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MINUTES - 01102006 - C.14
CLAIM C . # BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTIO &a V7 tie-11C.-Voor Claim Against the County, or District Governed by ) 1/ the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), give► Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: $1,350.00 NOV 3 0 2005 JENNIFER REESE COUNTY COUNSEL CLAIMANT: ATTORNEY: UNKNOWN DATE RECEIVED: NOV. 30, 2005 ADDRESS: 3350 HELEN: LANE BY DELIVERY TO CLERK ON: NOV. 30, 2005 LAFAYE'I'I'E, CA 94549. NOV. 26, 2005 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SW E leek Dated: NOVEMBER 30, 2005 By: Deputy II. FkOM: County Counsel. TO: Clerk of the Board of Sup rvisors ( his claim complies substantially with Sections 910 and 910.2. O 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 Fled late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). O Other: Dated: 57 -phi By: y'-- Deputy County Coun; III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV.BOARD ORDER: By unanimous vote of the Supervisors present: (tj 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:40^e=q/D�yrs JOHN SWEETEN, CLERK, By , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposit in (lie mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice: AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage full prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:V41�P7AAWV =-&e4OHN SWEETEN, CLERK By / Deputy Clet BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. A Clain 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. swam Nraaaansassenaaaaaaa%ssa.%an nen*saasnaassmo■aamasseaseasauuasaeecee%ONCE as RE: Claim By: Reserved for Clerk's filing stamp ) RECEIVED Against the County of Contra Costa or ) NUV 3 0 2005 CLERK BOARD OF SUPERVISORS �� h ra �l77�Fygn 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$ I,,3 TQ.oo and in support of this claim represents as follows: 1, tiVhen did the damage or injury occur? (Givice�exact date and hour) 2. Where did the damage or in�,u,ry occur? (Include city and epunt ) 3350 Hetes. Ln , L�J<�F CA 94/5yl 3. How did the dge or injury occur? Give full details; use extra paper if required) r 17 frc �� +c GJQS ern a�auv of �!nc Co��.' o�,L `j i @ ©Jr YlP/J52 C&-Id b&Cur4( 1 Al 0 ✓tn v1 4. What particular act or omission on the part of county di ict officers, servants, or employees caused the injury or damage? Sit 5 What are the names of county or district officers, servants,or pemployees causing the damage or injury? a,1C,` I Qr;v'er 17 4 6. What damage or injuries do your claim resulted? (Give full xtent of injuries or damages claimed. Attach two estimates for auto damage.) -Ozv-\1-Pa( Nr'.Avs 5.'00 ro�F 4otv 7. How was the amount claimed above computed? / (Include the estimated amount of any Q u prospective injury or damage.) Ai � G9f l S. Names and addresses of witnesses, doctors, and hospitals:, }✓i c� SZcr�< actdN�s So+i^c a5 ctal al7l CiF. C�/;s kJ ho4salvoS , &-'c F�e as�r�� OzJ09y/- 3-117 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT g**mamema mommtm omen m e m mom a to meaaaenRR BROWNBeanag WNmaesa■m menamon*eem■■n R n R a a*&Boom 0*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: (Attorrrey) ) Name and address of Attorney ) ( 1 ' is igna e) (Address) 9 Telephone No. ) Telephone No. (,U, ,z/77 ■WNWNug WN•a momemmmo mmmm aagm&eReuReemReene Bon gang■■WNmon e&WNanomann■nneetg■Banena WN� 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 fonn, including medical records. are also subject to public disclosure. a mom anon R was commune a•■an a am effogna ■RROgm•u WNemmeeRnmeeee■mng■enmanom a awe met one Nova" 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 imprisomnent and foe, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000), or by both such imprisonment and fine. VEHICLE ACCIDENT REPORT t DATE: -J l ' 1 Q IME: 1 _LQ_3o ACCIDENT LOCATION: 3 5 0 1�e 1 n V1 �� VEHICLE EQUIPMENT NO.: LIC. PLATE NO.:HAAY CES VEHICLE YEAR/MAKEITYPE: - J COUNTY VEHICLE: OTHER DRIVER: DRIVER INFOR ATION: DRIVER INFORMATION NAME I�i q j-rA Wk NAME DEPARTMENTC (! Fr Q Q t, HOME ADDRESS HOME ADDRESS 33QQ ocrr R RN HOME PHONE# HOME PHONE# WORK PHONE# WORK PHONE# -3 3 0 o DRIVER'S LICENSES# DRIVER'S LICENSES# VEHICLE INFORMATION: IF PERSONAL OR RENTAL VEHICLE: YEAR: MAKE: MODEL: NAME AND ADDRESS OF AGENT: REGISTERED OWNER ADDRESS PHONE#OF AGENT: PHONE# POLICE REPORT TAKEN O YES ONO WORK PHONE# POLICE DEPARTMENT LICENSE PLATE# OFFICER'S NAME INSURANCE INFORMATION: OFFICER'S BADGE# COMPANY ADDRESS LIST INJURED PERSONS: POLICY# NAME AGENT: ADDRESS NAME PHONE# PHONE# WITNESS INFORMATION: NAME NAME ADDRESS ADDRESS PHONE# PHONE# NAME NAME ADDRESS ADDRESS PHONE# PHONE# NAME NAME ADDRESS ADDRESS PHONE# PHONE# SEAT BELT WORN BY COUNTY DRIVER?: O YES O NO SEAT BELT WORN BY PASSENGERS?: O YES O. NO DAMAGE TO COUNTY VEHICLE: DAMAGE TO OTHER VEHICLE h ro � ZPt""/je / P. �i t A I a , � r qo 'Ir ,.. x7••pL fin,.•' ��,,. '1��� �1� a �� �`, , III�I� I 4 4 11,W 7i ry �� •:� ntF rt "sri"`u`G�s d�,.i�"Is�. �f"' { (f't'F ��#•'�iy 4m y` } 4 R"C�j���1° ,r',f✓f7$T..?� i.^ r✓,¢ y t of •t �• "i'^� ^ ��V�i � { � '�. �. � �. '+� a •`; a i. � �-0 �� Icy -• i ct dab ��,�� ,y •,ti'.,,. w . r ,. ter[ \ � / �. .. `' �• ,� �`tf�w � �I <w F ii 14 Date: 11/22/2005 02:20 PM Estimate ID: 1100 Estimate Version: 0 Preliminary Profile ID: PROFESSIONAL AUTO PROFESSIONAL AUTOMOTIVE ENTERPRISES 3331 MT DIABLO BLVD LAFAYETTE,CA 94549 (925)283-2160 Faxr(925)283-2169 Damage Assessed By: SCOTT MCKENZIE Condition Code: Good Deductible: UNKNOWN Owner JAN REESE Address: 3350 HELEN LANE LAFAYETTE,CA 94549 Telephone: Home Phone: (925)284-2174 Mitchell Service: 918161 Description: 1996 Mazda Miata Body Style: 2D Conv Drive Train: 1.8L Inj 4 Cyl 4A VIN: JMINA3538TO718598 License: 4AAY655 CA Mileage: 111,890 Color: BLUE-M8 Options: AUTOMATIC TRANSMISSION Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 802740 REF BLEND HOOD OUTSIDE C 1.1 2 804110 BDY REMOVEIREPLACE L FENDER PANEL NAY152-210 210.00 1.3 # 3 AUTO REF . REFINISH L FENDER OUTSIDE C 2.4 4 AUTO REF REFINISH L FENDER EDGE C 0.5 5 810920 BDY REMOVE/INSTALL R W/SHIELD WASHER NOZZLE Existing 0.2* 6 810930 BDY REMOVEIINSTALL L W/SHIELD WASHER NOZZLE Existing 0.2* 7 813690 REF BLEND L FRT DOOR OUTSIDE C 0.9 8 813941 BDY REMOVEIINSTALL L FRT BELT MOULDING 0.3 9 813947 BDY REMOVEIINSTALL L FRT REAR VIEW MIRROR 0.3 10 814518 BDY REMOVE/INSTALL L FRT DOOR HANDLE 0.5 # 11 AUTO REF ADD'L OPR CLEAR COAT 1.7 12 933003 REF ADD'L OPR TINT COLOR 0.5* 13 933008 REF ADD'L OPR CHIP RESISTANT MATERIAL APPLICATION 0.5* 14 AUTO REF ADD'L OPR FINISH SAND AND BUFF 2.2 15 933018 REF ADD'L OPR MASK FOR OVERSPRAY 5.00 0.2* 16 AUTO ADD'L COST PAINTIMATERIALS 228.00 17 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL 5.00 -Judgement Item #-Labor Note Applies C -Included in Clear Coat Calc ESTIMATE RECALL NUMBER: 11/22/200514:19:48 1100 UltraMate is a Trademark of Mitchell International Mitchell Data Version: OCT 05_A Copyright(C)1994-2003 Mitchell International Page 1 of 2 UltraMate Version: 5.0.212 All Rights Reserved Date: 11/22/2005 02:20 PM Estimate ID: 1100 Estimate Version: 0 Preliminary Profile ID: PROFESSIONAL AUTO r Add'l Labor Sublet 1. Labor Subtotals Units Rate Amount Amount Totals 11. Part Replacement Summary Amount Body 2.8 72.00 0.00 0.00 -201.60 Taxable Parts -210.00 Refinish 10.0 72.00 5.00 0.00- 725.00 Sales Tax @ 8.250% 17.33 Non-Taxable Labor 926.60 Total Replacement Parts Amount 227.33 Labor Summary 12.8 926.60 111. Additional Costs Amount IV. Adjustments Amount Taxable Costs 228.00 Customer Responsibility 0.00 Sales Tax @ 8.250% 18.81 Non-Taxable Costs 5.00 Total Additional Costs 251.81 I. Total Labor: 926.60 II. Total Replacement Parts: 227.33 III. Total Additional Costs: .251.81 Gross Total: 1,405.74 IV. Total Adjustments: 0.00 Net Total: 1,405.74 This is a preliminary estimate. Additional changes to the estimate may be required for the actual repair. I HEREBY AUTHORIZE PROFFESIONAL AUTOMOTIVE ENTERPRISES TO COMMENCE REPAIRS ON MY VEHICLE PER THIS ESTIMATE. SIGNED DATE ESTIMATE RECALL NUMBER: 11/22/200514:19:48 1100 UltraMate is a Trademark of Mitchell International Mitchell Data Version: OCT_05_A Copyright(C)1994-2003 Mitchell International Page 2 of 2 UltraMate Version: 5.0.212 All Rights Reserved P 11/22/2005 at 02 : 49 PM Job Number: 83169 CALIFORNIA AUTO BODY License #:AD227182 Federal ID #: 030512742 COMMITTED TO QUALITY 1225 Parkside Drive Walnut Creek, CA 94596 (925) 934-5424 Fax: (925) 934-9777 PRELIMINARY ESTIMATE Written By:. JOHN TINAY Adjuster: Insured: JENNIFER REESE Claim # Owner: JENNIFER REESE Policy # Address: 3350 HELEN LN Deductible: LAFAYETTE, CA 94549 Date of Loss: Day: (925) 284-2174 Type of Loss: Point of Impact: 11 . Left Front Inspect CALIFORNIA AUTO BODY Business: (925) 934-5424 Location: 1225 Parkside Drive - Walnut Creek, CA 94596 Insurance Company: 4 Days to Repair 1996 MAZD MX-5 MIATA 4-1 . 8L-FI 2D CNVT GREEN Int: VIN: JMlNA3538T0718598 Lic: 4AAY655 CA Prod Date: Odometer: . Intermittent Wipers Tinted Glass Dual Mirrors Clear Coat Paint Power Brakes Driver Air Bag Passenger Air Bag 4 Wheel Disc Brakes Hiback Bucket Seats Recline/Lounge Seats -------7----------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1 FENDER 2 Repl LT Fender 1 210. 00 2 . 0 2 . 8 3 Add for Clear Coat 1 . 1 4 Add for Edging 0. 5 5 DOOR 6 Blnd LT Door shell 1 . 1 7 HOOD 8 Blnd Hood 1 . 5 9# Subl Haz Waste 1 5. 00 X 10# Repl Cover Car 1 5. 00 0 . 3 11# Refn Color Match 0. 5 12# Rpr Color Sand and Polish 1 . 5 ------------------------------------------------------------------------------- Subtotals =_> 220.00 3. 5 7 . 8 1 11/22/2005 at 02 : 49 PM Job Number: 83169 PRELIMINARY ESTIMATE 1996 MAZD MX-5 MIATA 4-1 . 8L-FI 2D CNVT GREEN Int: Parts 215 . 00 Body Labor 3 . 5 hrs @ $ 71 . 00/hr 248 . 50 Paint Labor 7 . 8 hrs @ $ 71 . 00/hr 553 . 80 Paint Supplies 7 . 8 hrs @ $ 30 . 00/hr 234 . 00 Sublet/Misc. 5. 00 ---------------------------------------------------- SUBTOTAL $ 1256.30. Sales Tax $ 449. 00 @ 8 .25000 37 . 04 ---------------------------------------------------- GRAND TOTAL $ 1293 . 34 ESTIMATE OF REPAIR $ THE ESTIMATE OF REPAIR INCLUDES PARTS, LABOR, AND DIAGNOSIS. IF, ON FURTHER INSPECTION, ADDITIONAL PARTS OR REPAIRS ARE NEEDED, YOU WILL BE CONTACTED FOR AUTHORIZATION. WE ARE NOT RESPONSIBLE FOR LOSS OR DAMEGE TO YOU VEHICLE FROM FIRE, THEFT, ACCIDENTS, OR ANY CAUSE BEYOND OUR CONTROL. ALL TESTS WILL BE MADE BY OUR EMPLOYEES AT YOUR RISK. AUTHORIZED SIGNATURE: DATE: ADD'L REPAIR AUTHORIZATION AMOUNT: $ DATE: PHONE NO: TIME: PERSON CONSENTING: IF VEHICLE IS RETURNED TO CUSTOMER BEFORE AUTHORIZED REPAIRS ARE PERFORMED, A DIAGNOSTIC AND HANDLING CHARGE, INCLUDING RESSEMBLY, WILL BE MADE ------------------------------------------------------------------------- ------------------------------------------------------------------------- POWER OF ATTORNEY. I DO HEREBY APPOINT THE AFOREMENTIONED BUSINESS AS MY ATTORENY IN FACT TO ACCEPT ON MY BEHALF ANY AND ALL CHECK, DRAFTS, OR BILLS OF EXCHANGE, AND TO ENDORSE ALL SUCH CHECKS, DRAFTS, OR BILLS OF EXCHANGE FOR DEPOSIT TO THE AFOREMENTIONED BUSINESS' ACCOUNT FOR CREDIT ON MY ACCOUNT FOR REPAIRS ON MY VEHICLE WHICH HAS BEEN RELEASED AND ACCEPTED. ACCEPTED BY: DATE: 2 Orlsta Auto w "Committed to Quality" John'maty Ph:(925)9345424 1225 Parkside Drive Fk: (925)934-9777 Walnut Creek,CA 94596 LL RORNOW AUTOMOTIVEA E N T E E F SPRINGS & Stn � BERTI V 14611 lift Lu liJ.t i. Two Locations to Serve You 3331 Mt.Diablo Boulevard Lafayette,California 94549 (925)283-2160 2160 Erickson Road Concord,California 94520 (925)$27-4848 0 N 1C7 y ui . low 00 (C 2 _ r a .. 6 M NcQ 3 '•�. :r. M •t me s k C> 0 o p ul P a CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY VQV4«4r /� -e3, 04 BOARD AC ION: 'ham 176eI�/OWOI c� ye�t,rCS f/O�q�ey Claim Against the County, or District Governed by the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), give► 9 E fir? Pursuant to Government Code Section 913 and t: � ' 915.4. Please note all "Warnings". AMOUNT: $9.00 plus NOV 5 0 2005 COUNTY COUNSEL CLAIMANT: LAMOS WAYNE STURGISCALIF #200501896 ATTORNEY: UNKNOWN DATE RECEIVED: NOVEMBER 30/05 M.D.F. Q-MUDULE..#5 ADDRESS: 901 COURT STREET, BY DELIVERY TO CLERK ON: NOVEMBER 30/05 MARTINEZ, CA 94553 NOVEMBER 29/05 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. NOVEMBER 30 2005 JOHN ST&��Clerk Dated: By: Deputy I1. FROM: County Counsel TO: Clerk of the Board of SuI46rvisors (,This claim complies substantially with Sections 910 and 910.2. O 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). O 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). O Other: Dated: / 05 By: Deputy County Coun III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( } Claim was returned as untimely with notice to claimant (Section 911.3). IV. ARD ORDER: By unanimous vote of the Supervisors present: (y This Claim is rejected in full. 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' w° rt /V, g'af410HIV SWEETEN, - Deputy Clerk WARNING (Gov. code hction 913) Subject to certain exceptions, you have only six(6)months from the date this notice was personally served or deposit in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. ' AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of tl►e United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage full prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: 1�a��tM/�& J OHN SWEETEN, CLERK By —A�� --.Deputy-Deputy Clei j i i Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 1001' day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov't Code 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. ****************************************************************************************** REI: Claim By Reserved for Clerk's filing stamp RECEIVED Against the County of Contra Costa or ) NOV 3 0 200 1>el A;N T)e TEn17i n N 1'A! ;I;Tv District) CLERK BOARD OF SUPEWINORS (Fill in name) I CONTRA COSTA CG. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ ,DLJ 1- and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) /o�s�oS 1012D ///?/Os 2. Where did the damage or injury occur? (Include city and county) %/2 u,3T 11 eCou,JT o7�I°E 3. How did the damage or injury occur? (Give full details; use extra paper if required) Ml -ne xr Aecoun�- A e Ti>/;y Aee f Show / [i�A��9 ao G✓A� T./<en pa117-`Y /`CC'oun7 Al' �Aal'J`1a y YiS�� Dn �D daTPS o� /o-S-.oS c,m d ir,✓:ea o-n //-f--0,5 1heSe eop9/eS kro S Pl'oVeq / fo �e - gAonq. 1. 133- � Lam/ q1,,,,1-nee. //�e &l ,ojiCal JjeDAl'�6.,n/ and ipeir IkSPO"Se /'Efu/'n sbn/T,77 is n/0 �ie���A/ Anlws And pka,,YiAy hAx no eh"'Ale o- r"le /ys pn/ //-9-a.SL i ' I7o �os'S;�`j/e fog/AAYe- v1'. �U`f�edi/C�a� WS17S/On �7hiS o�TE'�' .i 14AS J /Jv i77 �iE �APi�r oil IcA.5 44 1- � �e -4 /7-49Zrr/ /�7u1I7 6 w TuAJ9 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? Wror� 411 Cala/9f' <pIr PP@ v1� 5. What are the names of county or district /officerss,,�servants, or employees causing the damage or injury? XXIJ97AC606w " eIriPe. 6. What damage or injuries do you claim resulted?(Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) by VL1 T 7. How-was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Ayvwun Off"nnloG/'ra'p / �"urlQ.l" 8. Names and addresses of/witnesses, doctors, and hospitals. v7, J7�/' �tZ �pu�► ��,� ✓`'/���Cal 9. List the expenditures ou made on account of this accident or injury. DATE TIME AMOUNT Gov. Code Sec. 910.2 provides "The claim must be signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney Name and Address of Attorney ) (Claimant's Signature) A �— (Ad ress) 1-7 Telephone No. )Telephone No. NOTICE Section 72 of the Penal Code provides: Every person who,with intent to defraud,presents for allowance or the payment to any state board or officer,or to any county,city,or district board or officer,authorized to allow or pay the same if genuine,any false or fraudulent claim,bill,account, voucher,or writing,is punishable either by imprisonment in the county jail for a period of not more than one year,by a fine of not exceeding one thousand($1,000), or by both such imprisonment and fine,or by imprisonment in the state prison,by a fine of not exceeding ten thousand dollars($10,000),or by both such imprisonment and fine. ti 1 • � of.. - 14M1 �. 4l 6 � 44 CONTRA COSTA COUNT DETENTION FACILITY INV ( ) INMATE REQUEST FOR INFORVAT:JW ( ) MEDICAL REQUEST From: L.Aig.#9 k/, S m A S =t L Bkg# /ey" (DOB) i Date: 9 Housing Assignment: Q-&v j,4 je OS Check One ( ) Request ( r evance ( )Appeal ( ) Other Request: / a/ .T 1.!,S;,t r iv-S-eS' �a��/!-:tea Wn S I � eYVf cl,"eokon y i t 414- vp1t4f i 41n/ -G c.Is e P SAS' I cl f Vats,. �i�hl�h ' ' ..� r w Pa � t�J•' fV" UA Z% ' S Jr 42,5 Routed To: ANSWER: ( )APPROVED ( ) DENIED-(state reason) it c J a i tTtP r. By: , -1 ; Date: I I / Pink:Kept by Inmate - Yellow:Reply to Inmate White:To Booking ) DET 024:FRM 1/2/91 CONTRA COSTA DETENTION FACILITIES _ Account Activity Fac: 1 Account Group:INMATE Account Type:CASH Account#:176845 Name(L,F,M,S): STURGIS, LAMOS,WAYNE Start Dt/Tm-. 01-01-1990 1200 Ending Dt/Tm: 11-21-2005 1239 Transaction # Transaction Type Transaction Date Amount Running Balance 838983 DEP1 Approved 09-05-20052021 $20.00 $20.00 840603 MDCOM 09-08-20051048 ($16.32) $3.68 843513 MDCOM 09-15-20051054 ($3.30) $0.38 846059 MDCOM 09-22-20051017 ($0.17) $0.21 846733 DEP1 Approved 09-23-20051728 $98.60 $98.81 848903 MDCOM 09-29-20051011 ($24.25) $74.56 851675 MDCOM " - 10-06-2005 1013 ($7.40) $67.16 C_852025_--_MED-1. _P_)1 VlSrt-row_. .90=06-200511_41 _ _($3:00) ___ _ $64.16----2 854389 MDCOM 10-13-2005 0952 ($4.75) $59.41 857371 MDCOM 10-20-20051036 ($57.64) $1.77 860134 MDCOM 10-27-20051008 ($1.56) $0.21 862910 MDCOM 11-03-20051025 ($0.20) $0.01 864309 DEP1 Approved 11-07-20051753 $20.00 $20.01 865787 MDCOM -- - 11-10-20051003 ($12.57) $7.44 P�ar acLVisr 866166---MED- r ;: `b o - - -- --l-1-10-20051138 _ ($3:00). $4:44 -- 866168—-MED 1 Phacmacjl J r 51 //,!� r!rL:-11-10-2005 1139- _ ($3.00)_:=--$1.44-- - 868388 MDCOM an����- � 11-17-2005 0954 ($1.05) $0.39 868998 CADJ1 11-18-20051001 $1.05 $1.44 Transaction Total: $1.44 Total Amount by Transaction Type CADJ1 /COMMISSARY ADJUSTMENT FOR MDF $1.05 DEP1 /MDF INMATE DEPOSIT-Approved $138.60 MDCOM/COMMISSARY MODULE TRANSACTIONS FOR MDF ($129.21) MED1 /MDF- INMATE MEDICAL PAYMENT ($9.00) Transaction Total: $1.44 Facility: 1 Page 1 of 1 Printed: 11/21/2005 12:38:03 515F MAIN Printed By:65495,CREWS { CONTRA COSTA COUNTY DETENTION FACILITY ( ) INMATE REQUEST FOR INFORVIAT ji:4 ( ) MEDICAL REQUEST To: From. 14, A::A&A }- t L Bkg# aj&ftSW IDoel �;)Dafe: J OV - J_d*9 Housing Assignment: Qe{yA fk 06 .s Check One: (. ) Requester{ nevance ( )Appeal ( ) Other 1 'e Request: .a rc 10-s ojr ` u JOA a• ®e✓ /0-%5 , x &i- � ter, m P AVID c1, hyo J'd0 ds/1' Date fff ZS�J45 Routed To: ANSWER: "' ( )APPROVED ( ) DENIED-(state reason) � ' �d �, t , ' '� eked; -, / r►��, By: Date: H / / Pink:Kept by Inmate.. Yellow:Reply to Inmate White:To Booking DET 024:FRM 1/2/91 • �, v ., a h _ tJ a A y X11 V 0 A, F 16'38] � 6L L'1 Gcr hif �a CD O M GA o CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY \/a�. "I'll e y BOARD A TIONN .T:4PI 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), gi` CLAIM AGAINST: COUNTY OF CONTRA COSTA Pursuant to Government Code Section 913 and 915.4. Please notwall;"-Warnings".. AMOUNT: $102000 000.00 DIANA QUINTANCE AND TRISTAN MICHAEL QUAINTANCE, DEC b `? 