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MINUTES - 10222002 - C8
CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Oct 22, 2002 Claim Against the County, or District Governed by } the Board of Supervisors, Routing Endorsements, } NOTICE TO CLAIMANT and Board Action. All Section references are to } The copy of this document mailed to you is your California Government Codes. } notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given 1rsuant to Government Cade Section 913 and s 15.4. Please note all "Warnings". AMOUNT: Exceeds $25,000 s > { CLAIMANT: Sarin Sy MM'1Y1 EZ AUF. i ATTOIZINEY: Thomas Miller DATE RECEIVED: Oct 7 2002 ADDRESS: 725 Washington St#300 BY DELIVERY TO CLERK ON: Oct 7, 2002 Oakland, CA 94607 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim, JOHN SWEEP Dated: Oct 7. 2002 By: Deputy '7 a ' x i 4- # U J II. FROM: County Counsel TO: Clerk of the Board of Supervisors (,,}/This claim complies substantially with Sections 910 and 910.2. { } This Claim FAILS to comply substantially with Sections 91.0 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 9101.$). ( } 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: . eputy County Counsel III, FROM: Clerk of the Board TO: _Co=tVJCQ=sel (1) C°ou2tK44t iinistrator t21 ( ) Claim was returned as unfimelv`Wim*notice LU cFitFFFiaFlt �. ._�_. a.J IV.. BOARD ORDER.: 'i'�t�iai�2S�TL7tas�c���tile s�trier c��szsicr: ( This Claim is rejecter d. ( } Other: I certify that this is a tr`ti6 art chrrIZI Mnvhf tte tsoard's'Orldei etitered inns ihinutes torthis date. R. < OCTOBER 22 , 2 � 0Ej Wj� ,^ �� . Dated: Zt _� ris , Deputy Clerk Subject to certain exceptions, you have only six (6)'mohths 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: OCTOBER 239 2002J0IN SWEETEN, CLERK.By � F 4 '� °' ,��- �.--.��;, :. --- Deputy Clerk I Miller & Ngo A PROFESSIONAL LAS' CORPORATION DU 'S BUILDING, COLD OAKLAND 725 Washington Street, Suite 300 Oakland, California 94607 Tel: (510) 891_0616 / Fax: (5 0) 839-9857 September 23, 2002 1 :s. Penny Bailey CONTRA COSTA CO "QTY 2530 Arnoldri se, Suite 140 Martinez, CA:. 94553 Re: Our Client Sarin Sy Your ur Insured Contra Costa County Claim Number-. 50253 Date of Loss : 04/10/2002 Our File _ AA1159 Lear Ms, Bailey.' As indicated to you in our t flier<()srre3poi)dence, this law office represents the legal interests of the abovenamed chem. We are now writing this letter to present the facts of our client's already timely submitted claim with a view toward an amicable settlement, This letter and the enclosed materials are submitted only for the purpose of settlement negotiations and should in no way be used in the event the matter is tried in court, FieldsonAssocates Inc v. WhitecliffL,aboratories Inc., 276 Cal.App. 2d 770; 1969; Evidence Code Section 1154> The inFormationcowainv.d in this letter and supporting materials are submitted in good fail}mid our office trusts you gill carefully examine, evaluate and respond to thein in a timely manner: FACTS OF THE ACCIDENT 'his accident: occurred during Ja,,Aight and under dry conditions on April le, 2002. Our chem eras proreed..n s-,ralpht on Baldwin toward 85" Street when your insured pulLod out frora tlw:11ek- =-Savtpaj kitt lot and collided will;inns let's front fender of our c=rent`s 1999 ford vw . Gf "�enlg_ iff mdi.',iion was exchanged, with your insured admitting clear liabildty.. The' farce of the impact itom your insured's vehicle violently threu,our client back and forth within his vehicle, causing his body to strike various portions of the vehicle. Our client was not rendered unconscious, but was confused, disoriented, suffered a neck strain, and was shaking immediately following the accident. He soon experienced dizziness,headaches, difficulty breathing,and pain in various parts of his body for which treatment was sought with Dr. Th .nh Vo. Dang, D.C. on April 11a', 2002. (Jur client's diagnoses by Dr. bang are as follows. Cervical sprain/strain associated with headache,joint dysfunction and cervical myositis. - Chest wall contusion - Upper thoracic sprain/strain associated with myospasm. Thoracoldtttbar sprain/strain associated with myospasm. He received a total of'24 treatments over the period of two months. He still experiences occasional neck:pain due to the injuries caused by the accident. BASIS OF.CLAIM As a driver, your insured had a duty of due care to operate a vehicle in a reasonably pTudent manner, Instead, your insured breached this clay by negligently being inattentive and failing to yield to on coming traffic. As a result, your insured is responsible for the physical harm,bodily injury, property damage and pain and suffering caused to our client. >There was no contributory negligence on our client's part. But for your insure d's negligence, our client would not have incurred damages or injuries. DAMAGE Physical Injury: As indicated above, our client was violently throw=n back and forth by the force of the sudden unexpected impact, causing the injuries, and resulting,in his seeking;medical treatment as indicated above. More detailed information is contained in the attached medical report ftom the treating doctor. In addition, he has been subjected to pain and suffering, restrictions in movements, and restrictions in his work and other activities. Our client'sMedical Specials to date are as follows: Car. l�3ang,, D,C, 308 12"1 Street Oakland, Califianni-a 94603' Tel: (5'1 3)444-5698,................. .... .......—$ 2,855.£103 All medical records and bills are enclosed. Work Loss: `vTo work loss is being claimed at this time. Property Damage: Property damage to our client's vehicle was estimated to be approximately $2,100, DENIAND With good faith intention to negotiate for an equitable settlement in an amicable manner, and with the understanding of our client's current and future suffering, we hereby demand a settlement as follows: For Property Damage $ 2,100.00 For Medical Specials $ 2,855.00 For Physical Injuries, Pain& Suffering $30,000.00 as equitable amounts that-would sufficiently compensate for all claims including pain and physical<suering, mental losses,end suffering, current and future lass crf'inccmi and proper."] damage. In submitting NO,demand., we expect you to advise us of good faith offer within a reasonable time period, bu -in no event late; than forty(40)calendar clays, pursuant to 2695.7 ofthe California totide of Regulations, Title 10, Chapter S. ;_See also California Insurance Cade § 790,03, Critz. V. Farmers-Insurance ., 230 Cal App. 2d', 788, 41 Cal. Rptr 401. Please contact the undersigned as soon as possible. Anticipating,your courtesy and cooperation, f am... Very truly yours, Miller&Ngo A Professional Law Corporation At By Thomi, ' Niller' v apl l enclosures ,a fx a f ti mill, x r l fjS y F+.1! Tt r n f fFv.•f - ��J l S¢, } l I T E M I Z E D S T A `.i' E M E N T LAW OFFICES OF THOMAS MILT-ER CLAIM NO: ADJUSTER: 725 WASHINGTON ST #300 OAKLAND CA 94607 EMPLOYER:CONSOLIDATED R PATIENT: BIRTHDAY: INSURED: SARIN SY 1,070 PI 07061962 2739 NICOLE AVE #5 SEX :M I . D.# OAKLAND CA 94602 RELATIONSHIP: GROUP: OTHER INSURANCE: WORK INj" RY: NO INSUREDS ADDRESS : AUTO ACCIDENT : YES RET.:EASE OF INS ORMA'T ILON:ON F TLE ASSIGNMENT OF BENEFITS : ON FILE ILLNESS/ACC LATE: 04 10 2002 FIRST TREATMENT: 04-11-2002 DIAGNOSIS : E812 0 MOTOR. VEHICLE COLLISION DRIVER 847 0 CERVICAL: SPRAIN/STRAIN ASSOCIATED WITH HEADACHE JOINT DYSFUNCTION AND CERVICAL MYOSITIS 786 5, CHEST WALL, CONTUSION 840 9 UPPER THORACIC SPRAIN/STRAIN ASSOCIATED WITH MYOSPASM 847 2 THORACOLUMBAR SPRAIN/STRAIN ASSOCIATED WITH MYOSPASM I WAS DRIVING ON 85TH AVE THE OTHER. PARTY CAM , OUT FROM PAK' S AND SAVE PARKING LOT AND SHE DID NOT YIELD SO L COULD NOT AVOID THE COLLISION DATE DESCRIPTION PROC CODE AMOUNT 04-11-2002 NP OV Detailed 99203-25 150 , 00 04--11--2002 Spinal ManiiDulation 98941 60. 00 04-11-2002 Ultrasound 97035 .30 . 00 04-11-2002 Heat/Co1d 97010 25 . 00 04-12-2002 Spinal Manipulation 98941 60 . 00 04-12-2002 Ultrasound 97035 30 , 00 04-12-2002 Hest/Cold 97010 25 . 00 04-13-x2002 Spinal Manipulation 98941 60 . 00 04-13-2002 Ultrasound 97035 30 .00 04-13-2002 Heat/Cold 97010 25 , 00 04-15-2002 Spinal Manipulation 98941 60 . 00 04-15-2002 Ultrasound 9"7 535 30 . 00 04-15-2002 Heat/Chid 37010 25 . 00 104-17--2002 Spinal Many p lLatLon 98941 60 . 00 04-17-2002 Ulurasound 97035 30. 00 04-1-7-2002 Heat/Cold 97010 25 , 00 04-19--2002 Spinal Manipulation 98941 60 . 00 04-19-2002 Elec Stirs 97014 30 . 00 Continued. . . THANH DANE, DC 06-24-2002 308 12th St Oakland, CA 94607 Acct. No 1070 51.0-444-5688 T E M _ z E D S T A T E M E N T LIN OFFICES OF THOMAS MILLER CLAIM NO: ADJUSTER: 725 WASHINGTON ST #300 OAKLAND CA 94607 EMPLOYER:CONSOLIDATED R PATIENT : BIRTHDAY: INSURED: SARIN SY 1070 PI 07061962 2739 NICOLE AVE #5 SEX:m I .D. # OAKLAND CA 94602 RELATIONSHIP: GROUP: OTHER INSURANCE: WORK INJURY. NO INSUREDSADDRESS : AUTO ACCIDENT : YES RELEASE OF INFORMATION:ON FILE ASSIGNMENT OF BENEFITS : ON FILE ILLNESSACC-DATE: 04 10 2002 FIRST TREATMENT. 