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HomeMy WebLinkAboutMINUTES - 01162007 - C.5 (14) CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 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 references are to ) The copy of this document mailed to California Government Codes. ENMF�m you is your notice of the action taken on your claim by the Board of DEC 1 5 2006 Supervisors. (Paragraph IV below), given Pursuant to Government Code COUNTY COUNSEL Section 913 and 915.4. Please note all AMOUNT: UNKNOWN MARTINEZ CALIF. "Warnings",CALIFORNIA STATE AUTOMOBILE ASS . 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 HAND DELIVERED BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is,a copy of the above-noted claim. JOHN CULLENA�W� Dated: DECEMBER 15 , 2006 By: Deputy II. 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). O Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). O Other: Dated: ��r� /� PrP By: /Yl 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). 1V. 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 con-ect copy of the Board's Order entered in its minutes for this date. Dated: \A�r»kM_e /` "�N CULLEN, CLERK, By eputy Clerk WARNING (Gov. ode section 913) Subject to ceitain exceptions,you have only six(6) mouths from the date this notice was personally seined or deposited in the mail to file a court action on this claim.See Government Code Sectiai 945.6.You may seek the advioee of an attorney of your choice in connection wide this matter. if you want to consult an attoi-iiey,you should do so immediately. *For Additional Warning See Reveise Side of'This Notice. AFFIDAVIT OF .MAILING I declare under penalty of pei jury 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: y' �,P JOHN CULLEN, CLERK By Deputy Clerk DEC-15-2006 14:44 CSAA LV1 702 270 3971 P.02 California State .automobile Association Inter-Insuranee Burmu P.O.Box 910 Suisan City, CA 94585-0910 December 18, 2006 Clerical Board of Supervisors Attn--Amy RECEIVED 651 Pinetrec room#106 Martinez,CA 94553 DEC 1 5 2006 RE: Your Insured: Scott Wortham CLERK BOARD OF SUPERVISORS Your Claim No.: UNR CONTRA COSTA Co. Our Insured: James H/Sharon B Patton Our Claim No.. 09-PB4522-8 Date of boss: 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, �y ri Ll ougnan Claims Representative II 888-582-3008 extension 7195 Fax 707-863-9052 Enclosure TOTAL P.02 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A claim relating to a cause of action for death 5°x mJury onths afterotherto personal,accrual of theperty or causeof growing crops shall be presented not later than �_� _ +, o =7,ear action. A claim relating to any other cause of action shall be.presen�eu not latae I aan ons after the accrual of the cause of action. (Gov. Code § 411.2.) 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 Supeiv-isors, rather than the County, the -name of the District should be filled in. If the claim is against more than one public entity, separate claims must be filed against each. public entity. ,. Fraud. See penalty for fiaudulent claims, Penal Code Sec. 72 at the end of this form. f!I I!III■[![I[![I■/!=l IN a M a K L K G T L[CC I C It I L I IN t[!G C G C C CC C C L L[[[■R!L![I[[!L[[L C I ZE: Claim By: Reserved for Clerk's filing stamp James Gr6n Against the County of Contra Costa or j DEC 1 5 ?006 District) C�ERKBOARr,of (Fill in the name) ) c�NT RA C s A�p V/SORB The undersigned claimant hereb,� ides clan against the County of Contra Costa or the above-named district in the sum of i I�� 1 and in support of thus claim represents as follows: 1. `Then did the damage or injury occur? (Give exact date and hour) 17- -55-06,o d ' s co v6re4 o f / .'. 00 Pm S+7101- 2. Where did the damageRR' X", ' occur? clud°city and ounty) No "Sa ` Na rt" �� S�er 3. How did the damage or injury occur? (Give full details;use extra paper if required) 5 h,er� fip� rn e One_ o�LFAe 1 r �ewpl©yeeS �.� f -Nib R°U r � 0 'a r tt;h /e C ,ole�r- Fn s-+-gi n Or i`n or orni.ssion on the art of coaty or district offices ser ants, o:employ eels , 4. ghat particular act P �j caused the injury or damage? .-T clOn 1'f )'n 010 S)Vr 'S 5 What are the names of county or district officers, sen�ants, or employees causing the I or injury? V n kn oLon m� qn sur4nC� `f us�r Of,-,P mho Spoke 6o)+�) 4e QmPloyee What darnale or injuries do your claim resulted? (Give full extent of injuries or damages b J �' Dt� Q� k f a)r claimed. -Attach two estimates for auto damage.) �I�SJ n. 00 Par hbrw e� ern oic-F. bl' l j G�qa I5 dll ho t- 4h Coon p sG" cf �cT�/IPS � l� � . rJ-' s�� . �� m s 7. How was the amount claimed above computed. (Include the estimated amount of any prospec ve ' jury or damage.) Q Q h u,S C-q' r uInPo ShnP and u, ► I ► &a ( co14h U( oLc Q� I �/ N 8. Names and addresses of witnesses, doctors, and hospitals: ` C6-r Jco-H G�D�-'��?Gat 13� lea !.t �'Q�min i 1 SUcs I o o o (,c,>o rd 5ifMhz 9y5s3 4a56 t/'�-46 Cl y O�1�e o-r� 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT 5 