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Home My WebLink AboutMINUTES - 02122008 - C.11 (5) ' 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 and Board Action. All Section references are to ) The copy of this document mailed to California Government Codes. ) you is your notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), JAN 0 9 2005 given Pursuant to Government Code AMOUNT: $3,000.00 plusffi��R Section 913 and 915.4. Please note all �MARTINE�Z ALF.L "Warnings". CLAIMANT: HEATHER HOUSTON ATTORNEY: UNKNOWN DATE RECEIVED: JANUARY 09, 2008 ADDRESS: 13 ORINDA LANE BY DELIVERY TO CLERK ON: JANUARY 09, 2008 PITTSBURG, CA 94565 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. JANUARY 09 2008 JOHN CULLEN, Cie , Dated: By: Deputy iI. FROM: County Counsel TO: Clerk of the Board of Supervisors (L,)-"f/11is 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 claire (Section 91 1.3). O Other: Dated: By: !�7?� Deputy County Counsel ill. 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. ARD 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. Datedf�6r�•a.Y�/.?_� CULLEN, CLERK, By Deputy Clerk WARNING (06V code section 913) Subject to certain exceptions,you have only six(6) months front 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 widt this matter. If you want to consult an -a ttori icy,you should do so!nuned;ately. *For Additional War nirtg See Reverse Side of Tltis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I ant 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:,S'6~.w'yjJ�-JOHN CULLEN, CLERK By Deputy Clerk BOARD OF SUPERVISORS OF CONTRA COSTA COLNno INSTRUCTIONS TO CLAFAANF A claim relating to a cause of action for det�aonr fsoixr�ury�to person teracoerpu�al Qf ther P�or of growing crops shall be presented notlater action. A claim relating to any other cause of action mall be.presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) Claims must be fled with the Clerk of the Board of Supervisors at its office in Room 106, 661 Pine Street,Martinez, CA 945 53'. County Administration Building, 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. If the claim is against more than one public entity, separate claims must be filed against each_ public entity. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form- ■[l[■L[[1[L[[L[[[[■ KKK L f[[[t[■i i[L[[[[[[[[L L L L L[[G C G E t C C L[L■[L[L[[ En L[[[L L[C[ [1 E: Claim By: Reserved for Clerk's filing stamp RECEIVED against the County of Contra Costa or ) JAN 0 9 euuo District) CLERK BOARD OF ""CCS$ CONTRA CC. - Fill in the name) ) INILI Z the undersigned cleimsrhereby makes claim against the County of Contra Costa or the above-named 3istrict in the sum of$2 e btu and in support of this claim represnts as folloR's: 1. %5a did the damage or ' Jury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give fun details;use extra paper if required} 4. ghat.particular act or o=si.on on the part of county or district officers, servants, or employees caused the injury or damage? k-7'0 �.`1 / � / �j J�t i c4o.0 4 od, 3 R'hat are the names of county or district officers,sevants, or employees causing damage or injury? CJ1 0 • What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach-two estimates for auto damage.) - - How was e amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 3 UC , Names and address�of witnesses, doctors, and hospitals: r, List the expenditures you made on account of this accident or injury: DATE ME AMOUNT [ ■a[i a[t a a a a i[a[[[a aIslas a to!!i f t a a[[a[t a e a a a a[a a[a11299192 l[[i a a a[a e a l t a [tae a a i l a a[[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: Uttomevl � Name and address of Attorney ) ai,mant's ignature) (Address) CJ G _ e e hone No. ) Telephone N . Tlp . ■also a a t a a a a c a a a Ran 1183 a ICE a a l c a[a[![{a[[a■[[a[a[[[[[[a[a[[ata[[i[[[[[a l[a a a a[[[[a t a a a l 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, 95 65DO et seq.) Furthermore, any attachments,addendums, or supplernmts attached to the claim form, including medical records, are also subject to public disclosure. ■ l as l Nils t a a a[a a a a a a i i a a i ■ ■ f[t i a[[[[t[[a IN a a[a[a a a a t t i i i a[[[i[[[[i[a■a MR a[a[t a a a[t NOTICE: Section 73 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 e period of not more than one year, by a fine of not exceeding one thousand dollars ($1,DDD.DO), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars (SIOMD),or by both such imprisonment and fine. r 0 CourRy Adn3inistrator Contra Risk Management Division Costa 2530 Arnold Drive,Suite 140 Risk Management Martinez,California 94553 County Administration (925)335-1400 Fax Number (925)335-1421 'T. August 17, 2007 coiix Heather Houston 13 Orinda Lane Pittsburg, CA 94565 Re: Claimant: Heather Houston Insured: Contra Costa County D/Accident: 08/15/2007 Claim No.: 63477 Dear Ms. Houston: The above captioned matter has been referred to my office for investigation and handling on behalf of the Contra Costa County Department of Contra Costa County Fire Protection District. I have enclosed a claim form that must be completed in order to file a formal claim against the County. Be advised that you have six months from the accident date to file a formal claim as stated in the California Government Code beginning with Section 900. This also notifies you that you must comply with the claims presentation and timely suit filing requirements of California law in order to preserve your claim. Our investigation of your claim does not affect your duty to comply with time limits set by law, and by investigating, considering, and discussing your claim with you or your representative, we do not waive our right to assert your failure to comply with those time limits as a complete defense to any claim or action you may bring. Should you have any questions, please do not hesitate to contact the undersigned. Sincer ly, Penny Baily CONTRA COSTA COUNTY Liability Claims Adjuster RECEIVED (925) 335-1442 AUG 3 0 2007 Enclosure RISK MANAGEMENT