Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
MINUTES - 04011986 - 1.16
BOARD OF SUPFyyismS OF CONTRA COSTA Comm, CALMMIA BOARD ACTION Claim Against the County, or bistriet ) NOTICE 70 CLAIMANT April 1, 19$6 governed by the Board of Supervisors, ) The copy of-th-t-9-document mailed to you is your Routing Endorsements, and Board ) notice of the action taken on your claim by the Action. All Section references are ) Board of Supervisors (Paragraph I119 below), to California Government Codes ) given pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". Claimant: AL GUNDERSEN County Counsel Attorney: MAR 0 4 1966 Address: 4951 Cherry Avenue, Apt. 56 Hand delivered Martinez, CA 94553 San Jose, CA 95118 ch By delivery to clerk on March Amount: $1, 100. 00 r �..�, 1986 Date Received: March 3, 1986 By mail, postmarked on I. FROM: Clerk of the Board of Supervisors 70: County Counsel Attached is a copy of the above-noted claim. � 'D Dated: March 3, 1986 PHIL BATCHELOR, Clerk, By300 Deputy n Cervelli II. FROM: County Counsel TO: Clerk of the Board of Supervisors (Check only one) ( ) 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.. 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). ( ) Other: Dated: Zit c12r6 By: ` Deputy County Counsel III. FROM: Clerk of the Board TO: (1) County Counsel, (2) County Administrator ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER By unanimous vote of Supervisors present (f ) 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 mi nuWor� l this date. Dated_ PHIL BATCHELOR, Clerk, By , ti L , Deputy Clerk WARNING (Gov. Code Section 913) Subject to certain exceptions, you have only six (6) months from the date of 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. V. FROM: Clerk of the Board TO: (1) County Counsel, (2) County Administrator Attached are copies of the above claim. We notified the claimant of the Board's action on this claim by mailing a copy of this document, and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. ( ) A warning of claimant's right to apply for leave to present a late claim was mailed to claimant DATED: APR 03 T986 PHIL BATCHELOR, Clerk, By , Deputy Clerk cc: County Administrator (2) County Counsel (1) s C , ?M R'17•, BOARD OF SUPERVISORS OF CONTRA CO*T_-6Tn%WWapplication to: Instructions to ClaimantC!erk of the Board &5-/P," e S,/./ kio 6 Martinez,California 94553 A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops must be presented not later than the 100th day 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. (Sec. 911.2, Govt. Code) 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, California 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 end his form. RE: Claim by )Reserved for Clerk's filing stamps. REC I Against the COUNTY OF CONTRA COSTA) MAR 3- 1986 Or �� J DISTRICT) PHIL BATF SUP R Fill in name \ K BO A OF SUP RV OR$ / CO A COST O � By PutY The undersigned claimant hereby makes claim against he County of Contra Costa or the above-named District in the sum of $ %/00 and in support of this claim represents as follo..s. ------------------------------------------------------------------- ---- l. When did the damage or injury occur? (Give exact date and hour] Y WKere did the damage or injury occur. (Include city and county) 3. How did the damage or injury occur? (Give full details, use extra sheets if required) LIO 4. What ptrticular dct or omission on the part of county or divsi t officers, servants or employees caused the injury or damage? (over) 9. t Wet Are the names of county or district officers, servants or ,employees causing the damage or injury? ------------------ --------- � K flete-almage or inj ries do you claim resulted? (Give fullextent of injuries or damages claimed. Attach two estimates for auto damage) ? lude the estimated ow was-! VhZIc -1 c�;�U4A� n c &e a�mo med above amount of any prospective injury or damage. ) 8. Names and addresses of witnesses, doctors and hospitals. A-J-6 AV4F SAOLVAdprz,-� rw.S 77 . VIS 69- - //Or Z_ A cir,#- jPVVOY 9. List the expenditures you made on account of this accident or in3ury: DATE -ITEM AMOUNT 13- 8,6- pgo,V ate, &%e Ce_JOL4','r Govt. Code Sec. 910.2 provides: "The claim signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf. " Name and Address of Attorney claimant's Signature Address Telephone No, Telephone No. y4f_ :2r,7_,r4E47 NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for all-owance or for payment to any state board or officer, or to any county, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is guilty of a felony. " i -� Co r✓�T alqo� t G�vr....� /�'I.e..Q�l'•� (�,. r"'.�,�f'- G+��,."'1[-/„!}�� �-'�+'.,�il..�i .�t��- t.�--- ,. /�RJ /YLO ..� _.-G�.v�•��� ..._ �" /�'''•�-- ��� �",,,� '`'cam-" 7 Cof-%l Oj 400 i 1 M ik (( 1 ice_Y I I CLAIK BOARD OF SUPERVISORS OF C511RA COSTA ODUf'Ti i* BOARD ACTION Claim Against the County, or bistrict ) p0'i'ICE TO CLAIMANT April 1, 198 governed by the Hoard of Supervisors, ) The copy of-Ws document led to you is your Routing Endorsements, and Hoard ? notice of the action taken on your claim by the Action. All Section references are ) Board of Supervisors (Paragraph IV, below), to California Government Codes ) given pursuant to Government Code Section 913 and 915.4. Please note all wWarnings". Claimant: MARILYN BACQUE County Counsel Attorney: MAR 0 4 1986 Address: 102 Ramona El Cerrito, CA 94530By delivery to clerk on Martinez, CA 94553 Amount: $210. 00 Date Received: March 3 , 1986 By mail, postmarked on �o�„-,ter 2,�, 1gg6 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. Dated: P.larch 3 , 1986_PHIL BATCHELOR, Clerk, By 01 A A., I Deputy _ 96111 II. FROM: County Counsel T0: Clerk of the board or Supervisors (Check only one) ( ) 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. 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). ( ) Other: r Dated: h BDeputy County Counsel III. FROM: Clerk of the Hoard TO: (1) County Counsel, (2) County Administrator ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER By unanimous vote of 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 mindate. Dated: ~� PHIL BATCHELOR, Clerk, y Clerk WARNING (Gov. Code Section 913) Subject to certain exceptions, you have only six (6) -months from the date of this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 915.6. 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. V. FROM: Clerk of the Board 70: (1) County Counsel, (2) County Administrator Attached are copies of the above claim. We notified the claimant of the Board's action on this claim by mailing a copy of this document, and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. { ) A warning of claimant's right to apply for leave to pment a late claim was mailed to claimant. DATED: Q 31� PHIL BATCHELOR, Clerk, ��' C� , Deputy Clerk cc: County Administrator (2) County Counsel (1) M A T1/ CI,AIM�T0:,{ BOARD OF SUPERVISORS OF CONTRA C a _ T�yapplication to: Instructions to ClaimantClerk of the Board .O.Box 911 Martinez,Califomia 94553 A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops must be presented not later than the 100th day after the accrual of the cause of action. Maims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Sec. 911.2, Govt. Code) 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, California 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the Distript 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 end o this form. RE: Claim by )Rese ng stamps AM IV RECEIVED 1,14 h '4 I / Pio r 10 MICR 3 1966 Against the COUNTY OF CONTRA COSTA) ERK S n OF SUP' is or �, �� rf �' DISTRICT) co r �C7S (Fillin 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: �. When did the damage or injury occur? (Give exact date an'27- d hour] WRre did tfie damage or injury occur? (Include city and county 3. How did the damage or injury occur? Giveul� details, use extra `�' ; sheets if required) T i� ��� �� �' L :t re`s u 4. What particular actor or omission on the part of county district officers, servants or employees caused the injury or damage? (over) 5. That are the names of county or district officers, servants or euilaloyees causing the damage or injury? 