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Home My WebLink AboutMINUTES - 02282006 - C.21 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: FEBRUARY 28/06 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 lull ,; ; i� Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and JA;`l 1 ;; 2� � (_ %� 915.4. Please note all "Warnings". AMOUNT: $39060.23 COUNTY CC' -�-� CLAIMANT: MITSUI SUMITOMO INSURANCE GROUP for: Toyota Tsusho America., Inca JANUARY 18/06 ATTORNEY:- RYAN BORKERT BY: MANDY LAMHART DATE RECEIVED: --UNKNOWN ADDRESS: 312 ELM STREET, SUITE 1250 BY DELIVERY TO CLERK ON: JANUARY 18/06 CINCINNATI, OH 45202 RECEIVED FROM RISK BY MAIL POSTMARKED: MANAGEMENT FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHNS E rk Dated: JANUARY 18, 2006 By: Deputy II. MOM: County Counsel TO: Clerk of the Board of Sup rvisors ( ) This claim complies substantially with Sections 910 and 910.2. (Q�-T`iis Claim FAILS fo 7 corhply 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: VYti a:Q� 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). IN7 140ARD 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:! 5Y^�Z9' iff JOHN SWEETEN, CLERK, By , Deputy Clerk WARNING (Gov. code sec ion 913) Ir 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: 7'64 o/ geaD 15 JOHN SWEETEN, CLERK By Deputy Clerk OFFICE OF THE COUNTY COUNSEL SILVANO B. MARCHESI COUNTY COUNSEL COUNTY OF CONTRA COSTA Administration Building •- ___. 651 Pine Street, 91h Floor SHARON L. ANDERSON Martinez, California 94553-1229 CHIEF ASSISTANT (925) 335-1800 _' n "� GREGORY C. HARVEY �; `z° ' 1 ;r'"5'� '� VALERIE J. RANCHE es3�p�1 /o �i (925) 646-1078 (fax) .. �'` `3" io ASSISTANTS O`Sr`4 COU%� NOTICE OF INSUFFICIENCY AND/OR. NON-ACCEPTANCE OF CLAIM TO: MITSUI SUMITOMO INSURANCE C;IZO(JI' Kelly Cziilibal, Claims I eclllllcal Associate P.O. Box 5435 f` Cincinnati. 01-145201 RE: CLAIM OF MITSUI SUMITOMO INSURANCE: GROUP Your IllSlll'CCI: Toyota I SLlsho America, Inc. YoLII- Claim No.: AA105557 Please Tale Notice as Follows: The claim you presented a0ainst the County of Contra Costa or District governed by the Board of Supervisors falls to C01111)1y SLibstantlally with the 1'CCILIII'CilleiltS 0.1`C;allforllla Goverillllent code Sectioll 910 and 910.2. or is otherwise insufficient for the reasons checked below: [X] 1. 'The claim fails to state the name and post office address ofthe claimant. [X] 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. The clailll fails to state the date, place or other circumstances of the occurrence rn- triulSaCtioll which ,.ave rise to the claim asserted. [ ] 4. The claull fails to state the name(S) 01 the pUbllc employees) CaLISill`( the 1I11L11'y, d_1111age. or loss. if'known. ] 5. The clanll fails to state whether the aI110Llllt clalllled exceeds tell thousand dollars (510,000). If the claim totals less than tell thollsand dollars (510;000). the claim falls to state the anloullt claimed as of the date of presentation, the estimated all101.111t Ofally prospective injury. damaue or loss so far as known, of the basis Of C011111LIt"Iti011 Ol'the amount Claimed. [X] 6. The claim Is not sl'(..ned by the claimant or by some pel'soil oil his or her behalf. MITSUI SUMITOMO INSURANCE GROUP Re: Claim Page Two [X] 7. You are required to submit your clallll oil the proper form, which is enclosed. Please resubmit vow' claim O11 the eL1c10SeCI 1:01'111. II1Cllld111LI, all the I'ig111red in orm' tion. Gov. Code., § 910.4. Please be aware that you have only a 11mited period of time in which to 111e all amended clallll. Sce Gov. Code. § 910.6. [ ] 8. Other: SIL.VANO 13. MARCHIES1 C:OUN N COUNSEL 13y: —J)g" / Nle nika L. Cooper Deputy County Counsel CERTIFICATE OI S1:RVICH, BY (MAIL (Code Civ. Proc., S§ 1012. 1013x. 2015.5. Evid. Code, §§ 641. (164) l am a resident ofthe State of California. over the age ofeighteen years, and nota party to the within action. My usiness address is Office of the County Counsel 651 Pine Street. 9th I"loor. Martinez. CA 94553-1229. On Z3,zoa�I served a true copyf otills Notice of 111SLIt1ICICIICy and/or Non-Acceptance of'Claim by acing the document in a sealed envelope with postage thereon Frilly prepaid, In the l_!nited States 111,111 at Martinez. California addressed to MitSLll SL1111Itolllo 111SL11'allce Group, Kelly Czimbal, P.O. Box 3=133, Cincinnati. 01-145201, as set forth above. I aln readily familiar with Oftice ol'Cou11ty Counsels practice ofcollection and processing ofcorrespondence for nrliling. Under that practice, it would be deposited with the U.S. Postal Service on that same day with postage thereon Cully prepaid in the ordlll,1ry course ot'business. I declare under penalty of perjury under the laws ofthe State ofCalifornia and the United States ol'Anlerial that the above is true and correct. Executed on- Ua�da� at Martinez, California. I'athleen O'Connell cc: Clerk of the Board of Supervisors (original) Risk Malmo enlent Page 2 *-Mitsui Sumitomo Insurance Group dFECEIVED Kelly Czimbal JAN 1 $ P.O. Box 5435 2006 Cincinnati, OH 45201 CLERK BOARD OF-SUPERVISORS 866.676.6272 ext. 8421 CONTRA COSTA CO. December 16, 2005 Contra Costa Sheriff Office 2467 Waterbird Way SHARON HYMES-OFFORD Martinez, CA 94553 9 2006 - 641 RE: Notice of Subrogation Claim JAN Insured: Toyota Tsusho America, Inc. Claim No: AA105557 Claimant: Ryan Borkert Date of Accident: 11/27/05 To Whom It May Concern:: Please be advised that Mitsui Sumitomo Marine Management ("MSMM") is paying for our insured's damages as a result of the above captioned loss. Our investigation reveals that you were responsible for this loss and we will, therefore, be entitled to recover the amount of damages from you. By the terms of our policy, our Insured's right of claim is assigned to us. Please complete the information on the attached page and return it to us in the self-addressed, stamped envelope. If you have liability insurance to cover this accident, our future correspondence will be with your insurance company. If you do not have liability insurance, please contact the undersigned to make arrangements to reimburse the damages owed. We look forward to hearing from you. If you have any questions regarding this matter, please feel free to contact our office at 1-866-MSMMCSC (1-866-676-6272). Yours truly, Kelly Czimbal Claims Technical Associate Mitsui Sumitomo Marine Management(U.S.A.), Inc., for Mitsui Marine& Fire'Insurance Company of America Sumitomo Marine & Fire Insurance Company of America P.O. Box 5435 Cincinnati,OH 45201 *.Mitsui Sumitomo Insurance Group PLEASE COMPLETE THE FOLLOWING INFORMATION Do you have liability insurance covering this accident? ( ) YES ( )NO Have you reported this accident to your insurance company? ( ) YES ( )NO Your Policy Number: Your Claim Number: Name of your Insurance Company: Their Address: The name of your Claim Representative Your Signature: Your Telephone Number: Return this form in the self-addressed, stamped envelope to: MITSUI SUMITOMO MARINE MANAGEMENT (USA) P.O. Box 5435 CINCINNATI, OH 45201 ATTENTION: RECOVERY SERVICES UNIT Mitsui Sumitomo Marine Management(U.S.A.),Inc., for Mitsui Marine& Fire Insurance Company of America Sumitomo Marine & Fire Insurance Company of America P.O. Box 5435 Cincinnati,OH 45201 Mitsui Sumitomo Insurance Group Mandy Lainhart Elm Street Suite 1250 Cincinnati, OH 45202 866.676.6272 ext. 8408 908.325.0181 Fax December 20,2005 City of Contra Costa Attn: Penny Bailey 2467 Waterbid Way Martinez, CA 94553 RE: Property Damage Lien Insured Toyota Tsusho America, Inc. Claim No AA 105557 Date of Loss 11/27/2005 Claim Amount $3060.23 Claim Number N/A Dear Penny Bailey: Please note that Mitsui Sumitomo Insurance Group is the insurance carrier for Toyota Tsusho. Be advised full and final settlement has been made with our insured. Property Damage $2060.23 Deductible $1000.00 I look forward to hearing from you. If you have any questions regarding this matter, please feel free to contact me at 1.866.676.6272 ext. 8408. Yours truly, Mandy La art RSU-Claim Representative Mitsui Sumitomo Marine Management (U.S.A.),Inc., for Mitsui Marine& Fire Insurance Company of America Sumitomo Marine &Fire Insurance Company of America 31.2-Elm Street, Suite 1250,Cincinnati,OH 45202 Session - PASSPORT December 20, 2005, 15 : 13 : 21 Claim Inquiry - By Claim MLAI 12/20/05 12 : 13: 44 Inquire History Detail Check 0498035 Check Replaces Check Date 12/08/05 Check Amount 636. 72 Check Status Check Accept Amount . 00 Check Type Check Printed P Check Stop ID Check Stop Date 0/00/00 Check Stop Reason Bank 01 Invoice # Invoice Date 0/00/00 Mail Address TOYOTA TSUSHO AMERICA, INC. ATTN: AKO TANAKA 595 MARKET ST. STE. 1920 SAN FRANCISCO CA 94105 Payee Name TOYOTA TSUSHO AMERICA, INC. In Pay of 2002 TOYOTA CAMRY F3=Exit F12=Cancel Session - PASSPORT December 20, 2005, 15 : 13 : 36 Claim Inquiry - By Claim MLAI 12/20/05 12 : 13 : 58 Inquire History Detail Check 0499629 Check Replaces Check Date 12/15/05 Check Amount 423 . 51 Check Status Check Accept Amount . 00 Check Type Check Printed P Check Stop ID Check Stop Date 0/00/00 Check Stop Reason Bank 01 Invoice # Invoice Date 0/00/00 Mail Address A-1 AUTO BODY 1720 EL CAMINO REAL SAN BRUNO CA 94066 Payee Name A-1 AUTO BODY In Pay of 2002 TOYOTA CAMRY LE - INSURED: AKO TANAKA MIDORI F3=Exit F12=Cancel STATP QF CALIFORNA / TRAFFIC COLLISION REPORT p g'05 J CHP 555 CARS Page 1(Rev 1-03)OPI 061 Pace 1 OT 6 SPECIAL CONDITIONS MAGER M+RN CITY JUDICIAL DISTRICT LOCAL REPORT NUMBER ON-DUTY EMERGENCY VEHICL E NAAED FELONY 0 n UNINCORPORATED BAY SUPERIOR wjsapKUM MLIT4 mm NG COUNTY REPORTING DISTRICT BEAT 11-336 *ft 0 CONTRA COSTA l0 COLLISION OCCURRED ON: MO DAY YEAR TIME 92400) NGC S OFFICER I.D. Z 3621 SAN PABLO DAM ROAD 11/27/2005 1850 9320 017411 MILEPOST INFORMATION: DAY OF WEEK TOW AWAY PHOTOGRAPHS BY: O NONE USUNDAY X YES No O AT INTERSECTION WITH: STATE HWY REL X oR 35 FEET EAST OF EL PORTAL DR. ClYEs X NO PARTY DRIVER'S LICENSE NUMBER JSCTATE CLASS ABR BAG SAFETY EQUIP. VEIL YEAR MAKE I MODEL I COLOR LICENSE NUMBER STATE 1 A9103083 A C M G 2003 FORD CROWN VI WHI 1139386 CA DRIVER HAME(FIRST.MIDDLE.LAST) RYAN BORKERT OWNERS NAME ❑SAME AS DRIVER PEDES STREET ADDRESS CONTRA COSTA SAIRIF OFFICE TRUN 555 GIANT IIWY OWNER'S ADDRESS ❑SAME ASDRIM PARKED GrvISTATE I?JP 2467 WATERBIRD WAY MARTINEZ CA 94553 VEHICLE RICHMOND CA 94804 DISPOSITION OF VEHICLE ON ORDERS OF: DoffICER E]DWAR OTHER BIC- SEX HMR EYES HEIGHT WEIGHT BIRTHDATE RAG? DRIVEN AWAY CLIST Lb 0- GRN IYI BRN GRN 6-0 180 3/11/1975 W PRIOR MEG!DEFECTS XINON_APP. REFER TO NARRATIVE OTHER HOMEPHONE BUSINESS PHONE VEHICLE MENRFICATION NUMBER: (925)646.2441 UNKNOWN VEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA, INSURANCE CARRIER POLICY NUMBER UNKNONE X MINOR SELF-INSURED 48 HMOD MAJOR ROLL-OYER OIR OF TRAVEL ON ST— OR HIGHWAY SPEED LIMR G D07 E SAN PABLO DAM ROAD 5 CAL-7 TCPlPSC ►ew PART. DRIVERS LICENSE NUMB?R STATE CLASS AIR BAC I SAFETY EQUIP. VEHL YEAR MAKE I MODEL I CALOR LICENSE NVMSER STATE 2 N5132546 CA C IYI G 202 TOYOTA CAMRY SIL 4YWE734 CA DRIVER NAME(FIRST,MIDDLE.LAST) AKIO KENNE•ITI TANAKA OWNERS NAME F—lSAME AS DRIVER PEDES- STREETADDRESS TOYOTA TSHUSHOLA94ER.INC. TRLAN 516 BAYVIEW AVE. OWNERS ADDRESS ❑SAME AS DRrVFR PARKED CITYISTATEIZIP 595 MARKET ST.#1920 SAN FRANCISCO CA 94105 VEHW NIILL13RAE CA 94030 DISPOSITION Of VEHICLE ON ORDERS OF: aOFFICER EDRNER [-�OTFIER BICY- F--r- EYES JHEIGHT WEIGHT BIRTHDATE RACE COURTESY TOW-(408)248.9116 CLIST Mo Dry YawjM_[BLK 5-05 140 11/20/1958 A PRIOR MECHANICAL DEFECTS NONE APP, El REFER TO NARRATIVE OTHER HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER (650)871-7310 (415)817-9113 VEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER UNC ❑NONE ❑MINOR NfITSUI SIMTMOTO T3VR 8402738 01 d- -OD R ROLL-OVER DIL OF TRAVEL ON STREET OR HIGHWAY SPEED UMIIT CA DOT E SAN PABLO DAM ROAD 5 CAL-T TCPNPSc Mcw PARTY DRIVERS LICENSE NUMBER STATE CLASS AIR BAG I SAFETY EOUIP. VELA YEAR MAKE I MODEL I COLOR LICENSE NUMBER STATE 3 DRIVER NA1E(FIRST,MIDDLE,LAST) OWNER'S NAME I ISAMEASDRPJER PEDES- STREET ADDRESS u TRAP! OWNER'SADDR!!SS aSAMEASDRFVER PARKED CITY I STATE I ZIP YeHrxE DISPOSRION OF VEHICLE ON ORDERS OF: OFFICER DRIVER THER I BICY. SEXHAIR EYES HEIGHT WEIGHT BIRTHDATEE RACE CLIST Mb Dry Vom �-I PRIOR MECHANCINL DEFECTS nNONE APP. ER TO NARRATIVE DINER HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER 11 '' VEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER LINK NONE nMINOR MOO AWOa ROLL-OVER DIR OF TRAVEL ON STR_E T CR HIGNINAY SPEED UMIT G DOT CAL•T TCPIPSC MCIMX PREPARER'SNAIE DISPATCH NOTIFIEDREVIE DATE 6LWEWED E.SANCHEZ 017411 YES 140 PVA STATE 4`CALIFORNb1 TRAFFIC COLLISION CODING CHP 555 CARS Paget(Rev.1.03)OPI 061 Page 2 of e DATE OF COLLISION(MO.DAY YEAR) TIAIE(NoD) NCI:■ OFFKER LD. NLOAMA 11/27/2005 1850 9320 017411 11-336 OWNER OWNERADDRESS NOTIFIED PROPER YES[]NO DAMAGE DEscRwnoNoF oAMACE SEATING POSITION SAFETY EQUIPMENT INATTENTION CODES OCCUPANTS L-AIR BAG DEPLOYED LUC BICYCLE•HELMET A M•AIR BAG NOT DEPLOYED DRIVER PASSENGER CELL PHONE HANDHELD A& A•NONE IN VEHICLE B•CELL PHONE HANDSFREE B•UNKNOWN N-OTHER V•NO X•NO C•LAP BELT USED P•NOT REQUIRED W•YES Y-YES C•ELECTRONIC EQUIPMENT D•LAP BELT NOT USED D-RADIO/CD 1 2 3 1-DRIVER E•SMOKING E•SHOULDER HARNESS USED 2 TO 6•PASSENGERS CHILD RESTRAINT EJECTED FROM VEHICLE F-EATING 4 S 6 7-STA.WGN REAR F•SHOULDER HARNESS NOT USED 0-IN VEHICLE USED G-CHILDREN 8 OCC TRK OR VAN G-LAP/SHOULDER HARNESS USED R-IN VENUE NOT USED 0•NOT EJECTED N-ANIMALS O .P H•LAPISHOULDER HARNESS NOT USED 1-FULLY EJECTED 9•POSITION UNKNOWN J-PASSIVE RESTRAINT USED S-1N VEHICLE-LE 2- EJECTED LE USE UNKNOWN I- PERSONNEL HYGIENE 0.OTHER K•PASSIVE RESTRAINT NOT USED T- VEHICLE IMPROPER USE 3•UNKNOWN UNKNOWN J•READING N U•NONE W VEHICLE K-OTHER ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK(')SHOULD BE EXPLAINED IN THE NARRATIVE. PRIMARY COLLISION FACTOR MOVEMENT PRECEDING UST NLWSER P)OF PARTY AT FAULT TRAFFIC CONTROL DEVICES ) 2 3 SPECIAL INFORMATION 1 2131 COLLISION A VC SECTION VIOLATED: CITEDF7eES A CONTROLS FUNCTIONING I JA HAZARDOUS MATERIAL I JA STOPPED LK1^,'• B CONTROLS NOT FUNCTIONING' 18 CELL PHONE HANDHELD IN USE X IS PROCEEDING STRAIGHT B OTHER IMPROPER DRIVING- C CONTROLS OBSCURED I IC CELL PHONE HANDWASE IN USE IC RAN OFF ROAD X D NO CONTROLS PRESENT/FACTOR* X X ID CELL PHONE NOT IN USE I ID MAKING RIGHT TURN C OTHER THAN DRIVER- TYPE OF COLLISION E SCHOOL BUS RELATED E MAKING LEFT TURN D UNKNOWN" A HEAD•ON IF 75 FT MOTORTRUCK COMBO F MAKING U TURN X B SIDE SWIPE G 32 FT TRAILER COMBO G BACKING C REAR END H H SLOWING/STOPPING WEATHER (MARK 1 TO2ITEMS) D BROADSIDE 1 I PASSING OTHER VEHICLE X JA CLEAR E HR OBJECT J J CHANGING LANES B CLOUDY ^F OVERTURNED K K PARKING MANEUVER C RAINING G VEHICLE/PEDESTRIAN L I IL ENTERING TRAFFIC D SNOWING H OTHER': Im X I M OTHER UNSAFE TURNING E FOG/VISIBILITY FT. N N RING INTO OPPOSING LANE I F OTHER" MOTOR VEHICLE INVOLVED WITH 0 0 PARKED { G WIND A NON-COLLISION P P MERGING LIGHTING B PEDESTRIAN O 0 TRAVELING WRONG WAY A DAYLIGHT X C OTHER MOTOR VEHICLE 1 Z 3 OTHER ASSOCIATED FACTORS IR OTHER% B DUSK-DAWN D MOTOR VEHICLE ON OTHER ROADWAY MARK I TO 2 ITEMS) X C DARK-STREETLIGHTS E PARKED MOTOR VEHICLE A WSECTMvinATm. altoYES D DARK-NO STREET LIGHTS F TRAIN BNO E DARK•STREET LIGHTS NOT G BICYCLE g VC11EMONVOATM WED BYES IO FUNCTNING- H ANIMAL: NO SOBRIETY-DRUG ROADWAY SURFACE C `'C VOLAU& CnW YES 1 2 3 PHYSICAL DRY 1 FIXED OBJECT: ONO (MARK t TO 21TEMS) X A B WET D X IX I JA HAD NOT BEEN DRINKING C SNOWY•ICY J OTHER OBJECT: E VISION OBSCUREMENT: I I B HBD-UNDER INFLUENCE 0 SLIPPERY(MUDDY.OILY.ETC.) F INATTENTION•: I IC MBD-NOT UNDER INFLUENCE' ROADWAY CONDITION(S) G STOP d GO TRAFFIC 10 MBD•IMPAIRMENT UNKNOWN' (MARK t TO 2 ITEMS) PEDESTRIANS ACTIONS H ENTERING/LEAVING RAMP IE UNDER DRUG INFLUENCE- TA HOLES.DEEP RUT- X A NO PEDESTRIANS INVOLVED I PREVIOUS COLLISION F IMPAIRMENT•PHYSICAL' B LOOSE MATERIAL ON ROADWAY* B CROSSING IN CROSSWALK J UNFAMILIAR WITH ROAD G IMPAIRMENT NOT KNOWN C OBSTRUCTION ON ROADWAY* AT INTERSECTION K DEFECTIVE VEH.EQUIP.: CITED IH NOT APPLICABLE D CONSTRUCTION•REPAIR ZONE C CROSSING IN CROSSWALK-NOT B YES 11 SLEEPY/FATIGUED E REDUCED ROADWAY WIDTH AT INTERSECTION NO F FLOODED' D CROSSING.NOT IN CROSSWALK I IL UNINVOLVED VEHICLE G OTHER': E IN ROAD•INCLUDES SHOULDERM OTHER*: X H NO UNUSUAL CONDITIONS F N R NOT IOAD X X N NONE APPARENT G APPROACHING/LEAVING SCHOOL BUS 0 RUNAWAY VEHICLE SKETCH FOR SKETCH DIAGRAN-1,SEE PAGE 3 0 MIsc LANM DOT INDICATENORTH �\crt M411 .,_..DA p'a JS0 CT OTHER STATE OF CALIFORNIA SKETCH DIAGRAM CIV 555 Pate A(Rev.8-97) OPI 042 PAGE 3 OF 6 DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 11/27/2005 1 1850 19320 1017411 11-336 ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED(SCALE= ) SAN PABLO DAM ROAD 0 V.2 I EL PORTAL DR PREPARED 8Y I.D.NUMBER DATE REVIEWER'S NAME DATE E. SANCHEZ 1017411 111/27/2005 STATE OF CALIFORNIA FACTUAL DIAGRAM CHP 555 Page 4(Rev.8.97) OPI 042 PAGE 4 OF 6 DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 11/27/2005 1 1850 1 9320 1017411 11-336 ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED(SCALE= j SAN PABLO DAM ROAD I Vehicles moved from point of EL PORTAL DR rest prior to CHP arrival. PREPARED BY I.D.NUMBER DATE REVIEWER'S NAME DATE E. SANCHEZ 1017411 1 11/27/2005 STATE OF CALIFORNIA NARRATIVE/SUPPLEMENTAL PAGE 5 OF 6 DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 11/27/2005 1850 9320 017411 11-336 1 FACTS: 2 3 NOTIFICATION: I was dispatched to a call of a property damage only traffic collision at 1855 4 hours. I responded from SR-24 at Alhambra Blvd., and arrived on scene at 1910 hours. All times, 5 speeds and measurements in this investigation are approximate. Measurements were taken by 6 visual estimation. 7 8 SCENE: At the scene of this collision, 3621 San Pablo Dam Road is a private parking lot, located 9 in the unincorporated area of Contra Costa County. The roadway is straight and level. The 10 surface is composed primarily of asphalt. For further scene information, refer to the Factual 11 diagram on page 5. 12 13 PARTIES: 14 15 PARTY#1 (Borkert)was located on scene, standing next to V-1 upon my arrival. Party Borkert 16 was identified by his valid California driver's license. Borkert was placed as a.party by the 17 following item: 18 19 • His statement that he was driving V-1. 20 21 Ford Crown Victoria Vehicle #1 (V-1) was located in the parking lot upon my arrival.:V-1 22 sustained minor front end damage consisting of a scratched left rear fender and rear bumper. No 23 prior damage to V-1 was noted or claimed. 24 25 PARTY#2 (Tanaka)was located on scene, standing next to V-2 upon my arrival. Party Tanaka 26 was identified by his valid California driver's license. Tanaka was placed as a party by the 27 following item: 28 29 His statement of being the driver of V-2. 30 31 Toyota Camry Vehicle#2 (V-2)was located in the parking lot upon my arrival. V-2 sustained 32 moderate damage from this collision consisting of a detached front bumper and a scratched right 33 front fender. No prior damage to V-2 was noted or claimed. 34 35 PHYSICAL EVIDENCE: 36 None. 37 38 39 40 41 PREPARED BY I.D.NUMBER DATE REVIEWER'S NAME DATE E. SANCHEZ 017411 11/27/2005 Y _ 1 � STATE OF CALIFORNTA NARRATIVE/SUPPLEMENTAL PAGE 6 OF 6 DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 11/27/2005 1850 9320 017411 11-336 1 STATEMENTS: 2 3 PARTY#1 (Borkert) 4 Party#1 related that he was driving his vehicle eastbound, in the parking lot approaching the rear 5 of V-2, at approximately 5 mph. P-1 saw V-2 stopped in front of him. As P-1 began to pass V-2 6 on the right side, P-1 saw V-2 accelerate and P-1 felt a bump to the left rear of V-1. 7 8 PARTY#2 (Tanaka) 9 Party#2 related that he was driving his vehicle eastbound, in the parking lot at approximately 1 10 mph. P-2 stated that he was looking at the street signs, when all of a sudden he saw V-1 pass 11 him at a high rate of speed, colliding with the right front of V-2. 12 13 OPINIONS AND CONCLUSIONS: 14 15 SUMMARY:This collision occurred in the parking lot at 3621 San Pablo Dam Road. Party#1 was 16 driving V-1 at approximately 5 mph, approaching the rear of V-2. Party#2 was driving V-2 at 17 approximately 1 mph. Due to P-1's unsafe turning movement, the left rear of.V-1 collided with the 18 right front of V-2. After the collision both parties parked their vehicles in the parking lot. 19 20 AREAS OF IMPACT(A01): 21 22 AOI #1 (V-1 vs. V-2)was located 65 feet south of the south roadway edge line of San Pablo Dam 23 Road and 35 feet east of the east roadway edge line of EI Portal Way. 24 25 The area of impact was determined from statements and vehicle damage. 26 27 CAUSE: Party#1 caused this collision by making an unsafe turning movement as V-1 passed 28 V-2. 29 30 The cause was determined from statements and vehicle damage. 31 32 RECOMMENDATIONS: None. 33 34 35 36 37 38 39 PREPARED BY I.D.NUMBER DATE REVIEWER'S NAME DATE E. SANCHEZ 017411 11/27/2005 12/15/2005 at 02:58 PM File ID: 109603 49554 NATIONAL INSURERS AUDIT NIAB (908) 526-5900 Fax: (908)526-5182 Written By: JASON FISCHER PRELIMINARY SUPPLEMENT 1 WITH SUMMARY Insured: AKIO TANAKA MIDORI Claim #AA10557 Owner: AKIO TANAKA MIDORI Policy #SMF36CIU1207F Address: Date of Loss: 11/27/2005 Type of Loss: Other Day: Point of Impact: 12. Front Evening: Inspect OTHER Location: Repair A-1 AUTO BODY Business: (650)589-7115 Facility: CA 3 Days to Repair License # 2002 TOYO CAMRY LE 4-2.4L-FI 4D SED Int: VIN: UNK Lic: Prod Date: Odometer: Air Conditioning Rear Defogger Tilt Wheel Cruise Control Intermittent Wipers Body Side Moldings Dual Mirrors Roof Console Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks Power Mirrors Driver Air Bag Passenger Air Bag Front Side Impact Air Bag Cloth Seats Bucket Seats ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1# FRT BUMPER COVER 1 167.00 2.0 2.2 2# R FRT BUMPER FOG LAMP COVER 1 28.29 Incl. 3** A/M R FENDER PANEL 1 195.00 1.6 2.0 4# R FENDER PANEL EDGE 1 0.5 5# R FENDER LINER 1 60.93 Incl. 6# R FRT DOOR OUTSIDE 1 0.9 7# R FRT BELT MLDG 1 0.3 8# R FRT DOOR HANDLE 1 0.3 9# FLEX 1 8.00 10# HWR 1 4.00 11# CLEAR COAT 1 1.6 12# TINT 1 0.5 13# COLOR SAND AND BUFF 1 0.5 14# CVR CAR 1 8.00 15# SO1 FRT UPR BUMPER REINFORCEMENT 1 26.42 16# SO1 R FRT OTR BUMPER REINFORCEMENT 1 25.66 0.4 17# S01 AIM FRT HEADLAMPS 1 0.4 18# Sol R FRT COMBO LAMP ASSY 1 253.99 0.3 ------------------------------------------------------------------------------- Subtotals =_> 777.29 5.9 7.6 1 i 12/15/2005 at 02:58 PM File ID: 109603 49554 PRELIMINARY SUPPLEMENT 1 WITH SUMMARY 2002 TOYO CAMRY LE 4-2.4L-FI 4D SED Int: ------------------------------------------------------------------------------- Estimate Notes: AGREED FIGURE WITH FRED OF A-1 AUTO BODY ON DECEMBER 7, 2005 @ 11:08 FAX COPY TO SHOP @ 65-589-7115 NO SUPPLEMENTS W/O PRIOR APPROVAL. THIS IS NOT AN AUTHORIZATION FOR REPAIRS. Parts 777.29 Body Labor 5.9 hrs @ $ 72.00/hr 424 .80 Paint Labor 7.6 hrs @ $ 72.00/hr 547.20 Paint Supplies 7.6 hrs @ $ 30.00/hr 228.00 ---------------------------------------------------- SUBTOTAL $ 1977.29 Sales Tax $ 1005.29 @ 8.2500% 82.94 ---------------------------------------------------- TOTAL COST OF REPAIRS $ 2060.23 ADJUSTMENTS: Deductible 0.00 ---------------------------------------------------- TOTAL ADJUSTMENTS $ 0.00 NET COST OF REPAIRS $ 2060.23 FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM: ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES: B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS: ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT W/_=WITH/_ SYMBOLS: #=MANUAL LINE ENTRY *=OTHER [IE. .MOTORS DATABASE INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. MQVP=MANUFACTURER'S QUALIFICATION AND VALIDATION PROGRAM. OPT OEM=ORIGINAI. EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. 2 12/15/2005 at 02:58 PM File ID: 109603 49554 PRELIMINARY SUPPLEMENT 1 WITH SUMMARY 2002 TOYO CAMRY LE 4-2.4L-FI 4D SED Int: 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 MANUFACTURER OF YOUR VEHICLE. Estimate based on MOTOR CRASH ESTIMATING, GUIDE. Unless otherwise noted all items are derived from the Guide APM8521 Database Date 11/2005, COC Data Date 11/2005, 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 Mme from an alternate data source. Tilde sign (-) items indicate MOTOR Not-Included Tabor operations. Non-Original Equipment Manufacturer afterniarket parts are described as PM, Qual Repl Parts or Com Repl Parts which stands for Competitive Replacement Parts. Used parts are described as IN), 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 AM, Qual Repl Parts or Comp Repl Parts 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. Some 2006 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts data from the previous year may be used. The Pathways estimator has a cmplete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. OCC Pathways - A product of Ox Information Services Inc. 3 a 12/15/2005 at 02:58 PM File ID• 109603 49554 PRELIMINARY SUPPLEMENT 1 WITH SUMMARY 2002 TOYO CAMRY LE 4-2.4L-FI 4D SED Int: ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- ------- ADDED ITEMS ------- 15# SOl FRT UPR BUMPER REINFORCEMENT 1 26.42 16# SO1 R FRT OTR BUMPER REINFORCEMENT 1 25.66 0.4 174 SO1 AIM FRT HEADLAMPS 1 0.4 18# SOl R FRT COMBO LAMP ASSY 1 253.99 0.3 ------------------------------------------------------------------------------- Subtotals =_> 306.07 0.7 0.4 ------------------------------------------------------------------------------- Estimate Notes: AGREED FIGURE WITH FRED OF A-1 AUTO BODY ON DECEMBER 7, 2005 @ 11:08 FAX COPY TO SHOP @ 65-589-7115 NO SUPPLEMENTS W/O PRIOR APPROVAL. THIS IS NOT AN AUTHORIZATION FOR REPAIRS. Parts 306.07 Body Labor 0.7 hrs @ $ 72.00/hr 50.40 Paint Labor 0.4 hrs @ $ 72.00/hr 28.80 Paint Supplies 0.4 hrs @ $ 30.00/hr 12.00 ---------------------------------------------------- SUBTOTAL $ 397 .27 Sales Tax $ 318.07 @ 8.2500% 26.24 ---------------------------------------------------- TOTAL SUPPLEMENT AMOUNT $ 423.51 r �COST, OF SUPPLEMENT $ 423.51 \ C Estimate 1636.72 JASON F'ISCHER Supplement S1. 423.Sl- JASON FISCHER Workfile Total $2060.23 NET COST OF REPAIRS $ 2060.23 4 12/15/2005 at 02:58 PM File ID: 109603 49554 PRELIMINARY SUPPLEMENT 1 WITH SUMMARY 2002 TOYO CAMRY LE 4-2.4L-FI 4D SED Int: FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM: ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES: B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS: ADJ�ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT W/_=WITH/_ SYMBOLS: #=MANUAL LINE ENTRY *=OTHER [IE. .MOTORS DATABASE INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. MQVP=MANUFACTURER'S QUALIFICATION AND VALIDATION PROGRAM. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. 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 MANUFACTURER OF YOUR VEHICLE. Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived fran the Guide APM8521 Database Date 11/2005, CCC Data Date 11/2005, and the parts selected are OEM-parts manufactured by the vehicles Original Equiprent 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 cane frau an alternate data source. Tilde sign (-) items indicate MOTOR Not-Included Labor operations. Non-Original Equignent Manufacturer aftermarket parts are described as AM, Qual Repl Parts or Carp Repl Parts which stands for Ccnpet.itive 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. Same parts that are described as AM, Qual Repl Parts or Camp Repl Parts 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. Sane 2006 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data fran the vehicle manufacturer, labor and parts data frau the previous year may be used. The Pathways estimator has a canplete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. Ox Pathways - A product of CCC Information Services Inc. 5 DEC-07-05 15:27 FROM-NIAB _`, + T-650 P.003/005 F-214 12/07/2005 ac 11:�6 AM File 10; 109603 49554 NATIONAL INSURERS AUDIT Nrnn (908)526-5900 Pax: (909)526-5182 Written By; JASON FISCHER PR$LIMINARY ESTIDSATE, insured: AKIO TANAKA MIDORI Claim ##AA10557 Owner: AKIO TANAKA MIDORI Policy #SMF36CIU1207F Addrasa: Date of Logs: 11/27/2005 Type of Loss: Other Day: Point of Impact: 12. Front Evening: Inspect. OTHER Location: Repair A-1 AUTO; BODY Buainasa: (650)589--7115 pacility: CA 3 Days to Repair License #► 2002 TOYO CAMRY LEI4-2.4L-FI 4D SED Int: VIN: UNK Lie: Prod Date: Odometer: Air Conditioning Rear Defogger Tilt Wheal Cruise Control Intermittent Wipers Body Side Moldings Dual Mirrors Roof Console Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks Power Mirrors Driver Air Bag Passenger Air Bag Front Side Impact Air Bag Cloth Seats Bucket Seats NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT -------------------7------------------------------------------------------------ 1# FIST BUMPER COVER 1 167.00 2.0 2.2 2# R;FRT BUMPER FOG LAMP COVER 1 28.29 Incl. 3"* A).M R FENDER PANEL 1 195.00 1.6 2.0 4# R :FENDER PANEL EDGE 1 0.5 5#k R1FENDER LINER 1 60.93 Incl. 6# RtFRT DOOR OUTSIDE 1 0.9 7# RIFRT BELT MLDG 1 0.3 8$ R :FRT DOOR HANDLE 1 0.3 9# FLEX . 1 8.00 1011 HOR 1 4.00 1.1# CLEAR COAT 1. 6 12# TINT 1 0.5 131E COLOR SAND AND BUFF 1 0.5 10 CVR CAR 1 8.00 ------------------------------------------------------------------------------- Subtotals 471.22 5.2 7.2 1 DEC-07-05 15:27 FROM IAS _ - + T-650 P.004/005 F-214 12/07/2005 at 11:56 AM File ID: 109603 4.9554 PML324INARY EST7IolATE 12002 TOYO CAMRY LE 4-2.4L-FI 4D SEF Int: -----------------=------------------------------------------------------------- Estimate Notes: AGREED FIGURE WITI FRED OF A-1 AUTO BODY ON DECEMBER 7, 2005 @ 11:08 FAX COPY TO SHOP 65-599-7115 NO SUPPLEMENTS W/Q PRIOR APPROVAL. THIS IS NOT AN AUTHORIZATION FOR REPAIRS. Parts 471.22 Body Labor 5.2 hrs @ $ 72.00/hr 374.40 Paint Labor 7.2 hrs @ $ 72.00/hr 519.40 ! Paint Supplies 7.2 hrs @ S 30.00/hr 216.00 ---------------------------------------------------i SUBTOTAL $ 1580.02 Sales Tax $ 687.22 @ 8.25003 56.70 ---------------------------------------------------- TOTAL COST OP REPAIRS $ 1636.72 i ADJUSTMENTS: Deductible 0.00 ---------------------------------------------------- TOTAL ADJUSTMENTS NET COST OF REPAIRS $ 1636-7.2 i FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM: ANY PERSON WHO KNgWINGLY 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 LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO LSE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR ABBREVIATIONS/SYMJIOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES: H=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F-LRAME G®GLASS M-MECHANICAL P=FAINT LABOR S-STRUCTURA� T-TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS: ADJ=ADJACENT ALGNaALIGN 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-INCLUflSD MISC-MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL oP-OPERATION NO=LINE NUMBER QTYI=QUANTITY QUAL RELY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART 90MP REPL PARTS=COMPETITIVE REPLACEMENT PARTS IRECOND-RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R-R«MOVE AND REPLACE RPR=RFPAIR RT=RIGHT SECT=SECTION SUB'L=SUBLET LT-LEFT W/O=WITHOUT W/_=WITH/_ SYMBOLS; 4=MANUAL, LINE ENTRY —OTHER [IE. .MOTORS DATABASE INFORMATION WAS CHANGED] **-DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. MQVP=MANUFAOTURER'S QUALIFICATION AND VALIDATION PROGRAM. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS ZITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. I 2 DEE-07-05 15:2T FROM-NIAS =='1 + T-650 P.005/005 F-214 i 12/07/2005 at 11:96 AM File ID: 109603 9.9559 PRELXMXNARY ESTIMATE : 2002 TOYO CAMRY LE 4-2.4L-FI 40 SED Int: THIS ESTIMATE HAS :SEEN PREPARED BASED ON THE USE OF CRASH PARTS SOPPLIED BY A SOURCE OTHER THAN !THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES APPLICABLE TO THSgE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OF THF PARTS, RATHER THAN BY THE ORIGINAL, MANUFACTURER OF YOUR VEHICLE. Estimate based on MOTOR CRASH ESTIMATING GUIDC. Unless otherwise noted all items are derived from the Guide ARMS521 Database Data 11/2005, CCC Data Date 11/2005, and the parts selected are OEM-parrs manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at of/vehicle dealerships: Asterisk (") or Double Asterisk (*•) indicates that the parts and/or labor information provide4 by MOTOR may have been modified or may have come from an alternate data source. Tilde sign (-) items indicate MOTOR Noe-Included Labor operations. Non-Original Equipment Manufacturer aftermarkgt parts are described as AM, Qual Repl Parts or Comp Repl Parts which stands for Competitive Replacl:ment Parts. Used parts are described as LKQ, Qual Racy Parts, RCY, or USED. Reconditioned parts ire described as Recon. Recored parts are described as Recore. NAGS Part Numbers and Prices are provided by National Auto Glass Specifications, Inc. Pound sign ((1) ieems indicaee manual entrigs. Some parts that are described as AM, Qual Repl Parts or Comp Repl Parts may be OE Surplus parts or other of 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. Soma 2006 vehicles contain minor changes from the previous year. For those vehicles, prior to recgiving updated data from the vehicle manufacrurar, labor and parts data from the previous year may be used. The Pathways estimator has a complete list of applicable vehicles. Parts numgers and prices should be confirmed with the local dealership. CCC Pathways - A product of CCC Information Services Inc. i i i 3 CLAIM oil BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY V • BOARD ACTION: FERU4RY 28/06 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". i AMOUNT: $139.95 4'�1 ��,�� 1 -'_'J 2000 CLAIMANT: JUSTIN MOORE COUNTY 00JN30EL IMA iTo'HEZ CALIF. ATTORNEY: UNKNOWN DATE RECEIVED: JANUARY 19, 2006 ADDRESS: 5214 JOMAR DRIVE BY DELIVERY TO CLERK ON: JANUARY 19, 2006 CONCORD, CA 94521-2343 : BY MAIL POSTMARKED: JANUARY 18, 2006 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JANUARY 19' 2006 JOHN SW T Jerk Dated: By: Deputy II. FkOM: County Counsel. TO: Clerk of the Board of Su ervisors (L�-Tliis 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: �'orf OCp By: Deputy County Counsel II1. 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 HOARD 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'"r'' --W 4t] JOHN SWEETEN, CLERK, By , Deputy Clerk WARNING(Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage frilly prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:: %�Qya/2 yl, 9 AOHN SWEETEN, CLERK By Deputy Clerk r 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. ones SMONERSON0smansNODOSE NME0E aEMENEMNONSURONOMMOREENSe0e0M, RE: Claim By: Reserved for Clerk's fling stamp T S+"n ECi�„�N p •, h i Against the County of Contra Costa or ) JAN 1 CLERK BOARD C; SUP RViSORS District) CONTRA LISTA CO. (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$ 13 R, q S 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) Aye,.s R_'0 neap .>?q,bio ViS+q. CT 6ECoA%C-0rot $lvo( 4•,v{ Lac�re� �2 ;n G'oncoro() Confra Cos4-4. County 3. How did the damage or injury occur? (Give full details;use extra paper if required) Trrv,',t9 n oMth on, Ay•e,-s, A•,*c, /4�'�C , 010e p.4 Aa l-e. cu"4* r,y r,',0- ahof r;��-F Y`e.a.� cuh�t.14 C[Z,uS�ri� 6o'f-1, whee/s '�o dCco�+,•e, rn�s-a,l�J he p(• 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? ra;/w-�e fo pre r e,-w•e et n at rn Q 8"h 4-CL,',, Q p � /; C roaat ;., a Sa-Pe Qno( Pa:s3 Ctblt Cohol,•t.',� 5 What are the names of county or district officers, servants, or employees causing the -tom damage or injury? 7-4,e Roaot 'Pro9ra,•►.. sfq�',� 0.r+c,a A-1q,k%'re-h4n e e L vis i e4P ♦!n e Cob,+a-0. CoS4 Cot.)rn+y Po 61:c w0t.k5 DepEcrf`r,..e.►p- •• . 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) The h.'g At -Pro-^,f' Q-*I of k, 'I J,+ r-egr� 4ih -M y/ CCtr 6-r-ear..4 ••1ISq 9r�eof as a ►-eta/t o,�' �,�tfr,�9 ♦he Pa-Fholf . 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) TA e a m oti+n.t e/Q,'--e d ,'s a ?U't / to *A e o-'4hew9`.tcI Q/,'9&%me ,F Service- Pertor,Y..eof /aY A1,c4q. ,Ste4at Nevro/e f• Cgoti 11 a e . A copy 4 -Fk-e- i•t of C e , 3 a-4-fia a ht a(, 8. Names and addresses of witnesses, doctors, and hospitals: A/o r, 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT 3; 44 PM% 139, 9s a am a a a o o■a s a a a a a■e■a memo■e■■■■a a o a a a a a a a a a a a a a■■.....................■a teas a C a a 6 a o e e 1 ) .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) 1 Name and address of Attorney ) N 1A ) 67 (Claimant's Signature) (Address) GorICO.-ol CA 9 Telephone No. )Telephone No. 9-?,5'- X71- 0238 son was a wants MENa a o a a e a a a a a t a a a a now a....■o.a o a a onus Suwon Sunni PUBLIC RECORDS NOTICE: Please be advised that this claire forin, or any claim filed with the County under the Tort CIaims 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. eeMEN eeeeaeaamounts eeeaeee...e...........eeown eeeeeeee■aaaaaaaaaaaaaaaaaaanaason aame$ NOTICE: Section 72 of the Penial 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. 2390 N. MAIN ST. CHEVROLET WALNUT CREEK, CALIFORNIA 94596 BAR#AGO80143 (925) 934-9300 US EPA ID#CAD981438500 CUSTOMEP No. ADVISOR TAG No. INVOICE DATE INVOICE No. 27040 _ _ WYMAN M ADCOCK 10.8 306_3_ _ 101/04/06 CDCS81869 LICENSE No. MILEAGE COLOR STOCK No. JUSTIN E MOORE i 4,111 BLUE CHIP_/L 1 14_01 5214 J 0MAR DRIVE YEAR/MAKE/MODEL DELIVERY DATE DELIVERY MILES CONCORD, CA 94521 _05/CADILLAC/CTS/CTS _06/22/05 89 VEHICLE I.D.No SELLING DEALER NO. I PRODUCTION DATE 1 G 6 D P 5 6 7 0 5 0 1 7 0 3 6 6 I F.T.E.No. P.O.No. R.O.DATE ! 01/04 6 REPRINT#_1_ RESIDENCE PHONE BUSINESS PHONE COMMENTS 925-671-0238 . 510-853-9496 MO: 4111 LABOR & PARTS•------------------•-•----_•---•---•---•------------- ---- ............ J#':1.,15CVZ='M1.,.,::.` ALIGNMENT: HOURS:' TECKS) 1671.. :.,: ;: . .: :' 139.95 CUSTOMER' STATES: HIT-LARGE CHUCK--HOLE':_'OWNER_REQUESTS: WARNING INSPECT ALIGNMENT AND ADJUST INSPECTION REVEALED THAT THE RIGHT FRONT TOE IN. THE Motor vehicles contain chemicals RIGHT REAR CAMBER AND THE RIGHT REAR TOE IN OUT OF SPECS known to the State of California to REAJUSTED ALIGNMENT TO SPECS cause cancer and birth defects or otherreproductive harm. These JOB # 1 TOTAL LABOR & PARTS 139.95 chemicals are contained in many --•------------------------•------------...--•---------------•-------•----------------------- -- vehicle components and ESTIMATE--------------------------------------------------------------------------- repla cement parts,vehicle fluids, CUSTOMER HEREBY ACKNOWLEDGES RECEIVING and paints and materials used to ORIGINAL ESTIMATE OF $139.95 (+TAX) maintain vehicles,including,but not limited.to..fuel,oil,.batteries,brakes, TOTALS --•-•-•--------------------------------------- and wheel balancing weights. MICHAEL STEAD'S WALNUT CREEK CHEVROLET CADILLAC TOTAL LABOR.... 139.95 When you service,clean or maintain GM GOODWRENCH TOTAL PARTS.... 0.00 your car;you will be exposed to LIMITED LIFETIME SERVICE GUARANTEE TOTAL SUBLET... 0.00 listed chemicals contained in used oil,waste and replacement fluids, ANY ABOVE PARTS FOR WHICH YOU PAID THAT ARE DESIGNATED TOTAL G.O.G.... 0.00 fumes,grease grime,touch-up WITH AN ASTERISK (*) . INDICATE THAT THE LIMITED LIFETIME TOTAL MISC CHG., 0.00 paint,certain replacement parts, SERVICE GUARANTEE APPLIES TO THAT .COMPONANT AS. LONG AS YOU TOTAL MISC DISC 0.00 and particulates from component OWN YOUR CAR! SEE YOUR SERVICE CONSULTANT FOR THE DETAILS. TOTAL TAX...... 0.00 wear. When we service your car, ............................................................. -------- we will return used components to TOTAL INVOICE $ 139.95 you upon request. Used parts and THANK YOU. WE ARE PROUD TO BE YOUR SERVICE HEADQUARTERS! components contain chemicals known to the State of California to REMOVAL CHARGES FOR MATERIALS WHICH MUST BE DISPOSED OF AS cause cancer and birth defects or HAZARDOUS WASTE ARE: WASTE OIL AND OIL FILTERS = $1.68 other reproductive harm. WASTE ENGINE COOLANT = $3.16: WASTE TRANS FLUID = $1.66 To minimize your exposure when WASTE BRAKE FLUID = $2.04: WASTE DIFF/TRANSFER CASE _ $2.04 servicing;maintaining or cleaning your vehicle: 1)work in a well ventilated area;2)do not smoke, ER �16NAIURL drink or eat While working;3)wash your hands when finished or when taking a break;and 4)follow all manufacturer instructions pertaining to proper use and maintenance of _ motor vehicles and vehicle components. (Posted in accordance with Proposition 65 in Cal. Health& Safety Code§25249.5 et seq.) For further information about Proposition 65: 3 http://www.oehha.org/prop65.html. PAGE 1 OF 1 NOTICE TO CONSUMER:PLEASE READ IMPORTANT WARRANTY INFORMATION ON BACK. CUSTOMER COPY [ END OF INVOICE ]03:49pm r V) 1 b , \\\» . .��a} \ ] ))) \ \ � LS y\ _<\ ' CL .24— Ul)CV) U-) = 0 (D < E CD < Q N V-- >: E -C a. o :5 (D o ou-) IT. cn C',J "t . m / \ > 14:r as E 20 Lo CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION:FEBRUARY 28/06 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". 21, AMOUNT: $1001000.00 !' JA�� 1 2006 CLAIMANT: KENNETH STINE CO? m TN�= �: ATTORNEY: M. KELLY COPENHAVER DATE RECEIVED: JANUARY 23/06 ADDRESS: THE LAW OFFICE OF M. KELLY BY DELIVERY TO CLERK ON: JANUARY 23/06 COPENHAVER 265 MILLER AVENUE BY MAIL POSTMARKED: JANUARY 20/06 MILL VALLEY, CA 94941 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. . JOHN SW T Clerk Dated: JANUARY 23, 2006 By: Deputy II. MOM: County Counsel TO: Clerk of the Board of Su ervisors ( r> This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: By: m T 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). VOARD 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. Datedl yM,4�'` 4VOHN 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 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. Dated:/A� a. JOHN SWEETEN, CLERK By Deputy Clerk JAN-09-2006 15:29 CCC RISK MANAGMENT 925 335 1421 P.02 BOARD OF SUPERVISORS OF CONTRA.COSTA C:OUN 1 Y 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. ■■rrrrararraarrrraarrrrrrarrrraraarrrrrraarrraarrrarraaararrarrrraarrrrrrrrrrr$ RE: Claim By: Reserved for Clerk's filing stamp RECEIVED Against the County of Contra Costa or ) 7AN2006 District) CLERK BOARD 0;SUPERMORS (Fill in the name) I CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named • district in the sum of$100.000 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) UU 11 Sit 201p 5 2. Where did the damage or injury occur? (Include city and county) 6"1� �' oo�..� I ;n CCn WC1 I GW% on *6- S Ide wean. in �� } oQ 4819 ci"im�oa.d I Cdn cordC14.21. ' y 53. How did the damage or injury occur? (Give full details;use extra paper if required) dca61a t+ w ks rid; )0i C-4 C.14C in Jra&} o4 A%C l0C&_+; �n 51xciP;cd , 0. bvcw� auk e*t V-vc l c.yo'n -Vk_ Sc ck�arc S4"%C" 1i;n1 c0a r v4is *eaX CLVC+t CA"S;ni 1 a tar0MdKS' 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? Fa�kN,2 kt� ��YvWA ;, 4t S 5 What are the names of county or district officers, servants,or employees causing the damage or injury? JAN-09-2006 15:30 CCC RISK MANAGMENT 925 335 1421 P.03 6. What damage 'or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) r k i"dm* S t i vuk Sogkwej cL UJ o.-%J hn,-L i Pu- a 6ra s ia+s &*J vv+,ul�4i \e. lay �.s lCR+ ¢�c r¢. , -� c.�l � 1p �tra,�h r�►�S -1'o h ' rc L c;v c d st-t c,l�¢.s• VojA .� nab- `t 1bi QS Ud-}A;hC<I . 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 9"spn cab& e%-ii YV &A'c- • 8. Names and addresses of witnesses,doctors,and hospitals: Gam ,�criG i $Yi art ?�el SOS. N1 v saxc� gcl�,r nes , C�c�n 2arks� oJ► kr" Ita �► e, 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT t�a4 ac ca5au-�a.�ra� . ■■aaaasarrsaaaaaDun aaaaaawas aaaaaaasaaarraaaraaaaaaaaaaaraaa■.aaararraaaaaaaaaaaaraaal .Gov. Code Sec. 910.2 provides"The claim shall be • )signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attornev) ) Name and address of Attorney } (Claimant's Signature) Vie.n n e.4 4. f_o re h� �s�, ) 1�f q S Sr, imp+ e-x 11 v fit' I`C� C. ) Co v� c o r J ` (Address) C Lt 5 2 I °t 1 } � 1, Telephone No.(415)S?2-52.91)Telephone No. 9 '2S , a us mosessal on Emu Env same am a a us SOON Bono offensummonsmKo anon weassm Romano as soon MEN an was so Ed • 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. ■a a a RON a a a r a r a a a DOG a a a ON ONE ON ME NOON SNOWS r a a NOE SENOR a a a a a a a a a a a a r a a a r EASE a r a a Mann rasa 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. TOTAL P.03 PROOF OF SERVICE BY MAIL I am a resident of the County of Marin. I am over the age of 18 years and I am not a party to this action; my business address is 265 Miller Avenue, Mill Valley, California 94941. On January 20, 2006 I caused the NOTICE OF CLAIM TO: COUNTY OF CONTRA COSTA, CALIFORNIA to be served upon the parties herein by placing a true copy thereof enclosed in a sealed envelope with postage thereon fully prepaid in the United States mail addressed as follows: Clerk of the Board of Supervisors Room 106 County Administration Building 651 Pine Street Martinez, CA 94553 I declare under penalty of perjury that the foregoing is true and correct and that this declaration was executed on January 20, 2006 at Mill Valley, California. M. Kelly Copenha r Acr C� C7- -Lr rn , r\ 1 N V � J CD i .n Lr) M �( N U i o tia o NyW O w~ c VI) v W �"' = •:� W E^ - eJ oL � ` g 2 Im t u- a > U I �> Ua a > 7005 3110 0000 8925 4906 WYE =_ ii y •i O y C.O N u;.M Cc ILLz �I u i CLAIM /J BOARD OF SUP RVISORS OF CONTRA COSTA COUNTY BOARD ACTION: FEBRUARY 28/06 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 (��6 DCL'S J I1� � ) notice of the action taken on your claim by the California Government Codes. Z`-° � JAN 2 ® 2006 Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and COUNTY COUNSEL 915.4. Please note all "Warnings". MARTINEZ CALIF. AMOUNT: $480,754.57 CLAIMANT: TRANSBAY FIRE PROTECTION, INC./ TRANSBAY FIRE PREVENTION SYSTEMS, INC. ATTORNEY: DOUGLAS A. KROLL DATE RECEIVED: JANUARY 20, 2006 ADDRESS: THE LAW OFFICES OF DAVID W. GINN BY DELIVERY TO CLERK ON: JANUARY 20, 2006 1981 BROADWAY, SUITE.275 WALNUT CREEK, CA 94596 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 E erk Dated: JANUARY 20, 2006 By: Deputy II. MOM: County Counsel TO: Clerk of the Board of Supe?Visors (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). (Maim re-et timelyfiled.sled. The c a e c aim ec ion (vY'Other: See 1e4�PC-TY-or n COO,'}4 LWmx1 r!!J�d 1-1st Sir,"�W I&4e— Gk4e.� h or}-�Lt. Dv r5 0�,-� -�,_/►bov_ code 1S� 5 lI 3.The. COO.,. ,_ /�+s de_ D S �5P_rVC / /Le- V ��7� COq��' �4 G'/SCD✓�t� Dated: By: r1��D-6-0�— 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: (t 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: 0.6 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 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 frilly prepaid,,a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:A'M;11�Q/ ALV:70.._JOHN SWEETEN, CLERK By Deputy Clerk OFFICE OF THE COUNTY COUNSEL SILVANO B. MARCHESI 5E-- COUNTY OF CONTRA COSTA ,S�j+ _. -=. f�-=' 0�, COUNTY COUNSEL Administration Building 651 Pine Street, 91h Floor �� -_ =i•,4 SHARON L. ANDERSON Martinez, California 94553-1229 e% ' n CHIEF ASSISTANT - GREGORY C. HARVEY (925) 335-1800 t�� _ >. .: ,.,.. . `'' '"�'�'��T�=�`"" (925) 646-1078 (fax) VALERIE J. RANCHE O• " ` ASSISTANTS STATUTORY WARNING PURSUANT TO GOVERNMENT CODE SECTION 911.3 TO: Douglas A. Kroll Law Offices of David W. Ginn 1981 Broadway, Suite 275 Walnut Creek, CA 94596 RE: Claim of Transbay Fire Protection, Inc./Transbay Fire Prevention Systems, Inc. Please Take Notice as Follows: The claim you presented to the Contra Costa County Board of Supervisors on January 20, 2006 was reviewed by County Counsel. The portion of the claim prior to January 20, 2005 was not presented within one year after the event or occurrence as required by law. Because you allege late discovery of the claim, the claim is "timely on its face" and will be reviewed and acted upon by the Board of Supervisors within the statutory time period. To preserve the rights of the County, its departments and employees to challenge the validity of your late discovery claim, you are warned pursuant to statute that if your delayed discovery argument is improper, your claim is late, and is being returned because it was not presented within one year after the event or occurrence as required by law. (See Gov. Code, §§ 901, 911.2.) Because the claim may not have been presented within the time allowed by law, we warn you that to preserve your right in the event your claim is detennined to be late, your only recourse at this time is to apply without delay to the Contra Costa County Board of Supervisors for leave to present a late claim. (See Gov. Code, §§ 911.4 to 912.2, inclusive, and 946.6.) Under some circumstances, leave to present a late claim will be granted. (See Gov. Code, § 911.6.) Page 1 Douglas A. Kroll re January 20, 2006 Transbay Claim Page 2 SILVANO B. MARCHESI COUNTY COUNSEL By: Monika L. Cooper Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (Code Civ. Proc., §§ 1012, 1013a, 2015.5; Evid. Code, §§ 641, 664) I am a resident of the State of California, over the age of eighteen years, and not a party to the within action. My siness address is Office of the County Counsel, 651 Pine Street, 9th Floor, Martinez, CA 94553-1229. On 26 ZpD�i , I served a true copy of this Statutory Warning Pursuant to Government Code Se C n 911.3 by placing the document in a sealed envelope with postage thereon fully prepaid, in the United States mail at Martinez, California addressed to Douglas A. Kroll,Law Offices of David W. Ginn, 1981 Broadway, Suite 275, Walnut Creek, CA 94596, as set forth above. I am readily familiar with Office of County Counsel's practice of collection and processing of correspondence for mailing. Under that practice, it would be deposited with the U.S. Postal Service on that same day with postage thereon frilly prepaid in the ordinary course of business. I declare under penalty of perjury under the laws of the State of California and the United States of America that the above is true and correct. Executed on ,zGc 7_�p lv at Martinez, California. `Kathleen O'Connell cc: Clerk of the Board of Supervisors (original) Risk Management Page 2 RE: Claim By: Transbay Fire Protection, Inc. ��v 14,46 C TED JAN 2 0 2006 TRANSBAY FIRE PREVENTION ) CLERK BOARD OF SUPERVISORS SYSTEMS, INC. ) CONTRA COSTA CO. Against the County of Contra Costa ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$480,754.57. 1. CLAIMANT: TRANSBAY FIRE PREVENTION SYSTEMS, INC. c/o The Law Offices of David W. GINN 1981 Broadway, Suite 275 Walnut Creek, California 94596 (925) 256-4466 2. STATUTORY BASIS OF TRANSBAY'S CLAIM: Breach of mandatory statutory duty under California Civil Code Section 3186, for failing to withhold monies due or to become due to the contractor in an amount sufficient to answer the claim stated in Transbay's Stop Notice which was served on the County on or about December 14, 2004, and for failure to provide for the public entity's reasonable costs of any litigation thereunder. Transbay's Stop Notice was served on the County in the context of fire prevention system work performed by Transbay on the County's project to expand the Juvenile Hall located in Martinez, California(""the Project"). 1 3. FACTUAL BASIS AND BACKGROUND OF TRANSBAY'S CLAIM: Transbay had a direct contract with the County to perform its scope of work at the Project. This contract was subsequently assigned by the County to the replacement/completion contractor on the Project, Flintco. As the replacement/completion contractor, Flintco's subcontractors had the right to assert stop notice claims against the funds due or to become due to Flintco. In this instance, following Transbay's filing and service of its Stop Notice, the County made direct payments of hundreds of thousands of dollars to Flintco. This is undisputedly money that was "due or to become due"to the contractor(Flintco) as contemplated and defined under California Civil Code Section 3186, and thus the County had a statutory duty to withhold the monies due to Flintco to satisfy the Stop Notice claims of Transbay. Instead, the County never responded to Transbay's Stop Notice, and no attempt has been made by the County, or anyone else involved in the Project, to post a stop notice release bond. The County also failed to notify Transbay that it either rejected Transbay's claim, or that it was refusing to set aside any money to respond to said claim. The first indication that Transbay ever received of the County's failure to perform its statutory duties in this context was during the deposition of the County's counsel, David Schmidt, on July 22, 2005, in the context of currently pending litigation arising out of the Project. During this deposition, Mr. Schmidt testified that the County had not set aside any monies in response to Transbay's Stop Notice because it believed that it was entitled to use all of the construction funds remaining for completion of the Project. 4. TRANSBAY'S CLAIM: Transbay's December 14, 2004, Stop Notice Claim was in the amount of$433, 165.68, together with interest at the rate of ten percent(10 %) per annum from December 14, 2004. None of this amount has been paid to Transbay. Based thereon, the current 2 • total of Transbay's Stop Notice claim is $480,754.57, calculated through January 19, 2006. [Interest calculated as follows: $433,165.68 x .10 = $43,316.57, divided by 365 = $118.68 per diem x 401 days = $47,590.68 in interest, added to principal amount of $433,165.88 equals $480,756.56.] 