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Home My WebLink AboutMINUTES - 10151991 - 1.13 DAE J( _ ITEM NUMBER THE ORIGINAL CLAIMS ARE FILED IN THE MINUTE FILE. / DENY CLAIMS OF; ASPRER M. , LAMB S . , MAYFIELD S . , OWENS E. , SEDLEY M. and J. , SPENCER G. STEPHEN M. , WHISLER D. and A. l0 � S i 1,0 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT October 15, 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: $10,000.00 gyp¢ Section 913 and 915.4. Please note all "Warnings". CLAIMANT: LAMB, Shemaria ATTORNEY: Olt ADDRESS: 1922 Roosevelt CMpR►NFZBYDELIVERYeTO CLERK ON September 18, 1991 Richmond, CA 94801 BY MAIL POSTMARKED: September 17, 1991 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: September 20, 1991 JaIl Dep�tyLOR, Clerk ,L 4-zLL4 _Jjaa� 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: ( 20 T 19 ) BY: I - �_ Deputy County Counsel U N �— III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (✓) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: OCT 1 5 1991 PHIL BATCHELOR, Clerk, ByClAnA0.114L.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 No 'ce to Claimant, addressed to the claimant as shown above. OCT 16 1991 Dated: BY: PHIL BATCHELOR b I ALJ 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, 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 1069 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 mxst 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 Shemaria Lamb ) 1922 Roosevelt j �� Richmond, CA. 94801 ) Against the County of Contra Costa ) SEP 1 8 1991 or ) District Attorney District) CLERK BOARD OFSUPERV Fill in name ) CONTRA COSTA CO The undersigned claimant hereby makes claim against the County of ntra Costa or the above-named District in the sum of $ 10.000.00 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) July 132 1991 9:00 A.M 2. Where did the damage or injury occur? (Include city and county) 1922 Roosevelt Richmond, CA. 94801 Contra Costa County 3. How did the damage or injury occur? (Give full details; use extra paper if� required) Mr. Greenberg intered my home without telling me my rights and without a warrant. See attached complaint. 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Mr. Greenberg wound not tell me what he wanted in the privacy of my home. Mr. Greenberg searched my home without prabable cause. (over) ► � �. What are the names of county or district officers, servants or employees causing the damage or injury? Mr. Griffin Social Service Department Richmond, Contra Costa County Mr. Greenberg District Attorney Contra Costa County ------------------------------------------------------------------------------------ 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. My civil rights were violated and punitive damage on behalf of my 2 children and myself -------------------------------------------------------------------------------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) settlement ------------------------------------------------------------------------------------- 8. Names and addresses of witnesses, doctors and hospitals. Mark and Jamael Thomas (Shemaria' s two sons) 1922 Roosevelt Richmond, CA. 94801 ------------------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf." Name and Address of Attorney Ms. Kim BakerA ' -k� East Palo Alto Community Law Claimant's Signature Project 1395 Bay Road 1922 Roosevelt East Palo Alto, CA. 94303 Address Richmond, CA. 94801 Telephone No. 853-1600 I Telephone No. 2 6- 87 * * * V V W V V. * * * 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)9 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. ' Shemaria Lamb September 2, 1991 i 1922 Roosevelt Richmond, CA. 94801 Case -#310-043201-'-00-0 Re: Complaint On July 11 , 1991 I had a 1 : 30 p.m. appointment to meet at Contra Costa County Social Service Department lvith Ar DC eligibility worker M. Griffin. My 2 small children Mr. Griffin and I went into a very small room. While interviewing me Mr. Griffin went and got another client and started interviewing the both of us at the same time, asking us both personal questions. The client and I felt very uncomfortable and felt that our confidentiality was being invaded. Mr. Griffin accused me of having a income and not reporting it. I told him that it was a income grant from school and I did report the income to my worker. Mr. Griffin turned the page on the case book and noticed that I did report the income from school. My children and I felt very intimidated by Mr Griffin during the interview and my 17 month old baby started crying. Mr. Griffin sent me home in the middle of the interview and rescheduled me for 7-18-91 at 1 : 30 p.m. At the end of the meeting on 7-11-91 I asked to speak with his supervisor. Mr. Griffins supervisor told me that it was normal for wor- kers to interview two clients at the same time and to leave my children home on the next interview. I told Mr. Griffin' s supervisor that my private life was invaded and I cannot leave my children at home, that is why I am on welfare. I returned to the Social Service Department on 7-18-91 for my 1 : 30 appointment with Mr. Griffin. Mr. Griffin telephoned me on the looby phone and told me that my appointment was for 2: 30 p.me and not 1 :30 p.m. I told Mr. Griffin that my appointment was for 1 : 30 because I have it documented in his hand writing to that acknowledgement. I told Mr. Griffin that I would wait until 2:30 to see him. Mr. Griffin called me in for my interview at 2: 30. sir. Griffin collected all doc- uments from me and started harassing me, asking for documents that I didnot have and didnot exist. Mr. Griffin and I started arguing at each other. A black lady came into the room and asked if everything was O .K. Mr. Griffin and I told her our story of why we were arguing at each other. The lady then looked at the document case work Mr. Griffin had and told Mr. Griffin that he didnot need to ask me for additional documents. The lady told Mr. Griffin that I had given him all the documents that was needed to -,rocess, activate, and continue my aid on AFDC. On 8 -13-01 inspector Greenberg from the District Attorney' s office knocked on my door and flashed a badge at me, and told me who he was. Mr. G,,_enberg asked if he could Come into my home and sta2-ted auestioning me. Mr. Gr<;enberg documented everything that I said, except the reason I am on welfare. I worked 10 years for .San Mateo County County Library :system and was discriminated against. I could no longer continue to work and use racism as a challenge and 'happily raise my 2 small children as a single parent, so I quit working for San Mateo County in 1990 and went on government assistance. I asked Mr. Greenberg what was he in- vestigating.. Mr. Greenberg responded "to see