6. What damage or fh�uries do you claim resulted? ZGfve full extent of injuries of damages claimed. - Attach two estimates for auto damage) 7 --------------------------------------------------------------------. Bow was the amount claimed above computed? (Include the estimated -- amount of any prospective injury or damage. ) ------------------------------------------------------------------------- 6. Names and addresses of witnesses, doctors and hospitals. 3. Lfst he •expenditures7yo-u made on account of this accident or injury: ATE • `_' ' ITEM AMOUNT A� 6 .. '24 7T, 17 A- F Govt. rode Sec. 910.2 provides: "The claim signed by the claimant SEND NOTICES TO: (Attorney) o, some person on his behalf. " Name and Address of Attorney Cl 3.mar s Signa re -y n q _ Address �— .• .t Telephone No. Telephone No. !r-�- 7- 7F I i VOTICE t 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, town, city district, ward or village board or officer', authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is guilty of a felony. " CLAIM BOARD OF SUPERVISORS OF COW COSTA ODUI [, CALI MIA BOARD ACTION Claim Against the County, or bistrict ) WTICE TO C[ AIMANT April 1, 1986 governed by the Hoard of Supervisors, ) The copy of this doicument7affled to you is your Routing Endorsements, and Board ) notice of the action taken on your claim by the Action. All Section references are ) Board of Supervisors (paragraph IV, below), to California Government Codes ) given pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". Claimant: Edward T. Patterson county CoUtiStl Attorney: MAR 0 4 198f� Address: P.0. Box 786 Hand delivered Martinez, GA 94553 Amount: Martinez, CA - 94553 By delivery to clerk on March 3 , 1986 $1364. 07 Date Received: March 3, 1986 By mail, postmarked on I. FROM: Clerk of the Board of Supervisors 70: County Counsel Attached is a copy of the above-noted claim. t D Dated: March 3, 1986 PHIL BATCHELOR, Clerk, By A&4 De y II. FROM: County Counsel TO: Clerk of t e Board of Supervisors (Check only one) (X) This claim complies substantially With Sections 910 and 910.2. - { ) This claim FAILS to comply substantially with Sections 910 and 910.29 and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( } Claim is not timely filed. 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). ( ) Other: Dated: -t,-k /K Deputy County Counsel III. FROM: Clerk of the Board TO: (1) County Counsel, (2) County Administrator ( } Claim was returned as untimely with notice to.claimant (Section 911.3). IV. BOARD ORDER By unanimous vote of 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 Dated nl or� � 1A date. ' By i PHIL BATCHELOR, Clerk L- i ; , �- --; Deputy Clerk WARNIPM (Gov. Code Section 913) Subject to certain exceptions, you have only six (6) months from the date of 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. V. FROM: Clerk of the Board 70: (1) County Counsel, (2) County Administrator Attached are copies of the above claim. We notified the claimant of the Board's action on this claim by mailing a copy of this document, and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. { } A warning of claimant's right to apply for.leave to present a late claim was mailed to claimant. DATED: PHIL BATCHELOR, Clerk, By ��-`'�� , Deputy Clerk ec: County Administrator (2) County Counsel (i) BOARD OF SUPERVISORS OF CONTRA COW*rF09W4Yappiicationto: Instructions to ClaimantC!erk of the Board Martinez.California 94553 A. ' Claims relating to causes of action for death or for injury to person or to personal property or growing crops must be presented not later than the 100th day 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. (Sec. 911.2, Govt. Code) 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 , California 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 end of this form. RE: Claim by )Reser , foT lerk's f ling stamps RECEIVE Against the COUNTY OF CONTRA COSTA) MAR D 198S DTSm"T�T� -MLBATCh1.LC?t —s-- L- ... •• RH S Dof SU VISORS F1 l In nam - ) C T ACOS ey .. Deputy The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $1,364.07 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour] February 17, 1986 at 2 :20 a.m. �. W�iere did the damage or in3ury occur? (Include city and county) Martinez, Ca. , Contra Costa County 3. How did the damage or injury occur? (Give full details, use extra sheets if required) i See attached police report ------------------------------------------------------ ----- --- 4. What particular act or omission on the part of county----or---distric:--t officers, servants or employees caused the injury or damage? Sheriff of -Contra Costa County, Martinez. (over) county or district officers, servants or are- the names of co y ` mg'loyees causing the damage or injury? Michael E. Paul, 651 Pine Street, Martinez -------------------z-. ------------- _________________ tett_------_tent---_ 6. What damage or zn�uries do you claim resulted? Give full extent of injuries or damages claimed. Attach two estimates for auto damage) See attached copy of police report ____________�----------------_-------------------_________---------tett__ 7. How was the amount claimed above computed? {Include the estimated amount of, any prospective , injury or damage. ) See attached copies of two estimates 8. Names and addresses of witnesses, doctors and hospitals. Antonio Jones 1507 Castro St . Martinez, Ca. 94553 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT See enclosed two estimates plus $20.00 for police accident report Govt. Code Sec. 910.2 provides: "The claim signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf. " Name and Address of Attorney �.h1 Claimant's Signature P.O. Box 786, Address Martinez, Ca. 94553 M sa e h e - Ask for Barbara 4Aep�ho e o, .29- na-In Telephone No. **** '1�?r�r�*°*=!!•*9r �ArIs>k1t.*ml�#�t ***ak****************** t*** **************** "F F�CiAtSEAL BARBARA !. CONWAY {r, '1( 1- NCITARY PUBt- CA !FORMA NOTICE ,r }r rii acipa att,ca G•titr=Costa fot,nt} � �L?' My tCori;prSii I)Ires ALS„!' t98- . g Sect Sri`°7� '" fe'"Pe�raf rovide s: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is guilty of a felony. " TRAFFIC-COLLISION REPORT PAGE SPECIAL CONDITIONS NO.INJURED N & R CITY JUDICIAL DISTRICT HUMBER FlLONY SNERIf r 'S F-1 MART/l/Ez to T. DrABco �'(n - 738 NO.KILLLD H & R COUNTY REPORTING DISTRICT BEAT M ISD. VE H X Lt O CONTRA C-057A /Z 0,5_ I COLLISION OCCURRED ON MO. DAY YR, TIME (2.00) NCIC NUMBER T1CER I.D. 671q 14 0 ------------------------------------------------------------- -7186 ------------------------------------ MILaPOST INFORMATION _ INJURY,FATAL OR TOW AWAY STATE HIGHWAY RELATED t V FEET OF MILEPOST D YES NO YES. NO 0 J L��/—'AT INTERSECTION WITH PHOTOGRAPHS ��[z�� OR: FC[T/SfFbB+ S OF HA VC-N S 7-. ❑YES N NO PARTY NAME (FIRST,MIDDLE,LAST) OWNERS NAME SAME AS DRIVER 14 A CL c U _Iv/-' Pq L( L C 0 NTRA C O STA COVAJZY DRIVER STREET ADDRESS HOME PHONE OWNERS ADDRESS SAME AS DRIVER 65-1 PIPJE ST. 37Z -2-4q/ 651 P/A-1E ST, n11AR-71AIER. CA. PEDC5- CITY/STATE/ZIP BUSINESS PHONE DISPOSITION OF Va.. ON ORDERS OF TRIAN /� /� CC 7 �y1r F�/� 'J� ILII rYl42T/kE z C A 4•� J 3 � ( 2_2-q q / 1\C movI,(� 0 OFFICER X DRIVER OTHER PARKED DRIVERS LICENSE NUMBER STATE BIRTHDATE SEX RACE DIRECTION OF ON/4c.