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HomeMy WebLinkAboutMINUTES - 10172006 - C.22 CLAIM ,/� HOARD OF SUPERVISORS OF CONTRA COSTA COUNTY (, . BOARD ACTION: OCTOBER 17 , 2006 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section re D ejuie � The copy of this document mailed to California Government Codes. you is your notice of the action taken SEP 12 2006 on your claim by the Board of Supervisors. (Paragraph IV below), COUNTY COUNSEL given Pursuant to Government Code AMOUNT: $1 384 . 76 MARTINEZ CALIF. Section 913 and 915.4. Please note all PUS RENTAL CAR "Warnings". CLA11vlANT: GERALDINE G. CUEVAS ATTORNEY:UNKNOWN DATE RECEIVED: SEPT:'.:412, 2006 ADDRESS: 1373 HULL LANE BY DELIVERY TO CLERK ON:SEPT. 12 , 2006 MARTINEZ, CA 94553 BY MAIL POSTMARKED: SEPT. 11, 2006 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, Cle SEPT. 122006 Dated: By: Deputy 11, FROM: County Counsel TO: Clerk of the Board of Suf ervisors ( 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 c)aimant. 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 9I I.3). ) Other: Dated: & (9(o By: N1 rZl1,� Deputy County Counsel , I11 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). 1V./ff'(0ARD ORDER By unanimous vote of the Supervisors present: (VI This Claim is rejected in full. O Other: I certify that this is a true and correct copy of the Board's Order entered ill its minutes for this date. Dated:�����'�?� OHN CULLEN, CLERK, By _ eputy Clerk WARNING (Gov, code section 913) Subject to certain exceptions,you have only six(6)mouths from the date this notice was personally served or deposited in the mail to file a cowl action on this claim.See Government Code Section 945.6.You may seek the advice of an atton►ey of your choice ur connection with this matter. If you want to consult all attorney,yon shotdd do so unurediately. *For Additional Warning See Reverse Side of 11ris Notice. AFFIDAVIT OF MAILING 1 declare under penalty of perjuiy that I am now, and at all times herein meutioned, have been a cilizen of the United States, over age I8; and that today I deposited in the United States Postal Service in Alartinez, Catliforuia, postage I'ully prepaid it certified cony of this Bowd 1-biler and [Notice to Clairnauct, addressed to file claimant as shown alcove. wle Date( e 7'l ICti i[V CLlt:f EN, CLL[ZK 13yA��I��Dcpuly Cleft: F OARD OF SUPERVISORS OF CQNFRA COSTA COUI�'TY INSTRUCTIONS TO CLAIMAN Ting to a cause of action for death or for injury to person or to personal property or s shall be presented not later than six months after the accrual of the cause of aim relating to any other cause of action shall be.presented not later than one yearual of the cause of action. 911.2.) Claims must be filed with the Clerk of the Board of Supervisors at its office in Roam 106, County Administration Building, 651 Pine Street,Martinez,CA 94553. If clam is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in, 1, If the claim is against more than one public entity, separate claims must be filed against each. public entity. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. ■■Kaas amURN%Raa as ac ama ■as a ala a Kan as as aQaaaaaaaaaa as a a as a aala malign as to as t as a a it ZE: Claim.By: Reserved for Clerk's filing stamp CERAldiue �. CUEVR� ) SEP 1 z Against the County of Contra Costa orRD OF ) 20!16 District) NRA COSTA COVISORS (Fill in the name) ) - The undersigned cl ' t hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ and in support of this claim represents as follows: PLUS {Zen}PL CRR EJ,pEtASe wli.le. tt-Z, CP%9-%5 'J%k the Shop berg 0.e_pd:%red. 1. When did the damage or injury occur? (Give exact date and hour) SeptembeR (,, '2.0010 @ Rppfo)CIMA+eL1 3 p.M. 2. Where did the damage or injury occur? (Include city and county) ?os4 OFFICE ON RLhAmbRR, RVE. , MRRTINEZ, Cog+RA Cos}A Cbum}y .3 How did the damage or injury occur? (Give full details;use extra paper if requited) See RTCTW-WLNT FoR t1�P1ANAtio►a, 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage?ZRIV E R - tbF C,buf4r A Ct S}R C bilary VAw W 46a"4-- - Ucet%se PlMe t* 1148099, Z3gcKe.d '%v%'ku ,rny ve6'.cle whe = woas pFm-sce-41i, 5 What are the names of county or district officers, servants, or employees causing the damage or injury? K14EM 'R. BA-)H0R'. R FHowwas or injuries do your claim resulted? (Give full extent of injuries or damages ch two estimates for auto damage.)I}eq}-._m_Ri%% t 5-ide gender Ana t3umpeRTwo Ssiimihies Fore amount claimed above computed? (Include the estimated amount of any jury or damage.) 2'q M r, +0 Sa p A r 0.i a R�.}o bo A, Stio p s Io r E sic mA t e o& damage }v V0%;u-e-. s. M-ise►E, was nUi iV�juRed % n +tie RGGdent- 8. Names and addresses of witnesses, doctors, and hospitals: RobeRi- E . PACkeR. (q 25)aa8-loboi-q :DRtveas lAtev%se 4 %b7IIA32-16 1=A0.L.*INe SV%k5freR (2.3.Q-5841 Horne)(ASS-Stabo woak) ARea coda 82.5 KRTS 1{opKK:rs Cgl5) a9. 5s9 x 9. List the expenditures you made on account of this accident or injury: DATE TWE AMOUNT Sept. 4, Oto 50.14 pm Z Feet r.- 31%0u1d at campensp}ea Sr wtia+ is A Se.P+. 7, 01# �k.y�ptn FAir t% M0W%+ For o'ny Time And GHS due 4o Ne9thence Awa e.wee.t-essness bf one of souk- iIziv�rs covnt� I-rnp4� • aXaril ss.Rai sle aanREasnoaawl*aA Russ l■aa■to a■n IRs*lila Xmas*as i es.al rasa l` e ■`bSfsass, ) .Gov. Code Sec. 910.2 provides"The claim shall be ) signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attomev) 1 Name and address of Attorney ) (�,�((/Claimant' ignature) 1373 HULL LRNE } (Address) j IV19RTrNE7-, CR 84553 Telephone No. )Telephone No. a5 ad S-q13�t 14 D M E 510) ?65 . 526z WOAX ■,■■i■■aala as It as RUN■■ll Inns aalRaSRI SAN MR IF a as l a ail a t a■on a■la l it a I a it its l i a■■■a iii■Ing al PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthermore, any attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. aoussu■sari■I■a■tla&%RuaIna a.I.Ii.a.....i..iia..i.ii.ii.la■ta■lt Rlaa aal a as a man%Roast NOTICE: Section 71 of the Penal Code provides: Every person who, vzth intent to defraud; presents far 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 faire or fraudulent claim, bill, account voucher, or writing, is punishable either by imprisonment is the County jail for a period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000.Q0), or by both sucb 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. )- H- 04 "406,mA s &, z ion .3 p, .i.►t.> Ar)/aA -�»Z`j a �.o Seg J.o 1Da�, h,i.1.1 .Wa�a ,vx t11 h- ` "Stt 7r7AZJ da44 w ,e-x e ix Poj �04,v a uxry vat si ,)o a r. . j lead . d, awd CSA`. �_ . ,of a•�,�i d� .� -47- ,�� • r.��,� . ..� Ax /Y aA � -t� MA-f � . �� .cox GP-s � d t'd yVaoo 444.? � ,cz�� F za 1w tlao d. A%cli d �Y-r1z�d mss. 'D .R Azdcld d ,8 .. ► �,f saw �.e w� ..� q d d ,xk .5 a ur f e -ot;tL�e a Ccd `rf 1• gad .t r,IA— g CHtc�y Ila,-), d-,t� 411 Valx) a-x-d /jAm;G OAI x�j e�dm d j4) "7-? Ilz V110 . 13"1 0j" �� 4kw yjAe eh P-O� Lv fp,(tt X46 a.. A.^z4 9-a- ,,J wao PI-le-Y44 P-6P;.. Btif Aoe di d WA4aT aid I)Iel . 