if you are telling the truth" . I asked Mr. Greenberg if he could be more specific he repeated himself "just to see if you are telling the truth". Pair. Greenberg then asked me if he could search my home. He searched in my rooms, closets, drawers, and cabinets. As Mr. Greenberg was leaving he told me that I shouldnot have a problem. pg. 1 of 3 Shemaria Lamb Mr. Greenberg didnot leave me a business card or ell me if I thave any questions where I can enauire. My private life has been invaded, my personal life has been intruded on, my children and I are afraid to stay home alone, and I feel like a criminal. I don' t bring men into my home, so for a white man to come into my home and search it, was very frighten- ing for my children and I. Our minority men are fraimed and institution- alized by the District Attorney, County, and Government. The Social worker has been replaced by the County' s District Attorney' s so that they may come into our homes, handcuff, and institutionalize our minority T omen in front of our children. Because I am low income and on govern- ment assistance, my rights have been taken from me. Mr. Griffin didnot investigate. Because he and I got into a argument he felt that he could punish me by sending a under cover cop into my home to search it. Mr. Griffin doesnot know how to -relate and communicate with low income people. Mr. Griffin is definitively in the wrong line of work, he doesnot deserve to be a eligibility worker. Over 50% of the people who receive government assistance are being abused by their workers. The government system and supervisors teach the eligibility and social workers to be unfair, mean and try and scare low income people off welfare and onto the streets and on drugs. I repeatedly asked to speak with Mr. Griffin' s supervisor on the ;)hone and was denied on numerous occasions. I asked If my worker could be changed to a more _people oriented worker and was denied. Until I told Ms. Judy a clerk on August 21 , 1991 on the phone that my layer said that I have the right to speak with a supervisor and change my worker. On 8-14-91 I spoke with Ms. Nelson who told me that I am being investigated for welfare freud because the welfare depart- ment assumed that because my ex-husband was paying half of the house note, he live here in my home and because my brother-inlaw' s name was on the house note payment book he also live here. 'ghat Ms Nelson was saying is once a black man leaves the '_tome he no longer cares for his children. I asked Ms. Nelson :what is the 7rocedure when the District Attc)rney searches a home. Ms. -Nelson said "they can do what ever they wa-it to do, they don' t have a procedure, If I don' t like it get off welfare". His. ;Tentiniglo a supervisor lied to me over the telephone on August 21 , 1991 , ;paying that my ex-husband said that he didnot ?gay half of the house note. 75% of the people are on government assistance because of the government' s poor minority educational school system and discrimination on jobs. If :we are offered an ea_ual opportunity in education and employ- ment, we would not need government assistance. My ex-husband and chil- dren' s father can no longer pay 1 of the house note. I depended on that shelter support in order to have a ?place to live. Since it was the value eaual to his obligation under child support guidelines. He has to pay 3450.00 directly to the welfare department. My welfare grant has been reduced from $694.00 monthly to $663.00. I cannot survive. The govern- ment is leaving me below poverty level. I am left by the government to eather swim or sink like most american welfare recipients. v pg. 2 of -3 i Shemaria Lamb cc: , KMTP Channel 32 television station District Attorney - Mr. Nimr supervisor East Palo Alto Law Project - Kim Baker Director of Social Service - Mr. Maddin Ms. Ventiliglo Social Service supervisor Civil Rights Department Office of Appeals Coordinator pRbard of Supervisors Social Service Commission Oakland Tribune News Paper Women Economic Agenda Project - Ethel Long-Scott Governor Pete Wilson Richmond Mayor - George Livingston Richmond City Manager - Lawrence M. Moore Legal Aid - Ms. Jody personal file pg. 3 of 3 r � y t ,. � t a • y _ f1 y•. •9; NI. S , C CF' 0 to Hca 6 .,A �, 4 � rurlA 4-3 � 0 v CP O � O C6 O ' �Nv CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT October 15, 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: $100.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: MARY KATMYN ASPRER ATTORNEY: Date received ADDRESS: 437 Cotta Court BY DELIVERY TO CLERK ON September 13, 1991 Vallejo, CA 94589-4306 BY MAIL POSTMARKED: September 12, 1991 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. EVIL BATCHELOR, Clerk DATED: September 16, 1991 : Deputy jI. FROM: County Counsel TO: Clerk of the Board of Supervisors \I�_ ) 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: C1 6 9 BY: JDeputy 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 (V'J"'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. OCT 15 199 Dated: 4_ , 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 No a to Claimant, addressed to the claimant as shown above. L Dated: OCT 1 U 1991 BY: PHIL BATCHELOR by C 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 Hoard 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 - j R ECE�Q:EQ r J_ 3 Aga4P�t the County of Contra Costa - ) 1991 or ) CLERK SOA9D C!:SUPE7iVi`�•sr District) y _ CONTRA_ <_STA u10, �- (Fill in name ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ f( }; 00 and in support of this claim represents as follows: ------------------------------------------------------------------------------------- 1. When did the damage or injury occur? (Give exact date and hour) -------------------------------- 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give�rful1 details; use extra. paper if require'd) / 5�✓1��G%1!1 AG A-dad., tGY�s2 ' tie' hlT x ,^ ' ,wi 4. What particular act or-omission on the part of county or district officers, servants or employees caused the injury or damage? (over) 7. wnat are the names of county or district officers, servants or employees causing the damage or injury? ----------- ----------------------------------------------------------------------- 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. - -----__-------------------------------------------------------------------------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses, doctors and hospitals. -------------------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov, Code `Sec, Q10:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attornev) or by some person on his behalf." Name and Address of Attorney Claimant's Signature Address Telephone No. Telephone No. * * V V T * * * * * * 