HomeMy WebLinkAboutMINUTES - 10052004 - C13 s<
CLAIM x ~a
BOARD OF SUPERVISORS OF C NTRA COSTA COUNTY ~ .
BOARD ACTION; Ek , 2004
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 1V below), given
Pursuant to Government Code Section 913 and
:4 915.4. Please note all`Warnings".
,
AMOUNT: $2,621.99 �Y>
+ C a
CLAIMANT: GEOPGINA ESPIN02A
ATTORNEY: UNKNOWN � DATE RECEIVED: AUGUST 30, 2004
ADDRESS: 2��0gqyy8�� CAL��Lr�3RNI,A-yryTRF�E"I',
BY DELIVERY'TO CLERK.ON: AUGUS�` 30, 2004
RULL'.V, laM. 9451 L
BY MAIL POSTMARKED: 'AUGUST 27, 2004
FROM: Clerk of the.Beard of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN SWE T Jerk
AUGUST 30, 2004
Dated: By: Deputy
II. 1*'R.OM: County Counsel. TO: Clerk of the Board of Sup isor`s
( )-` his claire complies substantially with Sections 910 and 910.2.
1
( } This Claim:PAILS to comply substantially with Sections 910 and 910.2, and we are so notiLying claimant. The
Board cannot act for 15 days(Section 910.8).
( } Claim is not timely fled. 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: ''r�,, �e; Deputy County Counse
111, FROM: Clem of the Board TO: County Counsel (1) County Administrator(2)
( } Claim was returned as untimely with notice to claimant(Section 911.3).
1V. OARD 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 ntered in its minutes for this date.
OCTt
Dated: JOHN SWEETEN, CLERK,Byeputy Cleric
WARNING(Gov. code section 913)
Subject to certain exceptions, you have only six(6)months from the date this notice was personally served or deposited
in the mail to file a court action on this claim. See Government Code Section 945.6, You may seek the advice of an
attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so
immediately, *For Additional Warning See Reverse Side of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned,have been a citizen of the United
States, over age 18; and that today I deposited in the United States Postal Service in Martine, California,postage folly
prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above.
Dated: ° 3 JOHN SWEETEN, CLERK By.- `f " Deputy Clerk
Claim tot BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. Claims relating to causes of action for death or for injury to person or to personal
property or growing crops and which accrue on or before December 31, 1987,must be
presented not later than the 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 Tiled with the Clerk of the Board of Supervisors at its office in
Room 106, County Administration Building,651 Pine Street,Martinez, CA
94553, either by mail or in person.
C. If claire 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 roust 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
Georgina Espinoza
Eflo
RECEIVED
Against the County of Contra Costa
or
AUG 3 0 RT
The Housing A uthority of Contra Costa (District) r z K
(Fill in name) -- v
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 fellows:
1. When did the danw4e or injury occur? (Give exact date afid hour) p+
mss,
2. Where did the damage or injury occur? (Include city and ty)
CVy -2
3. How did the damage or injury occur? (Give full details- use extra paver if re urr d)
e r n rll¢,r KA fCJ 1
4. a particular act or omission on the part of coup or districtffi rs, servants or
employees caused the injury or damage? � �" �ice, as h,. ltft t 4.r .
k. Irl at,
j
clm'0mUk t di /'C C(.(&J, t
t Oy
5. What are the names of county or district officers, servants or employees causing the
damage ornjury?
a
6. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attached two estimates for auto damage.)
'V>e.P" *V )o a- I I V0 'Ve-f d*7 C'&*�ew
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
8. Names and addresses of witnesses, doctors and hospitals.
41.1
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
Gov. Cade Sec. 910.2 provides:
"The claim must be signed by the claimant
SEND NOTICE TO: (Attorney) or by some person on his behalf."
Name and Address of Attorney - `
oag.4
(CI mant's Signatdrre)
26
(Address)
=` 72<
Telephone No. Telephone No.: 5 16)
NOTICE
Section 72 of the Penal Code provides:
"Every person who, with intent to defraud, presents for allowance or for payment
to any state board or officer, or to any county, city or district board or officer, authorized
to allow or pay the same if genuine,any false or fraudulent claim,bill, account, voucher,
or writing, is punishable either by imprisonment in the county jail for a period of not
more than one year, by a fine of not exceeding one thousand($1,000), or by both such
imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding
ten thousand dollars ($10,000) or by both such imprisonment and fine."
clmform
08/24/2004 at 11 : 36 AM Jab Number:
35.392
SAN PABLO AUTO BODY
2031 RUMRILL BLVD, #11
SAN PABLO, CA 94806
(510) 2?1-0722 Fax: (510) 215-•9110
PRELIMINARY ESTIMATE,
Written By: MARK KAMRAN'FAR
Adjuster:
Insured: GEORGINA ESPINOZA Crim #
Owner: GEORGINA ESPINOZA Policy #
Address: 208 CALIFORNIA ST Deductible:
RODEO, CA 94572 Date of Loss:
Evening: (510) 245-3152 Type of Loss:
C.ell-al ar: (520) 612-03305 Point. of Iraacts 6. Rear
Inspect SAN PABLO AUTO BODY Business: (510) 231-03722
Location: 20331 RUMRILL BLVD, #11
SAN PABLO, CA 94806
Insurance
Company: Days to Repair
1990 MERG COUGAR XR7 6-3 .8L-FI 2D CPE RED Int:CHARCOLE
VIN: 1MEPM62R5LH634846 Lie: 5AIP734 CA Prod Date: 01/1990 Odometer: 1613.94
Air Conditioning Intermittent Vipers Elec. Instrumentation
Tinted Glass Body Side Moldings ,Dual Mirrors
Clear Coat Paint Power Steering Power Brakes
Power Windows Power Locks Power Driver Seat
Power Passenger Seat Power Mirrors AM Radio
FM Radio Stereo Cassette
Anti--Lock Brakes (4) 4 Wheel Disc Brakes Positraction
Cloth Seats Bucket Seats Recline/Lounge Seats
Automatic Transmission Aluminum/Alloy Wheels
-------------------------------------------------------------------------------
%v Cs. PrP. DESCRIPTION -QTY- EXT. PRICE LA.BOR-.. PAT9111`
------------------------------------------------------------------------------
? QUARTER PANEL
2* Rpr RT Quarter panel 5.0 3.2
3* Rpr LT Quarter panel. 1 .0 3.2
4 Overlap Major Adj . Panel -0 . 4
5 O Repl RT Side molding 1" wade 1 41 . 1.8 0. 3
6 O Repl LT Side molding 1" wide 1 38 . 92 0.3
7 R&I RT Splash shield 0. 3
8 R&I LT Splash shield 0 .3
9 R&I R"' Glass w/o bright melding 1. 5
Ford
1J R&I `..,T Glass w/o ,aright moping 1. 5
Ford
11O Rept LT Ornament Cougar 1 16. 52 0 . 3
12 O Repl RT Ornament Cougar 1 17 . 75 0 .3
13 TRUNK LID
1
08/24/2004 at 11 : 36 AM Job Number:
35392
PRELIMINARY ESTIMATE
1990 MERC COUGAR XR7 6-3.8L-FI 2D CPE RED Int:CHARCOLE
-------------------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
-------------------------------------------------------------------------------
14* Rpr Trunk lid 1 . 0 2 . 5
15 Overlap Major Adj . Panel -0 .4
16 R&I Cyl & keys w/o anti theft 0. 6
17 ROOF
18� Rpr Roof panel w/o sunroof 3.0 4 .0
19 Overlap Major Adj . .Panel -0.4
20 Clear Coat 2. 5
21 REAP,. LAMPS
22 R&I RT Tail lamp assy XR-7 0. 4
23 R&I LT Tail lamp assy XR-7 0. 4
24 R&I Reflector panel XR--7 1.0
25 REAR BUMPER
26 R&I R&I bumper assy 1 ,0
27# Rpr ROPE BACK GLASS 0.5
28# Rpr REAR TRUNK EXT 1.0 1.0
29# ADD FOR CLEAR COAT 1 0.4
30# Color tint 1 0. 4
31# Cover for overspray 1 8 .00
32# Hazardous Waste Disposal 1 3 . 00
-------------------------------------------------------------------------------
Subtotals ==> 125. 37 19.7 16.0
Parts 125,37
Body Labor 19.7 hrs @ $ 58.00/hr 1142 . 60
Paint Labor 16.0 hrs @ $ 58 . 00/hr 928 ,00
Paint Supplies 16,0 hrs @ $ 24 .00/hr 384 .00
----------------------------------------------------
SUBTOTAL• $ 2579. 97
Sales Tax $ 509. 37 @ 8 .2500% 42.02
----------------------------------------------------
GRAND TOTAL $ 2621 , 99
ADJUSTMENTS :
Deductible 0.00
----------------------------------------------------
CUSTOMER PAY $ 0.00
INSURANCE PAY $ 2621 .99
2
8/24/2004 at 11 : 36 AM Job Number:
35392
PRELIMINARY ESTIMATE
1990 MERC COUGAR XR7 6-3 .8L-FI 2D CPE RED Int:CHARCOLE
The estimate of repair includes parts, labor, and diagnosis . If on further
inspection, additional parts or repairs are needed, you will be contacted for
authorization. We are not responsible for lost or stolen valuable itesr left in
your vehicle while its being repair.
We conditionally guarantee all work performed and all parts installed by San
Pablo Auto Body for as long as you own your car. This warranty covers only
repairs made necessary due to workmanship and said repairs must be performed by
San Pablo Auto Body. This warranty does not cover conditions resulting from
misuse, negligence, alteration, accidents or rust. Partial repairs insisted
upon and so ordered by the client are not covered under this warranty nor will
San Pablo Auto Body accepted any liabi.litily for ,such repairs.
Authorized signature: Date:
FOR, YOUR PROTECTION CALIFORNIA. LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS
FORM:
ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF
A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN
STATE PRISON,
THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO
DESCRIBE WORT{ 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 A.LGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA-CERTIFIED AUTOMOTIVE
PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT
PRICE MULTIPLIES? 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: #=MA,NUAL LINE ENTRY *=OTHER [IE. .MOTORS DATABASE
INFORMTION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES .ATTACHED TO
LINE. MQVP=MANUFACTURER`S QUALIFICATION AND VALIDATION PROGRAM.
