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Home My WebLink AboutMINUTES - 02122008 - C.11 (7) 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), given Pursuant to Govermment Code AMOUNT: $3,000.00 plus CAR RENTAL FEES Section 913 and 915.4. Please note all DCLALMANT: MICHAEL WALKER 5011a "Warnings". ATTORNEY: UNKNOWN JAN g TE RECEIVED: JANUARY 09, 2008 COUNTY COUNSEL ADDRESS: 13 ORINDA LANE MARTINVERY 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 09,21008 2008 JOHN CULLEN, r Dated: By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Su ervisors (,Y'fhis 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 warming of claimant's right to apply for leave to present a late claim (Section 911.3). O Other: Dated: By: rY) 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). 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. Dated:)C-6r' /.�.,�e�e6H�N CULLEN, CLERK, By Deputy Clerk WARNING ( ov. 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 covet 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 ani 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. DatedA94yA *r.k/3•&0e JOHN CULLEN, CLERK By Deputy Clerk BOARD OF SUPERVISORS OF CONTRA CdSTA COUNTY v 3(-1 -7�7 - INSTRUCTIONS TO CLARILN—L A claim relating to a cse of action for death or for injury to person or to persona] property or au growing crops shall be preean sentd not later thsix months after the accrual of the cause of 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 filed with the Clerk of the Board of Supervisors at its office in Room 106, Count),Administration Building, 651 Pine Street,Martinez,CA 945 53. If claim is against a district governed by the Board of Supervisors, rather than the CO 'Ys the :name of the District should be filled in. If the claim is against more than one public entty, 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.. !■E!!![[![!!!!!![!L KKR ■1!!![[■L G L[!L!!G[L!![[!t[E i G i C c L LLC[[![[■R■ [E[![[[![f[ [1 E: Claim By: Reserved for Clerk's filing stamp RECEIVD against the County of Contra Costa or ) JAN 0 9 cuuo District) CLERK BOARD Or SUPERVISORS e IlaIIle) ) CONTRA COSTA CO. I'he undersigned claielart hereby makes claim against+hp Cou--±Y of C'-n-ata Costa or the above-named 3istrict is the sum of$ r�eU� -�-VE ' �fofofr'`'S injury claim represents as MOVE: 1. When did the damage or ury o ur? (Give eaacf date and hour) �. vAV <�g )- 5-10 -7 2. Where did the damage or injury occur? (Include city and county) 3. How did the ae or ipiu occur? pive full details;use extra paper if required) 4. ghat Particular act or omission n the part o�coimty or 'rt ojcrs, servants, or aloytts caused the injury or damage? 5 What are the names of county or district off Cars, senlants, or employees causing the damage or injury? J 7 What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed: -Attach-two estumates for auto damage.) vAo��- How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage!) Names an addresses of witnesses, doctors, and hospitals: a. List the expenditures you made on account of this accjdent or injury: DATE TIRE AMOUNT 11 1 i C i 1 x 0 C C 1 i t 1 1 t t 1 i a I z i t a 1 R 1 1 t!i[■1 it 1 K i It 1 it 1 c 1 1 1 a f 9 I it 1 i l I It t l l 1 1 1 1 1 1 i t 1 1 1 1 1 C i t t 1 .C7ov. 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 ) (Claimant's Signature) (Address) Telephone No. ) Telephone NST </ i t t t 1 1 1 c l 1 1■t[1 1 awn ass MKS t ■ MERK t 1 c[1 t t 1 t■[1![RZKKKKNIKE 1 t 1 t 1 c a t 1 t c t[1 1 t t t 1 t t c 1 t 1 1 t t 1 I 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, s§ 6500 et seq.) Furthermore, any attachments,addendums, or supplements attached to the claim form, including medical records, are also subj ect to public disclosure. 1 1 an 1 all 1 1 1 1 1 1 t 1 l 1 1 1 1 1 i t t N Nil KKK t 1 l 1 1 1 1 1 t■i amt 1 t t 1 t t t t 1 1 t 1 1 1 1 1 t 1 1 1 l 1 1[l 1 1 am t/t 1 1 1 t I l I NOTICE: Section 71 of rhe Penal Code provides.- Every rovides.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 ar 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,DDON), or by both such imprisonment and nine, or by imm prisonent in the state prison; by a fine of not exceeding ten thousand dollars ($10,000), or by both such imprisonment and fine. Contra ' County Administrator Costa Risk Management Division 2530 Arnold Drive,Suite 140County Risk Management Administration (925)335-1400 Martinez,California 94553 Fax Number (925)335-1421 August 17, 2007`°""" cis>a Q Michael Walker (, t hl'fy a$jley 13 Orinda Lane ay ?�Or Pittsburg, CA 94565 Re: Claimant: Michael Walker Insured: Contra Costa County D/Accident: 08/15/2007 Claim No.: 63477 Dear Mr. Walker: 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. Sincerely, 06my Bailey Liability Claims Adjuster (925) 335-1442 ki"55 Enclosure