HomeMy WebLinkAboutMINUTES - 11182008 - C.12 (25) CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: NOVEMBER 18, 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),
OCT 2,3'2008M. given Pursuant to Government Code
Section 913 and 915.4. Please note all
AMOUNT: UNKNOWN COUNTY COUNSEL "Warnings".
MARTINEZ CALIF.
CLAIMANT: SOETANE, MENYON
ATTORNEY: UNKNOWN DATE RECEIVED: OCTOBER 23, 2008
ADDRESS: 1150i' ROOKSIDE DRIVE 4511 BY DELIVERY TO CLERK ON: OCTOBER 23, 2008
SAN PABLO, CA 94806 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, Cl
Dated: OCTOBER 23, 2008 By:By:
II. FROM: County Counsel TO: Clerk of the Board of Swpervisors
( 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: By: /VI _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).
IN/ 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.
Dated: AVID TWA, CLERK, By Deputy Clerk
WARNING(Gov. code<ection 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.
Dated r"4,e DAVID TWA, CLERK, By neputy Clerk
This warning doe riot al`nyly to claims which
are not subject to the California Tort Claims
Act such as actions in inverse.condemnation,
actions for specific retief'such`as-mandamus or
injunction, or Federal-Civil Rights claims. The
above list is not exhaustive and legal
consultation is essential to=iinderstliii 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 do'"'it waive rights under the statutes of
limitations applicable to actions not subject to
the California Tort Claims Act
F
1, •
BOARD OF SUPEOSORS OF CONTRA COSTA COUW
t INSTRUCTIONS TO CLAIMANT �S�
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 thaa one year
after the accrual of the cause of action.
(Gov. Code § 911.2.) OC�
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room I0
County Administration Building, 651 Pine Street,Martinez, CA 94553. ��
rho �y
C. If claim is against a district governed by the Board of Supervisors, rather than the County, the
naive 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.
UNUM■sessss a s■assetees■■s■sssaasses sssssussssss s■sesasasaas■ssssesaasesss se ss
RE: Claim By: Reserved for Clerk's filing stamp
Against the County of Contra Costa or ) ZCorqtta
ED
District)
(Fill in the name) ) 008
yi u�SO,The undersigned claimant hereby makes claim against the County oe ve-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)
2. Where did the damage or injury occur? (Include city and county)
��Ch�l to nc� , c • a4�
3. How did the damage or injury occur? (Give full details; use extra paper if required)
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4. What partic ar act or omission on the,part of count} or district officers, servants, or employees
caused the injury or damage?
5 What are the names of county or district officers, servants, or employees ONSTA'.C.°� �;T..
EEIVE
' damage or injury?
porgy S stun n�eA OCT 0 7 ?.Ong
RISK MANAGEMENT
M 0
WL-at damage or injuries do your claim resulted? (Give full extent of injuries or damages
claimed. Attach two estimates for auto damage.) rnU -Pp� WM &- COJ.e r 06 It --r; I l er,,
(-0-x adg1'-hv� �J
7. How was the amount claimed above computed? (Include
"I the estimated amount of any
prospective injury or damage.) Ace a ,.a+e Aulo RUl.� — 'Ji-I 5153 Croe- kie7k �
OCA 16 i q. y` v
S. Names and addresses of witnesses, doctors, and hospitals: hlt>ne
9. List the expenditures you made on account of this accident or injury: Non e
DATE TIME AMOUNT
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.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 )
aimant's Signature)
(Address)
Telephone No. ) Telephone No. (516)
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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.
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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,OOD.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.
