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HomeMy WebLinkAboutMINUTES - 10162007 - C.24 CLAIM2 # BOARD OF SUPERVISORS OF CONTRA T COS A COUNTY BOARD ACTION: OCTOBER 16, 2007 Claim Against the County,or-District Governed by ) the Board of5upervisots,Routing Endorsements, ) NOTICE TO CLAIMANT j and Board Action. All Section references are to The copy of this document mailed to California Government Codesyi is your notice of the action taken i��9 y' out claim by the Board of SEP upper visors..(Paragraph IV below), I 1.1 2007'Iliven Pursuant to Government Code AMOUNT: UNKNOWNCOUNTY COUNSELSection 913 and 915.4:Please note all PMRTINPZCALIF. Warnings', CHARLES EDWARD BROWN CLAIMANT: AND MARK GILLORY ATTORNEY: UNKNOWN , DATE RECEIVED: SEPT. 11, 2007 ADDRESS: 4320 SYCAMORE AVENUE BY DELIVERY TO CLERK ON: SEPT. 11, 2007 RICHMOND, CA 94.804 j BY MAIL POSTMARKED: SEPT. 10, 2007 FROM: Clerk of the Board of Supervisors. TO County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN CIel, SEPTEMBER 11 2007' Dated: By. Deputy-. IL FROM: County Counsel TO: Clerk of the Board of Super .isors O 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 9.11.3). O Other: Dated: y, 0— O� By:mti Deputy County Counsel III.. FROM: Clerk of the Board TO: County Counsel(1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 91 1.3). . I IV.,g OARD 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:oWa,6cY/G, N CULLEN,CLERK,By ��Teputy Clerk WARNING(Gov.code section 913) Subject to certain excetttions ,you(rave only six(6)months from the date this notioe was personally served or deposi led In the mail to file`a court action on this clahn.See Government Code Section 945.6.You may seek the advice of an attiamey of your choice In connectlorwith this matter. If you want to consult mn attorney,you should do so iminedlately.` For Addid goal Wpnting See Reverse Side of Tltls Notice, I AFFIDAVIT OF MAILING I declare under penalty of perjury that I ant now,and at all times herein mentioned, have been a citizen of theUnited"States, over age 18; anti that today I deposited In the United States Postal.Service In Martinez, Califo.rnia, postage fully prepaid a certified copy of tills Board Order said Notice to Claimant,addressed to the claimant as shown above. Dated:er_'IVAIX 12' 946-31-JOHN CULLEN,CLERK By Deputy Clerk �y C, This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions In Inverse condemnation$ actions:for.specific relief such as.mandamus or injunetion,or Federal Civil Rights claims.The above.list is not exhaustive and legal consultation Is essential to understand all the separate limitations perlods that may apply. The limitations period within which suit must -be tiled may be shorter-or longer depending on the nature-of:the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its.rights under California Tort Claims Act nor.does it waive rights under the statutes of . limitations applicable to actions not subject to. the California Tort Claims Act OFFICE OF THE COUNTY COUNSELSILVANO B. MARCHESI COUNTY OF CONTRA COSTA �t+ _-_ co-__oma COUNTY COUNSEL Administration Building 651 Pine Street, 911 Floor ' - ,A SHARON L.ANDERSON Martinez, California 94553-1229 y;'j� P_. CHIEF ASSISTANT GREGORY C. HARVEY (925) 335-1800 VALERIE J. RANCHE (925) 646-1078 (fax) '.p a�'�� ASSISTANTS Sr'`� COLT11'� NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Charles Edward Brown Mark Gillory 4320 Sycamore Avenue Richmond, CA 94804 RE: CLAIM OF CHARLES EDWARD BROWN and MARK GILLORY Please Take Notice as Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 91.0.2, or is otherwise insufficient for the reasons checked below: [ ] I. The claim fails to state the name and post office address of the claimant. [ ] 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [X] 3. The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [ ] 4. The claim fails to state the name(s)of the public employee(s)causing the injury, damage, or loss, if known. [X] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of presentation,the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. [ ] 6. The claim is not signed by the claimant or by some person on his or her behalf. Charles Edward Brown Mark Gillory Re: Claim of Charles Edward Brown&Mark Gillory Page Two [ ] 7. You are required to submit your claim on the proper form, which is enclosed. Please resubmit your claim on the enclosed form, including all the required information. Gov. Code, § 910.4. Please be aware that you have only a limited period of time in which to file an amended claim. See Gov. Code, § 910.6. [ ] 8. Other: SILVANO B. MARCHESI COUNTY COUNSEL By: Monika L. Cooper Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (Code Civ.Proc., §§ 1012, 1013a,2015.5; Evid.Code, §§ 641, 664) 1 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 L%'e 7 , 1 served a true copy of this Notice of Insufficiency and/or Non-Acceptance of Claim by placing the document in a sealed envelope with postage thereon fully prepaid, in the United States mail at Martinez, California addressed to Charles Edward Brown,Mark Gillory,4320 Sycamore Avenue,Richmond,CA 94804,as set forth above. i am readily familiar with Office of County Counsel's practice of collection and processing of correspondence for mailing. Under that practice, it would be deposited with the U.S. Postal Service on that same day with postage thereon fully prepaid in the ordinary course of business. I declare under penalty of perjury under the 1126-07 of the State of California and the United States of America that the above is true and correct. Executed on / at Martinez,California. Kath ern O'Connell cc: Clerk of the Board of Supervisors(original) Risk Management i BOARD OF SUPERVISORS OF CONTRA C05TA COUNT'S INSTRUCTIONS TO CLAMANT A claim relating to a cause of action for death or for injury to person or to personal properly orr 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.presenied not later than one year . after the accrual of the cause of action. (Gov. Code § 911.2.) Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County AL:iibistration Building, 651 Pine Street,Martinez,CA 94553. If claim is against a district governed by the Board of Supervisors, rather than the County, the :name of the District should be filled in.. If the claim is against more than one public entity, separate claims must be filed against each. public entity. Fraud., See penalty for fraudulent claims,Penal Code Sec.72 at the end of this form. a a Rua t a a a t a Rag a a am a a a a am a Ian a an Is an a a a a 1 t t t t t a a a a am Kit a C a zoo ga t a;R t a t it t t 12 a a[a a l E: Claim By: L4� 2��s i�cx� ►� Reserved for Clerk's filing stamp ) RECEIVED �,gainstthe County of Contra Costa or ) SEP 1 1 2007 District) CLERK BOARD Of SUPERVISORS Fill in.the name) ) CONTRA COSTA CO. �a(AY�� ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named. 3tstrict in the sum of$ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) 3. How did the�1a age or injury occur? (Give full details;use extra paper if required) RAtkt- SOP a�,[ 1"74,k S-r- 4. part alar act or OMiiss n on tthe part of county or district officers, servants, or employees caused the injury or damage? C d YLQ �s A a— 4ut> 5 What are the names of county or district ofricers, sen mts,or employees causing the damage or injury? Co `� :-f What damage or injuries do your claim resulted? (Give full extent of injuries or damages - --claimed: -Attach-two estimates for auto damage.) How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Names and addresses of witnesses,doctors, and hospitals: aa�g. �c�rw►c r ST-, �. List a e�.pendrtures you made on account of this accident or injury: DATE TIDE AMOUNT 1■tze[1.a{[a■eaasaERIK SEES"aalaaataaailaatawtaawtaw■watt[[a at a tat 1.2{[31122 t azat t111L.{es.21 ) .Gov. Code Sec. 410.2 provides"The claim shad 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) jd�� oy.oQ _ �rry mac✓ Q4 baq Telephone No. )Telephone No.�5i 9.2 MEWRIER9909994 Rigs MEN I a R am a Its It a IRKNISSIMEW ft 11 anal[sign INS 911st as as K11111999 Its it San calls it anal 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, s§ 6500 et seq.) Furthermore, any attachments,addendums,or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■it a a a[a a a a a a a an alas w an... ■ a t a a[a{[!a[a t t t t t a[a t t a a l t a t a w a a a a a a t a l t■[ata!a t a a a a{t i l ai NOTICE: Section 73 of the Penal Code provides: Every person who, vdth intent to defraud, presents for aIlowuce or for payment to any state board or offii=r, or to any covnt3,, city, or district.board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, accountvoucher, 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. 08/23/2007 at 03:54 PM Job Number: 70409 A-1 MARTIN'S AUTOBODY REPAIR & FRAM Federal ID #: 680406937 1507 MARKET AVE SAN PABLO, CA 94806 (510) 233-0066 PRELIMINARY ESTIMATE Written By: EFRAIN MARTIN Adjuster: Insured: WILLMOR BROWN Claim # Owner: WILLMOR BROWN Policy # Address: 4320 SYCAMOR AVE Deductible: RICHMOND, CA 94804 Date of Loss: Day: (510) 234-1441 Type of Loss: Point of Impact: 12. Front Inspect A-1 MARTIN'S AUTOBODY REPAIR & F Other: (510) 233-0066 Location: 1507 MARKET AVE SAN PABLO, CA 94806 Insurance Company: Days to Repair 1987 OLDS CUTLASS SUPREME 6-3.8L-2 2D CPE Int: VIN: 1G3GR11AOHP340155 Lic: 5WCW660 CA Prod Date: Odometer: Bumper Guards Dual Mirrors Power Steering Power Brakes AM Radio Cloth Seats Automatic Transmission Deluxe Wheel Covers ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT -------------------------------------------------------------------------------- 1 GRILLE 2 0 Repl RT Grille w/o black grille 1 83.89 Incl. 3 Repl LT Grille w/o black grille 1 87 .28 Incl. 4 0 Repl Panel 1 462.71 3. 0 2. 0 5 Add for Edging 0.5 6 Repl RT Grille bezel 1 152 .20 7 Repl LT Grille bezel 1 152.20 8 Repl Center support 1 34.58 0.4 9 FRONT BUMPER 10 Repl Cover 1 224.85 2 .0 2 .5 11 Repl Molding standard 1 66. 12 0. 8 12 FRONT LAMPS 13 Repl LT Headlamp assy outer 1 51.28 Incl. 14 Aim headlamps 0.5 15# Repl COVER CAR 1 0.5 16# Rpr COLOR,TINT & BLEND 0.5 17# Refn COLOR, SAND AND BUFF 2.0 ------------------------------------------------------------------------------- Subtotals =_> 1315. 11 7.7 7.0 1 08/23/2007 at 03:54 PM Job Number: 70409 PRELIMINARY ESTIMATE 1987 OLDS CUTLASS SUPREME 6-3.8L-2 2D CPE Int: Parts 1315. 11 Body Labor 7.7 hrs @ $ 69.00/hr 531. 30 Paint Labor 7 .0 hrs @ $ 69.00/hr 483..00 Paint Supplies 7.0 hrs @ $ 30.00/hr 210. 00 ---------------------------------------------------- SUBTOTAL $ 2539. 