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Home My WebLink AboutMINUTES - 02122008 - C.11 AMENDED CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTYe'll 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 NOTE: FIRST CLAIM WAS on your claim by the Board of JANUARY 09 , 2008rMection upervisors. (Paragraph IV below), iven Pursuant to Government Code AMOUNT: $3,215 . 00 , JAN 3 0 2008 913 and 915.4. Please note all "Warnings". COUNTY COUNSEL CLAIMANT: ANTHONY-BERNARD•N4l5NW1 41F DVE (ATTORNEY: UNKNOWN RECEIVED: JANUARY 30, 2008 ADDRESS: 2268 MINARET DRIVE, BY DELIVERY TO CLERK ON: JANUARY 30, 2008 MARTINEZ, CA. 49553 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, C r Dated: JANUARY 30, 2008 By: Deputy II. FROM: County Counsel T0: Clerk of the Board of Su ervisors ( 0his 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: n4CDeputy 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). (1V. 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. dr - Dated. AC"&OAYOHN CULLEN CLERK BV Deputy Clerk WARNING (Gov. 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 yr attorney,you should do so immediately. *For Additional Warnurg See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of per jury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that toddy 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 d' /.9 4Or'JOHN CULLEN, CLERK By Deputy Clerk BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. A claim relating to a cause of action for death or for injury to person or to personal property or growing 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. ■■rrrrrrrrrrerrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrArri RE: Claim By: Reserved for Clerk's filing stamp " n ) R E C lVED Against the County of Contra Costa or ) JAN 3 0 �UUO District) CLERK BOARD OF SUPERVISORS 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$ 32 LS _ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exac atei d hour) 1, me 0 7!6 L20JT-4c 2. Where did the damage or injury occur? (Include city and county) Q,gl-Yq Road by .5e11er5 3. How did the damage or injury occur? (Give full details; use extra paper if required) CoHr�q CoS'r4 She��- ' a�p4e-Y*rer7*1 Veti,c% Ite4f- ceded aur- 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? s►, �'�'1^ o-r'A ccr- Rear X)v6dO `r►y Vehicle 5 What are the names of county or district officers, servants, or employees causing the damage or injury? Dae 2/30225"701 MY Vehicle 4"1-ver R1c'Agrd Cra•foo? 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) g>✓4y. Court*er 12ane,I Gu ire,-Ae 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) JQ4) S C41wialet V61Kwe4gor1 8. Names and addresses of witnesses, doctors, and hospitals: `l Jnr 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT X31 ism., 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 ) (Claimant's Signature) 63 tzas T l)f-/'ye (Address) Telephone No. ) Telephone No. ...............0 0 a a 0 0 a a 2 0 a a a 0 a 0 0 a 0 0 0 0 a 0 a a 5 2 0 0 a 0 0 0 0 a 0 0 0 0 a a a a a 0 t.\.9..0 0 0..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. 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.