HomeMy WebLinkAboutMINUTES - 06201989 - 1.16 1 CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
C1aii? Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT June 20, 1989
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant � Government Code
Amount: $10, 000 . 00 Section 913 and 915.4. Please note a4941 '�Ui L
nSgI
CLAIMANT: JOSEPHINE DAVI ETAL I11AY
3
Archer-; McComas & Lageson '01989
ATTORNEY: C/o Angela Tysk Dolgirlow N1artlnez, CA 94553
P. O. Box 8035 Date received
ADDRESS: Walnut Creek, CA 94596 BY DELIVERY TO CLERK ON May 26 , 1989 CC
BY MAIL POSTMARKED: no envelope
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: May 30 , 1989. PpHHIL BATCHELOR, Clerk ),
BY: Deputy /
L. Hall
Il,,,�M: County Counsel TO: Clerk of the Board of Supervisors
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. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
A) 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: JUN 2 0 1989 PHIL BATCHELOR, Clerk, By Y�C�A _ Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from;the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
Ycu 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.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant as shown above.
Dated: JUN 21 BY: PHIL BATCHELOR by . y erk
CC: County Counsel County Administrator
MAY 2 2 REED
ANGELA TYSK DOLGINOW
1 LAW OFFICES
ARCHER, MCCOMAS & LAGESON
2 A PROFESSIONAL CORPORATION
2033 NORTH MAIN STREET.SUITE 800
3 PERI EXECUTIVE CENTRE
P.O.BOX 6035 W °
WALNUT CREEK,CALIFORNIA 94596 � �!]
4 (41 5)930-6600 illi CJ���✓✓✓
5 Attorneys for Claimants �, 61989
JOSEPHINE DAVI and JOSEPH DAVI
s P1 ki T� U�A OAS
7 CL[ 5 A S Degu�Y.
c .
BY
8
9
10 Claim of Josephine Davi and CLAIM FOR PERSONAL
Joseph Davi, INJURIES
11 Claimants,
12 V. (SECTION 910 OF THE
13 GOVERNMENT CODE)
CONTRA COSTA PUBLIC WORKS
14 DEPARTMENT,
15 Respondents.
18 To the Public Works Department of Contra Costa, 255
17 Glacier Drive, Martinez, CA 94553 :
18 You are hereby notified that Josephine and Joseph Davi,
19 whose address is 4050 Burbank Drive, Concord, CA 945211
20 claims damages from the Public Works Department in an amount
21 as yet ascertained, but exceeding $10, 000 as computed at the
22 date of presentation of this claim.
23 This claim is based upon equitable indemnity or partial
24 equitable indemnity for personal injuries sustained by Linda
25 Lou Hall on or about November 24, 1987, in the vicinity of
28 Navarrone Way and Treat Boulevard, Concord, where Mrs. Hall
27
allegedly sustained injuries as a result of a vehicle
28
1
1 accident when Josephine Davi.
2 Josephine Davi was traveling north on Treat Boulevard in
3 lane #1 (the far right lane) when warning cones forced her to
4 merge quickly into the left lane (lane #2) • A large mounted
5 blinking warning arrow was placed on the north shoulder of
6 Treat Boulevard near Navarrone Way and obscured the signal
7 light located on the corner of Navarrone Way and Treat
8 Boulevard.
9 Josephine Davi rearended Linda Lou Hall because these
10 construction warning devices were not placed sufficiently in
11 advance of the construction zone to allow approaching
12 vehicles to slow, merge, and simultaneously observe the
13 signal light and stopped vehicles.
14 A complaint for personal injury was filed by Linda and
15 David Hall against Josephine and Joseph Davi in the Superior
16 Court of the State of California, County of Contra Costa, on
17 November 21, 1988. Josephine and Joseph Davi were personally
18 served on December 12 , 1988. Josephine and Joseph Davi now
19 seek contribution or indemnification from the Public Works
20 Department to the extent that defendants are subjected to
21 liability in proximately causing the injuries and damages, if
22 any, to have been sustained by Linda and David Hall.
23 The names of the public employees causing claimants
24 injuries under the above-described circumstances are not
25 known to claimant.
