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HomeMy WebLinkAboutMINUTES - 11022004 - C15 CLAIM BOARD OF SUPERVI ORS OF CONTRA COSTA C UNTY BOARD ACTION: NOV'. 02, 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), give s Pursuant to Government Code Section 913 and 915.4. Please note all"Warnings". AMOUNT: $1,000.00 C"' t CLAIMANT: JEl*lY� C. BRADLEY ,, ATTORNEY: UNKNOWN DATE RECEIVED: SEPT. 27, 2004 ADDRESS: 22 WINDS0R AVENUE BY DELIVERY TO CLERK.ON: SEPT. 27, 2004 KENSINGTON, CA 94708-1041 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWE erk Dated: SEPTEMBER 27, 2004_ By: Deputy 11. W059T County Counsel, TO: Clerk of the Board of Supervisors r (t This claim complies substantially with Sections 910 and 91.0.2. { ) 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: 77 .Dated: g ' DaptAy County Cou 74 1111. FROM: Clerk of the Board TO: County 0�1 (1) County Acl inistrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). IVARD 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: *''�e A V&64OHN SWEETEN, CLERK, By , .Deputy Cleric WARNING(Gov. code sect'on 91 ) Subject to certain exceptions, you have only six(6)months from the date this notice was personally served or dept in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of ai 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 Unit States, over age 18, and that today 1 deposited in the United States Postal Service in Martinez, California,postage prepaid a certified copy of this Board Girder and Notice to Claimant, addressed to the claimant as shown above. f Dated:f �d'`� JOHN SWEETEN, CLERK By Deputy f BOARD OF SUPERVISORS OF CONTR k COSTA COUNTY INSTRUCTIONS TO CLAIMANT A A claim relating to a cause of action for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. aso*mesa**Reagan a a a am aanantamasssianapis aaBox JMason SUN aaaaa0a0aaa0Bonn man Stan RE: Claim By: Reserved for Clerk's filing stamp ECGEIVED Against the County of Contra Costa or ) SEP 2 7 2004 District) CLERK BOARD OF SUp RVIS (Fill in the name) ) `'O'" RACnSTA0.0_ S The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ loo®, bo and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) - J ►won'. 2. Where did the damage or injury occur? (Include Laity and county) ;e M�,•�l j �,�. �� 6 o A OL co,,,4y, 3. flow did the damage or injury occur? (Give full details; use extra paper if required) 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage`: art,�n 0, { CCL tv i iler.e+a �t ePetr+�t.�l _ e 5 What are the names of county or district officers, servants, or employees causing the damage or injury? 4k4att 6. What damage or injuries do your claim resulted? Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) p(#,c.,# -,,e e . , '(Form AV--1 'SO" or,,A KArro ce-cgJvm is O --04. 7. How was the amount claimed alcove computed' (Include the estimated amount of any prospective injury or damage.) AA A (Q; rm (,rr,. A 4 ; 8. Names and addresses of witnesses, doctors, and hospitals, oA4011Cf ,�/ 9. List the expenditures you made on account of thir.accident or injury. DATE TIME AMOUNT P -4 x-«-04 000,06 #s#R No I#s#Mon***r r#!!s#s r!#■s r r#s I#us!###r#I#####I i#####R s r####i##!I R#R r###s s!#* ) Gov. Code Sec. 910.2 provides "The claim shall be ) signed by the claimant or by some person on his }behalf." SEND NOTICES TO: (Attorney) Name and address of Attorney ) ;' (Claimant's Signature) } (Address) } } Telephone No. } Telephone No. S10 — 5' 41-3607 6/rr ) #r#r##r#I■rRR■srsRrsRrR■rrrrsrrl!###rRrr#R#Ilrr#iilRrnsea rrrra#r#r■#rlRrr■!I###Rrs# NOTICE Section 72 of the Penal Code provides: Every person who, with intent to defraud,presents for allowance or for payment to an), 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 Count),jail for a period of not more than one Frear, by a fine of not exceeding one thousand dollars ($1,000.00), ot- by both such imprisonment and fine, or by imprisonment in the state prison, by a tine of not exceeding ten thousand dollars ('$10,000), or by both such imprisonment and fine. ATTACIT ENT 1 -i- PERSONAL PROPERTY REI"URSEtIQNT CLAM TO BE GOHT1Z= BY CLAIMANT Claimant: Jeffrey C. Bradley mate: August 15, 2004 Address: 800 Ferry Street , Martinez , CA 94553 Department: Public Defender Employee No: 27558 Describe the manner in which the loss or damage occurred On 8/4/C4 I exited the paidrg lot of our office in Pichrcnd. I hem, and felt, a sidden jolt at the front end of ny bd-isle. Upon insp tion I saw that tle aVne was lelarg oil ard that there was dare to the oil cooler, att 3 hoses, the front bjq)er that caised by the driveway exit gradient. `Ihe darge, less my $1,000.00 dedmtible, vas cao-,e by ny irnsjae comer, MAA. I seek reirr urs2 t of the 19000. y. Amount of Loss Claim Amount of repair damaged property (attache invoice and actual revair) 2 , 107 . 59 Original Purchase price of article(s) (attach sales slip on same) $ Where purchased: Date: Do you carry private insurance coverage for property loss or damage to your personal property? Yes X No if yes, have you contacted your insurance agent for reimbursement? Yes No If yes, how much did your insurance reimburse you for the claim? $ 1 ,107 . 59 If rio, why did the company reject your claim? Em esignature Date TO BE COMPLEM BY WITNESS Confirming statement by witness to incident: Signature of Witness Witness's Name (Print) Horn .kip-i3o (39) ATTACK ENT 1 m 2_.<, TO BE CWI= BY ItflMIATE SUPERVISOR Confirming statement by immediate supervisor: Supervisor of Immediate Supervisor Supervisor' s Name (Print) TO BE CC TLETED BY DEPARTMENT HEAD OR DESIGNATED REIMES NTATM r 'recommend approval of this claim because said claim meets the criteria for reimbursement provided by Administrative Bulletin #313.2, as follows: (Please refer to items A-D under Administrative Bulletin 16313.2. ) I recommend rejection of this claim because said claim does not meet the criteria for reimbursement provided by Administrative Bulletin !6313.2, as follows: (Please refer to items A-D under Administrative Bulletin 16313.2. ) I Signature of Department Head or Designated Representative HAVE YOU CHECKED TO BE SURE 1. Damaged property is attached to this claim. If not, please explain. 2. This for: has been completely answered. 3. County demand form and Hoard Order, if needed, are attached. ........................................................................................................................................................................................................................................................................................................................... ........................................................................................................................................................................................................................................................................................................................... __._.... _..... ........_.. _. __ _...... _........ OFFICE OF THE PUBLIC DEFENDER County of Contra Costa Martinez, California Date: August 20, 2004 CPO To: - nt kk..'2ff2 G From: David Coleman, Public Defender Subject: Reimbursement for Damaged Property of an Employee I am forwarding this to your attention after reading Admin. Bulletin 518.2 which speaks of a County Demand Form and"Board Order" for property losses in excess of$300. Jeffrey Bradley is an attorney in the Department who drove his personal automobile from our office in Martinez to our Department's West County office at 3811 Bissell Ave. As you know, that office was recently redesigned, refurbished and our staff has moved back to that location. The improvements included installation of a new driveway entrance, across a sidewalk and into the rear parking area behind the building. Mr. Bradley was exiting the driveway in the middle of the business day to return to Martinez when his car became lodged on the depression between the sidewalk grade and the crown of the street(i.e. "bottomed out.") Damage to the oil cooler, hoses and the front bumper occurred. This is described in greater detail in the attached AK-130'and its attached repair invoice. Mr. Bradley's insurance covered much of the damage. However, his deductible of $1,000 remains as an out of pocket cost to him. Other Department employees entering and leaving the parking lot have encountered troublingly similar experiences with their vehicles and there are observable fresh marks and grooves in the pavement at the location associated with this problem We have instructed other employees using the parking lot to enter and exit with care for this reason. Signage will be posted. Ed Woodard,who has led the GSA team supervising the project,was alerted and he has begun conversations with the contractor, other General Services and Public Works staff, and the architect for the project about how this problem can be addressed. In the meantime, however, there is the issue of recompense for Mr. Bradley. I have read Administrative Bulletin 518.2 and recommend that Mr. Bradley's property loss claim be paid. I am aware that there is language that excludes "automobiles" from reimbursement. Under these circumstances though, I don't believe that language would be applicable. Mr. Bradley was on county business, using his personal car as do all attorneys in the Department and he would customarily be reimbursed for his mileage. His insurance coverage will provide over half the cost of the damage. He was not contributorily negligent. And though one might not be too sanguine about the County being reimbursed by someone associated with installing the improvements (e.g. general contractor,paving subcontractors), I believe Mr. Bradley should be reimbursed for his loss while that issue is explored. If I can provide further information or clarification,please let nye know. As I will be away from the office for the next two weeks,please contact Donna Broussard if further steps on behalf of the Department are required. Thank you for your assistance in this matter. cc: Donna Broussard,ASA 2 A 110546 230334 Member of the Cole Car Company Inc. JEFFREY C BRADLEY *INVOICE* Serving the Bay Area Since 1963 A��rt�'.3�'. BRADLEY Slates: 210}3 Notch Main Street Service&Parts: 1421 L.esnick Lane 22 WINDSOR: AVEDUPLICATE 2 Walnut Creek,CA 94596 KENS INGTON, CA 94708-1041 PAGE 1 Telephone: 925.935.2653 HOME: 510-524-3007 BUS: 925-335-8081 BAR#AS 130543 EPA#CAD 049233430 SERVICE ADVISOR: 376 BERNARD BALDEVISO jc TITAN 01 JAGUAR XKR SAJDA42B81.PA21857 26967/26969 T764 BATE A 3 ... .;..;, .: . . »`.>:;>,:>... EA't Ix!1kI 23JUL2001 17:00 10AUG04 MISC 12AUC?2OC74 �N A ootlo1 i p OPTIONS: STKs P2297 DLR.5653 AXL:2 1)SELECT EDITION 04AUCY04 12AUG0 LINE OPCODE TECH TYPE HOURS LIST NET TOTAL A CUSTOMER STATES CAR HIT A PIECE OF CONCRETE AND IS NOW LEAKING OIL. CHECK AND ADVISE. G12 REPLACED OIL COLLER AND PLACED POWER STEERING COOLER AND LINE 39 CJ 840.00 840.00 1 MJA-7440AB OIL COOLER 4012.22 402.22 402.22 1 MJE-7470AB HOSE 151.93 151.93 151.93 1 MJE-7471M HOSE OI t 133 .20 133 .20 133 .20 1 MJE-8084AA 139.50 139.50 139.50 8 5W50S SYNTEC BULK 7.40 7.40 59.20 3 DEXTRON QT. ATF 2.60 2.60 7.80 B** REPAIR FRONT BUMPER. G76 REPAIR SCRATCHES ON LOWER FRONT BUMPER. 99 CJ 0.00 0. 001 SUBL COLOR TECHNIQUE INV#6541 X7574 CJ 304.00 300.00 AAA INSURANCE TO SEND CHECK K Y USING US TO SERVICE YOUR CAR FOR $1107.59 PER: L7 EANNA 1 C91Vf`NG A SURVEY TO ENSURE YOUR BERGGREN 925-6865997 ?II,SEA C3N. IF. THEA IS ANY REASON WH WE CUSTOMER TO PAY $ 1000.00 C�'?�T SC��::A "10" PLEASE LET US KNOW DEDUCTABLE/BALANCE a THANK YOU, YOB'COMPLETE SATISFACTION IS OUR #1 PRIORITY BERNARD HARRY HENDRY, SERVICE MANAGER (925) 935-2653 FINALtlE .. TIT ES '$y law,you may choose another ORIGINAL ' licensed Sm Check facility to ESTIMATE: $ t i ,. REVISER i - the any needed repairs or LABOR AMOUNT $��;Ot7 ESTIMATE- $_ t adjustments that s Smog Check test indicates ere necessary., PARTS AMOUNT 893.85 "HAZARDOUS WASTE Of SPOSAL" GAS,OIL,LUSS E7 which Includes such Items as HAZARDOUS WASTE engine oil, automatic transmission SUBLET AMOUNT 300`(�� fluid, antifreeze, differential fluid, MISC.CHARGES DISPOSAL: $ batteries,etc. will be charged as a 0,07(7 separate charge If removed in the TOTAL CHARGES 2033 .85 Servicing of your vehicle. 3 ACKNO E Os:VEHICLE AND t I ACXNOWt E.AA RAL APPROVAL TEAR DOWN ESTATE: i LESS INSURANCE 1107.59 HAVE R Ef A.. OF THIS INVOICE. OF AN 1 1trHE L ESTIMATED PRICE. understand that my vshicie will be reassembled within days of SALES TAX 73 .74 the date shown above if I choose not to authorize the servicel PLEASE PAY PARTS ARE INEW UNLESS IFI CLAIM . l ''� BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: NOV: 02x. 2004 Claim Againstthe County, or District Governed by ) the Board of Supervisors, Routing Endorsements, NOTICE TO CLAIMANT P ) . and Board Action. All Section referencere ttr 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), give Pursuant to Government Code Section 913 and 915.4. Please note all"Warnings". AMOUNT: UNDETERMINED AMOUNT AND IN EXCESS OF THE LIMITED .JURISDICTION OF THE SUPERIOR COURT CLAIMANT: OF THE S'L'ATE OF CALIFORNIA JOSEPH HICKEY ARID GARY WEISBROD ATTORNEY: JANIS E. EGGLESTON DATE RECEIVED: SEPT. 27, 2004 ADDRESS: 2629 PIEDMONT AVENUE 4, UNIT D BY DELIVERY TO CLERK ON: SEPT. 27, _2004 BERKELEY, CA 94704 BY MAIL POSTMARKED- SEPT. 25, 2004 FROM: Clerk of the Beard of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. SEPTEMBER 27 2004. JOHN SWEE E k Dated: i By: Deputy II. MOM: County Counsel. TO: Clerk of the Board of Supervisors (This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.0. ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). ( ) Other: —�1 A� Sl{ I Dated: By: Dan, County Couni III. FROM: Clerk of the Board TO: County Counsel° l) County A,kninistrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). 117 nOARD 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: JOIN 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 deposit 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 Order and Notice to Claimant, addressed to the claimant as shown above. Dated:Abl er,vwhe. JOHN SWEETEN, CLERK By Deputy Cler Fire Fighters Gary Weisbr d d CLAIM AGAINST CONTRA COSTA Joseph Hickey, SEP LINTY, DEPARTMENT OF 2 4 MAN RESOURCES, and Claimants, Cry opsi,,�� ONTRA COSTA COUNTY FIRE lln''WoISTRICT, and their managerial VS. employees, LESLIE KNIGHT, Director of Human Resources, JO-ANNE Contra Costa County and Contra Costa LINARES, Human Resource Analyst, County Fire Protection District, et al., JACKIE LORREKOVICH, Personnel Services Assistant, Fire District, KEITH Respondents. RICHTER, Fire Chiu l A. CLAIMANTS' IDENTITY FIRST CLAIMANT JOSEPH HICKEY'S SOCIAL SECURITY NO: 283-54-7660 JOSEPH HICKEY'S ADDRESS: 4040 Cowell Rd., Concord, CA 94518 JOSEPH'S HICKEY'S TELEPHONE: (925) 930-5500 SECOND CLAIMANT GARY WEISBROD'S SOCIAL SECURITY NO: 293-50-1247 GARY WEISBROD'S ADDRESS: 5406 Sobrante Ave., El Sobrante, CA 94803 GARY'WEISBROD'S TELEPHONE: (510) 223-5401 FIRE FIGHTERS JOSEPH HICKEY and GARY WEISBROD's CALIFORNIA TORT CLAIM 1 B. ADDRESS TO WHICH NOTICES ARE TO BES NT IF DIFFERENT FROM ABQ VE: Janis E. Eggleston Attorney At Law 2629 Piedmont Ave. 4,Unit D Berkeley, CA 94704 Telephone: (510) 883-4329 Facsimile: (510) 217-6726 THE DATE(S), PLACE AND CIRCUMSTANCES GIVING RISE TO CLAIM: The date upon which Claimants' injuries occurred was April 5, 2004 when the Fire Protection District posted the eligibility list for the Fire Engineer's promotional exam and both Weisbrod and Hickey were not included on that list. These injuries were proximately cause by Respondents', and each of theirs', negligence in failing to take all steps necessary to prevent discrimination from occurring by: (a)Not conducting anage discrimination adverse impact analysis on each section of the Fire Engineer's promotional test prior to conducting the promotional exam; (b)Not conducting an age discrimination adverse impact analysis on each section of the Fire Engineer's promotional test prior to setting the pass point; (c) Failing to identify the cause of the age discrimination adverse impact on Problem Set 2 of the promotional exam; (d) Failing to take appropriate corrective action on a timely basis, once the adverse impact is found. (e)Not setting or posting the past point for the Fire Engineer's test until after the test results were calculated; (f)Arbitrarily setting the pass point on the Fire Engineer's performance section of the promotional exam after the results were in and then based on the number of candidates who passed or failed the test; FIRE FIGHTERS JOSEPH HICKEY and GARY WEISBROD's CALIFORNIA TORT CLAIM 2 (g)Not making the appropriate adjustment to the pass point, as the County did on the written portion of the promotional exam for other protected classes; (h) Setting a pass point that excluded fire fighters over the age of 40 from being placed on the promotional ranking list, solely because they failed Problem Set 2; (i)Not maintaining any EEO-1 (or similar such)records for the Fire Engineer position that would include labor market data, availability analyses and applicant and hiring data by age for the period 1995-2004, and 0)Refusing to make any adjustments and changes in the promotional ranking list, once they discovered that there was an adverse impact on candidates over the age of 40, and even after Claimants demanded that such an adjustment be made. These actions further violate Govt. Code §1135 et seq. because the Fire Engineer's performance section of the promotional exam test had an adverse impact on candidates over the age of 40. Evidence of this age discrimination because of an adverse impact against Fire Fighters over the age of 40 is shown by the following: On February 10, 2004, after the written portion of the Fire Engineer's promotional test had been scored, a review the Subgroup distribution report revealed that an adverse impact existed for two minority groups, whose scores fell below 70%. Accordingly, the pass point was adjusted to 59.82% (with a raw score of 70), and all 27 candidates who took the written test passed. Although the performance portion of the test was conducted on March 1 and 2, 2004, Human Resources did not set the pass point for the test until March 24, 2004, and did not set the pass point until all the test results were calculated. The pass point for each section of the test was set at 70%, where 12 candidates failed the test. Human Resources considered other possibilities for the pass point: (a) 65%where 8 candidates who have failed the test, (b) 60%, where only 6 candidates would have failed the test; and (c) a 70% overall score, where only 4 candidates would have failed the test. The pass point was arbitrarily set based upon the number of persons who passed or FIRE FIGHTERS JOSEPH HICKEY and GARY WEISBROD's CALIFORNIA TORT CLAIM 3 failed the test. Only 4 candidates did not pass Problem Set 2, the oral portion of the exam. All 4 of the candidates who failed Problem Set 2,were over the age of 40. Joseph Hickey and Gary Weisbrod failed only Problem Set 2, the oral portion of the exam, by less than 5%, 1.33% and 3.67%, respectively. The County's Human Resource Department posted the eligibility list on April 5, 2004. Four days later, on April 9, 2004, Human Resources received four age discrimination claims based on the promotional test. Contra Costa County Human Resources had Donnoe &Associates, the outside agency that constructed and conducted the test, the job analysis, and scored the Fire Engineers promotional test, conduct an adverse impact analysis based on age. On April 22, 2004, nearly one month after Human Resources set the pass point for the promotional test, Donnoe &Associates discovered that Problem Set 2 had an adverse impact on candidates over the age of 40. No adjustment was made to the pass points on Problem Set 2 to obviate or annul the adverse impact on candidates over the age of 40. The adverse impact on fire fighters over 40 could have been adjusted so that 3 of the 4 could pass that portion of the exam, by setting the pass point at 65% (total raw score 97.5), or with the fourth candidate able to pass the exam if the pass point was set at 62% (total raw score 93). In either scenario, an adjusted pass point for Problem Set 2 would have been much higher than the adjusted pass point set for the written portion of the promotional exam. Joseph Hickey's and Gary Weisbrod's scores on Problem Set 2 came within the standard measurement of error of plus or minus 5%. Thus, even considering the standard measurement of error, both Hickey and Weisbrod should have passed Problem Set 2. .FIRE FIGHTERS JOSEPH HICKEY and GARY WEISBROD's CALIFORNIA TORT CLAIM 4 F )'rF T31 rF4l E'.: iSTY. VF]F iCl ii?--FiF :Fii--iiii('fiYfi Y77CniiYifi :lien arirri in rrvre-.wr.rr.a a -.....rrr r..-. C. GENERAL DESCRIPTION OF INJURY. DAMAGE OR LOSS: The damages that resulted from the Respondents', and each of theirs, actions or inactions, include, but are not limited to injuries to Claimants' status on the promotional ranking list, their annual income, their corresponding contributions to their retirement funds, their standing within their employment, career, and community, and emotional pain and suffering, and general damages. Information provided herein is based on that which is available to claimants as of the date of the presentation of this claim. D. THE NAMES OF THE GOVT. EMPLOYEES CAUSING THE INJURY: The names of the persons causing this injury to Fire Fighters Joseph Hickey and Gary Weisbrod, included but are not limited to: CONTRA COSTA COUNTY, DEPARTMENT OF HUMAN RESOURCES; CONTRA COSTA COUNTY FIRE DISTRICT; and their managerial employees: LESLIE KNIGHT, Director of Human Resources; JO-ANNE LINARES, Human Resource Analyst; JACKIE LORREKOVICH, Personnel Services Assistant, Fire District; and KEITH RICHTER, Fire Chief F. DAMAGES SOUGHT EXCEED LIMITED CIVIL CASE JURISDICTION Damages are sought in an undetermined amount, pursuant to California Government Code Section 910(f), and said damages are in excess of the limited jurisdiction of the Superior Court of the State of California, per C.C.P. §§ 85, 86. P Signed by or on behalf of claimants: Attorney for Cla s Date of Claim: September 24, 2004 FIRE FIGHTERS JOSEPH HICKEY and GARY WEISBROD's CALIFORNIA TORT CLAIM 5 JANIS E. EGGLESTON ATTORNEY AT LAW 2629 PIEDMONT AVENUE,UNIT D BERKELEY,CALIFORNIA � TELEPHONE(510)3 �t1329 FACSIMILE(510)217-6726 E-MAIIL: jAnLngstne-. SEP 2 72004 September 24, 2004 a so or ✓;r ,^� 'ORS Office of the Clerk of Board of Supervisors Centra Costa County 651 Pine Street Martinez, CA 94553-1292 RE: Fire Fighters Joseph Hickey's and Gary Weisbrod's California Tort Claim against Contra Costa County, Department Of Human Resources, and Contra Costa County Fire District, and their managerial employees, Leslie Knight, Director Of Human Resources, Jo-Anne Linares, Human Resource Analyst, Jackie Lorrekovich, Personnel Services Assistant, Fire District, Keith Richter, Fire Chief. Dear Cleric of the Board of Supervisors: Fire Fighters Joseph Hickey and Gary Weisbrod, who are an employees of Contra Costa County's Fire Protection District, submit the enclosed California Tort Claim against the above named entity and individuals, per section 910 of the Government Code. This claim arises pursuant to Govt. Code Section 11135, and because of a negligently created and conducted promotional testing examination for the Fire Engineer's position, which had a posting date of January 2004. The performance section of the promotional testing examination had an adverse impact on candidates over the age of 40. The Department of Human Resources and Fire District had a duty to identify the adverse impact prior to conducting the test, setting the pass point, and making determinations about the pass and fail rate. The Department of Human Resources and Fire District had a duty to take corrective action to prevent an adverse impact on a promotional exam. The pass point was arbitrarily set on or about March 24, 2004 at 70%. The Department of Human Resources and Fire District did not learn that Problem Set 2 of the performance examination had an adverse impact on candidates over the age of 40 until some weeks after the promotional eligibility list had been posted, on April 4, 2004, and four candidates filed age discrimination claims. Only four candidates failed Problem Set 2—each of these four candidates were over the age of 40. No corrective action was taken nor adjustments made to the 70% pass point after the District and Human Resources learned that there was an age discrimination adverse impact on Problem Set 2, despite complainants' demand that such adjustment be made. This Califomia Tort Claim is timely filed. Sincerely, nis E. ggleston ttorney for Claima , Fire Fighters Hickey and Weisbrod. CLAIM * � BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: NOV. 02, 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. >r notice of the action taken on your claim by the . Board of Supervisors. (Paragraph IV below), give N Pursuant to Government Code Section 913 and 915.4. Please note all"Warnings". AMOUNT: $10,000,000.00 ., �. CLAIMANT: ROVENE ZAIKA., a minor and MISSY COY, her mother ATTORNEY: PATRICK T. GALLIGAN DATE RECEIVED: SEPTEMBER 28, 2004 ADDRESS: 630 N. SAN METED DRIVE, BY DELIVERY TO CLERK ON:SEPT. 28, 2004 SAN MATED, CA 94401 BY MAIL POSTMARKED: SEPT. 27, 2004 > FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEE E lark Dated: SEPTEMBER 28, 2004 By: Deputy II. FROM: County Counsel TO: Clerk,of the Board of Supe cors (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: D -' yore ; `fBy:, o /p ated: L �'County Cour, 111, FROM: Clerk of the Board TO: County C*s*lf(1) County AdVinistrator(2) ( } Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: (1r► 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:Aar:e,r.,v W•2 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 deposit 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 Order and Notice to Claimant, addressed to the claimant as shown above. Daed: t , » ` JOHN SWEETEN, CLERK By Deputy Cler PATRICK T. GALLIGAN Attorney at Law 630 North San Mated Drive SEP 2 8 2004 San Mateo, CA 94401o�� S' Facsimile: (654) 342-6392 Telephone: (654) 3423523 September 24, 2444 Clerk of the Board of Supervisors County of Contra Costa Attn: Ms. Jan Pennington, Chief Clerk 651 Pine Street Martinez, CA. 94553. Re: Claimant: Rovene Zaika Your Claim No.: Date of Lass: March 27, 2444 Dear Madam Clerk: Enclosed please find the claim for the above matter, which we are submitting formally-to the Board of Supervisor of Contra Costa Countyt, along with a copy. Could you please file the original with the Board and return to us a riled endorsed copy. Thank you, and I am, . Ve Yours. Patrick ligan ESEP 2 S 2004 CLAIM AGAINST GOVERNMENT ENTITY " �t c�OAR6 OF SUPERVISORS NT;R �-OSTA CO. CLAIMANTS NAME(S): Rovene Zaika, a minor and Missy Coy, her mot CLAIMANT'S ADDRESS: c/o Patrick T. Galligan, 630 N. San Mateo Drive, San Mateo, CA., 94401 GOVERNMENT ENTITY(Respondent) County of Contra Costa, Sheriff's Department, and various Districts. AMOUNT OF CLAIM: $10,000,000.00 ADDRESS TO WHICH NOTICES c/o Patrick T. Galligan, 630 N. San Mateo Drive, CAN BE SENT San Mateo, CA., 94401 DATE OF INCIDENT: March 27, 2004 DESCRIPTION OF OCCURRENCE: Rovene Zaika was run over by an ocean going power speed boat. The incident involves a failure to warn, inappropriate signage, negligent design/construction, destruction of evidence, encouragement of unsafe boating practices and operation, among other things. [See Sheriff's Report No. 04-9039]. DESCRIPTION OF DAMAGE/LOSS: Radial fracture of skull, blade cut through right femur, physical and emotion distress, permanent disfigurement and disability, among other things. [See records at Children's Hospital, Oakland, CA., and the Kaiser/Permanente Medical Group, Santa Clara County, CA.]. Dated: September 24, 2004 Patrick T. Gall Attorney for Claimant CLAIM L. . BOAJ.._..: OF SUPERVISORS OF CONTRA k )STA COUNTY BOARD ACTION;NOV. 02, 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), give Pursuant to Government Code Section 913 and 915.4. Please note all"Warnings". AMOUNT: $1,509.25 CLAIMANT: BE'TI'Y R. ELLIOT ATTORNEY: UNKNOWN DATE RECEIVED: OCTOBER 01, 2004 ADDRESS: 16401 SAN PABLO AVENUE #342 BY DELIVERY TO CLEF ON: OCTOBER 01, 2004 SAN PABLO, CA 94806 BY MAIL POSTMARKED: THRU INTER OFFICE MAIL FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETE terk Dated: OCTOBER O1, 2004 By: Deputy II. MOM: County Counsel, TO: Clerk of the Board of Supervisors { This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). ( } Other: Dated: s 6 By: !,y Deputy County Coun,, 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 m 4t0, JOHN SWEETEN, CLERK, By , Deputy Clerk WARNING(Gov. code sect' n 913) Subject to certain exceptions, you have only six (6)months from the date this notice was personally served or deposit 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. AFFDD)AVIT 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, addressed to the claimant as shown above. Dated:✓�47ee, �� JOHN SWEETEN, CLERK By Deputy Cler Clam to. BOARD OF SUPERVISORS OF CMTRA COSTA COUNTr �.