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MINUTES - 01082008 - C.25 (10)
CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 's 404r BOARD ACTION: dajutarq b LB 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: 2-`i 7'�'� + Section 913 and 915.4. Please note all �tt DEC 0 6 2007 "Warnings". ` CLAIMANT: ( Art* ATTORNEY: DATE RECEIVED: DPcen w Co, ?,607_ ADDRESS: f BY DELIVERY TO CLERK ON: BY MAIL POSTMARKED: Jbece� I =7 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN,Clerk ���e/;.�� Dated: r � - = By: Deputy .e 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. ( ,�-I'his Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: `� -7'o-7 By: /''?5� 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: (✓'j� This Claim is rejected in full. O Other: I certify that this is a true and con•ect copy of the Board's Order entered in its minutes for this date. Dat ,f CULLEN, CLERK, By Deputy Clerk WA ING ( v. code section 913) Subject to certain exceptions,you have only six(6) months from the date this notice was personally served or deposited in the 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 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 prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated. D OHN CULLEN, CLERK By `Deputy Clerk t This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief' such as, mandamus or injunction, or Federal Civil Rights claims. The above I'list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act OFFICE OF THE COUNTY COUNSEL SE L SILVANO B. MARCHESI COUNTY OF CONTRA COSTA $,�_" " �- "'��+ COUNTY COUNSEL Administration Building 651 Pine Street, 91h Floor �` • SHARON L. ANDERSON Martinez, California 94553-1229 '�' - _ CHIEF ASSISTANT / r ( ) 925 335-1800 yy GREGORY C. HARVEY C� �+i;�#IIti11�1 (925)646-1078(fax) VALERIE J. RANCHE a1_ X40"" ASSISTANTS OSpA_COU�� NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: GEICO DIRECT One Geico West Box 509119 San Diego, CA 92150-9090 RE: CLAIM OF GEICO, subrogee for Richard Clark Please Take Notice as Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910.2, or is otherwise insufficient for the reasons checked below: [ ] I. The claim fails to state the name and post office address of the claimant. [ ] 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [ ] 3. The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [ ] 4. The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. [ ] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. [✓] 6. The claim is not signed by the claimant or by some person on his or her behalf. Geico Direct Re: Claims of GEICO Page Two [ ] 7. You are required to submit your claim on the proper form, which is enclosed. Please resubmit your claim on the enclosed form, including all the required information. Gov. Code, § 910.4. Please be aware that you have only a limited period of time in which to file an amended claim. See Gov. Code, § 910.6. [✓] 8. Other: In response to your letter of December 4, 2007 to our office (copy enclosed), we enclose a copy of the Claim and supporting documentation sent from Geico to the Clerk of the Board for Contra Costa County on November 15, 2007. Geico sent an identical claim (unsigned)with duplicate documentation to the Clerk of the Board on December 4, 2007. You may be able to elicit the information you seek from the claim you sent. Thank you for your attention to this matter. Please do not hesitate to call our office should you have any questions. SILVANO B. MARCHESI COUNTY COUNSEL By: Monika L. Cooper Deputy County Counsel 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 12 - I L7 ,I served a true copy of this Notice of Insufficiency and/or Non-Acceptance of Claim by placing the document in a sealed envelope with postage thereon fully prepaid, in the United States mail at Martinez, California addressed to Geico Direct,One Geico West, Box 509119, San Diego, CA 92150-9090, as set forth above. I 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 12 :2- D 7 at Martinez, California. athleen O'Connell cc: Clerk of the Board of Supervisors(original) Risk Management iuuv. i. tun/ 1: I d Ni G KM MANAGEMEN I NO. 135 P. 7 M, s BOARD aF STjTF Sa S o CpNTkA COSTA COUN`T`Y z�vsrxuCTloNs a cLARYL U A. A claim relating to a cage of action for death or tot injure to person or to personal property or growing crops 'shall be presented not later than six months after the accrual of the carie of action. A claim relating to any othez cause o£action shall be,presented not Tater than one Year . after the accrual of the cause of action. (Gov. Code § 911.2,) laims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, B. C County Administratian Building, 651 Pine Street;Martinez, CA 945 533. C. If claim is against a divtnol governed by the Board of Supervisors, rather than the County, the .name of the District should be filled im J7, If thes claim is against more than one public entity, separate claims must be filed against each public Gntity. E. Fraud. Sea