HomeMy WebLinkAboutMINUTES - 02122008 - C.11 (4) CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY �• //
BOARD ACTION: FEBRUARY 12, 2008
Claim Against the County, or District Governed by )
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
anO Board Action. All Section references are to ) The copy of this document mailed to
alifornia Government Codes. ) you is your notice of the action taken
on your claim by the Board of
D
973ay�
Supervisors. (Paragraph IV below),
given Pursuant to Government Code
AMOUNT: UNKNOWN AN 0 9 2008 Section 913 and 915.4. Please note all
"Warnings".
CLAIMANT: DAVID S. ADAMSCOUNTY COUNSEL
MARTINEZ CALIF.
ATTORNEY: UNKNOWN DATE RECEIVED: JANUARY 09, 2008
ADDRESS: 1277 MARTIN LUTHER KING, JWP, bI,IVERY TO CLERK ON: JANUARY 09, 2008
BERKELEY, CA 94709
BY MAIL POSTMARKED: JANUARY 08, 2008
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JANUARY 09; 2008 JOHN CULLEN, rk
Dated: By: Deputy
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
(k)-lhis 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).
( ) Other:
Dated: By: 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).
IV. ,BOARD ORDER: By unanimous vote of the Supervisors present. .
(jef 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 -PPHN CULLEN, CLERK, By Deputy Clerk
WARNING (Gb4. 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 snail 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 wi8i this matter. if you want to consult an
a�tonrey,you should do so immediately. *For Additional Warning See Reverse Side ofThis Notice.
BAFFIDAVIT 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/.c�a►c��r.y / ",.li!/Y JOHN CULLEN, CLERK By Deputy Clerk
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 6 3?q0
I1�TSTRUCTIONS TO CLAIMANT pal>
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
naive 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.
[[[[[[[[[[[[[[[[[[[[[■man[MEN[[[[■a[[[[■e[[[[[[■■[[[[[[[[[[[[[[[[[[e[[[[[e[e■ [i
RE: Claim By: Reserved for Clerk's filing stamp
)
RECEIVED
)
Against the County of Contra Costa or ) JAN 0 9 2008
CLERK BOARD OF SUPERVISORS
District) CONTRA COSTA CO.
(Fill in the name) )
The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named
district in the sum of$ -see dj�A�4v-<. 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?I(Include city and county)
3. How did the damage or injury occur? (Give full details; use ex-tra paper if required)
4. What 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?
s�� ahs .
6. Whet damage 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.)
aFP
8. Names and addresses of witnesses, doctors, and hospitals:
S(�!2 uf fr�-j
9. List the expenditures you made on account of this accident or injury:
DATE TIT4E AMOUNT
..[.........[. BEEN■ ENRON ■ [■ Ross i iii■■■INENERREM !■won■Box ENERNEVERMSE■■ ■[ ME■■■■■■i■■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 address of Attorney )
-5.
(Claimant's Signature)
K>0
(Address)
Telephone No. ) Telephone No.
■ ■■■t■[■■■■■■i■i■■■■■■■i■ i■■■i i■■■i■■■■■i t[■[iii■t i■■iii![■■[iii[[■■■■![■ MEN [■!■■i[■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.
■ ■[[[[[[[[i■[i■ii[ei[[[■ ■ ■[ iiglass Russ i[[iiii[ [■■ii[i■■i[[[[i[[aiii[i[ii■ Ron ![[[[[[!1