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. ADDENDUM TO THE CLAIM OF I -IVY . (Print your full name) (1) Do you use the roadway as part of a daily commute? r Yes ( ) No ( ) ( 2) Were you aware that construction would be commencing on the roadway? Yes ( ) No ( 3) Was an alternate route available? Yes ( ) No ( ) �`l ie as 4D l a z - hvr) cA6-off , ( 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? Y e s No ( ) ( 6) Did the damage result from another- vehicle exceeding the 25 mile per hour advisory? JDrne aLr-5 5WUM clow)', 6*6r6 ltd Ko--, -tjg jawai was b om Yes No ( ) e(AV,r 44h e 6ne s who 616u j or dtdpi+, (7) Did a vehicle traveling in the same direction and exceeding the 25 mile per hour advisory sign attempt to pass you? _'A Yes ( ) No Q< ) Ud)Q,d'd� 0jD y)a 5 ' Ob rh;_e (8) Did a vehicle coming from the opposite direction cause gravel to be thrown onto your car? Yes ( ) No (X ) ( 9) Was the vehicle located directly in front of you exceeding the speed advisory? Yes ( ) No (x ) (10) Did you travel the roadway more than once during the resurfacing prior to the damage sustained to your car? Yes ( ) No (j�) ( 11) Did you obtain the identity of the car relating to questions 6 thru 9? Yes ( ) No ( �) 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 onto the car, along with the specific damaged parts on your vehicle. -Ulu, "OA( tL� J(I rn, `7MAII 1 �►i a6 i r) AC b5 ss 1.11& C,VrAf & roti v dI b/JJ ji �_ff YYV O, f r`c-h J-� a as 6 5'Aa ( 13) 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 information is true and correct under the penalty of perjury. ignature) "l LfP� (Date) California State Automobile Association Automobile Policy Declarations Inter-Insurance Bureau PLEASE KEEP WITH YOUR POLICY. 150 Van Ness Avenue SEE IMPORTANT NOTICE ON REVERSE. P.O.Box 1860 San Francisco,CA 94101-1860 .. O• Declarations Type Page' , Renewal Cer't.ificate 1 Of 1 1. Name and Address of Insured < Policy Type Process Date Member 06-10=91 0 Policy Number Insured Since LL LU ASPRER VICENTE P MARY KATHRYN Z L8-28-54-2 1981 . 437 COTTA CT } YOUR omN V POLICY JFr >07-20-91 Ito 07-20=92 i Z VALLEJO CA 94589-4306 J PERIOD Q 12c01 A.M., Standard Time at the address a of the Named Insured as stated herein. Alternate Address Occupation Alternate Number Telephone Number 571 HOLLIS EMERYVILLE PRINTER/MGR 654-2763 643-9123 Item Make Model ' Body Type Vehicle Identification Number Name Driver License No. y Year N V1 CENTE N8098553 . 01 N I SSN '86 1/2TN 04402 J X MARY N8709898 , 02 NISSA i 87 2DSED 75593LU - w - Drivers do not necessarily correspond to principally operated vehicles. COVERAGE ...••• LIABILITY LIMITS . _. .Item 01.... ._.. _......,Item 02.............. ...Item _... ..... ...Item ...... ......... Each Person Each Occurrence Deduct. i Premium Deduct. Premium Deduct. Premium Deduct. : Premium Bodily •I Y 0 0 68 Injury 2 5 000 1 50 0 168 u Y 1 Medical er a a No Covera e 4t{trzE:iaav 9 m 9 9 Payments Y v� n i s r U n u ed r e >� '"ver �`'''v r a e C N o Cove a >N`'< Ce a e "?%� e '•N o Coverage t� � N?i3.... .e► 9 9 � 9 9 Ist r' Mo o t s »> Property ....:...:.:...:•::, � P 6 0 0 1 1 UJ Dams 10 0 6 9e . ................................:.. .. ............................ a Comprehensive Actual Cash Value Less Deductible 100 : $58 10 0 0 $11 LU Collision LU 500..;..' $127 - 500 $168 (9ActualCash Value Less Deductible ...................................................... CC W All Risks No Coverage No Coverage Actual.Cash Value Less Deductible V TOTAL PREMIUM PER VEHICLE 3110- $414 $507 EXPLANATION,OF LIMIT CODES Limit Code Premium Automobile Death Benefits ` A•$15,000 first named insured. C-$15,000 each additional named in- B $8 B-$15.000 each first named insured and souse. surad shown on endorsement F329. Premium Summary This is nota bill, Savings Dividend: $100.00 Annual Premium: $929,00 v) Schedule•pf Changes LU a Z V , y Discounts : Coll , Avoidance Light Item(s) , 02. Mat . Driver , None. W 0 Good. Driver Discount : Item(s) , 01 , 02. Cn LU Item Item � $ vs w WrE'' E5 CL Ilam Item { �//�� .. •••• •:••Yii:•i:i%•i:•i:•?:•ii:j•'4i:y;W is t/a .. ) , , .;,t �,:ljj�lfj'�ijiir.'l.:ii:;:•:;iW:::i:�:�i:�: . t,. sm:n In.. 1.011 Declarations Continued on Reverse , •t t , -COM PLETE GLASS SERVICE' � I 1 .1• I DATE PREPARED BY INSURANCE COVERAGE INSURANCE CARRIER • TERMS QUAN.I DESCRIPTION UNIT PRICE I AMOUNT ORIGINAL INVOICE Nkitional Auto Glass DATE / 9 c// 425 Couch Street • Vallejo, California 94590 YEAR &MAKE,j f97 (707) 644-5201 [1 AUTOMOTIVE BODY STYLE RESIDENTIAL COMMERCIAL LICENSE NO. VEHICLE I.D. OR ENGINE NO. AGENT SOLD TO , S��I�► T'� QUAN. ARTN O. DESCRIPTION LIST p NET P LABOR OR SO� SUB TOTAL 71) RECEIVED IN GOOD ORDER STATE SALES TAX 22 BY: DATE TOTAL MATERIAL AND LABOR 015"7 INSURANCE PROOF OF LOSS INSURANCE CO. LESS DEDUCTIBLE PAID BY INSURED ADDRESS BALANCE DUE POLICY NO. COVERAGE VERIFIED BY DATE AND LOCATION OF LOSS CAUSE OF LOSS RELEASE AND AUTHORIZATION TO PAY OTHER THAN INSURED OR CLAIMANT THE GLASS HAS BEEN REPLACED TO MY COMPLETE SATISFACTION AND I AUTHORIZE THE TO PAY DIRECT TO NATIONAL AUTO GLASS CO. OF THE FULL AMOUNT DUE ME UNDER THE TERMS OF MY POLICY COVERING THE SAID AUTOMOBILE,AND I UNDERSTAND IF FOR ANY REASON MY INSURANCE COMPANY DOES NOT PAY THIS CLAIM I WILL BE RESPONSIBLE FOR PAYMENT OF SAME. INSURED t Zs : 4s ;s;f 166 z ck s�. i CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT October 15, 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: $850.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: MAYFIELD, Susan ATTORNEY: ur4 Date received ADDRESS: 4041 Via de Flores _ourll oo �F BY DELIVERY TO CLERK ON September 19, 1991 Martinez, CA 94553 MpRtW� 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: September 20, 1991 JaIl BeputyLOR, Clerk ' 1. 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: / 2 0 BY: I Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: Del in'T. PHIL BATCHELOR, Clerk, 8 A 0 hjAjO ° J Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: OCT 1 6 1991 BY: PHIL BATCHELOR b v Deputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY " - INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- ✓ sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed With the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553• C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's filing stamp FcLERK ECEIVE®4-fytt�, bG PIaYG�Against the County of Contra Cos > EP 191991 orARD OF SUFERVISQI9 District) I 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 $ 850`61 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) ---- b= '-= 1----------� ---g=-9=a! ------- --------- 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) 4. What particular actor omission on the part of county or district officers, servants or employees caused the injury or damage? 