Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
MINUTES - 01162007 - C.05
CLAI1'1 BOARD OF SUPERVISORS Of CONTRA COSTA COUNTY � BOARD ACTION: JANUARY 16 , 2007 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Eaidorsements, ) NO-TICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document trailed to California Government Codes. ) you is your notice of the action taken on your claim by the Board of gjas Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all ANi.OUNT: $1 , 553 . 25 DEC 11 2006 "warnings". CLAINIANT: JOHN KIKES COUNTY COUNSEL MARTINEZ CALIF. A'1'TORNEY: UNKNOWN DATE RECEIVED: DECEMBER 11 , 2006 ADDRESS: 611 EXETER PLACE BY DELIVERY TO CLERK ON: DECEMBER 11 , 2006 DANVILLE, CA 94506 BY MAIL POSTMARKED: DECEMBER 10, 2006 FRONT: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, C r Dated: DECEMBER . 11 , 2006 By: Deputy Ii. FROM: County Counsel TO: Clerk of the Board of Su rvis rs ( This 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). 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). ( ) Other: Dated: 2— ro By: ���� Deputy County Counsel Ill. 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: (V� This Claim is rejected ill full. ( ) Other - I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. L)ated:_4,»wa✓ / O HN CULLEN, CLERK, By Deputy Clerk WARNING (Go . code section 913) Subject to certain exceptio»s,you have only six(6) months from the date this notice was personally sensed or deposited in the mail to file a court actiol on this claim.See Govermnent Code Section 945.6.You play seek the advice of an attorney of•jour choice in connection with this matter. If you want to consult an attor11ey,you should do so inu11ediately. *1+or Additiolal\Warning See Reverse Side ol'This Notice. A1=FIDAViT OF MAILING -- 1 declare under penalty of pet jure that 1 1111 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 int Nlartinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: ila" Y /� a� JOHN CULLEN• CLERK By _Deputy Clerk BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. A claim relating to a cause of action for death or for uijury 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 Cleric of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street,Martinez,CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each. public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. ■■aaaaaaaaataaaaaaaaan ■aaaaaaaaa■aasaaaman aaaaaaa■Rataaaaaasataal RE: Claim By: Reserved for Clerk's filing stamp REC�IVSD DEC 1 1. 2006 Against the County of Contra Costa or ) 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$ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 7: 30�•m . a&'n Ino Where did the damage or injury occur? (Include city and county) T SA 3. How did the damage or injury occur? (Give full details;use extra paper if required 1�2w k' ado". Cwt w���w-rites "t R -- Q � o` �-�' �l'�,.� n.�S�.e,�. Yh� 1—,,,,,� � a�.�L. vu�•Ci�.s� -c�9o.� �- 1 tom. c��i�-R �. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? _ Ac fCLI� 5 What are the names of county or district officers,servants, or employees causing the damage or injury? jrvT-yp, 1 . . 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) .512A> awa� W - �- - 7. How was th ounf claimed above c�omputed? (Inc ude the estil6ated amount of any prospective injury or damage.) 8. Names and addresses of witnesses,doctors, and hospitals: 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT �1-ZZ-b(42 Zoo'+ I'1'l SL S� ■ ■aaaoaoaRUBBER aaanaManama a.■aaa■aaaaaacaaaaaaaBEEN aaaaaaaceaaaaeaaaaaaaaaan%aImage Rai .Gov. Code Sec. 910.2 provides "The claim shall be signed by the claimant or by some person on his behalf." _SEND NOTICES TO: (Attorney) Name and address of Attorney ) (Claimant's Signature) (Address) Telephone No. )Telephone No. ■_■aaaaaaaaaaaaaaaaaaEmma amMason aKailas Kansas aaaaaaaacaaaaaaaaaaaaacacaRua Oman acaaaaaal 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, §§ 6500 et seq.) Furthermore, any attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■aacaaaaaaanaaaaanaIamaa■ aaaaall aaaaaaNam aman aion aIaaaaamanName aasaw aaIna aaaaaaass Ia%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 exceeduig 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. SPELjAU G0/7DI710N5 �'-, Or.H� Hl78 ALW CITY �..,y o VV ii•• [ 1I�� COUNTY REPORTING DISTRICT BEAT REPORTING COUNTY V� f !F t 14 1 COLLISION OCCUR DON n ('\ i,. DAY Y`ARTYE(14000 NCIC �!7 OFFK:ER I.D. AT lNTEASECTION WITH DAYyOF[WEEK V TOW AWAY(/ STATE WOHWAY q L TED P R: FEET/MRLE9 OF S M T W T F S DYES ND OYES TY DWVER'BLICEEN6,ENU 12 2a 97A CLA+`e= SAF ETYEIXAP. BMADE SKETCH J� G` ��JJIIiiDM7AOEDER NAME f F1, MIDDL`E.LAST) Cc PHONE NNUMBER /�O�1V • � . ,k�(__S �S ZO G7 -SVSG AREAIN. 9TAEEi ADDRESB���T � "1 C!i/,STA'EI LP � V �Jy,...., NORi' PK VEH BE% ^C BIRTHDATE 1N5URANCE CARRIER' POIJGCiEY'N]U0AB•BEE.R. (,Q SL STw'r�Gw rl BICYCLE DIR.TRAVEL 011 STREET OR WGMWAY T SPEED LMR, OTHER EM.YR MANE/MODEL/COLOR LICENSE NUMBER STATE VEIL TYPE PARTY Zc> T`Aek"&� SL S S c�Yu a /u 1 cma4 6 1 f PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY EQUIP. SHADE 1 2 DAMAGED DRIVEN NAME(FIRST,MIDDLE.LAST) PHONENUMBER AREA j 7- r•-� �✓' PED. STREET ADDRESS CITY/STATE/LP ,_QNP M11 PK VEH SE% BIRTHDATE NSURANCE CARRIER POLICY.NUMBER (CYCLE DIV.TRAVEL ON STREET OR HIGHWAY SPEED LMR, ! v ! ■ OTHER VEH.YR MAKE I MODEL/COLOR LICENSE HUMBER' STATE VEK TYPE PARTY E v 2 WIT, RIO AGE SEX NAME ADDRESS PHONE NUMBER PARTY NO ❑ ❑ AGE SE% NAME ADDRESS PHONE NUMBER PARTY NO PROP NAME ADDRESS DAMAGED PROPERTY OWNER IMPORTANT — READ CAREFULLY Keep this report. This is your record of this accident. To comply with California Vehicle Code (VC) Section 20002 (duty where property damaged), you must either: a, Give the owner or person in charge of such property the name and address of the driver and owner of the vehicle; or in the absence of the owner, b. Leave a written notice in a conspicuous place on the other vehicle or damaged property, giving the name and address of the driver and owner of the vehicle involved and a statement of the circumstances. This information is necessary for the completion of your state SR-1 Form, Report of Traffic Accident, and your insurance report. VEHICLE CODE SECTION 16000 The driver of a vehicle involved in an accident resulting in damage to the property of any ONIE party in excess of the amount stated in VC Section 16000 or in the injury or cleath .ol any person MUST submit a SR-1 f=orm to the California Department of Motor Vehicles within j0 days. Note: Failure to comply may result in suspension of your driver's license. Form SR-1 may be obtained from the Department of Motor Vehicles, the California Highway Patrol, any police station, motor vehicle club, or insuranceagent. If city or state property is darnaged, you will be contacted regarding possible liability, CALIFORNIA HIGHWAY PATROL 4999 GiEASON DRIvE DUBLIN, CA 94368 CI1P 55500 rR[V71-00)OPI OA2 -- - —" DUBLIN, CALF. 94�t)b (925) 828-0-466 Counter Report Questionnaire (Form should be attached to a CEP 5-55-03tCounter PeDor-t Face P2-e) This report is for YOUR RECORD ONLY! This document i,,-M not be investigated or substantiated by the California Highway Patrol. ELt and Run Nlovti--Up �E on- Jv be conducted if driver and vehicle can be sufficient]). identified. Re,,6ex and answer all annlrcable ouestiars. Please-D-i.nz leo biv. 1. Date of Collision: kkvglo(o Dav of'W-.--h- 2. Time of Collision., A2-61:n 3. Todav's Date: x�2,kl ok-0 Time of Repan: 7:00 - A In what County were you? 'What Ciry were you near? 6. On what Highway/Sweet we-,-you dri vin g 7. In what direction were vou heading? 8. W-hat was the nearest Exit or SLTef!z? 9. were the traffic conditions;) "FAQ 10, In what number lane were you drivinz? Lei to right. 1 is the EST lane ) 11. How fas-, were you traveling.'y 11 'Whar was the Highway/ Stre--,speed limit? 13. In what number]ant Was the other vehicle? 4- Eov,• fasz was the othe.- vehicle traveling'' 15. If you were behind the other vehicle, how far? 0% 16. Did the wE2thcr contri'bute to the collision", If yes: Explain: - 17. What were you doing pTl*oT to the collision" (For example: Looking to the ILR to c-anme lanes: looking at a mar: tuning the radio: talking on the car phone: etc.) 18. Describe the events that lead up to the collision. including the actions that caused the I collision. Be specific. include as much detail as possible. \k 5%.OVN 2> A 4 11 C o I-)I I-T)u fd e11 I Page Counte-F,e,Don (continueq) 19. v+hat occun-ed afe- collision? Include actions and state grits. 4� f(Vyx n„CJD `tyL-z Nlz� l rn.,�y� c ►n Complete questions 20-27 only,if this was a hit and run collision. DtheruZse, go to question 28. 20. Did it appear that the other drive:was intentionally king to leave the sczne? If yes.explain 22. Did you speal: ugrh the other driver? 22. If so, what was said? 23. Was there a Alzrim,a e b= mer? 24. If not, did you artcmpt to stop the drive: or tet his/her attention? 2D. Is it possible the other driver u-2s un2ware of the collision? (Pulling up along side of their vehicle and waving your hands does not necessarily mean that the: lmou who you are. .Additional)y; a vehicle's size and the type of collision should also be considered) 26. Describe the other driver: Se;:: Face: VJeinht: Height: . Approx. Age: Hair Color: Lend h-of Hair: Facial Features; Tattoos: Scars: 27. If necessary, cou]d you positil'el} identity the other driver from a photoErraph? 28, Describe the other vehicle (Year, make model; color, license plate) - 6 2-� \ Connnued Next Page CALJFORNJA HJGHWAY PATROL - DUBLIN PLA Counter Repot', (continued) 29. Desc:;be damage (if anv) sus aineci to the other vehicle: PaM' -L uansfer Yes 114-0 Color: Extent or"dLmage: Location of Darna2e: 30. Descr-ibe.in detail. damage sustained to your vehicle: Paint Transfer: Yes vo Color ofpaint transfer: Extent of darn2ge: CAU, I Location of damage: 31. List any passengers in your vehicle at the-time of the collision: ?dame: Address: Date of Birth: Phone number: Name: Address: _ Date of Birth: Phone Number: Name: Address: Date of Birth: Phone Number: Name: Address Date olr Birth: Phone Number: Continued 'fiext Page CkL1rOP. ��lA HIGHPATROL - DL!L'Ll;v Counter Repo-, (continued) 32. Did you attempt to contact the Caiifornla 'r'_i2htiti?ay Patrol. or oihe: la- �c:,forctmtm; zee:tcv. to renoi, the accident? I?so. cid you speak with anE)ce:? -e �� ver a'{ nce the date of tht collisio T least e--ola _. w _�. if the. has bttm a lapse of o one d . SIN hat delayed your 7e-Doming this collision: r-o Si mature: Dare <<`� - —T Print Name: y Telephone Number: Home: 175) � Sb`-Z Vrorl.. 175- 4is 131 -7 For office L-se Only Courtesv report Area: Date forivarded: Report prepared by: ID n N[) REFUNDS ONDEPOSITS C]RSPECIAL ORDERS NATIONAL CUSTOMER SERVICE BIG O TIRES OF DUBLIN PHONE#80oou1-2446 7121 DUBLIN BLVD CUSTOMER MUST PRESENT COPY DUBLIN, CA 94568 0FINVOICE FOR ANY WARRANTY 925 829- 1950 ` W[ 0 1-86903 S11/22/2006 Emp: 1 -11 .' 1- 3 Page: 2 * * » WORK ORDER * * * Sold To hip To Other Info. : JOHH � VALERIE KIKES Veh : 04 MBZ SL55AMG 611 EXETER PLACE . Lic: NDAGRID DAHVILLE, CA 94506 Mil : 24, 500/0 Vin: PO#: H 51G'760-8783 BAR: AK169274 C 925-208-5050 EPA: Slsm Mpch part N 0Y Description Parts Labor FET Total ========================================================================================= 11 LEFG-11 \M 0C D���010NTROLW1 M93 8.00 ��C&I ` 2006' - . c ERK BOARD OF SUPERVISORS CONTRA COSI� . � AIR PRESSURE LR RR GRANT BIG 0 TIRES PERMISSION TO OPERATE THE VEHICLE HEREIN DESCRIBED FOR THE PURPOSE OF TESr ING. I UNDERkAND I WILLNOT RECEIVE TORQUE LBS. NSPECTING.INCLUDES REMOVAL OFWHEELS AND DRUMS FOR THE PURPOSE OF INSPECTING I HE BRAKES.SERVICING MY OLD PARTS UN-LESS CH-EC-KED OR DELIVERY ISHELEASE BIG 0 TIHES FROM RESPONSIBILITY FOR LOSS O%DAMAGF 10 VEHICLE OR CONTENTS BEE THEREIN.IN CA E FIRE.THEFT OROT HER CAUSE BEYOND BIG 0 TIRE ROL.I AUTHOHIZE THE HLPAIR AND FRONT SERVICE WORK LIST D ON TH 33 $10.00 PER DAY STORAGE CHARGE FOR ANY VEHICLE LEFT OVER R,2!Tl'l','l.A:�rHIVIE.11 VISUAL El YES.I'LEASE RETURN MY MED INSPECTIONS WILL BE CONF HMED BEFORE SERVICE IS PERFOR OLD PARTS. REAR INW B/W SIG ' 8Y� | �� &�8��&���� �� J0� ' x�o��� nwxx���� ���x��� ��x������� �xxn�o� ��u������x�x ����(REV,.;06) NO REFUNDS ON DEPOSITS OR SPECIAL ORDERS. NATIONAL CUSTOMER SERVICE ('31 0I'l PHONE#800 321-2446 CUSTOMER MUST PRESENT COPY 1;21. Y.Kff.11 1:!'! E.-I y I') 1A.R.?1TH" 5 OF INVOICE FOR ANY WARRANTY :1. 3 1: [7 11A) 0 R 11 ScO'd T) TO 0-ther Infc). . YAl 04 MTQ S!._ i5 (MG LJ vi vi 1-1 1'5,*I.(IJ- 870".3 Df)R;,, WIG927.4 2085 0 5 v) CAL000045296 SIsm Mech Part A QTY De;cription Parts Labor FET Total ................- it Lim 1.03 VI EEL 19Y.8.5 MTTI STELLA War, 475.0 &m. 0.1:x9 475.E9 It RETME 1.63 LUG HIT KC- If-TW,: AFTER 25 HILES 0.90 OM OM GAID ME M_FGR LIETAILS It SICNIT IM CAST INITIALS 9.90 0.C,.3 @Ao 0.M I1 T11 ,46T I.erj 114 245/355RI9 FALI(91 TIRE 299.95 8.03 0.00 299.9.3 UTED130 1.09 TIRE WIT & WIT1 & VALVE STER 9.00 15.013 0.93 ISM 11 LTJTISP 1.03 TIRE TIRE SERVICE P&ICY 0.430 OM IBM 0.Q unuk RE-DAIA"'CING �� ,EE TIRE ROTWIM ?i-,iFREE fliff REPAIR it G"Iff 1.riM D111,11110-0-ITAL.FEE TAX FGR TIREES.ULIFLIZ4 0.130 1.-75 &M 1.75 11 DISIPT 1.60 INTOSAL FE FOR TIRES 0.90 2.50 5.133 2159 11 PSIF IM 0.Oro 0.C2 0.90 0.bNJ 11 PSIR 1XI0 0.09 0.09 0.99 9.63 11 TORTE 1163 0.00 0.0 5.0 9.10 I1. BALER 1.gir ALIMBIT ALIM01T -ORKA11 4 tJ 0.03 104.95 0.0 104.195 11 PR9B 1.93 PRIMM DESCRIBE THE PROM 0.E-3 M0 0.09 9.09 11 DATI 1.03 10 ci.as 9.0 9.G3 11 WE 1.00 FE FO.T LHR MITRUL W 217.28 @.K 0.109 217.28 AIR PRESSURE LE RF LR RR SPA I GRANT BIG 0 TIRES PERMISSION TO OPERATE THE VEHICLE HEREIN DESCRIBED FOR THE PURPOSE OF TESTING. I UNDERSTAND I WILL NOT RECEIVE TORQUE LBS. INSPECTING,INCLUDES REMOVAL OF WHEELS AND DRUMS FOR THE PURPOSE OF INSPECTING THE BRAKES.SERVICING MY OLD PARTS UNLESS CHECKED OR DELIVERY.I RELEASE BIG 0 TIRESFROM RESPONSIBILITY FOR LOSS OR DAMAGE TO VEHICLE OR CONTENTS BE-LOW - THEREIN,IN CASE OF FIRE,THEFT OR OTHER CAUSE BEYOND BIG 0 TIRES CONTROL.I AUTHORIZE THE REPAIR AND 1'2 4 1 FRONT SERVICE WORK LISTED ON THIS INVOICE TO BE PERFORMED FOR THE AMOUNT SHOWN BELOW.THERE WILL BE A $10.00 PER DAY STORAGE CHARGE FOR ANY VEHICLE LEFT OVER 48 HOURS.ESTIMATES DERIVED By VISUAL r-1 YES.PLEASE RETURN MY INSPECTIONS WILL BE CONFI RMED BEFORE SERVICE IS PERFORMED. OLD PARTS REAR ;15,3; ".5 w B/W AMOUNT SIGN I L 3.25 T§RES WHEELS BRAKES SHOCKS STRUTS ALIGNMENT ITEM-34569(REV 3106) t'f� lol 00, ji C>qy. d`f), N y� Ir IV C4 j <I � S 1 �1 s` t 4t. LMC.t )�'v.• lfY.. t . 1 tit ,:S •� � 5 �t jrI r cr D �J GO �� 4 0 Y"^J f"'f f o C.7 .,I 'WO '•' j . ' F CLAIN'�t BOAR � V NT T 1 • U OF SUPERVISORS ISOItS Of CO RA COSTA COUNTY BOARD ACTION:JANUARY 16 , 2007 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, j NOTICE TO CLAINIANT and Board Action. All Section references are to ) The copy of this document mailed to California Government Codes. ) you is your notice of the action taken D n your claim by the Board of Dl� upervisors. (Paragraph IV below), DEC 1 1 2006 given Pursuant to Government Code Section 913 and 915.4. Please note all AMOUNT: $1 , 000,000 .00 COUNTY COUNSEL "Warnings". MARTINEZ CALIF. g CLAIMANT: HARLEEM SWEETS (AKA: STEVEN H. JONES) ATTORNEY: UNKNOWN DATE RECEIVED: DECEMBER 11 , 2006 ADDRESS: 3615 MARTIN LUTHER 'Bti' DELIVERY TO CLERK ON:DECEMBER 11 , 2006 KING, JR. WAY #1 OAKLAND, CA 94609 Bti' MAIL POSTMARKED: DECEMBER 08 , 2006 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CUL.LEN, II Dated: DECEMBER 11 , 2006 By: Deputy 11. FROM: County Counsel TO: Clerk of the Board of S ervisors PPAr4j 0, (,,;)/Chis claim onlplieSlUbstantially with Sections 910 and 910.2. ( ) This Claim. FA1LS 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). ( j Claim is not timely filed. The Clerk should return clai111.011 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). (v) Other: �� t S c;l GL r� l5 �1 t ` vYl F� -Fps' P�IJP�YtS OCLo r r-t wn- On 0y_ CQF-k� —7—Ljr'1C jK, 20OQ41 CAaC-rl5 TAr inc,lcQe�• , oc��r�tdkl r r 21;0 11 cart cam, C C'.t r Dated: /Z By: �'1 �LDeputy 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. ARD ORDER: By unanimous vote of the Supervisors present: ( Chis 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//his date. DatedN2 At-w,- ' 4 N CULLEN, CLERK, By eptity Clerk ow WARNING (Gov. ode section 913) Subject to ceitai n exceptions,you have only six(6) uwnths from the date this notice Nvas peisonalk,ser�-etl or deposittil in the nutil to file a court action on this claim.Sec 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. "hor Additiotwl NVarning Sev Reverse Side of This Notice. AFFIDAVIT OF MAILING 1 declare under penalty of perjury that I am non, and at all times herein mentioned, have been a citizen of the-Uuited 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 (lie claimant as shown above. Date& fi �flI IN C.Uf.,LEN, CLERK 13y _ �puty Clerk OFFICE OF THE COUNTY COUNSEL 5E_. SILVANO B. MARCHESI �- COUNTY OF CONTRA COSTA `s',�-:-_- �==='_,,;' COUNTY COUNSEL Administration Building ,; -=_---`•° 651 Pine Street, 911 Floor f ��—"` —_'.° SHARON L. ANDERSON ` Martinez, California 94553-1229 ;'f _�-= �• CHIEF ASSISTANT GREGORY C. HARVEY (925) 335-1800 0: " e::i";1!!!'! T' "'"1 • VAI-ERIE J. RANCHE (925) 646-1078 (fax) ASSISTANTS �OSrA COUP NOTICE OF UNTIMELINESS AS TO A PORTION OF THE CLAIM TO: Harleem Sweets aka. Steven H. Jones )615 Martin Luther King, Jr. Way, #1 Oakland, CA 94609 RE: CLAIM OF HARLEEM SWEETS aka STEVEN H. JONES Please Take Notice as Follows: In regards to the claim you submitted on December 8, 2006 on behalf of Harlecm Sweets aka Steven H. Jones,portions orthe claim are timely and portions are untimely. The portions of the claim prior to June 8, 2006 that you presented against the County of Contra Costa governed by the Board of Supervisors fail to comply substantially with the requirements of California Government Code Sections 901 and 911.2, because they were not presented within six months after the event or occurrence as provided by law. Because the portions of the claim prior to June 8, 2006 were not presented within the time allowed by law, no action was taken on these portions of your claim. The claim was forwarded to the Board for action only on the timely portions of the claims. The only recourse at this time is to apply without delay to the County ol'Contra Costa governed by the Board of Supervisors for leave to present a late claim as to the claims which are untimely. See Sections 911.4 to 912.2, inclusive, and Section 946.6 of the Government Code. Under sone circumstances, leave to present a late claim will be granted. See Section 911.6 of the Government Code. You may seek the advice of an attorney of your choice in connection with this matter. .If you desire to consult an attonney, you should do so immediately. SILVANO B. MARCHESI. COUNTY COUNSEL Monika .L. Cooper Deputy County Counsel Page 1 CERTIFICATE OF SERVICE BY MAIL (Code Civ. Proc., §§ 1012, 1013a, 2015.5: Evid. Code, tiff 641, 664) I am a resident of the State of California, over the age of eighteen years, and not a party to the within action. My business address is Officc of the County Counsel, 651 Pine Street, 9th Floor, Martinez, CA 94553-1229. On December 14, 2006, I served a true copy of this Notice of Untimeliness as to a Portion of the Claim by placing the document in a sealed envelope with postage thereon fully prepaid, in the United States mail at Martinez, California addressed to Harleem Sweets, alta Steven 11. Jones, 3615 Martin Luther King, Jr. Way, #1, Oakland, CA 94, as set forth above. I am readily familiar with Office of County Counsels practice of collection and processing of correspondence for mailing. Under that practice, it would be deposited with the U.S. Postal Service on that same day with postage thereon fully prepaid in the ordinary course of business. I declare under penalty of perjury under the laws of the State of California and the United States of America that the above is true and correct. Executed on December 14, 2Q06, at Martinez, California. 'athleen O'Connell cc: Clerk of the Board of Supervisors (original) Risk Management Page 2 Harleem Sweets r—pi(aka: Steven 11. Jones) % �0 3615 Martin Luther King Jr, Way #1 Oakland. Ca 94609 f'F 2��6 (510) 472-4271 CLERd BOARD OF 8UPERVIsnRs CONTRA CORTA CO. Dec 7, 2006 Claims Department Contra Costa County Administration Building 651 Pine Street, Rm 106 Martinez, Ca 94553 Rc: Excessive Assault by Deputy Welch, Badge No. 68239, against Harleem Sweet on Aug l 3). 2006 (He broke Harleem's ribs and fractured his skull) Dear Claims Department: This is a l million dollar claim against the Contra Costa County, Sheriffs Department of Contra Costa County, Deputy Welch, and John Doe Deputies involved in this brutal assault against Harleem Sweets on August 13, 2006 while in his Cell 34, Q MDF under the custody ofthe Contra Costa County Sheri 11's Department. The facts that support this claim are as follows: (1) On December 9. 2005, Harlem Sweets while driving on Highway 880 and taking the San Pablo Dam Road exist was hit from behind in his Dodge Van. He called the California Highway Patrol for assistance. Officer Jacquinot of the California Highway Patrol had I larlcem walk a straight line and he didn't pass the test. Harleem was then taken to the hospital to take the blood test. The result revealed that Harleem's blood alcohol was 20. Officer Jacquinot immediately arrested Harleem for driving under the .influence of alcoholic and resisting arrest or obstructing a peace officer in his duties (VC 23152(a) and Penal Code 148(x)(1). (Exhibit A) Ilarleem was taken to the Martinez County Jail Facility in Martinez. He was severely beaten by several deputies while in the jail. (Exhibit B) (2) On Auoust 9, 2006, ilarleem X. Sweet was placed in the Contra Costa County jail for violating certain conditions of the DUI Program. (Exhibit C) (3) On August 1-3. 2006. Harleem X Sweets was housed in Q Cell 32, and pushed the emergency light because he had headaches, high blood pressure. and needed medical attention. Officer Welch responded to Sweets request by informing him that he could not continually interrupt the deputies for medical attention. Harleem was being denied medical care. Instead of Page -1.