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from
the Guide DE2LC89 Database Date 07/2004, CCC Data Date 07/2004, and; the parts selected are
CEM-parts :manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at
GSE/vehicle dealerships. 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. Tilde sign (-) items indicate MOTOR Not-Included Labor operations. 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. Rec;ored parts are described as Recore. NAGS Part
Numbers and Prices are provided by National Auto Glass Specifications, Inc. Pound. sign (#) items
indicate manual entries.
CCC Pathways - A product of CCC Information Serv;.ces Inc.
3
Date: 812010+108:64 AM
Estimate 1D: 10468
Estimate Version: 0
Preliminary
Profile ID: STANDARD
Stewart's Body Shop, Inc.
12540 SAN PABLO AVE.RICHMOND,CA 946-1408
(510)23ti-3615
Fax: (510)236.8022
Tax ID: 68.0032104 BAR M AJ112826 EPA#: CAD981385321
tItirirkt#**###�k*irAr��,t�fr�kiirrt*t#trtY9lrrrAr�IF*�frrtr�5kit*iririe*tlrJc#*rklrit#�IrftAr*,t�lr�k#irArik�*rk
OVER 50 YEARS SERVING THE BAY AREA
Damage Assessed By: Lowell Biagi
Contact Dee. 8/20104
Payer: Customer Deductible: NONE
Owner GOERt INA ESPINOZA
Address: 208 CALIFORNIA ST RODEO,CA 84672
Telephone: Work Pune: (510)812.0305 Horne Prone: (610)245-3152
Mitchell Service: 917621
Description: 1880 Mercury Cougar XR7 Vehicle Production Date: 1/80
Body Style: 2D Cpe Drive Train: 3.8L Superchg Inj 6 Cyl SM
Vel: 1MEPM62R6LH634848 License: 6AIP734 CA
Mileage: 181,208
OEM/ALT: O Search Code: 884808
Color: F4/RED
Options: POWER STEERING,POWER BRAKES,AUTOMATIC TRANSMISSION,2-DOOR
Line Entry Labor Line Item Part Type/ Dollar Labor
Item Number Type Open Description Part Number Amount Units
1 718800 BDY REMOMINSTALL R FkT ROOF DRIP MLDG 0A
2 718$10 Boy REMOVEIINSTALL L FRT ROOF DRIP MLDG 0.4
3 718520 BOY REMOVEIINSTALL R REAR ROOF DRIP MLDG 0.3
4 718930 BDY REMOVE/INSTALL L REQ ROOF DRIP MLDG 0.3
5 718880 Boy REPAIR ROOF PANEL Existing 1.W#
6 AUTO REF REFINISH ROOF PANEL C 4.0
7 AT REAR GLASS LEFT
8 718890 BDY REMOVEIREPLACE BACK WINDOW REVEAL MLDG E9WY 8042430 A 108.47 2.5 #
9 720340 BLit REPAIR R QUARTER OUTER PANEL Existing 7.5'#
10 AUTO REF REFINISH R QUARTER PANEL OU'T'SIDE C 3.3
11 7100 BDY REMOVE1INSTALL R QUARTER ADHESIVE MOULDING Existing 0.0'
86
12 CLEAN AND REi'APE
13 721020 BDY REMOVENEPLACE R QUARTER EMBLEM FOWY"617A66 A d17.75 0.2 #
14 IF AVAILABLE
16 711196 BOY REMOVEANSTALL R UPR QUARTER TRIM PANEL Existing
16 721690 GLS REMOVE/INSTALL R QTR GLASS STATIONARY Existing
17 708161 BOY REMOVEANSTALL R REAR COMBINATION LAMP 0.3
ESTIMATE RECALL NUMBER: 8126104 09:64:51 10468
UttraMate is a Trademark of Mitchell international
Mitchell Data Version: AUG 04 A Copyright(C)1994-2003 Mitchell International Page i of 3
UttraMate Version: $.0.824 All Rights Reserved
batt: 8125104 09:54 AM
Estknate TD: 10468
Estimate Version: 0
Prellndnary
Profile ID: STANDARD
19 936012 ADD*L COST HAZARDOUS WASTE DISPOSAL 1.75*
18 AUTO REE ADD'L OPR CLEAR COAT 2.3*
20 933M03 SM* ADD1 OPR TINT COLOR 0.6*
21 833005 BOY AMM OPR RESTORE CORROSION PROTECTION 7.50* 0.2*
22 933017 REF AtfD'L OPR FINISH SAND ANA BUFF 1.5*
23 833018 BOS* ADD'L OPR MASK FOR OVERSPRAY 6.00* 0.2*
24 AUTO ADEM COST PAINTiMATERIALS 312.00*
26 900600 GLS* REMOVEIREPLACE ADHESIVE KIT Now 15.00* INC*
26 90050 BW* ADD'L LABOR OP PULL BACK WISHIELD MOLDING Existing 0.4*
27 800500 BDY* REPAIR PANEL BELOW REAR GLASS-SCRATCH Existing 0.5*
Zit REF REFTNISHREPAIR PANEL BELOW REAR GLASS-SCRATCH 0.8*
29 800600 BDS* AWL.LABOR OP POLISH DECK LID AT LT FRT-SCRATCH Existing 0.$*
30 800600 DDS' ADD'L LABOR OP POLISH LT 114 AT REAR GLASS Existing 0.6*
**Judgennent Item
#-Labor Note Applies
d-Discontinued by the Manufacturer
C-Included in Clear Coat Calc
AMI
Labor Sublet
I. Labor Subtotal* Units Rate Amount_ Amount Totals II. Part Replacement Sin wnary Amount
Body 1$.3 86.00 7.50 0.00 1,002.00 Taxable Parts 142.22
Bdy-S 2.1 05.00 5.00 0.00 141.60 Sates rax a 8.250% 11.73
Refinish 11.8 65.00 0.00 0.00 773.50
Glass 1.5 65.00 0.00 0.00 97.50 Total Replacement Parts Arnount 155.85
Non-Taxable Labor 2,014.50
Labor Surrvnary 30.8 2,014.50
l0. Additional Costs Amount IV. Adjustments Amount
Taxable Costs 312.00 Insurance Deductible 0.00
Sales Tax @ 8.250% 25.74
Non Taxable Costs 1.75 Custorneer Responsibility 0.00
Total Additional Costs 339A9
I. Total Labor: 2,014.50
if. Total Replacement Parts: 153.96
Ill. Total Additional Costs: 339„48
Gross Total: 2,507.94
IV. Total Adjustments: 0.00
Net Total: 2,507.94
Thus is a prelinlinant estimate.
Ad iti nal c aft to the-estimate may be required for the actual re air.
Poird(s)of Iknpact
4 Right Renu Side(P),a Left Rear Side(S)
ESTIMA'T'E RECALL NUMBER: 81251"09:54:61 10489
Utt+rsMata is a Tradesnarle of Mitchell International
Mitchell Data Version: AUG 04 A Copyright(C)1894.2003 Mitchell International Page 2 of 3
UltraMate Version: 6.0.024 All Rights Reserved
Date: 812ti10'4 09:84 AM
EstkwteID: 10M
Estirrcate Version: a
Prelimirl ry
Prole ID: STANDARD
Inspection Date: 8!28104
The above is a► estimate based on our inspection and does not
cover any additional parts or labor which may be required after the
work has been opened. up. Occasionally after work,has been started,
worn or damaged parts are discovered, which are not evident on the
first inspection. Because of this the above pries ,are not
guaranteed, and are for immediate acceptance only.
**Special Parts Note, All crash parts on this estimate are "NEW"
parte (OEM) unless specified. Parts described as Rechromed, Recored,
or Remanufactured are either "Reconditioned" parts or "Rebuilt„
parts. Crash parts described as "Qual Repl Part" are non-OEM
aftermarket pastas.**
I AUTHORIZE STEWARTS BODY SHOP TO REPAIR ABOVE SAID VEHICLE AS
ITEMIZED PER THIS ESTIMATE.
X DATE: — —
Cycle Tirrle In#orrrsrcikxr
Repair Dames:
Is Vehicle Driveable(Yft4?: Y
ESTIMATE RECALL WJMSER: 11126M4 08:54:61 10468
#ltracMste is a Traderwric of Mitchell Interridional
Mitchell Dame Version: At1Gi 04 A Copyright(C)1094-2003 Mitchell International Page 3 of 3
uttraMate Version: 6.1.024 All Rights Reserved
STATE Or CALIFgRN.'A
TRAFFIC COLL'iQ,ION REPORT"
'CNP 555 CARS Page 1(Rt, 1-03)ON 061 Page I Of 9
SPECIAL CONDITIONS Nff+PUN CITY JUDICIAL DISTRICT LOCAL REPORT NUMBER
WAM mavr UNINCORPORATED BAY MUNI
raArmsRfcrtS€a tnT+R�+
COUNTY REPORTING DISTRICT BEAT 7-1
0 El CONTRA COSTA 39
COLLISION OCCURRED ON: Md DAY YEAR TIME(2400) NCIC 0 PFFICER LD.
Z CALIFORNIA ST.SJB 07/0112004 1310 9320 014817
0 MILEPOST INFORMATION: DAY OF WEEK TOW AWAY PHOTOGRAPHS BY: NONE
Q THURSDAY Ll YESX NO
0 T M7TERSEOTION WtT#k STATE HWY REL
X on: 120 FEET SOUTH OF MARIPOSA ST. X YEs NO
PARTY DRIVER'S LICENSE NUMBER STATE ] IS AIR SAO SAFETY EQUIP, VEH.YEAR MAKE/MODEL(COLOR LICENSE NUMBER STATE
j D2306045 CA C M G 00 FORD F-650 WHT 2DH-692 OIC
DRIVER NAMEIPIRST,MIDDLE,UST)
DEMEARL DEWAYNE MOORE OWNER'S NAME ( SAME AS DRIVER
PEDES- STREETADDRESS BUDGET RENT A CAR SYSTEMS INC.