5. ENTITY AGAINST WHOM TRANSBAY CLAIM ASSERTED: County of Contra Costa 6. JURISDICTIONAL NATURE OF TRANSBAY'S CLAIM: Superior Court Hereby submitted on behalf of Claimant, Transbay, by the attorneys authorized by Transbay to represent them in this matter, The Law Offices of David W. Ginn. DATED: January 20, 2006 THE LAW OFFICES OF DAVID W. GINN By: . D uglas . Kroll, Es . 3 • ) Gov. Code Sec. 910.2 provides "The claim ) shall be signed by the claimant or by some SEND NOTICES TO: ) person on his behalf." TRANSBAY FIRE PREVENTION ) SYSTEMS, INC. ) c/o The Law Offices of David W. GINN ) 1981 Broadway, Suite 275 ) Wmneys OFID W. Walnut Creek, California 94596 ) 4` sq. ed y ansbay to his matter. TelephoneNo. (925) 256-4466 ) Against the County of Contra Costa or ) District ) 4 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY • BOARD ACTION: FEBRUARY 28/06 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" -'�, ,JAiN 2 2005 AMOUNT: $113.22 COUNTY C O;U. �rL CLAIMANT: STEVEN F. DUCKETT` -"''Ti's v;?''"' ATTORNEY: UNKNOWN DATE RECEIVED: JANUARY 26, 2006 ADDRESS: #9 JOPLIN.COURT BY DELIVERY TO CLERK ON: JANUARY 26, 2006 LAFAYETTE, CA 94549 RECEIVED FROM RISK BY MAIL POSTMARKED: MANAGEMENT FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JANUARY 26 2006 JOHN SWEET Dated: ,By: Deputy II. FkOM: County Counsel. TO: Clerk of the Board of Supervi rs ( ) This claim complies substantially with Sections 910 and 910.2. ( This Claim FAIL;S`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: rn Deputy County Counsel ow III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: (� This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated:r46.r*'�peo"Xo*-A f OHN SWEETEN, CLERK, By , Deputy Clerk WARNING (Gov. code section 91 Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage frilly prepaid a-certified-copy cerrtifed-copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated;; -!"/2� .�/. uaQ, HN SWEETEN, CLERK By Deputy Clerk OFFICE OF THE COUNTY COUNSELSILVANO B. MARCHESI SE-- COUNTY OF CONTRA COSTA �+ -: O� COUNTY COUNSEL Administration Building 651 Pine Street, 91" Floor 1 "- ` SHARON L. ANDERSON Martinez, California 94553-1229 -' CHIEF ASSISTANT �1.° 4° i --= - _.•�� GREGORY C. HARVEY (925) 335-1800 VALERIE J. RANCHE (925) 646-1078 (fax) As515TANr5 COU1a NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Steven F. Duckett #9 .101)1111 Court Lafayette, CA 94549 RE: CLAIM OF STEVEN F. DUCKETT Please Tale Notice as Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910.2, or is otherwise insufficient for the reasons checked below: [ ] L The claim ]ails to state the name and post office address of the claimant. [ ] 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [ ] 3. The claim fails to state the date, place.or other Cll'CUrnstances Of the OCCUrrence or transaction which gave rise to the claim asserted. [ ] 4. The claim fails to state the name(s) ofthe public enlployee(s) causing the injury, damage, or loss, if known. [ ] 5. "I'lle clallll falls to state whether the a111011I1t claimed exceeds tell thO11sand dollars ($10,000). If the claim totals less than tell thousand dollars (.$10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury. damage or loss so liar as known; or the basis of computation of the amount claimed. [ ] 6. The claim is not sighed by the claimant of by some person on his or her behalf. [ ] 7. You are required to submit your clallll on the proper form. lwlilch is enclosed. Please resubmit your claim on the enclosed form; including all the required information. Gov. Code. § 910.4. Please be aware that YOU have only a limited period of time 111 which to file an amended claim. See Gov. Code, § 910.6. Steven F. Duckett Re: Claim Page Two [X] 8. Other: Please clarity the (late of the accident. S11N.ANO B. MARCHFSI COUNTY COUNSEL. By: .Monika L. Cooper DepLItV C.01-1111.V COLHISCI C'ERTIFICATE 01: SERVICT; 13Y MAIL, (Code Civ. Ilroc., §§ 1012. 1013a. 201 S.�: livid. Code. ti 641. 664) I am a resident ofthe State ofCallforma, over the a,—,c ofeluditeeii vears, and not a party to the withill action. My business address is Officeof the County COLInsel, 651 I'me Streel. 9th Floor, N/lartinez. CA 9453-1229. On February 3, 2006. 1 served a true copy ofthis Notice ot'hisuff-Iciency and/or Non-Acceptance ol'Claim by placing the dOCLI111eilt In a sealed envelope with 1)osta(,e thereon I'611\1 prepaid, III the United States mall at Marmicz. California addressed to Steven F. Duckett, 99 Joplin Court. LaIlIvette, CA 94,5349, as set forth above. I Lam readily familiar with Office of County Counsel's practice of collection and processill(, of correspondence For 111,111111g. Under that practice, It NVOLI]d be deposited with the U.S. Postal Service on that SaIlle day with postage thereon fully prepaid in the ordinary COUrse ol'business. I declare under penalty Of PCI'ILII-\; Under the laws of the State (A.'Cl-illf'orma and the United States ol'Aincric.,I, that the above IS tI-LIe and COITeCt. EXCCLIted on F'ebruary 3. 2006. at jV11artinez. California. Katy-ifeell O'Connell cc: Clerk of the Board of Supervisors (.orluincil) Risk N/lana0ement Page 2 REV 12/3/05 JAN 2 6 Contra Costa County '�'U','rRF` HPRpNHyM�S_pFFORD Department of Public Works S N Z �p06 255 Glacier Drive ,A Martinez, CA 94553-4897 To Whom It May Concern, This morning (1-3-05) 1 was traveling along Reliez Valley Road in the 2300, 2400 and 2500 block west bound) and I hit a pot hole near the center line of the road while going 25 M.P.H. The pothole is so bad that when my truck went into the hole, my new left front tire popped and the rim broke. I had to have a tow truck come and take me to a repair shop. The section of road is right by some horse stables and near the entrance to Briones Park. This section of road is really bad. The roadway is so rough that I have considered changing my route (to a much longer roundabout way) to go to and from work in Martinez. I have considered several times on my way to and from work to write and or call someone to try and suggest that this road be repaired (or at least patched). I am writing to you to let you know of an extreme safety hazard along this stretch of roadway. I frequently ride my motorcycle to and from work and I am VERY happy that I did not ride my motorcycle to work this morning and get killed! If I had hit this hole on my motorcycle, I am sure I would not be any shape to write this letter to you. Attached, Please find a copy of the repair bill and the new rim. New Rim + Acker Wheels San Jose, CA + cost of shipping; $58.71 Pep Boys Pleasant Hill Bill for new tire installation: $54.51 TOTAL: $113.22 For Reimbursement: Please make the Check out to: Steven F. Duckett I am not sure who's responsibility this section of road is, (Contra Costa County, Pleasant Hill, Martinez, Cal Trans or the Park District) but it really needs some serious attention before someone really gets hurt on it. If you can please correct this unsafe condition or pass this along to the responsible parties for a repair. CONTRA COSTA COl!r--.TY RECEIVF0 JAN 2 4 2006 R6K M.aN��i�I`�:�NT Sincerely, Steven F. Duckett #9 Joplin Court Lafayette, CA 94549 (925) 705-1540 end (2) Cc: VW File Legal sfd ACKER WHEEL Invoice "Stock Wheels Only" 771 Coleman Ave. SAN JOSE, CALIFORNIA 95110 PHONE (408) 275-1218 FAX (408) 275-1499 .W n INVOICEw# ,:-PO,.Number.: � _ I�n.volce 925/705-1540 43202 1/5/2006 STEVEN DUCKETTShip To 9 JOPLIN COURT LAFAYETTE CA 94549 Resale'MUMDer -=: Gale „-r-�.,•?iae m; Tyre o B.::: Terms:': Salesperson :::::Date Shipped Ship:Via F 0:.....:.Pomf 9 .......................... KARL 1/5/2006 Calif Overnight ISA . scrl tion::::::...:::::. ... .:.:.:..:::.:::::::: . Qt ::;.. .:.. Extended Amount Holtan.der#... De p..: :..: .::::::... Y::: Price 69630 STEEL 1 $45.00 $45.00 Subtotal j $45.00 Type of Sale Taxable Sales Tax ; $3.71 o Weight 0 lbs. —� Acceptance subject to 10% per day restocking 9 fee on all returns. Shipping Fee $10.00 COD Fee Terms Net 10 days. 10% per month late fee. ---� Invoice Total $ 58.71 1 Customer is responsible for all shipping. .1/5/2006 Yellow •. .. . ... .......:...... !::4'.x:1.,..f:..rr• .�..::..:?+ .. .. � -. . `. = ♦VAL DA E I T TOTAL HERE 1. - :I•.I',..;, Customer Cop3 y:.. , 0 1 THE PEP BOYS MANNY MOE &JACK 968 520 CONTRA PLEASANTHILL,STA CA 94523 - ' ----_ (925)691-0178 I.,,rr.... ---- BAR/RS# AM192402 EPA# CAL000129292 E Plr O a9:'6 8, r'-10` ��9:1 '9 8�: �; 9 Policy ID ID No. Make Model Year Name STEVE DUCKETT Non-Vehicle Workorder Date 01/06/2006 Address JOPLIN CT License No. Mileage Vehicle Comments CA L 1 Entered By ECKERT LAFAYETTE, CA 94549- Vin No. Engine lime In 8:28AM Home Phone Contact Phone LOOSE Time Promissed 9:31AM (925)705-1540 Customer Waiting Storage Charges:If your car remains in our premises longer than 3 days Old Parts Returned no after notification that repairs are completed,storage charges will begin at the rate Of 10.00per day. I AUTHORIZE PEP BOYS TO PERFORM THE REPAIRS BELOW AND FURNISH NECESSARY PARTS AND MATERIALS.1 UNDEPSTAND ANY COST QUOTED IS AN ESTIMATE.PEP BOYS EMPLOYEES MAY OPERATE THIS VEHICLE FOR INSPEC rION,'TESTING AND DELIVERY,AND MAY PARK THE VEHICLE RI I HE PEP BOYS OUTSIDE LOT,AS NECESSAR I.I AGREE TOPIC X UPTHE VEHICLE NO LATER THAN THE CLOSE OF BUSINESS ON THE THIRD DAY AFTER THE DAY ON WHICH PEP BOTS NC.TIFIES ME THE REPAIRS ARE COMPLETED,OR THE VEHICLE 1,R OT'HERW'ISE AVALLABLE FOR PICK-IIP AND THAT AT ALL TIMES THEREAFTER I AM ASSUMING ALL RISK IN CONNECTION WITH MY VEHICLE kEMAINING AT PF,P BOYS FACILITY PARTS$ UBORf OTALf ATE AILD TIME OMPLETION DATE BOR RATE 40.72 10.99 51.71 O3 06 2006 8:28AM 01/06/2006 92.00FR/ 99.00FR NOTICE TO CUSTOMERS: CUSTOMER NOTIFIED OF AND APPROVED INCREASE(S) IN THE ORIGINAL ESTIMATED PRICE (_) IN PERSON (_) PHONE SIGNED LATE YOU WILL NOT BE CHARGED A TIRE HANDLING CHARGE IF YOU CHOOSE TO DISPOSE OF YOUR OWN TIRES. NOTICE:- IF.YOU ELECT TO DISPOSE OF YOUR OWN TIRES, YOU ARE RESPONSIBLE FOR PROPERLY DISPOSING OF YOUR USED TIRES IN ACCORDANCE WITH EPA GUIDLINES AND ANY APPLICABLE LAWS. CUST.SIGNATURE 11101 IN 1 ....................... .................................... M 4r 0Y: IN IN I 1 11 1 0 L Parts JET4-70Rl3 DAEWOO 175/:7:0813 82T 400AA�II N'` •"` .1;, 29.99 Parts 5635 CA TIRE TAX Nx:.. _ .i.t,; `', e. Parts 6001 TIRE SANDLING CHARGE - PSPBOYS N'' Y' '=;`': .,:;o°:'- 1`" 1.50 ..................... ..................... . ...... .. .. ... .. .. y _ :.:................ pkg 1811 » R -PROTECTION... 88RV CES.x ,� ..�'r;�T.j .,.;. >� �; .„„��.;�� •;, Declined:ALN: COMPUTERI'LED°'WHEEL P.:..IGN.;;.' Labor 1897 TIRE MOUNTINGD:... ..:_ ,''Eli MARTINEZ •*`• � 1 0 00 .. .. ,.: .,. .1,.. .. Labor 1801 TIR: WHEEL-'BFiI;ANCEPREMIUM LT' �,a•,Sl, 'm;; :{>;::MARTINEZ, `; :`6FI 10.59 Parts 4000 ECONOM.Ys;TIRE RHNIARRANTY” ':N - 1 4.99 Parte TV-413 30413500P$P 1 1/4 RUBBER VALVE STEMN: 'r .. ,, r '' J : a: t. = (, w Ij. B1 2.49 Package Subtotal y 18.47 X. .72 Labor X0...9a 2U TQT}1t, ... #.;.;5 ��... ....��G�� a::.> . �,� r:��as:��: Codes Description: S1:Suggested service-Close to being out of spec N:New SERVICE INFORMATION: lbr 1501 >>> TIR: WHEEL BALANCE PREMIUM LT <<< This Service Iacludes the Following if Applicable to Your Vehicle .:t• PREMIUM LIFETIME BALANCE . Torque (Wheels Torqued to) 100 Letter (Torque Stick) C Color (Torque Stick Color) GREY Performed by: W MARTINEZ Confirmed by: T TRAM lbr 1897 >>> TIRE MOUNTING <<< This Service Iacludes the Following if Applicable to Your Vehicle Torque (Wheels Torqued to)' 100 Letter (Torque Stick) C Color (Torque Stick Color) GREY Performed by: W MARTINEZ Confirmed by: M TRAM TIRE INFORMATION: DOTUTEPXC81505 Original 1 2 New Tire Torque Setting 0 - 0 Tire Position 3 4• Position Whitewalls: 5 Return Tires: Tire Pressure: 0 - 0 >>>>> END OF INVOICE ««< Ak Need A Tow Call 1-800-Pep-Boys (1-800-737-2697) ECONOMY TIRE RH WARRANTY ,.,y N 4000 1 @ 4_..99.,,_.- Order #: "1'699198 ; r; -'` � 3041350OPEP 1 114 :RUBBER>, <: -2.49. T - TV-413 1 @ 2.49 pip Order #: 1099198 Sub-Total 51 :71I i Pep Boys #968 ! Tax :=x::2.80 =- 520 CONTRA COSTRR BL "54.51' PLEASANTHILL•,,CR Total 94523'::-.; (510)691 60178•.•, ._ ..,,... ..;: ; Visa (S) 54.51 _.. Account 0519 , . ----�--- ------=----.._".-------- •�___ - Auth: 006604 �.A,.�::;'.;. 9:34:07 RM FST 01/06/2006 Store: Oa68 Total Tender :.::._, ;: :'• .,:54:51 '.Ti'll .servi Trans. : 002419 ... Res. : 105 Change Due 0.00 , Cashier: 277908 - Service Work Order COMPLETE 1 ENTER FOR A CHANCE `0 $5,000;:'_':`.`., ii IIIIIIIIIIIIIII.IIIIIII. 1-10,0-61 IIIIIIIIIIIIIIIIIIIII Call8 5100 At Pep Boys, we are committed to your 096816500241920060106;= satisfaction.' Take a brief survey about your shopping experience today at Pep - "- Boys. ComPlefe swe'epstakes ;rules'..are 29.99 T posted:.af.,parf.icipating :sfores.:' DAEWOO 175/70R13 82T 400 Sweepstakes ends February 25,:2006. JET4-70R13 1 @ 29.99 _ ..... . _....---...,, Order #: 1099198 .�:•_:::...:::.:::'.:.::':::;``:::!.. I Service Work Order Numberi75„N I CA TIRE TAX'.. ..@ ,..:;'75'::` w 5635 Order #: 1099198 i :.-1099198 T HANDLINGCHARGE. ....- .. TIRE HA � : .;' 6001 • 1 @ 1`.,.50 i Order #: 1'099198 !I Pep Boys 4968 TIRE MOUNTING 0.00 N 520 CONTRA COSTRR.BL'.':+;;,: 1 @ 0.00 ' PLEASANT HILL.,CA 94523,: www... ep oys.com. Order #.: 1099198 Customer Copy • ;10, 99 N TIR: WHEEL BALANCE.PREM.I, : Order #: 1099198 . .. ... ....-_..__. ..........__._...__. ... ...__.....__...._._.___.._.._...__................:..._.......... . ......................................._..._... .... .....-. _. _ .. ... ......_..____... _... .__..._....__.__.___.._..._._.._.__._____.___..._...__ ... ... _._._ .. ....... ..........:... ..__.. ..... . ,..._._....._....�...._._._. ......_._._......-.�..__.. _..__-_ .......__._..__ .__. .... ............. .......... .... .. ...... .. ... .. ..._.......... .._... ..._......_ ....... ,s ti. o M T3 � v rt c CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY C • BOARD ACTION: FEBRUARY 28/06 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 cP1uurrsuant to Government Code Section 913 and IN AN AMOUNT WHEREIN JURISDICTION WO1q plenqe "Warnings". REST IN THE SUPERIOR COURT, UNLIMITED Vuy [y AMOUNT: JURISDICTION JAN 3 0 2006 CLAIMANT: GREGORY CLOUTHIER AND ANN CLOUTHIER. COUNTY COUNSEL ATTORNEY: STAN CASPER DATE REI`JEDCALIF. JANUARY 27/06 GASPER, MEADOWS, SCHWARTZ & COOK: Y DELIVERY TO CLERK ON: JANUARY 27/06 ADDRESS: 212.1 N. CALIFORNIA BLVD. , STE. 102 WALNUT CREEK, CA 94596 HAND DELIVERED BY BY MAIL POSTMARKED: ONE HOUR DELIVERY FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SW Clerk Dated: JANUARY 30, 2006 - By: Deputy II. FkOM: County Counsel. TO: Clerk of the Board of Survisors (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: � '3��0(� 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. OOARD 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; aid OHN SWEETEN, CLERK, By , Deputy Clerk WARNING (Gov._ code se ion 916) 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 frilly prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated::-/y2�4911..42t?VJf0HN SWEETEN, CLERK By Deputy Clerk T 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,) i 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. F.rau.d. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form.' ooeeeeeroo■osooe■eoreeeeeooe■eeese000e■■■■eros■oo■oDeepe■eeOeoodowoee■eso■eo0■1 RE: Claim By: Gregory Clouthier and. Reserved for Clerk's filing stamp Ann Clouthier c/o Stan Casper Casper,Meadows, Schwartz 5 Cook , E`M D 2121 N. California Blvd, #1020 Wnlr%A,r CraeL- CA qA%q i 9.7 Against the County of Contra Costa CLERKf;.'if'??F:;UPERVISGRS District) I . ,,;T A CGSTA..co. (Fill in the name) ) } The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum oft and in support of this claim represents as follows: in an amount wherein jurisdiction would rest in the Superior Court, Unlimited Jurisdiction. 1. When did the damage or injury occur? (Give exact date and hour) August 1, 2005 2. Where did the damage or injury occur? (Include city and county) Contra Costa .County Main Detention Facility, Martinez, CA • i 3. How did the damage.or injury occur? (Give full details- use extra paper if required) See Attachment to Claim. I 4 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? See Attachment to Claim. r 5 What are the names of county or district officers, servants, or employees causing the damage or injury? Unknown at this time. 6. What damage or injures do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) Loss of love, comfort, society, companionship, protection, solace, affection, and moral support. 7. How was the amount claimed above computed? (Include the estimated aanount of any prospective injury or damage.) Damages are in an amount wherein jurisdiction would rest in the Superior Court, Unlimited Jurisdiction. 8. Names and addresses of witnesses, doctors, and hospitals: Miles Kramer, Director of Psychiatry & Detention Health, .and others who are I unknown at this time. 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT August 2005 Funeral and burial expenses (undetermined at this time) e as o a o s 0 a a a a Moog D a e o o o a all a moo Moe ovum ago Ouse son 1119010811611115 oa■as■ W410".1114 Ono on No 1116.811110 004 ) Gov, Code Sec. 910.2 provides "The claim.shall be ) signed by the claimant or by some person on his i behalf." SEND NOTICES TO: (Attorney) Name and address of Attorney ) Stan Casper ) Casper, Meadows, Schwartz & Cook) V ( lainlarit'S igia e) 2121 N. California Blvd ) Suite 1020 ) Walnut Creek, CA 94596 ) (Address) 1 ) I Telephone No. 925/947-1147 )Telephone No. aosoaamasadoPoaaaaaass■aaa■aaaaaasaa0000a0aao.aoaaoosaasoas■oaoaman aobooseman Ong even air? . 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.).Furtherrnore, any attachments, addendums, or supplements attached to the claim form, including medical records, are also subject.to public disclosure. Bosco DOGWOOD an o 0 a o a a 0 a 0 a'o 0101181148'e a a 1 a a e O e e o a o o s o o a 8504141608 agog a a o e o 0 a a o o Dogma do ease Got 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 nay the same if genuine, any false or fraudulent claim, bill, account voucher, or writing, is punishable either by imprisonment in the County jail fora period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000.00), or by both such i imprisonment and fine, or by imprisonment in the state prison, by afire of nor exceeding ten thousand dollars ($10,000), or by both such imprisonment and fine. 4 Claimant: Gregory and Ann Clouthier Attachment to Claim 3. Claimants' Decedent, Robert Clouthier (DOB: 05/01/1977), was given access to dangerous instrumentalities with which to do himself harm, as well as provided the opportunity to do himself harm, at a time when employees and agents of the Detention Facility knew, or should have known, that Robert Clouthier was suicidal, resulting in Robert Clouthier's committing suicide at the Detention Facility. 4. At all relevant times while Robert Clouthier was an inmate at the Contra Costa County Main Detention Facility, he was so negligently and carelessly confined, assigned, treated, classified, managed, controlled, supervised, and cared for so as to proximately result in the injuries and damages above-described. At all relevant times during his commitment to the Main Detention Facility, Claimants' Decedent, Robert Clouthier, was examined and treated by healthcare providers who were the agents, servants, and employees of Contra Costa County, and who negligently and carelessly treated, diagnosed, examined, classified, assigned, confined, and otherwise cared for Robert Clouthier so as to proximately result in the injuries and damages to Claimants' Decedent as set forth above. ANDREW C.SCHWARTZ Certified Civil Trial Specialist/ LAW OFFICES OF Nall()IIaI Board ofTflal Adl'(IC:ICV CASPER MEADOWS SCHWARTZ& COOK � � •rra_: (025)Q:r7-I I47 STAN CASPER A PROFESSIONAL CORPORATION Certified Civil Trial Specialist/ CALIFORNIA PLAZA FAX: (')?5)')47-1131 National Board or Trial Advocacy 2121 NORTH CALIFORNIA BOULEVARD SUITE 1020 EMAIL: 1NPO,,;gCMSL.AW.CON4 MICHAEL D.MEADOWS WALNUT CREEK,CALIFORNIA 94596-7333 LARRY E.COOK THOM SEATON January 27, 2006 RECEIVED JAN 2 7 2006 Clerk of the Board of Supervisors Count Administration Building CLERK BOARD 01:SUPERVISORS County g CONTRA COSTA CO. 651 Pine Street Martinez, CA 94553 Re: Claim of Gregory & Ann Clouthier Dear Clerk: Enclosed please find an original and three copies of a Claim Against the County of Contra Costa. In the envelope provided, please return one copy marked "received" for our records. Thank you for your courtesy and cooperation. Sincerely, Q0-4,&�cc4 Sandra L. Fritts Legal Assistant to Stan Casper /slf Enclosure Pi c �/ FROM: ® ��R (888) 311-1.221 DELIVERTO L__ 0� COMPANYCP-,,s�c�{ i��ra.ovdS,S G!l WAS-7�( COMPANY ADDRESS 21a ! ADDRESS SUITE-�� CITY LIVA/yy�J7 �K►� SUITE CITY CONTACT CONTACT N L LEGIBLE CONSIGNOR SIGNATURE • FOR .•. o OFFICE MLB IN , Z- /! Q _ USE. $ • O ! O 'O AM PM $ • i .ONLY .• ' . o THE LIABILITY OF ONE HOUR DELIVERY SERVICE,INC.IS LIMITED TO THE SUM OF$500.00.CLAIMS MUST BE MADE WITHIN 72 HOURS. a PACKAGE CLAIM I BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY RE-LISTED ON ------ FEBRUARY 28/06 BOARD ACTION: Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given �, `iij Pursuant to Government Code Section 913 and VF �j 915.4. Please note all "Warnings". AMOUNT: $150,000.00 JAN 1 1 2005 COUNTY COUNSEL CLAIMANT: F.G. HERNANDEZ fVARTINEZ CALIF ATTORNEY: UNKNOWN DATE RECEIVED: JANUARY 11/06 ADDRESS: 4603 BALFOUR ROAD #74 BY DELIVERY TO CLERK ON: JANUARY 11/06 BRENTWOOD, CA 94513-1635 JANUARY 10/06 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWE E erk Dated: JANUARY 11, 2006 By: Deputy 1I. MOM: County Counsel: TO: Clerk of the Board of Supeirvisois ( ) This claim complies substantially with Sections 910 and 910.2. (/This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: By: Deputy County Counsel 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. BOARD ORDER: By unanimous vote of the Supervisors present: (� This Claim is rejected in full. ( ) Other: I certify that this is a true and correct'copy of the Board's Order entered in its minutes for this date. Dated: GOnAA1&-rd PHN SWEETEN, CLERK, By , Deputy Clerk WARNING (Gov. code sec ion 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 frilly prepaid a��cce�ertified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:;/!`i?`_L_'-4m/ .40% OHN SWEETEN, CLERK By Deputy Clerk O�FICE OF THE COUNTY COUNSEL s�--L SILVANO B. MARCHESI COUNTY OF CONTRA COSTA - -_oma COUNTY COUNSEL Administration Building ,;�- 1 -_ •� 651 Pine Street, 91h Floor - — SHARON L. ANDERSON Martinez, California 94553-1229 ; = CHIEF ASSISTANT _ — GREGORY C. HARVEY 925 1800 ( ) 335- VALERIE J. RANCHE (925) 646-1078 (fax) AssisTANTs ST'S COUl`�'f`; NOTICE OF INSUFFICIENCY AND/OR. NON-ACCEPTANCE OF CLAIM TO: F.G. Hernandez 4603 Balfour Road, #74 Brentwood, CA 94513-1635 RE: CLAIM OF F.G. HERNANDEZ Please Take Notice as Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910.2, or is otherwise insufficient for the reasons checked below: [X] 1. The claim fails to state the name and post of Ilce address of the claimant. [X] 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. The claim fails to state the date, place of other ch-Cll111stances of the occurrence or transaction which gave rise to the claim asserted. [ ] 4. The claim fails to state the nanle(s) of the public enlployee(s) causing the injury, damage, or loss, if known. [ ] 5. The claim fails to state whether the alllount claimed exceeds ten thousand dollars (S' 10,000). If the claim totals less than ten thousand dollars ($1 0,000), the cla1111 (ails to state the amount claimed as of the date of presentation, the estimated.anlount of any prospective injury, damage or loss so far as known, or the basis ol`conlputatlon of the amount claimed. [X] 6. The claim is not signed by the claimant or by some person on his or her behalf. F.G. Hernandez Re: Claim Page Two [ ] 7. You are required to submit your claim on the proper form, which is enclosed. Please resubmit Your claim on the enclosed torn-, 1nClt►din`,, all the required Information. Gov. Code, 1 910. 1. Please be aware that you have only a I11111ted pet loci of time In which to hie all alllended claim. See Gov. Code; 9]0.6. [ ] 8. Other: SILVANO B. MARCI-IF.SI COUNTY COUNSFl. By: Monika L. Cooper Deputy County Counsel CERTIFICATE 01= SERVICF_, BY MAIL (Code Civ. Proc., §§ 1012, 1013a, 2015.5: Evid. Code, §§ 641, 664) I am a resident of the State of California, over the age of eighteen years, and not a party to the within action. My business address is Office Of the County Counsel, 651 Pine Street, 9th Floor, Martine-z_. CA 94553-1229. On January 12, 2006, I served a true copy of this Notice Of Insufficiency and/or Non-Acceptance of Claim by placing the document in a sealed envelope with postage thereon fully prepaid, in the United States mail at Martinez, California addressed to F.G. Hernandez, 4603 Balfour Road 474, Brentwood, CA 94513-1635. as set Iorth above. I ant readily familiar with Oftrco Of COU11ty Counsel's practice of collection and processing of correspondence. for mailing. Under that practice, it would be deposited with the U.S. Postal Service on that same day with postage thereon fully prepaid in the ordinary course ofbusiness. declare under penalty of perjury under the laws of the State of California and the United States o1'America that the above is true and correct. I,AmIted int .lanuary 12. 2006. at Martinez. itrma. Kathleen O'Conne I cc: Clerk of the Board of Supervisors (original) Risk Management Page 2 7`4 140ee' t{ G Hernande- „ II I �i 41-65-196 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 ore 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 naive 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. MM00NMa8a002XIM00M0ff005Mffr0XMMro20a0aaM000sff00a0N0Ma000MMWaaaX0aMaM20a50Maset0a RE: Claim By: Reserved for Clerk's filing stamp > RECElV1 'Ex Against the County of Contra Costa or ) JAN 1 1 2nn District) CLERK BOAR13 W 77 (Fill in the name) ) CONTRA t `:' The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$15_, 0 d e)A eP and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) / .3o r� a 2. r,e did the damage or injury occur? (Include city and county) �� % 3. How idtgamga—dor injury occur? (Give full details; use extra paper if required) Wkevt Pu +4.1 rap -frasA n eah � wiNer Ay eavne✓ oe, t oF ;45- opehi (2- 6(-r YM e- fo slip -d 5=a II . fie.. eah weHf vvev- d hit vrty, ke�cY ah fie 4. What particular act or omission on the part of county or district officers, servants, or employees 'tea f caused the injury or damage? _JL t C* o �=. a4- h e P Q.' N 0 i- ►ivy a / yt t a h a h C e—, y r f 5 What are the names of county or district officers, servants, or employees causing the damage or injury? o , d v a ,/- no, tM e s , 6. What damage or injuries do your claim resulted? (Give full extent of injuries of damages claimed. Attach two estimates for auto damage.) + br6 /te >1 Fewtur —ape vi .sol-�(�tlCler-) oh ba N,' 1e d �F'i9hi- I" ) CSfi// Ncf kca. (e- . 