- Harleem X Sweets Claim (cont) 12/8/06 Providing Harleem with medicine care for his headaches and high blood pressure. Officer Welch decided to handcuffs Sweets and place him in the visiting room to maintain harmony in the Module. in Exhibit D, Officer Welch explains how he went into Harleem cell and instead of assisting him in acquiring medication he told Harleem to put his hands through the food port so that he could handcuff them behind his back. Ilarleem responded by stating`1 Oust want my medication". Officer Welch then decided to go into I-Iarleem cell and ordered him to come out of the cell so that he could handcuff his hands behind his back. Sweets didn't respond to his request but was bent over looking through items on the floor. Officer Welch then grabbed Harleem's right arm and placing it in the flood port. Sweets responded by saying what are you doing and pulled his right arm away. Mr. Welch then claims that Sweet grabbed his right leg and pull it towards his head. Welch"s statement clearly doesn't make sense. Why would an inmate who is already locked in jail want to fight with an Officer. All he wanted was his medication. According to Harleem Officer Welch came into his cell and started hitting him in the ribs, head, shoulder, and legs. After he was assaulted then Officer Alexander came to assist in Putting his hands behind his back. After Officer Welch assaulted Harleem while acting under color of state law he then filed a Incident Report claiming Sweets assaulted him and disobeyed orders. (4) On August 13, 2006. after Officer Welch was finish assaulting i Iarleem Sweets he then turned around and filed an Incident Report charging Sweets with assault on staffand refusing to obey an order. Harleem was given 10 days. Harleem requested for medical attention atter Welch assault on him because his ribs, head, and knees were in pain. He requested to be taken too the hospital and asked for medical care but these deputies refused his request. He denied assaulting this Officer and clearly stated in his response to the charges that the report was a lie. Officer Welch had to write-up an incident report in order to cover-up for his misconduct while acting under"color of state law" by excessively assaulting I Iarleem Sweets. (Exhibit E ) (5) On August 14, 2006, Harleem Sweets requested to see a Public Defender so that he could tell the attorney about the assault upon him by Officer Welch. This is the second time that IIarleem Sweets was beaten up by Deputies of Contra Costa County .fail. The request was denied by the Deputies. (.Exhibit F ) (6) On August 28, 2006, .Harleem Sweets went to Highland Hospital Emergency room after being released from Contra Costa County jail for about a week because his ribs and head was hurting. The Doctor informed Harleem that his ribs were broken. Sweets has been having severe headaches as a result of the fist that pounded his head by Officer Welch. He also went to San Leandro Hospital on Sept 5, 2006. (Exhibit G) Deputy Welch, Deputy Alexander. Contra Costa County Sheriffs Jail, and other John Doe clearly violated Harleem Sweets Civil Rights by acting under"color of state law-" in assaulting Page -2- Harleem Sweets Claim (cont) 12/8/06 Harleem while in jail, denying him medical services, depriving him of Due Process and }equal Protection of the Law at the Disciplinary IIcaring. Harleem was not allowed to call any witnesses from the jail who probably-saw this Deputy assaulting him. This 1 million claim is against Deputy Welch, Contra Costa County, Sherifl,s Department of Contra Costa County. and Deputy John Doe for using Excessive Force against Harleem while acting under color of state law. You have 30 days to respond to my claim. Sincerely. Harleem X Sweets Cc: Sheriff Department of Contra Costa County Page -3- Harleem Sweets (aka: Steven H. Jones) 3615 Martin Luther King Jr, Way #1 Oakland, Ca 94609 (510) 472-4271 Dec 7, 2006 Internal Affairs Department Sheriff of Contra Costa County 651 Pine Street, 7th Floor Martinez, Ca 94553 Re:• Excessive Assault by Deputy Welch, Badge No. 68239, against Harleem Sweet on Aug 13, 2006 (He broke Harleem's ribs and fractured his skull) Dear Internal Affairs Department: This is a Complaint against Officer Welch who brutally assaulted me on August 13, 2006, while housed in Cell 34, Q MDF under the custody of the Contra Costa County Sheriff's Department. I want this officer investigated for his misconduct. The facts that support this claim are as follows: (l) On December 9, 2005, Harlem Sweets while driving on Highway 880 and taking the San Pablo Dam Road exist was hit from behind in his Dodge Van. He called the California Highway Patrol for assistance. Officer Jacquinot of the California Highway Patrol had Harleem walk a straight line and he didn't pass the test. Harleem was then taken to the hospital to take the blood test. The result revealed that Harleem's blood alcohol was 20. Officer Jacquinot immediately arrested Harleem for driving under the influence of alcoholic and resisting arrest or obstructing a peace officer in his duties (VC 23152(a) and Penal Code 148(a)(1). (Exhibit Harleem was taken to the Martinez County Jail Facility in Martinez. He was severely beaten by several deputies while in the jail. (Exhibit B) (2) On August 9, 2006, Harleem X. Sweet was placed in the Contra Costa County jail for violating certain conditions of the DUI Program. (Exhibit C) . (3) On August 13, 2006, Harleem X Sweets was housed in Q Cell 32, and pushed the emergency light because he had headaches, high blood pressure, and needed medical attention. Officer Welch.responded to Sweets request by informing him that he could not continually interrupt the deputies for medical attention. Harleem was being denied medical care. Instead of Page -1- - a Harleem X Sweets Claim (cont) 12/8/06 Providing Harleem with medicine care for his headaches and high blood pressure. Officer Welch decided to handcuffs Sweets and place him in the visiting room to maintain harmony in the Module. In Exhibit D, Officer Welch explains how he went into Harleem cell and instead of assisting him in acquiring medication he told Harleem to put his hands through the food port so = that he could handcuff them behind his back. Harleem responded by stating "I lust want my medication". Officer Welch then decided to go into Harleem cell and ordered hien to come out of the cell so that he could handcuff his hands behind his back. Sweets didn't respond to his request but was bent over looking through items on the floor. Officer Welch then grabbed Harleem's right arm and placing it in the food porn Sweets responded by saying what are you doing and pulled his right arm away. Mr. Welch then claims that Sweet grabbed his right leg and pull it towards his head. Welch's statement clearly doesn't make sense. Why would an inmate who is already locked in jail want to fight with an Officer. All he wanted was his medication. According to Harleem Officer Welch came into his cell and started hitting him in the ribs, head, shoulder, and legs. After he was assaulted then Officer Alexander came to assist in putting his hands behind his back. After Officer Welch assaulted Harleem while acting under color of state law-he then filed a Incident Report claiming Sweets assaulted him and disobeyed orders. (4) On August 13, 2006, after Officer Welch was finish assaulting Harleem Sweets he then turned around and filed an Incident Report charging Sweets with assault on staff and refusing to obey an order. Ilarleem was given 10 days. Harleem requested for medical attention after Welch assault on him because his ribs, head, and knees were in pain. He requested to be taken too the hospital and asked for medical-care but these deputies reftised his request. He denied --assaulting this Officer and clearly stated in his response to the charges that the report was a lie. Officer Welch had to write-up an incident report in order to cover-up for his misconduct while acting under"color of state law" by excessively assaulting Harleem Sweets. (Exhibit E ) (5) On August 14, 2006, Harleem Sweets requested to see a Public Defender so that he could tell the attorney about the assault upon him by Officer Welch. This is the second time that Harleem Sweets was beaten up by Deputies of Contra Costa County Jail. The request was denied by the Deputies. (Exhibit F ) (6) On August 28, 2006, Harleem Sweets went to Highland Hospital Emergency room after being released from Contra Costa County jail for about a week because his ribs and head was hurting. The Doctor informed Harleem that his ribs were broken. Sweets has been having severe headaches as a result of the fist that pounded his head by Officer Welch. He also went to San Leandro Hospital on Sept 5, 2006. (Exhibit Deputy Welch, Deputy Alexander, Contra Costa County Sheriff s Jail, and other John Doe clearly violated Harleem Sweets Civil Rights by acting under"color of state law" in assaulting Page-2- . a Harleem Sweets Claim (cont) 12/8/06 Harleem while in jail, denying him medical services, depriving hien of Due Process and Equal Protection of the Law at the Disciplinary Hearing. Harleem was not allowed to call any witnesses from the jail who probably saw this Deputy assaulting him. This is a complaint against Deputy Welch who excessively assaulted me while in the Contra Costa County, Sheriffs Department Jail that resulted in my ribs being broken, skull cracked, and knees damages. You have 30 days to respond to this complaint and investigate Deputy Welch. Sincerely, I rl em X Sweets Cc: Claims Department of Contra Costa County Page -3- EXHI $ IT A 's -s SUPERIOR. COURT OF CALIFORNIA, COUNTY OF CONTRA COSTA RICHMOND THE PEOPLE OF THE STATE OF CALIFORNIA, NO. 290641-0 DA NO. R 06 001331-8 VS . COMPLAINT - MISDEMEANOR HARLEEM X. SWEETS, 01) CVC 23152 (a) F DEFENDANT. / 02) CVC 23152 (b) 03) PC 69 The undersigned states, on information a.nd belief, that HJkFLEEM X. SWEETS, Defendant, did commit a misdemeanor, a violation of VEHICLE CODE SECTION 23152 (a) (DPIVIYG UNDER THE INFLUENCE OF ALCOHOL OR DRUGS) , committed as follows : On or about December 9, 2005 , in Contra Costa County, the Defendant, HARLEEM X. SWEETS, did unlawfully drive a vehicle while under the i.rifluence of an alcoholic beverage: and, ;;Under the combined ii:-fluence of an alcoholic beverage andior a drug. CH1'�r�GF SPECIAL AL'LEGATION ., DRIVTNQ .TTNTIFP TAT-PT,TTENCE r;lTH BLOOD ALCOH01 OVEn 2 0 It is further alleged, pursuant to Vehicle Code section 23578, that in the commission of the above offense the Defendant had a blood alcohol content of . 20 percent and inore by weight . COUNT TWO: The undersigned further states, on information and belief, that HARLEEM X. SWEETS, Defendant, did commit a misdemeanor, a violation of VEHICLE '-'ODE SECTION 23152 (b) (DRIVINT WHILE HAVING A 0 . 08 OR HIGHER BT.,OOD ALCOHOL) , committed as foll.c-ws : On or about December 9, 2005, in Contra Costa County, the Defendant, HARLEEM SWEETS, did unlawfully, while having a 0 . 08 percent and more, by weight, of alcohol. in his blood, drive a vehicle. � v i 4 PEOPLE V. nARLEEM X. SWEETS NO. 290641-0 PAGE i 2 DA NO. R 06 001331-8- y S CHARGE SPECIAL ALLEGATION DRIVING UNDER INF7UENCE WITH BLOOD ALCOHOL OVER . 200 it is further alleged, pursuant to Vehicle Code section 23578, that in the commission of the above offense the Defendant had a blood alcohol content of . 20 percent and more by weight. COUNT THREE : The undersigned further states, on information and belief, that HARLEEM X. SWEETS, Defendant, dial commit a misdemeanor, a violation of PENAL CODE SECTION 69 .(RESISTING EXECUTIVE OFFICER) , committed as follows : On or about December 9, 2005, in Concra Costa County, the Defendant, HARLEEM X. SWEETS, did willfully and unlawfully attempt by means of threats and violence to deter and preve^t OFFICER S . NICHOLS, who was an executive officer, frim perfrrmin.g a duty imposed the officer by law, and knowingly resisted 'Jy the use o : force and violence and by means of threats of violence the executive officer in the performance of duty- 7 j; i v COMPLAINANT REQUESTS THAT DEFENDANT (S) BE DEALT WITH ACCORDING TO LAW. I DECLARE UNDEP, PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. DATED: March 23, 2006 AT RICHMOND, CALIFORNIA OFFICER S . NICHOLS COMPLAINANT HOLLY HARPHAM jr DEPUTY DISTRICT ATTORNEY CALIFORNIA HIGHWAY PATROL, OAKLAND i EXgIBIT B 4�Aj V Z�lz -74 _ ASP 'r 17 ji���. . � !....._ . . ... ....... . 2 G�LIP o � r i _ Yl/ moi' ��•'� _ � - � 3 V � QJ CNI � 1 $ I .� C EX CONTRA COSTA DETENTION FAC"ILITIES Inmate Personal Property Receipt CIN: 070232491 Book#: 2006016930 Book Dt/Tm: 08-09-2006 1048 Name(L,F,M,S): SWEETS, HARLEEM DOB: 07-07-1953 Age: 53 Race: B Sex: M SSN: 565-86-0837 Intake Monies Storage Locations Fund Type Amount Item# Storage Number Rls/d CASH 1.87 BIN 000011 D1 Property Type Description Status SEALED BAG S Notes Housing The above is an accurate inventory of my property. X X (Inmate Signature/Date) (Witness Signature/Date) Release I have received all of my property. X X (Inmate Signature/Date) (Witness Signature/Date) Facility: 1 Page 1 of 1 Printed: 8/9/2006 10:50:56 102B NBKG Printed By:56458, MARCHESE . EXHIBIT D CONTRA COSTA DETENTION FACILITIES Incident Report Incident Information: Entry Dt/Tm: 08-13-2006 0942 Entered By: 68239 , WELCH Updated By: On 08/13/06 1 was assigned to Q module at the MDF with Deputy Alexander. At approximately 0644 an emergency light for an unknown cell was activated. I got up from the.Deputies Desk and proceeded to find what cell activated the emergency light. Deputy Alexander saw that cell 32 had activated the emergency light. Deputy Alexander told me that cell 32 had activated the light and that I-Sweets was housed in that particular cell. I went to cell 32 and asked I-Sweets what was the emergency. I-Sweets began to complain that medical needed to bring his medication. I explained to I-Sweets he could rJt activate the emergency light every time he wanted his medication. For the last couple of days I-Sweets has continually interrupted the deputies by activating the emergency light requesting his medication dozens of times through out the shift. Because of his actions I decided to place I-Sweets in a visit room to maintain harmony on the module. I opened the food port and asked I-Sweets to turn around and place his hands through the food port. I-Sweets looked at me through the window with a confused look on his face. I told I-Sweets to turn around and place his hands through the food port. [-Sweets began to put his hands through facing the door. I told I-Sweets that he needed to turn around and put his hands through the food port. I-Sweets looked at me and said, "I just want my medication". I-Sweets turned around and walked to the back of the cell and began to rummage through items on the floor. Feeling I-Sweets just did not understand my request to cuff up through the food port and that he was acting passive I decided to open the door. I opened the door and walked in to the cell. I asked I-Sweets to stand up and come out of the cell. I-Sweets remained bent over and continued to look through the items on the floor mumbling. I stepped towards I-Sweets and grabbed his right arm. I began to assist I-Sweets in standing up and escort him to the door. I-Sweets said, "What are you doing", and pulled his arm away. I told I-Sweets we were - . just aping to exit the cell and talk about his actions. I grabbed )-Sweets right arm placing it in a bar arm. I-Sweets violently attempted to pull away from my control hold. I applied pressure to his right arm and 17Sweets began to fall to his knees. I escorted I-Sweets out side of the cell. I-Sweets fell to the floor and began to spin on to his back countering the bar arm. I placed my left hand on I-Sweets right shoulder in an attempt to keep pressure on the bar arm. I did not want to lose control of I-Sweets' right arm fearing he wanted to fight with me. I-Sweets was able to roll on to his back and I lose pain compliance of his right arm. I-Sweets grabbed my right leg and started to pull it towards his head. Fearing I-Sweets was going to try and bite me or twist my foot I released his right arm. I-Sweets grabbed my right leg with both of his hands. I struck I-Sweets in the head three times in the head with closed fist in order for him to loosen his grip on my leg. I-Sweets rolled over on to his stomach tucking both of his arms under his chest. I reached into his left armpit grabbing his left forearm. I-Sweets grabbed my left hand with his right arm. I told I-Sweets to let go of my hand. I-Sweets refused and tried to pry my fingers off his left forearm. I struck I-Sweets twice in the back of the head with my left elbow. [-Sweets loosened his grip and I was able to apply a rock-out on I-Sweets' left arm. Deputy Alexander arrived and controlled [-Sweets' legs. I told [-Sweets to stop resisting and to give me his right arm. I-Sweets continued to resist and refused to remove is right arm from underneath his chest. I was able to place a handcuff on I-Sweets right arm. I told I-Sweets to take his right arm out from underneath his chest. I-Sweets did not respond and kept his right arm under his chest. I struck I-Sweets in the back with a left elbow and I-Sweets removed his right arm and placed it in the small of his back. I finished handcuffing I-Sweets and Deputy Alexander assisted I-Sweets to his feet and I escorted him to intake. Deputy Roberts and Nue assisted me in placing I-Sweets in to cell#3 in intake. I told Sergeant Evans about the incident and requested for a nurse to evaluate I-Sweets for injuries. I-Sweets received a small cut on his left ear. Nurse Ninita attended to I-Sweets and cleared him to stay in the facility. Deputy Robert and Nue unhand cuffed 1-Sweets and exited the cell with out further incident. Facility: 1 . Page 2 of 3 Printed: 08-13-2006 1713 5271 MAIN Printed By: 53953, EVANS ' CONTRA COSTA DETENTION FACILITIES Incident Report Incident#: 6004680 Incident Dt/Tm: 08-13-2006 0936 Incident Type Code: 03A Assault/Staff Additional Code 2 : 006 Disruptive Conduct Additional Code 3 : 046 Refuse to Obey Order Participants: Name (L,F,M,S): CIN/Book# Facility Mod Sect Rm Bed Inv SWEETS, HARLEEM 70232491 /2006016930 1 Q A 34 A M Incident Occurred: Fac: 1 Mod: Q Sect: Location: Cell 34, Q module, MDF Officer:68239, WELCH Submitted Dt/Tm: 08-13-2006 0939 Update By: Update Dt/Tm: Supervisor: Approval Dt/Tm: Use of force? Y CS Violence? N Inmate Violence? Y Contraband? N Facility Damage? N Disciplinary? Y Hearing Required? Y Action Taken: Approval Action: Inmate taken to intake Sergeant infromed Facility: 1 Page 1 of 3 Printed: 08-13-2006 1713 5271 MAIN Printed By:53953, EVANS EXHIBIT E Contra Costa County Detention Facilities DISCIPLINARY HEARING REPORT DETENTION FACILITY INMATE: T ' ' _�` SKG.# I.R.# Last First HEARING DATE & TIME: l ' "INCIDENT DATE & TIME You have been accused of violatling: the following rules) or regulation(s) : r' As a result of this charge, you may be subject to one or more of the following penalties: Loss of good/work time. . privileges or programs, job or housing transfer, extra work detail , segregation, reprimand, criminal prosecution. INMATE RIGHTS IN DISCIPLINE PRO . DURF: 1) To receive 24 hour prior notice of a disciplinary hearing. This may be waived in order to receive an immediate hearing. If not waived, the hearing will be held within 72 hours of the completed report (excluding weekends and holidays). 2) To receive a copy of the incident report within 24 hours of the completed report. 3) To be present during the hearing process. unless security of the Facility is jeopardized. 4) To present witnesses at the hearing, unless security of the Facility is jeopardized. 5) . To represent yourself or have a staff member represent you. 6) To appeal after the disciplinary hearing to the Facility Administrator for review. Such appeal request will be written on the Inmate Request Form and filed within 5 days of the Hearing. WAIV R - Check On n I do not want a Disciplinary.Hearing and do not c;n.test the charge. H ❑ I waive the 24 hour prior notice rule and request an immediate disciplinary hearing. ❑ I do not waive the 24 hour rule. ❑ Other t Inmate Signature: �� 12 �. �,,-12e."f,S Date & Time_g�.3 DISCIP i ARY HEARING: INMATE: o Present ❑ Not Pres e t Inmate Comments: ' 12lrE u Hearing Officer/Committee Investigation:.. �•� ��3 SEP=44FYCf4tiJib n i' .' . C�u F• C/. /I`/v r 44 LJ . -7 D r BA 41r Findings: Inmate committed the act as charged ❑ Inmate did not commit a prohibited act ❑ Inmate committed the following probibited act(s): Sanctions/Punishment imposed: Z A' Hearing Officer: Name Employee Number Committee Member:— Name Employee Number Copy to Inmate by: Approved by Operations Director: Distribution: BAS(Original) Copies to: Facility Administrator,Inmate Bookin.1,Operations Director,Inmate,Classification,Module where inmate is housed nPT nii,ppm ExKI $ IT F 1 w CO o cn m ED . b LLI a> �J � W L p ® : .� v 5 v U U ED o cu E z�. Co � °� o E� y Qco N 3 f/) V 6 w N O _ ,� oC N I r zCL LL Ncr ; .� LIJ a m CDI� w U °C , E a w -� Q c c LL �I N p LLI v zv = p Yo .! I� ti U Ncn Q m a o i EXHIBIT G Alameda Co Medical Center== High.and Campus Emergency Dept Pt Name: Sweets, Harleem 1411 East 31st St., Oakland, CA 9461J2 =_ (510) 437-4559 Pt�Accnt: 1006529166 MR#: 001336799 Pt Name: Sweets, Harleem DI Prntd:8/28/2006 2118 MD ED:Wills C. RN Eval: Dano J. Res/PA/NP: Paolinetti L. AFTERCARE INSTRUCTIONS We are pleased to have been able to provide you with emergency care. Please review these instructions when you return home in order to better understand your diagnosis and the necessary further treatment and precautions related to your condition. Your d;agnoses/prescriptions today are: Dx 1: Rib Fracture, 1 Rib, Closed Dx 2:Wrist Strain (_Unstecified Site Disp Med 1:Vicodin (Hydrocodone&c to irlo � ' Dose/Conc: 5mg1500mg DIP:#4 tablets Freq/Rte: 1-2 tablet by mouth every 4 to 6 hours as needed Rx 1:Vicodin (Hydrocodone&Acetaminophen) Dose/Conc: 5mg/500mg Disp:#15 tablets Freq/Rte: 1-2 tablet by mouth every 4 to 6 hours as needed Rx Print Lctr ACMC Pharmacy Please bring this to the Hospital Outpatient Pharmacy "Drop-Off"window to process your prescription(s), "Por favor lleve este papel ala Farmacia v deielo en la ventanilla "Drop-Off" para que su receta sea procesada." , y General Information on BROKEN RIBS The ribs are long, thin bones that curve around each side of the chest. There are twelve ribs on each side. Any firm blow to the chest can break a rib(s). Most of the time this results from sports injuries, falls or motor vehicle accidents. Medically speaking, the words "broken", "cracked"and "fractured" all mean the same thing. What are the symptoms? Ordinarily there is a sharp pain in the chest, usually in the area of the broken rib(s). The pain is often worse with bending, lifting, deep breathing or any strenuous activity. What can be done? Simple rib fractures usually heal on their own within TWO TO SIX WEEKS. Splinting and other therapies used in the past have proven not to be helpful and are generally hot recommended. What are the risks? Rib fractures usually heal completell,and produce no serious medical problems. There are, however, sorne risks: 1. Because of the pain, many people with broken ribs avoid breathing deeply. Persistent, shallow breathing increases the risk of developing neumonia. = `• . 2. A severe blow to the chest sometimes damages the lungs, heart, liver or spleen. This damage can be serious and is .occasionally even life-threatening, INSTRUCTIONS 1)Acetaminophen (Tylenol) or ibuprofen (Advil)will help ease the pain. WARNING: Do not take these drugs if you are allergic to them. Do not take these drugs if you are already taking a prescription pain medication that contains acetaminophen or ibuprofen. 