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HomeMy WebLinkAboutMINUTES - 10311989 - 1.1O t, t { ` CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT October 31, 1989 and Board Action. All Section references a to ) The copy of this document mailed to you is your notice of California Government Codes. 0ld,Ily Ge action taken on your claim by the Board of Supervisors (Para W-4h IV below), given pursuant to Government Code Amount: $50,000.00 rTr 2 S * n 913 and 915.4. Please note all "Warnings". CLAIMANT: WAPNIARSKI, Bogdan andS�lMay"7e ,, (;A 94,553 ATTORNEY: Michael J. Cochrane Nelson & Leighton Date received ADDRESS: 665 So�.. Hartz Ave. , Ste. 210 BY DELIVERY TO CLERK ON September 29, 1989 Danville, CA 94526 BY MAIL POSTMARKED: September 26, 1989 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PpHHIL BATCHELOR, Cler DATED: October 2, 1989 BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. � ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15. days (Section 910.8). ( ) Claim is not timely filed. The Clerk should 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: ­ 75�\ Dated: I(J� 1BY: I Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( This Claim is rejected in full . ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: OCT S 1 19 q PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (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 with this matter. If you want to consult an attorney, you should do so immediately. 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: ` BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator f NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Mi el J. Cochrane Nelson Leighton 665 So. Ha Ave. , Ste. 210 Danville, CA 6 Re: Claim of BOGDAN AND MAY WAPNIARSKI 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. If the amount claimed exceeds ten thousand dollars ($10,000) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. 6 . The claim is not signed by the claimant or by some person on his behalf . 7 . Other: VICTOR J. WESTMAN, County Counsel B I Y� Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL C.C.P. S§ 1012, 1013a, 2015 .5; Evid. C. SS 641 , 664 ) My business address is the County Counsel's Office of Contra Costa County, Co. Admin. Bldg. , P.O. Box 69, Martinez, California, 94553, and I am a citizen of the United States, over 18 years of age, employed in Contra Costa County, and not a party to this action. I served a true copy of this Notice, of Insufficiency and/or Non Acceptance of Claim by placing it in an envelope(s) addressed as shown above (which is/are place(s) having delivery service by U.S. Mail) , which envelope(s) was then sealed and postage fully prepaid thereon, and thereafter was, on this day deposited in the U.S. Mail at Martinez/Concord, Contra Costa County, California. I certify under penalty of perjury that the foregoing is true and correct Dated: �G�� , at Martinez, California. cc: Clerk of the Board of Supervisors (or ginal)/ Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910 . 2, 920 .4, 910. 8) r 1 MICHAEL J. COCHRANE NELSON & LEIGHTON 2 665 South Hartz Avenue , Suite 210 Danville , California 94526 `"�EV '� 3 Telephone: ( 415) 837-8019 4 FIE 2 91989 Attorney for Claimants 5 Bogdan and May Wapniarski PF11LFiATCHE:OR L-1 :ERK BOARD OF SUPERVISORS CO. STA CO. 6 e of 7 CLAIM AGAINST PUBLIC ENTITY 8 9 TO CITY OF MARTINEZ AND COUNTY OF CONTRA COSTA: 10 Bogdan and May . Wapniarski hereby makes claim against the City 11 of Martinez and the County of Contra Costa for the sum of Fifty 12 thousand dollars and makes the following statements in support of 13 the claim: 14 15 1. Claimants ' address is 568 Sherree Drive, Martinez , 16 California 94553 , in the County of Contra Costa. 17 18 2. All notices concerning the claim should be sent to 19 Michael J. Cochrane , Nelson & Leighton, 665 South Hartz , Suite 20 210 , Danville, California 94526 21 22 3 . The place of the occurrence giving rise to this claim is 23 568 Sherree Drive , Martinez , California 94553 , in the County of 24 Contra Costa . The date of the occurrence is ongoing: the claim 25 is made for damages sustained to the subject property as a result 26 of an active landslide . 27 28 -1- 1 4. The circumstances giving rise to the claim are as follows: 2 (a) Inverse Condemnation: As one theory of recovery , 3 claimants assert that the circumstances giving rise to the claim 4 are as follows : Claimants are the owners of the property located 5 at 558 Sherree Drive, Martinez , California 94553. Claimant is 6 informed and believes , and thereon claims , that the City of 7 Martinez and the County of Contra Costa planned, approved, 8 constructed , maintains , and operates the public roadway , drainage 9 improvements , and adjacent easement known as Reliez Valley Road , 10 which roadway, drainage improvements , and easement adjoins the 11 subject property. An active landslide has formed within the 12 easement maintained by the City of Martinez adjacent to the 13 subject property. The landslide has intruded into claimants 14 property causing actual physical damage to the subject property 15 and its appurtenances , as well as causing damages in the nature of 16 diminution of value of the subject property. The proximate cause 17 of the damage is the City of Martinez and the County of Contra 18 Costa actions and failures to act in planning , approving , 19 constructing , operating and maintaining the roadway, drainage 20 improvements , and the adjacent easement . Claimants have met and 21 conferred with various members of the City of Martinez , several of 22 whom have admitted that an active landslide exists in the City of 23 Martinez owned easement adjacent to the subject property. In . 24 addition , various members of the City of Martinez have admitted s 25 that the active landslide has intruded onto and is causing damage 26 to the subject property . 27 28 -2- 1 (b) Private Nuisance : As one theory of recovery, 2 claimants assert that the circumstances giving rise to the claim 3 are as follows : Claimants are the owners of the property located 4 at 568 Sherree Drive , Martinez , California 94553. Claimant is 5 informed and believes , and thereon claims , that the City of 6 Martinez and the County of Contra Costa planned , approved , 7 constructed , maintains , and operates the public roadway, drainage 8 improvements , and adjacent easements known as Reliez Valley Road , 9 which roadway , drainage improvements , and easement adjoins the 10 subject property. An active landslide has formed within the 11 easement maintained by the City of Martinez adjacent to the 12subject property. The landslide has intruded into claimants 13 property causing actual physical damage to the subject property 14 and its appurtenances , as well as causing damages in the nature of 15 diminution of value of the subject property. The proximate cause 16 of the damage is the City of Martinez and County of Contra Costa 17 actions and failures to act in planning ,; approving, constructing 18 and maintaining the roadway , drainage improvements , and the 19 adjacent easement . The active landslide is injurious to the 20 health of claimants , and is an obstruction to the free use of 21 property, so as to interfere with the the claimants ' right to 22 comfortable enjoyment of life and property. 23 (c) Public Nuisance : As one theory of recovery, 24 claimants assert that the circumstances giving rise to the claim s 25 are as follows: Claimants are the owners of the property located 26 at 568 Sherree Drive , Martinez , California 94553. Claimant is 27 informed and believes , and thereon claims , that the City of 28 -3- i 1 Martinez and the County of Contra Costa planned, approved, 2 constructed , maintains , and operates the public roadway , drainage 3 improvements , and adjacent easements known as Reliez Valley Road, 4 which roadway , drainage improvements , and easement adjoins the 5 subject property. An active landslide has formed within the 6 easement maintained by the City of Martinez adjacent to the 7 subject property. The landslide has intruded into claimants 8 property causing actual physical damage to the subject property 9 and its appurtenances , as well as causing damages in the nature of 10 diminution of value of the subject property. The proximate cause 11 of the damage is the City of Martinez and the County of Contra 12 Costa' s actions and failures to act in maintaining the roadway , 13 drainage improvements , and the adjacent easement. Claimants 14 assert that the inadequately planned , approved , designed , 15 constructed , and maintained improvement , `roadway, drainage 16 improvements , and easement adversely affects all private 17 properties owned adjacent to the roadway, drainage improvements , 18 and easement by threatening the aforementioned privately owned 19 properties with inundation from earth, debris , water and the 20 removal of lateral and subjacent support . Claimant is informed 21 and believes , and thereon alleges , that the only known active 22 landslide along the roadway is located in the easement adjacent to 23 their property, and has in fact entered across their property 24 line , causing claimants direct physical injury to their property s 25 different from that suffered by the general public . 26 27 28 -4- 1 i (d) Negligence : As one theory of recovery, claimants 2 assert that the circumstances giving rise to the claim are as 3 follows : Claimants are the owners of the property located at 568 4 Sherree Drive, Martinez , California 94553. Claimant is informed 5 and believes , and thereon claims , that the City of Martinez and 6 the County of Contra Costa planned , approved , constructed , 7 maintains , and operates the public roadway, drainage improvements , 8 and adjacent easements known as Reliez Valley Road , which roadway, 9 drainage improvements , and- easement adjoins the subject property. 10 Claimants ' are informed and believe , and thereon allege , that the 11 City of Martinez and the County of Contra Costa have a duty to 12 inspect and maintain the roadway , drainage improvements , and 13 easement collectively known as Reliez Valley Road. Claimants ' are 14 informed and believe , and thereon allege , that the City of 15 Martinez and the County of Contra Costa have breached this duty by 16 allowing the roadway , drainage improvements , and adjacent easement 17 to fall into a state of disrepair . That as a proximate cause of 18 this state of disrepair of roadway , drainage improvements , and 19 adjacent easement, an active landslide has formed, said active 20 landslide intruding into the Claimants ' private property and 21 physically damaging same and its appurtenances , as well as causing 22 damages in the nature of diminution of value of the subject 23 property. 24 (e) Trespass : As one theory of recovery, claimants s 25 assert that the circumstances giving rise to the claim are as 26 follows : Claimants are the owners of the property located at 568 27 Sherree Drive, Martinez , California 94553. Claimant is informed 28 -5- 1 and believes , and thereon claims , that the City of Martinez and 2 the County of Contra Costa planned , approved , constructed, 3 maintains , and operates the public roadway, drainage improvements , 4 and adjacent easements known as Reliez Valley Road , which roadway , 5 drainage improvements , and. easement adjoins the subject property. 