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Home My WebLink AboutMINUTES - 01232007 - C.9 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUN"1'Y � BOARD ACTION-. JANUARY 23, 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 ) Thecopy of this document mailed to California Government Codes. D 19 you is your notice of the action taken on your claim by the Board of DEC 2 8 L006 Supervisors. (Paragraph IV below), given Pursuant to Government Code COUNTY COUNSEL Section 913 and 915.4. Please note all AM0UN"1': OVER. $10,000.00 MARTINEZ CALIF. "Warnings". CLAIiV1AN'.l': JOHN AND AMY COLLEN, individually and as guardi-ams for SAMUEL COLLEN, A MINOR DEC. 28 2006 ATTORNEY: TIMOTHY':M. HAMILTON DATE RECEIVED: ' WALKER, HAMILTON & WHITE ADDRESS: 50 FRANCISCO ST. , #460 BY DELIVERY TO CLERK ON:DEC. 28, 2006 SAN FRANCISCO, CA 94133 DEC. 26 2006 BY MAIL POSTMARKED: ' FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DECEMBER 28, 2006 JOHN CULLEN ler Dated: By: Deputy 11. FROM: County Counsel TO: Clerk of the Board of S ervisors (L�Xrliis claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). O Other: Dated: �`� � By: /-Yl 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: ( This Claim is rejected in full. O Other: i certif, that.this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated. .,e.A/y -OZ N CULLEN, CLERK, By Deputy Clerk WARNING ( code section 913) - Subject to certain exceptiats,you have only six(6) months tibm the date this notice was pe�sonalh se��ell or deposited in the mail to file a comt action on this claim.See Govenunent Code Section 9,5.6.You may seek the advice of an attonicy of dour choice in connectim widi this matter. If you want to consult all attorneN,fou should do so inuuetliatelN,. For Additional NVaniiitgSLv Reverse Side of"lliis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am no-,i, and at all times herein mentioned, have been a citizen of the United States, over abe 18; and that today 1 deposited in the United States Postal Service in Martinez, Califoi-nia, postage fully prepaid a certified cope .of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Datcck*! a,,-JOHN CULLEN, CLERK By DepLity Clerk DEC. 19, 200E 2; 26PM CCC RISK NANAEMENT Nle, 510 P. 2 BO AIW.OP SUPERVISORS OF CONTRA COSTA CO= INSTRUCTIONS TO CLAIMAn A claim relafito a cause of action for death or for injury to person or to personal property or growing crop shall be presented not later than six months after the accrual of the cause of action. A clai m relating to any other cause of action sW be•presented not later than one year . after the accra d of the cause of action. (Gov. Code § 3, Claims mustbe filed vaith. the Clerk of the Board of Supervisors at its office in Room. 106, County Admb istration Building, 651 Pine Street,Martinez,CA 94553. �. If claim is t a district governed by the Board of Supervisors, rather flans the County, the nzra e of the 'ct should be filled in. D. If the claim against more than one public entity, separate claims must be fled against eacb- public entity, S. Fraud. See p salty for fraudulent claims,Peal Code Sec. 72 at the end of this form,. ■Aft l i/t ii tl IN/t It tt9 WR 9ttttR It X•SIX itst[[ittt■tal t RICRARt t t t AN Lt It l Rt R it ttt t t at Its K RE: Claim By: John and Amy Callen, Reserved for Clerk's filing stamp individually and as guardians ) for Samuel Collen,• a minor Against the County of Contra Costa(9x and ) DEC d 2006 Contra C(: sta Health Servides , ) Martin.es Family Practice CDistrict) CLERKBOAROOFSUPEI-I'IGUORS (Fill inipfif,2LE) o. Co. Reginmona_ Med.)- CONTRACOSTACO. Center, ealthy Start, K. Katz n M.D. The undersigned elf hant.hereby makes claim, against the County of Contra Costa or the above-named district in.the sumo $ over and in support of this claim represents as follows: ]_O ,000.o 1, When did th damage or injury occur? (Give exact date and hour) Please refer to Addendum 2. Where did tile damage or injury occur? (Include city and county) Please refer to .Addendum 3. How did tht dame or injury occur? (Give full details;use extra paper if regvlzed)P l e a s e refer to Addendum 4. What'parti Lr act or omission on the part of county or district officers, se-wants, or employees caused the 'u'-y or damage`1 Please refer to Addendum 5 'What are names of county or district officers,servants, or employees causing the damage or jury? Please refer to addendum DEC, 19. 2006 2. 2/PM CCC RISK MANNGEMENl NO. SyU r. 5. What dam e or injuries do your claim resulted.? (Give full extent of injuries or damages • - •claimed. -A tach.two estimates for auto damage.) - Please refer to Addendum 7, How was hD amount claimed above computed? (Include the estimated amount of any piospec,6ve injury or damage,) Please refer to .Addendum 8. Names.and addresses of witnesses,doctors, aad hospitals: please refer to Addendum 9. List the al enditarts you made-on account of this accident of injury: Please refer to Addendum DA M MJB •Al FOUNT aatatamaw 9a■aa■ Ran x Ina I IRK K Is a Ks a a Iva am 0 xxv a W as a Sawa NNE I PC it*9 0 2 as UK I a W a am am=4 as as awarl ) -Gov. Code Sec. 910.2 provides"The claim shall be ) signed by the claimant or by some person on his behalf" SEND NOTICESCO: (Attorney Name and address of Attorney ) `�' Timothy Y . Hamilton. Walker, Eanilton & White) (Claimant's Signature) 50 Francisco St. #460 San Francisco, CA 941.3.3) J�q,WatA, tonel 41.5-986- 339 ) enlace, San RAmon, CA 94582 (Address) ) Telephone No. )Telephone No. ■.taw NNE■aaw■ca It 30115 WX 0 9 X Is JW XVvtJw XEKvUZvm1wvW Raw wart Evans W son max NwXJ1KxZn x gig OR Ron Sawa atsmi PUBLIC RECORDS NOTICE: Please be advised t at this claim forms, or any claim filed with the County under the Tort Claims Act, is subject to r*.is dLsclosure i nder the California Public Records Act. (Gov. Code, a§ 6500 at seq.) Furthermore, any altacbment s,adde ums, or supplements attached to the claim form,including medical records, are also subject to public disclosure, ■IN a r a a a a a a a t a ■al 6 w a w w u r a MEN 1■c w t a a a a a a a a■now■an l a a w w a a■a a w w■■a a t a a■rasa it awn■a a a w r a a l NOTICE: Secrion 72 of the nal Code provides: EYery person who vrith intent to defraud, presents for allowance or for payment to any state board or o£ti=, or to any cormty, ci , or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account`rancher, or waiting, is punishable either by imprisonment in the County jail for a period of not mo than one year, by a fine of not exceeding one thousand dollars ($1,0D0.00), or by both such imprisonment an fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollar ($10,000),or by b Ah such imgriso=ent and fine. I Timothy M. Hamilton, Esq. (SB #90270) WALKER, HAMILTON & WHITE 2 50 Francisco Street, Suite 460 3 San Francisco, CA 94133-2100 Telephone: (415) 986-3339 4 Facsimile: (415) 986-1618 5 Attorney for Plaintiffs 6 John Collen & Amy Collen individually 7 and as guardians for Samuel Collen, a minor, 8 Claimants, 9 10 V. ADDENDUM TO CLAIM 11 The County of Contra Costa, Contra Costa Health Services, The Martinez 12 Family Practice Center, The Contra Costa Regional Medical Center, Healthy 13 Start and K. Katzman M.D. 14 Defendants. 15 / 16 17 1. When did the damage occur? - July 2, 2006. 18 2. Where did the damage occur? - Martinez Family Practice Center, Contra 19 Costa Regional Medical Center, Martinez, CA. 20 3. How did the damage or injury occur? -Amy Collen was pregnant with twin 21 boys in the winter and spring of 2006. She is a librarian for Contra Costa County 22 and her medical care was provided by the Martinez Family Practice Clinic and 23 other Co. Co. Health Services providers. Among other things, she was 24 negligently allowed to go into pre-mature labor and delivered Noah and Samuel 25 on July 2, 2006. Noah died several days later. Samuel stayed in the hospital for 26 Collen v.Contra Costa County,et al Addendum to Government Clain Page 1 of 4 I five months after delivery and will likely suffer life long injuries as a result of the 2 negligence of defendants. 3 4. What particular act or omission on the part if county or district officers, 4 servants, or employees caused the injury or damage? - On or about July 2, 5 2006 and prior thereto and thereafter, claimants engaged for compensation the 6 services of defendants, and each of them, and at or about said time, defendants, 7 and each of them, undertook to examine, diagnose, prescribe medicine and 8 drugs, and handling control of care treatment of claimants. In the aforesaid 9 10 examination, diagnosis, prescription of medicines and drugs and handling and 11 controlling of the care and treatment of claimants Amy Collen and Samuel 12 Collen, defendants, and each of them, negligently failed to possess and to 13 exercise that degree of knowledge and skill ordinarily possessed and exercised 14 by other physicians, surgeons, hospitals, nurses, nurse anesthetists, attendants, 15 aides, therapists, technicians and the like, in the same or similar locality under 16 similar circumstances as the said defendants, and each of them. 17 5. Names of county officers, etc., causing the injury? - E. Katzman, M.D. Other 18 names are not known at this time. 19 6. What damage or injuries do you claim resulted? - John and Amy Collen 20 claim wrongful death damages for the wrongful death of Noah Collen. John 21 Collen claims damages based on Thing v. LaChusa, for witnessing, as a 22 bystander, the injuries to Noah and Samuel. Amy Collen claims emotional 23 24 distress damages based on Burgess v. Superior Court. Samuel Collen has 25 sustained injuries to his body, causing emotional distress, pain, suffering and 26 Collen v.Contra Costa County,et al Addendum to Government Clain Page 2 of 4 1 anguish, all to his general damage in a sum in excess of the jurisdictional 2 amount of this court. Samuel has also incurred and will be caused to incur the 3 cost and expenses of hospitals, physicians, nurses, aides, attendants, therapists, 4 X-rays, drugs and other related medical expenses in an amount which is 5 presently unknown to claimants who pray leave to insert herein when the same 6 are finally ascertained. Samuel will also be prevented from attending his usual 7 occupation, for an undetermined period or periods of time, all to his damage in a 8 sum unknown at this time, but which claimants pray leave to insert herein when 9 10 the same are finally ascertained. 11 . Not applicable. 12 8. Names and addresses of witnesses, doctors and hospitals? - E. Katzman 13 M.D., various county employees and agents who treated claimants at county 14 facilities as well as other hospitals. Please refer to medical records to find these 15 names which are too numerous to compile here. 16 9. Expenditures? - Too numerous to list here. 17 18 DATED: December 22, 2006 WALKER, HAMILTON & WHITE 19 20 By: Timot M. Hamilton 21 Attorney for Claimants 22 23 24 25 26 Collen v.Contra Costa County,et al Addendum to Government Claim Page 3 of 4 1 PROOF OF SERVICE 2 Collen v. The County of Contra Costa, et al 3 4 My business address is 50 Francisco Street, Suite 160, San Francisco, California 94133. 1 am employed in the County of San Francisco, where this mailing occurs. I am 5 over the age of 18 years and not a party to the within cause. On the date set forth below, I served the foregoing document(s) described as: 6 CLAIM AND ADDENDUM TO CLAIM AGAINST THE COUNTY OF CONTRA COSTA, 7 CONTRA COSTA HEALTH SERVICES, THE MARTINEZ FAMILY PRACTICE CENTER, THE CONTRA COSTA REGIONAL MEDICAL CENTER, HEALTHY START 8 AND K. KATZMAN M.D. 9 on the following person(s) in this action by placing a true copy thereof enclosed in a 10 sealed envelope addressed as listed below. 11 [X] BY MAIL I sealed said envelope with postage thereon fully prepaid, and placed it for collection for delivery via certified mail by the U.S. Postal Service on 12 December 26, 2006, following ordinary business practices. 13 [] BY OVERNIGHT COURIER On December 26, 2006, 1 deposited said envelope for delivery via overnight courier to the office of the addressee. 14 [] BY MESSENGER On December 26, 2006, 1 caused such envelope to be 15 delivered via personal service to the office(s) of the addressee(s). 16 [] BY FACSIMILE On December 26, 2006, 1 transmitted this document to the 17 parties listed below at the facsimile numbers listed. 