HomeMy WebLinkAboutMINUTES - 02262008 - C.2 CLAIM
` BOARD OF SUPERVISORS-OF CONTRA COSTA COUNTY
BOARD ACTION: FEBRUARY 26, 2008
Claim Against the County, oi- 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. )
DI you is your notice of the action taken
P9 '�: on- :your claim by the Board of
Supervisors. (Paragraph IV below);
JAN 16 2QQQ given Pursuant to Government Code
AMOUNT: $10,000.00 Section 913 and 915.4. Please note all
COUNTY COUNSEL "Warnings".
MARTINEZ CALIF.
CLAIMANT: WILLIE CHARLES BARNES
ATTORNEY: UNKNOWN DATE RECEIVED: JANUARY.16, 2008
ADDRESS: P.O. BOX 9295 BY DELIVERY TO CLERK ON: JANUARY 16, 2008
PITTSBURG,: CA 94565
BY MAIL POSTMARKED: HAND DELIVERED
FROM: Clerk of the Boai•d of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JANUARY 16, 2008 JOHN CULLEN, eh•c '.
Dated: By: Deputy
iI... FROM: County Counsel TO: Clerk of the Board of S er•visor-s
( his claim complies substantially with Sections 910.and 910.2.
( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we al-e so
notifying claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claire on ground that it was filed late and
send warning of claimant's right to apply for leave to present a late claim (Section.91 1.3).
( ) Other:
Dated: By: rn -'`' Deputy County Counsel
111. FROM: Clerk of the Board TO: County Counsel (l) County Administrator-(2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present: .
This Claim is rejected in full.
Other:
I certify that this is a true'and correct copy of the'Board's Order entered in its minutes for
this date.
IN
Dated: 2 JOHN CULLEN, CLERK, B eputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions,you have only six(6) montlhs fi-om the to is notice was personally served
or deposited in the nwil to file a court action on this claim.See Gover run nt Code Section 945.6.You may
seek the.adviee of an attorney of your choice in connection with this matter, I'f you want to consult an
attorney,you should do so immediately. *For Additional Warning See Reverse Side ofTlhis Notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that 1. 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 Inc(wn above,
Dated: 2 JOHN CULLEN, CLERK By Deputy Clerk
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLADVIANT
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.
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RE: Claim By: Reserved for Clerk's filing stamp
RECEIVED
Against the County of Contra Costa or ) JAN 1,E
aw
CLERK BOARD OF SUPERVISORS
District) CONTRA COSTA CO.
(Fill in the name) Y.
The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named
district in the sum of$ and in support of this claim represents as follows:
1. When did the damage or injury occur? (Give exact date and hour)
UB 1 L�= O'?
2. Where.did the damage or injury occur? (Include city and county)
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3. How did the damage or injury occur? (Give full details;use extra 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?
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What are the names of county or district officers,servants,or employees causing the
damage or injury? 2 �QZ
3LA
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6. 'Wzat da.:mage or injuries..do your claim resulted? (Give full extent of injuries or damages
claimed. Attach two estimates for auto damage.) �„�s.Zt.3 C-I:1
CG V,3CLo t-3 C.— Cis`— C 1, e_.c - n� �P 1 u;000.00
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
S. Names and addresses of witnesses, doctors,and hospitals:
'Torte a2
9. List the expenditures you made on account of this accident or injury:
DATE TWE 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 ) �' ✓��/�� �� __ ��
N I� ) (Claimant's Signature)
ix,
(Address) .
Telephone No. )Telephone No.
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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 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..
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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.
1
1 IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA
2 IN AND FOR THE -COUNTY OF CONTRA COSTA
3 HONORABLE CHERYL R. MILLS, .JUDGE, PRESIDING
. 4 ---000---
5 THE PEOPLE OF THE STATE OF )
py
6 CALIFORNIA., )
7 Plaintiff, )
8 vs. ) No. 154900-5
9 WILLIE CHARLES BARNES III, )
10 Defendant )
11 )
12 REPORTER' S TRANSCRIPT OF PROCEEDINGS
13 COURTHOUSE, PITTSBURG, CALIFORNIA
14 DEPARTMENT NO. 19
15 NOVEMBER 29, 2007
16 A P P E A R A N C E S
17
18 FOR THE PEOPLE:
19 ROBERT KOCHLY, DISTRICT ATTORNEY
20 BY: TERRI LEONI,
21 DEPUTY DISTRICT ATTORNEY
22 CONTRA COSTA COUNTY
23
24 FOR THE DEFENDANT:
25 DAVID COLEMAN, III, PUBLIC DEFENDER
26 BY: LAURA BURGARDT,
27 DEPUTY PUBLIC DEFENDER
28 CONTRA COSTA COUNTY
PATRICIA D. MALONE, C.S .R. NO. 7689
2
1 THURSDAY, -NOVEMBER 29, 2007 MORNING SESSION
2 P R O C E E D I N G S
3 ---000---
4 THE . COURT: People' vs . Barnes.
5 Docket 154900-5 .
6 Counsel .
7 MS . LEONI : Terri Leoni for the People.
8 MR. BURGARDT: Laura Burgardt for Mr. Barnes
9 who is present out of custody.
10 MS . LEONI : Just one second, your Honor. I 'm. .
11 still on Trotty.
12 The People filed a motion to continue in this
13' case.. We served defense counsel and have papers for the
14 Court . Actually, can we file that here with you or do
15we need to do it at the Clerk' s Office?
16 THE COURT: You can do it here.
17 MS . LEONI : It ' s based on the .unavailability
18 of the investigating officer, Officer Del Greco. He ' s
19 the primary investigating officer, observed the victim' s
20 injuries, obtained witness statements from the victim
21 from various other witnesses, from' the Defendant . He is
. 22 on a medical or stress-related leave and there ' s no
23 estimated date of return. I did talk to a few people in
24 the Pittsburg Police Department 'and our office and we 'd
25. like time -= additional time 'to investigate this.
26 Hopefully we can get a date of return or some further
27 information from the Officer' s doctor about when he ' ll
28 return, the extent of his injury. :That type of thing.
PATRICIA D. MALONE, C.S .R. NO. 7689
3
1 So we are requesting a brief continuance to investigate
2 this further.
3 THE COURT: Is there any objection?
4 MR. BURGARDT: Well, your Honor, can' t be any
5 good cause for continuance based on witness
6 unavailability without some sort of showing unless a
7 showing of that witness will be availability. What the
8 district attorney showed is he will be out indefinitely.
9 Absolutely no idea what --. when we might be
10 able to set this for trial at this point?
11 THE COURT: What_ I would intend to do is put
12 it for a trial date in our regular course which would be
. 13 . in February and if at that time you still- don' t know
14 what ' s. going on, then that obviously is a very important
15 argument to the Judge. There ' s only been trial setting
16 so far. I ' ll do one more.
17 MS . LEONI : Thank you, your Honor.
18 MR. BURGARDT: Your Honor, I will set it --.
19 we ' ll set it on limited time .waiver then. I 've had
20 previously experiences where -- where cases were
21 continued up to a year because an officer was off for a
22 year indefinitely.
23 THE COURT: Do you. want to put it to February
24. and if it doesn' t go. that day pull your time waiver
25 then?
26 MR. BURGARDT: No, I ' ll pull the time waiver
27 now and.-put it on .limited time waiver so if it doesn' t
28 go on the date in February, we ' ll have our date within
PATRICIA D. MALONE, C.S .R. NO. 7689
4
1 ten days .
2 THE COURT: That ' s what I was going to say
3 next .
4 MR. BURGARDT: Yeah.
5 THE COURT: With the ten day.
6 Okay, so limited time waiver to and I ' ll put
7 the date. :Plus ten days.
8 How about if we put it February 25th, 2000 --
9 Oh.
. 10 This is a Thursday, right? Sorry.
11 Put' it February 28th, 2008 at 8 : 30 .
12 Department 1.2 .
13 Defendant ordered to appear.
14 Readiness is February 20th at 8 : 30 . . .
15 Department 12 .
16 Defendant ordered to appear.
17 MR. BURGARDT: Your Honor, there was one --
18 maybe two other issues I wanted to briefly ask the Court
19 about .
20 THE COURT: Sure.
21 MR.. BURGARDT: One was I was not sure if the
22 stay-away order that was in place at one time, I believe
23 it was. changed to a good conduct . order. And I wanted to
24 confirm that had happened so I can inform Mr. Barnes.
25 THE COURT: Can I see your copy.
26 Judge. Fenstermacher signed an order but didn' t
27 check any boxes .
28 MR. BURGARDT: Yes, I have a copy of that .
PATRICIA D. MALONE, C.S .R. NO. 7689
5
1 THE COURT: Is that what you have, too?
2 MR. BURGARDT: Well, to me that indicates that
3 numbers 5, 6, 7 and 8 would apply and not 9 through 14 .
4 The way the boxes ate that have been checked.
5 THE COURT: I agree that if it ever came down
6 to looking at it, that' s what it means. . What I do is I
7 circle the boxes so -- I mean, the numbers so we make
8 sure the officers know if they pull it up.
9 So let ' s. issue a new one today and make it
10 clear so you don' t end up with a problem later on,
11 Mr. Barnes .
12 Do we have- an order there I can do? Then
13 we ' ll fill it out .
14 MS . LEONI : Your Honor, does it say why it was
15 changed to a good conduct order?
16 And I, request only if the victim was here to
17 change it to a good conduct order would we do that .
18 THE COURT: Well, the note says on August 17th
19 Judge Fenstermacher made it a peaceful conductat the
20 request of Ms. Strippen 1ph. ] hyphen Barnes.
21 MS . LEONI : Okay.
22 THE COURT: And that appears to be who it ' s in
23 favor of . She came to court .
24 MS . LEONI : All right, thank you.
25 THE COURT: Okay.
26 MR. BURGARDT: And the other issue I wanted to
27 address, I don' t know if you' re busy with that .
28 THE COURT: Just one second.
PATRICIA D. MALONE, C.S-.R. NO. 7689
6
1 (Brief pause. )
2 Okay, what next?
3 MR. BURGARDT: The other issue has to do with
4 bail . There seems to be something a little strange
5 going on here. Mr. Barnes posted bail and then was
6 re-arrested, and I 'm not sure if this is something to do
7 with it : I 'm seeing this case showing up twice in 'my
8 computer with the same docket number. I don't know if
9 that ' s creating confusion but after he was re-arrested
10 after posting the bond, he -- it was set -- initially
11 appears to be set at $100, 000 bail . . Then after
12 re-arrested for the same case, it says $25, 000 bail . I
13 don' t understand why the bail would have been increased
14 when it apparently was just an error.
15 THE COURT: If I were to guess, and we will
16 look, it appears that Judge Fenstermacher on August 17th
17 when she arraigned him set bail at 25, 000. Someone .
18 probably did not tell her that bail had already been
19 posted at 100, 000 on August 14th. With the short
20 turn-around, the paperwork would not have been in the
21 file.
. 22 So what I 'm going to do, Ms. McCause, will you
23 make sure you check the paperwork to make sure I 'm not
24 making an error, what I would do is I would exonerate
25 the $100, 000 bond, leave the $25, 000 bond in place.
26 Both are here in my file but exonerate the one, keep the
27 25 there and you' re out on 25, 000 .
28 Unless something comes up when they' re
-PATRICIA D. MALONE, C.S .R. NO. 7689
7
1 checking the paperwork here, that will be the order. If
2 I did something wrong, we ' ll call your case back up
3 again.
4 (Whereupon, the proceedings were concluded. )
5 ---000---
6
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PATRICIA D. MALONE, C.S .R. NO. 7689
8
1 CERTIFICATE
2
3 STATE OF CALIFORNIA )
4 ) ss .
5 COUNTY OF CONTRA COSTA )
6
7 I, PATRICIA D. MALONE, Official Court Reporter
8 of the Superior Court of the State of California, County
9 of Contra Costa, do hereby certify that the foregoing
10 pages above my .printed name contain a full, true and
11 correct transcription of my stenotype notes of the
12 proceedings had in said Court of the cause entitled
13 "People vs. Willie Charles Barnes III. ° Case was
14 numbered 154900-5 in the files of criminal actions of
15 said Court; and that said transcript includes all
16 rulings, acts or statements of the Court, also all
17 motions, objections or exceptions of counsel, and all
18 matter to which the same relate.
19 IN WITNESS WHEREOF, I have hereunto set my
20 hand this 9th day of January, 2008 .
21
22
23
24
25 PATRICIA MALONE, C.S.R. #7689
26
27 PATRICIA D. MALONE, CSR #7689
Official Court Reporter
28
PATRICIA D. MALONE, C.S .R. NO. 7689
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: FEBRUARY 26, 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 Government Code
AM.OU.NT: $750,000.00 Section 913 and 915.4. Please note all
"Warnings".
CLAIMANT: BRIAN HAYDEN HARRIS
ATTORNEY: STAN LEVENTHAL DATE RECEIVED: JANUARY 17, 2008
ADDRESS: 1912 NORTH BROADWAY BY DELIVERY TO CLERK ON: JANUARY 17, 2008
SUITE-210
SANTA ANA, CA 92706 RECEIVED THROUGH
BY MAIL POSTMARKED: TNTER=OFFICE MAIL
FROM: Clerk of the Boai•d of Super•visoi•s TO: County Counsel
Attached is a copy of the above-noted claim.
JANUARY 17, 2008 JOHN CULLEN,.Ci
Dated: By: Deputy .
I.I.. FROM.: County Counsel TO: Clerk of the Board of Sup rvisors
( ) This 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 claire 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 911.3).
