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Home My WebLink AboutMINUTES - 01062009 - C.13 (10) CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 1 b• G i P.� BOARD ACTION: JANUARY 106 2009 '`:` 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), (� usv �. given Pursuant to Government Code v Section 913 and 915.4. Please note all AMOUNT: $50,000.00 ��j ti��g g "Warnin s". CLAIMANT: JANIE COLLINS COP�t.(NG F. ATTORNEY: UNKNOWN'- M DATE RECEIVED: DECEMBER 05, 2008 ADDRESS: P.O. BOX 15186 BY DELIVERY TO CLERK ON: DECEMBER 05, 2008 SAN FRANCISCO, CA 94115 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DAVID TWA, X�W�� Dated: DECEMBER 05, 2008 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Su ervisors (,V'.fhis 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). O 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). / 1 , (Other: 102 5v Z-r1,0l LOCA' 16 Q /S�GIK�/a Ty bll& -e---14i Gl.it� r70 G� /OCV'4--Ur�, l GS' i Dated: 12, By: Deputy County Counsel III. FROM: Clerk of the Board T0: County Counsel (1) County Administrator(2) ( ) 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. Dateg15n�*e AtOW19AVID TWA, CLERK, By Deputy Clerk WA ING(06v. code.section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personalty served or deposited in the mail to Me 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. Datedp4mmc.�.� e; )WAVID TWA,CLERK, By Deputy Clerk . 4 This warning doeg dt apply to claims which are not subject to 16 a'lifornia Tort Claims Act such as actions in inverse condemnation, actions for specific relief such„as mandamus or , injunction, or Federal Civil'Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may'apply. The limitations period withiii 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. was/f\/ff■tilt/\/!!/IIIIf 111!!1!■■I!/I■\!!1!1!/11\/1111!■!1!!\1f/!If!!!f'f!/Neat RE: Claim By: Reserved fo 's filing stamp Q FL Fd Against the County of Contra Costa or ) co°s.ya `008 NrgAep1 0 r District) STA OR`�SO,�S (Fill in the name) „ C6ud C�rK(64Lvo�kji_w tEc ilurtskh2M The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ ) 6lJ0,n and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) u 6(22 A ,'Vt , ,iii� ._ 2. Where did the damage or injury occur (Incu"�city and county) ��(/�-�" ��u p�r-c�►'-�u r�a�Con-��--C.�S�a-�,�1 �uY 1�a�i d c�S: 3. How dtheda=geormilury cc JGive 1 details;use extra aper if require r cel GwVtc�-�t` � /�j�8 ISS uC, CI VIC� (LOLOej C ovx4w Aw, 7 , 4. What articular act or omission on the art of coffin district officers servants, k P P qr > causedi .the injury or damage? �� h-u'Y�l�H 5 th esof coni or district o criers arvan yy�"� � e °� ty � � ts,o' r�nployees causie damage or injury?CI vi L Cris S 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) 1—Z-5 oF CLe rK. vn Zia rr►�' f�C1� uhn ��sa o►� ,n ll�,re d L�rr.ys, 7. How w� the amount c�iimed ab6 e competed? (Include the estithated amount of any prospective injury or damage.) lgc6o-d7iffj -�v e n i f. Ib GC S 8. Names and addresses of witnesses, doctors, and hospitals: D r R44-.—Wi LL PY'-1 l4e. addrefs CYIS�ra-n,�Sc�cnce�'�-aC�ir�ior /�ZL /�n��.cacfc�rerse� 9. List a expenditures you made on account of this accident or injury: DATE 17ME AMOUNT lel/ZG PHM:d e-�, _An ed le-� P gaseous sm(am Nauseam" ammommoss sum smallusam"a m u an mossolml Gov. Code Sec. 910.2 provides"The claim shall be signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attormyl l z Name and address of Attorney ) (Claimant's Signature) (Address) Telephone No. )Telephone No�`7 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. ■aNow 1■foo■aasBoom now o BI B ago&Hassan a non BI B BBB■on B o an Raw■Rupee&We muni Bonn f.a as on■■BBBI 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. 10 4/wL- k- ,OL &f8:�5-n64-- LS-kd-4 J-4 7'L� 7 �ZS_ o_ Zile C i G-�1-4 La sLt Il J l I ' i ! 4YA Le c �yy,e nes I tS Com( �V1 S}�� UC Df - 4q Q'» -� ' G/ Y1G�/�'�"P tL� t�U�cs Y16+ . q h� C.eN LA [nd �i J 1 YI C-811:y�1 y 2 �r e, �' J !.t � I f� 1�►�r d ��`�1. t...J (+ � eFev�` `t`S G? z, 6c � t� F Z rS� h�kl%Der 6 Yn kV-O.- ��,sY�cNt USA RAz4 > cd vk(4�- 4a 4-- D(c��, L, ) S h6 tT I-U er tau IS s ein Is6t, Uek-e-j z e�l rn cheap 4—, �C p,"esti C4l rr4. -�b _� _ 14 ' ( � C� 1�� c Z-e✓ 1nc.�y�c� el,r.s DYYW�'. nesd— I sZ// )(:f - of i 7_