TRIAN - -
614 12TH ST. OWNERS ADDRESS ❑SAME AS DRIVER
'ARKED CITYtSTATE IZIP 7100 TERMINAL LIR. 6T4T..AHOMA CITY OIC. 73159
rEHICLE RICHMOND CA 94801
DISPOSITIC>HI OF VEHICLE ON ORDERS Of: { t OFFICER {h IDRIVER i {OTHER -
BiJST SEX HAIR [EYES HEIGHT WEIGHT BIRTHDAMo DayTE RACE BILL WILLIAMS-(510)234-3581 f t i LJ
M BLK 1 5.11 160 06/05/1985 Yanr B PRIOR MECH.DEFECTS " NONE APP. REFER TO NARRATIVE
3THER HOME PHONE SuSiNESS04ONE VEHICLE IDENTIFICATION NUMBER:
(510)860-1526 (510)234-3581 VEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA
INSURANCE CARRIER POLICY NUMBER UNKX NONEMINOR
RENTAL 26 MOD ;MlOR PIROLLIOVER
DIR OF TRAVEL ON STREET OR HIGHWAY SPEED LIMIT CA DOT US I092
S CALIFORNIA ST. 25 CAL-T TCPlPsc Mcwx
ARTY DRIVER'S LICENSE NUMBER STATE CLASS j'A=FTYEQUlP. VERYEAR MAKE/MODEL/COLOR LICENSE NUMBER STATE
2 90 MERC COUGAR RED 5AIP734 CA
]RIVER NAME(FIRST,MIDDLE,LAST)
OWNERS NAME SAME AS DRIVER
'EDES- STREETADDRESS GEORGINA ESPIN{}�
'RAN
OWNER'S ADDRESS SAME AS DRIVER
'ARKBD CR`Y r sTATE l zIP 208 CALIFORNIA ST. RODEO CA 94572
SHICLE
DISPOSITION OF VEHICLE:ON ORDERS OF: �OfFICER []DRIVER CY' OTHER
-6-9-
BICY- SEX FLAIR EYES HEIGHT WEIGHT BM2THDATE
RACE PARKED
k�.l
.IST Fdn Dry YbSr
PRIOR MECHANICAL DEFECTS NONE APP. REFER TO NARRATIVE
7THER HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER:
VEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA
INSURANCE CARRIER POLICY NUMBER Dw NSE -X MINOR 1
01 MOD R jROL4DVER
OIR OF TRAVEL ON STR€ET OR HIGHWAY SPEED LIMIT CA DOT
CAL.T TCFyPSC _MOUX
UiTY DRIVER'S LICENSE NUMBER STATE CUSSAIR BAG SAFETY EQUIP. VEH.YEAR MAKE!MOD€L/COLOR LICENSE NUMBER STATE
3
2IVER NAME(FIRST,MIDDLE,LAST)
OWNER'S NAME SAME AS DRIVER .
tIDAEN STREET ADDRESS
OWNER'S ADDRESS ; IBAME AS DRIVER
,RKCEEDD CITY{STATE/ZIP L--!
DISPOSITION Of VEHICLE ON ORDERS OF: OFFICER DRIVER THER
`,5 SEX HAIR EYES HEIGHT WEIGHT SIRTHOATE RACE
JMa Day Ye#P -
PRIORM€CHANCAL DEFECTS 7NONEAPP. EfER TO NARRATIVE
rHER HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER:
VEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA
INSURANCE CARRIER POLICY NUMBER UW F7,NONE MINOR
L H MOD MAJOR ROLL-OVER
DIR OF TRAVEL ON STREET OR HIGHWAY SPEED LIMIT OA DOT
CAL-T TCPIPSO. MO+MX
REPARER'S NAME DISPATCH NOTIFIED R tE ft _ DATE REVIEWED
BUTAWAN 014917 F7YES C"iNO r5nWA " rwr 1 r ►I i
`TATE OF CALIFORNIA
rRAFFIC'CLISION CODING
,HP 555 CAMS Paget(Rev.1-03)OPI 061 P896 2 Of 9
ATE OF COLLISION(MO.DAY YEAR) TIME(2400) NcfC# - OFFICER LD. NUMBER
17101/2004 1310 9320 014817 7-1
OWNER OWNER ADDRESS2 CALIFORNIA ST. NOTIF[FD
PROPERTY CONTRA COSTA HOUSING AUTHORITY RODEO,CA 94572 " EYES❑NO
DAMAGE OESCRWTION OF 17AMAGE
2 DAMAGED PHONE/CABLE/ELECTRIC POLES AND WIRING
SEATING POSITION SAFETY EQUIPMENT INATTENTION CODES
OCCUPANTS L-AIR BAG DEPLOYED MIC BICYCLE-HELMET
M-AIR BAG NOT DEPLOYED DRIVER PASSENGER A-CELL PHONE HANDHELD
A-NON£IN VEHICLE B•CELL PHONE HANDSFREE
B UNKNOWN N-OTHER V-NO X-NO C-ELECTRONIC EQUIPMENT
C-LAP BELT USED P-NOT REQUIRED W-YES Y-YES
D-LAP BELT NOT USED D-RADIO f
CD
1-DRIVER E-SMOKING
2 TO 6-PASSENGERS E-SHOULDER HARNESS USED CHILD RESTRAINT
4.. 5 7-STA.W GN REAR Q IN VEHICLE USED F-SHOULDER HARNESS NOT USED EJECTED FROM VEHICLE F-EATING
• G-CHILDREN
8-RR.OCC TRK:OR VAN
G-LAPISHOULDER HARNESS USED 4-NOT EJECTED
R•IN VEHICLE NOT USEDH>ANIMALS
H-LAPISHOULDER HARNESS NOT USED 1-FULLY EJECTED
9-POSITION UNKNOWN S-IN VEHICLE USE UNKNOWN I- PERSONNEL HYGIENE
7 O.OTHER J-PASSIVE RESTRAINT USED T-IN VEHICLE IMPROPER USE 2-PARTIALLY EJECTED J-READING
K-PASSIVE RESTRAINT NOT USED U-NONE IN VEHICLE 3 UNKNOWN K-OTHER
ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK I-)SHOULD BE EXPLAINED IN THE NARRATIVE.
PRIMARY COLLISION FACTOR TRAFFIC CONTROL DEVICES Si'EC1AL INFORMATION j MOVEMENT PRECEDING
LIST WNSER(N)OF PARTY AT FAULT COLLISION
A VC SECTION VIOLATED: CIT€DRES A CONTROLS FUNCTIONING A HAZARDOUS MATERIAL A STOPPED
0 13 CONTROLS NOT FUNCTIONING* B CELL.PHONE HANDHELD IN USE X a PROCE£DiNG STRAJGHT
B OTHER IMPROPER DRIVING' C CONTROLS OBSCURED C CELL PHONE HANDSFREL IN USE C RAN OFF ROAD
X D NO CONTROLS/ RESENT I FACTOR` X D CELL PHONE NOT IN USE D MAKING RIGHT TURN
C OTHER THAN DRIVER* TYPE OF COLLISION E SCHOOL BUS RELATED E MAKING LEFT TURN
D UNKNOWN` A HEAD-ON F 75 FT MOTORTRUCK COMBO F MAKING U TURN
B SIDESWIPE G 32 FT TRA1L£R COMBO 10 BACKING
C REAR END H 114 SLOWING I STOPPING
WEATHER (MARK B TO 2 ITEMS) D BROADSIDE I it PASSING OTHER VEHICLE
A CLEAR X E HIT OBJECT J
J CHANGING LANES
B CLOUDY F OVERTURNED K K PARKING MANEUVER
C RAINING G VEHICLE I PEDESTRIAN L L ENTERING TRAFFIC
D SNOWING H OTHER*: M M OTHER UNSAFE TURNING
E FOG I VISIBILITY FB. N N XING INTO OPPOSING LANE
F OTH€ft' MOTOR VEHICLE INVOLVED WITH O D PARKED
G WIND A NON-COLLISION P P MERGING
LIGHTING B PEDESTRIAN C! Q TRAVELING WRONG WAY
A DAYLIGHT C OTHER MOTOR VEHICLEER ASSOCIATED FACTORS R OTHER':
B DUSK-DAWN D MOTOR VEHICLE:ON OTHER ROADWAY 1121310TH(MARK i TO 21TEMS)
C DARK-STREETLIGHTS E PARKED MOTOR VEHICLE A vcscYrokvmu cryFlYES
D DARK-NO STREET LIGHTS F TRAIN UNO
E DARK-STREET LIGHTS NOT G BICYCLE $ Ve sacnCa W AAM ortmD
FUNCTIONING" H ANIMAL: ENOyEg SOBRIETY-DRUG
ROADWAY SURFACE PHYSICAL
VC$W*N VKUTEs VIED 1 2 MARK 1 TO 2 ITEMS
A DRY X I FiXEC3OBJECT: PNO ( )
B WET CABL£IWiRES DX A HAD NOT BEEN DRINKING
C SNOWY-ICY J OTHER OBJECT: E VISION OBSCUREMENT: B HBI)-UNDER INFLUENCE
D SLIPPERY(!.BUDDY,OILY,ETC.) F INATTENTION': C HBO-NOT UNDER INFLUENCE'
ROADWAY COND11ION(S)t L G STOPS GO TRAFFIC D H8D-IMPAIRMENT UNKNOWN'
(MARK 1 TO 2 ITEMS) PEDESTRtAN'S ACTIONS H ENTERING I LEAVING RAMP E UNDER DRUG INFLUENCE'
EHOLES,DEEP RUT` XANOPEDESTRIANS INVOLVED I PREVIOUS COLLISION F IMPAIRMENT-PHYSICAL'
MATERIAL ON ROADWAY' $ CROSSING IN CROSSWALK J UNFAMILIAAR WITH ROAD G IMPAIRMENT NOT KNOWN
CTION ONROADWAY- AT INTERSECTION K DEFECTIVE VEH.EQUIP.: CITED H NOT APPLICABLE
UCTION-REPAIR ZONE C CROSSING IN CROSSWALK-NOT YES I SLEEPY i FATIGUED
D ROADWAY WIDTH AT INTERSECTION 8 NO
F FLOODED' 10 CROSSING-NOT IN CROSSWALK I I IL UNINVOLVED VEHICLE
G OTHER':SEE SUMMARY E IN ROAD-INCLUDES SHOULDER lig OTHER':
HNO UNUSUAL CONDfTK]NS F NOT 1N ROAD X N NONE APPARENT
Q
APPROACHING/LEAVING SCHOOL BUS O RUNAWAY VEHICLE
{ETCH FOR SKETCH DIAGRAM,SEE PAGE 4 0
MrsCg 8 ��
IMCATE NORT14 � CPWR
�19C CNP ...�..... �...:.
