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HomeMy WebLinkAboutMINUTES - 11182008 - C.12 P 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 j ,N 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),. given Pursuant to Government Code AMOUNT: $2,666.74 OCT 2.3 2008 Section 913 and 915.4. Please note all COUNTY COUNSEL "Warnings". CLAIMANT: FARMERS INSUR®> M09WEALIF. FOR: RUIZ LANDSCAPING, INC. ATTORNEY: UN OWN HOUSTON DATE RECEIVED: OCTOBER 23, 2008 ADDRESS: P.O. BOX 268992 RR�Y DELIVERY TO CLERK ON: OCTOBER 23, 2008 OKLAHOMA CITY, OK 73126-8912 BY MAIL POSTMARKED: OCTOBER 21, 2008 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DAVID TWA, Cler Dated: OCTOBER 23, 2008 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Sup rvisors (L/is 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: De oS� By:t�_(� d 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, $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.A/0a&s ,e ') eJZAVID 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. Date d!t's v� d"���VDAVID TWA, CLERK, By Deputy Clerk • S'N This warningdoes;riot apply to claims which are not subject to"the�alVprnia Tort Claims Act such as actions in inverse condemnation, actions for specific relief gkh a 40-Andamus or injunction, or Federal Civil Rights•elaims.. The above list is not exhaustiveCand legal•.. 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 FARMERS National Document Center P.O. Box 268992 Oklahoma City,OK 73126-8992 claimsdocuments@farmersinsurance.com Fax: 877-217-1389 10/20/2008 Self Insured RECEIVED Attn: Clerk Of The Board Of Supervisors 651 Pine St.- Room 106 OCT 2 3 2008 Martinez,CA 94553 CLER CONTRA BOARD COsSU TA C0.1S . Re:Our Insured: - Ruiz Landscaping Inc Our Claim#: 099 SUB 1012733414-1 Date of Loss: 09/08/2008 Your Insured: Ccc Fire Protection District Your Claim#: 09-18-08 Deductible Amount: $0.00 Loss of Use Amount: $0.00 Total Amount Owed: $2,666.74 Dear Clerk Of The Board Of Supervisors: We have made payment to our insured for damages resuking from this accident.Our investigation has established that the above loss was caused bythe negligence of your insured By virtue of our subrogation rights this letter is to advise you that we expect payment from you for the amount of damages within 14 days of the receipt of this letter.. Be advised that no partial payment,which is less than the full amount claimed herein,will be considered in any way an acceptance of benefits,a novation or an accord and satisfaction of this claim without the express written release of our claim executed by an individual who identifies himself/herself as a member of our subrogation department.Therefore,our legal rights to enforce collection on the remaining amount of the claim shall not be waived or estopped