HomeMy WebLinkAboutMINUTES - 06101986 - 1.9 t
CLUX
BOARD 0P SUMV13MS aF dXW COSTA TOM, CNAMIA
�,►� ACM
Claim Against the County, or bistr3et ) NMCE 70 CLAD�lAR'P wiled
June to 0� 1986
governed by the Hoard of Supervisors, ) The copy of this
Routing Endorsements, and Hoard ) notice of the action taken an 7cur chis by the
Action. All Section references are ) Board of Suspervis" (ParaB'aPh I0, halon).
to California Government Codes ) given pursuant to Government Code Section 913
- and 915.4. Please note all "H nes .
Claimant: Virginia Caldwell
Attorney: Joseph P. Connolly County Counsel
1616 Twenty Third St.
Address: San Pablo , CA 94806 MAY 0 1986
Amounts $25 , boo. oo By delivery to clerk an M,artinez� VA 94t;sq.
Date Raoeived: May 8 , 1986 By sail, postmarked an .Mgy 7 IQ R A
Clerk of the Bmrd of Supervisors TO: County
Attached is a copy of the above-noted claim.
Dated: m @* g , l"6 PHIL BATOMM, Clark. By L/c Deputy
II, : County Counsel s o Supero sora
(Check only one)
( ) 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).
( ) Others
r
Dated: n By: L� Deputy County Caageel
III. FROH: erk of the Board 70: (1) County Counsel, (2) County Administratosr
( ) Claim was returned as untimely with notice to claimant (Section 931.3).
N. BOARD ORDER By unanimous vote of Supervisors present
(x) This claim is rejected in full.
( ) Others
certify that this isa true and correct copy of the Board'a Order entered in is
dinutes this date.
Dated: JUN ��i PHIL BATCHELOR9 Clerk, By .. Deputy Clerk
WARNING (QOY. Code Section 913)
Subject to certain esooeptions, you have only six (6) months fr m the date of this
notice was personally served or deposited in the mail to file a court action on thia
elaia. see Government Code section 945.6.
You say seek the advice of an attorney of your ehoioe in oonneetion with this
batter. If you want to consult an attorney, you should do so immediately.
V. FRO1+L: Clerk of the Board 70: (1) Canty 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 Hoard's copy of this Claim in accordance with Section 29703•
( D A warning of claimant's right to apply for save to present a late claim was mailed
to claimant.
DATED: n t i 1 9 1qR�PfiIL BATQiF7.OR, Clerk, Deputy Clerk
7
,CLAIM TO: ' , BOARD OF SUPERVISORS OF CONTRA CCW*r 4Fappi!cationto:
Instructions to ClaimantC!erk of the Board
.O.Box 911
Martinez,California 94553
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. o.f the Board of Supervisors
at its office in Room 106,'. g, Pine
Street,. Martinezr- 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
oT this form.
RE: Claim by. )Reserved .ford a c's f irng. .stamps
Virginia Caldwell �
k� r CE .��•,
)
Against the COUNTY OF CONTRA COSTA) MAY 1986
)
or DISTRICT) vwL T HEL02
CIE BOAV, F SUPERY„
Fill 3M name ) CONTR syn c
t
The undersigned claimant hereby makes claim against th County of Contra
Costa or the above-named District in the sum of .$. 25,000. 00
and in support of this .claim represents as follows :
_.
1. When did the damage or injury occur? (Give exact date and_ hourj
February 12, 1986 at 8 :30 A. M.
--------T----------------T-T------------- --------------------------------'--------
Where did the~damage. or injury occur? (Include city and county)
At, the .,intersection of 2nd Avenue and Floora Street in Crockett, California
Countv of Contra Costa
--------------------------------------------------------T-----------------------------
3. How did the damage or injury occur? (Give full details, use ..extra
sheets if required) Claimant was walking down Second Avenue on her. wav to
a beautv salon in Crockett and when she came to the intersection of 2nd
Avenue and Floora St. , she was caused to fall over a metal water drain
that extended.. across 2nd St. , due to the street being in disrepair.