18 Clerk Chief Administrator Contra Costa County Board of Contra Costa Health Services 19 Supervisors 50 Douglas Drive 651 Pine St., Room 106 Martinez, CA 94553 20 Martinez, CA 94553 21 22 1 declare under penalty of perjury under the laws of the State of California that 23 the foregoing is true and correct, and that this declaration was executed on December 26, 2006, at San Francisco, California. 24 _ 25 26 Annie Reasoner �J Collen v.Contra Costa County,et al Addendum to Government Claim Page 4 of 4 WALKER. HAMILTON&WHI I E DEC { 8 2006 CLERX 500 O OF sRVURS CONTRA COSTA CO. December 26, 2006 Clerk Contra Costa County Board of Supervisors County Administration Building 651 Pine Street, Room 106 Martinez, CA 94553 Re: Collen v. 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 thcc-laim and return 1 cope in the enclosed stamped envelope, with some notation of its receipt.in%,our office. Thank you for your help with this. Sincerely, r Annie Reasoner Paralegal /ar Encl: as noted www.walkerhamiltonwhite.com 50 FRANCISCO STREET. SUITI 460. SAN FRANCISCO.CA 94133-2100 TE1.415 930-3339 FAX 415 98r1618 a '�s„ext.,•:�a �:• N . 00. u 2 00 cd . 00 Lin C,4 In .•�__ .O t7 L� - Cj'6 � Al @ Y O of CC) Y.^�. .✓. F v tz klS a 00 00 o G u �L VA 0 O U y 4 . s � DEC, 19, 2006; 2: 26PM CCf,' RISK MANAGEMENT N0. 590 P. 2 r BO OF SUPERVISORS OF CONTRA CdSTA COUN'T'Y INSTRUCTIONS TO CLARY ANTI' A claim relafi g to a cause of action for death or for injury to person or to personal property or growing crop shall be presented not later than six months after the accrual of the cause of action. A clai n relating to any other cause of action shall be.presented not later than one year . after the acc of the cause of action. (Gov. Code § 11.2.) 3, Claims must a filed with the Clerk of the Board of Supervisors at its office in Room. 106, CountyAdmh ' tration Building, 651 Pine Street,Martinez, CA 94553. If claim is t a district governed by the Board of Supervisors, rather than the County, the name of the strict should be filled im I if the claim ' against more than one public entity, separate claims must be filed against eacb- public entity. E. Fraud, See p natty for fraudulent claims,Penal Code Sec. 72 at the end of this form- WN All opitnumn orm.rMallopteur■ INNIL119 Kit Rttr"as KKK Ps WANK UtWAnit RMaNtrNiKE4RXERMIRWERK, RE: Claim By, JDhn and Amy Co l le n, Reserved for Clerk's filing stamp individually and as guardians ) for Samu l Co.11en,. a minor RECEIVED Against the Countyf Contra Costa cgx and ) JAN 0 4 2007 Contra C sta Health Servi_aes , CLERK BOARD OFSllPERVISORS Martines Family Practice CDistdct) CONTRACOSTAER (-Fillinf.Leb;�.t;} o. Co. Reginmona_ Med.) Center, Healthy Start, K. Katz . n M.D. The undersigned ch irnnnt hereby makes claim against the County of Contra Costa or the above named district is the sum o I over and in support of Pais claim represents as follows: ]_O ,000.o 1. Men did th,,damage or injury occur? (Give exact date andhour) ' Please refer to Addendum 2. There did a damage or injury o ccur? (Include city and county) Please refer to Addendum 3. How did th dame or injury occur? (Give full details;use extra paper if requlred)Pleas e refer to Addendum 4. What-parti ar act or omission on the part of county or district officers, servants, or employees CaUSedthe ' jw-yordam.a.ge? Please refer to Addendum 5 What are names of county or district officers,servants, or employees causing the damaae or jury? Please refer to addendum DEC, 19. 20H. 2: 27PNi CCC kISK NiANA(iEf�iENT N0, 59U P. 3 I : S. What dam a or injuries do your claim resulted? (Give full extent of injuries or damages claimed. •A tach two estimates.for auto damage.) - Please refer to Addendum 7. How was e amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Please refer to Addendum 8. Names and addresses of witaesses,doctors, and hospitals: Please refer to Addendum 9. List the ex, enditures you made•on account of this accident or injury: Please refer to Addendum DA CE TIME AMOUNT raaaaaaafaAaaa■ asalaaaaaartaaaaawwaawwwaaaaaaaawRaa■aaRwwig■aawwwIaaaasit aAct lie[aaaaRal ) .Gov. Code Sec. 910.2 provides"Tire claim shall.be ) signed by the claimant or by some person on his behalf" SEND NOTICES 0: Lkttomev Name and address of Attorney ) __� Timothy Y . Hamilton Walker, Earnilton & White) (Claimant's Signature) 50 Francisco St. #460 San Francisco, CA 941.33) nW & Am Co.11 41.5-986-.. 339 ) �� Waterystone Race, San RAmon, CA 94582 (Address) Telephone No. )Telephone No. ■a wig WEN■as■■III l Sato to a a a sr aaat a taaartaaaa wits Kukla aaa aa■omit a as wNYaataa wast a lea aRwl as Sul PUBLIC RECORDS NOTICE: Please be advised t iat thjs claim form, or any claim filed with the County under the Tort Claims Act, is subject to public disclosure Inder the California Public Records Act. (Gov. Code, s§ 6500 et seq.) Furthermore, any atta.ebments,adde ums, or supplements attached to the claim form, including medical records, are also subject to public disclosure, ■rrtw aaa aawal■ ■tt■naw tRW M...ats'rwafaaww■/w&aa Iraaawwaaw aaata RESERVE away a ata■aaaaree1 NOTICE: Section 72 of the nal Code provides: Eyery person who with intent to defraud, presents for allowance or for payment to any state board or offices-, or to any county, ci , or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, ill, account voucher, or writing, is punishable either by imprisonment in the County jail for a period of not mom 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 dollar ($10,000),or by b Ah such imprisonment and fine. I Timothy M. Hamilton, Esq. (SB #90270) WALKER, HAMILTON & WHITE 2 50 Francisco Street, Suite 460 3 San Francisco, CA 94133-2100 Telephone: (415) 986-3339 4 Facsimile: (415) 986-1618 5 Attorney for Plaintiffs 6 John Collen & Amy Collen individually 7 and as guardians for Samuel Collen, a minor, 8 Claimants, 9 10 V. ADDENDUM TO CLAIM 11 The County of Contra Costa, Contra Costa Health Services, The Martinez 12 Family Practice Center, The Contra Costa Regional Medical Center, Healthy 13 Start and K. Katzman M.D. 14 Defendants. 15 / 16 17 1. When did the damage occur? - July 2, 2006. 18 2. Where did the damage occur? - Martinez Family Practice Center, Contra 19 Costa Regional Medical Center, Martinez, CA. 20 3. How did the damage or injury occur? - Amy Collen was pregnant with twin 21 boys in the winter and spring of 2006. She is a librarian for Contra Costa County 22 and her medical care was provided by the Martinez Family Practice Clinic and 23 other Co. Co. Health Services providers. Among other things, she was 24 negligently allowed to go into pre-mature labor and delivered Noah and Samuel 25 on July 2, 2006. Noah died several days later. Samuel stayed in the hospital for 26 Collen v.Contra Costa County,et al Addendum to Government Claim Page 1 of 4 I five months after delivery and will likely suffer life long injuries as a result of the 2 negligence of defendants. 3 4. What particular act or omission on the part if county or district officers, 4 servants, or employees caused the injury or damage? - On or about July 2, 5 2006 and prior thereto and thereafter, claimants engaged for compensation the 6 services of defendants, and each of them, and at or about said time, defendants, 7 and each of them, undertook to examine, diagnose, prescribe medicine and 8 9 drugs, and handling control of care treatment of claimants. In the aforesaid 10 examination, diagnosis, prescription of medicines and drugs and handling and 11 controlling of the care and treatment of claimants Amy Collen and Samuel 12 Collen, defendants, and each of them, negligently failed to possess and to 13 exercise that degree of knowledge and skill ordinarily possessed and exercised 14 by other physicians, surgeons, hospitals, nurses, nurse anesthetists, attendants, 15 aides, therapists, technicians and the like, in the same or similar locality under 16 similar circumstances as the said defendants, and each of them. 17 5. Names of county officers, etc., causing the injury? - E. Katzman, M.D. Other 18 names are not known at this time. 19 6. What damage or injuries do you claim resulted? - John and Amy Collen 20. claim wrongful death damages for the wrongful death of Noah Collen. John 21 Collen claims damages based on Thing v. LaChusa, for witnessing, as a 22 bystander, the injuries to Noah and Samuel. Amy Collen claims emotional 23 24 distress damages based on Burgess v. Superior Court. Samuel Collen has 25 sustained injuries to his body, causing emotional distress, pain, suffering and 26 Cole,,v.Contra Costa County,et al Addendum to Government Claim Page 2 of 4 I anguish, all to his general damage in a sum in excess of the jurisdictional 2 amount of this court. Samuel has also incurred and will be caused to incur the 3 cost and expenses of hospitals, physicians, nurses, aides, attendants, therapists, 4 X-rays, drugs and other related medical expenses in an amount which is 5 presently unknown to claimants who pray leave to insert herein when the same 6 are finally ascertained. Samuel will also be prevented from attending his usual 7 occupation, for an undetermined period or periods of time, all to his damage in a 8 sum unknown at this time, but which claimants pray leave to insert herein when 9 10 the same are finally ascertained. 11 7. Not applicable. 12 8. Names and addresses of witnesses, doctors and hospitals? - E. Katzman 13 M.D., various county employees and agents who treated claimants at county 14 facilities as well as other hospitals. Please refer to medical records to find these 15 names which are too numerous to compile here. 16 9. Expenditures? - Too numerous to list here. 17 18 DATED: December 22, 2006 WALKER, HAMILTON & WHITE 19 20 By: Timot M. Hamilton 21 Attorney for Claimants 22 23 24 25 26 Collcn v.Contra Costa County,et al Addendum to Government Clain Page 3 of 4 1 PROOF OF SERVICE 2 Collen v. The County of Contra Costa, et al 3 4 My business address is 50 Francisco Street, Suite 160, San Francisco, California 94133. 1 am employed in the County of San Francisco, where this mailing occurs. I am 5 over the age of 18 years and not a party to the within cause. On the date set forth below, I served the foregoing document(s) described as: 6 CLAIM AND ADDENDUM TO CLAIM AGAINST THE COUNTY OF CONTRA COSTA, 7 CONTRA COSTA HEALTH SERVICES, THE MARTINEZ FAMILY PRACTICE CENTER, THE CONTRA COSTA REGIONAL MEDICAL CENTER, HEALTHY START 8 AND K. KATZMAN M.D. 9 on the following person(s) in this action by placing a true copy thereof enclosed in a 10 sealed envelope addressed as listed below. 11 [X] BY MAIL I sealed said envelope with postage thereon fully prepaid, and placed it for collection for delivery via certified mail by the U.S. Postal Service on 12 December 26, 2006, following ordinary business practices.. 13 [] BY OVERNIGHT COURIER On December 26, 2006, 1 deposited said envelope for delivery via overnight courier to the office of the addressee. 14 [] BY MESSENGER On December 26, 2006, 1 caused such envelope to be 15 delivered via personal service to the office(s) of the addressee(s). 16 [] BY FACSIMILE On December 26, 2006, 1 transmitted this document to the 17 parties listed below at the facsimile numbers listed. 18 Clerk Chief Administrator Contra Costa County Board of Contra Costa Health Services 19 Supervisors 50 Douglas Drive 651 Pine St., Room 106 Martinez, CA 94553 20 Martinez, CA 94553 21 22 1 declare under penalty of perjury under the laws of the State of California that 23 the foregoing is true and correct, and that this declaration was executed on December 26, 2006, at San Francisco, California. 24 _ 25 Jin u 26 nie Reasoner Collcn v.Contra Costa County,ct al Addendum to Government Clain Page 4 of 4 go= F WALKER. HAMILTON &WHITE RECEWED DEC 2 8 2006 December 26, 2006 CONTRA C05fA h1EALTH SVCS ADMINISTRATION 50 DOUGLAS DR#310 MTZ Chief Administrator Contra Costa Health SeLti-ices 50 Douglas Drive — Martinez, CA 94553 Re: Collen v. Contra Costa Health Services To Whom It May Concern: Enclosed please find an original and 2 copies of a government claim in this ,,natter. Please process the claim and return 1 copy in the enclosed stamped envelope, with some notation of its receipt in your office. Thank you for your help with this. Sincerely, Annie Reason Paralegal Encl: as noted. JAN 0 4 2001 CLERKCONARIAD�f AOCOSTACO.ISORS SHARON HYMES'OF�ORD JAN 3 'I001 www.walkerhamiltonwliite.com 50 FRANCISCO S'I REET. SHITE 460. SAN FRANCISCO.CA 94133-2100 TEL 415 986-3:339 FAX 415 986-1618 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION:JANUARY 23, 2007 Claim Against the Comity, or District Governed by ) the. Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to California Government Codes. ) you is your notice of the action taken on your claim by the Board of D r � Supervis6rs. (Paragraph IV below), given Pursuant to Government Code DEC 2 g 2006 Section 913 and 915.4. Please note all AMOUNT: $1,400.00 COUNTY COUNSEL "Warnings' . MARTINEZ CALIF. CLAIMANT: ANGELINA COX ATTORNEY: UNKNOWN DATE RECEIVED: DEC. 28, 2006 ADDRESS: 2050 RILEG COURT #24 ' BY DELIVERY TO CLERK ON: DEC. 28, 2006 CONCORD, CA 94520 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DECEMBER 28, 2006 JOHN CULLEN, lk Dated: By: Deputy H. FROM: 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 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: 02 0 By: Y 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). I.V. ARD ORDER: By unanimous vote of the Supervisors present: (pr 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. Date HN CULLEN, CLERK, By Deputy Clelk WARNING (G co section 913) Subject to certain exceptiot is,you have only six(6) months from the date this notice Naas personally served or deposited in tile llil to file a court action on this chum.Sec Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection witli this matter. If you want to consult an attomeyou should do so immediately. *For Additional\k'arning Sec Reverse Side of This Notice. _ AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now.. and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated.✓CLar2'&UI'V o o JOHN 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 Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. ■■rrrrrrrrrrrrrrrrrrrrrr�rrrrrrrrrrrrrrrrrrrr�rrrrrrrrrrrrrrr■'rrrrrr �rrrrrrrrr . RE: Claim By: Reserved for Clerk's filing stamp rz Against the County of Contra Costa or ) ) DEC z 8 2006 District) CLERK B (Fill in the name) j CON pAo f SUP COSrq Cod/ SOBS The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ /400. and in support of this claim represents as follows: 1. When did the dama e or injury occur? (Give exact date and hour) � aoo �h✓► noi' � a hoz�-� rel o� ?. Where di the d age or injury eccur? (Include ci and count�)" / Cbn+fa sTa o►aal �AC4 C'erc.t6v) c a'�oo-9-thWO nq ► 3. How did the damage or injury occur? (Give' uI1 details: use extra paper if required �0 ' . ��.e i4*M-( kUP� Idst,( '� Wf �- Gt �fd lD �-�' l�Jn u)a1S J 4. What particular act or omission do the part of t oror d�o ff kers, servants r employees � causedthe injury or damage? 11� 48 , f-�� 5 What are the names of county or district officers, servants, or employees causing the damage or injury? �kw ►n Tha 7W • 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) ire fhZ �nJ �t ��►./00 the estimated amo� • L11rar ` 7. How was the amount claimed above computed? (Includeh stun unt of P prospective injury or damage.) 8. Names and addresses of witnesses,doctors,and hospitals: of IOW W gD>7 AA)hyo f I coed/VKQ. WaS -4 w 9. List the expenditures you made on account of this accident or in' P Y JAY• fA� N IIS DhQ. � �►"�C DATE TIME AMOUNT �O Due) AWyU&Io 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) JIT Telephone No. )Telephone No. qa,� 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. on an mom no a among a now a am a am a a no a a same no Iowans Raman on=was Now as ommon-m ago man a an 1.a am a a a MOEN I NOTICE: Section 72 of the Penal Code provides: Every person who, with intent to defraud. presents for allowance or for payment to any state board or officer, or to any county, city, or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account voucher, or writing, is punishable either by imprisonment in the County jail for a period of not more than one year, by a fine. of not exceeding one thousand dollars ($1,000.00), or b), 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. i id �� Iii , / • ! , , !I�� r � i I,11 II � � ! . � I • i � 1 1 � � ! ► fI1 � p 1 ' im 2 TA417-01 W60 51� MCI F� I'I 1 e 0 � ! � I 1 � � 1 s � • I � u• � •��i 1 1�1 �/v 1 , 1,� • ► t , JUS 1. SkaA 0 _ es� w u CLAIN'I BOARD OF SUPERVISORS OF CONT11A COSTA COUNTY pEC 2 E BOARD ACTION: JANUARY 23, 2007 Clam..Aaiust�•t'he County, or District Governed by ) C t J ,� C1��S�'upervisors, Routing Endorsements, ) 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 on your claim by the Board of CLAIM AGAINST CONTRA COSTA COUNTY Supervisors. (Paragraph 1 V below), given Pursuant to Government Code AMOUNT: $1,479,022.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: RANCHO DIABLO MOBILE HOME PARK, LP ATTORNEY: MARK L. MOSLEY DATE RECEIVED: DECEMBER 28, 2006 MOSLEY & GEARINGER, LLP* ADDRESS: 825 VAN NESS AVENUE, 4th FL&'�DELIVEIZY TO CLERK ON: DECEMBER 28, 2006 SAN FRANCISCO, CA 94109 HAND DELIVERED ' BY MAIL POSTiv1ARKED: FRONT: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, ler Dated: DECEMBER 28, 2006 By: Deputy IL FROM.: County Counsel TO: Clerk of the.Board of Supervisors (vr'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 91 1 .3). ( ) Other: Dated: �a -Z 104P 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: (� This Claim is rejected in full. ( ) Other: I certil}, that this is a true and correct copy of the Board's Order entered in its minutes for this date. DatedV2W,>zt4 Y 4 /-6)bHN_ CULLEN, CLERK, By Deputy Clerk WARNING (GW code section 913) Subject to certain exceptions,you have only six(G) months from the(late this notice Nvas personally served or deposited in the mail to file a court actin on this c6inr.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connectim widr this matter. If you want to consult an attonrey,you should(lo so imnrecliately. *For Additiotral Warning See Reverse Side of I"his 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 Nlartinez, California, postage full' prepaid a certified copy of' this Board Order and Notice to Claimant, addressed to the claimant as shown above. Datedv -C-a y _. JOHN CULLEN, CLERK 13y Deputy Clerk 12/2.1/2006 14:28 FAX 9'25 335 1 866L) (RuN 3►LC"I'Y COl1IYSEl. Q 002.. 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 tb#n one year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street,Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. , RE: Claim By: Resery or Clerk's filing stampi Rancho Diablo Mobile Home Park, LP Against the County of Contra Costa or 0 District) ooN9ooFs�A 1��6 (Fill in the name) ) ST9C�9L/,p� 9S The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ 1,479,022 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) December 31, 2005. 2. Where did the damage or injury occur? (Include city and county) Throughout the Rancho Diablo Mobile Home Park in Pacheco, Contra Costa County, CA. 3. How did the damage or injury occur? (Give full details;use extra paper if required) The County's storm drainage facilities adjacent to Buchanon Field, operating as deliberately designed and constructed, diverted storm drainage waters onto claimant's land; causing flooding. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? The County designed, maintained, and operated its storm drainage facilities in a manner that caused storm drainage waters to enter upon and flood claimant's land. 5 What are the names of county or district officers,servants, or employees causing the damage or injury? Unknown at this time. The foregoing acts give rise to causes of action for inverse condemnation, trespass, nuisance, and dangerous condition of public property. Claimant brings this claim on its own behalf and on behalf of each of its residence who sustained property damage as a result of the flooding. 12/21/2006 14:29 FAX 925 335 1866 CONTRA COSTA CTY COUNSEL Z003 6. What damageor injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) Claimant currently estimates $79,022 in repair/clean-up costs, $350,000 for damage to electrical infra- structure, $300,000 for damage to residents' property, and $750,000 in diminution'in value to land. 7. How was the amount claimed above computed? (Include the estimated amount! of any prospective injury or damage.) Damages are based on repair/clean-up costs incurred, estimates furnished by electrical engineer, and estimates of residents' damages and of diminution in value to land made by claimant. 8. Names and addresses of witnesses,doctors,and hospitals: Virtually all residents of Rancho Diablo Mobile Home Park are witnesses to the flooding and damages. 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT This information and backup documentation will be furnished upon request. ■■■r■■a.■■■rrrr■■■■r■■■■■.■■.■•■■■■■.■■■.■■.■.■■■■■■r■■r..ra■■■■■■■r■■.rr■.■■�■.rr■■t 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 AttorneyJ A a�l ) Mark L. Mosley.(State Bar No. 136449)) ) (Claimant's Signa e) _Mosley & Gearinger LLP ) 825 Van Ness Avenue, 4th Floor ) San Francisco CA.94109 ) (Address) ) Telephone No. (415) 440-3102 )Telephone No. -MOWN ONE.■Boom WON■.■.owns.■r■■■■r■rmeson.rrMonosson owns mass■■■■■r■■■■.r■.■..■i■■.■■■I PUBLIC.RECORDS NOTICE: Please be advised that this claim form,or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthermore, any attachments,addendums,or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■■■■■■■■■■■■r■■■r..■■ ■■■■■■.■■.■■■■■r■■■■■■■.■■■■.rr■■■■■r.r■i■■■r...■...■r. .■.r■■I NOTICE: Section 72 of the Penal Code provides: Every person who,with intent to defraud, presents for allowance or for payment to any state board or officer,or to any county, city, or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account voucher, or writing, is punishable either by imprisonment in the County jail for a period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000.00), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand'dollars ($10,000),or by both such imprisonment and fine. i tP�1 CLA[I\I 44 BOAitD OF SUI'CIIVISORS OF CON'I'RA COSI�A COUNT}' dot !EC 2 i 2006 BOARD ACTION: JANUARY 23 2007 COI:CIn i» gainst-tlie County, or District Govei7ied by ) 1`1At�I,e�B6ardufISupervisors, 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 CLAIM AGAINST FLOOD CONTROL AND WATER CONSERVATIOItupervisors. (Paragraph IV below), given Pursuant to Government Code AMOUNT: $1,479,022.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: RANCHO DIABLO MOBILE HOME PARK, LP ATTORNE)': MARK L.' MOSLEY M DATE RECEIVED: DECEMBER 28, 2006 GEA MOSLEM & ESS AVENUE, 4th FL�t LLP ADDRESS: 825 VAN NESS AVENUE, DELIVERY TO CLERK ON: DECEMBER 28, 2006 SAN FRANCISCO, CA 94109 HAND DELIVERED B)' MAIL POSTMARKED: FRONT: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN Cl Dated: DECEMBER 28, 2006 By: Deputy 11. FRONI: County Counsel TO: Clerk of the Board of upervisors (L.4 phis claim complies substantially with Sections 910 and 910.2. ( ) This Chilli FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911 .3). O Other: Dated: �a �—��O 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. ARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. ( ) Other: f certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated u.0 -a3 s HN CULLEN, CLERK, By Deputy Clerk WARNING ( code section 913) Subject to certain exceptions,you have only six(G) ntontlis from thedate this notice was personally set vd or deposited in the snail to file a court action on this claim.See Government Code Sectim 945.6.You may seek the advice of an attorney of your choice in connection wide this matter. If you -*vont to consult an attorney;you should do so imunetliately. *For Additional NVarnijig See Reverse Si tie ofThis Notice. AFFIDAVIT OF MAILING 1 declare untler penalty of perjure that 1 am 11011, and at all timjes 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 Nlartinez, California, postage fully prepaid a certified coPy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Date0 JOHN CULLEN, CLERK By Deputy Clerk I 12/21/2006 14:28 FAX 925 335 1866 DRA WMAUNSEL 0002 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 Q#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 rrounty, 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. ■■■■....■■■■■■■.■ ■■■■■■■■■■■Ya■.■■...■■■.■■■■■■■■■■■■■.■.■■■■■■.■..