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HomeMy WebLinkAboutMINUTES - 12092008 - C21 (6) CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: DECEMBER 09, 2008 Claim Against the County, or District Governed.by ) the Board of•Supervisors, Routing Endorsements, �i NOTICE TO CLAIMANT and Board Action. All Section references are to • The copy of this document mailed to California Government Codes. 1111�U you is your notice of the action taken Rig, IIV D on your claim by the Board of OCT 3'1 2008 Supervisors. (Paragraph IV below), given Pursuant to Government Code AMOUNT: $5,723.28 COUNTY COUNSEL Section.913 and 915.4. Please note all MARTINEZ CALIF. CALIFORNIA STATE AUTOMOBILE ASS. . "Warnings CLAIMANT: FOR: KENGFAI LEE BY: DAN v:: DUFFY ATTORNEY: UNMOWN DATE RECEIVED:. OCTOBER 31, 2008 ADDRESS: P.O. Box 920 BY DELIVERY TO CLERK ON: OCTOBER 31, 2008 SUISUN CITY, CA 94585-0920 BY MAIL POSTMARKED: OCTOBER 29, -2008 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. OCTOBER 31, 2008 DAVID TWA, Cie Dated: By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Su ervisors ( This claim complies substantially with Sections 910 and 910.2. This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board.cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed..The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 91.1.3). O Other: Dated: f�, ��� By: M C.Aa&!j�. 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 911.3). . IV. BOARD ORDER: By unanimous vote of the Supervisors present: (vThis 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&tmo6os'9,ee#OkAVID TWA, CLERK, By Deputy Clerk WARNING(Gov. code section 913) Subject to certain exceptions,you have only sur(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 withthis 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. Dated: u.�.arr�&�/o JOL00AVID TWA,CLERK, By Deputy Clerk This warning does"not,apply to claims which are not subject to then California Tort Claims Act such as actions'in inverse condemnation, actions for:specific relief'such as mandamus or injunction, or Federal Ciyil.Rights,claims. The above list is not exhaustive`andrlegal consultation is essential to understand all the separate limitations periods that may"apply. The limitations periodi 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 y ;,> , JUN-12-2003 09:23 CCC RISK MANAGMENT 925 335 1421 P.02 Claim 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, 1987, 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, 653 Fine 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 farm. # # f # # # f # # # # # # # f # * # # # # # # # # # # # # f f # f # # # f f f f f f # RE: Claim By ) Reserved for Clerk's filing.stamp CS A Gs 3"6 ea :lee Ar— ) RECEIVED F )• Against the County of Contra Costa ) OCT 3 1 2008 CLERK BOARD OF SUP-RV'ISORS District) CON3HA COSTA