-- zuruM® s Ct. xrrr A. Claims relating to causes of action for death or for injury to person or to per- sonal Property or growing maps and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the mouse of action. Claims relating to cues of action far-death or for injury to person or to persoml property or growing amps and which accrue on or atter January I, 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 sure year after the accrual of the cause of actio. (Govt. Code 5911.2.) B. Clams must be filed with the Clerk of the Board of "vemisors at its office in ii= lob, qty Administration Building, 651 Pine street, wartimz, CA94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the harm of the District should be filled in. D. if the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this form. RE Claim By Reserved for Clerk°s filing stamp RECEIVED r5lnst the County of Contra.Costa ) OCT 01 RECD I CLERK BOARD OF SUI'VISORS District) Ct?NTRAcsra ._� The undersigned claimant hereby, makes claim against the Cotnty of Contra Costa or the above-named District in the sum of $ A and in support of this claim represents-as follows: 1. 'When dial the damage or injury occur? (Give e=at date l and our) x/7 &i� 2. Where did the damage or injury sur? (Include city and CMnty) 3. How did the damage or injury occvr? (Give full details; use extra paper if required) 4. What Particular act or coissio an the pJt of =mty or district officers, servants or .empl.oyees caused.the.in jury or.damageAMO 7M',4 ArPbT C' '_'7A iNSWJtiNt#W AS I6 30D b0:ST vow-Lz-inr £0*d -lUiOi Wnar- are t»be names of county or district officers, se is or employees causing the damage or injury? 6. What damage or injuries do you. claim resulted? (Give full eft of in juries or damages claimed. Attach two estimtes for auto dmga. 7. How was the amount claimed abate computed? (Imlude the estimated amount of any prospective in_iw7 or damage.) B. Names and addresses of witnesses, doctors and Zspitlis. 9. List the expenditures you made on account of this accident or Injury: DATE ITEM. AMM14T I A iF Gov;. Cade Sec. 910:2 provIdes: "The claim must be Sigred by the claimant Dame anti Address of Attorney ess } Telephone Noielepho ne No. T I I T e e NOTICE ' Sectiw- 72 of the Penal Code provides: "Every pion who, with intent to defraud, presents for allounance 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.genui.ne, any false or fraudulent claim, hill, ,mount, vomer, or writing, is fishable either by imprisoziment in the oounty jail-for a period of not more than crAe•year, by a f Inc of not exceed Ing one thousand ($1,000), or by-both such imoi-isoment and fine;' car by imprisonment in the state prLum, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. r M•_j T 7«.T CICIC, c�a 1 N'AWO8NdW AS I N DOD 170:SS VOOe•-•Li-_nr CROCKETTS PREMIER AUTO BODY 900 SAN PABLO AVE PINOLE, CA 94554 ( r -� (510) 741-9001 CD LOG NO 13801-1 DATE 08/17/04 SHOP: CROCKETTS PREMIER AUTO BODY INSP DATE: 08/17/04 ADDRESS : 900 SAN PABLO AVE, CONTACT: VINCE VEGA CITY STATE: PINOLE, CA PRONE 1 : (510) 741-9001 ZIP: 94554- FAX: (510) 741-9009 OWNER: ELLIOT, BETTY HOME PHONE: (51.0) 508-4017 ADDRESS : 1.6401 SAN PABLO AVE WORK PHONE: (510) 741-9111 CITY STATE: SAN PABLO, CA ZIP: 94806- LIC# : 4PQM901 STATE: CA VIN: 1B3EJ46U01N542645 BODY COLOR.: GOLD MILEAGE: CONDITION: ACCTNG CTL##: PROD.DATE: 10/01 PAINT CODE: PTE *=USER-EN'T'ERED VALUE E=REPLACE OEM NG=REPLACE NAGS EC=REPLACE ECONOMY UC=RECONDITIONED PRT UM=REMAN/REBUILT PRT EU=REPLACE SALVAGE EP=REPLACE PXN PC=PYN RECONDITIONED PM=PXN REMAIN/REBUILT TE=PARTL REPL PRICE ET=PARTL REPL LABOR IT=PAR.TIAL REPAIR I=REPAIR L=REFINISH BR=BLEND REFINISH TT=TWO-TONE CG=CHIPGUARD SB=SU-BLET N=ADDITIONAL LABOR RI=R&I ASSEMBLY P=CHECK AA=APPEAR ALLOWANCE RP=RELATED PRIOR UP=UNRELATED PRIOR 2001 DODGE STRATUS SE 4DOOR SEDAN 6CYL GASOLINE 2 . 7 CODE: N1553A/A OPTNS D/24ACFHW OPTIONS : TWO-STAGE - EXTERIOR SURFACES TWO-STAGE - INTERIOR SURFACES ELEC REMOTE CONTROL MIRRORS POWER DOOR LOCKS REAR SPOILER AUTOMATIC TRANS CRUISE CONTROL OP GDE MC DESCRIPTION MFG,PART NO. PRICE AJ% B% HOURS R I 0382 PNL,REAR DOOR OUTER RT REPAIR 1 . 5 '1 L 0382 PNL,REAR DOOR OUTER RT REFINISH 2 . 5 4 RI 031.6 MLDG,REAR DOOR BELT RT R&I ASSEMBLY 0 . 2 1 E 0309 01 MLDG,REAR DOOR SIDE LT SX15DX8A2 58 . 75 0 . 3 1 RI 0314 APPLIQUE ASSY,REAR RT R&I ASSEMBLY 0 . 3 1 RI 0308 PNL, INNER DOOR TRIM RT R&I ASSEMBLY INC 1 RI 0306 NDLE,RR .DOOR OUTS RT R&I ASSEMBLY 0 . 6 1 BR 0341 13 PANEL,ROOF BLEND REFINISH 2 .4 4 BR 0389 PANEL,QUARTER LT BLEND REFINISH 1 .4 4 PAGE 1 08/17/04 200.1 DODGE STRATUS SE 4DOOR SEDAN CD LOG NO 13803-1 0390 PANEL,QUARTER RT REPAIR L 0390 PANEL, QUARTER RT REFINISH 2 . 4 4 RI 6397 DOOR, FUEL FILLER LT R&I ASSEMBLY 0 .2 1 BR 0397 DOOR, FUEL FILLER LT BLEND REFINISH 0 . 1 4 E 0430 NAMEPLATE,QTR PANEL LT 4805648AB 18 . 20 0 . 2 1 E 0431 NAMEPLATE,QTR PANEL RT 4805648AS 18 .20 0 .2 1 RI 0407 MAST,ANTENNA QTR PN RT R&I ASSEMBLY 0 . 2 1 RI 0533 TAILLAMP ASSEMBLY LT R&I ASSEMBLY INC 1 RI 0534 TAILLAMP ASSEMBLY RT R&I ASSEMBLY 0 . 3 1 N 0565 REAR BUMPER COVER R&I ADDNL LABOR OPERA 1 . 0 1 EC M14 CORROSION PROTECTION ECONOMY PART 8 . 50* 0 . 2*1* N M15 COLOR TINT ADDNL LABOR OPERA 0 . 5*1* N M17 COVER CAR EXTERIOR ADDNL LABOR OPERA 0 . 3*4* SB M60 HAZARD. WSTE. REM. SUBLET REPAIR 4 . 00* 1* N M66 COLOR, SAND & BUFF ADDNL LABOR OPERA INC* 1 . 0*1* 24 ITEMS MC MESSAGE (S) 01 CALL DEALER FOR EXACT .PART NUMBER / PRICE 13 INCLUDES 0 . 6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE FINAL CALCULATIONS & ENTRIES GROSS PARTS 105 . 15 OTHER PARTS 8 . 50 PAINT MATERIAL 254 . 80 PARTS & MATERIAL TOTAL 368 .45 TAX ON PARTS & MATERIAL @ 8 . 250% 30 .40 LABOR RATE REPLACE HRS REPAIR HRS 1-SHEET METAL 68 . 00 2 . 7 5 . 5 557 . 60 2-MECH/ELEC 72 . 00 3-FRAIME 72 . 00 4-REFINISH 68 . 00 8 . 8 0 .3 618 . 80 5-PAINT MATERIAL 28 . 00 LABOR TOTAL 1, 176 .40 SUBLET REPAIRS 4 . 00 TOWING STORAGE GROSS TOTAL 1, 579 . 25 NET TOTAL 1, 579 ,25 ADP SHOPLINK U0080 ES CD LOG 13801-1 DATE 08/17/04 09 :47 :49AM R6 .35 CD 06/04 PXN: Y/00/00/00/00/00 CUM 00/00/00/00/00 GEOCODE 94525 HOST LOG (C) 1998 - 2004 ADP CLAIMS SOLUTIONS GROUP, INC. 2 . 5 HRS WERE ADDED TO THIS EST. BASED ON ADP TWO-STAGE REFINISH FORMULA. ADP TWO--STAGE EXTERIOR THRESHOLD OF 2 . 5 HOURS WAS CALCULATED IN THIS ESTIMATE. PAGE 2 08/17/04 ' 001 DODGE STRATUS SE 4DOOR SEDAN CD LOC NO 13801-1 ---------- --- ------------------------------------- THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE . ANY WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OF THE PARTS, RATHER THAN BY THE ORIGINAL MAN-JFACTURER OF YOUR VEHICLE. PACE 3 08/17/04 Contra Costa County PU-11L1C/Sf AFF.CNCI.DEN`TtRERORT "Socidl'Service, Department An incident is any occurence which is not consistent with routine performance and/or expectation. It may be'a situation in which there is an injury or the potential for an injury. The report should state exactly what happened, who was present and what was said. CHECK APPROPRIATE C1 Abusive language d Ph Physical threat 0 Physical attack INCIDENT TYPEY Y QgWole a all aoQi - bI items p�ksorvsiN-V*OL ci NAME LOCATION/ADDRESS/CITY ,� PHONE Employee i f ��..1 e� /� � Client Witness and/or Wisitor(s) z INCIDENT LOCATION or Cl TELEPHONE CALL INCIDENT DATE TIME " DESCRIBE INCIDENT FULLY: NOTE EXACT WORDS USED, INCLUDING FOUR LETTER WORDS. DESCRIBE PERSONS ATTITUDE AND CONDITION'. COMMENT ON WHAT YOU THINK PROVOKED OR CAUSED INCIDENT..(use reverse if necessary) i -77 i fi w , J C rte' � (C' /rPg.�<�'\J.....L'--•.— ,l .f.+r. C.`..'r. a....✓ l J// / / �;/ .'/ %.J �k (-!,I'.�Y��1'-. AJ �t 1 } � ref" (✓ f ER r' 1 SIGNATURE OF EMPLOYEE/REPORT ,� �"`--�-"' /,� � � >r P ,, i DATE ADM 23 (Rev, 4/82) Ref: D -100 Ct�py 1. afety©fficer, Bldg. 0 y 2. Supervisor; Copy 3. Case Record ... RECEIVED 9/29/2004 OCT 0 1 MCI) j CLERK BOARD OF SUPERIJISORS a CONIi3A CflSTfi 0 TO: Penny Baily From Betty ElliottA Subject: Auto Repair for Accident Attached is the estimate for the auto repair to my 2001 Dodge Stratus. The parking lot gate at the EHSD Building at 1305 Macdonald Ave.,Richmond closed on my car, doing the body damage. Please nate that the repair will take up to four(4)days. I will need a rental vehicle or an unrestricted county car for my transportation during the repair period. I have one estimate, which is for the only establishment I will allow to fix my car. I understand that by law I only need one estimate. Please process as soon as possible, as this event took place in July. Thank you, BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. A claim relating to a cause of action for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street,Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. •R■!!!!#!!R!!!R!R!!#!#i!#R!!!!#i R!!!!#!!#!!R R!R#!##!#R R!R#!!#!##!!!R!R!!!R R!R R F RE: Claim By: Reserved for Clerk's filing stamp RECEIVED A,ggainst the Count of Contra Costa OCT +:Zra ' r� VG t }# 2004 District rR f /. gay CLEPKF30AR o tt er VISORS (Fill iiithe name) $ T7 /T , 1. OMUTRA cOs A co. The undersigned claimant hereby makes claim against the County of Contra. Costa or the above-named district in the sum of$ "'p and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full details; use extra paper if required) Z/ 1j 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? 5 What are the names of county or district officers, servants, or employees causing the damage or injury? 6. What damage or injuries do your claim resulted? (Give fail extent of injuries or damages claimed. Attach two estimates for auto damage.) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses, doctors, and hospitals: 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT Y ■raraaaarrrrssaaassaassaasssrrrraararrrsrrs u■0ago sasssaaarrasssssaNavy ana■■aascaaan$ ) Gov. Code Sec. 910.2 provides "The claim shall be ) signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney) ) Name and address of Attorney } (Claimant's Signature) % (Address) ) Telephone No. )Telephone No. ■rrrrarrrsrrasrrrsasasrrrassrrrrrararrarasasassassssaaassssssaaarraarrrasaaaaasaasaa1 PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the County under the Tort Maims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthermore, any attachments, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■anoun rraaaaaasssaaa2aanaasmass sassarrrrarrrrasrrrassaraaassasaaarsrrrrraman aEvans a*I 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 dollars ($1,000.00), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000), or by both such imprisonment and fine. CLAIM AGAINST THE COUNTY OF CONTRA COSTA, CONTRA COSTA COUNTY AIRPORT, AND BUCHANAN FIELD AIRPORT TO: Contra Costa County Board of Supervisors Office of the Clerk of the Contra Costa County Keith R. Freitas, Director of Airports Pursuant to the provisions of the Government Code of the State of California, claim is hereby presented on behalf of Arianna Jimenez, a minor, age 12; and her parents Armando and Janeen Jimenez, the specifics of which are as follows: 1. The claimants' name and mailing address: Arianna Jimenez, a minor by and through her guardian ad litem, natural guardian and parent, Janeen Jimenez, and Armando &Janeen Jimenez, individually, as parents. Mailing address is: 92 Alto Loma, Danville, CA 94526; telephone: (925) 831-9252. 2. The mailing address to where notices concerning this claim should be sent is: c/o Claimants' attorneys, Sterns & Walker, 961 Clay Street, Oakland, CA 94607; telephone: (510) 267-0506; fax (510) 267-0506; email: stems@trial-law.com. RECE'VED OCT 0 5 2004 CLERK BOARD OF SUPERVISORS CONTRA Ct75TA GO. -1- 3. The date, place and circumstances that gave rise to the claim asserted: April 13, 2004, approximately 4:50 p.m., local time on Interstate Highway 680, approximately 1450 feet north of marker CCC 18.71 on 1-580 and the state route 242 over crossing (generally just directly south of the departure end of Runway 19R of Buchanan Field). At that time, an aircraft identified as a Piper PA28RT 201T, Registration No. 2920C, owned by Larry D. Kempton dba Kempton Air Service of Grand Junction, Colorado and others unknown, being operated by a Robert Curt Hatch, also of Grand Junction, while allegedly attempting an emergency landing, crashed into a vehicle proceeding southbound on the 680, a 2004 Dodge Caravan owned by Dollar Rent-A-Car and operated by Barry R. Gallas. Riding in the second seat of said van as a passenger was the minor, Arianna Jimenez. The Piper Aircraft crashed at high speed at and great violence into the side or top of the Gallas minivan, and the propeller or other parts of the aircraft violently ripped through the roof and door of the minivan, tearing into the leg of Arianna Jimenez; almost amputating same and causing extensive and dramatic injuries to the leg, and other injuries. Investigation of this matter was conducted by the California Highway Patrol, {see Trak Collision Report, No. 4-170 and CIC No. 9320, which contains the names and addresses of all witnesses known at this time to claimants; the National Transportation Safety Board has an ongoing investigation; its Preliminary Report is identified LAX 04LA187; it is also _2_ believed that the Federal Aviation Administration has conducted an investigation and has prepared or is preparing a report; the further identification of that report is not known to claimants. Any and all known witnesses are listed in these reports. 4. A general description of debt, obligation, injury damage and loss incurred as best can be determined at this time, so far as it may be known at the time of the presentation the claim is as follows: (a)The obligation of the entities upon whom this claim is served is based upon the government Code which subjects a public entity to liability when it constructs, operates or maintains public property in a dangerous condition and/or acts negligently in the conduct of county business. Buchanan Field and its surrounding and adjacent properties impacted by the local public entity property, whether owned by that entity or not, was Government property in a dangerous condition within the meaning of the Government Code and the interpretative case law. The airport was situated and maintained in an area of known high risk to any and all persons who might be using that property or adjacent public property with due care. Buchanan Field is situated and maintained in an urban, crowded and busy location, where there is exposure literally on all sides of the airport, but more particularly, directly to the south, -3- southwest, and southeast where departing aircraft, on the main Runway, 19R, will constantly encounter and need to navigate over high density and high flow traffic, both north and south on Interstate 680, well known to be one of the busiest arteries in Northern California. In addition, immediately adjacent to Buchanan Field and equally bearing substantial and continuous traffic are State Highways 242 and 4, along with major surface streets, and high density residential, commercial and industrial areas, including the very large Sun Valley mall just southeast, which was the scene of another serious aviation mishap involving Buchanan Field some years ago. The operation and maintenance of a general aviation aircraft field with daily operations exceeding 400 per day, 56% of which are more transient general aviation, presents and ongoing, continuous and unreasonable risk to the general public in all of the above-described areas and activities around and in the vicinity of Buchanan Field. Any aircraft faltering or encountering any problem whatsoever, or which for any reason lose its directional control or altitude or crashes or attempts to land, or any other combination of potential circumstances, creates a potential and immediate disaster similar to the Sun Valley Mall and the incident that is the subject of this claim. -4- (b) Claimants are informed and believe that there have been a number of other similar situations over the years which resulted in crash incidents or near crashes or misses, all of which was more than enough to have long since put all public entities involved on notice of the continuing and escalating dangers. Instead of creating any sort of"safe zone" or emergency landing area in line with the departure end of the runways, in order to accommodate foreseeable aircraft problems, losses of power and other emergencies, the public entities instead continue to allow and encourage continued high density development in these danger zones. All of the above, plus facts which have yet been made known to claimants, substantiate the contention that the entire situation constitutes public property in a dangerous condition, and negligence on the part of involved public officials. (c) The injury, damage and loss incurred as best can be determined at this time are as follows: Arianna Jimenez' date of birth is April 10, 1992, had just turned age 12. She lives with her family, three siblings and parents in Danville, Contra Costa County, California and up to the time of this tragedy was a normal, healthy, active girl, and a good student, among other -5- things, exhibited extraordinary talent for playing soder at a higher level. She had a bright and promising future, perhaps even at a select level, college or as a professional soccer player, with the potential to compete at World Cup or Olympic level. When the crash occurred, it was apparently the propeller that crashed through the car and slashed violently through Arianna's left thigh, leaving only a few strands of muscle, the femoral artery and a nerve. It also shattered her femur and causing a 3-inch segment of the bone to be lost and much of the remaining femur shattered into small shards. She also sustained traumatic injuries such as shock and loss of blood. Through what can only be described as remarkable and heroic surgery at Children's Hospital in Oakland, the leg was reattached and miraculously saved, although there are significant residuals, including loss of leg mass, significant shortening, loss of bone, major physical impairments and other complications, which will require further extensive ongoing care, including surgeries. The present future situation is unclear as to whether she will end up with a permanent differential in leg length, or some other steps that need to be implemented to impair growth of the other leg in order to achieve equal length. She has to use a combination of crutches _6- and a wheel chair and is facing continuing problems, although she was able to return to the opening of school this fall. (d) The medical expenses to date are unknown. Recipients of the claim are referred to the billing department at Children's Hospital and to the Kaiser Permanente HMO, which are dealing with those charges. It is anticipated that Kaiser, and according to the general practice, will be asserting a claim of some type for the value of the services to dater which, as indicated, cannot be stated with precision, but obviously running into several hundreds of thousands of dollars. For the information of the recipients of this claim, the Kaiser information with regard to Arianna billing is Healthcare Recoveries, P.D. Box 35380, Louisville, KY 40233, telephone (877) 840-0781. Her Kaiser no. is 07940271; SSN is 608-60-5027. In addition to the medical charges which will also include charges for ambulance, other first responders, physical therapy, prosthetic devices, wheelchair, drugs, medications and other related matters, the parents have and will incur substantial expense, necessitated by special care required of Arianna, plus transportation. The totals cannot be stated at this time. -7- (e) In addition to the foregoing, there may be a significant component of impairment of earnings capacity in the future. This cannot be quantified at this time. {f} In addition to the foregoing medical and related care, expenses, past, ongoing and future: Arianna has suffered and sustained and will continue to sustain in the future severe injuries, both physical and mental, emotional, and permanent general damages, exact sum which cannot be stated with specificity at this time due to the continuing care required and uncertainty of prognosis, but which will most certainly be substantial. For purposes of this claim, the damages under this category exceed the jurisdictional limits of the general jurisdiction of the Contra Costa Superior court by a substantial margin. (g) In addition, claimants Janeen and Armando Jimenez, as parents, have sustained loss and damages by reason of the loss of consortium of their daughter, witnessing on a day to day basis her distress, and other elements as may be recognized by law. 5. No documentation is available at this time. Billing for medical and related would be the province of Kaiser system per above, at least as to medical care to date. _g_ 6. The name of any public employee causing the injury, damage and loss is not known at this time. The claim identifies the persons in charge of and responsible of the operation of Buchanan Meld. 7. Amount claimed: Please see discussion above in item 4(b). ©ate " 2fl04 Respectfully submitted: STERNS & WALKER By: /;Z- Gerald C. Stems -9- CLAIM AGAINST THE COUNTY OF CONTRA COSTA, CONTRA COSTA COUNTY AIRPORT, AND BUCHANAN FIELD AIRPORT r , RECE TO: Contra Costa County Board of Supervisors =0 'Office of the Clerk. of the Contra Costa CountyKeith R. Freitas, Director of Airports CLERK BOARD Off=SLIPE�, r;ry Pursuant to the provisions of the Government Code of the State of California, claim is hereby presented on behalf of Arianna Jimenez, a minor, age 12; and her parents Armando and Janeen Jimenez, the specifics of which are as follows: 1. The claimants` name and mailing address: Arianna Jimenez, a minor by and through her guardian ad litem, natural guardian and parent, Janeen Jimenez, and Armando &Janeen Jimenez, individually, as parents. Mailing address is: 92 Alto Loma, Danville, CA 94526; telephone: (925) 831-9252. 2. The mailing address to where notices concerning this claim should be sent is: c/o Claimants' attorneys, Stems & Walker, 901 Clay Street, Oakland, CA 94607; telephone: (510) 267-0506; fax (510) 267-0506; email: sterns.a trial-law.corn. 3. The date, place and circumstances that gave rise to the claim asserted: April 13, 2004, approximately 4:60 p.m., local time on Interstate Highway 680, approximately 1450 feet north of marker CCC 18.71 on 1-680 and the state route 242 over crossing (generally just directly south of the departure end of Runway 19R of Buchanan Field). At that time, an aircraft identified as a Piper PA28RT 201T, Registration No. 2920C, owned by Larry D. Kempton dba Kempton Air Service of Grand Junction, Colorado and others unknown, being.operated by a Robert Curt Hatch, also of Grand Junction, while allegedly attempting an emergency landing, crashed into a vehicle proceeding southbound on the 680, a 2004 Dodge Caravan owned by Dollar Rent-A-Car and operated by Barry R. Gallas. Riding in the second seat of said van as a passenger was the minor, Arianna Jimenez. The Piper Aircraft crashed at high speed at and great violence into the side or top of the Gallas minivan, and the propeller or other parts of the aircraft violently ripped through the roof and door of the minivan, tearing into the leg of Arianna Jimenez; almost amputating same and causing extensive and dramatic injuries to the leg, and other injuries. Investigation of this matter was conducted by the California Highway Patrol, (see Traffic Collision Report, No. 4-170 and CIC No. 9320, which contains the names and addresses of all witnesses known at this time to claimants; the National Transportation Safety Board has an ongoing investigation; its Preliminary Report is identified LAX 04LA187; it is also -2- believed that the Federal Aviation Administration has conducted an investigation and has prepared or is preparing a report; the further identification of that report is not known to claimants. Any and all known witnesses are listed in these reports. 4. A general description of debt, obligation, injury damage and loss incurred as best can be determined at this time, so far as it may be known at the time of the presentation the claim is as follows: (a) The obligation of the entities upon whom this claim is served is based upon the Government Code which subjects a public entity to liability when it constructs, operates or maintains public property in a dangerous condition and/or acts negligently in the conduct of county business. Buchanan Field and its surrounding and adjacent properties impacted by the local public entity property, whether owned by that entity or not, was Government property in a dangerous condition within the meaning of the Government Code and the interpretative case law. The airport was situated and maintained in an area of known high risk to any and all persons who might be using that property or adjacent public property with due care. Buchanan Field is situated and maintained in an urban, crowded and busy location, where there is exposure literally on all sides of the airport, but more particularly, directly to the south, -3- southwest, and southeast where departing aircraft, on the main Runway, 19R, will constantly encounter and need to navigate over high density and high flow traffic, both north and south on Interstate 680, well known to be one of the busiest arteries in Northern California. In addition, immediately adjacent to Buchanan Field and equally bearing substantial and continuous traffic are State Highways 242 and 4, along with major surface streets, and high density residential, commercial and industrial areas, including the very large Sun Valley mall just southeast, which was the scene of another serious aviation mishap involving Buchanan Field some years ago. The operation and maintenance of a general aviation aircraft field with daily operations exceeding 400 per day, 56% of which are more transient general aviation, presents and ongoing, continuous and unreasonable risk to the general public in all of the above-described areas and activities around and in the vicinity of Buchanan Field. Any aircraft faltering or encountering any problem whatsoever, or which for any reason lose its directional control or altitude or crashes or attempts to land,-or any other combination of potential circumstances, creates a potential and immediate,disaster similar to the Sun Valley Mall and the incident that is the subject of this claim. -4- (b) Claimants are informed and believe that there have been a number of other similar situations over the years which resulted in crash incidents or near crashes or misses, all of which was more than enough to have long since put all public entities involved on notice,of the continuing and escalating dangers. Instead of creating any sort of"safe zone" or emergency landing 'area in line with the departure end of the Runways, in order to accommodate foreseeable aircraft problems, losses of power and other emergencies,-the public entities instead continue to allow and encourage continued high density development in these danger zones. All of the above, plus facts which have yet been made known to claimants; substantiate the contention that the entire situation constitutes public property in a dangerous condition, and negligence on the part of involved public officials. (c) The injury, damage and lass incurred as best can be determined at this time are as follows: Arianna Jimenez' date of birth is April 10, 1992, had just turned age 12. She lives with her family, three siblings and parents in Danville, Contra Costa County, California and up to the time of this tragedy was a normal, healthy, active girl, and a good student, among other -5- things, exhibited extraordinary talent for playing soccer at a higher level. She had a bright and promising future, perhaps even at a select level, college or as a professional soccer player, with the potential to compete at World Cup or Olympic level. When the crash occurred, it was apparently the propeller that crashed through the car and slashed violently through Arianna's left thigh, leaving only a few strands of muscle, the femoral artery and a nerve. It also shattered her femur and causing a 3-inch segment of the bone to be lost and much of the remaining femur shattered into small shards. She also sustained traumatic injuries such as shock and lass of blood. Through what can only be described as remarkable and heroic surgery at Children's Hospital in Oakland, the leg was reattached,and miraculously saved, although there are significant residuals, including loss of leg mass, significant shortening, loss of bone, major physical impairments and other complications, which will require further extensive ongoing care, including surgeries. The present future situation is unclear as to whether she will end,up with a permanent differential in leg length, or some other steps that need to be implemented to impair growth of the other leg in order to achieve equal length. She has to use a combination of crutches -6- and a wheel chair and is facing continuing problems, although she was able to return to the opening of school this fall. (d) The medical expenses to date are unknown. Recipients of the claim are referred to the billing department at Children's Hospital and to the Kaiser Permanente HMO, which are dealing with those charges. it is anticipated that Kaiser, and according to the general practice, will be asserting a claim of some type for the value of the services to date, which, as indicated, cannot be stated with precision, but obviously running into several hundreds of thousands of dollars. For the information of the recipients of this claim, the Kaiser information with regard to Arianna billing is Healthcare Recoveries, P.O. Box 36380, Louisville, KY 40233, telephone (877) 840-0781. Her Kaiser no. is 07940271; SSN is 608-60-5927. In addition to the medical charges which will also include charges for ambulance, other first responders, physical therapy, prosthetic devices, wheelchair, drugs, medications and other related matters, the parents have and will incur substantial expense, necessitated by special care required of Arianna, plus transportation. The totals cannot be stated at this time. -7- (e) In addition to the foregoing, there may be a significant component of impairment of earnings capacity in the future. This cannot be quantified at this time. (f) In addition to the foregoing medical and related care,expenses, past, ongoing and future: Arianna has suffered and sustained and will continue to sustain in the future severe injuries, both physical and mental, emotional, and permanent general damages, exact sum which cannot be stated with specificity at this time due to the continuing care required and uncertainty of prognosis, but which will most certainly be substantial. For purposes of this claim, the damages under this category exceed the jurisdictional limits of the general jurisdiction of the Contra Costa Superior Court by a substantial margin. (g) In addition, claimants Janeen and Armando Jimenez, as parents, have sustained loss and damages by reason of the lass of consortium of their daughter, witnessing on a day to day basis her distress, and other elements as may be recognized by law. 5. No documentation is available at this time. Billing for medical and related would be the province of Kaiser system per above, at least as to medical care to date. 6. The name of any public employee causing the injury, damage and lass is not known at this time. The claim identifies the persons in charge of and responsible of the operation of.Buchanan Field. 