26 The injuries sustained by the underlying plaintiff, as
27 far known, as of the date of presentation of this claim,
28 consist of neck, shoulder, and back injury, headaches, and
2
r r I
1 emotional distress. Linda Lou Hall claims medical and wage
2 loss damages in excess of $10,000. David Hall alleges loss
3 of consortium, loss of spouses services, companionship,
4 affection, anxiety and solace in an unspecified amount.
5 The amount claimed as alleged injuries, as of the date
6 of presentation of this claim, are computed as follows:
7 Linda Lou Hall:
8' Alleged damages incurred to date:
9' 1. Expenses for Medical and $10, 300
Hospital Care
10 2 . Loss of earnings $ 21642
11 3 . Special damages for $ 11005
12 automobile deductible,
day care, clothing, contact
13 lenses, household services
14 4. General damages allegedly
according to proof
15 5. Estimated prospective
16 damages are uncertain
17 David Hall:
18 Alleged damages incurred to date:
19 1. Lost wages as a result of loss
of spousal services $ 1, 288
20
21 2 . General damages for Amount unascertained
emotional distress and loss
22 of consortium
23 Total specials claimed by the
underlying plaintiffs as
24 of the presentation of this
claim $15, 000+
25
26 The above lawsuit was filed in the Superior Court of the
27 County of Contra Costa, Action No. C88-04849.
28 All notices and other communication with regard to this
3
• I claim should be sent to claimants, Joseph Davi and Josephine
2 Davi, at Archer, McComas & Lageson, c/o Angela Tysk Dolginow,
3 Esq. , P.O. Box 8035, Walnut Creek, CA • 94596.
4 DATED: May 18, 1989 ARCHER, McCOMAS & LAGESON
5
6
Ang Ty of
7 Attorneys for Claimants
JOSEPHINE DAVI and JOSEPH DAVI
8
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CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT June 20 , 1989
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by theo1'S�u,pervisors
(Paragraph IV below), given pursuant toGovv� tel
Amount: $300, 000 . 00 Section 913 and 915.4. 1 Please note aly�q ry y ..
CLAIMANT: CHRISTINE MCCRACKEN ETAL Ma 7 UU 1989
c/o Allan M. Schuman, Esq. rtl nez' CA 94,553
ATTORNEY: 2165 Filbert Street
San Francisco, CA 94123 Date received
ADDRESS: BY DELIVERY TO CLERK ON May 26, 1989
BY MAIL POSTMARKED: May 25 , 1989
Certified P 947 087 245
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
PPHHIL BATCHELOR, Clerk
DATED: May 30, 1989 BY: Deputy
L. Hall
I FROM: County Counsel TO: Clerk of the Board of Supervisors
�) 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. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: Cj����. BY: Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
( This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date. c1
Dated: JUN 2 0 198 9 PHIL BATCHELOR, Clerk, By Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately,
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certified copy of this Board Order and tice to Claimant, addressed to
the claimantasshown above.
JUN N 2 1 1989 BY: PHIL BATCHELOR by Deputy Clerk
CC: County Counsel County Administrator
eY�E�%LC(//G � J c���t.l �.JViJWiCiGCIiLF/J- .
A PROFESSIONAL LAW CORPORATION
2165 FILBERT STREET,SUITE 300, SAN FRANCISCO, CALIFORNIA 94123 • 415/563-2111 • CHICAGO OFFICE 312/346-8090
May 25, 1989
Clerk
Board of Supervisors
County Administration Building , Room 106
651 Pine Street
Martinez, California 94553
Re: McCracken vs. County of Contra Costa
Dear Sir :
Enclosed is an orginal and a copy of a Claim against the
County of Contra Costa. Kindly file the original and return a
file-endorsed copy to this office 'in the self-addressed stamped
envelope provided .
Thank you for your attention to this matter .
Very truly yours,
KER Y BARDI .
Enclosures
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 per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for death or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. Code §911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in
Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553.
C. If claim is against a district governed by the Board of Supervisors, rather than
the County, the name of the District should be filled in.
D. If the claim is against more than one public entity, separate claims must be
filed against each public entity.
E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this
form.
RE: Claim By ) Reserved for Clerk's filing stamp
Christine McCracken and ) RECEIVED
Kevin McCracken
Against the County of Contra Costa ) MAY 2 G 19-6-9-
or )
D Tf JP R
f_
City of T�aayette, CA District) CLE NT � oas
Fill in name ) dY . ..
The undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $ 300 , 000 . 00 and in support of
this claim represents as follows:
-------------------------------------------------------------------------------------
1. When did the damage or injury occur? (Give exact date and hour)
9 : 00 a.m. , March 25, 1989
------------------------------------------------------------------------------------
2. Where did the damage or injury occur? (Include city and county)
3366-omt. `-Diablo -BIN-7d. Iafavette, Contra Costa Countv;-da1:if-o'rriia
------------------------------- -------- ----------------------------------------------
3. How did the damage or injury occur? (Give full details; use extra paper if
required)
Cause to slip and fall (Christine) and Loss of Consortium and services
(Kevin) .
---- - - - - - - - - -
---- ---------- --- -- -------- -- --- ---- -- -
- -
4. What, particular act or omission on the part of co-unty- --or-----district----------officers,-----------
servants or employees caused the injury or damage?
Failure to keep and maintain the sidewalk ' in proper repair.
(over)
5. What are the names of county or district officers, servants or employees causing '
the damage or injury?
Exact names are unknown, but it is those individuals-and .dependants
responsible for proper sidewalk maintenance and repair. ,
------------------------------------------------------------------------------
6. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
Serious injuries including broken left leg.
-------------------------------------------------------------------------------------
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
Prospective future surgery.
------------------------------------------------------------------------------------
8. Names and addresses of witnesses, doctors and hospitals.
Douglas M. Lange, M.D. John Muir Hospital and Diablo Valley Radiology
Medical Group `"_ Additional information under
investigation.
-------------------------------------------------------------------------------------
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
to 5/22/89 Medical approximately $7 , 500 . 00
Gov. Code Sec. 910.2 provides:
"The claim t e signed imant
SEND NOTICES TO: (Attorney) or b n on is ehal .
Name and Address of. Attorney
ALLAN M. SCHUMAN, ESO. 412LK& - ��va
ai Signa ure
ALLAN M. SCHUMAN & ASSOCIATES
2165 Filbert Street 3366 Mt. Diablo #205
San Francisco, CA 94123 Address
Lafayette, CA 94549
Telephone No. (415) 563-2111 Telephone Nor(415) 284-7632
N O T I C E
Section 72 of the Penal Code provides:
"Every person who, with intent to defraud, presents for allowance or for
payment to any state board or officer, or to any county, city or district board or
officer, authorized to allow or pay the same if genuine, any false or fraudulent
claim, bill, account, voucher, or writing, is punishable either by imprisonment in
the county jail for a period of not more than one year, by a fine of not exceeding
one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in
the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by
both such imprisonment and fine.
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1
CLAIM /
-BOARD OF SUPERVISORS OF CONTRA COSTP, COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT June 20 , 1989
and Board Action. All Section references are to The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $2 ,403 . 46 Section 913 and 915.4. ' Please nnootteall "Warnings".
CLAIMANT: STATE FARM INSURANCE COMPANY (LUMACHI , EUREL qty Counsel
6400 State Farm Drive #05 0265 211 MAY 3;0 1989
ATTORNEY: Rohnert Park, CA 94926-0001
Date received Maya5jne�IQ4 qc1fM Manage.
ADDRESS: BY DELIVERY TO CLERK ON
BY MAIL POSTMARKED: no envelope
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
May 30 , 1989 PpHHIL BATCHELOR, Clerk
DATED: Y BY: Deputy
L. Hall
FROM: County Counsel TO: Clerk of the Board of Supervisors
This claim complies substantially with Sections 910 and 910.2.
i ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying
claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: 01 BY: Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
() This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date. A
Dated: J U N 2 0 1989 PHIL BATCHELOR, Clerk, By �� Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code-Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant as shown above.