2) Every two or three hours, while you are awake, take several deep breaths and cough. This will help keep your lungs well expanded. You can challenge yourself to take deep breaths by trying to blow up a balloon, or blow to knock down an empty paper cup. You should continue this routine until the pain is gone (usually two to six weeks). 3) Except for deep breathing, avoid any strenuous activity that makes your pain worse, Pg 5 Alameda Co Medical Center== Highland Campus Emergency Dept Pt Name: Sweets, Harleem 1411 East 31 st St., Oakland, CA 94602 =_ (510)437-4559 Pt Accnt: 1006529166 MR#: 001336799 * dry mouth * i'tching "flushing * pinpoint pupils Where can I keep my medicine? Keep out of the reach of children in a container that small children cannot open. Do not share or give this medicine to anyone else. Avoid accidental swallowing of acetaminophen-hydrocodone by someone (especially children)other than for whom it was prescribed as this may result in severe side effects and possibly death. Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Protect from light. Keep container tightly closed. Throw away any unused medicine after the expiration date. Follow-up 1: Urgent Care (E.M. 9A-7P M-F, 11-4Sa-Su) F/U 1 Ph: (510)437-4340 1411 East 31 St Street 4Th Floor, H Bldg (Station 4) Oakland CA 94602 Follow-up 1 Date:As Needed Other Instr: SPLINT CHEST WITH A PILLOW, DEEP BREATHING AND CLEAR SECRETIONS WITH COUGHING. RETURN FOR FEVER, SHORTNESS OF BREATH OR NEW SYMPTOMS EKGs and X-Rays: If you had an EKG or X-Ray today, it will be formally reviewed by a specialist tomorrow. If there is any change from today's Emergency Department reading, you will be notified. IMPORTANT NOTICE TO ALL PATIENTS: The examination and treatment you have received in our Emergency Department have been rendered on an emergency basis only and will not substitute for definitive and ongoing evaluation and medical care. A follow-up physician has been designated for you. It is essential that you make arrangements for follow-up care with that physician as instructed. Report any new or remaining problems at that time, because it is impossible to recognize and treat all elements of injury or disease in a single Emergency Department visit. Significant changes or worsening in your condition may require more immediate attention. The Emergency Department is always open and available if this becomes necessary. BILLING AND/OR FINANCIAL COUNSELING: For billing inquiries and/or Financial Counseling, our specialists are available Monday-Friday, 8am -430pm in the Admitting Office, window#6. After-hours you may leave a voicemail message at (510)437-4961. Your call will be returned within 48 hours. ALAMEDA COUNTY MEDICAL CENTER ADVICE NURSE TELEPHONE CARE PROGRAM: (510) 437-8341 Alta bates Summit Medical Center A Sutter Health Affifate Request for Diagnostic Imaging Examination MAGING & MAMMOGRAPHY CENTER Required Items Needed for Appointment ►730 Telegraph Ave. • Insurance Card )akland, CA 94609 • This Doctors Order For Exam =ax order to (510) 204-1049 More directions on reverse.) IX-Ray (510) 204-1880 Monday through Friday 9:00 AM -5:00 PM - Please call to register All X-Ray's are done on a walk in Basis.. A pre-registration phone call will usually take about.10 minutes, but will save you from significant delays upon arrival. Patients that have not pre-registered for X-Ray may not be seen after 4 pm. *Ultrasound (510) 204-1880 PLEASE CALL FOR APPOINTMENT- PLEASE CALL TO PRE-REGISTER Pre-Registration is required for all scheduled appointments. Please bring prior films and reports with you to your appointment. *Bone Densitometry (510) 204-1880 Please call_for appointment/pre-registration. 0 Hip/AP L-Spine ❑ Hip/AP L-Spine with Lateral Spine Patient Name: Exam Requested(D K U I Vv o L) i y wr, Clinical History: 1110f- ICD9 Code: - Priority: routine - Typed report within 72 hours Lj STAT - Immediate Fax Report to Fax# Requested by: M.D. ❑ Patient to leave Phone Number: ❑ Patient to return to office ❑ Patient to wait ❑ Patient to take film Note: - Please do not bring children. - Please advise the technologist if you are pregnant. - See other side for pre-exam instructions and maps to our office. 60045(6/03) t.• A � • �_ (lam\( 1 j 2 � �% n i � F �'-�(/ter / C 47 Cxl -., y 1 � � d J M NVp N��,(� inti C"� Cfl a Ul d CO i ca r r Ila �c to vr\ L �� J cs` d � rd o i CLAIN-1 BOARD OF SUPERVISOi1S OF CONTRA COSTA COUN'ry e .. BOARD ACTION: JANUARY 16 , 2007 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section 1t The copy of this document mailed to California Government Codes. !`1 ')1 c° you is our notice of the action taken Y Y DEC 1 2 2006 on your claim by the Board of Supervisors. (Paragraph 1V below), COUNTY COUNSEL given Pursuant to Government Code i IARTIREZ CALIF Section 913 and 915.4. Please note all A�vl0UNI THIS CASE WOULD LIE IN THE "W 11 SUPERIOR COURT, UNLIMITED CLA1[VIANT: JURISDICTION =--MARITZA RENTERIA ATTORNEY '. . DATE RECEIVED: DECEMBER. 12 , 2006 WILi;IAM L..: `BERG; Esq . ADDRESS: 2440 SANTA CLARA AVENUE' DELIVERY TO CLERK ON: DECEMBER 12 , 2006 ALAMEDA, CA 94501 BY i NAIL POSTMARKED: HAND DELIVERED. FRON,1.: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-Voted claim. JOHN CULLEN, eli Dated: _ DECEMBER 127 2006 By: Deputy IL FRON4: County COLInsel TO: Clerk of the Board of Sullervisirs (, This claim complies substantially with Sections 910 and 910.2. ( ) This Clain FAILS to COI1lPIy 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 We claim (Section 911.3). ( ) Other: _ Dated: By: /����-�eputy County Counsel 1.11. 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. BOARD ORDER: By unaninlous vote of the Supervisors present: (� This Claim is rejected in full. ( ) Other: I certify that this is a true and co17-ect copy of the Board's Order entered in its minutes for this date. Datec7sea.Y OH:N CULLEN, CLERK, By Deputy Clerk WARNING ((V,. code section 913) Subject to certain exceptions,you have only six(6) months I'mm the date this notice was peisomally served or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.I'm may seek the advice of an attorney of your choice in connection N ith this matter. If you want to consult an attorney,you should(10 so inunetliately. *For Additimal NVarnhl ;See Reverse Side off-his Notice. AFFIDAVIT OF ti9A1LING 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 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. L)ateii�C�y7�taa+�' / 4 JOHN CULLEN, CLERK ByeA �__Deputy Clerk 12/08/20195 10:59 CONTRA COSTA COUNTY CLERK OF THE 3 915105238851 " NO.850 D01 BQARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLATNIANT i 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 146, County Administration Buildiag, 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. j i 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 clairns, fenal Code Sec. 72 at the end of this form- I RE: Claim 13y: Reserved for Clerk's filing stamp Maritza Renteria ) RECEIVE® Against the County of Contra Costa or ) DEC 1 2 .2006 District) (Fill in the name) ) CLERKBOARD CON AOSUPERVISORS COSTA CO. 7'he undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of S and in support of this clean represents as follows: This case would lie in the Superior Court, Unlimited Jurisdiction. 1. When did the damage or injury occur? (Give exact date and hour) July 3, 2006, about 7:00 — 7:05 PM. l ?. Where did the damage or injury occur,? (Include city and county) Richmond Health Center, 100 28th Street, Richmond, California. 3. How did the damage or injury occur'? (Give full details; use extra paper if required) Ms. Renteria was at the Richmond Health Center for an evening appointment. Janitors were cleaning the building , and had made the floor excessively wet and slippery. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury OT damage? The County's servants/employees caused the floor to p be excessively wet and slippery, and. failed to place warning cones or signs. w 5 What are the names of county or district officers, servants, or employees causing the damage or injury? Not Known. 0 1210812006 10:59 CONTRA COSTA COUNTY CLERK OF THE -� 915105238851 N0.850 D02 6, What damage or injuries do your claim resulted'? (Give hill extent of injuries or damages claimed, Attach two estimates for auto damage.) Fractured left knee cap, bruises and contusions, and emotional distress. 7. How was the amount claimed above computed? (Include. the estimated amount of any prospective injury or damage.) Medical records and bills are still being compiled. This case would lie in the Superior Court, Unlimited Jurisdiction. j I S. Names and addresses of witnesses, doctors, and hospitals: No known witnesses. Claimant treated at the Richmond Health Center and Contra Costa Health Services. 9. Dist the expenditures you made on account of this accident or injury: DATE "CIMr AMOUNT Medical records and bills are still being compiled at this time. 4.-f!' ) Gprovides"The claim shall be ) sior by some person an his )be SEND NOTICES TO: (Attorney)_____) Name and address ofAtformy ) William L. Berg, Esq, ) I (Claimant's Signature) p�h�y C dlihail 2440 Santa Clara Avenue ) Alameda, CA 94501 ) 1415 Visalia Avenue (Address) Richmond, CA 94805 Telephone No, (5 10) 523-3200 )Telephone No. (510) 965-9713 ■r■■■Mrr■■rrr■■■■■r■■■rr■rrr■/■rr■r■•■r■■t■r■■■■■■■■r•■rr■■■■■■■■rr■■r■■■■r■rrr■■rrr� PUBLIC RECORDS NOTICE: Please be advised that thio 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,addend.ums,or supplements attached to the claim form, including medical records,are also subject to public disclosure, ■t■■■rrllr■■rr■r■�..■■■rr■•■r■■■■■rr■■••r■rr■■•r■■■e.■■•■rrrrr■■rrr■r■rrrr■r■rrr■■r■■, NOTICE: Section 72 of The Penal Code provides.- Every rovides.Every person who,with intent:to defraud., presents for allowance or for payment to any skate 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.imprison-ment in the state prison, by a.fine of not exceeding ten thousand dollars ($10,000),or by both.suall imprisonment a.nd fine. CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JANUARY 16 , 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. �(� �� �� 1'f} you is your notice of the action taken on your claim by the Board of DEC 12 2006 Supervisors. (Paragraph 1.V below), given Pursuant to Government Code AMOUNT: $500,00 0. 00 COUNTY COUNSEL Section 913 and 915.4. Please Mote all MARTINEZ CALIF. "Warnings". CLAIMANT: MICHAEL K. HARRISON ATTORNEY: UNKNOWN DATE RECEIVED: DECEMBER 12/06 ADDRESS: 1061 CLEARLAND DRIVE BY DELIVERY TO CLERK ON: DECEMBER 12/06 BAY POINT, CA 94565 BY MAIL POSTMARKED: HAND DELIVERED FRONT: Clerk of the Boai'd of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DECEMBER 12 2006 JOHN CULLEN, C k Dated: By: Deputy 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. ( fhis 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: /2 '� �P By: l���o Deputy County Counsel lll. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) O Clalnl 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. Date 2 wv x /6 e;UHN CULLEN, CLERK, By Deputy Clerk WARNING (Go . code section 913) Subject to ceitain exceptions,you have only six(6) months from the date this notice was personally served or deposited in the nail to file a coint action on this claim.See Government Code Section 945.6.You may seek the advicv ofan attorney of your choice in connection with this matter. ll'you want to consult an attorney,fou shoulc.l do so inuuecliatelw. *For Additiaial Warning See Reverse Side ol'This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am noir, 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 Postel Service iu Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dateci'✓a���' ./1" ".JOHN CULLEN, CLERK BY DeputyClerk OFFICE OF THE COUNTY COUNSELS?�_ SILVANO B. MARCHESI L COUNTY OF CONTRA COSTA _-_=- _ '�.� COUNTY COUNSEL Administration Building % _ - "`-_��`•" :>- - ` 651 Pine Street, 9' Floor � _ -_',4 SHARON L. ANDERSON Martinez, California 94553-1229 �" - " s CHIEF ASSISTANT - _ GREGORY C. HARVEY (925)'335-1800 0. :; '�, , VALERIE J. RANCHE (925)'646-1078 (fax) ASSISTANTS -'G QOSrAr COL31`Z NOTICE OF FICIENCY AND/QR NON-ACCEPTANCE OF CLAIM TO: Michael K. Harrison 1061 Clearland Drive Bay Point, CA 94565 RE: CLAIM OF MICHAEL K. HARRISON 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 91.0.2, or is otherwise insufficient for the reasons checked below: [ ] 1. The claim fails to state the name and post office address of the claimant. [ ] 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 j loss, if known. I [ i] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). if the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. [ :] 6. The claim is not signed by the claimant or by some person on his or her behalf. [ ] 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, S 910.6. Michael K. Harrison Re: Claim of Michael K. Harrison Page Two [X] 8. Other: Please provide the date the car was towed. SILVANO B. MA.RCHESI COUNTY COUNSEL r � By: Monika L. Cooper ✓� Deputy County Counsel CERTIFICATE OF SERVICI: F BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT 4 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.) �`l25 3S� � 9- 7 B. Claims must be filed with the Clerk of the Board of.Supervisors at its office in Room 106,5 1 ,3 U 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. ....................women .......................an.................Nano....... RE: Claim By: Reserved for Clerk's filing stamp l RECEIVED. } DEC 1 2 2006 Against the County of Contra Costa or ) CLERK BOARD OF SUPERVISORS Q �( 6 i]}i^y �� C / CONTRA COSTA CO. District) (Fill in the name) ) } The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ e, o0 0 and in support of this claim represents as follows:. eq 0kn S�ad��e �l - ter � ., �s eP��l D�{r� �l�- t:VkJeeJ l y1. When did the damage or injury occur? (Give exact date and hour) / v lam/ L1e ,1r' 1gnJ. t) f � Gsc' Serr -Lnc �' �, 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full deter ls;us eextra pap r if i q d). G �` C1. r w '?s a w .d_ C ��l L. S e_ s r-� ti a i-, 4. What particul act or omission on the part of county or district of ers, servants, or employees caused the injury or damage? /�/O LAS, .j-) Qin 7Y �- a1,/ �ob� What are the names of county or district officers, servants, or employees causing the damage or injury? / / -e CrJ (ergWill s P �°°S6�1�yo 4s o�. LOI Pi iF.'On S •- ser ,'d.�. 6.. 'V�That damage or injuries. do your claim resulted? (Give full extent of injuries or damages claimed. Attach.two esti.S mates for auto damage.) lzj fe. ' G� 0 0 S p� P �G p o O C " v �r �1� ? . S � �io Q �.r. d � ►� / �D /a)ny 7. H wrs mea mount claime� above col e�7 (Include the estimated amount of prospective inj , or damage.) u r U a��C IL I I �o "y q P1 �✓ C a ,-- 8. Names and address of witnesses,doctors, and hos itals.- D ` �a L-D Y\ S �a Shy baa ' S w ' d 1e J . `. moo re�' <� � -. /7�/ C/<S 9�.S.. ____------ 9. ist the expenditures you made on account of this accident or tnJtiry. DATE �. TIME Nil r✓,r n AMOUNT d O C qS �✓ t n /1� r- vi ��// Oki �r w b !�1 P/ Gn e lel O S 7�4 P ■..■■■...■■.S...O■r..rr......r..rrr...........r....rr......................■ . r.■ ...� \.. Gov. Code Sec.'910.2rovides"The claim shall be P � aS S ) signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney) ) Name and address of Attorney te'l"J, e ) (Clai-nan 's Signature) 0! L ) ) (Address) Telephone No. Sq Gn Telephone No: (� PUBLIC RECORDS NOTICE: Please be advised that this claim form,or any claim filed with.the County under the Tort Claims Act, is subject to _ public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthermore, any attachments, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■■E.EEM..E.■NNO M■■ME MEN 0■■■.ES■■OEN■ ....r...............■....i............■ .■■■Nonni NOTICE: Section 72 of the Penal Code provides: C t A .E �t K f + 1-1 't r C/ ' . VI e Ce0"5 0 r q tecl. . Every person who, with intent to defraud, presents for allowance or for paymerif 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 Count--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. _ 691, r m nay � ►� � ►� � � NOTICE NOTICE NOTICE Date �C' ��—' License Time Make Location �Dl /PCc`' GCT- �016L/ Year The Hol sing Authority of*the County of'Contra Costa will have this vehicle towed away at owner's expense if riot removed from the project within seventy-two ours. �bw e.r`o� 151 O t using Man ger 1 Tenant sh;dl not allow•tneile-rs and non-operating vehie•les or parts thert•ol to remain on project gromnds.Vcb cles shall br parked in parking an•as ooh.F'trking areas and Project grounds sh:dl not be used for repair of vehicles.Tenant shall be responsible for the removal of any vehicle or vehicle parts which appe•:r to I re•abandoned,or which the Authority determines not to 1w in reasonable use.•rhe Authority sh:dl notify Tenant oflhis determination and shall request re-m o%A of the vrhicle and/or parts within it specified period of time,and failing such removal the Tenant shall Ire responsible for the costs of remmal which shall then Ix•charged to the Ten:mt's account Form N51 I1/93 �( ? `� A NOTICE NOTICE NOTICE Date _� " License--` Time /l �% � r� Make/" l/ %t('c:,�l e./ S 'ff� - Location Year The Htrlrsing Authority of the County of Contra Costa will have: this vehicle towed away at owner's expense if not removed from the project within seventy-two hot.lrs. (, , o wring !� nLfgcr (/ Tenant shall not adlnw trailers and non operating vehicles or 1xi is thereof to remain on project grounds.Vehicles shall be parked in parking areas only.l*rrking areas and Project grounds sh;dl not he used for repair of vehicles.Tenant shall be responsible for the removal of any vehicle or vehicle parts which appear to he ab:urcloned,or which the Authoritydetenmities not to Ix•in reasonable use.The Authority shall notify Tenant of this detemrination and shall request removal of the vehicle and/or p;rts within it specified period of time,and failing such remova the Tenant shall be responsible for the costs of remmal which shall then 1w charged to the Tenant's account Form/51 11/93 � .� O � `� .tea N .`d•� o 9 'd'0 OU O O�— C) 'C' O TN cn v d v p t G b p Cy N � G P -U ^ bD.�.� 9 Y 0 O •'C3 v� •� -o �'� �, cn �G O--• � t-.' '-per-�cd G a S >, CIS O G' 3 A �`� � `"' cd aA y, ,.-+ -C� � O '� G y O m o �y � O � � U N O .� G c,,.• G O . C� G ¢ b O Q� iT, o w j H U H CdI'd CIS O� O G O O p ccs r(.',•� .� ✓ _, ,� � cd +-'' .-, +'' OOH ,,• v �`� r V •'t�•� 7,... +�'�, --. "�,+ .� ""' oo ra C.) ?*� .� �y}' � *O cd � �yr`" � Sa � U w .,.. CS cd � ..•, C <. n �} y •`^ cd RS cd H Cd ceS .a•. ,G to .D O DV Cl O G y Q.) �. � 'v p� S� O O j ,,,vno �„� rs O G•� a) N � O G .y 10 a b U CLO O 4 G r OE' �O '> •Q H 'a O y � O a� .� .0 '> , o O G a) G HCZG W .d ri H ..-+ � N bo 4-A V G ¢` Cs o o�._ vn r_ ��.,� a vHp Lf' H ct� i�+ 6> N ..• t4tp.R y Q•' n r. 7' ''D U b C '� ,�,, O ••+`'""' ''�" +a ,n .'� •'"''�.` O y H ro O {l y O O v O yr (i v v b w U It U :6 G ti N 5- O N tYa O p N tn ✓, %, cd z1: G C3 U •f O cd v , d v v d U cGd P c- cd p U.f n o �° u G ^ ' acd y Gd u, O 'd > ?O `n a 1. �- p a• o " N cy ti, O n ev cd pp -d o0CdcdooC7, � a� 3Cs .d GoE"` o v CIScn y Urns O � GbUA U,✓•� "�� H '' � ,,, .� G N,O a,4 ��°•; It cd w n ea -rte• �'I rn CL•U,,, O N In un L13 '�+ -31y n y•.� r > G .'�—' O f1+ ,,_, d -� Cj".+ cn .� c+-d cd G N p G -+ CIS U N G d a1 o o v " bA O cd N // y G s CS . c3 r O S3+ Q1 + IQ L Un, „ UU✓ U >S+ Q O D n } T G b Q G T �+ N G ti• I . o c n n 'o U cd p � d ' C', o rn 'a•-o '� o• G r C T V n u p ;� r•i N U''' .� N V ".. ��c- .� �. O"cd r y > O N N N "LJ LnUJ?d �, L+ p G N i Q ani a H H cd O O n ted u, s O {� G cS a> { �••� Q�{"vy, ,� . ;, a,d O+ r-+ C G .•+ S �•1.... "� v© .G'�n �n >• r H r G T d c! e"' -* R tU tT0 C o o .U +•+ Q .."". y., ap a`�.+'Crd 9 N cl ° 6 U U G Cd cd o Cl a M G �+ O N r a G U G ? ++ C) b y o s �.r v w vn Ck r H O v W ao v > O �D "•9 , O y O no n A O• , --+.d� 'y u n Ycd ° c° u . ll va O`f d ur N n G r CS �' p O ", ✓ ✓ n O t'. o• 'o 'y . v %t} U G .S> vi .• 'ea D•vr..... r �.-- O .D .� 'Sa bA ✓ s° r„ e^sbrA. '..S oo : ) j a O U n ? Ly v V W r^� a t w G ani O Cl 't-, H w O C G d Ca , o o v . N r "C u G .%a ;.^ •v n o •.t� '.rte'' `� 7:1 (� )-+ 7•, F: O "' •,M'.., G *c� '.C�'bp Cl v a v T; = O Os rFJ wQ yU y H N ,G � :n t co � rG � a O cd � G j- ar o c3, o No a n tn UtS � Cs n nJ cn Lj H CS 'p O . " c v o .o �•-.� o � �� o�'a ... .,., H ¢` a) N � � t)G � i �•� '-'G .^�.. �=r � r^ U H G � ti.,.`� � 'C •U n .fl o U cd �✓ n a`G' A,0 S, O �' •✓+�".' •Q c,.-+ . •= Ct v A p, O c� '� G Cd c1 p p rcd TZ * G . d �, cs •. N Vi c ! H y o p a C4 K � Cl CL o , a a 00ci [ p C J7 n. a'p ,4O_, Lam' O C C U V) 00 C O c U ca .o u ...^ C ) v� � � rn vi .rU y .•�" cd .� .0 w � h "'" u y c y ❑ y '� ""' � 1r p ❑ v ;� ° ... C1 GJ O O -O u w u �1= 'C o a� oNo 0 3 .� c o' 0 ° C V .14d o '` ro a L o a °N' R :° IA w `yy cUi > o� cd axi ❑ b Q'C " G D oo v d C o —n. ao'^ ° wo O 04 U C [ >�>..,, C" C G V T1 N ° cl! L p O C ,O C � C O b G y u O ti O aCi o o A o E e o 'a .M a 3 v ro ° '' 0 ° +.:1 C N U y y y C w b w U a x -r- c� o o E > v c o E ° rn.• TJ U :n v'i c3 U cd rn y G, cs y LImo. o z uJr . Cp„ q n `• y = td A� °❑ C4 ° tf=n�•� y co OC) p uu E y u �o U C's ° T > UGU . 'fl L Np 00 :D C13 CJ l � ' a � � 7 u w a > u • u .J " a vi j •G po o © T > 'C O O CrN a) ' 0uu p u f oO OcavL °U p O U > p d 'O o � ... y o. ooh ti . ° 3 vw ° d .� •a• •� d•c1 u C p C U u •u w y 7 u✓ CO tU ° v a O N y C a o..R G v y O p a U c! cJ '� C CL 3 c -o —Ca a —Cl o a ,o t: -0 w n o- c > a Ec,oy�maCC, OGC "Ct777 wGQoCJ FWbO uoCo N EN. UOF cl Od .00 7uC `O ° oC a) � oK� C o o o ° p 0 3° 'a,Oavi, .LtibUeE>� wocv [fKNM C) Ua ' E QJO ti~ nC - U .. > O 0 C's:: O F. w O �Cd y o> Uo o oW a a0 C) , u Z OOC y" C 7o ocCc cn p cp to O � O0 D. y 0U 0 .0 lb U o � aC C cu x E E ' o0 i C 3oow Z E c0- ° PROJECT No. LEASE No.. UNIT SIZE UNIT No. II NOTICE OF INTENT TO VACATE PROJECT NAME r I LOCATION Room I hereby serve notice of my Intent to vacate Apartment No. on the day of 19 I Intend to move to /J STREET NO. CITY B'i ATE Aly reason for ming fY�fl �E^ `4''l 1"r Jf t t cy DATE NOTICE GIVEN SIGNATURE OF TENANT DATE OF FIRST OCCUPANCY DATE VACATED RENT SHALL BE CHARGED TO RENT PAID TO BALANCE IN PROJECT REFUND 0 UNPAID Z Romarks . 3 ,.,Ce � Cr �J/`r C i G 1 s tl •-Sctl S � f ./, �, � r"t �n . � 1, �, c •i � y✓�(Dn f " � � � wl !►�`` > PASUBMITTED BY / a s atid �n�"l I� f�� V�=k� ,..� o o -, J 71 1 / I- � O} C A.N}L�l. Q4 /i1 S d f np �,� %e" Q �/� �1. �V S 5�� ��� 1 <�J crf,'r'� >' i I r / byC carr G U O N 7 r ? :n v �d G �' a m N G +-' G amu. � '� v ✓ j L O G r C .' � Ui ✓ n d y i Cy bp w UGA d L) vli O r 3 �� O CA v N a ` G tS G A a s- pG N 7-, GD L• J r �' L- r 'to :✓ d C m nc + G ca bD d y, 7, y i .r o *'c3 O 7F ° ' �.r C c� _ t- y �' a• y O r CA o G N ✓ O Y G _ y bD .G N d G L w P� N H G Hca 1 'LS 7 �' � w ca d N ycs y ` a d N r d y o o °' '� i ca r y G a G o N ' p O OU T Gk a .