6a &). bl,4 . eadj"d,) t o QCCcdvx . .� Tu xa.l)Lc a ,vx a d y"ce VERnLd i,v, uE V19S Date: 9/7/2006 04:41 PM Estimate ID: 10831 Estimate Version: 0 Preliminary Profile ID: LAB LAFAYETTE AUTO BODY, INC. 3291 Mt.Diablo Blvd.Lafayette,CA 94549 (925)283-3421 Fax: (925)283-3579 Damage Assessed By: RANDY SANDLIN Deductible: UNKNOWN �p Insured: GERALDINE CUEVAS �`} Address: 1373 HULL LN MARTINEZ,CA 94553 Telephone: Work Phone: (510)705-5202 Home Phone: (925)228-9134 Mitchell Service: 918287 Description: 2001 Mercedes-Benz C240 Vehicle Production Date: 8/00 Body Style: 4D Sed Drive Train: 2.61-Inj 6 Cyl 5A RWD VIN: WDBRF61J31F023978 License: 5FHN793 CA Mileage: 51,300 OEM/ALT: O Search Code: None Color: BLACK Options: ALUWALLOY 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 CONTROLIELECTRONIC,PREMIUM SOUND SYS.,POWER DRIVER SEAT AM-FM STEREO/CDPLAYER(SINGLE) Line Entry Labor Line Item PartType/ Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 800009 REF REFINISH FRT BUMPER COVER C 2.2 2 800011 ,REF REFINISH R FRT OTR IMPACT STRIP C 0.5 3 800018 BOY OVERHAUL FRT BUMPER COVER ASSY 3.1 # 4 803682 BOY REPAIR FRT BUMPER COVER Existing 0.5*# 5 800050 BOY REMOVE/INSTALL R FRT COMBINATION LAMP 0.3 # 6 801876 BOY REPAIR R FENDER PANEL Existing 3.5*# 7 AUTO REF REFINISH R FENDER OUTSIDE C 1.9 8 800237 BOY REMOVE/INSTALL R FENDER MOULDING 0.3 9 900500 BDY* ADD'L LABOR OP TINT COLOR Existing 0.5* 10 900500 REF* ADD'L LABOR OP COVER VEHICLE Sublet 5.00* 0.2* 11 900500 BDY* ADD'L LABOR OP FLEX New 5.00* 0.0* 12 AUTO REF ADD'L OPR CLEAR COAT 1.4 13 AUTO REF ADD'L OPR COLOR SAND&BUFF 1.2 14 AUTO ADD'L COST PAINTIMATERIALS 186.00* 15 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL 3.00* -Judgement Item #-Labor Note Applies C-Included in Clear Coat Calc ESTIMATE RECALL NUMBER: 9/7/2006 16:41:03 10831 UltraMate is a Trademark of Mitchell International Mitchell Data Version: JUL 06 A Copyright(C)1994-2003 Mitchell International Page 1 of 2 UltraMate Version: 5.0.215 All Rights Reserved Date: 9/7/2006 04:41 PM Estimate ID: 10831 Estimate Version: 0 Preliminary Profile ID: LAB Add'I Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals IL Part Replacement Summary Amount Body 8.2 75.00 0.00 0.00 615.00 T Taxable Parts 5.00 Refinish 7.4 75.00 0.00 5.00 560.00 T Sales Tax @ 8.250% 0.41 Taxable Labor 1,175.00 Total Replacement Parts Amount 5.41 Labor Summary 15.6 1,175.00 Ill. Additional Costs Amount IV. Adjustments Amount Taxable Costs 186.00 Customer Responsibility 0.00 Sales Tax @ 8.250% 15.35 Non-Taxable Costs 3.00 Total Additional Costs 204.35 I. Total Labor: 1,175.00 it. Total Replacement Parts: 5.41 III. Total Additional Costs: 204.35 Gross Total: 1,384.76 IV. Total Adjustments: 0.00 Net Total: 1,384.76 This is a preliminarV estimate. Additional chances to the estimate may be required for the actual repair. This estimate is based on current parts prices and labor rate which are subject to change at a later date. This estimate does not include repair costs of any hidden damage found on tear-down. LAFAYETTE AUTO BODY, INC. agrees to perform repairs which serve to restore the damaged vehicle to its pre-loss conditon relative to safety, function and appearance and further agrees to warranty workmanship, including refinishing, in writing for a period of not less than one (1) year from the date of completion of repairs. Lafayette Auto Body, Inc. 3291 Mt.Diablo Blvd Lafayette.Ca 94849 fax(925j283-3579 - RANDY SANDLIN