e:r date of loss . ............. ......................... .... ............ ........................ .. .. .......... ............................................................ ............. . ............................................................ C1 ::--8:E7:: Z> € > 05 -15-08 .................. ....................................... ................ ................................................................................. Estimate Vehicle Info Vehicle Owner: VOGEL, KENNETH .k Vehicle Description: 05 TOYO COROLLA LE 4D SED SILVER 05/30/2008 AT 07 : 54 AM JOB NUMBER: 111079 40462 MIKE ROSE' S AUTO BODY INC. - VDM LICENSE # :BAR# AG18474 FEDERAL ID # : 942621349 WHERE QUALITY COUNTS 2260 VIA DE MERCADOS CONCORD, CA 94520-4920 (925) 689=1739 FAX: (925) 689-0991 SUPPLEMENT OF RECORD 1 WITH SUMMARY WRITTEN BY: JOHN GLOYN #EPACAR000004317 05/30/2008 07 : 38 AM ADJUSTER: ROBIN PARRA INSURED: KENNETH VOGEL CLAIM #05-B084-18001 OWNER: KENNETH VOGEL POLICY # ADDRESS : 4980 WITTENMEYER CT DEDUCTIBLE: $500 . 00 MARTINEZ, CA 94553 DATE OF LOSS : 05/15/2008 AT 10 : 30 AM DAY: (925) 370-0998 TYPE OF LOSS : COLLISION POINT OF IMPACT: 7 . LEFT REAR INSPECT MIKE ROSE' S AUTO BODY INC. - VDM BUSINESS : (925) 689-1739 LOCATION: 2260 VIA DE MERCADOS CONCORD, CA 94520-4920 INSURANCE STATE FARM INSURANCE COMPANIES COMPANY: 6400 STATE FARM DRIVE DAYS TO REPAIR ROHNERT PARK E/V, CA 94928-9886 VEHICLE DROP OFF DATE: 05/20/2008 REPAIR START DATE: 05/20/2008 REPAIR COMPLETION DATE: 05/27/2008 PROMISE DATE: 05/27/2008 2005 TOYO COROLLA LE 4-1 . 8L-FI 4D SED SILVER INT: VIN: 1NXBR32E05Z501801 LIC: 5NDB679 CA PROD DATE: ODOMETER: 21288 5 SPEED TRANSMISSION OVERDRIVE BUCKET SEATS CLOTH SEATS POWER STEERING TILT WHEEL POWER BRAKES REAR DEFOGGER POWER WINDOWS FULL WHEEL COVERS AM RADIO FM RADIO STEREO SEARCH/SEEK CD PLAYER POWER LOCKS AIR CONDITIONING DRIVER AIR BAG PASSENGER AIR BAG CONSOLE/STORAGE DIGITAL CLOCK INTERMITTENT WIPERS WOOD INTERIOR TRIM POWER MIRRORS DUAL MIRRORS BODY SIDE MOLDINGS KEYLESS ENTRY CLEAR COAT PAINT ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1# S01 FINAL BILLING ESTIMATE= 1 0 . 00 0 . 0 0 . 0 2# SO1 AUTHORIZATION TO PAY SECURED 1 0 . 00 0 . 0 0 . 0 - OWNER 3# S01 PROVIDED WITH A COPY OF 1 0 . 00 0 . 0 0 . 0 ESTIMATE/FINAL BILL 4 ROOF 5 R&I LT DRIP MOLDING W/O XRS. 0 .0 . 00 0 . 3 0 . 0 6 PILLARS, ROCKER & FLOOR 1 05/30/2008 AT 07 : 54 AM JOB NUMBER: 111079 40462 , SUPPLEMENT OF RECORD 1 WITH SUMMARY 2005 TOYO COROLLA LE 4-1 . 8L-FI 4D SED SILVER INT: ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ---------------------7------------------------7-------------------------------- 7* BLND LT HINGE PILLAR UP AND OVER * 0 0 . 00 S 0 . 0 0 . 8* SAIL 8 REAR DOOR 9 BLND LT DOOR SHELL W/POWER LOCK 0 0 . 00 0 . 0 1 . 0 10 R&I LT BELT MOLDING W/O XRS 0 0 . 00 0 . 3 0 . 0 11* R&I LT BODY SIDE MLDG LE, XRS, & 0 0 . 00 0 . 3* 0 . 0 S MODEL SILVER 12# CLEAN AND RETAPE LT REAR 1 2 . 00 0 . 2 0 . 0 B. S .M. 13 R&I LT HANDLE, OUTSIDE LE, XRS, & 0 0 . 00 0 . 2 0 . 0 S MODEL, SILVER 14 R&I LT R&I TRIM PANEL 0 0 . 00 0 . 4 0 . 0 15 QUARTER PANEL 16* RPR LT QUARTER PANEL W/O XRS 0 0 . 00 6 . 5* 2 . 4 17 ADD FOR CLEAR COAT 0 0 . 00 0 . 0 1 . 0 18 R&I LT PRESSURE VENT 0 0 . 00 0 , 2 0 . 0 19 BLND FUEL DOOR 0 0 . 00 0 . 0 0 . 2 20 R&I FUEL DOOR 0 0 . 00 0 . 3 0 . 0 21 REAR BODY & FLOOR 22 R&I LT SIDE TRIM PANEL 0 0 . 00 0 . 3 0 . 0 23 REAR LAMPS 24* REPL USED LT COMBO LAMP ASSY +250 1 106 . 25* 0 , 3* 0 . 0 25 REAR BUMPER 26 O/H BUMPER ASSY' 0 0 . 00 1 . 8 0 . 0 27** REPL RECOND BUMPER COVER CE & LE 1 156 . 00 INCL. 3 . 0 28 ADD FOR CLEAR COAT 0 0 . 00 0 . 0 1 . 2 29* REPL USED LT FILLER +250 1 25 . 00* 0 . 3* 0 . 0 30# ROPE LT SIDE OF BACK GLASS 1 0 . 00 0 . 3 0 . 0 31# REPL COVER CAR 1 7 . 50 T 0 . 2 0 . 0 32# SUBL HAZARDOUS WASTE 1 5 . 00 X 0 . 0 0 . 0 33# TINT COLOR 1 0 . 00 X 0 . 5 0 . 0 34# SET UP FOR FLOOR PULL 1 0 . 00 X 1 . 0 F 0 . 0 354 RPR PULL UNI-BODY STRUCTURE 0 0 . 00 1 . 0 0 . 0 36# C.A.D. # 92200 BRIAN 1 0 . 00 0 . 0 0 . 0 37 SO1 REFN LT FILLER 0 0 . 00 0 . 0 0 . 3 38# SO1 ROPE LT SIDE OF FRT WINDSHIELD 1 1 . 00 0 . 2 0 . 0 ------------------------------------------------------------------------------- SUBTOTALS =_> 302 . 75 14 . 6 9 . 9 PARTS 290 . 25 BODY LABOR 13 . 6 HRS @$ 64 . 00/HR 870 .40 PAINT LABOR 9 . 9 HRS @$ 64 . 00/HR 633 . 60 FRAME LABOR 1 . 0 HRS @$ 64 . 00/HR 64 . 00 PAINT SUPPLIES 9 . 9 HRS @$ 28 . 00/HR 277 . 20 SUBLET/MISC. ' 12 . 50 ---------------------------------------------------- SUBTOTAL $ 2147 . 95 2 05/30/2008 AT 07 : 54 AM JOB NUMBER: 111079 40462 SUPPLEMENT OF RECORD 1 WITH SUMMARY 2005 TOYO COROLLA LE 4-1 . 8L-FI 4D SED SILVER INT: SALES TAX $ 574 . 95 @ 8 . 2500% 47 . 43 -----=---------------------------------------------- GRAND TOTAL $ 2195 . 38 ADJUSTMENTS : DEDUCTIBLE 500 . 00 -----7---------------------------------------------- CUSTOMER PAY $ 500 . 00 INSURANCE PAY $ 1695 . 38 THIS IS A PRELIMINARY ESTIMATE AND ADDITIONAL CHARGES MAY BE REQUIRED FOR THE ACTUAL REPAIR. THIS IS A PRELIMINARY ESTIMATE AND ADDITIONAL CHARGES MAY BE REQUIRED FOR THE ACTUAL REPAIR. 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 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=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. .MOTORS 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. NWCPP=NATIONWIDE CRASH PARTS PROGRAM. THIS ESTIMATE HAS .BEEN BASED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES APPLICABLE TO THESE REPLACMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OF THE PARTS, RATHER THAN BY THE ORIGINAL MANUFACTURER OF YOUR VEHICLE . 3 05/30/2008 AT 07 : 54 AM JOB NUMBER: 111079 40462 SUPPLEMENT OF RECORD 1 WITH SUMMARY 2005 TOYO COROLLA LE 4-1 . 8L-FI 4D SED SILVER INT: ESTIMATE BASED ON MOTOR CRASH ESTIMATING GUIDE. UNLESS OTHERWISE NOTED ALL ITEMS ARE DERIVED FROM THE GUIDE ARM8427 , CCC DATA DATE 05/01/2008 , 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) OR ALT OEM (ALTERNATIVE OEM) PARTS ARE OEM PARTS THAT MAY BE PROVIDED BY OR THROUGH ALTERNATE SOURCES OTHER THAN THE OEM VEHICLE DEALERSHIPS . OPT OEM OR ALT OEM PARTS MAY REFLECT SOME SPECIFIC, SPECIAL, OR UNIQUE PRICING OR DISCOUNT. OPT OEM OR ALT OEM PARTS MAY INCLUDE "BLEMISHED" PARTS PROVIDED BY OEM' s THROUGH OEM VEHICLE DEALERSHIPS . 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 RELY PARTS, RCY, OR USED. RECONDITIONED PARTS ARE DESCRIBED AS RECOND. 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. 4 05/30/2008 AT 07 : 54 AM JOB NUMBER: 111079 40462 SUPPLEMENT OF RECORD 1 WITH SUMMARY 2005 TOYO COROLLA LE 4-1 . 8L-FI 4D SED SILVER INT: ------- -------------------------=---------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- ------ ADDED ITEMS ------- 1# SOl FINAL BILLING ESTIMATE= 1 0 . 00 0 . 0 0 . 0 2# SOl AUTHORIZATION TO PAY SECURED 1 - OWNER 0 . 00 0 . 0 0 . 0 3# S01 PROVIDED WITH A COPY OF 1 ESTIMATE/FINAL BILL 0 . 00 0 . 0 0 . 0 37 SO1 REFN LT FILLER 0 0 . 00 0 . 0 0 . 3 38# SO1 ROPE LT SIDE OF FRT WINDSHIELD 1 1 . 00 0 . 2 0 . 0 ------------------------------------------------------------------------------- SUBTOTALS =_> 1 . 00 0 . 2 0 . 3 PARTS 1 . 00 BODY LABOR 0 . 2 HRS @$ 64 . 00/HR 12 . 80 PAINT LABOR 0 . 3 HRS @$ 64 . 00/HR 19 . 20 PAINT SUPPLIES 0 . 3 HRS @$ 28 . 00/HR 8 . 40 ---------------------------------------------------- SUBTOTAL $ 41 . 40 SALES TAX $ 9 . 40 @ 8 . 25000 0 . 78 ADDITIONAL SUPPLEMENT TAXES -0 . 01 -----7---------------------------------------------- TOTAL SUPPLEMENT AMOUNT $ 42 . 17 NET COST OF SUPPLEMENT $ 42 . 17 ESTIMATE 2153 . 21 JOHN GLOYN SUPPLEMENT S01 42 . 17 JOHN GLOYN -------- CUSTOMER PAY $ 500 . 00 JOB TOTAL $ 2195 . 38 INSURANCE PAY $ 1695 . 38 THIS IS A PRELIMINARY ESTIMATE AND ADDITIONAL CHARGES MAY BE REQUIRED FOR THE ACTUAL REPAIR. THIS IS A PRELIMINARY ESTIMATE AND ADDITIONAL CHARGES MAY BE REQUIRED FOR THE ACTUAL REPAIR. 