6 That an active landslide has formed in the easement owned and 7 maintained by the City of Martinez adjacent to Reliez Valley Road, 8 and said active landslide has physically trespassed into the 9 Claimants ' private property and that said trespass has physically 10 damaged Claimants ' private property and its appurtenances , as well 11 as causing damages in the nature of diminution of value of the 12 subject property. 13 (f) Dangerous Condition : As one theory of recovery, 14 claimants assert that the circumstances giving rise to the claim 15 are as follows: Claimants are the owners of the property located 16 at 568 Sherree Drive , Martinez , California 94553. Claimant is 17 informed and believes , and thereon claims , that the City of 18 Martinez and the County of Contra Costa planned , approved, 19 constructed , maintains , and operates the public roadway, drainage 20 improvements , and adjacent easement known as Reliez Valley Road , 21 which roadway, drainage improvements , and easement adjoins the 22 subject property. An active landslide has formed within the 23 easement maintained by the City of Martinez adjacent to the 24 subject property. The landslide has intruded into claimants e 25 property causing actual physical damage to the subject property 26 and its appurtenances , as well as causing damages in the nature of 27 diminution .of value of the subject property. The proximate cause 28 -6- 1 of the damage is the City of Martinez and the County of Contra 2 Costa' s actions and failures to act in planning , approving , 3 constructing, operating and maintaining the roadway, drainage 4 improvements , and the adjacent easement . Claimants have met and 5 conferred with various members of the City of Martinez , several of 6 whom have admitted that an active landslide exists in the City of 7 Martinez owned easement adjacent to the subject property. In 8 addition , various members of the City of Martinez have admitted 9 that the active landslide has intruded onto and i-s causing damage 10 to the subject property. Claimants assert that the City of 11 Martinez and the County of Contra Costa , with actual and 12 constructive notice of the condition, have caused a dangerous 13 condition to exist ; to wit ; an active landslide in an easement 14 owned and maintained by the City of Martinez . 15 5 . Claimant' s injuries are as follows : 16 (a) Damage to real property in an amount in excess of 17 twenty-five thousand dollars. 18 (b) Damage due to diminution of value of real property 19 in an amount in excess of than twenty-five thousand dollars . 20 (c) Engineering costs and legal fees in an as yet 21 unknown amount . 22 23 6 . The names of the public employees causing the claimants ' 24 injuries are unknown. a 25 26 7 . The . claimant ' s claim as of the date of this claim is 27 fifty thousand dollars . 28 -7- 1 8. , The basis of computation of the above amount is as 2 follows : Estimating the total of 5 . (a) , 5. (b) , and 5. (c) . 3 4 DATED : ozd ��f NELSON & LEIGHTON 5 i 6 _ By: Michael J. Cochrane 7 On Behalf of Claimants Bogdan and May Wapniarski 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 6 25 26 27 28 -8- 1 DECLARATION OF SERVICE BY MAIL 2 I , the undersigned, declare: 3 That I am a citizen of the United States , over the age of 4 eighteen years , and not a party to the foregoing action; that my 5 business address is 665 South Hartz Avenue , Suite 210 , Danville , 6 California . 7 That on September 26 , 1989 , I served copies of the foregoing 8 CLAIM AGAINST PUBLIC ENTITY by placing them in envelopes addressed 9 as follows : 10 Clerk Board of Supervisors 11 County of Contra Costa 805 Las Juntas Street 12 Martinez , California 94553 13 Jack E. Garner City Manager 14 City of Martinez 525 Henrietta Street 15 Martinez , California 94553-2394 16 which envelopes were then sealed and deposited , postage 17 prepaid , in the United States mail at Danville, California; 18 that there is regular service by mail between the place of 19 deposit and each of the foregoing addresses . 20 I declare under penalty of perjury that the foregoing 21 is true and correct . 22 Executed September 26 , 1989 at Danville, California . 23 24 Lisa McNeil 25 26 27 28 -9- . � k \ G Q - = •> � \ N co C-) 0 2 7 Do 0 ro U� ? p� m 0 nt0 � COCt / 0 ® / (ID ML . � 7 � X- U . � � b� � o $ » z C � .� . �� CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT October 31: 19 8,9 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice o California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $250,000.00 Section 913 and 915.4, piVd%I eLAWNr"Inflings". CLAIMANT: McCLAIN, Lawrence Alan 1969, ATTORNEY: ATTORNEY: Roosevelt O'Neal Martinez, CA ,94553 Date received ADDRESS: 1419 McAllister Avenue BY DELIVERY TO CLERK ON September 28, 1989 Sacraento, CA 95822 - BY MAIL POSTMARKED: September 27, 1989 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: September 29, 1989 ppHHIL BATCHELOR, Clerk BY: Deputy Il. FROM: County Counsel TO: Clerk of the Board of Supervisors �+ ) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should 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: 9 2G 179 BY: I Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD OR By unanimous vote of the Supervisors present ( ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: nc,T HIL BATCHELOR, Clerk, By Deputy Clerk WARNING (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 with this matter. If you want to consult an attorney, you should do so immediately. 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: OOT 3 1 1989 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §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. RE: Claim By ) Reserved for Clerk's filing stamp LAWRENCE ALAN McCLAIN ) ' � I Against the County of Contra Costa ) SEP 281989 or District) ne Fill in name ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 250,000.00 and in support of this claim represents as follows: ------------------------------------------------------------------------------------- 1. When did the damage or injury occur? (Give exact date and hour) May 19, 1989, at 1 :45 a.m. ------------------------------------------------------------------------------------ 2. Where did the damage or injury occur? (Include city and county) Contra Costa County. Sheriff 's Detention Facility , Martinez, CA. ------------- 3. How did the damage or injury occur? (Give full details; use extra paper if required) See attached statement --------------------------------------------------------------------------------- --- 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Use of unreasonable and excessive physical force by one or more custodial personnel . (over) 0 5. What are the names of count or district officers, servants or employees causipg y � y the damage or injury? Sgt. Larch; Sgt. Carey; Deputy T. Anderson; Deputy Yates; and Deputy Rosso. -------------------------------------------------------------------------------------- 6. What damage or injuries do you claim resulted? (Give 'full extent of injuries or damages claimed. Attach two estimates for auto damage. Broken bones in right arm and physical and mental trauma. - 7. How was the amount claimed abovecomputed? (Include the estimated amount of any prospective injury or damage.) General and punitive damages --------------------------------------- --------------------------------------------- 8. Names and addresses of witnesses, doctors and hospitals. Highland General Hospital ; emergency medical staff on duty May 19, 1989. ------------------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf." Name and.Address of Attorney / ROOSEVELT O'NEAL G Attorney for Claimant Attorney at Lawimant!.s Signature Califtip t�gns 1419 McAllister Avenue '` Sacramento, CA 95822 Iawr�e A.4McQain -216fZ �� Address P.O. Box 7000, Cell # V-348, Vwwil..]_e, CA 9-9696- Telephone No. (916) 978-7548 Telephone No. * 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 ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. Attachment Item #3 County claim Lawrence Alan McClain On May 19 , 1989 , I was in custody at the Sheriff ' s Detention Facility in Martinez , CA. At the time of this incident I was housed in Module Q. At approximately 1 :45 a.m. , May 19 , 1989 , Deputy Anderson accused me of being disruptive and stated that he was going to move me to D Module and to get my bedding and things together . Deputy Anderson and I were walking towards D Module when I asked him why I was being moved since I had not done anything to justify being moved . At that point I just dropped my stuff and stood there looking at him waiting for an ,answer. Next thing I knew, Deputy Anderson had grabbed me and placed me in some sort of hold and started pushing me around . During this time another deputy came running in and grabbed my right arm while Deputy Anderson still had me in the hold . The other deputy twisted and jerked my right arm in such a violent manner that it caused my arm to make two or three very loud snaps. As a result , my arm was broken in two or three places . R7fGMa�a�crr- tv::.:`.:'sa:c�v:,.r:n_nr.+-+.n�taaa+��reru.xae+a.......::s:nn,.., . .• �'•.^airmmuar..n�mcs6.rczaa+ccs•cnv...awxnc:.-: mer:^v.xae+:.ca,:v-.-.«r►.cicw+�.++•,..,:+.•=eTr.•.r✓.�• ,r A i O CLAIM ' BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT October 31, 1989 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. C,-_;4W) the action taken on your claim by the Board of Supervisors q4R& greph IV below), given pursuant to Government Code Amount: $28.00 7 Section 913 and 915.4. Please note all "Warnings". 1989 CLAIMANT: CARGILE, Anthony J. "}l i CA 94,553 ATTORNEY: Date received ADDRESS: 115 Begonia Court BY DELIVERY TO CLERK ON September 29, 1989 Martinez, CA 94553 BY MAIL POSTMARKED: September 28, 1989 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: September 29, 1989 gtIl �eputyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should 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: C Dated: � Z `� BYDeputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD OR By unanimous vote of the Supervisors present ( ) This Claim is rejected in full . ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: D CT 3 t_ 1989 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (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 with this matter. If you want to consult an attorney, you should do so immediately. 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. 9- Dated: t 1.qpq BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator +" ,CLJ1TK TC? BOARD OF -.SUPERVISORS ;OF. CONTRA .CO t� �UOTr�' _ - . -Ve�ur�b —vzn appllcatlon to: Instructions to Claimant Clerk of the Board P.O. Box 911 Martinez,California 94533 A. Claims relating to causes of action for death or zor injury to person or .to personal. property :.or growing cropsmast -be presented not later than the =100th day after the accrual of- the `cause -cif action. . Claims relating"t any other cause of action 'must be presented not later than one year after the ,accrual of the cause . of action. (Sec. 911. 2 , Govt. Code) 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 , California 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 mast be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at end of this . forma RE: Claim byry ) Reserved :for Clerk's filing stamps _ - V Agaj_nst the COUNTY OF CONTRA COSTA) SEP 2 91989 Or c.6N✓r� CoSJd Catiii� 4c,`� DISTRICT) rr �,7c�c;oa Y �re CL R,r C -•U7ERVISORS (Fill in mile) ) "vSTA CO. De pti The undersigned claimant hereby makes c.laaim. agaithe panty of Contra. Costa or the above-named District in the sum of. $ �. and in support of this claim represents as follows : - l . When did the-damage or injury occur? - (-Give exact date and hour) OSI �G ne 1q)l9�' q(OC1,1 j 1 L;o o,n-,%cf n ti �- T 6-'-45. hl-Og h-�- d o yQ 4, s1 A ACZ (A 2. Where did the-damage or-injury: occur? (Include city and county)--- 3. How'did the damage-or injury occur. (Give full details , useextra sheets if required) Iocl L054- M/ C/64A nj t410r-r,z o9GG�e�crlSefYG��,Ycd $ - - lg9b a�' Dorm 5--ro> s , w 1�►� -- :q -E ��,�ic e a 3 r1N3 �. 