Loading...
HomeMy WebLinkAboutMINUTES - 01142003 - C5 CLAIM BOARD-OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JANUARY 14, 2003 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 gr=j WIT ursuant to Government Code Section 913 and 5.4. Please note all "Warnings". AMOUNT: E34.0• SEC 1 2002. CLAIMANT: RICHARD BARTLEY COUNTY C=NSEL ATTORNEY: UNKNOWN DATE RECEIVED: DECEMBER 10, 2002 ADDRESS: 95 TORNEY AVENUE BY DELIVERY TO CLERK ON: DECEMBER 10, 2002 BAY POINT, CA 94565 BY MAIL POSTMARKED:DELIVERED THRU INTER- FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETEN, er f' Dated: DECEMBER 11 2002 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors {0"'T 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 sonotifying claimant. The Board cannot act for 15 days (Section 910.$). ( ) 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: 1241-� 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: (x) 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. JANUARY 14 2003 - Dated: JOHN SWEETEN, CLERK, By , Deputy Clerk WARNING {Gov. code sectiofi 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: JANUARY 15, 2003 JOHN SWEETEN, CLERK.By DeDuty Clerk p Y CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JANUARY 1.4 200.E 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". AMOUNT: $834.00 CLAIMANT: RICHARD BARTLEY ATTORNEY: UNKNOWN DATERECEIVED: DECEMBER. 10, 2002 ADDRESS: 95 TORNEY AVENUE BY DELIVERY TO CLERK.ON: DECEMBER 10 , 2002 BAY POINT, CA 94565 BY MAIL POSTMARKED:DELIVERED THRU INTER- FROM: Clerk of the Beard of Supervisors TO: County Counsel MANAGEMENT Attached is a copy of the above-noted claim. JOIN SWEETEN, er Dated: DECEMBER 11,_ 2002 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantiallywith 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 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: 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 Warnin 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. Bated: JOHN SWEETEN, CLERK.By Deputy Clerk Claim to; BOARD OF SUPERVISORS OF CONTRA COSTA QTY INSTRUCTIONS TO CLAD Am A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing drops 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 to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six monthss after the accrual of the cause of action. Claims relating to any ether cause of action must be presented not later than ons year after the accrual of the cage of action. (Go,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 eadh public entity. E. . Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's filing stamp R ")2 4�Al. RECEIVED Agalnst- the County of Contra Costa } 3 I 02_ car } District) CONTRA COSTA CO. Fill in name The undersigned claimant hereby makes claim istthe County of Contra Costa. or the above-named District in the sum of $ ` r 2 and in support of this claim represents as follows: � � , 1. When did the damage or injury occur: (Give exact date and hour) 4-v ". i" t 2. Where dial the damage or injury occur? (Include city and county) r Ll 3. How did the damage or injury occur? (Give full details; use extra paper if rewired.) 4. What'particular act or omission on the part of county or district officers, {servants Or eOPloYees caused. the injury or damage? (over) j, wriat are the names of county or district officers, servants or employees causing the damage or injury? 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. 7. How was`-�the-amount clai ,mid above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses, doctors and hospitals. ------w_..___...___.._---..._.______ 9. List the expenditures you made on account of this accident or injury: DP_TE ITEM AMOUNT Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorne ) or by someperson-on his. behalf." Name and Address of Attorney , Claimant's gnature Address Telephone No. Telephone No. i � ' * `# F NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if .genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine;� or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. _. ................................................................................................................................................................................................................................................ .................................................................................................................... __................. _ _ _ ... _ ji6ril's Auto Service AuTo REPAIR ORDER . 418 E. 10th St. Pittsburg, CA. 94565 A�t7t ESS Tel: (925) 427-5661 CITY,STX1TE • • NAME OF PART DATE C'u'STL7. 'SYO ANL). WpEt1?ROASiSE� :fHJvE ? AAKL � t{ � tSGAiA3. f . ✓ rfc�. wit t rN eY LICENSE NO t�DfJMETER. O >« t , WAW % POLIS CRAma 4a- 2 2 � i i yGALS.GAS ARTS ` OTAL PARTS QT S•OIL JAGCESSORIES iGAS,Ct Gc.ASi ' TC3TAL aA WSC MERCHANDISE OIL& y SUBLET REPAIRS e GREASE --- E]RETAIN PARTS []DESTROY A ROY PARTS CC- TAX a c� sCa�s _ �. •- AUTf RY to! 1. _ � E ESTINIAT E AMOUN ' PANS 3 LABOR ++E?EBY A'vTHOF42£T+f A$CUz REPAIR VdO4R TC BED A C`!c-ES r_R aq'c h'AYN?f E5S AW THE ES;l AT£sal.:11 C e%G6EG T� AS.MA-7E W�gHC•E Rf�AAiR sr es�n„te..wating9e aro;^oe0:n eye,ra - NECESSAN�AFA.c4 A�A`�^,H 4 3Y G?AN'TCU AKDIOa VCi; TE, 2.Phase✓>< d r� 9 ir.:SS ON TQ QPcgA THE CA- 'QUO Ofi N'chfC=:ie�f.y CEC.R eEC CN P"cRicd zSICN YCvR S;G'3Ar�t, Vd3�tN.^. ATE YOzR ES E C bN. rn reavre.Gr ari mstatare con§num it Me Pr!ce x i� STREE,S.HtG!'WA Ca E:S£WHFR: 0?-uE PJR OSs FE Y1N Ah."vICR 3.1do ne:ovsr�en soft•.:le. g ! �ry t� A yy r 90-HON TftAN, eXpgF,I�CK ti VE$iC OASECL'n=_Tf AM£Y., C Ap��s �rc`Q C aHE CA ESHCN.?i�FlC4+OCS'c NOT 70 ACTu'J4 Z=dTife.SERVICES ^�C0.4:dEt�T1ED. —GAYS AL.i.T�"l f4.�`Plh Flx ,e GT387G _ _ _ CCyCK>Ye^M RU-rC> SeMN/YCa CeWre 2 A DIVISION OF THE GOODYEAR. TIRE & RUBBER COMPANY tial 0DfV'Ed lit 2145 RAILROAD AVE PITTSBURG, CA 54565 (925)473-1600, BAR REG# AL186190, S.D. CAL000159636 �T IMP FEDERAL TAX ID# 340253240 .�" T RTP. 11/25/02 11/25/02 A> � 01:01. PM 01:01. PM � TERR: 8770 WAGE: 01 NONSIG: 908770 -A l="F Z J1C T 2 NIRT�' C7r C "CYT FL'A`Y' BILL TO: RICHARD BARTLEY 95 TORMUY AVE ANTIOCH, CA 94509 PHONE 1. . . . . . . (925)458-2448 VES YEAR/MAKE. 93 GMC TRUCK PHONE 2. . . . . . . VEHICLE MODEL. 01.500 1/2 TON 2WD PI DATE REQUESTED 11./25/02 VEHICLE COLOR. BLUE TIME REQUESTED ER/ /OE. 1340008 /ETURNPRT .. NO ODMTINUT / NA SALESMAN. . . . . . 021 / 021 ACCOUNT # COB TC OUST# TYPE/STATE 877000001 2 01 05924 0 CA SLSM TECH PRODUCT CODE BC QTY DESCRIPTION CORE PARTS LBR/EXCISE LINE TOTAL 021 430-920-176-0 R 4 P235/75R15 X2 WRL AT/S OWL TL 128.00 .00 512.00 021 041-263 R 4 NEW VALVE STEM 2.99 .00 11.96 021 044-275 R 4 WHEEL BALANCE - AUTO - LIFETIME 5.95 10.00 63.80 Wl 8.00 WHEEL WEIGHTS 021 048-180 R 1 "GOOD TO GO" TIRE INFLATION-WHEEL TORQUE .00 .00 .00 I................. CERTIFY THAT THIS VEHICLE IS -GOOD TO GO-. THE FOLLOWING HAVE BEEN SET TO THE VEHICLE MANUFACTURER SPECIFICATIONS: TIRE INFLATION PRESSURE FRONT.......(LBS) REAR.......(LBS) WHEEL LUG TORQUE FRONT.......(FT LBS) REAR.......(FT LBS) 021 671 R 4 SCRAP TIRE DISPOSAL AUTO 3.00 .00 12.00 021 078-000 R 1 CHECK VEHICLE FOR ALIGNMENT .00 .00 .00 021 092-205 R 4 ROAD HAZARD 12.80 .00 51.20 QTY. 4 NO This is your list of Road Hazard Registration No(s). You MUST Present this invoice when requesting Road Hazard Protection Service. AMERAAN ROAD HAZARD INCLUDES PRO-RATED TIRE REPLACEMENT FOR THE LIFE OF THE ORIGINAL TREAD, FREE FLAT REPAIRS AND 24 HOUR ROADSIDE ASSISTANCE. THE PROGRAM ADMINISTRATOR CAN BE REACHED AT 1-800-445-2146. _.... C?CyC E YY"EAF2 ^U-rC> SE=-F;.V= CE CEW-raFZ A DIVISION OF THE GOODYEAR TIRE & RUBBER COMPANY 21.45 RAILROAD AVE ceoopfir,rAAA PITTSBURG, CA 94555 (925)473-1600, BAR REG# AL186190, I.D. CAL000159636 I►"I,"2VX"taw FEDERAL TAX ID# 340253240 E TZ ATE 11/25/02 11/25/02 C] {►6 8 01:01 Pm 01:01 PM TERR: 8770 PAGE: 02 NONSIG: 908770 -J'-'F='F2 2 C:E: NC)T F"AY'"� SLSM TECH PRODUCT CODE 8C QTY DESCRIPTION CORE PARTS LBR/EXCISE LINE TOTAL I UNDERSTAND THAT ALL CUSTOM WHEEL LUG NUTS MUST BE RE-TORQUED AFTER 25 MILES AND CHECKED PERIODICALLY. signature .Z F YC3U AF;ZE NCD-f 'I CC / SATS=S F = t3,� CALF F F2 A NKi_Z STC? "E C 5 5 ? - 6OC) TF�iE MANACa��2r A`�`" '1 PARTS TOTAL........ 610.96 LABOR TOTAL........ 40.00 STATE TIRE FEE 4.00 SUB TOTAL ......... 650.96 X - - -- --- ---- TAXABLE AMOUNT 547.76 SALES TA 45.19 CUS flMER AUTHORI IOC! F R, TAL EST=MATE _cYr^l... c)" _ 15 F>F23C:E C)^TE J cZ j ZC3;? SEE REVEFZSE S ][De FC I;t XMF'C>M-r^NT SAFETY WAF2N'=NC=- AND WAF2F-ANTY xmFC>l;tMA`TZC7rN 6 �. CLAIM _ }� BOARD OF SUPERVISORS OF CONTRA CO TA COUNTY BOARD ACTION:JANUARY I f 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; i,E C 1, 0 2 a 0 2 Pursuant to Government Code Section 913 and COUNTY COUNSEL 915.4. Please note all ""Warnings". AMOUNT: VITHIN THE UNLVAfDT5§ZA4f3DICTION OF THE SUPERIOR COURT SEE GOVERNMENT CODE § 910(f) CLAIMANT: LINDA KOLBE ATTORNEY: KELLEY ANN BURG, Esq. DATE RECEIVED: DECEMBER 10, 2002 ADDRESS: P.O. BOX 70231. BY DELIVERY TO CLERK ON: DECEMBER 10, 2002 PT. RICHMOND, CA 94807 BY MAIL POSTMARKED: DECMBER 09, 2002 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETEN=er Dated: DECEMBER - 10, 2002 By: Deputy ,. II. FROM: County Counsel TO: Clerk of the Board of Supervisors 0. (t Yfhis 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 Beard 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: f' _1 'Z-' By: fir' i w 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: (x) 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: JANUARY 14, 2003 JOHN SWEETEN, CLERK, By ` , Deputy Clerk WARNING(Gov. code sectio 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: JANUARY 15, 2003 JOHN SWEETEN,CLERK.By 3 .Deputy Clerk CLAIM BOARDQF_aUPE&V_1SQR. S OF CONTRA COSTA CDUNTY BOARD ACTION: 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 a9tion 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: WITHINTHEUNLIMITED JURISDICTION OF THE SUPERIOR COURT SEE GOVERNMENT CODE SS 910(f) CLAIMANT. LINDA KOLBE ATTORNEY- KELLEY ANN BURG, Esq. DATE RECEIVED: DECEMBER 10, 2002 ADDRESS: P.O. BOX 70231 BY DELIVERY TO CLERK ON: DECEMBER 10, 2002 PT. RICHMOND, CA 94807 BY MAIL POSTMARKED: DECMBER 092 2002 FROM. Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim, I JOHN SWEETEN, er Dated: DECEMBER 101 __2002 _. By: Deputy R. FROM: CountyCounsel 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: By: Deputy County Counsel M. 