■Y■■■■■■■.I RE: Claim By: Reserved for Clerk's filing stampi Rancho Diablo Mobile Home Park, LP } ) Against the County of Contra Costa or ) RECEIVED Flood Control and Water Conservation ) Y District) (Fill in the name) } DEC Z 8 2006 CLERK BOARD OF SUPERVISORS CONTRA COST c0. The undersigned claimant hereby makes claim against the County o on a above-named district in the sum of$ 1,479,022 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) December 31, 2005. 2. Where did the damage or injury occur? (Include city and county) Throughout the Rancho Diablo Mobile Home Park in Pacheco, Contra Costa County, CA. 3. How did the damage or injury occur? (Give full details;use extra paper if required) The District's storm drainage facilities adjacent to Buchanon Field, operating as deliberately designed and constructed, diverted storm drainage waters onto claimant's land, causing flooding. 4. What particular act or omission on the part of county or district officers, servants, or'employees caused the injury or damage? The District designed, maintained, and operated its storm drainage facilities in a manner that caused storm drainage waters to enter upon and flood claimant's land. 5 What are the names of county or district officers,servants, or employees causing the damage or injury? Unknown at this time. The foregoing acts give rise to causes of action for inverse condemnation, trespass, nuisance, and dangerous condition of public property. Claimant brings this claim on its own behalf and on behalf of each of its residence who sustained property damage as a result of the flooding. 12/21/2006 14:29 FAX 925 335 1866 CONTRA COSTA CTY COUNSEL Z003 6. What damage or injuries do your claim resulted? (Give fall extent of injuries or damages claimed. Attach two estimates for auto damage.) Claimant currently estimates $79,022 in repair/clean-up costs, $350,000 for damage to electrical infra- structure, $300,000 for damage to residents' property, and $750,000 in diminution'in value to land. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Damages are based on repair/clean-up costs incurred, estimates furnished by electrical engineer, and estimates of residents' damages and of diminution in value to land made by claimant. 8. Names and addresses of witnesses,doctors,and hospitals: Virtually all residents of Rancho Diablo Mobile Home Park are witnesses to the flooding and damages. 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT This information and backup documentation will be furnished upon request. ■■aaaa■aaa■r■■aa■■■aaaaa■■■■■aaa■aaaaaaa■■aar■■aaaa■■aaaa■aaaaaaara■a■aar a■aaRaaaaa■R 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) ) r Name and address of Attorney Mark L. Mosley (State Bar No. 136449)) (Claimant's Signature) Mosley & Gearinger LLP ) 825 Van Ness Avenue, 4th Floor ) San Francisco CA 94109 ) (Address) Telephone No. (415) 440-3102 )Telephone No. ■.■rrrraaaaaaaa■aaaaa■■aa■■■■a■■r.■rasa■■■raaaa.■aaaaaaa■aaaaaaaaaaaaar■aaaaai■aaaaa• 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. man awaaaaaaaa■rrraa.■■■aa■■■aaaa■■■■ran■■aaa■a■■■■.■ra■■■■rami■■■raa■a■aaarria■■anal 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 dfficer,or to any county, city, or district board or officer, authorized to allow or pay the same if genuine, an* 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. i AI�I EN DEll CLAiM BOARD OF SUPERVISOR9 OF` CONTRA COSTA.COUNTY BOARD ACTION-JANUARY 23--2An7 Claini 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. ) r� You is your notice of the action taken p ori your claim by the Board of Supervisors. (Paragraph IV below JAN 1 1 2007 P ), given Pursuant to Government Code COUNTY COUNSEL Section 913 and 915.4. Please note all A.MOUN'f: $1 , 637 :17 MARTINEZ,'CALIF "Warnings". CALIFORNIA STATE AUTOMOBILE ASS . CLAMANT: FOR-; JAMES H. AND SHARON B. PATTON BY: AMANDA COLEMAN JANUARY 11 , 2007 ATTORNEY: UNKNOWN IDATE RECEIVED: ADDRESS: P. O. BOX 920 i BY DELIVERY TO CLERK ON: JANUARY 11 , 2007 SUISUN CITY, CA 94585i0920 ' BY MAIL POSTMARKED. january 10, 2007 FROM: Clerk of the Board.of Supervisors TO: County Counsel Attached is a copy of the.above-noted claim. JOHN CUL.LEN, C1 Dated: JANUARY 11, 2007 i By: Deputy 11. FROM: County Counsel . TO: Clerk of the Board of Sup rvtsors ( 'his claim complies substantially with Sections 910 and 910.2. i ( ) This Claire FAiLS to comply substantially with Sections 9.1.0 and 910.2, and we are so notifying claimant. The Board cannot act for i 5 days (Section 910.8). O 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: I Dated: - -�7 I Y �!� 1 Deputy County Counsel , Ill. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( Claim was returned as untimely with notice to claimant (Section 911.3). IV. OARD ORDER: By unanimous vote oftheSupervisors present: ( This Claim is rejected in frill. ( ) Other: I 1 . certify that this is a true and correct copy of the Board's Order entered in its minutes for . this date. Dated✓aV004.3r ° 36 HN CUL,.LEN, CLERK, By Aq, WDeputy Clerk WARNING M code section 913) SubJect to.certain exceptions,you have only six(6)months from the date this notice was personally sewed or deposited in the mail to file a court action on this claim.See Goverliment Code Section 945.6.You.niay 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. *tor Additional Warning See Reverse Side of Tlris Notice AFFIDAVIT OF MAILING I declareunder penalty of perjury that I am now, and "at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in N'tartinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above.. Datedu4a� ---�'f� =IOi 1N CU.LLEN, CLERK By - Deputy Clerk V California State Automobile Association Inter-Iaarrance Bureau P.O.Bor l_0 Suisun 01.1% C1 9458.5-0920 January 10, 2007 RECEIVE® JAN 1:1 2001 Clerical Board of Supervisors Attn--Amv CLERK BOARD OF 80 651 Ninetree Room#106 CONTRA CU3;?ERUISORS Martinez,CA 94553 ��•O. RF.: Your Insured: Scott Wortham Your Claim No.: UNK Our insured: James i-i/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 SIR.MARTINEZ,CA.our insured's vehicle was parked and un-attended at the time. This will continn our subrogation interest arising from this loss. We have settled the claim with our insured and based on the following facts,request payment directly to California State Automobile Association Inter-insurance Bureau (CSAA-11B): In order to assist with and expedite the evaluation and processing of this subrogation demand,we enclose the relevant documentation in support of our claim. This inlonmation may contain personal or privileged information about our insured,and is being provided to you pursuant to California Insurance Code Section 791.13 and may not be used for any unauthorized purpose. Based upon this information,we ask that you issue payment of$1637.17 Repair Bill $1637.17 Deductible $0.00 Loss of Use $0.00 Tow/Storage $0.00 Miscellaneous $0.00 -------------------------- TOTAL $1637.17 Please be advised that any payment in an amount less than that set Ibrth in this letter that is forwarded to CSAA without its prior authorization as described below will not constitute u full and,inal settlement and will be accepted as partial payment only. Since payments received in the mail are processed by clerical staff and deposited as a matter of course without examination, unauthorized payments for less than the full amount demanded may be processed inadvertently. Although such payments may be demarked as"payment in full"or have other words of similar meaning written on them, their processing will not constitute an accord and satisfaction.as CSAA has not agreed to acceptance of'such payments. F26BK(Apr 2002) Only an authorized Subrogation Specialist may communicate,orally or in writing,CSAA's specific agreement to accept an amount less than that demanded in this letter. Il'you have any questions,please feel free to contact the CSAA Subrouation Department. Sincerely, Subrogation Specialist 888-I00-6520 extension 6232 Fax 707-863-9052 Enclosure Date: 12/13/2006 09:05 AM Estimate ID: 1276 Estimate Version: 1 Supplement 1(F) 12/1342006 09:05:35 AM FINAL Profile ID: CSAA DOM Antioch Auto Body, Inc. 1401 Verne Roberts Circle EM41L:bodytechgsbcglobal.netAntioch,CA 94509-7915 (925)7573586 Fax: (925)757-6246 Tax ID: 6"336031 BAR#: AK23SIGS EPA#: CAR000004440 Damage Assessed By: Sergio Gonzalez Supplemented By: Sergio Gonzalez Condition Code: Good Date of Loss: 12/5/2006 to Final to Owner. 1211112006 CD v Deductible: WAIVED er Policy No: P845228 Claim Number: A09PS4522801 1 r C4 Insured MAUREEN PEREZ r Address: 4306 SILVA ST ANTIOCH,CA 945D9 4 Telephone: Work Phone: (925)5655606 Home Phone: (925)7795883 fA V Mitchell Service: 917529 m p Description: 2004 Chrysler Sebring GTC j Body Style: 2D Conv Drive Train: 2.7L Inj 6 Cyl 4A FWD VIN: 1C3EL75RX4N368678 License 5MHU863 CA W Mileage: 18,538 V W OEM'ALT: A Search Code: C316475 Color. RED MET Options: ALUM/ALLOY WHEELS,AIR CONDITIONING,POWER STEERING,POWER WINDOWS POWER DOOR LOCKS,TILT STEERING WHEEL,CRUISE CONTROL,ELECTRIC DEFOGGER AUTOMATIC TRANSMISSION,AM-FM STEREO/CD PLAYER(SINGLE) Line Entry Labor Line Item PartTypel Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 701867 BDY REPAIR R QUARTER OUTER PANEL Existing tA'# 2 AUTO REF REFINISH R QUARTER PANEL OUTSIDE C 2A 3 701412 BDY REMOVE/INSTALL R OTR QUARTER BELT MLDG 0.7 # 4 700802 BDY REMOVE/INSTALL R QUARTER ADHESIVE MOULDING Existing 02' 5 900500 BDY' REPAIR CLEAN&RETAPE S/MLDG Existing 02' 6 700804 BDY REMOVE/INSTALL R QUARTER ANTENNA ASSEMBLY Existing 05' 7 701960 BDY REMOVE/INSTALL LUGGAGE LID SPOILER 03 8 701954 BDY REPAIR LUGGAGE LID SPOILER Existing OS' 9 AUTO REF REFINISH SPOILER C 1.0 10 900500 BDY' REMOVE/REPLACE FLEX ADDITIVE '-`Qual Repl Part 7.00' OA' 11 700978 BDY REMOVE/REPLACE R REAR COMBINATION LAMP ASSEMBLY 4805462AA 17940 INC 12 701000 BDY REMOVE/REPLACE REAR BUMPER COVER Remanufactured 31540' 13 13 AUTO REF REFINISH REAR BUMPER COVER C 2.7 S1 14 701029 BDY REMOVE/REPLACE REAR BUMPER IMPACT ABSORBER 4BD5451AB 14640 15 936012 ADD'L COST HAZARDOUS WASTE DISPOSAL 3.00 16 AUTO REF ADD'L OPR CLEAR COAT 1.7 17 933003 BDS' ADD'L OP TINT COLOR 05' 18 AUTO ADD'L COST PAINT 21050' ESTIMATE RECALL NUMBER: 12/6/2006 09:22.'50 1276 UltraMate is aTrademark of Mitchell International Mitchell Data Version: NOV_06_V Copyright(C)1994-2003 Mitchell International Page 1 of 3 UltraMate Version: 5.0215 All Rights Reserved Date: 12/13/2006 09:05 AM Estimate ID: 1276 Estimate Version: 1 Supplement 1 (F) 12/13/2006 09:05:35AM FINAL Profile ID: CSAA DOM -Judgement Item -Labor Note Applies C -Included in Clear Coat Calc Add'[ Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 4.7 57A0 0.00 0.00 267.90 Taxable Parts 647.00 Bdyf 0.5 57A0 0.00 0.00 28.50 Parts Adjustments 32.50- Refinish 7.8 57A0 0.00 0.00 444.60 Sales Tax 8.250% 50.70 Non Taxable Labor 741.00 Total Replacement Parts Amount 66520 Labor Summary 13.0 741.00 III. Additional Costs Amount IV. Adjustments Amount Taxable Costs 210.60 Insurance Deductible WAIVED Sales Tax 8250% 17.31 Customer Responsibility 0.00 Non Taxable Costs 3.00 Total Additional Costs 230.97 1. Total Labor: 741.00 11. Total Replacement Parts: 66520 01. Total Additional Costs: 230.97 Gross Total: 1,637.17 IV. Total Adjustments: 0.00 Net Total: 1,637.17 Less Original Net Total: 994.93 Net Supplement Amount 64224 S1: Sergio Gonzalez 64224 THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE- ANY WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OF THE PARTS, RATHER THAN BY THE ORIGINAL MANUFACTURER OF. YOUR VEHICLE. InsuranceCo: CSAA Insurance Body Shop: ANTIOCH AUTO BODY INC. 1401 VERNE ROBERTS CIRCLE ANTIOCH,CA 94509 Telephone: (925)7573586 Fax Phone: (925)757-5246 **Special Parts Note: All crash parts on this estimate are ESTIMATE RECALL NUMBER: 1216V2006 09:22:50 1276 UltraMate is aTrademark of Mitchell International Mitchell Data Version: NOV 06_V Copyright(C)1994-2003 Mitchell International Page 2 of 3 UltraMtite Version: 5.0215 All Rights Reserved Date: 12J1 312006 09:05 AM Estimate ID: 1276 E stim ate Version: 1 Supplement 1(F) 12/13/200609:05:35AM FINAL Profile ID: CSAA DOM "New" parts (OEM) unless otherwise specified. Parts described as Rechromed, Recored, or Remanufactured are either "Reconditioned" parts or "Rebuilt" parts. Crash parts described as "Qual Repl Part" are non-OEM aftermarket parts.