4 . What particular act or omission on the par of county ordistrict Officers , servants or employees caused the injury or damage? 6 (over) i. -,at- ar.e..the.,.names of county or district officers, servants or employess::causing ,.the. damage or injury? i -. ��� ,`cS %/1 19ke. a ` 5 . What damage or injuries do you claim resulted? (HVe full extent of injuries .or damages claimed. Attach two -estimates for .auto. damage) 0 %%1J 4 r C-SS �} �dsy.- a° UG +.rhry ------------------------------------------------=--------------- 7 . . How was the amount claimed above computed? (Include the estimated amount of any prospective injury 'or damage. )' Z hc�ry 4A� _S�v�d-s Al A 4y W7 c. cre 1�- n r+e w --------------------------------------------------------=---------------- 8. Names. and addresses of witnesses , doctors and hospitals. 9. List the expenditures you made-on account of this accident-or-injury: DATE ITEM 7MOUNT y0 AY E 44- rl,'CS-e✓i y- Govt. Code Sec . 910 . 2 provides : "The claim signed by the claimant SEND NOTICES TO: (Attorney) or by ome person on his behal-F . " Name and Address of 'Attorney _ 1 zmant s Signature �g��lYlee, 1°�b1f c Occ��r� I/S� eG�N Address Telephone No. (4r�( 2��// t S Telephone No. *_ NOTICE Section 72 of the Penal Code provides: "Every person whb , with intert to de`raud, presents for allowance or for payment to any state, board or officer, onto :any county, town, city district, . ward or``-village board or officer, authorized to allow-or nay the' same if genuine anv false or fraudulent claim:, bill, account , voucher, or writing, is guilty of a felony. " /r .CDei Sr `�� irh /C�G/I�oyy✓ Y LP4 CoN/o1�0/c,4Se P c�u1 ,. Boalfy ®4J,�c1 iy,e f -- - --.11. 17c4e . moo `' /c/ _ -1-4o,L/kF, 1. v r kl Oct S qN A u w y ll` r CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT October 31, 1989 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to G eernmoupin �pO��tSe1 Amount: Undetermined Section 913 and 915.4. Please note all "garnings". CLAIMANT: MC CLELLAN, Tena Charlene OCT t, IR ATTORNEY: Martinez.{.QAAAM c/o County Jail Date received BY DELIVERY TO CLERK ON September 29, 1989 (via Public ADDRESS: 901 Court Street Martinez, CA 94553 Defenders Office BY MAIL POSTMARKED: hand delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PpHHIL BATCHELOR, Clerk DATED: October 2, 1989 BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supe'r<sors ( ) 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). ( ) Other: Dated: o j 5 )9 BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDE By unanimous vote of the Supervisors present ( This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: 0 CT 3) 1 1989 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (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 with this matter. If you want to consult an attorney, you should do so immediately. 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. Oct Dated: ACT 31 19 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator v NOTICE OF INSUFFICIENCY AND OR NON-ACCEPTANCE OF CLAIM TO: Tena Cha ene McClellan c/o County i1 901 Court Stre Martinez, CA 945 Re: Claim of TENA CHARLENE MCCLELLAN 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. 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. x 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. If the amount claimed exceeds ten thousand dollars ($10,000) , the claim fails to state whether jurisdiction over the claim would rest in municipal- or superior court. 6 . The claim is not signed by the claimant or by some person on his behalf. 7 . Other: VICTOR J. WESTMAN, County Counsel By: _ �) A4,-,, Deputy County Co el CERTIFICATE OF SERVICE BY MAIL C.C.P. §§ 1012, 1013a, 2015 .5; Evid. C. §§ 641, 664) My business address is the County Counsel's Office of Contra Costa County, Co. Admin. Bldg. , P.O. Box 69, Martinez, California, 94553, and I am a citizen of the United States, over 18 years of age, employed in Contra Costa County, and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non Acceptance of Claim by placing it in an envelope(s) addressed as shown above (which is/are place(s ) having delivery service by U.S. Mail) , which envelope(s) was then sealed and postage fully prepaid thereon, and thereafter was, on this day deposited in the U.S. Mail at Martinez/Concord, Contra Costa County, California. I certify under penalty of perjury that the foregoing is true and correct. Dated: ��( \� at Martinez, California. cc: Clerk of the Board of Supervisors (original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910 . 2, 920 .4, 910 . 8) CLAIM TO: BOARD OF SUPERVISORS OF CONTRA C 0atton to: TrRPWiyapplic Instructions to ClaimantC!erk of the Board Martinez,Calitomia 94553 A. . Claims relating to causes of action for death or for injury to person or t:o personal property or growing crops must be presented not later than the 100th day after the accrual of the cause of r action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Sec. 911. 2, Govt. Code) 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 , California 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. ;. ..•aud. See penalty for1fraudulent claims , Penal Code Sec. 72 at end o this form. RE: Claim by �� ) Reseryer c > 1 g "stamps RECEIVED �4�� /.'1>0I 0a- Against the COUNTY OF CONTRA COSTA) SEP,2q 1988 10'D OP PHIL BATCHELOR DISTRICT) CLERK BOARD OF SUPERVISORS Fill 1n name ) e C F COSTA CO. eputy By The' undersigned claimant hereby makes claim against a County of Contra Costa or, the above-named District in the sum of $ L Ae=�-�r,rn�ra and in support of this claim represents as follows: 1. _When did the damage or injury occur? (Give exact date and �lOurj dun a31 \g TCA q: A o° ? m ---- ---- -----------i - ....................-:------------------ 2. Where did the damage orlinjury occur? (Include ca.ty. and county) CI t3 2e_l lo` i Skc,.. 0\,3e- '�S)D tet` C ; Lb�� � Q10sku- 0-0 w\ _ _,._.----------------------------------------------------- ----- ---- --- 3. now did the damage or injury occur? (Give full details, use extra . sheets if required) .._ — .__ _-- •T_—_—__—__�--••--•�------------------- _ -- 4.—rWhat_particular act or omission on the part of county or di.strIet___ officers , servants or employees caused the , injury or damage? o iL.� W e-ke e S N o 0"M d W o.g e...rt._ A�o �je or c!,kk"^ (over) 5. What are the names of county or district officers, servants or . employees causing the damage or .injury? . Ma.tt.k 1►��e�e�y �.e '� Cx;��n e�� �...:�-``�: S e✓�t e fig} , 1`0.�'s w e-\\ Du Q5 6. What damagu or injuries�do+you claim resulted? (Give full extent of injuries or damages claimed. - Attach two estimates for auto . damage) 7 . How was the^amount�claimed�above computed?�+(Include the estimated amount of `any prospective injury or damage. ) 8. wNames and addresses-of witnesses, doctors and hospitals.! ..- .t.�_..�..�....___..__ .�....._,. 9. List the expenditures you made^on'account^of thi accident or fn�ury: DATE ITEM AMOUNT . ie�kyt�*::itis**�t****�*********irk*****it*****it******�!t*•k•k*****iAc,kdt*fit***♦t,ktk*.***�**d 3 Gov't. Code Sec. 910.24provides : "The claim`'signed' by the claimar SEND NOTICES T04 - (Attorney) orb some ' erson on his behalf. Name and'Address- of Attorney fAC 1e cimam jA nature Add jess �o C-0 j c ee�A--- S-S` ) c�Q2 4\e_t_ Ccs, �ttES s'L1 Telephone No. Telephone No. 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, town, city district, ward * br village board or officer, authorized to allow or,.•pay the same if genuine, any false or fraudulent claim, bill, .account, vouches or writing, is guilty of a fe•1bny. 11 . . �3�� �.E'11m .' t,,,.,. :r°`'h'�.fi��rj..'+rl•�}��;� .. - .. +int{;1'�f'�T'e�`�:�'� ,i. -j �' �...,r CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT October 31, 1989 and Board Action. All Sect ion referenQ to ) The copy of this document mailed to you is your notice of California Government Codes. Y CPUjft action taken on your claim by the Board of Supervisors or 2 (Paragraph IV below), given pursuant to Government Code Amount: $163.02 it 19�9ection 913 and 915.4. Please note all "Warnings". CLAIMANT: HOUCK, Stanley R. , 1cZErj��' CAI 94,5903 ATTORNEY: Date received ADDRESS: 16711 Marsh Creek Rd. #147 BY DELIVERY TO CLERK ON October 2, 1989 Clayton, CA 94517 - BY MAIL POSTMARKED: September 29, 1989 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. October 2 1989 PpHHIL BATCHELOR, Clerk DATED: BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Sup rvisors ( ) 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). ( ) Other: Dated: ((j Is W BY: � � Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. a� Dated: OCT 3PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (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 with this matter. If you want to consult an attorney, you should do so immediately. 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: OCT 3 A 9005 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: St ey R. Houck 16711 sh Creek Rd. #147 Clayton, 94517 Re: Claim of STANLEY R. HOUCK 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. If the amount claimed exceeds ten thousand dollars ($10,000) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. x 6 . The claim is not signed by the claimant or by some person on his behalf . 7 . Other: VICTOR J. WESTMAN, County Counsel By: Deputy County Couns 1 CERTIFICATE OF SERVICE BY MAIL C.C.P. SS 1012, 1013a, 2015 . 5; Evid. C. 99 641 , 664 ) My business address is the County Counsel's Office of Contra Costa County, Co. Admin. Bldg. , P.O. Box 69, Martinez, California, 94553, and I am a citizen of the United States, over 18 years of age, employed in Contra Costa County, and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non Acceptance of Claim by placing it in an envelope(s ) addressed as shown above (which is/are place(s) having delivery service by U.S . Mail) , which envelope(s) was then sealed and postage fully prepaid thereon, and thereafter was, on this day deposited in the U.S. Mail at Martinez/Concord, Contra Costa County, California. I certify under penalty of perjury that the foregoing is true and correct. Dated: , Q , at Martinez, California. r- cc: Clerk; of the Board of Supervisors (original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910 . 2, 920 .4, 910 . 8) Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §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. RE: Claim By, ) Reserved for Clerk's fi tamp � Hu OIL Against the County of ContraCosta ) ' , . - OCT, 21989 or ) rH! L EATCHELOR C-E£K L A D O` UPE?.Vi CiS ACV. District) z[ a of Fill in name ) The undersigned claimant hereby makes claim. the County of Contra Costa or the above-named District in the sum of $ ,(p , �-Z-- and in support of this claim represents as follows: ------------------------------------------------------------------------------------- 1. When did the damage or injury occur? (Give exact date and hour) ----------------------- ,2. Where did the damage or injury occur? (Include city and county) _"RA —-(L_a_4ons,----= _-------- 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? elX U QC-&0(2A I� o� - (over) 5. What are the names of county or district officers, servants or employees causing the .damage or injury? ------------------------------------------------------------------------------------- 6. What damage or injuries do .you claim resulted?