41 Sales Tax $ 1525.11 @ 8.2500% 125. 82 ---------------------------------------------------- GRAND TOTAL $ 2665.23 ADJUSTMENTS: Deductible 0. 00 ---------------------------------------------------- CUSTOMER PAY $ 0.00 INSURANCE PAY $ 2665.23 I HEREBY AUTHORIZE THE REPAIR WORK TO BE DONE ALONG WITH THE NECESSARY MATERIALS. YOU AND YOUR EMPLOYEES MAY OPERATE VEHICLE FOR PURPOSES OF TESTING, INSPECTION OR DELIVERY AT MY RISK. AN EXPRESS MECHANIC'S LIEN IS ACKNOWLEDGED ON VEHICLE TO SECURE THE AMOUNT OF REPAIRS THERE TO. YOU WILL NOT BE HELD RESPONIBLE FOR LOSS OR DAMAGED TO THE VEHICLE OR ARTICLES LEFT IN VEHICLE IN CASE OF FIRE,THEFT, ACCIDENT OR ANY OTHER CAUSE BEYOND YOUR CONTROL. SIGNED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .DATE. . . . . . . . . 2 08/23/2007 at 03:54 PM Job Number: 70409 PRELIMINARY ESTIMATE 1987 OLDS CUTLASS SUPREME 6-3.8L-2 2D CPE Int: FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM: ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES: B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS: ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED. BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT W/ =WITH/_ SYMBOLS: #=MANUAL LINE ENTRY *=OTHER [IE. .MOTORS DATABASE INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. MQVP=MANUFACTURER'S QUALIFICATION AND VALIDATION PROGRAM. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. NWCPP=NATIONWIDE CRASH PARTS PROGRAM. Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide DOlDC82 Database Date 08/2007, CCC Data Date 08/2007, and the parts selected are OEM-parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM vehicle dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount. -OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle dealerships. Asterisk (*) or.. Double Asterisk. (**) indicates that the parts and/or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign (-) items indicate MOTOR Not-Included Labor operations. Non-Original Equipment Manufacturer aftermarket parts are described as AM, Qual Repl Parts or Comp Repl Parts which stands for Competitive Replacement Parts. Used parts are described as LKQ, Qual Recy Parts, RCY, or USED. Reconditioned parts are described as Recon. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not included. Pound sign (#) items indicate manual entries. Some 2006 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts data from the previous year may be used. The Pathways estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. CCC Pathways - A product of CCC Information Services Inc. 3 Y• j $ - 1 �t I of � � a Lt. v1 j pa t. a t� f� CLAIM �a BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: OCTOBER 16, 2007 Claim Against the County,or District Goveimed by ) j the Board of Supervisors Routing Endor-5ements ). NOTICE TO CLAIMANT i 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 g0 g))�Supervlsors.�(Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4.Please note all AMOUNT: SEE ATTACHED COUNTY COUNSEL "Warnirigs j CLAIMANT: ARLYN ERDMAN ; PAARTINEZ CALIF ATTORNEY: UNKNOWN DATE RECEIVED'._ SEPT.. 13, 2007 ADDRESS: 2621 STAR TREE'COURT BY-DELIVERY TO CLERK ON: SEPT. 13, 2007 MARTINEZ, CA .94553, i BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN; r Dated: SEPTEMBER 13, . 2007, _ gy, Deputy I.I. E ROM: County Counsel "` TO Clerk of the Board..f Supei`visi.ors �. u4his claim complies substantially with Sections 910 and 9102. ( ) This Claim FAILS to comply substantially.with Sections 910 and 910.2, and we are so notifying claimant.The Board cannot act fol• 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 9 t 1.3). O Other: i Dated: / 0 �7. By: m)����+ _ Deputy County Counsel III. FROM.: Clerk of the Board TO: County Counsel.(1) County Administrator(2) i O Claim was returned as untimely with notice to claimant(Section 911.3). . i IV. ARD ORDER: By unanimous vote of the Supervisors present: j (v) This Claim is rejected in full. O Other: CceI ify that this is a'true and correct copy of the Board's Order entered in its minutes for this date. Dated: /6.!�-AJR i CULLEN,CLERK, By. Deputy Clerk WARNING(Gov.code section 913) Subject to certain exceptions,you have only six(G)tnontlu fwm the date tills notice was personalty served or deposited in the nwll to rile a cawt acdon on this claim.See Government Code Section 945.6.You cony seek the advice of an attorney of your eholee in connection wide this matter. tl'you want to consult air attorney, ou should do so Immediately. For Addition y y y * aI Wanting See Reverse Side ofTltls Notlo AFFIDAVIT OF.MAILING; I declare under penalty of perjury that I am now,and at all tines 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 Mortfuez, California, postage-fully prepaid a certified copy of this Board Order and Notice to Ciahnant,,addressed to the clahnant as shown above. Dated:ye 06"�lI'AwlJOHN CULLEN,CLERK By eputy Clerk i, This warning does not apply to claims which are not subject to the California Tort Claims Act such as.actlons in Inverse condemnation, actions for,specific relief such as mandamus or injunrttion,or Federal Civil Rights claims,The above.list is not exhaustive and legal; . consultation Is essential to understand all the separate limitations periods that may apply. The limitations period within which salt