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HomeMy WebLinkAboutMINUTES - 11062007 - C.27 : CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: (I -Qb_b7 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. I� you is your notice of the action taken [I gT jV t� on your'claim by the Board of Supervisors,(Paragraph IV below), { OCT 4 1 2002 given Pursuant to Government Code AMOUNT: �73 g� Section 913 and 915.4.Please note all COUNTY CbUNSEL "WarI1111gS 'I MARTINEZ CALIF. CLAIMANT:. Sal r`lnal NeV6S ATTORNEY: DATE RECEIVED: ADDRESS:a Pt'$Y1�f�,�T BY DELIVERY TO CLERK ON:(�'"bL'07 1�2�V6 ' [36(j, CA BY MAIL POSTMARKED:.. FROM: Clerk of the Board.of Supervisors O:. County Counsel Attached is a copy of the above-noted claim. �"����, ry JOHN CUL lerk Dated: `� 0 1 a 20o1 By Deputy cJIML Y�(IL-� .. IL FROM.: County Counsel TO:Clerk of the Board of Supervisors . O 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: 3-D-1 Dated: By: eputy County Counsel III. FROM: .Clerk of the Board TO: County Counsel(I) 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: (K This Claim is rejected in full. O Other: I certify that this is.a true and con•ect copy of the Board's Order entered in its minutes for this date: Dated V_. JOHN CULLEN CLERK, By _Deputy Clerk WARNING(Gov. code section 913) Subject to certain excelitions,you have only six(6) nonths frpm the date thls noNre was personally served or deposited In.the mail to file a.court action on this claim See Government Code Section 945.6.You may seek the advice of an attorney of your choice In connection with this matter.if you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side ofT ils Notim AFFIDAVIT OF MAILING I declare under penalty of perjury.that.l:an now,and at all ilines herein mentioned, have. been a citizen.of the United States,over age 181 and that today l deposited In the United States Postal Service in Martinez,C8111-.•ala, postage fully prepaid a certified copy of this Board Order And Notice to Claimant,addressed to the claimant as shown above. Dated;/UOd. !P3--""z JOHN CULLEN,CLERK By eputy Clerk i OFFICE OF THE COUNTY COUNSELE SILVANO B. MARCHESI S -- O COUNTY COUNSEL COUNTY OF CONTRA COSTA 1'+.-_: h==='••,��' Administration Building — 651 Pine Street, 911 Floor SHARON L. ANDERSON Martinez, California 94553-1229 / �e CHIEF ASSISTANT z GREGORY C. HARVEY (925) 335-1800 ii:raliVl\ :•- — :2! VALERIE J. RANCHE 1 (925) 646-1078 (fax) 0', f3"SHO ASSISTANTS COSTA C6[111 NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Sabrina Nevis 2440 Pismo Court Discovery Bay, CA 94513 RE: CLAIM OF SABRINA NEVIS 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: [ ] I- The claim fails to state the name and post office address of the claimant. [ ] 2. The claim fails to state the post office address to which the person presenting the 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 sone person on his or her behalf. Sabrina Nevis Re: Claim of Sabrina Nevis Page Two [ ] 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. [X] 8. Other: Please provide information as to where on Marsh Creek Road the pothole is located. SILVANO B. MARCHESI COUNTY COUTSEL By: �Z2,91 Monika L. Cooper Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (Code Civ.Proc., §§ 1012, 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 bu iness address is Office of the County Counsel, 651 Pine Street, 9th Floor, Martinez,CA 94553-1229. On 0 1 .5' ,I served a true copy of this Notice of Insufficiency and/or Non-Acceptance of Claim by placing the document in a sealed envelope with postage thereon fully prepaid, in the United States mail at Martinez,California addressed to Sabrina Nevis, 2440 Pismo Court, Discovery Bay,CA 94514, as set forth above. 1 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—1 d " D at Martinez,California. K thleen O'Connell cc: Clerk of the Board of Supervisors(original) Risk Management 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 945 53. 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. ■■attttttttttttttttt■tttttttt■tattttttttsuttttattarattasaetttttttttttttttttettl RE: Claim By: - Reserved for Clerk's filing stamp S Kfe,yIS RECEMIE® Against the County of Contra Costa or 2007 Distract CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. (Fill in the name) ) The undersigned claimant hereb makes claire against the County of Contra Costa or the above-named &strict in the sum of$ 3 S and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) aryl 2.- -Where did the damage or injury occur? (Include city and county) ererwoo& , Coofvk- C044A-, co 3. How did the damage or iniury occur? (Give full details;use extra paper if required) V tel. 4. ghat'par6cular'act or omission on the part or county or aisuzUL UIIAX-a, servanIS, Ur c►npioYCUS caused the injury or damage? � 1 . n a 3 -- Corgi, W 1'- r' no� m W-9- What are the names of county or distract officers,servants,or employees causing the damage or injury? i NIS.. 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages - -claimed. -Attach two estimates for auto damage.) 5'-e� . 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage,) , ,Sem 8. Names and addresses of witnesses,doctors, and hospitals: 9. List the exTenditures you made on account of this accident or injury: DATE TIME AMOUNT IlLf -1�aa000[a■i[[[i-R[isSamoan aKansas Eggs Menlo Mann Ong[[i[[[Inv i[rRun Hills ni[[[[[[[[[i[s[aI .Gov. Code See. 910.2 provides"The claim shall be signed by the claimant or by some person on his )behalf." SEND NOTICES TO: (Attorney) Name and.address of Attorney ) } J (Claimant's Signature) -P s W1.0 C14- (Address) Telephone No. )Telephone No. to 65 ■■■i[f■e[[[■[f■i f a i■■■■a■■ ■as a a a a■a■t maim i a a a a■r[a a[l CRERRIZORM i a a■l a■Hamm ma■an a■■■/l 1 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 at seq.) Furthermore, any attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■■MEN■llall[■gaff ata aSEEN t ■aalaraalaatal/afaRaglan among[la[ata aaaaartaa a■■Elf■man Inv Sol 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 notexceeding 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. :.,.. '...f: -,fir - _ _ - { '� .c. �.:e 4R .} , Y 1. 35851`• her ` 5 6 2�9 7 1.1"'i �x ��� � r� r' *INVOICE* �� "+ ,u F SP;BRINA NEVIS L f A',," sz CONCORD w � ` T051BURNETT AVE. ' CONCORD CA 94520 2440 PISNO COURT },", + ::,! �� y (925) 8s7.6000=;.';: Y J, h � r ,�, , J' •'�,: DISCOVERY BAY,.. CA 9451'4 PAGE41a1sF 11� ,.:. _. dintocom HOME:925-395-3557 BIISc % �" r:, SERUICE;AD .SQR 173:DAMIEIJ .FE&RARPr• CCiI:OR YEA AA4E/AJIQfJ>L......11:... LIGE# E M1EEAcGE;IN/;:C1JT...... ;:: T� r� "" i,- BEIGE 06 VOLKSWAGEN BEETLE-.CO 3VWSF31Y16M3202031. 5UGX243 149�6I :1J49'.61 -.T384 .... . ...:.:. ..:... :.....::.:..... : :.. :::DEL.-L.—P f1 :a. :PRt3L3:.DA.- :::3lVl i#tM. EXP PRf3hA#SED .. ...:.::....:.::.:;::..".:.":: ..::::::"Y....:..: ;;:' ;;:: %NC:::::. F14i'144Eis#T_.: ;ITViF BATE> a 10MAY06 I 17:00 .27APRDT- = .CASH 7APR07 ,;, :............... :>s;:RsD<O?1=NED..;.... ::'[ <:[:<:>i`::::::?:#>. Y.: Dirito CUSTOMER #:35851 5 6 2 9 7 Brothers SABRINA NEVIS WORKORDER CONCORD 2440 PISNO COURT PAGE 1 1051 BURNETT AVE. - CONCORD, CA 94520 887-6000 DISCOVERY BAY, CA 94514 di(925)rito.com HOME:925-395-3557 BUS: SERVICE ADVISOR: 173 FERRARA,DAMIEN GOL ............ ....... ........... ......... WAKEM .OR:: YEAR......::... .:�::: .... ....... ......... ........... .. ........... BEIGE 06 1 VOLKSWAGEN BEETLE CO 3VWSF31Y16M32020315UGX243 1 14850/ �384 ..... .... ..... . . .............. ....... ................... ............ :...DEL..DATE.:::::: :P 0.D: PROMISED. .......... .......................... . ........... .... ........ ........................ 10MAY06 IS1 17:00 27APR071 I CASH R.O:QPENEO:; READY OPTIONS: DLR:426048 ENG:2.5—Liter 27APR2007 07:191 1 LINE OP CODE TECH. TYPE DESCRIPTIONS INSTRUCTIONS #.:AB80 .... ...... .. C.w.....0U TOM....R.... 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THIS IS NOT AN INVOICE ALL PARTS REMOVED WILL BE DISCARDED UNLESS OTHERWISE REQUESTED PRIOR TO BEGINNING BY LAW,YOU MAY CHOOSE ANOTHER LICENSED SMOG CHECK FACILITY TO PERFORM ANY NEEDED REPAIRS WORK.I REQUEST THAT MY PARTS BE SAVED,. . ........................ ....... OR ADJUSTMENTS WHICH THE SMOG CHECK TEST INDICATES ARE NECESSARY. 1,the registered vehicle owner,hereby authorize the repair work herein set forth to be done along F] SAVE PARTS .. ................. with the no 'a hc,snisry maten I on"i'"'s that 'a rr:t be.p.-itile for an,del...caused by unavallabilitypeiiiii ,,=,h.,n pots a gri by the A'L PARTS ARE NEW UNLESS OTHERWISE SPECIFIED. supplier or transporter.I hereby,grant you and/or your employees pesminc, to or .the ra,r descn ad on streets, DATE I TIME JPIIONE#ORIN PERSON JAUTHORIZED BY ADDITIONAL AMOUNT highways or elsewhere forge Purpose of testing and/or inspection.An mechanic's lien is hereby acknowledged on th above vehicle to.—v,the amount of pairs "act and I d h drab thereto.I hereby appoint CONCORD NISSAN as mV attorney in onnp.wor y to negotiate an cash any m or issued payment of this repair order by any third pony in my name and my nm"',r*,d.'1,cciptcf vehicle described herein for repair or 0 h1n:b olkno, d.9,Vby REASON REVISED TOTAL deals, . 'o..,i. 1. . prole tg 8 Said hereby ha,.,,., :.idjpnr.,dpan, r its contents,is notof Dy rid .jeo n=-siadb r against Ion occasioned by theft,fire or vandalism while the actual cash value thereof,or othe articles of 11 It property remains with the dealer.Customer slates no a as Dersonq orgerly have been in the vehicle.and the dealmer DATE I TIME IPHONE 0 OR IN PERSON AUTHORIZED BY ADDITIONAL AMOUNT s not responsible for payment of reasonable attorney fees and costs in the event suit is brought for collection.I authorize vromirityworkto be performed on my vehicle.In th event the work performed is not accepts or warranty Payment by the n 1, manufacturer, he the customer,willbeheld responaibi?,,for the outstanding balance.This agreement in no REASON REVISED TOTAL co'e if this dh warranty rage. situation oft occur,then you w, receive documentation of denied warranty for your records. WHICH INCIU'DES AE DATE TIME By NT "AST PHONE#OR IN PERSON ADDITIONAL AMOUNT PRELIMINARY HAZARDOUS $ ESTIMATE DISPOSAL FEE OF REASON REVISED TOTAL AUTHORIZED BY:X TERMS: CASH OR VISA,MASTERCARD,AMERICAN EXPRESS,OR DISCOVER QUALITYY—ONTROLLED BY MILES UNLESS PRIOR ARRANGEMENTS HAVE BEEN MADE. GUN"BIF R_CW BAR#AG234817 EPA#CAL000284767 Attachment for question #3: On April 24, 2007, 1 was on Marsh Creek Road headed west bound at approximately 5:30 am. As I was coming around the corner, I hit a very large pothole. Upon inspection, this pothole was inside the white shoulder line. This caused my tire to blow out and completely break the rim. Attachment for question #6: The damages my car received because of the pothole were a blown out tire and a broken rim. Neither was repairable and I had to replace both. CLAIA'I C BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY r1 BOARD ACTION: Claim Against the County,or Dishict 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 Cali fornia.Government Codes. ) you is your notice of the action taken on your claim by the Board of f �� II97 ,, Supervisors. (Paragraph IV below), C"� given Pursuant to Government Code AMOUNT: OCT G 2 200 UU Section 913 and 915.4. Please note all ��� "Warnings". CLAIMANT: JCOUNTYCOUNaEL J m JMARTINEZ CALIF. ATTORNEY: DATE RECEIVED: ����•br. r ADDRESS: I �`�+ Sf BY DELIVERY TO CLERK ON: KoAtnezI CA BY MAIL POSTMARKED: nth) 84553 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULL , lerk :� � DateddD� �,�,ry L 2 (J( _ By: Deputy IL. FROM: County Counsel T0: Clerk of the Board of Supervisors (0/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 retum claim on ground that it was filed late and send warming 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). I V. BOARD ORDER: By unanimous vote of the Supervisors present: ( 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 t��h iss.�..date. Dated V". Ore -&049?'JOHN CULLEN,CLERK, By,16�. Deputy Clerk WARNING(Gov. code section 913) ell Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the nail 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 widr this matter. If you want to consult an attorney,you should do so inunecliately. *For Additional Warning See Reverse Side ofThis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that 1 am novo, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant,addressed to the claimant as shown above. Dated,e,V. 0.—P ?- RI JOHN CULLEN,CLERK By uty Clerk ' Contra County Administrator Risk Management Division Costa 2530 Arnold Drive,Suite 140 Risk Management Martinez,California 94553 County Administration (925)335-1400 Fax Number (925)335-1421 September 27,2007 \ = ��' RCLERKBOARD CEIVED OCT 0 2 2007 Pauline Jones OF SUPERVISORS A COSTA CO. 727 Lafayette St. Martinez, CA 94553 Re: Claimant: Pauline Jones Insured: 'Contra Costa County D/Accident: 09/19/2007 Claim No.: 63710 Dear Mr. & Mrs. Jones: The above captioned matter has been referred to my office for investigation and handling on behalf of the Contra Costa County Department of Child Support Services. I have enclosed a claim form that must be completed in order to file a formal claim against the County. Be advised that you have six months from the accident date to file a formal claim as stated in the California Government Code beginning with Section 900. This also notifies you that you must comply with the claims presentation and timely suit filing requirements of California law in order to preserve your claim. Our investigation of your claim does not affect your duty to comply with time limits set by law, and by investigating,considering, and discussing your claim with you or your representative, we do not waive our right to assert your failure to comply with those time limits as a complete defense to any claim or action you may bring. Should you have any questions, please do not hesitate to contact the undersigned. .Sincerely, Penny Bailey Liability Claims.Adjuster :(925)335-1455 . . Enclosure _ � 3r7i0 , BOARD OF SUPERVISORS OF CON'T'RA 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 gro-wing 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 ane 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 945 53. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the nine 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. aaaaaaaaaaaaataaaaaa■■■■aaaa■■a■aaasaaaaaaaa■■a■■aaaaataaaaaaaswon ataaaaaaaca as RE: Claim By: Reserved for Clerk's filing stamp RECEIVED Against the County of Contra Costa or ) OCT 0 2 2001 District) CLERK BOARD OF SUPERVISORS CONT^nr.COSTA CO. (Fill in the name) ) The undersigned claimant herebb 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) Z)e,gct d �vv� 37here did the damage or injury occur? (Include city and county) 7 (-.csu � 5�-- �o.�t' Y� z �szrn �e,., CpS . W`+ 3� How did the damage or injury occur? (Give full details;use extra paper if required) 4. What particular act or omission on the part of coag or.district officers. servants, or emplo cc, caused the injury or damage? Q j\4W 5 'What are the names of county or district officers, servants, or employees causing the damage or injury? f���-`J�9 6. What damage or .injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.)—X�� t1 3 0 7. Hove was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) qvb,�Of\q S. Tames end addresses of witnesses, doctors, and hospitals: �S t c�A- 9. List the expenditures you made on account of this accident or injury: DATE TME AMOUNT ■.■■■raa■a.a.Iaar.i■■ir'a■�.aaa . ..... V.VeJ ... ■ ....., ) .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 ) 0 (Claim t ignature) ) (Address) ZaLlltisS3 Telephone No. )Telephone No. Q�S 67 7 , qQ�—aW .FEE■■......a.a.son......a..Room..a......a...son aaman■■.Mason.woman a..a.. a.a....aaa.1 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, an), attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. .........■.............■........aara■u.■ar.■aa.a..■a.■■.aa a.aa■a■a.aaa.aa a.a sass.■aa, 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 ($10,000), or by both such imprisonment and fine. Page No. � of Pages 1 iSLRIaT"41'9�.'�a Y q L'[179a- P,/.-Ort.�BOX 656 CLKc auft Urr— 4752969 (925) 672-8466 C&N (M) 260-4083 PROPOSALSUBMITTEDTO_.f. PHONE DATE �7 STREET ? JOB NAME � - `� CITY,STATE and ZIP CODE i JOB LOCATION ARCHITECTDATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: CA '14 P,"d �Z -` d-M- n F 13fQt105F hereby to furnish material and Libor—cott`a e i See wtf�above specifications, for theey f: dollars($ c Payment to be made as follows: rtJ o lAi /rt All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above:specifications Authorized involving extra costs will be executed only upon written orders,and will beccme an extra Signature charge over and above the estimate. All agreements contingent upon strikEs, accidents Note:This proposal may be z �delayrsq�.Y.,,,,d our control.Owner to carry fire,tornado and other necessary insurance. P P y fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. Arreptattrr of 11) "roposal —The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature R` To f CLAil1'i BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: gvatttmloer fe,2au7 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. `� M,, you is yournotice of the action taken on your claim by the Board of OCT0 4 2007 Supervisors. (Paragraph IV below), given Pursuant to Government Code (COUNTY COUNSEL Section 913 and 915.4.Please note all AMOUNT: 'To be �+aterwnnne MARTINEZ CALIF. "Warnings". CLAIMANT: MartL'y- �nr1e SPelt�01� ATTORNEY: �iChcar� A' f�u�Se� DATE RECEIVED. OC bei(�t 2W- ADDRESS: MadSE✓' lc�olCh,L.L BY DELIVERY TO CLERK ON: lyp*- 4D55 A(vr{v► B+� Ski+e tGt� BY MAIL POSTMARKED: - nl4- WGly�ut 6-tm, CA qtlE�% FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN,Clerk Dated 10er 3, � _ By: Deputy C2"_d%r- 11. FROM: County Counsel TO: Clerk of the Board of Supervisors (-rfhis claim complies substantially with Sections 910 and 910.2. ( ) This Clairn 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: 5-o By: CQ }� � 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. OARD ORDER: By unanimous vote of the Supervisors present (1/� 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/-0 1% -�oF JOHN CULLEN,CLERK, By Deputy Clerk WARNING(Gov. code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the nail to file a court action on this cWnn.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection wide this matter. If you want to consult an attorney,you should do so inunediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that i am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant,,addressed to the claimant as shown above. Dated/4/dd. O? -2";P JOHN CULLEN,CLERK By Deputy Clerk This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief'such as mandamus or injunction,or Federal Civil Rights claims. The above list.is not exhaustive and legal consultation is essential to understand'ff the----v, separate limitations periods that may apply. The limitations period within wliic`h Sul mus. be tiled may be shorter or longer,•depend;ing on ffie mature of the claim. Consult the specific statutes and cases applicable`to claim. The County of Contra Costa dbes`not'WMVe-:iiY `"''`'' of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject.to California Tort Claims Act I I I 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 personally 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. ■���� �� ����■......... .......