�" (STREET OR HIGHWAY) SPEED LIMIT VEH. MO. DAY YR. TRAVEL S 03 is 35 2-Gc� 3 . zN;So M w N GASTRO ZS BIC fT VEH.VR(S) MAKES)/MODEL(S)/COLOR(S) LICENSE NO.(5) STATE(S) CHP USE VEHICLE DAMAGE—EXTENT/LOCATION CLIn (l�I/yam( �T/G Q O N L Y $S Fo R D "TRH NS. �•`. U { v 7 • V V CA, VEHICLE TYPE � MINOR Q MODERATE �MAJOR Cl TOTAL OTHER t4/77E R- SIDE PARTY NAME (FIRST,MIDDLE,LAST) OWNERS NAME Li SAME AS DRIVER 2 COWARa T. PA7-TEIz50N DRIVER STREET ADDRESS HOME PHONE N€.,S*FDDRE_SS SAME AS DRIVER 77(e CLoV DALE 0A PEDES- CITY/STw TL!21P BUSINESS PHONE DISPOSITION OF VEH. ON ORDERS OF TRIAN `CIC 7- PA9KcD r" OFFICER DRIVER OTHER PARKED DRIVER'S LICENSE NUMBER STATE BIRTHDATE SEX RACE DI �^ RECTION OF ON/ ^^�- (STREET OR HIGHWAY) E P SPEED LIMIT Va.. MO. DAY YR. TRAVEL X N Q C A STRO ST C vies 2 5 BICY- VIE".YR(S) MAKE SI/MODEL(S)/COLOR(S) LICENSE NO.(S) STATE(s) CHP USE VEHICLE DAMAGE-EXTENT/LOCATION CLIST y //�� ONLY �Ty:� e�. DODGE./PICK-ur, - 1 GBE ZSS CA VEHICLE TYPE N MINOR 0 MODERATE Cl MAJOR CD TOTAL OTHER WX744 C-AMPEp- LI - REAR OF CAMPER PARTY NAME(FIRST.MIDDLE,LAST) OWNERS NAME Lj SAME AS DRIVER 3 1 w!�. �.y DRIVER STREET ADDRESS �� " I=� PHONE OWNERS ADDRESS L_jSAME AS DRIVER PAGES- CITT/fTAT!/ZIP �"`�` - • L I �IVVti�i dV51 N!S5 PHONE .DISPOSITION OF VEH. ON ORDERS OF TRIAN t `1( ('�7�/ `y J 1 CON t\• ( .1 B 1'. L AAV LJ OFFICER 11 DRIVER L�OTHER PARKED DRIVER'S LICENSE NUMBER STATE BIRTHDATE ISE' RACE DIRECTION OF pry/ACROSS (STREET OR HIGHWAY) SPEED LIMIT VAN. MO. DAY YR. TRAVEL _ l BICY- VAN.YR($) MA KE(S)/1;yOD'EL )/ SE � T TE ) CMP USE VEHICLE DAMAGE-EXTENT/LOCATION CLIST ��- ONLY �� VEHICLE TYPE MINOR El MODERATE El MAJOR 0 TOTAL OTHER. �. . � . . . PARTY NAME (FIRST,MIDDLE,LAST) 'F.` rO.11fj oert a OWNER'S NAME SAME AS DRIVER 4 DRIVER STREET ADDRESS HOME PHONE OWNER'S ADDRESS I SAME AS DRIVER PEDES- CITY/STATE/ZIP BUSINESS PHONE DISPOSITION OF VAN. ON ORDERS OF TRIAN OOFFICER D DRIVER O OTHER PARKED DRIVER'S LICENSE NUMBER STATE BIRTHDATE fEX RACE DIRECTION OF ON/ACROSS (STREET OR HIGHWAY) (PEED LIMIT VAN MO. DAY YR. TRAVEL -ICY- VA—YR(S) MAKES)/MOD[L(S)/COLOR(S) LICENSE NO.(S) STATES) CHP USE VEHICLE DAMAGE -E XTE NT ILDc wTION CLIST ONLY �� VEHICLE TYPE El MINOR D MODERATE O MAIOR EJ TOTAL OTHER CHP 555—Page 1 (Rev 8-81) OPI 042 ; XED PAGE c C.ECK ONE C.6c.ONE ECK ONE - NAR RATI�IVSOPPLEMENTAL Eg' NARRATIVE SUPPLEMENTAL COLLISION REPORT OTHER: DATE Of OhiGi—L INCIDENT (1100) MCIC NUMO^ OPFICER I.D. NUMVER MO. DAV -7 44 Z 07 1 Ll t4 7,38 CITY/COUNTY/JUDICIAL DISTRICT REPORTING DISTpICT/BMAT CITATION NUMDER MAR:rbvEt, LOCATION/SUBJECT C,A-s-rp-o 44 VE A-l' si 7-, C , F CALL-: /1129 7-/ME 01= A,4--kIVAL: t'13(9 SCC". FZ-A-7 -0 WC 7-, 4-6 VEL A sAwg r (V co-1 E",w-r 1204 D 101,01VIOCID tj /TN OME 4-AAJ67 or 7-RAVEL N ' Atin 5 ' Soutif) f>4 p-kE To 4—, Zqn4 E' ** Afjo W, cup-Es 4r A P,-,R 0 x .. ,::?-I/` aj/D IF R.040., 14,eA-V I E F- 774-A sJ "(JR-MAL T-RAFFIC- 0 Ce E 7-0 7-9/5 ROAD SCIA16- ",:5C—Z:> AS A DG7T-,LtR- u 7-C Z)UeJV WqlCq - CLOSC6 In,41AI VEgicLeIS V - i wmEp FF-om P,oZ. AND Polgetp AT S ' Ca&Z 0 F V 4E tO s-r, pp-jog T-o mV Aep-wAL . V-2- yjAS A PA&e-Cb VE14 , A "Z) WAS Sr)(-L Ar P,6,1- A/ -/ WA5 Z4-07A6fZ-- dOJ "f,— E! -SIDIE V- WAs OPlvKAG-iE- K7,j 0m TWE L- izEA#e_ jD,qyS1c1O,L EVIDEAlcc : BEV /DEoc E PP-ESEOT , O"TgEFZ , PLATWCJT- - rAei-LOQ ojFc#P-m,4-r1ci-j-." V-1 is Co, CO , co , zz,,4C�-lcr 'S y.EHICI-4F utillr S900 . SAID TH.47 146 WAS IQA-ZrgO ST. Atip T74-Ar-r A ' SROW" %7-A770,v w-46-OAJ (Alo Fi:/R-7NF,,e Vft.C,--1f770,Vj WAS A-PPEOACH11,4G, ; HIM HE F641 7710147 - 7-#le- ZS/ l "0'L1Sh',FD-" ///0? OVCif- IA17D V--;L- WMIC9 'yj A S P4P-KCZ) AT T7IC 6 ' CURS of OAS7-Ao Si. OPM10APS AMD COOCLU5.100S P.0,.T, V676 ,7111J6.) 8f-OCAMAJ 0 DESP-1 Pp-cscor . C-AOSE, APPC*R-,E0 7-a 86 A P-Csicle-7- 01F T-jqc OCE"AlYCE Ale-6Z)6V -For_ 5ArtF fAS!;A66 of FECOMMEWDA-rIDMS : MONS — ....ARE ME VR. I REVIEWER'S NAME 0. DAY Y.. A 4127" 1 "0- f4c) R4(01W— - t — 1'*"*NUMBER A' CHP 5d(R..8-811 OP{042 Use previous editions until depleted. 94a,41-45c 9-el Osp Mcm (7 TRAFFIC COLLISION CODING t - PAGE Z D A17.;7O LLISIOF /- TIME 12.00) NCIC NVMBER14 z ( OFFICCR 1.0. NUMQB I/R 7 Q Mo oAY l Yw. �o 1 �7 ' 44 PROPERT-Y_DAMAGE DESCRIPTION,OF DAMAGE - OR'MER'S NAME/AOORCSS NOTIFIED ❑vcs ❑No VIOLATION(S) PARTY 1 PARTY 2 PARTY 3 PARTY ! CHARGED PRIMARY COLLISION FACTOR RIGHT OF WAY CONTROL 1 2 1 1 1 4 TYPE OF VEHICLE 1 2 ] 6 M OVEMENT P RECEDING LIFT NUMBER (B)OF PARTY AT FAULT) A CONTROLS FUNCTIONING A PASSENGER CAR/STA.WAGON COLLISION R A VC SECTION VIOLATION: B CONTROLS NOT FUNCTIONING B PASSENGER CAR W/TRAILER A STOPPED C CONTROLS OBSCURED IC MOTORCYCLE/SCOOTER B PROCEEDING STRAIGHT ♦r B OTHER IMPROPER DRIVING. D NO CONTROLS PRESENT D PICKUP OR PANEL TRUCK C RAN OFF ROAD E PICKUP/PANEL TRK W/TRLR D MAKING RIGHT TURN C OTHER THAN DRIVER* TYPE OF COLLISION F TRUCK OR TRUCK TRACTOR E MAKING LEFT TURN D UNKNOWN* A MEAD-ON G TRK/TRK TRACTOR W/TRLR F MAKING V TURN WEATHER (MARK I TO I ITEMS) B SIDESWIPE H fCMOOL BUS G BACKING A CLEAR C REAR END I OTHER BUS H SLOW IND-STOPPING B CLOUDY D BROADSIDE J CMERGENCV VEHICLE I PASSING OTHER VEHICLE xC RAINING E MIT OBJECT K MWY CONBT.EQUIPMENT J CHANGING LANES D SNOWING F OVERTURNED L BICYCLE K PARKING MANEUVER E ROG G AUTO/PEDESTRIAN M OTHER VEHICLE ENTERING TRAFFIC FROM F OTHER': H OTHER': N PEDESTRIAN SHOULOER,MCDIA N, L G WIND O MOPED PARKING STRIP OR LIGHTING MOTOR VEHICLE INVOLVED WITH PRIVATE DRIVE A DAYLIGHT A MON-COLLISION 1 2 3 d OTHER ASSOCIATED FACTOR M OTHER UNSAFE TURNING B DUSK-DAWN B PEDESTRIAN (MARK 1 TO 2 ITEMS) N XING INTO OPPOSING LANE, C DARK-STREET LIGHTS C OTHER MOTOR VEHICLE A VC SECTION VIOLATION: O PARKED D DARK-NO STREET LIGHTS D MOTOR VCM.ON OTHER ROADWAY P MERGING STREET LIGHTS NOT E PARKED MOTOR VEHICLE B VC SECTION VIOLATION: O TRAVELING WRONG WAY' E DARK- FUNCTIONING* F TRAIN R OTHERS: G BICYCLE C VC SECTION VIOLATION: ROADWAY SURFACE H ANIMAL: 1 2 ) 4 SOBRIETY-DRUG- A DRY D VC SECTION VIOLATION: PHYSICAL B WET I FIXED OBJECT: (MARK I TO 2 ITEMS) C SNOWY-tCY E VISION OBSCUREMENTS: A MAD NOT BEEN ORINKING D SLIPPERY (MUDDY,OILY,ETC.) J OTHER OBJECT: B MBD-UNDER INFLUENCE F INATTENTION C MBD-NOT UNDER INFLU.' ROADWAY CONDITIONS G STOP&GO TRAPP IC DNBD-IMPAIRMENT UNKN' MARK I TO 2 STUNS) PEDESTRIANS ACTION H ENTERING/LEAVING RAMP E UNDER DRUG INFLUENCE' A MOLES,DEEP RUTS* A NO PEDESTRIAN INVOLVED I PREVIOUS COLLISION F IMPAIRMENT-►H YSICAL' B LOOSE MATERIAL ON ROADWAY* CROSSING IN CROSSWALK J UNFAMILIAR WITH ROAD G IMPAIRMENT NOT KNOWN B C OBSTRUCTION ON ROADWAY- AT INTERSECTION K DEFECTIVE VEM.EOVI►.: H NOT APPLICABLE D CONSTRUCTION-REPAIR ZONEC CROSSING IN CROSSWALK-NOT I ELSE►Y/FATIGUED E REDUCED ROADWAY WIDTH AT INTERSECTION L UNINVOLVED VEHICLE XF FLOODED' D CROSSING-NOT IN CROSSWALK M OTNER': 1 2 1 3 1 4 1 SPECIAL INFORMATION G E IN ROAD-INCLUDES SHOULDER N NONE APPARENT A NAZ A RDOUS MATERIALS* H NO UNUSUAL CONDITIONS F MOT IN ROAD O RUNAWAY VEHICLE B FIRE INVOLVED* G APPROACHING/LEAVING SCHOOL BUS C TIRE DEFECT/FAILURE' SKETCH MISCELLANEOUS P.O.Z. APPRoX. Sys 5 ' 0F S' CuRg INDICAT! O f7 HAVEN ST, A AID 8 W ' OlBi PAVENNDRTsr. THE• E ' C-URS Oi- CASTRo S1, JrA VIZ PHYSICAL DESCRIPTION OF PARTY NUMBER HAIR EYES MCIGNT Wl16 MT O V-1 PwEPARER'S NAME 11*0*NUMBKR MO. DAY YR. RCVIEWER'S NAME MO. DA YR. C 55—Page 2 (Re,8.81) OPI 042 *Explain in narrative W-VII-M 9/81 1.Wo u-o2r DR. SCOrt"IrS R.V.CLINIC Complete Repairs and Service P108C. Medburn St. • Concord, California 94520 • (415) 827-3855 As listed for Labor and Materials No. ESTIMATE OF REPAIRS verbal agreements are not binding OwnerQwA D A SoN Phone Date Address P•Q • �p x �� l'1A R i��Z XS-3 Claim No. Insurance Co. Agent Address Phone License* Yearg Make �' �� ,�,��,1, Model ('N.e55i P76L v7 No ial Operation DESCRIPTION OF LABOR OR MATERIALS MATERIAL HOURS — A </M , 04A,v,64.0SIC „>�¢ P[,AIN PIU A, ¢ co n.