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Home My WebLink AboutMINUTES - 10142008 - C.12 (22) 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, ) 1he9copy JI'ICE TO CLAIMANT and Board Action. All Section references are to ) n' • of this document mailed to V California Government Codes. you is your notice of the action taken RIMC6g II �17Z%10 on your claim by the Board of SEP 17 2008 !J Supervisors. (Paragraph IV below), given Pursuant to Government Code COUNTY COUNSEL Section 913 and 915.4. Please note all AMOUNT: $626.47 MARTiNEZCAUF. "Warnings". CLAIMANT: JANICE WHITFIELD ATTORNEY: UNKNOWN DATE RECEIVED: SEPTEMBER 17, 2008 ADDRESS: 1852 W. 11th STREET, #477 BY DELIVERY TO CLERK ON: SEPTEMBER 17, 2008 TRACY, CA 95376 . BY MAIL POSTMARKED: SEPTEMBER 16, 2008 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DAVID TWA, Cle f Dated: SEPTEMBER 17, 2008 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Su ervisors (yy"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 9113). O Other: Dated: �g 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). IOARD 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:Qu., /f4 DAVID TWA, CLERK, By Deputy Clerk WARNING (Gov. code section 913) — W 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&,6;kd/q._J40grDAVID TWA, CLERK, By _Deputy Clerk This warni'ag does not apply to claims which are not subject'to`th'e California Tort Claims Act such as actions in inversexondem nation, actions for specific relief such as mandamus or injunction, or Federal Civif Rights 'claims. The above list is not exhaustive and rylegal.o 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 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 propertq or growwing 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 forma ■■■■■ME u4a11211■■oma Eno■ER■■��a�a��a�e�a�u��'�a mmama at RE: Claim By: Reserved for Clerk's filing stamp REV 'Q '1 7 2008 . Against the County of Contra Costa or �' ) SEP CLERK BOARD OF SUPERVISO;jS D15tL1Ct1 CONTRA COSTA CO. (Fill in the name) ) The undersigned claimant hereb • makes claim against the County of Contra Costa or the above-named district in the sum of$ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) A k k�r►v�nr3 a. MY�,o..rs l�. CTn--i-�-l.�. 12�. I��,'}�� . c�.lg.,.�.s �na�.t.,.c 2. did th e r Qt dlc to� d a �"gd ,Cr�l f� l/t F�C.4- Q-4�, 2. Where did the damage or injury occur (Inc u e city and 3. How did the damage or injury occur? (Give full details; use extra paper if required)C.h q6 kA-eL yet b-camC �'� ReSco(t ; OCc�w�►�� ` � � CA\�SpCIA �a � " ' tsM6 PA I ( p 4. What 'articular act o onvssi o o un r distnc rs se pan , ore lovees caused the injury or damage?CV\ e5 KOPL MJ bt<_eN %W&Vt 10,24 V', C+W Escorz-T TJAC-f�c -VMO. S What are the names of county or district officers, servants, or employees causing the damage or injury? J , 6. IvNrcat damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) w 1 4JbS4a-J,1) G(-}-1 (ger-is t f� (MJ(,71.PL6 -PLAN C4G S_ NA-.,S,p fi CP.ACV-S ry\po E+FFcc�i+FtG �inl� ✓1soN Y Iss��s 7. How was the amount claimed above computed? (Include fFie estimated amount of any prospective injury or damage..),1rC,.A N-A (Z-om' Le SS 1 Ot CN-� hrL� -0-e.�,r ' l'z--Ar-� ,t-4; 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 eaacnew■■ataa■ONE■aa■■INS■a■aIsm a■a■■aaa■■aaaaa[Russ aaaaaaaaa a[aaa[a■aa as a••aa■[aacal ) .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 ) (Claimant's gnature) I �Sl JAJ . ► If,� s4 +1492 (Address) Telephone No. ) Telephone NH 1 Xq - Z JL. •74J 7 V ■BEEN ENERBROWER s now mua■an an a•■e a■■[a a[t a a a BOOMERS a[a a as a a a t a t a.a a a a[a a a a ME Mae REPERWRI 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, §9 6500 et seq.) Furthermore, any attachments, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. .aa[eaaaacaaaa■mass a mama a 0a a■■■■a■aa■ca■eaaRon aaa..e.......a..........