must be flied may be shorter or:longer depending on the natureof the claim.Consult the specillc statutes and cases applicable ti)your particular claim. The County of Contra Costa aloes not waive any of Its,rights under.California Tort Claims Act nor.does It walve,.righ,ts under the statutes of limitations applicable to actions not subject to the California Tort Claims Act i DOARD OF SUP +`RVISORS OF CONTRA CQSTA CO= INSTRUCTIONS TO CLAWANT A claim relates to a cause of anion for death or far injury to person MID peasonal urO Pty or growing craps shall be present--d not later than six mBntbs after the accrual of the cause of a=ction. A claim relating to any other c=ause of a=ction shall be,gres=.t!:d not later thou once ytar . after the accrual of the cause of action. Code j 911.2.) Claims must be filed with the Clerk of the Board of Supervisors at its office iu Room 106, County Administr6on Building,651 Pine Street,Mar�nez,CA 94553. If claim is against a district goveimed by tha Board of Supm-ison, rather tan tb.e County, the :name of the District should be celled in. If the claimis aggaiast more than. one public envy, separate claims must be filed agabaA each. public entity. Fraud.. See pen=alty for fraudulent cla=ims,Penal Code Be:.72 at the and of this form anKInttt tk l[AlitlittiS,CIto<lIAttANxazztit llttttgym Rage t it IF k s r l l It ltl t[■c r L lte l R ergo 1 E; By: Rwer ed for Clerk's firin=g stam=p J<7�/Y �. RECEIVED %gaiastthe Count�ofContra Costa or ) SEP 1 3 cuui District) CLERK BOARD OF SUPERVISOriS CONTRA COSTA CO. Fall in the name} )" I'hn undersig d c1A �Ut hezo xdapes claim against the Cor_nV of ConLa Costa or the above-named distzict is the slim of in support of his claim rzpresents as follows: L When did the daage or injury ocz=? (Criva i=date ana hour) y////0 7;2- 2. 7. Where did the damage or injury occur? (include city and county) / 3. Haw aid the.d ju occur? (Give full dm-ls;tut extra.pap—if i ed) ' 4. 'parfimu ar ant or omission o the p of co or o Gars, rpenwtts, or enpl caus:d the injury or damage? 5 Whit are be names of coma r or distrirrt of servants, or employees music„the dam=age or injuzy? I d lEti 'ON 1N3W39dNdW �M 999 W1 :6 10H 'll 'd3S i Vak da M&Ior injuries do your claim resulted.? (Give full extent of injuries or damages - -claimed_ A.v=b two-estirnEtes for auto damage:) •: --- -- . How was the amatmt claimed above camptafied? {Imlude the esdmatul am,otmt of any Prospecve inp or da�m.aae,} N es d dare es a esses dryc#ors,and lo S011MI �} �. Listtb� you made,on ac omt of this amident or injury DATE FiIi213 Al~rlOUNT tsRlta to s�ee�Lesa Rats sacs s K a RRa am eRRt1919lttt man IRtelee ik Wet L194a RR AN LIKINS K[K=■a 942 CRtt ) .Gov.Code Sec. 910?provides"The claim shall be )sifacd byth or by some person on his }b " SEND NOTICM TO; [ tttsszaevl 1 Name and address of Attomey } } (Claunaat°s Signa =) } (Ad ) } =' C Tel ephoae No. )Telephone No. s R.aak*at tat Rse LK a RasR am k e R am It ILK a R a Alan x11 IN R Kit t arae 4 s a R13LE Lee I■R RK as c4 z at EKE*RR a at a a as kt PUBLIC RECORDS NOnCE: Pim-no be advised that this claim farm,or any clan fled with 93c Cotmty under elle Tort Claims Ag.,is subject to public disclowe� wrier'the C4fo=ia. Publ a P=grds Act {Gov. Codi, c§ 5500 ct seq) Fin irrmora, any etr bra=ts,eddendums.or mpplumants attaohcd b the claim form,including medical records,are also subject to public disclas¢rc. alias 1911 it IFI 9RRRa AN 0ANAIR a IR Iran ANN ask Aat•tta�klaaaIN a RR at a RIRR a I a L a R Kitt AN a a a tae sa IF a L Rtt NOTICE: ICE: Secfion 72 of the Penal Code prtrvidw: Every person who,wi&iatEnt to defrand,pmsent for n.11owwc- or for payment to any state board or oMcer, or to any ootm),, arty, or district board or of=, atdbarimd to allow or pay lb-, same if gmulne, my false or fraudulent elms,bill, erccnsnfi voucher, or wtfiag is pnaishablc eitb=by imprisonmd in fixe County jail for a period of not more than one year, by a $mc of not=--eding ono thoumd dollars ($1,000.44), or by both such imprisonment and tine, or by impri.somnent in the state prison, by a fine of not �rerdi�ten thousand dbllers CS1U;000},orbybofa such i>r!prisoument and fm--. 4 GD 'ON 1N3W30b'M YSId .DO) W1 �6 0H V 'd3S 2tRENTAL CONTROL DOCUMENT Controller Reservation No. PreparedBy� LOW Edition- `�� t4K\A O V N Shop Name 1J Q \ Delivery Date Time Referral Source: Phone - Contact O P-Up Cust O Cust come in- O Del to Cust Shop Address q Z_ S-2 Veh.Type Delivery or pickup location/address Car Class-Rate.Quoted RENTER INFORMATION O Claimant O Insured RENTER'S PERSONAL INSURANCE COVERAGE Name I U lJ r�✓ d M�9�1 Renter's Insurance Co. Address Renter's Agent Phone# City State Zip Policy# Exp.Date Home Phone DOB Liability Comp Collision Transfers:Y/N Work Phone Employer Sub.Trans Add'l Policy Drivers DL# State Exp Verified by: BILLING p REQUIREMENTS O DIRECT BIL O SPLIT BILL O SEL P Is Direct Bill Authorized? ❑ Yes ❑ No /PO/RO# DOL Upsell Reviewed? ❑ Yes C3 No Claim Bill / O/ DOL Minimum Age Reviewed? C3 Yes C3 No CC/Cash Qua]Policy Reviewed? C3Yes ❑ No Address City State Zip NOTES Adjuster Phone# Insured's Name Pol.