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HomeMy WebLinkAboutMINUTES - 10131992 - 1.18 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA M Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT OCTOBER f3 , 1992 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: Unknown Sectik9kiNft 915.4. Please note all "Warnings". CLAIMANT: BURKE, James D. SEP 3 1992 - 471 Hintz Ave. ATTORNEY: Tracy, CA 95376 COUNTY OOUWa Da"MA" ADDRESS: BY DELIVERY TO CLERK ON September. 9, 1992 (via Risk Mgmt) BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. p�{ gg HH DATED: September 22, 1992 BTIL DeputyLOR, Cler IL. FROM: County Counsel TO: Clerk of the Board of Wervisors (� 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: /MBY: Q 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: /O L3 JZ-- PHIL BATCHELOR, Clerk, By Deputy Clerk If WARNING (Gov. code se 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. *For additional warning see reverse side of this notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to. Claimant, addressed to the claimant as shown above. Dated: /O / Z 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_.aetion for-death or for.injury to person or to personal property or growing.,crops and which accrue on or after January l, . 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 James D. Burke ) RECEIVED , Against the County of Contra Costa ) SEP —9QW or- . ) District) CLERK BOARD OF SUPERVISORS Fill` 'n 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 $ U nkQwn and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) See attached sheet 2.: Where did the.damage or injury occur? (Include city and county) Speg_attached sheet 3. How did the damage or injury occur? (Give full details; use extra paper if required) See attached sheet ---~---------..------------ ----------------------_..M_--_--____ 4. What particular act or omission on the part of county or district officers, servants or.employees caused the injury or damage? (over) 1. July 11, 1992 at approximately 10:30 pm. 2. On Delta Way by the town of Knightsen, Contra Costa County. 3. When the front tire of my motorcycle became caught in the area on the bridge where a missing plank had been. Upon approaching the end of the bridge with my tire still caught in this area my bike struck a 6" bolt protruding from the grove where the plank was missing. 4. Proper maintenance was not performed on the bridge. 5. Unknown. 6. Repairs to my Harley-Davison Motorcycle amount to $1463.56. To date my doctor's bill is $44.00. I have had continuous pain in my back and knee. I am still under a doctor care. 7. Not computed as of yet. 8. Witnesses: John & B.J. Seidl Lee Mullins 3229 Barbara St. 1846 Locust Stockton, CA. Livermore, CA. 94550 (209) 463-7066 (510) 443-4699 Marilyn Largent 2305#A Peppermint Dr. Modesto, CA. 95355 (209) 522-9381 9. Date Item Amount 8/12/92 Dr. Visit 44.00 .. ti a Q U") O O ~ GeorC MSm3y xmro I Uo G O m OQ m £�Vg�mmUs"a . x� n oom a� O00pEo91 ..r. �n Oma✓ Z La > Cmaau Sd0 o gas�4o m O v TO e090 m� m m O L O>n :- V O 7 .�yO �omDu mnO mam 3 �'c>g O m_ N m { ✓ Z «"— is ` m y G "1 ".C V m f yq 1 1 aG m CG�i OpY j 1 �j- ys� o s m" Eo o 'a W o o E Q�m p6 2o'or W 3 � m cs xOt cn W Z"nw O o m p W Z .0 w rn 70 o o.d m `r �osm3 OOr 4 a V o. a8 O. " w 01 v p O .+°' Cal � nq o uom�$o ac "n'6 } aro C m S� O.��d 1 O .O0�L m6�m�O W 11 p+ O O'" U G O Zsa1 Z �J OD F'L9_N m,m Uk mm iN 3 ? N m O D pmoI9 OO; m ry 3Emmm�N V% 0. rD9' rmm^o mw"o f I>. n7 C ,°`m ° mmrmgc$no ZT N Y no s obmry a- N Z •� � 3� oQ N b mm oom�`dv'`} o m E vr?momm V Q o nu-,n - w E oms�E9O yN. V4 wm o omoowc Y -5,15 wa 1 zj V 0 f r to i► d r Wa r r ow cc ..