Dated: JUN 21 1989 BY: PHIL BATCHELOR by GC�� puty Clerk
CC: County Counsel County Administrator
• ) STATE EARM
State Farm Insurance Companies
INStl RANCE
REC
Ia Northern California Office
6400 State Farm Drive
May 19, 1989 Rohnert Park CA 949260001
MAY 2 51989
Contra Costa County
[�t; P.� ` Lf tV
c% Risk Management Department _ _ ..651 Pine St., 6th Floor ``
Martinez, CA 94553
IMPORTANT
PLEASE WRITE OUR CLAIM
NUEER* ON YOUR REPLY
-- OR PAYMENP '"THANK'YOU. --
Re: Our Claim Number: *05 0265 211
Our Insured: Lumachi, Eurelio
Date of Loss: 02-16-89
State Farm Mutual Automobile Insurance Company on behalf of Subrogee
Eurelio Lumachi hereby makes claim for $2,403.46 and makes the
following statements in support of the claim.
1. Notices concerning this claim should be sent to State Farm
Insurance Companies, 6400 State Farm Drive, Rohnert Park,
California 94926, referencing the above claim number.
2. The date and place of the accident giving rise to this claim are;
on February 16, 1989 on Alhambra Blvd, at Hwy 4 in Martinez, CA.
3. The circumstances giving rise to this claim are as follows:
Our insured, Eurelio Lumachi, was operating his/her vehicle, when
your vehicle, a 1988 International Pick-up, driven by Robert
Gomez, negligently collided with our insured causing property
damages and injuries.
4. Our insured's injuries are back and neck pain,
5. Our total claim is as follows:
Company's Net Payment $2,203.46
Insured's Deductible Interest 200.00
Total Property Damage $2,403.46
I '
HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001
- STATE EA0.M
State Farm Insurance Companies
' INSY0.ANCE
O
Northern California Office
6400 State Farm Drive
Page 2 Rohnert Park CA 94926-0001
NOTICE:
This form is to provide notice of our claim for damages in accordance
with the six (6) month statute. If this form is not acceptable for
cmpliance with the statute, please rush the necessary forms to my
attention for proper filing. f
STATE ARM TNSotoOANIES --
Dated: ✓ 'U I BY zom,�
Bill Rossi
Claim Specialist - ROAC
(707) 584-6471
BR:KA:kz 19-014
AC-51
Encl: Supporting Doc=ents
cc: 4499
HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001
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Page No.
CLAIM ACTIVITY LOG 1 �--��
Claim Number
YEAR Insured
MO./DA CLAW NO. OS-0265--211 `==• H11�LT�P.crav+.-` ����
1 AUTHORIZE �O (�LyP� /1� c /3 ARIA INSU
TO REPAIR VE W 1E ACCORDING TO REPAIR COST AS ITEMIZED.ALSO,I Mall
THIS APPRAISAL TO REPAIRER BEFORE REPAIRS ARE STARTED. RIChI►IOnc C
-MGNATU E,� 4
STGNATt1REl X �' ���yy DAT
. WE ACCEPT REPAIR COSTS AS ITEMIZED. ;TAX ID
REPAIRER'S
SIGNATUREI Z
THE REPAIRS HAVE BEEN COMPLETED.I AUTHORIZE E O T AY ENT'
OF$ O•�• � t^'" •To THIS EPAI OP ON M ' . a
DO NOT SIGN UNTIL-""REPAIRS HA 'BEEN OMP TED TO R SATISFACTION..
- - - -
DATE
... DATE THIS FORMED
STATE FARM CLAIM
REPRESENTATIVE
REPAIR 4100. THIS ORIGMAL FOR PAYMENT TO CLAIM SERVICE" FFlCE AT:-. - -:
�N <: J. MAR 24 1999 a
SEE REVERSE FOR STATE FARM'S'AUTO DAMAGE CLAIM POLICY
(160)G 4372b.2 REV 3-83 Printed in U.S.A.
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M "11 �_11-87 Pmted inU.SA-
STATE RAIRM —uKA; P
A A ImSi" WNCE ! !v?p2Lk1:m1tb
CLAIM NO. T 3-9 8 HILLTOP SERVICE CENTER
DATE OF INSPECTION a ESTIMATE VWIFRE INSPECTED/BY VVHW
EURtLIO LUMACHt- 7 {aft INSURED NUMBER
4 w�
945 YUBA 'Stk1
ft&4SEPRKn ET R1CHM6ND-'%' *CA 94805 HOME PHONE
ADDRESS
vfsiz-
w6k PHONE" EXT
MAKE . .-ell IL 43F
ly
N'Em
"
Vbj e,
1982
'
DRE MANUFACTURED ]MILEAGE
71 7-,'?6
0
REPAIR RE- I
DESCRIMM PARTS
(SEE ABWXMTKW LIST ON REVERSE) so
I@ tw
PLA(;E MRS A NET ITEIA
6 $7itiq 5 . ... $
/Jr.17
2
w_ eI A!tv
3
4 0 ';Oelo.o V Ak?