CO. Fill in name ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 5 7 Z3. '28 and in support of this claim represents as follows: 1. When did the damage:or` injury occur? (Give exact date and hour) aq�/� zooY #7 id PM 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) 4, he TC veh cl4c Were tiu-,%a� y +jowr veji,�c wo+& f-'00 6� air t�su.red 4. What particular act or omission on-the part of county or district officers, servants or.employees caused.the.injury or.damage? /def ,�!�joy Y� •. orvD-Q t� ktc 64, ,L +' �c. o- �•� Jun-1e- 005 09:23 CCC RISK MANAGMENT 925 335 1421 P.03 j, wnat are the names of county or district orficers, servants or employees causing the damage or injury? 11�� �An2e-s r�rj I4S AkW Z2 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.) / �s�i m��fGS ou� e2c90 eeS GA�Le c� 8. Names and addresses of.witne-Ases, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: �~ DATE ITEM AMOUNT Y LS"&a-7r3 c2 R4a1M 8C1-*WAeAr1 50,9 - po/9� C:o cttSre,J RC .+Jt- . fzsy l-S ,p/z2 boss OFc.b¢.lRaw�YRc �+F,Q- �r•� Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES T0: (Attorney) or by some person on his.behalf." Name and Address of Attorney 1� y ON 4 Claiinan ignature �cl Address CITV 61 Telephone No. Telephone No. -900 - (� �Zo X NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if.genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county Jail,for a period of not more than one-year, by a fine of not exceeding one thousand ($1,000), or by 'both such imprisonment and Pine;-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. HERTZ LOCAL EDITION Rental Agreement No: A18302255 Phone: 1-888-777-3700 . Invoice Date: 10/07/2008 Fax: 405-775-5413 Document: 609088166961 E-mail: CUSTOMERBILLING@HERT7.CDM LOCAL EDITION Renter: LAWRENCE LEE Direct All Inquiries To: ORIGINAL INVOICE Account No. : ********2188 HCC HERTZ LOCAL EDITION CDP No. : 1464607 c HLE INSURANCE DEPT 1139 CDP Name: HLE CSAA FRP INSURED S n PO BOX 121139 co DALLAS, TX 75312-1139 Q TAX Id: 13-1938568 0 Q MURR EVALYN 0 CSAA FRP-INSURED >- *ATTN CLAIMS DEPT M PO BOX 920 0 SUISUN CITY, CA 94585-0920 W LU RENTAL REFERENCE RENTAL DETAILS W Rental Agreement No: A183O2255 Rate Plan: IN: HIDA OUT: IIID Reservation IO: 037-1217190 Rented On: 09/13/2008 11:57 LOCI; 726002 Special Bill Info: A257B74237O2XLU CONCORD, CA Returned On: 10/04/2008 12:45 LUC# 726002 CONCORD, CA Car Description: CAMRY 6EVL838 VIN I<: 4T1BE46K89U3359O7 CAR CLASS Charged: F MILEAGE In: 1,548 Rented: F6 Out: 926 Reserved: 99 Driven: 622 BILLING INFORMATION BILLING DETAILS Claim No: 25-767423-7 FRP 209.00 Policy No: EXTRA DAYS 2 @ 21.00 42.00 Date of Loss: 2008-09-11 SUBTOTAL 251.00 Type of Loss: D Repair Facility: CONCORD COLLISION FRP AMOUNT DUE 251.00 USD Authorized Rate: 25.00 Authorized nays: 22 Adjuster: MURR EVALYN Insured: KENGFAI AMOUNT DUE 251.00 