Loading...
HomeMy WebLinkAboutMINUTES - 10282003 - C25 CLAIM 4' ►� BOARD_OF SUPERVISORS OF CONTRA COSTA COUNTY OBER 28, 2003 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 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: $250,000-00 CLAIMANT: I-A TANYA WILSON ATTORNEY: RICHARD G. BATES, JR. DATE RECEIVED: SEPTEMBER 22, 2003 ADDRESS: THE LAW OFFICES OF RICHARD G. BA'I'ESgYJbELIVERY TO CLERK ON: SEPTECER 22, 2003 1430 WILLOW PASS ROAD, STE. 160 - -- CONCORD, CA 94520 By MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of above-noted claim. JOHN SWE T lark Dated: SEPTEMBER 22, 2003 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Sup isors j This claim complies substantially with Sections 910 and X910.2. �{ 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: = B _- 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). VIV. OARD ORDER: By unanimous vote of the Supervisors present: {y 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: t N SWEETEN, CLERK, By , Deputy Clerk WARNING (Gov. code section-11 3) Subject to certain exceptions, you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18, and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above, Dated: CY OHN SWEETEN, CLERK By Deputy Clerk P11- Claim to: BOARD OF SUPERVISORS OF COQ COSTA COL%7f INSTRUCTIONS TO CLAIM.PM A. Claims relating to causes of action for death or for injury to person -. sonal property or growing crops and Mich accrue on or before December 31 must be presented not later than the 100th day after the accrual of the cause 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 rause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed With the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. ' Fraud. See penalty for fraudulent claims, Penal. Cade Sec. 72 at the end of this form. RE: Claim By } Reserved for Clerk's filing stamp } LA Tanya WJ 1 so t �# } Against the County of Contra Costaor } S .District} The undersigned clai=nt hereby makes claim against the County of Contra Costa or the above—rued District in the sum of $ 250,000.00 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) .March 26, 2,003 1.718 hours : 18 ,,... .... ,_._ ,_.. .. .... _........._..._._.....»��.._____ 2. Were did the damage or injury occur? (Include city and county) Antioch Public Libra 508 W. 1 8th t �" ..w. .......w_..._.._.......»�......�....,. 3. Boer did the damage or injury occur? (Give full details; use extra paper if required) See Attachment 4. What particular act or omission on the part of county or district officers, servants or.employees caused. the injury or e? See Attachment (over) What are the names of county or district officers, servants or employees causing the damage or injury? Unknown to Claimant. 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. See Atachment. _ 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) See Attachment. 8.� Names and addresses of witnesses, doctors and hospitals. Kaiser Permenante, Antioch. 9. List--the------------ youmadeon account of this accident or injury: DA'I'S ITEM AMUJNT As of this date undetermined. Gov. Cod 10:2 provides: "The maimbe s' ed by claimant SEND NOTICES 'Ta: (Attorne ) ory some rso ,gin,h •" Name and Address of Attorney Richard G. Bates; Jr. (SBN1 44835) _r lajmant's Signat, The LAW Offices of Richard G. Bat t5'Jr. 1434 Willow Pass Rd Ste. 160 Concord, CA 94520 ZA&iress5 925-798-8055 . Telephone Na. Telephone No. N O T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if .genuine, any false or fraudulent claim, bila., 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 ($10,0000 or by both such imprisonment and fine. ......... _ ......... ......... Attachment to Claim Against Contra Costa County of La Tanya Wilson 3. La Tanya Wilson was assaulted by a transient, John Jones at the Antioch Public Library, the assault resulted in physical injuries to Mrs. Wilson. See attached police report. 4. The individual responsible for the assault was in the Antioch library premises for some time before the assault, disturbing the peace of the library and acting in a threatening manor to the occupants of the library. The staff of the Library was negligent by failing to contact the police when it became clear and obvious that Mr. Jones was a present and immediate Cheat to the patrons of the library. 6. Physical injury to the face head and broken fingers on her right hand requiring medical treatment for injuries at Kaiser Permanente Hospital and physical therapy. The full extent and nature of Mrs. Wilson's physical injuries have not been determined at this time. In addition, Mrs. Wilson suffered serious and substantial emotional trauma and distress as a direct and proximate result of the afore mention assault. 7. The claim amount represents general damages for pain and suffering and emotional distress. Special damages for medical bills have as of yet not been determined. _: _ _Y % _ a CASE NO. 330 `L' Street AntioC , CA 94509 - CODE SECTION: ' CLASSIFICATION: �` ❑ MISD DATE OCCURRED: TIME OCCURRED' ❑ INFRAC CJ *2,& -,0.3 �t INFO ONLY DATE REPORTED : TIME REPORTED: / , DOMESTIC VIOL: C] YES NO HOW REPORTED: ] ON VIEW (5) ISPATCHED (2) ❑ OTHER:_ LOCATION OCCURRED: j r + BEAT: f D#3i'OSITlC7 Or DULT L+� AF'C7 -ODE: � �, BCS CODE: / ADULT ❑ ,�Uv OW Rs € is Ay fry`< t �4E 09 tvcpr tR rare MODLE RACE SEX L}O8 NAME: ..,\- LA � FIRST 'f— B -76 NUMBER 5 STR APT ADDRESS: . RET7 CITY: � STATE: 44 H PHONE: (IW-- WORK PHONE: HT: 40 Wl. H afg., I E , MARKS,SCARS,TATOOS: S.S. .4%51D.L. ► i i AKA'S ,�r CHARGES CITED 0 E T� �/,, � # BOOKED NAME: LjSLFAST ./�"' MIDDLE RAc sEx w v -Y le NUMBERS STREET TYPE AP TATE: VA- ADDRESS: CITY: S H PHONE: WORK PHONE: ( ) HTH !!jy��d MARKS,SCARS,TATOOS: Tss --Cr-7- Pr. D L: I -Z-71 AKA'S CHARGES CITED 0 BOOKED ❑ VE#fICLE Ctt � ro / SiJS DtUti yUiT I F 1 RJt I tRIVEft �3(SPQ F�T€7 iMi'G DARK f STCR..! MARE VEH tC LQ N }. ST: LIC: COL t iCOL 2 YR: MAKE: j RIO C3 MODEL: BODY: DRIVER: C7 j ADDRESS: CITY: STATE: I hereby arrest the above named individual(s) for and request the po#ice take him/her into custody. I will appear as directed to sign a complaint. SIGNED: NAME (Printed) SYNOD: r { i ORIGREPT CJ SUPP REPT ill F'F,OP SN I ATTACH REPT. TIM : t BOOKING SHEET ATTACH. '7 DOMV PAMPHLET DESIRES PROSECUTION MIN, DA PROCEDURE f] (V)VIOLENT CRI E CARD OFF. NAME/NO. DATE 1C.+' lh TIME: I HRS. - 1;-,� ROUTE TOO DET Ca SUSPENDED t' CLOSED UNFOUNDED OTHER REV. BY: Page One of Pages ANTIOCH POLICE DEPARTMENT PROPERTY RECEIPT GIVEN: PROPERTY SHEET C! IN PERSON CASE NO:�4 LOCATIC,U: DATE: f3 OFFICER/ GCXL3.S btc lin ecc re €r fi t t l e t c►� tl C s' S_ef�k ping ...., V. {,�.': �; .V9��IZ��:' � 7w- "•'�knV3i� F n���in� {'f`'7 .;h xz :% :s. r G r CODE ARTICLE BRAND/MAKE SERIAL # MODEL # DESCRIPTION VALUE t t CODE MAKE Mt)DI:L CAT. SERIAL # TYPE CALIBER DESCRIPTION VALUE Cate4ory Cade !yR#Code A Automatic M Machine A - Cannon B Bolt Action N Launcher B - Submachine Gun C - Carbine O - Over & Under C - Rifle/Shotgun Combination D Derringer P Pump Action t3; - Grenade E - Double Barrel (Side by Side) Q Antique F Flare Gun R - Revolver ; i � I M - (Machine Gun G - Gas or Air S - Single Slh , , f s O - Mortar H - flintlock T - FieooiflaSa' ;' P Pistol 1 - Semi-Automatic U Percussion R Rifle J - Jet Propulsion W - Three Barrels 5 Shotgun K - Blank Pistol X - Fodr or More Hargeh T Tear Gas (Gun) L - Lever Action V Silencer Z All Others Officer's Received From: Signature: WRITE-FILE YELLOW-INVESTIGATION PINK-RECEIPT IF APPLICABLE GOLD-EVIDENCE Page� ages OFFICER J. T0,, NjVIDF5#.3346 C"A..EO3-30147 Raq-1: of On listed date/time, I responded to the Antioch library located at 508 W. I ' St for a reported assault, just occurred. I arrived and contacted Vic-La Tanya Wilson, who stated that a WMA wearing dark clothes with long, dark shaggy hair and a beard just punched her in the head and threw her into a bookshelf. The subject was seen walking SIB on the G St overpass, prior to my arrival. I left and locateda subject matching her description at the intersection of G St at W. Madill St. I contacted him and identified myself. I recognized the subject as John Jones through prior contacts. I asked Jones if he had been involved in an altercation at the library and he stated, „Whatever they said happened, happened..." I asked him who "They" were and Jones no longer would answer my.questions. Assisting Ofcr Kollo brought Wilson over for an in--field show-up. Wilson positively identified Jones from his person as well as his clothing. Jones was transported to APD. I transported Wilson to her residence. I took digital photos of her injuries. She had bruising on the left side of her face., slight blood draw around her chin, and she was unable to move the outer 3 fingers of her right hand. Wilson stated the following in summary to me; She was at the library using a computer. Jones sat down at the terminal next to her and tried to use it. The librarian came and told- Jones that the terminal"was reserved for someone else. Jones did not move from the computer. He got upset and reached underneath the table, unplugging the cords. She asked Jones to please leave her terminal cord alone. He stated to her, "Don't say anything to me Bitch..." as he turned towards her. She got up to get out of his way. Jones grabbed her throat area and threw her into the bookshelf w , behind her. She put her hands up to protect herselfbut Jonas able to punch her hard twice on the left side b her" teac extremely hard. Jones let her go and ran off towards the exit ,, nocking the computers down and books off of the shelf as he left. He`exited and went W/B on W. 191" St. She has never seen him before and does not know who CIFICER T. .TLA/UNZ�E`.S#3346 CA5A`03-3047 he is. Sometime during the assault she hurt her right hand, but she is unsure of how. Wilson's injuries were consistent with her statement. She signed a medical release waiver (enclosed) and stated that she was going to have her hand checked. She is willing to cooperate with prosecution. I returned to APD to obtain a statement from Janes. I attempted to Mirandize him and he became enraged again, pacing in the jail. We refused to speak or answer me. I did not attempt further questions, Jones was transported to MDF for PC245. I did nothing further regarding this investigation. , .' ,a 2„s OFFICER K. K©LLO ;#2990 ***SUPPL:i=>fENTAL*** CAST' 03-3047 Pace I On listed date/time, I assisted Ofcr Joannides with an in-field show-up of a subject (Jones) he had detained at the corner of G St at W. Madill St. While enroute, I advised Vic La Tanya Wilson of the In-Field Admonishrr3ent, in which, she stated she understood. Wilson described the subject to be wearing dark blue top and have long hair. I arrived and Wilson immediately identified Jones as the responsible. She also described his clothing having red print on the back of his sweatshirt. As Jones was taken into custody and was walking to the patrol vehicle, Milson also recognized him from the back print of his sweatshirt and was positive he was the responsible. I released Wilson to Ofcr Joannides to be transported home. I did nothing further regarding this investigation. K. Kollo #229 , 03-27-03/03 hrs 11 : .s MARK A. MOCZULSK; Police Department Chien of Police 3OG L Strut, Antioch, CA 9450^ 11 Co � (925) 779-6900 C�LIFOR`i�P CASE NO. • � � � � EXPLANATION This authorization for use car disclosure of medical information is being recauested of you to comply with the terms of the Confidentiality of Medical Information pct of 1981, Section 55, et seg. , California Civil Code. B.' AUTHORIZATION I, hereby, authorize 1�ATS C,- _DL a _Fysn a-N As,77Vc (Name of Facility) (Address) to furnish to the ANTIOCH POLICB DEPARTXF"NT medical records and information pertaining to medical history, mental, drug or alcohol abuse, or other treatment rendered to 4?:rtArj7 r.jyLso �,j M-6-9 This (Patient's Name) authorization is limited to the following medical records and type cf information: e-�sc L C. USES The re r estor may use the medical records and type of information authorized only for the following purposes: PoSGr�a,� s uce- D.. RESTRICTIONS y �M ..,. i ,:,'4 T understand that the requestor may not further use or disclose 'the medical infoz•mation unless another a.uthcrization, is obtai;%ed 'from me or unless such use or disclosure is specifically' ri e uire;d or permitted by law. E. S2GNATURE, ►� Signed by: - (Date) * (P ient or Represents ive) (Witness) (Relationship if signed by other than the Patient) *A spouse or financially responsible pa y may only authorize release of medical information tor use in processing. an. application for the patient, as a spouse or dapenden-, .dor a:, healoth insurance- -rla.n or policy, a nonprofit b-aspital pZ:anA a h al.th_ cane s.ervite g��an or..ari employee benefit. plan. j p4 n OW ti AA �.x�% 4 rte`F• s - ', „ s u NN.1-1`v, { 03/26/2003 03/26/2003 jwMI LIAO 1:1 � t � �[.t� /� 03/26/2003 � /{r`}L f{ fir} CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: OCTOBER 28, 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: $400.00 CLAIMANT: MARK PETRONI ATTORNEY: UNKNOWN DATE RECEIVED: SEPTEMBER 23, 2003 ADDRESS: 540 SUNNY LANE BY DELIVERY TO CLERK ON: SEPTEMBER 23, 2003 EL SOBRANTE, CA 94803 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. SEPTEMBER. 23, 2003 JOHN SWEETS , l Dated: By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( } This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). ( ) Other: Z)B Dated: y, Deputy County Counsel III. FROM: Clerk of the Board TO. County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). IVOARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. ( } Other: I certify that this is a true and corred copy of the Board's Order entered in its minutes for this date. Dated: 041W OHN SWEETEN, CLERK., BY Deputy Clerk P Y WARNING(Gov. code section 913) Subject to certain exceptions, you have only six(6)months from the date this notice was personally served or deposited in the mail to .file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned,have been a citizen of the United States, over age 1$, 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: * 04W13JOHN SWEETEN, CLERK.By Deputy Clerk Clain to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing craps and which accrue on or before December 31, 1967, 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, 1968, 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 Fine Street, Martinez, CA 94553. C. If claire is against a district governed by the :acrd 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 farm. RE: Claim By ) Reserved for Clerk's filing stamp l RECEIVED Against the County of Contra Costa } ! S P 0M or SORS District) �,;N 1 .` 'AC2. (Fill in na The undersigned claimant hereby makes claim against the County of Contra Costa or the above-nam d. District in the sum of $ 4100, d o and in support of this claim represents as follows: 1. �.en did the Aamage.or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) 5qo 5u K rill ' �_'1 X66 c5v +rte 3. How did the damage or injury occur? (Give full details; use extra paper if required) ( � p � -t 4, 4A_,__ D^ t ` 7 4. What particular act or omission on the part of aunty or district officers, servants or .employees caused. the.injury or. damage? k $ fc e 5. wnat are the names of county or district officers, servants or employees causing the damage or injury? pice , , - ?, �; F" f f r � t •'�'w to 0.