■..o.o ■................... RE: Claim By: ) Reserved for Clerk's filing stamp MARILYN ANNE SPELLMAN, Claimant Against the County of Contra Costa or ) 7007 District ) (Fill in the name CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of $ TBD and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) April 6, 2007; approximately 2210 hours. 2. Where did damage or injury occur? (include city and county) 341 Bryan Drive,Alamo, Contra Costa County, California, 94507. 3. How did the damage or injury occur? (Give full details, use extra paper if required) Deputies responding to unverified report of underage party, illegally entered Claimant's home and unreasonably and excessively exercised force against Claimant, including, but not limited to, punching, kicking, and throwing Claimant to the floor of her own home, resulting in serious and ongoing physical and psychological iniuries• 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Illegal entry to Claimant's home: excessive and unreasonable use of force; violation of civil and constitutional rights. 5. What are the names of county or district officers, servants, or employees causing the damage or injury? Contra Costa County Sheriffs Department; Contra Costa County Sheriffs Deputy J. Johnson (ID No. 66345); DOES 1-25, investigation is continuing. 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) Serious and ongoing physical and psychological in juries; Fingernail ripped from left middle finger; blunt trauma; knee to back injury; investigation is continuing. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Damages greater than $100,000.00 and in excess of appropriate court of jurisdiction. This is not a limited civil case. 8. Names and addresses of witnesses, doclors and hospitals: Daniel Zimmerman; David Zimmerman; See also Contra Costa County Sheriffs Department Report No. 07-9014; investigation is continuing. 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT Medical expenses are unknown at this time; discovery is continuing. Gov. Code Sec. 910.2 provides"The claim shall be signed by the claimant or by some person on his SEND NOTICES TO: (Attorney) ) behalf:" Name and address of Attorney ) / Richard A. Madsen,Jr., Esq. (SBN 146174) ) Richard A. Madsen,Jr., Afiorney for Claimant MADSEN & WOLCH, L.L.P. ) 2055 North Broadway, Suite 100 ) 2055 No. Broadway,Ste. 100, Walnut Creek 94596 Walnut Creek, CA 94596 ) (Address) Telephone No.: (925) 974-0800 ) Telephone No. (925)974-0800 .............................................................................................................................. 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. ■..............................■............■...■....................................._..-.u................-..............-..... NOTICE: Section 72 of the Penal Code provider: 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 len thousand dollars($1.0,000.00),or by both such imprisonment and fine. CLAIM ,Ott BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: V tp Claim Against the County,or District Governed by ) i the Board of Supervisors Routing Endorsements: ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to California Government Codesi'- )� t- you is your notice of the action taken �; on your'clarm.by the Board of 'Super visors.(Paragraph IV below), �ol IJCT G 42007given,Pursuant to Government Code AMOUNT: L�Q(��i, � COUNTY 0U�$EL SecUon.913 and 915.4:Please note all MARTINEZ CAU "Warnings", CLAIMANT: "D9rr?5,5 i ve,`�Ur "n ` ' ` ATTORNEY: DATE RECEIVED: ADDRESS: P,l% icJ �GI`fztD BY DELIVERY TO CLERK ON: LO— �D'rn cktRkndf 04 rr BY MAIL POSTMARKED:. �Nm I"- OL FROM: Clerk of the Board of Supervisors TO County Counsel Attached is a c.'opy of the above-noted claim. 1 JOHN CUL ,: Jerk Dated: � �7/ �ByDeputy �U L FROM.: County Counsel TO:Clerk of the Board'of Supervisors O This claim complies substantially with Sections 910 and 910.2.. (,,KThis 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: i Dated: - By: Deputy County Counsel 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. ARD ORDER: By unanimous vote of.the Supervisors present; (Pf 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 thise. is�date; ! DateW0a-•d 0 -&.10,7 JOHN CULLEN,CLERK, By,&5� Deputy Clerk. WARNING(Gov.code section SubJect to certain exceptions,you have only.six(6)nwnths front the date this nodcr was personally served or deposited In the nwll to file a court action on this clalin See Government Code Sectio[945.6.You may seek the advise of an attorhey of your choice in connection with this matter. fl'you want to consult an attorney,you should do so immediately. *For•Addiilonal Warning See Reverse Side ofTlris Notice, AFFIDAVIT OF MAILING I declare under penalty of peam now,that anow,and at ail 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 III Martinez, Califoruia, postage:fullyPrepaid a certitled copy of this Board Order acid Notice to Clalrirant,addressed to the ciaiinnir.t as shown above. DateJOHN CULLEN,CLERK By Deputy Clerk .This warning does not apply to claims which are not subject to the California Tort Claims Act such as act[ohs In inverse condemnation, actions for specific relief such as.mandamus or injuncition,or`-Federal Civil Rightselaims.The above list is not exhaustive and legal. consultation is essential to understand all the separate limitations periods that may apply. The limitation§,period within which suit must be flied may b.e shorter or longer depending on the nature.of the claim.'.Consult the specific statutes and Cases applicable to your.particular Claim.', The County of Contra Costa does not waive any. of its.rights under California Tort Claims Act nor does [t waive rights under the statutes of 'limitations applicable to actions tot subject to the California Tort Claims Act OFFICE OF THE COUNTY COUNSEL gE I SILVANO B.MARCHESI COUNTY OF CONTRA COSTA 5�+ _"�i`� =_0.�+ COUNTY COUNSEL Administration Building ti ,iD_ S_ SHARON L. ANDERSON 651 Pine Street, 9" Floor ° CHIEF ASSISTANT Martinez, California 94553-1229 (925) 335-1800c�; �_.' m,1''1 ;�'....:.,5 GREGORY C.HARVEY O• VALERIE J. RANCHE (925) 646-1078 (fax) 3°�' _ p ASSISTANTS OOsr'� COUl��,G4' NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Bridget Magar Subrogation Representative PROGRESSIVE P.O. Box 89440 Cleveland, OH 44101 RE: CLAIM OF PROGRESSIVE Your Insured: Ann Barrett Your Claim #: 072931822 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: [ ] 1. The claim fails to state the name and post office address of the claimant. [X] 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [ ] 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. [X] 6. The claim is not signed by the claimant or by some person on his or her behalf. Bridget Magar PROGRESSIVE Re: Claim of PROGRESSIVE 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. MARCHESI COUNTY COUNSEL By: Monika L. Cooper Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (Code Civ. Proc., §§ 1012, 1013a, 2015.5; Evid. Code, §§ 641, 664) I am a resident of the State of California,over the age of eighteen years,and not a party to the within action. My busines address is Office of the County Counsel, 651 Pine Street, 9th Floor, Martinez, CA 94553-1229. On -U —,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 Bridget Magar, Subrogation Representative,PROGRESSNE, P.O. Box 89440, Cleveland,01-1 44101, as set forth above. I am readily familiar with Office of County Counsel's practice of collection and processing of correspondence for mailing. Under that practice, it would be deposited with the U.S. Postal Service on that same day with postage thereon fully prepaid in the ordinary course of business. I declare under penalty of perjury under the law-3 of t e State of California and the United States of America that the above is true and correct. Executed on at Martinez, California. athleen O'Connell cc: Clerk of the Board of Supervisors (original) Risk Management Cortespondence Address: RVERA ����/L. Cleveland,OH 101 Phone:(877)818 0139 Fax(888)792-5922 NOTICE OF CLAIM: CERTIFIED MAIL#: 917108 2133 3932 6146 7525 OUR INSURED: Q ANN BARRETT p�h r �1 114 VISTA HERMOSA by sail ✓1° WALNUT CREEK,CA 94597 ocr PL @y 01 X001 DATE OF LOSS: 8/30/07 ��� TIME OF LOSS: . 05:25 PM LOSS LOCATION:HIGHWAY 4 AND I-6130,MARTINEZ CA FACTS OF LOSS: OUR INSURED'S VEHICLE WAS MERGING ONTO I-680 FROM HIGHWAY 4 WHEN A MUIR POLICE DEPARTMENT VEHICLE,DRIVEN BY KEITH CHILINI,FAILED TO MAINTAIN PROPER BREAKING DISTANCE AND REAR ENDED OUR INSURED'S 2004 HONDA ACCORD EX NAVI,CAUSING DAMAGE TO THE REAR BUMPER. YOUR INSURED: MUIR POLICE DEPARTMENT YOUR DRIVER: RECEIVED KEITH CHILINI OCT 0 4 2007 AMOUNT REQUESTED: $1,068.34 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. 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N O 7 rn�G a 63 14 o � m�y C Y O n n � m � N r Jw � Y n � �a R N w n � N F N � O (D O M K G Y Y �H 7 � m n n ? a y w � °a a a Y Y A w s m LP 0 e-n ARMS@ - Automated Rental Management System(Patent Pending) Page 1 of 1 Rental Company:ENTERPRISE RENT-A-CAR ® PROGRESSIVE INS Invoice: D177826-2384 Bill To: Billing Detail: ATTN: REGINA DEGIDIO Rental Period: 9/4/07 to 9/7/07(4 days) Billed Period: 9/4/07 to 9/7/07(4 days) RENTER INFORMATION: Description Rate: Amount: Renter: BARRETT,ANN 4 DAYS @ $25.99 $103.96 1 SALES TAX% %8.25 $8.56 RENTAL INFORMATION: Rental Branch Location: TOTAL CHARGES: $112.54 ENTERPRISE RENT-A-CAR(2384) Less Amount Received: $0.00 2266 NORTH MAIN STREET WALNUT CREEK, CA 945963521 (925)210-9550 AMOUNT DUE.......... $112.54 ADDITIONAL CLAIM INFORMATION: Claim Number:07-2931822 Claim Type: Insured Vehicle Condition: Driveable Date Of Loss: Insured Name: Owner's Vehicle:2004 HONDA/ACCORD Additional Driver: Repair Facility: JIM'S AUTO BODY-WC WALNUT CREEK„ CA 94596 (925)933-2109 VEHICLES RENTED Effective Date and Time Year Make Model VIN Mileage 9/4/07 7:49 AM 2007 FORD FUSI 3FAHP06Z07R241660 200 Rental Invoice Please Return This Portion with Remittance Make Payment To: Total Charges: $112.54 ENTERPRISE RENT-A-CAR Less Amount Received: $0.00 P.O.BOX 795110 Total Amount Due.................... $112.54 ST. LOUIS, MO 63179-0795 Federal ID:43-0724835 Please include on your check: Invoice:D177826-2384 https://www.enterprise.com/armsweb/closecicustomerfile.do 09/24/2007 September 24, 2007, 11: 18 :55 CMSD2340. /CMSM2340 P A C M A N SEP 24 07 - 11: 18 OPID: KXM0194 CLAIM PAYMENT INQUIRY TERMID: ?02C INSD: BARRETT, ANN M POL: 60480126-8 DOL : AUG 30 07 CA-CONINJ-BRN- CLM: 072931822 ACTIVE REP: R DEGIDIO PAY TO THE ORDER OF: TOTAL DRAFT AMOUNT: 955. 80 LINE 1: ANN M BARRETT AND JIMS AUTO BODY ONLY*********** LINE 2 : LINE 3 : ADDRESS: CITY: ST/PR* CA ZIP/CPC: CNTRY* USA IN PAYMENT OF: COLL - 04 HONDA ACCORD - DED WAIVED 1099 ? Y FEDERAL TAX ID: 94:2227228 LAST UPDT REP: RXF0073 CDS CODE * 01 PCL EFT TRACE #: ISSUING REP: R FRIEDMANN BANK CODE* AS2 ISSUE DATE SEP 06 07 APPROVED BY: STATE . * CA AREA * 770 REVIEW DATE: 00 00 STOP RSN * DRAFT ## 452939261 REVIEWED BY: COMMAND: FAX TRANSMITTAL SUBROGATION September 24, 2007 91 7108 2133 3932 6146 7525 PROGRESSIVE CHOICE To: RISK MANAGEMENT INSURANCE COMPANY Company: CONTRA COSTA COUNTY P.O. Boz 89440 Our Insured: BARRETT,AVN M Cleveland, OH 44101 Our Claim#: 072931822 Facsimile:888-792-5922 Date Of Loss: AUG 30 07 pro ressive.com Your Insured: MUIR POLICE DEPARTMENT g Your Claim/Policy#: UNKNOWN Total Subrogation Balance: $ 1,068.34 . This includes our insured's $0.00 deductible. We are seeking reimbursement at 100°/i, for a total of$ 1,068.34 . Please take this as formal notice of our subrogation rights with regards to the above captioned claim. We have completed our investigation into the facts of the above captioned loss and find that your insured was the proximate cause of the accident. Please make draft payable to"PROGRESSIVE CHOICE INSURANCE COMPANY as Subrogee of BARRETT,ANN M",in the amount stated above and mail it to the attention of the undersigned. All supporting documentation is enclosed. I have diaried my file ahead fifteen(15) days. Thank you for your anticipated,prompt attention to this matter. PROGRESSIVE CHOICE INSURANCE COMPANY BRIDGET MAGAR Subrogation Representative Toll Free 1-877-818-0139 ext. 37152 BPMGET MAGAR@Progressive.Corn "PLEASE INCLUDE MY NAME AND CLAIM # ON ANY AND ALL CORRESPONDENCE" PR99REIIIYE Not what you'd expect from an insurance company.'" CLAiM �� 2 BOARD OF SUPERViSORS OF CONTRA COSTA COUNTY BOARD ACTION: NOVEMBER 06, 2007 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 Govemment Codes. ) you is your notice of the action taken on your claim by the Board of Dnp n Supervisors.(Paragraph IV below), I given Pursuant to Government Code Section 913 and 915.4.Please note all AMOUNT: $2,098.29 OCT 0 9 2007 "Warnings". CLAIMANT: DYLAN JAMES COUNTY COUNSEL MA19TINEZ CALIF. ATTORNEY:UNKNOWN DATE RECEIVED: OCTOBER 9, 2007 ADDRESS: 208 HEMME AVENUE BY DELIVERY TO CLERK ON:OCTOBER 9, 2007' ALAMO, CA 94507 BY MAIL POSTMARKED OCTOBER 5, 2007 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached isa copy of the above-noted claim. OCTOBER 09, 2007 JOHN CULLEN, lerk Dated: _ By: Deputy iL FROM: County Counsel TO: Clerk of the Board of Supervisors (v<This claim complies substantially with Sections 9 t0 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 retum 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 Ili. 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 V DOARD ORDER: By unanimous vote of the Supervisors present: (1of 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. Dated4-041 of}ai�+-e>iJOHN CULLEN,CLERK, ByDeputy Clerk WARNING(Gov. code section 913) - Subject to certain exceptions,you have only six(6)utonths from the date this notice was personally served or deposited in the mail to file a covet 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. ll'you want to consult an attorney,you should do so immediately. *For Additional Waming See Reverse Side of This Notice. AFFIDAVIT OF MAILING 1 declare under penalty of perjury that 1 am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today f deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Orderand Notice to Claimant,addressed to the claimant as shown above. Dated//,. m� 4W? JOHN CULLEN,CLERK By Deputy Clerk This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be tiled may be shorter or longer depending on, the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act I I �I I l BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CL.kUAANT 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 o:" 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 claim;; Penal Code Sec. 72 at the end of this form. [[[[[[[[[[[[[[[[[[■[[■[[[[[[[[[u.[[[[[■■■■[[[[[■■[ N[[[I RE: Claim By: Reserved for CIerk's filing stamp o A� � RECEIVED Against the County of Contra Costa or ) OCT 0 9 2007 District) CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. (Fill in the name) ) The undersigned claimhereb ' makes claim against the County of Contra Costa or the above-named ant district in the sum of$ and in support of this claim represents as follows: k Zp°I 1. When did the damagge-or injury occur? (Give exact date-and hour) I Kv r`7 gf-_� `w, W1, ZX50- 2. Where did the damage or injury occur? (Include city and county) damp, GA ��507 3. How did the damage or injury occur? (Give full details;use extra paper if required) •� r&J- +- 66,C.144 ^4o M� -5f,? 6�d C-N 4. What particular act or omission on the part or county or district officers, servants, or employees caused the injury or damage? k4e- Jhe_ `{Y-, Aer ,N,4,0 M 1 Cad 5 What are the names of county or district officers, servants, or employees causing the damage or injury? GZ(o5' 11o0�j f 6. 'What damage or injuries do your clava resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) hWJ CVe�N�eA , VIZ-5 i hvM�er- gas 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses, doctors, and hospitals: 9. List the expenditures you made on account of this accident or injury: DATE TIRE AMOUNT ■ ■■aa■a■aataaaaUna nun MEN a■a■aamaaass a■11■aInn aaa■a■aa0am a am a as as..oils am a s am an a a s■aa a■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: (Attornev) ) Name and address of Attorney ) ( iaimant's Signature) (Address) G,4 7 q 5a '7 Telephone No. )Telephone No. Z� ................aaaa0aaaaasIII a■aaa0a9a2a■5aaaaaown aaaaaaaaaaaa..amus aa■a■a aaa aaaaaaaae PUBLIC P:ECORDS 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 Re-.ords Act. (Gov. Code, §§ 6500 at seq.) Furthermore, any attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. aaaaaaaaaaaaaaaaaaawoman aaaaaata.aaaa. aaaaaaaaaa.aaaa■■aaaaaaaaaaaaaaaa■a■■amonsoons t 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. The Hertz Corporation Page I of 2 Home Rates and Reservations w: E Pvri rRip E YOUR REQUESTED ITINERARY GO A Quote Reserve a Car Cancel a Reservation a YOUR QUOTE Plan Trip ViewfModitv a Reservation- You have selected a Chevrolet Malibu at similar Pick-UplReturn Location: Standard 24 Door 2005 Crow Canyon Place HLE.2005 Crow Special Offers P. Canyon Place,San Ramon,CA,US Locations,Cars,and More P;-� CWRdij,_..4M_i1gD Location Type:Corporate ITUrt Ifiriffted-Freielfiles iM Club 0:.. Fo_iw-1n--c1Udi—ng Xp7pFo—iiniate Charges:I77.49 U59 Ral.P.1kils SFr 07001800,Sa-Su 0900-1300 Special Bevins Child Seats Tax,vehicle licensing cost recovery Partners It Total Approximate Charges Include: Hand Controls Business to Business 01: Insurance Services About Hertz P Charges are in USD • Gold Service Other Hertz Operations Iiproxrmaferentarchargesare.�ased:onavailable `. '- • Pick Up: 1 Vi�ftrrridationiatthe-tiinwi.Pri�, atio"Iciereintprs ag(L P1.k-Up:Thu.OcI18.2007.tI0:00AM Customer Supper 11, .5..ah,tiae For Teirteirbunder ag"15 an.additional Nent-01.charge Refum:Men,Oct 22.2007 at 10.00 AM �Iy agqeOd be Q fica uaUficationsand.Requiremehts',Iir�k.belowto.thg Arrival Information: Airline: NoArrival Info ,.hilloiat_C IS_ P ight for detalk-Adbitional fees or SLircharges may HeA 7 at lun.0 eappricidat time of rental. How Login Join Now No affiliations have been applied Learn More Your Personal Information (JIC HA Nr.r: Selected Car Vehicle Type First Name: Last Name: Chevrolet malibuor similar Standard • 2-4 Door E-mail Address: • Automatic,(if you'd like to receive an o .1 email confirmation) VerifIr E-mail Address: Extras I F allANGEO F Please send text based E-mail only If you have a Company OrderiBilliNl Reference Number IMPORTANT INFO enter it here: Rental Qualification-and Requirements Frequent Traveler(optional) Frequent Traveler Number A Frequent Flyer Surcharge of up to$0.50 per day up to a maximum of$2.00 per rental may apply when renters choose to take miles cc credits from a U.S.Frequent Flyer program. Please note that at the time of rental you will need to present a anent driiier's license and a valid major credit Card.Hertz locations also accept most but not all,debit cards.Use of a debt card to rent avehicie is subject to a review of your credit history. A few locations do not accept debit cards at time of rental If you have questions about the acceptability of your form of payment call Hertz. By clicking on the RESERVE IT button,•jou confirm that you understand and accept our Rental Qualifications and Requirements.To review our Rental Qualifications and Requirements,click on the Rental Clualifications and Requirements link in the"Your lfineraryR box Total Approximate Charge:177.49 USD RESERVE IT A:START OVER RATE DETAILS FOR QUOTE at IDB of page _ Selected Vehicle Chevrolet Malibu or similar Standard 2-4 Door j�UtCrn2tic Air Total Approximate Charges 177.49 USD Base amount: Daily: Wy.