7. e. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) sow e-o h,e: Far 4 o+o- ) rut w e, 5--J n c e, s e p t 9' U.re o P Ca y- S=a r a 10 P 0 i h f'�rx e��S, �fG. W k e,I(2,kw� I b a f h tr a ch F i x+u y e s 614 A f a' /e-f- i �°-p po'� o f tin e� Par- b o t h h u r b q not 4 Se 8. Names and addresses of witnesses, doctors, and hospitals: ahyokie_ 0011*e-4 a07; An-P q- afe.r �C Lo 4.oks cz f—Pl'l 's b P-q a At ccaQfio ;k7 �J/s'1J. 1 9. List the expenditures you made on account of this accident or injury: (C,h a �- l aTl e, DATE TIMEAMOUNT 3.SD. C�t�� 7 ,cQ.c Q.c e�.c.J 10:65 f y i o ov .CS . naz1Z e,� /A `7 •Q 9 L P 767 ..rM%VWXaa :60a0aaa0aaa............mass.........................................Mal ) .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. ................man....ff.ff...........soon..............RONnow............BE0aman sonot 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.) Furthennore, any attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■.f..f.......f..../was f■a a ■f....f f f.....Q.../..f f..f.f f.f f/f.../....f.now 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. Jane Pennington To: Emelda Sharp/COB/CCC@CCC 02/10/2006 01:28 PM cc: MTrot@cob.cccounty.us Subject: Re: Claim Filed by F.G. Hernandez[j Please list the Claim on the February 28 agenda. Thanks- Jane Emelda Sharp J �::` > :`:;.. Emelda Sharp To: JPenn@cob.cccounty.us >02/10/2006 01:18 PM cc: MTrot@cob.cccounty.us Subject: Claim Filed by F.G. Hernandez A::: Jane, With regards to the Claim filed by F.G. Hernandez on January 11, 2006, Maceo check on the Draft 1 and Draft 2, and can't find the name of F.G. Hernandez. I am sorry but I really don't know what happened., because on my reading of my claims both data base and on my claims her names was posted. Jane please do me a favor to e-mail Maceo your decision on what to do. Thank you Jane. Emelda L. Sharp Clerk of the Board " 4 J ZrCA- 10 Q r� �•4 3i, LO - LU cin V �M y LU �FZd x a M � � c.� CLAIM I BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and JAN 3 1 2006 915.4. Please note all "Warnings". AMOUNT: �,i N COUNTY-COUNSEL MARTINEZ CALIF. CLAIMANT: f_�t t`1 C4SCa-2j __DIG ATTORNEY: S 6w A A , 1—ok Ule'r DATE RECEIVED: daguar� 2-1, ZOU ADDRESS: Oo BY DELIVERY TO CLERK ON: J BY MAIL POSTMARKED: Ra-1-KWOO (�aryAko FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ` JOHN SWEETEN, Clerks ` Dated:( CIVIWY- Z� IRW By: Deput..............w_ y II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. (�is 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: 1-3t-C& By; .:'-�l -- Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: G9A>Y ?!t OV -&W4:;J0HN 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 inay seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:!`' ?' 0/� `�� 4OHN SWEETEN, CLERK By Deputy Clerk OFFICE OF THE COUNTY COUNSEL SILVANO B. MARCHESI COUNTY OF CONTRA COSTA -='=- '�= Off, COUNTY COUNSEL Administration Building 651 Pine Street, 9'" Floor a;' 1`� `�'�° SHARON L. ANDERSON CHIEF ASSISTANT Martinez, California 94553-1229 ;d (925) 335-1800 GREGORY C. HARVEY ®� ;i'111\�\ VALERIE J. RANCHE (925) 646-1078 (fax) ASSISTANTS covr��-� NOTICE OF .INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Shawn A. Toliver Lewis, Brisbois, Bisgaard & Smith LP One Sansome Street, Suite 1400 San Francisco, CA 94104 John W. Busby I1 Law Ofli.ces of John W. Busby 11 1212 Broadway, 10°i Floor Oakland, CA 94612 RE: CLAIM OF MOUNTAIN CASCADE, INC. against the County Of Contra Costa and the Contra Costa Flood Control and Water Conservation District Please 'Take Notice as Follows: The claim you presented against the County oj`Contra Costa or District governed by the Board of. Supervisors falls to C0111ply substantially with the reCluirenlerlts of California Government Code Section 910 and 910.2. or is otherwise insufficient for the reasons checked below: [ ] I. The claim fails to state the name and post ol'Iice address of- the claimant. [ ] 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. The claim fails to state the date, place or other circumstances of the occurrence or transaction which agave rise to the claim asserted. [ ] 4. Tile claim fails to state the name(s) Of tile public enlployee(s) causing the injury, damage. or loss, if known. [ ] 5. 1"he claim fails to state whether the amount claimed e\CeedS tell thousand dollars ($10,000). .If the claim totals less than ten thousand dollars (,S 10,000).. the claim fails to state the amount claimed as of the date of.'presentation. the estimated amount of any prospective, injury, damage or loss so tar as ]clown, or the basis 0I`COl11pLltation of the alllount clainled. Shawn A. Tolivcr ,Iohn W. Busby II Re: Claim of Mountain Cascade, Inc. Page Two [ ] 6. The claim is not signed by the claimant or by some person on his or her behalf. [ ] 7. You are required to submit your claim oil the proper form. which is enclosed. Please resubmit your claim on the enclosed form, including. all the required information. Gov. Code, § 910.4. Please be aware that you have only a limited period of time in which to file all amended claim. See Gov. Code, 5 910.6. [X] 8. Other: Please provide the dates Mountain Cascade, inc. was served with the initial complaints and SUbSeClUent cross-complaints for each case. SIL:VANO B. MARCHES]. COI,JNTY COUNSEL. B v: e6 �.�. Monika L. Cooper — Deputy County Counsel CERTIFICATE 01 S1='RVIC'E BY MAiL. (Code Civ. Prot., §§ 1012, 1013x. 2015.5; livid. Code, ti ti 64L, 664) 1 am a resident of the State of California, over the a��e of eiohtcen years, and not a party to the within action. My business address is Office of the County Counsel, 651 Pine Street, 9th Floor, Martinez, CA 94553-1229. On . February 3, 2006. 1 served a true copy of this Notice of Insufficiency and./or Non- Acceptance of Claim by placing the document in a sealed envelope with postage thereon fully prepaid, in the United States mail at Martinez, California addressed to Shawn A. Tolivcr; Lewis, Brisbois, Bisgaard & Snlith .LP, One Sansome Street, Suite .1400. San l"rancisco. CA 94104: ,Iohn W. Busby i1. Law Offices of John W. Busby 11, 1212 Broadway, 10" Floor, Oakland. CA 94612, as set forth above. I ani readily familiar with Office of County Counsel's practice of collection and processing. of correspondence for maIIIng. Under that practice, it would be deposited with the U.S. Postal Service on that sante day, with postage thereon fully prepaid in the ordinary course ofbusiness. i declare Under penalty of perjury under the laws of the State of California and the United States of America that the above is true and correct. Executed on February 3, 2'00(1. at Martinez California. Kathleen O'Connell cc: Clerk of the Board of Supervisors(original) Rist: Management Page 2 1•vle �.YtIW ' WARP IIWV garmeols OF COMU CMA murn Y. �,. AAMMMUftto&MM of$WM tQtda*W tat bixy'to room ar to of gtm�VWg tis abs ba p *t IOU dM * m GAS awe tt a MId of tip souse of aWm A aWm 1*bg to aI d w awe of vdao d4 be paesm ud not I=ft On year dig 00=me of the aauaa of aatiax - �. CW=ow be fined V(*the a0* of tp chard d Sm><paAsors It its asu 1a RM 1061 141tmiaMaat +b5�viaehs ,iacdat 94s53. C. Irraaha is vg&m a dot od'by ft Raaf 4f ggpavisoss, raduar tW Cam,the �taa a�tha Diat�otahouldbe fiticd id. . 6f daiaa is sVJP t at= On are FOOD IAMY,sept maim must be MW ager mh Pmay. IL $a pm ty sot doluas.Pana!Caft Sm.72 Oft=4 of d*ftm: Ise FIRRwRIOwRRfawtwROwwtwRRww@Rww#**woof*#Ri/4f48go@owrNew94106weve51//f/RW9546&I RB: C $Y: R+esaYed�ax C�'a �P • MOUNTAIN CASCADES INC. how incoma ar00a+M JAN 2 7 2006 Contra Costa County Flood Control and Water Conservation CLERK SMAH GI UMP RVISORS IU Uvft=ka GWM agd=U CQmty of OMM Costa.Of ft dQu4med di &ia u sm at unknown aa<d is oftbis Cl t esanmts as fallaws; L W&M4600 dame or*q 000 (0tft 099 data MA November. 9, 2004 at approximately 1 :30 p.m. I. VhM did+'bar a'b04W occur? 0WII*dtY=dQMMW Approximate Station ' 100+12 on South Broadway between Retell Avenue and Rudgear Road in the City of Walnut geek, Contra Costa County. - - 3. RM did the doupori4**MO tGhv IA *trio cmpW i(retWod) Please see attached 4. What pxft r agd or m s=an the paof mwq or 46tat 4=,ser�►a0l%or c* yas Y doup Please see attached 5 What at 1ho too of 0MV at distciat ofrxm,eenvaa%or ampimes causingthc daraago or bqury9 Unknown at this time Wbd deme vir iia o do WX dit sMalt 47 (01"fill Meg of WMIMS of dam e; Please .cee attached 71' low wo the mmm ottdaaad abrin can"W4 (Anda to asdvoW aaaowu of ate► p'�P�"a ill cewdaaiag��• . . please see attached R. Jim"mod 90ra80 dwiht=s dootGpt ad t w. Please see attached �. *6 r gmdram yaa=*oo aoaoaat of*k 404W a WW. please see attached ' lftWesel agog tfffer0l0wage f1lofffoff141e1ft101OWN tPogo$Rf/lffffft■ot►eftfl,ffoil 14451Val ' l3a�r.c src.9�la� ''T'4a eWm Rube Nstaw fat of A#DMY y Shawn A. Tol i ver . (qW=W1 M ) One Sansome Street, Suite 1400 One Sansome Street, Suite 1400 . San FranCiSCo. CA 94104 San FRancisco CA 94104 415 362-2580 415 362-2580 dNv� ltlop3aaola 611e1Vif1114miose5eagle tlfllfflffffffttllff fowls tftff#lrelfe11f11f4two wellaffff•1r/a1 r=C KQUM - ' Y'b�e6s adirtKd�acdds t�ars��t�Ihepndat�a Tactt�tts Aa.is m pabtia aleft*0 Cd P" -Ari.(Gov.cWts is 6504 et"Oftftmem omw Form"Olift �,�,,o��plaa�t ataahedio tbat >3aer+an„6tiG{atiiagtaedicat mvards.am�aul�eotm �f�ttffefrlttffl�.flfflfffov9paw1w11w►f/tTWWI 1•vrr&lvlfrffRooveUW•1ftaw fffuels 1004I V01 N4'xlt� . �Yl �,rr�iabont to de�aQ,N'a��'a or far payrtteas tq m4Y�boe:d or odYivcr�or to+ 'GMTr ftp or iliattiat taw oe o91eer,augiarird to d w-w 1 rbc.mom.I'Pa u% my fft or fitgtd*t dam.A acto*vaUdwe ar Wdit b pvc"TA Mier by b*iso wAt m to Coo*JAR tar a paiad of nat Rim tap too!wr by IL&D of pat��ps tae t 02mid dollars($1 00AN ar by bah" i tl aati4 attd fats,a by iaagrr�soammeac la F icato pt ty a fiat of at tqt tbovsana do]tars ��R,00O},or brybo�aaah iu�aamneattadfma . Attachment to Mountain Cascade,Lrc.'s Government Tort Claim Presented to Contra Costa County Flood Control and Water Conservation District 3. How did the damage or injury occur? (Give full details, use extra paper if required) On November 9, 2004 at approximately 1:30 p.m., a crew from Mountain Cascade, Inc. ("Mountain") excavating a trench for a water main inadvertently ruptured an underground,high- pressure petroleum line that ignited and caused a substantial explosion and fire. This incident occurred at approximate Station 100+12 on South Broadway between Newell Avenue and Rudgear Road in the City of Walnut Creek, Contra Costa County("the County). At that time, Mountain Cascade was the general contractor for the project,which is known as the Walnut Creek-San Ramon Valley Transmission Improvements,Northern Pipeline Completion (the "Project"). An employee of Mountain Cascade was operating the excavator that punctured the underground pipeline. The East Bay Municipal Water District ("EBMUD") originally contracted with Modern Continental Construction Company, Inc. ("MCC") as general contractor for this project in 2003, and the project at that time was given Specification No. 1861. Due to conflicts and delays, MCC was terminated May 28, 2004, and Mountain Cascade was hired as general contractor to complete the job. The Project was given Specification No. 1861A, and Mountain Cascade began work on the Project in or about September 2004. During all relevant times, the Project was controlled,'managed and/or supervised by EBMUD employees, officials and/or agents. There is ongoing litigation between EBMUD and MCC related to the termination of MCC's work on this project. MCC claims it was wrongfully terminated from the project, and MCC contends that the delays EBMUD blamed on MCC were due, at least in part, to the proximity of this gas pipeline to the work. Specifically, the Project includes making tie-ins to an existing tee and finishing the installation, including necessary pipe lining and coating repairs, for approximately 450 feet of existing 69" steel pipe, in trench within Civic Park; furnishing and installing approximately 2,530 feet of 69" steel pipe, in trench along South Broadway; installing approximately 950 feet of 69" steel pipe remaining to be placed within the main tunnel, located below the San Ramon Bypass Channel, including tunnel and shaft backfill, contact grouting, in-site mortar pipe lining of the entire 4,400 feet of this main tunnel; and performing related required work in Walnut Creek, Contra Costa County, California; the same being Bid Items 1 thru 3 and Bid Item 4A of the Bidding Form contained in and all in accordance with the Contract Documents. (Contract dated August 10, 2004 between Mountain Cascade and EBMUD.) Mountain Cascade is informed and believes that the intrastate pipeline that ruptured is 4831-8675-6608.1 1 owned by Sante Fe Pipeline, LP, a subsidiary of Kinder Morgan Energy Partners, LP, and is used to transport gasoline,jet fuel, and diesel from the Concord area to San Jose, including the San Jose Airport. At the time of the incident, Mountain Cascade is informed and believes that the pipeline was being used to transport unleaded automotive fuel. The pipeline was built in the late 1980s. Generally,the pipeline travels in a straight line path parallel to the sound wall east of the roadway. But in the location where this incident occurred, the pipeline diverts from a straight line path to a radically different shape depicted in the map prepared by East Bay Municipal Utility District after November 9, 2004, which is attached hereto as Exhibit 1. Mountain Cascade is informed and believes and thereon alleges that the purpose of this diversion depicted in Exhibit 1 was to bypass the drip line of a 40-inch diameter City of Walnut Creek heritage oak tree, which was a"Highly Protected Tree"pursuant to the City of Walnut Creek Municipal Code. That is, for the pipeline path to continue in a straight line, the heritage oak tree would have had to have been cut down. Accordingly, Mountain Cascade is informed and believes and thereon alleges that the City wanted, required and/or authorized that the tree be preserved and that the pipeline be built around the tree. 4. What particular actor omission on the part of county or district officers, servants, or employees caused the injury or damage? Mountain Cascade is informed and believes and thereon alleges that the location of the pipeline where the rupture occurred was within the limits, right of way and/or jurisdiction of the County, Contra Costa County Flood Control and Water Conservation District ("Flood Control District"), City of Walnut Creek, State Fire Marshal, East Bay Municipal Water District ("EBMUD"), and/or other entities not yet identified at this time. Mountain Cascade is informed and believes and herein alleges that the section of the pipeline that was ruptured was located within the County and/or the Flood Control District's right of way and/or jurisdiction. Mountain is informed and believes and thereon alleges that the County and/or the Flood Control District granted an encroachment and/or other permit(s) to EBMUD and/or to the EBMUD's contractor, under which Mountain Cascade was lawfully working at the time of the incident. Mountain Cascade is informed and believes and thereon alleges that Sante Fe Pipeline, LP a subsidiary of Kinder Morgan Energy Partners, LP; Kinder Morgan Energy Partners, LP; EBMUD; Corollo Engineers; Camp, Dresser&McKee; ARB, Inc.; City of Walnut Creek; County of Contra Costa; Contra Costa County Flood Control and Water Conservation District; State Fire Marshal; and/or other unnamed entities or persons knew or should have known (including but not limited to, because they drafted,prepared, reviewed and/or approved maps, plans and/or drawings) that certain of the maps,plans and/or drawings failed to depict the pipeline with reasonable accuracy. Specifically, certain maps, plans and/or drawings incorrectly identified the location, shape and dimensions of the underground pipeline at issue within the County and/or Flood Control District's right of way and/or jurisdiction. 4831-8675-6608.1 2 For example, certain of these maps,plans and/or drawings identify the location of the pipeline as being approximately two to three feet from the sound wall that parallels the excavation. In fact,where the rupture occurred, the pipeline was approximately 11.8 feet away from the sound wall that parallels the excavation. In addition, certain of these maps, plans and/or drawings identify the shape of the pipeline diversion as a"V"-shape, instead the true shape. The County and/or the Flood Control District had a duty and obligation to investigate, ascertain and/or record the accurate location, route, shape and dimensions of all subsurface installations, including the pipeline, within its right of way and/or jurisdiction. The County and/or the Flood Control District failed to do so relative to the subject pipeline where the rupture occurred on November 9, 2004. The County and/or Flood Control District had a further obligation to keep accurate and accessible records of the location, route, shape and dimensions of all subsurface installations, including the underground pipeline at issue,within its right of way and/or jurisdiction. The County and the Flood Control District did not keep accurate and accessible records of the location, route, shape and dimensions of the underground pipeline where the rupture occurred on November 9, 2004. The County and/or Flood Control District had a duty to ensure that it made available and/or distributed to all interested parties, including but not limited to, EBMUD, its design professionals and Mountain Cascade,maps,plans and/or drawings accurately depicting the location, route, shape and dimensions of the pipeline in its right of way and/or jurisdiction. The County and/or Flood Control District failed to ensure that it made available and/or distributed to all interested parties, including but not limited to, EBMUD, its design professionals and Mountain Cascade, maps,plans and/or drawings accurately depicting the location, route, shape and dimensions of the pipeline in its right of way and/or jurisdiction. The County and/or Flood Control District knew or should have known the scope and details of the Project, including but not limited to the fact that contractors, including Mountain Cascade, would be excavating near subsurface installations. The County and/or Flood Control District had a duty to inform and/or warn all interested parties, including but not limited to, EBMUD, its design professionals and Mountain Cascade, of the accurate location, route, shape and dimensions of the pipeline in its right of way and/or jurisdiction. Mountain Cascade is further informed and believes that the County and/or the Flood Control District, the City of Walnut Creek, the East Bay Municipal Water District and/or other entities not yet identified at this time owned, operated,maintained or controlled the property where the Project was occurring and where the Kinder Morgan Pipeline intersected with the EBMUD Water Pipeline, and that the property was in a dangerous condition at the time of the incident. The County and/or the Flood Control District, the City of Walnut Creek, the East Bay 4831-8675-6608.1 3 Municipal Water District and/or other entities not yet identified at this time created a dangerous condition of public property by performing work, or allowing work to be performed on its behalf and with its consent, on the Project in the immediate vicinity of the Kinder Morgan Pipeline rather than insisting and requiring relocation of the Kinder Morgan Pipeline or the Project pathway to a location not in close proximity to the Kinder Morgan Pipeline. The dangerous condition created a reasonably foreseeable risk of the kind of incident that occurred. The County and/or the Flood Control District, the City of Walnut Creek, the East Bay Municipal Water District and/or other entities not yet identified at this time had both actual and constructive notice of a dangerous condition of public property arising from the location of the Kinder Morgan Pipeline within the confines of the Project and allowing work to be performed in close proximity to the Kinder Morgan Pipeline, for a long enough time to have protected against it,but took no steps to do so. The dangerous condition was a substantial factor in causing MOUNTAIN CASCADE's harm. Mountain is informed and believes and thereon alleges that the County and/or Flood Control District had a duty to report any information or data regarding the pipeline, including but not limited to, the location,route, shape and dimensions, to the State Fire Marshal pursuant to California law, including but not limited to, California Government Code section 51015.05. Mountain is informed and believes and thereon alleges that it failed to do so. By the County and/or Flood Control District's acts and omissions discussed herein, the County and/or Flood Control District failed to promote the health, safety and well-being of persons and property in its right of way and/or jurisdiction, as required. The County and the Flood Control District's breach of the duties discussed herein constitute negligence, and/or statutory or other violations of California law and/or County ordinances. Such breaches and violations caused or contributed to the occurrence of the subject incident. As such Mountain Cascade is entitled to defense, indemnity, contribution and/or apportionment from the County and/or Flood Control District with respect to any and all damages arising from the subject incident, including but not limited to the damages discussed herein. On or about September 13, 2004 at 12:30 p.m., Mountain Cascade personnel notified Underground Service Alert of Mountain Cascade.'s anticipated excavation on"South Broadway from centerline to 30 [feet] beyond east edge of payment between Redgear(sic)Road and Newell Avenue." Following notification to Underground Service Alert,Mountain Cascade, timely renewed its notification through and including November 22, 2004. Among other agencies and entities, Underground Service Alert sent a notice of the work to the County and/or Flood Control District. Following Mountain Cascade's notification to Underground Service Alert, Kinder Morgan representatives were in continuous and ongoing contact with Mountain Cascade personnel concerning the location of the pipeline. Kinder Morgan representatives and other responsible persons and entities failed to mark the area of its pipeline where the damage occurred on November 9, 2004. Kinder Morgan representatives assured Mountain Cascade personnel and 4831-8675-6608.1 4 representatives of EBMUD that the pipeline alignment followed a series of yellow placard markers imbedded in the ground in close proximity to sound wall east of the roadway. At the location of the damage the pipeline was not located below the yellow placard markers but in fact approximately 11.8 feet from the sound wall. This location placed the pipeline within the trench zone of the excavation. Pursuant to California law, including but not limited to, Government Code section 4216 et seq, the County and/or Flood Control District either owns, operates or maintains a subsurface installation—the pipeline in question that ruptured—and therefore is an operator of the subsurface installation. As an operator, after receiving notice by Underground Service Alert of the upcoming excavation, the County and/or Flood Control District was required to "locate and field mark the approximate location" of any subsurface installations that may be affected by the excavation"to the extent and degree of accuracy that the information is available either in the records of the operator or as determined through the use of standard locating techniques." (Cal. Gov't Code sec. 4216.3(a).) Notwithstanding its duty described above, the County and/or Flood Control District failed to locate and mark the approximate location of.the pipeline at issue that ultimately ruptured, and therefore violated California law, including but not limited to, Government Code section 4216.3(a). Breach of this duty constitutes negligence and statutory violations. Alternatively, the County and/or Flood Control District was required to "advise the person that the operator does not operate any subsurface installations that would be affected by the proposed excavation,"pursuant to California law, including but not limited to, Government Code section 4216.3(a). Notwithstanding its duty described above, the County and/or Flood Control District failed to advise Mountain Cascade that it did not operate any subsurface installations that would be affected by the proposed excavation, and therefore violated California law, including but not limited to, Government Code section 421-6.3(a). Breach of this duty constitutes negligence and violations of statute. By virtue of all of the above, the County and/or Flood Control District, an employer, violated California common law and California Labor Code section 6400 et seq. because it failed to furnish employment and a place of employment that was safe and healthful for the employees therein. 6. What damage or injuries do you claim resulted? The personal injury and property damages include,but are not limited to, the death of five workers (two Mountain Cascade employees and three Matamoras Welding employees); the serious bodily injury to four workers (two Mountain Cascade employees and two Matamoras Welding employees); the emotional and psychological impact to workers and civilians within the 4831-8675-6608.1 5 zone of danger exposed to the personal injuries and loss of life which occurred as a result of the ensuing explosion and fire; the evacuation of approximately 270 residents from their homes; the evacuation of one high school and one elementary school;property damage to two residences and to two vehicles in the vicinity of the explosion; the business impacts to businesses located in two shopping centers that were in the vicinity of the explosion and fire and impacted by the command center set up at the intersection of Newell Avenue and South Broadway by police and fire emergency crews; adverse impacts to the atmosphere from the burning fuel; adverse impacts to the ground and ground water resulting from the escaping petroleum product; other anticipated environmental damages/issues; damage to the sound wall; damage to the work progress, including the pipeline; and costs and expenses of police, fire and other emergency response. The damages include,but are not limited to, personal injury and property damage described above and related expenses, which Mountain Cascade is seeking equitable indemnity, apportionment of fault and declaratory relief. See Section 7 herein. The exact amount of Mountain Cascade's claim is not ascertainable at this time, but it will exceed $25,000. 