--(Give full extent of injuries or damages claimed. Attach two estimates for auto damage'. 7. How was the amount claimed above computed? (Include"t' he-estimated amount -of- any prospective injury or. damage.) b n 8. Names and addresses of witnesses, doctors and hospitals. ------------------------------------------------------------------------------------- .9. List the expenditures you made on account of this accident ..or injury: DATE ITEM AMOUNT Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf." Name and Address of Attorney Claimant's Signature Address Telephone No. Telephone No. N O T I C E 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 ($1,000), or by both such imprisonment' and .fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. Date Order T 9149 WINDSHIELDS V' ,, V,11A1AMERICA Initials Transfer to from Invoice No. P.O.No. CUSTOMER RMATION: NAME HONE �r12 r STREET We—OFFICE CITY STATE ZIP PICKUP ❑ DATE MOBILE ❑ TIME WILL CALL ❑ GLAZING ❑ SPECIAL INSTRUCTIONS: VEHICLE INFORMATION: YEAR //7 MAKE MODE &Lt, I.D.# LIC.# BILLING INFORMATION: POLICY# CLAIM# DATE OF LOSS WHERE HOW INSURANCE AGENT/AGENCY INSURANCE COMPANY DEDUCTIBLE e ,BAY,, OK'D❑ BILL❑ HOLD❑ PRICING INFORMATION PART W/H❑ SUPPLIER LIST LABOR NON-CRITICAL ZD.IIE R ESTIMATES GOOD FOR 30 DAYS—THIS IS NOT AN INVOICE SAFELITE"'Glass Corp. SAFEL I TE AUTO GLASS " U-U E3-IF 2049 CONTRA COSTA BLVD. PLEASANT HILL, - CA. 94523 - C)9-18--89 415 687-7200 THIS IS A QUOTE ONLY - DO NOT PAY CASH SALES - LOC 493 665 S. DAKOTA CLAIM # SEATTLE, WA. 98108 0000 000 000-0000 i HOUCK SAFESEAL POSSIBLE ❑YES ❑NO DECLINED CUSTOMER SIGN. PART# REPAIRED Year Make Model Mileage License # Reference # 1979 01 MOBILE CUTLASS SUP --- 2D COUPE (NOTCHBACK) DescriptionQuantity Part No. 1 W888-S SHADED WINDSHIELD 249. 25 119. 64 1 19. 64 LABOR 35. 00 0 35. 00 SUB TOTAL 1 t54. 64 SALES TAX : 8. 38 TOTAL: 163. 02 Replacement has been made to my satisfaction and I hereby authorize the above insurance company to pay direct in full to the above listed firm for said installation. If for any reason the insurance company does not pay for these repairs or replacements, the below signed agrees to pay for said repairs or replacement. DATE SIGNATURE • G.�T v5 00 493. CASH SALES - LOC 493 665 S. DAKOTA SEATTLE, WA. 98108 0000 iRlease Reference Invoice10-G._D CJ-r 000 000-00 00 59- 9898-00(--)349--5'-39898 CASH CUSTOMER COPY INSURANCE OR CHARGE MAILING.COPY• RT-0035 SAFELITE" ass Corp, y Invoice AN Date +r C L * A I M A N �w T r Policy No. N S U R E D 4"r year Make Model Mileage Serial tt License # Reference N 1979 01—DSMQBII—E- con—ASS 'SUP 2D COUPE M ' Quantity Part No. Description Extension Total ' M . • Z�'tt t. }:I-rC�' yy��.1�" .-',aY::LA ftp-t�r t;)���� t..nc;':,.A•.. ■ '�),. ,�„t�h� Yi.p, ••l�y�T.}i���t �,.� Y;". ,K.{-C�mC�Ci1.(�fA.C� � 1.. � t � ✓.�,� c x-.a �t-.t.l/-r+•CFJ,`rtl.��ti-.., ',c��'�.Fch• .�'r,3''_r�,L`�"i,�� '.'zr'-jP . tz- .7i..1.�4?!,aC�;.3C,3 J'f'04 ftU2;r,.'7-r�Oj b9:�Z�rr ?'IIS .ir.. :,u �( :•�^ ,�,t,t`_^.. X,Q?rL7LY�.7'j ti=+.•'C� � r.�{ �j•(rfr:d�i :�;'���4�r���� r{�.r��(`J11O ��'. 'mit- ,lL '�• ti j�]"_`1'7 1. '�'SY.% l.•♦ �i r��,:-�-: V�' .r j`�"'•. �.�r�.i.� CZ1.� �G.l t,`.CZI�-''�`�CJi';-{...•''�a,��+1.-f�C4..tJ�.).':v5�:.y r.;��1 �.c•7�6�r. �M�.�`b'1'xt��t"h_�t`IC"rta��`�-�a��,",-„-tt.�r..��G}• �•�•;'7�) ►� Q J: ry; ^,v,.J;`h .r'i c (`a X11,4. y.i41�-�-�r����'14'6:•"1^.. ti�� -r,",.,,t- i:�;•-�t'lr � r•)lyl t 9(r tt.� .�Z i�,u E?r f;C• �J �l� �I n(, Z� 2 (L) 74 %),ti 42 .�.'�'-�`yi'J;�r'7n��'I�•�1.•}�lfltz y• C:A .;,: 1r�-:�s..��fr,'•;.;�.,m1t tJi,1.(9 .(� •ClJ.•.;Ca7.; 1S y.:�j';t�>�y_':•�7�•iL t y`�'<n,ttl G'� �tj G.l.:�,('a�`�.2''�G�.fit(]a��Ci!K•r� ��s,.fv:� �j _1 -_ JE^?.'•1 X71_` t, ci��. i� ._w..-t.-�`�l •yN � 1'r.;� Y1•aw t.�� �.•� ... AAAt i iklb .�.G��.1�� i�.�rL•),I;CJwC:-r �^;•,8.;;.C,.�.=i.�r_):,;tRl� ,•� !Li i.i... >7 I f �...A -.,ini r.-..�>,"iia !-v .L•�....�./,,�. x �„ 1 k , >, IAV� �{^j- }}♦L�'1 Ci?....jy..�fj�l)f.-i.. CJ-(-•.r�.l� �jFr .iJ.`.it� Replacement has been made to my satisfaction and I hereby allthorize the above Insurance company to pay direct in full to the above listed firm forsaid installation. for - • - company does notpay for -•. or -• - the below signed agrees to pay for said-repairs or replacement. DATE SIGNATURE Date of Loss Work Order2,385 00493 COSH SALES Cause of Loss Store Location A A Authorized . 665 S. D14KOTAG E - • 108 0000000 000-0000 ly Please Reference Invoice ' I T When Remitting j i jC3E i 599398,---000 3149-599898 INSURANCE OR CHARGE CUSTOMER • • C • • SAFEU U IT'C- 'AUTO €,k. n.sS {7/rte t: N'TRA PL.EASAN!T "HILL., C+r'14 9451:13 c}9_-1 a--as) -11-1110 IS A DUl:3'?`E' ONLY . DO NICIT PAN' Co- SI-1 SAI-ES _ LOC 493 665 C. DrIIKOTA, CL,AIM -it S`-AT'fTLS:.=4 W1t 1. 98108 0000 000 000-000-() .{_}00-i.) SAFESEAL POSSIBLE ❑YES ❑NO DECLINED CUSTOMER SIGN. PART# REPAIRED', Year Make Model Mileage Serial # License # Reference # 1.97OOL DSIVIRB I L E CU-1-1-ASS SUP 2D COUPfie.. (NOTCHBACK) ;. +3 Quantity Part No. •: cription Extension Total W888--S t1'?1'11y�yC•rl�D WIPSD SI-�:�1�'I-D 2�• 9 t 119. 64•� 1 19. f:4 35. 00 SUS; TOTPL.e - 15 GA. F Replacement has been made to my satisfaction and I hereby authorize the above insurance company to pay direct in full to the above listed firm for said installation. If for any reason the insurance company does not pay"for these repairs or replacements, the below signed agrees to pay for said--repairs or replacement. DATE ti_ '. SIGNATURE "` J //�� ® {..){.)"i 93 ;CASs'1 SALES L,0C 493. GG5 S. DAKOTA SEn-TTl_I•. y W61.. 98108 0000 11-J!C3 T'6: :.. 000. 000.-0000. CHARGE CUSTOMER COPY RT,-0035 " .a 1 � ` ti J I� W � CD co `o C;)IZ, , Vc' I� s' CLAIM b BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT October 31, 1989 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors ZWtKagraph IV below), given pursuant to Government Code Amount: $194.59 SectiY� A Oland 915.4. Please note all "Warnings". CLAIMANT: HOUCK, Stanley R. c^yft(��� 198 Ce ATTORNEY: �i 945.53 Date received ADDRESS: 16711 Marsh Creek Rd. #147 BY DELIVERY TO CLERK ON October 2, 1989 Clayton, CA 94517 - BY MAIL POSTMARKED: September 29, 1989 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: October 2, 1989 §qIL �eputyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. � ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should 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: I(; BY: / Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER:, By unanimous vote of the Supervisors present �This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy o.f the Board's Order entered in its minutes for this date. Dated: O C T .11 19x9 PHIL BATCHELOR, Clerk, By Deputy Clerk 00, WARNING (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 with this matter. If you want to consult an attorney, you should do so immediately. 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: OCT9g�� BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator 1 NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Sta ey R. Houck 16711 sh Creek Rd. #147 Clayton, 94517 Re: Claim of STANLEY R. HOUCK 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. If the amount claimed exceeds ten thousand dollars ($10,000) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. x 6 . The claim is not signed by the claimant or by some person on his behalf . 7 . Other: VICTOR J. `WESTMAN, County Counsel Y' Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL C.C.P. §§ 1012, 1013a, 2015 .5; Evid. C. §S 641 , 664 ) My business address is the County Counsel's Office of Contra Costa County, Co. Admin. Bldg. , P.O. Box 69, Martinez, California, 94553, and I am a citizen of the United States, over 18 years of age, employed in Contra Costa County, and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non Acceptance of Claim by placing it in an envelope(s) addressed as shown above (which is/are place(s ) having delivery service by U.S. Mail) , which envelope(s) was then sealed and postage fully prepaid thereon, and thereafter was, on this day deposited in the U.S. Mail at Martinez/Concord, Contra Costa County, California. I certify under penalty of perjury that the foregoing is true and correct. Dated: � jq _�, at Martinez, California. c cc: Clerk of the Board of Supervisors iginal) _ /J Risk Management �/ (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910. 2, 920.4, 910.8) ` ClAim to: BOARD OF SUPERVISORS OF CONTRA COSTA'COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not .later than one year after the accrual of the cause of action. (Govt. Code §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. RE: Claim By ) Reserved for Clerk'sr filing--atap ic f ) V Against the County of Contra Costa ) OCT' or S lJl` v�SVRS CLERK l':•;✓Ar;D(:>F L; >­.,O'STACO. District) .... De ut Fill in name ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ R4.5`51 and in support of this claim represents as follows: ------------------------------------------------------------------------------------- 1. When did the damage or injury occur? (Give exact date and -hour) --- ( rIncTude 2. Where .did the damage or injury occur? city and county) ROC CA 3. How did the damage or injury occur? (Give full details; use extra paper if required) G ro-u G peom C)r) fin, --------------------------- ----- ------------------------ -------------- -------- 4. What particular act or omission on the .part of county or district officers, servants or employees caused .the injury or damage? [Ae&o i qco*eti� o P i,�� maA (over) 5. What are the names of county or district officers, servants or employees causrijg--! + the damage or injury? ------------------------------------------------------------------------------------ 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. _ti n_ t��l_►� S�_ _Clr__ � _'0A L((LCl� ------------------------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 1+e _G 5 �b =- '- �'-� t c S _V ✓vim-�i C_cL- 8. Names and addresses of witnesses, doctors and hospitals. W/7 ---------------------- --- ---------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf." Name and Address of Attorney Claimant's Signature) � Address Telephone No. Telephone No kw'l 5) f) ° 39 1-- N 0 T I C E 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 ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. Date Order Takenj��/y WINDSHIELDS V-1;V11�1AAMERICA Initials Transfer to from Invoice No. P.O.No. CUSTOME ORMATION: NAME PHONE STREET &7 7 OFFICE CITY STATES J+ ZIP PICKUP ❑ DATE MOBILE ❑ TIME WILL CALL ❑ GLAZING ❑ SPECIAL INSTRUCTIONS: VEHICLE INFORMATION: YEAR MAKE MODEL I.D.# LIC.# BILLING INFORMATION: POLICY# CLAIM# DATE OF LOSS WHERE HOW INSURANCE AGENT/AGENCY INSURANCE COMPANY DEDUCTIBLE BY / OK'D❑ BILL❑ HOLD❑ PRICING INFORMATION PART# W/H❑ SUPPLIER LIST LABOR NON-CRITICAL ACUTE- CRITICAL v///y DRIVEawl{ ESTIMATES GOOD FOR 30 DAYS—THIS IS NOT AN INVOICE / • SAFEL.I TE AUTO GLASS d G U C3 9 2049 kCONTRA COSTA BLVD. PLEASANT HILL, CA. 945523 09-18-89 415 687-7200 THIS IS A QUOTE ONLY — DO NOT PAY CASH SALES — LOC 493 665 S. DAKOTA CLAIM # SEATTLE, WA. 98108 0000 000 tapir—Qui 0 STAN, HOUCK 778 3281 SAFESEAL POSSIBLE DYES ❑NO DECLINED CUSTOMER SIGN. PART# REPAIRED Year Make Model mileage Serial 4 License Reference # 1979 JEEP WAGONEER 4D STATION WAGON DescriptionQuantity Part No. 1 W831—S SHADED WINDSHIELD 310. 