email:LAFAUTOBODYOOL.com ESTIMATE RECALL NUMBER: 917/200616:41:03 10831 UltraMate is a Trademark of Mitchell International Mitchell Data Version: JUL_06_A Copyright(C)1994-2003 Mitchell International Page 2 of 2 URraMate Version: 5.0.215 All Rights Reserved 09/06/2006 at 05:14 PM Job Number: 97164 ADVANCE AUTO EDDY, INC. License #:DAR AC171433 Federal ID #:680280418 917 Howe Rd Martinez, CA 94553 (925)370-7789 Fax: (925)228-0588 PRELIMINARY ESTIMATE Written By: Adjuster: insured: Geraldine Cuevas Claim # Owner: Geraldine Cuevas Policy # Address: 1373 Hull Ln Deductiblo: Martinez, CA 94553 Date of Loos: Evening: (925) 228-9134 Typo Of Lose% Point of Impact: Inspect Locations Insurance Company: Days to Repair 2001 BENZ C240 6-2.61-FI 4D SED BLACK Int: VIN: wDBRF61J31F023978 Lia: 5FITN793 CA Prod Date: Odometer: Air Conditioning Rear Defogger Tilt wheel Cruise Control Telescopic wheel Intermittent wipers Climate Control Keyless Entry Theft Deterrent/Alarm Steering wheel Controls Dual Mirrors Fog Lamps Clear Coat Paint Power Steering Power Brakes Power windows Power Looks Power Driver Seat Power Passenger Beat Power Mirrors AM Radio FM Radio Storoo Cassette Search/Seek Anti-Lock Brakes (4) Driver Air Sag Passenger Air Bag 4 wheel Disc Brakes Positraction Leather Seats Bucket Seats 6 Speed Transmission Aluminum/Alloy wheels N0. OF. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- I FRONT BUMPER 2* Rpr Bumper cover Classic, 1.0 2.4 Elegance w/lmp washer 3 Add for Clear Cost 1.0 4 O/H bumper &say 2.5 5* Ropl RT Molding Classic w/o 1 70.00 Incl. 000 Parktronic beige 6 FRONT LAMPS 7 R&I RT Headlamp assy w/o xenon 0.3 lamps 8 FENDER 9* Rpr RT Fender w/o C55 AMG 3.00 2.0 10 Add for Clear Coat 0.8 11 R&I RT Fender liner front upper 0.3 W/o 4-Matic 12 R&I RT Fonder liner rear w/o C55 Incl. AMG w/o 4-Matic 13 R&I RT Body side mldg Classic 0.2 black 14# Subl Hazardous waste 1 3.50 15# Rpr Coloroand and Polish 0.5 16# Ropl Flex Additive 1 8.00 17# Ropl Car Cover 1 5.00 0.2 18# Rpr Tint Color 0.5 -----------_a------------------------------------------------------------------ Subtotals ®®> 86.50 8.5 6.2 1 09/06/2006 at 05:14 PM Job Number% 97164 BR2LIMINMY ESTINRTZ 2001 BENZ 0240 6-2.6L-FI 4D SED BLACK Int: Parts 86.50 Body Labor 8.5 hre 0 $ 72.00/hr 612.00 Paint Labor 6.2 hrs 0 $ 72.00/hr 446.40 Paint Supplies 6.2 hra 0 $ 30.00/hr 186.00 SUBTOTAL $ 1330.90 Sales Tax S 272.50 0 8.2500% 22.48 GRAND TOTAL S 1353.38 ADJUSTMENTS: Deductible 0.00 CUSTOMER PAY S 0.00 INSURANCE PAY $ 1353.38 I authorize Advance Auto Body Inc, to perform the needed repairs to my vehicle. Repairs include parts, labor, and diagnosis. The above estimate is based on our inspection and does not cover additional parts or labor which may be required after the work has started. Worn or damage parts, not evident on first inspection, may be discovered and you will be contacted for authorization for additional work. Parts prices are subject to change without notice. ACKNOWLEDGEMENT: I have road and understand the above estimate and authorize repair service to be performed, including sublet work and acknowledge receipt of this estimate. An express mechanics lien is hereby acknowledged on the above vehicle to secure the amount of repairs completed. This Estimate Authorized By: Signed: Date: Work Accepted By: Signed: Date: POWER OF ATTORNEY: I do hereby appoint the aforementioned business as my attorney in fact to acoept on my behalf any and all checks, drafts, or bills of exchange