USO MISCELLANEOUS INFORMATION TOTAL RENTAL DAYS 22 BILLED TO CUSTOMER 0.00 PAYMENT DUE UPON RECEIPT PER THE AGREEMENT BETWEEN HERT7 AND THE INSURANCE COMPANY, THANK YOU FOR RENTING FROM HERTZ THE FLAT AMOUNT DUE LISTED ON THIS INVOICE SUPERCEDES ANY DAILY RATE AMOUNTS CONTAINED IN THE ORIGINAL RENTAL AGREEMENT. PLEASE INCLUDE RENTAL AGREEMENT NO. ON YOUR CHECK. REMIT TO: HERTZ LOCAL EDITION HLE INSURANCE DEPT 1139 PO BOX 121139 DALLAS, TX 75312-1139 UNITED STATES AMOUNT DUE: 251.00 USO Phone: 1-888-777-3700 Fax: 405-775-6413 E-mail: CUSTOMERBILLING@HERTZ.COM Date: 9/30/2006 03:12 PM Estimate ID: P257B7423701 Estimate Version: 1 Supplement: 1 (F) 9/30/2008 10:32:10 AM Profile ID: WC Region California State Auto Association PO BOX 920,Suisun City,CA 94585-0920 Fax'. (707)663-9052 Damage Assessed By: Laura Ethridge Supplemented By: Laura Ethridge Should have any questions regarding this estimate please contact: Laura Ethridge Phone : 925-671-2502 Fax: 925-671-6024 0o Email: Laura Ethridge@csaa.com o O N C, O Ci c Condition Code: Good Date of Loss. 9111l200B Deductible: 500.00 W Policy No: 7874237 Claim Number: P257B7423701 V } W Insured: KENGFAI LEE C Owner: KENGFAI LEE W > Address: 15 FAWN GLEN CT, PITTSBURG,CA 94565 W Telephone: Work Phone: (925)825-1993 Home Phone: (925)261-1274 C1 W Pi Mitchell Service: 910207 Description: 2009 Toyota Camry Hybrid Body Style: 4D Sed Drive Train: 24L Inj 4 CyIA FWD VIN: 4T1BB461<091-1067850 License: 6EHY772 CA Mileage: 8,044 OEM/ALT'. A Search Code: CONTRACOST Color: GRAY Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 000023 BOY REMOVE/INSTALL FRT BUMPER ASSY INC 2 002159 BOY REMOVE/REPLACE FRT UPR BUMPERSEAL 53395-06010 40.10 0.2 3 002524 BOY CHECK/ADJUST HEADLAMPS 0.4 4 002525 BOY REMOVE/INSTALL R FRT COMBINATION LAMP INC # 5 000089 REF BLEND HOOD OUTSIDE C 1.2 6 000205 BOY REMOVE/REPLACE RFENDER PANEL 53801-06110 213.09 3.0 # 7 AUTO REF REFINISH R FENDER OUTSIDE C 2.1 8 AUTO REF REFINISH RADD FOR EDGE C 0.5 9 D00209 BOY REMOVE/INSTALL R FENDER PROTECTOR Existing 0.2' 10 000211 BOY REMOVE/REPLACE R FENDER CLIP 2@0.92 90467-10183 1.B4 11 002161 BOY REMOVE/REPLACE R FENDER SEAL 53882-06080 29.38 12 000219 BOY REMOVE/REPLACE R FENDER ADHESIVE NAMEPLATE 75374-33010 33.98 0.1 13 000221 BOY REMOVE/REPLACE R FENDER LINER 53805-33030 76.79' INC This estimate has been re-calculated with a modified profile. ESTIMATE RECALL NUMBER: 09/30/200810:31:46 P257137423701 UltraMate is a Trademark of Mitchell International Mitchell Data Version: SEP_08_V Copyright(C)1994-2005 Mitchell International Page 1 of 3 UltraM ate Version: 6.0.032 All Rights Reserved Date: 9/30/2008 03:12 PM Estimate ID: P257B7423701 Estimate Version: 1 Supplement: 1 (F) 9/30/2D08 10:32:10 AM Profile ID: WC Region 14 000227 BDY REMOVE/REPLACE R FENDER.SPLASH SHIELD CLIP 11@1.29 90467-09166 14.19 15 002216 BDY