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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. D g2a%?J you is your notice of the action taken
on your claim by the Board of
AN 1 1 2008 Supervisors. (Paragraph IV below),
given Pursuant to Government Code
AMOUNT: $239.59 COUNTY COUNSEL Section 913 and 915.4. Please note all
MARTINEZ CALIF. "Warnings".
CLAIMANT: JOSEPHINE PITTA-FLANNERY
ATTORNEY: UNKNOWN DATE RECEIVED: JANUARY 11, 2008
ADDRESS: 900 SOUTHAMPTON ROAD BY DELIVERY TO CLERK ON: JANUARY 11, 2008
4122
BENECIA, CA 94510 BY MAIL POSTMARKED: HAND DELIVERED
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JANUARY 11, 2008 JOHN CULLEN, Clerk
Dated: By: Deputy
11. FROM: County Counsel 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 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
111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
1V. BOARD 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 tip .Z Jow JOHN CULLEN, CLERK, By Deputy Clerk
WARNING ( v. 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 ofThis 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:Ar•o,*rf JOHN CULLEN, CLERK By Deputy Clerk
I
BOARD OF SUPERVISORS OF CONI'R.A.COSTA. COUN'T'Y
INSTRUCTIONS TO OLALMANT
A. A claim relating to a cause of action for death or for injury to person or to personal propFlyor
growing crops shall be presented not later thm six months after the accrual of the c of
action. A claim relating to any other cause of action shall be presented not later than c e 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 Roo06,,
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 Cc ;the
name of the District should be filled in.
D. If the claim is against more fhan one public entity, separate claims must be filed ag ' ch
public entity.
E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form.
■W■■wpm MXWQ RRf f Rf■i■■■ON ON■■SEEN Lff f[Rf RRtRMMM or..■■an■asefa YYi Y;M tff MML1Cf■Mics el
RE: Claim By: Reserved for Clerk's filing stamp
r L f )
7 1 1 ✓�� I ^te l CL 11 r\ P/4-1� )
} RECEIVED
Against the County of Contra Costa or ) JAN 1 1 mo
vN l et L l/istrict} CLERK BOARD OF SUPERVISORS
(Fill the name) CONTRA COSTA CO.
}
The undersigned claimant hereby malces claim against the County of Contra Costa or the above ed
district in the sum of$ Z 3q Sq 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? (Include city and county)
3. Now did the damage or injury occur? (Give details;use extra paper if required)
4. Whaf"pa� mss
Ro'lar act or osion on the part of couq or district officrs, servants, or em 1 yeeg
caused the injury or damage? (,c, o Kew ����•�� t ✓�1 r�r t U
5 What are the names of county or district officers,servants, or employees causing the
damage or injury? e\,� �
Z •d 989 'ON ONIAHMA KlN 00D. AVBI :8 808Z •6 Ur j
6, What damage or injuries do your claim resulted? (Give full extent of injuries or daniagesl
claimed. Attach two estimates for auto damage.) j ml `(p r D 11
1 CA Q. of VIA &1t' Lk)c-S
7. How was the amount claimed above computed? (Jaclude the estimated amomt ol ,anp
prospective injury or damage.) t -��� 4c�J� JW�-' to {?[,)
8. Names and addresses of witnesses, doctors, and hospitals: �J ov le j
i
9. List the expenditures you made on account of this accident or injury:
DATE TIME AMOUNT
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} .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
Name and address of Attorney I I
laimant's ignatt.�.re)
(Address) I i
Telephone No. ) Telephone No. U`- 4Z ._ S7—
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PUBLIC RECORDS NOTICE:
Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act,is het to
public disclosure under the California PubIie Records Act. (Gov. Code, 99 6500 et seq.) Fu-Ttb QQr i any
attachments.addendums, or supplements attached to the claim form, including medical records, are also sdbActto
public disclosure.
I; I.
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NOTICE:
Section 72 of the Penal Code provides: i'•
Every person who, with intent to defraud,presents for allowance or for payment to any state board or o i r, or
to any county, city, or district board or officer, authorized to allow or pay the same if genuine, any false of
fraudulent claim, bill, account voucher, or writing, is punishable either by imprisonment in the County 'for.1
period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000.00), or by b such
imprisonment and fine, or by iTmprisomnent in the state prison, by a fine of not exceeding ten tbousan bilary
($10,000), or by both such imprisonment and fine,
I'
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01/0'3/2008 at 04 :49 PM Job Number:
23399
REED'S BODY & FENDER WORKS, INC.