� so Y`•« ES 10*19 � Ova X00 ov 0 s 1 CLAIM f� � BOARD OFSUPERVISORS-OF CONTRA COSTA COUNTY t.� • BOARD ACTION:OCTOBER 28, 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". Nw ADDRESS PER L. S. ZELLERS TSU AMOUNT: $1,000,000.00 _. h.-.. .. PHONE CONVERSATION 3:05 Orn MARCH 29/04 16711 MARSH ;CREEK ROAD, APT. 174 CLAIMANT: LISA S. ZELI ERS CCLAyTON, CA 94517 ATTORNEY: uNKNOwN DATE RECEIVED: SEPTEMBER 23, 2003 ADDRESS. P.O. BOX 649 BY DELIVERY TO CLERK.ON: SEPTEMBER 23, 2003 OAKLEY, OA 94561 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEET , Dated: , SEPTEMBER 24, 2003 By: Deputy II. FROM: County Counsel TO: Clerk,of the Board of Superv'sors 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 914.8). ( ) 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: Ac Dated: / Deputy County Counse 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. ARD 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: �✓' ' -20,V0 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 deposite< 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 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 VO, >°&2Y JOHN SWEETEN, CLERK.By Deputy Clerk Claim to. BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY IN tt3CTIONS'TO CLAD—AA—A —NT t 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, 1997,must be presented not later than the I0&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 tater than one year after the accrual of the cause of action. (Gov't Cade 911.2.), B. Claims must be filed with the Clerk of the Board of Supervisors at its offke`in Room 106, County Administration Building, 651 Pine Street,Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors,rather than the County,the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. B. Fraud. See penalty for fraudulent claims,Penal Cade Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp Against the Coun of Contra Cassa or } SEP d District) E KV i So RS (Fill in name) } The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sura of$�U 0 , sand in support of this claim represents as follows: I. When did the damage or injury occur?(Give exact fate and hour) 2. Where did the damage or injury occur?�clude city and cormty) ��� � Cc,,rv'v. -. . cAYc .- - 3. Ploy did the damage or injury occur?(&ive full details;use extra paper if required), .. `. ° . 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? c3 �. r �'r�I A 1, -3 Z(\ t 0 5. What are the names of county or district officers, servants, or employees causing the damage or injury? 6. What damage or injuries d you claim resulted?Give Il extent ofinjuries or damages claimed. Attach two esti cies for auto damage.) - �c:t C LL i ?`a 7. law was the amount claimed above coni`put ?(�ncude t ernatei aniti oany prospective injury or damage.) 0 0a - R S. Names and addresses of witnesses, doctors, and hospitals. 9. List the expenditures you made on account of this accident or injury. DATE TWE AMOUNT Gov. {Code Sec. 910.2 provides"The claim must be signed by the claimant or by some person on his behalf." SEND UTI TQ: Alt me Name and Address of Attemy SQ `` { (Claimant's Sign re} ck,-�es , (Address) �2. Telephone 1`l0._2_, Telephone No. ` N0110E 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 frarrtiulent claim,bill,account, voucher,or writing,is punishable either by imprisonment nment in the county jail for a period of not more than one year,by a fire of not exceeding one thousand($1,boo),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 OF S RVIS RS OF CONTRA CO TA gOUNTY BOAR„ AA,CT :QCBER 28, 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 claire by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all"Warnings". AMOUNT. $3,846.89 CLAIMANT: ALLSTATE INDEMNITY COMPANY FOR: NELSON LEMUS ATTORNEY: UNKNOWN DATE RECEIVED: SEPTEMBER 25, 2403 ADDRESS: P.Q. BOX 168288 BY DELIVERY TO CLERK.ON: SEPTEMBER 25, 2443 IRVING, X 7541.8 BY MAIL POSTMARKED: INTEROFFICE MAIL FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN S'WEETE ,Cle Dated: SEPT. 25, 2003 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervi rs { } 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 y 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: £ By. UA liu Deputy County Counse'. III, FROM: Clerk ofthe Board TO: County Counsel (1) County Administrator(2) ( } Claim was returned as untimely with notice to claimant(Section 911.3). IV OARD ORDER.: By unanimous vote of the Supervisors present: ( This Chum 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: A L-0—e-vI447.2fttJOHN SWEETEN,CLERK, By , Deputy Clerk WARNING(Gov. cede section 913) Subject o certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the '1 to .file a court action on this claim. See Government Code Section 945,6, You may seep the advice of an attorne 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 1'8; and that today I deposited in the CUnited 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: `` OHN SWEETEN, CLERK By Deputy Clerk OFFICE 6F THE COUNTY COUNSEL SILVANo B.MARCHESI COUNTY OF CONTRA COSTA ; COUNTY COUNSEL Administration Building y 651 fine Street, 91' door � � � ~ `�"t� � SHARON L. ANDERSON ' CHIEF ASSISTANT Martinez, California 94553-1229 (925) 335-1800 GREGORY C.HARVEY .. VALERIE.J. RAN{HE (925) 646-1078 (fax) A551STANTS NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Allstate Indemnity Company P.O. Box 168288 Irving, TX 75016 RE: CLAIM OF: NELSON LEMUS Please Take Notice as Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910.2, or is otherwise insufficient for the reasons checked below: [ ] 1. The claim fails to state the name and post office address of the claimant. [ ] 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [X] 3. The claim fails to state the date,place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [X] 4. The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. [ ] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. [X] 6. The claim is not signed by the claimant or by some person on his or her behalf. [X] 7. You are required to submit your claim on the proper form, which is enclosed. Please resubmit your claim on the enclosed form, including all the required information. Gov. Code, § 910.4. Please be aware that you have only a limited period of time in which to file an amended claim. See Gov. Code, § 910.6. Page 1 Allstate Indemnity Company Re: Claim of Nelson Lemu5 Page Two [ 18. Other: SILVANO B. MARCHESI COUNTY COUNSEL By; (I"-AL—C,' Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a,2015.5;Evidence Code§§641,664) 1 declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553;I am a citizen of the United States,over 18 years of age,employed in Contra Costa County,and not a party to this action. 1 served a true copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as shown above,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. Dated: `" y. ' at Martinez,California. li Kathy O'Corltie cc: Clerk of the Board of Supervisors(original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM:GOVT.CODE§§910,910.2,920.4,910.8) Page 2 An state® ,} . You're it good'Hands. ALSIAIE lMDEMMllY COMPANY 09/04/03 P .O. box i68288 QVING IX A016 �003 4 8OO 3 fenny Sawy RISK MNGM l PENNY QLEY_.. 53649 AUG 0 7 2003 20SO ARNOLD DR 110) hARIINEZ CA 9455 OUR !NVE::N E'ICArION lNsltAVEtFHAr YOUR INSURED WAS R:S=iiEB.E'• VUR THIS ` SS SINCE : HAVE ALREADY MADE A SErFLEmEmr WIrHOUR PO. 3C; "O_ t :R, 11 CLAIM "AS BEEN `SE2NiD 40 USCOPIES OF t FINAL PAPERS R LA mVO t -E LOSS ARE E REeC€ tS:. . PLEASE LL ✓EPt( lttIS LEITER ANOTICE OF OUR S3 ?UA ION C _AT E-`LE:.ASE FORWARD D 3'L3UR. f--AYflEwr W l E E-E U M CLAIM NUMBER R S £.I: ALLSTATE PAYMhNI PROCESSING CEN7EFj,' 22120? DALLAS, IX, 25222-725';' mEcr ANY Lamm i u €HE:. ADDRESS A: FE-EE F01' Uy !HXS LEIIER, SUBROG0410M CLAIM REP AE..S..S F A S E INDEMNIFY COME"+AN k tri#P: Le YOUR tj INSURED t,ON r�-A COSFA ;g=ay D f \ SS 2520 OUR CLAIM NO3953650775 NJA OUR INSURED NELSON LEMUS LOSS DnIE 05/05/03 LUCA FT 0N PINE Sl CONCORD CA Of, LOSS, - 4� ;-3 K f ALLST INDEMNITY AUTO ASSIGNMENT WORK ORDER PAGE 1 05127/03 ON0540 3950 STOCKTON 209-982-6400 DESK. NJA CLAIM NUMBER: 3953658775 LOSS DATE: 05/05103 NOTICE DT: 05/05103 � e POLICY NUMBER: 627783076 LINE: 19 EMP: EFF DT: 01 /16/03 ORIG YEAR: 01 ���' GOV LIMIT: BB100, DD-W100, HH INSURED NAME: NELSON LEMUS ASSIGNMENT FOR: 01 NELSON LEMUS ITEM/CLMT: DD01 ADDRESS: 1650 PINE STREET APT CONCORD CA 945203463 PHONE: 925-827-3788 BUS: 9.25-675-2096 X: HOURS: 17->72 VEHICLE: 93 FORD PROBE WHITE PLATE: CA VIN: 1ZVCT22B6P5237584 ODOMETER: 110000 PHOTO: Y DRIVEABLE: N TYPE OF LOSS: CLAIMANT STRUCK PARKED INSURED STATED VALUE: N LOSS OF USE: N ASSIGNMENT: 03 SETTLE/COLLISION TRANS REASON: 03 LEASED: N PRIOR DAMAGE: NONE VEH S-CODES: NONE PRIOR CLAIMS: 1665183289 1665584551 *MORE** AREAS DAMAGED: -ENGINE, -WINDSHIELD, -HOOD,GRILL AREA, -L FRONT FENDER, -R FRONT INSP LOCATION: 925-827-3788,MAYRA LEMUS, 1650 PINE STREET,CONCORD,CA COMMENTS: IVSD NOW WNTS ALLSTATE TO HANDLE CLAIM. TPC HAS NOT DONE ANYTHI NGTO THIS DAY. K9ZR AS TH ORIGINAL T/L TECH ON THIS BCK ON 5-7CLEAR-CANCEL PF3-RETURN PF8-FOR RD PF9-PRT SCREEN V ! JUN 0 in STOCKTON -C-0; .c_0 /n ------------ -------------- f_-,------------------­ POLICY NUMBER CLAIM NUMBER ) SSNMN DESK LOC EMPLOYEE I.D. ti.>.. x k C.�o f Z,.. f x � e�3 7 t 4 �, J 7 S t ° l<•_i i . -i, z", t t sa, � 3a�I �3 3 E INT _A_ "k A,44 -4:-,,k- A, v4D — — INVOICE UMB R I pfigg M O 13R 5A—TE iMustate, You're In goof hands. '434 "� ~ "" 3811530 5 X15 ALLSTATE INSURANCE COMPANY OR ONE OF ITS AFFILIATES COMPANY NAME SM bn batt ` � InC utl I FILE CO SABLE VOID IF NOT PRESENTED WITHIN THREE HUNDRED,SfXTY FIVE DAYS OF THE DATE OF ISSUE. � AUTHORIZED SIGNATURES .INS'[?RANCS AUTO} AUCTIONS Pittsburg 1055 N. Parkside Drive Bay Point, CA 94565 Tel .# (925) 439-7087 Date: 07/23/03 Salvage: Ag2ort Sw of alvags, �rii or Bost Account of sale: ACV IAA Stock No. 330-0205774.3 Sales... . . . . . .. . . . ... .. ... . .. . . . $475.00 13.07 Fed. Tax I.D. 3$37901.11 Comission... ....... . . . ... .. . . 35.00 0.96 ADJUSTER- Michelle Foy Hauling... .... ... . ... .. . .. . . .. 41.00 1.1.3 Pqt�ICY HOLDER.- NELSON LEMUS Title Fee— . ... . .. ... .. . .. . .. . 3.00 0.Da Detail-Full. . ... . .. . .. . .. . .. . . 1.2,00 0.33 CO. FILE: 3953636775-01 VIC/FIS/Sm#rtL080 (tm} . . ., . -;, . 7.00 0.1.9 POLICYO: ------ WHIMS- -_,_ - v1HIMS: 1993 PROBE GT TOTAL IAA CHARGES. .. . . .. . .. . . 98.00 2.70 UVDC: Front end NET IAP, RETU1W. . .. . .. . ... .. . ... .. .$377.00 10.37 V-1-N' ' 1ZVCT22B6P52375B4 ACV: $3,535 OUTSIDE CHADORS .ADVANCZD BY IAA: NICB DATE: 07/2$/43 Paid Towing. ... .... .. . .. . ... .. $0.00 1.65 BUYER: Victory Tune Up Brakes Labor.. . .... .... .. . . .. . .. . .. . 1,68.00 4.62 ADDRESS- 160 B ACme St TOTAL O/S CRARGES.. .. . ... . .. 228.00 6.27 CITY,ST ZIP: Oakley, C4 94561 NET REMITTANCE. . .. . ... .. . ... .... $145.00 4.1.0 El.apaed hays A"Wais r Date of gvont: # of Days Liaause Refund Caloulatiou Lass 05105103 Recovered NIA --- Assigned 05/27/03 23 Released 05128/03 2 Pickup 05129103 2 Title Redd 00/25103 28 Cart Recd 07116103 22 AUCtion Date 07122/(73 7 sale. 07/.2.2103 28 Not Enrolled in License Refund Program Remittance 07/23/03 2 ,Salvage Certificate Issued 07116103 r2apeed rata) Mayas: 80 Ret&in thze Partiva for your records INSURANCE AUT© AUCTIONS SALW CS ZXF0RAMTXW Pi t tabu rg Co. File, 3953638775-02 1055 .N. Parkside DX-ive a01.1ay Zf1dr: NELSON LOWS Bay Point, CA 94.565 Doz 05105/03 Tel. # (925)439-7087 ZAA Stoak#z 130-02057742 Fed. Tax X,D. 95-3790211 AAWUA'f 07/23/03 33307.3. 425 $149. 00 PAY TsxAcmr One Hundred Forty-,Nine and =1100 dollars Allstate Insurance - CFp .111103 PGS Box 6.50598 Attn; Scott Parker Dallas, TX 75. 65 <-DUPLICATB-> Claire:3;?5363877.5-01 .,tosource Valuation 1993 Ford Probe GT 2D Hatchba ADP Request: 10715261 U W:x 2 Ausat u nc&e Vdmluafilc)alobi -- :Administrative Data 1993 Ford Probe GT 2DHatchback: Cheryl Stoltz (None) Allstate Insurance Company `Nelson Lemus Capitol Auto MCO Branch 3953638775-01 1025 Creekside Ridge Dr#203 ;; 05/05/2003 Roseville CA 95678 " Collision � (None) (None) -------------------------------- VINSOURCE Analysis 1993 Ford Probe GT 2D ww',v 1ZVCT22B6P5237584 1993 Ford Probe GT 2D Hatchback Decodes Correctly Activity was reported l3 Autosource Total loss activity: (NONE). •Autotrak total lass activity: (NONE). ❑Audatex estimate activity: (NONE) II Sales history activity: (NONE) NICB Report 1993 Ford Probe GT 20 Hatchback: A007 ALLSTATE INSURANCE COMPANY 1665584551H01 07109102 ESTIMATE ' H0083838724 4084678221 �:.. Left Front Side 1993 Ford Probe GT 2D Hatchbackli Valuation $3,030 $3,030 6 Cylinder 2.5 6 Cylinder 2.5 5 Speed Manual 5 Speed Manual 121 920 M1{T ira# 116 197 Mi Actual 145 195 3,370 265 • � -• 3 635 i,iili,i !lit The market value displaved rnav not . RN 10 / s reflect the activity detected by VINSOURCI and/or NiCB research. Ci+ _._......._.l Please contact Client Services at ' 1-800-351-3133 for review. } 1 Version:3 Page 1 �, s' ° 7 05130/03 11:04 Claim:3953638775-01 .tosource Valuation 1993 Ford Probe GT 2D Hatchba. ADP Request: 10715261 ValuationVehicle Detail ••. i • Probe GT 2D Hatchback The TYPICAL VEHICLE represents the average mileage, condition, equipment level and estimated selling price of a vehicle of the same year, make, model, doors, edition, body and fuel type as the LOSS VEHICLE and is representative of the market area. Concord Concord $3,030 $3,030 u 1993 1993 Ford Ford ° Probe Probe kit Gt 2D 2D ' x Hatchback Hatchback 6 Cylinder 2.5 6 Cylinder 2.5 0 ,p 5 Speed Manual 5 Speed Manual 0 Not Applicable Not Specified 121,920 Mi(Typical) 116,197 M€(Actual) 145 Air Conditioning Air Conditioning . �Tilt Steering Wheel Tilt Steering Wheel Cruise Control Cruise Control Rem Trunk/Liftgt Release Rem Trunk/Liftgt Release Rear Window Defroster Rear Window Defroster )Tinted Glass Tinted Glass " Bodyside Cladding Bodyside Cladding n fir` �a Center Console Center Console Fog Lights Fog Lights t t !'Air Sag Restraint Air Bag Restraint Sport Suspension Sport Suspension Rear Window Wiperlwasher Rear Window Wiper/washer Power Brakes Power Brakes r Power Drivers Seat 35 Power Mirrors Power Mirrors ° Power Windows Power Windows Power Steering Power Steering Power Door Locks Power Door Locks AM/FM Stereo Tape Compact Disc Player 60 Alarm System 25 Aluminum/Alloy Wheels Aluminum/Alloy Wheels O tlon Irk 75 3,370 265 NEON= r- e. r ♦ -aa $$635 i Condition-Adjustment Detail 1993 Ford Probe GT 2D Hatchback v. 8. Minor Wear Good 50 Minor Wear Minor Wear Minor Damage Good 20 Good Needs Repair -55 Good Good Minor Damage Minor Damage Moderate Damage Minor Wear 100 Minor Damage Minor Damage Version:3 Page 2 05/30/03 11:04 Claim:3953638775-01 itosource Valuation 1998 Ford Probe GT 2D Hatchba. ADP Request: 10715261 Minor Wear MinorWear Minor Wear Minor Wear Good(30-79%Of Tread) New(80-100%Of Tread) 75 k r Good 30-79%Cif Tread New 80-100%Of Tread 75 . . 