REMOVE/REPLACE ALLOYWHEEL New 178.00' 0.3 16 002230 MCH REMOVE/REPLACE R FRT SUSP STRUT -M 48510-09R40 138.10 INC'# 17 000467 MCH REMOVE/REPLACE R FRT SUSP SUPPORT -M 48609-06190 75.71 INC'# 18 900500 MCH' REMOVE/REPLACE STRUT LABOR Sublet 301.88' 0.0' 19 931118 BDY REMOVE/REPLACE RIGHT FRONT TIRE New 193.00' 0.0' 20 900500 MCH' ADD'L LABOR OF MOUNT &BALANCE TIRE (INC WEIGHTS &STEMS.Sublet 52.50' INC' 21 000799 REF REFINISH RHINGE PILLAR C 0.7' 22 000867 REF REFINISH R ROCKER MOULDING C 14 23 000869 BDY REMOVE/INSTALL R ROCKER MOULDING INC 24 000877 BOY REPAIR R ROCKER MOULDING Existing 1.0' 25 000889 BDY REMOVE/REPLACE R ROCKER MOULDING CUP 2@4.32 75867-AA010 8.64 26 900500 MCH* CHECK/ADJUST 2WHEEL ALIGNMENT Sublet 172.50' INC` 27 OR PER INVOICE PLUS MARKUP 28 900500 REF ` ADD'L LABOR OP SU BSEQUENTBAG GING/COVER "QUALREPLPART INC 02' 29 900500 BDY ' REMOVE/REPLACE SEAM SEAL New 7.00' INC` 30 RT FRONT DOOR AND UPPER/LOWER HINGES 31 000693 BDY REMOVE/REPLACE R FRT ROCKER GROMMET 90169-06177 0.75 32 000895 BDY REMOVE/REPLACE R LWR ROCKER MOULDING CLIP 7@4.72 75867-30120 33.04 33 001185 BDY REMOVE/REPLACE R FRT DOOR SHELL 67001-06100 702.62 5.5 # 34 AUTO REF REFINISH R FRT DOOR OUTSIDE C 1.B 35 AUTO REF REFINISH R FRT ADD FOR JAMBS&INTERIOR C 1.0 36 001195 BDY REMOVE/REPLACE R FRT UPR DOOR BLACKOUT TAPE 75965-06010 22.84 0.2 37 001197 BDY REMOVE/REPLACE R FRT DOOR REAR BLACKOUT TAPE 75975-06010 10.37 0.2 38 001191 BDY REMOVE/REPLACE R FRT DOOR REAR WINDOW FRAME MLDG 75755-06020 30.01 INC # 39 001223 BDY REMOVE/REPLACE R FRT DOOR POWER MIRROR ASSY 87910-33670-81 163.91 ' INC # 40 001243 BDY REMOVEIINSTALL R FRT DOOR TRIM PANEL INC 41 001294 BDY REMOVE/INSTALL R FRT OTR DOOR HANDLE INC # 42 001296 BDY REMOVE/INSTALL R FRT DOOR HANDLE COVER INC # 43 002412 BDY REMOVE/REPLACE R FRT UPR DOOR HINGE 68710-02020 40.44 0.2 # 44 AUTO REF REFINISH RFRT UPR HINGE C 0.5 45 002414 BDY REMOVE/REPLACE R FRT LWR DOOR HINGE 69730-AC010 44.87' 0.2 # 46 AUTO REF REFINISH R FRT LWR HINGE C 0.5 47 001362 BDY REMOVE/REPLACE R FRT DOOR WEATHERSTRIP 67661-06040 45.87 INC 48 002108 REF BLEND R REAR DOOR OUTSIDE C 0.9 49 002116 BDY REMOVEIINSTALL R REAR OTR BELT MOULDING 1.0 # 50 002118 BDY REMOVE/INSTALL R REAR DOOR TRIM PANEL INC 51 002128 BDY REMOVEIINSTALL R REAR OTR DOOR HANDLE 0.7 # 52 001436 BDY REMOVEIINSTALL R REAR DOOR LATCH ASSEMBLY Existing 0.3 # 53 R&R Time Used in R&I Operation 54 936014 ADD'LCOST FLEX ADDITIVE 7.00' 55 AUTO REF ADD'L OPP CLEAR COAT 2.8 56 933005 BDY ADD'L OPP RESTORE CORROSION PROTECTION 10.00' 0.1' S1 57 933017 REF ADD'L OPP FINISH SAND AND BUFF 2.0' 58 933018 REF ADD'L OPP MASK FOR OVERSP RAY INC' 0.2' 59 AUTO ADD'L COST PAINT/MATERIALS 408.00' 60 AUTO ADD'LCOST HAZARDOUS WASTE DISPOSAL 3.00' This estimate has been re-calculated with a modified profile. ESTIMATE RECALL NUMBER: 09/301200810:31AB P257B7423701 UltraMate is a Trademark of Mitchell International Mitchell Data Version: SEP_08_V Copyright(C) 1994-2005 Mitchell International Page 2 of 3 UltraM ate Version. 