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Home My WebLink AboutMINUTES - 08122008 - C.21 3 .. CLAIM ;✓' BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BO ACTION: AUGUST `12, 2008 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) OTICE 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 CLAIM AGAINST CCC AND 0 IId� on your claim.bythe Board of THE SHERZ IFFS w Supervisors. (Paragraph IV below), JUL 0 7 2008 given Pursuant to Government Code AMOUNT: UNKNOWN Section 913 and 915.4. Please note all COUNTY"COUNSEL "Warnings". MARTINEZ CALIF. CLAIMANT: ANGELA B-ENITEZ, BUNTHA PRUM, ARIANNA BENITEZ (a minor) , ALEX ATTORNEY BENITEZ (a minor) SARAHDM%4eE�K91Br) JULY b-7,1 2008 =AND MARIAN. HAINES =AUDREY SCHONBORN ADDRESS: P.O. -BOX 72424 BY DELIVERY TO, CLERK ON: JULY .07, 2008 OAKLAND, CA, 94612 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk'of the Board of.Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JULY 07, 2008 JOHN CULLEN, e k Dated: By: Deputy II. FROM.: County Counsel. TO: Clerk of the Board of S ervis rs is claim complies substantially with Sections 910 and 910.2. ( ) : This Claim FAILS Jo comply substantially with Sections 910 and 91.0"2, and we are so notifying claimant. The Board cannot act for I S days (Section 910.8). O Claim is not timely filed. The Clerk should return claim onsground 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 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). IN OARD ORDER: By unanimous vote of the Supervisors present: P ( 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. Dated( 4& .?d)KN,CULLEN, CLERK, By Deputy Clerk WARNI.N (Gov. code section 913) Subject to certain exceptions,you have only six(6) i»onths from the date this notice was personally served or deposited in the mail to file'a court action on this elaim:See Government Code Section 945.6.You may seek the advice of an attorney of'your choice in connection with this matter. [f•you want to consult an attorney,you-should do so immediately. *Fol'Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that1. 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 Martinez, California, postage fully prepaid a certified copy of,this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:,0-614U46 ,.!!t"kHN CULLEN, CLERK By' Deputy Clerk 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. ■!�l■!!rr■!!!!!!!!!!!GrlrG!!!!an!!,lere°rrr!!!i!liGri ir!! lrorrrl RE: Claim By: Reserved for Clerk's filing stamp A� [A_ nr �vn �vm r ianrll3f. ) ��_ - f I Q (Ylar.id� ) , ,C E I�L Against the County of Contra Costa orlr*IC-1— ) JUL 0 7 2008 . LGYtt-rA Cvs+d S�ri� s . t��u1`l�rcc loS+a ) . ©{ t ,j " v .1-100 District CLERK BOARD OF SUP!-RVISORS CONTRA COS FA CO. (Fill in the name) Cir Ca'dA, ) ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ dtx`°V&1,� and in support'of this claim represents as follows: On S `'��#1�ChC11Etlt A''� 1. When did the damage or injury occur?" (Give exact date and hour) On or a 64. Jnu�r Q, �Eg ctt zYnrax�in 'y 2. Where did the damage or injury occur? (Include city and county) L1( Alaflen L�np, 0d Ipy , Cat;-Fernia - 00tra C czs a Ccacr►`�G 3. How did the damage or injury occur? (Give full details; use extra paper if required) P lac Se See "-A+4p�G�3mei t l 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or'damage? (to See 5 What are the names of county or district officers, servants, or employees causing the damage or injury? ✓tSCO\i�v C�rn�FrnU6 dsce r- T rc ri& c?nd �o�s .1rIOQ 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage) fis can`-iau; 7. How was the amount claimed above computed?. . (Include the estimated amount of any prospective injury or damage.) u �f ob'Eefran't to 6A�c4rr,�� P 16,aSe seN �� hvn��t-E Q� SCUUc�(tom t'S , 60n.-0001 tl . 8. Names and addresses of witnesses, doctors, and hospitals: V h See in �n-�i0f➢� 9. List the expenditures you made on account of this accident or injury: ` D "i tS DATE TIME AMOUNT -LkzrkAseF .�rnr2t rviE� e 1 n �* Pcc, eow('nuInri son...■■ . as aL .r............ .......... ... rr..rr.rI 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 ) A�4 re G r 1De� 6or n. ) (Claimant's Signature) Pb . 04 K'Idnd, Ca Qcffo (a ) (Address) Telephone No. RdS,I X158 '315 I ) Telephone No. 9a �� YS-9- 3I S- ■.a■■aaaraa■■■■■■a�aaa'■■a■■�■■a�aaa■aaaa■■■....■■■■■aaa■■aa�a■..rrr.rr.r..r. .�rrr.rrrarY 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. -.ran■■a■■aaa■■aa■■aa&away...■a■■a■■aa■■Manana■si■■aaaaraaaaaOraaraaaar00Wa.Waa■aaa■aI 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. ATTACHMENT "A" TO CLAIM FORM Audrey Schonborn Attorney at Law P.O. Box 72424 Oakland, California 94612 (a.schonbom@att.net) (925)'458-3159 Re: Claim Against Contra Costa County This letter will serve as notification to Contra Costa County pursuant to Government Code sections 910 et. Seq: Claimants' Names: Angela Benitez Buntha Prum Arianna Benitez (a minor) Alex Benitez (a minor) Sarah Prum.(a minor) Marian Haines Address of Claimants: 1026 Power Avenue, Apt. 130 Pittsburg, California Claimants' Phone Number: c/o Audrey Schonborn, Attorney at law, (925) 458-3159. Claimants are being represented by counsel and all contact shall be made with their attorney only. Address of Attorney/Mailing Address: c/o Audrey Schonborn Attorney at Law. P.O. Box 72424 Oakland, California 94612 Claimants are being represented by counsel and all contact shall be made with their attorney only. Date of Occurrence: On or about January 9, 2008 l Location of Occurrence; 41 Wallen Lane Oakley, California Name of Public Employees and Public Entities Involved: Contra Costa County, Contra Costa County Sheriffs Department, Contra Costa County Office of the Sheriff, City of Oakley, Oscar Aranda and DOES 1-,100, individually and;in their official capacities. Discovery continuing, Circumstances of Incident: Tenancy Issues: On January 9, 2008, the above listed Claimants were tenants of,a rental house located at 41 Wallen Lane in Oakley, California. The landowners of the;residence were James M. George (aka "Mitch" George) and Marcia Brigance (aka Marcia George). Angela Benitez and her,husband, Buntha Prum, had begun moving their belongings into the house at the end of December 2007 by agreement with the landowners. The Prum family had begun physically residing in the premises on January 3, 2008. Prior to moving.into the-premises, the tenants informed the landlowners that many repairs had to be made. The defects pertained to the safety and habitability of the premises. Many of the repairs were not made by the landowners prior to the tenants residing on the premises. One such defect was that there were no locks on two windows in the house (a window in the back bedroom and a window in the front bedroom). The landowners were asked to repair this defect, were aware that two windows did not have locks but did not make the repairs prior to the tenants taking possession of the house. On the evening of January 4, 2008, most of the Prum family members were at their previous residence preparing to move the last of their belongings into the house. Only Angela Benitez's elderly mother, Marian Haines, remained in the 41 Wallen residence alone and slept in a front bedroom_ During the night, intruders) entered the house and stole many family belongings including jewelry, social security cards, checkbooks, financial records, medical cards, a breathing (respirator machine), medication, clothing and other personal records, items and property. Thousands of dollars of property were stolen from the Prum family. When Mr. Prum returned to the house on January 5th, he found the front door of.the residence wide open. He entered the house and found the window in the back bedroom (the window that had no lock) was open.. Marian Haines was unharmed. That same day, the police were called. The evidence indicated the intruder(s) had entered through the back bedroom window (the window with no lock). After the police left the premises, the landowners met with the Prum family and the family's attorney at the residence. The landowners were informed at that time that the scene and the evidence indicated that the intruder(s) had entered the house through the back bedroom window (a window with no lock). The family again requested 2 immediate repairs, asked for the landowners insurance information and it was agreed the tenants and landowners would meet again in two days for further discussions concerning the theft, the safety and condition of the premises and issues concerning the tenancy. The next day after the illegal entry of the Prum family's. home and the1 theft, on January 6, 2008, the landowners served the tenants with a notice to vacate the premises in six days —to vacate the premises by January 12, 2008. The landowners wrote that if the family did not vacate in six days, the landowners would "involve the Sheriffs Department for eviction actions." However, the landowners had not filed any action in court to commence civil eviction proceedings against these tenants, At the time Angela Benitez was served with the notice to vacate, she told the landowners that she discovered that day that the living room floor was soaking.wet, that the family's personal property,and boxes that were in that area of the room were soaked and damaged and the'.water probably came from a leak somewhere in the roof (there :had been recent rainstorms). The landowner did not respond and walked away. The next day, January :7th, the landowners returned to the Prum residence' and taped to the residencedoor a 24 hour notice that they intended to enter the premises to inspect for the water damage and further conducted themselves in a way that resulted in the harassment and intimidation of the residents. On January 8th, 1.the landowners. did not come to the residence to make the inspection. The tenants were given instruction by their attorney that the 24 hour notice of entry„of the landlords had expired, not .to let the landowners onto the premises, to call the police for a police civil standby and permit the repair persons to enter and inspect the premises to estimate repairs should the landowners come to the house unannounced and without notice'. 