�aI40 9 9 US (Unlimfted Free Milet Rate Code LHIDR Rate Includes: Vehicle Licensing Cost Recovery Additional Items{included in Approximate Tots%Charges) Tax 8.25%7 This Rate is Guaranteed Total Approximate Charges 1549 USD Optional Items(not included in quote) Rates for Optional Items are exclusive of tax and other associated charges Liability Insurance Supplement 12.95 USD Per Day Loss Damage Waiver 14.99 USD Per Day Personal Accident Insliranoe,t Personal Effects 5.50 USD Per Day Coverage https://www.hertz.com/rentacar/reservation!gaq/indexisp?targetPage=bookab]eQuoteView... 9/26/2007 The Hertz Corporation Page 2 of 2 This information will also be displajmd on your confirmation page.Reiuro.to top t'n�!Agents Johs Phi=, 2ky- Legal C—tl It Us O 2007Th,Har Gcrpa.ton.AO Rights R...—d.H.rh ants Fads and other fine cars. https://www.hertz.com/rentacar/reservation/gaq/index.j sp?targetPage=bookabl eQuoteVi ew... 9/26/2007 Rental Terms Page 1 of 1 Please choose a topic and click Go Age Restrictions and Exceptions C0 On most rentals the minimum age is 25 without an additional Age Differential Charge,and 21 with an additional Age Differential Charge. Age Differential Charge Policy At corporate locations in the United States,Puerto Rico,.and St.Thomas Hertz will rent selected car class vehicles(Prestige Collection and some other models excluded)to customers who are age 21-24 with the following per day Age Differential Charge in addition to the nofmal rental rate. QI ales exceat New York.a e 21-24' _—rm conamy Car,Compact Car,Intermediate Car,Standard Car,Fu slrizeCar,-1'nfermediate Sport,– coE Homy Sp. Full&ize Sport' USD 27.00 per day Other Car Classes(some models excluded) USD 3T.00 per day In New York age 21-24 Economy Car,Compact Car,Intermediate Car,Standard Car,Fullsize Car,Intermediate Sport,Economy Special, Fullsize Sport USD 35.00 per day Other Car Classes(some models excluded) USD 45.00 per day In the states of New York and Michigan only,Hertz will rent to 18-20 years old with the following per day Age Differential Charge in addition to the normal rental rate. In New York,age 18-20 Economy Car,Compact Car,Intermediate Car,Standard Car, Fullsize Car,Intermediate Sport,Economy Special, Fullsize Sport USD 51.00 per day In Michigan,age 18- Economy Cas,Compact Car,Intermediate Car,Standard Car,Fultsize Car,tntermediate Sport,Economy Special, Fullsize Sport USD 41.00 per day Corporate Accounts Various corporate accounts have agreements with Hertz which permit employees of those companies,between the ages of 21-24,to rent for business purposes.Renters must present a valid Corporate Identification Card at the time of rental and additional fees may apply.Please contact your company travel department to verify age exceptions when renting for business purposes. ®2005 The Hertz Corporation.All Rights Reserved https://www.hertz.com/rentacar/reservation/reviewmodifycancei/en US/rentalTerm s.j sp?K... 9/26/2007 09/25/2007 at 04 :48 PM Job Number: 22895 SAN RAMON BODY AND DETAIL SHOP Federal ID #: 942863297 10 BETA CT SAN RAMON, CA 94583 (925) 838-8380 Fax: (925) 838-6254 PRELIMINARY ESTIMATE Written By: x Kim, John Adjuster: Insured: DYLAN JAMES Claim # Owner: DYLAN JAMES Policy # Address: 208 HEMME AVE Deductible: ALAMO, CA 94507 Date of Loss: Cellular: (753) 740-3316 Type of Loss: Point of Impact: Inspect Location: Insurance Company: Days to Repair 2007 FORD FUSION SE 4-2 .3L-FI 4D SED WHITE Int:TAN VIN: 3FAHP07Z07R214554 Lic: 5ZBE345 CA Prod Date: Odometer: 11089 Air Conditioning Rear Defogger Tilt Wheel Cruise Control Telescopic Wheel Intermittent Wipers Theft Deterrent/Alarm Steering Wheel Controls Body Side Moldings Dual Mirrors Roof Console Fog Lamps Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks Power Driver Seat Power Mirrors Power Trunk/Tailgate AM Radio FM Radio Stereo Search/Seek CD Changer/Stacker Driver Air Bag Passenger Air Bag Front Side Impact Air Bag 4 Wheel :disc Brakes Cloth Seats Bucket Seats 5 Speed Transmission Aluminum/Alloy Wheels ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1 FRONT BUMPER 2 O/H bumper assy 2. 9 3* Rpr Bumper cover 2.5 2. 6 4 Add for Clear Coat 1 . 0 5 GRILLE 6 Repl Grille chrome 1 129. 80 0.3 7 Repl Emblem 1 17. 75 Incl . 8 HOOD 9* Rpr Hood 3.0 2 . 8 10 Overlap Major Non-.Adj . Panel -0. 2 11 Add for Clear Coat 0. 5 12# Rpr TINT COLOR 0.5 13# Repl FLEX ADDITIVE 1 9.00 T 1 09/25/2007 at 04: 48 PM Job Number: 22895 PRELIMINARY ESTIMATE 2007 FORD FUSION SE 4-2 .3L-FI 4D SED WHITE Int :TAN ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT -------------------------------------------------------------------------------- 14# Rpr COLORSAND AND POLISH 1.0 15# Repl COVER CAR FOR OVERSPRAY 1 7.00 T 0.3 16# Subl HAZARDOUS WASTE REMOVAL 1 5. 00 X 17# Repl CORROSION PROTECTION 1 10 . 00 T 0. 3 -------------------------------------------------------------------------------- Subtotals =_> 176.55 10.8 6 . 7 Parts 147. 55 Body Labor 10.8 hrs @ $ 78. 00/hr 842. 40 Paint Labor 6 . 7 hrs @ $ 78. 00/hr 522.60 Paint Supplies 6. 7 hrs @ $ 35. 00/hr 234. 50 Sublet/M'_sc. 31.00 ----------------------------------------------------- SUBTOTAL $ 1778. 05 Sales Tax $ 408.05 @ 8.2500% 33. 66 ----------------------------------------------------- GRAND TOTAL $ 1811 . 71 ADJUSTMENTS: Deductible 0.00 ----------------------------------------------------- CUSTOMER PAY $ 0.00 INSURANCE PAY $ 1811 . 71 2 09/25/2007 at 04: 48 PM Job Number: 22895 PRELIMINARY ESTIMATE 2007 FORD FUSION SE 4--2 .3L-FI 4D SED WHITE Int:TAN FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS ORM: ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. THE FOLLOWING IS A LIST OF ABBREVIA"TIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES: B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT LABOR S=STRUCTURAL T=TAXED MISCELLA14EOUS X=NON TAXED MISCELLANEOUS PATHWAYS: ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT A14D RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT W/_=WITH/_ SYMBOLS: #=MANUAL LINE E14TRY *=OTHER [IE. .MOTORS DATABASE INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. MQVP=MANUFACTURER' S QUALIFICATION AND VALIDATION PROGRAM. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. NWCPP=NATIONWIDE CRASH PARTS PROGRAM. Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide DR2JP06, CCC Data Date 09/01/2007, and the parts selected are OEM-parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at of/Vehicle dealerships. OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM vehicle dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount. OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle dealerships. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign (-) items indicate MOTOR Not-Included Labor operations. Non Original Equipment Manufacturer aftermarket parts are described as AM, Qual Repl Parts or Comp Repl Parts which stands for Competitive Replacement Parts. Used parts are described as LKQ, Qual Recy Parts, RCY, or USED_ Reconditioned parts are described as Recond. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not included. Pound sign (#) items indicate manual entries. Some 2006 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts data from the previous year may be used. The Pathways estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. CCC Pathways - A product of CCC Information Services Inc. 3 09/25/2007 at 04 :48 PM Job Number: 22895 PRELIMINARY ESTIMATE 2007 FORD FUSION SE 4-2.3L-FI 4D SED WHITE Int:TAN ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 14# Rpr COLORSAND AND POLISH 1.0 15# Repl COVER CAR FOR OVERSPRAY 1 7. 00 T 0.3 16# Subl HAZARDOUS WASTE REMOVAL 1 5. 00 X 17# Repl CORROSION PROTECTION 1 10. 00 T 0.3 ------------------------------------------------------------------------------- Subt.otals ==> 178.55 10.8 6 .7 Parts 147.55 Body Labor 10.8 hrs @ $ 78. 00/hr 842 . 40 Paint Labor 6 . 7 hrs @ $ 78. 00/hr 522.60 Paint Supplies 6. 7 hrs @ $ 35 . 00/hr 234 .50 Sublet/Misc. 31 .00 ----------------------------------------------------- SUBTOTAL $ 1778.05 Sales Tax $ 408.05 @ 8 .2500% 33.66 ----------------------------------------------------- GRAND TOTAL $ 1811 . 71 ADJUSTME14TS: Deduct'-ble 0.00 ----------------------------------------------------- CUSTOMER PAY $ 0. 00 INSURANCE PAY $ 1811 .71 2 09/25/2007 at 04:30 PM Job Number: 17682 SYMMONS BODY AND FENDER, INC. License #:AE070127 Federal ID #:942536583 Since 1974 509 San Ramon Valley Blvd. Danville, CA 94526 (925) 820-3--117 Fax: (925) 820-8897 PRELIMINARY ESTIMATE Written By: JIM WALTON Adjuster: Insured: DYLAN JONES Claim # Owner: DYLAN JONES Policy # Address: 208 A HEMME AVE. Deductible: ALAMO, CA 94507 Date of Loss: Cellular: (253)740-3316 Type of Loss: Point of Impact: Inspect Location: Insurance Company: Days to Repair 2007 FORD FUSION SE 4-2.3L-FI 4D SED WHITE Int: VIN: 3FAHP07Z07R214554 Lie: 5ZBE-'145 CA Prod Date: 02/2007 Odometer: 11000 Air Conditioning Rear DE!fogger Tilt Wheel Cruise Control Telescopic Wheel Intermittent Wipers Theft Deterrent/Alarm Steering Wheel Controls Body Side Moldings Dual Mirrors Roof Console Fog Lamps Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks Power Driver Seat Power Mirrors Power Trunk/Tailgate AM Radio FM Radio Stereo Search/Seek CD Changer/Stacker Driver Air Bag Passenger Air Bag Front Side Impact Air Bag 4 Wheel Disc Brakes Cloth Seats Bucket Seats 5 Speed Transmission Aluminum/Alloy Wheels 1 09/25/2007 at 04:30 PM Job Number: 17682 PRELIMINARY ESTIMATE 2007 FORD FUSION SE 4-2.3L-FI 4D SED WHITE Int: -------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT -------------------------------------------------------------------------------- 1 FRONT BUMPER 2 O/H bumper assy 2.9 3* Rpr Bumper cover 2.0 2.6 4 Add for Clear Coat 1.0 5 GRILLE 6 Repl Grille chrome 1 129.80 0.3 7 HOOD 8* Rpr Hood 3.5 2.8 9 Add for Clear Coat 1. 1 10* Add for Underside(Complete) 0.5 11 WINDSHIELD 12 R&I RT Washer nozzle 0.2 13 R&I LT Washer nozzle 0.2 14# CAR COVER 1 5.00 0.3 1 15# TINT COLOR 1 0.5 16# Subl HAZARDOUS WASTE REMOVAL 1 5.00 X 17# Repl FLEX ADDITIVE 1 10.00 T 18# COLOR SAND & POLISH 1 1.0 1 19# Repl RESTORE CORROSION PROTECTION 1 10.00 T 0.3 1 ------------------------------------------------------------------------------- Subtotals =_> 159.80 10.7 8.5 Parts 134.80 Body Labor 9.1 hrs @ $ 75.00/hr 682.50 Paint Labor 8.5 hrs @ $ 75.00/hr 637.50 Refinish 1.6 hrs @ $ 75.00/hr 120.00 Paint Supplies 8.5 hrs @ $ 32.00/hr 272.00 Body Supplies 5.5 hrs @ $ 8.00/hr 44.00 Sublet/Misc. 25.00 ----------------------------------------------------- SUBTOTAL $ 1915.80 Sales 'Pax $ 470.80 @ 8.25000 38.84 2 09/25/2007 at 04:30 PM Job Number: 17682 PRELIMINARY ESTIMATE 2007 FORD FUSION SE 4-2.3L-FI 4D SED WHITE Int: FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM: ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIME AND MPY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES: B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS: ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=:NON ADJACENT 0/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED- PART QUAL REPL=QUALITY REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT W/_=WITH/_ SYMBOLS: #=MANUAL LINE ENTRY *=OTHER [IE. .MOTORS DATABASE INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. MQVP=MANUFACTURER'S QUALIFICATION AND VALIDATION PROGRAM. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. NWCPP=NATIONWIDE CRASH PARTS PROGRAM. 4 09/25/2007 at 04:30 PM Job Number: 17682 PRELIMINARY ESTIMATE 2007 FORD FUSION SE 4-2.3L—FI 4D SED WHITE Int: Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide DR2JP06, CCC Data Date 09/01/2007, and the parts selected are OEM-parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM vehicle dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount. OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle dealerships. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign (-) items indicate MOTOR Not-Included Labor operations. Non-Original Equipment Manufacturer aftermarket parts are described as AM, Qual Repl Parts or Comp Repl Parts which stands for Competitive Replacement Parts. Used parts are described as LKQ, Qual Recy Parts, RCY, or USED. Reconditioned parts are described as Recond. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not included. Pound sign (#) items indicate manual entries. Some 2006 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts data from the previous year may be used. The Pathways estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. CCC Pathways - A product of CCC Information Services Inc. 5 USA FIIi57 V' ^u rUSA �A55' F3 t Jl a QN U) E a c LU d LU ci a v acr- �� pc� 0 c l ^1 09/25/2007 at 04:30 PM Job Number: 17682 PRELIMINARY ESTIMATE 2007 FORD FUSION SE, 4-2.3L-FI 4D SED WHITE Int: -------•--------------------------------------------- GRAND TOTAL $ 1954.64 ADJUSTMENTS: Deductible 0.00 ----------------------------------------------------- CUSTOMER PAY $ 0.00 INSURANCE PAY $ 1954.64 I hereby authorize Symmons Body & Fender Inc. to make the above repairs. Body Shop will not be responsible for loss or damage to vehicle or articles left in case of FIre, Theft or Accident. PLEASE SIGN COPY TO OWNER IF ADDTIONAL DAMAGE FOUND OR SUPPLEMENT APPROVAL NEEDED FROM INSURANCE COMPANY DELAY IN FINISH DATE MAY OCCUR. 3 a 1 Nr ISIN k1l CLAiNI BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: NOVEMBER 06, 2007 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 on your claim by the Board of Supervisors. (Paragraph IV below), OCT 1 1 2007M given Pursuant to Government Code Section 913 and 915.4. Please note all AMOUNT: $4,311.23 COUNTY COUNSEL "Warnings". MARTINEZ CALIF. CLAIMANT, JAMES A. FRANK ATTORNEY uNKNOWN DATE RECEIVED: OCTOBER 11, 2007 ADDRESS: P.O. BOX 335 BY DELIVERY TO CLERK ON: OCTOBER 11, 2007 BRENTWOOD, CA 94513 BY MAIL POSTMARKED: HAND DELIVERED FRONL Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. OCTOBER 11 2007 JOHNDeputy CULLEN, Dated. By. Depputy LI. FROM: County Counsel T0: Clerk of the Board of Supervisors ()�Xnis 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 retum 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 91 l.3). O Other: Dated: I — Z U7 By, /)7(__2jk__Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel(1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). J V. I�OARD ORDER: By unanimous vote oft he Supervisors present: ( This Claim is rejected in full. (.) Other: I certify that this is a true and correct copy of the Board's Orden entered in its minutes for t��is/hise�date. Dated!t%oy OG JAO,;�-JOHN CULLEN,CLERK, By Deputy Clerk WARNING(Gov. code section 913) 11, Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim.See Govemment Code Section 945.6.You may seek the advice of an attorney of your choice in connection witln this matter. If you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side ol'This Notice. AFFIDAVIT OF MAILING i declare under penalty of perjury that I ani now,and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today 1 deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant,addressed to the claimant as shown above. Dated: r/.m�`�ia-O� JOHN CULLEN,CLERK By Deputy Clerk � Fri• - . �My Thiswarning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be tiled may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of itsi rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT 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.) 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. 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. 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. ■■a■■■■■RK"N a■■■a■Eamon Aa a am Is a■■■■■■a a s aa Ban Inn■an Inaaaa■■a am Is Nato■a a aaass a a al E: Claim By: Reserved for Clerk's filing stamp J_8mes A• 1=6 _.Nk QFC i ainst the County of Contra Costa or ) g ty � OCT 1 �Uu" AgcFS� District) C�ERCo gR�oF �STq o9f�is� Fill in the name) ) NTRq coS q co�yso Che undersigned claimant hereby makes claim against the County of Contra Costa or the above-named iistrict is the sum of$ Y 3 [1. 13 and in support of this claim represents as follows: i. When did the damage or injury occur? (Give exact date and hour) Apni / 16 V-00? a+ 1: 30 p 2. Where did the damage or injury occur? (Include city and county) K niyk4 s tN !n C-04mQ Cauh+y .3. How did the damage or injury occur? (Give full details;use extra paper if required) 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? F a i tc a t e 10ash 4"(1019 plA c e W ann .d.�,�ue Sl Jhs of s,�, V� I dk ,e m de y AAd f)r� � p2�s�lan ckc,.red b� 2-er�►e�� o� gspl,al�, 5 What are the names of county or district officers,servants,or employees causing the ;_ damage or injury? ukn . tn,�dF fcfepkar►e can�-gcf wig. p�tatic� Stage:��1t'S�h� b�ve. N�ptn.�' ya7- $s6�, J'�e. s�-q�-c� r,anftv�►nn�� 3 n5 S�i� ! 1d«d b > P y ,. day awt A� ��S,__Z. icv► gpala 1 pp-��. �.. K iia--clk�r►a-a-2 How Damage Occurred: At approximately 1330 hrs. on April 16,2007 I left my home located at 2141 Ranch Rd. and proceeded West to the intersection of Eden Plains Rd. I then turned right(North)on Eden Plains Rd. Just before making the turn I observed vehicles down the road to my left at the intersection of Eden Plains Rd. And Sunset Rd. There were no traffic control signs or devices directed at traffic coming southbound, At the other end of Eden Plains Rd,at the bend approximately one quarter of a mile away,there were some vehicles parked on the road shoulder but there was no traffic control personnel and/or devices stationed to warn northbound traffic of the construction work or hazzards present. As I proceeded northbound on Eden Plains Rd. I noticed what appeared to be freshly patched areas of both lanes.I was unable to detect the fact that the darkened areas were actually areas when material had been removed, leaving a"trench"approximately 4" deep in both lanes. Before I could recognize the darkened areas were actually areas under repair leaving 4" drops, and not finished work,my vehicle dropped into the open area of excavation located in the northbound lane My vehicle struck both sides of the pit tearing up tires and/or bending rims. I then contacted the repair crew down at the intersection of Sunset. There was one person there, lying in the bed of a County truck. I asked to speak with the supervisor and he told me he was not there at the moment but would have him call me right away. A short time later I received a call from Dave Harper of the County's road department. After I explained to him what had happened he apologized for the accident and stated they should have had warning signs at the site of the actual hazzard (trench). Due to the extensive damage to my rims and tires I was forced to have it towed that afternoon to the BMW dealership who is the only one who had worked on the car in the past. In is my position that since there were no personnel or warning signs directed at traffic coming from Ranch Rd.,Cunha Rd. and at least on other road off Eden Plains between Sunset Rd. on the south and Delta Rd. on the north,the County was negligent. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. -Attach-two estimates for auto damage.) How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) ka IY1 3k�tl t S. CD54 PfL S-M kgo�t4.ttj 61,11 12fparr�5 Names and addresses of witnesses, doctors, and hospitals: Ave P-ft(Co. Ro6,d .btp�) List the expenditures you made on account of this accident or injury: DATE TM AMOUNT ��261a7 clan'l ktcAll 1/. 236e-e 04WAtd . iIf) on annual a a a a a a must a a a a a a a a a a a a a a■a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a 7 a it a a a a as .Gov.Code Sec. 910.2 provides"The claim shall be signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney) 1 Name and address of Attorney ) (Claimant's Signature) Pa, r3 a x 33 5 (Address) Telephone No. )Telephone No. (n5) 615'3 7 73 ■.a Minimal NEEMNIEVIRREMMIUM no a■aaa a s a l a a t a a a l a a a a a a a a t a a a a a a a a a a a a a a a t a■aaa■aaa l a a■aaa 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. ■aaaaaaaaaaataaaaaaaa■aaaaa■aaaaaaataataaaaaaatataataaaaasatasaaauaaaaaaaaaaaaaaaaat NOTICE: Section 72 of rhe Penal Code provides: Every person who, with intent to defmud,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. 1 f � - i TOTAL Z4311.23 I ' SAINT y - -' - SIS _ _ _ TA � East Bay BMW THE ULTIMATE East Bay MINI DRIVING MACHINE 4350 ROSEWOOD DRIVE VISIT OUR WEB SITE AT PLEASANTON, CA 94588-3002 http://www.eastbaybmw.com/ 925-463-2555 CUSTOMER No. ADVISOR TAG No. I INVOICE DATE INVOICE No. 30027 _ MICHAEL MCKEE_ 596 __ 7.9.63.-.. 04/26/07 _ BMCS191920 LABOR RATE LICENSE No. iMILEAGE COLOR STOCK No. 3AMES A. FRANK 34,826. l _ SLATE GREEN P.O. BOX 335 YEAR!MAKE r MODEL DELIVERY DATE DELIVERY MILES BRENTWOOD, CA 94513 03/BMW/7 SERIES/7451 11/30/02 8 VEHICLE LD.No. - - SELLING DEALER NO. PRODUCTION DATE W B A G L 6 3 4 1 3 D P 6 1 9 9 3 F.T,E.No IPO No R.O.DATE _ 04/16/07 REPRINT# 1 - --— — RESIDENCE PHONE BUSINESS PHONE COMMENTS 925-625-3773 MO: 34829 [ DEL. DATE VER. ] 11-30-02 SERVICE DEPARTMENT HOURS: LABOR & PARTS---------------------------------------------------------------------- Monday through Friday 7:00a.m,to7:00p.m; J# 1 45BMZ STEERING/SUSPENSION . TECH(S):590 699.60 Saturday 7:30 a.m.to 5:00 p.m. CUSTOMER RAN OVER A POT HOLE. INSPECT RIMS AND SUSPENSION. REPLACED ALL 4 WHEELS AND TIRES AND COMPLETED 4 WHEEL PARTS DEPARTMENT HOURS: ALIGNMENT Monday through Friday 7:00 a.m.to 6:00 p.m; Saturday 7:30 a.m.to 5:00 p.m. PARTS------QTY---FP-NUMBER---------------DESCRIPTION--------------------UNIT PRICE- NEW AND USED CAR SALES HOURS: JOB # 1 2 36-11-6-753-242 WHEEL BM 458.92 917.84 Monday through Friday 9 a.m.to 8 p.m; JOB # 1 2 36-11-6-753-241 WHEEL BM 386.40 772.80 Saturday 9 a.m.to 6 p.m. JOB # 1 2 36-12-0-418-830 245/45 R19 9 BM 373.00 746.00 Sunday 11 a.m.T05p.m. JOB # 1 2 36-12-0-418-831 275/40 R19 1 BM 438.00 876.00 SPECIAL ARRANGEMENTS MUST BE MADE JOB # 1 4 36-12.1-116-326 VALVE BMMI 2.10 8.40 IN ADVANCE TO PICK UP YOUR CAR JOB # 1 TOTAL PARTS 3321.04 AFTER SERVICE DEPT.HOURS TERMS: JOB # 1 TOTAL LABOR & PARTS 4020.64 CASH,CHECK.OR CREDIT CARD ---------------------- ------------------------------- ----------------------------- (Visa,Mastercard.American Express) .J# 2 70BMZ05 TOWING TECH(S):590 No credit allowed without prior approval TOW IN NOTICE TO CONSUMER: PARTS------QTY---FP-NUMBER---------------DESCRIPTION------------•---•---UNIT PRICE- JOB # 2 TOTAL PARTS 0.00 NEW BMW LIMITED 24 MONTH JOB # 2 TOTAL LABOR & PARTS 0.00 WARRANTY ON ALL GENUINE BMW AUTOMOTIVE PARTS ESTIMATE-------------------------------------------------•-----------------•-•----- CUSTOMER HEREBY ACKNOWLEDGES RECEIVING ORIGINAL ESTIMATE OF $0.00 (+TAX) APPROVED REVISED ESTIMATE (# 1) OF $5032.00 (+TAX) ON 04/20/07 AT 01:04pm BY JAMES COMMENTS COMMENTS---------------------------------------------------------------------------- LOANER ONB HOLD TOTALS---------------- -----—-----------------------------------....................----------- "ALL PARTS ARE NEW UNLESS OTHERWISE NOTED' TOTAL LABOR.... 699.60 TOTAL PARTS.... 3321.04 EAST BAY BMW/MINI WOULD LIKE TO THANK YOU FOR YOUR TOTAL SUBLET... 0.00 BUSINESS AND LOOK FORWARD TO SHARING OUR EXPANSION WITH TOTAL G.O.G.... 0.00 OUR CUSTOMERS. WE WILL BE TAKING OVER THE SATURN BUILDING TOTAL MISC CHG. 0.00 IN THREE MONTHS AND THE NEW FACILITY WILL BE COMPLETED IN TOTAL MISC DISC 0.00 2009. WE HOPE TO CONTINUE TO MEET AND EXCEED YOUR SERVICE TOTAL TAX...... 290.59 EXPECTATIONS! -------- **** ***************** *** ******************************* TOTAL INVOICE$ 4311.23 ********************URGENT MESSAGE********************** SKY ALLAND, AN INDEPENDENT RESEARCH COMPANY, MAY CONTACT YOU TO GRADE THIS SERVICE EXPERIENCE. THE GRADING SYSTEM UTILIZED IN THIS SURVEY IS SIMILAR TO A PASS/FAIL ARRANGE- MENT WHEREBY THE ONLY PASSING RESPONSE = '5"! (THIS SURVEY IS YOUR ADVISOR'S REPORT CARD!!!!!) CUSTOMER SIGNATURE BAR#AC 182794 US EPA ID#CAL 000204968 PAGE 1 OF 1 CUSTOMER COPY [ END OF INVOICE 1 09:32am NEW BMWNA 24MONTH LIMITED WARRANTY GENUINE BMW AUTOMOBILE PARTS ;-- BMW of North America. Inc.,warrants genuine BMW replacement parts and genuine BMW accessories,and genuine exchange BMW parts,imported by BMW of North America, Inc., and installed by an authorized BMW dealer, "Sold on or after April 1, 2003" against defects in materials or workmanship for 24 months commencing with the date of installation. (Warranty on parts replaced during the warranty period will remain in effect for the duration of the longer of the vehicle warranty or the replacement parts warranty.) To obtain service under this warranty, the BMW automobile must be presented to an authorized BMW automobile dealer. Upon presentation of the original repair order showing the date and mileage, the dealer will repair or replace said part(s) or accessories covered by this warranty without charge for parts or labor to the customer.The decision to repair or replace said part(s)being wholly the responsibility of BMW of North America. Inc. Parts,for which replacements are made,become the property of BMW of North America, Inc. BMW OF NORTH AMERICA,INC., MAKES NO OTHER EXPRESS WARRANTY ON THIS PRODUCT. THE DURATION OF ANY IMPLIED WARRANTIES, INCLUDING THE IMPLIED WARRANTY OF MERCHANTABILITY IS LIMITED TO THE DURATION OF THE EXPRESS WARRANTY HEREIN CONTAINED. BMW OF NORTH AMERICA, INC., HEREBY EXCLUDES INCIDENTAL AND CONSEQUENTIAL DAMAGES, INCLUDING LOSS OF TIME, INCONVENIENCE, OR LOSS OF USE OF THE VEHICLE FOR ANY BREACH OF ANY EXPRESS OR IMPLIED WARRANTY INCLUDED THE IMPLIED WARRANTY OF MERCHANTABILITY APPLICABLE TO THIS PRODUCT.Some states do not allow limitations on how long an implied warranty lasts or the exclusion or limitation of incidental or consequential damages, so the above exclusions or limitations may not apply to you. This warranty gives you specific legal rights,and you may also have other rights which vary from state to state. THIS WARRANTY DOES NOT APPLY TO THE FOLLOWING: Maintenance Services —This includes scheduled maintenance, oil changes, wheel balancing, wheel alignment. and mechanical adjustments or repairs which become necessary through normal use or wear and tear. Service Items—This includes the replacement of spark plugs, filters, brake pads or linings, windshield wiper blades. V-belts. incandescent bulbs, fuses, tape head cleaning cassette, ignition points and condensors.distributor caps and rotors, and tools. Batteries—Batteries have a separate warranty. Please contact your authorized BMW dealer for details. Lack of Service—This includes damage attributable to failure to perform maintenance services at the specified intervals or in accordance with the instructions in the"Owner's Manual."Proof must.be provided either by a paid invoice copy or filling in the appropriate boxes in the service manual. Damage—This includes damage which results from negligence, improper treatment, improper accident damage repairs, corrosion frorn road salt, battery acid, environmental influences,or treatment contrary to the "Owner's Handbook." Towing THIS WARRANTY SHALL BE NULL AND VOID IF: a.The vehicle is used in any competitive events. b.The odometer has been replaced or altered,and the true mileage cannot be determined. Non—BMW Parts—This includes damage to a component or assembly due to the installation of replacement parts with specifications that differ in any material respect from genuine BMW parts. The only warranties applying to this part(s) are those which may be offered by the manufacturer. The selling dealer hereby expressly disclaims all warranties, either express or implied, including any implied warranties of merchantability or fitness for a particular purpose, and neither assumes nor authorizes any other person to assume for it any liability in connection with the sale of this part(s) and/or service. Buyer shall not be entitled to recover from the damages to property, damages for loss of use, loss of time, loss of profits, or income,or any other incidental damages. 1. Customer is hereby notified that the said property is not insured or protected to the amount 7. Said Dealer is authorized to deliver the.,vehicle described horem or any of its contents to any of the actual cash value thereof, or otherwise. against loss occasioned by theft, fire or person presenting this receipt. vandalism while the property remains with the dealer. 8. In addition to any and all other legal remedies.available, I authorize Said Dealer to 2. Customer states no articles of personal property have been left in the vehicle and dealer is have a lien on the vehicle described herein for all c-hargas for repairs, including labor not responsible for inspection thereof. and parts. sloragc and!or towing, and to enforce such lien. Said Dealer is hel expressly authorized to sell said vehicle at public auction after giving a twenty (20) 3. Tire dealer is not responsible for unavailability of parts or delays in parts shipment beyond day.vrdteii notice by certified mail to the legal owner.registered owner,and Department dealer's control. of Motor Vehicles of intent to do so. On the sale date, the vohicfe shall be sold to the highest cash bidder and the proceeds of sate must be.•used first to satisfy the lien plus 4. Due to the type of service requested same repairs must be subinL stonpe coats_ and costs incident !o sale, and the halance shall be forwarded to the 5. All charges for repairs including labor and matenals furnished are due and payable legal owner, or it none. to the registered owner, or d the address is unknown, it shall simultaneously with the delivery or the within described vehicle of prior to delivery upon the be forwarded tc the Department of Motor Vehicles. expiration of three(3)days after notice that the repairs have been completer.Notice shall Said expenses Ior sale shall also include a reasonable attorney's fee. which may be be deemed to have been given upon the deposit in the United States maul,postage prepaid, necessarily incurred. of writtennotification to that effect addressed to the customer at the address given on the neve roe side hereol. 9. It any such charges remain unpaid for thirty(30)days after such request for payment.Sa,d Dealer may also refer such charges to its attorneys for c.ollection and the customer will pay 5. It the vehicle described herein is not called for wilhin three(3)days atter such notice is given, a reasonable ittornoy's fee. a storage charge of$50.00 per day will be.made for each day thereafter. *"20%CHARGE ON ALL RETURNABLE PARTS ENVIRONMENTAL COMPLIANCE CHARGE Maintaining and repairing your vehicle inevitably involves the use of chemicals and generation of waste (solvents, oil, caustic lead, asbestos, etc.) that must be stored, managed, and disposed of in strict compliance With federal, state, and local environmental regulations. We support these regulations and also believe our customers do too because they help ensure a safer, healthier environment for everyone.Complying with these regulations increases the cost of service. CZlil I-lx3 OZ6161SSIV48 MW9 AVO 1SV3 OM61.SOWt3 ON adicnul i'O'21 aweN dtysjaieaO ON aalonul/-0'Li 8S0L-Il,sz(sz6) 0SOL-1•9Z(sz6) Wey6u18 saucer yolaepueW uehaC_LOV�:iiNOO -L4S(sz6) :;oelluo0 ; �vo HO -Asea•jl i9yeW d/ay//,aM OIA83S anox 33S .40 doad. Ul-aped. lno�nlw o00`00l 8' Ol do HOA NVId NIVlN 030N31X3 -I!paseyofnd no�f aaegm jo sse/paeBai rdjay uea aM 2i1NOO 301Aa3S�pu3uV.of 6u1wo0 este �no,�s1 NV Hi 3 d 8IS1133I01H3A anox 1W� . . ! M141GAV`8iSV3 >INVHJ 'V S3Wdr PHOTO LOG No 1 view looking North on Eden Plains from just North of Ranch Rd. No. 2 looking West from on Ranch Rd. To Eden Plains Rd. No. 3 same view as #2 with addition of Cunha Rd on the west side of Eden plains. No 4. Same as no. 1. No. 5 blank No. 6 Dug out areas on Eden Plains Rd. North of Ranch Rd. No. 7 Areas that were under construction. Contributed to damage. Nob. Close up of excavated that caused most all the damages. No.9 Additional close up of area causing most damage. No. 10 View of Knightsen Ave. And Delta Rd., where all the signs and personnel were working. 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' -y. x 7✓$ y gbh I I� f; t�, �T,. ?s i-4, c-,a �f qhs k ,,: Fai r��Y c 7 t f -- �t + P , a q . . IL' 3Y Y t-c' 1- t r t -L d :Lw-IT,cis J s r' b as til rt . . ' �. t;- \,Ya M 3- r s fnl- Y. % 8 S „ { H ! .� -' v -fie ''t" to r. ate'' \ 2Y - a Il"C. t - - f- 4 L-#: >. z 3 . � , f �< _ 'f L '\. _. Lt i1. \ J L r, 1 `` , r .t a-i 1 C ''•,y P t't� .., 4 ray <-ti+rvi slb 1' J i i t - �.i a CLAINI BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION NOVEMBER 06, 2007 Claim Against the County,or District Governed by ) the Board of Supervisors,Routing Endorsements, ) NOTICE TO CLAVVIANT 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 on your claim.by the Board of Supervisors. (Paragraph IV below), OCT 11 2007 given Pursuant to Government Code AMOUNT: $196.07Section 913 and 915.4. Please note all MA,RTiNEZCALIFL "Warnings". CLAIMANT: GERARDO MILLAN ATTORNEY UNKNOWN DATE RECEIVED: OCTOBER 11, 2007 ADDRESS: 512 APPLE HILL DRIVE BY DELIVERY TO CLERK ON: OCTOBER 11, 2007 BRENTWOOD, CA 94513 BY MAIL POSTMARKED: OCTOBER 10, 2007 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, .l Dated: OCTOBER 11, 2007 By: Deputy 11. FROM: County Counsel TO: Clerk of the Board of: upervisors This claim complies substantially with Sections 910 and 910.2. ( ) This Claire FAfLS 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 91 l.3). O Other. Dated: By: Deputy County Counsel Ill. FROM: Clerk of the Board TO: County Counsel(I) County Administrator(2) O Claire was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the SupervisorS present: (� This Claim is rejected in full. O Other: I certify that this is a true and con-ect copy of the Board's Order entered in its minutes for- th or tt�hiis�s date. DatedA/et/. 04,ge+O?JOHN CULLEN,CLERK, By Deputy Clerk WARNING(Gov. code section 913) Subject to certain exceptions,you have only six(6)months from the(late this notice was personally served or•deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your•choice in connection with this matter. If you want to consult an attonreNl,)•ou should do so imntecliateiv. "For Additional Warming See Reverse Side of This Notice. AFFIDAVIT OF MAILING f declare under penalty of perjury that f ann novv, incl at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant,addressed to the claintan.t as shown above. Dated/VB rdf/• BZJOHN CULLEN,CLERK By Deputy Clerk y This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction,or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be tiled may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act BOARD OF SUPERVISORS OF CONTRA COSTA COUNT' fNSTRUCTIONS 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 pause of action. A claim relating to any other cause of action shall be presented no: later tban 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- so ■■■r..ram.hs..a■■tralsamass loan ongana....c■ff.a.■..ae.aatem01 RE: Claim By: t A Reserved for Clerk's filing stamp G ) RECEIVE® Against the County of Contra Costa or ) OCT 1 1 2007 District) CLERK BOARD OF SIIPERVISORS (Fill in the name) ) CGi:';.': iiOSTACO. The undersigned claimant herabY mak-as claim against the County of Contra Costa or the above-named district in the sum of S _ N '�.C�i and in support of this claim represents as follows: 1. When did the damage or iujury occur? (Give exact date and hour) 01 - � -k - 0`4 S . 0`6 PM- 2. Where did the damage or injury occur? (Include city and county) W' Q K,„ GrceV o.rck-:,-� \v% Pa's �-5 N,A6 cvY� 3. How did the damage or injury occur? (Give full details;use extra paper if required) 4. W a.t particular act or'oniission un tue pint 6i county or district ofhcers, servants, or employees ccaused the injury or damage? C a �i� v C.v- ,�- V �n Ste• c o w c���,o k . v �e.�c e o t- ?r•o r qCt'J1A 5 What are the names of county or district officers,servants,or employees causing the rS v�S6ke- damage or injury? �Sc e enc �u b� C,, w o.r�s �o�d M��r.It a•�a...Q,Q_ G�v�S�o�► Ad 0U 'ON AA13J VIA1 �S`H 333 Wd6ti E 10R '2 U0 6. Met damage or injuries do your claim resulted? (Give M 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 MY prospective injury or damage,) S. Names and addresses of witnesses,doctors,and hospitals: �ovv_ kAC_ gkv 9. List the expenditures YOU made on account of this accident or injury: DATE TIME AMOUNT 6'.00 It— 04, VX4Zt\ �,OJ rs Bus I galled X.A."no-onto sign a so #one 5195annswason 5 a a a a ussua.But Gov.Code Sec. 910.2 provides"The claim shall be signed by laimant or by some person on bis behalf." SEND NOTICES TO: f Attorney) Name and address of Attorney (Claimant's Signature) A 0_4 tAddress} 512j Telephone Na, Telephone No. 9c) 3 04 opens antusurav.09.20owme 5 unseal bat*.*..axon son as sale a.list PUBLIC RECORDS NOTICE: Please be advised that this claim farm, 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, 55 65DO et seq.) Furthermore, any attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure, NOTICE: Section 72 of the Penal Code provides: Every person wbo, with intent to defraud,presents for allowazce 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 out year, by a fine of not exceeding one thousand dollars ($1,000-00), or by both such imprisoament and fine, or by imprisonment in the state prison, by a fine of not ==ding ten thousand dollars ($10,000),or by both such imprisonment and fine. EL 'ON iNA3MMA ON *8 'DO Gerardo Millan Oct-05-2007 512 Apple Hill drive Brentwood, CA 94513 . (925) 997-8385 Rico-072871@nisn.com I was on my way to work on Sep 27"' at approximately 5:08 pm. I was driving W/B on Marsh Creek rd.between Walnut blvd and Camino Diablo west of Orchard In past the 25 mile curb and just before the grade. My speed at the time was approximately 35 to 45 miles per hour. There was what appeared to be an identified object on the road. Not being able to identify this object from the distance, I decided to go around it. As I move closer, to the right to avoid what I could now recognize as a fast food bag, I encounter a section of the road that is missing starting from the left side of the white lane and stretching about 4 feet. My front tire fell into the missing section of road causing my rim to bend and my tire to sustain damage beyond repair. I continued on until I could find a shoulder to pull over and assess the damage. After surveying the damage and realizing that I had no cell phone reception, I moved to a safer section of the road where I could put my spare tire on.Not knowing if the damage was only to.the rim and tire, I decided to return home and drive a different vehicle to work. The next day, I called two different shops and made appointments to bring vehicle in for inspection and to order new replacement parts.The total cost of the damage is $196.07 this includes the cost of a new rim and tire. I am seeking reimbursement from the county for damages to my vehicle. I have not calculated nor attempt to claim loss time from work. I have included pictures showing the section of the road that cause the damage to my vehicle. I have also included the receipts for the cost of repair to my car. Thank you. . Gerardo Millan, Avg �ew� I � L ; . 