�ROCKETT AUTO BODY •
900 SAN PABLO AVE
/ PINOLE, CA 94564
(510) 741-9001 FAX: (510) 741-9009
CD LOG NO 31423-1 DATE 09/12/08
SHOP: CROCKETTS PREMIER AUTO BODY INSP DATE: 09/12/08
ADDRESS: 900 SAN PABLO AVE, CONTACT: PAUL RAGATZ
EPA�0 0. 54 PHONE l : (510) 741-9001
CITY STATE : -HOLE, CA FAX: (510) 741-9009
ZIP: 94564-
OWNER: SAETANE, MEIYON CELL PHONE :. (510.) 837-1507
ADDRESS : 6 TRALEE CT
CITY STA SAN PABLO, CA
ZIP: 806
POINT OF IMPACT: 3
LIC# : 5RUA031 STATE : CA VIN: WDBLJ65G2WF018958
BODY COLOR: SILVER MILEAGE :
CONDITION: ACCTNG CTL# :
*=USER-ENTERED VALUE E=REPLACE OEM NG=REPLACE NAGS
EC=REPLACE ECONOMY UE=REPLACE OE SURPLUS UC=RECONDITIONED PRT
UM=REMAN/REBUILT PRT EU=REPLACE SALVAGE EP=REPLACE PXN
OE=REPLACE PXN OE SRPLS PC=PXN RECONDITIONED PM=PXN REMAN/REBUILT
TE=PARTL REPL PRICE ET=PARTL REPL LABOR IT=PARTIAL REPAIR
I=REPAIR L=REFINISH BR=BLEND REFINISH
TT=TWO-TONE CG=CHIPGUARD SB=SUBLET
N=ADDITIONAL LABOR RI=R&I ASSEMBLY P=CHECK
AA=APPEAR ALLOWANCE RP=RELATED PRIOR UP=UNRELATED PRIOR
1998 MERCEDES-BENZ CLK320 STD 2DOOR COUPE 6CYL GASOLINE 3 . 2
CODE: 32103A/A OPTNS F/24
OPTIONS :
TWO-STAGE - EXTERIOR SURFACES TWO-STAGE - INTERIOR SURFACES
OP GDE MC DESCRIPTION MFG. PART NO. PRICE AJ% Bo HOURS R
-- --- -- ----------- ------------ ----- --- -- ----- -
E 0006 COVER, FRONT BUMPER 2088800140 470 . 00 3 . 1 1
L 0006 13 COVER, FRONT BUMPER REFINISH 3 . 6 4
2 . 5 SURFACE
0 . 6 TWO STAGE SETUP
0 . 5 TWO STAGE
E 0010 FILLER, FRONT BUMPER 2088850321 212 . 00 INC 1
L 0010 FILLER, FRONT BUMPER REFINISH 1 . 0 4
0 . 8 SURFACE
0 . 2 TWO STAGE
ECM03 FLEX ADDITIVE ECONOMY PART 7 . 50* 4*
PAGE 1
09/12/08
1998 MERCEDES-BENZ CLK320 D 2DOOR COUPE •
CD LUQ NO 31423-1
N M1•3 , COLOR TINT ADDNL LABOR OPERA 0 . 5*4*
SBM60 HAZARD. WSTE . REM. SUBLET REPAIR 4 . 00* 1*
N COLOR TINT 2ND COLOR ADDNL LABOR OPERA . 0 . 5*4*
8 ITEMS
MC MESSAGE (S)
13 INCLUDES 0 . 6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE
FINAL CALCULATIONS & ENTRIES
GROSS PARTS 682 . 00
OTHER PARTS 7 . 50
PAINT MATERIAL 196. 00
PARTS & MATERIAL TOTAL 885 . 50
TAX ON PARTS & MATERIAL @ 8 . 750% 77 . 48
LABOR RATE REPLACE HRS REPAIR HRS
1-SHEET METAL 75 . 00 3 . 1 232 . 50
2-MECH/ELEC 89 . 00
3-FRAME 79 . 00
4-REFINISH 75 . 00 4 . 6, 1 . 0 420 . 00
5-PAINT MATERIAL 35 . 00
LABOR TOTAL 652 . 50
SUBLET REPAIRS 4 . 00
TOWING
STORAGE
GROSS TOTAL, 1, 619 . 48
NET TOTAL . 1, 619 . 48
SHOPLINK U0080 ES CD LOG 31423-1 DATE 09/12/08 08 : 43 : 21AM R6 . 37 CD 08/08
PXN : Y/00/00/00/00/00 CUM 00/00/00/00/00 GEOCODE 94564 -
HOST LOG
(C) 1998 - 2008 AUDATEX NORTH AMERICA, INC.
1 . 3 HRS WERE ADDED TO THIS EST . BASED ON AUDATEX TWO-STAGE REFINISH FORMULA.
--------------------------------------------------------------------------
. THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF- CRASH PARTS SUPPLIED BY A
SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES
APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR
DISTRIBUTOR OF THE PARTS, RATHER THAN BY THE ORIGINAL MANUFACTURER OF YOUR
VEHICLE .