1�v� PUJ— O-VA r" poor A . (over) 5. ` What are the names of county or district officers, servants or employees causing the damage or injury? 6 c� w�W 10 1) way ®e w�� I�2eY,wA -------------------------------- -------- What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. ---m I�5 v" )--� =��-------------------------------------------------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Ja ` � --- � ---_' ' ��-_Ccs -- -,-"-G- ------A( --=, ------------ 8. Names and addresses of witnesses, doctors and hospitals. ------------------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf." Name and Address of Attorney Clai t' S gnature Vta dt kavjes Address N/lC;A �c�553 Telephone No. Telephone No. N 0 T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. PROPERTYJCLOTHING RECEIPT .. -CONTRA COSTA COUNTY : AEC.'No.1.0 7 2xG, FACILITY DATE.: TIME: aVAME: ..-.:P�F.#tLL SSS, J, MARIE I; C r .BOOKING NBR INTAKE CASH: .$ - ✓L IO SI11RT/BLOUSE DRESS s ,_ t C7 COAT/JACKET 'M/SCARF 0- SHORT'S/PANTIES _ W JEWlf[ N RI S LD 50CKS/NYLONS j 4-A CJ:SWEAT�R/SWT SHIRT : 11IATCH• C� BELT 7 r fl -PANTS/SKIRT SH 0ES/BOOTS 'C� T-SHIRT/BRA. ❑ WALLET HAT/PURSE' ,0 KEYS O 'KNIFE ❑ GLASSES C ;'OTHER 77. .BKG OFC: 'INMATE.SIGNATU - _ I have received ali of_my per DATE. "` •± ; sorest properxY hnd ;,,clothing. - REIOFC;r-- x INMATE SIGNATURE !� 1;3 s CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT October 15, 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: $One Million Dollars Section 913 and 925.4.—i'0tVse note all "Warnings". CLAIMANT: OWENS, Ester May 0 � ] MNO ATTORNEY: STEPHINE M. WELLS �?lN�,ft Date received WAI ADDRESS: 3030 Bridgeway BY DELIVERY TO CLERK ON September 19, 1991 Sausalito, CA 94965 BY MAIL POSTMARKED: Via Risk Management I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim, ppH►{ gg DATED: September 20, 1991 BYIL DeputyLOR, Clerk I1, FROM: County Counsel TO: Clerk of the Board of Supervisors \j�1 ) 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: ' 20 91 BY: Deputy County Counsel —T 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 ( Vr This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated:—OCT 1 5 1991 PHIL BATCHELOR, Clerk, B AAA JA,O H9, . Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: OCT 16 1991 BY: PHIL BATCHELOR by �0,_Deputy Clerk CC: County Counsel County Administrator P`• f y ' Law Offices of Stephine M. Wells 3030 Bridgeway RECEIVED Sausalito, Ca. 94965 via (415) 332-9033 Facsimile (415) 332-4395 SEP 1=1991 September 17, 1991 CLE R BO AARRAOF TA SSU �ISORS Risk Management Division Clerk of the Board of Supervisors 651 Pine Street Martinez, CA 94553 Re: Wrongful death claim Dear Sir/Madame: On behalf of claimant Ester May Owens, the enclosed file for the wrongful death of Phillip Perkins is filed. Please return a stamped filed copy in the envelope provided. 7teph truly yours, ne M. Wells Enclosures s September 17, 1991 RECEIVED 7 "Z Claim Against the County of Contra Costa SEP 191991 Risk Management Division Clerk of the Board of Supervisors 1CLEjjC-9—WD OF SUPERWSORS 651 Pine Street CQNTRA COM CO. P . Martinez, CA 94553 , Re: Phillip Perkins/ wrongful death 1. Claimant's Name:Ester May Owens, mother of decedent Phillip Perkins 2 . Claimant's Address: 121 Maher Court, Vallejo, CA 94591 3. Total Amount of Claim: $ one million dollars 4. Address to which notices are to be sent, same as line # 2 above. 5. Date of Accident/loss: March 19, 1991. 6 . Location of Accident/Loss:Martinez County Hospital 7 . How did accident/loss occur: Phillip Perkins died March 19, 1991, his date of birth was 9/5/49 On March 19, 1991 Phillip Perkins (deceased) sought treatment at the 37th Street clinic in Richmond, the Richmond Health Clinic or the Contra Costa Health Clinic located at 37th and Bissell. Claimant is uncertain of the name of the clinic but identifies its name by the address. Claimant reserves the right to amend her claim to allege the true and correct name of the clinic when such information is ascertained. For identification purposes, reference to the 37th Street Clinic will be "clinic. " It is alleged that both the Clinic (Richmond Health Clinic) and Martinez County Hospital failed to timely and adequately treat decedent, was negligent in not treating the deceased and such negligence was a proximate cause of death. After waiting 2 hours to be seen at the clinic (Richmond Health Clinic) , the decedent was taken' to Martinez County Hospital where he was taken from ward to ward without immediate care. But for the Martinez County Hospital's failure to promptly diagnose and treat decedent he would not have died. The neglect and failure to diagnoses and treat decedent was the proximate cause of his death. Unidentified doctors and nurses could have prevented decedent's death but for their negligence. Page 2 It is further alleged that such hospital and clinic officials were aware that decedent had been diagnoses HIV positive. Because of that diagnosis, it is alleged that such persons failed to treat and diagnose promptly. 8. Describe injury/damage loss: wrongful death 9 . Name of public employees causing injury/loss, If known: medical personnel responsible have not been identified. The county of Contra Costa is responsible because it administrates, operates and controls the level of . care and performance of its medical personnel. 10. Itemization of Claim: Claimant does not have the figures attenuated with her loss but will provide same when determined except to the extent that claimant demands one million dollars for the wrongful death of her son. Funeral Expenses: $ Hospital and medical bills: $ Emotional distress 11. Signed on behalf of Claimant: l�jphi M. Wells Attorney at Law for Claimant 12 . Dated: 1. 13 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT October 15, 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: $1327.66 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: MARK & JANE SEDLEY (Claim No. 05-0224-873 ATTORNEY: State Farm Insurance Claim Office Date received ADDRESS: P.O. Box 4011 BY DELIVERY TO CLERK ON September 16, 1991 Concord. CA 94524 BY MAIL POSTMARKED: From Risk Management I. FROM: Clerk of the Board of-Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: September 16, 1991 gVIL BAATCHELOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. N ) 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 910.6). ( ) 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: l BY: 6_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. 