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Home My WebLink AboutMINUTES - 10072008 - C.12 (18) CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: OCTOBER 07, 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), J� 'ill given Pursuant to Government Code AMOUNT: $614.81 SEP 0.8 2008 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: GREG R. COE COUNTY 0 MARTINEZ CALIF. ATTORNEY: UNKNOWN DATE RECEIVED: SEPT. 08, 2008 ADDRESS: 4874 MONTAGUE AVENUE BY DELIVERY TO CLERK ON: SEPT. 08, 2008 OAKEEY, CA 94561 RECEIVED FROM BY MAIL POSTMARKED: RISK MANAGEMENT FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DAVID TWA, C k Dated: SEPTEMBER 08, 2008 By: Deputy. II. FROM: County Counsel TO: Clerk of the Board of S 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 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 (1) County Administrator (2) O 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. DatedCelpiGgM&VID TWA, CLERK, By eputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mail to Me 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:CroA%/A 9, leA14AVID TWA, CLERK, By Deputy Clerk This warning does nott?apply to claims which are not subject to fhei,Cni fornia Tort Claims Act such as actions in.i'nverse condemnation, actions for speciflorelief;such,as,mandamus or injunction, or Feder':1 Civil-R'ightsjclaims. The above list is not exhaustive;and,legal consultation is essential to understand all the separate limitations perio'ds,1thatmay 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 COMMUNITY FIRST PAGE 01/02 0 MP9/03/2oes 15.:e2 9256256138 3 1; iAZ BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO A. A claim relating to a cause of action for death or for injury to person or to personal Property Or growing crops sliall be presented not later than six months after the accrual of the cause Of adion, A claim relating to any other cause of action shall be.presented not later than One Y= after the accrual of the CMUSO 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 natiie 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. F. Fraud, See penalty for fraudulent claims,Pend Code See.72 at the end of this form •a po Xas Move--*ft mpg a N as was wool my a ON son mpg"SweveN1111*0 Aft*W9 a no as RE: Clain By: < p� Reserved for Clerk's Ming stamp -J'A 64-kC, RECEIVED t�Ls-i L4 CA 3qS- � k SEP 0 U"' 2008 Against the County of Contra Costa or CLERK BOARD OF SUPERVISORS District) CONTRA COSTA CO, (Fill in the name) The undersigned. claimant hereby makes claim against the County of Contra Costa or the above-named distnet in the sum of$ jol 14 and in support of this claim represents as follows: L When did the damage or injury occur? (Give exact date and hour) ;N O-IC) f FA qL%-J('V-LtW vgTel-r��) 1 %ere did the d!m�ae or injury occur? (Include city and county) MArzn 31 How did the damage or injury occur? (Give fa details;use wara 'paper if required) t40--% V— V'JA-s t.OPT-' 13\1 4DV\9n--O`f CC I T0%41tT 3fw-vIe'o -TVW-N $-TX4Lt'L%< IAv vel-4tc-L4�� TA\t7k(?-D R, 4. What'particular act or omission on the pan of county or district officers, servants, or employees caused the injury or L=�? 5 What are the names of county or district officers,servants,or employees causing the damage or injury? N t4 I E Vj(Z.\ 6 WT VV\0r*—T% k--L� CA 5'� el r7) . rulp-c- Qcr� rrl')C) J09/e3/2008 15:02 9256256138 COMMUNITY FIRST PAGE 02/02 6. Wwafi damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) W"FAza 0— 7. How was the amount claimed above computed? (Include the estimated amount of any \\ prospectibe injury or damage.) A I P A2:z1Tr M wak--T- — 13r*11, Y C a L N T2u6 IL 0� 2. 7,m%es ae kz, 2 VV%A (te.nfr40 -r'2t0l &AS MI 12 M� QE�R- /,au- t k8�Er2-�Cu<irahS71 8. Names.and addresses of ivi-resses,doctors,and hospitals: r� 3 �o d£tL, � t�l A' 9. List the expenditures you made on account of this accident or injury: DA L- AMOUNT R� �I3Iot3 j^ oo PM I VN g) I ■Rmbox RRR R RRR R[RRR[RRRan R■RR SOME RR RRR RRRR RRR RRR R RR R R[RRR■R MRS RR RRR@■■RR RRRR note gram or ) ,Gov. Code Sec. 910.2 provides"The claim shall be )signed by the claimant or by some person on his behalf." SEM—NOTICES TO: (Aktomey)_�) Name and address of Attorney ) laimant's Signaime) j 1-7y d?oNV 6� acs A8 (Address) ) � Y 014 9� l Telephone No. )Telephone No. 998-QRZ 3 ■RRRRRR RRR RRRRRRRRR[RR■R/R[R■U RRRRRR■■RRRf RR■RRRR[RRRRRR[RRRRR[[RR RRRRRR R■RR RRR[RRRI 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, SS 6500 at seq.) Furthermore, any attachments,addendums, or supplements attached to the claim form, including medical records, aro also subject to public disclosure. R RRRR RR[R[R.R[.RtR[[RRRRRRR[R[RR[[RRRf RRR[[RrRRR■[RR RIRRt[[R■RRRIR/RR R.RR R1l RR[R[Rt[1 NOTICE: Section 72 of the Penal Code provides: Every person who, with intent to defraud,presents for allowance or for payment to any stats board or officer, or to any county, city, or district board or officer, authorvcd 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 jai] for a period of not amore 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 tan thousand dollars ($10,000),or by both such imprisonment and fine. 7d L- ' f�7Cm Peri ��i/eri fl- aq. ii SEP 0 2008 CLERK BOARD OF OUP-fiV1SORS