'January 9,2008 On January 9, 2008 in the evening; Mr. Prum heard a loud knock on the door, and heard someone say, "Sheriffs Department." The family' members, including the teenage daughter, were in pajamas. Angela Benitez was not present in the home at that time. Mr. Prum opened the door and saw a uniformed. Contra Costa County Sheriff, Oscar Aranda, and the two landowners - James George and Marcia: Brigance. There was also another person - the landowners' contractor/repairman. The Claimants had no notice that the landowners, their contractor/repairman and a Contra Costa County.Sheriff would be present at the house that night or at that time or that the Sheriff.and landowners would demand entry into their home. -Mr. Prum opened the door. While standing outside and in front :of the door, the Sheriff, Mr. Aranda, told Mr. Prum that he was present for a civil standby and that the landowners needed to go into the house. Mr. Prum told the Sheriff and the landowners that, due to advice from legal counsel, he would permit the repairman to enter the premises. Mr. Prum told the Sheriff that, as recently as the day before, the landowners had come to the house and had harassed and intimidated the family 3 and, as a result, Mr. Prum refused to permit the landowners into his home, Mr. Prum told Mr. Aranda that only Mr. Aranda could enter the home and that the landowners could not come into the residence with the Sheriff. In addition, Mr. Prum also told Mr. Aranda that the landowner's 24 hour'notice of entry had expired. Mr. Prum handed'the notice (the notice is attached pherein as "Exhibit A'} to Mr. Aranda to read. Mr. Aranda glanced at the paper. Mr. Prum repeatedly told Mr. Aranda that the landowners' 24 hour notice had expired and that the landowners could not enter the" premises. Mr. Aranda repeated, that the landowners had a right to enter the residence. Contrary to Mr. Prum's refusal to permit the landowners to enter the house, Mr. Aranda entered the house and permitted the landowners to enter the house with him. The landowners and the Sheriff entered the house in the living room. During the time period the landowners were in the house, the landowners walked into the living room. The landowners then walked into the dinning room area of the house as the Sheriff remained in the living room. The landowners visually looked at the two rooms and the family's personalbelongings. The family had many of their personal belongings in boxes and bags in those two rooms as the family had just moved into the house.: At- one point, the Sheriff went with Mr. Prum and the repairman into a bedroom and left the landowners alone, unmonitored and unobserved in the living room of the house. The landowner's repairman took photos of the interior of the family home. The Sheriff, the two landowners and the repairman remained in house approximately fifteen minutes. Upon request by. Mr. Prum, Mr. Aranda gave Mr. Prum his business card which indicated Mr. Aranda was not simply a Sheriff deputy but a detective of the Contra Costa County Office of the Sheriff's Investigations Unit. Mr. Aranda did not inform Mr. Prum whether or not the landowners had alleged criminal violations against members of the Prum family, whether ,there was a pending criminal investigation, if there was a search warrant applicable or whether,Mr. Aranda was present at the premises also in his official capacity as a detective of the Sheriffs' Investigations Unit. Mr. Aranda, the two landowners and the repairman then exited the house. The Sheriff then left the area but permitted the landowners and the repairman to remain on the property near the porch area in the front yard area of the house. The Sheriff left the area, did not monitor the situation, did not ensure the claimants were safe and secure and permitted the landowners and the repairman to remain on the property. The landowners and the repairman remained in front of the house in the family's front yard area for approximately fifteen minutes after the Sheriff had left the premises. On January 23, 2008, the City of Oakley Building Department inspectors inspected the house, determined it was unsafe and uninhabitable and red tagged the house. The family was prohibited from residing in the house. The family had to complete moving their furniture and personale property out of the premises and relocate. The family vacated the premises on.January 28, 2008. 4 On January 9, 2008, Oscar Aranda was a Detective with the Contra Costa County Sheriffs Department and/or Contra Costa County Office of the Sheriff. Claimants are informed and believe that Contra Costa County, the Contra Costa County Sheriffs Department and/or Contra Costae County Office of the Sheriff provides law enforcement services for, has contracted with and/or was the agent of the City of Oakley, California. Claimants and/or each of them, is informed and believes and herein alleges that he/she/they has/have, or may have, claims for damages against, including but not limited to, Contra Costa.County, Contra Costa County Sheriffs Department, Contra Costa County Office ofthe Sheriff, the City of Oakley, Oscar Aranda and Does 1-100 and/or each'of them, individually and/or while acting in concert with one another and/or as within the scope of employment or' as agents for/with one another, based on theories of liability which include, but not limited to, negligence, intentional tort, intentional infliction of emotional, distress, trespass, 1, negligent infliction of emotional distress, violation of civil rights, including but not limited to, violation of Constitutional and/or statutory rights under California law, including but not limited to California, Civil Code Sections 52, 52.1, and violation if civil rights under federal law, including but not limited to, 42 USC sections 1983 and pursuant to California and federal common law and statues, and that the acts and/or omissions of Mr. Aranda resulted in assisting the_ landowners in the wrongful and/or constructive eviction of the claimants from their home, wrongful eviction pursuant, including but not limited -to, California Civil Code sections 1940, 1941 and 1942 et. Seq, Claimants allege the above named public entities and/or individuals are liable under the theory of respondeat superior and failed to adequately hire, train, monitor, supervise, control and/or discipline the acts of Mr. Aranda and/or its employees and/or agents and that the acts and/or omissions as alleged herein were committed within the scope of employment by its employees and/or agents. Claimants allege other causes of actions subject to continuing discovery. + Iniury or Damage: Claimants have, or may have in the future, a claim for general damages, including, but not limited to,' claims for pain, suffering and severe emotional distress and/or other general damages in amounts to be determined according to proof. Claimants may have and/or may continue to have in the future, claims for special 'damages, including, but not limited to, claims for medical, and/or other special damageein amounts to be determined according to proof. Claimants will also be entitled to an award of statutory damages, exemplary damages, punitive damages and attorney fees and/or costs pursuant to California and federal statutes and pursuant to California Civil Code section 52, 52.1, 1942.5 and 42, USG Section '1983 and/or other statutes and/or laws amounts to be determined according to proof. Discovery is continuing. bv+ otf5. F6kf tat 62 rnm from E P me Amount of Claim: This claim is in excess of $25,000. Jurisdiction is designated as unlimited and jurisdiction would be in the Superior Court of the state of California for the County of Contra Costa and/or the United States District Court. Demand for Preservation of Evidence: Claimants do hereby demand that Contra Costa County, the Contra Costa County Sheriffs Department, the Contra Costa County Office of the Sheriff, the City of Oakley, their employees, servants and/or attorneys, maintain and preserve all evidence, documents and tangible materials that relate to the subject matter of this Claim during the pendency of this matter. Which include and until the completion of any and all civil and/or criminal litigation arising from the events. This demand for preservation of evidence'includes, but is not limited to, a demand that all Sheriff and, police departments and/or public safety entities preserve all tapes, logs and/or other tangible materials of any kind. GENERAL OBJECTION TO CONTRA COSTA COUNTY'S CLAIM FORM: The claimants have provided information in this claim as required under California Government Code section 910. To the extent Contra Costa County's claim form requires additional information (ie. home phone numbers, dates of birth, social security numbers, driver licenses numbers, insurance information, basis for all liability, etc.) such requirements constitute an invasion of the Claimants' privacy and is not required to be provided by the Claimants under Government Code Section 910. Therefore, the Claimants have submitted the above detailed information in support of their Tort Claim pursuant to Government Code section 910. 6 "'A if q Date: Monday January 7,2008. To: Angela Prun and Family RE: Roof leak(?) you informed us about yesterday 116/2008. THANK YOU FOR BRINGING THIS ROOF LEAK(YOU CLAIM) TO. OUR ATTENTION.THE-STORMS THAT HAVE PASSED THROUGH MUST HAVE CAUSED SOME DAMAGE TO OUR ROOF AND WE NEED TO GET IT FIXED ASAP, WE REPORTED THIS TO.OUR INSURANCE COMPANY THIS, MORNING IS- MORNING AND NO` HAVE AN OPEN CLAIM. INSURANCE COMPANY AND WE (HOMEOWNERS) WILL NEED TO COME INTO THE HOAR TO SEE WHERE THE ROOF IS LEAIITG..INSIDE THE DOME (7) AND THE INSURANCE COMPANY ALSO WANTS TO TAKE A LOOK AT THE CONDITION OF THE.ROOF. I DON'T KNOW EXACTLY WHEN THE INS. COMPANY WILL BE READY TO CONTE AS THEY HAVE NOT TOLD US A DATE OR TIME YET, THEY HAVE HAD A LOT OF REPORTED CLAIMS DUE TO STORM DAMAGE--BUT I DO KNOW IT WILL BE VERY SOON. THIS NOTICE WILL SERVE AS OUR"24 DOUR NOTICE OF ENTR IF YOU HAVE ANY QUESTIONS OR CONCERNS, PLEASE FEEL FREE TO PHONE.MARCIA AT: 925-584-7030. REMINDER: PL]E:4;SE CONTINUE TO MOVE OUT OF OUR HOME AS INFORMED YESTERDAY(yoga MUST be OUT BY 1/12/08).IF YOU FEEL UNSAFE TO BE THERE FOR ANY REASON: YOU SHOULD LEAVE THE-PROPERY MEDIATELY AND TAKE YOU AND YOUR FAMILY TO A SAFE PLACE SAFETY FOR YOU AND YOUR FAMILY IS LEFT UP TO YOU AND YOUR PERSONAL JUDGEMENT, NOBODY IS MAEI NG OR FORCING-YOU AND.YOUR FAMILY TO STAY. ! j ✓I ��C6 MY Nx N c� 6 CLAIM . BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: AUGUST: 12, 2008 Claim Against the County, or District Governed by ) the Board of Supervisors, Routin n rSfj=nts ) NOTICE TO CLAIMANT and Board Action. All Section ref I The copy of this document mailed to California Government Codes. you is your notice of the action taken ju( () 8 ZOO8 on your claim by the B at of Supervisors. (Paragraph IV below), CouNT,Y CO NS iven Pursuant to Go ernment Code MARTINEZ CALL f AMOUNT: $3, 736 . 