5 05/30/2008 AT 07 : 54 AM JOB NUMBER: 111079 40462 SUPPLEMENT OF RECORD 1 WITH SUMMARY 2005 TOYO COROLLA LE 4-1 . 8L-FI 4D SED SILVER INT: 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 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=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. .MOTORS 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. NWCPP=NATIONWIDE CRASH PARTS PROGRAM. THIS ESTIMATE HAS BEEN BASED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES APPLICABLE TO THESE REPLACMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OF THE PARTS, RATHER THAN BY THE ORIGINAL MANUFACTURER OF YOUR VEHICLE. 6 05/30/2008 AT 07 : 54 AM JOB NUMBER: 111079 40462 SUPPLEMENT OF RECORD 1 WITH SUMMARY 2005 TOYO COROLLA LE 4-1 . 8L-FI 4D SED SILVER INT: ESTIMATE BASED ON MOTOR CRASH ESTIMATING GUIDE. UNLESS OTHERWISE NOTED ALL ITEMS ARE DERIVED FROM THE GUIDE ARM8427, CCC DATA DATE 05/01/2008, 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) OR ALT OEM (ALTERNATIVE OEM) PARTS ARE OEM PARTS THAT MAY BE PROVIDED BY OR THROUGH ALTERNATE SOURCES OTHER THAN THE OEM VEHICLE DEALERSHIPS . OPT OEM OR ALT OEM PARTS MAY REFLECT SOME SPECIFIC, SPECIAL, OR UNIQUE PRICING OR DISCOUNT. OPT OEM OR ALT OEM PARTS MAY INCLUDE "BLEMISHED" PARTS PROVIDED BY OEM' S THROUGH OEM VEHICLE DEALERSHIPS . 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 RECOND. 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. 7 05/30/2008 AT 07 : 54 AM JOB NUMBER: 111079 40462 SUPPLEMENT OF RECORD 1 WITH SUMMARY 2005 TOYO COROLLA LE 4-1 . 8L-FI 4D SED SILVER INT: ALTERNATE PARTS SUPPLIERS 27 RECOND BUMPER COVER CE & LE PART NO. 5215902911 PRICE 156 . 00 BAY AREA BUMPERS (510) 505-9010 7887 ENTERPRISE DRIVE (800) 285-2867 NEWARK, CA 94560 8 05/30/2008 AT 07 : 54 AM JOB NUMBER: 111079 40462 SUPPLEMENT OF RECORD 1 WITH SUMMARY 2005 TOYO COROLLA LE 4-1 . 8L-FI 4D SED SILVER INT: ALTERNATE PARTS USAGE AFTERMARKET PARTS AFTERMARKET SELECTION METHOD: AUTOMATICALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT AN AFTERMARKET PART WAS AVAILABLE: 5 NO. OF AFTERMARKET PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 OPTIONAL OEM PARTS OPTIONAL OEM SELECTION METHOD: MANUALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT AN OPTIONAL OEM PART WAS AVAILABLE: 0 NO. OF OPTIONAL OEM PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 RECONDITIONED PARTS RECONDITIONED SELECTION METHOD: MANUALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT A RECONDITIONED PART WAS AVAILABLE: 2 NO. OF RECONDITIONED PARTS THAT APPEAR IN THE FINAL ESTIMATE: 1 RECYCLED PARTS NO. OF TIMES USER WAS NOTIFIED THAT A RECYCLED PART WAS AVAILABLE: 2 NO. OF RECYCLED PARTS THAT APPEAR IN THE FINAL ESTIMATE: 2 9 IN RBZ0006Z ..yy..(�.]Xl1Ip .�y[am!� T� ............................ date : 06-06-08 page : 1 y'*!.:4�....^. :::......:� �':. w1{LZ:6:6:::£1 . STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY AUTO PAYMENTS BY COL ............................................ �1; ; ry k:e' policy number 5 ` ' 8 7 #:4 .. 0 8 7 -4S4 -0 -5 named insured date of loss VO G E L , K ENN ETH O 5 — 1 5 — 0 8 C O L 4 0 0 C denotes consolidated payment E denotes EFT payment P denotes previous data COL: 400 indemnity: 1, 695 . 38 dir rcov: 0 . 00 expense: 0 . 00 payment number payee amount status COL pay cd rsn reporting party E 102880578K MIKE ROSE' S AUT 1, 695 . 38 PAID 400 1 Named Insu 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 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 § 91 1.2.) 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. RE: Claim By: Reserved for Clerk's filing stamp ) ) Against the County of Contra Costa or ) District ) (Fill in the name) ) The undersigned claimant hereby makes claim against the County of Contra Costa of the above-named district in the sum of$2,195.38 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) May 15, 2008 2. Where did the damage of injury occur? (Include city and county) Parking Lot, Pacheco, CA 3. How did the damage or injury occur? (Give full details, use extra paper if required) Insured backed out of parking space when Contra Costa County em looyee Andre Moses backed up and turned into insured's vehicle causingdamage. 4. What particulate act of omission on the part of county of district officers, servants, or employees caused the injury of damage? Unsafe backing on the part of the county employee. 5. What are the names of county of district officers, servants, or employees causing the damage or iniurv? Andre_Moses 6. What damages or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) Damage to left quarter panel 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Estimate attached 8. Names and addresses of witnesses, doctors, and hospitals: none 9. List the expenditures you made:on-account of this accident of injury: DATE TIME, AMOUNT 5-3008, $1,695.38 Gov. Code Sec. 910.2 provides"The claim shall be signed by the claimant of by some person on his behalf.».. . SEND NOTICES TO: (Attorney) ) Name and address of Attorney ( ai ant's Signature) PO Box 2371, Bloomington, IL 61702-2371 (Address) Telephone No. )Telephone No. 877-457-8276 Team 60 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,of to any county, city,or district board or officer,-authorized to allow or pay the same if genuine,any false or fraudulent claims,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($10,000.00),or by both such imprisonment and fine. VSES POS., 166-1031 A-01 Printed in U.S.A. 02-10-2005 I `• �0 c Subrogation Services - Auto Bloomington =� g STATE FARM INSURANCE COMPANIES 102 1M $ (0So.2,CO P.O. Box 2371 0[ 0004245894 JUN 10 2008 7008 05DD DDD 1 n_ MAILED FROM ZIP CODE 61 ]01 Bloomington, Illinois 61.702-2371 - ----- (_-- IVED JUN 1 3 2008 • CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. • FIRS i r -.1 i CLAIM r BOARD OF SUPLI-WISOi1S OF CONTRA COSTA COUNTY \' BOARD ACTION:-JLt, j 2_-Z, 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. California Government Codes. ) you is your notice of the action taken on your clairn.by tiie Board of Rip;CGSupervisors. (Paragraph 1V below), JUN 1 9.2008 given Pursuant to Government Code AMOUNT: °7a,� a-� Section 913 and 915.4. Please note all COUNTY COUNSEL "Warnings". MARTINEZ CALIF. CLAIMANT: V�.`dShWtl tC re_AUA ATTORNEY: DATE RECEI.VED: dt 11 e' , 1 3 2,L b ADDRESS: 461 R. .., !�t, BY DELIVERY TO CLERK ON' �'`: ," ffDM � ?al CA 01 IFS �- BY MAIL POSTMARKED: /��(, FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. t,1,f11✓ �� ��� JOHN CUL , C..lerk n t Dated: By: Deputy Wo A bme(;�% vv 11. FROM: 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). . ( ) 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 91 l.3). O Other: Dated: O&" By: /7'7 -__. Deputy County Counsel 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). V1V. 