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Home My WebLink AboutMINUTES - 08052008 - C.23 (6) 'R CLAiM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION 2 ffib Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) e,013 copy of E TO CLAIMANT and Board Action. All Section r this document mailed to California Government Codes. MTFI you is your notice of the action taken JUN 2 7 2008 on your claim by the Board of Supervisors. (Paragraph IV below), COUNTY COUNSEL given Pursuant to Government Code MARTINEZ CALIF. Section 913 and 915.4. Please note all AMOUNT:-�ejq,�q "Warnings". CLAIMANT: J ATTORNEY: DATE RECEIVED:d GI. c 261 IXT ADDRESS: f?j.( 2BY DELIVERY TO CLERK ON: CA BY MAIL POSTMARKED:,AXI•c 2b, FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. g ry 2t g' JOHN CULLEN, Glerk Dated: G / By: D e p u t A,[1714AI 1171 At L, 11. FROM.: County Counsel TO: Clerk of the Board of Supervisors (t,KThis claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). O Other: Dated: By: mi Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD 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. Dated: o iKCULLEN, CLERK, By eputy Clerk WARNI.N (Gov. code section 913). Subject to certain exceptions,you have only six(6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of yourchoice in connection wide this matter. If you want to consult an attorney,you should do so immediately. *For Additional Warring See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that .1 am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: �� JOHN CULLEN, CLERK By ,,� Deputy Clerk BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY •� IN ISTRUCTIONS TO CL_kEVIANT 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 uvt later uian 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 naive 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. ■ E■...ae■.aaa■..a■......ts■.■■.ic■te..ee■c■i■■...■ ■aee..e.a�a�e��si��eru RE: Claim By: Reserved for Clerk's filing stamp J P-Q bV�N/i A RECEIVED Against the County of Contra Costa or ) JUN 2' 6 2008 District) CLERK BOARD OF SUPEWSORS (Fill in the name) ) CONTRA COSTA CO. The undersigned claimant heresy u,ak es claim against ,h. County of Contra Costa or the above-named � district in the sum of$ `p1q, Pand in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) -30 VIM , 2. Where did the damage or injury occur? (Include city and county � V,iAS VZQ-*-7WC� 1IV PW' �"lTl�nrsi�u SZ Cxv T 'w�-ctzn)C V� UNO-�w�5 ktitsRIMAY-A �+, f,Jl � c i-�%U e�i�n��sci�. ta,L-D � �S GE NSD 1��P iNTD A k- r ft LC-C�qu��,Jts ky' 'c-C f5k CYC►-i-iAT. t-� B OJ t Pic FOVN J� �. How did the damage or injury occur? (Give full dels;use extra paper if required) - - My a2 loco eV020MC Fly �► ��. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or dama e? A I I-v 9-E: "rU R'\ I1 k -A,� GAPS N&' Hvi-C I tJ t� sfX�" 1 uJ Co Cpu� �� 0� -At �n-rp eAt6.1nl& /.\ AL-vwn► -nr� A�., 0 A �k" M • � -n� 5 7,1hat are the names of county or district officers, servants, or employees causing the iv damage or injury? "'r� �Uvlvi� IN- �1J'le m 1NCit, �l � 0CCU1(1- '1� iS (�ON�A (�O_-�r� Cbun1Tj , exr� of ��-rT5C3t4 6. IWL,ct damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) A-N o Ci"ZbVJ& -E-->\ M 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) � b �� 'p�� 1CS—C Vvl 8. Names and addresses of witnesses, doctors, and hospitals: MN i S ViA &(DLt, 4a-0 V,�TS - Sat 017)tNA► 201"1-Cg32- - A 5. �q�.�) 10��—(p401 1-451-L 9�tp. C�+ List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT i�01 i/�{�t IfiI POP C 1.4 I M TD 136 CD ° ? VACAW 8V "A09 , A1,J-110104-tt-:V AIW04,1, 5S ■ .aes■aaassa■as■a■aaa■aca ■aaaas■aa■asaaa■asssaaaea■■saaaaaaasaasaaaaaaaaaaaaaeaaaa■Be .Gov. Code Sec. 910.2 provides "The claim shall be signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney) Name and address of Attorney ) (Claimant's Signature) IA (Address) 9 z4 Telephone No. ) Telephone No. (k5) 1 :� (Ab ■ a■a■aaeaa■aaaaaasaaaa■saaaa■aa■a■aaaass aasa■■aasaaaaa■amsason aaIsm.aaaanaaamaass aasI 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. ■asa■assaa■a■■sa■aaaBoom aasaaaasaasaasaaasseaaaasaaa■sass■aaaaauasasaasa aassaaaaaaal 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. 1ES SCHWAS * * * * * PRICE QUOTATION * * * * * PRICES GOOD FOR 15 DAYS. Store . . .. . .. . . . . . . 623 LES SCHWAS TIRE CENTER Quote# . . . . . 87059 2160 N Texas St Invoice# . . . Fairfield, CA 94533 3204 Page# . . . . . . 1 707-438-7700 BAR# ARD207191 Customer Name . . . . . Date . . . . . . . 6/17/2008 Address . . . . . . . . . . . Time . . . . . . . 5:44:21 PM City,State, Zip . . . License . . .. Phone . . . . . . . . . . . . . Year . ... . .. Make . . . .... Salesperson .. . . . .. MARIE Model ...... REE ------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------- Product Qty Code Product Description Price FET Amount ALL PARTS NEW UNLESS SPECIFIED 1 08711817 265/35ZR-22 102W PROXES S/T ALL SEASONS BLACKWALL 185.48 185.48 1 00695348 WHEEL SPIN BALANCE 11.25 11.25 1 00000452 22X9.5 F5-70 5-4.5/115MF CHRME 240.97 240.97 1 00000636 FREIGHT 20.00 20.00 4 00695320 CHROME VALVE STEM 6.75 27.00 Sales Tax: 33.44 Tire Tax: 1.75 QUOTATION Total: 519.89 Customer Signature: Estimate Decision: --------------------------------------------------------------------------------------------------------------------- Revised Estimate: In Person Phone#: Customer Signature: Date: Time: Revised Date:9/05 Print Date:4/08 •. - - .. f ° 'x�t rya-;,. kid Y'b ' rr.: '�'•S ayd� iL. Y' t 44 �s�St. 4., � "t i� '+fivaC. > •~ 'V et f'. •IFN' x-_�� 'TV •'♦1"`�: �. •-✓.:�}y _ .6 �,yti .,tet �1... ♦ ri• >l ��,sic .�w 4 W : F 9� III �� •► #,c '�t