21 . . Section 913 and 915`4. Please note all "Warnings MERCURY CASUALTY as CLAIMANT: subrogate for ROBERT ETTER ATTORNEY: UNKNOWN DATE RECEIVED- JULY 08 , 2008 ADDRESS: P.'0. BOX 997,195 BY DELIVERY TO CLERK ON: JULY: 08, 2008 SACRAMENTO; CA 95899 ' RECEIVED FROM BY MAIL POSTMARKED: RISK. MANAGEMENT FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-,,noted claim. JULY 08, 2008 JOHN CULLEN, r Dated: By: Deputy II. FROM.: County Counsel TO: Clerk of the Board of Su rviso s ( This claim co' plies substantially with.Sections 910 and 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 days (Section 910.8). O Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send war-tting of claimant's right to apply for leave to present a late claim (Section 911.3). O Other: Dated: By: Deputy County Counsel ' 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) O Claim was returned as untimely with notice to claimant (Section 911.3). l.V. ARD ORDER:- By unanimous vote of the Supervisors present: (vfThis 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. Dated r/a2 Z�04HN CULLEN, CLERK, By Deputy Clerk WARN1. (Gov. code section 913) Subject to certain exceptions,you have only six(6) months ti-0111 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 with this mattee. If you warif to consult an attorney,you should do so immediately. *For Additoihal Warning See Reverse Side ofT'his Notice. AFFIDAVIT OF MAILING [ declare under penalty of perjury that .1 ain now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today .i deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of,this` Board Order and Notice to Claimant, addressed to the claimant as shown above. Date OHN CULLEN, CLERK By. Deputy Clerk -� BOARD OF SUPERNUSORS OF CONTRA COSTA. COUNTY R MmYi7it::.i•T.iT�T�ri iii ZiyS RTUC�,ON � Com- TNLA- r A. Y ,21 m relaiing t,�� a cease of action for death or for injury to persoll or to personal prapeity or growing crops shall be presented not hater than 'six monft a'-'ier nue acs.al of the ca.ze of action. A claim relating to any other cause of action shall be presented not later tuau after the accrual of the cause of a dop. SHARON I `l�IE FFORD (Gov. Code § 911.2,) JUL 3 2008 'B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Roam 106, County Administration Building,651 Pine Street Mardnez, CA 94553. C. If claim is against a district governed by the Board of Supt:msors, rather t as the County, the name of the District should be filled in, D. If the claim is.against more than one rublio eotity, separate claims must be filed against each. public antity- E. Fraud. See penalty for fraudulent claims,Peml Code Sec.72 at the end of this form,. Russ wows NUN MRR=l[ R*u le RE: Claim By: Reserved far Clerk's filing stamp 2000 Against the County of Contra.Costa or, ) _ '"+D OF SUPE, 6IRS A COSTA CO. District) (Fill in the name) ). The undersigned claimant hqqbyTnake3 claim ap TRS the Cmmty of Contra Costa or the above-named district in the sum,of$_1-7 and in support of this claim represeutss as follow,%: 1. when did the dmage or injury occur? (Give exact date and hour) j _ 1 (0 — 0Y 0:14a�. 2, Where id the damage or injury occur? (Include city and county) p vs. VW\ a•c k W h V tS� „% JV4%aY)t S Ott C bra 46VCn ,C 0 3. How did the damage or PI- occur? Crave fall details;use extra paper i required) VakAY ��Vcr 0&a. o. � c -tL&T V%. �rd . r�q h} 1 uA;- . -tlidQ,t� wt - bka k V% Sswt� . 54J." 96kict f,LPa(�- 4ex 4 I s - (I ACAL4 4. What'particular act or omission on the part of cozmty or dlstriat officers, sertants, ore )Oyaes caused the injury or damage? CJ Y1 Sq�e 1Q. - +� 5 What are the names of r., mty or district officers,smmats, or employees causing the damage or injury? 7-i mQkW/ C-1 ray$oV\ SA n f m oi` UAII e ,' v{,, •••1 hl'1Il.I'111UAI UTAI 11n1\I nnn [Alute I �r AAA, .n - 6. WYe, damage or injuries do ym 1'11 'm yeswIted? "Give leu e<A ez. i- __ t p f kj,�eS or dam.$ges claimei. Attach two estimates for'auto damage.) m ok rad-c:. cla w a q , 'vb ;rcm GC*I WA ),2 t-a 7. How was -the amount claimed above computed? (Include the estimated amount of any prospective injury or damage) �.� G�-t b M G1*GlAr 'S iM A, e re a l t�}1 Q,u3 u (11 a �c�e S. Names and addresses of witnesses, doctors, and hospitals: 9. List the expenditures you made on account of this aocidai t of itray: . DATE TIME AMOUNT Cism atIts sItaasIts gNit as7Wass aaaasAlsaaWsas■s Wtssantkalaaalss:asssaaasesaa■aaIKMmall via krXaal ) .Gov. Code Sec, 910.2 provides"The claim shall,be , ) signed by the claimant or by same person on his )behalf" MERCtiRYLNSURAN SRM NOTICES TO: (A.ttomev) l CE CROUP Name and address of Attomey ) PO BOX 99719'3 SACRAMENIQ CA 95899-7195 (Claimant's Sipat►ue) O 66A q7/ 76- (Address) Telepboae No. ) Telephone No, f 70 2W tsaw aassasa=sEwa Itaa aas aME a s as a s IN a s NOW tan a Kurt atK*Maaa ta■Ram Vail a cavzWWffaaRRaasata s l a t sl PUBLIC RECORDS NOTICE: Please be advised that this claire fay, or any ot..?m.filed with the County under the Tort Claims Act, is subject to public disclbsure under the California Public Records Act (Gov. Code, §5 6500 at seq.) Furthermore, any atfachmmznts, addemdums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■fiR■ataEmail saaksmcasarir><.isaaaslatms■:ssssaaRavi tastasra■a aWWtasaRaasat<—mmMEWMENkstaal NO1`ICE: Vection 72 of the Fen al Code provides: Every person who, with intent to defraud,prest-,ats for allowance or for payment to any state board or officer, or to any co=y, city, or.district board or officer, authorized to allow or pay the same if gmuine, 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 me year, by a fine of not exceeding one thousand dollars ($1,000.04), or by both such imprisonment and fine, or by impriso=ent iu the state prisda, by a fme of not exceed ng ten thousand dolks (K0,000),or by both each imprisonment and fine. • var,nunruur ttntV nun tuna . f AAAA P.O. Box 997195 M E R C U RY Sacramento, CA 95899-7195 INSURANCE GROUP (916) 636-1534 June 27,2008 Contra Costa Risk Management SHARON HYMES-OFFORD 651 Pine Street Admin Building, Room 106 JUL 2 2008 Martinez,Ca. 94553 RE: OUR INSURED: Robert Etter OUR FILE NUMBER: 2008-0015-000320-86 DATE OF LOSS: January" 16,2008 YOUR INSURED: San Ramon Valley Fire/Sean T Grayson YOUR FILE NUMBER: 64301 Dear Contra Costa Risk Management: We have obtained information regarding the above date of loss suggesting that damages incurred were caused by your insured's negligence. Enclosed for your review please find copies of our supporting documentation. The breakdown of our payments is as follows: Initial Repairs $3,381.23 Deductible $250.00 Supplements $104.98 Rental Expense $0.00 Out of Pocket Expense $0.00 Other $0.00 Salvage(+/-) $0.00 VLF, if applicable $0.00 . Total $3,736.21 Our insured's version of the loss is as follows: OTHER PARTY MADE A LEFT TURN FROM RIGHT LANE AND COLLIDED WITH OUR INSURED. Please return a copy of this form with your payment,to ensure proper credit. Should you have any questions or need additional information,please contact meat(916)636-1534,ext. 2249. Thank you for your cooperation. Very truly yours, MERCURY CASUALTY COMPANY 444✓✓✓""" �/'_ _ _ � �`� �ii Ir.- . GWEN VANBRUNT Claims Adjuster Sacramento Claims Enclosures P.O. Box 997195 ; MERCURY Sacramento, CA 95899-7195 INSURANCE GROUP (916) 636-1534 June 27,2008 Contra Costa Risk Management 651 Pine Street Admin Building,Room 106 Martinez,Ca. 94553 RE: OUR INSURED: Robert Etter OUR FILE NUMBER: 2008-0015-000320-86 DATE OF LOSS: January 16,2008 YOUR.INSURED: San Ramon Valley Fire/Sean T Grayson YOUR FILE NUMBER: 64301 Dear Contra Costa Risk Management: We have obtained information regarding the above date of loss suggesting that damages incurred were caused by your insured's negligence. Enclosed for your review please find copies of our supporting documentation. The breakdown of our payments is as follows: Initial Repairs $3,381.23 Deductible $250.00 Supplements $104.98 Rental Expense $0.00 Out of Pocket Expense $0.00 Other • 1 $0.00 Salvage(+/-) $0.00 VLF, if applicable $0.00 Total $3,736.21 Our insured's version of the loss is as follows: OTHER PARTY MADE A LEFT TURN FROM RIGHT LANE AND COLLIDED WITH OUR INSURED. Please return a copy of this form with your payment,to ensure proper credit. Should you have any questions or need additional information,please contact me at(916)636-1534,ext.2249. Thank you for your cooperation. Very truly yours, MERCURY CASUALTY COMPANY GWEN VANBRUNT Claims Adjuster Sacramento Claims Enclosures STATE OF CAL'FORNIA . TDAFFIC ' 0L ll"-'lnll rRE—PO +T CHP 555 Page 1 (Rev 7-03)OPI 061 Page 1 SPECIAL CONDITIONS NO.INJURED HIT&RUN FELONY CITY JUDICIAL DISTRICT LOCAL REPORT NUMBER 0 ❑j ivIARTuvEZ iviT DIABLO 08-223 NO.KILLED HIT&RUN MISD COUNTY REPORTING DISTRICT BEAT 0 CONTRA COSTA 161 1 COLLISION OCCURRED ON: - MO DAY YEAR TIME NCIC# OFFICER I.D. O MARINA VISTA 01/16/2008 1046 CA0071400 114 AMILEPOST INFORMATION DAY OF WEEK TOW AWAY PHOTOGRAPHS BY: NONE T WEDNESDAY ❑YES Z NO I O �{ AT INTERSECTION WITH COURT ST - STATE HWY REL N OR YES N]NO PARTY DRIVERS LICENSE NUMBER STATE CLASS AIRBAG SAFETY EQUIP. VEH YEAR MAKElMODEUCOLOR LICENSE NUMBER STATE I A6513043 CA B M G 1994 FORD/BRONCO/WIII 363806 CA DRIVER NAME OWNER NAME ❑SAME AS DRIVER ❑X SEAN TIMOTHY GRAYSON SAN RAMON VALLEY FIRE PEDEST STREET ADDRESS OWNER ADDRESS 209 BEL FORA �SAME AS DRIVER ❑ 1500 BOLLINGER CANYON RD SAN RAMON:CA 94583 KD VEH CITY/STATEIZIP DISPOSITION OF VEHICLE ON ORDERS OF: []OFFICER a DRIVER 0 OTHER ❑ ROSEVILLE,CA 945747 DRIVEN AWAY BICYLST SEX HAIR EYES HEIGHT WEIGHT BIRTHDATERACE PRIOR MECH.DEFECTS X NONE APP. REFER TO NARRATIVE M BLN GRN 5'9" 175 12/07/1976 W VEHICLE IDENTIFICATION NUMBER: 1FMEU15H7RLB06144 OTHER HOME PHONE BUSINESS PHONE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA ❑ 916-543-3805 925-838-6620 VEHICLETYPE ❑LINK ❑NONE Z MINOR ` INSURANCE CARRIER POLICY NUMBER ❑MOD O MAJOR ROLL-OVER SELF INSURED/RISK MANAGEMENT SELF INSURED 43 DIR OF TRAVEL I ON STREET OR HIGHWAY SPEED LIMIT WEST MARINA VISTA 25 Ca Dor CAL-T TCP/PSC MC/MX PARTY DRIVERS LICENSE NUMBER STATE CLASS AIRBAG SAFETY EQUIP. VEH YEAR MAKE/MODEUCOLOR LICENSE NUMBER STATE 2 N6741669 CA C M G 2001 NISS/PATHFINDERMLK 4LFU718 CA DRIVER NAME OWNER NAME ❑SAME AS DRIVER OX ROBERT LINWOOD ETTER JR. KAREN ETTER PEDEST STREET ADDRESS OWNER ADDRESS FX�SAME AS DRIVER 130 SERRA CT KD VEH CITY/STATE2IP DISPOSITION OF VEHICLE ON ORDERS OF: ❑OFFICER DRIVER ❑OTHER ❑ VALLEJO,CA 94590 DRIVEN AWAY BICYLST SEX HAIR EYES I HEIGHT WEIGHT BIRTHDATE RACE PRIOR MECH.DEFECTS -X NONE APR ' REFER TO NARRATIVE M BLK BRO 6'1° 220 05/17/1958 B VEHICLE IDENTIFICATION NUMBER: JN8DR07XI I W502125 OTHER HOME PHONE BUSINESS PHONE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA ❑ 707-644-6004 707-644-6004 VEHICLE TYPE ❑UNK ❑NONE a MINOR r INSURANCE CARRIER. POLICY NUMBER ❑MOD ❑MAJOR ❑ROLL-OVER " a MERCURY CAS.COMP.. AP05293064 07 DIR OF TRAVEL ON STREET OR HIGHWAY SPEED LIMIT 'NEST MAP INA VISTA 25 CA DOT CAL-T TCP/PSC MC/MX PARTY DRIVERS LICENSE NUMBER STATE CLASS AIRBAG I SAFETY EQUIP; VEH7 MAKE/MODEUCOLOR - LICENSE NUMBER STATE 3 DRIVER NAME - OWNER NAME ❑SAME AS DRIVER ❑ 'W EN VAN BRU NT PEDEST STREET ADDRESS ,nn,11 OWNER ADDRESS ❑SAME AS DRIVER U9a KD VEH CITY/STATEOP - DISPOSITION OF VEHICLE ON ORDERS OF: []OFFICER* ❑ ❑ DRIVER OTHER BICYLST SEX HAIR EYES HEIGHT WEIGHT