� NhA cO G G N N d d N L S, s- �- G °'as by, t d H y °' G d rJ 0 > N o G © tn aii N 'd d V Gatn in w •2S � � .oa 'p �, o o r *'' y � ,rr m •� � � � '4 w N N a u.y' a> � � N d � 7� rG O o ,G W d to o. sw. �zG m w N N ?'d m d `S51o �N ? `t r < ,,y CA rA pp L7 0 da G 'U N w N ,� a r^ N y yo o t' y w N r y d a a G o ,r .J f' O DD .r .Y' •N t" o ti` aS d u, N o N •+> d p,05 .r N � o � � o f N„ N `� 'N �' y �+ ° , -J ��`- tun o F .r G• N N w G U r G `�� T o ? NGy r �.' �m 6 `� y d d o Y E o y o d o p ^G N G y o d d 'G P. 7 N p+ 'd G r' 7+ y tun d r "' to r -d m d O N G .� .� w ' GL �" P � o .r .G 'k o N � O• y o a o p cA w w o d U a U d '3 'W to Gd w �' .'' o o �� 0 oEDo d G N � V 0 r 'd a bo 41 to "" . J +� (� O � /per 116 a r . w ° 3 v G '' 7 y o G i. bD O� w o d G N y ••' .:;4 bDC5 to .x .✓. G N N Oy av% O e� ct N v d mD S+ r t "::5 wrN :d d S7 oc- CA y p 0 v O v '' `A G bG C- G O i O 7 N •3 Q cwa O n U ? Q w N G r �' a '� O O p d u y t3 ,? .r a y y d c r^ y d N Ny GO d O y L� - .i a v 7''rr, eco a;, 6i `"' .G J d. 3 ?+ 4 J yO ' �^ d, O, d , =a N a O �' 9 d p, o C G o N o N w GGl �, d w L� 3 w `' o '' d a c� >,� d �. 05 y y N m Q, 3 d t5 7,cc) Gd ?. y v U •r a c o bD' o �r ° G a a o a !�. 0 0 0 co N d tn t.f) i "� G• $ ° �d s. '3 CD d % bD w , d r- C9 y N ya r r y C4 S'= d d , O o N n ✓ dy t' w N d y 7� CA u7 a ° o o, T o �'� o Ntt- r' d G o m o G 3a y .4 d 'os y w d G d N ,� d H N v 7 E'' v s. o G G _ 0 7 cai Ga `'' " o e,.,, .�i .o-� .""` O '� G a•' V U �' o °= T•. y �D o o m a a N y ° ' = y % a wu, nD ° `� t+ G E- d m y G * m N G S.. . , N tn bp T S� �_d ¢. d N d G d a 7 c- o f. O N ' d N `� , s `: o y N d > G a G CO e� bD w a r � N G O N d N r U r y i � d U m a d '' d r3 G p a c W wn G' v o � �^�A inc0 N ' bp o3 y ° d Q G 4 ? 9 d ad °' G m "b Q d ° w °v `� ca o ° o d ., d T ° .°� G p, toj w GU 0 NbD O o bGA� v� N v o o G w7 m m G ¢. o o w CA fd 0 CA per, ¢ o ,• Clth dd O• tn d ,^ s• m p ?� o 3 v a) G bD y N , N o $ N d d d d c� F+ o t� w p ° s. N ✓_ y d i C {"e t'n �d wA L. .�i O N ,�i d d i ? .� d f• UwDo 0 Go 00tD .•� •un y � � d tJ' � 7. 3' G � CA H P. dCA dw C y rN to d Ga os. CIA N W v a H JA a� .G �� u o O � � � � a3 � ,�, •� •� U � d •� d SCS rqj y � d � "� 3 � G � � :� •� s: � '� ° �' '��+•+ +3 ° ~, P, y a > m o r. . o a °> d t ¢.• m ° o + ai P+v d m k d C N S1. o U 03 Ko v ° H f 3 o tos v. ° o d '� ¢, +' 'G m 03 c, �,, O O. o CO aoi c ° i P. U s: v a> o 'd O aJ d ° aw C m .� ca c c o ., A s. a s z3 w x.+ t .� y s. •� G •` b0 b0 at+a ° y p c7 s~ ;> sp+ +a C a +�' m N d c>w Q R 0 O w C > A c, `� H m cs a " `� a, 3 o mn '' o v°, o z3 0 3 > 3 o O mC4sa. o a `n.. ° y s`A. q ¢ w GUG (W$ o4 `a)w Cq a) as p b0 w 0.0+ 3 a''xcoOS m G. �' ° " �. O. ed • m ?c.> 03 w 90 ° 4+ c +' s b0 ca A c >' ° " 'o o b m t3 '� m w >> �. ° d v o c c+ ° > .� w o w ca N o C3 ""'r, G� w S •� d '^ ,�. +�' �" +� ai +, 4�i m0 d +� ° of Ss C, > { y O a03 bA d �: � �3 .� � � � � °; � A w00m o sem. 00 °e ce an d f^ t L" ,, 1 >, cA bD w b0 vy � d tn. a> L'1 bib) O >a yy O A ? .w > > m n 'in U v w i L� yr v N r. m yis t a1 0 01 U ^Q a s " 03 W 4, o > ori .� � aJ � 4°. r y p c w EE� � E" � 0 3 a > G. dS +� 4. ps 'O .0 bD' S ai w P. y o y � q^ E' R. • � 5: s~ ^ m -* k y W ► a> O � '�' y S~ o -� ys�•.G+ r. y U i], C C1• ° d a� 03 ai Srtcdo 03 el m so " p �. �• � ro ro o � ,� � o c� � m � d p G $0 r � CD m *3 m ro �'. y m o ° ro y t5 wy ¢ ' v,�dw UQ U` p O m r3 ro p to O O ap r, t7 cYo �+ "0 � o b 9 V. r, m o ccoo G ro G O ?" m �n m �+ s✓ W m y �° ~ G1 L3 y �+ c� r-A C}n m `C m y y a m m m m y m m mc r ?C O^ gD R5 '.1 o C O "t*•► ty d mr* O ° m � %t 'fid o wto -1y 00y9 G y C93 :1 =1 pn o ►l - O{o O !9 P�O c* p PD Cr a p m r+ CL OG m o ' cp o m p o Sy p �s m co y w m Oy O '+ p� p d, ro m m °r,► u o S' p CD ° C -f y a z o m p m p t3 ►3 CD 9 b � ° y r3 ty Otii G O � omG y 'O m eGf p M eb �,1 yy�• Rp" -] � � y O co o .,s c�' � �• p � i� � m Ln Cf O tS00O m Sb+ in rri r* ✓ CD p p r+ r• 'L3 r+ "� a A �, r+a m m O' m m CO tp cC �'• CT' 4'i`� O ems•* r*, m @o `D. •e `�. sn ��" ' c° `R `etngo a oz's Amy n d o L4 , `" `G3.. <+ :i• °t m m coo ° « o ami t+ m o y Sy o a ro Cq y ro a' e R �• m ° o y o r- o .*. m ro n e+ '� 'C.. ;�• `" ,.. ¢'' cv m O !D rn S'3. *+gym @ �• ro «� ; '� 'y ¢' cq a m .� m coo ro 7: m aQ s m `7' rn n o m �d ro o C' m m S�. Fr o CD �' C ro ro sn ro 'D nz m c� �' : cb y m 00 h p •� Q ro y o✓ � - O C1. a m O � iro a m 03 my C 4 a c ro n C� tom m `G m e- �- m O f " cn ° C ro m e- m b `e y -o m = tz y C —4 = o ..• eDa. sn Q.uQ a n o y °� 9 on > > � ro * �' !L N ? � (p O m ro O CD r m L~ S� m C� ? rG A ro Gq ti OCV m 1 cos �' a o ro r o t3 G o y rna y � z o a' °� a a CD :n O q p O i-. CS v O O C tv ro ro y y y et MICHAEL K HARRISON Statement Period: September 5 through September 15, 2006 Accodrit (dumber: 01418-46128 1 -Ra..Ytf1a.�ItY.Y�ie'/f .�� ❑ Checks Paid Continued - Date Paid .NumberAmount 1��I Date Paid Number Amount Total of 2 Checks Paid $2,400.00 ❑ Account Activity Date Posted Description Reference Nunter Amount i Withdrawals, Transfers and Account Fees 09/12 CA Tlr cash withdrawal from Chk 6128 Banking Cti Manteca #0000143 CA Confirmation# 8077436082 $600.00 09/14 CA Tlr cash withdrawal from Chk 6128 Banking Ctr Pittsburg Branch #0000140 CA ConfinY-taticn# 8263690328 i 200.00 Total Withdrawals, Transfers and Account Fees I $80).00 ❑ FACTS - FDIC Insured Account Disclosure Information Your 2006 Privacy Policy for Consumers is now available at www.baiikofamerica.com/privacy. Please read the policy caret ally for important updates. If you have other accounts with Bank of America you may receive more than one 2006 Privacy Poli:y notification. rb ankofAmerica ®® SS D Your Bank of America « n MyAccess checking 1) — �r- � . q j-0 E 41 P P Statement I C .G/ lti �� � ' � / T' � ✓ Statement Period: 5 �� September 16 through October 17, 2006 Account Number: 01418-46128 MICHAEL K HARRISONAt Your Service 1061 CLEARLAND DR e,:;, Call: 925.682.4644 BAY POINT CA 94565-3268 — / Written Inquiries Bank of America Concord Main Office -� PO Box 37176 San Francisco, CA 94137-0001 / Customer since 2006 Bank of America appreciates your business and we enjoy serving you. Our free Online Banking service allows you to check balances, track account activity, pay bills and more. With Online Banking you can also view up to 18 months of this statement online and even turn off delivery of your paper statement. Enroll at www.bankofamerica.com. ❑ Summary of Your MyAccess checking Account Beginning Balance on 09/16/06 $11,195.00 Number of ATM withdrawals and transfers 53 Total Deposits + 798.50 Number of purchase transactions 25 Total Checks, Withdrawals, Number of 24 Hour Customer Service Calls Transfers, Account Fees - 6,839.58 Self-Service 0 BankofAmerica s® T-1 - He, ` e Your Bank of America p !� MyAccess checking — ,70141 P P Statement _ EO-3 Statement Period: 8 September 5 through September 15, 2006 ti Account Number: 01418-46128 Il J9Irl1ri.lriI111 11411 11111 MICHAEL K HARRISON At -.au,.- Service 1061 CLEARLAND DR Call: 925.682.4644 BAY POINT CA 94x565-3268 Written Inquiries Bank of America Concord Main Office PO Box 37176 San Francisco, CA 94137-0001 J � - � Customer since 2006 Bank of America appreciates your _ % win e..-.Joy _—ervirlg you. Our free Online Banking service allows you to check balances, track account activity, pay bills and more. With Online Banking you can also view up to 18 months of this statement online and even turn off delivery of your paper statement. Enroll at www.bankofamerica.com. ❑ Surnmary of Your MyAccess checking Account Beginning Balance on 09/05/06 $0.00 Number of ATM withdrawals and transfers 0 Total Deposits + 14,395.00 Number of purchase transactions 0 'Total Checks, Withdrawals, I Number of 24 Hour Customer Service Calls ITransfers, Account Fees - 3,200.00 1 Self-Service 0 Assisted 0 Ending Balance $11,195.00 WA ❑ Bank of America News Not everyone's life travels the same path. That's why we're bringing YOU more choicer. Fy rffering both High Yield and Risk Free CDs, we're helping you invest your money wisely - no matter what your life may look like. Visit us at you.- nearest banking center today or call 1.800.242.2632 and see why opening a CD with us is such a smart move. Ready to Buy a Home? You can save up to $2000 at closing with Bank of America's Mortgage Rewards. Call 1-800-900-9000 today or visit your neighborhood banking center. Credit subject to approval, normal standards apply. Certain restrictions apply. Offer subject to change without notice. Bank of America is an Equal Flour;-;-t Lender. a Branch/ATN] Deposits Number Date Posted Amount 1 09/05 $14,395.00 ❑ Checks Paid Date Paid Number Amount Date Paid Number Amount 09/08 98 $ 400.00 09/11 99 2,000.00 Continued on next page 0062333.001.T13.1 California Page i of 3 Scudder Funeral Care, Inc. DBA Colonial Chapel 2626 High Street Oakland, CA 94619 (510) 536-5454 Fax (510) 536-1912 Tax IIs# 68-0575754 ASSIGNMENT OF BENEFITS The lrndersigned, in consideration for the services rendered by Colonial Chapel. In with tt.e funeral serMary Harrison provided for _ .hereby assigns and transfers to Colonial Chapel any interest the undersigned has as a bane c!arr� or owner of policy number _ issued by CUNA Mutual Insurance Co. Amount not to exceed 4, 6 31 •8S Said amount being the balance owed to Colonial C:hape:� Director for :he funeral services set forth above. `lichael Harrison s �O / ( fes / L12 v Beneficiary Name (Please print) Beneficiary social security number Fdene.ticiary signatur� Beneficiary date of birth 12 06 _ Sao Date signed Address �e.eo- --- hone dumber' it State Zi code p y, P v J � STATEWIDE SELF STORAGE II I 1901 Verne Roberts Cir u t Antioch CA 94509 �. 5 (925)754-5452 Customer: Rental Contract Receipt r � b Michael K Harrison Date: 8/3/2006 12:50 � rt� Contract#: 79C8 1061 Clearland Dr. v Bay Point, CA 94565 Effective: 8/3/2006 Salesperson: PA Address Service Requested Unit(s): 632 $170.00 Monthly Rent Charges: Payment: Pro-rata Rent: $170.00 Check payment $0.00 Advance Rent: $0.00 #Advance Periods: 0 Gross Rent: $170.00 Credit card payment $0.00 Less: Discount: $0.00 Net Rent: $170.00 Insurance: $0,00 Cash payment $170.00 Other charges: $0.00 Total Amount Paid: $170.00 Deposit: $0.00 Total Charges: $170.001 Next payment: $170.00 Due on: 9/3/2006 Thank you for storing your belongings with.us. We take pride in keeping our facility clean and safe. If you ever have a question, please drop in and see us or call us at 925-754-5452. G. /-Than you, 1 The management at Statewide Self Storage Page 1 . CSF Receipt In-Town Reservation 6-HAUL EQUIPMENT CONTRACT g25 439 3545 Contract Number: 00020121 (71008 CENTER PITTSBURG PITTSBURG CA.94565 SS AVE (925)439-3545) Thursday 8/312006 2:55 PM (714082) Customer Ph No(6): Customer Name: 925-458-4614 MICHAEL HARISON Rental Date/Time: 8/6/2006 3:30 PM Estimated Return Date/Time: 8/7/2006 3:30 PM _. ----� V `Safeh4ove/SafeTovvlCDW Rental Rental . 4 Estimated Estimated> Actual„; EQuipment ` Mi MI Rate ML. Rate Charge. :Tax: harges' '• C C Out Charge'.' $19.95 $19.95 $4.90 $54:45'. 14'TRUCK 0 $0.79 X $39.50 $0.00 __-_._._._____.r --• _...__r_._...____.�_.._._...__._..- __.._... —._,._-.__..______ Estimated Subtotal: $54.45 Estimated Tax: $4�g0. Estimated Total Charges: $6435 Reservation Deposit Paid:. $.0.00 $0 00 Previous Payment: Net Paid Today: $0.00 ur move,subject to scheduling,the exact pickup locations and time. •This reservation confirms that equipment will be made available for yo •Your rate is subject to change if you change your pickup date. To cancel this reservation,call 9254393545 prior to.your pickup day.There will be a$50 cancellation fee if notice of cancellation is not received prior to the pickup day.You authorize this fee to be charged to your credit card. X X U-Haul Signature-(Roy Miller) Customer Signature-(MICHAEL HARISON) CUSTOMER TO BRING PHONE BILL AND PG&E BILLS WITH DEPOSITE. - +r + •- ....Space: a � : , �s -r �tQTAL:Due Month(Y:: .:� ? Keep these documents'in&and-place:` i 5•� e; .'ri:�' ,—.,.�.., _ .{... -a.:.{.,':_,....i,;i''«-.:. .+i,=•:i-.F.#'q"?>-:•'ev .,{.,�; =: `:r.+=-'.- —•C.y ri-r.n_ .� ...-•- d Rental Truck Reservation Receipt 66363 -PITTSBURG/LOVERIDGE o 0. 0 w 2100 LOVERIDGE RD. PITTSBURG CA 94565 RESERVATION DATE: 7/5/2006 09:30 AM PICKUP DATE: 7/5/2006 09:30 AM RETURN DATE: 7/5/2006 03:00 P`VI MICHAEL HAMSON VEHICLE HEIGHT: 12 Feet FMPLOYEE NAME: Gerald Bushman Local Rental Truck Reservation #716295 Account #8853802 Reservation Details Reservation Total Week Day Rate 0 days @$39.95/day $0.00 Week Day Slot Rate I slots @$24.95/slot $24.95 Week End Day Rate 0 days @$39.95/day $0.00 Week End Day Slot Rate 0 slots @$29.95/slot $0.00 Miles Charge 30 miles @,$0.89/mile $26.70 Free Miles 0 miles @. $0.89.%mile ($0.00) Handtrucks 0 units�`%$15.00/trip $0.00 Furniture Pads 0 units(a)$1.25/trip $0.00 LDW I LDW days @$18.00/day $ 18.00 Tax 8.25% $4.26 Total $73.91 r I - f --RENTAL AGREEMENT-- THIS RENTAL AGREEMENT is executed in duplicate this 06/30/2vv �md between, Public Storage,Inc., as Owner or agent for Owner,2350 MONUMENT BLVD.,CONCORD,CA 94520, ("Owner"), Tax ID#95-3551 121, and MICHAEL HARRISON ("Occupant")whose address and alternate contact address are as follows: Occupant Address Alternate Name and Address 1061 CLEARi..AND DR iv1ARY HARRISON BAY POINT, CA 94565 849 19TH ST (925)458-4614 OAKLAND, CA 94607 1D Number:N5738216 Phone: (510)834-8620 Enclosed/Parking Space No. B231 (approximately 10.0 x 15.0 ) Account No. 88.53727 NO. 125550868 - 20404CA Occupant advises Owner that Occupant intends to allow the following individuals to have access to the Premises: FEES AND CHARGES: $207.00 Monthly Rent(Due on or before 1st of Month) S25.00 Lien Sale Fee $22.00 New Account Administration Fee(Non-Refundable) $25.00 Lien Handling Charge after Thirty(30)Days(Whether or not Sale Occurs) $31.05 Late Charge after l Oth of the Month S0.00 Lien Sale Fcc INITIALS TIER By placing his INITIALS IIERE)7/1 7Z/.Occupant acknowledges that the above information is correct,that all payments are due before the close oi'business on the day indicated to be applied to the oldest delinquency first,including late charges and other fees which have become due,that he understands and agrees to pay the FEES AND CHARGES as noted above and that Owner reserves the right to require that rent,fees and charges be paid in cash,certified check or money order. it is agreed by and between Owner and Occupant: 1.PURPOSE AND DESCRIPTION OF PREMISES.The parties have entered into this Rental Agreement for the purpose of leasing or renting certain space as herein described and with the express understanding and agreement that no bailment or deposit of goods for safekeeping is intended or created hereunder.Owner leases to Occupant and Occupant leases from Owner the above-noted space(hereinafter the"Premises")located at the above-referenced address of Owner and included in a larger- facility at such address containing similar leased real property and conunon areas for the use of Occupant and other occupants(the entire facility is hereinafter referred to as the"Property").Occ rtt examined the Premises and the Property,including the dimensions and condition of the Premises and Property,and,by placing his INITIALS HERE acknowledges an'•agrees that the P remises and the comr:ron areas of the Property are satisfactory for all purposes for which Occupant shall use tl" th Premises or the common areas of the Property.Occupant shall have access to the Premises and the common areas of the Property only during such hours and days as are posted at the Property. 2.TERM AND RENT.The term of this Rental Agreement shall commence as of the date written above(the"Commencement Dale")and shall continue from the first day of the month immediately following on a month-to-month occupancy until terminated.Occupant shall pay Owner as a monthly rent,without deduction,prior notice,demand of- billing rbilling statement,the sum noted above(plus any applicable lax imposed by any taxing authority)in advance on the first day of each month.Rent shall be subject to the late charge noted above if not received by the close of business on the l Oth day of the month.if the term of this Rental Agreement shall commence other than on the first day of the month,Occupant shall pay a full month's rent for the first month and shall owe a pro rata portion of the second month's rent.Occupant understands and agrees that under no circumstances will Occupant be entitled to a refund of the first month's rent paid upon execution of the Rental Agreement,and,thereafter,if this Rental Agreement terminates other than on the last day of the month,Occupant shall not be entitled to a refund of a pro rata portion of the rent for the month in which the termination occurred, but,if termination occurs before the fifteenth(15th)day of the month,Occupant may pay only the rent(and any applicable tax)that accrues frorn the first(I st)day of the month until the date of termination.Rent,fees and/or charges as stated in the Rental Agreement,the monthly due date for rent,and/or timing of fees or charges.and any other tern of the Rental Agreement,may be adjusted by Owner by written notice to Occupant given not less than thirty(30)days prior to the effective date of the adjuSUnent.Any such adjustment shall not otherwise affect the terms of this Rental Agreement. 3.USE OF PREMISES AND PROPERTY AND COMPLIANCE WiTH LAW.Occupant shall store only personal property that belongs to Occupant.Because the value of the personal property may be difficult or impossible to ascertain,Occupant agrees that under no circumstances will the aggregate value of all personal property stored in the Premises exceed,or be deemed to exceed,$.5,000 and may be worth substantially less than$5,000.-.7ccupant shall not permit any Hazardous Materials(as defined below)to be stored in the Premises or the Property or store any improperly packaged food or perishable goods,flammable materials,explosives or other inherently dangerous material,in the Premises or the Property.Occupant shall not store any personal property on the Premises which would result in the violation of any law or regulation of any governmental authority,including without limitation,all laws and regulations relating to Hazardous Materials,waste disposal and other environmental matters,and Occupant shall comply with all laws,rules,regulations and ordinances of any and all governmental authorities concerning the Premises and its use.For purposes of this Rental Agreement,"Hazardous Materials"shall include but not be limited to any hazardous or toxic chemical,gas,liquid,substance,material or waste that is or becomes regulated under any applicable local,state or federal law or regulation.Occupant shall not use the Premises in any manner that will constitute waste,nuisance or unreasonable annoyance to other occupants in the Property nor perform any welding in the Property.Occupant acknowledges and agrees that the Premises and the Property are not suitable for the storage of heirlooms or precious,invaluable or irreplaceable property such as(but not limited lo)books,records,writings,works of art,objects fur which no immediate resale market exists,objects which are claimed to have special or emotional value to Occupant and records or receipts relating to the stored goods.(:)ccupant agrees that the value of any such items shall not exceed for any purpose the salvage value of the raw materials of which the item is constituted.Occupant acknowledges that the Premises may be used for storage only,and that use of the Premises for the conduct of a business or for human or animal habitation is specifically prohibited.1 pon termination of this Rental Agreement,Occupant shall remove all Occupant's personal property from the Premises unless such property is subject to Owner's lion rights as referenced in paragraph 6 and shall immediately deliver possession of the Premises to Owner in the�p e condition as delivered to Occupant on the Commencement Date of this Rental Agreement,reasonable wear and tear excepted.By placing his INITIALS HERE IYI • ,Occupant acknowledges that he has read and understands the provisions of this paragraph and agrees to comply with its requirements. CA-04,103 Rental Agreement Page l of INff1ALS HEREi, N moi, nl,. i)CCITAN'r 0 4-4 ' M Cd 60q 6N9 W tn U O i O O is.�:a.���.. ����:::.•:Cl��'� �'i��'�.,.r'.:�':.:�: O Gn it V-1 O v c... s.. .:.:. o V p Z 69 i 69 i cu � C:) .. .: : :: :. o b c 5nlu 22 2 � cr 71 CL ' kr) _O o W z oo - . cn U V O '� Ct C'. N � d � o zo Owen _ O o cl o 0 �s Cko m � o Lu � . p :•: . v� o tea,. tea. � H :3 ❑ O'� c _ o I I 4i..: to v1 V\) p O W 5 ^'it:'lSP_.-:n.%.�,�rc- Y i i.�:J�:'y l:�i r:,4't.:. 'L'5:.: rJi ..,'.+:1" !'_�':r,. - - T•�.'�`�~K'. ';=..r�,� f,F:y:G+• ,'.... .} `:JoY;�`f 'le T.iY^a`�. ,},i:::.:. . �. z �4< -r'ti - 'L Q• ,,.I.� .,Y: ,7 I_1 -: 5". �;: �.. 1:.1;L�..tr4';::i':: € a%�:4�: ,./: 9 r1,1:':,,,,,,,•:��.),l i. i �h;'-'� --- �u�iY Vit:'.:' �f $ ;.\'F:Li:S�'• y aM'.: ,.,I•'..:i:+•'-�i�'3•�., ��7;;,yC!;]r..Ji",:r:R - ':;;,.:t;sL'ac„':•:•. `:Xti',t'y.!:••.iZ�l�i �f. - '�il:":. ,LxF TL y,:.'!]:.:.':;�,'� �:. __ vh�l..,tit'!' " :�`•" ���..'^w_..<n� A+.�'.i.'Y.� �� :'k. •'.:.. :v'+'i'ri:J�S' 3�-'?II` .� n,>^ ••r.,. �r�a•'/'•eT';i�;::.=q<�.•"'�: __ � .�_... �1 _ ��'� '~t.•s`C� .•�w..• F` J �]' •l°OM1� .,.. f: � ;;>g., ;$:.- ;tis,•§,a �q - - +i: ;;:p3'i..y'�.!i'k.^ ..F•.']'�, :,1y;:,',,•�-'g_�yY,:r• - Irl..r. .O''J b,�'::�5 7ii:'f',:'?n,>,� •.1, (t" �L:'y .t,� ,':1_=;:ti�R� Cl:i,,2]�4'• 1 ,.'� .,,'�L4.1..!J:iil�.h.':&"ice'•:,. ��-:A`:z:s".,'- r•yti>+`,7L.:.��:z, ::8.':i::;:. �L�t.-'i7z-•11t:. ter` #.?;:ia-•�zc:'.:!',;.::<-_ ' .�:.. =-awe:,: _r.1'.:: :5,3:-,,sY.•i:t,: -.:?••!Ys.:� at": ,;its :x"±.>-.�i,..y;.,;+,;:.w: •• ;;(c;a':::u';;'.' - +.:2' <.::M:C::.L.'�:+ .:>� 1 .L`•*,v <Y:rf:q �S ... �h'j,�. '7:�''�r,:. „c-•... 7:�..::' :fi wY' r^!' ..�.f4,.� - ?;•n e. Se,- ;.4 ff ,J :Gr2.,.' y�,••.!•�':. ,•r 1,. ::..�aL,:c:� r,. ..::•v+. .�'s' ..G:�:r %'�"e8:,:.• - ....'. ..W._'.y,},.. ...-_u, nk':. r:Y.r.�S• +,.f�'-ir r!^. '...�• .c vr:�'i.!'v.lf. , ;.C' :�::' ;irr' 1 1;;.i :d. rjc=;i h ...:.r.,..--,•-.,=.N...,ti..r:•:i!�::�i a AA ,.k •l''',1:._,::. ,.�P ]„�}h:.'.f:. •�..}.. ..iyT..i.:`_'Wy::� ~ti;F�,2``".f..`�ti��:^,:�K�,:��" v..7!a'�.^ T''r;:f`x`.54 ..c lc 11 t :y r`; �f4r'i'Y':-t' Lt 'd:f,•';i"':'C��.r:-'�.rr::!!:,:. { ,,.1.':. -:y:;:'.�r'i-�j.,t;, ' at4ra'�;"n;,uc-rj�(i: i e b .t le�%-r.' Y �•F ..y"d'. .,... ;0.- dJl � :t.'•lei�..,� Y`y N.t:._.,).:,V�' P." ia7Y�F'�K.p �'.�L _ ,lst.f•` - X„7!r .vr..:-,.•<s + :::• : r 1°" E. _'� q LY_ 0� : �., :.r,:�. ,• e y' -» .,:; Fiv': 3 w.:k -7 :;,.. �:.r:...r.';a.. �'f•'-rl�, -I.. i'+: -•'.P.F ,r::- ,'lr':`J=r :.. ;. 9 .r rp h•. fir.:c....:,,.r;.. :::'•'�<� - {{5�...,.,. .,,+., :, ,,...:..; ...�:;, 0,:4. '.£1F'�<, '••N�., i'fit.,. ..,:?!.*':: ,X �.e,:�:.:,;.._„ _. ��.�'i %,�.�:�:,�'�Y+' '�:;'i-•'qv w.:l1.._::._:....J�^..�y:.::�r":52%':a a� .1f,•T'4 i',4. _ ��i/.,�a'•i�� {y} s::;t£ti7i 'v_. .L�'wjk:.