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HomeMy WebLinkAboutMINUTES - 12162008 - C.30 CLAIM BOARD OF SUPERVISORS OF'CONTRA COSTA COUNTY Q� BOARD ACTION. 1� U Claim Against the County, or District Governed by ) the Board of,Supervisors, Routing Endorsements, ) TICE TO CLAIMANT and Board Action. All Section references are to ) e- ANhiecopy of this document mailed to California Government Codes. you is your notice of the action taken on your claim by the Board of NOV 12 12008 Supervisors. (Paragraph IV below), given Pursuant to Government Code AMOUNT: ` , COUNTY COUNSEL Section 913 and 915.4. Please note all MARTINEZ CALIF. "Warnings". CLAIMANT: E-Sumrvz rib�Pf" C t ctb Stto"9ee=-Car Ko c lo- 0"fs t-I� ATTORNEY: DATE RECEIVED: ADDRESS:3195 Pie `(orp criltC BY DELIVERY TO CLERK ON: 4*-roma -l?tSlL BY MAIL POSTMARKED: 90CH U) . CIA- LI S I &S FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ���� �ot a�� DAVID TW Clerk _ Dated: r By: Deputy Gt II. FROM: CountyCounsel 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 Boardcannot 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: ?- ��D By: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim*i%a`s'returned as untimely with notice to claimant(Section 911.3). IV BOARD ORDER: By unanimous vote of the Supervisors present: (Vf 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,de As4w P'DAVID TWA, CLERK, By-Ag� Deputy Clerk WARNING(19k.code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in.connection with this matter.If you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING 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. DatedO�. J aAOV' DAVID TWA, CLERK, By y Clerk `\ 4d This warning.,des no-.iapply to claims which are not subject to tlie4California Tort Claims Act such as actions ananverse condemnation, actions for specific relief,such as.mandamus or injunction, or Federal Civil Right's claims. The above list is not exhaustive,aiidlegal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed 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 N. `n 5 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT j — 0Dq 9; I�J A.• A c1 ' relating to a cause of action for death or for injury to person or to personal property or gro g crops shall be presented not later than six months after the accrual of the cause of actio A claim relating to,any other cause of action shall be.presented not later than c"AMHYMES-OFFOW after a accrual of the cause of action. (Go' . Code § 911.2.) NOV 1 0 2008 B. Cl ' must be filed with the Clerk of the Board of Supervisors at its office in Room 106, Co ty Administration Building,651 Pine Street,Martinez,CA 94553. C. If cl ' is against a district governed by the Board of Supervisors, rather than the County, the nam of the District should be filled in. D. Ife claim is against more than one public entity, separate claims must be filed against each. pub 'c entity. E. Fra d. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. ■.■ ■.1...■L■l/.Y..■■■..1.....i......■f.■l..t.■■".........■�..■■1..../..[....■.I RE: Cl By: Resery fQr Clerk's filing stam RECEIVED FC l,;tS ) NOV 1 2 2008 oCir ZO Against th Co ty of Contra Costa or ) C P1 fEY ^u ,AciQ4 De �tCl�lj•Q District) Fill in th name ) NOV 1 0. 