HomeMy WebLinkAboutMINUTES - 10122004 - C14 CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY •
BOARD ACTION: OCTOBER 12, 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
F >...: Pursuant to Government Code Section 913 and
F 915.4. Please note all"Warnings".
AMOUNT. UNKNOWN
CLAIMANT: KEITH SPENCER j
ATTORNEY: JEFFREY L. JACOBS DATE RECEDED: SEPT. 08, 2004
ADDRESS: JACOBS IAW GROUP BY DELIVERY TO CLERK.ON: SEPT. 08, 2004
1420 RIVER PARK DRIVE, SUITE 100
SACRAMENTO, CA 95815-4506 BY MAIL POS'T'MARKED: SEPT. 04, 2004
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN SWE EN erk
Dated: SEPTEMBER 08, 2004 By: Deputy
II. MOM: County Counsel TO: Clerk of the Board of Supefvisors
(
4Y~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: ...� `.i ,✓`^t { c�. 81 < 1 .<. ._.. }r c°er`s j.tL`> .; F 2 .4 r ', i r E
: f
�`5[`% u'i..c✓'i !,, ` `: ..'3i.~.: I '"'t:' j 1'Z . �-'i r 3 ;i' "we .`°_C.,�
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Dated: B i 4, a: 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. 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 entered in its minutes for this date.
Dated: OHN SWEETEN, CLERK., By A , 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 depositec
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.
.O,--
DatedY ,JOHN SWEETEN, CLERK By Deputy Clerk
I JEFFREY L. JACOBS, SBN 140057 THIS SPACE FOR FILE STAMP ONLY
JACOBS LAST GROUP
2 1420 River Park Drive, Suite 100
Sacramento, California 95815-4506
3 Telephone: (916) 569-1600 RECEI
Facsimile: (916)569-1618
4 SES' 0 8 2004
5 Attorneys for Claimant CLERl(BOARD F SUPERVI S
KEITH SPENCER Cn1T1aCC TALC.
7
8 GOVERNING BOARD
9 FOR THE COUNTY OF CONTRA COSTA
10 CLAIM NO.
KEITH SPENCER,
11 CLAIM AGAINST LOCAL PUBLIC
Claimant, ENTITIES AND AGAINST THE STATE
i 2
FOR INJURY TO PERSON(Cal.Gov't
13 V. Code§910)
14 CITY OF LAFAYETTE, COUNTY OF
CONTRA COSTA, STATE OF CALIFORNIA;
15 CONTRA COSTA TRANSPORTATION
AUTHORITY,
16
Respondents.
17
18 TO THE GOVERNING BOARD FOR.THE COUNTY OF CONTRA COSTA:
19 Name and Post Office Address of Claimant("s)
20 Keith Spencer
21 5004 Brookheaven Way
Antioch, California 94531
22 (925) 978-0440
23 Post OfficeAddress to Which the Person Presenting the Claire Desires Notices To Be Sent
24 Jeffrey L. Jacobs
Jacobs Lav Group
25 1420 River Park Drive, Suite 100
Sacramento, California 95815-4506
26 Telephone: (916) 569-1600
Facsimile: (916) 569-1618
27
28 fll!
_1_
1 The Date,.Place and Other Circumstances of the Occurrence or Transaction Which Have
.Mise to the Claim.Asserted,
2
3 This claim is based on the personal injuries sustained by Keith.Spencer("Keith")as a result
4 of the incident that occurred on July 16,2004,at approximately 8:30 p. .The vehicle incident,more
5 particularly described in the following paragraphs, occurred on SR 24E/B, 100 feet east of 24 CC
6 06.5 1, 100 feet east of First Street U/C.
7 On July 16,2004,Keith was riding solo a 2002 Suzuki GSXR 600,eastbound on State Route
8 24 in an incorporated area of Contra Costa County,in the City of Lafayette,California.At the scene
9 of the collision, eastbound SR 24 consists of four lanes. Keith was traveling east at an unknown
10 speed in the number one lane when he came upon unknown and unanticipated discontinuities and
11 deficiencies in the roadway causing him to lose control of the Suzuki motorcycle and be ejected onto
12 the roadway, sustaining serious and grave bodily injuries and emotional distress as a result.
13 The vehicle incident and the injuries sustained were caused by the County of Contra Costa
14 Public Works Department and any other department,agency,or division of or in such entities,and/or
15 their employees or agents for reasons including but not limited to the acts and/or omissions which
16 resulted in the following conduct:
17 Failure to warn of and/or prevent and/or correct a"dangerous condition"; that is, a
18 condition of property that creates a substantial risk of injury when such property or
19 adjacent property is used with due care in a manner in which it is reasonably
20 foreseeable that it will be used.
21 Failure to provide and/or maintain adequate signs, signals, devices, pavement,
22 shoulders, superelevations, guardrails and/or stripings.
23 Failure to maintain a clear zone.
24 Failure to provide and/or construct and/or maintain an adequate shoulder along the
25 roadway.
26 Failure to provide and/or construct and/or maintain adequate lane widths in the
27 vicinity described above.
28
-2-
I * Failure to prevent and/or correct and/or warn of an unsafe and inadequate
2 superelevation of the roadway.
3 Failure to wam of and/or prevent and/or correct an unsafe and dangerous
4 superelevation transition of the roadway.
5 * Failure to warn of and/or prevent and/or correct unsafe and dangerous curve(s)in the
6 road surface.
7 * Failure to adequately warn of a dangerous and unsafe condition.
8 Failure to reinstate transverse profile of the roadway.
9 Failure to maintain pavement sealing and pavement texturing in the roadway.
IQ Failure to restore safe pavement surface characteristics to provide adequate
11 frictional properties to polished pavement otherwise structurally sound.
12 Failure to correct polished roadway surfaces.
13 * Failure to correct pavement rutting due to sub-grade consolidation in the wheel
14 path.
15 Failure to repair and/or eliminate potholes in the roadway.
16 Failure to repair and/or eliminate cave-ins in the roadway.
17 Failure to repair and/or eliminate hummocks in the roadway.
18 Failure to repair and/or eliminate ponding in the roadway.
19 • Failure to perform rut filling or pavement profiling to reduce roadway
24 deficiencies.
