HomeMy WebLinkAboutMINUTES - 09162008 - C.23 (15) CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNT
BOARD ACTION: SEPTEMBER 16, 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 ) The copy of this document mailed to
California Government Codes. ) you is your notice of the action taken
on your claim by the Board of .
p �(���(� Supervisors. (Paragraph IV below),
`V' V given Pursuant to Government Code
AMOUNT: $1,037.69 AUG 0 ,q 2008 Section 913 and 915.4. Please note all
"Warnings".
CLAIMANT: LENWOOD LEWIS COUNTY COUNSEL
MARTINEZ CALIF.
ATTORNEY: UNKNOWN DATE RECEIVED: AUGUST 04, 2008
ADDRESS: 5016 WOODMONT WAY, BY DELIVERY TO CLERK ON: AUGUST 04, 2008
ANTIOCH, CA 94531
BY MAIL POSTMARKED: HAND DELIVERED
FROM: Clerk of the Board of Supervisors T0: County Counsel
Attached is a copy of the above-noted claim.
AUGUST 04, 2008 JOHN CULLEN, k
Dated: By: Deputy
1I. FROM: County Counsel TO: Clerk of the Board of Su ervisors
(This claim complies substantially with Sections 910 and 910.2.
( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so
notifying claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should 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:0 By: y /-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: 5"& D
r WWA , CLERK, By Deputy Clerk.
WARNI.ING (Gov. code section 913)
Subject to certain exceptions,you have only six O months from the date this notice was personally served
or deposited in the snail to file a court action on this claim.See Government Code Section 945.6.You stay
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 perjury that I ant now, and at all timesherein 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 claintan.t as shown above.
Dated:� °f'wa DAVID TWA CLERK By ✓ Deputy Clerk
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This warning.does not apply to claims which
are not subject to.the California Tort Claims
Act such as actions in inverse condemnation,
actions for speci:fic,relief'-such.as.mandamus or
injunction, or Federali
_' .ilfTt'i 'Agiclaims. The
abovelistis not exhaustiv,e.,and..legal'11
consultation is essential to understand all the
separate limitations per-io"'ds,th'aVmay apply.
The limitations period 'wi.thin'which suit must
be filed may be shorter or longer depending on
the nature of the claim. Consult the specific
statutes and cases applicable to your particular
claim.
The County of Contra Costa does not waive any
of its rights under California Tort Claims Act
'•;nor-- does it waive rights under the statutes of
limitations applicable to actions not subject to
the California Tort Claims Act
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. A claim relating to a cause of action for death or for injury to person or to personal property or
groiving crops shall be presented not later than six months after the accrual of the cause of
action. A claim relating to any other cause of action shall be.presented not later than one year
after the accrual of the cause of action.
(Gov. Code § 911.2.)
$. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106,
County Administration Building, 651 Pine Street, Martinez,CA 945 53.
C. If claim is against a district governed by the Board of Supervisors, rather than the County, the
name of the District should be filled in.
D. If the claim is against more than one public entity, separate claims must be filed against each.
public entity.
E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form.
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RE: Claim By: Reserved for Clerk's filing stamp
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RECEIVED
Against the County of Contra Costa or ) AUG 0 4 2008
CLERK BOARD OF SUPERVISORS
District) CONTRA COSTA CO.
(Fill in the name) ) r
The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named
district in the sum of$ 4 V and in support of this claim represents as follows:
1. When did the damage or injury occur? (Give exact date and hour)
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2. Where did the damage or injury occur? (Include city and county)
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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? C 0 V�• 4-0 C 0A
5 What are the names of county or district officers, servants, or employees causing the
damage or injury?
'6. VL-at damage or injuries do your claim resulted? (Give full extent of injuries or damages
claimed. Attach two estimates for auto damage.) Ito% 11.,W/,�1EA IJAs ,Vef/i^.o y-e
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
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S. Names and addresses of witnesses, doctors, and hospitals: AJII'
9. List the expenditures you made on account of this accident or injury:
DATE TIME AMOUNT
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) .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) 1
Name and address of Attorney )
}
} (Claimant's Signature)
GJ o oar A4 e-v� GJ� �J
(Address)
jTl0e- C/f C!' X31
Telephone No. ) Telephone No. 7S 3 7
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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.
