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MINUTES - 03261991 - 1.12
CLAIM �•j 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 MARCH 26, 1991 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: $1,975 .67 Section 913 and 915.4. Please note all "WarningPECAVED CLAIMANT: CAMP, Sherman A. MAR 1001 51 Lusherm Court ATTORNEY: Walnut Creek, CA 94596 OUNTY CAUNSUL MARTINF?. CALIF, Date received ADDRESS: BY DELIVERY TO CLERK ON February 28 , 1991 (hand e ivere ) BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. March 4 1991 PpHHIL BATCHELOR, Clerk I DATED: BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors 1 ) 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: ql BY 1 i �• 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. Dated:—MAR 2 6 1991 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code recti 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: ?j- q - f BY: PHIL BATCHELOR b Deputy Clerk CC: County Counsel County Administrator :_.,. RECEIVED Fa 2 s 1991 In The Matter of the Claim of CLERK 80ARD OF SUPERVISORS Sherman A. Camp, Claimant CLAIM FOR D ON COSTA CO. TO PROPERTY VS. Contra Costa County, et.al. 1 . Sherman A. Camp hereby presents this claim to the Contra Costa County Board of Supervisors, pursuant to Section 910 of the California Government Code. 2. The name and mailing address of claimant: Sherman A. Camp 51 Lusherm Court Walnut Creek, CA 94596 3 . The mailing address to which all correspondence and notices affecting this claim should be sent to: Sherman A. Camp 51 Lusherm Court Walnut Creek, CA 94596 4 . On September 11, 1990, at approximately 9: 45 p.m. , I was driving my pickup truck westbound on Mayhew Way, toward Buskirk Avenue. An approaching vehicle, headed eastbound on Mayhew Way, had its high beam headlamps on. The glare from these headlamps temporarily obscured my vision, and I turned my wheel slightly to the right to avoid a possible collision with the approaching vehicle. As I moved toward the right, my pickup truck struck a metal guardrail set diagonally along and adjacent to the shoulder of the pavement. I have attached three photographs of the. guardrail, indicating its dangerous proximity to the road -surface. Mr. Martin Wallen, a traffic engineer consultant and former City Traffic Engineer for the cities of. Richmond and. Long Beach, California, has inspected the scene of the accident. in his professional opinion, the location of this guardrail created an unreasonably dangerous condition for westbound traffic on Mayhew Way. I 've attached a copy of Mr. Wallen' s letter dated December 14, 1990, including his qualifications, to support this claim. 5 . As a result of this accident, I have incurred costs to repair my truck, in the sum of $1,325.67 , plus $650. 00 worth of my time ( 90 hours) to complete those repairs. 1 6. The public employees principally responsible for my damages are unknown at this time. Dated• c SH RMAN A. CAMP 51 Lusherm Court Walnut Creek, CA 94596 2 ` t �a. . -' 4 Tz C 1 tom'���..,,,.. •.. t ✓✓:,..-- ,.,.... ✓ � i-s",../^v` -ti. LL '"'4!S'',.;;�+fir' F{��f:.3�• ifff t� r otp•` k' �; .. .., ,. r P+, 4177 r 5 ! t 4 ` Fag ut 4 •- C A V\AWALLEN ASSOCIATES/Transportation Consultants 5820 Wilshire Blvd., Suite 304 Tel (213) 937-2768 Los Angeles, CA 90036 Fax (213) 937-0124 December 14, 1990 Mr. Sherman Camp 51 Lusherm Court Walnut Creek, CA 94596 Re: Bingle Vehicle Accident - Mayhew Way, Pleasant Hill CA September 11, 1990 9:45 pm Dear Mr. Camp: This letter report is in response to your request that I inspect the highway in the vicinity of your accident that occurred during the evening of September 11, 1990 at approximately 9:45 pm. The reason for the request is your belief that the condition of the roadway in the vicinity of your accident contributed to or was the primary cause of the accident. The enclosed current resume of my education and experience describes over 40 years practice as a traffic engineer including 15 years as the City Traffic Engineer for Richmond and Long Beach California. I have also been retained as a consultant in over 350 tort liability cases relating to highways for both defendants and plaintiff. I have testified as an expert witness in regard to.the adequacy of highway design, operation and maintenance in .municipal, superior and federal courts in California. On the afternoon of November 3 , 1990 I visited Mayhew Way between Este Way and Buskirk Avenue. It is my understanding that your route of travel was from your home at 51 Lusherm Court northerly to westbound on Mayhew Way. At the time your vehicle struck the guardrail an auto was traveling easterly, toward you along. the center of the roadway. To avoid ahead oncollision