2K5 CLAIMANT: both as legal heirs of decedent for purposes of the California wrongful death statutes, and as represen- GOUNTYCC)llfAi tives of the Estate of MARTHA CUSIMANO for purposes 1V:A.'1TiNhZ CAL",-, ATTORNEY: of prosecuting a survival action. DATE RECEIVED: DECEMBER 02/05 ---ANDREW R. GILLIN . DECEMBER 02/05 ADDRESS: GILLIN, JACOBSON, ELLIS & LARSEN BY DELIVERY TO CLERK ON: 2 THEATRE.: SQUARE, SUITE 230 ORINDA, CA 94563 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DECEMBER 02 2005 JOHN SW E Jerk Dated: By: Deputy II. MOM: County Counsel, TO: Clerk of th6 Board of Sup rvisors ( 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 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: �1 -- Deputy County Coi III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). (IV. ARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated:\I[t.v*o m-4wy /P ce"e—JOHN SWEETEN, CLERK, By , Deputy Clerk WARNING (Gov. code sectfon 913) Subject to certain exceptions, you have only six(6) months from the date this notice was personally served or depc in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of ar. 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 Unite States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage 1 prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:\-"&-" �� A?"OOHN SWEETEN, CLERK By Deputy C e RE: Claim By: Reserved for Clerk's filing stamp DIANA QUAINTANCE AND TRISTAN MICHAEL QUAINTANCE, BOTH AS LEGAL p HEIRS OF DECEDENT FOR PURPOSES OF nECElV�� THE CALIFORNIA WRONGFUL DEATH STATUTES, AND AS REPRESENTATIVES OF DEC 4.2 2005 THE ESTATE OF MARTHA CUSIMANO FOR CLERKBO PURPOSES OF PROSECUTING A SURVIVAL CONT q�FSUPERVISORS ACTION. os co. Against the ) The County of Contra Costa ) The undersigned claimant hereby makes claim against the County of Contra Costa in the sum of$10 million and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and time) Sunday, June 5, 2005 at approximately 2:45 P.M. 2. Where did the damage or injury occur? (include city and county) Intersection of Vasco Road and Camino Diablo Road, Contra Costa County 3. How did the damage or injury occur? (Give full details; use extra paper if required). On June 5, 2005 at approximately 2:45pm the deceased, Martha Cusimano was a passenger in a car driven by Carol Kretchmer (the car was a 2005 Corolla northbound on Vasco Road). Ms. Cusimano, Ms. Kretchmer and one other passenger were returning from a church retreat when they proceeded northbound on Vasco Road toward the intersection of Camino Diablo Road. Driver Kretchmer had a green traffic signal as she entered the intersection, and East Diablo Fire truck, license plate CAEO54492, appeared suddenly in front of Kretchmer. The truck was heading eastbound on Camino Diablo Road. The truck was crossing the intersection even though it had a red traffic signal. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? Joseph Felot, the driver of the East Diablo Fire Protection District Fire Truck, failed to stop for the real traffic signal as he proceeded eastbound on Camino Diablo Road to the intersection at Masco Road. He had a duty to drive with the regard for the safety of all persons and property. He failed to drive with due regard for the safety of all persons and property and the result was injury to these Claimants. 5. What are the names of county or district officers, servants, or employees causing the damage or injury? Joseph Felot 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) Economic and non economic damages for the wrongful death of Martha Cusimano, and the injuries suffered by her subsequent to the accident and prior to her death, are in the amount of$10 million. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) This claim is based upon the best current information claimants have regarding this case. 8. Names and addresses of witnesses, doctors, and hospitals: Witnesses: Joseph Pelot, 134 Oak Street, Brentwood, CA 94513 Chris Aleksunas, 134 Oak Street, Brentwood, CA 94513 Sinette Chavez, Unknown a Joseph Quilates Macaranas, 2825 Pendleton Dive, San Jose, CA 95148 Christina Macaranas, 2825 Pendleton Drive, San Jose, CA 95148 Jessica Macaranas, 2825 Pendleton Drive, San Jose, CA 95148 Jasmine Lauretta, 2825 Pendleton Drive, San Jose, CA 95148 Robert Thornton, 6919 New Melones Circle, Discovery Bay, CA 94514 Alexei Beliaev, 2309 Wayfair Drive, Discovery Bay, CA 94514 Hospitals: John Muir Medical Center 9. List the expenditures you made on account of this accident or injury: Not determined at the present time 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 ) Andrew R. Gillin ) Gillin, Jacobson, Ellis & Larsen ) 2 Theatre Square, Suite 230 ) Orinda, CA 94563 ) (,U//drew R. Gillin, Attorney for Diana Quaintance and Tristan Michael Quaintance) j Cail(i�Js�c°b�� �r(is� Lam. 0 ri nAA) C-t 1-t45�3 Z�3 _ ��� Telephone No. (925) 253-5800 )Telephone No. �zs� LAW OFFICES OF GILLIN, JACOBSON, ELLIS & LARSEN 2 THEATRE SQUARE, SUITE 230 ORINDA,CALIFORNIA 94563 TELEPHONE(925)253-5800 Authorization of Attorney Pursuant to Section 2695.2(c)of the California Code of Regulations, Title 10, Chapter 5, I authorize GILLIN, JACOBSON, ELLIS &LARSEN, my attorneys, to handle my personal injury claim. This Authorization shall be valid for the duration of this claim unless revoked by the undersigned. Any and all prior authorizations are hereby revoked by the undersign d as of the date of this Authorization. / Signatu k5)1�w Printed Name )6 (Y L)A t NTOnl C.-f w Date 6 - 2- 7-OS Address ;aZ (36-iTni Tows✓ )�W- Telephone A, CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY Jet"Ago r /,0/ OUP6 BOARD ACT ON: "9'�J WW �iYJ7GG//c4� G�G��"S O ic��y, Claim Against the County, or District Governed by the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), give CLAIM AGAINST: EAST DIABLO FIRE PROTECTION DISTRICT pursuant to Government Code Section 913 and 915.4. Please note-all "Warnings,',•': AMOUNT: 0 000.00 DIIANAOQ6ZTANCE AND, TRISTAN MICHAEL. QUAINTANCE, ` DEC 0 ? 2005 ti CLAIMANT: both as legal heirs. of decedent for purposes of the California wrongful death statutes, and as represen- COUNT(COUNS'L tives of the Estate of MARTHA CUSIMANO for purposes IUA.3TN'2ZCALY. ATTORNEY: of prosecuting a survival action. DATE RECEIVED: DECEMBER 02/05 =- ----ANDREW R. GILLINDECEMBER 02/05 ADDRESS: GILLIN, ,JACOBSON, ELLIS I& LARSEN BY DELIVERY TO CLERK ON: 2 THEATRE'- SQUARE, SUITE 230 ORINDA, CA 94563BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DECEMBER 02 2005 JOHN SWEEFNP ., e k Dated: By: Deputy II. FhOM: County Counsel, TO: Clerk of the Board of Supe isors ( This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). O Other: Dated: PZ 5- By: M Deputy County Coun III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. ARD ORDER: By unanimous vote of the Supervisors present: (v)rThis Claim is rejected in full. 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:,Arn°�v3, /!5��4JOHN 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 deposi 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 ful prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: %-4m&*Wary 0,��JOHN SWEETEN, CLERK By Deputy Cie t RE: Claim By: Reserved for Clerk's filing stamp DIANA QUAINTANCE AND TRISTAN MICHAEL QUAINTANCE, BOTH AS LEGAL HEIRS OF DECEDENT FOR PURPOSES OF THE CALIFORNIA WRONGFUL DEATH STATUTES, AND AS REPRESENTATIVES OF RECEIVED THE ESTATE OF MARTHA CUSIMANO FOR PURPOSES OF PROSECUTING A SURVIVAL DEC 0 2 2005 ACTION. ' CLERK BOARD OF SUPERVISORS CONT'.A.,nSTA CO. Against the ) East Diablo Fire Protection District ) The undersigned claimant hereby makes claim against the above-named district in the sum of$10 million and in support of this claim represents as follows: I. When did the damage or injury occur? (Give exact date and time) Sunday, June 5, 2005 at approximately 2:45 P.M. 2. Where did the damage or injury occur? (include city and county) Intersection of Vasco Road and Camino Diablo Road, Contra Costa County 3. How did the damage or injury occur? (Give full details; use extra paper if required). On June 5, 2005 at approximately 2:45pm the deceased, Martha Cusimano was a passenger in a car driven by Carol Kretchmer(the car was a 2005 Corolla northbound on Vasco Road). Ms. Cusimano, Ms. Kretchmer and one other passenger were returning from a church retreat when they proceeded northbound on Vasco Road toward the intersection of Camino Diablo Road. Driver Kretchmer had a green traffic signal as she entered the intersection, and East Diablo Fire truck, license plate CAE054492, appeared suddenly in front of Kretchmer. The truck was heading eastbound on Camino Diablo Road. The truck was crossing the intersection even though it had a red traffic signal. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? Joseph Felot, the driver of the East Diablo Fire Protection District Fire Truck, failed to stop for the real traffic signal as he proceeded eastbound on Camino Diablo Road to the intersection at Vasco Road. He had a duty to drive with the regard for the safety of all persons and property. He jailed to drive with due regard for the safety of all persons and property and the result was injury to these Claimants. 5. What are the names of county or district officers, servants, or employees causing the damage or injury? Joseph Felot 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) Economic and non economic damages for the wrongful death of Martha Cusimano, and the injuries suffered by her subsequent to the accident and prior to her death, are in the amount of$10 million. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) s This claim is based upon the best current information claimants have regarding this case. 8. Names and addresses of witnesses, doctors, and hospitals: Witnesses: Joseph Pelot, 134 Oak Street, Brentwood, CA 94513 Chris Aleksunas, 134 Oak Street, Brentwood, CA 94513 Sinette Chavez, Unknown Joseph Quilates Macaranas, 2825 Pendleton Dive, San Jose, CA 95148 Christina Macaranas, 2825 Pendleton Drive, San Jose, CA 95148 Jessica Macaranas, 2825 Pendleton Drive, San Jose, CA 95148 Jasmine Lauretta, 2825 Pendleton Drive, San Jose, CA 95148 Robert Thornton, 6919 New Melones Circle, Discovery Bay, CA 94514 Alexei Beliaev, 2309 Wayfair Drive, Discovery Bay, CA 94514 Hospitals: John Muir Medical Center 9. List the expenditures you made on account of this accident or injury: Not determined at the present time ................................................................... 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 ) Andrew R. Gillin ) Gillin, Jacobson, Ellis & Larsen ) 2 Theatre Square, Suite 230 ) Orinda, CA 94563 ) (Andrew R. Gillin,Attorney for Diana Quaintance and Tristan Michael Quaintance) C�illin� J�.wbyuvl, 1✓t(is t LA44�� Z Th"� S*4- . J `z�+c Z� Telephone No. (925) 253-5800 )Telephone No. ('q7,5) LAW OFFICES OF GILLIN, JACOBSON, ELLIS & LARSEN 2 THEATRE SQUARE,SUITE 230 ORINDA,CALIFORNIA 94563 TELEPHONE(925)253-5800 Authorization of Attorney Pursuant to Section 2695.2(c)of the California Code of Regulations, Title 10, Chapter 5, I authorize GILLIN, JACOBSON, ELLIS & LARSEN, my attorneys, to handle my personal injury claim. This Authorization shall be valid for the duration of this claim unless revoked by the undersigned. Any and all prior authorizations are hereby revoked by the undersign d as of the date of this Authorization. / Sign. 4 1091 Printed Name )b o AJ (90 A I AMM C-6 xTo f W►J Date Address a?b`D (jENT✓y 70w.✓ �' #�� /yn11�OC� 9f��y Telephone 9 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY (j %/&n! BOARD ACTIQN: j I I I I , HFr Xzv9lse/�e�/ fiu/V Gaor,B d/, V Claim Against the County, or District Governed by the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) , -,r notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and rayDEL 0 ''' 2005 � 915.4. Please note all "Warnings". i AMOUNT: $15,047.08 COUNTY COUN"ELR,FlART:"d:Z CALIF PACIFIC GAS AND ELECTRIC."pCOMPANY CLAIMANT: BY: JANET PACRING ATTORNEY: UNKNOWN DATE RECEIVED: DECEMBER 02, 2005 1 i ADDRESS: CREDIT AND RECORDS BY DELIVERY TO CLERK ON: DECEMBER 02, 2005 P.O. BOX 8329 STOCKTON, CA 95208 RECEIVED FROM RISK G BY MAIL POSTMARKED: MANAGEMENT FROM: Clerk of the Board of Supervisors TO: County Counsel f Attached is a copy of the above-noted claim. DECEMBER 02 2005 JOHN SWE E Irk Dated: By: Deputy Il. FkOM: County Counsel TO: Clerk of the Board of Sup rvisors f 1 (4<his claim complies substantially with Sections 910 and 910.2. O 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). O Other: I Dated: f�� �' O5� By: Deputy County Couns( I III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) O Claim was returned as untimely with notice to claimant(Section 911.3). I IV.PARD ORDER: By unanimous vote of the Supervisors present: (� This Claim is rejected in full. O Other: i I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated:V v�d,,a,.yZ/o 0*6,!� JOHN SWEETEN, CLERK, By , Deputy Clerk �— WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6)months from the date this notice was personally served or deposite in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *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(lie United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage full prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: i6?0?A0,$0HN SWEETEN, CLERK By Deputy Clerk , SRA C Contra Costa County "�" '= 9 Fire Protection District N'ry Fire Chief r KEITH RICHTER November 29, 2005 w (� ZQQS TO: Risk Management Division Penny Bailey Attn: Penny Bailey, Liability Claims Adjuster NOV 3 0 2005 FROM: Mike George, Chief of Administrative Services 8��3 SUBJECT: PG&E Correspondence Re 5-19-05 John Ross Accident Per our phone discussion today, please find enclosed two (2) pieces of correspondence from PG&E —dated November 2 and 14, 2005 — regarding the accident of May 19, 2005, involving John Ross in which a District pick-up truck struck a PG&E pole. The November 2 correspondence (received on November 3) advises us that we may be legally liable for damage to PG&E's property and requests insurance coverage information. The November 14 correspondence (received on November 16) includes PG&E's invoice in amount of$15,047.08 for cost of repairs. FAXED the two (2) pieces of correspondence to you today; as requested, this is to provide you with the originals. If you have any questions in adjusting this claim, call me at 941-3311. RECEIVE® Enclosures FDEC 0 2 2005 CLERK BOARD O SUPERVISORS u"NTRA COSTA CO. Ll:\SRMRGS\MHG\RISKMGMT5112.DOC 2010 Geary Road•Pleasant Hill,California 94523-4694•Telephone(925)941-3300•Fax(925)941-3309 East County •Telephone(925)757-1303 • Fax(925)941-3329 West County •Telephone(510)374-7070 www.cccfpd.org 1 Pacific Gas and Electric Company Credit and Records P.0.Box 8329 Stockton,CA 95208 November 14, 2005 Contra Costa Fire District 2010 Geary Road Pleasant Hill, CA 94523 Gentlemen: Per our correspondence to you dated November 2, 2005, we are enclosing our invoice for damages amounting to $15,047.08 arising out of the incident of May 19, 2005 at Franklin Canyon Road in Martinez. Your check should be made payable to Pacific Gas & Electric Company (PG&E), in the amount of$15,047.08, and mailed in the envelope provided for your convenience. Please call me at 1-800-945-5251, Extension 7474, if you have any questions. Sincerely, g ing pr`esenta ve Enclosure File No.: E2005252386 Non-Energy Invoice 99950006622752100015047080001504708 1nvgige Piumkier lnvatce mate4nmunt Dua AmountEn�losec#' 0006622752 -1 11/14/2005 $ 15,047.08 CONTRA COSTA FIRE DISTRICT PG&E Box 997300 2010 GEARY ROAD Sacramento,CA PLEASANT HILL CA 94523 95899-7300 Please return this portion with yourpayment. Thankyou. * O j .... _.... _ ..... - _.- ..._.- ....._- __...... When Making Inquiries or Address Changes, ustamer;Number,;:; Please Contact: 529818 Non-Energy Collection Unit nyolce `.lute e P.O. Box 8329 0006622752-1 Stockton CA 95208-8329 (800) 945-5251 I/R 5252386,1550 FRANKLYN CANYON RD,MTZ Unit 0f .. D @SCn 1YGq.. tl9tlt NieBsure !'lmount* Reference Number: E2005252386 LABOR TO REPAIR ELEC FACILITIES-CAPITAL • 1 EA 14,272.78 OTHER COSTS FOR REPAIR OF ELEC FAC-CAP 1 EA 1,481.34 MATERIAL FOR REPAIR OF ELEC FAC-CAPITAL 1 EA 1,053.96 CREDIT FOR JOINT POLE INTEREST(CAPITAL) 1 EA 1,761.00- Line Item Subtotal 15,047.08 AMOUNT NOW DUE $ 15,047.08 NOTE: This invoice reflects current charges only. Any past due amounts will be billed separately. ® Recycled Paper 20%Post-Consom er Waste t , a eH�= moo a — �LO y = z a a - o v N MU CD - J 00 LJJ N _ a Q w m L) _- LD coo L) x LL o U V m O d d N N Place stamp Name here.Post Address Office wifl not deliver mail without postage. 1 PACIFIC GAS AND ELECTRIC COMPANY PO BOX 8329 � s STOCKTON CA 95208-0329 i. t Pacific Gas and Electric Company Credit and Records P.0.Box 8329 Stockton,CA 95208 November 2, 2005 Contra Costa Fire District 2010 Geary Road Pleasant Hill, CA 94523 Gentlemen: This refers to an incident on May 19, 2005, when your employee, John William Ross was driving a 2002 Ford F150, he struck and damaged our electrical facilities at Franklin Canyon Road in Martinez. The conditions under which this damage occurred indicate you may be legally responsible for the damage to our Company's property and, in our opinion, we have the right to recover from you the cost of repairs which are presently being determined. If you have insurance coverage, please provide the name and address of your insurance carrier, as well as your policy number in the space provided below. We will then forward our bill for damages to them. If you do not have insurance, we shall forward our bill to you for payment. Please call me at 800-945-5251, Extension, 7474 if you have any questions. Sincerely, ----- —_. a �" _J net acring , Claims egresentattve File No.: E2005252386 ( ) Submit invoice directly to me for payment. O Submit invoice to insurance carrier. Insurance Company: Agent: Address: City: State: Zip: Phone: Contact Name: Claim/Policy No.: Insured's Name: File No.: E2005252386 N M 0 F g < ww� 0U)< CL U g Z W z LL Z 7 J a U ® C7 cc a � U Z Q z J c � w F- W oL) LU NJ �y�+ ULn li z w Fes- O co u y W J N /A CL m O J LO V o z O o) W a ¢ a ¢ Z Q m Q N On U N cn M z N �` J CO O n g L) ¢ x `�D L? L3 f°C o ¢ W O F- a a. U d N LL W & BUSINESS REPLY MAIL FIRST-CLASS MAIL PERMIT NO.2663 SAN FRANCISCO,CA POSTAGE WILL BE PAID BY ADDRESSEE PACIFIC GAS AND ELECTRIC COMPANY CENTRALIZED COLLECTION CENTER PO BOX 8329 Cu STOCKTON CA 95297-0825 CLAIM �.