449356man 5 Oft I 9m ON S a2 D 4493562 (Tj R E Financing Available AMERICA'S LARGEST INDEPENDENT TIRE DEALER See store for details DATE: 10-04-2007 TIME: 11:51 AM INFORMATIOW -:,:'..: VEHICLE INFORMATION I STORE LOCATION RICO MILL.AN 20507 TOYOTA CAN 31 513 APPLE HILI_ DR CAMRY . 5551 LONE TREE WAY 16-INCH CE/i..E/XLE BRENTWOOD CA 94513 BRENTWOOD CA 94513 MILEAGE: i PHONE: 925-516-1789 925-997-8385 310 ROP COSTELLO TORQUE SPECS: 080 WORK ORDER#t •D • ON AMOUNT 55641 NRM 1 18X7.5 5-100/11442SM HTWL REDLNE 901875313-425 .00 131.00 131.00 WARRANTY- LIFETIME STRUCTURAL AND i YEAR FINISH 3845; RHZ -1 22"J/407R-18 88 RBL BFG G-FORCE SPORT RPL .1210 109.50 -109.5o 3845'2 NRM 1. 225/407R-18 88 PBL BFG G-FORCE SPORT RPL .00 146.00 146.00 WARRANTY: SEE REVERSE SIDE FOR WARRANTY DETAIL=: 80075 NRM 1 STATE REQUIRED ENVIRONMENTAL FEE .00 1.75 1. 75 :11: 403 NRM ADJUSTMENT LIFETIME BALANCE & IfALUE . &A 13.00 13.00 AMERICA'STIRE CO A ERICA'S TIRE 7 •fr. 513 %d CO.c' }'gyp R.{'; .Wy' , -�,-i ` ,D .ta:ry4��fir4[t AA!f wad {[i f n z011".., i3 i '1Jttl 1 ,�i//.... 7 M r s^ Tx. L WORK ORDER ❑Air Check LF RF ❑ Return Tires _ ....._: ;. . . ❑Change Snows LR RR ❑ Repair ❑ Rotation IS] ❑ Rebalance I ❑ Wheel Lock Key X _ Installed/Pretorque / Customer Signat rp Torqued by: Ft.Lbs. Cardholder acknowledges receipt of goods and/or services in the amount�he Total shown hereon and agrees to perform the obligations set forth in the Cardholder's agreeinon-f with the issuer. Bay Coordinator: Upon refund or credit of sales tax,Customer hereby acknowledges such credit or refund. The additional acknowledge satisfies a technical requirement in the sates tax statutes and/or Comments: regulations for many jurisdictions that a signed receipt must be obtained upon the refund or credit of sulrs tnr.es. americastire.com .J II (41493769 D ' 4493769' cr' Financing Available AMERICA'S LARGEST INDEPENDENT TIRE DEALER see store for details DATE: 10-09-2007 TIME: 12:40 PM • •- • e- • FTT - • •RICO i+iILLNhd c0f116 iiONI 513 APPLE HII.._!_ DR ACCORD .-.�REE WAYSEDA1u L:� SRC EDI �, f �:� .• BRENTWOOD CA 94513 5-516-1.78992`.i-`?9'?-8:;85 PLAT,E. # 5TLC9t.1 FL. HERS1+TOP,G�LiE SG'ECS: 080 ER# •D • ..DESCRIPTION • 80085 NRM 1 LABOR LABOR .rf0 .00 yCv .0AC COMMENT: N114CI=1_ AND TIRE. FROM INVOICE #449_5621ON 10/4/17:7 WAS FOR A 200Er HONDA ACCORD COMMENT: NOT A `007 TOYOTA CAMRY \ (l IJIJ lne�a L pmt �, �r �\^e- LAS +- 1 pQ rc:�l��SC ih,,�/ t«S' hTo`M �'� 5� S�P o lve ".t.. 3+'r .v .7 iS•Y'w6y _ .... v"'.`-er..__�-x-__. La�t�i�/✓rP''4.•., AMERICA'S TIRE Coo AMERICA'S IRE C0111 r -.t IT Y '�` ytpiP � ! 1 f WORK ORDER ❑Air Check LF RF ❑Return Tires ❑Change Snows LR RR ❑ Repair ��� ❑ Rotation I s I 71 Rebalance ❑Wheel Lock Key X Installed/Pretorque / Customer Signature Torqued by: Ft.Lbs, Cardholder acknowledges receipt of goods and/or services in the amount of the Total shown hereon and agrees to perform the obligations set forth in the Cardholder's agreement with the issuer. Bay Coordinator: Upon refund or credit of sales tax.Customer hereby acknowledges such credit or refund. The additional acknowledge satisfies a technical requirement in the sales tax statutes and!or Comments- nlyelalions for many jurisdictions that a signed receipt must be obtained upon the refund or credit of sales laxos. americastire.com Customer Invoice,. FIRESTONE COMPLETE AUTO CARE Service Advisor: •', 072436 - ANTIOCH 06 ADRIAN 09/29/2007 . 3214 DELTA FAIR BLVD 925.706.0137 ANTIOCH, CA. 94509 MILLAN, GERARDO 2005 HONDA ACCORD LX[BLACK] 512 APPLE HILL DR Lic#: 5TLC961 CA Vin#: BRENTWOOD, CA 94513-2681 In: 09/29/07 7:48AM Mileage: 37,133 925.997.8385 Out: 09/29/07 9:25AM Store#015504 RETAIL SALE REG#AG222583, EPA#CAL000035010 Article Unit Extended Job Descdl#ion_ — Number ID_—__ Qty ——Price— Price Total ALIGNMENT CHECK-LIFETIME 06 Symptom:- HIT A POT HOLE AND CRACKED RIMS WANTS TO SEE IF ALIGNMENT IS STILL OK. LIFETIME ALIGNMENT RECHECK 7022837 11 NN 1 NIC N/C Road test vehicle before servicing Inspect steering and suspension system including tire, condition and air pressure Put vehicle on alignment rack, mount and compensate { i sensors; and print out the initial alignme.n"t�ead+rigs a. When adjustmentsore necessary .Print outfinal alignment, y t; readings to verify alignmenfis within specifications' When adjustments are heoessary' 41ign all four wheels if applicable, using adjustments provided.by:manufacturer, to manufacturer's specification When adjustments arenecessary:•�Road test vehicle after completing the alignment'. COURTESY CHECK 06 COURTESY CHECK 7046930 1.1 NN 1 N1C` '::..: N/C Technician(s):-,'.: 11 JOHN KOHUT Payment History: Summary: Parts 0.00 Labor 0.00 Shop Supplies 0.00 Sub-Total 0.00 Tax(8.25%) 0.00 Total $0.00 I have received the above goods and/or services. If this is a credit card purchase, I agree to pay and comply with my cardholder. . agreement with the issuer. Customer Signature All parts are new unless otherwise specified. TELL US ABOUT YOUR EXPERIENCE AND RECEIVE$10 OFF YOUR NEXT PURCHASE OF$25 OR MORE! 1) For a short survey Call 1-800-859-9203 or logon to www.FirestoneSurvey.com; enter code 015504-072436; 2)Write redemption code here: _Offer expires 6 months from date of invoice, good at all participating locations. Must have valid redemption code. May not be combined with any other offer or to reduce existing debt. No copies accepted. COMMITTED TO PROVIDING A POSITIVE CUSTOMER EXPERIENCE Page I of I See reverse Sm ide for Warranty Inforation ren ciu�ci„r.r.--n+,ni«c nn vi rnr,r i oar-n.eu.�:-ann.r. nc�r mav, Invt 070305 U cc U) O C=) Lwu c®m LL 0 Ir cc 4L NCLQ (�� N % � ; ;. Qk) = _ CIO 0 v L niij Q 0 0 ., .::.moi'.' .. .. _ .. :.�• , • w s. .: v,} ' �•F J i .. .. '�r�,.ab, •+1�0'=, ,,ray. f � t u � � a J � �i� = _ }-.- bL E 1•"3` Yi ' •�i it ,�'�� `; •.. �... , ? it ?;:. u� l 1 ' O N r, Ll 4 -- CLAINI 0. 27 BOARD OF SUPERViSORS OF CONTRA COSTA COUNTY BOARD ACTION. NOVEMBER 06, 2007 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 Ebyi��� on your claim by the Board of Cy I Supervisors. (Paragraph IV below), CT 122007 given Pursuant to Government Code Z AMOUNT: $1,031.56 Section 913 and 915.4.Please note all COUNTY COUNSEL "Warnings". CLAIMANT: JENNIFER C. LUND MARTfNEZCALIF. ATTORNEY: UNKNOWN DATE RECEIVED: OCTOBER 12, 2007 ADDRESS: P.O. BOX 3462 - BY DELIVERY TO CLERK ON: OCTOBER 12, 2007 FAIRFIELD, CA 94533 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. OCTOBER 12 2007 JOHN CULLEN,C r] f_ Dated: By: Deputy 11. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant.The Board cannot act for 15 days(Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). O Other Dated: By m Deputy County Counsel 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: (� 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'4t/e. Of, .AO 7�0I4N CULLEN,CLERK, By y eputy Clerk WARNING(Gov, code section 913) r Subject to certain exceptions,you have only six(6)months from the date this notice was personal h,served or deposited in the ni lil 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 Nvidi this matter. If you want to consult an attonney,you should do so immediately. *For Additional Warring See Reverse Side of This Notice. AFFIDAVIT OF MAILING declare under penalty of perjury that 1. am uow, and at all tinnes herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant,addressed to the claimant as shown above. Dated: �"a� ®/x �O� JOHN CULLEN,CLERK By Deputy Clerk Az This,lwarning does not apply to claims which are iiot subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction,or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under Caiifornia Tort Claims Act nor hoes it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act j i i i i i i i i i j i BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAINLANT 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 bepresented 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 945 5' C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each. public entity. E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. ■■■■■■■■■a■SEEN■■■a a■Now"■■am■a Kama■■■MEN a■■■■now■■■■■■■■■NORM a■■■son■Eggs■a■ a 1 RE: Clain By: Reserved for Clerk's filing stamp L-VY14 RECEIVED Against the County of Contra Costa or ) OCT 1 ;t cuui District) CLERK BOARD OF SUPERVISORS (Fill in the name) ) CONTRACOSTACO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of�r 1051.5f0- and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. 'Where did the damage or injury occur? (Include city and county) HO Mu Uv- e-OCt G\ i MGL r-h v,.Q 2 qu S' 3= �b rrtrc.� Cc�S`rG C6 u,n 3. How did the damage or injury occur? (Give full details;use extra paper if required) �I�Cu e sek, atto Cie C1 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? a ScxA a 1 r o mar ci v i�v w 9 CA LbV�� car h 1+ 5 What are thb names off'county or district officers; servants, or employees causing the damage or injury? a.r��vzt yvbVl1d t'1�; Vnk-noy n, -� �p 1 Y)-FbYlm OM oy), .IOeCCL&,e J+j pClMon mud(knv 6. WhFt damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) Darn a q e +o r-ea,r d(l v e r'S sIC4- tom,h-) maid uo1j-e- j X11. Se-e C tH-Ml A eStimaJ . 7. How was the amount claimed above compute ? (Include the estimated amount of any pIosm-..&;17 ;—jury or damaaP_) . ._ _ 1 Gee ct(,Yc i� r� - o►� s s► ► ,� d _U(f�deivr r2; -(('-h - Saf91 e�� Pci and aU t-a 8. names and�ddresses of witnesses, doctors, and ho5pitats: k hn WQ�d, ? ISI lc, service, OfH c,¢X, `-E0 m u l l� i� i'11 GI V fl✓�2 GarL-,ay-A ml I l.-i; SW M w L40 muI r Y-611 rn C4-KI-7YW_Z 9. List the expenditures you made on account of this accident or injury: DATE TDYM AMOUNT _- 12 _�0-?,0P q -5 3. . See at-M(;i�.eC1 �! c� - s Lez firms too egiancfh6 _55 33 � � - ■/.l■.!.!!5101 !ll■.e..■!e!.•!■u1!!!!!!..le.l..e■"■NE iEM@ 0 .■.e.ln (e!//!/a!�'i'lilFrW� `• , ) .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 ) 0 j ( aimant' Signature) PO 30 3q(02 (Address) Telephone No. ) Telephone No. f 70-1) .........e.■............. .....!!l....1. .!!..■..!■...■■..l..l....l.NEVER.SEE onto.l.l1 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. 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. Ll a►m � 1�35� I work at 40 Muir Road as a Social Casework Specialist. It is my belief that my car was hit by county car#651 based on the way the car was left on the evening of July 31, 2007. On August 2, 2007, Public Service Officer, John Ward, parked the two cars next to each other to compare damages. When the two cars were placed next to each other, the scrapes on my car matched scrapes on the passenger rear door of county car #651. Below is what happened on the day after the incident occurred. I did not move my car for the entire day, nor was there any damage to my car in the morning when I parked it. I was parked at the end of building 40, where there are several parking places. On the evening of July 31, 2007, 1 was leaving the office and noticed the county car #651 parked extremely close to my car. Car 651 was parked so close to my car that I could only open my driver's side door a few inches and had to squeeze my body into the car. Car#651 was parked at an angle, and in the front there was more space than in the back, in the rear of the car, there was only about three to four inches between the two cars. Car#651 was parked on my driver's side in the second space from the right hand side of the parking row. My car was parked in the first space. My car was parked straight and within the lines of it's respective parking place. I noticed damage to my driver's side bumper and scrapes down the length of the bumper (see attached photos). The black plastic under the bumper was revealed and it was mixed with white scratches, which appeared to be paint transfer from the car that hit mine. The damage extends from the rear of the car to the back wheel well. A coworker exited the building with me that evening and witnessed the fashion in which the county car was parked. Her name is Barbara Miller. She can be reached at (925)313-7720. Below is a drawino how the two car were arked. OWL -sfu�f� Expenditures wan Cay In order to fix my car, it will cost at least$9301ir I spent one day off collecting two estimates for the damages. It cost me a total of$5.62 in gas (attached are the total miles traveled and the mpg rating for my car). Since the damages were work related, I am also charging my time. I get paid $31.25 hourly and spent approximately three hours colle ting the estimates. That is a total of$93.75. In addition, it cost a total of $1.40 to elop th f ur pictures showing the damages (they are attached). q � 0� Je er Lund (�3 e) Date: 8/6/2007 02:39 PM Estimate ID: 24919 Estimate Version: 0 Preliminary Profile ID. BYRONS BYRON ORRIS INC. 906 ENTERPRISE WAY,NAPA,CA 94558-6209 (707)253-8615 Fax: (707)253.8314 BAR#: AM136368 Damage Assessed By: Byron Orris Condition Code: Excellent Deductible: UNKNOWN Insured: JENNIFER LUND Owner: JENNIFER LUND Address: P.O.BOX 3462,FAIRFIELD,CA 94533 Telephone: Home Phone: (707)421-1648 Mitchell Service: 910049 Description: 2005 Mazda 6 s Sport Vehicle Production Date: 6105 Body Style: 4D Sed Drive Train: 3.01-In)6 Cyl 5M FWD VIN: 1YVHP80D555M72487 License: 5RBZ237 CA Mileage: 52,845 OEM/ALT: 0 Search Code: LOCATOR Color: SILVER MET Options: ALUM/ALLOY WHEELS,POWER DOOR LOCKS,CRUISE CONTROL,5 SPEED MANUAL TRANSMISSION POWER DRIVER SEAT,AM-FM STEREO/CDPLAYER(SINGLE),FRONT WHEEL DRIVE,4-DOOR ALARM Line Entry Labor Line Item part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units -- 1.6 # 1 001313 BDY OVERHAUL REAR BUMPER ASSY 2.0*# 2 001310 BDY REPAIR REAR BUMPER COVER Existing C 2.6 3 AUTO REF REFINISH REAR BUMPER COVER 0.5* 4 900500 BDY* ADD'L LABOR OP POLISH SCUFF ON LT QTR PANEL Existing 1.0* 5 900500 REF* ADD'L LABOR OP PRIME&BLOCK BODY REPAIRS Existing 6.25 6 936014 ADD'L COST FLEX ADDITIVE 1.0* 7 AUTO REF ADDT OPR CLEAR COAT 0.5* 8 933003 BDY* ADD'L OPR TINT COLOR 184.00* 9 AUTO ADD'L COST PAINT/MATERIALS 3.00* 10 AUTO ADD'L COST SHOP MATERIALS 1.15* 11 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL *-Judgment Item #-Labor Note Applies C-Included in Clear Coat Calc ESTIMATE RECALL NUMBER: 08/06/200714:39:17 24919 UltraMate Is a Trademark of Mitchell International page 1 of 3 Mitchell Data Version: JUL_07_V Copyright(C)1994-2005 Mitchell International UltraMate Version: 6.0.026 all Rinhtst Rwcaruad Date: 8/6/2007 02:39 PM Estimate ID: 24919 Estimate Version: 0 Preliminary Profile ID: BYRONS Add'I Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals H. Part Replacement Summary Amount Body 4.6 86.00 0.00 0.00 395.60 Refinish 4.6 86.00 0.00 0.00 395.60 Total Replacement Parts Amount 0.00 Non-Taxable Labor 791.20 Labor Summary 9.2 791.20 III. Additional Costs Amount IV. Adjustments Amount Taxable Costs 193.25 Customer Responsibility 0.00 Sales Tax @ 7.750% 14.98 Non-Taxable Costs 1.15 Total Additional Costs 209.38 I. Total Labor: 791.20 II. Total Replacement Parts: 0.00 III. Total Additional Costs: 209.38 Gross Total: 1,000.58 IV. Total Adjustments: 0.00 Net Total: 1,000.58 This is a Preliminary estimate. Additional chances to the estimate may be required for the actual repair. Point(s)of Impact 7 Left Rear Corner(P) I authorize Byron Orris 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 damaged 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 rear 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: ESTIMATE RECALL NUMBER: 08/061200714:39:17 24919 UltraMate is a Trademark of Mitchell International Mitchell Data Version: JUL_07_V. Copyright(C)1994-2005 Mitchell International Page 2 of 3 UltraMate Version: 6.0.026 All Rights Reserved Date: 8/6/2007 02:39 PM Estimate ID: 24919 Estimate Version: 0 Preliminary Profile ID: BYRONS ESTIMATE RECALL NUMBER: 08/06/2007 14:39:17 24919 UltraMate Is a Trademark of Mitchell International Mitchell Data Version: JUL_07_V Copyright(C)1994-2005 Mitchell International Page 3 of 3 UltraMate Version: 6.0.026 All Rights Reserved LoS5(oE3 Date: B/6/2007 02:07 PM Estimate ID: 20409 Estimate Version: 0 Preliminary Profile ID: STANDARD ADVANCED AUTO BODY CENTER 2497 Second Street,Napa,CA 94559 (707)226-9693 Fax: (707)226-9265 Tax ID: 47-0870594 BAR M AG184626 EPA#: CAL000206519 Damage Assessed By: MIKE McDANIEL Deductible: 0.00 Claim Number: 20409 Insured: JENNIFER LUND Owner: JENNIFER LUND Address: P.O.BOX 3462,FAIRFIELD,CA 94533 Telephone: Home Phone: (707)421-1648 Mitchell Service: 910049 Description: 2005 Mazda 6 s Grand Touring Body Style: 4D Sed Drive Train: 3.01-In)6 Cyl 6A FWD VIN: 1YVHP80D555M72487 License: 6RBZ237 CA Mileage: 52,840 OEM/ALT: O Search Code: B94559 Options: ALUM/ALLOY WHEELS,POWER DOOR LOCKS,CRUISE CONTROL,LEATHER SEATS POWER SUNROOF,AUTOMATIC TRANSMISSION,POWER DRIVER SEAT **Special Parts Notice: All crash parts on this estimate are new original equipment manufacturer parts, unless otherwise specified. Parts described as Rechromed, Recored,Remanufactured or, Reconditioned are considered "rebuilt" parts. Crash parts described as Quality Replacement Part", are Non-original equipment manufacturer aftermarket new parts. " Line Entry Labor Line Item PartType/ Dollar Labor Item Number Type Operation Description _ Part Number Amount Units 1 001197 BDY REPAIR L QUARTER OUTER PANEL Existing 0.8*# 2 POLISH QTR 3 001313 BDY OVERHAUL REAR BUMPER ASSY 1.6 # 4 001310 BDY REPAIR REAR BUMPER COVER Existing 2.5*# 5 AUTO REF REFINISH REAR BUMPER COVER C 2.6 6 AUTO REF ADD'L OPR CLEAR COAT 1.0 7 933003 REF ADD'L OPR TINT COLOR 0.5* 8 AUTO ADD'L COST PAINT 164.00 9 AUTO ADD'L COST SHOP MATERIALS 0.00' 10 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL 5.00 11 900500 BDY* REMOVE/REPLACE FLEX ADDITIVE Now Non OEM 10.00 0.0* ESTIMATE RECALL NUMBER: 08/06/2007 14:07:31 20409 UltraMate is a Trademark of Mitchell International Mitchell Data Version: JUL 07_A Copyright(C)1994-2005 Mitchell International Page 1 of 3 UltraMate Version: 6.0.026 All Rinhfa RPamr pd (0 Date: 8/6/2007 02:07 PM Estimate ID: 20409 Estimate Version: 0 Preliminary Profile ID: STANDARD -Judgment Item #-Labor Note Applies C -Included in Clear Coat Calc Add'I Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals It. Part Replacement Summary Amount Body 4.9 82.00 0.00 0.00 401.80 Taxable Parts 10.00 Refinish 4.1 82.00 0.00 0.00 336.20 Sales Tax @ 7.750% 0.78 Non-Taxable Labor 738.00 Total Replacement Parts Amount 10.78 Labor Summary 9.0 738.00 i III. Additional Costs Amount IV. Adjustments Amount Taxable Costs 164.00 Insurance Deductible 0.00 Sales Tax @ 7.750% 12.71 Customer Responsibility 0.00 Non-Taxable Costs 5.00 Total Additional Costs 181.71 I. Total Labor: 738.00 II. Total Replacement Parts: 10.78 Ill. Total Additional Costs: 181.71 Gross Total: 930.49 IV. Total Adjustments: 0.00 Net Total: 930.49 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. This is a preliminary estimate. Additional changes to the estimate may be required for the actual repair. Point(s)of Impact 7 Left Rear Corner(P) ****PART PRICES SUBJECT TO INVOICE**** AUTHORIZED AND ACCEPTED: You are hereby authorized to make the specified repairs. I understand that payment in full will be due upon release of vehicle, including additional supplemental damage charges, and/or storage and hereby grant you and/or your employees, permission to operate the car, truck, or vehicle herein described on streets, ESTIMATE RECALL NUMBER: 08/06/2007 14:07:31 20409 UltraMate Is a Trademark of Mitchell International Mitchell Data Version: JUL_07_A Copyright(C)1994-2005 Mitchell International Page 2 of 3 UltraMate Version: 6.0.026 All Rights Reserved (o3S(o8 Date: 8/6/2007 02:07 PM Estimate ID: 20409 Estimate Version: 0 Preliminary Profile ID: STANDARD highways, or elsewhere for the purpose of testing and/or inspection. An express mechanic's lien is hereby acknowledged on the above car, truck or vehicle to secure the amount of repairs thereto, or for storage charges if applicable. You will not be held responsible for loss or damage to the vehicle or articles left in vehicle in case of fire, theft, accident or any other cause beyond your control. OLD PARTS REMOVED FROM CAR WILL BE JUNKED UNLESS OTHERWISE INSTRUCTED. REPAIRS authorized by Date I authorize any and all supplements payable direct to Advanced Auto Body and authorize Advanced Auto Body to act as POWER OF ATTORNEY to sign supplemental payments. Authorized by Date This is a final bill of the actual repairs done to your vehicle and may differ from the insurance companies final estimate. *******ALL REPAIRS WILL BE BASED ON ADVANCED AUTO BODY'S FINAL ESTIMATE AND INVOICE AND NOT THAT OF ANY OTHER PARTY.