due to a partial payment by you or someone acting on your behalf. If you need additional support for our claim or require further information,please call me at 909-801-3342 with your FAX number so that the requested information can be sent to you. Sincerely, Truck Insurance Exchange Oona Houston Auto Subrogation Representative oona.houston@farmersinsurance.com ATI'ACH EN T(S) BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY ' INSTRUCTIONS TO CLAMANT 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. ■aa■aaaraa■a■arae■■r aaaaaaasaaurrraauaca■is a race in a a, RE: Claim By: Reserved for Clerk's filing stamp ova 0A,\0- - o� ) 126\7, �yv��gC ..�O. -Snc. Against the County of Contra Costa or ) District) (Fill in the name) ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ 6.?'t 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) Did ll ,,` { v�ea� o+Er C 3. How did the damage or injury occurs?("Give full details;use extra paper if required) 4. What"particular act or omission on the part of county or district officers, servants, or employees Cie-awed the injury or damage? 03ep-Av-x-was de.r,+re�c �J ;Aromc 61ooea '^ b� -bdo�••d w1`�. u� cd f osop 4 oa5 wvpx-; HeuaasM4-,FVhe , Z ,�o veI-"k, .4ror "o-1n*.\ 5 What are the names of county or district officers,servants,or employees causing the damage or injury? a`� 61V4L1LV1. OV CCC 4. 6. What &-nage or injuries do your claim resulted? (Give M extent of injuries or damages claimed. Attach two estimates for auto damage.) 2o077 CV%&v�5ooTk&up- wear bovr��r`�s x �d.ecS, loer�:� cruc eco 7. How was the amount claimed above computed? (Include the estimated amount of any' prospective injury or damage.) 8. Names.and addresses of witnesses,doctors,and hospitals: 9. List the expenditures you made on account of this accident or injury: DATE TIME AM IN a\■u■a■\■tat\■mean Ian■an moon Reason uaaa■u■is■■■■■a■■\a■\aru.■■\sat a■■■s■\a■a, .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 ) ( is Si )rQOnliox ?�8`�aK �DY Cwt��Ol�t�2(d (Address) Telephone No. )Telephone No. an no No a■■a■a■*too r\■iam am a■\■ ozone onto Ban\MEN alto 0 aago won ass[new Its a us a a a■s Russ a■n PUBLIC RECORDS NOTICE: Please be advised that this claim form,or any claim Sled with the County under the Tort Claims Act,is subject to public disclosure under the California Public Records Act. (Gov. Code, §S 6500 et seq.) Furthermore, any attachments,addendums, or supplements attached to the claim form,including medical records,are also subject to public disclosure. •\own ago■b[■■a\a Raw I Bass\■■as■■•i\■■a■i■■\■■Baanalogy■■was was r\aaa■now \\■[\[\■[\\■\\1 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. FARM E R S National Document Center P.O. Box 268992 Oklahoma City,OK 73126-8992 claimsdocuments@farmersinsurance.com Fax : 877-217-1389 10/20/2008 Payment Log Account Number: DDD082922 Date of Loss: 09/08/2008 Insured's Name: -Ruiz Landscaping Inc Claim Number 099 SUB 1012733414-1 Loss Type Proof of Payment Date: 09/18/2008 Payee: RUIZ LANDSCAPING& D AND K.AUTO BODY COLLISION 50 WOODLAND AVE SAN RAFAEL,CA,94901 Payment Description: Material Damage Amount: $2,037.25 Date: 10/01/2008 Payee: RUIZ LANDSCAPING& D AND K AUTO BODY COLLISION 50 WOODLAND AVE SAN RAFAEL,CA,94901 Payment Description: Material Damage Amount: $629.49 Sub Total: $2,666.74 Deductible Amount: $0.00 Salvage $0.00 Total Amount: $2,666.74 10/01/2008 AT 10:46 AM 1012733414-1-2 52112 IACH03EI TRUCK INSURANCE EXCHANGE MARTINEZ SERVICE CENTER FOR SUPPLEMENT CALL (800)282-7033 PO BOX 268994• OKLAHOMA CITY, OK 73126-9750 (800)435-7764 SUPPLEMENT OF RECORD 1 WITH SUMMARY WRITTEN BY: CHRISTOPHER DUKE 10/01/2008 10:21 AM ADJUSTER: JESSICA ANGLEY (510)520-7851 INSURED: - RUIZ LANDSCAPING IN CLAIM #1012733414-1-2 OWNER: - RUIZ LANDSCAPING IN POLICY #0604196735 ADDRESS: 4694 MAMMOUTH IN DATE OF LOSS: 09/08/2008 AT 12:00 AM OAKLEY, CA 94561 TYPE OF LOSS: MD EVENING: (925)625-2902 POINT OF IMPACT: 6. REAR BUSINESS: (925) 679-0767 INSPECT 4694 MAMMOUTH LN EVENING: (925)625-2902 LOCATION: OAKLEY, CA 94561 HOME REPAIR'D & K AUTO BODY COLLISION 4 DAYS TO REPAIR FACILITY: 50 WOODLAND AVE LICENSE # SAN RAFAEL, CA 94901 2007 CHEV C2500 4X2 SILVERADO CREW LT 8-6.6L-TD 4D SHORT WHITE INT:GRAY VIN: 1GCHC23D17F186398 LIC: 8L32901 CA PROD DATE: 01/2007 ODOMETER: 24202 AIR CONDITIONING REAR DEFOGGER TILT WHEEL CRUISE CONTROL INTERMITTENT WIPERS KEYLESS ENTRY THEFT DETERRENT/ALARM MESSAGE CENTER BODY SIDE MOLDINGS DUAL MIRRORS PRIVACY GLASS OVERHEAD CONSOLE CLEAR COAT PAINT POWER STEERING POWER BRAKES POWER WINDOWS POWER LOCKS POWER MIRRORS HEATED MIRRORS AM RADIO FM RADIO STEREO SEARCH/SEEK CD PLAYER ANTI-LOCK BRAKES (4) DRIVER AIR BAG PASSENGER AIR BAG 4 WHEEL DISC BRAKES CLOTH SEATS REAR STEP BUMPER AUTOMATIC TRANSMISSION OVERDRIVE ALUMINUM/ALLOY WHEELS ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT --------------m REAR BUMPER 2 S01 O/H REAR BUMPER 0 0.00 1.8 0.0 3 SOI REPL BUMPER CHROME PRODUCTION 1 309.54 INCL. 0.0 4 REPL REINFORCEMENT 1 190.99 0.0 0.0 5 REPL RT BUMPER BRACE 1 31.28 INCL. 0.0 6 REPL LT BUMPER BRACE 1 34.48 INCL. 0.0 7 REPL RT`BUMPER BRACKET 1 35.41 INCL. 0.0 8 REPL LT BUMPER BRACKET 1 36.82 INCL. 0.0 9 REPL RT STEP PAD OUTER W/0 HEAVY 1 68.80 INCL. 0.0 DUTY 10 REAR LAMPS 1 10/01/2008 AT 10:46 AM 1012733414-1-2 52112 IACH03EI SUPPLEMENT OF RECORD 1 WITH SUMMARY 2007 CHEV C2500 4X2 SILVERADO CREW LT 8-6.6L-TD 4D SHORT WHITE INT:GRAY ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 11 R&I RT COMBO LAMP ASSY 1/2 & 3/4 0 0.00 0.4 0.0 TON CHEVROLET 12 PICK UP BOX 13* S01 RPR RT SIDE PANEL 0 0.00 