4831-8675-6608.1 6 7. How was the amount claimed above computed? a. Fourteen lawsuits'-'have been filed thus far. They are: 1. Angeles v. Kinder Morgan, et al., Alameda County Superior Court Case No. RG-05-195680; 2. Arias, et al., v. Kinder Morgan, et al., Alameda County Superior Court Case No. RG-05-195567; 3. Becerra v. Kinder Morgan et al., Contra Costa County Superior Court Case No. C05-02451; 4. Chabot v. East Bay Municipal Utility District, et al., Contra Costa County Superior Court, Case No. C05-02312; 5. Farley v. Mountain Cascade, Inc., et al., Contra Costa County Superior Court Case No. C05-01573; 6. Fuentes v. Kinder Morgan Energy Partners, L.P., et al., Contra Costa County Superior Court Case No. C05-02286; 7. Im v. Kinder Morgan, Inc., Contra Costa County Superior Court Case No. C05-02077; 8. Knox v. Mountain Cascade, Inc., Contra Costa County Superior Court Case No. C05-00281; 9. Matamoros v. Kinder Morgan Energy Partners, L.P., Contra Costa County Superior Court Case No. JCCP NO. 4433; 10. Paasch v. East Bay Municipal Utility District, Contra Costa County Superior Court Case No. C05-01844; 1.1. Ramos v. East Bay Municipal Utility District, Contra Costa County Superior Court Case NO. C05-01840; 12. Reyes v. East Bay Municipal Utility District, Alameda County Superior Court Case No. RG-05-20770; 13. Taylor v. East Bay Municipal Utility District, Contra Costa County Superior Court Case No. C05-02306; 14. United Services Automobile Association v. East Bay Municipal Utility District, Contra Costa County Superior Court Case No. C05-02128; Copies of the operative complaints are attached hereto as Exhibits 2-15. These actions have been coordinated in one Judicial Council Coordination Proceeding("JCCP"),Number 4433, in Contra Costa County Superior Court, Department Five, the Honorable Terence L. Bruiniers Presiding. b. In addition, the following parties have filed cross-complaints against Mountain '-'Mountain Cascade's Government Tort Claim against the Flood Control District for equitable indemnity, apportionment of fault/contribution and declaratory relief pertaining to the Arias, Angeles and Knox coordinated actions was served on May 6, 2005. 4831-8675-6608.1 7 Cascade, seeking affirmative relief, indemnity, declaratory relief and other causes of action: (1) SFPP, L.P. and Kinder Morgan entities; (2) EBMUD; (3) County of Contra Costa and Flood Control District. Copies of the cross-complaints are attached hereto as Exhibits 16-18. These cross-actions have also been coordinated in JCCP,Number 4433. Additionally, it is anticipated that future complaints will be filed by additional parties. C. Mountain Cascade denies any liability in connection with the allegations for injuries and damages in the claims, complaints and pleadings filed by the various parties arising out of this incident, including but not limited to those referenced herein. However, in the event that Mountain Cascade is found responsible, in whole or in part, to the various parties asserting liability against Mountain Cascade, Mountain Cascade's liability, if any,would be based solely upon a derivative form of liability not resulting from its conduct,but only from an obligation imposed upon Mountain Cascade by law. Therefore, Mountain Cascade is entitled to complete and total equitable indemnity from Flood Control District, relative to all known and unknown damages, costs and expenses. If Mountain Cascade is adjudged to be liable to the various parties asserting damages against Mountain Cascade arising out of this incident,Flood Control District shall be required to (1)pay a share of each of the parties'judgment which is in proportion to the comparative negligence of Flood Control District in causing any and all damages; and (2) to reimburse Mountain Cascade for any payments made to the parties asserting damages against Mountain Cascade, in excess of Mountain Cascade's proportional share of liability, if any. Mountain Cascade denies any and all liability in connection with the claims,complaints and cross-complaint asserted by the various parties,including but not limited to those referenced herein, but if Mountain Cascade is held liable for any damages to any of the parties, such liability exists,if at all, only as a direct and proximate result of acts, omissions and/or negligence of Flood Control District. MOUNTAIN CASCADE is informed and believes and thereon alleges that Flood Control District was at fault with reference to the allegations in the various claims, complaints, cross- complaints and pleadings filed as a result of the incident. Therefore, if Mountain Cascade is held obligated to pay to the any of the parties sums representing a percentage of fault not its own but that of Flood Control District,Mountain Cascade requests a judicial declaration and adjudication of the percentage of fault on the part of Mountain Cascade,if any,and on the part of Flood Control District, so as to determine Mountain Cascade's rights to be obligated to the various parties only in an amount representing Mountain Cascade's proportional share of liability,if any. An actual controversy now exists between Mountain Cascade and Flood Control District , as to Mountain Cascade's right of defense and indemnity from Flood Control District, the existence of which Flood Control District denies. A judicial declaration and adjudication is necessary and appropriate such that the parties may ascertain their rights and responsibilities. 4831-8675-6608.1 8 8. Names and addresses of witnesses, doctors, and hospitals. The names and addresses of each and every witness are presently unknown to Mountain Cascade. But the following is a list of many of the persons who were at the jobsite the day of the incident. a. Mountain Cascade. These persons may be reached at Mountain Cascade. Individuals include,but are not necessarily limited to: Greg W. Berry; David Bower, Miguel Angel Fuentes; Jose Pena; David Stickney; Martin Topete; Clay Frades; Miguel Calderon; Alfred Carrillo; Marcus Escobedo; Patrick T. Farley; Ignacio Becerra, Rafael Gonzalez; Jaylon Hunt; Tom LeRoux; Daniel May; Raul Pichardo; Alejandro Ramirez; Jose F. San Roman Salas; Ryan Stroup; Tony Taylor; Rosario Aguilar•, Wenceslao Guerra; Salvador Juarez; Stephan W. Lewis; Duke Fuller; Roger Williamson; Jay Mulligan; Shawn Ross; Mike Nelson; Jim Ratliff; Mike Kallsen; and Jeff Patton. Mountain Cascade is informed and believes that Mr. Farley was treated for a sprained ankle, injured lower back and right knee at Kaiser OCC Medical Clinic in Walnut Creek and Mr. Topete, Mr. Fuentes and Mr. Becerra were treated for burns. b. EBMUD. Mountain Cascade is informed and believes that these individuals may be reached at EBMUD, 375 11`h Street, Oakland,.CA 94607. Individuals include but are not necessarily limited to: Kevin Canada; Keith Beckwith; Carlos Rodriguez; Mark Miller; Mark Warzyniak; Michelle Blackwell; Ed Ostrowski;Norm Settle(Brown & Caldwell); Joe Kacyra; and Martin Falarski. C. City of Walnut Creek. Mountain Cascade is informed and believes that these individuals may be reached at the City of Walnut Creek, 1666 N. Main Street, Walnut Creek, CA 94596. Individuals include but are not necessarily limited to: Don Murphy; and Mark Cordeiro. d. Contra Costa County. Mountain Cascade is informed and believes that this individual maybe reached at Contra Costa County 651 Pine Street, Martinez, CA 94553. Individuals include but are not necessarily limited to: Lary Cornelius. e. Pacific Boring, Inc. Mountain Cascade is informed and believes that these individuals may be reached at PO Box 727 Caruthers, CA 93609. Individuals include but are not necessarily limited to: Bradley Gardner; Christopher Bergamini; Scott Efird; and Jonathan Jamison. f. Viking Drillers, Inc., whose address is 801 Northport Drive, West Sacramento, CA 95691. g. Cell-Crete Corporation,whose address is 135 E. Railroad Ave, Monrovia, CA 910165. 4831-8675-6608.1 9 h. Matamoros Pipelines, Inc. Mountain Cascade is informed and believes that these individuals may be reached at Matamoros Pipeline, 3991 Nerdly Road, Oakley, CA 94561. Individuals include but are not necessarily limited to: Roger Paasch and Jeremy Knox. Mountain Cascade is informed and believes that Mr. Paasch was treated for burns at the University of California at Davis Medical Center and Mr. Knox was treated for burns at the Doctors Medical Center. i. Oscar Navarro, address unknown j. Arroyo Trucking, Inc.,whose address is PO Box 2174, Livermore, CA 94550 9. List the expenditures you made on account of this accident or injury: Please see Section 7 above,which is incorporated herein. Official notices and correspondence should be sent to each: Shawn A. Toliver Jason C..Zhao Lewis, Brisbois Bisgaard & Smith LP One Sansome Street, Suite 1400 San Francisco CA 94104 415/362-2580 toliverOlbbslaw.com zha glbbslaw.com John W. Busby H Law Offices of John W. Busby H 1212 Broadway, I Wh Floor Oakland, CA 94612 510/465-2800 jwbusbyayahooxotn 4831-8675-6608.1 10 f CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY ,,I_ BOARD ACTION: r—A 28, 2-W6 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. p aav� notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given JAN 3 1 -2006 Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". COUNTY COUNSEL AMOUNT: U,1� �np(O MARTINEZ CALIF. CLAIMANT: MottIl f 7kt ISI cascade_ Zjy, ATTORNEY: 5�Wn A. TDLt Ver DATE RECEIVED: JCcaw( � 2-7) X606 ADDRESS: � n SDP��tL �-�, � I 4� BY DELIVERY TO CLERK ON: JXU,�rW 2'7 2W c�Cin. rte.U Sip' GA qu!D� R : O'Llmin-A earyr.�. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETEIVIerk ' Dated: Q L 2U06 By: Deputy l" II. FitOM: Court y Counsel, TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. ( This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: By: ti 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. B - 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- 2Z QeA&C. JOHN SWEETEN, CLERK, By , Deputy Clerk WARNING (Gov. code se ion 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. Datedg/,. JOHN SWEETEN, CLERK By Deputy Clerk OFFICE OF THE COUNTY COUNSEL �1✓�_i SILVANO B. MARCHESI COUNTY OF CONTRA COSTA COUNTY* COUNTY COUNSEL Administration Building K; 651 Pine Street, 91" Floor A \„+ SHARON L. ANDERSON •;• ;'� �-=�- r.., ...;, = , Martinez, California 94553-1229 CHIEF ASSISTANT•y _ .-. ��t.:. , -._:. _' -_- .fit'. i Q GREGORY C. HARVEY (925) 335-1800 VALERIE J. RANCHE E` C (925) 646-1078 (fax) ASSISTANTS s� COUI3 NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Shawn A. Toliver Lewis, Brisbois, Bisgaard & Smith LP One Sansome Street. Suite 1400 San Francisco, CA 94104 John W. Busby II Law Offices of John W. Busby II 1212 Broadway, 10°i Floor Oakland. CA 94612 RE: CLAIM OF MOUNTAIN CASCADE, INC. against the County of Contra Costa Mild the Contra Costa Flood Control and Water Conservation District Please Take Notice as Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors falls to comply substantially with the reLluirements of California Government Code Section 910 and 910.2. or is otherwise insufficient for the reasons checked below: [ ] I. The claim fails to state the name and post office address of the claimant. [ ] 2. The claim fails to state the post office address to which the person presenting the �:lalnl desires notices to be sent. The claim fails to state the date, place or other circumstances ofthe occurrence or transaction which cave rise to the claim asserted. [ ] 4. The claim fails to state the name(s) of the public employees)causing the injury, damage. or loss. if known. [ ] 5. The claim fails to state whether the amount claimed exceeds tell thousand dollars ($10,000). Ifthe claim totals less than tell thousand dollars (510.000). the claim fails to state the amount claimed as of the date of'presentation, the estimated amount of any prospective injury, danha(ge or loss so far as ]mown, or the basis of computation of the amount claimed. Shawn A. Toliver John W. Busby 11 Re: Claim of Mountain Cascade. Inc. Page Two [ ] 6. The claim is not signed by the claimant or by some person on his or her behalf.'. [ ] 7. You are required to submit your claim on the proper torm. which is enclosed. Please resubmit your claim on the enclosed form, including all the required information. Gov. Code. ` 910.4. Please be aware that you have only a limited period of time in which to file an amended claim. See Gov. Code. § 910.6. [X] 8. Other: Please provide the dates Mountain Cttscade. .Inc. was served with the initial complaints and subsequent cross-complaints for each case. SILVANO B. MARCHESI COUNTY COUNSEL B v Mollika L. Cooper Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (Code Civ. Proc., §§ 1012. 1013a. 2015.5: Ovid. Code. 5§ 641. 664) 1 am a resident of the State of California, over the age of eighteen _years, and not a party to the within action. My business address is Office of the County Counsel. 651 Pine Street, 9th F'loor, Martinez, CA 94553-1229. On , February 3, 2006, I served a true copy of this Notice of Insufficiency and/or Non- Acceptance of Claim by placing the document in a sealed envelope with postage thereon full- prepaid, in the United States mail at Martinez. California addressed to Shawn A. Toliver. Lewis. Brisbois_ Blsuaard & Smith LP, One Sansome Street, Suite. 1400. San Francisco. CA 94104: John \V. Busby .11. Law Offices of John W. Busby 11, 1212 Broadway, 10" Floor, Oakland, CA 94612, as set forth above. I ani readily familiar with Office of CountV Counsel's practice OCcollection and processing ofcorrespondence for mailin_. Under that practice. it would be deposited with the U.S. Postal Service on that same day with postage thereon f,ullN., prepaid Ill the ordill.11-v COLIrse ofbtlSllless. I declare under penalty oi'perjury under the laws ofthe State of'California and the United States of.Anlerica that the above is true and correct. Executed on February 3. 2006. pt Martinez, California. Kathleen O'Connell cc: Clerk of the Board of Supervisors(original) Risk Maria-einellt Page 2 BOA'S.OF B VISQnS sF CON VA COSTA G mia x T1tU • 9= .To MAMA A. A two Riding to a awe of aaft Or death or for tgjoy 10 pa'saa ory pomW pm"or &m CM0 ahafi to PM0000d rpt lata 4= do raoatbs afar tlu Uarual 4f to awe of =do& A clalat Tdaftg to=7 odtet camas of aafl m d. M be wed lads t m am year aftot the aocalO du am of aeon. (Qap.Cods 1911.2 j S. Claim v=be filed with the Ge* of dt Soerd of Supavlsan at its of6ex in Reom 106, rotuM DOW4 01 No MwA Mwdpm CA 94553. C. ir vbW is apbd a d w6 x go'vmcd by the Board of Saporvhwic n4a 4m the cu".tho umm of to IX*kt*auldbe fslled in. �. If ft ddm Is main raom On an P*Uo vanitys eeps m oiaims must be SW team c-h .� �,,d, Ger pamtttyEvt��claims.Peaal Code flea 72 etd�e tad o�tl� . !!/1rl■f!ltfl•ff7tf��ffi/•$\vy0#$#agoga069/4f/toppisW084f99606110162/iff4/f1fl ItE: ClatoA�y: Rases d$dt'Clew s aft clump MOUNTAIN CASCADE, INC. } F7 NECE V D Cotmtp afCaohatha oc JAN 2 7 2006 CLERK MIRD Or OWERMORS 1 COP2SRIA t;OSiA CO. Tha=&alp"ddmw$mrby m ea olaua agahMto Cody of Cam Costa ort o abovoemad district k ft scut ttf S unknown aid ht capon dt&ddra=p=g%ft as Man: 1. Vb=dtd*damage or b ftq oc=I (Gins=act date andMa) November 9, 2004 at approximately 1 :30 p.m. 2. W ce tie ciat�ge of iglury 000t>x? aad 'Approximate Station 100+12 on South Broadway between Newell Avenue and. Rudgear Road in the City of Walnut Creel, Contra Costa County. 3. Now dM(be c ga or*XT ooaut? (01vo full =a om papa'if mqaUA Please see attached 4. � cWas sto k&y car vndssian oa the pan of comity or dbtriot offices,servsata,or c�tloyees Please. see attached 5 wbat am to>aemes of cowaty of&arw ofam,sctvauts,or employees causing*0 dasaagc or bjmp Unknown at this time Ll r 6. dam or Wuda do ym ddm YmglW? (Cava W ma it bW= t dm dalmed. A1WA talo aa0==ft 0W0 data W-) Please see attached 7. Hoo We ft 4moW Mad Am mp*vd? (bdvde dna asd=Wd mat, of QM Please see attached . . Nantas mdaddmMofAmoss doh 04bosg s: Please. attached 9. I t16+a a�ez i On- yam*tmaavo *of*k aad"arWWr- Please see attached • \fit#111t�#11M#weaves aelr9i/tg#1ii0#I#i##wRi4MrM#cue*10 oval vowwwoso ' } �� IC�ltR1bC idpeysdnao�CCby� CAhie ftZ lam&ad sddam a(Mamcy Shawn A. Toliver � ��ladauta�'s Shy One Sansome Street, Suite 1400 One Sansome Street, Suite 1400 San Francisco, CA 94104 —�- #---�^ San Francisco, CA 94104 bonoNo. 362-2580 �Tdcybp�aNa 415 362-2580 44. 3... .. .�. t##91111Ma9ii11#t91119i9Ititfee i#sitiif#!#�#tyyi��ti#moi*!i#il�f#Y* #1�,i#i�tiil**fewg tapoffe stool �i iziitvwr�� • ' p1go ba 0*4 go ft obb bim.ac aq alataot tlleo*0 dm CamW=der*a Tbm CWW AM b sulm m pat &dMaw nada*a CdOunk Parc Rocas Aat.(Gov. trade, Sg 6500 et MQ PW*mm,MY attaahaeep fir+%or W01MM 99"W the tUm ftv%hr&dttnedW mcutdt m+o All*aub*t10 yrublic diecloxt�ce. •si9/i11i.rwool off go*11f#f Ito Opp moo"w9vt#tItt11l9v#9ts+r♦itti woo*tsrt9lsgYtr1#Igatoo f##9f NOTIM Mewoh TI Ob Pdxd Code p"iiYkW Emy palov*^Wft MW to d0A.— =cwv (a4%voare or for pomt ay to my 0*board ar o er,or a W &W r ft or& bMT4 a IWArbW to allow or pay tba me if.pCnvk% aw out or fm r dga,WL ocavoA vouftr,or wcift.b tift by bpi** tt in ift QDU*gall far a pood of me 4m to to ym,by a fis of eg wmdiag alta tlmuW4 dales(St WDAQ� at by b*such now prisoam�la.ilm s �by a f�na of aat aucee�ng��aaaad dotlarr QEgO11),g"b'y mch lsaommtWAfiW Attachment to Mountain Cascade, Inc.'s Government Tort Claim Presented to Contra Costa County 3. How did the damage or injury occur? (Give full details, use extra paper if required) On November 9, 2004 at approximately 1:30 p.m., a crew from Mountain Cascade, Inc. ("Mountain") excavating a trench for a water main inadvertently ruptured an underground, high- pressure petroleum line that ignited and caused a substantial explosion and fire. This incident occurred at approximate Station 100+12 on South Broadway between Newell Avenue and Rudgear Road in the City of Walnut Creek, Contra Costa County("the County). At that time, Mountain Cascade was the general contractor for the project, which is known as the Walnut Creek-San Ramon Valley Transmission Improvements,Northern Pipeline Completion (the "Project"). An employee of Mountain Cascade was operating the excavator that punctured the underground pipeline. The East Bay Municipal Water District ("EBMUD") originally contracted with Modern Continental Construction Company, Inc. ("MCC") as general contractor for this project in 2003, and the project at that time was given Specification No. 1861. Due to conflicts and delays, MCC was terminated May 28, 2004, and Mountain Cascade was hired as general contractor to complete the job. The Project was given Specification No. 1861A, and Mountain Cascade began work on the Project in or about September 2004. During all relevant times, the Project was controlled, managed and/or supervised by EBMUD employees, officials and/or agents. There is ongoing litigation between EBMUD and MCC related to the termination of MCC's work on this project. MCC claims it was wrongfully terminated from the project, and MCC contends that the delays EBMUD blamed on MCC were due, at least in part, to the proximity of this gas pipeline to the work. Specifically, the Project includes making tie-ins to an existing tee and finishing the installation, including necessary pipe lining and coating repairs, for approximately 450 feet of existing 69" steel pipe, in trench within Civic Park; furnishing and installing approximately 2,530 feet of 69" steel pipe, in trench along South Broadway; installing approximately 950 feet of 69" steel pipe remaining to be placed within the main tunnel, located below the San Ramon Bypass Channel, including tunnel and shaft backfill, contact grouting, in-site mortar pipe lining of the entire 4,400 feet of this main tunnel; and performing related required work in Walnut Creek, Contra Costa County, California; the same being Bid Items 1 thru 3 and Bid Item 4A of the Bidding Form contained in and all in accordance with the Contract Documents. (Contract dated August 10, 2004 between Mountain Cascade and EBMUD.) Mountain Cascade is informed and believes that the intrastate pipeline that ruptured is 4820-7946-0352.1 1 owned by Sante Fe Pipeline, LP, a subsidiary of Kinder Morgan Energy Partners, LP, and is used to transport gasoline,jet fuel, and diesel from the Concord area to San Jose, including the San Jose Airport. At the time of the incident, Mountain Cascade is informed and believes that the pipeline was being used to transport unleaded automotive fuel. The pipeline was built in the late 1980s. Generally, the pipeline travels in a straight line path parallel to the sound wall east of the roadway. But in the location where this incident occurred, the pipeline diverts from a straight line path to a radically different shape depicted in the map prepared by East Bay Municipal Utility District after November 9, 2004, which is attached hereto as Exhibit 1. Mountain Cascade is informed and believes and thereon alleges that the purpose of this diversion depicted in Exhibit 1 was to bypass the drip line of a 40-inch diameter City of Walnut Creek heritage oak tree, which was a"Highly Protected Tree"pursuant to the City of Walnut Creek Municipal Code. That is, for the pipeline path to continue in a straight line, the heritage oak tree would have had to have been cut down. Accordingly, Mountain Cascade is informed and believes and thereon alleges that the City wanted, required and/or authorized that the tree be preserved and that the pipeline be built around the tree. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? Mountain Cascade is informed and believes and thereon alleges that the location of the pipeline where the rupture occurred was within the limits, right of way and/or jurisdiction of the County, Contra Costa County Flood Control and Water Conservation District ("Flood Control District"), City of Walnut Creek, State Fire Marshal, East Bay Municipal Water District ("EBMUD"), and/or other entities not yet identified at this time. Mountain Cascade is informed and believes and herein alleges that the section of the pipeline that was ruptured was located within the County and/or the Flood Control District's right of way and/or jurisdiction. Mountain is informed and believes and thereon alleges that the County and/or the Flood Control District granted an encroachment and/or other permit(s) to EBMUD and/or to the EBMUD's contractor, under which Mountain Cascade was lawfully working at the time of the incident. Mountain Cascade is informed and believes and thereon alleges that Sante Fe Pipeline, LP a subsidiary of Kinder Morgan Energy Partners, LP; Kinder Morgan Energy Partners, LP; EBMUD; Corollo Engineers; Camp, Dresser&McKee; ARB, Inc.; City of Walnut Creek; County of Contra Costa; Contra Costa County Flood Control and Water Conservation District; State Fire Marshal; and/or other unnamed entities or persons knew or should have known (including but not limited to, because they drafted,prepared, reviewed and/or approved maps, plans and/or drawings) that certain of the maps, plans and/or drawings failed to depict the pipeline with reasonable accuracy. Specifically, certain maps, plans and/or drawings incorrectly identified the location, shape and dimensions of the underground pipeline at issue within the County and/or Flood Control District's right of way and/or jurisdiction. 