265 ':Valuation Notes 1993 Ford Probe GT 2D Hatchbackli •Adjustments of Special Note No special adjustments were made for this vehicle. •Information provided by Allstate Insurance Company . Loss vehicle description was provided by Allstate Insurance Company. . All values are in U.S. dollars. E3 Autosource Valuation Process • Over 2,000,000 vehicles are entered weekly into the database used for researching this value. This database includes dealer inspected, dealer inventory, dealer advertised, phone verified and advertised private party vehicles. . The originating search area for this valuation was Concord, California. • A 5-character postai code was not provided during the initial request of the Autosource valuation. The default locale of the loss vehicle was used to complete the request. Please contact Client Services at 1-800-351-3133 if you wish to update the locale of the loss vehicle. . The VIN decoded correctly. . The value of the Package adjustments displayed include only those items that cannot be purchased individually. Other equipment items included in the package that can be purchased separately are adjusted with the vehicle equipment, and these adjustments are noted by the applicable options. o Other Adjustments or Comments . Seats are good with seat covers. Carpet shows minor wear. Rock chips and long crack in windshield. Right quarter dent and parking lot dings. Rock chips on hood. Rear bumper cover has scrapes and nicks. All tires have 8/32 tread. . As reported by Subba Nabhi on 08/29/03, Autosource has revalued the loss vehicle with revised conditions. . As reported by Michelle Foy on 05/30/03, Autosource has revalued the loss vehicle with revised equipment. Replacement . . Ford Probe GT 2D The following replacement vehicles may include a sampling of the actual vehicles used to calculate the selling price. The replacement vehicles represent vehicles that have recently been offered for sale in the marketplace. These vehicles have similar attributes and characteristics to the total loss vehicle. ill�llil 111 1111 IN - 1993 Ford Probe GT 2D Hatchback 03182103 .:.gip. '.➢YJ71�d 80,OflO Mies 6 Cylinder 2.5 San Jose,CA O O" 5 Speed Transmission Power Brakes Dealer Power Steering Power Windows (408)9982200 Compact Disc Player Aluminum/Alloy Wheels Air Conditioning Cruise Control Air Bag Restraint Bodyside Cladding Center Console Fog Lights Sport Suspension Maintenance Records Original Owner of Vehicle Version:3 Page 3 05/30/03 11:04 Claim:3953638775-01 Aosource Valuation 1993 Ford Probe CT 2D HatchbL ADP Request: 10715261 1993 Ford Probe GT 2D Hatchback 02t1p/p3 ��~ .. �53,995.. 83,000 Miles 6 Cylinder 2.5 San Jose,CA Power Brakes Power Steering , Baghi Mani " AM/FM S#tirtio Tape Alurr�inumlA#loy Wheels - )998-2321 AirConditioning Cru#se Contro# Tilt Steering Wheel Air Bag Restraint Bodyside Cladding Center Console Fog Lights Sport Suspension 1993 Ford Probe GT 2D Hatchback 05/24103 ) � � $2,995 100,000 Miles 6 Cylinder 2.5 �'� Diablo Dealer 5 Speed Transmission Power Brakes Manteca,CA Power Door Locks Power Steering (209)601-2870 Power Windows AM/FM Stereo Aluminum/Alloy Wheels Air Conditioning Air Bag Restraint Bodyside Cladding x Center Console Fog Lights Sport Suspension Excellent Condition x .Wtll Acce t Best Offer 1993 Fc�td Prob+�GT ZD Hatchback p5122lp3 �$3,200 05/17103 .. _.. _ ,,$3,500 140,00 Mites 6 Cylinder 2.5 Sacramento Bee 1 , Automatic Power Brakes x Davis,CA Power S#tiering AM/FM S#ereo (530)756-0418 Aluminum/Alloy Wheels Air Bag Restraint Bodyside Cladding Center Console , ` Fog Lights Sport Suspension b` Wtiff Equipped Will Accept Best Offer *' KI, -'tK i 1993 Ford Probe GT 2D Hatchback 115,66 Miles 6 Cylinder 2.5 Modesto Bee Automatic Power Brakes . .'Manteca,CA Power Steering AMIFM Stereo . (209)612-8300 Aluminum/Alloy Wheels Air Bag Restraint Bodyside Cladding Center Console Fog Lihrts Sport Suspension Wi#I Acce t Best Offer w 1993 Ford Probe GT 2D Hatchback � pdID67p3 53,950 6 Cylinder 2.5 Power Brakes Cancra Costa Times Power Steering AM/FM Stereo . Frtirnont,CA Aluminum/Alloy Wheels Air Bag Restraint (925)339-1054 Bodyside Cladding Center Console Fog Lights Sport Suspension Weli E ui ped 19x3 fiord Probe GT 23 Hatctibck _ 04/07103 $2,55p _ 03/24/03 �_)$2,550 n o_.,. 5 Cylinder 2.5 5 Speed Transmission r San Francisco Chronicle Power Brakes Power Stetiring ` r San Mateo,CA AM/1°M S#ereo Aluminum/Alloy Whee#s (650)576-2777 Air Conditioning Cruise Control Air Bag Restraint Anti-look Brakes Bodyside Cladding Center Console Fog Lights Sport Suspension & Will Accept Best Offer Version:3 Page 4 05/30/03 11:04 Claim:3953638775-01 itosource Valuation 1998 Ford Probe GT 20 Hatchba ADP Request: 10715261 w 1993 Ford Probe G�'2D Hatchback r 4212U1Q3 �,�� � $2,5011 , 5 Cylinder 2,5 Pt�wer Brakes t Contra Costa Times _ Power Steering AMlFM Stereo Concord,CA AluminurnlAlloy Wheels Air Bag Restrain# )671-7049 Bodyside Cladding Center Console Fog Lights Sport Suspension .Well Equipped ' The following vehicles were not considered in the calculation of the selling price, However, they may facilitate in finding a replacement vehicle. These vehicles have similar attributes to the lass vehicle but may vary in year and type. � R 1994 Ford Probe GT 20 Hatchback � . //4126/83 �, "$4,950 67,000 Miles 5 Cylinder 2.5 San Mateo,CA 5 Speed Transmission Power Brakes •r Dealer Power Steering Leather Seats (550)5711359 AM/FM Stereo Aluminum/Alloy Wheels Bodyside Cladding Center Console Digital Clock Dual Air Bag Restraints . Fog Lights Leather Steering Wheel Sport Suspension Tachometer ° Tented Class Well Equipped Maintenance Records On final Owner of Vehicle 1994 Ford Probe GT 2D Hatchback a� Q3{13lQ3 $4,0(10 84,000 Miles Cylinder2.5 • Santa Rose,CA .„,:Automatic Power I3rakes .. Dealer Power Steering Leather Seats (707)292-7599 AM/FM Stereo AluminurnlAlloy Wheals Bodyside Cladding Center Console Digital Clock Dual Air Bag Restraints � � Fog Lights Leather Steering Wheel w Sport Suspension Tachometer ° Tinted Glass Well Equipped Recall Bulletins 1993 FordProbe GT 2• Hatchback Nat'l. Highway Traffic Safety Admin (US)has issued a total of 1 recall bulletin that may apply to this vehicle. • 93VO58000 04/05/93 April 1992-June 1992 ° Structure:liftgate. ti Passenger cars. The lower pivot pin that jolns the liftgate gas strut to the body can separate from the lower strut mounting bracket due to an undersized rivet head. Pivot pin separation causes the liftgate to descend suddenly,resulting in an injury if someone is s#ruck by the liftgate. x k Replace liftgate shrut assemblies have undersized pivot pin rivet head diameters with assemblies z with adequate pivot pin rivet heads. -------- Original Equipmenty . 1993 Ford Probe GT 2DHatchback! * 6 Cylinder2.5 STD 5 Speed Manual STD peed utomatrc $732 . 4 q tar . * Air Bag Restraint STD Air Conditioning $817 Anti-lock Brakes $595 Power Antenna $85 * Bodyside Cladding STD * Cruise Control $224 * Center Console STD * Rear Window Defroster TYP Version:3 Page 5 05130/03 11:04 Claim:3953636775-01 Aosource Valuation 1993 Ford Probe GT 2D HatchbL, ADP Request: 10715261 * Fog Lights STD Rem Trunk/Liftgt Release TYP Keyless Entry System $137 Tilt Steerin 1 Wheel TYP Lighted Entry System * Rear Window Wiper/washer $182 * Power Drivers Seat $305 " Sport Suspension STD Power Brakes STD * Tinted Glass TYP Power Door Locks $152 Power Mirrors TYP * Alarm System $200 * Power Steering STD * Compact Disc Player $840 * Power Windows $153 AM/FM Stereo Tape $339 111NMENUIRSe -�e SEEM AM/FM Stereo STD Power Sunroof $646 Gra hip 1Tquall�er Z wF k' _ ,ei..... _.. ..,._. ... r ..... r r ... .. � . Leather Seats $523 * Aluminum/Alloy Wheels STD Light Group $249 Includes:Illuminated Entry System,Dual Illuminated Visor Vanity Mirrors,Map Lights&Dome Light With Delay. * Option Pkg $795 Dual Power Mirrors;Rear Window Wiper;Tinted Glass; Variable Wipers;Remote Fuel&Hatch Release; Headlamps-On Warning; Rear Defrost;Tilt Steering Wheel. $15 504 R• • + g" •. * 18990 Editions available for the same body style (in order of original cost, increasing): Std, Se, *Gt * Indicates loss vehicle equipment. Vehicle Locator Service 1993 Ford .. w GT 2D Ha tchback' After your claim is settled, Autosource provides free assistance in locating your next vehicle. Call us Monday through Friday, between 8:00 AM and 5:00 PM, Pacific time, at (800)351-3133, ext 7428. Our specialists will work with you to find a new or used vehicle in your area. About •i . .- GT 2D Hatchback I This report contains proprietary information of ADP and shall not be disclosed to any third party (other than the insured or claimant) without ADP's prior written consent. If you are the insured or claimant and have questions regarding the description of your vehicle, please contact the insurance company that is handling your claim. Information within VINsouree/NICB is provided solely to identify potential duplicative claims activity. user agrees to use such information solely for lawful purposes. Copyright @ 2003 ADP Claims Solutions Group, Inc. All Rights Reserved. Version:3 Page 6 05/30/03 11:04 Vehicle Registration www.dmvlink.com Requester: Allstate Capitol MCO Date: 05/27/2003 User: KL Time! 15:17:59 Reference: 3953638775-01-MICHELLE Reason: 99 Miscellaneous/Other Search Key: IZVCT22B6P5237584 ------------------------------------------------------------------------------ Expires: 10/26/2003 License; 3FIG947 Yr: 93 Make: FORD Model: 2H VIN: IZVCT22B6P5237584 *Year: 00 Reg Owner: LEMUS NELSON EDILVERTO 1650 PINE ST M 6 CONCORD 94520 County: 07 CONTRA COSTA Purchased: 00/00/93 Reg Issued: 10/31/02 Title Issued: 08/10/00 Last Issue: Reg or PNO from Series 1 - Computer generated. Leg Owner; Type: 11 Body: 0 Power: G VLF: AX Fee: 0000 Axles: Weight: Engine: REC STATUS: 11/02/02 SMOG DUE 10/26/04 NO MAILING ADDRESS 07/31/2000-ODOMETER: 94,438 MILES ACTUAL MILEAGE ----- FEE CALCULATION - TOTAL LOSS ----- Loss Date: 05/05/2003 Reg. Expires: 10/26/2003 Veh. Type: A VLF Class: AX Exempt? N ELP's? N Theft? N County: CONTRA COSTA Zip: 94520 SETTLEMENT SUMMARY Registration Fee 28.00 CHP Fee 2.00 License Fee 59.00 VLF Offset 67.5% -40.00 Air Quality Fee 4.00 Emergency Service Fee 1.00 Abandoned Veh Fee 1.00 Auto Theft Fee 1.00 Fingerprint Fee 1.00 ---------- Total 57.00 Transfer Fee 15.00 Partial VLF Used (7 months) -11.00 TOTAL SETTLEMENT 61.00 VEHICLE LICENSE FEE REFUND License Fee 59.00 VLF Offset -40.00 Partial VLF Used (7 months) -11.00 DMV Admin. Fee -7.00 REFUND AVAILABLE 1.00 ----- End ----- CVR(888)466-5427 7 CVS:(888)466-5427 8 066/27/2003 08:58 925686174e' MIKE'S A/B FREMDNT-$ PACE 05 05/23/2003 at 05 : 36 PM Job Number : 17908 MIXE ROSZ' S AUTO} BODY INC. License # :BAR# AA07562 Federal ID # : 992623.349 WHERE QUALITY COUNTS 2001 FREMONT STREET CONCORD, CA 94520-2616 (925) 686-1739 Fax: (925) 686-1749 EBTIMATR OF RECORD Written by: VINCE vEGA # 05/23/2003 05 : 36 PM Adjuster: DD 2744692OXXX05202 # Insured: NELSON LEMUS Claim #3953638775-01 Owner: NELSON LEMUS Policy # Address: 1.650 PINE STREET APT Deductible: 100 . 00 CONCORD, CA 94520-3463 Date of Loss : 05/05/2003 Day: (925) 827-3788 Types of Loss: Collision Business : (925) 675-2096 Point of Impact , 1S . Total Lose Inspect MIKE ROSE' S AUTO BODY INC. Business: (925) 686-7.739 Location: 2001 rREMtONT STREET CONCORD, CA 94520-2616 insurance ALL STA'I`R INSURANCE COMPANY company: 1025 Creekside Ridge Dr, Suite 2 10 Days to Repair PO) Box 619054 Roseville, CA 95661 1993 FORD PROBE GT 6-'2 P 5L-FI 3D WHITE int : YIN: IZVCT2236P$237584 Lic : 3FIG947 CA Prod Date: 02/1993 Odometer: 11.61.9' Dual mirrors Fog Lamps Clear Coat Paint Power Steering Power Brakes driver Air Sag 4 Wheel Disc Brakes Cloth Seats Bucket Seats Recline/Lounge Seats 5 ,Speed Transmission Aluminum/Alloy Wheels ----- -- - - ---- - ---- - --- - - -- ------- -- ---- ---- - - - -- - - - - -- - - - -- - - - -- -- - -- -- - - - - - - - - NO . OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT --- -- ------ - - - - - - - - ------ -- --- -- -- - -- ----- -- --- - - - - - - -- - - --- - - -- -- - - ----- 1 FRONT SUMPER 2* Rept, USED bumper assy +25* 1 218 . 75 1 . 7 2 . 5 3 Acid for Clear Coat 0 0 . 00 0 . 0 1 . 0 4 Refn edges 0 0 . 00 0 . 0 0 . 5 5 O/H bumper asst' 0 0 . 00 3 . 0 0 . 0 6 Repl RT Bumper cover bracket 1 31 . 12 Incl . 0 . 0 7 Repl LT Bumper cover bracket 1 .31 . 12 Incl 0 . 0 8 Repl Upper support 1 23 . 87 Incl. . 0 . 0 9 Rept. Support 1 50 . 28 Incl . 0 . 0 10 Repl Face bar GT & SE 1 342 . 59 Incl . 0 . 0 11. FRONT LAMPS 12* Rpr LT Cover 0 0 . 00 0 .3 0 . 5 13 Add for Clear Coat 0 0 . 00 0 . 0 0 . 1 14 Blnd RT Corer 0 0 . 00 0 . 0 0 . 3 15 COOLING 16* Rpr Support assy 0 0 . 00 sr 1 . 5 0t/27/2003 08.58 925686174 ' MIKE'S AJB FREMONT..S PAGE 06 05/23/2003 at 05 : 36 PM Job Number . 17908 ESTIVATE Or RZCORD 1993 FORD PROBE GT 6-2 . 5L-FI 3I1 WHITE Int ! -- --- -- - - - - `- --- ----- ------ --- - - -- --- - - -- -- - -- - -- - -- - - - -- - - --- - - - --- -- -- -- -- - - - NO . OP . DESCRIPTION QTY EXT. PRICE LABOR PAINT _ - ------ - ------ - - - - - - --- ---------- -- _ -- -- -- -_- --- - -__ - - --- - - -- - - --- - - - -- -- - - - - _ 17# SET UP FOR ROUGH PULL 1 0 . 00 1 . 0 0 . 0 18# PULL TO SQUARE FRT END 1 0 . 00 2 . 0 0 . 0 19## PULL RAI? SUPPORT 1 0 . 00 1 . 0 0 . 0 20 R&I Recovery tank 0 0 . 00 0 . 7 0 . 0 21 HOOD 22* Repl USED hood +25k 1 .:.. •? 0 . 7 3 . 0 23 Overlap Minor Panel 0 0 . 00 0 . 0 -0 . 2 24 Add for Clear Coat 0 0 . 00 0 . 0 1 . 1 25 R&I insulator 0 0 . 00 0 . 3 0 . 0 26 R&I hinge 0 0 . 00 0 . 3 0 . 0 27 Refn underside 0 0 . 00 0 . 0 1 . 5 28 Repl Look w/o anti theft 1. 68 . 05 0 . 5 0 . 0 29* Algn RT Hinge 0 0 . 00 Qom, 0 . 0 30* Algn LT Hinge 0 0 . 00 0 . 2 0 . 0 31 Repl Insulator retainer 10 11 . 10 0 . 0 0 . 0 32 FENDER 33* Repl USED LT fender assy +254 1 132 .50 1 . 4 2 . 5 34 overlap Major Add . Panel 0 0 . 00 0 . 0 -0 . 4 35 Add for Clear Coat 0 0 . 00 0 . 0 0 . 4 36 Refn edges 0 0 . 00 0 . 0 0 . 5 37 R&I splash shield. 0 0 . 00 0 . 3 0 . 0 38 R&I molding 0 0 . 00 0 . 2 0 . 0 39 Blnd RT Fender SE & GT 0 0 . 00 0 . 0 1 . 3 40 R&I RT Molding lower, SE & GT 0 0 . 00 0 . 3 0 . 0 41 R&I LT Molding lower, SE & GT 0 0 . 00 0 . 3 0 . 0 42 Repl RT Molding beady side 1. 38 . 43 0 . 1 0 . 0 43 Repl LT Molding body side 1 38 . 43 0 . 1 0 . 0 44 ELECTRICAL 45 R&3~ Battery tray 0 0 . 00 m 0 . 6 M 0 . 0 46 R&I Horn high note 0 0 . 00 0 . 4 0 . 0 47 R&T Dorn low note 0 0 . 00 0 . 4 0 . 0 48 DOOR 49 Blnd LT Outer panel SE & GT 0 0 . 00' 0 . 0 1 . 1 50 R&I LT Belt w " strip 0 0 . 00 0 . 3 0 . 0 51 R&I LT Body side mldg lower SE & 0 0 . 00 0 . 4 0 . 0 GT 52 R&I LT Mirror power w/o heat 0 0 . 00 0 . 6 0 . 0 53 Repl LT Decal I,GT" gray 1 15 . 93 0 . 3 0 . 0 54 R&I LT Handle, outside 0 0 . 00 0 . 4 0 . 0 5 R&I R&I trim panel 0 0 . 00 0 . 5 0 . 0 56## Repl COVER CAR 1 5 . 00 X 0 . 0 0 . 0 57# Repl FLEX ADDITIVE 1 5 . 00 0 . 0 0 . 0 58# Refn TINT COLOR 0 0 . 00 0 . 0 0 .4 59## Repl CORROSION PROTECTION 1 5 . 00 T 0 . 3 0 . 0 60# XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 1 0 . 00 0 . 0 0 . 0 61# ESTIMATE OPEN PENDING TEAR.DOWN 1 0 . 