IV. BOARD ORDER: By unanimous vote of tine Supervisors present: .
This Claim is rejected in full.
( ) Other:
I certify that.this is a true and correct copy of the'Board's Order entered in its minutes for
this date.
Dated: 0 JOHN CULLEN, CLERK, y ty Clerk
W A RN ING'(GW code section 913)
Subject to certain exceptions,you have only six(6) months firm the we this notice was personally served
or deposited in the nuril to file a court actiar on this claim.See Government Code Section 945.6.You may
seek the ptivice of'an attorney of your choice in connection with this matter. Ifyou want to consult an
attorney,you should do so imniediately. *For Additiaral Warning See Reverse Side ofTlris Notice.
AFFIDAVIT OF MAILING
I declare under penalty of per jury that f. 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 clainlan as town above.
Dated: 0- O JOHN CULLEN, CLERK y puty Clerk
-AW-1
1 SCHAPIRO & LEVENTHAL
A Professional Law Corporation ���
2 1912 N. Broadway, #210
Santa Ana, CA 92706 ®�
3 (714) 835-7800 c JAN j
FAX: (714) 835-0830 �F9ke0
4 Stan Leventhal Bar No. 103342 co�TRgCoS��pFq��s
5
6 Attorneys for Claimant, Brian Hayden Harris
7
SUPERIOR COURT OF THE STATE OF CALIFORNIA
8
COUNTY OF CONTRA COSTA
9
10 Claim of Brian Hayden Harris )
)
11 )
12 vs. )
CLAIM FOR PERSONAI NJURY
13 AVSD
14 Contra Costa County }
17 2008
15 ) ___
CLERK '•.1D OF SUPERVISORS
16 TO THE COUNTY OF CONTRA COSTA: C ?: PACOSTAco.
17 You are hereby notified that Brian Hayden Harris, whose address is 1340 Morningside
18 Way, Venice, California, claims damages from the County of Contra Costa in the amount,
19 computed as of the date of presentation of this claim, of$ 750,000.
20 1 This claim is based on personal injuries sustained by claimant on or about July
21 11,2007, in the vicinity of Sellers Avenue, in the City of Oakley in the County of Contra Costa
22 under the following circumstances: The claim is based.upon the negligence of the County of
23 Contra Costa and its employees and agents. Specifically the area along 5400 Sellers
24 Avenue in Oakley, California constitutes a dangerous condition of public property.
25 Specifically the roadway is improperly lined, the speed limit is inadequate, there are visual
26 obstructions along the roadway. As a result of the dangerous condition of Sellers Avenue, a
27 collision took place between Brian Harris and Cerario Aredin causing serious and permanent
28 injuries to Mr. Harris.
1
CLAIM FOR PERSONAL INJURIES
I The name of the public employee causing claimant's injuries under the described
2 circumstances is the County of Contra Costa.
3 The injuries sustained''by claimant, as far as known, as the date of presentation of this
4 claim, consist of a fracture of the right distal tibia and fibula.
5
6 The amount claimed , as of the date of pi,esentation of this claim, is computed as
7 follows:
8 Damages for medical and hospital care $ 59,974.45
9 Loss of earnings $ 10,000.00
10 General damages $ 680,000.00
11 Total.damages incurred to date $ 750,000.00 .
12
13 Estimated prospective damages as far as known
14 Future expenses for medical and hospital care $ Unknown at this time
15 Future loss of earnings $ Unknown at this time
16 Other prospective special damages $ Unknown at this time
17 Prospective general.damages $ Unknown at this time
18 Total estimated prospective damages Unknown at this time
19
20 Total amount claimed as of date presentation of this claim $ 750,000.00
21. All notices or other communications with regard to this claim should be sent to claimant at
22 1912 N. Broadway Suite 210, Santa Ana, CA 92706
23
24 Dated: January 9, 2008
25
26
ANLEVENTHAL
27 Attorney for Claimant
28
2
CLAIM FOR PERSONAL INJURIES
Schapiro o Le`-enthc-ll
A Professional Law Corporation RECEIVED
1912 North Broadway JAN 1 '7 2008
(Suite '210
(Santa Ma, California 92706
CLERKBOARD CONTRAO �SORS COSTA CO!
(714) 835-7800 • F (714) 835-0830
&even L. 6chapiro
Stan Leventhal
January 9, 2008
Clerk of the Court
Superior Court of California, Contra Costa
725 Court Street
Martinez, CA 94612
Re: Harris v. Contra Costa County
Dear Clerk of the Court.
Enclosed is an original and one copy of the Claim for Personal Injury. Please file and
conform and return a conformed copy to our office in the envelope provided.
Thank you for your courtesy and cooperation.
Sincerely,
SCHAPIRO & LEVENTHAL
A Professional Law Corporation
*SANi�LEVENTH`AL
SL/tme
Enclosure
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CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: FEBRUARY 26, 2008
Claim Against the County, or District Governed by )
the Board of Super'visor's, Routing Endorsements, ) NOTICE TO CLAIMANT
and Board Action. All Section refer a � ! The copy of this document mailed to
California Government Codes. you is your notice of the action taken
JAN 1 7 2008 on your claim.by the Board of
Supervisors. (Paragraph IV below);
COUNTY COUNSEL given Pursuant to Government Code
AMOUNT: OVER $25:;:000.00 MARTINEZ CALIF. Section 913 and 915.4. Please note all
"Warnings".
CLAIMANT: TERRIE KENT
ATTORNEY: LAWRENCE W. FASANO, JR. DATE RECEIVED: JANUARY 17, 2008
ADDRESS: . FASANO LAW OFFICE VERY TO CLERK ON: JANUARY 17, 2008
720 MARKET STREET, PENTHOUgE},A4,
SAN FRANCISCO, CA 94102
BY MAIL POSTMARKED: JANUARY 16, 2008
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN CULLEN, C k
Dated: JANUARY 17,;i,.2008 By: Deputy_
It. FROM.: County Counsel TO: Clerk of the Board of Supervisors
(L4-fliis 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).(t�Clarm is not timely filed. T
(�Other: `'he Clai i--n i,5rOOC4,N`l > OGe--U/— ir?el Dr► b� �
`7 &l0 7. . i aCG r ��/iry 0 u i�-ei
aC_114,14"_,. 61,179-e-I
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).
IV. . BOARD ORDER: By unanimous vote of the Supervisors present: .
This Claim is rejected in full.
.Other
I certify that this is a true and correct copy of the'Board's Order entered in its minutes for
this date.
Dated: 6 O JOHN CULLEN, CLERK, BYC16 eputy Clerk
WARNING kGov. code section 913)
Subject to certain exceptions,you have only six(6) months ficin the dto 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 nray
seek the advice of an attorney of your choice in connection widr this matter. Ifyou want to consult an
attorney,you should do so inpnedlately. *For Additional Warning See Reverse Side of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty of Pei jury that 1.. am now, and at all times herein mentioned, have
been a citizen of the United States, over age 18; and that today I deposited ill the United
States Postal Service in Martinez, California, postage frilly prepaid a certified copy of this
Board Order and Notice to Claimant, addressed to the claimant as own above.
Dated: JOHN CULLEN, CLERK y D uty Clerk
FASANO Lawrence W. Fasano, Jr.
Attorney at Law
720 Market Street,Penthouse Suite
San Francisco,Califomia 94102-2500
tel(415)956-8800■fax(415)956-8811
TAN
EIVED
January 14, 2008 1 7 2008
Via Certified Mail- Return Receipt Requested c�ERKeoNTR OF sTA co Isoas
Clerk of the Board of Supervisors of Contra Costa County
Board of Supervisors Office, Room 106
County Administration Building
651 Pine Street
Martinez, CA 94553
Re: Kent, Terrie Claim Form
Dear Sir/Madam:
Enclosed please find an original and two copies of a Claims For Damages Form. Please file the
original and return the endorsed file copy(s) in the envelope provided for the convenience of the
court.
Should there be any problems regarding this filing, please do not hesitate to contact our office.
Thank you.
Very truly yours,
Y
W FFICE_Tate
Assistant to Lawrence W. Fasano, Jr.
/lyt
Enclosures
SAClient Data\Kent,Terrie\Comm clerk 1.7.8.wpd
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.
■■rrrrrrrrrrrrrrrr�r■■rrrrrirrrSrrrrrrrrrrrrrrrrrrrrrrrrrrrrr'rrrrrrrrrrrrrrrrrrrrrrr■
RC: Claim By: Reserved for Clerk's filing stamp
Terrie Kent '. _) RECEIVED)
Against the County of Contra Costa or ) JAN 1 7 2008
Department of Mental Health District)
(Fill in the name) ) CLERK BOARD OF SUPERVISORS
CON,RA COSTA CO.
Contra Costa County Health Services Department _)
The undersigned claimant hereby makes.claim against the County of Contra Costa or the above-named district
in the sum of$over 25,000 and in support of this claim represents as follows:
1. When did the damage or injury occur?(Give exact date and hour)
February 2006-October 2007
2. Where did the damage or injury occur?(Include city and county)
See Attachments"A"+"B"
3. How did the damage or injury occur?(Give Full details; use extra paper if required)
See Attachments "A"+"B"
4. What particular act or omission on the part of county or district officers,servants,or employees
caused the injury or damage:
Negligent supervision,breach of contract, intentional misconduct, hostile work environment;
discrimination, retaliation and other violations of state laws. See Attachments"A"+"B"
5. What are the names of county or district officers,servants,or.employee causing the damage or
injury? .
Donna Wigand, Mental Health Director;Victor Montoya, Adult/Older Program Chief;
Ednah B. Fiedman, Program Manager; Albert Flanagan , Probate Supervisor and Debra Tyler,
Co-Worker. See Attachments"A"
6. What damage or injuries do your claim resulted?(Give full extent of injuries or damages claimed.
Attach two estimates for auto damage.)
Loss of earnings over$25,000,general damages, loss of benefits,and retirement.
7. How was the amount claimed above computed?.(include the estimated amount of any prospective
injury or damage.)
Loss of monthly savings to date alone is an excess of$60,000.
8. Names and addresses of witnesses,doctors,and hospitals:
All of claimants treatment was at Kaiser, Vallejo
9. List the expenditures you made on account of this accident or injury:
I have incurred wage loss to date of over$60;000,which do not include future wage loss and
benefits. .
)Gov. Code Sec. 910.2 provides"The Claim shall be
)signed by the clai erson on his
behalf."
SEND NOTICES TO: (Attorney) I )
Name and address of Attorney )
Lawrence W. Fasano Jr.,(SB# 80017)' )
FASANO LAW OFFICE ) Cla s ignature)
720 Market Street, Penthouse Suite )
San Francisco,California 94:102 -2500 )c/o Fasano Law Office, San Francisco,CA. 94102
(Address)
Telephone No. X4151956-8800. ) Telephone No._(415) 956-8800
Facsimile No. (415) 956--881,1 .
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PUBLIC RECORDS NOTICE:
Please be advised that this claim form,or ay 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.
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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
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,
Terrie Kent's Attachment to Claim Form
Lawrence W. Fasano, Jr: (SB 480017)
FASANO LAW OFFICE
720 Market Stree, Penthouse Suite
San Francisco' California 94102 ''2500
Telephone: (415) 956-8800
Facsimile: (415).956-8811
Attorneys for Claimant:
Terrie Kent
Attachment "A"
Right to Sue letter, Claim W. DFER, Notice to Claimant
_ • U.S. Departs* ,)af Justice
Civil Rights Division {
NOTICE OF RIGHT TO SUE
WITkIIN 90 DAYS
CERTIFIED MAIL 950 Penn.Fyh an(n n venue,N.W
5069 2469 .Koren P"ergo con,EMP,PMN,Room 4239
P11V1J nf;torr,DCIOS30
M9. Terrie L. Kent November 20, 2007-
P.O.
007P.O. Box 20255
El 8obran.te, CA, 94820.
Re: EEOC Charge Against Contra, Costa County
No. 555200800096
Dear Ms . Kent
Because you filed the above charge with the Equal, Employment
Opportunity Commission, and the Commission has determined that it
will not be able to investigate and conciliate that charge within
180 days of the date the Commission_ assumed jurisdiction over the
charge a.nd. t-he Department has determined - that it will not file any
lawsuit (s) based thereon within, that time, and because you have
specifically requested this Notice, you are- hereby notified that you
have the right to institute a ci.vil action under Title VII of the
Civil Rights Act of 1964 , as amended, 42 U.S . C. 2000e, et seq. ,
against the above-named respondent .
If you choose to commence a civil action, such suit must be
filed in the appropriate Court within 90 days of your receipt of
this Notice. If you cannot afford or are unable to retain an
attorney to represent you, the Court may, at its discretion, assist-
you in obtaining an attorney. If you plan to ask the Court to help
you find an attorney, you must make this request of the Court in the
form and manner it requires . Your request to the Court should be
made well before the end of the time period mentioned above . A
request for representa.tiozz does not relieve you of the obligation to
file suit within ' thi.s 90-day period.
This Novice should not be taken to mean that the Department of
Justice has made a judgment as to whether or not your case is
meritorious .
Sincerely,
Rena J. Comisac
Acting Assistant Attorney General
Ci.vi. Rights Division
by ��-- 6y
Karen. L. Ferguson
Supervisory Civil Rights Analyst
Employment Litigation Section
cc: oa.)cland Local Office, EEOC
Contra. Costa county
**** U.S. EQUAL EMPLOYMENT OPPORTUNITY COMMISSION****
CHECKLIST DATA INOFRMATION REQUIRED TO PROCESS
A NOTICE OF RIGHT TO SUE
Attn: Joyce A. Hendy,Director
Please note i,6ou request a Notice of Right to sue, no investigation will be done.