21 Failure to reduce oxidization causing raveling,potholes, thermal and age cracking.
22 The County of Contra Costa Public Works Department and any other department, agency,
23 or division of or in such entity, and/or its employees or agents created these dangerous conditions
24 of public property,and had actual and/or constructive notice of these dangerous conditions, as well
25 as sufficient time in advance of the subject incident and of the subject consequent injuries to have
26 taken measures to protect the public against these dangerous conditions.
27 /I(/
28 Illi
-3-
I A GeneralDeseription ofthelndebtedness,Obligation,Injury,Damage,OrLoss Incurred
Insofar as It May Be Known at the Time of Presentation of the Claim.
2
3 Keith suffered severe personal injuries,including injury to right leg and consequent damage
4 to the hip;other presently unascertained and undiagnosed bodily injuries;and suffered mental pain,
5 suffering,and emotional distress,as well.Keith is incurring ongoing medical expenses for continued
6 medical care and treatment.
7 Keith has also suffered ongoing lost wages and earning capacity as a result of the incident
8 caused by the dangerous condition of public property.
9 The Name or Names of the Public Employee or Employees Causing the Injury,.Damage,
or.Loss, if Known.
to
I 1 The names of the public employee or employees causing the injuries and loss is unknown
12 at this time.
13 TheAmount Claimed as of the Date ofPresentation of the Claim,Including the Estimated
Amount of Any Prospective Injury,.Damage, or Loss,Insofar as It May Be Known at the
14 Time of the Presentation of the Claim, Together With the Basis ofComputation of the
Amount Claimed.
15
16 Keith Spencer claims damages in an amount such that his case would be Filed in the superior
17 court unlimited civil jurisdiction. The current medical expenses are in excess of$56,000. Keith's
18 damage claims include but are not limited to general damages including pain, suffering, and
19 emotional distress; special damages including medical costs incurred, ongoing medical expenses,
20 and future medical expenses; other damages undetermined at this time.
21 The claim of Keith Spencer is therefore not a limited civil case, but would properly rest
22 within unlimited jurisdiction in the superior courts of California.
23 Dated. September 4, 2004
JACOBS LAW GROUP
24
25
By:
26 JE ; L. JCOB
Atto e :for C aiman
27 KEH SPEN. ER
28 ,
-4-
1 PROOF OF SERVICE
CCI'Sy 1013(x)and 2015.5
2 STATE OF CALIFORNIA.
CASE NAME: Spencer v.County of Centra Costa
4 CASE NO.: Before the Governing Board for the County of Contra Costa,California
DOCUMENT(S): Claim Against Local Public Entities and Against the State for Injury to Person(Cal.Gov't
5 Cade§91.0)
6 I am employed in the County of Sacramento,State of California. I am over the age of 18 and not a party to the within
action.My business address is Jacobs Law Group, 1420 River Park Drive,Suite 100,Sacramento,Ca 95815-4506.
7
On September 4,2004,I served the parties,or attorneys for the parties who have appeared in this action,with copies of
g the captioned documents as follows:
9 (BY MAIL)-In a sealed envelope,addressed as stated below,with postage thereon fully prepaid and caused
such envelope to be placed in the United States mail in Sacramento,California.I am readily familiar with this
10 firm's practice of collection and processing correspondence for trailing.Under that practice,;nail is deposited
for mailing with the United States Postal Service in Sacramento in the ordinary course of business on the same
11 day mail is placed in the office receptacle for mailing,with postage thereon fully prepaid.I am aware that on
motion of the party served,service is presumed invalid if postal cancellation date or postage meter date is more
12 than one day after date of deposit for mailing in affidavit.
13 Clerk of the Board
County Board of Supervisors
14 Contra.Costa County
651 Pine Street
15 Martinez,California 94553
16 ❑ (BY CERTIFIED MAIL AND RE'T'URN RECEIPT) -In a sealed envelope, addressed as stated on the
attached service list,with postage thereon fully prepaid for Certified Mail and Return Receipt and caused such
17 envelope to be placed im the United States mail in Sacramento,California.
18 ❑ (BY EXPRESS MAIL OR ANOTHER METHOD OF DELIVERY PROVIDING FOR OVERNIGHT
DELIVERY)-In a sealed envelope,addressed as stated on the attached service list,with postage(Express
19 Mail)or delivery fees(another method of delivery providing for overnight delivery)thereon fully prepaid,and
caused such envelope to be deposited in Sacramento, California, in a receptacle or at a facility regularly
20 maintained by the United States Postal Service(Express Mail)or in a receptacle or at a facility of a carrier
providing for overnight delivery.
21
® (BY FACSIMILE) - I caused the document(s) to be transmitted to the facsimile numbers of the parties or
22 attorneys for the parties who have appeared in this action,as stated on the attached service list.The transaction
report generated by the facsimile machine of sending party with facsimile number(916)569-1618 stated all
23 pages were transmitted with no error stated in the report.
24 ❑ (BY PERSONAL SERVICE) - I caused the document(s)to be personally served by hand delivery at the
offices of the addressees stated on the attached service list.
25
1 declare under penalty of perjury under the laws of California that the foregoing is true and correct. Executed on
26 September 4,2004,at Sacramento,California.
2?
r
28 C.J. Sidq')
-5-
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION:OCIOBER 12, 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
Pursuant to Government Code Section 913 and
915.4. Please note all"Warnings".
AMOUNT: $584.95
t
CLAIMANT: BONNIE ANDREWS `
ATTORNEY: UNKNOWN DATE RECEIVED: SEPT. 08, 2004
ADDRESS: 664 DONNA MAE COURT BY DELIVERY TO CLERK ON:SEPT. 08, 2004
EL SOBRANTE, CA 94803
BY MAIL POSTMARKED: SEPT. 07 2004
FROM- Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
HN SWE le
SEPT.. 08 2004 rk
Dated: By: Deputy
76
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
(,..)-This claim complies substantially with Sections 910 and 910.2.
{ j This Claim FAILS 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 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 Counse
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. 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: JOHN SWEETEN, CLERK, By IF , 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 depositei
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: '0' 060 YA ZV4JOHN SWEETEN, CLERK By Deputy Clerk
REC
Cl.a ire to BOARD OF 5JP1R VISORS OF CONTRA COSTA COUNT-Y SEP 0 8 2004
EP
VISORS
Ab Claims relating to cau.s4s of action for death o.- for injury to
sonsl property or growing crops and which accrue cin or before Dece�ber �� � 19�, s
must be presented not lAter than the 100th day after the acerual of the czase of
action. Clams relating to cauae3 of action fordeath or for injury to person;
or to personal property or growing crops and .i&. accrue on or after January 1,
1988t must be presented not later than six months after the accrual of the cause
of aot on. Claims relating to any other cause of action must. be presented not
later than one year atter the accrue of the cause of action. (Govt. C e §9114.2.