penalty for fraudulent claims,Penal.Code Sec.72 at the end of this fornL c■[ Ran am 21RARKMEMK[■R[[�■LR■EIl[1 [[[[�K[l�[RlEcccc cl[[[[a[F[clZ F[it RE; Claim By. Reserved for Clerl-'s filing stamp >l� G Sy , s RECEIVED Against the Co t5'of Contra Costa ) DEC 0 6 2007. ?i'14 D�ct) CLERK BOARD OF SUPERVISORS the name) CONTRACOSTA CO. The undersigned claimant hereby makes Claim amt the County of Lantra Costa or the above-named district in the sum of$.,2 / and in support of this claim rapresents as follows: - e�vr7� �aea�e�dates and how 1. When zd e damage or 2. Where did the damage or Wury occm'4 (Include city and coon ) 3. Ifow did doge or iWilry occur' (Give full details;use extra paper if required) 4. What-particular act or emission ou the part of aomty or district ofcers, Sawants, ar =ployees caused the injury or damage? —� � uJ�S'� f z-e-- b'rGn C'vn \off t -K- nc) )-Vc. 5�D)P 5�� Y► 5 What are the names of county or district officers,servants,or employees causing the damage,or injury? �►'� CJ� L U��5 ) �. - NVY. I. LM L. IOfIYI I,10i nt%)n IYIMIIMUUYILINI yam• IJJ J ae or in}uxies do your claim resulted? (Grive full e�:tcnt of injtuies or dama.es 6. what danlab claimed. Attach-two estimates far auto damage.) - I�S v . p-u t ofany� a� _7, How was the amount claimed above Computed? (T.nelude the estr � prospective injury or daiage.) S, dames and addresses of witnesses,doctors,and hospitals: r ilij'UY 9. List the expenditures you n3dc on account of this acrid t o DATE F- m l i l l[K!L 1 1/r!! Y<![■i R f!Xmas I a A R 1 M 1 K K iRam a[f YSWR a K!R ! R [ 1!!!! ![Y! !R !f[4!c! K[[l i[1 a } _Gros,.Code Sec. 910.?provides"The claim shallbe signed by the claimant or by some person on his behalf." SPND NdTICES TpAttome .�� Name an"d address of Attorney j _ ) (C1a.;m.ant's signat�) (Address) ) Telephone No. Telephone No. kl![&[K llyKll T=!\1MiL1 1'1[}.1i[1l1 KK1l Rf1R 1f■KlRlt[![[[[![!!1RliR![[1aw![R1[Kl111!l�ilf PUBLIC RECORDS NOITCE: er the Tart G]RimS Act,is sabject to Please be advised that this Ielaim farm,or any claim filed with the County F�ermore, any public d'isclo=-o under the California Public Records Act (Gav inc uCod�ng§ medical re6500 etcords, ate also subject to attachm ts,addendums, or sezpplernmtr attached in the claim faxen, public disclosure. . R R !RAK ,{ l� 111■[!IR!!1• ■�11lM1 IsKa9it k[!R ! lif■[Li[11[![1[!R[■R■1 K![ ■■ aiF1{�L! iKli !■■!1 111 NOTICE: Section 7Z of the Penal Code provides: present for allowance or for gaYme�nt to any state board or officer, or Every person who,with intent to defiaud,pr the same if trenuine, any fake or to any oaunty, city, or district board or o$tcrs, authorized to allow or paY smmmmt in the County jail for a fraudulent claim,bill, account voucher, or wr4n&is punishable either by unpn or both such pen of not more than ome year, by a fine of not axceo&g one tbLou=d dollars ($1,000.QAn,thabusaad dollars p im risonment in the state, pHsob, by a fine of nat exceeding i imprisonment and fine, or by F ($10,000),or by both such imprisonment and fine. I x . f �Y pap 7717, ash s �+ A 1 "w a ., ��.t r d�.e'er✓-`. %i'�.1' � � i�f fir,... Ys v� Pe`val � � F��� ' ', � .. a v rs�� � � f�s ✓`�r�il'€� � '�'*l '���sd 4���k �' s 01 L� x:r 'i s � g l i <s �F } s�Y T MAN of ity 4 r r. Wi i f y a. fitar s f it ` ? , xfti va e "MM lF I a p V �r Of Ala � r a. awl r � jowl a r � a -40 a s n �iM a g F � x' i x•, i�_.; is 3i--$, ,_� ax f L I a 8 xs ter; ` �.: 09-05-07:02:01PM:DTG Subror^Tion :9186692735 # 2/ 13 ' � K'pis � ' i:. .•�. R E N T A L A R September 4, 2007 G E 1 C 0 DATE OF LOSS: 07-21-07 OUR CLAIM # : 573178 CLAIM AMOUNT: 58461.51 YOUR CLAIM .#i 0013407440101139 r YOUR INSURED: RICHARD CLARKE Our records indicate that our rental vehicle was damaged Aile• in the possession of your insured. Finding-that the renter is insured for this incident, we expect that payment will be remitted .in full for the above claim amount. Pldase contact me within three (3) days of receipt of this' Letter. Estimated Cost of Repairs: F 7796.51 Diminished Value: S 0.00 r Loss of Use: $ 0.00 Calculated as o days o@S34.99 Towing: $ 515.00 : Administration: $ .150.00• Appraisal Fee: $ 0.00 Tax: $ 0.00 TOTAL CLAIM AMOUNT S 8461.51 1 If the Total Claim Amount includes the Estimated Repair Cost, .we will•receive invoices for the parts, parts delivery and repair charges. if the total is less than the payments received -from you for the estimated cast of repairs, we.witl refund the difference to you. -I'f our supplemental costs are greater, you wilt be bitted accordingly. The toss of use, noted, is calculated by dividing the number of repair hours by five and -rouriding. it to the next highest number times the daily. rate. This represents the nurber of days this vehilce isunavailable to us while the car is undergoing necessary repairs. If you are' in agreement with our position as set forth in this. letter and would like to resolve this matter at this time, please remit payment in full referencing our account number. Make checks payable.to DTG Operations, Inc. and . send to the address on this document. Feet free to contact me at 1-800-832-1141, Ext. 2322. Sincerely, JESSICA Y Zdperu�na%co e y Agent�orldwidc Reservations Subrogation Dcpartaicnt 800-800-1000 Enc: tit• rt Rental Agreemerft�ufj,7if9%te, Photo(s), Tow Bill RI 'D.