4 . What particular act or. omission. on the part of.,-county or, district:. .
officers., servants or employees caused. the injury or. damage,.?..
The County has failed to maintain street in oroper ..renair, causing the
surface of the road to become broken and creating chuck holes thereon,
especially near a metal drain that extends across said street creating a
danaerous condition.
(over)
'M'
LAW OFFICES OF
JOSEPH P.CONNOLLY JOSEPH P. CONNOLLY - AREA CODE 415
CHARLES J.WRIGHT A PROFESSIONAL CORPORATION 234-9436-234-1476
1616 TWENTY-THIRD STREET
SAN PABLO, CALIFORNIA 94806
Mav 7 , 1936
Contra Costa County
Board of Supervisors
651 Pine Street, Room 106
Martinez , CA. 94553
Attention: Clerk of the Board
Re:';Virainia Caldwell
Gentlemen:
Enclosed please find original and copy of Claim Form to
Board of Supervisors of Contra 'Costa Countv.
Will you please acknowledge receipt on the copy and return
to me in the enclosed, self-addressed, stamped envelope.
Thank you for your courtesy.
er trul v urs ,
OSEP P. CONNO LY
JPC:b
Enclosure
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1RA Y` 4 1986
Mar.tfnez,
QJUX CA ,�53
BOARD OF SCPERVI M CF CUM COSTA W201, CUMMU
WAM ACTION
Claim Against the County, or District ) VMCE TO CLAINA IT d.0 eto �1`lts `
0— 199 866
governed by the Board of Supervisors, ) The copy e
Routing Endorsements, and Hoard ) notice of the action taken on your dais by the
Action. All Section references are ) Board of Supervisors (Paragraph IY, below)o
to California Government Codes ) given pursuant to Government Code Section 913
and 915.0. Please note all *warnings".
Claimants Richard A. Cordero
Attorneys
Address 425 Norvell St.
E1 Cerrito , CA 94530
Amount: $1, 953 . 03 By delivery to clerk on
- Date Received: May 12 , 1986 By mail, postmarked an _ May 8 . 1986
s erk of the -Board of Supe sora 708 County Counsel
Attached is a copy of the above-noted claim.
Dateds May 13 , 1986 PHIL BATCHELOR, Clerk, By VDeputy
Ca h les \
FROM:n. County Counsel _- Mt Cler4rof the Board of Supervisors
(Check way 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
no 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. PROMs Qerk of the Board TO: (1) Ckunty Counsel, (2) County Administrator
( ) Maim was returned as untimely with notice to claimant (Section 911.3).
V. BOARD OMER By unanimous trate of Supervisors present
(x) This claim is resected in full. -
( ) Other:
I oertify that this-is a true and Correct copy of the Board's Order entered in its
winuxes for xh,i.a date.
Daieds .�1UUl�V 1 ���yt8stb) PHIL BATOMOR, Clerk, By , Deputy Clerk
WARNING (Gov. Code Section 91
Subject to Certain exceptions, you have only six (6) Wnths from the date of this
notice was personvitly served or deposited in the wuutil to file a court action an thin
Claim. See Government Code Section 945.6.
You way seek the advice of an attorney of your choice in oonnection with this
natter. If you want to Consult an attorney, you should do so immediately.
V. !ROMs Clerk of the Board TO: (1) Canty Cansrl, (2) County Administrator
Attached are Copies of the above claim. We notified the claimant of the Board's'
action on this claim by wailing a copy of this document, and a 2em0 thereof has been filed
and endorsed on the Board's copy of this Maim in aeoordanee with Section 29703•
( D A yarning of claimant's right to apply for leave to present a late maim Was wailed
to claimant. n- �� D
DATE. PHIL BATOMLOR, Mark, BY l�-T►^^�► �k , Deputy Merk
CLAIM TO: BOARD OF SUPERVIS(?RS OF CONTRA COSTA COUNTY
i
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 Cor 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
Cca&io
)
RECEIVEJD
Against the COUNTY OF CONTRA COSTA) MAY J�- 1986
or DISTRICT) Mul9 T McLOR
CLERK OARO SUDERVI(Fi.11 in name) ) NTRA TACO.The undersigned claimant hereby makes claim against a unty otra
Costa or the above-named District in the sum of $ ,,Q SS . o S
and in support of this claim represents as follows:
------------------------------------------------------------------------
1. When did the damage or injury occur? (Give exact date and hour)
rq4 -a L i q S`�' -----------q'`�3-A11------ -------------------------------
2.� iREe�re did .t/heI damage or inljlury( occur? (Include city and county)
�bSt C7< Wef otilwiy �° RA2,bce_ Awc E�4 . Amk tock ) a4f..