_-......0A PD/SO
_.
STATE OF CALIFOANLA
INJURED t WIT14ESSES r PASSENGERS
-CHP 556 CARS_Rage 3 iRev 1-03 OPI 061 Page 3 at 9
DATE OF COLLISION(MO. DAY YEAR) TMkgmo) NCIC# OFFICER I.D. NUMBER
07/01/2004 1310 9320 014817 7-1
WITNESS PASSENGER AGE SEX EXTENT OF INJURYfX'ONE) INJURED WAS CV.ONE)ONLPARTY SEAT AIR SAFETY EJECTED
FATAL SEVERE OTHER VISIBLE COMPLAINT NUMBER p05. BAG EQUIP.
INJURY I INJURY INJURY OF PAN DRIVER PASS. PED. BICYCLIST OTHER
❑# ❑x1 is m a ❑ ❑ L❑ ❑ ❑ ❑i ❑ ❑ 1 3 m r, o
NAME!D.O.S.I ADDRESS
TELEPHONE
MISEAN MOORE (04/27/1989) 61412TH ST. RICHMOND CA 94801 (510)860-1526
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
DESCRIBE INJURIES:
VICTIM OF VIOLENT CRIME NOTIFIED
�# ❑ 19 lvl ❑ ❑ LTJ ❑ _J ❑ ❑ 1 1 M G 0
NAME I D.O.B./ADDRESS
TELEPHONE
D1 MEAR.L DEWAYNE MOORS 06105/1985 614 12TH ST. RICHMOND CA 94901 510 860-1526
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
AMR.AMBULANCE LINtf#16 DOCTORS HOSPITAL
DESCRIBE INJURIES:
COMPLAINT OF PAN TO LOWER BACK
Ll VICTIM OF VIOLENT CRIME NOTIFIED
TAME/D.O.B./ADDRESS TELEPHONE
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
7ESCRIBE INJURIES:
VICTIM OF VIOLENT CRIME NOTIFIED
El
LAME/D.O.B./ADDRESS TELEPHONE
INJURED ONLY)TRANSPORTED BY: TAKEN TO:
)ESCRIBE INJURIES:
VICTIM OF VIOLENT CRIME NOTIFIED
�# ❑ ❑ ❑ ❑ ❑ I El].-79 ❑ ❑ 1
IAME/D.O.B./ADDRESS
TELEPHONE
INJURED ONLY)TRANSPORTED BY: TAKEN TO:
ESCR16E INJURIES:
;-� ( { VICTIM OF VIOLENT CRIME NOTIFIED
�# L ! ❑ ❑ ❑ ❑ ❑ ❑ ❑ El [I
AME/D.O.H./ADDRESS TELEPHONE
NJURED ONLY)TRANSPORTED BY: TAKEN TO:
ESCRISE INJURIES:
VICTIM OF VIOLEENT CRIME NOTIFIED
NAME I.D.NUMBER MO. DAY Y!AR REVEEWER'S NAME MO. DAY YEAR
�EPAR
WAN 014817 tl7l01/2004
STATE OF CALIFORI1,1IA
SKETCH DIAGRAM.
CHP 555 Page 41 Rev.$9-7) ON 042 PAG E 4 OF 9
DATE OF INCIDENT `GIME NCIC NUMBER OFFICER I.D. NUMBER
0710112004 1 11310 19320 1014817 7-1
ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED{SCALE= )
California St,
Sidewalk Edge Sidewalk lodge
Parking Lot Parking Lot
V-2
Wooden Pala#1 Telephone/Cable/
V-4 Electric Wires Wooden Pole 42
Mariposa
St.
Asphalt Roadway
397
PREPARED BY I.D.NUMBER DATE REVIEWER`S NAME DATE
E. BUTAWAN 1014811 07/t 11/2004
STATE OF CALIFORNIA
FACTUAL. DIAGRAM
CHP 555 Paite A Rev.8-97 ORI 042 PACE 5 OF 9
DATE OF INCIDENT TIMENC€C NUMBER OFFICER I.D. NUMBER
07/01/2004 11310 9320 014317 7-1
ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED(SCALE=
California St.
Sidewalk Edge Sidewalk Edge
Parking Lot Parking Lot
,
Telephone/Cable!
--- Electric Wires
V-1
V.2
Wooden Pole#1
Wooden Pole#2
Mariposa
St.
Asphalt Roadway
397
PREPARED BY I.D.NUMBER DATE REVIEWi=i '3 NAME DATE,
E. BUTAWAN L014817 07/01/2004
STATE OF CALIFORNIA
NARRATlVg/SUPPLEMENTAL. PAGE 6 OF 9
DATI= OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
07/0112004 1310 9320 014817 7-1
1 Factual Diggrrarn Legend:
2
3 Vehicle#1's Point of Rest:
4
5 V-1's right front wheel was located 168 feet south of the south edge of Mariposa St. and 10.5 feet
6 east of the west roadway edge line of California St.
7
8 V-1's right rear wheel was located 146 feet south of the south edge of Mariposa St. and 11 feet
9 east of the west roadway edge line of California St.
10
11 V-2's right front wheel was located 925 feet south of the south edge of Mariposa St. and 49 feet
12 west of the west roadway edge line of California St.
13
14 V-2's right rear wheel was located 125 feet south of the south edge of Mariposa St. and 40 feet
15 west of the west roadway edge line of California St.
16
17 Physical Evidence:
18
19 2 damaged wooden telephoneleablelelectrical line poles (no number posted on pops)
20
21
22
23
24
25
26
27
28
29
PREPARED BY W.NUMBER DATE REVIEWER'S NAME DATE
E. SUTAWAN 014817 0710112004
STATE OF CALIFORNIA
NARRATIUEI UPPLE1ViL1'w TA4 PAGE 7 OF 9
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
0710112004 1310 9320 014817 7-1
1 FACTS:
2
3 NOTIFICATION- I received a call from CHP dispatch of a property damage only collision
4 at 1510 hours. I responded and arrived on scene at 1523 hours. Upon► my arrival I
5 discovered this to be a miner injury collision.
6
7 All times, speeds and measurements in this investigation are approximate.
8 Measurements were taken by rollmeter, except where otherwise indicated.
9
10 SCENE: This collision occurred in the city of Rodeo and the county of Contra: Costa. At
11 the scene of this collision California St. is a northbound/southbound roadway consisting of
12 one lane designed for two way travel. The roadway is composed primarily of paved
13 asphalt. The roadway does not have any type of delineating markings to separate north
14 and south bound traffic. The roadway edges are bordered by raised curbs. The roadway is
15 straight and level. Adjacent to both side of the roadway edges are residential parking lots.
16 Wooden poles are located to the west and the east of the roadway, which are joined by
17 wires for cablelphonelelectricity. These wires cross directly above the roadway. The
18 posted,speed limit is 25 mph. The weather was clear and the roadway was dry. (see
19 factual diagram for additional details)
20
21 PARTIES:
22
23 PARTY# 'I (P-1/IVl6ore) was located standing out of his vehicle by Fire Department and
24 AMR ambulance personnel. P-1 was identified by his valid California driver license. P-1
25 was placed as a driver by the following items:
26 - Driver statement
27 - Being designated as a driver on the rental agreement
8
29
PREPARED BY I.D.NUMBER DATE REVIEWER'S NAME DATE
E. B UTAWAN 014817 07/0112004
STATE of CALIFORNIA
NARRATIVEISUPPILEMENTAL PAGE 8 OF 9
®ATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
07/01/2004 1310 9320 014817 7-1
1 Ford V-'I , P-1's vehicle, was located on it's wheels facing south. V-1 was on California
2 St., south of Mariposa St. The front upper portion of V-1's cargo area was snared against
3 the hanging wires that crossed over California St. V-1 did not appear to have sustained
4 any damages.
5
6 Mercury (V-2)was located parked in a parking stall within a parking lot, west of the
7 roadway. V-2 was unoccupied. V-2 sustained minor damages, consisting of, but not
8 limited to a dented and scraped right quarter panel.
9
10 STATEMENTS:
11
12 P-1 related to me, in essence the following. He had just turned from Mariposa St. on to
13 south bound California St. He was at 7-8 mph when he heard a loud crashing sound. He
14 immediately pressed on his brakes hard. This hard braking caused him to be jolted back
15 and forth causing some pain to his back.
16
17 OPINIONS AND CONCLUSIONS:
18
19 SUMMARY:
20
21 P-1 was driving V-1 on south bound California St., south of Mariposa St. at 7-8 mph. P-1
22 did not observe that there were low hanging telephone/cable/electrical wires ahead. V-1
23 subsequently struck'and pulled on the wires with it's upper front cargo area. This caused
24 both wooden poles supporting the wires to be pulled loose breaking one of the poles in
25 half. A metal support rod was also pulled loose which struck V-2's right quarter panel. P-1
26 eventually felt the tension and abruptly applied VA's brakes.
27
28
29
PREPARED BY-- I.D.NUMBER DATE REVIEWER'S NAME DATE
E. BLITAWAN 014817 07/01/2004
STATE OF CALIFORNIA
NARRATIVEISUPPLEMENTAL PAGE 9 OF 9
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
07/01/2004 1310 9320 014817 7-1
1 AREA OF IMPACT:
2
3 A01 #1 (V-1 vs. over held wires)was determined to be 120 feet south of Mariposa 5t. and
4 15 feet east of the west roadway edge of California St.
5
6 A01 #2 {metal support rod vs. V-2}was determined to be 125 feet south of Mariposa St.
7 and 40 feet west of the west roadway edge of California St.
8
9 CAUSE:
10
11 The cause of this collision is other than driver.
12
13 The Summary, Areas of impact, and Cause were determined from P-Is statement,
14 damages to V-2, damages to the wooden poles and my observations.
15
16 RECOMMENDATIONS:
17
18 None
PREPARED-BY I.D.NUMBER DATE REVIEWER'S NAME DATE
E. l3UTAWAN 014817 0710112004
CORRECTED COPS'! w CLAIM
PLEASE DESTROY KD OF SUPERVISORS OF CONTRA COSTA COUNTY €�
PREVIOUS ISSUE BOARD ACTION: OCTOBER 05, 2004
Claim Against the County, or District Governed by )
the Board of Supervisors,Routing Endorsements, ) NOTICE TO CLAIMANT
and Beard 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), giver.