+o f Al L e- 8Aii AiR Na 4.PL 1/+t a Re4A PAp 4 4 A, X 4' 'sS d e5 I- NL �3L ' 2;' 50 O L.1, -hAm4&oT6 FI{Aly A, h /a F A)7A A P oR n,4-AZ IQ u�. ST /3,f N 4 it F,,N ,OCL BOG CA (J. P�4r o ro• R ti All-A06 1A LPL S 3 S w A � til l S C ,A to/dr Z C4I-A ova F A S 7-,r v/r4 S A C (..-i I Q,c 7-B'S7-64 fQo -e q-r Fr Q 7 1 Al Tr C A-2 15,T- A ST�cAr6wr�s•vi,u� o� s«� .r �� ly lo'z- PtFK rpq.4/fD F Ac 57 WE ASSUME NO RESPONSIBILITY TO REPAIR PRIOR DAMAGES NOT INCLUDED IN THIS ESTIMATE. TOTAL Old parts will be junked unless otherwise Instructed In writing, MATERIALJ 2 Parts and labor to repair concealed damage will be charged at regular shop retail.However,no wOfk ivlll pro- Total Labor-ZS 40— JD 00 GO teed on concealed damage without authorization. 3. Camper loading and unloading from truck not Included unless specified. Total Material ZSo 3O 4. Trailer towing to and from shop will be at published P.U.C.rates. 5. This estimate not binding after thirty(30)days. F"hlQ 6. All work is C.O.O.unless rior arrangementsw have boon consummated. Estimated By Approved By Tax 1p AUTHOR I ZED qND ACCEPTED Paid Out-Tow A Sem. Date Sublet.Repairs ev Owner TOTAL 1 3 4 9 G or Agent CONCORD COACH CO. MOTORHOMES— CAMPERS— TRAILERS— VANS REPAIRS—MODIFICATIONS 2082 Commerce Avenue Concord, California 94520 Telephone (415) 676-0888 No. As listed for Labor and Materials, ESTIMATE OF REPAIRS Verbal agreements are not binding _ s Owner il./4-4e � �, p7fPhone: =2&k Date a1 � °2 7 �6 Address i�(51 Est No. Insurance Co. 1 Order No. Address Phone: Licenser 16 Year / Serial Make d / z Model No. 4 I t` DESCRIPTION OF LABOR OR MATERIAL MATERIALI HOURS XPX e— �/ r 3- T - D • /h^ ' f a h d ieova p: I �y WE ASSUME NO RESPONSIBILITY TO REPAIR PRIOR DAMAGES NOT INCLUDED IN THIS ESTIMATE. TOTAL I. Old parts will be junked unless otherwise instructed in writing. MATERIAL 2. Parts and labor to repair concealed damage will be charged at regular shoo rates. However, no work w.11 proceed '� on concealed damage without authorization. Total Laboro7. 3. Camper load-ng and unloading from truck not included unless specified. `1M /n� 4. Tra,ter tow.ng to and from shoo—11,te at published P.U.C. rates. - Total Material V V 5. Th estimate not b-n0,ng atter ch�rty 1301 days. A 6. A11 wo•k .s C.O.D.unless prior arrangements have been consummated. n�/�r 03 P Estimated 8 q "\ Tax 1 1 Approved By JF AUTHOR ZED AND ACCEP D Paid Out-Tow & Star. Date Sublet Repairs By Owner r or Agent , 4 \ ,� TOTAL .••iii _�¢-3 ...�aSt ,r•. ti * '�' ,,r ^}r,+,t �.-sib c mko- £ •F -" � ,� IyL. -T��.�'.�a +� 4 .- r�'� l . ! .:i � �s ,� - °'S � A fY ':fix �' r t4":•. 7�1 as 74 - L y.: y C:5 S kms` �-. �� /yT ��`•Y� _ � March 3 , 1986 TO CONTRA COSTA COUNTY: Gentlemen: To expedite delayed trip and use of camper, I will accept cash settlement based on the low bid and release Contra Costa County from an open claim for removal and testing of my air conditioning unit which was damaged. This would increase the claim by five hours of labor and a high probability of replacement of my air conditioning unit . Edward T. Paterson 46 CUD4 BOARD OF SUPERVISORS OF CONTRA COSTA COONTL CALIFORNIA BOARD ACTION Claim Against the County, or bistriet ) NOTICE TO CLAIKpNT April 1 ; 1986- governed 985governed by the Board of Supervisors, ) The copy of-t-ld-9-document mailed to you is your Routing Endorsements, and Board ) notice of the action taken on your claim by the Action. All Section references are ) Board of Supervisors (Paragraph IV, below), to California Government Codes ) given pursuant to Government Code Section 913 and 915.4. Please note all "Warnin ountY Counsel Claimant: GLEAN UMONT Attorney: MAR 0 4 1986 Address: 392 Bryan Drive Martinet, CA 94553 Amount: Danville, CA 9.4526 $200. 00 By delivery to clerk on Date Received: March 3, 1986 By mail, postmarked on February 28 , 1986 I. FROM: Clerk of the Board of Supervisors 70: County Counsel Attached is a copy of the above-noted claim. Dated: March 3, 1986 PHIL BATCHELOR, Clerk, By Deputy Ann Cervelli II. FROM: County Counsel TO: Clerk of the Board of Supervisors (Check only one) (x) 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. 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). ( ) Other: Dated: / By: Deputy County Counsel III. FROM: Clerk of the Board TO: (1) County Counsel, (2) County Administrator ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER By unanimous vote of Supervisors present (X) 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.f r thia date. Dated: AMG 1 'g PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. Code Section 913) Subject to certain exceptions, you have only six (6)-months from the date of 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. V. FROM: Clerk of the Board 70: (1) County Counsel, (2) County Administrator Attached are copies of the above claim. We notified the claimant of the Board's action on this claim by mailing a copy of this document, and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. ( ) Aw�a1rning of claimant's right to apply for leave to present a late claim was mailed DATED:tRrK 1j $6 PHIL BATCHELOR, Clerk, By , Deputy Clerk cc: County Administrator (2) County Counsel (1) CLAIM a" BOARD OF SUPERVISORS OF CMTU OOSTA anm, CALIFORNIA HOARD ACTION Claim Against the County, or bistriet ) NOTICE TO C.LUOM April 1 , 1986 governed by the Board of Supervisors, ) The copy of-this domment Far3ed to you is your Routing Endorsements, and Board ) notice of the action taken on your claim by the Action. All Section references are ) Board of Supervisors (Paragraph IV, below), to California Government Codes ) given pursuant to Government Code Section 913 and 915.4. Please note all wWarninga"un Counsel Claimant: GLENN UMONT ti00 Attorney: MAR 0 4 1986 Address: Martinet, CA 94553 392 Bryan Drive Amount: Danville, CA 94526 By delivery to clerk on $200. 00 Date Received: March 3, 1986 By mail, postmarked on February 28 , 1986 I. FROM: Clerk of the Board of Supervisors 70: County Counsel Attached is a copy of the above-noted claim. - Dated: March 3, i 1986 PHIL BATCHELOR, Clerk, By Peppy -A—nnk Cervelli II. FROM: County Counsel TO: Clerk of the Board of Supervisors (Check only one) (x) 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. 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). ( ) Other: Dated: Z.a�J / By: •� Deputy County Counsel III. FROM: Clerk of the Board TO: (1) County Counsel, (2) County Administrator ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER ' By ,unanimous vote of Supervisors present (X) 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 minutm fprA date. Dated: AP K G 1X905 PHIL BATCHELOR, Clerk, By � , Deputy Clerk WARNING (Gov. Code Section 913) Subject to certain exceptions, you have only six (6)-months from the date of 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. V. FROM: Clerk of the Board 70: (1) County Counsel, (2) County Administrator Attached are copies of the above claim.. We notified the claimant of the Boardis action on this claim by mailing a copy of this document, and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. ( ) A warning of claimantts right to apply for leave to present a late claim was mailed to claimant. DATED: PHIL BATCHELOR, Clerk, By , Deputy Clerk cc: County Administrator (2) County Counsel (1) trr.enr BOARD OF SUPERVISORS- OF CONTRA COSTA COUNTY Instructions to Claimant A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops must be presented not later than the 100th day 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. (Sec. 911. 