6.0.032 All Rights Reserved Date: 9/30/2008 03:12 PM Estimate ID: P257B7423701 Estimate Version: 1 Supplement: 1 (F) 9/30/2008 10:32:10 AM Profile ID: WC Region *- Judgment Item #- Labor Note Applies C- Included in Clear Coat Calc Add'I Labor Sublet 1. Labor Subtotals Units Rate Amount Amount Totals If. Part Replacement Summary Amount Body 13.6 75.00 10.00 ODD 1,030.00 Taxable Parts 2,104.54 Refinish 163 75.00 0.00 0.00 1,185.00 Sales Tax @ 8.250% 173.62 Mechanical 0.0 75.00 0.00 225.00 225.00 Non-Taxable Parts 301.88 Non-Taxable Labor 2,440.00 Total Replacement Parts Amount 2,580.04 Labor Summary 29.4 2,440.00 III. Additional Costs Amount IV. Adjustments Amount Taxable Costs 415.00 Insurance Deductible 500.00- Sales Tax @ 6.250% 34.24 Customer Responsibility 500,00- Non-Taxable Costs 3.00 Total Additional Costs 452.24 I. Total Labor: 2,440.00 11. Total Replacement Parts: 2,580.04 111. Total Additional Costs: 452.24 Gross Total: 5,472.26 IV. Total Adjustments: 500.00- Net Total: 4,972.28 Less Original Net Total: 4,822.28 Net Supplement Amount: 150.00 S1: Laura Ethridge 150.00 THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES APPLICABLE TO THESE REPLACE4ENT PARTS ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OF THE PARTS, RATHER THAN BY THE ORIGINAL MANUFACTURER OF YOUR VEHICLE. Insurance Co: CSAA Insurance This estimate has been re-calculated with a modified profile. ESTIMATE RECALL NUMBER: 09/301200810:31:48 P257B7423701 UltraMate is a Trademark of Mitchell International Mitchell Data Version: SEP_08_V Copyright(C) 1994-2005 Mitchell International Page 3 of 3 UltraMate Version: 6.0,032 All Rights Reserved 5,2TEOP'JALIFORNIA - TRAFFIt COLLISION'REPORT CHP 555 Page 1 (Rev.8-97) OPI 042 Page ( or 3 SPECIALCONDITIONS NAa" NTARur A/ NLXLIL LX INI�ALD YLLa� ✓(L G /� OBTRtCT LDG/ALR/E'PlpxRE NI,MeER G'V 1' Y �`�1YFE/} NUM9 RN D MsOEulA COUNTY REPORTING DISTRICT BEAT O COLLISION OCCURRED ON MO DAY U� tj10 fff TIME N070`� OFFICER 0 � y MILEPOST INFORMATION DAY OF WEEK TOW AWAY PHOTOGRAPHS BY: NONE 0 PEETMIES OF S M T WU F S ❑YES © NO Q AT INTERSECTION WITH . p STATE HOW REL OR: E MLES OF /_.yl' ACCOS" ❑YES 09 NO PARTY DRIVERSUCC�ENSE IS/S��ER+EL STATE CLASS SAFETY VEH.YEAR M,EEA�.K�EIMCOEUCOI/L R'y e'.�L, LlCEN6E NVMBE/R STATE •� ( s\V 1 ��'` CA EQUIP. I V1���v.Aljj OKRA NAME(FIRST,MIDDLE,LAST) 1/ G Zc ✓` �J'L 5 ft � U OWNERS NAME(� ❑ SAME 3•DRIVER (' sTREBTADDR/,Ess 6011rXA LaStA 12`t El16tiLAvD OWNERSADDRESS SAME AS DRIVER i RAIAOLQ(E CITY/STATE2IP �'( q'.1 r/ 2-. ,b y S LVO OI f A5,i e _L. �t ❑ P \S� .