# 07 S i✓�l t CC Type # Exp. Rental Agreement No. 2 2- AF - Lova/Edition The Hertz Corporation 145 John Glenn Drive Concord,CA 94520 Phone:(925)691-0104 to fax: (925)691-0211 09/12/2007 al 01 : 55 PM Job Number: 21975 MARTINEZ AUTO BODY SHOP License # :BAR AB085474 Federal ID # : 942574428 615 ALHAMBRA AVE MARTINEZ, CA 94553 (925) 228-3689 Fax: (925) 372-6546 PRELIMINARY ESTIMATE Written By: GARY HERNANDEZ Adjuster: Insured: ARLYN ERDMAN Claim # Owner: ARLYN ERDMAN Policy # Address: Deductible: Date of Loss: Business: (925) 957-0304 Type of Loss: Point of Impact: 5 . Right Rear Inspect Location: Insurance Company: Days to Repair 1999 CADI DEVILLE 8-4 . 6L-FI 4D SED PEARL Int:TAN VIN: 1G6KD54Y1XU761118 Lic: 4GOP181 CA Prod Date: 01/1999 Odometer: 100044 Condition: Excellent Air Conditioning Rear Defogger Tilt Wheel Cruise Control Intermittent Wipers Auto Level Climate Control Keyless Entry Theft Deterrent/Alarm Dual Mirrors Traction Control Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks Power Driver Seat Power Passenger Seat Power Antenna Power Mirrors Power Trunk/Tailgate AM Radio FM Radio Stereo Cassette Anti-Lock Brakes (4) Driver Air Bag Passenger Air Bag Front Side Impact Air Bag 4 Wheel Disc Brakes Cloth Seats Automatic Transmission Overdrive Aluminum/Alloy Wheels ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1 REAR BUMPER 2 R&I R&I bumper assy 1 . 5 3 QUARTER PANEL 4* Rpr RT Quarter panel 1 . 5 2 . 3 5 Add for Clear Coat 0. 9 6* R&I RT Body side mldg all 0. 3 7* R&I RT Emblem crest standard 0. 3 8 BACK GLASS 9 R&I Back glass GM 2 . 0 10 O Repl Adhesive kit 1 52 . 63 11# Repl Corrosion Protection 1 5. 00 T 0. 3 1 09/12/2007 at 01 : 55 PM Job Number: 21975 PRELIMINARY ESTIMATE 1999 CADI DEVILLE 8-4 . 6L-FI 4D SED PEARL Int:TAN ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 12# Subl HAZ WASTE (F) EPA# 000157611 1 3 . 00 X 13# R&I ANTENNA MAST 0. 5 14# Rpr TINT FOR PANEL MATCH NO BLEND 1 . 0 15# Rpr COLOR SAND POLISH 0 . 5 16# Repl RETAPE MOULDINGS/EMBLEMS 1 5. 00 0 . 5 17# Repl MASK FOR OVESPRAY 1 5. 00 0 . 3 18# Subl PTD STRIPES 1 100. 00 X ------------------------------------------------------------------------------- Subtotals =_> 170. 63 8 . 7 3 . 2 Parts 62 . 63 Body Labor 8 . 7 hrs @ $ 76. 00/hr 661 .20 Paint Labor 3 . 2 hrs @ $ 76. 00/hr 243. 20 Paint Supplies 3 . 2 hrs @ $ 34 .00/hr 108 . 80 Sublet/Misc. 108 . 00 ---------------------------------------------------- SUBTOTAL $ 1183 .83 Sales Tax $ 176. 43 @ 8 . 2500% 14 . 56 ---------------------------------------------------- GRAND TOTAL $ 1198 . 39 ADJUSTMENTS: Deductible 0. 00 ---------------------------------------------------- CUSTOMER PAY $ 0..00 INSURANCE PAY $ 1198 . 39 AUTO BODY REPAIR CONSUMER BILL OF RIGHTS A CONSUMER IS ENTITLED TO: 1 . SELECT THE AUTO BODY REPAIR SHOP TO REPAIR AUTO BODY DAMAGE COVERED BY THE INSURANCE COMPANY. AN INSURANCE COMPANY MAY NOT REQUIRE THE REPAIRS TO BE DONE AT A SPECIFIC AUTO BODY SHOP. . 2 . AN ITEMIZED WRITTEN ESTIMATE FOR AUTO BODY REPAIRS AND, UPON COMPLETION OF REPAIRS, A DETAILED INVOICE. THE ESTIMATE AND THE INVOICE MUST INCLUDE AN ITEMIZED LIST OF PARTS AND LABOR ALONG WITH THE TOTAL PRICE FOR THE WORK PERFORMED. THE ESTIMATE AND INVOICE MUST ALSO IDENTIFY ALL PARTS AS NEW, USED, AFTERMARKET, RECONDITIONED, OR REBUILT. 3. BE INFORMED ABOUT COVERAGE FOR TOWING SERVICES. THE INSURER SHALL PAY REASONABLE TOWING AND STORAGE CHARGES INCURRED BY THE INSURED TO PROTECT THE VEHICLE AND PROVIDE REASONABLE NOTICE TO AN UNSURED BEFORE TERMINATING PAYMENT FOR STORAGE CHARGES SO THAT THE INSURED HAS TIME TO REMOVE THE VEHICLE FROM STORAGE. 2 Y ' i 09/12/2007 at 01 : 03 PM Job Number: 42658 MIKE ROSE'S AUTO BODY OF WC, INC. - N. M License # : BAR AF195098 Federal ID 4 : 680291453 WHERE QUALITY COUNTS 2288 NORTH MAIN STREET WALNUT CREEK, CA 94596 (925) 979-1739 Fax: (925) 279-4334 PRELIMINARY ESTIMATE Written By: RICK FARRELL Adjuster: Insured: Claim # Owner: Arlyn Erdman Policy # Address: 2621 Star Tree Lane Deductible: Date of Loss: Evening: (925) 957-0304 Type of Loss: Day: (925) 228-1600 Point of Impact: 5. Right Rear Inspect Location: Insurance Company: Days to Repair 1999 CADI DEVILLE 8-4 . 6L-FI 4D SED Ivory prl Int: VIN: 1G6KD54Y1XU761118 Lic: 4GOP181 CA Prod Date: 01/1999 odometer: 100033 Air Conditioning Rear Defogger Tilt Wheel Cruise Control Intermittent Wipers Auto Level Climate Control Keyless Entry Theft Deterrent/Alarm Dual Mirrors Traction Control Three Stage Paint Power Steering Power Brakes Power Windows Power Locks Power Driver Seat Power Passenger Seat Power Antenna Power Mirrors Power Trunk/Tailgate AM Radio FM Radio Stereo Cassette Anti-Lock Brakes (4) Driver Air Bag Passenger Air Bag Front Side Impact Air Bag 4 Wheel Disc Brakes Cloth Seats Automatic Transmission Overdrive Aluminum/Alloy Wheels ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1 QUARTER PANEL 2* Rpr RT Quarter panel 0 0. 00 2 . 5 2 . 3 3 Add for Three Stage 0 0. 00 0. 0 1 . 6 4* R&I RT Body side mldg all 0 0. 00 0 . 3 0.0 5 Repl RT Emblem crest standard 1 47 . 38 0. 3 0. 0 6 Repl RT Emblem wreath standard 1 22 . 73 Incl . 0. 0 7# R&I Antenna Bezel 0 0. 00 0. 3 0. 0 8 REAR BUMPER 9 R&I R&I bumper assy 0 0. 00 1 . 5 0. 0 10 REAR LAMPS 11 R&I RT Tail lamp assy 0 0. 00 0. 5 0. 0 1 ro 09/12/2007 at 01 : 03 PM Job Number: 42658 PRELIMINARY ESTIMATE 1999 CADI DEVILLE 8-4 . 6L-FI 4D SED Ivory prl Int: ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 12 REAR DOOR 13 Blnd RT Door shell 0 0. 