�:�i^'�:4.Y,.i,1`^"�•1�]"=>•"� ,rip:: rb':'::�: -::�9i�' ;ta:�?C;:a +_'.�`_..':"Zyi.:SM�:.':,:'�'-, ",'r'S'r• .,r.t.�'k• w•-+:h::� f ,:.S.c A 13 II ,i• " C } '1 ++x�• '^S,Ly } , ...Yt�.:' :..f ,.m td�si A..:w i+. •a'J1 A= ! Vit!3 ?°tet.-. ...; a z';R`;: .(�:• �,s.. .�i�i�,: �:;1't•!-:�•z..'':. .:f:',1J'-:'%;�.;r'i-' �: ^.;::`rig•I:,:.Le..';.:;- .,�d•�;,i - ':rhe•''2i.�,:`4 ca�' �..i, .s�.a "..��•', i., '..h..�p/: ,' ::5 :('J %I'„iC"<2::,• `•:kti i,^:u,:p:.F .e: L;:: i:" �ryl:t.4�:.;,.:ti"'... -::f V�: ::{:�,-f:':I: !t,'�..;:. a..:�s;•:!.. ::iS�:::: ai:F.rr��;, ': �.t. .1.�..< ..US's 4'„..t:�r'r'-':,::3. 't•p. <i,. ' briLL,G4;��,e - ,°.6T.e�s'::A2:.._F r..^:-f.'��:�.�.f.�c '•r����'.rr_ :'NL.. 8c+:.. I�G'narn.:.t., i.'4y:+:rg.-,y� �, �y.n.. 7.'•�ii',.t'i:.: .. :sF•�',". -_;"aX '•'�.! i`'a., `'.+D!t-a•:,.._ :, .-,,_^. w:+.� t;.r 1':'.:Lv,:;.,:.,.,. ; _•J., .:t•+. ".Z42''a:roit'„ s,""�`�3a:';i't's--,. :c`G'`-. :!n7•']'`•, -.:F;�S .8^:� :tf' _<[... L. ,{., .e�:K.-.4• "7" `:x.'�...3. r n`'`om, ,: ti; .r�4: :$',`�ei�'':':iu`F:r1'=;•:.." ,..,N. .. ,�.:'" r' n-..:: +cu.• �r'S,..:'�`'r.:; a�4:r•}.. Y.: .i^ - �':'f%% er,(:.1✓N.. _�;:>:.:.t. •:{:: :.1G.CF�s.�y:'"ct:.; '•�_is, p4`;.i'a ::xv.r�y,?%'%S'�•". ::�.tr;�'r ".I,:. .-k•�;F+.'- '.3•*�`]-. .=,t::n...,��'. -,'�y }:3;.r,.,...tri.'.t......-'ii,.•:,..:�':r,,.;:r:1.7bae:.�..':..,5..,.aLUa'R:.ca�.'';eiu:.�=�a';_.�':.,'�a_:l::_W' �`.:ti?��:a'i".6��'.a•fes`��•. .r i J. r�_ S FEE1 F01 I FU9 P GFEE1 PCVS 59209407 9 VFEEP 0 040406 1553 VDA R *** G E N 'E R A T E D F E E S *** 01 CURR RF 31 . 00 16 1PY AIR OLT 4 . 00 31 2PY RF PEN 45 . 00 02 CURR CHP 9 . 00 17 2PY RF 31 . 00 32 2PY VLF PEN 5 . 00 03 CURR VLF 4 . 00 18 2PY CHP 9 . 00 33 TRANSFER PEN 04 CURR SAFE 1 . 00 19 2PY VLF 6 . 00 34 05 CURR FID 1 . 00 20 2PY SAFE 1 . 00 35 06 CUR AUTO/DUI 1 . 00 21 2PY FID 1 . 00 36 07 CURR ABN VEH 1 . 00 22 2PY AUTO/DUI 1..00 37 08 CURR AIR OLT 6 . 00 23 2PY ABN VEH 1 . 00 38 09 1PY RF 31 . 00 24 2PY AIR OLT 4 . 00 39 10 1PY CHP 9 . 00 25 TRANSFER 15 . 00 40 11 1PY VLF 5 . 00 26 DUP O/C 16 . 00 41 12 1PY SAFE 1 . 00 27 .CURR REG PEN 15 . 00 42 13 1PY FID 1 . 00 28 CURR VLF PEN 1 . 00 43 14 1PY AUTO/DUI 1 . 00 29 1PY RF PEN 44 15 1PY ABN VEH 1 . 00 30 1PY VLF PEN TOTAL FEES DUE : 258 . 00 FEE #- $AMT- REASON- PASSWORD- CURR EXP DATE: 03/18/04 FR- R30- VESSEL TAX BYPASS- NEW EXP DATE : 03/18/07 VIN- 1MEBM50U4HA637930 ENTER WAIVER-PF1 NO RENEWAL-PF2 KEY FEES-PF3 FALLBACK RESTART CANCEL FEE1 F01 B LF4 S GFEE1 PCVS 50435035 31 VFEEP 0 121605 1616 VDAP R *** G E N E R A T E D F E E S *** 01 CURR RF 31. 00 16 1PY AIR QLT 4 . 00 31 02 CURR CHP 9 . 00 17 TRANSFER 15 . 00 32 03 CURR VLF 5 . 00 18 DUP O/C 16 . 00 33 04 CURR SAFE 1. 00 19 CURR REG PEN 34 05 CURR FID 1. 00 20 CURR VLF PEN 35 06 CUR AUTO/DUI 1.00 21 1PY RF PEN 45 . 00 36 07 CURR ABN VEH 1. 00 22 1PY VLF PEN 5 . 00 37 08 CURR AIR QLT 4 . 00 23 TRANSFER PEN 38 09 1PY RF 31. 00 24 39 10 1PY CHP 9 . 00 25 40 11 1PY VLF 6 . 00 26 41 12 1PY SAFE 1 . 00 27 42 13 1PY FID 1 . 00 28 43 14 1PY AUTO/DUI 1. 00 29 44 15 1PY ABN VEH 1. 00 30 TOTAL FEES DUE: 188 . 00 FEE ##- $AMT- REASON- PASSWORD- CURR EXP DATE: 03/18/04 FR- R30- VESSEL TAX BYPASS- NEW EXP DATE: 03/18/06 VIN- 1MEBM50U4HA637930 ENTER WAIVER-PF1 NO RENEWAL-PF2 KEY FEES-PF3 FALLBACK RESTART CANCEL V i �- �� 1Ll � i RETURN THE ATTACHED DOCUMENTS AND REQUESTED ITEMS TO ANY DMV TO OBTAIN A TITLE/OR REGISTRATION CARD. PENALTIES ARE COLLECTED ON RENEWAL FEES PAID AFTER THE EXPIRATION DATE. PLANNED NON OPERATION (PNO) STATUS MUST BE REQUESTED WITHIN 90 DAYS AFTER THE EXPIRATION DATE OR ALL FEES AND PENALTIES ARE DUE. CALL 1-800-777-0133 FOR AN APPOINTMENT OR MAIL DOCUMENTS TO: PO BOX 932345 SACRAMENTO, CA 94232. SMOG INSPECTION/CERTIFICATION REQUIRED AT A TEST ONLY CENTER. * * * BILL OF SALE FROM JANICE BROWN TO (� MICHAEL HARRISON 504 121605 35 0032 F01 11 f �• 2EEU950 930 ,'�' �f'•f REPORT OF DEPOSIT .. ..t7, ...._ ... .....t. ..:�..,r^t. .b...r ..1::... .:::.. ..k •i';.Z,,. :.u.„:,}y,. ...f;"- :q�: :-�.;':y" .:�.'•:�. :ry'” (^n, .q::F4a.:».. :?•:r'.^ :;'=':' r 1.� I• PORT OF DEPOSIT OF FEES **THIS IS NOT AN.' OPERATING PERMIT** REG" BX: 00/0.0/00 MAKE YR MODEL YR 1ST SOLD VLF CLASS *YR' TYPE VEH TYPE LIC LICENSE NUMBER` .::. MERC 1987 1987 AT 1997 120' 11 2EEU950 BODY TYPE.MODEL MP MO VEHICLE/VESSEL ID NUMBER 4D G • LZ 1MEBM50U4HP;637930 TYPE VEHICLE/VESSEL USE DATE ISSUED. CC/ALCO DT FEE,RECVD PIC t AUTOMOBILE 12/16/05 0..7. 12/16/05 0 RDF 'REASONS: .1 A HARRISON MICHAEL KENT " AMOUNT PAID` R 1061 CLEARLAND. DR $ 188. 00 / AMOUNT..DUE AMOUNT.RECVD 0 '� $' ;..188 :.00 CASH BAY ,POINT CHCK CA 94565 CRDT 188 ..00 rte' L I PR EXP DATE: 03/18/2004 O o f: r-()4. 35 00.18800 0032 CS 121605 2EEU950 .930 Ix CLAIM BOARD OI, SUPERVISORS OF CONTRA COSTA COUNTY • BOARD ACTION:JANUARY 16 , 2007 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements,. ) NOTICE TO CLAIMANT and Board Action. All Section refer s� _ The copy of this document mailed to California Government Codes. �i� Bj you is your notice of the action taken on our claim b the Board of DEC 1 �..�� Y Y 3 2006 Supervisors. (Paragraph IV below), COUNTY COUNSEL given Pursuant to Government Code AMOUNT: $1 , 190. 17 MARTINEZ CALIF Section 913 and 915.4. Please note all "Warnings". CLAIMANT: WAYNE A. SCHMID ATTORNEY: UNKNOWN - DATE RECEIVED: DEC. 13 , 2006 ADDRESS: 1200 WILLOW LAKE ROAD BY DELIVERY -1.0 CLERK ONDEC. 13 , 2006 DISCOVERY BAY, CA 94514 BY MAIL POST'NIARKED: HAND DELIVERED FRONL Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, Ik Dated: DECEMBER 13 , 2006 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 clainn (Section 911.3). Other: Dated: ��- �"- By: Deputy County Counsel Ill. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) O Claim was returned as untimely with notice to claimant (Section 911.3). IV. B ARD ORDER: By unaninnous vote of the Supervisors present: ( This Claim is rejected in full. O Other: I cetrtify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dater r_7 r G/JPU.N CULLEN, CLERK, By eputy Clerk WARNING; (G cod section 913) Subject to certain exceptions,you have only six(6) months from the date this notice was personially ser-ved or deposited in the imil to Tile a comt action on this cLaim.See Government Code Section 945.6.You may seek the advice of an attorney of dour choice in connection with this matter. if you want to consult an attorney,you should do so iIll uediately. k For Additional NVarning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare mlder penalty ol' perjure that I am noir, and at all tunes herein mentioned, have been a citizen of the United States, over age 18; and that today i deposited in the United States Postal Service inn Nlartillez, California, postage fully prepaid a certilied copy of this Board Order and Notice to Claimant. addressed to the claimant as shown above. ?? �VJOI1N CULLEN, CLL:RK By eputy Clerk $OARD OF SUPERVISORS OF CON,CRA COSTA CO=Y �ISTRUCTIONS O CLAMANT +M�.T��V��..w.r-r+•::-.... i...T'.OIVi.�1�•.. .��..<Aay-_1�•a 6.rA•..r iAl!n:•h:^.:. :... - A claim relating to a cause of action for death or for injury to person or to person2 property growing crops shall be presented not later than six months after the accrual of the cause If action. A claim relating to any other cause of action shallbe.presented not latex than.one y 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 I County Administration Building; '51 Piny Street,Martinez, CA. 945 53. if claim is against a district gov,=td, by the Board of Supervisors, rather than the County, e -name of the District should be filled in. If the claim is a aios't more than one public endtp, separate claims must be filed agziart Ih public entity. : ?, Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. PNNEEPKNNRNREEXORtR... ...RnumadealwrNunn aelaw �91 tE: Claim By; Reserved for Clerk's filing stamp ) RECEIVED Against the County of Contra Costa or ) DEC 13 2006 CLERK ASSESSMENT APPEALS SOARO District) CONTRA COSTA CO. (Fill is the name) ) The undersigned claimEnt hereby makes claim against the Comfy of Contra Costa or the above^m eed district in the sum of s Z/26/2 and in support of ties claim represents as.follows: �' Men di4 tl;e1L=Qe or injury occur? (give exact date and hour) F?r 6-0 11n 2. Where did the damage or injury occ ? (Inclucity d coynty) Inol 3. How did th/e damage or inl ' occUT? (Givederails;use extra aper if tequire'd� 4. What particular act or omission on the part of comty or district officars, servants, or emp yees caused the injury or damage? %�crs-tc� 5 What are the names of county or strict officers,servants,or employees causing the damage or injurY? ���7^a /l71ti/I%a�lcG�. I — l d ebb 'ON 90H w i ;. What damage or injuries do your claim resulted? (Give full extent of injuries or lama Fs -claime, Attach-two estimates/for rut damage.) - G'`i/ogle /lo� ivGiPc�.�1 dc�iNcz��� 1. How was the amount claimed above computed? (inc/lude the estimated amount of y prospectiive iri ury or damage;) co 3 b d/c v� �vN«�S Cv`t•r�,�lc ��4/�c�_ eels PA%j- �a js%mess r•->10, Ge, S. N es and adresses of wi esses,doctors, hospitals: tee SLi�;� Kt 9. List the expenditures you made on account of tS is accident or injury: DATE TME ,�MOUI',rP a■sacssaitalaiamass Raa■aaaaM[tataEggs[[aaeaa■suffix aatts■[s[aaNestle Bass aawas smatte ■al .Gov.Code Sec. 910.2 provides"The claim shall be signed by the claimant or by some person on bis )behalf." SEND NOTICES TO: (Attdrmevl 1 Name and address of Attorney ) (Claimant's Signaturtr) `/l G�z ' �U GGc _a. J /3� Telephone No. ) Telephone No, ■•■aaasranew er[■saraasataaINaaaaaKate@sassaaaaaamaIRaasrrsssaaaaassastssaaasaaaaasaaI PUBLIC RECORDS NOTICE: ,-`Please be advised dwt this claim form,or any claim filed with tb: County under Elie Tort Claims Act',is su ect to public disclosure under the California Public Records Act (Gov. Cod4, SS 6500 et seq.) Purthcs:uo , ray atmchments,addendums, or supplements attached to the claim form, including medical records, are also su ,ect to public disclosure. area[■s�assaasaasa[aasssaarsaa[aa[taaalataa[[[baa[aa■tarlatanspaatatata/ataaa[a sate$ NOTICE: Section 72 of the Penni Code provides: Every person who, with intent to defraud, presents for allowance or for payment to any state board or o cer, or to any county, city, or district board or officer, authorized to allow or pay the same if genuine, my a or fraudulent claim,bill, account voucher, or writing, is punishable either by i aprisoament in tiro. County j for B period of not more tbaa one year, by a fine of not exceeding one thousand dollars ($1,000.00), or by b th such imprisonment and fine, or by imprisonment in the stag prison: by a fine of not exceeding t.-,u thousEm dollars (S 10,000),or by both such imprisonment and fine. _. Z d E�� '04 1N3W39b�1bW 1IS�� �U� NH :s 9UUZ L 'J3'� r MERCEDES BENZ OF WALNUT CREEK STQ-C Service quote Name: WAYNE A SCHMID Quote Date: 17:35 07DEC2006 Address: 1200 WILLOW LAKE ROAD Make: MERCEDES DISCOVERY BAY, CA 94514 Model: E500 Year: 06 Contact Phone: Odometer: 3681 Home Phone: (925) 516-8279 VEHID: 6A879470 Customer. ##: 26879470 Service Advisor: SCHMID,WAYNE A (688) Line OpCode Operation Description Price -------------------------------------------------------------------------------- A 40 CUSTOMER STATES HE RAN OVER A POT HOLE ON 1190.17 MORGAN TERITRY ROAD AND SINCE THEN. THERE IS A VIBRATION, CHECK AND FOUND BOTH RIGHT SIDE WHEELS ARE BENT COST TO REPLACE THEM IS . $996 .00 FOR THE WHEELS $72 .00 FREIGHT OUT OF L.A. AND $40.00 LABOR TO MOUNT AND BALANCE TAX $82 .17 TOTAL $1190.17. Est: Misc 1190. 17 Labor: 0. 00 Parts: 0. 00 Misc: 1190. 17 Lube: 0.00 Sublet: 0. 00 Subtotal: 1190.17 Tax: 0.00 Total: 1190.17 Customer Copy Page 1 CLAiM BOARD OI SIJPH:ItVISOIZS Of CON 1'ItA COSTA COUNTY ti • BOARD ACTION: JANUARY 16 , 2007 Claim Against the COL.mty, or District Governed by ) the Board of Supervisors, Routin - 4rNOTICE 7'O CLAIMANT Board Action. All Section re �� a� The copy of this document mailed to California Government Codes. you is your notice of the action taken DEC 1 3 2006 on your claim by the Board of COUNTY COUNSEL Supervisors. (Paragraph IV below), MARTINEZ CALIF. given Pursuant to Government Code AMOUNT: $5 , 300. 00 TO $6 ,060. 00 Section 913 and 915.4. Please note all "Warnings". CLAINIANT:RICHARD ANDERSON ATTORNEYUNKNOWN DATE RECEIVED: DECEMBER 13 , 2006 ADDRESS: 1502 CHELSEA AVENUE BY DELIVERY TO CLERK ON: DECEMBER 13, 2006 HERCULES , CA 94547 RECEIVED FROM BY MAIL POSTMARKED: RISK MANAGEMENT FROM.: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DECEMBER 13 , 2006 JOHN CULLEN, C rk Dated: By: Deputy 11. FROM: County Counsel TO: Clerk of the Board of Su ervisors ( his claim complies substantially with Sections 91.0 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 tiled late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: _ Dated: G-0 By:,: l�/Z c ,_-Deputy County Counsel III. FRONT Clerk of the Board TO: County Counsel (1) County Administrator (2) O Claim was returned as untimely with notice to claimant (Section 91 1.3). I V. 90ARD 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--V4 CA-610-1-IN CULLEN, CLERK, By Deputy Clerk WARNING (Go code section 913) Subject to certain eaceptims,you have only sit(6) months 11-om the date this notice was peisonaliq served or depositLil in the imil to.lile a court actin on this cLaim.See Government Code Sectim 945.6.You may seek the advice of an attorniey of your choice in connection ividi this matter. if you want to consult an attorney,}ou should do so inunc-diatehy. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OI- MAILING 1 declare under penalty of perjury that 1 amnow, 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 certilied copy ol' this Board Order and Notice to Claimant, addressed to the claimant as shown above. j�"J(: HN CULLEN. CLERK By �- CpLlty Clerk .A30A-RD 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 in.ore than one public entity, separate claims must be filed against each. public entity. . E. Fraud. See penalty for fiaudulent claims,Penal Code Sec. 72 at the end of this form. ■r r r r r r r l r r t r�r r� an r MR ■r r r ORR M R a r O r r r r 0 t e u N I r 1 9 9 6 G R r a C s a e f 1 r t r r X r an r E X R E S K s r s 1 RE: Claim By: Reserved for Clerk's filing stamp SHARON HYMES-OFFORD ^( ' )\ DEC 1 1 2006 �L Jli�-�V/� 1 .c. �n�n,� Against the County of Contra Costa or ) DEC I 'S 2006 BOARD OF SUP o fJ P-- l'fdi 6ct) CLERKCONTRA COSTA CO.ISORS (Fill in the e) Y . The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ 5:300`°6000 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) . Ce 2. Where di the damage or injury occur? (Include city and county) C ry ~ Co 0N" 3. How did the damage or injury occur? (Give full details;use extra paper if required) '-f� --ircuc k <54111y) 4. What particular act or omission on the part of county or district officers, servants, or employees J caused the injury or damage? C 7 J 5 What are the names of county or district officers,servants, or employees causing the W� damage or injury? i a 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 injuty 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 TWE AMOUNT salNauman son tins ssa[sexams arWs■r/[/ssal■s//[■a■■asa/sa■■ssaa■■asmagnums aaaus a■mammon aI ) .Gov. Code Sec. 910.2 provides"The claim shall be ) signed by the claimant or by.some person on his behalf." SEND NOTICES TO: (Attorney) Name and address of Attorney ) (Claimant's Signature) (Address) ) Telephone-No. )Telephone No. �.� 7q-3/Z a.a/as/e/s/afasssafaasss..ria/sassss/s■assassaKong RUN as■[aa Ron aa[a[a[aRon asun Bonn Raw[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, any attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. songs ssas[aissssEwen owns Igo Evil own ia[[a/a■■SENSE[!//a/////[aaa■oat■a[[a[an aSan■a[aa/SRI NOTICE: Section i2 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. -11/29/2006 at 12 : 27 PM Job Number: 29679 ` AUTOTRENDS License # :AK236344 JUST FIX IT 2840 BROADWAY WWW.AUTOTRENDSBODYSHOP. COM OAKLAND, CA 94611 (510) 251-9510 Fax: (510) 251-9819 PRELIMINARY ESTIMATE Written By: Adjuster: Insured: ANDERSON RICHARD Claim #61847 Owner: ANDERSON RICHARD Policy # Address: Deductible: Date of Loss: Day: Type of Loss: Liability Evening: Point of Impact: 6 . Rear Inspect AUTOTRENDS Other: (510) 251-9510 Location: 2840 BROADWAY WWW.AUTOTRENDSBODYSHOP.COM OAKLAND, CA 94611 Insurance CONTRA COUNTY COUNTY Business: (925) 335-1440 Company: Days to Repair 2003 NISS 350Z 6-3 . 5L-FI 2D CPE BLACK Int : VIN: JN1AZ34D93T116974 Lic: 5CIP900 CA Prod Date: Odometer: 73001 Air Conditioning Rear Defogger Tilt Wheel Intermittent Wipers Climate Control Keyless Entry Rear Window Wiper Theft Deterrent/Alarm Dual Mirrors Roof Console Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks Power Mirrors AM Radio FM Radio Stereo Search/Seek CD Player Anti-Lock Brakes (4) Driver Air Bag Passenger Air Bag 4 Wheel Disc Brakes Cloth Seats Bucket Seats Recline/Lounge Seats 6 Speed Transmission Aluminum/Alloy Wheels ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1. REAR BUMPER 2 O/H rear bumper 2 . 0 3 Repl Bumper cover 1 328 . 87 Incl . 3 . 0 4 Add for Clear Coat 1 . 2 5 Repl Bumper cover clip 1 4 . 77 Incl . 6 Repl Bumper cover grommet 1 10 . 10 Incl . 7 Repl Bumper cover retainer nut 1 1 . 28 Incl . 8 Repl RT Sice..-bracket 1 31 . 62 Incl . 9 Repl LT Side bracket 1 31 . 62 Incl . <: 10 Repl Energy absorber 1 46 . 38 Incl . 11/29/2006 at 12 : 2.7 PM Job Number : 2.9679 PRELIMINARY ESTIMATE 2003 NISS 3502 6-3 . 5L-FI 2D CPE BLACK Int : ----- -------------------------------------------------------------------------- NO . OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT --------------------------------------------------------------------------------- 11 Repl Reinf beam 1 283 . 05 Incl . 12 REAR LAMPS 13 Repl RT Combo lamp assy 1 156 . 70 Incl . 14 R&I LT Combo lamp assy Incl . 15 Repl RT License lamp 1 32 . 32 Incl . 16 Repl LT License lamp 1 32 . 32 Incl . 17 Repl RT Side marker lamp 1 74 . 30 Incl . 18 Repl LT -Side marker lamp 1 . 74 ..30 Incl . 19 LIFT GATE 20 Repl Lift gate w/o spoiler 1 538 . 67 4 . 2 2 . 1 21 Add for Clear Coat 0 . 8 22 REAR BODY & FLOOR 23 Repl Rear body panel 1 303 . 78 6 . 5 1 . 5 24 Overlap Major Adj . Panel -0 . 4 25 Add for Clear Coat 0 . 2 26 Add for .Inside 0 . 8 27 QUARTER PANEL 28* Rpr RT Quarter pnl assy 6 . 0 2 . 2 29 Overlap Major Adj . Panel -0 . 4 30 Add for Clear Coat 0 . 4 31. DOOR 32 R&I RT R&I trim panel 0 . 5 33 R&I RT Handle, outside 0 . 4 34 R&I RT Mirror assy w/o heat 0 . 4 35 Blnd RT Outer panel 1 . 1 36 R&I LT R&I door assy 1 . 2 37# SETUP MEASURE 1 2 . 0 F 3841 HAZARDOUS WASTE 1 5 . 00 N 394 PUI-,L TO SQUARE 1 4 . 0 F ------------------------------------=------------------------------------------ Subtotals =_> 1955 . 08 27 . 2 12 . 5 Line 39 REAR FRAME DAMAGE CONSISIT OF SAG AND SIDE SWAY. RT QTR PANEL BUCKLED AND RT DOOR DROPS . FRONT COVER ALSO MISALIGNED Parts 1955 . 08 Body Labor 21 . 2 hrs @ $ 75 . 00/hr 1590 . 00 Paint Labor 12 . 5 hrs @ $ 75 . 00/hr 937 .50 Frame Labor 6 . 0 hrs @ $ 75 . 00/hr 450 . 00 Paint Supplies 12 . 5 hrs @ $ 32 . 00/hr 400 . 00 Body Supplies 16 . 7 hrs @ $ 3 . 00/hr 50 . 10 ---------------------------------------------------- SUBTOTAL $ 5382 . 68 Sales Tax $ 2405 . 18 @ 8 . 7500% 210 . 45 ---------------------------------------------------- GRAND TOTAL $ 5593 . 13 ADJUSTMENTS : Deductible 0 . 00 2 11./29/2006 at 12 : 27 PM Job Number: 29679 PRELIMINARY ESTIMATE- 2003 HISS 3502 6-3 . 5L-FI 2D CPE BLACK Int : ---------------------------------=------------------ CUSTOMER PAY $ 0 . 00 INSURANCE PAY $ 5593 . 13 ** Special Parts Notice : All crash parts on this estimate are new-OEM {Original Equipment Manufacturer} unless otherwise specified. Parts described as Rechromed, Recored, or Remanufactured are either Reconditioned or Rebuilt . Parts that are described as Qual Repl Part, andQRP CAPA, are Non-OEM crash parts . 'PHIS DAMAGE REPORT IS BASED ON OUR INSPECTION AND DOES NOT COVER ANY ADDITIONAL, PAR'T'S OR LABOR WHICH MAY BE REQUIRED AFTER THE WORK IS OPENED UP. OCCASIONALLY AFTER THE WORK HAS STARTED,WORN OR DAMAGED PARTS ARE DISCOVERED WHICH ARE NOT EVIDENT ON FIRST INSPECTION. PROCUREMENT AND DELIVERY CHARGE MAY BE ADDED FOR SPECIAL, SERVICE ON ITEMS NOT AVAILABLE LOCALLY. WARRANTY AU'I'O'PRENDS WARRANTS ALL WORKMANSHIP, INCLUDING PAINTING, FOR ONE YEAR FROM THE DATE OF COMPLETION. DATE COMPLETED_ NO VEHICLES RELEASED WITHOUT PAYMENT IN FULL, STORAGE CHARGES WILL APPLY AFTER �8 HOURS . FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM: ANY PERSON W140 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 L1-ST 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 ASSOCIATTON D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT !'R:CCE MULTTPLIED BY THE QUANTITY TNCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFIC ATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION NO=IJNE NUMBER QTY=QUANTI'.l'Y QUAL RELY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS I�EC`OND=RECONDI:'T'I:ON REF'N=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 J!_=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 PAR'I'S PROGRAM. 3 11/29/2006 at 12 : 27 ' PM Job Number : 29679 PRELIMINARY ESTIMATE 2003 NISS 3502 6-3 . 5L-FI 2D CPE BLACK Int : Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide ARF3714 Database Date 11/2006, CCC Data Date 11/2006, and the parts selected are OI:M-parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at OI:/Veh:i.cle 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 A1.:'.1' 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 Pe placement Parts. Used parts are described as LKQ, Qual Recy Parts, RCY, or USED. Reconditioned parts are describQd as Recon. Recored parts are described as Recore. NAGS Part Numbers and E3enchma.rk f)rices 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 (4) 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 E?stimator 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. 4 d i Q G7 �. O :;. - !. � a a w �:,_ � u1 N a �r . M' w � ;; p. •,� +:`, a' o -xr u,. �. a ti BOYD ' S BODY SHOP 1245 POWELL STREET EMERYVILLE, CA 94608 OFFICE: '510) 654-0425 FAX: (510) 654-9750 CD LOC NO 1583-1 DATE 11/29/06 SHOW: B()Y.D',- BODY SHOP I.NSP DATE; 11/25/06 ADDRESS: 1245 POWELL STREET CONTACT : BOB GHAZIANI CORNER BEAUDRY AND POWELL PHONE 1 : (510) 654-0425 CITY STATE: EMERYVILLE, CA FAX: (510) 654-9750 ZIP: 94608-2603 OWNER: ANDEROSN, RICHARD HOME PHONE: (510) 799-328'' ADDRESS: 1502 CHELSEA AVE CITY STATE: HERCULES, CA ZIP: 94547 CLAIM#: 61A47 POINT OF IMPACT: 0 DAYS TO REPAIR: 4 LIC#: 5C1P900 STATE: CA VIN: JN1AZ34D93Tll6974 BODY COLOR: BLACK MILEAGE: 73, 001 CONDITION: GOOD ACCTNG CTL#: DRIVEABLE: YES VEH. INSP#: ` *=.USER-ENTERED VALUE E=REPLACE OEM NG=REPLACE NAGS EC=REPLACE ECONOMY UE=REPLACE OE SURPLUS UC=RECONDITIONED PRT UM=RF,MAN/REBUI.LT PRT. F11=RF,PT ACF, .SAT,V.AGE EP=REPLAC.F _PXN OE=REPLACE PXN OE SRP.LS PC=PXN RECONDITIONED PM=PXN REMAN/REBUILT TE=PARTL REPL PRICE ET=PARTL REPL LABOR I.T=PARTIAL REPAIR I=REPAIR L=REFINISH BR=BLEND REFINISH TT=TWO-TONE CG=CHIPGUARD SB=SUBLET N=ADDITIONAL LABOR RI=R&I ASSEMBLY P=CHECK AA=APPEAR ALLOWANCE RP=RELATED PRIOR UP=UNRELATED PRIOR 2003 NISSAN 3502 STD -"'DOOR COUPE 6CYL GAS 3. 