7. Amount claimed: Please see discussion above in item 4(b). Dated !� , 2004 Respectfully submitted: STERNS & WALKER . /-;Z—By: Gerald G. Sterns -9- CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: 11/02/04 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), give r Pursuant to Government Code Section 913 and x, 915.4. Please note all"Warnings". AMOUNT: 2180.11 ; £ ° :a << 3 f CLAIMANT: tum A. CO'M trA ATTORNEY: NONE DATE RECEIVED: 10/5/04 ADDRESS: 2921 sycrre street BY DELIVERY TO CLERK ON: Martinez, Ca 94553 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN EETEN, C1er'` Dated: y4'By: Deputy, II. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. { ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8), { ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.0. ( ) Other: Q1111u, Bated: � By: Deputy County Couni 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: Ae, ,,-- d 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 deposit in the mail to file a court action on this claim. See Government Code Section 945.5. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California,postage full prepaid a certified copy of this.Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: (3,44OHN SWEETEN, CLERK By Deputy Cler BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. A claim relating to a cause of action for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. mass UNNER000220 wwwwwassus am Ran an MUSSMARENE too no a a RE: Claim By: Reserved for Clerk's filing stamp ) rt, ��` ,.:> � FILED Against the County of Contra Costa or ) Eou -- 1.1 201 4 �. A 0(- ) CLERK BOARD OF SUPERVISORS `� District) CONTRA COSTA CO. (Fill in the name) } € -7 The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sW 0.190.11 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) 3 o Zr 3. How did the damage or injury occur? (Give full details; use extra paper if required) 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? xrt % _41- Oki 5 What are the names of county or district officers, servants, or employees causing the damage or injury? 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) rr , '�" a 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 1'n e 8. Names and addresses of witnesses, doctors, and hospitals: 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT assaaamasgongs a was aaasaanaaanarNOON asown assun aaaUna anson names■Russo Ong mass 0asaass aaai } Gov. Code Sec. 910.2 provides "The claim shall be ) signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney) ) Name and address of Attorney } (Claimant's Signature) (A e4ss) 5— Telephone No. }TelephoneNo. f ' s° rr sssssaaassssss■■saassaarsarsaarassss . iaa a� ■ass rraaX�6Q asa .2��■s i 7. "aa PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthermore, any attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. assassassassssaaaassssassJaassssssssassssssasSammons Ron ass•assaassaaaason aass assssast 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 dollars ($1,000.00), 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. 10/05/2004 at 10:31. AM Tub Number: 21975 MARTINEZ AUTO BODY SHOP License #:BAR AB0B5474 Federal ID # : 942574428 615 ALHAMBRA AVE MARTINEZ, CA 94553 (925) 228-3689 Fax: (925) 372-6546 PRELIMINARY ESTIMATE Written .By: KELLY SHAVER Adjuster: Insured: RICHARD CORDOVA claim # Owner: RICHARD CORDOVA Policy # Address: 2921 SYCAMORE STREET Deductible: MARTINEZ, CA, 94553-2745 Date of Loans: Day: (925) 367-8333 Type of Loss: Evening: 1\925) 957-1787 Point of Impact: 6. Rear Inspect Location: Insurance Ory: Days to Repair 2000 FORD RANGER 4X4 SUPERCA.B 6--4 . OL-FI 4D P/U BLUE Int:GRAY VIN: 1FTZR15XOYPA78550 Lic: 6F20081 CA Prod Date: 12/1999 Odometer: 79494 Air Conditioning Tilt Wheel Cruise Control Intermittent Wipers Dual Mirrors Privacy Glass Fog Lamps Clear Coat Paint Metallic Paint Power Steering Power Brakes Power Windows Power Locks Power Mirrors AM Radio FM Radio Stereo Cassette Search/Seek Anti-Lock Brakes (2) Driver Air Bag Passenger Air Bag Cloth Seats Split Bench Seats Rear Step Bumper Bedliner Automatic Transmission 4 Wheel Drive Overdrive Styled Steel Wheels ---------------------------------------__---------___------------------------------ NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT _--------------------------------_-----_----_-------_------------------------_-----_-_ 1 REAR BUMPER 2 O/H rear bumper 1.2 3** Repl RECOND Bumper assy flareside 1 232 .00 Incl. 1.8 painted 4* Acid for Clear Coat 0 . 0 5 Repl Step pad flareside 1 77 . 80 Incl. 6 Rept RT Support arm outer 1 12 . 98 Incl . 7 Rep' LT Support arm. outer 1 12 .52 Incl. 8 Rept. RT Support arm inner 1 12 .1.8 Incl. 9 Repl LT Support arm inner 1 22 . 16 Incl. 10## Rpr SET UP & MEASURE 2 . 0 ll# Rpr PULL RT REAR RAIL 1 . 0 12# Rpr PULL LT REAR RAIL 1 . 0 13 REAR LAMPS 10/05/2004 at 10:27 AM Job Number: 21975 PRELlIffNARY ESTIMATE 2000 FORD RANGER 4X4 SUPERCAR 6-4 . 0L-FI 4D P/U BLUE Int:GRAY ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT -------------------------------------------------------------------------------- 14 R&I RT Tail lamp assy 0. 3 15 PICK UP BOX 16 Repl Set back box assy 1 1 .5 17* R&I RT Side panel 2 . 0 i8* Rpr RT Side panel 4 . 0 2 . 9 19 Add for Clear Coat 1.2 20 Add for Edging 0. 3 21 Repl RT Mat side step 1 15.23 0 . 2 22 R&I RT Upper molding 0. 3 23 Repl RT Transfer 4X4 OFF ROAD 1 34 . 03 0.2 silver 24 Repl RT Splash guard bracket 1 24 .20 25 Repl RT Stone guard 1 18 . 12 0 .2 26# Subl HAZ WASTE DISP. EPA 000157611 1 5. 00 X 27# Rpr TINT FOR BLENDABLE MATCH 0 . 5 28# Repl FIBERGLASS MATERIALS 1 40 . 00 29# Rpr TEAR DOWN REQUIRED 30# ADDITIONAL DAMAGE POSSIBLE 1 ------------------------------------------------------------------------------- Subtotals =-> 496.24 14 . 4 6.2 Parts 491 .24 Body Labor 14 . 4 hrs @ $ 70. 00/hr 1008 .00 Paint Labor 6.2 hrs @ $ 70 .00/hr 434 . 00 Paint Supplies 6.2 hrs @ $ 30 . 00/hr 186. 00 Sublet/Misc. 5.00 ---------------------------------------------------- SUBTOTAL $ 2124 .24 Sales Tax $ 677.24 @ 8 .2500% 55. 87 ------------------------------------------------------- GRAND TOTAL $ 2180. 11 ADJUSTMENTS: Deductible 0 . 00 ----------------------------------------------------- CUSTOMER PAY $ 0.00 INSURANCE PAY $ 2180 . 11 If you have coverage for damage to you vehicle under this policy it is our obligation to inform you that Under California Code of Regulations, Title 10, Chapter 5, Section 2695.8.d.2 .e, you have the right to select the vehicle repair facility of you choice. We are prohibited by law from requiring that repairs be done at a specific shop. you are entitled to select the auto body shop to repair damage covered by us . we have recommended a repair shop that will repair your damaged 2 10/05/2004 at 1.0:27 AM Job Number: 21975 PRELIMINARY ESTIMATE 2000 FORD RANGER 4X4 SUPERCAB 6--4 . OL-FI 4D P/U BLUE Int- :GRAY vehicle. As you have agreed to use our recommended repair shop, we will cause the damaged vehicle to be restored to its condition prior to the loss at no additional cost to you other than as stated in the policy or as otherwise allowed by law. If you experience a problem with the repair of you vehicle, please contact us immediately for assistance. AUTO BODY REPAIR CONSUMER BILL OF RIGHTS A CONSUMER IS ENTITLED TO: 1 . SELECT THE AUTO BODY REPAIR SHOP TO REPAIR AUTO BODY DAMAGE COVERED BY THE INSURANCE COMPANY. AN INSURANCE COMPANY MAY NOT REQUIRE THE REPAIRS TO BE DONE AT A SPECIFIC AUTO BODY SHOP. 2 . AN ITEMIZED WRITTEN ESTIMATE FOR AUTO BODY REPAIRS AND, UPON COMPLETION OF REPAIRS, A DETAILED INVOICE. THE ESTIMATE AND THE INVOICE MUST INCLUDE AN ITEMIZED LIST OF PARTS AND LABOR ALONG WITH THE TOTAL PRICE FOR THE WORK PERFORMED. THE ESTIMATE AND INVOICE MUST ALSO IDENTIFY ALL PARTS AS NEW, USED, AFTERMARKET, RECONDITIONED, OR REBUILT . 3. BE INFORMED ABOUT COVERAGE FOR TOWING SERVICES. THE INSURER SHALL PAY REASONABLE TOWING AND STORAGE CHARGES INCURRED BY THE INSURED TO PROTECT THE VEHICLE AND PROVIDE REASONABLE NOTICE TO AN UNSURED BEFORE TERMINATING PAYMENT FOR STORAGE CHARGES SO THAT THE INSURED HAS TIME TO REMOVE THE VEHICLE FROM STORAGE. 4 . BE INFORMED ABOUT THE EXTENT OF COVERAGE, IF ANY, FOR A REPLACEMENT RENTAL VEHICLE WHILE A DAMAGED VEHICLE IS BEING REPAIRED. 5. BE INFORMED OF WHERE TO REPORT SUSPECTED FRAUD OR OTHER COMPLAINTS AND CONCERNS ABOUT AUTO BODY REPAIRS. COMPLAINTS WITHIN THE JURISDICTION OF THE BUREAU OF AUTOMOTIVE REPAIR Complaints concerning the repair of a vehicle by an auto body repair shop should be directed to: Toll Free (800) 952-521.0 California Department of Consumer Affairs Bureau of Automotive Repair 10240 Systems Parkway Sacramento, CA 95827 The Bureau of Automotive Repair can also accept complaints over its web site at. www.autorepair.ca.gov COMPLAINTS WITHIN THE JURISDICTION OF THE CALIFORNIA INSURANCE COMMISSIONER Any concerns regarding how an auto insurance claim is being handled should be 3 10/05/2004 at 10:27 AM Job Number: 21975 PRELIMINARY ESTIMATE 2000 FORD RANGER 4X4 SUPERCAB 6-4 . OL-FI 4D P/U BLUE Int:GRAY submitted to the California Department of Insurance at: (800) 927-HELP or (213) 897-8927 California Department of Insurance Consumer Services Division 300 South Spring Street Los Angeles, CA 90013 The California Department of Insurance can also accept complainted over its web site at: www. insurance.ca.gov All supplements must be pre-approved before any work can be completed. 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 BLVD=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RELY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT W/ =WITH/_ SYMBOLS: #=MANUAL LINE ENTRY *=OTHER [IE. .MOTORS DATABASE INFORMATION WAS CHANGED) **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. MQVP=MANUFACTURER'S QUALIFICATION AND VALIDATION PROGRAM. Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide DR2MD98 Database Date 09/2004, CCC Data Date 09/2004, 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. Some parts that are described as Recon. may be OE Surplus parts or other OE parts offered at a special pricing discount. For further clarification please review the Suppliers List attached to this estimate, or consult the appraiser or estimator. 4 CLAIIYI /�r ��✓ BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 4► BOARD ACTION: 11/02/04 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), give PA Pursuant to Government Code Section 913 and 915.4. Please note all"Warnings". AMOUNT: $4,750.00 SwY f CLAIMANT: KIRK M. VALENTINE ATTORNEY: N/A DATE RECEIVED: ADDRESS: 140 Boulder Sheet BY DELIVERY TO CLERK.ON: N/A Nevada City, Ca cer if'ed POSTMARKED:BY MAIPOSTMARKED: 4---- FROM: Clerk of the.Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SW EETEN, Clerk Dated: 10 OBL By: Deputy II. FROM: County Counsel, TO: Clerk of the Board of Supervisors AThis claim complies substantially with Sections 910 and 910.2. { ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). ( ) Other: Dated ' J BYZ Atd2 Deputy Y De ut Count Coum a., III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). IVOARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated:�'�' '� �'$ JOHN SWEETEN, CLERK,By , Deputy Clerk WARNING(Gov. code s ction 913) Subject to certain exceptions, you have only six(6) months from the date this notice was personally served or deposit 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 prepaida certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:��,'04*1�eW" OHN SWEETEN, CLERK By Deputy Cler TRECffIVED M D f Government Tart Maim Clerk of the Beard of Supervisors, Agent of Service for Contra Costa County October b,2004 This is a demand for the County of Contra Costa to pay Kirk M. Valentine, $4750. This is the Market and Tax Assessors value,of my boat CF8512KX,which the Contra Costa County Tax Collector sold at auction on July 14,2004 without due process. Please contact me,Kirk.M. Valentine, at 140 Boulder St Nevada City Ca. 95959 on this matter. /i � 1 .. Va entine d VA v; 2 J 1" u V1 f �r CLAIM ` BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY , Air BOARD ACTION: NOVEMEL 02:, 004 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 41- f Pursuant to Government Code Section 913 and 915.4. Please note all"Warnings". AMOUNT: $127129.00 CLAIMANT: KIRK M. VALENTINE ��' Ah ATTORNEY: UNKNOWN DATE RECEIVED: OCTOBER 08, 2004 ADDRESS: 140 BOULDER ST. , BY DELIVERY TO CLERK ON: OCTOBER O& 2004 NEVADA CITY, CA 95959 BY MAIL POSTMARKED: OCTOBER 06, 2004 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWE Jerk OCTOBER 1$ Dated: r 2004 By: Deputy IL MOM: County Counsel. TO: Clerk of the Board of Supervisors (, ).A his 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 notifying claimant. The Board cannot act for 15 days(Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply.for leave to present a late claim (Section 911.3). ( ) Other: Dated: `%j`6--- _o By: ' Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). IV..,BOARD CORDER: By unanimous vote of the Supervisors present: OT This Claim is rejected in full. ( ) Other: Iceertify that this is a true and correct'copy of the Board's Order entered in its minutes for this date. Dated:,41,sAkr,.v JOHN SWEETEN, CLERK, By Deputy Clerk WARNING(Gov. code sec on 9 3) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned,have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: ' °� JOHN SWEETEN, CLERK By Deputy Clerk I[R=ECE:IVED 11 80 RHU'DuD 0iJ€' JiS: �RA CTA-Co. Government Tort Claim Clerk of the Board of Supervisors, Agent of Service for Contra Costa County October 6, 2004 This is a demand for the County of Contra Costa to pay Kirk M. Valentine, $12129. This is the Market and Tax Assessors value, of my U.S. documented boat 699-01299, which the Contra Costa County Tax Collector sold at auction on July 14, 2004 without cause and due process. Please wit me,Kirk M. Valentine, at 140 Boulder St Nevada City Ca. 95959 on this chatter. Kirk M. Valentine CLAIM / Ar BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY L BOARD ACTION: NOV. 02, 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), give Pursuant to Government Code Section 913 and . - 915.4. Please note all"Warnings". AMOUNT: $1,685.81 CLAIMANT: CSE INSURANCE COMPANY BY: COL-EEN QUENTO ATTORNEY: UNKNOWN DATE RECEIVED: OCTOBER 12, 2004 ADDRESS: P.O. BOX 13506 BY.DELIVERY TO CLERK ON: OCTOBER 12, 2004 SACRAMENTO, CA 95853 RECEIVED FROM RISK BY MAIL POSTMARKED: MANAGE-MEN1 T'I RII - - INIER OFFICE MAIL FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SW T lark Dated: OCTOBER 12, 2004 By: Deputy II. MOM: County Counsel TO: Clerk of the Board of Suillervis4rs 0-kihis claim complies substantially with Sections 910 and 910.2. { ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). ( ) Other: Dated: L' #J' By; `jf '` � `' c- Deputy County Count III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). IVOARD ORDER.: By unanimous vote of the Supervisors present: , ( This Claim is rejected in fall. { ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated:/ d JOHN SWEETEN, CLERK, By , Deputy Clerk WARNING(Gov. code sect'on 91 Subject to certain exceptions, you have only six(6) months from the date this notice was personally served or deposit 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 acertified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. � Dated: 44 `y d JOHN SWEETEN, CLERK By Deputy Cler 08130/2004 07:55 AM BOARD OF SUPERVISORS OF CONTR t COSTA COUNTY INSTRUCTIONS TO CLAIMANT A A claim relating to a cause of action for death or for injury to person or to personal property or growing; crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code§ 911.2.) B. Claims most be filed with the Clerk of the Board of Supervisors at its office in Room j 106, County Administration Building, 651 fine Street, Martinez,CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County,the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. as a■�����ssr�rrrr�����rra���u rr�������as��a sr����r�t�i �r�w���rra�esr���r��r RE: Claim By: Reserved for Clerk's filing stamp RECEIVED Against the County of Contra Costa or } OCT 12 RECT } District) M-i K ffAR? i (Fill in the name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$�_,-`° _ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 6 2. Where did the damage or injury occtu_O. (Inclu`de,.ity and county) 3. How did the damage or injury occur? (Give full details; use extra paper if required) 4. What particular act or omission on the part of county or district officers. servants, or employees caused the injury or damage? f'��'s 0813012004 07:55 AM 5 What are the names of county or district officers,servants, or employees causing the damage or injury? 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) f 8. .Names and addresses of witnesses, docters;anis tspitals.- - -- r� 9. List the expenditures you made on account of thin accident or injury. DATE TIME AMOUNT /6 IN*aa■e//eass•Sam ssboasts aaasras as a as ass a a aams/asessa/sssaass*Sol as aamove a as to amean a ) Gov. Code Sec. 910.2 provides"The claim shall be )signed by the claimant or by some person on his }behalf." SEND NOTICES TO: (Attorney) ) Name and address of Attorney ) (Claimant's Signature) } (Address) } Telephone No. )Telephone No. _. --- - - taB/■ea//■B•ass Bases soon as/aeras aB/fie■a a■aaa•/RaR/a■■••eaata a asssubses miaiaallata Rosea 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 sante 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 dollars ($1,000.00), 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 tine. JUN-24-04 09 :45 AM O. C. S. INC. 916 632 9888 P.01 y tf ? E E ocs VEHICLE INiSP CT"ION REPORT OUTSIDE CLAIM SUPPORT INC. ocS File No. OC 2067 r Insurancs Cv,CSE insured: ROY AGUILERA , Adjuster: COLEEN OLIENTC Claimant: Claim No, 390545 Vehicle Owner: 0 Insd, C3 ClmtG We of Loss: 06/1812004 deductible: 80.00 Appraiser: JeFF GORDON DaRBC: 08/21/2004 Contacted: 06121/2004 Inspected: 0612212004 Comps ted; 0812312004 © Collision 0 Theft 3 Camp. 0 Repo R_ 2"ernd: Roper 0 Total Loss Vehicis In for , n: VIN., WAUBH64B21 N135387 Year/Make/Model 01 AUCs A6 License/State 4SYG770-CA Mileage: 29960 Color: BLACK Engine 2,8 Condition Flotos: faint: GOOD Interior: GOOD Drivable: YES 't Tires Brand: Size: Tread: LIF: 132 RIF: 132 UR: 132 R/R: 132 Spare: 132 f LaIrment or Old Qamano Explanation � ' j Description: NONE Amount: $0,00 Description: Amount: $0.00 i . i Loss Reae : Estimated Damage: -SI.685.81 Approximate ACV: 3 9.750.00 i Suggested Betterment: $0.00 Estimated Salvage Value: $2750.00 Estimated Damage After Betterment: $1.695.81 lays to Repair: 5 � r � Repair,Shores; C,A.R, AUTO BODY Address: 444 233RD ST Phone: 5108346506 OAKLAND CA Fax: 510 272 0983 94612 Tax 10: 36 4540505 Agreed Price: 3 ' as Q No i E I inspected Q the strop. Found damage to the hood,and burnper cover. Both Can be repaired. AjCopy of the estimate was faxed to the shop, r i l t i r i PH:209-640-1888 FAX:209-832-3074 � GCS Inc. $06 AMorraur Avo Rocklin,Ge.955677 Ph: 866-666-0444 FAn; 800-7 (W# i i 7 r s JUN-24-04 09 :45 AM O. G. S. INC. 916 632 9988 P. 02 } p 6123/2004 ta,43 PM I Estinz( : OCU-2067 i Eatimata VsriiO : ® I carnmkt Proluo I : �r4STOMIZED y r { i OUTSIDE CLAIM SUPPORT, INC. 3465 ARGONAUT AVE RCCKLIN,CA 05677 (816)8324444 Fax: (816)832-®858 d o � 3 Damao♦Assessed By: Jeff Gordon 202440.7166 Appraised For: C56 In6tAMnoa Colson 13uento (A18)584$1126 � 6 Condition Code: **ad Date of Loss: WIM004 Typi at Loan: Comprehensive � I r Confect Date: 6/21/2004 Deductible: UNKNOWN , File Number; OC94.2087 1 CWm Number: 380545 ;t insured: Ray Aguiteera ! Address: 1t6 Pla6ta Clt Orinda,CA 94$63 Telephone: Work Phone: (6i0)$01.5142 Hams Phone; (625))75-3202 i � i Mitchell Ssnrlt:e: 818214 i Description: I001 Acini A6 Vehicle i'radUCtiatt Darr, 4101 Body Style. 4D Sed Drive Train: 2.8L U6 6 C 6A FWD j VIN: WAUS1t84621N138367 License: 48YG770 t:A Mileage: 28,480 Color! ®lack Options, ANTI-LUCK&RAK€SYS.JABS},ALUWALLOV WHEELS,AIR CONDITIONING.POWER STEERING j POWER&RAKES,POWER WINDOWS,POWER DOOR LOCKS,POWER PA"KNORR BRAT TILT ST€ERINC WNiEL;CRUISE CONTROL,ELECTRIC DEFQc44ER.AM-FM STEREO CASSETTE UdATHRA SEATS,POWER SUNROOF,AUTOMATIC TRANSMISSION TRACTION CONTROL121.40TRONiC,PREMIUM BOUND SY8.,POWER DRIVER BEAT AM-FM STERROICOPLAYER(SINGLE),CENTER CONSOLE,PASS€NGRA-FRONT AIR SAG ` POWER REMOTE MIRROR,4 WFiM DISC BRAKES.4-000111,DRIVER-#RONT ASR SA© j k Line Entry Labor Lino(tam ParntDollar kern N"4r Type Operation Description Pvt Nu Number ' Amount Lebof I Unna 4 804$12 BAY OVERHAUL FRT COVER ASAP 2 800013 EDY REPAIR FRT BUMPER COVER Rxisting 3 AUTO REF REFINISH FRT BUMPER COVER COMPLETE G 1.8 4 602733 BUY REMOVE/INSTALL GRILLE ASSY 5 800109 BDY REPAIR HOOD PANEL Existing BA+M j 8 AUTO REF REFINISH HOOD OUTSIDE ; e C 2.8 o { 7 836012 ADD'L COST HAZARDOUS WASTE DISPOSAL 5A4+ k 1 2380114A00%COST FLEX ADDITIVE 9 AUTO REF A13b'L OPR CLEAR COAT 1 # 10 1.i 833409 REF AOD'L OPR TINT COLOR ; .6+ i 11 AUTO BOY • ADD'L OPR FWW$AND AND BUFF 1.4 12 83301$ BOY + AOD'L OPR MASK FOR OVERSPRAY s 6.00 0.3+ 13 AUTO ADD'L COST PAINTIMATERIALS i 739.40' -Judgement Item #-Labor Rote Applies f C-Included in Clear Coat Calc E i EarIMATE RECALL NUMBER: tU2il2044 32:43.4$ OC$4.2087 k uxraMate Is i Trademarit of vnohe8 lnternationW r Mltcnsu Data Verelan: JUNrb4-A CopyNght(tr)1884.2003 Mitchatl intsmautond r UttraMata Version: $.0.0x3 All Rights Reserved Papa t at 5 } , JCJN--24-04 09:46 AM O.C. S. INC.. 916 632 9899 P.03 alai : 6l281200d 10l4l P4lt ' ltotkrtats t tiCBe-2D67 ' � Estimate Vera o # Commht Probe t : CUBTt�p i Add'l l Labor Bublot ! L 6absr subtotals Unfit* Rats Arnount Amouta Tom$ IL Part Repleoement Summary $ Body 11.8 80.00 too 0.00 809400 TT Itori sh 6.3 60.00 0.00 0.00 554.00 T Total Ita;Aaeetnsnt Parts AMW 9 0,00 Taxable Labor 1,tii.t3tt Labor 8ummaty 17.6 1,413.00 l It Addltlonal Costs Amottre TV. Adjustments € aunt ( ## Taxable Costs Customer Rosponsibil 0.00 28TAC j { Sale*Tax � 6.25054 20.11 jj Non.Takeble Costs too Total Additional Colas 272.x1 ? E i. Ttxal Labor. I Total R;placement Ports; 0. Total Addl kmW Cost*: tr as Total. . E M Total Adjustmonta: , } Not Total: 1.685 i1. Body&hop" C.A.R.Auto Body Inepeotion aka: #hopp Z Address: 144 23rd 69roat D#cl#nd.CA Oakland,CA $4412 Inspection Dat*: 6/22/2004 Telophone: (6i0)SU ss I fax Prions: (Sid)4324888 4 state Lia.No: 86.4540505 E THIS IS NOT AN AUTHORIZATION TO RXPAIR. ALL COSTS TO REPAIR All � THESOL9 RESPONSIBILITY OE' TETE VEHICLE OMMA, AS IS AUTHORIZATION ! # OVAEPAIR. NO SUPPL73T 2NTS WILL 333E NQNORRO WITHOUT ]PRIOR INSPECTION 2YOEt'P$%vZ Claim SUPPORT ZNC. OUTSID& CLAIM SUPPORT INC. SPECIFIES T'3tAT ALL REPAIRS At3Li/OR PARTSRZPLACXMM LISTED 33EREIN ARP,' nRVORMZD IN STRICT ACCORDANCZ � b WiTHIMMSTRY AND XARUTACTUStXRS S3PWI7aTIC&TIONS. +��w�w,t�rw�rw�rw,rte*�r*�r�r�r'tr,t,t�r�r�rtr,t,t'+r�e,ere�rww,rw�r�rt*orf*'tr�r�terre"rw**tr,r,tt,t,t�r,lr�ttr*�r���e'rr 1 ACCORDINO TO SECTION 2605.0 BUD—SZCfTION 3, OP TIM INSURANCE CODE, i # "THE XNSMMR XKY REABONA#LY ADJUST ANY NRXTT1W ESTIMATE 13RI63?A ZD $YTE REPAIR. SHOP OF THE INSURRED I S CHOIC211 t I7+I ACCO7RDA14cZ WITH YOUR AUTCMOZILZ POLICY, PART" YII, "COVERA % 7('ORDAM LOZ TO YOUR AUTO", MMOR "LIMIT'S Els" LIARILITT", SECTION C: "IF A REPAIR OR 3MPLACZMWT RESULTlt IN BETTER T3L14t"t LIKE KI1"Tti OR! 1 � QUALITY, 7TE WILL NOT PAY FOR THE AMOUNT! O8' THE BETTERMENT"t � f THEREFORE, 8>9ETTZRfis7WT/VZPRZCXATION, MAY BIG APPLIED TO ALL PARTS TPAMLL RZQUIRR RZPLAC73 MT UNDZR NOS USS, DUE TO WEAR Atm TZARWHICH CONSTITUTES A LIMITED LIVXA AN OF TRZ PART. { 1 r ( ElTWATls RECALL NUMSERr $12812004 22:43:06 CC$4-2667 i ukra5Aeta to a Trademwk of Mitchell International ? # mit4hall ON*Version: JU&04_A CopyrigN(t)1SS4.2043 Neohail International Past 2 or 6 1 UNMMate Version; 5.0. 23 As Rlyhte Roamed r f + f JUN-24-04 89:46 AIM O.C. S. INC. 916 632 9889 P. 04 S 61#313001#Ct1's PM i;stitrirtr 1 QCad�0d7 E:stllhWe Yrr d Caamtltitt Profi#r S CtaetT+ D * BETTERMENT AM DEPRECIATION ARE APPLIED PARTS TKhT Wim, i * B1cTTERM NT IS BASED ON THE CONDITION Or PINISR OR PRIOR WEAR Or PART. • DEPRECIATION ON A MSCX=CAL PART xS SAAED ON %,Xz ACCRUSD N21 EE 1 t BETTZMWT ANDS DZPRSCYATION ARE CALC'tJ ATED AS Tom PERCSNTAaz or !R FROM THAT OT A NEW OR UNDA1l"= PART, In order to amply with California Dapartment, of Insurance ! rQ9ulat#0A*, this office zrUst advise you of the following iftfosmatic n that pertains to the repaira to your vehicle for daanaaago occuring Er this loaaal t 1 ? � Wel are prohibited by law from requiring that repairs be done at a i 2 specific ropaair shop. You are entitled to select the auto body rwp � I , i shop to repair damage covered by uaaa. We have rsaaetanendaad a reWaal,r � shop that will repair your damaged vehicle. As you have agreed to use our recossmnded repair strop, we will cause the damaged vehicle to be ' # } restored to its condition prior to the lass at no additional cost t � you other than as stated in the insurances policy or otherwise � all.owedby law. Sf you experience a problem with than repair of your � vehicle, please contact us inmediateely for assistance. , Autos Body Repair Consumer Rill of Rights A CONSU A is ENTITLED T4; 1 E 1. SELECT THE AUTO BODY REPAIR SHOP TO REPAIR AUTO BODY DANWZ COVERED BY THE. INSURANCE COMPANY. AN INSURANCE COMPANY I&Y MOT REQUIRE THE REPAIRS TO BS DONE AT A SPECIFIC AUTO BODY SHOP. t 2. AM tTEMISLED WRI'T'TEN a68MaTz FOR AUTO BODY 22PAXISa AND, UPON � COMMON Or REPAIRS, A DETAILED INVOICE. THE 9STIMR,'TB Jam'# THE l INVOICE MUST XNCLUDE AN ITWaZ1D LIST Or PARTS AND LABOR A;i+ONO WITH, I j THE TOM PRICE FOR TRZ WORK PERRON=. THE ESITXM l,TE AND INVOYCE MCY T i ALSO IDENTIFY ALL PARTS AS KILN, USED, "TERMAAREfi, RECONDITIONY.13, REBUILT. F � 3. 22 IWOFMED ABOUT COVERASS FOR TOWINO SZRVZCES. UNLSS$ THE INSURANCR COS MANY HAS PROVIDED Ata INSURED WITH THE MW or A APSCirlp � TOWINIS COIGANY PRIOR TO THE mt mm,E usz or ANOTHER ' onxGG Comm,� f THE INSURANCE COMPANY MUST PAT ALL MMOMLE TORI2NO CHARGES Of Tax ; ! TOt TNG COMPANY USED SY THE TUSURED, s 4. SS IN8'OMM ABOUT nX SXTINT OF COVERK01, XV ANY, FOR, A e � RZIPIACEMMT RENTAL VZRICLE WHILE A UASS'hSZD VXXICLZ 12 3ZTX0 RZPMI= 5, RE INFOR341D OF W ZAZ TO RRPORT SUSPECTED FRAUD OR OTHER CC I,JI4S AM CONCERNS ABOUt AUTO BODY REPAIR;{, j COOLAINTS WITHIN t'XZ JURISDICTION OF TRX BUREAU OF AUTOMOTIVE REPAIRS , Cmplaints concerning than repair of a vehicle by an auto body repay � shop should be directed to: I 4 I Toll Free (goo) 982-5210 fi E BTIMATI RMCALL N 6*!t; 8rx3124"22,43:09 cCA440SI r WOUMrtr 10 r TM4rma*of lVkahrU htsmolanal Mttohrlt Oatr Vrrrlver .ItlN-W A C0004 t M 11104.MI eeltch*U Iretsmr kmt Uftn%Mrts Vsr%ion: 5.0,6-23- Alf R400Rrrsrvsd PApr 3 M # r }r 's { JUN-24-04 09 :46 AM O.C. B. INC. 916 632 9888 P. 0!5 cm : 818]8200410:43 PM Wmata t : 4CS4»8087 it etlntats Ys 0 C4nlmltt � Proms I r CURTCNMO ! i Ca.lifarna.a Depaxtment of Consumer affairs Bureau of Automtive Repair l 10240 Syotwu Parkway € � Sacramento, CA 98827 � { i ! ifi T'he Bureau of Autm ot.:,ve Repair can also accept cst c*laints over its � ! web site at; .lautorepai,r.csa.y'ov I#; ; 6 ! 