HomeMy WebLinkAboutMINUTES - 12031991 - 1.26 f _ Xa 6
CLAIM
a BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
:k
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT December 3, 1991
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: $942.77 Section 913 and 915.4. Please note all "Warnings".
RECEIVED
CLAIMANT: FONG, Lilian
File No. 000783942 0101 028 N O V 04 1991
ATTORNEY: Geico Insurance Group
Date received COUNTY COUNSE!
ADDRESS: P.O. Box 85650 BY DELIVERY TO CLERK ON Octog-rz31-;U .991
San Diego CA 92186-5650
BY MAIL POSTMARKED: October 29, 1991
I. FROM: Clerk of the Board of Supervisors TO: County. Counsely
Attached is a copy of the above-noted claim.
DATED: November 4, 1991 PgHHIL ATCHELOR, Clerk f;
BY: Deputy /Z� o- oiLt
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: h BY:(I _ qjq �, Deputy County Counsel
'C[
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:—DEC o 3 1991 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 un 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 perjur„v 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 Claim nt, addressed to
the claimant as shown above.
P
Dated: ®6eC Q 4 �991 BY: PHIL BATCHELOR by O Deputy Clerk
CC: County Counsel County Administrator
1 _-
i
NOTICE OF INSUFFICIENCY
AND/OR
NON-ACCEPTANCE OF CLAIM
TO: Geico Insurance Group.
P.O. Box 85650
San Diego, CA 92186-5650
Re: Claim of Lilian Fong Claim #7839420101028-01 Loss Date 7-18-91
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 Ichecked 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
employees ) 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, Co ty Counsel
By: Q
eputy C my Counsel
CERTIFICATE OF SERVICE BY MAIL
C.C.P. S6 1012, 1013a, 2015 . 5; Evid. C. §9 641 , 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:�A� , /9 , at Martinez, alifornia.
cc: Clerk of the Board of Supervisors ( ginal )
Risk Management
(NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910 . 2, 920 . 4, 910 . 8 )
GEICO RECOVED
INSURANCE GROUP
F70 3 11991 y
II
10680 Treena Street ■ San Diego, CA 92131-2442 CLERK BOARD OF SUPERVISORS II
CONTRA COSTA CO.
SUBROGATION NOTICE
Date:
Our File #
Our Insured!—
Your Insured/Driver: 1z1MMzWe,1
( (?,-
Your File #: — /j� �QD�.�
WHEN RESPONDING--
Your Vehicle: Tag #: PLEASE REFER TO OUR
CLAIM NUMBER.
Date of Loss/Location of Loss:
Our investigation shows your insured to be at fault in the accident.
► 1. Repair or replacement of our vehicle has been concluded.Our subrogation claim will be forwarded.
Please protect our interest.
�. Payment for repairs has been made. Documentation is attached. Please honor our claim.
CO's Interest: $ 7Ya• 2� Insured's Deductible: $
Rental: $ Total: $
► 3. Our vehicle was declared a total loss. Documentation is attached. Please honor our claim.
Amount paid to the insured: $ Insured's Deductible: $
Net salvage recovery $ Total: $
► 4. We have subrogation rights for no fault benefits paid.Our documentation is attached. Please honor
our claim.
Medical: $ Wages: $ Other: $ Total:$
► 5. Since.notifying you on of our subrogation claim, we have paid additional
damages of . Please include this in your payment to us. Documentation is
attached. Our Total Claim is $
► 6 ocumentation of our claim a�s� + t� When—mai we-expect pay-men#?
► 7. Arbitration was filed and a decision was rendered in our favor on . When may
we expect payment?
► 8 Plea make your check payable to:
�[I GEICO ❑ GEICO Indemnity Company ❑ Criterion Casualty
❑ GEICO General Insurance Company ❑
Thanks For Prompt Attention
■ Government Employees Insurance Company
■ GEICO General Insurance Company Signature: i
■ GEICO Indemnity Company
Shareholder Owned Companies Not Affiliated with the U.S.Government Phone:`'� )
S-54-B (6-90)
r
1:0 INSURANCE GROUP 15-3
!ce—GEICO Plaza■Washington,DC 20076 _ VOID.AFTER 180 DAYS' 540
ERNMENT EMPLOYEES INSURANCE CO. ❑ . ` DATE ISSUED POUCY/CLAIM NUMBER DRAFT NUMBER
;O GENERAL INSURANCE CO. ❑ �/ - L^ {�J'% ; ;1 f-Ulu`; w �'
:O INDEMNITY CO. ❑
1 ; .-� ,I o = a �— Uo Q1517706 71
'ERION CASUALTY INSURANCE CO.❑ co.CODE i ACCIDENT DA CLAIMANT
IRS NUMBER ATTY J ID FEATURE AMOUNT ' IN PAYMENT. EXPENSE FCC
OF
and /1 OLLARS ,
Y TO
'HE
.DER r y-- J SURER
1:,." " - GOTIAB-E"--
OF ;"/ % F•`•'v vN i Al'FORiZEDS E.
} f ,
PIRI T NAME HERE k "
NAME OF FIRM
IL TO': tAC� �V' �
PAYABLE THROUGH THE RIGGS NATIONAL BANK OF WASHINGTON,DC
PROCESS THROUGH FEDERAL RESERVE SYSTEM. '
�- I
^ ~
bf
-
0 071200(V/� 9 12:2} P.l
. EST 1 MATE 0: COV783Y42O!O1C�8->�
'
~^ ^`"' ^~
� (415""633-
DAMAGE ASSESSED BY:
Dl CGDE
LICENSE #
LOSS DATE/ NY18/91 INSPECTION DATE. 07/27).i91 CONDITION CODE, G00
[1AlH NUMBER: 000,78394N1N02501 TYPE OF LOSS: COLLlSlON
EXAMINER CODE: F680 PAY CODE: 2 150.00
\ `
O8TOM NAMa 1ILlAN FONG ;
`
8WN[R ADDX[S1 225 GRIZZLY PSAK DLY0 S[RKELEY CA 94703
TELEPHONE: WORK: 20ME: (415) 945-1635
_
.~ - -.
SERVICE CODE! Y14455
VINr 163QC69POK306477 DESCRIPTION: 1986 OLDS FlREN A 4DR SED LlCENSE.1RUC158 CA MILEAGE: 31.686
COLOR: GRAY OLD DAMAGp Y U0 AVAILABLE N
LINE ENTRY LABOR LINE lTEM PART TYPE/ DOLLAR LABOR
ITEM NUMBER TYPE OPERATION 8ESC8lPTION PART NUMBER AMOUNT UN[T
1 42322V BODY REPAIR OUTER PANEL` QUARTER PANEL LEFT 1.5*
2 935OV0 REFlN REFINISH/REPAIR OUTER PANEL, QUARTER PANEL LEFT 1.4*
J 428840 BODY REPAIR PAWEL, REAR BODY 2.0»
4 AUTO REFlN REFINISH REAR BODY PANEL' REFINISH C 1.5
5 AUTO 8ODY OVERHAUL COVER ASSY` REAR O/H 2,5
6 430950 BODY REMOVE/INSTALL BUMPER ASSY` REAR R&l ' lNCL
7 431000 088Y REPAIR CUY[k` REAR BUMPER 1.5*
8 AUTO REFlN REFINISH COVER, REAR REFINISH C 1.5
9 431030 8U0Y REMOVE/REPLACE COVER MOULDING, REAR BUMPER 22514995 GM PART 40.VA INCL
10 4MO40 8GDY KEHGVE/REPLACE .=;P;=~ GM PART lNCL
11 431090 BODY REMOVE/REPLACE OVER RETAINER, BEAR 3VMPER LEFT 22514905 GM PA3T J.VV lHCL
12 431110 BODY REMOVE/REPLACE REINFORCEMENT' 8EARB8HPER *a'81O\5 _ l}3.VV INCL
�
13 43114O BUY R[NN[/REPLAC[ COVER SUPPORT, REAR BUMPER K514745 GH PART .^`26.VV INCL
14 431150 B0Uy HONEYCUM0 RElWFOKCEMENT` REAR RUMP[R 2252O547 ~ GM PART5 MEL
\5 AUTO GEFIN A80'LLADO8 VPH CLEAR COAT ,9
16- �0 �A�'L 0� PAIN ��8l�S BY 25
»`JUDGEMENT lTEM- ~ �'- CINCLUDED. IN' CLtA
COAT Q&C
� @UALlTY*REPLACEMENTPARTS - SEARCH CODE. BAY
S. j. TRADING CO'` INC.
2038 CONCOURSELRlVE
~~-~
SUITE B
- P«�
SAN JOSE
--�'
CA
95131
(408) 434-9222 (800i '660-6067
LINE - DOiLAIR
ITEM PUT NUMBER AMOUNT �~--
12; 81015 113.00
/
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PAM: 1
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r1 �r•.Tr
EST_�AT ID, A tit.�L�v�av_'{li_:t_
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r"'TL - '-J r : f a r•:. { - t ^i i T" r a� r,T'
THIS -1 HAS BEEid ,R PARES BASED `N 'HE USE'GF CRASH PAR-. J tPF iEL J4.RCE i ; A IR-;r �F yrl�;,�t
NI coCJI IMATE L J 3 IJ L L J„L•L 3 `�: l�ti1� ,rC .:.}ZL'i L';LI,_•, L,
?•lx `FIi.: al• i T' 7 T 1 H' I Ltrb+_'IT:ten{ ry t r TQC aa, -T"GSC r,ICTK°..:,Tit
�{ll:t. V_ L.LE, A;;Y WAhRk. Tits A.PL`'.LkBLi ,t�J;-TNESi .rF.SU ,_, , , F ;E_i'-J1It�.S Ai L ���'L�F�,L.t II:LR c:i iri�:�;,
THE ?ARTS, ATHER THAN f'I' THE !l�IGi'tinL,�!��L!FACTLwEIt OF` rtd lEHi�L_E.