** Cycle Time Information Drop Off Date: 12/5/2006 Repair Dates: Promise Date 12/112006 StartDate: 12/5/2006 Pick Up Date: 12/112006 Completion Dale: 12/11/2006 ESTIMATE RECALL NUMBER: 121&200609:2Z50 1276 UltraMate is a Trademark of Mitchell International Mitchell Data Version: NOV 06_V Copyright(C)1994-2003 Mitchell International Page 3 of 3 UltraMate Version: 5.0215 All Rights Reserved co CD . o N C1 N I� U CHECK NO.: 711 L297843-9-R m DATE: 12-19-2005 LU luuwujj NAME AND ADDRESS INFORMATION: ANTIOCH AUTO BODY INC 1401 VERNE ROBERTS CIRCLE ANTIOCH CA 94509 - INSURED: PATTON,JAMES H/SHARON B PAYMENT INFORMATION/DESCRIPTION: DATE OF LOSS: 12-05-06 CLAIM NO.: 09—PS4522-8 CLAIMANT: PATTON,JAMES H/SHARON B PAYEE: ANTIOCH AUTO BODY INC AMOUNT: $1 ,637- 17 IN PAYMENT OF: PAT T ON PAID IN FULL ADJUSTER: GLINDA RUTHRUFF ADJUSTER NO.: 35707 KIND OF LOSS: COL 16610702 DETACH AND RETAIN FOR YOUR RECORDS No. 711 L297843-9-R DATE OF LOSS CLAIM INSURED'S NAME DATE 12-05-06 09—P84522-8 PATTON,JAMES H/SHARON B 12-19-2006 POLICY TYPE KIND OF LOSS SUFFIX CLAIMANT'S NAME PAY AUTO COL 01F I PATTON,JAMES H/SHARON B $1 ,637. 17 D.O. ADJUSTEn NO. IN PAYMENT OF BANK OF AMERICA Iv1_i�1N DR2 35707 PATTON PAID IN FULL BBarrt of America Customer Comeclion ank of America. N.A. TIN: 58-0336031-00 Allaraa, Dekalb Courtly. Georgia PAY *ONE THOUSAND SIX HUNDRED THIRTY SEVEN 17/100* ANTIOCH AUTO BODY INC This check moist be properly endorsed on the reverse side by all payees. TO THE ORDER OF Date: 12/612006 09:23 AM Estimate ID: 1276 Estimate Version: 0 Committed Profile ID: CSAA DOM Antioch Auto Body, Inc. 1401 Verne Roberts Circle EMAIL: bodytech§sbcglobal.net Antioch,CA 94509-7915 (925)7573586 Fax: (925)757-6246 Tax ID: 6"336031 BAR#: AK236169 EPA#: CA R000004440 Damage Assessed By: Sergio Gonzalez Condition Code: Good Date of Loss: 12/512D06 Deductible: NONE Policy No: PM228 Claim Number: A09PS4522801 ro CD 0 Insured: MAUREEN PEREZ N Address: 4306 SILVA ST ANTIOCH,CA 94509 co c Telephone: Work Phone: (925)5653606 Home Phone: (925)779-9883 1 N r Q Mitchell Service: 917529 iWl Description: 2004 Chrysler Sebring GTC Body Style: 2D Conv DriveTrain: 2.7L Inj 6 Cyl 4A FWD m VIN: 1C3EL75RX4N368678 License: 5MHUS63 CA p Mileage: 18,538 OEMALT: A Search Code: C316475 Color: RED MET 3(wj Options: ALUMIALLOY WHEELS,AIR CONDITIONING,POWER STEERING,POWER WINDOWS POWER DOOR LOCKS,TILT STEERING WHEEL,CRUISE CONTROL,ELECTRIC DEFOGGER AUTOMATIC TRANSMISSION,AM-FM STE REO/CDPLAYER(S INGLE) Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 701867 BDY REPAIR R QUARTER OUTER PANEL Existing 1,D # 2 AUTO REF REFINISH R QUARTER PANEL OUTSIDE C 2A 3 701412 BDY REMOVE/INSTALL R OTR QUARTER BELT MLDG 0.7 # 4 700802 BDY REMOVE/INSTALL RQUARTER ADHESIVE MOULDING Existing 02' 5 900500 BDY' REPAIR CLEAN 8 RETAPE SIMLDG Existing 02' 6 700804 BDY REMOVEIINSTALL R QUARTER ANTENNA ASSEMBLY Existing 05' 7 701960 BDY REMOVE/INSTALL LUGGAGE LID SPOILER 02 8 701954 BDY REPAIR LUGGAGE LID SPOILER Existing 05' 9 AUTO REF REFINISH SPOILER C 1.0 10 900500 BDYREMOVE/REPLACE FLEX ADDITIVE —Qual Repl Part 7.00* OA' 11 700978 BDY REMOVE/REPLACE R REAR COMBINATION LAMP ASSEMBLY 4805462AA 179A0 INC 12 701000 BDY REMOVE/REPLACE REAR BUMPER COVER Remanufactured 315A0* 1,3 13 AUTO REF REFINISH REAR BUMPER COVER C 2.7 14 936012 ADD'L COST HAZARDOUS WASTE DISPOSAL 3.00, 15 AUTO REF ADD'L OP CLEAR COAT 1.7 16 933003 BDS' ADD'L OP TINT COLOR 05' 17 AUTO ADD'L COST PAINT 21080' ESTIMATE RECALL NUMBER: 12/6/2006 09:22'.50 1276 UltraMate is aTrademark of Mitchell International Mitchell Data Version: OCT 06_V Copyright(C)1994-2003 Mitchell International Page 1 of 3 UltraMate Version: 5.0215 All Rights Reserved Date: 1216/2006 09:23 AM Estimate ID: 1276 Estimate Version: 0 Committed Profile ID: CSAA DOM -Judgement Item -Labor Note Applies C -Included in Clear Coat Calc Add'I Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 4.7 57A0 0.00 0.00 267.90 Taxable Parts 5D1.00 Bdy-S 0.5 57A0 0.00 0.00 28.90 Parts Adjustments 17.90- Refinish 7.8 57jD0 0.00 0.00 444.60 Sales Tax (Lb 8.250% 39.86 Non Taxable Labor 741.00 Total Replacement Parts Amount 5122.96 LaborSummary 13.0 741.00 III. Additional Costs Amount IV. Adjustments Amount Taxable Costs 210.60 Insurance Deductible 500.00- Sales Tax 40 8.250% 17.37 Customer Responsibility 500.00- Non-Taxable Costs 3.00 Total Additional Costs 230.97 I. Total Labor: 741.00 II. Total Replacement Parts: 522.96 111. Total Additional Costs: 23097 Gross Total: 1,494.93 IV. Total Adjustments: 500.00- Net Total: 994.93 THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OF THE PARTS, RATHER THAN BY THE ORIGINAL MANUFACTURER OF YOUR VEHICLE. Insurance Co: CSAA Insurance Body Shop: ANTIOCH AUTO BODY INC. 1401 VERNE ROBERTS CIRCLE ANTIOCH,CA 94509 Telephone: (925)7573586 Fax Phone: (925)757{246 **Special Parts Note: All crash parts on this estimate are "New" parts (OEM) unless otherwise specified. Parts described as Rechromed, Recored, or Remanufactured are either "Reconditioned" parts or "Rebuilt" parts. Crash parts described as "Qual Repl Part" are non-OEM aftermarket parts. ** ESTIMATE RECALL NUMBER: 12/6/200609:2Z50 1276 UltraMate is a Trademark of Mitchell International Mitchell Data Version: OCT 96_V Copyright(C)1994-2003 Mitchell International Page 2 of 3 UltraMate Version: 5.0215 All Rights Reserved Date: 12/6/2006 09:23 AM Estimate ID: 1276 Estimate Version: 0 Committed Profile ID: CSAA DOM CycleTime Information Drop Off Date: 12/5/7006 Repair Dates: Promise Date: 12/11/2006 ESTIMATE RECALL NUMBER: 12/6x2006 09:22.'50 1276 UltraMate is a Trademark of Mitchell International Mitchell Data Version: OCT_06_V Copyright(C)1994-2003 Mitchell International Page 3 of 3 Ultr7aMate Version: 5.0215 All Rights Reserved ,h.. i ..r ......: .. :. ..., t. ,'i.•' r:+.� .kA"'.4' :.•'t:::7.S" .:,2•: S':,f.: Y.4,'�it. _� ...,. �.. ..:... ,.:tri.,: .,.:.•.`+F..:-� .... �.'; i��.r' ,.*�.. ��.'� :. ...b3 ,.....:. .>- : .s„�:,.. ............:.... ..::. ....... � :.. }zusz- "��z�"��s•�rw�';x:w;;F..:..J.h;•..�. - 4 5 .: .. ...y,. 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R��.��.�."�'• Inter`Insurante Bureau P.O.Box 920 Suisun City,CA 94585-0920 _ I RECEI n JAN .1.1 2007 CLERK BOARD OF.^, sVISORS CONTRA CC FIPST CLASS M3 �' 5 ^'- UNITF > ,�r •�S O T. TA co d `J .� I)S� jq a !A $j �i California State Automobile Association Inter-insurance Bureau P.O.Box 920 Suisun City,CA 94585-0920 RECE JAN -!,1 2007 CLERK BOARD OF�, -.. "M' RS CONTRA CC —.. FIRST CLASS I �p. i Ko UNIt4 .i D m A �' •p'.� , m a 1' 4 P, coN 0 2� n j d QQQKJJJ v (0 q " r') H Cn O W O A � CLAIN'l es BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JANUARY 23 , 2007 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO C.LAI:NIANT 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 ?92alu� on your claim by the Board of Supervisors. (Paragraph IV below), DEC 2 6 2006 given Pursuant to Government Code AN10UN"I': $4 , 173 - 00 Section 913 and 915.4. Please note all COUNTY COUNSEL "Warnings". MARTINEZ CALIF. CLAINIANT: JESUS AND MARY ANN GARCIA ATTORNEY: UNKNOWN DA'L'E RECEIVED: DEC. 26 , 2006 ADDRESS: 3217 TABORA DRIVE BY DELIVERY TO CLERK ON:DEC. 26 , 2006 ANTIOCH, CA 94509 RECEIVED FROM RISK BY MAIL POSTMARKED: NhGEMEIVT FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, C Dated: DECEMBER 26 , 2006 By: Deputy H.. FROM: County Counsel TO: Clerk of the Board of Supervisors ( "Fliis claim complies substantially with Sections 910 and 910.2. ( ) This Claim BAILS 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: By: e?�j Deputy County Counsel Hl.I. FRONI: 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: (V)�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: �A131;lce.u,y ~ULLEN, CLERK, By Deputy Clerk WARNING (Go ode section 913) Subject to certain exceptions,you have only six(6) months from the date this notice was personally,seined or deposited in the niail to file a count actin on this claim.Sec Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection wvidr this matter. ll'you want to consult an attonrey,fou should do so inrnuiliately. *For Additional NN'anrirx;SL v Reverse Side of"1'his Notice. AFFIDAVIT OF MAILING declare under penalty of perjury that I am now, and.at all times herein mcntioned, have been it citizen of the United States, over age 18; and that today 1 deposited in the United States Postal Service in llartinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: aWg�A X 1-IN CLJLLEN, CLERK B 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 injwy to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be.presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street,Martinez,CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the :name of the District should be filled in. . D. If the claim is against more-than one public entity, separate claims must be filed against.each. public entity. E. Fraud. See penalty for fiaudulent claims,Penal Code Sec. 72 at the end of this form. pehrj ■■as ■mmumt\ iiztzmnxusaRzgm ■■ poeesaeAJ l�r)■�aat�a�ae�1�LE1 yeas%y 16 RE: Claim By: (k"d Itirds oT 19ty G f Reserved for Clerk's fling stamp1?006 Com• Against the County of Contra Costa or ) DEC 2 2006 � �istrict) CLERK BOARD OF COSTA CO ISORS e v C• ecilka vSft� (Fill in thd name) Y The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of Z7,J and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) .>✓and�, DeeeljihFr t/; J606 :53 '2. Where did the damage or injury oc/c/ur? (Include city and county) 3. How did the damage or injury occur? (Give full details;use extra paper if required) ZQ S�s�9_S nye ¢rOre- YYt.- 44ar rn owGr �v ei�lter. Ivvne By e. 4Gh1-&G t'S GUPi 1 hv`x�t 4. What-particular act or omission on.the pint of county or district officers, servants, or employees caused the injury or d age? 'fie Slw�t7 s �� 5 What are the names of county or district officers, servants, or employees causing the damage or injury? Lk diVe �O Smi'0e, 4�1 Uii 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estiin tes for auto damage.) � �c eJ� l eor S . 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: 4;10r 'A �O' 'de4 4110-/ d00 IZei, �t 9. List the expenditures you made on account of this accident or injury: " 6 /E�2�S�flOrG2� DATE TIME AMOUNT ■a as on a 13 a am a a am its a ME a am UK t no a as Manx Solna a a ass a an ME son am t a am on a a a a a mats t ILE am INK a sons 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: (Attorney) Name and address of Attorney ) (Claimant's Signature) Ar.fi'�og �c. (Address) Telephone No. )Telephone No. �7',�� D� �� R3;0 -3 yap ■signs anassssaaasssas■asaaearrassaasssaraaasressasaarsassaararsssssaaaa■assarsaaassrsa� PUBLIC RECORDS NOTICE: Please be advised that this claim fonn, of 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. ■ ■asaaaaasa5t0a0araaaaaa■ ■■aaaaaaaaaassaaaaaaaasaaaasaaaaaaaaasaaas11aaa0aasa0aaaaaaIII NOTICE: Section iI 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 fore 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. 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Z:`:: J J 2 Z m w a_ W Q w Q Fw- O 0 p Z oz-C p 0 p >- Z a= w w Q F F U F Q w o U J U Q J Q O w Q: LL 0 (n Q Z U) 0 m } U J W 0 U W w LL W Q Z w z F o z Q LL 3 W a 0 F- L � m o � c - �; - - . - - — _ — — . — �- CLAiNI R0AItD OF SUPERVISORS Of CON'T'RA COSTA COON'CY � BOARD ACTION:JANUARY 23 , 2007 Claim Against the County, or Dist+ft�ttl ege -e-d by ) the Board of Supervisors, Routing+�t'_Bem nts,, g NOTICE "1'O CLAIMANT and Board Action. All Section rela��c sEai;e o The copy of this document mailed to California Government Codes. 3 20L)6 you is your notice of the action taken COUNTY COUNSEL on your claim by the Board of MARTINEZ CALIF. Supervisors. (Paragraph IV below), UNLIMITED JURISDICTION CLAIM given Pursuant to Government Code FOR CONTRACT DAMAGES RANGING Section 913 and 915.4. Please note all ANI0UN": FROM $215 , 0.00 TO OVER $520 ,000"Warnings". CLAIMANT: GILBEIT SOMMERHALDER ATTORNEY: MARC L. TERBEEK DATE RECEIVED: DECEMBER 19 , 2006 ADDRESS: MEHLMAN TERBEEK, LLP ,- D VERY TO CLERK ON: DECEMBER 19 , 2006 2125 OAK GROVE ROAD, S1� WALNUT CREEK, CA 94598-2406 HAND DELIVERED BY NIAI.L POSTNIARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOl-IN CULLEN, Cle-k- Dated: k Dated: DECEMBER L9 , 2006 By: Deputy IL FROM: County Counsel TO: Clerk of the Board of Sup rvisors (VKFlhis 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 claire (Section 911.3). (Vrother: -This c�ci�m 'ts c�ri l� 45--K,- c.r a6-4-o coo-n z. occur✓`IrIci bv% o `l, 200(e nU (ens -Pc-e ©�Lc>r,�i►-�� p� for �DJc�r72 ��1.?