2, Govt. Code) 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 (or mail to P.O. Box 911, Martinez, 'CA) _ 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 end of this form. RE: Claim by ) Reserved for Clerk' s filing stamps Glenn uWlOY14 ) RECEIVED Against the COUNTY OF CONTRA COSTA) MAR 3 13$6 or DISTRICT) ERx e+wi eAuHEtOR (Fill in name) ) Lacot "` c'� 3 The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 7j-)0 and in support of this claim represents as follows: ------------------------------------------------------------------------ d 1. When did the amage or injury occur? (Give exact date and hour) F�>eAo ------------------------------------------------------------------------ 2. Where did the damage or injury occur? (Include city and county) C-o__A 10 6" S••1. � {�,, A— Ai R--,d (o, k.., n co--, rh �Vv-, --------------------------------------- -- ------ - -- -- -- - 3. How did the damage or injury occur? (Give full details, use extra sheets if required) — -- — ------------------------------------------------------------- 4—.--Wh—at—pa--rticular act or omission on the part of county or district officers , servants or employees caused the injury or damage? (over) 5. �• "Wh&t are the names of county or district officers,-_servantseur {, employees causing the damage or injury? ------ - - ------------------------------------------------------ 6. Wh-at-d-amage------or--injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage) ��.- Jw Q cove . �� ,�ti..e1 ,y�c� /��•�— --------------------------imed------------------------------------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. )\\ --------e-----------e---e-------------e-------------------------------------- 8. Names and addresses of witnesses, doctors and hospitals. ------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury.. f....._ i"Pf;»......... .o............:s ITEM AMOUNT 1 71"1 '`rt nn� �� Snr►,�.r.�/ 3 S So Govt. Code Sec. 910.2 provides: "The claim signed by the claimant SEND NOTICES TO: (Attorney) or by some er on on his behalf. " Name and Address of Attorney Claimant' s Signature 392 13.`` c Address Telephone No. Telephone No. X .16 -A8Sq ************************************************************************** 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, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill , account, voucher, or writing, is guilty of a felony. " ® r REPAIR ESTIMATE ` IMSYI.MCI, ~ CLAIM NO. a ,� DATE OF INSPECTION&ESTIMATE WHERE INSPECTED * LICENSE._ NUMBER INSURED -'4 � • N• HOME ..WORK / (/ ADDRESS 14S PHONE PHONE MAKE , 7 YEAR SERIES BODY STYLE � DATE MANUFACTURED MILEAGE PARTS LABOR' REFIN- PAINT REPAIR RE DESCRIPTION ISHRAG MATERIALS PLACE ,,• _ .. ® LIST HRS.; HRS. &NET ITEMS e $ f � 20olGly � .. �/ri�. .• . .ci G v , . .. plNe. 5 • 6 8 g - 10 12 -- 13 14NEWT IS ESTIMATE Ta - !tlwLr--�J"ftTN&r%ltAGE Offftl ROM- Wp 15 flem 'A' EKIPME TOM! ! • 16 A Y S PPLEMENT TO THIS ESTIMATE MtW K - AUTHORIZED BY A STATE FARM CLAIMiMAN. TOTAL $ LABOR HRS. � CLAIM NO4(,,257---- 3 23 Z-- oa � •r�- REF.HRS. TOTAL •� PER JJ I AUTHORIZE LABOR HRS. X i/fZ_HR. TO REPAIR VEHICLE ACCORDING TO REPAIR COST AS ITEMIZED. ALSO,I AGREE PARTS TO SHOW THIS APPRAISAL TO REPAIRER BEFORE REPAIRS ARE STARTED. 0 LIST LESS '%DISC. _ tj INSURED'S SALES TAX S�� SIGNATURE DATE PAINT,MATERIALS,&NET ITEMS S WE ACCEPT REPAIR COSTS AS ITEMIZED. TOTAL REPAIR REPAIRER COST SIGNATURE DATE LESS `!/��— BETTERMENT i THE REPAI HAVE BEENCOMPL TED. 1 AUTHORIZE THE COMPANY TO MAKE PRIOR DAMAGE i Qf) PAYMENT OF S TO THIS REPAIR SHOP ON MY BEHALF. DEDUCTIBLE -`� INSURED'S __ _.__. _ SIGNATURE DATE Q,OO TOTAL DEDUCTIONS STATE FAR CLAIMOTAR FARM fNSURgNCE COIyIpA COMPANY TO PAY REPRESE ATIVE ch Dive, utcaaalli REPAIR SHOP. RETURN THIS ORIGINAL FOR PA�jYMEf f/Te C 4011 ' _ OWNER TO PAY SERVICE OFFICE AT /a,/'! G'/ IeCiOricmd� A 94g24� SEE�REVERSE FOR STATE FARM'S AUTO DAMAGE CLAIM POLICY NOTICE .— REPAIRS TO THIS VEHICLE MAY REQUIRE SPECIFIC WELDING EQUIPMENT AS RECOMMENDED BY THE MANUFACTURER. . f. r DIABLO LINCOLN-MERCURY-SAAB 32727 ®�© 2800 Willow Pass Road P.Q.Box 6690dm ` " Telephone 682-3190. CONCORD.CA UF.94624-1$90. �+ NAME {. GATE # � is ' { COST.ORDER No CASH CHARGE RETD.GOODS I RETAIL WHOi.ESA1.E ESMAN CODE EOU . PART NO. DESCRIPTION T NET AMOUNT ? ti .r 1b REFUNDS AFTER 30 DAYS.tell CHARGE FOR ALL RETUFu�d PARTS TAX yw NO REFUNDS ON ELECTRICAL ITEMS OR SPECU1l ORDER PARTS. TOTAL2 V A. NO REFUND .WITHOUT THIS INVOICE RECD By I rrn Z m oo m LAI s' C4` ort s IT! �5 rn Z _ r m Cf� -4 < -4 ID 9 > � En fnC m` ^� o D ~ 10 <� m y ?: a qjTi LLij I I X i o C' ua► v N 392 Bryan Drive Danville, CA 94526 John DeLeuze State Farm Insurance 3705 Mount Diablo Blvd Lafayette, CA Dear John: Attached are forms and receipts for the road mishaps I .suffered on the 18th. Since the Saab dealer did not mount tires, I had to purchase a wheel , and bring it to the shop which both mounted it and alligned the front end. Could you please help make sure this is processed properly., Thank you, Glenn Umont r l C�.AIM BOARD OF S[1PERVISORS OF ON= COSTA tXiWM CALn0WIA BOARD ACTION Claim Against the County, or bistriot ) NMCE TO CLAIMANTApril 1, 198-6 governed by the Board of Supervisors, ) The copy of this document mailed to you is your Routing Endorsements, and Board ) notice of the actio taken on your claim by the Action. All Section references are ) Board of Supervisors (Paragraph IV, below), to California Government Codes ) given pursuant to Government Code Sectio 913 and 915.4. Please note all "Warnings". Claimant: JONATHAN L. CROUCH 11minty Counsel Attorney: Lazzarini & Frazier MAR 11 1986 A Professional Corporation Address: 49 Quail Court, Suite 212 Hand delivered Martinez, GA 9455$ Walnut Creek, CA 94596 Amount: $4,000, 000- 00 . By delivery to clerk on March 6 , 1986 Date Received: March 6, 1986 By mail, postmarked on I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. 0 Dated: March 10, 1986 PHIL BATCHELOR, Clerk, By ° Deputy n eve II. FROM: County Counsel 70: Clerk of the Board of Supervisors (Check only one) ( ) This claim complies substantially with Sections 910 and 910.2. - ( ) This claim FAILS to comply substantially with Sections 910 and 910.20 and we are so notifying claimant. The Board cannot act for 15 days (Section 910.$). ( ) Claim is not timely filed. 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). { } Other: Dated: By: Deputy County Counsel III. FROM: Clerk of the Board TO: (1) County Counsel, (2) County Administrator ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER By unanimous vote of Supervisors present 0 This claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Boardfs Order entered in its minutes for ,�t�� date. , Dated: . PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. Code Section 913) Subject to certain exceptions, you have only six (6} months from the date of 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. V. FROM: Clerk, of the Hoard TO: (1) County Counsel, (2) County Administrator Attached are copies of the above claim. We notified the claimant of the Hoard's action on this claim by mailing a copy of this document, and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. { ) A warning of claimant's right to apply for leave to present a late claim was mailed to claimant. DATED: A.P.R. 0 3 198E PHIL BATCHELOR, Clerk, By - '�� , Deputy Clerk cc: County Administrator (2) County Counsel (1) CLAIM BOARD OF 5 U PE RV I-1 016 oy Instructions to Claimant Clerk the Board J/./ Martinez,California 94553 A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops must be presented not later than the 100th day 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. (Sec. 911. 