HomeMy WebLinkAboutMINUTES - 02032003 - C.29 'O: BOARD OF SUPERVISORS
FROM: John Sweeten, County Administrator * a, Contra
i.
DATE: February 4, 2003
Costa
SUBJECT: Personal Property Reimbursement fcounty
SPECIFIC REQUEST($)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
Receive this report concerning the personal property loss of Michael Hernandez and authorize
payment of$503.71 for theft of personal work tools from County vehicle.
RA
CNCG&QUNDIREASCNS FOR REC2MMENDATICtN:
Ron Harvey, Risk Manager for the County, is recommending payment for personal property
Sustained by our County worker. The matter has been investigated by the Office of Risk
Management and determined that payment is appropriate under the compensation for Loss or
Damage to Personal Property Policy,
CONTINUED ON ATTACHMENT: YES SIGNATURE: .�.. ,
4,,- RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
1--�AF'PROVE . OTHER
Q,.'SIGNATURE(S):
ACTION OF B R N FEBRUARY 11, 2003 APPROVED AS RCOMMENDED xx OTHER
VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE
AND CORRECT COPY OF AN ACTION TAKEN
AND ENTERED ON THE MINUTESS OF THE BOARD
RX UNANIMOUS (ABSENT III OF SUPERVISORS ON THE DATE SHOWN.
AYES: NOES:
ABSENT: III ABSTAIN:
ATTESTED
FEBRUARY 11 , 2003
C:tMy DoeumentstBoerd Order\13020 I300wMHemPereProp.doc JOHN SWEETEN,CLERK OF THE BOARD OF
Contact Ran Hervey (335.1443) SUPERVISORS AND COUNTY ADMINISTRATOR
cc: CAO,Risk Management
mt
Auditor-Controller BY �� •DEPUTY
COMPENSATION FOR LOSS OR DAMAGE TO PERSONAL PROPERTY
SHARON HYMES-OFFORU
TO BE COMPLETED BY CLAIMANT /1 J A N Z 4 X003
Claimant: �te.WAWL l 08e-Ar J A1A-AJbE a— Date: /OCT-,* Cr 1, 2042
Address: .�w.... .
QbNeo R 3, C--A R lt.52-0
Department: Employee No: 6 3 940
E`APLOYMXAIT- 4 ffumAn1 SgAv,ces bEPT
Describe the manner in which the loss or damage occurred: I uRtn! , Tttx�;' C-"VJVA)/N'G OF
5FFY 30 '2002- Couw7'Y VAM '0 *S47 Arok" th i `T`M,s d2&-AA &J.S0-AJ6WA-.S1AX-
W,4�o►r rslA� sM.��N e rr� G�ht ienJ Tlw tyro 1-m*- ,ail . Tit r�ve s 7-H�` �,e0k.6 ►N
Tor 1lsu. . jr hn1lz ' rpt..& MY 'TisPLCt C nn)7A!/111NGMY FIMSow114L Yl�?AX bO tS ._
Amount of Loss Claim: $ 3 . 71
Amount of repair damaged property
(attach invoice and actual repair) $
Original Purchase price of article(s)
(attach sales slip on same) pp $ �, .
Where purchased: 7!'S /JG Ft?uip awe 14AY l�d}n 01er Ayd—w na 7�t ate: /
Do you carry private insurance coverage for property loss or damage to your personai
property? Yes No L--"--
If yes, have you contacted your insurance agent for reimbursement? Yes No
If yes, how much did your insurance reimburse you for the claim'? $
If no, why did the company reject your claim?_
Employee's Signature Date
TO BE COMPLETED BY WITLESS
Confirming statement by witness to incident:
Signature of Witness Witness' Name. (print)
Form AK130 (Revised 6/90)
TO BE COMPLETED BY IMMEDIATE SUPERVISOR
Confirming statement by immediate supervisor: a E J i tJ tr ►` 4d1��b
—V AAID A1-1-sm bl; (a,4K.sTy t� t2t[ t_�� i Ott �f � t�� �-� IAC 190-9 , �r7
t.� t�`''�r, r�+i` C.i_r4 t rr•, R 1!Nt t }t r4 Z. t ► s v d 3 �++ I.�G,
c..L,ls c
SupepAsor of Immediate Supervisor Supervisor's Name (Print)
TO BE COMPLETED BY DEPARTMENT HEAD DR DESIGNATED REPRESENTATIVE
I recommend approval of this claim because said claim meets the criteria for
reimbursement provided by Administrative Bulletin #313.1, as follows: (Please refer
to items 1-4 under Administrative Bulletin #313.1)
I recommend rejection of this claim because said claim does not meet the criteria
for reimbursement provided by Administrative Bulletin #313.1, as follows: (Please
refer to items 1-4 under Administrative Bulletin #313.1)
S' atur of DepartnTent Head or Designated Representative
HAVE YOU CHECKED TO BE SURE
1. Damaged property is attached to this claim. If not, please explain.
2. This form has been completely answered.
3. County demand form and Board Order, if needed, is attached.
VENDOR NO A C DEMAND
4 4 D El on the Treasury of the
COUNTY OF CONTRA COSTA � r�
Made By: STATE OF CALIFORNIA DATE 10—L -Ci9t92
CT t�f�fy}J1� s A c-+4ACt.