bF THb71 r RACE PRIOR MECH.DEFECTS NONE APP. REFER TO NARRATIVE ❑ VEHICLE IDENTIFICATION NUMBER: OTHER HOME PHONE BUSINESS PHONE DESCRIBE VEHICLE DAM IN DAMAGED AREA ❑ VEHICLE TYPE 1:1 LINK ❑NONE ❑•MINOR - INSURANCE CARRIER POLICY NUMBER ❑MOD❑MAJOR B-OvER 2900 DIR OF TRAVEL ON STREET OR HIGHWAY SPEED LIMIT - ,L S CA DOT CAL-T TCP/PSC MC/MX PREPARED BY - DISPATCH NOTIFIED - REVIEWED BY DATE REVIEWED KEVIN BUSCIGLIO 114 0 YEs ❑NO 0 N, JIM CHASE 88 01/27/2008 STATE OF CALIFORNIA T RrtA F I IC COLLISHON CODING CHP 555 Page 2(Rev 7-03)OPI 061 Page 2 DATE OF COLLISION(MO.DAY YEAR) TIME(2400) _ NCIC# OFFICER I.D. - NUMBER i046 C�+^v^v714C"v 114 � 08=223 OWNER - JOWNERADDRESS NOTIFIED PROPERTY YES NO DAMAGE DESCRIPTION OF DAMAGE SEATING POSITION SAFETY EQUIPMENT INATTENTION CODES OCCUPANTS L AIR BAG DEPLOYED M/CBICYCLE-HELMET A-CELLPHONE HANDHELD Q A-NONE IN VEHICLE• M-AIR BAG NOT DEPLOYED DRIVER PASSENGER B-CELLPHONE HANDSFREE B-UNKNOWN N-OTHER V-NO X-NO C-ELECTRONIC EQUIPMENT VER C-LAP BELT USED P-NOT REQUIRED W-YES Y-YES O-RADIO/CD 1 2$ 1-DRID-LAP BELT NOT USED E,-SMOKING 2 TO -PASSENGERS 4 5 6 7-STA PAS REAR E-SHOULD HARNESS USED CHILD RESTRAINT EJECTED FROM VEHICLE F+-EATING F-SHOULDER HARNESS NOT USED Q-IN VEHICLE USED 0-NOT EJECTED G-CHILDREN B-RR,OCC TRK,OR VAN G-LAP/SHOULDER HARNESS USED R;-IN VEHICLE NOT USED 1-FULLY EJECTED H-ANIMALS 7 9-POSITION UNKNOWN H-LAP/SHOULDER HARNESS NOT USED S-IN VEHICLE USE UNKNOWN 2-PARTIALLY EJECTED I -PERSONAL HYGIENE 0-OTHER J -PASSIVE RESTRAINT USED T IN VEHICLE IMPROPER USE 3-UNKNOWN J READING K-PASSIVE RESTRAINT NOT USED U-NONE IN VEHICLE ITEMS•MARKED BELOW FOLLOWED BY AN ASTERISK(')SHOULD BE EXPLAINED IN THE NARRATIVE PRIMARY COLLISION FACTOR MOVEMENT PRECEDING LIST NUMBER(#)OF PARTY AT FAULT TRAFFIC CONTROL DEVICES 1 2 1 3 1 SPECIAL INFORMATION 1 2 3 1 COLLISION I q 'VCSECTIONVICLATED: CRED❑ YES A CONTROLS FUNCTIONING A HAZARDOUS MATERIAL A 'STOPPED CVC 22107 No B CONTROLS NOT FUNCTIONING B CELL PHONE HANDHELD IN USE X B 'PROCEEDING STRAIGHT B OTHER IMPROPER DRIVING` C CONTROLS OBSCURED C CELL PHONE HANDSFREE IN USE C ^RAN OFF ROAD X D NO CONTROLS PRESENT/FACTOR` D CELL PHONE NOT IN USE D u MAKING RIGHT TURN C OTHER THAN DRIVER' TYPE OF COLLISION E SCHOOL BUS RELATED X E 'MAKING LEFT TURN D UNKNOWN` A HEAD-ON F 75 FT MOTOR TRUCK COMBO F MAKING U TURN E FELL ASLEEP' B SIDE SWIPE G 32 FT TRAILER COMBO G BACKING C REAR END H SIDESHOW H 'SLOWING/STOPPING MATHER (MARK 1 TO 2 ITEMS) X D BROADSIDE I STREET RACING I PASSING OTHER VEHICLE X q CLEAR E HIT OBJECT J CHANGING LANES B CLOUDY F OVERTURNED K PARKING MANEUVER C RAINING G VEHICLE-PEDESTRIAN L ENTERING TRAFFIC D SNOWING H OTHER M OTHER UNSAFE TURNING E FOGNISIBILITY N =XING INTO OPPOSING LANE F OTHER' MOTOR VEHICLE INVOLVED WITH 1 O PARKED G WIND A NON-COLLISION P `MERGING LIGHTING B PEDESTRIAN IQ TRAVELING WRONG WAY X A DAYLIGHT X C OTHER MOTOR VEHICLE OTHER ASSOCIATED FACTORS IR OTHER- B DUSK-DAWN D MOTOR VEHICLE ON OTHER RDWAY 12 3 1 (MARK 1 TO 21TEMS) C DARK-STREET LIGHTS E PARKED MOTOR VEHICLE '" A VC SECTION VIOLATED: CRED❑ YES D DARK-NO STREET LIGHTS F TRAIN ❑ NO E DARK-STREET LIGHTS NOT G BICYCLE B VC SECTION VIOLATED: CRED❑ YES FUNCTIONING H ANIMAL: ❑ No SOBRIETY-DRUG ROADWAY SURFACE VC SECTION VIOLATED: CITED❑ YES PHYSICAL X A DRY I FIXED OBJECT: ❑ NO 1 2 3 (MARK 1 TO 2 ITEMS) B WET D ;'''' nl """" "5' X X A HAD NOT BEEN DRINKING C SNOWY-ICY J OTHER OBJECT: E VISION OBSCURED: B HBD-UNDER INFLUENCE D SLIPPERY(MUDDY,OILY,ETC.) F INATTENTION: C HBD-NOT UNDER INFLUENCE` ROADWAY CONDITIONS G STOP 8 GO TRAFFIC D HBD-IMPAIRMENT UNKNOWN' (MARK 1 TO 2 ITEMS) PEDESTRIAN ACTIONS H ENTERING/LEAVING RAMP E UNDER DRUG INFLUENCE` A HOLES,DEEP RUT' X A NO PEDESTRIANS INVOLVED I PREVIOUS COLLISION F 'IMPAIRMENT-PHYSICAL' B LOOSE MATERIAL ON RDWAY' B CROSSING IN CROSSWALK IJ UNFAMILIAR WITH ROAD G'IMPAIRMENT NOT KNOWN C OBSTRUCTION ON ROADWAY` AT INTERSECTION K DEFECTIVE VEH EQUIP: CITED H NOT APPLICABLE D CONSTRUCTION-REPAIR ZONE C CROSSING IN CROSSWALK-NOT ❑ YES I SLEEPY/FATIGUED E REDUCED ROADWAY WIDTH IN INTERSECTION ❑ NO F FLOODED' D CROSSING-NOT IN CROSSWALK L UNINVOLVED VEHICLE G OTHER' E IN ROAD-INCLUDES SHOULDER M OTHER' $Xx NX H NO UNUSUAL CONDITIONS F NOT IN ROADNONE APPARENT G APPROACHING/LEAVING SCH BUS O RUNAWAY VEHICLE SKETCH MISCELLANEOUS 0 SKETCH IS NOT TO SCALE. INDICATE NORTH, N. ANDING FEB 0 6 2V". r CLAI MIS STATE OF CA!:.IFORNIA T vi=Cw %.#w iv17 vvL'p IV CHP 555 Page 3(Rev 7-03)OPI 061 Page 3 DATE OF COLLISION(MO.DAY YEAR) TIME(2400) NCIC# I OFFICER I.D. NUMBER 01/16/2008 1046 CA0071400 ,,A i,'* 08-223 WITNESS PASSENGER EXTENT OF INJURY('X'ONE) INJURED WAS('X'ONE) PARTY SEAT SAFETY ONLY ONLY AGE SEX EJECTED ' FATAL I SEVERE OTHER VISIBLE I COMPLAINT NUMBER POS. EQUIP DRIVER PASS. INJURY INJURY INJURY OF PAIN PED, BICYCLIST OTHER ❑ ❑ 31 M ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ I I G 0 NAME/D.O.BJADDRESS TELEPHONE SEAN TIMOTHY GRAYSON (12/07/1976) 209 BEL FORA,ROSEVILLE,CA 945747 (H)916-543-3805 (B)925-838-6620 (INJURED ONLY)TRANSPORTED BY TAKEN TO N/A N/A DESCRIBE INJURIES ❑VICTIM OF VIOLENT CRIME NOTIFIED ❑ ❑ 149. M ❑ ❑ ❑ I ❑ ❑ ❑ 1 ❑ I ❑ J .E] 2 I G 0 NAME/D.O.B./ADDRESS TELEPHONE ROBERT LINWOOD ETTER JR. (05!17/1958) 130 SERRA CT,VAL LEJO,CA 94590 (H)707-644-6004 (B)707-644-6004 (INJURED ONLY)TRANSPORTED BY TAKEN TO N/A N/A DESCRIBE INJURIES ❑VICTIM OF VIOLENT CRIME NOTIFIED ❑ ❑ ❑ ❑ ❑ ❑ ❑ Ell DI ❑ ❑ NAMEID.O.B.IADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY TAKEN TO DESCRIBE INJURIES ❑VICTIM OF VIOLENT CRIME NOTIFIED o ❑ ❑ ❑ ❑ o o -o ❑ ❑ ❑ NAMEID.O.B./ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY - TAKEN TO DESCRIBE INJURIES " ❑VICTIM'OF VIOLENT CRIME NOTIFIED ❑ ❑ - ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ NAM E/D.O.BJADDRESS - TELEPHONE (INJURED ONLY)TRANSPORTED BY TAKEN TO DESCRIBE INJURIES ❑VICTIM OF VIOLENT CRIME NOTIFIED ❑ ❑ ❑ ❑ I ❑ ❑ ❑ ❑ ❑ ❑ 1 ❑ - NAMEID.O.B./ADDRESS - TELEPHONE ' (INJURED ONLY)TRANSPORTED BY - TAKEN TO DESCRIBE INJURIES VICTIM,OF VIOLENT,CRIME NOTIFIED NAME OF PREPARER I.D.NUMBER MO, DAY YEAR NAME OF REVIEWER MO. DAY YEAR KEVIN BUSCIGLIO 114 01/16/2008 JIM CHASE 01/27/2008 STATE OF CALIFORNIA NARRATIVE/SUPPLEMENTAL Citic 556(Rev.7-90)OPI 042 Page 4 DATE OF INCIDENT/OCCURENCE TIME(2400) NCIC NUMBER OFFICER I.D.NUMBER NUMBER 01/16/2008 1 1046 CA0071400 114 08-223 "X"ONE "X"ONE TYPE SUPPLEMENTAL(7-APPLICABLE) Narrative []Collision Report BA update , 11 Fatal []Hit and run update Supplement ElOther. Hazardous Materials School bus E]Other: CIN/COUNTY/JUDICIAL DISTRICT REPORTING DISTRICTIBEAT CITATION NUMBER MARTINEZ/CONTRA COSTA/MT DIABLO 161 LOCATION/SUBJECT STATE HIGHWAY RELATED MARINA VISTA/COURT ST 0 Yes QX No NOTIFICATION: On 01/16/07 at 1057 hrs., I was dispatched to Court St. at Marina Vista to investigate a Non-Injury Accident. I arrived within a few seconds later. All measurements are approximate and were obtained by pacing. SCENE DESCRIPTION: The accident occurred on Marina Vista which is a two lane, one way, asphalt roadway. i his area of Marina Vista goes west only and was approximately thirty feet wide. . PARTIES: Driver 41 was identified as Sean Grayson by his valid CDL. Dl Grayson said he drove vehicle #1 and was the sole occupant. V1 faced south/west and was at rest in the middle of the intersection of Marina Vista at Court St. Driver#2 was identified as Robert Etter by his valid CDL. D2 Etter said he drove vehicle 92 and was the sole occupant. V2 faced west and was at rest in lane #1 of Marina Vista at Court St. STATEMENTS: D2 Etter said he drove V2 west bound on Marina Vista in the number one lane. D2 Etter said that V 1 was west bound in the number two lane in front of him. D2 Etter stated that V 1 made a left turn from the number two lane and drove into the number one lane, in front of him. D2 Etter said he did not have enough time to stop and the front of his vehicle(V2) struck the drivers side front of V I. D 1 Grayson said he drove V 1 west bound in the number one lane on Marina Vista. D 1 Grayson attempted to make a left turn onto Court St. D1 Grayson said he never saw V2 until the vehicle's collided. I told D1 Grayson that it did not look like'he drove in lane one, due to the position of the vehicle's when I arrived on scene and the damage to the vehicle's. D 1 Grayson said he knew it looked like he drove in land two, but he remembered driving in lane one. D 1 Grayson said he may have taken the left turn wide. SUMMARY: VI traveled WB in the number two lane of Marina Vista. V2 traveled west bound in the number one lane of Marina Vista. V 1 made a left turn from the number two lane in an attempt to turn SB onto Court St. V 1 turned in front of V2 and V2's passenger side front contacted the drivers side front quarter panel of V.I. This caused minor damage to both vehicles. CAUSE: D1 Grayson was the cause of the accident for violation of CVC 22107-unsafe turning movement. PREPARER'S NAME AND I.D.NUMBER Date: REVIEWER'S NAME DATE KEVIN BUSCIGLIO 114 01/17/2008 JIM CHASE 01/27/2008 Use previous editions until depleted.. 9057841 STATE OF CALIFORNIA NARRATIVE/SUPPLEMENTAL CHP 556(Rev.7-90)OPI 042 . Page 5 DATE OF INCIDENVOCCURENCE TIME(2400) NCIC NUMBER OFFICER I.D.NUMBER NUMBER 01/16/2008 1046 CA0071400 114 08-223 "X"ONE )CONE TYPE SUPPLEMENTAL("X"APPLICABLE) ❑X Narrative Collision Report BA update Fatal E]Hit and run update Supplement Other. E] Hazardous Materials School bus Other: CITY/COUNTY[JUDICIAL DISTRICT REPORTING DISTRICTIBEAT TITATION NUMBER MARTINEZ/CONTRA COSTA/MT DIABLO 161 LOCATIONISUBJECT STATE HIGHWAY RELATED MARINA VISTA/COURT ST E]Yes QX No AOI: 18' west from the prolongation of the east curb line on Court St. and 12'north from the prolongation of the south curb line on Marina Vista. RECOMMENDATIONS: None. PREPARER'S NAME AND I.D.NUMBER Date: REVIEWER'S NAME DATE KEVIN BUSCIGLIO 114 01/17/2008 JIM CHASE 01/27/2008 Use previous editions until depleted. 