00 0. 0 1 . 7 14* R&I RT Body side mldg all 0 0. 00 0. 3 0 . 0 15 R&I RT Fixed glass GM 0 0. 00 0. 9 0. 0 16 R&I RT Window molding 0 0. 00 0. 3 0. 0 17 R&I RT Belt w' strip 0 0 . 00 0 . 3 0 . 0 18 R&I RT Handle, outside 0 0. 00 0. 6 0 . 0 19 R&I RT R&I trim panel 0 0. 00 0. 4 0. 0 20# Repl COVER CAR 1 7 . 50 T 0. 2 0. 0 214 Repl CORROSION PROTECTION 1 10 . 00 T 0. 3 0. 0 22# Subl HAZARDOUS WASTE 1 5 . 00 X 0. 0 0. 0 23# Subl PAINTED STRIPE PER PANEL (PER 1 135 . 00 X 0. 0 0.0 INVOICE) 24# TINT COLOR 1 0. 00 X 0 . 5 0. 0 25# COLOR SAND & POLISH ( . 5 PER 1 0. 00 1 . 0 0 . 0 REPAIRED PANELS) ------------------------------------------------------------------------------- Subtotals =_> 227 . 61 10. 2 5. 6 Parts 70 . 11 Body Labor 10 . 2 hrs @ $ 82 . 00/hr 836. 40 Paint Labor 5. 6 hrs @ $ 82 . 00/hr 459. 20 Paint Supplies 5 . 6 hrs @ $ 35 . 00/hr 196. 00 Sublet/Misc. 157 . 50 ---------------------------------------------------- SUBTOTAL $ 1719. 21 Sales Tax $ 283 . 61 @ 8 .25000 23. 40 ---------------------------------------------------- GRAND TOTAL $ 1742 . 61 THIS IS A PRELIMINARY ESTIMATE, ADDITIONAL CHANGES TO THE ESTIMATE MAY BE REQUIRED FOR THE ACTUAL REPAIR. 2 1 . • 09/12/2007 at 01 : 03 PM Job Number: 42658 PRELIMINARY ESTIMATE 1999 CADI DEVILLE 8-4 . 6L-FI 4D SED Ivory prl Int: FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM: ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES: B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS: ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT 0/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL REPL=QUALITY" REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT W/ =WITH/ SYMBOLS: #=MANUAL LINE ENTRY *=OTHER [IE. .MOTORS DATABASE INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. MQVP=MANUFACTURER'S QUALIFICATION AND VALIDATION PROGRAM. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. NWCPP=NATIONWIDE CRASH PARTS PROGRAM. Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide DE1BA94, CCC Data Date 08/01/2007, and the parts selected are OEM-parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM vehicle dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount. OPT OEM or ALT OEM parts may include 'Blemished" parts provided by OEM's through OEM vehicle dealerships. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign (-) items indicate MOTOR Not-Included Labor operations. Non-Original Equipment Manufacturer aftermarket parts are described as AM, Qual Repl Parts or Comp Repl Parts which stands for Competitive Replacement Parts. Used parts are described as LKQ, Qual Recy Parts, RCY, or USED. Reconditioned parts are described as Recond. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not included. Pound sign (#) items indicate manual entries. Some 2006 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts data from the previous year may be used. The Pathways estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. CCC Pathways - A product of CCC Information Services Inc. 3 CLAIM V®ov BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Claim Against the County,or District Governed by ) the Board of Supervisors,Routing Endoisementsl ) NOTICE TO CLAIMANT and Board Action.All Section references ar a to ) The copy of this document mailed to California Government Codes.: 'I ) 4 s you is your notice of the action taken on your claim by the Board of P 1 4 07 Super visors.:(Paragraph IV below), SE 20 given Pursuant to Government Code AMOUNT: a 57•oZ o2 COUNTY caunlst���.t Section.913 and 915.4.Please note all MARTINEZ♦;A "Warnings'.'. d CLAIMANT:paCGli(S� I ATTORNEY: {�/Q DATE RECEIVED ADDRESS: AJ614 ff� l OIM ; BY DELIVERY TO CLERK ON: Y MAIL POSTMARKED,. FROM: Clerk of the Board of Supervisors TO. County Counsel Attached is a o0 of the above-noted claim. pY . . ���hhvl JOHN CULLEN P�..ler Dated: St'el� G`f L��f . By Deputy' It. FROM; County Counsel TO: Clerk of the Board of Supervisors (u4`fiiis 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: ! i Dated: 021'—a7 By: mt_�'l� Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel(1) County Administrator(2) O Claim was returned as untimely with notice to claimant(Section 911.3). . i IV. 8 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: CULLEN,CLERK, By_ Deputy Clerk. WARNING(Gov.code section 913) Subject to certain exceptimis,you have only six(6)pnontbs fipm the date this notice was personally served or.deposited hr the nwll to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this matter. (I'you want to consult an attorney,you should doso Inunedlately, *For Additional Wgrning See Reverse Slue ofTlris Notice, AFFIDAVIT OF MAILING I declare under enalt of �er'ur that I ann now,and at all times herein mentioned, have p Y . I JY been a citizen or 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 Clahnant,addressed to the claimaint as shown above. DatedaVZ--- JOHN CULLEN,CLERK By Deputy Clerk This warning does not Apply to claims which ` are not.subject to the California Toet Claims Act such as actions in inverse condemnation, actions for specific relief such as.mandamus or lnjuncltion or Federal Civil Rights claims.The above list is not exhaustive and legal consultation is'essential to understand.all the .separate limitations periods:that may apply. The limitations period within which suit must be tlled'may be shorter`.or longer depending on the.nature of the claim.Consult the specific statutes and cases applicable to your particular claim.