REMARKS
HAR
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Aft ii I
LAB=IR
I I v{` - ,Al r +. - A Ar,0"i• 'i T i r,n T 1t -c l�11 MC N
HLIC{i1 V:�EI L? -!1j eve AIL 1f UL:1I I.j: _� __• 1 r111: REP! -LL.,L f{. Sti!i-SARTI l_�tYi
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IOR. SUMMARY TEi ALS 1�.8 `scu. tl L1TtiL ;�F'LACEM IT FARTSAMOUNT: 294.44
1- 1 f i ! �. b T
T 1,, ALJ't! LiNtiL LE'STw tilTv is; 1':. title i i,E5 ;I�lL I! .
TAXABLE COSTS 89.25 "v5=+RAtvCc DEDUC T I i+LE s0.:
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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 December 3, 1991
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: Section 913 and 915.4. Please note all "Warnings".
RECEIVED
CLAIMANT: HASSEN, Joel
NOV 04 1991
ATTORNEY:
Date received C�MjOUnl7r COUNIUsJet
ADDRESS: 309 Wi 11 oughby. Court BY DELIVERY TO CLERK ON Octo lerN�l,A1F991
Lafayette CA 94549
BY MAIL POSTMARKED: October 30, 1991
I. FROM: Clerk of the Board of Supervisors TO: County- Counsel-4
Attached is a copy of the above-noted claim.
DATED: November 4, 1991 PpHHIL ATCHELOR, Clerk
BY: DeputyYLUIa
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:
i
Dated: 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
(,-f^ 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:—DEC 0 3 1991 PHIL BATCHELOR, Clerk, By v 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: D E C 0 `� 1991 BY: PHIL BATCHELOR bynvm 11 0, eputy Clerk
CC: County Counsel County Administrator
v '
-
`
6
'
~
[ RECEIVED
OCT 3 11991
CLERK BOARD OF SUPERVISO
COMA COSTA CO.
::L
July 5, 1991
Joel Hassen
309 Willoughby Court '
Lafayette, California 94549
Contra Costa County
Room 106
County Administration Building
651 Pine Street
Martinez, California 94553
Dear Sir or Madam:
Enclosed is a two-page completed claim form for �broken
s
windhielut
d due -to rock from negligent paving hitting car on
Taylor Blvd. near Pleasant Hill Road at 8: 00 A. M. Thursday,
June 27, 1991 . My son, Jon Hassen, was driving the car owned
. by me.
Please stamp the enclosed copy of this letter and
return it to me in the enclosed self-addressed stamped
envelope so I have evidence claim was received.
Please call me at 415-271-3036 as soon as possible to
advise me when claim has been accepted so I can get the
window repaired.
w
Si l
�
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 -16ter 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 ithe .Board of Supervisors at its office in
Room 106, County Administration Building, 651 Pine Street, Martinez, CA 945530
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 agalnst'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 ) Res(=Astamp
V_
OCT 3 11991
Agains the County of Coi]tr -fiesta )
CLERK BOARD OF SUPERVISORS '
CONTRA COSTA CO.
' District) - '
Fill in name
The undersigned claimant hereby makes lain against the Count of ontra Costa or
the above-named District in the sum o $ - in support of
this claim represents as follows:
----------------- -------------------------------------------------------------------
1. When 4id the damage or injury occur? (Give. exact date and hour)
2. Where did the damag; or injury occur? (Include city and count
3. How did .the damage or injury occur? (Give full details--'use extra paper if
pp"
required)
4. What particular act or omission on the part of county or district officers,
servants or a ploye s caused the injury..or. damage?
;''�/�-���
(over)
7., what. are the names of. county or. district officers, servants or employees causing '
the damage or injury?
5< What damage or injuries do you claim resulted? (Give full extent-
^of or
- damages claimed. Attach two estimates for auto damage:
7. How was,the amount claimed above computed?::.(Inelude �-the.estimated amount of any
prospective injury or damage.)
------ -------------------------------------------=-----------------------
8.
----- ----8. - Names and addresses of witnesses;. oc;ors. and hospital
CO/L4-o �17�
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
-:
to Gov. Code Sec.- 910::'2 -provides: r
"The claim must be signed by the claimant
SEND NOTICES TO- `;;(Attorney) or 'by oe persoo oX his behalf."
Name and Address,`of`Attorney
_ i-- •. - . - - Cl' i t's"Signature.
..
C, c
Address
Telephone No. Telephone No. 39- f 7 2 a -3 0 ,4,
* * * *
NOTICE
Section'72 of the.-Penal.Code~provides:
"Every person who, with intent to defraud, presents for allowance or. fo'
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 falseor 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.
i
ADDENDUM TO THE CLAIM OF.
(Print your full name)
( 1) Do you use the roadway as part of a daily commute?
Yes , No ( )
( 2) Were you aware that construction would be commencing on
the roadway?
( 3) Was an alternate route available?
Yes ) No ( )
... . . ,fes; ,.•T' �.-'-' ' t-� - -
( 4) . Did-you -read about the impending resurfacing in the local
newspaper? :� ,�,s .•_
'Yes ( ) No
( 5) ,Did you see warning signs advising of 'l'oo'se gravel and a
25 ,milt per 'hour ;adv`isory sign?
Yes No ( )
( 6) Did the -:damage result from. another- vehicle exceeding the
_...._ . 25' mile -per`hour -advisory? -.-.d. 4.• r,�.•,
. .. .. - .. - . 1. _ Yes •( • �, � No )
(7) Did a vehicle traveling in the same direction and exceeding .
the 25 mile per hour advisory gign attempt to pass you?
Yes (' `�Y" ~_ No
( 8) Did a vehicle coming from the. opposite direction cause '
gravel to'-be thrown onto 1yout`car--? '
:4
Yes No
C a I
( 9) Was the vehicle located directly in front of' you exceeding .
the speed advisory?
Yes ( ) No ( )
( 10 ) Did you travel the. .roadway' more than once during the-
resurfacing prior to the damage sustained to your car?
Yes ( ) No
( 11) Did you obtain the identity of the car relating to
questions .6 thru 9?
Yes ( No ( )
-If yes, please provide identification bel
(12) Please describe in your own. words how the gravel caused
damage to "your vehicle and the angle the. gravel was thrown
onto the car, -along with the specific damaged parts on your
vehic ea
. - b
( 13j Were you aware that- using the road during. the chip seal
process might result in damage to your car?
Yes ( ) No
I declare that the above inform ion ' s. t e nd correct
under the penalty .of perjury.
(Signature)
( ate)
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LAFAYETTE GLASS
QUALITY WORK No. 17720
REASONABLE RATES 3469 MT. DIABLO BLVD. LAFAYETTE,CA 94549
(
284-9510
CUSTOMER ORDER NO. DATE ORDERED PHONE NUMBER ✓ PHONE FIRST TERMS: INSTALLED BY JOB DATE
❑ COD ❑ NET 10 ❑ NET 30
QUANTITY SIZE > DESCRIPTION UNIT PRICE AMOUNT
X
x 157 E C AA',,,u
X �
� r
X
X
X
X
X
RECEIVED BY: XTOTAL.
FULL PAYMENT AT JOB COMPLETION UNLESS NOTED OTHERWISE::';'•, f ..�� � �
PLEASE PAY FROM THIS INVOICE-STATEMENT SENT ONLY UPON-REQUEST
TERMS-NET 30 DAYS - FINANCE CHARGE OF VA% PER MONTH(ANNUAL RATE: 18%)C RGED ON PAST DUE BALANCE.
LAFAYETTE CLASS
C�Ul�LITY"WORK N O' 27730
3469 MT. DIABLO BLVD. LAFAYETTE, CA 94549
'REASONABLE RATES
284-9510
CUSTOMER ORDER NO. DATE ORDERED PHONE NUMBER ✓ PHONE FIRST TERMS: INSTALLED BY JOB DATE
❑ COD ❑ NET 10 ❑ NET 30
QUANTITYSIZE _
n DESCRIPTION - UNIT PRICE 'AMOUNT
x
e ,
x
x
x
_ x -
x
e'
x
4
p yF�
RECEIVED BY: X
FULL PAYMENT AT JOB COMPLETION UNLESS NOTED OTHERWISE. _
PLEASE PAY FROM THIS INVOICE-STATEMENT SENT ONLY UPON REQUEST
r
TERMS-NET 30 DAYS - FINANCE CHARGE OF'V/2% PER MONTH (ANNUAL-RATE: 18%)CHARGED ON PAST DUE BALANCE.
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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 December 3, 1991
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: $125,00 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: HELMS, Pam RECi VED
ATTORNEY: NOV 06 1001
Date received Novem-NwTY5�ou1ffil
ADDRESS: 5721 Fleming Avenue BY DELIVERY TO CLERK ON MARTIMEZ CA11p,
Oakland, CA 94605 From Risk Management.
BY MAIL POSTMARKED.
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
November 6, 1991 PpHHIL BATCHELOR, Clerk
DATED: BY: Deputy
14-4
FROM: County Counsel TO: Clerk of the Board of Supervisors
{�S ) 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: r / Q, A Deputy County Counsel
U
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
(✓'S 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: DEC 0 3 199 1 PHIL BATCHELOR, Clerk, Byq4= L '� 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 Cl imant, addressed to
the claimant as shown above.
0
Dated: DEC 0 4 .1991 BY: PHLL BATCHELOR by Deputy Clerk
CC: County Counsel County Administrator
Claim t0: 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 propertyor 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 ofaction 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
RE: Claim By ) Reserved for Clerk's filing stamp
RECEIVE®
Against the County of Contra Costa ) NOV 51991
or }
District) CLERK BOARD OF SUPERVISOR
Fill in name - ) CONTRA COSTA CO.
The undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $ 12S°C and in support of
this claim represents as follows: _
-------------------------------M-N----a-N----NN-N---�-N-----N--N------r----
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),
O�__ CE Adi _t__ Con3� COSTA ; 3k D
---N-N---N wN--N-N--N--�-----N- ---
3. How did the damage or injury occur? (Give full details; use extra paper if g
required)TU COUP( \►joL� Vjtt pct NTS NCn -C+m—
�T P��' .•.(s�0� � � ��511.)p4:K-S� �:E�7�: l�N��• �. �P� ®U�-..
----- -----------------
4.
-- -4. What particular act or omis`sion• on the part ofcounty.or district officers,
servants or employees caused .the injury or damage? '
(over)
5. What are the names of county or district officers, servants or employees' causing ,
the damage or injury?
u�t�bw r`J
-----------------------------------------------------------------
5. What-damage or injuries do you claim resulted?- (Give full 'extent of injuries or
damages claimed. Attach two estimates for auto damage.
• '•w�tT� P���r,' O� LST' S1�� O� iNt.t•! v�ll-�Gl� .
-------------- --- -----------------------------------------------------------
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective .in jury or. damage.) :Z- t.v�v i -Te> bV A&)Iro t L � r�
UJAIAIL x.91- 0? Mi* st i,vLAT
--------------------------------------------= ------------------------ ------------
8.
------- ------ ------------
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 st be igned by the claimant
SEND NOTICES TO: (Attorney) so Pe n o his behalf."
Name and Address of Attorney
Claimant Signature
Address
Telephone No. ' Telephone No. 1d
* *
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 ($10,000, or by
both such imprisonment and fine.
AnI sIMAEL'S AUTO DEETAIL 7 819
• 2740-J NORTH (MAIN ST.
WALNUT CREEK, CA 94596
(415) 934-1543
AS LISTED FOR LABOR AND MATERIALS
ES, TE OF REPAIRSVERBAL AGREEMENTS NOT BINDING ESTIMATES FREE
OWNER DATE
�!�-, c Ing /O
IADDRESSPHONE EST. NO.
INSURANCE CO. - ORDER NO.
ADDRESS PHONE LICENSE NUMBER
YEAR-M KE - MODEL MILEAGE MOTOR NO. SERIAL NO.
i d
!i Com'W
z
PARTS PRICES$ASEfl Ott STAI�fflARD CAfiALOG PROCtJlkENi€tJ3 pRtCE L15TS SU$]ECT TO CHAPtGt WITHOUT NiJTtCE TOTAL
RROCUREMENT AFID flE1tVERY CHARGI 5 PoIAY::.6E AfxCiE4 POR SPECIAL SERVECE Oh(fYEAAS PIAT AUAILA$LE LOCALLY MATERIAL r.
OLD PARTS REAAOVEfl FROAA CARS WILL$E 3l3fWCEfl Ufdl ESS OTtfE13Wt5f IFiSTRUCTED(fd WRlT1t�fG TOTAL LABOR
THE A6G1VE IS lt�I ESTIAt1ATE 9A51*D ON:OUR INSPECTFON ANO DOES NC)T COVER Af�DITtONAL PARTS
'.OR LAQOR Wfi1GH MAY,SE�QUIRED AFTER TFtE WORK HAS HEEN OPENED UP OCCASIONALLY AFTER
W¢RK .HAS STARTED Wt7RN ARTS ARE:f]fSCOYE'REp WH.ICkI ARE NOT ENIpENT CSN PfRST:.tN$PECTION TOTAL MATERIAL
`:BECAUSE OFT1-I�5 TfdE�490�I♦Y F'F7tCES AR..!~TVQ't'GUARANT�Ep
ESTIMATE TAX
ESTIMA`T'ED 8Y,�:; G.1 APPi20VED 13Y
l�UTHORf D A ; ACC:;;F'TEi�
PAI D OIJT-TOW&STORAGE
SUBLET REPAIRS
E3Y C7UYIVi✓R
Cif?AGENT DATE'. Z�
4H 429 RFMFORM
A o�
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
ClaimiAgainst the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT December 3, 1991
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: $5,458.08 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: HYATT, Hary/Farmers Insurance RECEIVE®
ATTORNEY: Paul H. Cryar, Branch Claims Manager NOV 06 1991
Farmers Insurance Date received COUNTY COUNSEL
ADDRESS: P.O. BOX 4035 BY DELIVERY TO CLERK ON 6kWMW.5, 1991
Concord, CA 94524
BY MAIL POSTMARKED: From Risk Management
B2-55371
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
IL BATCHELOR, Clerk a
DATED: November 6, 1991 ��: Deputy
(Lvi 4444
III.. FROM: County Counsel 10: 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( /Th BY: -� L_ 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: D E C, n 1 1991 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.
CE
Dated: D E C 0 4 I��I BY: PHIL BATCHELOR by Deputy Clerk
CC: County Counsel County Administrator
Claim to:. BOARD OF VJPERVfSORS 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 341987,
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..acerual .of •the•cause of action. (Govt. Code 5911.2.)
B. Claims must be filed with the Clerk of the Board of.Supervisors;lat 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 fiiing .stamp
FARMERS INSURANCE AS RECEIVE® </
SUBROGEE FOR MARY HYATT I'i0`R`°A
Against the County of Contra Costa AN 51991
:or x��
CLERK BOARD OF SUPERVISOR/
Julie Aumack DistriC CONTRA COSTA CO. _
Fill in name
The undersigned. claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $ t 5 .4,8 .0 8 and in support of
this claim represents as follows:
1. When did the damage or injury occur? (Give exact date and hour)
6-1.9-9.1. @ 3:05P.M,
--__--------- -------
2. Where did the damage, or-injury occur? (Include city, and county)
3. How did the damage or injury occur? . (Give full details; use. extra-paper if
required) Mary Hyatt driving her 86 ' toyota northbound on Bear Creek
road and was unable to swerve `or avoid a large bump.• •in•. the road due
to traffic . severe damage to underside-of vehicle-,•-.bump in road •marked
by county risk management 1 -hour' after-ac.ciden,t .,
- --------------- __ N_
-------------- ---
4* What particular act or. omission on .the out of county or_district:officers,
servants or employees"caused the injury or damage?
Negligent upkeep of the 'road. . .-
(over)
5. Wnat are the names of'.dounty or district -officer_ servants or employees causing
the da _,,ge or i r fury?
Contra- Costa County
-----------------------------------------------------=------------------------------
5. What damage or.-injuries .do you claim resulted? (Give full-extent of injuries or
damages claimed-. - Attach"two estimates for auto damage: ' " ?
.,%s.evere underc;arriage-.damage to .our insureds vehicle,:"
-�---..7777-..------- ••--r------w-----M--..----..-..-..---....--------
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or- damage.)
$692'. 52 pai ..to Toyota of Walnut :Creek; Estimate attach_ed_.
$4 ,765.56 paid- to Mike' s:' Auto body, estimate attached
5;458,.08 _TOTAL.:DUE
-----------7777-- -------------------------------------=-----------------------------
8. Names and addresses of witnesses, doctors. and hospitals.
Mary Hyatt, ` 335 Lowell -Lane, 'Lafayet•te,. Ca '94549 4.,
-------------------------------------7---------------------------------------------
List the expenditures you made on'-account' of this accident or injury:
DATE :�: . "ITEM! AMOUNT _
6719-91 -Bering, windshield T692 52
6-27-91 Tie rod, steering _ shaft,wh-el bearings $4,765 .56
Gov. Code Sec. 910:2 provides:
"The claim-mus t—beigned by the claimant
SEND NOTICES TO: (Attorney) _ or by wm( ersowon his half."
Name and Address of Attorney
... Paul H. . 9 tTrf ims Manager
Farmers"Insurance, P.O. BOX 4035, Concord, Ce
Address` - 94524
Telephone-No. `` Telephone No'. (510') 827-1186
e * .4 I. ..
NOTICE
Section 72 of the Penal Code provides:' . Xr' '
"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, isepunishable 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.
THE
Farmers . Insurance Group OF COMPANIES
CONCORD BRANCH CLAIMS OFFICE
Date: 11-1-91 1660 CHALLENGE DRIVE
P.O.BOX 4035
• Count Administrator.
CONCORD,CA 94524 .
County 415-827-1186
Risk Management Division
651 Pine Street, 6th Floor
Martinez, Ca 94553
Attn: Julie Aumack 1220
IN REPLY PLEASE REFER T0: B2-55371
Our Insured: Mary Hyatt
Date of Loss: 6-19-91
Our Policy No.: 11910-67-20
Your Insured: Orinda County
Address: Bear Creek Road, CA
Your Policy No.: unknown
Our Claim No.:
B2-55371
Accident Location: Northbound Bear Creek Road, Orinda, Ca
Date of Accident: 6—1 9—9 1
Total Claims: M458 .08
(incl.ins.deduct.)
Deductible: $240.00
Our insured's vehicle was recently damaged in a collision with your policyholder's automobile.
Our investigation established that the accident was caused by the negligent operation of your policyholder's
vehicle.
We have made payment.to our insured for the damage to his/her car. By virtue of our subrogation rights,
we request reimbursement from you for the amount shown on the attached repair bill.
❑ By virtue of our subrogation rights, this is to advise you that we shall seek reimbursement from you for
the amount of the damage. We are arranging for the repairs to our insured's car and when completed
a copy of the repair bill will be forwarded to you.
❑ This is to advise you that we have a medical payment subrogation interest in any payments you may
make to settle injury claims, arising out of this accident. Please acknowledge our rights and protect us
on any payments you make.
Our name should appear on any draft made payable to our insured in settlement of his/her car damage or
medical expenses. If you have already made a settlement with our insured, please advise us immediately.
Check # 1010008964 , Paid to Toyota of Walnut Creek $692 . 52
Check #10100091,38, 1st check paid to Mike ' s A/B 12,870: 63
2,01630
Verytrulyyours. Check #110010067 Paid to Mike ' s A/B (overpaid)
see refund check. sent by Mike ' s for ($361 . 37)
Cindy lyn Newman Q�
SUBROGATION CLAIMS
' I
WE ARE MEMBERS OF THE INTERCOMPANY ARBITRATION AGREEMENT
23-0271 12-89 1251 WI125 C/1000 PRINTED IN U.S.A. M
9 `Ve•
CLAIMS, CHECK.