00 0 . 0 0 . 0 624f xxxxXXxXXXXxXXXXXXXxXXXXXXX?CXX 1 0 . 00 0 . 0 0 . 0 2 OS/27/2003 08:58 925686174 MIKE'S A/B FREMONT>;.S PAGE 07 05/23/2003 at 05 : 36 PM Jab Number: 17908 ESTIMATE OF RECORD 1993 FORD PROBE GT 6-2 . 5L-Fi 3D WHITE Int : - -- - -- - - -- - - ---- - - -- ----- --- -- --- - - --- - - - - - - - - - - - - - - - - - - --- - - -- - - -- - - - - -- - - -- - - NO . OP . DESCRIPTION QTY EXT. PRICE LABOR PAINT - - - - - - - -- -- - - - -- - - - -- - ----- --- - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - -- - -- - -- -- - - - - - - - - - 63# LKQ QUOTE # FRT HMP, HOOD, LT 1 0 . 00 0 . 0 0 . 0 FENDER 64# RPN QUOTE # 138713 NO HITS 1 0 . 00 0 . 0 0 . 0 65# CONCOR AUTO NO HITS 1 0 . 00 0 . 0 0 . 0 - --- -- ---- -- - ---- ------ -------- -- --- --- -- -- - -- - - -- - - - - -- - - - --- - -- - -- - - -- - - - - - - - - Subtotals ==> 1366 . 91 22 . 8 17 . 6 Parts 1355 . 91 Parts Discount $ 650 . 91 -5 . 0% -32 . 55 Body Labor 22 . 2 hrs 9 $ 56 . 00/hr 1243 . 20 Paint Labor 17 . 5 hrs 9 $ 56 . 00/hr 985 . 60 Mechanical Labor 0 . 6 hrs 0 $ 60 . 00/hr 36 . 00 Paint 400 . 00 Sublet/Mist . 11 . 00 - -- - - - - - -- - - --- --- --- -- - - -- - ------ --- -- -- --- -- - - -- - - SUBTOTAL $ 3999 . 16 Sales Tax $ 1728 . 35 a 8 . 2500* 142 . 59 --- --- -- ----- -- --- - - - --- - - -- - - - -- - --- ---- - -- - - -- - - - - GRAND TOTAL $ 4141 . 75 ADJUSTMENTS : Deductible 100 . 00 -- ----- -- -- - - - - - -- - -- - - - - - - -- - - ---- - - - -- ---- - - - - - - - - CUSTOMER PAY $ 100 . 00 INSURANCE PAY $ 4041 . 75 THIS IS A PRELIMINARY ESTIMATE AND ADDITIONAL CHARGES MAY BE REQUIRED FOR THE ACTUAL REPAIR . THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR ABBREVIATIONS/SYMBOLS : D.DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES : B=BODY LABOR D=DIAGNOSTIC E=ELRCTRICAL F-FRAME G=GLASS M=MECHANICAL ?=PAINT LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS : ADJ=ADJACENT ALGN=ALIGN A/MaAFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RRCONNECT EST_ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H®OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART RECORD=RECONDITION REFN-REFINISH REPLRREPLACE R&I�REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=RSPAIR RTGRIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT W/_=WITH/_ SYMBOLS : #=MANUAL LINE ENTRY *mOTHER (IE. .MOTORS DATABASE INFORMATION WAS CHANGED] **mDATABASS LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE . 3 Autosatlrce Pre-I)amage Appraisal: Capin-, 840-433-4413 Bas: 00-959-3114 a- 1+.'. `itsu e d tI SouLe $ laiti�is. oro Autosource Vto 0 AMtosaur aq t#i Product ii�avee Valuation Mark Search fieportRzErieval E»mall A axBank Pax# 0 Other: Audatex ID#(Required) Co.barna&Branoh Claim Rep Name Claim Rep Phone# Loss r ClaimalicylMemiser# Insured NameInsu P a # LOSS e hi 4433.4 Lkai& . kjlt Are (Ci 1p/P l�de) Clairnatit Natrie Clamant Phone# e l Jae Odom,IT l xt. zVcr :2.. -64 '. I h-ma l yea A-80 B=8I C-82 D-93 E,-94 F=85 G-86 H-97 J-98 IC=89 L-90 M-91 N-92"3 R=94 Sys T.96 V-197 W--98 X=99 Y-=20001-012-02 Y Make l4fo I S}aors R y»_ keg Cab EXt Cali ]give Edition G Crow Cab 09talssildo [32WE34W nglua Cas biesol Tittix3 Supercharged int Size #Cylinders Trans, Auto 2 sp 3 sp 4 sp 5 sp CVT c?ther: JM Manual 3 rl 4 52 1&5 sp 0 6s #Passenger Bad Lcngtt: Capacitymnnage: Vari Type:11 Pa ager 0 Cargo El Reguier U Extended Ca ad- : Shod 0 Lon r!a T %T____Q IT Conversion Name: Ins ectcd F3 F3ate Location of VahiclG Peal# VEffiCLI.EQiIIPM 't` FROMAP I{ADIOSl.AI.AE ms SEATS ROOF BUMPERS O-MER Poway Brakes(PB) O'AM Radlo(AM) [3 Power seat(B5) 0`Vinyl Top(VNL) Q Rear Step Hamper(M) Q Grill ward(OG)) Power Steering(PS) AMlI+M Sty(FMS) Drtal Pwr(E52) [3 Carriage hoof(CRF') Tube Bumper [2 Fog Lights(FOG) Purer Windows{PW) AMJPM Tape M4C) Q Pleated seats(HSS) Q Luggage Rack gLAX) C1 Chrome Bumper(CIS) Q Winch(WCH) Power Locks(PL) CI ANVFM Casa/CD(M'I} d Split(SBS)[3 60140 l3 Ml BadUte Bar(BAR) i�Chrome Stp Bmper(Cf3S) 0 Canopy(CATS) Power Mirrors(PAS} �l CD Player(CD) F (BSP} rlCoRmlible Top(Cow) WHEELSMRES ®Camper shell(CSH)Heated Mirrors(I}F3Ni) l:j CD Changer(CDC) lotit/Ya1 (VEL) C�Hard Tap(9M) 0 Wuo Wheels(Ww) [3 Bed Liner(BDL�)�p�.Cruise Control(CC) ( Egaalt'ar(G uther(LTH) SUNROOF l3 Miro Wheel Cvrs(WPIC) 0 Rear Tool Box('EBX) Tilt Wheel(TW) [2 Removed 13 Vinyl(VNS) D sliding--Power(PS13) M Alloy(ALW) (I AM [I Extra Tank(AUX) Rest Defroster(DEF) 13 CH(CB) 0 rain Chairs 2(CC 2) 13 Sliding-1"UMMI(Usk) El Chrome(CHR.)[3 AM 11 Hydraulic Liftgate OMT) Air Conn,(AC) 13 Alarm system(Ai-R) [f 4(CC4)0 6(CC d} ®PopA]P(PMR) ©Styled Steel(STY) Q Sift Kit(LOI)(LOWLI O) C�Deal Air Coral(DAC) ' 0 Phone(CTI") I'Ah2VTJTRIM/+GLAS3 0 T-Tap Glass(CPR) 0 Auto Lock Nabs(ALIT) 0 Ground Eff.flee.( ) C]Anti Lock Brakes(ABS) Q Remote Stertor(RIvIS) 13 Tei Time(TN2) 0 T•Top Solid(TTI.') M Mmuaf Lock(Ieefl.Fl) C3 Lowered___._._in.(LM FAu Bag-Driver(ABR) p Keyless Enty(SES) 13 0tom(CPT) TRICK VANS 0 Wide Tires(WDT) E3 Sido Rear Wind(SRW) Air flag-Passenger(1?AB) C3 Navigation Sys 0 Grepbira(MA) 0 fieftsrxtor(R€It.) LL}. Dual hest Wheels(DRW) 0 Exterior Visor [3 Air Bag Other_ 13 Tachometer(TCM 13 Tinted Giaas(ostATN`i) 13 Telovision(BTV,CTV) SUSPENSION 13 bash Mat 05 Power Arttanua(AMT) Q Center COMIC(CTC) Q Tinted AM_ 0 Microwave [7 77ailar Tow Pkg.(TOW) C3 Running Boards(ILNB) ',Rear Wiper(RW W) 0 Overhead Carole(OF4 13 Priv*cy Glass(PRG) [3 Full Pop-Top El'Camper special ©BRA Remote Trunk Rio(RTR} 0 luted EntrY Sys(LES) i ❑Rear Spoiler(SPL) 0 V.POP-TOP 0 Tmfw Bitch(REI) Cl Air barn(FAD) 13 LTIPIrMEVT NOTES: VEMCI,E Ct3NEllf'£1"ON Check either Sub-sate- rslPuinr/n etc. arCuff; lEll7lMEGf rl71RE r wrtre in I.Iescrr 'on and S ramotou MERTOR ABOVE AVERAGE AVERAGE Q BELOW AVERAGE BEATS: Restored Good Igor Wear Moderate Near Needs;R.eplarilag besefS: CARPETS: R,aWrad Quad ?.IinOr VYesr Moderato War Needs Replacing DescJS: DASIXIMIM: Restored Gond Mlnor Wear Moderato Damage Needs ReIi��B t}asttS; r4 'JA GLASS: Replaced Goad West- r1,3 Wass, Boole Repair Needs Replacing DescJ$: H LIIyTIIR: R.estnred Good Minor Wear IKcsdeaate Wear Noels Replacing I3esc( ; EXTERIOR 0 ABOVE AVERAGE 0 AVERAGE BELOW AVERAGE BODY E3 Restored 13 Good M.,Damage 0 Moderate Damage 0 serious Damage Desc/$: PAINT New Good Miner Wear 0 W. dacais Damage M V=t ds RepaiOtmg I3easc�: Repainted Yes LJ No pate: Cost: S MINI, New 0 Good or Damage Moderate Damage, 0 NW&Replacing 3)c5e1$: ROOFITOP: C1 Good Moor Daasagm moderate Damage Nome Replacing T7esct$: MECHANICAL 0 ABOVE AVERAGE AVERUG 0 BMOW AVERAGE ENGINE, 0 ldewltobuitt C2 Well Maint "M Wear I EQjNtods Minor Work 0 Needs major Wary Dose/S: ILabuiht En giae 0 Yes NO Miles on Rebuilt Cost:S TRANS: NOW built 0 Welt Maint Minor Wear 0 Needs Mbar Work U bleeds Major Work I Dzsc/S; R.ebuilt'Irans - Yes UNO Miles on Rebuilt I Cost:S OTHER MECHANICAL RECEIPTS DesclS; I Dates work donefTa s TIRES 0 ABOVE AVERAGE El AVERAGE 0 BE'U VV A4r'ERAGE FRONT 2JoSv or g0-I Ci0%of read. Rubber subs visible avoid tire treed. Good or 30-79%tread retrains. Wom of 9.29°A Of tread remain& Wear bar visible amid tire treed. REAR New or 80 ICi9°°Of tread. Rubber mobs visible amid Circ tread. Goad Or 30-79%tread remains. W oro or 0-29%of tread remains. Weer bar visible arnid tire tread. DM/S, ADD'L ADJUSTMS M W/Ct)MMFNTS(IQCI°/a$added or deducted)- ,,, GEN'L COMMENTS(to appear as text,no adjustments): r ti. K�a i, r a r, s t,r„�'✓�.ir '�;%-4� 'rt55i�r'"t�"��> ^� � y���4. r��i. �"`'i',�.��"��' �i,,;,%�x�i,��+},�.��,� �. y,. }s° r.� 'k� f ' v*�"� ����� �,a,�c ,�. �^+'a i � ���y3ay'�'�`�w}•t�""t���ie�a�� �< �'�'�"'�'� fd•'s.. c;" " >,�^� tri � � fi�''`y t"F�'d�;- ,��>x��$ „�,t����y; *�'�� t�.'���; ` � '• ,, �, � �� �"' °'rte , f���»��� 1 .t AN ,„,fir BRAM ti mow. 9' r- � z r f ^'+t}'Pp ,� •.;Tw��5� 2 j`+r.,-�`"h :'�S r��s�-� w`•�.�.�' S�;? �,�� �✓�"�` .�,�` -'�\ x, .,,�'r r3����� � '�' r� �,,;:: � �'�> t'r�>>. '° F„� c FSff` �" ���; �8 i�+r�z�yi°w � Y���s� �, "� � ✓ ti��: �uw= t`. F � P y � +'.r �'�, 5 ���t'-t-�� .rt`•t+°L�'�S�`` b,� r #�'� a {�.�` �i� ''r,F,' off° � A.?'�����"yx c'v' rr+ �.s j �'*. '. '�.✓ r F ��, � �,�%'t'•,�?•�}��>� �'�a'i�� ��s°,," `��i f:�: �s c s"k ��.a�� _%` x��`� �" 4' ,,. ✓ .,fir{ � '*vim,# "t�°,�?-t'4 ¢ .r � v t� x � � <>f � Pr >"ff .c i�P � c �" � �� M � �,Wr�u� {p�C�v��. ` '� �.�,s ,. ✓�iThY{ 5 �' ys+ '>�; � �,^ �- �..,5t✓� �.f d >tf� f r��� '- ,' Esq �, Y* 1r s �r .��'�G' LG r �Y' i G.._' � �,ys�,. �,r',✓a'� t fry ,at k.-,✓'�,;.yn"°'a'r� � r`�"`�`x' ✓� �s�,s"'.y1 'S�w� t E '�� f ; fir. � ✓) fi� yds t`zr, '� � „�fi� a s z kxta s Vs , a F. t a,a x „�., r `€� y x y>• ar £-� /�r # ._ yfi�a�y .�^ a'n. ,r :.a3 • y�v t;•, ' � .c e" k w't, a x• ?,Y' "°.,. ,� Y{�L �,' 451 ' "�� m";-0!s;•'> �' 's".7*� Qs''" •5 x a"`, ,� x r^,.„„ #'°' hf .p 'Nr- r.. a,. ZK zz r �:� � �� f+ �q,rg...,,y � - �''`-�',.`� sti "6 •. *€^x'c^'xy� ill Y r � k rr 5 k � IN 3 jr rx r _ r h s�' `} �" a; r ?�` ' t r } Yx �p r 2�', � �f^�'�,� � � +'t ✓z?`Y� �.�'`�frr�c k � 4 Y RM ­� MEN .r3r3` r` $� 9 i ggs $ * i ✓ M4 z* 1-0 .a+ s r�`°`�s �°�'' •�w � ���� �'`.� � r tic �' � .r 'IR rxa n � ''� �. tx> „aka' r�... '.5or•;. At >y .� J ��� <>�rh dry✓��y ,,. � i.�. �. �,9'+r �' y� s,;�r`. -� f / s � rz 7 ; " t +r ✓�"3 � r t&� �r ,�-3 T ;t —51 po „,r f ITT , sr oil � r > � 4 t§1',.z���,r fc�n r2. # xy-, ��Sc ^�`rr�:�. w �i �' 'r,�c5 w, m-���Y.F b x f ;4� »s✓r°��''` J:✓�a,i� z' '.�"'ori f�%�,.hir �f" �. "'.w�' ;'� Fr �,w �r ,tr lot„;;� o z;� r<v � rs l n}x r t, ; 2sr CLAIM # BOARD OF SUPERVISORS OF CONTRA COSTACC)UNTY BOARD ACTION:OCMBER 28, 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. J, notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given F . Pursuant to Government Code Section 913 and .. 915.4. Please note all"Warnings". AMOUNT: $1,000,000. f ALLIE M. LEE: AL LEE: MARIE SANDERS CLAIMANT: BARBARA CUNNINGHAM: MINOR CHILDREN OF 'PERRY LEE AND DOES 1-20 ATTORNEY: BELVIN KENT SMITH DATE RECEIVED: SEPT. 25, 2003 ADDRESS: 1970 BROADWAY, STUIE 1250 BY DELIVERY TO CLERK ON: SEPT. 25, 2003 OAKLAND, CA 94612 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a coley of the above-noted claim. JOHN SWEEV rk Dated: SEPTEMBER 25, 2003 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Superfisors XThis 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: te Deputy County Counsel Dated.: 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 13) Subject�p certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mfil 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 c'► ti--fied copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. �i W Dated: I L.AO'OHN SWEETEN, CLERK.By Deputy Clerk Sep 24 03 01 : 16p Clerk of the Board 926 336 1913 p. 1 Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY IISTR'UCTIQNS TO CLAWANT 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 I001 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 alter January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov't Code 911.2.)- B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street,.Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors,rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. . E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. RE:: Claim By Reserved for Clerk's filing stamp C , , ., - t. tt►,1t > RECEIVED ,. Againsf the County of Contra Costa or ) SEF 2 5 2003 *C wwo�►. District) CLERK (Fill in name) ) A ¢F SU'PEFVISORS CON f SfA Co. 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: L When did the damage or injury occur?(Give exact date and hour) ~4 '" , ►,S 2. Where did the damage or injury occur?(Include city andcounty) 3. How did the damageor njury occur?(Give full details;use extra paper if required) s�� irtr fie rL Ao +ti ;0 k + ► ', Ser" tdU-40 Sega 24 03 01 : 16p Clerk of the Soares 925 339 1513 p. 2 4. What particular act or ornission on the part of county or district officers, servants, or employees caused the in.ury or damage? F41Gvte-t 1-0 Adlv*Mt st"noiO,0a t•< Off, 40 /",v f44 0,0 e S. What are thr,names ofcoun or di trice officers, servants,or employees ca u ing the damage or injury? eO*tt�'4 6T .S te►k'r t�S` Cp ST,#V-&n 609t-V k'lt�., '81.LA �-raw AV, A WAA-0 006M 6. What damage or injuries do you claim resulted?(Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) De4T f . low :,t'e xotor0l 04w.rfwr 7. How was the amount Claimed above computed? (Include the estimated amount of any prospective lnlury or damage.) °oc of r*s M e4op S. Names and addresses of witnesses,doctors, and hospitals. 1-4 1lD r A-4&- ..tet /UC.t►fr► Mi' S_ 4',44.* 4W , TkP D owe 04*tRG 44 m*e*1 P 9%9OW 4r 9. List the expenditures you made on account of this accident or injury. DAM J111 AMOUNT („,lmf Mx w.a ArT N s s lr t t"a h r; Ond A-it 7D .P4*� Gov. Code Sec. 910.2 provides"The claim must be } signed by the claimant or by some person on his behalf." SEND NQnCES TO:_._JAttorne Name and Address of Attorney � Jt/#,U d ,tar'&-hr I r4 7 ct 7v e wa , ,y (Claimants Signature) DAkItom/, A 00a 7 I (Address) } � ell Telephone No,S'r C35 ) )Telephone No. 5/� 9 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 clairn,bill,account, voucher,or writing,is punishable either by imprisonment in the county}ail for a period of not more than one year,by a fine o(not exceeding one thousand($I,000),or by both such imprisonment and fine,or by imprisonment in the state prisons,by a fine of not exceeding ten thousand dollars($10,000),or by both such imprisonment and fine. cop� VETIGA l ME REPORT CAST~;#: 03-0713 Date: 03/31/2003 Time: 1430 Hours At 1.425 hours Contra Costa Regional Medical Center Doctor Wille telephoned to report the; death of'ferry Lee. Dr. Wille advised that on 3-34-2003 the decedent had been in the Main Detention Facility in Martinez when he suddenly collapsed and bye non responsive. The decedent was transported to the medical venter and admitted to ICU. Dr. Wille advised the decedent was tale Nifedipine at the time. It is unknown if the medication is involved in the death. Based on the culcumstances I assumed jurisdiction of the decedent. Dr. 'Mlle advised that the decedent's family was at the medical center and wanted access to the decedent. I asked to spew to a deputy guarding the decedent. I spoke with Deputy Borkert. Deputy Borkert advised that Sgt. poplin had authored the family to have access to the body. I requested that an officer remain m the room with the decedent and family until a Coroner's Deputy arrived to take custody of the decedent I advised. Sgt. England of the death. Sgt. England telephoned the Main Detention Facility and attempted to obtain a: copy of the decedent's medical records. Based on irunate booking records the decedent`s NOK will be his mother, Allie Lee. Deputy A. Burt Date: 04/02/2003 Time: 1530 Hours A representative from Fuller Funerals presented a release signed by the next of kin, Allie Lee, the mother of the deceased. I released the remains and all property to the representative. The representative also presented a check in the amount of$100.00 for the removal fee, receipt G1084692. 