70 149. 14 149. 14 LABOR 35. 00 35o 00 SUB TOTAL: 184. 14 SALES TAX: ].too 45 TOTAL: 194. 59 Replacement has been made to my satisfaction and I hereby authorize the above insurance company to pay direct in full to the above listed firm for said installation. If for any reason the Insurance company does not pay for these repairs or replacements, the below signed agrees to pay for said repairs or replacement. DATE SIGNATURE • . G..tB._ p v 00 493 CASH SALES — LOC 493 665 So DAKOTA SEATTLE, WA. 98108 0000 Please Reference Invoice u-U C3-'E—:: 000 000—0000 rpt_r 599898-000349-599898 CASH CUSTOMER COPY INSURANCE OR CHARGE MAILING COPY RT-0035 ` sAFELITE°Glass Corp. Invoice No. + '� Date C L M A I M A N T Policy No. N ■ S U R E '• milli • • P Year Make Model Mileage Serial # License # Reference # 1979 JEEP, WAGONEER 4D s"rATION WAGON6 Quantity Part No. Description Extension Total �. ..,.... ice.. .. . .-•,..._., � �..i.. � ) ''S;tti%.Nr:"j.1G�� rN�� ,,�X:�! '(��q4',- •� [f,t.;y,`o.•,r f:,��4`':%.�).�^-•'Li''"S;��{�f.?.7 i�+.�'(11!,�,C•)t.){.3 03 o�vi- r.4 S \t 1 P1_E1__0AI111T W i.-i_a Cn. -:"49.12.3 „y JS_.J.G...fS f's 19 .0 171IJ0 E OI`&.Y - DO NOT PAY Cf)SH SALES LOC 4-93 C..rC S. Df-V'0TA CL.A 114 � �3EA T TI_E, 98108 00ta O 000 0,00—o0oo s-mim H01.UK '778 328 SAFESEAL POSSIBLE_, OYES.-❑NO_ Q.ECLINED'.CUSTOMER-SIGN. " PART# REPAIRED r. • "D .R'itj ' .. ; y � 2 r � ✓ 1LN 7-fir { . ) �PI07l 1W 3 t. LnBOR 35. 00 35. 0 3n-.L.;=_S TFl4 10- tys 199. 5 Replacement has been made to my satisfaction and I hereby authorize the above Insurance company to pay direct in full to the above listed firm for said installation. If for any reason the insurance company does-not pay for these repairs or replacements, the below signed agrees to pay for said repairs or replacement.' DATE SIGNATURE 2 383 °-;w.11 4 ..ter S, LOC 493 CaC. :� 1, IM—f..T?TA OE,•1TTL E, NIP. . :?8'i,08 0000 000 000--0+700 ; u_... CHARGE CUSTOMER COPY �RT-0035 _ ,� ' ►N � ��C�e ' ��r�,a ' r, a, -.z r., ,... �, �� w�s��, �. ��-. 1 h V\� `�y,� 1J r^r:�., � �'�. �. � � s ��� of`,,..—.� �-�., � . �� -., r. .,, � ����; a _, �� � n �s AL ,� t=J a, �: �'� i`' �� ��' a .. „''j:`� �'. ��:i �J �``--� C`oN � � nl I} � n ,�. � � y .j CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA l Claim Aga'�nst the County, or District governed by) BOARD ACTION the Boa-.d of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT October 31, 1989 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes.. ;�}p��}„ ) the action taken on your claim by the Board of Supervisors _(36,-, UQ44agraph IV below), given pursuant to Government Code Amount: $10,000.00 �� Section 913 and 915.4. Please note all "Warnings". 1989 CLAIMANT: ANDERSON, Terry Martinez, CA '945,53 ATTORNEY: Stanley T. Grydyk Grydyk & Pierce Date received ADDRESS: 4006 Macdonald Avenue BY DELIVERY TO CLERK ON September 29, 1989 Richmond, CA 94805 Cert. No. P 682-789-832 BY MAIL POSTMARKED: September 27, 1989 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PpHHIL BATCHELOR, Clerk DATED: September 29, 1989 BY: Deputy oFor- II. FROM: County Counsel TO: Clerk of the Board of Supervisors � ) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should 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: IO f �y BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) Cou dministrator (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. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: OCT 3 1 1989 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (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 with this matter. If you want to consult an attorney, you should do so immediately. 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: q,.T 1"a BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator A G/� ill/ ✓ �'� mew September 26 , 1989 9-/1,fOS VIA CERTIFIED MAIL -------- IF-RECEIVED Clerk , Board of Supervisors SEP 2 X989 651 Pine Street Martinez , CA 94553 PHLBATCHELQR CLERK CQARD OF SUPEMSQQS Re : CLAIM UNDER GOVT. CODE 910 CO "'A C STACC. Gentlemen: The following claim is hereby presented : 1 . Name and address of claimant: Mr . Terry Anderson dba Terry' s Super Shine, 4739 Appian Way, El Sobrante, CA 94803 - 2 . Address to which claimant desires notices to be sent: Stanley T. Grydyk, Esq. , 4006 Macdonald Avenue, Richmond , CA 94805 . 3 . Date, place and circumstances of occurrence: Contra Costa County mandated the Appian Way Construction Project consisting of relocation and undergrounding of utilities on Appian Way. Claimant owned and still owns a business engaged in washing, detailing and polishing autos at 4739 Appian Way, El Sobrante, California, which is a corner on Appian Way and Pebble Drive. The county project required EBMUD and PG&E to excavate , block access , and during construction generated great quantities of dust , which were deposited on claimant ' s washed and detailed autos and deprived access to the business by tape and parked trucks . 4 . Description of injury, damage or loss incurred: The above activity caused claimant to suffer losses in having to rewash and redo detailing of autos already done and prevented claimant from enjoying his usual access to his customers , thereby decreasing his volume of business during the period from approximately April 7 , 1989 to July 7 , 1989 . Clerk , Board of Supervisors Page 2 ' 5 . Names of employees causing such injury, damage or .'loss are not known. 6 . The amount of the claim insofar as known at this time is the sum of $10 ,000 determined by the cost of rewashing and detailing autos and loss of business . This claim is being presented by Stanley T. Grydyk on behalf of Terry Anderson this 26th day of September 1989 . STANLEYT. GRYDYK Attorn y for Terr Anderson dba Terry' s Super Shine oya m o m 0 .• I ,D O 0 0 n a �: m m M d. � � o � nC) PJcn O F- 11 11 Z tt F3 Fl (D N (D C) bd 0 0 C) rt- H �i a.., rLi n O O r-h cf) d [� cn H r, FC I(DfCi, f i x m DOU j Flr rN cc �. S j r ; 41/Pl,ii„ . ry _ 'fin' , _ + 1 Y g;. ChesterW�Vimitz' :Ches[e W.Nimitz z ChesterW.'Nimitz Ches�!rWlYi Ttz CLAIM �• �O BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT October 31, 1989 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors J U7I y COUMM*ph IV below), given pursuant to Government Code Amount: $147.50 Section 913 and 915.4. Please note all "Warnings". 0 c,T 2 19$9 CLAIMANT: PETROFF, James Dewey PAartine , Ct/k gzdf5«j ATTORNEY: Date received ADDRESS: 2104 Rheem Avenue BY DELIVERY TO CLERK ON September 29, 1989 Richmond, CA 94801 BY MAIL POSTMARKED: September 28, 1989 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. September 29, 1989 PpHHIL BATCHELOR, Clerk DATED: BY: Deputy I1. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should 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: A BY: - Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: CT 3 1 989 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code sec 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 with this matter. If you want to consult an attorney, you should do so immediately. 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:—n c T �q 1 1989 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator 1 :LAIN% TCS• BOARD OF SUPERVISORS OF CONTRA COT �5� 1��' PP e ur i dl application to: Instructions to Claimant Clerk of the Board P.O.Box 911 A. Claims relating to causes of action for death or zorneinjury��tojL 94533 person or to personal property or growing crops must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Sec.' 911. 2, Govt. Code) . B. Claims must be- filed with the Clerk of the Board of Supervisors at its office in Room 106 , Courity _Administration Building, 651 Pine Street, Martinez , California 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 m;,st be filed against each public entity. .- E. ntity. "E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at end of --his form. , RE: Claim by .) Reserved for Clerk' s filing stamps REChIVEP) Against the COUNTY OF CONTRA COSTA)_ rKL BATCHELOR. or DISTRICT) CLERK COARD OF SUPEPASORS C r ...COSTA CO. (Fill in name) De ut . The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ Zk �'�' _ _ _ s and in support of this claim represents as follows : -----=------------------`=-==--==---------- ----------------- - --- ---- =1.:: ..When, did the,, amage ,:or, injury occur?:: (Give exact date and hour) --------=-=--------------(-.-------------------------------------- d 2. Where dia" the amage or injury occur? (Include city and county)------- ----------------------------------------------------------- d - --- 3. How did the amage or injury occur? (Give full details-, -us--e--extra--- sheets if required) Los �' . GGA/SES /� � Cv1✓•� � / , / ��c�'L�r1/ 4 . What particular act or omission on the part of county or district officers , servants or employees caused the injury or damage? (over) '.:5..:.:•j� zat.. ar.e...the..names of county or district officers, servants or I employees:: causing the damage or injury? ------------------------------------------------------------------------- 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto . damage) ---- ----------=----------- =------------------------------------------------- 7 . How was the amouTit _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 ITEM AMOUNT Govt. Code Sec. 910 .2 provides : "The claim signed by the claimant SEND NOTICES Tb.-'• (A-tcrne y) or by_some person' on his behalf. " Name and Address of 'Attorney t'/ems Claimant' g Signature Address -4- Tele-h, e No. Te iephone No. NOTICE Section:.,7 2 of the Penal"..-Code .provides "Every person who, with intert to defraud, presents for allowance or for payment to any state, board or officer , or to any county, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine , any false or fraudulent claim, bill , account , voucher , or writing, is guilty of a felony.," • 4 st4 E CONTRA COSTA DETENTION FACILITY___. ._.__..... .... .. CLOTHING RECEIPT DATE. t Q$ ' '. � REC: 1'?252 TIME: t?�'I3t~+ =s :ti �aLiiii'1: t NAME(L, F, M) !PLTR0Fr .iA3SF.S lJ t:El' r �r k BOOKING NBR:--- '020640 } Gam` �� C a< i A SKIRT .2. p.. ACKET `' "" .0 HO OTS X.5' f HO PANTIES Z !RT A C NYLONS -Z mcs;° HAT/PURSE S EATER/SWT. SHIRT DRESS OTHER tipf 1 BKG QFC ::�+y r-,r +:r'• �'�'�s'-�W ' " „�. /;INMATE 'rs.. t• 4 DATE I HAVE RECEIVED ALL OF MY CLOTHING, w ` REL OFC INMATE SIGNATURE S 0 Q �, gas � � a. - _� �•. Q6 1 cL .n c0 C� u Q e ejl -Zz 4 V V CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT October 31, 1989 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $7,883.00 Section 913 and 915.4. PleftC1W0ddM&gs CLAIMANT. FARMERS INSURANCE GROUP CAti;,c,(i�o 5�`-� S t P 2 J 199 ATTORNEY: Martinez, CA 945,53 Date received ADDRESS: P.O. Box 4035 BY DELIVERY TO CLERK ON September 28, 1989 Concord, CA 94524 BY MAIL POSTMARKED: September 27, 1989 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. Se tember 29 1989 gPV�{IL BATCHELOR, Clerk DATED: P BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should 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: i 12, t 7q BY: I Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated:CT 3 1 1.989 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code se ion 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 with this matter. If you want to consult an attorney, you should do so immediately. 