5
6
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ell
tz
8
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0
ve�f.
112A__
-13
�4
v
15
cLQm No. LABOR
I AUTHORIZE PER HRS.
If b P
TO REPAIR VEHICLE ACCORDING TO REPAIR COST AS ITEMIZED.ALSO,I AGREE TO SHOW
T(you"A
THIS APPRAISAL TO REPAIRER BEFORE REPAIRS ARE SWrED.
LAO HRS� fflzj.x'�$. HFL _z
71
PARTS
x .4 765
$
sr WE ACCEPT REPAIR COSTS AS ITEMIZED. �_,lTAX ID
e:' PAINT,MATERIALS.&NET ITEMS
REPAIRER'S
SIGNATURE TOIAL REPM COST
NT
THE REPAIRSHAVE BEEN COMPLETED.I
AUTHORI�. *Ty LESS
SATISFACTION.DO NOT SIGN UNTIL REPAIRS HAVE BEEN OF$ 0—?, "�—fDT"Skj10jJPON
TO R IMP TED IrFACTION. ' PRIOR 6AMIA& . $7-------
=_ X — DEDUCTIBLE-f=.3,
'A
TOTAL DEDUCTIONSsa2L(_jL_1
DATE THIS FORM I ED
STATE FARM CLAIM COMPANY.TO PAYu2O 3.V
REPRESENTATIVE TU
REPAIR SHOP. THIS ORIGINAL FOR PAYMENT TO CLAIM SERVICE OFFICE AT: OWNER TO FAY
jcE rz 9
THIS VEHICLE MAY
JnAGE CL.=.. : EQUIPNIE.�'lj— AS
i, C ,
PVIAINIWCTIMER
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT June 20, 1989
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $186 . 7 0 Section 913 and 915.4. ' Please note all "Warnings".
CLAIMANT: LUISA FARQUHAR County Counsel
1905 Coventry Court
ATTORNEY: WalnutLCreek, CA 94595 MAY 101989
Date receivedgg
ADDRESS: BY DELIVERY TO CLERK ON May 22 1 'S�Z, CA 94,9i,52
BY MAIL POSTMARKED: May_:.20;'1989
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
May 30 , 1989 PpHHIL BATCHELOR, Clerk
DATED: BY: Deputy
L. Hall
I FROM: County Counsel TO: Clerk of the Board of Supervisors
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. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
q (
Dated: c `�U I I BY: Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) Coun finis r (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
(�) This Claim is rejected in full .
(/ �) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date. 1' y A
Dated: JUN 2 0 1999 PHIL BATCHELOR, Clerk, By c�, Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certified copy of this Board Order Pd Notice to Claimant, addressed to
the claimant as shown oabove. /
Dated: JUN 21 1909 BY: PHIL BATCHELOR by r Deputy Clerk
CC: County Counsel County Administrator
r Ciaim• 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 per-
sonal property or growing crops and which accrue on or before December 31, 19879
must be presented not later than•the 100th day after the accrual of the cause of
action. Claims relating-to causes of action for death-or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action-must be presented not
leiter:.-than one year after the accrual -of the cause of action. (Govt. Code §911.20
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in
Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553•
C. If claim is against a district governed by- the Board of Supervisors, rather than
the County, the name of the District should be filled .in.
D. If the claim is against more than one public entity, separate claims must be
filed against each public entity.
E. Fraud: See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this
form. _
RE: Claim By ) Reserved for Clerk's filing stamp
RECEIVED
Against the County of Contra. Costa ) MAY X1989
or )
•• - ^- PHIL BATCHELOR.
CLERK BOARD OF SUPERVISORS
District)
CONTR C ACO.