9057841 Mercury Insurance :: NextGen Page 1 of 1 LOSS Check Maintenance GVANBRUNT .1111WMERCURY NextGen 05 06/26/2008 tNSURANCE GROUP ` Claims I WIP I IT I Low Off Mac laim Ingwry: Claim Log I Adjust Claim I Maintenance J Directories J Alert heck Li _. heck Details& Diary_Maintenance " File Notes Claim Number 2008 0015 000320-86 Handling Unit 0015 SACRAMENTO Claimant Maintenance Policy Number 0401 05 005293064 Date of Loss 01/16/2008 11:00 AM ^ Check Maintenance Named Insured ROBERT ETTER' Claim Status Regular Open Request Vendor Maint 019423 Gwen VanBrunt --d M_ -- -Subrogation Referral Adjuster 916i 636-1534 Ext 2249 Orig.'Cost of Vehicle 20,000.00 Loss Check Issued Maintenance Subrogation Report Check Maintenance Type` Type Payee Assign SubroVendor Reportable � Control Vendor Clmt Pymt Record Check Number 460483404 Code Code 61083089 Legal File AssignmtF Payee SOLANO COLLISION INC Closing Suit_ Additional AND ROBERT ETTER BI/UM Settlmnt Eva). - Payee Veh. Registration Address 3267 SONOMA BLVD,VALLEJO,CA 94590 Issued By 019423 Gwen Issue VanBrunt Date 02/05/2008 Honored 02/11/2008 Date Coverage Amount Type Adjuster Code° Total Loss , COLL 31486.21 Final 019423 N Check Amount 3,486.21 In Full Settlement Of CN Claims Backup Withholding 00.00 To Be Authorized By Nick Anding Net Check Payee 3,486.21 Authorized By Nick Anding Claimant/Reference ROBERT ETTER Authorized Date 02/06/2008 Comment I�(,. `ri Y�i(►y_i�a, kl y� t� ��"'�".f��_-' �•r�a,':r't�;¢� �....a��v,'�v�F_ ,. .FF� https://nextgen.mercuTyinsurance.corn/ClaimsWeb/checkMaintenanceDir.do 6/26/2008 Mercury Insurance :: NextGen Page 1 of 1 Loss Check Maintenance GVANBRUNT AWMERCURY NextGen .05 06/26/2008 INSURANCE GROUP — Claims I WIP 11T I Loci 0ff ,=c 46laim Inquiry`: ;: Claim Log I Adjust Claim I Maintenance Directories ( Alert Check Li Check Details Diary Maintenance File Notes Claim Number 2008 0015 000320-86 Handling Unit 0015 SACRAMENTO Claimant Maintenance Policy Number 0401 05 005293064 Date of Loss 01/16/2008 11:00 AM Check Maintenance Named Insured ROBERT ETTER Claim Status Regular Open Request Vendor M_aint019423 Gwen VanBrunt �-- ---- Adjuster (916)636-1534 Ext 2249 Orig.Cost of Vehicle 20,000.00 Subrogation Referral .._.. .__ �....�..�.�... Loss Check Issued Maintenance-- Subrogation Report _.. Payee Type* Non-Reportable Check Maintenance Te' 1:3Assign Subro Vendor Type Clmt Pymt Record ar...., - Control DED Check Number 460612256 Code Reason REIMBURSEMENT Legal File Assignmt Closing Suit Payee ROBERT ETTER BI/UM Settlmnt Eval�- Additional Payee Veh. Registration Address 130 SERRA DR,VALLEJO,CA 94590 Issued By 019423 Gwen Issue VanBrunt Date 04/07/2008 Honored 04/14/2008 Date Coverage Amount Type Adjuster Code Total Loss COLL 250.00 Additional 019423 N Check Amount 250.00 In Full Settlement Of CN Claims To Be Authorized By Nick Anding Authorized By Nick Anding Claimant/Reference ROBERT ETTER .Authorized Date 04/09/2008 Comment DEDUCTIBLE REIMBURSEMENT https://nextgen.mercuryins'urance.com/ClaimsWeb/checkMaintenanceDir.do 6/26/2008 Page 1 of 8 Date: 1/31/2008 12:22:16 pm Estimate ID: 080015000320-8600101 Estimate Version: 2 Supplement: 1 (F) 1/31/2008 12:13:48 PM Profile ID: CUSTOMIZED Solano Collision Inc : 3267 SONOMA BLVD, VALLEJO, CA 94591 (707)644-4044 . Fax: (701) 644-4045 Tax ID: 48-1299380 BAR #: AF228086 EPA #: CAL0002B0088 Damage Assessed By BOBBY TAYLOR Appraised For: Condition Code: Fair Type of Loss: Date of Loss: 1/16/2008 Arrival Date: Contact Date: Final to Owner: Payer: Claim Paid: Policy No: 040105005293064 Claim Number: 080015000320-6600101 Deductible: 250,00 File Number: None Insured: ROBERT ETTER Claimant: Address: Telephone: Owner: ROBERT ETTER 130 SERRA DR VALLEJO, CA 94590- Home Phone: (707) 644-6004 Mitchell Service: 916777 Description 2001 Nissan Pathfinder LEVehicle Production Date:2/00 Body Style: 4D Ut Drive Train: '3.5L. Inj. 6 Cyt 2WD VIN: JN8DR07X11W502125 License: 4LFU718 CA Mileage: 115,850 OEM/ALT: 0 Search Code: None COlor:BLK Options: Power Sunroof,Automatic Transmission ** SPECIAL PART NOTE: All. parts on this estimate are "NEW" parts (OEM) unless otherwise specified. Parts described,as Rechromed, ESTIMATE RECALL NUMBER: 1/18/2008 10:08:33 080015000320-8600101 UltraMate,is a Trademark of Mitchell International Copyright (C) 1994 - 2005 Mitchell International Mitchell Data Version: JAN_08_A All Rights Reserved Page 1 ,of 7 U1traMate Version: 6.0.028 https://www.emitchell.com/review/ReportPrintSingleEst.asp?PID=MY:4626868 I&Print=l... 6/26/2008 Page 2 of 8 Date: 1/31/2008 12:22:18 pm Estimate ID: 080015000320-8600101 Estimate Version: 2 Supplement: 1 (F) 1/31/2008 12:13:48 PM Profile ID: CUSTOMIZED 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 Dollar Labor CEG Item Number Type Op Description Amount Units Unit 1 AUTO BDY OV FRT BUMPER COVER ASSY 2.5 #2.5 S1 2. 602788 BDY RR FRT BUMPER COVER 188.00 *INC #2.2T 3 AUTO REF RO FRT BUMPER COVER C1.9 1.9 4 602793 BDY RR R FRT BUMPER OPENING COVER 27.55 INC T 5 602797 BDY RR FRT BUMPER REINFORCEMENT BAR . 204.45 INC 2.5T 6 607102 BDY RR R GRILLE FILLER PANEL 58.35 INC #0.3T S1 7 602820 BDY RR R H/LAMP ASSEMBLY 254.06 *0.6 #0.6T 8 AUTO BDY CA HEADLAMPS 0.4 0.4 S1 9 602837 BDY RR R FRT PARK/SIGNAL LAMP ASSEMBLY 86.03 INC #0.2T 10 602845 BDY RR R FOG LAMP ASSEMBLY 128.22 INC #0.3T 11 608528 BDY RI R HOOD WASHER NOZZLE 0.2 #0.2 12 608527 BDY RI L HOOD WASHER NOZZLE 0.2 #0.2 13 604076 BDY RP HOOD PANEL 1.0* 1.2 14 AUTO • REF RO HOOD OUTSIDE C2.6 2.6 15 600141 BDY RI REAR HOOD SEAL 0.2 0.2 16 R&R Time Used in R&I Operation 17 604131 BDY RR R FENDER PANEL 267.02 2.0 #2.2T 18 AUTO REF RO R FENDER OUTSIDE C1;7 2.1 19 AUTO REF RO R FENDER EDGE 0,5 0.5 20 604143 BDY RR R FENDER FRONT LINER 40.33 INC #0.3T 21 602994 REF RO R FRT WHEEL OPENING FLARE C0.9 0.9 22 605325 BDY RP R FENDER WHEEL OPENING FLARE 0.5* 0.4 23 605401 BDY RR R FENDER PROTECTOR 39.83 T 24 604175 BDY RR R UPR FENDER CLIP 2@1.08 2.16 T 25 602311 BDY RR R LWR FENDER CLIP 5@1.12 5.60 T 26 600316 BDY RI FENDER ANTENNA ASSY 1.0 1.0 27 R&R Time Used in R&I Operation S128 600322 BDY RR FENDER ANTENNA BASE 11.12 T S129 600323 BDY RR FENDER ANTENNA NUT 5.98 T ESTIMATE RECALL NUMBER: 1/18/2008 10:08:33 080015000320-8600101 UltraMate is a Trademark of Mitchell International Copyright (C) 1994 - 2005 Mitchell International Mitchell Data Version: JAN_08_A All Rights Reserved Page 2 of 7 UltraMate Version: 6.0.028 https://www.emitchell.com/review/ReportPrintSingleEst.asp?PID=MY:4626868I&Print=l... 6/26/2008 Page 3 of 8 Date: 1/31/2006 12:22:18 pm Estimate ID: 080015000320-8600101 Estimate Version: 2 Supplement: 1 (F) 1/31/2008 12:13:48 PM Profile ID: CUSTOMIZED 30 600335 BDY RP FRONT BODY RADIATOR SUPPORT -S 2.0*#8.4 31 PARTIAL REFINISH ONLY 32 REF RF FRONT BODY RADIATOR SUPPORT -S 0.4* 1.5 33 602210 BDY RR W/SHIELD WASHER RESERVOIR 110.00 0.;2 #0.2T 34 900500 BDY *RP COLOR TINT 0..5* 35 900500 BDY *RR COVER CAR 10.00 *0.0* T 36 900500 BDY *RP COLOR SAND AND POLISH 1`.2* 37 .3 HRS PER PNL 1.5 MAX 38 900500 BDY *RR FLEX ADDITIVE 8.00 *0.0* T 39- 900500 BDY *AD TWO WHEEL ALIGNMENT 75.00 *0.0* 40 DAMAGE RT OVER RT FRT WHEEL 41 601139 REF BL R FRT DOOR OUTSIDE C0.9 2.2 42 608275 BDY RI R FRT BELT MOULDING 0.3 0.3 43 608273 BDY RI R FRT DOOR MIRROR 0.3 #0:8 5144 607766 BDY RR R FRT DOOR MIRROR ASSY 201.12 *INC #0.3T 45 608284 BDY RI R FRT'DOOR TRIM PANEL 'INC 0'.5 46 601236 BDY RI R FRT DOOR HANDLE 0.3 #0.8 47 606394 GLS RI R FRT DOOR MOVEABLE GLASS 0.9 0.9 48 R&R Time'Used in R&I Operation 49 607885 BDY RI R FRT DOOR GLASS RUN INC* 50 R&R Time Used in.,R&I Operation 51 900500 BDY *RI RT FRT DOOR MLDG •0.3* 52 900500 BDY *RR CLEAN & RETAPE TWO SIDED MOULDING/EMBLEM 2.95 *0.2* T 53 936012 AC HAZARDOUS WASTE DISPOSAL 3.00 * 54 AUTO REF AO CLEAR COAT 2.0 55 AUTO AC PAINT/MATERIALS 272.50 * T * - Judgment Item # - Labor Note Applies C - Included in Clear Coat Calc' ESTIMATE RECALL NUMBER: 1/18/2008 10:08:33 080015000320-8600101 U1traMate is a Trademark of Mitchell International Copyright (C) 1994- 2005 Mitchell International Mitchell Data Version: JAN_08_A All Rights Reserved Page 3 of 7 U1traMate Version: 6.0.028 https://www.emitchell.com/review/ReportPrintSingleEst.asp?PID=MY:46268681&Print=l... 6/26/2008 Page 4 of 8 Date: 1/31/2008 12:22:18 pm Estimate ID: 080015000320-8600101 Estimate Version: 2 Supplement: 1 (F) 1/31/2008 12:13:48 PM Profile ID: CUSTOMIZED Recycler Information Section: Prior Damage Remarks Add'1 Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals Body 13.9 65.00 0.00 75.00 978.50 Bdy-S 0.0 '65.00 0.00 0.00 0.00 Refinish 10.9 65.00 0.00 0.00 708.50 Glass 0.9 65.00 0.00 0.00 58.50 Mechanical 0.0 65.00 0.00 0.00 0.00 Frame 0.0 65.00 0.00 0.00 0.00 Taxable Labor Labor Tax @ 0.000 0.00 Non-Taxable Labor Non-Taxable Laborl,745.50 Labor Summary 25.7 1,745.50 II. Part Replacement Summary Amount Taxable Parts 1,650.77 Parts Adjustments 72.09- Glass Adjustments @ 5.000 0.00 Sales Tax @ 7.375 116.43 @ 7.375 Non-Taxable Parts Parts Adjustments 0.00 Glass Adjustments @ 5.000 0.00 ESTIMATE RECALL NUMBER: 1/18/2008 10:08:33 060015000320-8600101 U1traMate is a 'Trademark of Mitchell .International Copyright (C) 1994 - 2005 Mitchell International Mitchell Data Version: JAN_08_A All Rights Reserved Page 4 of 7 U1traMate Version: 6.0.028 https://www.emitchell.com/review/ReportPrintSingleEst.asp?PID=MY:4626868 I&Print=l... 6/26/2008 Page 5 of 8 Date: 1/31/2008 12:22:16 pm Estimate ID: . 080015000320-8600101 Estimate Version: 2 Supplement: 1 (F) 1/31/2008 12:13:48 PM Profile ID: CUSTOMIZED Total Replacement Parts Amount 1,695.11 III. Additional Costs Taxable Costs 272.50 Sales Tax @ 7.375 20.10 Non-Taxable Costs 3.00 Total Additional Costs 295.60 IV. Adjustments Amount Betterment 0.00 Insurance Deductible 250.00 Appearance Allowance 0.00 Related Prior Damage 0.00 Customer Responsibility 250.00- I. Total Labor: 1,745.50 II. Total Replacement Parts: 11695.11 III. Total Additional Costs: 295.60 Gross Total: 3,736.21 IV. Total Adjustments: 250.00- Net Total: 3,486.21 Less Original Net Total: 3,381.23 Net Supplement Amount: 104.98 S1: BOBBY TAYLOR 104.98 Point(s) of Impact Insurance Co: Mercury Insurance Company Address: 11150 International Drive Suite 100 Rancho Cordova, *CA 95670 Telephone: (916) 636-1534 Fax Phone: Body Shop: Address: ESTIMATE RECALL NUMBER: 1/18/2006 10:08:33 060015000320-8600101 U1traMate is a Trademark of Mitchell International Copyright (C) 1994 - 2005 Mitchell International Mitchell Data Version: JAN 08_A All Rights •,Reserved Page 5 of 7 U1traMate Version: 6.0.028 a https://www.emitchell.com/review/ReportPrintSingleEst.asp?PID=MY:46268681&Print=l.i. 6/26/2008 Page 6 of 8 Date: 1/31/2008 12:22:18 pm Estimate ID: 080015000320-8600101 Estimate Version: 2 Supplement: , 1 (F) 1/31/2008 12:13:48 PM Profile ID: CUSTOMIZED Telephone: Fax Phone: State Lic. No: Cycle Time Information Drop Off Date: Repair Dates: " Promise Date: Start Date: Pick Up Date: `Completion Date: Is Vehicle Driveable (Y/N)?: Assisted With Rental (Y/N)?: ' Inspection Site: None Address: Inspection Date: THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACUTRER OR DISTRIBUTOR OF THE PARTS, RANTHER THANBY THE ORIGINAL MANUFACTURER OF YOUR VEHILCE. Date vehicle driven/towed in?. . . . . Date vehicle was inspected. . . . . . . . Number of photos. . . .. . . . . . . . . . . . . . Number of days to repair. . . . . . . . . . Closing type (repairable or Total) . . . Send check to facility (yes or no) . . . LKQ parts available (yes or no) . . . . . . . ESTIMATE RECALL NUMBER: 1/18/2008 10:06:33 080015000320-8600101 U1traMate is a Trademark.of Mitchell International Copyright (C)11994 - 2005 Mitchell International Mitchell Data Version: JAN_08_A All Rights Reserved Page 6 of 7 U1traMate Version: 6.0.028 https://www.emitchell.com/review/ReportPrintSingleEst.asp?PID=MY:46268681&Print=l... 6/26/2008 Page 7 of 8 Date: 1/31/2008 12:22:18 pm Estimate ID: 080015000320-8600101 Estimate Version: 2 Supplement: 1 (F) 1/31/2008 12:13:48 PM Profile ID: CUSTOMIZED Source. . . . . Phone and reference. . . .. This estimate has been re-calculated with a modified profile. ESTIMATE RECALL NUMBER: 1/18/200,8 10:08:33 080015000320-8600101 U1traMate is a Trademark,of Mitchell International Copyright (C) 1994 - 2005 Mitchell International Mitchell Data Version: JAN_08_A All Rights Reserved Page 7 of 7 U1traMate Version: 6.0.028 https://www.emitchell.com/review/ReportPrintSingleEst.asp?PID=MY:46268681&Print=1... 