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. Sated: JOHN SWEETEN, CLERK, By -Deputy Clerk WARNING(Gov. code section 913) '5'ubject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited n the mail to file a court action.on this claim. See Government Code Section 945.6. You may seek the advice of an #omey of your choice in connection with this matter. If you want to consult an attorney, you should do so mmediately. *For Additional Warning See Reverse Side of This Notice, AFFIDAVIT OF MAILING declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United ;tater, over age 18; and that today I deposited in the United States Postal Service in Martinez, California,postage fully repaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. )ated: JOHN SWEETEN, CLERK By Deputy Clerk Kelley Ann Burg Attorney At Law Telephone No. Mailing Address Street Address: 510-237-7982 P.O.Box 70231 999 W.Cutting Blvd, Facsimile Pt.Richmond,CA 94807-0231 Suite 16 310-237-4797 Pt. Richmond,CA 94804 December 9, 2002 Clerk of the Board of Supervisors County Administration Building" 651 pine Street, P.m. 106 Martinez, CA 945553 DEC 1 0 2,002 jt 7 S{r9i f } Contra Costa County rs �; IHSS Public Authority 1330 Arnold Dr., Rm. 103 Martinez, CA 94553 Re: Our Client: Linda Kolbe D10/L: June 11, 2002 Dear Sir/Madam: I am enclosing the original and one copy of the claim in the above matter. Kindly forward { a copy back showing that it was stamped as received. Thank you for your cooperation. Very truly urs, /hillippAllen Legal Assistant Licensed to practice in California and Hawaii BEFORE THE COIATY QF CULNIRA�GSTA IN THE MATTER OF THE CLAIM OF ) LINDA KOLBE ) GOVERNMENTCLAIM against Contra Costa County and Centra ) Costa County IHSS Public Authority ) The undersigned claimant hereby makes claim against the Contra Costa County and Contra Costa County IHSS Public Authority: CLAIMANT'S NAME: Linda Kolbe CLAIMANT'S ADDRESS: 1928 Runuill Blvd., #2 San Pablo, CA 94806 ADDRESS TO WHICH NOTICES ARE TO BE SENT: Kelley Ann Burg,Esq. P.O. Box 70231 Pt. Richmond, CA 94807 Tel. (510) 237-7982 Fax(510)237-4797 AMOUNT OF CLAIM: Within the unlimited jurisdiction of the Superior Court. See Government Code § 910(f) DATE OF INCIDENT: June 11,2002 LOCATION OF INCIDENT: 459 5h St. Richmond, CA FACTS, CIRCUMSTANCES AND BASIS FOR CLAIM: On June 11, 2002, 2002,the Claimant was working at the home of Cleo Ginter, when she was assaulted and injured by several individuals who were at the Ginter home. The Claimant was placed in the position of an In Home Care Giver by the Centra Costa County IHSS Public Authority. At all times, the Contra Costa County IHSS Public Authority was governed by the Board of Supervisors of Contra Crista County. On information and belief, the Contra Costa County IHSS y .. . .. . ........ . ... ........... Public Authority had actual knowledge that there were individuals at the Ginter home who had past criminal records and who could pose a danger to any person working at the home. The basis of the claim is that Contra Costa County and Contra Costa County IHSS Public Authority were negligent in placing the Claimant in this home and thereby placing her in a position of danger. INJURIES AND DAMAGES: Claimant sustained numerous injuries,including facial,skull,back,neck and other injuries. Claimant has sustained and continues to sustain substantial medical,hospital and medication bills. In addition,plaintiff has sustained great pain and suffering and has lost income. ITEMIZATION OF DAMAGES: (known at this time) I. Hospital,physician,therapy and other Unknown at this time. types of medical expenses 2. Loss of earnings and earning capacity Unknown at this time 3. General Damages Within the unlimited jurisdiction of the Superior Court. See Government Code § 910(f) 4. Future Damages: Within the unlimited jurisdiction of the Superior Court. See'Government Code § 910(f) Kelley Ann Burg, Esq, Dated: By:A ,4,,A,- Kell Ann Burg, Esq. 2 1 PROOF OF SERVICE 2 1, Phillip B. Allen, do hereby declare and state: 3 1 am employed in the County of Pt. Richmond,California. 1 am over the age of 18 years 4 and not a party to the within action. My business address is 999'West Cutting Blvd., Ste, 16,Pt. 5 Richmond, CA 94844. 'k 6 4n this day of 402, 1 served the foregoing 7 GOVERNMENT CLAIM on the parties in this action,by placing a true and correct copy thereof 8 in a sealed envelope,and each envelope addressed as follows. 9 Clerk of the Beard of Supervisors County Administration Building 10 651 Pine Street,Rm. 106 Martinez, CA 945553 11 Contra Costa.County 12 IHSS Public Authority 1330 Arnold lir.,Rm. 103 13 Martinez, CA 94553 14 lS I caused each such envelope, with postage prepaid thereon, to be placed in the United States mail at Pt. Richmond, California. 16 1e under penak ofperj that the foregoing is true and correct. Executed on this 17 day of 402 at Pt. Richmond,California. 18 19 20 lip W Allen 21 22 23 24 25 26 27 28 ........ . _.._.... _. _. . ........ ........ .........._. .. _..__. _. .__.. . ....__ .......... ........ ........ ......... .._...... . ........ ......... E.11 a Kelley Ann Burg Attorney At Law _...r......_n�_�.�..:.r:�n:._..:�::..._..._.�.......�. Telephone No. Mailing Address Street Address: Fabs237-7982 P.O. Bax 70231 999 W.Cutting Blvd, Facsimile- Pt.Richmond,CA 94807-0231 Suite 16 51 f}-23'7-4'79'7 Pt.Richmond, CA 94804 .December 9, 2002 Clerk of the Board of Supervisors County Administration Building 651 Pine Street, Rm. 106 Martinez, CA 945553 Contra Costa County IHSS Public Authority 13.30 Arnold Dr., RnL 103 Martinez, CA 94553 Re: Our Client: Linda Kolbe Dear Sir/Madam: b/t)1L: June 11, 2002 I am enclosing the original and one copy of the claim in the above matter. Kindly forward a copy hack showing that it was stamped as received. Thank you for your cooperation. Very truly urs, Killip B. Allen Legal Assistant Licensed to practice in California and Hawaii BEfORE THE COUNTY ' CONTRA!QQSTA IN THE MATTER OF THE CLAIM OF } } LINDA KOLBE ) GOVERNMENTCLAIM against Contra Costa County and Contra } Costa County IHSS Public Authority } } The undersigned claimant hereby makes claim against the Contra Costa County and Contra Costa County IHSS Public Authority: CLAIMANT'S NAME: Linda Kolbe CLAIMANT'S ADDRESS: 1928 Rumrill Blvd., #2 San Pablo, CA 94806 ADDRESS TO WHICH NOTICES ARE TO BE SENT: Kelley Ann Burg, Esq. P.O. Box 70231 Pt. Richmond, CA 94807 Tel. (510)237-7982 Fax(510)237-4797 AMOUNT OF CLAIM: Within the unlimited jurisdiction of the Superior Court. See Government Code § 910(f) DATE OF INCIDENT: June 11,2002 LOCATION OF INCIDENT: 459 5"'St. Richmond, CA FACTS,CIRCUMSTANCES AND BASIS FOR.CLAIM: On June 11, 2002, 2002,the Claimant was working at the home of Cleo Ginter, when she was assaulted and injured by several individuals who were at the Ginter home. The Claimant was placed in the position of an In Home Care Giver by the Contra Costa County IHS S Public Authority. At all tunes, the Contra Costa County IHSS Public Authority was governed by the Board of Supervisors of Contra Costa County. On inforrnation and belief, the Contra Costa County IHSS 1 Public Authority had actual Knowledge that there were individuals at the Ginter home who had past criminal records and who could pose a danger to any person working at the home. The basis of the claim is that Contra Costa.County and Contra Costa County IHSS Public Authority were negligent in placing the Claimant in this home and thereby placing her in a position of danger. INJURIES AND DAMAGES: Claimant sustained numerous injuries,including facial,skull,back,neck and other injuries. Claimant has sustained and continues to sustain substantial medical,hospital and medication bills. In addition,plaintiff has sustained great pain and suffering and has lost income. ITEMIZATION OF DAMAGES: (known at this time) I. Hospital,physician,therapy and other Unknown at this time. types of medical expenses . Loss of earnings and earning capacity Unknown at this time 3. General Damages Within the unlimited jurisdictionof the Superior Court. See Government Code § 9I0(f) 4. Future Damages: Within the unlimited jurisdiction of the Superior Court. See Government Code § 910(f) Kelley Arun Burg,Esq. Dated: A Kel Ann Burg, Esq. 2 I PROOF OF SERVICE 2 I, Phillip B. Allen, do hereby declare and state: 3 1 am employed in the County of Pt. Richmond,California. I am over the age of 18 years 4 and not a party to the within action. My business address is 999 West Cutting Blvd.,Ste. 16,Pt. 5 Richmond, CA 94804. „ 6 On this day of sewed the foregoing 7 GOVERNMENT CLAIM on the parties in this action,by placing a true and correct copy thereof 8 in a sealed envelope,and each envelope addressed as follows: 9 Clerk of the Board of Supervisors County Administration Building 10 651 Pine Street, Rm. 106 Martinez, CA 945553 11 Contra.Costa.County 12 IHSS Public Authority 1330 Arnold Dr., Rm. 103 13 Martinez, CA 94553 14 15 I caused each such envelope, with postage prepaid thereon, to be placed in the United States mail at Pt. Richmond,California. 16 1.4ecAare under penaltv,,pfperj that the foregoing is true and correct. Executed on this 17 a of a#Pt. Richmond, California, 18 19 20 ip B. 21 22 23 24 25 26 27 28 CLAVI BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY V BOARD ACTION: JANUARY 14, 2003 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 Joard of Supervisors. (Paragraph IV below},given ursuant to Government Code Section 913 and r- , 15.4. Please note all `'"Warnings". nt I � 100 AMOUNT: $3,000. COUNTY COUNSEL MARTINEZ CALIF. CLAIMANT. LAMOS WAYNE STURGIS J-40508 ATTORNEY: UNKNOWN DA.TER.ECEIVED: DECEMBER 10, 2002 SAN QUENTIN STATE .PRISON ADDRESS: SAN QUENTIN, CA 94974 BY DELIVERY TO CLERK.ON: DECEMBER 10, 2002 BY MAIL POSTMARKED: DECEMBER 09, 2002 FROM: Clerk of the Board.of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETEN rk Dated: DECEMBER 10, 2002 By: Deputy II. 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: $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: bac} 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. JANUARY 14' 2003 �� Dated: JOHN SWEETEN, CLERK,By ,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 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: JANUARY 15, 2003 JOHN SWEETEN, CLERK.By Deputy Clerk CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION.- JANUARY 14, 2003 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: $3,000. CLAIMANT: LAMOS WAYNE STURGIS ATTORNEY: UNKNOWN DATE RECErTED: DECEMBER 10, 2002 SAN QUENTIN STATE PRISON DECEMBER 10 2002 ADDRESS: SAN QUENTIN, CA 9497'4 BY DELIVERY TO CLERK ON: } BY MAIL POSTMARKED: DECEMBER 09, 2002 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOAN SWEE rk Dated: DECEMBER 10 2002 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. { ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). { ) Other: Dated: 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 Beard's Order entered in its minutes for this date. 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 FAILING 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: JOHN SWEETEN, CLEF By Deputy Clerk ',7 RECEIVED f Fr' JAN 5 2003 wCLMBOAfrO OFSUPERVISORS v.. vt'.-.'/ f / � _ ! d rtir't?. f <` srC�;7- /'Z / / ice% %/ " G r7r fM1 r 200 P � ' 200 TODAY, CIAW's A 1 D 35 r r PRI- 'Emy Sham'_° 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 officein 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 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 A KO S 1&r' ,;S } } Against the County of Contra Costa or } District) (Fill in name) } The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ and in support of this claim represents as follows: 1. Wt�hen did the damage or injury occur? (Giveexact date and hour) Jw -F O� a0f. foXJ mo:Fe-111 y J,S.5 *M 2. Where did the damage or injury occur? (Include city and county) MA1K7-,'NC CA Ls fi6kill; , 6o Gro C:Va ;y 3. How did the damage or injury occur? (Give full details; use extra paper if required) SiFeF -27;4e_// SM - ..------- .---............ ..-.---- . ----.. ......... ....-...� -.->... --.. ..... -. .---.... ..._... .. .--- --.- ----- .... .. : "-.. t ....:_..... ..........f.F ..:......... ... ............................. ..... ..._.... ..--.. .... ..... ... .- ............... .. ... ii F' ........ ........ ......... .. ......._.... ::...:.... .:�:.: :._..:.i. .........-. ................... :... .... ........ ........ ...:..:...... ...... .....:._ ...... --..... ...... ... .. ---.--. �.--. 11 ..::.:. ....... ....-. . .-.. ...:: --.---- ....... .... ....... S .. .....:.. ... .--... ... .. ..... .............. .... ...................... _..... )f `3 _.. _.. ----...................................... .......... . --- ---.. ---------------- .. -------................................................. �3 .f .. -- ..................... 7 } S 5 - ff f : ........ : ........ .. ------------- ..----- --....... ....._.-. - ......... 11} .:..:.........:::. .. -. _ .......: -::. ................. "::.-:.. .::. ... ---. --..- ... ...,.. ._.. .. i ..... ------------------------------------------------ ...... .. ............... ........ f # . ............................... _. s ................. -------- .....- .....-........... ....... .................... _._._. . :--.: ....... ....:....... _:- _.... f _. ...................-. ....._.. .... ... ........................ . #. ...- ------- ...... ................ ............... O' � 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? Dep,f 71j,'s/6" � My W r,s � 7;;-n s es r;�s 5. What are the names of county or district officers, servants, or employees causing the damage or injury? ���� � ��•;���rpt ,��� � �`1,���,y' -��P°°'� �'��rZ��,�s 6. What damage or injuries do you claim resulted?(Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) �° MV l,-� ,f ` ✓t l.S ?'. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) / 8. Names and addresses of witnesses, doctors, and hospitals. �rtr4 };r e-r~ j A-4#I ;y -Dor � S k M ctc"r it -crc7V'Jes mF,o; e^I jee r ck—a 4 9. List the expenditures you made on account of this accident or injury. DATE TME AMOUNT ) Gov. Code Sec. 910.2 provides "The claim must be ) signed by the claimant or by some person on his behalf;' SEND NOTICES TO: !CAggrnev Name and Address of Attorney ) C 5 e 7=p Claimant's Signature), (Address) Telephone No. }Telephone No. NOTICE Section 72 of the Penal Code provides: Every person who,with intent to defraud,presents for allowance or the 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 that one year,by a fine of not exceeding one thousand($1,000),or by both such imprisonment and fine,or by imprisonment in the state prison,by a fine of not exceeding ten thousand dollars($10,000),or by both such imprisonment and fine. CLAIM BOARD OF SUPERMORS t9F CONTRA COSTA COUNTY BOARD ACTION:JANUARY 14<, 200 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 talon 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: $627 .00 9EC 1 2-002 CLAIMANT: AMY SELLAR COUNTY COUNSEL >AAR T€M CALIF ATTORNEY: UNKNOWN DATE RECEIVED: DECEMBER 10, 2002 ADDRESS: 12.3 N. VILLA WAY BY DELIVERY TO CLERK.ON: DECEMBER 10, 2002 WALNUT CREED, CA 94595 BY MAIL POSTMARKED:DELIVERED THRU INTER- OFFICE MAIL BY RISK MANAGEMENT FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETEN, Cjerk Dated: DECEMBER 102 2002 By: Deputy H. FROM: County Counsel TO: Clerk of the Board of Supervisors (s l`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 lata and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). ( ) Other: .r, Dated: j' p By: f} `p �' � � ` 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: (ka 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: JANUARY 14, 2003 JOHN SWEETEN, CLERK.,By - ,Deputy Clerk WARNING (Gov. code section 513) 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 BoardOrder and Notice to Claimant, addressed to the claimant as shown above. Dated: JANUARY 152003 JOHN SWEETEN,CLERK.By - Deputy Clerk CLAIM BOARD OF SUPERVISORS OF CQl jTRA COSTA COUNTY BOARD ACTION JANUARY 14_1 2003 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 GovernmentCode Section 913 and 915.4. Please note all"Warnings". AMOUNT: $627 .00 CLAIMANT: AMY SELLAR ATTORNEY: UNKNOWN DATE RECEIVED: DECEMBER 10, 2002 ADDRESS: 123 N. VILLA WAY BY DELIVERY TO CLERIC ON: DECEMBER 10, 2002 WALNUT CREEK, CA 94595 BY MAIL POSTMARKED.DELIVERED THRU INTER- OFFICE MAIL BY RISK MANAGEMENT FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETEN,Clerk Dated: DECEMBER_10, 2002 , By: Deputy H. FROM: County Counsel TO: Clerk of the Board of Supervisors ( } This claim complies substantially with Sections 910 and 914.2. ( } 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 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: 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.Beard Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JOIN SWEETEN,CLERIC By Deputy Clerk Claim to: BOARD OF SUPERVISORS OF COMM COSTA COUNTY INSTRUCTIONS TO CLADiANT 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 Deoember 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for-death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106# County Administration Building, 651 Pine Street, Mortinez, Ci 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 f 3F—M'. FI: Claim.By Reserved for Clerk's filing stamp Arm RECEIVED Against the CFu—nty of Contra Costa 1 0 2002. or DECECURK JO R4 c District) CONTRA CUSNA 301 ZFill- TF name 3 - . ) The tmdersigned claimant hereby makes claim, against the Cou:nty of Contra Costa or the above-named District in the sum of $ and in support of this claim represents �as foillcaws: 1 4r did the damage or injury occur? (Give exact date and hour 02- 2. Where did the damage or injury occur? (Include city and aunty) dr, -LIL 3. How did the damage or injury 6ccur? (Give full details; use extra paper if required) txos 4. What particular act or omission on the part of county or district officers, servants or .employees caused. the,injury or damage? Al pp 1w J wnat are the names of county or district officers, servants or employees causi the damage or injury? 5. What damage or injuries do you claim resulted? {Give full extent o, injuries or damages claimed. Attach two estimates for auto damage. i J 7. How was the amount claimed above compo d. (Include the estimated ry mated amo aryl. prospective injury or damage.) lL L/u �. ames and addresses of witnesses, doctors Id ?:ospitals. 9. st�the expenditures you made on account of this accident or injury: DATE I' M AMOUNT #G€ e ,' f Gov. Code Sec. 910:2 provides: "The claim asst be signed by the claimant SEND NOTICES TO: (Attu. ) or _by some wpon on his. behalf." Name and Address of Attorney s C tis Si gilr"i tu2'$ Address Telephone No. Telephone No. ij , * * * * * 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 cne-year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fitie. ITEMIZED DISPOSITION OF SECURITY DEPOSIT Pursuant to CivilC de Section 1950.5, Owner, on they_ day of hereburnished the o Ing statement of disposition of security deposit monies to former resident(s): 0(Nemef for the preml as orated at: California da;aea to } I t e m I z a d Damages: *" t .01 a r TOTAL MAG Necessary cleaning of premises upon termination: ' cu w z sn t u� 2 TOTAL �! 4 CLEANING COSTS �s M Default In rent (explain): 0 st 4.1 +C Z TOTAL RENT DUE stwrrca BALANCE aulo OWNER TO: TOTAL CHARGES $ " NAME TOTAL SECURITY �}...... ADDRESS DEPOSITS DECEIVED $ CITY.STATE,ZIP BALANCE DUE OWNER PLEASE REMIT IMMEDIATELY $ BALANCE DUE RESIDENT FORMER REstoE T's N w ADDRESS PAID BY CHECK NO. $ , f OWNERIA E T _,._.. APPROVED ��>I� 0 A FORM CALIFORNIAM87R APARTMENT ASSOCOPYRIGHT 10 UNAUTHORIZED REPRODUCTION OF THIS FORM IS ILLEGAL FORM t8.0 REVISED 7/82 COPY1�1{3HT 1982 VV1 �Pr ) d 7973ybj( Invoice Sold To;.