WANE iLAI'll
,}. I tFIR57) IMPORTANT
2—SZ-7 Sri wZ!LJJ �AI VE- See Instructions on Reverse Side
ADOR SS
0&COiQ 21/9 0- tSS7
CITY, STATE ZIP CODE
((,,..��I —1 I I i I 1 1 1
For the sum of _ tvE /frtNT�Reb � Dollars $ t'�•�I
As itemized below:
DATE DESCRIPTION AMOUNT
9 3. 2002. -701 K -r=cns15- PAOlgar 1.14, ' ra-S7x7t 110.96
9139X400 2 7'M- S CAI t.C- 7 e'S7-6-j a-4—r-4 C! t.E=7 `" L /Z _- 13 /.32.
9/30/2002- P,rASgNAL C-O*thA rr/L -rVOtrS,rr 32.q6
fl 200 f- 80X C u T'7-9-A -2,2
9/r3ca/ c°
POA-r,4aLr WJ+tal- `SS ic.L-9'c-TvItic ta:w�RlV rZ �v 10.7q
o orm A - E .Y- IR
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/r3�/2�ot til.!`BB f�.mA�1� el_tSTJCe STWAA4,C Go-4-r4 9'4.S 4 ,.0 '.RJ e • 2S 91r
Gs C>2 LN J .046
9�3%z b tvt D e'r'ts
F;-& g t nJ Z>M , 30 P�to .i`+e " eo-/I ►
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4.17
The undersigned under the penalty of perjury states: That the above claim and the items as t erein set out are true and correct,
hat no part thereof has been heretofore paid, and that the amount therein is justly u and th s is prese d with___ a—w
Fear after the last item thereof has accrued.
_ Signed y�r�
VENDOR NO. Received, Accepted , and Expenditure Authorized _ L�L.t gig ! z
DEPARTMENT HEAT OR CH EP m
-COUJ M N N C PAYMENT M U
uld.no I/INVOICE
.. ...
....: .;;.;y....:.:..:.�::.:•:::zs;.• •..::::0.:o-::..: .. T1119tvAMOUNT1 CY I V I T Y ttkE 155. ISC UN
.....:.
UM.N0. INVOICE DATE OEBCRI►TION FUND 01115. ACCOUNT ENCUMSRANCE N0. IP/C 1 PAYMENT AMOUNT
d'Xi _ - >
TAXA- !MOUNT TASK 6►TION ACTT PITY 6NC0U NT
::?.a•..;••••:`�.'i'{:{vii.':ii::.;::.;:?:::i:::•j:Y..::::..::.. I
1
UM NO. INVOICEDNSCRI TION FUND ORS. ACCOUNT ENCUMBRANCE NO-III/C14 PAYMEM AMOUN
1
3 1
TAXAB4E AMC- UNT TASK OPTION ACTIVITY SPEC FL53 DISCOUNT
it
(015 Rev-10/77)
COPIED DATA ENTRY STATS LEGAL !ROUTED —
-_ �j
it Ali J 1 2 8 4 5 t B 9 10 f 1 12
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CONCORD POLICE DEPARTMENT CR# 02-25785
OFFENSE REPORT
PAGE 1
DATE AND TIME REPORTED
.10/01/02 11:49
- -
OCCURRED DATE '..ENDING DATE OCCURRED TIME ENDING TIME � - LOCATION
09/30/02 10/01 02 18:00 09:30 2377 STANWELL DR CONCORD, CA
ROUTING -�— - - — --
FINANCIAL CRIMES
CLASSIFICATION _ �.�------ - -_--
459V BURGLARY VEHICLE _
PERSON INVOLVEMENT CODES: A-ARRESTEE 8-SUSPECT K-CN V-VICTIM C-COMPLAINANT J-SUBJECT W-WITNESS B-BUSINESS VICTIM 0.OWNER
INVL LAST NAME,FIRST MIDDLE HOME PHONE BUS.PHONE
B CONTRA COSTA COUNTY, NIP _ NIP _
ADDRESS CITY STATEZIP SOCIAL SECURITY NO.