2 , Govt. Code) 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 , California 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 end oY—this form. RE: Claim by ) Reser xe ,31 for lq�rk s filing stamps JONATHAN L. CROUCH FRIEECEIVIRD V ~ Against the COUNTY OF CONTRA COSTA) MAR � M6 4:05 ef" or DISTRICT) "Tcwtof �4'.NCUEQK OAM Of W, (Fill in name) 0'1 �or 1. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 4 , 000, 000 . 00 and in support of this claim represents as follows : -----------------------:---------------------- did the damage or injury occur? (Give exact 23, 1985, at 8:30 p.m. ---------- ------ Y__i�Eer__e_21d_ t-h-e-a-am—age or injury occ--ur--?--lin-El�a-e--c-i-t-y--a-nd---county) ----- y The Sun Valley Shopping Center, Concord, California ----------------------- 3. W_�I�_t�e_H;age or injury occur? (Give fuli-Z�ia-irl-s-, --use--extra -- sheets if' required) Please see the attached sheet incorporated by reference. ------------------------------------------ 4 . What particular act or omission on the part of county or district officers , servants or employees caused the injury or damage? Please see the attached sheet incorporated by reference. (over) ployces causing the damage or injury? ------------------------------------------------------------------------- 6 . t4hat damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage) Mr. Crouch was extensively burned as a result of the' airplane crash. The -exact nature and extent of his injuries are unknown to Claimant at this time. For his damages Mr. Crouch _ claims S�4 X000`000 _00 - ________________ 7 . How was_the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) Claimant has incurred substantial hospital, doctor, and physical therapy bills. The exact amount of these bills and the amount necessary for future treatments is unknown to claimant at this time. ------------- -- --------------------------------------------------- 8. Names and--add-resses---- of witnesses , doctors and hospitals. Alta Bates Burn Center The exact number and names of Doctors Alta Bates Hospital and Witnesses are unknown to Claimant Berkeley, California at this time. Kaiser Hospital Martinez, California ------------------------------------------------------------------------- 9 . List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT This information is being ascertained at this time. Govt. Code Sec. 910. 2 provides : "The claim signed by the claimant SEND NOTICES TO: (Attorney) or by some pers n on his behalf. " Name and Address of Attorney . LAZZARINI & FRAZIERClaiman ' s Signature A. Professional Corporation c/o George Crouch, 4018 Lillian Dr. 49 Quail Court, Suite 212 Address Walnut Creek, CA 94596 Concord, California 94521 Telephone No. (415) 934-5000 Telephone No. 682-8841 NOTICE Section 72 of .the Penal Code provides: "Every person who, with intent .to defraud, .presents for •all•owance or !for payment to any state board or officer, or to any county, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine , any false or . fraudulent claim, bill , account, voucher, or writing, is guilty of a felony. " P PP7 CLAIM OF JONATHAN L. CROUCH SUPPLEMENTAL SHEET On December 23, 1985, at approximately 8: 30 p.m . , an aircraft piloted by JAMES MOUNTAIN GRAHAM crashed into the roof of the Sun Valley Shopping Center , Concord, California. This crash occurred as a proximate result of Contra Costa County' s negligence and carelessness in allowing the shopping center to be built in an area which was unreasonably dangerous due to the then existing and expected future flight activity at Buchanan Field. Contra Costa County failed to require appropriate aircraft warning , safety, fire-fighting equipment and medical treatment facilities within the Sun Valley Shopping Center . It was foreseeable that a plane would crash into the shopping center causing oil and fuel fires . Further , the Contra Costa County failed to adequately supervise flight operations and safety procedures at Buchanan Field at the time of the accident . Additionally, Contra Costa County did all of the above acts and omissions in conscious disregard for the safety of plaintiff and others similarly situated. � Y aAlm BOARD OF SUPERVISORS OF OONTRA COSTA MMM, CALI1UNIA BOARD ACTION Claim Against the County, or District ) NOTICE TO CL AIKW April 1, 198-6 governed by the Board of Supervisors, ) The copy of-M-91&aFnWt led to you is your Routing Endorsements, and Board ) notice of the action taken on your claim by the Action. All Section references are ) Board of Supervisors (Paragraph I9, below), to California Government Codes ) given pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". Claimant: GLORIA JEANNL KING County Counsel Attorney: Blackie Burak Attorney at Law MAR 0 4 1986 Address: 2255 Contra Costa Blvd. , Suite 207 Pleasant Hill, CA 94523 Martinet, CA X553 __ . Amount: $100, 000. 00 By delivery to clerk on Date Received: March 3, 1986 By mail, postmarked on February„ 19986 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. GJ O Dated: March 3, 1986 PHIL BATCHELOR, 'Clerk, By � J Deputy nn Cerve li II. FROM: County Counsel T0: Clerk of the Board of Supervisors (Check only one) ( ) This claim complies substantially with Sections 910 and 910.2. (/�C) 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. 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). ( ) Other: Dated: Z,-- By: Deputy County Counsel III. FROM: Clerk of the Board TO: (1) County Counsel, (2) County Administrator ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER By unanimous vote of 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 1min Vs for 199 date. r\ Datbd: PHIL BATCHELOR, Clerk, By l�e'�_ �.,t_: L�.eDeputy Clerk WARNING (Gov. Code Section 913) Subject to certain exceptions, you have only six (6) months from the date of 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. V. FROM: Clerk of the Board TO: (1) County Counsel, (2) County Administrator Attached are copies of the above claim. We notified the claimant of the Board's action on this claim by mailing a copy of this document, and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. ( ) A warning of claimant's right to apply for leave to present a late claim was mailed DATED:to AcW J 986 PHIL BATCHELOR, Clerk, By , Deputy Clerk ec: County Administrator (2) - County Counsel (1) • i a ` i I 4 r � LAW OFFICES OF 2255 CONTRA COSTA BLVD.,SUITE 207, PLEASANT HILL,CA.94523 (415)827-9990 BLACKIE BURAK CERTIFIED SPECIALIST IN CRIMINAL LAW February 25 , 1986 Clerk of the Board of Supervisors County of Contra Costa 651 Pine street , Rm. 106 Martinez , CA 94553 Re: Claim of Gloria Jeanne King against County of Contra Costa Dear Sir or Madam: I represent Ms . Gloria Jeanne King relative to the above referenced claim. Enclosed please find an original and one copy of a Claim for Personal Injuries . Please stamp the copy "received" and return that copy to me in the envelope provided. You may wish to refer this matter to your insurance carrier for further handling. Very truly yours , i �ACKI — BB:ac i' Encl:' As Stated i EEIVv MAR 3 1w$S Rk 6o ! U! `Jt'C.. 0 SR C:?4tAC IAJ r' a 1 BARRY BLACKIE BURAS ATTORNEY AT LAW E 2255 CONTRA COSTA BOULEVARD, SUITE 207 v ! 2 PLEASANT HILL.CALIFORNIA 94523 MAR �j 1{Q TELEPHONE(415] 827-9990 MICR �J 1986 3 I PHIL tATCHELOR , 4 ExK 9y r^G SU' 2 :SORB .:0 ACrcf 5 ATTORNEY FOR Claimant Gloria Jeanne King r 6 7 8 MUNICIPAL COURT OF CALIFORNIA 9 COUNTY OF CONTRA COSTA 10 WALNUT CREEK-DANVILLE JUDICIAL DISTRICT 11 CLAIM OF GLORIA JEANNE KING 12 against No. 56415-3 13 COUNTY OF CONTRA COSTA CLAIM FOR PERSONAL INJURIES 14 15 TO TIi.E BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY: 16 1, , You are hereby notified that Gloria Jeanne King, whose ad- 17 dress is 125 Near Court , #313 , Walnut Creek , California, claims from 18 Contra: Costa County the sum of $100 , 000. 