�7 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: A11,Section,refdrences are to )' The copy of this document mailed to you is your California dov.''ernment Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given c GSC 0 J 2005 Pursuant to Government Code Section 913 and Cr,11' fY f,, j_ 915.4. Please note all "Warnings". AMOUNT: $5,249.57 I CLAIMANT: CALIFORNIA STATE AUTOMOBILE ASSOCIATION FOR: MIKE/APRIL PERRY BY: CHRISTOPHER HICKS DECEMBER 05/05 ATTORNEY: UNKNOWN DATE RECEIVED: 4DECEMBER 05/05 ADDRESS: P.O. BOX 920 BY DELIVERY TO CLERK ON. SUISUN. CITY, CA 94585 IROVEMBER 28/05- [ BY MAIL POSTMARKED: [ i FROM: Clerk of the Board of Supervisors TO: County Counsel + Attached is a copy of the above-noted claim. JOHN SWT Jerk Dated: DECEMBER 05, 2005 By: Deputy 1 II. FkOM: County Counsel.. ; TO: Clerk of the Board of Su &visors Ehis 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. Tile i 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). I O Other: i Dated: Z S By: Deputy County Counst I i III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) i ( } Claim was returned as untimely with notice to claimant(Section 911.3). IV. RD ORDER: By unanimous vote of the Supervisors present: (v) This Claim is rejected in full. ( ) Other: i i j I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated 4v->b-c tVWy /10, Qedw4OHN SWEETEN, CLERK, By , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposite in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. " AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage full} prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:✓av-31 10?J*80J6HN SWEETEN, CLERK By Deputy Clerl JUN-12-2003 09:23 CCC RISK MANAGMENT 925 335 1421 P.02 Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA CO= INSTRUCTIONS TO CLAD-UM A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than ane year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its .office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553• C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more. than one public entity, separate claims must be filed against each public entity. E." Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this form. f * !F iG * * f � IF * � i iF � ■ # # i f 1F � 1F �F * � i iF iF � 4 IF 9E * * # * f if * K * � RE: aim Ev ) Reserved for Clerk's filing. stamp FWNTRARsrA ECEIVE® Against the County of Contra Costa , EC 0 5 2005 or ) BOARD OF SUPERVISORS District) so. Fill in name . ) The undersigned claimant hereby-makes claim against the County of Contra Costa or the above-named District in the sum of $ 52`f4 •.7 and in support of this claim represents as follows: 1. When did the damage_or injury occur? (Give exact date and hour) ©S .. ICU:12 AK 2. Where did the damage or injury occur? (Include city and county) �zaL s-T T MAP C TRfE l F_�,a jsUtaY 3. How did the damage or injury occur? (Give full details; use extra paper if ,(Irequired) Y Q a(�tVP2- &Q-4-D i-}Ts. Dcx><- maTo "T?AF�J_9-- AS nuZ &(SbeEb VLR2L6- 1vhSS - 4. What particular act or omission on the part of county or district officers, servants or.employees caused,the.injury or.damage? �sb�a �ccmi of UVC_ 22S t 7 -cRj;.1NZ •A Li, bWe -2a6-rM(2F1C- Jun-ld-zbes 09:23 CCC RISK MANAGMENT 925 335 1421 P.03 7. what are the names of county or district orficers, servants or employees causing the damage or injury? 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. 7• How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) B. Names and addresses of.witne.;Tses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT iv�i��cs s�2s ���7S.S7 Gov. Code Sec. 910:2 provldes: "The claim must be signed by the claimant SEND NOTICES TO: (Attorne ) or b some n his.behalf." Name and Address of Attorney Claimant's Si tura Address Co I s- S Telephone No. Telephone No.m ZC) # # N # # # # I W NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if.genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one-year, by a fine of not exceeding one thousand ($1,000), or by ,both such imprisonment and fine;°'or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. California State Automobile Association Inter-Insurance Bureau P.O.Box 920 Suisun City,CA 94585-0920 November 24, 2005 Clerk of the Board of Supervisors 651 Pine St.Room 106,County Administration Building Martinez,CA 94553 RE: Your Insured: Jeffrey Charles Bennet Your Claim No.: Unknown Our Insured: Mike/April Perry Our Claim No.: 01-KW7555-0 Date of Loss: 08/31/2005 Dear Clerk of the Board of Supervisors: This will confirm our subrogation interest arising from this loss. We have settled the claim with our insured and based on the following facts,request payment directly to California State Automobile Association Inter-Insurance Bureau (CSAR-IIB): In order to assist with and expedite the evaluation and processing of this subrogation demand, we enclose the relevant documentation in support of our claim. This information may contain personal or privileged information about our insured, and is being provided to you pursuant to California Insurance Code Section 791.13 and may not be used for any unauthorized purpose. Based upon this information,we ask that you issue payment of$5,249.57 Repair Bill $4,975.57 Deductible $0.00 Loss of Use $274.00 Tow/Storage $0.00 Miscellaneous $0.00 -------------------------- TOTAL $5,249.57 Please be advised that any payment in an amount less than that set forth in this letter that is forwarded to CSAA without its prior authorization as described below will not constitute a full and final settlement and will be accepted as partial payment only. Since payments received in the mail are processed by clerical staff and deposited as a matter of course without examination, unauthorized payments for less than the full amount demanded may be processed inadvertently. Although such payments may be demarked as"payment in full"or have other words of similar meaning written on them, their processing will not constitute an accord and satisfaction,as CSAA has not agreed to acceptance of such payments. Only an authorized Subrogation Specialist may communicate,orally or in writing,CSAA's specific agreement to accept an amount less than that demanded in this letter. Sincerely, t��vw�a�.ytv� ftclza Subrogation Specialist 888-900-6520 extension 6203 Enclosure Date: 10/12/2005 4:51:44 pm Estimate ID: AOlKW7555001 Estimate Version: 1 Supplement: 1 (F) 10/12/2005 04:50:08 PM W) FINAL O Profile ID: CSAA O VORNHAGEN BODY AND PAINT 600 Harvest Park Drive Brentwood, CA 94513 (925) 516-1969 Fax:(916) 516-9166 Tax ID: 68-0466225 BAR M: AD216007 } Damage Assessed By JOEL NOVERO Appraised For: Cinde McKnight m 0 Condition Code: Good Type of Loss: Collision LJ Date of Loss: 8/31/2005 Arrival Date: Final to Owner: 10/12/2005 W Payer: (� claim Paid: (yJ Policy No: Claim Number: AOIKW7555001 Deductible: 1,000.00 File Number: None Owner: MIKE/APRIL PERRY Insured: MIKE/APRIL PERRY ' Claimant: Address: Telephone: Work Phone:Home Phone: Mitchell Service: 914767 Description 2002 Lexus GS 300 Vehicle Production Date: / Body Style: 4D Sed Drive Train: 3.OL Inj 6 Cyl 5A RWD VIN: ST8B069S020166752 License: 4XOC270 CA Mileage: 74,106 OEM/ALT: A Search Code: C88118 Color: GREY MET Options: Alum/Alloy Wheels,Air Conditioning,Power Steering,Power WindoWS,Power Door Locks,Power Passenger Seat,Tilt Steering Wheel,Cruise Control,Electric Defogger, Leather Seats,Automatic Transmission,Traction Control/Electronic,Premium Sound Sys.,Power Driver Seat,AM-FM stereo/CDPlayer(Single) ACCEPTABLE VERSION RECENTLY SUPPLIED BY THE S.A.R. "All Crash parts ESTIMATE RECALL NUMBER: 9/14/2005 14:16:35 AOIKW7555001 UltraMate is a Trademark of Mitchell International Mitchell Data Version: SEP O5 A Copyright (C) 1994 - 2003 Mitchell International Page 1 of 6 UltraMate Version: 5.0.211 All Rights Reserved Date: 10/12/2005 4:51:44 pm Estimate ID: AOIKW7555001 Estimate Version: 1 Supplement: 1 (F) 10/12/2005 04:50:08 PM FINAL Profile ID: CSAA on this estimate are "new" original equipment manufacturer parts, unless otherwise specified. Parts described as rechromed, recored, remanufactured or, reconditioned are considered "rebuilt" parts. Crash parts decribed as "quality replacement part" are non-original equipment manufacturer aftermarket new parts." Line Entry Labor Line Item Part Type/ Dollar Labor CEG Item Number Type Op Description Part Number Amount Units Unit 1 400021 BDY REMOVE/INSTALL FRT BUMPER ASSY 2 "LOOSEN ONE SIDE FOR PAINT" 3 400051 BDY REMOVE/INSTALL R FAT COMBINATION LAMP 0.3 #0.3 4 400101 BDY REMOVE/INSTALL R FRT SIDE MARKER LAMP 0.3 #0.3 5 400215 REF BLEND R FENDER OUTSIDE C 0.9 2.2 6 400243 BDY REMOVE/INSTALL R FENDER WHEEL OPENING MLDG 0.3 0.3 7 400245 BDY REMOVE/INSTALL R FENDER SIDE MLDG 0.2 0.2 S1 8 403596 BDY REMOVE/REPLACE R FENDER ADHESIVE NAMEPLATE PT211-33001 36.87 ' 0.2 0.2T 9 DECAL-SPORT DESIGN" S1 10 403597 BDY REMOVE/REPLACE L FENDER ADHESIVE NAMEPLATE PT211-33001 38.87 ' 0.2 0.2T 11 *'HAD TO REPLACE BOTH SIDES TO MATCH- 12 OLD STYLE NOT AVAIL. ANYMORE. CONC. LEXUS." S1 13 900500 BDY' REPAIR RECODE ELECTRONIC KEY LOCK CYL. Sublet 175.00 * 0.0' 14 403250 BDY REMOVE/REPLACE R FRT DOOR SHELL 67001-30820 597.66 5.0 #5.OT 15 AUTO REF REFINISH A FAT DOOR OUTSIDE C 2.0 2.0 16 AUTO AEF REFINISH R FRT ADD FOR JAMBS S INSIDE C 1.0 1.0 17 "LKQ DOORS NOT COST EFFECTIVE" 18 402564 BDY REMOVE/REPLACE A FRT DOOR BELT MOULDING 75710-30372 65.02 INC #0.3T 19 403945 BDY REMOVE/REPLACE A FAT DOOR MOULDING 75071-30062-B3 437.08 INC 0.4T 20 404427 BDY REMOVE/REPLACE A FRT DOOR LATCH 69030-3A121 244.68 INC #0.3T S1 21 403931 BDY REMOVE/REPLACE R FRT DOOR OUTSIDE HANDLE 69210-30270-132 118.57 INC #0.3T S1 22 404898 BDY REMOVE/REPLACE R FAT DOOR LOCK CYLINDER 69051-30330 216.58 INC #0.3T 23 401520 BDY REMOVE/REPLACE R FRT DOOR WEATHERSTRIP 67861-30251 107.24 INC 0.5T 24 403364 BDY REMOVE/REPLACE R REAR DOOR SHELL 67003-30580 486.97 4.0 4.OT 25 AUTO REF REFINISH A REAR DOOR OUTSIDE C 1.6 2.0 26 AUTO REF REFINISH R REAR ADD FOR JAMBS S INSIDE C 1.0 1.0 27 402584 BDY REMOVE/REPLACE R REAR DOOR BELT MOULDING 75730-30252 65.02 INC #0.3T 28 404227 BDY REMOVE/REPLACE R REAR DOOR MOULDING 75075-30061-B3 315.86 INC 0.4T 29 401664 BUY REMOVE/REPLACE R REAR UPR DOOR HINGE 68750-30110 42.27 0.2 #0.2T 30 AUTO REF REFINISH R REAR UPR DOOR HINGE DOOR SIDE C 0.2 0.2 31 401666 BDY REMOVE/REPLACE R REAR LWR DOOR HINGE 68770-30100 42.27 0.2 #0.2T 32 AUTO REF REFINISH R REAR LWR DOOR HINGE DOOR SIDE C 0.2 0.2 33 401614 BDY REPAIR R QUARTER OUTER PANEL Existing 3.5'#17.5 ESTIMATE RECALL NUMBER: 9/14/2005 14:16:35 AOIKW7555001 U1traMate is a Trademark Of Mitchell International Mitchell Data Version: SEP 05 A Copyright (C) 1994 - 2003 Mitchell International Page 2 of 6 U1traMate Version: 5.0.211 All Rights Reserved Date: 10/12/2005 4:51:44 pm Estimate ID: AOIKW7555001 Estimate Version: 1 Supplement: 1 (F) 10/12/2005 04:50:08 PM FINAL Profile ID: CSAA 34 AUTO REF REFINISH R QUARTER PANEL OUTSIDE C 2.0 2.4 35 401853 BDY REMOVE/INSTALL R QUARTER WHEEL OPENING MLDG 0.3 0.3 36 404183 BUY REMOVE/REPLACE R QUARTER MOULDING 75605-30190-B3 45.54 0.2 0.2T 37 402187 BUY REMOVE/INSTALL R REAR COMBINATION LAMP 0.4 0.4 38 402234 BDY REMOVE/INSTALL REAR BUMPER ASSY 0.5' 1.8 39 '*LOOSEN SIDE FOR PAINT" 40 900500 BDY' REMOVE/REPLACE SOUND DEADENING MAT'L "Qual Repl Part 15.00 ' 0.1' T 41 900500 BDY' REMOVE/REPLACE MASK FOR OVERSPRAY "Qual Repl Part 0.00 ' 0.2' T 42 900500 BDY' REMOVE/REPLACE CORROSION PROTECTION "Qual Repl Part 10.00 ' 0.1' T 43 AUTO REF ADD'L OPR CLEAR COAT 2.4 44 AUTO ADD'L COST PAINT 293.80 ' T 45 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL 3.00 ' - Judgement Item R - Labor Note Applies C - Included in Clear Coat Calc Recycler Information Section: Prior Damage Remarks VEHICLE HAS DAMAGE TO RT DOORS. Add'l Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 16.8 57.00 0.00 175.00 1,132.60 Taxable Parts 2,867.50 Bdy-S 0.0 57.00 0.00 0.00- 0.00 Parts Adjustments 229.00- Refinish 11.3 57.00 0.00 0.00 644.10 Glass 0.0 57.00 0.00 0.00 0.00 Glass Adjustments @ 0.000 0.00 Mechanical 0.0 57.00 0.00 0.00 0.00 Sales Tax @ 8.250 219.33 Frame 0.0 57.00 0.00 0.00 0.00 @ 8.250 0.00 Taxable Labor Non-Taxable Parts Parts Adjustments 0.00 Labor Tax @ 0.000 0.00 ESTIMATE RECALL NUMBER: 9/14/2005 14:16:35 AOl KW7555001 UltraMate is a Trademark of Mitchell International Mitchell Data Version: SEP_05_A Copyright (C) 1994 - 2003 Mitchell International Page 3 of 6 UltraMate Version: 5.0.211 All Rights Reserved Date: 10/12/2005 4:51:44 pm Estimate ID: AOIKW7555001 Estimate Version: 1 Supplement: 1 (F) 10/12/2005 04:50:08 PM FINAL Profile ID: CSAR Non-Taxable Labor Non-Taxable Laborl,776.70 Glass Adjustments @ 0.000 0.00 Labor Summary 26.1 1,776.70 Total Replacement Parts Amount 2,877.83 III. Additional.Costs IV. Adjustments Amount Taxable Costs 293.80 Insurance Deductible 1,000.00- Betterment 0.00 Sales Tax @ 8.250 24.24 Appearance Allowance 0.00 Related Prior Damage 0.00 Customer Responsibility 1,000.00- Non-Taxable Costs 3.00 Total Additional Costs 321.04 I. Total Labor: 1,776.70 Ii. Total Replacement Parts: 2,877.83 III. Total Additional Costs: 321.04 Gross Total: 4,975.57 IV. Total Adjustments: 1,000.00- Net Total: 3,975.57 Less Original Net Total: 3,381.83 Net Supplement Amount: 593.74 S1: Williams Travis 593.74 Related Prior Damage Labor Subtotals Units Rate Totals RL-Body 0.0 57.00 0.00 RL-Refinish 0.0 57.00 0.00 RL Taxable Labor 0.00 GST - E Tax @ 0.000 0.00 Labor Tax @ 0.000 0.00 Labor Tax 0.00 RL-Non-Taxable Labor 0.00 Related Prior Damage Labor Summary 0.0 0.00 Part Replacement Summary Amount ESTIMATE RECALL NUMBER: 9/14/2005 14:16:35 A0IKW7555001 U1traMate is a Trademark of Mitchell International Mitchell Data Version: SEP 05 A Copyright (C) 1954 - 2003 Mitchell International Page 4 of 6 UltraMate Version: 5.0.211 All Rights Reserved Date: 10/12/2005 4:51:44 pm Estimate ID: AOIKW7555001 Estimate Version: 1 Supplement: 1 (F) 10/12/2005 04:50:08 PM FINAL Profile ID: CSAA RL-Taxable Parts 0.00 GST - E Tax @ 0.000 0.00 Sales Tax @ 8.250 0.00 Sales Tax @ 8.250 0.00 RL-Non-Taxable Parts 0.00 Related Prior Damage Parts Summary 0.00 Related Prior-Total Labor: 0.00 Related Prior-Total Replacement Parts: 0.00 Related Prior-Damage Total: 0.00 Unrelated Prior Damage Labor Subtotals Units Rate Totals UN-Hotly 0.0 57.00 0.00 UN-Refinish 0.0 57.00 0.00 UN-Taxable Labor 0.00 GST - E Tax @ 0.000 0.00 Labor Tax @ 0.000 0.00 Labor Tax @ 0.000 0.00 UN-Nan-Taxable Labor 0.00 Unrelated Prior Damage Labor Summary 0.0 0.00 Part Replacement Summary Amount UN-Taxable Parts 0.00 GST - E Tax @ 0.000 0.00 Sales Tax @ 8.250 0.00 Sales Tax @ 8.250 0.00 UN-Non-Taxable Parts 0.00 Unrelated Prior Damage Parts Summary 0.00 ESTIMATE RECALL NUMBER: 9/14/2005 14:16:35 AOl KW7555001 UitraMate is a Trademark of Mitchell International Mitchell Data Version: SEP 05 A Copyright (C) 1994 - 2003 Mitchell International Page 5 of 6 UltraMate Version: 5.0.211 All Rights Reserved Date: 10/12/2005 4:51:44 pm Estimate ID: AOM7555001 Estimate Version: 1 Supplement: 1 (F) 10/12/2005 04:50:08 PM FINAL Profile ID: CSAR Unrelated Prior-Total Labor: 0.00 Unrelated Prior-Total Replacement Parts: 0.00 Unrelated Prior-Damage Total: 0.00* ' Total does not include overlap or labor adjustments 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. Pcint(s) of Impact 3 Right Side (P) Insurance Cc: CSAA Address: Telephone: Fax Phone: Body Shop: Vornhagen Body and Paint Inspection Site: None Address: 600 Harvest Park Drive Address: Brentwood, CA 94513 Telephone: Inspection Date: (925) 516-1969 Fax Phone: (925) 516-9166 State Lic. No: Cycle Time Information Drop Off Date: 9/26/2005 Repair Dates: Promise Date: 10/12/2005 Start Date: 9/26/2005 Pick Up Date: 10/12/2005 Completion Date: 10/12/2005 Is Vehicle Driveable (Y/N)?: Assisted With Rental (Y/N)?: ESTIMATE RECALL NUMBER: 9/14/2005 14:16:35 AOIKW7555001 U1traMate is a Trademark of Mitchell International Mitchell Data Version: SEP 05 A Copyright (C) 1994 - 2003 Mitchell International Page 6 of 6 U1traMate Version; 5.0.211 All Rights Reserved g i r, T x �"M � wca a h� � € s Baas a�;d� �+ •E�w« F � a �" � � � w�A e�'�� 4 S sf. �`"3`' � °s"�?�y �F �}a x a '• i r i �s �a �piin .A sf A n 4 ,Fp gye �4 TEm� red'^.. -spa # i b rMg, IX " iii o"i §✓•'b t£° mn.fix'' 3 B V+ € 4$s e ; ay w L¢-,a ,3 9 ter✓ �.�. mr c µ f g Mr, { �.FIv 'w [(9 Y�# e 4 } ¢ o i✓>f 7 mt ^w tA561 q -,W! �4 r�+ aw+uwvm�'»wa .' t o s l ra�. x+t +�.�, =+dg� e9 'y" �¢,y ' ar� �F s¢ F� `a .,L f 0 P 13 N S ?y fl r r 4 � r. S egz�' Y eat#�iry r2' y x4di5 �"450a6 r �§yrv. sx � Y J HTd i�� �� 4w' 3 w'u'. s ?r P'wi'fv q5 8 ate. A Y k fi x 0 `4 "E � F 33,"F4 ,�a f� f Frir �;" �as,s e st.mYPTy sxsv »- :a'Tft" tea. w �`°,,,,•a " ^' w:.a� k`3 aft".. J fi ^ffi3 N A r v t I q at�� � Pm yq fl»✓ Y• 'F iy q fid,gYn i �r .WWk. Ad *.Ygry.d"d¢ AP m' W I 3e M, r ti_ �. x,.�� b'��' aE � � � _ .tea"�w.,. �� �-� .��%F�w� �. 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M1A ','.:. reg, �w' g '�mid� •�•. � -... a ion qq a a t sell`M id1lJF 1 N ,O O N 00 r O 0 CHECK NO.: 710 L485263-2—R U m DATE: 10-18-2005 > NAME AND ADDRESS INFORMATION: Lu U Lu VORNHAGEN BODY & PAINT INC 600 HARVESTPARK BLVD BRENTWOOD CA 94513 INSURED: PERRY,MIKE/APRIL PAYMENT INFORMATION/DESCRIPTION: DATE OF LOSS: 08-31-05 CLAIM NO.: 01-KW7555-0 CLAIMANT: PERRY,MIKE/APRIL PAYEE: VORNHAGEN BODY & PAINT INC AMOUNT: $4,975 ,57 IN PAYMENT OF: PERRY, PAID IN FULL ADJUSTER: CINDE MCKNIGHT ADJUSTER NO: 31120 KIND OF LOSS: COL 16610702 DETACH AND RETAIN FOR YOUR RECORDS No. 710 L485263-2, DATE OF LOSS CLAIM INSURED'S NAME DATE 08-31-05 01—KW7555-0 PERRY,MIKE/APRIL 10-18-200 POLICY TYPE KIND OF LOSS SUFFIX CLAIMANT'S NAME PAY AUTO COL 01F I PERRY ,MIKE/APRIL $4,975.57 D.O. ADJUSTER NO. IN PAYMENT OF BANK OF AMERICA DR2 31 120 PERRY, PAID IN FULL Bank of Amorlca Cunomar Connoctlan Bank of America, N.A. TIN: 68-0466225-00 Atlanta. Dokalb County, Georgia PAY *FOUR THOUSAND NINE HUNDRED SEVENTY FIVE 57/100* This check must be properly endorsed on the reverse side by all F VORNHAGEN BODY & PAINT INC TO THE ORDER OF THE HERTZ CORPORATION Rental Agreement #: A2895-0784 Invoice Date: 10/13/05 Batch: 1052860 Insured: PERRY,MIKE/APRIL Renter: APRIL PERRY HERTZ LOCAL EDITION PO BOX 26141 OKLAHOMA CITY, OK 73126-0000 TIN: 13-1938568 CSAA INSURANCE ATTN: MAIL CENTER P.O. BOX 920 SUISUN CITY, CA 94585-0920 Claim #: 01-KW7555-0 Suffix: 02 KOL: XLU Loss Date: 08/31/05 Rental Car: MURANO AWD Rental Veh License #: 5NRZ882 Hertz Local Edition Store: 0738802 BRENTWOOD CA Rented On: 09/22/05 Returned On: 10/12/05 Total Rental Days : 0021 FRP: 274 .00 Extra Days: 000 @.00 .00 Subtotal: 274.00 Upgrade: .00 Damage Waiver(CDW/LDW) : .00 PAI: .00 Fuel and Service: .00 Customer Paid: - .00 Time and Mileage: - .00 Amount Due: 274 .00 Billing Inquiries: PHONE: 1-888-777-3700 FAX: 405-775-6413 E-MAIL: CUSTOMERBILLING@HERTZ.COM .o 0 N r O r U CHECK NO: 710 L483341-8-R m DATE: 10-15-2005 O > NAME AND ADDRESS INFORMATION: W U W THE HERTZ CORPORATION PO BOX 26141 OKLAHOMA CITY OK 73126 INSURED: PERRY,MIKE/APR I L PAYMENT INFORMATION/DESCRIPTION: 08-31-05 VENDOR PAYMENT FOR DATE OF LOSS: INVOICE#: A28950784 CLAIM NO.: 01—KW7555-0 BATCH#: 1052860 CLAIMANT: INSURED PAYEE: THE HERTZ CORPORATION AMOUNT: $274.00 IN PAYMENT OF: A28950784 1052860 ADJUSTER: ACH REP ADJUSTER NO.: ACH01 KIND OF LOSS: XLU 16610702 DETACH AND RETAIN FOR YOUR RECORDS No. 710 L483341 -8- DATE OF LOSS CLAIM INSURED'S NAME DATE 08-31-05 01-KW7555-0 PERRY,MIKE/APRIL 10-15-200 POLICY TYPE KIND OF LOSS SUFFIX CLAIMANT'S NAME PAY AUTO XLU 02F I INSURED $274.00 O.O. ADJUSTER NO. IN PAYMENT OF BANK OF AMERICA LRW ACHO1 A28950784 1052860 Bank of Amorica Castombr Coonoctlon Bank of Amcrica, N.A. TIN: 13-1938568-00 Atlanta, Dekalb County, Georgia PAY *TWO HUNDRED SEVENTY FOUR 00/100» This check must be properly endorsed on the reverse side by all p THE HERTZ CORPORATION TO THE ORDER OF 5TATE0Fq-ALIFCRNIA I `TRAFFIC COLLISION REPORT CHP 555 Pap I (Rev 7.03)OPI 061 Page I SPECIAL CONDI AOW$ NO.INJURED mi f&FUJ`FeLdkY CITY JUDICIAL DISTRICT LOCAL REPORT NUMBER MT DJARI.