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.Q4 eoDate o?ioG HN CULLE.N, CLERK, By Deputy Clerk WAI IN (Gov. code section 913). Subject to certain exceptions,you have only six(6) months 11rom the date this notim was personalty seiwed or deposited in the null to file a court action on this claim.See Government Code Section 945.6.You may seek the .advice of an attorney of your choicie in connection wide this matter. lf'you want to consult an attor-irey,you should do so inunecliately. *For Additional Warning See Reverse Side of'This Notice. . AFFIDAVI"T OF MAILING I declare under petralty of per jury that 1. am noiv, and at all times herein mentioned, have been a citizen of tine United States, over age 18; incl that today 1 deposited in tine United States Postal Service in Ntartinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. DateJOHN CULLEN, CLERK By_ eputy Clerk BOARD OF SUPERVISORS OF CONTRA COSTA COUTNTY SHARON HYMES-Or=FORD Il\TSTRUCTIONS TO CL.A,IMAN�' - JUN 1 t< A. A claim relating to a cause of action for death or for injury to person or to personal property or 2008 growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to anv other-cause of action shall be prese�ited 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 Supervist9m 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-*aims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. ■■aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaIaaaaa0aaaaaaasaaaEaaaaaaa■saaaaraaeeasi RE: Claim By: Reserved for Clerk's filing stamp �0S� yC� � 1r\ Against the County of Contra Costa or ) JAN Y 3 2008 CLERK 13001 o OF SUPERVISORS WQ),(�kS District) CONTRA COSTA CO. Will in the name) ) ) The undersigned claimant hereby makes clain against the.County of Contra Costa or the above-named district in the sum of$ Ct_7 ,a1- and in support of this claim represents as follows: 1. When did the da1314TC or irljui;' occur? (Give exact date and Lour) �1 IN OS /D : DO �111'\ 2. Where did the damage or injury occur? (Include city and county) 'Rodeo GA) 9'��S � u� (�/ol r�rsi Sr ) 3. How did the damage or injury occur? (Give full details;use extra paper if required No+ 4or ww5 dY,iPe� or Pare. 0n-� VY\ Cmy po,,rlce� � in �rvn�' 4� n1Y house o.s ?0' 61es to S+gee_+p wtve, be,+nc� ��,ke.6. N0 sighs or wo.ry);n(� o-F a,41 4. V7bl at particular ac or omission on the p� count), or district officers, servants, or employees caused the injury or damage?' 1 t✓U►J 1\(� W p T C,5' 5 What are the names of county or district officers, servants, or employees causing the , damage or injury? COYLY&, C,05 /Pub�fc, Works Pe "�Mev)i 6. V1' �.L'dainage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. :Attach two estimates for auto damage.) -�' e, (4e �WO CS�i V"c4eq> n +\MeD VCK k;-Q� -�6r ln�' c10,�, 7. How was the amount claimed above computed? (Include the. estimated amount of any prospective injury or damage.) �) ] / '7 7q S. Names and addresses of witnesses, doctors, and hospitals: 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT 9:0 0 ■ ■■aaaaaaaaaaataaaaaaaaaaaamaaaaaaaa1.■aaaaataaaaaamaaaataaaaaataaaaaaaasKaaamaaraaaaI ) .Gov. Code Sec. 910.2 provides "The clai n shall be ) signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attornev) 1 Name and address of Attorney ). ` (Claimant's Si_ ature) (Address) L g r) C� �95�� Telephone No. ) Telephone No. ■■taaaaeaaaaaaaaaaatsons aaataataaasaraaraaaaaaaaaaa9a0a2aaaaaaaaaaaaaaa2aa0aaIaaaaa61 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 attaeluments, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■ ■aaaarraaaaaaaaaaa*sump aaaaaaaaaaraaaaraaaeaaaaaaaaaaaaaraaaaraaaaaaaaaawas araaaaaai 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. J & M AUTO CUSTOMS 895 HOWE ROAD, UNIT F MARTINEZ, CA 94553 (925) 229-3819 FAX (925) 229-3898 CD LOG NO 6371 DATE 05/15/08 SHOP: J & M AUTO CUSTOMS INSP DATE: 05/15/08 ADDRESS: 895 HOWE RD PHONE 1 : (925) 229-3819 CITY STATE: MARTINEZ, CA FAX: (925) 229-3898 ZIP: 94553— EMAIL: SIX495@SBCGLOBAL.NET OWNER: KREMIN, JOSHUA CELL PHONE: (510) 812-9339 POINT OF IMPACT: 0 LIC# : STATE: VIN: 2G1WX12KOW9321182 BODY COLOR: GOLD MILEAGE: 78, 958 CONDITION: ACCTNG CTL# : *=USER-ENTERED VALUE E=REPLACE OEM NG=REPLACE NAGS EC=REPLACE ECONOMY UE=REPLACE OE SURPLUS UC=RECONDITIONED PRT UM=REMAN/REBUILT PRT EU=REPLACE SALVAGE EP=REPLACE PXN OE=REPLACE PXN OE SRPLS PC=PXN RECONDITIONED PM=PXN REMAN/REBUILT TE=PARTL REPL PRICE ET=PARTL 'REPL LABOR IT=PARTIAL REPAIR I=REPAIR L=REFINISH BR=BLEND REFINISH TT=TWO-TONE CG=CHIPGUARD SB=SUBLET N=ADDITIONAL LABOR RI=R&I ASSEMBLY P=CHECK AA=APPEAR ALLOWANCE RP=RELATED PRIOR UP=UNRELATED PRIOR 1998 CHEVROLET MONTE CARLO Z34' 2DOOR COUPE 6CYL GASOLINE 3. 8 CODE: U2432C/D OPTNS K/24AHBKDGI OPTIONS: TWO-STAGE - EXTERIOR SURFACES TWO-STAGE - INTERIOR SURFACES ELEC REMOTE CONTROL MIRRORS POWER DOOR LOCKS ' POWER WINDOWS REMOTE KEYLESS ENTRY SYSTEM ANTI-LOCK BRAKE SYSTEM CRUISE CONTROL STRG WHEEL MTD RADIO CONTROLS OP GDE MC DESCRIPTION MFG. PART NO. PRICE AJo Bo HOURS R -- --- -- ----------- ------------ ----- --- -- ----- - N 000°6 . FRONT BUMPER COVER R&I ADDNL LABOR OPERA 1 . 2 1 I 0006 COVER, FRONT BUMPER •REPAIR 1. 0*1 L 0006 13 COVER, FRONT BUMPER REFINISH 3. 5 4 RI 0017 MLDG, FRT':BUMPER COVER R&I ASSEMBLY 0 . 3 1 I 0103 FENDER, FRONT LT REPAIR 1. 0*1 L 0103 FENDER, FRONT LT REFINISH 2 . 8 4 E 0123 01 MLDG.;.FENDER SIDE L/R 12491262 GM PART 28 . 10 0 . 2 1 RI 0158 MLDG, RCKR PANEL' FRO LT R&I ASSEMBLY 0 . 4 1 I 0207 DOOR SHELL, FRONT LT REPAIR 1. 0*1 PAGE 1 05/15/08 1998 - CHEVROLET MONTE CARLO Z34 2DOOR COUPE 'CD L�G NO 63-1 r L 0207 DOOR SHELL, FRONT LT REFINISH 2 . 5 4 E 0170 01 MLDG, FRONT DOOR SID LT 12491264 GM PART 61. 10 0. 2 1 RI 0066 MLDG, FRONT DOOR LOW LT R&I ASSEMBLY 0 . 3 1 .RI 0229 MIRROR, SPORT R/C LT R&I ASSEMBLY ' 0. 7 1 L 0227 HANDLE, FRONT DOOR 0 LT REFINISH 0. 4 4 N M15 COLOR TINT ADDNL LABOR OPERA 0. 5*4 N M17 COVER CAR EXTERIOR ADDNL LABOR OPERA 7 . 00* 0 . 2*4 N M66 COLOR, SAND & BUFF ADDNL LABOR OPERA 1 . 0*4 17 ITEMS MC MESSAGE (S) O1 CALL DEALER FOR EXACT PART NUMBER / PRICE 13 INCLUDES 0. 6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE FINAL CALCULATIONS & ENTRIES GROSS PARTS 89 . 20 OTHER PARTS 7 . 00 PAINT MATERIAL 327 . 00 PARTS & MATERIAL TOTAL 423 . 20 TAX ON PARTS & MATERIAL @ 8 . 7500 37. 03 LABOR RATE REPLACE HRS REPAIR HRS 1-SHEET METAL 73 . 00 2. 1 4 .2 459. 90 2-MECH/ELEC 73 . 00 3-FRAME 73 . 00 4-REFINISH 73 . 00 9. 2 1 . 7 795 . 70 5-PAINT MATERIAL, 30 . 00 LABOR TOTAL 1, 255. 60 TAX ON REFINISH LABOR @ 8 . 750% 58 . 77 SUBLET REPAIRS TOWING STORAGE GROSS TOTAL 1, 774 . 60 NET TOTAL 1, 774 . 60 SHOPLINK UI 051 ES CD LOG 63-1 DATE 05/15/08 03: 39: 17PM R6. 37 CD 03/08 HOST LOG (C) 1998 - 2007 AUDATEX NORTH AMERICA, INC. 2 . 1 HRS WERE ADDED TO THIS EST. BASED ON AUDATEX TWO-STAGE REFINISH FORMULA. -------------------------------------------------------------------------- J & M AUTO CUSTOMS PAGE 2 05/15/08 CLAIM ` I30Ai1D OF SUPEitV.1.SOItS OF CON"i'RA COSTA COUNT' BOARD ACTION: Claim Against the Count r i i v g y, o District Go er-ned 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 California Government Codes. ) you is your notice of the action taken (o?U'p6g it Us on your claim.by the Board of Supervisors. (Paragraph IV below), JUN 1 9 2008 given Pursuant to Government Code AMOUNT: o�F,�' � COUNTY COUNSEL Section 913 and 915.4. Please note all MARTINEZ CALIF. "Warnings". CLAIMANT: ATTORNEY: �(,(� . DATE RECEIVED: ADDRESS: CG�'�'101 �� BY DELIVERY TO CLERK ON: I�eG AVt 2 BY MAIL POSTMARKED: ht OC�I . CA a FROM: Clerk of the Board oE'Supervisors TO: County Counsel Attached is a copy of the above-noted claim. U. ` JOHN CUL rk �' Dated:V LL/It°i 't� By: Deputy"QAtC. 11. FROM.: County Counsel TO: Clerk of the Board of Supervisors (WIllis 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: O,?- By: i /L.CLfL„� Deputy County Counsel . III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. ,KOARD 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. Date 4o2J"AHN CULLEN, CLERK, By Deputy Clerk WA .N (Gov. code section 913) Subject to certain exceptions,you have only six(6) months from the date this notice was personally seiwed or deposited in the mail to file a court action on this claim.See Governinent Code Section 945.6.You may seek the advice of an attorney of your choice in connection wide this matter. if you want to consult an ,attorney,you should do so immediately. *l..o.r Additional War-iiiitgSee Reverse Side ofT'his Notice. AFFIDAVIT' OF MAILING 1 declare under penalty of pei jury that .l. 