�( 1_`✓W .. d6LPosJmpN OF VEHICLE ON ORDERS IOFJ 1 E. 7 OFFICER❑DRIVER ❑OTHER AICA SEX HAIR EYES HEIGHT V.flOHT BIRTHDATE RACE ❑aw u 9'1 h v (�V 'L tl� 6� PRIOR MECHANICAL DEFECTS: NONEAPPARENf F1 REFERTONARRZAZTNE own HOME PHONE �I E� BUSINNESSSE.PHONE VEHICLE IDEMIFICATION NUMBER (F To r, Z`(L 16 Q Z J ❑ RTS - -1-L1 �V���' Jftm'i- CHP USE ONLY DESCRIBE VEHICLE DAMAGE SENDE W DAMAGED AREA WSURANCE CARRIER / C POLICY NUMBER VEHICLE TYPE C/ A/�• A I�JJ7A { DUNK ❑NONE MINOR �•—�� UAV I� C(,✓N 1 MOD. OMA OR❑ROLLOVER DIP OF TRAVEL ION STREET OR HIGHWAY SPEED LIMIT G DDT W' LCl L A,)C) r'b l_ CAL-7 TCPRSC MC/M�__ PARTY DRIVERS LICENSE NUMBER STATE CUSS SAFETY VEH.YFAR MAKEMODE R LICENSENUMBER STATE 2 6 3 6 c E 0-I �,Y r C in �tty G�0 y7 C/�- OEWER NAME(FIRST;MIDDLE tA5 -------- ------------ -- -------------- ® b At-jyt Ci v /T-Lo(L G i� OWNERS NAME ❑ SAME AS DRIVER /FOES STREETADDRESS TaMI •� .. .. r ❑ UTI/N (ALN G OWaERSADDRESS ❑ SAME AS DRIVER «K"E DRY/6TATEa� G ❑ 0-Ts 6 vk(L(, CA 1�LJ( < DISPOSITION OF VEHICLE ON ORDERS OF: El OFFICER❑DRIVER ❑OTHER OKT. SEX HAIR EYES HEIGHT WEIGHT BIRTHDATE RACE MIT ^ JDay F] IA" 17 L,(L- 60-. 6-1 115'5' (0 k7_ C)6 PRIOR MECHANICAL DEFECTS: NONEAPPARENT REFER TO NARRATIVE 0� HOME PHONE C, BUSINESS VEHICLE IDENTIFICATION NUMBER:/J rl Li IL10 u /'S-0 Alo JJ CHP USE ONLY DESCRIBE VEHICLE DAMAGE V SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE ❑UNK El NONE MINOR AAA 2, �/' /// ' -7(-t- 3 ❑MOD. ❑MAJOR❑ROLL-OVER C DIP OF TRAVEL ON STREET,OR HIGHWAY /� SPEED LtUA(IT/ �T / 1.13 W , ` C_k—'/1 ro `J CAL-T TCP/PSC MCR.EX PART,DRIVERS LICENSE NUMBER STATE CLASS I SAFETY VEA.YEARMAKEJMODELI GR LICENSE NUMBER STATE EQUIP. 3 ------------------------ ----------- ----- AAy(q NAME(FIRST,MIDDLE,LAST) ❑ OWNERS NAME SAME AS DRIVER MKS STREETADDRESS TRMR ❑ OWNER'SADDRESS r ❑ SAM d IQMIED DOCUMENT PaAOLR CITY/6TATHZIP �IIILIII4 I,ETVTRLrITI[ YERIQE I--I ❑ D16Po6moN OF VEHICLE ON ORoeas oF: n OF�ICER ISI fyrDRNER O OTHER NO, SEX HAIR EYES HEIGHT WEIGHT BIRTHDATE RACE -�C rh d ( `L-'L7UU LLLSf W. Day Year PRIOR MECHAMCAL DEFECTS: NONE APPARENT TO NARRATIVE OBER HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER P(I ISUUII FO(_IvL ❑ CHPUSEONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGEDAREA VEMICLETYPE INSURANCE CARRIER POLICY NUMBER - DUNK ONONE MINOR • ❑MOD. ❑MAIOR❑ROLL-OVER / DIR OF TRAVEL ON STREET OR HIGHWAY SPEED LIMIT CA DOT COLT TCPRSC MCJMX rREPARER'S NAME r _ DISPATCH NOTIFIED REVIEWS ' DATE�EV/}�WED .IES ❑NO ❑N/A 9'12/a'e Dl Cwxes: t�,� l"S�Lr. d�J. CaA;x r oson E 0-1 STATE OF C4LIFORNIA :. TRAFFIC-C,OLLISION•CODING CHP 555 PFge 2(Rev.8-97) OPI 042 Page 2-of 3 DATE OF COLLISI N DD Y YEAR) TIME(2400) NCIC 9 OFFICER I.D. NUMBER °1 11 D`6 tcl a OWNER'S NAME -OWNER'S ADDRESS NOTIFIED PROPERTY To YES ❑ No DAMAGE DESCRIPTION OF DAMAGE SEATING POSITION SAFETY EQUIPMENT EJECTED FROM VEHICLE OCCUPANTS L-AIR BAG DEPLOYED M 10 BICYCLE.HELMET PoOTHER A-NONE IN VEHICLE M-AIR BAG NOT DEPLOYED 0-NOT EJECTED B-UNKNOWN N-OTHER DRIVER i-FULLY EJECTED C-LAP BELT USED P.