License #:BAR AK149717 Federal ID #: 680310094
REEDS BODY & FENDER WORKS, INC
479 East L Street
Bencia, CA 94510
(707) 745-0454 Fax: (707) 745-5243
PRELIMINARY ESTIMATE
Written By: Dave Moore
Adjuster:
Insured: JOSEPHINE FLANNERY Claim #
Owner: JOSEPHINE FLANNERY Policy #
Address: 900 SOUTHAMPTON RD #122 Deductible:
BENICIA, CA 94510 Date of Loss:
Day: (925) 957-5771 Type of Loss: Other
Evening: (707) 748-4257 Point of Impact:
Inspect REED'S BODY & FENDER WORKS, INC. Business: (707) 745-0454
Location: 479 East L Street
Bencia, CA 94510
Insurance
Company: Days to Repair
2002 TOYO CAMRY LE 4-2.4L-FI 4D SED 4Q2 Int:
VIN: JTDBE32K520046906 Lic: 4VUE222 CA Prod Date: 11/2001 Odometer: 54333
Condition: Good
Air Conditioning Rear Defogger Tilt Wheel
Cruise Control Intermittent Wipers Body Side Moldings
Dual Mirrors Console/Storage Roof Console
Clear Coat Paint Power Steering Power Brakes
Power Windows Power Locks Power Mirrors
AM Radio FM Radio Stereo
Cassette Search/Seek CD Player
Driver Air Bag Passenger Air Bag Cloth Seats
Bucket Seats 5 Speed Transmission Overdrive
Full Wheel Covers
-------------------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
-------------------------------------------------------------------------------
1 FRONT DOOR
N 2* Repl RT Mirror assy power w/o 1 191 .10 0.4 0.0
heater beige
-------------------------------------------------------------------------------
Subtotals =_> 191 .10 0.4 0.0
Line 2 : VERIFIED COLOR AVAILABLE PART # CORRECT AS PER VALLEJO TOYOTA
01-09-08 SPOKE TO RANDY
Parts 191 .10
Body Labor 0.4 hrs @ $ 86.00/hr 34 .40
----------------------------------------------------
SUBTOTAL $ 225.50
Sales Tax $ 191 .10 @ 7.37500 14 .09
----------------------------------------------------
GRAND TOTAL $ 239.59
ADJUSTMENTS:
Deductible 0.00
1
01/09/2008 at 04:49 PM Job Number:
23399
PRELIMINARY ESTIMATE
2002 TOYO CAMRY LE 4-2.4L-FI 4D SED 4Q2 Int:
----------------------------------------------------
CUSTOMER PAY $ 0.00
INSURANCE PAY $ 239.59
***************PART PRICES ARE SUBJECT TO INVOICE***************
AUTHORIZED AND ACCEPTED:YOU ARE HEREBY AUTHORIZED TO MAKE THE ABOVE SAID
REPAIRS. I\WE UNDERSTAND THAT PAYMENT IN FULL IS DUE UPON COMPLETION OF AND
RELEASE OF VEHICLE, UNLESS OTHERWISE STATED. I\WE AUTHORIZE YOU AND\OR YOUR
EMPLOYEES PERMISSION TO OPERATE SAID VEHICLE ON STREET OR HIGHWAYS FOR THE
PURPOSE OF TESTING, INSPECTION OR DELIVERY. AN EXPRESS MECHANICS LEIN IS HEREBY
ACKNOWLEDGED ON THE ABOVE VEHICLE TO SECURE THE AMOUNTOF REPAIRS THERETO. ALL
OLD PARTS ARE DISPOSED OF IN ACCORDANCETO LOCAL AND FEDERAL REGULATIONS UNLESS
OTHERWISE NOTED OF PRIORTO THE REPAIRS BEING STARTED.UNDER CALIFORNIA CODE OF
REGULATIONS
TITLE 10, CHAPTER 5, SUBCHAPTER 8, SECTION 2695.8.d.2.c YOU ARE
ADVISED THAT YOU HAVE THE RIGHT TO HAVE ANY REPAIR SHOP OF YOURCHOICE TO DO THE
REPAIRS TO YOUR VEHICLE. HOWEVER, YOUR INSURANCECOMPANY CAN REASONABLY ADJUST
ANY WRITTEN ESTIMATE PREPARED BY THESHOP OF YOUR CHOICE. REED'S BODY AND FENDER
WORKS, INC. WARRANTS
ALL REPAIRS FOR NO LESS THAN ONE YEAR, UNLESS OTHERWISE STATED.
DAMAGE REPORT AUTHORIZED
BY DATE
SUPPLEMENT AUTHORIZED
BY DATE AMOUNT
WORK ACCEPTED
BY DATE
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.
2
01/09/2008 at 04 :49 PM Job Number:
23399
PRELIMINARY ESTIMATE
2002 TOYO CAMRY LE 4-2.4L-FI 4D SED 4Q2 Int:
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from
the Guide ARM8521, CCC Data Date 12/01/2007, 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 2006 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.
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