7nnq M RISK MANAGEMENT The unde signed claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$-i,M-)-. �HQ and in support of this claim represents as follows: 1. Z en did the damage or injury occur? (Give exact_date and h ur 0(,t C+�i� a-v 3 2vOv � �pl�kt,h�Gt- �� ( l•Ub ftt-1 2. ere did the damage or injury occur? (Include city and county) UJ i. 1 i Cw pass Oad a+ ON) 0v v-1-w PS , CIV ovd Cts conth'-u (usk Cute 3. ow did the damage or injury occur (Give details;use extra paper if required) p t.ase sei Wt-�G.w ed . 4. at particular act or omission on the part of county or district officers, servants, or employees aused the injury or damage? ►�sa �e i a�e ��a� W , i ler pvo I- v 1001 .o c t_ t- c4spl& 4 Mi ��' u �'At icy{Q, �p�i 3�-' Vt�Vt- Z . at artthe names o co or stnct o er ervants or em o ees c us a the damage or injury? P-DhZ,rI6 tl q,t-h" 2 , 1�►'i u�X Covd--�--a WStk 'h e6W a i a vuffS • 6. Vaal damage or injuries do your claim resulted? (Give full extent of injuries or damages clain Led. Attach two estimates for auto damage,) 7. HoA was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) �►D��- . a-0 C i V���u d e S c�a m a -t ft[� �ICbO U(� 8. Names-and addresses of witnesses, doctors, and hospitals: dcdccG "ble) 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT 6/>7-7/6 v 1 1 S 4J- COOS M tD olio/U� $U-7c0- 7b ChOVIS f to [ [t\..[[■ ■■■[[[[.t[woman■[f[[[■■1■[..[[.[[[BEEN[[[■■■■[[[[t■.......[.[[[[[[[[[[[[[[1 ) .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 iddress of Attorney ) � do Irby ESWILVIU as (Cl ' ant's Signature)JW 1<�at°lQ , I�GI VI Sflu >� EM `�91in QDl.dlb Gig R��3"7 (Address) ) -Pam r�Y. St, ), (Zbr,I�l�!'� Gw Telephone No. )Telephone No. t'7j LP) E EEEEEEE ■EEEEE stop uses E EEEEE Et EEE■EEEEBEE unusual EE ME■■EE[EEEEEEE■EE EE[E EEEE E EEEE B[EI PUBLIC RECORDS NOTICE: Please be vised 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. E EEBB BEB ■BEE mussels BBEE EEEEB EBBBEEBEEEBEEEeEEEEE EEE[■..............................� NOTICE: Section 71 of the Penal Code provides: Every pe on who, with intent to defraud, presents for allowance or for payment to any state board or officer,or to any co ty, city, or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulen claim, bill, account voucher, or writing, is punishable either by imprisonment in the County jail for a period of of more than one year, by a fine of not exceeding one thousand dollars (51,000.00), or by both such imprisonr itnt 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. R esurancee A member of the White Mountains Insurance Group November 07,2008 Attachment: Contra Costa Claim Form This accident occurred on October 20,2008 on Willow Pass Road at the traffic signal/intersection of the 680 Freeway Onramp. Willow Pass Road has 4 lanes in this direction.The furthest left lane becomes the 680 northbound ramp,the next two lanes are through traffic lanes and the furthest right lane turns into the 680 southbound ramp. Our insured driver Davis Ho,was traveling straight in the third lane from the left(through traffic lane). As our insured is slowing for the red light at this intersection, Mr.Roberto Martinez driving Contra Costa Medical Service vehicle makes an unsafe lane change from the second