--------------------------------------------------- --------------------
3. How did the damage or injury occur? (Give full details, use extra
sheets if required)
�2EhQ_ 6'n!J Cm()isto.qoAL hR-e-6: WA�/
4 . What particular act or omission on the part of county or district
officers, servants or employees caused the injury or damage?
1L �'nn�fir�((// (r ,^)
""7 Tie C'aA1C'JL�IOtJs � aiiitu�
7 (over)
�J
5. ' What are the names of county or 'district officers;:•,servantsr . :r.aenz
employees causing the damage or injury?
0Ae-k5�9 BEAU KAC (EV5 , )4a ? Pojvy t''Y
------------ ------------------------------------
r6. What damage or injuries do you claim resulted? (Give full extent
of injuries or damages claimed. Attach two estimates for auto
damage) ;2�Cc1G `E3 Ec� i w L�a4 z (� Z. r� ` 1 wc�CC4 6.
�02e I�tsck Iyc-ck_
7 --
--. H-----ow-wasth-------e---amount------------claimed---above------------computed?----------(Include----the-----------estimated---
amount of any prospective injury or damage. )
-------------------------------------------------------------------------
8. Names and addresses of witnesses, doctors and hospitals.
mgie �I koIJ tsscs j -75- - 03s7
ti! o c(ti C1`E5 C 5
--.--L-i-st-the--ex-p-e-nd-it-u-r-e-s--y-o-u--m-a-d-e--o-n--a-c-c-o-u-n-t--o-f--t-h-is---a-c-c-id-e-nt-o-r- injury.
'ITEM
ITEM AMOUNT
GLI C t Z" '` �;
==----- ---- -- --d;.:• - ' 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 ,.p
Cla 'mant' s i,gnature
dry s
�. . Q�IS3 b
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. "
DEPARTMENT OF CALIFORNIA HIGHWAY PATROL
r INOUIRIES MUST INCLUDE THE NUMBER SHOWN AT THE UPPER RIGHT No. 675341
If this receipt is for the purchase of an accident report NO AUTOMATIC NOTICE COUNTER RECEIPT
OF SUPPLEMENTS WILL BE GIVEN; PROCUREMENT IS YOUR RESPONSIBILITY.
DATE: �- — LOCATION
FILE, REFERENCE, SERIAL NUMBER(S): CODE:
CASH El CHECK ❑ MONEY ORDER
_ RECEIVED FOR AMOUNT
ACCIDENT
G
REPORT(S)
PHOTOGRAPHS
RECEIVED OF
PUBLICATION(S)
OTHER
r...... ... :..... ...........� (SPECIFY)
SALES
..... ,Q.,l.. .. ... . ....................t7�`:!........... . TAX
L.... C�l'ftr J TOTAL
y�� ....... .......................... RECEIVE
G+a zsl,(R€V 3-e5) 83 932/ USE PREVIOUS EDITIONS UNTIL DEPLETED
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ALBANY,CALIFORNIA 94706
Jim Rose 526-1562
OWNER "R L/1^�`KJ ` ADDRESS
PHONE 1 a { CITY
MAKE I✓ MAKPL) MODEL LICENSE DATE
FRONT PARTS LABOR RIGHT PARTS LABOR LEFT PARTS LABOR MISC. PARTS LABOR
Bumper Fender, Fri. Fender, Fri.
Bumper Brkt. Skirt 8 Batik Skirt, Baffle
Bumper Gd. Fender Mldg. Fender Mldg.
Fri. System Fender Side Midg. Fender Side Midg.