1 0 Dated: OCT 1 5 .199 1 PHIL BATCHELOR, Clerk, ByLDeputy Clerk 4 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 16; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: OCT 16 1991 BY: PHIL BATCHELOR by AA.0 ko, Deputy Clerk CC: County Counsel County Administrator NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: State Farm Insurance Claim Office P.O. Box 4011 Concord, California 94524 Re: Claim of Mark & Jane Sedley 05-0224-873 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: X 1 . The claim fails to state the name and post office address of the claimant. X 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. X4 . 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. X6 . The claim is not signed by the claimant or by some person on his behalf . 7 . Other: VICTOR J. WESTMAN, County Counsel By: . f� Deputy C my Counsel CERTIFICATE OF SERVICE BY MAIL C.C.P. §§ 1012, 1013a, 2015 . 5 ; Evid. C. SS 641 , 664 ) My business address is the County Counsel's Office of Contra Costa County, Co. Admin. Bldg. , P.O. Box 69 , Martinez, California, 94553, and I am a citizen of the United States, over 18 years of age, employed in Contra Costa County, and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non Acceptance of Claim by placing it in an envelope(s ) addressed as shown above (which is/are place(s ) having delivery service by U.S. Mail ) , which envelope(s ) was then sealed and postage fully prepaid thereon, and thereafter was , on this day deposited in the U.S . Mail at Martinez/Concord, Contra Costa County, California . I certify under penalty of perjury that the foregoing is true and correct. Dated: 9 �7-' 9/ , at Martinez, Californi cc: Clerk of the Board of Supervisors (o final ) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910 . 2, 920 . 4 , 910 . 8 ) i f STATE FARM ry_ISTATE FARM MUTUAL STATE FARM LLOYDS AUTOMOBILE INSURANCE COMPANY ®® r_1 STATE FARM FIRE AND CASUALTY COMPANY STATE FARM COUNTY MUTUAL INSURANCE INSURANCE COMPANY OF TEXAS STATE FARM GENERAL INSURANCE COMPANY DATE OUR INSURED ACCIDENT DATE CLAIM NUMBER 9/12/91 Sedley, Mark and Jane 31618t 05-0224-873 RECEIVE® SEP 1 0,1991 r- I From: CLERK BOARD OF SUPERVISORS; STATE FARM INSURANCE CLAIM OFFICE CONTRA.COSTA Cr). Risk Management = _ _ 333 Civic Drive 651 Pine Street, 6th Floor Pleasant Hill, CA Martinez, CA 94553 P.O. Box 4011 Concord, CA 94524 ATTN: Julie Aumont . By: C.,athV Caran�C1dim RPQ Fold— Agent Code: 6677 We are writing you about the accident in which you were involved with our insured on the date shown. Our investigation of this accident indicates that you are responsible for this accident. ® Please accept this letter as notice of a claim we have for Personal Injury Protection (PIP). ❑ Vehicle Damage. ❑ Medical Payments Coverage (MPC). ❑ Other: ❑ Should we be called upon to make payment under our policy, we will be looking to you or your insurance company for reimbursement. ❑ If you have insurance to protect you against such liability, please refer this letter to your insurance company. ❑ Please send us the name of your insurance company, its address, and your policy number. ❑ We have had no response to our previous letter concerning our claim. We assume you have overlooked writing us. Please let us hear from you at once. ❑ We have made the following payments and request reimbursement as shown below: Net Vehicle Damage Other Name of Our Payee PIP/MPC Payment (Less Salvage) Payment/Expense* Mark and Jane Sedley $ $ 1 ,327.66 $ * 6677 SUPPORTING DOCUMENTS ATTACHED Net Amount Paid 1 ,327.66 Insured Vehicle 500.00 $1 ,827.66 By Company $ Deductible $ TOTAL ' We enclose a return envelope for your assistance in replying. (160)G 4378.5 REV.2-86 PRINTED IN U.S.A. ......... + .__._---NORTHERN CALIFORNIA OFFICE -_ROHNERT$PARK CA-- ---- - ^^- -- - - - -_.r. `"' 11-4/1210 ®STATE FARM MUTUAL AUTO INS.CO. 0 STATE FARM FIRE AND CASUALTY CO. FILE COPY n' STATE FARM GENERAL INS.CO, - 0 STATE FARM LLOYDS NOT NEGOTIABLE 102 109738 ' `� ❑STATE FARM CCUNTY MUTUAL INS.CO.OF TEXAS CAR✓, ;�NO. 0 013 044 CLAIM NUMBER 05-0224-873 :.LALICY MER 1519-32$-05A onrE OS-21-.91 PAORDERTHE . ..- MARK SEDLEY AND "JANE SF_DLE'Y 1260 EL CURTOLA BLVD LAFAYETTE CA 94595-11354 ****13NE THOUSAND THREE HUNDRED TWENTY-SEVEN AND 66/100 DOLLARS $- ****1 ,327. 66* COVERAGE DATE LOSS NAME OF OLL I S I ON (LOMV) OF 03-06-89 INsuRED 55-MI-EY , MARK 400-1-$ 1 ,327.6b CAT. aAun V /r CODE REPRESENTATIVE __ • ( l ' xJ dill • 1 [165 L UNIT 1 COM-MENT ILUCGA t �I APPROVED BY - --------- -— ----- "ATE FARVI MUT10" i 1NQ11PAN',E COMPANY PLEASANT HILL. SEPk/I('.E CENTER, >U) a C I vi c A 1c. DRIVE P. 0. BOX 4011 cn_0 i CONCIORD. '-A 94524 > m c b') 6 8,0-4 A t 0 MK Al LOG NO 4 3 6 8.314 0 WIFE 0i/21/91 -nm >Z2 cn c M C 3 ti4U 0224 87:3po; ICYA 0 L K_C 3 :10 N EU SF_DLEY, MARK' CLAIMANT mm 3: m TE 'lYpl.: Ol 1.0-s Co. -0 3 31/8 9 L 22 C M02 Cf)-n m Z> C DA I E 0612 1 '9 11 0 i-'A 7 1 ON PH >-0 ry A,N Y i IL4,1 1)k E; I A YL Cl oirllv_ ::j M <0 N'l`fki E fii.401 0 E rr _t LLI b L u 26 i - V L) - I TY "A i E F`Y EL U TEl C ji 7 F 518 1 17 86 8 X 011 2 S V 2 It- 4 > cn up 0 E "74046 _0 ON rRc)�ti > z r- I m c -p't L m K -n m > >z z J. I TY R F_P LA C,E 1A F"! I P`R,T n N i� p AR! EU='Jkl ViAil-L EP=SEE PX REPORT cn > CK I V,/Ai f C N. I b L E F t.=REC)mFINISH M L h L> i 4L I "BOk OPERA-1 ION I i P k-I A PJ IAL L k E PLACE:A C E El =LABOR/PARTIAL REPLACE C m I Ll�I k,E m F4 -L.AB-Dk/PARl_IAL RFPAIk AA=AP� ' RAIW E ALLOWANCE RP=RELATED PRIOR DAMAGE mm > lNr'FJ_A_l-'D PRIOR DAMAGE m 0 ma? 0 m0 cn M E D A KI Y1713A OPINS A/ Z> 7 10Y01 CAMRY DELUXE 4 DOOR S m >-0 m -ION G :j:u -0 KC DESCRIP , M PART NO. PRICE AJ% HOURS R u-I;_ 0 > P-I R E.PA I R/A L 16 N r- 11 PNLjRlT DOOR OIR i0 PNL.FRT DOOR 01-P RT REFINISH 2.5 4 111E A p IT 7 0 C 3 32 10 0 -Z17 .64 3.5 1 DOOk SH'LLL 4 S DOOR SHELL.REAR r,T REF=INISH 2. 5 4 t, 4 01 ML06,11P 01, S 1 DE P,-i 15-4 132 1 0 c1 .51 .2 1 h _ PANEL,OUAklER 'r;'f 6160132923 268.84 1 1 N I SH 2.8 4 r- -j L R-F R.E'F 6;_`0 PANE' (WARIER ER 0 1 R'l F R -1 L ABO k/PA R T 'L REPLACE A C PANE L QUA. 1� ) F'r 101 L 5.9 1 4007 PNL,WHLHS OUTER P,T REPAIR/ALIGN 1. 