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 R'lartinez, California, postage fully prepaid a certified copy of this Board Order and Notice to.Clainiant, addressed to the claimant as shown above. Date im JAWIJOHN CULLEN, CLERK By eputy Clerk (n Cost tip`' (s) ~ BOARD OF SUPERVISORS OF CONTRA CO TA COUNTY INSTRUCTIONS TO CL_AI1'VL4NT 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 945 53. 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. y E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. Room r r r r e t e r e t r e e r r■■■■■e r e r e r i r e e e e t e r t e l e e e r■■■i r r e r r e e r e e e r e e e r t t e e e e!r e r`,r 1 RE: Claim By: Reserved for Clerk's filing stamp RECEIVED x,01 n Costa Dun- Against the County of Contra Costa or ) I T 2008 COL Q_6 � �+ +�U_ L ) D'Stnct) Yes `J�J CLERK BOARDOF SI.iFER`•iISOR:i (Fill in the IIame) ) CONTRA COSTA.CO. The undersigned claimanthere_b-• mares clai-n against the County of Contra Costa or the above-named district in the sum of and in support of this claim represents as follows: I. When did the damage or mJ1 occur? (Give exact date and hour) 2. Where did the damage or injury-occur? (Include city and county) LR C+c�_ 3. How did the damage or injury occur? (Give full details;use extra paper if required) T w^�S C\t�V�r� STd��� rL'� �l✓tc\ -1 t� 4�Q1 CMA. C4"`1�j- irlvtilsl t�� �-�f�oq/_ 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? 0-} 4,e (L c��" C�Vt u c 4.7 q�d i- i VV)i s r0- (L (,Ocb 16-e, 5 What are the names of county or district officers, servants, or employees causing the damage or injury? 6. WL-zt da-mage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) �� �,�, 5 e � F sr�x ce l C0S- - 0'-� _, ZY1- 6& 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage,) c os 6- a v1 a LA rlCq S fe-i � `1vvt mar �; S. Names and addresses of witnesses, doctors and hospitals; -Y -t -:,,e �c� �� C i s yZ Z.cltl6 iv— f{(oe-evl at Cc<a �w: -vU+ j CIL 9. List the expenditures you made on account of this accident or injury: DATE TE\4E AMOUNT ■ r s s a s s a a s a s a s a Milan s MAINNE a a r a■a■■■ass to sass■■■■s no s s■Monosson s a a s s a s s s a an and a s s s s s s s t .Gov. Code Sec. 910.2 provides"The claim shall be signed by the claimant or by some person on his behalf." SEND NOTICES TO: (_Attornev) � Name and address of Attorney ) ��Ll�� u���( P Z (Claimant's Signature) �Cc�Vv)© (Address) Telephone No. ) Telephone No. 2 C)—S6 �� ■ ■■■sssasasass■saaraas■■sass■■.■sasasassssa■■sa■■aresassssaaassaaaas■■asasassssasess� 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.) Furnermore, any attachments, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■ ■rsssssasaaasa■atasBonn ■ ■■sssun Romans■■s■■s as sassaasassasss■aassaasaaasaaaaasasassai 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. i ................................ penny SUN 2 2008__�---�—'`` ��. ------ � CLERK B ',-c ;IS0RS CONTRA COSTA GO. r . A CLAiM BOARD OF SUPERVISORS OF CONTRA COSTA COUN1'Ye j BOARD ACTION: Claim Against the County, or District Govemed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) T}1e 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), JUN 19-2008 given Pursuant to Government Code l� -I-�, Section 913 and 915.4. Please note all AM.OUN"I': � � COUNTY COUNSEL MARTINEZ CALIF. Warnings". CLAI.MANTAM.r2u) e,vofai ATTORNEY: a? DATE RECEIVED: ���� '- 1T. 2009 ADDRESS:Agq— ftk�" C rr tv BY DELIVERY TO CLERK ON: �I 1 C,1q. eIta'► C?q J BY MAIL POSTMARKED: _ FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN CUL ��.... Dated:V l(f�� I -`.'l�� By: DeputyU/� ��`U-� II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( -Flnis 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). O Other: Dated: By: Deputy County Counsel 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). 1V. J�OARD ORDER: By unanimous vote of the Supervisors present: (�,)/ This Claim.is rejected in full. O Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for. this date. Date -24# ISN CULLEN, CLERK, By eputy Clerk WAR N Gov. code section 913). Subject to certain exceptions,you have only six(6) months from the date this notice was personalty served or deposited in the snail to file a court action on this claim.See Government Code Section 945.6.You may seek the .idviee of an attorney of your choicie in connection widr this matter. If you want to consult an attonrey,you should do so immediately. *For Additional Warning See Reverse Side of'Ilnis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that 1 ant 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 I\ilartinez, California, postage fully prepaid a certified copy of.this Board Order and Notice to Claimant, addressed to the claimant as shown above. Date °1 OHN CULLEN, CLERK By uty Clerk Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented no later than the 100`" day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code 5911.2.) 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. RE: Claim by ) Reserved for Clerk's filling stamp A)i m EW NrOTW4 ) RECEIVED Against the County of Contra Costa ) or ) JUN 1 2008 District ) CLERK BOARD Or SUPERVISORS (Fill in name) ) CONTRA COSTA CO. The undersigned claimant hereby makes claiiaagainst the County of Contra Costa or the above- named District in the sum of$ _/ytf and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) /C� ,��'''�• l��►�t,{,GfI� QO 02.00? 2. -Where did the damage or injury occur? (Include city and county) � e Cc,") 3. How did the damage or injury occur? (Give full details; use extra paper if required) 4. What particular act,or omission on the part of county or district officers, servants or employees caused the injury or damage? (over) ' \I 5. What are the names of county or district officers, servants or employees causing the damage or injury? Kq A-cev-1 oDevf-4 j /0 Di�j) O�RGZ�hUA 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed.) Attach two estimates for auto damage. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) Avrmge q-�' .�j�-wO ��Y�-�c�✓ -� U s� �k'S ,Jas i. Inav� bec✓� 1.1�y `�/ 8. &ames and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 7b SET TDON l YtT1V -:C c �yE� C.,t.At m �v►�T Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO : Attorne or by some p&son on his behalf." Name and address.of Attorney . (Claimant's Signature) 3ia7q -Bove*,Cilr l_a-�'uue�'e Address Telephone No. Telephone No. A/Df3-d45 a3,3J 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 on 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. ) Additional Information for inclusion on the following document: Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY Item 3. Damaged occurred during a traffic stop by Lafayette Police Officers in Lafayette, CA, Damage was caused by the K9 Dog jumping on top of my vehicles trunk lid, subsequently scratching the paint as the dog slid across the top of the trunk. As the dog slid off the top, it also broke the radio antenna and scratched the side rear quarter panel as he fell to the ground. The scratches were caused by the dog's nails. Exterior of driver's door was also scratched when dog when up on hind legs and extended it's front paws up near the window opening. When getting down, scratched the door, as pushed off from window. Item 4. Improper handling/control of K9 dog. Handler (Officer McDevitt) unable to maintain control of dog. Unnecessary use of K9 dog during a routine traffic stop, where no probable'cause existed. Later discovered there was NEVER A BULB out, which indicates there was no reason to pull the vehicle over in the first place. Filed official complaint against Officers, incident, and damage. Investigation is ongoing. NOTE: Lafayette Police Department is currently conducting a formal investigation of the incident. We have met with City Manager, Chief of Police, and investigating Sergeant regarding this incident. If necessary, contact them for additional information/verification. Chief of Police provided claim form. Item 6. Multiple deep