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Home My WebLink AboutMINUTES - 12092008 - C21 (9) 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, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) A/ The copy of this document mailed to California Government Codes. C � you is your notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code AMOUNT: $7,500.00 !!1\ Section 913 and 915.4. Please note all NOV 0'4 2008 "Warnings", CLAIMANT: LENNON EVERET COUNTY CouNSEL MARTINEZ CAUR ATTORNEY: uNKNpyN DATE RECEIVED:. NOVEMBER 04, 2008 ADDRESS: P.O. Box 2752 BY DELIVERY TO CLERK ON: NOVEMBER 04, 2008 RICHMOND, CA 94802 RECEIVED FROM RISK BY MAIL POSTMARKED: MANAGEMENT FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DAVID TWA, Cl er Dated: NOVEMBER 04, 2008 By: Deputy 11. FROM: County Counsel TO: Clerk of the Board of Sup rvisors (v)efhis claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board-cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it.was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). O Other: Dated: By: mom. 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. XARD 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. DatedA r�*c.» i� >✓oZVID TWA, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personalty 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. DAVID TWA, CLERK, By eputy Clerk 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 injunction, or Federal Civil Rights,claims. The above list is not exhaustive and legal consultation is essentialrto ungderstand all the separate limitations period"W 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 oftits.nights under California Tort Claims Act 1' ntviioesjt waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act 1f i ROARD OF SUPERVISORS OF CONTRA COSTA COUNTY INTSTRUCTIONS TO CLAIMANT A. A claim relating to a cause of action for death or for injury to person or to personal property or gro-wing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street,Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the.County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each. public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. Claim By: Reserved for Clerk's filing stamp A enn ) Lo- 4 ® 00- y8�"Iek 00 Agamst-rne e>ounty on`u..,.>; LL or ) 08 r t .Q VISORSD15tr7Ct) . (k ill in me e) ) The undersigned claimant hereby makes claire;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 dial the damage or injury occur? (Give exact date and hour) CONTRRECE VEDOUNTY OCT 3 0 2008 2. ere did the dfmage or injury' cur? (Include city and county) RISK MANAGEMENT VICIAM6114 AA 3. SoL d}the damage or injury . ry occur? (Give full details; use extra paper if required) YX 6 aL 4. What particular act or omissioy�n the part of county or district officers servants, emplo ees caused the injury or damage? My 1' y d p 3 I w OA C%Co gS 5 What are the names o co aty, or dist�t�lRetrs servants, or empl yees causingthe damage or injury? 9� C�I C ( l fah,yY14 Y1 i t 6. IArL-sk di:;;uage or injuries do your claim resulted? (Give full extent of injuries or damages "Claimed. Attach two estimates for auto damage.) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 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 a ■■■■■■■■Romano auto■■■■■a■ ■.■t■■..■■■•■■■■■■■■■[Ramos■s■■■■■■■■■■■■s■■■ ■l as a■■■■a s■■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) 1 n Name and address of Attorney ) O•/\� \ ) (Claimant's Signature) ( ddress �- ) Telephone No. ) Telephone No.510' ■ ■s■■■■l■■■■a■■■now*man s■ a■ mamas■■a■■■a■■!■■■■t.■l[■■■.■■■■■■..■[l■■■■■■ ONE■a!a■■a■■1 PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthermore, any attachments, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. a,■■■t a a s a a■■a■■a■s a sawn a a l a[a■■L..a....[..!..■s s■a a a■s a■■■a■■■■■s■a a■ass am K s s a s Naomi NOTICE: Section 72 of the Penal Code provides: Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city, or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account voucher, or writing, is punishable either by imprisonment in the County jail for a period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000.00), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000), or by both such imprisonment and fine. 1 �v� 07 35 r, iE r 5i c- '.5 Y rc�3mol An f r k-K n ! 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