34�11-2002 DIAGNOSIS : E812 0 MOTOR VEHICLE COLLISION DRIVER 847 0 CERVICAL SPRAIN/STRAIN ASSOCIATED WITH HEADACHE JOINT DYSFUNCTION AND CERVICAL MYOSITIS 786 5 CHEST WALL CONTUSION 840 9 UPPER THORACIC SPRAIN/STRAIN ASSOCIATED WITH MYOSPASM 847 2 THORACOLUMBAR SPRAIN/STRAIN ASSOCIATED WITH MYOSPASM I WAS DRIVING ON 85TH AVE THE OTHER PARTY CAME OUT FROM PAWS AND SAVE PARKING LOT AND SHE DID NOT YIELD SO I COULD NOT AVOID THE COLLISION DATE DESCRIPTION PROC CODE AMOUNT 04-19-2002 Heat/Cold 97010 25 . 00 04-22-2002 Spinal Manipulation 98941 60 . 00 04-22-2002 Elec Stirr. 97014 30 . 0101 04-22-2002 Heat/Cold 97010 25 . 00 04-24-2002 Spinal Manipulation 98941 60 . 00 04-24-2002 Elec Stin 97014 30 . 00 04-24-2002 Heat/Cold 97010 25 . 00 04-26-2002 Spinal Manipulation 98941 60 . 00 04-26-2002 Elec Stim 97014 30 . 00 04-26-2002 Heat/Cold 97010 25 . 00 04-29-2002 Spinal Manipulation 98941 60 . 00 04-29-2002 Elec Stint 97014 30 . 00 04-29-2002 Heat/Cold 97010 25 . 00 05-01-2002 Spinal Manipulation 98941 60 . 00 05-01-2002 Elec Stirr. 97014 30 . 00 05-01-2002 Heat/Cold 9701101 25. 00 05-03-2002 Spinal Manipulation 98941 60 . 00 05-03-2002 Elec Stir: 97014 30 . 00 Continued. . . THANH RANG, DC 06-24-2002 308 12th St Oakland, CA 94607 Acct No 1070 510-444-5688 I T E M I Z E D S T A T E M E N T LAW OFFICES OF THOMAS MILLER CLAIM NO: ADJUSTER: 725 WASHINGTON ST ##300 OAKLAND CA 94607 EMPLOYER:CONSOLIDATED R PATIENT : BIRTHDAY: INSURED: SARIN SY 1070 PI 0706/962 2739 NICOLE AVE, #5 SEX:M T . D. # OAKLAND CA 94602 RELATIONSHIP: GROUP: OTHER INSL?RANGE: WORK INJURY: NO INSUREDS ADDRESS : AUTO ACCIDENT : YES RELEASE dF INFdRMATTON:dN FILE ASSIGNMENT OF BENEFITS : ON FILE _1 .ILLNESS ACC DATE: 04 10 2002 FIRS".' TREATMENT : 04-' -20 "2 DIAGNOSIS : E812 0 MOTOR VEHICLE COLLISION DRIVER 847 C CERVICAL SPRAIN/STRAIN ASSOCIATED WITH HEADACHE JOINT DYSFUNCTION AND CERVICAL MYOSITIS 786 5 CHEST WALL CONTUSION 840 9 UPPER THORACIC SPRAIN/STRAIN ASSOCIATED WITH MYOSPASM 847 2 THORACOLUMBAR SPRAIN/STRAIN ASSOCIATED WITH MYOSPASM I WAS DRIVING ON 85TH AVE THE OTHER PARTY CAME OUT FROM PAK' S AND SAVE PARKING LOT AND SHE DID NOT YIELD SO 1 COULD NOT AVOID THE COLLISION DATE DESCRIPTION PRBC CODE AMOUNT 05-03-2002 Heat/Cold 97010 25 . 00 05-06--2002 Re-evaluation 9921.3-25 50 . 00 05-06-2002 Spinal Manipulation 98941 60 . 00 05-06-2002 Elec Stim 97014 30 . 00 05-06-2002 Massage 97124 25 . 00 05-09-2002 Spinal "Manipulation 98941 60 . 30 05-09--2002 Elec Stim 97014 30 . 00 05-09--2002 Massage 97124 25 . 00 05-13-2002 Spinal Manipulation 98941 60 . 00 05-13-2002 Elec Stim 97014 30 . 00 05-13-2002 Massage 97124 25 . 00 05-16-2002 Spinal Manipulation 98941 60 . 00 05-26---2002 Elec Stir, 97014 300 . 00 05W-16-2002 Massage 97124 25 . 00 05--20-2002 Spinal Manipulation 98941 60 . 00 05-20-2002 Elec Stim 97014 30 . 00 05-20-2002 Massage 971.24 25 . 00 05-24--2002 Spinal Manipulation 98941 60 . 00 Continued. . . THANH DANE, DC 06-24-2002 308 12th St Oakland, CA 94607 Acct No 1070 510-444-5688 I T E M I Z E D S T A T E M E N T '�A.W OFFICES OF THOMAS M I LILER CLAIM NO: .ADJUSTER: 725 WASHINGTON ST 4300 OAKLAND CA 94607 EMPLOYER:CONSOLIDATED R PATIENT: EIR' HDAY: INSURED: SARIN SY 1070 PI 07061962 2739 NICOLE AVE #5 SEX:M I . D. # OAKLAND CA 94602 RELATIONSHTP: GROUP: OTHER INSURAI�'CE: WORK INJURY: NO INSUREDS ADDRESS : AUTO ACCIDENT : YES RELEASE OF !NECRaATTON:ON ^TLE ASSIGNMENT OF BENEFITS : ON NILE ILLNESS/ACC DATE: 04 a0 20102 FIRST TREATMENT : 04-11-2002 DIAGNOSIS : E812 0 MOTOR VEHICLE, COLLISION DRIVER 847 0 CERVICAL SPRAIN/STRAIN ASSOCIATED WITH HEADACHE JOINT DYSFUNCTION AND CERVICAL MYOSITIS 786 5 CHEST WALL CONTUSION 840 9 UPPER "HORACTC SPP ATN/STRAIN ASSOCIATED WITH MYOSPASM 847 2 THORACOLUMBAR SPRAIN/STRAIN ASSOCIATED WITH MYOSPASM I WAS DRTVING ON 85TH AVE THE OTHER PARTY CAME OUT FROM PAK' S AND SAVE PARriIN:s .SOT AND SHL DID NOT YIELD SO � COULD NOT AVOID THE COLLTS"'IN v..de DATE DESCRIPTION PROC CODE AMOUNT 05-24-42002 Elec Stint 97014 30 . 00 05-242002 Massage 97124 25 . 00 05-28-2002 Spinal. Manipulation 98941 60 . 00 05-28-2002 Elec Sti:c 97014 30 . 00 05--28-2002 Massage 97124 25 . 00 05-31-2002 Spinal Manipulation 98940 50 . 00 05-31--2002 Elec Stirn 9701.4 30 . 00 05-31-2002 Massage 97124 25 . 00 06-03-2002 Spinal Manipulation 98940 50 . 00 06-03-2002 Elec Stun 97014 30 . 00 06--03-2002 Heat/Cold 97010 25 . 00 06-06-2002 Spinal Man:_pulation 98940 510 . 00 06-06-2002 Elec Sties 97014 30 . 001 06-06-2002 Heat/Cold 97010 25 . 00 06-10-2002 Spinal Manipu" ation 98940 50 . 00 06-10-2002 Elec Stir. 97014 30 . 00 06-10-2002 Heat/Cold 97010 25 . 00 06-17-2002 Final Exam 99213-25 50 . 00 TOTAL 2855 . 00 Ayer ID No THANH DANE, DC 1,12 943274232 308 12th St Social Sec No Oakland, CA 94607 510-444-5688 THANH RANG, DC PATIENT TREATMENT CARD i Name: SY, Case ?: 1 070 ' Tefiaphone #: ( 510 - 385-5632 >✓at�: 4' -_._ ? 1 —v^�_ Address: 2739 -Nicole Ave. , #5 Cit Oakland C gate of Birth: 07-06-11962 Socials Security #; 538-51 —9211 6 r y L�� Asa 05948793 51n2louar's Name & Address: Consolida-ed R . � r-mpl, Telephone #: { 51 0) 377-7548 Occupation: Driver ',aAJOR COMPLA!>T&SYMP7ONlS:p-/A , N1 i G` e RE•EVALJ i'i C N %�L`C`D�'°5,{"tJ 5' ... C'2��= �`i 7"5.�;,� ff•`C`r'�,r1'r� /'°1 S r_,i,c-�1 L-� t.� I 7�- b€a 41-e E7's �11STGRY Cr ONSET: P IV4 crr, ^fir-!!1- C7 '�t�ct.� c�� �"tri_ 3 SLPPLEN EhTS/SJPPI-R-S: r C Ic" c, t e rl U 2 -t�'j' 5cy cr. tcical ,nvdc`�r e;� � i.or;ti�Lr yT, r CiAGt�C�S3S: � 4�1�• C) t��lr:'v{'t'rSFc>'� ; G'�rt't�s�'x° � I tidTRlTIUN.;L T?<EI-.L,P�: I((,, L.. <._1-7nt.jC-moi 7S' .. 4 fic.� 1 � 7 :c" 1 'r , a H ,M, 1°�'i d";"`� t•t,,.A,t �"2 �r Cc_2 � S c=a✓a s cr' / LV �fl y 1 PAR?IAL DISABIl-ITY: ? S.f3P1tFiCA'.7 i=S V`fi:3S rrQ#T t - - { ! TOTAL D;SAS'LIrY. ' F1,orr t0 f ' Prec.usions: j { 4 J f � 1 a ReSVtGY�G^5: E AT ME!N i P L: 1:IItL9>,f;i 11_1'p jCe C e..y J /Zt/ , i _ 7 !- h 4't:-! �.1 31 (� tit• ' i�/. :/� C'j �"rl 1'1;:"'/ Ste'nc....�r '{ 3.-L' .i i`;:1 E�?.�.2'7 t' 5_._...�_.ry��C _..} EXACERBATIOVAGGRAVATION; �3'T 2 c r G B ....�..�_ �.�..__-•' __-_. T REFERRAL TO OR FROM: rRT!PJC.SYs"rEM o H.,,.R ss C urno::nYc, J fia::, EXAMINATION REPORT stet' Ne —� iL���___------_� Dat - PHYS!CAL. EXAMINATION: ORTHOPEDIC AND NEURoLOG,Cr:L i LS7S: Sax: -` -- Age -�1 Height: rr - Weight: 13s TESTS: F L P, Pulse._7_3 Shou do ; Dao ess'cn es L Fps L kct a ❑N:3eos As. st Ji or ---- - t F�ram�na Gcr',�,re'son „J; f uF entei� '. Alnbl.l2 t.C7n: ;:r' \ n13. Jtn2r. P a:.5C-rrarY.uea(s) 'injury orl(jiscomfoit a3 sha,.vn be c,,it the exompie nC cxe � -- � -- ra degreaof patn u rg n s cif cf ,(dis cm',orj tot (©xGalne p4in). G 3r ms's r -e 3 - -n, mLrc-ss ",s s Na',c"eS 3urn:,rJ e^ir'g StaGt ing 00 DOC 1AA1.. :XX �.va. C7Conocnue '�:}; � � � Ir1,u9 7 �-- S al Percu c«7 s; 1,ac !. p. ss _ - /,� �REPEEXES �� IEEF,C PIN\V, EEL n �' 8icaps So Trceps J'J J r1 PaGw lar l JAMAR DYNArhO.rtLTEF Ui6l "E.3 'S: tvta,C rl'wd CRAN#AW NERVES - - - -_ MEASL'REMiaN?C7P LEGS; r - ;nC:i85.Cnt i r3 O Ic_ . Fi d1 - - ---- -�-- -- -- - -- —__ �. i ssureLectG-EcK LET - ___- COMPLAINTS: sty' e Srt 3 f-�,c .J ,, 4 vNn,s r) ._. i-.cc.d 1 Jf r e 3 c C,rt c...r. / 3c.Ct vc _ ryncc-- ,:Cagl P,ci 3,, r E3 Gh r �,.._._ �_4__'�=C.k�'' �r•.�.._ .~v�' � r. c ,.5�c it}^.r r C71 PoL ossal ':trr��ny(�yyje)�y-^-`- --RE ANALYSIS: ,. �,)-/� `/ ! -- - - - - f _::opt t.��':�� r���>t ��C��) CVS 3. i.1HItlN�.o. ii:"�. - t`.., 1r ! C�S LEFT NORMAL RIGH 7 =n L wo r. ^ I1.2., '.r i'. C Cr a''". r �r r ✓ � I �r r n � �G�r - �r c -cer onF- I� 8P' Pu. S:i.,t__s ,.:r, .t �. S .-r. r' ";gl' Dr _ - r ,i ..� - -- at t C lits arr; to107`c r '"� c � • = r. Ca' ' ;e y rs:c,n ✓ liod Oy l tl u " n 1c�CC,^� C.a�c„.510n �'r'.� Li t7 •mss. c _l.l"Cc'ifs �.. e '.SAO❑ J w.1 Ft,l ir., �, i CC ,G 1 C-rvical Sprue.: indrn Norma! f 1 EX,RE, TIE "ii ErDr.(le'/ ?,r r E n 80 t Pa.-) 3%,15e 3,,1., e^., jm -ater3i Flex 45 4 _r.:e Fiaxior 45 .7 y U t11�, �,r Fe.^ , C3 uise r -t Ccra Cn-~ G/' OTHER TES`'S / COMMEND S: f, G 75 17 �� } C/7 G�. PT� LL{1t f �`� t`c� r , ✓ Ocrsal-Lumv r5pir,e Not—Mal ! Finding ; ' r; 1 90 f La (V k�� f ) !I `i2"_--D-_�Ci -�- 7-e�-I-c_ti �, l- - rrS.c ;;�—w-- - y� C � � ,r.Lat--rcil Flexi_' JS J _'r _E t_a:eral=ex cr 35 - e t.t tauon 3D A _ �,2•y"S rylfi ����e L) �� �Y..(..;iY':,`,'f Y.l/.'��i'�i/...�. � �.,j t�"✓� ��.Si;�'t '� ate C�4. !-o?1 S See pain Lb-awing. Z-Y1UA., aNk pri)k ider pit, auB pn, a MS pI;a-B pn. C SI pn, A< Jleg sympto ns, 0 R"ROM loss: T'Ctt L- C�t� a ❑ O:he'r C-mdings.'Y,b- ('cz: r L 'L ❑ Mlvofasciai adhesions/,NLS^ie iCer/il lC7tl ntjt -<:�/r :�= ✓,� ti'-' ; r � A ;D1: �.✓1�1�.Y'� ,?-4.•�' rt,.y A� y p;�.f')•i"6LLiG(^ �.cY :, u . • ji...f�`,' t �j'C �L--6�:r 1� jTJ t E ( I P ! ❑ See jt� c^ times a w�ek- 17 des ❑ No RefeMll/testilig indicated I'-, y.y�; ! ❑ Xray ccliictpaciiUS!Muscle stiitt ❑ M}'other Date S. E�HUJ C NkISh pn 0:113 on :2"MB pn 13 pit 0 S. n CL/R AmILes s,, npu,rns c,-�-(2-U M' i , > Visit Code . 'i reaet.ent response 'Improvement/Mild ltrproveinent l Worse). See!/y.. ?tinncs b�eek ! 1 Z 4 1 P. Tx:AdjC;c�C<C7�; uS�usc!e Stizr� � Myot lerapy ❑C�c"�t lotpack ❑ i u�Ycis� r ,np NijS'n pn U 3 pn Q M31 pn p 1 ;ji � a 1 t S. � pUA Q ❑ Li3 i ❑ S: Jit C' _Z �1nt�li,e svinptc ns is. 0. Rom loss' Mini les under/tibrotic/hyp� t�iuc V slt Code A.Treatment response(Improvement/ Mild Improvement/ I tinics,v'uck i P. Tx. Ad-j ti.,u ;2(US/Musc1e Stim ❑ Myodi rapt' �(� /iiotpack r:xcrci5e Date S. H/A f Nk/Sh pn M-UI3 pn M--Mi3 n ErLf3 pa OSI pr: ❑L/R Arndl.es s-*.r..piuins rill r ' e M l^' 3LSoie5:et 'r/fibroiic/nPriOrl�o� .