00 for person.,:-i injuries 19 infl4_cted by employees of Contra Costa County. 20 2 ., This Claim is based on injuries sustained by claimant 21 while in custody at the County Jail in Martinez and for intentional 22 infliction of emotional_ distress in said custody and following 23 her release from custody. 24 3, To the best of claimant ' s knowledge , the public employees 25 who caused her injuries are Deputy Sheriff T. Coronia and Deputy 26 Sizemore, both of the Contra Costa Sheriff ' s Department . -1- i 1 4 . The injuries sustained by claimant to date consist of 2 head and back trauma and multiple contusions as well as emotional 3 distress . The amount of claimant ' s medical bills are unknown 4 at this time. 5 5 . All notices and communication with regard to this claim 6 should be sent to Blackie Burak, Attorney at Law, 2255 Contra 7 Costa Blvd. , Suite 207, Pleasant Hill, California 94523; 8 (415)827-9990. 9 DATED: : ?j LS 10 LACKIE 11 Attorney for Claimant 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 ARRT HLACKIR DURAR -� ATwNNn A*uw WOO YONYYINT[DVL[vAND _ CONCORD.CA.94010 TK[INDM[ Ali)[il•[MO y 1 PROOF OF SERVICE BY TIAII. (CCP 1013a , 2015. 5) 2 3 I The undersigned declares as follows : 4 I am employed in the County of Contra Costa , California . 5 I am over the age of eighteen years and not a party to 6 ! the within entitled cause. 7 i My business address is 2255 Contra Costa Boulevard, I 8 j Suite 207 , Pleasant Hill , California 94523 . 9 �! I further declare that on the date set forth below, I 10 l served the documents described below by placing a true copy 11 1 thereof enclosed in a sealed envelope with postage thereon 12 I fully prepaid in the United States mail at Pleasant Hill , i 13 California. 14 DESCRIPTION OF DOCUMENTS SERVED 15 Claim of Gloria Jeanne King against County of Contra Costa 16 17 18 NAME AND ADDRESS OF PERSON SERVED, AS SHOWN ON SEALED AND DEPOSITED ENVELOPE : 19 20 Clerk of the Board of Supervisors County of Contra Costa 651 Pine Street , Rm. 106 2] Martinez , CA 94553 22 23 24 DATE OF MAILING: 2/28 1986 25 I declare under penalty of perjury that the foregoing is true and correct and this declaration was executed at 26 Pleasant Hill , California, on 2/28/ 1986 . 27 - - --- 28 Amy S Cote ✓_--- (Type or print name) (Signature) ca" BOARD OF SUMVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD ACTION Claim Against the County, or bistriet ) CE TO CLAIMANT Apr i 1 ' 1, 1936- CLA governed by the Board of Supervisors, ) The copy of s t led to you is your RoutingEndorsements, and Board ) notice of the action taken.on your claim by the Action. All Section references are ) Board of Supervisors (Paragraph IV, below), to California Government Codes ) given pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". Claimant: MRS. MARIE KENNEDY County Counsel Attorney: MAR 111986 Address: 2852 Doidge Avenue Martinez, CA 94553 . Pinole, CA 94564 Amount: 154. 50 Approx. By delivery to clerk on Date Reeei ved: 11ar ch 5 , 1986 By mail, postmarked on March 40 1986 I. FROM: Clerk of the Board of Supervisors 70: County Counsel Attached is a copy of the above-noted claim. Dated: March 10, 198EPHIL BATCHELOR, Clerk, By n ° Deputy n Cervel ' II. FROM: County Counsel TO: Clerk of the Board of Supervisors (Check only one) (x) 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. 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). ( ) Other: Dated: By: Deputy County Counsel III. FROM: Clerk of the Board TO: (1) County Counsel, (2) County Administrator ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER By unanimous vote of Supervisors present X) 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: _ ..AF R 0 11986 PHIL BATCHELOR, Clerk, By ` t_At Deputy Clerk WARNING (Gov. Code Section 913) Subject to certain exceptions, you have only six (6) months from the date of 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. V. FROM: Clerk of the Board 70: (1) County Counsel, (2) County Administrator Attached are copies of the above claim. We notified the claimant of the Board's action on this claim by mailing a copy of this document, and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. ( ) A warning of claimant's right to apply for leave to present a late claim was mailed to claimant. DATED: APR Q ;1 1986 PHIL BATCHELOR, Clerk, By , Deputy Clerk cc: County Administrator (2) County Counsel (1) ".CLAIM TO: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY Instructions to Claimant A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops must be presented not later than the 100th day 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. (Sec. 911. 2, Govt. Code) 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 (or mail to P.O. Box 911, Martinez, CA) 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 end of this form. RE: Claim by ) Reserved for Clerk' s filing stamps RECEIVED 6'iW Against the COUNTY OF CONTRA COSTA) MAR S 1986 r SATCHROQ or DISTRICT) IERK6 nofw s (Fill in name) ) c T COSTA o 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) Y e C�_ L? 12/ *, - k - 2. Where did the damage or injury occur? (Include city and county) ---------------------- -------------------------------------------------- 3. How did the damage or injury occur? (Give full details, use extra sheets if required) 4. What particular act or omission on the part of county or district -- officers , servants or employees caused the injury or damage? -r h rqf6"Pr (over) +5:_; •i b.4t are the names of county or district officers, , ser.vants4tuorta ,.t.7 :-c ' , ''fr :employees causing the damage or injury? ,. 4, -- --h---d-- ------------------------------------------------------ 6.--Watamage------or--injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage) 7--. H-----ow-wasth-------e---amount------------claimed-----above-----computed?---------------(Include----the-----estimated--------- amount of any prospective injury or damage. ) �o---Names and addresses of witnesses, doctors and hospitals. -------------------------- ---------------------------------------------_ 9. List the exp.enditures you made on account of this accident or injury f IA� ITEM AMOUNT 4 6 i o- `rc� rZ Govt. Code Sec. 910.2 provides : tt YYt, The claim signed b -o.. 1, g Y the claimant SEND NOTICES 0. (Attorney) or by some person on his behalf. " Name and Address of Attorney Claimant' s ,_Signature Address Telephone No. Telephone No. ************************************************************************** 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, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is guilty of a felony. " •D O - D- N mXav ac o civ, - �� - z m " o o a-d�ro moo'='� _d.._o o n C O m G7 - ,Q m ^ a o to gym . ,cy O - > O �^ A 0 IF d7 p - -I m C� "� v �•e=aa � ao �m„ dc �� _� =odCG) m 3a y ma1 acr'c m.a, n' a c "c QD Ox A m 1 m O n D ;D kms O a^ .� n m mm � 0 a N y Dd m ca �� + _ N 9 m r'C m A co.d o KIT Z 1 m m N p .\ e a _�y - a f f1 yin O O _ O z C f•+ b1 3 '� O 37 M N z =c ]7 m n3 + ma ° � ca a 7 � iN hl 'v <b'+ m v+ c''o n= oQ=" D Z ry m D 1�,�� +n es c f_ >�p x,5 D" v D O s i N Er m 77 l� a m y stn ti tb tD may. D z x K a�c A m mm m n O D \ . m a 1 3 rn = 0 D i O 3 cci a f m ^ _ m A < m m a 1u� r.i m Ab m ; a:n rut NN z 3t�1 D m er5� � � � � J � !A � m a W w� c o m - v+ 01�� �..1 O O 7 a c f c W J m m m S i a 0 c' m O < N zG mn w 1 CL N {C'3 U1 Amo 4 'YY Ozm m O + d A ` ZD � or� D 1 m N 2N 60a V m If r• . (�l O c z > z oLn H .' � f�� y �rti i ~ mco D fm A m 1 , t z z m A Om m e m m =o r,< to c C` nr. r_ \ m r+ y< N N �. D S > 0 c D a i r o1 D MIS M D .