2467 WATERBIRD WY MARTINEZ CA 94553
OLN AD NO. :STATE DOB AGE RACE SEX HEIGHT W€IGHT HAIR EYES
i
-- 0
ADDITIONAL INFORMATION _ -u-
INVL LAST NAME,FIRST MIDDLE HOME PHONNEJ� BUS.PHONE
C WELDEN, JOHN N/P _! (925) 646-5_123
— - —
ADDRESS CITY
STATE ZIP SOCIAL SECURITY NO.
,
2377 STAN ELL DR CONCORD CA
OLN/ID NO. I STATE DOB AGE RACE SEX -
HEIGHT WEIGHT HAIR - EYES .�
N4208405 ICA ;07/15/83 49 -
ADDITIONALINFORMATION —�- ----
DEPARTAMENTAL PC COORDINATOR/ SUPERVISOR
INVL — LAST NAME,FIRST MIDDLE HOME PHONE _TBU_S PHONE
VHERNANDEZ, MIKE :NIP _ 1 (925) 646-5123
.,III AD�DR��ESSSS - CITY STATE ZIP SOCIAL SECURITY NO.
12377 STANWELL DR CONCORD CA
OLN IID NO. � STATE DOB _- AGE RACE 7 SEX �HEIGHT___. WEIGHT =HAJR EYES ----
CA 0 M
ADDITIONAL INFORMATION -�� ---- L----__.
INFORMATION SYSTEMS TECHNICIAN
VEHICLE INVOLVEMENT CODES: A-ARRESTEE S-SUSPECT R-RECOVERED N-STORED P-PARKED V-VICTIM X-STOLEN 1-IMPOUNDED O-RELEASED TO OWNER Z-REP488E881ON
INVL LICENSE STATE/EXP YEAR MAKE MODELS� TYLE COLOR VIN#
REGISTERED OWNER ADDRESS
f 9NRA r_ngmA +` TY 2467 WA` ERATRD WV - _
�'A ITIONAL INFC3iTii7i'1'�ON/UF1IEATURES � VALUE
__ $0.00
PROPERTVINVOLVEMENTCODES —
INVOLVEMENT Ct]DES CATEGORY CODER DISPOSITION CODES
E-Evidence K-Safekeeping A-Automotive B-Bicycle C-Camera P-Property Room STOLEN $5f94.00
S-Stolen F-Found E-Equlpment/Tools H-Household Appliances M-Musical Instruments R-Returned to Owner
R-Recovered L-Lost O-Office Equipment P-Personal Accessories R-Radio/Sound Devices O.Other
O-Safety of Others 8-Sports Equipment T-TV V-Viewing Equipment RECOVERED`
Y.Other_ D-Dollars/Mon K-Credit Cards
# INVL :CAT BRAND MODEL SERIAL# -- VALUE :DISPO
1 S o 1 UNKNOWN UNKNOWN $224.00
ARTICL"`E _ -_--
[2 PLASTIC ,BOXES WITH COMPUTER CABLES, LOCKDOWN CABLES, AND FOUR OPTICAL MICE.
CONCORD POLICE DEPARTMENt
CONTROLLED DOCUMENT
Released b-
F.
., ..... ... -.row-.,.�,..... ,.,,. .. _
REPORTING OFFICER I.D.8 # FEAT DATE AND TIME WRITTEN SUPERVISOR APPROVING TYPIST DATE AND TIME REPORT TYPED V SAA 7 _
,LEONE # 7069 1.0/01/02 11:49 0220 KINCANNON 7069 10/01/02 11:50
CONCORD POLICE DEPARTMENT CR# 02-25785
OFFENSE REPORT
PAGE 2
PROPERTY INVOLVEMENT CODES
LL -
' INVOLVEMENT CODES CATEGORY CODES DISPOSITION CODES
E-Evidence K-Safekeeping A-Automotive B-Bicycle C-Camera P-Property Room
S-Stolen F-Found E-Equipment/Tools H-Household Appliances M-Musical Instruments R-Returned to Owner STOLEN: $564.00
R-Recovered L Lost O-ORica Equipment P-Personal Accessories R-Radio/Sound Devices O-Other
O-Safety of Other S-Sports Equipment T-TV V-Viewing Equipment RECOVERED: $
Y-Other D-DolleralMone K-Credit Cards
# INVL CAT BRAND MODEL SERIAL# VALUE DISPO-
2S lP _ UNKNOWN - -- UNKNOWN - $280.00 _
ARTICLE
BLACK BRIEFCASE WITH DATALINE TESTING EQUIPMENT. J
# INVL CAT-- BRAND i MODEL SERIAL# �W-- VALUE DISPO -
3 S R UNKNOWN ; _ (UNKNOWN 1$20.00
ARTICLE _ --- - �
CD ROM CASE WITH MISCELLANEOUS COMPUTER SOFTWARE CD'S
# INVL CATBRAND MODEL _ SERIAL# VALUE -DISPO
4 -]S E UNKNOWN �� UNKNOWN - 1$40.00
ARTICLE _. --
COMPUTER TOOT, SET
TOTAL PROPERTY VALUE
�+ -- -- $564.00
NARRATIVE
On 10/01/02at 1149 hours, C-John Welden telephoned CPD's Northern.Field Office to report a vehicle burglary.