********* *****THANK YOU FOR COMING TO OUR SHOP FOR YOUR REPAIRS.***** ESTIMATE RECALL NUMBER: 08/06/2007 14:07:31 20409 UltraMate is a Trademark of Mitchell International Mitchell Data Version: JUL-07_A Copyright(C)1994-2005 Mitchell International Page 3 of 3 UltraMate Version: 6.0.026 All Rights Reserved Contra Costa County Check Surt lD: EMPL&H S Advice a: 1477692 Stephen Ybarra,County Auditor-Controller Mail Drop ID: 6MUR4 Advice Date oaL10J07 Martinez,CA 94553 Pay Begin Date: 07/01/2007 P End Date: 07/3112007 JENNIFER C LUND Employee ID: 71040 TAX DATA: FEDERAL STATE Department: EHSD-CHILD&FAMILY SVCS Marital Status: S S Job Title: SOCIAL CASEWORK SPEC I Allowances: 1 1 Addl.pct.: Add].Amt.: :.. .. .. HOURSANDiEARNINGS - - >- ... -:�''�' -- 'i.EMPLOYER.PAID!BENEF.ITS ... ........ .............. :..: ..... .: --------------- Current YTD ---------- Description Hours Hours Earnings Description Current YTD REGULAR PAY 5.118.69 39,530.05 FED MED/ER 78.01 OVERTIME COMP HOURS TAKEN 16.00 FED OASDI/ER 333.55 OVERTIME ADJUSTMENT 271.42 374.82 STATE UNEMPLOYMENT TAX 10.78 PERSONAL HOLIDAY HOURS TAKEN 13.00 WORKERS COMP COSTS 373.27 WORK LEAVE PLAN HOURS TAKEN 8.00 CCHP PLAN A PCP 458.0D EARNINGS ADJUSTMENT 238.96 DELTA DENTAUCCHP PCP 40.51 OVERTIME EARNINGS®1.50 . 325.71 RELIASTAR LIFE$10000 ER 2.10 RETIREMENT-CO SHARE 1,650.28 Total: 'Taxable BEFORE-TAX DEDUCTIONS AFTER-TAX DEDUCTIONS .': .TAXES:.. Description Current YTD Description Current YTD Description Current YTD CCHP PLAN A PCP 9.35 74.80 ADVANCE PAYBACK 1,672.77 13,063.56 FED WITHHOLDNG 849,47 5,302.08 DELTA DENTAUCCHP PCP 0.83 6.64 UNION DUES SOC SERV LOC 84.46 652.24 FED MED/EE 78.01 585.63 RETIREMENT 324.38 2.518.47 FED OASDI/EE 333.55 2,504.06 CA W ITHHOLDNG 258.77 1,739.71 CA SDI FTDI 32.34 242.82 Total: Total: Total: : TOTAL FED'>:": FED TAXABLE GROSSTOTALTAXES r`::TOTAL.DEDUCTIONS-::: ::: -:----:cNE7PAY r.. Current: 5,390.11 5,055.55 1,552.14 2,091.79 1,746.18 YTD: .. ... .. Accrual Desc -Begin of PP Earned .::Bought ' Taken :. Sold .: Adjustment`: Bal at End:PF NET:PAY..DISTRIBUTION ;; VACATION 117.09 10.00 127.09 Advice 1477692 SICK LEAVE 44.67 8.00 52.67 PERSONAL HOL 21.00 2.00 13.00 10.00 WORK LEAVE 8.00 8.00 Total: 1,746.18 MESSAGE: Contra Costa County Date Advice No. Stephen Ybarra,County Auditor-Controller 08/10/07 1477692 Martinez,1114111 som ��IA ID h 0 W 11�10� Direct De oslt-Distribution W� S -�D Ve VI Account Type Account Number Deposit Amount 1,746 .18 Y EM/ L# 71040 Credited Credited To The JENNIFER C LUND Account(s)Of k359 Total: 1,746.18 Directions to FAIRFIELD,CA Page 1 of 3 L02, �8 Directions t0 FAIRFIELD, DA Summary and Notes .......................................................................................................... . ........................................................................................ START P 2097 Bluebird Way, Add your notes here... FAIRFIELD, CA D Advanced Auto Body Center(707) 226-9693 2497 2nd St, NAPA, CA Byron's Auto Body Incorporated (707) 253- 8615 906 Enterprise Way, NAPA, CA FINISH 2097 Bluebird Way, FAIRFIELD, CA -Total Distance: 44.5 miles, Total Time: 1 hour (approx.) .................................................................................. Distance .............................................................................................................................................................................................................................................................. ..... P 2097 BLUEBIRD WAY, FAIRFIELD, CA 1.Start at 2097 BLUEBIRD WAY, FAIRFIELD go < 0.1 mi going toward NIGHTINGALE DR 2.Turn 0 on NIGHTINGALE DR go 0.2 mi 3.Turn on DOVER AVE go 0.3 mi 4.Turn 0 on AIR BASE PKY go 1.4 mi 5.Continue on WATERMAN BLVD go 0.1 mi 6.Turn to take ramp onto 1-80 W toward go 6.9 mi SAN FRANCISCO 7.Take the NAPAISONOMA exit onto go 6.3 mi JAMESON CANYON RD(CA-12) 8.Turn Q to follow CA-12 go 4.0 mi 9.Continue on CA-121 N go 1.4 mi 10.Continue on CA-29 N go 1.3 mi http://xml l.maps.yahoo.com/pmt.php?v3=0&&q4=2097°/.2OBLUEBIRD%2OWAY,%2OFair... 10/9/07 Directions to FAIRFIELD, CA Page 2 of 3 11.Take ramp toward FIRST go 0.2 mi STREET/DOWNTOWN NAPA 12.Turn Q on 1ST ST go < 0.1 mi 13. Bear Q on CALIFORNIA BLVD go < 0.1 mi 14.Turn 0 on 2ND ST go < 0.1 mi 15.Arrive at 2497 2ND ST, NAPA, on the 2497 2ND ST, NAPA, CA ............................................................................................................................... .......................................---------............................................................................... Distance: 22.3 miles, Time: 27 mins . . ... .. ..................... ... .. .. ...................................- . .............................................................................. 2497 2ND ST, NAPA, CA 1.Start at 2497 2ND ST, NAPA going toward go 0.4 mi CALIFORNIA BLVD 2.Turn 0 on JEFFERSON ST go 1.0 mi a 3.Turn on W IMOLA AVE(CA-1 21 N) go 1.1 mi a a 4.Turn Q on NAPA VALLEJO HWY(CA-221 go 1.6 mi S) 5.Turn Q on KAISER RD go < 0.1 mi 6.Turn on ENTERPRISE WAY go < 0.1 mi 7.Arrive at 906 ENTERPRISE WAY, NAPA, on the 906 ENTERPRISE WAY, NAPA, CA a .................................................................................................................................................................................................................................................................. Distance: 4.2 miles, Time: 9 mins ............................................................................................................................................................................................................................................................. 906 ENTERPRISE WAY, NAPA, CA 1.Start at 906 ENTERPRISE WAY, NAPA go < 0.1 mi going toward KAISER RD 2.Turn on KAISER RD go < 0.1 mi 3.Turn Q on NAPA VALLEJO HWY(CA-221 go 1.1 mi S) 4. Bear 4b on CA-12 E go 7.3 mi 5.Take ramp onto 1-80 E go 7.3 mi 6.Take the TRAVIS A F B/AIR BASE go 0.3 mi a PKWY1WATERMAN BLVD exit toward WATERMAN BLVD http://xml I.maps.yahoo.com/pmt.php?v3=0&&q4=2097`/*20BLLJEBRW%2OWAY,%2OFair... 10/9/07 Directions to FAIRFIELD, CA Page 3 of 3 7.Turn 10 on AIR BASE PKY go 1.2 mi 8. Bear on DOVER AVE go 0.3 mi 9.Turn loon NIGHTINGALE DR go 0.2 mi 10.Turn on BLUEBIRD WAY go < 0.1 Mi 11.Arrive at 2097 BLUEBIRD WAY, FAIRFIELD, on the 2097 BLUEBIRD WAY, FAIRFIELD, CA .......................................................................................................................I......................................................... ............ ............................ Distance: 18.0 miles, Time: 24 mins Total Distance: 44.5 miles,, Total Time: I hour (approx.) When using any driving directions or map, it's a good idea to do a reality check and make sure the road still exists, watch out for construction, and follow all traffic safety precautions. This is only to be used as an aid in planning. http://xmlI.maps.yahoo.com/pmt.php?v3=0&&q4=2097%2OBLUEDIRD%20WAY,%2OFair... 10/9/07 2005 Mazda MAZDA6 specs, auto safety at Edmunds Page 1 of 3 Welcome,Guest t$! i;�o!Ni Edmunds.com i Inside WELCOME TO i ADy Z t. } f withexcpA niii NEW CARS i'-�'f;�'`�"hs.., .,, ',G'�`e,��e t15�D�GAR� - s�,4�'i� �' 5 F ''�b N (� .. M........ ... !z' `,-.r+�... _ V'; 3 4'Know the AutoCheck Score68 before you buy.Only available on Experian's AutoCheckl 4 : ^, ; .. 2005 Mazda MAZDA6 "r' 4 Or s Sport Sedan View 2005 Styles Other years for this style 2007 Z. View: Pictures I Video Consumer Rating 9.0FiKrra 165 Reviews View all Ratings I Overviews PRICING • Search Used Mazda Listings •Calculate Low Payments • Sell Your Car Online. • Get a Bad Credit Car Loan True Market Value Pricing Appraise Your Car Specifications True Cost to Own Certified Program Edmunds Type:Midsize Sedan Vehicle History Report Where Built:United States EPA Class:Midsize Cars Payment Calculators Resale Values Dimensions ...................... _........_...... VEHICLE FEATURES Exterior ......... . ... ............ .... . .... Standard Features Length: 166.8 in. Width:70.1 in. ........ ..... .......... Specs Height:56.7 in. Wheel Base: 105.3 in. Colors Ground Clearance:5.1 in. Curb Weight:3287 lbs. . ... ............................... Gross Weight:4312 lbs. Safety ................. ................... Interior Photos 8 Videos Front Head Room:38.7 in. Front Hip Room:54.7 in. Maintenance Front Shoulder Room:56.1 in. Rear Head Room:37.1 in. Standard Warranty Rear Shoulder Room:54.9 in. Rear Hip Room:54.1 in. Front Leg Room:42.3 in. Rear Leg Room:36.5 in. REVIEWS&RATINGS Luggage Capacity: 15.2 cu.ft Maximum Seating:5 ........................................................... Awards&Road Tests ....Performance Data Ratings Model Review Performance Base Number of Cylinders:6 Base Engine Size:3 liters Consumer Reviews Base Engine Type:V6 Horsepower:220 hp Consumer Discussions Max Horsepower:6300 rpm Torque: 192 ft-lbs. ................................................I............. http://www.edmunds.com/used/2005/Mazda/mazda6/100467716/specs.html 10/10/07 2005 Mazda MAZDA6 specs,auto safety at Edmunds Page 2 of 3 NEXT STEPS Max Torque:5000 rpm Drive Type:FWD Search Used Listings Turning Circle:38.7 ft. Sell Your Car Fuel Data Calculate Monthly Payments Get a Bad Credit Car Loan Fuel Free Insurance Quotes Fuel Tank Capacity: 1S gal. ...... ............ ....... ...... EPA Mileage Estimates:(City/Highway) Free Warranty Quote Manual' 19 mpg 126 mpg Automatic::20 CARFAX Record Check mpg/27 mpg Range In Miles:(City/Highway) .............................................................. Automatic:360 mi./486 mi. Manual:342 FIND A RELATED CAR mi./468 mi. ................................................... 2A05 Styles VEHICLE SPOTLIGHT :_„_;:- c:;::.,:., PARTNER SPOTLIGHT ..::.:•;:U i ... ....... . ...... ....... Previous Years 2007 Saturn AURA AutoTrader: Start Searching Today i � why wait to sho Other Mazda Models ^” "=" y P AURA KE models I , r-.! offer EPA + .,_ until Sunday? Find Other Midsize Sedans the car you want MPG 20 crty/30 hwy. _.. ... .. . ................. wow. Other Performance Sedans AlaredTr.zsf-rr-4;.-.; ... :,,..VIew,Used.Veh"LlstinQs In.Your.Area...................................................................... . SELECT ANOTHER MODEL .............................................................. Select a Meke.... ...........3 Find for sale in our neighborhood: Select a Modal �� Y 9 r��:}�r'�'�' �'`•� Go Mazda Yr ZIP. 94553 Ao; USEFUL TOOLS .................................. } ,. .. ,�-,_ ;,....: rte'.:-' , ''• E-mail this Peg to a Friend Powered FlaitCa t^3ct'�t _r x -r V. Get Pre-Approved Financing Download to Your PDA Appraise Your Trade-in Get your car in front of millions of on-lines v R � q1t9.�x; ��. car shoppers! ....... ............... . .................... ' ZIP: 94553 Gtl J ptwerad bj ryrytt ►See our Review for more information. . Search Used Mazda Listings •Calculate Low Payments • Sell Your Car Online • Get a Bad Credit Car Loan Home I New Cars I Certified I Used Cars I Car Reviews I Tips&Advice I Forums I Inside 1 About I Dealer Inquiries I Search I Car Dealers I Directory I Help1 Contact http://www.edmunds.com/used/2005/mazda/mazda6/100467716/specs.htrnl 10/10/07 2005 Mazda.MAZDA6 specs, auto safety at Edmunds Page 3 of 3 Edmunds is hiring Employment Opportunities C 1995-2007 Edmunds Inc. Privacy Statement I Visitor Agreement http://www.edmunds.com/used/2005/Mazda/mazda6/100467716/specs.html 10/10/07 FOR SHOPPING 4 AT WAL-MART PHOTO CENTER r 85 WE MAKER 4X6 5 1.40 TOTAL $ 1.40 ((II IIIIII II II II ;�. �y- _tTu Plcf'Ar�s 9 t. • ,' i �7 .r,�� t r d farTj'h� 'a..�%' -4 y-� ^•6, y,- d4:rr'S:'J.'•. �- _ � `� t .-r ��. r � �� __.. r� .� ``�:$t "Y-}�vii,;,;,a�: ...::� }y 1.�` • ,43�,.�..`...� t _~_. ' � �' �(i . �'f.� ,,.;; 4',�v �:�i, �'i:t :. !``:� ,}y�,,. i.4,?1M� e4' -yl%'�'f ;�dip yi�,K:. �;.�.; tw6�f �: I�.YY�.. ...���� y(. ��j '<, '�.. _._---• -r� ,, �.!• r it � ''." -� S f � k •e 4 y 46 .,y: IN Lo OK r.'..: i� ' f r` r how :_r t' 4�✓ ciArni BOARD OF SUPLRViSORS OF CONTRA COSTA COUNTY V BOARD ACTION NOVEMBER 06, 2007 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 on your claim.by the Board of 109MVE-M. Supervisors. (Paragraph IV below), given Pursuant to Government Code OCT 1 a 2007 Section 913 and 915.4.Please note all AMOUNT: $11,875.00 COUNTY COUNSEL "Warnings". CLAIMANT: MIKE CARTWRIGHT MARTINEZCALIF. ATTORNEY: UNKNOWN DATE RECEIVED: OCTOBER 17, 2007 ADDRESS: P.O. BOX 942 BY DELIVERY TO CLERK ON: OCTOBER 17, 2007 CLAYTON, CA 94517 BY MAIL POSTMARKED: IINTEROFFIICEOMAIL FROM: Clerk of the Board of Supervisors TO. County Counsel Attached is a copy of the above-noted claim. OCTOBER 17 2007 JOHN CULLEN, C r � Dated. By: Deputy fl. FROM: County Counsel TO: Clerk of the Board of Sup rvisors m/Tiis 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: JI(T— By / t (� �Deputy County Counsel iIi. FROM.: Clerk of the Board TO: County Counsel(1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). I V. OARD ORDER: By unanimous vote of the Supervisors present: (10 This Claim is rejected in full. O Other: i certify that this is a true and con-ect copy of the Board's Order entered in its minutes for this date. Dated: 4O JOHN CULLEN,CLERK, By eputy Clerk WARNING(Gov. code section 913) Subject to ceilain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the nail 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 rvidi this matter. Il'you want to consult an attorney,you should do so inmiediately. *For Addidaial Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that i am novo, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board ,Order and Notice to Claimant,addressed to the claimant as shown above. Dated/✓Oel- 614 JOHN CULLEN,CLERK By Deputy Clerk 1' This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific reliet'such as mandamus or injunction,or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be tiled may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of ..limitations applicable to actions not subject to the California Tort Claims Act i I I I P ` 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. RE: Claim By: Reserved for Clerk's filing stamp eRECENVED .. Against the County of Contra Costa or ) OCT 1 ` 7007 CLERK BOARD OF SUPERVISORS District) CONTRA COSTA CO. (Fill in the name) ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ // S•O and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) q eO All 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give fall details; use extra paper if required) ►Pvh/I? �`� jtj` i✓t�; ��/��nor r' C'✓t,v G 1,,7'7'- Pe: h /ker5 0,,4 /1,?), la i1 t7 J 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or dama e? �'6�f1' �/�S' /7c�L� O>^ C�a�h f�'�- S 5 What are the names of county or district officers, servants, or employees causing the / damage or injI ury ,l' /j c �,,����•�15 /��ri'i1 t«l�i�!'� %����,���vre;17/- 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for,;uto damage.) e)A f frr rS !'K f" :=si f© /1 el4✓ .f�HIVIj�S //) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) �� �i�74ghed 8. Names and addresses of witnesses,doctors, and hospitals: 70'17 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT ) .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) ) Name and address of Attorney ) LD (Claimant's Signature) (Address) ) Telephone No. )Telephone No. %;;2- am EMS 9 NMI 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. 0 son NUNN Naomi 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 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. ALLiance Contracters, Inc. License #847734 Leo Childers 1405 Fargo Court Concord, CA 94521 Phone: 925-497-8588 Fax: 925-429-5089 Date: October 11, 2007 Bill To: Project: Replacing Trees Mike Cartwright 11650 Marsh Creek Road Clayton, CA 94517 (925) 864-6351 1) Removal of stumps $ 680.00 2) Replant ten trees $ 6,615.00 A) Three Saplings 8) Three 36 inch box trees C) Four 48 inch box trees 3) Labor $ 4,580.00 Total Estimate: $11,875.00 Note: Replacement trees will not be as large as trees removed. Sizes of the trees being removed are not available. Prices May Need to be adjusted based on unforeseen site conditions. CLAIM /- BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: NOVEMBER 06, 2007 Claim Against the County,or District Governed by ) tlne Board of Supervisors, Routing E7(Aoe r�tts� s, ) NOTICE TO CLAIMANT and Board Action. All Section refer ee�ar�t Ir, The copy of this document mailed to California Government Codes. QCT eb ) 1 , you is your notice of the action taken 2007 on your claim by the Board of Supervisors. (Paragraph IV below), MARTOu�SEL given Pursuant to Government Code �� BTi�JE2 AMOUNT: $5,000.00 - $10,000.00 CALIF. Section 913 and 915.4.Please note all "Warnings". CLAIMANT: FRANCES SHINN ATTORNEY: UNKNOWN DATE RECEIVED: OCTOBER 17, 2007 ADDRESS: 115 CAROLYN DRIVE BY DELIVERY TO CLERK ON: OCTOBER 17, 2007 PITTSBURG, CA 94565 BY MAIL POSTMARKED: OCTOBER 10, 20077 FROM: Clerk of the Board,of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. OCTOBER 17, 2007 JOHN CULLEN, CI Dated: By: Deputy MI. FROM: County Counsel TO: Clerk of the Board of Sup visors (/This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant.The Board cannot act for 15 days(Section 910.8). ( ) Claim is not timely filed. The Clerk should retum claim on ground that it was filed late and send wanting of claimant's right to apply for leave to present a late claim(Section 911-3). O Other: Dated: By: Cse� Deputy County Counsel [if. 