6/26/2008 Page 8 of 8 y https://www.emitchell.com/revieW/ReportPrintSingleEst.asp?PID=MY:46268681&Print=l... 6/26/2008 Pagel of 8 Date: 1/18/2008 10:08:36 am Estimate ID: 080015000320-8600101 Estimate Version: 0 Committed Profile ID: CUSTOMIZED Solano Collision Inc 3267 SONOMA BLVD, VALLEJO, CA 94591 (707) 644-4044 Fax: (707) 644-4045 Tax ID: 48-1299380 BAR #: AF226086 EPA #: CAL000280088 Damage Assessed By BOBBY TAYLOR Appraised For: Condition Code: Fair Type of Loss: Date of Loss: 1/16/2008 Arrival Date: Contact Date: Final to Owner: Payer: Claim Paid: Policy No: 040105005293064 Claim Number: 080015000320-8600101 Deductible: 250.00 File Number: None Insured: ROBERT ETTER Claimant: Address: Telephone: Owner: ROBERT ETTER 130, SERRA DR VALLEJO, ,CA 94590- Home Phone:'(707) 644-6004 Mitchell Service: 916777 Description 2001 Nissan Pathfinder LEVehicle Production Date:2/00 Body Style: 4D Ut Drive Train: 3.5L Inj 6 Cyl '2WD VIN: JN8DR07X11W502125 License: 4LFU718 CA Mileage: 115,850 OEM/ALT: O Search.Code: None Color:BLK Options: Power Sunroof,Automatic Transmission ** SPECIAL PART NOTE: All parts on this estimate are "NEW" parts (OEM) unless otherwise specified. Parts described as Rechromed, ESTIMATE RECALL NUMBER: 1/18/2008 10:06:33 080015000320-8600101` U1traMate is a Trademark .of Mitchell International Copyright (C) 1994 - 2005 Mitchell International Mitchell Data Version: DEC_07 A All Rights Reserved Page 1 of 7 U1traMate Version: 6.0.028 https://www.emitchell.com/review/ReportPrintSingleEst.asp?PID=MY:4626868 I&Print=.L. 6/26/2008 Page 2 of 8 Date: 1/18/2008 10:08:36 am Estimate ID: 080015000320-8600101 Estimate Version: 0 Committed Profile ID: CUSTOMIZED 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 Dollar Labor CEG Item Number Type Op Description Amount Units Unit 1 AUTO BDY OV FRT BUMPER COVER ASSY 2.5 #2.5 2 602788 BDY RR FRT BUMPER COVER 195.00 *INC #2.2T 3 AUTO REF RO FRT BUMPER COVER, C1.9 1.9 4 602793 BDY RR R FRT BUMPER OPENING COVER 27.55 INC T 5 602797 BDY RR FRT BUMPER REINFORCEMENT BAR 204.45 INC 2.5T 6 607.102 BDY RR R GRILLE FILLER PANEL 58.35 INC #0.3T 7 602820 BDY RR R H/LAMP ASSEMBLY 180.00 Q*0.6 #0.6T 8 AUTO BDY CA HEADLAMPS 0.4 0.4 9 602837 BDY RR R FRT PARK/SIGNAL LAMP ASSEMBLY 45.00 Q*INC #0.2T 10 602845 BDY RR R FOG LAMP ASSEMBLY 128.22 INC #0.3T 11 608528 BDY RI R HOOD WASHER NOZZLE 0.2 #0.2 12 608527 BDY RI L HOOD WASHER NOZZLE 0.2 #0.2 13 -604076 BDY RP HOOD PANEL 1.0* 1.2 14 AUTO REF RO HOOD OUTSIDE C2.6 2.6 15 600141 BDY RI REAR HOOD SEAL 0.2 0.2 16 R&R Time Used in.R&I Operation 17 604131 BDY RR R FENDER 'PANEL 267.02 2.0 #2.2T 18 AUTO REF RO R FENDER OUTSIDE C1.7 2.1 19 AUTO REF RO R FENDER EDGE 0.5 0.5 20 604143 BDY RR R FENDER FRONT LINER 40.33 INC #0.3T 21 602994 REF RO R FRT WHEEL OPENING FLARE C0.9 0.9 22 605325 BDY RP R FENDER WHEEL OPENING FLARE 0.5* 0.4 23 605401 BDY RR R FENDER PROTECTOR 39.83 T 24 604175 BDY RR R UPR FENDER CLIP 2@1.08 2.16 T 25 602311 BDY RR R LWR FENDER CLIP 5@1.12 5.60 T 26 600316 BDY RI FENDER ANTENNA ASSY 1.0 1.0 27 R&R Time Used in R&I Operation 28 600335 BDY RP FRONT BODY RADIATOR SUPPORT -S 2.0*#8.4 29 PARTIAL REFINISH ONLY ESTIMATE RECALL NUMBER: 1/18/2006 10:08:33 080015000320-8600101 UltraMate is a,Trademark of Mitchell International Copyright (C) 1994 - 2005 Mitchell International Mitchell Data Version: DEC_07_A All Rights Reserved Page 2 of 7 UltraMate Version: 6.0.028 https://www.emitchell.com/review/ReportPrintSingleEst.asp?PID=MY:46268681&Print=l... 6/26/2008 'Page 3 of 8 Date: 1/18/2008 10;08:36 am Estimate ID: 080015000320-8600101 Estimate Version: 0 Committed Profile ID: CUSTOMIZED 30 REF RF FRONT BODY RADIATOR SUPPORT -S 0.4* 1.5 31 602210 BDY RR W/SHIELD WASHER RESERVOIR 110.00 0.2 #0.2T 32 900500 BDY *RP COLOR TINT 0.5* 33 900500 BDY *RR COVER CAR 10.00 *0.0* T 34 900500 BDY *RP COLOR SAND AND POLISH 1.2* 35 .3 HRS PER PNL 1.,5 MAX 36 900500 BDY *RR FLEX ADDITIVE 8.00 *0.0* T 37 900500 BDY *AD TWO WHEEL ALIGNMENT 75.00 *0.0* 38 DAMAGE RT OVER RT FRT WHEEL 39 601139 REF BL R FRT DOOR OUTSIDE C0.9 2.2 40 608275 BDY RI R FRT BELT MOULDING 0.3 0.3 41 608273 BDY RI R FRT DOOR MIRROR 0.3 #0.8 42 607766 BDY RR R FRT DOOR MIRROR ASSY 211.18 INC #0.3T 43 608284 BDY RI R FRT DOOR TRIM PANEL INC 0.5 44 601236 BDY RI R FRT DOOR HANDLE 0.3 #0.8 45 606394 GLS RI R FRT DOOR MOVEABLE GLASS 0.9 0.9 46 R&R Time Used in R&I Operation 47 607885 'BDY RI R FRT DOOR GLASS RUN INC* 48 R&R Time Used in R&I Operation 49 900500 BDY *RI RT FRT DOOR MLDG 0.3* 50 900500 BDY *RR CLEAN & RETAPE TWO SIDED MOULDING/EMBLEM. 2.95 *0.2* T 51 936012 AC HAZARDOUS WASTE DISPOSAL 3.00 * 52 AUTO REF AO CLEAR COAT 2.0 53 AUTO AC PAINT/MATERIALS 272.50 * T * - Judgment Item # - Labor Note Applies Q - Quality Replacement Part C - Included in Clear Coat Calc ESTIMATE RECALL NUMBER: 1/18/2008 10:06:33 080015000320-8600101 U1traMate is a Trademark of Mitchell International Copyright (C) 1994 - 2005 Mitchell International Mitchell Data Version: DEC_07_A All Rights Reserved Page 3 of 7 U1traMate Version: 6.0.028 https://www.emitchell.com/review/ReportPrintSingleEst.asp?PID=MYA626868I&Print=I... 6/26/2008 Page 4 of 8 Date: 1/18/2008 10:08:36 am Estimate ID: 080015000320-8600101 Estimate Version: 0 Committed .Profile ID: CUSTOMIZED Recycler Information Section: . Prior Damage Remarks Add'1 Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals Body 13.9 65.00 0.00 75.00 978.50 Bdy-S 0.0 65.00 0.00 0.00 0.00 Refinish 10.9 65.00 0.00 0.00 708.50 Glass 0.9 65.00 0.00 0.00 58.50 ,Mechanical 0.0 65.00 0.00 0.00 0.00 Frame 0.0 65.00 0.00 0.00 0.00 Taxable Labor Labor Tax @ 0.000 0.00 Non-Taxable Labor Non-Taxable Laborl,745.50 Labor Summary 25:7- 1,745.50 II. Part Replacement Summary Amount Taxable Parts 1,535.64 Parts Adjustments 54.73- Glass Adjustments @ 5.000 0.00 Sales Tax @ 7.375 10'9.22 @ 7.375 Non-Taxable Parts Parts Adjustments 0.00 Glass Adjustments @ 5.000 0.00 Total Replacement Parts Amount 1,590.13 ESTIMATE RECALL NUMBER: 1/18/2008 10:08:33 080015000320-8600101 UltraMate is a Trademark of Mitchell .International Copyright (0) '1994 - 2005, Mitchell International Mitchell Data Version: DEC_07_A All Rights Reserved Page 4 of 7 UltraMate version: 6.0:028 https://www.emitchell.com/review/ReportPrintSingleEst.asp?PID=MY:4626868I&Print=I... 6/26/2008 Page 5 of 8 Date: 1/18/2008 10:08:36 am Estimate ID: 080615000320-6600101 Estimate Version: 0 Committed Profile ID: " CUSTOMIZED III. Additional Costs Taxable Costs 272.50 Sales Tax @ 7.375 20.10 Non-Taxable Costs 3.00 Total Additional Costs 295.60 IV. Adjustments Amount Betterment 0.00 Insurance Deductible 250.00 Appearance Allowance, 0.00 Related Prior Damage 0.00 Customer Responsibility 250.b0 I, Total Labor: 1,745.50 II. Total Replacement Parts: 1,590.13 ' III. Total Additional Costs: 295.60 Gross Total: 3,631.23 IV. Total Adjustments: 250.00- r Net Total: 3,381.23 Point(s) of Impact Insurance Co: Mercury Insurance Company Address: 11150 International Drive Suite 100 Rancho Cordova, CA 95670 Telephone: (916) 636-1534 Fax Phone: Body Shop: Address: Telephone: Fax Phone: State Lic. No: Cycle Time Information ESTIMATE RECALL NUMBER: 1/18/2008 10:08:33 080015000320-8600101 UltraMate is a Trademark of Mitchell International Copyright (C) 1994 - 2005 Mitchell International Mitchell Data Version: DEC_07_A All Rights Reserved Page 5 of 7 UltraMate Version: 6.0,.028 hnps://www.emitchell.com/review/ReportPrintSingleEst.asp?PID=MY:46268681&Print=l... 6/26/2008 Page 6 of 8 Date:` 1/18/2008 10:08:36 am Estimate ID: 080015000320-8600101 Estimate Version: 0 Committed Profile ID: CUSTOMIZED Drop Off Date: Repair Dates: Promise Date: Start Date: Pick Up Date: Completion Date: Is Vehicle Driveable (Y/N)?: Assisted With Rental (Y/N)?: Inspection Site: None Address: Inspection Date: THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER,OF YOUR MOTOR VEHICLE. ANY WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACUTRER OR DISTRIBUTOR OF THE PARTS, RANTHER THANBY THE ORIGINAL MANUFACTURER OF YOUR VEHILCE. Date vehicle driven/towed in?. . . . . Date vehicle was inspected. . . . . . . . Number of photos. . . . . . . . . . . . . . . . . . Number of days to repair. . . . . . . . . . Closing type (repairable or Total) . . . Send check to facility (yes or no) : . . LKQ parts available (yes or no) . . . . . . Source. . . . . Phone and reference. . . . . ESTIMATE RECALL NUMBER: 1/18/2008 10:08:33 080015000320-8600101 U1traMate is a Trademark of Mitchell International Copyright (C) 1994 - 2005 Mitchell International Mitchell Data Version: DEC_07_A All Rights. Reserved Page 6 of 7 UltraMate Version: 6.0.028 https://www.emitchell.com/review/ReportPrintSingleEst.asp?PID=MY:46268681&Print=L. 6/26/2008 Page 7 of 8 Date: 1/18/2008 10:08:36 am Estimate ID: 080015000320-8600101 Estimate Version: 0 Committed Profile ID: CUSTOMIZED ESTIMATE RECALL NUMBER: 1/18/2008 10:08:33 080015000320-8600101 U1traMate is a Trademark of Mitchell International Copyright (C) 1994 - 2005 Mitchell International Mitchell Data Version: DEC_07_A All Rights Reserved Page . 7 of 7 U1traMate Version: 6.0.028 https://www.emitchell.com/review/ReportPrintSingleEst.asp?PID=MY:46268681&Print=l,... 6/26/2008 Page 8 of 8 https://www.emitchell.com/review/ReportPrintSingleEst.asp?PID=MY-4626868 I&Print=I... 6/26/2008 Claim#080015000320-8600101 Owner: ETTER,ROBERT Page 1 of 6 �.-�n � r w �zev https://www.emitchell.com/review/REVMOD7PRINTIMAGES.asp?PrintXMLPID=2240... 6/26/2008 Claim# 080015000320-8600101 Owner: ETTER,ROBERT Page 2 of 6 7� yx r https://www.einitchell.com/review/REVMOD7PRINTIMAGES.asp?PrintXMLPID=2240... 6/26/2008 Claim#080015000320-8600101 Owner: ETTER,ROBERT Page 3 of 6 w sig N- 4 .._ .. ..... ,....N,y.Via., .. x q https://www.emitchell.coin/review/REVMOD7PRINTIMAGES.asp?PrintXMLPID=2240... 6/26/2008 Claim#080015000320-8600101 Owner: ETTER,ROBERT Page 4 of 6 ig r.;;g-jai r yt.:: .,�-• ;,� r ;, r t�Y:�+�y'ft`s.. Y: k y 4�9 https://www.emitchell.com/revieW/REVMOD7PRINTIMAGES.asp?PrintXMLPID=2240... 6/26/2008 Chaim • 080015000320-8600101 •wner: ETTER,ROBERT Page 5 of• - Vit--- - https://www.emitchell.com/review/REVMOD7PRINTIMAGES.asp?PrintXMLPID=2240... 