�o�p 1 e_ v n_k 1C( .V)A , e_410 11-CCV1 A-0 1�� n9 a La G a /,�,7. Dated: / 0-R-06o / By: I-r? puty 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: ( 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.429A40"s' � 4,�)HN CULLEN, CLERK, By Deputy Clerk WARNING (G( . code section 913) Subject to ceatain exceptions,you have only six(G) months from the date this notice was peasonalh,served or deposited in the mail to file a court action on this claim.See Government Code Section 915.6.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 Additioml Nkar ;Sec hfReverse Sick orris Notice. AFFIDAVIT OF NIAILING declare under penalty of perjury that I am now, and at all tinnes herein mentioned, have . been a citizen of* the United States, over awe 18; ,and that today I deposited in the United States Postal Service in Martinez, California, postage faafly prepaid a certified copy of this Board Order and Notice to Claimant, :addressed to the claimant as shown above. Dateci:Vl�7 LY o2 JOHN CULLEN, CLERK By Deputy Clerk OFFICE OF THE COUNTY COUNSEL SE" L SILVANO B.MARCHESI �.--" __.O COUNTY OF CONTRA COSTA ��-:� -- .:•:�' COUNTY COUNSEL Administration Building =5 ; 651 Pine Street, 9'" Floor �� .- o SHARON L. ANDERSON d; Martinez, California 94553-1229 ;e CHIEF ASSISTANT (925) 335-1800 ®, GREGORY C. HARVEY ' = w ;;yJ;'il�r 'i. .. / VALERIE J. RANCHE (925) 646-1078 (fax) A H ASSISTANTS r'� COUla NOTICE OF UNTIMELINESS AS TO A PORTION OF THE CLAIM. TO: Marc L. Terbeek Mehlman Terbeek, LLP 2125 Oak Grove Road, Suite 125 Walnut Creek, CA 94598-2406 RE: CLAIM OF GILBEITSOMMERHALDER Please Take Notice as Follows: In regards to the claim you submitted on December 19, 2006, on behalf of Gilber Sommerhalder, portions of the claim are timely and portions are untimely. The portions of the claim prior to June 19, 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 91 1.2, 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 19, 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 clauns. The only recourse at this time is to apply without delay to the County of Contra Costa governed by the Board Of Supervisors for leave to present a late claim as to the claims which are untimely. (See Gov. Code, §§ 911.4 to 912.2, inclusive, and 946.6.) Under some circumstances, leave to present a late claim will be granted. (See Gov. Code, fi 911.6.) SILVANO B. MARCHER COUNTY COUNSEL By: Monika L. Cooper Deputy County Counsel Page 1 CERTIFICATE OF SERVICE BY MAiL (Code Civ. Proc., §5 1012. 1013a, 2015.5; livid. Code., §§ 641, 664) I am a resident of the State of California, over the age of eighteen years, and not a party to the within action. My business address is Office of the County-Counsel, 651 Pine Street, 9th Floor, Martinez, CA 94553-1229. On January ] 1, 2007, 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 Marc L. Terbeek, Mehlman Terbeek, :LLP, 2125 Oak Grove Road, Suite 125, Walnut Creel:, CA 94598-2406, as set forth above. I am readily familiar with Office of County C'ounsel'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. r 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 "f/ —07 at Martinez, California. Katl een O'Connell- cc: Clerk of the Board of Supervisors (original) Risk Management Page 2 .. 7 I STEVEN J. MEHLMAN CSB #95881 MARC L. TERBEEK CSB #166098 2 MEHLMAN❖TERBEEK LLP 2125 Oak Grove Road, Suite 125 3 Walnut Creek, California 94598-2406 Telephone (925) 935-3575 DEC 1 9 2006 4 Fascimile (925) 935-1789 CLERK BOgRD 5 Attorneys for Gilbert Sommerhalder CONTRgCOS7rACRVISORS Y srq co. 6 7 SUPERIOR COURT OF THE STATE OF CALIFORNIA 8 COUNTY OF CONTRA COSTA 9 GILBERT SOMMERHALDER, Case No: None Assigned 10 Claimant, CLAIMAGAINST GOVERNMENT ENTITY 11 FOR LOSS-- GOVERNMENT CODE vs. SECTION 910 ET SEQ. 12 COUNTY OF CONTRA COSTA; CONTRA COSTA COUNTY FIRE 13 PROTECTION DISTRICT; EAST CONTRA COSTA COUNTY FIRE 14 PROTECTION DISTRICT; DOES ONE THROUGH ONE HUNDRED 15 Respondents. 16 17 TO THE ENTITIES AND PERSONS IDENTIFIED IN THE ATTACHED PROOF 18 OF SERVICE: 19 You are hereby notified that Claimant Gilbert Sommerhalder claims damages as set forth 20 in the attached Exhibit A: "CLAIMAGAINST GOVERNMENT ENTITY FOR LOSS-- 21 22 GOVERNMENT CODE SECTION 910 ET SEQ. ' Additional information concerning this claim is disclosed in the attached Exhibit A. 23 Dated: December 18, 2006 MEHLMAN❖TERBEEK LLP 24 25 By: 26 Marc L. TerBeek 27 Attorneys for Claimant 28 Notice of Claim CLAIMAGAINST GOVERNMENT ENTITY FOR LOSS— GOVERNMENT CODE SECTION 910 ET SEO. A. Claimant Information Claimant: Gilbert Sommerhalder [SSN: 566-52-0183] Mailing Address: Post Office Box 222, Knightsen, California 94548 Telephone No: (925) 516-0708 B. Names of Public Entities/Emnlo ewes Against Whom Claim Asserted County of Contra Costa East Contra Costa Fire Protection District Contra Costa Fire Protection District C. Incident Date & Location Ongoing since January 1, 1997 in and throughout Contra Costa County, during employment with the Contra Costa and East Contra Costa Fire Protection Districts. D. Amount of Claim This is an Unlimited Jurisdiction Claim for contract damages ranging from $215,000 to over $520,000. E. General Statement of Factual Circumstances Underlying Claim Mr. Sommerhalder is a longtime County employee, whose currently performs firefighting duties for the County of Contra Costa with the East Contra Costa Fire Department and the Contra Costa Fire Protection District, where he hold the title of Fire Captain. Throughout his employment, he has been denied the full wages and benefits to which he is entitled as a full-time County employee, and instead has only been compensated as a part time employee. Consequently, Mr. Sommerhalder has been shorted some $215,000 in contract benefits to which is legally entitled over the last four years, and over$520,000 in such benefits over the last ten years, exclusive of interest thereon. F. Nature of Claimed Loss Mr. Sommerhalder's claim is in the nature of a contract claim, for the amounts stated above. G. List of Entities Served With This Notice 1. County of Contra Costa: Stephen L. Weir, County Clerk-Recorder John Cullen, County Administrator Silvano Marchesi, County Counsel 651 Pine Street, I I" Floor Martinez, California 94553 1 2. Contra Costa County Fire Protection District: Keith Richter, Fire Chief 2010 Geary Road Pleasant Hill, California 3. East Contra Costa County Fire Protection District William Weisgerber, Fire Chief 134 Oak Street Brentwood, California 94513 H. Address for Service of Related Notices or Communications All notices or communications regarding this claim should be sent to the following address: MEHLMAN❖TERBEEK LLP Attention: Marc L. TerBeek Attorneys for Claimant Gilbert Sommerhalder 2125 Oak Grove Road, Suite 125 Walnut Creek, California 94598-2406 Telephone (925) 935-3575 Facsimile (925) 935-1789 Date: December 18, 2006 MEHLMAN❖TERBEEK LLP By: Marc L. TerBeek Attorneys for Claimant 2 Gov't Tort Claim—Tarnowski v CCC, et al 1 PROOF OF SERVICE [C.C.P. §§ 1013, 2015.5, 20081 Re: Gilbert Somerhalder v. County of Contra Costa, et al 3 4 I, Jamie Plotnick, am a citizen of the United States and employed in Contra Costa County, California. I am over the age of eighteen years and not a party to the within action. 5 My business address is P.O. Box 4222, Walnut Creek, CA 94596. On December 19, 2006 1 served: 6 CLAIM AGAINST GOVERNMENT ENTITY FOR LOSS - GOVERNMENT 7 CODE SECTION 910 ET SEQ 8 _ by MAIL as follows: by causing a true copy thereof enclosed in a sealed envelope,with postage thereon fully prepaid,to be placed in the 9 United States Post Office mail box at Walnut Creek, California, addressed as indicated below. (I am readily familiar with this business' 10 practice of collecting and processing correspondence for mailing. It is deposited with the U.S. Postal Service on the same day in the 11 ordinary course of business). 12 X by PERSONAL SERVICE causing a true copy thereof enclosed in a sealed envelope to be delivered to the person(s) and/or entities designated 13 herein. 14 by OVERNIGHT MAIL causing a true copy thereof to be placed in 15 FEDERAL EXPRESS MAIL on Oak Grove Road, in Walnut Creek, CA before the final collection time, addressed as indicated below 16 following ordinary business practice, said practice being that in the ordinary course of business, correspondence is deposited in the 17 Federal Express Depository on the same day as it is placed for processing. 18 by FACSIMILE as follows: I caused the said document to be 19 transmitted by Facsimile machine to the addressee(s) at their fax numbers indicated below. The Facsimile machine I used complied 20 with Rule 2003(3) and no error was reported by the machine. Pursuant to Rule 2005(i), I caused the machine 21 to print a transmission record of the transmission. 22 County of Contra Costa: 23 Steven L. Weir, County Clerk-Recorder John Cullen, County Administrator 24 Silvano Marchesi, County Counsel 651 Pine Street, 11"' Floor 25 Martinez, CA 94553 26 Contra Costa County Fire Protection District: Keith Richter, Fire Chief 27 2010 Geary Road Pleasanton, CA 28 PROOF OF SERVICE I East Contra Costa County Fire Protection District William Weisgerber, Fire Chief 2 134 Oak Street Brentwood, CA 94513 3 4 I declare under penalty of perjury under the laws of the State of California that the foregoing is 5 true and correct, and that this Declaration was executed on December 19, 200 t Walnut Creek, 6 California. 7 8 JAMIE PL TNI CK 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 PROOF OF SERVICE 2 F ul � RJ 1Y.''J ..i Q S cr oo U N rJ� N 4� '� oo W .fin dpW CA N �o N it 56 W r- cn � J J ep d iv►-i cc O 10, -~ 0 o H .y rn Q a 0 o "S Y U �d U rn oa oG +T G U .a^ ' u C/) e^1 W H W U-i ON � d d W -' wx aow '� H � d CLAIM BOARD OF SUPERVISORS OF C01`4"1-11A COSTA COUNTY • BOARD ACTION: JANUARY 23 , 2007 Claim Against the County, or District Govenied by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO C.LAINIANT 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 olgIIt on your claim by the Board of DEC 2 2 Supervisors. (Paragraph 1V below), 2006 given Pursuant to Government Code ANiOUNT: $205 . 15 COUNTY COUNSEL Section 913 and 915.4. 1?lease note all MARTINEZ CALIF. "Warnings". CLAIMANT: DANNIE TALMADGE AND COURTNEY TALMADGE ATTORNEY. UNKNOWN DATE RECEIVED: DECEMBER 22 , 2006 ADDRESS: 6505 GREEN CASTLE CIRCL3L'RDELIVERY "1.0 CLERK ON: DECEMBER 22 , 2006 DISCOVERY BAY, CA 94514 BY MAIL POSTMARKED: DECEMBER 21 , 2006 FRONT: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DECEMBER 22 , 2006 JOHN CULLEN, C rk Dated: By: Deputy 11. FROM: County Counsel TO: Clerk of the Board of Sup rvisors ( 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 wai7iing of claimant's right to apply for leave to present a late claim (Section 911.3). O Other: Dated: M-- By:/' l 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). 1 (V. BOARD ORDER: By unanimous vote of the Supervisors present: This Claim is.rejected in fill. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. DatedfC "^&V d HN CULLEN, CLERK, By eputy Clerk WARNING ( code section 913) Subject to ceilain exceptions,you have only six(6) months frown the date this notice Nvas personalty served or deposited in the null to file a court action on this chiim.See Government Code Sectim 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, ddiateh. *for Additio+�. l Warning Sec Reverse Side of"ihis Notice.le AFFIDAVIT OF MAILING 1 declare under penalty of perjury that 1 ain now, and at all trues herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in INlartinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Datecl�,21VA ,GtT� Cjz 01 IN CULLEN. CLERK By Deputy Clerk V _ r $OARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLABUNF 4. A claim relating to a cause of action for death, or for 1jury to person or to pmonal proptaty z growing crops shall be presented not later than six months after the accrual of the cause f action. A claim relating to any other cause of action shall be.presented not later than one y 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 Doom 116, County Administration Building, 651 Pine Street,Martinez,CA. 94563. C. If claim is against a district governed by the Board of Supervisors, rather than.