3eputy F. Smith )sate: 08/07/2003 Time: 1420 Hours On. 8/5/20193 a Coroner's Inquest was held into the decedent's death. The Coroner's u3ry, after hearing testimony from witnesses called before hearurg officer Stuart Wills, uled that the decedents death was from natural causes. The Certificate of Fath reflects the finding of the Coroner's Jury. eputy L. Martin C SHERIFF CoRoNjWS RspORT Page 4 Ys . OFFICE "' ""HE SHERIFF COROpWJv CORONER'S REPORT :BASSI ICATION: Nates CASE: 03-0713 3CEDENT: LEE TERRY Last First �diraCle WE REPORTED: 03/31 2003 TIME REPORTED: 1425 HOURS WE OF DEATH : 03131Z2003 TIME OF DEATH : 1421 HOURS ►A: Other I.D.: CDL#N0126211 )B: 12105/1953 _ AGE: 49 YEARS (UNDER 1 YE — MONTHS DAYS) O: Male RACE: Black EST HGT: 51101, EST W GT: 204 SIR: Black EYES: Brown SOCIAL SEC#: WAL ADDRESS: 2616 Bush Ave. IY STATE ZIP: Richmond,CA 94806 PHONE#: _ ('925) 646-4701 ENTIFIED BY: _ D duty Borkert DATE.- 03131 f 2002 TIME: 1430 HOURS )DRESS and PHONE#: `HER INVESTIGATING AGENCY: C.C.C.S.O. fENCY FILE#: 03-8919 ASSIGNED OFFICER: Borkert NEXT OF KIN Allie Lee Mother NAM€7F LEGAL NFAT OP KIiiir RRt.AMNSUP TO DECEASED D )DRESS: 2616 Bush Ave Richmond CA 94806 SIDENCE PHONE #: 510-237-9434 BUSINESS PHONE#: Abed Lee Brother At1MflPMEDALTI*.MTE NEXT OleKW RELA27ONSF W TO DBC ASW ,DRESS: 210 Riverview Drive V'alleio, CA 94 589 SIDENCE PHONE #: 707-642-5231 BUSINESS PHONE#: 925-686-7214 CAL NOK NOTTMD BY: _ Hospital Staff AGENCY: C.C.R.M.C. MMED DATE: 0313 X2003 TIME: 1421 HOURS HOW: In Person 'PORTED BY DEPUTY CORONER.- A. Burt SHERIFF C ACNER'S REPORT Peps i WENT: LEE.- 'PERKY CABS #; 03-0713 ism a FUNERAL HOME 0. C.: ft ler F=eral Inc. ZES S, PHONE: 4647 E. 14th. St., Oakland A 94601 510 534-2282 "LACE OF DEATH .'TION: Contra Costa Re 'anal Medical Center ICU &L'.,Kesaklenm/Hos t-.R or IP/PUb&or Private Roadumy, etc.,) ZESS: 2500 Alhambra Ave and S'TA'TE: _ Martinez, CA 94553 CORONEWS SEAL? No `OUNCED AND / OR DETERMINED BY: Dr. M. WMe R'TED BY: Dr. Wille PHONE #: A SED DISCOVERED BY: PHONE #: :ESS: REMOVED TO: ORDERED BY: A. Burt MEDICAL HISTORY LAR PHYSICIAN: PHONE #: JSS: LAST SEEN: MEDICAL NUMBER: ..AL HISTOR'Y'': taldne NIFEDIPINE FF CORONERS REPORT Page 2 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION OCTOBER 28, 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". l r AMOUNT: $33,781.12 CLAIMANT: KEITH SYKES ; ATTORNEY: UNKNOWN DATE RECEIVED: SEPT. 25, 2003 ADDRESS: 1500 PINE STREET, #58 BY DELIVERY TO CLERK ON:SEPI`. 25, 2003 CONCORD, CA 94520 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETEN, le .Dated: SEPTEMBER 25, 2003 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 PAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 914.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). ( } Other: Dated. Deputy County Counsel 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, OARD ORDER: By unanimous vote of the Supervisors present: ('V This Claim is rejected in full. { } Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: ` **&3 JOAN SWEETEN, CLERIC., By , Deputy Clerk WARNING(Gov. code section 913) Subject too 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 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: '' ' AA % JOHN SWEETEN, CLERK By Deputy Clerk Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO C..ADAPM 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, 1967, 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 carps 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 rause of action Must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims mint be filed with the Clerk of the Board of Supervisors at its office in Room " )6, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If c".aim 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: Clain 3y } Reserved for Clerk's filing stamp Against the County of Mntr a Costa ) or 2 Ilu District) ll in name ) �5?A PS The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ _33-79'1,l2 and in support of this claim represents as follows: 1. When dial the damage or in ju:7 occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full, details; use extra paper if required) �,Vr 4. "What particular act or omission on the part of county or district officers, se.rvants or ,employees caused. the injuur► or e? 4, � G1 ' ; j. Wnat are the names of county or district officers, servants or employees causing the damage or injury? p4 � = 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. 7. How was the amount claimed above computed? (Include the estimated amour'; of any prospective .injury or damage.) iZ p jlge,5�',4"�e5-",t!4- 8. rNames�and�addresses of witnesses, doctors and hospitals. lt"1 f_J 9TH sl lel C1 2,, 71. 5 367 6-5, " 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sea. '910;2 provides: "The claim must be signed by the claimant SEND NOTICES T0: (Attorney) orb some .person on his.behalf." Name and Address of Attorney laimantIs Signature Address Telephone No. Telephone No. les- .6 4 * * * * N 0 T I CE .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 ($11400) 1, 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. Elate: 9122103 02:23 PM Estimate ID: 2606 Estimate Version: 0 Prehminary Profile 10: Mitchell Mhke Rose's Aute Body, Inc. 2260 Via De Mercados Concord,CA 948204920 (925)689-1739 Fax: (926)699-0991 Tax ID: 94-2621349 BAR M 0969527 EPA#: CAR 000004317 Damage Assessed By: ED DIZON Condition Code: Good Payer: Customer Deductible: UNKNOWN Owner KEITH SYKES Address: 1600 PINE ST.#58 CONCORD,CA 84620 Telephone: dome Phone: (925)699-8497 Mitchell Service: 911779 Description: 2003 Nissan Maxima OLE Vehicle Production Date: 6102 Body Style: 4D Sed Drive Train: 3.6L Inj 6 Cyl 4A VIN: JN1DA31A03T414344 License: 6AUU996 CA Mileage: 6,300 OEM/ALT: O Search Code: None Color: MET SILVER Options: ANTI-LOCK BRAKE SYS.(ABS),ALUM/ALLOY WHEELS,AIR CONDITIONING,POWER STEERING POWER WINDOWS,POWER DOOR LOCKS,TILT STEERING WHEEL,CRUISE CONTROL ELECTRIC DEFOGGER,AUTOMATIC TRANSMISSION,CUSTOM PKG.,POWER DRIVER SEAT AM-FM STEREOiCDPLAYER(SINGLE),FOG LIGHTS,PASSENGER-FRONT AIR BAG POWER REMOTE MIRROR,4 WHEEL DISC BRAKES,FRONT WHEEL DRIVE,POWER ANTENNA VB ENGINE,4-DOOR,DRIVER-FRONT AIR SAG "ALL CRASH PARTS ON THIS ESTIMATE ARE "NEW" ORIGINAL EQUIPMENT MANUFACTURER PARTS, UNLESS OTHERWISE SPECIFIED. PARTS DESCRIBED AS RECHROMED,RECORED,REMANUFACTORED OR, RECONDITIONED ARE CONSIDERED "REBUILT" PARTS. CRASH PARTS DESCRIBED AS "QUALITY REPLACEMENT PART" ARE NON—ORIGINAL EQUIPMENT MANUFACTURER AFTERMARKET NEW PARTS" Line Entry Labor Line Item Part Type/ Dollar Labor CEG Item Number Type Operation Description Part Number Amount Units Uni, 1 100393 BDY REPAIR WHEEL Sublet 166.00* 0.0* 03 i RT REAR WHEEL SCRATCHES 3 100998 BDY REMOVE/INSTALL R ROCKER MOULDING 0.4 # 0.4 4 101580 REF BLEND R REAR DOOR OUTSIDE C 0.8 210 6 101886 BDY REMOVEIINSTALL R REAR BELT MLDG 0.3 0.3 6 101869 BDY REMOVE/INSTALL R REAR DOOR REAR WINDOW FRAME MLDG 0.3 # 0.3 7 102236 BDY REMOVE/REPLACE R REAR DOOR ADHESIVE MOULDING $2970-SY776 64.97 0.2 012T $ 101894 BDY REMOVEAN.STALL R REAR DOOR TRIM PANEL INC 04 9 101640 BDY REMOVE/INSTALL R REAR DOOR HANDLE 1.5 # IS 10 101736 REF BLEND ROOF PANEL C 1.1 2.8 11 101762 BDY REMOVEIINSTALL R ROOF SIDE RAIL WEATHERSTRIP Existing 0.3* 0.3 12 101$13 GLS REMOVE/INSTALL BACK WINNOW 0.4 # TA 13 101816 BDY REMOVE/REPLACE BACK WINDOW MOULDING 79760-2Y010 86.63 T 14 101$32 BDY REMOVE/REPLACE R QUARTER OUTER PANEL 7$112-6Y730 416.05 16.6 # 15,0" ESTIMATE RECALL NUMBER: 9/22/03 14:23:09 2606 UltraMate is a Trademark of Mitchell International Mitchell Data Version: SEP-03_A Copyright(C)1594-2002 Mitchell International Page 1 of 3 UltraMate Version: 4.8.012 All Rights Reserved Date: 8/22103 02:23 PM Estimate IO: 2905 Estimate Version: 0 Preliminary Profile ID: Mitchell 16 AUTO REF REFINISH R QUARTER PANEL OUTSIDE C 2.0 2.0 16 AUTO REF REFINISH R LOCK PILLAR C 0.6 0:{ 17 AUTO REF REFINISH R QUARTER PANEL EDGE C 0.6 0.5 18 101834 BDY REMOVE/REPLACE R QUARTER LAMP MOUNT PANEL 78140-2Y900 36.40 1.0 1.0T 19 101902 BDY REPAIR LUGGAGE LID PANEL Existing 3.0* 1:2 20 AUTO REF REFINISH LUGGAGE LID OUTSIDE C 1.8 2:i. 21 101932 BOY REMOVE/REPLACE LUGGAGE LID WEATHERSTRIP 84830-2Y900 60.04 0.3 0,3 22 101847 BOY REMOVE/REPLACE LUGGAGE LID ADHESIVE EMBLEM 84890-SY700 20.05 0.2 p k£ 23 101948 BOY REMOVE/REPLACE LUGGAGE LID ADHESIVE NAMEPLATE 94894-SY700 16.67 0.2 0.2" 24 101949 BOY REMOVEIREPLACE LUGGAGE LID ADHESIVE NAMEPLATE 84896-SY700 20.06 0.2 0.2T 26 102022 BOY REMOVEIREPLACE REAR BODY PANEL 79110-2Y900 196.36 4.2 # GAT 26 AUTO REF REFINISH REAR BODY PANEL C 1.6 2.0 27 AUTO REF REFINISH ADD FOR EDGE&INSIDE. C 0.8 0.8 28 102046 BOY REMOVEIREPLACE R REAR BODY FINISHER 84960.3Y112 71.62 0.2 0.2 29 102065 BOY REMOVE/INSTALL L REAR COMBINATION LAMP INC 0.4 «0 102096 BOY REMOVE/REPLACE R REAR COMBINATION LAMP ASSEMBLY 28660-6Y725 130.70 INC 0/1 31 102127 BOY OVERHAUL REAR COWER ASSY 0.8 # 1.8 32 102128 BOY REMOVE/REPLACE REAR BUMPER COVER 96022-2Y925 201.32 INC # 1:.5' 33 AUTO REF REFINISH REAR BUMPER COVER C 2.2 2.2 34 102138 BOY REMOVE/REPLACE R REAR BUMPER MOUNTING BRACKET 85220-2Y900 28.35 INC T 36 102141 BOY REMOVE/REPLACE R REAR UPR BUMPER MOUNTING BRACKET 86040-2Y900 12.63 INC T 36 102143 BOY REMOVE/REPLACE REAR BUMPER IMPACT CUSHION 85090-2Y900 71.18 INC 14T 37 102145 BOY REMOVE/REPLACE REAR BUMPER ABSORBER REINF 86032-2Y900 216.08 INC 1.9- 38 :8 '38 936012 ADO'L COST HAZARDOUS WASTE DISPOSAL 3.00" T 39 936014 ADD'L COST FLEX ADDITIVE T 40 AUTO REF ADD'L OPR CLEAR COAT 3.0 41 933003 REF ADD'L OPR TINT COLOR 0.6* 42 933005 BOY ADD`L OPR RESTORE CORROSION PROTECTION 16.00* 0.5* 43 933009 FRM ADD%OPR FRAME/RACK SET UP 1.5* f. 44 933017 REF ADO'L OPR COLOR SAND&BUFF 2.0* 45 933018 REF ADO'L OPR MASK FOR OVERSPRAY 10.00* 0.3* 46 933036 FRM ADD'L OPR SHEETMETAL PULL 3.0* 47 RT REAR AREA 48 AUTO ADD'L COST PAINT/MATERIALS 370.00* 0 900600 MCH* ADD'L LABOR OP MOUNT AND BALANCE Sublet 18.00* 0.0* 900600 BDY* REPAIR SHEETMETAL FABRICATION Existing 2.0* II 61 BY ORT PNL AREA 52 MAY HAVE HIDDEN PARTS DAMAGED E 63 NEEDS TEAR DOWN FOR INSPECTION Judgement!tern #-Leber Neste Applies $, C-Included in Clear Coat Calc Remarks REAR RT DAMAGES {4 ESTIMATE RECALL NUMBER: 9/22/03 14:23:08 2605 Ultra Mate is a Trademark of Mitchell International Mitchell Data Versions SEP 03_A Copyright(C)1994-2002 Mitchell International Page 2 of 3 UltraMate Version: 4.8.012 All Rights Reserved Date: 9/22103 02:23 PM Estimate ID: 2606 Estimate Version: 0 w. Preliminary Profile ID: Mitchell Add'] Labor Sublet Labor Subtotals Units Rate Amount Amount Totals 11. Part Replacement Summary Amount Body 31.1 66.00 16.00 166.00 2,201.60 T Taxable Parts 1,607.89, Refinish 17.1 66.00 10.00 0.00 1,121.60 T Sales Tax f 8.250% 132.66== Glass 0.4 66.00 0.00 0.00 28.00 T Frame 4.15 86.00 0.00 0.00 292.50 T Total Replacement Parts Amount 1,740.54 Mechanical 0.0 66.00 0.00 18.00 18.00 T Taxable tabor 3,669.50 Labor Summary 53.1 3,659.60 Ill. Additional Costs Amount IV. Adjustments Amount Taxable Casts 373.00 Customer Responsibility 0.00 Sales Tax 8.250% 30.77 Total Additional Costs 403.77 1. Total Labor: 3,859.60 II. Total Replacement Parts: 1,740.64 Ill. Total Additional Costs: 403.77 s Gross Total: 6,803.81 { y. IV. Total Adjustments: 0.001. Net Total: 6,803.81 This is a Preliminary estimate. Additional changes to the estimate may be required for the actual repair. Point(s)of Impact 5 Right Rear Corner(P) Insurance Co: CONTRA COSTA RISK MANAGEMENT WARNING: Accidental air bag deployment is possible. Personal injury may result Avoid area near steering wheel and Instrument panel even if air bags have deployed. Dual-stage air bag modules may be present that could contain an undeployed stage. When disposing of a deployed dual-stage air bag,always treat It as a"live"module. See appropriate MITCHELLS AIR BAG SERVICE&REPAIR MANUAL,or OEM Information. s ESTIMATE RECALL NUMBER: 9/22/03 14:23:08 2605 UltraMate is a Trademark of Mitchell International Mitchell Data Version: SEP 03_A Copyright(C)1994-2002 Mitchell International Page 3 of 3 UltraMate Version: 4.8.012 All Rights Reserved 09/12/2003 at 12:11 PM job Number: 16014 M2 COLLISION - CONCORD License #:AH2O0993 Federal ID #:330577123 BAR# AH2O0993 EPA #008252405 2291 VIA DE MERCADOS CONCORD, CA 94520 (925)685-2294 Fax: (925)685-7295 PRELIMINARY ESTIMATE Written By: HONESTY BRADY Adjuster: Insured: KEITH SYKES Claim # Owner: KEITH SYKES Policy # Address: 1500 PINE ST Deductible: CONCORD, CA 94520 Date of Loss: Evening: (925)698-8487 Type of Loss: Point of Impact: Inspect M2 COLLISION - CONCORD Business: (325)6$5-2294 Location. 2291 VIA DE MERCADOS CONCORD, CA 94520 Insurance Company: 15 Days to Repair 2003 NIBS MAXIMA GLE 6-3.5L-FI 4D SED SILVER TIN: ?N1DA31A03T414344 Lic: Prod Date: odometer: Air Conditioning Rear Defogger Tilt wheel guise control intermittent Wipers keyless Entry Theft Deterrent/Alarm steering wheel controls Body side Moldings Dual Mirrors clear Coat Paint Power Steering Power Brakes Power windows Power Locks Power Driver Seat Power Mirrors Power Trunk/Tailgate Anti-Lock Brakes (4) Driver Air Bag Passenger Air Bag Front side Impact Air Bag 4 wheel Disc Brakes Leather seats Bucket seats Recline/Lounge seats Aluminum/Alloy wheels ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1 REAR BUMPER 2 O/H rear bumper 2.2 1 09/12/2003 at 12:11 PM Job Number: 16014 PRELIMINARY ESTIMATE 2003 NISS MAXIMA GLE 6-3.5L-FI 4D SED SILVER ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 3 Repl Bumper cover 1 201.32 Incl . 2.8 4 Add for clear Coat 1.1 5 Repl RT Bumper cover mount bracket 1 12.53 Incl . Outer 6 Repl RT Bumper cover side bracket 1 29.35 Incl . 7 Repl RT Bumper cover clip 1 3.95 Incl . 8 Repl Energy absorber 1 71.18 Incl . 9 Repl Reinforcement 1 216.08 Incl . 10 Repl RT Reinforcement stay 1 31.58 Incl . 11 REAR LAMPS 12 Repl RT combo lamp assy all 1 130.70 Incl . 13 Repl RT Lens assy 1 27.07 Incl . 14 Repl RT Mount bracket 1 4.20 15 Repl RT Mount bracket trim plate 1 26.07 Incl . 0.2 silver 16 TRUNK LID 17* Rpr Trunk lid GLE, GXE 3.00 2.1 18 Add for clear coat 0.8 19 R&I Finish panel silver 0.2 20 Repl weatherstrip 1 60.04 Incl . 21* R&I Cyl & keys 0O5 22 Repl Emblem 1 20.05 0.2 23 Repl Nameplate "MAXIMA" all 1 16.57 0.2 24 Repl Nameplate "GLE" 1 20.05 0.2 25 REAR BODY & FLOOR 26 Repl Rear body panel 1 196.35 4.8 1.5 27 Overlap Major Adj . Panel -0.4 28 Add for clear Coat 0.2 29 Add for Inside 0.8 30* Rpr Rear floor pan rear 3..0 1.5 31# Pull Rear Body and Floor 1 1.0 32 QUARTER PANEL 33 Repl RT Quarter panel 1 415.05 15.0 3.0 34 Overlap Major Adj . Panel -0.4 35 Add for Clear coat 0.5 36 Deduct for Overlap -1.3 37 Deduct for Rear Bumper R&i -1.4 2 09/12/2003 at 12:11 PM .lob Number: 16014 PRELIMINARY ESTIMATE 2003 HISS MAXIMA GLE 6-3.5L-FI 4D SED SILVER ______r__.._____________W_____-________..____-________-__-__-________-_____-____.. NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 38* R&I RT Drip rail 0.5 39 Repl RT inner wheelhouse 1 158.13 4.5 40 Repl RT outer wheelhouse 1 134.37 Incl . 41 Blnd LT Quarter panel 1.1 42 R&I Fuel door 0.3 43 Refn Fuel door 0.3 44 Add for Clear Coat 0.1 45 BACK GLASS 46 R&I Glass Nissan w/o Bose system Incl . 