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HomeMy WebLinkAboutMINUTES - 08052008 - C.23 (9) CLAIM • BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: AUGUST 05, 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 13The co f this s document marled to California Government Codes. ) you is your notice of the action taken 29097�m on your claim by the Board of Supervisors. (Paragraph IV below), JUL 01 2008 given Pursuant to Government Code AMOUNT: UNKNOWN Section 913 and 915.4. Please note all COUNTY COUNSEL "Warnings". CLAIMANT: JOHN KINCAID MARTINEZ CALIF. ATTORNEY: UNKNOWN DATE RECEIVED: JULY Ol 2008 ADDRESS: 315 DIABLO ROAD #222 BY DELIVERY TO CLERK ON: JULY 01, 2008 DANVILLE, CA 94526 RECEIVED FROM RISK BY MAIL POSTMARKED: MANAGEMF;►yT FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JULY Ol, 2008 JOHN CULLEN, Dated: By: Deputy — *41�7 iI. FROM.: County Counsel TO: Clerk of the Board of Sup &visors (V-�/Tlnis 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: 7-17' Ok By: m� 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). ( ,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: HN CULLEN,CLERK, B Deputy Clerk WARNI. (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 your choice in connection wide this matter. Ifyou want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today i deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: a4tllw�' s6 2Md'OHN CULLEN, CLERK By puty Clerk 06/:7/2008 14: 58 9258382146 JOHN E KINCAID PHD PAGE 02/03 BOARD OF SUPERVISORS OF CONTRA COSTA COTT.Nn INSTRUCTIONS TO CLAII\'I�N 5���'Y7 OpertY or - A. A claim relating to a cause of action fozdeath 5°X mJurY o thso after°the Ito personal�c� o��r a� of growing crops shall be presented not later 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 § 9112) 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. ■ANN g also INA 0 a ,a Is P A w sang WN-any manna Oman now,w w w e w a i w w R R n w f n Pa.wall Igo a w w l RE: Claim By: Reserved for Clerk's filing stamp -...1 o 4 ky' RECEA V E Against the County of Contra Costa or j JUL C 1 2008 District) CLERK BOARD OF SUPERVISORS CON?RA COS i A CO. (Fill in the name) ) The undersign©d claimant hereby makes claim against the County of Contra Costa or the above-named district in the sung of$ and in support of this claim represents as follows! 1. When did the damage or injury occur? (Give exact date and hour) �" a j Z2/ _,?. 06) W 2. Where did the damage or injury occur? (Include city and county) /- 3. How did the damage or m1ury occur? (Give full details;use extra pap�required) , 4. )rJhat particular act or o�nisston on the of cointy or district officers, servants, or emplo ees caused the injury or damage? a,,g r, tr-o­� -- 0, 5 What are the names of county or district officers, servants, or employees causing the damage or injury? G T _ CC T' �., 06/T/2006 15: 00 9258922146 JOHN E KINCAID PHD PAGE 01/01 ■■■ 10 ■ ■ ■�. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damn�-= e.) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage) 8. Names and ad esses of witnesses, doctors, and hospitals: X10, S . �d4,� G-a- -t6 V'�s,�' .2-- 9. List the ex-pmditures you made on account of this accident or injury: DATE TIME AMOUNT ■ t r■1■■1 1 1■■r a■a t■a t ■■■■■ r noun r■a■■a■■■1■a a a■Ism a■■■R sip■■l■[■■1 1■1 a R■■t■R MOWN t t■■■■■ ) .Gov. Code Sec, 910.2 provides "The claim shall be ) signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attomey) Name and address of Attorney (Claimants ignature) )�:)c � f0 L>� -1"- Z22— (Address) le�5- Telephone No. ) Telephone No. y q `2- A WEENEWINWXF AMR■man■ ■t 1■ a■ass■[[a[[[1[[[[[■■ [t r■■l a■■■■r w■■■ r■■r■■t■■■■■ USE ■■■■a■■■1 PUBLIC RECORDS NOTICE-- Please OTICE:Please be advised that this claim form, or any claim filed with the Couuty under the?ort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code, §9 6500 et seq.) Furthermore, any attachments, addendums, or supplements attached to the claim f6im, including medical records, are also subject to public disclosure. a■■R F■[1Ivan a a&a ass a as I a announce a all 1 a a r a t■1Names r■r■■■r R■l■■■■■■■r r ■R an R i■■■■■■f 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 wi 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 impri,soamcat and Erne. 'M 06/.x„7/2008 14:58 9258382146 JOHN E KINCAID PHD PAGE 01/03 Contra County Administrator Costa Risk Management Division CC 2530 Arnold Drive, Suite 140l 1 n�\/ Liability Claims (925)335-1440 Co Martinez.California 94553 County 1 1 r Fax Number (925)335-1421 June 02, 2008 h John Kincaid 214 Still Creek Rd Danville, CA 94506 kc:: ClaiaDant. John Kizacaid Insured: Contra Costa County D/Accident: 05/22/2008 Claim No.: 64971 Dear Mr. Kincaid: The above captioned matter has been referred to my office for investigation and handling on behal£.of the Contra Costa County Department of Sheriff/Coroner. I have enclosed a claim form that must be completed in order to file a formal claim against the County. Be advised that you have six months from the accident date to file a formal claim as stated in the California Government Code beginning with Section 900. This also notifies you that you must comply with the claims presentation and timely suit filing requirements of California law in order to preserve your claim. Our investigation of your claim does not affect your duty to comply with time limits set by law, and by investigating, considering, and discussing your claim with you or your representative, we do not waive our right to assert your failure to comply with those time limits as a comYle*edefense to any claim or action voll may bring. Should you have any questions, please do not hesitate to contact the undersigned. Sincerely, Penny Bailey Liability Claims Adjuster, .(925) 3.35-1455a _.�-�- Enclosure (� G 06/2 /2008 14:58 9258382146 JOHN E KINCAID PHD PAGE 03/03 w ►�V�. 11 T PAINnESS DENT REPAIR ESTIMATE DATE: WRITTEN BY: a7�i-� (� �'3 ' CUSTOMER KROig-5- C n4V� L[_,( C4- 9 -SZG STOCK # OR V.I.N. # BILLING RFENDER YEAR RFD Igo RRD MAKE RR 1/4 LR 1/4 LRD MODEL LFD At" jq rTR NDER COLOR UNK HOOD ROOF OL 15 if fNC� TOTAL Ea irnaje voted for 30 da»From above dote.