1) LETTER REQUESTING (NRTS)
Ina letter requesting for a Notice of Right to Sue, please include the following:
(Please state that you are requesting for a Notice of Right to Sue)
A) CHARGING PARTY(NAME) Terrie Kent
Job Title:Mental Health Treatment Specialist II/Deputy Public Guardian
Status: On Leave of Absence/Disability
Race: African American
Sex: Female
Age: 46
National Origin: African American
Address: c/o Fasano Law Office 720 Market St., 10th Floor
City: San Francisco
State: CA.
Zip Code: 94102
Day Phone Number: (5 10) 367-3179
Evening Phone Number: (510) 707-422-7072
Date of Birth: 8/22/61
Supervisor's name and job.title Al Flanagan. Conservatorship Program Supervisor
CONTACT PERSON
-Name &address of a person to contact when you cannot be reached. Give complete
Name:Fasano Law Office
Address.. 720 Market St., I& Floor
City: San Francisco
State: CA.
Zip Code: 94102
Day Phone Number: (415)956-8800
2) RESPONDENT INFORMATION
Name of Company: Contra Costa County
(Or where you applied)
ISR Director/CEO: Lori Gentles,Director Human Resources
Address: 651 Pine Street, 3rd Floor
City:Martinez.
State: CA.
Zip Code: 94553-1262
Day Phone Number: (925) 335-1766 for Lori Gentles
(Include both facility where person worked and address where charge to be served)
Name of Company: Public Employees Union. Local One
(Or where you applied)
HR Director/CEO: Bill Schlant-Senior Business Agent
HR/Director/CEO: Rollie Katz- Supervising Business Agent
Address: P.O. Box 6783
City: Concord
State: CA.
Zip Code: 94524-1783
Day Phone Number: (925) 228-1600
CORPORATE OFFICE:N/A Government Position
HR Director/CEO: Lori Gentles, Human Resources
Address: 651 Pine Street, 3`d Floor
City: Martinez
State: CA.
Zip Code: 94553-1292
Day Phone Number: (925) 335-1766
Number of employee's working for the company(approximate)
15-100 employees
100-200 employees_
200-300 employees_
300-500 emplovees
500 plus employees X
What is the nature of the business, manufacturing, trucking,warehousing, painting etc...
Public Services, Health Department
NOTICE: Should you fail to include any of the above information, your Notice of Right to Sue
cannot be processed. Please include a day time phone number where you can be reached for
additional information.
3) STATEMENT
On a separate piece of paper,provide a statement of particulars including date of Key event
(application, training, denial of promotion, layoff, discharge). See attached
Please indicate in your statement if your employment rights have been violated because of your
race, color, sex, religion,national origin, age, disability or because of retaliation.
(This statement must be signed and dated under penalty of perjury).
EEOC CHARGE # 555-2008-00096
I declare under penalty of periurX that the above statements are true and correct.
Terrie Kent
Date Signature
A Charge Statement is not necessary if you have provided the Commission with a copy of you]-
Department
ourDepartment of Fair Employment and Housing (Complaint of Discrimination). This Complaint
of Discrimination must be resigned and dated. We need original
TERRIE KENT RECEIVEDP.O. Box 20255
El Sobrante, CA. 94820 OCT 2 9 ZOO7
Cell (510) 367-3179
10/02/2007 EEOC - OLO
I have been on a leave of absence(LOA) since 04/09/2007 to present due to Contra Costa Colony
and Local 1 failing to resolve a grievance filed by myself and other colleagues. The work
environment continues to be hostile, intimidating, unsafe and dangerous, and the union
discrimination against me refusing to process my grievance.Mygrievance is ongoing and the
discrimination against me continues to be demonstrated by the company's refusal to provide a
safe work environment free of harassment by a non African American co-worker, and the union
is refusing to process my grievance.
As a result of my continued pursuit to eliminate discrimination,harassment and retaliation in the
work place, I have been singled out and maliciously persecuted by management.Local 1 has
failed to provide fair and adequate representation not only for myself but other colleagues; who
have also felt the ferocious stings of management/union inadequacies to address the hostile
circumstances which continue in the work place. The following explain the chain of events that
have culminated and prevented my safe return.
A) On 02/26/2007 a group grievance was.filed against management for failing to provide
an environment that is free of disruption, hostile,provocative, disrespectful, verbal abuse
and unpredictable explosive behavior displayed by one individual in the work place.
B) Since the filing of grievance this individual's behavior has considerably escalated to a
point of fear for my personal safety and the safety of others.
C) On 03/08/2007 I was informed by my supervisor that it had been alleged by a
colleague that I had misrepresented the truth. (This is the same colleague that is
continually causing fear, chaos and disruption in the workplace). This allegation led to an
investigation by management.
D) As a result of the'investigation on 03/21/2007 management implemented a
e
EEOC CHARGE ## 555-2008-00096
Professional
Development Action Plan for all employees. The plan focuses on improving professional
interpersonal relationships. The plan does not address the real issues which are this
persons unpredictable, provocative, hostile, non-directable behavior.
E) On 07/11/2007 For the step three grievance process, Local 1 met with myself and
another colleague and three management representatives to discuss and present our
concerns.
F) On 07/20/2007 Management presented their decision for the step three grievance
process which they denied any violation of the Memorandum of Understanding (MOU).
G) On 08/08/2007 The union quoted a violation in compliance with the (NIOU) section
25. Therefore,requesting to proceeding to step 4 grievance process.
H) Management continues to refuse to discipline or otherwise curtail the harassment of
me by a non-African American female.
I)I am unable as a result of the action of my union and the company to secure a step 4
grievance hearing.
I declare under penalty that the above statements are true and correct.
Dated: October 2007
RECEIVED
Te ent
OCT 2 9 2007
EEOC - OLO
Attachment "B"
The county was negligent in it hiring, supervision and retention of Debra Tyler; failing to
correct a hostile work environment, breach-of contract; and discrimination. Claimant
.complained to her supervisors about the work environment created by D. Tyler and did not
receive a resolution which allowed her to return to work, and defendant is expected to
tenninate claimants employment.
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OFFICE OF THE COUNTY COUNSEL �� � SILVANO B. MARCHESI
COUNTY OF CONTRA COSTA -_ _' -v-
COUNTY COUNSEL
Administration Building
'..
651 Pine Street, 91h Floor -'�" `�`,• SHARON L. ANDERSON
Martinez, California 94553-1229
•',I° = " CHIEF ASSISTANT
GREGORY�
(925)335-1800
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HARVEY
(925)>W-1:078 EIOXJ... - _ VALE
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.' ASSISTANTS
NOTICE OF UNTIMELINESS
AS TO A PORTION OF THE CLAIM
TO: Lawrence W. Fasano, Jr.
Fasano Law Office
720 Market Street, Penthouse Suite
San Francisco, CA 94102
RE: CLAIM OF: Terrie Kent
Please Take Notice as Follows:
In regards to the claim you submitted on January 16, 2008, on behalf of Terne Kent, portions of
the claim are timely and portions are untimely. The portions of the claim prior to July 16, 2007 that you
presented against the County of Contra Costa governed by the Board of Supervisors fail to comply
substantially with the requirements of California Government Code Sections 901 and 911.2, because they
were not presented within six months after the event or occurrence as provided by law. Because the
portions of the claim prior to July 16, 2007 were not presented within the time allowed by law, no action
was taken on those portions of your claim. The claim was forwarded to the Board for action only on the
timely portions of the claims.
The only recourse at this time is to apply without delay to the County of Contra Costa governed by
the Board of Supervisors for leave to present a late claim as to the elaims which are untimely. (See Gov.
Code, §§ 911.4 to 912.2, inclusive, and 946.6.) Under some circumstances, leave to present a late claim
will be granted. (See Gov. Code, § 911.6.)
SILVANO B. MARCHESI
COUNTY COUNSEL
By: / /'C''l �
Monika L:Cooper Y
Deputy County Counsel
Page 1
CERTIFICATE OF SERVICE BY MAIL
(Code Civ. Proc., §§ 1012, 1013a, 2015.5; Evid. Code, §§ 641, 664)
I am a resident of.the State of California, over the age of eighteen years, and not a party to the within action. My
business address is Office of the County Counsel, 651 Pine Street, 9th Floor, Martinez, CA 94553-1229. On
5 O , I served a true copy of this Notice of Untimeliness as to a Portion of the Claim by placing
the document in a sealed envelope with postage thereon fully prepaid, in the United States mail at Martinez,
California addressed to Lawrence W. Fasano, Jr., Fasano Law Office, 720 Market Street, Penthouse Suite, San
Francisco, CA 94102, as set forth above. .1 am readily familiar with Office of County Counsel's practice of
collection and processing of correspondence for mailing. Under that practice, it would be deposited with the U.S.
Postal Service on that same day with postage thereon fully prepaid in the ordinary course of business.
I declare under penalty of perjury under the laws of the State of California and the United States of America that
the above is true and correct. Executed on�`" 3� D"F ...at Martinez, California.
Itathleen O'Connell
cc: Clerk of the Board of Supervisors (original)
Risk Management
Page
• d
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: rej)
Claim Against the County, or District Governed by )
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
and Board Action, All Section ref e The copy of this document mailed to
California Government Codes. D �� you is your notice of the action taken
JAN 1 72008 on your claim by the Board of
Supervisors. (Paragraph IV below);
COUNTY OOUNSEL given Pursuant to Government Code
AMOUNT: , " MARTINEZ CALIF. Section 913 and 915.4. Please note all
"Warnings".
CLAIMANT: p,q1 -(J � Qn
ATTORNEY: DATE RECEIVED: J, l 2_00
ADDRESS: 41 . YV`k(;kU__ &k_1 BY DELIVERY TO CLERK ON:-3041 .(3rX[1:Z4
BY MAIL POSTMARKED: Gt/
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claire.
r JOHN CUL ,,Clerk G
Date ( 1/ 2 By: Deputy
H. FROM.: Count/Counsel TO: Clerk of the Board of Supervisors
( ) liis 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.caimot act for 15 days (Section 910.8).
( ) Claim is not tirnely 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).
O Other:
Dated: By: Deputy County Counsel
iII. FROM:: Clerk of the Board TO: County Counsel (]) County Administrator(;)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present: .
This Claim is rejected in full.
Other:
I certify that this is a true and correct copy of the'Board's Order entered,in its minutes for
this date.
Dated: &I I ® JOHN CULLEN, CLERK,'B eputy Clerk
WARNING Gov. code section 913)
Subject to certain exceptions,you have only six(6) months fi-oin the da a 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. ff you want to consult an
attorney,you should do so immediately. *For Additional Warning See Reverse Side of This Notice.
AFFIDAV[T OF MAILING
I declare under penalty of perjury that 1. am now, and at all times herein mentioned, have
been a citizen of the United States, over age 1.8; 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 clairnan., as sh above.
Dated. JOHN CULLEN, CLERK By Deputy Clerk
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT T��
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
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.
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RE: Claim By: Reserved for Clerk's filing stamp
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Against the County of Contra Costa or ) !1rJ
[: �
District) CLERK BOARD Oi. z: :=;=i!V(SORS
(Fill in the name) ) CONTRA C;
The undersigned claimant hereby Lakes claim against the County of Contra Costa or the above-named
district in the sum of$ and in support of this claim represents as follows:
1. When did the damage or injury occur? (Give exact date and hour)
2,j 31v`7 \o
2. Where did the damage or injury occur? (Include city and county)
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3. How did the damage injury occur? (Give full details; use ex-tra paper1i rewired)
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4. 'Ahat particular act or omission on the part of ci�unty or district officers, servants, or employees
caused the injury or damage? t
5 What are the name of coup or district officers, servants or employees causing the
county
damage or injury?
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6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages
claimed. Attach two((estimates for auto damage.)
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7. Hove was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.) 1 �� �� �� �,� ,2pc�Y s���P
8. Names and addresses of witnesses, doctors, aid hospitals:
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9. List the expenditures you made on account of this accident or injury:
DATE TD\4E AMOUNT
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) .Gov. Code Sec. 2 rovides"The claim shall be
) sign - ,the claimant orbV some person on his
be
SEND NOTICES TO: (Attornev) )
Name and address of Attorney )
(Claimant's Signature)
(Address)
Telephone No. ) Telephone No. �Z-S
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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 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.
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NOTICE:
Section. 72 of the Penal Code provides:
Eveq 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 ,,Aziting, 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.
• ♦ 'y
Contra Cheryl Marchion
Costa Recycle/Surplus Lead w
County (925)646-4322
(925)646-4036 Fax
(925)383-5403 Cell
General Services Department
220 Glacier Drive
Martinez,CA 94553-4826
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12/14/2007 at 01 : 38 PM Job Number:
97164
ADVANCE AUTO BODY, INC.