47 REAR DOOR 48 Blnd RT Outer panel 1.2 49 R&I RT window molding 0.3 50 R&I RT Belt w'strip 0.3 51 Repl RT Body side mldg silver 1 54.97 0.4 0.4 52* R&I RT Fixed glass Nissan 00.66 53 R&I RT Handle, outside GLE, GXE 0.4 silver 54 R&I RT R&I trim panel 0.5 55 ROOF 56 Blnd Roof panel 1.5 57 R&I RT Drip w'strip 0.5 58 R&I LT Drip w'strip 0.5 59# Rape windshield 1 0.5 60# Haz waste 1 3.00 X 61# Restore Corrosion Protection 1 0.3 62# Cover Car 1 0.2 63# set up and Measure 1 2.0 F 64# **15 working Days 1 ------------------------------------------------------------------------------- Subtotals 1832.61 39.1 18.6 3 09/12/2003 at 12:11 PM Job Number: 16014 PRELIMINARY ESTIMATE 2003 NISS MAXIMA GLE 6-3.5L-FI 4D SED SILVER Parts 1829.61 Body Labor 32.1 hrs @ $ 65.00/hr 2411.50 Paint Labor 18.6 hrs @ $ 65.00/hr 1209.00 Frame Labor 2.0 hrs @ $ 65.00/hr 130.00 Paint Supplies 18.6 hrs @ $ 28.00/hr 520.80 Sublet/Misc. 3.00 ---------------------------------------------------- SUBTOTAL $ 6103.91 Sales Tax $ 2350.41 @ 8.2500% 193.91 ---------------------------------------------------- GRAND TOTAL $ 6297.82 ADJUSTMENTS: Deductible 0.00 ---------------------------------------------------- CUSTOMER PAY $ 0.00 INSURANCE PAY $ 6297.82 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 NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION NO--LINE NUMBER QTY=QUANTITY QUAL RELY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT 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. MQVP=MANUFACTURER`S QUALIFICATION AND VALIDATION PROGRAM. 4 09/12/2003 at 12:11 PM Job Number: 16014 PRELIMINARY ESTIMATE 2003 HISS MAXIMA GLE 6-3.SL-FS 4D SED SILVER Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide ARF3799 Database Date 8/2003 and the parts selected are OEM-parts manufactured by the vehicles original Equipment manufacturer. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Non-original Equipment manufacturer aftermarket parts are described as Am, Qual Repl Parts or Comp Repl Parts which stands for competitive Replacement 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. 5 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: OCTOBER 28, 2103 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". 1 ..f -.}yr ' '.• .a r AMOUNT: $680.75 < A CLAIMANT: KIM TIED ,t < :;1.• ATTORNEY: UNKNOWN DATE RECEIVED: SEPT. 26, 2003 ADDRESS: 1849 TOYON DRIVE BY DELIVERY TO CLERK.ON: SEPT. 26, 2003 CONCORD, CA 94520 BY MAIL POSTMARKED: SEPT. 22, 2003 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claire. JOHN SWEETEN : 1 Dated: SEPTEMBER 26, 2003 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors XM1 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: � �� � ;- .,�F' } By tv ` 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). IIV.AOARD 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:AL&Ig' cOAW 3 JOHN SWEETEN, CLERK, By Deputy Clerk s p Y WARNING (Gov. code section 913) Subject 0 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. *Far 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: '' JOHN SWEETEN, CLERK BY Deputy Clerk Clain to. BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO Ct.,APAANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and Mich accrue on or before December 31, 1987, must be presenters 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 Soars! of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. ' Fraud.. See penalty for fraudulent claims, Penal. Cade Sec. 72 at the end of this fo.^m. RE: Claim By } Reserved for Clerk's filing stamp Against the County sof Contra Costa ) SEP 2 6W l or CLARK 6C3A#�j ?=S�fr�c�s4'3a��{ District) CONTA C057Aco: S Fill in name ) The undersigned claimant hereby takes claim ithe County of Contra Costa or the above-named District in the sum of $ ' and in support, of this claim represents as follows: 1. When did the damage or injury occur': (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full details; use extra paper if required) 4. What particular act or omission on the part of county or district officers, servants or .employees caused- the injury or damage? �...rc .. (aver) Wnat are the names of county or district officers, servants or employees causl.t . the damage or injury? �' / i 0, ✓} 5. What damage or injuries do you claim resulted"? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. 7. How was the amount claimed above computed? (Include the estimated ,amount of any prospective injury or damage.) B. *lames and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910;2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or some person on his. behalf." Name a-nd Address of Attorney t Claimant's Signature { "` ,. Addressr Telephone No. Telephone No N O T I C E Section 72 of the Penal. Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if .genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($I,QGU), or by both such imprisonment and fine;-'or by imprisonment in the state prison, by a fine of not exceeding tent thousand dollars ($14,000, or by both such imprisonment and fine. 09/11/2003 at 09:03 AM Job Number: 41212 KEE'S AUTO BODY Federal ID #:680469355 WE MEET THE NICEST PEOPLE BY ACCIDENT 2171 MONUMENT BLVD. CONCORD, CA 94520 (925) 671-9432 Fax: (925)688-8998 PRELIMINARY ESTIMATE Written By: Adjuster: Insured: KIM TIEU Claim # Owner: KIM TIEU Policy # Address: Deductible: Date of Loss: Other: (925) 681-2106 Type of Loss: Point of Impact: Inspect KEE'S AUTO BODY Business: (925) 671-9432 Location: 2171 MONUMENT BLVD. CONCORD, CA 94520 Insurance Company: Days to Repair 2001 HOND ACCORD VALUE PACKAGE 4-2.3L-FI 4D SED VIN: 1HGCF86641AO87131 Lic: Prod Date: Odometer: 55001 Air Conditioning Rear Defogger Tilt Wheel Intermittent Wipers Body Side Moldings Dual Mirrors Clear Coat Paint Power Steering Power Brakes Driver Air Bag Passenger Air Bag Cloth Seats Bucket Seats Recline/Lounge Seats --------------_..---------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1 REAR BUMPER 2** Repl RECOND Bumper cover USA built 1 198.00 1.1 2.8 3 Add for Clear Coat 1.1 4# Refn TINT COLOUR 0.5 54 HAZ WASTE CHARGE 1 5.00 X 6# FLEX ADDITIVE 1 7.00 -------------------------------------------------------------------------------- Subtotals =_> 210.00 1.1 4.4 Parts 205.00 Body Labor 1.1 hrs @ $ 60.00/hr 66.00 Paint Labor 4.4 hrs @ $ 60.00/hr 264.00 Paint Supplies 4.4 hrs @ $ 24.00/hr 105.60 Body Supplies 1.1 hrs @ $ 8.00/hr 8.80 Sublet/Misc. 5.00 ---------------------------------------------------- SUBTOTAL $ 654.40 Sales Tax $ 319.40 @ 8.2500 26.35 ---------------------------------------------------- GRAND TOTAL $ 680.75 INSURANCE PAY $ 680.75 1 09/11/2003 at 08:59 AM Job Number: 41212 PRELIMINARY ESTIMATE 2001 HOND ACCORD VALUE PACKAGE 4-2.3L-FI 4D SED ALTERNATE PARTS SUPPLIERS 2 RECOND Bumper cover USA bui Part No. HO1100184RP+ Price $198.00 Keystone Auto (800)7946911. 1069 HENSLEY STREET (510)234-6960 RICHMOND, CA 94807. Keystone Auto (916)3'72-3300 1045 TRIANGLE COURT, SUITE B (800) 669-7528 W. SACRAMENTO, CA 95605 4 09/11/2003 at 09:03 AM Job Number: 41212 PRELIMINARY ESTIMATE 2001 HOND ACCORD VA1,UE PACKAGE 4-2.3L-FI 4D SED ESTIMATE OF REPAIR The Estimate of Repair includes parts, labor, diagnosis, and any applicable taxes. If, on further inspection, additional parts or repairs are needed, you will be contacted for authorization. We are not responsible for loss or damage to your vehicle from `ire, theft, accidents or any cause beyond our control. All tests will be made by our employees at your risk. AUTHORIZED SIGNATURE: DATE. ADD'L REPAIR AUTHORIZATION AMOUNT:$ DATE:--- PHONE ATE:PHONE NO. : TIME; PERSON CONSENTING: If vehicle is returned to customer before authorized repairs are performed, a diagnostic and handling charge, including reassembly, will be made. POWER OF ATTORNEY - I do hereby appoint the aforementioned business as my attorney in fact to accept on my behalf any and all checks, drafts, or bills of exchange for deposit to the aforementioned business' account for credit on my account for repairs on my vehicle which has been released and accepted. ACCEPTED BY: DATE OFFICE USE ONLY================== DEDUCTIBLE: $ Received From Amt Recd Type of Payment BalanceDue Repaired As Per Owner own authorized. THE FOLLOWING IS A LIST OF ABBREVIATTONS 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 NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT 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. MQVP=MANUFACTURER'S QUALIFICATION AND VALIDATION PROGRAM. 2 Y� 5 w C t ' s CLAIM ` BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY f✓ BOARD ACTION: OCTOBER 28, 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 yours your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given e Pursuant to Government Code Section 913 and 915.4, please note all"Warnings". SE AMOUNT: AMOUNT REST WITHINY �i i&ION OF THE UNLIMITED JURISDICTION COURT CLAIMANT: LINDA KING AND LEGAL GUARDIAN OF REBECCA KING, a minor ATTORNEY: STEVEN L. DERBY DATE RECEIVED: SEPT. 26, 2003 ADDRESS: THE DERBY LAW FIRM BY DELIVERY TO CLERK ON: SEPT. 26, 2003 TWO WALNUT CREEK CENTER 200 PRINGLE AVENUE, SUITE 350 BY MAIL POSTMARKED: UNKNOWN DATE WALNUT CREEK, CA 94596 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOIN SWEETEN �OP Dated: _-- SEPTEMBER 26, 2{03 By: Deputy A 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 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: ; 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: Vfid►.PG1 ' JOHN SWEETEN, CLERK, By , Deputy Clerk WARNING{Gov. code section 913) Subject�p certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the m#il 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. *Far 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: oA4CXHN SWEETEN, CLERK.By Deputy Clerk Tbe erb p 103 fim Professional Corporation Two Walnut Creek Center Tel -(925)935-8923 200 Pringle Avenue,Suite 350 Fax-(925)937-4273 Walnut Creek,CA 94596 September 25, 2003 Contra Costa County Board of Supervisors t, 651 Pine Street, lst Floor � �fas Martinez, CA 94553 Re: King-v. County of Contra Costa, et al. HONORABLE MEMBERS OF THE BOARD: This is a Government Tort Claim brought on behalf of Linda King for herself and as legal guardian of Rebecca King, a minor who both live at 118 Arapaho Circle, San Ramon, CA 945832496. All communications should be through this office. You are specifically instructed not to contact either Linda King or Rebecca King. The events which give rise to this claim are as follows: On March 27, 2003, a vehicle driven by Linda King in which Rebecca King was a passenger was struck by an emergency vehicle belonging to the City of San Ramon and being operated by San Ramon police officer Charles Clifford Escover. The collision took place on Broadmoor Drive near its intersection with Weymouth Court in front of the exit driveway for the municipal pool and High School. The police report prepared by investigating officers from the Danville Police Department is attached for your reference and information. The Danville Police who investigated this incident failed to take into account (1) The Officer's poor judgment in deciding to pursue an alleged speeder through a school zone in the middle of the day at a speed in excess of 25 MPH (2) The poor visibility for Ms. King(because of legally-parked cars)while exiting the driveway, and(3) The inattention of the Officer in failing to avoid Ms. King when he clearly could have without crossing the center line if he had been maintaining a proper lookout. As the report discloses, Officer Escover, traveling at an excessive rate of speed,passed the entrance of the San Ramon Olympic Pool and California High School when the passenger side of his vehicle struck the front of the King vehicle spinning that vehicle violently to the right and causing severe damage to it. Officer Escover then proceeded to hit two other vehicles before finally bringing his patrol vehicle to a stop. We contend that Officer Escover was negligent in the operation of his vehicle. We further contend that Officer Escover's supervisors were negligent in their training, hiring, retention and supervision of him. The names of these individuals are not known at this time. Page Two Re: King v. County of Contra Costa, et al. We further contend that a patrol vehicle driven by Officer Escover was inappropriately equipped,modified, repaired and/or maintained and that such was a legal cause of the incident along with Officer Escover's negligence in operation of that vehicle. We are informed and believe that the County of Contra Costa through its sheriff's office contracts to provide police services through the City of San Ramon and that, as such, an on duty police officer such as Officer Escover is an employee of Contra Costa County and is driving a county-owned emergency vehicle. As a result of the incident, Linda King sustained severe damage to her vehicle which had to be repaired. Both Linda King and Rebecca King sustained severe injuries which required medical treatment and some of which continue to bother and affect them to this day. Based upon the foregoing, Linda King for herself and on behalf of Rebecca King, a minor presents this Government Tort Claim against the County of Contra Costa in an amount which will rest within the jurisdiction of the Unlimited Jurisdiction Court. Resperully submitted, Sk-VEN ;DERBY SLD/mm Enclosure MM/Clients/King/Letters/Letter to Contra Costa County 9 25 03.doe ISTATE OF CALIi=pFlN A TAAFFIC COLLISION REPORT CHI'555 BARS Plage 1 (Rev 8198)OPI 442 page 1 of 13 SPECIAL CONDITIONS W-WER OOT a Am CITY JUDICIAL DISTRICT LOCAL REPORT NUMBER tPR.£LNINARY Guam FrLo t ON-DUTY EMERGENCY VEHICLE 1 DANVILLE WALNUT CREEK COURMYREPORT NUM81IRMU:ee COLWTY REPORTING DISTRICT BEAT 03-8510 0 CONTRA COSTA 25 72 COLLISION OCCURRED ON: MO DAY YEAR TIME(8400) NCIC N OFFICER 1.0. 2 BROADMOOR DRIVE 0312712003 1243 0700 43759 MILEPOST INFORMATION: DAY OF WEEK TOW AWAY PHOTOGRAPHS BY: F1 NONE THi3RSDAYX YES NO D.HEINBAITCrFi OINTEPSECTION wrTH: STATE HwY REL 46512 �AT OR: 113 DEET SOUTH OF WEYMOUTH COURT El YES NO PARTY DRIVER'S LICENSE NUMBER STATE CLASS EOUtP.SAPETY VOLKS PASSAT WFL VEH.YEAR MAKE I MODEL/COLOR LICENSE NUMBER STATE ______j 1 A1667660 CA C G 2002 4YNP940 CA DRIVER NAME(FIRST.MIDDLE,LAST} FX-j LINDA C.KING OWNERS NAME �i SAME AS DRIVER PEDES- STREET ADDRESS I� THAN 118 ARAPAHO CIRCLE OWNERS ADDRESS n SAME AS DRIVER PARKED CITY/STATE/ZIP LJ VEHICLE - � - SAN RAMON CA 94583 DISPOSITION OF VEHICLE ON ORDERS OF: F1E y u OFFICER iDRIVER OTHER �'• SEX HAIR EYES HEIGHT WEIGHT BIRTHDAY!; RACE SAN RAMON TOW-(925)820-6304 CLIST Mo Day Year - F BRN BLU 5-05 120 09/29/I955 PRIOR MECIi,DEFECTS NONE APP. REFER TO NARRATIVE OTHER HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER: (925)833-8771 CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE UNKNONE MINOR ALLSTATE 6 99 952873 07/03 MOD X MAJOR ROLI OVER H- DIR OF TRAVEL ON STREET OR HIGHWAY SPEED LIMIT CA DOT W BROADMOOR DRIVE 25 CALT TCP/PSC MtJMx ARTY ORIVER'a LICENSE NUMBER STATE CLASS SAFETY VEH.YEAR MAKE i MODEL!COLOR LICENSE NUMBER STATE 2 N7197134 CA C G 2001 FORD CROWN VI Ww 1071533 CA DRIVER NAME(FIRST,MIDDLE,LAST) ON DUTY EMERGENCY VEHICLE FX-j CHARLES CLMRD ESCOVER OWNERS NAME ❑SAME AS DRIVER PEDES- STREET ADDRESS CY SAN RAMON TRIAN 2222 CAMINO RAMON OWNER'S ADDRESS (X 1$AME AS DRIVER PWN PARKED CITY/STATE/ZIP !