✓ _ . ; Visit Code A.?reauiwiit response(improvement/ Na3_fn-rov<»i�went/U;t h.znged� t�'�:.�e;. See� - tinius �tieek n. ;LJ ; P. _'x: Adj C-2 I 4 I,zL,I MuScie Stini Myotiierapy t= ice;i rp i:x rcise DE°e & in IIIA �NkJSh pn U'jB on 2"MB pn Cq LB on 0 SI pn ❑L/R ArizA,eg syinptums Qo l�/�_.i.G-g V1i. Ctt"s-Ii '1Ls 7'/ill�It):1C:%h5' i'fcitj,cn sL -V19:t Code ' i reatrnelti reponse(hmproverner t /l�il 1 1 fI�11 ti tP.t/ t'rl 11l k e Ch vrSC}, See v_iillit ,14CCr +t:Adj �W�a.ri : C,,,.' ,.,(� '.�.�'jV.`„1 IusCIc Sr,irn ❑ Myot;?,,rapy t: iC,'ii'r6l ,c ek .`�`J <:.xcrcisc ! Date St�, It H/A NVSh pri M/UB pn C MB pr vB pn C Si pn CIL/R Arm/Leg symptoms i G^- C t t. Su `i�Cit S `en( fljJrt7tic/13e tQyl i F'., x _r. , Visit Code r ! A. Treatment response(In iprove.nent/ki In prov; Znt! Unc.h.inced; W oc ie)_ c-, P, Tx: Adj �1: , ❑ US/Must(; - Ci Myot i,.rapy ❑ 'c ;l i, tpa.A; C 1 xzr ;se . , i o3te S. ;1 H/A 7 Nk/Sh on 2*U3 pn MB on r t3 pit IDS! itn OT/R F_rii Leg sv�r.piuins ❑ ti•c - L 2 G Z 0. te�r/fibrotic/hgef Visit Code A, Treatment response(Improvement/ .�d`t ni �av�?nentl Ulict.ult¢c ci/ Worse). See _5 _times.week X: AC'ry !iZ C u ❑ S/i�/SS, �r �;SIL ❑ Myot:trrap;' ❑ �. 'I ict� 1 ❑ _ X�r ise # Date S. L:� � Nk/Sh.pn l�t'lil3 pn M 3 pn L pn ❑ 5 pn C71.IR ,,mu'L sv rotulr.v v ✓ � Q. R V i v Id`.� cTe� °mer/#Iurotitih> :.' tae t _y '. Visit Code A. Treatment response (Improvement I. !d >1: ent/ C r :ta:iged "Vol i ), 3cz V-l P, -'x: Adj l �r LCL US/N s� im - y `:t pt' r ? 5, J M o. -ra cs 'l T f:xerc:Is,. Dae S. ❑ i-I/A Nk/SI?pn :D•U3 pn ' MB pn El L13 pn ❑ SI on ❑L/I' nnil,eg sv:rgums 0. CM i � h'luscie� �czder/ ibrocic/hy�Yrto_iic Visit Code �,. reaLnent response(Ipt©v�rrit/Mild Improvemelit/L^ itartged Worse). See tunas-'v<aek 3 P. Tx: Adj US/Mii"sc �tr © Myot:,erapy ❑ lce/UQ!,�:,k r Exercise Abbreviations: US =Uluasol id, Adj ="hit-ooractic adjustment, L= Left, R= Right, '[/,k=headaci;e. N! ='neck, -B u�pfr back, MB =middle back, SI =sacroiliac,LBP d Low back pain,'pn pain, p:LN As nee eu, iao =.ncl_tlt Patient: S , Dr. Th ni: Dan,;, D,C, D.D.B.: b2- D.Q.L.: �- Io- o Z Reorder 200i Nordhof office Forms (925) 484-2167 ! , 3 sTa Tjj"110- 1 yam---- _---------- ---- ---- )_ .� ,. A U3 pn C J MB pn [; 1_13 pr. S! 6`�� - A, Mild _�����`.� f '' [V 'fid'���`2I��i(fo'iL. ✓C � `v`J�% L13C`i�l�:,TCi1Ct10!1 L� I�'��lC'.CC£ipV' i�: 1r��'"�� la. r' Cruz r__�__r� N` Sh pn L113 rn M3 pr. L13 pr. CS! pn �Lif; :a,r't: Lt: , p;clns L. ,�.m,ent sponse � r ti� :1 Mild Improven,cnr Unchancc,, VLorsc, --S-. uta 1 S/N ''c[e 'Tractlo - 9. _ t-i'.� UE3 pn �1E3 p:� LB pr. I SI prn `L ` �r:n LL o. IZ ss> j `, ;3 I er r/!idrotic 1:Ir iLk Treatment rzsponse (Itr ertt.' Mild Improsemem ' Lnchan-d ' \Voe tures I x. .Adl yO/y" :1 L S,/m- ale-y> /Traction C M 'cr:e',t;w ;C,' a E Nk,Shpi l;Bpn UM0pn LB pn :"JSIpn C.. R Aim v s, n n5 rr ,i rS_ 'c; �jam+ •o t 7 x �1 �. t�.Lrl�G?� i-•t.; LL ii �c:i' IrLp[C�C'nJCL L .... 1 C ' '. l G I 5 � 4 ! �� LS,.,y�Ie /fract;cii Sh prUB .2n M3 pn ,L3 pn � SI pn :11 k �.n, c3 S,II p.r IS r ids i 'A tcr;ribro,ic1tzrt ; A. eIn Mild Improvem�-,n,. nc`iari. _ AVc,rse _2-'. il-es :1 S�"Vl — �� r{ Ls}, pn UB pn Mia pn J�; .B pn ® S1 pn EIL,R Arm, Lac �dinlCilC response Mild IrnprcvemenI nC i Iinand is�'. ' ,�''C� 531, `E _ ',15T C �'.;;k ::1 uS% N S'a pr, UB pn [ M3 pn L3 pn SI ; n D iZ Arm. L.e s,,t Pc—, s c? 0. C ,^,1 - v �.� ra fir; lora is-" y crt _ �, eatm�nt rdsponse (:rr t! Mild Improvement; 7-'r�chnn2 d :I. :s ���"' I3, 1 =���.. _-. X1.7 i'y t�_I'•Z�,, .-1 I..:J/I ra t}(r '1'i d�il� I � 'Vi} �Y}'.Pit t71�s � If:l `,r I'll UL3 pn C Ni3 p;—, Of, 51 pn ,vrn' LcL stil R /i� J� �SI'Or1sC T'/�:rOA`etY7'n:/ 1e111cn. L:STra.::ion pn UP pn NAB pn C L3 n Si pr. ©:_,!Z . Z _ �. i � s MUSCIes C :1 Clef/r17"oto /.']) ,Cft nl �- /,tb fix. i� �, -7��- L. _ -- A. Ire �mff t\T Ci( ' '1Ld IIn�rG`delT; i;I, L ncminii,d /Traction ',k Sh pn UB pn MB pn. CEJ LB pn E SI pn C]L'R M"'Iscles tender/f�bro:iciii} �, L A. (! 7I'Ov C1 rt/ %Ud 1nnprC)vem--ntnchanz:J i '71,'uI-s p. \: ,\u ( Z 1 G ? L S ? -,ff IT'act'OI'. Ei 'Vl�il r � ,1.:/l�ll:t �_}; C Itropracu-- adiustmem, L Le:?,, R = Rizh: , i e ta. K. S1 = sdcrvi.!ac. ._LP = L..;)%v back pain. pn pa.n, PR.ti' 1-11,111,- i)-i Il -�-� �---- - r i�; =I 1 ruts f 0t, ort s (92 3) 484-2 167 low-p—pwom,0511014 1-t-MI'MR U,milool r L3 pn 0 NIB pn 0 LB pr 1: S! "�. i� �• t � ( -1 L] tusciCs :znJCi bio[,C :l, er[ response plcy r_i � P�lil improvemen, unchange' , Wo S: A�. ClUS:Mr.`"21ya !Traction Cl N � p'1 LI3 pr. El MB pn Cl LB pr. 7- SI pn rL'<< 'n !D ..- C�;- �- � - 01_ �). i��i �,- ^,iuscl�s ,erld•�r!ilbrot:ca'r.��4��c _.,.»:'.. �_�� 1^u rr, .� t k3, �`ii � Imp'oven;r J:tcl,an�r j `� �. j��nn^ —" _ n ��!� C' SfTrcCiiC:1 �✓ C ❑ 1-13'.p3,_,--- p-i C M3 pn C L3 pr S. pn rL r rJ Muscles 'girder/'i'aruc:c,: t ;ir fmp-oenlec[ UnchaV,crs -----�- �. JE pn Cl ^;B pn C1 LB pe C SI pn UE pn Cl �,'':E on r,3 pn Si pn JSc ;SusCles ;;:7pro�e,nen[ r Mild Irr.pra�emenr ' l ha : ��� ' ��� crs�- e_ �_ � , �'• � r' �'S'Muscle Snm !"!'ract�.�:� n M�c[:�.e��sr.�. ��°�:.�__=�.`__-_.`- _. St': n r l 3 F:t C ^SB pr. r L.3 pr` J. pn l.l. .._. s I�>> •1'aSG�Cs [el'.G:rlilOrO:IC�IYrpE('<01?r_ -' a[- np'ov°m r,i,r 'vl d II-n ro,verlWin: , SINLsCie S. In, Tr3ci,- pr, Cl ME 3 pn - U, lusc'es ,_., _rr:ibr�.:cr:; ertoni" r�r c�t`r._�r[ i d ImprLvein Lr 1'. Ac --- . �.n � : ,.. �. _...:1.� , . _sr„.s� (; r�p o ..m_r[ y1:.d�n:��ro�crr;e-.t l .•,cr<:. _ _ _.i � ' --- � �- . f'. Ac. S/v?us le Srir: iTra u� ✓Iy�"cra��� �:�I�C ---- __ — �._..�� 7 ./B pn r LB p;r r SI pn CL`:2 ern' .oss ✓]uscfes tender!'tbro!:r :ypertoai: CF,7: (I rp o e^l�c[l M !mp-mverne .[r l l,cnan�_�, rs3) _ t`' -- __ • .:r fa rt'c, r 1 S"Mus S!;::-,-,i ~arr;cr, <a_ v. r 5:. :�n '_ �i3 hr. r :MB pn �� LB pn SI pn L:_`�t :� rl.'r sl ct"_:� 'oss vluscies tencer!flbro[ic/Tyne or;ic e'n S T..S%, (L:l.,xovr.[/ M 'd :;l,F:r0vement , Lncl:�.r2� -- i' 1' ..rri r t_'S/MLa-le Stim/T,,act`en G ,'viva n ra:rr S, - s , !.BP - Lo,r back pa;:a, pn _ par ?1tti i 11 � ',�'? � Wit'',�'• �'� p � `t�y�y Cn �`' �`� +��� �,•� ►'�•`��y,,',��C� ;�. 1 y �\,}`� � `'��•� n ��� '��„� '��.,' ;�'C"Z1��C't;�,,� ,yam` �1� �t� �� >, ,, �,t�•`,``'�'� � � �... "�' '�'t�' ' ��"� � `�'`�'".�i�� '�,�"'` �C�� :��,';� '��'+,�t„��•�° •'� (� � '���t, �'`_•; '�' 1 rte\ �s .�°'' � ',� '�` �'�z� 't� �S+` 'ice� �•'� �,j� '"�� �',�,:, i Lr �, ����; +� ,�y�`�, ,';, � '� ,.,opt \ 4 ,�'t�� � � �' r'Ci ; l.� '1 �y�,l'i St1� i` , `�l •~, 1'� t . ,t t 4 t, `t `� i Name; DOB: D01: Sy SARIN 07-06-1962 04-10-02 i D-Ite i Ul,ra ;'frac- !,TCms 1-ie'.1Cold Massage L?xam Signatu re of I'arient� « tion F' Pecks 9 j APR 1 1 20T4- E APR 1 2 200.2 e , 'APR 1 3 200 J j f APR 1 7 201,32 j ? ✓ .- PR 1 9 2002 _Jm ; PR 2 2 200 / ✓ j V i 1 APR 2 6 2002 ! APR 2 9 20021 �AY 01 2002 l r t IY MAY 0 3 202LA �AY 0 6 2002 j I ✓ I 1 j MAY 0 9 200 M; AY 1 3 2002 ✓ '� ' j --- i MAY 1 6 200 � I I MAY 2 0 200 :MAY 2 4 2002 ,MAY 2 8 2002 : Zo-nd I MAY 3 1 2042 � ✓ � � � --- JON 0 3 2002 { c i JUN 06 2� 3 « ' JUN 1 0 2002 LJd F 20'02 i r cLl/tf7l A PrCOT r) s Doctor C,f Cn;i0oia-IiC t & '1 t i _ 'CIr C<_'yCt ifC`d lI 94607 ` .Pho ^E'? (,510) z.4—,) 'i6 '( (51'! �)a 03-'y h-.reby attest 'hat I was seen and 'reated on the dates stated and signed by fine. Date: Q 1 SiZA'i1 3CLzt : Pr rated Name: _ CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Oct 22_, 2002 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. } notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given g Pursuant to Government Code Section 913 and 15.4. Please note all "Warnings". ( f OCT s' rn AMOUNT: $745.80 ° 20.02 CLAIMANT: Constance AmesARTI F-Z CAU ATTORNEY: DATE RECEIVED: Oct 8_2002 ADDRESS: 821 Escobar BY DELIVERY TO CLERK:ON: Oct 8. 2002 Martinez, CA 94553 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. , T £ JOHTv SWF� e�k�, Dated: Oct&2002 2002 By: Depufy II. FROM: County Counsel TO: Clerk of the Board of Supervis6rs (_ 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 claire(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. OCTOBER 22 2002 Dated: JOHN SWEETEN, CLERK, By , Deputy Clerk WARNING(Gov. code section 913) Subject to certain exceptions, you have only six (6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *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: OCTOBER 23, 2002 oHN SWEETEN, CLERK.By .% tp, ® �� .._ Deputy Clerk Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COLJN Y INSTRUCTIONS TO CL.AIKU4T A. Claims relating to ceases 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, 1937, 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 prevented not later than one year after the accrcral 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 Fine 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 :gairst each public entity. B. Fraud. See penalty for fraudulent claims, Renal Code Sec. 72 at the end of this form. :iB� Chaim By ) Reserved for Clerk's filing swamp MOCT8 1 Against the County of Contra Costa or District) iF'i1; in name The tidersigned elaimar:t hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ r ' e- and in support of this clams represents as follows: d A V•0� � tom- A 4i�'f � � .