1 i ' i f 1 i 1 1 }4 } (1 t � (� y f 1 f �`e 1 F 1 3 ! i t3 i 4 EETWATE RBCALL WMSER; 912$=04 22A3:Od 00".2017 ' f{ uhrat8ats to a Trsdomrk of Mkohalt intamallonal I ltitaha$Acta vereiort: dUlV G4_A C*pyMgW(C)iltBs, 18Msholl itisimsdanal Peg# d of a UhraMats Ysraien, t.d.C10 AN Rlt is Rssetwtt 1 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA C'()UNTY BOARD ACTIONOUMfM Wi 2 Claim Against the County, or District Governed by } the Board of Supervisors,:Routing Endorsements, } NOTICE TO CLAIMANT and Board Action. All Section references are ts� } The copy of this document mailed to you is your California Goverment 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: UNDETERMINED AS TO THE SUBJECT PLAINTIF S. CLAIMANT: CAROL DIVITA ATTORNEY: GAVIN & CUNNINGR M DATE RECEIVED: OCTOBER 12, 2004 ADDRESS: 1530 TETE ALANEOA, SUITE 210 BY DELIVERY TO CLERK ON: OCTOBER 12, 2004 SAN JOSE, CA 95120 BY MAIL,POSTMARKED: OCTOBER 07, 2004 FROM: Cleric of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEET k Dated: OCTOBER 1.3, 2004 By: Deputy II. )M: County Counsel, TO: Clerk of the Beard of Supervisors ( fhs claim complies substantially with Sections 910 and 910.2. t { } This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 clays (Section 910.8). ( } Claim is not timely filed. The Cleric 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: e' ' By; ' �` �. _. Deputy County Counsel 111, FROM: Clerk of the Board TO: County Counsel(1) County Administrator(2) ( } Claim was returned as untimely with notice to claimant(Section 911.3). IV.,,8OARD 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:•/4`et.G ' ,o✓G► JOHN SWEETEN, CLERK, By � De Clerk WARNING(Gov. code section 13) Subject to certain exceptions,you have only six(5)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 arra 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 Canned States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Carder and Notice to Claimant, addressed to the claimant as shown above. Dated: + c�r' HN SWEETEN, CLERK By AV Deputy Clerk p y CLALV AGAINST GOVERNMENTAL ENTITY—CONTR,4 COSTA COUNTY This is a government claim submitted on behalf of Carol Divita and it is directed to the Contra Costa County. The claim concerns a boat accident that happened on or about June 22, 2003. All notices and communications should be directed to Carol Divita's attorneys (Gavin & Cunningham) at the address and telephone number indicated below. This claim is delivered to the subject government entity at the following address: Contra Costa County Clerk of the Board of Supervisors County Administration Building, Room 106 RECEIVED 651 Pine Street E � ; Martinez, CA 94553 OGS 1. Marne &Mailing Address of Claimant ,< Carol Divita C/O Gavin&Cunningham 1530 The Alameda, Suite 210 San Jose,CA 95126 4081294-8500 2.mature of Claim &Circumstances Giving Rise To Claim This is an indemnity claim pertaining to personal/bodily injuries and property damage claims arising out of a Tune 22, 2003, boat accident. Attached hereto, and incorporated herein by reference and strictly for reference and information purposes, is a copy of the Complaint filed in Alameda County Superior Court Action RG-o4162125, Ding v. ,tri ht, said complaint includes applicable government claims previously filed by the Plaintiffs in said Action. 3. Dollar Amount Of Claim: Undetermined as to the subject Plaintiffs. This is an indemnity claim. 4. Date Of Accident The accident happened on June 22, 2003. 5. Date Of Service Plaintiffs served the subject complaint on Carol Divita sometime in September 2004. 6. Act Or Omission Carol Divita asserts the indemnity claim that is the subject of this government claim strictly on the basis of information and belief relative to the matters set forth by Plaintiffs in the attached documents and without admitting any of the allegations or information set forth in the attached documents—in point of fact, Carol Divita expressly denies liability relative to the subject accident, and expressly denies all of the material allegations and purported information set forth by Plaintiffs' in the attached documents insofar as the same pertains to Carol Divita or any related party. 7. Involved Government Entity Employees Undetermined. 8. Other Information None Dated: October 7, 2004 G in Cu for Carol Divita CS} 4 Sep 09 04 09: 43) p. l SUMMONS Of nA-4ao (CITAC ION,JUDICIAL) (SOLO PAM USOOUAr &Ei.ACORM NOTICE TO DEFENDANT-. (AMSC}AL DEMANDADO). SAMUEL GERM, WRIGHT SR., RICHARD LOUIS WRIGHT, KENNETH FRAGA, CAROL DIVITA, THE COUNTY OF SAN JOAQUIN, THE, COUNTY OF CONTRA COSTA, THE STATE OF CALIFORNIA, and DOES ONE through FORTY, inclusive, YOU ARE BEING SUED BY PLAINTIFF: (LO ESTA DEMANDANDO EL DEMANDANTE): NA.TALIE ICING, as an individual and as Guardian ad Lite:), CHARLES KING, as an individual, and MELISSA KING, a minor by and through her GAL, NATALIE KING You have 30 CALSNDAR DAYS after this summons and legal papers are served on you to His a written response at this court and have a copy served on the plaintiff. A tetter or phone tali will not protect you.Your written response must be in proper legal form It you want the court to hear your case. 'There may be a court form that you can use for your response,You can find these court forms and more i Iinformahon at the California Courts Online Self-help Center(wavw.courtinfo.ca.goviseifhelp),your county law library,or the courthouse nSaMtYou- if you cannot pay the filing fee,ask the court clerk for at lea waiver form. If you do not.file your response on time,you may lose the case by default,and your wages,money,and property may be taken without further warning from the court. There are other legal requirements.You may want to call an attorney right away.if you do not know an attorney,you may want to call an attorney referral service,K you cannot afford an attorney,you may be eligible for free legal services from a nonprofit legal services program.You can locate the"nonprofit groups at the California Legal Services Web site(www.lawhs1pcallfornla.org),the California Courts Online Self-Help Center(www.courtinfo.ea.goviselfhelp),or by contacting your local court or county bar association. 17ene 30 DIAS DE CALENDAR10 despues do quo to enftguen austa cltacidn y popetes legalesr pare presenter uta r+espuesta por ascrito on osta torte y heccarr quo so antrerguo una copra of demandents. tins carts,o Una 712mads foleffinics no to proteg+en. Su respuesto por escrfto bene quo aster on formato legal comedo sf dessa qua procesen su caso an to tortes. Es posible quo hay*un formutado quo usted ,pusclaa us*r pare su reespuesta. Puede encontrar estos forrnularios do la conte y mats lnformacdbn on el Centra des Ayude de lass Cortes der California(w4Yw courtlnfo.ca.govtseftholplespanolO,on is bibiloteca de teyes der su condadna o on is sorts quo to quads mos ceras. Sl no puede pager Is cuoto do presentacl6n,plda at sacr otarle do Is carts quo to del urn formulerto de exend6n do page de cuotaat. Sl no presents su nospue U ai 6ampo,puede perder at caso por lncumpffrnlernto y is torte ler podrA quftatr su sualdo,dlnsrc y blones sin mss adversancia. Hay otros requisltos loples. Es recomendable quo Items a un aebogado lamedlatemente. S1 no conoce a an ebogado,puede Ifammarr a un serviclo de rarmisid3n of abogadot Si no puade pager a un abogado,ars posibfe quo cumpl*con ices requisitos pars obfensr serviclos le3gales gratultos de un programa do serviclos legales sin fines do lucre. Puede ancontmr estos grupos stn fines de lucro on e/sitio web de Celomle Legal Services,(wwwdowhalpcslifornis.org),an at Cenfro der Ayud*do las Cortes tie California, Www.countinfoxa.govIselfhalpiesponoo o aalendose on corntacto con to torte o al col to tle abogados locales, The name and address of the court is: cutis rau maam: � � � �' � t� (El hombre y direcci`6n de to ootte es): fft der Coto): + Alameda Superior Court 1225 Fallon Street Oakland, CA 94612 Unlimited Jurisdiction The name,address,and telephone number of piaintIffs attorney,or plaintiff without an aftomeay,is: (Ef rnombre,la direcd6n y el n6mero de telf4fono del abogedo del demandante,o del demandente quo no Irene abogado,es): Christopher B. Bolan \1#1655358) (415) 421-2800 The Bolan Law ,Firm 78 First Street San Francis AUG 2 8 b , 94105 _�� Clerk,by ,Deputy BATE: EXECUTIVE OFFIC Sacre3tarlo Rd'unto Facile (Por proof of service of this summons, use Proof of Service of Summons(form POS-1910).) (Para pruebe de elntrega de$std citatO n use ail formalarto Proof of Service of Summons,(POS-010)). NOTICE TO THE PERSON SERVED:You are servedL€�? esMl (JOtJRT CpC 1, as an individual defendant.Q+ ►s„s e4 2. as the person sued under the fictitious name of(specify): at,~� Cyn t y3. [- on behalf of(specify): under: CCP 416.10(corporation) CCP 416.64(mirror) CCP 416.20(defunct corporation) CCP 416,74(conservatee) . C3 fl ( CCP 416,40(association or partnership) CCP 416.44(authorized person) F other(specify).. 4, = by personal delivery on date): flogs r an r farm Adocted oar Mand#iA Use Code of Civil Aroaaduna§§412.20,465 ,rudtciai coinnoi=.or utiforrie SUMMONS U 61}M•190 lRev.January 1,2W41 p. � 'rep 09 04 OS.43a 08/22/2004 15.54 PAX 415421.2830 'THE DOLAN LACY FIRM Q0o2 { ( FILED BY FAX hns4apher B. Dolan(#165358) ALAMEDA COUNTY Shaam A.RAhman(# 195519) June zz,zot� 2 THE I)OLAN LAW F 1 78 First Street CLERK OF 3 San Fmncis o, California 94105 THE SUPERIOR COURT Telephc ne: 415 421=2500 By Rosanne Cara,Deputy 4 FacsMile: 0415)421-2830 CASE NUMBER: RG04162125 5 Atton for Plaintiffs 6 Natalie Xing,Charles Ding,and Melissa King,a minor by and through her GAL,Natalic King 7 SUPERIOR COURT OF THE STATE OF CALIFORNIA 8 FOR THE COUNTY OF ALANMDA 9 CIVIL DIVISION UNL,IMTED JURISDICTION 10 NATALIE KING,as an individual and as ) CASE# 11 Guar&an ad Litem,CHARLES DING,as ) an individual,and:MELISSA KING,a ) 12 �G by and through her GAL,NATALIE } COMPLAINT FOR DAMAGES 13 ) FOR NEGLIGENCE,NEGLIGENCE } PER SE,INTENTIONAL,WFLICTION OF EMOTIONAL DISTRESS, 14 Plaintiffs, NEGLIGENT INFLICTION OF 15 EMOTIONALEDISTRESS,PREMSE } ILITY/DANGEROUS CONDITION 1 fi vs. ) PUNITIVE DAMPUBLIC S PROPERTY, FOR PERSONAL INJURY 17 SAMUEL GERAL WRIGHT SR,, [UCHARD LOUIS WRIGHT,KEN-1, TH- 18 FRAGA, CAROL,DIVITA,THE ) C4t.NTY OF SARI JOAQUIN,THE 19 COUNTY OF CONTRA COSTA,THE STATIi,OF CALIFORNIA and DOES 20 ONE through FORTY,inclusive, Defendants. 22 23 Y'laintifl"s NATALIE KING,as an individual and as Guardian ad Litem for MELISSA KING, 24 11 mino+t•, CHARLES DING, as an individual, and MELISSA RING, a minor by and through her 25 guardian ad litem,NATALIE KING("Plaintiffs"),allege as fellows. 26 ALLWAno-Na 27 l, At all relevant times,Plaintiffs am and have been individuals residing in the County of 28 t;ontra Costa,California. At all relevant times,MELISSA KING,was a minor and a resident of C OM*LAINT FOR I AIMAG8'S FOR NWLIGtNCZ,2+XGLIGZNCL FER 8$.,lMNTIONAL INFLICTION OFMOTIONAL DMIM . ?IV-L1C4M ilMJCMN OF RMOTIONAL DISTRE23,M.MSZS LLABUXI`VIVANG1MOUS CONDITION OF PUBLIC PROMTY,PL'Nn" DAMAM AND FOR PCMNAL INXRV Sep 09 04 99. 43a p< 3 E 06/22/2004 15.55 FAX 4154212830 THE DOLAN LA's FiRx �pp3 i l Coma Costa County, E 3 2. Plaintiffs are informed and believe and thereon allege that at all relevant times,Defendants 4 RICI!AR.D LOL4s WRIGHT and SAMUEL GERAL WRIGHT SR.were and are individuals 5 residing in the County of Alameda, California. 6 7 3. Plaintiffs are informed and believe and thereon allege that at all relevant tines,Defendant 8 KENNTM FRAGA and CARoL DiwA are and were individuals residing in the County of 9 Contra Costa,California.. 10 11 4, At all relevant tunes,Defendants Contra Costa County, San Joaquin County and the State 12 of Catifornia are and were public entities. 13 14 5, The"Santa Fe Cut"is not a navigable water of the United States subject to the admiralty 15 juris&,-tion of the federal courts. 16 17 6. Plaintiffs are ignorant of the true names and capacities of Defendants sued herein as Does 18 1 throw&40, inclusive,and therefore sue these Defendants by such fictitious:names pursuant to 19 Code of Civil Procedure section 474. Plaintiffs are further ignorant of the appropriate charging 20 allega ons and theories of liability with respect to said fictitiously named Defendants, Plaintiffs 21 will anend this Complaint to allege the true names,capacities and liabilities of such fictitiously 22 named Defendants when the same are ascertained. Plaintiffs are infbnned and believe and 23 thereo:,t allege that each of the fictitiously named Defendants is legally responsible and liable in 24 some r-inner for the occurrences herein alleged.,and is therefore liable and responsible to 25 Plain iff's for an amount to be hereinafter determined. 26 27 7. Based on information and belief,each Defendant named or fictitiously named herein, 28 acted in his,her,or its own right,and/or was or is the agent,employee or servant of each of the x CV+*LAINT FUR DAMAGES FOR NEGLICINM NEGLIGENCE 1181k K INTENTIONAL vI�NF,�LICTICIN of EMOTIONAL MSTI M, NXGLDG*NT EMICTION OF EMOTIONAL DIST M HMMISESi LL4DILTrY1DAA?4GZROV6 CONDMON OF PUBLIC PROPERTY,PL"I4ME DAMAGES AND FOR PMSOKAL(WRY p. 4 Sep 09 94 09s44a 06/2-2/2004 25,55 FAX 4154212830 THE DOLAN LAW FIRM 2004 f� i 1 other Defendants,as to each of the matters set forth heron, and based on information and belief, 2 each xuch Defendant,whether fictitiously or individually named.,or named in any other capacity, 3 was A all times acting within the scope and purpose of such agency,employment or Betrvicc;or } 4 alternatively,if the acts sof each such Defendant were nest authori d at the time,such acts were 5 subsequently ratified by the appropriate principal. 6 7 8, Defendants RICHARD LOUD WRIGHT and SAMUEL GEI2AL WRIGHT SR..and 8 DOES 1-5 were,at the time of collision as hereinafter described,the owners and operators of 9 Trihull Runabout boat(the Runabout). 10 11 9. Defendants KENNETH FRAGA and CAROL DIVITA and DOES 6-10 were,at all 12 relevwit titres,the owners and operators of an offshore speedboat,a Wellcraft Scarab named the 13 Rehab(the Rehab). 14 15 10. On or about June 22,2003,Plaintiff ME ZSSA KING's care was entrusted to defendant 16 DIVITA, 17 18 11. On or about,lune 22, 2003,defendant DIVITA brought plaintiff MELISSA KING aboard 19 1 boat ealled the Rehab,which was awned and operated by Defendants FRAGA and DIVITA. 20 On this date,defendants FRAGA.and DIVITA operated the Rehab on or near the Santa Fe Cut 21 700'wast of Old River located within San Joaquin and Contra Cresta Counties at which time 22 Defendants FRAGA and DIVUA operated the Rehab at an extreme speed on a course 23 approximately due west towards the boat operated by defendants RICHARD LOUIS WRIGHT 24 and SAMUEL GERAL WRIGHT,The defendants,and each of them,negligently opted their 25 vessels so as to engage:in a head-ort collision course causing the boats owned and operated by 26 the"*,fendants to collude on their respective port sides. 27 28 :.2. kamediately following the collision referred to in paragraph 11,the Rehab continued on C ONOLA NT FOR VAMA.GES FOR NEG'LIGMI,NEGUGENCB Pla$9. N'I` IMONAL INFLICTION OF RMOTiONAL DISTRVAW tQ our.vn MuG IOr4(W IMMORAL DIe9TRE8i9,FRX[eli$F g LXABILMMANGWO S CONDI tox OF PUBLIC PROPER`T'Y,PUNTI YVE DAMAGES AND FOR P'ERAONAL XNAIR'Y S.ap 09 94 09: 44a p` 5 06/22/2404 15:55 FAX 4154212830 THE DOLAN LAW F1RY Q005 1 its cmrse at a high rate of speed across the Sang Fe Cut making contort with land on Faye 2 L%1=4.As a result,Plaintiff,MELISSA KING was ejected from the boat onto tate land where she 3 sustained serious injuries to her head, face,hip,torso,neck,back and lower extremities, as well 4 as other areas of her body. 5 6 13. At all times herein mentioned,County of Sao Joaquin,County of Contra Costa and State 7 of Ca4for nia employed persons whose identities are unknown to plaintiffs at this time,and in 8 doing the acts hereinafter described, such employees were acting within the scope of their 9 amploymeant. Such unknown employees are sued.as Doe defendants,as forth above. 10 11 14. Plaintiffs presented to the County of Contra Costa.,the County of Sats.Joaquin,ant the 12 State of California written claims of liability for the injuries,lasses,and damages suffered and 13 incurnawd by plaintiff MELISSA KING by reason of the occurrences described herein as required 14 by Ccvernment Code §900 et seq.Copies of the claims are attached hereto as Exhibits A.,H and 15 C,resimetively. 16 17 15. On or about January 20°',2004, Contra Costa County rejected the claim of plaintiffs in 18 their cotirety, On or about February, 5`n',2004 County of San Joaquin rejected the claim of 19 plaintiffs in their entirety.The State of California has not rejected the claim of the plaintiffs. 20 21 FURS-1-CAUSE OF ACTIM 22 (By Plaintiffs Against 23 All Defendants for NXGLIGENCE) 24 25 15. Plaintiff alleges and incorporates by reference to this cause of action each and every prior 26 allegation of this Complaint as if set forth in full herein. 27 28 17. Plaintiffs are informed and believe and thereon allege that on or about June 22nd,2003, C OMPLAM MR DAMACU FOR NEGLIGENCE,NE LIGANCE PER 88,INTIN TONAL INFLICTION OF EMOTIONAL DISTR S, NEGmiw INnicnON OF EMOTIONAL DIME85,tRZMt=LIABILITYIDA NGEROUS CONDt'C((ON OF KMLIC PROPERTY,rUNi'rrVt DAMAiG98 AND FOR I''EIE&i3NAL iNAKY Sep 09 04 09: 44a p. 6 Oe/22/2004 25:55 FAX.. 4154212830 TRF. DOLAIN LAW FIRM i I 1 deferPUMts RICHARD LOLUS WRJGHT and SAIWAL GERAL WRIGHT SR, operated the 2 Run :hut in the Santa Fe Cut in or near Contra Costa County and San Jwquin County, 3 Calif vnia,for the purpose of recreational boating, 4 5 18, Plaintiff's are unformed and believe and thereon allege that on or about June 22,2003, 6 defendants FRAGA and DrVITA operated the Rehab in the Santa Fe Cut 700'west of Old River 7 in or near Contra Costa County and San Joaquin County,California,for the purpose of 8 recre*ional boating. 9 10 19, Plaintiffs are informed and believe, and thereon allege,that at all times mentioned herein, 11 defendants and each of'them,breached them duty in that they so negligently,awned,inspected, 12 supervised,modified,altered, controlled,operated,managed and maintained the boats and 13 premi;ds at issue so as to create an unreasonable risk of harm to plaintiff, Furthermore, 14 defendants,County of Contra Costa,County of San Joaquin and State of California and each of 15 them,failed to warn plaintiff concerning dangerous and defective conditions,acts and omissions 16 coneerning the waterways at issue,which the defendants knew,or in the exercise sof reasonable 17 care should have known, existed and which dangerous and defective conditions,acts and 18 omissions acted so as to create a further unreasonable risk of harm to foreseeable users of the 19 watem ays,including Plaitktif .. Said dangerous and defective conditions,acts,and omissions, 20' included,but are not limited to the following: Defendants,and each of them,failed to maintain, 1 itLstall,and/or monitor signage,waterway markers,and warning signs at the location of the 2 incident for traffic control and other purposes. 23 24 20. On or about June 22,2003,the defendants,FRAGA,DIVI'TA,RICHARD LOUIS 25 WRIGHT and SAMUEL GERAL WRIGHT, SR.and each of them,so carelessly and negligently 26 drove,,opemted,maintained.,entrusted,serviced,and controlled their vehicles described above 27 so as to cause the two vehicles to collide. 28 s COIOLA3 n FUR DAMAGES FOR NEGLIGINCE,NEGLIGENCE PERS&,INTENTIONAL INFLICTION OF EMOTIONAL DISPR K' N ZGLWIWT WLICnON OF EMOnONaAL BISrI IK PUI41M LIABILnYMANGUOUS CONDITION Or PUBLIC PROPERTY,PUND'I`VE DAMAGES ANO FOR PERSONAL INJURY Sap 09 04 09: 44.a p. 7 t 08122/2004 15:58 FAX 4154212839 THE DOLAN LAW FIRM 407 1 21. The collisions referred to inar P agraph l 1 and 12 above were the proximate result of € 2 defemlants` negligence as they failed to exercise due care to avoid a collision. The collision was ! 3 caused by the negligent acts and/or omissions of the defendants,and each of them, including but 4 not liftnited to their failure to slow their vehicles,their traveling at excessive speed, failure to 5 abide by navigational rules and failure to warn of the danger. 6 7 22. The collisions referred to in paragraph 11 and 12 above were the proximate result of the 8 breacAcs of duty of the other defendants and DOES 1 -40,as enumerated above. 9 10 23. As a proximate result of the negligence of all defendants,plaintiff MELISSA KING was 11 injured in her health,strength,and activity, sustaining grievous bodily injuries and shock which 12 have 4aused,and will cause ghat mental and physical pain and suffering,the full mature and 13 exteni of which injuries are not known to Plaintiff at this time who will request leave to attend 14 this 03mplaint to conform to proof at the time of trial, Plaintiff is informed and believes and 15 therein alleges that said injuries are permanent and by reason of the foregoing,Plaintiff has 16 sufferod special and general damages in an amount to be proven at trial. 17 18 24, ,As a further, direct,and proximate result of Defendants'negligence and conduct,Plaintiffs 19 were mquired and did employ physicians to examine,treat,and case for MELISSA KING. 13y 20 reason thereof,plaintiffs have incurred medical expenses in a total amount which is 21 undetermined at this time. Plaintiff MELISSA KING is informed and believes, and thereon 22 alleges;,that by reason of said conduct of Defendants,and each of them,additional medical 23 expen.ses and attendant incidental expense will be incurred by Plaintiffs. The exact nature and 24 extent of said expense is presentlyunknown,and Plaintiffs therefore pray for damages in an 25 amount according to proof. 26 SEMM CATSf► M ACDON 27 (Sy Plalntifft NATA►LIE KING,CIES KING and MELISSA I(ING 28 Ag3kinst Defendants RICHARD LOUIS WRIGHT,SAMUEL GERAL WRIGHT SR., i COMPLAINT POR DAMAGES FOR ritGUGENM NFOUGMCR Pn 61,IN'IXXX IOMAL INn ACPIfNY OF BMEMOIVAL 7iWMES8, NEGLIG",T IAP IAC"ON OF EMOTIONAL DIST rA P'REMISU LIABILrrV/DANG9ROU5 COh' mON oft rVALIC PROtERTY,ruNrrm DAMAGIS AND FOR PMSONAL MJURY Sap 09 04 05a45a P• 8 06/12/2004 15.57 FAX 4154212834 THE DOLAN LAW FIRM �y008 I CAML l?I V f'A and KENlTH FRAiGA fOr NEGLIGtXCV,PJVR 8E} 2 � 3 25. Plaintiffs allege and incorporate by reference all of the allegations set forth in paragraphs 1 4 through 24,inclusive,as though fully set forth herein, 5 6 26. The acts of defOndants FRACIA, DI VITA, RICHARD LOUIS WRIGHT and SAMUEL 7 GE%iL WRIGHT, SR. described in paragraphs 140 were in violation of Section 655(x) of the 8 Harbcts and Navigation.Code,which was in effect at the time of the accident described herein and 4 which provides that no person shall operate any vessel in a reckless or negligent manner so as to 10 ends er the life,limb or property of any person and of Section 281 of the Harbors and Navigation I I Cade,,which requires vessels proceeding in opposite directions to right rudder"so as to pass on the 12 port side of each ether." 13 14 27. Flaintiff MELISSA KING was a member of the class of people intended to be protected•by 15 the provision of Sections 281 and 655(x) of the Harbors and Navigation Code. 16 17 18 28. As a direct and proximate result of the negligence of defendants,and each of them,plaintiff` 19 MELT:SA K1NG was injured in her health,strength,and activity,sustaining grievous bodily injuries 2€1 and slack and injury to her nervous system which have caused„and will cause her great mental and 21 physical al pairs and suf erring,the full nature and extent of which injuries are not known to plaintiff` 22 at this time. Plaintiff is informed and believes and thereon alleges that said injuries are permanent 23 and by reason of the foregoing,plaintiff has suffered special and general damages in an amount to 24 be proiren at trial. 25 26 29. As a further duct, and proximate result of defendants' negligent and conduct,Plaintiff 7 MELIwSA KING has incurred medical expenses in a total amount which is undertermined at this 28 time. P laintiff M ELISA.KING is informed and believes,and thereon alleges,that by reason of said 7 COAOLAINT FOR DAMAGES FOR NECU GENCC NEGLIGENCE PER 91,IMNTIONAL INFLICTION DIE EMOTIONAL DIMER NEGLIGL•NT INFi.iMON OF EMOTIONAL DM2tM PIMMrAs r.IABILIVIDANGWOUS CONDITION or ftBLIC VIROPUTY,nNmn rA KAOE8 AND FOR FSAWMAL INJURY S.ep 09 04 00: 455 08/22/2004 15.57 FAX 4154212830 THE DO"N LAW FIRM 009 t 1 condur-t of defendants,additional medical expenses and attendant iaciden:W expertise will be incunred 2 by Plidntift'MELISSA K1Nfx. The exact nature and extent of said expense is presently unknown, 3 and Plaintiff MELISSA KING therefore prays for damages in an amount according to proof, 4 JHM CAUSE QF AMU 6 (By Plaintiffs NATALIE 1UNiG,CIIA ALES)(IN G and MELISSA KING 7 Against Defendants CAROL DIVITA and'KENNETH FRAGA for IN`TEN'TIONAL 8 INFLICTION OF EMOTIONAL DISTRESS) 9 10 30. Plaintiffs incorporate by reference the allegations contained in paragraphs 1.29 and Exhibits 11 A-C of this Complaint. 12 13 31, Defendant CAROL DIVTrA by her extreme and outrageous conduct, calling plaintiff 14 NATALIE KING and telling her:"[Melissa]is bleeding to death"intended to and did inflict extreme 15 mental distress upon Plaintiffs. 16 17 32. As a direct and proximate result of the actions ofdefendants FRACA and DIVITA,plaintiffs 18 were ir4ured in their health,strength,and activity,sustaining grievous bodily injuries and shock and 19 injury,�o their nervous systems which have caused,and will cause them great mental and physical 20 ,rt pain and suffering,the full nature and extent of which injuries are not known to plaintiff'at this 21 `brae, rlainti are informed and believes and thereon alleges that said injuries are permanent and 22 by reason of the foregoing,plaintiffs have suffered special and general dates in an amount to be 23 proven at trial. 24 25 ;13. As a further direct, and proximate result of defendants' conduct, Plaintiffs have incurred 26 inedia expenses in a total amount which is undetermined at this time. Plaintiffs are informed and 27 believe,,and thc=n allege,that by reason ofsa id conduct of defendants,additional medical expenses 28 turd attendant incidental expense will be incurred by Plaintiffs, The exact nature and extent of said CY?WL ALN T'MR VAMAGO FOR NWLIGME,14WLT iCE PER SE,I1 TEN F ONAL INRLIL`t'iON OF 9NOTMAL DL , jaoLIGgft T 39EEL=10N OF 3EMO IONAL IMRVSIr PUMISES X,IABB,CTY/f}ANG OUS CON=[ON Of rVBLTC rROPERTY,PVNfCIVE DAMAGB6 ANT)FOR PKRSOML INNRY Sep 09 04 09: 46a p. ICI 08/2212004 15:57 FAX 4154212830 THE DOI.AN i AW FIRM q010 1 experft is presently unknown,and Plain#if3&thomfore pray for d"es in an amount according to 2 proof. 3 5 (By Plaintiffs NATALIE KING,CHARLES MG and MELISSA KING 6 Against Defendants COUNTY OF CONTRA,COSTA,COUNTY LINTY OF SAN JOAQUIN, 7 STATE OF CALIFORNIA for PREMISES LIABILITY[DANGEROUS CONDITION OF 8 PUBLIC PROPERTY) ) 9 10 34. Plaintiffs incorporated by reference the allegations contained in paragraphs 1.33 and Exhibits 11 A-C of this Complaint. 12 13 35. On public property premises or adjacent to the premises upon which the INCIDENT occurred 14 was, a known dangerous condition, as more fully set forth above, which was negligently owned, 15 operattd,maintained and managed by Defendants. 16 17 36. The known dangerous condition, as set forth above, created a substantial risk of the type of 18 injury,alleged herein when the property was used with due care and in a manner in which it was 19 reasonably foreseeable that such property would be used, 20 21 37. On or about.Tune 22,2003,defendants,and each of them,their employees and agents,while 22 acting within the scope of their employment,were Negligent and careless in doing or omitting to der 23 the act4 set forth above which negligence created a dangerous condition, Plaintiffs are Wonnaed.and 24 behowand thereon allege that defendants had the authority and funds and ether means immediately 25 available to'take alternative action which Auld not have created the dangerous condition described 26 herein- 27 28 38, 'Defendants, their employees and agents, and each of them, had actual and/or constructive C 0PLAINT FOR DMIA.,U FOR NEGLIGSNCLT,NE+CLIC4 CE PER SE.INTMICIt+AL INP ICTION Of EMOTIONAL D15lTR?A NMUGI NT INFt CTIONt OF)&MOTIONAL#IS'Cgtw PRIMINW LIAWLITY10ANG9ROUS CUNIXTION OF PUBLIC PROPBRTY$PUNITIVE DAMAGES AND FOR PXX$tNAL INJURY Sap o#9 04 09: 46a p. 11 06/Z,2t2004 16:58 PAX 4154212830 THE DOLAN LAW FIRM 19 p11 1 r 1 ° knowled a of the existence Of the � dangerous condition and knew or should have known of its 2 dangt Imus character in that the condition had existed for a sufficient period of time and was of such 3 an ob�✓icrus nature that defendants,in the exercise of due care should have discovered the condition 4 and W dangerous character within a sufftcierzt period of time prior to June 22,2203,to have taken 5 measures to protect against he dangerous condition. f 7 39. Asa proximate result ofthe dangerous condition ofpublic property,and the�tirtg injuries 8 to plabAifd',these plaintiff's have sustained severe emotional distress and meatal suffering, all of 9 whicx, has caused., continues to cause, and will cause them great physical and metal pain and 10 suffon g, all to their damage in an amount to be proven at a trial herein. 11 12 40. As a further proximate result of the dangerous condition, these plaintiffs were reasonably 13 requirod to and did incur medical,and incidental expenses for the examination,treatment and rare 14 oftheir injuries. Plaintiffs are informed and believe,and therefore allege,that they will in the future 15 be reasonably required to incur similar obligations,all in an amount to be proven at trial. 16 17 Wherefore,plaintiff's pray for judgement against defendants,their employees and agents,and 18 each afthe as set forth herein below, 19 20 FIF'I`1ti CAUSE OF ACTION 21 NEGLIGENT INFLICTION OF EMOTIONAL DISTRESS(Dangerous Condition of 22 Public Property) (Defendants Contra Costa County San Joaquin,State of California) 3 24 41. 'Plaintiffs incorporate by reference the allegations contained in paragraphs 1 through 40,and 25 Exhibits A,B,and C of this Complaint. 26 27 42. Due to the dangerous condition and as a proximate result thereof,these plaintiffs sustained 28 severs emotional distress and mental suffering,all of which has caused,continues to cause,and will COSWLAW MR DAMAGES MR NEGLiGILNCE,xXGLIG$NCZ PER se,INTENTIONAL.INFLWrItiON OF ElMaT OVAL Dt,SMSS, NECLIGANT Bl`I IACnON OF EMOTIONAL DX USE NIiE ASES LIAIIIi t•t MANGUOUS C NOTrION Or rMic rN=rwy,PLWITIVE DAMAGES AND FOR PERSONAL INJURY Sep 09 04 09:47a p. 1 08/2-212004 15:58 FAX 4154212830 THE DOLAN LAW FIRM: Q012 ' cause themlPhysical and mental Pain and sufferin g, all to thein`damage in an amc►unt to be 2 proven at trial herein. 