0*1 (n 0 as A P 15.00* I_5*1 -0 I C L r_ Z GOAT REFINISH F 1 N I S H , z m a i I IL 1191 COLOk HNI AND BLEND R.F F I N I mK .nm Z_ Mi Pil E S'S A 6 E m kL!r r. 0"i Sl kthl li I. PAR I i'.S ;.1EN! I IF E I p m C) Z 4 0 P X I` I I fI ij m Z> CD > rra -A� n Folk- //8.9 1:-; Al PAYK A gA |LKAL i0% KA , L�69K ~ RA FE REPLACE HK REPAIR HAS \�^� 46�0O � i d �� O 62�.6J > ' �� - 2-NEC [ 4G�80 ' �wo I-FKAry"�� ' 46,00 c - . x 4-Q& [NI3H 4600 y .8 358 80 � �z 5-PAINT MATERIAL 70.80 � - LABOR TOTAL 984.40, � TAX ON LABOR C) SUBLET REPAIRS - � TUHlNQ & STOAAG[ _ � 027.66� GROSS TOTAL l,827 6� LESS ' DEDUCTIBLE 50U O0- � - ' . � oz cn NET 10TAL 1 .327.66 � c ADP#AUDA7EX Al U ES LOG 4358340 DATE 08/21/91 19: 83:43 043 ' 0 � P\N�YY/0l/U0/00/0U C04�0l/U0/OU/8U N3U �> � ' / r "NOTICE ~ REPAIRS TO THIS VEHICLE MAY AEOUIAE SPECIFIC WEiDlN6 EQUIPMENT AS RECOMMENDED BY !HE MANUFACTURER'' _---------------------_---------_----------------------_-----_----_----------- kso) ! HIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE ANY WARRANTIES > � APPLJCAHLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR ,- �� ' - ' ' ^ Contra Costa County RECEIVED S EP 13 1991 Rick Mra rnent L: 3 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT October 15, 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: Not specified 4F1V�B Section 913 and 915.4. Please note all "Warnings". CLAIMANT: SPENCER, Gary C. SO ,, Q � ATTORNEY: BOOR N O64W NUS Date received ADDRESS: 806 Alana Court BY DELIVERY TO CLERK ON September 17, 1991 Pleasant Hill, CA 94523 BY MAIL POSTMARKED: September 16, 1991 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. September 20 1991 &QHHIL BATCHELOR, Clerk DATED: P BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: q / 20 191 BY: Jaj& 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. oC11 � X991 Dated: PHIL BATCHELOR, Clerk, By v Deputy Clerk WARNING (Gov. code section 913) Sub;,ect 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 Ni a to Claimant, addressed to the claimant as shown above. Dated: OCT 1 6 95 BY: PHIL BATCHELOR by JO Deputy Clerk CC: County Counsel County Administrator State o CA, ornia` C Department of Transportation District 4 , 30 Van Ness Avenue Mail:P.O. Box 7791 San Francisco,CA 94120-7791 (415)557-8421 Gary C.Spencer ATSS 597-8421 Senior Right of Way Agent FAX 557-2520 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.Distriet 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 Seca 72 at the end, of this To—m. RE: Claim By ) Reserved for Clerk's filing stamp RECEIVE® Against the County of Contra Costa ) SP 17 1991 or ) District) c SLU1 o isoaS Fill in name Y. The undersigned claimant hereby makes claiainst the County of Contra Costa or the above-named District in the sum of $ � �� . 73 and in support of this .claim- represents as follows:. ------------------------------------------------------------------------------------ 1. When did the damage_or injury occur? (Give exact date and hour) -- ------------------------------------------ -- ---- ----- 2. Where diff the damage or injury occur? (Include city and county) all 3. . How did the damage or injury occur? (Give full details; use extra paper. if required), w. ?s � . ,.:s mti, c�. . r OR ✓! N G- f�-�1° , z o d.� 00 H .moi ►vG �dt st 601.N to CrIK "Tir�.w fL+:. /3 G ✓.0. w 1 7�/_ /� N�,� {- (Z D �fJ'SS ElO {A.J a"1'a-E •{'^/�-�i" �w n� �1 N G' .'{ 5 R r - -�- -(�d-c �t i�5 0 ,�---- �o K e cn (2�i2 roc K V-0 � _....-- --••--- - �nr fJS�/fid. 4. What particular act or omission ori.'"the part of county or district officers, servants or employees caused -the' injury'or damage?' . , 2 c t- uo �t-i ods-k�9- �J �- U11 G- C,rn��w✓ I r w ✓J S W A-(ZYvi N&- � 6^ f-r `Q over?ta Ud],e-� 7_- P�" b L i w�1� �► ✓T s /V a- ��.► -,R c.,�0 1,/!'FNr'SS�I'j 4`''•� �"� f►�O�T rC)am 5. What are the names .of county or district officers, servants or employees causfng the damage or injury? %A- ------------ ------------------- --------- --- -- -------------------- 5. What-.damage or injuries` ktwo!etsttimattes esulted? (Give full extent of in uries or damages claimed. Attach for auto damage. - --i -r-----------.------------------ 7. How was the amount claimed above computed? (Include the estimated amount- of any prospective injury or damage.) ------------------------------------------------------------------------------------ 8.. Names.and..addresses of witnesses, doctors and hospitals. do - c;� -------=P=-L--=--- ---------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT .....- �F �E iF � �F �E � �E�.�r"T�.*,.* �E-��F=�F"•'`�.f'F !E �-� �F.!F 1F. �L u Gov. Code Sec. 91,0:2 provides: r >`'3 "The claim must be signed .by the claimant SEND NOTICES TO: Attorney),. or bv s=e person on his behalf." Name and Address,of Attorneys Claimant's ignature Address 23 Telephone No. Telephohe,No. F-,• _ • NOTICE " Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer-, authorized to allow or pay the same if genuine, any,false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment 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 finer 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. ADDENDUM TO, THE CLAIM OF (Print your full name) ( 1) Do you use the roadway as part of a daily commute? Yes O No ( ) ( 2) Were you aware that construction would be commencing on . the roadway? 1. Yes ( X) No ( ) ( 3) Was an alternate route available? Yes ( ) No (4) Did you read about the impending resurfacing in the local newspaper? Yes ( ) No (�C) ( 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 (>d) No ( ) (7) Did a vehicle traveling in. the same direction and exceeding the 25 mile per hour advisory sign attempt to pass you? Yes ( No ( ) ( 8) Did a vehicle coming from the opposite direction cause gravel to be thrown onto your car? Yes ( ) No (�) ( 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 -thb identity of the car relating to questions 6 thru 9? Yes ( ) No ) 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 onto the car, along with the- specific damaged parts on your vehicle. ` ivb w 10.5 MA 4Ta'J ( 13) 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 information is true and correct under the penalty of perjury. ignature) 2 cj (Dat/e) C�S�/� � ' 1090 Folsom Street W�rnrn�MM W W Californ►a San Francisco, CA 94103 MEN MGIassCo. (415)255-9900 N2 1629 NAME �i DATE OF ORDER ADDRESS •�l.CJ RES.PHONE BUS.PHONE INSURANCE COJAGENT ALL_• POLICY NO. ADDRESS YEAR,MAKE,MODEL DELIVERY DIRECTIONS ❑FURNISH&INSTALL SOLD BY CASH CHECK C.O.D. CHARGE ONACCT. ❑FURNISH ONLY ❑WILL CALL ❑DELIVER OTY., SIZE DESCRIPTION AMOUNT .._..1.. `CLL .... �7I.... _ , � _-t ............................................. . . ..: ... - `...._............... ...... ....... ...................................... 5'q ke7 .... .. .. ` ., r............... / � �� ' ........................................... _ ..... ._. _.... .. _. I .................... . .... ..