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). 1 V. BOARD ORDER: By unanimous vote of the Supervisors present ( This Claim is rejected in full. O Other: I certify that this is a true and con ect copy of the Board's Order entered in its minutes for this date. Dated: -Od ,9 C At&o.#HN CULLEN,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 personalh,served or deposited in the nail to file a court action on this thrum.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection wide this matter. If you want to consult an attorrev,you should do so innuafiately. *For Additional Warning See Reverse Site ofThis Notice. AFFIDAVIT OF MAILING i declare under penalty of per jury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant,addressed to the clainnant as shown above. Dated:/4'd,J. d P� •e-";;'-JOHN CULLEN,CLERK By� --a. —deputy Clerk This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as.mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be tiled may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to,your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of :limitations applicable to actions not subject to the California Tort Claims Act 3 r �� �• BOARD O'F SUPERVISORS OFCONTRA COSTA COUNTY INSTRUCTIONS TO:CLAI,'MANT A. A claim relating,to a cause of action for death'or for..'i 'ury 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:tl an 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 945.53. 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. 72.41ttie::endw�of.this.forrn. some rrrrrrrrrrrrrrrrmango soon r11r.■rrrrrrrrrrrrrrrr11rnoun rr men one omega us RE: Claim By: Reserved for Clerk's.filing stamp �ro►rCto5 ) _ ) RECEIVED Against the County of-Contra-Costa or ) ) District) OCT 2 4 2001 (Fill.in the.name' ) CLERK BOARD OF SOPERVISORS . . mac. .. %W S eryCONTRij COSTA CO. Erik ni-eVAOrirs VV SolowAav�) The:undersigned claimant here y 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: I. When did the dama e or injury occur? (Give exact date and hour) w a s1 C' gtvei� Ev fY1s . Cuf-reno 2. Where did the damage or injury occur? (Include city and county) 3:: How did the .. age:.oRec jury occur? (Give full-details;:use-details; paper_if re wired) oma}tnv m OIALG� ty),CLhelle r�'er1OJ Ir144 r✓Y1-t'-J We On AL r a U`1 S DT751�r r�1 c7l -�-1'1 Sln� W A 5 631 Ve V1 D n 4. What particular act or omission on thfpart of county or district officers, servants, yr1 employees caused the injury or damage?—T”h �S �,i'-u e i V1 �q rt-► Gv�lci.t' l e 1Ctc-4- -I I cy- - I ve been J' tnos�d v�'c 5 at are tie nam s of county or distri t officers, servants, or employees causing t e �i�D�hrevl► damage.or injury? . �-1�-�- Y► ► e �� a reS �- (Tv 1i'C So 1 U wk o o 6. What damage or injunes do yourclaim resulted? . (Give full extent of injuries or damages claimed. Attach two estunates.for auto damage:} rye: -}— E� O ©Vl b c ,ry-e s rn-e n. � r� �;� d sk,-e�-s �,oss o slime �OSS� bye T os o-� - >�e w t C:raz�nds�n Possible �cq r►1.�/ ( ��q1 Cr$ i�se 7. How Nas trM amount; claimed above compute chd�e the esttinated aiTfount or any prospective injury-:ond' age-). YnC e 8. Names apd addresses fwitnesses,.dbetors, and'hosp tats: �a(-1 0�S rn�cl�t?i l-e • h r r-,F"o D S Ck r �-oPe°zogele E �ry��rn bei �05o GOeCA CY1:Ar-� ,. o9 1e �r� ogele ' o� +0e- 9... . :..•List.tlie expenditures.you made on account of this�accident or injury: cow rn 0 11 DATE TIME AMOUNT iV >� .....:.,■:._....:..a.aeasa.a.■a.0i...■:19_s.a...■a..:■..,■■...a M.■■.■■.■.r -a■■■.■■....■■.■.■■tiof■..■.a■a■"i i■".-.:o"iiYi..,a as ■a■1 ) Gov. Code Sec. 910.2 provides"The claim shall be ) signed by the claimant or by some person on his. behalf." SEND NOTICES TO: (Attorney,) ) Name and address of Attorney ) 0 . (Claimant's Signature) (Address) ) 1--7 1ftsbora Telephone No. )Telephone No. C9-Z.5) ............................................................asama.aaass amaaaaaason ova"1 PUBLIC RECORDS NOTICE: Please be advised th t this claim form, or any claim filedwith the County under the Tort Claims Act, is subject to public disclosure under the California Public Records_Act. (Gov:`_Code, 6500 et seq.) Furthermore,-any` attachments, addendums, or supplements.attached to the.claim form, including medical records, are also subject to public disclosure. •..■■■.■a....■...■.......a.....a......monsoon a"museum noun oil Igo.■.■.aEvans......■.■a..i NOTICE: _ _.- Section 72 of the Penal Code provides: Every person who, with intent to defraud, presents for allowance or.for payment to any state board or officer, or to any county, city, or district board or officer, authorized.to allow or pay the-same if genuine, any false or fraudulent claim, bill, account voucher, or writing :is punishable either by imprisonment in the County jail for a period of not more than one year, by a fine of not:exceeding one thousand.dollars ($1,000.00), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine.of not exceeding ten thousand dollars ($10,000),or by both such imprisonment and fine: Uf5 [oYX " OYl �IU�C clay.of a hearing=:iii'Superior Court; The report stated:th t.1.Frances Shinn,Ms.Carreno's mother,had been--diagnosed with:schizophrenia when she,Ms:Carreno was a young child. This"false information has been not only vett'14jisetting,but also,embarrassing to me,and my.;fami y Not.to mention what this FALSE Ififormation might be doing to damage my•daug>lter's case,and the chance of her.gett ng her. back mi her custody. BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY f INSTRUCTIONS TO CLAIMANT A. A claim relating to a cause of action for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. ■rrrrrrrrrrrrrrrrrrrrrrr■■■Paso rrrrrrrrrrrrrrrrrrrrr■■■■rrrrrrrrr■■r r 008■0■r■■1 RE: Claim By: Reserved for Clerk's filing stamp Frances S 6nyi j RECEIVED Against the County of Contra Costa or ) ) OCT 1 7 2001 District) CLERK BOARD OF SUPERVISORS (Fill in the name) ) CONTRA.COSTA CO. Brik�inie d r>°S �,�°�e ��o rv�s✓�� e undersigned claimant hereey makes claim against the County of Contra Costa or the above-named district in the sum of$ - and in support of this claim represents as follows: 1. When did the damae or injury occur? (Give exact date and hour) 5 j 2 70-7r_)a le +-i,Me r-p a r�4- w L1 v 4-o Ms . Carre no 2. Where did the damage or injury occur? (Include city and county) Iii }sbUrg CA- . Con4-a CaS+-a Co un-h/ 3. How did the damage o i jury occur? (Give full details, use extra paper if re wired) c o ori m day ► erg m c_h e I I e C r r e no n- � M diel M o-F CL V`iS DDSs�r�✓� �Z� old �-1r)c sl�� v\f Gt S 1V�Vl Dn 4 What particuldr act or omission on thpart of count or district officers, servantor employees caused the injury or damage?'Th �15 OSI oVl Fwri}��� 1'i F—i 0 _f-S 5 Wh{-�U e q c V�k Q C +dl e �ctc� �-�41 Aoc�- I ve bee v� t �0- cl vw`( l at are t9J nam sof county or distri t officers, servants. or employees causing the h z D�h�evttr�, damage or injury? Cc-S F�r-�-��-otv► e �1 a res (�"�1 i e S o ! wl o >n C ` J 6. What damage or injuries do your claim resulted? (Give full extent of injuries or dama,-es claimed. Attach two estimates for auto damage.) E m 6 e MON ovlk vo ss� bl e 1 ost &-- 4�W)e v\► ►1 n Y`f �a��ds�.n Possible yv��`l � 4 r��/ a��h��r� < o S e 7. How as t amount claimed above compute (lnc e the est ated a ount o any prospective injury or damage.) (ES-hMC6fA 1 8. Names apd addressesof witnesses, doctors, and hospitals: �/'a 1 c1 t I l-e Ca r-r nn o 0 S Cccr 1-upe-,-- C q�G, v 05ele ,6 p�0S s Rose Ctnea CYIArr �f a9 ele r�kU ogele ► dine 9. List the expenditures you made on account of thi2accident or injury: Ct>Yvl m 0 1 DATE tTIME AMOUNT �V A •■■n■¢:■o.ce.■■r.�■acccc��■ore■a..■■...o■v....■om■■■■■.s■■s■C.■e■.o■r■s■e■■■.■■C■■■■■■� ) 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) ) 0 Name and address of Attorney ) (Claimant's Signature) 115 C o�rca�v In Dr. (Address) Telephone No. ) Telephone No. Z SJ ........................................................................■■..■.■now Val 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. ■■■■r■■■■.■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■NEON■■■■■■■■■.■■■■■■■■■■■■■.■■■■■.■■■■■■■■■1 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 an), county, city, or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bili, account voucher, or writing, is punishable either by imprisonment in the Countyjail 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. day of a hearing in Superior Court.The report stated that 1,Frances Shinn,Ms. Carreno's mother,had been diagnosed with schizophrenia when she, Ms. Carreno was a young child. This false information has been not only very upsetting,but also embarrassing to me,and my family.Not to mention what this FALSE information might be doing to damage my daughter's case, and the chance of her getting her son back in her custody. S,T(ov) 1 -Angel J. Carreno J07-00505 2 3 maintains a 'relationship with her mother and father, who are not together. It is reported that Ms. 4 Carreno's mother was diagnosed with`-schizophrenia when Ms. Carreno was a young child. Ms. Carreno has an extensive history with the Child Welfare System, as a child. When she 5 6 was just thirteen years old, Ms. Carreno was already a discipline problem for her mother, in that Ms. 7 Carreno refused to follow household rules and refused to attend school. Ms. Carreno was placed in 8 voluntary foster placement. A petition was filed on her behalf, indicating that she had already failed 9 in five foster placements, due to her unwillingness/inability to cooperate with reasonable expectations or her behavior, that she had initiated physical and verbal confrontations with her mother or other 10 11 authority figures to the extent that she was so out of control that law enforcement had to be called to 12 contain the situation on many occasions, that..she destroyed property, ran away, and/or feigned illness 13 in an effort to exert control over situation, and that she refused to go to school to the extent that she 14 failed a grade level. Ms_ Carreno's mother indicated, at that time, that she could not handle Ms. 15 Carreno, as she was unwilling to follow household rules or attend school. Ms. Carreno's father 16 never provided Ms. Carreno with a home. From 1997 — 2000, Ms. Carreno was in numerous group 17 home placements, as she often ran away, got into fights, or was put into Juvenile Hall. 18 Furthermore it was reported by a family member that while she was on the run from group 19 homes, Ms. Carreno told other family members that she had been having sex with a variety of older 20 guys who had-been taking:her-to-a=ml otel in Valejo.",A family.member also reported that she had seen 21 Ms.-Carreno.get picked up.by_.an African-American man in-a silver car and that Ms. Carreno had told 22 her that the man was.going:to take her to,San.Francisco-or Reno and that she was going to get five hundred dollars for the;;.date.: However, at that time, Ms. Carreno denied ever telling the family 23 member that information. 24 There was.a lot of concern about the type of people that Ms. Carreno was spending time with 25 26 and their negative influence on her. The Bureau remains concerned about Angel's safety if he were 27 to be returned to Ms. Carreno, as she seems to have a very unstable and somewhat violent past. 28 Disposition Report 9 05/21/2007 CLAIM BOARD OF Sl1PERVI.SORS OF CONTRA COSTA COUNTY BOARD ACTION: NOVEMBER 06, 2007 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 on your claim by the Board of D MSection Supervisors. (Paragraph IV below), given Pursuant to Government Code AMOUNT: $4,884.73 CCT 18 2007 913 and 915.4. Please note all "Warnings". COUNTY COUNSEL CLAIMANT: ROSALBA MUNOZ. S. NIAiRT1NFZ CALIF. ATTORNEY. UNKNOWN DATE RECEIVED: OCTOBER 18, 2007 ADDRESS; 124 HILL STREET, BY DELIVERY TO CLERK ON: OCTOBER 18, 2007 BAY POINT, CA 94565 BY MAIL POSTMARKED: OCTOBER 16, 2007 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, C k Dated: OCTOBER 18, 2007 By: Deputy If. FROM: County Counsel TO: Clerk of the Board of Supervisors ( liis claim complies substantially with Sections 910 and 910.2. ( } -This Claim FAILS to c0111ply 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 retu17i claim on ground that it was filed late and send wai7ning of claimant's right to apply for leave to present a late claim (Section 91 1.3). O Other: Dated: le By: Deputy County Counsel 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). lel. OARD ORDER: By unanimous vote of the Supervisors present. (✓ This Claim is rejected in full. ( } Other: I certify that this is a true and con-ect copy of the Board's Order entered in its minutes for this date. Date44-10 /- d F FLN CULLEN, CLERK, By Deputy Clerk WARNi.NG (Gov. code section 913) Subject to certain exceptions,you have only six(6) months from the date this notice was peisonalh,served or deposited in the nihil to file a covet action on this cLnim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection wide this matter. If'you want to consult an attorney,you should do so immediately, *For Additiaial N1'arnhn g See Reverse Side ofThis Notice. AFFIDAVIT OF MAILING I. declare under penalty of perjury that I. ani now, and at all tinies 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 INlartinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. DatedNetJ .90/4-- -e*b1X JOHN CULLEN, CLERK By eputy Clerk :� ' i. This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is' not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations lieriod within which suit must be tiled may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa .does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act 3 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 groiNring 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 naive of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against eacli. public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. ONUS MURK'tasmanRollo RaanMEN NonESERESaONMEMOREERMKENNKWEEK EMBENIFEEMENENMuffilmRICK RI RE: Clain By: Reserved Reserved for Clerk's filing stamp RECEIVED Against the County of Contra Costa or ) OCT 1 8 2001 CLERK BGP.RD OF SUPERVISORS District) CONTRi: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$ and in support of this claim represents as follows: L When did the damage or injury occur? (Give exact date and hour) 2. Where did the damageor injury occur? (Include city and county) Tf'rT5J3u(6 ' Coy+CL C05ka 3. How did the damage or injury occur? (Give full details; use extra paper if required) 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? 5 What are the names of county or district officers; servants, or employees causing the damage or injury? Va 0 D au 1. d L- vs i S 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) S. Names and addresses of witnesses, doctors, and hospitals: 0 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT 2aa■a0aaaaaaaaa22aaaaaaaaaaaaaaaaaaaaa00aaaaa20aa0aa20aa0a050aataaaa9aaaa0a2aIaaaaaaI ) .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 ( . 0 (Claiman 's Signature) (Address) ) CQ Telephone No. ) Telephone No. l 5 q q 7 1q S ■ aa a aaaaa■■aaaaaaaaaaaasaaa■■■aaaasaaaaaaaaaaEmma BEER aaaaaaaaaaaaaaMEN aaanaagame ENNUI 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, an), attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■■aaaaaaaaaaaamamasaaaaaaananaaaaaaaaaaaaaaaaataaaeaoaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa# NOTICE: Section 712 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. STATE OF CQI_IFORN'A TRAFFIC COLLISION REPORT CHP 555 P':,^ge 1 (Rev.7-03) OPI 061 AUG 3 O 20 Page/ of [SPECIAL CONDITIONS NUM gF HIT&RUN CITY JUDIGIAL DISTRICT LOCAL REPORT NUMBER �� � INS 'U I LLONi /_L/` - NUMBER KILLI:fI RIT s RUN COUNTY REPORTING DISTRICT BEAT MISDEMEANOR COLLISION OCCURRED ON MO. DAY YEAR TIME(2400) NCIC* OFFICER I.D. z 320 MILEPOST INFORMATION DAY OF WEE TOW AWAY PHOTOGRAPHS BY: I- LLfiONE UfEELWL" /V OF 7 L_L O o.l - S M T W F I J YES NO ✓] O u AT INTERSECTION WITH STATE HWY REL J �OR:/�� FEELJAM�ES � OF �j4 it/ �Z�,E[� �L�/� f.✓J YES El NO DRIVER'S I ICENSE NUMBER STATE CIASS AIR 0,1C: 'SAFETY EQUIP. VERY MAKF/MODELICOLOR LICENSE NUMBER S'fAT� PARTY i C �UJP,T� Zf�,c.' > �D Lf4 - - --- -- ... . .--- .. - ---------- ...... ........... ..... UIIIVIIt NAME(FIRST,MIDDLE,LAST) ,c� n C OWNER'S t!Ah" - -- "...._._.._(�YAn� /���1J C,GC.�7-J=- - /,7�� �, ! S DRIVER PEDES-ISTREEf:ADDRESS /�AI7c (),C!V ER`f rl1!.1N _ OWt,:_R'S AD^R[:SS. ..r_ ._._. .._........__ f (JVD 1.1�/7�II � ti-VLL _ SAME AS DRIVER V;:Icil j c!TVJSTAI EIZIP /y����� .Vi..'�CI.L ! Is i DIS 311 ION )F V'EHICIE ON GitDE(tS"•' LJ --_ J_ _ - - -• _ .- � � OFFICER DRIVER ; '1THER RICY SEX HAIR EYES HEIGHT WEIGHT BIRTHDATE RACE qq ::rZIC;•:..:"'HAt:,'•;.'�.E,EI:r" 1 J NO ,.J NE APPARENT n REFER TO NARRA'"rig D"IrIEI. HOME P11c;.1E BUSINESS PHONE (VEHICLE IU(i%T:F!L'ATIO UMBER: 92s._35. r-30- - __. _ _..- - N ' � � V::;tlCl.f�TYPE � !DESCRIBE VL:HICLE DAMAGE SHADE If:DAM:=: .REA 1 I.NSURANCE CARRIER POLICY NUh,::_R j F I UNK. C I NONE MINOR I IMOD. (J MAJOR C,:OLL-OVER �oiP.OF TR.:./ELTON STREET OR HIGHWAY ;SNr L!'I:'.' > 1. DOT... '. C�• !l• l I :�� CA4-` __ _ __TCF•••gC __MC/MX '-.�` ..-�.• PART YrRIVER'S LICENSE NUh'."TER STATE IC,ASS IA!: DAT_ �.rV r^!:I'I%. VEKY AR (MAKE/MODEIJCULOR LICENSE NUMBER S':Al I 1 n n z_ /i0 �_ �W� .x . �I5s01,Z - - -- - -- . ,)RIVEFI NAM(_(FIRS r,MIDDLE,LA.: OWNER'S NAME L1� _ /�C1iVJGl//y �,L(�ry� L, SA'�M//�EJ�q�S�D/RIVEQR PFUF.S. STREET ADDRESS --_ ... .. .�� r,�lV� RIAN — KE /2^L OWNER'S ADDRESS (/�//y� SAME AS DRII/VY/,R PAF CITY/STATEIZIP // / / -�`-+_ VEFIICI.E Q�C� ��(y �/,� /�J�� DISPOSITION OF VEHICLE ON ORD:NS OF: ,, L�VJ (] OFFICER DRIVER OTHER "ICY- SE% I1AIR EYES HEIGHT WEIGHT BIRTHDATE RACE._ ��X�/��'� �,�•� CLISr ! __ �J, s /lLD T •Zf�. Al IZV- PRIOR MEC'HANICAt.DEFECTS: NONE APPARENT REFER TO NARRATIVE OTHEII HOME PHONE BUSINESS PHONE VEHICLE IDE!:TIFK ATION NUMBER'. u VEHICLGTYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA INsuRANCE CARRIER POLICY NUMBER UNK. NL-ONE MINOR _ 0/ : ;nMon. - MAJOR❑ROLL-OVER UIH f.F TRAVEI. ON STREET OR HIGI IWA'f l SFEEO LVNT CA — DOT • 2-1L(/ CAL-T _ __..—TCP/PSC--.---_—MC/MX PARTY DRI'VER'S LICENSE NUMBER STATE [CLASS iAIR BAG ..:FEN ?I:P. `JC-FI.YEAR I';,(F1M!DEL:'COLOrt LICENSE NUMBER IURIV:FI NA•..E(F)R'.:',MIDDLE,LAST) ----..__-...- -..- .-.-__--.....- ._-_.. _. (OWNE'R'S NAME. -I SAME AS DRIVER I PI:IIES SfF._cT ADDRESS -- 1'I1IAN OVA VERS ADDRESS__. ........- SAME AS DRIVER PAFIKED CITY/STATFJZIP VEHICLE _ II--11 .,.,[:_,. •i I•: DISPOSITION OF VEHICLE 07:ORDERS OF: I 1 OFFICER C4 DRIVER OTHER _.. OILY SE% HAIR EYES HEIGHT WEIGHT SIRTHUATE RAI;F. CUSr Mo, Dey Vcll �. �') •, PRIOR MECHANICAL DEFECTS: n NONE APPARENT REFER TO NARRATIVE OTHER HOMF.PHONE BUSINESS PHONE VEHICLE IDENI IFICATION NUMBER: VEHICLE TYPELo BE VEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER K. IJ NONE F]MINOR D. MAJOR❑ROLL-OVER DIR OF:TRAVEI.ON STREET OR HIGHWAY 1 SPEED LIMIT CA DOT CAL-T —TCP/PSC MC/MX [7-S NAME rSPATCH NOTIFIED RE -VJE .$NA EV W7 /OyC�S �YES [:] NO F] N/A c555 703.frD STATE OF CALIFORNIA TRAFFIC COLLISION CODING CHP 555 Page 2(Rev. 7-03) OPI 061 Prgc�ol DATE OF COLLI510 O. PAY O ) TIME(j400/) NCIC# � OFFICEFjIn.