3 4 43. Plaintiffs were reasonably required to and did incur medical and incidental expenses for the 5 exarryiaation,treatment and care of their injuries. Plaintiffs are informed and believe,and therefore 5 alleg,g, that they will in the future be reasonably required to incur similar obligations, all in an 7 amowt to be proven at trial, 8 9 44. Plaintiffs lost wage benefits and have thereby suffered damages in an amount to be proven 10 at triat. 11 12 SIXTH CAUSE OF ACTION 13 Tu€ 4tivt Damages y Plaintiffs NATALIE MG,CHARLES Tt NG and MELISSA ING Against Defendants RICHARD LOUIS WRIG�HT,SAMUEL GEPAL WRIGHT SR, 14 and KENNETH FRAGA) IS 45. Plaintiffs incorporate by reference the allegations contained in paragraphs 1 through 44,and 15 Lxhil~its A,B,and C of this Complaint` 17 18 46. At all time herein mentioned, defendant RICHARD LOUIS WRIGHT drove the above- 19 20 deseri d boat in a highly reckless manner with absolute and conscious disregard and callous 21 indif%mnee to the rights and safety of plaintiff`, in that despite the fact that defendant knew that 22 defen4ant RICHARD LOUIS WRIGHT wouldthereafter operate the boat,defendant knowingly and. 23 willfiily caused defendant RICHARD LOUIS WRIGHT to become intoxicated with full knowledge that the intoxication rendered defendant physically unfit to operate a mater vehicle safely and them 24 `lid fitly and proximately cause injury and damage to plaintiffs. 25 26 47. At all time herein mentioned,defendant FRAGA drove the above-described boat in a highly 27 28 recklcas manner with absolute and conscious disregard and callous indifference to the rights and �x COMPLAWi`FMDAMAG0 FOR NEGLIGENCE,NEGUGENCE PER 89,WMNTCONAL INFLfMON OF EMOTIONAL DISMEW 14EfiLtMNfiT INPLiCTION OF Ei►#OMNAL D18TRESS,PREMIM LIARILITYMANGEROUS CONDITION OF PUBLIC PROPERTY,PUNMW DAMAGES AND FOR PERSONAL IMMY Sep 09 04 09: 47a p' 19 0-6/22/2004 15:58 FAX 4154212830 fi$E DOLAN LAW FIRM 9013 1 safety of plaintiff,in that he engaged in speed racing with the boat despite the fact that defendant 2 knew that his actions would cause injury to others.Defendant's actions did directly and proximately 3 cause injury and damage to plaintiffs, 4 5 48. Therefore,plaintiffs are entitled to punitive and exemplary damages in an amount according 6 to proof,subject to the extent and nature of defendants' assets, 7 8 WHEREFORE,Plaintiffs NATALIE KING,CHARLES KING,AND MELISSA YM4G pray 9 I for jl:�igment against the Defendants,and each of them,as follows: 10 1 I I. For general damages in an amount riot yet fully ascertained,but in excess of 12 limited jurisdiction; 13 2, For special damages in an amount according to proof; 14 3. For last wages in an amount according to proof-, 15 4. For costs of suit; 16 5. For pre judgment interest at the legal rate; 17 , 6, For such other and further relief as the court may deem proper. 18 7. For punitive or exemplary damages in an amount sufficient to make an 19 . example of Defendatrt and each of them; 21 , bated: Jure 22,2004 THE DOLAN LAW FIRM 22 23 BY: 24 A RAHMAN for Plaintiffs 25 E NATA2IE KING,CHARLES KENT 1, ' 4 26 and MELISSA.KING 27 28 E 12 CM.iIr1i L AINT You D AM&G MR NFOLIORNCS,Nr3GLIGLNCt PSR S&IIVT 8.�2TIf3NAL INSLI CI IClN OF EMf}f IONAL D15TICE5S, .NXGLIGINT INrLIC ON OF EMOTIONAL D18'rRi SS,PUMIXES LIAR1CI.t't YMANG64 OUS CONDITION OF PC BUC PROPERTY,KNIT DAMAGES AND MR PERSONAL IN.113 V p. 14 Sap flS 04 09: 47.a 06/2.212004 1.5:68 FAI 4154212830 THE DOLAN LAW FIRM 0014 i I E i s { f ]EXHIBIT A i i s i Rep 08 04 08: 48a x. 15 06/*22/2004 15:59 FAX 4154212830 THE DOLAN LAW FIRik i;�ozb �-- ,3 of C"Ifforinlia Submit oompteted Balm form and three oopiel Board of Control STATE 130ARD of CONTROL GOVERNMENT CLAIM GOVERNMENT CLAIMS BRANCH P.O.Box 3036 SSOC-00 02(Row 6 0)Revern ��r�� � StcraMnttrr,CA 955912 5� Section 3: Insurance Information (must be rpoleledlaim involves a motor vehicle) Has the claim for t,e afleged damageytnjury been died Pdicy Number i Telephone number{indudeareae or will rt be filed wit-i your insurance carrier? t t y I t j No i Mailing Address state dip Code 1 Name of in,,wrance:camer Amount of Deductible - - i Are you the regiatw+ed owner? 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E �z,��iytF\.,�� *�A y .tr,i: `':4,. :' '• :..• • � :1 tt.i '�'•rn.• � �. ..•r• R� tiY r i! s f,�t�t; A��t '+�"A� i° 44;k`;?df"�i �y, r !rte �. :-� 1 itsy� y h n 1 •ii' t t' !� i +7 � 9 + r r 1i•-��a �t k 4r S 1 J F`5 r 'i Ss ry 4 3a i m y�. t r ar <�' � •��, ty 1 }� } A -5 �o �r>� � i tray r r {o?" !'.3i..(4L t a ''..ltilrt r� 3rt":°.1tiA.'taa' `T_.. yai� ! �..�y:i§ ,• �k*" �,'[ t1 �` +t' t t 7 t,.+ �,1°aT�q� 4w • ;,•: n• �nT a' Ff."� C S '�iy� �� a 4 5r Ti,•t 4 r'�. -�{Ll�lgc�k�3�t �r�"r#4 �'� li`6k 1 h�+ir t.';t"1,'+r',;;.'-L i r d:y >r•. 1 { a n. {eF tr t3�r- "5u ..yy++Y-lt j .,r X rs , •s, ti x:..�1• ,.:1 + �'i Y ! h1§ rF° 'sig:�;�'Y -a 1•h 1 i � «Y,r .1' '"�'\:,R�.l.; 4 f•}'c 15S ,�{,.4 In r '� u�r aiRi l,C 1.. �•'�•:...tjia+r., r.rr,. :+jt�w°:tI.��G iN,+.�'�;,,.�` ,y ,.t•' J.�•';•. ..5w♦ nl, :.'�.' , ''1; �.Et•'• .�:yi '�y1• .1Y, i:r.'�� .5 'k..�. ".te.• is,' "ti. ... . r �• Y�.. 4: r , .} ••alt~ ,•.._'t'. .t.i ., '3" ...4t�[.''Dt't`,•_ ..t.FF�.C• i;• ..�'Ss:S'rt•t `1 !y ,t} ��:' :.yYi. ...i1'n X..1�J�"i:�,°:1:•:.,`.r25L's•1•t'�:21. ..r1 � .. ...- y 1 Section B: Ropresentotive Wbrmation (must be tumpieted if ctelin Is ging filed by an attorney or aut�oozed repreasntad N ofA:[ meylf pre 'r4WhomNu'rbwkdL c6awc ode} Jeremy Pasternak/ The Dolan Law Firm (415) 421-28001 _ . 21P 333 Fine 5t.t , 4th Floor San Francisco CA ! 94104 Section B: Notice and Signature Section 72 of t le Penal°soda provides that"every person who,With intent to defraud,presents for allowance or for payment to any State Board or Office.,or to any county,town,lily,dish;ward,or village,board or officer:au sd to allow or pay the sar7e if genuine,any false or fraudulent claim,691,account,voucher,or w guilty of a felony,, agnature c f Clai � „j.• Data s re c{, yJPieprrr 6 �i Vito A 9k Aw at * . r y 40 y to kit 1 °. � 1• `j � �-� .',; ��,!mss t i :t t 1 Sip 09 04 09: 49a p. 17 06122/2004 16:00 FAX 415421283D THE DOLAN LAW FIRM 2017 a of 0111foollafteW �6gSiy ram"11t8ttuCtfotta for Filing Mm" 01' #ycusmewmb�y�d�bc�fn�terk�a�tc�e, Sao=-0002"V.as) Q Section tc tlalffiant lntor flon. N&"CfC*rQrd Melissa King (minor) , Charles Icing (father) ; TGWPhaneNurnber &t Nathalie King (mother) , as individuals and Charles King for (92j 634-7251 t►1 IngAcdress einor chug ter . Cfty 9 21PODdS 745 Camino Diablo, Byron. CA 94614 iat31 E3h #fi ##t����iT1 ffVi�. - Is the dakn flied cin bshal of a nl norMVes C1 No if yes,ply indicate:Rsllatonship to the rte a t h e rO8te of bkth of the rn�r 12 fie Of C.�te Apanq against which this cialrn Is Red lrtddent Dats D0krA=Lntof Cly Department of Boating & Waterways, Month 6 Day 22 Yr. 03 over $50,000.00 mmint $10,066,;n i to type of dvll arse: E49aln howt odollaretiruntclaInvd was cx nputed. U Umli ad C&A Case IQ Plan-Umited Civil Can 0 fidsui ftdc=mWtdmf0rthe 4"C1WtcW 8dW 'fttM.)Medical expenses Ctascrbe the s#:e0c damage C+r lrjury lt=rmf as a result of travel—expenses, pa n su er ng the inckl 4rYt - Includee but. not limited to puncture to left leg, fractured cheek bone, orbitalto tax7t�fti�rtt(if8llirE" ,Ittdet t s�arscrr=xty h l mvikw pWrrism rrbrardd d'tv _fac .a1 d . These to mknor. EMotional distress, - - .At or near Santa Fe (Faye) cut of No as �c€ dI s�, rave expenses, oOld i ver . Per investigator, , epi - 4 - - 14 yeti tial trnrsc a Second k!pc,t.. 1. lbauk of Sante Fe (Faye) Isl, ---- -. _ Cl�rttsr�a �i.x�s OGtamnd QSanDkW Explaintheclmunwtancw ti t led to the alleged darraga or Injury:Sude all%cIstvisuppodywdaim asst the State of Callfomia whytyou betl sve th*Stats is moble for the alleged dswrtage,or lNury.It icnm ,provide ft name(s)of the ate empioy*s)wh, abga*ausWth*Wry,dwne orr kw.(U ni is►tri#,o aftchar ldor d*wft.) There was Ao signagelI no waterway markers. , warnings, or other steps taken vt governmenentities `moo preyen or w c ere de`gign4d ev ' ttrt a-ae� cfespit the .. -isrt re -eend �ea -- n - aaadtony—� ccidng� t andnear this location and of this type. As a. result, there was a coll.ission between two boats. Melissa Ring was in oftheboa..s. 'That boii collides wit t e an 1�e7�s�a��ins-c�as t�iriiwri aii Sep 09 04 09: 50a P. 113 06/2212004 16:01 FAX 4154212830 THE DOLAN LAW FIRM X018 A`r`Ctt,I,L'F:1"t1R :tii'Cl`11Tf}j(Yl'TA'I'tt)ItSf'I'{\;11tt ,l�ilAlSltltltiSt 3't 1Rt'ilt'RTC'Riit},yt,{' 'T'hc Dolali.;i..:tw Firm 1Ea Pine ,street,41h Moor 415 421-2800 Francisco, CA. 9'41014 Itt'IPRIINL NUMBER" l�a.r.smrrrftvwr•jtwfxlvlslihrri.Knrhran:f,¢ntx'L!I`dty.uMlPrrurNSktaciatnutrrWn;ax �Sta:e of California Board of�.'.ontrol SHtttt rNAZN1(tl CANE., �+ +�,;C OF'OL' FILING DATE: 1. At tide time of filing I was at least 18 years of age and not a party to this action,and I filed copies of tint following documents: Government Claim 2. A. place where papers were filed:State of Caiifornla Board of Control B. Person who accepted papers:Melissa Turbin,Clerk Address: 630 K Street Sacramento,CA.45814 3. I filed the papers named in item 2 A. By personally filing (1)On: 12/23/03 (2) At: 10.45 am 4. The Notice to the papers filed were completed as follows: EmIgrices p Regis.cmd: Sacramento i dedwv under penalty o ptr;ury tiuit the kncgning is twc and Lonvct 1 uml er: 00-24 that thk ikdatation waF mcutod On: 12/22/03. At:Sacranientcl, ilcirnia .- ter Capitol Couriers,INC:. Signature: X e,- 30M T Street,Suite 200 Name: Michael - or s $acramento,CA 45816 Title: Process Servcr 11hone:(916)451-3617 PROOF OF SERVICE SLp 09 04 O9: 5Oa 06/22/2004 18.01 FAX 41.54212830 THE DOLAN LAW FIRM 0419 a } 4 f E i 4 P. 20 Sep flS 04 09:50a 06/2212004 16:01 FAX 4154212830 THE DOLAN LAW FIRM la 020 . Ya►a torte t aea� �ts� C aunty of San Joaquin Cixtti.N FOR DAMAGE Ok INIU.RX propoto ie h*rx typewriterfte original amt one cVY with Ctaek Of the Elland of Su€,orvisom, J gain Cotatty,=I3.W Web*,Avenue,Raoin"'-Stixict c,Caiifotititt 452#32, Use sci i- tirr:talpay�cr tut sry. Mr. Charles ming Mather) ; Mrs. Kst a.lie King ( pother) Ms. Melissa King (minor-daughter) Nsrite ot�Gtztm,eitt individual claimai.nts and Charles King for Melissa H the A$4resitftj*ho0e; 749 Camino Diablo. Byron, 094514 925 - 634-725 ttzn,a+ Bead CwTetsponitencae To. Jeremy Pasternak, 333 '_Pine t. , nFiRRcisctr 4�S-�ZI-28t1� we,wcrtr«�.,rt`+►s 1 f34�» When did NurY or Vainap Occur n a 22, 2 003 94 M r o x. 7:20 ,m. W14ERE DID INJIJJKY OR DAMA(;H XCUR, at or near Santa Fe Cut of North .f3Ld iwer aken br San Joaquin County Sheri indicate initial impact at _� e ' 56 minutes 543 seconds north, .an 121 degrees, 33 mine es, 972 seconds w «at . A rox. 700 feet west of Old River on Santa FeCut.' HOW.DIf) INJURY OR DAMAOE OCCUR: Impact at staut Frn itirc or Santa Fe (Pays) _T'w pjwabcats collided. The one in which Kelfssa ling was a passenger hit t bank a£ Seintt} 'e (Paye Is . . Melissa King was t Town out, pn susta ne t _..1haro vjIgL no sig-nage, and no waterway markers, warnings, or any other steps taketi by the County that would have preven espite t e existentoe« of con itioF; an37or chanwea changeco and a history of asci ent at ar.d near this Location. and of this tyke. ideadty of Cotlay VtWCW.. tit appticatbie) None/U n k n o wr n Ntrnets3 tat C�►ttate B ployeeds)ittvcti ve�iT Unknown ® ,� WHAT INJURMSS OR DAMA08 VII +CLAIMANT'SUFFIS ; physical injuries to Melissa King, pain grid sisffering , ,emotional distress, mt* ea Physic a iniur et$ In but ac:t limited to puncture to Ieft ).eg, rarctttre c de , or to I Tract i.n ur t!o._"'7e, -permanent scarring, facial and hes aceret ort Par hay.A__jnrjjrted to dical bills , time off work, ,emotional distress. MOUNT OF DAMAGE OR LCM: t0knpXnat t itge fog t al 1 - GA" r>t t„1440 u„4 ruga rtv}e Total Gait* s of jurisdictional limit of Superior Court, over $50,000 ,tare under pemwity of polury that the forgoing is true and correct. --- �iy P'�sterttalt, Esq. Attorney for All Claimants t2i�`g/�'l ewa """'' NOT& PREST�.NTAT ION 4F A PAI.,SR CI ATM 13 A FF,1,0W - p. 21 S_-p Lig 04 09:51a 00122/2004 18:02 FU 4154212830 TEM DOLAN LAW FIRM 2021 ! tV ! �I .^ ..' J"'d tr � { {t• •f.� Ytr t w i K rf1 � Y t i+ t!^j• � { !i{i� �. [ 1 �> ,1�, �all a f i Sep 09 04 09: 51a p. 22 0612212004 16:02 FAX 4154212830 THE DOLAN LAW FIRM &1022 F d: x ExFMSS 1 Tracking I Results M-tail Pagel of l T•acts SMpments SHO Clatailod Results 'rr*c*lnt ntxnber 843157*WWS fiol"Mid to Maftorn Iftned 4*r by T,l3LAINe Dolivory location STOCKTON CA Ship dols Dec 18,2003 sawfoo typo Priority Envelope Deltvory'datalTIme Exec 19,200311,30 am Datefro o Status Lacation Comments 1300 14,:1003 11-.30 ern Doff Brod STOMON CA 5:10 am On FodFx vshkft for delivery STOCKTON CA 7:01 arts Arrived at FadEx Destination i. tion STOCKTON CA Sac 10,1003 40:48 pm Arrived st Sart Fadiity OAKLAND GA 6:56 pm Left FedEx Origin Location SAN FRAWSCO CA 5,33 pm Pklcetl up by FedEx SAN FRANCISCO CA r MMU y0ar detailed trVC dng results(cp0 s4 her yew smelt,submit up to three small address (separated by commas),add your m (optional},and click Send small. Add a Mon !to this.small. 4 i i { f fi { i t r htp.//wwN*w,fedex.com/ushmeking/?Itrk--6&p ja&action—track&ftc_3=null&templatc_t-,. 1211932003 Sep 09 04 09: 51a p. 23 06/22/2004 16:02 FAX 4154212830 THE DOLAN LAW FIRM 023 i i i ! JL:rhL"l Brt C E !t E ti i p. 24 S p €3q 04 C)9-51a 0612212004 18:02 PAX 4154212330 TUE DOLAN LAW FIRM _..� y�4024 l�� Utdo to BOARD 7 S#PERVI S OF tON'I'1tA =rA CMWY T TO A. clal s relating to causes of actio for death or for injury to person or to per- sona;l property or gaming crops and which acorn on or bercre December 31, 1987, wjzt, be presented riot later than the 100th day after the accxual of the 04=4 Or aotion. Claims ralatitig to oau of actic)6 for4ea'th or fw iA�a7 to person or to peaarAL property or gvwiAg moops and iddah aaar m on or after . ry 1: 1988, mit be presented not later the six m mths thAr the aearual of the cause of *otlon. ' aal= relating to any other cause of actio mut be presented not l.at tr thn one year aftAr thqk,aperid gr the cue of 92t:ion. (Govt. COft 5911.2.) B. Clafza asst to ruAd with the mark of the Board of . temism at its +ct ricte in Rcto10A 146, County Adm.inistmtion WU : 651 Pias Street r AlrtineZ, 9� • C. if claim Is against a district governed by the Board of Supervisors, rather thaA the County, the name of the Di4tz iat, should be filled in. D. if the claim is ags4nst more than one public entity, separate claims taunt be ril*d against each public entity. Pragd. Sae pe ity for fraudulent claims Paml.Code: See. 72 at the and of this e 1eiF �Eeltit # FM leeeee * eeeeiEeel eeeeli �E * ee * ! # fe RE C2,.3im 9y ) Reserved flor McWs filing stam Malissa rias, a minor, Charles � (masher) , all individual claimants or Wa.t r Reclamation t' ta~ 0t) ) s wdwsiped 4Udnant inert.ekes c unt a4inst the Casty of Contra: Costa or tlac above-namd District 14 the a of o v e r $5O 1000-0 0__ and its SVPort of this 63 s I repre =tu•as follows 1. Vhw did the 6/22//03, approx'." .�m, _.. ... „ , 2.2 Vhero did the damse er• inJury °? (Maude city and cc=ty) at or near Santa Fe (Faye)cut of North Old River; CPS reedinings per She � f i v st a or re 3�7- -643 north and 121-31- 971 west and thea, at ran o an a ( aYe1 la�ana .. .......�.. 3.3 trot 4id the &=P car inJWY =W? Wi.vea full details; We extra tom' if regUired) Two boats collided in the water-way. THe brut in which Melt { K..ng w-as travelling hit the bank. Melissa* King was thrown from the boat stistai-ning injuries. 4. 'fit Partimlsr acct or €mi:sstion oa the part of Goursty or district offieelns w sam is oremloyea rased.the inJur*Y or ? i TIIe a was sa sLgnspe,,. t3o water way 'mar`ker�s', ,t�ar�i`�8s+ or other steps t to prevent or designed to prevent this accident despite the existence of conditions rind/or changed conditions aad a history of accidence at - and near t£7is location rind of '-this type _ _ _ _ _. ._.. 5 p 09 04 09: 52a p. 25 08/22/2004 16:03 FAX 4154212830 . THE I30LAN LAW FIflsi -- Z025 D. Wnat area the s of county or district off'icer's, sermts or eMrloyees causing the doge or Injury? Ukkown. mat a ar in juries do you Claim MwIted? give full, extent of irr,blies or . tl1 AM& Attach two estimates tar auto damage. I n c l�d i.n g but not l i m i,t to puncture left leg, fractured cheek bone, orbital fracture, injury toey permanent scars, face and head lacerations, &urger to Melissa King. Medic 777 lkk wb U0fa1Q atr ocra, e e es emc►unt of any pr'Wpeaativs inJur '" Or dame*) AMounts unknown. Include emotional distres5 pa:Cn ar,d suffering, medical care, including helicopter evac;, hdspi.tal,/dc bills, surgery bills, travel expenses, last wages. Same& and addresses of Witness , dootors stat hospitA;. Dr. axtie Bishop, 744 52nd $treat, t 414#1, ?alllgl.�JJ4�18-147-1500 Dr. S aphen Trine He same area ,45t f t ; ltl-� 8� kris a.d k:747 5 rk St . , OaklanA , OA 94 9; 4 g hilren H6spital, 4e It 9. U.114 the wqmdi,turma you m de on Mount of this swidesnt or Injury& DATE I*m AM= Expenditure amounts unknown; please see above i Qui. Code 5aa:`910:2 pr 44"t #The Waim ash be Biped by ft OUI=t = N T01 CAttor�cr orai W ort hio sae sPd Addow or Att=wy ,enemy Psste,rn�k, . i The Dolan Lary Firm remy esternalc, rfar al.l claimants ! 333 Piine. St. , 4th Floor Scan Francisca, CA• 94104 i ...rr..............e-w w. .. o .�.—,.�-.r r..----... .�c...r.r.r.+wr.... �........ -.,® . y - .4 a .. r.. ..+ .. . ...r r .n . ...-.... . i Tslepl"d+` a No. - 415-421-28.00 Telephone No. ■ # N0TICg " Seotiot 72 of the 1'wAl Code pmvidass wtvary iWson wbo, With intent to defraud, pmts far allowance or for pmt to any stats board or officer, or to any wmty, ofty or district -board or officw, authwited to shoat or pay the =me if.Vmdm, any f"alm or framialecnt Claim,, bill, a000unt, Vouc r", W write, iB pculi bl'4 aithW by iAPri30r;zWt in t:he ocunty jail• ar a period of n t mom UM Me•year, by a urns of not (me tbouC$1:�?t or m3oha ' t and finer r by impri ntin � t2w sta.to pri", by to fire of riot emaeediq tan Umsand .dollars (410#000# or by I)oth sn3nh impr bormmt and tine. 1 TOTAL P.02 p. ��; ��� y�o2s sbp C33 04 THE T1OUN LAW FTRM 06/22/2004 18:43 FAX 4154212630 fit � N � 41 � ,7) ._ iN .. } iT U.1 Ul LM ru .'j, :y/'t `45 �tt� L � �... �1,,i f �'•� 'y } li"� � Mr`+` Mb cl iii' ♦ � S t }w}� , 1 < i ru Ul i U sf IQ i t t r f i i C { Sep 08 04 09: 52a p. 27 06/22/2004 16:04 M 4164212830 TRE DOLAN LAW FIRM Q027 Fod Ex Emm I Tracking j ResWts Detail Page I of 1 Track Shipments (D Qwzhft De died Results Trw1dnq number 643157OW624 Delivered to R pt/Fmt desk Signed for by E,SHARP Devvery location MARTINEZ CA Ship d81te Cleo 18,2OD3 Urvice type First Overnight 0etiverr dat l'lme Doc 19,2003 7:05 am Envelope DatWT Status Leers_ Ca+mrraer Doc 18,=3 7:05 arts Delivered MAR 71NLIZ CA 8:36 am On FedEx vehk;tW for delivery PACHECO CA 8:22 am Arrived at FedEx D odristicn Location PACHECO CA 4:27 am Last FedEx Boat Faclitty CA4KLAND GA 4:02 am Left FedEx SW Facility OAKLAND CA Doc 18,2003 10:46 pan Arrived tat Sort Fucilty OAKLAND CA 0:56 Pm Left FedPjt 060 Location SAM FRANCISCO CA ( 5:33 pan Picked cap by FedEx SAN FRANCISCO CA NM&M-90 li if 4&M 14 M Erned yu r delalied tracking results(Wdm* Ender your sem,subn*up to threes arna6 add (separated by commas),add your ars (optional,and dick Swtd small. Add a meassae to tib ill. ._ ..,..,....1 4 ( From F I To 4 {t i i �3} { S ht'.p://wvw.fedcx.corn/us/tracking/7tink=6&pv ja&action�--track&ftc_3=null&template t,.. 12/19/2003 5rap 09 04 09: 59a p. 28 T€-f DOLAN LAW FIRM � r � Satrfuel Geral Wrigllt Sr, Attu: RAML4N,SHAANA A, 78 First Street San Francisca,CA 94105 L L Su erior Court of California, Conak of Alameda King No.&G 4162125 PIsEn#If1'Jit'etttloner(s) vs. NOTICE OF CASE MANAGEMENT CONFERENCE AND ORDER ht Unlimited Jurisdiction DefoadantlRespondent(s) (Abbreviated Title T4 ALL PARTIES AND TO THEIR ATTORNEYS OF RECORD, Notice is given that a Case Management Conference has been scheduled as follows: ate: 10122/2004 Department: 303 ommissiorter:�tui�ss�h fiche: 01x30 PM Location: George Lr,McDonald Hatt of Jus#ice `lerk: Melinda Guerrero Second Floor Jerk teleplhone: (510)268.4242 2233 Shoreline Drive,Alameda CA 94501 -ttrail: epf.303 u l eda.courts.ca.gov Internet: hftp://www.co,alaModa.ca.ustcourts/ ORDERS I. You must: a. Serve all:sailed defendants and file_proofs of service on those defendants with the court within 6o days of the Ming of the complaint(CRC 201.7); b, Give notice of this conference to any party not included in this notice and file proof of service; C. Meet and confer,in person or by telephone,to consider each of the issues identified in CRC 212(e) no later than 30 calendar dayys before the date set for the Case Management Conference; d, pile and serve a completed Case Management Coufb=oe statement(use of Judicial Council Form Clot 110 ism ndator at least 15 stays before the Case Management Conference(CRC 212(c}) : 2. If you do not fallow the orders abova, are hereby ordered to show cause why you should not be sanctioned under CRC 227: The hearing on the Oar to Show Cause re:Sanctions will be at the same time as the Case ManWrnent Confererfcce. Sanctions may include monetary sanctions and any other sanction permitted by law, { includepleadings or dismissing the action. 1 You are further ordered to appear inn*(or through your attorney of record)at the.Case Management Conference noticed above.You must a thoroughly familiar with the;case and fully authorized to proceed 4, The Case Management judge will issue orders at the conclusion of the conference that should include: a. Referring to AIR and setting an ADR completion date b, Dismissing or severing claims or parties c. Setting,a trial date, 5. The Case Management judge may be the trial judge in this cam. *T�honic appearances at Case Management Conferences may be available by contacting it CONFER N CALL SERVICES,are independent vendor,at least 3 business days prior to the scheduled conference. Parties may make arrangements by calling 1(888)527.7327,or farting a service request to 1(900) 833-5133. This service is subject to c by the vendor. CLERK'S CERTIFICATE OF MAILING I w fy that the€oltowir+.g is true and omvm I am the obis afthe above-named Doom atul avt a patty to this cause, 1 roved this Notice aMuring by plaD4 copies in earvaiopes eddresaed as shown hwoon and thou by soalins na4pladn them for oondxiotr,slar*ng or metering with prepaid postop, arra matting on tha daft stated below,ir.the TJ wl smas mail at Alameda County,Caiiiomia,following standard ort pracdm. Executed on 08/17/2004, By Dep*Clerk 08 04 09: 53a P. 29 ALTERNATIVE DISPUTE RESOLUTION INFORMATION PACKAGE Effe4etiVe JUIV 2.200 Instructions to Plaintiff/Cross-Complainant :1n all general civil cases filed in the trial courts after June 30, 2001, the plaintiff is rt is required to serve a copy of this ADR information package on each defendant. California Rules of Court, Rule 201.9 (Excerpt} (a) Each court must make available to the plaintiff, at the time of filing of the complaint, an Alternative Dispute Resolution (ADR) information package that includes, at a minimum, all of the following: (1) General information about the potential advantages and disadvantages of ADR and descriptions of the principal ADR processes . . . (2)Information about the ADR.programs available in that court . . . (3) In counties that are participating in the Dispute Resolution Programs Act (DRPA), information about the availability of local dispute resolution programs funded under the DRPA . . . (4) An ADR stipulation form that parties may use to stipulate to the use of an ADR process, (b) Court may make package available on Web site (0 The plaintiff must serve a copy of the ADR information-RKkag ,a ,r each defendant along with the complaint. Cross-co Mlainants -must serve a copy of the ADR information package on any new parties to the action along-with the cross-gomp jaint. Rev 2 D102 Palo 1 of 7 P. [7 cjap cS 04 09:54e GENERAL INFORMATION ABOUT ADR. Introduction to Alternative Dispute Resolution Did you know that most civil-lawsults settle without a trial?And did you know that there are a number of ways to resolve civil disputes without having to sue somebody?These alternatives to a lawsuit are known as alternative dispute resolution (also called ADR).The most common forms of ACR are mediation,arbitration,and neutral evatuation.There are a number of other minds of ADR as well. In ADR,trained, impartial persons decide disputes or help parties decide disputes themselves.These persons are called neutrals. In Mediation,for example,the neutral is the mediator. Neutrals normally are chosen by the disputing parties or by the court,Neutrais can help parties resolve disputes without having to go to court. ADR is not now.ADR is available in many communities through court-connected and community dispute resolution programs and private neutrals., Advantages of Alternative Dispute Resolution ADR can have a number of advantages over a lawsuit: • AIR can be speedier.A dispute often can be resolved In a matter of months,even weeks,through ADR,while a lawsuit can take years. • ADR can save money.Court costs,attorney fees,and expert witness fees can be saved. • AUR can permit more participation.With ADR,the parties may have more chances to tell their side of the story then in court and may have more control over the outcome. • ADR can be flexible.The parties can choose the ACR process that is best for them. • AUR can be cooperative. in mediation,for example,the parties having a dispute may work together with the neutral to resolve the dispute and agree to a remedy that makes sense to them, rather than work against each other. • ADR can reduce stress.There are fewer,if any,court appearances.And because ADR can be speedier, cheaper,and can create an atmosphere in which the parties are normally cooperative,ADR is easier on the nerves.The parties don't have a lawsuit hanging over their heads.For all the above reasons, many people have reported a high degree of satisfaction with AIR. Because of these advantages, many parties choose ADR to resolve a dispute instead of filing a lawsuit.Even when a lawsuit has been filed,ADR can be used before the parties'positions harden and the lawsuit becomes costly.ADR has been used to resolve disputes even after a trial,when the result is appealed. Disadvantages of Alternative Dispute Resolution ADR May not be suitable for every dispute. if ADR is binding,the parties normally give up most court protections,including a decision by a Judge or jury under formal rules of evidence and procedure and review for legal error by an appellate court. There generally is less opportunity to find out about the other side's case with ADR than with litigation.ADR may not be effective if it takes place before the parties have sufficient information to resolve the dispute. The neutral may charge a fee for his or her services. if a dispute Is not resolved through ADR,the parties may have to put time and money into both AOR.and a lawsuit. Lawsuits must be brought within specified periods of time,known as statutes of limitations.Parties roust be careful not to let a statute of limitations run out while a dispute is in an ADR process. Rcv z41G2 Page 2 of 7 Seep 09 04 03a54a p. 31 Three Common Types of Alternative Dispute Resolution This section describes the forms of ADR most often found In the California stats courts and discusses when each may be right for a dispute. Mediation In mediation, a neutral(the mediator)assists the parties In reaching a Mutually acceptable resolution of their dispute. Unlike lawsuits or some other types of ADR,the mediator does not decide how the dispute is to be resolved;the parties do. Mediation is a cooperative process in which the parties work together toward a resolution that tries to meet everyone's interests,Instead of working against each other where at least one party loses.Mediation normally leads to better relations between the parties and to resolutions that hold up. For example, mediation has been very successful in family disputes, particularly with child custody and vis€tation. Mediation is particularly effective when the parties have a continuing relationship,like neighbors or business people. Mediation also is very effective where personal feelings are getting in the way of a resolution,This is because mediation normally gives the parties a chance to let out their feelings and find out how they each-see things. Mediation may not be a good Idea when one party is unwilling to discuss a resolution or when one party has been a victim of the other or has unequal bargaining power In the mediation. However, mediation can be successful for victims seeking restitution from offenders.A mediator can meet with the parties separately when there has been violence between them. Arbitration In arbitration,a neutral(the arbitrator)reviews evidence,hears arguments,and makes a decision(award)to resolve the dispute.Arbitration normally is more informal and much speedier and less expensive than a lawsuit.Often a case that may take a week to try in court can be heard by an arbitrator in a matter of hours,because evidence can be submitted by documents(like medical reports and bills and business records)rather than by testimony. There are two kinds of arbitration in Cailfornla: (1)Private arbitration,by agreement of the parties Involved in the dispute, takes place outside of the courts and Is normally binding. In most