•rhe Count�r, e nary a of the District should be filled in. D. if the claim is against more than one public entity, separate claims must be filed against a 11 public entity, r 7✓. Fraud. See penalty for fraudulent claiz ,Penal Code Sec. 72 at the end of this form. ■R AZ Zp■Z1IZZZZ ER■■■1FYtt ■Ennui ILESP;RMaZfCti•ZLE CZIfs#ZEN q r ZZ•c Zila0.1w�42 ZR RXEMMM3 SRI RE: Claim By: Reserved for Clerk's filing,stamp TCA �t a L ;FC; 2006 Against the County o Contra Costa or ) } CLERU COARD OF SUPE ITCORS CONTRA COSTA CO. — - District) (Fill in the name) }' The u�dersiped claimant hereby makes claim against the unty of Contra Costa or the above-w, ed district in the sum of S 9 DST 1 s and in support of tis claim represents as follows: 1. %en did the damage or injury occur? (Give exact date and hour) 2. Where • •d the damage or injury occur? (Include city.U d county) — on S c&,y e� c j 3. How did the damage or injury occur? (rive full details;use extSa paper if nqd red) fir►V i n W"PS's- o n ��+� Sl�-+� t"t + i 0 + ,16 l-rwon &_ jDoa- ►-��he 4. What'particulas act or omission on the part of county or district officers, servants, or emp]Dyees caused the injury or damage? �1Xtd ptr1'Y�0) 5 5 What are the names of county or district offi=, servants, or employees causing the damage or injury? V 91 i G W o✓�5 6. What damage or injuries do your claim resulted? (Give full extent of injuries or dam es claimed. •Attach-tvo es6mates'for aato damage.) -OnA- . 1''►5 7. How was the amount Claimed above computed? (Include the estimated amount of y prospective injury or d age,) w �a� �u►''C8✓� o` �� -A eel �- S. Names and addresses of vAtaesses, doctor's, and hospitals: 9. List the expenditures you madb on account of this accident or injurer: _70—� j DATE TIME AMOUNT ■tl■RMhlM■FRINMKaa EiFBRE■h a 101011!3■ tial .Gov. Code Sec. 910.2 provides"The claim shall be ) signed by the clairnpt or by some pexson on his bebalf." SEND NOTICES TO: (Attomev) 1 NtiTame and address of Attorney ) (Cl ' is Signature) ei(l(Kh COG&Ic (Address) j SSC ' C* Telephone No. )Telephone No. �q GJ) �R- a.aa■Y�[R1�■a�111■■llaa>,11■t■AYl ■ ■■Y■aK■a■■t■■RRICla{■e■Rt'.�lt R■■i•Os [11lin. ■a■IS� testi PUBLIC RECORDS NOTICE: Please be advised that this claim form, or auy claim filed with the County under the Tort Claims AcL isjest to public disclosure under the California public Records Act, (Gov. Coda, §§ 6500 et seq.) Furtherm- e, any attachments,addendums, or supplements attached to the claim form, iuclwing medical records, are also s jeor to public disclosure, ■s _■■■1■t l■■t t■MKS t t■■t■ le RUN A■l R R k t■t M t a t•■a[Big■t a■■■an MKS NONE R■t t■■ME and man ME Y■R it a i NOTICE: Section 72 of the Penal Code provides: Every person who, with intent to defraud; presents for allowance or for payment to any state board or car, or to any couulq, city, or district board or officer, authorized to allow or pay the same if genuine, an false or fraudulent claim,bill, account voucher, or writing, is punishable either by imprisonment in the County ail for a period of not more than one year, by a fine of not exceedbig one thousand dollars ($1,000.00), o:by oth such unprisonment and fine, or by imprisonment in the state prisoa, by a fine of net exceeding ten thous d dollars ($10,000),or by both such bprisommmt and fine. r (Ir 'n• L j v ill i►i 1�r l 1ti i�, ni y`i,� 1 iPd,_' +� q n 7 J J� n •[ iS" i n CAM Liu Financing Available AMEI !'S iGEST TIRE STORE See store for details NMI )i-iNNY• i�`= 2006 ;':tE6(__DE-,n .Ii�:1`�? �%il`.! 0j 3505 G(~ LI-}; C L. h_350 .12.:':` t:. i:ls_.-._.i_:' f t.1 .'_ �E.1Li'd .�J.7�.eVYr1• 1�'1+ f_1_.i =L:`".1'Y 1 i�11�...5'� +.,..n .. 0Vi {'' ON. L..IIi�..'-�:t_{l..-'t';:•Y.A: y i,." � 1=�c5 �:13•:'_:�i._%1.�f3 .-iti,S Jij�l:�9�'_i-' �Irl'rijl[� {' 3 `:.F :ir'=}lii%l11!'.n.'...-- - •- -.... ._.... , t . !Y'?=40 ? '• :iiN; CdiV..:l1)�{: e�•:e <; .._ t .. is ,- ;+; ;;< . sl101� WRff ,rt_ - . iA. ._ i { y7 ;ykrul l 1 1 i: :._...!,?: :r { ;',! :_ .'li.:ri:...�`..: . . ± !::.'.:.. t•'+!t 1: r .... _ . a� 1 r . L!__ � I .. �.. i:1.1•'f,�.-._: N1,...- Q)4Q 1 i. (r''Fi...'.i�= i:�.-:-i�.-'.�-:L .i�ir:-:_ _. ._'IFE.I..t iris. s[L. +l;,: 7rl r:.. .. :. _ .. '..__.. ' ,4 ,.rn at�^ )RK ORDER rr Air Check L' ❑ Return Tires ❑ Change Snows 77_11:_-7 ;t:L L_ [ E] Repair ❑ Rotation Q Rebalance +y - Wheel Lock Ke Insta Prc : Iue - / +, '. '-' ustomer Signature Torgi y: _ Ft. Lbs. Cardholder ackno%iledges.receipt of gbo is and/or services in the amount offthe-Ibtal shown hereon and agrees to Performllhe obligations sel forth in the Cardholder's agreement with the issuer. Bay 1 fine : ------------\. � com s:_ . >,amencastireecom c nR I OCAL TAXES AND,WHERE REQUIRED OR CHARGED,ENVIRONMENTAL OR DISPOSAL FEES ARE EXTRA. ki a .i .T y •s s `�w F �. _`yin• �'�a � � ,=_ j N ` j+•i i t _ � ►A � ��0 Jaw r a rlO d Qp V414 ii I m c 0.n '',...... a � u,in O P CLAIN'l BOARD OF SUPERVISORS OF CONTRA COSTA COUNTi' BOARD ACTION: JANUARY 23 , 2007 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAINIANT and Board Action. All Section referetices are to ) The copy of this document mailed to California Government Codes. D you is your notice of the action taken on your claim by the Board of DEC 2 6 2006 Supervisors. (Paragraph IV below), given Pursuant to Government Code COUNTY COUNSEL Section 913 and 915.4. Please note all AM.OUN"I.': $40) 000 . 00 MARTINEZ CALIF. "Warnings". CLAIMANT: STEVE AND LORI CAMENSON A'I FORNEY: UNKNOWN DATE REC.EI.VED: DEC. 26 , 2006 ADDRESS: 1621 RAMONA WAY, BY DELIVERY "r0 CLERK ON: DEC. 26, 2006 ALAMO, CA 94507 B)' ivIA1L POSTNiARKED: DATE UNKNOWN FRONI: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, lead Dated: DECEMBER 26 , 2006 By: Deputy IL'. 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 warning of claimant's right to apply for leave to present a late claim (Section 911.3). O Other: Dated: I Z-2.�]--D�o :By: .Deputy County Counsel ill. FROM: Clerk of the Board 1'0: 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. 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. .-.oar ;?"CULLEN, CLERK, By Deputy Clerk WARNING (Ge -. code section 913) Subject to certain exceptions,you have only six(6) months 11-om the date this notice Nvas personally served or deposited in the nulil to file a count action on this cNim.Sev Government Code Section 945.6.You may scTk the advice ol'an attorney ofyour choice in coniuTtion wit)r this matter. If you 1 ant to consult an attonrey,you should do so immediately. *For Additional NVanning See Reverse Side of This Notice. AFFIDAVIT OF MAILING 1 declare under penalty of perjury that I ann non, and at all times herein mentioned, have been a citizen of, the United States, over age 13; and that today 1 deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Omer and Notice to Claimant, addressed to the claimant as shown above. Datedv_60_744A-111- 4� 4A-IN CULLEN, CLERK By DelAuty Clerk BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY ' INSTRUCTIONS TO CLAIMANT A. A claim relating to a cause of action for death or for injuty 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 Admidistration 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 fi audulent claims,Penal Code Sec. 72 at the end of this form. ■■■■mom■■■■■■■a■■■n MEN onus EWEN M 0 a name e 0■1 a■■■R■■a assume a a a a i RE: Claim By: Reserved for Clerk's filing stamp R+ 7r r1 Q� l.P 2 t�-�VVY1(�V1 Q, LI,�G�1 DEC 2 '� 2006 Ag ainst the County of Contra C tam ) w -0 �� District) CLERK BOARD OF STA CO.ISORS CONTRA COSTA CO. (Fill in the'name) ) The undersigned claimant ereb rmakes claim against the County of Contra Costa or the above-named district in the sun of$ and in support of this claim represents as follows:. 1. When did the damage or injury occur? (Give exact date and hour) VDD � m 2. Where did the damage or injury occur? (Include city and county) pe'c' lJe i Q Ulf oJv GUnwc +Y-om tkV) M(k t r)4-a i n cd C 66 l V1. �. 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 n mes of co or dis ict officers servants or em to gees causethe tY P 3 damage or injury? now 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.) 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 to a mans a 19 a a Ono Est a an a a a MR a !al Ism am a a s IN t Bit■BENZ NOUN a a a a t a s t e a a s a a l a s s a t a a a a e a a a a s a s a al .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) I Name and address of Attorney ) ljl�j"Y } (Cl ' ant's Signature) } "I aVY�y►� a a rno (Address) ) Telephone No. )Telephone No. .Z S ■,■■a a a s a a a s t a s a s l a a a a s a a■sa a a a a 1 a s a a s a s s a a s s s s mans a s a a a s s a s s a a a a s s a a a s son a a a t s a a s s a a a l PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthermore, any attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■a a a a a s a a a t e a a a a all a a SEEM a ■ lama all a s s s a a s a a a a a a a■in ENRON SENSE RUN s s a s a t a a Raw a us It SEEM 2011111 NOTICE: Section 171 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 imprisorunent and fine. � 11�--ecce,vn h�Pi, 3 � Sfi aL2�5 � We -�O,,utGQ 0� a��c Erna-FSI-c g, f�: 00 am o L.4 t� �.� -F��S-i- �JDDK OLAd OULK P(-ordeA� ��n�,, -1� I&out , -,T4 a w I c��, s� � p� 04v fina,-f" W 15 a , -e-A() -tn p�C, cL,(-o�uIvj Ide)s l�-&rxe a3 �-�- o cu�,�►��e� cP,u.,�� v� -lie �uc�,r�, u�� .er� �,+�aw a�e `�v�a-f� r-I- �u a s (��i�etc� , UPM W-O,/LL* V lit.S �2a4 r-orla�y0 +0 -tri' -f-D COfYf,.t+- t�U p ro b[.eKv, and jtSco vm ej, uJoAr �as rlof dray rl,t vKa &u -h/ .e J"ou-cp _fhe C"U-jv\.e,r+ cv, i+ wcLS qqPos,�J + aKd gxg —Hq *vj o-y tKe land 5 pes at I OF \--Fhc w&kr- was t05+e'ad 40ve[t +6 c)uv- 4YDK,-y cod LM --twe �,'re -qa--f- me--rif at tKO-i +iwie avid -f-hr y h��e�B +aJOe+ line GP �a� ✓tirz�eCor�e �}ec� . Taney - Wz�k }t anti eq -I u Vvw Le a Ja (YI him 3ftfd_tic k pla4ic 5k-e-c+t v� Bi -bn�s 4A wLe �o m a CkI Vj lead run tv\ ro u p ,�� pro�ae�'+y �en tv�x Jar�aje dad done Knew as e-zovi as -14 s+ar+ed y �� t 01-3 al 0 rrl UId 109 LVA w0--,5 on -rile- Olaane.. }o -Iv�e U-1-Yi- 0, Oil hour on the hou , e � 4-y,-y t � o��t -I� heli � c-1-e-ar ItTj 5o�e One vie c1ra� � p k was r� holicf� week � v�cQ � ii- upas al mist mposs� 6le . � wc�.s promised bv-er- and �Je✓ 11�ai a c �e� WOU-0 ou'+i bud i� +00k, days ecutka9 C) V-\ tv�e ptnone be�'ore T r-esucl-T-,r bue +6 Inokjay We, we're- L'Una-b� I-o ob4ain any k&[fim Y-n e-J +D Ce ✓nove 11ne yyyuJ and wce-ley � ' ofn our hovne nny Kusb&nd I vnysel� CIL"nj my yeaw o) d soy , did m6s1 O-F- -hqt clean up "rY� ere fps G I o} ore Shovelecd Duf our hove . C2 �rneh + I k eQrive - Way � loo a CA insicle D rn -e cpnt�e -F� �s+ � IoD C re+aini "I walk wc�s s-edfi ail oe 1fn�e_ vi akv -tin.c�-f ra..,rt .-f+w ujh1 Gt.,�ou►�d � �� u�d� i;-� . ire a.�-e MOLA maA� lar. packs L�v) -(1ne, -I-0 �ge apoq, re-d . {� cu" A� paj ,lb l'-s nb [ Dyyj.ev- I.-e-vel a_rjyoS ru.►rnoti-ed 0,-rd u.nf vfn �eG-Funs. Gkx vna" 11OW-S �a-,viiq rn u d a o d OP p ol (kp rum e) u,,v- h ay-me-� -�m cu:(Y ou, (�&l Vl� cur-eoc 5 - (;fie Kav-p-, D-k,n -TIOX (noy)(lo I - Ve-0.tq( Q, lot+ nD+ at red oJe are G-h.11 ) tuLj�, be -Fa I r, ju.s� � sKcv� � ��-�a�r5 -I--t� _e/ ��lo� �f-v -fie, u��--{�r� c��w�.a5e - l� �le� �o��r� �,�ou� � au.� hie o u�r�e�s t vl S�.rQ VI C-Q,, . -The- G��. � rv� w c� de,✓1) f-CL �e au c, i-}- cues -Fl DO � da.magu �. � h.a0 e n o+ see- yi a o,.-o ulvi4y ir tkck ma. yl e O/u) vf,(-i--3 6 ' ��-eats - � ,rn.� �I-� ��c�r -hie [fit v� �,�tG� G��b�`� s -fid im `-�h� �c-l-�e s. of- ►rn� -�-rn �� y'S -I-�m e `the. -F-, �s -f- -Fein ✓n� v�-��-s � `� e ��a,� Cll\ Lk Ce, Q-4tcn+uw� pp ( a f iAA P � � copies CrF reee � pts a �' est� n2a1PS p}� � c �ecP 5oc@ fftp-a4 ,,P )a(-e s)&z yarc( Cris pe+ down s+ftLY"s � � S�Z� ayKaI4 4o coffcc+ � b5 -n 00 �tcerva� d.✓ � veu�a�/ pa* $ moo°� $ g�q��o r� Placefare�iv� , n9wce� l feQta�L��ec� *°`ic�o�y�edrs 1> -7c'zooz)6 ccerpe+ Ao,uns+acrs � 145 °� �mber ( iaeck feplaceeV� � 25��`'s YYIU-d � u��r' d� mm � C4vr�en+ v, )aq- eta--Fedb 84 °o 3q�0S434 � uc.� ural r-e a� rs Tessa(, FD) 000 00 • CARPET PURCHASE ORDER. • Cash,Certified Check Money Order,or Bankcard DATE ORDER No. �y ESTIMATED DELIVERY DATE SALESMAN NUMBER C.O.D. tl i. i M ,i I t va4__' } i ' " ' ; No Personal Checks DELIVER TO: ire Em Buyer(s)Name / , Name m _ p ' Buyers)Address ! Address Carpets _ California® LP Suyer(s),City Zip — City State Zip Empire. 'Y�.i 'TODAY 2900 FABER STREET,UNIT 2 UNION CITY,CA 94587 Buyer(s),Phore. .�, Unit# Phone Unit# 800-588-2300 ( ..•±' - [.,q �� 1 CUSTOMER SERVICE HOTLINE: / ( 888-588-2324 Buyer(s)Work Phone E-Mail Activity# CA Lic.#770250 AREA ROLL# CARPET COLOR CASH PRICE , 1 1 1 1 ' 1 , 1 1' 1 EXISTING FLOOR:aCONCRETE (D TILE O WOOD O OTHER O TAKE-UP i0 SCRAPER TAX TYPE OF INSTALLATION: r. -..'; TYPE OF PADDING: TOTAL ii .