-O 05-4179 Ko—.Rulo A IF i RUN_M*0 _(ZTPFT_yREPORTING DISTRICT' BEAT 0 CONTRA COSTA 130 1 COLLISION OcWRrkjzo ON. MO DAY YEAR 11ME NGC a OFFICER 10 L 1112005 1012 CA0011400 121 0 PINL ST W1 1 1 C A hNLEVOST INFI]RAGTION --- - DAY OY VVEFK —------TOW!AWAY PploroGRAPHsay! NONE Li WFDNF,9DAY 191 YES NO STAYE HIM.R F. CPL LYNCH g INIATWFLASCC71ONWMH MARINA VISTA N OR YES n NO PARTY DRIVERS LICENSE NUMIJU� 5TTTFCL555 _T7RFAG7_S_AFF_I EQUIP. VF4 YEAR �WKEMOOL"OLORpQEmcwwER STATE A100226i CA C P 0 GMC/P/TjfW]iI . 1050015 CA DRIVER NAME OWNER NAIAL ❑S.MF AS DRJVER Fx_J jerrERYCHARLES BFNNFr CONTRA COSTA COUNTY ............ pECE3T bTSLLY ADDPL�_;S' OWNER ADDRUSSAME AS DRIVER Ll U2695 SHAMROCK DR 1220 MORLLLO AVE 9200 DRIVER PM VEH CIT Y/WSTArEtZ I P MPOSITION OF VEHICLE ON ORDERS OF: OFFICER OTHER FIX-I SAN PABLO,CA 94606 Li F1 ZYffs— HEIGHT _;�E_11HT _71— M BICYI,ST SEX 1.01TE RACE PRRMFCH.DLILCfS NONLAPP R 9FER TO NARRAIWE 5 1.N :j BLU 6'8" 245 04/18119fi7 W VEHICLE IDENTIFICATION NUMBER: OTFIEH P54 PHONE F.@SNESE PHINE CHIP USE ONLY ort.CRIUE VEHICLE DAMAGE GHADL IN DAMAGED AREA L] S10.724-�,S09 925-313-7100 VEHICI-STYPE UNK NONE MINOA WjVANCE r4RmER PCLICYNUIASER moo MAJOR Lj ROUL-CVER 4 CONTIV,COSTA COUNTY GFNERAL SE SELF INSURFID bill OF TRAVEL ON STREET OR HIGHWAY bpUb LIMIT CAoar N/S PINE ST 1 25 CAT TCFPtC PARTY DRIVERS LICENSE NUMBER STATE L1A55 AIRBAG SAFiFFQUIP. VLM YEAR MAKEXtODELCOLOR UCENZE NUMBER 2 B5813267 CA C M G 2002 LFX5/l5X3Q()lGky 4 XOAC270 DRIVER NAME OWNER iJA-w- SAME AS DRIVER 7X APRILANNPERRY Lij PUUT 15TREETADDRSUS OWNER ADDRESS fvI SAME A DRIVER 1145 LAY RAM CT CITYisTATE7jp DISPOSITION07 VLII;CLE OKOROERS OF; D OFFICER LXJ DRIVER OTKLR BRENTWOOD,CA94513 FFj _kyLs A—MW Rwr* To�HWEIGHT 7ofgrMDATE CE PRIOR AfECH.OLI LCI„ 'n NONE APP LRBFER TO NARRATIVE Q F BRO BRO 5'3" 130 1024/1978 H VEHICLE IDENTINCAVON NUWFZ sKAj3r IN DAMAGED AREA -ETHER HOME PI IONIC BUSINUtIS PHONE CHP USE ONLY DESCRIBE VEHICLE DAMAGE 925-240-7237, �CUE TYPE UNK NONE mmg my ltull_�I F1 N MOO El mp4w Li AAA KW75550 _r6WNi�WF STREET OR H1014WAY SP LIMN DIROFTRAVEi: CA DoT _... NIB PINE ST 25 CAL-T TCP/P5C STATE: wwYCulp PARTY DRIVERS LICENSE NUMBER. STATL Z7RS_, CBSAG it SVT 7YEQUIP. VFH YEAR �QDELJCOUOK UCENSENLwK3ER m EE, a : - 0 "D m Dmvm NAME OWNER NAME GAME NS ORIVER < m STREETAMRMS 0 7 F17 �11111R ADDRESS..IST............................ L SAME AS oRwER FECEST a) PKDVECITYISTATF171P nispmSCr&OF VEHICLE ON ORDERS OF; 1�OFFICER El QRivER 0 OTHER 0 W 're > al'y T Fj'A LYL$ HEICHT �5�7- cm PmoKmEOH.DUECTS EjNOME.�7p �L RZFERTONAMATNt L LS 'E_*4 VEHICLE w NTI(GATION MULUIER! DAMAGED AREA 7 H07AIFE PHONE I ausimss PrONE CHIP USG ONLY DrSCFUDL VEHICLE OAMA SHADE IN C VEHICLE TYPE LjMK NONE MINOR INSURANCE—CARNER MOO JJ MNOR RQUDVER 0 0 Ull PREPAREIR OF TRAVEL ON STREET OR HIGHWAY SPEED LIMIT CA D07--.. L C.M.-T TCP/PSC DISPATCH NOTIFIED REVIEWED UY DATE REVIEWED ADAM WINS 1,21-f 121 M YES Ll No D NIA WILLIAM KRUTA 69 09/13/2005 JAaq aDilod Duaggilid 99COLZ62Z6 YVd 60:60 11HI 90/CT/OT -STATE OF CALIFORNIA TRAFFIC COLLISION CODING CHP 555 Page 2(Rev 7-03)OP 061 Page 2 DATE OF COLLISION IMO DAV YEAR) TI,yL(GLOP) NGL# OFFIDER 1.0. NUM[tER OXY312005 1012 CA0071400 121 05.4174 DWNCR .. ....T OWNER NOTIFIED..... PROPERTY1 I YES �_�NO DAMAGE —._._._.. . _....--- --........ SEATING POSITION SAFETY EQUIPMENT INATTENTION CODES ^ OCCUPANTS O-CHILD RESTRAINT-USED MIC HICYCLE-HELMEI [A-CELLPHONE HANDHELD \ A,NONF IN VEHICLE R-CHILD RESTRAINT-NOT USI. pORjVER PASSENGER.N-CELLPHONE HANDSFREE R-UNKNOWN S-CHILD RESTRAINT-USE UNKNV_NaX_Np C-ELECTRONIC EQUIPMENT . 1 L7RIvER C-LAP BELT USED T-CHII,O RESTRAINT-(MPROPtfW_YES Y-YES :D:RAOIOICD 1 2 3 0-LAP BELT NOT USED E-SMOKING 2 Ti r Q_PAS$FNGERS E-SHOULD HARNESS USED S.t1U.RRCST.RAINT F.IFCTSD FROM VFHICLE F-EATING 456 7-STA WGN REAR F-SHOULDER HARNESS NOT USED U- NONE IN VEHICLE 0-NOT EJECTCD G-CHILDREN B-PJR,OCC TRK OR VAN G-LAP/SHOULDER HARNESS USED V- HELMET NOT USED 7-FULLY EJECTED H-ANIMAI S 7 0-POSITION UNKNOWN H-LAPISHOULDGR HARNESS NOT USFD W- HELMET USED 2-PARI)ALLY EJECTED I 'PERSONAL HYGIENE 0.OTHER J -PASSIVE RESTRAINT USED X- HELMET NOT USED 3,UNKNOWN J-RF.AOING K.PASSIVE RESTRAINT NOT USED Y- HELMET USED ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK(')SHOULD BE EXPLAINED IN THE NARRATIVE PRIMARY COLLISION FACTOR MOVEMENT PRECEDING DST NUMBER fR OF PARTY AT FAULI TRAFFIC CONTROL DEVICES 1 2 3 SPECIAL INFORMATION T 1 COLLISION I A vcaE0<mw::1ArE0: a7E9n YES A CONTROLS FUNCTIONING )A I W11RO011$MATFRIAI CVC 22517 U NO 13 CONTROLS NOT FUNCTIONING (5 CtLL PHONE HANDHELD IN USE X PROCEEDING STRAIGHT .......... ...._.._....._.__ ._ _..__.._._._... . B OTHER IMPROPER DRIVING' C CONTROLS OBSCURED I I IC CELL PHONE HANOSFREE IN USE RAN OFF ROAD X D NO CONTROLS PRESENT/FACTOR' ?._Cr PHQNE NOT IN U$F, MAKING RIGHT TURN C OTHER THAN DRIVER' TYPE OF COLLISION E SCHOOL BUS RELATED MAKING LEFT TURN D UNKNOWN' A HEAD-0N IF 75 FT MOTORTRUCK COMBO MAKING U TURN E FELL ASLEEP B SIDE SWIPE G 32 F'f TRAILER COMBO BACKING ._........... .. .. ._....._.. ..__ C REAR END I 1H SIDESHOW SLOWING/STOPPING WEATHER ARK 7 TO 21TEM5 D BROADSIDE 1 STREET RACING PASSING OTHER VEHICLE X A CLEAR E H17 OBJECT CHANGING LANES B CLOUDY F OVERTURNED PARKING MANEUVER C RAINING G VFHICI F-PFOESYRIAN ENTFRINGTRAFFIC D SNOWING X H OTHER OPEN DOOR OTHER UNSAFE TURNING E FOGNISIBI UTY XING INTO OPPOSING LANE F OTHER' MOTOR VEHICLE_INVOLVED WITH X PARKED ._.. ..........._ ,._........._.... ({_WIND A NON-COLLISION _, MERGING WGHTING B PEDESTRIAN TRAVELING WRONG WAY X A 134Y66H7 x C OTHCR MOTOR VHHICLE_ OTHER ASSOCIATED FACTORS OTHER' S DUSK-DAWN D MOTOR VF.HIC(.F ON OTHER ROWAY T 2 3 (MARK 7 TO 2ITEMS) C DARK-STREETLIGHTS E PARKED MOIORVEHICLE X vc eemwHwIXAitn: cmo A YES CVCM117 .... . ................... ........ D DARK-NO 5}'BEET LICNTS F TRAIN X NO E DARK-STREET LIGE ITS NOT G BICYCLE B YCMOT"MOLATE. 01 n YES FVNCTIONING "' ""'- I-- _.................._. H ANIMAL' t NO SOBRIETY-DRUG nr� ROADWAY SURFACE n:beCln�Nvxxnleu: ra�eu YES PHYSICAL X A DRY I FIXED OBJECT: I NO Z 3 (MARK t TO 2ITEM3) 8 WET D x x HAD NOT BEEN DRINKING C_SNOWY-ICY J OTHER OBJECT: E VISION OBSCURED: HBO-UNDER INFLUENCE D SLIPPERY;MUDDY,OILY,ETC. X F INATTENTION; K HBD-NOT UNDER INFLUENCE' ROADWAY CONDITIONS G STOP d GO TRAFFIC HBO_IMPAIRMENT UNKNOWN" MARK 4 TO 2 ITEMS __ ....... (MARK.. . „.,).._......._._ PEDESTRIAN ACTIONS I ENTERING AL-CAVING RAMP...."„....„ ., ._„ „�NQER DRUG INFLUENGE' A HOLES,DEEP RUT' X A NO PEDESTRIANS INVOLVED PRBVIGUS COLLISION IMPAIRMENT-PHYSICAL' B LOOSE MATERIAL ON ROWAY' $ GROSSING IN CROSSWALK UNFAMILIAR WITH ROAD IMPAIRMENT NOT KNOWN C OBSTRUCTION ON ROADWAY" AT INTERSECTION DEFECTIVE VEH EQUIP: CITED NOTAPPLICABLE D CONFCRUC710N-8EPAIRZONE C CROSSING IN CROSSWALK-NOT YES _ SLEEPYlFATIGUEO E REDUCED ROADWAY WIDTH IN INTERSECTION NO F FLOODED' D CROSSING-NOT IN CROSSWALK UNINVOLVED VEHICLE G OTHER' E INROAD-INCLUDESSI IOULDER _ OTHER" _ X N NO UNUSUAL CONDITIONS F NOT IN ROAD X NONE APPARENT G APPROAGHINGfLCAVING SCH DLJ$ I I RUNAWAYVEHICLE. SKETCH 0 MISCELLANEOUS INDICATE NORTH CML 000 J.daa mmod mins,L.LId 99COLZVSZ6 %VS SO:60 IM, SO/CT/OI ,,5TATE,OF CALIFORNIA TkAFFIC COLLISION CODING CHP 555 Page 3(Rev 7-03)OPI 061 Page 3 DATE OFCOLLISION IMO.DAY YEAR) TIME(1400) NBCA CFFII�ER I.I), NUMBER 08/31/2005 1 1012 CA0071400 121 05-4179 WITNESS PAEEENCER EXTENT OF INJURY(`X'ONE) INJURED WAS(7C ONE) PARTY SEAT SAFETY NUMBER POS. F,pUIF ONLY C4LY AGE X __.-.-...._ ............. ..._...7 ` EJECTED FATAL SEVERE OTMERVISIBLE COMPLAINT DRIVER I PA`)S CFD BICYCLIST O1'ND{ INJURY INJURY INJURY OF PAIN ❑X #11 � 48 F ❑ ❑ ❑ ❑ ❑ � ❑ ❑ I ❑ I NAMEID.O.BJAOORE:iR TELEPHONE MONICA MARIE 13ALDSON (01/13/1957) 1028 HIGHLAND AVE,VALLEJO,CA 94590 (H)707-557-9374 (8)925-64(,4150 (INJUkEO ONLY)fAAN$PORTCD UY i---- - TAKEN TO ""_............. DESCRIBE INJURIES _.......... . ....._.._.._—___ NONE ❑VK-TAI OF VIOLENT CRIME NOTIFIED n 38 M ❑ ❑ ❑ ❑ U U ❑ n L...I 1: I G 0 NAMEJD.O.B.fAWRE35 ... - .____-. ... .... TELEPHONE JEFFERY CHARLES BENNET (04/18/1967) 2695 SHAMROCK OR,SAN PASt_U,CA 948UG (H)SIO-724-5509 (8)925-313-7100 (IN.fURED ONLY)TRNN$!'ORTF,D by TAKEN TO DESCRIBE INJURIES NONE nVICTIM OF VIOLENT GRIME NOTIFIES] 26 F U ❑ ❑ ❑ 2:. 1 G 0 NAMEID.O.BJADDREUB .. _.-._ TELEPHONE'.., .. .. APRIL ANN PERRY (10/2411978) 1145 LATHAM CT,BRENTWOOD,CA 94513 (H)925-240-7232 (INJLIRFD pNLY)TRAN$FQRTEO-BV TAKEN TO DEECRME INJURIES . ... ............-..... . ......_- NONE ❑VICTIM OF V SOLENT CRIME NOTIFlED uu ILI I0 I ❑ n o a I ❑) _u i._ NAMEJ0.0 B IAOORF^i• � TELEPHONE (INJURED ONLY)TRANEFORTED BY � � - TAKEN TO OLSCRIUE INJURIES VICTIM OF VIOLENT CRIME NOTIFIED LJ ❑ ❑ � ❑ [10 1100 u u NAMLA.O.UTADORESS � - --- TELEPI'IONL (I WURED ONLY)TRAN;PORTED BY TAKENTO DESCRIES INJl1RIE5 ' ❑VICTIM OF.v1OLLNT CAfME NCTII ILD ❑ I ❑ ❑ ❑ u 1_1 ❑ F]i ❑1 ❑ ❑ .-"TELEPHONE'_. (WJURFp!)NLY)TRfN$PpRTED BY TAKEN TO _._..--....._. ___.. ,.... .._._..__-..._....-___. --------- DESCRIBE INJURIES71'- VICTIM DF VIOLENT CRIME-NOTIFIED NAMEOF PREPARER IAL NUMULR MO. DAY YEAR NAME OF REVIEWER MO. DAY YEAR ADAM WINSI,,M- 121 08/31/2005 WILLIAM KRU7A 09/13/2005 00 In Id3Q dUI'IOd 02I11HS,L,LId 99C0LZV9Z6 YVd 90:60 11Hl 40/CT/OT NARRATIVEISUPPLEMENTAL CHP 556(Rev.7-90)OP!042 Page 4 DATE OF INCIOCNTIOCCURENCE TIME f2400) NCIC NUMBER OFFICERLD,NUMBER NUMBER 08/31/2005 1012 CA0071400 121 05-4179 '. 9C ONE `)'ONE TYPE SUPPLEMBN I'AL(-X"APPLICABLE) JR-1 Nvn,tivc ❑ColgslDn Report � SA Update E]Fatal OHll and rurrupdale El Supplement other 0 Hazardous Materials School bus ❑Other: CITYlCOUNTYIJUDICIAL DISTRICT REPORTING QISTRICTIRPAT CITATION NUMBER MARTINF7XONTRA COSTA/MT n1ART 0 130 LOCATIOWSUBJE CT Si A!E HIGH WAY RELATED FIN L S MARINA VISTA �Yca ©No NOTIFICATION: I was dispatched to a non-injury accident involving two vehicles. Measurements are approximate and paced. Both vehicles were in the approximate area of the accident scene. SUMM.t RY: D#l, BENNETT, was in a county pick-up truck and parked his vehicle half way on the curb of Pine Street approximately 60' south of Marina. Vista. D41 stated he pulled his truck onto the curb and parked. He turned on the yellow hazard lights facing to the rear of his vehicle. The lights were 0ashiTJg in a sequential pattern to direct traffic around the left side of D#1's vehicle. D#1 opened his driver side door as D#2 was passing 1)#1's vehicle. The door struck D#2's, PERRY,passenger side door of her vehicle as she attempted to drive around D#1's parked vehicle. D02, PERRY, said she was driving behind D#1 on Pine St. when D#1 stopped in the middle of the road, then turned to the right and pulled onto the curb as:.if to let traffic chive around hint_ D#2 then began to drive around D41 when D41 drivers door opened into the side of her vehicle. D#2 immediately pulled over in front of D#1's vehicle and stopped her car. There was moderate damage to both vehicles. D41's vehicle's driver's door was bent fonvard and unable to be shut, it was towed at the owners request. D#2's vehicle had moderate damage starting at the passenger side front door and ending at the passenger side rear tire. D#2 drove her car away from the scene. D#2's speed was estimated by both parties to be under 10 mph. AREA OF IMPACT: The A01 is approximately 60' south of the south curbline prolongation at Marina Vista and S' west of the east curbline on fine Street. CAUSE: D#1 caused the accident by being in violation of CVC 22517-Opening a vehicle door into traffic. PREPARER'S NAME AND LD.NUMBER Date: REVIEWER'S NAME DATE AL)AM W1NSL�1"1 121 u910112005 WILLIAMKRUTA Ug/1372005 Use previous editions until depleted. 90 57841 f7( V_W� � 00 In jAsa am iod ouags,L,LId 99COLZVS96 XVd 90160 1111,E SO/CT/OT �o �o co �IY ° W w S® 70 h� OR`C c LU4)ti. b 4. N , 4 alINC� 002 P io r ; C r:+ r w LU ° Q z �! 0 V ' o - .o � Q Q ma d O o M Z C v o � � , 04 z N n N LO 6 05f-I F— COS tl`3 6 0 , G 1�Y tX� 1 v M M r � i < 00 O �n 0 u � r � �n h� 1 e , A. mad • �r.� N o , ,a CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY • X, BOARD AC ION: Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board,A& on. All Section references are to ) The copy of this document mailed to you is your Californias Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: $15,145.73 1 CLAIMANT: MERCURY INSURANCE GROUP FOR: CAROL KRETCHMER BY: SEAN TIMMONS DECEMBER 05/05 ATTORNEY: DATE RECEIVED: UNKNOWN . ' ADDRESS: P.O. BOX 997195 BY DELIVERY TO CLERK ON:DECEMBER 05/05 SACRAMENTO, CA 95899-7195 RECEIVED FROM RISK BY MAIL POSTMARKED: MANAGEMENT t FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DECEMBER OS 2005 .. JOHN SWEE N, erk i Dated: By: Deputy II. MOM: County Counsel TO: Clerk of the Board of Supe isor i j ( ) This claim complies substantially with Sections 910 and 910.2. ( tis 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). i ( ) Other: i i Dated: 2-- "pSBy: _— Deputy County Couns( III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) O Claim was returned as untimely with notice to claimant(Section 911.3). IV. 130ARD ORDER: By unanimous vote of the Supervisors present: (a/ This Claim is rejected in full. 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:4a/®,PU-6( SWEETEN, CLERK, By , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposite in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *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 frill) prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:f.-,u�y/ � JOHN SWEETEN, CLERK By Deputy Cleric 'OFFICE OF THE COUNTY COUNSEL s^, L SILVANO B.MARCHESI COUNTY OF CONTRA COSTA COUNTY COUNSEL. Administration Building , 651 Pine Street, 91" Floor _ ;. SHARON L. ANDERSON CHIEF ASSISTANT Martinez, California 94553-1229 'j ' GREGORY C. HARVEY (925) 335-1800 Qi ai10\\® ; VALERIE J. RANCHE (925) 646-1078 (fax) `, an'1 As515TANTs OSTA COUK� NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: MERCURY INSURANCE GROUP P.O. Box 997195 Sacramento, CA 95899-7195 RE: CLAIM OF YOUR INSURED: CAROL KRETCHMER YOUR FILE NO.: YNO02584-88 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: [ ] L The claim fails to state the name and post office address of the claimant. [ ] 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [X] 3. The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [ ] 4. The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. [ ] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. [ ] 6. The claim is not signed by the claimant or by some person on his or her behalf. MERCURY INSURANCE GROUP RE: CLAIM OF YOUR INSURED CAROL KRETCHMER Page Two [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. [ ] 8. Other: SILVANO B. MARCHESl COUNTY COUNSEL 10 Z*2 By. - c Monika L. Cooper Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (Code Civ. Proc., §§ 10 12, 1013a, 2015.5; Evid. Code, §§ 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 Floor, Martinez, CA 94553-1229. On December 9, 2005, 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 Mercury Insurance Group,P O.Box 9971.95,,Sacra_mento, CA 95899, asset 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 fully 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 December 9, 2005;,,at Martinez, California. K ileen O'Connell cc: Clerk of the Board of Supervisors (original) Risk Management Page 2 AV- 0 P.O. Box 997195 M E R C u RY Sacramento, CA 95899--7195 INSURANCE GROUP (916g)+636-1534 September 7,2005 RECEIVED DEC 0 5 2005 Contra Costa County,Risk Management Division CLERK 90ARD OF SUPERVISORS Attn:Penny Bailey CONTRA COSTA CO. 2530 Arnold Drive,Suite 140 Martinez,Ca 94553 Penny Bailey RE: OUR INSURED: Carol Kretchmer SGP i i 9 2005 OUR FILE NUMBER: YNO02584-88 DATE OF LOSS: June 5,2005 YOUR INSURED: Contra Costa Fire YOUR FILE NUMBER: 58439 Dear Ms.Bailey: Under the terms of a policy issued to the above named insured, we have paid for damage to our insured's property in the amount of$15,145.73. Our information indicates that the damages resulted from your insured's negligence. Enclosed for your review is a copy of our repair bill(s) and settlement check(s). The breakdown of our payments is as follows: Collision $15,145.73 Deductible $0.00 Supplements $0.00 Rental $0.00 Out of Pocket Rental $0.00 Total $15,145.73 Salvage Deduction $0.00 VLF Deduction $0.00 Total $15,145.73 Please be advised that the salvage on our insured's vehicle has not yet sold. We are simply sending this subrogation demand to put you on notice of our interests. Please call me at(916)636-1534,ext. 2323 if you have any questions. Thank you for your cooperation. Very truly yours, MERCURY CASUALTY COMPANY S� c% r SEA InIlY1ONS -= l'ecel%z-P clamp Field Representative Delta Claims TeY 4`76 C'le''-k 0 0 Phone#: ^323 , Total Loss Evaluation and Survey Date of Loss:6/5/2005 Adj: 1 4058 SEAN TIMMONS Car Claim#:YNO02584-88 - I Insd.: CAROL KRETCHMER Clint: CAROL KRETCHMER Make.: TOYOTAS Yr: 5 Model.:COROLLA VIN:1NXBR32E05Z344271 Cyl: 4 Mileage:8,800 Kelly Blue Book:Edition Sched.Car 6 Condition Report Lie Plate:5HJB548 Wholesale Retail Overall condition of vehicle for model year: ❑ Poor ❑ Below Avg. Q Average ❑ Above Avg. ❑ Excellent $13,200.00 Add or deduct for: $15,000.00 Existing Damage to: Deduction:(if any EQUIPMENT Tires: 75 %all $0.00 Mechanical: $0.00 $550.00 © Auto Transmission $735.00 Interior: $0.00 ❑ Man.Trans Spd Glass: $0.00 0 Power Steering Paint: $0.00 $175.00 0 Power Windows $235.00 Sheet Metal: $0.00 $100.00 Q Power Door Locks $135.00 Notes: ❑ Power Seat Dual Total Deductions: X0.00 Q Air Cond Estimate Amount: $24,083.00 Repairability Threshold: 182.45% ❑ W/O Air Cord. ACV Threshold: 104.75% $150.00 0 Tilt Wheel $200.00 ADVANCE CHARGES $100.00 Cruise Control $135.00 ffo er Tow(To date); Storage(All to date): Rear De -. _----._.---------❑-Rear- oger --- - --- - -Daily-Rate: _..--- .. - -- #ofDays:—..