scratches running across trunk lid, as well as down the rear side quarter panel of vehicle, requiring both to be removed and repainted. Radio antenna broke off, requiring replacement. Driver's door also scratched and damaged by K9, requiring it to be removed and repainted. Date: 4/17/2008 01:12 PM Estimate ID: 19645 Estimate Version: 0 Preliminary Profile ID: COOKS(DOMESTIC) Cooks Collision on Pine St. 1414 Pine St,Walnut Creek,CA 94596 (925)935-4041 Fax: (925)935-2508 Tax ID: 94-3344759 BAR#: AG228820 EPA#: CAD981579295 Damage Assessed By: Tim Bollinger Condition Code: Good Deductible: UNKNOWN File Number: P Insured: ANDREW NEWTON Owner: ANDREW NEWTON Address: 3674 BOYER CIRCLE,LAFEYETTE,CA 94549 Telephone: Home Phone: (408)205-2331 Mitchell Service: 910130 Description: 1993 Honda Accord EX Body Style: 4D Sed Drive Train: 2.21-Inj 4 Cyl 5M VIN: JHMCB755XPCO37035 License: 4PAX155 CA Mileage: 222,896 OEM/ALT: 0 Search Code: None Color: GREEN *ESTIMATE WRITTEN PER OWNERS REQUEST* *NO INSURANCE INFORMATION PROVIDED AT TIME OF ESTIMATE* ***** THIS IS A PRELIMINARY ESTIMATE ONLY. AND DOES NOT INCLD ANY HIDDENDAMAGE OR PART PRICE INCREASES. ALL PART PRICES ARE SUBJECT TOINVOICE PRICING. PLEASE ALSO NOTE THAT COOK'S COLLISION IS NO LONGER ABLE TO RELEASECOMPLETED VEHICLES WITHOUT FULL/ FINAL PAYMENT AT TIME OF DELIVERY.WE THANK YOU IN ADVANCE FOR YOUR UNDERSTANDING AND ATTENTION TO THISIMPORTANT MATTER. WE ARE ABLE TO ACCEPT VISA OR MASTER CARD CREDIT CARDS UP TO $1,000 , PERSONAL CHECKS UP TO $250, CASH OR CERTIFIED BANK CHECKS FOR EXACTAMOUNT, INSURANCE CHECKS FOR FULL AMOUNT. ***** Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 024210 BDY REPAIR L FRT DOOR REPAIR PANEL Existing 1.0*# 2 AUTO REF REFINISH L FRT DOOR OUTSIDE C 2.2 3 024870 BDY REMOVE/INSTALL L FRT DOOR POWER MIRROR ASSY Existing 0.4 4 R&R Time Used in R&I Operation 5 000074 BDY REMOVE/INSTALL L FRT DOOR TRIM PANEL 0.4 6 027340 BDY REMOVE/INSTALL L FRT DOOR OUTSIDE HANDLE Existing 0.2 # 7 R&R Time Used in R&I Operation ESTIMATE RECALL NUMBER: 4/17/2008 08:36:10 19645 Mitchell Data Version: OEM: MAR-08_A UltraMate is a Trademark of Mitchell International Copyright(C)1994-2008 Mitchell International Page 1 of 3 UltraMate Version: 6.5.016 All Rights Reserved Date: 4/17/2008 01:12 PM Estimate ID: 19645 Estimate Version: 0 Preliminary Profile ID: COOKS(DOMESTIC) 8 035230 BDY REMOVE/REPLACE QUARTER ANTENNA ASSEMBLY 39150-SM4-305 324.72 0.6 9 000039 BDY REPAIR LUGGAGE LID PANEL Existing 1.5* 10 AUTO REF REFINISH LUGGAGE LID OUTSIDE C 2.3 11 038570 BDY REMOVE/REPLACE LUGGAGE LID ADHESIVE EMBLEM 75701-SM5-A00 15.15 0.2 12 038590 BDY REMOVE/INSTALL LICENSE LAMP ASSEMBLY Existing 0.4 13 R&R Time Used in R&I Operation 14 038610 BDY REMOVE/REPLACE LUGGAGE LID CLIP 3@2.15 75525-SD4-013 6.45 15 AUTO REF ADD'L OPR CLEAR COAT 1.3* 16 AUTO ADD'L COST PAINT/MATERIALS 226.80 * 17 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL 1.89 * 18 900500 REF* ADD'L LABOR OP TINT COLOR Existing 0.5* 19 -FOR COLOR MATCH 20 900500 BDY* ADD'L LABOR OP CLEAN CAR Existing INC* 21 INSIDE AND OUT AT NO CHARGE 22 900500 BDY* ADD'L LABOR OP COVER CAR-FOR OVERSPRAY New 5.00 * INC* 23 900500 BDY* REPAIR COLOR SAND AND POLISH Existing 1.0* *-Judgment Item #-Labor Note Applies C-Included in Clear Coat Calc Estimate Totals Add'I Labor Sublet I. Labor Subtotals Units_ Rate Amount Amount Totals II. Part Replacement Summary Amount Body 5.7 82.00 0.00 0.00 467.40 Taxable Parts 346.32 Refinish 6.3 82.00 0.00 0.00 516.60 Sales Tax @ 8.250% 28.57 Non-Taxable Labor 984.00 Non-Taxable Parts 5.00 Labor Summary 12.0 984.00 Total Replacement Parts Amount 379.89 III. Additional Costs Amount IV. Adjustments Amount Taxable Costs 226.80 Customer Responsibility 0.00 Sales Tax @ 8.250% 18.71 Non-Taxable Costs 1.89 Total Additional Costs 247.40 I. Total Labor: 984.00 II. Total Replacement Parts: 379.89 III. Total Additional Costs: 247.40 Gross Total: 1,611.29 IV. Total Adjustments: 0.00 Net Total: 1,611.29 ESTIMATE RECALL NUMBER: 4/17/2008 08:36:10 19645 Mitchell Data Version: OEM: MAR_08_A UltraMate is a Trademark of Mitchell International Copyright(C)1994-2008 Mitchell International Page 2 of 3 UltraMate Version: 6.5.016 All Rights Reserved Date: 4/17/2008 01:12 PM Estimate ID: 19645 Estimate Version: 0 fj Preliminary Profile ID: COOKS(DOMESTIC) This is a preliminary estimate. Additional changes to the estimate may be required for the actual repair. ******* SPECIAL PARTS NOTICE: ALL CRASH PARTS ON THIS ESTIMATE ARE NEW-OEM (ORIGINAL EQUIPMENT MANUFACTURER) UNLESS OTHERWISE SPECIFIED. PARTS DESCRIBED AS RECHROMED, RECORED, OR REMANUFACTURED ARE EITHER RECONDITIONED OR REBUILT. PARTS THAT ARE DESCRIBED AS QUAL REPL PART, AND QRP CAPA, ARE NON-OEM CRASH PARTS. ******* ESTIMATE RECALL NUMBER: 4/17/2008 08:36:10 19645 Mitchell Data Version: OEM: MAR-08_A UltraMate is a Trademark of Mitchell International Copyright(C)1994-2008 Mitchell International Page 3 of 3 UltraMate Version: 6.5.016 All Rights Reserved Date: 6/14/2008 12:02 PM Estimate ID: 4041 Estimate Version: 0 Preliminary Profile ID: STANDARD PARKER ROBB COLLISION CENTER 1750 LOCUST STEET,WALNUT CREEK,CA 94596. (925)4764255 Fax: (925)943-1765 Tax ID: 94-1278730 BAR M AG103714 EPA#: CAD066391462 Damage Assessed By: ED NIELSEN Payer: Customer Deductible: NONE File Number: P Claim Number: 4041 Owner: ANDREW NEWTON Address: 3674 BOYER CIRCLE,LAFAYETTE,CA Telephone: Home Phone: (408)205-2331 Mitchell Service: 910130 Description: 1993 Honda Accord LX Vehicle Production Date: 1193 Body Style: 4D Sed Drive Train: 2.21-Inj 4 Cyl 5M VIN: JHMCB755XPCO37035 License: 4PAX165 CA Mileage: 80,000 OEM/ALT: O Search Code: None Color: BG30P/GRN Options: 4-DOOR Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 023850 REF REFINISH L FRT DOOR OUTSIDE C 2.2 2 6-14-08 C/R REFINISH LT FRT DOOR 3 024500 BDY REMOVE/INSTALL L FRT DOOR BELT MOULDING Existing 0.3 4 R&R Time Used in R&I Operation 5 024680 BDY REMOVE/INSTALL L FRT DOOR ADHESIVE MOULDING Existing 0.3 6 R&R Time Used in R&1 Operation 7 024870 BDY REMOVE/INSTALL L FRT DOOR POWER MIRROR ASSY Existing 0.4 8 R&R Time Used in R&I Operation 9 000074 BDY REMOVE/INSTALL L FRT DOOR TRIM PANEL 0.4 10 027340 BDY REMOVE/INSTALL L FRT DOOR OUTSIDE HANDLE Existing 0.2 # 11 R&R Time Used in R&I Operation 12 034930 REF REFINISH R QUARTER PANEL OUTSIDE C 1.9 13 SCRATCHES QTR PANEL 14 035220 BDY REMOVE/INSTALL L QUARTER FUEL DOOR Existing 0.2 15 R&R Time Used in R&I Operation 16 035240 BDY REMOVE/REPLACE QUARTER ANTENNA MAST 39152-SM4-A03 57.72 0.6 17 037810 REF REFINISH LUGGAGE LID OUTSIDE C 2.1 18 SCRATCHES TRUNK 19 038570 BDY REMOVE/REPLACE LUGGAGE LID ADHESIVE EMBLEM 75701-SM5-A00 15.15 0.2 20 038590 BDY REMOVE/INSTALL LICENSE LAMP ASSEMBLY Existing 0.4 21 R&R Time Used in R&I Operation 22 046982 BDY REMOVE/INSTALL R REAR COMBINATION LAMP 0.3 23 046983 BDY REMOVE/INSTALL L REAR COMBINATION LAMP 0.3 24 936012 ADD'L COST HAZARDOUS WASTE DISPOSAL 3.00 ' 25 AUTO REF ADD'L OPR CLEAR COAT 1.7" ESTIMATE RECALL NUMBER: 061141200812:02:33 4041 Mitchell Data Version: OEM: MAY-08_A UltraMate is a Trademark of Mitchell International Copyright(C)1994-2008 Mitchell International Page .1 of 3 UltraMate Version: 6.5.017 All Rights Reserved Date: 6/14/2008 12:02 PM Estimate ID: 4041 Estimate Version: 0 Preliminary Profile ID: STANDARD 26 933003 REF ADWL OPR TINT COLOR 0.5* 27 933018 REF ADD'L OPR MASK FOR OVERSPRAY 5.00 * 0.2* 28 .AUTO ADD'L COST PAINT/MATERIALS .269.80 * * -Judgment Item #-Labor(Vote Applies C-Included in Clear Coat Calc Estimate Totals Add'I Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 3.6 74.00 0.00 0.00 266.40 Taxable Parts 72.87 Refinish 8.6 74.00 5.00 . 0.00 641.40 Sales Tax @ 8.250% . 