you attempted to keep as far to the right as possible. I note from published street maps that a section of Mayhew Way between Este Way and Buskirk Avenue may be in the City of Concord. I believe that you have no more than six months to file an action against a government agency. I suggest that if you desire to pursue this matter that you ascertain which city has jurisdiction of Mayhew Way, specifically at the location of the guard rail in the roadway that was struck by your vehicle. I took a total of 35 photographs during the course of my site investigation on November 3 , 1990. The first 32 were on Mayhew Way and those marked 33, 34 and 35 were taken on Hookston Way east of Buskirk Avenue. The purpose "of the latter three photographs was to record another situation wherein guardrail was utilized to distinguish between the improved and unimproved portion of a roadway. Mr. Sherman Camp Mayhew way December 14 , 1990 Page 2 Photograph A-1 was taken from the passenger seat of an automobile westbound on Mayhew Way. The westbound section of roadway in the foreground is fully improved. This includes curb, gutter and sidewalk, parking section and traveled lane. Photo A- 2 was taken facing westerly from approximately 200 feet before the guardrail projecting into the roadway. Photo A-3 is a closer view of the guardrail. Note the almost entire obliteration of the 35 MPH sign by foliage from the perspective of an approaching driver. Photo A-21 taken from the gutter more clearly indicates the 35 MPH sign. Photos A-4 through A-10 show that the reason for the guardrail was to keep a motorist from traveling on the unimproved northerly portion of the roadway. Photos A-4 & 5 show a 5" drop- off between the surface of the asphalt roadway and the unimproved section of roadway. Any driver attempting to utilize this the unimproved roadway with a drop-off of such magnitude is in danger of loosing control of the vehicle and possible turning over. Photos A-11 through A-14 show the east bound roadway, that used by a vehicle traveling in the direction ,toward you at the time that your vehicle traveling westerly struck the guardrail . Photo A-14 shows that the due to vegetation and incomplete paving Qn' the south side of Mayhew Way the maximum width of the easterly roadway is 12 feet. Any vehicle attempting to shy away from the shrubbery along the south side of the roadway would travel close to, if not encroach upon the painted centerline. Photos A-15, 16 and 17 show the west bound roadway. The distance from the centerline to the drop-off is 14 '-4" as shown in Photo A-15. Photos A-18, 19, 20 and 21 show the guardrail and approaching roadway. Photos A-19 and 20 show that prior to the overlay along the center section of Mayhew Court there had been a white diagonal line for the purpose of directing traffic away form the guardrail. The white diagonal has not been repainted since the installation of the asphalt overlay. These photos also show a complete lack of any day or nighttime delineation of the guardrail. As a minimum delineators on flexible post should have been installed by the appropriate government agency along the location of the white painted line on the approach to the guardrail. Photo A-22 shows the roadway west of the guardrail. A-23 shows that the end of the guardrail is about 18 feet from the centerline of the roadway or 3 '-6" north ,of the beginning of the 5" drop-off. WALLEN ASSOCIATES f Mr. Sherman Camp Mayhew Way December 14 , 1990 Page 3 Photo A-25 clearly shows the dangerous condition due to the incomplete roadway and resulting pavement drop-off with inadequate advance warning especially for night time conditions. Photos 26, 27 and 28 show the very poor condition of the 3" white edge line. The paint has been largely obliterated and has NO reflectivity. As a minimum the edgeline leading to the guardrail should have been repainted on a regular basis, maintaining adequate nighttime visibility. The probably reason for this dangerous condition is that the local agency did not want to use government funds for completion of the road improvements. The city was waiting for an occasion to compel the adjacent property owner to complete the curb, gutter, sidewalk and paved parking area. It is appropriate for local government to attempt to achieve property owner participation in minor residential street improvements. It is NOT appropriate to leave the street in the condition that has been allowed to develop at Mayhew Way at the location where you struck the guardrail. Based on my experience and investigation of this incident I •would be most happy to support any claim for damages that you would file against the local agency(s) due to your accident of September 11, 1990. Please let me know if I can be of further service. Ver , ruly your j Mar rtin a en, P.E. ` Enclosure. WALLEN ASSOCIATES \AA \ 411LE 2'`,`-DC!