4820-7946-0352.1 2 For example, certain of these maps,plans and/or drawings identify the location of the pipeline as being approximately two to three feet from the sound wall that parallels the excavation. In fact, where the rupture occurred, the pipeline was approximately 11.8 feet away from the sound wall that parallels the excavation. In addition, certain of these maps,plans and/or drawings identify the shape of the pipeline diversion as a"V"-shape, instead the true shape. The County and/or the Flood Control District had a duty and obligation to investigate, ascertain and/or record the accurate location, route, shape and dimensions of all subsurface installations, including the pipeline, within its right of way and/or jurisdiction. The County and/or the Flood Control District failed to do so relative to the subject pipeline where the rupture occurred on November 9, 2004. The County and/or Flood Control District had a further obligation to keep accurate and accessible records of the location, route, shape and dimensions of all subsurface installations, including the underground pipeline at issue, within its right of way and/or jurisdiction. The County and the Flood Control District did not keep accurate and accessible records of the location, route, shape and dimensions of the underground pipeline where the rupture occurred on November 9, 2004. The County and/or Flood Control District had a duty to ensure that it made available and/or distributed to all interested parties, including but not limited to, EBMUD, its design professionals and Mountain Cascade, maps, plans and/or drawings accurately depicting the location, route, shape and dimensions of the pipeline in its right of way and/or jurisdiction. The County and/or Flood Control District failed to ensure that it made available and/or distributed to all interested parties, including but not limited to, EBMUD, its design professionals and Mountain Cascade, maps, plans and/or drawings accurately depicting the location, route, shape and dimensions of the pipeline in its right of way and/or jurisdiction. The County and/or Flood Control District knew or should have known the scope and details of the Project, including but not limited to the fact that contractors, including Mountain Cascade, would be excavating near subsurface installations. The County and/or Flood Control District had a duty to inform and/or warn all interested parties, including but not limited to, EBMUD, its design professionals and Mountain Cascade, of the accurate location, route, shape and dimensions of the pipeline in its right of way and/or jurisdiction. Mountain Cascade is further informed and believes that the County and/or the Contra Costa County Flood Control and Water Conservation District, the City of Walnut Creek, and/or the East Bay Municipal Water District and/or other entities not yet identified at this time owned, operated, maintained or controlled the property where the Project was occurring and where the Kinder Morgan Pipeline intersected with the EBMUD Water Pipeline, and that the property was in a dangerous condition at the time of the incident. The County and/or the Contra Costa County Flood Control and Water Conservation 4820-7946-0352.1 3 District, the City of Walnut Creek, and/or the East Bay Municipal Water District and/or other entities not yet identified at this time created a dangerous condition of public property by performing work, or allowing work to be performed on its behalf and with its consent, on the Project in the immediate vicinity of the Kinder Morgan Pipeline rather than insisting and requiring relocation of the Kinder Morgan Pipeline or the Project pathway to a location not in close proximity to the Kinder Morgan Pipeline. The dangerous condition created a reasonably foreseeable risk of the kind of incident that occurred. The County and/or the Contra Costa County Flood Control and Water Conservation District, the City of Walnut Creek, and/or the East Bay Municipal Water District and/or other entities not yet identified at this time had both actual and constructive notice of a dangerous condition of public property arising from the location of the Kinder Morgan Pipeline within the confines of the Project and allowing work to be performed in close proximity to the Kinder Morgan Pipeline, for a long enough time to have protected against it, but took no steps to do so. The dangerous condition was a substantial factor in causing MOUNTAIN CASCADE'S harm. Mountain is informed and believes and thereon alleges that the County and/or Flood Control District had a duty to report any information or data regarding the pipeline, including but not limited to, the location, route, shape and dimensions, to the State Fire Marshal pursuant to California law, including but not limited to, California Government Code section 51015.05. Mountain is informed and believes and thereon alleges that it failed to do so. By the County and/or Flood Control District's acts and omissions discussed herein, the County and/or Flood Control District failed to promote the health, safety and well-being of persons and property in its right of way and/or jurisdiction, as required. The County and the Flood Control District's breach of the duties discussed herein constitute negligence, and/or statutory or other violations of California law and/or County ordinances. Such breaches and violations caused or contributed to the occurrence of the subject incident. As such Mountain Cascade is entitled to defense, indemnity, contribution and/or apportionment from the County and/or Flood Control District with respect to any and all damages arising from the subject incident, including but not limited to the damages discussed herein. On or about September 13, 2004 at 12:30 p.m., Mountain Cascade personnel notified Underground Service Alert of Mountain Cascade.'s anticipated excavation on"South Broadway from centerline to 30 [feet] beyond east edge of payment between Redgear(sic) Road and Newell Avenue." Following notification to Underground Service Alert, Mountain Cascade, timely renewed its notification through and including November 22, 2004. Among other agencies and entities, Underground Service Alert sent a notice of the work to the County and/or Flood Control District. Following Mountain Cascade's notification to Underground Service Alert, Kinder Morgan representatives were in continuous and ongoing contact with Mountain Cascade personnel concerning the location of the pipeline. Kinder Morgan representatives and other responsible persons and entities failed to mark the area of its pipeline where the damage occurred 4820-7946-0352.1 4 on November 9, 2004. Kinder Morgan representatives assured Mountain Cascade personnel and representatives of EBMUD that the pipeline alignment followed a series of yellow placard markers imbedded in the ground in close proximity to sound wall east of the roadway. At the location of the damage the pipeline was not located below the yellow placard markers but in fact approximately 11.8 feet from the sound wall. This location placed the pipeline within the trench zone of the excavation. Pursuant to California law, including but not limited to, Government Code section 4216 et seq, the County and/or Flood Control District either owns, operates or maintains a subsurface installation—the pipeline in question that ruptured—and therefore is an operator of the subsurface installation. As an operator, after receiving notice by Underground Service Alert of the upcoming excavation, the County and/or Flood Control District was required to "locate and field mark the approximate location" of any subsurface installations that may be affected by the excavation "to the extent and degree of accuracy that the information is available either in the records of the operator or as determined through the use of standard locating techniques." (Cal. Gov't Code sec. 4216.3(a).) Notwithstanding its duty described above, the County and/or Flood Control District failed to locate and mark the approximate location of the pipeline at issue that ultimately ruptured, and therefore violated California law, including but not limited to, Government Code section 4216.3(a). Breach of this duty constitutes negligence and statutory violations. Alternatively, the County and/or Flood Control District was required to "advise the person that the operator does not operate any subsurface installations that would be affected by the proposed excavation," pursuant to California law, including but not limited to, Government Code section 4216.3(a). Notwithstanding its duty described above, the County and/or Flood Control District failed to advise Mountain Cascade that it did not operate any subsurface installations that would be affected by the proposed excavation, and therefore violated California law, including but not limited to, Government Code section 4216.3(a). Breach of this duty constitutes negligence and violations of statute. By virtue of all of the above, the County, an employer, violated California common law and California Labor Code section 6400 et seq. because it failed to furnish employment and a place of employment that was safe and healthful for the employees therein. 6. What damage or injuries do you claire: resulted? The personal injury and property damages include, but are not limited to, the death of five workers (two Mountain Cascade employees and three Matamoras Welding employees); the serious bodily injury to four workers (two Mountain Cascade employees and two Matamoras Welding employees); the emotional and psychological impact to workers and civilians within the 4820-7946-0352.1 5 zone of danger exposed to the personal injuries and loss of life which occurred as a result of the ensuing explosion and fire; the evacuation of approximately 270 residents from their homes; the evacuation of one high school and one elementary school; property damage to two residences and to two vehicles in the vicinity of the explosion; the business impacts to businesses located in two shopping centers that were in the vicinity of the explosion and fire and impacted by the command center set up at the intersection of Newell Avenue and South Broadway by police and fire emergency crews; adverse impacts to the atmosphere from the burning fuel; adverse impacts to the ground and ground water resulting from the escaping petroleum product; other anticipated environmental damages/issues; damage to the sound wall; damage to the work progress, including the pipeline; and costs and expenses of police, fire and other emergency response. The damages include, but are not limited to, personal injury and property damage described above, equipment, standby costs, delays in contract performance, increased costs of contract supervision and administration, increased costs of home and field office overhead, costs of attorneys and expert investigators, insurance deductible payments, and all other costs reasonably associated with this incident. The exact amount of Mountain Cascade's claim is not ascertainable at this time,but it will exceed $25,000. 7. How was the amount claimed above computed? a. Fourteen lawsuits''-'have been filed thus far. They are: 1. Angeles v. Kinder Morgan, et al., Alameda County Superior Court Case No. RG-05-195680; 2. Arias, et al., v. Kinder Morgan, et al., Alameda County Superior Court Case No. RG-05-195567; 3. Becerra v. Kinder Morgan et al., Contra Costa County Superior Court Case No. CIVMSC05-02451; 4. Chabot v. East Bay Municipal Utility District, et al., Contra Costa County Superior Court, Case No. C05-02312; 5. Farley v. Mountain Cascade, Inc., et al., Contra Costa County Superior Court Case No. C05-01573; 6. Fuentes v. Kinder Morgan Energy Partners, L.P., et al., Contra Costa County Superior Court Case No. C05-02286; 7. Im v. Kinder Morgan, Inc., Contra Costa County Superior Court Case No. C05-02077; 8. Knox v. Mountain Cascade, Inc., Contra Costa County Superior Court '-'Mountain Cascade's Government Tort Claim against the County of Contra Costa for equitable indemnity, apportionment of fault/contribution and declaratory relief pertaining to the Arias, Angeles and Knox coordinated actions was served on May 6, 2005. 4820-7946-0352.1 6 Case No. C05-00281; . 9. Matamoros v. Kinder Morgan Energy Partners, L.P., Contra Costa County Superior Court Case No. JCCP NO. 4433; 10. Paasch v. East Bay Municipal Utility District, Contra Costa County Superior CourtCase No. C05-01844; 11. Ramos v. East Bay Municipal Utility District, Contra Costa County Superior Court Case NO. C05-01840; 12. Reyes v. East Bay Municipal Utility District, Alameda County Superior Court Case No. RG-05-20770; 13. Taylor v. East Bay Municipal Utility District, Contra Costa County Superior Court Case No. C05-02306; 14. United Services Automobile Association v. East Bay Municipal Utility District, Contra Costa County Superior Court Case No. C05-02128; Copies of the operative complaints are attached hereto as Exhibits 2-15. These actions have been coordinated in one Judicial Council Coordination Proceeding("JCCP"),Number 4433, in Contra Costa County Superior Court, Department Five, the Honorable Terence L. Bruiniers Presiding. b. In addition, the following parties have filed cross-complaints against Mountain Cascade, seeking affirmative relief, indemnity, declaratory relief and other causes of action: (1) SFPP, L.P. and Kinder Morgan entities; (2) EBMUD; and (3) County of Contra Costa and Flood Control District. Copies of the cross-complaints are attached hereto as Exhibits 16-18. These cross-actions have also been coordinated in JCCP, Number 4433. Additionally, it is anticipated that future complaints will be filed by additional parties. C. Mountain Cascade denies any liability in connection with the allegations for injuries and damages in the claims, complaints and pleadings filed by the various parties arising out of this incident, including but not limited to those referenced herein. However, in the event that Mountain Cascade is found responsible, in whole or in part, to the various parties asserting liability against Mountain Cascade, Mountain Cascade's liability, if any, would be based solely upon a derivative form of liability not resulting from its conduct, but only from an obligation imposed upon Mountain Cascade by law. Therefore, Mountain Cascade is entitled to complete and total equitable indemnity from the County, relative to all known and unknown damages, costs and expenses. If Mountain Cascade is adjudged to be liable to the various parties asserting damages against Mountain Cascade arising out of this incident,the County shall be required to(1)pay a share of each of the parties' judgment which is in proportion to the comparative negligence of the County in causing any and all damages;and(2)to reimburse Mountain Cascade for any payments made to the 4820-7946-0352.1 7 parties asserting damages against Mountain Cascade,in excess of Mountain Cascade's proportional share of liability, if any. Mountain Cascade denies any and all liability in connection with the claims,complaints and cross-complaint asserted by the various parties,including but not limited to those referenced herein, but if Mountain Cascade is held liable for any damages to any of the parties, such liability exists, if at all, only as a direct and proximate result of acts, omissions and/or negligence of the County. Mountain Cascade is informed and believes and thereon alleges that the County was at fault with reference to the allegations in the various claims,complaints,cross-complaints and pleadings filed as a result of the incident. Therefore, if Mountain Cascade is held obligated to pay to the any of the parties sums representing a percentage of fault not its own but that of the County,Mountain Cascade requests a judicial declaration and adjudication of the percentage of fault on the part of Mountain Cascade, if any, and on the part of the County, so as to determine Mountain Cascade's rights to be obligated to the various parties only in an amount representing Mountain Cascade's proportional share of liability, if any. An actual controversy now exists between Mountain Cascade and the County, as to Mountain Cascade's right of defense and indemnity from the County,the existence of which the County denies. A judicial declaration and adjudication is necessary and appropriate such that the parties may ascertain their rights and responsibilities. 8. Nantes and addresses of witnesses, doctors, and hospitals. The names and addresses of each and every witness are presently unknown to Mountain Cascade. But the following is a list of many of the persons who were at the jobsite the day of the incident. a. Mountain Cascade. These persons may be reached at Mountain Cascade. Individuals include, but are not necessarily limited to: Greg W. Berry; David Bower, Miguel Angel Fuentes; Jose Pena; David Stickney; Martin Topete; Clay Frades; Miguel Calderon; Alfred Carrillo; Marcus Escobedo; Patrick T. Farley; Ignacio Becerra, Rafael Gonzalez; Jaylon Hunt; Tom LeRoux; Daniel May; Raul Pichardo; Alejandro Ramirez; Jose F. San Roman Salas; Ryan Stroup; Torry Taylor; Rosario Aguilar; Wenceslao Guerra; Salvador Juarez; Stephan W. Lewis; Duke Fuller; Roger Williamson; Jay Mulligan; Shawn Ross; Mike Nelson; Jim Ratliff, Mike Kallsen; and Jeff Patton. Mountain Cascade is informed and believes that Mr. Farley was treated for a sprained ankle, injured lower back and right knee at Kaiser OCC Medical Clinic in Walnut Creek and Mr. Topete, Mr. Fuentes and Mr. Becerra were treated for burns. b. EBMUD. Mountain Cascade is informed and believes that these individuals may be reached at EBMUD, 375 11`h Street, Oakland, CA 94607. Individuals include but are not necessarily limited to: Kevin Canada; Keith Beckwith; Carlos Rodriguez; Mark Miller; Mark Warzyniak; Michelle Blackwell; Ed Ostrowski; Norm Settle (Brown & Caldwell); Joe Kacyra; 4820-7946-0352.1 8 and Martin Falarski. C. City of Walnut Creek. Mountain Cascade is informed and believes that these individuals may be reached at the City of Walnut Creek, 1666 N. Main'Street, Walnut Creek, CA 94596. Individuals include but are not necessarily limited to: Don Murphy; and Mark Cordeiro. d. Contra Costa County. Mountain Cascade is informed and believes that this individual may be reached at Contra Costa County 651 Pine Street, Martinez, CA 94553. Individuals include but are not necessarily limited to: Larry Cornelius. e. Pacific Boring, Inc. Mountain Cascade is informed and believes that these individuals may be reached at PO Box 727 Caruthers, CA 93609. Individuals include but are not necessarily limited to: Bradley Gardner; Christopher Bergamini; Scott Efird; and Jonathan Jamison. f. Viking Drillers, Inc., whose address is 801 Northport Drive, West Sacramento, CA 95691. g. Cell-Crete Corporation, whose address is 135 E. Railroad Ave, Monrovia, CA 910165. h. Matamoros Pipelines, Inc. Mountain Cascade is informed and believes that these individuals may be reached at Matamoros Pipeline, 3991 Nerdly Road, Oakley, CA 94561. Individuals include but are not necessarily limited to: Roger Paasch and Jeremy Knox. Mountain Cascade is informed and believes that Mr. Paasch was treated for burns at the University of California at Davis Medical Center and Mr. Knox was treated for burns at the Doctors Medical Center. i. Oscar Navarro, address unknown j. Arroyo Trucking, Inc., whose address is PO Box 2174, Livermore, CA 94550 9. List the expenditures you made on account of this accident or injury: Please see Section 7 above, which is incorporated herein. 4820-7946-0352.1 9 Y Official notices and correspondence should be sent to each: Shawn A. Toliver Jason C. Zhao Lewis, Brisbois Bisgaard & Smith LP One Sansome Street, Suite 1400 San Francisco CA 94104 415/362-2580 toliver c�lbbslaw.com zhaoQbbslaw.com John W. Busby H Law Offices of John W. Busby II 1212 Broadway, 10`h Floor Oakland, CA 94612 510/465-2800 jwbusb a.yahoo.com 4820-7946-0352.1 10 APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD ACTION FEBRUARY 28/06 Application to File Late Claim ) NOTICE TO APPLICANT Against the County, Routing ) The copy of this document mailed to you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to ) the Board of Supervisors (Paragraph III, below), California Government Code.) ) given pursuant to Government Code Sections 911.8 and 915.4. Please note the "WARNING"below. Claimant: . BRENTWOOD ROD AND GUN CLUB Attorney: LORI B. FELDMAN, Esq. 200S Address: LAW OFFICES OF LORI B. FELDMAN 165 NORTH REDWOOD DRIVE, SUITE 110 `" Amount:= SAN RAFAEL, CA 94903 By delivery to Clerk on: JANUARY 24, 2006 =--UNKNOWN ! UNKNOWN Date Received: JANUARY 24, 2006 By mail,postmarked on: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted Application to File Late Claim. DATED: JANUARY: 24, 2006 JOHN SWEETEN, Clerk,By: DEPUTY II. FROM: County Counsel TO: derk of the'Board of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6): ( I,-The Board should deny this Application to File Late Claim (Section 911.6). DATED: a y- Q� SILVANO B. MARCHESI, County Counsel,By: W_eA".(ti.. DEPUTY III. BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( ) This Application is granted (Section 911.6). (� This Application to File Late Claim is denied (Section 911.6). I certify that this atrue and correct copy of the Board's Order entered in its minutes for this date. t, DATE: � . o*1oa&44; JOHN SWEETEN, Clerk, By: DEPUTY WARNING (Gov. Code §911.8) i 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 apj?lfcation 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` JOHN SWEETEN, Clerk, By: DEPUTY V. FROM: (1) County Counsel (2) County Administrator TO: Clerk of the Board of Supervisors Received copies of this Application and Board Order. DATED: County Counsel,By: County Administrator, By: APPLICATION TO FILE LATE CLAIM I Lori B. Feldman, Esq. (SBN 99655) Q110, LAW OFFICES OF LORI B. FELDMAN 2 165 North Redwood Drive, Suite 110 San Rafael, CA 94903 3 Telephone: 415-492-2120 Telefax: 415-492-2019 4 Attorneys for Defendant and Cross-Complainant 5 BRENTWOOD ROD AND GUN CLUB 6 7 IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA 8 IN AND FOR THE COUNTY OF CONTRA COSTA 9 UNLIMITED CIVIL JURISDICTION 10 11 PAUL BERGSTROM, ) Case No. C05-00248 12 Plaintiff, ) APPLICATION FOR PERMISSION TO PRESENT LATE CLAIM 13 vs. [Govt. Code § 911.4] 14 SAND HILL RANCH MOTOCROSS, ) BRENTWOOD ROD AND GUN CLUB, ) In the Matter of the Claim of 15 TOM M. ANDERSON, THOMAS SMITH, ) BRENTWOOD ROD AND GUN and DOES TWO through FIFTY, ) CLUB against THE COUNTY OF 16 ) CONTRA COSTA Defendants. ) 17 ) 18 AND RELATED CROSS-ACTIONS. ) 19 20 TO THE COUNTY OF CONTRA COSTA AND ITS GOVERNING BOARD OF 21 SUPERVISORS: 22 Defendant and Cross-Complainant BRENTWOOD ROD AND GUN CLUB 23 ("BRENTWOOD") hereby applies to the Clerk of the Board of Supervisors of the County of Contra 24 Costa for permission to present the claim attached to this application against the COUNTY OF 25 CONTRA COSTA ("COUNTY"). 26 As stated in the claim, Defendant BRENTWOOD's cause of action accrued on or about May 27 24, 2005, when it was served with plaintiff PAUL BERGSTROM's complaint as DOE ONE in 28 Contra Costa Superior Court Case No. C05-00248. On June 8, 2005, plaintiff filed a First Application for Permission to Present Late Claim 1 I Amendment to Substitute True Name for Fictitious Name, substituting DOE ONE as 2 BRENTWOOD ROD AND GUN CLUB. The time for presentation of the claim expired on or 3 about November 28, 2005 (the Thanksgiving holiday fell on November 24-25, 2005). 4 The claim was not presented within the time provided in Government Code § 911.2 because 5 of the excusable neglect of counsel for BRENTWOOD in that counsel was not aware of any 6 potential claim for indemnity or contribution against the COUNTY until she was advised by Mr. 7 Ron Downs, the President of BRENTWOOD, on January 10, 2006, while he was working on 8 responses to discovery propounded by the plaintiff, that he thought the COUNTY, prior to the date 9 that plaintiff was injured, ordered property owners, Defendants TOM ANDERSON and TOM 10 SMITH, to fill in the hole or cliff that plaintiff fell into. Defendant BRENTWOOD contends that by 11 failing to enforce its own order(s) against ANDERSON and SMITH, the COUNTY is at least 12 partially responsible for causing the incident. Prior to January 10, 2006, Mr. Downs had never 13 advised counsel of this fact, and because discovery was stayed until December 16, 2005, by the 14 Honorable Terence L. Bruiniers of Department 5 of the Contra Costa Superior Court, counsel did 15 not have any reason to suspect the COUNTY of any knowledge of or involvement with the subject 16 property. As soon as counsel for BRENTWOOD became aware of this potential claim, she notified 17 the Court at the Case Management Conference of January 18, 2006 that she was considering 18 bringing the COUNTY into the action as a cross-defendant, she sent a Public Records Act Request 19 for Information from the COUNTY Community Development Department for documents relating to 20 the COUNTY's orders/citations/correspondence to Defendants ANDERSON and SMITH 21 (BRENTWOOD has no documents confirming what Mr. Downs suspects), and she filed this 22 Application for Permission to File a Late Claim. 23 The relatively minor delay in filing the claim will not prejudice the COUNTY. As 24 previously stated, the Court imposed a complete stay on discovery until December 16, 2005, at 25 which time only written discovery was permitted to be propounded. As of the filing of this 26 application, no written discovery responses have yet been served by any of the parties to the action. 27 At the last Case Management Conference on January 18, 2006, the Court ordered that party 28 depositions could be commenced, and the first depositions in the case are not scheduled until Application for Permission to Present Late Claim 2 I February 28, March 1 and March 7, 2006. Also at the Case Management Conference on January 18, 2 2006, a trial date was set for November 27, 2006. Sufficient time exists for the COUNTY to 3 conduct discovery and prepare for trial, and counsel for BRENTWOOD is informed and believes, 4 and thereon states, that no material information, discovery, or evidence will have been lost or 5 unavailable to the COUNTY due to this delay. 6 I declare under penalty of perjury under the laws of the State of California that the foregoing 7 is true and correct. 8 Executed this 23`d day of January, 2006, in San Rafael, California. 9 10 LORI B. FELDMAN 11 Attorney for Defendant and Cross-Complainant BRENTWOOD ROD AND GUN CLUB 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Application for Permission to Present Late Claim 3 I Lori B. Feldman, Esq. (SBN 99655) LAW OFFICES OF LORI B. FELDMAN 2 165 North Redwood Drive, Suite 110 San Rafael, CA 94903 3 Telephone: 415-492-2120 Telefax: 415-492-2019 4 Attorneys for Defendant and Cross-Complainant 5 BRENTWOOD ROD AND GUN CLUB 6 7 1N THE SUPERIOR COURT OF THE STATE OF CALIFORNIA 8 IN AND FOR THE COUNTY OF CONTRA COSTA 9 UNLIMITED CIVIL JURISDICTION 10 11 PAUL BERGSTROM, ) Case No. C05-00248 12 Plaintiff, ) CLAIM FOR INDEMNITY AND CONTRIBUTION AGAINST THE 13 vs. ) COUNTY OF CONTRA COSTA 14 SAND HILL RANCH MOTOCROSS, ) BRENTWOOD ROD AND GUN CLUB, ) 15 TOM M. ANDERSON, THOMAS SMITH, ) and DOES TWO through FIFTY, ) 16 ) Defendants. ) 17 ) 18 AND RELATED CROSS-ACTION. ) 19 20 Pursuant to Government Code § 910, Claimant BRENTWOOD ROD AND GUN CLUB 21 submits a claim against the COUNTY OF CONTRA COSTA for indemnity and contribution. 22 1. Claimant is BRENTWOOD ROD AND GUN CLUB. Its address is: 280 Camino Diablo 23 Brentwood, CA 94513 24 2. The address to which notices should be sent is: Lori B.Feldman, Esq. 25 Law Offices of Lori B. Feldman 165 North Redwood Drive, Suite 110 26 San Rafael, CA 94903 Telephone: 415-492-2120 27 Email: lbfeldmanlawt aol.com Attorney for BRENTWOOD ROD AND GUN CLUB 28 Claim for Indemnity and Contribution Against the County of Contra Costa 1 F ' 1 3. Date, place and circumstances of the occurrence which gives rise to the claim: 2 March 11, 2004, near the Sand Hill Ranch Motocross motorcycle park located at 50 Camino Diablo Road, Brentwood, CA 3 Plaintiff PAUL BERGSTROM was operating a Yamaha motorbike as a fee paying invitee of 4 Sand Hill Ranch Motocross. He was proceeding west when he claims that a trail he was on suddenly and without warning abruptly ended because it had been cut away. As a result, plaintiff 5 alleges that he and his motorbike went over the cliff and he landed violently on the surface below, sustaining serious personal injuries. 6 4. General description of the indebtedness, obligation, injury, damage or loss incurred so far as 7 it may be known at the present time: 8 BRENTWOOD ROD AND GUN CLUB has been sued by Plaintiff BERGSTROM for alleged negligence in owning, managing, maintaining and controlling its property adjacent to the 9 Sand Hill Ranch Motocross. BRENTWOOD ROD AND GUN CLUB seeks indemnity and contribution from the COUNTY OF CONTRA COSTA since it is informed and believes that THE 10 COUNTY was aware that the cliff had been cut away, and had ordered property owners TOM ANDERSON and TOM SMITH to fill in the cliff prior to the plaintiff's accident. However, THE 11 COUNTY failed to enforce its order(s) against ANDERSON and SMITH, and is therefore wholly or at least partially responsible for causing the incident. 12 5. The name(s) of the public employee(s) causing the injury, damage, or loss, if known: 13 BRENTWOOD is not currently aware of the public employee(s) who ordered the property 14 owners to fill in the cliff, and/or who failed to enforce THE COUNTY's order(s). However, BRENTWOOD is informed and believes that employees within THE COUNTY'S Community 15 Development Department may have served notices to property owners ANDERSON and SMITH. 16 6. Amount claimed: 17 This claim exceeds $10,000, and is an unlimited civil case. 18 Dated: January 23, 2006 LAW OFFICES OF LORI B. FELDMAN 19 � 20 B Eq-r'/B. Feldman 21 Attorneys for Defendant BRENTWOOD ROD AND GUN CLUB 22 23 24 25 26 27 28 Claim for Indemnity and Contribution Against the County of Contra Costa 2 PROOF OF SERVICE 1 2 I, the undersigned, declare as follows: 3 I am over the age of eighteen years and not a party to the within action. 4 My business address is 165 North Redwood Drive, Suite 110, San Rafael, California 94903. 