B. Claim must be filed with the Clerk of the Board of Supervisors at its office ir:
Boom 106, County Administration Building, 651 Pine Street, Martinez, CA 94553.
C. T f-claim ..it . . ` i'"t ..s, diltrict governed by the Board of Supervi3ors, rather than
the C<aunty, t-ha name of the District should be .filled in.
D. If the claim is against mwe than one public entity, separate clai= =ust be
"'lied against each public entity.
Fraud. See penalty for fraudulent claims Penial, Code Secy 72 at the end of this
Yom.
RE: Claim By Reserved for Clerk's filing stam-p
na-iFSt e r5MEY cif Cont stta
or �
District)
The undersigwd claimant hereby mkes claim against the County of Contra Costa 04-
the
rthe above- d District in the s= of � ` � ,�. , and in support of
this cairn represents -as foU a
3. When did the dama a or ipjury ocour? (Give exact date and hour)
2. 'mere dial the damage or inJury sur*: (include city and county)
3. € ow diff the dae or injury occur? (Give f 3. details; use extra paper if
re uIrets, -6u
4. What Particular act or omission on the part of county or district oi"fIcers,
servants car . sloye��es cauaed° the injury or damage?
S. Wnat tree rimes of o*unty or distriet affiters, servants or employees Causing
the damage or iniury? `,` V � -� ` -VNe ��t��'t`l} t Sc�C � cm-d,
a-v�. ��
1 ! 'S 0n rh t�G,-U k4rrs 4 l Et i rpt 1rAF e ArJrews) S,tperoxsor s�,aw 4o_m&,
+4AA ry-),e 16 --dry PfWe:�,S r o n u l wrr s
6. What damage or injuries do you claim resulted? (Give full extent of inJuaries or
damages claimed. Attach two estimates for auto die. i
ter Der SPr�� 0 n U��i�.,�, � -- ,nye �� -�� G�� Ce OX00
7. 1,Jow was the amount claimed above s ut;t? (Inclu a t-he estimated amotmt of any
prospective injury or fie.)
Ayo (o
8.. Names and addresses of witnesses, doctors euid hospitals.
r\_0 k
"+TsuiFq.wlw+r+ua.e.YweaalwM•aihae+wsrre+4 rww w+:F11YiYPWw:rYN.o•rer�.s+isnbul:ripaL.uemilvaill+ave .Ms4¢iafY:Y+i1+eMh�ws.pFK.+erw
9i List the expenditures you made on account Of this accident or injury}
DATE ITEM AMOUNT
r` GA !'af w 3 X, 4�f% tf✓` �
Goi. Code Sec. 91M provi des:
"The claim must be sipAd by the clai nt
SEM NOTICES T3: (Attome ) or toX som.,i2erson an his.behalf"."
2Ee- and Address sof Attorney
at sSignature)
kAddre
Telephone No. Telephone No.
e " aW, 1 9 g # I I T I' T I X
NOTICE
Section 72 sof the Penal Code provides:
"Every person who, with intent to defraud, presents for allm anise or for
payment to any state boater or officer, or to any co=ty, city or district board cr
+officer, authorized to allow or pay the same if .genuine, any false or fraudulent
claim, bili., account, voucher, or writing, is punishable either by imprisoriment in
the county jail for a, period of not more thon one•year 3 by a fine of not exceeding
one thousand ($1,000), or by bath suoh' 1vspr_is t and fine;,- or by imprisonment in
the state prison, by a fine of not ex ding ten thousand dollars ($10,000, or by
both such Imprisonment and fine.
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Grand Prix Pvto Wash
3080 San Pablo DaMRd
1 :48pm 7-87-04
SHIFTO I '1" €'MIHAL# i
SLSMN# 2
6rand Prix
MINI VANS 1. 00
€ asternC r d 24. 95
IF IT RAINS WITHIN
,24 HFAS OF PAID F. Sa W
YOU WILL. €.SEI" AN EXT
WASIA WITHIN 3 D SYS t S
YOU MUST PROVIDE THE
(NOT VALID ON EXT.
WASH) BRING G "I H I S
COUPON FOR $1. 00 OFF
ON YOUR NEXT VISIT.
(NOT VALID WITH OTHE
R GFS' ) THANX YMJ
09/07/2004 at 05:23 PM Job Number:
33581
ANDY'S AUTO BODY
License # :AL186430 Federal ID # : 680242263
235 24th St.
Richmond, CA 94804
(510) 232-5749 Fax: {510} 232-8130
PRELIMINARY ESTIMATE
Written By: Mario Jacobus
Adjuster:
Insured: Bonnie Andrews Claim #
Owner: Bonnie Andrews Policy #
Address: 664 Donna Mae CT Deductible:
El Sobrante, CA 94803 Date of Loss:
Day: (510) 222-1948 Type of Loss:
Point of Impact:
Inspect ANDY'S AUTO BODY Business: (520) 232-5749
Location: 135 24th St.
Richmond, CA 94804
Insurance
Company: Days to Repair
1997 GMC M15 4X2 SAFARI 6-4 .3L-FI 3D VAN Shite .int:
VIN: 1=KDM19WXVB545996 Lic: Prod Date: Odometer: 85210
Air Conditioning Intermittent Wipers Dual Mirrors
Clear Coat Paint Pourer Steering Power Brakes
Anti-Lock. Brakes (4) Driver Air Bag Passenger Air Bag
Hiback Bucket Seats
----__-_--_-__------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
-----------------------------------------------------------------------------
1# Clean Overspray 1 4 . 0
2# Polish & Detail 1 4 . 0
3# Solvent & Polishing Supplies 1 40 . 00
-------------------------------------------------------------------------------
Subtotals = 40. 00 8 . 0 0 . 0
Parts 40. 00
Body Labor 8 . 0 hrs 2 $ 70 . 00/hr 560 . 00
----------------------------------------------------
SUBTOTAL $ 600. 00
Sales Tax $ 40 . 00 a 8 .2500° 3 . 30
----------------------------------------------------
GRAND TOTAL $ 603 . 30
09/07/2004 at 05:23 PM Job Number:
33581
PRELIMINARY ESTIMATE
1997 GMC M15 4X2 SAFARI 6-4 . 3L-FI 3D VAN Shite Int:
Can an Insurer require, direct, suggest or recommend that your automobile be
repaired at a specific shop?