- Ucense 4726213 Dated Origined 9/23/2002 Kronick Building Account a ~21 ! Qg Latest Printing 9/231200, 266 La Casa Via Ph one:(92 5)-6 76-69 10 FAX: (925)-676-8163 Walnut Creek, Ca. 94598 110 2nd Ave So C-5; Pacheco, Ca. 94553-5551 Due: Office Jobsite:Apt. entry door. Bill Date F.O.S. Pacheco Job Patrick cell 767.5774 Patrick Cashelf ordered U Hnges-> Hauer 9C1741 53 bdqt T-5/8' -ge—velf/j-Uninitered $1540( FAX Casing-�-� L 14 RH sore city Door Size & Typo Jamb 5.0 -I/—o Tj B 1 1�-4 —1 -:T/ Ext f —0x6/8xj.75' SC Birch Flush 4-718' . w/str Ah�In UD 2' x 81-3/4 203.1< C Brown Weatherstrip Alum.Sill&D oor Shoo D E 1 Peephole US3 installed in door 0 F 60' from bottom of door, G Door Size & Type Jamb L 0 R —S T yly U V .4 A W _ �_ _ _Y Dr Qtv jamb Z A A ,A, A, !Ae oty Sub Total $24_7.5 Date Ck No Appto 9 Tax 20.42 as Ve $0.00 heill Sdbboh r6ci Estimate Approved Received: To Order: Completed: No Delivery TOTAL $267.95 CHECK CHECK THIS LIST CAREFULLY, as these are the materials you are ordering. This list supercedes all 2� First Pmt lists 0.4 previous lists and blueprints. No returns on special orders and machined items.Restocking charge of Red'i' r 'n( balance '3. will .1 20%wiil be added for all reseltabie items returned, Sun Valley Doors retains ownership of materials listed herin until payment in full has been received. PLEASE READ REVERSE SIDE FOR ADDITIONAL CONDITIONS. _rnt r / PROPOSAL t'O - 51iEr=T PdC)_ / _ f l t3 A 1{r C I ED 'T 0: Nwom< TU BE PEnr-onMED AT: IT"t- n (,ITY, SfAIF. I s OAI E OF Pl ANS ARCtiiTECT 1,-0-,v pfnrnr,to furnish tha nwl perfr)rm the labor nprr<sary for the completion of All is qunfnntf?ed tr> he n, spncifiorl, anct the nhove work to he performed In accords? ce lih the drawings nod �� nrifh�ntint,5 sffhrnitterf for nhr,,.ve wntk n6d colt pImed in a sutsstantial workmanlike manner for t SLIM of: r'titi f,r,l',fir�sl! SSI hsz n, follow., - Pfdr_- Noto .This propnsrrl finny be withdrawn by us if not rccepind within ACCEPTANCE OF PnOPOSAL and c1olCfitionr-are satisfactory and ate hereby accepted You are authorized to do the work as specili€d Pays wnts will nnt4tl -i hl ' SSGN�TUf1F SIC,HATUnE i".Ariarrt, 9.15© CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JANUARY 14, 2003 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: $1,000,000 . E C 02, D CLAIMANT: NATHAN BANKS :* COUNTY COUNSEL IMARTINEZ CALF ATTORNEY: UNKNOWN DATE RECEIVED: DECEMBER 11 , 2002 ADDRESS: 3175 SOUTH FRANCISCO WAY BY DELIVERY TO CLERK ON: DECEMBER 11 , 2002 ANTIOCH, CA 94509 or BY MAIL POSTMARKED: DECEMBER 10, 2002 M.D.F. C ROOM 8 M"TTNV7_.__ZA 94SS_l - FROM: Clerk of Board Of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETEN=Cl r Dated: DECEMBER 11 , 2002 By: Deputy_ II. FROM: CountyCounsel TO: Clerk of the Board of Supervisors oce 47 4 (,VThis claim'complies esubstantially with Sections 910 and 910.2. A 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). I I (V)11'�' 'L Other: l�' 4 rr_v�l I tv,- Alf 1�16A in'15 i2rior - 4Sl jL11 _n/1 U ialm C� Dated: Deputy County Counsel By: All, _t_11�21 M. 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: (x� 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- JANUARY 14, 2003 - JOHN SWEETEN, CLERK, By Deputy Clerk WARNING(Gov. code recti n 91 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. JANUARY 15, 2003 JOHN SWEETEN, CLERK By Deputy Clerk OFFICE OF THE COUNTY COUNSEL Brie SILVANO B.MARCHESI COUNTY OF CONTRA COSTA > t? COUNTY COUNSEL Administration Building SHARON L. ANDERSON 651 line Street, 911' Floor CHIEF ASSISTANT Martinez, California 94553-1229 GREGORY C. HARVEY (925) 335-1800 10' , �;',`t, j VALERIE J. RANCHE (925) 646-1078 (fax) _ F :` pf ASSISTANTS L! NOTICE OF UNTIMELINESS AS TO A PORTION OF THE CLAIM TO: Nathan Banks 3175 South Francisco Way Antioch, CA 94509 Please Take Notice as Follows: In regards to the claim you submitted on December 11, 2002, portions of your claim are timely and portions are untimely. The portions of your claim prior to June 10, 2002 that you presented against the County of Contra Costa governed by the Board of Supervisors fail to comply substantially with the requirements of California Government Code Sections 901 and 911.2, because they were not presented within six months after the event or occurrence as provided by law. Because the portions of the claim prior toJune 10, 2002 were not presented within the time allowed by law, no action was taken on those portions of your claim. The claim was forwarded to the Board for action only on the timely portions of the claims. Your only recourse at this time is to apply without delay to the County of Contra Costa governed by the Board of Supervisors for leave to present a late claim as to the claims which are untimely. See Sections 911.4 to 912.2, inclusive, and Section 946.6 of the Government Code. Under some circumstances, leave to present a late claim will be granted. See Section 911.6 of the Government Code. You may seek the advice of an attorney of your choice in connection with this matter. If you desire to consult an attorney, you should do so immediately. SILVANO B. MARCHER COUNTY COUNSEL By: ` h s �F'✓L Monika L. Cooper Deputy County Counsel Page 1 CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013x,2015.5;Evidence Code§§641,664) I declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553;1 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 UNTIMELINESS AS TO A PORTION OF THE CLAIM by placing it in an envelope addressed as shown above,sealed and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California. I certify under penalty of perjury that the foregoing is true and correct. Executed in Martinez,California. Dated: December 16,2002 l' cc: Clerk of the Board of Supervisors(original) Risk Management Page 2 CLAIM B A OF SU9gWVIS.QLtS QF Coal—RA 900-1y BQARD ACTIQN: JANUARY 14, 2003 Claim Against the County, or District Governed by ) the Burd 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 anion 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: $1,000,000. CLAIMANT: NATHAN BANKS ATTORUNKNOWN DATE RE IVED DECEMBER 11, 2002 3175 SOUtH .FRANC1SC0 ;WAy BY DELI'VBRY TO CLERKON: -DECEMBER 1.1, 2002 ADDRESS: ANTIOCH, CA 94x09 ° BY MAIL POS TMARI ED: DECEMBER 10, 2002 M.D.s'. C ROOM FROM: Clerk of the Board bf Supervisors 'ICt: County Counsel Attached is a copy of-the above-noted claim. JOIN SWEETEN Cl Dated: DECEMBER 11, 2002 By: Deputy 11. FROM: County Counsel TO: Clerk ofthe Board.of Supervisor { } This claim complies substantially with Sections 910.and 910.2. { } This Claim FAILS to comply subst ntially'with Sections 910 and 914.2, and we are so notifying claimant.The Board cannot act for 15 days(Section 910.0. { } 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: B : Depu 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: JOHN SWEETEN,CLERK,By , De uty 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 945.5. 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 W!Ti ing 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: JOIN.SWEETEN,CLERK By Deputy Clerk Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSM= 'f(3 G 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 I oO*day. after the accrual of the case 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 Roam 106, County Administration Building, 6:51 P'the 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. . See penalty for fraudulent claims,Penal Code Sec.72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp A Pit RECEIVED Against the County of Contra Costa or } �_ PEC I 12002 skm&� uIr District) Fill in name) D of SUPE V1 CON tFiA COSTA Ct}. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$.I 0A00, d in support of this claim represents as fellows: 1.. When did the damage or injury occur?(Give exact date and hour) lq-0 0, 02 2. Where did the damage or injury occur?(Include city and county, Ul �A 3. Flow did the damage or injury ryoccur' (Give ful details; use extrtra paper if required) i t o4 7 DCA 4. What particular act or omission on the part of county or district officers, servants, or emp M41TTUsed the injury or damage? i kANCA Vci k k { 5. What are the dames of aunty or tstrtct ers, servants, ar employees causing the damae orjury. rz rk b. WWha damage or anjunes do you claim t �u ed�( eAill extent of injuries or damages claimed. Attach (4 two estimates for auto damage.} 7. How was the amount claimed above computed?(Include thii'Wimated a taunt of any prospective injury or damage.) -s 1 p .,7 V 1 /�i➢ �0 `'✓ S 8. Na es nd dd114 3: resses ofwrtnesses, doctors, and hospitals. ; ' l st. to, �fo�t �._�} \,.hJ 1 ¢` F a p ,+r. ..a �. �'��'zK ,� p .,i " t ` - 9. tat the expenditures you made on account cftliis�accident or injury. DATE AMOUNT ` M1 } Gov. Code Sec. 910.2:provides"'The claim must be } signed by the claimant or by some person on his behalf." Name and Address ofAttomey } � ��� �' } (Claima)ffs Signature) } (Address) Telephone No. Telephone No� „t IL Nana Section 72 of the Penal Cade provides: Every person who,with intent to defraud,presents for allow-mce or the payment to any state board orr officer,or to any county,city,or district board or officer,authorized to allow or pay the same if genuine,any Use 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(SLOOOX or by both such imprisonment and fine,or by imprisonment in the state prison,by a fne of not exceeding ten thousand dollars(S I O,000),or by both such imprisonment and fine. a Y� tea , l,wwl IN ljlll co U-01 +��.- . �. �. � `nth! ... •,...�. ' MOM �MM ON '" y1 t 1� NOWall IONS 0 # •,� l k WIj �9 I Ill mil �f Mill Ilk - lid 3 G- . . � .r►�E� � � � tib: e y IIIIII I� P. Y APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY,,CALIFORNIA JANUARY 14, 2003 BOARD ACTION Application to File Late Claim } NOTICE TO APPLICANT Against the County, Routing ) The copy of this document mailed to you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to ) the Board of Supervisors (Paragraph III,below), California Government Code.)_ ) given pursuant to Government Code Sections 911.8 and 915.4. Please note the"WARNING"below. Claimant: DEREK W ICKERS Attorney: THOMAS P. GREERTY SBN 085616 � DEC1 2fir Address: 917 LAS JUNTAS STREET COUNTY COUMSEL MARTINEZ, CA 94553 MARTJNEZ CALIF. Amount: UNKNOWN By delivery to Clerk on: DECEMBER 11, 2002 DECEMBER 11 2002 HAND DELIVERED BY bate Received: 3 By mail,postmarked ons' . VAUGHN 12111/02 1. FROM: Clerk of the Board of Supervisors TO: County Counsel t Attached is a copy of the above noted Application to File Late Claim. , i DATED: DECEMBER 12, 29 IN SWEETEN,Clerk,By: DEPUTY 1I. FROM: County Counsel TO: Clerk o the!Board f Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6) (� The Board should deny this Application.to File Late Claim (Section 911.6). DATED: 1`J-57, SILVANt B.MAI2CI3ESI,County Counsel,Byx" fss ,f' DEPUTY III. BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( } This Application is granted (Section 911.6). (x) This Application to File Late Claim is denied(Section 911.6). I certify that this a true and correct copy of the Board's Order entered in its minutes for this date. JANUARY 14 2003 E DEPUTY DATE: � JOHI! SWEETEN,Clerk,By: WARNING (Gov. Code §911.8) If you wish to file a court action on this matter,you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945A(claims presentation requirement).See Government Cade Suction 946.6.Such petition must be filed with the court within six(6)months from the date your application for leave to present a late claim was denied. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney,you should do so immediately. IV. FROM: Clerk of the Board TO: (1) County Counsel (2)County Administrator Attached are copies of the above Application. We notified the applicant of the Board's action on this Application by mailing a copy of this document,and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. DATED: JA=NUARY 14 2003 JOHN SWEETEN,Clerk,By: � � � DEPUTY V. FROM: (1)County Counsel (2)County Administrator TO: Clieri of the B and of Supervisors Received copies of this.Application and Board Carder. DATED: County Counsel,By: County Administrator,By: APPLICATION TO FILE LATE CLAIM APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTM COSTA COUNTY CALIFORNIA JANUARY 14, 2003 BOARD ACTION Application to File Late Claim ) NOTICE TO APPLICANT Against the County,Routing ) The copy of this document mailed to you is your Endorsements, and Board Action,) notice of the action taken on your application by (All Section.References are to ) the Board of Supervisors (Paragraph 111,below), California Govemment Code.} I given pursuant to Government Code',Sections 911.8 and 915.4.Please note the"WARNING"below. Claimant: DEREK WICKERS Attorney: THOMAS P. GREERTY SBN 085616 Address: 917 LAS JUNTAS STREET MARTINEZ, CA 94553 Amount: UNKNOWN By delivery to Clerk on: DECEMBER 1.1, 2002 • DECEMBER 11 2002 AND DELIVERED BY Date Received, a By mail,postmarked on:= AUGHN 12 11/02 1, FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted Application to File Late Claim. DATED: DECEMBER 12 , 296 N SWEETEN,Clerk,By: ADEPUTY 11. FROM: County Counsel TO: Clerk of theBoard f Supervisors { } The Board should grant this Application to File Late Claim (Section 911.6). ( } The Board should deny this Application to File Late CIaim (Section 911.6). DATED: SILVANO B.MARCIIESI, County Counsel,By: DEPUTY III. BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( ) This Application is granted(Section 911.6). This Application to File Late Claim is denied(Section 911.6). 1 certify that this a true and correct copy of the Board's Order entered in its minutes for this date. DATE: JOHN SWEETEN,Clerk,By: DEPUTY WARDING(Gov. Code §911.8) If you wish to file a court action on this matter,you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4 (claims presentation requirement).See Government Code Section 946.6.Such petition must be filed with the court within six(6)months from the date your application for leave to present a late claim was denied. You may seek the advice of an attorney of your choice in connection with this matter'. If you want to consult an attorney,you should do so immediately. IV. FROM: Clerk of the Board TO: (1) County Counsel (2)County Administrator Attached are copies of the above Application. We notified the applicant of the Beard's action on this Application by mailing a copy of this document,and a memo thereof has been Bled and endorsed on the Board's copy of this Claim in accordance with Section 29703. DATED: JOT_IN SWEETEN,Clerk,By: DEPUTY V. FROM: (1)County Counsel (2)County Administrator TO: Clerk of the Board of Supervisors Received copies of this Application and Board Order, DATED: County Counsel,By: County Administrator,By: APPLI ATIOI!TO FILE LATE CLAIM 11OV, 27, 2002 1 :49PV THE SCOTT LAW FIRM O, tJ0 P, '0 I MOM.A.S P. GREERTY SBN 095616 Attorney at Law- 2 917 Las Juntas Streetr Martinez, California 94553 _-� 3 Telephone., (925) 370-8400 { Facfizxaxile- (925) 370-O778 4 DEC 1 1 2002 E Attorneys for the Plaintiff 5 6 { 7 f 8 € APPLICATION FOR,LEAVE TO PRESENT A LATE CLAIM 9 TO CONTRA.COSTA COUNTY, CALIFORNIA 10 DEREK WICKERS, 11 Claimant, ) APPLICATION FOR LEAVE TO 12 ) PRESENT A LATE CLALM ON BEHALF Vs. ) OF DEREK VVICUERS 13 CONTIi.A. COSTA. COUNTY. � 14 15 ) 16 TO CONTRA COSTA COUNTY BOARD OF SUPERVISORS: 17 1. Application is hereby made pursuant to Oo°vernmennt Code § 911.4 for leave to present a late claim founded on causes of action against the County, its agents and employees for breach of'the 18 County's mandatory duties to,and neglimt care and supervision of,Claimant Derek Wickms whsle he was a minor clilld in the County's foster care. Claimant was sexually molested by his foster 19 parent, Thomas Bead uson, while placod by the County in Bertinuson's foster home in 1992. Bertiaawon forced claimant to masturbate Bertinuson and another boy Claimant, in. 6,e home, and 20 forced Claimant to masturbate them. He took pornographic photos of+Claimant, Ike made birra e shower with the other boy and fondle his genitalia while he watched.. Claimant, who was born on 21 February 13, 1981,was I 1 or 12 years old at the time. 22 2, Claimant filed a tort claim pursuant to Government Code § 911.2 on May 10, 2002. The County-rej ed the•c1aiAm-on M-ay 29, 2002 on grouzxds -it was­anti�=ely. The reason.-C1-aimHnt 23 presented his claim at that time is based on the following facts and circumstances., 24 In 1992, while Claimaut was still placed in Bertinuson's home, Claimant told his County Social Worker, Yvonne Chevalier,that Berth uson was maldng him shower with the other boy in 25 the home. Claimant also told. Chevalier that Bertinuson made him sloop in the same bed with Bertinuson and the artier boy, Bertinuson found out about Claimant's talk with Chevalier. Within 26 a couple of weeks,Bertinuson accused Claimant of engaging in"acts out"behavior. In rosponse to Bertinuson's accusations,the County had Claimant removed from Bertinuson's Dome and placed 27 in a.locked juvenile home,where he remained for 2-1!2 years. No one from the County visited him throughout the entire time of his incarceration. 28 V. 27. 2uC2 1 :-OPM THE SCOTT LAW F RM NO. 001 R, 12 1 Because of the traum,atio consequences of reporting Bertinuson's conduct to the, social worker it 1992 Claimant thereafter Dept Berrttinuson's sexual abuse to himself. On or axttund 2 Thanksgiving 2601 he learned born the sister of mother boy who had been placed in Bertinuson°s horse that another male had complained to the Moraga police Department about sexual abuse by 3 Bertinuson,and that Bertinusou was being investigated and criminally charged. Claimant then event to the Moraga Police Department and agreed to assist in the pmaecution The District Attorney 4 interviewed him.in£roast of the grand jury the week ofDecember 10,2001,where Claimant testified to the abuse be suffered in Bertinuson.'s home. These recent events requiting Claimant to recall and 5 recount the childhood sexual abuse has caused Claimant to discover at be suffers serraus , psychological injury and illness to the present that w-as caused by the abuse. � 6 3, This application is being presented within a reasonable time after the accrual of this cause 7 of action,particularly in nature of type of conduct alleged. Uzxlikc ether causes of actions accruing during zrxi nority for which the statute of limitation runs one year after the age of'ra jority,the time 8 for comra,encement of an action for damages suffered as a result of childhood sexual abuse "shall be within eight yeah of he date the plaintiff attains the age of majority or within three years of the 9 date the plaintiff discovers or reasonably should have discovered that psychological iujury or illness occurring after the age of majority was caused by the sexual abuse." Cat. Code.Civ.Prue. §340.1. 10 Government Code section 901 provides that,for the purpose of computing the time limit prescribed by section.911.2"the date ofthe awl of a cause of action to which a.claim relates is the date upon 11 which the cause of action would be deemed to have accrued within the meaningof the statute of limitations which would be applicable thereto ifthere were no requirement that a cam be presented 12 to and be acted upon by the public entity before an action could be commenced thereon."Thus "the date of accrual for the purpose of starting the claim presentation period"is the same as for the statute 13 of limitations which would otherwise be applicable." T hfo?ield v. Roth(1974 10 Cal. 3d 874,885; Wozniak v.Peninsula Hospital(1969) 1 Ca1.App.3 d 716,722. Cases interpreting CCF §340.1 held 14 that the statute of limitations on claims arising under that statute is tolled,and the cause of action dries not accrue, until the victim discovers, uzzderstands and connect the sexual abuse with his 15 psychological inju7ies. Sellers v. Cressey(1996)48 +Cad.. App. 40,538;Lent v. Doe(1995)40 Cal. ` App. 4h 1177. 16 Claimant is 21 years old. His tont claim was filed within six months sof discovering he staffers 17 psychological injury caused by the childhood sexual abuse. This applimtion to file a late claim has been filed withiin one year of that discovery. 18 WHEREFORE, it is respectfully requested that this application be granted and that the 19 attached proposed claim be received and acted on in accordance with §§ 911.3 of the GovernmentCode. 20 21 Dated:November- ,2442 T ONUS P. G Attorney for Claimant 22 23 24 j 2.5 26 27 28 -2 - 6 Or C, '1. 2002 3:23PM THE SCOTT LAW PiRM NOA67 P. 2 + }^'� + John sten The Board of Super _ -sors Costa Contra C*kcf ft rd and County Adminletnxition Building ( 1"SL'`�� County AdMi?isir Oe 651 trite Street,Hoorn 106 k.,i4..l+�a (M)335-1900 Martir'tex,CallorniB�-1M County John r#IC N 1 st DistFict t ayfe&Ufflrerna,2nd lkrirtct a r Donna Gwber.3rd Distrtct r _x+ Mm* tab`s.4th L1 biot Federal 0.Gloves',8th District TO: Thomas P. Greerty Attorney at Law 9'17 Las Juntas Street Martinez, CA 94553 � RE CLAIM OF: DEREK WIGKERS NO-T(CE TO CLAIMANT (Of Late-Filed Claim) (Government'Code Section 911.3) The claim you presented to the Board of Supervisors of Contra Costa County, California. as governing body of the County of Contra Costa on May 10, 2002, on behalf of Derek Wickers has been reviewed by County Counsel and is being returned to you herewith because: X Your claire for an injury to person or personal property was not presented within six months of the event or occurrence as required by law. (See Government Code sections 901 and 911.2) _ Your claim relating to a cause of action other than Injury to person, personal property or growing craps was not presented within one year after the event or occurrence as required by law. (See Government Cade sections 901 and 911.2) Because the claim was not presented within the time allowed by law, no action was takers on the claim. Your only recourse at this time is to apply without delay for leave to present a late claim. (See Government Grade sections 911.4 to 912.2 and 946.5) Under some DEC . 