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HomeMy WebLinkAboutMINUTES - 01162007 - C.5 (11) 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 ref ?,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 �eD 1 8 m Supervisors. (Paragraph IV below), cc given Pursuant to Government Code AMOUNT: $2 , 606 . 25 o L Section 913 and 915.4. Please note all "Warnings". CLAIMANT: 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 MAIL POSTMARKED: MANAGEMENT FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, Cl Dated: DECEMBER 18 , 2006 By: Deputy A444-'voc— IL FROM: County Counsel TO: Clerk of the Board of Supervisors ( 0,4his 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: f ���a� By: Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) O Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: (vf This Claim is rejected in full. O Other: I ceilify that this is a true and coi7•ect copy of the Board's Order entered in its minutes for this date. Dated. �Iaw HNCULLEN, CLERK, By Deputy Clerk WARNING (GV code section 913) Subject to certain exceptions,you have only six(6) months fronn the date this notice was personally served or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney,you should do so inuneciiately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING declare under penalty of perjury that 1 ann now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. DatedL< JOHN CULLEN, CLERK By Deputy Clerk BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY SHARON HYMES-OFFORD INSTRUCTIONS TO CLAIMANT DEC 1 d 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 .name of the District should be filled in. D. If the claim is against more than one public Pnti-ty, 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 fora. ■eaaaJIM asoon aeeeaaaan■ ■■aaeaasaaaaamONaaeeeceaeaeaecaaaeaaeeeuee�aaaaieaeeeceai RE: Claim By: Reserved for Clerk's filing stamp Against the County of Contra Costa or ) DEC 1 g 2008 District) C`ERE{ (Fill in the name) ) CC,v7Rq CCS ACRVISORS 0 The undersigned claimant hereby makes claire against the County of Contra Costa or the above-named district in the sum of$ 2-"� , 2 -1> and in support of this claim represents as follows: 1. 'When did the damage or injury occur? (Give exact date and hour) ©6 i'1-2-00 Sit -x'��Ic -*'cc 404�N 2. Where did the damage or injury occur? (Include city and county) 0,4$c3 di e G A., CvL;,-,Q4 Otis-t.Q 3. How did the or in damage occur? (Givefull details;use extra paper if required) Jam' o 11 '1 im. roti Ac— �c a�:N +2c�. W �E'bvt�;?�C3 '� • cc,k��.sc� s�-caOEN`�j ��At�`� K.e�1;+�6 66�C�c.�1�r� GNC�� �i�nTEQs�`'01► A-Nd (/l�} F..tc� CSR. 4. What particular act or omission on the part of county or district officers, servants, or enzp ogees caused the injury or damage? ' �6-"G v.>i�L•0�< CONsFC r;rG �� G�-Rs S nG- 5 What are the names of county or district officers, servants, or employees causing the damage or injury? a �`"'°"�T �'��-� _ stv OT- \J�No CAkc- ANP KADC- \h- NRuC T 0 RE&C 1r.�+;\ves E ' amu.) 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage awc) Feu&J�� a Na 7. How was the amount claimed above compute c (Inlude the estimated amount of any prospective ivnijuiy 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 TIIyIE AMOUNT son BROKEN gas sea■■[■■[■[■■ [ KMIala■[[■[!![[a■a[a!■[e■[[[■[[a[[[[■!eu[[![■a■■[■!a!■[a■■[ .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 Sign -e-)- 90 (Address) g6C( Telephone No. 5�o — 75g 4S io`1 Telephone No. ) P . ■■■[■■■!■[t[a■■■Max■ONES■ ■ ■ ■■■!■[t[[!■!!■■[!■!■[[[■f[■■■!l t!!!■![[t[■Mann saw anal sagas PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthermore, any attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■ ■■[[[[[[[■a![[[■[■ Manus ■ ■ awl miff aEvans Kansas man lux[■■■■■[[[!■■[■[■!!a■a■■[ man mass roast 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. 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: 1.51-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-A01 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-A02 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-A01 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: 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 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 II. 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 II. 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