__ ... ................... . ........................................................... ..........._. ...................................................................... .............. .. ...................._. ............... ....... I I DESCRIPTION OF WORK 1 � / I 04 _&qo I OTAL STATEMENT OF AUTHORIZATION AND SATISFACTION MATERIAL Replacement has been made to my satisfaction and I hereby TOTAL authorize the above insurance company to pay direct in full to the LABOR above listed firm for said installation.If for any reason the insurance company does not pay for these repairs or replacements,the below signed agrees to pay for said repairs or replacement. TAX SUB-TOTAL I SIGNATURE o DEPOSIT D DEDUCTIBLE LRECEIVED BY DATE TOTAL I� BAY CITIES GLASS INVOICE Remit to:Administrative Office 4 The Bay Areas Complete Glass Replacement Centers a P.O.Box 2636,Castro Valle ,CA 94546 A utos • Stores • Homes # (Formerly AA Glass) - 14800) 358-4444 REF. ANTIOCH CONCORD DUBLIN FREMONT I HAYWARD I LIVERMORE OAKLAND RICHMOND I SAN JOSE SAN LEANDRO WALNUT CREEK NO. 757-2800 686-9792 828-3434 791-6464 481-7100 373-9900 451-1200 233-0313 1 286-7100 351-1275 944-9888 D_. CD 2 ACCOUNT AGENT PURCHASE NO.: NO.: CAOAK5 ORDER NO. DATE CUSTOMER STATE TAX OR EXEMPT NO. CUSTOMER FEDERAL TAX.I,D.NO. ADV.CODE SALESMAN I.D. ORDER TAKEN BY INSTALLED BY FEDERAL TAX I.D.NO. H D I ANE 94-3036631 BILL TO: SOLD TO: GARY SPENCER P. O. BOX' 1147 ALAMEDA, CALIF. 9 45 1 INSURANCE PROOF OF LOSS INSURANCE CO. BAY CITIES GLAS'S-~OANLANID POLICY NO. INSURANCE CO. PHONE NO. (415 Y 8.15-"2636 CLAIM NO. 1 CAUSE&. POLICY NAME ! ; LOSS LOCATION AGENT NAME BAY C4I T I ES GLASS—OAKLAND VERIFIED BY AGENT PHONE 1�l t _'1335-2636•.�: A DATE OF LOSS DEDUCTIBLE VEHICLE INFORMATION• r'� NAME Toyota MODEL Pickup YEAR 1988 DOORS 2 ODOMETER LICENSE VEHICLE I.D. NO. QUOTE ONLY . LIC CL#489786 PAY FROM INVOICE. NO STATEMENT SENT NOTICE "Under the Mechanic's Lien Law(California Code of Civil Procedure,Section 1181 at seq.),any contractor,subcontractor,laborer, supplier or other person who helps to improve your property but is not paid for his work or supplies,has a right to enforce a claim against your property. This means that after a court hearing,your property could be sold by a court officer and the proceeds of the sale used to satisfy the indebtedness. This can happen even if you have paid your own contractor in full,if the subcontractor,laborer, . or supplier remains unpaid." The above work has been done to my satisfaction by I HEREBY AUTHORIZE THE ABOVE-REPAIR WORK TO BE DONE Subtotal 169. 84 Bay Cities Glass and payment is to be made directly ALONG WITH NECESSARY MATERIAL AND I AGREE TO PAY FOR ALL �f a 25% T K 9'. 139 to them. CHARGES WHICH ARE NOT COVERED BY INSURANCE. TERMS 1 R • s,a�Gv 279. 73 X By X . � � r �:�� 1 x� � � k I� a� �� ,, � � �� , �._ � . .� a i f. � �`i�, � �`� �� C� >, �� il � � � , �. �. .� � '. � '�� 1 �-,� - -�'' ,e � � �� ,a �r 3� S�� ; �; 3` r� Q .� N .� �,, �x � � � �� r . � � �� 1. 13 f CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT October , 991 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: $250.00 ,VfcO Section 913 and 915.4. Please note all "Warnings". CLAIMANT: STEPHEN, Michael a�LE ATTORNEY: r-ooi Nom, b40' Date received ADDRESS: 714 Yuba Street ;01 BY DELIVERY TO CLERK ON September 16, 1991 Richmond, CA 94805 BY MAIL POSTMARKED: September 13, 1991 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: September 20, 1991 JVIL BAATTCHELOR, Clerkuty 1I. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 9 / 20 1 9 1 BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: OCT 1 5 1991 PHIL BATCHELOR, Clerk, B 1 1ALja 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 nd Notice to Claimant, addressed to the claimant as shown above. Dated:_ 0 CT �� BY: PHIL BATCHELOR by ° Deputy Clerk CC: County Counsel County Administrator Clam to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 45 -� INSTRUCTIONS TO CLAIMANT � ,A4- S'id –c>23;7___ .7--72— r 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 m 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.) MD CL lice 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. 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 C� ) RECEIVED Against the County of Contra CostA SEP i 61991 or ) . ; District) a BOARD SUCOSTovisoRs Fill in name )_. .. �. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of. $ ,�0 ``� and in support of this claim represents as follows: ` =Z! - - -N--NN--N..-.�--M--N--N-N-NN----N-----0---- N-�--- w N- N 1. When did the damage _or injury occur?, (Give exact date and hour) 930 336 --N--�-Y-rN------�---MN-N--N-N-rN-�N----NNO-iN__-`---� "0 - 2. Where did the damage or injury occur? (Include cit and county) -MN--N----N-----M---NM-N-----r--N-�-N- -NMN--M-----N--�--N---- N 3. How did the damage or injury occur? (Give full details; use extra paper if required)_ • �,�.� `r,��c .��-�.- ��s-,u� .��h�,. �- / jtst Y-N-----N----N---N-MN-N/N- --- _ =+�=T --1�-------------------N! 4. What particular act or omission on the part of county or district officers, servants or employees caused the 1injury or damage? (over) :,. w11dL. dre cne names of county or district officers, servants or employees causing the damage or injury? L , -- ----------------- - -------- '- ' 5. What ,damage or injuries do you claim resulted? (Give full extae®nt,of injuries or damages claimed. Attach two estimates for auto damage. + { —_ ---------------------------- ---N--N__N--r--.w----NM-----------------a---- 7. How was the amount claimed above computed? (Include the estimated amount of any �n prospective, injury or damage.) -------------------�—_--��=4' -- ----_NMe' -----M--_�—sir-- __--------_1—_—_—__--. 8. Names and addresses of witnesses, doctors and hospitals.' 9. List-the exp nditures you made on account of this accident or ~njury. 7 '' DATE ITEM AMOUNT -Gov. Code Sec. 910:2 provides: gz q "The claim must be signed by the claimant SEND NOTICES TO:, (Attorney)' ' orb some person on his behalf." Name and Address"of. Attorney ; Claimant% Signature (Address), Telephone No. Telephone No. NOTICE Section 72 of the Penal Code..provides: . _...._ .._..._.. . "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, 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. ADDENDUM TO THE CLAIM OF /'`'/ IM ei e-- z 1!5 (Print your full name) ( 1) Do you use the roadway as part of a daily commute? Yes (k ) No ( ) ( 2) Were you aware that construction would .be commencing on the roadway? Yes ( } No (�') ( 3) Was an alternate route available? A4.ak Yes ( ) No ( 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 (�O (7) Did a vehicle traveling in the same direction and exceeding the 25 mile per hour advisory sign attempt to pass you? No (�O ( 8) Did a vehicle coming from the opposite direction cause gravel to be thrown onto your car? Yes ( ) No ( ) ( 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 (Y- ) No ( ) ( 11) Did you obtain the identity of the car relating to questions 6 thru 9? Yes No ( ) 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 onto the car, along with the specific damaged parts on your vehicle. i ( 13) 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 information is true and correct under the penalty of perjury. 1.661. 