for deposit to the aforementioned business' account for credit on my account for repairs on my vehicle which had been released and accepted. Signed: Date: 2 e�maes iv m 1Wf10Wd 93:oiso3t 90,'Il d3S ,� ESSb6 Hi Z3uudltitiW rZ i, Cie (�_� c/� ��/ V � � O ® Er 2 ru -a N W T Ln / .A a co ms=s Ol— O y. ..o�r'ij L nQ�) \� W Ln C3 U C4-- 2 M O (n43f Ln Ln K7 O Lu Z v v �3 �- Qrr JCi e . uJ J 3 0A N uP,A :t� CC W 6e 6 rt" CLAIM BOARD OF SUPERVISORS Or CONTRA COSTA COUNTY BOMW ACTION. OCTOBER 17 , 2006 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 California Government Codes. ) you is your notice of the action taken D Ggan on your claim by the Board of Supervisors. (Paragraph IV below), SEP 1 4 given Pursuant to Government Code AMOUNT: $664 . 00 2006 Section 913 and 915.4. Please note all COUNTY COUNSEL Warnings". CLAIMANT: MARK KAUZER MARTINEZ CALIF. ATTORNEY: UNKNOWN DATE RECEIVED: SEPT. 14 , 2006 880 JUANITO DRIVE SEPT. 14 2 ADDRESS: WALNUT CREEK, CA 94595BY DELIVERY TO CLERK ON: , 006 RECEIVED FROM BY MAIL POSTMARKED: RISK MANAGEMENT FROM: Clerk of the Board of Supervisors TO: County Cownsel Attached is a copy of the above-noted claim. SEPTEMBER 14 , 2006 JOHN CULLEN, C k Dated: By: Deputy It. FROM: County Counsel TO: Clerk of the Board of Supervisors ( 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). O Other: Dated: By: _Deputy County Counsel 111. 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. B.PAR—D ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. O Other: 1 certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: pd`� /ZBHN CULLEN, CLERK, By eputy Clerk WARNING (Gov. code'section 913) Subject to cetiain exceptions,you have only six(6)months from the date this notice was personally setved or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You ntay seek file advice or an attorney of your choice in couneciiou with this matte. If you wturt to consult on attor-tiey,you shotdd do so unntedintely. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of pet juiy that I am now, and at all times herein mentioned, have been if citizen of the Uttlted States, over age 18; and that today I deposited in the United States Postal Service in 51,111ill ez, California, postage fully prepaid a certified copy of this Board Orrder rind Notice 1v -'laivaant, addressed to file claimant as strown above. a--Fiepuly Clerk MAY-24-2006 07:56 CCC RISK MANAGMENT 925 335 1421 P.02 BOARD OF SUPEROOM OF CONTRA CQSTA COUMO INSTRUCTIONS TO CLAIMANT A. A claim relating to a cause of action for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be,Presented not later than one year after the accrual of the cause of action. Penny Bailey (Gov. Code § 911.2.) AUG 2 8 2006 13. Claims must be filed with the Cleric 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. raud. See penalty for fraudulent claims,Penal Code Sec.72 at the end of this form. ■•a■■■■4aa■■■■■aaaa.X ■a c s al a a s a t a a a a I a a 4anaa a a a V a s a a G 4 a A I a I a■4■■a a s as a■a 5 a a RE: Claim By: Reserved for Clerk's filing stamp 6d C. Against the County of Contra Costa or ) E� SEP 1 4 2006 District) CLERK BOAR p (Fill inthe name) YCONTgq�sUPERvrg STA CO, � The undersigned claimant hereby mat es claim against the County of Contra Costa or the above-named district in the sum of$ i and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 3100 > ►� 2. Where did the damage or injury occur? (Include city and county) ?eko .?'v cl.