5.0* 3.1 14 ADD FOR CLEAR COAT 0 0.00 0.0 1.2 15# REFN BASE COAT REDUCTION, FULL 0 0.00 0.0 -1.0 CLEAR 16 R&I RT FLARE GRAINED 0 0.00 0.4 0.0 17# R&I BEDLINER 0 0.00 1.0 0.0 18# R&I TOOL BOX 0 0.00 1.0 0.0 19# R&I LUMBER RACK 0 0.00 2.0 0.0 20# SUBL HAZARDOUS WASTE 1 5.00 X 0.0 0.0 21# COVER CAR 1 10.00 X 0.0 0.0 22# CORROSION PROTECTION 1 8.00 X 0.0 0.0 23* SO1 RPR TAIL GATE 0 0.00 0.5* 2.1 24 SO1 OVERLAP MAJOR ADJ. PANEL 0 0.00 0.0 -0.4 25 S01 ADD FOR CLEAR COAT 0 0.00 0.0 0.3 26# S01 REFN BASE COAT REDUCTION 0 0.00 0.0 -0.5 27 SO1 R&I HANDLE PAINTED BLACK 0 0.00 0.4 0.0 28 SO1 R&I SPOILER 0 0.00 0.3 0.0 29 SO1 REPL DECAL "SILVERADO" 1 51.46 0.2 0.0 30 S01 REPL SET BACK BOX ASSY 1 0.00 1.5 0.0 ------------------------------------------------------------------------------- SUBTOTALS =_> 781.78 14.5 4.8 PARTS 758.78 BODY LABOR 14.5 HRS @$ 85.00/HR 1232.50 , PAINT LABOR 4.8 HRS @$ 85.00/HR 408.00 PAINT SUPPLIES 4.8 HRS @$ 35.00/HR 168.00 SUBLET/MISC. 23.00 ---------------------------------------------------- SUBTOTAL $ 2590.28 SALES TAX $ 926.78 @ 8.2500% 76.46 ---=------------------------------------------------ TOTAL COST OF REPAIRS $ 2666.74 ADJUSTMENTS: DEDUCTIBLE 500.00 ---------------------------------------------------- TOTAL ADJUSTMENTS $ 500.00 NET;COST .OF REPAIRS $ 2166.74 2 � � � � � � � . �w�;F� � � q�,gMz- .w,... - a �.r. .. a , ,. � ,, a a�`=r r `.. ti �! y� xldxlwOtWr�f'1l� y. ,a;;i'�rk: �,�y d:.�l •,,.c� � � �/ afi sr� � a e �, S wronxau�oe�. _� // ff ,,�: ,. i (� .f>*i.„. _ p 'i � i',i � ; ,.� _. _� —.. — ___ _.. - .,,h 9 a'v � ... ,. � �. N I p � aapm�e s n� � 1 ,� r ,,A ,� � � � }�` `1hj .rp 7 . � '+w-...,_ e t§�'A+��� t SIT.F H� Fl1 Y Z .I «�. ,.� .� ' �` �� .,... _ _ * 1 �_. ...�.� �. �{ � I CRN PhotoWizard Page 2 of 4 v" i Y 9 ,z. gist+ 3 sty A ;X BUMPER PUSHED INTO BED STEP PAD BENT CRN PhotoWizard Page 3 of r l r DENT IN BUMPER UNK IF CENTER STEP PAD IS BROKEN.TABS APPEAR TO BE INTACT r_ ,via�==�3`.,_•, CRN Photo Wizard Page 4 of 4 r e 333Mq.P qy x =^ AE s) } �t BUMPER BRACKET BENT REINFORCEMENT IS BENT Choi c e Po i n t ChoicePoint Police Records P.O.Box 740167 Atlanta,GA 30374-0167 Phone: 1.800.934.9698 Fax 1.800.934.6449 Email: orderpoint.support@choicepoint.com REPORT ATTACHED PAGE COUNT: 6 CLIENT : 207857 DIVISION : L2 ADJUSTER : USWBEL1I CLAIM : 1012733414 TRANSACTION# : 249846621 DATE : 10/04/2008 DATE OF LOSS : 09/08/2008 TIME OF LOSS : 03:00 PM STREET : OLD HIGHWAY 4 NEAR LOVERIDGE CITY : PITTSBURG COUNTY : CONTRA COSTA STATE : CA INVESTIGATING AGENCY : PITTSBURG PD REPORT NUMBER : C08-6984 REPORT TYPE : Auto Accident PARTY 1 : ARMANDO RUIZ PARTY 2 : PARTY3 : CAR : 2500 MAKE : CHEVROLET YEAR : 2007 TAG : AL32901 DRIVER LICENSE : ADDITIONAL INFO : NOTE : STATE OF CALIFORNIA TRAFFIC COLLISION REPORT CHP 655 Page 