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Home My WebLink AboutMINUTES - 01132009 - C.09 (6) CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JANUARY 13, 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. )s you is your notice of the action taken on your,claim by the Board of Supervisors. (Paragraph IV below), DEC. 0 8 2008 given Pursuant to Government Code COUNTY COUNSEL Section 913 and 915.4. Please note all AMOUNT: UNKNOWN MARTINEZ CALIF. "Warnings". CLAIMANT: CALIFORNIA STATE AUTOMOBILE ASS: ATTN: 15-507177-7 ATTORNEY: UNKNOWN DATE RECEIVED: DECEMBER 08, 2008 ADDRESS: P.O. BOX 920 BY DELIVERY TO CLERK ON: DECEMBER 08, 2008 SUISUN CITY, CA 94585-0920 BY MAIL POSTMARKED: DECEMBER 04, 2008 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a.copy of the above-noted claim. DAVID TWA, Cl Dated: DECEMBER 08, 2008 By: Deputy. II. FROM: County Counsel TO: Clerk of the Board of Su ervisors (0"rhis 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 9113). O Other: Dated: �� By: �'�'` Deputy County Counsel III. FROM: Clerk of the Board TO: 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. Dat AVID TWA, CLERK, By eputy Clerk WA ING( . code section 913) Subject to certain exceptions,you have only sir(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 / DAVID TWA, CLERK, By Deputy Clerk This warning does 40t apply to claims which are not subject to the Cali ornia Tort Claims Act such as actions hnvmyere,condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil`Rightsclaims. The above list is not exhaustive tand,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 4 e. JUN-12-2003 09:23 CCC RISK MRNRGMENT 925 335 1421 P.02 Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA CMM INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. 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, 653 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 Seo. 72 at the end of this form. RE: 'Claim By } . Reserved.for,Clerk's filing stamp. ) PCIE�VE Against the County of Contra Costa DEC 0 8 2004 i CLERK BOARD 0r^' District) CONTI FIA Cr Fill in name The undersigned claimant hereby 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) 2. Where did the damage or injury occur? (Include city and county) fA . C'S) F--C� ('st�� -- 3. How did the�mage or injury occur? (Give full details; use extra paper if r-equired)C7ffiCer U v%,.5. w0-" pa� Kcr_'�. Grid r�cx� 1u��r� SpPecl {v. j'� ..:~.oma ._.._bke .*1p6a Gl.6 ;h','+Ait q rrt. � r{��c%c�.� 1 �er0454_det%S �l. What particular act or omission on the' part...of. county or.disrrict.,officers,� servants.'or. a employees caused..the.injury or damage? V`�6,"�c+ .. _, __ fit• .. . . �. ._ .. .� _. -� .. �- ... .. _ , . . ...{at" -. . - ,1 ,.. ..t,. Jun-le-gees 09:23 CCC RISK MPMGMENT 925 335 1421 P.03 j. what are the names of county or district officers, servants or employees causing the damage or injury? 5. What damage or injuries do you claim resulted? (Give Hill extent of injuries or damages claimed. Attach two estimates for auto damage. 7. ow was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) $. Names and addresses of.witne-ses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT saaaas s * .* * ssss -* s.sssaasasaas * * s +k.* � Gov. Code See. 910:2 provides "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or bv some person on his.behalf.r Name and Address of Attorney is signature w �ZAddress ��4��ico-toszfl �5� Telephone No.. Telephone No. * swan * IF * * ssaas sss 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 3ail,for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by*both such imprisoriment and finei-or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,0009 or by both such imprisonment and fine. �« V \ƒ\o - <� 00 � & \OE a $ � � o 0) *a I %� f ƒ � @ . � � . ƒ \ . /\ Z 10 �\ r is ,•� m .,,gyp.Tt �� ' r U U i LO U N C: r � t � 2 p3dlNt? `='o C31 L CD + a� E Qt N o a) rn 0UQU) GU p N N o o y/ •rd !,t {4! N � O