License # :BAR AC171433 Federal ID # : 680280418
917 Howe Rd
Martinez, CA 94553
(925) 370-7789 Fax: (925) 228-0588
PRELIMINARY ESTIMATE
Written By: MARK LINDEN
Adjuster:
Insured: PAULA .LORENTZEN Claim #
Owner: PAULA LORENTZEN Policy #
Address: Deductible:
Date of Loss:
Day: Type of Loss:
Evening: Point of Impact:
Inspect
Location:
C
Insurance
Company: Days to Repair
1997 FORD THUNDERBIRD LX 6-3 . 8L-FI 2D CPE Int:
VIN: Lic: Prod Date: Odometer:
Air Conditioning Tilt Wheel Cruise Control
Intermittent Wipers Tinted Glass Dual Mirrors
Console/Storage Clear Coat Paint Power Steering
Power Brakes Power Windows Power Locks
Power .Mirrors Power Trunk/Tailgate AM Radio
FM Radio Stereo Cassette
Driver Air Bag Passenger Air Bag Cloth Seats
Bucket Seats Automatic Transmission Overdrive
Full Wheel Covers
-------------------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
---------------------7---------------------------------------------------------
1 DOOR
2* Repl LT Mirror electric control 1 185. 00 0 . 3 0 . 5
w/o bright molding
3 Add for Clear Coat 0 . 1
4* R&I LT Door trim panel cloth 0 . 9
-------------------------------------------------------------------------------
Subtotals =_> 185. 00 1 .2 0 . 6
1
1'2/14/2007 at 01 : 38 PM Job Number :
97"161
PRELIMINARY ESTIMATE
1997 FORD 'THUNDERBIRD LX 6-3 . 8L-FI. 2D CPE Int:
Parts 1.85 . 00
Body Labor 1 . 2 hrs @ $ 75 . 00/hr 90 . 00
Paint Labor 0 . 6 hrs @ $ 75 . 00/hr95 . 00
Paint Supplies 0 . 6 hrs @ $ 30 . 00/hr 18 . 00
----------------------------------------------------
SUBTOTAL $ 338 . 00
Sales Tax $ 203 . 00 @ 8 . 2500`. 16 . 75
----------------------------------------------------
GRAND TOTAL $ 354 . 75
ADJUSTMENTS':
Deductible 0 ..00
----------------------------------------------------
CUSTOMER PAY $ 0 . 00
INSURANCE PAY $ 354 .75
I authorize Advance Auto Body Inc. to perform the needed repairs to my vehicle .
Repairs include parts, labor, and diagnosis . The ' above estimate is based on our
inspection and does not , cover additional parts or labor which may be required
after the work has started. -Worn or damage parts, not evident on first
inspection, may be discovered and you will be contacted for authorization for
additional work.
Parts prices are subject to change without notice.
ACKNOWLEDGEMENT: I have- read and understand the above estimate and authorize
repair service to be performed, including sublet work and acknowledge receipt
of this estimate. An express -mechanics lien is hereby acknowledged on the above
vehicle to secure . the amount of repairs completed.
This Estimate Authorized. By:
Signed: Date:
Work Accepted By:
Signed: Date :
POWER OF ATTORNEY: I do hereby appoint the aforementioned business as my
attorney in fact to accept on my behalf any and all checks, drafts, or bills of
exchange for deposit to the aforementioned business ' account for credit on my
account for repairs on- my vehicle which had been released and accepted.
Signed:__ ___ Date: .
a a
2
CLAiM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: ,e 2�
Claim Against the County, or District Governed by )
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
and Board Action, All Section references ar e to The copy of this document mailed to
California Government Codes. D you is your notice of the action taken
on your claim by the Board of
JAN 17 2008 Supervisors. (Paragraph IV below),
given Pursuant to Government Code
COUNTY COUNSEL Section 913 and 915.4. Please note all
AMOUNT: URKY 00f) MARTINEZ CALIF.
"Warnings' .
CLAIMANT: �� -1�-� 'lam OM3
ATTORNEY: = �- �7 2
usao 4," ( (,()(;tj DATE RECEIVED:ED: G u
ADDRESS. iwaaeh, OW. BY DELIVERY TO CLERK ON:�mckaj 17. 2X
3mi t.,t KL e BY MAIL POSTMARKED:
Ro�ew(ae; CA-: q5W '
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN CULN,�CIerk- ,
Dated: �� f ��� By: Deputyt,71 1.IPhQ�11.�
II. FROM.: Coun Counsel TO: Clerk of the Board of Supervisors
(L,)//This claim complies.substantially with Sections 910 and 910.2.
This Claim FAILS to comply substantially with Sections 910 and 910.2, and we at-e so
notifying claimant. Tile Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claire 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: j� By: 17� 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).
IV.. BOARD ORDER: By unanimous vote offlre Supervisor-s present: .
This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the'Board's Order entered in its minutes for
this date.
Dated: D O JOHN CULLEN, CLE K, By uty Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions,you have only six(6) months from theate this notice was personally served
or deposited in the mail to file a court action on this cLaiinn.See Goven anent Code Section 945.6.You may
seek the advice of an attorney of yqur choice in connection with this matter. if you want to*consult an
attorney,you should do so immediately. *For Additional Warning See Reverse Side of17his Notice.
AFFIDAVIT OF MAILfNG
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 o h above.
l
Dated: JOHN CULLEN, CLERK By ----B""ty 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 a 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.
RE: Claim By: ) Reserved for Clerk's filing stamp
CLAUDIA L. WILLIAMS )
1115 Dennis Court ) RECEDED
Rodeo, CA 94572 )
Against the County of Contra Costa or )
JAN 1 7 2008
District)
(Fill in the name) ) CLERKCON TR OCONTRA
COSTA CO.
The undersigned claimant hereby snakes claim against the County of Contra Costa or the above-named district in
the sum of S * and in support of this claim represents as follows:
* An amount in excess of the minimum jurisdiction of the Superior Court.
1. When did the damage or injury occur? (Give exact date and hour).
July 21, 2007, at 9:18 a.m.
2. Where did the dainage or injury occur? (Include city and county)
Intersection of Willow Avenue and Viewpoint Drive, Hercules, Contra Costa County
3. How did the damage or injury occur? (Give full details; use extra paper if required).
See attached.
. 4. What particular act or omission on the part of county or district officers,servants,or employees caused the
injury or damage?
Foliage obstructed the other driver's view of the stop sign,and limit lines and painted
word "STOP" were covered over by recent re-paving of area.
5. What are the names of county or district officers, servants, or employees causing the damage
or injury`? Unknown at this time.
6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach
two estimates for auto.damage.)
Physical injuries to claimant and property damage to claimant's vehicle. Amounts unascertained.
7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury
or damage.)
The value of personal injuries and property damage exceeds the minimum jurisdictional level of the
Superior Court.
8. Names and addresses of witnesses, doctors, and hospitals:
1. Ronald White, Hercules, CA 94597;
2. Richard S. Clarke, 10 Links Lane, Berlin, Maryland 21811;
3. Doctor's Hospital, 2000 Vale Road, San Pablo, CA 94806;
4. UCD Medical Center, Sacramento, CA 95826;
5. Michael Morford, M.D., 2089 Vale Road, Ste. 17, San Pablo, CA 94806.
■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■
Gov. Code Sec. 910.2 provides: "The claim shall be
SEND NOTICES TO: (Attorney) ) signed by the claimant or by some person on his behalf."
Name and Address of Attorney )
Daniel V. Kohls, Esq. ) (Claimant's Signature)
Hansen, Culhane, Kohls,Jones & Sommer,LLP )
3001 Lava Ridge Court, Ste. 120 ) 1115 Dennis Court
Roseville, CA 95661 (Address)
3 Rodeo, CA 94572
Telephone No. (916)781-2550 ) Telephone No. (925) 799-4167
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.
ATTACHMENT TO CONTRA COSTA COUNTY CLAIM FORM
January 15, 2008
Claimant: Claudia Lee Williams
Date of Loss: July 21, 2007
#3. How did the damage or injury occur?
Claimant was southbound on Willow Avenue. After coming to a full and complete stop and
viewing the intersection to insure it was safe to proceed, Claimant began turning left onto Viewpoint
Drive. Richard S. Clarke was driving northbound on Willow Avenue. Richard S. Clarke did not stop at
the intersection because the stop sign was not visible and there were no other indications that a stop was
required. The Clarke vehicle struck the rear passenger side of the Williams vehicle.
HANSEN RECEIVE®
CULHANE
KOHLS JAN 1 7 2008
JONES &
S OMME R LLP CLERK BOARD OF SUPERVISORS
CONTRA COSTA CO.
A LIMITED LIABILITY PARTNERSHIP
INCLUDING A PROFESSIONAL CORPORATION
3001 LAVA RIDGE COURT, SUITE 120 WWW.HCKJS.COM 770 L STREET, SUITE 950
ROSEVILLE, CALIFORNIA 95661 HARTLEY T. HANSEN SACRAMENTO, CALIFORNIA 95814
TELEPHONE: (916) 781-2550 1944-2004 TELEPHONE: (916) 781-2550
FACSIMILE: (916) 781-5339 FACSIMILE: (91 6) 781-5339
REPLY TO:
ROSEVILLE OFFICE ❑ SACRAMENTO OFFICE
DANIEL V. KOHLS
January 16, 2008
Via Federal Express
Clerk of the Board of Supervisors
Contra Costa County
651 Pine Street,.Room 106
Martinez, CA 94553
Re: Claimant - Claudia Lee Williams
Auto Accident: July 21, 2007
Dear Sir/Madam:
Enclosed please find an original and two copies of a Contra Costa County
Claim Form which we are submitting on behalf of our client, Claudia Lee Williams. The
claim arises out of an automobile accident which occurred within the jurisdictional
boundaries of Contra Costa County. Please stamp the copies affirming the County's
receipt of the Claim and return the copies to our office in the enclosed return envelope.
Please present the enclosed Claim to the appropriate individual(s) for their
consideration. If you need any further information or if there are any questions
regarding this matter, please do not hesitate to contact our office.
Thank you for your courtesy and assistance. We look forward to receiving
the County's response in this regard.
Very truly yours,
HANSEN, CULHANE, KOHLS, JONES &
SO MER, LLP
SUSAN . TWITTY
Secretary to DANIEL V. KOHLS
Enclosure
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CLAIM
BOARD OF.SUPERVISORS OF CONTRA COSTA COUNTY
: BOARD ACTION: FEBRUARY 26, 2008
Ciaiin Against the County, or.Disti-ict 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),
AN 2 2 2008 given Pursuant to Government Code
AMOUNT: UNKNOWNSection 913 and 915.4. Please note all
COUNTY COUNSEL ".Warnings'.
MARTINEZ CALIF.
CLAIMANT: AAA AUTO INSURANCE
FOR DAN',BUMGARDNER
BY RAYMOND BAILEY JANUARY 22, 2008
ATTORNEY: DATE RECEIVED:
UNKNOWN
ADDRESS: P.O. Box 920 BY DELIVERY TO CLERK ON: JANUARY 22, 2008
SUISUN CITY; CA. 94585
BY MAIL POSTMARKED: JANUARY 18, 2008
FROM: Clerk of the Board of Supervisors TO: County Counsel .
Attached is a copy of the above-noted claim.
JANUARY-22, ,2008 . : , JOHN CULLEN, ei1
Dated: ' By: Deputy --'
11. FROM: County Counsel TO: Clerk of the Board of Supervisors
( This claim complies substantially with Sections 910 and 90.2.
( ) This Claim FAILS to comply substantially with Sectioris 910 and 910.2, and we are so
notifying claimant. The Board cannot act for 15 days (Section 910.8).
(.. ) Claim is not timely:fired. The Clerk should.return claim`oi�l 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).
O Other:
Dated: j''a2 S' OF 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).
I.V. BOARD ORDER:` By unanimous vote of the Supervisors.}resent: -
This Claim is rejected in;full.
Other: t
I certify that this is a trud and con•ect.copy of the'Board's Order entered in its minutes for
this date.
Dated: JOHN CULLEN, CLERK, By Deputy Clerk
WARNING Gov. code section 913)
Subject to certain exceptions,you have only six(6) nrontiis Froin the ate this notice was,
personally served .
Or.depositetl in the nis`it'1 to file a COU.rt action on this cl�`ilin.See GOverninent Code Sectloti`945.6.You may
seek the advice of an attorney of your Choice in connection witli this matter. If you want to Consult all
attorney,you should do so immediately. *For Additional Waiiling See Reverse Side of Tliis Notice.
AFFIDAVIT OF MAILING
I declare under penalty of per jury that 1. and 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 sh wn above.
Dated: d JOHN CULLEN, CLERK By Deputy-Clerk
JUN-12-21703 • 09:23 CCC RISK MANAGMENT 925 335 1421 P.02
Clair to: BOARD OF SUPERVISORS OF CONTRA COSTA COM;TY
INSTRUCTIONS TO CLAIMANT
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for death or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other, cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. 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 mane 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 pen=alty. for fraudulent claims, Penal. Code Sec. 72 at the end of this
Form.
BE: Claim By ) Rese_rved for Clerk's r'.iling.starae
A`� RECEIVED
II )
�1i:; � ,6t, Pon : �inni ����►��'� ) N 2008
.Against the County of Contra-Costa ) JA 2 2
CLERK'BO
TRA COSTA CO.
ISORS
District)
Filmel in naw)
)
The undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $ o o e51-rM,,i yc t and in support of
this claim represents-as follows:
1. When did the da.mage_or injury occur? (Give exact date and hour)
0 t / U
2. `I Where didthedamage or injury occur?. (Include city and county) _
"\ 0-f
SG.� VG �� Ave r,� Ne.1 cIn e j &e ,A ICL'JCS� ` .
3. How did the daraage or injury occur? (Give full details; use Xtra paper if� +
required) .� v''c�S �rctivc(inG �vv Scn G,��(r� NVe v✓�1 i1 le
,� ` U�r�IG 'I gni vlc�� � �o,� �, r G-`tS 0A ,°J SC�n IIPe'L J
ivy ;���� o`�your L���i�� cc,� 51ru ,�ti„ Ve �;c Ir � 1r'� ydL , ��;,`�J�'
_ ;
4. What 'particular actor omission on the part of county or district officers,
servants & .employees caused..the.in ury damage?