6/26/2008 -• P �w F� Claim # 080015000320-8600101 Owner: ETTER,ROBERT Page 6 of 6 httos://www.emitchell.com/review/REVMOD IPRINTIMAGES.asp?PrintXMLPID=2240... 6/26/2008 � CLAIM HOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: AUGUST 12., 2008 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 ) 11he 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), JUL Q 7 2008 given Pursuant to Government Code AMOUNT:- $503,000.00 COUNTYCrOUNSEL Section 913 and 915.4. Please note all MARTINEZ CALIF. "Warnings". - CLAIMANT: LEONA THOMPSON ATTORNEY: STEVEN. R. CLAWSON DATE RECEIVED: JULY 07, 2008 WELLS, CALL, CLARK, .BENNETT ADDRESS: AND CLAWSON BY DELIVERY TO CLERK ON: JULY 07, 2008 620 GREAT JONES STREET, FAIRFIELD, CA .94533 HAND DELIVERED BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, Dated: JULY 07 , 2008 By: Deputy II. FROM.: .County Counsel TO: Clerk of the Board of pervisors (0/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 isnot 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 1.11. FROM: 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. ARD 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. Dateca /.2 ?�4KHN CULLEN, CLERK,,By Deputy Clerk WARM. (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 ii1oil to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of per jury that .i. am now, and at all times herein mentioned, have been a citizen of the United States, over age 1.8; and that today1 deposited en the United States Postal Service in [Martinez, California, postage ,fully prepaid a certified copy of,this Board Order and Notice to Claimant, addressed to the claimant as shown,above. DatedA-7 Z"cPJOHN CULLEN, CLERK By eputy Clerk O2/21/200;6 16:39 CONTRA COSTA COUNTY CLERK OF THE 91717425^x785 N0.815 991 s BOARD 00UPERV7SGRS OF.CONTRA COST RUNTY 'rNSTRUCTIONS 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 accraal 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 govemed by the Board of Supervisors, rather tl= 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 fortn.' RE: Claim By: Reserved for Clerk's filing stamp Leona _Th=,9on Jo Against the County of Contra Costa or ' ) CD�RD�FSUp District) CST FRV/S (Fill in the name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ 50,.000.00 and in support of this claim represents as follows: 1. When did the damage or injury,occur? (Give exact date and hour) January 8, 2008 - discovered May 13, 2008, 2. Where did the damage or injury occur? (Include city and county) Richmond Dental Clinic, 100 38th Street, Richmond; Contra Costa County, California. 3. How did the damage or injury occur? (Give full details; use extra paper if required) See Attachment A 4. What panieular act or omission on the part of county or district officers, servants, or employees caused the injury or damage) See Attachment A 5 What are the names of county or district officers, servants,or employees causing the damage or injury) Dr. Yee at the .Richmond Dental Clinic. 02i21i2Y26 16:39 CONTRA' COSTA COUNTY CLERK OF THE 917074 765 NO.815 UO2. 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach rwo estimates for auto damage.) See Attachment A i - 7. How was the amount claimed above computed? (Include.the estimated;.arnc unt of any prospective injury or damage.) -Damages are above the jurisdictional limit and based on dental bills, future dental expenses, pain and suffering. S. Names and addresses of witnesses, doctors, and hospitals: E,,atv,7gom4,qSoti� �. Y � 1Nvh�f21(n,:) w► p�►cn� Yl�S/�OMSE�. ��S fld5?rw L SEa nAQ-D� S;�� 1q r , lc:.vILS�NTfiC 2iu(tMoN7 Ue�.s-rArLGtu,c+c 9. List the expenditures you made on account of this accident'or injury: DATE TIME AMOUNT �JN�r�owl-� AJj CotiriQulNU- - ,vQ�50�c71u.►J l��\ . /,,J !i-e— 5--V&rzuX_ (_0U4T1 ■■aarraasasars�sa■aaaaarr■■■.■•�aa�aaaar�rarr■■��■.�..■s�araaaaaaarrrr.■saaraaa�aaaa� Gov. Code Sec. 910.2 provides "The claim shall be )signed by the claimant or by some person on his }behalf." SEND NOTICES TQ- (Attorney) l Name and address of'Attomey Steven °R. Clawson ) Wells, Call, Clark, Bennett (C1 mant's Signature) and Clawson ) 620 Great Jones Street ) 6814 DelMonte Avenue . Fairfield, Cis 94533 ) (Address) jRichmond, CA 94805 Telephone No, 707-426-5300 )Telephone No. raaaraaarrarr■�aaaa•roar.■■■■■aaraaaa�arr■r■r■-ups Maaaaaaaaarar■■maspepasit aalaaaarh■. PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the Counry,under the Tort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code, §§ 6540 et seq.) Furthermore, any I attachments, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■•ss■6482ssoMrsssssssoma son prsissass■••arrr•s■s■5sssssas•s■s@Msrr■■■■■■ssassssstele aI 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. L a ' 0 ATTACHMENT A3. Dental malpractice on the part of Dr. Yee, DDS at the Richmond Dental Clinic. Dr. Yee failed to give proper advice, notices and informed consent of the procedures; Dr. Yee failed to diagnose, treat and properly treat the periapical lesions that required root canals on teeth 47 and 49; Dr. Yee failed to diagnose, treat and properly treat fractures to the enamel of teeth 48,and #10; Dr. Yee failed to properly diagnose, treat and extract tooth #29; Dr. Yee improperly and partially extracted a,tooth and negligently left the roots embedded in the gums; Dr. Yee improperly diagnosed, treated and extracted her teeth that were not in need of extraction and left teeth in that were in need of extraction; Dr. Yee improperly medicated the Claimant causing seizures, ambulance and emergency treatment at Doctor's Medical Center in San Pablo; Dr. Yee improperly made and formed an upper stayplate and a lower partial. In all of the above acts Dr. Yee negligently, and carelessly practiced dentistry causing and necessitating a considerable amount of additional dental work and putting Claimant in severe pain and suffering, and causing the damages and injuries herein alleged. The County of Contra Costa negligently, carelessly and improperly taught, trained, oversaw, tested, supervised, equipped, managed and instructed its dentists and employees in proper and safe dentistry procedures, including but not limited to, X-ray reading, tooth extraction, anesthesiology, root canal, teeth fractures, creation of partials and stayplate. ATTACHMENT A4 See Attachment A3 above. ATTACHMENT A6 Claimant had two teeth (#7 and#9) with periapical lesions that required root canals and two teeth (#8 and #10) with fractures in the enamel. Claimant also needed tooth#29 extracted and her upper stayplate had a crack in it. Tooth 929 had to be extracted and the fractures on 48 and #10 were repaired along with the upper stayplate. Root canals are scheduled for teeth#7 and #9. When the roots were left in following an extraction, along with Dr. Yee's failure to diagnose and treat the fractures and decaying teeth, Claimant was in severe pain which required additional treatment and associated medication and pain relief. With regard to the failure to properly anaesthetize, Claimant was put into a seizure and was required to be taken via ambulance for emergency services. WELLS, CALL, CLARK, BENNETT & CLAWSON A PROFESSIONAL CORPORATION - ATTORNEYS AT LAW R. DAYTON CALL 620 GREAT JONES STREET E. GORDON WELLS, JR. THOMAS C. CLARK RETIRED SCOTT, R. BENNETT FAIRFIELD. CALIFORNIA 94533 STEVEN R. CLAW SON }` TELEPHONE 707/426-5300 FAX 707/425-7785 July 3, 2008 RE IVJD THIS IS NOT A y'LAIM p "� Clerk of the Board of Supervisors a ER,<aoaR�of s County Administration Building corarRt�co 651 Pine Street,'Froom 106 Martinez, CA 941553 Re: Oilar Client: Leona Thompson D._;ie of Accident: January 8, 2008 Dear Sir or Mada, This law f�:m has been retained by Leona Thompson to represent her interests in connection with an injury acc;�Ient that occurred at the Richmond Dental Clinic,Richmond,California on January 8,1 2008. Our invesi, ation indicates that this accident occurred as a result of your negligence, and you are therefore, lego ly responsible for all damages sustained by my client. Please ad,t"se this office of the name and address of your insurance carrier, or-have your insurance agent o]".adjuster contact me. In any eve-fit, if we do not hear from you or your representative within ten days from the date of this letter, we shall have no alternative but to institute all appropriate legal proceedings against you in order to protect' the rights of our client. Very truly yours, -;VEL S, CALL, CLARK BENN 1 T& CLAWSON STEVEN R. CL WSON SRC/kks CO o c, m �q 0 cow Q a OrU. %o w 031Mn o r3 AP O '10 a U � H � � w to as W CLAIM BOARD OF SUPERVISO.RS OF CONTRA COSTA COUNTY BOARD ACTION: AUGUST 12, 2008 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 ) ke copy of this document mailed to California Government Codesyou is your notice of the action taken on.your claim.by the Board of Supervisors. (Paragraph IV below), JUL T 2008 Q given Pursuant to Government Code` AMOUNT: 6, 000. 0.0 COUNTY COUNSEL Section 913 and 915.4. Please note all MARTINEZ CALIF. "Warnings" CLAIMANT: TAI SHA GATLIN NEWMAN ATTORNEY: KAT SIEFFRIED DATE RECEIVED: JULY 10, . 2008 BAY .AREA LEGAL AID JULYI10 2008 ADDRESS: CCC REGIONAL OFFICE BY DELIVERY TO CLERK ON: 1025 MACDONALD AVE. P.O. BOX 22.89. BY.MAIL POSTMARKED: HAND DELIVERED RICHMOND, CA 94802 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached.is.a copy of the above-noted claim. JOHN CULLEN, C k Dated:. JULY 10; 2008 By: Deputy i.I. FROM.: County Counsel TO: Clerk of the Board of SupKrvisori O 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 fol- 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerkshould 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 III. FROM: 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. 50ARD 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. Dane �-&v OHN CULLEN, CLERK; By Deputy Clerk WARN1. (Gov. code section 913). Subject to certain exceptions,you have only six(6) monthsTrom 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 choicein connection with this.matter. If you want to consult an attorney,you should do so immediately. *For Additiaial Wariiing See Reverse Side ofThis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that .