No - Unless the referral is expressly requested by you. SB551 prohibits an
insurer from requiring an auto be repaired at a specific auto repair dealer.
The insurer can only recomend an auto repair dealer if the insured asks for a
referral, or if the insured is informed in advance in writing of the right to
choose the repairer of his or her choice. If an insured takes an auto to a shop
of his or her own choice, an insurer cannot limit or discount reasonable repair
costs based on charges that would have been incurred had the insured gone to
the insurer' s chosen shop.
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 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 BT ND=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.
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from
the Guide DRlGG85 Database Date 08/2004, CCC Data Date 08/2004, and the parts selected are
OEM-parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at
OE/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. Recored 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 Services Inc.
2
Date 81712004 01:57 PM
Estimate ID: 605
Estimate version: 0
Preliminary
Profile ID: Mitchell
Bill Nelson Chevrolet
3233 AUTO PLAZA RICHMOND,CA 94806
(510)222-2070
Fax: (510)223-8569
Tax ID: 94-1699426 BAR#: AB007001 EPA M CAD989387588
Damage Assessed By: Chris Hoglund
Type of Loss: Comprehensive
Deductible: UNKNOWN
Insured: BONNIE ANDREWS
Address: 664 DONNA MAE CT EL SOBRANTE,CA 94803
Telephone: Home Phone: (610)222-10,48
Mitchell Service: 915484
Description: 1957 GMC Safari SLE
Body Style: VanPassExt 111"WS Drive Train: 4.31-Inj 6 Cyl 2WD
VIN: 1 GKDM19WXVB546996
Mileage: 85,110
OEM/ALT: O Search Code: None
PLEASE NOTE: LINE ITEM REPAIRS DESCRIBED AS SUBLET,REFERS TO
THOSE REPAIRS PERFORMED BY OTHER FACILITIES OTHER THAN
BILL NELSON CHEVROLET,OLDSMOBILE. FOR EXAMPLE: GLASS,STEREO,
TIRES, AND UPHOLSTERY. IT MAY BE NECESSARY TO OPERATE VEHICLE
HEREIN DESCRIBED, TO AND FROM SUBLET VENDOR.
Color: WHITE
Options: ALUMIALLOY WHEELS,AIR CONDITIONING,POWER WINDOWS,POWER DOOR LOCKS
CRUISE CONTROL,AUTOMATIC TRANSMISSION,AM-FM STEREOICDPLAYE€t(SINGLE)
"ALL CRASH PARTS ON THIS ESTIMATE ARE "NEW" ORIGINAL EQUIPMENT
MANUFACTURER PARTS, UNLESS OTHERWISE SPECIFIED. PARTS DESCRIBED AS
RECHROMED,RECORED,REMANUFACTURED OR, RECONDITIONED ARE CONSIDERED
"REBUILT" PARTS.CRASH PARTS DESCRIBED AS "QUALITY REPLACEMENT PARTS"
ARE NON ORIGINAL EQUIPMENT MANUFACTURER AFTERMARKET NEW PARTS.
THOSE LISTED AS "LKQ" LIKE KIND AND QUALITY PARTS ARE USED PARTS.
Line Entry Labor Line Item Part Typel Dollar Labor
Item Number Type Operation Description Part Number Amount Units
1 goo 500 BDY* CHECKIADJUST OVERSPRAY Existing 8.0*
2 REMOVE FOREIGN
3 SUBSTANCE FROM
4 4 " SURFACE
ESTIMATE RECALL NUMBER: 91 712004 13:57:34 605
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: SEP 04 A Copyright(Cj 1884-2003 Mitchell International Page 1 of 2
UltraMate Version: 5.0.{€18_ All Rights Reserved
g Crate: 9/712004 01:57 PM
Estimate ID: 605
Estimate Version: 0
Preliminary
Profile ID: Mitchell
Judgement Item
Add'I
Labor Sublet
1. Labor Subtotals Units Rate Amount Amount Totals 11, Part Replacement Summary Amount
Body 8.0 70.00 0.00 0.00 560.00 T
Total Replacement Parts Amount 0.00
Taxable Labor $60.00
Labor Summary 8.0 560.00
Ill. Additional Costs Amount IV. Adjustments Amount
Total Additional Costs 0.00 Customer Responsibility 0.00
1. Total Labor: 560.00
it. Total Replacement Parts: 0.00
Ill. Total Additional Costs: 0.00
Gross Total: $60.00
IV. Total Adjustments: 0.00
Net Total: 560.00
This is a preliminary estimate.
Additional changes to the estimate may be required for tate Actual repair.
SPECIAL PARTS NUTE:ALL CRASH PARTS ON THIS ESTIMATE ARE "NEW"
PARTS (OEM) UNLESS OTHERWISE SPECIFIED. PARTS DESCRIBED AS
RECHROMED, RECORED, OR REMANUFACTURED ARE EITHER "RECONDITIONED"
PARTS OR "REBUILT" PARTS. CRASH PARTS DESCRIBED AS QUAL REPL
PARI"' ARE NUN OEM AFTERMARKET PARTS.
Cycle Time Information
Drop Off Date: 9/712004 Repair Dates:
Promise Date: 91712004 Start Date: 9/7/2004
ESTIMATE RECALL NUMBER: 9171200413:57:34 605
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: SEP 04_A Copyright(C)1994-2003 Mitchell International Page 2 of 2
UltraMate Vision: 5.0.018 All Rights Reserved
y
CLAIM
BOARDCUPERVI ORS OF CONTRA COSTA COUNTY
BOARD ACTION:OCIOBER> 12, 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), giver
Pursuant to Government Code Section 913 and
Pr 915.4. Please note all"Warnings".