Frame Heodlomp Heodlomp
Cross Member Heodlomp Door Heodlomp Door
Stabiliser Sealed Beam Sealed Beam
Wheel Park Light, Lens, Door Park Light, Lens, Door
Hub Cop Door, Front Door, Front
Hub and Drum
Knuckle Door Hinge Door Hinge
Knuckle Sup. Door Glass Door Gloss
Lr. Cont. Arm Vent Gloss Vent Gloss
Lr. Cont. Shall Door Midg. Door Mldg.
Up Conl. Arm
Up. Cont. Arm Shaft Door Handle Door Handle
Steering Gear Center Post Center Post
Steering Wheel Door, Rear Door, Reor
Horn Ring Door Gloss Door Glass
Grill Midg. Upper Door Midg. Door Mldg.
Right Door Handle Door Handle
Left
Center Rocker Panel n to err Rocker Panel inneOuter
Lower Rocker Midg. Rocker Mtdg.
Front Deflector Floor Floor
Horn Frame From
Baffle. Side
Baffle, Lower Quar. Panel Quor. Panel
Boffle, Upper Ouar. Midg. Ouor. Mldg.
Lock Plate, Lr.
Lock Plate, Up. Ouor. Glass Ouar. Glass
Hood Top Fender, Rear Fender, Rear
Hood Hinge Fender Midg. Fender Midg.
Hood Midg.
Ornament REA MISC.
Nome Plate r Inst. Panel
Rod, Sup, Bumper BrijIr Front Seat
Rod. Core Bumper Gd. Rear Soot
Anti Freese Grovel Shield Front Soot, Adj.
Rod. Hoses Lower Panel Trim
Fon Blade Floor Headlining
Fon Belt Trunk Lid Roof Panel
Water Pump Trunk Light Tire %Worn
Cowl Trunk Handle Tube
tte y
Windshield toil Light Door. Lens nt
Windshield Midg. Toil Pipe, Brackets Undercoat
Gas Tank- Door Aerial
Motor Mts. Frame TOTAL MATERIAL
Clutch Linkage Wheel TOTAL LABOR
V Hub and Drum
IronsmMion Linkage Axle TOWING
Spring SUBLET REPAIRS i
SYMBOL A—ALIGN N-NEW OH—OVERHAUL S-STRAIGHTEN OR REPAIR EX—EXCHANGE RC-RECHROME
THE ABOVE 15 AN ESTIMATE BASED ON OUR INSPECTION AND DOES TAX -�
NOT COVER ANY ADDITIONAL PARTS OR LABOR WHICH MAY BE RE
OUIRED AFTER THE WORK 'AS
BEEN OPENED UP, OCCASIONALLY
AFTER THE WORK HAS STARTED DAMAGED OR BROKEN PARTS ARE GRAND TOTAL
DISCOVERED WHICH ARE NOT EVIDENT ON THE FIRST INSPECTION. BY
' KOEHLER AUTO BODY, 9 6 52
BODY PE�CONSTRUCTION '• PAINTING 's WELDING
1712 San Pabl#'Ave. • -Berkeley, CA -91702 • Phone 526-1262
REG. $38 t
`\ _
Car Owner Ad ress r - Phone t
i
`Make License N �� Body Stylee
_ ,
2Y4r
Serial No. Adjuster — - Phone > Flle.No �
insurance Co. Policy No
.<
OH c`OVERHAUL S = STRAIGHTEN A o ALIGN N c NEW R c REPAIR LKQ = LIKE KIND AND QUALITY
-FRONT OF CAR LEFT SIDE RIGHT SIDE
HOURS PARTS(f) SUBLET(f) HOURS PARTS(f) SUBLET(f) HOURS PARTS(fl -SUBLET(f)
F/E ASSY 1 I FENDER I I FENDER
• I I "SKIRT 1I "SKIRT. - .-..1--
BUMPER N RC I 1 "MLDG./EMB. - 1 I "MLDG./EMB.
..BKT.