�..». ..�_.�_......_.._.,...»._. .._��w.....�».»...... .. .._. 1. WhI e-n did the damage or injury occLLL"? (sive exact date and hour) . 'Where did the damage or injury occur? (Include city and county) AIA 3. Row did the damage or injury occur? '(Give :hzl.l details; use extra paper if�a A-c41 required) What particular act ar Omission an the part of county or district facers, servants or .employees caused the injury or e? (over) 5. what are the names of county or district officers, servants or employees causing the damage or injury? 5. What damage or, injuries doyouclaim resulted? Give full extent of injuries or damages claimed. Attach two estimates for auto damage. 7. How was the amount cla above computed? (Include the estimated amount of any fie. 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. 910:2 provides: "The claim must be signed by the claimant SENO NXICrS TO: (Attorne ) or some person on his. behalf." Name and Address of Attorney Claimant's _gnature CA 6S ce r Addrress 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 imprisorzo-ent in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. 10/07/2002 at 03 :13 PM Job Number: 40462 NIKE ROSE'S AUTO BODY INC. License #:BAR# 0969827 Federal ID #:942621349 WHERE QUALITY COUNTS 2263 VIA DE MERCADOS CONCORD, CA 94520-4920 (925) 689-1739 Fax: (925) 689-0991 PRELIMINARY ESTIMATE Written by: Bruce Hubert # Adjuster: Insured: CONNIE AMES Claim # Owner: CONNIE AMES Policy # Address: 1233-D PINE CREEK WAY Deductible: CONCORD, CA 94520 Date of Loss: Evening: (925) 689-1884 Type of Loss: Point of Impact: Inspect MIKE ROSE'S AUTO BODY INC. Business: (925) 689-1739 Location: 2260 VIA DE MERCADOS CONCORD, CA 94520-4920 Insurance Company: 3 Days to Repair 2002 TOYO CAMRY XLE 6--3 .0L-FI 4D SED BLK WALNUT Int: VIN: 4T1BF30K22U507791 Lic: 4URY510 CA Prov. Date: 09/2002 Odometer: Air Conditioning Rear Defogger Tilt Wheel Cruise Control Intermittent wipers Climate Control Keyless Entry Theft .Deterrent/Alarm Body Side Moldings Dual Mirrors ROOF Console Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks Power Driver Seat Power Passenger Seat Power Mirrors Anti-Lock Brakes (4) Driver Air Bag Passenger Air Bag Front Side Impact Air Bag 4 Wheel Disc Brakes Cloth Seats Bucket Seats Aluminum/Alloy Wheels ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1 REAR BUMPER 2 O/H bumper asst' 0 0.00 1.8 0.0 3* Rpr Bumper Cover US built 0 0.00 2.0 3.0 4 Add for Clear Coat 0 0.00 0.0 1.2 8# Repl FLEX ADDITIVE 1 8.00 T 0.0 0.0 61,1 TINT COLOR 1 0.00 X 0.5 0.0 ------------------------------------------------------------------------------- subtotals 8.00 4.3 4.2 1 10/07/2002 at 03:13 PM Job Number: 40462 PRELIMINARY ESTIMATE 2002 TOYO CAMRY XLE 5-3.OL-FI 4D SED BLK WALNUT Tnt: Parts 0.00 Body Labor 4.3 hrs @ $ 55.00/hr 279.50 Paint Labor 4.2 hrs @ $ 55.00/hr 273 .00 Paint Supplies 4.2 hrs @ $ 28.00/hr 117.60 Sublet/Misc. 8.00 ---------------------------------------------------- SUBTOTAL $ 578.10 Sales Tax $ 125.50 @ 8 .2500& 10.35 ---------------------------------------------------- GRAND TOTAL $ 588.45 ADJUSTMENTS: Deductible 0.00 ---------------------------------------------------- CUSTOMER PAY $ 0.00 INSURANCE PAY $ 588.45 THIS IS A PRELIMINARY ESTIMATE AND ADDITIONAL CHARGES MAY BE REQUIRED FOR THE ACTUAL REPAIR. THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES: B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS: ADJ=ADJACENT ALC-N=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=U' PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION NO=L1.NE NUMBER. QTY-QLIIA-V. TITY QUAL RECY=QUALITY RECYCLED PART QUAL REPL=QUAL?TY REPLACEMENT PART RECOND=RECONDITTON REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RSGHT SECT=SECTION SiBL=SUBLET LT=LEFT W/O=WITHOUT W/_=WITH/_ SYMBOLS: #=MANUAL LINE ENTRY *=OTHER. (IE. .MOTORS DATABASE INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide ARM8521 Database Date 8/2002 and the parts selected are OEM-parts manufactured by the vehicles Original Equipment Manufacturer. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Non-Original Equipment Manufacturer aftermarket parts are described as AM or Qual Repl Parts. Used parts are described as LKQ, Qual Recy Parts, RCY, or USED. Reconditioned parts are described as Recon. Recored parts are described as Reccre. NAGS Part Numbers and Prices are provided from National Auto Glass Specifications, Inc. Pound sign (#) items indicate manual entries. Pathways - A product of CCC Information Services Inc. 2 Date: 10t 7/02 03:08 PM Estimate ID: 4101 Estimate Version: 0 Preliminary Profile ID: Mitchell M2 Collision Care Centers 2291 Via De Mercados Concord,CA 94520 (925)685-2294 Fax: (925)665-7295 Tax ID: 33-0577123 BAR#: AH 200993 EPA#: CAO 006252405 Damage Assessed By: BRYAN WIESE Deductible: UNKNOWN Insured: CONNIE AMES Address: 1233 D PINE CREEK WAY CONCORD,CA 94520 Telephone: Work Phone: (925)646-9055 Home Phone: (925)689-1884 Mitchell Service: 910754 Description: 2002 Toyota Camry XLE Vehicle Production Date: 9101 Body Style: 4D Sed Drive Train: 3.01-Inj 6 Cyt 4A VIN: 4T1BF30K22U507791 License: 4URY510 CA OEM/ALT: O Search Code: None Color: GREEN Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 003554 BDY REMOVE/INSTALL REAR BODY TRIM PANEL Existing 0,2* 2 003562 BDY REMOVEIINSTALL R REAR BODY SIDE TRIM PANEL Existing 0.2* 3 003564 BDY REMOVE/INSTALL L REAR BODY SIDE TRIM PANEL Existing 0.2* 4 003622 BDY REMOVE/INSTALL REAR BUMPER ASSY 1.4 5 003624 BDY REPAIR REAR BUMPER COVER Existing 1.5* 6 AUTO REF REFINISH REAR BUMPER COVER C 2.4 7 936012 ADD'L COST HAZARDOUS WASTE DISPOSAL 3.00 8 AUTO REF ADD'L OPR CLEAR COAT 1.0* 9 933003 REF ADD'L OPR TINT COLOR 0.5* 10 AUTO REF ADD'L OPR COLOR SAND&BUFF 0.7 11 ***3 DAYS TO REPAIR****** 12 AUTO ADD'L COST PAINT/MATERIALS 101.40 13 900500 REF * REMOVE/REPLACE FLEX ADDITIVE **Quaff Rep€Part 10.00* 0.0* *-Judgement Item C o Included in Clear Coat Calc Add'I Labor Sublet 1. Labor Subtotals Units Rate Amount Amount Totals If. Part Replacement Summary Amount Body 3.5 62.00 0.00 0.00 217.00 Taxable Parts 10.00 Refinish 4.6 62.00 0.00 0.00 285.20 Sales Tax @ 8.250% 0.83 Non-Taxable Labor 502.20 Total Replacement Parts Amount 10.63 Labor Summary 8.1 502.20 ESTIMATE RECALL NUMBER: 10/7/0215:04:11 4101 UltraMate is a Trademark of Mitchell International Mitchell Data Version: SEP_02—A Copyright(C)1994-2002 Mitchell International Page 1 of 2 UltraMate Version: 4.8.011 All Rights Reserved Hate: 10/7/02 03:08 PM Estimate ID: 4101 Estimate Verslon: 0 Preliminary Profile ID: Mitchell IIB. Additional Costs Amount IV. Adjustments Amount Taxable Costs 101.40 Customer Responsibility 0.00 Sales Tax @ 8.25010 8.37 Non-Taxable Costs 3.00 Total Additional Costs 112.77 1. Total Labor: 502.20 II. Total Replacement Parts: 10.83 [if. Total Additional Costs: 112.77 Gross Total: 825.80 IV. Total Adjustments: 0.00 Net Total: 825.80 This is a weliminary estimate. Additional chances to the estimate may be required for the actual repair. WARNING: Accidental air bag deployment la possible. Personal Injury may result. Avoid area near steering wheel and instrument panel even If air bags have deployed. Dual-stage air bag modules may be present that could contain an undeployed stage. When disposing of a deployed dual-stage air bag,always treat it as a"live"module. See appropriate MITCHELLID AIR BAG SERVICE&REPAIR MANUAL,or OEM information. ESTIMATE RECALL NUMBER: 10/7/02 15:04:11 4101 UltraMate is a Trademark of Mitchell International Mitchell Data Verson: SEP_02 A Copyright(C}1994-2002 Mitchell International Page 2 of 2 €tltraMate Version: 4.8.011 _ All Rights Reserved jnt&pri'se Rent-A-Car Page I of I Buy a Car Manage Your Fleet Careers About i t u.t .:,� cl . m.: E d Your sel tion$ Vehicle Details >c Selected Vehicle Your Dates and Times Enterprise Location: Change 1339 OLIVER RD Start: tact 9: 2002, Noo FAIRFIELD,CA 94534-3470End: Oct1 (707)422-3700 C., 2€#{32, l�oc 'Ve Pic:c You Ug 9, r#oar Quote Dates/BuTim : Start: 8,2�2 nom_ I Day Standard Da'siy $39.99 End. Oct 1t?,2002l'#a Pontiac Grand Arta, "Subtotal Vehicle Class: ht9"a Hodge Stratus or similar SALES TALC Standard 2 or 4 doors Total Estimated Renter's Age: change Automatic Transmission Air Conditioning haemes 25 and Up AMIFM Stereo *Additional surcharges,lo, Renter's Information: Room to seat 5 passengers etc.may apply. (stat yet entered) View other vehicles: Sr:a;er I �d r Lsraer Restrictions MILEAGE IS UNLIMITEDWHEN VEHICLE REMAINS IN THE RENTING STATE. VEHICLES ARE NOT ALLOWED OUTSIDE OF THE STATE. Our Fick-tap Policy, If you need a ride from your place to our place, our famous pick-up service makes it easy. Call our office now at(70711422-3700, and we'll do our bast to help you. Geographic restrictions may apply. SuciS"s c Tori Rent a Car I BuY a Cer I Nl r°.atg"`e''J'u''ui ;Beet I Cgreers I A u+itis 1 Cnontaet Lis arra, Yf Priya-,y Statement I -Qal infoannaltion 0 2002 Enterprise Rent-A-Car Company.Patent Pending http:// .enterprise.co /ca;- rental/location.do?selectedLocationld=233 transa ionld 10/8/02 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Oct 22, 2002 Claim.Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: Unknown41� CT3 CLAIMANT: Carol LeejN ATTORNEY: DATE RECEIVED: Oct 7, 2002 ADDRESS: 18 lz E 6th St BY DELIVERY TO CLERK ON: Oct 7, 2002 Antioch, Ca 94549 _ BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. . JOHN SWEETIVNI'; Dated: Oct 7 2442 By: Deputy i II. FROM: County Counsel TO: Clerk of the Board of Supervisors ` (,-)'-This claim complies substantially with Sections 914 and 910.2. ( } This Claim FAILS to comply substantially with Sections 910 and 914.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 914.8). ( ) Claim is not timely filed. The Clerk should return claire 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. ..- B f � . y: 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: OCTOBER 22 2002 JOHN SWEETEN, CLERK, By , Deputy Clerk WARDING (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. `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: OCTOBER 23, 2002JOHN SWEETEN, CLERK By Deputy Clerk 10/07/2002 07:17 HUB HIGHWAY 4 3351913 PvC1.424 9001 Claizat to: BOARD OF SUPERVISORS OF CC3',NA COSTA C(3UTNTY WSTRUC7IONS 10 CLAfiN AN_? A. 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 before December 31, 1987,must be presented not later than the 10&day after the accrual of the cause.of action. Claims relating to causes of action for death or for injury to person or to persrarta1 property or growing craps and which accr►ae on or after JIMMY 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, (Gov't +Goole 911.2.3 B, Claims must be fled with the Clerk of the Board of Supervisors at its office in bloom 106, County Administration Building,651 Fine Strect,Martinez,CA 94553. C Uciaim 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. F. ELa . Sae penalty for fraudulent.claims,Petal Coude Sec.72 at the end of this form. �##+kR+sAc#:It##a(e###+Irl+ir#air+R*##i+kR�t#�►jk####�K�iN�#!tt###��R�flt#3trEsti###f#sY####+k+�#;kik#i(rsRrF##*#�'+i#�Y�t7eWAt3tir%# RE: Claim By Reserved for Clerk's filing stamp , , , ECif VE ,ASkinst the County of Contra Costa or ) FnT 2002 � - ) -- F U'iStriet) x,11 aname)� � �,®_ � � ✓0IS �T?AC0 Sf?1CV. The undersigned clai t hereby makes claim against the County of Contra Costa or the atbovc-zn►med district in the sum of,S and in support of this claim represents as follows: I. When did a damage or injury ea=r?(Give exact date and hour) 2. Where did the damage or inlwy ocPArl(Tulle city and county) � 3. .How slid the damage or injury+ter?(Give full detaHs;use extra paper if required) 7 "C - �' ` 10/07/2002 07.17/ WB HIGHWAY -) 3351913 NO.424 X7002 Ca ule- UV;4*a uierK of t.ne Hoare SZS 335 1913 p. 3 *bat particular act or orris sslon on the pert tat county or district officers, servants,or employees caused the injury or damage? 5, .What are the names of counry or district officers, servants, or employees causing the damage or injury? 6. What damage or injuries do you claire resulted?(give full extent of'injuries or damages claimed. Attach . two estimates for auto damage) ' 7, Row was the smolunt claimed above computed!(Include the estimated amount Marty prospective injury or damage,) Karnes and addresses uf-witnesses, doctors, and hospitals. 9, List the expenditures you made on account of this accident las injury. PAZ— IM AMOUNT ##*+r�r*s+t.•�*�*��#see«�.�s*t#�*��aa*�+.*st�r�t*#��►**tsw�k�e���wsbr##**s�:*»**�*►*.+��aa��aa►+rca*�►�►. } Gov. Code Sec. 910.2 provides"The claim tritest be } signed by the claimant or by some person on his behalf:" Name and Address ofAttomey } } (Claimant's Signature) } (Address) Telephone No. )Telepltc�ne.TTo. +�+��*��:s�s�►��*�►�r,.+rye:�+�.�r«x►.:�►«...*,�..�+�.:»sr�►.�.:r��..art+�+a��r,.��r.��rvaa�.�.������t*r�*s�►+��,►**�r.t 2vOMM Sermon 72 oftU Peaa3 Code provides. Every p, %U,with intuit to deh%A prm ats for agowamo or dw payment to any state board or officer,or to any c qty,city,or district board or officer,autdwrizod to allow or pay the sme if g enuitw,tory false or fnu4nient cladur bill,acoomt, fir,or writing,is penal, le cither*impnsoravent to the=wty jail for a period of not mor+/:#tart year by a fim of Wert exceeding one th ($1,000),or by boat such JoVriscommi.rad tine,orty imarisonwatt in the stage prison,by a tinea or not 1 exceeding test tlxtmd dollars(S3t1,iXtD),.or by botb such im risMotrmtt;t and ftrre. 10/07/2002 0 >17 HUB HIGH 3351913 NO.424 PM3 10/07x'2002 07:17 WB HIGHWAY 335190 NO.424 9004 7, Z y t } EEjEt t f 7 i P claim to, J3t}A.R.1} OF SUP`ERVpSORS OF CONTRA COSTA COUNTY ;- 1SMUC7 ON-5.1CL A� Claims relating to causes of action for death or for injury to person or to persorial property or growing crops and which accrue an or before December 31, 1987, truest be presented not later than the 10e day suffer the accrual of the mouse of action. Claims relating to causes of action for death or for injury to person or to personal property or growing craps and which arguer on or after January 1, 1998,must be presenter)not later than six months after the accrual of the cause of action. Claims relating to any ether cause of action must be presented not later than one year after the accrual of the cause of action, � (Gov't Code 911.2.) ! B. Claims must be filed with the Clerk of the Beard of Supervisors M its office in Room 106, County Administration Building,651 Fine Street,Martine4 CA 94555. C. if claims 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 trust be filed against each public entity. E. Er4qd. See penalty for ffaudulent.clai s,Penal Code Sec. 72 at the end of this form. «���w�r.��s*��s�:r::.**r��#*�r*•��,r*r�+►�r*r�w�t�s*:�w�*a:,��r�«*e�.«t**�r��*��►s��,.r.�r*.rr���r�*,�r,xrs:��s RE: Claim By Reserved for Clerk's ftlini stamp RECEIVED Against the County of Contra Costa or ) OCT 7 2002 } CLERK_S{ATI''5P SUPERVISCIIS District) CONTRA COSTA CC?. (Pill in name) ) The undr r-signed clai t hereby crakes claim against the County of Contra Costa or the above-narned district in tete sum of oared in support of this claim represents as follows: 1. When did damage or injury.occur?(0ive exact date and hour) ,*.-- ., 2. Mere did the damage or irfjtuy (Include city and county) , ,✓'��"C1 -+�'"C I Rove slid the damage or injury qtr?(Give full details;use extra papier if required) � .► r ^y TSTS M-'PWIW erw 6T"9T /170/OT zep CO VC U11" c +aa U Terre or tna Noard r 925 335 1913 F- 3 } 3 r .4_ W +at particular act ar omission on the p�of county or district officers, servants,tqr ernplcyets r;aused the injury or dazriage? What are the names of county or district officers, servants,or employees causing,the damage or injury? ���'` rpt...• 6. What damage or injuries do you claim resulted?(Give SII extent of injuries or damages claimed. Attach . twoestimates for auto damage. 7; How was the amount claimed above computed? (Include the estimated amount Qf any prospective,injury or. damage.) Names and addresses of witnesses,doctors, and hospitals. 9. List the expenditures you made tin account of this accident or injury, 4�rs+»»as,�»�v��w�r�.��rr►�r��.���wrF#���►��*`*a�*�.»�a��e»�r.�r��*.r���»...*,�.��,�����*+�rr�r��»»;�e���rs*�r:a�w»�� Gov.Code Sec.910,2 provides"The claim :Host be signed by the claimant or by some person on his bch&IE" T0: A 4 Nime and Address of Attorney � } (C'laimant's Signature) (Address) 3 Telephone No. __ )Telephone No. I +fir.*,�s�e�r��*�a*e,�,�+�a��+�e��r��.*��.��t:�►*,r��«s�s�*��earr�rs�►es�rr�:s#�s�:.��r�#«»�e+�ee*�+.»s�e*v��srr*�*• NOTICE Section 72 of the Pew Code provides: r; Every pens n arta,with intern to del 1,presents for allmaox or tk paymew to a"state board or officer,or to any ceun;y,city,ar district beard or oMcer,audwicrd to altoa or pay the sanxte if grnuin&any t'$.ise or fraudulent claittr;biX accoti nt, 'ermxbcr,or writing,is pmishark either by impirisserr neat in tU coamy,iall for a period at not more than aft year.by a ase ut= exaxadtag Atte tbouszod($1,000),Barley bats€ueb kWisoament sod#Sae,orby imprisonment in the start p6son,by,a bw of s* excee=ding ten d*vsaad dollars(SMOM),of by bait such imprisomnent and ftc. "00d MI-ON lrTfT t't JtH F# ST:9T rg X01 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNT`' BOARD ACTION: Oct ; 2002 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and t x _} 915.4. Please note all"Warnings".�. AMOUNT: $301.26 S�- CLAIMANT: Lisa Im ,'O€N TY COUN-SEL ARMN— CALIF, ATTOIU EY: DATE RECEIVED: Seat-25, 2002 ADDRESS: 140 Moraga Way BY DELIVERY TO CLERK.ON: Sept 25, 2002 Orinda, CA 94563 BY?MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEF. Dated: Sept 26. 2002 By: Deputy r fi: 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: BYAil 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 frill. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. OCTOBER 22 , 2002 ,d Dated: JOHN SWEETEN, CLERK., By , Deputy Clerk WARNING(Gov. code section 913) Subject to certain exceptions, you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945,6. You may seep 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. OCTOBER 232002 Dated: ' JOHN SWEETEN, CLERK By o Deputy Clerk FFBCt OF THE COUNTY COUNSEL � .,��`� StIrvANO B.MARCHESt COUNTY €,3F CONTRA COSTA COUNTY COUNSEL Administration Building 651 Pine Street, 911' Floor �% g SHARON L. ANDERSON 11 ' l _ = CHIEF AssisTANT Martinez, California 94553-1229 1t 1 &5 (925) 335-180011 N GREGORY C.HARVEY VALERIE J. RANCHE (925) 64+6-1073 (fax) i °6 x AssisTANTs a # NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Lisa Im 140 Moraga Way Orinda, CA 94563 Please Tape Notice as Follows: The clam 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: [ l. The claim. fails to state the name and post office address of the claimant. I The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [ 3. The claim fails to state the date,place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [X] 4, The claim fails to state the name(s) of the public employee(s) 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 than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10,000), the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. [ ] 6. The claim is not signed by the claimant or by some person on his or her behalf. Page 1 Lisa Inn Re: Claim Page Two [Xj T Other: The claim fails to identify whether a County vehicle or employee was involved. SILVANO B. MARCHESI COUNTY COUNSEL By V Deputy County Counsel s CERTIFICATE OF SERVICE BY MAIL (C.C.P.§§ 1012, 1013a,2015.5;Evidence Code§§C-41,664) I declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553;I am a citizen of the United States,over 18 years of age,employed in Contra Costa County,and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as shown above,seated and postage fully prepaid thereon:,and thereafter was,deposited this day in the U.S.Mail at Martinez,California. I certify under penalty ofperjury that the foregoing is true and correct, Dated: October ,2002,at Martinez,California. r' cc: Clerk of the Board of Supervisors(original) Risk Management (NOTICE OF FN5UFFICIENCY OF CLAIM:GOVT.CODE§§910,910.2,920.4,910.8) Page 2 f i n y ,jI ey SEP Claim to: BOARD OF SUPERVISORS CP CONTRA COSTA CC MTY INS R.$iC'I IONS TO C;L.ABIWTT A. Claims relating to causes of action for death or for injury to person car to per- sonal property or growing crops and wtieh accrue on or before December 31, 1937, must be presented not later than the 1030th 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 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 accrrual of the cause of action. (Gott. Code §91.1.2.) S. Claims wast be .filed with the Clerk of the lid of Supervisors at its ,office in Room :-06, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the z3oard of Supervisors, rather than t e I;CS=ty, t21e nye of the District should be filled in. D. If the claim is against more than one public entity, separate claims- gust 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 , � RECEIVED Against the County of Contra Costa ) I SEP 2 ;? 2002 or CLERK SUPERVISORS District) �s»�3�a IQs A Cn. Pill in rr e The undersigned claimant hereby makes claim against�he County of Contra. Costa. or the above-named District in the suit oaf $ � and in support of this claim represents as follows: ,. �� � 14 Vh.:ra -Aid Cisilli 04" ii �i, Sr ct a. i1Ve exact ate grad hour) -71 2. Where did the damage or injury occurs (Include city nand county) . How did the damage or injury occur? (Give full details; use extra paper if required) 4. Wgat particular act or omission on the part of county or district officers, servants car .employees caused. the injury or e? �over°? wnat are tre names of county or district officers, servants or employees causing the damage or injury? 5. What damage or injuries do you claim resulted? (Give full extent of infuries or damages claimed. Attach two estimates for auto damage. ?. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) $. Hames and addresses of witnesses, doctors and 'hospitals. ---------..._--...w. .__�� 9. List sthe�expenditures youmadeon 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 T0: (Attorne ) or by some person on his. behalf." Name and Address of Attorney Ciaimant's Signature 7d ss - k-A e C A Telephone No. * Telephone No. N0TICL 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 p...., f'�" 4 1 vicer, authorized „o al..ow or pay the same if .genuine, any false or fraudu',.ent claim, bill, account, voucher, or writing, is punishable either by imprisonment in '#W county jail for a period of not more than one year, by a fine of not exceeding czae thousand ($1,fl00), or by both such imprisonment and fine,- or by imprison*�ent in t�ie state prison, by a fine of not exceeding ten thousand dollars ($10,00J, or by �"` doth such imprisonment and fine. Dare: 9i1 21 2 09:25 AM Estimate ID: 4813 Estimate Version: C. Prefiminazy Profle M: ILAS LAFAYETTE AUTO BODY, INC. 3291 NA,.Diablo Sivd,Lafayette,CA 94549 1 ,925)283-3421 Fax: (925)283-3579 Damage Assessed ay: RANDYSANDUN Dedu-ctiNe: 1UNKNOWN Insured: LISA i-M. Address: 140 ORAGA WAY ORINDA,CA 94563 I 8iephone: it Pone: (925)529-1234 Home Phone: (925)2'A-0400 N'Rche!iService: 910120 Description: 2001 Monda CR-V EX 'VehlcieProduction bate: 11,100 Body Style: 4D:fit DrNe TrMn: 2.0L in;4 Cy'41JVD ViN: jH:_RD86510017M License: 4SHH134 CA Mieage: 14.000 OEMIALT: 0 Search Code: None Color: RED OW-tions: AlR CONDITIOMNG,POWER STEERING,PaVVER BRAKES,POWER WINDOWS.POWER-DOOR LOCKS `NL7 STEERiNG WHEEL,CRUISE CONTROL,AM-FM STEREO,AUTO,.,VIATiC_T RANSMIS&ON Line Enin/ Labor Line item Par',Type/ Dv,.iar Labor ii item Numb&, Typo- Operation Description PaA Number Amount U n:U I AUTO RDD OVERHAUL REAR COVER ASSY — 1.8 # 2 002759 BOY REMOVEIREPLACE REAR BUMPER CO'M'ER 71.501-SIO-A91 '7012 !NC # 3 NEED TO REMOVE REAR BUMPER TO iNSPr #- Labor Note Applies Add l Labor Subiet i. Labox Subot�is Ur-ft Rats Amount Arnwnt Totals IL Part Replacerrient Summary Amount Body 1.8 65.00 0.00 0.0-6 117,00 T TaxaUe Parts I703,22 T axabie Labor1417.001 Safe.Tax 9 6.250% 14.134 TotalLabor Surmmwy 1.8 11 7M Total Re0acement Panu Paris Annont 1.84.26 Iii. Ad&fioria!Costs Amount M Adjustments Anount Tota:Additionai Cosm _03.003 C�storner ReWnsibii;ty _0.013 ESTIMATE RECALL NUMBER: 9i!V020.9:22:35 4813 UftraMate is&Trademark of woh—eii inter-national Da-a Versww SEP—022—A Copyright(C)1994-2002.%Aft&mo.i intematjonal Page I of 2 Uitramate Version: 4,8.0011 M Rights Reserved Date: glt ZiC2 W:26 AM Estlrra.e 0: 4813 Estimate Version: 0 Pre#irr Mary Profile i0: LAB 1. Total Labor: 11. Totals Repiacemer t Parts: 184.26 #11. Total Addificnai Gosh: 0.00 Gross Tota:: 301.26 lt`. T0a# te€s5'sY3Erl 0.0 Net Taal: 301.29, This is a prelimiqgIry estimate. Additional changes to the estimate may-be re €piled for the actual E% air. This estimate -.s based on current, parts prices and labor rate which are sub;ect to mangle at a later dare. This est'mate does not .ncl uae repair costs of any hidden damage -found on tear down UTO BODY, agrees to perform repairs ilic*~ serve to restore the damaged ve l"c e to its pre-loss condi on relative to safety} function and appearance and further agrees to warran zr work ansh p, � C °,dIng ref-nishina, in writi-rig for a period of not- less than one (1) year from t-e date of com-clet ori of repairs. ":ARS:MG: Acc c real air b8g depiayrnent is ssi61a. Persmf injury may r u#t. Avoid are:near steering Mieel and lnst€urant wan.el even If air bags have°ve_4,-y . Dua#-stage a%bag?rwaies may be present t est cculd contain an undepioyed std. When disposft of a deplayed duel-stage air bag,always treat it as a li,4'modde. See apo r€ate.''CHE:LLe AiR BAG SERVICE&REPAIR MA.,NUAL,cr OEM in brmat#or,. ESTIMATE RECALL?•UMBER: 91€2)02OS:22:35 4613 ito-a41a%e is a Trademark o?1~f oW:htsmat onai Mitchel!Date.uemion: SEP 02_A Copyr#g'nt(C)1994-20012 lv9tct e i#nternational Page 2 of 2 ditraMate slersior:: 4.8.61 t A1>Rights Reserved CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COi.,TNTV BOARD ACTION: Oct 22, 2002 Claim Against the County, or District Governed by ) the Beard.of Supervisors,Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. } notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all"Warnings". 5 ,,... , .r.^ AMOUNT: Unknown CCOUNSEL CLAIMANT: Jared Crabtree . I s:�i N A3 F, ATTORNEY.': Valerie Mann BATE RECEIVED: Oct 4, 2,402 ADDRESS: 1430 Willow Pass Rd#160 BY DELIVERY TO CLERK,ON: Oct 4. 2002 Concord, CA 94520 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWE =` Cly x s , Dated.: Oct 7 2002 By: Deputy° {>�, ` II. FROM: County Counsel TO: Clerk of the Board of Supervisors` 0chis claire complies substantially with Sections 910 and 910.2. ( } This Claim PAILS 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: Bated: Ir_ By, x r 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: OCTOBER 22 , 200 2 ` Hyl ,_ JOHN SWEETEN, CLERK, By S ,�;;� -° .