AMOUNT: $3,357.84
CLAIMANT: PAUL A. BARNES
ATTORNEY: UNKNOWN DATE RECEIVED: SEPT. 10, 2004
ADDRESS: 29 CELIA DRIVE BY DELIVER'TO CLERK.ON: SEPT. 10, 2004
PLEASANT HILL, CA 94523
BY RAIL POSTMARKED: � HAND DELIVERED
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
SEPT. i0 2004 JOHN SWE erk
Dated: By: Deputy_
II. MOR: County Counsel. TO: Clerk of the Board of Supervisors
This claim complies substantially with Sections 914 and 910.2.
( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so noticing claimant. The
Board cannot act for 15 days(Section}10.8).
{ ) 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: ''i,vl 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: pa; y'` JOHN SWEETEN, CLERK., By , Deputy Clerk
WARNING(Gov. code section 913)
Subject to certain exceptions,you have only six (d)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 per ury 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: e''V'w !�AeA1N SWEETEN, CLERK.By Deputy Clerk
AUG-25-2004 13:1? CCC RISK MANAGMENT 925 335 1421 P.02
Claim to: BOARD CF SPERVISMS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before December 31, 1967,
Must be presented not later than the 100th day after the accrual of the cause of
action. Claim relating to causes of action for.death or for Wury to person
or to personal property or growing tamps and which accrue on or after January 10
1988, must be presented not later than shit months after the accrual of the cause
of action. Claims relating to ani* other cause of action must to presented not
later U= one year after the accrual of the cause of action. (Govt. Code §911-2-)
B. Claims mist be filed with the Clerk of the Board of Supervisors at its Office in
Room lob, 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 avastbe
filed against each public entity.
E. " Fraud. See pity for fraudulent claims, Penal. Code 'Sec. 72 at the end of this
Yom.
RE: Claim By ) Reserved for Clerk's filing stamp
6arnes
r
SEP 10 RED
Against the Couxtty of Contra Costa } `
or
Y'
1
.District)
(MI'S'a mate
The undersigned claimant herby makes claim against the County of Contras Costa or
the above--named District i
09/10/2004 at 09 : 20 AM Job Number:
17908
MIRE ROSE'S AUTO BODY INC.
License # :BAR## AA07562 Federal ID #: 942621349
WHERE QUALITY COUNTS
2001 FREMONT STREET
CONCORD, CA 94520-2616
(925) 686-1-739 Fax: (925) 686-1744
PRELIMINARY ESTIMATE
Written By: BRUCE HUBERT ##CAD981159189
Adjuster:
Insured: PAUL A. BARNES Claim ##
Owner: PAUL A. BARNES Policy ##
Address: 29 CELIA DRIVE Deductible:
PLEASANT HILL, CA 94523 Date of Loss:
Evening: (925) 349-7777 Type of Lass:
Point of Impact:
Inspect MIKE ROSE' S AUTO BODY INC. Business: (925) 686-1739
Location: 2001 FREMONT STREET
CONCORD, CA 94520-2616
Insurance
Company: 8 Days to Repair
2000 JEEP GRANT) CHEROKEE 4X4 LIMITED 8-4 .7L-FI 4D UTV BLACK Int :
VIN: 1J4GW58NOYC306579 Lic: 5HUA787 CA Prod Dates Odometer:
Air Conditioning Rear Defogger Tilt Wheel.
Cruise Control. Intermittent Wipers Climate Control
Keyless Entry Theft Deterrent/Alarm Rear Wiper
Steering Wheel Controls Tinted Glass Dual Mirrors
Roof Console Luggage/Roof Rack Fog Lamps
Clear Coat Paint Power Steering Power Brakes
Power Windows Power Locks Power Driver Seat
Power Passenger Seat Power Mirrors Anti-Lack Brakes (4)
Driver Air Bag Passenger Air Bag 4 Wheel Disc Brakes
Leather Seats Bucket Seats Aluminum/Alloy Wheels
-------------------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
-------------------------------------------------_-------------------------------
1 REAR BUMPER
2 O/H bumper assy 0 0 . 00 2 .0 0.0
3 Repl Bumper cover w/hitch bezel 1 425 . 00 Incl . 3 .2
primed
4 Add for Clear Coat 0 0 . 00 0 . 0 1 .3
5 QUARTER PANEL
6* Rpr RT Panel assy w/o lwr pillar 0 0 . 00 12 . 5 2 .7
7 Add. for Clear Coat 0 0 . 00 0 . 0 1 .1
8 R&I RT Applique "'D" pillar black 0 0. 00 0 . 1 0 .0
9 R&I RT Lower molding Limited 0 0 . 00 0 .1 0 . 0
primed
I
09/10/2004 at 09 :20 AM Job Number:
17908
PRELIMINARY ESTIMATE
2000 VEEP GRAND CHEROKEE 4X4 LIMITED 8-4 . 7L-FI 4D UTV BLACK Int:
-------------------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
--------------------------------------------------------------------------------
10* Repl RT Qtr glass Jeep privacy_j 1 250 .00 1 . 5 0.0
SCRATCHED
11# Urethane kit 1 26 .25 T 0 . 0 0 . 0
12 R&I RT Lower tram agate 0 0 . 00 0 . 7 0 . 0
13 REAR LAMPS
14 R&I RT Tail Lamp assy 0 0 . 00 0 .4 0 . 0
15 REAR DOOR
16 Blnd RT Outer panel 0 0 .00 0 . 0 1 .1.
17 R&I RT Belt w' strip outer 0 0 . 00 0.3 0.0
18 R&I RT Lower cladding Limited 0 0 . 00 0 .4 0 . 0
primed
19 R&I RT Handle, outside Limited 0 0 . 00 0 . 3 0 . 0
black
20 R&I RT R&I trim panel 0 0 . 00 0 .4 0 . 0
21# Repl COLTER CAR 1 5 . 00 T 0 .2 0 . 0
22# Repl FLEX ADDITIVE 1 10 . 00 T 0 . 0 0 . 0
23# Refn TINT COLOR 0 0 .00 0 . 0 0 . 5
24# Subl HAZARDOUS WASTE 1 5 . 00 X 0 . 0 0 .0
254 COLOR SAND & POLISH 1 0 . 00 1 .5 0 . 0
26# Subl PAINTED PINSTRIPES - "PER 1 1.35 . 00 X 0 . 0 0 .0
INVOICE"
---------------a------------------------ ------------------------------------------
Subtotals =_> 856 .25 20 .4 9 . 9
Parts 675 . 00
Body Labor 20 .4 hrs Q $ 70 . 00/hr 1428 . 00
Paint Labor 9 . 9 hrs @ $ 70 . 00/hr 693 . 00
Paint Supplies 9 .9 hrs @ $ 30. 00/hr 297 . 00
Sublet/Misc. 181..25
----------------------------------------------------
SUBTOTAL $ 3274 .25
Sales Tax $ 1.013 . 25 Q 8 .2500% 83 . 59
-_-_-------------------------------------------------
GRAND TOTAL $ 3357 . 84
ADJUSTMENTS:
Deductible 0 . 00
------------------------------------------------------
CUSTOMER PAY $ 0. 00
INSURANCE PAY $ 3357 . 84
THIS IS A PRELIMINARY ESTIMATE AND ADDITIONAL CHARGES MAY BE REQUIRED FOR THE
AC'T'UAL REPAIR.