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: BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator CLAIM 'A�u o 80ARD Of SURERVI.SOPS OF CdNTVtA, Instructions tg ClaimantC•erk of the Board M rtine2,Califomia94553 A. Claims relating to causes- of action for death or or injury to person or to personal property or growing crops must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Sec. 911.2, Govt. Code) B. Claims must be filed with the Clerk of the Board c-f Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, California 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 end o this form. RE: Claim by )Reseed for Clerk's fJ1.4ng stamps FARMERS INSURANCE GROUP P.O. BOX 4035, CONCORD, . CA. 94524 j SEP 2 0 1989 Against the COUNTY OF CONTRA COSTA) Pki;l BATCNEL^ j Or DISTRICT) `Rcc°n RnUrsr,iE'o:'J^' (Fill n name ) .......... �. ne I The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 7 ,88.3_ nn and in support of this claim represents as follows: l. When did the damage or injury Occur? (Give exact date and hour] 8-11-89 at 1310 �. Where did tie damage or injury occur? (Include city and countyS- Marsh Creed Road east of Morgan Territory Rd. , Clayton, CA. county of Contra Costa . 3T How did the damage or-injury occur? (Give �uII �etai�s, use extra sheets if required) Our insured was driving west bound on March Creek Rd. , in the west bound lane at 20 mph and lost control due the loose gravel on the roadway and could not stop before his vehicle went off the road and over the side.' --- ----------T--�---------------T-----------••-----------------T�•--T----- What --What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? loose gravelon road way. (over) employees causing the damage or injury? 6. What damage or injuries do you claim resulted? ZGNve full extent of injuries or damages claimed. Attach two estimates for auto damage) Auto damages - $7,499. 00__ _ towing charges - $384. 00 -` total of $7,883 . 00 --------------------------------------------------------------------- -- 7. How was the amount claimed above computed? (Include the estimate amount of any prospective injury or damage. ) See a ttache&,, 8. Names and addresses-of witnesses,-doctors and hospitals. - Donald Chamblee 400 Woodmont PZ . Oakley, CA. �. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 8-29-89 Vehicle damages $7,499. 00 8-16-89 towing 384'. 00 TOTAL $7 ,883 .00 Govt. Code Sec. 910.2 provides: "The claim signed by the claimant SEND NOTICES TO: (Attorney) or by some -person on his behalf. " Name and Address of Attorney -a. -J„y C aimant Sig ature P.O. BOX 4035 Address C4N6�3Rit, Chi. Ra 5,7Q Telephone No. Telephone No. 415-827-1186 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, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is guilty of a felony. " • -.,,. �+• •• FARMERS INSURANCE CROUP OF COMPANIES 11-571713 - �- PLEAUSTON,CALIFORNIA I51; i I I I 1 I 1210 - C+wnr• Cash Twe h-6 ci oil . Yrne C11M/ o Mc <of m. (1) R) CidnwM(Oa To.6ro buu.deo.ca o.�c.a Mba.r.la air ba.); t .; ALft 3 R- Ws s f,� . .. � -K..r,.�. �.' �` ,�• #',e,_�,�zs�.'`. y"" a "` +3 .#'� 6 M. 7 ft Cot 1 D 4zNao'A Rar" C•Ildos - -'{aa�pnhe'"ti' 'TypEi�Aai"tart ' �. .lm buddy '.Q3Camlr 38 t 30 - - comp. 1 ] 3-4 5'..6 .PAY'SFie �'1 t0r c c .i..t P- . BCOIv E T co 10 G '✓ '.f.. L_E - - - - BQO Na �o • • v o®AFret su Mordttls - ia. J €." • •' ' ` Fmts►pt ' 0 'Tf Ax1t ortAw►aet�a spa'! s i - TRIPLICATE BCO`COPY - = RMERS IAtS�1RA11 �CRQ�J COIilII�AIVf �ii 57f�13 » ' w u-xEA'sr>xsatt�ke�h�asc>1 __L7 ,1,.....� �t��i F-n�.>��I. as � �i s.�"� ��;1.� T tee`. l � -4k �,.t '•Q•�! x � .lsiff7 �� , tal �CE1fAk -. :. ♦ a6�� p sg„��—s-...gra- Y-�z.s:�ar�_,.�' — a- ,-�.Via- - _ -.�:,�.r,.,..P.,�i....m,...��; -. xi-�� -.x.. -^.� �.r,._.s°- � n^1. t8 w -ra�ra-x�-o� •s-- - r �e:+�^•....���_ , \ 3 PCrabie rOY Cat6l1RN1I1 ,... €t ' x . 8Y♦!C __„iCdC �`; �i 3 'r -v, -� 'a rte,a-aa-"� aw v s„ .i v. F R� .. S4� ra�'` �' 't+&°,I" W t*"" �"•_ "St BTlpllfL=TV DRIVER OF OUR 'VEHICLE ROBERT CHAD FENTON,. POLICE REPORT. # 8=.150 •�► VOID ENTERPRISES 3640 GRAND AVE.•OAKLAND,CA 94610•(418)465-8167 P.O.BOX 3333 ARCADIA,CA 91066 • (818)574-6888 IA G0023410 —85 677 631 Yes Yes Yes NO Yes NO NO Yes rs • A P P R A LI S AYdings, Cargo dents, ction. PREPARED FOR FARMERS INSURANCE GROUP 1986 TOYOTA STANDARD 4x4 PICKUP ed n in PHYSICAL INSPECTION REPORT Page 2 Headliner in good condition. Dash pad and dash fascia good. Door and trim panels in good INTERIOR 'Good' condition. Tear/rip noted in left side of seat cushion. Rubber floor mat in good condition. MILEAGE 050,788 Odometer reading TIRES 54 % wear 5/32 ± average remaining tread depth. Big Foot Mudders 35xl2.5SR15 LT Blackwalls • ( a► BI® ENTERPRISES, INC. ®� 3640 GRAND AVE OAKLAND CA 94610 (415)465 8167 PO BOX 3333 ARCADIA CA 91006 (819)5 74 6888 1986 TOYOTA "STANDARD 4x4" PICKUP APPRAISAL ESTIMATED CASH VALUE. . . . . . . . . .(date of loss). . . . . . . . . . .$ 7,000.00 The above value is based on good mechanical condition of vehicle. Proper adjustment should be made for any serious mechanical defects existing at date of loss. The above cash value includes adjustment for the following items. CREDIT DEBIT 1) Sheet metal 1) Paint (as noted) 2) Paint 2) Interior (as noted) 3) Interior (overall) 3) Tires 4) Options/Accessories 5) Mileage SPECIAL NOTE: VALUE APPRAISERS Pl! F I Cl 1 NSIJRE--(,) 13m I I H PH I L. C,I A 1 MAN-(- = NCUNE PICKUP i. G T 1 `-j/PWR 1-OCK-';/FNK'E I S 7`;1"6—`,x'7`7 --349- 70 73 7 5 0 0 TIF-,,E':"./NERF DAPS/MAG LIFT/EXTRAS 408-1268-1708 7675 NEW TIRES/GREAT COND . 400--97@-9436 790-0 -1 INES 916 677 -747"" 7:00 TIRES/MINT 408-972-0321 7950 -L-L-D Oe iTREC 1;,-:1144- 227 4 7 95 ' �/!)I-X PKG/CUSTOM CHROME/ENKFA 916 441 -76 R 0 F'USTOM PAINT//WHLrZD' 9200 & TIRES 12' E- 9300 IIIUDOEI, 4 1 6 0 6, 0 0 0 i.-USIOM PNT/GRILL & BUMPER': 4 1 79 2 4464 1(11300 "TIPS MANY EX i 1--�A S -7 U7-4=;6-1 117 111:100 -j 71RES/KC LIGHTS/ROLLBAR 41.5—2"2 H,9 5 13`+9` D I F" E,N L f f-)I FARMERS i NSURr)N1.-Il- IAF (ll.lF - PO BOX C:Of�C:ORI") , 1 8-16 nATc= M L F7, F-.NG 1 V�1[ Ti- Op 1 4/8Y 69K IVIG VG Y AM/F M y 1986, s-,1 8/06/89 G G 1986 T/TDR 8/18/B9 44K G G AM/FM Y '1986 r-,AC BE 7/09/89 L.0 O/T y 1986 T/TDR 8/11/89 4,; K E E 1986 1987 1986 D/DLR 8/17/89 69K G G A M F I'l Y SUN 1986 SAC BE Fj 6 89 1987 C) I-I J-7 r: - .1 1 9U69U6-7 T;"TDR 8/ 1 1 ./8Q AM/FM Y -17 T;/TDR 89 SP E 19e7 D/D!.-R o/11. y AM/FM CB 1986 BID ENTERPRISES ® 3640 GRAND AVE..OAKLAND.CA 94610.(415)465-8167 ' P.O.BOX3333 • ARCADIA,CA 91006 • (818)574-6U8 1986 TOYOTA STANDARD 4x4 PICKUP FILE NO.: BEI 14-631 Attn: Craig Kinzer FARMERS INSURANCE GROUP PO BOX 4035 Concord, Ca. , 94524 August 23, 1989 POLICY NO.: DATE OF ACCIDENT/LOSS CLAIM NO.: B 240677 PHIL SMITH 8/11/89 AUTOMOBILE( 36 MILES) .......................$ 10.80 TRAVEL TIME .................................................$ 21 -00 PHOTOGRAPHS .............................................$ N/C SERVICES .............. 120.00 _ Y TELEPHONE (LOCAL/LONG DISTANCE)......$ N/C �Qri ,46.80 CLERICAL ......................................... . ..........$ 15.00 EXPENSES.................`.s?�y MARKET SURVEY..........................................$ 45.00 rq s 6�0 APPRAISAL FEE.............................................$ 75.00 TOTAL AMOUNT DUE .................................... 166.80 .........................................................................$ .......$ TAX I.D. NUMBER 94-228+4022 PLEASE RETURN COPY WITH REMITTANCE ' L AU G, `'51989 COR+ ;0p0 D.C.0. VALUE APPRAISERS AND SALVAGE REPORT 2❑ Theft ti S y: gab 30 Fire FARMERS ❑ MLD-CENTURY ❑ TRUCK ❑ TEXAS CO.MUTUAL q❑ Comp. �o tHEe Claimant License Number ZUD(o <6 1` State Polic Number SALN Date of Loss Complete Vehicle Identification No. 2- CiI ?32yn ��� -rr - �� p yio VEHICLES EVALUATED Loss Vehicle Vehicle Evaluated Add or Subtract Number of Sources Used to Select Settlement Vehicle Year and Make ( // for Difference G D in Condition Comparable Vehicles Dealer Quotes I Model No. Per Guide pt U or Equipment Used Car Guide used Body Style Name I Typ of Equipment Type of Equipment of Sources and Condition and Condition and 2. ' } atfw.:, Vehicle Sale Price ` « �r k x Phse 3. Mileage S� Comments 8 Explanation of Settlement Engine L,C Transmission Power Steering tN Air Condition { Sheet Metal U , 3 Paint Interior U Vinyl Top � Stereo _ N/ .Wheels Tires Recondition ❑ Dealer Quote L)Li Market Valuation Service Actual Cash Value of loss Vehicle Settlement ❑ Comparable Car LL'j Vendor Valuation Number p 0 0 0 Based on ❑ Used Car Guide No. SALVAGE REPORT Add Sales Tax N c1 O,` PHONE SALVAGE BIDS Lic. &/or Transfer Fee Buyer Norne Bid Amount BCO Settling BCO Selling loss of Use Advance Tow 0=) Wearing Wearing Apparel Storage/Day Less Salvage Service Charge Less Deductible Est. Salvage Value Amount of Draft Location of Salvage Upon Inspection Name Address Phone# Salvage Released to: Name CR BCO 7 Name B'i # >Z CR Address Phone p c ID# Date " Phone t/ � 7�t Release Date Sale� Stall # — —1 g' M,ICHr.E �� =N BC M or -� C Rep rled to Com y Rep rted to BCq Assigned to CIR BCS _I L( � `I Ll— 'C,7 60 - r16 Approval DATES Assigned to N.A.T.B. As igned to Vender or Buyer Loss Settled- AUG - I� `b ' C`! ` Date B.C.O. COPY 23-0637 388 1901 2001ST PRINTED IN U.S.A. •i' 7 i i R � +---� l l R l' � . I�� ! � I l j__L_ __li- i---(--i---;---? � i��_~—f > r 4 Z a N 9 � m n A N N > m Cs q > z +n Co~ $ n B Z 0 > 9 � ®w �'� r m m 'i (l O �nm^wm �' � { 2 77 m �0 alM m .► ,m,. : m vIla V U) o o Z " Z m m O to o N0.. z 0# O m i m -s A0 01r a " N f ua 31 r n 0 0 � (P Z > 0 m m m Z N o 0 { 10 ❑ S �s c rn A m / ft r m i >-4 N ��„ " 3> > D; DO = x 00 m C >_ m m -C _ p> m r h2 pi OZ wt i p N 9 c r- tii In 2-t N A> A Z P! » i ,i 1 Z > % r > 2 r o r z r a ❑ nr 0 >� x "o° m j _ 2 No►ick Oklohomo City 8D T W HI � 199 J MAYHEW WAY' j l WALNUT CREEK, CA 94596 I 933-1221 AUTHORITY ' 1. 0727 7 2 7 24 HOUR SERVICE V VALUE - CASE F!p DATE NAME ADDRESS -. —_ — ------ -' --'-- CITY - SiAT�- TnV+I REOLIESTED BY --_—lam ---- _ iME_----r.M. YEAR MAKE LIC. NO COLOR �"� V.I.N. NO. `• .�` DRIVER CASH CHARGE ON ACCT. FOR JUNK REPORTED c / TOW: FRONT ❑ REAR ❑ DOLLY ❑ WHEEL LIFT ❑ CARRIER ❑ 10 FROM: k5 G' -;7- TO: r=To: t---7 C�. c CA GA�c 2ND TOW - �� _ / Al LABOR: START LEIN COMPLETE LEIN ADVANCE CHGS i - n T- STORAGE: FROM: —�f j TO. _❑ LOCK OUT ❑.,.DEL.GAS,, AFTER HR. LJ TIRE CHANGE } DEAD,-BATTERY RELEASE RELEASE OF PERSONAL PROPERTY SERVICE }. RECEIVED BY �( ? TQTAL s e e R.O. P.O. EXPIRATION DATE MEMBERSHIP NO,OR DRIVERS LIC.NO, FILE COPY iwi W- t Hdd��✓,�a v ' m t � m 0. c� F 7 w • y h to .o oh W W i Z � E+ N ' Q y p Q) � 0V � W O a H a amara oo � a LL W ri %0 O IL Z) O uiU W u = U 0 C L. Z LL F\ CN CO LO 001 Qz LO C Q� "'�l� •4 0) m � w M m O @ ��1U W o V u YY���, v 0[: L X P t 0 U O T r� m O f Q0 CD O LL U n- U CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT October 31, 1989 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code .Amount: ;Unspecified Section 913 and 915.4. Ple h_knt/aQYLWF*e�gs". CLAIMANT: STEELE, Lisa j p N � 5 ATTORNEY: Martinez, GA .945,53 Date received ADDRESS: 285 Schuman Way BY DELIVERY TO CLERK ON September 28, 1989 (hand deliverer Livermore, CA 94550 via Ris Mgmt. ) BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. September 29, 1989 PpHHIL BATCHELOR, Clerk DATED: BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors � ) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying , claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should 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: 29 / 9 BY: I Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( Pf This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: DCT 31 1989 PHIL BATCHELOR, Clerk, By ry,g...-- Deputy Clerk WARNING (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 with this matter. If you want to consult an attorney, you should do so immediately. 