� •� 1'W f1 J- � '..F y Q' . A } c 18121192 PATIENT FINANCIAL HISTORY Page 1 Jay Patel, N.D. Accounts 3483 — 3483 All Dates Acct Date Dep 1 Name Orl Procedure Diag Units Amount 3483 BURKE,JANES Previous Balance 1.81 6812192 1 BURKE,JAMES 1 91151 EST.PT.LINITED VISIT 129.1 1.11 44.11 -------- ------------ TOTALS FOR ACCOUNT 3483 PAYMENTS 1.11 ADJUSTS 1.11 CHARGES 44.11 1.11 44.11 REFUNDS: 0.0/ 1.11 1.66 44.81 44.11 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 13, 1992 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: $3,68-.57 Section .913pr41915.4. Please note all "Warnings". CLAIMANT: FLEMMER, Daniel SEP 2 3 1992 ATTORNEY•• Farmers Insurance Group COUNTY OOOUN So. Bay Area Property Branch Date e"ived- -"-" ADDRESS: Claims office BY DELIVERY TO CLERK ON September 9, 1992 (vj.a Risk .Mgmt) P`.O_ Box 43,70 Santa Clara, CA 95054 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. Se tember 21 1992 ppY�IL ATCHELOR, Clerk GATED: P BY: Deputy Il. FROM: County Counsel TO: Clerk of the. Board of Sbp1_rv41ors ( ) This claim complies substantially with Sections 910 and 910.2. ( vl'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: 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: (-0 �(3 Z PHIL BATCHELOR, Clerk, By . Deputy Clerk YARNING (Gov. code secti ) 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. FOR ADDITIONAL WARNING SEE REVERSE SIDE OF THIS NOTICE AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: /q2_-___ BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM T0: Farmers Insurance Group So. Bay Area Property Branch 1! Claims Office P.O. Box 4370 Santa Clara, CA 95054 Re: Claim of -R,,nmEf.s aanniT emm r 'Pultty 908=2vul' Please Take Notice as Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910.2, or is otherwise insufficient for the reasons checked below: 1. The claim fails to state the name and post office address of the claimant. V,2- . The claim fails to state the : post office address to which the person presenting the claim desires notices to be sent. .3. The claim fails to state the date, place or other circum- stances of the occurrence or .transaction which gave rise to the claim asserted. The claim fails to state the name(s) of the public employees causing the injury, damage, or loss, if known. 1/ 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000) . If the claim totals less that 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 woulc. rest in municipal or superior court. 6. The claim ins not signed by the claimant or by some person on his behalf. 7. Other: VICTOR J. STMAN, County Counsel B �• Y• Depu C unty Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a, 2015. 5; Evid. C. §§ 641, 664 ) My business address is the County Counsel"s Office of Contra Costa County, Co.Admin.Bldg. , P.O. Box 69, Martinez, California 94553, and I am a citizen of the United States, over 18 years of age, employed in Contra Costa County, and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non- Acceptance of Claim. by placing it in an envelope(s) addressed as shown above (which- is/are place(s) having delivery service by U.S. Mail) , which envelope(s) was then sealed and postage fully prepaid thereon, and thereafter was, on this day deposited in the U.S. Mail at Martinez/Concord, Contra Costa County, California. I certify under penalty of perjury that the foregoing is true and correct. Dated: September 24, 1992 , at Martinez, California. Y cc: Clerk of the Board of Supervisors /riginal) Risk Management (NOTICE OF INSUFF) ;NCY OF CLAIM: GOVT. C. ' §§ 910, 910 . 