------Notes:-- ---------_ AM/FM Stereo — -- ❑ AM/FM St w/Tape Vehicle Location $200.00 W CD Player $265.00 At Shop ;y3 With Owner ❑C128 Sent ❑ CD Stacker/Changer SALVAGE ❑ Premium Sound Pool: ❑ IAA 0 COPART ❑Other COPART Stock#: 5970625 vdl ❑ W/O Radio . Q Spoke With: Dale called: Alarm 0 Keyless Entry DEC Value/PD Limits: $17,000.00 ❑UMPD ❑U137 ❑ Air Bag Dual ❑ Leather ❑ Salvage Title Deduction for Salvage: 0.00 (See Dealer Quotes): $0.00 E] Alum/Alloy Wheels ❑ ABS 2/4 Wheel EJ Privacy Glass OK to settle E] ACV ❑ T-Tops Remarks: ❑ Sun Roof Sliding ❑ Moon Roof RECOMMENDED ACV LOCAL MARKET ❑ Convertible ACV: $13,827.00 94513 ❑ Luggage Rack ❑ Spoiler Agreed Settlement: $13.827.00 CCC-34294843 ❑ Ground Effects Sales/Tax: 8.25% $1,140.73 ***RENTAL*** Mileage Lease Tax: $0.00 $1,275.00 Totals $1,705.00 Transfer: $15.00 INTERNET ADD IN FILE FOR VLF/Salvage Certificate Refund: $163.00 EXAMPLE. Other Adjustments: $0.00 Total Settlement: $15,145.73 Less Salvage: $0.00 Less Deductible: $500.00 Other Deductible: $0.00 Other Deductible: $0.00 Net Settlement: $14,645J3 Supervisor Approved: 6576 KIUWHA GAMBOA Appraiser Approved: Whlse Book Mid Book _Retail Book__ 6/28/05(10:24AMI ACV APPROVED $14,475.00 $15,590.00 $16,705.00 Total Loss Adj: 8016 JAIMIE BOSTON Date: C83/TLA 0 a Phone#: 2323 Total boss Evaluation and Survey Date of Loss:61512005 Adj: t 4058 SEAN TIMMONS Car Claim#:YN002584-88 - 1 Insd,: CAROL KRETCHMER Clint: CAROL KRETCHMER Make.: TOYOTAS Yr: 5 Mode).: COROLLA VIN:INXBR32E05Z344271 Cyl: 4 Mileage:8,800 Kelly Blue Book:Edition' Sched,Car 6 Condition Report Lie Plate:5HJB548 Wholesale Retail Overall condition of vehicle for model year: ❑ Poor ❑ Below Avg. RJ Average ❑ Above Avg. ❑ Excellent $13,200.00 Add or deduct for: $15,000.00 Existing Damage to: Deduction:(if any) EQUIPMENT Tires: 75 %all $0.00 Mechanical: $0.00 $550.00 Q Auto Transmission $735.00 Interior; $0.00 ❑ Man.Trans Spd Glass: $0.00 RJ Power Steering Paint: $0.00 $175.00 Power Windows $235.00 Sheet Metal: $0.00 $100.00 0 Power Door Locks $135.00 Notes: ❑ Power Seat Dual Total Deductions: $0.00 0 AirCond Estimate Amount: $24,083.00 Repairability Threshold: 182.45% ❑ W/0 Air Cond. ACV Threshold: 104.75% $150.00 0 Tilt Wheel $200.00 ADVANCE CHARGES $100.00 0 Cruise Control $135.00 ❑ Rear Deffoger Tow(To date)_ Storage(All to date): AM/FM Stereo Daily Rate: #of Days: Notes: ❑. AM/FM St w/Tape Vehicle Location $200.00 0 CD Player $265.00 Q At Shop NJ With Owner ❑C128Sent ❑ CD Stacker/Changer SALVAGE ❑ Premium Sound Pool: ❑ IAA 0 COPART Other COPART Stock#: 5970625 vdl ❑ W/O Radio Q Alarm Spoke With: Date called: 0 Keyless Entry DEC Value/PD Limits: $17,000.00 ❑UMPD ❑U137 ❑ Air Bag Dual ❑ Salvage Title Deduction for Salvage: 0.00 ❑ Leather E) Alum/Alloy Wheels (See Dealer Quotes): $0.00 ❑ ABS 2/4 Wheel ❑ Privacy Glass � OK to settle � ACV ❑ Remarks: T-Tops ❑ Sun Roof Sliding ❑ Moon Roof RECOMMENDED ACV LOCAL MARKET ❑ Convertible ACV: $13,827.00 94513 ❑ Luggage Rack ❑ Spoiler Agreed Settlement: U1827.00 CCC-34294843 ❑ Ground Effects Sales/Tax: 8.25% $1,140.73 ***RENTAL*** Mileage Lease Tax: $0.00 $1,275.00 Totals $1,705.00 Transfer: $15.00 INTERNET ADD IN FILE FOR VLF/Salvage Certificate Refund: $163.00 EXAMPLE. Other Adjustments: $0.00 crW ��Total Settlement: 15 1$0.00A Less Salvage: $0.00 Less Deductible: $500.00 Other Deductible: $0.00 Other Deductible: $0.00 Net Settlement: $14,645.73 Siipervisor Approved: ---- Apprai`''A proved: Whlse Book Mid Book Retail Book_ $14,475.00 I $15,590.00 $16,705.00 _ ... Total Loss Adj: 8016 JAIMIE BOSTON -' -Date= C83/TLA Wed Jun-22-2005 02:37pm Claim YNO02584-881 From:MERCURY INSURANCE.Cy r r ' Phone": 6113 Total LOSS Evaluation and Survey Data ofl.oss:6h;2005 .Adj: 4515 AARON KRUSE Car Claim":YNO02584-88 - 1 Insd.: KRETCHMER C Choi: Make.: TOYOTA y"r; 5 Modzl.: COROLLA VIN:IN\BR32E05Z344271 Cyl: 4 Mileage: Kelly Blue Book:Edition Schell Car 6 _ Condition Report Lic Plate:5HJB548 WholesaleRetail Overall condition of vehicle for model year: ----.---_--- - -----___.-- ----- ❑ Poor ❑ Below Avg. 0 Average ❑ .Above Avg. ❑ Excellent $13,200.00 Add or deduct for: 515,000.00 Existing Damage to: Deduction:(if any) EQUIPMENT Tires: 75 %all $0.00 Mechanical: $0.00 $550.00 '.k/, Auto Transmission $735.00 Interior: $0.00 I� Man.Trans Spd ---- Glass: $0.00 ;t/i Power Steering Paint: $0.00 $175.00 ':y7 Power Windows $235.00 Sheet Metal: $0.00 $100.00 Power Door Locks $135.00 Notes: Power Seat Dual Total Deductions: $0.00 Air Cond _.`._ Estimate Amount: $0.00 Repairability Threshold: 0.00% WIO Air Conti ACV Threshold: $150.00 Tilt Wheel $200.00 ADVANCE CHARGES $100.00 J Cruise Control $135.00 Tow(To date): Storage(All to date): Rear Deffoger AMiFM Stereo Daily Rate: N of Days; Notes: A&FFM St wiTape Vehicle Location $200.00 :V.. CD Player $265.00 At Shop 'J With Owner ❑C128 Sent CD Stacker/Changer SALVAGE Premium Sound _ Pool: ❑ IAA COPART Other COPr1RT Stock": 5970625 I W/O Radio v Alarm Spoke With: Date called: 7 Keyless Entry DEC Value/PD Limits: $0_00 ❑UMPD []U137 I Air Bag Dual Salvage Title Deduction for Salvage: $0.00 j I..cather Alum/Alloy Wheels (See Dealer Quotes): $0_00 ABS 2A Wheel OK to settle ACV Privacy Glass -7 T-Tops Remarks: CCC REQUEST N 34283575 1 Sun Roof Sliding -! Moon Roof RECOMMENDED ACV LOCAL MARKET ❑ Convertible ACV: ^I Luggage Rack _ Spoiler Agreed Settlement. -? Ground Effects Sales fax: $0.00 Mileage Lease Tax: $0.00 $1,275.00 Totals $1,705.00 Transfer: $0.00 VLF/Salvage Certificate Refund: $0.00 Other Adjustments: $0.00 'Cotal Settlement: Less Salvage: $0.00 Less Deductible: $0.00 Other Deductible: $0.00 Other Deductible: $0.00 -' "---` Supervisor Approved: Net Settlement: Appraiser Approved: Whlse Book I Mid Book Retail Book $14,475.00 $15,590.00 I $16,705.00 Total Loss Adj: 4843 RICHARD NEWBURN Date: C83/ILA -AutoT'rader.corn - Cars For Sri- Printable Version Page 1 of 1 , A-1 Auto Contact: Tony AlutonaderoW Wholesale Call Toll Free 1-877-883-8441 __ /A=11 AUATd) 2233 Fulton Avenue Your car Is waiting. wMaL]Eep El Sacramento, CA 95825 Distance from ZIP 94513: 49 miles O 2005 Toyota Corolla Price $13,700 1 Mileage 7,470 Exterior Color Black .a Body Style Sedan , _... Doors Four Door Engine 4 Cylinder Gasoline Transmission Automatic FuelType Gasoline ;►Comments FWD. Air Conditioning. Power Steering. Tilt Drive Type 2 wheel drive-front Wheel. AM/FM Stereo. Single Compact Disc. — — - Dual Front Air Bags Stock No. 8222 Unless the vehicle has a remaining factory warranty, all sales are "AS-IS" with no VIN 1NXBR32E55Z450778 warranty. Fraud Awareness Tips. Common-sense advice for Buyers and Sellers. Sales Tax, Title, License Fee, Registration Fee, Dealer Documentary Fee, Finance Charges, Emission Testing Fees and Compliance Fees are additional to the advertised price. Information provided in whole or in part byr` Edmunds_co_m,_Inc_ Please refer to our Visitor Agreement for further information on vehicle data. ©2005 AutoTrader.com L.L.C. Baric to Car Details f vc[ http://www.autotrader.com/fyc/vdpprintable.j sp?mess age_typ e=link&link type=PH ONE&... 6/28/2005 CCC Valuescope Market Rep O Page 1 of 12 i f ' Mercury Insurance CCC VALUESCOPETM Croup Claim Services Market Report Report Reference Number: 34294843 Adjuster: Timmons, Sean Claim reference: YNO02584-88 Loss Incident Date: 0610512005 Claim Submitted Date: 06/2412005 Policy no: AP05291255 Appraiser: NEWBURN, RICH Insured: Kretchmer Owner: Kretchmer Introduction Mercury Insurance Group has conducted an appraisal of your 2005 Toyota Corolla S 4 Door Sedan located in Brentwood,CA.The appraisal information was used to conduct research in your local market to determine the local market value of your vehicle. The local market value for your vehicle was defined by the ZIP code 94513 -- Brentwood, CA . The recommended settlement amount based on the loss vehicle description provided by Mercury Insurance Group is $ 13,827.00. Vehicle Valuation Summary Provides the market valuation summary Vehicle Valuation Allowances Describes factors affecting the value of the vehicle Vehicle Desertion Describes the components of the vehicle Vehicle Condition Details the vehicle's pre-accident condition and Appraiser inspection recap I Qca! iVlni_ket C9_m_parable Vehicles. Provides summary information on each comparable vehicle that contributes Summary to the Local Market Value Local Market ConrparaU Vebieles Detail Presents the comparable vehicles located in your market V1NguardT'1 Vehicle Identification Details the vehicle configuration information VINguar —,"'INehicle_History Provides the results of vehicle history research Information CARFAX e ort Provides the results of a CARFAX branded title database search Valuation Methodology_ Describes the method used to evaluate the loss vehicle Local Market Definition Details the local market basis for this valuation VehicleAp_graisaland Valuation Nikes Lists detailed log notes for this file httos://www.ecevaluescope.conVPrintReport.asp 6/28/2005 'CCC Valuescope Market Rep a Page 2 of 12 r Claim reference: YN002584-88 Report Reference Number: 34294843 Vehicle Valuation Summary 2005 Toyota Corolla S 4 Door Sedan - Brentwood, CA VIN: 1 NXBR32E05Z344271 Local Market Value $ 13,827.00 Local Market Value $ 13,827.00 Pre Tax Amount $ 13,827.00 Adjusted Vehicle Value $ 13,827.00 The Local Market Value is derived from comparable vehicle(s)available or recently sold in the marketplace at the time of valuation. Vehicle Valuation Allowances Compared to the typical vehicle in this local market,your vehicle's value was affected by these factors: Odometer 8,800 These allowances illustrate factors that influence the settlement amount when compared to a typical Options vehicle.The typical vehicle is a vehicle of the same Automatic Transmission AT Reported year,make,and model as the loss vehicle,including Power Windows PW Reported average mileage,and all standard and predominant Cruise Control CC Reported equipment. Keyless Entry KE Reported In cases where a standard or predominant option is superceded by a replacement or upgrade,a. corresponding addition will appear for the option to reflect this. The vehicle valuation allowances also reflect proper deductions for all standard or predominant equipment not present on the loss vehicle. These allowances are illustrative only.The actual Local Market Value is calculated entirely from the comparable vehicles contained in this report with adjustments to reflect the loss vehicle configuration. httDs://www.eecvaluescoae.coin/PrintReport.asp 6/28/2005 'CCC Valuescope Market Re O Page 3 of 12 Claim reference: YNO02584-88 Report Reference Number: 34294843 Vehicle Descripti®n 2005 Toyota Corolla S 4 Door Sedan - Brentwood, CA Below are the components for your vehicle,provided to CCC by Mercury Insurance Group, included in this local market valuation: Component Loss Vehicle Information Odometer 8,800 Equipment Transmission Automatic Transmission AT Reported Overdrive OD Standard Power Power Steering PS Standard Power Brakes PB Standard Power Windows PW Reported Power Locks PL Standard Power Mirrors PM Standard Decor/Convenience Air Conditioning AC Standard Rear Defogger RD Standard Tilt Wheel TW Standard Cruise Control CC Reported Cloth Seats CS Standard Bucket Seats BS Standard Dual Mirrors DM Standard Fog Lamps FL Standard Keyless Entry KE Reported Radio AM Radio AM Standard FM Radio FM Standard Stereo ST Standard Search/Seek SE Standard Compact Disc Player CD Standard Other Body Side Moldings BN Standard Intermittent Wipers IW Standard Air Bag AG Standard Passenger Air Bag RG Standard Full Wheel Covers FC Standard httns•//www.cccvaluescone.com/PrintReoort.asp 6/28/2005 'CCC Valuescope Market Rep4� O Page 4 of 12 l Claim reference: YN002584-88 Report Reference Number: 34294843 i I VINguard" Vehicle Identification VIN: 1 NXBR32E05 Z344271 Every vehicle sold in the United States is required to have a manufacturer assigned Vehicle Identification Number (VIN). This number provides the exact specifications of the vehicle. Decoding the VIN identifies the exact vehicle for which the local market value will be determined. Insurer Description VINguard Analysis Year 2005 2005 Make Toyota Toyota Model Corolla S Corolla CE/LE/S Model Number BR32E BR32E Body Style 4 Door Sedan 4 Door Sedan Engine 4-1.8L-FI 4-1.81-Fi Transmission Automatic Transmission Overdrive Restraints Air Bags (Driver+Pass.) Air Bags (Driver+Pass.) Curb Weight 2,530 Odometer 8,800 This vehicle was assembled in FREEMONT, CA VINguard7M is a database used to decode completely and accurately all manufacturer assigned Vehicle Identification Numbers. VINguard TM Vehicle History Information VINguard T" Messages: VINguard has decoded this VIN without any errors. ISO Vehicle History ISO response indicates no history for this VIN, Number of times reported to ISO: 0 ISO's file number: H0107577374 I I I I I htt+�c•//zzrurur crrirahr�.cnnnP r.nm/PrintRennrt.asn 6/28/2005 CCC Valuescope Market Re10 O Page 5 of 12 Claim reference: YNO02584-88 Report Reference Number: 34294843 13 ` 013[il Branded Title Information VEHICLE HISTORY REPORTS carfax.com VIN: 1NXBR32E05Z344271 The Vehicle Identification Number submitted was checked against the CARFAX(R) branded title and odometer rollback database of over 100 million records. The results of this search are displayed below. Carfax Results Salvage Title No branded title found Junk Title No branded title found Rebuilt/Reconstructed Title No branded title found Flood Damage Title No branded title found Dismantled Title No branded title found Loss Due to Fire No branded title found Hail Damage No branded title found Canadian Total Loss No branded registration found Manufacturer Buyback(LEMON)' No branded title found Exceeds Mechanical Limits Title No branded title found Not Actual Mileage Title No branded title found CARFAX found no relevant record of your vehicle in its database. ODOMETER ROLLBACK CHECK No odometer rollback detected in the CARFAX database. Last reported odometer reading: 7,778 miles on 01/06/2005. l littns://www.cccvaluescot)c.com/PrintRei)ort.asp 6/28/2005 "CCC Valuescope Market Rep?--k, O Page 6 of 12 Claim reference: YN002584-88 Report Reference Number: 34294843 I Local Market Definition I The local market value for your 2005 Toyota Corolla S 4 Door Sedan was defined by the ZIP code 94513 -- Brentwood,CA . If required, the search area may have been expanded for additional information. Details of the specific markets searched follow. The state of California is composed of 23 distinct local markets. The following 8 local markets were used in the preparation of this vehicle market I de W, i report. East Bay CA-Primary local market vehicle database In this market, CCC maintains a database of 8,066 inspected dealer vehicles located at 64 dealerships, and 40,379 dealer advertised, and 8,966 privately advertised vehicles taken from 31 local papers or magazines. East Bay Sacramento CA - Secondary local market vehicle database In this market,CCC maintains a database of 7,328 inspected dealer vehicles located at 29 dealerships,and 50,493 dealer advertised, and 11,363 privately advertised vehicles taken from 45 local papers or magazines. Redding CA- Third local market vehicle database In this market, CCC maintains a database of 682 inspected dealer vehicles located at 5 dealerships, and 7,234 dealer advertised, and 1,895 privately advertised vehicles taken from 13 local papers or magazines. Other markets searched - San Joaquin Valley Marin County. Santa Rosa,Bay Sacramento Area and Fresno In these markets, CCC maintains a database of 14,734 inspected dealer vehicles located at 88 dealerships and 113,430 vehicles taken from 99 local � 1 newspapers or magazines. cy N4 Search extended to locate additional comparable vehicles. u In certain circumstances, the area searched may be further extended to locate additional comparable vehicles for use in the valuation of your vehicle.That was done in connection with this valuation, and CCC was able to locate comparable vehicles in San Jose. Adjustments were made to the value of each comparable vehicle to account for differences, if any, in year, model,body Redding style, engine configuration,packages, options, and mileage. Nationwide, CCC maintains a database of 829,316 inspected dealer vehicles located at 4,509 dealerships, and 4,893,211 advertised vehicles taken from 1,864 local papers and magazines. For your vehicle's CCC Valuescope Market Report, CCC identified 2 advertised vehicles as comparable to your vehicle, and used their values to determine the Local Market Value. i I I httns://www.eccvaluescope.com/PrintReport.asp 6/28/2005 'CCC Valuescope Market Rep'cp'N ` Page 7 of 12 Claim reference: YNO02584-88 Report Reference Number: 34294843 Valuation Methodology This CCC Valuescope Market Report was prepared for Mercury Insurance Group by CCC Information Services Inc. CCC has been preparing market value reports for the insurance industry since 1981. CCC physically inspects vehicles for sale at vehicle dealerships in the local markets, and subscribes to local newspapers and automotive publications in these markets. CCC also obtains vehicle sales prices from the California Department of Motor Vehicles. CCC maintains vehicle databases containing these inspected dealership vehicles, the dealer and private party advertised vehicle information,and a database of California DMV vehicle registration sold transactions. When Mercury Insurance Group requests a CCC Valuescope Market Report from CCC, they provide CCC the VIN . (Vehicle Identification Number) of the loss vehicle. Decoding this VIN identifies the exact vehicle for which the local market value will be done. See the VINguardi'm Vehicle Identification section. Mercury Insurance Group also provides CCC the vehicle owner's ZIP code. This identifies the local market that will be used to determine the market value. See the Local Market Definition section. Finally, Mercury Insurance Group provides CCC with the configuration of the loss vehicle including equipment, odometer, condition,maintenance, etc. This information is the starting point for determining the local market value. The vehicle value is based solely on CCC's recent previous valuation of this vehicle,reflecting the current appraisal information provided by Mercury Insurance Group . Adjustments may have been made where the current information differs from that provided to CCC regarding the previous valuation, such as differences in condition, body style, engine corhiguration,packages, options,,and mileage. After the Adjusted Value for the previous valuations are calculated(see the Local Market Comparable Vehicles section), CCC calculates the Local Market Value. The comparable vehicles are presented for information purposes only. I I . Ji I i t,ttn� //zznu a nrcvah n.crnne cnm/PrintRennrt.asn 6/28/2005 CCC Valuescope Market Rep('] Q Page 8 of 12 j Claim reference: YNO02584-88 Report Reference Number: 34294843 Vehicle Condition Mercury Insurance Group uses Condition Inspection Guidelines to determine the condition of key components of the loss vehicle. These guidelines are specific to geographic location,year,and vehicle type. The guidelines describe physical characteristics for each of the vehicle components. Based on these guidelines, Mercury Insurance Group has determined the condition of the vehicle prior to the loss. Component Condition Value Typical Vehicle Description Impact Mechanical Normal Engine: No seepage evident. Belts and hoses NC firm, show no wear. No significant dirt and grease in engine compartment.No burn marks around tailpipe. Transmission : Fluid may be slightly discolored.No seepage evident. Tires Normal Front Tires : 5-7/32" of tread present. 