a a G t C G t[[C 9 G t t■[ [[E[t[a■a a■■t■■ ■[■[Is a[a■■ass am 3 a t■■a[■■K a■a a[a[Ina I a a t■■an a ME 5o 1 .Gov. Code Sec. 910.2 provides"The claim shall be signed by the claimant or by some person on his behalf." SNOTICES TO: (Attornev) Name and address of Attorney d U S - n -71 9 s (Claimant's Signature) q nna ncla- CCc)lema n } ��� S� I u a, -t ire ggSo (Address) la 1444 a Q- P915;z_-I-S ) Telephone No30 b 9 ) Telephone No. aRuss■■e t[tat[t■a■■a as I Me a MIKE[a a t N■c a a■a t t a a a[a t a[t[t[t[■■[[[■[[t t[[tet[[e e[[■[e[[1 PUBLIC RECORDS NOTICE: Please be advised that this claim form or any claim filed with the County under the Tort Claims Act, is subj eft to public disflosure 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 subjeft to public disclosure. ■[aaaaa[taaaatatacaaa■ataaaatNMI t■a■aa■tatttaa.aaa[tt[ttt[Ron[aat[[t[tanaits at[[[aaall 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. cavorwa swe Auf~bik Asso n /nttr-insurance Bwmu P.O.Box 920 Suisun City,CA 94585-0920 i December 8, 2006 James H/Sharon B Patton , 4306 Silva Street Antioch,CA 94509 Re: Insured: James H/Sharon B Patton Claim No.: 09-P84522-8 Date of Loss: 12/05/2006 Dear James H/Sharon B Patton: Thank you for selecting California State Automobile Association Inter-Insurance Bureau("AAA")for your automobile insurance. I'm song to hear about your accident,and I'm eager to help you through this claim. Our regular business hours are 8:30am to 5:30pm,Monday through Friday(Pacific Standard Time). You can leave a message for me at any time,and I'll get back to you within the next business day. Based on the claim you've reported under your policy,here are the policy coverage(s)and limits that could potentially apply to your loss: ❑ Collision Deductible $500.00 ❑ Comprehensive Deductible $100.00 ❑ Medical Payments $10,000.00 ❑ Uninsured Motorist $100,000.00/$300,000.00 ❑ Bodily Injury-Liability $100,000.00/$300,000.00 ❑ Property Damage-Liability $100,000.00 ❑ Uninsured Property Damage $0.00 We'I I cover up to$25 per day,but no more than$750,for your transportation you incur while your car is being repaired, or until AAA offers to pay for your loss. We've waived your deductible for this loss. AAA is committed to helping you secure quality repairs for your vehicle at a competitive price. I've included the following information,taken from the California Code of Regulations,to help you understand our estimate and repair process. We are prohibited by law from requiring that repairs be done at a specific automobile repair dealer. You are entitled U select the auto body repair shop to repair the damage to your vehicle. We have recommended an automotive repai dealer that will repair your damaged vehicle. If you agree to use our recommended automotive repair dealer, we wil cause the damaged vehicle to be restored to its condition prior to the loss at no additional cost to you subject to the provisions in the insurance policy by applicable law. F268K(Apr 2002) RO: 0014594.00, Detailed Customer Invoice Page: 12 11 06 11:01 AM Antioch Auto Body,Inc. 1401 Verne Roberts Circle Antioch.CA. 94509 Phone(925)757-3586 Fax(925)757-5246 BAR# AK2636169 EPA-H CAR000004440 MAUREEN PEREZ Date of Loss. 12;0506 CSAA-DOM 4306 SILVA STREET ANTIOCH,CA 94509-0000 Year: 04 Male: Chnsler Home: 925-779-9883 'Model: Sebring Phone: Work: 925-565-8606 Type: PC Fax: Est.: SERGIO Style: 2D Cone Adjuster: Received: 12.105'06 Color: RED MET Claim#: A09P84522801 Del. Date: License: CA 5MHU863 Policy: P845228 Date Paid: Mileage: 18.538 Betterment: VIN: 1C3EL75RX4N368678 Deductible: 500.00 Ln. Description Parts Labor Units Refin Units Other I Repair R QUARTER OUTER PANEL BL 1.00 Refinish R QUARTER PANEL OUTSIDE pl- 2.40 3 Rem'Inst R OTR QUARTER BELT MLDG BL 0.70 4 Rem Inst R QUARTER ADHESIVE MOULDING BL 0.20 5 Repair CLEAN&RETAPE S/MLDG BL 0.20 6 Rem Inst R QUARTER ANTENNA ASSEMBLY BL 0.50 7 Renvinst LUGGAGE LID SPOILER BL 0.30 8 Repair LUGGAGE LID SPOILER BL 0.50 9 Refinish SPOILER PL 1.00 10 FLEX ADDITIVE PM 700 11 R REAR COMBINATION LAMP ASSEMB PT 179.00 12 Rem/Repl RECOND.REAR BUMPER COVER PT 315.00 BL 1.30 13 Refinish REAR BUMPER COVER PL 2.70 14 HAZARDOUS WASTE DISPOSAL HW 3.00 15 Add Labor CLEAR COAT PL 1.70 16 Add Labor TINT COLOR BL 0-50 17 PAINT/MATERIALS PM 210.60 18 Pmts Discount/Markup PT -32.50 19 Rear Absorber PT 146.00. Totals 640.00 5.20 7.80 188.10 Total Category Rate Units Est. Suppl. Total LABOR:BODY 57.00 5.20; 296.40 296.40 LABOR:PAIINTT 57.00 7.80 444.60 444.60 MTL:PAINT 217.60 217.60 PARTS:OEM 461.50 146.00 607.50 HAZARDOUS WASTE 3.00 3.00 Subtotals 13.00 1,423.10 146.00 1,569.10 SALES TAX 56.02 12.05 68.07 Grand Total: 13.00 1,479.12 158.05 1,637.17 County Administrator Contra Risk Management Division Costa 2530 Arnold Drive,Suite 140 Liability Claims (925)335-14 Martinez,California 94553 County Fax Number (925)335-14 10 December 11, 2006 -- ' 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, 4tAPenny Bailey Liability Claims Adjuster (925) 335-1455 Enclosure