cases"binding"means that the arbitrator's decision (award)is final and there will not be a trial or an appeal of that decision. (2)"Judicial arbitration"takes place within the court process and is not binding unless the parties agree at the outset to be bound.A party to this kind of arbitration who dues not lime a judicial arbitration award may file a request for trial with the court within a specified time, However,if that party does not do better in the trial than in arbitration, he or she may have to pay a penalty. Arbitration is best for cases where the parties want a decision without the expense of a trial.Arbitration may be better than mediation when the parties have no relationship except for the dispute. Arbitration may not be a good Idea when the parties want to decide on the outcome of their dispute themselves. (Ventral Evaluation In evaluation,a neutral (the evaluator)gives an opinion on the strengths and weaknesses of each party"s evidence and arguments and makes an evaluation of the case. Each party gets a chance to present his or her side and hear the other side,This may lead to a settlement or at least help the parties prepare to resolve the dispute later on. If the neutral evaluation does not resolve the dispute,the parties may go to court or try another form of ADR. Neutral evaluation,like mediation, can come early in the dispute and save time and money. Neutral evaluation is most effective when a party has an unrealistic view of the dispute,when the only real issue is what the case is worth,or when there are technical or scientific questions to be worked out. Neutral evaluation may not be a good idea when It is tyro soon to tell what the case is worth or If the dispute is about something besides money,like a neighbor playing loud music late at night. Rev 10102 Page 3 of 7 p. 32 p 09 04 09: 55a Other Types of Alternative Dispute Resolution Where are several ether types of ADR besides mediation, arbitration,and neutral evaluation.Some of these are conciliation,settlement conferences,fact-finding,mini trials,and summary Jury trials. Sometimes parties will try a combination of AIR methods.The Important thing Is to try to fetid the type or types of AOR that are most likely to resolve your dispute, The selection of a neutral is an important decision.There is no legal requirement that the neutral be licensed or hold any particular certificate. However,some programs have established qualification requirements for neutrals,You may wish to inquire about the qualifications of any neutral you are considering. Agreements reached through ADR normally are put In writing by the neutral and, If the parties wish,may become binding contracts that can be enforced by a judge. You may wish to seek the advice of an attorney about your legal rights and other matters relating to the dispute. Help Finding an Alternative Dispute resolution Program (Mediation) in Your Community To locate a dispute resolution program or private neutral in your community: • Visit the California Department of Consumer Affairs'Web site.The Department of Consumer Affairs(also called the DCA)has posted a list of conflict resolution programs throughout the state.The list can be found at http://www.doe.ca.gov/r_r/mediabl,htm You can also call the Department of Consumer Affairs,Consumer Information Center,at 800-952-5210. • Contact your county's small claims court legal advisor.You can find a list of small claims legal advisors for most counties in the Small Claims Court section of this Self-Help Center. • Contact your local bar association.You can find a list of local bar associations in California on the State Bar Web site at http:Jlwww,calbar.org/21in/2bar..htm. If you cannot find a bar association for your area on the State Bar Web site, check the yellow pages of your telephone book under"Associations." • Look In the yellow pages of your telephone book under"Arbitrators"or"Mediators." • Automotive repair,Smog Chuck:The California Bureau of Automotive Repair(also known as BAIL)offers a free mediation service for consumers who are dissatisfied with an auto repair or a smog check,or who dispute an invoice for such services.BAR registers and regulates California automotive repair facilities and licenses smog, lamp,and brake inspection stations,Learn more at hftp:flsmogoheck.ca.govismogwebigeninfo/otherinfo/ msdiation.htm or call 800-952-5210. • Burglar Alarm Companies,Cemetery/Funeral,Electronic and Appliance Repair,Firearms/Baton Training Facilities/Instructors,Horne Fumishings and Thermal insulation,Locksmith Companies,Private investigators,Private Patrol Operators,Repossession Agencies,Security Guards;The California Department of Consumer Affairs offers a complaint mediation program for all consumer complaints fled against Callfnmia businesses regulated In the areas of:cemetery and funeral,electronic and appliance repair,home furnishings and thermal insulation,and security and investigative services.Lwin more at http:ffwww,complsinthelp.dca,ca.gov or call 800-952-5210. • Attorney Fees:The State Bar of California administers a mandatory fee arbitration prograrn to resolve attorney fee disputes between lawyers and their clients.The program is an informal, low-cost forum and is mandatory for a lawyer if a client requests It.Mediation of attorney fees disputes may also be available in some areas of California. Learn more at l,,ttp:tfwww.calbar.org/2bar/3arbi3arbndx.htm or call 415-538-2020. Pzv 10i02 Page 4 o£7 Sep 09 04 09: 55n p. 33 DISPUTE RESOLUTION PROGRAMS IN ALAMEDA COUNTY Alameda County Bar Association,AUR Placement Service 364 22'J Street Shite 800,Oakland,CA 94612 Phone:8934 Provides civil dispute resolution alternatives countywide, offering disputants the opportunity to select at, alternative dispute resolution (ADR) provider from a poral of experienced professionals. Program recruits, trains, and evaluates qualified ADR providers, places civil cases with ADR providers for resolution and settlement, and educates local citizens,consumer groups,businesses,schools,lawyers,and judges on the benefits of ADR. Mediation Resolution Services 22.227 Redwood Road,Castro Valley,CA 94546 hvnv.733-494 Provides mediation for neighbor-to-neighbor disputes in Central and South County,receiving and responding to referrals from the courts, schools, organizations and public protection providers to help resolve disputes between neighbors, students,tenants and landlords,merchants and consumers,and employees and employers. Berkeley Dispute Resolution Service 1769 Alcatraz Avenue,Berkeley,CA 94703 Phone:428-181 11 Services the Berkeley-Albany area. Provides mediation between neighbors, roommates, family members, business partners,etc. Mediates construction permit disputes referred from administrative hearings and works collaboratively with law enforcement,schools and the judicial system, Conciliation Forums of Oakland 2222 Preservation Park Way,Oakland,CA 94612 hone:763 2I I Provides services in Oakland-Piedmont-Emeryville, Alameda, Berkeley-Albany, San Leandro, Hayward and Castro Valley. Services include educating the public about the fundamentals of conflict resolution,referring individuals to other social service agencies,and distributing a training manual on conflict resolution. Multilingual services provided. Catbolic Charities,Victims:Offender Reconciliation Program(i'ORP) 433 Jefferson Street,Oakland,CA 94607 Ohone:768-310611 Program mediators facilitate an intensive intervention for victims and juvenile offenders referred by the Probation Department, Mediators are responsible for mediation sessions involving the youth, victim and family members to work towards a mutually agreeable restitution agreezrzent. Also provide free workshops in anger management and mediation. Center for Community Dispute Settlement 291 McLeod Street,Livermore,CA 94550 1P'hone:("92S)17�3-I S Provides services in Tri-Valley for all of Alameda County. Program goals are to increase the number of court cases resolved,,mediating small claims cases four days per week, and training youth in listening and conflict resolution skills. Arts Arbitration and Mediation Services Fort Mason Center Cr255 San Francisco,CA 94123 Ehone:(415)775720017 This program increases the resolution of arts related disputes such as artistic control,ownership of intellectual property, credit for work performed or produced and contract issues, through the use of alternative dispute resolution. It also increases the capacity to provide services for counseling, conciliation and administration of mediation, arbitration and meeting facilitation. Rev 10102 Page 5 n°7 S,ep 39 04 09: 56a p. 34 ALAIt'l`EDA COUNTY SUPERIOR COURT ADRPROGRAM ADR troyrare Administrator Pursuant to California Rule of Court 15 803,the presiding judge of the Superior Court of C:alifomia,County of Alameda has designated Benjamin 17,Stough,Berkeley Trial Court Administrator,to serve as ADR program administrator. A Plaintiff may elect,the parties may stipulate or a judge may refer a case to Judicial Arbitration.. The Judicial Arbitration Prograzn Coordinator may be contacted at(5 10)674-6646. The Ludtclal ALbitration Process Appointment o€Arbtrater(Must be appointed within 30 days aftareferral er CRC 16051. Parties mailed list of five names from which to select, (List mailed within 5-10 business days after receipt of referral). Each party may reject one of the names listed(.l0 calendar days per CRC 1605a) The administrator randomly appoints the arbitrators from the names remaining on the list. If only one retrains then is deemed appointed. AL4gnwent gWse(CRC 1665a(M Within 15 clays of notice of the appointment,the arbitrator shall contact parties in writing about time,date, and place of the hearing. The parties shall receive at least 30 days notice prior to the hearing. Hearjngs L(RC 1611) Shall be scheduled so as to be completed not less than 35 Clays nor more tha-t 90 clays from the date the arbitrator was assigned. For good cause shown,the case may be continued an additional 90 days by the Case Management Judge. Awa lrtl of Arbitrator t"CRC 1615b&c} => Arbitrator trust file an award within 10 days after conclusion of the arbitration hearing. The court may allow 20 additional clays upon application of arbitrator is cases of unusual length or complexity. Within 30 days of the filing of the award the parties may file a Request for Trial do Novo. The clerk shall enter the award as a judgment after 30 days provided a Trial de Novo has not been filed. Return itf Can to Court Upon piling of Trial de Novo the action is returned to Case Management Judge for farther proceedings. (CRC 1616&Local Rule 6.4) => If Trial de Novo is not filed them judgment is entered and the Case Management Judge is notified(CRC 1615c&Local Rule 6.6) If parties indicate a settlement then case is returned to Case Management Judge and case is continued 45 days for an Order to Show Cause RB ding a dismissal. (Local Rale 6.6) Rey 10102 Pale 6 of 77 Sa-p 09 04 09: 56a SUPERIOR.COURT OF CALIFORNIA,COUNTY OF ALAMEDA Alien B.Bromeard Justice Center Berkeley Courllrcrusasertraiay courthouse 6t14 Wa t n Feet Oakland,CA 94707 2000 Center Berke! ,CA 94704 2120 Martin Luther K n ,Jr.Way,Beft§y 94704 Fremont hall Of,lustice —d3wscherurne fW1 of Juatico LGeorge F-*Donald Hag of Justics 39439 Paseo Padre Pafta,Fremont,CA 94536 5672 ftnaLdp Drive,Pleasanton,CA 94588 2238 Shorallna[?rive,Alameda,CA 8541 Hayward Hatt of Juane Rend C,Davidson Courthouse Whey W,manual Courthouse 24445 Amador Street Ha ard.CA 94544 1275 Fallon Sheat Crakiand 0A946112 661 Washin StreaL Oakland,CA N807 Case No.: Plaintiff vs. STIPULATION FOR.ALTERNATIVE DISPUTE RESOLUTION(ADR.) Defendant The parties by and through their attorneys of record hereby stipulate to submit the within controversy to the following Alternative Dispute Resolution process: ORDER The foregoing stipulation having been read and considered,and good cause appearing,now therefare, IT IS SO ORDERED. IT IS FURTHER ORDERED that the matter be set for Order to Show Cause Hearing RF: Dismissal on at a.m,lp.m.in Department Dated: JUDGE OF THE SUPERIOR COURT (SEAL) Rev I0/02 Page 7 of 7 CLAIM ,/j ��► " - BOARD OF SUPERVISORS OF CON'T'RA COSTA COUNTY BOARD ACTION.-NOV. 02, 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), give Pursuant to Government Code Section 913 and 915.4. Please note all"Warnings". AMOUNT: $1,062.00 CLAIMANT: RONALD E. HALL ATTORNEY: UNKNOW DATE RECEIVED: OCTOBER 12, 2004 ADDRESS: 1306 POTTER ST. , BY DELIVERY TO CLERK,ON: OCTOBER 12, 2004 MARTINEZ, CA 94553 . OCTOBER fl8, 2004 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. OCTOBER 13 2004 JOHN SWEETEN,C erk Dated. By: Deputy II. FPOM: County Counsel. TO: Clerk of the Beard of Supervisors ( 'phis 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 tate and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). ( ) Other: Dated: Imo' ? - By: ? Deputy County Coun� III. FROM: Clerk of the Board TO: County Counsel(1) County Administrator(2) { ) Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ( f This Claim is rejected in full. ( } Other: a I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated:,A1V_,Ve,_ a v`-V JOHN SWEETEN, CLERK.,By , Deputy Clerk WARNING(Gov. code secti n 913) Subject to certain exceptions, you have only six(6)months from the date this notice was personally served or deposit 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 Order and Notice to Claimant, addressed to the claimant as shown above. Dated: e'"wh. v' OHN SWEETEN, CLERIC By Deputy Cler Board of Supervisors Room 106 County Admin Bldg 651 Pine St Martinez, CA 94553 To Whom It May Concern: Enclosed is claim for damages to my front door that occurred on September 7, 2004, from.Officers of the County of Contra Costa. If I need to provide any additional information please advise. Thank you. Sincerely, Ron Hall 1306 Potter St Martinez, CA 94553 (925) 335-2320 BOARD OF SUPERVISORS OF CONTR k COSTA COUNTY 11NISTRUCTIONS TO CLAIMANT A A claimrelating to a cause of action for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Fine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. ■a f a a a a a a a a a a a a a a a a a a s a a a a a a a a a a a a a s s a a a a a N1 B a a a a a a a a a s s s a s s a a was SUNSSWUNRON RE: Claim By: p Reserved for Clerk's filing stamp y � Against ` � � � � � a the County of Contra Costa or ) OCT 12 RECT District) i (Fill in the name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-pawned district in the sum of$� oo and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 11 2. Whe(r.✓ed jdid the da+,mageJ or injury occur? (Include ,;ity and county) 60 9y5V 3. How did the damage or injury occur? (Give full details; use extra paper if required) ,`eft 5t p:9,rr ot-r5' €)t�i-r &,4rco t7, s ow Pa 4. What particular art or omission on the part of county or district officers, servants, or employees caused the injury or damage? T4— i�,Wc ev o t") s, ok did £bc, 000-- Dai' U.l f's S i.3 ia�ocleed a c � pueEo to 84-46 DOLUO 5 What are the names of county or district officers, servants, or employees causing the damage or injury`' 5190-Ctom, tv f io t C 'f C O�AzYeA— C,0ST- CCVEBF Y 6. What damage or injuries do your claim resulted? (Give 'full extent of injuries or damages claimed. Attach two estimates for auto da ge.) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Co,'3-r �;:e . S. Names and addresses of witnesses, doctors, and hospitals-10 6 9. List the expenditures you made on account of this accident or injury. DATE TIME AMOUNT sVk- Is asus*sas Seems sasa4as4r4asssswas sssaaa*was s=sarissssrssaass:rraarssssesssr4rs4■4aas } Gov. Code See. 910.2 provides "The claim shall be ) signed by the claimant or by some person on his }behalf." SEND NOTICES TO; (Attorney r / Name and address of Attorney } (Claimant's Signature) } (Address) Telephone No. } Telephone No, .s w a s waves a w■h a it a w 4 a 0 0 4 a w w 4 4■a us w a man w r w r w a 0 a a a a 1R a■r a s a r■r Y f 4 wass on 409490624 w Y a s s a a 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 dollars ($1,000.00), 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. Home Depot Store 0634 2094 MERIDIAN PARK BLVD CONCORD,CA 94520 DATE: 1010212404 (925)798-9600 CUSTOMER: HALL,RON SALES ASSOCIATE: 1306 POTTER ST P.CJ.#: MARTINEZ,CA-94553 (925)-3352320 Thank you for shopping The Home Depott We value your busineasl ITEM LOCATION PRODUCT CODE TOTAL FRAME SIZE DESCRIPTION UNIT PRICE QTY PRICE MA n ey 1 Frame Size=36"'W x 80"H Product Ga` RO Size=3'2 114"W x 6'10"H ory: Entry Doom Product Type: Pre-hung Doors Product Style: Pre-hung Doors Product Line: Fiberglass + f1 ����' Product: Pre Finished Woodgrain Product Configuration: Single Door Unit ' Door with Class: Yes Door Swing: Leff Inswing Glass Family: Delaney Glass Style: D58 I ExteriorFinish: Red Mahogany . i Jamb Finish: RTI Primed Jamb Width: 4 9116" Lock Prep: Double Lock Prep Backset: 2 318" Deadboit Prep Diameter: 2118" SHI Style: Brass finish Composite Adjustable Hinge Type: Standard Hinge finish: Brass Bdckmold: Standard(RTI White) Brickmoid Shipped Separate: Yes Frame Type: Boxed "*Pre Finished Fiberglass Door does not have Pre j Finished jamb. Jamb finish Is RTI Primed. I � Fiberglass Delaney D58 $ 647.00 $ 647.00 $ 807.04 CLAIM BOARD OF SUPERVISORS OF CONTRA COS'T'A COUNTY (,,,,�• �i / BOARD ACTION:_NOVER 02, 2004,, Claim Against the County, or District Governed by } the Board of Supervisors, Routing Endorsements, } NO'T'ICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: $1,200.00 j CLAIMANT: SHARON M. BUDD ATTORNEY: €JNmOWiV DAVE RECEIVED: OCTOBER 13, 2004 ADDRESS: 579 CAPITOL DRIVE, BY DELIVERY TO CLERK ON: OCTOBER 13, 2004 BENECIA, CA 94510 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEE , rk Dated: OCTOBER 14, 2004 By: Deputy II. WO—M: County Counsel. TO: Clerk of the Board of Super .cors (.�s claim complies substantially with Sections 910 and 910.2. ( } This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( } Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). ( ) Other: Dated: ? By: F ._ Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel(1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). (IV. 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:4!�4 JOHN SWEETEN, CLERK, By , Deputy Clerk WARNING(Gov. code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *Far Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned,have been a citizen of the United States, over age 18 and that today I deposited in the United States postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: i �� q4OHN SWEETEN, CLERK By Deputy Clerk OCT-04-2004 10:23 CCC RISK MAKAGMENT BOA"OF SUPER"So ltS QkV UUA IAA%,%J0 JL ��. . 9�s 335 1421 P.�2i�� z TNSTgtU�ONS LA NT TO C A - j - -"' A claim relating to a cause of action for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 91.1.2.) B. Claims must be filed with the Clem of the Board of Supervisors at its office in Room 105, County Administration Building,551 Pine Street,Martinez,CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. ArASASAsi+ssAsrsrASAsrssssassrrsAsome Saba rrArAsrArts■soaANUM Neoax ri RE: Claim By: Reserved for Clerk's filing stamp aro n w.u� } RUED hc Against the County of Contra Costa or } # OCT 2004 District} trr"n{ � �SORS, (Fill in the name) } The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$—/2,00.Od in support of this claim represe is as follows: Z 2 S 1ma. is fr eiAe r /" 4-P404* carr e 1. When did the damage or injury occur? (Give exact date and hour) 4Nslof- "'oa PM 2. Where did the damage or injury occur? (Include city and county) 'Y4P*i�mg2�4+ 3. How did the damage or injury occur? (Give full details;use extra paper if required) ?Geis a �prdopr r3 .2`` Vt � t& p� 1 �r ,eAwn afar 4. Wha particular act or mission the part of county or district officers, servants, or employees caused the injury or damage? j�rc�d . � ? ., 5 What are the names of county or district officers,servants,or employees causing the damage or injury? 0014p,f 014p,f lin 'ki il I As I,` OCT--04-2004 10:24 CCC RISK iYlANAGMENT 925 335 1421 P.03/03 .f 5. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) dr r�pptd buorer fry = Ste- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) ag:& 'boa( 8. Names and address s of witnesses,doctors,and hospitals: , Con +ct , Z)j'Mt r iO 9. List the expenditures you made on account of this accident or injury: m 4a;rid ' DATE TIIyIE lU A4LVtM'# 'Mr �aJ car lafiRri Raaar#ar ms***a asSalim Kis##i#rr##iirii#i#t#i.ii#Riaria##i##i*iR#i#San w#!ir#!#R#1 _Gov.Code Sec. 910.2 provides"The claim shall be signed by the claimant or by some person on his } behalf'° SE0 NQnCES TO: (Attornev� Name and address of Attorney ) ) } Claimant's Si e Vf 4C4yol�d 40 Prit, '4 Telephone No. )Telephone No. 44- 01 a*RR**Ra arrarrRRirr orfs#r#now ###^#(�i##Its###ii##a1Rll{#iRPRaif'�i7RRi iilirrrriaiir#RR if YRRR#!#Rif PUBLIC RECORDS NOTICE: Please be advised that this claim form,or any claim filed with the County under the Tort Claims Act,is subject to public disclosure under the California Public Records Act. (Gov. Code, §6 6500 et seq.) Furthermore, any attachments,addendums,or supplements attached to the claim form, including medical records, are also subject to public disclosure. sararwarr#rrRwarrrs�ris#iaar##a a a a a as Manama**war##aileiariaaa#X06680■w Saw as a#am arwrw, NOTICE: Section 72 of the Penal Cade 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 dollars ($1,000.00), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,00, or by both such imprisonment and fine, TOTAL. P.03 10/11/2004 at 10:41 AM Job Number: 84144 i AAO IWORT Agro BODY Federal ID #:68OD40781 BAR.## AX113382 - EPA## CADI03451878 1812 Arnold Industrial Place Concord, CA 94520 {925} 675-1944 Fax: (925) 575-0869 PREL3XXNARY ESTIMATE Written By: Ray Aydel ott Adjuster: Xnsureds SHARON BUDD Clain # Owners SHARON BUDD Policy ## Address 579 CAPITOL DR Deductibles BENICA, CA 94510 Date of Loom: Bvening: (707)747--5673 Type of Loess Point of Inpacts 12. Front inspect MAWS IMPORT AUTO BODY Businesms (925)676-1944 Locations 1812 Arnold Industrial Place Concord, CA 94520 Insurance Co*Vanys Days to Repair 2002 BMW 5301 5-3 .OL-FI 4D SED BLUE MET Int:BLK VINs WBADT634X2CH91648 Lies 4WKR123 CA Prod bates 12/2001 Odonet*rs Air conditioning Rear Defogger Tilt Wheel Cruise Control "telescopic Wheel Intermittent Wipers climate Control Keyless Entry Steering Wheel Controls Dual Mirrors Traction Control Fog Lamps Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks Power Driver Seat Bowser Passenger Seat Prower Mirrors Power Trunk/Tailgate Anti-Lock Brakes (4) Driver Air Bag Passenger Air Bag Front Side Impact Air Bag 4 Wheel. Disc Brakes Cloth Seats Bucket Seats Recline/Lounge Swats Automatic Transmission Aluminum/Alloy Wheels ----..-------------------------------------------------------------------------- NO. op. DESCRIP'T'ION QTY EXT. PRICE LABOR. PAINT ------------------------------------------------------------------------------- I FRONT BUMPER 2 O/H front bumper 2 . 0 3 Repl. Hamper cover w/o Imp washer 1 354 .00 Incl . 2 .6 4 Add for Clear Coat 1.0 5 Repl. Grille center 1 31.00 Incl. 6 Rept Protect strip w/o chrome 1 15.60 Incl . 7 FENDER 8 Regi. LT Fender liner 1 45.00 0. 5 9# COLOR 'TINT 1 0.5 10# COLOR, SAND & BUFF 1 0.5 1 T `d 00c C 13rb3SHI dH WUDV :0; b00a IT 100 10/11/2004 at 10:41 AM Job Number: 84144 PRELIMINARY NOTINATE 2002 BMW 5301 6-3.OL-FI 4D SBD BLUE MET Int:BLK ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- Subtotals =_> 405.50 3 .5 3 .6 Parts 405.60 Baily Labor 3 .5 hrs 0 $ 75.00/hr 262.50 Paint Labor 3 .6 hrs 0 $ 75.00/hr 270.00 Paint Supplies 3 .6 hrs 0 $ 36 .00/hr 129.60 Body Supplies 0.5 hrs 0 $ 7.00/hr 3.50 ---------------------------------------------------- SUBTOTAL $ 1071..20 Sales Tax $ 535.20 0 5.2500* 44.15 ---------------------------------------------------- GRANA TOTAL $ 1115.35 ADJUSTMENTS: Deductible 0.00 ---------------------------------------------------- CUSTOMER PAY $ 0.00 INSURANCE PAY $ 1115.35 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 j?-FRAME G=GLASS M=MECHANICAL P=PAINT LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS : ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMA.RKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE (QUANTITY INCL-INCLUDED MISC=MISCELLANEOUS NAGS-NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RELY-QUALITY RECYCLED PART QUAL REPT;=QUALI'T`Y REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PART'S RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=R.IGHT SECT=SFECTION S'{UBL-SUBLET LT=LEFT WJO=WITHOUT W/_-WITH/_ SYMBOLS: #=MANUAL LINE ENTRY *=OTHER [IE. .MOTOR.S DATABASE INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. MQVP=MANUFACTURER'S QUALIFICATION AND VALIDATION PROGRAM. 2 P- .d 0026 13rN3SHI dH WUOip :OI 1v00a 11 130 10/11/2004 at 10:41 AM Job Number. 84144 VRBLnINARY ZOTIXATH 2002 HMW 5301 6-3 .OL-FI 4D SED BLUE MET In.t:HLK Estimate based on MOTOR CRASIK ESTIMATING GUIDE. unless otherwise noted all items are derived from the Guide NRE1911 Database Date 09/2004, 'CCC Data Date 09/2004, and the parts selected are OEM-parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at OE/vshicle 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. Wilde sign (-) items indicate MOTOR Not-Included Labor operations. :kion-Original Equipment Manufacturer aftermarket parts are described as AM, Qual Repl Parts or Comp Ropl ?arts 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. RAGS Part Numbers and Prices are provided by rational Auto Glass Specifications, Inc. Pound sign (#) items indicate manual entries. some parts that are described as Recon. may be OE surplus parts or ether OE parts offered at a special pricing discount. For further clarification please review the Suppliers List attached to this estimate, or consult the appraiser or estimator. CCC Pathways - A product of CCC Information Services Inc. 3 10/08/2004 at 10:24 AM Job Number: 13023 snaXINS AUTO CARE, INC. License #:AE 221709 Federal ID #:030413976 SIMPKINS AUTO CARE, INC. WWW. SIMPKINSAUTOCARE.COM 980 ADAMS ST BENICIA, CA 94510-2943 (707) 746-0535 Fax: (707) 746-7825 PRELIMINARY ESTIMATE Written By: Francine Welsh Adjuster: Insured: Sharon Budd Claim # Owner: Sharon Budd Policy # Address: 579 Capitol Drive Deductible: Benicia, CA 94510 bate of Loss: Evening: (707) 747-5673 Type of Loss: Point of Impact: 12 . Front Inspect SIMPKINS AUTO CARE, INC. Business: (707) 746-0535 Location: WWW.SIMPKINSAUTOCARE.COM 980 ADAMS ST BENICIA, CA 94510-2543 Insurance Company: Days to Repair 2002 BMW 5301 6--3 . OL-FI 4D SED Blue Met Int: VIN: WBADT634X2CH91648 Lie: 4WKR123 CA Prod Date: 12/2001 Odometer: 24176 Air Conditioning Rear Defogger Tilt Wheel Cruise Control Telescopic Wheel Intermittent Wipers Climate Control Keyless Entry Steering Wheel Controls Body Side Moldings Dual Mirrors Traction Control Fog Lamps Clear Coat Paint Metallic Paint Power Steering Power Brakes Power Windows Power Locks Power Driver Seat Power Passenger Seat Power Mirrors Power Trunk/Tailgate AM Radio FM Radio Stereo Search/Seek CD Player Anti-Lock Brakes (4) Driver Air Bag Passenger Air Bag Front Side Impact Air Bag 4 Wheel Disc Brakes Cloth Seats Bucket Seats Recline/Lounge Seats Automatic Transmission Aluminum/Alloy Wheels ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1 FRONT BUMPER 2 O/H front bumper 2 . 0 N 3 Repl Bumper cover w/o lmp washer 1 314 . 00 Incl . 2 . 6 4 Add for Clear Coat 1 .0 5 Repl Spoiler 1 17 . 90 0 . 3 6 R&I RT Corner molding w/o chrome Incl . upper 1 10/08/2004 at 10:24 AM Job Number: 13023 MELIMINARY ESTIMATE 2002 BMW 5301 6-3.0L-FI 4D SED Blue Met Int: -__ __�____ _______- No. OP. DESCRIPTION QTY EXT . PRICE LABOR PAINT __________-__________________-____________________________________w _ 7 R&I LT Corner molding w/o chrome Incl. upper 8* Refn RT Corner molding w/o chrome 0 .3 upper 9* Refn. LT Corner molding w/o chrome 0 .3 upper 10 Rept. Grille center 1 31. 00 Incl . 11 R&I License mount w/o chrome 0 . 3 12 FENDER 13 Rept. LT Fender liner 1 45 . 00 0.5 14 Repl Splash shield grommet 2 0 .78 15# COLOR MATCH 1 0 .5 16# Subl Hazardous Waste Removal 1 3 . 00 X 17# Repl Flex Additive 1 5 .00 18# Colorsand & polish, 30% of 1 0 . 6 base pt time ________________..______ - Subtotals ----> 416. 68 4 .2 4 .2 Line 3 Recond. Not Available Per Keystone Parts 413. 68 Body Labor 4 . 2 hrs @ $ 70 . 00/hr 294 . 00 Paint Labor 4 . 2 hrs @ $ 70.00/hr 294 . 00 Paint Supplies 4 . 2 hrs @ $ 32 .00/hr 134 . 40 Sublet/Misc. 3.00 ---------------------------------------------------- SUBTOTAL $ 1139.08 Sales Tax. $ 548 . 08 @ 7 .3750% 40 . 42 ---------------------------------------------------- GRAND TOTAL $ 1179. 50 CONGRATULATIONS ON SEEKING OUT OUR "GOLD CLASS I-CAR CERTFIED FACILITY. BESIDES OUR FULL "LIFETIME WARRANTY", WE STAND BEHIND OUR 10- POINT INSPECTION TO INSURE YOUR SATISFACTION. WE CERTAINLY HOPE YOU WILL BE PLEASED WITH OUR PERFORMANCE. ALL SUBLET WORK IS COVERED BY A FULL ONE YEAR WARRANTY. WE WILL SUPPLY YOU WITH A WRITTEN COPY UPON REQUEST . WE SINCERELY THANK YOU FOR YOUR PATRONAGE ! ! 