2 , 0120 . 4 , ^� ^ . 3 1 92 -r " u 1 .4 2 1 Motr W Mc o! k-- i t o s P �� t'M� Farmers Insurance Group OF COMPANIES SO. BAY AREA PROPERTY BRANCH CLAIMS OFFICE Dote: $ !0/92 2945 DEMOCRACY DRIVE "P.O. BOX 4370 SANTA CLARA. CA 95054 SCC :onservatorship Guardianship Program. 408-982-0888 P.O. Sox 8, �/�p, VMV1 Mart ine2,CA 94553 �I����� ® Att �1 Flanigan 14 REF'1.Y PIXASE REFER TO: SEP 9 M Our Ir . Dan:.el Flemmer Data of loss 7/1'./92 Our Powy No 9W29681 CLERK BOARD OF SUPERVISORS SAW: N1 176543 CONTRA COSTA CO. Acadant location 984 South 7th St, San Jose Total Amount ofi3,68e'.57 Claim to Date (Incl.Our IM Oetluct A revi-w of the facts of the loss indicates that our insured is entitled to recover damages from you. There,ire. we have the right to make claim for these damages in our insured's behalf. This letter is to notify you of our subrogation rights and to advise you that no one-has authorityto give you a release for our interest except a representative of this Company. If you .3rried liability insurance to protect you for such losses, we shall present our claim to your Company. Please complf,te the following information and return to us. In•curance Company Name: Policy No. At(dress Nr ime and address of 4gent or Adjuster If you :,-a not insured, please send us your check for the amount due. If you are unable to fulfill this obligation. please •ontact the undersigned immediately. Vero truly y Signed FI}i.E I ER G G ''NE LDRE VE., GATION CLAIMS Pe son that caused the damage to our Insureds house wasJames Zaratoga. tlossv..tt�r:cmi.+rzon.c rrnren.�r.._e.,.�. WE._ARE MEMBERS OF THE INTFOC nAADAAIV ADDITO ATIr &$ A r+ncca Ar-►1+ AUG-20-1992 14:27 4156462853 P.002 � H v ��-- L rte• - _ .z. . . . :�• ... . � .� _ .. ,. - .. 'ta1 t� f \ Farmers IGroup '.,.COMPANIES SO. SAY AREA PROPERTY BRANCH CLAIMS OFFICE per,. 8, !0/92 2945 DEMOCRACY DRIVE P,O. BOX 4370 SANTA CLARA, CA 05054 PCC :onservatorship Guardianship Program. 408-982-0888 P.0. 3ox 8, KartLnez.CA 94553 Att tl Flanigan ,�: ... RECEIVE® By REP t.Y PLEASE REFER TO: ~ ourtnsurw- Dan'-el Flemmer Ya4•- Date of Loss 7/1 '492 SEP 2 1992 Our cbt.cy wo 908 29681 �L N1 176543 Acvd*M L=fiat: 984 South 7th St, San Jose CLERIC B©.+ARD OF SUPERV150RS Total Amauttl ata,68'' .57 CONTRA COSTA Co . clan to Date (Ind.Our in*. Deduct) A revi-w of the facts of the loss indicates that our insured is entitled to recover damages from you. There-re. we have the right to make claim for these damages in our insured's behalf. This k.tter is to notify you of our subrogation rights and to advise you tnatno one-has authority to give you a release for our Interest except a representative of this Company. If you 3rried liability insurance to protect you for such losses, we shall present our claim to your Company. Please complfsre the following information and return to us. In-curance Company Name: Policy No. At(dress ' N-vne and address of Agent or Adjuster R you :--e not insured, please send us your check for the amount due. if you are unable to fulfill this obligation, please ,-ontact the undersigned immediately. Vere, truly Signed I FI}i E I EX G G YE LDRE ldF ON CLAIMS Pe son that caused the damage to our Insured's house wasJames Zaratoga. t1-OJ�lr..f fnTT. lf7 .gY/2rnn.�un TFn/.v s_..••.