1,(Rev.8-97) OPI 042 PAv DY 5 SPECML CONDITIONS "BER w6nm CITY SWI D18TAICT LOCAL REPORT NUMBER NHNHER Rnuo Hra AVx COUNTY REPORTING DISTRICT BEAT to luA wsovaxun ❑ COLLISION OCCURRED ON MO. DAY YEAR TIME C24M NCIC IN OFFICER LD, MILEPOST INFORMATION DAYOFWEW TOWAWAY PHOTOGRAPHS Sr. E)NONE a ®T W T F S ❑YES ® NO a�rTi�-j (� FEDTMILES OF S Q .y❑.y�L AT INTERSECTION WITH ! STATE HWY REL +q OR: REFEST OE OF J�+ Q66 IC.L ❑YE8 NO PARTY DRIVER'S LICENSE NUMBER STATE CU38 6AFETY VEM.YEAR]MAXEMOVELiCOLOR LICENSE NUMBER STATE . 1C 3010 O"� F9PA_� J�l�Utft� _ S \43.L-- -- DRNER NAME(FIRST,M/pOLE.LAST) ® �1Jl�.l�U..�itaCL1ES A�1 OWNER'SNAME ❑ SAME AS DRIVER PEK& STREET ADDRESS //1� ❑ ON Q 6 6^4z, Q-0 O Mum ADDRESS ❑ SAME AS DRIVER PA"R ?-010 CRY/STATE21P .. ❑ S `' �.�;.4... GA OHSFOSmON OF VEHICLE OJ gtoERa OP: ©OFFICER❑DRIVER ❑OTHER RILY. SEX HMR EYES - HEIGHT WEICHT BBRTHDATE RACE l v-1 ODE R� nn M0. DHy YAx M StrJ�t3 ❑ " R7Cp •Y 4D , FRIORMECHAMCALDEFECTS: NONEAPPARENf "MTONARRATIVE OTHER HOME PHONE BUSWESSPHONE A�\l VEHICLE IDENTIFICATIONNIlA1"I"' v ❑ y \"1\+ 3S 11 S-40 CHP08EONLY DESCRIBE VEHICLE DAMAQE +l SIUDEWDAMAGEDAREA INSURANCE CARRIER POLICYNVMBER VEHICLE TYPE ❑UNK NONE ®MINOR I I IE]MOD_ ❑MAJOR❑ROLL-OVER OIR OFTRAVFl ON STREET OR HIGHWAYSPEED LIMIT SS GA DDT CAL•T TCP/PSD MCMX PARTY DRIVERS LICENSE NUMBER STATE CUSS SAFETY VEN.YEAR MANEAgpEVCOLOR LICENSE NUMBER STATE z C 21��iZ C'A C - cr+__aAe,)-[N_(w;t -st _eA_ DRIER NAME MRST,MIDDLE LASST)` ` (� ® RQ_CtA.J \ V Q-Qi-L °WHEETsNAME ® $AME AS DRIVER. P01% STREET ADDRESS ULU! ❑ RWpA t!�Al�IHA'�O J'N (_f�a�Z OWNERS ADDRESS SAME AS DRIVER PMKIO CITYISTATEIZER WRICLE oBPOSmgJ OF VEHICLE ON ORDERS OF: ®OFFICER❑DRIVER r-1 OTHER OR SE!( HAIR EYES HEIGHT 1WI]p3HHT� BIRTHDATE 1 RACE I ❑ \'\` A ,Ry 6YT-AI PRIOR MECHANICAL DEFECTS11�: NONEAPPARENT f7 RffER TONARRATNE OTHER HOME PHONE BUSINESS PHONE a•'� VEHICLE IDENTIFICATION NUMBER: ❑ �7• 1JI �p „S• , +'q�-{�{ CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHAOE IN OAEMGEDAREA VEHICLE TYPE INSURANCE CARRIER POIICYNUMBER ❑UNK NONE RMINOR I I 11 MOD. ❑MAJOR ROLL-OVER > DWOFTRRAVEL ONSTREET ORHIGHWAY SPEEDUMIT CA WT lip, Virl S� CAL•T TCP/PSC MCMX PARTY DRIVERS LICENSE NUMBER STATE SAFETY VELYEARFOCIELicaum LICENSEMIAaER STATE$ _ eouw.NmrM NAME(FIRST,MIDDLE,HAST) ' ----- ---------------- --------------- ❑ q MAOWNERS NAME ❑ SAME AS DRIVER PEDES, STREET ADDRESS �•-� El 'TCI _, ARII D JUV� OWNERSADORESS ❑ SAME AS DRIVER EMS CITYISTATEMP WHICLIE ❑ DISPOSRWNOFVEHICLEONOROERSOF: , S�IT❑'� OFFICER DRIVER❑OTHER BAT. SEX HAW EYES HEIGHT WEIGHT BIRTHDATE RACE COIVIR I .r. CURT Ma 13 DAY Y. n-. ❑ PRIOR MECHANICAL DEFECTS: NONEAPPARENC REFEATONARRATIVE DRIER HOME PHONE BIIBW EBB PHONE VEHICLE IDENTIFICATION NUMBER: . ❑ CHP USE ONLY DESCRIBE VEHICLE DAMAGEDEIW5U