2 P ` 10/08/2004 at 10 :24 AM Job Number: 13023 PRELndINARX ESTIMATE 2002 BMW 5301 6-3 . OL-FI 4D SED Blue Met 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 WORM TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES: B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS: ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RELY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT ?SART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS RECOND=RECONDITION REFN=REFINISH REPT=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET IST=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 ERE1911 Database Date 09/2004, CCC Data Date 09/2004, 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 Rept 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. Some parts that are described as Recon, may be OR Surplus parts or other OR parts offered at a special pricing discount. For further clarification please review the Suppliers List attached to this estimate, or consult the appraiser or estimator. CCC Pathways - A product of CCC Information Services Inc. 3 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: NOV. 02 2004 Claim Against the County, or District Governed by ) the Hoard 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. s _, ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all"Warnings". AMOUNT: $1,006-58 CLAIMANT: DAVID RAYMOND F'ERREIRA II ATTORNEY: UNKNOWN DATE RECEIVED: OCTOBER 13, 2004 ADDRESS: 17320 MAY FLOWER BY DELIVERY TO CLERK'.ON: OCTOBER 13 2004 GASTRO VALLEY, CA 94546 BY MAIL POSTMARKED: OCTOBER 12, 2004 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEE rk Dated: OCxO�� 139 2004 By: Deputy IL FIROM: County Counsel. TO: Clerk of the Board of Super, tsars (% his claim complies substantially with Sections 910 and 910.2. { ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.$). { ) 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: 40-/J_1*` By: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). (IV. 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 , Deputy Clerk WARNING(Gov. code sectio 913) Subject to certain exceptions, you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning_ See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: + ' ' JOHN SWEETEN, CLERK By Deputy Clerk .. Claim Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988,must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Bi U rd,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 claim is against a district governed by the Board of Supervisors, rather than the County,the name of the District should be filled in. D. If the claim is against more than one public entity; separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's filing stamp David Raymond Ferreira II ks'Y'✓I!1� 7'�[J/7✓!! + � L'�� / �y�JyI3� Tw , ,m.�.............E Aga' st the County of Contra Costa 44 'l k � OCT 13 REC' �f or 1CLERK �.. The Housing Authority of Contra Costa (District) (Fill in name) The undersigned claimant hereby makes rlaim against the County of Contra Costa or the above-named District in the sum of L3G`4�'r I and in support of this claim represents as follows 1. Wheal did the damage or injury occur? (Give exact date and hour) JV . 2. Where did the damage or injury occur? (Include city and county) ' 3. How did the damage or injury oc r? (Give fulldetails; use extra paper if required) 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? clmform 5. What are the names of county or district officers, servants or employees ca'l�ising the damage or injury? y. 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attached two estimates for auto damage.) 7. How was the amount claimed above computed? (Include the estimated amount of any - prospective injury or damage.) /) A 8. Names and addresses of witnesses, doctors and hospitals. eq r�� - 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SENT?NOTICE TO: (Attorney or by some person on his behalf." Name and Address of Attorney ,. J (Claimant's Signature) / 3 - (Address) go Ile Telephone No. Telephone No. 57 V,— f PA�--- 4-1111-111 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." Omform Date: 9/3/2004 10:48 AM Estimate ID: 2240 Estimate Version: 0 Preliminary Profile ID: EXPERIENCE (t,�(perienrp 4uto Body 2230 INTERNATIONAL BLVD OAKLAND,CA 94606 (510)532-2356 Fax: (510)532-2357 Tax ID: 94-3298931 BAR#: AD199158 EPA#: CAL000172285 Damage Assessed By: JUN ODION Condition Code: Fair Deductible: UNKNOWN Mitchell Service: 912529 Description: 1999 Chrysler 300M Body Style: 4D Sed Drive Train: 3.5L Inj 6 Cyl AO FWD VIN: 2C3HE66G9XH816310 License: 4HGU172 CA OEM/ALT: O Search Code: None Options: ALUMIALLOY WHEELS,AIR CONDITIONING,POWER STEERING,POWER WINDOWS POWER DOOR LOCKS,POWER PASSENGER SEAT,TILT STEERING WHEEL,CRUISE CONTROL ELECTRIC DEFOGGER,LEATHER SEATS,AUTOMATIC TRANSMISSION TRACTION CONTROUELECTRONIC,PREMIUM SOUND SYS.,POWER DRIVER SEAT AM-FM STEREO/CDPLAYER(SINGLE) *** SPECIAL PARTS NOTICE: ALL CRASH PARTS ON THIS ESTIMATE ARE NEW-OEM (ORIGINAL EQUIPMENT MANUFACTURER) UNLESS OTHERWISE SPECIFIED. PARTS DESCRIBED AS RECHkOMED, RECORED, OR REr'iA!4UFACTUI:]D- ARE EITHER RECONDITIONED OR REBUILT. PARTS THAT ARE DESCRIBED AS QUAL REAL PART AND QRP CAPA ARE NON-OEM CRASH PARTS. *** Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 200707 BDY REMOVE/INSTALL R REAR ROCKER CLADDING 0.5 # 2 201082 REF BLEND R REAR DOOR OUTSIDE C 1.0 3 201136 BDY REMOVE/INSTALL R REAR DOOR HANDLE 0.6 # 4 201287 BDY REPAIR R QUARTER OUTER PANEL Existing 4.0*# 5 AUTO} REF REFINISH R O.TARTER PANEL OUTSIDE C 2.4 6 201514 BDY REMOVE/INSTALL R REAR COMBINATION LAMP 0.3 7 AUTO REF ADD'L OPR CLEAR COAT 1.2 8 933003 BDY* ADD'L OPR TINT COLOR 0.5* 9 933005 BDY ADD'L OPR RESTORE CORROSION PROTECTION 12.00* 0.3* 10 AUTO BDY* ADD'L OPR FINISH SAND AND BUFF 1.4 11 933018 BDY* ADUL OPR MAST{FOR OVERSPRAY 5.00* 0.3* 12 AUTO ADD'L COST PAINT/MATERIALS 138.00* 13 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL 2.00* *-Judgement item #-Labor Note Applies C- Included in Clear-Coat Calc ESTIMATE RECALL NUMBER: 9/3/2004 10:48:43 2240 UltraMate is a Trademark of Mitchell international Mitchell Data Version: SEP 04mA Copyright(C)1994-2003 Mitchell International Page 1 of 2 UltraMate Version: 5.0.024 All Rights Reserved Date: 9/3/2004 10:48 AM Estimate ID: 2240 Estimate Version: 0 Preliminary Profile ID: EXPERIE=NCE Add'i Labor Sublet 1. Labor Subtotals Units Rate Amount Amount Totals II. Dart Replacement Summary Amount Body 7.9 67.00 17.00 0.00 546.30 Refinish 4.6 67.00 0.00 0.00 308.20 Total Replacement Parts Amount 0.00 Non-Taxable Labor 854.50 Labor Summary 12.5 854.50 Ill. Additional Costs Amount 1V. Adjustments Amount Taxable Costs 138.00 Customer Responsibility 0.00 Sales Tax @ 8.750% 12.08 Non-Taxable Costs 2.00 Total Additional Costs 152.08 I. Total Labor: 854.50 il. Total Replacement Parts: 0.00 Ill. Total Additional Costs: 152.08 Cross Total: 1,006.58 N. Total Adjustments: 0.00 Net Total: 1,006.58 This is a preliminary estimate. Additional changes to the estimate may be required for the actual repair. ESTIMATE RECALL NUMBER: 9/3/2004 10:48:43 2240 UltraMate is a Trademark of Mitchell International Mitchell Data Version: SEP 04_A Copyright(C)1994-2003 Mitchell International Page 2 of 2 UltraMate Version: 5.0.024 All Rights Reserved Oct 11 04 09: 22a Fred Moreno 510-481 0137 p. 2 Date: 10/1112004 09:19 AM Estimate V. 7084 Estimate Version: 0 Preliminary Pro19e 0, CUSTOMIZED BAY RAM COLLISION CENTER INC. 20531 MISSION BLVD.HAYWIYARD,CA 94541 (510)4$14W 0 Fax: {510)481-0137 BAR 4: AM13M6 Damage Assessed By: FRED MORENO JR. Deductible. UNKNOWN Insured: DAVE FERREIRA Atldress: 1785 TIMOTHY tiff.SAN LEANDRO,CA 94577 _ Telephone: Home Phone: (510)908.6189 Mitchell Service: 912529 Description: 1898 Chrysler 300M Body Style: 40 Sed Drive Train: 3.5L Hy 9 Cyt ACI FWD VIN: 2C3HE66G8XH816310 License: 4HOU172 CA Calor. CHARCOAL MET. Options: .ALUMIALLOY WHEELS,AIR CONDITIONING,POWER STEERING,POWER WINDOWS POWER WOR LOCKS,POWER PASSENGER SEAT,TILT STEERING WHEEL,CRUISE CONTROL ' ELECTRIC:DEFOGGER,LEATHER SEATS,AUTOMATIC TRAKWISSION TRACTION CONTROLIELECTROIRC,PREM#JM SOUND SYS.,POWER DRIVER SEAT AM-FM STEREOICOPLAYElt{SINGLE) Line Entry Labor Line Item Part Typal Dollar Labor Item #lumber Type Ops*ion Description Part Number _ Amount Units 1 201082 REF REFINISH R REAR DOOR OUTSIDE C 2.4 2 201094 BUY REMOVEANSTALL R REAR UPR WOR WINDOW FRAME MLDG 1.3 dF 3 201118 BOY REMOVEANSTALL R REAR DOOR TRIM PANEL INC 4 201135 BOY REMOVF1tNSTALL R REAR DOOR HANDLE 0.2 * 5 201285 BOY REPAIR R QUARTER OUTER PANEL Existing 3.0'fk 8 AUTO REF REFSMSH R QUARTER PANEL OUTSIDE C 2.0 7 201514 BUY REMOVEANSTALL R REAR COMBINATION LAMP CA 8 900500 REF* REMOVEMEPLACE FLEX ADDITIVE New 10.00* 0.0* 8 9(10500 BW* REMOVEIREPLACE MASK FOR OVERSPRAY New 5.09 0.1* 10 AUTO REF ADM OPR CLEAR COAT 1.4 11 AUTO BOY* AWL OPR COLOR SAND A BUFF. 1.4 12 AUTO ADD'L COST PAINTIMATERIALS 174.00' 13 AUTO AWL COST HAZARDOUS WASTE DISPOSAL 5.00' *-Judgement helm #-Labor dote Applies C.Included In Clear Coat Calc ESTIMATE RECALL NUMBER: 4011112004 09:01:26 7034 Ukral *W is a Tradon ark of Alitchel#lirternational Mitchell Data Version: AUC3 0-k A Copyright JC)1"4-2003 MRchell h lternational Page 1 of 2 Uitromats Version: 5.0.024 AN flights Reserved Oct 11 04 O9. 22a Fred Morena 510-481 0137 p. 3 Date: 90t11l2004 09:19 AM Estimate ID: 7034 Estimate Version: 0 Preliminary Profile ID: CUSTOMIZED Add'i Labor Sublet 1. Labor Suhtotab Units Rate Amount Amount Totals H. Part Replacement Summary Amount Body 6.5 8B 80 0.00 0.00 442.80 Taxable Parts 15.00 Refinish $A 66.110 0.00 0.00 394.40 Sales Tax @ 8.7so% 1.31 N*n-Taxable Labor 836.40 Total Replacement Paris Amount 16.31 Labor Summary 12.3 836.40 IN. Additional Costs Amount W. Adjus yw is Amount Taxable Casts 174.00 Customer Responsibility 0.00 Sages Tax 8.750% 15.23 Non-Taxable Costs 5.00 Total Additional Casts 194.23 I. Total tabor: 836.40 it. Total Replacement Parts: 15.31 Ill. Total Additional Costs: 194.23 Dross.Total: 1,046.94 tV. Total Adjustments: 0.00 Not Total: 1,045.94 This Lea nr01minary 20IM010_ Additional ctlana"to ON gjt-RMA&may be rsttuired for the actual reaair. ESTIMATE RECALL NUMBER: 1011112084 09:01:M 7034 (litraMais is a Trademark of MPoabe#international Witchell Data Version: AUG 04 A Copyrilght(C}9994-2003 M ItcbeH International Page 2 of 2 UltraMate Version. 5.0.024 All Rights Reserved _... CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 4 BOARD ACTION- NOVEM ER>02, 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: UNKNOWN CLAIMANT: MERCREY LaFAYETTE ATTORNEY: UNKNOWN DATE RECEIVED: OCTOBER 14t___2004 ADDRESS: 4.1.2 CLEARWOOD DRIVE BY DELIVERY TO CLERK ON: OCTOBER 14, 2004 OAKLEY, CA 94561 LAND DELIVERED BY BY MAIL POSTMARKED: SHARON OFFORD FROM: Clerk of the Beard of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SW ' E erk Dated: OCTOBER 14, 2004 .. By: Deputy II. MOM: County Counsel TO: Clerk of the Board of S ervisors { } 'his claim complies substantially with Sections 910 and 910.2. 5 { ) 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: /7 Dated: i' By: �-, , Deputy County Counsel III, FROM: Clerk of the Board TO: County Counsel(1) County Administrator(2) { ) Claim was returned as untimely with notice to claimant(Section 911.3). A/ BOARD ORDER: By unanimous vote of the Supervisors present: {4 This Claire is rejected in full. ( } Other: a I�ce+rtify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: + ' JOHN SWEETEN, CLERK, By , Deputy Clerk WARMING (Gov, code secti n 915) Subject to certain exceptions, you have only sic(6)months from the date this notice was personally served or deposited in the snail 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. A Dated: "4AlG rod#�'' + OHN SWEETEN, CLERK By Deputy Clerk AUG—i9-2004 10:34 CCC RISK MWGI ENT 925 335 1421 P.02 Cl.a im to: BOM CF SUMV1SOPS OF COMA Cis`""1'A coulter i STRCC?'IONS TO CLAIMANT A. Claims relating to causes df` action for death or for in,ury to person or to per-- son.al property or grcwtng crops &nd which accrue on or before December 31, 1987, must be presented not latero thin the 100th day after the accrual of the cause of action. Claims relating to causes of action for.death cr for in�ur°y to person or to personal property or growing props and which accrue on or after January 1, 1988, 'rust be presented not later there sire months after the accruall of the rak e of actio.. Claims relating to any other cause of action =t be presented not later thaxr me year after the Acct of the cause of action. CCovt, Code S. Claims =st be filed with the Merk of the Board of Supervisors at its office In Roo, 106, County Administration Buildi.rg, 651. Pine Street, Martinez, CA 9,4853= C. If ala m is against a district governed by the Board of Supervisors, rather t�2n the CoLLity, the name of the District shoUd be f113ed in. D, If the claim is e.gai:rxt more than one public e:rtity, separate clam must be filed against each public entity. E. Fraud. See persalt; for fraudulent. clairs, Pe 1. Code Sac. 72 at tyre wird Of th?s a �t e a a a a �► a �t e REQ Claim BY Reserved for Clerk's filing swamp ' II irt. the C,dmity ofC6r-tr a Costa } T o X004 District) '' �c�?Qst t Q� •' v� The undersign clalwnt hereby. es claim against the County of Contra Cosh or t' above-rimed District in the sup of $ and In support of this claim represents -as follows: 1. When dad the e,or injury occur? (Give exaot date and hour) f '4 2m Ware did the damage or injury occur? (Include city and county) 3. How dial the damage cr injury t>,,wur? (Give full details; use extra paper if required) t. O_p4�,tc,er Pt,r ad I n Pit(-Kir L.O+,, he, 'qe- 0 C 4. Writ. partioul,ar act or: orisalon on the part of c ty ctr district officers, servants ter ..employees caused-the.in jury or e': ` . hot. U'f._ i n r PF0DP_f-tCf RUCs-19-2004. 20;35 CCC RISK MANP° #T _ . 925 335 1421 P-03 wrest are tne rames of compy or district officers, servants or employees causing the damage or f.njur7? �L),ee-p-LA+tA Sao-+ efn 6. What damage or injuries do you clam resulted? (Give full extent of inJur ies or damages chained. At ;h two estimates for auto die. 7. Hoer s the amount claimed above muted? , (Include the estimated amount of any pro emotive Injury or damage..) Names and addresses of witnezzes, doctors and hospitals. �jo List* the expenditures you made on account of this accident or injury: DATE No w Gov°. Code Sec. '9M2 provides: "The claim must be signed by the claLwanl- SM NOTIM TO-. Attorney or sme erson on 's.bahal.f.n ame Ed- of Attor y 71 Smit 5 A ess Telephone No. Telephone H . N 0 T I C E Section 72 of the Pena. Code provides: . "Every Person who, with intent to defraud, presents for allowance or forpayment to any state board or officer, or to any county, city or district beard or Officer, authcri.Zed to allow or pay the same if.genuine, any false or f"raudulant, claim, bi.l?, accounts voucheri, or vritizg, is punishable either by imprlsorimnt in the county Jail' for a period of not more t o one-year, by a fine of not exceed ins; ane th=a1nd ( 1,000), or 1Y 'both sum iai3z' oviment and fine�-or by imprisorment• in the state pri3=, by a fine of not exceeding ten thousand..doilars ($10,000, cr by. both such imprisor..roent and fine. TOTAL P.03 ,�9102r`2004 04 : 14 FAX 925 667 2335 MORGAN FENCE & AWNING I�14i�3�t��3 M J11 n Allurnir�um Products, 1r�+�. 11 "No Jab Too Small" FENCE & AWNIN ► � CONTRACT PRCPOSA L 4035 Folsom Ct, . Concord, CA 94520 Contractor's License No, 363662 Concord Richmond Fairfield I (92 1) 687-9620 (451 ) -4114 (707) 428-3302 1 In Business Since 1962. ia a glf224-+203 w -2335 USTOVER NAME Delta Kids Center DATE 3.2-04 ADDRESS 61 Delta Tkd P.0.A , . S-7ATE ZIP Oakleyj Ca. 94561 SALESPERSON Gaiy WERIALIINSTAi M. j .AX....,... ATM M�a�"C r*y COLOR w ..._ 7,--4,5TALLAT1Q1N>ADORESS Same as above REPAIR j STREET&NUMBER i CHAIN LINK i 101T'S'ST,ATE ZIP ORNAMENTAL!RON I -R 08S BTIEETi STYLEgal TOTAL LINEAR , C4.AYVER LINE I GATE FRAME SZE - SPECAi. INSTRUCTIONS FOOTAGE LESS 1 POST I we will tear out and haul away (1)20x6 � GATES ; 00 IN iNcHF-$ damaged wood gate. Supply install (1) I OD 00 Z r, i 2U6 ornamental iron gate, Using customer I wood, pasta for hinge posts. I OVERALL TDPRAil-OR T,.NSEON't`;)RE � s HEIGHT � BrRA�lsti� ETCH 00 All contracts aro oublect to Companies zappro;ma` YOP SOT-01V VIRE PABRIt `f i�vti SPACING E EJ GAL#:^aE i n V V OR IaNCRET NLESS i _._ �✓'"l Y j1.�... DIRT FROM HOLES XINUCKI F-1P GATF SIZE r {3AR sap LEAVE TAKE 00 i 00 DIAMETER "xU,% D;ice SATE POST ! RAIL TERMINAL FOS,OD1 SIZE NNE I SIRE t DiAM.ITER 3ATE qO L BATE PICKET � Ali metesis wili mmain trm propetly Df Mkrgsn A jrninam koducte,Inc.until Si iwolc€ss pe.,taining 0 011 ii j POST 015 IN INCHES liE f 5th job ve PsId In fait.Ai h;at atoll ant tsmovai is cgarl6S I*fv%nart Ailuffinvrn Frodtida,Inc,in I he ewnt r Ott $ Gi 21g 0 0 � ���3 ra I `M,A,P.assumes At rssPVs1hritty tr sly and ail r airs W underground l~ sot,W.'Virtt,s uii�ne.,*,,mu leu r,4trrxil course of inawktim- # 4MT i RE EiPT G ^t;P,� N A i YYi." ik __Y__ _ TOTAL CWFLEIE �VILt Rz.;CNARGEL ON AL L AC:O'LJNTS r,.0T€+AID WITWN _=AYSOf INVOICE DATE, � vATE Proposal/Contract L:mTl A 2, s ."*a 1 5 FENCECO. -. «SAY e,Y fence you in, i.y them off-, ;s uscoorpwounwo License No.470'n'1 r. , P0. BOX 8 BRENTWOOD,CA 94513 (925)634-5990-FAX (925)634-0520 Pro ,s :to Mks Lafayette Date 9/13/04 Address 412 Clearwood Drive P,ONo, — Phone NO.----634-7611 W,_.... .,., Oakley CA �:f }4561 Fax shb to _ Same – DeltaKidsCenter �_. Site Phone No Address, 61 Delta Road Job No main va;; Installed Oakley y ;. Style Peace ornamental. iron 3uts£ t «3st_.. 61 – Height of Fabric 6 1 Style of Heavy Rega1.�.. ._._ _.._...,.a . _�._. e.: /4'�._ 1. 1 eSh 4"space _K ykle-tap Et-- arl.:v,,; pickets . 'ne Posts , �"l)£�cad _ E3�i y;si r?> {l;. ^ ...'_.'. }__._ ? ?;t 'w^E ?3 Conc_ete Top .,..-.._._�_...._..__.......... S G" e£�a' f__.�__._..._� �+'.��° __.__.._...._..�_.........� S3�airsg),._.1.. M�'1�' &4e��rs'�f�{"�i�{.�..�fi EtsE:�_.• ._........ Terms of Payment__. _w _. � � _. _..-.._.. ����r rye �t�._608.00 _ r µCom letFence --------- _ _ _ ;,,'PON ACCEPTANCE OF coN€RAc'r, PLEASE :aI.L U.S.A, Un,Ft iF+,mpieW tfflc*_ _ .__.. .� - _._._ � (l13`£DEAGR3€IND SUAV�CE ALERT,M00-642-2444)2 DAYS BEFORE vS'0"Wes INSTAILLATiON THEY WtL'AT NC;CHARGE,LOCATE F--08 YOU ALL eaWalk Gates 1 _Via,Drive Gales SKETCH ea, Drive Gates ea. Slide Gia'es End,Post _ _ _ — _.._#r was 0-D3 _....,_.3. Corne, Poc'ts inches O.D. Corer Posts s c eS OA' „s. Gate Pos,s Heavy 4" so. eLx #u Set poste inside wood postsHandate, remove wood mates and haul away. Customer res onsib e for repis to undergro4ri lines should any be _ y dammed 4ur#g construction 1 eaCc�r� e e :ur double gate PRICE GOOD FOR 5 BUSINESS DAYS FROM DATE OF THIS PROPOSAL TOTAL COMPLETE $1826.00 Z CCFPTAht„£—-111.0V0903as whlln twc*W-v,ray the Ceecst Oapa:t- .s?and an tW sr—-'. v D'etta Fwx;lp"s...,vft Maotftm mcc'mes'A c:antract betvraen 2vr0 pas.i��a>w` is nit sut£pct to ACCEPITE 3---VF1-TA i NICS Ci.,,NC Ar,CEPTE ± .Please 5.9n w!d relurr y£s<€0W cn–Vv x Leroy Valencia �.�.Mato 9/13/04 x .. ,.... - _ ogre_.._. 8fi tVHITE•k'ustcr°:e-C:;_,{ Y UcsIN -Fie. 'P3NK-Fle GOLD_''ie€d ............................................................................................................................................................................................................. ............................................................................................................................................................................................................................. ............... ..........I......... YOUR ESTIMATOR --s-- c DATE No 13 1 ALL AMERICAN FENCE CORP. State Contractors Lic. 4 670853 0 Box 3057, Danville, CA 94526-3057 Scheduling office& Deliveries, 925-743-8583 Stepped I I Sloped I I Scheduling fax, 925-443-7119 PROPOSAL STJBW. TTED TO: LAP] NAME ADDRESS 90, Cl'rY_a4k1.e1 PHONE_OYJ,�// NIODIFIC,-VI'ION OF 'HIIS fHNNIXIT WILL VOID THIS ESTIMATE 6' CONST. COMMON REDWOOD (estimate includes all new materials, labor and disposal of existing wood fence. Construction heart material additional I I !*STYLES* Board on board t I Louvered I I Nall on I I p2g:qarrecl I Shadow box I I Side by-side I I I' Lattice I I I Areas of estimate: Ri -ht side I I Left side I I Back I I Left front I treated pos I 4x4x8 I I 4x4x 10 1 1 4x6x8 I I&W I I MATERIALS: Redwood posts I I or Pressure ts Concrete footlnR FW4" I I or 10"x36"1 I I Solid frame rails I 11x1 x8 Trim I I 2x6 Cap 1. 1 1x4x8 Trim I I GATES: 42" 1 1 rails grooved I I FENCE MATERIAL UU41 I lx6x5 11x668 1 1 Kickboard 1x8x8 I 12x8x8 1­1 I understand that Earl es quoted arelqqq_f+ r �9Q)days franrt the date of this esflmate. _,. NOTE: Pressure treated Workmanship warranty: I All-American Pence SoTp!atlon warranties Its workmanship for III year. lAcceptance of proposal will not be processed without the waiver of responsibillU initiated.... (Waiver of responsibility) ACCEPTANCE OF PROPOSAL All American Fence Corp. is to be held The above prices,specifications&conditions are sato harmless for any drain lines,sprinkler factory and are hereby accepted.I understand alter- !leads, R G,&E.,electrical,lost pets,land- ations reducing estimate in sin will incur higher cost& scaping,fiber optic, personal property, You are authorized to complete this agreement as specified. We do not accept credit cards phone lines or sprinkler lines. Payment in full will he made solely by me and does not O�-.tiers initiator hinge upon any agreement I have made with my neighbors. Extra's- /",Z:— I will have payment in fall ready for pick up same day the job Jackhammer: lump sum S-10— is completed. There will be a S 25.00 charge for any return checks. or to be determined S Greet) retnovah Ivy & overgrom.-n YO--M;Crs—Siilltull Date vegetation: Iunip sum S '} — All work to be completed in a workmanlike manner according to standard practices. I undti-stand all wakers & extras. Any alteration or deviation from the above specification involving extra cosft will be executed only upon written orders,and will become in extra charge over&above tl,. initials estimate. Our workers are fully covered by Workman's Compensation Insurance. Proposal/Contract Prins and Quality DUTU 1 Fence Co. You Can Count On P.O. Box License No.62940 f x:402�} Brentwood,CA 94513 Chain Link 634-7085 • Fax 516-7085 Ornamental iron Proposal to r' - , }i., = L t Bate : Address 4L 2fr P.O. No. city State zp zr Phone _ � Ship to _ . 6 Fax Address City State Material lnstalled U yes ID no Style Fence I r LJLr Ua' _( J\j Overall Height _ Height of Fabric Style of Fabric lit M CGauge Mesh 3 'YU Knuckle-up Gi Barb-up is^e Posts Gate Frame(Swing) 1-� Gate Frame(Slide) SKETCH Lin. Ft.Complete Fence i ea.Waik fates ea.Walk Cates Imo. ea. give Castes ' 4"- ea.Slide Gates End Posts Inches O.I . Corner Posts inches 0,D. Gate Posts inches O.D. Gate Posts Inches O.D. x E y1 PSG Complete Erection Complete Removal TOTAL COMPLETE $ Terms of Payment Reglred Deposit $ UPON ACCEPTANCE 4F CONTRACT,PLEASE CALL U.S.A.(UNDERGROUND SERVICE ALERT)(800 642-2444)2 DAYS BEFORE INSTALLATION. THEY WILL AT NO CHARGE,LOCATE FOR YOU ALL UNDERGOUND UTILITIES. ACCEPTANCE-The above proposal,when accepted by the Credit Department and an officer of CTR Fence Co.,of its Main Office,becomes a contract between two paries and isnot subact to canceilation. ACCEPTED-DTR F CE CO. ACCEPTED-Please sign and return yellow copy By _M. Daisy X Cate COPY DISTRIBUTION: WHITE-ORIGINAL YELLOW-CUSTOMER PINK-FILE 0TR-106 THE COUNTY OF CONTRA COSTA 110F1'tlaret DELTA STATION Oaktey,CA 94$61 Admin.Off ice:(923)613-2341 Di*atch:(925,1228-8181 WARREN E RUFF or(923)613-8f160 Emergency:9.1.1 $htriff STATE OF CALIFORNIA i DEPARTMENT OF CALIFORNIA HIGHWAY PATROL COLLISION REPORT INFORMATION iiALIFORNIA HIGHWAY PAIRO CHP 418£Rey.1!fl l OR!Q90----_ 5001 KUM 'S0ad DATE) TIME IS roto & Highway 4 -f rnrtinez. California. J4 NCIC NUMB r OFFICER`S I.D.N ER YOUR VEHICLE WAS REMOVED TO: A copy of the collision report can be obtained from the address above4nd will normally be available within 10 days from the date of the collision. A request by mail is preferredand must include; date,time,NCIC number,and Officers I.D.number printed above. The certification for purchase information(see reverse) must also be completed,signed and attached to your written request with your check for payment. Make your personal check or money order payable to the California Highway Patrol(CHF')for$8.04. Reports may also be obtained in person during the office hours stamped above. Please call to determine if the report is ready. in the event the cost exceeds$6.00,you will be notified. Reports are retained 4 years. � A 1i II 3 �� a • ,y S� N fr.', 1 JAM T �. N'M+•�.•wyrn...k,�.y, w.er-w.....� ��Y_ _ �'I SII y: ;. f j.. r r{'':'> �y4��'i�t=3r '^���,�s3- ..,s"' ZX`�''_"t• z`+ ��¢. `'.,{.� � o ��x x^ �''h�y�°Yy���.`'d€rf�t<3.-'4.�'�} x � '��p�.�,�.fy}'��y� 4•. �x A `°'�a�y��S•"tiv,�t .��,xyt r Y��� {'�ifia.. �'� �! x r x ,f I F xt <r ,wra'C 5� ' ry {kms 3F6 e { " 4 w fir. ,:. `;3R\�h�� 'h�'1+� � •���� }, '�,� �� � 412 CtearwoW Dr. • Oakley,CA.94561 M -ter + 6 - September 13,2004 2530 Arnold Drive,Suite 140 Martinez,CA.94553 Dear Sharon Hymes-Offord. Sorry it took so long in getting this papers over to you. I had a really hard time getting estimates. I have a few for you to look over.Also,pictures are included. Thank you for everything! Sincerely, M Fayette ,�j, yoy ,r�yy • s • a • a • • r f s • f f f i f f s • f f CLAIM / BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY �*✓ • BOARD ACTION: NOVEMBER 02, 2004 Claim Against the County, or District Governed by } the Beard.of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California.Government Conies. ) 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: $4,615.00 { r CLAIMANT: EDUARDO BAKER .ATTORNEY: UNTKNOWN DATE RECEIVED: OCTOBER 15, 2004 ADDRESS: P.O. BOX 22192 BY DELIVERY TO CLERK'.ON: OCTOBER 15, 2004 OAKIA'ND, CA 94623 BY MAIL POSTMARKED: OCTOBER 14, 2004 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim, OCTOBER. 15 2004 JOHN S WE E rk Dated: By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Sup sons ( 'This claim complies substantially with Sections 910 and 910.2. s { } 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 hied tate and send warning of claimant's right to apply for leave to present a late claim.(Section 911.3). { ) Other: Dated: B . s f4 ; Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) { } Claim was returned as untimely with notice to claimant (Section 911.3). I BARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. { ) Other: I certify that this is a true and correc#copy of the Board's Order entered in its minutes for this date. Dated; --01 tJ JOHN SWEETEN, CLERK., By , Deputy Clerk WARNING(Gov. code section 13) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Cade 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'turning 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 OHN SWEETEN, CLERK BY Jr do De ut Clerk p Y 3 g, h•0 ..Aare;°t ..la,3n relating t.;trF.+e ofaction 01' death or fo.: iStjitS''� to saa {.x. _ _r, prop_w.5 F, or a;?.,00 ing crops WH be presented not later fsr.�M six E,3€airtsr.. ,aftivr' Asa, ,accrual of the t°3i s €' of action. A claim relating to any odrer cause of xr.ction AM W present"! nk later than (Sr§c year r after the accrual of the F_sxuse of Action. must A Pled Ivit z the £; , S. o},`h Board ;.T ? t its ol'l i.. ;i neo, rY �' 6 4:: k,cgs>;E � d3 ai gii.fag Co$k,-olv Administration Building. 65 sk nc �Stxts.c I'Nla€rthl z, U}:5+ q-1551 _ e if Win is against s3 ai�f.> ris:t r�€sard'.rr. ,s_� by the t�c�£'ER €3 S�rAc'::r"'���oi� y rather than the the �ierkfn .,' 3#€ j"Hstr``k-t .`f5'h43uld filled iris It if the claim "s against more ,kre'sn d3ki=e s:trs3Uc entity, s;£epa3F"aClaim,; i E a e$ s?€:' ;ikd,, �:'.. .'arN # Sur ass, 4.>.h %r fra�� z�3.St$�:n €him Penal CodeSO 72 a the end of Ohs Gn ii2, 1 s v c.a n�a...�:,s s.s.a�x,�a>a w.n e:�e+:��+a��^.a sa:,�.��s s a r,.P: a s<�,s�a�.:n x e;.•a a o x+r,r. sa.: 4;av,a.�¢n.�: ...s.:. RE: tiahnBy- Res r'aed for A 3 ,rWs fliiai ga Suiai p q� q Ailf.0k, £, INCEIVED a Againstai : a.ik � y `,ri (Vow Costa :fir" t ? �� 2004 %3 E K SOArj? Oi-Sf, RVISOpS fn*�„^,, Co (ITI in ths? name) I he r£sr.ra�rsSays'#vd f_f..dfiN'ant 3si:mby makes i`him ag2fnSt taH Cou.n£,rs' o`#s °. €x'r''s'stra Ctb..ea£ or the, - k , ab:3<-tx r>.i."ata:a'r '_i6M in the v#rgr8 of � .� �,. � %rrii.'� in s4.kZ� ���i'b tis air•. r;, ,.,, s `s; y --._._.[,_--�!�� '_ a r��,�a ass§<:## s_it�` ,.,Ya�� d , 1 r:n did the damage or iour"., o4:sin', (Give e x ct d atc afiirdl .3,oi..r z'F. ;!�- r2A, _ Whery A:'a' the damAge.= ' air. >rSii d'4' occur?r;.> t t s s,'.sri.? .,icy <wd c€irm,,zy) S< A 3rf:aw ilk! the thim 3 e or hqur v occur (Give IM da--Asa £4c exra paper r,,j#. a"t..-A r 4. M hal _"dart ff ula x' act or ,ralossion on the part pA` #mit r dMY-h t offllc vs, v 11-hat one the nat.rt..:. of county or dish'% t3€+j rq 5i rvauB. or v rqAf3k'..s ca£ Ang 10" damage or hquW.' owe 0- What damage w", inparics th) your claint rvsulled? Tive fill WC10 of i1julies ar damages While? Much two estinlatch for nuto dalnage.)� 0 i- How 3 the n i 3 �.lah � y above ..:s �,`astm 'a�"$�:E�ude the estimated ?�€'3i2€3un 3'` any 2: �Y1}.� )i t: ��.r �6. � r .�! aS ��� �r Y h. 8..�� S. Names and addlyss"'s of'-�Ofxkess�es, doclug", and hospitals. t v F e of en fr Vim We . 5 ._ ,-.ar .b. .;?i you made a.,u account of this acchlent or z[4E AMOUNT �p.. hex :v d.4�R:r nv..n. .r ..�.Y.... J,F.:"✓Y.V f .,d;{1:#,;5 ifi R;G bt L 4 Gf GI 4v.3 VS�R St T.2.3 R 9 n T R�'s{;:�f.5 x l:8 r:•:^4 C[.M C:Y.Ct S .:M 3 t:&:5 A.. L Si S Code'! :k.et4, 1W .1 pro08den ' < arc sh--111 '+,,"e ..t - ��'AM�37 i .� Name and addmss of A"orney r s 77' SySm 72 • i hi MAI (Amin provides. , } .. .7. soak .:£,:X. eaa'.j5 r:L iJ. to kteD Yia.;y 1.w.1pxiYl§4 nw fit r.sri B2¢:EC '.dt`. .r.'$- ¢..Xfa, Xr.a+.l:7 s4 .7q 74w` n boa ,x iia uR f ;`ry or lo any county. My, or WHO Ward :>. <nc6"i':f"4 a4Eerhorked £ 3 RUmv ov pa z_c Saw if r `" ia . ' > asT . �im9fixaccount voucher, or wrHog, 6 Ya7 . 4FrW a "- impz .:>..:.