from the left lane, into our insured's vehicle,slowing in the third from left lane. After the impact Mr. Martinez advised our insured Mr. Ho that he didn't see our insured's vehicle. ESU-0093498 DOL: 10/20/08 Kaela Ho/Davis Ho P.O. Box 2890, Rocklin, California 95677-8464 www.esurance.com 800.343.7262 ©916.435.1238 10/30/2008 at 02 : 58 PM ESU93498-01 34323 CCO2U1QB ESURANCE Rocklin Claims Office *****Supplement Hotline ( 866-514-4788 ) ****** jblack2@esurance . com P .O. BOX 2890 Rocklin, CA 95677 (510) 295-5484 Fax: (866) 454-0890 SUPPLEMENT OF RECORD 1 WITH SUMMARY Written By: Kay Senephanh 10/30/2008 02 : 58 PM. Adjuster : Jon Black Insured: kaela Ho Claim #ESU93498-01 Owner: kaela Ho Policy #PACA003092558 Address : 1314 Zinnia CT Date of Loss: 10/20/2008 Patterson, CA 95363-2992 Type of Loss: Collision Day: (925) 321-2992 Point of Impact: 9 . Left T-Bone (Le Inspect 1314 Zinnia CT Day: (925) 321-2992 Location: Patterson, CA 95363-2992 HOME Repair CHOY' S AUTO BODY & REPAIR Business: (510) 532-8488 Facility: 1407 FOOTHILL BLVD 6 Days to Repair OAKLAND, CA 94606 License # 2001 FORD RANGER 4X2 SUPERCAB 6-3 . OL-FI 2D PIU YELLOW 2 D Int : VIN: IFTYR14EOlPA78985 Lic: UNK CA Prod Date: Odometer: 122028 Intermittent Wipers Dual Mirrors Console/Storage California Emissions Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks AM Radio FM Radio Stereo Search/Seek CD Player Anti-Lock Brakes ( 4) Driver Air Bag Passenger Air Bag Cloth Seats Rear Step Bumper 5 Speed Transmission Overdrive Aluminum/Alloy Wheels ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1 FRONT DOOR 2 R&I LT Belt w' strip from 6/1/99 0 . 3 3 R&I LT Mirror assy XL & XLT manual 0 . 3 4 R&I LT R&I trim panel 0 . 4 5 R&I LT Handle, outside black 0 . 4 6* S01 Repl Qual Recy Parts LT door assy 1 437 . 50 1 . 4 3 . 5 +250 7 S01 Add for Clear Coat 1 . 4 8 CAB 9* Rpr LT Side panel 2_5 1 . 6 10 SOl Overlap Major Adj . Panel -0 . 4 11 Add for Clear Coat 0 . 2 12 R&I LT Glass & frame stationary 0 . 8 FORD, tinted 1 10/30/2008 at 02 : 58 PM ESU93498-01 34323 CCO2U1QB SUPPLEMENT OF RECORD 1 WITH SUMMARY 2001 FORD RANGER 4X2 SUPERCAB 6-3 . OL-FI 2D P/U YELLOW 2 D Int : ------------------------------------------------------------------------------- N0 . OP . DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 13# S01 Refn LT LoCk Pillar 1 . 0 14 PICK UP BOX 15* Rpr LT Side panel 6 foot bed 3_0 2 . 9 w/whl opening mldg 16 Overlap Major Non-Adj . Panel -0 . 2 17 Add for Clear Coat 0 . 5 18 R&I LT Upper rail w/6 foot bed 0 . 4 black 19 Repl LT Transfer "EDGE" aqua 1 28 . 42 0 . 2 20* S01 Rpr LT Wheel opng mldg vermillion 1 . 0 0 . 8 21 R&I LT Wheel opng mldg vermillion 0 . 3 22 R&I Splash guard 2WD 0 . 2 23# Color Tint 1 0 . 5 N 24* R&I R&I box assy 1_0 25 REAR LAMPS 26 R&I LT Tail lamp assy 0 . 3 27 REAR BUMPER 28 R&I R&I bumper assy Incl . 29# Hazardous Waste 1 3 . 00 30# Cover Car 1 5 . 00 T 0 . 2 N 31# Rope Glass 1 0 . 5 32 S01 FRONT LAMPS 33 S01 R&I LT Side marker lamp 0 . 2 34 S01 R&I LT Headlamp assy 0 . 2 35 S01 FENDER 36 S01 Blnd LT Fender w/o wheel opening 1 . 3 molding 37* S01 R&I LT Nameplate "RANGER" chrome 0 . 2 38 S01 R&I LT Fender liner 0 . 6 39 S01 FRONT BUMPER 40 S01 R&I R&I bumper assy 0 . 