=TSS/T(cnsporfotlon onsu'aon s 5820 VA/ilshi;e Blvd., Suite 304 Tel (213) 937-2768 I.os Angeles, CA 90036 Fox (213) 937-0124 MARTIN WALLEN,P.E. PROFESSIONAL QUALIFICATIONS EDUCATION: B.S.,Civil Engineering,University of California Certificate in Highway Traffic,Yale University Registered Civil Engineer and Traffic Engineer-California EXPERIENCE HIGHLIGHTS: Wallen Associates, 1973- Principal VTN Consolidated,Inc.,1971-1973 Project Manager Long Beach,California, 1969-1971 City Traffic Engineer Daniel, Mann,Johnson and Mendenhall, 1965-1969 Senior Transportation Engineer Richmond, California, 1952-1965 • City Traffic Engineer City of]Los Angeles, 1951-1952 Associate Traffic Engineer Yale University,1948-1949 Research Assistant, Bureau of Highway Traffic DeLeuw,Cather& Company,San Francisco,CA,1947-1948 - Traffic Engineer FIELDS OF SPECIAL COMPETENCE: - Assessment of the Impact of Transportation Concepts,Measures and Facilities - Street and Highway Planning,Location and Design - Transit Planning and Operations - Facility Planning and Design - Municipal Traffic Engineering, Street Lighting and Off-Street Parking - Energy-Efticient Urban Transportation Planning - Expert Witness, Highway Design and Operation v� MARTIN WALLEN, P.E. 2 of 4 MAJOR PROJECTS• Investigated the feasibility of grade separations within the Port of Long Beach in response to the use of unit trains for the export of grain and coal. Recommended that any changes in Port transportation be part of a regional transportation improvement program. Directed study of highway service to the Ports of Long Beach and Los Angeles and to naval. facilities on Terminal Island. Concluded that improvements to existing highway network would provide greater benefit than limited northerly extension of Route 47 (Terminal Island) freeway. Conceived of highway improvement program adopted by Southern California Association of Governments which resulted in 58 million dollars funding in the 1982 Surface Transportation Act. Prepared traffic engineering section of Draft EIR for proposed Intermodal Container Transfer Facility (ICTF) to serve Ports of Long Beach and Los Angeles. Helped develop and evaluate traffic control program, as consultant to Neighborhood Traffic Committee of City of Pasadena, to restrict traffic growth in single-family area adjacent to Downtown Pasadena. For EIR prepared program of alternative employee transportation--shared ride auto, taxi, vanpool etc--for California Department of General Services office building project in Van Nuys, California. Helped prepare application for a demonstration employee travel program in the Van Nuys, California government administrative center, as consultant to the Office of Service and Methods Demonstration of the Urban Mass 'Transportation Administration, U.S. Department of Transportation. Program sought to determine the extent of change in mode of employee travel to work in response to ridesharing subsidies and imposition of charges for parking of single-occupant autos. Developed concept of Active Employee Transportation Program to reduce employee traffic and parking requirements for 800,000 square foot State of California office building project in Downtown Los Angeles. Determined that least total cost is to fund part of employee ridesharing and transit rather than provide .parking to accommodate employee demand. Performed EIR required parking and traffic studies, for General Services Administration and California Department of General Services, for proposed new office buildings in Los Angeles Civic Center. Provided data and analysis, including technical, cost and management requirements as well as a rationale, to Northrop Corporation for participation in Department of Energy electric vehicle fleet demonstration program. Proposal resulted in Northrop receiving DOE grant for purchase of electric vehicles. Subsequently prepared electric vehicle acquisition program. Prepared application for funding of battery-powered downtown transit shuttle system for Santa Barbara Metropolitan Transit District. Analyzed alternate sources of power, techniques to extend battery range, and provisions to permit incremental technological improvements. Provided traffic input to EIR for proposed 3,490-uniti, housing development in Thousand Oaks, California. Work included recommendation that City pursue Transportation Systems Management programs that Would reduce peak hour traffic generation. WALLED! ASSOCIATES MARTIN WALLEN, P.E. 3 of 4 Assisted Northrop Corporation in the traffic and parking aspects of the