5 LITER 287HP CODE: Z1162A/A OPTNS D/24 OPTIONS: TWO-STAGE - EXTERIOR SURFACES TWO-STAGE - INTERIOR SURFACES OP GDE MC DESCRTPTION MFG. PART NO. PRTCE AJ% B% HOURS R -- --- -- ----------- ------------ ----- --- -- ----- - E 0479 SHELL, TAILGATE K0100CDOMM 538 . 67 4 . 9 1 L 04"79 # SHELL, TAILGATE REFINISH 3 . 3*4 # = 13, 10 2 . 0*SURFACE 0 . 6 TWO STAGE SETUP PAGE 1 L1' 2003 NISSAN 3502 STD 2DOOR COUPE CD LOG NO 1588-1 0. 7 TWO STAGE E 0385 N/PLATE, TAILGATE 84895CD000 36. 75 0. 3 1 E 0460 ACTUATO_P., T/C, _LOCK 90550CD000 149. 35 INC 1 E 0551 SPOILER, TAILGATE K6030CDOMM 472 . 85 INC 1 L 0551 SPOILER, TAILGATE REFINISH 1 . 0 4 1 . 0 SURFACE I 0509 PANEL, REAR BODY REPAIR 3 . 0*1 L 0509 PANEL, REAR BODY REFINISH 1 . 6 4 1 . 3 SURFACE 0 . 3 TWO STAGE E 0533 TAILLAMP ASSEMBLY LT 26555CDO25 156. 70 INC 1 E 0534 TAILLAMP ASSEMBLY RT 26550CD025 156. 70 INC 1 E 0565 BUMPER, REAR 85032CD010 283. 05 INC 1 E 0545 COVER, REAR BUMPER 85022CD025 328 . 87 1 . 7 1 L 0545 COVER, REAR BUMPER REFINISH 3 . 2 4 2 . 7 SURFACE 0 . 5 TWO STAGE E 1052 CLIP, REAR BUMPER LT MULTI-PART 6. 99 INC 1 E1053 CLIP, REAR BUMPER RT MULTI-PART 6. 99 INC 1 E 1237 CLIP, REAR BUMPER MULTI-PART 23 . 85 INC 1 E 14,20 CLIP, REAR BUMPER MULTI-PART 5. 28 INC 1 E 0499 ABSORBER, REAR BUMPER 85065CD000 58 . 15 0. 2 1 E 0575 ABSORBER, REAR BUMPER 85090CD000 46. 38 INC 1 E 0549 01 BRKT, REAR BUMPER MT LT 85211CDO15 45. 210 0 . 2 1 E 0550 01 BRKT, REAR BUMPER MT RT 85210CDO15 45 . 20 1 . 8 1 E 0571 -.,'-BRKT, REAR BUMPER MT LT 85223CD000 31 . 62 INC 1 E 0572 BRKT, REAR BUMPER MT RT 85222CD000 31 . 62 INC 1 E 0543 SEAL, REAR BUMPER LT 85094CD000 1 . 30 INC 1 E 0471 CL`OSURE, REAR BUMPER LT 78819CD000 11 . 10 INC 1 L 0471 CLOSURE, REAR BUMPER LT REFINISH 0. 4 4 0 . 3 SURFACE 0 . 1 TWO STAGE E 0472 CLOSURE, REAR BUMPER RT 78818CD000 10. 13 INC 1.11 L 0472 CLOSURE, REAR BUMPER RT REFINISH 0. 4 4 0 . 3 SURFACE 0 . 1 TWO STAGE E 0487 SHIELD, BMPR CVR SPLASH 85050CD000 33 . 83 INC 1 L 0487 SHIELD, BMPR CVR SPLASH REFINISH 0. 1 4 0 . 1 SURFACE L M01 CLEAR COAT REFINISH 2 , 0*4 L M15 COLOR TINT REFINISH 1 . 5*4 SB M60 HAZARD. WSTE. REM. SUBLET REPAIR 5. 00* 1 I SET UP & PUL REPAIR 3 . 0*1* P REAR FRAME DAMAGE CHECK 1* 35 ITEMS MC MESSAGE (S) 01- CALL DEALER FOR EXACT PART NUMBER / PRICE 10 INCLUDES AUDATEX TIME TO CLEAR ENTIRE PANEL 13 INCLUDES 0 . 6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE FINAL CALCULATIONS & ENTRIES PAgF 2 2003 NISSAN 3502 STD 2DOOR COUPE CD LOG NO 1588.1 GROSS PARTS 2, 480;._5. PAINT MATERIAL 405: 0`0 PARTS & MATERIAL TOTAL 2, 885 . 58 TAX ON PARTS & MATERIAL @ 8 . 750% 252 . 49 LABOR RATE REPLACE HRS REPAIR HRS 1-SHEET METAL 70 . 00 9. 1 6. 0 1, 057 . 00 2-MECH/ELEC 70 . 00 3-FRAME 70 . 00 4-REFINISH 70 . 00 13. 5 945 . 00 5-PAINT MATERIAL 30 . 00 LABOR TOTAL 2, 002 . 00 SUBLET FEPAIRS 5 . 00 TOWING STORAGE GROSS TOTAL 5, 145. 07 NET TOTAL 5, 145 . 07 SHOPLTNK UB659 FS CD LOG 1500-1 DATE 1.1./29/06 01 : 00; 31PM R6: 37 Cly 1.1 /06 HOST LOG (C) 1998 - 2006 AUDATEX NORTH AMERICA, INC. 2 . 3 HRS WERE ADDED TO THIS EST. BASED ON AUDATEX TWO-STAGE REFINISH FORMULA. -------------------------------------------------------------------------- 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 TIIESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OF THE PARTS, RATHER THAN BY THE ORIGINAL. MANUFACTURER OF YOUR VEHICLE. PAC;'F 3 CL: ANI 4x BOARD OF SUPERVISORS OF CONTRA COSTA COCIN'i'Y BOARD ACTION:JANUARY 16 , 2007 Claim Against the County, or District Governed by ) p the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAINIANT and Board Action. All Sectionreter i tB ) 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 DEC 15 2006 Supervisors. (Paragraph 1V below), COUNTY COUNSEL given Pursuant to Government Code Aivi.OUNT: $1 ,000 ,000 . 00 MARTINEZ CALIF. Section 913 and 915.4. Please note all "Warnings". CLAINIANT: GARY NORRIS GRAY ATTOR.NEY:WILDA WHITE DA'L'E RECEIVED: DEC. 15 , 2006 WALKER, HAMILTON & WHITE ADDRESS: 50 FRANCISCO STREET, BY DELIVERY TO CLERK ON: DEC. 15 , 2006 SUITE 460 SAN FRANCISCO,: CA. 9413IJ), N1A1L POSTMARKED: DEC. 14 , 2006 FRONT: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DECEMBER 15 , 2006 JOHN CULLEN, r Dated: By: Deputy 11. FRONT: County Counsel TO: Clerk of the Board of Su ervisors (This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 9102, 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). ( j Other: -- Dated: ( Z'��`�� 0 By: Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) O Claim was returned as untimely with notice to claimant (Section 911.3). IV. RD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. ( ) Other: I certify that this is a true and coi -ect copy of the Board's Order entered in its minutes for this date. Dated..✓6znrta,Y� !G N CULLEN, CLERK, By Deputy Clerk WARNING (Go\-./code section 913) Subject to certain exceptiois,you have only six(C) months from the date this notice was peisonal4,served or deposiled in the imil to tile.a court action on this cLiim.Seg:Goverument Code Section 945.6.You may seek the advice of an attorney of dour choice in connection with this matter. If you Nvant to consult an attoriiev,you should do so i[ill ned.iateh. For Additional NVarning Sm Reveise Sick of This Notice. AFFIDAVIT OF NIA1LI.NG declare under penalty of'perjury that I ani noir, 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 clainiant as shown above. Da1ed:✓&""-41>' 07'TOI-IN CULLEN, CLERI< By Delxtty Clerk R�CElvED Board of Supervisors of Contra Costa County DEC 1 5 2006 RE: Claim by Reserved for Clerk's filing sta LERKCO ARD OF SUPE OVISORS NTRGary Norris Gray against the County of Contra Costa The undersigned claimant hereby makes claim against the County of Contra Costa or the above- names district in the sum of$1,000,000 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) June 15, 2006 2. Where did the damage or injury occur? (Include city and county) In the City of El Cerrito on Elm Street 10 feet north of Blake Street 3. How did the damage or injury occur? (Give full details; use extra paper if required) While attempting to cross the intersection of Blake and Elm Streets (in the City of El Cerrito) in his wheelchair, claimant Gary Norris Gray was struck by a motorist who asserts his vision of the intersection was obscured by the combination of poor lighting, overgrown vegetation that cast shadows on the roadway, and the configuration of the roadway. The sidewalks on Mr. Gray's route were in disrepair and without curb cuts which forced him into the street. The sidewalk curb cuts that existed led to sidewalks without curb cuts. There were no warnings that alerted pedestrians and motorists to the complex intersection and restricted vision. Page 1 of 3 .-f The intersection, roadway and the area in and around the intersection and roadway were in a dangerous condition, and in violation of the Americans with Disabilities Act. 4. What particular act or omission on the part of county or district officers,servants, or employees caused the injury or damage? The County of Contra Costa created the condition, and/or had sufficient notice of the dangerous condition in time to correct it. 5. What are the names of county or district officers, servants,or employees causing the damage or injury. Unknown. 6.. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) The claims exceed $10,000 and cannot be further delineated pursuant to Government Code §910(f). 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) The claims exceed $10,000 and cannot be further delineated pursuant to Government Code §910(f). 8. Names and addresses of witnesses, doctors,and hospitals: Witness Frederick Francis Adams 5107 MacDonald Avenue Richmond, CA 94805 (510) 965-1522 Hospital John Muir Alta Bates Page 2 of 3 .`t 9. List the expenditures you made on account of this accident or injury? The claims exceed $10,000 and cannot be further delineated pursuant to Government Code §910(f). SEND NOTICES TO: (Attorney) Name and address of Attorney Representative's Signature De",wier /Y1 zoo6 Walker, Hamilton & White 50 Francisco Street, Suite 460 San Francisco, CA 94133 (415) 986-3339 Page 3 of 3 `i 1 PROOF OF SERVICE 2 Gray v. City of El Cerrito 3 My business address is 50 Francisco Street, Suite 160, San Francisco, California 94133. I 4 am employed in the County of San Francisco, where this mailing occurs. I am over the age of 18 years and not a party to the within cause. On the date set forth below, I served the foregoing 5 document(s) described as: 6 Claim Presented to Contra Costa County on the following person(s) in this action by placing a true copy thereof enclosed in a sealed 8 envelope addressed as listed below. 9 [] BY MAIL I sealed said envelope with postage thereon fully prepaid, and placed it for collection by the U.S. Postal Service, following ordinary business practices. 10 [X] BY OVERNIGHT COURIER On December 14, 2006, I deposited said envelope for 11 delivery via overnight courier to the office of the addressee. 12 [ ] BY MESSENGER I caused such envelope to be delivered via personal service to the 13 office(s) of the addressee(s). 14 [] BY FACSIMILE I transmitted this document to the parties listed below at the facsimile numbers listed. 15 Cheryl Morse 16 City Clerk 17 City of El Cerrito 10940 San Pablo Avenue 18 El Cerrito, CA 94530-2392 19 I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, and that this declaration was executed on December 14, 2006, at 20 San Francisco, California. 21 22 Y " L y'" emie Reasoner T, 23 24 25 26 WnlxElt, I[AM IDroN &W1 1111 D 1 5 2006 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. December 14, 2006 Board of Supervisors County Administration Building 651 .Pine Street, Room 106 Martinez, CA 94553 Re: Cray fir. County of Contra Costa To Whom It May Concern: Enclosed please find an original and 2 copies of a government claim in this matter. Please .process the claim and return 1 copy in the enclosed stamped envelope, with some natation of its, receipt in your office. Thank you for your help with this. Sincerely, Annie Reasoner Paralegal /ar Encl: as noted www.walkerhamillonwliitc.com 50 FRANCISCO S I"REE I. SUITE 460, SAN FRANCISCO.CA IN1;i3-2100 TEL 415 986 3 339 FAX 415 956-1615 R �s V 00 -� V- 00 i` —o j 4 co 00 in - A Vii+� p_r m� W �r r lot 00 tn .r 01 kri d' 4y ch L- C(� da t o `",dpi.� � to� ,t„..�" N L+ --'-'"'-•' pd � dui o Ov ca W I rW E a a Y �o V � oa L rA bio LL RMEM CO CD t9 LO o m > Ln Q w LO I w �0; 0% M �m C. m > 9 r Ln J Qdo W o asL Y q Vl U r C/)¢Cl)¢ to O 00 DXEZAC � � N c -- J O m m O �J M M a> m C/� o w L) ¢ V O O __ C w O LL. O a k Ez�LL z d N C � ^f7 LL¢J'Us fA L-) m V CG w ' i CLAIM 130 ARD OF SUPERVISORS OF CONTRA COSTA COUNTY erqi 441f, BOARD ACTION-JANUARY 16 , 2007 Claim Against the County, or District Govemed 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. �t D ) you is your notice of the action taken on your.claim by the Board of DEC 15 2006 D� Supervisors. (Paragraph 1V below), given Pursuant to Government Code COUNTY COUNSEL AMOUNT: UNKNOWN MARTINEZ CALIF. Section 913 and 915.4. Please note all CALIFORNIA STATE AUTOMOBILE ASS . Warnings CLAIMANT: FOR: JAMES 'H/SHARON B. PATTON .BY: AMANDA COLEMAN ATTORNEY: UNKNOWN DATE RECEIVED: DEC. 15 , 2006 ADDRESS: P.O. BOX 920 BY DELIVERY TO CLERK ON: DEC. 15 , 2006 SUISUN CITY, CA 94585-0920 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is.a copy of the above-noted claim. JOHN CULLEN, Cl rk. Dated: DECEMBER 15 , 2006 By: Deputy 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( his claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send waiving of claimant's right to apply for leave to present a late claim (Section 91 1.3). O Other: .Dated: ��'� /' PrP 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). I V. ARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. ( ) Other: I certify that this is a true and cor7•ect copy of the Board's Order entered in its minutes for this date. Dated: �VRN CULLEN, CLERK, By eputy Clerk WARNING (Gov. ode section 913) Subject to certain exceptions,you have only six(6) mouths from the date this notice was personally served or deposited in the mail to file a 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 attor-irey,you should clo so immediately. *For Additional NVarnirg See Reveise Side ofTlris 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 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: IL Y O J01-IN CULLEN, CLERK By Deputy Clerk CSAA LU1 702 270 �q`'1 P.02 DEC-15-2006 14:44 . . r California State Automobile Association Infer-Insurance Bureau P.O.Box 920 Suisun City, C4 94585-0920 December 18, 2006 Clerics!Board of Supervisors Atm--Amy RECEIVE® 651 ftetree room#106 Martinez,CA 94753 DEC 1 5 2006 . CLERK BOARD OF SUPERVISORS RE: Your Insured: ScottWortham CONTRACOSTACO. Your Claim No.: UNK Our Insured: James H/Sharon B Patton Our Claim No.: 09-P84522-8 Date of Loss: 12./05/2006 Dear Clerical Board of Supervisors Attn--Amy: This is notice of our subrogation interest arising from this loss. We are in the process of settling the claim directly with our insured. We will forward copies of the repair bills as soon as they are available. One of your employees back into our insured's vehicle. On 1000 WARD STR, MARTINEZ,CA, our insured's vehicle was parked and un-attended at the time. If you have any questions, please feel free to contact the CSAA Subrogation Department. Sincerely, A mango. CA,77v m, Claims Representative I1 888-532-3008 extension 7195 Fax 707-863-9052 Enclosure TOTAL P.02 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAUVL4-NT 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 § .0 11.2.) 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 945 53. 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 entitq, 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. ■E E E E E E E E E E[E E E E E.E E E. ■■■E E E E l i C E E E L E■!1![[[t E[E E i G Q E E E E G c[[![[■(!E E E E[E[!E[[t l ZE: Claim By: Resen ed for Clerk's filing stamp SnG r6 n . d6�40)1 Against the County of Contra Costa or ) ® DEC District ccs 1 5 2046 (Fill in the name) ) RCONTRAOFSOp�RV OSTA CO 1SORS The undersigned claimant hereb, des claim against the County of Contra Costa or the above-named district in the sum of$e jr(3r l ( and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) -T-466d a 1 .7--5�-0CP d i s co v&-ed of / .'. 00 PM 2. Where did the damage r in'ury occur? clud-city and gty) / Lo Kc} cs- -cLC0U �4.1 �Cl r t h l:o S. 'I tt '_5" v` , t-�I�.S WiE g '1 3. How did the damage or injuryoccur? (Give full details;use extra paper if required S k)eri f� l t-h e one o-`-('fie l r ���/o'fees h ) `cif 1714 r D7`Ae f a r to J) /C E i 4-A q r Fn-)Pr- n aa 0 r L ea y r-oq f jaAi n.44 S q cif . 4. What'particular act or omission on the part of coahty or district office's servants, oremployees caused the injury or damage? :' �pn 1� ��dW SIvrl-) S 5f 1oq I d 5 What are the names of county or district officers, servants, or employees causing the damage or injury? On knowr1, m� ::r�swzq r)ce Y`f w,7rAr cvh z) 5Poke eoI4 I h.e Qrrm p/o yee .'i�M - - _.'S h.�. TZO: OQ14594.00 Uetai[A.Gisfbri�r.:1nvoiee Page: . . ... . ...::..:.. :. 127,14706P' l.l_OIAM Antic i>h'Aufo oily,Inc. - 14:01.�Veinq%aheits Circle AnO. h;��A<_'�;94509 . y: Phone.. 925 7,5;-3586 Fax'(925)757-5246 BAR; #1K263 'ifi9N:-'EPXff.;CAR000004440 .:.. ... F•:RLQ...:i^ t1.AL'1t.EFN l'1;REZ Date ofT oss' i7 0 4060 . CSAA-DOM r X306 SILL A STREET "i , .. ANTIOCH.CA 94509-0000 Home: 97, 9-9883 Model::; S i ;t,.ls`4 R` " Phone: Work: 925-565-8606 Type: P(? :' ; `:;Fi'? Fax: Jh ''..�'.,�S'::i Est.: SERGIO Style. 2I7t oi :4:Ri x:, Adjuster: 1. Received: 12:%05'06 Color: D T� Claire/#: A09PS4522801 Del. Date: 1 cense: CA5N1HlJ -'` Li 8f;3`a Policy: 11845228 Date Paid: I Mileage 18=X38": : : tir Betterrtrent: VIN: 11 I75RX4N36.K67K . : veductib..le:`:'_ 500 C3 .00 Ln. Description Parts RLabor Units; ";;Ren Units.! Other ..i. I Repair R QUARTER OII'I'L:R PANEL. 01- 1.00: RetiuishR Ql1A(ZTFR PANEL.OUTSIDE iYL `:`.>?ii; •240 i:. Renvin;i R OTIZ QUARTER BEL.'I'MLDCi BL- 0.70 Ren n,ln;t R QI!AR'I ER ADHESIVE MOULDING BL 0.20. Repaii 0_EAN&RETAPE.S/MI.DG BL 0-20 b Renuln l R QUARTER ANTENNA ASSEMBLY BL 0.501 Rernihist LUGGAGE I.ID SPOILER F.iL. 0.30. 8 Repair LUGGAGE LID SPOILER BL 0.50 9 Refinish SPOILER PL, I.00t IU FLEX ADDIIIVL PM 7.001 I 1 R REAR C-'ONIBINATION LAMP ASSEMB PT 179.00 12.RenVRepl IZI=C'OND.REAR BUMPLR COVER P3- 315.00 BI_ 1.30. I Refinish RI-AR BUMPER COVER PI- 2.70: la FIAXAIZDOUS\'VAS'1'1:DISPOSAL -HW 3.00: 5 Add l.aburC•LLAR COA-1 PL 1.70 10 Add U11)01 TIN I COLOR 131. 0,50, 17 PAIN'1/MATERIALS TM 210.60 I`Parts Discount/Markup 'PT -32.50 19 Rear Absorber P1' 146.00; Locals 640.00' 5.20 7.80 188.10 Total Category Rate Units .. Est. SapUl: Total 1_AI30R:FiOL)Y 57.00' 5:20... ..:- ;:'.::296.40,.:..:.; 296.40 LABORTAINT 57.00 7.50; ::.;444.601:.: 444.60: M ITTAINT 217.60:. : 217.60; PARTS:OFN 461.50;.;: 146.00 607.50 HAZARDOUS WASTE 3.00' Subtotals 13.00 1,423.10. 146.00. 1,569.10 J SALES TAX 56.02; 12.05', 68:07.;., Grand`total: 13.00:. 1,479.12 155.05. 1,637.17.: County Administrator Contra Risk Management Division Costa 2530 Arnold Drive,Suite 140 CountyLiability Claims (925)335-14 Martinez, California 94553 Fax Number (925)335 14 December 11, 2006 ra.coun"� James Patton 4306 Silva St. Antioch, CA 94509 Re: Claimant: James Patton Insured: Contra Costa County D/Accident: 12/05/2006 Claim No.: 61943 Dear Mr. Patton: The above captioned matter has been referred to my office for investigation and handling on behalf of the Contra Costa County Department of Sheriff/Coroner. 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 brine. Should you have any questions, please do not hesitate to contact the undersigned. Sincerely, Penny Bailey Liability Claims Adjuster (925) 335-1455 Enclosure • - CLAINI BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION.-JANUARY 16 , 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 1V below), ►..p «.�,�., ;� `. p given Pursuant to Government Code ANi.OUNT: $2 ,000 . 0 0 Section 913 and 915.4. Please note all . DEL ? f,��� „Warnings". CLAINIANT: JOHN BROWN COUNTY^.^"1" "L MARTINL/- ATTORNEY: UNKNOWN DATE RECEIVED: DECEMBER 18 , 2006 ADDRESS: 1680 DETROIT AVE. #203 BY DELIVERY TO CLERK ON:DECEMBER 181 2006 CONCORD, CA 94520 HAND DELIVERED BY MAIL POSTMARKED: FRONT: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, ler Dated: DECEMBER 18 ,. 2006 By: Deputy ll.. FROM: Comity Counsel TO: Clerk of the Board of S ervisors (%, This claim complies substantially with Sections 910.and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: _ �'�� By: —Deputy County Counsel 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. ARD ORDER: By unanimous vote of the Supervisors present: Chis 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. Dated. _ a JORN CULLEN, CLERK, By Deputy Clerk WARNING ( c de section 913) Subject to certain exceptiwu,you have only six(6) nionths 11rom the date this notice Nvas personally seined or depositull in the mail to Tile a count actin on this chiim.See Govelllment.Code Sectim 945.6.You may seek the advice ol'an attorney of your choice in connecti(xi wide this matter. If you want to consult an attornley,),Oil should do so iniiuediately. "For Additional NVarning See Reverse Side of"Phis Notice. 'AFFIDAVIT OF N1AILI.N declare under penalty of )erjury am that i non, and at all times herein mentioned, have f been a citizen othe Unite States, over age 18; and that today 1 deposited in the United Slates Postal Service in Nlantinez, California, postage fully prepaid a certified copy of this Board Order and Notice to 6aiivant, addressed to the claimant as shown above. Dated: \""4vy /� Jeh--IN CULLEN, CLERK By eputy Clerk ' BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. A claim relating to a cause of action for death or for injury to person or to personal property or growing crops shall 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 Cleric of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street,Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each. public entity. E. Fraud. See penalty for ft audulent claims,Penal Code Sec. 72 at the end of this form. ON an r a a a a r r a a r a a a an mums man man on MOORE ONNINKNINEXERE OR a MMURENSILINEKE anus Karr r REKI RE: Claim By: Reserved for Clerk's filing stamp ) ) RECEIVE® Against the County of Contra Costa or, ) e- � �0?Cf/ ) DEC 1 8 2006 _ 12 co S� District) CLERK BOARD OF SUPERVISORS (Fill]n, file name) ) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$_Z%.Of) and in support of this claim represents as follows: I. When did the damage or injury occur? (Give exact date and hour) �� An� , 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full details;use extra paper if required) 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? 5 What are the names of county or district officers, servants, or employees causing the damage or injury? 6. What damage or injuries do your claim resulted? (Give 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: 9. List the expenditures you made-on account of this accident or injury: DATE TIME AMOUNT ■ [■SUMMER Son man[[Ron Exxon■ EmMEEEa[ElRERRRERaEE[R[EM[E■■[[!E!E[M![!EM[EaaaMEN[EaMEa[[l ) .Gov. Code Sec. 910.2 provides"The claim shall be ) signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attornev)� Name and address of Attorney ) (Claimant's Signature) ko (Address) QQ Telephone No. )Telephone No./'2--'� M.Nummom Exxon Roza RURREN summommummuzzu OUR Eons sawn as not 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. MRM[Seim R!!aE[![ano*aNunn[ . won a.aREERR[RlaaEa......a....R Ra R..a.M.....M..a[[a EURE Ea ERl 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. John Brown 12-18-06 Claim 13v: John Brown Against: Against the County ol'Contra Costa or Contra Costa Regional Medical Center !. When did the damage or injury occur? August 29. or the 30`x' of 2006 2. Where did the damage or injury occur'? Contra Costa Regional Medical Center. Mental Health Department 2500 Alhambra Ave. Martinez, Ca 3. 1 low did the damage or injury occur`? On August 29'x' or the 30`x', 1 was transported to the medical center mental health department for 50-1-50. When 1 first arrived, I was in isolation then moved to a room ot�8 to 9 beds. In the room was another patient was in the room turning beds over. throwing thinks. Atter falling asleep the other patient came over me and started punching me in the face, hitting me on the left side ol'my face and eye. 1 ask the head nurse to do an accident report but on was never done. but 1 was told that they charted the accident. 