2x02 : 8?f THE SCOTT !AW FIRIM NO, X067 R, 3 Thomas P. Greerty, Es"q. Re: Claim of Derek Wipkers Page Two circumstances,leave to present a late claim will be granted. {See Government Cade section Date:IYVOA 9q, C467DDJOHN SWEETEN, Clerk of the Board .� of Supervisors and County Administrator Icy; Deputy Cldr Enclosure Affidavit of Mallina I declare under penalty of perjury that l am now, and at all times herein mentioned, have been a citizen of the united States, over age 16, and that today i deposited-in the United States Postal Service in Martinez, California, postage fully prepaid, a copy of the above NOTICE TO CLAIMANT (OF LATE-FILED CLAIM), addressed to the claimant as shown above. Dater rU� i"` Deputy Clerk APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY CALIFORNIA • BOARD ACTION Application to File Late Claim } NOTICE TO APPLICANT JANUARY 14, 2003 Against the County, Routing The copy of this document mailed to you is your Endorsements, and Board Action.) notice of the action takers on your application by (All Section References are to ) the Board of Supervisors (Paragraph.III, below), California Government Code.) ) given pursuant to Government Code Sections 911.8 and 915.4. Please note the"WARNING"below. 1 r Claimant: RICHARD BAUGH Attorney: ANGELA DORSEY-THOMAS Ns: DIE C 131 20.92 21st CENTURY INSURANCE COMPANY `": J ITYCOUNS L Address: ��'A 1TIN Z CALIF P.O. BOX 4430 Amount: WOODLAND HILLS , By delivery to Clerk on: DECEMBER 12, 2002 CA 91365 Date Received: 1' 58 " 68 DECEMBER 10, 2002 By mail,postmarked on: I. FROM: Clerk of the Board of Supervisors TO: County Counsel I Attached is a copy of the above noted Application to File Late Claim. DATED: DECEMBER 13 it 'WEETEN,Clerk,By: r , DEPUTY 11. FROM: County Counsel TO: Clerk of thelBoard of Supervisors ( ) The Board should grant this Application to File Late Claire (Section 911.6); { : The Board should deny this Application to File Late Claim (Section 911,6). DATED: 02--- SILVANO B.MARCHESI,County Counsel,By :`y i ,, aw DEPUTY III. BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( ) This Application is granted(Section 911.6). (x) This Application to File Late Claim is denied (Section 911.6). I certify that this a true and correct copy of the Board's Order entered in its minutes for this date. DATE: JANUARY 14, 2003 JOHN SWEETEN,Clerk,By: - DEPUTY WARNING(Gov. Code §911.$) If you wish to file a court action on this matter,you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4 (claims presentation requirement).See Government Code Section 946.6.Such petition must be filed with the court within six(6)months from the date your application for leave to present a late claire was denied. 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. IV. FROM: Clerk of the Board TO: (1) County Counsel (2)County Administrator Attached are copies of the above Application. We notified the applicant of the Board's action on this Application by mailing a copy of this document,and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. DATED: JANUARY 14 2003 JOHN SWEETEN,Clerk,By: �.' DEPUTY V. FROM: (1)County Counsel (2)County Administrator TO: Clerk of the Board of Supervisors Received copies of this Application and Board Order. DATED: County Counsel,By: County Administrator,By: APPLICATION TO FILE LATE CLAIM APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA,COSTACOUNTYCALIFORNIA BOARD ACTION JANUARY 14, 2003 Application to File Late Claim NOTICE TO APPLICANT Against the County,Routing The copy of this document mailed to you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to the Board of Supervisors(Paragraph 111,below), California Government Code.) given pursuant to Government Code Sections 911.8 and 915.4. Please note the"WARNING"below. Claimant: RICHARD BAUGH Attorney: ANGELA DORSEY-THOMAS Address: 21st CENTURY INSURANCE COMPANY P.O. BOX 4430 Amount: WOODLAND HILLS , By delivery to Clerk on: DECEMBER 12 , 2002 CA 91.365 $1,589 .68 d on: DECEMBER 10, 2002 Date Received: By mall,postmarked.. I­­.... I. FROM: Clerk of the ROAM of Supervisors TO: County Counsel Attached is a copy of the above noted Application to File Late Claim. DATED: DECEMBER 13J0AV§WEETEN,Clerk,By: DEPUTY 11. FROM: County Counsel TO: Cler.K of thejBoarJ of Supervisors The Board should grant this Application to File Late Claim (Section 911.6),. The Board should deny this Application to File Late Claim (Section 911.6). DATED: SILVANO B.MARCHESI,County Counsel,By: DEPUTY 111. BOARD ORDER By unanimous vote of Supervisors present (Check one only) This Application is granted(Section 911.6). This Application to File Late Claim is denied(Section 911.6). 1 certify that this a true and correct copy of the Board's Order entered in Its minutes for this date. DATE: JOHN SWEETEN, Clerk,By: DEPUTY WARNING (Gov. Code §911.8) If you wish to file a court action on this matter,you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4 (claims presentation requirement).See Government Code Section 946.6.Such petition must be filed with the court within six(6)months from the date your application for leave to present a late claim was denied. You may seek the advice of an attorney of your choice In connection with this matter. If you want to consult an attorney,you should do so Immediately. IV. FROM: Clerk of the Board TO: County Counsel (2)County Administrator Attached are copies of the above Application. We notified the applicant of the Board's action on this Application by mailing a copy of this document,and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. DATED: JOHN SWEETEN,Clerk,By: DEPUTY V. FROM: (1)County Counsel (2)County Administrator TO: Clerk of the Board;f Supervisors Received copies of this Application and Board Order. DATED: County Counsel,By: County Administrator,By: APPLICATIGN TO FILE LATE CLAIM 21stCENTURY INSURANCE i21.CPJm 1-800-211-SAVE P.O. Box 4430,woodland Hills,CA 81365 Office Number 1-800-322-8200 December 6, 2002 CERTIFIED MAIL RETURN RECEIPT REQUESTED Contra Costa County DISC 1 2X002 Clerk of the Board of Supervisors �n .:Ars: }.: , RS County Administration Building ` EK31111,fj )F S°����`s� 651 Pine Street, Room 106 "�� rz4 . Martinez, CA 94553 Insured : Richard Baugh Claim No. : 164 07 34-01 CS-47 Date/Loss : 3/16/02 Your Reference : Central Contra Costa Transit Authority (John Glen) Your File No. J019373 Dear Sir/Madam: I am the subrogation examiner handling the above-captioned claim. On March 6, 2002, our insured was involved in an accident with Constance Theal on Bishop Drive and Sunset Drive in San Ramon, CA. This loss occurred at approximately 3:50 p.m. Our insured was southbound on Sunset Drive. Your driver, Constance Theal, was Number 960, was also southbound on Sunset Drive. Our insured was positioned in Lane Number 2 when the bus pulled away from the curb, into our insured's lane, striking the right rear of our insured's vehicle. At this time, we would like to present a request for a late claim. We originally SUbmitted our subrogation and claim documentation to John Glen Administrators on Jule 20, 2002. At t€iat time, we received confirmation that they had received our claim, but we have no'. re(eived any notification that an official claim needed to be submitted to Contra Costa County. We have received a second letter from them, stating that they did a search with your office and could not locate an official claim being filed. At this time, we would like to present a late claim, due to the fact that we were not advised or aware that an official government claire needed to be submitted by your agent, John Glen Administrator, notifying us, in writing, that they had received it on June 20, 2002. We feel this was acceptance and a proper filing of the claim. Please review the enclosed documentation and. advise us if we can proceed fulti er. Sic ly, Lla Dorsey-Thomas 21 st Century Insurance Company 1-818-719-5229 Enclosure opesct.at. JUN-14-2002,, 13 00 CCC RISK MP.�RGMENT 925 335 1421 P.02 Claire t .. BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT 3` 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 10Oth day after the accrual of the cause of action'. Claims relating to causes of action for.death or for injury to person or, to oersox�al property or griming amps and which accrue on or after January I, 18384, dust be presented not later than six months after the accrual of the cause cif Wit' Claims relating to any ether cause of action must be presented not later one year after the accrual of the cause of action. {Govt. Code B. Clouts',must be filed with the Clerk of the Board of Supervisors at Its .office in Ro m' I 6, County Administration Building; 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than k¢ 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 ,gainst each public entity. E. ' Fr . See penalty for fraudulent claims, Penal., Code Sec. 72 at the end of this s * ii # seesaseesesaa �tasea �reaase REz Claim By ) Reserved' for Clerk's filing stamp ga zoo a County or conti-4to � or n District) " Lf �inname) "" """.e..._._..�...._. it rt.r mr� it i i.ar�.■ i n �� r+r.�.r The =46x s geed claimant hereby makes claim Inst a County of Ccrrttra Costa or <, the ab6vC-r imed District in the sum sof $ �, �., and in support of this claim arepresents as folks 1. Whirl did the damage or injury occur? (Give exact nate and hour) 2. Where did the damage or injury oomir? (Include city and count } 3.. Row die the damage or injury occur'? {Clive full details; use extra paper if f required} �'�"�,t�C.