5 On January 23, 2006, I served a copy of the attached 6 APPLICATION FOR PERMISSION TO PRESENT LATE CLAIM [Govt. Code § 7 911.41; CLAIM FOR INDEMNITY AND CONTRIBUTION AGAINST THE COUNTY OF CONTRA COSTA 8 by placing a true and correct copy thereof in a sealed envelope, with postage thereon fully prepaid, 9 in the United States mail at San Rafael, California, addressed as follows: 10 Clerk of the Board of Supervisors County of Contra Costa 11 651 Pine Street, Room 106 Martinez, CA 94553 12 I am readily familiar with my office's practice of collection and processing 13 correspondence/documents for mailing. It is deposited with the United States Postal Service on that same day in the ordinary course of business. 14 I declare under penalty of perjury, in accordance with the laws of the State of California, 15 that the foregoing is true and correct. 16 Executed on January 23, 2006. 1 17 j 18 B. FELDMAN 19 20 21 22 23 24 25 26 27 28 LAW OFFICES OF LORI B. FELDMAN 165 North Redwood Drive Suite 110 San Rafael, California 94903-1962 Telephone: 415-492-2120 Telefax: 415-492-2019 E-mail: Ibfeldmanlaw@aol.com 9.y. January 23, 2006 9� VIA UPS OVERNIGHT DELIVERY s Clerk of the Board of Supervisors County of Contra Costa 651 Pine Street, Room 106 Martinez, CA 94553-1229 Re: Application for Permission to Present Late Claim [Govt. Code § 911.4] Claim for Indemnity and Contribution Against the County of Contra Costa Dear Sir or Madam: Enclosed please find BRENTWOOD ROD AND GUN CLUB'S Application for Permission to Present Late Claim [Govt. Code § 911.4]; and attached Claim for Indemnity and Contribution Against the County of Contra Costa for filing with your office. Please file the original, mark the date it was received on the copy, and return the copy to us in the envelope provided. Thank you for your courtesy and assistance in this regard. Ve truly yours, (Ayzi Lori B. Feldman Enclosure laodx3 e3nn3a N J o c Z U ' a LL IIE w ` Nw o h a 1 w w c d •� +p� o' X Z O Z J Q W e CO -n o ^ 0 p� o O 0 O 0 co D D D O O O � O I � 0 0 OL Q o � o rp 0 02 N NCV O N ? Z z u O (p C7 N N Nm m W M Z LU X s I � LL CF M� Li Ll- n L LL U) 41 a (�� J fk [0 LUN a. o y ' o 1 `PCL • 07 R } E C13U) cli ca a ai O wN W O g OI ® U 4S x0) /VIII11 V' ��. r., w1U��- cn. n° Jo j F� r J W Q ,p LLI U e Q LL F V � a. ( 9 w m w 2 m s-j c M All O eg LL -C d ® O W _ ao u) N a w`e (� = WtR co L) NUJ M 3: ® w Q (4 1= w J r to CL o el z Y LLI O 5 B w X Rj t O L ..T m z 0) -0 C ¢ C/) o Q- N 0 rn d i cd i e0 aUoi 7 m .N U) Z r G r C • AMENDED CLAIM �fI I30A1tD OF SUPERV[SORS Or CONTRA COSTA COi INTI v BOARD ACTION: FEBRUARY 28/06 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 CLAIM AGAINST COUNTY OF CONTRA COSTA 915.4. Please note all "Warnings". AMOUNT: UNKNOWN FEB 0 8 2006 CLAIMANT: MOUNTAIN CASCADE, INC. COUNTY COUNSEL MARTINEZ CALIF. FEBRUARY 08/06 ATTORNEY: SHAWN A. TOLIVER DATE RECEIVED: LEWIS, BRISBOIS, BISGAARD & SMITH:; LP FEBRUARY 08/06 ADDRESS: ONE SANSOME STREET, STE. 1400 BY DELIVERY TO CLERK ON: SAN FRANCISCO, CA. 94104 RECEIVED FROM COUNTY BY MAIL POSTMARKED: COUNSEL FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEE erk Dated: FEBRUARY 0&, 2006 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Sup visors (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. Tire Clerk should return claim on grGund that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). ( ) Other: Dated: By: %/ ( ,= Deputy County Counsel iil. 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. BQARD ORDER: By unanimous vote of the Supervisors present: (� This Claim is rejected in frill. O 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 tinder 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 1 r pb-07-2006 05:12pim To-19256461078 From-LEWIS BRISBOIS BISGAARD & SMITH LLP . T-866 P.001/003 F-493 a , + It LEWIS BRISBOIS BISGAARD & SMITH LLP ATTORNEYS AT LAW ONE SANSOME STREET, S01T8 1400, SAN FRANCISCO, CA 94104 PHONE: 415.362.2580 1 FAX: 415.434.0882 1 WEBSITE: www.lbbslaw.com « JASON C.ZRAO February 7, 2006 DIRECT DiAu 415.262.8527 E-MAIL:2bao@lbbslaw.com CE, Via Facs >rrile and U.S. Mailr�tr U 2006 Monike, ctFR . Cooper cacARo op S Deputy County Counsel NrRAc0s A�oVISORS Office,of the County Counsel Co a'qty of Contra Costa A!jministraTion Building 651 Pine Street, 91'Floor 'Martinez, CA 94553-1229 (Fax: 925.646.1078) (Phone: 925.335.1800) y' 1 Re: Mountain Cascade's Government Tort Claims For Indemiiijy Against County of Contra Costa and the Contra Costa County Flood Control and Water Conservation District Date of claims: January 27, 2006 Claimant: Mountain Cascade Dear Ms. Cooper: Pursuant to the notice served by your office on February 3,2006,pertaining to Mountain Cascade's government tort claims for indemnity against the County of Contra Costa and the Contra Costa County Flood Control and Water Conservation District,this correspondence is to provide the County and the Flood Control District with the dates on which Mountain Cascade was served with the various complaints and cross-complaints as referenced in Mountain Cascade's government tort claims presented on January 27, 2006. As referenced in the claims and exhibits thereto, fourteen lawsuits have been filed thus far. They are: 1. Angeles v. Kinder Morgan, et al., Alameda County Superior Court Case No. RG- 05-195680; 2. Arias, et al., v. Kinder Morgan, et al.,Alameda County Superior Court Case No. RG-05-195567; Lcbmm= SANDMGO COSTAMRSA WAMEWMR SACKV4WO NEWYORK LAS VEGAS PHOEM 'TUCSON CFIICAGO 213250.1800 619233.1006 714.545,9200 9M.597.1130 916564.5400 212232.1300 7OX8933383 602.385.1040 520202.2565 312.345.1718 4846-9113.7792.1 Fab-07-2006 05:13pm To-19256461078 From-LEWIS BRISBOIS BISGAARD ii SMITH LLP T-866 P.002/003 F-493 LEWIS BRISBOIS BISGAARD&SMITH rl.P February 7, 2006 Page 2 3. Becerra v. Kinder Morgan et al., Contra Costa County Superior Court Case No. CIVMSC05-02451; 4. Chabot v. East Bay Municipal Utility District, et al., Contra Costa County Superior Court, Case No. C05-02312; 5. Farley v. Mountain Cascade, Inc., et al., Contra Costa County Superior Court Case No. C05-01573; 6. Fuentes v. minder Morgan Energy Partners, L.P., et al., Contra Costa County Superior Court Case No. C05-02286; 7. Im Y. Kinder Morgan, Inc., Contra Costa County Superior Court Case No. C05- 02077; 8. Knox v. Mountain Cascade, Inc., Contra Costa County Superior Court Case No. C05-00281; 9. Matamoros v. Kinder Morgan Energy Partners,L.P., Contra Costa County Superior Court Case No. C05-02349; 10. Paasch v. East Bay Municipal Utility District, Contra Costa County Superior Court Case No. C05-01844; 11. Ramos v. East Bay Municipal Utility District, Contra Costa County Superior Court Case NO. C05-01840; 12. Reyes v. East,Bay Municipal Utility District,Alameda County Superior Court Case No. RG-05-20770; 13. Taylor v. East Bay Municipal Utility District, Contra Costa County Superior Court Case No. C05-02306; 14. United Services Automobile Association v. East Bay Municipal Utility District, Contra Costa County Superior Court Case No. C05-02128; See Exhibits 2 - 15. In addition,the following parties have filed and served cross-complaints against Mountain Cascade, seeking affirmative relief, indemnity, declaratory relief and other relief: (1) SFPP,L.P. and Kinder Morgan entities; (2) EBMUD; and(3) County of Contra Costa and Flood Control District. See Exhibits 16-18 hereto. Mountain Cascade's government tort claims for indemnity against the County and Flood Control District with respect to the Arias, Angeles and Knox cases were presented on May 6, 2005. In letters dated June 7,2005, the County and Flood Control District rejected those claims. The present claims for indemnity are presented with respect to the remaining actions and cross- actions referenced herein. The dates on which the complaints and cross-complaints were served on Mountain Cascade are as follows: • The Chabot lawsuit was served on Mountain Cascade on December 2, 2005; The Mnra.»oros lawsuit was 3otv9d on Mountain Coacado on Dcccmbcr 7, 2005; 4946-9113-7792.1 Fab-07-2006 05:13PM To-19256461078 From-LEWIS BRISBOIS BISGAARD & SMITH LLP T-866 P.003/003 F-493 f L { LEWIS BRISBOIS BISGAARD&SMITH up February 7, 2006 Page 3 • The Paasch lawsuit was served on Mountain Cascade on December 27, 2005; • The Reyes lawsuit was served on Mountain Cascade on July 29,2005; • The United Services Automobile Association lawsuit was served on Mountain Cascade on November 14,2005; • The Cross-Complaint filed by SFPP, L.P. and Kinder Morgan entities was served on Mountain Cascade on November 4, 2005; • The Cross-Complaint filed by East Bay Municipal Utility District was served on Mountain Cascade on January 18, 2006; • The Cross-Complaint filed by the County of Contra Costa and the Flood Control District was served on Mountain Cascade on January 20, 2006; • With respect to the lawsuits filed by plaintiffs in the Becerra,Farley,Fuentes,Im, Ramos and Taylor cases'-',Mountain Cascade was not directly named as a defendant. With respect to these lawsuits, Mountain Cascade's claims for indemnity accrued when the indemnity Cross-Complaints referenced herein were served on Mountain Cascade. Please feel free to contact me if you have any questions. Ve y yours, n ao for S BRISBOIS BLSGAARD & SMITH LLP JCZ cc: John W. Busby SAT '-'Plaintiffs in these cases did not directly name Mountain Cascade as a defendant because plaintiffs/decedents in these cases were employees of Mountain Cascade when the subject incident occurrcd. Acs ouch, the cxclu.SiVv rcmcay provision of tie California Labor Code prohibits them from pursuing a civil action against Mountain Cascade. 4846-9113-7792.1 Office of the County Counsel Contra Costa County 651 Pine Street, 9th Floor Phone: (925)335-1800 Martinez, CA 94553 Facsimile: (925) 335-1866 Writer's Direct Dial: (925) 335-1885 Date: February 8, 2006 °k a To: Clerk of the Board of Supervisors CLU. Attn: Emy Sharp, Deputy Clerk �qco AR: Nr�,; From: Silvano B. Marchesi, County Counsel � s By: Monika L. Cooper, Deputy County Counsel (n �� Re: Amended Government Tort Claim Please process the attached letter from Mountain Cascade as an Amended Government Tort Claim. Thank you for your assistance. Please call with any questions. Attachment CONFIDENTIAL ATTORNEY CLIENT DOCUMENT b-07-2006 05:12pm To-19256461078 From-LEWIS BRISBOIS BISGAARD & SMITH LLF I-d5b F.UUI1uue r-4a4 !J LEWIS 13RIS130IS BISGAARD & SMITH LLP ATTORNEYS AT LAW ONE SANSOME STREET, SUITE 1400, SAN FRANCISCO, CA 94104 PHONE: 415.362.2580 1 FAX: 415.434.0882 1 WEBSITE: www.lbbslaw.com JASON C.ZHAO February 7,2006 DIRECT DIAL:415.262.8527 F,MAI.:zhao@lbbslaw.com V' U.S. Mail r t 200 ><a Facsiil>rlle and ail cL 6 Monika.`,. Cooper E�COOAiiN il)OF, JpeRVIS Deputy �,ounty Counsel Bra co ORS Office"Of the County Counsel Conary of Contra Costa Administration Building 651 Pine Street, 9h Floor Martinez, CA 94553-1229 (Fax: 925.646.1078) (Phone: 92 5.3 3 5.18 00) Re: Mountain Cascade's Government Tort Claims For Indemnity Against County of Contra Costa and the Contra Costa County Flood Control and Water Conservation District Date of claims: January 27, 2006 Claimant: Mountain Cascade Dear Ms. Cooper: Pursuant to the notice served by your office on February 3,2006,pertaining to Mountain Cascade's government tort claims for indemnity against the County of Contra Costa and the Contra Costa County Flood Control and Water Conservation District,this correspondence is to provide the County and the Flood Control District with the dates on which Mountain Cascade was served with the various complaints and cross-complaints as referenced in Mountain Cascade's government tort claims presented on January 27, 2006. As referenced in the claims and exhibits thereto, fourteen lawsuits have been filed thus far. They are: 1. Angeles v. Kinder Morgan, et al.,Alameda County Superior Court Case No. RG- 05-195680; 2. Arias, et al., v. Kinder Morgan, et al.,Alameda County Superior Court Case No. RG-05-195567; L46A►vMM SMDIDGo C:wrAMA.SA AaxmEww sncmwp 10 NPWYORK LASVEWS PHOEM TUCSON MCn00 213250.1800 619233.1006 714.545.9200 909387.1130 916564.5400 212232.1300 MX893.3383 602.385.1040 520202.2565 312345.1718 4846-9113-7792.1 Feb�07-2006 05:13pm To-19256461078 From-LEWIS BRISBOIS BISGAARD & SMITH LLP T-866 P.002/003 F-493 LEWIS BmBOIS 13TSGAARD&SMITH r LP February 7,2006 Page 2 3. Becerra v. Kinder Morgan et al., Contra Costa County Superior Court Case No. CIVMSC05-02451; 4. Chabot v. East Bay Municipal Utility District, et al., Contra Costa County Superior Court, Case No. C05-02312; 5. Farley v.Mountain Cascade,Inc., et al., Contra Costa County Superior Court Case No. C05-01573; 6. Fuentes v. minder Morgan Energy Partners,L.P., et al., Contra Costa County Superior Court Case No. C05-02286; 7. Im v. Kinder Morgan, Inc., Contra Costa County Superior Court Case No. C05- 02077; 8. Knox v. Mountain Cascade, Inc., Contra Costa County Superior Court Case No. C05-00281; 9. Matamoros v. Kinder Morgan Energy Partners,L.P., Contra Costa County Superior Court Case No. C05-02349; 10. Paasch v. East Bay Municipal Utility District, Contra Costa County Superior Court Case No. C05-01844; 11. Rarnos v. East Bay Municipal Utility District, Contra Costa County Superior Court Case N0. C05-01840; 12. . Reyes v. East Bay Municipal Utility District,Alameda County Superior Court Case No. RG-05-20770; 13. Taylor v. East Bay Municipal Utility District, Contra Costa County Superior Court Case No. C05-02306; 14. . United Services Automobile Association v. East Bay Municipal Utility District, Contra Costa County Superior Court Case No. C05-02128; See Exhibits 2 - 15. In addition,the following parties have filed and served cross-complaints against Mountain Cascade, seeking affinniative relief, indemnity, declaratory relief and other relief: (1) SFPP, L.P. and Kinder Morgan entities; (2) EBMUD; and(3) County of Contra Costa and Flood Control District. See Exhibits 16-18 hereto. Mountain Cascade's government tort claims for indemnity against the County and Flood Control District with respect to the Arias,Angeles and Knox cases were presented on May 6, 2005. In letters dated June 7,.2005,the County and Flood Control District rejected those claims. The present claims for indemnity are presented with respect to the remaining actions and cross- actions referenced herein. The dates on which the complaints and cross-complaints were served on Mountain Cascade are as follows: • The Chabot lawsuit was served on Mountain Cascade on December 2, 2005; The Matamoros lawsuit waz 3o:v9d on Mountain Cascadc on Dcocmbc;r 7,2005; 4946-9113-7792.1 Feb-Z7-2006 05:13Pm To-19256461078 From-LEWIS BRISBOIS BISGAAKU b SMiin LLr —000 r.uuaiuuo -»•� LEWIS BRISBOIS BISGAARD &SMITH LLP February 7, 2006 Page 3 • The Paasch lawsuit was served on Mountain Cascade on December 27, 2005; • The Reyes lawsuit was served on Mountain Cascade on July 29,2005; • The United Services Automobile Association lawsuit was served on Mountain Cascade on November 14,2005; • The Cross-Complaint filed by SFPP, L.P. and Kinder Morgan entities was served on Mountain Cascade on November 4,2005; • The Cross-Complaint filed by East Bay Municipal Utility District was served on Mountain Cascade.on January 18,2006; • The Cross-Complaint filed by the County of Contra Costa and the Flood Control District was served on Mountain Cascade on January 20, 2006; • With respect to the lawsuits filed by plaintiffs in the Becerra,Farley,Fuentes,Ln, Ramos and Taylor cases'-`, Mountain Cascade was not directly named as a defendant. With respect.to these lawsuits, Mountain Cascade's claims for indemnity accrued when the indemnity Cross-Complaints referenced herein were served on Mountain Cascade. Please feel free to contact me if you have any questions. Ana for OIS BLSGAARD & SMITH LLP JCZ cc: John W. Busby SAT '-'Plaintiffs in these cases did not directly name Mountain Cascade as a defendant because plaintiffs/decedents in these cases were employees of Mountain Cascade when the subject ineidonc occurred. As such, the cxclusivc mmcay provision of the California Labor Code prohibits them from pursuing a civil action against Mountain Cascade. 4846-9113-7792.1 Office of the County Counsel Contra Costa County 651 Pine Street, 9th Floor Phone: (925)335-1800 Martinez, CA 94553 Facsimile: (925)335-1866 Writer's Direct Dial: (925) 335-1885 Date: February 8, 2006 �: ;: w. To: Clerk of the Board of Supervisors r t b U ?Orin Attn: Emy Sharp, Deputy ClerkCO,Vo�ERK�oA; ; From: Silvano B. Marchesi, County Counsel By: Monika L. Cooper, Deputy County Counsel Re: Amended Government Tort Claim Please process the attached letter from Mountain Cascade as an Amended Government Tort Claim. Thank you for your assistance. Please call with any questions. Attachment CONFIDENTIAL ATTORNEY CLIENT DOCUMENT AMENDED CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: FEBRUARY 28/06 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 cla.iin by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and CLAIM AGAINSTCONTRA COSTA FLOOD ( ( to all "Warnings". CONTROL & WATER CONS. DISTRICT AMOUNT: UNKNOWN FEB U H 2006 CLAIMANT: MOUNTAIN CASCADE, INC. COUNTY COUNSEL MARTINEZ CALIF. ATTORNEY: SHAWN A. TOLIVER DATE, RECEIVED: FEBRUARY 08/06 LEWIS, BRISBOIS, BISGAARD & SMITH,..LP FEBRUARY 08/06 ADDRESS: ONE SANSOME STREET, STE. 1400 BY DELIVERY TO CLERK ON: _ SAN FRANCISCO, CA. 94104 RECEIVED FROM COUNTY BY MAIL POSTMARKED: COUNSEL FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN SWEE Dated: FEBRUARY 08, 2006 By: Deputy — If. FROM: County Counsel TO: Clerk of the .Board of Sup isors (j)/(his claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on grc.und that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). O Other: Dated: �" � ° 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. ARD ORDER: By unanimous vote of the Supervisors present: ( his Claim is rejected in full. O Other: In�ce//rtify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated:092;6 ,PM, 0&0) JOHN SWEETEN, CLERK, By _ , Deputy Clerk WARNING (Gov. code section . 13) Subject to certain exceptions, you have only six (6) months from+he 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, your should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of per jury 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. Date d:, �a'� �/i a??/��I JOHN SWEETEN, CC,ERK By �rJ Deputy Clerk b-07-1006 05:12pmTo-19256461078 r rom-UW I b vrt i aOu I-) G 1 Q-11w LFWIS 13RIS130IS BISGAARD & SMITH LLP ATTORNEYS AT LAW ONE SANSOME STREET, SUITE 1400, SAN FRANCISCO, CA 94104 PHONE: 415.362.2580 1 FAX: 415.434.0882 1 WEBSITE: www.lbbslaw.com JASON C.Zhao February 7,2006 DIRECT DIAL:415.262.8527 E-MAtL:211ao@1bbs1aw.com a® � Via Facsirraile and U.S. Mail CL r OAF? U b �OQb ERk�OgRD Monika .L. Cooper CCtNv �P,LIP .RVJS Deputy County Counsel °5Tq Co CRs Office of the County Counsel Cmuty of Contra Costa A,dxninistration Building 651 Pine Street, 9*Floor Martinez, CA 94553-1229 (Fax: 925.646.1078) (Phone: 9 2 5.3 3 5.18 0 0) Re: Mountain Cascade's Government Tort Claims For Indemnity Against County of Contra Costa and the Contra Costa County Flood Control and Water Conservation District Date of claims: January 27, 2006 Claimant: Mountain Cascade Dear Ms. Cooper: Pursuant to the notice served by your office on February 3,2006,pertaining to Mountain Cascade's government tort claims for indemnity against the County of Contra Costa and the Contra Costa County Flood Control and Water Conservation District,this correspondence is to provide the County and the Flood Control District with the dates on which Mountain Cascade was served with the various complaints and cross-complaints as referenced in Mountain Cascade's government tort claims presented on January 27, 2006. As referenced in the claims and exhibits thereto, fourteen lawsuits have been filed thus far. They are: 1. Angeles v. Kinder Morgan, et al.,Alameda County Superior Court Case No. RG- 05-195680; 2. Arias, et al., v.Kinder Morgan, et al.,Alameda County Superior Court Case No. RG-05-195567; LMANMM Sn Dawo Uff,&MM^ kA.%ME SwUtwM&nD NEWYOW L&SVEWS PMOEM TUCSON CECAGO 213250.1800 619233.1006 714545.9200 909387.1130 916564.5400 212232.1300 7079933383 602-385.1040 520202-2565 312344.1718 4946-9113.7792.1 Feb-07-2006 ,..05:13pm To-18256461078 From-LEWIS BRISSOIS BISSAARD & NMI Ih LLr 1-000 r.uuciuuo r-wa, LEWIS BRISB01S 13TSGAARD&SMITH UP February 7,2006 Page 2 3. Becerra v.Kinder Morgan et al., Contra Costa County Superior Court Case No. CIVMSCOS-02451; 4. Chabot v. East Bay Municipal Utility District, et al., Contra Costa County Superior Court, Case No. C05-02312; 5. Farley v.Mountain Cascade,Inc., et al., Contra Costa County Superior Court Case No. C05-01573; 6. Fuentes v. Kinder Morgan Energy Partners,L.P., et al., Contra Costa County Superior Court Case No. C05-02286; 7. Im v. Kinder Morgan, Inc., Contra Costa County Superior Court Case No. C05- 02077; 8. Knox v.Mountain Cascade, Inc., Contra Costa County Superior Court Case No. COS-00281; 9. Matamoros v.Kinder Morgan Energy Partners,L.P., Contra Costa County Superior Court Case No. C05-02349; 10. Paasch v. East Bay Municipal Utility District, Contra Costa County Superior Court Case No. C05-01844; 11. Ramos v. East Bay Municipal Utility District, Contra Costa County Superior Courn Case NO. C05-01840; 12. Reyes v.East Bay Municipal Utility District,Alameda County Superior Court Case No. RG-05-20770; 13. Taylor v. East Bay Municipal Utility District, Contra Costa County Superior Court Case No. C05-02306; 14. United Services Automobile Association v.East Bay Municipal Utility District, Contra Costa County Superior Court Case No. C05-02128; See Exhibits 2- 15. In addition,the following parties have filed and served cross-complaints against Mountain Cascade, seeking affirmative relief, indemnity, declaratory relief and other relief: (1) SFPP, L.P. and Kinder Morgan entities; (2) EBMUD; and(3) County of Contra Costa and Flood Control District. See Exhibits 16-18 hereto. Mountain Cascade's government tort claims for indemnity against the County and Flood Control District with respect to the Arias,Angeles and Knox cases were presented on May 6, 2005. In letters dated June 7,2005, the County and Flood Control District rejected those claims. The present claims for indemnity are presented with respect to the remaining actions and cross- actions referenced herein. The dates on which the complaints and cross-complaints were served on Mountain Cascade are as follows: • The Chabot lawsuit was served on Mountain Cascade on December 2, 2005; The"---os lawsuit was aorvod on Mountain Camradc on Dcocmbor 7, 2005; 4846-91 13-779:.1 Feb-07-2006 .05,13pm To-16256461078 From-LEW 1 s eK i aau i b e i bUAAKW a ami in 661 --- --- -- LEwiS BmBOIS BIsoAARD &SMITH LLP February 7, 2006 Page 3 • The Paasch lawsuit was served on Mountain Cascade on December 27, 2005; • The Reyes lawsuit was served on Mountain Cascade on July 29,2005; • The United Services Automobile Association lawsuit was served on Mountain Cascade on November 14,2005; • The Cross-Complaint filed by SFPP,L.P. and Kinder Morgan entities was served on Mountain Cascade on November 4,2005; • The Cross-Complaint:filed by East Bay Municipal Utility District was served on Mountain Cascade on January 18,2006; • The Cross-Complaint filed by the County of Contra Costa and the Flood Control District was served on Mountain Cascade on January 20, 2006; • With respect to the lawsuits filed by plaintiffs in the Becerra,Farley,Fuentes,Im, Ramos and Taylor cases'-',Mountain Cascade was not directly named as a defendant. With respect to these lawsuits, Mountain Cascade's claims for indemnity accrued when the indemnity Cross-Complaints referenced herein were served on Mountain Cascade. Please feel free to contact me if you have any questions. V y yours, I ao for S BRISBOIS BISGAARD& SMTTH LLP JCZ cc: John W. Busby SAT 1-'Plaintiffs in these cases did not directly name Mountain Cascade as a defendant because plaintiffs/decedents in these cases were employees of Mountain Cascade when the subject incidcru occurred. As such, the cxelusivc rcmcay provision of The California Labor Code prohibits them from pursuing a civil action against Mountain Cascade. 4946-9113-7792.1 Office of the County Counsel Contra Costa County 651 Pine Street, 9th Floor Phone: (925) 335-1800 Martinez, CA 94553 Facsimile: (925) 335-1866 Writer's Direct Dial: (925) 335-1885 Date: February 8, 2006 ;: To: Clerk of the Board of Supervisors c� hob Attn: Emy Sharp, Deputy Clerk ; ............. 1 Nr� From: Silvano B. Marchesi, County Counsel By: Monika L. Cooper, Deputy County Counsel ()1 Re: Amended Government Tort Claim Please process the attached letter from Mountain Cascade as an Amended Government Tort Claim. Thank you for your assistance. Please call with any questions. Attachment CONFIDENTIAL ATTORNEY CLIENT DOCUMENT f AMENDED CLAIM. I30Altll OF SUPERVISORS OF CONTRA COSTA COUNTY . � BOARD ACTION: FEBRUARY 28/06 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 FEB 0 9 2006 915.4. Please note all "Warnings". COUNTY COUNSEL AMOUNT: $3,060.23 MARTINEZ CALIF. MITSUI SUMITOMO INSURANCE GROUP CLAIMANT: FOR: TOYOTA TSUSHO AMERICA, INC. BY: MANDY LAMHART ATTORNEY: UNKNOWN - DATE RECEIVED: FEBRUARY 09/06 312 ELM STREET, SUITE 1250 FEBRUARY 09/06 ADDRESS: CINCINNATI, OH 45202 BY DELIVERY TO CLERK ON: BY MAIL POSTMARKED: RECEIVED FROM RISK M6a0fr FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. FEBRUARY 09 2006 JOHN SW EE N, 1 rk Dated: By: Deputy 11. FROM: County Counsel TO: Clerk.of the Board of Supe•visors (;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). ( ) Clairn is not timely filed. The Clerk should return claim on grc.und that it was filed late and send warning of claimant's tight to apply for leave to present a late claim(Section 911.3). O Other: Dated: By: Deputy County Counsel 1..i1. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). [V. LjOARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. O Other: I cerrtify that tris 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 sect on 913 Subject to certain exceptions, you have only six (6) months from he date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of per jury 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:./v&? C'J !F// JOHN SWEETEN, CLERK By Deputy Clerk 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 lie presented•not.later than pix months after the accrual of the cause of action. A claim relating:to and oth*r.eause roJ aitipn shall be presented not later than one year after the accrual of the�caus;of Mien: • (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. MEMO mums moon..mmo.mmmNONMEMBER moon Ramos.oso..ummummomONE OWN mmo■■O.sum now..m00me RE: Claim By: Reserved for Clerk's filing stamp RECEIVED Against the County of Contra Costa or ) FEB 0 9 2006 CLERK BOARD OF SUPERVISORS District) CONTRA COSTA CO. (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$ 'W(9 . Q3 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 05 �� g5o 2. Where did the damage or injury occur? (Include city and county) 15 Por �� dl 3. How did the damage or injury occur? (Give full details;use extra paper if required) egse._ T h c V cAv� \UVYQa 01 4. What articular act or omission on the art of AV district officers, servants or employees P P caused the injury or damage? V v\S ck�-e A-v Y, Y1 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.) PC opv'NY Do * . �.ro n�-,es��, ,��o��e � 7. How was the amount claimed above camputea? �,(Iilquae she;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 ■ONE Noonan asssssss0OWN srssssMEN•rasaaasasaaa■■asssssrrssasasassaassaIsms a0amaa0aasssse _ 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) 1 Name and address of.Attorney...