4. What particular act or omission on the part ofcounty, or district officers, servants, or employee cause the injury or damage? The other person that was in the room with me should have been in isolation, or a room to himself'. When a person is turning beds and throwing things that person is a danker to others and the nurses over looked that. 5. What are the names ol'county or district officers, servants, or employees causing the damage or injury? Contra Costa Regional Medical Center Mental Health Department. 6. What damage or injuries do your claim resulted'? I".ver since I got hit in the lace around my eye have been sore to touch, shutting pain, my eye jumps all the time, it is all was running, in the morning, when I wake Lip my lett eye is caked with puss, my vision has changed, and I was given eve- drops. the first week the left side of'my lace was swollen. 7. I-low was the amount claimed above computed'? For pain and suffering 8. Nano and addresses of witnesses, doctors, and hospital A.) Nursing staff at C.0 Regional Medical Center in the mental health department B) `.ye doctor- DR. Robert TUrcios. 61 Chilpancingo PKWY. Pleasant Hill, CA (925-676-8365) C) DR. Paul Sarvasy- C.C. Regional Medical Center( Medical Doctor) 9. List the expenditure you made on account of�this accident or injury'? I will have to buy new glasses that or going to cost me $139 John Brown . CLAINI BOA11D OF SUPERVIS011S Of CONTItA-COSTA COUNTY • BOARD ACTION.. JANUARY 16 , 2007 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. Ail Section ref c gre 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 DEC, 1 g Supervisors. (Paragraph I.V below), given Pursuant to Government Code cowye EL Section 913 and 915.4. Please note all ANIOUNT: $2 , 606 . 25 MA"m , «Warnings". CLAINIANT: RUMEN IVANOV SAVOV ATTORNEY: UNKNOWN DATE RECEIVED: DEC. 18 , 2006 ADDRESS: 869 MARIN ROAD BY DELIVERY TO CLERK ON: DEC. 18 , 2006 EL SOBRANTE, CA 94803 RECEIVED FROM RISK BY NIAIL POSTMARKED: MANAGEMENT FRONT: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, C1 Dated: DECEMBER 18 , 2006 By: Deputy 11. FROM: County Counsel TO: Clerk of the Board of Supel isors ( his claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910:8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 91 1.3). ( ) Other: Dated: � ��r�� By: Deputy County Counsel 1.11. 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. ARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. ( ) Otliei*: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: y I—alo-17mHN CULLEN, CLERK, By Deputy Clerk WARNING (GV. code section 913) Subject to certain exception,you have only six(C) months from the date this notim was peisonalh servcll or deposited in the mail to file a court action on this chitin.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connectioi wifh this matter. [I'you Nunt to consult an attorlley,you should do so immediately. "For Addidomal\VarniltgS(-v Iteveise Sick ofThis Notice. AFFIDAVIT OF MAILING declare under penalty of perjury that I am now, and at all tinges 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 Nlartinez, Calilornia, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated t'e" _ d JOHN CULLEN, CLERK By _Deputy Clerk BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY SHARON HYMES-OFFORD INSTRUCTIONS TO CLAIMANT DEC 1 2006 `,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 Cleric of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street,Martinez,CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the -naive of the District should be filled in. D. If the claim is against-more than one public entity, separate .claims must be filed against each. public entity. E. Fraud. See penalty for fiaudulent claims, Penal Code Sec. 72 at the end of this form., ■s ss ssssstststss.ss.!IS Is ■.tss.■■S Cssss ssotltsttstts■CIO Is RGs sostttss Rs ss ss sss tt tssa RE: Claim By: Reserved for.Clerk's filling stamp Against the County of Contra Costa or DEC 1 8 2006 District) c�faf�e„t�o (Fill inthe name) ) CO%v l.� OF Sup A COSTA CORS/SOgS The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ 2-.o�. , 2 s and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) ©6. 11 2-00 -c- nF N 2. Where did the damage or injury occur? (Include city and county) Gl��o31e � G A. C0.YQ_4_ cos-too 3. How did the damage or injury occur? (Give full details;use extra paper if required) �'11 P — Sack 6za,-� (� -1 WA-S. CQD&.;, wG eYN�o► &&(x-�ivQ 0r � ' aS2. WA ya2",N J2A. E vJWZC\ ' -(0cG V 1\s �C.ARr k§V'1j N 6 e>&cV Lkm Q=k, zl p4k o1 Q SEC l Qo V P4 w ck (A .+ 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? 'a•��12.sJ 4'�� 5 What are the names of county or district officers,servants, or employees causing the damage or injury? � s�� �i`�e�Val" N - ��� Au;Vr�2 E R "J Wilo cAk� qpp NAD 1 tlp mc- -\C> ►s�;;vc� WAS 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. -Attach two estimates for auto damage sl oar, �H���. P �Q A-WCJ FbJ&P, A-pl44 j��' Uc� Fcvcl*y � �,l d�7Wee 0� . �1�c►,tet �Q�c �� � . 7. How was the amount claimed,above computed? dude the estimated amount of any prospective injury or dainage.) 8. Names and addresses of.witnesses,doctors, and hospitals: � �. C-Pl�e-s,{ UF, 9. List the expenditures you made on account of this accident or injury: DATE Ta E AMOUNT ■■a .amasaasas.aa.sammassaamammas asraaarassasasnoun Rosanna■aa.s.aaasaaaa.a.raamotion rat .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 (Claimant's Sign *_ i �¢a� _C'� _ct.21 ���• (Address) 6 �( 1�a123 N Zvi_ Telephone No. )Telephone No. 5ro _.7 5 g—49 10 y a..a.aana MEN a.a.sa.a..aa... a Runs a..........a.sRoom nitwit saa..as as aaraaraanamaass aNon aaaI 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. a■asa■■rarararsasign ss■■a■ rNon aaataarm'.aa..aaaaasaas■aman a.Nunn rataarara.saa.m.aa.aaa� 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. Date: 12/8/2006 02:42 PM Estimate ID: 472 Estimate Version: 0 Preliminary Profile ID: Gilman Collision GILMAN COLLISION REPAIR 1348 7th STREET BERKELEY,CA 94710 (510)528-5940 Fax: (510)527-9528 Tax ID: 20-5513756 BAR#: AC247953 EPA#: CAL000305452 Damage Assessed By: Craig Gaignard Deductible: UNKNOWN Owner Rumen Savov Address: 869 Marin Rd EI Sobrne,CA 94803 Telephone: Home Phone: (510)758-4364 Mitchell Service: 913130 Description: 1992 Honda Civic DX Body Style: 4D Sed Drive Train: 1.5L Inj 4 Cyl A VIN: JHMEG8644NS028503 Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 301970 BDY OVERHAUL FRT BUMPER COVER ASSY 2.0 2 302010 BDY REMOVE/REPLACE FRT BUMPER COVER **Qual Repl Part 160.00* INC 3 AUTO REF REFINISH FRT BUMPER COVER 1.9 4 302100 BDY REMOVE/REPLACE L FRT BUMPER GROMMET 71144-SR3-A00 1.10 INC 5 302110 BDY REMOVE/REPLACE FRT BUMPER HONEYCOMB REINF 71170-SR3-AO1 73.41 INC 6 302120 BDY REMOVE/REPLACE FRT BUMPER REINFORCEMENT BAR 71130-SR3-A01ZZ 146.93 0.3 # 7 302160 BDY REMOVE/REPLACE L FRT BUMPER REINFORCEMENT EXTENSION 71172-SR3-A00 12.17 0.2 # 8 302820 BDY REMOVE/REPLACE L SIGNAL/MKR LAMP ASSEMBLY 33350-SR4-AO2 50.75 INC # 9 303040 REF REFINISH HOOD OUTSIDE 3.0 10 303050 REF REFINISH HOOD UNDERSIDE 1.5 11 303080 BDY REMOVE/INSTALL HOOD ASSY INC 12 303120 BDY REMOVE/REPLACE HOOD PANEL 60100-SR4-000ZZ 329.84 1.0 13 303150 BDY REMOVE/INSTALL L HOOD RUBBER CUSHION Existing 0.5* 14 303170 BDY REMOVE/REPLACE L HOOD STOP BUMPER 74827-SH2-003 3.73 - 15 303200 BDY REMOVE/REPLACE L HOOD HINGE 60170-SRO-AOOZZ 10.55 0.2 # 16 AUTO REF REFINISH L HINGE 0.3 17 303270 BDY REMOVE/REPLACE HOOD LATCH 74120-SR3-AO1 37.68 0.3 18 304890 REF REFINISH L FENDER OUTSIDE 1.9 19 304910 REF REFINISH L FENDER EDGE 0.5 20 304930 BDY REMOVE/INSTALL L FENDER ASSY INC # 21 304960 BDY REMOVE/INSTALL L FENDER MOULDING INC # 22 305060 BDY REMOVE/REPLACE L FENDER PANEL 60261-SR3-507ZZ 235.32 1.8 # 23 936012 ADD'L COST HAZARDOUS WASTE DISPOSAL 24 936014 ADD'L COST FLEX ADDITIVE 25 933003 REF ADD'L OPR TINT COLOR 26 933018 REF ADD'L OPR MASK FOR OVERSPRAY 27 AUTO ADD'L COST PAINT/MATERIALS 273.00 ESTIMATE RECALL NUMBER: 1218/2006 14:36:35 472 UltraMate is a Trademark of Mitchell International Mitchell Data Version: NOV_06_V Copyright(C)1994-2005 Mitchell International Page '1 of 2 UltraMate Version: 5.0.215 All Rights Reserved Date: 12/8/2006 02:42 PM Estimate ID: 472 Estimate Version: 0 Preliminary Profile ID: Gilman Collision * -Judgement Item # - Labor Note Applies Add'I Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals 11. Part Replacement Summary Amount Body 6.3 75.00 0.00 0.00 472.50 Taxable Parts 1,061.48 Refinish 9.1 75.00 0.00 0.00 682.50 Sales Tax @ 8.750% 92.88 Non-Taxable Labor 1,155.00 Total Replacement Parts Amount 1,154.36 Labor Summary 15.4 1,155.00 III. Additional Costs Amount IV. Adjustments Amount Taxable Costs 273.00 Customer Responsibility 0.00 Sales Tax @ 8.750% 23.89 Total Additional Costs 296.89 I. Total Labor: 1,155.00 11. Total Replacement Parts: 1,154.36 III. Total Additional Costs: 296.89 Gross Total: 2,606.25 IV. Total Adjustments: 0.00 Net Total: 2,606.25 This is a preliminary estimate. Additional changes to the estimate may be required for the actual repair. ESTIMATE RECALL NUMBER: 12/8/2006 14:36:35 472 UltraMate is a Trademark of Mitchell International Mitchell Data Version: NOV_06_V Copyright(C)1994-2005 Mitchell International Page 2 of 2 UltraMate Version: 5.0.215 All Rights Reserved AMENDED CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA.COUNTY C • BOARD ACTION: JANUARY . 16 , 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. ) ':flle copy of this document.mailed to California Government Codes. you is your notice of the action taken on your claim by the Board of DEC 1 3 2006 Supervisors. (Paragraph IV below), given Pursuant to Government Code COUNTY COUNSEL Section 913 and 915.4. Please note all AMOUNT: $500 ,000 . 0.0 MARTINEZ CALIF. "Warnings" CLAIMANT: MICHAEL K. HARRISON ATTORNEY: UNKNOWN DATE RECEIVED: DECEMBER 19 ; 2006 ADDRESS: 1061 CLEARLAND 'DRIVE BY DELIVERY.TO CLERK ON: DECEMBER 1.9 , 2006 BAY POINT, CA 94565 RECEIVED FROM BY MAIL POSTMARKED: COUNTY COUNSEL FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, rl .Dated: DECEMBER 19 , 2006 By: Deputy 11. FROM: County Counsel T0: Clerk of the Board of Sufervisors (-)-,Tllis clairii 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 1.5 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 applyfor leave to.present a late claim(Section 911.3). (�<Other; �)`1�GI a i ,-i-� r S b h 1 + ('14 Q'S 40 e_je--,+5 UGc v�✓' ✓� p� or a -(� f�ef�,�bo(� ,The. GIG tA ovle) .g- ym-� rre2(y 05 F�p Q�e��-j pC.Gyrri vi �' J (p "D-0 0(0. Am Ld 00,1;me ( e la�%►'1? �ov 01-e�n p 16--e-/-7 C),-7 -moi L.1 {�- C���� �7'v.n coo.-I Dated: / v' o���U6o By: /1/1 Deputy County Counsel . Cou. 1 11.1. 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. OA.RD ORDER: By unanimous vote of the Supervisors present: ( This Claim is refected in full. ( ) Other: 1 certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated .,O�WIN CULLEN, CLERK, By Deputy Clerk WARNING (GM-/code ,ection 913) Subfiject to certain exceptions,you have only six(6)months om the date this notice was personally sewed oi*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•Additionid Warning See Reverse Side of This Notice AFFIDAVIT OF MAILING I declare under penalty of perjury that I am qow, and at all times herein mentioned, have been a citizen of the United States, ower age 18; and that today 1 deposited in the United Slates Postal Service iu Martinez, California, postage fully prepaid a certified copy of this Boal-d Order and Notice to (1aimant, addressed to the claimant as shown above. JOI I..N CULLEN, CLERK By I)eputy Clerk OFFICE OF THE COUNTY COUNSELS�_ L SILVANO B.MARCHESI COUNTY OF CONTRA COSTA `;+''- f`f_= COUNTY COUNSEL Administration Building 651 Pine Street, 9'" Floor '��C '=�_ -�y`,• SHARON L. ANDERSON b Martinez, California 94553-1229 CHIEF ASSISTANT�'� _ =' 1 (925) 335-1800 n; GREGORY C. HARVEY O "" m VALERIE J. RANC:HE (925) 646-1078 (fax) :� -� �'�� _ 'p AssIsTAws �OSrA COU���G4' NOTICE OF UNTIMELINESS AS TO A PORTION OF THE CLAIM. TO: Michael K. Harrison 1061 Clearland Drive Bay Point, CA 94565 .RE: CLAIM OF MICHAEL K. HARRISON Please Take Notice as Follows: In regards to the claim you submitted on December 19,2006, portions of the claim are timely and portions are untimely. The portions of the claim prior to .lune 6, 2006 that you presented against the County of Contra Costa governed by the Board of Supervisors fail to comply substantially with the requirements of California Government Code Sections 901 and 911.2, because they were not presented within six months after the event or occurrence as provided by law. Because the portions of the claim prior to Tune 6, 2006 were not presented within the time allowed by law, no action was taken on those portions of your claim. The claim was forwarded to the Board for action only on the timely portions of the claims. The only recourse at this time is to apply without delay to the County of Contra Costa governed by the Board of Supervisors Ior leave to present a late claim as to the claims which arc untimely. See Sections 911.4 to 912.2, inclusive, and Section 946.6 of the Government Code. Under some circumstances, leave to present a late claim will be granted. ,See Section 911.6 of the Government Code. You may seek the advice of an attorney of your choice in connection with this matter. I f you desire to consult an attorney, you should do so immediately. SILVANO .B. MARCHESI COUNTY COUNSEL By: lie Monika L. Cooper .Deputy County COLn1Sel Page 1 Q CERTIFICATE OF SERVICE BY MAIL (Code Civ. Proc., § 1012, 1013x. 2015.5, Evid. Code, tiff 641, 664) I am a resident of the State of California, over the age of eighteen years, and nota party to the within action. My business address is Office of the County Counsel, 651 Pine Street. 9th Floor, Martinez, CA 94553-1229. On January 11, 2007, 1 served a true copy of this Notice of Untimeliness as to a Portion of the Claim by placing the document in a sealed envelope with postage thereon fully prepaid. in the United States mail at Martinez. California addressed to Michael K. Harrison. 1061 Clearland Drive, Bay Point. CA 94565, 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. 1 declare under penalty of perjury under the QINs ofthe State of California and the United States of America that the above is true and correct. Executed on Z. 7,01a , at Martinez, California. �a(1-6� athleen O'Connell cc: Clerk of the Board of Supervisors (original) Risk Management Page 2 OFFICE OF THE COUNTY COUNSEL 9 �� -1 SILVANO B. MARCHES[ COUNTY OF CONTRA COSTA +•,:� COUNTY COUNSEL Administration Building 651 Pine Street, 9+" Floor 1, 'i•_ S�•�Ar+UN L. ANt)rR5`.)N Martinez, California 94553-1229 CMier As515ratvT r ' (925) 335-1800 �; ,,� ;t .�`' "� � :,�+'` Gkk(3r_,(Y C, HARVEY (925) 646-1078 (fax) +�° " :'ri l ; VALPRII'. J. KANCHE ASSISTANTS NOTICE UIQ ,FTC•ILNTC-`Y ANDIOT2. NON-ACCEPTANCE OF CLAIM` �--� TO: Michael K. 1Tarrison N j j 1 (\ 1061 C.learland Drive �r Bay Point, CA 94565 � RE: CLAIM Ol'M. ICHAEL K. HARRISON f Please Take Notice as Follows: The clam you presented against the County of Contra Costa or District Y governed b the.Board of Supervisors fails to comply su.bsfanta ially with the requirements of California Govenlrnent Corse Section 910 and 910.2,,or is otherwise insufficient for the;reaso'iis checked below: hip' S .S ie claim fails to state the name arid post office address of the claimant. el Ly7 �j •1 ( � 2. The cralm nails to state the post office address to which. the perso» presenting the claim desires notices to be [X] 3. The claim fails to state the date, place or other circumstatIces of the Occurrence or transaction w1iich gave rise to le slain] asserted. ;I/- . The clairn fails to state tk�Vn,ine(s) of the pt.iblic 0T2 R10yCe(S) 06USirIg the 1I1)Ll1'y, dal1,age, or loss, if lulown. o 15. The claim fails to s ate whether the amount clainacd exceeds'ten thousand.dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the el.ainz fails to state the amount. claimed as of the date of presentation, the estimated wnount of any prospective iniury, damage or loss so far as lmown, or the basis of computation of the arnot.trlt claimed. [ ] 6. The claim is not signed by the claimant or by some:person on his or her behalf. j ] 7,:r, You are required to submit your(lain on the proper form,which is enclosed. Pleasc resubulit your claim on the enclosed form, including all the required informatiom Gov. Code, § 910.4. SUjkPleasc be aware,that you have.only a limited period of time.in which to file ati alnended Claim- See Gov. Code, § 91.0.6, - 47 Ed WdSE:SO 900E ST oaQ SASE ESE SEG: ON Xdd SAWl 1 iN I Od AU9: Wpdd FROM :BAY POINT WORKS FAX NO. :925 252 2333 Dec. 18 2006 05:25PM P1 O � • , �► in o `4i • v,S a Jq iey Id o� Cp oz V. lunj -t►' t,,y � �" `� c,,, ,� o' t"' � t3 °� � 4"'� c3 +� t� �.., o► �" 'rte 1 Itt �T} C4*, X41 (}�yj a�'{. �' '44 I'.P.h'MIZATI6N CONT'rNUED SINGLE ACCOUNT. HARRISON MICI-M-B;L KENT DkC ]./I, 2005 DESK; 02 ACCOUNT # 502-383 C'LIENIDEBTDR. If DE8.K: 02 OUR CLIENT NAME, FAST COUNTY TOWTNC 87 MERCURY SABLE l'NTERP.:.qT AT: IW� FROM DATE OF SERVICE.. �)ATE OF REFFRRAL:08/l5/06 .DATE OF SERVICE: 07/20/06 DATE OF LAST PMT. AMOUNT REVERRED! 2165,00 PPINCI.PAL FiALIMCE-. 2165 .00 ACCUMULATED ENTEREST. $ 0. 00 OTHFR CHARGES: $ 0 . 00 COURT COSTS: $ 0 .00 ATTORNEY PEES. $ 0 . 00 OTHE',`.t-- $ 0.00 INTEREST; $ 86 .60 ACC'T DAL: 225.1,60 PAYMENT TRANSACTION HISTORY 'YPE DATE PAYMENT., PAID ON PAID ON PAID ON PAID ON PAID ON PAID Oti AMOUNT PRINCIPAL INTEREST OTHER CHCS COURT COST ATTY FEES OTHER *NO P.kYMY-,NT'j THIS JACCOUNT-h ,R.IlliD TOTAfj 0 .00 0 .00 0 .00 0.00 0 . 00 0 .00 0 .00 OTAT, DUE ON ALL ACCOUNTS 225:2. 60 '0'.JrAL 'INTEREST .6' ID 'I-'OR 2005 0. 00 'OTAL iurERE:ST PAID TO DA 1'r FOR 2006 0 .00 GcJ WcJBF:SO 9007- BT '07)(1 222E ESE SE6: 'ON XUJ SAWM INIOd ),Ug: Wo�jj 31 9 3 7 t111, 1 ,01 r CONSTITUTION OF THE STATE OF } ':�1.::,,:�,�,,,:1 ri��,,�' i �� ! CA L I FO R.NJ A rP C 01 -4 r J� v P n 4 PREAMBLE7., 11,4/'L ls- -People of ihe -ate u td A.Irnighly God We, tl�ie' State of ifoniia, gr I I Of cur- k-eedom, in order to secure and pei'petwite Its blessings, do A establish this Constitution. rr,f ill 0 J gA� -14- ARTI ,,P1 DECLARA140N OF AIGHTS 4"r §2, -Speech and press 3. Assembly and petition §4. Religion § 5. The milimt-y 6, Involuntat-y SerViWde I , ; '. V 1)�e §7. Duc pix.)cess; Equal protcclion; Privileges and lmmuriitie, S. Employment discrimination % Bills of attainder; Ex post facto laws; Obligation of contract 10. Detent.iOTI (If Witn6SSC-i; Imprisorimcia for debt of § 12, Bail; Release on own i,ecognizarice 13. Search and seizure 14. Pros'CCLIGOT) OHCIOTly; Arraignment § 1.5. Safeguards in criminal prosecutions` 16. Trial by jury j'y') 4 11 w Y- § 17. CJ Uel or IMUSUal punishment; Excessive hw,-, & I 9 ]. ,Inalienable rights All people are by nature free and independent and have inalienWe rights. Among these are C11j0yjTIg and defending life and liberty, acquiring, possessing, and protecting property, and pursuing and obtaining safety, happiness, and privacy. AL4)pted November 5, 1974. Ed WdSF-:Sal 900E 8T 222E ESF- SE6: 'ON XUJ SMOM INIOd AU9: WOZIA CREDIT DURT-:AU ASSOCIATES Po ROX 150 1,4) 4G0 UNION AVE - STE C F)k'XJ)RFIET- CALTVORNLA, 94533 ,--'COUNT ITEII-A'l't!ON PHONE: (707) 429-3211. DHC 14, 2005 11:11 /* AO MICHI-1,19L, KENT HARRISON 1.061 CLEARLAND DR 14 1K.4 • vo PAY POINT, CA 94565-:3268 le 0 'THE FOLLOWING IS' AN IT.SMIZATTON OF YOUR ACCOUN'T'S AS OF DEC 14, 2006 PLE;ASE RETAIN THIS COPY FOR YOUR RECORDS. FOR YOT)R CONVENIENCE WE HAVE INCLUDED ALL IN'l'BREST PAID LAST YEAR AND THIS CURRENT YEAR TO DAT&,, J tel- �j -�'�' � r if`� � f,_ c") N 0 T I C E THE FEDERAL LAW RR'QUIRES WE, INFORM YOU THAT THIS IS AN A-fTEMPT BY A DF111T Cr,)'fLEC'l'OR '.1,'0 CO't..LECT A DBMT, ANY IN"IFOR-MATI(N OBTAINXD WILL B32 USED FOR THAT PURPOSE. h? .=--�`� All C�m (� � � fS Vd wdgE:so goop- BT 222E ESE SE6: 'ON XUJ SAdOM iNlOd AUG: Woa-4 0)- 0 CkEDIT BURE,&.1i ASSOCIATES PO BOX 150 (AJ) 460 UNION AVE - STE C rAT11FIELI7 CAL.11'11PNI,A, 94,513 :'CQUVT ITEMIZATION PHONE; (707) 429--3211 DSC 14, 2006 .11:1-1.1 (A Je� VJCIiAP.;:r.j KENT -HARRISON 1061 CLEARLAND DR :8AY POINT, CA 94565-3268 HERE>- cz fief ,YRE FOLLOWING iS AN ITEMIZATION OF YOUR ACCOUNTS AS OF DEC 1 2006 PLEASE RETAIN THIS COPY FOR. YOUR F.ECOR:os. FOR YOUR CONVENIENCE WE HAVE INCLUDED ALL INTEREST PAID LAST YE!kR AND THIS C!Up.'-c?-ENlJ:l YEAR. TO DATE. Q �� � S N 0 T I C E THE FEDERAL/LAW REOUIRES WE INFORM YOU THAT THIS IS 2:N ATTEMPT 13Y A DEBT COL.TiECTOR r1lo COj'.,LEC'J,' A DEB'J'- ANY" !N]?ORMATION OBTA-IM-M W CLL BE USED ,FOR THAJ.' PURPOSE. �� Cf VJ l �!-L �1 Sd wd9E:so 9oo.-I ST 222E FSF- SF-6:, "ON XUJ SMOM iNlOd AUS: WOaA BOARD 01F SUrERVISORS 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.) 3 3SA1_1 7 B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106,S) ,,�g 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. ■■•■■ .■•A■■ ■'■t■Y�■Y■■t•■A■t■■Y■■Yw■.■Yq■fad■ f■Y■A■Y■■■1POWNP■■A■■r■■■■■P■.n'r■■MR RB: Claim By: Reserved for Clerk's filing stamp ) RECE'I'VED. DEC 12 .2006 Against the County of Contra Costa or ) CUM BOARD OF SUPERVISOR$ District) CONTRA COSTA CO. (Fill in t4name) ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named f district in the su of S oa 0 in u ort of this claim r reseants as follows: L S/ a�t C4�P�c°d' �-t✓I '/ Ccs. �� e. ✓� Q�p,er•e 1. When did the dathage or injury occur? (Give exact date and hour) S'e rte.. 2. Where did the damage or injury occur? (Include city and county) r66 ,/A /'-' 4" & "t 'I / L 3. How did the damage or injury occur? (Give full details; use extra paper if required) `rn 1 � L.1/r l1.._S O w e d C' 0( ti. S e.. ^-M CJ t q v`y C o 0 0 o, Q S, 6i f I t✓ .as I _� /3 r'�► to�c' 4. V& particulat act or omission on the paint of county or district ottiders, servants, or employees caused the injury or damage? ,t/o t � � 1 1y /,- e-e �' p eo Iry 5' 6- a.t^j (ooh, e f-- (J 5 What are the names of county or district officers, servants, or employees causing the damage or injury? Q /'1q J4-,2",e 4��'r e % �� r !. 7 Q 1 / ! 1 � � � K (r10 {%�f��� � �� �•��l �J / �� ` �.1/ �/Cr az ("�rtG : 9d kJd9Z:S0 900, 8I ESE SEG:' 'ON XHd SMOM 1N I Od J,tig: Wade IMV VEHICLE REGISTRATION INFORMATION for VIN/License Request: 1MF-EY50U4RA637930 C O N T I N U E D 7 Snftwarri u: 58224 Base Rocord: 2 of 2 Vehicle Dascrip-icn ........ 10del Year: 87 Make: P=Izc "Vehicfb'([) Number 1MZSM50U4HA637930 ':�vv9!•/Fuel Code: G = GAS Body/Hull Code: 0 = PASSENGER VEHICLE AND MOTORCYCLE udy Tyne (%fadek 4D = SEDAN 4 ISR -- —..... --..... Registretlon > xpiration Date: 03/1.8/07 irst Sold: 00/00/87 ,; Yr:' 97" VLF:CIas§: "AT' County: 07 CONZRA'COSTF el-ocle Type: 12 AUTO OLD is:nse Type: 11 = REGULAR AUTO Filc Code: L = ENVIRONMENTAL LICENSE PLA'I'D �..... _. .. owner(s) I3ocistered 0wnr:r: HARRISON MICHAEL KENT Registration Certificate Issued: 04/04/06 1061. CLEARLAND DR BAY POINT, CA 94565 rdlln..:. cnc.x�. ..,.v cl rl I Cl e—Iv•wuln11Ut 1 ni r.,n bt70 L;4 at r.0 Legal Owner Code: o Status - TO MAILING ADDRESS (mriTV, . fl'I •• ^ilfVrxA :f(�c:r1•• Zd Wd2E:S0 900E 8ti oaQ ���E ESE SE6: 'ON XUd SAaOM 1NIOd AUH: WOJd FAX NO. :925 252 2333 Dec. IS 2006 05:27PM PS FROM :BAY POINT WORKScj _._-•--.: ---'.'