2
09/10/2004 at 09 :20 AM Job Number:
17908
PRELIMINARY ESTIMATE
2000 JEEP GRAND CHEROKEE 4X4 LIMITED 8-4 . 7L-FI 4D UTV BLACK Int:
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 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 HAS 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 DR3WA99 Database Date 08/2004, CCC Data Date 08/2004, and the parts selected are
GEM-parts manufactured by the vehicles original Equipment Manufacturer. CEM parts are available
at OE/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. Recored 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 Services Inc.
3
Sep 07 04 04:25p Martinez PD 925-228-3759 p=2
STATE OF CALIF001A
TRAFFIC COLLISION REPORT
CHP 566€age 1{Rev 8198}OFI 042 Pag o 1
SPECIAL c'JMO:T"s N0,w#slxeEO HIT L Ru m PGtONY CRY ADICIAL DIBTRR:T LOCAL REPORT NUMBER
Msrtincz MT DIABLO 04-3916
N0.KCLLEO MIT A RUN WSD COWN REPf7RTf, DISTRICT BEAT
CONTRA COSTA 2
COLLISION CY:CtJRR€O Oi'L 00 DAY YBAR �TA#E NGIC R OFFICER I.D.
C2504 ALHAMBRA AVE __._+__ 9/1 If2404 1649 CA4071440 114
MIiEPOST INFORfiAF10N DAY
OF WEEK ;OW AWAYP#VO'TOGRAPHffi
T PARKING LOT B WEDNESDAY []YE3 NJNO
{ FERRI R
0 � AT LrdTP_RSECTKYN WITH STATE lIYVt'REL I
H OR. YES 'X NO I
IAR0i4VEMe LICENSE NLMASER STATE CLASS `AIRBAG SAFETY EQUIPWE. YEAR VAKWMOM!iWCOLOR I3ikE�iSE NtMiBER STATE '
1 B8696057 CA { 4 JEEPIGRAND CHERMLACK SHUA7$7 CA
DRIVER NAME ......NAME
XX t PAUL ALEXANDER BARNES X SAMEAa DRIVE{
PSDEST S"PREET ADDRESS -. _... .. OWNER ADDRESS
29 CELIIA DR �SAW AB DRIVER
VE CdF7'}STATEfLiP INSCOSITION Of VEMIOLE ON ORDERS OF:
OPFIOER ]{ DRIVER OFNA
PLEASANT HILL,CA 44523 LEFT AT SCENE
SICYLSF:
sex HAIR EYES HE/DMT' WL40HF BwT—„DATE RACE PRKTR MEGtI.DEPOTS
�-~� }(°NONE APP. RdtIER TO NAPWATriE
Ell, M 1211611980
W VIBOCAE q}ENTIFTCATION NUk18ER:
OTHER HOME PHOME BUSINESS PHONE CMPUSEONLY DESCRIBE VEHICLE DAWOE imAN IN
425-343-7777 vEH eLt 7YPE uawc E)NONE- X www
NsURANcE CARRIER P'Oi1CY I6UlitBER # M00 0 MA.iOR RI9LL-OV@ft `
COAST (344445653440
OBC OK TRAVEL OPt ST1@EE7`OR.HOHWAY SPEED UWT
N N1B PARKING STALL i DA DO
CAL•T _. ._ _.._ TCP4,$C
PARTY ORfVERS Lf CENSE t°7I.IMbETI STATE CLASS A1RBA* SAFI9TYEQLRA. VBM YEAR MtktiEiMO0F1JJQDLOR LICENSE NUMIBER STATE
2 C4037791 CA 1 1 TOYOICAMRY/WHITE II4II4 CA
DRNER NAME RNAME •SAiiEASDRNEIt
CHARL.ENE ANN THOMAS CONTRA COSTA COUNTY
PewsrSTIVE S A SS OWNER AOORI BS
�? 2540 AL14AMBRA AVE X SAME At DRIVER
KVE CCYYISTATVZIP DISPOSITION®P WHOLE ON ORDERS OF: OFFICER ,DRIVER j{ Ix i
{ MAR i 1TEZ,CA 94553 LEFT AT SCENE
IBK;YLSF 9EX 'I'D'SIR'�'f rw HEIGHT RVVE HT BIRTHOATE RAGE PRIOR MBgN.DEFECTS .�(
NONE APP. REPER TO NARRAT"YE 1
(`; I El
9£2911966 W VEHKO.E OeNTwmTlON NUMBER:
OTHER NOW sHOt BuaµiEBa PHONE DESCRISE VEtCLE OAAiACiE W DAMXG$B ARLIt
t WORK 425-335.8923 VEM usernx F7 UNK NONL WHOR
PISURANCE CARIii£R�,-•�••_� - POLICY NUUBER �MOO MAJOR RgLL•OVIIR "r
MR OF TRAVEL CNV STREET OR HIQH'VYAY SPEED LIMIT
CA DOFo,.,.
