HomeMy WebLinkAboutMINUTES - 10142008 - C.12 (18) 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 ) �/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
ISEP
Supervisors. (Paragraph IV below),
given Pursuant to Government Code
AMOUNT: $4,039.00 0 9 2008 Section 913 and 915.4. Please note all
"Warnings".
CLAIMANT: TRINA M. HILL COUNTY OOUNSEL
MARTINEZ CALIF.
ATTORNEY: UNKNOWN DATE RECEIVED: SEPT. 09, 2008
ADDRESS: 2310 DOUGLAS STREET, BY DELIVERY TO CLERK ON: SEPT. 09, 2008
SAN PABLO, CA 94806
HAND DELIVERED
BY MAIL POSTMARKED:
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DAVID TWA, Cler
Dated: SEPTEMBER 09, 2008 By: Deputy +L-
II. 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 910.2, 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: �' �g d By: MC6j27, Deputy County Counsel
I11. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2)
O Claim was returned as untimely with notice to claimant (Section 911.3).
1V�OARD 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:®cl�6r/i��a?,Io�AVID TWA, CLERK, ByDeputy 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.
Dated:(PC f,W.>/, f"o?AMai/AVID TWA, CLERK, By Deputy Clerk
t '
This warning doq,,ppt apply to claims which
f
are not subject othe,California Tort Claims
Act such as actions in" ih4r'se condemnation,
actions for specific;relief�such,.as ,mandamus or
injunction, or Federal Civil Rights. claims. The
above list is notexhaustive. and-legal;`
consultation is essential to understand all the
separate limitations p'er16ds 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
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.
................................................•.......\....\s...............1
RE: Claim By: Reserved for Clerk's filing stamp
14 11
RECEIVED
Against the County of Contra Costa or ) SEP 0 9 2008
D'1StT1Ct) CLERK BOARD OF SUPERVISORS
(Fill in the name) ) CONTRA COSTA CO.
The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named
district in the sum of$ 14 p .60 and in support of this claim represents as follows: Sem 1/yl"11T_�U�
p L L
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) L W.�D
�f�i n Z.2 Ci�. C o n •�'rc,... CQ S rl.� C D J ✓� 7 �j
3. How did the damage or injury occur? (Give full details; use extra paper if required)
Q,,0?C0 -r ee" O ve 4 A"4" 5 cc.lcd ; � ,.-oper1-7 /��,5 nCve --- v'e u ✓.�C
qV ►M t U?U'A V%J*� S c .
4. What particular act or omission on the part of coup or district officers, servants, or employees
caused the injury or damage? F�f e i S�tG, �I c4 It 4�/ ,S�i n�(S �{ � iu 7 ,�w 4,(c✓5, f-0
S�
/ It'J �C 4.�1 K YACVG
n o ��
M Y v SS CS i s„ a.�a;�. a F�-e,r d�;rls VC�-.+�•�c�P o f� !ti, y �•/10..�
5 What lethe names of county or district officers, servants, or employees catlsinkthe
damage or injury? . L
�OoN� KC OKCas
Co up, v ^/
Y
t
. 1
•, r! •� � -`, j.. r �+t � •,4 f.; C"'. / i� ' 5..11 ti
t I
h. 5 — .� r� ✓� 1Ji 3'. � ..'r r r"i .. Jrr. .�+rj� .
t � . .. r' .�' ,•5•• � ; c '- J�+r. 1 .,r;•� ♦'•t•_ J" i�. r�1r /y,;! {.t � c ..
a .j � . +2 4, iS. '-1 .` a .� ,'.~.M •✓•r i'. � i , C . '; ,. .1; r `�< f,� •d•. f� .
t i 5�n3 e r
6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages
claimed. Attach two estimates for auto damage.)
SIA1trWf �e��r1v�PrlTf"
7. How was the amount claimed above computed? (lnclude the estimated amount of any
prospective injury or damage.) L L l
�Sl�tna�,..�,� �rqr. ct,wra.�� 1 U1 aV ✓L�nc,�,se �al
8. Names and addresses of witnesses, doctors, and hospitals: e GN C� t'O ��✓�Z �?G���
S,• t. M--ve,1. 555 �-; ti � lfwy �rti�y��s�rrch-F .�l' f ►�-r
t"06hea•t 5' A. �1rt5 Ki c. A-o4 ci , 1� 'd6 S o
9. List the expenditures you made on account of this accident or injury: �,--� IF
DATE TIME AMOUNT ^�
.............................■■ZA
I1lf lfflrfll lffflff■......................women=map
Gov. Code Sec. 910.2 provides"The claim shall be
signed by the claimant or by some person on his
behalf."
SEND NOTICES TO: (Attorney) )
Name and address of Attorney )
(Claimant's Signature)
L (Address)`�p
Telephone No. ) Telephone No.�5i°%N) 5 a!