`lei o�`Ino �J. \. . ... J(1 I d` ��n zyFr,V
I� file 101 0
i
09:23 CCC RISK MANAGMENT 925 335 1421 P.03
7. wnac are the names of county or district officers, servants or employees causing
the damage or injury?
F Jes
KUM LAC
5. What damage or injuries do you claim resulted? (Give Hill extent of injuries or
d es claimed., Attach twa estimates for auto e.
-
�� �{21 i! � 61P
Y'l1 S �°�r�„� ✓G��:T�/'��' t0 (ef �.c/' ' `, nP� cis, P�'
s r
7. How was the account claimed above computed? (Include the estimated account of any
prospective injury or. damage.)
$. Names.and addresses of.witne!ses, doctors and hospitals.
n �
_-- -----
9. List the expenditures you made on account of this accident or .injury:
DATE ITEM AWMT .
J
Gov. Code Ser:. 910:2 provides:
"The claim must be signed by the clairm nt
SEND NOTICES TO:,, (Attorney) or b ,spme p2E.4 on his. b-.half."
Name and Address o3 ttorne '
y M)
Claimant's .Signature
VOA
Address
Sir5�A
Telephone No. I telephone No.
NOTICE , iUG�� � j
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 boz^d 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 imprisoriment in
the county jail-for a period of not more than one-year, by a fine of not exceeding
one thousand ($1,000), or by 'both such Imprisonment and finei-or by imprison-uent in
the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by
both such imprisonment and fine.
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CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY .
BOARD ACTION: FEBRUARY 26, 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 ) you is your notice of the action taken
on your claim by the Board of
Supervisors. (Paragraph IV below),
AN 2 2 2008 given Pursuant to Government Code
AMOUNT: $554.38 COUNTY COUNSEL Section 913 and 915.4. Please note all
MARTINEZ CALIF. "Warnings''.
CLAIMANT: JOHN D. MASON
JANUARY 22.9 2008
ATTORNEY: : UNKNOWN DATE RECEIVED:
ADDRESS: 460 N CIVIC DRIVE #311 . BY DELIVERY TO CLERK ON: JANUARY 22, 2008
WALNUT CREEK, CA 94596
BY MAIL POSTMARKED: JANUARY 19, 2008
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JANUARY 22; 2008 JOHN CULLS er
Dated: By: Deputy .
iI. FROM: County Counsel TO: Clerk of the Board of upervisots
( 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. Tile 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).
( ) Otlier:
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 911.3).
IV. . 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: a JOHN CULLEN, CLERK,'By Deputy Clerk
WARNING tGov. code section 913)
Subject to certain exceptions,you have only six(6) iuonths from(lieto this notice was personally served .
or deposited in the niail 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 ofTltis 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 anti Notice to Claimant, addressed to the claimant shown above.
Dated.tRzQaLe JOHN CULLEN, CLERK By Deputy Clerk
4
r BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 6; V
INSTRUCTIONS TO CLAIMANT
A. A.claim relating to a cause of action for death or for injury to person or to personal property or
gro«Ting 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
nine 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.
■��������������.............r■ now sffMEEKSMEN81NEEMENEWNRESENtaKI
RE: Claim By: Reserved for Clerk's filing stamp
RECEIVED
Against the County of Contra Costa or ) JAN 2 2 2008
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$,S$y. 3i 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. How did the damage or injury occur? (Give full details; use extra paper if required)
AGourrR'ti{ �vwdJ(b y E,rtr i ry A A' .9M KA.01a,L.*E (S -L�cED ,W-V ✓t^.y
G4-fit.. r`' 114f a�.'Z E MALea � C% ��r-.
4. what particular act or omission on the part of county or district officers, servants, or employees
caused the injury or damage?
oI 4e"
5 What are the names of county or district officers, servants, or employees causing the
damage or injury? l-HuL? 'C>uw Cabe,^/
6. Whot damage or injuries do your claim resulted? (Give full extent of injuries or damages
claimed. Attach two estimates for auto damage.) 5C4_4PeTb �g,s, ,.,� ,� /L*_�
7. How was the amount-.claimed above computed? (Include the estimated amount of an r
prospective injury or damage.) A%jCru g,,t,z:t-t S+}-c>p Oz n W%A,TE S CX
S. Names and addresses of witnesses, doctors, and hospitals:
9. List the expenditures you made on account of this accident or injury:
DATE TDVM AMOUNT
■ a a a a a a a a a a a a a a Mason Exxon a a a a a a a a a a a a a a a a a a a a a a a e a a a a a a a■A a a a a a a a a a a a a a a a a a It a a a a a a 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: (Attornev) )
Name and address of Attorney }
(Claimant's Signature)
4,3 1 k
(Address),
GA. 4W5��
)
Telephone No. ) Telephone No.�C 3 7— Ca [
■a a a t a a!ata■■a a a t a a■\a t a■■■10.a!a a a a a a a a t a!a a a a a a a a R a a\a t a a a■■a a a a a a f a a a a■ MEN a!a a a t 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
attaclunents,addendums, or supplements attached to the claim form, including medical records. are also subject to
public disclosure.
■ a a a a a a a a a a a a a a a a a a a a a a a a a a a a a■;■so Russ ma a a a a a a a a a a a a a a liens a a a a a a a f a a■a'a■a nit a a ata mass i
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.
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Cassette Driver tP I JL r Baa Passenger A-ir Baa
-L�-t '
L' .1.O n t e I mp ca c-L. 'A'Lr B Baq C I c thl a Ls zUC- Zj
5, e el d Trl-l-msmi.ss-ion Ovc�-d r ve Buil W 11h P e Covers
--- ---------------------------------------------------------------------------
I I—, rl--, n I T
110. U:I .. -' - ' I UN I . -f
1L L'�,i.lll�I L -I -- 1 L v� 1 ,1. ;
-------------------------------------------------------------------------------
1 R
.AR R Ul M,ISN R
r"OE
7 7
444 Siihl Cover Car 1 7 50
m r- 'r`, F,p r
7# P.e iD 11 Ti t Color
0 x
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o r eo i 1 S-1
S r,,r! i 0 . 5
-------------------------------------------------------------------------------
L 12 . n 31 j . I
01/00/200b at ' 10 : 39 AM job Number :
25244
PRELI-NaWARY EST11_'MTE!
2004 HYUN ELANTRA GLS 4-2 . OL-F! 4D SED int ;
Parts 0 . x'0
Body Labor 3 . 1 hrs @ $ 70 . 00/hr 217 . 00
Paint Labor 3 . 1 hrs @ $ 70 . 00/hr 217 . 00,
Paint Supplies 3 . 1 111 @ $ 32 . 00/hr 99 . 20
Sublet/Misc- 12 . 50
----------------------------------------- ----------
SUBTOTAL $ 545 . 70
Sails Ta.%.. $ 99 . 20 @ 8 . 7500% 8 . 68
----------------------------------------------
GRAND TOTAL $ 554 . 38
ADjUSTMENTS :
DFductibie 0 . 00
----------------------------------------------------
CUSTOMER PAY
INSURANCE PAY
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=APPROXIMATF PRICE LABOR TYPES :
B=BObY LABOR D=DIAGNOSTIC E=E LECTRICAL F=FRAME G=GLASS M=MECHANICAL -=PAINT
LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS :
ADj=ADjACENT ALGN=ALTGN A/M=AFTERMARKET BLND=BLEND CAPA=CFRTTFTED AUTOMOTIVE
PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT . PRICE=UNIT
PRICE MULTIPLIED BY THE QUANTITY !NCL=INCLUDED MISC=MI SCELLANEOUS NAGS=NATIONAL
AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/A=OVERHAUL OP=OPERATTON
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=SUBLETOTORS LT=LEFT W/O=WITHOUT
W/ -WITH/ SYMBOLS : &MANUAL LINE ENTRY *TQTHER NE —MDATABASE
INFORMATION WAS CHANGEDj --=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO
LINE .
TR
LINE .
AUFACTURERIS QUAL IFICATIOM AND VALIDATION PROGRAM . OPT
OEM=CRIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OF,
OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT . NWCPP=NATIONWIDE CRASH
PARTS PROGRAM ,
2
at 00 : 39 Am job Number :
2 5 2 441
PRELIMINARY ESTIMATE
2004 H_UN ELANTRA CLS 4-2 . QL-F! 4D SED int :
Estimace based on MOTOR CRASH 0STIMATINO GUIDE. Unless otherwise noted all items are derived from
the Guide APR1055 DaLabase Date, 12/2007, CCC Data Date 12/2007, and the parts selected are
UEM-parLs &nnaFauLwrmd by Lhe vehicles WgInal EqUIPTUHL Manu&cLwfer . OEM pdrLs wu available W_
OE/Vehicle dealerships. OPT OEM (Optional OEM) ur ALT OEM (AlturnaLive OEM) parts are OEM parts
that may be provided by or through altownate sources oLher than the OEM vehiclo dealerships. W&I,
OEM cc ALT OEM pdrLs may reElucL some snewHim, Special, o u0iquw prWing cc disaounL. OPT OEM or
ALT OEM pacts may includo "Blemished" parts provided by OEM's through OEM vehicle dealerships.
Asterisk fO ! or Double Asterisk t**) indicates that the parts and/or 2abor infonmation provided by
M070R may have been mdiLled or way hays tome frow an alLennaLe daLa source. Tilde sign (-) iLems
indicaze MOTOR Not--_... ciuded Labor opefations. Non-Original Equipment MauufacLurer aftermarkeic.
ports 5re Gescrived ±s AM, Qua! Rep! Parts or Comp Rep! Parus which stands oor Competitive
Toplacynenu PaKs. Used panLy one described as TTQ, Qua! Racy Va0s, RCY, cc USED.
parts are describcd as Recon. Recared parts are Wsuribed as ..eco-Le. 'INIAGS Pa.,,.-L 'Nunnbz.zs end
Eenchnark Prices are provided by Nationil Auto Glyss Specifications. Labor operation times listed
on We 1kne w4h Lhe NAGS AnWrmaWon are MOTOR suggesLed latuf opvraLiun Wnns. NAGS IaW7
Operation times are not included. Pound sign W items indicace manual entries. So `2006
vehicles contain minor changes frok tKe previous year. Yor those 7-Tehic-re-s; to rtceiving
updaLed dhLa from Lhe vChicle manufacLuzer, labow and par-s dwLa from Lho provioui year may be
used. The Pathways estimator has a complete HsL of applicable vehicles. Parts humbecs and pcice�
should be confirmel with the local dealership.
CCC Pathways A product CCCin. corma--Lion Sc:rv.,,cc s Inc.
01/ 8/2008 at 01 : 36 PM Job Number:
33581
ANDY'S AUTO BODY
License # :AL186430 Federal ID #: 680242263
135 24th St.
Richmond, CA 94804
(510) 232-5749 Fax: (510) 232-8130 .
PRELIMINARY ESTIMATE
Written By: Rick Crenshaw
Adjuster:
Insured: John Mason Claim #
Owner: John Mason Policy #
Address: 460 N. Civiv Dr. # 311 Deductible:
Walnut Creek, CF. 94596 Date of Loss:
Day: (925) 437-0194 Type of Loss:
Point of Impact:
Inspect ANDY'S AUTO BODY Business: (510) 232-5749
Location: 135 24th St.
Richmond, CA 94804
Insurance
Company: Days to Repair
2004 HYUN ELANTRA GLS 4-2 . OL-FI 4D SED Int:
VIN: KMHDN46D34U739426 Lie: Prod Date: Odometer:
Air Conditioning Rear Defogger Tilt Wheel
Intermittent Wipers Keyless Entry Theft Deterrent/Alarm
Body Side Moldings Dual Mirrors Console/Storage
Clear Coat Paint Power Steering Power Brakes
Power Windows Power Locks Power Mirrors
AM Radio FM Radio Stereo
Cassette Driver Air Bag Passenger Air Bag
Front Side Impact Air Bag Cloth Seats Bucket Seats
5 Speed Transmission Overdrive Full Wheel Covers
-------------------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
-------------------------------------------------------------------------------
1 REAR BUMPER
2 R&I R&I bumper cover 1 . 4
3* Rpr Bumper cover sedan 0 . 4 2 . 6
4 Add for Clear Coat 1 . 0
-------------------------------------------------------------------------------
Subtotals =_> 0 . 00 1 . 8 3. 6
1
O1/18/2008 at 01 : 36 PM Job Number:
33581
PRELIMINARY ESTIMATE
2004 HYUN ELANTRA GLS 4-2 . OL-FI 4D SED Int:
Parts 0 . 00
Body Labor . 1 . 8 hrs @ $ 73 . 00/hr 131 . 40
Paint Labor 3 . 6 hrs @ $ 73 . 00/hr 262 . 80
Paint Supplies 3 . 6 hrs @ $ 30 . 00/hr 108 . 00
----------------------------------------------------
SUBTOTAL $ 502 . 20
Sales Tax $ 108 . 00 @ 8 . 7500" 9. 45
----------------------------------------------------
GRAND TOTAL $ 511 . 65
ADJUSTMENTS :
Deductible 0 . 00
----------------------------------------------------
CUSTOMER PAY $ 0.. 00
INSURANCE PAY $ 511 . 65
Can an Insurer require, direct, suggest or recommend that your automobile be
repaired at a specific shop?
No - Unless the referral is expressly requested by you. SB551 prohibits an
insurer from requiring an auto be repaired at a specific auto repair dealer.