}`: ,Deputy Clerk WARNING (Gov. code section 13) 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 tunes 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. OCTOBER 2 3 2002 Dated: ' JOHN SWEETEN, CLERK.By Deputy Clerk 4 k I Claim to: 2 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY , !. �rX '3. f t 3 County Claim# 50384 4 RE: Claim by ) 6 Jared Crabtree ) 7 Against the County of Contra Costa ) 8 or ) 9 ) District ) 10 ) II ) } 12 13 The undersigned claimant hereby makes claim against the County of Contra Costa or the above- 14 named District in the sum of an indeterminate amount,unlimited liability, for general damages, for 15 medical expenses according to proof, for interest as provided by law, for costs of claim and such 16 other relief as the Board of Supervisors of Contra Costa county deems just. In support of this claim 17 the undersigned claimant represents as follows: 18 1. When did the damage or injury occur? 19 Tuesday April 30th, 2002 at approximately 1:45 P.M. 20 2. Where did the damage or injury occur? 21 Collision occurred on Willow Pass Road, at the intersection of Franquette Avenue-Waterworld 22 Parkway, in the City or Concord, Contra Costa County, State of California 23 3. How did the damage or injury occur? j i 24 6 Claimant,Jared Crabtree,was stopped at a red light southbound Waterworld Parkway,preparing to 25 turn onto eastbound Willow Pass Road. His light cycled to green at which point he entered the 26 intersection. The left rear of his truck was suddenly struck from the left by a county work van 27 driven by William Lee Perry. 28 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? I The driver of the county van failed to slow down and then stop at a red light, in violation of 2 California VC21453 A. The county van driver negligently drove into Jared Crabtree's vehicle, 4 3 5.What are the names of county or district officers,servants,or employees causing the damage 4 or injury? 5 E The County van driver's name is William Lee Perry,(925)957-7700.Any other persons responsible 6 for the injury are unknown and are represented in this claim as Does 1-25. 7 6. What damage or injuries do you claim resulted? 8 Medical: 9 Emergency Room - John Muir Hospital 10 05/01/2002 JOHN MUIR MED CTR $285.00 r 11 05/01/2002 CA Emergency Physicians $170.00 12 Chiropractic Services: Mt. Diablo Chiropractic Center, 2281 East Street, Concord, CA 94520 13 05/01/2002 - 09/2002 (treatment continuing todate) $2537.00 14 Auto Repair/Loss of use: 15 1. Estimates: 16 Jim's Calif. Auto Body, Inc. 2520 Monument Blvd., Concord, CA 94520, $2713.17 17 Enterprise rent-a-car, 2550 Monument Blvd. Concord, CA 94520, $300.00 18 7. Hove was the amount claimed above computed? (Include the estimated amount of any 19 prospective injury or damage.) 20 Estimated Amount of Prospective Injury or Damage: 21 Actual Medical Bills: $2992.00 22 Prospective Medical Bills: 23 Continuing visits to Chiropractor $Undeterminable at this time 24 Pain& Suffering $Undeterminable at this time 25 (My client has injuries which he feels will last throughout his lifetime) 26 Auto Repair/Loss of Use: $3013.17 27 8. Names and addresses of witnesses, doctors and hospitals. 28 Witnesses: - 2 - I Robert Ericson, 8/20/49, 1650 Nuala Street, Concord, CA 94518 h(925) 686-6682 2 Edward M. Stone,2000 Pomar Way, Walnut Creek, CA (925) 944-0158 3 Diane Browne, Marsh Risk& Insurance Services, 1 California Street, San Francisco, CA 94111 4 (415) 743-8335 5 Doctors: 6 Dr. Andrew Kives,M.D. 7 Dr. Mark W. Wilbur, Chiropractor 8 Hospital: 9 John Muir Medical Center,1601 Ignacio Valley Road, Walnut Creek, CA 94598, (925) 939-3000 10 Mt. Diablo Chiropractic Center, 2281 East Street, Concord, CA 94520, (925) 676-1955 11 9. List the expenditures you made on account of this accident or injury: 12 Property Damage: 13 Date Item Amount 14 04/30/2002 Enterprise rent-a-car $300.00 15 05/2002 Jim's Calif. Auto Body, Inc. $2713.17 16 Medical Injury: 17 Date Item Amount 18 05/01/2002 JOHN MUIR MED CTR $285.00 19 05/01/2002 CA Emergency Physicians $170.00 20 ' !C 21 22 CC 23 /C 24 // 25 H 26 27 28 /C 3 0 f 1 kk+k�k��ak�kk�a�ik�###�k�& kkskkk#>k�kkikksk��k�k�9kkikakkak�kskkik# kkkikkkkaFxhhk*��gF�+k�kkk�5k�sk�mkak�k9k 2 Gov. Code Sec. 910.2 provides: 3 "The claim must be signed by the claimant or 4 SEND NOTICES TO: tAttorney) by some person on his behalf.,' 5 Name and address of Attorney 6 Valerie A. Mann 7 Law Office of Richard G. Bates Valerie A. Mann, Attorney for 8 1430 Willow Pass Road Jared Crabtree 9 Suite 160 3330 Woodhaven Lane 10 Concord, CA 94520 Concord, CA 94519 11 Telephone No. (925) 798-8055 (925) 671-2270 12 13 NOTICE 14 Section 72 of the Penal Code provides: 15 "Every person who,with intent to defraud,presents for allowance or for payment to any state 16 board, or officer, or to any county, city or district board or officer, authorized to allow or pay the 17 same if genuine,any false or fraudulent claim,bill,account,voucher,or writing,is punishable either 18 by imprisonment in the county jail for a period of not more than one year,by a fine of not exceeding 19 one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state 20 prison,by a fine of not exceeding ten thousand dollars($10,000),or by both such imprisonment and 21 fine. 22 23 24 25 26 27 28 - 4 - CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY � - f, BOARD ACTION: Oct 22, 2002 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and RS915.4. Please note all "Warnings". il AMOUNT: $116.88 'Uri ul. ,o rM' � 1312' CLAIMANT: Pacific Bell G4j ' tW N EL %4ART FEZ Q'Ai , ATTORNEY: DATE RECEIVED: Oct 3, 2442 ADDRESS: 3235 N. Texas St#204 BY DELIVERY TO CLERK ON: Oct 3. 2002 Fairfield, CA 94533 BY MAIL POSTMARKED: Oct 2, 2002 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWE Clea r� r Dated: _ Oct 4, 2002 By: Deputy d'� ;1> 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( his claim complies substantially with Sections 914 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 9111.8). { ) Claim is not timely filed. The Clerk should return claim on ground that it was fled late and send warning of claimant's right to apply for leave to present a late claim.(Section 911.3). { ) Other: Dated: y' _. 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.jBOARD 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: OCTOBER 22 , 2002 JOHN SWEETEN, CLERK., By 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 seep 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: OCTOBER :23, 2002JOHN. SWEETEN CLERK.B '; r� F ._... Y _ ' � Deputy Clerk Claim to: BOARD OF 91PER'VISORS OF CONTRA COSTA C OUN iY INSTRUCTIONS TO GLADiAM 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. Claim relating to causes of action for..death or for injury to person or tc personal property or ,growing crops and which accrue or. or after January 1, 1988, mint 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 §9"%! .2. ' ar B. Claims must be filed with the Clerk +of the Board of Supervisory at its office in Booc 1-06, County Administration: Building, 651 line Street, Martinez, CA 94551-. C. If claim is against a district governed by the Board of Supervisors, rather than the Cowty, the name of the District should be filled in. D. If the claim is against more tha:z one public entity, separate cla.imz must, be filed against each public entity. E. ' Fraud. See penalty for fraud€::ent claims, Venal Code. Sec. r2 at the end of thlis farm. :i8 :1ai: By Reserved for Clerk's filing stamp 5 --� . E ED Agairs ti. the County of Contra Costa C or LO�LER K M-80,T�pff RA Co District) Fill in ___7Z- The __ .The undersigned claLMnt hereby :rakes claim against the County of Contra Costa or the above-named iii s tri of in the sum, of $ �� � and in support of this" dim represents •as "allows; 18 When did the ear injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) 3. Hoa did the damage or injury occur? (Give full details; use extra paper if required) 4. What p ticuiar act or omission on the part of county or district officers, servants or .employees caused. the.injury or. e': ZO/T0°d T�!b; SEE Sed EO'C1 iu of 5. Wrat are tine names of county or district officers, servants or employees causing the damage or injury? t 5. haat damage or injuries do you claim resulted? (Gave full extent of in,uries or damages claimed. Attach two estimates for auto damage. tom€A*, _ 7. How was the amou: t claimed above computed? (Include the estimated mount of any prospective injwy or damage.) Names and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DA'I`S. ITS AMt�u"�4T Gov`. Code Sec. 910.-2 provides: ��y+}ty/ ,��+ "q /�y s�r'y"xIne claim must be siy�,n:edy t,scy�,,��the claimant SM L{tC i.CES i V a (Attowrn,d ) o .i ra a1 of his. i,Tw'LtSi w Mame and Address of Attorney AU CLaimantIs Signature- Address Er=� �_.. Telephone No. Telephone No. 41 * � N O T I C E Section 72 of the Penal Code provides: tzEvery 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 beard 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 fail for a period of not me thane year, by a f iz:e of not exceeding one thousand ($1,000), or by 'bath such imori,sonment and fine,'--or by imprisorraent in the state prise, by a fine sof not exceeding ten thousand ,dollars ($10,000, or by both such imprisonment and tine. Eoiuo°d `tZI!7 1 SEE SZ6 iNBWOUNkM ASIN 333 Pacific,Bell Telephone CompanyPA I � BELL w CRr Risk Management Service / "�� 666 Folsom Street,Room 920 i San Francisco,California 94107 (600)728-4202 Bill For Damages To: CONTRA COSTA COUNTY OF Date: 8/20/2002 1911 SAN MUGUEL DRIVE SUITE 200 Page i of I WALNUT CREEK.,CA 94596 Claim#: PACB-CN-200207-OG-0049 Charge For Damage To: PACIFIC BELL FACILITIES On Or About: 7/23/2002 At: 1851 NEWELL AVE,W.C. WALNUT CREEK,CA By PAT GILES While: _ CO CO COUNTY TRUCK TORE DOWN 2 DROPS LABOR TRANSFERRING DROP WIRES 1.00 REG FIRS $108.08 MATERIAL 2 PAIR DROP WIRE 1 QTY $8.80 Amount Daae: $116.88 This kill is due upon receipt. If payment is not received within 15 days further collection action will be taken. REMIT PAYMENT TO:Pacific Bell Attn:Risk Mgmt. Svcs. ONE BELL CENTER,ROOM 39-N-13 ST. LOUIS,MO 63101 Inquiries call TOLL FREE 1-800-728-4202 Hours:Mon.