41% to NC 68%of new.No signs of uneven wear. Rear Tires : 5-7/32" of tread present. 41% to 68%of new.No signs of uneven wear. Paint Normal Minimal surface chipping or scratching. NC Slight fading. Body Normal Sheet Metal : No dents. Small/few dings. No NC significant surface rust. Trim : Minimal peeling or fading.No significant rust. Glass Normal Minimal surface scratches or pitting. Few NC chips. Seals are intact and watertight. Interior Normal Carpets : Lightly soiled or stained. Minimal NC tears,holes or burn marks. Light wear in primarily driver's area. Dashboard : Small/few cracks or scratches. No broken or missing components. Light wear or fading. Headliner : Small/few tears or light fading. Minimal staining or soiling. Seats : Lightly soiled or stained. Minimal fading,tears, holes or burn marks. i Total Adjustments: $0 e The Condition Inspection Guidelines provide information based on vehicle age,vehicle type,and geographic location. Your vehicle has been identified as being located in the California region as a newer passenger car. a The Condition Inspection Guidelines,and all dollar adjustments,are determined by surveys,inspections,and interviews with dealerships across the United States. o The Typical Vehicle Description illustrates the condition characteristics of a typical vehicle in Normal Wear condition. I hff„c•//vxvixi rrrvalnP.ernnP rnm/PrintRennrt ,.n 6/28/2005 'CCC Valuescope Market Re Q Page 9of 12 Claim reference: YNO02584-88 Report Reference Number: 34294843 I ]Local Market Comparable Vehicles Summary The vehicle value is based solely on CCC's recent previous valuation of this vehicle,reflecting the current appraisal information provided by Mercury Insurance Group . Adjustments may have been made where the current information differs from that provided to CCC regarding the previous valuation. The comparable vehicles are presented for information purposes only. Type I Comparable Vehicle I Price Adjusted Value 1]Verified Sold 2005 Toyota Corolla CE Sold Price$12,3991 $13,430 2]Dealer Vehicle 2005 Toyota Corolla CE Asking Price$13,9901 $13,997 31 Previous valuation 2005 Toyota Corolla S Value$14,0041 $13,827 Arithmetic Mean $ 13,827.00 I i i I I i I i i I littn,q-//www.cccvaluescone.com/PriiitReDort.asD 6/28/2005 I , CCC Valuescope Market Repf Page 10 of 12 Claim reference: YN002584-88 Report Reference Number: 34294843 Local Market Comparable Vehicles Detail The local market comparable vehicles are compared to the loss vehicle,and adjustments are made for differences in equipment, odometer, model, etc. The Adjusted Value represents the price of the comparable configured exactly as the loss vehicle. Loss Vehicle Verified Sold Dealer Vehicle Previous valuation Comparable 1 Comparable 2 Comparable 3 2005 Toyota 2005 Toyota 2005 Toyota 2005 Toyota Corolla S Corolla CE Corolla CE Corolla S 4 Door Sedan 4 Door Sedan 4 Door Sedan 4 Door Sedan Automatic Transmission Automatic Transmission Automatic Transmission Automatic Transmission Overdrive Overdrive Overdrive 4-1.8 L-FI 4-1.81, 4-1.8L 4-1.8L Air Conditioning Air Conditioning Air Conditioning Air Conditioning Radio: AM/FM Stereo Seek AM/FM Stereo Seek AM/FM Stereo Seek AM/FM Stereo Seek Compact Disc Player Compact Disc Player Compact Disc Player Compact Disc Player Not Found on Loss Vehicle Anti-Lock Brakes (4) Not Found on Comparable Power Windows Power Windows Vehicle Cruise Control Power Locks Keyless Entry Keyless Entry 8,800 miles 11,404 miles 3,000 miles Unlisted miles Sold Price$12,399 Asking Price $13,990 Value$14,004 Adjustments Model/Year +525 +525 Not Found on Loss -500 Vehicle Not Found on +350 +350 Comparable Vehicle Mileage +156 -368 -177 Adjusted Value $13,430 $13,997 $13,827 Location Reliable Rent a Car Yama Auto Brokers, Inc Contact Khawaja/Yama Telephone 415928-4414 866-706-9843 Stock ID Plate: 5HNT296 Stock: 063973 VIN 1NXBR32E05Z344271 Verified 5/11/2005 Pub Date 6/01/2005 Distance from Brentwood 41 Miles- San Francisco i e The local market comparable vehicles are compared to the loss vehicle, and adjustments are made for differences in equipment,odometer,model,etc. • Adjustments are determined by surveys, inspections,and interviews with dealerships across the United States. • Adjusted Value represents the value of the comparable vehicle configured exactly as the loss vehicle. • Ask Price is the asking price of the vehicle. • Sold Price is the actual selling price as provided by the California Department of Motor Vehicles or other sources. I onrn/PrintRe.nort.a:sn 6/28/2005 CCC Valuescope Market RO Page I 1 of 12 Claim reference: YN002584-88 Report Reference Number: 34294843 I I Vehicle Appraisal and Valuation Notes $500 REBATE AVAILABLE ON NEW, EXPIRES 07/05/2005 Included in our backup are similar models to the loss vehicle, Proper adjustments were made for this valuation. This valuation has been prepared in accordance with the California Fair Claims Settlement Practices Regulations (C) Copyright 2005 CCC Information Services Inc. All Rights Reserved. Various aspects of our Market Report are covered by one or more pending patent applications. The trade names and/or trademarks used herein are owned by their respective trademark owners. I i ! 1 i l https://www.cccvaluesrope.coin/PrintReport.asp 6/28/2005 -CCC Valuescope Market Repf� (O Page 12 of 12 Settlement Tracking Complete this form when file is closed. Date valued: 06/24/2005 Date of loss: 06/05/2005 SEND TO: CCC INFORMATION SERVICES INC. ATTN: SETTLEMENT TRACKING 100 S. MAIN ST. SIOUX FALLS, SD 57104 FAX: 1-800-621-7070 Settlement Data Request number: 34294843 User id: 48969 Code: MY Insured: KRETCHMER Vehicle: 2005 TOYO COROLLA S Claim reference: YNO02564-88 Adjuster: TIMMONS, SEAN Settl Adj : CCC Values Settlement Values Base Valuation: 13827.00 Condition Adjustment Amount: Additional Considerations: (+) Prior Damage: (-) Non-Factory Options: (+) Other Pre-Tax Adjustments: (+/-) Subtotal (ACV) : 13827.00 + Tax: (+) Deductible: (-) Other Post-Tax Adjustments: (+/-) Owner Retained Salvage: (-) Adjusted CCC Amount: 13827.00 + Final Settlement Amount: Settlementdate: _/_/ Insured report date: (mm/dd/yyyy) (mm/dd/yyyy) Claim Representative Settlement Notes: i i I I I r I i I h ttns://www.c,cevaluescope.com/PrintRel)ort.asp 6/28/2005 O O Page 1 of 1 I i Jaimie M. Boston From: Auto Shoppers Club [forms@autoshopper''sclub.com) Sent: Monday, June 27, 2005 3:22 PM To: Jaimie.M. Boston Subject: Autos Shoppers Club -Your Replacement Vehicle 5 , 11.3 4 y _- E , s�5�..�'.-.^y >��6�kYY�7•�` #'%v°1 ..Yfi�Y� "Sr, .��rt ksk`2ti`i,G�.'"�:"A .✓£°3't cx.e".x"�" C+ ���„ r' .it3 r'Y't.,,�,y a yC.,ii .'�, >+,�•ryt'"�v'%s3 ? Y 'k�ta t' ♦♦♦ 'a' ...p �s`,y�`�.0 xL ?Sn u,,.5w .e�^r,. -.. 4_.f w ` a+'� w-Y x.,4 � � ASC Replacement Vehicle 888-230-2582 4091 E. La Palma Ave. Suite O. Anaheim, CA 92807 i EHICLE INFO INSURANCEINFO ,Year: 2005 tMake: Toyota Claim: YNO02584-88 !Model: Corolla VIN #: INXBR32EOSZ344271 (Style: 4dr Sdn S Auto (Nati) Mileage: 8800 iTrans: Automatic w/OD Insured: CAROL KRETCHMER iEngine: Gas I4 Zip Code: 94513 !Color (ext/int): J Date of Loss: 6/05/05 50 STATE EMISSIONS,STANDARD Appraiser: JAIMIE BOSTON IOptions: pAINT,PWR PKG,CRUISE Appraiser Phone: (800) 827-1570 ext.3421 CONTROL Office Location: RANCHO CORDOVA } I View Standard Featu! res Adjuster: SEAN TIMMONS View Technical Specs Adjuster Phone: (800) 827-1570 ext.2323 i Comments: C4od MATCH FOUND ;Vehicle `.. $15,508.00 jStock #: 1538 I rReplacement +Taxes/Fees Price: City: Delivery to Home or Office ';'Mileage: New i Replacement vehicle price includes a $300.00 rebate. Prices subject to change due to rebates, market trends, and availability. i 6/28/2005 Wed Jun-22-2005 02:37pm Claim N002584-881 From:MERCURY INSURANCE.0 v I i Total LOSS StatusNew ,Choosela'iormtodisplay,n TTL010 Claim Number: YN00258488 Ca Number i Status' Received Branch:- 14 Adjuster r 4058 SEAN TIMMONS Insured Name: KRETCHMER C Date of Loss' 6/5/2005LDate'Reported: 6/912005 Claim Type ; �- Source. ` Field Claimant. Year: 5°:Make. TOYOTA Model:"COROLLA VIN 1 NXBR32EOSZ344271 Lic Plate. 5HJBW Mileage:,�� Date Assigned' 6/27J2005 Field Appraiser 4843 RICHARQ NEWBORN Date Inspected:' 6/22/2005 Date Estimate:', 6/22/2005 Supervisor. 517 TOM BENSON' Date Ib.eIteIrmhL-ed TTL. 6/2212005 �'""".'- �� Opened By. 4843 RICHARD NEWBURN Previous Opened 1 bate;E-Total: Salvage Pool -- Date`Rece ved by TTL: 6/22 2005 Date o,*dd' . . 6/22/2005. 0 IAA ^ COPART C Ofher Stock#: Date Ist Contact; -' Date Called To Pick Upa Called in By QatPicked Up: #of Bus Days toI Pickup: 0 Previous Closed' DateOKTo Setfie: ACV Amount Dafe 1 st Offer' —�Delay Reason: y Close Type: Date;Closed: Delay Reason: �— Closed By Date Check Issued: Date Documents Sent: �� Comments. I i I f i I I I I I I i Wed Jun-22-2005 02:37pm Claim t'�J002584-881 From:MERCURY 1NSURANCE.Cr This is a Total Loss Notification Date: 6f22f2005 Attn: Total Loss Unit,Brea CC Elizabeth Pone Betty Rauch From: 4843 MCHNEWBURN Please begin a Total Loss Evaluation Claim information available at: m and merc tnsurance.com Hard copy paperwork should follow within 24 hours of this notification. Please contact the area supervisor if hard copy paperwork is not received within 24 hours. Claim No: YNT002584-88 Date Of Loss: 6/5/2005 Insured: KRETCMIE&CAROL Claimant Year: 2005 Make: Toyota Model: Corolla License Plate: 5HJB548 VIN: 1 NXBR32E05Z344271 E-mail notification Date: 6/2 21200 5 1:17:24 PM I I I Wed Jun-22-2005 02:37pm Clai YNO02584-881 From: MERCURY INSURANCE. Field Appraiser Total Loss Checklist Claim#: YN0025M-88 Vehicle: 2005 TOYOTA COROLLA Date: 6/22/2005 Claimant: Insured: KRETCHMER C C-68 Foran in File: No F�/l Yes Type of Loss:: Coll Camp ❑PD ❑ UkfPD PD Limit: $0 Vehicle Registration: n No r! Yes (Copy Attached) Coverage Confirmed: E] No D Yes Attorney Represented: W No E] Yes Name: Phone: C-127 Sent to Adjuster- U No U Yes - C-83 Foran: Complete �_, Incomplete Photos: In file To follow Photos of Odometer. No Yes Estimate of Damages: 0 Complete Fvo� Incomplete Old Existing Damages: 0 No ❑ Yes Amount: $0$0^00 Vehicle Drivable: Q No Yes Owner Advised a TotaI Loss: No Yes Vehicle with Owner: FVJ No Yes Vehicle with Body Shop: W No [] Yes. Has C-128 been sent: 0 No ❑ Yes (Copy Attached) Other Location of Vehicle: COPART YARD 1 Salvage Sticker on Vehicle: W No 11 Yes Released by Owner: No Yes Date of Release: Tow Bill Attached: No [] Yes - Towing Charges: $0_00 Storage Per Day: $0_00 , Storage To Date: $0_00 Tear Down Charges: $0_00 Total Charges: $0_00 Approved Charges: $0_00 Vehicle Pick Up Arranged: r] No r] Yes IAA COPART StockU: 5970625 Date: 6/22/2005 Spoke With: Comments; INSPECTED AUTO AT COPART YARD 1 JII I Field.Appraiser. RICHNEWBURN Extension: Supervisor: 'TORI BENSON Dispatch: SANDY"VANAIUYDEN Adjuster. Default Salvage: Dzfault � r Wed Jun-22-2005 02:37pm Claim 002584-881 From: MERCURY INSURANCE.Cy ) Date: 6/22/200512:21 PM Supplement: 0 MERCURY CASUALTY COMPANY 11150 INTERNATIONAL DR. RANCHO CORDOVA, CA 95670 (916) 636-1534 APPRAISAL REPORT DAMAGE ASSESSED BY: FILE NUMBER: None ASSIGNMENT DATE: 6/21/2005 CLAIM NUMBER: YN002584=88 CONTACT DATE: None DATE OF LOSS: 6/5/2005 INSPECTION DATE: 6/22/2005 TYPE OF LOSS: Collision RECD DATE: 6/21/2005 ADJUSTOR: SEAN TIMMONS Point(s) of Impact 12 Front Center (P), 6 Rear Center(S) INSURED: CAROL KRETCHMER CLAIMANT: None 1242 COMICE PARKWAY BRENTWOOD, CA 94513 (925) 634-3290 OWNER: CAROL KRETCHMER BODY SHOP: CO-PART SALVAGE POOL 1242 COMICE PARKWAY 282 5TH STREET BRENTWOOD, CA 94513 VALLEJO, CA 94590 (925) 634-3290 (800) 526-3536 (800) 526-3536 INSPECTION SITE: CO-PART SALVAGE POOL 282 5TH STREET VALLEJO, CA QUALITY RECYCLED PARTS: No AFTERMARKET NEW PARTS: No VEHICLE DRIVEABLE: No Prior Damage UNKNOWN Corn,meIIt:S 06/22/05 INSPECTED AUTO AT COPART YARD 1. COST TO REPAIR EXCEEDS VALUE. TOTAL LOSS. COMPARISON ESTIMATE: 0.00 j TOWING: 0.00 ACTUAL CASH VALUE: 13,200.00 APPRAISER ESTIMATE: 23,583.45 1 STORAGE: 0.00 SALVAGE VALUE: 0.00 AGREED UPON AMOUNT: 0.00 DEDUCTIBLE: 500.00 SETTLEMENT: 0.00 REPAIR VS. ACV: 24,083.45 DRAFT/CHECK NUMBER: 0 ESTIMATE FEE: 0.00 DRAFT/CHECK AMOUNT: 24,083.45 TRAVEL EXPENSE: 0.00 DATEISSUED: None PHOTO EXPENSE: 0.00 MISC EXPENSE: 0.00 TOTAL CHARGES: 0.00 I UltraMate is a Trademark of Mitchell International Copyright (C) 1994- 2005 Mitchell International Page 1 of 1 A111 Rights Reserved Wed Jun-22-2005 02:37pm Claim N002584-881 From: MERCURY INSUP.ANCE.C( I ( Date: 6/22/2005 12:21 PM Estimate ID: YNO02584-88 Estimate Version: 0 Committed Profile ID: CUSTOMIZED MERCURY CASUALTY COMPANY 11150 INTERNATIONAL DR. RANCHO CORDOVA, CA 95670 (916) 636-1534 Damage Assessed By: Rich Newburn#4843 Adjustor: SEAN TIMMONS (916) 636-1534 Condition Code: Good Type of Loss: Collision Date of Loss: 6/ 5/2005 Accident Date: 6/5/2005 Deductible: 500.00 Policy No: AP05291255 Claim Number: YNO02584-88 Insured: CAROL KRETCHMER Address: 1242 COMICE PARKWAY BRENTWOOD, CA 94513 Telephone: Home Phone: (925) 634-3290 Mitchell Service: 911754 Description: 2005 Toyota Corolla S Vehicle Production Date: 4/04 Body Style: 4D Sed Drive Train: 1.81-Inj 4 Cyl 4A FWD VIN: 1NXBR32EOSZ344271 License: 5HJB548 CA OEM/ALT: 0 Search Code: None Color: GRAY/MET Options: ALUM/ALLOY WHEELS,AIR CONDITIONING, POWER STEERING, POWER WINDOWS POWER DOOR LOCKS, TILT STEERING WHEEL, CRUISE CONTROL, ELECTRIC DEFOGGER AUTOMATIC TRANSMISSION, AM-FM STEREO/CDPLAYER(SINGLE) Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 100027 BOY OVERHAUL FRT COVER ASSY 1.8 # 2 100028 BOY REMOVE/REPLACE FRT ADD W/FOG LAMPS 0.3 3 102343 BDY REMOVE/REPLACE FRT BUMPER COVER 52119-02947 ` 185.81 INC # 4 AUTO REF REFINISH FRT BUMPER COVER C 2.5 5 100032 BDY REMOVE/REPLACE R FRT BUMPER PROTECTOR 52541-02020 2.07 INC 6 100033 BDY REMOVE/REPLACE L FRT BUMPER PROTECTOR 52541-02020 2.07 INC 7 102354 BDY REMOVE/REPLACE R FRT BUMPER BRACKET 52115-02061 19,83 INC 8 102355 BDY REMOVE/REPLACE L FRT BUMPER BRACKET 52116-02061 19.83 INC 9 102359 BDY REMOVE/REPLACE FRT BUMPER IMPACT ABSORBER 52611-02100 62.19 INC 10 102362 BDY REMOVE/REPLACE FRT BUMPER REINFORCEMENT 52021-02060 147.99 INC 11 100045 BDY REMOVE/REPLACE R FRT BUMPER REINFORCEMENT BRKT 52145-02080 25.24 INC 12 100046 BDY REMOVE/REPLACE L FRT BUMPER REINFORCEMENT BRKT 52146-02070 25.55 INC 13 102371 BDY REMOVE/REPLACE R FRT BUMPER SPOILER 76081-02030-CO 350.10 INC 14 102372 BDY REMOVE/REPLACE L FRT BUMPER SPOILER 76083-02030-CO 350.10 INC 15 102363 BDY REMOVE/REPLACE FRT CTR BUMPER SPOILER 76082-02900 119.43 INC 16 100064 BDY REMOVE/REPLACE GRILLE j 53100-02020 97.96 INC 17 102362 BDY REMOVE/REPLACE R FRT COMBINATION LAMP ASSEMBLY 81110-02370 214.87 INC # 18 AUTO BDY CHECK/ADJUST HEADLAMPS I 0.4 19 102383 BDY REMOVE/REPLACE L FRT COMBINATION LAMP ASSEMBLY 81150-02360 214.87 INC # 20 102394 BDY REMOVE/REPLACE R FOG LAMP ASSEMBLY 81210-02060 203.06 INC # 21 102395 BDY REMOVE/REPLACE LFOG LAMP ASSEMBLY 81220-02060 203.06 INC # 22 102408 BDY REMOVE/REPLACE HOOD PANEL 1 53301-02130 242.13 1.2 ESTIMATE,RECALL NUMBER: 6/22/200512:21':32 YNO02584-88 UltrMate is a Trademark of Mitchell International Mitchell Data Version: MAY 05-A Copyright(C) 1994- 2003 Mitchell International Page 1 of 5 UltraMate Version: 5.0.206 All Rights Reserved I Date: 6/22/2005 12:21 PM Estimate ID: YNO02584-88 Estimate Version: 0 Committed Profile ID: CUSTOMIZED 23 AUTO REF REFINISH HOOD OUTSIDE C 2.3 24 AUTO REF REFINISH HOOD UNDERSIDE 1.2 25 100116 BOY REMOVE/REPLACE HOOD INSULATOR 53341-02070 121.06 INC 26 100118 BOY REMOVE/REPLACE FRT HOOD SEAL 53381-02070 20.29 0.2 27 100122 BOY REMOVE/REPLACE R HOOD HINGE 53410-12410 23.41 0.2 # 28 AUTO REF REFINISH R HINGE 1 O,3 29 100123 BOY REMOVE/REPLACE L HOOD HINGE 53420-12330 23.41 0:2 # 30 AUTO REF REFINISH L HINGE 0.3 31 100130 BOY REMOVE/REPLACE HOOD SUPPORT ROD 53440-02050 7.89 0.1 32 100133 BOY REMOVE/REPLACE HOOD LATCH 53510-02230 40.27 INC 33 100136 BOY REMOVE/REPLACE HOOD SHIELD LOCK 53525-33040 12.55 34 100137 BOY REMOVE/REPLACE HOOD RELEASE CABLE 53630-02061 23.69 1.0 # 35 100140 BOY REMOVE/REPLACE HOOD RELEASE CABLE HANDLE 53601-02020-B1 32.47 INC 36 100145 BOY REMOVE/REPLACE COOLING RADIATOR 16400-OD240 462.95 INC 37 100149 BOY REMOVE/REPLACE R UPR COOLING RAD MTG BRACKET - 16533-OD030 14.80 38 100150 BOY REMOVE/REPLACE L UPR COOLING RAD MTG BRACKET 16533-OD030 14.80 39 100151 BOY REMOVE/REPLACE R UPR COOLING SUPPORT 16523-OD030 3.09 40 100152 BOY REMOVE/REPLACE L UPR COOLING SUPPORT 16523-OD030 3.09 41 100153 BOY REMOVE/REPLACE R LWR COOLING SUPPORT 16535-OD040 10.66 42 100154 BOY REMOVE/REPLACE L LWR COOLING SUPPORT 16535-OD040 10.66 43 102412 BOY REMOVE/REPLACE COOLING FAN SHROUD ORDER FROM DEALER 98.83 0,4 # 44 100157 BOY REMOVE/REPLACE COOLING FAN BLADE 16361-OD090 50.22 INC # 45 102416 BDY REMOVE/REPLACE COOLING FAN MOTOR ORDER FROM DEALER 142.04 INC # 46 102420 BDY REMOVE/REPLACE UPR COOLING RADIATOR HOSE ORDER FROM DEALER 15.86 0.1 # 47 100160 BDY REMOVE/REPLACE LWR COOLING RADIATOR HOSE 16572-OD120 14.38 0.1 # 48 100176 BDY REMOVE/REPLACE COOLING DRIVE BELT ORDER FROM DEALER 27.67 0.5 49 100178 MCN REMOVE/REPLACE EVACUATE &RECHARGE A/C -M 1.4 50 100179 MCH REMOVE/REPLACE A/C REFRIGERANT RECOVERY -M 0.3 51 102428 MCH REMOVE/REPLACE AIR COND CONDENSER -M ORDER FROM DEALER 409.55 INC 52 102429 MCH REMOVE/REPLACE FRT AIR COND EVAPORATOR PIPE -M 88710-12720 152.48 0.9 # 53 102322 MCH REMOVE/REPLACE REAR AIR COND EVAPORATOR PIPE -M 88716-02380 22.70 0.4 # 54 100224 BDY REMOVE/REPLACE R FENDER PANEL 53801-02070 222.06 1.6 # 55 AUTO REF REFINISH R FENDER OUTSIDE C 1.4 56 AUTO REF REFINISH R FENDER EDGE C 0.5 57 100225 BDY REMOVE/REPLACE L FENDER'PANEL 53802-02070 222.06 1.6 # 58 AUTO REF REFINISH L FENDER OUTSIDE C 1.4 59 AUTO REF REFINISH L FENDER EDGE C 0.5 60 102440 BDY REMOVE/REPLACE R FENDER LINER 53875-12380 70.02 INC 61 102441 BDY REMOVE/REPLACE L FENDER LINER 53876-12370 70.02 INC 62 100254 BDY REMOVE/REPLACE FRONT BODY RADIATOR SUPPORT -S ORDER FROM DEALER 317.84 7.7 # 63 AUTO REF REFINISH RADIATOR SUPPORT COMPLETE 1.7 64 100272 BDY REMOVE/REPLACE R ENGINE SPLASH SHIELD 51441-02100 41.87 INC 65 100273 BDY REMOVE;REPLACE L ENGINE SPLASH SHIELD 51442-02170 34,70 INC 66 AUTO REF REFINISH R LOWER SIDE RAIL COMPLETE 1.0 67 AUTO REF REFINISH L LOWER SIDE RAIL COMPLETE 1.0 68 100292 BDY REMOVE/REPLACE R FRONT BODY APRON ASSY S 53701-02120 190.77 6.0 # 69 AUTO REF REFINISH R APRON ASSEMBLY COMPLETE 1.0 70 100293 BDY REMOVE/REPLACE L FRONT BODY APRON ASSY -S 53702-02060 190.77 6.0 # 71 AUTO REF REFINISH L APRON ASSEMBLY COMPLETE 1.0 72 100311 BDY REMOVE/REPLACE R OTR FRONT BODY SIDE RAIL -S 57115-02030 103.40 INC # 73 100312 BDY REMOVE/REPLACE L OTR FRONT BODY SIDE RAIL -S 57116-02030 96.54 INC # 74 100313 BDY REMOVE/REPLACE R OTR FRONT BODY RAIL EXTENSION -S 57113-02040 31.27 INC # 75 100314 BDY REMOVE/REPLACE L OTR FRONT BODY RAIL EXTENSION -S 57114-02040 30.29 INC # 76 100315 BDY REMOVE/REPLACE R INR FRONT BODY SIDE RAIL -S 57101-02902 346.81 4.0 # 77 100316 BDY REMOVE/REPLACE L INR FRONT BODY SIDE RAIL -S 57102-02904 296.43 4.0 # 78 100325 BDY REMOVE/REPLACE R INR FRONT BODY REAR SIDE RAIL . -S 57191-02090 132.84 3.5 # 79 100326 BDY REMOVE/REPLACE L INR FRONT BODY REAR SIDE RAIL -S 57192-02090 132.84 3.5 # 80 100327 BDY REMOVE/REPLACE R FRONT BODY RAIL REINF -S 57033-02030 159.67 INC # 81 100328 BDY REMOVE/REPLACE L FRONT BODY RAIL REINF -S 57034-02030 159.67 INC # 82 100329 BDY REMOVE/REPLACE R FRONT BODY+RACKET 57107-02900 104.06 ESTIMATE RECALL NUMBER: 6/22/200512:21:32 YN002584-88 UltraMate is a Trademark of Mitchell International Mitchell Data Version: MAY_05_A Copyright (C) 1994- 2003 Mitchell International Page 2 of 5 UltraMate Version: 5.0.206 AIL'Rights Reserved (C) Date: 6/22/2005 12:21 PM Estimate ID: YN002584-88 Estimate Version: 0 Committed Profile ID: CUSTOMIZED 83 100330 BOY REMOVE/REPLACE L FRONT BODY BRACKET 57198-02900 158.67 84 100331 MCH REMOVE/REPLACE SUB-FRAME CROSSMEMBER -M ORDER FROM DEALER 1,078.96 3.5 # 85 100335 MCH REMOVE/REPLACE SUB-FRAME SUPPORT -M 51204-02050 192.46 INC # 86 102450 MCN REMOVE/REPLACE AIR BAG MODULE-DRIVER FRONT -M 45130-02212-B1 648.10 INC 87 100349 MCH REMOVE/REPLACE AIR BAG SPIRAL CABLE -M 84306-02110 202.00 0.7 88 102453 MCH REMOVE/REPLACE AIR BAG MODULE-PASSENGER FRONT M 73970-02050-Bl 751.66 0.5 89 102455 MCH REMOVE/REPLACE CTR AIR BAG SENSOR -M ORDER FROM DEALER 215.42 0-4 # 90 102456 MCH REMOVE/REPLACE R FRT AIR BAG SENSOR -M 89173-09120 54.89 0.4 # 91 102457 MCH REMOVE/REPLACE L FRT AIR BAG SENSOR -M 89173-09120 54.89 0.2 # 92 AUTO BDY REMOVE/REPLACE BOTH QTRS/REAR BODY PANEL 30.1 93 101800 BDY REMOVE/REPLACE R QUARTER OUTER PANEL 61601-02150 494.53 IN C # 94 AUTO REF REFINISH R QUARTER PANEL OUTSIDE C 1.6 95 AUTO REF REFINISH R QUARTER PANEL EDGE C 0-5 96 AUTO REF REFINISH R ADD FOR PILLAR C D-5 97 101801 BDY REMOVE/REPLACE L QUARTER OUTER PANEL 61602-02130 494.53 INC # 98 AUTO REF REFINISH L QUARTER PANEL OUTSIDE C 1.6 99 AUTO REF REFINISH L QUARTER PANEL EDGE C 0.5 100 AUTO REF REFINISH L ADD FOR PILLAR C 0.5 101 101887 BDY REMOVE/REPLACE LUGGAGE LID PANEL 64401-02100 380.44 1.5 102 AUTO REF REFINISH LUGGAGE LID C 1.8 103 AUTO REF REFINISH LUGGAGE LID UNDERSIDE 1.1 104 102986 BDY REMOVE/REPLACE REAR BODY PANEL 58307-12A10 264.39 INC # 105 AUTO REF REFINISH REAR BODY PANEL C 1.6 106 AUTO REF REFINISH ADD FOR EDGE&INSIDE 0.8 107 102008 BDY REMOVE/REPLACE REAR BODY FLOOR,PAN 58311-02904 353.36 10.0 # 108 AUTO REF REFINISH FLOOR PAN ASSY 1.5 109 102011 BDY REMOVE/REPLACE R REAR BODY FLOOR PAN EXT 58313-02040 55.96 INC 110 102012 BDY REMOVE/REPLACE L REAR BODY FLOOR PAN EXT 58314-02040 55.96 INC 111 102990 BDY REMOVE/REPLACE R REAR COMBINATION LAMP ASSEMBLY ORDER FROM DEALER 114.35 INC # 112 102991 BDY REMOVE/REPLACE L REAR COMBINATION LAMP ASSEMBLY ORDER FROM DEALER 114.35 INC # 113 102044 BDY REMOVE/REPLACE R BACKUP LAMP ASSEMBLY 81670-02030 71.37 INC # 114 102045 BDY REMOVE/REPLACE L BACKUP LAMP ASSEMBLY 81680-02030 71.37 INC # 115 102074 BDY OVERHAUL REAR COVER ASSY 0.9 116 102077 BDY REMOVE/REPLACE REAR BUMPER COVER 52159-02912 191,21 INC 117 AUTO REF REFINISH REAR BUMPER COVER C 2.3 118 102103 BDY REMOVE/REPLACE R REAR BUMPER SEAL 52591-02050 17.29 INC 119 102104 BDY REMOVE/REPLACE L REAR BUMPER SEAL 52592-02040 16.78 INC 120 102994 BDY REMOVE/REPLACE REAR BUMPER IMPACT ABSORBER 52615-12120 64.13 INC 121 102109 BDY REMOVE/REPLACE REAR BUMPER REINFORCEMENT 52023-02080 159.47 INC 122 AUTO REF ADD'L OPR CLEAR COAT 4.4 123 AUTO ADD'L COST PAINT/MATERIALS 450.00* 124 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL 3.00* * Judgement Item # - Labor Note Applies C - Included in Clear Coat Calc i Prior Damage UNKNOWN I I I i ESTIMATE RECALL NUMBER: 6/22/2005 12:21:32 YN002584-88 Ultra Mate is a Trademark of Mitchell International Mitchell Data Version: MAY_05_A Copyright (C) 1994- 2003 Mitchell International Page 3 of 5 UltraMate Version: 5.0.206 All Rights Reserved (� (cp e 6122/200S Dat1221 PM Estimate ID: YNO02584-88 Estimate Version: 0 Committed Profile ID: CUSTOMIZED Add'I Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 86.9 70.00 0.00 0.00 6,083.00 Taxable Parts 13,475.45 Refinish 34.8 70.00 0.00 0.00 2,436.00 Sales Tax @ 7.375% 993.81 Mechanical 8.7 70.00 0.00 0.00 609.00 Total Replacement Parts Amount 14,469.26 Non-Taxable Labor 9,128.00 Labor Summary 130.4 9,128.00 III. Additional Costs . Amount IV. Adjustments Amount Taxable Costs 45D.00 Insurance Deductible 500.00- Sales Tax @ 7.375% 33.19 Customer Responsibility 500.00- Non-Taxable Costs 3.00 Total Additional Costs 486.19 I. Total Labor: 9,128.00 it. Total Replacement Parts: 14,469.26 III. Total Additional Costs: 486.19 Gross Total: 24,083.45 IV. Total Adjustments: 500.00- Net Total: 23,583.45 Point(s) of Impact 12 Front Center(P), 6 Rear Center(S) Body Shop: CO-PART SALVAGE POOL Inspection Site: CO-PART SALVAGE POOL Address: 282 5TH STREET Address: 282 STH STREET VALLEJO, CA 94590 VALLEJO, CA Work Phone: (800) 526-3536 Inspection Date: 6/22/2005 NOTE: THIS IS NOT AN AUTHORIZATION TO REPAIR. THE UNDERSIGNED REPAIR FACILITY AGREES TO REPAIR THIS VEHICLE USING INDUSTRY ACCEPTED EQUIPMENT AND REPAIR METHODS, AND TO COMPLETE AND GUARANTEE SAFE REPAIRS AT A PRICE OF $ INCLUDING ALL CHARGES INCIDENTAL THERETO. AGREED PRICE BY: THE WRITING OF THIS ESTIMATE DOES NOT CONFIRM COVERAGE OR GUARANTEE OR -IMPLY ACCEPTANCE OF LIABILITY. THIS ESTIMATE IS FOR THE REPAIR OF DAMAGE CLAIMED BY THE OWNER OF THE VEHICLE, AND THIS ESTIMATE IS NOT AN ADMISSION THAT THE DAMAGE RESULTED FROM THE ALLEDGED LOSS. SHOPS SHOULD FORWARD ALL SUPPLEMENTS TO: RICH NEWBURN. CELL # 916-240-2267 . FAX # 707-966-0810. NO SUPPLEMENTS WITHOUT PRIOR NOTICE, ALL SUPPLEMENTS MUST INCLUDE THE FIRST PAGE OF THI+ ESTIMATE. I - I I ESTIMATE RECALL NUMBER: 6/22/2005 12:21:32 YNO02584-88 UltraMate is a Trademark of Mitchell International Mitchell Data Version: MAY 05-A Copyright(C) 1994- 2003 Mitchell International Page 4 of 5 UltraMate Version: 5.0.2D6 AII;Rights Reserved CD 'c�) Date: 6/22/2005 12:21 PM Estimate ID: YN002584-88 Estimate Version: 0 Committed Profile ID: CUSTOMIZED i I ESTIMATE RECALL NUMBER: 6/22/2005 12:21:32 YN002584-88 UltraMate is a Trademark of Mitchell International Mitchell Data Version: MAY 05-A Copyright(C) 19.94- 2003 Mitchell International Page 5 of 5 UltraMate Version: 5.0.206 All Rights Reserved f�. (C Date: 6/22/200512:21 PM Estimate ID: YN002584-88 ,• Estimate Version: 0 Committed Profile ID: CUSTOMIZED I MERCURY CASUALTY COMPANY 11150 INTERNATIONAL DR. RANCHO CORDOVA, CA 95670 (916) 636-1534 Damage Assessed By: Rich Newburn#4843 Adjustor: SEAN TIMMONS (916) 636-1534 Condition Code: Good Type of Loss: Collision Date of Loss: 6/ 5/2005 Accident Date: 6/ 5/2005 Deductible: 500.00 Policy No: AP05291255 Claim Number: YN002584-88 Insured: CAROL KRETCHMER Address: 1242 COMICE PARKWAY BRENTWOOD, CA 94513 Telephone: Home Phone: (925) 634-3290 Mitchell Service: '911754 Description: 2005 Toyota Corolla S Vehicle Production Date: 4/04 Body Style: 40 Sed Drive Train: 1.81-Inj 4 Cyl 4A FWD VIN: INXBR32E05Z344271 License: 5HIB548 CA OEM/ALT: 0 Search Code: None Color: GRAY/MET Options: ALUM/ALLOY WHEELS,AIR CONDITIONING, POWER STEERING, POWER WINDOWS POWER DOOR LOCKS,TILT STEERING WHEEL, CRUISE CONTROL, ELECTRIC DEFOGGER AUTOMATIC TRANSMISSION, AM-FM STEREO/CDPLAYER(SINGLE) Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 100027 BDY OVERHAUL FRT COVER ASSY 1.8 # 2 100028 BDY REMOVE/REPLACE FRT ADD W/FOG LAMPS 0.3 3 102343 BDY REMOVE/REPLACE FRT BUMPER COVER 52119-02947 185.81 INC # 4 AUTO REF REFINISH FRT BUMPER COVER C 2.5 5 100032 BDY REMOVE/REPLACE R FRT BUMPER PROTECTOR 52541-02020 2.07 INC 6 100033 BDY REMOVE/REPLACE L FRT BUMPER PROTECTOR 52541-02020 2.07 INC 7 102354 BDY REMOVE/REPLACE R FRT BUMPER BRACKET 52115-02061 19.83 INC 8 102355 BDY REMOVE/REPLACE L FRT BUMPER BRACKET 52116-02061 19.83 INC 9 102359 BDY REMOVE/REPLACE FRT BUMPER IMPACT ABSORBER 52611-02100 62.19 INC 10 102362 BDY REMOVE/REPLACE FRT BUMPER REINFORCEMENT 52021-02060 147.99 INC 11 100045 BDY REMOVE/REPLACE R FRT BUMPER REINFORCEMENT BRKT 52145-02080 25.24 INC 12 100046 BDY REMOVE/REPLACE L FRT BUMPER REINFORCEMENT BRKT 52146-02070 25.55 INC 13 102371 BDY REMOVE/REPLACE R FRT BUMPER SPOILER 76081-02030-CO 350.10 INC 14 102372 BDY REMOVE/REPLACE L FRT BUMPER SPOILER 76083-02030-CO 350.10 INC 15 102363 BDY REMOVE/REPLACE FRT CTR BUMPER SPOILER 76082-02900 119.43 INC 16 100064 BDY REMOVE/REPLACE GRILLE ( 53100-02020 97.96 INC 17 102382 BDY REMOVE/REPLACE R FRT COMBINATION LAMP ASSEMBLY 81110-02370 214.87 INC # 18 AUTO BDY CHECK/AD3UST HEADLAMPS 0.4 19 102383 BDY REMOVE/REPLACE L FRT COMBINATION LAMP ASSEMBLY 81150-02360 214.87 INC # 20 102394 BDY REMOVE/REPLACE R FOG LAMP ASSEMBLY 81210-02060 203.06 INC # 21 102395 BDY REMOVE/REPLACE L FOG LAMP ASSEMBLY 81220-02060 203.06 INC # 22 102408 BDY REMOVE/REPLACE HOOD PANEL 53301-02130 242.13 1.2 I ESTIMATE RECALL NUMBER: 6/22/2005 12:21:32 YN002584-88 UltraMate is a Trademark of Mitchell International . Mitchell Data Version: MAY_05_A Copyright (C) 1994 - 2003 Mitchell International Page 1 of 5 UltraMate Version: 5.0.206 All Rights Reserved t i Date: 6/22/200512:21 PfN Estimate ID: YND02584-88 Estimate Version: 0 Committed Profile ID: CUSTOMIZED 23 AUTO REF REFINISH HOOD OUTSIDE C 2-3 24 AUTO REF REFINISH HOOD UNDERSIDE 1.2 25 100116 BDY REMOVE/REPLACE HOOD INSULATOR 53341-02070 121.06 IN C 26 100118 BDY REMOVE/REPLACE FRT HOOD SEAL 53381-02070 20.29 0.2 27 100122 BDY REMOVE/REPLACE R HOOD HINGE 53410-12410 23.41 0.2 # 28 AUTO REF REFINISH R HINGE 0.3 29 100123 BDY REMOVE/REPLACE L HOOD HINGE 53420-12330 23.41 0-2 # 30 AUTO REF REFINISH L HINGE , 0.3 31 100130 BDY REMOVE/REPLACE HOOD SUPPORT ROD 53440-02050 7.89 0.1 32 100133 BDY REMOVE/REPLACE HOOD LATCH 53510-02230 40.27 INC 33 100136 BDY REMOVE/REPLACE HOOD SHIELD LOCK 53525-33040 12.55 34 100137 BDY REMOVE/REPLACE HOOD RELEASE CABLE 53630-02061 23.69 1.0 # 35 100140 BDY REMOVE/REPLACE HOOD RELEASE CABLE HANDLE 53601-02020-B1 32.47 INC 36 100145 BDY REMOVE/REPLACE COOLING RADIATOR 16400-OD240 462.95 INC 37 100149 BDY REMOVE/REPLACE R UPR COOLING RAD•MTG BRACKET 16533-OD030 14.80 38 100150 BDY REMOVE/REPLACE L UPR COOLING RAD MTG BRACKET 16533-OD030 14.80 39 100151 BDY REMOVE/REPLACE R UPR COOLING SUPPORT 16523-OD030 3.09 40 100152 BDY REMOVE/REPLACE L UPR COOLING SUPPORT 16523-OD030 3.09 41 100153 BDY REMOVE/REPLACE R LWR COOLING SUPPORT 16535-OD040 10.66 42 100154 BDY REMOVE/REPLACE L LWR COOLING SUPPORT 16535-OD040 10.66 43 102412 BDY REMOVE/REPLACE COOLING FAN SHROUD ORDER FROM DEALER 98.83 0.4 # 44 100157 BDY REMOVE/REPLACE COOLING FAN BLADE 16361-OD090 50.22 INC # 45 102416 BDY REMOVE/REPLACE COOLING FAN MOTOR ORDER FROM DEALER 142.04 INC # 46 102420 BDY REMOVE/REPLACE UPR COOLING RADIATOR HOSE ORDER FROM DEALER 15.86 0.1 # 47 100160 BDY REMOVE/REPLACE LWR COOLING RADIATOR HOSE 16572-OD120 14.38 0.1 # 48 100176 BDY REMOVE/REPLACE COOLING DRIVE BELT ORDER FROM DEALER 27.67 0.5 49 100178 MCH REMOVE/REPLACE EVACUATE&RECHARGE A/C -M 1.4 50 100179 MCH REMOVE/REPLACE A/C REFRIGERANT RECOVERY -M 0.3 51 102428 MCH REMOVE/REPLACE AIR COND CONDENSER -M ORDER FROM DEALER 409.55 INC 52 102429 MCH REMOVE/REPLACE FRT AIR COND EVAPORATOR PIPE -M 88710-12720 152.48 0.9 # 53 102322 MCH REMOVE/REPLACE REAR AIR COND EVAPORATOR PIPE -M 88716-02380 22.70 0.4 # 54 100224 BDY REMOVE/REPLACE R FENDER PANEL 53801-02070 222.06 1.6 # 55 AUTO REF REFINISH R FENDER OUTSIDE C 1.4 56 AUTO REF REFINISH R FENDER EDGE C 0.5 57 100225 BDY REMOVE/REPLACE L FENDER PANEL 53802-02070 222.06 1.6 # 58 AUTO REF REFINISH L FENDER OUTSIDE C 1.4 59 AUTO REF REFINISH L FENDER EDGE C 0.5 60 102440 BDY REMOVE/REPLACE R FENDER LINER 53875-12380 70.02 INC 61 102441 BDY REMOVE/REPLACE L FENDER LINER 53876-12370 70.02 INC 62 100254 BDY REMOVE/REPLACE FRONT BODY RADIATOR SUPPORT -S ORDER FROM DEALER 317.84 7.7 # 63 AUTO REF REFINISH RADIATOR SUPPORT COMPLETE 1.7 64 100272 BDY REMOVE/REPLACE R ENGINE SPLASH!SHIELD 51441-02100 41.87 INC 65 100273 BDY REMOVE/REPLACE L ENGINE SPLASHISHIELD 51442-02170 34.70 INC 66 AUTO REF REFINISH R LOWER SIDE RAIL COMPLETE 1.0 67 AUTO REF REFINISH L LOWER SIDE RAIL COMPLETE 1.0 68 100292 BDY REMOVE/REPLACE R FRONT BODY APRON ASSY -S 53701-02120 190.77 6.0 # 69 AUTO REF REFINISH R APRON ASSEMBLY COMPLETE 1.0 70 100293 BDY REMOVE/REPLACE L FRONT BODY APRON ASSY -S 53702-02060 190.77 6.0 # 71 AUTO REF REFINISH L APRON ASSEMBLY COMPLETE 1.0 72 100311 BDY REMOVE/REPLACE R OTR FRONT BODY SIDE RAIL -S 57115-02030 103.40 INC # 73 100312 BDY REMOVE/REPLACE L OTR FRONT BODY SIDE RAIL -S 57116-02030 96.54 INC # 74 100313 BDY REMOVE/REPLACE R OTR FRONT BODY RAIL EXTENSION -S 57113-02040 31.27 INC # 75 100314 BDY REMOVE/REPLACE L OTR FRONT BODY RAIL EXTENSION -S 57114-02040 30.29) INC # 76 100315 BDY REMOVE/REPLACE R INR FRONT BODY SIDE RAIL -S 57101-02902 346.81 4.0 # 77 100316 BDY REMOVE/REPLACE L INR FRONT BODY SIDE RAIL -S 57102-02904 296.43 4.0 # 78 100325 BDY REMOVE/REPLACE R INR FRONT BODY REAR SIDE RAIL -S 57191-02090 132.84 3.5 # 79 100326 BDY REMOVE/REPLACE L INR FRONT BODY REAR SIDE RAIL -S 57192-02090 132.84 3.5 # BO 100327 BDY REMOVE/REPLACE R FRONT BODY RAIL REINF -S 57033-02030 159.67 INC # 81 100328 BDY REMOVE/REPLACE L FRONT BODY RAIL REINF -S 57034-02030 159.67 INC # 82 100329 BDY REMOVE/REPLACE R FRONT BODY BRACKET 57107-02900 104.06 i ESTIMATE RECALL NUMBER: 6/22/2005 12:21:32 YNO02584-88 UltraMate is a Trademark of Mitchell International Mitchell Data Version: MAY 05-A Copyright (C) 1994 - 2003 Mitchell International Page 2 of 5 UltraMate Version: 5.0.206 All'Rights Reserved CD {c�) Date: 6/22/2005 12:21 PM Estimate ID: YNO02584-88 Estimate Version: 0 Committed Profile ID: CUSTOMIZED 83 100330 BDY REMOVE/REPLACE L FRONT BODY BRACKET 57198-02900 158.67 84 100331 MCH REMOVE/REPLACE SUB-FRAME CROSSMEMBER -M ORDER FROM DEALER 1,078.96 3-5 # 85 100335 MCH REMOVE/REPLACE SUB-FRAME SUPPORT -M 51204-02050 , 192.46 INC # 86 102450 MCH REMOVE/REPLACE AIR BAG MODULE-DRIVER FRONT -M 45130-02212-B1 648.10 IN C 87 100349 MCH REMOVE/REPLACE AIR BAG SPIRAL CABLE -M 84306-02110 202.00 0.7 88 102453 MCH REMOVE/REPLACE AIR BAG MODULE-PASSENGER FRONT -M 73970-02050-B1 751.66 0.5 89 102455 MCH REMOVE/REPLACE CTR AIR BAG SENSOR -M ORDER FROM DEALER 215.42 0.4 # 90 102456 MCH REMOVE/REPLACE R FRT AIR BAG SENSOR -M 89173-09120 54.89 0.4 # 91 102457 MCH REMOVE/REPLACE L FRT AIR BAG SENSOR -M 89173-09120 54.89 0.2 # 92 AUTO BDY REMOVE/REPLACE BOTH QTRS/REAR BODY PANEL 30.1 93 101800 BDY REMOVE/REPLACE R QUARTER OUTER PANEL 61601-02150 494.53 INC # 94 AUTO REF REFINISH R QUARTER PANEL OUTSIDE C 1.6 95 AUTO REF REFINISH R QUARTER PANEL EDGE C 0-5 96 AUTO REF REFINISH R ADD FOR PILLAR C 0-5 97 101801 BDY REMOVE/REPLACE L QUARTER OUTER PANEL 61602-02130 494.53 INC # 98 AUTO REF REFINISH L QUARTER PANEL OUTSIDE C 1.6 99 AUTO REF REFINISH L QUARTER PANEL EDGE C 0.5 100 AUTO REF REFINISH L ADD FOR PILLAR C 0.5 101 101887 BDY REMOVE/REPLACE LUGGAGE LID PANEL 64401-02100 380.44 1-5 102 AUTO REF REFINISH LUGGAGE LID C 1.8 103 AUTO REF REFINISH LUGGAGE LID UNDERSIDE 1.1 104 102986 BDY REMOVE/REPLACE REAR BODY PANEL 58307-12A10 264.39 INC # 105 AUTO REF REFINISH REAR BODY PANEL C 1.6 106 AUTO REF REFINISH ADD FOR EDGE &INSIDE 0.8 107 102008 BDY REMOVE/REPLACE REAR BODY FLOOR PAN 58311-02904 353.36 10.0 # 108 AUTO REF REFINISH FLOOR PAN ASSY 1.5 109 102011 BDY REMOVE/REPLACE R REAR BODY FLOOR PAN EXT 58313-02040 55.96 INC 110 102012 BDY REMOVE/REPLACE L REAR BODY FLOOR PAN EXT 58314-02040 55.96 INC 111 102990 BDY REMOVE/REPLACE R REAR COMBINATION LAMP ASSEMBLY ORDER FROM DEALER 114.35 INC # 112 102991 BDY REMOVE/REPLACE L REAR COMBINATION LAMP ASSEMBLY ORDER FROM DEALER 114.35 INC # 113 102044 BDY REMOVE/REPLACE R BACKUP LAMP ASSEMBLY 81670-02030 71.37 INC # 114 102045 BDY REMOVE/REPLACE L BACKUP LAMP ASSEMBLY 81680-02030 71.37 INC # 115 102074 BDY OVERHAUL REAR COVER ASSY 0.9 116 102077 BDY REMOVE/REPLACE REAR BUMPER COVER 52159-02912 191.21 INC 117 AUTO REF REFINISH REAR BUMPER COVER C 2.3 118 102103 BDY REMOVE/REPLACE R REAR BUMPER SEAL 52591-02050 17.29 INC 119 102104 BDY REMOVE/REPLACE L REAR BUMPER SEAL 52592-02040 16.78 INC 120 102994 BDY REMOVE/REPLACE REAR BUMPER IMPACT ABSORBER 52615-12120 64.13 INC 121 102109 BDY REMOVE/REPLACE REAR BUMPER REINFORCEMENT 52023-02080 159.47 INC 122 AUTO REF ADD'L OPR CLEAR COAT 4.4 123 AUTO ADD'L COST PAINT/MATERIALS 450.00 * 124 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL 3.00 * * - Judgement Item # - Labor Note Applies C - Included in Clear Coat Calc I I i Prior Damage UNKNOWN i I ESTIMATE RECALL NUMBER: 6/22/2005 12:21:32 YNO02584-88 UitraMate is a Trademark of Mitchell International Mitchell Data Version: MAY 05-A Copyright(C) 1994- 2003 Mitchell International Page 3 of 5 UltraMate Version: 5.0.206 All Rights Reserved Date: 6/22/200512:21 PM Estimate ID: YNO02584-88 Estimate Version: 0 Committed Profile ID: CUSTOMIZED I i Add'I j Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 86.9 70.00 0.00 0.00 6,083.00 Taxable Parts 13,475.45 Refinish 34,8 70.00 0.00 0.00 2,436.00 Sales Tax @ 7.375% 993.81 _ Mechanical 8.7 70.00 0.00 0.00 609.00 Total Replacement Parts Amount 14,469.26 Non-Taxable Labor 9,128,00 Labor Summary 130.4 9,128.00 III. Additional Costs Amount IV. Adjustments Amount Taxable Costs 450.00 Insurance Deductible 500.00- Sales Tax @ 7.375% 33.19 Customer Responsibility 500.00- Non-Taxable Costs 3.00 Total Additional Costs 486.19 I. Total Labor: 9,128.00 II. Total Replacement Parts: 14,469.26 III. Total Additional Costs: 486.19 Gross Total: 24,083.45 IV. Total Adjustments: 500.00- Net Total: 23,583.45 Point(s) of Impact 12 Front Center(P), 6 Rear Center(S) Body Shop: CO-PART SALVAGE POOL Inspection Site: CO-PART SALVAGE POOL Address: 282 STH STREET Address: 282 STH STREET VALLEJO, CA 94590 VALLEJO, CA Work Phone: (800) 526-3536 Inspection Date: 6/22/2005 NOTE: THIS IS NOT AN AUTHORIZATION TO REPAIR. THE UNDERSIGNED REPAIR FACILITY AGREES TO REPAIR THIS VEHICLE USING INDUSTRY ACCEPTED EQUIPMENT AND REPAIR METHODS, AND TO COMPLETE AND GUARANTEE SAFE REPAIRS AT A PRICE OF $ INCLUDING ALL CHARGES INCIDENTAL THERETO. AGREED PRICE BY: THE WRITING OF THIS ESTIMATE DOES NOT CONFIRM COVERAGE OR GUARANTEE OR IMPLY ACCEPTANCE OF: LIABILITY. THIS ESTIMATE IS FOR THE REPAIR OF DAMAGE CLAIMED BY THE OWNER OF THE VEHICLE, AND THIS ESTIMATE IS NOT AN ADMISSION THAT THE DAMAGE RESULTED FROM THE ALLEDGED LOSS. ` I SHOPS SHOULD FORWARD ALL SUPPLEMENTIS TO: RICH NEWBURN. CELL # 916-240-2267. FAX # 707-966-'0810. NO SUPPLEMENTS WITHOUT PRIOR NOTICE, ALL SUPPLEMENTS MUST INCLUDE THE FIRST PAGE OF THIS ESTIMATE. I ESTIMATE RECALL NUMBER: 6/22/2005 12:21:32 YNO02584-88 UltraMate is a Trademark of Mitchell International Mitchell Data Version: MAY-05_A Copyright(C) 1994- 2003 Mitchell International Page 4 of 5 UltraMate Version: 5.0,206 A111 Rights Reserved