RNFCTICOVER I 1 HDLMP. I I HDIMP. L i
CUSH/GRD. -. 1 I "S/B'/DOOR _ - I _, ... I . .:. _.•.S/B/.DOOR
' -ABSBR./ISLTR. I 1 PRK.LMP. - I I K. LMP.-
GRVL SHLD. IMKR. LMP. I I P.
R. IM ,1•-+ '1
'. _VALANCE I 1 IM LMP'S - 1 .1 j. - -�.-1 -•=s _,---.
FILLER - 1 COWL / I COWL -1
SPOILER - I 1 DOOR FRT. I 1 DOOR 27.
• 1 "PANEL
FRAME/CROSS 1 1 "GLASS 1 7 -' 1
I tl "MLDG. I "MLDG. 1
HINGE
•'•'GRILLE/SUPT. - - I C ST 1 CENTER POST
" HDR. PNL I I DOOR REAR I 1 REAR 1
"' MLDG. 1 I "PANEULOCK I EULOCK •••- -1--- - I
• EMB. I 1 "G .S RIP. dl "GLASSIW.STRIP. I
• I I "M I I "MLDG. I 1
RAD.BAFFLE I H E I I HINGE
RAD. SUPT. I I I I l I
CORE 1 I ( R' KER ANEL I i ROCKER PANEL - I 1
"FANIBELT I 1 ML I.- I "MLDG. `� _ I I
"COOLANT I I PI R I I FLOOR 1 I
SHROUD I I. I I PILLAR 1 I
WATERPUMP - 1 I QUARTER PANEL" l I I QUARTER PANEL --T•� I
A/C COND. I I EXT. I "' XT.
RCHG, I I' MLDG./EMB. I DG./EMB 1_ 1
• 1 I .WHL. HSG. .1 fl,
WHL G. } I
HOOD I I WIO MOLDG. I ,/ WIOMLDG."HNG. I 1 TRAIL LMP. TAIL LMP. U
"MLDG.EMB. 1 1 MKR. LMOC I MKR. 1 " I
"LOCK I 1; REAR O CAR 1 I
"LOCK SUPT. I, ADIO ANTENNA 1
I 1! ABS./ISLTR. 1 .I CEL ANEOUS'ITEMS
WHEEL I I', BUMPER/COVER I I •� -•1.,•i 1
TIRE - -=•I 1 '• "BKT./RN FCT I I WINDSHIELD -
HUB CAP DISC. - •-•1 I CUSH./GRD. I I ROOF PANFjI•
VALANCE I I I lME PNL
KNUCKLE 'i I FILLER I 1 T&MATERIAL
CONT.ARM LR. - - - I I REAR LWR.-PNL. 1 ^dF _'.l
COM.ARM UP. 1 I FLOOR I I BATTERY .. 1
TIE ROD
FRA I I LABOR Q $
STRUT 1 I DECK LID/TL. GTE. I f PARTS LESS g'o $
FRONT END ALIGN I I "HNG. 1 I SUBLET $
STEERING WHL I I "MLDG. 1 I TOW CHARGE $
MORN I 1 I 1 TAX % ON $ $
MOTOR MNI. GASTANKICAPy 1 I TOTAL $ -
MIRROR I 1 MUFFLER/PIPE4'xp" 1 1 SIGNATURE
... _.�__.�.__...�.....- T__._ _ ..a-_ . _.�__ ._. _.. .--••---`^"^'rte—a.,•.- �. .-....,-.-..�.- ...•--+----_.�� ..•--,-..�..... _ .
UAN
; BDAM OF SUMVI90RS Cr C5M META MOM CAUP RA
. IDIIA'D ACT=
Claim Against the County, or bistriat ) NOTICE TO CLADUE T June 10 , 1986
governed by the Hoard of Supervisors, ) The Copy Of this document M118a to YOU Is YOW
pouting Endorsements, and Hoard ) notice of the action taken on your claim b7 the
Action. All Section references are ) Board of Supervisors (Paragraph IV, bedew),
to California Government Codes ) given pursuant to Government Code Section 913 .
and 915.4. Please note all WwaraiW*
Claimants Creekside Terrace Apartments
Attorney:
Address: 503E San Pablo Dam Rd. ,#17
$62 . 86rante, CA 94803 By delri iitkerk on Mav 9 , 1986
Amount: ,
Date Received: May 9 , 1986 By X19 postmarked on.