6.01 Non-Taxable Labor 907.80 Total Replacement Parts Amount 78.88 Labor Summary 12.2 907.80 Ill. Additional Costs Amount IV. Adjustments Amount Taxable Costs 268.80 Insurance Deductible 0.00 Sales Tax @ 8.250% 22.18 Customer Responsibility 0.00 Non-Taxable Costs 3.00 Total Additional Costs 293.98 1. Total Labor: 907.80 11. Total Replacement Parts: 78.88 111. Total Additional Costs: 293.98 Gross Total: 1,280.66 1V. Total Adjustments: 0.00 Net Total: 1,280.66 This is a preliminary estimate. Additional changes to the estimate may be required for the actual repair. Point(s)of Impact 16 Non-Collision(P) Inspection Date: 2/25/2008 **SPECIAL PARTS NOTE: ALL CRASH PARTS ON THIS ESTIMATE ARE "NEW" ORIGINAL EQUIPMENT MANUFACTURER PARTS, UNLESS OTHERWISE SPECIFIED.. PARTS DESCRIBED AS RECHROMED, RECORED, REMANUFACTURED OR, RECONDITIONED ARE CONSIDERED "REBUILT" PARTS. CRASH PARTS DESCRIBED ESTIMATE RECALL NUMBER: 06/14/2008 12:02:33 4041 Mitchell Data Version: OEM: MAY-08 A UltraMate is a Trademark of Mitchell International Copyright(C)1994-2008 Mitchell International Page 2 of 3 UltraMate Version: 6.5.017 All Rights Reserved Date: 6/14/2008 12:02 PM Estimate ID: 4041 Estimate Version: 0 Preliminary Profile ID: STANDARD AS "QUALITY REPLACEMENT PART "ARE NON—ORIGINAL EQUIPMENT MANUFACTURER AFTERMARKET NEW PARTS. "ALL PARTS PRICES ARE SUBJECT TO INVOICE, WHICH MAY CHANGE FROM ORIGNAL ESTIMATE.** ESTIMATE RECALL NUMBER: 06/1412008 12:02:33 4041 Mitchell Data Version: OEM: MAY-08_A UltraMate is a Trademark of Mitchell International Copyright(C)1994-2008 Mitchell International Page 3 of 3 UltraMate Version: 6.5.017 All Rights Reserved C LA M ' BOARD OF SUPERVISORS OF CON'CRA COSTA COUNTY. L�D� BOARD ACTION:_ Claim Against the County, or District-Governed by } the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section r- The copy of this document mailed to California Goveiitment Codes. you is your notice of the action taken on your- claim by the Board of JUN 19 2008 Supervisors. (Paragraph IV below), COUNTY COUNSEL given Pursuant to Government Code AMOUNT: [*L MARTINEZ CALIF, Section 913 and 915.4. Please note all ft�.Siw'+h "Warnings". CLAIMANT: `C®t�".d� svnith, �!'1d'i , :,"'�T�!�(i1. $rn i'I-ri, �'¢ 1�1�v►a Switth ATTORNEY: G ce et �} • ' o_OVN %a0n DATE RECEIVED: ADDRESS: ZorIe5, C��+'Fo2�• BY DELIVERY TO CLERK ON: '7c>>1nsc�fi`3ohr.s�n LLP 1cu blah l4c-56 Ave- 1a4"'R• BY MAIL POSTMARKED: �( Sar�TrtattCi 5Cb, C!A cjq t,02_ FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, Clerk Dated: 2w% By: Deputy (A VL.(,Q�S�.•o 11, IaRONi.: County Counsel TO: Clerk of the Board of Supei-visoi-s (-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). ( ) Claim is not timely filed. The Clerk should retui i 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) (vKOther: 1411% 5 S 4'1,-�-- k I el LA)CZ 1,1 h Q Con o141 n z , 1)11)1 C-:.121) DIV Dated: By: �� it_ - Deputy County Counsel 111. FROM.: Clerk of the Board TO: County Counsel (1) County Adirrinisti-atoi-(2).. ( ) Claim was returned as untimely with notice to claimant (Section 91 1.3). 1V. OARD ORDER:. By unanimous vote of the Supervisors present: This Claim is i-ejected in full. O Other: I certify that this is a true and.correct copy of the Board's Order entered in its minutes for- this orthis date. Dated: BHN CULLEN, CLERK, By eputy Clerk WARNg4Gfjov. code section 913) Subject to certain exceptions,you have only six(6) months fi•orn the date this notice was personally served or deposited in the mail to file a couit action on this claim:See GoverTunent Code Section 945.6.You may seek the advice of an attorney of your choice in connection wide this matter. Il'you want to consult an ittoi*iiey,you sliouid do so immediately. *For Additional Wai-ning See Reveise Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I ani now; and at all times herein nientioned, have been a citizen of the United States, over age .18; and that today I deposited iii the United States Postal Service in 1\'l.ai•tinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the clainian.t as shown above. Dated: JOI-IN CULLEN, CLERK By eputy Clerk w ,r RECEIVE® TORS" LIA1311LITY CLAIM DORM COITNTY OF CONTRA COSTA I JUN 1 s 2008 Clerk of the. Board of Supervisors CLERK BOARD OF SUPERVISORS 651 fine Street, Room 106 CONTRA COSTA CO. Martinez, CA 94553 Name of Claimants Yolanda Smith, widow of decedentErnest rnest SI ith, Jr. Christina Smith, mother of decedent Ernest Smith, Jr. Jadyn Smith. minor child of decedent Ernest Smith, Jr. Te'Ahna Snlith, minor child of decedent Ernest Snlith, Jr, Claimants' :address : 1008 Flo]lyhock Drive Oakley, CA 94561 Address to Which Notices Should be Sent: Steger 1'. Johnson Jones, Clifford, Johnson & Johnson, LLP 100 Van Ness Avenue, 19tH 1'loor Sall l`raIlcisco, CA 9=1102 Type of Loss: Wrollta ul death Date, Place, and Circumstances of Occurrence Giving Rise to Claim: rvI'hc accident resulting in the death of Enicst Smith, Jr. occurred oil January 11, 2008. Decedent was travelim, CaSthoLlnd on l-li�ghway 4 just west of Bailey Road; 121 an unirlcorporatecl area of Contra Costa County, north of'Pittsburo General Description of Injury: Wrongtul death Nance of Cnovernment Employees Causing; the Injury, il'Ianown: Total Amount of Claim: Amount in excess ofthe jurlsdictlonal linllt ofunlirnited civil cases DA FED: June 16, 2008 1 C� aima2-it��ie1)resent<itivc; % • ' 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 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), JUN 19 2008 given Pursuant to Government Code c� Section 913 and 915.4. Please note all AMOUNT: 1560 COUNTY COUNSEL "Warnings". MARTINEZ CALIF CLAIMANT: Lg511e F't.o0�e ATTORNEY:r C�lC1Ul�C,C CICS DATE RECEIVED: c�tJ�r�2� LT aws ADDRESS: (PH{ CC—dc ` CV—Y) BY DELIVERY TO CLERK ON: tiVulnuk ��'.:QR1C1(k �i4�tb BY MAIL POSTMARKED: �r�lr..Q_ 17, 2WT FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN Clerk Dated: rl�W-40_ `c�1 Zim By: Deputy � A,A.Q.6cr�, 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should retum 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 91.1.3). O Other: Dated: lr�— ,�C)—0,i, By: �11 tr Deputy County Counsel 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). 1V. OARD ORDER: By unanimous vote of the Supervisors present: (f 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. Dat �vgOHN CULLEN, CLERK, By ����eputy Clerk WA 1.. (Gov. code section 913) Subject to certain exceptions,you have only six(6) montlis from the date this notice was personally served or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the .idvice of an attorney of your choice in connection wide this matter. If you want to consult an attorney,you should do so immediately. *For Additional Warming See Reverse Side ofThis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that i. ani 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 lWartinez, California, postage fully prepaid a certified coley of.this Board Order and Notice to Claimant, addressed to the claimant as shown above. DatJOHN CULLEN, CLERK. By eputy Clerk BOARD OF SUPERVISORS OF CONTRA COSTA COUI�'IY P . INSTRUCTIONS TO CLAM4NL 64M A claim relating to a cause of action for death or for injury to person or to personal properly 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..) Claims must be fled with the Clerk of the Board of Supervisors at its office in Room 106, CounT Administration Building, 651 Pine Street,Martinez,CA 94553. 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- If the claim is against more than one public entty, separate claims must be filed a.gaiast each. public entity. Fraud. See penalty for fraudulent claims,Penal Code Sec.72 at the end of this form. t■■■■t t t t I t t a i{[[L L L C L a f a a.K.L or.i i t C t t a IF a a i Bit t a as C G L am Mr.l 22 11 a i 4 am a a a a a a a a C C a l E: Claim By: Reserved for Clerk's filing stamp Moo?, p.0 . 