` The County of Contra Costa does not waive any of Its,rights, under,California Tort Claims Act nor does it waive,rights.under the statutes..of limitations applicable to actions not subject to the California Tort Claims Act alPacific Gas and Electric Company® Credit and Records Center September 12, 2007 P.O.Box 8329 Stockton,CA 95208 Clerk of the Board of Supervisors 651 Pine Street, Rm-106 County Administration Bldg 11, Martinez CA 94553 SFp 1 � 2001 Subject: Damaged: PG&E Facilities CLERK BO; IPERVISORS Date of Loss: 7/21/2007 CON ra co. Location: 2143 Trinidad Place PG&E File No.: C2007400641 Dear Sir and/or Madam: We are writing this letter to call your attention to the above referenced claim. Enclosed is our repair invoice in the amount of$257.22. Please send your payment, along with the invoice, in the envelope that is provided. Please call me at 1-800-945-5251 extension 7470, if you have any questions. Otherwise, we look forward to receiving payment as soon as possible. All other correspondence to should be directed to: Pacific Gas & Electric Co. (PG&E) Attn: Non-Energy Collection Unit P. O. Box 8329 Stockton, CA 95208. Thank you for your prompt attention to this matter. Sincerely, Mari Jacinto Claims Representative Enclosure Claire to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1967, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for..death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not .later .than one year after the accrual of the cause of action. (Govt. 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 ) Reserved for Clerk's filing stamp LX Cifl C 614-0 CU ) ERECEIVED Against the County of Contra Costa ) 1 4 2007orSUPERVDistrict) ACOSTACO.OF �S�RS Fill in name ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) W 0712 . 071- 2. . Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full details; use extra paper if required) C 4)T7ei4 Cos'rt►MCOa.• ty -eXli/c';6 UXLF MWhat particular act or omission on the part of county or district officers, servants or.employees caused. the.injury or.damage? 5. What are the names of county or district officers,. servants or employees causing the damage or injury? 5. What damage or injuries do you 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.) $. Names and addresses of witnesses, doctors and hospitals. .9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT tifi¢TE?2I/Yt�C �'4 oz • � 1F iE If .ik * iE IE �F .� � * * IE iF � � IE -f *.� � * � Ik � f # � � * * * * � IF # � iE iF.IE iE Gov. Code Sec. '910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: -or by some person on his-behalf:". Name and Address I �E X- &_G6FC7W_& ed, (Claimant's Signature _PAMe D •C3�X �� 9 Address lST Z3 CSC 773 �✓�a 0 Telephone No. L-209 15'7-7V716 Telephone No. � '� N O T I C E 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 ($1,000), or by both such imprisonment and finei-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. Non Energy Invoice a 99950006792858000000257220000025722 lnvaeC Numbar 1nvo�c0 mate Amount»ue AMount nclosi'tl .. .. . . . .. ... 0006792858-0 09/12/2007 $257.22 COUNTY OF CONTRA COSTA PG&E Box 00 2467 WATERBIRD WY• Sacramento, Sacramento,CA MARTINEZ CA 94553 95899-7300 Please return this portion with your payment. Thank you. *O .................... .......................... ............... ........ ......... . ......... ...................................... .......... ............................ ..... _- ............ When Making Inquiries or Address Changes, Cuslomer:Nbt t . Please Contact: 646905 - on- nergy ect�on: nit nva�ce tem er..::: O Box 829 - . 0006792858 0 tockto►i.C 95208=8329: 80t)j 945 5251; PK 3PTY 7/21/07 GDIGIN 2143 TRINIDAD FFL Unit: Descriptron' _Duanttty :: ...Pacior Amounf.r:: Reference Number: E2007400641 LABOR TO REPAIR GAS FACILITIES-EXPENSE 1 EA 248.80 MATERIAL FOR REPAIR OF GAS FAC-EXPENSE 1 EA 8.42 Line Item Subtotal 257.22 AMOUNT NOW DUE $ 257.22 NOTE: This invoice reflects current charges only. Any past due amounts will be billed separately. ® Recycled Paper 30%Post-consumer Wine o t' O . n N � N N O Vi �f 1F W .i 1�{ Vol. i;l t,t PEtRREsS�f C�R�S ' . r f b r P m yo �Qr 00 �w�Osr t pN :,�• O� ti 4 i p c� co m N? ry N D Of a> CLAIM o BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: O' Claim Against the County,or District Governed by ) the Board of Supervisors Routing Endorsements ), NOTICE TO.CLAIMANT i and Board Action.All Sectroii references are to ) " The copy of this document mailed to California Government Codes. P �)? you is your notice of the action taken on your claim by the Board of SEP 14 2.007 Supervisots,(Paragraph IV below), Siven,Pursuant to Government Code AMOUNT: oo COUNTY CQr UNSEL Section 913 and 915.4.Please note all 1 KsARTINEZ CALIF "Warnings , CLAIMANT: M r ATTORNEY: }�(� DATE RECEIVED. ADDRESS: BY DELIVERY TO CLERK ON: CA ��tOl(J BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO County Counsel Attached is a copy of the above-noted claim. JOHN CULLnzi�,�WjaA� Dated: � ' By Deputy if. 