�J V SAN RAMON CA 94583 DISPOSITION OF VEHICLE ON ORDERS OF: El OFFICER DRIVER OTHER BICY• SEX HAIR EYES HEIGHT WEIGHT BIRTHDATE RACE SAVE TOW-(925)866-7283 � OUST Mo DaY Y. M BRN GRN 6-00 165 03131/1959 PRIOR MECHANICAL DEFECTS � NON€APP. REFER TO NARRATIVE OTHER HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER: -LI ( ) _ (925)373-2700 CHP USE ONLY DESCRIBE VEHICL€DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER VEHICLETYPE LINK NON€ nMINOR RISK MANAGEMENT.. MOD ZAAJOA RDLLOVER DIROF TRAVEL ON STREET OR HWAY SPEED LIMIT CA DOT N BROADMOOR DR 25 CALT TCP/M MCAdx PARTY DRIVER'S LICENSE NUMBER $TAT€ CLASS SAFETY VEH.YEAR MAKE/MODEL/COLOR LICENSE NUMBER STATE 3 1994 HONDA CIVIC BLU 3HSU406 CA DRIVER NAME(FIRST,MIDDLE,LAST) -.- ElOWNERS NAME El SAME AS DRIVER PPEOF STREET ADDRESS COX,CHIT"B TRAN OWNERS ADDRESS [(SAME AS DRIVER vPEARKE CITY/STATE/ZIP 2479 TALAVERA DR SAN RAMON CA 94583 X DISPOSITION OF VEHICLE ON ORDERS OF: OFFICER DRIVER X THER SICY• Sex HAIR EYP$ tI�IGHr WEIGHT BIRTHDATE RAc€ LEIS i'AT SCENE DUST w Day Year PRIOR MECHANOIAL DEFECTS X .NONE APP. F€R TO NARRATIVE OTHER HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER: 11 CHP USK ONLY DESCRIBE-VEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE LINK NONE �Mll,*R OD MAJORROLL-OVER DIR OF TRAVEL ON STREET ORHIGHWAY SPEED LIMIT CA DOT N BROADMOOR DR 25 CAL-T TCP/PSC MC?Mx PREPARERS NAME OfSPOA70HNOTIFIED - REVIEWER'S NAME DATE REYI£WED - MICHAEL BRIGGS 43759 YES DOOWA r�� ucs (( j `-2 5— 'TAT&OF CALIFORNIA rRAPFIC COLLISION REPORT `HP 555 CARS Page 1 (Rev 8/98)OP1042 pqm 2 of 13 SPECIA.CONDIMNS rnfea0[A Ta+ + CITY JUDICIAL DISTRICT LOCAL REPORT NUMBER PRELIMINARY xvn�naa ruww+ ON-nurY EMERGENCY VEHKIE 1 17A1�YD LE WALNUTCREEK COURT'ESYREPORT mumsmaim * A COUNTY REPORTING DISTRICT BEAT 03-8510 0 ICONTRA COSTA 25 72 COLLISION OCCURRED ON: - MO DAY YEAR TIME(24M NC1C N OFFICER I.D. Z BROADMOOR DRIVE 03/27/2003 1243 0700 43759 MILEPOST INFORMATION: DAY Of WEEK TOW AWAY PHOTOGRAPHS BY: ("""NONE THURSDAY }( YES NO D.HEINBAUCH f� AT INTERSECTION WITH: STATE HWY REL 46512 R: 113 FEETSOUTH OF WEYMOUTH COURT YES X NO 'ARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEH.YEAR MAKE I MODEL!COLOR LICENSE NUMBER STATE €QUIP. 4 2002 DODGE JAM G D 6Y81067 CA DRIVER NAME(FIRST,MIDDLE,LAST): OWNERS NAME SAME AS DRIVER TRo STREET ADDRESS SWEDELSON,DAVM OWNER'S ADDRESS SAME AS DRIVER - 'ASCL CITY rSTATE tZIP 122 ARAPAHO C1R SAN RAMON CA 94583 �—� X DISPOSITION OF VEHICLE ON ORDERS OF: �Omm i ?ORIVER I y I OTHER GYIST SEX HAIR EYE8 HEI�3HI'T WEIGHT BIRTHDATE RACE LEE1"T AT SC NE L.J L::J Mo Day Yaae PRIOR MMH.DEF€CT8 NONE APP, REFER TO NARRATIVE OTHER HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER: CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE tN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE UNK NONE MINOR MOD MAJOR HOLt-tWER DIA OF TRAVEL ON STREET OR HIGHWAY SPEED LIMIT CA DOT N HRCIAIJMOOR ITR 25 CAL-T -__- -_ TCP/PSC MCA" PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEH.YEAR MACE t MODEL I OOLOR LICENSE NUMBER STATE 2002 MEP I MERTY RED SAMR442 CA DRIVER NAME(FLRST,MIDDLE,LAST) OWNER'S NAME �E SAME AS DRIVER � PEDE& STREET ADDRESS TftlAN SRAMEK,JOHN OR BERNADETTE OWNW8ADDRESS SAME AS DRIVER PARKED Vv4fCL CiiTY7STATE ra1P 108 GREENWICH CT SAN RAMON CA 94583 x DISPOSITION OF VEHICLE ON ORDERS OF: �ORFHER DRIVER —R CYTH£R BI� ar SEX NAIR M. HE.HT WEIGHT BIRTHDATE RACE AAA fL.�:*�I Mo Day Ye PRIOR MECHANICAL DEFECTS X NOPE.APP. REFE£tTONARRATIVE OTHER HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMSME CHP USE ONLY DESCRIBE VEH=E DAMAGE,, SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE UW NCNB MINOR ROLL-OVER MR OF TRAVEL ON STREET OR HIGHWAY SPEED LIMIT CA HXX DOT bw N BROAUMOOR ITR 25 CAL-T TDPIPSO PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEK YEAR MAKE I MODEL/COLOR LIC£NS€NUMBER STATE 6 DRIVER NAME(FiRBT.MIDDLE,LAST) OWNER'S NAME ( SAME AS DRIVER T STREET ADDRESS L...J OWNER'S ADDRESS aSAME AS DRIVER p 'CITY/STATE t YIP DISPOSITION OF VEHICLE ON ORDERS OF: DFFICEfl DINER ]OTHER S T SEX t#AdR EYES HEI#iT W€IGH7 BIRTHDATE Y RACE Clio ., PROS MECHANCIAL DEFECTS NONE APP, F£R TO NARRATIVE OTHER HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER: CHIP Use ONLY DESCRIBE VEHICLE DAMAGESHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE LINKNONE MINOR MOD MAJOR ROLL-OYER DIR OF=ET OR HIGHWAY rjFMT— CA DOT CAL•T TCPtPBC MCAW PREPARERS NAME DISPATCH NOTIFIED REVI E $ E WEO AA'If"'id a T.T R'R TC;fiC 43759 7YES [—]NO f_NWA `"" STATE OF CALIFORNIA TRAFFIC COLLISION CODING CHR 555 CARS Pa 112tSS OPI 042 Pape 3 o1 13 Si TE OF COLLISION IMO.DAY YEAR) TIM(ZOO) NOC N OFFICER I.D. NUMaER t3/27/2003 1243 0700 43759 03-8510 OWNER OWNER AWRESS NOISED PROPERTY DYES NO DAMAGE DESORPTION OF DAMAGE SEATING POSIITION OCCUPANTS M!C BICYCLE-HELMET SAFETY EOUIPMENT EJECTED FROM VEHICLE ---"'--` L-AIR SAG DEPLOYED 0•NOT EJECTED A:NONE IN VEHICLE M•AIR SAG NOT DEPLOYED 1•FULLY EJECTED B-UNKNOWN N-OTHER DRIVER 2-PARTIALLY EJECTED f 21-DRIVER C•LAP BELT USED P-NOT REQUIRED V-NO 3-UNKNOWN D LAP BELT NOT USED W-YES 4 5S 6 2 TO 6-PASSENGERS E-SHOULDER HARNESS USED CHILD RESTRAINT 7-STA.WGN REAR F-SHOULDER HARNESS NOT USED O-IN V£H"` K, USED PASSENGER 6-RR.OCC TRK,OR VAN G-LAP/SHOULDER HARNESS USED R-IN VEHICLE NOT USED X-NO 9-POSITION UNKNOWN H-LAP/SHOULDER HARNESS NOT USED S•IN VEHICLE USE UNKNOWN Y•Y>S 0-OTHER J-PASSIVE RESTRAINT USED T-IN VEHICLE IMPROPER USE K PASSIVE RESTRAINT NOT USED U•NONE IN VEHICLE ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK(')SHOULD BE EXPLAINED IN THE NARRATIVE. PRIMARY COLLISION FACTOR TRAFFIC CONTROL DEVICES � � � TVP€QF VEHICLE � '� LIST NUMBER $1 OF PARTY AT FAULT MOVEMENT PRIcCEL7ING COLLISION A `0 VMA ° E9 A CONTROLS FUNCTIONING X X X A PASSENGER CAR 1 STATION WAGONX A STOPPED 21${14(A) X o $ CONTROLS NOT FUNCTIONING` $ PASSENGER CAR W 1 TRAILER $ PROCEEDING STRAIGHT $ OTHER IMPROPER DRIVING. C CONTROLS OBSCURED C MOTORCYCLE I SCOOTER C RAN OFF ROAD- -X D NO CONTROLS PRESENT/FACTOR` D PICKUP OR PANES.TRUCK D MAKING RIGHT TURN C OTHER THAN DRIVER' TYPE OF COLLISION E -PICKUP/PANEL TRUCK W/TRAILER E MAKINQ LEFT TURN DUNKNOWN" HEAD-ON F TRUCK OR TRUCK TRACTOR F MAKING U TURN E FI=LL A51 EeEP` L3 SlOE$WIPE G TRU K/TRUCK TRACTOR W/TRLR. G BACICINQ C REAR END H SCHOOL BUS H SLOWING ISTOPPING WEATHER MARK 1 TCI2 aM_ X D SR0AI3SiDE If OTHER SUS I PASSING OTHER VEHICLE X A CLEAR E H!T OBJECT J EMERGENCY VEHICLE J CHANGING LANES $ CLOUDY F OVERTURNED K HIGHWAY CONST.EQUIPMENT K PARKING MANEUVER C FIR{NINA G VEHICLE/PEDESTRIAN L BICYCLE L ENT ERft I TRp�FIC D SNOWING H OTHER`: M OTHER VEHICLE M OTHER UNSAFE TURNING E FUG/VISI8ILITY FT. N PEDESTRIAN N XING INTO OPPOSING LANE - IF OTHER` MOTOR VEHICLE INVOLVED WITH 0 MOPED X O PARKED G WIND A_NON-COLLISION P MERGING LIGHTwo $ PEDESTRIAN G TRAVELINQWRONGWAY X A DAYLimHT X G OTHER MOTOR VEHICLE OTHER ASSOCIATED FAC`tORS R OTHER*: $ DUSK-DAWN D MOTOR VEHICLE ON OTHER ROADWAY MARK 1 TO 2 ITEMS C DARK--STREET LIGHTS E PARKED MOTOR VEHICLE Avc uccr�cavw��sao �'T� YE@ f} DARK•NO STREI<T LIGHTS F TpAIN NO E DARK-STREET LIGIHTSNOT G BICYCLE $ w s�taH vaurl[o crtu YES FUNCTIONING` H ANIMAL. NO BOIEIRI>;TY-CTRU1i ROADWAY SURFACE C vc e�erxutaul nr� �� YE8 � � � PHYSICAL X A DRY I FIXED OBJECT: NO (MARK 1 TO 2 ITEMS) W D , X A HAD NOT BEEN DRINKING : : C WY•K:Y J OTHER OBJECT: E VISION OBSCUREMENT: $ "so-UNDER WFLUENCC' D SLIPPERY MUDDY OILY.ETC. X X :F INATTENTION• Y-OTHFJt C HSD•NOT UNDER INFLUENOE' ROADWAY CONOITION(S) G STOP S GO TRAFFIC q HBO•IMPAIRMENT UNKNOWN` MARK I TO 2 M5 PEDE'STRIAN'S ACTIONS H ENTERING/LEAVING RAMP E UNDER DRUG IN AHOLES DEEP RUT* X AND PEDESTRIANS INVOLVED I PREVIOUS COLLISION F IMPAIRMENT-PHYBJIM- $ LOOSE MATIMIAL ON ROADWAY' B CROSSING FI CROSSWALK J UNFAMILIAR WITH ROAD G AIRMENT NOT KNOWN C OBSTRucTION UN ROADWAY* AT INT CTION K DEFECTIVE VEH.EOUIP.: CITED X NUT APPL&W& D CONSTRUCTION-REPAIR ZONE C CROSSING IN CROSSWALK,NOT YES I SLEEPY1 FATIG D E REDUCED ROADWAY WlOTH AT INTERSECTION NO SPECIAL INFORMATIGIN F FLOODED" G CROSSING•NOT IN CROSSWALK L UNINVOLVED VEHICLE A HATAROOUS MATER_ G OTHER": E IN ROAD-INCLUDES SHOULDER MOTHER•: $ CELL PHONE IN ItSE X H No UNUSUAL CONDITIONS F NOT IN ROAD X N NONE APPARENTt CELL PHONE NOT IN USE G APPROACHING/LEAVING SCHOOL SUS n RUNAWAY VEHICLE X X X D CELLPHONE NONFJLINICNUiNN SKETCH FOR SKETCH DIAGRAM,SEE WAGE 6 MISCELLANEOUS 0 INDICATE NORTH rATe,of=CALIFORNIA "RAFFIC COLLISION CODING Page 4 of 13 :,!,,�P 555 CARS Pa e2 8/983 OPI 042 4TE:OF COU-ISION(MO.-DAY YEAR) NCIC 9 OFFICER I.D. NUMBER 13/27/2003 1243 0700 43759 03-8520 OWNER OWNERADDRESS NOTIFIED 'RoPERTY []YES NO DAMAGE DEscFR ftMN of DAMAGE SEATING POSITION SAFETY EOUIPMENT EJECTED FROM VEHICLE OCCUPANTS f NC BICYCLE-HELMET L•AIRBAG DEPLOYED a-NOT EJECTED A-NONE IN VEHICLE M-AIR BAG NOT DEPLOYED #-FULLY EJECTED S-UNKNOWN N-OTHER DRIVER 2-PARTIALLY EJECTED C-LAP BELT USED P-NOT REQUIRED V-NO s-UNKNOWN 1 2 3 1-DRIVER D-LAP BELT NOT USED W-YES 52 TO 6•PASSENGERS E-SHOULDER HARNESS USED CHILD RESTRAINT 7-STA WGN REAR F-SHOULDER HARNESS NOT USED 0-R V ROLE USED PASSENGER 8•RR.OCC TRK.OR VAN G-LAPISHOULD€R HARNESS USED R-IN VEHICLE NOT USED X-NO 9•POSITION UNKNOWN H-LAPISHOULDER HARNESS NOT USED S-IN VEHICLE USE UNKNOWN Y-YES a-OTHER J-PASSIVE'RESTRAINT USED T-IN VEHICLE IMPROPER USE K-PASSIVE RESTRAINT NOT USED U NONE IN VEHICLE ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK ' SHOULD BE EXPLAINED IN THE NARRATIVE. PRIMARY COLLISION FACTOR TRAFFIC CONTROL DEVICES 4 516 TYPE OF VEHICLE 4 56 MOVEMENT COLLISIONPRECE INfl LIST NUMBER R OF PARTY AT FAULT _ A vcs*cTfoNv=LAT C"D F IfM A CONTROLS FUNCTIONING X A PASSENGER CAR I STATION WAGON A STOPPED 21804(A) CONTROLS NOT FUNCTION, ' B PAS$ENGER CAR W I TRAILER 1 8 PROCEEDING STRAIGHT B OTHER IMPROPER DRIVING' C CONTROLS OBSCURED C MOTORCYCLEtSCOOTER C FLAN OFF E282 X D NO CONTROLS PRESENT I FACTOR' X 0 PICKUP OR PANEL TRUCK 0 MAKING RIGHT TURN C OTHER THAN DRIVER` TYPE OF COLLISION E PICKUP I PANEL TRUCK WI TRAILER MAKING LEFT TURN D UNKNOWN' A HEAD-ON IF TRUCK OR TRUCK TRACTOR MAKING U TURN E FELL ASLEEP" SIDE SWIPE TRUCK I TRUCK TRACTOR WI TRLR. IQ BACKING C REAR ENI) H SCHOOL BUS I IH SLOWING I STOPPING WEATHER hfARK#TO 2ITEMS} BRQADSIDE I OTHER BUS I PASSING OTHER VEHICLE ){ A C#£AR MIT OBJECT EMERGENIGY VEHICLE J CHANGING LANES — 6 CLOUDY F OVERTURNED K HIGHWAY CONST.EQUIPMENT i4 PARKIN13 MANEUVER C RAINING Q VEHICL£i PEDESTRIAN L BICYCLE L EfBrfllPiG TfAFEIC CI SNOWING, H OTHER--M OTHER VEHICLE M OTHER UNSAFE TURNING. FOt3l VISIBILITY FT. H PEDESTRIAN N XING INTO OPPOSING LANE F OTHER`' MOTOR VEHICLE INVOLVED WITH O hK7PED X X C) PARKED £Q WIND A NON•COLLISION P MERGING LIGHTING PEDESTRIAN C TRAVELING WRONG WAY X A DAYLIGHT X C oTHER.MOToR vENICI E 4 � 6 OTHER ASSOCIATED FACTORS R OTHER': B DUSK-DAWN D MOTOR vEIiICLE ON OTHEi ROADWAY MARK#TO 2 ITEMS) C DARK-STREET LIGHTS E PARKED MOTOR VEHICLE A vc° T°" "T �K A YES D DA 4K-NO STRSET LIGHTS F TRAIN NO E DARK-STREET LIGHTS NOT G ,BICYCLE B Ye ae tum voLavall arraL FUNCTIONING` II ANIMAL ROADWAY SURFACE Cvc2wtovv z crrg4 4Or6 $C)BPHYSlICALX A DRY I FIXED OBJECT: {MARK 1 TO 2 ITEMS} B _WET__ D A HAD NOT BEEN RINKINt3_ C: SNOWY-ICY J {STHER OBJECT: E VISION OBSCUREMENT: B HBO-UNDER INFLU€4CE D SLIPPERY MUDDY OILY;,ETC, F INATTENTION': C HBC?-NOT UNDER INFL £NCE' ROADWAY CDNDiT#ON{8} 0 STOP 3 ISQ TRAFFIC C HBD-IMPAIRMENT UNKNOWN- MARK#TO 2 Il ELAS PEDESTRIAWS ACTIONS H ENTERING I LEAVING RAMP E UNDER DRUB INFLUENCE' A HOLES DEEP RUT` X A NO PEDESTRIANS INVOLVED I PREVIOUS COLLISION F IMPAIRMENT-PHYSK:AI.' B LOOSE MATERIAL ON ROADWAY' B :CROSSING IN CROSSWALK I IJ UNFAMILIAR WITH ROAD I I IQ IMPAIRMENT N T KNOWN C OBSTRUCTION QN ROADWAY• AT ItURSECTtON K DEFECTIVE v€H.EQUIP.: CITED X I X I I H NOT APPLICABLE D CCNSTRUCTiQN-REP #F3 20NE C CROSSING IN CROSSWALK-NOT YE# I SLEEPY I FATIGUED E REDUCED ROADWAY WIDTH AT INTERSECTION NO SPECIAL INFORMATION F FLOODED• D CROSSINGS•NOT IN CROSSWALK L UNINVOLVED VEHICLE A HA7ARDOU9 MATERIAL 0 OTHER": E IN ROAD-tIPLUDES SHOULDER M OTHER': E CELL PHONE IN USE X NO USUAL CONDITIONS If NOT IN ROAD X X N NONE APPARENT C CELL PHONE NOT IN USE O APPROACHING I LEAVING SCHOOL BUS O RUNAWAY VEHICLE X :x±_:D CELL PHONE NONEIUNKNOWN SKETCH FOR SMCH DIAGRAM,SEE PAGE 6 MISCELLANEOUS 0 INDICATE NORTH - STATE OF CALIFORNIA INJURED]WITNESSES/ PASSENGERS tiP 555 CARS Page 3 Rev 8198 OP!1342 Pafle 5 of 13 DATE OF COLLISION(MO. DAY YEAR) TIME(2400) NCIC d OFFICER I.D. NUMBER 63/27/2003 1243 0700 43759 03-8510 WITNESS PASSOMER EXTENT OF INJURY'X`ONENE ONLY ONLY AGE SEX { ! _ INJURED WAS(+X'd ) PARTY SEAT SAFETY EJECTED FATAL SEVERE OTHER VISIBLE COMPLAINT NUMBER POS. EOUiR INJURY INJURY INJURY Of PAIN I DRIVER PABB. PED. SICLYCUST OTHER C 0 4 Cl EL., 11 CJ J El 11:11 El I E1 Cjl 1 1 G p NAME J O.O.B./ADDRESS TELEPHONE LINDA C.KING (0912911955) 118 ARAPAHO CIRCLE SAN RAMON CA 94583 (925)833-8771 (INJURED ONLY)TRANSPORTED BY: TAKEN TO, DECLINED DESCRIBE INJURIES, REPORTED STRIKING HER LEFT LECs ON THE INTERIOR DRIVER'S DOOR. VICTIM OF VIOLENT CRIME NOTIFIED �# 14 F ❑ 1 3 G 0 NAME/D.0.8.1 ADDRESS TELEPHONE REBECCA KING LQ%/01/19881 118 ARAPAHO CIRCLE SAN RAMON CA 94583 (925)833-8771 (INJURED ONLY)TRANSPORTED SY: TAKEN TO: DE SCReE INJURIes; VICTIM OF VIOLENT CRIME NOTIFIED F El 139T - 1 b F0 L L NAME/O.O.S./ADDRESS TELEPHONE TAMARA RE1N'EAU L09/26/19631 4246 DENKER DRIVE PLEASANTON CA 94588 (925)484-0358 (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES. VICTIM OF VIOLENT CRIME NOTIFIED �# 2 ❑ 18 Im 0 F El ❑ NAME/D.O.B./ADDRESS TELEPHONE DER TIC OLDRIDGE 01118!198 M LARKWOOD CIRCLE SAN RAMON CA 94583 (925)3.14-9963 (INJURED ONLY)TRANSPORTED BY, TAKEN TO: DESCRIBE INJURIES: VICTIM OF VIOLENT CRIME NOTIFIED # 3 18 F ❑ El El 0, D 0 1 ---1 ]-- I-- - NAME/D.O.S./ADDRESS TELEPHONE hlEC3AN OS'TASIUK Q2115/1984 3287 ENSENADA DRIVE SAN RAMON CA 44583 (925)803-8052 (INJURED ONLY)TRANSPORTED BY. TAKEN TO: DESCRIBE INJURIES. VICTIM OF VIOLENT CRIME NOTIFIED " 4 LC�1 17 NAME/D.O.B./ADDRESS TELEPHONE RICHARD MILANO 09/3011985 3128 RIVIERA WY SAN RAMON CA 94583 r925')829-2924 (INJURED ONLY)TRANSPORTED SY: TAKEN TO: DESCRIBE INJURIES: VICTIM OF VIOLENT CRIME NOTIFIED �PREPA!EA,'$N I.D.NUMBER MO, DAY YEAR REV�E NAME MO. DAY YEAR STATE OF CALIFORMA _ SKETCH DIAGRAM CHP 555 Paste 4 ev.8-97 LIPS 042 PASE 6 0 13 C3ATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 03/27/2003 1 1 1243 10700 143759 103-8510 ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED{SCALE= } .Broadmoor Dave J .V-2 V-2 Aa#4 4 .Weymmouth Court 3 .San Ramon Olympic Pool Aa#t Ae V2 PREPARED 9Y I.D.NUMBER DATE REV/ DATE MICHAEL BRIGGS43759j 03/27/2003 STATE OF CALIFORNIA FACTUAL DIAGRAM CHP 555 Pa e 4 Rev.8-97 QN 042 PAGE 7 OF 13 DATE OF INCIC7ENT TIME NCIO NUMBER OFFICER I.D. NUMBER 03/2712(3(33 1243 0700 43759 03-8510 ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED{SCALE= } Broadmoor Drive X LEGEND .Skid Marr .Gauge Mark 5 Tire Scuff Mark + .Reference Measurement Point 4 SCALE: 1"=4a Weymouth Court 3 Aa .San Ramon Olympic Pool laffic Divwcn Acid l e,► A c sAnad Cn + �ti#�asi]ete: Q317-03 8SI0 ' I:W I DM;6W Ck N&Thom PREPARED i3`I C.D.NUMBER DATE REVIEWE0 ItDATE MlCwAEL BRIGGS 43759 03/27/2003 STATE OF CALIFORNIA NARRATIVE/SUPPLEMENTAL PAGE 8 OF 13 DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 03/27/2003 1243 0700 43759 03-8510 1 FACTUAL DIAGRAM MEASUREMENTS 2 03-8510 M. Thoma 3-27-03 3 4 5 Vehicle NIS of S/C/UP Weymouth Ct. E/W of E Foq Line Broadmoor Dr. 6 7 V-1 (VW Passat Sedan) 8 RF 97.'5"S 3'1"E 9 RR 1057"S 6'5"E 10 LF 99'3"S 27W 11 LR 107'4"S 9"E 12 13 V-2 (SRPD Ford Grown Victoria Sedan) 14 15 RF 224" N 0 16 RR 13'9" N 9"E 17 LF 23'6" N 67 E 18 LR 14'1"N 5'8"E 19 20 V-3 (Honda Civic Coupe) 21 RF 73'8"S 1'5"E 22 RR 82'5"S 11511E 23 LF 73'8"S 6'9"E 24 LR 82'5"S 619"E 25 26 V-4 (Dodge Dakota PIU) 27 RF 20'1"S 17E 28 RR 31'3"S 9"E 29 LF 191511S 7'511E 30 LR 30'6"S 6'5"E 31 32 V-5 (Jeep Liberty SUV) 33 RF 20'10S 1'8"E 34 RR 31'30S S 2'4"E 35 LF 3'3"N 8'4"E 36 LR 5'2"S 8'40%E 37 38 Evidence 39 40 V-1 RF Tire Scuff Mark (Length 5'4" visible) 41 Start 106'4" S .. 