-Ian,OK 74182 918-669-.34.52 Fax 918-669-2733 rlaimaervirr.QdLzc.cam wDINDExit 27447_22072107 CNT001 ,-- „- . u 1 u zuur use ' i un ;9186692735 # 3/ 13 Accident/Damagallncldent Report DTG Opomdoas'Inc. LncaUofif Vet11c►e Reporti Ci # Rap�olll� Renting i MAI-age: Vin# UniW�g t jDense_ _Pfdtao�a Stat Year/Nleke/ModeC �. .,I LDW on RA? SLI: / UMP Otharb 7 Com"T�'� u Yes No Yea o Yes No Area Damaged: Driver Information Circle one: Renterl Auttrorized Driver / Employee /Unauthorized Name. l=mptoyee# Location# 1 Mailing Addfcss: i Cay. Smote: ZVPestal Code: Country: M Date f Birth PQqW P fk. Work Phone A: Cell Phone# Emall Address: Lyz0a -- o - - . T et s Linee#/State: Expo date Citation If-wjod? If citation issued,describQ of(ortsa ! Yes I r-s nce Company I Agent! hone# / Clalm#: 1 _ y, o _ Credit Card InsuranceCarrier/Card Type/Phone A Claim# - ter Name(Iditfarent Dri fver)' Address I City/Zi Postal Coda I StAWProvince/Country. Ilion'. irtsu nce Company/Agent/Phone# Poticy/Claim 9 Credit Cerd insurance Center/Type/Phone it Facts of Lots Cirdeap pfl ale r1pe of rentat agreement; R ular/Tour/Cogwate I Government I Employee Oste of Time: Location of Accident: Ci /Stats/Province Police Re r : PrlU Report# Police Depanmenl f f'reclrxl: Potoe Department Phono tt: umber or Occup i Car, ea No -7 G� 2� Injurias? List all involved In lhla accident• Describe How Accident Happened: �- 10 s » ,_A 7• Other Party Circle Ono: Owner /Driver/Passenger!Petlostrian/Em l0 0o Name: Home Phone# Omer Pnone P. Address_ Street I Apartment#I City I State /Province I Zip 1 Postai Code I Country Odvaes License#I state Data of Birth Vehicle Year I Make 1 ModeL- Plate#/State: Insurance Company/Agent/Phone#: Policy d/Claim#: Citation Issued?: #of Occupants In Car Yes No Additional Information Circle One: P'assert r/ Pedestrian /Witness I Claimant I Ownor I Attorne Name: Phone# Other Phone It Address:: Street/Apart rient#I City I State [Province / Tip /Postai Code If inju 71d4 The Injuries: N o nt81 @ s nature below,the undo ' 0 a es that they heVe read the notice on the reverse of this tone. $ na e: R I Drivel• Decell- Signature-Reportin pilo rt,? rO _ Questions or CQncema with your Acrident/•DamaWriddent event can bo sena via entail to Ciolmservice@dtag-Qom or mailed to D G Operations,Inc., Subrogation,5330 East 315t Street Tulsa,OK 74135. PAYMENT'S SHOULD BE SENT TO: Dept 827 Tulsa,OK 74182. Claim Service Phone#:800432-1141. FW#i.-9113-869.2733 GA0072 DTG RATIONS,INC 0107M75 Distribution:White: FAX and location Yellow: Place In vehide Piny Renter Copy ' Yellow Areas-Must be completed by the-Customer Blue Areas-To be cornpletod by the Customer N applicable Green Areas-Must be completed by the DTG Reporting Employee 7Jtaifge/ignd';(lfo� ua-un-ui;uz:uivm;uiu Sunror^tion ;9186692735 # 4/ 13 Rental Location �lehlde klfofm&9on Retied Ex0(ree-On. 7 RHARTD%dba Df>LLAR RENT R tziRLLIIC.4:94 STALL11i 1044 0 JU;s007 8808 F F&%484-4 CD OMMAO 87 WDGE GRCAMPA { eRatumedTo.Ab0WLKfttStated Below Ratei REUD31DIst XUAR 919033 TIME OT TIME IN EUS. LOM I11Tr FULL 111120V 1981 lSIiZW OUT i 5659 ENT[&.RAT11"T C#8. — QD11TMIii AtJ>f IS RESAON- Fi:ss • 34.99% e s 139.96 L . PER T1 ittitd slycastamtuirilor anon LI te Tag 8.750%§ .. IiiEiLINED t1g MUFAE ILGO I.teRISN i R. AQOME.DGE YLU • HEM � 182.62 to LINKS LN D NED THE ABOVE OU ARE X111 FELT OUR NMUN@ 9ERUN i{O 21811 I#lVE VEO 1MATIMS. IE FAIT. 13 PA YOUR 7630 ISO Sl8I12ale 418-x'.06-9481l3i: M L.DSi lig1G IEKET(£), ID TADOIL DRIVER: Nana MED ITATI1 WILL PE REI. X AcsKAY iM CNG MY�MR5 CREDIT CARO AUIHORIIATI(MIM DEPOSIT yIl�e+H�iliE#;�52$3/05546B/ 350.08lA1�/17 PH CALIFORNLA-NOTIcE TO RENTERS A per,hour rate for late returns is dtarged right after the start of new Rental bay. re You aresponsible for II coliision damage to the rented Vehicle even• if someone eNe causeo It tar'thd cargse th yntmown.You aye•respon- sible for the cost of repair to to the value 0 the Vehicle,.and towing, storage and Impound fees. ourotini lnsurancp,or the.issuer of the credr' It card You use to g mp pay.forfhe CaF reiltAl tranr3actlorh,rrtay cover 811 or part of Your ilnanciaf resppon�ibifity4or the rented Vehicle.You Whtii,ld chG*with Your Insurance company, or credit card issuer,to find out aboutYqqur coverage'and'tho etnount of the doductible,•If arty,for which You'My be liable.Further, If Ypu use a credit card that provides coverage forYour potential liabliity,•You should check with the Issuer to deter- mine it You must first exhaust coverage I'anits of Your own Insurance before the credit card coverage applies. LVW does not apply if,(1)the damage or loss results frpm Your til intentional willful,wanton or reddess conduct, 1p operation of the v9hi- ole under.the influence of druggss or alcohol In vivlatior7 of secdorr 2 1.52 of the WhIcle Code (SIF)towing or puthin a htng, or(iv)operation of the vehlde ort an unpaved-,road If the damage or loss is a direct result of the road of drWing,c�ndltEons,, 2) he aatthage or-loss occurs while the vablcle is used(1)for commercial•hire.nl)In neotlon with conduct that could be properly.charge as a fa ony,or.