Deputy
Fill in name ) B
The undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $ 02, es+frn ,+-5 and in support of
this claim represents as follows: �e;-
-------------------------------------------------------------------------------------
1. When did. the damage or injury_occur? (Give exact date and hour)
/✓f a4f 31 196'9 /Z: D 0. ^oeP7
------------------------------------------------------------------------------------
2. Where did the damage or injury occur? (Include city and county)
c�a.1�;//e r3/�� e /wpen Crest RK�Pye�✓ - M/a/r,It t Gve/ ou h e
Cona'Ya COStA L
--------------------------------------------------------- -
3. How did the damage or injury occur? (Give full details; use extra paper if
re3uired),
l (; . s o�i'� p V) Ja h V; //e 3l✓�..� �r fro e �&i ve-,eh f
9{ztc/C J�� Z �o ff�rrl ou13iG12 _'
-------------------------------------------------------------------------- ---------
4. What particular act or 'omission on the part of county or district officers,
,servants or employees caused the injury or damage? /.
l"ave.�,e�f 1A)9Z54-Ar �v g,plg7�L� ok7 tv
(over)
5. What are the names of county or district officers, servants or employees c2using-
the damage or injury?
unkkio
-------------------------------------------------------------------------------------
5. What damage-or_injuries do you claim resulted? (Give full extent of _injuries or
damages- 'claimed. - Attach two estimates for auto damage..?.;
clJ�ma 2• • i�•- �aihf "'ah `Y»y.. '`Ca-r— -estima�5 .�A.f]�a��eaQ• •
------------------------------------------------------ ------- ------------------------
7. - 'How was the amount-claimed above computed? .(Include -the.estimated amount-of any
prospective injury or damage.)
.SEC GS+ ,n•;raPs•_ - .. _ .-.. , + ._ .. - _
8.- Names and addresses, of witnesses, doctors and hospital"sc
-------------------------------------------------------- ------------
. 9.
--- ---9. List the expenditures you made on account of this accident or injury:
DATE ITEM- AMOUNT
_� _.v. __: ._ .•._.� . _�..:. n need pyo have �a� renove
.o'...,.. .r ,.yP7Il _ Y
Gov. Code.Sec. 910:2 provides.:
"The claim must be signed by the claimant
SEND NOTICES„TO; ";'(Attorney) or by someperson on his behalf."
Name and.,Address'=of'Attorney,
.. .,.�:•.. . .__ , .,_. ._,y,... _ , . � • Claimant' Signature �-
_ MJ_ Co ve I, Gt `
Address
4UCi �ha,t. G re e-k Cf1 - 9`x -95
Telephone No. Telephone No934-- 0 55,2
N O T I C E
Section 72 of the Penal Code provides:
"Every person who, with intent to defraud, presents for allowance or for
payment to any state board or officer, or to any county, city or district board or
officer, authorized to allow or pay the same if genuine, any false or fraudulent
claim, bill, account, voucher, or writing, is punishable either by imprisonment in
the county jail for a period of not more than one year, bya fine of not exceeding
one thousand ($1000), or by both such imprisonment and fine, -or by imprisonment in
the state prison, by a fine of'not 'exceeding•,ten.thousand dollars ($10,000; or .by
both such imprisonment and fine.
CUBTQM£R'S COPY: DAMAGE REPORT 30120
NAME }hU DATE
ADDRESS// / FI G'J W✓/ �j1� �f /1P CITY v�� ( •1-/ L.'C<J�(�� ZIPOME BUS
YEAR q& MAKE�Ii(�✓s4U'%( MODEL 5166 • P ONE - PHONE
INS. APPRAISER'S CLAIM
CO. APPRAISER PHONE' t NO.