■■■ ■a a■acaaaaal 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 ($10,000), or by both such imprisonment and fine. :� '� . . ,_ , ... • � � � 1� •� � � i � � � ESTIMATE OF REPAIRS " CHRYSLER LER TRACY, CA 95304-7304 WEEP LEADERS IN AUTOMOTIVE RETAILING (209) 820-1800 FAX (209) 832-8980 SHEET NO. OF SHEETS r� R.O.NO. Date �l / l 20 67 NAME ADDRESS PHONE MAKE YEAR VIN �?u MOTOR NO. BODY STYLE MILEAGE /1 h LICENSE NO. / PAINT NO. TRIM NO. INS.CO. 7 UX ADJUSTER PHONE NO. FILE NO. QUAN. ESTIMATE OF REPAIR COST LABOR HOURS TOTAL The above is an estimate based on our inspection and does not cover any additional parts or labor which may be required after the work has been opened up.Occasionally after the work has started damaged or broken parts are discovered which are not evident on the first inspection.Because of this the above prices are not guaranteed. The undersigned agrees to complete the above repairs for$ Labor $ Of this amount the above named insured is to pay Parts $ $ insurance deductible Misc. $ $ depreciation Sublet $ $ work not covered by insurance Sales Tax $ ESTIMATE TOTAL $ v"�� Y, By ADVANCE CHARGES $ ae.nsa0 toads GRAND TOTAL $ Don ' s Mobile Glass "Quality Glass wares" REMIT TO: 3800 Finch Road Since 1960 Modesto,CA 95357-4100 ***** Q U O T E ***** BAR #AB006607 ** 127465 08-21-08 ** Cont. Lic #375316-C17 FEIN:94-1631634 Order # : 127465 Policy#: PO #: Ord Date : 08-21-08/10:22 Claim #: Invoice#: Sched Date : / Agent Inv Date: / CSR Phone Deduct . Sales Rep 809 BLACKMORE, TIMO Auth by: Loss Date: Installer Auth Code: Loss Cause: INSURER / BILL TO: INSURED / SHIP TO: 0 CASH SALES Home: - Qty Part Number Description Mfg List Net Total 1 FW2712 GBN WINDSHIELD s n ?? 446.80 367.34 367.34 LABOR 95.00 1 Z (2) URETHANE,DAM,PRIMER PPG 20.00 .20.00 1 WFS F2710 MOULDING (REVEAL) (3/4, TOP & PRP 74.55 74 .55 SIDES) Ir 4t+" Notes: LOCATION INFORMATION AUTOMOBILE INFORMATION MATERIAL 461.89 LABOR 95.00 Contact Year 08 TAX 38.11 Install Make HYUNDAI SUB TOTAL 595.00 Model ELANTRA DEDUCTIBLE City Style 4 DOOR SEDAN State, Zip Lic # TOTAL 595.00 Phone - Mileage State DEPOSIT Clr/Unit AMT PAID VIN AMT DUE 595.00 DIRECTION TO PAY: The glass listed above has been replaced with new parts unless otherwise indicated to my satisfaction, and I authorize my insurance company to pay DON'S MOBILE GLASS, directly. Additionally, I assign to DON'S MOBILE GLASS the rights to benefits claimed under my policy. I agree that if my insurance company does not pay in full I am responsible for the balance. Purchases on account are due 30 days from date of purchase. A FINANCE CHARGE OF 1 1/2t per month or 18% ANNUAL PERCENTAGE RATE will be added to all past due accounts. If Collection is made by suit or otherwise, I agree to pay interest at the above rate until the amount is paid, collection costs including reasonable attorneys fee and legal expenses. Customer's Signature OUR LOCATIONS: MODESTO, 1424 H Street, Modesto, CA 95354-2586 (209)526-9100 FAX (209)526-9112 TURLOCK, 326 S. Center, Turlock, CA 95380-4919 (209)667-1222 FAX (209)667-1247 MANTECA, 151 S. Main St., Manteca, CA 95336-5719 (209)823-7678 FAX (209)823-1387 MERCED, 28 West Main St., Merced, CA 95340-4929 (209)723-4576 FAX (209)723-3617 SHOWER DOOR/COMMERCIAL, 240 Bunker Ave, Modesto, CA 95351-3910 (209)526-5848 FAX (209)526-6530 RESIDENTIAL/WINDOW, 240 Bunker Ave, Modesto, CA 95351-3910 (209)526-5848 FAX (209)526-6530 ADMINISTRATION, 3800 Finch Road, Modesto, CA 95357-4100 (209)548-7000 FAX(209)544-7160 SO. SAN FRANCISCO, 130 E S. Linden St, So. San Francisco CA 94080 (650)871-1505 FAX(650)588-0633 TRIVALLEY (925)803-7745, SOUTH BAY (408)845-9181, SO. PENNISULA (650)685-0410, EAST BAY (925)803-7745 F � {, f { i' s s31 O �� 2 L l Y � t 'jJ3 f I Y -r ice( G L Y 'kn r.� m y N V YQ V