SA,N: 0 .73 INSURED: -' h l �l
L
PAYMENT FOR: ❑ INJURY LIABILITY ❑ INJURY MEDICAL T�VATERIAL DAMAGE ❑ OTHER DAMAGE ❑ PROPERTY
IS 1099 ❑ YES IS PAYMENT ❑ YES IF PYMT. IS FOR MD, O CIS PAYMENT El
APPLIES TO:
❑LOSS OF USE
REQUIRED?: 0 ADDIT'L.ISUPPL.?: �10 NEED CR: NAME ASSOCIATED? ❑WAIVE UM'DED.
(D NOT U E 1) ❑COLL.PLUS
CLAIMANT'S NAME:' ❑AUTO RENTAL
REIMBURSEMENT
❑SPL.EQUIP.,CB,ETC.)
TYPE OF PROPERTY LOSS; ❑ BUILDING ❑ ALE ❑ CONTENTS ❑ OTHER ❑
CHECK IDENTIFIER INFORMATION[May also be used for Payee Name(s)] .!Y.;;
PAYEE(S)NAMED
NUMBER AND STREET
-
CITY STATE ZIP CODE
AMT. OF ,�\FIELD TOTAL CASH OWNER
CHECK: 6ql, FIN
$ a AL ❑ PARTIAL DJ 4MDLE ❑ LOSS ❑ IN LIEU ❑ RETAINED SALVAGE
CAT. SHOP r 11
CODE: CODE
9 Nis
❑ No sub
INSTRUCTIONS:
DATE
RFOLIFSTED.BY:.- TIA, REQUESTED, APPROVED BY: __. I REQUIRED
Pleasanton Regional Office
Check Number 1010008964
pAy VOID VOID VOID VOID VOID VOID VOID VOID VOID VOID VOID VOID VOID Date 07/19/91
VOID VOID VOID VOID VOID VOID VOID VOID VOID VOID VOID VOID VOID
TO
MARY HYATT & TOYOTA WALNUT CREEK amount $692.52********
over 2100 N. BROADWAY
WALNUT CREEK, CA 94596
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CLAIMS.CHECK:
SALN: -2- S-!� 7/ INSURED: G v
PAYMENT FOR: ❑ INJURY LIABILITY rr❑ IINJURY MEDICAL L MATERIAL DAMAGE 1:1OTHER DAMAGE El PROPERTY
IS 1099 ❑ ES IS PAYMENT ', ES IF PYMT. IS FOR �, R COMP., IS PAYMENT ❑ YE
'1S APPLIES TO:
REQUIRED?: 0 ADDIT'L./SUPPL.?: ❑ NO' NEED CR. NAME ( ������ ASSOCIATED? 0 ❑Loss of , ,"
(DO NOT USE DI) ❑WAIVE L DD ED.""
❑COLL.PLUS
CLAIMANT'S NAME:'I ` ' ❑AUTORENTAL, .
,;.c.,:;^-REIMBURSEMENT
h ❑SPL.EOUIP.,CB,ETC.)
TYPE OF PROPERTY LOSS; ❑ BUILDING ❑ ALE ❑ CONTENTS ❑ OTHER V ❑
CHECK IDENTIFIER INFORMATION[May also be-used for Payee Name(s)] — --—- —'- Ir �,Y,} ,r H
PAYEES)NAME(Sj 'j'�s
UMBER AND STREET
CI Y STATE ZIP CODE
AMT. OF /J -FIELD — TOTAL CASH OWNER
CHECK: $ )f Lj G ❑ FINAL ARTIALANDLE El LOSS El IN LIEU El RETAINED SALVAGE
CODE: `� CODE C /
❑ SUB NO SUBSly
INSTRUCTIONS: 'SUB
4 ..'UZ
DATE Z
REQUESTED BY: REQUESTED. , APPROVED BY:
-.',...,��> ..�..-.�.�:,��---��:�.,.__'.,'-'-/_�-�--_-- -IF REQUIRED •
Pleasanton Regional Office
` Check Number 1010009138
Date 07/26/91
PAYV D VOID VOID VOID VOID VOID VOID VOID VOID VOID VOID VOID VOID
VOID VOID VOID VOID VOID VOID VOID VOID VOID VOID VOID VOID VOID =
Amount $2,016.30*******
the MIKES AUTO BODY =
order 2001 FREMONT ST ,
of CONCORD, CA 94520
SALN: J3 INSURED:
PAYMENT FOR: ❑ INJURY LIABILITY ❑ INJURY MEDICAL Cll: GATERIAL DA AGE ❑ OTHER DAMAGE ❑`PROPERTY
IS 1099 ❑ YES IS PAYMENTE IF PYMT. IS FOR MD, PD, OR COMP., IS PAYMENT El YES APPLIES TO:
REQUIRED?: 10 ADDIT'L./SUPPL.?: ❑ NEED CR. NAMEe ASSOCIATED? [XO 0 LOSS OF USE,
\\ (DO T USE DI) O WAIVE UM DED.
h ❑COLL.PLUS
AUTO RENTAL
CLAIMANT'S NAME:' " Cv ❑REMBURSEMENT
TYPE OF PROPERTY LOSS; ❑ BUILDING ❑ ALE El CONTENTS El OTHER sPL.EQUIP.,CS,ETC.)
,.I
CHECK IDENTIFIER INFORMATION(May also be used for Payee Name(s))- -"""
PAYEE(S) AME(S) _-...
NUMBER AND STREET
CITY STATE ZIP COOE
AMT. OF „ _._...._....- FIELD TOTAL..- "CASH OWNER
CHECK: $ ❑ FINAL RTIAL ANDLE ❑ LOSS ❑ IN LIEU ❑ RETAINED SALVAGE
T H
CAT. P S 0
CODE: CODE
amu. 4 U B +O _• Y y i r ti ,
IN IONS:
DATE
------ REQUESTED.
. ._. � � qi
REQUESTED BY: REQUESTED;: PPROVED BY:
IF REQUIRED
Pleasanton-Regional office,
Check Number 1010010067
Date 09/04/91
���VOID VOID VOID VOID VOID VOID VOID VOID VOID VOID VOID VOID VOID
VOID VOID VOID VOID VOID VOID VOID VOID VOID VOID VOID VOID VOID ******
Amount $2 .63
the MIKES AUTO BODY
order 20 EMONT ST
of CONCORD, CA 94520
Mzke Rose ' s Auto Body nc .
20.0,1' Fremont St.
•. "f.oncord , CA . 94520
(415) 686-1739
� STATEMENT
8501 08/29/91
Hyatt, Dana 3
o/o Farmers Ins-.,
1660 Challenge Dr-?�? AMOUNT
REMITTED
Concord , Ca . 94520
Payment Due 09/08/91
PLEASE DETACH AND RETURN WITH YOUR PAYMENT.
Balance Forward 0 . 00
07/22/91 30217 Sale 4 , 404 . 19 4 , 404 . 19
07/24/91 Payment 24.0;: 0;0 4 , 164 . 19
07/31/91 ,Payment , 2i;x016h•30:- 2, 147 . 89
08/29/91 30472 Sale 2 , 509 . 26
Someone needsto� review7this,file�since our original', invoice, that was submitted
our. ent�was short b" 2 147 9. which�waso��even_less than our estimate our
Y palm Y' $ �-' c Y Y
office wrote.
At this time, we have a balance owing for -the above amount and we'd like to get this
matter cleared up. Thank you,
2 , 509 . 260 . 00 0 . 00 0 . 00 ,2";x.5'09 . 26
Attn : Clem Claim #;B2"0.553'71
Please our supplmenets attached which
was previously approved by Mark Rieder
Make Rosei's Auto Body,
2001- Fremont St.
Concord, CA. 94520
(415) 686-1739
STATEMENT
8501 07/22/91
Hyatt, Dana
o/o Farmers Ins. .
1660 Challenge Dr. AMOUNTREMITTED
Concord, Ca. 94520
Payment Due 08/01/91
PLEASE DETACH AND RETURN WITH YOUR PAYMENT,
Balance Forward 0.00
07/22/91 30217 Sale 4,404.19 4,404.19
d
c
4.404.19 . 0.00 0.00- 0.00 . . 4,404. 9
Claim # B2 055371
Please find copies enclosed
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OFFICE
r<:e��air Order 30217 07/18/91 Frage 1 Damaae r<epor,t 14199
t+1 JE V,E Fit CI C_z;E ' S L.J T"C) F%C)L}N, .. Y tV C: _
c'001 FREMONT STREET , CONCORD. CA 94520
(415) 686-1739
SERVING ALL. OF CONTRA COSTA AREA SINCE 197c
Vehicle Owner: Vehicle : InsLir;ance:
DANA HYATT 85 TOYOTA FARMERS INSURANCE
335 LOWELL LANE EAST VAN 1660 Challenge Drive
LAFAYETTE GOLD Concord.