CAtrT
PAFWM DRIVERSLICENSENLIMER STATE CLASS AIRBAG 'BAPETYEQUIP, VEH YEAR ODEUC[w.OR LIC EHBE NUM STAT'@
3 X10433559 CA
ORIVER NAME OWNER NAME
gK�N SANE AS ORIVY'.R
KENNETH JOHN SALONEN El
STREETDD#ESS OWNER ADDRESS
SAttE As DRIVER
ADERA CIR
FJZP' DISPOSITION OF Cab Ota ORDE7iS OR:
{ OFFICER 'DRIVER ,OTN�
RITO,CA 94534
HAIR. EYEHEIGHT WEIGH; tlRiTHDA78 RAGE PRK1R MECM,CERhKTNE APP. REPER TO NARRATESB#�'d BLU 6'1” 140 7/28/1954 w VEHICLE IDENCIFICATISNJWJMSER:
OTHER HOME PHONE BUSINESD PHgNE CHP USE ONLY DE ISE V8lNCL oaMAOE SNARE IN DAMIAOEO '
Xj WORD. 425-335-$746 VEHIOLETVPE �UNK L]NOW MINOR
INSURANCE CARRiETI POLICYNUMBER MDO MAtOR ROLLOVER
IR OF TRA ON S OR"'Gl'wAY SP€EO ItM1'P'
%'A DOT
;MDFERRER
RED BY CNSPATCH NOTIFIED REVI BO
114 (X .
Na Na rt124f2444
Seep 07 04 £14: 25p Martinez PD 925-226-3753 p• 3
STATE OF CALIFORNIA
TRAFFIC COLLISION CODING
CLIP 555 Page 2(Rev SM)OFI 042 Page 2
SSA OF GStLi MiFX-
W.DAY YEAIS} TWO f34tlQl NGtC t L1F�ICER 1.6. Ni ItlEir
811112004 1548 CA0071494 110 04-3916
C}WNER OWNER AGDRESB NGTrPtE6Y
PROPERTY �Yee Na
DAMAGE �€scrtwnoNc�onsuoB
SEATING POSITION � SAFETY EQUIPMENT EJECTED FROM VEHICLE
n OCCUPAN75 L-AIR SAG DEPLOYED MIC BICYCLE-HELMET a-NOTEJECTED
i G y A-NONE IN VEHICLE M-AIR BAG NOT GEPLOYEO DRIVER 1:FULLY EJECTED
8-UNKNOWN N•OTHER V-mo 2-PARTIALLYEJECTED
'E-bRiV€R C-LAP BELT USED O-NOT REQUIRED W-YES 9-UNKNOWN
i 2 3 D-LAP BELT NOT USED
2 TO 6-PASSENGERS E-SHOULD HARNESS USED SL411 EL$E�NT
466 i 7-STA.WGN REAR IF-SHOULDER HARNESS NOT USED Q-USED PASSENGER
8-RR,OC C TRK,OR VAN G.LAPtSHOULDER HARNESS USED R-NOT USED X-NO 1
T 9-POSITION UNKNOYM H-LAPISIOULDER HARNESS NOT USED S•USE UNKNOWN Y-YES
O.OTHER 'J -PASSIVE RESTRAINT USED T-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 MOVEMENT PRECEDING
LIST NUMBER(S Of PARTY AT FAULI TRAFFIC CONTROL DEVICES t 23: TYPE OF VEHICLE ) 2 3 I COLLISION
3 A vcs[etmnuwures —071 YES IA CONTROLS FUNCTIONING 5C I X A PASSENGER CAWSTATION WGN 1 IA STOPPED
22517 RI No B CONTROLS NOT I=UNCTIONING B PASSENGER CAR WtTRAILER S PROCEEDING STRAIGHT
B OTHER iMPROPER DRIVING* .0 CONTROLS OBSCURED C MOTORCYCLEISCOOTER 1 10 RAN OFF ROAD
X 10 NO CONTROLS P SENT)FACTOR` D PICKUP OR PANEL TRUCK D MAKING RIGHT TURN
G OTHER THAN DRIVER* TYPE OF COLLISION E PICKUPIPANEL TRUCK Wt TRLR E (IRKING LEFT TURN
D uNKNOWN- -- A F tU-ON F TRUCK OR TRUCK TILER f MAKING U TURN
is FELLASLEEP* X B SIDESWIPE 0 TRUCK tTRUCK TRAILFA W/TRLR X 6 BACKING
C REAR END H SC1400L BUS H SL OWINPaISTOPPING
WEATHER(MARK i TO 2ITEMS) D BROADSIDE I OTHER BUS 1 PASSING OTHER VEHICLE
X A CLEAR E HIT OBJECT J EMERGENCY VEHICLE j jJ CHAtiCf1NGLANES
8 CLOUDY :F OVERTURNED K HIGHWAY CONST.EQUIPMENT I N PARKWOMANEWfR
C RAINING IG VE#ICLE-PEOESTRIAN L BICYCLE 11. ENTERING TRAFFIC
D SNOWING _ H OTHER M OTHER VEHICLE IN OTHER UNSAFE TURNING
H FOGIVISIBILITY - N PEDESM AN IN XING INTO APPOSING LANE
F OTHER" MOTOR VEHICLE INVOLV90 WITH O MOPED X O PARKED
G WIND JA NON-COLLISION _ P MERGING
UGHTI Q, 0 PEDESTRIAN O TRAVEi.ING WRONG WAY
X'A DAYLIGHT C OTHER MOTOR VEHICLE OTHER ASSOCIATED FACTORS R OTHEW
K OU53S-DAWN_ D MOTOR VEHICLE ON OTH€R RD—WAY 1 2 3 (MARK 1 TO 2 ITUS)
C DARK-STREETLIGHTS X E PARKED MOTOR VEHICLE A wcsccxmn wuxea ramp YES
D DARK-NO STREET LIGHTS F TRAIN
S DARK-STREET LIGHTS NOT G BICYCLE 13 ++e scera xa c Agra c�Tm YM
FUNCTIONING H ANIMAL xyO
SOBRIETY.SUS
ROADWAYSURFACE x C %MSI MMATEIl: 11M Y€6 i PHYSICAL
X A DRY I FIXED OBJECT: IIUT # No 1 2,3 (MARK i TO2ITEMS)
a WET is x X X A HAD NOT BEEN DRINKING
C SNOWY-ICY # OTHER OBJECT. IE VISION OBSCURED: 9 HBO-UNDER INFLUENCE
O SLIPPERY(MUDDY,OILY,EMT IF INATTENTION: C HBD-Nat UNDER INFLUENCE*
ROADWAY 47NDITIONS G STOP A OO TRAFFIC is HW-IMPAIRMENT UNKNOWW
(MARK'S TO 2ITEMS) PEDESTRIAN ACTIONS H ENTERING ILEAVING RAMP 9 UNDER DRUG iNFLUE14w
A HOLES,DEEP RUT, X A NO PEDESTRIANS INVOLVED I PREVR)US COLLISION if (MPAftMENT-PHYSICAL*
® LOOSE MATERIAL ON MIDWAY' B CROSSING IN CROSSWALK J UNFAMILIAR WITH ROAD G IMPAIRMENT NOT MOWN
C OB$TRUCTtON ON ROADWAY* AT INTERSECTION K DEFEC7WE VEH EQUIP: CITED H NOT APPLICABLE