-tta, 'L 3. How did the damage/or injury occur? (Give full details;use extra paper if requir d) / 4. What particular act or omission on the part -of,county or district officers, servants, or employees caused the injury or damage? 5 What are the names of county or district officers,servants, or employees causing the damage or injury? 08/08/2006 06: 35 0000000 PAGE 02 �. 'What damage or�iiWMies do YOM claim =ltui? (OM fall extent of iWu im or damacree ��go-.) .._-• ,..� .._- ' . . . . 7. How wes the ==t claimed above ooaaputad? (Include the estimated AMD'lit of eery prosTxtiveiajury ar dan:}age.) C��.�-�� t `�� 8. Names.and addresses of witnesses, doctors, and.hospitals; 9. List the expenditures)r=msdv on account of this accident or i M: .' � DATE 1'M Rasamaws■Rolls[■awon Icon all RNaWass KRUK%0 not aNaaaILK tas*aswas aaItaattatasIto on%ISO ataoil EaR -Clog. Code Soo. 910.2 provides Me claim ABU be )si�bythe claims or by some person on his OND NQN=T(I rrievl 1 Name and address of AUomey ) (Qaunant's Signatrae) (Address) Lh S Telephone No. )Telephone No. 1_t am a nut as as noun as wins It a a a was a a a lam R Iowa t a It a sae It ten It s situ a,a s aawwaRt■a tam aRaioil amu nel PUBLIC RECORDS NOTICE, Please be advised tbd this claim form,or any claim filed witiA the Cotmty tmdar$w Tort Claims Act is subject to public disclomn =der the (''41ff mia+a Public Records AaL (Gov. Code, 55 6500 et seq.) Furtmmore, auy atraelune=,addandums,or rapplatruenis atawhed to the claim form,inolu ft medical f=&,am also subjeot to public dimlommm, AP aawnoMR a a R a a ser an An a a an It ser am E wwama ase as Ion Emitaa MANOR■■amW■Ito a■R It an as gun a sw a as aanawa at( NOTIM Section 72 of the Pedal Cade provides; Every parson who,with intent to dafiwd,pmmts for allowance or for payment to ag stem board or officer, or to aaY wuWq, ftn or di Et t board or off, aatbortmd to allow or pW the same if genuine, my h1se or ftw&lent oWma, bill, account voucher, or wdit b pmdabeble eithat by ia¢prisonmeot m.the Cmmt d jail for s period of not more than ono year, by a fine of not aYeeeding one thousand dollars($1,DDD.00), or by both such isaprisoameat and fine. or by imprlsoamant in the state prison, by a fine of not e%ocectia„ true thousand doIlm ($10,000),or by both snot imprisommeut and fine 'd 096 'ON 1N3W3DVNVW 033 WVIZ:R 9002 '9 'las y Tr[ . � t k1b IV WR I m -.-r � rL nr m rrn (� ` � rLyl t� N �. O C3 (D I Q -4� c O / s V Ln —f" -tlw3)clo . .. Q- 02 Lyl w z t� ° a L-0 70 nnomrr V.J. VJIIIVL _ MARTINEZ,CA 9455? SEP ll. 06 iEn starts- AMOUNT At SERVICE 4q y - H� 0000 99553 000047 988-09 .-_---- . .9 `- B0 X11 Eli® JOB t BID# ADDR,SS �6 DATE FIRM PREPAREDBY ADDRESS PPROVED BY L, rt!1 �4 TYPE OF _ n tt - PHONE WORK M du a E 2 t - Wt Otel G tee_ sa c,4 Ar pa Q TOTAL BI &?o t h. - 'k`` � ,'� ^.,.� ;- l'Y�J.`�"1'!.C`.UrAIJ�`1 GIlLIJ P � `y 5" �nk,v �,'� E�s•.�', ` G f .n41 `� txl�� jt��i 9� l� x 4 y`� Y Y ai ,�� Z tt LL'* � xti�lry�c. fr.kZ.� •.`i .� t 11 i;. fie itt� i" zt t rr :fvt � '`t"Sr{�S ����,.,�4rf��„� SRR N'r':. .. . .r d�,r,.-r t..-r.:1..a'n"'-"7r :!K.r.. ,.�..e�'r�l#'."h. w•',.w-e_.a.:.s�....., ,e, .,x A ,» 9".._.... .,;..:. 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M,� .kw �1 k �FVtf .. }{ ' .b" t j z t + t Sd, t ( z�� as:,_� � �;iy�a i �•�a � � .i�yy.:rrr'"�-*�"` v: ..c..-.•�` �"� a k ���; .,'` �) '9- -�Y � �� i� /� '4k• y � T� .7 lilt �M1� :4'-"' fM ! x,. � i .� � ..,.. s ^Y r T i#V'� r Pan f il6•'a �r #{ 1c �A F �f 'l .{ s' `�.