CA 94549 3U78115 CA. 94520
W0r-k : Mileage : 104807 (415) 827-1186
Home : Vehicle ID Nl_tmber Policy: 96-1191067.=';-
Date of Loss : 6/19 JT3YR26418G5v ),:)l'74 Claim No: P2-55371
--------------------------------------------------------------------------------
-- r=I NAL. BILL Written By STEVE: KELLY -- --------
Item F,rice Metl Mech Othr Plaint
Remove & e-ir,5tall ;;)ONT bLihI'ER 1.7
iteoair :k gtrdioht?n FRONT BUMPER 1.3 2,c'•
refove k Re Di ace FLAUNT RH.0 I OR � +26.57* 1.0
4. Remove & neolace FRONT AIR CONDITIONING CONDENSER. S 162.63* 1.3
5. Remove & Replace FRONT CR514BR i 191.07 4.7
6. Remove & Replace FRONT SKID PLATE f 22.13 0.4 .
7. Remove & Replace FRONS ENGINE OIL PAN S 66.49 1.8 . ',
8. Remove & Replace FRONT FEEL S 96.53* 0.2-
9. Miscellaneous Parts FRONT WHEEL $ 9.20
10. Remove & Replace FRONT WHEEL TRIM RING $ 42.20
11. Remove & Replace LEFT FRONT WHEEL INNER BEARING . $ 16.92 0.3
12. Remove & Replace RIGHT FRONT WHEEL INNER BEARING $ 16,92 0.3
13. Remove & Replace LEFT FRONT WHEEL SEAL. BEARING 1 3.94
14. Remove & Replace LEFT FRONT WHEEL SEAL BEARIN6 S 3.94
15. Remove & Replace LEFT FRONT STEERING KNUCKLE 4 92.63 1.1
16. Remove & Replace RIGHT FRONT STEERING KNUCKLE $ 92.63 1.1
17. Remove & Replace LEFT LOWER ARM BALL JOINT S 35.77*
18. Remove & Replace RIGHT LOWER ARM BALL JOINT S 35.77*
19. Remove & Replace LEFT FRONT LOWER ARM CONTROL $ 87.60 2.3
20. Remove & Replace RIGHT FRONT LOWER ARM CONTROL / 87,60 2.1
21. Remove & Replace LEFT FRONT SHOCK ABS S 19.42
22. Remove & Replace RIGHT FRONT SHOCK ABS f 19.42
23. Remove & Replace LEFT FRONT STRUT ROD D S 28.31 0.4
24. Remove & Replace RIGHT FRONT STRUT STRUT ROD S 30.37* 0.4
25. Remove & Replace FRONT STABILIZER BAR S 109.16 0.2
26. Remove & Replace STEERING GEAR ASSY $ 733.83*
27. Remove & Replace STRG COL LOWER SHAFT S 152.66*
28. Remove & Replace LEFT FRONT TIE ROD ASSEMBLY S 42.33* 0.1
.29. Remove & Replace RIGHT FRONT TIE ROD ASSEMBLY 1 99.01 0.1
30. Structural Align SET UP AND PILL 2.0
31. Structural Align PILL 4.0
32. Align/Suspension S 72.00
33. Paint Material Supplies S 40.00
34: Discount - PARTS (10x) S- 219.48
35. Remove & Replace LEFT FRONT
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Repairr Order 30217 07(18(91 Page
--` - - ----------- _ ----------
FINAL
--_ Y_
=- FINAL BILL Written By-`..STEVE •"KELLY•: =-Labor.--
_
_
Price,,, filet l Medi Othr Pa' int
37. OEM Part Not Used LEFT FRONT STEERING KNUCKLE::, f ,92»63 _ _--- - ---
38-,.GEN Part Not Used RISK,FW,, ING KNUCKLE P f A 92.63f#�
46. OEN Part Not Used RIGHT FRONT SHOCK ABS
41. OEM Part Not Used LEFT FRONT STRUT STRUT ROD f- 28.31 ..
42» OR Part Not Used FRONT STABILIZER BAR f- 189.16+
43. Discount - NOT ALLOWED ON FOREIGN f. 219»48**
44._Reoove B Replace FRONT AIR CONDITIONING RECEIVER f 3L 63**
45. Remove & Replace FRONT OIL PAN GASKET f 16.56"
46. Remove & Replace FRONT FAN SHROUD. f 74»36 .
47. Additional metal Labor PAR STEERING RACK 2.3+
48. Air Conditioning f 24.K" 1.4+
49. Remove& Replace COOLANT f 15.w"
58. Aim Head Lights 8.4+
51. Refinishing Requires FRONT 8UMpER (COLOR MATCH) _ 8.5+
52. Refinishing Requires FRONT BUMpER (CLEAR COAT) 1.@+
NOTES:
FINAL BILL SUMMARY
MECHANICAL_ LABOR 276. 00 . . . . 6. 0 hours 46. COO r,er hour
METAL LABOR 11 1, 131. 60 . . . . 24. 6 hours . i0 $ 00 otor`
PAINT LABOR $ 16 1. 00 . . . . 3. 5 hours Cd $ 4G 00 oi_+r
PARTS $ 2. 542'. 79
PAINT MATERIALS $ 40. vO
SUBLET $ 72. 00
SALES TAX $ 180. 80 Part Price Increase
# Additional Supplemental Part
FINAL PILL TOTAL $ 4, 404. 19 + Addit.ional Supplemental Labor
Insurance Payable Repair Total $ 4. 404. 19 ---___
Customer Payable. including Deductible $ tZ+. +21O
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Repair Order 30472 08/27/91 Page 1 Damage Report 14685
MIKE ROSE'S AUTO BODY, INC.
- ------------
2001 FREMONT STREET, CONCORD, CA 94520
(415) 686-1739
SERVING ALL OF CONTRA COSTA AREA SINCE 1972
Vehicle Owner: Vehicle: Insurance:
DANA HYATT 85 TOYOTA FARMERS INSURANCE
335 LOWELL LANE EAST 1660 Challenge Drive
LAFAYETTE GOLD Concord,
CA 94549 3U78115 CA. 94520
Work: Mileage: (415) 827-1186
Home: (415) 284-4981 Vehicle ID Number Policy: SUPPLEMENT
Date of Loss: 0/00 JT3YR26W8G5009174 Claim No: B2055371
-------------------------------------------------------------------------------
-- FINAL BILL Written By STEVE KELLY -- --------Labor---------
Inspected By MARK REIDER Price Metl Mech Othr Paint
-------------------------------------------------------------------------------
1. Remove & Install DASH ASSEMBLY 6.5+
2. Additional Metal Labor REPAIR HEATER & A/C CABLES
3. Remove & Replace HEATER/CONTROL CONTROL $ 45.61**
NOTES:
------
FINAL BILL SUMMARY --------------------------=---
---- -- --METAL LABOR LABOR $ 312. 00 . . . . 6. 5 hours @ $ 48.00 per hour
PARTS $ 45. 61
SALES TAX $ 3.76
* Part Price Increase
FINAL BILL TOTAL $ 361.37 ** Additional Supplemental Part
+ Additional Supplemental Labor
tal $ 361. 37
ble $ 0.00
s
zt
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i II
fi
f NO
MIKE,ROSE'S AUTO BODY, INC. dba
2001 FREMONT ST. ® CONCORD, CALIF. 94520 ® PHONE (415) 686-1739
September 6, 1991 UTcig �
Farmers Insurance
Attn: Claims Department
1660Challenge Drive
Concord,CA. 94520
Subj: Your Claim #B2-055371 Dana Hyatt
Re: Overpayment
Thank you for the recent additional payment received in the amount of $2,870.63 but
according to our paperowrk., only $2,509.26=was due so we are refunding your office
a check in the amount of $. 361.37.
If you have any questions,please feel free to give me a call.
Thank you,
Mike Rose's Auto Body, Inc.
]BKKPR. PEBRA M RYOR
. Enc: B2-055371 Check #01960
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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 December 3, 1991
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: $550.14 Section 913 and 915.4. Please note al'. "Warnings
oc:e•Fev�17
CLAIMANT: MATTHEW LEDT EBUR
(�419`31'
ATTORNEY:
Date received , FIS
ADDRESS: 614 — 24th Street BY DELIVERY TO CLERK ON ctobez 30, 1991
Richmond CA 94804
BY MAIL POSTMARKED. Hand Delivered-
I. FROM: Clerk of the Board of Supervisors TO: -C6unty Counsel' .
Attached is a copy of the above-noted claim.
IL BATCHELOR, Clerk
ff
DATED: November 4, 1991 • DeputX
11. FROM: Goun:ty_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).
S
( ) Other:
Dated: % BY: �. Deputy County Counsel
V
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.
O
Dated: DEC 0 3 1991 PHIL BATCHELOR, Clerk, By a , 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: D E C a 4 1991 BY: PHIL BATCHELOR b 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.
� � � � � � � * � � � � *-� � :♦ � � � � td: .� � :E,* � �..� :a. � *. -*. � � �t. � � qtr.� � � � �
RE: Claim By ". ) Reserved for Clerk's filing stamp
MATTHEW LBDEBUR ) RECEIVED61 4 - 2 ) . -.
RICHMOND ; CA 94804 ) _ %,C
Against the County of Contra Costa ) OCT 3 Q 1991
District) CLERK BOARD OF SUPERVISORS
Fill-'in* name ) ;
CONTRA COSTA CO: .
The undersigned claimant hereby makes claim aZainst the County of Contra Costa or
the above-named District in the sum of $ 5 5 0. /y and in support of
this claim represents as follows:
1. When did the damage or injury occur? (Give exact date and hour)
10/10/91. @ 11 :00 A .M.
_.._.----------------------------- ----- --------------------------------------
2. > Where -did--the damage-or -injury occur? (Include city and•county)_
2 3 RD . STREET Ti B U R B B C K, RICHMOND CA '
- --------------------------- ------- ---------
3. How did the damage or injury occur? . (Give. .full. details; use extra .paper if
required) I / 1
C�-' �r �n (4e be ct,r:l h +'Vr`luer hy. Cc t�f iVPt DXG.'
-------- --
4.' What particular. act or omission on the: part of county or .district officers,
servants..or employees. caused.-.the ;injury,or damage?
(over)
5. Wnat are the names of county .on district officers, servants or employees causing
the damage or injury?
-------- ----- -----------------------------------------
6.
- ------ ---------------------------------------
5. 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 theestimatedamount of any
prospective injury or damage.)
----------.16L_�:---�'.kl--- ---—7- -
- ---{----Q - �- -fir=-�- w'E .
$. Names and addresses of witnesses, octors and hospitals.