NOTICE:
Section 172 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.
M & M GARAGE
1505 SAN PABLO AVENUE
BERKELEY, CA. 94702
PH# (510) 527-8410 FAX# (510) 527-8414
CD LOG NO 6139-1 DATE 11/20/07
SHOP: M & M GARAGE INSP DATE: 11/20/07
ADDRESS : 1505 SANPABLO AVE PHONE 1 : (510) 527-8410
CITY STATE : BERKELEY, CA FAX: (510) 527-8414
ZIP: 94702-
OWNER: ADAMS WORK PHONE: (510) 526-1176
ADDRESS : DAVE
POINT OF IMPACT: 0
LIC#: STATE: VIN:
BODY COLOR: MILEAGE:
CONDITION: ACCTNG CTL#:
*=USER-ENTERED VALUE E=REPLACE OEM NG=REPLACE NAGS
EC=REPLACE ECONOMY UE=REPLACE OE SURPLUS UC=RECONDITIONED PRT
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
2000 HONDA CIVIC EX 2DOOR COUPE 4CYL GASOLINE 1 . 6 VTEC
CODE: H0254F/E OPTNS C/24BCDPFEIL
OPTIONS :
TWO-STAGE - EXTERIOR SURFACES TWO-STAGE - INTERIOR SURFACES
ELEC REMOTE CONTROL MIRRORS POWER DOOR LOCKS
POWER WINDOWS REMOTE KEYLESS ENTRY SYSTEM
MOONROOF POWER STEERING
AIR CONDITIONING CRUISE CONTROL
OP GDE MC DESCRIPTION MFG. PART NO. PRICE AJo Bo HOURS R
-- --- -- ----------- ------------ ----- --- -- ----- -
I 0389 PNL ASSEMBLY, QUARTE LT REPAIR 4 . 0*1
L 0389 13 PNL ASSEMBLY, QUARTE LT REFINISH 3 . 8 4
2 . 7 SURFACE
0. 6 TWO STAGE SETUP
0 . 5 TWO STAGE
RI 0533 TAILLAMP ASSEMBLY, O LT R&I ASSEMBLY 0. 3 1
RI 0566 REAR BUMPER COVER R&I R&I ASSEMBLY 0 . 8 1
4 ITEMS
MC MESSAGE (S)
PAGE 1
2000 HONDA CIVIC EX 2DOOR COUPE
•CD LOG NO 6139-1
13 INCLUDES 0 . 6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE
FINAL CALCULATIONS & ENTRIES
PAINT MATERIAL 133. 00
PARTS & MATERIAL TOTAL 133 . 00
TAX ON PARTS & MATERIAL @ 8 .750% 11 . 64
LABOR RATE REPLACE HRS REPAIR HRS
1-SHEET METAL 75 . 00 1 . 1 4 . 0 382 . 50
2-MECH/ELEC 75. 00
3-FRAME 75. 00
4-REFINISH 75. 00 3. 8 285. 00
5-PAINT MATERIAL 35. 00
LABOR TOTAL 667 . 50
SUBLET REPAIRS
TOWING
STORAGE
GROSS TOTAL 812 . 14
NET TOTAL 812 . 14
SHOPLINK U8444 ES CD LOG 6139-1 DATE 11/20/07 01 : 54 :38PM R6. 37 CD 10/07
HOST LOG
(C) 1998 - 2007 AUDATEX NORTH AMERICA, INC.
1 . 1 HRS WERE ADDED TO THIS EST. BASED ON AUDATEX TWO-STAGE REFINISH FORMULA.
--------------------------------------------------------------------------
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 REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR
DISTRIBUTOR OF THE PARTS, RATHER THAN BY THE ORIGINAL MANUFACTURER OF YOUR
VEHICLE .
M&M GARAGE GUARANTEES REPAIRS PERFORMED BY THE SHOP WITH EXCEPTIONS TO ROAD
HAZARDS , SUCH AS ROCKCHIPS, FLYING DEBRIS AND ETC. . . AND NORMAL WEAR AND TEAR
ALL REPAIRS ARE GUARANTEED FOR AS LONG AS YOU OWN YOUR VEHICLE.
ALL ESTIMATES ARE SUBJET TO ADDITIONAL DAMAGES PENDING TEARDOWN INSPECTION OF
VEHICLE.
I , X AUTHORIZE M&M GARAGE TO REPAIR MY VEHICLE.
IF ANY INSURANCE COMPANY IS INVOLVED ,YOU HAVE MY AUTHORIZATION TO REPAIR MY
VEHICLE AS PER THE ESTIMATE AND MY SUPPLEMENTAL REPAIRS .
PAGE 2
KOEHLER AUTO BODY, INC.
BODY RECONSTRUCTION e PAINTING e WELDING REPAIR ESTIMATE
1712 San Pablo Ave.• Berkeley, CA 94702• Phone (510) 526-1262 • FAX (510) 526-1393
EPA#CAD 981431?73 • AB076054
/ Date I
Car Ow er / Address Phone
Make eor4::�—License No. Body Styli O`i_Llln-ae Jl
Serial No. Adjuster Phon File No.
Insurance Co. Policy No.