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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.
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On Tuesday, July 1, 2008, at approximately 10:30pm I was driving westbound on
Highway 4. 1 turned left on Marsh Creek and as I got about 1 mile onto Marsh Creek I
ran over one of the tall orange cones with the rubber bottom which was in my lane. It was
laying on its side and didn't have any reflectors so I couldn't see it until it was too late. It
went under my car destroying my bumper.
Date: 7/22/2008 03:01 PM
Estimate ID: 38319
Estimate Version: 0
Preliminary
Profile ID: Mitchell
JIM'S CALIF. AUTO BODY, INC.
1530 W.10TH STREET,Antioch,CA 94509
(925)754-7600
Fax: (925)754-3614
Tax ID: 94-2227228 BAR#: AH134092 EPA#: CA0983607624
Damage Assessed By: James Maltbie
Deductible: 0.00
Claim Number: 38319
Insured: LENWOOD LEWIS
Owner: LENWOOD LEWIS
Address: 5016 WOODMONT,ANTIOCH,CA 94531
Telephone: Home Phone: (925)753-5466
Mitchell Service: 918623
Description: 2000 Lincoln Town Car Executive
Body Style: 4D Sed Drive Train: 4.6L Inj 8 Cyl 4A
VIN: 1LNHM81W1YY837406 License: IZZL388 CA.
OEM/ALT: O Search Code: None
Color: BLACK
"ALL CRASH PARTS ON THIS ESTIMATE ARE NEW-OEM(ORIGINAL EQUIPMENT
MANUFACTURER) UNLESS OTHERWISE SPECIFIED. PARTS DESCRIBED AS
RECHROMED, RECORED, OR REMANUFACTURED ARE EITHER RECONDITOINED OR
REBUILT. PARTS THAT ARE DESCRIBED AS QUAL REPL PART, AND QRP CAPA,
ARE NON-OEM CRASH PARTS.
Line Entry Labor Line Item PartType/ Dollar Labor
Item Number Type Operation Description Part Number Amount Units
1 800005 BOY REMOVEIREPLACE FRT BUMPER COVER F8VZ 17D957 BA 339.14 2.3 #
2 AUTO REF REFINISH FRT BUMPER COVER C 2.5
3 800013 BDY REMOVE/REPLACE FRT BUMPER LICENSE BRACKET F8VZ 17A385 AA 18.32 INC
4 900500 BDY* REMOVE/REPLACE FLEX ADDITIVE **QUAL REPL PART 8.00 0.0*
5 800014 BDY REMOVUREPLACE R FRT BUMPER COVER MOULDING F8VZ 17K833 BA 34.05 INC #
6 800015 BDY REMOVE/REPLACE L FRT BUMPER COVER MOULDING F8VZ 17K834 BA 33.70 INC #
7 AUTO REF ADD'L OPR CLEAR COAT 1.0*
8 933003 REF ADUL OPR TINT COLOR 0.5*
9 AUTO ADUL COST PAINT 128.00
10 AUTO ADUL COST HAZARDOUS WASTE DISPOSAL 4.00 '
"-Judgment Item
#- Labor Note Applies
C -Included in Clear Coat Calc
ESTIMATE RECALL NUMBER: 07/22/200815:01:41 38319
Mitchell Data Version: OEM: JUN_08_A UltraMate is a Trademark of Mitchell International
Copyright(C)1994-2008 Mitchell International Page 1 of 3
UltraMate Version: 6.5.018 . All Rights Reserved
Date: 7/22/2008 03:01 PM
Estimate ID: 38319
Estimate Version: 0
Preliminary
Profile ID: Mitchell
Estimate Totals
Add'I
Labor Sublet
I. Labor Subtotals Units Rate Amount Amount Totals 11. Part Replacement Summary Amount
Body 2.3 74.00 0.00 0.00 170.20 Taxable Parts 433.21
Refinish 4.0 74.00 0.00 0.00 296.00 Sales Tax @ 8.250% 35.74
Non-Taxable Labor 466.20 Total Replacement Parts Amount 468.95
Labor Summary 6.3 466.20
111. Additional Costs Amount IV. Adjustments Amount
Taxable Costs 128.00 Insurance Deductible 0.00
Sales Tax 0 8.250% 10.56
Customer Responsibility 0.00
Non-Taxable Costs 4.00
Total Additional Costs 142.56
I. Total Labor: 466.20
II. Total Replacement Parts: 468.95
III. Total Additional Costs: 142.56
Gross Total: 1,077.71
IV. Total Adjustments: 0.00
Net Total: 1,077.71
This is a preliminary estimate.