S he w
-------iacy ------------------------------------------------------------------------
9• List the expenditures you made on account of this accident or injury:
DATE. ITEM AMOUNT -
/Vt� diel
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)'
K is r,
Telephone No. Telephone No. (,00) .Z32'-
W.
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"6uch 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.
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Argainst the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT December 3, 1991
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: $30.00 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: STEWART, Christopher
ATTORNEY: NOV 06 1901
Date received �OUNIY COUNSEL
ADDRESS: 8 Warren Court BY DELIVERY TO CLERK ON N WABW, 99uF1991
Tiburon, CA 94920 November 4, 1991
BY MAIL POSTMARKED.
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: November 6. 1991 &a
IL ATCYELOR, ClerkQan 44Ac
p
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: j� /41 BY: Deputy County Counsel
- I tr
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.
"1
Dated: D E C 0 3 1991 PHIL BATCHELOR, Clerk, BDeputy 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:_ 4 1991 BY: PHIL BATCHELOR bflAju fi JLj Deputy Clerk
CC: County Counsel County Administrator
Claim dos 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, 19879
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
��r�s�o��er stewa✓fi )
RECO ED
Against the County of Contra Costa )
or ) NOV 51991
District) CLERK BOARD OF SUPERVISORS
Fill in name ) CONTRA COSTA CO.
The undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $ 9 pa oO and in support of
this claim represents as follows:
1. When did the damage or injury occur? (Give exact date and hour)
--7--/--0--/--o-f 11 '-3-4---c-t-m-------C--C-o-A-r-q-(-o-5-f-a--S----1-
�S 411_19s73
---------
---------
2. where did the damage or injury occur? (include city anti county)
r
V(1 C �o_urrlq---- `_1 8?_ 23" LaIl�-------------------------
3. How did the
damage or injury occur? (Give full details; use extra paper if
required) My Stolen Car . wq,. reco✓ere� �y -rl efa Leo Po(ic e d q rjweIA4�.
-It w115 towel to W+C tow Ona A call was Place k fi0 �� Conifa Costa SkerWi's
��t^artmeny afi 12.;(S 1'� of Tk_b 5aoe day , ov% 7/101q( al 12 noon j r'ece.ued
_hoJ►ce_hJ_�L I o f c!.e d y l 12 frog+_fih2_ 5_n Pa b(n_�ot��e.-------------•---------—
4. What particular act or omission- on the part of county or district officers,
_ servants or employees caused the injury or damage?
1 fie_ car was repa,,te 4 sto(en to flee Conita Costa 5�ertg`S c(e�cri hien. ( I`e Y
( r
bad o4 f) (Lo flee p6me- flnmberS all wiT� wrklo AMSweri�ag w�ac(ntKPS. Tl e 4er'tt�15
dePdrtr�eh1 �a��ed tO OCt Oh tl,e te( (torte &L� froom `I-I~e Sao ublo l;te avid
Q4 t 1p�p
re� dt/la �d r, I,P_in i'Ip�t-CI�� Qrt a SfOC@@ V�(n� c �2 l0y �'WO gAyS. C�v►[.L
y Y t y , (over)
r���w-d tl�� wt,
►nvf�`ej 1 reir'eved X1,2 Carr U,' saw &Ly, On �7/I1/` /)T1V_
4y 4Ft'er L refrre✓ed- t-1,P_ curi T}ie -6lerdePa,11men`F . 4Iled to v►ofif,I nne of lie cars reav&,'y/,
5. What are the names of county or district officers, servants or employees causing,
the damage or injury? C outtr-a C,„t a S her i K S Do.pa rt we A-V
---------------------------------------------------------------------- -------------
5. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
Two da.y s sloita3e- ckarV afI1 s er 1,/ 3 a fig fa .
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
2 Y5 at 4 )�_/day :- � 30 . O0
.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
statdge fe-e--5 3o, 00
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
-� C aimant's Signature
rd' w�r�en C-f
(Address)
�l bvrdw (1-A / 2- 0
Telephone No. Telephone No. S q,35- 2-676 e
iF 7F" F—i� �F ` i€ �F iF'" �F 1F` iF �t ,e • ,. : : x * a : s W x ;. r
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.
W & C TOWING _& STORAGE
r iOwner: John-Freeman Jr. - Jack Freeman INVOICE NO.24 -HOUR TOWING 1 1987 23rd STREET 6-SAN PABLO, CA. 94806 24310 4310
RO'AD,SERVICE A TELEPHONE (415) 234.1861
'-REPAIR ORDER NO:'
DATE IN �Z7 -�' - DATE OUT
NAME
-PURCHASE ORDER NO."'
STREET
I_
CITY PHONE ? -
�SER4AlORMOTOR�:1V0.'`
LEGAL OWNER
YR. MAKE- " MODEL COLOR LICENSE N REQUESTED BYV I
��5�6 _
.LOCATION OF PICKUP S �z o b
TOWING j.
TAKEN TO
DOLLY
DOLLY
EXTRA LABOR TIME OU7 E s .LABOR
[ERA
/ ADDT L?TOWIP4tG
L.
ADDITIONAL TOWING
OO
TIME
��'� ( S 1
Aw. s STORAGE.' C7---
ig
s
STORAGE FROM �' �� �� TO �TQC �� ENDINGSMILEAG
MILEAGE
NUMBER
DAYS@�f7 � DAY MILEAGE
START € ADVANCE PAYOUT
TAX RECORD:CITY ❑ COUNTY ffl
I,THE UNDERSIGNED, DO HEREBY CERTIFY THAT I AM LEGALLY AUTHORIZED MILES RELEASE F.EE I
AN,D ENTITLED TO TAKE POSSESSION OF THE VEHICLE DESCRIBED ABOVE s
AND ALL PERSONAL PROPERTY THEREIN. I HAVE RECEIVED VEHICLE-IN
SATISFACTORY CONDITION. _- DRIVER - BRIDGE
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SIGNED - TRUCK NQ, TOTAL' y1
• -y CH£CK NO w, .:GA3 CHARGE�.,�j
NOT RESPONSIBLE FOR LOSS OR DAMAGE-TO
CARS OR ARTICLES LEFT INCARSIN CASE OF
FIRE. THEFT OR ANY OTHER CAUSE BEYOND
OUR CONTROL.
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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 December 3, 1991
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 Governm-nt Code
Amount: $100.00 Section 913 and 915.4. Please note all "Warnings".
root
�,4�►i:D
CLAIMANT: WASIDLOW, BOGDAN T.
ATTORNEY:
Date received cpop��'�.`Novn�F��H'
ADDRESS: 101 Augustine Drive BY DELIVERY TO CLERKember 4, 1991
Martinez CA 94553
BY MAIL POSTMARKED: November 1, 1991
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim. PH g
DATED: November 4, 1991 BYIL Deputy OR, ClerkiarL�rtt.CrIw
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: fI /q h i BY: JJ Deputy County Counsel
I U '<t
III. FROM: Clerk of the Board TO: County Counsel (1) County Admini trator (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 Or r entered in its minutes for
this date.
Dated: D E C 0 3 1991 PHIL BATCHELOR, Clerk, By o 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: DEC 0 4 1991 BY: PHIL BATCHELOR b Deputy Clerk
CC: County Counsel County Administrator
X, `
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 319 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,,elaim is againsta 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.
w.
RE: Claim By' ) ' Reserved for Clerk's filing stamp
: . ) RE�®
Against the County of Contra Costa NOV 41991
or )
._ District) ���K BOARD OF SUPERVISO �
Fill in name � ` +� -` " _):-,.The undersigned claimant hereby makes claim against the County of Con ra Costa or
the above-named District in the, sum.of:$• 1 ode 00 and in support of
this claim represents as follows:-
--—---------------
1. When did'th damag or injury.occur?- (Give exact date and hour)
----rr-M---r--r--rr ..---rr-r-r----r--, -----rr-M --r-r----r---r-r-rr----------
2. Where did the damage or injury occur? (Include.city and county)
V_&Ovo C C
-r--rr -- -..-w--------r-r-- ----r-------rr--r---r
---------- -----r--
3. How did the damage or injury occur? (Give full details; .use extra paper if
required) ;
LI�
O�L4_a srt t eck
-_--r- ----rr_r3r-w-c(r---r--M-..iir�-r---r-r-r------r--rr--------..----e-----r-r
4. What particular act or omission on'the part of county or district officers,
servants or employees. caused` the.'injury_or damage?
SKD 1?_0C SObtJe uuA-s
V_C (CC,CS t fV (over)
�. ►.iux,, wv une names ov county or district officers, servants or employees causing
the damage or injury?
IP
r---rr-----------._r ....- -- -r--r - r_��__..-____..-r_r -_____r__-_r-
5 What damage or. in juries-do you claim`,'resulted? (Give :.f ull.,extent of injuries or
damages claimed.. Attach twp estimates for auto.damage..
-=''�-------------
7. How was-the amount-,claimed 'above computed? (Include,.the estimated amount of any
'prospective• injury or.,damagel.{)
,too ®� ��JC- ; ' U6Zr
--------------------------
-----
------- ------q �-c°°°�----------
8.
--------
8. Names and addresses of witnesses,, doctors and hospitals. ;
�,,, D� ll l` L L'� ,.; �.Cl ,(':4 ►. O'D Poo(., ® F'"(�1 C
-----------------------------------------r-------N--N--r-r--------_
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 sign .by the claimant
SEND NOTICES TO: (Attorney) or b some son o s behalf."
Name and Address of Attorney : :, ,.•.-...,..;<.. ,
laiman"t Signat e .
a -
(Address,7777 .:.w?...
Telephone No. - telephone No.
* . . ,. .
N 0 T,I C..,E
Section 72 of the Penal Code provides:
"Eve erson 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
thelcounty jail for a period.of. not.more than one,year, ,by�a fine of not exceeding
one thousand ($1,000), or by both"s,uch 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. .' .
i
ADDENDUM TO THE CLAIM. OF o C.O (�
('Print your ,full name)
_:( 1)
Do you ;use the •roadway" ass part ,Of.,a daily,. commute?