—... L/ WE._ARE MEMBERS OF THF INTF nAADAMV A D921TO A Tt/'1wP t •i^ .002 r-► �' AUG-20-1992 14:27 4156462853 P'00 ho ti 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 13, 1992 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: Unknown, Section 913 and 5.4. Please note all"Warnings". CLAIMANT: LARGENT, Marilyn SEP `' 2305 #A Peppermint Dr. �, 1 I996 J G ATTORNEY: Modesto, CA 95355 COUNTY COUNSEL Da to ftVO Ti4'>4dCA1tF. ADDRESS: BY DELIVERY TO CLERK ON September 9, 1992 (via Risk Mgmt) BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: September 2T, 1992 VIL BAATTCHELOR, Clerk ty I1. FROM: County Counsel TO: Clerk of the Board of Supervisors ( v) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: �"` Z y liyZ BY: " �< �--�-p Deputy County Counsel II1. FROM: Clerk of the Board TO: County Counsel (1) County Admin rator (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: /3 1-1-2— PHIL BATCHELOR, Clerk, 8y Deputy Clerk OF WARNING (Gov. code seion 3) 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. FOR ADDITIONAL WARNING SEE REVERSE SIDE OF THIS NOTICE. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:_ /p BY: PHIL BATCHELOR by Deputy Clerk _— F CC: County Counsel County Administrator 1 Clain 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 •f"or injury .to person or to personal property or growing,erops and which.,aecrue,,on or after January 1, 198-8, 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 theBoardof Supervisors at-its .offiee 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 Marilyn Laraent } RECEIVE® - Against the County of Contra Costa ) S t) CLERK CLERK BOARD OF SUPERVISORS CONTRA COSTXCO. ll irl e The undersigned-claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ unknown and in support of this claim represents as follows: bYN®------Np1®- -N--O - -NMN---------N--NN---N---------M----eM-®aw 1. When did the damage or injury occur? (Give exact date and hour) See attached. sheet B.. Where did the damage or injury occur? (Include city and county) See attached sheet -.----------------------------- -N-��----------- 3. How did the damage or injury occur? (Give full details; use extra paper if required) r, See attached sheet ----- ------------ - 4. What particular act or omission on the part of county or district officers, servants ,or ,employees caused the injury or damage? See attached sheet (over) t 1. July 11, 1992 at approximately 10:30 pm. 2. On Delta Way by the town of Knightsen, Contra Costa County. 3. When the front tire of the motorcycle I was riding upon became caught in the area on the bridge wherea missing plank had been. Upon approaching the end of the bridge with the tire still caught in this area my bike struck a 6" bolt protruding from the grove where the plank was missing. 4. Proper maintenance was not performed on the bridge. 5. Unknown. 6. To date my doctor's bill is $179.56. I have had continuous nightmares and have not been able to get back on a motorcycle. 7. Not computed as of yet. 8. Witnesses: John & B.J. Seidl Lee Mullins 3229 Barbara St. 1846 Locust Stockton, CA. Livermore, CA. 94550 (209) 463-7066 (510) 443-4699 9. Date Item Amount 7/12/92 Dr. Visit 179.56 F fAA P I L YA N? N 'a 07712792 9 2 0 7 2 0 9'2 .3 1 1 DiAT SERVICE DATE oTY DEScRIPT1OG A 1-i r;,J 9T Rvs Noe 07X12/92 1 oE¥E lL INJ 75O-!G 15. 06 99 C,7 1 11 1 PHE'NERGAN !NJ sO*O.G 14o39 99 --CIHARmAcy sUe TOTAL-- 29,#5 7 P C0¥PLZX 143. 11 33 AF TEP HRs CH kf'.GE ER 7. 00 33 Y,'- 'k C,:-- N, y SUB TOTAL-- 150. 1 ! T r"Tt,.L (BARGES THIS !39, 55 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 13. 1992 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: $1,234.09 SectionR913 'nom® . 