OH = OVERHAUL S = STRAIGHTEN A = ALIGN N = NEW R = REPAIR LKQ = LIKE KIND AND QUALITY
FRONT OF CAR LEFT SIDE RIGHT SIDE
HOURS PARTS($) SUBLET($) HOURS PARTS($) SUBLET ($) HOURS PARTS($) SUBLET($)
BUMPER COVER I I FENDER I I FENDER I I
BUMPER END I "SKIRT I "SKIRT I I
BUMPER N RC I I "MLDG.%EMB. I "MLDG.i EMB I I
BKT I I I I I I
RNFCT/COVER I I HDLMP I HDLMP I I
CUSH/GRD I I " S/B DOOR S/B/DOOR I
ABSBR /ISLTR I PRK LMP I I PRK. LMP I I
GRVL SHLD. I I MKR. LMP. I I MKR. LMP. I I
VALANCE I AIM LMP'S I I I I
FILLER I I COWL I I COWL I I
SPOILER I I DOOR FRT/PANEL I I DOOR FRT/PANEL I I
BUMPER MOLDING I I DOOR LATCH I I DOOR LATCH I I
FRAME CROSS I I "'GLASS 1 I "GLASS I I
I I "MLDG I I "MLDG. I I
- I I HINGE I I HI E / I I
GRILLE SUPT I CENTER POST I,' C91M POST I
" HDR. PNL. I DOOR REI 1 R RE R I I
MLDG. I PANE4qjj I I PANE I I
EMB I " GLA T P. I I "GLASS/W.STRIP. I I
RAD RESEVOR I "MLDG V MLDG I
RAD.BAFFLE I I HINGE I I I HINGE I I
RAD. SUPT. VI I I
CORE I ROCKER PANEL I 1 ROCKER PANEL I I
FAN/BELT MLDG i1 "MLDG I
COOLANT I PILLAR I I FLOOR I
SHROUD ;� I I PILLAR I
WATER BOTTLE I QUARTER PANEL I I QUARTER PANEL I I
A/C COND I EXT I I EXT I I
"RCHG - I I MLDG EMB - I I MLDG 'EMB I I
I WHL. HSG I WHL HSG. I 1
HOOD 1 I W/O MOLDG. I W/O MLDG. I I
"HNG TAILLMP. 1 I TAIL LMP I I
"MLDG. EMB. 1 I MKR LMP I MKR. LMP I I
LOCK REAR OF CAR I
LOCK SUPT I BUMPER ENDRADIO AN I I
I ABS ;ISLTR MISCELLANEOUS ITEMS
WHEEL I 1 BUMPER COVER • .>` STRI I I
TIRE I BKT RN FCT WINDSHIELD CT I I
HUB CAP DISC. I I "CUSH./GRD. I I ROOF PANEL I I
SHOCK TUBE I I "VALANCE I I INSTRUMENT PNL I I
KNUCKLE I I FILLER I I PAINT 8 MATERIAL 1
CONT ARM LR I REAR LWR PNL I I CLEAR COAT I 1
CONT. ARM UP. I I FLOOR I I r BA2!E 1
TIE ROD I FRAME/CROSS I I LABOR QQ $ i
STRUT I DECK UD TL GTE I I HAZARD WASTE $ S pcl
FRONT END ALIGN I " HNG I I SUBLET $
STEERING WHL. 1 I '"MLDG I I TOW CHARGE $
HORN I I I I TAX % ON $ $
MOTOR MNT I I GAS TANK/CAP I I TOTAL [
MIRROR 1 I MUfFIERiPIPE I I SIGNATURE
RECEIVED
JAN 0 9 2008
CLERK BOARD OF SUPERVISORS
CONTRA COSTA CO.
January 7, 2008
1277 Martin Luther King Jr. Way
Berkeley, CA 94709
Clerk of the Board of Supervisors
Attention: Penny Bailey, Auto Claims
County Administration Building, Room 106
651 Pine Street
Martinez, CA 94553
RE: Claim for Auto Damage
Ms. Bailey:
Enclosed please find my claim for auto damage that occurred on October 18, 2007, at
12:30pm in Martinez, CA. The car that hit mine was driven by a Contra Costa County
employee.
Per the instructions to claimant form, I have provided detailed responses about the
incident as well as two estimates for the auto damage. Please find both attached. No
expenditures have been made to date; I will repair my car once this claim has been
processed and paid.
In the meantime,please don't hesitate to contact me with any questions. I can be reached
at(510) 684-3987.
Thank you.
Sincerely,
David S. Adams
1/7/2008 David S. Adams
Auto Damage Claim
Attention: Penny Bailey, Auto Claims
Below are my responses to the attached questions.
1. When did the damage or injury occur? (Give exact date and hour)
Thursday, October 18`h, 2007. 12:30 P.M.
2. Where did the damage or injury occur? (Include city and county)
Martinez, Calfironia. Contra Costa County.
3. How did the damage or injury occur? (Give full details; use extra paper if
required)
My vehicle was parked in the parking lot in front of Lucky's grocery store on
Morello Street in Martinez. I backed out of my parking spot and started to drive
forward. At that time, I felt an impact. I looked back and saw that a vehicle had
backed up into the driver's side rear fender of my vehicle. Both cars pulled back
into their previous respective parking spots, and we exchanged information. The
car that backed into my vehicle was driven by Scott McQuarrie, an employee of
Contra Costa County.
4. What particular act or omission on the part of county or district officers,
servants, or employees caused the injury or damage?
As above, Scott McQuarrie did not see my vehicle and backed up into my vehicle
as I was already moving forward.
5. What are the names of county or district officers, servants, or employees causing
the damage or injury?
As above, Scott McQuarrie.
6. What damage or injuries do your claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.)
The county vehicle collided with my driver's side rear fender, causing a large
dent. Two estimates for repair of the damage are attached.
7. How was the amount claimed above computed? (Include the estimated amount of
any prospective injury or damage.)
Estimated amount is per the two above mentioned estimates.
8. Names and addresses of witnesses, doctors, and hospitals:
Witness:
Scott McQuarrie
5380 Clayton Road, Appt. J
Concord, CA 94521
9. List the expenditures you made on account of this accident or injury:
No expenditures have been made to date (fender will be repaired as per attached
estimates when claim is processed and paid.)
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