�( 2) Were ,you aware that construction would be commencing on
the -•roadway.)'I -
- Yes, ( ) _ 'No'-,,(
( 3) Was an alternate route available?
Yes" '(
( 4) Did-. you read .about the. impending resurfacing in the local
• newspaper? _ •_ _ � -++
Yes ( ) No ( )
( 5) Did you see warning signs 'advising of loose. gravel and a
25 mile- per hour advisory -sign?
Yes (. . .) - . ..- No -( )
( 6) Did the damage result from another vehicle •exceeding the
- 25 mile -per hour •advisory? ---- `
._. _.. - =!•- Yes ('�-� ` . No •( 5 )
(7) Did a vehicle traveling iii•the'-same`direction, and exceeding
the -25 mile per hour advisory sign -attempt to pass you?
- L -Yes (' ) No ( )
( 8) Did a vehicle coming from the opposite direction cause
gravel to be thrown onto your car?
Yes ( ) No ( ) ( NT �C1JID
(9) Was the vehicle located directly in front of you exceeding
the speed—advisory?
Yes ( ) No ( )
(10) Did you ,travel the roadway more than' once during the
resurfacing prior to the damage sustained to your car?
Yes ( ) No (�/)
( 11) Did you obtain the identity of .the car relating ,to
-questions, a6 -thru 9? /
Yes ( , ) No ( v)
If yes, please provide identification below:
( 12) Please describe in your own words how the gravel caused
damage to your vehicle and the angle the gravel was thrown
ontothe car, along'wth the specific -damaged parts on your
vehicle.
�cC_Es Tt (bJG rN ?oTq
1�1)l: N�. , r. � to�T
NOW R
C ki
( 13) Were you aware that using the road during the chip seal
process might result in damage to ,your car?
• '�
I declare- that the above 'information is. true correct
under the penalty of perjury.
Si na re)
( ate)
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AMENDED
l4 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 December 3, 1991_
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".
CLAIMANT: TABOR, Allan M. and Suzanne "�""-SV'� D
ATTORNEY: Ryan & Tabor NOV 06 1091
Allan M. Tabor Date received '—QU TY OU s �
ADDRESS: 50 Francisco Street, Suite 122 BY DELIVERY TO CLERK ON NOVelfit (@rq ,�q 1
San Francisco, CA 94133 _
BY MAIL POSTMARKED: November 4, 1991
Certified P 562 760 502
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
gH
DATED: November 6, 1991 JdILATCELOR, Clerk: Deputy
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
( ) This claim complies substantially with Sections 910 and 910.2.
r
Thisnc aimim 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: �� S' /W Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Admini trator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
(V1' 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.
O
Dated: D E C 0 3 1991 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: D E Q 0 11991 BY: PHIL BATCHELOR b &N0Deputy Clerk
CC: County Counsel County Administrator
NOTICE OF INSUFFICIENCY
AND/OR
NON-ACCEPTANCE OF CLAIM
Allan M. and Suzanne Tabor
TO: Ryan & Tabor
50 Francisco Street, Suite 122
San Francisco, CA 94133
Re: Claim of Suzanne and Allan M. Tabor
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 naive 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.
X3 . 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
i
By.
lDeputy onty Counsel
CERTIFICATE OF SERVICE BY MAIL
C.C.P. 1012 , 1013a, 2015 . 5 ; Evid. C. SS 641 , 6641
My business address is the County Counsel's Office of Contra Costa
County, Co. Admin. Bldg. , P.O. Box 69 , Martinez, California, 945531
and I amia citizen of the United States, over '18 years of age,
employed, in Contra Costa County, and not a party to this action. I
served atrue 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: November 7, 1991 at Martine ) Californi, .
a
cc: Clerk of the Board of Supervisors ( ginal )
Risk Management
(NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910 . 2, 920 . 4 , 910 . 8 )
11 RYAN & TABOR RECEIVED
ALLAN M. TABOR
2 STATE BAR NO. 52 846
50 Francisco Street, Suite 122 NOV 51991
3 San Francisco, CA 94133
(415) 9 81-2010 CLERK BOARD OF StJPERVISORS
4 CONTRA COSTA CO.
Attorneys for Plaintiff
5
6
7 ADDENDUM TO CLAIM FOR DAMAGES
8
ALLAN M. TABOR AND
9 SUZANNE TABOR,
10 Claimants
11 v S.
12 EAST BAY MUNICIPAL WATER
DISTRICT, CITY OF DANVILLE,
13 COUNTY OF CONTRA COSTA,
14 Respondents.
15
16
Claimants ALLAN M. TABOR AND SUZANNE TABOR present the
17
following addendum to claim for damages:
18
1. The location of our claim is 460 Eagle Valley Place,
19
Danville (Blackhawk) , California.
20
2. The date of the occurrence is uncertain in that said
21
water pipes leading to the house and in house are corroded and
22
contaminated with copper. This is a long standing problem that
23
the county is well aware of and has been put on notice and
24
claimant is unaware of the exact date and time that the pipes
25
were put in or that the water became contaminated.
26 DATED: October 31, 1991 RYAN & OR
27
28 BY
AN M. T AB O R
RYAN&TABOR - - -
ATTORNEYSAT LAW
SO FRANCISCO ST.,SUITE*122 l
SAN FRANCISCQ CA 24133
(410)001.2010
1 PROOF OF SERVICE BY MAIL
(CCP SECTION 1013 (A) , 2015. 5)
2 I am a citizen of the United States and am employed in the
3 City and County of San Francisco, California. I am over the age
4 0£ eighteen years and not a party to the within action ; my
5 business address is 50 Francisco Street, Suite 122, San
6 Francisco, CA 94133.
7 On October 31, 1991, I served the within ADDENDUM TO CLAIM
8 FOR DAMAGES in said action by placing a true copy thereof
9 enclosed in a sealed envelope with postage thereon fully prepaid,
10 in a United States Postal service mail box at San Francisco,
11 California addressed as follows:
12 EAST BAY MUNICIPAL
13 W ATE R DISTRICT
P. 0. Box 2060
14 Oakland, CA 94604
15 CITY OF DANVILLE
510 LaGonda Way
16 Danville, CA 94526
17 COUNTY OF CONTRA COSTA
Board of- Supervisors
18 651 Pine Street, Room 106
Martinez, CA 94553
19
20 I declare under penalty of perjury that the above is true and
21 correct. Executed on the above date at San Francisco,
22 California.
23
ALL M. TABOR
24
25
26
27
28
RYAN&TABOR
ATTORNEYS AT LAN 2
SO FRANCISCO SL.SUITE*122
SAN FRANCISCO,CA 04193
(4151981-2010
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h 46
APPLICATION TO FILE LATE CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
BOARD ACTION
Application to File Late Claim ) NOTICE TO APPLICANT December 3, 1991
Against the County, Routing ) The copy of this document mailed to you is your
Endorsements, and Board Action.) notice of the action taken on your application by
(All Section References are to ) the Board of Supervisors (Paragraph III, below),
California Government Code.) ) given pursuant to Government Code Sections 911 .8 and
915.4. Please note the "WARNING" below.
Claimant: HINES, James Earl E-86628
Attorney: IN PRO PER N O
Address: P.O. Box 705 LB-239 COUNTY COUN5€i
Soledad, CA 93960 MARTINEZ, MIF.
Amount: Nineteen Million Dollara By delivery to Clerk on November 4, 1991
Date Received: By mail, postmarked on November 1, 1991
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above noted Application to File Late Claim.
DATED: November 1, 1991 PHIL BATCHELOR, Clerk, By y3a4 }2,•a 41Deputy
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
( ) The Board should grant this Application to File Late Claim (Section 911.6).
The Board should deny this Application to File Late Claim (Sectio
DATED: �� `�) VICTOR WESTMAN, County Counsel, By ! S
J Deputy
III. BOARD ORDER By unanimous vote of Supervisors present
(Check one only)
( ) This Application is granted (Section 911 .6).
(✓)'' This Application to File Late Claim is denied (Section 911 .6).
I certify that this is a true and correct copy of the Board's Order entered in its
minutes for this date.
DATE: DEC 0 3 199 PHIL BATCHELOR, Clerk, By 0 JAI 10 ° Deputy
WARNING (Gov. Code §911.8).
If you wish to file a court action on this matter, you must first petition the
appropriate court for an order relieving you from the provisions of Government Code
Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such
petition must be filed with the court within six (6) months from the date your application
for leave to present a late claim was denied.
You may seek the advise of any attorney of your choice in connection with this
matter. If you want to consult an attorney, u should do so immediately.
IV. FROM: Clerk of the Board T0: 1 County Counsel 2 County Administrator
Attached are copies of the above Application. We notifed the applicant of the
Board's action on this Application by mailing a copy of this document, and a memo thereof
has ben filed and endorsed on the Board's copy of this Claim in accordance with Section
29703.
DATED: ®EC 0 4 1991 PHIL BATCHELOR, Clerk, By 000 Deputy
,V. FROM: 1 County Counsel 2 County Administrator TO: Clerk of the Board
of Supervisors
Received copies of this Application and Board Order.
DATED: County Counsel, By
County Administrator, By
APPLICATION TO FILE LATE CLAIM
i JADES EARL NINES E-86628
705 LB-239 IR
2 S.OLEDAD� CALIFORNIA, 93960ECEWED
3 CLAIMANT IN PRH PER NOV 41991
4 C1_ERK BOARD O' SUP-RVVISORS
CONTRA C ST .CO. j
DATE: OCTOBER 24,1991
RE: CLAIM BY
6 �
7 I, HA.MES EARL HINES
AGAINST THE. COUNTY OF CONTRA. COSTA, AND
8 �� EMPLOYEE( S) .: ACTING WITHIN SCOPE, OF EMPLOYMENT
9 LEAVE TO PRESENT LATE CLAIM: /
10 I!
on or about October 7,1991, petitioner/plaintiff/claimant ,
11 presented a claim to -the Board of Supervisor.. Said claim was
12 (� returned because it was "alledgely" late.