-NOT REQUIRED V-NO 2-PARTIALLY EJECTED.' D-LAP BELT NOT USED W-YES 3-UNKNOWN 1-DRIVER E-SHOULDER HARNESS USED 2706-PASSENGERS F-SHOULDER HARNESS NOT USED CHILD RESTRAINT PASSENGER 7-STATION WAGON REAR G-'LAPISHOULDER HARNESS USED Q-IH LEUSED X-NO B-REAR OCC.TRK OR VAN H-LAPISHOULDER HARNESS NOT USED- R-IN VEHICLE NOT USED Y-VES B-POSITION UNKNOWN J-PASSIVE RESTRAINT USED S-IN VEHICLE USE UNKNOWN K-PASSIVE RESTRAINT NOT USED T-IN VEHICLE IMPROPER USE U-NONE IN VEHICLE ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK r)SHOULD BE EXPLAINED IN THE NARRATIVE- PRIMARY LIST NUMBERN)OF PON FACTOR T FAULT TRAFFIC CONTROL DEVICES 1 2 3 TYPE OF VEHICLE 1 2` 3 MOVEMENT PRECEDING COLLISION A Ycs[clronxuuk CRFs A CONTROLS FUNCTIONING A PASSENGER CAR/STATION WAGON A STOPPED yy1(1� YE5 B CONTROLS NOT FUNCTIONING' B PASSENGER CAR W/TRAILER I B PROCEEDING STRAIGHT B OTHER IMPROPER DRIVING': IC CONTROLS OBSCURED CMOTORCYCLE/SCOOTER C RAN OFF ROAD D NO CONTROLS PRESENT I FACTOR• D PICKUP OR PANEL TRUCK I D MAKING RIGHT TURN C OTHER THAN DRIVER- TYPEOFCOLLISIOH IE PICKUP/PANEL TRUCK W/TRAILER E MAKING LEFT TURN D UNKNOWN' A HEAD—ON IF TRUCK OR TRUCK TRACTOR I F MAKING UTURN E FELL ASLEEP' B SIDE SWIPE G TRUCK/TRUCK TRACTOR W/TRLR. I G BACKING C REAR END H SCHOOLBUS H SLOWING I STOPPING WEATHER IMARX f TO 2ITEMS D BROADSIDE I OTHER BUS I PASSING OTHER VEHICLE CLEAR -E HIT OBJECT J EMERGENCY VEHICLE J CHANGING LANES B CLOUDY F OVERTURNED K HIGHWAY CONST.EQUIPMENT K PARKING MANEUVER C RAINING G VEHICLE/PEDESTRIAN L BICYCLE L ENTERINGTRAFFKI D SNOWING % .H OTHER^, M OTHER VEHICLE M OTHER UNSAFE TURNING E FOG I VISIBILITY FT. - N PEDESTRIAN N XING INTO OPPOSING LANE F OTHER': MOTOR VEHICLE INVOLVED WITH 0 MOPED 0 PARKED WIND JA NON-COLLISION P MERGING LIGHTING I B PEDESTRIAN Q TRAVELING WRONG WAY A DAYLIGHT 1,4 C OTHER MOTOR VEHICLE 1 21 3 OTHER ASSOCIATED FACTOR($) R OTHER': B DUSK-DAWN D MOTOR VEHICLE ON OTHER ROADWAY (MARK 1 TO 217EMS) C DARK-STREETLIGHTS E PARKED MOTOR VEHICLE AnON: °❑YES . D DARK-NO STREET LIGHTS F TRAIN ONO E DARK-STREET LIGHTSNOT G BICYCLE B ve aecnoxaounpx; 00E00YES FUNCTIONING' H ANIMAL: ONO SOBRIETY-DRUG ROADWAY SURFACE C vc sscnoN aounoN: Cools 1 2 3 PHYSICAL IIt+A DRY I FIXED OBJECT: ONO I (MARK f 702ITEMS) B WET 1) — K. A HAD NOT BEEN DRINKING C SNOWY-ICY J OTHER OBJECT: E VISION OBSCUREMENT: B HBD-UNDER INFLUENCE D SLIPPERY MUDDY OILY.ETC. F INATTENTION': C HBD-NOT UNDER INFLUENCE' ROADWAY CONDITION(S) G STOP&GO TRAFFIC D HS-IMPAIRMENT UNKNOWN' (MARK 1 TO 2ITEMS) PEDESTRIAN'S ACTIONS H ENTERING/LEAVING RAMP E UNDER DRUG INFLUENCE' A HOLES,DEEP RUT' NO PEDESTRIANS INVOLVED I PREVIOUS COLLISION I F IMPAIRMENT-PHYSICAL' B LOOSE MATERIAL ON ROADWAY' B CROSSING IN CROSSWALK J UNFAMILIAR WITH ROAD G IMPAIRMENT NOT KNOWN C OBSTRUCTION ON