-Fri.7:00 am-4:30 pm or DIRECT 1-415-542-0269 FAX 415-542-0111 CUSTOMER COPY PACIFIC BELL Pan 1 of t BREAKDOWN OF CHARGES FOR DAMAGES RUN LATE: 9/30/2002 CLAIM NUMBER. PACB-CN-200207-Si 049 TRv E DATE OF REG REG OVT OVT DBIL, DBL EMPLOYEE REPAID HRS RATE IRS RATE HRS RATE AMOUNT SL 7/24/2002 1.430 108.08 $108.08 LABOR SUE-TOTAL $108.08 MATERIAL DESCRIPTION QUANTITY UNTIT COST AMOUNT 2 PAIR DROP WIRE 1 $8.80 $8.80 MATERIAL SUE-TOTAL 58.80 CONTRACTOR CONTRACTOR NAME AMOUNT LOSS OF USE DESCRIPTION GUAIv"II UNIT COST AMOUNT OTHER ITEMS DESCRIPTION AMOUNT TOTAL TIME,MATERIAL, CONTRACTOR.,LOSS OF USE.OTHER ITEMS $116.88 CLAIM TNTY BOARD OF SUP'ER'VISORS OLISORS OF CONTRA COSTA C BOARD ACTION: tact 22,2002 Claim Against the County, or District Governed by ) the Board of Supervisors,Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action, All Section references are to The copy of this document mailed to you is your California Government Codes. notice of the action taken on your claim by the Board of Supervisors, (Paragraph IV below), given l ant to Government Code Section 913 and "VI Please note all"Warnings". C 0 7 AMOUNT: More than $25,000 C 0 VA F jl �A L�F CLAIMANT: C. Evans;N. Evans; T. Fan2 vansA. Evans; C. Evans; ATTORNEY: DATE RECEIVED: Oct 2, 2002 ADDRESS: 546 17' St BY DELIVERY TO CLERK ON: Oct 2002 Richmond, CA 94801 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEE Dated: Oct 4, 2002, By: Deputy Il. FROM: County Counsel TO: Clerk of the Board of Supervisors ( 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: By: Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) Claim was returned as untimely with notice to claimant(Section 911.3). IV./BOARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in fall. Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. OCTOBER 22 , 2002 6;./, Dated: JOHN SWEETEN, CLERK, By Deputy Clerk WARNING(Gov. code section Y13) 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: OCTOBER 23, 2002JOHN SWEETEN, CLERK By —Deputy Clerk r REQUEST TO SPEAK FORM (THREE (3) MINUTE LIMIT) PLEASE PRINT LEGIBLY Complete this form and place it in the hoax near the speakers' rostrum before addressing the Burd. Name:-' sj %t ..k 71-L.. Z hcane t-rldress: f City : #r .: Zip Code <F ;_ I:gym speaking for myself or organization. (name of organization) CHECK ONE: I wish to speak on Agenda Item# Date: My Comments will be general for against I wish to speak on the subject of I do not wish to speak on the subject but leave these comments for the board to consider: Clans 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 personal property or growing crops and which accrue on or before December 31, 1987,roust be presented not later than the 100 'day after the accrual of the cause of action. Maims 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 roust be presented not later than one year after the accrual of the cause of action, (Gov't Code 911.2.) B. Claims roust 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 claire is against more than one public entity, separate claims roust be filed against each public entity, E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the enol of this form. RE: Claire By Reserved for Clerk's fling stamp ) Mr, Charles Evans H, , Nicole t,., Evans (Parents)) `sera€yr R..,Renis M.,Armae N.&Chasles TEvans(Minors) � n �3 u Against the County of Contra Costa or ) District) a 4J UN Rtl �OFz.rv' (Fill in name) z� ) The underssigned,claimant hereby makes claim against the County of Contra Costa or the above-named district in the sura ofUnlimited Civil (lore than $25,000.)and in support of this claire represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) Wednesday April 24, 2002 1330hre 2. Where did the damage or injury occur? (Include city and county) Superior Court of California, 100 37th Street Richmond .... Contra Costa County 3. flow did the damage or injury occur? (Give full details; use extra paper if required) The Alternate Defenders Office, upon receiving minors as clients, failed to advocate and defend their best interest as required. Fvery nprenn xubn i:rit-b ;nfp it to A.f;�,rl nvac sr+ C—Al---m rr._ CLALM T BOARD OF SUPERVISORS OF CONTRA COSTA COLNTY BOARD ACTION: Oct 22,2002 Claim Against the County, or District Governed by ) the Board of Supervisors,Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of this document mailed to you is your i California Government Codes. notice 0 the action taken on your claim by the A Board of Supervisors. (Paragraph IV below), given IV Pursuant to Government Code Section 913 and )J�l 915.4. Please note all"Warnings". AMOUNT: More than $25,000 �,T.)UNTY COU"J'SEIL 11 ,,AARTNEZ CAUR CLAIMANT: C. Evans; N. Evans; T. Evans; H. Evans;A. Evans; C. Evans; ATTORNEY: DATE RECEIVED: Oct 2,_2.002 ADDRESS: 546 17'h St BY DELIVERY TO CLERK ON: Octd, 2002 Richmond, CA 94801 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. 7 tj�k io* JOIN SWEET"--� , T i �__ V! Dated: Oct 4, 2002 By: Deputy 1 Lill H. FROM: County Counsel TO: Clerk of the Board of Supervisors a '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. Deputy County Counsel , f, _, -,, B 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. Other: 1 certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. C::a Deputy Clerk Dated OCTOBER 22 , 2002 JOHN SWEETEN, CLERK, By WARNING (Gov. code section913) 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 ol-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: OCTOBER 23; 2002jolIN SWEETEN, CLERK By Deputy Clerk 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 personal property or growing crops and which accrue on or before December 31, 1987,must be presented not later than the 100"'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. (Gov't 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 Mr. Charles Evans 1-Mm. Nicole L. Evans warents)) ?r 9y R,,Henry M_Armae N.,&Charles T,Evans(Mirsom) RECEIVED Against the County of Contra Costa or 2002 District) (Fill inname) P ISOM "K 10.1 Dlt C_ The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ Unlimited Civil (Mori.than,$26,QDAO and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) Wednesday April 24, 2002 1330hrs 2. Where did the damage or injury occur? (Include city and county) Superior Court of California, 100 37th Street Richmond — Contra Costa County 3. How did the damage or injury occur? (Give full details; use extra paper if required) Office of County Counsel conspired with the Children & Family Services Bureau to continue depravation of civil liberties, provided misleading and unsubstantiated evidence to Juvenile Court, When presented evidence and complaints of civil rights violations County Counsel did nothing to address or correct the matter, 4.What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? Negligent Malpractice Conspired to place false information in official social work case file. Used authority of office to intimidate and harass paronts, in attempt to deny civil rights. Failed to act ethically and fairly during Juvenile Court proceeding, 5. ghat are the names of county or district officers, servants, or employees causing the damage or injury? Lapl . te, & Rettig, Others Currently Unknown 6. What damage or injuries do you claim.resulted?(Give fall extent of injuries or damages claimed. Attach two estimates.for auto damage.) Denial of Due Process Depravation of Civil Liberty 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Nature of damageslinjury Court Cases involving similar facts 8.Names and addresses of witnesses, doctors, and hospitals. NI 9. List the expenditures you made on account of this accident or injury. D-T—E TIME AMOIJI`3T NIA NIA 1 / ) Gov. Code Sec. 910.2 provides "The claim must be ) signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Claimant) Name and Address of Attorney ) � (Claimant's Signature) N/A 546 '1 ` street Richmond, Ca. 94801 (Address) Telephone No. NIA ) Telephone No. (510) 215-7772 NOTICE Section 72 of the Pend Code grog-ides: Every person who,with Ment to defraud,presents for allowance or the payment to any state board or officer,or to any county,cite,or district beard or officer,authorized to allow or pay the same if genuine,any false or fraudulent claim,aid,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 ti"Lousand($1,000),or by both such imprisonment and fine,or by impmonment in the state prison,by a fine of not exceeding ten thousand dollars ($10,000).or by both such imprisonment and fine.