MGEDMEA INSURANCE CARPER POLICY NUMBER VEHICLE TYPE ❑UNK MINOR ❑MOD. t9r,fc�sE� ArMENr DIR OF TRAVE ON STREET OR HIGHWAY SPEED LOAR CA 007 GALT TCPNSC^_MCRA% PREPARER'S NAME DISPATCH NOTIFIED REVIEWER'S NAME DANE RXVIEVVED v ITEYX7 1 � ®YES ❑NO ❑N/A `�I PITTSBURG POLICE DEPARTMENT PITTSBURG, CAUFORNIA Case No. 9-ORIGINAL PROPERTY/EVIDENCE REPORT Q004 O SUPPLEMENT PN0. Code Sect/ ctdent Victim(Last Name First) Suspect's Name Ofc. Trig Prop. ' ti Property S-Stolen F-Found R-Recovered Dispos. ER-Evid.Room PL-Prepared ter Lab Property v.,nae„ w•WAMW 0. oma Legend E-Evidence SK-Safe Keeping Legend R-Refrigeration LO-Ret.to or lett with owner Owner Cade s-surosw F-Fbtft Property Owner Code Address Nome Phone Business Phone Bln N Item Prop. DescriptionFbthnated Disp. Prop. No. Lep. Value Log. Code 1xF Wo &zk) — CO ROLLED 00CUME1 IT Ivestlgatin 00 er Assisting Offlcer/s Processed byDate and Time M -le0SA SEP 3 0 MU6 -romments Reviewed by Date and Time PITTSBURG Assigned Q Patrol Q Traffic Copies Q Patrol Q Alm.Ser. Q D.A. ❑Other case Q Inv. ❑Juv. to: Q Inv. Q Chief CII Closed Q PD-096 Rev.02/02 STATE OF CALIFORNIA TRAFFIC COLLISION CODING CHP 555 Page 2(Rev.8-97) op, 042 pap?.Df DATE OF COLLISION 10O.�AV YEAR) TIME NCICi „T OFF � NUMBER �• �� (�` 8OYMER•S NAME !V OWIISIM ADDRESS NOTIFIED PROPERTY DYES � NO DAMAGE DESCRIPTION OF DAMAGE SEATING POSITION SAFETY EQUIPMENT EJECTED FROM VEHICLE OCCUPANTS L-AIRBAGOEPLOYED MICBICYCLE- ^ HELOT - 0-NOT EJECTED X.NONE IN VEHICLE M-AIR BAG NOT DEPLOYED 1-FULLY EJECTED B-UNKNOWN N-OTHER DRIVER 2-PARTIALLY EJECTED C-LAP BELT USED P-NOTREQUIRED. �V-NO 3-UNKNOWN -• 1 2 3 1-DRIVER D-LAP BELT NOT USED W-YES 2TO6-PASSENGERS E-SHOULDER HARNESS USED 4 5 6 7-STATION WAGON REAR F-SMOl1lDER HARNESS NOT USED CHILD RESTRAINT PASSENGER 8-REAR OCC.TRKIOR VAN G-LAP/SHOULDER HARNESS USED U-IN VEHI LE USED ' X-NO S-POSITION UNKNOWN H-LAPISHOULDER HARNESS NOT USED R-IN VEHICLE NOT USED Y-YES T J-PASSIVE RESTRAINT USED S-IN VEHICLE USE UNKNOWN 0-OTHER IK-PASSIVE RESTRAINT NOT USED T-IN VEHICLE IMPROPER USE ' ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK C)SHOULD BE EXPLAINED IN THE NARRATIVE. PRIMARY COLLISION FACTOR TRAFFIC CONTROL DEVICES TYPE OF VEHICLE MOVEMENT PRECEDING LIST NUMBER OF PART'AT FAULT 1 2 3 1 2 3 .CO BION ,L A vcseeiaN.AaATmv urco A CONTROLS FUNCTIONING A PASSENGER CAR I STATION WAGON A STOPPED y KS B CONTROLS NOT FUNCTIONING' IS PASSENGER CAR W/TRAILER 41P IS PROCEEDING STRAIGHT B OTHER IMPROPER DRIVING': IC CONTROLS OBSCURED IC MOTORCYCLE I SCOOTER C RAN OFF ROAD D NO CONTROLS PRESENT FACTOR' D PICKUP OR PANEL TRUCK D MAKING RIGHT TURN C OTHER THAN DRIVER' TYPEOFCOLLISION E PICKUP I PANEL TRUCK W1 TRAILER E MAKINGLEFTTURN D UNKNOWN' I A HEAD-.ON F TRUCK OR TRUCK TRACTOR F MAKINGUTURN E FELL ASLEEP' B'SIDESWIPE