ROADWAY' AT INTERSECTION K DEFECTIVE VEH.EQUIP: CITED H NOT APPLICABLE D CONSTRUCTION-REPAIR ZONE C CROSSING IN CROSSWALK-NOT OYES I II SLEEPY/FATIGUED E REDUCED ROADWAY WIDTH AT INTERSECTION, ONO SPECIAL INFORMATION F FLOODED' D CROSSING-NOT IN CROSSWALK L UNINVOLVED VEHICLE A HAZARDOUS MATERIAL G OTHER`. E IN ROAD-INCLUDES SHOULDER M OTHER' H NO UNUSUAL CONDITIONS F NOT IN ROAD N NONE APPARENT G APPROACHING I LEAVING SCHOOL BUS O RUNAWAY VEHICLE SKETCH , >1 O MISCELLANEOUS I I INDICATE NORTH ( t.�llwD rt 0 CONTROLLED DOCUMENT SEP 2 ! 2boo L PITTSBURG POLICE DEPARTMENT I 1�Or V( s 1 a OSP 98 13DD9 STATE OF CALIFORNIA NARRATIVE/SUPPLEMENTAL PAGE 3 DATE OF INCIDENT TIME NCIC NUMBER OFFICER ID NUMBER 9/11/2008 1910 0708 1 P299 C08-7069 "X"ONE AC� [ls TYPE SUPPLEMENTAL("X"APPLICABLE) Narrative Colion Report BA update Fatal Hit and Run update Supplemental Other: Hazardous materials Schoolbus Other: CITY I COUNTY!JUDICIAL DISTRICT DISTRICT/BEAT I CITATION NUMBER Pittsburg1 Contra Costa/ Delta 4 --- LOCATION/SUBJECT STATE HIGHWAY RELATED W. Lelaand Rd. / San Marco Blvd. Yes X No 1 NOTIFICATION: 2 3 1 was dispatched to a call of a non-injury traffic collision at 1910 hours. I responded 4 and arrived on scene at approximately 1921 hours. All times, speeds, and 5 measurements in this investigation are approximate. All measurements were taken by 6 Strolimeter. 7 8 SUMMARY: 9 10 V-1 is Con-Fire Ford Van with a boat trailer being towed and was driven by D-1 11 (Huntze.)V-2 is a Toyota and was driven by D-2 (Lee.)V-1 was traveling east bound 12 onto W. Leland Rd from San Marco Blvd. in the number two turn lane of traffic at 13 approximately 15 mph. V-2 was traveling eastbound onto W. Leland Rd. from San 14 Marco Blvd. in the number one turn lane of traffic at approximately 15 mph. As V-1 was 15 turning east bound onto W. Leland Rd. entering the number two of east bound traffic, 16 the left side wheel well of the boat trailer went into the number one lane and collided 17 with the right front passenger door of V-2 as V-2 was simultaneously turning east 18 bound onto W. Leland Rd. It should be noted that no injuries resulted from this traffic 19 collision. Parties exchanged information. 20 21 AREA OF: IMPACT: 22 23 The area of impact was determined to be 21ft 41n north of the south curb line of W. 24 Leland Rd. and 24ft east of the prolongation curb line of San Marco Blvd. 25 26 CAUSE: 27 28 D-1 caused this collision by being in violation of CVC 22107-Unsafe turning movement. 29 This was determined by D-1 and D-2's statements. 30 31 32 33 RECOMMENDATIONS: 34 35 None CONTROLLED r)OCIj[0ENT SEP 2 ,'i [u; PREPAPr_WSNAME I.D. NUMBER DATE REVIEWER'S NAMIR7SBURG p0 IDApEPA�TM NT J. Curtis P299 9/11108 SOW N °o �^ ONO i ~ v F NQ`2 0. b1S031Mn "O . OC ` Gk� VD 0 r P .ems .f� 1� IVY`i'4. 4 01 V' r N Yp yU3 ala+ z o- vs �3 $st t . Sas