PAGE 2
09/12/08
09/12J2U8 at 09: 07 AM Job Number:
299'99 `
ACCURATE AUTO BODY
License # :AJ196460 Federal ID # : 911829674
1095 BROADWAY
SAN PABLO, CA 94806-2260
(510) 236-5576 Fax: (510) 236-5593
PRELIMINARY ESTIMATE
Written By: DAN SILVA
Adjuster:
Insured: MEIYON SAETANE Claim #
Owner: MEIYON SAETANE . Policy #
Address: 6 TRALEE CT. Deductible:
SAN PABLO, CA 94806 Date of Loss:
Cellular: (510) 837-1507 Type of Loss:
Point of Impact: 12 . Front
Inspect ACCURATE AUTO BODY Business: (510) 236-5576
Location: 1095 BROADWAY
SAN PABLO, CA 94806-2260
Insurance
Company: Days to Repair
1998 BENZ CLK320 6-3 .2L-FI 2D CPE Int:
VIN: WDBLJ65G2WF018958 Lic: 5RUA031 CA Prod Date: Odometer:
Air Conditioning Rear Defogger Tilt Wheel
Cruise Control Telescopic Wheel Climate Control
Keyless Entry Theft Deterrent/Alarm Dual Mirrors
Console/Storage Fog Lamps Clear Coat Paint
Metallic Paint Power Steering Power Brakes
Power Windows Power Locks Power Driver Seat
Power Passenger Seat Power Mirrors Heated Mirrors
AM Radio FM Radio Stereo
Cassette Search/Seek Premium Radio
Anti-Lock Brakes (4) Driver Air. Bag Passenger Air Bag
Front Side Impact Air Bag 4 Wheel Disc Brakes Positraction
Leather Seats Bucket Seats Automatic Transmission
Overdrive Aluminum/Alloy Wheels
--------------------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
-------------------------------------------------------------------------------
1 FRONT BUMPER
2 Repl Bumper cover 3.2L w/o AMG w/o" 1 470. 00 2.5 2 . 6
washer
3 Add for Clear Coat CONTRA b(�-TACOUNT
4* Repl Impact strip 1 212 . 00 RX)GPIV150
54 Repl Flex additive 1 4 . 50 T OCT O
6# Subl Hazardous waste removal 1 2 . 00 X 7 2008
7# Color tint 1 0. 5R1SK MANAGEMENT
Rpr Color sand and buff 1 . 0
1
09/12/2008 at 09: 07 AM Job Number:
29999
PRELIMINARY ESTIMATE
1998 BENZ CLK320 6-3 . 2L-FI 2D CPE Int:
-------------------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
-------------------------------------------------------------------------------
-------------------------------------------------------------------------------
Subtotals =_> 688 . 50 4 . 0 3 . 6
Parts 682 . 00
Body Labor 4 . 0 hrs @ $ 75. 00/hr 300 . 00
Paint Labor 3 . 6 hrs @ $ 75 . 00/hr 270 . 00
Paint Supplies 3 . 6 hrs @ $ 35. 00/hr 126 . 00
Sublet/Misc. 6. 50
----------------------------------------------------
SUBTOTAL $ 1384 . 50
Sales Tax $ 812 . 50 @ 8 .2500% 67 . 03
----------------------------------------------------
GRAND TOTAL $ 1451 . 53
ADJUSTMENTS:
Deductible 0. 00
----------------------------------------------------
CUSTOMER PAY $ 0 . 00
INSURANCE PAY $ 1451 . 53
FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS
FORM:
ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF
A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN
STATE PRISON.
THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO
DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR
ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES :
B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT
LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS :
ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE
PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT
PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL
AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION
NO=LINE NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL REPL=QUALITY
REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS
RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE
AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT
W/ =WITH/ SYMBOLS: #=MANUAL LINE ENTRY *=OTHER [IE. .MOTORS DATABASE
INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO
LINE. MQVP=MANUFACTURER' S QUALIFICATION AND VALIDATION PROGRAM. OPT
OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR
OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. NWCPP=NATIONWIDE CRASH
PARTS PROGRAM.
2
09/12/2008 at 09: 07 AM Job Number:
2999
PRELIMINARY ESTIMATE
1998 BENZ CLK320 6-3.2L-FI 2D CPE Int:
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived
from the Guide ERI5769, CCC Data Date 08/01/2008, and the parts selected are OEM-parts
manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at
OE/Vehicle dealerships. OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM parts
that may be provided by or through alternate sources other than the OEM vehicle dealerships.
OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount. OPT
OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle
dealerships. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor
information provided by MOTOR may have been modified or may have come from an alternate data
source. Tilde sign (-) items indicate MOTOR Not-Included Labor operations. Non-Original
Equipment Manufacturer aftermarket parts are described as AM, Qual Repl Parts or Comp Repl Parts
which stands for Competitive Replacement Parts. Used parts are described as LKQ, Qual Recy
Parts, RCY, or USED. Reconditioned parts are described as Recond. Recored parts are described
as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass
Specifications. Labor operation times listed on the line with the NAGS information are MOTOR
suggested labor operation times. NAGS labor operation times are not included. Pound sign (#)
items indicate manual entries. Some 2006 vehicles contain minor changes from the previous year.
For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and
parts data from the previous year may be used. The Pathways estimator has a complete list of
applicable vehicles. Parts numbers and prices should be confirmed with the local dealership.
CCC Pathways - A product of CCC Information Services Inc.
3