5.4. Please note all "Warnings". CLAIMANT: RENTUMA, Vincent F. VEE SEP 640 Second Street J ���� ATTORNEY: Brentwood, CA 94513 GOUN'[Y QOUN4h DatA4VWEeQIWFL ADDRESS: BY DELIVERY TO CLERK ON September 10, 1992 (hand deliverec BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ClerSe September 22, 1992 ppTILBATCHELOR DATED: II. FROM: County Counsel TO: Clerk of the Board of Sup sors ( )his 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: �` 2'3 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 ( V) 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: 0Cw /3,JZPHIL BATCHELOR, Clerk, By4&M9ZLc1__ Deputy Clerk WARNING (Gov. code sec 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. . You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For additional warnina See reverse side of this notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: /O J/� ��!L BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Clain 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 310 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 ..dater than .one-year..after the accrual of...the. cause of`action. (Govt...Cgde §911.2:) Be 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. ' I 11 It 4e , RIE: Claim By ) Resery for e k's fi Ing stamp _i►'Z C_ n r R EC S N/ Y. Against- the County of Contra Costa ) SO' 1 0 1992 - District) GLERK soaR®OF SUPERVISORS COSTA c F ill .name--in - ) cosvTR o. .ct.c . The undersigned claimant_'hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ �Lr� �( • 07 and in support of this claim represents as follows: 1. When did the damage or-injury occur? (Give exact date and hour) Ajor P_ 349 2. Where;-did-the damage or inury occur? (Tnelude city and coon y) 3. How did the damage or injury occur? (Give full details; use extra paper if requi red)GL Gar e-=• 7"re�- !,'rn b T o l • rvfw +h e_ Co/tfr�-- Cos tai, Co. IP ar•kin j �.at �aCa:Meal 0-t' tl,? Irak 6t. FFItAtuDOM anct landed C/7 Du-r Cab- pv e-r- CC &Vt1_ 0a44si� 'e eX� ASi ve_ ola nLc C�,> e r- i s i/1 Dec I_ ,h asp q 4.r ct Gtd3 acuAt . yD -th c_ n u.n tV Pc-?'kin� G o f. 4.. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? y �l'e e- G i 1n b Dn �'�r1f�a Ca�f� CD • f�/0�2�?Ll (over) DAVE'S TRAILERS SERVICE ' 155 O'Hara Ave. P. O.:Box 262 Oakley, CA 94561 '(415) 625-3622 AS LISTED FOR LABOR AND IALS ESTIMATE OF REPAIRS VERBAL AGREEMENTS NOTSINONG ISTIMATESFRE=_ OWNER - DATE ADDRESS ' PMONE ES .NO. IN5URANCE Co. ORDER NO. ADDRESS PHONE LICENSE NUMBER YEAR-MAKE MODEL MILEAGE MOTOR NO. - SERIAL NO. 7k Ll-IjZ4 v- R �2 mor- 70 4 0 7 a Vo c' 4et klo Pa LQ C- R r I I� vt, A sint AVo ; ;, ow -k ow a� I mt o� 4"I Gr ra m i . o I y (Sc� _r tX <i P, QAIP 517 v .S L /C wAlAk C-2,a e74 a - r z` PRItiSPR[ ;SASE��+kSFAt7E�ti83, 1�TAECIC�P .: yH�H TOTAL p EIlREMt3�[ :Ai�iF7CCt)EftXER1 CEf iRG "rZEAUDWFOJtSPEaAL MATERIAL - � ....... .. :.. ...vow _. ..._ _ :. :. ...... .' :> :...:. V 17,0 y �;FJ•fE'iLHl1�iE LS:.,ickE•:EaT#fk`t� [S3�i:;CliJtt``.stYSPEC7'[CNkx 't�lESrtCG�RF.ti�%�7TOTAL LABOR OY 3 N.Csli a RSIIt�1Nt t[C'thuUtAY BLG RECIFIt /if 1 EF fZiEUVcsRlCltis sEFr oAENEQ UMO CAMONAts.Y£/IEFEx: `s ' hIQRKy/RaSTARTt3t7NlORf�FF AR�mSx�RNt�+ � �> TOTALMATERIAL ,�z _`.��,-YF' .ate.'-:•s�O'��}�- w -"YS � y?�c zf> t��-K:�".r,H'�",wi"�L,,,,'�`"�;fi� �� �� �'�`<' � �f'/ • t.x„ z -.>,�a a-.fr %' �,5, :ra�'aZ'��''` e.�� "}'�Y.Fe 5..^r.� 'L"a ^^���',w�,u4^c°?Xz p >� TAX )sfj .-•7 A.�TRI /iyK/•'.•1��.�sv.'... -E•..: . .?.q,r ..s, 'hy,3t"w:sx 9 3- ..�,�:�' `. PAIDOIfT-XW&Si'ORAGE �1 a .� ,°' �'^;*"'S.'� L''* ^etSq.nEa•%S*,>•�,aYFva• _ •a s-- rm > .,j a ��4 f�,`� s p.e:.` a ��a.'�at r:1�•�ae�� a-y: s.p : �� a 'sy rr� �ry~ su4b aa�k.' �c�r�" C� i �x�as �r; SUBLET REPAIRS 10 a n�w��x ,T .��3' �� � +,i.•�°`cex�y,, a,�l y„ `S7"�a�a� `c i ^' y �-••¢oPib, Lcc""'i" ."aw �:;�i�s,3.::." 18 J�, .,c- ......3.: • PV ,� s. "•5 •.•••'Y.�. "'" .� i' `�i __ ..•..