Clerk of the Board of Supervisors 70: County
Attached is a copy of the above-noted claim.
Dated: -mq;zg i a s ti PHIL BATOMM, Clerk, By ��Q�-T h� Deputy
U. : County Couas 70: Uerw of the Board of Supero sora
(Check only one)
o6 This claim complies substantially with Sections 910 and 910.2.
( ) Ibis claim FAILS to oomply 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).
t ) Other:
Dated: - M>L By: L Deputy Comity Counsel
III. FROM: erk of the Board 70: (1) Ity Counsel, (2) County Administrator
( ) Maim was returned as untimely with notice to claimant (Section 9111.3).
IV. BOARD ORDER By unanimous vote of Supervisors present
O
We claim is rejected in full.
t ) Other:
certify that this 33 a true and oorrect oo y o the 'a Order en ' in Tt3
minu� f 0 1 s date.
Dated: JUS PHIL BATCMOR, Mark, By vw , Deputy Mark
itARNDiG (Gov. Code Section 91
Subject to oertain azoeptions, 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 Cay seek the advice of an attorney of yea► choice in Connection with this
matter, If you want to consult an attorney, you should do so.immediately.
V. FM: 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'a
action an this claim by mailing a copy of this document, and a memo thereof has been filed
and endorsed an the Board's Copy of this Maim in accordance with Section 29T03.
( ) A warning of claimant's right to apply for leave to present a late claim was mailed
to claimant.
DATEN -iliN 1 9. 14A6 PHIL BATamm, Mark, By , Deputy Clerk
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 9.11, 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 or Clerk's tamps
QST' � j E
v O 3s T P«.e-2 a � 4ce #/7 RECEIVE
)
Against the COUNTY OF CONTRA COSTA) MAY
}
or DISTRICT) Elk a no NE ERY
TMC AGO.
Fill in name) ) .. , , ,.
The undersigned claimant hereby makes claim against the C ty 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)
..z 7, I9SZ y;vo 00"
------ ----T----------- 1p -----
---
2. Where did the damage or---in--jury-- occur?------(Include- - -
city and county)----
3. How did the-damage or injury occur? (Give fu lll d s, use extra
beets if re uired)
4k1-c,e(
/
i------------r-------------------------=----------------------------------
What paticular act or omission on the part of county or district
officers , servants or employees caused the injury or damage?
(over)
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Name
Address
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j DUAN. DESCRIPTION PRICE AMO NT
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V-2 Customer's Rei d
Order No. - By
f —
CLAN
BOARD OF SOP' nSORS OF CUM COSTA OMM, ULYrO -0
PDARD AM=
Claim Against the County, or bistrict ) NOTICE I'0 CLADWT June 10 , 1986
governed by the Board of Supervisors, ) The oopY of this document W1180 to you is yoia
Routing Endorsements, and Board ) notice of the action taken on your skim by the
Action. All Section referenoes are ) Board of Supervisors (paragraph IVv below), '
to California Government Codes ) given Pumsent to Government Code Section 913
and 915.4. Please note all *Warnings e
Claimant: Gerald and Darleen Ellingson COUnty Counsel
Attorney: MAY 0 1986
Address: 300 East "H" St . , #38 Martinez, CA 94553,'.
Amounts Benicia, CA 94510 By delivery to clerk on
Unspecified
Date Reoeiveds May 8 , 1986 By sail, postmarked on May 7 , 1986
-Clerk of the Board of Supe cors 70: County CiNiig
Attached is a copy of the above-noted claim.
Dated: Ma3z R r i a u� PHIL BATQ�]AR, Clerk, By DepttLY
es
Il. YROMi Coun y Couns : of the Board of Supery sora
(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 rets claim on ground that it vas 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 ty Counsel
III. FROKs &rk of the Board
70: (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.
( ) Others
I certify that this is a true and correct oo of the 's Order an in its
minutes for s date.