[ am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today 1 deposited in the United States Postal Service in Martinez, California, Hostage fully prepaid a certified copy of.this Board Order and Notice to Claimant, addressed to the claimant as shown above. Date wed 1A JOHN CULLEN, CLERK By Deputy Clerk, OFFICE OF THE COUNTY COUNSEL SILVANO B. MARCHESI COUNTY OF CONTRA COSTA �'�'��- O� COUNTY COUNSEL Juvenile Division SHARON L. ANDERSON P.O.Box 69 *�_ _= _• CHIEF ASSISTANT Martinez, California 94553-0116 _ , GREGORY C. HARVEY (925) 335-1830 p; _ :> i11r11y :.. VALERIE (925) 646-2461 (fax) ASSISTANTS •ti ODSrA,COUP NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM July 15, 2008 TO: Kat Siefried Bay Area Legal Aid CCC Regional Office 1025 MacDonald Avenue P.O. Box 2289 Richmond, CA 94802 RE: CLAIM OF TAISHA GATLIN NEWMAN Please Take Notice as Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910.2, or is otherwise insufficient for the reasons checked below: [ ] 1. The claim fails to state the name and post office address of the claimant. [ ]'2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [X]3. The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [ ] 4. The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. [ ] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. [ ] 6. The claim is not signed by the claimant or by some person on his or her behalf. Kat Sieffried Re: Claim of Taisha Gatlin Newman July 15, 2008 Page Two [ ] 7. You are required to submit your claim on the proper form, which is enclosed. Please resubmit your claim on the enclosed form, including all the required information. Gov. Code, § 910.4. Please be aware that you have only a limited period of time in which to file an amended claim. See Gov. Code, § 910.6. [X] 8. Other: Please provide dates claims began. SILVANO B. MARCHESI COUNTY COUNSEL ,r By: V4, Monika L. Cooper Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (Code Civ. Proc., §§ 1012, 1013a, 2015.5; Evid. Code, §§ 641, 664) I am a resident of the State of California, over the age of eighteen years, and not a party to the within action. My business address is Office of the County Counsel, 651 Pine Street, 9th Floor,Martinez, CA 94553-1229. On July 15,2008,I served a true copy of this Notice of Insufficiency and/or Non-Acceptance of Claim by placing the document in a sealed envelope with postage thereon fully prepaid, in the United States mail at Martinez, California addressed to Kat Sieffried,Bay Area Legal Aid, CCC Regional Office, 1025 MacDonald Avenue, P.O. Box 2289, Richmond, CA 94802, as set forth above. I am readily familiar with Office of County Counsel's practice of collection and processing of correspondence for mailing. Under that practice, it would be deposited with the U.S. Postal Service on that same day with postage thereon fully prepaid in the ordinary course of business. I declare under penalty of perjury under theelaws of the State of California and the United States of America that the above is true and correct. Executed on ��' at 'nez, California. Enclosure cc: Clerk of the Board of Supervisors (original) Risk Management 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.- ■aaaaaamamaaaaaaaaaaamaasaaoamamaaeaaaaaamamaaaaaaaeaaaaaeeeeeeeeeaeaaaaaoaaaal RE: Claim By: Reserved for Clerk's filing stamp Against the County of Contra Costa or ) �� 1 J ?OOg , ) CIERBD District) Cpl RDpFRDpFa (Fill in the name) ) T4 co. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$'( ---- and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 1: e,4 c' ��-- 2. Where did the damage or injury occur? (Include city and county) een��' 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? .1,,,7,c f , ,J ?Gc.L f S r � , ��r✓��s �t,�� 5 What are the names of county or district officers,-servants;or employees causing the damage or injury? u�/ ilk - 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) Gam. 7. How was the amount claimed..above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses, doctors, and hospitals: 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT ■.■sr■..■■son rrr■.rar■■0■■r■rr■rrrr■rrrrrrr■a■■.r■■■■■■rrrrrrrrrrrrrrrrra .rrrrrrrrrr1 ) 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 I&Zl-� ate e A,l ) (Claimant's Signature) /0 2 ddress) C CIO 74 1,�'a-AeIepho e No. _ goo 233-'i%S`� ) Telephone No. s - ,�nr ..:.L.......................r......rrrr..rr.......rrrr.rrr.r.rr...r...now:...rrrrrrri 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, 5§ 6500 et seq.) Furthermore, any attachments;addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. son■■r■■r■■rrr■■r■■■■r■■rrrr■■r■■rrrrrrrr■■■■rrr■■r■■■■rrrrr�rrrrrr.rr.r� �.rrr�rrrrr� 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. it - [By Certified U.S. Mail] [Via Hand Delivery] Stephen L.Weir County Clerk-Recorder P.O. Box 350, - Martinez, CA. 94553 (street•address: Clerk-Recorder's Office 555 Escobar,St., Martinez, CA. 94553) June 4, 20,08 Dear Mr. Weir, .I am'submitting this elaim in compliance with California Tort Claims Act & California Government Code &§ 810-996.6: My name`is Taisha Gatlin-Newman (DOB 11/23/1976), and my mailing address is 149. W. Gertrude Ave,Richmond,•California 94801. General Description of the Incident Causing Injury and Loss: Sometime early this year, after I applied for cash aid, food,stamps'and child care,, _ assistance,Welfare:Fraud Field Investigator Roberta Haynes began an investigation of my case. In the course of this investigation, Ms. Haynes has harassed.me, my family, my neighbors, and myemployers. She-has also revealed the nature`of her investigation to third parties in violation of confidentiality'rules and said degrading things about me. Finally,even though the investigation has not resulted in prosecution or termination,for fraud, Ms. Haynes has interfered with my ability to get charity assistance with my security deposit. I have had to seek mental health services because of her outrageous conduct.. Ms. Haynes' behavior has caused me personal injury, emotional distress, injury to my reutation and other.'losses: If litigated, my claim amounts'to an unlimited civil case in p g the`Superior`Court of California. Please contact ine at (707).712-6437 should you like to discuss this`matter. Thank you for,your,time. Sincerely, Taisha Gatlin-Newman;' .. CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: AUGUST 12 2008: ' 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 California Government Codes. " ) ke copy of this document mailed to . • you is your notice of the action taken �� on your claim.by the Board of Supervisors. (Paragraph IV below), v . JUL0.2008 given Pursuant to Government Code OOUNTY COUNSEL Section 913 and 915.4. Please note all A.MOU.NT: 6,000.00 MARTINEZ CALIF "Warnings" CLAIMANT: TAISHA GATLIN NEWMAN t ATTORNEY: KAT SIEFFRIED DATE RECEIVED: JULY 10, . 2008 A AREA'LEGAL "AID ; JULY I1+0, 2`008 ADDRESS:' CCC REGIONAL OFFICE BY DELIVERY TO CLERK-ON 1025''MACDONALD AVE. , P.O. 'BOX 2289 BY MAIL POSTMARKED. HAND '_DELIVERED RICHMOND, CA 94802 FROM: Clerk of the Board of Supervisors. TO; County Counsel Attached is.a copy of the above-noted claim. JOHN CULLEN, C k Dated:' JULY 10 '2008 By: Deputy — If. FROM.: County Counsel TO: Clerk of the Board of Supervisors O This claim complies substantially with Sections 910 and 910.2: . (V),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: �.��1f By T1� ' ti Deputy County Counsel Ill. FROM: Clerk of the Board TO: County Counsel (1), County Administrator(2) O Claim was returned as untimely with notice.to claimant (Section 911.3). LV: ARD 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.' Date2 iib OFiN CULLEN XLERK, By Deputy Clerk WARN1. (Gov. code section 913). Subject to certain exce Aims,you have only six(0 motitits 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 94.5.6.You may seek the advice ol'an attorney of your choice in`connection witlr this:matter. LI•you want to consult an attorney,you should do so immediately. *Eor Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of lierjury tlraf`� ani iiorv; and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today 1 deposited in the United States Postal Service in INIartinez, California, postage fully prepaid a certified copy.of_this Board Order wind Notice'io Claimant, Addressed to the elainian.t as shown, above. ' Date JOHN CULLEN, CLERK By --Deputy Clerk ►?, G OFFICE OF THE COUNTY COUNSEL gEAL SILVANO B. MARCHESI COUNTY OF CONTRA COSTA ,� -�' —'O� COUNTY COUNSEL Juvenile Division P.O.Box 69 , •�« SHARON L. ANDERSON Martinez, California 94553-0116 - _ _ ;r CHIEF ASSISTANT _ 'da GREGORY C. HARVEY (925) 335-1830 cel +„oi1111E`" _r O, F;� ;z VALERIE J. RANCHE (925) 646-2461 .(fax) x: 33 O ASSISTANTS - - Osr`A COUIZt� .NOTICE.-OF INSUFFICIENCY AND/OR . NON-ACCEPTANCE OF CLAIM July 15, 2008 3 TO: Kat Siefried Bay Area Legal Aid CCC Regional Office 1025 MacDonald Avenue P.O. Box 2289 Richmond, CA 94802 RE: CLAIM OF TAISHA GATLIN NEWMAN Please Take Notice as Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with'the requirements of California Government Code Section 910 and 910.2, or is otherwise insufficient for the'reasons checked below: [ ] 1. The claim fails to state the name and post office address of the claimant. [ ] 2. The claim fails to state the post office address to which the person presenting the.claim desires notices,to be sent. [X]3. The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted:: [ ] 4. The claim fails to state the name(s) of the public employee(s) causing the injury; damage, or' loss, if known... [ ] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of presentation,the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. [ ] 6. The claim is not signed.by the claimant or by some person on his or her behalf Kat Sieffried -h Re: Claim of Taisha,Gatliri Newman July 15, 2008 ;K Page Two [ ] 7. '':,You are required.to submit your claim on the proper form, which is enclosed. Please resubmit your claim on the enclosed form, including all the required information. Gov. Code, § 910.4. , Please be aware that-you have only a limited period of time in which to file an amended claim. See Gov. Code, § 910.6. [X] 8. Other: Please provide dates claims began: SILVANO B. MARCHESI COUNTY COUNSEL By; Monika L. Cooper 'Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (Code'Civ. Proc., §§ 1012, 1013a, 2015.5; Evid. Code, §§641, 664) I am a resident of the State of California,over the age of eighteen years, and not a party to.the within action. My business address is Office of the County Counsel, 651 Pine Street, 9th Floor,Martinez, CA 94553-1229. On July 15, 2008, I.served a true copy of this Notice of Insufficiency and/or Non-Acceptance of Claim by placing the. document in a sealed envelope with postage thereon fully prepaid, in the United States mail at Martinez, California addressed to Kat Sieffried,Bay,Area Legal Aid, CCC Regional Office, 1025 MacDonald Avenue, P.O. Box 2289, Richmond, CA 94802, as.set forth above. I am readily familiar with Office of County Counsel's practice of collection and processing of correspondence for mailing.':.Under that practice, it would be deposited with the U.S. Postal Service on that same day with postage thereon fully prepaid in the ordinary course of business. I declare under penalty of perjury under.th 1 ws of the State of California and the United States of America that the above is true and correct. Executed on ,- loaf' at "nez, California. Enclosure cc: Clerk of the Board of Supervisors(original) Risk Management . t