� NUMBER OWNER'S NAME. OWNER'S ADDRESS TIF IED PROPERTY �— YES NO DAMAGE DESCRIPTION OF DAMAGE SEATING POSITION SAFETY EQUIPMENT INATTENTION CODES OCCUPANTS L AIR BAG DEPLOYED M I C BICYCLE-HELMET A-CELLPHONE HANDHELD A-NONE IN VEIIICLE M-AIR BAG NOT DEPLOYED DRIVER PASSENGER B-CELLPHONE HANDSFREE B-UNKNOWN N-OTHER V-NO X-NO C-ELECTRONIC EQUIPMENT C.-IAP BELL'USED P-NO I REQUIRED W-YES Y-YES D-RADID I CD D-LAP BELT NOT USED E-SMOKING 1 2 3 1-DRIVER F-SHOULDER HARNESS USED F-EATING 4 5 2 CO 6-PASSENGERS' F .SHOULDER HARNESS NOT USED CHILD RESTRAINT FJECTED FROM VEHICLE G-CHILDREN 6 7-STATION WAGON REAR .G-LAI'/SHOULDER HARNESS USED 0-IN VEHICLE USED 0-NOT.EJECTED H-ANIMALS:.. 8-REAR OCC.TRK.OR VAN 11-LAP/SI LOULDER HARNESS NOT USED R-IN VEHICLE NOT USED 1-FULLY EJECTED I-PERSONAL IIY61FNE 7 9-POSH ION UNKNOWN J-PASSIVI:RESTRAINT USED S-IN VEHICLE USE UNKNOWN 2-PARTIALLY EJECTED J-READING 0-of HER K-PAL3IVE RESTRAINT NOT USED T-I,1 VEHICLE IMPROPER USE 3-UNKNOWN K-OTHER _ U-NONE IN VEI IICLE ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK I')SHOULD BE EXPLAINED IN THE NARRATIVE. PRIMARY COLLISION FACTOR 'TRAFFIC CONTROL DEVICES I SPECIAL INFORMATION I MOVEMENT PRECEDING LIST NUMBER 11)OF PARTY AT FAULT 1 2 3 1 1 2 1 3 1 COLLISION v:.•cTID IMUI 11.. cIII.D A CONTROLS FUNCTIONING A HAZARDOUS MA FERIAL A_tifOPPED A f -- -... . -- - - -.. - YE - NO_[11D B CONTROLS NO I:FUN(:l"ZONING' -._ -- B CELI.PHONE HANDHELD IN USE ;- B..PROCEE lINO SITRAIGI I I B OTHER IMPROPER DRIVING': _CONTROLS OBSCURED _ _ _C CELI.PHONE I IANDSFREE IN USE _- C IRAN OFF ROAD - __- NO CONTROLS PRESENI I FACTOR' - "_D CELI.PHONE NOT IN USE -- __ D_MAKING RIGHT TURN_'___ C OTHEH'fH/:N DRIVER' _ - ;_ TYPE OF COLLISION '�. _ E SCHOOL BUS RELATED _ __E_M_ikI<lNG::EFT TURN _- D UNI(NOWN'_ - TA IIEAD-ON :-- __ F.7517T MOTORTRUCK COMBO --_- _ IF_MAKiNG U-TURN .. v B SIDESWIPE G 32 FT TRAILER COMBO __ _ _ ,G BACKING IC REAR END H I_ i I H SLOVIING/STOPPINC:_ WEATHER(MARK 1 TO 21TEM17S! D BiROAD:,iDE I PASSING 01 HER.VEHICLE -- A CLEAR."--_ --_- -. _- E_HIT OBJEC'_" - _ -. J __.J CHANCING LANES-- I ---- -- --.._.. -'- ---- --- i - B CLOUDY F OVERIURNED _ _ _ K _ _K PARK'.NGMANEUVER___ -� - C RAINING !G VEHICLE/PEDESTRIAN - L L-ENTE:2ING TRAFFIC D.SNOWING _- -1 H OTHER': - - M - - - M OTHER UNSAFE TU tNING _- EFOG/VISIBL..ITY FTI N' _ N XING INTO OPPOSINC LANE F OTHER'_- MOTOR VEHICLE INVOLVED WITH 0 - -_ --_ _O.PARKED I G WIND _ A NON-COLLISION _ __ P MERGING' i LIGHTING - B PEDESTRIAN _ - _ Q TRAVELING WRONG WAY ✓A DAYLIGHT_- C OTHER MOTOR VEHICLE 1 2 3 OTHER ASSOCIATED FACTOR(S) - __-_R'OTHER'_ B DUSK-DAWN D MOTOR VEHICLE ON OTHER ROADWAY (MARK 1 TO 21TEMS) -C DARK-STREET LIGHTS - E PARKED_MOTOR V_EHICLE _ - A VC SEC1109MDLAIIDN: CITED — �— L-I YES - D DARK-NO STREET LIGHTS.. F TRAIN (';.: ."': ❑NO E DARK-STREET LIGHTS NOT. G_BICYCLE _ - B SECTIONVIOU'IION CITED --..- -. ❑YES FUNCTIONING' H ANIMAL: 0140- SOBRIETY-DRUG VC SEC LION MOLATION: CIIEO ROADWAY SURFACE _ _. C E)I-I YES 2 3 (MARK 4YT0 2plTEMS) I_ A DRY I FIXED OBJECT: B WE'fv IA HAD NOT BEEN DRINKING _ IJD C SNOWY:ICY— _ J OIF.ER OBJECT: E VISION OBSCUREMENT: -_ _B HBG UNDER INFLUENCE SLIPPERY MUDDY,OILY,ETC.' F INATTENTION': C HBD-NOT UNDER INFLUENCE' ROADWAY CONDITION(S) G STOP 8 GO TRAFFIC ___ D_ HBD-IMPAIRMENT UNKNOWN'. (41ARK,1 TO 21TEMS) PEDESTRIAN'S ACTIONS _ _H ENTERING/LEAVI_NG RAMP __ _E UNDER DRUG INFLUENCE' A HOLES,DEEP RUT' - L/A NO PEDESTRIANS INVOLVED-__ _ I PREVIOUS COLLISION___ _ F IMPAIRMENT.-PHYSICAL' B-LOOSE MATERIAL ON ROADWAY' B CROSSING IN CROSSWALK.- -_. _- J UNFAMILIAR WITH[ROAD - - IG imR? !RMENT NOT•KNOWN C OBSTRUCTION ON ROADWAYA'I INl EIRSECTION_ __ _K DEFECT_IVI'VEH.EQUIP.: C1 FD ____ H N_OT APPLICA-EILE _ D CONSTRUCTION-REPAIR ZONE C CRO'iSING IN CROSSWALK-NO'T �I YES I SLEEPY/FATIGUED- --- -- - - - E REDUCED ROADWAY WIDPI.I AT INTERSECTION NO F FLOODED' ID CROSSING-NOT IN CROSSWALK L UNINVOLVED VEHICLE 'O'IHER': IN(ROAD-INCI.UDES SI IOUI.DER M OTHER' H NO UNUSUAL L'_L'NDI TIONS "• NOT IN ROAD ---.--'--- - - ------ ---._......-. --_-_--. .._I_i_- f_ I_ N NONE APPARENT G API Ri::AC Cl 1114G I I_!_AVINC 5CHOOL 10 RUNAWAY VEI IICLE . SKETCH I I CT J l MISCELLANEOUS L ! INDICATE NORTH DO � I vz II ,9c 1 1 1 �Anl /'G02C0 �JLv/) DA PCS/5U -- II _cT OTHER OSP 03 79147 STATE OF CALIFORNIA ' NARRATIVE/SUPPLEMENT-AL CHP 556 (Rev. 7-90) OPI.061 -� Page DATE OF INCIQ�T/OC�R�� TIME(2400)�D NCIC NUIvi��;-�• •� � ' OFFICER NUMBER ' ROX" E "X"ONE TYPE SUPPLEMENTAL("X"APPLICABLE . Narrative 2 Collision Report ❑ BA Update-.. Fatal ❑ Hit and Run Update ❑. Supplemental ❑ Other: ❑ Hazardous Materials ❑ School Bus. ❑ Other: CITY/COUNTY/JUDICIAL DISTRICT REPORTING DISTRICT/BEAT CITATION NUMBER LOCATION/SUBJECT STATE HIGHWAY RELATED ❑ Yes ❑ No 2. 3. 5. 6. 7. 10• � //u6 I�4^r �{/J()I✓/� , --- — 12._ /lh/Lp TLL//E T���/JNe7 �-,T�'X l /;,3 �/dGl�iO�L� C�� Y/! "2 S �C ,:470/1 _ 13. )t&,fAl- I �rt�irif' — T��:'�PA162. ,GoAeS �iO 7 —_ 14. /. ANG'' /d T� '-5 1-0,4-le . 15. 16. 17. 18. 19. 20. 21. 22. --- ---- ------ -- — -- 23. 24. i 25. — ---- — i 26. 27. 28. 29. 30. 31. ❑ Conlinued PREPARER'S NAME rind I.D.NUMBER DAT REVIEWER'S NAME DATE Use previous editions until depleted. E;;� OSP 04 82787 Lincoln M.Haven BODY&COLLISION CENTER Lifetime Warranty-Free Estimates Computerized Color Matching-Frame Repair specialists-Factory Like Baked Finis Ph(925)687-3117-Fx(925)687-4747 Elite Lincoln@pacbell.net :0Concord, 10/10/2007 at 03 : 48 PM Job Number: 73920 ELITE AUTOBODY & COLLISION CENTER Federal ID # : 204326297 Tax Id : 20-4326297 BAR# AJ223861 EPA# CAL000230 -2180 MARKET ST. CONCORD, CA 94520 (925) 687-3117 Fax: (925) 687-4747 PRELIMINARY ESTIMATE Written By: Adjuster: Insured: ROSALBA MUNOZ Claim # Owner': *F2OSALBA MUNOZ r. . Policy # Address: " D'eductilile: Date of Loss: Day: Type of Loss: Evening: Point of Impact: Inspect ELITE AUTOBODY & COLLISION CENTE Business: (925) 687-3117 Location: 2180 MARKET ST . CONCORD, CA 94520 • Insurance Company: 5 Days to Repair 2004 PONT GRAND PRIX GTI 6-3 . 8L-FI 4D SED Int : VIN: 2G2WP522541111594 Lic: Prod Date: Odometer: Air Conditioning Rear Defogger Tilt Wheel Cruise Control Intermittent Wipers Keyless Entry Body Side Moldings Dual Mirrors Console/Storage Fog Lamps Rear Spoiler Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks Power Mirrors AM Radio FM Radio Stereo CD Player Driver Air Bag Passenger Air Bag 4 Wheel Disc Brakes Cloth Seats Bucket Seats Recline/Lounge Seats Automatic Transmission Overdrive Full Wheel Covers ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT . PRICE LABOR PAINT -------------------------------------------------------------------------------- 1 FRONT DOOR 2* Rpr LT Door shell 4 . 0 2 . 1 3 Add for Clear Coat . 0 . 8 4 R&I LT Reveal molding 0 . 5 5 Repl LT Body side mldg 1 67 . 27 0 . 2 0 . 4 6 Overlap Minor Panel -0 . 2 7 Add for Clear Coat 0 . 1 8 Repl LT Mirror outside 1 130 . 50 0 . 3 0 . 5 9 Overlap Minor Panel -0 . 2 10 Add for Clear Coat 0 . 1 11 R&I LT Handle, outside 0 . 4 12 R&I LT R&I trim panel 0 . 5 1 10/10/2007 at 03 : 48 PM Job Number: 73920 PRELIMINARY ESTIMATE 2004 PONT GRAND PRIX GT1 6-3 . 8L-FI 4D SED Int: ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT . PRICE LABOR PAINT ------------------------------------------------------------------------------- 13 REAR DOOR 14* Rpr LT Door shell 3 . 5 2 . 2 15 Overlap Major Adj . Panel -0 . 4 16 Add for Clear Coat 0 . 4 17 Repl LT Body side mldg 1 83 . 69 0 . 2 0 . 3 18 R&I LT Belt w' strip 0 . 3 19 R&I LT Handle, outside 0 . 3 20 R&I LT R&I trim panel 0 . 5 21 QUARTER PANEL 22* Rpr LT Quarter panel 3 . 0 2 . 0 23 Overlap Major Adj . Panel -0 . 4 24 Add for Clear Coat 0 . 3 25 REAR LAMPS 26 R&I LT Tail lamp assy 0 . 4 27 REAR BUMPER 28 R&I R&I bumper cover 1 . 3 29 FENDER 30 Blnd RT Fender 1 . 2 31 FRONT LAMPS 32 R&I LT R&I headlamp assy one side 0 . 4 33# TINT COLOR 1 0. 5 34# MASK JAMS 1 0 . 5 35# Subl HAZ MAT 1 8 . 00 36# NIB & BUFF 1 2 . 0 37# COVER CAR 2 10 . 00 0 . 2 ------------------------------------------------------------------------------- Subtotals =_> 299 . 46 19 . 0 9 .2 Parts 299 . 46 Body Labor 19 . 0 hrs @ $ 80 . 00/hr 1520 . 00 Paint Labor 9 . 2 hrs @ $ 80 . 00/hr 736 . 00 Paint Supplies 9 . 2 hrs @ $ 35 . 00/hr 322 . 00 ---------------------------------------------------- SUBTOTAL $ 2877 . 46 Sales Tax $ 621 . 46 @ 8 .2500% 51 . 27 ---------------------------------------------------- GRAND TOTAL $ 2928 . 73 ADJUSTMENTS : Deductible 0 . 00 ---------------------------------------------------- CUSTOMER PAY $ 0 . 00 INSURANCE PAY $ 2928 . 73 2 TED BRUSHABER A U `r O B O D Y 925/680-6946 FAX 925/680-6961, 2110 MARKET STREET, CONCORD, CA 94520 Date: 10/10/2007 03:28 PM Estimate ID: 324 Estimate Version: 0 Preliminary Profile ID: Mitchell SIMPLY SUPERIOR AUTO BODY 2110 Market Street,Concord,CA 94520 .(925)680-6946 Fax:, (925)680-6961 ` Tax ID: 54-2191707 BAR#: AC251858 EPA#: CAD981368590 Damage Assessed By: Ted Brushaber Condition.Code: Fair Deductible: UNKNOWN Owner: ROSALBA MUNOC Address: 124 HILL ST.,BAY POINT,CA.94565 Telephone, Home'Phone: (925)497-1952 ` Mitchell Service: 910064 Description: 2004 Pontiac Grand Prix GT1 Body Style: 4D Sed Drive Train: 3.8L Inj 6 Cyl 4A FWD VIN: 2G2WP522541111594 License: 5BEZE022 CA Color: RED ***SPECIAL PARTS NOTICE: All crash parts on this estimate are "new" orginal equipment manufactured parts, unless otherwise specified. Parts described as rechromed, recored, remanufactured, or reconditioned are considered "rebuilt" parts. Crash parts described as "quality replacement part" are non-original equipment manufactured aftermarket new parts. "*** Line Entry Labor Line Item PartType/ Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 000174 BDY REMOVEIREPLACE WHEEL COVER 9595202 GM PART 64.60 2 001036 GLS REMOVE/INSTALL WINDSHIELD 2.4 # 3 000401 BDY REMOVE/REPLACE W/SHIELD REVEAL MOULDING 88957289 GM PART 61.70 INC # 4 900500 BDYREMOVE/REPLACE DOOR EDGE GUARD **QUAL REPL PART 80.00* 0.0* 5 000555..BDY REPAIR L FRT DOOR REPAIR PANEL Existing 4.0*# 6 AUTO. REF " .REFINISH....;;.. L FRT DOOR OUTSIDE C 2.2 7 001664 BDY REMOVE/INSTALL L FRT UPR DOOR GLASS REVEAL MOULDING 1.0 # 8 001065 BDY REMOVEIINSTALL L FRT OTR BELT MOULDING 0.3 # 9 001666 BDY REMOVE/INSTALL L FRT DOOR REAR APPLIQUE 0.3 10' 000563•: BDY REMOVE/REPLACE L FRT LWR DOOR ADHESIVE MOULDING 19120791 GM PART 67.27 0.2 - _ 1.1. _AUTO REF REFINISH L FRT LWR DOORNOULDING -.-- C 0.5 12 001569 BDY REMOVE/REPLACE L FRT DOOR ADHESIVE EMBLEM- 10348686 GM PART 22.40 0.2 13 001565 BDY REMOVE/REPLACE L FRT DOOR ADHESIVE NAMEPLATE 10350911 GM PART 20.59 0.2 14 000571 BDY REMOVE/REPLACE L FRT DOOR REAR VIEW MIRROR 10348393 GM PART 130.50 INC # 15 AUTO REF REFINISH L FRT DOOR MIRROR C 0.7 16 001072 BDY REMOVE/INSTALL L FRT DOOR TRIM PANEL INC 17 001083 BDY REMOVE/INSTALL L FRT OTR DOOR HANDLE 0.3 # 18 000658 BDY REPAIR L REAR DOOR REPAIR PANEL Existing 5.5*# 19 AUTO REF REFINISH L REAR DOOR OUTSIDE C 1.8 20 001668 BDY REMOVE/INSTALL L REAR UPR DOOR GLASS REVEAL MOULDING 1.7 # ESTIMATE RECALL NUMBER: 10/10/2007 15:27:38 324 UltraMate is a Trademark of Mitchell International Mitchell Data Version: SEP_07_A Copyright(C)1994-2005 Mitchell International Page 1 of 3 UltraMate Version: 6.0.027 All Rights Reserved Date: 10/10/2007 03:28 PM Estimate ID: 324 Estimate Version: 0 Preliminary Profile ID: Mitchell 21 001095 BDY REMOVE/INSTALL L REAR OTR BELT MOULDING INC 22 001670 BDY REMOVE/INSTALL L REAR DOOR APPLIQUE 0.6 # 23 000668 BDY REMOVE/REPLACE L REAR LWR DOOR ADHESIVE MOULDING 19120793 GM PART 83.69 0.2 24 AUTO REF REFINISH L REAR LWR DOOR MOULDING C 0.5 25 001097 BDY REMOVE/INSTALL L REAR DOOR TRIM PANEL INC 26 001105 BDY REMOVE/INSTALL L REAR OTR DOOR HANDLE 0.3 # 27 000760 BDY REMOVE/REPLACE L ROOF JOINT MOULDING(ADHESIVE) 88980519 GM PART 70.80 0.2 28 AUTO REF REFINISH L ROOF MOULDING C 0.5 29 001118 GLS REMOVE/INSTALL BACK WINDOW 2.3 # 30 000814 BDY REMOVE/REPLACE BACK WINDOW MOULDING 88980184 GM PART 81.51 INC # 31 001636 BDY REPAIR L SIDE BODY PANEL ASSEMBLY -S Existing 4.5* 32 AUTO REF REFINISH L SIDE BODY PANEL COMPLETE C 5.4 33 001043 BDY REMOVE/INSTALL L ROCKER MOULDING 0.7 34 001149 BDY REMOVE/INSTALL L REAR COMBINATION LAMP INC 35 003441 BDY REMOVE/INSTALL REAR BUMPER COVER 1.4 # 36 936012 ADD'L COST HAZARDOUS WASTE DISPOSAL 5.00* 37 AUTO REF ADD'L OPR CLEAR COAT 2.8 38 933003 REF ADD'L OPR TINT COLOR 0.5* 39 AUTO REF ADD'L OPR FINISH SAND AND BUFF 3.1 40 933018 REF ADD'L OPR MASK FOR OVERSPRAY 7.80* 0.3* 41 AUTO ADD'L COST PAINT/MATERIALS 521.50* * -Judgment Item #-Labor Note Applies C -Included in Clear Coat Calc Add'I Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 21.6 80.00 0.00 0.00 1,728.00 Taxable Parts 683.06 Refinish 18.3 80.00 7.80 0.00 1,471.80 Sales Tax @ 8.250% 56.35 Glass 4.7 80.00 0.00 0.00 376.00 Total Replacement Parts Amount 739.41 Non-Taxable Labor 3,575.80 Labor Summary 44.6 3,575.80 III. Additional Costs Amount IV. Adjustments Amount Taxable Costs 521.50 Customer Responsibility 0.00 Sales Tax @ 8.250% 43.02 Non-Taxable Costs 5.00 Total Additional Costs 569.52 I. Total Labor: 3,575.80 II. Total Replacement Parts: 739.41 III. Total Additional Costs: 569.52 Gross Total: 4,884.73 IV. Total Adjustments: 0.00 Net Total: 4,884.73 ESTIMATE RECALL NUMBER: 10/10/2007 15:27:38 324 UltraMate is a Trademark of Mitchell International Mitchell Data Version: SEP_07_A Copyright(C)1994-2005 Mitchell International Page 2 of 3 UltraMate Version: 6.0.027 All Rights Reserved 0 i� y o � its 7i c - r`y jo S rJ _ USP� � � !✓ ,t v� .w � AMENDED CLAIM BOARD OF SUPERVISORS 01. CONTRA COSTA COUNTY d 's ;Z BOARD ACTION: NOVEMBER .06, 2007 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLALN4.ANT 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 on your claim by the Board of NOTE: FIRST CLAIM FILED ON OCTOBER 04, 2007 Supervisors. (Paragraph IV below), BOARD ACTION ON NOVEMBER 06 ®�017 �'�iven Pursuant to Government Code V ' , . 1m Section 913 and 915.4. Please note all AM.OUNJ': $1,068.34 �t " ' „ OCT 2 3 2007 !W.`arnings . PROGRESSIVE INSURANCE CLAIMANT-. FOR: ANN BARRETT COUNTY COUNSEL BY: BRIDGETT MAGAR MARTINEZ CALIF. ATTORNEY: UNKNOWN DATE RECEIVED: OCTOBER 23, 2007 ADDRESS: 5920 LANDERBROOK DRIVE BY DELIVERY TO CLERK ON: OCTOBER 23, 2007 3rd FLOOR MAYFIELD HTS. OH 44124 OCTOBER 17, 2007 BY MAIL POSTMARKED- FROM.: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, C < Dated: OCTOBER 23, 2007 By: Deputy I.I. FROM: County Co>.rnsel TO: Clerk of the Board of Supervisors ( his claim complies substantially with Sections 910 and 910.2. ( ) .['his 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: I D a�?—�� 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). 1V. A-RD ORDER: By unanimous vote of the Supervisors present: (�1Hiis Claim is rejected in full. ( ) Other: I.certify that this is a true and correct copy of the Board's Order entered in its minutes for.. this'�date. Dated.,., 4 . 4 9, �0�JO.HN CUL.LEN, CLERK; By eputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this matter. if you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side of'11tis Notice. AFFIDAVIT OF MAILING I declare under penalty of pet jury that I ant 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 N-lartinez. California, postage fully prepaid a certified copy of this Board Orderawl Notice to Claimant., addressed to the claimantas shown above. Dated: __,d-� � IOI.IN CULLEN, CLERK By Del)uty Clerk This warning does not apply. to.clainls Which are not subject to the California Tort Claims Act such as actions in inverse condemnation actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims..The above list is not exhaustive and legal consultation is essential to understandall the sei agate limitations periods that nay Apply� The-limitations period within which,suit must be filed may be shorter or'Ionger depending on the nature of the claire. Consult the.specific statutes and cases applicable to your particular claim: The County of Contra Costa does not:waive any of its rights:under-California:Tort.Claitits Act` 'nor does it waive rights under the statutes of limitations,applicable to actions. not subject to the California Tort Claims Act 10/15/2007 15:56 FAX 925 335 1866 CONTRA COSTA CTI COUNSEL Z003 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 atter 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 penaltyforfraudulent claims,Penal Code Sec. 72 at the end of this form. ■maoammem"aaaq ...E w a Maas sea ONaa a as a a a as as a a as aaa an a Name awe aaa Massa MEN ON a as a a a RE: Claim By: � 7 ,���Z r Reserved for Clerk's filing stamp RECEIVED Against the County of Contra Costa or ) OCT 2 3 2001 District) CLERK BOARD OF SUPERVISORS (Fill in the name) ) CONTRA COS-iACO. The undersigned claimant hereb makes claire against the County of Contra Costa or the above-named district in the sum of$ j and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) -J�C� -�� Jam• �Jr�n'C 2. Where did the damage ori jury occur. (Include city and county) /r 61 3. How did thi damage or injury occur? (Give fu 1 details;use extra paper if required) XK0*- 4. Va'hat particular act or omission on the part of county or district officers, servants, or employees caused the inV' ry or damage? 5 What are the names of county or district officers, servants,or employees causing the damage or injury? ! r r a PAGE 314 RCVD AT 10115/20076:56:30 PM[Eastem Daylight Time]*SMS430002110'DNIS:13650'CSID:925 335 18661 DURATION(mm-ss):01-04 10/15/2007 15:56 FAX 925 335 1866 CONTRA COSTA CTY COUNSEL IM004 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages cl ' Attach two estimates for auto damage.) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses,doctors,and hospitals: 9. List the expenditures you made on account of this accident or injury: / /2 DATE TIME AMOUNT /�CJ/� 7 a (/o �. � a�rs 44p- 47-6 -0-1-7 7� MONSOON see mammon aadogaamass swags aaaamaaaaaaaaaaarrraaaaeasaaaaaaaaa■aaaaarrmass Emu Mae Gov. Code See. 910.2 provides"The claim shall be }signed by the claimant or by some person on his behalf.." SEND NOTICES TO: (Attorney) Name and address of Attorney ) �' { laimant' igoature) ) 2Z r-hy ( ddress) / V Telephone No. )Te phone No. sommossammumn Osamu on WWWWOR a a am mummom swam now no me ONE unums MENNEN@ Mumma NONE"a UNA At guano so I PUBLIC RECORDS NOTICE: Please be advised that this claim form,or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public.Records Act. (Gov. Code, §§ .6500 et seq.) Furthermore, any attachments,addendums,or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■■a a s a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a W a a a a a a a a a a a a a a a a a a a a a l 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 ($10,000),or by both such imprisonment and fine. PAGE 414 RCVD AT 1011512007 6:56:30 PIN[Eastern Daylight Time]`SVR:S430002110•DNIS:13650.CSID:925 335 1866'DURATION(mm-ss):01-04 VIIN[Y&OYYF$ �^. S 14 02 IA $ 03 91° -11 • 000431 3564 OCT 17 2007 ' MAILED FROM ZIPCODE 44143 o N LC cc aws cr U ........,.�„ m CC) - � a• V a rn 145Z jr rn.`...�`..." mru C ---- ...... ate- j O a v w 0 a E oq= a � caaaz® twsnti[v ssovt�s O +e 02 1A 0004313564 OCT 17 2007 ° MAILED FROM ZIP CODE 44143 G ----- --- _ � `V cam+ omm U p . �c V- 100 W J m ---"`y m V ------ ru Q k jI I t jY. I(r� O V V O p V E `rQ G aro @ }C C N 00 22 G.n:U ac