+ 'r t;�� �.,3t }t c �� � •t'�»k'r is e „ '' � „`«„V,e '+. � #m ,� �r` s. }y. v 4 } r ,r. ''�" 1 s�'`�°'�`� �4 .q Me v�,.a.3.^,� f �y. �y� 1 s a i � ��a(.,•�`.' ��. �,> Y* a a _'�..�a'4'4•-e4Et'cs'"�+�a'4'r'C'4 k :�bl�' ,ya '+a`x t YF >� ,� `;,sx�Wn,1'd y �:.�,��4 c � _ {t +ity+i rk �k�.�4,�" i 4� ��wS �(��. e6+. ..• s 3t �3 tx z 5 '�i� a s.kr•�• 3 r A � x. �Y08/08/2006 06:35 0000000 PAGE 01 DEL AMIGO HIGH SCHOOL,. 189 DEL AMIGO RD DANVILLE, CA 94526 SEP 1 4 200 (925)552-5571 • Fax (925)838-5372 - cadams@srvusd.k12.ca.us C(ERKB�A !i Carol Adams, Principal CONRACFSUPFRVI Co Cp, SORs FAX COVER SHEET Dere: Attention: Receiving FAX Number. From: Number of Pages: County Acfrnln,f�brator Rlsk ManagementDivision Contra 2530,Amoff)Drivo,Suite i 4o 94553 Costa CountRisk Management ty AdmiAlztrmion (923)N.26-14e;o jFax Number (025)335-1421 a FAX TRANSMITTAL DATE: TO.- ORGANIZATION: FAX NUMBER: - NUMBER OF PAGES'TO FOLLOW: REMARKS- FROM: TELEPHONE NO.: L925-) 335 /95M= F*lba$;R The lmwmaSon 001twirsea -n rJ7fcPrMafl0" intended thin fac�arI7tij�5 message may be folfffclentfOl ancV*r legally Pf"Yoged .v fiar the use of die_;j707vrduW cxr enff4,",v"7 ab ,f Me message is not Me h7ft"creci reorplen,4 YOU ea reaurer Of this hereby no CrIstabu iron of conNefentrar inifb"nesar,is notified fflat the ccppyln ar ayproftiblAlrd. 9. CrIssarnli7affon DCX="EntAMasbMre%FORMS\FAX-Old.d= NOI—D3NNOD 31fWJGDVJ ONb: j� Asns �z a �Tvj ANII �3�SNV ON (�-3 �0 an UNVH (4-3 — bOJ NOSV�3 —--- ----------------------------------------------------------------------------------------------- NO ZLE58E96 Xi AbOININ 086 ---------------------------------------------------------------------------------------------------- 39VJ llnS3b SS3HOV N011dO 300A 31IJ INVOZ :G 90OZ '9 'd3S Q]WiS/0311IASNVNI IN3h39VNM YS18 DDO :830V3H XVJ AVt6 :8 900Z *9 'd3S ) 180d32 il(IS3y NOIlVOINnimoo 'd r CLAIM n �� ' BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: OCTOBER 1.7 , 2006 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorseptents, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to California Government Codes. d g��� D you is your notice of the action taken on your claim by the Board of SEP 15 2006 Supervisors. (Paragraph IV below), COUNTY COUNSEL given Pursuant to Government Code AN/IOUNT: Biu, 000. 00 MARTINEZ CALIF. Section 913 and 915.4. Please note all "Warnings". CLAIMANT:JOHNYAR THIERE HORRELL ATTORNEY:UNKNOWN DATE RECEIVED: SEPT. 15 , 2006 ADDRESS: 4081 CLAYTON ROAD #332 BY DELIVERY TO CLERK ON: SEPT. 15 , 2006 CONCORD, CA 94521 BY MAIL POSTMARKED: SEPT. 142 1006 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. SEPTEMBER .15 , 2006 JOHN CULLEN 1 Dated: By: Deputy 11. FROM: County Counsel TO: Clerk of the Board of upervisors ('Itis claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.21 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 avply for leave to present a late claim (Section 911.3). (Other: T`ht✓ �',vncot-za Pvl �ce d et-,� 1s no-�- wit l- -fi-hL- L'quyA-u Dated: 9 0(p By: r��C'&,:Q� Deputy County Counsel Ill. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) O Clain was returned as untimely with notice to claimant (Section 911.3). 