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Home My WebLink AboutMINUTES - 01162007 - C.5 (12) CLAINI BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY • 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 refer� � The copy of this document mailed to California Government Codes. ` you is your notice of the action taken on our claim U the Board of Y Y DEC 13 2006 ` Supervisors. (Paragraph IV below), COUNTY COUNSEL given Pursuant to Government Code ANI.OUNT: $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 TO CLERK ONDEC. 13, 2006 DISCOVERY BAY, CA 94514 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, rk Dated: DECEMBER 13, 2006 By: Deputy 11. FROM: County Counsel TO: Clerk of the Board of Supervisors (0--This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should 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: /.;?-/ c/ren& By: r" 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 unanimous vote of the Supervisors present: ( This Claim is rejected in full. O Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated s,. oJ.;;qIN CULLEN, CLERK, By eputy Clerk WARNING (G coM section 913) Subject to certain exceptions,you have only six O months from the date this notice was personally served or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING 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 I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: &t-s.v �/? OJOHN CULLEN, CLERK By eputy Clerk BOARD OF SUPERVISORS OF CONTRA COSTA COUNT' nNSTRUCTIONS TO ChA11YlAN-1 A claim relating to a cause of action for death oz for injury to person or to person2l property it growing crops shall be presented not later than six months after the accrual of the cause f action. A claim relating to eny other cause of action shall be.preseated not le.tea than one y after the accnlal of the cause of action. (Gov. Code § 911.2.) Claims must b-. filed with the Clerk of the Board of Supervisors at its office in Room 1 51 County Administration BuUdin.r,., 5551 fine Street,MT!-- ez,CA. 945 53. if claim is against a district gov,.zaed by the Board of Supervisors, rather than the County, e aarbe of the District should be filled in. If the claim is against more than one public entity, separate claims must be filed against Mh public entity. ?, Fraud. See penalty for fraudulent claims,Penal Code Sec, 72 at the end of this form. A■a■■aaaa as a a a A 11 an a ail a■as aaa a F a ria a as aa!I'm aa■IINA ME a as aaC aaa a aa;■a a at'Ra ISO: I a ZE; Claim By. Reserved for Clerk's filing stamp ) RECEIVED Against It County of Contra Costa or ) DEC 1 3 2006 A CLERK ASSESSMENT APPEALS BOARO District) CONTRA COSTA CO. (Fill in the name) )• The undersigned cla'irnprt hereby makes claim a,' inst the County of Contra Costa or the aboveru taed district in the sum of$__Z/ 10./.-2 and in support of this claim represents as follows: L. %Jen di4 thelLiruge or injury occur? (Give ea'act date and hour) 2. 'Where did the damage or injury occ ? gnelu or co ty) Rol 3. How did the damage or inj occur? (Give details;use extra apes if required), - 4. what particular act or omission oa the part of county or district officers, servants, or emP yea caused the.in jury or damage? y� /od f_ �/r1a i�% // p (X x,/P i!r S'e' 7O /®4 5 What:are the aures of county or ,,strict officers,servants, or employees causing the dwnaEe or injury? (:�C l TYat CvjT I-oa d I i d Db 'ON MA39MA Hld �� MR 'S 9002 'L 930 ;. 'what damage or injuries do your ctaim resulted? (Give full extent of injuries or danla s °'chain /� �A q-ch*two es6matas..for auto dams ge.) 7. How was the amount claimed above computed? Clnclude the estimated amount of y prospectiverydmdamage..) f�&�dc/X/�j'r-�GcuPij pQ-'�4 C1 �aw lln- F/ 40" 2.y" e; C ? L1% {cam li r r L� 8. N es and adresses of v itnes es,doctors, hospitals: 9, List the expenditures you made-on account or"flus accident or injv DATE TRY AMO t■a a c t t a l l a a a l a e a as l a a a E a a t N e a a a Resign l a a a a a a a Islas a 1 a a a a 1 a t a a a■a t l a l a a■a a a a e a @428 gel .Gov. Code Sec. 910.2 provides "The claim shad be sieved by the claimant or by some person on his )behalf." SEND NOTICES TO: (Attbrney2 Name and address of Attorney ) (Claimant's Signature) ) (Ad els) Telephone No, ) Telephone 1\70. a a a a a a a t a a a e t a a a a a u a a a at as R Kate a Romps ZROWER a along so s l/l e a t a a a a a l a a 1 1 a a a l WERE game medal 'PUBLIC RECORDS NOTICE: Please be advised that this claim farm,or any claim filed with th. Couaty undo the Tort Claims Act,is Sul ect to public disclosure under the uaItfom�ents ublic attache soothe e]aim forte including medical erecords, ere also u ec� attachments,addmdums, ors pp public disclosure. aowl Call•laaaBasuto*ease aaago ataataaaataaaaaaaeutataaaatatta ■asci NOTICE: Section 72 of the Penal Code provides: Every person who, with int--nt to defraud, presents fer al]ownce or for payment to any stale board or ocer, or to eny county, city, or district board or oincer, authorized to allow or pay the same if genuine, any a or fraudulent claim, bill, account voucher, or writing, is punishable eithne er by imprisonment iu the County j for a period of not more than one year, by a fiof not exceeding one thousand dollars ($1,000.00), or by b such imprisonment and nne. or by imprisonment in the state prisoa, by a fine of not exceeding ten thowan dollars (S 10,000),or by both such imprisonment and fin=. AIA39MA �SIb M WAo *s 9DR I '330 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