G TRUCK MUCK TRACTOR W/TRLR. G BACKING C REAR END H SCHOOL BUS': I H.SLOWNGI STOPPING WEATHER IMARK I TO 2 MEAM I D BROADSIDE I OTHER BUS I PASSING OTHER VEHICLE IA A CLEAR I E HR OBJECT J EMERGENCY VEHICLE J CHANGING MANES B CLOUDY IF OVERTURNED K HIGHWAY CONST.EQUIPMENT I IK PARKING MANEUVER C RAINING G.VEHICLE I PEDESTRIAN L BICYCLE L ENTERING TRAFFIC D SNOWING H OTHER''. M OTHERVEHICLE I IM OTHER Uh ETURNING E FOG I VISIBILITY FT. N PEDESTRIAN I IN XING INTO OPPOSING LANE F OTHER': MOTOR VEHICLE INVOLVED WITH 0 MOPED 1 10 PARKED ND - A NON-COLLISION I IF-MERGING LIGHTING B PEDESTRIAN 1 10 TRAVELING WRONG WAY qf A DAYLIGHT AM C OTHER MOTOR VEHICLE OTHER ASSOCIATED FACTORS) .R OTHER'[ ' B DUSK-DAWN D MOTOR VEHICLE ON OTHER ROADWAY 1 2 3 (MARK 1 TO 21TEMS) C DARK-STREET LIGHTS E PARKED MOTOR VEHICLEveseom+vlouTw": cmc D DARK-NO STREET LIGHTS F TRAIN. A SEs E DARK-STREET LIGHTS NOT G BICYCLE B Kae ^T014o❑Y� FUNCTIONING* H ANIMAL: ❑ND SOBRIETY•DRUG ROADWAY SURFACE C �MGTON"01"110M' YES 1 2 3 PHYSICAL A DRY ) FIXED OBJECT: �NNO (MARK 1 TO 2 ITEMS) B WET D T AHAD NOT BEEN DRINKING C $NOWY-ICY J OTHER OBJECT: E VISION OBSCUREMENT: B HED•UNDER INFLUENCE LIPPERY MUDDY OILY,ETC. F INATTENTION': - C HBO-NOT UNDER INFLUENCE' ROADWAYCONDITION(S) _ G STOP S GO TRAFFIC D HBO-IMPAIRMENT UNKNOWN' (MIRK 1 TO 2ITEMS) PEDESTRIANS ACTIONS I H ENTERING I LEAVING RAMP E UNDER DRUG INFLUENCE' A HOLES,DEEP RUT' APIA NO PEDESTRIANS INVOLVED I .I PREVIOUS COLLISION .F IMPAIRMENT-PHYSICAL• B LOOSE MATERIAL ON ROAOWAY' B CROSSING IN CROSSWALK J UNFAMILIAR WITH ROAD G IMPAIRMENT NOT KNOWN C OBSTRUCTION ON ROADWAY' AT INTERSECTION K DEFECTIVE VEH.EQUIP.: CITED H NOT APPLICABLE D CONSTRUCTION-REPAIR ZONE C CROSSING IN CROSSWALK-NOT ❑�p�-{Y I SLEEPY/FATIGUED E REDUCED ROADWAY WIDTH AT INTERSECTION LJNO SPECIAL INFORMATION F FLOODED' D CROSSING-NOT IN CROSSWALK L UNINVOLVED VEHICLE A HAZARDOUS MATERIAL G OTHER': E INROAD-INCLUDES SHOULDER M OTHER', dM H NO UNUSUAL CONDITIONS F NOT INROAD N NONE APPARENT G APPROACHING I LEAVING SCHOOL BUS 1 10 RUNAWAYVEHICLE IF SKETCH MISCELLANEOUS PDX x0Ica78 NOATH t 12 - V_ r PITC f AQT LyW.l CONTROLLED DOCUMENT SEP 3 0 2U!1:6 PITTSBURG POLICE DEPARTNIFNT .. OSP 99 3800 STATE OF CALIFORNIA NARRATIVE/SUPPLEMENTAL PAGE DATE OF INCIDENT TIME NCIC NUMBER OFFICER ID NUMBER 09/08/08 1 0643 0708 1 P247 C08-6984 "X"ONE "X"ONE TYPE SUPPLEMENTAL('X"APPLICABLE) X Narrative F—X-1 Collision Report BA update Fatal Hit and Run update Supplemental Other. Hazardous materials School bus Other. CITY/COUNTY/JUDICIAL DISTRICT DISTRICT/BEAT I CITATION NUMBER Pittsburg /Contra Costa / Delta 8 ---- LOCATION/SUBJECT STATE HIGHWAY RELATED PittsburgAntioch Hwy 1 .80 miles E of Loveridge Rd. Yes rx-1 No 1 FACTS: 2 3 NOTIFICATION: I was dispatched to a call of a collision involving a county vehicle at 4 approximately 0700 hrs. I responded from the station and arrived on scene at 0705 5 hrs. All times, speeds and measurements are approximate. Measurements were made 6 by visual estimation, except where otherwise indicated. 