___. ) (Cl ant's Signa e) ) (Address) Telephone No. )Telephone No. 53 • � )9�� 0 � ■■asarsamsaaa■■ssaasrssow■■rsssasassass■■sasssasaaaaarssr■sassssssssraraasarraaasaa&I 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. ■■ssaaraassas■■ssssssssrsssssassssssaaassssssasrsssssssssssaaaisasssrssassrsraasssaaN 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. MITSUI SUMITOMO INSURANCE GROUP Re: Claim Page Two . . .. . . . . . . 00 . . . . . .. . .. .... ... . .0 *.. [X] 7. You are required to submit your claim on the proper form, which is enclosed. Please resubmit your claim on the enclosed form, including all the required information. Gov. Code, § 910.4. Please be aware that you have only a limited period of time in which to file an amended claim. See Gov. Code, § 910.6. [ 18. Other: SILVANO B. MARCHESI COUNTY COUNSEL r By: Monika L. Cooper Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (Code Civ. Proc., §§ 1012, 1013a, 2015.5; Evid. Code, §§ 641, 664) I am a resident of the State of California, over the ape of eighteen years, and not a party to the within action. My ,--business address is Office of the County Counsel, 651 Pine Street, 9th Floor, Martinez, CA 94553-1229. On served a true copy of this Notice of Insufficiency and/or Non-Acceptance of Claim by acing the document in a sealed envelope with postage thereon fully prepaid, in the United States mail at Martinez, California addressed to Mitsui Sumitomo Insurance Group, Kelly Czimbal, P.O. Box 5435, Cincinnati, OH 45201, as set forth above. I am readily familiar with Office of County Counsel's practice of collection and processing of correspondence for mailing. Under that practice, it would be deposited with the U.S. Postal Service Oil that same day with postage thereon fully prepaid in the ordinary course of business. I declare under penalty of perjury under th laws of the State.of California and the United States of America that the above is true and correct. Executed oi at Martinez, California. Kathleen O'Connell �— cc: Clerk of the Board of Supervisors (original) Risk Management Page 2 Mitsui Sumitomo Insurance Group Mandy Lainhart Elm Street Suite 1250 Cincinnati, OH 45202 866.676.6272 ext. 8408 SHARON HYMES-OFFORD 908.325.0181 Fax January 31,2006 FEB 7 2006 City of Contra Costa Attn: Penny Bailey 2467 Waterbid Way Martinez, CA 94553 RE: Property Damage Lien Insured Toyota Tsusho America, Inc. Claim No AA 105557 Date of Loss 11/27/2005 Claim Amount $3060.23 Claim Number N/A Dear Penny Bailey: Please note that Mitsui Sumitomo Insurance Group is the insurance carrier for Toyota Tsusho. Be advised full and final settlement has been made with our insured. Property Damage $2060.23 Deductible $1000.00 I look forward to hearing from you. If you have any questions regarding this matter, please feel free to contact me at 1.866.676.6272 ext. 8408. Yours truly, Mandy Lai art RSU-Claim Representative Mitsui Sumitomo Marine Management(U.S.A.),Inc., for Mitsui Marine& Fire Insurance Company of America Sumitomo Marine & Fire Insurance Company of America 312 Elm Street,Suite 1250,Cincinnati,OH 45202 Session - PASSPORT _: _ D--ember 20, 2005, 15: 13 : 21 Claim Inquiry - By Claim MLAI 12/20/05 12 : 13 : 44 Inquire History Detail Check 0498035 Check Replaces Check Date 12/08/05 Check Amount 636. 72 Check Status Check Accept Amount . 00 Check Type Check Printed P Check Stop ID Check Stop Date 0/00/00 Check Stop Reason Bank 01 Invoice # Invoice Date 0/00/00 Mail Address TOYOTA TSUSHO AMERICA, INC. ATTN: AKO TANAKA 595 MARKET ST.. STE. 1920 SAN FRANCISCO CA 94105 Payee Name TOYOTA TSUSHO AMERICA, INC. In Pay of 2002 TOYOTA CAMRY F3=Exit F12=Cancel Sessi6n - , PASSPORT , D-2ember 20, 2005, 15 : 13 : 36 Claim Inquiry - By Claim MLAI 12/20/05 12 : 13 : 58 Inquire History Detail Check 0499629 Check Replaces Check Date 12/15/05 Check Amount 423 . 51 Check Status Check Accept Amount . 00 Check Type Check Printed P Check Stop ID Check Stop Date 0/00/00 Check Stop Reason Bank 01 Invoice # Invoice Date 0/00/00 Mail Address A-1 AUTO BODY 1720 EL CAMINO REAL SAN BRUNO CA 94066 Payee Name A-1 AUTO BODY In Pay of 2002 TOYOTA CAMRY LE - INSURED: AKO TANAKA MIDORI F3=Exit F12=Cancel STATE OF CALIFORNIA TRAFFIC COLLISION REPORT 9 05 CHP 555 CARS Page 1(Rev 1-03)OPI 061 Page I Of 6 SPECIAL CONDITIONS IAAOER HIT&ALN CITY JUDICIAL DISTRICT LOCAL REPORT NUMBER ON-DUTY EMERGENCY VEHICLE r++oNY o FELOUNINCORPORATED BAY SUPERIOR i IAASOPKUM MLX COUNTY REPORTING DISTRICT BEATLOSO&WA11-336 ~' 0 E] CONTRA COSTA 10 COLLISION OCCURRED ON: MO DAY YEAR TIME Q/001 NGC F OFFICER I.D. Z 3621 SAN PABLO DAM ROAD 11/27/2005 1850 9320 017411 MILEPOST RIFORMATION: PAY OF WEEK T0IN AWAY PHOTOGRAPHS BY: aNONE Q SUNDAY X YESElNo U AT INTERSECTION WITH: STATE HWY REL X oR 35 FEET EAST OF EL PORTAL DR. YEs X NO PARTY DRIVER'S LICENSE NUMBER STATE CU55 AIRBAG SAFETY EOUIP. VEH.YEAR M4KEIMODELICOLOR LICENSE NUMDER STATE 1 A9103083 CA C h! G 2003 FORD CROWN VI WHI 1139386 CA DRIVER N.AAE(FIRST,MIDDLE.UST) RYAN BORKERT OWNERS NAME ❑SAME AS DRIVER PEDES STREET ADDRESS CONTRA COSTA SaRR[F OFFICE TRIAN 555 GIANT HWY OWNERS ADDRESS ❑SUIFE AS DRIVER PARKED CITY I STATE I ZIP 2467 WATERBIRD WAY MARTINEZ CA 94553 VEHICLE RICHMOND CA 94804 DISPOSITION OF VEHICLE ON ORDERS OF: lfl OFFICER DORMER OTHER BCT SEX HAIR EYES HEIGHT WEIGHT Lb BIRTHDADayTE RACE DRIVEN AWAY L_J hf BRN GRN 6-0 180 3111/19 5 Y� W PRIORAIECKDEFECTS XINONEAPP, REFER TONAaRATIVE OTHER HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER (925)646-2441 UNKNOWN VEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER UNK NONE X UINM SELF-INSURED 48I IH MOO MAIOR ROLL-OVER DIROF TRAVEL ON STREET OR HIGHWAY SPEED LIMIT GL DOT E SAN PABLO DAM ROAD 5 CAL-7 TcP/PSC MCUX I ul PARTY CRIVER'S LICENSE NUMBER STATE CUSAFETY SS AIR BAG Y EQUIP. VEIL YEAR MAKE I MODEL I COLOR LICENSE NUMBER STATE 2 N5132546 CA C M G 202 TOYOTA CAMRY SIL 4YWE734 CA DRIVER NAME(FLRST,MIDDLE.UST) AKIOKENNEI-11TANAKA OWNERSNAME n�S"ASDRIVER PEDES STREETADDRESS TOYOTA TSHUSIIO�IER.INC. TRIAN 516 BAYVIEW AVE. OWNEISADDRESS ❑SAM AS DRIVER PARKED CITY I STATE I ZIP 595 MARKET ST.#1920 SAN FRANCISCO CA 94105 VEHICLE aMILLBRAE CA 94030 DISPOSITION OF VEHICLE ON ORDERS OF: aOFFICER aDRIVER OTHER BICY- SEX HAIR EYES I H-EIGHT WEIGHT BIRTHDATE RACE COURTESY TOW-(408)248-9116 CAST Mo Dry Y–M BLK BRN 5-05 140 11/20/1958 A PRIOR MECHANICAL DEFECTS NONE APP. REFER TO NARRATIVE OTHER HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER' (6.10)871-7310 (415)817-9113 VEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER LINK []NONE MINOR NIITSUI SIMTMOTO BVR 8402738 01 X MoD R ROLL-OVER MROF TRAVEL ON STREET OR HIGHWAY SPEED LIMIT CA DDT SAN PABLO DAM ROAD 5 DAL-T TCP/PSc MaMK ED PARTY DRIVER'S LICENSE NUMBER— LICENSESTATE CLASS AIR BAG sAFE7Y EOUIP. VEK YEAR MAKE I MODEL I COLOR NUMBER STATE 3 DRIVER NAMELFIRST,MIDDLE.LAST) ' OWNER'S NAME Li ISAMEASORNER PEDES, STREET ADDRESS u TRIAN FlOWNERSADDRrSS ❑SAMEASDRIVER PARKED CITY STATE IZIP VEHICLE DISPOSITION OF VEHICLE ON ORDERS OF: OFFICER DRR'ER -L. ]OTHER BICY• SEX HAIR EYES HEIGHT WEIGHT BIRTHDATE RACE CLIST IkW D7y Yea PRIOR MECMANCIAL DEFECTS �NOfiE APP. _HER TO NARRATIVE OTH?.R HOMIE PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER VEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER lHuNK NONE OMINOR MIDMAJOR f-IROLL-ONTA DIR OF TRgVEL ON STREET OR HIGHWAY SPEEO LIMIT CA OT CAL•T TCPIPSC MCAAX PREPARsA'S NAME DISPATCH NOTIFIED REM 'S _ DAT EW E.SANCHEZ 017411 YES ANO TC wA STATE 4`CAIIFORNW — TRAFFIC COLLISION CODING CHP 555 CARS Paget(Rev.1-03)OPI 061 Page 2 Of B DATE OF aXUS10N(MO.DAY YEAR) TUM(2400) NCIC AF01'7411 KxR LD. NUMBER 11/27/2005 1850 9320 11-336 OWNER OWNER ADDRESS NOTIFIED PROPER DYES❑NO DAMAGE DESCRIPTIONOFOAMAGE SEATING POSITION SAFETY EQUIPMENT INATTENTION CODES OCCUPANTSL.AIR BAG DEPLOYED MIC BICYCLE•HELMET A'NONE IN VE)iK LE M-AIR BAG NOT DEPLOYED DRIVER PASESNGER A•CELL PHONE HANDHELD _ 0-CELL PHONE HANDSFREE B•UNKNN-OTHER V-NO X-NO C-ELECTRONIC EQUIPMENT C•LAP BELTELT USED P-NOT REQUIRED W•YES Y•YES D-LAP BELT NOT USED D-RADIO I CD 1 2 3 1•DRIVER E•SMOKING E•SHOULDER HARNESS USED 2 TO 6•PASSENGERS CHILD RESTRAINT EJECTED FROM VEHICLE F-EATING 4 5 6 7-STA WGN REAR f•SHOULDER HARNESS NOT USED 0-IN VEHICLE USED G•CHILDREN G-LAPISHOULDER HARNESS USED O•NOT EJECTED 8-RR.OCC TRK OR VAN R-IN VEHICLE NOT USED H-ANIMALS H-LAPISHOULDER HARNESS NOT USED 1-FULLY EJECTED 9-POSITK)N UNKNOWN 3-11:VEHICLE USE UNKNOWN I- PERSONNEL HYGIENE J-PASSIVE RESTRAINT USED 2-PARTIALLY EJECTED 0.OTHER K-PASSIVE RESTRAINNT NOT USED T- VEHICLE IMPROPER USE 3-UNKNOWN J•READING U•NONE W VEHICLE K-OTHER ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK I-)SHOULD BE EXPLAINED IN THE NARRATIVE PRIMARY COLLISION FACTOR TRAFFIC CONTROL DEVICES 12 3 1 SPECIAL INFORMATION 1 I2 3 MOVEMENT PRECEDING UST NUMBER P)OF PARTY AT FAULT COLLISION A VC SECTION VK)LATEM CITEDFlYEg JA CONTROLS FUNCTIONING I JA HAZARDOUS MATERIAL I JA STOPPED FL-J{''D B CONTROLS NOT FUNCTIONING' IB CELL PHONE HANDHELD IN USE IX I I B PROCEEDING STRAIGHT B OTHER IMPROPER DRMNG' C CONTROLS OBSCURED C CELL PHONE HANDSFREE W USE I I C RAN OFF ROAD 4S,! ! 7_.; F: ,;w ` T X 10 NO CONTROLS PRESENT I FACTOR' X X D CELL PHONE NOT IN USE 1 10 MAKING RIGHT TURN C OTHER THAN DRIVER- TYPE OF COLLISION JE SCHOOL BUS RELATED I I E MAKING LEFT TURN D UNKNOWN- A HEAD-ON IF 75 FT MOTORTRUCK COMBO IF MAKING U TURN X B SIDE SWIPE G 32 FT TRAILER COMBO G BACKING C REAR ENO H H SLOWING/STOPPING WEATHER (MARK a TO2ITEMS) D BROADSIDE I 1 PASSING OTHER VEHICLE X A CLEAR E HIT OBJECT J J CHANGING LANES B CLOUDY F OVERTURNED K K PARKING MANEUVER C RAINING G VEHICLE/PEDESTRIAN L L ENTERING TRAFFIC D SNOWING H OTHER': M X M OTHER UNSAFE TURNING E FOG/VISIBILITY FT. N N RING INTO OPPOSING LANE I F OTHER:' MOTOR VEHICLE INVOLVED WITH 7lLcnm 0 PARKED 1 G WIND A NON-COLLISION P P MERGING LIGHTING B PEDESTRIAN - O TRAVELING WRONG WAY A DAYLIGHT IX C OTHER MOTOR VEHICLE OCIATED FACTORS R OTHER% B DUSK-DAWN D MOTOR VEHICLE ON OTHER ROADWAY 1 2 3I TO 2 ITEMS) X C DARK-STREETLIGHTS E PARKED MOTOR VEHICLE cuna men YES D DARK-NO STREET LIGHTS F TRAIN BND Durm annDARK•STREET LIGHTS NOT G 81CYCLE BrEs FUNCTIONING' H ANIMAL: NO SOBRIETY.DRUG ROADWAY SURFACE COLAnn Cnc YFb 1 2 3 PHYSICAL )( A DRV I FIXED OBJECT: ONO (MARK 1 T021TTM5) B WET D X X A HAD NOT BEEN DRINKING C SNOWY-ICY J OTHER OBJECT: E VISK)N OBSCUREMENT: B HBD-UNDER INFLUENCE D SUIPPERY(MUDDY.OILY.ETC.) F INATTENTION': C HBD-NOT UNDER INFLUENCE* ROADWAY COND(TION(S) G STOP d GO TRAFFIC D HBD-IMPAIRMENT UNKNOWN' (MARK I TO 2 ITEMS) PEDESTRIAMS ACTIONS H ENTERING I LEAVING RAMP MH DRUG INFLUENCE' A HOLES.DEEP RUT' X A NO PEDESTRIANS INVOLVED I PREVIOUS COLLISION ENT-PHYSICAL' B LOOSE MATERIAL ON ROADWAY' B CROSSING IN CROSSWALK J UNFAMILIAR WfTH ROAD ENT NOT KNOWN C OBSTRUCTION ON ROADWAY' AT INTERSECTION K DEFECTIVE VEH.EQUIP: CITEDPLICABLE D CONSTRUCTION-REPAIR ZONE C CROSSING IN CROSSWALK•NOT I I YES /FATIGUED E REDUCED ROADWAY WIDTH AT INTERSECTION NO F FLOODED' D CROSSING-NOT IN CROSSWALK L UNINVOLVED VEHICLE G OTHER•: E IN ROAD-INCLUDES SHOULDER M OTHER': X H NO UNUSUAL CONDITIONS 7 NOT IN ROAD X Ix N NONE APPARENT G APPROACHING ILEAVING SCHOOL BUS 1 0 RUNAWAY VEHICLE SKETCH FOR SKETCH DIAGRAM,SEE PAGE 3 O Mlsc LANfm DOT --- INDICATE NORTH \ Vl� V l4R —19C cmp -DA PDJSO CT OTHER STATE OF CA-LIFORNIA SKETCH DIAGRAM CHP 555 Page 4(Rev.8-97) OPI 042 PAGE 3 OF_6 DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 11/27/2005 1850 9320 1017411 11-336 ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED(SCALE= } SAN PABLO DAM ROAD 0 1 v-1 V-2 I EL PORTAL DR. PREPARED 8Y I.D.NUMBER DATE REVIEWER'S NAME DATE E. SANCHEZ 1017411 1 11/27/2005 3 f STATE OF C-LIFORNIA FACTUAL DIAGRAM CHP 555 Page 4(Rev.9.97) OPI 042 PAGE 4 OF 6 _ DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 11/27/2005 1 1850 19320 1017411 111-336 ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED(SCALE= ) SAN PABLO DAM ROAD I Vehicles moved from point of EL PORTAL DR rest pray to CHP arrival. PREPARED BY I.D.NUMBER DATE REVIEWER'S NAME P ATE E. SANCHEZ 017411 11/27/2005 j STATE OF CALIFORINIA NARRATIVE/SUPPLEMENTAL PAGE 5 OF G DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 11/27/2005 1850 9320 017411 11-336 1 FACTS: 2 3 NOTIFICATION: I was dispatched to a call of a property damage only traffic collision at 1855 4 hours. I responded from SR-24 at Alhambra Blvd., and arrived on scene at 1910 hours. All times, 5 speeds and measurements in this investigation are approximate. Measurements were taken by 6 visual estimation. 7 8 SCENE: At the scene of this collision, 3621 San Pablo Dam Road is a private parking lot, located 9 in the unincorporated area of Contra Costa County. The roadway is straight and level. The 10 surface is composed primarily of asphalt. For further scene information, refer to the Factual 11 diagram on page 5. 12 13 PARTIES: 14 15 PARTY#1 (Borkert)was located on scene, standing next to V-1 upon my arrival. Party Borkert 16 was identified by his valid California driver's license. Borkert was placed as a.party by the 17 following item: 18 19 • His statement that he was driving V-1. 20 21 Ford Crown Victoria Vehicle #1 (V-1) was located in the parking lot upon my arrival.:V-1 22 sustained minor front end damage consisting of a scratched left rear fender and rear bumper. No 23 prior damage to V-1 was noted or claimed. 24 25 PARTY#2 (Tanaka)was located on scene, standing next to V-2 upon my arrival. Party Tanaka 26 was identified by his valid California driver's license. Tanaka was placed as a party by the 27 following item: 28 29 His statement of being the driver of V-2. 30 31 Toyota Camry Vehicle#2 (V-2) was located in the parking lot upon my arrival. V-2 sustained 32 moderate damage from this collision consisting of a detached front bumper and a scratched right 33 front fender. No prior damage to V-2 was noted or claimed. 34 35 PHYSICAL EVIDENCE: 36 None. 37 38 39 40 41 PREPARED BY I.D.NUMBER DATE REVIEWER'S NAME DATE E. SANCHEZ 017411 11/27/2005 pp 3 STATE OF CALIFORvIA NARRATIVEISUPPLEMENTAL PAGE 6 OF 6 DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 11/27/2005 1850 9320 017411 11-336 1 STATEMENTS: 2 3 PARTY#1 (Borkert) 4 Party#1 related that he was driving his vehicle eastbound, in the parking lot approaching the rear 5 of V-2, at approximately 5 mph. P-1 saw V-2 stopped in front of him. As P-1 began to pass V-2 6 on the right side, P-1 saw V-2 accelerate and P-1 felt a bump to the left rear of V-1. 7 8 PARTY#2 (Tanaka 9 Party#2 related that he was driving his vehicle eastbound, in the parking lot at approximately 1 10 mph. P-2 stated that he was looking at the street signs, when all of a sudden he saw V-1 pass 11 him at a high rate of speed, colliding with the right front of V-2. 12 13 OPINIONS AND CONCLUSIONS: 14 15 SUMMARY: This collision occurred in the parking lot at 3621 San Pablo Dam Road. Party#1 was 16 driving V-1 at approximately 5 mph, approaching the rear of V-2. Party#2 was driving V-2 at 17 approximately 1 mph. Due to P-1's unsafe turning movement, the left rear of.V-1 collided with the 18 right front of V-2. After the collision both parties parked their vehicles in the parking lot. 19 20 AREAS OF IMPACT (AOI): 21 22 AOI #1 (V-1 vs. V-2) was located 65 feet south of the south roadway edge line of San Pablo Dam 23 Road and 35 feet east of the east roadway edge line of EI Portal Way. 24 25 The area of impact was determined from statements and vehicle damage. 26 27 CAUSE: Party#1 caused this collision by making an unsafe turning movement as V-1 passed 28 V-2. 29 30 The cause was determined from statements and vehicle damage. 31 32 RECOMMENDATIONS: None. 33 34 35 36 37 38 39 PREPARED BY I.D.NUMBER DATE REVIEWER'S NAME DATE E. SANCHEZ 017411 11/27/2005 12/15/2005 at 02:58 PM File ID: 109603 49554 NATIONAL INSURERS AUDIT NIAB (908) 526-5900 Fax: (908)526-5182 Written By: JASON FISCHER PRELIMINARY SUPPLEMENT 1 WITH SUMMARY Insured: AKIO TANAKA MIDORI Claim #AA10557 Owner: AKIO TANAKA MIDORI Policy #SMF36CIU1207F Address: Date of Loss: 11/27/2005 Type of Loss: Other Day: Point of Impact: 12. Front Evening: Inspect OTHER Location: Repair A-1 AUTO BODY Business: (650)589-7115 Facility: CA 3 Days to Repair License # 2002 TOYO CAMRY LE 4-2.4L-FI 4D SED Int: VIN: UNK Lic: Prod Date: Odometer: Air Conditioning Rear Defogger Tilt Wheel Cruise Control Intermittent Wipers Body Side Moldings Dual Mirrors Roof Console Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks Power Mirrors Driver Air Bag Passenger Air Bag Front Side Impact Air Bag Cloth Seats Bucket Seats ------------------------------------------------------------------------------- NO. OP. DESCRIPTION . QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1# FRT BUMPER COVER 1 167.00 2.0 2.2 2# R FRT BUMPER FOG LAMP COVER 1 28.29 Incl. 3** A/M R FENDER PANEL 1 195.00 1.6 2.0 4# R FENDER PANEL EDGE 1 0.5 5# R FENDER LINER 1 60.93 Incl. 6# R FRT DOOR OUTSIDE 1 0.9 7# R FRT BELT MLDG 1 0.3 8# R FRT DOOR HANDLE 1 0.3 9# FLEX 1 8.00 10# HWR 1 4.00 11# CLEAR COAT 1 1.6 12# TINT 1 0.5 13# COLOR SAND AND BUFF 1 0.5 14# CVR CAR 1 8.00 157# Sol FRT UPR BUMPER REINFORCEMENT 1 26.42 16# Sol R FRT OTR BUMPER REINFORCEMENT 1 25.66 0.4 17# S01 AIM FRT HEADLAMPS 1 0.4 18# Sol R FRT COMBO LAMP ASSY 1 253.99 0.3 ------------------------------------------------------------------------------- Subtotals 777.29 5.9 7.6 I 12/15/2005 at 02:58 PM File ID: 109603 49554 PRELIMINARY SUPPLEMENT 1 WITH SUMMARY 2002 TOYO CAMRY LE 4-2.4L-FI 4D SED Int: ------------------------------------------------------------------------------- Estimate Notes: AGREED FIGURE WITH FRED OF A-1 AUTO BODY ON DECEMBER 7, 2005 @ 11:08 FAX COPY TO SHOP @ 65-589-7115 NO SUPPLEMENTS W/O PRIOR APPROVAL. THIS IS NOT AN AUTHORIZATION FOR REPAIRS. Parts 777.29 Body Labor 5.9 hrs @ $ 72.00/hr 424.80 Paint Labor 7.6 hrs @ $ 72.00/hr 547.20 Paint Supplies 7.6 hrs @ $ 30.00/hr 228.00 ---------------------------------------------------- SUBTOTAL $ 1977.29 Sales Tax $ 1005.29 @ 8.2500% 82.94 ---------------------------------------------------- TOTAL COST OF REPAIRS $ 2060.23 ADJUSTMENTS: Deductible 0.00 ---------------------------------------------------- TOTAL ADJUSTMENTS $ 0.00 NET COST OF REPAIRS $ 2060.23 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 ALG14=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT W/_=WITH/_ SYMBOLS: #=MANUAL LINE ENTRY *=OTHER [IE. .MOTORS DATABASE INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. MQVP=MANUFACTURER'S QUALIFICATION AND VALIDATION PROGRAM. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. 2 12/15/2005 at 02:58 PM File ID: 109603 49554 PRELIMINARY SUPPLEMENT 1 WITH SUMMARY 2002 TOYO CAMRY LE 4-2.4L-FI 4D SED Int: 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 MANUFACTURER OF YOUR VEHICLE. Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived frau the Guide ARM8521 Database Date 11/2005, OCC Data Date 11/2005, 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 cane 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 Carp Repl Parts which stands for Canpetitive 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. Sane parts that are described as AM, Qual Repl Parts or Cargo Repl Parts 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. Sane 2006 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data frau the vehicle manufacturer, labor and parts data frau the previous year may be used. The Pathways estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. Ox Pathways - A product of Ox Information Services Inc. 3 12/15/2005 at 02:58 PM File ID: 109603 49554 PRELIMINARY SUPPLEMENT 1 WITH SUMMARY 2002 TOYO CAMRY LE 4-2.4L-FI 4D SED Int: ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- ------- ADDED ITEMS ------- 154 SO1 FRT UPR BUMPER REINFORCEMENT 1 26.42 16# SO1 R FRT OTR BUMPER REINFORCEMENT 1 25.66 0.4 17# SO1 AIM FRT HEADLAMPS 1 0.4 18# SOl R FRT COMBO LAMP ASSY 1 253.99 0.3 ------------------------------------------------------------------------------- Subtotals =_> 306.07 0.7 0.4 ------------------------------------------------------------------------------- Estimate Notes: AGREED FIGURE WITH FRED OF A-1 AUTO BODY ON DECEMBER 7, 2005 @ 11:08 FAX COPY TO SHOP @ 65-589-7115 NO SUPPLEMENTS W/O PRIOR APPROVAL. THIS IS NOT AN AUTHORIZATION FOR REPAIRS. Parts 306.07 Body Labor 0.7 hrs @ $ 72.00/hr 50.40 Paint Labor 0.4 hrs @ $ 72.00/hr 28.80 Paint Supplies 0.4 hrs @ $ 30.00/hr 12.00 ---------------------------------------------------- SUBTOTAL $ 397.27 Sales Tax $ 318.07 @ 8.2500% 26.24 ---------------------------------------------------- TOTAL SUPPLEMENT AMOUNT $ 423.51 (ti rft P COST';. OF SUPPLEMENT $ 423.51 Estimate 16 6.72 JASON.FISCHER Supplement Sl 423.51_.JASON FISCHER Workfile Total $ '2060.23 NET COST OF REPAIRS $ 2060.23 4 12/15/2005 at 02:58 PM File ID: 109603 49554 PRELIMINARY SUPPLEMENT 1 WITH SUMMARY 2002 TOYO CAMRY LE 4-2.4L-FI 4D SED Int: FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORI4: ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES: B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS: ADJ-ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT W/_=WITH/_ SYMBOLS: #=MANUAL LINE ENTRY *=OTHER [IE. .MOTORS DATABASE INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. MQVP=MANUFACTURER'S QUALIFICATION AND VALIDATION PROGRAM. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. 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 MANUFACTURER OF YOUR VEHICLE. Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived frau the Glide APM8521 Database Fite 11/2005, OCC Data Date 11/2005, 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 cane fran 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 Ccnp Repl Parts which stands for Campotitive Replacement Parts. Used parts are described as LIQ, 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. Sane parts that are described as AM, Qual Repl. Parts or Cargo Repl Parts 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. Sane 2006 vehicles contain minor changes frau the previous year. For those vehicles, prior to receiving updated data frau the vehicle manufacturer, labor and parts data from the previous year may be used. The Pathways estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. CSC Pathways - A product of CCC Information Services Inc. 5 DK-07-05 . 15:27. FROM-NIAB + } T-650 P.003/005 F-214 r 12/0'7/2005 ar 11:56 AM File ID; 109603 49554 'NATIONAL INSURERS AUDIT NIAS (908)526-5900 Pax: (909)526-5182 Written By: JASON FISCHER PRELIMINARY ESTIMATE Insured: AKIO TAIAKA MIDORI Claim #AA10557 owner: AKIO TAIJAXA MIDORI Policy #SMF36CIU1207F Address: Data of Loss: 11/27/2005 Type of Lose: Other Day: Point of Impact: 12. Front Evening; Inspect OTHER Location: Repair A-1 AUTO'; BODY Busineaa; (650)5897115 Facility. CA 3 Days to Repair License # 2002 TOYO CAMRY LE14-2.4L-FI 4D SED Int: VIN: UNK Lic: Prod Date: Odometer: Air Conditioning Rear Defogger Tilt Wheal Cruise Control Intermittent Wipers Body Sade Moldings Dual Mirrors Roof Console Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks Power Mirrors Driver Air Bag Passenger Air Bag Front Side Impact Air Bag Cloth Seats 3ucket Seats NO. OP. DESCRIPTION QTY EXT. PRICE LABOR FAINT ------------------ ------------------------------------------------------------ 14 FRT BUMPER COVER 1 167,00 2.0 2.2 2# R ,FRT BUMPER FOG LAMP COVER 1 28.29 Incl. 3** A/M R FENDER PANEL 1 195.00 1.6 2.0 4# R :FENDER PANEL EDGE 1 0.5 51) RIFENDER LINER 1 60.93 Inc1. 6# R :FRT DOOR OUTSIDE 1 0.9 71) R 1FRT BELT MLDG 1 0.3 84 R :rRT DOOR HANDLE 1 0.3 94 FLEX 1 8.00 1011 Heft 1. 4.00 1.1 CLEAR COAT 1.6 12# TINT 1 0.5 13# COLOR SAND AND BUFF 1 0.5 1.441 CvR CAR 1 6.00 Subtotals -o> 471.22 5.2 7.2 i 1 DE'-07-05 . 15:27. FROM IAB _:... + __::_$ T-650 P.004/005 F-214 12/07/2005 at 11:516 AM File ID: 109603 49554 PREL324INARY ESTn,&kTR 12002 TOYO CAMRY LE 4-2.4L-FI 4D SED Int: ----------------- -------------------------------------------------------------- Estimate Nates: AGREED FIGURE WITf FRED OF A-1 AUTO BODY ON DECEMBER 7, 26.05 @ 11:OB FAX COPY TO SHOP 65-569-71.15 NO SUPPLEMENTS W/O PRIOR APPROVAL. THIS IS NOT AN AUTHORIZATION FOR REPAIRS. Parts 471.22 Body Labor 5.2 hrs @ $ 72.00/hr 374 .40 Paint Labor 7.2 hrs @ $ 72.00/hr 516.40 ! Paint Supplies 7.2 hrs @ $ 30.00/hr 216.00 ------------------------ ---------------------------- SUBTOTAL --------------- ------„-----------$-------- SUBTOTAL 1580.02 Sales Tax $ 687.22 @ 6.2500% 56.70 ---------------------------------------------------- TOTAL COST OC REPAIRS $ 1636.72 ADJUSTMENTS: Deductible 0.00 ---------------------------------------------------- TOTAL ---------------- -- --------------------------- TOTAL ADJUSTMENTS $ 0.00 NET COST OF REPAIRS $ 1636.72 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 9E DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR ABBREVIATIONS/SYMIIOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LAHOR TYPES: B=aODY LABOR D=DIP�GNOSTIC E=ELECTRICAL F-TRAME G®GLASS M-MECHANICAL P=PAINT L11BCR S-STRUCTURAZ T--TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS: ADJ=ADJACFNT ALGN=IAL,IGN A/M=AFTERMARKET BLND-BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATIONS D&R-DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED aY THE QUANTITY INCL-INCLUOS,D MISC-MISCEL7.,ANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP-OPELIATION NO=LINE NUMBER QTj=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART 90MP REPL PARTS=COMPETITIVE REPLACEMENT PARTS RECOND-RECONDITION R_SN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R-REMOVE AND REPLACE RPR=RFFAIR RT=RIGHT SECT=SECTION SUSL=SUBLET LT-LEFT W/O=WITHOUT W/=WITH/_ SYMBOLS: 4=MANUAL, LINE ENTRY w-OTHER [IE. .MOTORS DATABASE INFORMP_TION WAS CgANGE01 **-DATABASE LINE WITH AFTERMARKET N=NOTES ATTACI3ED TO LINE. MQVP=MANUFAOTUR=R'S QUALIFICATION AND VALIDATION PROGRAM. OPT OEM=ORIGINAL EQUIIiMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTH• IIRWISL PROVIDEWITH SOME UNIQUE PRICING OR DISCOUNT. I 2 i 1 :.a I U