• ESTIMATED STARTING DATE: / i'•'N ESTIMATED COMPLETION DATE- -Li- I % /_':' r, TERMS: ................................ ERMS:...................... ........................................................................................................................................................................... DEPOSIT ~: l <:, .•! .�. Bic .� 1 ;' _, 4'•, ")BALANCE ACCT.# ,:.., t t , ; t` EXP.DATE /_% APP.# PLEASE INSPECT FLOORING AND INSTALLATION FOR ANY PROBLEM WHILE THE INSTALLERS ARE AT YOUR HOME.THEY WILL BE HAPPY TO CORRECT ANY PROBLEM BEFORE LEAVING. The owner or tenant has the right to require the contractor to have a performance and payment bond. This Agreement, front and back, constitutes the entire understanding between us, and there are no verbal understandings changing any of these terms. Buyer(s) hereby acknowledge. that they have read the front and the back of this Agreement and has received a completed,signed and dated copy of this Agreement, including the two attached Notice of Cancellation forms,on the date first written above. Buyer(s) also acknowledge that they were orally informed of their right to cancel this transaction. EMPIRE CARPETS CALIFORNIA®, LP Accepted by: ! '�I, E i f�"� rail ra %#1CCepted by: Accepted by: PURCHASER (Print name) PURCHASER (print name) EMPIRE REPRESENTATIVE SIGNATURE (vrintnama) Accepted by: i'f 'fR - `F t Accepted, :--) Accepted by _•'< PURCHASER SIGNATURE ! PURCHASER SIGNATURE EMPIRE REPRESENTATIVE License Number ptwucabte) t.r' You,the Buyer(s), may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. See the attached Notice of Cancellation form for an explanation of this right. ADDITIONAL TER S AND CONDITIONS Buyer's Responsibilities: If customer is removing.existing carpeting, it must be removed at least one day prior to installation of the new flooring. Buyer is responsible for removing all breakable items from installation areas inside the home` rior to installation and for inspecting all areas prior to installation.Buyer must arrange for the moving of industrial or extra-heavy furniture such as pianos,stoves, pool tables,etc..and must disconnect any electrical appliances in the installation area or which must be moved prior to time of installation.Any unused flooring should be saved by the customer in the event of future unforeseen damage-such as cigarette burns.All other waste will be left in area designated by the customer. Empire's Responsibilities: Empire will perform all work in a professional manner and in keeping with industry standards. 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W I'll --�,e ;i;'. i' ,,.til;, u pl^: +i: „��n1 •\ ,.z ':5�t O iti•'` H ,i:' te :L, ti, :: t N ,i . 1: I w I V—L �t Ft � t 1!^ :1 ,.d. %i,,. ,:`.,` `h;1...,9:`?int•.h ;;g^�;".1''ir`.,,:R"".." \ ..11t �Iti�l`;rlb,d 1`.j;1u';�1'l51 i'}„a'`�1`,' '�,•:,` is a�1 W ail^•,:• �;3`n tii':hi�l:ti i ti;1:;; 1�y�,;17,v;ti`�,1`1y,",,:�”}°'�!y,:. ;;w. :Il,,;, ;,,�-'X.t; ;Tri: O c :'l":.1. ;ic; :.:;: s'i„ o :.5.` '' J H :�i:.�' mak,' 1:,�•\,' h ;.... 'jj' .•,'•l l.o ,�'. 1 i o `aa' ,"�,\. :\.,;\ti�;t 5,,,L Vii,.' ca LU LL. `^ ','X;�.,``•a:,x11`.1,,,;4o.?r'Aa`' Sh,.1�1 M W Q ��' W ::.;'. . x - la�,;i,S:; ;t:��511��.�,;`�i•,•tl`11atF��w,\"g,4"", �'��+`5;;1, Q O F� W OC Lu C43y O .''U,,.l`,,'`'\;1:::•, .I,.\VjP,\,.,\.; '•aii;"�1;`•;ji::is•I:i'�,;:';I��i�:j4�;;�:'' :,�:.i; ® /�1 San Ramon CARPET 1985 San Ramon Valley Blvd. '- t� ONE /,/r Ph(925)837-3716 Fax(925)820-6759 --i—. �� v SR /r C� Llv Page Of More Floors. More Choices. Livermore 1917 First Street Ph(925)455-9210 Fax(925)449-9386 CA. CONTR. LIC.#780026 / Sold To Date I� � �, r�c, Rep. Purchase (O Order Cust.Ph� :7 J r'l� Job Contact Job Cust.Ph.#W: Contractor: Address: _ Cust.Fax#: REQUESTED INSTALLATION DATE(S): 1 1` j\ CA filk., t -1 VIP Ac 7147f et DOOR TRIMM146-ISO .'� V1 Ef <,n � ,4 G TOTAL $ SALES AMT- TER MS: MT:TERMS: 50% DEPOSIT WITH ORDER - BALANCE DUE ON COMPLETION. DEPOSIT: C$ > PAST DUE INVOICES SUBJECT TO FINANCE CHARGES OF 1'b% PER MONTH. BALANCE DUE * RESTOCKING CHARGE FOR ORDERS CANCELLED AFTER 24 HRS FROM DATE OF PURCHASE. UPON COMPLETION: Accepted By X Merchandise not returnable without this slip. THANK YOU FOR THIS ORDER.WE LOOK FORWARD TO SERVING YOU AGAIN. Lifetime Installation Warranty-Guaranteed Lowest Prices SUPERIOR DECKS / E.ric Rumpf COIISIRICLiOn CO. ® / I I5 Hardy Circle. Plea�:uu Hill. CA 9452', • License#565157 Tel: (925) 931-0121 Fax: (91-5)934-0223 Date: Oc,-� ,57 2006 Home: 930 • X1'75// Fax: Client(s): Lori-e M E.,,.,go„i Cell: M 2/ /Qair►e1♦.cs, w�/, Office: Job Site: �o„.C., Job No: BID PROPOSAL gU�1� - N, Zl Ar. p,„ Z f-- 1.2 i_ .� A& lacIL Y-I& � j Payment Deposit e�(,V check # Schedule: i ov � 1 od t�0 V6w ;V� 6W 1) Inception 2) ,j SY 3) 4) Completion Currently available start date:/my/O —so scheduled call to schedule Estimated Duration of work: Thank you for the opportunity to bid this job. Accepted by: Date: Date: I✓1'1C I umpf 01 client ® www.superiordecks.net ASPHALT AND CONCRETE SURFACING COMPANY 9110-B Alcosta Blvd., PMB 235, San Ramon, CA 94583 (800)481-0441 • (925) 828-1432 • Fax: (925) 833-9008 To: Ms. Lori Compenson Date: October 23 , 2006 1621 Romona Way Alamo, Ca. 94507 We propose to furnish all materials and perform all labor necessary to complete the following: Re: Asphalt Driveway - Approx. 3 ,286 sq. ft. (1) Entire driveway area to be power cleaned. (2) High areas near the front and side entrance to be jack hammared up and removed. (3) Tack oil and petro-mat then applied to ,entire driveway area. (4) By machine method 2" of hot asphalt then applied to entire driveway area. (5) Compaction by roller method done for job completion. We Propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum of: Six thousand five hundred and seventy ------------collars ($ 6 ,570 . 00 Payment to be made as follows: $2, 570. 00 due at job start with balance of .$4 ,000 .00 due at job completion A Finance Charge of 1'/s%per month which is an annual percentage rate of 18%will be assessed on invoices N/A days past due. Any alteration or deviation from the above specifications involving extra cost of material or labor will only be executed upon written orders for same, and will become an extra charge over the sum mentioned in this contract.All agreements must be made in writing. In the event suit is brought to enforce or interpret any part of this agreement,the prevailing party shall be entitled to recover as an element of his costs of suit, and not as damages, a reasonable attorney's fees to be fixed by the court. Name and Registration Number of any salesperson Respectfully submitted, who solicited f negotiated this c ntract: By Brad Butcher, Asphalt&Concrete Surfacing Co. f' 9110-B Alcosta Blvd., PMB 235, San Ramon, CA 94583 Nam NO. Address Contractors are required by law to be licensed and (800) 481-0441 or (925) 828-1432 regulated by the Contractor's State License Board.AnyTelephone questions concerning a contractor may be referred to Contractor's State License No. 390268 the registrar of the board whose address is: Contractor's State License Board, You, the buyer, may cancel this transaction at any time 1020 N.Street, prior to midnight of the third business day after the date of. Sacramento, California 95814 this transaction. ACCEPTANCE You are hereby authorized to furnish all materials and labor required to complete the work mentioned in the above proposal, for which agree to pay the amount mentioned in said proposal, and according to the terms thereof. This acceptance is valid only if made within 45 days of the date first appearing above. ACCEPTED DATE NOTICE TO OWNER Under the Mechanics' Lien Law, any contractor, office of the county recorder of the county where the subcontractor, laborer, materialman or other person property is situated and requiring that a contractor's who helps to improve your property and is not paid for . payment bond be recorded in such office. Said his labor, services or material, has a right to enforce bond shall be in an amount not less than fifty his claim against your property. percent (50%) of the contract'price and shall, in Under the law, you may protect yourself against addition to any conditions for the performance of the contract, be conditioned for the payment in full such claims by filing, before commencing such work of of the claims of all persons furnishing labor, services, improvement, an original contract for the work of equipment or materials for the work described improvement or a modification thereof, in the in said contract. t ASPHALT AND CONCRETE SURFACING COMPANY 9110-B Alcosta Blvd., PMB 235, San Ramon, CA 94583 (800) 481-0441 • (925) 828-1432 •Fax: (925) 833-9008 To: Ms. Lori Compenson Date: October 23 , 2006 1621 Romona Way Alamo, Ca. 94507 We propose to furnish all materials and perform all labor necessary to complete the following: Re: Side Patio — approx. 542' sq. ft. (1) 33 sq. ft. of concrete installed in the patio. (2) Entire deck area to be power washed and etched. (3) Pene—Krete solution then applied to the deck to harden. the concrete, remove impurities and reduce water vapor emissions. (4) Cracks to be crackfilled where needed. (5) Two coats of Ure—Stain 9500 in your choice of colors to be applied to patio area. (6) One coat of clear seal then applied for job completion. We ose hereb to f rnish mate ial an lab —complete in accordance with the above specifications for the sum of: $ 8 thousYanc� nine unc�re°c!r ------------------------dollars ($ 2, 900. 00 ). Payment to be made as follows: $1 ,000. 00 due at job start with balance of $1 ,900 .00 due at job completion A Finance Charge of 1'/2%per month which is an annual percentage rate of 18%will be assessed on invoices N/A days past due. Any alteration or deviation from the above specifications involving extra cost of material or labor will only be executed upon written orders for same, and will become an extra charge over the sum mentioned in this contract.All agreements must be made in writing.In the event suit is brought to enforce or interpret any part of this agreement, the prevailing party shall be entitled to recover as an element of his costs of suit,and not as damages, a reasonable attorney's fees to be fixed by the court. Name and Regigtration Number of any salesperson Respectfully submitted, who solicited'or'negotiated-this contract: By Brad Butcher, Asphalt&Concrete Surfacing Co. 9110-B Alcosta Blvd., PMB 235, San Ramon, CA 94583 Name// ame 'f o.3 390268 Address Con ractors are required by law to be licensed and _ (800) 481-0441 or (925) 828-1432 regulated by the Contractor's State License Board.AnyTelephone questions concerning a contractor may be referred to Contractor's State License No. 390268 the registrar of the board whose address is: i Contractor's State License Board, You, the buyer, may cancel this transaction at any time Street, prior to midnight of the third business day after the date of. 1020 a Sacramento, California 95814 this transaction. ACCEPTANCE You are hereby authorized to furnish all materials and labor required to complete the work mentioned in the above proposal, for which agree to pay the amount mentioned in said proposal, and according to the terms thereof. This acceptance is valid only if made within 45 days of the date first appearing above. ACCEPTED DATE NOTICE TO OWNER Under the Mechanics' Lien Law, any contractor, office of the county recorder of the county where the subcontractor, laborer, materialman or other person property is situated and requiring that a contractor's who helps to improve your property and is not paid for payment bond be recorded in such office. Said his labor, services or material, has a right to enforce bond shall be in an amount not less than fifty his claim against your property. percent (50%) of the contract price and shall, in addition to any conditions for the performance of the Under the law, you may protect yourself against contract, be conditioned for the payment in full such claims by filing,before commencing such work of of the claims of all persons furnishing labor, services, improvement, an original contract for the work of equipment or materials for the work described improvement or a modification thereof, in the in said contract. , ._ r JkAk 3P. 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