�J- V1 3°+X- ��Y)'wr�# J. 4. What ticulakr act or omission on the part of county or district officers, serves or.empl,oyess caused. the.injury cr damage' OIX 06/14102O2 12:00925335` 421' _> 21ST CENTURY INS. ,TEL=818 7'1950411 JUN -14-2002 13:00 CCC RISK MANAGMENT 925 335 1421 P.03 3 �t ;arae tyre Haines of county or district officers, servants or employees causing Abe' age or injury'. x ' b. What 1damage or injuries do you claim resulted? {Give full extent of injuries or f 4"e3 claimed. Attach two estimates for auto damage. 7. as the amount claimed above computed? (Include the estimated amount of anyY ros ctive injury or damage.) 8. Named and addresses of witnesses, doctors and hospitals. 9. LtlitIthe expenditures you made on account of this accident or injury: h �iATE ITEM AM 7ZT Gov. Code Sec. "910:2 provide 3: '1 "The claim must be signed by the clairmant SEND': T S TO: ( ttorne ) or by some pqrson cn his. behalf." Name'arid Address of Attorney . < (Claimant's Signature) t; Address Telepranet No. 1Z, `1\` - Telephone No. NOTICE Sectio "? of the Penal. Code provides: t "Every person who, with intent to defraud, presents for allowanceor for : payment th any state board or officer, or to any county, city or district board or t offiOws authorized to allow or pay the same if .genuine, any false or fraudulent c].air4, `b11., account, voucher, or writing, is punishable either by imprisoriment in then jail for a period of rpt more than (me-year, by a tine of not exceeding one arra ($1,000), or by both such iMrisonment and finev or by imprisonment in the tt3 prison, by 8 fine of not exceeding ten thousand dollars «10,000, or by. both's impri,scrnr�errt and tine. TOTAL P.03 92533514211, => 21ST CENTURY INS. ,TEL=818 7195040 06/14'02 12:00 105086 -LAIM ADMINISTRATION 06/17/02 FHMG 1.1 CHECK IMAGE 12:23:12 X 21ST CENTURY INSURANCE COMPANY CONTROL NUMBER CHECK NUMBER 21ST CENTURY CASUALTY COMPANY S 71966 7496874 CLAIM NUMBER DATE OF LOSS INSURED DATE OF ISSUE AP 1.640734-01 03/06/2002 RICHARD BAUGH 03/26/2002 HANDLING CONTROL VENDOR TAX-ID OFFICE DESK CODE IVSD/SHATTUCK AUTO CENTER INC 943146196 SJ 2BF PAYEE: RICHARD .7 BAUGH AND SHATTUCK AUTO CENTER INC AMOUNT ****3.,037.87 PAY: ONE THOUSAND THIRTY SEVEN AND 67/100 FOR: COLLISION F3=EXIT F12=CANCEL ENTER=CHECK STUB 105086 ':LAIM ADMINISTRATION 06/17/02 FHMG 1.1 CHECK IMAGE 12 :23 :17 X 21ST CENTURY INSURANCE COMPANY CONTROL NUMBER CHECK NUMBER 21ST CENTURY CASUALTY COMPANY S 82875 7509390 CLAIM NUMBER DATE OF LOSS INSURER DATE OF ISSUE AP 1640734-01 03/06/2002 RICHARD BAUGH 04/03/2002 HANDLING CONTROL VENDOR TAX-ID OFFICE DESK CODE ENTERPRISE RENT A CAR. 953475810 SJ' 6J'4 PAYEE: ENTERPRISE RENT A CAR. P O BOX 1528 NOVATO CA 94948 AMOUNT ******325.00 PAY: THREE HUNDRED TWENTY FIVE AND 00/1.00 DOLLARS*********************************** FOR: RENTAL REIMBURSEMENT F3=EXIT F12=CANCEL ENTER=CHECK STUB July 22, 2002 ANGELA 0I3,w , _ :;35 TONY MICHAEL OHN GLS AUG 0 -6 . }y JUL 3 0 2002 MUSTERS AND 4 MSTRATOK INC- 21"Century Insurance Company P.O. Box 4430 License No, Woodland Hills,CA 91365 21153421 24 Hour Re: O/Principal: Central.Contra Costa Transit Authority rM Availability Y/Insured: Richard Baugh HOME OFFICE Y/Claim: j.1640734-01 CS 47 D/L: 3/6/02 ALN CREEK File: J 01-9373 1525 Oakland Blvd. Suite 250 alnut Creek,CA 94596 Tel 925-280-9320 To Whom It May Concern: Fax 925-280-5532 mall jgaa/7a,pacbetl.net I am in receipt of your subrogation demand of June 20, 2002 for a total of$589.68. However, I require a non-injury statement from your insured. The statement can be BRANCH OFFICES taken in person, over the phone or in writing. Without this statement,I cannot proceed 2.os ANGELES on your subrogation demand. 17216 Saticoy Street Shite 372 Please advise at your earliest possible convenience. Van Nuys,CA 91406 Tel 818-779-0116 Very truly yours, Fax 800-990-2358 TUS'TIN John Glenn Adjusters 275 Centennial Way And Administrators;Inc. Suite 211 Tustin,CA 92780 Tel 714-508-0300 Fax 714-508-0393 _Robert P. Haugltt SAN JOSE if 50 North First Street Claims Adjuster Suite 219 San lose,CA 951 12 RPH/rg Tel 408-297-0747 Fax 408-297-1116 + t� SAN RAFAEL is`1 � 3100 Kerner Boulevard„ Suite E ,W San Rafael,CA 94901 f"`7 Tel 415-499-9321 r3 � Fax 800-990-2358 ^:3 co .r7 NATIOAtal hY tMD$UREPFN6EN.NL � a [ ADIJ5TER51 1i Y Am - 1515 Oakland Blvd.,Suite 250 •Walnut Creek,California 94596 October 16, 2002 TONY MICHAEL 10 LENN 0JUSURS AND OCT 2 5 2002 [MRWORS,INC. 21st Century Insurance P.O. Box 4430 A License No. Woodland Hills,CA 91365 WAVCuk Z13 3421 L Atte: Angela Thomas J 24 Hour Availability 40ME OFFICE Ile: Principal: Central Contra Costa Transit Authority D/L: 3/16/02 ALNUT CREEK Your Insured: Richard Baugh Isis Oakland Blvd. Your Claim: 1640734-01 Suite 250 Our File: J 01-9373 alnut Creek.CA 94596 Tel 925-280-9320 Fax 925-280-5531 mall jgaa(aDpacbell.net Dear Ms.Thomas BRANCH OFFICES This letter is in reference to your subrogation demand. LOS ANGELES Please be advised that I have contacted m principal d the cannot find on file an 17216 Saticoy Street y p an �' y Shite.372 verified claim presented by you. If you have in fact presented a claim to the District van Nuys,CA 91406 please send me a copy of the rejection letter at your earliest possible convenience. Tel 818-779-0116 Fax 800-990-2358 Thank you for your anticipated cooperation. TUSTIN 275 Centennial Wray Very truly yours, Suite 211 _4 Tustin,CA 92780 Tel 714-508-03300 John Glenn Adjusters Fax 714-508-0393 + And Administrators,Inc. SAN JOSE c. 1150 North First Street it Suite 219 San Jose,CA 951!2 Robert P. Ha tight -0 i 1 Tel 408-297-0747 Claims Adjuster ' lax 408-297-1116 SAN RAFAEL R.PHlrg 3100 Kerner Boulevard Suite E San Rafael,CA 94901 Tel 415-499-9321 Fax 800-990-3358 *� s N$UNANA� 1515 Oakland Blvd.,Suite 250 •Walnut Creek,California 94596 TONY MICHAEL - � g JUL 0 2 2002 a cn U , 2t 110 �igi + Lu > �C� USC, Ln Am Ile 0- LIQ Z LU tt « v1 � U �C e� +�'6. '^*. � �. �., he •U CS> CJ!Y 9 W Lit +.. C1 u < CI Q • 47 S' di t3 •..� will'' Lry C... QLu � r- JUL 0 2 2002 Supplement Screen Page 1 of 7 Supplement Data This data is current as of 06-17-2002 12:24:10 refresh ; Pant 3/25/2002 AT 11:12 AM JOB NUMBER: 6512 26486 SHATTUCK AUTO COLLISION CENTER 3207 SHATTUCK AVE 6618 SHATTUCK AVE, OAKLAND BERKELEY, CA 94705 (510) 848-6281 FAX: (510) 848-7286 SUPPLEMENT OF RECORD 1 WITH SUMMARY WRITTEN BY: JARED ANDERSON # 03/26/2002 11:12 AM ADJUSTER: DRP UNIT # INSURED: RICHARD BAUGH CLAIM #2070072 OWNER: RICHARD BAUGH POLICY #AP 1640734 ADDRESS: 1600 LAKESHORE DR #207 DEDUCTIBLE: 200.00 OAKLAND, CA 94606 DATE OF LOSS: 03/06/2002 AT 03 :50 PM DAY: (510)625-1284 TYPE OF LOSS: COLLISION POINT OF IMPACT: 5. RIGHT REAR INSPECT LOCATION: INSURANCE 21ST CENTURY INSURANCE COMPANY BUSINESS: (818) 715-6174 COMPANY: 6301 OWENMOUTH AVE DAYS TO REPAIR WOODLAND HILLS, CA 91367 1999 BUIC LESABRE CUSTOM 6-3 .8L-FI 4D SED BLUE INT: VIN: 1G4HP52KOXH410122 LIC: 4FDR580 CA PROD DATE: ODOMETER: 25242 AIR CONDITIONING REAR DEFOGGER TILT WHEEL CRUISE CONTROL INTERMITTENT WIPERS BODY SIDE MOLDINGS DUAL MIRRORS CLEAR COAT PAINT POWER STEERING POWER BRAKES POWER WINDOWS POWER LOCKS ANTI-LOCK BRAKES (4) DRIVER AIRBAG PASSENGER AIRBAG CLOTH SEATS SPLIT BENCH SEATS AUTOMATIC TRANSMISSION ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1 QUARTER PANEL 2* RPR RT QUARTER PANEL 7.0* 2.2 3 ADD FOR CLEAR COAT 0.9 4 R&I RT UPPER TRIM PANEL BLUE 0.3 5 REPL RT WHEEL OPNG MLDG 1 54 .60 0.3 6 REAR LAMPS 7 R&I RT TAIL LAMP ASSY 0.3 8 REAR BUMPER 9 R&I R&I BUMPER ASSY 1.0 10 WHEELS i http://dilprod.20theentins.com/pages/supplement.cfm?comparekey=2070072 06/17/2002 Supplement Screen Page 2 of 7 03/26/2002 AT 11:12 AM JOB NUMBER: 6512 26486 SUPPLEMENT OF RECORD 1 WITH SUMMARY 1999 BUIC LESABRE CUSTOM 6-3.8L-FI 4D SED BLUE INT; ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT" ------------------------------------------------------------------------------- 11 REPL RT/REAR CENTER CAP ALLOY 1 28.40 WHEEL 15X6 WHEEL 12 .REAR DOOR 13 BLND RT OUTER PANEL 1.1 14 R&I RT BELT MOLDING 0.3 15 R&I RT SIDE MOLDING 0.4 16 R&I RT HANDLE, OUTSIDE 0.5 17 R&I R&I TRIM PANEL 0.5 18# S01 SUBL FOUR WHEEL ALIGNMENT 1 50.00 X 19 ROOF 20* R&I RT MOLDING 0.5* 21# REPL CAR COVER 1 7.50 T 0.5 22# SUBL HAZARDOUS WASTE 1 5.00 X 23# REFN COLOR MATCH 0.5 24# S01 SUBL PINSTRIPE 1 50.00 X 25# S01 FINAL ESTIMATE GIVEN TO 1 CUSTOMER ------------------------.._-----------------------------..__---_-------.--------_- SUBTOTALS ==5 195.50 11.6 4.7 PARTS 83.00 BODY LABOR 11.6 HRS @$ 56.00/HR 649.60 PAINT LABOR 4.7 HRS @$ 56.00/FIR 263 .20 PAINT SUPPLIES 4 .7 HRS C $ 24.00/FIR 112.80 SUBLET/MISC. 112.50 -_--„----------------------------------------------- SUBTOTAL $ 1221.10 SALES TAX $ 203.30 @ 8.25005 16.77 ------------------------------------____---_------_- GRAND TOTAL $ 1237.87 ADJUSTMENTS: DEDUCTIBLE 200.00 ---------------------------------------------------- CUSTOMER PAY $ 200.00 INSURANCE PAY $ 1037.87 2 http://dilprod.20thcentins.com/pages/supplement.ef n?comparekey--2070072 06/17/2002 Supplement Screen Page 3 of 7 03/26/2002 AT 11:12 AM JOB NUMBER. 6512 26486 SUPPLEMENT OF RECORD I WITH SUMMARY 1999 BUIC LESABRE CUSTOM 6-3.8L-FI 4D SED BLUE INT: SHATTUCK AUTO COLLISION CENTER WARRANTS ITS WORKMANSHIP ON VEHICLE REPAIRS FOR AS LONG AS CUSTOMER OWNS VEHICLE. EPA# CAD983642786 BAR# AC068066 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 ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP.-OPERATION NO.-LINE NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL REPL-QUALITY REPLACEMENT PART RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RICHT SECT=SECTION SUBL=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 DRIAA97 DATABASE DATE 11/2001 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. NODI-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 RECORE. 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. 