9 T d33 ( Signaturel ss !' UIa03 Uluot) ( to) a C n 4 4 n4 fj y /J tt 946 (� ti f CLAIM i BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT October 15, 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: $219.81 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: DAVID & ALLYN WHISLER ATTORNEY: Date received ADDRESS: 2814 Rockridge Drive BY DELIVERY TO CLERK ON September 13, _1.99.1_ Pleasant Hill, CA 94523 BY MAIL POSTMARKED: September 12, 1991 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppHH BB �� DATED: September 16, 1991 BYIL DeputyLOR, Clerk JA" J j444 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: C3 rill) BY: J _ 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 (V,rThis 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. q n Dated: UT , 1�a� PHIL BATCHELOR, Clerk, By b 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. CL Dated: OCT 16 1�� BY: PHIL BATCHELOR by d -eputy 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 .See. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's filing stamp RECE- 1 " ; Against the .County of Contra Costa ) 3 or, ) _ -- District) CLERIC SOA_ R® G��;;,y� Fill in name ) CONTR`a- The undersigned claimant hereby makes claim againqt the County of Co Costa or the above-named District in the, sum of $ a-19, 91 and in support of this claim represents as follows: --------------T--------------- ----------------N--------------------------------- 1. When did the damage or injury occur? (Give exact date and hour) -------+-==5.�- ----- i •� 2. Where did the damage ori injury occur? (Include city and county) l� ? �itJ{PH /o ; -� rr t - KIM -�vaaQ -L4 - e-F�e C • - •• �- -- -----��-- -----••� 1 ✓ 0. 1 -�t CNS < --Y-�l Z G -- ...� --....- --— 3. How did the damage or injury occur? (Give full details; use extra paper.if required); /• rr :` � L9ra✓el �r8,,c � i Ls r/o1!/'ra/ ;q 7,t4•e_ e-elce v . ----------------------------------- . 4. What particular act or-omission on'the part of county or district officers, servants or employees caused the"injury or'damage? l �•L G 7`rucl� GfJc�s acv f / /Vra�/,c-�-�y Cho✓r''roO /��o �rfvrK �' (' 6 T' 77t'C /f'✓t...G .r J e�.ti-c Co.a'�`rD ✓vo.,�we� e aw 5 f'a s1�4.,1d! e�l�m t�c.n� b e�w e�PA ^o✓ e� , (over) �. wnat are the names of county or 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. c�ra�G� . .. ��•fi(.6i u<' 1i 1�'Cl� ��4d:�• ��/�O/C� �4i�'/�. �.V^G - C:r✓C �.✓•��•'(Ci' �� 7. How was' the• amount claimed above computed? (Include the estimated amount of any prospective injury or damage.)- r__ ,� dZ_�__=_ fig'.-__v_��o.-s $. Names and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEMS AMOUNT -_ �Cpa f✓ i5 tWt�i�e� G_S / . �� c�ol L✓i!� �e �'lt Ge.l� s -P ere..a_ d.S f'•rSo �'�f�uK 074lS CA.r Gov."Code Sec. 910.2 provides:. "The claim must be signed .by the claimant SEND NOTICES TO: (Attorney) or b• some person on his behalf." Name and Address of Attorney w • U/ Claimant's ure Address .. ....cA. crq9 3. . -. Telephone No. Telephone No. 370 y8 AlS- 74 B -5 �l 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•.tenwthousand dollars'-($10,000, or by both such imprisonment and fine. ADDENDUM To THE CLAIM OF (,J (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? Yes ) No Na �"" u�� l .. c4✓off Q ` f�.� rC �k . ( 3 ) Was an alternate route available? Yes ( ) No ( ) (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 (7) Did a .vehicle traveling in the same direction and exceeding the 25 mile per hour advisory sign attempt to pass you? Yes ( ) No ) ( 8) Did a vehicle coming from the opposite direction cause gravel to be thrown onto your car? Yes ( ) No ( 9) Was the vehicle located directly in front of you exceeding the speed advisory? Yes ( ) P10 ) I"1UU-1__0-I=JJ1 L"- 1 f rRUll LUI I..LIY 11\flL 1`IU. �f1L.U11 I U (UIJUCJU_ vi gLiby-Owens-Ford Co. O�J�1 � C�-' �� ESTIMATE 802156934 Glass Centers WORK ORDER INVOICE . SALESMAN E S T I M A T E 08 c^8/91 TO; DATE sold To — 4P SEDAIN ADDI ESS MAKE/MODEL Fel ' ' ADDRESS V.I.N.S Cl.Y STATE LICENSE# MILEAGE CLAI ANT SPECIAL INST. DATE TIME WOF� PHONE# HOME PH CUSP OMER# CASH INST# C04DATE TIME MN1.O# L- 06ANTITY ITEM NUMBER DESCRIPTION LIST PRICE SALE PRICE TAX 1 W 1 @58S DOMESTIC W I NDS41 EL.D 184. 56 TX , I LDWCASH LABOR-DOMESTIC W/S 55. 00 1 UDW U-KIT DOMESTIC WINDSHI 9. 95 TX i I i I ! I� I i I I t payint Reference Aoproval Date Amount Sub 249. 51 --L-- ----=---------------- ------------- ----- ---------- Tax 16. 05 Balance Total 265.56 ?� THIS IS NOT AN INVOICE - DO NOT PAY OLD T O: INSURANCE COMPANY INFORMATION BELOW THIS LINE I INSU4kd W#qY AGENT I)AVE QRTSL-ER— NAME AD6AESS 2E3L 4 ROCKR I DCE ADDRESS ADbRESS PLEASANT HILL CA 94523 ADDRESS CITY, ITY.STATE CSTATE PHIONE# FLEET A PHONE# POLICY# CLAIM O rN6URANCE DATE OF CAUSE OF VAfIIFISD BY LOSS LOSS 1 ®bel glass� inc, WHEN PAYING BY Ar �lt4d CHECK,PLEASE INCLUDE THIS INVOICE NO. REMIT TO: (415) 834-7841 s oalccd - ;INVOICE NUMBER P.O. BOX 657 nl WO-3-5646 OAKLAND, CALIFORNIA 94604 ` '�U 1F#9F#3F . 9F#�F9f# ,,.,'FEDERALTAX NO. DAVE__WHISLER DAVE WHISLER 2814 ROCKRIDGE DR 2814 ROCKRIDGE DR PLEASANT HILL, CA 94523 PLEASANT HILL, CA 94523 CASH SALE # SCHEDULE. DATE CASH,;`';.CH 4RGE `CREDIT^;'"WHSC'E'.. 'RETAIL,r WPU: ' -- EL`- 1NSTL,., MOBILE vI = 'T`. W,: ,TH . F. -"S 'AM PM , :TIME.'. X + X X DATE ", 'AC OUNT NUMBER` P:O:J POL'iCY NUM6'ER, ;; .ClA1MaNUMBER ,;= SALESMAN,==; ORK.OROERPHONE',NUMBER 07-30-91 0 01 YEARK' w p Ml1yK y? , , . 3-. 6 bAustDEDUCTILDlTE OF` LITHO AGENT~„ t10ENSE.# INSTA LLDBODY STYLE, -STOCK, a 190 FORD ITAURUS CUSTOMER' S PHONE 1. ) 2. ) QTY.' PART NO. DESCRIPTION --CTL . LIST - PRICE ,;. - '-TOTAL°t.. , 1 W980 S WINDSHIELD (WINDSHIELD) I X 461. 40 161. 49 161. 49 1 LABOR 45. 00 45. 00 *THANK YOU FOR CHOOSING OBEL GLASS, I C. ! SPECIAL INSTRUCTIONS, SUB 206. 49 TOTAL LOCATIONS: CONTRACTORS LICENSE NO.374136 SALES TAX ❑ 400 FRANKLIN STREET, OAKLAND, CA 94607 • (415)834-7841 ❑ 1992 REPUBLIC AVE., SAN LEANDRO, CA 94577 • (415)357-0747 ❑ 5292 PACHECO BLVD.,PACHECO,CA 94553 • (415)827-3900 REC'D BY TOTAL ❑ 1711 BARRETT AVE., RICHMOND, CA 94806 • (415)232-1337 NOTICE:"Under the Mechanics Lien Law(California Code of Civil Procedure,Section 1181 et seq.)any contractor,subcontractor,laborer,supplier or other person who helps to improve your P�Q 1 property but isnot paid for his work or supplies has a right to enforce a claim against your property.This means that after a court hearing,your property could be sold by a court officer ,_, and the proceeds of the sale used to satisfy the indebtedness.This can happen even if you have paid your own contractor in full,if the subcontractor,laborer or supplier remains unpaid" CONDITIONS OF CREDIT.TERMS—A FINANCE CHARGE IS COMPUTED ON A PERIODIC RATE OF 1V.%PER MONTH WHICH IS AN ANNUAL PERCENTAGE RATE OF 18%ON ANY PREVIOUS BALANCE NOT PAID WITHIN 30 DAYS.All accounts,industrial,corporate,and private are included. 0 �J (Y Iz IT flj- Lu i, ca� t 3 � r � CA