conversion of the former Ford Motor Company facility in Pico Rivera, California to production of the B-2, stealth bomber. Designed rail, truck, auto and parking elements of conversion plan, for Northrop Corporation, of 73-acre/1.9 million square foot former B-1 bomber facility in E1 Segundo. Also completed traffic studies to improve efficiency and safety of vehicle and pedestrian movement at Northrop facilities in Hawthorne, California. Transportation consultant to 850-acre Santa Barbara Central City Redevelopment project. Included location and design of combined freeway and railroad corridor (U.S. 101) , multimodal regional transportation center, and at grade people mover demonstration project to reduce parking requirements and auto traffic. Developed "minimum" freeway alternates for proposed U.S. 101 freeway in Santa Barbara. Prepared application_for bicycle paratransit demonstration project awarded by Office of Service and Methods Demonstrations of Urban Mass Transportation Administration to the Santa Barbara Metropolitan Transit District. Transportation consultant to Redevelopment Agency, City of Los Angeles, from 1967 to 1976, for numerous projects including concept of Downtown People Mover to intercept regional transit, analysis of peripheral parking, and analysis of traffic and bus transit element of DPM program. Prepared study design in 1973 for downtown fixed guideway people mover system as part of City of San Diego comprehensive center city redevelopment plan. Concluded that people mover system was not justified in downtown San Diego. Planned all aspects of ground transportation for proposed new international airport in Bangkok, Thailand. Action Plan (PPM 90-4) for State of Montana Department of Highways. Outlined process for inclusion of economic, social and environmental considerations and for public involvement in the planning, design and construction of transportation projects. TOPICS (Traffic Operations Program to Increase Capacity and Safety) studies for Orange County, Newport Beach and Westminster, California. Project manager of studies regarding municipal acquisition and expansion of transit system in Portland, Oregon. Work resulted in establishment of Tri-County Metropolitan Transportation District. Outlined traffic and transit requirements for new 12,000-room hotel resort community of Wailea, Hawaii, and for either expansion or creation of new resorts at Big Sky, Montana; Stratton Mountain, Vermont; Sun Valley, Idaho; and Snowmass, Colorado. Project manager of study for U.S. Navy of Comparative Feasibility and Cost Analysis of Vehicular Crossing to Ford Island. Report included preliminary design, cost, and benefit analysis of six types of crossings in Pearl Harbor, Hawaii. Analyzed rubber tire-track friction characteristics, as element of Baltimore Regional. Rapid Transit System evaluation of transportation equipment technology. WALLEN ASSOCIATES MARTIN WALLEN, P.E. 4 of 4 Developed rational procedure in Contra Costa County, California, for joint county-city funding of highway capital improvements. Involved in planning of San Francisco Bay Area Rapid Transit District (BART) through membership in Technical Advisory Committe and studies relating to route and station location in Richmond, California. Wrote position papers leading to Western Contra Costa County rejoining Alameda-Contra Costa Transit District. Published research which showed relationship between frequency of police traffic citations and traffic engineering deficiencies. Transportation consultant to the Puerto Rico Planning Board, 1961-62. Chairman, California Department of Transportation Advisory Committe (DTAC) , 1980 and 1981. Invited as participant to International Forum for Traffic Safety, Rio de Janeiro, Brazil, June 1988, Chamber 9. Presented paper "A Problem of Legislation and Administration." Consultant - expert witness in over 350 tort liabililty cases regarding highway design, construction, operation and maintenance. PUBLICATIONS• Copies of those on file available upon request. PROFESSIONAL ORGANIZATIONS: Institute of Transportation Engineers Impacts and Responses of the Energy Crisis on Transportation and Traffic (Chairman) Urban Traffic Engineering Performance Evaluation (Chairman) Field Evaluation of Urban Traffic Service Alteration of Minor Traffic Flows Through Control Measures Criteria for Recommendations of Mass Transportation Improvements Traffic Considerations in Subdivision Planning and Layout Task Force on Tort Liabililty Case Feedback to Operating Agencies CURRENT MEMBERSHIPS: - - Safety Coordinating Committee - Expert Witness Council - ITE Reviewers - Uniform Traffic Control Devices Transportation Research Board Committee on Tort