=y a 1 O O O N O N .� Gf m N N 70 A c m D RI y z O m O m N v O O z o O ., D #\ m N X z o m s X z z iV ►J � N � O tLn O 71 M �{ M < �OS o1aaoo 0000a < m N XID T8�co D m rZ rZ 2 DC0 "moo Az z n v � qzZ l")m m Z D \.�s..PH V) x'' OD z Aerr Z ..� cil cl ol �r =b cl cl cl bi b MO I , cla ie m 11-67224-2 NORICK OKLAHOMA CITY �teve r Order 575578 Motor Vehicle Repair California `} ' Registration Number Date Em I.D.- Year Car Make/Model Color License Odometer ll 7 19 9j , t In Out Unit Amount c Description SKU Number Qty. Price of Sale d R All Parts Are New Unless Stated Otherwise.Code e Block Denotes:Remanufa a ebt;ilt ;J ✓ L .� ' ': rV1 )FOpKt 00. 4th t' 9 l21� TIt. AR U 22509 474?S'l11jsr5i - r (4Attin,,1 Merchandise 17 r x'4 ''1 i} 3 Q+f:;�:ih!Y. Tax ;:Customer Information Merchandise Total r j . Name Including Tax NM Code Service Work Amount Requeste Done by of Sale Coupon city / -state 99 466 8 Booklet j �L 4 WheelZip �. 99 467 1 Alignment• �� "� Wheel • Phone Numbers,,� 99 550 2 Alignment �FIj � C Home ) Bus. 5 Year Ori inal Estimate Revised Estimate set,"7664 84fn�tf!+rt�C� 99 551 5 Alignment {t Add•1. Sublet 'i ` � Auth.Sublet 99 552 8 Brakes ' Add'L Est.Mdse. Auth.Mdse. r a e 3 It i ..-1 J AddT Est.Labor t Auth.Labor Wheel / L/Notal Est. l� Total Add•1. - - 99 553 1 Balance '`( Ione-Up Revised.Estimate: 99 554 4 Service ' Smog- Approved by Insp. 13 In Person Date credit card ❑By Phone Time Front " 99 555 7 End Parts Verified byr Previous W.O. �h �t10�Q sez w is old parts I authorize the work o e one as estimated. CHes E3p� Montgomery Ward and their employees may Customer wants to inspect old parts operate and examine this vehicle for purposes Shock/ 13 Yes ❑to -: of performing in-shop safety checks,inspection, 995560 Struts Comments: diagnosing,testing,or delivery at my own risk. An express garageman's lien is acknowl- 99 557 3 Exhaust• edged on the vehicle to secure the amount of repairs.I will not hold you liable for loss or . damage to the vehicle or articles left in the Lube,Oil, vehicle in cases of fire,theft,accident or any 995586 Filter other cause beyond your control. 99 559 9 Other A storage charge of$5.00 per day is;appli- cable 3 days after notification. By signing/affixing my signature on the below listed line I acknowledge reading and understanding my customer rights,and the aforementioned customer information:This Vehicle Emission Inspection purchase is paid for on the following terms: "I understand that I have the right to Montgomery Ward Charge Account have emission service and/or sh❑Jefferson/Ward❑Visa/Mastercharge, adjustment done elsewhere. Customer's I hereby waive this right" Signature Xe'°'r' Labor Total Signature Date - - Account No Total Amount 3 Approval No. of Sale *Road test performed on this service. *�On OmQy-Ward jYl �ijy V1/ 35417-6 Customer Copy-4 BOARD OF SUPERVISORS OF CONTRA COSTA COTRM9 CALIFORNIA BOARD ACTION Claim Against the County, or District ) NOTICE TO CLAIMANT April 1. 1986 governed by the Board of Supervisors, ) The copy of this document mailed to you is your Routing Endorsements, and Board ) notice of the action taken on your claim by the Action. All Section references are ) Board of Supervisors (Paragraph IV, below), to California Government Codes ) given pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". Claimant': Suzanne Norvell County Counsel Attorney: MAR 18 1986 Address: 1501 Monument Blvd. , Apt. 19 Concord, CA 94520 Martinez, CA 94553 Amount: By delivery to clerk on March 13 , 1986 Date Received: March 13, 1986 By mail, postmarked on I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. Dated: March 17 , 1286PHIL BATCHELOR, Clerk, By Deputy Ann CPr gal 1 i II. FROM: County Counsel TO: Clerk of the Board of Supervisors (Check only one) (X) 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. 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). ( ) Other: Dated: By: Deputy County Counsel III. FROM: Clerk of the Board TO: (1) County Counsel, (2) County Administrator ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER By unanimous vote of 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 19��s date. Dated: APR PHIL BATCHELOR, Clerk, By c�L 'C : : . , Deputy Clerk WARNING (Gov. Code Section 913) Subject to certain exceptions, you have only-' six (6)-months from the date of 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. V. FROM: Clerk of the Board TO: (1) County Counsel, (2) County Administrator Attached are copies of the above claim. We notified the claimant of the Board's action on this claim by mailing a copy of this document, and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. ( ) A warning of claimants right to apply for leave to present a late claim was mailed to claimant. DATED:\ APR C 3 1986 PHIL BATCHELOR, Clerk, By ti , Deputy Clerk cc: County Administrator (2) County Counsel (1) CLAIM CONTRA COSTA COUNTY SHERIFF'S DEPART RE ]rVEj� VEHICLF. RELEASE SAAR )4 1386 , ►01 EATCHRM EEx f J4 fit!SUK. g Cori .7SfA C D Type of Original Report CFM Victim/Complainant �� L.)(3(_(�O)'� Ka Date . AUTHORIZATION IS HEREBY GRANTED TO Su ZZa in TO RECOVER A Pm 1/7 7 , LICENSE , STORED BY set S vh -Z�shorv�s- J CERTIFICATION: I , the undersigned, do hereby certify that I am ,.legally authorized and entitled to take possession of the above described vehicle.,' 4gn e o.f owner or Aegal owner or agent of owner. PRESENT THIS RELEASE TO: -4-0 1 { 4 Y' J J1 4 VEHICLE STORED AT: ,S L �1 F� JS /1►'�Rpt-��y.D Y-A fZ b THIS RELEASE AUTHORIZED BY: DATE: T 112 6 CA F)o RECEIVED 1AAR 1986 YN't EAiC.kF1Cp CCr fi 44.airi V NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Suzanne Norvell 1501 Monument Blvd. , Apt. 19 Concord CA 94520 Re: Claim of Suzanne Norvell Please Take Notice as follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910. 2, or is otherwise insufficent for the reasons checked below: 1. The claim fails to state the name and post office address of the claimaint. 2. -The claim fails to state the post office address to/which the person presenting the claim desires notices to be sent. x 3. The claim fails to state the date, pL1o=m= x0t3x gtama= of the occurrence or transaction which gave rise to the claim asserted. '(See below) 4 . •.Tha claim fails to state the name (s) of the public employees) causing the injury, damage, or loss, if known. 5. The claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage, or loss so far as known, or the basis of computation of the amount claimed. 6. The claim is not signed by the claimant or by some person on his behalf. x 7 . Other: Please give exact date of damage or injury RECEIVED VICTOR J. ��' Co ty Counsel �� 5�/ MAR 1`4 MG By� Deputy unty Counsel 722 -z-(� o� Cr T /, GSIi. V y CATE OF SERVICE BY MAIL i I .2 — �2ol� , 8 . C.C.P. 1013a, 2015. 5; Evid.C. §§ , 664) My business address is the County Counsel's Office of Contra Costa County, Co.Admin.Bldg. , P.O. Box 69, Martinez, California 94553, and I am a citizen of the United States, over 18 years of age, employed in Contra Costa County, and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non-Acceptance of Claim by placing it in an envelope (s) addressed as shown above (which is/are place (s) having delivery service by U.S. !Jail) , which envelope (s) was then sealed and postage fully prepaid thereon, and thereafter was, on this day deposited in the U.S. Mail at Martinez/Concord, Contra Costa County, Califc !-nia. I certify under penal y of perjury that the foregoing is true and correct. Dated: h(\Q��� x°01 \��lp , at Martinez, California. cc: Clerk of the Board of Supervisors riginal) Administrator (NOTICE OF INSUFFICIENCY OF CLAIM: GOVT. C. S§910, 910.2 , 910.4 , 910. 8)