D CONSTROCTIO N-REPAIR ZONE C CROSSING IN CROSSWALK-NOT Yes 1 SLEEPYIFATIOVED
E REDUCED ROADWAY WNDTH IN INTERSECTION f NO SPECIAL,INFORMATION
F FLOODED' D CROSSING-NOT IN CROSSWALK L UNINVOLVED VEHICLE JA HAZARWLIS MATERIAL
G OTHER' I IE IN ROAD-INCLUDES SHOULDER Im OTHER* B CELL PHONE IN USE
X.H NO UNUSUAL CONDITIONS F NOT fN ROAD X N NONE APPARENT X X X j C CELE PHONE NOT IN USE
!G APPROACHINGfLEAVING$CH BUS O RUNAWAY VEHICLE O CELL PHONE NONEfUNK
SKETCH MISCELLANEOUS
01
INDICATE NORTH
Sep 07 04 04.26p Martinez P!7 S25-228-3753 p.4
STATE OF CALIFORNIA
TRAFFIC COLLISION CODING
CHP 555 Page 3(Rev 8198)OF!042 Page 3
DA Of OLt#DIOtiiJ :6}AYV Tfld@($ibOf tiCtCB OPP iJS. NUf�ER
8111/2004 1648 CA00?1400 Ito 04-3916
wlTr sD Pas$D mese ASE Dat EXTENT OF INJURY C) ONE) INJURM WAS fV ONE) PARTY SHAT SAFETY
ONLY 1JM Y tA7F83ER POD. g CiEG
FATAL SEVERE OTKR V13MA COMPtAN3Y ORIVER PADS. PED. BIAYCL7ST OTNER
INJURY INJURY S+{JURY dp PAIN
L^! qt 24 , M 7IAJ tL—j �! L?'I IJ A
NnaiE>t�.cs.8lat�rz€s8 ?q.BPsrtrNE
FIDEL GERARDO TINOCC (6123/1984) 2737 EDWARD AVE,CONCORD,CA 44524 (t'1)925-227-3318
(WAP%ED 4"TRANSPORTED BY gAKEN TO
NIA
AESCRaBs 04JURtE$
{ l �vissTlMc�PHd�sNTcxtr�NOT�CD
N"mm0.6.la0ORES$ TEL PNON@
(INJURED dNLY)TRANSPORTED 8V TAKEN TO
O€SCRISE INJURIES
vlcTua OF VfOIENTGRIME*><TltFiED
NAMM0.81ADOR"S tEtFPFwNc
(INJURED ONLY;7RANSPOt2TED DY TAXIew TO
MWOE KAMIE$
VICTW OF VIOLENT CRIME NOTE&O
NAMEM.O.&MUORESS TELEPHONE
pNJUAE.D dNLY}TRA.VDFORTE'D 8Y T"EN TO
OEsmse INJURIES
vlcriM dP mdr.�ar CRR tE NOTIFIED
NAMEJD.O.BJADORE$S .. TEL€PMONE
{qi ER3 ow.Yj TRaNBYORYFA eY TA"N rd
AESLY2IBE iNJLARiE$ `J`
NAMEiO.d.BJADdREBS TrL-.vmONE
OMRE0OhRY)T Wi}PORTEOSY TAMN`fd
OfaB�RiiE INJURIES
VICTIM OF VIOLENT CRME Norms0
NA D OP P R t.O.NUMDER NAM REVma.
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rREt3 FERRER Ito 8/11/2004 8/24)2{104
hep 07 04 04:26p Martinez PD 925'-228-3753 p.5
STATE OF CALIFORNIA
NARRATIVE/SUPPLEMENTAL
CHP 556(Rev.7-90)OP1042 Page 4
DATE OF INCIDENTIOCCURENCE TIME 12 3 NVO WNBERt FiCER L£i.NUMBER NUMBER
8111/2094 1648 CA00714DO 110 04-3916
W ONE
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C"ICOUNTYl l 01CtAL DiSTAICT REPORTING 131aTRiL?18EAT OITATIQN NUMBER
11+1ARTINFZCONTRA COSTAIMT DIABLO
LOCATIONISUEJECT STATE H04WAY RELATED
2590 ALHAMBRA AVEIPARKING LOT B []Yae ®No
1' O TIFICNTIQN, i received this collision call at 1648 hrs. I arrived on sone and both vehicles were perked in
n/b parking stalls,where the collision occured. All times,speeds,and measurements are approximate.
Measurements were obtained by pacing.
U1VI1"dAR.Y: V2(Toyota)was parched in the parking stall west of V l (Jeep). VI was backing itno the stall
when the front right passenger door was was opened on by P3(Salonen). V 1 collided with the open door.
The parking stalls in the aisle of the collision face north and south. The entrance to this aisle is designated by a
white arrow on the ground for eastbound travel only.
Statements: P2(Thomas)said she parked V2 in the stall and when P3 opened the passenger door of V2,V1
collided with the door.
P3 said he looked toward the parking stall east of V2 after V2.parked. P3 said he opened fornt right passenger
door and V l collided with the door
D I (Barnes)said he established position in the parking stall east of V2. DI said he started backing further into
the stall when P3 opened the front right passenger door. D1 said the open door collided with the right rear fender
of his vehicle.
W l (Tinoco)-Unable to contact at time of report
AREA OF PTPAC'I': Area Of Impact was determined by statements of DI,P2,and P3;along with damage to
vehicles consistent with the collision. Area Of Impact was 1/10 mile south of the south curb of Ilene and 2/10
mile west of the west curb of Berrellesa.
CAUSE: Cause was determined by all parties statements,vehicle placement,and damage consistent with the
collisison. P3 caused the collision by being in violation of CVC 22517-Opening and Closing Doors.
PREPARER'S W ME AND LO.14UM SER Data: RE'Y1EWER'S NAME =8n4a604
FR D FERRER t10 08/11/2094
Use previous editions until depleted. 9067841