5 ------------------------------------------------------------------------------- Subtotals =_> 473 . 92 15 . 4 12 . 6 Line 24 : Set Back Only Line 31 : Back Glass Parts 468 . 92 Body Labor 15 . 4 hrs @ $ 75 . 00/hr 1155 . 00 Paint Labor 12 . 6 hrs @ $ 75 . 00/hr 945 . 00 CONTRA COSTA COUNTY Paint Supplies 12 . 6 hrs @ $ 30 . 00/hr 378 . 00 RECEIVED Sublet/Misc . 5 . 00 ---------------------------------------------------- NOV 10 2008 SUBTOTAL $ 2951 . 92 Sales Tax $ 851 . 92 @ 8 . 2500% 70 . 28 RISK MANAGEMENT ---------------------------------------------------- TOTAL -------- ------------------- -------- TOTAL COST OF REPAIRS $ 3022 . 20 2 10/30/2008 at 02 : 58 PM ESU93498-01 34323 CCO2U1QB SUPPLEMENT OF RECORD 1 WITH SUMMARY 2001 FORD RANGER 4X2 SUPERCAB 6-3 . OL-FI 2D P/U YELLOW 2 D Int : ADJUSTMENTS : Deductible 1000 . 00 ---------------------------------------------------- TOTAL ADJUSTMENTS $ 1000 . 00 NET COST OF REPAIRS $ 2022 . 20 THIS IS NOT AN AUTHORIZATION TO REPAIR ALTHOUGH IT IS AGREED BETWEEN THE REPAIR FACILITY AND ESURANCE THAT THE ABOVE VEHICLE CAN BE REPAIRED BY THE REPAIR FACILITY FOR THE AMOUNT STATED IN THE GROSS TOTAL SECTION . ONLY THE VEHICLE OWNER CAN AUTHORIZE THE REPAIR OF THE VEHICLE AND ALL COSTS OF REPAIR ARE THE SOLE RESPONSIBILITY OF THE VEHICLE OWNER. THIS APPRAISAL WAS BASED ON VISIBLE OR CERTAIN DAMAGES AT THE TIME OF INSPECTION . TO REQUEST A SUPPLEMENT, PLEASE CALL (866) 514 4788 . PLEASE FAX THE SUPPLEMENT AND ALL SUPPORTING DOCUMENTS WITH CLAIM NUMBER TO (866) 454 0890 . THE REPAIR FACILITY AND ESURANCE WILL REACH AN AGREED PRICE PRIOR TO BEGINNING ANY OF THE SUPPLEMENTAL REPAIRS . THE REPAIR FACILITY WILL THEN SEEK AUTHORIZATION FROM THE VEHICLE OWNER FOR THE ADDITIONAL REPAIRS . NO SUPPLEMENTS WILL BE HONORED UNLESS APPROVED IN ADVANCE BY ESURANCE. REPAIR FACILITY MUST BE PROVIDED A COPY OF THIS ESTIMATE PRIOR TO COMMENCEMENT OF REPAIR. FAILURE TO DO SO MAY SUBJECT THE VEHICLE OWNER TO ADDITIONAL EXPENSE. DISCLOSURE STATEMENT This estimate has been prepared based on the use of one or more crash parts supplied by a source other than the manufacturer of your motor vehicle . Warranties, if any, applicable to these replacement crash parts are provided by the parts manufacturer or distributor rather than by the manufacturer of your vehicle . THIS IS NOT AN AUTHORIZATION TO REPAIR. ALL COST OF REPAIRS ARE THE SOLE RESPONSIBILITY OF THE VEHICLE OWNER. NO SUPPLEMENTS WILL BE HONORED UNLESS APPROVED IN ADVANCE BY ESURANCE. PLEASE FAX SUPPLEMENTS TO 1866-454-0890 3 10/30/2008 at 02 : 58 PM ESU93498-01 34323 CCO2U1QB SUPPLEMENT OF RECORD 1 WITH SUMMARY 2001 FORD RANGER 4X2 SUPERCAB 6-3 . OL-FI 2D P/U YELLOW 2 D 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 DR2MD98, CCC Data Date 10/01/2008, 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 MOTOP, suggested labor operation times. NAGS labor operation times are not included. Pound sign (#) items indicate manual entries. Some 2009 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. 4 10/30/2008 at 02 : 58 PM ESU93498-01 34323 CCO2UlQB SUPPLEMENT OF RECORD 1 WITH SUMMARY 2001 FORD RANGER 4X2 SUPERCAB 6-3 . OL-FI 2D P/U YELLOW 2 D Int : ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT . PRICE LABOR PAINT ------------------------------------------------------------------------------- ------- CHANGED ITEMS ------- 18* Rpr LT Wheel opng mldg vermillion -0 . 