Additional changes to the estimate may be required for the actual repair.
AUTHORIZED AND ACCEPTED: You are hereby authorized to make the above
specified repairs, I understand that payment in full will be due upon
release of vehicle, including additional supplemental damage charges,
and hereby grant you and/or your employees, permission to operate the
car, truck or vehicle herein described on street, highways or
elsewhere for the purpose of testing and/or inspection. An expressed
mechanic's lien is acknowledged on above car, truck or vehicle equal
to the amount of repairs thereto, You will not be responsible for
loss or damage 'to vehicle or articles lost in vehicle in case of fire,
theft, accident or any other cause beyond your control.
ALL OLD/DAMAGED PARTS REMOVED FROM VEHICLE WILL BE DISPOSED OF UNLESS
REQUEST OTHERWISE PRIOR TO REPAIRS.
ESTIMATE RECALL NUMBER: 07/22/200815:01:41 38319
Mitchell Data Version: OEM: JUN_08_A UltraMate is a Trademark of Mitchell International
Copyright(C)1994-2008 Mitchell International Page 2 of 3
UltraMate Version: 6.5.016 All Rights Reserved
Date: 7/22/2008 03:01 PM
Estimate ID: 38319
Estimate Version: 0
Preliminary
Profile ID: Mitchell
REPAIRS AUTHORIZED BY DATE
ESTIMATE RECALL NUMBER: 0712212008 15:01:41 38319
Mitchell Data Version: OEM: JUN-08_A UltraMate is a Trademark of Mitchell International
Copyright(C)1994-2008 Mitchell International Page 3 of 3
UkraMate Version: 6.5.018 All Rights Reserved
+ SFA i
07/22/2008 at 02 : 46 PM T9 Job Number:
31033
ANTIO'CH`..AUTO BODY, INC.
,License #,:•379, 6S'yFederal ID '# : 680336031
1401"•VERNE'Z,ROBERTS CIRCLE
'ANTIOCH":�C
A 94509-7915
(925) 757-:3586 Fax: (925) 757-5246 ;
5`t
PRELIMINARY ESTIMATE
Written By: NICOLETTE BROWN
Adjuster:.
Insured: LENWOOD LEWIS Claim #
Owner: LENWOOD LEWIS Policy #
Address: Deductible:
Date of Loss:
Day: Type of Loss:
Evening: Point of Impact: 12 . Front
Inspect ANTIOCH AUTO BODY, INC. Business: (925) 757-3586
Location: 1401 VERNE ROBERTS CIRCLE
ANTIOCH, CA 94509-7915
Insurance
Company: 2 Days to Repair
2000 LINC TOWN CAR EXECUTIVE 8-4 . 6L-FI 4D SED BLACK Int:
VIN: 1LNHM81W1YY837406 Lic: 1ZZL388 CA Prod Date: Odometer: 408000
Condition: Excellent
Air Conditioning Rear Defogger Tilt Wheel
Cruise Control Intermittent Wipers Climate Control
Keyless Entry Body Side Moldings Dual Mirrors
Traction Control Clear Coat Paint Power Steering
Power Brakes Power Windows Power Locks
Power Driver Seat Power Passenger Seat Power Mirrors
Heated Mirrors AM Radio FM Radio
Stereo Cassette Search/Seek
Anti-Lock Brakes (4) Driver Air Bag Passenger Air Bag
Front Side Impact Air Bag 4 Wheel Disc Brakes Leather Seats
Bucket Seats Automatic Transmission Overdrive
Aluminum/Alloy Wheels
-------------------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
-------------------------------------------------------------------------------
1 FRONT BUMPER
2# Repl FLEX ADDITIVE 1 10 . 00 T
3 0/H front bumper 1 . 8
4* Repl Front Bumper Cover 1 339. 14 Incl . 2 . 8
5 Add for Clear Coat 1 . 1
6 R&I License bracket 0 . 2
7* R&I RT Cover molding bright Incl .