Pursuant to Government Code Section 913 and
s 915.4. Please note all"Warnings".
229 043 24 C
AMOUNT: j �,: Y.>• v.0
CLAIMANT: RAVEN CONSULTING, INC
ATTORNEY: TRENT J. THORNIEY DATE RECEIVED: AUGUST 30, 2004
ADDRESS: Law OFFICE OF TRENT J. THORNLEY BY DELIVERY TO CLERK ON: AUGUST 30, 2004
345 FRANKLIN STREET, , STE. 103
SAN FRANCISCO, CA 94102 BY MAIL POSTMARKED: HAND DELIVERED
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
AUGUST 30 2004 JOHN SWE lark
Dated: By: Deputy_
II. MOM: County Counsel. . TO: Clerk of the Board of Sup rvisors
:-}`This claim complies substantially with Sections 910 and 910.2.
( ) This Claim FAILS to comply substantially with Sections 910 and 910.22, and we are so notiLying 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: t £ By: ' , ' < { ,-• ., , Deputy County Couns{
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:
This Claim is rejected in foil.
( } Other:
I certify that this is a true and correct copy of the Board's Order ntered in its minutes for this date.
Dated JOHN SWEETEN, CLERK, By , Deputy Clerk
WARNING(Gov. code section 913)
Subject to certain exceptions, you have only six(6) months from the date this notice was personally served or deposite
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. *Por 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 full}
prepaid a certified copy of this Board Order and Notice to Claimant, ddressed to the claimant as shown above.
f
Dated: ' JOHN SWEETEN, CLERK By ` ' Deputy Clerk
15-03 CONTRA COSTA COUNTY CLERK OF THE 3 914153585929
ND.844 p@1
Claim to: BOARD OF SUPERMORS OF CONTRA COSTA COUNTY t
I STRUC 1�T{�C r
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 Stat later than the 100*day
after the accnral of the cause of action. Claims relating to causes ofaction for death or for injury to
person or to personal property or growing craps 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 aCdon.
(Gov't Cada 911.2.)
B. Claims must be filed with the Clerk ofthe Board of Supervisors at its office in ROOM 106, County
Mministration Building, 651 Pine Street,Martinez,CA 94$53.
C. If'claim is against a district governed by the Board of Supervisors,rather than the County,the name of
the District should be filled in.
D. 1f'the claim is against more than one public entity,separate claims must be filed against each public
entity.
E. EL&UA. See penalty for fraudulent claims,Penal Cade Sec. 72 at the end of this form.
RE: Claim Ey Reserved for Clerk's filing stamp
RAVEN-CoNsiij `fTNG IUC . 2154 Ash .-,tr t �
.., +� .
PdiQ Altcl, CA Q4306
Against the County of Centra Costa or� � C AUG �
District
(Fill in name)
The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district
in the sum of$ and in support of this claim represents as follows:
$229,043.24
1_ When did the damage or injury occur?Give exact date and hour)
October 14, 2003 - refereuee letter from Dick Pollock attached hereto.
2. 'Where did the damage or injury occur?(Tholude city and county)
Contra Costa County - General Services Department - Purchasing Division
3. Row did the damage or injury ocean?(Give full details,use extra paper if required)
County failed to pay $42,852.70 for good� _.�. ��
delivered under enclosed PO and failed �t,��Fax� �e71
to abide by contract for an additional m 9
T® M �. i
$986, 190.54 for future delivery of goods ce./Dept CO.
Reference enclosed PO & additional docs, ronva Phone 7
all incorpGrated herein by reference. lax 1�- 3g_ 5 U#
0Q./2?i2 4 15:03 CONTRA COSTA COUNTY CLERK OF THE 4 914153565929 NO.844 P02
4. What particular act or ornission on the part of county or district officers,servants, or employees caused the
injury or damage?
Failure to pay for goods delivered in full to County and breach
of contract for future delivery. Raven performed in full .
S.
What are the names of county ar district officers,servants,or employees causit3g the damage or injury?
Dick Pollock, Buyer II, Contra Costa County Purchasing, 1220 Morello Ave.. Ste. 210
Kevin Berenson, Contra Costa County Purchasing, (925) 313-7326.
5, what damage or injuries do you claim resulted?(Ove full went of injuries or damages claimed. Attach
two estimates for auto damage.)
Damages for breach of contract, totalling $229,043.24, plus interest
and attorney's fees and cost of suit.
7. How was the amount claimed above computed?(Include the estimated amount of any prospective injury or
damage_)
Reference to contract.
$. Names and addresses of witnesses, doctors, and hospitals.
Larry Butler, Sr. & Larry Butler, Jr. for Raven Consulting (address above, contact
through counsel) ; Carlos [last name unknown], technical contact for Contra Costa
County, h�ealth Serv'c
9. List the expenditures you made g Iccount of this accident or injury.
Gov. Code Seta.910.2 provides"The claire must be
signed by the claimant or by some person on his behalf""
SEM NOMI ES TO: --fA4-0=
Name and Address of Anorney
Trent J. Thornley, SBN 184402
LAW OFFICE OF TRENT J. THORNLEY ) laimant+g irrtature)
345 Franklin Street, Ste. 103 )
San Francisco, CA94102415) �'�- �-�
Fax: (415)60-1860-5929 ) (Address)
)
)
)
Telephone No. 41L-760-1860 J Telephone No.
**###*�**#�*�*#f#*#****��Mw#���r#*+M�.r�M�*s*+�N���r+����#+M+r*###�*��+M***#s*�r#�r*�+Me*«a��w+���ta►>r*•
N0710E
Snoop 72 of'tt}e PUW Qde previd=
Every person wbo,with intent to dtdNA presents for OWN=ar the payrnont to any crate bOd cr officer,or to any
wanty,city,or disMett board of officer,authorixcd to allow or Fay the is&enuim my fol se oI ftwduleat CWM bail,wv=4
voucher,or writing,is pwidmWe eitho by imprisonment in tha oounty jail for a period of not more tm ims ym,by a fins of oat
zxgotMug mu Lhounad(S 1,+ 00),or by botb such imprisonment wW baa or by imprisommt in the two Pis04 by#fine of no
exoft ling to ihoumd dollars(S 10,000).or by both lucb impriwwntmt and fins.
Jun, to 03 03. 23p 816. 567-1936 p. 2
Purchase Order
Contra PURCK"W4 wl=
sta c tea.,SV*VJCX!)V&AW"ft-W
county im Zo "nue.su k*zio
tlarcl.�#cA xwa,�r s�
v Vendor Number. 003616 Purdmae Order Number
E RAVE CONSULTMG p O
1,321 MOWE AVENUE,#101 Po Dow owot2m ALL PACK94G$UPS.tl<ArOKES
SACRA1Iil WTO CA e#>�or � r,Ilk ANO COFMSPONIJMCE MUST
P#tsxsa: 09253 #3-x3r NEFERIENCE THM PO WUMHM
tr stir`AN MVC4CIE TO TME
Foe;004iflsw *000"TRK!"DEPT Foot
� :SFSaELOW
.
s r
P• HEALT"Ir ERVOM D1E)+ARTMAT p "MTK SAES
026 AMOK"D&SAY Off t 06 CEIMR AVr.SU 210
JAAI C'rWEZ CA#49634M G MARTOMEZ CA X34
E
EA►t�sNen+pet 3r 84d tpNrul+w �#Irt
�t.Tii SE�tVICE�t!'tF{jl�#11FAT�4#ir SE#i�Gt rf134-3-fivt 54
to Mac EA 5682,68 i3N4.t10I M
OeSKTUR PCC PR€C**PER CftlS REVERSE AUCTtC N r
402ftO.LOT 2, C0WtGURAY*N PER IkEWAO SPEORCAMONS
aAAT 3024!'03(PLUS SUS-SCOUENT CASE SOSTITVrION).
NOTE: WEEKLY A 4R 6WKf-KLY DELIVEAlkig-PERI
€E WEEN#MT AND LAST 0ELNE€ICS NOY TO EXECO 12
V4"- #<S.
PAYWWTTER#M: 30%AMR#S, OELIYERY,U%AFTER 17"S
symm oary Reo,BALANG"E NeT 3o oAY$A"LeR Fw LL,
0CLIVERY.
Subtalar. $344,001,00
oW-Coat4a:.TEFF WA 'R, (M)3134220 Tow #26.300,05
TOTAL, 337'2. 4.4A
VENDOR
Trft P#1 trr#�tt SOW by s�PW# rrtp#+�an#ka0"WS,&AMU r!s"+WW"oft" prn4�M Af4 Ata�vl M s#�tct 160 am
Ctnrta C4ty"r1 stlrar�'�`artm a#�I C#ttui#t+�#s"ava#I#�r#pit vkti1#t9� ,tc#acowcrs,�.t�.u> p.rv9�d�!`��t.Mx+�. x cay�r rns�ams ba
ovoon"vie'b*aY csr+%the cow*Swvion Putt+""41*19*19(425)31 •vo,
All.09 01941%
` tlltCstt S � OPT ItCC!#iiYF t ... �'
IL-
�" r+�,nrr�.+r t�,e�resf�,tYrrr
i+��++ttlRZ.ti.17)
IL-Zd 6► 1£L-EI£-St6-lwm%4V,-oI E001 11 'Aywo
�AU-G. -6, 2004 6:21AM 1-925-313-7319 Nv. 673 P, 10
' {GENERAL, SERVICES DEPARTMENT Barton I G#pmrt
Contra
tri Directs;OF General Services
Costa Purchasing Divislon
1220 Morello Avenue, Suite 210
County Martinez, California 94553.4711 Keain$erenson
(925) 31397300• (0825)313-7319 fax Purchasing Services tvianager
•� r
Larry Sutler, Sr. October 14, 2003
Raven Consulting
230 California St., Ste. 4220
San Francisco, CA 94111
Re, Your letter of October 10, 2003
Deer Mr. Butler,
The purpose of this letter is to inform you of the steps you need to take to receive final
payment for Purchase Order no. 02484. Although your referenced letter to Mr. Wanger
states that no issues have been identified regarding the 175 systems delivered, Data
Processing has advised Purchasing that neither of the specified Microsoft products
(Windows 2000 Professional Operating System licenses and Microsoft Office 2000
Professional licenses) have yet been received. Additionally, your letter states that
you've received one payment; however, the county's Auditoes Office records indicate
two redeemed payments totaling $143,337.84.