-t. r f .'' .:te O .;ri' jah for r)a'' .f{$ f... uo! O sin oiw, ye;m by t Hod. Or r'?,i a 2a..s{ <. thousand ,S, 0 ..[>t'h '1 9r_ r£aenr and Ann v.f_ by Qwro ,, §t..'€n :n € hoe of=1 1 a:'be a.ng ten t.s,",£3so-iu df'.+Mr (SI �}spO 4.r i., - p-, trs :%�' .3d}h„ `r'tS3.. 8rz3g3. &ds G.Gka Board of S em-isors of Contra Caste Coin -Claim Questionnaire For- Eduardo Baker 1.. When did the damag or injiury occur"/ Saturday, September 4. 2004 %. Where did she, dwnage or injuny occur? On Hwy 12, in Rio Vista, CA 3. mUo 'ury occur 1 was pulled over by the Rio Vista Police Department dor unrelated driving violation. Then I was taken into custody for a warrant issued by Contra Costa County. 4. Nkhat particular act or omission on the part of the county or district officers, ien?arts, or employees caused the injury or damage? A warrant-was obtained in error. 'I be wvarrant was obtained because the county had inaccurate and faulty records pertaining to my case. , What are the names of county or district officers, seni salts, or employees causing the damage or injury? die departments that caused the ordeal are the Contra Costa County Superior Court, Rio Vista Police Department, and the Superior Courts Collection and Compliance Unit. 6. What damage-or iniuries do your claim resulted? Damages inchude forfeiting bail to get out of jail and all costs associated with that through Aladdin Bail Bonds, Also, vehicle towing, unpound-, and release fees though Rio Vista Police Department. 7. 1-low was, the amount claimed above computed? -1-owing $ 155.00 Release 45M Bail 415,00 injuries $4,000.00 . Name and addresses ol wwrituesses, doctors, and hospitals. Judge Jill C. Fannin Ellen K. Hole, Cowl Probation Officer "fir, Martinez, Collections &Compliance Unit M.-S. Faulke.nberTy, Collections & Compliance Unit Li,,t the expenditures you made on account of this accident or iqj -y`? Pwiitive damages,of$4,000,00, PROBATION ORDER COMMITMENT FORM CONCORD ' rIMARTINE/ 4.1 PITTSBURG ' _i RICHMOND U WALNUT CREEK DE?-ENDrr NT - DOCKET NO. 7M Off° The above named defendant.ttavirl been cortvic , in this ct� the e se{s) f�i on ot: section(s) [J-1123152 _r i_with priors)) I--1 Litter: iT iS 0F3DERED: That F]imposition 1-1 execution of sentence be suspended during period of probation with the following terms: 149 F-F!ROaA10N(Applicable Items Checked): W LJ Abstain from the use of alcoholic beverages. 517.1'-,]Submit to drug/alcohol use detection tests as directed by Court Probation vQiIRT i�R<?S�;s#OV G;Ali t"Ei1:Conditional and revocable release n the i con-mrmur'ty aritho d o ation supervision except as specified by the Court Officer or try any peace officer. for a period of_ /yaps from the date cf this order. ! 1E'1_I Not go to places where alCoholiC beverages ars the chief item of sols. 2, STANDARD TERMS(See reverse€,standard tennis and additional instructions")' 19.1-]Take antabuse as prescribed by physician&if directed by alcohol program. C.i PEVIEW'SATE: PROGRAM TERMS ve€e1 rd�n must appear in Dort. £.J Defendant need not,appear. 1 20 1 Attend and complete the First Offender Drinking Driver's Program: JAIL IFI Ot,LINT"EE€�WO ESTITUTION Level 1 `_1 Level 2 (area of choice authorized) 4 - -- --- hr day onths i J Other_ hr ays/ the credit. 121.I .l Report to Rost Conviction Dunking Driver's Program within 10 days and _ -__ hr days/monihs suspended, comply with its rules and fee requirements. [_1 Ser:tence to corrzrrence (Take completed DL 103 form to DMV within 30 Mays) r l Serve casecutivelwcncurrerrt with—_- --__i-- - 22.4.'Participate in counseling as directed by the Court Probation Officer and r-= J Any imposed sentence. not leave or terminate programwithout lout permission. 1 lb';asn jail Fork Alternative Program 11 Electronic Home Detention � 23.0 Referred for HIV testing.Return to Court on__-_---------�-�-� _ T_County allowed_ 24 CJ Other vccoma t C 15ta v A to nerve Bureau(CAS) da RIVING TERMS Pay for day cre ri,o. ,'mo sery in app ed re entl�l"ram. !� 25.C_]i�'r"tvirrg privilege restricted for---__ to Idrtrngtfrorn: `:ether employment,treatment program ll i Schooll� Pay a FINE ofl 1 Otl1L'F:= i Susp>w�rd Nayment cit?; _ � 26 F.J Driving privilege suspended/revoked for ,___---- ----- � -- ay res.,az.+r n fine of 27.[]Not drive a motor vehicle unless property licensed and insured. ake monthly instaiimerts to Court Collections&Compliance Unit, 28.r;Not drive vehicle with any measurable:alcohol in blood. RO. Box 7515 Sar;Francisco,CA 94120 by:-_. _-_.._ ----- 29.11 If arrested for a violation of 23952 or 23153 CVC,not refuse a Chemical .1 Pay to C#erk of Court by - - --_---_� test for the detection of alcohol. -1 Probation to terminate upon:payment of fine/completion of;'ail sentence. VEHICLE IMPOUNDMENT TERMS days jail cowurrenticonsecutive in lieu of fire. 30.,LJ DEFENDANTS VEHICLE BE: impounded Proof by-_ ._ L"Not Impounded Cli Perform _ hours VOLUNTEER COMMUNITY SERVICE ! 1 Not Registered Owner i_-i Loss of employment C_i Other lieu of gime I I"reu of Interiock 31-171 Install ignition interlock device on any vehicle owned/operated from now $how proof of co np#etion to Cowl by ( until --years after license reinstatement. 32 l 'Provide proof of installation to court by °alar$a+ &tltittifsn , ' ` 33 U Ignition Interlock Device l_l ordered i rot ordered F-1 Make RESTITUTION as determined by the Court Probation Officer Defendant: Cl 1 does not corn vehicle i?has no ability to pay Shaw proof of restitution to court by 34.F Do not drive any motor vehicle unless said vehicle is equipped with a I Pomo CCU =s ,tea_rnents as a result of this conviction. Certified Ignition Interlock Device. 3 # g non r Pay i�tt;er Submit your Person,pier e of residence,storage locker or any vehicle under your control to seamh and seizure at any time of day or night,with or without I warrant,to any apace office; C J for alcotroiic beverages 01_ ! Although not a condition of proba'lon,you are ordered to pay the following fees: ' Not use or possess any dangerous drugs, narcotics, or narcot c l t-1$25 Booking Fee 1-ll$10 Cite Fee C''G.JA -- L.Other Garapfr$rrtalSa YaittiCtlf prescription. I HAVE READ AND RECEIVED A COPY OF THESE CONDITIONS OF PROBATION AND r UNDERSTAND toot i`tava a£'sir*-ig account 6r charge aowurrls,nor have any checks Or Credit AND AGREE TO PERFORM THEM AND UNDERSTAND THAT IF I FAIL TO DO SO,MY P903ATION AAY BE REVOKED .40 I MAY BE SENT ED TO JAIL OR SENTENCED AS OTHERWISE PROVIDE cards n your possession,rontro or custody,except checks madeya# you. BY LAW, DO not anon or have nossession or control of any firearm.or weapon. DEFENDANT'S SIGN 4ruAL 12INeapon orde-red ''confiscated 1.?destroyed i i returned to y --- - SOCIAL SECUPITY# = - j- DOB v7 l fro not anriovfthreatt�nfcont< t__� ADDRESS t STATE 44_ ZIP CODE PHONE#(xxj } ' ;G. l Atlend natterers/oomestic ;!olence program as directed by the Deur 1 COMMITM .TO THE SHERIFF:I HERCERT iFY THAT THE FOREGOING IS ATRUE COPY Probation Officer and not;Gave}or terminate program.without permission. f OF T H E F F JUDGFJET OP, ORDER AND 1S YOUR A;THGRjW FOR THE FXECU`t TN `, !contact Court Probation HER AL FO A ru 4. t~ E f�3 P v " WAN , PROCEEDINGS �•._.,., . l E. rti. ; , D p a, t� E �Y � TER 0;ERK APPU ABILF ENTMES MARKED v. pelt , zx"O4d° s ori P 40. .: 5s. fid;rSutif:�trije f aMG&^Cha.t'get; •.. ., .,S.N,•,• .SSC,a;�:�1£rest wa3 rano ;Q�^Suo Y ; s r'¢;a: 3Yfs �_.._:a..� _ __..__..___.._..._.,.._.a....�.,.,..__....�__..__. S4 &.:'mac*,".3.: _....___.__._.....____ P 9 t_.: y 4i rt._y i'`,..j.,"3L., ,..,.:.,f.�°. .✓__...,... .___:_.,._v__�......,_......___ �..I '1`€t2sJ£;��ak'17"e.'u�a�,Fi?i~,•ofe.,Q£fyU:r3.}fiS 1....d 'i+'u€i..4t?Y. �._4+Ci9ik ('P, f.__�. {'^.vti?p 'tff Handed,Copy r� r?Ui 3ir:'I�i a va � ; 't PTA�eese ti^e� ' APO �' £ v m#.n ..,�, . u>.e._ ,_..._ .. 00,11.,'iu:t a££. .._� video 2('.,i.on k�.Sl'i!. l,la, T j �£� �.._._��.__..._......,.-_m.-..,........a._� _ �, 4p B Fd - } 'Deft. t 43x' tR 5"9, 4Y } - { °.R."v'sPiCi"{4$�i X398 i R 1,3.1.•5 am f3. Pit.e^ndd9Ci CZ3r`f�ti631tT. �� �� ��u"t!1ta'f43ii CG^t:?t..eu":'�'�„S � '�s�&+��X�'•f �§ �" i_;iso-n-cert.. ou,'W#tod per Rule 904.E � � wai s�sf�#t £as se mide, <,i t�ry�1� Q, 5;> '» wd ' . a led.rd..aS��i a Rt o _` �_ ......._ ...,.-- .__.�__._....m,._.._._.e. vTtio t"3d F«`i si)Ci p 1 �y 3r•i`x'.�4Ir�£:Yl.F'�d Mart}#t43d 11`s{K?ic'.'S ,t s 3 ' s e t.;a :i? ..••6)Days a!vacj " !Waivl:S 3caf—s£ e 977wa s "fit j 10-11 A-d-nivDani»,'^_,_.,_,.»_....__.Y P6u^f&t'�<."-+�5,���k.1��3aE•i$?"iis3 9 El Def: f us,,,Ine# d not appamw 3, 7 G1±4 :Vxxr.;{}i t„H.,!�C13?t. .�,.,,....,�_, _.__.....� 0 _:Q::;:Probation granted 'w- PJ argut"!ier", Lj,.•`A4ivil E Y:Fc11. 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CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION; NOVEMER 02 2004 Claim Against the County, or District Governed by ) the Beard of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action.All Section references are to The copy of this document mailed to you is your California Government Codes, ) notice of the action taken on your claim by the .Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and {. 915.4.please note all"Warnings". AMOUNT: $160.00 CLAIMANT: RUTH REEVES # F ATTORNEY: UNKNOWN DATE RECEIVED: OCTOBER 15, 2004 ADDRESS: 1716 COMTOCK DRIVE BY DELIVERY TO CLERK.ON:OCTOBER 15, 200 WAI NUT CREEK, CA 94595-2459 BY MAIL POSTMARKED: OCTOBER 14, 2004 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SW T Jerk Dated: OCTOBER 15, 2004 By: Deputy IT FaROM: County Counsel. TO: Clerk of the Board of Supervisors claim complies substantially with Sections 910 and 910.2. k { ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). { } Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). { ) Other: Dated: les —/5---e)1 By: �" w�. Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) { ) Claim was returned as untimely with notice to claimant (Section 911.3). IV, 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 JOHN SWEETEN, CLERK.,By , Deputy Clerk WARMING(Gov. code sectio 913) Subject to certain exceptions, you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned,have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California,postage fully prepaid a certified copy of this Beard Order and Notice to Claimant, addressed to the claimant as shown above. Dated: tv' HN SWEETEN, CLERK By Deputy Clerk BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY IN STRUC TIIONS TO CLAMANT A. A claim relating to a cause of action for death or for WJury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code§ 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building,651 Pine Street,Martinez,CA 94553, C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. fraud. See penalty for fraudulent claims,Renal Code Sec. 72 at the end of this form. awe a a a a mean an aaaassaassoaasssassaasaasaamawsasantasaaaaamaasaaarmassassasaan0of RE; Claim By; Reserved for Clerk's filing stamp Against the County of Contra Costa or ) 0C T . 5 2004 District) ., (Fill in the name) ) ���`� � t?15. The undersigned claiman her snakes claim against the County of Contra Costa or the above-named district in the sum of$ � 0 — and in support of this claim represents as follows: 1. When did the dpr injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) P ' 3. How did the damage or injury occur? (Give full details;use extra pa if required) 4. What particular act or omission on the part of county or district officers, servants, or:employees s,%- caused�the injury or damage? -s-.� �C7D U 3 ��G�� �F15st;! /1-//i A)i P i i 5 What are the names of county or district officers, servants,or employees causing the damage or injury? J- -/)C, ILS 0 k,&O6` ,l 7-#,�7 A'41-16-- 9 F T co/,/7Tt4,c,7-ne— e I ti °d TZt T SEC SES 1N3Mufgdw AS T4 6 ODD 6. What. damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) C o6 j4 I CIA) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) V 0 ��e C LFtp f Al . 8. Names and addresses of witnesses,doctors,and ho itals: E,b �. ,+ fit/U 1 o AT 19 9. List the expenditures you made on account of this accident or injury: BATE 0 T l0 rrNr Kwrrrw am ras%ran**NRR KKrrNN rrrrr rRir Nr■rN Nr Nr Niw rrriver rKrrrrKwrNrr r NMrr N M R r KrrrKr of } Gov. Code Sec. 910.2 provides"The claim shall be signed by the claimant or by some person on his behalf" SEND NOTICES TO: Attorney ?Fame and address of Attorney } (Claimant's Signature) } Telephone No. )Telephone No. io �. ■NrrNNrwrKwMwrrrrrrr■rrK aeon rresrrwrrrwrrKNwwoKMOUNNrrrwwrrwrrRrverrrrrNrrrrMNKrMrrrri PUBLIC RECORDS NOTICE: Please be advised that this claim forme, oi-any claim filed with.the County under the Tort Claims Act, is subject to public disclosure under the California Public Records .Ants (Gov. Code, 59 6500 of seq.) Furthermore, any attachments,addendums,or supplements attached to tate claim form,including medical records,are also sub ject to public disclosure. r Nwlrrlrri Nr rNRtKrrw Rr rRr rRwrw rtrrrwR*m emo rr R'''tUNN*rrN MOONRNrrrKr%rRRrrrr Ni r rrrrlrrr NOUN$ NO i ICE: Section 72 of the Penal Code provides: Every person who, with intent to defraud,presents for alIowanee or for payment to any state beard or officer, or to any county, city, or district board or officer, authorized to allow or pay tlee name 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 mom than one-year, by a fine of not exceeding one thousand dollars($1,000.00), or by both such imprisonment and fiat, or by imprisonment in the state prison, by a fine of not exceeding ton thousand dollars ($10,000),or by both such imprisonment and fine, 'old TP-!7T S22 SEG TS:TT tOai!-60-.LDo ` �,r� -�,,� '�r��'"a�,,� .ice- .�-t�-C�.-'i-'f%�'�- A + ------ X44 r f + } ?+ + ? r fr + xMI ? f •�,f f i+f F ff�f f, :, f•ffr F f�/ r 4::. /rf : .f + x + / + f v . } f% f. : }; t+ f ;'i -, . 11tdt�t rr " � -%,-',-,%%'---ll --,.'l,.,.,. - -.,--,---l-.... ...... ub,J:::-: - 11 - ' ' ' ' 11 I I 'll '' I", - - I - 11,11 ,11,1111,11,11, 1'I'l'','''""',..""",.'''I I", . -,''.....''..''. 11 11: " rse1 : 1,11,� � I'll, ',',-%%',-",, ..,...,..,...,.,.,.".,".,"""".,.,.,"......,......".",..'','',.,..I.....I--....- .....-....11.111,1.1-111-1 11.111, -.-...111.11,......-.------ 111.i ...........1.11,11,111, 111.I I 11 , � .....11 '' I 'll ? �. o€ 999999999999 9999999 9999999 9 9999999 9 9 9999 7P 19 9 99 999999999 9999 999.99999.9999.99..9..99.99999999.9 999999.999999999.99.999.9 99-9-..99...999 999.99.99 99999 99 99.999 99 99.9999.99 9 99 99999.9.9...9999.9..9.99.999....9999.99999..9999999999999999999 99999999999999 9999.99.99 9 99999 999 999999999999999 9999 9999 99 9999999999999999 99999.9999999 99 99 999999999.99999 99999 9999999 999 9 ! 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Please note the"WARNING"below. Claimant: RAajELBMNry CORRECTED COPY! Attorney: n/,a PLEASE DESTROY PREVIOUS ISSUE Address: 327 West-20th Street, Antioch Amount: 5,000.00 By delivery to Clerk on: �I Date Received: By mail,postmarked on: Bate, not 1e 'b1e 1. FROM: Clerk of the Board of Supervisors TO County Counsel Attached is a copy of the above noted Application to File Late C14im. r DATED: 10/4/04 JOHN SWEETEN,Clerk,By: ' - DEPUTY I1. FROM: County Counsel TO. Clerk of theBoard of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.5). ( The Board should deny this Application to File Late Claim (Section 911.6). F! DATED: ALVANO B.MARCHESI, County Counsel,Bd. -DEPVTY IIL BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( ) This Application is granted (Section 911.6). This Application to File Late Claim is denied (Section 911.6). Ice�rtify that this a true and correct copy of the Board's Order entered in its minutes for this date. DATE: rc1e,m Gr"0 OHN SWEETEN,Clerk,By: ZEf4DEPUTY WARNING(Gov. Cade§911.8) If you wish to file a court action on this matter,you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4(claims presentation requirement). See Government Code Section 946.6.Such petition must be filed with the court within six(6)months from the date your application for leave to present a late claim was denied. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney,you should do so immediately. IV. FROM: Clerk of the Board TO: (1) County Counsel (2)County Administrator Attached are copies of the above Application. We notified the applicant of the Board's action on this Application by mailing a copy of this document,and a memo thereof has been filed and endorsed on the Board's copy of this ,�Claim In accordance with Section 29703. DATED:xlr&7rz6e,>'! 3 JOHN SWEETEN,Clerk,By: DEPUTY V. FROM: (1)County Counsh (2)County Administrator TO: Clerk of the Board of Supervisors Received copies of this Application and Board Order. DATED: County Counsel,By: County Administrator,By: .APPLICATION TO FILE LATE CLAIM Clair" to: BOARD OF SUPERVISORS OF CON7R,A COSTA CX?IF;TY INSM, 3CTIONS TO CLAD-iAN3' A. Claims r-alating to causes of action for death or for injury to peerson or `o per- sonal sona.l property or growing crops and which accrue on or before D Vanv°r 31 , 1987, must be presented not later than the 100th day after the accrual of the cause o. action. Claims relating to causes of action for.death or for injury to pe.-son or to personal property or growing crops and wt,,.ich accrue on or after January 1, 1988, mist 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 aster the accr-.sal of the cause of action. (G,vt. Code B. Claims must be filed With the Clerk of the Board of Supervisors at its off'ioe in, Room 106, County Administration Building, 651 Fine Street, Fa tire:, CA 194553. C. If' claim is against a district governed by the Board of Supervisors, rather t��..r, the County, the name of District should be fil?.edl in. D. If the claim is against more than one public entity, sepa..ate claiTs most be filed against each public entity. E. ` Fraud. See penalty for fraudulent claims, Renal Code Sac. 72 at the end of i s form. Rw r Claim By ) Reserved for C?erk's filing stamp } } [CLERK EER `E Against the County of Contra Costa � T 0 4 RM11 car Rn P.YDistrict) ' Fill in ','he undersigned claimant hereby makes claim against the County of Contra Costa or the above-ra d District in the s,,= of $ _��?� �?� and in support of this claim represents -as fellows: ?. When did the damaZe.or injury occur? (Give exact date and hoar) 2. Where did the damage or injury occur? (Include city and county) c 3. HOW did the damage or injury occur? (Give full details; use extra paper if required) I dr oeoM CJAA-t Ac.c . P.Ck� Iq- M0; old 9611 w7i ,� ` a---? 4. What particular act or adseion on the part of county or district officers, servants or .employees caused. the.injury or.damage" �. wnat are the rimes of county or district Officers, servants or employees causing the da--age or injury? an 5. W'bat damage or injuries do you cla m resulted? (Give full extent of injuries or /dames claimed. Attach two estimates for auto dame. �� , h7�S; r7o bZ1, �„! ' �J 7 .� �'°� ..✓tat ry}p C�. lyra.yG �i.�c�Y.. t . '� w s he amount a a ov E&F ted? (include t e es4uraated amount' of any prospective injury 'or damage.j p- ° ) o - (L ` 0-c. . CJ . Name a� addresses*o?!'witnessas, doctors and hosp?talw. 1 J RCLv X121- 6r ?? S �# y�� t ciaj�c� List the expenditures you made on account of this accident or injury: • � "� iF � � if iF # iE .4E � i'r 9t !F iF � �F '!F!� �E.f �E iE �f !F �_;`_ .c iF �r wt � f �F �F � lE � 1�,,, if �E Gov. Code Sec. 910:2 provides I'The claim must be signed by the c?a loran t S.a"LM NOTICES 'TO: (Attorney) or by same person on his.behalf." Name and Address of ,Attorney 22L� " .1 r- Ci aimant Is gn .ture 'Address Telephone No. Teltphone No.5(t7- AqQ:? __'�io NOTICE Section 72 of the Penal. Code provides: "Every person who, with intent to defraud, presents for allo�mnce or for payment to any state board or rofficer, or to any county, city or district board or offices, authorized to allow or pay the same if .genuine, any false or fraudulent . claim, bill, account, voucher, or writing, is punishable either by imprisortte—nt in the county jail,for a. period of not more thin Luxe•year, by a. Pine of not exceeding one thousand ($19000)p or by 'beh such` imprisorimmt and f"ine;=-or by imprisonment in the stag prison, by a, fine of not exceeding ten thousand .dolls.^s ($1C,000, or by- bath s=h imprisonment and fine. Ltt Ul � �( t 4 V_ OR 4j2-r ` Om ._1 i i 6 LAor --v r y I e M ''.11, l�!11 jj,-� a 1 1 I 1 t � t no bno _ a V,0-4- Li 'Old 2 hL7aA,-�2, 4 0 I .� .� E h i { 6- v,O .0j)iV rjLr�. 11'4 CeQ2-(�L cl I nft. w OcAk,-? �)�-r i A-io, Ono r d c ►'1 4�vr a t tIl C, COP rY16� a RECEIVED DICT 0 4 RECT CLERK BOARD OF SUPERVL, CONTRA gp -TA DI 7345 NMI A=11CIP:A"TOR,Y GUIDANCE Safty Car Seat {4 yrs AND 40lbs) Nuts Street Safety Stairways I Smoke Dete=ctors Tobacco-FreefCun-Tree Home - ParentinalBehavior I Redirection/Set dear Limits l potty Trainin 1 Limit Tv time Reading discussed/Book title: . . +►�v W G YYl 1Li ri -- vx � -s �.,. – PIAN: -1tac�nke given I. HEALT'Ii CAR. MAII�7'iEN CE Discussed risk/benefits of vaccines _ Ac _ en us etarsiinonh e .' Immunizations: Reaction to:;prev3.ous vaccines? : Hep --A Bets #� PPD Ven' at. least 6 mos . after #I) Heb Lead { . Labs: (at dears) No prablem.' Routine mental vests Dental: Class I: T�enta7 -refer�.al. Class II: Mild g�ng �ryt slsmall`n cam ies ent dental ef.errai. Mass -Ill:' g .va t� f-abscellge cares, t3rg ;Ir u f oY � nfect�cncelllxlzts Immd�ate Dental.:referral. Class IV:, 7 Y A ... .... :-, ._... ..«- ....-..-. .....:._a -. .+.tea ...r..u..v..m.-`..- ._,.-..C,r- .• _ _ - �" .r..:mr -'csF=.r-s.,•z�r� r! .<is. w � � a.'• •, Y V 7t+�- J C, i✓ Y Clw►- 1 - _ LA 1 h . ( : ' me :Uut Next v– 1 Year _ fo Well Child Care -- T,_ -L- 3/PNP up inwks nios' fargnavure r� r► ► v�- Patient seen and-discusses thr - ATTENDJ�G NOTE- 777 —2— Si rl itlire 1HILDREN'S HOSPITAL OAKLA D Name: BROWN,RACHEL LOC: CON'TC 2-3 Year Visit MR #: 742345 B.D. : 04/46/02 AGE: 2Y 04M SEX- F Acute/Follow up Visit INS: MCBX-CP' #: 91.055568D ACCT#: 2549690 Date of Visit: 08/23/04 Family M.D. : RANADIVE,SAYALI MD Old chart available? yes no RFS: ,, LAST CXDP VISIT: 10/07/03 Weight: r kg tile) (. Temp:r _ Pulse: RR: EP: Height: (%tile) Head Circ. : cm (M� tile) Reason for visit: C✓ C✓ �„�_ BMI kg/m2 Mile) l Pair. now? des,i Recent pain? Yes � CAI LVH Dietary concerns? Yes,(t Recent weight loss/gain? Yes/ Interval History/Parental Concerns/RCS: . � N7NLl FINDINGS Time In: 2jj +M.t1• V4 �✓� i General Skin ID CA” Head ' N G aS 5 1N 0 y1 5 c Eyes Oropharynx Teeth t Zj Stv�tSSES ,�. �1t .Qt Neck/Nodes Meds: IX," Chest/Lungs' ,K tit- Ci+ V V - -- ` CV IWD Ls: No vrohlem ?> Abdomen �04 � yi,* Yin 4- DIET .DIET: Weaned from bottle Table Food/Well-Balanced Diet GU �t�N Y1 v t Musculo- SLEEP: skeletal Sleep through the night f Neuro ELIMINATION: _ Constipation Diarrheas Social History j DEVELOPMENTAL: I What new things can your child dos? Walk up stairs/jumps -CCircle (3 Years) Says 2 word phrases (2 Years) Uses sentences (3 Years) Feeds self with spoon s . R CEIVED _. _. OCT 0 4c CLEFIK 80 AD OF SfJFxGo A 0 TA ��Jlc,.... Y el .. ..................... . ......... ..... .. .. ..........: .. ....... ................. . .................. ... . ................... .. ........................ . . ..................... . ................. . ?345 Nam AN-LICIPATORY G'JID"Cz. Safer Car Seat (4 yrs A-I23 40lbs) Nuts Street Safety Stairways Smoke Detectors , Tobacco-Free/Gun-Free Home i Parentina/Sehavicr ` Redirection/Set Clear Limits - I j Potty Training Limit TV time i Reading, discussed/Rook title: A.SSESSXENT: W- t4vlL Alt IVY Vlw - -.----P A23• _ — + TY-��+c t1 73J ?�C et Gtiven H dALTFi CARR MAINTHN CR _. Acetattiinophe: use Immunisations. � Discussed-risk/benefits of va^dries . Reaction tq ,,PreYio`4s vaccines' _Nom yes PPD "Hep A#1 Y Hep A# (given at least 6 ,mts. 'after #1; Y at 2 Years) Hgb: Lead:, -- Labs: ( Dental: ( Class I r No prr�blem. RPutine :dental visits Class II: mild gingivatissma caries Dental-refeTal-;: ass III Gsngi�vitis/abs ss Dirge�caraes t7rrent Dental referral. Cl Class IV:. In /oral 'nfectjbn-/cel.I aul t� �Tmtned�ate 33ental.:referral. _.. . a V . Ilk t - , Aa Y � yv ON fry Xext-_visit sn l Year fo WellChild. ChiCarer !'"'�'L-�JPNP l lowp �-a a in wks. mcrs for �_� i+�d4 1follow --- _ �gnature '�,l�t, t�i Patient seenanaTscc sed rrr th �� _ ATTSND G NOTE: "�-; CHILDREN'S HOSPITAL OAKLAND :lame: BROWN,RACH8L LOC: CONIC 2-3 Year Visit MR #: 742345 H.D. : 04/05/02 AGE: 2Y 04M SES-: P Acute/Follow UP Visit INS: MCBX-Cr #: 910555551) ACCT#: 2549690 Date of Visit: 08/23/04 Family M.D. : RA-VADI'VE,SAYALI I IM Old chart availabje? yes no RFS: LAS'S" C.`nDP VISIT: 10/07/03 all Weight: f kcr Temp: Pulse: RR: BP. He-ght. Head Circ. . cm ( tile) t Reason for ` visit BMI: kg/m2 { Mile) / Pain now? Y©stli) Recent pain? Yes C /LVN :Dietary concerns? Yes, i Recent weight loss/gain? YesJ do lnterva History/Parental Concerns/Ros: l it SIM=GS Time In: O, V-t.A-; vv 4. General off, p ' Skin a rr 51 -5 Head 4-VJs , 4j1 Vv p n etS+ eyes ve 4~s i d ENI' d t- 1 r Oropharynx Teeth u Vt 't v�tSS 'S aD. - �tt1t G�.Q Neck/Nodes -Ry -,v " alt h tfh/rYOf fryl Meds: t y � Chest/LungsOL p - Cv No Ls: No problem l Abdomen - V1a Yet 4-S<e :1)IET. F7Weaned from Mottle Table rood/Well-Balanced Diet Gd �a�sV (rdt $ Musculo- SLEEP: skeletal Sleep through the night Neuro 1 ELIMINATION: Constipation i Diarrhea Social History DEVE'LOPMEN T.AL: What new things can your child do? Walk up stairsl;umps ' —. -Zopies Circle (3 Years) 1 Says 2 word phrases (2 Years) } Uses senVences (3 Years) Feeds self with sDoon Claim tri i BOARD OF SU ERMO S OF CONTRA COSTA CMr17 A. Cl.ail:s relating to causes of action for death, cr for inwur y to person or to per- soral property or ,m mwing crops and which accrue or. or before December 31, 19087, must be presented not later than the 100th day after the accru=l 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 veUch accrue on or after janua+ry 1, 1988, must be presented not later than six months after the accrues o:" the cause of action. Clams rel.a4i.ng to any other cause of act on mast be presented not later than one year after the accz-u ,. of the cause of action. (Govt. Corse §911.2.) B. Claims must be filed with the Clark or the Board of Supervisors at itw office In Room 146, County Administration asilding, 651 Fine Street, yz_�rtinez, CA 94553. C. If claim is against a district governed by the Bcarrd of Supervisors, rather t':Lan the County, the rare of the District should be filled in. D. If the claim is against more thazi one public entity, separate cl=aii-s =st be fled against each public entity. E. ' F r .ud- Sea penallity for fraudulent, claims, Penal. Code Sec. 72 at the e"d of t rs forma. R-1 Claim By ) Reserved for Clerk's filing stamp [GLERK ECEIV Against the County of dnt,� Costa ) C ' 0 4 C� W 0ARt=')1, n ; Districts �r ,..._ . a... 7:111-1 in Sia The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the surra of s Lnoo , Pn and in support of this c:air represents as follows. 06 1. When did the a .age or injury occur? (Give exact date and hour) 42 2. Where did the damage or injury occur? (Include city end county) . t' � - co�ft 3. how did the damage or injury occur? (Give fug details; use extra paper if required) r ; 4- I"hat particula-" act or cession on the part of county or district officers, Bert hs cr.empldyees caused.the-injury or.damage' �. rinac are the ra.,*.�es of county or district officers, servants or employees causing the dazge or injury? 5, What damage or injuries do you ciair� resulted? (Give fu ? extent of injuries or jdamages claimed. Attach two estimates for auto damage. Ti Y) 1�( �fl /i+ j�(3lr Q�T iYl t3 1 Lw `*45 c J �J aJ U ry��(� G�7 �'V�y✓cJ 1 ��� �'h�� ,+ ,�r�+''"C" �',r�,�i•4'-�'""`.. ...'�s•,,,J� �' LCA+' P �'.r`h`> ��5"-c,n7� 1�0``�.•�' l�11��" l�k•�. P�c,�'`� �. Ak � ws' he scum 9ai� a 0v c r 11ted? (Include t, e estimated amount of any prospective injury or deo.) f` h1 v1 C) Sarre an addresses o • it* esses, d©dors and hospit�titals. �"`i�� t/� List the expenditures you made on account of this accident or injury: DME 1T AMOUNT Gov. Code Sec. '911J;2 Provides: "The clam must be signed by the clai.rp—nt SST N(r1T(_SS TO: (Attorna ) or by some arson ren his.behalf." Nie and Adrtess of Attorney �qO4 "(/ Claimant's S Lure I/J. Address -�t7 0 On , Telephone No. T'elipphone 'No.i�, NQT10E Section 72 of the Penal. Code provides: "Every person who,, with intent to defraud, presents for a??oS,a_nce 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, bile., accounts voucher s or writing, is punishable either by imprisonment in the countyjail•for a period of not mare than one.year, by a Pine of not exceed ir.g one thousand ($1,000), or by -both such.• im'pr*Izorimment and fine; •or by imprisonment in the state prison, by a fine of not exceeding ten thor.:sand .dollzrs ($10,000, or by both s`,.r-h imprisonment and fi.ne. j 'Cc`s P kRO-L' ptk-t- OIL �..z� ' ? �O� _ —5C-� ,- a 4141 Ae.to AAIJ I ar Llt as Anti • 1 { 4 3 no 6y t VV) 5 h e- wa 5 o�tv J Ll JL - e�e 5- c-, ov u4- _ 44�t456 1 � of f i F } i 1,64 \ r'o-p-rn Con te �L_ olu ISO -CA G�'Kl d n s a -44 - s,Z- n L oAb akcl------------ t 4 4e AL,e",e )oo�- Fuen VY, ( r RAUe S, L, ` � nk- Vlbtx)- no "4, hof coy p w kms' A 540- r 1 I A1bc17v f o 67 r, Lot',11 r - t was 0 x, ci tLy c k�� Ger :5kik- J� -- -h i k2ec;l5 eQ qelli: ?to s4edUly V t! J I ��rr l Ah CA r cq- an- V-�12-V ZA- R42AU �j- r,-r)/57,z i r LVIA ir a �; ri/r t u�� �.l"+�. �. r..., i W-..., �,.�� �e... "x".,,. �.. e.,--. r".� a '-.. .. �..._ "ti:� �_-_ .� �. ., 4.. ,. .. ,...., ._,..... es«r:..s�nw r r........w ���� ..ate �5 tom..... t �"�„ x'�. fs__..�, 4 ..�:sz .,.�,r �' ..,........res/Y _ -`�',_, �-