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:_ QCT 3 1 1989 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or -for injury to person or to per- sonal property or growing crops and which accrue .on or before December 31, 1987, must- be, presented not later than he 100th day after the accrual of the cause..of action,. : Claims relating to..causes .of action for death "or for.. injury to 'person on to personal property or growing crops. and which accrue on or After.January .19 1988, must be presented riot later than six months; after the aecrual 'of the-cause of action. Claims relating to any other cause of .acti,on' must be, presented. not ; later than one year after the 'accrual `of the cause of action. (Govt. 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. RE: Claim By ) Reserved for Clerk's filing stamp SIS f4 EL� ) R E(;` F 1 V E D Ind _DL-"d VIL, _ Against the County of. Contra Costa ) 1989 or ) PHIL BATCHELOR CLEnK BOARD OF SUPERVISORS District) C T COSTA CO. Fil in name ) By TDeputy-11 The undersigned claimant hereby makes claim against the (ounty 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) pr 2. Where did the damage or injury occur? (Include city and county) ___------ � a_ ou _ _____ 3. How did the damage or in 'ur occur? (Give full details; use extra paper�if required) OA( t1 U �G /_�S_U - 4. What particular act or omission on the part of county or district officers, servants or employees caused..t e injury or damage? YlQ 5PLL.( � 0_oy-\+y-6 1 ( OLVUk C�A r 0 q over 5. What are the names of county or district officers, servants or employees causing , the damage or injury? ---------�v'�=° C��- ------------------------ --------------- ------------------- 6. -------- ------ ----- 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. I!! jil L 2- ----------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) —E&L-------- -- - ---------------------------------------------------------- 8. Names and addresses of witnesses, doctors and hospitals. Spy- 6" -1��_� -m� --- --- - ---------------------------------------- 9. List the expenditures you made on, account of this accident or injury: DATE ITEM AMOUNT ` Gov. Code Sec. 910.2 provides: 4 The claim must be signed by the claimant SEND NOTICES TO , ,..JAtt;orney) orb some person on his behalf." Name and Address'of Attorney Claimant's Signature Address Telephone No. Telephone No. d . N 0 T I C E ° ii9L Coup Section 72 of the .Penal Code provides: , (r "Every person who, with intent to defraud, presents SPA' oMe or for payment to any state board or officer, or to any county, city or distri9t board or officer, authorized to allow or pay the same ifgenuiian$yal� mrraudulent claim, bill, account, voucher, or writing, is punishab e either by imprisonment in the county, jail for 'a period of not more than one year, by a fine of not exceeding one thousand ($1,000) , 'or by both�such 'imprisonment and fine, or by imprisonment in the state prison, by a fine of not'exceeding. ten thousand dollars ($10,000, or by both such imprisonment and fine. JIM'S GLASS 2321 1st Street P.O. Box 970 LIVERMORE, CALIFORNIA 94550 (415) 455-1235 f' CUSTOMER'S ORDER NO. PHONE DAT NAME r-.�.j/�jI/�,,/� _.............._�'✓''+- z"\:1.✓.�'.'�..+....... .. ... - .................-....-.......................... ADDRESS ......................................................................................... .................................................................................................................................................:................................................................................................................ SOLD BY CASH C.O.D. CHARGE ON ACCT. MDSE.RET'D. PAID OUT QTY. DESCRIPTION PRICE AMOUNT ............................ - - .......r ? � ............................ ............... - . ... .......... ..... -- --_--............. ............................ ................ . ......................... ............. ...................... .................. hG.. :....... ._.......................................... ... ............................................................................................... ........................ . . .............................. ......... .............................--------------------------- ......... ........................ . .........................----------------- ..................-........................................ ......... ._.._. . . .................................................._..................................................... _ ..............._ -------------- ....... ........................................................................ ..........................._.. ........................ . ..i .._ .. .... ... . ......................... ...........- ....:........... I ................ .. .. ............................................ ........................ ................ ........................ . .............. ..a............------ .................................._..... . ..:..-.----.............._........... ............ ..... . ... ...................... ... .... ........... . . TAX O � RECEIVED By / TOTAL 2 All claims and returned goods MUST be accompanied by this bill. sink"Y®u the - Giass Guys 415-534-7000 415-449-4455 AUTOMOTIVE •COMMERCIAL•RESIDENTIAL LIVERMORE GLASS CO. t A, 12 So. Livermore Ave. UJ LIVERMORE, CALIFORNIA 94550 �vfl� 9 (415) 447-6411 CUSTOMER'S ORDER NO. PHO rO� DATE NAME ADDRESS __._..------- . SOLD 8CASH C.O.D. CHARGE ON ACCT. MDSE.RETD. AID OUT DESCRIPTloN ;PRIG PUNT I - v I I -��-� _ -- ----- ---.._ ----------- ---------------- - -- ........... ----- �1�-'D --- - -- - --------------------_ ' - I - -- I _ I I TAX RECEIVED BY TOTAL 6 3 I op All claims and returned goods MUST be accompanied by this bill. PRODUCT 610 I Y SAFELITE TE A11 T(] GLASS -------- QUOTE 4001 FIRST STREET LIVERMORE,ORE, CA.. 94550 ® 09_..22-89 41 455-8207 CONTRA COSTA COUNTY THIS IS A QUOTE ONLY - DO NOT PAY 1220 MORELLO AVE MARTINEZ CA CASH SALES .... LOG-4 92 665 S. DAKOTA SEA'TTLE, , WA.. 98108 00.00 000 000-0000 LISA SA STEELE SAFESEAL POSSIBLE ❑YES ❑NO DECLINED CUSTOMER SIGN. PART# REPAIRED 1987Year Make Model Mileage Serial # License # Roferenc. # MITSURSHI SPX MIGHTY 2D MINI—PICKUP DescriptionQuantity Part No. 1 F CW5-48--S SHADED WINDSHIELD � 346. 50 181. 91. 181. 91 LABOR 35. 00 35.; 00 :SUED TOTAL: , 216491 SALES TAX: 1.2. 7:3 T61AL_: 229.. 64 Replacement has been made to my satisfaction and I hereby authorize the above insurance company to pay direct in full to the above listed firm for said installation. If for any reason the insurance company does not 'pay for these repairs or replacements, the below signed agrees to pay for said repairs or replacement. DATE SIGNATURE 001092 CASH SALES _ LOC 492 660S. DAKOTA Please Reference Invoice SEATTLE, WA.. 98108 0000 QUOTE 000 000-0000 DO NOT PAY 589337-000149-589387 CASH CUSTOMER COPY INSURANCE OR CHARGE MAILING COPY RT-0035 CLAIM ' �.. .. BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT October 31, 1989 :and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of "California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $441.86 Section 913 and 915.4. Plea sC6jMtV70',laff�fs% CLAIMANT: KAUFMANN, Thomas Lee SEP 29 1989 ATTORNEY: Martinez, CA 9,45-:53 Date received ADDRESS: P.O. Box 5212 BY DELIVERY TO CLERK ON September 27, 1989 (via Counsel) Sonora, CA 95370 BY MAIL POSTMARKED: September 22, 1989 I. FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. DATED: September 29, 1989 EVIL BATTCHELOR, Clerk eutII. FROM: County Counsel TO: Clerk of the Board of Supervisors � ) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should 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: 1 BY: ) SDeputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County hmidstrator (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. ( ) Other: I certify that this is a true and correct copy o.f the Board's Order entered in its minutes for this date. Dated: 0(;T 111 1989 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code sec 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 with this matter. If you want to consult an attorney, you should do so immediately. 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: O CI 3 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator . � . _ 4f 0 August 23, 1989 � ^� O~ Contra Costa County -� County Counsel . "��. ~�. 651 Pine Street - Martinez, Ca. 94553 ` Dear Sir: Last Friday, August 18, 1989 at approximately 3: 00PM, my family and I traveled northbound on Tassajara Road, about one half mile south of the Tassajara Fire Station. At that time a orange yellow colored dump truck ` which bore the Contra Costa County seal on the door began entering onto the roadway southbound, from the west side shoulder, as we passed by in the opposite direction. As the truck continued onto the roadway surface it "kicked up" loose pieces of gravel from the road surface. These pieces of gravel struck and caused damage to the windshield on our 1977 Mercedes Benz 240D. We immediately attempted to make a u-turn to catch up to the responsible vehicle in hopes of determining identifing information such as the truck number, license number, drivers name, and etc. , but the width, condition and area of the roadway prevented us from doing so until we traveled another three hundred yards further northbound. By the time we were able to make this u-turn and travel south in the trucks direction of travel it had fled the area making further identification impossible. Just prior to the truck entering onto the roadway there were no other vehicles traveling southbound in front or to the rear of the truck, nor were there any vehicles to our front, northbound. This area of Tassajara Road was being resurfaced with gravel (chip sealed) by a crew from the Contra Costa County Road Department. The damaged windshield has to be replaced as it violates section 26700 of the California Vehicle Code. The replacement cost was estimated at $441 . 86, refer attached estimate copy. . This letter is a request for the County of Contra Costa to reimburse the cost to replace said damaged windshield, which was damaged as a result of resurfacing materials placed on the road surface and by a t n employee of the county. Awa reimbursement Tho Kaufmann -- Post e Box 5212 - Sonora, Ca. 95370 209 532-1380 ` ` ` . 1 Lic.6274528 SIERRA GLASS, Inc. , Date' Since 1947 z REQUESTEC' CARROLLMANNING (209Y532-3652" 1901:Mono Way, } Add fe98 Fax(209)532-0589 Sonora;CA 95370 y i4 Telephone ;:. . : Customer's.Order No. 2 , tMORK DESIRED.. ;i•, .y "V12," s- �a s v •t � �� , , r s n n , t V:1 TERMS Order Taken by I _ s A ƒ Lil � � d � \ � � \ \ . i . ' Q \ . � gz Vie \ { 6lk � VICTOR J. WESTMAN CONTRA COSTA COUNTY COUNSEL P.O. Sax 69. CO. ADMIN. BLDG.. MARTINEZ. CA 94553 TO DATE SUSJECT I -------------- S t �l El I+ V _. 71989 PHIL DAA IIELOP CLERK HOARD OF 9'UPERVISCR'' i By .........G4.. Deputy i i q i L�� CLAIM J`140 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT October 31, 1989 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Unspecified Section 913 and 915.4. Please note all "Warnings". County Counsel CLAIMANT: KURUTZ, Audrea s r 198 ATTORNEY: Date received Martinez, CA 945513, ADDRESS: 809 Gloucester Street BY DELIVERY TO CLERK ON. September 27, 1989 Antioch, CA 94509 BY MAIL POSTMARKED: September 26, 1989 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy.of the above-noted claim. September 29, 1989 PpHHIL BATCHELOR, Clerk DATED: BY: Deputy 11. FROM: County Counsel TO: Clerk of the Board of Supervisors (�► ) This claim complies substantially with. Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should 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: 9 /99 BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER- By unanimous vote of the Supervisors present ( This Claim is rejected in full. Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: OCT 3 1 1984 PHIL BATCHELOR, Clerk, Rv �-yf,�.,�.— Deputy Clerk WARNING (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 with this matter. If you want to consult an attorney, you should do so immediately. 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: OCT 2 1 9 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator i Cla *toa BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating 'to causes of action fo^ death or for '.'injury to person or to` per- ` sonal property or growing crops and which accrue on or before December 31, 1987, must be. presented notelater than the 100th day after the accrual of'the"cause of action.,", Claims relating to causes of action for death or for injury to person or to ersonal property or growing crops and which accrue on or after January 1, 1988, must be presented not `later than six months after the accrual of the cause of action. Claims relating to any other cause ofaction must be presented not later than one year after the accrual of the cause of action. (Govt. 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. RE: Claim By ) Rese pie I S .P,;1A stamp cr oil I V E ) Against the County of Contra Costa ) S.r_p .;2;7l989 or ) PHIL BATCHELOR CLERK BOARD OF SUPERVISORS CONT COSTA CO. District) By ....... Deputy Fill in name ) 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) 64- week of G C t.s� r�o cxc -e 0-F 4--4 -C, bectu s _ ;Q!it'�_ '_ e- --.ice (_ ak_cc.) 2. Where did the damage or injury occur? (Include city and county) 4ae,.�.Jf � .0-[ ? 9 _Somersv�cz 3. How did the damage or injury occur? (Give full details; use extra paper if required) /)2 til ow- wQS,, �C�i ted�� Pf�k, -ILC �o tvV �C cul�' 00 `�l C s -OA- ---------------------------L1 -------------------------- �+. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? 4a�led �Lo hlb�k 0,f�( old- — r}1 v VE c✓ /IU/ (over) 4 f 5: What are the names of county or district officers, servants or employees ca rig the damage or injury? 1 7 b , JAMES ��Az� ��I�u71 G �Lo.1 C 5. What. damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. _ r1 s oUer w AC�_12J------------- ----------------------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) A P 1 ---------------- LeLL 8. Names- and addresses of witnesses, doctors and hospitals. s fie. Jow es b t z- -e-e 5 6&M G�Ot,t� ,' da/m 0 cc u-Yee e use ---_-- ------- --- or-------------- ---- y--------_------ -- - . 9. List the expenditures you made on account of this accident or injury: DATEI,T/aEM AMOUNT /7 +, ] cov, _Jh * * * * * * * * * * * * i * Q7e--* Gov. Code Sec. 910.2 provides: , "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) ,: lor by some person' on his behalf." Name and Address of•Attorney Claimant's Signat FAddress)ouen's S1 horh _CA Telephone No. Telephone No -,77)/ (2 N O T I C E Section 72 of the Penal Code provides: . .. ."Every person who, with intent to defraud, presen",s 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 thari .one:;year, ;by a fine of 'not :exceeding one thousand ($1,000), or by-both such imprisonment and. fine, or.by imprisonment in the state prison, .by a fine of• not exceeding ten thousand dollarsl($i0,000„ or by both such imprisonment and fine. %A"10.1-1., ITIMMAGE :QUOTATION 009050 NAME A �'1 f .•,�' ` 1` V T� DATE' " / WORK PHONE r `�t � HOME PHONE` ��7771"� ADDRESS 61W L S�� /� -CITY/�/ FTl CC—t, STATE�-�/I ZIP�� 77�/ YEAR MAKE��jU Ick MODE +" �� - r ��If C� I.D.NO. ` } PAINT CODE'''S PROD.DATE TRIM MILEAGE LICENSE NO. y r✓ �"� DATE OF LOSS WRITTEN BYINS.CO. FILE NO. CLAIM NO. P.O.NO. ADJUSTER LIC.NO. PHONE Deductible/Betterment LINE RE RE- DETAILS OF REPAIR PARTS INDEX NO. PAIR PLACE R=Repair S=Straighten A=Aftermarket N=New PI PARTS LABOR PAINT SUBLET/MISC. R/C=Recycle/Rechrome/Recore U=Used R=Rebuilt is 1 - 2 s 4 dt OVen t?O U W/oV QQWr 5 6 7 8 9 10 11 12 13 tp 14 15 16 17 18 19 20 , 21 ,22 , 23 24 25 26 27 I hereby authorize the above work and acknowledge receipt of copy. TOTALS M, X Date /y/y0 Signed PARTS Pic s subject lo,nvoice $ �} ,h ' g LABOR hrs.@ wLc' $ Shop Supplies $ :N < / PAINT hrs.tla $ _ ,���' `: 18 � PaintiSupplies $ -75-,00 100 Railroad Ave. Towing/Storage $ Antioch, CA 94509 Sublet/Miscellaneous $ (415) 757- 586 o B.A.R. # 96504 EPA/Waste Disposal Charge $ ` 1'41 'CORK - Owner SUBTOTAL $ DOUG PEDERSEN ® 'anagen $ TAX ....................... $ 70TAL $ ©1988 I/D/E/A inc.Form No.1002 I/D/E/A inc.,One I/D/E/A Way,Caldwell,ID 83605-6902 CALL TOLL FREE 1-800-635-9261 Eq y< ' I tot Tl�I H, $ s ROOM i MAKE YEAC L ,� BODY STYLE COLOR `tet/�'r /./� ,f%i l�/, MILEAGE LICENSE SERIAL NO. INSURANCE COMPANY CLAIM# COMPLETE BODY AND FRAME REPAIR C c" c.- rte, t'r 2505 Devpar Court • Antioch,CA 94509 754-4477 ADJUSTER PHONE NAMV—,-g/1 HOME # f f /C� WORK # `f G f, -:<flr !J REPAIR REPLACE ESTIMATE OF REPAIR COSTS PAINT BODY PARTS SUBLET < -17 r PARTS PRICES SUBJECT TO INVOICE HRS. (a $-6/-, Per Hr. $ ALIGNMENT PARTS $�� D U CHARGE A/C PAINT MATERIALS $ AIM H/L SUBLET-PARTS $ SUBLET- LABOR $ STRIPE STORAGE/TOW $ SALES TAX $ 9 COLOR MATCH TWO TONE GRAND TOTAL TWO STAGE THIS ESTIMATE IS BASED ON OUR INSPECTION AND DOES NOT COVER ADDITIONAL ROCK GUARD PARTS OR LABOR WHICH MAY BE REQUIRED AFTER THE WORK HAS BEEN STARTED. AFTER THE WORK HAS BEEN STARTED,WORN OR DAMAGED PARTS WHICH ARE NOT EVIDENT ON FIRST INSPECTION MAY BE DISCOVERED. NATURALLY THIS ESTIMATE CANNOT COVER SUCH CONTINGENCIES. PARTS PRICES SUBJECT TO CHANGE WITHOUT NOTICE.THIS ESTIMATE IS FOR IMMEDIATE ACCEPTANCE. TOTAL r This work authorized by: dfl : t a venVon COP ` app v is U y p •� O .c Uti t tl ' i CLAIM " BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT October 31, 1989' and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $100,000.00 Section 913 and 915.4. Pleasnote all "Warnings". bounty Counsel CLAIMANT: THE CUSTOMER COMPANY dba E"P 1O Jeff's Food & Liquor c� ATTORNEY: Eric L. Nordskog, Esq. Martinez C Offices of Charlotte M. Venner Date received rt%:3. ADDRESS: 50 Fremont Street, Suite 801 BY DELIVERY TO CLERK ON September 27, 1989 San Francisco, CA 94105 BY MAIL POSTMARKED: September 26, 1989 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. September 29, 1989 HHIL BATCHELOR, Clerk DATED: BPpY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors �(v ) 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). ( ) Other: Dated: 29 cj BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Admi strator (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 . ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. [� Dated CT 3 1 1989 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code se n 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 with this matter. If you want to consult an attorney, you should do so immediately. 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:_ OCT 3 1 1989 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator RECEIVED Eric L. Nordskog, Esq. a 1 LAW OFFICES OF CHARLOTTE M. VENNER 50 Fremont Street, Suite 801 p,,t' ApH• d CLERK t3QA Fa San Francisco, CA 94105 cord o A VISORS 6y Deputy Attorneys for Claimant The Customer Company, dba Jeff' s Food & Liquor CLAIM FOR DAMAGES AGAINST THE COUNTY OF CONTRA COSTA i TO: County of Contra Costa The following claim for indemnity arising from a claim for personal injuries by Tiffany Nelson is hereby made on behalf of The Customer Company, dba Jeff ' s Food & Liquor against the County of Contra Costa. 1. Name and Post Office Address of Claimant: The Customer Company, dba Jeff' s Food & Liquors c/o Law Offices of Charlotte M. Venner 50 Fremont Street, Suite 801 San Francisco, CA 94105 2. Address to which notices are to be sent: Eric L. Nordskog, Esq. Law Offices of Charlotte M. Venner 50 Fremont Street, Suite 801 San Francisco, CA 94105 3 . Date, place and other circumstances giving rise to the claim: Plaintiff' s complaint alleges that on or about February 7, 1989 on Willow Pass Road near Balclutha Drive in the County of Contra Costa, plaintiff encountered icy conditions due to water run off across the street, and adverse vehicle collided with plaintiff' s vehicle, causing bodily injury. Defendant The Customer Company, dba Jeff' s Food & Liquor claims total equitable indemnity and/or partial equitable indemnity according to principles of comparative fault against the County of Contra Costa. This is a timely claim. The Customer Company, dba Jeff ' s Food & Liquor ' s first notice and knowledge of the incident was The County of Contra Costa September 25, 1989 Page 2 the date upon which it was served with summons and complaint, which was on or about July 10, 1989 . Thus, this claim is brought within six months of that date, as required by Government Code Sections 901 and 911 . 2 . 4. Description of Damages: The extent of plaintiff ' s damages are unknown to The Customer Company, dba Jeff' s Food & Liquor. However, it is believed that pliaintiff ' s medical expenses exceed $45 ,000 and that she sustained lower body injuries, including a broken tibia and left femur. She is also believed to claim general damages, lost wages and loss of earning capacity. 5. Employees causing damages: Unknown at this time. Discovery is just beginning on this matter. However, the employees responsible for designing, constructing and maintaining the roadway at the accident site would be responsible. 6. Amounts claims: The Customer Company, dba Jeff ' s Food & Liquor does not know what amounts plaintiff is seeking against it. It is believed that plaintiff has settled its claim against the adverse driver for $100,000. The Customer Company, dba Jeff' s Food & Liquor claims full indemnity and/or partial equitable indemnity according to principles of comparative fault against the County of Contra Costa for plaintiff' s damages, if there are any. Dated: September 25 , 1989 LAW OFFICES OF CHARLOTTE M. VENNER Eric L. Nordskog Attorneys for Defendant The Customer Company, dba Jeff' s Food & Liquor 1178r PROOF OF SERVICE BY MAIL CCP 1013 (a) and CCP 2015. 5 I , the undersigned, Say: I am, and was at all times herein mentioned, employed in the City and County of San Francisco, State of California. I am over the age of 18 and not a party to the within action or proceeding; that my business address is 50 Fremont Street, Suite 801, San Francisco, CA 94105 and that on the date set forth below, I enclosed a true copy of the attached; CLAIM FOR DAMAGES AGAINST THE COUNTY OF CONTRA COSTA in a separate envelope for each of the persons named below, addressed as set forth immediately below the respective names. Clerk of the Board of Supervisors County of Contra Costa 651 Pine Street, First Floor Martinez, CA 94553 Each said envelope was sealed and with proper postage thereon fully prepaid at first-class mail; that I deposited the same on the date set forth below, in a mailing facility regularly maintained by the United States Post Office Department for the mailing of letters at my above-stated place of business. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on September 26 , 1989 at San Francisco, California. Donna Lingel 1179r r. hu sJ� a�9 tt�YY '•C�l .. yt..+I N S- O .r L T O S- O 13 w tFh 0 O 4Yl w � C T - Li 7G �j Uf O � a �'