If Raven provides the licensing to complete the 175 systems to specifications, and
invoices for the valance in tho amount of$42,852.70, the final payment will be
processed.
Regards,
Dick Pollock, Guyer 11
Contra Costa County Purchasing
1220 Morello Ave., Ste. 210
Martinez, CA 84553
Ph: 9251313-7311
Fax: 9251313-7319
dpallgsci.cv.centra-cns�a,ca.us
?Iark'G:. 6. 20040 6:20,AM ' 1-925-313-7319 Ulb`w"-"NO673 P. 9 p`
CONMRA COSTA COUNTY
Request for Qr;otntxnn(PFQ)
'€isle:COMPUTERS 2003-2404
)ixstte Date:it 2ftl 7 2003
Ckmtrm Coma Coumy hat determined(lies rcvarw.tuction method will be utilixcd av a mi:ant 01`procurOmLnt fitr iiiis purtha..c.
The auction evom is%obcduicd to s=t March 1&20,03, 1,00 9-M.p.S.'C.and is scheduled to cad hl=h j#t_2p23.1 t30
rx.ttt.P-6-- '..in ncccrdancc wit((auction rule, Bids can 07thvr be t;vbm:ttcd utsing;unlit(biddin*or by proxy. Sce'rerrrts&
Conditions,Section 1.3 oil proxy bidding..
T'I,I+tASF TIF-A l7 THt,'x NTIR RTD PACKAGE,kND PROV11)F THr REt 1111E'D ttii[NATURr,-';.
All inquiries,i`or ininrmatiun un this 0'O shooks ho tlirrc' d m, p
Dick Pollock Phone: (925)13-7311
Buysr T1.Gones-Al Servic.s:1)rpt. FAX. (9215)31;L7319
C,r.ntrn C mitt Cuttfity c+�nlnil: t ?Cl+r?tirttetf.cntttrtrert�i0,dy.ttw
The individual listed abovo may be mlophoned orvisitcd far ctaTilication of specification(,%)oply, 1%Zo authority is intended or
in'trtittl(hal srCcilicadon(s)may bl:gfsivmlcd or,.ttltrilaivt:acccnt;;d prior to hitt opening without wriacn appruvat or(;tsmpt
Cc>.ut County.
For clarilication r0ming to the cnnddjct of.or fi)r technical gjcxtions nboul the revel-c auction.hi kiar omy coninct:
Gilbert Lozano Phone., (210)576-7600 or Toll Free(977)5804949 x 9076
SentorAmilyst rA. (210)576-0760
Cirhiu Online.Inc. a-mail., it��x tr►»� (r�)rsr!>j�rnntinr_ra
The individual listed abov;: nay be Wlcphoaod or vi*cd for clarification of question.;por minitiF to the operation arthc:
m,mrNc nuction event only, Ne outhoriV Is inicnclyd Or IiMpliad iT,:tf vpccii5citrion(A)may be amcndcd ur ttltcra:ttas:irceptecE
prior to:tt,'trt of rovcrsc uuotiun cvcm wi rhout whiten approval or C;(I NTP A COSTA COUNTY.
Tri compliance with this,Rc{qutst for(houltikm and to all tht T4rrne&Conditions irtsncswd therein.tend hereby incorpororrd
ley re#�rc;ncs.the undcrvigsnod o!'ti:tx„ind up,r`4v to#it:ni,ti tlsc^ittt„{a)nnciJor a'ervicr(x}*'nt the pritc(s)indiC:ttt:ct un the
reverse auction.
rt t;t t+t;t't14tH'rtt tutt•taMt+t,t;"t'sto itY t�ililai;K. rt.r:nv+:t'tirN'{`.
alkider Arts(Name
city.:yt,te Zip
AA-
C n (Tfnt��546:�;�...�:!'�..y..�14..,�...._
Co i N• Tiili
' +
FAX
F
Si �ttrts+rr ( r,j 1. .k ur blue idk) llatc
A LAt 'rA~,tLT 111"'N'RA d:U:i'inCOUNTY NtdSABg I'ItINP.
Nance ni'Awhurived Ropea.swmatc(vc
Signakre('Picaee uco hlmek or biuc ink) Date
Conte Costa t`6uniy F2ra
Poq+�7
M?Bt`-AUG,-. 6. 20043 6:20AM 1-x1/26-313-7319 u1,"t"""NO, 673 P, 8 P.
The quantity shown is an ostimatc Only arld is sut�jml to 0-range. The vendor agrccr,11(71 it)Rhip ally(ttateri:d:d until
i etrtt6tt�:ttx are rs+:t ivre#fres:}a L`:tner t t'tr E:t{';only. !)OivM will Welds)-o verbal#y aAd(011 ii'mad ill
wraini,by CONTRA C:CIS't`A COUNTY, The is±titat ea ttfa Purthtt7t+:Ur&r is not a request to da:livcr unlotrt the purchvsc
on1crstatm otharwiw
711 r Rrilt'Krr ll7�lt rtIrl"salt
TERMS AND CONDITIONS FOR REVr,,R$r,ATICTIO.W5
CONTRA COST COUNTY HAS 17ETERMIT+iED'THAT Tyle IEV);It$M AUCTION mETHOa WILL BE
UTTLIZED AS A`VI VAATS OF PdROCUPVMNT FOR TMS PURCHASE
Ail bitM will b,,-a040+44 via onlitdw ruvurrty auction during,thu event, S44 taxed or delivered n ILA be mccived priorto that
ychedulyd clq�ing Lune of the oalina TCvcr ac auction.
To be clig iblu to bid.bidders mum rgr,rtLr with Orbis Oniino.Inc.. st wwwfctrhiK rntir�c.Cettt. C tick on"Tr1imact and
rogigierbefore Lilaa`tmrtarcvehreverse auction event. See Section 1,3rorproxy biddinZ.
Itidlticr tmr+t sign ail lostLN. ltiel(lcry will be rcquirctI lel send.1 aigne d droeumeftt stating that they.,)m,ut ualhatiYodt
t"mwntalivc ortheir company and the bl&n they submit onliata raprc.,unt their company'-,off'cr W CON 1,AA COSTA
All 11 of'1tJEl6(Awtrtttrn cnK_tlLtlCtdstid"tY'et i` t_�+_(•tL$i lKrt"» Ih (.[f}wt'i'1th C.'���`2'h 1s11)NIY ['rrmw y {)4
nad U,sir of,_2'Irr�s lm%-It, -nA*ttis ,C'i'1 cmc ortbc&jW§3LnMaill)r$ retJt}±:L estwhet er
.VXjI2.t�.....,�tt �Ir,*tf�t, w iddor, I-tto,iltc#lible,unsi$r td andlor incomplete hill packages tiwi#1 not he acecprcd. Porson
'41gnittlo;bid 7MNI lloyo Etre mallorily tzt h#nci lite Bret;n a 00hir19t, t'AHUI a W d0---0 will tt':7tt UIdity bud.
Documents can Ito faxed or.,=x via tivemigtht Mail to'
Dick Pollock Contra Coma CKtunty
Buyc,r 11,General Ncrviocr-Dept. I ZZO Merolla Aveautz 9ZID
VAX- {02l}31-1-7.119 Martinm CA 9441.1
If not biddirti;,do not return this roan.
114:n17;iaclow,,reply 141,x11(1#+vctm%c;(pltrt;rl'bitl. Any eRComptions theroio MUM hd,in writing.,.
1.1 Iii(klerr11t1uxt price per unit.howet on the h,-Ird copy bid shtict, I)uring ths.raversu suction bidders call btd based an total
IOL dol lar anjoultt or unit prices.depending on the&-trttcmre of tho nevem auction. in:x11 corms unit prieaat-,hall govern I n Ilia
event of extett pion error-,.
i.1-bids tivIvylitted via proxy should he s.-ub€niucd uiing this Rcquain for quotation("o)docmrtent. rlid s must be time
sw,ntped on or Worc the hoar acrd dakc,pccificd lar the tmd of the auction cvcstt r LS~vh'at6 n pro'`� �x
tl},,r the bictslt rt -7�}•i.t• ",i.F. th .�t'n,.C,t t#± (vett(
I 1 Wiltn bidding.each bid must be plaucd onlino daring a rcvcmc auction even,or faxed or delivered to the address below
p!lor to the Nati of tltc quelion evcm.
Orh;i Online,Ine. VAX number for proxy bidding only Isi (230)37t5.4760
Attu!Auction M,1n'a2iZr
too NE,Loop 410.Cuitr$00
San rt,t7toniu.'i'vxas 18216
Comm C,viz C;owty RTQ
P.Vtt 2
mar,AUG. 6. 2004' 6:20AM 1-925-313-7319 " � ` ""NO, 673 P. 7
1.4 Quote FOB destination.
1.5 laid price%are r4:4.1tiesi ed tea lltL,fin,11 for('( NTKA COSTA('01INTY ucccplance through Maruh'I)."sWA. "1Ji,'4dount
fresh Ih%t"bids are not acceptable unibus mqucstcd.
I,(t Ilia price shall not execcd three(2)dcoirnalli.
1.7 No hitt can bn Withdrlvin ttfttrcla90 ofauction limo without approval by CONTRA COSTA COUNTY basod on an
accupl:tttle Writtcm ecaspil,
1.9 C;OtTl'ltA M$TA COUNTY railprvus the right to accept or rtjtet all ter any p-,"of any bid.wWve minor tuehnicaHlics
anti award the bid to tom:t serve the interests of CONTRA COSTA C.011W T V.
1.9 ConxtSYent god Wrttin=d tic bidding could cause rejection of bids by CONTRA COSTA COUNTY and/or invcmigation
for antitrum viol,ttiwL%.
1.to The tctcphonc nuinticr Aw VAX yubmia;.vlon ol'hs'ds is(2 til)576.0760. This is tilt only numbu tluAt will be used for the
r=cipt orbids. C:ON'T P.A COSTA COUNTY shill not be responsible for failure of etcttronit equipment or operator o"t.
1.1 1 All inquiric;t Jlcrt;aining to I0'Qx;tntaultt includu the Requisition Number.
