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Home My WebLink AboutMINUTES - 10142008 - C.12 (20) 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, ) TICE TO CLAIMANT and Board Action. All Section references are to ) Ithe copy of this document mailed to California Government Codes. ) Cyou is your notice of the action taken n�6g an� on your claim by the Board of ID ttllLL11 Supervisors. (Paragraph IV below), SEPI 7 2008 given Pursuant to Government Code AMOUNT: $2 200.00 Section 913 and 915.4. Please note all COUNTY COUNSEL "Warnings". MARTINEZ CALIF. CLAIMANT: ARTHUR F. PEDREIRA SAN � nr� TORER_17, 2008 ATTORNEY: UNMOWN DATE RECEIVED: t n� 17, 2008 t�1N ADDRESS: 2373 ACACIA DRIVE, BY DELIVERY TO CLERK ON: . CONCORD, CA 94520 16, 2008,1""- BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. OCTOBER 17, 2008 DAVID TWA, Cle Dated: By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Su ervisors ( 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 Boardcannot 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: �' '0By: /tel 5Deputy 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.�OARD 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:Qr2kd,!�J o AVID 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 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. DatedQJW&V Ar UDf DAVID TWA, CLERK, By Deputy Clerk r 4 l This warning' 6cs not apply to claims which are not subjecf`to the California Tort Claims Act such as actions Winverse condemnation, actions for specific relief`such-'as`mariidamus or injunction, or Federal CiviljRights.claims. The above list is not exhaustive and legal consultation is essential to,;und'er:'sfarid 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 por;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 Il\'STRUCTIONS TO CLAIlVLA NT ... . . . . ...... _ 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 eacb. public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. ■■g.■ENKERESERRE mass man MEN HIMMENNUMERM■■e■t l■■■■■■-N•■■a s■■■■■■a■s■■a•e o■e a e■■e NMI RE: Claim By: Reserved for Clerk's filing stamp CEI Against the County of Contra Costa or ) SEP J 7 2008 BOAR District) CSR CON RA OF SUPERVI (Fill in the name) ) COSrA Co SO4S The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$_' f.2-(Y6' 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) 2 �7 �eQef �r 4VIleorJ Con 4D 3. How did edama ury �' fIl details; extra paper equired)sVi �v ' , a d wt�`lr ed 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? C&P1 00r F� ,S�L)A4 T40- -'rka, 5 What are the names of county or district officers, servants, or emplo�Tees causing the l 1 f Y (/.ft1�i damage or injury? �' �A , (�5 at ► �vr(� i �: .. r; : . . . . ,r . . ;�: .�� .ri. Y" Z 6. 'Wr4aL damage or injuries do your claim resulted? (Give frill extent of injuries or damages claimed. Attach two estimates for auto damage.) 'nLM-7,1 (�Ujo CJa VV)6 9I 1 0/111 `05-f-55 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.)"�`1 W� 1 e d w,�v T"� 7-�Q A-Yo q g'e J , 8. Names and addresses of witnesses, doctors, and hospitals: 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT A ` may ■ [aa[.,a,ago man saaa[Room[ [ a[as[a[taaaa,aaamamta■aaaaaa■aaaaat asasaaaaaa a[[.■aaaa[aaal .Gov. Code Sec. 910.2 provides"The claim shall be signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attomey) 1 Name and address of Attorney ) (Claimant's Signature) (Address) . ) q Telephone No. ) Telephone No. �z`�`— � `�` , 2maaaa,aa,aaa[aswam aaa,a[a■ aoan aaa,aaaal i 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. 0a[aaa„[a„a,,,a[a,raaa[■a„taaa,atauaae a sun■aaataaa■a„aaaa,a.aa.aa an aa,ata,a,t NOTICE: Section 72 of the Penal Code provides: ili 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 GL la � � � r o ' .. - ,y �, ,. y �� ; '' jyr va �':�.:' ' �, .. � 't .. i�',..'h' ' ' � 4' `� . � �y !i ' 'J ' t'1, n Y � �.. • 0 A A5-CtSSEO EV J p u 1 � i r „ KQA r•; c s y � Q \ i ry d D 6. �• fit,? �� ¢ V y*S -