60X' 9.33 UJ*UIL� -CR.CA• ) RECEIVED qtiSq 6 ) against the County of Con a Costa or ) JUN 1 $ 2008 QePRRTiMEnTof SL - I risPFrnort ) District) CLERK BOARD OF SU t ERViSORS C0!-; „A Cn?,T,a co. Fill in the tee) ) Ih-.undersigned claimant hereby makes claim against the Coi:n137 of Contra Costa or the above-named district is the sum of$ and in support of this claim represents as follows: 1. When did the damagr injur e or occ ? (Give exact date and hour) 3.26Pm ov 1,2z 2. Where ld the damage or injury occur? (Include city and county) 16-1440,0 VAt.I..EY RD . WT 114 0145 A V10 I AwTCAEEK GA - I CORTRR LWA COUNTY 3. How did the damagei or njury occur? (Give uI1 details;use extra paper if required) U1t�tl.E sMMD 0-T or RED TgW'r C w6-0,r, Ren-ENDED BY C.0-C. VERICL6 4. What'particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? oR pf��R�11C VE't�tCLt SV3{�Z C v�R«E FAU0 TO ST )P Y1 RESUL-rim.- (tA ft R,E1AR EMD QW61 oN . 5 What are the names of county or district officers,servants, or employees causing the damage or injury-? CA Ry p#)TR t C K F1qg-ZA What damage- or injuries do your claim resulted? (Give full extent of injuries or damages - -claimed: -A-tach-two estimates for auto damage.) - - 1yo �NSuR1E5 D+RWIK,+. iti BvYNPE R 1- 64CI( OF- CiR k How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage) - TRE" 4500 IS TRE, Dt'DUCTAISLE 19$y. �'i !S -TbT14L D'Atl► PW Names and addresses of witnesses, doctors, and hospitals: NoHE +. List the expenditures you made-on account of this accident or injury: DATE ME AMOUNT P-E Dt>Ct79,b M i D A { 6 og q:00 em 4* �600 .oN 6111 08 1 as t[t[[t t[a[[!off BE[21111111 ME tat■[ ■a[[a■■![[a 1■112111151111111151111![[[[[![l!{[[■■KRZR t t[[[[■al ) .Gov. Code Sec. 910.2 provides"The claim shall be ) signed by the claimant or by some person on his behalf" SEND NOTICES TO: (Attomev) 1 N- ante and address of Attorney ) } U (Cl ' t Signature) 6.4q CGDAR &LO Cr. } (Address) j (. ALNVT CRS 01. 141M Telephone No. )Telephone No. `IZS q 3U•Qt{'}� tta[[a[eatt■[Call KEN aa{■[■ tt [att[[t[[t[{t1[[[tt[tt[[[[[[t[[[![R[t[[!t{[[[tspin[[[t t Ica&I 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, s§ 650D et seq.) Furthermore, any attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure, ■a man III ININI a a t a t■■SEEK■ in t MR sun[a[!■a■a[■[[t[l![[[[[[[[[[[{[[[[a[t t a man a t![mass[[t t S NOTICE: Section 73 of the Penal Code provides: Every person v,6o, with intent to defraud; presents for allowance or for payment to any state board or officer, or LO any county, city, or district board or officer, authorized to allow or pay the same if wine, 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,DDON), or by both such imprisonment and fine, or by imprisonment in the state prison; by a fine of not exceeding ten thousand dolks ($10,000),or by both such imprissonment and fine. e — B GS l v✓T( MA- Date: 0529/0812:-:,2 PM BYW R 7 I R S()O'• Estimate Version: 0800031st!?772-1300101 I�l� Preliminary Profile ID: Mercury Whe's Auto Body - N. Broadway 2140 North Broadway,Walnut Creek,CA 94596 (925)210-1739 Fax: (925)2104772 Tax 1D: 942621349 BAR#. A8170842 EPA#. CAR 000058362 BAR# AB170842 Damage Assessed By: JASON LAOS Appraised For: GEORGE ARAKELYAN (916)636-1534 ext.2258 Condition Gode: Good Date of Loss: 05173108 Deductible: 500.00 Claim Number: 0800030027724300101 Owner: ALEXANDRA MOORE, Address: 648 CEDAR GLEN COURT,WALNUT CREEK,CA 94698 Telephone: Work Phone: (925)260-6923 Home Phone: (925)930.8477 Mitchell Service: 911368 Description: 2002 Volkswagen New Beetle GLS Body.Stgle: 2D HB Drive Train: 2.01-Inj 4 Cyl 4A FWD VIN: 3VWCK21C82M426527 License: 6AMP190 CA Mileage: 46,127 OEMIALT: O Search Code: C627014 Color RED "All Crash parts on this estimate are "new" original equipment manufacturer parts, unless otherwise specified. Parts described as rechromed, recored, *pnianufactured or, reconditioned are considered "rebuilt" parts. Crash parts described as "quality replacement part" are non-original.equipment manufacturer new parts" Line Entry Labor Line Item Part Type/ Dollar Labor CEG Item Number Type Operation Description Part Number Amount Units Unit REAR FENDER 1 101094 BDY REMOVEINSTALL R REAR FENDER ASSY INC # 2.8 2 101095 BDY REMOVEANSTALL L REAR FENDER ASSY INC # 2.8 REAR LAMPS 3 101270 BDY REMOVEANSTALL R REAR COMBINATION LAMP INC 0.2 4 101271 BDY REMOVEANSTALL L REAR COMBINATION LAMP INC 0.2 MANUAL ENTRIES 5 900500 BDY' ADD'L LABOR OP COLDRSAND AND BUFF .3 PER PANEL 11.5 MAX Existing 0.3` 6 900500 BDY' AWL LABOR OP FLEX ADDITIVE "QUAL REPL PART 8.00 " 0.0' T REAR LAMPS 7 101290 REF REFINISH R LAMP HOUSING C 0.3 0.3 8 101291 REF REFINISH L LAMP HOUSING C 0.3 0.3 ESTIMATE RECALL NUMBER: 06129200812:41:54 0800030027724300101 Mitchell Data Version: OEM: MAY 08_V UltraMate is a Trademark of Mitchell International Copyright(C)1994-2008 Mitchell International Page 1 of 3 UltraMate Version: 6.5.017 All Rights Reserved Date: 0529!0812:42 PM Estimate ID: 0800030027724300101 Estimate Version: 0 Preliminary Profile ID: Mercury 9 101349 BDY REMOVEIREPLACE R LICENSE LAMP LENS 100 943126 15.08 INC # 0.2T 10 101350 BDY REMOVEIREPLACE L LICENSE LAMP LENS 1C0 943125 15.08 INC # 0.2T 11 101292 BDY REMOVE/REPLACE R LICENSE LAMP RETAINER 1C0 943138 8.40 INC # 0.2T 12 101293 BDY REMOVEIREPLACE L LICENSE LAMP RETAINER 1C0 943137 8.40 INC # 0.2T 13 101294 BDY REMOVEIREPLACE R LICENSE LAMP BULB N 017 753 5 3.67 INC # 0.2T 14 101295 BDY REMOVEIREPLACE L LICENSE LAMP BULB N 017 753 5 3.67 INC # 0.2T 15 101297 BDY REMOVE/REPLACE L LICENSE LAMP SOCKET 1C0 943167 13.77 T REAR BUMPER 16 101308 BDY OVERHAUL REAR BUMPER COVER ASSY 3.8 # 3.8 17 102948 BDY REMOVEIREPLACE REAR BUMPER COVER Remanufactured 198.00 * INC # 3.8T 18 REF REFINISH REAR BUMPER COVER C 2.3 2.3 ADDITIONAL OPERATIONS 19 REF AWL OPR CLEAR COAT 1.0 20 933003 BDY* AWL OPR TINT COLOR 0.5' ADDITIONAL COSTS&MATERIALS 21 AWL COST PAINT/MATERIALS 109.20 * T 22 ADD'L COST HAZARDOUS WASTE DISPOSAL 3.00 * "-Judgment Item #-Labor Note Applies C-Included in Clear Coat Calc Remarks Estimate.Totals Add9 Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals 11. Part Replacement Summary Amount Body 4.6 67.00 0.00 0.00 308.20 Taxable Parts 27407 Refinish 3.9 67.00 0.00 0.00 261.30 Parts Adjustments 3.40- Sales Tax co 8.250% 22.33 Non Taxable Labor 569.50 Total Replacement Parts Amount 293.00 Labor Summary 8.5 569.60 111. Additional Costs Amount IV. Adjustments Amount Taxable Costs 109.20 Insurance Deductible 500.00- Sales Tax @ 8.250% 9.01 Customer Responsibility 500.00- Non-Taxable Costs 3.00 Total Additional Costs 121.21 I. Total Labor: 569.50 11. Total Replacement Parts: 293.00 III. Total Additional Costs: 121.21 Gross Total: 983.71 ESTIMATE RECALL NUMBER: 05129200812A7:64 0800030027724300101 Mitchell Data Version: OEM: MAY 08_V U1traMate is a Trademark of Mitchell International Copyright(C)1994-2008 Mitchell International Page 2 of 3 UNraMate Version: 6.5.017 All Rights Reserved Date: 052910812:42 PM Estimate ID. 0800030027724300101 Estimate Version: 0 Preliminary Profile ID: Mercury IV. Total Adjustments: 600.00- Net Total: 483.71 This Is a preliminary estimate. Additional changes to the estimate may be required for the actual repair. Point(s)of Impact 6 Rear Center(P) Insurance Co: MERCURY INSURANCE Body Shop: MIKES AUTOBODY Date vehicle driven in/towed in? Date vehicle inspected? Date vehicle released? NA Date vehicle determined a total? NA Number of photos? Estimated number of days to repair? Closing type? Send check to facility? Copy of estimate given to owner? LRQ PARTS AVAILABLE? NO SOURCE? CONCORD AUTO DISMANTLERS PRONE AND REFERENCE? 