Dated: JUN 10 M" PHIL BATCHMOR, Clerk, By .o , Deputy Clerk
WARNING (Gov. Code Section 913
Subject to certain exceptions, you have only six (6) months from the date' or this
notioe was personally served or deposited in the sail to file a court action ca this
claim. See Government Code Section 945.6.
You say seek the advice of an attorney of your ohoioe in connection with this
matter. If you want to consult an attorney, you should do so Immediately.
V. FMt Clerk of the Board 70: (1) County Cosset, (2) County Administrator
Attached are copies of the above claim. We notified the claimant of the Board's
action on this claim by sailing a copy of this document, and a memo thereof has been filed
and ondcrsed on the Board's copy of this Claim in a000rdanoe with Section 29T03.
( ) A warning of claimant's right to apply for leave to t a late claim was sailed
to claimant.
DATED: JUN 12 1986 PHIL BATCHELOR, Clerk, By L _ , Deputy Clerk .
" LAIM- TO: BOARD OF SUPERVISOFS Off' CONTRA COSTA COUNTY
r 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, Martjnez, ,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
Gerald and Darleen Ellingson )
300 East "H" St. 38 Benicia, Ca 94510 RECEIVED
Against the COUNTY OF CONTRA COSTA) MAY 1986
or DISTRICT) rmE eRcHEEoa
Fill in name ) ac eOM UPEh_. ;
O41 OSTA
The undersigned claimant hereby makes claim against the unty of Contra
Costa or the above-named District in the sum of $
and in support of this claim represents as follows:
-----------------a------------------------------------------------------
1. When did the damage or injury occur? (Give exact date and hour)
3:55 or 4:OOP.M. Thursday, April 24, 1986
-----------r---- --------------------------- --------------------- -----
2. Where did the damage or injury occur? (Include city and county)
At the end of Bruns Road and Byron Highway J4 Contra Costa County
---------------------------------------
3. How did the damage or injury occur? (Give full details, use extra
sheets if required) While driving north on Bruns Road I passed a road repair
crew and my car was sprayed by some chemical that tarnished the exterior of my
car on drivers side of car. When I went home I washed the car and whatever had
been sprayed would not come out.
4. What particular act or omission on the part of county or district
officers , servants or employees caused the injury or damage?
No warning or flagman present.
(over)
S.' What are the names of county ordistrict officers, :.servantw.l=
1. employees causing the damage or injury?
I N/A
- -----------------------------------------------------------------------
6-. Whatdamage or injuries do you claim resulted? (Give full extent
of injuries or damages claimed. Attach two estimates for auto
damage)
SEE ATTACHMENTS
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.
N/A
-------------------------------------------------------------------------
9. List the expenditures you made on account of this accident or injury.:
�...�..,... . DPiTE.,:. ....�,._. .. ITEM AMOUNT
''" `` " SEE ATTACHMENTS
i
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
Clamant' s Signa ure
3a o _ � IV3
Address
Telephone No. Telephone No. 70'7 - 7L/ S 3 J
**************************************************************************
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
ESTTMATE OF REPAIR COSTS
Date—, Mane Na /
t
Name REED'S BODY & FENDER WORKS
AUTO PAINTING
Address State Lic.No.AB 6330 R
Cit479 East L Sty , Benicia,Calif.94510 Phone 745-0454
y QL /1'7/
LMake of Car Year Type tote License No-IX�—)C
Motor No. Serial No. M;tea a Insurance _
OUAN. WORK TO BE DONE PARTS LABOR
I
j�
z
of
The above is an estimate based on our inspection and does not cover TOTAL LABOR
any additional pans or labor which may be required after the work has TOTAL PARTS
been opened up. Occasionally after the work hos storied,worn or damaged
parts are discovered whicw are not evident on the first inspection. BecouSB
of this the above prices are not guaranteed, and are for immediate ac- TAX ON PARTS
ceptonce only.
TOWING AND STORAGE
Accepted by Oe or Aaent TOTAL OF ESTIMATE
Fenn EF-913 IMenState Press;2210 Venire Wed.las Angeles 6'
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