John told me the following:
John is a supervisor at the B-Contra Costa County building at 2377 Stanwell Dr. V-Mike Hernandez works for
the county.
On 09/30/02 at 1800 hours, Mike parked and locked his work van in the parking lot at 2377 Stanwell Dr. He left
the listed items in the back of van.
On 10/01/02 at 0930 hours, Mike returned to the van. He saw that the rear passenger window of the rear double
doors of the van had been completely shattered. The doors were closed, but they had been unlocked. Mike
opened the doors and discovered that the listed items had been stolen. There was no other damage to the vehicle
and nothing else had been stolen.
I requested ID (Ch#151 on 10/01/02).
Disposition: Case suspended.
REPORTING OFFICER&I.D.# SEAT DATE AND TIME WRITTEN SUPERVISOR APPROVING TYPIST DATE AND TIME REPORT TYPED V 8.1.127
';LEONE #7069 1 10/41/02 11:49 0220 KINCANNON 7'069 10/01/02 11:50
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Page 1 of 2
CONTRA COSTA COUNTY
Office of the County Administrator
ADMINISTRATIVE BULLETIN
Number: 518.2
Date: 5-23-89
Section: Property & Equipment
SUBJECT: Compensation for Loss or Damage to Personal Property
The loss of or damage to personal property of employees is subject
to reimbursement under certain conditions. The following policies
apply:
I. BASIS FOR REIMBURSEMENT. To qualify for reimbursement, the
loss or damage must result from a sudden, unexpected event
which is not normally encountered or anticipated on the job
and which is not subject to the control of the employee.
Ordinary wear and tear on personal property used on the job is
not compensable. Employee tools or equipment provided without
the expressed approval of the department head and automobiles
are excluded from reimbursement under this policy.
Reimbursement will be considered under the following
conditions:
A. The loss or damage must have occurred within the line of
duty.
B. Negligence or lack of proper care by the employee was not
a contributory cause for the damage or loss. The
exercise of good judgement under the prevailing
circumstances at the time of loss or damage is an
important consideration in the evaluation of this
condition.
C. The personal property was necessarily worn or carried by
the employee in order to adequately fulfill the duties
and requirements of the job.
D. The loss of or damage to eyeglasses, dentures, or other
prosthetic devices did not occur simultaneously with a
job injury covered by workers' compensation.
IT. AMOUNT OF REIMBURSEMENT. The amount of compensation allowed
will be the actual cost to repair damages. Reimbursement for
items damaged beyond repair will be limited to the actual cash
value of the item at the time of loss or damage but not more
than the original cost, and items my be depreciated because of
age or wear.
As an illustration of this policy, only the repairs to
eyeglass frames and replacement of similar quality damaged
lenses is allowable. The cost of re-examination is not
allowable. Damaged clothing should be repaired when possible.
The actual value at the time of loss will be determined for
clothing damaged beyond repair. When private insurance covers
http://intranet.co.contra-costa.ca.us/bulletins/518comp.txt 12/31/2002
Page 2 of 2
part of the claim loss, the County will only pay the
difference.
III. REIMBURSEMENT PROCEDURES. Claims from employees for
compensation should be forwarded by the department head or
designated representative to the Risk Management Division for
representation to the committee appointed to review claims.
The department head or designated representative of employees
presenting claims will be members of the committee. The
damaged property should accompany the claim, if practical, for
committee examination. The following procedure is to be used
by Departments when filing a claim:
A. Completion of Form AK-130 along with County Demand Form
D-15 for items up to $300.
B. Completion of Form AK-130, a County Demand Form and Board
Order for items over $300.
In the case of personal property loss which meets all of the
conditions stated above, proof of loss must also be submitted.
The burden of proof of loss shall rest with the employee.
All claims approved by the committee shall be forwarded to the
Auditor-Controller for payment; claims in excess of $300 shall
be presented by the County Administrator to the Board of
Supervisors for approval.
NOTE: Forms may be requisitioned from Central Service.
Orig. Dept. : County Administrator
Reference: Board Order dated December 19, 1973
Is/ Scott Tandy for
County Administrator
r�
http:Hintranet.co.contra-costa.ca.us/bulletins/518comp.txt 12/31/2002