13
Plaintiff claims that Richard K. Rainey, Sheriff, J. Morse
14 '�
�! Law Librarian at the Martinez Detention Facility, Deputy District!;
15
Attorney, David. G. Brown conspired to deny plaintiff a fair triap
16
;! and to cause him to be convicted on groundless charges by tam"
17 !; I
pering with witnesses and knowingly presenting-false evidence anV
11 perjured testimony to the Court in Case No. 902447, Superior
19
� Court Contra Costa County.
20 11 . {
Plaintiff alleges the acts were pursuant to an official
21 i
'I policy of said county to deprive plaintiff of Constitutional
22
�!!Irights. I i
23
Plaintiff contends all acted within scope of employment as
24 --
24 public employee in bad faith with knowledge of their acts.
Plaintiff was denied self-representation and acess to the
26
Court by J.- Morse ,intentional disregard to Judge Arnason ordered
27
II dated November 1984.
28 !
Rainey, and agents harrased legal runner
100
BOARD OF SUPERVISORS
OCTOBER 24,1991 . .
PAGE TWO
DAVID G. BROWN# deputy district attorney knew that his conduct in
his investigator compacity that the perjury that he presented to the
court would violate plaintiff statutory or constitutional rights®
That on October 4:1988# '`JOANNE: OLIVER PURSE AND IDENTIFICATIONt' WAS,
WC ATED; HOWV.ER, ALL THE. EVIDDNCE HAD BEEN DESTROYED AND WAS NOT PUT
IN THE: INVENTORY :PROPERTY; HOWEVER, MIRACULOUSLY HE HAD A WITNESS (BEAL)
HE RECALLED THE MATTER IN 199 1.,p
ALL ACTW WERK DONE WITHOUT ANY JUSTIFICATION ASSOCIATED WITH LEGITIMATE
EMPLOYMENT, -
LATENESS. OF SAID CLAIM:
Plaintiff claims said claim is not late, aszuming. arguendo# plaintiff
contends that pursuant to Givil Code of g1vil Procedures 312, 3 Witkin
California Procedure 351362# and 352( x) ( 3) 352( c) said statutory time
is tolled. _
Furthermore pursuant to Government Code sections 945.4 & 950 the
employees are liable, and 945A6( c) , 912,,4.
WHEREFORE, Plaintiff prays that said claim be acted. upon by the
Board and that Plaintiff be granted ($19,00,000000) (Nine-teen million
dollars) . for punitive, compensatory and exemploary damages.
n
r � '
DATE:
JAMESEARL HINES.
P.O. BOX 705 LB-239
SOLEDAD., CALIFORNIA 93960
JAMES EARL HINES E-86628
2
P.O. BOX 705 'ta-239 4r'Q
80LEDAD,, CALIFORNIA 93960
4 CLAIMANT,. IN .PRO PER RECEIVED
5 NOV 41991
G DATE: OCTOBER 24o1991
R CLAIM BY CLERK BOARD OF SUPERt/';'
i CONTRA COSTA CO._ .
S IrAMHS EARL HINES
AGAINST THE. COUNTY OF CONTRA COSTA AND
9 EMPLOYEE(S) ACTING 14ITHIN SCOPE, OF EMPLOYMENT
10 LEAVE TO PRE= T LATE CLAIM: /
on or about October 7,1991, petitioner/plaintiff/claimant
12
presented a. claim to the Beard of Supervisor. Said claim was
13
returned because it was "al.ledgely" late.
14
Plaintiff claims that Richard K. Rainey„ Sheriffs J. Morse
15
Law Librarian .at the Martinez Detention Facility, Deputy District
16
Attorney, David G.. Brows conspired to deny plaintiff a fair trial
17
and to cause him to be convicted on groundless charges by tains
18
peri:ng with witnesses and knowingly presenting, false evidence and
19
perjured testimony to the Court in Cane No. 902447, Superier
24
Court Contra Costa County.
Plaintiff alleges the acts were pursuant to an official
22
policy of said county to deprive plaintiff of Constitutional
23
rights.
24
Plaintiff contends all acted within scope of employment as
25
26 public employee . in bad faith with knowledge of their acts.
27 Plaintiff was denied self-representation and aeess to the
Court by I. Morse intentional disregard to Judge Arnason ordered
dated November 1984.
Rainey, and agents harrased legal runner
HOARD OF• SUPERVISOI S
OCTL OM ER 2491991
PAGE TWO
DAVID G. BROWNi deputy district attorney knew that his conduct in
his investigator compacity that the perjury that he presented to the
court would violate plaintiff s&atutory or constitutional rights.
That on October 4,19880 "JOANNE OLIVE-R PURSE ARID IDENTIFICATION"' WAS
LOC ATEDb HOWZVERp ALL THE EVID,DWCE HAD BEr3N DESTROY8D AND WAS NOT PUT
?N THE INVENTORY PROPERTY; HOWEVER, 14IRACU�:,OUSLY HE HAD A WITNESS (SEAL)
HE RECALLED THE MATTER IN 1991.
ALL ACT14 WERE DONE WITHOe3T ANY JUSTIFICATION ASSOCIATED WITH LEGITI14ATE
EMPLOYMENT,
LATENESS 6F SAID CLAI N Z
Plaintiff claims said claim ism late, assuming arguendo, plaintiff
contends that pursuant to Civil Code of Cdvil Procedures 3129 3 Witkin
California Procedure 351-362, and 352( a) (3) 352(c) said statutory time
is 't oiled.
Furthermore pursuant to Government Code sections %5,4 & 950' the
employees are liable, and 94-5.6( c)., 912,4.0
WHEREFORE., Pla- ntiff }grays that' said elaim be acted upon by the
Board and that 'Plaintiff be granted ($19100.000,00) (14i.ne-teen million
dollars) . for punitive .compensatory and exemploary damages..
DATE 3..
JAMES ARL MINES. 17
P.O. BOX- 705 LH-239
SOLEDA;D, CALIFORNIA 93960
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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 December3, 1991
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 given pursuant to Government Code
Amount: Unspecified Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: DEBORD, Andrew Nov Q 8
COUNTY COUNSEL
ATTORNEY: In Pro Per MARTINEZ, CALIF
Date received
ADDRESS: 2135 Alhambra Avenue BY DELIVERY TO CLERK ON November 7, 1991
Martinez, CA 94553
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.
DATED: November 7, 1991 gglL BAATTCYELOR, Clerk
epuII. 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:
1
tt
Dated: , /9.1 BY: 9122 Deputy County Counsel
U \U
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. 00
Dated: DECO 3 1991 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
1 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: ®E C 0 4 1991 . BY: PHIL BATCHELOR by JLDeputy Clerk
CC: County Counsel County Administrator
i ANDREW DEBORD
2135 ALHAMBRA AVE.
2 MARTINEZ, CA 94553 ��EIY/E®
370-8751 Y/
3
NOT. 1991
4
5 CLERK BOARD OF SUPE V'lb011
ANDREW DEBORD CONTRA COSTA CO.
ae
6 IN PRO PER
7 ANDREW DEBORD, ) CLAIM AGAINST A
8 ) PUBLIC ENTITY
Claimant, )
9 )
V. )
10 )
CITY OF MARTINEZ )
11 POLICE DEPARTMENT, COUNTY OF )
CONTRA COSTA SHERIFF' S )
12 DEPARTMENT, UNKNOWN DEPUTY )
SHERIFF DOE I AS AN INDIVIDUAL )
AND AS AN AGENT OF THE CONTRA )
13 COSTA COUNTY SHERIFF ' S )
14 DEPARTMENT AND DOES 2-100 )
INCLUSIVE, )
15 )
16 TO: COUNTY OF CONTRA COSTA SHERIFF ' S DEPARTMENT
17 Andrew DeBord hereby makes claim against the City of
18 Martinez, California, Police Department; Unknown Deputy Sheriff
19 Doe 1 , individually and as an agent of the Contra Costa County
20 Sheriff ' s Department; Contra Costa County Sheriff ' s Department
21 and Does 2-100 for a sum continuing to be incurred and unknown
22 at this time, and he makes the following statement in support
23 of the claim:
24 1 . Claimant ' s address is 2135 Alhambra Ave. Martinez,
25 California 94553 .
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27 1
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1 2 . Notices concerning this claim should be sent to the
2 above address.
3 3. The date and place of the incident giving rise to this
4 claim are June 6, 1991 in and about 2135 Alhambra Ave. Martinez,
5 California .
s . 4. The circumstances giving rise to this claim are as
7 follows : Claimant was inside his residence when the residence
8 was invaded by unknown persons who claimant latter learned were
9 police officers. Claimant ran from the residence as he feared
10 for his physical safety.
11 5. . During the chase that insued the claimant was forcibly
12 restrained by an unknown Contra Costa County Deputy Sheriff.
13 That officer after claimant had been subdued took claimant
14 by the neck and slammed his face into the pavement two times ,
15 causing claimant ' s dental bridge to dislodge and claimant inhaled
16 that bridge. Said piece of claimant ' s bridge is now lodged in
17 claimant ' s lung and he will need surgery to remove the foreign
18 object. As well claimant ' s upper front tooth was so severely
19 damaged that it was necessary to remove that tooth many hours
20 after claimant had notified officers of his injury.
21 6 . Claimant' s injuries are to his mouth and face as well
22 as internally.
23 7. The name of the public employees responsible for
24 claimant ' s injuries are unknown at this time but may be revealed
25 in discovery.
26 8 . At the time of the presentation of this claim, claimant
27 claims damages within the jurisdiction of the Superior Court .
2
28
1 Dated: July/-O , 1991
2 Andrew DeBord/Claimant
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