4 -0 . 8 20* SO1 Rpr LT Wheel opng mldg vermillion 1_0 0 . 8 ------- DELETED ITEMS 2* Repl Qual Recy Parts LT door assy 1 +25% -200 . 00 -1 . 4 -3 . 5 3 Add for Clear Coat -1 . 4 10 Overlap Major Adj . Panel 0 . 4 ------- ADDED ITEMS ------- 6* SO1 Repl Qual Recy Parts LT door assy 1 +25% 437 . 50 1 . 4 3 . 5 7 SO1 Add for Clear Coat 1 . 4 10 SOl Overlap Major Adj . Panel -0 . 4 13# SO1 Refn LT Lock Pillar 1 . 0 32 SO1 FRONT LAMPS 33 SO1 R&I LT Side marker lamp 0 . 2 34 SO1 R&I LT Headlamp assy 0 . 2 35 S01 FENDER 36 SO1 Blnd LT Fender w/o wheel opening molding 1 . 3 37* S01 R&I LT Nameplate "RANGER" chrome 0 . 2 38 SO1 R&I LT Fender liner 0 . 6 39 SO1 FRONT BUMPER 40 SO1 R&I R&I bumper assy 0 . 5 ------------------------------------------------------------------------------- Subtotals =_> 237 . 50 2 . 3 2 . 3 Parts 237 . 50 Body Labor 2 . 3 hrs @ $ 75 . 00/hr 172 . 50 Paint Labor 2 . 3 hrs @ $ 75 . 00/hr 172 . 50 Paint Supplies 2 . 3 hrs @ $ 30 . 00/hr 69 . 00 ---------------------------------------------------- SUBTOTAL $ 651 . 50 Sales Tax $ 306 . 50 @ 8 . 2500% 25 . 29 Additional Supplement Taxes -0 . 01 ---------------------------------------------------- TOTAL SUPPLEMENT AMOUNT $ 676 . 78 NET COST OF SUPPLEMENT $ 676 . 78 Estimate 2345 . 42 Jon Black Supplement SO1 676 . 78 Kay Senephanh -------- TOTAL ADJUSTMENTS $ 1000 . 00 Workfile Total $ 3022 . 20 NET COST OF REPAIRS $ 2022 . 20 5 10/30/2008 at 02 : 58 PM ESU93498-01 34323 CCO2U1QB SUPPLEMENT OF RECORD 1 WITH SUMMARY 2001 FORD RANGER 4X2 SUPERCAB 6-3 . OL-FI 2D P/U YELLOW 2 D Int : THIS IS NOT AN AUTHORIZATION TO REPAIR ALTHOUGH IT IS AGREED BETWEEN THE REPAIR FACILITY AND ESURANCE THAT THE ABOVE VEHICLE CAN BE REPAIRED BY THE REPAIR FACILITY FOR THE AMOUNT STATED IN THE GROSS TOTAL SECTION. ONLY THE VEHICLE OWNER CAN AUTHORIZE THE REPAIR OF THE VEHICLE AND ALL COSTS OF REPAIR ARE THE SOLE RESPONSIBILITY OF THE VEHICLE OWNER. THIS APPRAISAL WAS BASED ON VISIBLE OR CERTAIN DAMAGES AT THE TIME OF INSPECTION. TO REQUEST A SUPPLEMENT, PLEASE CALL (866) 514 4788 . PLEASE FAX THE SUPPLEMENT AND ALL SUPPORTING DOCUMENTS WITH CLAIM NUMBER TO ( 866) 454 0890 . THE REPAIR FACILITY AND ESURANCE WILL REACH AN AGREED PRICE PRIOR TO BEGINNING ANY OF THE SUPPLEMENTAL REPAIRS . THE REPAIR FACILITY WILL THEN SEEK AUTHORIZATION FROM THE VEHICLE OWNER FOR THE ADDITIONAL REPAIRS . NO SUPPLEMENTS WILL BE HONORED UNLESS APPROVED IN ADVANCE BY ESURANCE. REPAIR FACILITY MUST BE PROVIDED A COPY OF THIS ESTIMATE PRIOR TO COMMENCEMENT OF REPAIR. FAILURE TO DO SO MAY SUBJECT THE VEHICLE OWNER TO ADDITIONAL EXPENSE . DISCLOSURE STATEMENT This estimate has been prepared based on the use of one or more crash parts supplied by a source other than the manufacturer of your motor vehicle . Warranties, if any, applicable to these replacement crash parts are provided by the parts manufacturer or distributor rather than by the manufacturer of your vehicle . THIS IS NOT AN AUTHORIZATION TO REPAIR. ALL COST OF REPAIRS ARE THE SOLE RESPONSIBILITY OF THE VEHICLE OWNER. NO SUPPLEMENTS WILL BE HONORED UNLESS APPROVED IN ADVANCE BY ESURANCE . PLEASE FAX SUPPLEMENTS TO 1866-454-0890 6 10/30/2008 at 02 : 58 PM ESU93498-01 34323 CCO2U1QB SUPPLEMENT OF RECORD 1 WITH SUMMARY 2001 FORD RANGER 4X2 SUPERCAB 6-3 . OL-FI 2D P/U YELLOW 2 D 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 DR2MD98, CCC Data Date 10/01/2008, 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 2009 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. 