(W)is Involved. In a speed test or contest or In delver training a ty; operated�y a person other than an Authorized EYrivex,(4 operated outside of the Lfiited States;,or(�You It >ov)ded fraudulent Information to the Company or(N)provided'false inforrnation and he Company would not have rented the Vehicle If It rtad Instead repeived tTus Sniormation.`Authorized Ddyaro means_(1)'the Renter;(2)the Renters spouse If that person is a licensed driver and satisfies iihe Company"s minimum age re uirement;(3)the I�ertters emptWer or co-wbriaer If they are onja d, In buSinesa activity with the•Renter,are licensed drivers,and satisfy.th�Qompany's minimum age-requ cements;ancr(4)any persorx Itsted by the Company on the rental agreement as an authorized driver. The cost of optional LDW is$—-...to$ for everyday,depending upon the,vehicla rented. These terms supersede any conflicting terms stated elsewhere. rtw RwAwJAi9qTnMW but~the undere.pnaa end the wnpW IdaMded 000* eComparhl}.By 9XIALM beWK the underatprnd edmowladgba end reprem Ve that4hey aro letwty aufho,tMd to operate Ne rerM velddo w and that#"two read ared.aprao to ma temw,ow d gurw and nodoes.Dont gMftc'ana-wrAon,mamxfhp.that=Damage Wawa.K manor,mol appear on Itta rlaoial slalemeN aro on tM aepamte ranfai bhowtwwoad.hwahTHE UW,) 3lWdM&'arO=THCVWPANYTOPf=CC 4AWMQETOTtioRCRE9fLDM'F0A•OW Qf1C RD44n•EAMOUNr8PECtFEDABWL MR WS. RffMIW- t+1 BELOW AND FOR ALL ADDMUM OWOM DUE UPON WWRN OP711E VEFlME.ALLCHAHGIM eUBJt CrY0 AWM No addfdnst dthhra re.pertnitted WhM%rt¢u camparh/e oppnml. K RENTER X ADOMONAL Dt3NER u.v-uzj-u1 .uj.uirm;uiu juorop--jon # 5/ 86692735 13 -. ti- - : - - - - - .:i:. •:• - - •:n:• ''�:i.i:ni'• .:y.� _ YaHARF..•¢'FIHWY.: _ ,.:_..:_- P ,(4_5b92�i2QQ r•p LOG Nf0 5'x'08... 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A,y '� '' :':�•:. ::, '�' � 4 �r.i �rtt �'�'�tfA�r.r'.Mi•S .. i Yr;}f...•.!ti. ,r...:: 'i� 't'Mt�,,`+k/i��e�iyA a ia��6 i yi i- >.. : �, .._.y..+-;w,F .g,+�w'tir(y` .:j � 'F.. - ML a Idrai }a}k ,. a :�(�°"')"�•�`!^�.�p:.�:i w^�.r.y,,, �IIIUI�I{���I�IIII Account No. 31405 GEICO-CA EM Attention: 03B150 , GEICO Customer Service: Metro Reporting Customer Support 1-800-245-6686 or help@metroreporting.com Metropolitan Reporting Bureau 13ox9Z6, William Penn Annex Philadelphia, PA 19105-0926 Type of Report: AUTO ACCIDENT INSURED RICHARD CLARKE CLAIM NUMBER: 0013407440101139 POLICY NUM. : Time: 09 :20 A DATE OF LOSS: 07/21/2007 LOSS STREET WILLOW AVE LOSS CITY HERCULES , CA POLICE DEPT. : HERCULES PD PD REPORT NUM. H07-14727 INS. DRIVER UNK UNK OTHER DRIVER: DOLLAR RAC PCT. /DIST. VIN NUMBER PLATE/TAG # : 5ZJ040 DRIVER # : DOLLAR RAC THANK YOU FOR THE ORDER! Any questions or problems please feel free to contact us. PH. (800) 245-6686 or HelpOMetroReporting.com L *5034062051* ^� STATE OF CALIFORNIA TRAFFIC COLLISION REPORT CHR 555 Page 1 (Rev.7-03) OR 061 Papa , of SPECIAL CONDITIONS --BE- CITY .NOICIAL DISTRICT LOCAL REPORT NUMG[R wuRen FELONY RuwcR aLLEO RIT&RVR COUNTY REPORTBJG DISTRICT BEAT 14-707 COLLISION OCCURRED ON MO. DAY YEAR TIME R� NCIC OFFICER ID. Z iA�t�Lc�w ���t�u� _7 2 t o7 �qI o�� 3q p MILEPOST INFORMATIONDAY OF WEEK TOW AWAY PHOTOGRAPHS BY: ❑NONE UFEETIM,IES Of S M T W T F�S YES ElNo .�- //-- 1 � � '��1� J ,- Q ©AT INTERSECTION WITH \j)I t--w Q bt(_i 7-C STATE MYW REL O~ ❑OR: FEETIMKES OF ❑YES E] NO PARTY DRIVERS LICENSE NUMBER STATE ICLASS �AIRIIAGSAFETYEWIP. VEH.YEAR MAKEMOOEI/COLOR LICENSE NUMBER STATE 1 G q(DZ 73k i77 6-3v\1) l_ r]1 �t�6t CF I?- T>Ull.v jZ 3' p �0 Ca ----------- ------------ ---- DRIVER NAME(FIRST,MIDDLE LAST) © /�l--�: f_� e K l OWNERS NAME ❑ SAME AS DRIVER PEDES STREETAWRESS lr llT rs ��E t -�1 a 5 o1- DOLL-AL 'L WT A- COP— TRAINDES { ( ❑ `O L l 4`1 IG S OWNERS ADDRESS ❑ SAME AS DRIVER PARKED CITYfSTATE2� 7600 E A RN6'-T R.> OF r-�N 9 CA VFJIICLE (� ` � � \V�``L,.`'L�.T 1.1,� Y`nt Z i l DISPOSITION OF VEHICLE ON ORDERS OF: 0 OFFICER n ORNER ❑OTHER BICY- SEX HAIR EYES HE(3HT, ` MG14T BIRTHDATE RACE .�,F`t f) CU4T ` r 1 T". r T/ I7'V k G���,.J u12�„• �,� l 3 2 1}3 t'� '?�C� lav PRIOR MECHANICAL DEFECTS: � NONE APPARENT n REFER TO NARRATIVE OTHER HOME PHONE f 1t p t R Vr� /'� BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER:d�t`(•`G.D L�(i l rf 1"1 C� (�to) I q - V„! lJ �A 5 • `g rY ,VVEEHICLE TY/PEE� DESCPoBEd VEHICLE DAMAGE SHADE IN DAMAGED AREA 0 LINK ONE E]MINOR INS'JRA`El C"I�} OC-111 -7q 5( POLICY `- : a ©MOO. ENMAJOR❑ROLL-OVER DIRCOF TRAVEL ON STREET OR HIGMNAY \ SPEED LIMIT ODOT L)t L L O ;Y' N i.. L 1 CAL-T -TCP/PGC MGd7[ PARTY DRIVERS LICENSE NUMBER STATE CLASS 1,1111 BAG ;SAFETY EQUIP. VEH YEAR MAKE/MOOEUCOLOR LICENSE NUMBER STATE 22ar p�gJ ; n 2 l� t a_ �'r G ! i � --�.