/ �e�P�ePP�ePG� DESCRIPTION OF DAMAGE
1 I
2
3 ///`t L A 0 Ile i /'7'rC G^TCA 7 S-/ -
4
o
6
8
9
10
11
12
13
14
15 i
16 - -
17
18
19
20
21
22
23
24
25
26
27
28
29 TOTALS
REMARKS: 120 PARTS PRICE $
102 BODY LABOR HRS. @ $ $
I
104 FRAME LABOR 11 HRS. @ $ $
LCO�OLLISION
103 PAINT LABOR �� !�+ HRS. @$� $For people who care
101 MECH. LABOR HHS. @$ $
KS175 SUPPLIES CENTER Division of _
Woods auto Body,Inc. 130 SUBLET $
i
1414 Pine St. • Walnut Creek, CA 94596 • (415) 935-4041
1104 Main St. • Redwood City, CA 94063 • (415) 365-3206 134 TOWING $
360 Convention • Redwood City, CA 94063 • (415)367-7084.
8120 Raintree Dr. • Scottsdale, AZ 85260 • (602) 951-/3441/� MISC. $
Our Specially Js Safi.41ied (.udfomer3 85o rnx • / $
Complete Auto Reconstruction _ a NO. 15496
Broadway Auto Body Inc.
i
- ESTIMATE
2143 N. Bcardway •Walnut Creek, CA 94596 � OF
4
— WALK TO BART— (415) 944-1027 REPAIR
OWNER PHONE DATE
ADDRESS CLAIM NO.
MA E&R BO V MODEL LICENSE NO. MILEAGE
Symbol FRONT Labor Hrs. Parts Symbol LEFT Labor His. Parts Symbol RIGHT Labor Hrs. Parts
Bumper(U)Ex-New Fender Fender
U Isolator Fender Ext. Fender Ext
Bumper Brkt. R. L. Fender Apron Fender Apron
Bumper Gd. R. L. Fender Midg.W./O. Fender Midg. W./O.
Reinforcement Fender Mldg. Side Fender Midg.Side
Gravel Deflector Fender Marker Lite Fender Marker Lite
Frt. System Headlamp Assy Headlamp Ass
Frame Set up Headlamp Door Headlamp Door
Frame Sealed Beam In-Out Sealed Beam In-Out
Cross Member Cowl-Screen Cowl-Screen
Spindle R. L. Front Door Front Door
Upper Cont.Arm Door R•Panel Door R-Panel
Lr. Cont. Arm R. L. Door Key Lock Door Key Lock
Shock Door Glass T-CL Door Glass T-CIL
Park Lite R. L. Door Mldg. Door Mcq.
Grille Brace Door Handle In-Out Door Handle In-Out
Grille Shell Center Post Center Post
Header Panel Rear Door Rear Door
Hood Door Door
Hood Mld Door Class T-Cl. Door Glass T-CI.
Hood Lock Door Mldg. &Jamb Door Mld . &Jamb
Hood Hinge Rocker Panel Rocker Panel �•
Hood Ornament Rocker Mldg. Rocker Mdq.
Radiator Wheel House Wheel House
Rad. Sup. Quarter Panel Quarter Panel
Rad. Shroud Quar. Ext. Quar. Ext
Coolant Quar. Modgs. Side Quar. Modgs. Side
Rad. Hose Quar. Marker Lite Quar. Marker Lite
Fan Blade Quar. Modgs.W/O Quar. Mld s.W/O -
Clutch Fan REAR
Water Pump-Pulley Bumper Ex.-New
Air Cond. Core Isolator
Dehydrater Reinforcement
Recharge A/C Bumper Brkt. L. R.
Freon Gravel Shield
Washer Bottle Lower panel
Top Floor Pan
Tire %Worn I L Trunk Lid Paint&Material
Windshield Trunk Hinge Block&Prep
Battery Trunk Lid W/S Strip Clear Coat
Antenna Trunk Lid-Name Gravel Guard
Mirror-Remote Trunk Mldgs. Color Match
Tail Light Assy Blend
Tail Light Bezel Under Seal
License Lite Stripe
Back Up Light Waste Disposal
Frame L. R.
Frame X-Member TOW & STORAGE $
Gas Tank-Filler Labor Hourh-( v ry $ 1 e:rn
Wheel Cover Parts & _--`
Wheel-13-14-15 Mat'l. Less Disc. $ 0 c rc)
Tail Gate
Sublet & Net Items $
Sales Tax $ 7 d
Agreed With TOTAL $ 176
A—Align N—New S-Straighten or Repair Ex—Exchange PAYMENT DUE ON COMPLETION OF JOB
Items not covered by estimate or hidden will be additional. ESTIMATE VOIDED AFTER 60 DAYS INSURANCE COPY
PARTS PRICES SUBJECT TO CHANGE