•IIIlfff ffllff•If■If1■fI11111fffl1ffl11 f1f■f1flfllff■11■II ffllfff•IIf If■IIIIf■I fff 111
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.
..................................If IIf IIff 111111111\■..f....................f......�
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.
I Vy
ell
PROPERTY/CLOTHING RECEIPT
CONTRA COSTA COUNTY REC. NO.
DATE: mn
��I�laB I3F
TIME: Yl1yIS
e zAft
NAME:
BOOKING NBR r
\� CASH: $�l _
C j ❑ SHIRT/BLOUSE 0 DRESS
❑ COATMACKET 0 TIE/SCARF
❑ SHORTS/PANTIES `JEWELRY 1
❑ SOCKS/NYLONS Jk
❑ SWEATER/SWT.SHIRT 71ILBELT MAN
❑ PANTS/SKIRT
❑ SHOES/BOOTS
QT-SHIRT/BRA ❑ WALLET
!3- WI/PURSE ❑KEYS
❑ KNIFE 0 GLASSES
BKG OFC:
INMATE SIGNATUFM
RELEASE
I have received all of my per-
DATE: sonar property and clothing.
REL OFC: X
INMATE SIGNATURE
DET:065 FRM White - Booking
Date Claim`Filed: � D >
Booking Number: eeo8 QE
Contra Costa County Detention Facilities
INMATE REQUEST FOR .PERSONAL PROPERTY REIMBURSEMENT
Q MCDF E] MDF WCDF
THIS SECTION IS TO BE ''COMPLETED BY INMATE/CLAIMANT:
:,NAME:
ADDRESS; '23 /D
CITY, STATE,, ZIIP: 14'
L� Z is L-0 cot C2, (o
TELEPHONE: ( /o—9`j 3 Z (oZ(o(o (WORK) PAA Sirr'-SCoS /0 /3
How did the loss or damage occur? _til/ 777fe- ?055Fss�a/
o
776i i AT /A bF .
DESCRIPTION OF LOST OR DAMAGED PROPERTY:
Item (Describe fully) Original Purchase Price and
Date of Purchatsel.
GyNK ss Gz�� A LLAF . . �<SO
Z H-o o P
Z PICA-LvT?-4A r ro oil cf ►.15 AB�v�'
Z� t: MOtVO G2o�� ,t^SUS t:;,JS
2 G o LLI t-Irz�P �}ky�N U S �
X00
(SOIrTU
y �•�a�D RsN� s . � _. - -- � 3�
la DS7 oNn s+►��,�-rs(�PPx cP� 2,'-ZJ
3� bot ftsNc7 $N SSMdtr M�NrjS oN ?DP CTf?t k .
O iZSlJt,/ NAPE
DFzsCUnrs an -.' Anro Dsn.� or.LDS oN rpe � v
Distribution: Original. Director of Support Services �v
L '�t+'°nl�• ' ' '3t u`j �T M�t i sv Yellow - Inmate _
1(v
DET 071:FPM
Rev. �,/
7/17/96
INMATE REQUEST FOR PERSONAL PROPERTY REIMBURSEMENT Page 2
[ ] This request for reimbursement is approved by authority of
California Government Code Section #26640 and Detention fi
Division Policy Chapter. 276 for. the-. following reasons:
}
[ ] I do not recommend approval -of this request because it '-does
not meet the criteria for reimbursement outlined in the above
cited authority and policy for the following reasons:
[ ]..,I authorize payment to the Inmate/Claimant in the amount bf
[ ] I. do not authorize payment.
Signature Date
r
t
i JJJYYY y �'
i
\
I l
�,_'" r�,l\?SS'S�Stl V"t`i .\.. t ,.. l.. 4 .. + t \ ( .' � • y211C
3 j rT ill}" � 11t +itf✓ _ • i a • •
It
t !fit
tT! , it�y'�i Ci`h.x� ' '� ,ws.";� . � * �} �! .x •
s"cra !( tit p r ' t rr Ot •�fG;, VN
.AY, _ - • r F'S'1 .4 p� y,"`,- k a r\ �S v 11 l sG 24v.�=rL
Ai� "1 SJY .9 � 5^} h ��� 6 { u I i�4� i•rA.t. � i� :F '�'d�*�' pr 1
.1 f
1
P a V�2'�l��"'✓3i5.'It M�'.'�� j' ! �xj �}��R � F' .�rN � y G /'^' � r'• ,JS'
w �?r
3
i
yq 4
dal�
.41
. 4
�T-• d.
' _ >-v-CFC`<'♦ _ .f.. �`�..
i
ry
1 ,♦g
..s
aI[ilJ w ,
�
� a
y
`moi }5,.. r , 3x{ .t }' R-.:•
OY
� nSy
Js i �r te.y
� d • -1
I
4�'
��
� i� �
(;6�j� , F3V� ��4�`�,f
���\l � h � � 2��
i��,���
� � � ��
) ok
�2.
QUO
boa
� bO
3 �o
Z
I 1 bs