---•• .......................................... . ..C.�... DRIVER NAME(FIRST.ArIDOLE LAST) 1 a �P�. �C-, 1 L L J(^ tl'�1 C OYMER*SNAME ❑ SA�ME AS DRIVER PODES STREET ADDRESSTRIAN p-i" bVL ` j,IVLWtLL L L.l 5 O '.TSF OF r-�1 i S C�+J(-Irr OWNERS ADDRESS SAME AS DRIVER PARKED CRY/ST1AJTEaIP VEHICLE ❑ i.utJ C U DISPOSITION OF VEHICLE ON ORDERS OF: OFFICER DRIVER ❑OTHER gCST SIX JHAIR JEYES WEIGHT WEIGHT BIRTHDATE /: t Mo. Pay riar i `bV- l 2 0 �. Z a PRIOR MECHANICAL DEFECTS: j` NOAPPARENT REFER TO NARRATIVE OTHER HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER: 'r 1/`C• CJ 3 ❑ (SID) -7 C - LA 1 V7 ^J J 2 • VEHICLE TYPE DESCRIBE VEHICLE DAMAGE ! �P SHADE IN DAMAGED AREA MURANCE CARRIER POLICY NUMBER ❑LINK []NONE [:]MINOR F T\�M E 25 q � �5(CJ'�L`. 14 ,; 3 1 Z MOD. []MAIOR❑ROLL-OVER OIR OF—L ON STR T(OR HIGHWAY (t, :ED LIMIT CA C � Atf.",_b��J A,\j ` t l' DGT rr 1 CAL-T TCPR6C MCMC_ PARTY DRIVERS LICENSE NUMBER STATE CLASS JAIRBAG 1SAFETY EQUP. VEH.YEAR AWff1M00EUCOLOR LICENSE NUMBER ---------------- ---- ---JSTATE- 3 ---------- DRIVER NAME(FRST,WO LF-LAST) ❑ / OWNER'S NAME ❑ SAME AS DRIVER/ PEDES- STREETADDRESS TRIAN OOVONER'SkDDRESG SAME AS DRIVER PARKED CITY/STATEMP VERICIE ❑ "=POSITION OF VEHICLE ON ORDERS OF: ❑OFFICER❑DRIVER❑OTHER BICY- SEX HAIR EYES FEICHT WEIGHT BIRTHDATE _-RACE' CLIST W. Dry rYsa 7 7f 1�-' PRIOR MECHANICAL DEFECTS: NONE APPARENT REFER TO NARRATIVE OTHER HOME PHONE BUSINESS PLONE— VEHICLE IDENTIFICATION NUMBER: OVEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER ❑UNK []NONE MINOR _ ❑MOD. ❑MAJOR D ROLL-OVER DRi OF TRAVEFONSTREET OR HIGHWAY SPEED L"IT CA - DOT -�� / CAL-T TCPIP6C MGMK_ PREPAREgSNAME /� DISPATCH NOTIFIED REVIEWER'S NAME - DA:17A� YES ❑NO ❑NIA 0555 703.fro STATE OF CALIFORNIA TRAFFIC COLLISION CODING CHF 555 Page 2(Rev.7-03) OPI 061 Papa 2 or Z DATE OF COLLISION(110. DAY TEAR) TIME olm NCIC s —ICER I.D. - NUMBER -1 - 21 '(::-,-1 0 610 l39 1 727 OWNERS NAME OWNERS ADDRESS NOTIFIED PROPERTY DAMAGE DESCRPTIONOFOAMAGE ❑YES [] NO SEATING POSITION SAFETY EQUIPMENT INATTENTION CODES Oq; PA L-AIR BAG DEPLOYED M IC BICYCLE-HELMET A-CELLPHONE HANDHELD ^ A-NONE IN VEHICLE M-AIR BAG NOT DEPLOYED DRIVER PASSENGER B-CELLPHONE HANDSFREE 8-!UNKNOWN N-OTHER V-NO X-NO C-ELECTRONIC EQUIPMENT C-LAP BELT USED P-NOT REQUIRED W-YES Y-YES D-RADIO/CD D-LAP BELT NOT USED E-SMOKING 1 2 3 1-DRIVER E-SHOULDER HARNESS USED F-EATING 4 5 6 2 TO 6-PASSENGERS F-SHOULDER HARNESS NOT USED CHILD RESTRAINT EJECTED FROM VEHICLE G-CHILDREN 7-STATION WAGON REAR G-LAPISHOULDER FARNESS USED 0-IN VEHICLE USED 0-NOT EJECTED H-ANIMALS 8-REAR OCC.TRK OR VAN H-LAPISHOULDER FARNESS NOT USED R-IN VEHICLE NOT USED 1-FULLY EJECTED I-PERSONAL HYGIENE 7 9-POSITION UNKNOWN J-PASSIVE RESTRAINT USED S-IN VEHICLE USE UNKNOWN 2-PARTIALLY EJECTED J-READING 0-OTHER K-PASSIVE RESTRAINT NOT USED T-IN VEHICLE IMPROPER USE 3-UNKNOWN K-OTHER U-NONE IN VEHICLE ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK(-)SHOULD BE EXPLAINED 1N THE NARRATIVE. PRIMARY COLLISION FACTOR TRAFFIC CONTROL DEVICES SPECIAL INFORMATION 2 3 MOVEMENT PRECEDING LIST NUMBER 1 OF PARTY AT FAULT 1 2 3 COLLISION iA VCaECT1DHwu Ep. CITED YES xr A CONTROLS FUNCTIONING A HAZARDOUS MATERIAL A STOPPED 2.2 7 5 O B CONTROLS NOT FUNCTIONING' B CELL PHONE HANDHELD IN USE X B PROCEEDING STRAIGHT OTHER IMPROPER DRMNG': C CONTROLS OBSCURED B C CELL PHONE HANDSFREE IN USE C RAN OFF ROAD D NO CONTROLS PRESENT/FACTOR' D CELL PHONE NOT IN USE D MAK�ING RIGHT TURN C OTHER THAN DRIVER' TYPE OF COUJSION E SCHOOL BUS RELATED X E NG LEFT TURND UNKNOWN• A HEAD-ON F 75 FT MOTORTRUCK COMBO F NG U TURN $ S10E SWIPE G 32 FT TRAILER COMBO G BACKING C REAR END H H SLOWING/STOPPING WEATHER RK I TO 2ITEMS 7'D BROADSIDE I I PASSING OTHER VEHICLE X A CLEAR E HfT OBJECT rN J CHANGING LANES $ CLOUDY F OVERTURNED K PARKING MANEUVER C RAINING G VEHICLE/PEDESTRIAN L ENTERING TRAFFIC D SNOWING H OTHER': M OTHER UNSAFE TURNING E FOG/VISIBILITY FT. N XING INTO OPPOSING LANE F OTHER`. MOTOR VEHICLE INVOLVED WITH 0 PARKED IG WIND A NON-COLLIStON P MERGING LIGHTING B PEDESTRIAN Q TRAVELING WRONG WAY A DAYLIGHT 1C C OTHER MOTOR VEHICLE 1 2 3 OTHER ASSOCIATED FACTOR(S) R OTHER B DUSK-DAWN D MOTOR VEHICLE ON OTHER ROADWAY (MARK I TO 2 ITEMS) C DARK-STREET LIGHTS E PARKED MOTOR VEHICLE A -"'T"`'�wolwrarc CMD E] YES D DARK-NO STREET LIGHTS F TRAIN X v T5 o D E DARK-STREET LIGHTS NOT G BICYCLE �c SECTION�wu* u ea FUNCTIONING' H ANIMAL B OYES LJw SOBRIETY-DRUG ROADWAY SURFACE C ��C1OM1�A^0� 'I 2 3 PHYSICAL A DRY J FIXED OBJECT_ O NOS (MARK I TO 2ITEMS) B WET A HAD NOT BEEN DRINKING C SNOWY-ICY j OTHER OBJECT: E VISION OBSCUREMENT: B HBO-UNDER INFLUENCE D SLIPPERY(MUDDY,OILY ETC. X F INAITENTfON•: C HBO-NOT UNDER INFLUENCE' ROADWAY CONDITIONS) G STOP S GO TRAFFIC D HBO-IMPAIRMENT UNKNOWN- (MARK 1 70 211EMS) pEDE67RIAM5 ACTIONS H ENTERING I LEAVING RAMP