7 From: 510 532 9045 Page: 1/6 Date: 10/28/2008 1:08:08 PM CHOY' S AUTO BODY & REPAIR 1407 FOOTHILL BOULEVARD OAKL,ANn, CA 94606 (510) 532-8488 & (510) 532-8491 FAX: (510) 532-9045 COMPLETE BODY, FRAME WORK & MECHANICAL CD LOG NO 8128-1 DATE 10/24/08 SHOP: CHOY' S AUTOBODY & REPAIR INSP DATE: 10/24/08 ADDRESS: 1407 FOOTHII,L BOULEVARD CONTACT: TAT VANG CITY STATE: OAKLAND, CA PRONE 1: (510) 532-8488 ZIP: 94606 FAX: (510) 532-9045 OWNER: HO, KAELA CELL PHONE: (925) 321-2992. CLAIM#: ESU93998-01 POINT OF IMPACT: 0 VEH. DROP OFF DATE/TIME: 10/24/08 02: 31 PM INS. CO: ESURANCE CONTACT: JO BLACK ADDRESS: P.Q. BOX 2890 PHONE 1: (510) 295-5484 CITY STATE: ROCKLIN, CA FAX: (866) 454-0890 ZIP: 95677— LIC#: 6N96641 STATE: CA VIN: 1FTYR14E01PA78985 BODY COLOR: MILEAGE: 122, 076 CONDITION: GOOD ACCTNG CTL#: *=USER—ENTERED VALUE E=REPLACE OEM NG:=REPLACE NAGS EC=REPLACE ECONOMY UE=REPLACE OE SURPLUS UC=RECONDITIONED CRT UM=REMAN/REBUILT PRT EU=REPLACE SALVAGE EP—REPLACE PXN OE=REPLACE PXN OE SRPLS PC-PXN RECONDITIONED PM=PXN REMAN/REBUILT TE=PARTL REPL PRICE ET=PARTL REPL LABOR IT=PARTIAL REPAIR I=REPAIR L=REFINISH BR=BLEND REFINISH TT=TWO—TONE CG—CHIPGUARD SB=SUBLET N=ADDITIONAL LABOR RI=R&I ASSEMBLY P=CHECK AA=APPEAR ALLOWANCE RP=RELATED PRIOR UP=UNRELATED PRIOR 2001 FORD RANGER XLT 2DOOR EXT CAB 6CYL GASOLINE 4. 0 CODE: P8334B/D OPTNS H/24MNP OPTIONS: TWO—STAGE — EXTERIOR SURFACES TWO—STAGE — INTERIOR SURFACES FOUR WHEEL ANTI—LOCK POWER STEERING AIR CONDITIONING QP GDE MC DESCRIPTION MFG.PART NO. PRICE AJC, B% HOURS R R10028 GRILLE ASSEMBLY R&1 ASSEMBLY 1. 2 1 RIO047 LAMP,SIDE MARKER LT R&I ASSEMBI.,Y INC 1 RIO113 NAMEPLATE, FENDER LT R&I ASSEMBLY 0.2 1 RT0099 FLARE,WHEEL OPENING LT R&I ASSEMBLY 0. 9 1 L 0099 10 FLAREeWHEEL OPENING LT REFINISH 0.7*4 PAGE 1 This fax was received by GFI FAXmaker fax server. For more information,visit: http:/twww.gfi.com From: 510 532 9045 Page: 2/6 Date: 10/28/2008 1:08:09 PM 2001 FORD RANGER XLT 2DOOR EXT CAB CD .LOG NO 8128-1 0. 5*SURFACE 0.2 TWO STAGE L 0592 PILLAR, BODY LOCK LT REFINISH 1.2 4 1, 0 SURFACE 0.2 TWO STAGE E 0207 01 DOOR SHELL, FRONT LT 5L5Z1020125A 150. 00* INC*1 EXTRA COST FOR ELECTRIC DOOR 10020 FLARE,WHEEL OPENING LT REPAIR 0. 6*1 L 0020 # FLARE,WHEEL OPENING LT REFINISH 2.0*4 # = 13, 10 1. 2*SURFACE 0. 6 TWO STAGE SETUP 0.2 TWO STAGE L BLEND LT FENDER REFINISH 1. 0*4" 10 ITEMS MC MESSAGE (S) O1 CALL DEALER FOR EXACT PART NUMBER /PRICE 10 T.NCLUDES AUDATEX TIME TO CLEAR ENTIRE PANEL 13 INCLUDES 0. 6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE FINAL CALCULATIONS & ENTRTRS GROSS PARTS 150. 00 PAINT MATERIAL 147. 00 PARTS & MATERIAL TOTAL 297. 00 TAX ON PARTS & MATERIAL @ 8 . 750% 25. 99 LABOR RATE REPLACE HRS REPAIR HRS 1--SHEET METAL 75.00 2. 3 0. 6 217. 50 2-MECH/ELEC 75. 00 3-FRAME 75. 00 4-REFINISH 75.00 4 . 9 367. 50 5-PAINT MATERIAL 30.00 LABOR TOTAL 585. 00 SUBLET REPAIRS TOWING STORAGE GROSS TOTAL 907 . 