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 j send warning of claimant's right to apply for leave to present a late claim(Section 911.3). O Other: I i Dated: q-,Zy-D-7 By:- Deputy County Counsel III. FROM: .. Clerk of the Board TO: County Counsel(1) County Administrator(2) O Claim was returned as untimely with notice to claimant(Section 911.3). IV. ARD ORDER: By unanimous vote of the Supervisors present: (,This Claim is rejected in full. O Other: i I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: 'J&fIN CULLEN,CLERK;By. Deputy Clerk. WARNING(Gov.code section 913) Subject to certain exceptiats,you have only six(G)iittonths from the date tills notice was personally served or deposited In the mail to file a court actlarl on this clahn.See Government Code Section 945.6.You may seek the advice of..an attoivey of your.clroice in connection with this matter. if you want to consult all attorney,you should do'so immediately. *For Addidonal Wari!lm See Reverse Side of This Notice, AFFIDAVIT OF MAILING j I declare under penalty of pet jury that [ant now,and at all times herein mentioned,have. been a citizen (if the United States, over age 18; and that today I deposited in the United States Postal Service In Martluez; California; postage.fully prepaid a certified copy of this Board Order and Notice to Clalmant,,addressed to the claimant as shown above. i i. Dated: -610,30HN CULLEN,CLERK By Deputy Clerk i This warning does not apply to claims which are notsubject to the California Tort Claims, Act such. as.actions In inverse condemnation, actions for specific relief such as_mandamus or Injunrttion,or`..Federal Civil Rights claims.The above list is not exhaustive and legal consultation is,essential to understand all the separate limitations'periods that may aprply. The limitations period within which.suit must be flied may be shorter or longer depending on the nature of the claim:Consult the specific . statutes and cases applicable to your,particular claim.' j The County of Contra Costa does not waive any. of its.rights under California Tort Claims Act nor does) it waive rights cinder the statutes.of limitations applicable to actions not subject to. the California Tort Claims Act j i i i I i , i, i i i i i i , I j. i i 1 M 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 fled against each. public entity. E. Fraud. See penalty for fraudulent claims,Penal Code Sec.72 at the end of this form. ■■tttttttaataMann tettttatutlung aaMann tt1tt1ttttttatttttsttsa RE: Claim By: Reserved for Clerk's filing stamp fJY . N uY-lavt (-/1e sse gcUeVve RR11WU e� 6ak—(("4 , ���� a RECEIVE® Against the County of Contra Costa or ) SEP 1 4 2007 District) (Fill in the name) ) CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ 1►42-0 .C o and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) July 2S� 2va'( 2. Where did the damage or injury occur? (Include city and county) 1361 -Pow• ov.a s•{ r�Q't Cro c (,- elf, -A. 3. How did the damage or injury occur? (Give full details;use extra paper if required) Coun4i cc) v-Ay-ac-1or (ower-d tidol4-* co"rV.N.esr c,4 1sr' Q o w,a+np, ( -,---& �. cll v�.t r e p t c,_c e are r a w<<c 4i 4. What'particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? W 6,t IL - w u-% gt v r•I at C ro c L e UpgvaCLE ( PIS(rSe () P"jeC-F Pa : 0662 - 6K 4t-L 5 What are the names of county or district officers,servants,or employees causing the damage or injury7 d u w a W a A a 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach-two estimates for auto damage.) r- .-„tx << T� Ie pro ✓ to VJ Com} W 0 S L—t Si d-P i-i cL L tIL (P✓e- ! � f J• Vi o LJ . 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) L cJk a t i o LA_ t".> � /4?-0 . t<S`(-7 S. Names.and addresses of witnesses,doctors, and hospitals: 9. List the expenditures you made-on account of this accident or injury: DATE TIME AMOUNT J4 o vL e 40 a a a a a a a a a a r a a a a r a a a a a a a a a a s aaaaa a a a a a a a a a a a a a a a a a a a a a a a a a a e a a a a a a s a a a a a us man a a a a a a a a .Gov. Code Sec. 910.2 provides"The claim shall be signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney) Name and address of Attorney j , a, ke�Se I ) V (Claimant's Signature) r3c(levu L � 7 � ���,lyve C( ve ✓� �e (Address) Telephone No. )Telephone No. - bio - 452- gY-7c1 ■a a am ME a a If Molts a a a■/In a ME a It In ■it am a a am a a s a t In It ass It am a an a a as a a a a a Its a a a a ZEN a It a f a an a air nit 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 at seq.) Furthermore, any attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■a a r a a a a a a t a a t a r t r■aaaaa■ ■ONE a t a a a a a a a a r a a a a t a a a a r a a a a aaaaa a.a.a■a a a a a tat a a a a a l a a a.al NOTICE: Section 73 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. 2007-09-12 18: 9 >> 925 938 7725 P 2/2 C ATTN: ALAN C:URTIS Fax no. 925-283-0784 Re: 1301 Pomona Street Cnx:kett,CA. Greetings again Alan, Adjusted estimate for the repair work at front of store liont windows. I) Removal of broken tile and prep 10T new the 2) Cut and set 12"tile or equivalent design to be determined tont level pointb of 12"to existing sidewalk 3) Grout and seal 4) Clean-up and debris removal Labor 1100.00 Material allowance 300.00 Total estimated cost 1420.00 Thank you,. _ Sincerely, Steve 13ackes •1 t w r � © � A d <\ y `J" t!7 - i . oto bin o .