311"W 42 End 10119"S 0 PREPARED BY I.D.NUMB0 DATE REVI B SNA DATE MICHAEL BRIGGS 43759 03/27/2003 STATE OF CALIFORNIA NARRATIVE/SUPPLEMENTAL PAGE 9 OF 13 DKK_E OF INCIDENT TIME NCI C NUMBER OFFICER I.D. NUMBER 03/27/2003 1243 0700 43759 03-8514 1 Evidence Cont N/S of S/C/UP Weymouth Ct. E/W of E-Fo_g Line Broadmoor Dr 2 3 4 V-2 Skid Mark LF Tire (Length 277") 5 Start 5'6"S 402V 6 Mid 515"N 51W 7 End V-1 LF Tire POR 8 9 V-2 Skid Mark LR Tire (Length 277") 10 Start 137"S 31811W 11 Mid 0 37"W 12 End V-2 LR Tire POR 13 14 V-2 Gouge Mark RF Suspension (Length 32'3") 15 Start 911"S 8"E 16 End 23'6"N 0 17 18 V-2 Skid Mark RF Tire (Length 30'11 19 Start 9'1"S 1'E 20 End 23'8"N 5"E 21 22 V-5 LR Tire Scrub Mark (Length 8'3") 23 Start 13'6"S 11511E 24 End 5'1„S 212"E 25 26 27 FACTS 28 Notification 29 On Thursday, March 27, 2003, at approximately 1244 hrs., I responded to a reported nen-injury 30 collision in San Ramon involving a San Ramon Police Department patrol vehicle. I responded 31 from the Danville Police Department and I arrived at approximately 1253 hrs. SRPD Cpl. D. 32 Helnbaugh ##45512 arrived just ahead of me. SRPD Ofcr. M. Thoma #58338 was already on 33 scene as was SRPD Sgt. }'Mary#48573. All times and measurements are approximate and 34 measurements were taken with a rolatape. 35 36 Scene Description 37 This collision occurred on Broadmoor Drive, which is a two lane, two-way, flat, asphalt roadway 38 within: a "residence district" and it passes California High School, which was in session. 39 Broadmoor Drive runs primarily N/S in direction. There is one lane in either direction separated by 40 a broken yellow line. That broken line and a white lane line that separates the individual lane from 41 an improved shoulder and the raised concrete curbs and sidewalks that border the roadway 42 delineate the lanes. Parked vehicles lined both sides of the roadway at the time of the collision. PREPARED EY I.D.NUMBER DATE E E ' NAME DATE MICHAEL BRIGGS 43759 03/27/2003 STA'T'E OF CALIFORNIA NARRATIVE/SUPPLEMENTAL PAGE 10OF 13 DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 03/27/2003 1243 0700 43759 03-8510 1 The posted speed limit on Broadmoor Drive is 25. For N/B traffic a 25 mph speed sign is located 2 north of the intersection of Broadmoor Drive and Pine Valley Road, For SIB traffic a 25 mph 3 speed sign is located-south of the intersection of Broadmoor Drive and Montevideo Drive. There 4 are no posted school zone signs. 5 6 Parties 7 0-1 (King): After I arrived I took note of the collision scene and the involved vehicles, including 8 their respective positions relative to the road, their respective condition, and how they may have 9 gotten to their respective positions of rest. California High School Principal Mark Corti pointed out 10 P-1 to me. P-1 identified herself with a valid California [giver's License as Linda King. She was 11 identified as the driver of V-1 by her statements, her daughter's statement, and the statement of 12 Wit-1 (Reneau). 13 14 P-2 (Escover): P-2 contacted me upon my arrival. P-2 identified himself to me verbally. I am 15 familiar with P-1 due to past work related contacts. P-2 was identified as the driver of V-2 by his 16 statements,'and the statements of the witnesses. 17 18 Wit-1 (Reneau): verbally identified herself as Tamara Reneau. 19 20 Wit-2 (aldridge): verbally identified himself as Derrik Oldridge. 21 22 Wit-3 (Ostasluk): verbally identified herself as Megan Ostasiuk. 23 24 Wit-4 (Milano): verbally identified himself as Richard Milano. 25 26 Pass-1 (King): verbally identified herself as.Rebecca King. 27 28 Veh 29 V-1 (Volks);: V-1 was found on its wheels at its place of rest (POR). The vehicle was facing in a 30 northwesterly direction bisected by the N/B lane line, which traveled from the Driver's side B pillar 31 through the front center of the vehicle. V-1 sustained major contact damage to its front end. V-1's 32 front bumper was ripped off of the vehicle and was located on the east curb gutter between the 33 gutter and V-3. V-1 was subsequently towed by San Ramon Tow. 34 35 V-2 (Ford): V-2 was found on its wheels at its place of rest (POR). The vehicle was facing in a 36 northerly direction bisected by the N/B lane line, which traveled from the rear bumper, right of 37 center, through the right side B pillar. V-2 sustained major contact damage to its RF bumper, 38 fender, and wheel. V-2 was subsequently towed by Save Tow. 39 40 V-3 (Honda): V-3 was found on its wheels, facing north within 18" of the east curb. V-3 was 41 unattended'and legally parked. V-3 sustained minor damage to its RR bumper and was 42 subsequently left at the scene. PREPARED BY I.D.NUMBER DATE REW JNME ©ATE MICHAEL BRIGGS 43759 0312712003 STATE OF CALIFORNIA NARRATIVE/SUPPLEMENTAL RAGE 11 O13 DATE OF INCIDENT TIME NCIC NUMBER OFFZER I.D. NUMBER 03/27/2003 1243 0700 43759 03-8510 1 2 V-4 (Dodge): V-4 was found on its wheels, facing north within 18" of the east curb. V-4 was 3 unattended and legally parked. V-4 sustained minor damage to its Driver's door and LF fender 4 and was subsequently left at the scene. 5 6 V-5 (Jeep); V=5 was found on its wheels, facing north within 18" of the east curb. V-5 was 7 unattended and legally parked. V-5 sustained moderate damage to its LR bumper, quarter panel, 8 wheel, and tire, and was subsequently towed at the registered owner's request. 9 10 Infuries 11 P-1 (King); P-1 said that her left leg had struck the interior of the driver's door. P-1 declined 12 medical attention at the scene. 13 14 Physical Evidence 15 1 located a tire scuffmark caused by the northerly lateral movement of the RF tire of V-1. The 16 scuff mark was approximately 64" long. It started approximately 106' 4" south of the SCL 17 prolongation of Weymouth Court, and approximately 11' 1" west of the ECL of Broadmoor Dr. It 18 ended approximately 101' 9" south of the SCL prolongation of Weymouth Court, and 19 approximately 8' west of the ECL of Broadmoor Dr. 20 21 Photograph 22 Cpl. Heinbaugh took 58 photographs of the scene and vehicles using a digital Camera. 23 24 STATEMENTS 25 26 All statements are paraphrased and organized from handwritten notes unless otherwise noted. 27 Exact words or statements are denoted with quotation marks. 28 29 P-1 (King): I contacted P-1 at the scene shortly after my arrival. After identifying herself to me 30 she said she was driving W/B on a publicly maintained driveway, intending to turn right (north) 31 onto Broadmoor Drive. She said she stopped, east of the lane line separating the N/B lane and 32 the improved shoulder. She said she was taking a 2nd look and was not moving when she saw V- 33 2 strike her vehlcle: She said V-2 had "no lights flashing or no siren". She said she did not see V- 34 2 prior to the collision. 35 36 P-2 (Escover); I contacted P-2 immediately following my arrival. P-2 said he was originally 37 traveling S/13 on Broadmoor Drive. He witnessed a speeding vehicle, described as white, and 38 made a U-turn in front of the California High School sign. He accelerated N/B in an attempt to 39 overtake the white vehicle to affect a traffic enforcement stop. As he was accelerating N/B, V-1 40 pulled out of the driveway, canto the roadway. P-2 said he attempted to avoid her but failed. P-2 41 said that he had not activated his emergency lights since he was not in a position to affect the 42 traffic enforcement stop. PREPARED B`t I.D.NUMBER DATE REVIEWS A DATE MICHAEL BRIGGS 43759 03/27/2003 STATE OF CALIFORNIA NARRATIVE/ UPPLEMENTAL. PAGE 120F 13 DATE-OF INCIDENT TIME NC IC NUMBER OFFICER I.D. NUMBER 03/27/2003 1243 0700 43758 03-€3510 1 2 Wit-1 (Reneau): While talking with P-1, she painted out that Wit-1 had witnessed the collision. ! 3 talked with Wit-1 who related that she was on foot and was located on the sidewalk, near the 4 entrance to the High School parking lot, approximately 150' south of the collision. She said she 5 saw V-2 make a U-turn and accelerate rapidly N/B. She turned and looked to the north to see 6 what he was chasing and saw a white vehicle traveling N/B on Broadmoor. At that time she 7 noticed that V-1 was stopped. She then saw V-2 strike V-1. 8 9 Wit-2 (Oldridge): Wit-2 approached me and said that he had seen the collision. Wit-2 said he 10 was in his vehicle, stopped on Weymouth Court at the intersection with Broadmoor Dr. He said he 11 saw V-2 make a U-turn; accelerate rapidly N/B then strike a stopped V-1. 12 13 Wit-3 and Wit-4 were walking together N/B on the west side sidewalk. I interviewed them 14 independently. 15 16 Wit-3 (Ostasluk). Wit-3 approached me and said was walking N/B on the west side sidewalk 17 almost directly across from the originally AOL She said she heard an engine accelerate and 18 looped to see V-2 accelerating N/B. She said she saw P-2 look into the interior of his vehicle, then 19 look up to the roadway just prior to striking V-1. She said it appeared that V-1 was stopped. 20 21 '1fWIt•4 (Mllano): Wit-4 told me he was walking N/B on the west side sidewalk of Broadmdor Dr. 22 He saw V-2 travel S/B past him. He watched V-2 make a U-turn in front of the California High 23 School sign. He watched V-2 accelerate rapidly N/B. He saw P-2 look into the'interior of V-2, 24 then look up just before V-2 collided with V-1, 25 26 Other factual Information: 27 on or about 411/03 SRPD Cpl, D. Heinbaugh informed me that V-2 had a "black box" on board 28 that may have information concerning the speed of the vehicle prior to the collision. He said that 29 the black box would be given to Mr. Rudy Dagger, a traffic accident re-constructionist, who has 30 the ability to download that information. I am awaiting that information to conclude my report. 31 32 OPINIONS AND CONCLUSIONS 33 34 Summary 35 V--1 (Volks) was driven W/B in a publicly maintained driveway by P-1 (King) who was 36 accompanied by her daughter, Pass-1 (Rebecca). Both occupants were wearing 3-point type 37 seatbelts, and neither had been drinking. 38 39 V-2 (Ford) was driven N/B on Broadmoor Dr by P-2 (Escover) who was alone in the vehicle, .was 40 wearing a 3-paint type seatbelt, and had not been drinking. P-2 was on-duty, in uniform, in a 41 marked San Ramon PD patrol vehicle. 42 PREPARED BY I.D.NUMBER DATE REv1EWE E DATE MICHAELwBRINGS 43759 03/27/2003 STATE OF CALIFORNIA ' NARRATIVE/SUPPLEMENTAL PAGE 13 OF 13 DATE OF INCIDENT TIME NCIC NUMBED OFFICER I.D. NUMBER 03/27/20031248 0704 48759 03-8510 1 V-3 (Honda) was legally parked and unattended, facing north at the east curb of Broadmoor Dr. 2 3 V-4 (Dodge) was legally.parked and unattended, facing north at the east curb of Broadmoor Dr. 4 5 V-5 (Jeep) was legally parked and unattended, facing north at the east curb of Broadmoor Dr. 6 7 V-2 was traveling N/B in an attempt to overtake a traffic violator. V-1 was entering Broadmoor Dr. 8 from public ',property and came to a stop within the N/B lane, with the RP tire approximately 3' west 9 of the east fog line. P-1 failed to see V-2 traveling N/B. P-2 looked into the interior of his vehicle 10 prior to reaching the area of impact and failed to see V-1 enter the roadway. When P-2 looked 11 back up at the roadway he had no time to react and V-2 collided with V-1. The force of the 12 collision cawed V-1 to rotate approximately 5 feet in a clockwise direction. The front bumper of 13 V-1 was detached, was thrown northward, and struck a parked V-3. The force of the collision 14 broke the RF wheel of V-2, causing it to pull to the right. V-2 sideswiped a parked V-4 and a 15 parked V-5 before coming to rest. 16 17 Area of Impact (AOQ: 18 Based on statements, vehicle debris, and physical evidence, four A01's were determined as 19 follows: 20 AO1 #1 occurred when V-2 collided with V-1 approximately 12' 9" west of the EDL of Broadmoor 21 Drive and approximately 113' south of the SCL prolongation of Weymouth Court. 22 AOI #2 occurred when the front bumper of V-1 struck a parked V-3 approximately 3' west of the 23 ECL of Broadmoor Drive and approximately 84' south of the SCL prolongation of Weymouth 24 Court. 25 AOI #3 occurred when V-2 collided with V-4 approximately 7' west of the ECL of Broadmoor Drive 26 and approximately 24' 5" south of the SCL prolongation of Weymouth Court. 27 AO1 #4 occurred when V-2 collided with V-5 approximately 7' 6" west of the ECL of Broadmoor 28 Drive and approximately 14' south of the SCL prolongation of Weymouth Court. 29 30 Cause: 31 P-1 (King) is at fault for this collision. Pursuant to 21804(a) CVC--The driver of any vehicle about 32 to enter or cross a highway from any public or private property, or from an alley, shall yield the 33 right-of-way to all traffic, as defined in Section 620, approaching on the highway close enough to 34 constitute an immediate hazard, and shall continue to yield the right-of-way to that traffic until he 35 or she can proceed with reasonable safety. P-1 entered Broadmoor Drive without yielding to a 36 marked patrol vehicle, which was attempting to overtake a traffic violator. An associated factor in 37 this collision is P-2's inattention stemming from his looking into his vehicle's interior while 38 attempting to overtake a traffic violater, which prevented him from seeing V-1 enter the roadway. 39 40 This is a preliminary investigation pending any and all relevant information available from V-2's 41 black box. 42 ef PREPARED 6Y E.0.NUMBER DATE REV AME HATE MICHAEL BRIGGS 43759 03127/2003 � � �'w��s ;•acs � o Cs—cd 4.1 1 er+n c o bp 4A w ca w � q �. ' 1-4 � pp a o °'^d ar bAFS -40 :.::. `rr. l ' w o.bAD G cd 'Li im W cd OP z IA A/W �e " gggg (;. d r'' Y'�r 'a s..� H Ce3 O •� 0qq =o� /y�/� i o �i ,Y'� ��.L �bA. 'rd F+^C.— r e c p.'O ' (.tom w 0" c17 CJ.7 OC o ai tc�Nd t-' h i e !1 iv ^O m iP1A cd CFo+L eor bD4 In ear , w b %ool cd +� 00 � 5 ry `� a cca.� N i c� � '+� �00•� � w.[o--7 ri r 7 w'7�'�.� o�C� f,.., L^ is = ❑ m ... � W r O 7 Qbr"rommm ,. cp Ln Li. tq N'! i w Vti -cy b) C7 c j o ;3sr��t+yova cmc W e s(aoisl 4oa i fit o y i o. 04 a� ... -.. .._..�� C.7�U C1r�G�� �.....t= C.7 U:2 Gr e� � .-� (.-i ce.) NlUd UO:3cih1_3SV" d r Ad s. jj � � r t 0 *` L w Q G4 vs $A w�v � w � o