—'— _ N u r'� L t] c•t ` to G r7} P.0 -tt " C7� Fife U 63 c � rn � d Hr: ` -N�•,�_ -_ Amo � �+ O N. tl.G H Cts m Q rl H ni r t' d d w o H m n] ye aCt us U� V � + c n r m s T.,:� I•� .-a � T � E. � G.' H c o ea ti N PtS 4 w P+ a, C� U 0. �.7 fi -) 0. (n R m•-' 'y^.'. as u n c. G � ;N a'L- a; Q W Lo cm, W i. w c � Q ti \ w - ,.r '= m.. : i R� :i Lt't ""c .• � 411 © .p. Q R e LU 1"s" F w.c rnv- 'o o t" 9 0 Q � � � M �� >- p ,� t7•.. "' � is � R.' o m - G G jl r. n-1T�4 u G Y �•i •�' G'.rj Q A 2,'. 12 ko n !a Qa -a Ytl O `.4 i �i o' ``f '� COLD Ell Y u 3 r a m -,01 tn u rr i.i•i U � � `^ '� =T. ,_:_ � '.� � l- W+ � 1 T ()) c m w L.t QI ?s W tr W a w y r� r E rn i rn = a o o N �x Fz w1 9 n+ m u d �'1 t? b H rr `� m c o. U m UJ •�vi rlt a O 3 u -76 2 Lijm� t� cn o t= = n7 - lf1 in X Ft tam Q as v y�•- i ;� r)1 g _ .r y�y, e m ..t'�# 4,3 O 41 25 ~ moLa u r Its. _ ,, c S yy •� f'yP v y {a r �' S i mow, t�E © •t-._ J2 'C c c . -��,Y�, m 3 rm-, s [t's t,j '�° lb i��{ - W—•r^ s Yi Z" 5 r-t c , u d N Ln m 124ti ,�" m u CJ a E t,7 vt u u r-i W H .:C! �, W 1 nt v a O to q td u04 ti' stsi,:ao W vii '` as F",w ''•i p w4- -� tea cc � j W. C) 0 � to �. oEav W OdW b Li. Q u A E C] c LL. Q fit a ^-d Ln:`C)•+- Q ? N o " ' CERTIFICATION OF LIEN SALE LIEN SALE UNIT FOR VEHICLE VALUED AT X4.000 OR LESS P.O.BOX932317 (CIVIL CODE 3072) SACRAMENTO,CA-04)32.:)1,70 )TE T;) THE LIENHOLDER; icn a vehicle is sold ai auction,immediately complete this form and rive to the buyer,Retain a copy to submit to the DMV with;lny excess fees, It the vehicle is not sold becrose lu0-1011�bid vvos writ received, the lienholder become s the buyer indicated ori the Certificate 0 Sale Sertion. When the vehicle is sold in the lttllrre,complele a Wl of solp and re batll forms to the.buyer.All:eyistration teas olid peneiiias becDlTTe due and payable on the lien sale date, F❑llnwinp the sale o1 a vehicle,remove and destroy(lie vehicle's r.nsr plare(s), and within 5 drys of sate,30wit a complete.,Not}re'of'Rrleate'ofddability'(NRL)fbrfh'to-the department: - VEHICLE LIVN'',14U.Nt'FN �7 A1C DIeTEAEa �?011,16E E%HIRATI(INnATE •� �VEIIICLF It')kNIVICATI7N NUMUCP IVIN)tE 2EE1i9,',0 CA ;):3j1Qi04 1NILMM50U4litk637930 DFSCRIPTIOrJ MAkF - -YEAS MUNFE UODY TYHF. FNrmE r:UMaEaIFACTJRr,YCIE cualYl MER.CLIRY 1.907 SAFL2- GS 41) (!A;[vClr!W rAMk W7D MY P()9SCDSIJN ()ATF u1VNCR D!L!Fn FUN SERt'ICfs!sfuRAOE DATE wL1RC oR SERvICES COMPLF ILII IF AUTNORIZEa aY A HUHLI�'ACEKCY,Ufi'r UP101,' TUVC?W6.13 T1•7UgCLE a'As Iuwto 0 G/ 1.9/0 G 1)G/1..41 6__..._._._.......... !n accoidarlcc with Civil Code Section 3072,my authority to conduct this lien sale is: X] After the Notices of Ponding Sale were mailed to.the rogistaredllegal owners,interested parties(listed on the attached vehicle record(printout)obtained from DMV)and DMV,the sale was conducted not less than 37 days or more than 41 days,I have not AUTHORITY TO reccivec notice from DMV prohibiting this lien sale. )NDUCT LIEN SALE U A certified copy of the court judgement to proceed with the sale. fcllzeclr GIM ❑ A re!ease of interest from the opposers)after opposition filed. [� Auihori:ation from DMV after proof of unsuccessful service. There is no record on file and no known interested parties.A total of 31.41 days have elapsed before the sale was GUIIFIIICiad. NOTE:Vehicle record From DMV and)or a certifled ropy of the court judgement or release of iritorest fes apprupriate)must be attai;lied, NOTICE,OF,,,,,,,,, ;,,,'Art accordanro with Clvfl.Goda Section„3D72;,Notiees nLPenoing,Sale,With.occomppnying Declarations of Opposition were PENDING SALE mailed 10 the registered and legal owners,interested parties,and DMV,31 to 41 days prior to th3lieri sale. (Postal receipts or postal listing sheet must be attached,) CERTIFIED// /004 1160 000'7 5155 y954 -•- 15'JYER'S TRUF FL+LL NAME The above described vehicle was sold on. EA%'1' COUNTY 'J.'OW CERTIFICATE AUDREss OF SALE 0'7 ?U {in FU BOX_ 8305/590 W 1.0711 QST —• CITY STA IE IIP M1.1101 UBy 'fearL— PITTS RUR0 CA 9!t565- NOTE TO LIENHOLUER:.If vehicle r,etained,by lion hoIdor,,-C,pinplin 'OumUer,Z.oIlly. 1. THE VEHICLE WAS SOLD FOR...,•........:...... $ • I), THE 1i11-LING AND COSTS WERE: A.TOWING...................................................... $ 245 - 00 El. STORAGE.................................................... $ 1850 .00 11E AUCTION SALE I C. REPAIRS..................................................... AND PROCEEDS D. %05i OF SELLING(CANNOT EXCEED s7O) $ 7U . 00 ITOTAL OF 2 IADP A THROUGH D)............................................................. $ 2165 , DO 3. 'ARKING VIOLATIONS................................................. $ 4.EXCESS FEES`ILINE 1 MINUS TOTAL OF 2 AND 3)......................... . „ . `EXCESS FEES MUST BE SUBMITTED rO DMV WIMA COMPLETED copr OF THIS FORM WITNINFIFrEfli DAYS OF THE SALf DATA”. lL4ritiOLOF'N'sNAW tkLiH2ONF NUMDfA EAST COUNTY TOW ..—. (925) 93`3-269 f — ..--.— — ,— --. .—..._. --..4.. .— r-1,vF CITY 570.(E ilr c07E PC PDX 2305/590 W 10TH ST• PITTSBURG CIA 94565- `r �� •"' RECrb1RATIDt15ER1'1'vFNUM9HH TFLEF•1;rNFA'I�MDEA .AGENT ACTING FOR LI!'tRIDLDf�.lPArA']'NAMP! CER141CAT 10N 1 sT'?EF I aDDF.FSS CITY TAI k 71F CODE 'I terrify Fender persalt y of perjury under the lows of the State of Cafffornro that the inforu etron I have provided is true and correct," DAtE LIENHULDER•S(III AatNT'SIAC,rin.Fr:RLIE. ,)LCER?51mA%u.;C —10_I/2 0 f 0 6X ::AST COt N�`X Z'()W by www,ex5oftware.corn (Rack $4,400 or leas) REG.1b8A 1RCV.312000; ©Td WdSZ:S© 90OF St •ONXHd ' SAiHOF1 1N I Od Aug: WmId DMV VEHICLE REGISTRATION INFORMATION for VIN/License Request: 1MnnM50U41•E1637930 R,egt:ester; EAST COUNTY TOW neSponse date: 06/19/06 PO BOX 8305/590 W 10TH ST PITTSBURG, CA 94565- cZ ;software #: 88224 L3-ase Record: 1 of 2 --..... ... . ..:..... — Vehicle Desc:ri tlon.�--•........, - — PAodel Year: 87 NP,L-ike: MERC Vehicle ID Number: 1M`FBM50U4RA637930 Powe[/Fuel Code: V = GAS 3ody/Hu!lCode: 0 PASSENGER VEHICLE AND MOTORCYCLE oc;cy Type Model: 4D = SBDAN 4 DR License No: 2EEU950 Expiration Date; 03/18/04 . .yH..r....... .. .. 'ff. ::t. .q.yg..1 . . .. . . I—. . . – .- - I .. ..yam,. First Sold: 00/00/87 '--Yr: 97 VLF Class: AT County: 01 ALAMZDA Vetii::le Tyne: 12 = At7TO OLD i,i r1,e Type: 11 = REGULAR AUTO File Code: A AUTO OR HISTORICAL VEHICL14 --.....................................,- Owner(s) Registered Owner: BROWN JANICE 'YVETTE Registration Certificate Issued: 04/03/03 926 E 17TH ST APT 10 OAKLAND, CA 94606 , Ownership Certificate Issued: 06/26/97 Legal Owner Code: 9 _.. Record St::rtus --........... _... .... _ _...._...-- 07/09/02 SMOG DUE 03/18/04 NO MA1'LINV ADDRE55 '.RIP OFC: 592 D:04/04/06 ID/S:070010 T:V00 V:0025800 R:1BA RTt RIF OFFICE: PITTSBURG TRANSACTION DATEr 04/04/06 IT)/SEQUENCE#t 07001.0 , F'ELS PAIDt $258.00 TRANSACTION: TRANSFFM REGISTERED OWNER (R/0) PROCESS REASONS: BIENNIAL SMOG CBRTIFWCATE IS REQUIRED SIONTATURE REQUIRED ON DOCUMENT(S) BILI. OF SALE REQUI"t) 11/07/03 SMOG INSPECTION AT TEST ONLY CLNTER RFQD PARKING VIOLATIONS ON F'ILEt :='AT'ION # VIQDATE COURT BAIT, STAT LICENSE DTSPDATE ADD-DATB X000814459976 06/28/02 01301 041 P 29EU950 01/27/03 )6/12/1997-ODOMETERt 70,870 MITES ACTUAL MILEAGE :TT n,4 rn7•ri•, r14 04 �rir, ITS/cA;DUFidCFr 'i 07{1!)10.,..- FEP:6 ZZd Wd87-:S0. 900F 8Z 'oaQ 2222 ZSz SEG: 'ON Xdd SAiJOM 1NIOd J,dH: WOJd Dec. 15 2006 05:24PM YOUR LOGO : BAY POINT WORKS YOUR FAX NO. : 925 252 2333 Mo. fHER FRCS I MILE 5 'AF:T T I ME__ USAGE TIME.., MODE PAGES PESULT 1 93351866 Dcc. 15 05:22PM 02'45 SND 08 OK TO TURN OFF REPORT, PRESS 'P'IENU' #04. THEN SELECT OFF BY USING '+' OR FOR FAX ADVANTMOE ASSISTANCE, PL.IASE CALL A-800-•F-ELP-FAX (435-7329). ZTd Wd8Z:S0 9002 8T 222E ZSZ SZG: 'ON XHA SANOM 1NIOd A09: WONj r - � O _sCD �' - f "A - 1. , 1 ✓i p. ej 4e/�l eul C. �T C/t. a kn s 7f Co m Tec � � a ✓ � �,�G1 h'1 i 61 LA T cy 2 Zd Wd6E:S0 900E 8I '0aQ 222E ESE SE6: 'ON Xdd SAIOM 1NIOd AUS: WMJ-d 1,4 e-It•K c 1- 6' e, 4' C/ - -2e /4"?y -X le w (7\11, t,�) le7 -s, 7L"-- Ile, (�Z( 4, ep r IL -9 -(. Ye 5� V-e r f rc " L Co tq 19 4-" Ze /J ae Ll r ct) (A� r k Fle �_ �`/ 1A, 1/1 cq 171 c. P, 0 k-11 0,19 oil bZd J�4 7L WCJGE:so 900E BT oz3cj 222E ESE SEG: 'ON XUA SA�JOM iNIOd JUg: WO�U 19 /� � � �.e.. it ,��- � � �•-��j�•�° 12 tle r f /e. tip. INS. 'fie I'-le, le. Icr ca �' 4- } "2 ej r A fa 4-Ij ZIL U.44: 4-Al ��_ Gtrr�z c._ � -f-. _. re rk- c/-e r fear e 10?el f7 ��-C f^_ C1. U. S K=� c�•n �- J 1� , �1"� �� h ^g 4 c.� ti-1 � '�� e... It..o (/62 I'll S 4-11 d! tA STcl WcJ6E:S0 900E 8T 07;(1 222E ESE SE6: 'ON XU-J SMOM INIOd Mg: WOaA cel tj 71 -17 0 I-A el o-le kip— r— 'WIlt k de ,d (,,t' r S"r L< 4-Z. ,S r e pt cy -e f S t 'iq v,'I e. , �r 44 q. -S I' go �� J, S-1 Aq evcl, C 1 ` - e , o ej kee W* S ra 12--t (P--S* j ct 9Td Wd6E:S0 900E BT 222E ESE! SM: 'ON XUJ SAaOm INIOd Aug: Sal s �- 5 —66 /1 C) T UNI) C'c, cre mac.f�,� � �/�f � u. c t. � .S r� � 01,/,1 <3( .s, c o, 615`7/ 1 Yr, x-- -; 5 e.s ovk Irl t-'L T 61 V, e-.-, e,,e Y-k i- lo-L) d�11 C9 er �� res .,5 > -te C 2-T,J WdO�:So 900?, eT 'Oa(I 222E ESE SEG: 'ON XUA • SMOM iNIOd Mg: WMIA f14 V i 6r, C? I 4 ' cl f r. r-.e eq CA Pl r. ep is-% e -vs oql i me(l /41 _ %0l (4t1Y`,5 v) f I/ tA, fe. Cl A9 C 4 `14 e- 71c, ki ern 0 C/ t� --ter; ( ��r� .. 0 ZVI ,Ilho Sid Wdo�:SO 900E ST 222E ESE SE6: 'ON XUj SAaOM iNlod AUg: Wodj - /', ly 5A 1 l A9 % CIN d'I'Y- eel C �. e. -11 t't, c6 4 T /,o (,J m f o N� .. �?,e a,re' �c.. f •f��. 1�e l �./ .. CCSB rei/ y J .t rq S . 't/ C. o t'.... /0 ` ,3 77 t " .5,X t-f I o r f J P C .... {l 4^1 'tl�. C3.... L Y' C� !p C ! i �t.•� �"/t '�/� � J ciI J�� ty `" 1 .4 f t4. 1'y It lr i r9 ;^ C.� E d 1�f.� G ? (�trC' t 61d Wd02:S0 900E SI as 222E ESE SZ6: 'ON }skid SA81M 1N I Od AHB: WOZId roe i-li �� rle- A le 71L ct e� W7 5 t-L rL C q /W m a dg Iz 4,e r 09 4, , ms C: �� ` Y, �--4l ley vtl- re,7 ..f U �, � � ZI Z4 OEd WdT2:SO 900?- BT '0;3(1 222E ESE SE6: 'ON Xd-d Ski OM iNIOd AUE: WO�U Alt z cc) OK 6X, 14 � s h/Y gv 7 .1 or t aw x `` ' aw fie, `! o y,''{ vi �? v * 5y1L, _.� t � � j/)/ /�• � t" .� ,JJJ � Ir`\. �Jq j/ J/� /,�r�� ( /� cb t`may' 1. A +0 te f V\ y fe- a� V.\- ' JI UT Y-k ��d WdT2:S0 9002 ST 'O;gQ 222Z ZSZ Sz6: 'ON xbd SA1JOM 1NIOd Ma: WMH OFFICE OF THE COUNTY COUNSEL �, SILVANO 13.MARCHESI ---• '=�. ^�U COUNTY COUNSEL COUNTY OF CONTRA COSTA Administration Sulldin 651 Pine Street, 911' Floor t r.- `�_-'`''"_ =_;��.* SHArON L. ANDERSON '' f * �- Martinez, California 94553-1229 ;'�'� � 1• CMIEr-AsSISTANY (925) 335-1800 GREGORY C.HARVEY (925) 646-1078 (tax) �1 .., a:o=== � ' VALERIE I. RANCFiE AssmAws NOTjCE O . FICIENC.Y ANll OR NON-ACC EPTANCE OF CLAIM _- 'U � �. TO. Michael K. Harrison �- (� O�}(/� 1061. Clearland Drive .v Bay Point, CA 94565 " f� RE: CLAW OF MT.CHAEL K. HARRISON 7 � 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 GovemiaLent 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 elate,place or other circumstances of t]ie occurrence or transaction which gave rise to the claim asserted. [ ] 4. The claim fails to state;the namne(s) of the public emnp)oyee(s) causing the injury, damage, or loss, if known. [ 1 -5. The claim fails to stag whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim fails Lo state the amnourmt claimed as of the date of presentation, the estimated i mount of any prospective injury, damage or loss so far as kmiown, or the basis of computatiomi of the amount claimed. [ j 6. The claim is not signed by the claimant or by sone porson on his or her behal,l: [ ] 7. You are requiredto scibmnit your claim on the proper form, which is enclosed. Please resubmit your claim on the enclosed form, h3cluding 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. Td WdEE:SO 900E SZ 'oaQ 222E ESE SE6: 'ON XUA S1iNOl'1 1N I Od .da: W0�{-1 CREDIT BUREAU ASSOCIATES PO BOX 150 460 UNION AVE - STE C FAIRFIELD CA7.TFORNIA, 94533 ACCOUNT ITEMTZPTION PlIONE-. (707) 429 3211 DEC 14, 2006 11:11 ---------------------- - - --------------- VIC' -5 V/ Jen MICHAEL KENT HARRISON 1.061, CLEARLAND DR BAY POINT, CA 94565-2268 -------------------------------------------------<FOLD I4ER9>------------------------------ ------------- 27 < VA THE FOLLOWING :I'S AN ITEMIZATION OF YOUR ACCOUNTS AS OF DEC 14, 2006 PLEASE RETAIN THIS COPY FOR YOUR RECORDS, FOR YOUR CONVENIENCE WE HAVE INCLUDED ALL INTEREST PAID LAST YEAR AND THIS CURRENT YEAR TO DA'I'S. N 0 T I C E THE FEDERAL LAW REQUIRES WE INFORM YOU THAT THIS IS AN ATTEMPT BY A DEBT COLLECTOR TO COLLECT A DEBT. ANY INFORMATION OBTAINED WILL PE USED FOR THAT PURPOSE. Ed WdE?-:SO 9002 ST -3z3G 222E ESE SF-6: 'ON XIJ-d SAJOM iNIOd AU9: WMIA ITEMIZATION CONTINUED SINGLE ACCOUNT: HARRISON M;1=CAAEL KENT DEC 14, 2006 DESK: 02 ACCOUNT #: 502363 CLIENT DEBTOR #: 2EEU950 DESK: 02 OUR CLIENT NAME: EAST COUNTY TOWING; ROR: 87 MERCURY SABLE INTEREST AT: 10% FROM DATE: OF SERVICE. DATE OF REFERRAL:08/15/06 DATE OF SERVICE: 07/20/06 DATE OF LAST PMT: AMOUNT REFERRED: $ 2165.00 PRINCIPAL BALANCE: $ 2165.00 ACCUMULATED INTEREST: $ 0.00 OTHER. CHARGES: $ 0.00 COURT COSTS: $ 0.00 ATTORNEY FEES: $ 0 .00 OTHER- $ 0 .0 0 INTEREST: $ 86 .60 ACCT BAL: $ 2251 .60 PAYMENT TRANSACTION HISTORY TYPE DATE PAYMENT PAID ON PATI) ON PAID ON PATD ON PAID ON PAID ON AMOUNT PRINCIPAL INTEREST OTHER CHGS COURT COST ATTY FEES OTHER *NO PAYMENTS THIS ACCOUNT* c;:ZAND TOTAL 0 .00 0.00 0.00 0.00 0.00 0.00 0.00 TOTAL DUIE ON ALL ACCOUNTS 2251-60 60 TOTAL INTEREST PAID YOR 2005 0 . 00 '1'0'IAL INTEREST PAID TO DN11 FOR 2006 0. 00 2d Wcj2E:S0 900E ST aQ 222Z ZSZ SZG: "ON XUA SAIOM 1N I Od A09: WO�JJ . FROM :BAY POINT WORKS FAX N0. :925 252 2333 Dec. 15 2006 05:23PM P4 1 _ V 'r. dQ fJ� � �s E d r a!c a IA O G a �c"i c y F j rHr s r / L.n 4 c ? o E c �� a� N � (] m r :U C � YI � W C]' ✓� Q G V7 rg� V O.C. G Cr) Nm N aU2d H u EGSL_. cH1O �� �F "C'- a C En 0 d y� ry 4 W Ff pi �"' (0 m G � Q1 W^+y;,«: ' z r la•�v " o p Y .aCu ti n7 y�+ In.� v�i� 1•" ¢ OC Gl A Qy W !w- N oma: V d A CL C: -5 V oor E _ J 2��d�E N. •�.- � gym ' Z 1 .� LnGa C• u s E z a O o p n` �, ❑ b Co• W ti ed,y a o LU V tV a O O odi O 'er R W Co LL N m c � i•i � h{ � � �� a 5 �� aGjli Ln aEH c ko H p ri Cf QI ;z—m La Q W CM 'Re a a A G J O LL E T C4 m o N o 3 a LLl V rn a o a) O v m�-..- }�� Ca .a p `o d -a.12 m y d w o m O of a14 N yy Ln it 0 �( H L!} {a "' 7g� a , div 3'.� N Y Gd kbm W. ..N - '.\ i aiz izm tE � y�a u� C Ln O In so N ,'�o� S c u u, v i. cN d Wy r� s CO l0 ` a N W c •^ �7 LO Y y sqm e No ja U1 i-� lO p O � u O O w O°�o. `tn W P pQ al p�fLl k }�` o.o a. = v = " r a9 Z � 5 d .oc Z 2 Z y a g °�ti!q O O Y mE y v d a 'Z Qin m , _ _I•. LL C r U s ,� O IUUJ �2 O d W t� O V7 rJ o V d o a+ xV s0a a0to N d a 3 0 .� ja �T n= = •" o w y p m O m CC C� it y W LLQ LV q LL w O z > Cfro C -FROM :BAY POINT WORKS FAX NO. :925 252 2333 Dec. 15 2006 05:23PM P5 �,u-.t,•,.:.� ..�..u��a�...s:�,s.� ...o�;ooc.u=-�#;�;�rl:�r��xsi.ui •��,� b„ib;, •:�.��«• ,.,u.,.L:,•:�;�•.. ,. 51!)Vzrllx riVa DY SHIM OLs'OL SHELM40.Q0-L66T/zT/90 EO/LZ/TO OS6naaZ d TI'o ToETO ZO/8Z/8o 9466sb6Ts000s a1VC1_aC[y asvadsxa asxaoirl sVss gtva LKQOa 9J.VaOIA # NoT zvaiD a g'jILi NO 5HOzsY7101A 0NIX-dVd CIUld xaaxa0 7-I.NO ISM-1 SV xOI.La36SNT OOIS £0/LO/TT asdifiz5ax aws ,ao zzza (s)sa akmooa xo aauin6au aunivNois as2iTn�Sa23 ST slvolalluao DONS gyiNxaT_S a sNQSvau SS230"dd HERMO ua,aSNvul =xOT.;,OKs&_*Cd,L oo•esz$ =alyd sass OT0040 1#R;manoH5/az 90/!W/ o falva xoTtDvsrz-,rd,z ounasssxd :aax.aao di-a �12I VIRI:'i 0095200°A 003ty OTOOLO!S/Ctl 90/PO/Vot(I UStO90 al'8 sSauGav E)xlriivw ON VO/RT/EO RXIa DONS Z6/60/LO .......--- -------,-._ ._,.........-..,.._ sniei$ pjooad— �.... 6 :R170:) JeUMp jesel L6/9Z/90 :penssl aieoijjijaO dILISAUM0 909V6 VO `aNV9NV0 OI JAV IS HILT 21 9Z6 £o/£0/j,o :panssl oleo)}lla2o uolieiislf3ald 2[,L,LJAr( 301NVt\MOUff :jaumo paaaislGeP ----,-. ---- (2 p o u m Q ---.—, 2701HEA gVIDI-deasIH 210 OInv = V :apo0 911d OMLIV ?IV7=921 = IT :adA_L esueolj ario 01ty = ZT :adA i 9F)"IaA lfclaKviv A To :Alunoo IV :sselJ J_fn L8/00/00 :ploS lsj'_� iso/ST/EO :sled uo1jej1dx3 OS6fk �Z :ON 9suaa�7 _..--• - uolieaislfiaa Zia D, Zm-cia5 a6 :IepoA ods_L Apoe s'ID.J DUolobz any ZIOTHaA 'Eaoxassrra = 0 :apo0 11nHIAP00 syf) = 0 :epo0 lan j/j@AAoL4 OE6GE9'dHvQosWRHKT :JagwnN a! 010149A 02I :e>IaA L8 :1eak IapOW U011 060a 0101'46A Z J.O T :plooay asps 6ZZ89 :# 81N/'.'gjQs Z_i -S9Si�6 '�1'O '�ti.C1�S�.LId IS RIOT M 065/50E8 x08 Od 90/6:/90 :aiep asuodsea MOaa AS MOD ,LS` E :aeisenbo, j OE6LE9VH"KIOSXsaWT :Isanb9U 9SU90II/NIA JOS N0UVAU0JNI NOLLVHIS03a T10IH9A AAA FROM :BAY POINT WORKS FAX NO. :925 252 2333 Dec. 15 2006 05:23PM P6 ..tt,i,:,u:�:.vn,l.tlli.: LU .n.lu,ru. , -.L`t.:.�:.:ssul'•1-�'In /.f; ���• . ��;i ilrl�r,('; :l,.c:.. ssalaaav 5XVIr�l ON enielg pjoosu Q :2poz) .19UM() 1e881 n�C 1 i 0WVf4l0CIA IQ'ZIWT AfifItl '1wWFA7 mini r q rr,t,r ,.,,,, •- 595176 V3 `, N10d AVH WE (lNV IUVal7 1901 90/W,vo :penssi eleoi;iliac u01jejIS1508 ,I„�( x 'j2jVH31X NOSIU'd II :JQLIM0 peJ81s060ej (slaaumo —_.. 31.)d'Id 2SHROT'T q-'f HXN0'dTAKH = rl :ap00 ali; oxriv UirinDad = TT :ed/\l osua01l a70 DI. V = ZT :adAj_ aloigon :: .'asso�.�ZC2I oo 4o..._.;Aiuno0 Z� ^sse��.d.1n..,r.. ;;.,... .46...._ d� 4100/00 :PIGS lSal:J GO/9T/EO :a,�E'CJ uortelydx3 _. 2iQ V xv(aRs =. Qb :18poW adhl Apo�l �I0�0?i0x0AI CC13K FgDIHEA UffolgZSSVd 0 :apo0 IInH/Apofl SfIJ = 0 :OpaO Iar1�/)aroo :l 0E6LE9V-9VlloS)gEMXT :aaqLun( !CIl.- 0lLI9A: :. O'dz I :8�1eW GB .... ;Aea/A IaPcW Z }o Z :tsaoaalq aseB - - - {+ZZ88 '!/ '')t'M11o5 Z] a 3 n N 11. N 0 0 0£6[.E9�lll3np5�78�tT :Zsanbaa GSUPOI-I/NIA a0} N0l-LVMI03Nl NOLLV8lSIE) H 310IH3n /QAC -ROM :BAY POINT WORKS FAX NO. :925 252 2333 Dec. 15 2006 05:24PM P7 IODpZ/E'�3lil d891'O�a (6681 JO wo,0•BJRMJj0SIB'MMM D G r, i �MO,I: �LN1100 IS4',1 X 90 0Z G0 „ yaa�i�a prJe an»sJ pa/�rnoid ovary/uorlawJo�u/s�/a�ayt a/u�n�ga��o alelg ay1 yo ship/ay1�apun.f�n/pad o.�1/euad�epun./�u�as A 3GQl du3LV1.9 Alin 6;311000'L11NIS t > NOj1V�1311N30 tl36WfIN 3NOHd31311 tl38WnN 301Aa35 N011tltl19.lg3tl� � ,,,�.,,�, ,,,,,„��,,;,,,.,..t e�.,,,.,..,.., „(7AyYN1NlNdl UlU10NN311 H03 ONIL]r 1N3otl 59sb6 �� �itnssss�Ia IS xr.,ot M 065/SoEe xoso�i J01JU d12 31`f1s A11U SG301V 13JULS -- uimm iNONd3131 IlA'kAU aWv'�S,U301n,Lv111 y. — '.�.L!r'0 37I/S 3H.(�0 SA II4 N3311/�N/Hl/M�1If/0.�S/Nl�0 AdO�Q'�1�7dl�YQ�d N1IM AWl7 Ol 0�11/lYBAS;<S�Sn`S/53,y�SS3,7X3'. ................---."".(E ONV Z 10IMI 0NIW l 3NI11.S33d SS3JX3 'V S ................ ..................................................... ...SN011V101A 9NI)18Vd 'C :,...... ...(Q HonDdH1 V OOV)Z 101V101 —oo OG $ W$ 0330XI IONNV0)ONI.113S 30:.500'0 S03300ad ONV �., — $ 31Vs No11inV 3NJ, ..... ,""'sj31vd3a 'a 00 ops i $ .... ......,,,39Vl1GIs.a 00 5b2: ..........Man-V :3j13M S1S03 ONV 0N11119 31-117 --- — �. .....................................................................:ao3 alOs SVM 313IH3A 3H1'( y . - •A(uo'z'�equ)nil:exoldwd�;'�Iaploynajj Aq peulela�elol>Ilan;1':d3fl70liN311 OA 310N -5 _§_9 b u fi0 �?L141 S,I.L I d LeeA Aan uleny� dlz 4 LVls All' 9 0 Q Z LO _ _ •T tS I;,T.OT M 06s/SOti=43 XOE Or: 31Vsj0 S9aw0Y 31V01311H3O ;uo pins MO ^A,LM03 ISYS T, sr,An alalyen paglJasap annge 041 3WVN 111W MIDI s,ulAne SSTs i.,o o_0 ()_ 1 1 boot #031311 N3,_3 ('payaello ey isnw laegs Uui1sil jelsod Jo sI 1—d;aosa(eisod) — •610613011 ayl 01 Joud shop LV 01 lE'AWO pue'salped pejsaJalul'snumn 1eBal pue p6JalsleeJ ay101 palieul 31VS sNION3d eJBm an111sodd0 10 sucilvalaeQ BLl(AuHdWoosB'y1jJVt'alg$'Blir�tra o saajloN"r(p�1103178s'bp0'J 11A70 jll!M'6911Bp10ssB Ul' ( '" '"'"""30'39t10N 'payaell� eq"lsmu(o1el��nJ o so)16010113!;o 0600161�a 1ue�ua pn•lanoa ayi�oAdU3 pal RIR a ao(pue AWq WOJI 1310000 elo!gaA 3ION 'pai:lnpu0o sem alas ey1 aJ01eq pasdEle enetl sAep LV-[C 10 Ieloj V•Se11Jed pels6Jajul UMOU t ou pue 6111 uo paao6J ou sl a.laq,l (� •aolAJas Inlssasansun jo 1ooJd J611e AN1Q w0J1 uolle211000V [� 'pa111 uoirsodde Ja110(s)Jasoddo aLp wail 1saJalw 10 asealaJ V [] I (Ytvn J1193/Ij.' -alas aqj gJim peamid al juawa5pnl pnoo aq;10 Ill ppylaaa V G 31VS N111 J.anaN01 ,ales ua!I slyJ ouaptloJd AWL7 tuoJJ aapou panlaoaJ 91 A.tij30Hlnv IOU eney I•sAep l,q ueill aJow Jo sAep LF Lleyj Ha1 lou palonpuoo sem ales ayl'AW0 pue(AWO woJ1 poulelgo(lnolu!Jd)pJaaaJ 610lg6A pay!1e112 eq1 uo palslp saljJad p6lsaJelul'sigumo 1e9e11pwajsloul B41,01 pel!ew eJam,ales lfulpuad 10 seopoN 841 Jeliv M :sl ales 130!1 slLll lanpuoa o1 A11Japlo Aw'ZCOE uopaS apo0 11A13 t11!M 00130/310000 131 90jbi/9090/6Y 90 90/bt/90 03M01 sd�1 11'11N3A 31 VO'21 591r 4imsen11 0,0439v.Mild V AO 03Y1U01+1r1V dt 04411dr4m 1.10 M3S do>ItlnM 31V0 30YUCIV9401AWS Vol 1191119 H3NA10 317rJ NO SS3SSOd All 11i.Nt 3NtlJ 1171t{3n atrC L861: A2iLl�,3�1?] .. 1A1N03110P.01.0YOHMM3N19N? 3dALAUn9 1f11UW MA 3YVW NOI��tdas�a 0£6LZ9d14tbR05Wa2W1; b0. 78 _b d:) I 0�6nu3Z 1 311 a OIH LNiAIU3ijwnNNutLV;1JIJN3N131UIHP i1rON011VU1dnW43111 uA>JIM1431tl15I u'.9v1nN18NAUII 1uawlJedap ayl.olyj?q1.(1aN)h1!IIgs1110 esealal3;lo.B�IIoN pajaldwaa a 1!ulgns'ales 40 sAHp c ulgl!m pus 1(s)aleld adsu@oi s aianlen aqj AOJlsop pue anowoJ'8131tlaA C 10 RIES eyl Oul.Ana110 j'emp ales wall ay1 uo algeAod pue arlp awaaaq salljeuad pue seal uo11E11316eJ IIV':aAnq 0t11 01 sw.101 1j10q aAl; pup,alEs p)lip E alaldmu'am1n1 a111 lH MOS SI 8191(14A 041 U04M 'U0110aS 91E$jt)a1P01j11J60 aLl1 UO pa1e01pU1 JaAnq Dill salLJoOag J6111011LIa11 0111'p?ARM Lou sena p1q Bu1A 111Enh [ asneaeq P1os 1013 sl 81.11119A ayl jl'6001 ssa lxa Aue 411AA AWC 6111 01 ljwgns of Aduo a ulalaH'JaAnq ayi 01 6AI8 pue w101 spi a161dulna A161e11)?ulun'UollOnp,1e Plus 31 21:114aA a uayN ;H3010HN311 Ilii 0 L :1101' R1C-ZFZvs VO'oiN3V4VdovS (ZLOC 3003 IIA13) ctCUSX08•o'a ss3i ao 000t$ 1v a3men 3131H3n U0J 1103111801 31VS N311 30 N011VO1311H30 s ZCt,: FROM :BAY POINT WORKS FAX NO. :925 252 2333 Dec. 15 2006 05:24PM P8 Michael K. Il.an•ison Re: Claini of Michael K. Harrison Page Two [X] 8. Othcr; Please provide the date the car was towed. SILVANO B. M kRCT:CI;SI COUNTY COUNSEL. Jf Motiilta L. Cooper. Deputy County Counsel CERTIFIC'A' E OF SERVICE BY MAIL (Code Civ.Proc., 1012, 1013a, 2015.5; Evid. Code, §§ 641,664) T am a resident of'the State of California., over the age of eighteen years, and not a party to the within action. My business address is Officc of the County Counsel, 651. Pine Street, 9th Floor, Martinez,CA 94553-1229. Can December 14, 2006, I served a true copy of this Notice of insufficiency and/or Non-Acceptance of Cla.ilrf by placing the document in a sealed envelope with postage t1ic-rcun fully prepaid, in the United States mail at Martinez, California addressed to Michael K. Harrison, 1061 C1ea.rland Drive,Bay Point, CA 94565, 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 he deposited witli the T.J.S. Postal Service on that same da.y with postage thereon fully prepaid in the ordinary course of business. I declare under penalty of perjury under the laws of the State of Califort).ia and the United States of America that the above is true and correct. Executed on December 14,2006, at,Martinez, California. Kathleen O'Connell cc: Clcrk of the Board of Supervisors (original.) Risk Management Page 2