E UNDER DRUG INFLUENCE' A HOLES,DEEP RUT' 1! A NO PEDESTRIANS INVOLVED I PREVIOUS COLLISION F IMPAIRMENT-PHYSICAL- 13 LOOSE MATERIAL ON ROADWAY- B CROSSING IN CROSSWALK- J UNFAMILIAR WITH ROAD I IG IMPAIRMENT NOT KNOWN C OBSTRUCTION ON ROADWAY• AT INTERSECTION K DEFECTIVE VEH.EQUIP.: CITED )<I X I 1H NOT APPLICABLE D CONSTRUCTION-REPAIR ZONE C CROSSING IN CROSSWALK-NOTs. ❑YEs ( SLEEPY(FATIGUED' D NO E REDUCED ROADWAY WIDTH AT INTERSECTION F FLOODED' D CROSSING-NOT IN CROSSWALK L UNINVOLVED VEHICLE G OTHER*: E IN ROAD-INCLUDES SHOULDER M OTHER': H NO UNUSUAL CONDITIONS F NOT IN ROAD N NONE APPARENT G APPROACHING/LEAVING SCHOOL BU3 O RUNAWAY VEHICLE SKETCH 1j I VIE P01 �"E I qMISCELLANEOUS �O II INDICATE NORTH •7. _ V-1 i _----- � d WJ L_LaW 9V CE W1I '; OSP 03 79147 STATE OF CALIFORNIA INJURED!WITNESS 1 PASSENGER CHP 555 Page'3(Rev. 1-03) OPI 061 Page 1 of 4 DATE OF COLLISION(MO. DAY YEAR) TIME 12400) NCK:N OFFICER I.D. NUMBE -7 a► 0-� meq ,? es-7 oc� iZ)9 Fjd-� - ►�❑ �-7 WITNESSPAssENDER PARTY SEAT AIR aAF EXTENT OF INJURY("X"ONE) INJURED WAS("X"ONE) ONLY ONLY AGE SEX EJECTED FATAL SEVEREOTHER VISIBLE COMPLAINT DRIVER PASS. PEO. BICYCLIST OTHER POS. BAD EQUIP. INJURY INJURY INJURY OF PAIN 0# © �� [_ 1:1 ❑ ❑ ❑ ❑ CD ❑ ❑ ❑ 1 s i o NAME 10.0 B.IADDRESS 1 In TELEPHONE CF. RP �hlt) ;z!c LINKS BEyLII-t wo rt (� (5I�>7Y1 Sol (INJURED ONLY)TRANSPORTED BY. TAKEN TO: DESCRIBE INJURIES ❑VICTIM OF VIOLENT CRIME NOTIFIED ©# � ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1-7- - - o NAME ID.O.B.I ADDRE TELEPHONE F,0"1 .L I) Wu Tc ;� I I� �� � F��'� , .. t F-- iac'3 `5 CNA `e-15L4 CSIol �LIS --7734 (INJURED ONLY)TRANSPORTED 13Y: TAKEN TO: DESCRIBE MURIES ❑VICTIM OF VIOLENT CRIME NOTIFIED NAME 10 O.B.I ADORESS TELEPHONE (INJURED ONLY)TRANSPORTED BY. TAKEN TO: DESCRIBE INJURIES ❑VICTIM OF VIOLENT CRIME NOTIFIED ❑#_ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ NAME I D.O.B.!ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY. TAKEN TO: DESCRIBE INJURIES -CTiM OF VIOLENT CRAZE NOTIFIED ❑# ❑ ❑ ❑ 101010. 1 ❑ ❑ NAMEID.O.B.IADDRESS TELEPHONE QNJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES ❑VICTIM OF VIOLENT CRIME NOTIFIED ❑# ❑ ❑ ❑ ❑ ❑ ❑ FO ❑ ❑ ❑ NAME 10.O.B./ADDRESS TELEPHONE (INJUREO ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES ❑VICTIM OF VIOLENT CRIME NOTIFIED PREPARERS NAME I.O.NUMBER MO. DAY YEAR REVIEWER'S NAME MO. DAY YEAR ASC) t3`t 7 GS7 I a Narrative Page 1 DATETIME - TYPE. OFFICERAD CASE NO. 7/21/07 0918hrs Narrative 139 H07-14727 1 NOTIFICATION: 2 On 7121/07 at approx 0918hrs I was on patrol, driving southbound on Willow Avenue at 3 the intersection of Viewpointe Drive. I saw two moderately damaged vehicles at the 4 intersection that had just been involved in a collision- 5 6 INVESTIGATION: The first vehicle I saw was a Toyota (Vehicle-2, V-2) that was 7 stopped on the northbound side of Willow Avenue facing westbound. I saw the 8 passenger side rear had moderate damage on the fender well. Several citizens were 9 assisting the occupant for the possibility of her being injured. I immediately requested 10 RHFD and AMR be in route for a "Vehicle collision, injuries unknown". 11 12 Just east of V-2 was a Dodge (Vehicle-1, V-1) that was stopped facing southbound on 13 the center median of Viewpointe, partially blocking the westbound lane. 14 15 1 saw a WFA who was crying and standing next to V-2 who stated she was the driver. 1 16 asked if she had any injuries, she stated her left arm was "Burning" (possibly from her 17 air bag deployment). Other than being visibly shaken and the redness on her forearm 18 she appeared to be OK. 1 asked if she wanted to sit in the rear of my patrol car and she 19 did. 20 21 1 walked over to V-1 to check the occupants for possible injuries. Both occupants 22 appeared shaken, but free of any visible injuries. Moments later, AMR and RHFD 23 arrived on scene, assessed both parties for injuries, and left. Neither party was taken to 24 the hospital. :NAME DATE PRINTED REVIEWED BY 'DATE BEASON 139 7/26/07 Narrative Page 2 DATE TIME TYPE �, OFFICER ID W.. CASE NO: - 7/21/07 0918hrs Narrative 139 H07-14727 1 All times, speeds, and measurements are approximate. All measurements were taken 2 by roller tape. 3 4 STATEMENTS: 5 Party#1 (P-1, Clarke) was located sitting in the driver's seat of V-1. P-1 declined 6 medical and stated the following in summary: He said he was driving V-1 at 35-40mph 7 (northbound on Willow Avenue) in the #1 lane. He saw V-2 making a left turn in front of 8 him. He said he slammed on the brakes as fast as he could, but could not avoid 9 colliding into her. He said the collision caused the Dodge to arch right approx 180 10 degrees until it struck the center median on Viewpointe. 