8* R&I LT Cover molding bright Incl .
9# HAZARDOUS WASTE 1 5 . 00 X
10# 'Refn COLOR MATCH 0 . 5
1
)
. r
07/22/2008 at 02 : 46 PM Job Number:
31033
PRELIMINARY ESTIMATE
2000 LINC TOWN CAR EXECUTIVE 8-4 . 6L-FI 4D SED BLACK Int:
-------------------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
-------------------------------------------------------------------------------
-------------------------------------------------------------------------------
Subtotals =_> 354 . 14 2 . 0 4 . 4
Parts 339. 14
Body Labor 2 . 0 hrs @ $ 77 . 00/hr 154 . 00
Paint Labor 4 . 4 hrs @ $ 77 . 00/hr 338 . 80
Paint Supplies 4 . 4 hrs @ $ 34 . 00/hr 149. 60
Sublet/Misc. 15 . 00
----------------------------------------------------
SUBTOTAL $ 996. 54
Sales Tax $ 498 . 74 @ 8 . 2500% 41 . 15
----------------------------------------------------
GRAND TOTAL $ 103"1 . 69
ADJUSTMENTS :
Deductible 0 . 00
----------------------------------------------------
CUSTOMER PAY $ 0 . 00
INSURANCE PAY $ 1037 . 69
FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS
FORM:
ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF
A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN
STATE PRISON.
THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO
DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR
ABBREVIATIONS/SYMBOLS : D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES :
B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT
LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS:
ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE
PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT
PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL
AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION
NO=LINE NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL REPL=QUALITY
REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS
RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE
AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT
W/ =WITH/ SYMBOLS : #=MANUAL LINE ENTRY *=OTHER [IE. .MOTORS DATABASE
INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO
LINE . MQVP=MANUFACTURER' S QUALIFICATION AND VALIDATION PROGRAM. OPT
OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR
OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT . NWCPP=NATIONWIDE CRASH
PARTS PROGRAM.
2
07/22/2008 at 02 : 46 PM Job Number:
31033
PRELIMINARY ESTIMATE
2000 LINC TOWN CAR EXECUTIVE 8-4 . 6L-FI 4D SED BLACK Int:
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from
the Guide DR2KC98, CCC Data Date 06/02/2008, and the parts selected are OEM-parts manufactured by
the vehicles Original Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships.
OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM parts that may be provided by or
through alternate sources other than the OEM vehicle dealerships. OPT OEM or ALT OEM parts may
reflect some specific, special, or unique pricing or discount. OPT OEM or ALT OEM parts may
include "Blemished" parts provided by OEM's through OEM vehicle dealerships. Asterisk (*) or
Double Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have
been modified or may have come from an alternate data source. Tilde sign (-) items indicate MOTOR
Not-Included Labor operations. Non-Original Equipment Manufacturer aftermarket parts are described
as AM, Qual Repl Parts or Comp Repl Parts which stands for Competitive Replacement Parts. Used
parts are described as LKQ, Qual Recy Parts, RCY, or USED. Reconditioned parts are described as
Recond. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are
provided by National Auto Glass Specifications. Labor operation times listed on the line with the
NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not
included. Pound sign (#) items indicate manual entries. Some 2006 vehicles contain minor changes
from the previous year. For those vehicles, prior to receiving updated data from the vehicle
manufacturer, labor and parts data from the previous year may be used. The Pathways estimator has
a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the
local dealership.
CCC Pathways - A product of CCC Information Services Inc.
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