1,12 Bidder s`c requested to provide the name and shoes/number of a pnint{lr cent:aet for tho:submitted bid,how0vcr,Milder
is hereby adviscd fit-it thi will not he or;abccptcd in live ortho"aulhori cd siymitut'C"
r,-quircmcni of thi,rquest for qucstacinn.
t.0 The:Orbis Onlinc,Irst.User Agl,.*t�mt:ttt cah b0 Viewed tit;
Irtts�-l1A_y_eti L�MSp��l,�,nnfiine. neer��cb���C:'9reslb�hfi�+recr�,,c,Ott.i�rn:tFCarsrcr�r��£oet+r=+C)C1�Z�'W,�
22. Llilia AND N fjTIi?TC,,4; I(�t4; 1,11tu vendor v4;tll pay Orbis onlinc.lac.a li-C tW2.5%(11'1114.1111num awarklcd by
CONTRA COSTA COUNTY(Sea pilga two o f this RFQ). Thin roc will be date:anti payable to Orbi-t Online.Inc..within
thirty(.10)days or vendor receiving puymcnt(s)frill»(,nN'TPA COSTA CM rl 7Y. Vendor ngmcs to provide Orhix Online.
Inc-7 copy ut'cnclt llitrchu.p,u+'eter v;.vucd by CONTRA t'()%'I'A C' ONTY within Ihirly(30)days(Wvvittive's rv(:6j t of saa;lt
pumizz a order us°C-01 tsut.
Ik-AUXIaC6xt0A-(Eu
3.1 Any cxseptiorl� to the TE RMS&CONDITIONS,AND SPECIFICATIONS tftll be elatriy idendried in writing as part
of the vCrttl(tr'a!hid respomQ.
3.2 FINAL DECISION ASTO TITS QUAT.ITV AND ACCEI'TATI3MITY Of ANY ITEM IS MAT OF THE
CONTRA COSTA CC3x TY lt)E' TtTly mNT LLTS'T'EID oN TAE xFE.
3.3(at tlttEis-beetle/nasties pr manufacturcesr rcl'viun=utdicaits type itntl quWity desire(!,
3.4 WNm rr line ifc'm i,4,:pi611041.or x Calf(-[`A't lt<it112Y/wlIll(:It()i7p ti14"1'TUTP?''v" Thi:
(mainly WIE,1.N(7"I`at rcpt n:ub3trtulctl i!Lttalhrand air like ll;mk, I7U Ni7't'oiler:t xsthv!ittttt£1 pent:tr 1't`WlI,L N()1'Cie
xcacptcti.
.1.5 wh¢el a tine i1cm N snovif iod °'I:'QTJAI,TO'a gjvcrV stated brarltl.you t:rc cne ttum�.atl to+hole un that(spot;!f pail brand,
L?lt yt to rn;ly bid to wubrtituL;:4 brand. fiowuvcr,pre fczrcrlce may be given ro tho UpcCilsed brand name over i subsrhttcd
brand. BID NO MORV,THAN ONE(1)T',QLlL TO/xubstitutod item.
Cerflrn cosstD C.oursty RI:Q
l�.•sGa 3
K ,� ,. b, 24u4 6. 19P,idi '-925-313-7319 s26` 567-190. 673 P. 6
�s.6 Samplc;�I'or�u6stizutad ices»s:
I ryou t 110 .w its knit€isa ti aubxtltittt t#itr:rti t:iiMr:r lltati#i1C spuClI icd btanu,±.$g4p
.ajr i7,r{nYr!Irxf,rh. 7ir:►s xcinlplts tilt::i#bC
#abcicd with;bite Carresponding lot itom numbalitcm dcccnptsatt/and brand nama.
#i'a�.tihola is NOT ptovidcd orNOT propr-rly lnbe€ed yourorrcr WILL NOT IM AC:CE.11TV0 ror th:ti Sulu.
CATI'GORY/sMs CROUP,
#I'tha sw"p!e i%round to be untta=ptahic Cor tasty rvwi\nn{ilunlity,l,rier,P11ek1'1f,c x111 Wity.typr orks:rrk;ti;ing,1volor,etc,),your
atI'#i:r will not tti ticsuvp ;il Ii+r iliac Ott#S-C`A`##:Girt#tY/tit.lti LrI{t)t!#',
tiAM#s€.Ii\MIIti'1'Ise t€ulivrretl(kNI,Y its-,
Contra t`ti,vta County
Agxnuics Its lrstt:si on o-ach lot
Sample.,arc ttt no coal tat ihu("antra Costa County Clonond St rvit:cs Dopunmcnt,Purchaxing Division.
3.7 Unless*%crwiv spooified,itetris:hurl#be new and unusod aml ol'current production,
3,9 CONTRA COSTA COON'TY will not he hound by mly cirsl stalcnicir or representaiion(s)t olur;uy to tilt-writlttu
s)s�•tli,otl;tttt+rt(ti)oi't{tii Itl�f?.
:�. ittritil:rt tuisr`rt Ctnitdctta#w;rrrvnfychall apply unit,+c p(hefWtvi at tYut##ri thik 10'0'
3,i{) ricrcis: 'e eI'urtal t> ±eft o AI,t. W+#} _ I t#I h ' `phI'^ lEh It N WAlt1?EI
Rr-SN MltMp TO A V13ivDC7k It% t c rt)t(}ttrrg ibiibt-of thv WTIor to verily ihat 7���E2S!Cca sus rprtcct rsrirtr tt�the
�+'s��C.S:b;UII.(,y c+tnc�rrs�+ttnrsji��,st;�,(.Iit€,�'1itl n Ice+:.
3.11 Miriufacwtwl;Nartia Lind Item Nuntbtrr
Poreach€icm being hitt,wlvet6c:r tI10-9pceificJ blond tar a subr;itme brand.the niamillivittr6;r's heiiitl nanw isn(€ICIrs tirnttnvi-
til EAI.E,Ise•titled Uader Ihv i-ttwiissn III Ivs`•VI"N00R tm vach p)pa:. #fit#Iirru to do-W tri:ry lie ju:tt:rausv ttr rojcet Ilie ontim,hie{,
Sca.ATTACH LD 111,ANK AT LN 1)OF THIS 1X)(:UMCNT ax to what document is expectod front the vendor. fl'biddibg
online Tho dicumenr will bo 13lhhl vitt wM tho hum bld you pinta tl on the system,
3.12 Usm only the:-UNIT OF Myi°AtSURE":tpt`Cllled, Bid by unit only(I�:i�Ibttx/aitrtonitiaxCnit:lChlpaCkaSi+lrt grrilTClUSct4
acrid show t.IMTS per case. ISUTOW YOUR tJ VE'r OF MUASt33tL•packaging!Erdifferent trout that crncct#.
3.13 rXI a¢9d fit itt Fitntt pr bu a j d extend-ed nrtce Failurrttci txt:nd ririruir sh!#I he jv t-nir4e to re g( t
Si" �d_
1.14 Vandor may not spceify minimum cutler quantities,
A.Y-ADM._Wa.l E_.abming roquircflicntt;at,}Sar ttpccifiCaxltlnC,
AGIN I Mctitotl col,packagling as pmrtirt:cil;satW1)' {lnttuAtry;:t:ntdarci} iuinil;i ct C::tricrttw MStW'ittitiilt wcigia 5U
pounds per tiarion Pai;€sing Litt roquircd o#t llia outsit#c ofc o cartonlpnzkaga.
in the:evom ora tit:.uw:trd wit',b.-ovRIC in the best inferest ol'(:t)NTIZA t:t)N7A L OUNITY,
contra cosh County AFQ
P..Va 4
mar-AUG., 6. 20943 6: 19AM - 1-925-313-73119 SIG -56"7-190, 673 P, 5 ia• �
7.1 i hMgmatcd order.:MUST be dtyliVered cur„plcro to tho requtufinp,UcTiatvnent. Therm orderr dC11VerlL:e,4holj be nide
wilhin SLS hour,of'the ixaB4 tim oritac Pumhaxc Or(lcr. PCH-uy.lays rnicall bushic:,s days, 41111erwixv xPCC111t.tt,
t#ttroulisii4 do livtay ptluitis m ttm%y extisc[)ad to It,;disirc•)tairdcj.
7,Z jf dclzy i fi)rt>tieC)i,ventitir atiaJi 1?ive ivrit(eri tttiricc f(t t't}NT1tA C'C1tiTA C' tjht'1 Y, VC11dor nt(ita kocp(',0N P A
t osrrA VMINTY tstivi cd nt:rtl tint.x ol',4t,((tut t)r{Sl'tlsr.Irfititlk•()rtici's nt;4tlr Ilio'Vendor%Iutf#eiIIter!rhino air.:till ort a
Parra).)the t)nterinl;action.uir:tr`rci 1)cparinient tri dix"xz tinct:ire ttp()ti a Hank-order dclivcr lout:. Failurc to ntcot Lh(:
diadline delivery d.110%and othurdelivcry rcquimmunts AMI bC just Auttxe for minoval from any iintire bid HAL
7..�ARcreutttriic:l is 4witrtlud,tit)tsuhxttlutiori(x)will lie,r1CN1tillQd wiltitlttl.tic written appravaf oI'CON'1'M cos'rA
COUNTY.
7A 1311 tivsa'y(s)shni#l+r atru!(;dttemp,normal husittc'm haturx W..tb 11;00 AM tuld 1:00 3:10 11M,illy Maittl.ty thNuif,li
Vriticty.Lxeept on regularly ut),scrvad xuac tir}edcrnl holiday,,ttnlCsi Iiriornttpriav:tl lam boon obtained!rosti C ONO TkA
C04TA COUNTY and chill he dclivcred to the Rhip T(r(iddrrt;scs as xpeiciricsd,
7.5 For shipping or hick up lnstm=iamr.,CON RA COSTA COUNTY may contact[hc foilowing:
V1.ND()(41N 81I111111INC POINT-OF-CONTACT
Contact Nanlof bide P4tllock
Title: _{rr►)slrttl icrvlt't��1}rpurtrncrtt
Tulophimc No.: ('3 S)j�i3 7311
FAX No.: (935)313-7319
7,0 All dalivurles shall be is &rr Oc =unless otftcrw6o nowd.