11 12 Party#2 (P-2, Williams) was located standing in the middle of the intersection at 13 northbound Willow Avenue and Viewpointe next to V-2. P-2 stated the following in 14 summary: She said she was stopped at the stop sign in the left turn pocket to enter 15 Viewpointe from southbound Willow Avenue. As she began negotiating her turn, she 16 said she saw V-1 heading directly for her, but thought they would stop at the stop sign. 17 Instead of stopping, they drove directly into her passenger side. The collision caused V- 18 2 to spin 180 degrees before coming to a stop (in the middle of northbound Willow 19 Avenue), 20 21 Witness Statements: 22 Passenger (Pass-Clarke, Geraldine) was sitting in the front passenger seat of V-1. She 23 declined medical and stated the following in summary: She said she agreed with 24 everything P--1 stated and didn't wish to add any further other than she screamed prior NAME DATE PRINTED REVIEWED BY DATE BEASON 139 7/26/07 Narrative Page 3 DATE TIME TYPE OFFICER ID 7/21/07 0918hrs Narrative 139 EH:E] 1 to the collision. 2 3 Witness #1, (W-1 Whitewas located standing next to P-2. He stayed at the scene for 4 approx ten minutes until AMR and RHFD arrived. At the time I was unable to obtain his 5 statement so he gave me his contact information and left. I telephoned him later and 6 left a message for him to call back with his statement. 7 8 On 7/26/07 1 received a voice message from W-1 which stated the following: He said he 9 saw V-1 as it entered the intersection of Willow Avenue at Viewpointe (northbound). W- 10 1 said V-1 failed to stop and in addition appeared to be going faster than the posted 11 speed limit of 40mph. He observed V-2 conducting a left turn from Willow Avenue onto 12 Viewpointe when it was broadsided by V-1. W-1 did not state what his position was at 13 the time of the collision. 14 15 W-1 added he thought the stop sign, located on the curb line of northbound Willow 16 Avenue at Viewpointe, was partially obstructed by nearby trees and thought that may 17 have played a role in V-1 failing to stop. 18 19 SUMMARY: 20 P-1 (Clarke) was driving V-1 (Dodge) in the 41 lane of northbound Willow Avenue 21 approaching the intersection with Viewpointe. P-2 (Williams) was driving V-2 (Toyota) 22 and began negotiating a lett turn onto Viewpointe from southbound Willow Avenue. P-1 23 failed to stop at the stop sign and continued traveling in V-1 at approx 40mph. P-1 24 applied a hard brake application to V-1, but could not avoid colliding into V-2. The force NAME DATE PRINTED REVIEWED BY DATE BEASC 139 7/26/07 Narrative Page 4 DATE, TIME TYPE OFFICER 10 •CASE NO. 7/21/07 0918hrs Narrative 139 H07-14727 1 of the impact caused both vehicles to spin approx 180 degrees. V-1 came to rest in the 2 center median of Viewpointe after arching right approx 50-75 feet east from the area of 3 impact. 4 5 V-2 came to rest approx 25 feet from the area of impact in the northbound lanes of 6 Willow Avenue, 7 8 ADDITIONAL INFORMATION: 9 This area of Willow Avenue (both north and southbound) has recently been re-paved 10 (approx 2 days prior to the collision). All stop signs have remained in place. The 11 standard roadway markings (i.e solid white lines and the words "STOP") had been 12 removed or paved over. Instead, small approx four inch by two inch plastic reflector 13 tabs have been molded into the pavement where the vehicles are required to stop. 14 15 1 drove just south of the intersection and noted some trees on the east side of the 16 intersection (for northbound traffic on Willow Avenue) where partially obstructing the 17 stop sign. There are two stop signs at the intersection for this direction of traffic, one on 18 the east curb line, the other on the center median of Willow Avenue. 19 20 In an effort to avoid the possibility of future collisions occurring, I requested Public 21 Works cut/trim the trees to open visibility for on coming vehicles to clearly view the stop 22 sign on the east curb. 23 24 AREA OF IMPACT: See sketch. [ENAME. DATE PRINTED• REVIEWEDZY. DATE BEASON 139 7/26/07 _J1 Narrative Page 5 DATE TIME " TYPE , OFFICER ID CASE•NO. 7/21/07 0918hrs Narrative 139 H07-14727 1 CAUSE: 2 1 determined P-1 to be at fault based on the statements given by him, P-2, Pass, W-1, 3 the point of rest for both vehicles, and the damage to V-1 and V-2. 4 5 P-1 caused this collision by driving too fast. The posted speed limit for this area of 6 Willow Avenue is 40mph. Due to P-1's inattentiveness, as he approached the 7 intersection he did not see the two posted stop signs for his direction of travel. Instead 8 of stopping, P-1 continued to travel at the posted speed limit into the intersection and 9 collided into the passenger side rear of V-2. P-1 was driving V-1 in violation of section 10 22350 CVC (unsafe speed) and 22450 CVC (stop requirements). 11 12 Section 22350 CVC states in part: No person shall drive a vehicle upon a highway at a 13 speed greater than is reasonable or prudent having due regard for weather, visibility, 14 the traffic on, and the surface and width of, the highway, and in no event at a speed 15 which endangers the safety of persons or property. 