3 http://dilprod.20thcentins.co /pages/supple ent.cf n?comparekey=2070072 06/17/2002 Supplement Screen _. _ Page 4 of 7 03/26/2002 AT 11:12 AM JOB NUMBER: 5512 26486 SUPPLEMENT OF RECORD 1 WITH SUMMARY 1999 BUIL LESABRE CUSTOM 6-3.8L-FI 45-7, SED BLUE INT: ----------------------------------------------_--_------------------------------ NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ---------------------------------------------_---------_-----_-----------_----_ ------- CHANGED ITEMS------- 19# SUBL FOUR WHEEL ALIGNMENT 1 -79.95 X 18# S01 SUBL FOUR WHEEL ALIGNMENT 1 50.00 X ------- DELETED ITEMS------- 10# REPL PINSTRIPE, TAPE 1 -7.50 T -0.3 ------- ADDED ITEMS -------- 24# S01 SUBL PINSTRIPE 1 50.00 X 25# S01 FINAL ESTIMATE GIVEN TO CUSTOM 1 -------_-------------------------------------------------------------------------- SUBTOTALS =-> 12.55 -0.3 0.0 PARTS 0.00 BODY LABOR -0.3 HRS Q$ 56.00/HR -16.80 SUBLET/MISC. 12.55 ----------------------------------------------------- SUBTOTAL $ --4.25 SALES TAX $ -7.50 @ 8.2500% -0.62 ---------------------------------------------------- TOTAL SUPPLEMENT AMOUNT $ -4.87 NET COST OF SUPPLEMENT $ -4.87 ES'T'IMATE 1242.74 JARED ANDERSON SUPPLEMENT Si -4.87 JARED ANDERSON -------- CUSTOMER PAY $ 200.00 ;TOB TOTAL $ 1237.87 INSURANCE PAY $ 1037.87 SHATTUCK AUTO COLLISION CENTER WARRANTS ITS WORKMANSHIP ON VEHICLE REPAIRS FOR AS LONG AS CUSTOMER OWNS VEHICLE. EPA# CAD983642786 .BAR# AC068066 4 http://dilprod.20theentins.com/pages/supplement.cfm?comparekey-2070072 06/17/2002 P K , 220021 1 42Piv1 L&S REPORT SERVICE 60227016! N" 6702 P , 20 r1 Jp CALWOMWA !c +Cts LISION REPORT• Property 0- .age Only odowtoearrorrcasrOwto +w+wc r«rl 4 cofoA Y9M8 W&oww C7YY iLitfClAL ikffMfCT: NUYffM '�•- b YyN wrTY ru nlsTMrcT MEATAII►Y+RTSMIOOmeLx OOHSOCOIMIMSI[DdN "v V A Taw(Dow I. d C, C e#rr9G `(j JI' "F dfffMII>iC'T>aN WITH '} }R' DAY O wifK TO�sM AWAY sTATf If00WAY M AM ►etrTrMxtlf D► S M T T F mases MAD [Amfn am Y owvSPrsuewu*&ow"m !SAYS CLAss sA►STY SOUP* sNAYf RITC" Ca IMAYAOSD `�.✓ ;x K{}1MfM.rpotf"LAST M ► MMMIrfM �' i TMftTAtlDMisf CITYifTATSinr Z)Q, y# sex aRTMOAn CAM " �lGY 1ANf� 5 2a ftl!`"t' 4>I WDM._ Rk ON O6 i94MAYz+ S►ttU LYT. 7 1- Ei \ l M HMC YR MAA#QE E 1d06tL/CW 4x q U001"MAA MATS YSMt TYof PARTY 1 ty Yd:HTf Nt#MSfx (TATS "A"sA►tM'i IOM,p. slu" OAdiADfit S^"' dM NA"(v"wT.w0"JL LAST) ►"CNE H IAIN" A $� t �ADbxfts a"I STATS M L► 'C. 1rfi+• J to sexs�Yi t1 MAPICS CAvisso poucy"w"m rt U a �T f. u TMMAvfL DN qtf *:ws�T C7 swffnur r :xJU leftwlKitNODfi Mowsue mer +II+IIf4M A v"YY► PARTY L s.7R c5A6 CA.. 'K, p 2 I M�O y L-kAw ►AR"NO. At dfM[ MOM" pm"I moss; ►ARTY NO. DP. AMaM runty nAw�ssD rMD►fMMri 'HER PRIMARY COLLISION FACTOR TRAFFIC CONTROL DEVICES 1121 TYPE OF VEHICLE 112 MOVEMENT PRECEDING QST NUMBER(N)OF PARTY AT FAULT COLLRRON AVC SECTION mLATE0: ACONTROLS FUNCMNtHQ A PASSENGER CAR 7 STATION WAGON STOPPED { J^• .k o-' CU C, CONTROLS NOT FUNCTIONING 18 PASSENGER CAR W I TRAILER PROCEEptW STRAIGHT OTHER IMPROPER DRIVING` CONTROLS OBSCURED C MOTORCYCLE I SCOOTER RAN OFF ROAD (}NO CONTROLS PRESENT I FACTOR D PICKUP OR PANEL TRUCK D MAKING RIGHT TURN C OTHER THAN DRIVER' TYPE OF COLLISION PICKUP I PANE[TRUCK W I TRAILER �MAIONCI LEFT TURN UNKNOWN' NEAR•oN TRUCK OR TRUCK TRACTOR MAKING U TURN FEU ASLEEP' StDESvnr TRUCKITRUCK TRACTOR W 1TRLR AACKINLi REAR t�ND SCHOOL BUB SLOWING t STOPPING W T MARK I 2I S k BROAD'EIDE OTHER SUB PASSING OTHER VEHICLE CLEAR E HIT OBJECT EMERGENCY VEHICLE �j CHANGING LANE! CLOUDY OVERTURNED K HIGHWAY CONST.EOUIPMENT PARKING WHOM C RAINIOG VEHICLE I PEDESTRIAN MICYCLE_ tNTERING TRAF"c SNOWIHk3 H OTHER•: OTHER VEHICLE OTHER UNSAFE TURNING FOG t VISIBILITY FT. MO OR VEHICLE INVOLVED WL PEDESTRIAN )UNG WTO OPPOSING LANE I~OTHER: 'A ooN•COLLISION MOPED pARKED w,"o PEDESTRIAN MERGING LIGHTING G C OTHER MOTOR VEHICLE , OTHER ASSOCIATED FACTOR(3) TPAVELING W14ONG WAY A DAYLIGHT MOTOR VEHICLE ON OTHER HIGHWAY (MARK i TO ITEMS) OTHER` DUSK-DAWN PARKED MOTOR YEMICLE AVC SOECTION VIOLATION DARK-STREET LIGHTS TRAIN OARK-NO STREET LIGHTS BICYCLC ON LA DARK-STREET UGHTS NOT ANIMAL: SOBRIETY-DRUG FUNCTIONING 1 PHYSICAL ROADWAY SURFACE FIXEI)OBJE (MARKS To 2 HTm) DRY A HAD NOT BEEN DRINKING WET ISD-tIHDER INFLUENCE SNOWY•ICY OTH OBJECT: VISION OHISCUREMENT: fir`NBD•NOT UNDER INFLUENCE 0 SLIPPERY(MUDDY,OILY,ETC.) F INATTENTION' NSD.IMPAIRMENT UNKNOWN" ROADWAY CONDITIC"S) PEDESTRIANS ACTION STOP A SIO TRAFFIC E UNDER DRUG INFLUEMGE' (MARK t TO 2ITEIaS) NO PEDESTRIAN INVOLVED H ENTERING!LEAVING RAMP F IMPAIRMENT-PHYSICAL" 4 PREVIOUS COLLISION Ht9L£S,DEEP RUTS' CROR�Iti IH CROBSWAI.M( �IMPAIRMENT HOT KNOWN LOOSE MATERIAL ON ROADWAY° AT INTERSECTION r{ UNFAMILIAR WITH ROAD NOT APPLICABLE OBSTRUCTION ON ROADWAY' 5CROSWHIG IN CROSSWALK-NOT DEFECTIVE YEH.EQUIP.: if SLEEPY t FATIGUED {)CONSTRUCTION-REPAIR ZONE AT INTERSECTION SPECIAL INFORMATION REDUCED ROADWAY WIDTH DCROSSINO.NOT IN CROSSWALK L UMNVOLYED VENCCLE A HAZARDOUS MATERIAL. � FLOODED- E IN ROAD.INCLUDES SHOULDER OTHER•: F OTHER'; F NOT IN ROAD NON@ APPARENT HO UtifS5LIAL CONDITIONS C;APPROACHING I LEAVING SCHOOL BUS 0 RUNAWAY VEHICLE R dSd-03 t RE Y##-dH)LSP►W 2 89 8C3 t E r��r 23 . 2001- 1 :43PW;, L&S REPORT SERV`CE 60227'; 0 16 1 ,� «.,.x No•5792 ..,.P . 3/10 �.�+ 07. { +} ro%AZ•Ci �. DAY a�C3 �',f, tiwi lF+a tir- `� Ss tam t� G7 '9Cs , e. r' ARf[M'f MAN.t t.+d�.l.0 MiiCN Mi. Ow! YR. I*Cvluwtw eti M ■ MO. AAY VA.� R '1 4 i 4 REPORT SERVICE � Apr . 23. 2002 1 :43PM L&u REPOR SER ICE P�o.6r °2 P. 4l10 or GALWORNIA RRATIVE/SUPPL.EMENTAL g58(Flev 1-9t),OPI t)42 Page OF triCIDEN UUW.;URRENCE TIME M400) NCIC NUMBER fMIERIAN €R N€ 'X'ONE TYPE SUPPLEMENTAL r"X-AFPLCMLE} Narrative ' Collision report C]SA update D Fatal Hit and run update Supplemental Other: Hazardous materials �School bus Q Other: lGWNTY/JUDICIAL OfST€iICT R€PORTWG DISTAMSEAT CITATION NUMBER ATtONtSUBJECT STATE HIGHWAY BELATED Yes ®No t 3. t t. 3. B. 9. G. i t ' 3. 4. :7, '9. 10. ,Af;PARER`S NAME AND I.7.NUMBER I DATE REVIEWS ' Use previous editions until depleted. sc srao, Print Selected f ages Page I of 8 } i. F a^' I 3� �i i Av" , Claim Number: ,2070072 Vehicle Year: 1999 Policy Number: 11640734 Vehicle Make: JIBUIC Date of Loss: 1103-06-2002 {Vehicle Madel: LESABRE CUSTOM Insured: IFBA UGH RICHARD i Vin: 111G4HP52KOXH410122 ;) ,Date Inspected: 03-19-2002 Vehicle Color: IIBLUE I� LEstimator: JAREI3 ANDERSON Vehicle License:;?4FDR580 CA II ;Request Number: 112070072 � —lbeliver to: Alvarez Elaine ;Print Date: 1106-1 0�02 http://dilprod.20theentins.comipages/locaiprint.cfrn?tile=20 i 0072-TOOO.�pg_20700�2-TO(... 06/11 7/%002 Print Selected Images Page 2 of$ m 4 i r 1 4 � x say, 1� Claim Number: '2070072 'Vehicle Year: 1999 ;MPolicy Number: 1640734 l Vehicle l ake: 1BUIC !� ;Date of Lass: CO3-06-2002 ��,Vehicle Model: 1 LESABRE CUS`T+tJiYi 'Insured: tBAL`GH RICHA 1 Vin: iG4HP 2 OK1 410122 I Date Inspected: 103-19-2402 Vehicle Color BLUE yEstimator: j 3ARED ANDERSON (Vehicle License: 4FllR580 CA iDeliver t©: Alvarez Elaine Request Number: 2070072 Print Date: i 06-17-2442 7 -TQC.. Obi 17/200? f,ttn: '/d iiprod.20thcentins.corn/gages/locaiDn'nt.cf:n?�iie=2070072-TOOO.JPg_2 700 Print Selected Images Wage 3 of R { a 1 i n f ' c Claim Number, 2070072 - �- Vehicle Year: 111999 Policy Number 16I0734 ,Vehicle Vial IBUIC 11D of Loss: H03-06-2002 Vehicle Model: 1 LESABRE CUSTOM Ilrsured: 'BAt;GH RICHARD i Vin: i 1G4#HMKOXH410122 ; Date Inspected: ;03-19-2002 Vehicle Color:��BLUE IEstir ator: ,TARED ANDER C3IV Vehicle License: 4EI112580 CA ] Request i�iumber:^2070072 _. Deliver to: ;Aivarez Elaine Print Date: 06-17-2002 bttp:/,'dilprod??theentins.com/pages`/local print.cfrn?file=2C 7/0072-10001jpg_2070072-3"0C... 06/17/2002 Print Selected Images Page { of $' A I rF i ay ,x 1 � I �r �t it I i if f 1Claim Number: 2070072 ��Vehicle Year: 1999 s 1Policy Number: '11640734 Vehicle Make: BUIC Date of Loss: 103-06-2002 ;Vehicle Model: 11LESABRE CUSTOM Insured: BAIJGH RICHARD ;Viu: � j1 G�2i{OH410122 [Date Inspected: 103-19-2002 i Vehicle Color: "BLUE i ?IEstimator: JARED ANDERSON ,Vehicle License:;4FDR580 CA Request Number: 12070072 Deliver io: �(Alvarez Elaine Print gate: 06-17-20102 j I rittp:,'!dilprod.24thcentins.corn/pagesllocaiprint.c m?fil,=2470472-'rOOO.�pg_2474472-SGC.., 06/17/200-7 Print Selected Images Page 6 of 8 i �r izc a x fY Y b }V $ h �r }� d � ` P� Claim Number: 2070072 i Vehicle Year: 1999 1,Policy Numb er: ; 1640734 {Vehicle Make: BUIL Date of Loss: 03-06-2002 Vehicle Model: LESA 3RE CUSTOM Insured: (BAUGH RICHARDi Vin: 1G4HP52KOXH410122 !Date Inspected: ?03-19-2002 'Vehicle Color: BLUE EEtimator: - - OARED ANDERSON (Vehicle License:!�4FI7R580 CA l Rei quest Number: 2070072 Deliver to: (Alvarez Elaine !:Print Date:: 06-17-2002 7ttp:/idilproti.20tlicentins.com/pagesllocalprint.cf:n?rte=2070072--'OOO.;pg_2070072-i OC... 06/i7/2001 Print Selected images Page 7 of 8 t rx t tl I ; f Yl ti i Claim Number: 12070072 ~� ;Vehicle Year:�1999 ;,Policy ltiuher: 34 �Vehicle i�a�e: BUIC Date of Loss: 03-06-2002 Vehicle l�iodel: 11LESABRE CUSTOM - -� i (Insured: ?BAi.3GH RICHARD � n; 11G4HP52KOYII4�0122 ;y ,jDate Inspected 0 -19-2002 #Vehicle Color: IiBLUE - - , wstimator; ��` I) *1DERSC31'r ;Vehicle License 4FIl�R BQ CA s Request Number: j 20''0072 'deliver to: Alvarez Elaine 1 Print Date: 106-17-2002 nttp:/r`aitprod. 0thcontips.cor-�lpagesflvcaltirint.cf,-r'?Fi:e-2-0700?'-TOOO.;Ppa 2 070C-72-O(.- 06!1;112002 tri Enterp Rental AL :rnent 0732333 - 2305 3001 SHATTUCK AVE ascription Rate Amount �ir�N�rwi BERKELEY CA 54705-1820 13 GAYS @ 25.00 325.00( 30 Sr SALES TAX% 3.25 26.81 Bill To: r�Q , 1 Y anaaoae.00aatJaooOar,,.:aa�rvFsau �("�� �I 13 ''" rrrwrnrr 21ST CENTURY-SAN JOSE ATTN: BRYANT*BRAD X4611* MARC ARGUELLES 1732 NORTH IST STREET.STE 350 SAN JOSE CA 55112 cc A2 INFORMATION1 Date Out Date In 3/13/02 3/25/02 Renter Home Phone RICHARD BAUGH 510-426-0950 Address Office phone 757 54TH ST c i City State Zip i OAKLAND CA 94609 Driver License State Expires 91565927 CA 4/12/04 OO$ 4/12/29 s Additional Driver ;TOTAL CHARGES 351 -81 Mame ESS AMOUNT RECEIVED 26.61 NO OTHER DRIVER PERMITTED .{ Age Driver license State Expires AMOUNT OUE. . . . . . . . . . . . . . 10110� 325.06 RENTAL VEHICLES CLAW iNFORNIATION Color License No. Claim #/Policy #/P.O. # ,,, WHITE 4STP751 1640734-01 Billing inquiries Call Fed Tax ID # OWN Model Unit # Insured 510-841-8300 36-3041733 ; 02 CENT XG3317 RICHARD BAUGH Billing Information --~ Date of Loss Type of loss $25.00/DAY NO SALES TAX INSURED Type of Car Repair Shop LESABRE SHAT TUCK AUT Thank You For Choosing Enterprise VISIT US AT OUR WES SITE WWW.ENTERPRISE.COM L i i i i ■ ■ i i ■ • ■ i.'�i i i i i i i i i i ■ i i i ■ ■ i Please Return This Portion with Remittance AMOUNT ME. ... . . . . . . . . . . . 11111► 325.00 Remit to: ENTERPRISE RENT A CAR Paid by: ATTN: ACCTS RECEIVABLE 21ST CENTURY--SAN JOSE P.O. BOX 1528 ATTN. BRYANT»BRAD X4611* NOVATO CA 94948-3147 1732 NORTH IST STREET.STE 350 SAN JOSE CA 95112 Customer# Rental A regiment Amount GPBR 03/26 TWE23SJ 0732333 325.00 2305