The insurer can only recomend an auto repair dealer if the insured asks for a
referral, or if the insured is informed in advance in writing of the right to
choose the repairer of his or her choice . If an insured takes an auto to a shop
of his or her own choice, an insurer cannot limit or discount reasonable repair
costs based on charges that would have been incurred had the insured gone to
the insurer '.s chosen shop.
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CLAIM
BOARD OF SUPERVISORS Or, CONTRA COSTA COUNTY
BOARD ACTION: -FEBRUARY 26, 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 Government Code.
AMOUNT: UNMOWNSection 913 and 915.4. Please note all
"Warnings".
CLAIMANT: CARL LEE BAITY, JR. .
2007011835
ATTORNEY: UNKNOWN DATE RECEIVED: JANUARY 23, 2008
ADDRESS: MARTINEZ DETENTION FACILITYBY DELIVERY TO CLERK ON: JANUARY 23, 2008
901 COURT STREET
MARTINEZ, CA 94553 BY MAIL POSTMARKED: JANUARY 22, 2008
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JANUARY 232008 JOHN CULLEN,.Clerk
,
Dated: By: Deputy
1I. FROM: County Counsel TO: Clerk of the Board of Supe visors
( ) This 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 isnot timely filed. Tile Clerk should return claim on ground that it'was filed late and
send warping 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):
IV. BOARD ORDER: By unanimous vote of the Supervisors present: .
This Claim is rejected in Ul.
( )
Other
1 certify that this is a true and correct copy of the'Board's Order entered in its minutes for
this date.
Dated: JOHN CULLEN, CLERK, By Deputy Clerk
WARNING Gov. code section 913)
Subject to certain exceptions,you have only six(6) mouths froth the d to this notice was personally served
or deposited in the uhlil to file a court action on this clainn.See Government Code Section 945.6.You may
seek the advice of an attortrey of your choice in connectiar with this matter. If you want to consult an
attorney,you should do so immediately. *For Additional Wareing See Reverse Side of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that i. am now., and at all tinnes 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�u i wn above.
Dated: JOHN CULLEN, CLERK By Deputy Clerk
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RECEIVED
JAN 2 3 2008
CLERK-BOARD-OF-SUPERVISORS
CONTRA COSTA CO.
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CLAIM
BOARD OF SUPiJRVISORS OF CONTRA COSTA COUNTY,,
BOARD ACTION: FEBRUARY 26,. 2008
Claim Against the County, or District Governed by
the Board of Supervisors,. out �) NOTICE TO CLAIMANT
and Board Action. All Section i t The copy of this document mailed to
California Goveinmeat Codes. JAN 2 4 200 you is your notice'ofthe action taken
on your claim by the Board of
COUNTY COUNSEL Supervisors. (Paragraph IV below);
MARTINEZ CALIF.. given Pursuant to Government Code
AMOUNT: EXCEEDING THE :'$25,000.00 Section 913 and 915.4. Please note all
JURISDICTIONAL LIMITS OF THE "Warnings".
SUPERIOR COURT
CLAIMANT: JEANNETTE BARNES; WILLIE BARNES, CHARLES BARNES III '(minor)
ALYSSA BARNES (minor); ALIAH BARNES (minor) JANUARY 24, 2008
ATTORNEY: TIMOTHY A. WALKER DATE RECEIVED:
MEHL,MAN, TERBECK
ADDRESS: 2125 OAK GROVE ROAD j, STE. ,1b5. DELIVERY TO CLERK ON: JANUARY 24, 2008
WALNUT. CREEK, CA 94598
RECEIVED FROM
BY MAIL POSTMARKED: - COUNTY COUNSEL
FROM: Clerk of tlhe Board of Super'visor's TO: County Counsel
Attached is a copy of the above-noted claim.
JANUARY 24, . 2008 JOHN CULLEN, Cl k
Dated: By: Deputy
II. FROM.: County Counsel TO: Clerk of the Board of Supervisors
( 4-This claiiii conip Iies. ith 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.ca»not act for 15 days (Section 910.8).
�"��v✓�l
�C1aim is not timely filed. The e
semi wQ1:I4iAg-ef Claimant 's ri2llt to a ahl for If-nve to nrPs n.talat-Q-claim (Section 911...3).
(`KOther: -die, .(001_�•4U e:�: CG17`Tra (f09 - /5 4 eo bllL
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Dated: /'�� O By: Deputy Coun y.Counsel
III.. FROM: Clerk of the Board T0: County Counsel (1) County Administrator(2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: , By unanimous vote of the Supervisors present: .
This Claim is rejected in full.
Other:
I certify that this is a true and correct copy of.the'Board's Order entered;in its minutes foi-
this date.
t
Dated: Z ,b JOHN CULLEN, CLERK, B Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions,you liave ohily six(6) months fivm th date this notice was personally served
or deposited in the mail to file a court action on this claim.See Goverrnnent Code Section 945.6.You may
seek the advice of an attonhey of your choice in connection with this matter. If you want to consult an
attonicy,you should do so immediately: *For Additional Wanking See Reverse Side of This 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 ph' id a certified copy of this
Board Order. and Notice to Claimant, addressed to the claim ht a shown above,
Date JOHN CULLEN, CLERK By e uty Clerk
CLAIM AGA.INST GOVERNMENT ENTITY FOR LOSS— GOVERNMENT CODE
SF_CTION 910 ET SE Q.
A. Claimant Information
Claimants: Jeannette Barnes; Willie Barnes, Charles Barnes III (minor), Alyssa Barnes
(minor),Allah Barnes (minor) D
Mailing'Address: 4282 Suzanne Drive, Pittsburg, CA
JAN 2 3 2008
Telephone No: (925) 473-9596 COUNTY COUNSEL
MARTINEZ CALIF.
B. Address to.Which Notices To Be Sent IV�®
Mehlman -:•TerBeek LLP JAN 4 4u&o
.Att'n Timothy A. Walker,'Esq. ' CLERKaOARo
Attorneys for Claimants CONTRA°os A Cov�SC,Rs
2125 Oak Grove Rd., Suite 125
Walnut Creek, CA 94598
C. Names of Public Entities/Employees Against Whom Claim Asserted
County of Contra Costa
Ronald Polk, (Former Acting Principal of Pittsburg High School)
Pittsburg High School
Pittsburg Unified School District
D. Incident Date & Location
(1) Various dates in a course of continuing conduct for approximately one year prior to, and
including, August 14, 2007,&Pittsburg High School,Pittsburg; California for the sexual
harassment and intentional infliction of emotional distress claims; (2)August 22, 2007 and
October 26, 2007, the dates Pittsburg Unified School Districtfiled temporary restraining orders
against Willie Barnes. .
E. Amount of Claim
This is an Unlimited Jurisdiction Claim for tort damages exceeding the $25,000 jurisdictional
limits of the Superior Court, the exact amount of which is.unknown at this time.
F. General Statement of Factual Circumstances Underlying Claim
On various dates for approximately one year prior to,:and including the month of June, 2007,
Claimant Jeannette Barnes was sexually harassed by Ronald Polk, her direct supervisor at
Pittsburg High School. Ms. Barnes was Mr. Polk's secretary during the relevant:p e'riod. Mr.
Polk is known to have conducted himself in this'inappropriate fashion in the past.
When Ms. Barnes told Mr.Polk that she was going to file the.sexual haraassment':complaint
against him, on August 14,2007„ he threatened to kill Ms. Barnes and her family as well as
threatening her employment status. Then, he.told the.Barnes' son Charles Jr., 16, daughter
Alyssa, 19, their nephew Nick, 18, and their daughter Aliah, then 10, that he "was having sex
with your mother." Those children had come to Pittsburg High School after Mr.;Barnes got in a
car accident a Mock away froni'the school, arid-Mr. Polk called them into the office to-tell them
this. Later, on August 22, 2007 and October 26, 2007, Pittsburg Unified Schodl District filed
temporary restraining orders against Willie Barnes in retaliation for Ms. Barnes:.filing the sexual
harassment complaint...
As a result of Defendants' intentional conduct and negligence (and strict liability tender
California law prohibiting.sexual harassment by a supervisor), Claimants have suffered severe
emotional distress and other damages associated with Mr. Polk's conduct, including treatment
costs for Claimants; emotional distress. As a further result of Defendants' intentional conduct
negligence, and strict liability, Claimants have suffered a diminution of earnings or.earning
capacity.
G. Nature of Claimed I.,oss
This claim is in the nature of a tort claim and statutory claim under California and Federal laws
prohibiting sexual harassment by an employee's supervisor, which includes losses for general
and special damages.such as emotional distress, mental suffering, loss of earnings, loss of
earning capacity, medical expense,and.other expenses not yet known.
H. List of Persons/Entities Served With This Notice
1. County of Contra Costa:
Stephen L. Weir; County Clerk-Recorder
John Cullen, County Administrator
Silvano Marchesi, County Counsel ;
651 Pine Street, 11`h Floor.
Martinez, California 94553
(925) 335-7800
2. Ronald Polk
Ex- Acting Prin6ipal, Pittsburg High School.
Present Assistant Principai, Central Junior High School
1201 Stoneman Avenue
Pittsburg, CA 94565
J925) 473-4459
3. Pittsburg High School
Todd Whitmire, Principal
250 School Street
Pittsburg, CA 94565
(925) 47.3-4100
4. Pittsburg Unified School District
Dr. Barbara Wilson, Superintendent
2000 Railroad Avenue
Pittsburg, CA 94565
(925) 473-4230
I. Address for Service of Related Notices or Communications
All notices or communications regarding this claim should be sent to the following address:
MEHLMAN •:,TERBEEK LLP.
Attention: Timothy A. Walker
Attorneys for Claimants
2125 Oak Grove Road, Suite 125
Walnut Creek, California 94598-2406
Telephone (925)935-3575
Facsimile (925) 935-1789
Date: January , 2008' MEHLMAN ❖TERBEEK L
By:
Timothy . Walker
Attorneys for Claimants
PROOF OF SERVICE
[C.C.P. §§ 1013, 2015.5, 2008]
Re: Jeaunctte Barnes, et al. and County of Contra Costa ct al
I, Phyllis L. Thomas, am efnployed in Contra Costa County, California. I am over the age
of eighteen years and not a parfy:to the within action. Mybusiness address is 2125 Oak Grove Road,
Suite 125, Walnut Creek,.CA 94598. On January ,'2008, I served:
CLAIM AGAINST GOVERNMENT ENTITY FOR LOSS - GOVERNMENT
.CODE SECTION 910 ET SEQ.
X by MAIL as follows: by causing a trice copy thereof enclosed in a
sealed envelope, with postage thereon fully prepaid, to be placed in
the United States Post Office mail box at Walnut Creek, California,
addressed as indicated below. (I am readily' familiar with this
business.' practiceofcollecting and processing correspondence for
mailing.' It is deposited with the U.S. Postal Service on the same day
in the ordinary course of business).
(AND.CERTIFIED MAIL RETURN RECEIPT - REQUESTED.)
by OVERNIGHT MAIL causing a true copy thereof to be placed in
FEDERALEXPR ESS MAIL on Oak Grove Road, in Walnut Creek,
CA before the final collection time, addressed as indicated below
following ordinary business practice, said practice being that in the.
ordinary. course of business, correspondence is deposited in the
Federal Express'Depository on the same day as itis placed for
processing..
by FACSIMILE,as follows: I caused the said document to, be
transmitted by Facsimile.machine to the addressee(s) at their fax
numbers indicated below. The Facsimile machine I used complied
with Rule 2003(3) and.no error was reported by the machine.
Pursuant to Rule 2005(1),1 caused the machine to print a transmission
record of the transmission.
by PER SONAL DELIVERY.
County of Contra Costa:
Stephen L. Weir, County.Clerk-Recorder
John Cullen, County Administrator
Silvano Marchesi, County Counsel
651 Pine Street, 11`h Floor
Martinez, California 94553
4
Ronald Polk
Ex- Acting Pri,icipal, Pittsburg High School
Present Assistant Principal, Central Junior High School
1201 Stoneman,Avenue
Pittsburg, CA 94565
3. Pittsburg High School
Todd Whitmire;Principal
250 School Street
Pittsburg,-CA 94565
4. Pittsburg Unified School District
Dr. Barbara Wilson, Superintendent
2000 Railroad Avenue
Pittsburg, CA 94565
I declare under penalty of perjury under the laws of the State of California that the foregoing
is true and correct, and that this Declaration was executed on January ,2008, at Walnut Creek,
California.
PHYLLIS L. T MAS
6
CONTRA COSTA COUNTY
RECEIVED
JAN 1 7 2008
OFFICE OF
COUNTY ADMINISTRATOR
1�S�
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i•i
>>:
OFFICE OF THE COUNTY COUNSELSILVANO B. MARCHESI
COUNTY OF CONTRA COSTA t _ rl^ � COUNTY COUNSEL
Administration Building _ .----: •. F;_-..� +
SHARON L. ANDERSON
651 Pine Street, 91h Floor
Martinez, California 94553-1229 CHIEF ASSISTANT
r 4'
(925) 335-1800 n• `'i GREGORY C. HARVEY
(925) 646-1078(fax) �,� "L'' �°Q �R J'� VALERIE J. RTANTS
`�����•�'ir� ASSISTANTS
NOTICE OF UNTIMELINESS
AS TO A PORTION OF THE CLAIM
TO: Timothy A. Walker .