16 17 Section 22450 CVC states in part: (a) The driver of any vehicle approaching a stop sign 18 at the entrance to, or within, an intersection, or railroad grade crossing shall stop at a 19 limit line, if marked, otherwise before entering the crosswalk on the near side of the 20 intersection. 21 22 If there is no limit line or crosswalk, the driver shall stop at the entrance to the 23 intersecting roadway or railroad grade crossing. 24 NAME DATE PRINTED REVIEWED-BY DATE BEASON 139 7/26/07 Narrative Page 6 DATE TIME. TYPE' OFFICER iD'. ', -CASE'NO. 7/21/07 0918hrs Narrative 139 H07-14727 I RECOMMENDATIONS: None. 2 3 MME DATE PRINTED REVIEWED BY DATE BEASON 139 7/26/07 Rental Location Vehicle Information ntal Expires On 702,80 TG 9-EtT Uff,a dts W-LAR Mri A GTR 1'EN.#: 274472-2 EO Effl- 'T IM LICA: 5ZJZ040 STA1.Li1: D-14 1! 1231WX QC6 Wr;r 09-4 IN111141p, CA 177 DOME BRCRRVIT3 gE6} n;;W46-be Returned TD Above Unless Stated Below Fate: EQM Cls: XVAR MOB Tllc OUT TIM IiI FU& LEVEL (kl ITU 711912037 ISM MLERRE OUT. fl U59 ' RRITAL RATES" ,�•EST G:G taue's 6.75! inlz CU"aT&I.a- D=CLIMS LD14 X40 IS 'REC.W_ ay5 3i,S91 ills, <- 131% SI>iE `,. u. -R.tfi.;�OF KR TEMS 1BIi>rifid nes Cir ER1T12i IT, -Uel 6, 91go1 (ltstomer Information Lt;' 1xCl Ii.TT /l hate Tax 11.7:3 DECLI ci I,M ,pf_'on4ecFee 11.10 Imo\ P DECLIt0 T6;ER FAC 10.0711tit 10.CJ 1 �ouRIs,1 sur 2.r,r�% i 3.59 J � 1i4'E kICii;tRLt ley 1fttiJrAI11ITIMS tfll Pt;iil'��rl:H YIJVJ fFMl;�tTE} ARUG *f 1��,`'..E2 Ci LK"M U.' VE i. KB CF IKED TIME FMIJE MARE RESPID, 1 1 FOR ,OURN'11 d IERLM loll 21811 C _" T5, A' ME RECEIVEit VIC'LATIM. IF FAIL JO KAY YOUR 1630 lib M/121IM9 410-M-9401 or, 1IKLritiX TMT I.WJ IMI t ID$TE til, S- L 9AI6 TICI;I_t M . 15P9'L DRUER: Rine DLA n.9TE iRl.q Iio'-giME COVEP9GE: `019-TIES LW i '_�.Q FEE PElf- X �- ITATIt4J HILL LLE i T01OUR. UEDIT BRIT. X � :.3TWITEd}/F Tf! �, 1 o 'r 1111 DG 1D -24HR13------ ��iyz� - �11ic�$fcFrrS f Cro,�RCD171J1 IFORNIA-NOTICE TO RENTERS PE.' 1G� YavF!Tri 1ne rd-unz`Wi.iarged •right aftt; A- te--at-at^•f-A ittit are responsible for all collision damage to the rented Vehicle even if someone else caused it or the cause is unknown.You are respor; for the cost of repair up to the value of the Vehicle, and towing, storage and impound fees.Your own insurance,or the issuer of the cret rd You use to pay for the car rental transaction, may cover all or part of Your financial responsibility for the rented Vehicle.You shouli :k with Your insurance company, or credit card issuer,to find out about Your coverage and the amount of the deductible, It any,for whict may be liable.Further, if You use a credit card that provides coverage for Your potential liability,You should check with the issuer to deter if You must first exhaust coverage;limits of Your own insurance before the credit card coverage applies. does not apply if:(1)the damage or loss results from Your 'r intentional willful,wanton, or reckless conduct, (ii)operation of the vehl ender the influence of drugs or al-cohol in violation of section 23152 of the Whicle Code (iii)towing or pushin anything, or(iv) operatlol e vehicle on an unpaved-road if the damage or loss is a direct result of the road or driving conditions;(2)yhe damage or loss occur: the vehicle is used (i) for commercial hire, (it) in connection with conduct that could be properly charged as a felony, or(iii) is involve( speed test or contest or in driver training activity;(3) operated by a person other than an Authorized Driver,(4) operated outside of th( ad States;or(5)You (i) provided fraudulent information to the Company or(ii) provided false information and the Company would no' I rented the Vehicle if if had instead received true information."Authorized Driver"means (1)the Renter;(2)the Renter's spouse if that on is a licensed driver and satisfies the Company's minimum age requirement;(3)the Renters eiTiployer or co-worker if they are engage( isiness activity with the Renter, are licensed drivers, and satisfy the Company's minimum age requirements;and (4) any person lisle( to Company on the rental agreement as an authorized driver. cost of optional LDW is$--to$—for every day, depending upon the vehicle rented. -These-tolms--sttpL!sode'sny-conflictftTg- rn stated efs'ewh-ere. atal reemeni is between the undersigned and the co `+ l g company identH2ed above(Ow Company").By signature below, he underslgId a ger and reprosenllT91—ibey ere legally a,A'ore ed to operate tho•rental vehid drlrier rroeruo,end that they have read and agree to the tarts,conditions and notices,both printed and written,rod mg the Loss Damage Waiver information,thatspQear. Ih �rsta�Statement and on the sepamto r@ni he"A reement')Which Is tncorporated herein.THE UNDERSIGNED AUTHORIZE THE COMPANY TO PROCESS A HARGE TO THEIf�tjEDITf DEBIj QR(CWdE(3/180 �8 AMOUNT SPECIFIED WVE r-0R TNI P N SIG N�7URE BELOYJ AND FOR ALL ADOMONAL CHARGES DUE UPON RETURN OF THE VEHICLE.ALL CHMU S tills JEDTTO AUDIT.'Ng additional drivers are permitted without the.Company s epprova •�� -�" Y 4�y RENTER X ADDITIONAL DRIVD I