#t.`:hMPLtLS'D Irt-coitired will lv,tont Ia uhG 0s:paritns ill within d;(1)nut'k rrrilit t'Ctlticltt,
0_AWARV OF C0N'i'I2ACT
9 f AWARD NOTECT', CONTRA COSTA tY9uwry rc:.drvex Lht<ritthi tit r9tttR( an awnrcl(in 11w W tia ol'fow Iit:u item}rift,
low total Of lint'items,or In any wher enrnhinaLion that will serve in the best interest of CONTRA COSTA GO LINTY and to
rojr=any and sill bid itcmi at tho xtrla(vivrutiol9 of CONTRA COSTA COUNTY.
o,Z A re,rponwc to this ltFQ i:t-.ul aI'ibvut camr:tct bagcd upon the terms,coaditiom and speCi iCLition(s)aonlaincci herein.
kl;d4i do not bccom:coat=is unLii Itley art:Acupted thrattj;h an opm virkat purchase order_
10,titjIII%fly hx1{ nlun uA W P1CA1111t_N"4 IAida o"mulvt he Prolrerllt 1=111 Mi ki(III N4,14A4^,is in Lha:SLttW t)1 CalilorAju.
$:lt F _ T1 N: Sipinir Lhis bid with n fal,o s,uttrncnt 1F a mat0d."I lyra ach of contract and shah void the
><nhcxtlitcd bi(I ur any re,.Ullinf,4(nttraCt ,itttt! l
1110'I?t�1ifCC tv#i;lll hc 1 nittvct!.'rill)){t#119}jj16my\ll;ii;ftltra hatCd)n aI XCCI,Llti
biddar haY(:by ccatfiox Hutt;
hi(Ider hn.4;nnr ftivj:n'orJzred to giv(%new infands to Wiva nr any tisti>r licr+:aller any uctlnvinic Opportunity,lttmre
cuirloymcm,gift,louft,gratuity,griecial digeuunL,trip,l'1'tVor,or Narrvice w o CONTRA COSTA C()t N'rY craiployet`In
connection with the submitted bid.
1 1.2 The C;untr.wior shaft da fi+)al,ii9ticti11jil'y,and halt{hart Ices CONTRA t,'08TA COUNTY,tt11 OI'ilio tt1'Eidvi'x,uycutL4 un(I
employc+-';i fr6ril and against all c1alniv action,:,units.dcma.ndx,PwAmcdin;s,costs,damage&and liabilities,arising taut of,
conncctcst with,or resutting from anyl:tcls oromissiom of oontructor or nny aficet,employee,subcontra or.or,iupplior of
contractor in lht:exectjtiou tor perrormincc orthix cortirict.
11.3 Bidd5r aVuus to mninty with tta:irhed CONTRA COSTA.COUNTY Titrms and Conditionf;,
t 1 !VK)'['E 1.9) firr7nU'._ r Atty tornv mW em'ditions u(Melitul t()n bit]will i1ol be conshh rc(►ur9Jt:y pv`iili:t1ly rt;r(:rrcd to
on this.bid fbrin ttnd ni.)y result in of tho bid
Ccr*z C=a C tmh f R
P,-VO 6
-arAUG,- 6. 2004° 6: 19AM • 1-925-313-7319 816-5s7 -1ENO, 673 P, 4 7
12.1 POST AUCTION:Bid shamcwill be f4ra*,d(.lc#bot#t cioct(mically on a dlokuttc,and in hard eopy to:
Dick I'niltwk
Contra Costa county
�inn�z tI Scrvicas rkpTMcht
T't�rsJ;it r�t� 1}iviAott
1220 Morrllu Aw:aCtc SUitO 210
MmIncz,C;ztil'ttrpia 94553-4711
I-ailutt.111 provitlu t11;4 inrortttation uritltin 49 lWum w(ha clue ui"Lfie motion may bu grounds for tt:jc►:tlon oryour bid.
Pura+c scu:mAoh;:d SAMPLL rIlD PRC-ISRA.'i't NS SHELT: .5'.,flMPLE 0)%LE
Lott l'torn No.tshort Ouscrl uv`rr L►nIe tlttit PrFt:a GxtQr►dnd PrNca h+cndtsr Wand
1 001 240 Hx P ntiurri d 200 £n $1,000.00
$200.000.00 IBM
2 001 1.8 GHz Pontiuni A 350 pa $1,000.00 350,008.00 DELL
001 .4g#4 P_n+t uM 4 S5tI1t.C+#} 55G 0Ct4,Oti NP
SA
OAT,Y
!?f r.'JfiTli l PLL SEE F11
IrV .+'iNJ/RG/URlV7/Jl,it;L MAR LrRI!LL,:.S/ ,61L!'
Lot 1tom No. Short Description Unit Unit Pr2cs ond*d Pfta Vonddr Smind
1 001 200 Ea
2 001 PIC 350 am x h ka
3 d01 79-100 Ea
t'AGE I SiGNA'TU OF TmS JIN V'r ArION FOR Bili INDICATES"}"MI.is IS A I.`F TMTATt OMR TO THF-
CONTRA
ITCt'`NTRA;COSTA Ct')[J'N TV GZNV14AL,F.R'VTCX,,;DFPAUTMEN lr,
Cc=Cotmty PFQ
CoNS 1,TTM_Y
We Provide
Ccs tra Cu to + ".t xt RFO#40 0
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CLAIM t�
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: OMBER 51 2004
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
fi`s r. Pursuant to Government Code Section 913 and
� t<
915.4. Please note all"Warnings".
AMOUNT: UNKNOWN O N11T C t} S
CLAIMANT: JEFFREY COLLINS
ATTORNEY: UNKNOWN DATE RECEIVED: AUGUST 31, 2004
ADDRESS: 255 SHERWOOD DRIVE BY DELIVERY TO CLERK.ON:AUGUST 31, 2004
BRENTWOOD, CA 94513
BY MAIL POSTMARKED: 'AUGUST 26, 2004
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
AUGUST 31, 2004 JOHN SWEE E , C erk
Dated: By: Deputy
II. FI OM: County Counsel TO: Clerk of the Beard of Supe `isors
{-) 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:
F' i 1� ,• f
Dated: 5- `r' B : � — Deputy County Couns{
By:
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:
( This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct'copy of the Board's Ord entered in its minutes for this date.
Dated: T 0 5 M 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 deposits
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 full,
prepaid a certified copy of this Board Carder and Notice to Claimant, 4ddressed to the claimant as shown above.
Dated.: .L200� JOHN SWEETEN, CLERK,By r` � �� Deputy Clerl
1 ,
Claita ttr: BOARD (W SMMMR5 OF CWMA COSTA COMM
1NSTPUC MONS TO Cf.ADc2
A. Cial= relating to reuses of aettoa for deal-h or for ir.�ury to ;eraoss nr tea per-
scrral Fj~op ty or gmwfng crops ani acerae
which on or before December 31, 1987,
=:st be presented cot later than the 100th day aftw- the accrual of the ca.=e or
action. C.°.€aims relating to caU362 of action tW-death or for injw? to person
or to ,persoz-Al property Cr grvAng Omps and Uh ch acor* on o: after jxrjary 1.,
2988, must be pre-serted not later^ than sic wntb3 atter the anerua' of the clause
Of action. Clli= relating to any other cause of action m.,st be presented nor,
later than cal Yeas` after the actni l of the cause of an-tion. (Govt. Code
H. Clai= roast be filed with the Clerk of the Board of Supwvispre at its offioe in
am
Rc106, C�ourty Administration building, 651 ?Ina Street, Martinez, CA 94553.
C. If claim is against a distract governed by the Board of Supe,:visors, rather, than
the CcXety-, thlt rA= of thea District should be tilled 1-t.
D. if r,he 01aL1 is against more than one public entity, acute claims XU3t to
filen agairat eaVh PU"iio entity.
F.-' F;wu$. Sec per%al:v for Fraudulent, claims, Penal,Code Sec.. 72 at tr* and of th.s
To—m.
acae +1a0 +a11ea afataiaas �► aa tcra :aa � aaaca � * � �
RE: Claim By ? Reseed for Clertrs tiling strap
irsat y o tra
or _ AUG
IJP«„riot}
14775m #
Tine undersigned.claix=t h+em makes a calix inst the County
y Of�C Frzi''" �r
the Above-gla d ftiatrict in the of � and in ripport of
this olaiw represents as :rlitntss
1. Wen did tht e_or injury occ= (Gime exact dat,s and hour)
0 - g
2. Wh" did th,@ da
a or Jri�L*y cel (Includ�e'r alty and ty)
3. Hoa did the da=ge or in i yr aat::u•'? (Give full dem ilaoxixs P::�per
a jf pix a Gm Tcad t� ga1e-U-
to 3 '.XP U. What particular acct or wissi.csr an the part of aounty or district officers,
i�tr1 `Taarvants ear.emplov.tes causead.the injury or.�7?
i@'d TZ01 SE£ _C'6 6
20"d ItUOI
Wr C are the names or county or district officers, Servants or employee causi7
— yyV 'X s*6 e }o .,a A_6A O d"'.— � ° 4... '� • P
6. What doge or injuries do you claim resulted? (Give full extent of injuries or
dews claimed. Attach jtwo e3timates for auk die.
d"`
CA A 1v A
i> How was the au&mt claimed above o=*uted? (Include the estimated =unt of any
prospective injury or damage.)
8, *dames ard addresses of witnesses, doctors and hospitals.
g. List the expenditures you made oo acoourt of this acoident* or inJury;
SATE M Aad
Gov'. Cade See. '914:2 providest.
"The *121 must be aigred by the claimant
=0 NOTZCM TO: (Attorne ) or by Wm pe== his elf»"
ame mad A eSs Or AttOrney
f
1 igraa ure
5 k �v
Address
Telephone No. Telepi Ope WO. W
h0TIC 'S
Section 72 of the Penal. Code provides:
'Every person who, with intent to defraud, presets 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 ff.ganuin+e, any false or fraudulent
claim, bill, acoo mt, voucher, or writing, is fishable either by impriso6ment in
the county jail for a period of not mare that one.year, by a flne of not exceed Ing
one thousand ($1,000), or by both such JwOeLsonment and fine,,'or by imprisonment in
* qtate nr•i3on. by a rine of not exceeding ten thousand dollars ($10,000, or by
�G td 7 t111��G�.x c�'1H