1V. ARD ORDER By unanimous vote of the Supervisors present: (vf 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:&�41/;� N CULLEN, CLERK, By eputy Clerk WARNING (Gov. code section 913) Sidled to cetlain exceptions,you have only six(6)months from the date this notice was personally served or deposited ut lite[tail to file a cowl action on this claim.See Government Code Section 945.6.You may seek the advice of an allort►ey of your choice 6t connection with this matter. U you want to consult all attorney,you should do so immediately. *For Additional Warning See Reverse Side ofTltis Notice. AFFIDAVIT OF MAILING I declare under penalty of geljuiy that I am now, and at all times herein mentioned, have been a citizen of the. United States, over age .IS; and that today 1 deposited in (fie United SLtles Vomit Service in I<I;rrlinez, Califoruiat, postt►ge fully prepaid a certified colry or this Board Order mod Notice to Claimant, addressed to the claimant as showii above. Dai ed: KAN CULLEN, CLERK By DelntlyC.lerk BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. A claim relating to a cause of action for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. NUMENNEMAWAR*map 60090 M, RE: Claim By: N v AT({{r. t-pa-rrc Reserved for Clerk's filing stamp ) RECEIVE ) SEP 1 5 1006 Against the County of Contra Costa or ) CLERKBOARDOF CONTRA COSTAORS (rg�,Do , poi - T District) (Fill in the name) ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 9 - 136 !4_PP�� TIwk�C yA3m �M 2. Where did the damage or injury occur? (Include city and county) C-I 3. How did the damage or injury occur? (Give full details; use extra paper if required) om7k-p_� 'DA�Aivd7'1h\ , sAbavIT, _-r- L�JcA9 13 r-0E( A d F-V� AT 7- I 1 0 Q-( R\i76 c--% acs rrf (N Co N-0,0 K. _ A S S 06 M A- S�14 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? �C G(� r �l^,,, yy�� 11t4 al �(�� � ��, � ry cam( tk�f\Nt(z. Adybs4_ sqniJgg_1the-VL4Cr 1��-c � .��-rgrad 5 What are 'epi m of county or c istnct off cels; IT skMmf damage or injury? ©F�'r tf- V-\/-1 E- 08 (_�aT.✓`,3T C��t��._��. � ' .C._�&<w-N�a-r^�� �� A� (:enc=Tt���{- a-- r�r�� T � a as /6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) M-EgrOkL `p � IgT/ tgS, 2 /�(dc�J (—� qd^ , K �� tLlz i t4iJ� ► -v►a -t / C l �VCJ4 , W�lfc." K SC-r-_ A Po t r f AI�d1 k(l Ass�_MZ(40 Wk (rc, (r,-A 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) AtSU Q� t-Or 1 C1,QCid. Cc p�(TL{�v�C{�c� A'S / wap. Q*4C+f7 tis s IF r WA-rv,('--QtEy' Dc l T a tn-1 8. Names and addresses of witnesses, doctors, and hospitals: 2c bera' ��M� � <T , 4ND L60,TOe" (6'rY 0, EOz JT(MC % 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT •Nq NmeNN aamanm•Nmgne NDN as NeaaeaaeNea¢eaD ee se Neaea••mma••Na DNq NemNaaNNmaa■NNE DDaaNNa NM 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 ) laimant's Signature) el&N �c� 332 . CoN�•^�,L�� rSZ( (Address) } Telephone No. ) Telephone No. y/ 6 7 ■mamO•■N•■■ONONO.ONONONN■Sea■OONO•■ODOODDO Bonn Now SOON ea•aaaa OO DamONna N■Nape on Damen a al PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthermore, any attachments, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. e a N N m a m a N N N N a a N a N N e Na e N a a N e N a N N a N N N a e N n N N a a a a D a N•a a a a a N a N a N N a D a a a a N a N a a N N a a N a m a a Naa Ni NOTICE: Section 72 of the Penal Code provides: Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city, or district board or officer, authorized to allow or pay, the same if genuine, any false or fraudulent-claim, bill, account voucher, or writing, is punishable either by imprisonment in the County jail for a period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000.00), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000), or by both such imprisonment and fine. cc O o � v _ Fa L t;, V s tic k Too i 1 t b by 0° � � x