925-685-7700 ESTIMATE RECALL NUMBER: 0529*00812:41:54 0800030027724300101 Mitchell Data Version: OEM: MAY_08 V UltraMate is a Trademark of Mitchell International Copyright(C)1994-2008 Mitchell International Page 3 of 3 UltraMate Version: 6.5.017 All Rights Reserved 7. Date: 08!29/0812:42 PM Estimate ID: 0800030027724300101 Estimate Version: 0 Preliminary Profile ID: Mercury Itemized Totals 1. Labor Subtotals Units Rate Totals U. Part Replacement Summary Amount Body 4.6 67.00 308.20 Taxable Parts 274.07 Additional Labor 0.3 20.10 New 68.07 Overhaul 3.8 254.60 "Qua!Rep[Part 8.00 Add"fionalOperation 0.5 33.50 Remanufactured 198.00 Refinish 3.9 67.00 261.30 Parts Adjustments 3.40- Refinish Only 2.9 194.30 New 3.39- Additional Operation 1.0 67.00 Discount 3.39- Non-Taxable Labor 869.50 Sales Tax @ 8.290% 22.33 Labor Summary 8.5 569.50 Total Replacement Parts Amount 293.00 III. Additional Costs Amount IV. Adjustments Amount Taxable Costs 109.20 Insurance Deductible 500.00- Sales Tax 8.250% 9.01 Customer Responsibility 500.00- Non-Taxable Costs 3.00 Total Additional Costs 121.21 I. Total Labor. 669.50 If. Total Replacement Parts: .293.00 III. Total Additional Costs: 121.21 Gross Total: 983.71 IV. Total Adjustments: 500.00- Net Total: 483.71 Total includes Additional Labor($)dollar amounts as shown within the group ESTIMATE RECALL NUMBER: 05129/200812:41:54 0800030027724300101 Mitchell Data Version: OEM: MAY-08_V UltraMate is a Trademark of Mitchell International Copyright(C)1994-2008 Mitchell International Page 1 of 1 UltraMate Version: 6.5.017 All Rights Reserved Contra County Administrator Risk Management Division Costa 2530 Arnold Drive,Suite 140 . Martinez,California 94553...,. County nt Liability Claims (925)335-1440 J Fax Number (925)335-1421 June 02. 2008 r' IVED 1 JU.N 1 8 2008: Alexandra Mooreo; i:zo OF SurERVISORS CLkf.r:�_A 648 Ledau Geln Ct co; 0,cosrA co. Walnut Creek, CA 94598 Re: Claimant: -Ai(:Xa 1dla.V.e.):e Insured: Contra Costa County D/Accident: 05/22/2008 Claim No.: 64973 Dear Ms. Moore: The above captioned matter has been referred to my office for investigation and handling on l elia'If 6f the Contra Costa County Department of Building Inspection. l haye�en,closed-a claim form that must be completed in order to file a formal claim against th`e-County.':Be.'advised that you have six months from the accident date to file a formal claim as stated in the California Government Code beginning with Section 900. This also notifies you that you must comply with the claims presentation and timely suit filing requirements of California law in order to preserve your claim. Our investigation of your claim does not affect your duty to comply with time limits set by law, and by investigating, considering, and.discussing your claim with you or your representative,we do not waive our right to assert.your failure:to comply with those time'limits as a coni.piete d:Ilease;o a-ny e;aim or Ction. }.,;,, ma✓ brine. A Should you have any questions, please do not hesitate to contact the undersigned. Sincerely, Penny Bailey Liability Claims Adjuster,. (925) -1455 . ' Enclosure r CD : ; Q 0 tr i k a \. O Q v 1p `x CLAIM BOAitD OF SUPERV.i.SORS 01, CONTRA COSTA COUNTY BOARD ACTION: Claim Against the County, or District Goveried by the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of tills document mailed to California Government Codes. ) you is your notice of the action taken n your clairn.by the Board of pervisors. (Paragraph IV below), en Pursuant to Government Code AMOUNT: �I' (; • 3 JUN 2 0 2008 ection 913 and 915.4. Please note all COUNTY COUNSEL "Warnings CLAIMANT: ' � 7 A )r J Ace- MARTINET CALIF. ATTORNEY: (�Gt,' DATE RECEIVED: 20 , ADDRESS: Z!.3 02j N; Jun. 18. 2008 10: 05AM No. 3 19 0 P. 2 BOARD OF ` ,PERVISORS OF CONTRA COSTA L)= ' S�'RUCTION5 TO A. A claim relating to a cause of action for death or far h jz to person or to pmson.4 propert9 of . growing =ops shall be preseated not 1alm than six montbs afor the an=al of tbs.caw action. A claim gelding to nay other cause of action sball IDM presauted not latex'tbaa one yrafhy after:.tha ,accrual of th-cause of acrion. LIUN j aC?day (Gov. Code j 911.2.) B. Claims m= be fled with the Clerk of the Board of Supervisors at its office in Room 106, CouatyAdmisistration Btildia•g, 652 Piue Street,Marina.-,,CA 94553. C. If claim is against a disraiot governed by the Board of Sapanisors, rather Ih the County, the name of the District should be f lied in. D. If the olEdm is agamr, more than on-- public entity, separate claim; must be $led against each. _ - - _public anlft� .- - -_---- - - . _. .. _ -- - =- -----•• .- .. .�.� .. __. . E. Ud. See penzltpfor frandulcat claims,Penal Code Sec. 72 at the end of this fo= ■■■■■■.c■■■aRaiRARE■■■■■■■.■e■c■r■■srrr11ie§&■MEADE e��acc■■c■■i�■r■■e■e■■ee■Rr RB: Claim By: Reserved for Ctrrk's fag stamp AJ Agairzst the Cowry of Confta Cost or ) I :I'.)N CL �� N.C:Of (Fill in the name) )' The u�clersigwd ala=t hareby des claim against the County of Contra Costa or the above-named duct in to sum of s-i 97 i 3 _and in support of this claim represents as follows; --- 1. Va=did the d=zge-oz 2afuty-eea �- (Give est data aad bo=) 2. Where did the damage or ' occur? (Include city end county) C�o�1�� b� �ticrs 4 rodeo Lch- C00"r"A- X5•-4- &X-1- r ,/ 3. How did the dam ge or injury occur? (01ve full detaUs;use adm paper if reauimd) \ tv f Qr Cop,�t1 �a ck�C G1ef2 s�VA . 20 A, tj t, �,�us ?aSTed J7kef_9 t, i DUB, 5 C�1 6, 5:dc �0 1 0 7TH 4. What,patticuI�r teat or omission o th�par of cry or ict o cers, sews=, or employees caused`lo injury or damage? iA-{ v�1 I' y� '-4`-�•ef w[Fe,re ►µ� �r�ef.� _ 107 II�e� W �� A7.t li �L' Wt C �tg .�-i /-/ 5 What=the n=--s of county or district officals,servants, or emp oyees causing`.he �cx d8lgr Dr W=Y?. SCO T T`/ 65 t U.-So r , 0 A 5 T31-4,T- 7 UIIII-1I%VAIUIII vnT %l Net % IIIun1.In nn/\i -nl linn Jun. 18. 2003 10 : 06AM No. 3190 F. 3 6. Vzr danage or mju iaz do your cldM resulted? (Give full crtent of iajtnies or damac,.1m chimed. Attach two estzmates for auto damP.ge.) 7. I3ow was the emo= claimed above computed? (Include the estimated o ouat of any prospective injury or damage.) A{l o S A-wT a -640 / FA-x.&d TO '� 8. Names and addresses of witnesses, doctors, and hosph1s: QCL:JCA- A}IRen,i s 3 e3 &.4 j h i#3• A-citeo (,'A-,.9"S7 9 C44C)c-s ,I S7,919-rrr;50-1 " r, tz � v? odeo,o+t 9 � 9. List the ea-p=dit-=you made oa eccoi of this exid mi or injury: DATE TAS AMOUNT A5 77"l��t -rp f-ro.'" i■na&SR■aaRsRaIaits slaus!■s.agoinF12aIIIs[/l■slanMILK ■1t!l E��YReirR��l�YsiYs[7Ttl ) .Gov. Code Sec. 910.2 provides"The clak ahall be ) signed by the claimant or by some p-..son on his 9MM NOTICES T0: lAttbmrv) Name and add=s of Attomey ) ) (Claimant`s Signe) (Address) �Z-f `7 Telephone No. )Telephone Ivo. ,�/�� �7 `�� 570 0(„ ■101RRIMS llenlassss■RBLMkresatas■salsRalaass!!s!lllEms[srsSssRAAtREms a■■EMS trsysonof PUB-UC RECORDS NOTICE:_ Please be advised that this clean form or any claim a1!.-1 with the Cotmty=der the Tort Claims Act, is =u Fwtto public disclosure under the Catzfori& Public Records Act. (Gov. Codc, ss 6500 et sect) Funhemo.-, any at acbments, e.ddendv-, or supple lz attached to the claim form,intawUng mediosl r—mords, are also svbjxt to public disclon re. ■r■■asaSarssarsDRIVE loss■ ■srrrrrsessssss1lllall■s■■rr■■ass mass aal!lrsIEms RseIFsrrsaslf NOTICE: Section 72 ofthe Penal Codeprvvides: Every prison who, with in=to defraud,presents for 0owance or for payment to airy stag board or offices, or to Any county, city or district board or of 5=, m6or= d to allow or pay the same if g nume, nay false or fmukknt charm, bill, e0000nt voucher, or wiitinz, is punishable either by hprisonmant in tht Couidy jail for a pa-iod of not more than one year, by a fine of not exceeding one thousand doll= (S1,000.00), or by both su:b imprisonment sad fine, or by imprisonment in tihe stateprison, by a fine of not exceeding tea thousand dolls (S!0,000 or by both such imprisonment and fine, C I l I f1 'r\ki n nnn7 'Al n nn