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Home My WebLink AboutMINUTES - 10142008 - C.12 (17) CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: OCTOBER 14, 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 /Pady whe copy of this document mailed to California Government Codes. 4 ou is your notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code AMOUNT: $3,408.00 Section 913 and 915.4. Please note all SEP 0 9 "Warnings". CLAIMANT: SANDRA WALLS COUNT`!COUNSEL ATTORNEY: UNKNOWN MARTINEZ,CALIF DATE RECEIVED: SEPT. 09, 2008 ADDRESS: 144 LAKE AVENUE BY DELIVERY TO CLERK ON: SEPT. 09, 2008 RODEO, CA 94572 BY MAIL POSTMARKED: SEPT. 08, 2008 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. SEPTEMBER 09, 2008 DAVID TWA, Cl Dated: By: Deputy II. FROM: County Counsel TO: Clerk of the Board of S pervisors ( 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. 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: 1-4 —o �K 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 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:��mt6ID TWA, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult 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 prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dateda bfiI /C(".200A ID TWA, CLERK, By Deputy Clerk T This warning does not apply to claims which are not subject•,tgsAe California Tort Claims Act such as actions iirmVerse condemnation, actions for specific relief such as mandamus or injunction, or Federal�Ciuil�Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitationsperiods that may apply. The limitations period w thii"*hich 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 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 Cleric 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. memo■aaaaaaaaaaaaa■a■■ ■■SMOKE■a as ata aaaaeuaaa aaaa o¢aaaaaaausaait■■a■aaaaaa tool RE: Claim By: Reserved for Clerk's filing stamp RECEIUEED Against the County of Contra Costa or ) SEP 0 9 2008 District) CLERK 80ARD Or SUPERVISORS (Fill is the name) ) CONTRA COSTA Co. The undersigned claimant hereby des claim against the County of Contra Costa or the above-named district in the sum of$ 51 and in support of this claim represents as follows: k w 1. When did the damage or injury occur? (Give exact date and hour) ` 716x /0 '/5- 2. Where di the amage or inj occur? (Include city and county 5lO1 drl'. r�ve� C�o✓rf C'oi 4 Oovtify 7� S�.✓Vl��-e ;StCl��DN - 3. How did the damage or injury occup? (Give full details;use extra paper if required) aH 4 Lo vack i m fi .e s i&ula/,l< upl-dised 0 r?Q v- d *tr,2 e� clid Fv_.%l o H m y 45-ac42_,.„Vt ivcys it +eav- a 6e�A 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? 5 What are the names of county or district officers, servants, or employees causing the damage or injury? dva 1 f A/11,00 ed Jh 2 - { d 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. -Attach-two estimates for auto damage:) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) so-e, O ecj 8. Names and addresses of witnes es d tors and hos tals: r�ten1Cd)lad AAA Sheri �v�h, rY ` LDiv> � , ,gmet-too o . ed�L. (A&'c f - 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT .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 ) ) ' � a. �7 (Claimant's Signature) (Address) Telephone No. )Telephone No. 510 ............uamaa■■tiammmaamRaammmmaa�anmaKaaRoza Kam an nations a NNEmama■Room■anmmmom■not PUBLIC RECORDS NOTICE: Please be advised that this claim f6rm, 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. a mono swoussonsam suns onus a 14 not own mono mostil 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 sucb 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. of �t� � D-h—tl t/ c(Uof g A-os -7�5 Ogg 1D�. �� .-yr_._�_--- _ �.�-.� j1�� ..�^' -r'�.r`-"'� OF J;,O, f A, 15 waif ---- — Ve, -o ea+p t^ �/' ,n s y,yr �o Z9 ry✓s� 7 ),, o 02-.0® gpLs .� .r��.s.,,;,.:'••-�,�1 ^moi u1 '} L; - .. 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