99 NET TOTAL 907 .99 SHOPLINK UA615 ES CD LOG 8128-1 DATE 10/24/08 02 : 56:45PM R6. 37 CD 10/08 HOST LOG (C) 1998 - 2008 AUDATEX NORTH AMERICA, INC. 1.2 HRS WERE ADDED TO THIS EST. BASED ON AUDATEX TWO-STAGE REFINISH FORMULA. PAGE 2 This fax was received by GFI FAXmaker fax server. For more information,visit: http://www.gfi.com From: 51053290115_. _ Page:316 Date: 10/28/2008 1:08:09 PM 10/22/2008 at. 02:16 PM 3Q977 ESU93998-01 CCO2U1QB ESURANCE Rocklin Claims Office *****Supplement Hotline ( 866-514-4788 ) **+*** jblack2Lesurance.corn P.O. Box 2890 Rocklin, CA 95677 (510)295-5484 Fax: (866) 954-0890 ESTn&kTE OF RECORD Written ny: Jon Black #123 10/22/2006 02: 16 PM Adjuster: Jon Black #123 Insured: kaela Ho Claim #ESU93498-01 Owner: kaela Ho Policy #PACA003092558 Address: 1314 Zinnia CT Date of Lose: 10/2.0/2008 Patterson, CA 95363-2992 Type of Loss: Collision Day: (925)321-2992 Point of Impact: 9. Left T-Bone (Le Inspect 1314 Zinnia CT Day: (925) 321-2992 Location: Patterson, CA 95363-2992 HOME Repair 6 Days to Repair Facility: License # 2001 FORD RANGER 9X2 SUPERCAR 6-3.0L-F1 2D P/U YELLOW 2 D Int': VIN: 1FTYR14EOI PA76985 Lic: UNK CA Prod Date: Odcmeter: 122026 intermittent Wipers Dual Mirrors Console/Storage California Emissions Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks AIM Radia FM Radio Stereo Search/Seek CD Player Anti7Lock Brakes (4 ) Drive L- Air Bag Passenger Air Bag Cloth Seats Rear Step Bumper 5 Speed Transmission Overdrive Aluminum/Alloy Wheels - -----------------------------------------------------------NO. OP. DESCRIPTION QTY EXT. PRTCE LABOR PAINT 1 FRONT DOOR 2* Repl Qual Recy Parts LT door asst' 1 200.00. 1 . 4 3. 5 +25% 3 Add for Clear Coat 1 . 4 4 R&I LT Belt w'strip from 6/1/99 0.3 R&I LT Mirror assy XL & XLT manual 0.3 6 R&I LT R&I trim panel 0.4 7 R&I LT Handle, outside black 0.4 8 CAB 9* Rpr LT Side panel. 2.5 1. 6 10 Overlap Major Adj . Panel _ -0. 4 11 Add for Clear Coat 0. 2 12 R&I LT Glass & frame stationary 0. 8 FORD, tinted 13 PICK UP BOX 1 This fax was received by GFI FAXmaker fax server. For more information,visit. httP://www.gfi.com From:510 532 9045 Page:426._ Date: 1012812008 1:08:09 PM _ 10/22/2008 at 02: 16 PM ESU93498-01 30972 CCO2UIQB ESTIMATE OF RECORD 2001, FORD RANGER 4X2 SUPERCAB 6-3.,OL-FI 217 P/U YELLOW 2 D Int: ---------------------------------------------------------------------- NO. OF. DESCRIPTION QTY EXT. PRICE LABOR PAINT -------------------------------------------------------- ----------------------- 14 * - --------- -------- 14 * Rpr LT Side panel 6 foot bed 3. 0 2 . 9 w/whl opening mldg 15 Overlap Major Non-Adj . Panel -0,2 16 Add for Clear Coat 0. 5 17 R&I LT Upper rail w/6 foot bed 0. 4 black 18 Repl LT Transfer "EDGE" aqua 1 26: 42 0. 2 194 Rpr LT Wheel opig mldg vermillion 0.4 0.8 20 R&I LT Wheel opag mldg vermillion 0.3 21 R&I Splash guard 2WD 0, 2 22# Color Tint 1 0.5 N 23* R&I R&I box assy 1 .0 94 REAR LAMPS 25 R&I LT Tail lamp assy 0.3 26 REAR BUMPER 27 R&I R&I bumper assy Incl. 28# Hazardous Waste 1 3. 00 29# Cover Car ] 5..00 T 0.2 N 30# Rop;Glas 1 0.5 ------------------ ------------------------------------------------------ Subtotals -----------_-------- ---- -----_------•--------�-- r' Subtotals =_� 236.:42 13. 