Mehlman * Terbeek
2125"Oak Grove Road, Suite 125
Walnut Creek, CA 94598
RE: CLAIM OF: Jeannette.Barnes,'Willie Barnes, Charles Barnes, III, Alyssa Barnes, and Aliah Barnes
Please Take Notice as Follows:
In regards to the claim you submitted on January 24, 2008, on behalf of Jeannette Barnes, Willie
Barnes, Charles Barnes, III, Alyssa Barnes, and Aliah Barnes, portions of the claim are timely and portions
are untimely. The portions of the claim prior to July 24, 2001 that you presented against the County of
Contra Costa governed by the Board of Supervisors fail to comply substantially with the requirements of
California Government Code Sections 901 and 911.2, because they were not presented within six months
after the event or occurrence as provided by law. Because the portions of the claim prior to July 24, 2007
were not presented within-the time allowed by law, no action was taken on those portions of your claim.
The claim was forwarded.to the Board for action only on the timely portions of the claims.
The only recourse at this time is to apply without delay to the County of Contra Costa governed by
the Board of Supervisors for leave to,present a late claim as to the claims which are untimely. (See Gov.
Code, §§ 911.4 to 912.2, inclusive, and 946.6.) Under some circumstances, leave to present a late claim
will be granted. (See Gov. Code, § 911.6.) Please also note that the County of Contra Costa is a separate
public entity .from the Pittsburg Unified School District.
SILVANO B. MARCHESI
COUNTY COUNSEL
Monika L. Cooper
Deputy County Counsel
Page 1 .
CERTIFICATE OF SERVICE BY MAIL
(Code Civ. Proc., §§ 1012, 1013a, 2015.5; Evid. Code, §§ 641, 664)
I am a resident of the State of California, over the age of eighteen years, and not a party to the within action. My
business address is Office of the County Counsel, 651 Pine Street, 9th Floor, Martinez, CA 94553-1229. On
�enserved a true copy of this Notice of Untimeliness as to a Portion of the Claim by placingthe docd envelope with postage thereon fully prepaid,"in the United States mail at Martinez,
California addressed to Timothy A. Walker,Mehlman * Terbeek, 2125 Oak Grove Road, Suite 125,Valnut Creek.
CA 94598, as set forth above. lam readily familiar with Office of County Counsel's practice of collection and
processing of correspondence for mailing. Under that practice,it would be deposited with the U.S.Postal Service
on that-same day with postage thereon fully.prepaid in the ordinary course of business.
I declare under penalty of perjury under the�aws,of the State of California and the United States of America that
the above is true and correct. Executed on ,-3 at Martinez, California.
Kath een O'Connell
cc: Clerk of the Board of Supervisors (original)
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CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION:, FEBRUARY 26, 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 Government Code
AMOUNT: UNKNOWN Section 913 and 915.4. Please note all
"Warnings".
CLAIMANT: JACOB D. .McCLELLAN
#2007027123 70121796.
ATTORNEY: UNKNOWN DATE RECEIVED: JANUARY 24, 2008
ADDRESS: MARTINEZ DETENTION FACILIT�Y DELIVERY TO CLERK ON: JANUARY 24, 2008
901 COURT STREET,
MARTINEZ, CA 94553 ' RECEIVED FROM
BY MAIL POSTMARKED: COUNTY COUNSEL
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN CULLEN, .•k
Dated: JANUARY 24, 2008 By: Deputy
II. FROM.: County Counsel TO: Clerk of the Board of Su ervisors
( ) This 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 waiting 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):,
I.V. BOARD ORDER: By unanimous vote of the Supervisors present:
This Claim is rejected in full.
( ) Other.:
I certify that this is a true and correct copy of the'Board's Order entered in its minutes for
this date.
Dated: JOHN CULLEN, CLERK, epu Jerk
WARNING (Gov. code section 913)
Subject to certain exceptions,you have only six(6) months fi-oin tine Lte this notice was personally served .
or deposited in the nkail 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 wilt this matter. If you want to consult an
attorney,you should do so immediately. *For Additional Wanting See Reverse Side ofTltis Notice.
AFFIDAVIT OF MAILING
I declare under penalty of pet jury 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 tate United
States Postal Service in Martinez, California, hostage fully prepaid a certified copy of this
Board Order and Notice to Claimant, addressed to the claimat . s s own above.
Dated: JOHN CULLEN, CLERK By uty Clerk
�weZ De- kn�\ ,or\ GLC., RECFq.;`.ED
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CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: FEBRUARY 26, 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
R'AN
on your claim by the Board of
Supervisors. (Paragraph IV below),
2 4 2008 given Pursuant to Government Code
AMOUNT: $1,756.43 Section 913 and 915.4. Please note all
COUNTY COUNSEL "Warnings".
MARTINEZ CALIF.
CLAIMANT: GEANNINA PEREZ
ATTORNEY: UNKNOWN DATE RECEIVED: JANUARY 245 2008
ADDRESS: 2409 LANCASTER DRIVE #4 BY DELIVERY TO CLERK ON: JANUARY 24, 2008
RICHMOND, CA 94806
BY MAIL POSTMARKED: HAND DELIVERED
FROA Clerk of the Board of Supei'visors TO: County Counsel
Attached is a copy of the above-noted claim.
JANUARY 24, 2008 JOHN CULLEN, Cle pe
Dated: Bv: Deputy
11. FROM: County Counsel TO: Clerk of the Board of Supervisors
( This claim complies substantially with Sections 910 and 910.2.
( ) This Claim FAILS to comply substantially with Sections 910 and 910.21 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 waming of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: �' S "0 By: AlDeputy County Counsel
III. FROM.: Clerk of the Board TO: County Counsel (I) County Administrator(2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV BOARD ORDER: By unanimous vote of the Supervisors present:
This Claim is rejected in full.
/( `) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date.
Dated: Ca A JOHN CULLEN, CLERK; By eputy Clerk
WARNING Gov. code section 913)
Subject to certain exceptions,you have only six(n) niontlis from 41e(fate this notice was personally served
or deposited in the mail to file a court action on this claim.See Govemnnent 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 1 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 prepi a certified copy of this
Board Order and Notice to Claimant, addressed to the claimai t s gown above.
Dated: JOHN CULLEN, CLERK By ` eputy Clerk
- i
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
IISTRUCTIONS TO CLAMANT
A. A claim relating to a cause of action for death or for injury to person or to personal property or
gro«ring 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.
aaa�a�aaaaQaaQaQa■aaaa.aaa■aaman aaaaaaaatauanMEMENNSWERMaacaaI
RE:. Claim By: Reserved for Clerk's filing stamp
Receive,)
Against the County of Contra Costa or } ,
SAN 4 �uuu
D15tr1Ct} CLFRK BOARD OF SUPERVISORS
(Fill in the name) } CON TRq COSTA Co.
The undersigned claimant hereby rn-akes claim against the County of Contra Costa or the above-named
district in the sum of$_I,7.5&-z13 and in support of this claim represents as follows.:
1. When did the damage or injury occur? (Give exact date and hour)
T nvary 7, g oo g a,� 3:/Sim
2. Where did the damage or injury occur? (Include city and county)
303 W st 54- Richmohd Ch 14MS, Con+ra COSAR Coo n-l-y
3. How did the damage or injury occur? (Give full details;use extra paper if required)W1 Ca{ (06 �-�` �y
Cc coun+y employee driv►nca Covni-y Van when she was +rymn t-o park "e-
CO00}yV" in 4-he Pwkrk s-Facl on the lef+ side o- my Ca r.
4. What particular act or omission on the part of county or district officers, servants, or employees
caused the injury or damage? Covn+YY e pI"ee, d r v i by C,._ County VaA att.,leen 41a Lk )
&Cltec� ►n +o my Cir
5 What are the names of county or district officers, servants, or employees causing the
damage or injury? Afjip-✓va 4-rieeiman
6. WL-E-t damage or injuries do your claim resulted? (Give full extent of injuries or' damages
claimed. Attach two estimates for auto damage.) Rep BV 1rotpp_f, LT /amp 6ts5y, Lt SoGkt�-
+G;IGane, G7' sockd 134r -t damp,. (Zprr QWLe- er Pcr,el,, pay n
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.) ,ee
S. Names and addresses of witnesses, doctors, and hospitals:
9. List the expenditures you made on account of this accident or injury:
DATE TIME AMOUNT
NOR muma'snammano a Ron X mosses ME ammommossam Mason same menus a wanness mmemnNnumm a a.a 2 a I a a a a 5 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) 1
Name and address of Attorney )
(Claimant's Signature)
y�9 La»casfer r �` �
(Address)
p Cff 9q
sd, 6
Telephone No. ) T elephone No: 3-3193
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
attaclunents, 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.
01/14/2008 at 06:08 PM Job Number:
94763
CCS AUTO BODY
License #:BAR AC250539
1868 Rumr.ill Blvd
San Pablo, CA 94806
(510) 215-9528 Fax: (510) 215-9597
PRELIMINARY ESTIMATE
Written By: F.aiyaz Khan
Adjuster:
Insured: Pere Giannina Claim #
Owner: Pere Giannina Policy #
Address: Deductible:
Date of Loss:
Cellular: (510)253-3993 Type of Loss:
Point of Impact:
Inspect
Location:
Insurance
Company: Days to Repair
2008 DODG AVENGER SE 4-2.4L-FI 4D SED Int:
VIN: 1B3LC46J58N141223 Lic: Prod Date: Odometer:
Air Conditioning Rear Defogger Tilt Wheel ,
Cruise Control Telescopic Wheel Intermittent Wipers
Keyless Entry Theft Deterrent/Alarm Dual Mirrors
Console/Storage Clear Coat Paint Power Steering
Power Brakes Power Windows' Power Locks
Power Mirrors Power Trunk/Tailgate AM Radio
FM Radio Stereo Search/Seek
CD Player Driver Air Bag Passenger Air Bag
Front Side Impact Air Bag Cloth Seats Bucket Seats
Automatic Transmission Overdrive Full Wheel Covers
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR ',PAINT
-------------------------------------------------------------------------------
1 REAR BUMPER
2* Repl Bumper cover w/o dual exhaust 1 369.00 1.4 0.0
tips
3 REAR LAMPS
4 Repl LT Tail lamp assy 1 82.25 0.3
5 Repl LT Socket tail lamp 1 3.45
6 Repl LT Socket signal lamp 1 3.75
7 QUARTER PANEL
8* Rpr LT Quarter panel 1.5 2.0
9 Add for Clear Coat 0.8
10 R&I LT Applique 0.2
11 REAR DOOR
12* Rpr LT Outer panel 1.0 2 .2
13 Overlap Major Adj . Panel -0.4
14 Add 'for Clear Coat 0.4
15 R&I LT Side molding 0.3
16 R&I LT Applique rear 0.2
17 R&I LT Applique front 0.2
18 R&I LT .Handle, outside black 0.4
19 FRONT -DOOR
20 Blnd LT Door shell 1.2
21 R&I LT Applique 0.2
22* R&I LT Body side mldg 0.3
1
01/14/2008 at 06:08 PM Job Number:
94763
PRELIMINARY ESTIMATE
2008 DODG AVENGER SE 4-2.4L-FI 4D SED Int:
-------------------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
------------------------------------------------------------------------
23 R&I LT Power mirror w/foldaway 0.5
black
24# Subl HAZARDOUS WASTE REMOVAL ' 1 5.00 X
25# Repl COVER VEHICLE FOR OVERSPRAY 1 5.00 T 0.3
26# Repl TINT COLOR 1 0.5
27# DE NIB AND POLISH AS NEEDED 1 0.5
28# Repl RESTORE CORRISION PROTECTION 1 10.00 T 0.5
--------------------------------------------------------------------------------
Subtotals =_> 478.45 .8'.3 6.2
Parts 458.45
Body Labor 8.3 hrs @ $ 70.00/hr 581.00
Paint Labor 6.2 hrs @ $ 70.00/hr 434.00
Paint Supplies 6.2 hrs @ $ 30.00/hr 186.00
Sublet/Misc. 20.00
----------------------------------------------------
SUBTOTAL $; 1679.45
Sales Tax $ 659.45 @ 8.2500% 54 .40
----------------------------------------------------
GRAND TOTAL $,: 1733.85
ADJUSTMENTS:
Deductible 0.00
-7---------------------------------------------------
CUSTOMER PAY $ 0:00
INSURANCE PAY ' $ 1733.85
I authorize CCS Auto Body to perform the needed repairs to my vehicle.! Repairs
include parts, labor, and diagnosis. The ,above estimate is based on our
inspection and does not cover additional parts or labor which may be required
after the work has started. Worn or damage parts, not evident on first
inspection, may be discovered and you will be contacted for authorization for
additional work.
Parts prices are subject to change without notice.
ACKNOWLEDGEMENT: I have read and understand the above estimate and authorize
repair service to -be performed, including sublet work and acknowledge receipt
of this estimate. An express mechanics lien is hereby acknowledged on the above
vehicle to secure the amount of repairs completed.
Authorized By:
Signed: Date:
Work Accepted By:
Signed• Date•
POWER OF ATTORNEY: I• do hereby appoint the aforementioned business as my
attorney in fact to accept on my behalf any and all checks, drafts, or bills of
exchange for deposit .to the aforementioned business' account for credit• on my
account for repairs on my vehicle. which had been released and accepted.:
Signed: Date•
2
01/14/2008 at 06:08 PM Job Number:
94763
PRELIMINARY ESTIMATE
200.8 DODG AVENGER SE 4-2.4L-FI 4D SED Int:
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 'O/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 1.
OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR-
OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. NWCPP=NATIONWIDE CRASH
PARTS PROGRAM.