i i G © CD O. d CVR Report I www.dmviink.com Vehicle Registration Inquiry Report 76002733 * All inquiries conducted on the system must adhere to the requirements of your requester agreement, , and must be for the business purpose authorized in that agreement. * No inquiries may be transmitted or given to anyone outside of the requester' s company. ******************************************************************************** Reference: YNO02584-88 JB Date: 06/24/2005 Requested: 5HJB548 Time: 08 :13 :37 AM Reason: Insurance Claim User ID: KG Loss Date: 06/05/2005 -------------------------------------------------------------------------------- ----------------------------- REGISTERED OWNER INFO ---------------------------- NAME: BELT PATRICIA M OR KRETCHMER CAROL M ADDRESS: 1242 COMICE PARKWAY CITY: BRENTWOOD COUNTY: CONTRA COSTA ZIP CODE: 94513; ------------------------- LEGAL OWNER (LIENHOLDER) INFO ------------------------ NAME: TOYOTA MTR CRDT CORP ADDRESS: PO BX 105386 ATLANTA CITY: GA ZIP CODE: 30348 --------------------------------- VEHICLE INFO ------------- -------------------- EXPIRES: 05/08/06 VLF: EJ VIN: 1NXBR32E05Z344271 TYPE: 11 :Regular - Automobile LICENSE: SHJB548 ENGINE NO: YR MODEL: 2005 WEIGHT: YR SOLD: 00/00/04 AXLE: * YEAR: FUEL: G BODY TYPE: SD VEH TYPE: 12 EQUIP NO: HULL NO: MAKE: TOYT SUP PLATE: ----------------------------------------'---------------------------------------- .Date of latest Registration Card Issuance: 05/17/2005 Date of latest Ownership Certificate Issuance: 06/12/2004 .: --------------------------------- RECORD STATUS ------------------------------ - 06/04/04 SMOG DUE 05/08/11 NO MAILING ADDRESS 05/06/2004-ODOMETER: 11 MILES ACTUAL MILEAGE ------------------------------ End of LVS Printout ----------------------------- Computerized Vehicle Registration- - j - - Fee Calculation Report -------------------------------------------------------------------------------- Transaction: Total Loss Settlement Request: Reference: 5HJB548 Date: 06/24/2005 Time: 08 :17:56 AM User: KG Loss Date: 06/05/2005 I ELP Status : None Out-of-State: No Last Reg. Period: 05/08/2005 Fee based on CONTRA COSTA County. -------------—--------—------------------------------------------------------- ************************************ NOTICE ******+***************************** * ESTIMATE is based on data received from DMV and assumes that there is I CVR(800)333-6995 10 i CD no transfer taking place. It does not include charges/credits such as duplicates, transfers, non-ops, ets. County fees are based on the registered Owners county and zip code if available. ---------------------------------- SETTLEMENT ---------------------------------- FOR THE PERIOD FROM 05/08/2005 TO 05/08/2006 ---------------------------------------- Registration Fee $ 31 CHP Fee $ 9 Vehicle License Fee $ 340 Vehicle License Fee Reduction (67.5%) $ -230 Transfer Fee $ 15 Air Quality $ 6 SAFE $ 1 Auto Theft/DUI $ 1 Abandoned Vehicle Abatement $ 1 Fingerprint Fee $ 1 Smog Abatement Fee (2005) $ 12 Vehicle License Fee Used (1 mo. ) $ -9 SETTLEMENT TOTAL: $ 1,78 )k � -------------------------- PREVIOUS REGISTRATION FEES --------------------------- FOR THE PERIOD FROM 05/08/2005 TO 05/08/2006 ---------------------------------------- Registration Fee $ 31 CHP Fee $ 9 Vehicle License Fee $ 340 Vehicle License Fee Reduction (67.50) $ -230 Air Quality $ 6 SAFE $ 1 Auto Theft/DUI $ 1 Abandoned Vehicle Abatement $ 1 Fingerprint Fee $ 1 Smog Abatement Fee (2005) $ 12 ---------------------------------------- TOTAL FEES PAID: $ 172 -------------------------------- LICENSE REFUND -------------------------------- ---------------------------------------- Vehicle License Fee $ 340 Vehicle License Fee Reduction (67.5%) $ -230 Vehicle License Fee Used (1 mo.) $ -9 DMV Administration Fee $ -16 ---------------------------------------- REFUND: $ 85 --------------------------------------- ---------------------------------------- TOTAL REFUND: $ 85 ----------------------------------------------------------------------------- Fee Calculations include all changes 'as of 1/1/2005 I End of Fee Calculation Report i i I i CVR(800)333-6995 panJasab sTU6RI IIV 90Z'0'S :uo!sj@A aaeWeialn S 30 S abed leuo!Tewa4ul IlaUo7!W EOOZ - b66T (J) 4U6!a/\do3 d S0 AVW :uolsaaA edea I(aUo71W leuopewaauI Ila4oa!W do )iaewapeil e s! aaeweilin SS-b95ZooN,l ZE:TZ:ZT SOOZ/ZZ/9 ndd9wr)N 11VDTd 31VWI1S3 I a3ZIWolSno :QI alyoJd pala!wwoD „ 0 :uols'aA alew!1s3 99-b95Z00NX :oI a)4M!;s3 Wd TZ:ZT S00Z/ZZ/9 :azea ) i CD I DMV License Plate/Vin Number/Driver's License Request Purpose for running request through CVR vs.the Basic Claims System Total Loss r° Requestor's Name: Kiuwha Gamboa Ex(: 2289 Mgt/Sup Date Stamp: Claim Number:Nt k Cgt)564-SDate of Loss: Information being requested: T License Plate Numbel Vin Number Vehicle Description Year: Make: 0 Model: The loss vehicle involved belongs to: Insd: Clint: Other,explain: Vehicle registeredCity. County: Type of Claim Theft, Fire, FauGndel,Total Loss,Other; explain: Total Loss Driver's License Number Name(If running DLN) The information being requested was obtained from: The Insured on (Date) Registered Owner on _ (Date) The C-9 The Police Report (Date received Police Repord) The Claimant on (Date) Other,explain: ti�> °n (Phone, mail,NICB, Phnto etc. .) This is a vehicle that showed up on (he ANI(altach the request to the claim file for supervisor review).The ANI was received on 1 have called the insured to v'erify the vehicle is still owned. I have no( had a rcply -!-- _ _ Insured no lonCer owns vchicic. P erlurtl r,vh:+ e ininho s I I v Wed Jun-22-2005 02:37pm Claim No:YN 584-881 From:MERCURY INSURANCE.CO t i gay� x ~r 'fit RM,F NSp'4G � ..A yr ,= �jrr, x°' J , 5 Y . t l a � L Kai'Ti� �.: •"_...e•.v:`2 5' M � 5' .""^tJ' ^-+^j'•� SM. Y K a -• :fl�..ti� �Y� t� '{t' � '^ Lri>t, xis � .S '�'�.t � �9 'j � _ f $ 1.J .� � � Vy�✓�ti.ti Y Y FF'4 1. a" I I � •i H 1 M >ti a mu '1�,���.h�+�h4p �'4� fIs 4Y,y'f �„�,. +, h ,Y♦� <r':.' t+'4 rv: >I .!.i;�' �^� '. � ¢ �^�1°.�����1 :(.�f y°�^' `S. 2 c\tr -+ �t i '.til i ♦ 5 �V�i f -• f r4� I S w ''p - t 06 22.2005 10 15:,. . err•+ Zl t • .♦.� - O6 �2 2005 �Oft16�y . � #epi fr'}•y���,yz"-3 W�� f/t arr a r : .`." )inti •'. Kt,� '''fit,'... �F u '_f R NSAµ a`.". �.� - �'; n �� .=^rsv`� { �• Cr o s-.-'' .lw. is A' � lril� fr 'At� tC of l � �r 1 Jr OB.22-2005 10 16 ' MERCURY INSURANCE.COM i i Phone Fax Claim No YNO02584-881 Adjuster TIMMONSS 1VIN 1NXBR32EO5Z344271 2005 Toyota Corolla Owner KRETCHMER C Appraiser NEWBURN R""Policy AP05291255 D/Loss 6/5/2005 DRP No 4843 Insured KRETCHMER C TOTALLOSS Printed with Eazylmage from GO Media, Inc. 1-888-546-7593-www.eazyimage.com Wed Jun-22-2005 02:37pm Claim No:YNO02584-881 From:MERCURY INSURANCE.COM V— AND t . ar` frg1,1 ,41 �.� "!�' 1f1�;�•� hi' � cGf. J R - I 4 yiiff M r+ 1 �7 All : FFF ipv .� s +y t Y I x a MERCURY INSURANCE.COM Phone Fax Claim No YNO02584-881 Adjuster TIMMONS S IVIN 1NXBR32EO5Z344271 2005 Toyota Corolla Owner KRETCHMER C Appraiser NEWBURN R.Pohcy AP05291255 D/Loss 6/5/2005 DRP No 4843 Insured KRETCHMER C TOTALLOSS Printed with Eazylmage from GO Media, Inc. 1-888-546-7593-www.eazyimage.com Wed Jun-22-2005 02:37pm Claim No:_YN002584-881 From:MERCURY INSURANCE.CO� r C I ` I 24 soh� v W � J6e'J•y. *Y� I I ' I f MERCURY INSURANCE.COM Phone Fax Claim No YNO02584-881 Adjuster TIMMONS S VIN 1 NXBR32EO5Z344271 2005 Toyota Corolla Owner KRETCHMER C Appraiser NEWBURN R Policy AP05291255 DJLoss 6/5/2005 DRP No 4843 insured KRETCHMER C TOTAL LOSS Printed with Eazylmage from GO Media, Inc. 1-888-546-7593-www.eazyimage.com CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 'V/2a9wcr�+ /D ' `o d BOARD AC ION: (iQi�'7C�i8�/� G� GatY1s O i 4�V 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 c Board of Supervisors. (Paragraph IV below), given I i Pursuant to Government Code Section 913 and E DEC il J Zi;^i 915.4. Please note all"Warnings". C> • ry AMOUNT: 1k.,.i,T&8XCESS„OF $25,000.00, SUPERIOR I COURT TO HAVE JURISDICTION CLAIMANT: FERNANDO SALGUERA ATTORNEY: ROBERT J. BELES DATE RECEIVED: DECEMBER 05/05 ADDRESS: THE ORDWAY BUILDING BY DELNERYTO CLERK ON: DECEMBER 05/05 i I KAISER PLAZA, SUITE 2300 OAKLAND,. CA 94612-3642BY MAIL POSTMARKED: DECEMBER 02/05-'-_ ( FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWE Eerk Dated: DECEMBER 05, 2005 By; Deputy10 II. MOM: County Counsel, TO: Clerk of the Board of Sup rvisors I ( his claim complies substantially with Sections 910 and 910.2. O 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 i claimant's right to apply for leave to present a late claim (Section 911.3). O Other: G„ I r Dated: if OS� By; Deputy County Counsc I III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) O Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: i (✓f This Claim is rejected in full. i O Other: i 1 I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated:v47? � �� eJ JOHN SWEETEN, CLERK,By , Deputy Clerk WARNING(Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposite in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. ' AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California,postage full} prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:\ai r, c2o4OHN SWEETEN, CLERK By / j� Deputy Clerk ROBERT J. BELES ATTORNEY AT LAW THE ORDWAY BUILDING PHONE (5 1 O) 836-0100 1 KAISER PLAZA. SUITE 2.300 OAKLAND. CALIFORNIA 94612-3642 FAx (51 0) 832-3690 Tuesday, November 22, 2005 Clerk, Board of Supervisors, Contra Costa County 651 Pine Street, 11th Floor Martinez, CA 94553-1229 Sheriffs Department, Contra Costa County 651 Pine St. 7th Floor Martinez, CA 94553-1229 CLAIM FOR DAMAGES Claim against: Sheriffs Department, Contra Costa County, Deputy W. Baker and other unknown deputies of the Sheriffs Department, Contra Costa County. Claimant's Name: Fernando Sal uera Claimant's Address: c/o Robert J. Beles, 1 Kaiser Plaza suite 2300 Oakland CA 94612 Address to which notices are c/o Law Offices of Robert J. Beles to be sent: 1 Kaiser Plaza, Suite 1750 Oakland, California 94612 Tel. (510) 836-0100, fax (510) 832-3690 Date and Time of Incident: Sunday, November 20, 2005, 1:00 pm Location of Incident: El Sobrante, County of Contra Costa, California. Description of Incident: On Sunday, November 20, 2005, in El Sobrante, County of Contra Costa, at approximately 1:00 pm, claimant Fernando Salguera was driving his truck in El Sobrante. He came to an abrupt stop to avoid pedestrians,triggering the air bags in his truck. He then parked his truck and began walking home. Unknown sheriff's deputies approached him, ordered him to get on the ground, and began beating him and hitting his head on the ground, after which they falsely arrested him for possession of a "stolen" vehicle (his own truck), assaulting police officers (Penal Code section 243(b)), threatening police officers (Penal Code section 422) resisting arrest(Penal Code section 69),damage to property (Penal Code section 594), and a non-existent crime, Penal Code 7. The deputies and/or Sheriff's Department set an excessive bail for claimant of$200,000. Claimant had to pay a premium of $19,015. ROBERT J. BELES I KAISER PLAZA, STE 2300 OAKLAND, CALIFORNIA 94612-3642' PHONE (510) 836-0100 FAX (510) 832-3690 page 2 Torts Committed: Unknown deputies, Sheriffs Department, Contra Costa County: use of excessive force, general negligence, false arrest, malicious prosecution, denial of civil rights. Sheriffs Department,Contra Costa County: False arrest,malicious prosecution,respondeat superior liability, negligent supervision, hiring, training, and placement of unknown deputies of the Sheriffs Department, Contra Costa County. Damages Incurred: Pain, suffering, legal and other expenses, worry, anguish, humiliation, inconvenience, emotional distress and mental anguish, other damages not yet known. Officials, employees, and agents causing damages: Unknown deputies of the Sheriffs Department, Contra Costa County. Itemization of claim: Specials presently unknown Generals In excess of $25,000, Superior court to have jurisdiction Attorney's fees presently unknown Total In excess of $25,000, Superior court to have jurisdiction Signed by or on behalf of claimant: Robert J. Beles Attorney for Cl 'mant Dated: a " 2 F CEIVED C 0 5 2005 ROBERT I BF,I,Ec 1,,.- ARO 0 ,'rtRV(s'LiC8 ATTORNEY AT LAW !TI?aCOCiACO. THE ORDWAY BUILDING PHONE(510)836-0100 I KAISER PLAZA,SUITE 2300 -------------- OAKLAND,CA 94612 FAX (510)832-3690 Friday, December 2, 2005 Clerk, Board of Supervisors, Contra Costa County 651 Pine Street, 11"' Floor Martinez. CA 94553-1229 Enclosed: COPY OF CLAIM FOR DAMAGES for your information O please call 4Q for your files O please read O for your review O please comment (. ) PLEASE FILE AND RETURN THE ENDORSED FILED COPY IN THE SELF ADDRESSED STAMPED ENVELOPE TO OUR OFFICE. Thank you for y ur attention in this matter. lexa Goldstrom, legal assistant for Robert J. Beles Enclosure bisnd sn cl O t4 0 N w Rf Iso oau��� v + U 4� Ca ",14�Q 41 N raI Irl W C+ 41 ri Q.i rl 1 1 w LnLn �- O N a£ b J it m 0) N uj Cg u IIQ -A 1 ' E�£ N j W ° 0. � � 0 .t S f ' CLAIM �� BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY Lf -A/ airwGbryId C2�,6 11ARDACTION: J14i�W-897/66 (��7vG�U/ G ld�S Ol V Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) I NOTICE TO CLAIMANT and Board WCtio`h.-All-SCctibtf references are to } The copy of this document mailed to you is your California Government`Codes. I ) notice of the action taken on your claim by the { Board of Supervisors. (Paragraph IV below), give t-f- 51EC 0 0 2005 Pursuant to Government Code Section 913 and CC:'AZTY Orr: (\';'rL 915.4. Please note all "Warnings". �..r.e T I:des'CALK=, AMOUNT: IN EXCESS OF $25,000.00, SUPERIOR COURT TO HAVE JURISDICTION CLAIMANT: KENNETH SALGUERA ATTORNEY: ROBERT 'J. BELES DATE RECEIVED: DECEMBER 05/05 ADDRESS: THE ORDWAY BUILDING . BY DELIVERY TO CLERK ON: DECEMBER 05/05 1 KAISER PLAZA, SUITE '2300 OAKLAND, CA 94612-3642 BY MAIL POSTMARKED: DECEMBER 02/05--- FROM: 2/05-FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEET Dated: DECEMBER 05, 2005 .. By; Deputy II. FROM: County Counsel, TO: Clerk of the Board of Supe tsors (v),this claim complies substantially with Sections 910 and 910.2. O 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). O Other: Dated: F•-os-� By: rV7 _ Deputy County Cour. 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: (vr This Claim is rejected in full. 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:A-P-oje�rt 140,0&eg' 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 deposi 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 fu; prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:V2OHN SWEETEN, CLERK By Deputy Cie a: ROBERT J. BELES ATTORNEY AT LAW THE ORDWAY BUILDING PHONE (5 1 0) 836-0 1 00 1 KAISER PLAZA. SUITE 2300 OAKLAND, CALIFORNIA 94612-3642 FAX (5 10) 832-3690 Tuesday, November 22, 2005 Clerk, Board of Supervisors, Contra Costa County 651 Pine Street, 11th Floor Martinez, CA 94553-1229 Sheriffs Department, Contra Costa County 651 Pine St. 7th Floor Martinez, CA 94553-1229 CLAIM FOR DAMAGES Claim against: Sheriffs Department, Contra Costa County, Deputy W. Baker and other unknown deputies of the Sheriffs Depart ent, Contra Costa County. Claimant's Name: Kenneth Salguera Claimant's Address: c/o Robert J. Beles, 1 Kaiser Plaza suite 2300 Oakland CA 94612 Address to which notices are c/o Law Offices of Robert J. Beles to be sent: 1 Kaiser Plaza, Suite 1750 Oakland, California 94612 Tel. (510) 836-0100, fax (510) 832-3690 Date and Time of Incident: Sunday, November 20, 2005, 1:00 pm Location of Incident: El Sobrante, County of Contra Costa, California. Description of Incident: On Sunday, November 20, 2005, in El Sobrante, County of Contra Costa, at approximately 1:00 pm, claimant Kenneth Salguera observed unknown deputies of the Contra Costa County Sheriff's Department beating his brother, Fernando Salguera, who was handcuffed and lying on the ground. Claimant was approximately 60 feet away, across the street from the beating. Claimant called out "He's in fucking handcuffs. Why are you doing that?" Deputy W. Baker arrived, got out of his car, and went over to the spot where Fernando Salguera was being beaten. One of the unknown deputies pointed to claimant and told Baker "Get himtoo." Baker ran towards claimant. Claimant turned around and put his hands behind his back. Baker threw Claimant on the ground, slammed his face into the ground, and struck Claimant's head approximately four times. Baker and the other deputies then arrested claimant for Penal Code section 422,threatening officers,and Penal Code section"!48, interference with officers or resisting arrest.[ The deputies set bail for petitioner at an excessive I ROBERT J. BELES I KAISER PLAZA. STE 2300 OAKLAND. CALIFORNIA 94612-3642 PHONE (51 O) 836-0100 FAx (510) 832-3690 page 2 amount, $75,000. Petitioner had to pay $7,515 in bail premiums to be released. Torts Committed: Deputy W. Baker: Excessive force,false arrest, malicious prosecution,general negligence, violation of civil rights under California and United States Constitutions, use of excessive force, general negligence, denial of civil rights. Unknown deputies, Sheriffs Department, Contra Costa County: , intentional and negligent failure to prevent wrongful acts of Deputy W. Baker, use of excessive force,general negligence, false arrest, malicious prosecution, denial of civil rights. Sheriffs Department,Contra Costa County:False arrest,malicious prosecution,respondeat superior liability, negligent supervision, hiring, training, and placement of Deputy W. Baker and unknown deputies of the Sheriffs Department, Contra Costa County. Damages Incurred: Pain, suffering, legal and other expenses, worry, anguish, humiliation, inconvenience, emotional distress and mental anguish, other damages not yet known. Officials, employees, and agents causing damages: Deputy W. Baker and unknown deputies of the Sheriffs Department, Contra Costa County. Itemization of claim: Specials presently unknown Generals In excess of $25,000, Superior court to have jurisdiction Attorney's fees presently unknown Total In excess of$25,000, Superior court to have jurisdiction Signed by or on behalf of claimant: --- Robert J. Beles Attorney for Caimant Dated: 2 RECEIVE® DEC 0 5 2005 ROBERT J. BELES CLERK BOARD N SUPERVISORS ATTORNEY AT LAW COP7TRAGOS1 CO. THE ORDWAY BUILDING PHONE(510)836-0100 --------------- OAKLAND, _______ _____OAKLAND,CA 94612 FAX (510)832-3690 Friday, December 2, 2005 Clerk, Board of Supervisors, Contra Costa County 651 Pine Street, 11"Floor Martinez, CA 94553-1229 Vneloserl: COPV OF CLAIM FOR DAMAGES ()o for your information O please call for your files O please read ( 1 for vnur review ( 1 please comment ( 1 PI.EASF_.FILE AND RETURN THE ENDORSED FILED COPY IN THE SELF ADDRESSED STAMPED ENVELOPE TO OUR OFFICE. Thank you for your attention in this matter. JexaAGoldstrom, legal assistant for Robert J. Beles Enclosure ...6.IC.�. 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