7 8 SUMMARY: D2 (RUIZ)was driving V2 (CHEVROLET)east on the Pittsburg/Antioch 9 Highway in stop and go commute traffic. D1 (CHAMPION) was driving V1 (FORD)east 10 on the Pittsburg/Antioch Highway behind V2 (CHEVROLET). V2 (CHEVROLET) 11 stopped due to traffic and V1 (FORD) struck V2 (CHEVROLET). Both vehicles pulled to 12 the right shoulder of the roadway and contacted police 13 14 AREA OF IMPACT: 15 16 AOI#1 V1 (FORD)vs. V2 (CHEVROLET)was determined to be 4' S/SCL of 17 Pittsburg/Antioch Highway and .8 miles east of Loveridge Road. 18 19 CAUSE: D1 (CHAMPION) caused this collision by being in violation of CVC 22350- 20 Unsafe Speed for Conditions. 21 22 RECOMMENDATIONS: None 23 CONTROLLED DOCUMENT PREPARER'S NAME . I.D.NUMBER I DATE REVIEWER'S NAME SEP 3 U ZDANTE J M Terry I P247 09/08/08 E DEPARTMENT o Z N N N N � A W NrOtDO� V m -M ? W NrO � � V M � W Nr rn CD 0 Z . CD � W � � � o � Lo a =. O Q. 0 G) v � 9 rn 8 0 v m rn -zj O m o �3 O GCL O � rnN O x G1 o L 3 z ro rn Ln 3 rn n rn o n 0 Z D C NT OLL D D oU z P TTS UR Lf < P PA T D FARMERS? SUBROGATION/SALVAGE CENTER OF EXCELLENCE PO BOX 288992 OKLAHOMA CITY OK 73126-8992 T 26 O L,o srgco G/s OyS I ti i W N 0occ�,, N N • CDiA a� cl nl . � , om �O h m `0 N W W O r 00 v, NOVp 2008 National Document Center . ..:.:. FARM R. S4 " P.O. Box 268992 COUNTY COUNSEL Oklahoma City, OK 73126-8992 MARTINEZ, maklt,documents@farmersinsurancc.com Fax : 877-217-1389 11/03/2008 RECEIVE® Self Insured Nov 0 6 2008 Attn: Clerk Of The Board Of Supervisors 651 Pine St. -Room 106 CLERK 30P.RD OF SUPERVISOR Martinez, CA 94553 coN;R,4 cosz�co. Re: Our Insured: -Ruiz Landscaping Inc Our Claim#: 099 SUB 1012733414-1 Date of Loss: 09/08/2008 Your Insured: Ccc Fire Protection District Your Claim#: 09-18-08 Amount Owed: $2,666.74 Dear Clerk Of The Board Of Supervisors: We previously informed you of our subrogation claim. Please review your file and advise us if you are now in a position to consider our claim. If we do not receive payment within 7 days of receipt of this letter, we will assume that we have your permission to arbitrate. If you are not a participating company with Arbitration Forums Inc.,we will file a lawsuit against your insured. If you need additional support for our claim or require further information,please call me at 909-801-3342 with your FAX number so that the requested information can be sent to you. Sincerely, Truck Insurance Exchange Oona Houston Auto Subrogation Representative 909-801-3342 oona.houston@farmersinsurance.com ------------- ctal`rt