1 10. 3 Line 2 Damage 2. Suppliers Part Description: Door, Lt Ft RQ WHITE DINGS/ NTUAL Line 23 : Set Back Line 30 : Back Glass Parts 231 .42 Body Labor 13, 1 hrs; @ $ 75.00 /hr 982.50 Paint Labor 10.3 hrs, @ $ 75.00 /hr 772.50 Paint. Supplies 10. 3 hrs, @ $ 30.00/hr 309.00 Sublet/Misc. 5.00 SUBTOTAL 4 - - $ 2300. 42 Sales Tax $ 545. 42 @ 8.25001 45.00 TOTAL COST OF REPAIRS --^ - $ 2345, 42 ADJUSTMENTS: Deductible 1000.00 ' TOTAL ADJUSTMENTS $ 1000.00 NET COST OF REPAIR$ $ 1345.42 2 This tax was received by GFI FAXmaker tax server. For more information,visit. http:ttwww.gfi.com From: 510 532 9045 Pa-ge: 5/6 Date: 10/28/2008 1:08:10 PM _ - - - -- -- PM -7 10/22/2008 at 02: 16 PM ESU93498-01 369,72 CCO2UIQB ESTHETE OF RECORD 2001 FORD RANGER 4X2 SUPERCAR 6-3. 0L-FI 2D P/U YELLOW 2 D Int; THIS I5 NOT AN AUTHORIZATION TO REPAIR ALTHOUGH IT IS AGREED BETWEEN THE REPAIR FACILITY AND ESURANCE THAT THE ABOVE VEHICLE CAN BE :REPAIRED BY THE REPAIR FACILITY FOR THE AMOUNT STATED IN THE GROSS TOTAL SECTION. ONLY THE VEHICLE OWNER CAN AUTHORIZE THE REPAIR OF THE VEHICLE AND ALL COSTS OF REPAIR ARE THE SOLE RESPONSIBILITY OF THE VEHICLE OWNER. THIS APPRAISAL WAS BASED ON VISIBLE OR CERTAIN DAMAGES AT THE TIME OF INSPECTION. TO REQUEST A SUPPLEMENT, PLEASE CALL (866) 514: 4788, PLEASE FAX 'I'tiE SUPPLEMENT AND ALL SUPPORTING DOCUMENTS WITH CLAIM NUMBER TO (866) 454 0890. THE REPAIR FACILITY AND ESURANCE WTT,L REACH AN AGREED PRICE PRIOR To BEGINNING ANY OF THF: SUPPLEMENTAL REPAIRS, THE REPAIR FACILITY WILL THEN SEEK AUTHORIZATION FROM THE VEHICLE OWNER FOR THE ADDITIONAL REPAIRS. NO SUPPLEMENTS WILT, BE HONORED UNLESS APPROVED IN ADVANCE BY ESURANCE. REPAIR FACILITY MUST BE PROVIDED A COPY OF THIS ESTIMATE PRIOR TO COMMENCEMENT OF REPAIR, FAILURE TO DO SO MAY SUBJECT THE VEHICLE OWNER TO ADDITIONAL EXPENSE. FOR YOUR PRO'T'ECTION 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 P.BBREVIATIONS/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 NUN-ADJ=NON ADJACENT O/H=OVERHAUL GP=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. Recycled Part Costs based on information provided by Car-ParL` .com. For assistance, call GCC at 800-637-8511. 3 This fax was received by GFI FAXmaker fax server. For more information,visit: http:/twww.gfi.com From:5.1.0 532 9045_ Page:616 Date: 10728/20081:08:10 PM -- -- 10/22/20018 at 02: 16 P14 ESU93498-01. 30872 CCO2UIQB E5Tn4ATE OF RECORD 2002 FORD RANGER 4X2 SUPERCA.B 6-3,OL-FI 2D P/U YELLOW 2 D Int: RECYCLED PART SUPPLIERS Lice Line Description Price 2 Qual Recy Partes LT door a +25% Stock No. : R2874 $ 200.00 AUTOGATQR ROSEVILLE (800)833-9292 3961 P.F.E. ROAD RON DUMAS ROSEVILLE, CFS 95747 5 This fax was received by GFI FAXmaker fax server. For more information,visit: http://www.gfi,com Image View Page 1 of 17 Photos Claim Number: ESU93498-01 Print File: ... 10/22/2008 4:21 PM i6'�G, �'`.a '� •.i �'frf�,k�•- x ten,^ / . � 3 e & 14 r { )4t1 � t�< •'� � r li w'• � r µ_ -r' y .N. 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TO: EMY SHARP, CLERK OF THE BOARD FROM: CAO/RISK MANAGEMENT DIVISION - LIABILITY UNIT ATTACHED MAIL RECEIVED AT RISK MANAGEMENT DIVISION: VIA MAIL (� VIA FAX (/ ) DROPPED OFF WITH RECEPTIONIST ( ) SHARON HYMES-OFFORD NOV 1 0 2008