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived
from the Guide DR3PM08, CCC Data Date 01/01/2008, 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 0 E 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.
3
01/14/2008 at 05 :40 PM Job Number:
44019
SAVY'S AUTO BODY
License # :AK241991 Federal ID # :203561099
THANK YOU FOR SELECTING SAVY' S AUTOBODY
12920 San Pablo Ave,
RICHMOND, CA 94805
(510) 237-6399 Fax: •(510) 237-6460
PRELIMINARY ESTIMATE
Written By: SAVY LY
Adjuster:
Insured: PEREZ GIANNINA Claim #
Owner: PEREZ GIANNINA Policy #
Address: 2409LANCASTER. DR# 4 Deductible:
RICHMOND, CA 94806 Date of Loss:
Other: (510) 253-3993 Type of Loss:
Point of Impact: 6 . Rear
Inspect SAVY' S AUTO BODY Business: (510) 237-6399
Location: 12920 San Pablo Ave,
RICHMOND, CA 94805
Insurance
Company: Days to Repair
2008 DODG AVENGER SE 4-2 . 4L-FI 4D SED Int :
VIN: 1B3LC46J58N141223 Lic: Prod Date: Odometer:
Air Conditioning Rear Defogger Tilt Wheel
Cruise Control Telescopic Wheel Intermittent Wipers
Keyless Entry Theft Deterrent/Alarm Dual Mirrors
Console/Storage Clear Coat Paint Metallic Paint
Power Steering Power Brakes Power Windows
Power Locks Power Mirrors Power Trunk/Tailgate
AM Radio FM Radio Stereo
Search/Seek CD Player Driver Air Bag
Passenger Air Bag Front Side Impact Air Bag Cloth Seats
Bucket Seats Automatic Transmission Overdrive
Full Wheel Covers
- - - - - - - -- - - - -- - - - - - - -- - - - - - - -- ------ - --'- -- - -- - - - - -- -- - - - - - - -- -- - - -- - - - -- - - - - - --
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
- - - - - - - - - - - - -- - - - - - - - -- - - - - -- - - - - - - - - -- - - - - - -- - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - -
1 QUARTERPANEL
2* Rpr LT Quarter panel 1 . 0 2 . 0
3 Add for Clear Coat 0 . 8
4 R&I Fuel door 0 .3
5 Refn Fuel door 0 . 3
6 R&I LT Applique 0 .2
7 R&I LT Wheelhouse liner 0 .4
8 REAR LAMPS
.9 R&I RT Tail lamp assy 0 .3
10 Repl LT Tail lamp assy 1 82 . 25 0 . 3
11 REAR BUMPER
i
01/14/2008 at 05 :40 PM Job Number:
44019
PRELIMINARY ESTIMATE
2008 DODG AVENGER SE 4-2 .4L-FI 4D SED Int :
- - - - - - - - - - -- - -- - - --- - - - - - - -- - - - - ---- - -- - -- - -- - - - - -- - - -- - -- -- - - - - - - - -- -- - - - - - - - -
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - --- -- - - - - - ----- --- - - - - - - - - - - -- - - - - - -- - - - - - - - - -
12 O/H rear bumper 1 . 8
13 Repl Bumper cover w/dual exhaust 1 402 . 00 Incl . 3 . 0
tips
14 Add for Clear Coat 1 . 2
15* R&I RT Reflector Incl .
16* R&I LT Reflector Incl .
17# Rpr TINT COLOR 0 . 5
18# Rpr COLOR SAND &. POLISH 1 . 0
19# Repl FLEX AGENT 1 8 . 95 T
20# Repl COVER CAR . 1 8 . 95 T
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - -- -- - - - - - - - - - - - - -- -- - - - - - - - - - - -
Subtotals =_> 502 . 15 5 . 8 7 . 3
Parts 484 . 25
Body Labor 5 . 8 hrs @ $ 73 . 00 /hr 423 . 40
Paint Labor 7. 3 hrs @ $ 73 . 00 /hr 532 . 90
Paint- Supplies 7 .3 hrs @ $ 32 . 00 /hr 233 . 60
Sublet/Misc. 17 . 90
--- ----- - -- - --- - --- - - - - -- - - - -- - - -- - - - ---- -- - - - - - - - - -
SUBT OTAL $ 1692 . 05
Sales Tax $ 735 . 75 @ 8 . 7500 % 64 . 38
- ----- - --- - - -- - - -- - - - - - --- - - - - - - - - - - - - - - - - - - - - - -- - - -
GRAND TOTAL $ 1756 . 43
ADJUSTMENTS :
Deductible 0 . 00
- - - - - - - - -- - -- - - -- -- - - - -- - - - - - - - - -- - -- ----- --- - - - - - -
CUSTOMER PAY $ 0 . 00
INSURANCE PAY $ 1756 .43
***AUTHORIZATION FOR REPAIR*** I hereby authorize SAVY AUTO BODY to repair my
vehicle per estimate along with necessary materials . You and your employees
may operate the vehicle for purposes of testing, inspection or delivery at my
risk. An express mechanic ' s lien is acknowledged to secure the amount of
repairs thereto. Storage charges will begin 48 hours after repairs have been
completed. I HAVE READ• AND UNDERSTAND THE TERMS ABOVE.
Signature Date
Registered Owner or Agent
2
01/14/2008 at 05 :40 PM Job Number:
44019 .
PRELIMINARY ESTIMATE
2008 DODG AVENGER SE 4-2 .41,-FI 4D .SED Int :
FOR YOUR PROTECTION CALIFORNIA LATA 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 O/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.
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from
the Guide DR3PM08 Database Date 11/2007, CCC Data Date 11/2007, 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 dea=ersrips. 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
MU:'OR 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
Rep].aceRent Parts. Used parts are described as LKQ, Qual Recy Parts, .RCY, or USED. Reconditioned
parts are described as Recon. 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.
3
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CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION:. FEBRUARY 26, 2008 .
Claim Against the County, or District Governed by )
the Board of Supervisors, Routing Endorsements.,. ) NOTICE TO CLAIMANT
and Board Action. All.Section referei
II I The copy of this document mailed to
California Government Codes. you is your notice of the action taken
JAN 2 5 2008M on your claim by the Board of.
Supervisors. (Paragraph IV below),
COUNTY COUNSEL given Pursuant to Government Code
AMOUNT: $250,000.00 or MARTINEZ CALIF. Section 913 and 915.4. Please note all
to be proven at the later time "Warnings".
CLAIMANT: FATEMEH MAHANL00
ATTORNEY: UNMOWN DATE RECEIVED: JANUARY 25, 2008
ADDRESS: 540 CANYON WOODS CIRCLE, AP'1$Y DB`)'✓VERY TO CLERK ON:JANUARY 25, 2008
#204
SAN RAMON, CA 94582 HAND DELIVERED
BY MAIL POSTMARKED:
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JANUARY 25, 2008 JOHN CULLEN,. r c
Dated: By: Deputy
II. FROM: County Counsel TO: Clerk of the Board of S ervisors
(0-this 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).
O 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: /r7Deputy County,Counsel
ill.. FROM: Clerk of the Board TO: County Counsel (l) County Administrator(2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
1 V BOARD ORDER: By unanimous vote of the Supervisors present:
This Claim is rejected in full.
( Other:
I certify that this is a true and correct copy of the'Board's Order entered in its minutes for
this date. .
__�QDated: c JOHN CULLEN, CLERK, By Deputy Clerk
WARNING ( ov. code section 913)
Subject to certain exceptions,you have only six(6) months from the ate this notice was personalty served .
or deposited in the nwil to file a.count action on this claim.See Government Code Section 945.6.You niay
seek the advice of anti attorney of your choice in connedloti wide this matter. iii'you want to consult an
attorney,you should do so immediately. *For Additional Warning See Reverse Side ofTlnts 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 prepa' certified copy of this
Board Order and Notice to Claimant, addressed to the-el"I s 9110 vn kbove.
Dated: b7r/n JOHN CULLEN, CLERK By Deputy
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INISTRUCTIONS TO CLAIMANT
A. A claim relating to a cause of action for death or for injury to person or to personal prop erty or-
growing
rgrowing 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.
■0o0aaaszffaaXMasa...........i■aREWSKERMEEKERREson anEXEMEOUREMREM RESKEREEREMRMal
RE: Claim By: Reserved for Clerk's filing stamp
aewe� iaa kay% ha
RECEIVED
Against the County of Contra Costa or/om )
Cpn{va&s J Gi JAN 5 cuu�
District) CLERK BOARD OF SUPERVISotiS
(Fill in the name) ) n CONTRA COSTA CO.
S? Ill e,S C L-n G{11 �'X�u�v► / C���e
6 r Cv S D 19(a) 7Y,t�y,e-d, Gid F�► -&t'K I
The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named
district in the sum of$ and in support of this claim represents as follows:
be Pvbve')l cam-' Ole hd-e4-
1. When did the.damage or injury occur? (Give exact date and hour)
A,-q A—0grg qty , D
2. Where did the damage or injury occur? (Include city and county) ,
�`�r� Cask-� Ca�.�� Yeyia'n�t1l ��u�c.� C�►�'-- .; 2'
3. How did the damage or injury occur? (Give full details;use extra paper if required)
4. What particular act or omission on the part of county or district officers, servants, of-employees
caused the injury or damage?
}'PGt.�it Z� l��°0'1� 1 � -t�'�� 1��5'�'►� �•Lp .
5 'What are the names ofi county or district officers, servants, or employees causing the
damage or injury?
Corp �Y,6L Cc S -G� Co u` l Co �-vot CSS c� {'��'i���,� `�►�er.GiC� C ,�-
vo I� Q w.
6. 'WL-at dainage or injuries do your claim resulted? (Give full extent of injuries or damages
cllaim�e�d. Attach two estimates for a/ut�o damage.)
74— / V
+c) LV P� n-nod W,0 �u�G'av► .G�;'�a. �t V c s`l�
7. How was the amount claimed above computed? t(Inycde the estimated amount of any
prospective injury or damage.)
8. Names and addresses of witnesses, doctors, and hospitals: l=r6161x1 &k AA ;A Y '
f
Cep.-►"w C , pct e� ,� s t j i q �S 8 Lia k e wt-fur, 1}�,� M G Sg 2D 5� , c 3o,�
9. List the expenditures you made on account of this accident or injury:
DATE TEVIE AMOUNT
a ME annaffirm amass a Nairn Ease 0 n Mass a same a it an K'amnsasnal
.Gov. Code Sec. 910.2 provides"The claim shall be
signed by the claimant or by some person on his
behalf."
SEND NOTICES TO: (Attornev) 1
Name and address of Attorney
ants Signature)
540 60n�o y1 14)00A Ct U/' fi ofi n41171
(Address)
Telephone No. ) Telephone No.
aaaerssresraaasMesa aamass esEssex aaasssaeeeesesrsNunn man aeaseasaasaassesamamaa2arsaa21
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
attaclunents, addendums, or supplements attached to the claim form, including medical records, are also subject to
public disclosure.
■soon aesssaaBananas araaassasrsaecas■■ssrseae+ear■■sasss+sssasaaaessraasas ss+s acs a as II
'NOTICE:
Section 72 of the Penal Code provides:
Every person who, with intent to defraud, presents for allowance or for payment to anv 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 v�Titing, 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.
3- in 07-31-2007 I had my basic mammography like every year. After a few days, I
received a letter by mail form contra Costa Regional Medical Center Martinez that-I had
to go for another mammography and ultrasound from my left breast. I went for second
mammography of my left.breast and ultrasound in 08-17-2007. They told me they found
a lump in my left breast, so they made an appointment for biopsy. I had my biopsy'in 09-
10-2007 in Martinez. After that they called me that my FNP Marcia Furtado wanted to
see me on 09-18-2007. 1 went by my son and Mrs. Furtado told me I have breast cancer.
Also, on the same day 09-18-2007 1 had an appointment by a surgeon, David H.C. ,
Raphael, M.D, in the same hospital after I was visited by Mrs. Furtado. Doctor Raphael
explained to me about my cancer and treatment. He said that I can have mastectomy or
lumpectomy but if the cancer did not spread to lymph nods.Because I was afraid, I chose
to go to a better hospital, so I went to the Stanford hospital and had appointment by
Frederick M. Dirbas M.D., surgeon, in 09-20-2007. After he visited me, he wanted all my
mammograms, and results of biopsy and ultrasound. For the next appointment by.him I
brought all mammograms from 2007 and results and medical records. After he visited me
and looked at records and mammograms, he'said this kind of lump must be more than 1
year in my breast, and he said that he believed I had this from last year or 2 years ago, so
he wanted my mammograms from 2006. For the next time, I gave my 2006
mammograms to him, and he realized the lump in my mammogram from 2006; he said it
was small. The problem is when I had mammography in 2006 in Martinez-hospital, I
received a note that everything is right, and my mammograms are ok, no lumps or
masses. The radiologist in Martinez did not 'realize my lump in my breast in 2006. Doctor
Dirbas said this one year gave enough time for cancer to grow. Alter that they made me
ready for surgery, and I had a special exam for realizing that cancer spread to my lymph
nods or not, and it was before surgery. The result was positive, and cancer spread to my
lymph nod. On 10-10-2007 I.had my mastectomy in Stanford, and they removed all my
lymph nods. Now I am under chemotherapy.since doctor Dirbas said this one year maybe
gave enough time to cancer to spread to any.part of my body. Therefore, the carelessness.
of radiologist, and other unknown people in this problem for 2006 increased the risk of
cancer effects inmy y body, and I had mastectomy and am in the bad situation now.