Liability and Risk Management, A4002 Transportation Research Forum American Society of Civil Engineers Urban Transportation Safety Committee Association for Commuter Transportation Lambda Alpha International (Honorary land economics society) ;`SS00;-,"-JES 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,, MARCH 26, 19.9:1 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 Governfffik€VVE® Amount: $550-00 Section 913'and 915.4. Please note all "Warnings". CLAIMANT: EVANS, Marguerite for JesseE Evans 4" FEB 26 1991 117 W. Ruby Street '` COUNTY COUNSEL ATTORNEY: Richmond, CA 94801 MARTINEZ, CALIF. Date received ADDRESS: BY DELIVERY TO CLERK ON February .22, 1991 (hand del.iv. ) BY MAIL 'POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. February 26 1991 PpHHIL BATCHELOR, Cher DATED: Y BY: Deputy II. 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: BY: / 1 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. n Dated: MAR 2 6 1991 PHIL BATCHELOR,'Clerk, By Deputy Clerk WARNING (Gov. code sec 13) 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: 3-0-5 — f BY: PHIL BATCHELOR b Deputy Clerk CC: County Counsel County Administrator Clair. to: BOARD OF SUPERVISORS OF CONTRA COSTA CX7=_ INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to perscm 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 5911.2.) 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 Sac. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's filing stamp t El p Agai-nst the County of Contra Costa �) "" 2 2 or ) CLERK BOARD OF SUPERVISORS District) CONTRA COSTA CO. Fill in name ) The undersigned claimant hereby makes claim against the County of Contra .Costa or the above-named District in the sum of $ )�Lc),_�o and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury oc ? (Give 1 details; use xtra paper if required) 4 -�� sly �✓�d�u=�--�tl�=- - -- --- --- VWhat par cular act or omission on the part of county or dis ct officers, servants or employees caused the injury or damage? _.._._. . M_.a ^_.. . . _ .. .. .. (over) . 5. What are the.na-ries of coL:.nty or district officers, servants or employees causing the damage or injury? 5. What damage or injurie do you laim resulted. (Give full extent of injuries or damages claimedV-O- Attach two estimates for auto damage. --- ---- ---------------------------------------------------- 7. How was the amount c med above computed? (Include the estimated amount of any prospective injury or damage.) W _ .- '� _ --- -- --- - -�------ --- 8. )4 Nam and addresses of witnesses, doctor and hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT -e P? A, �* Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES-TO -- (Attorrieyl)s x or by some person,on his behalf." Name and Addressof Attorhey " Claimant's Signature 7 U)c ' Addres ga 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, 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. ra . •::J r2 111 4 r Y U r j Q0.to V a eL m ^. ul Y. Vy� '! �L 01 �a � 63 (p V CU �. .• � 1V1 . ©10 0 n7 30 ' 000 o �� N Vo ! r N OC 41P 'D W i► W o � N r 4 a z N wp oO.m fd � Ka.' �Zv'e.s �..r' �3�Ovs ra- >;cw�°�' .• A a. Z �� try,042 LO O N ruUS 6 O a xppU J I p.pa; lam Z o n� . Z .�, y,�.e '-J_�/t- - -- ------ ---- '---T —- _ - ------ �-/----f�—----- - / `, ' �., --�� - --- --- —-- --- --- ------- -----tet �-, ------- 1 A, ,. � ! -� qo����� CLAIM 1 Z !� BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA i Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT MARCH 26 1991 and Board Action. All Section references are to ) The copy of this document mailed to you is your no?ice of California Government Codes. ) the action taken on your claim by the Board oj,,�ysors (Paragraph IV below), given pursuant to Government Code Amount: $S24, 177 .06 Section 913 and 915.4. Please note all 'pld Is". CLAIMANT: RAILEY, Kevin E. cou" 9@0§4 MARTINET, CALIF, ATTORNEY: Randal M. Barnum Bowl s & Verna Date received ADDRESS: 2121 N . California Blvd. BY DELIVERY TO CLERK ON February 28 , 1991 Suite 875 Cert . P367 847 bbi Walnut Creek, CA 94596 BY MAIL POSTMARKED: February 27, 1991 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: March 42 1991 gyiL BAATputyLOR, Clerk II. FROM: County C6unsel 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: 3 1 C 91 BY: 1 � 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. Dated: MAR P. 6 1991 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code sect 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: BY: PHIL BATCHELOR b Deputy Clerk CC: County Counsel County Administrator LAW OFFICES OF RICHARD T. BOWLES MICHAEL P. VERNA BOWLES & VERNA RECEIVE® ROBRANDAL MILBARNUM CALIFORNIA'PLAZA ROBERT I. WESTERFIELD 2121 NORTH CALIFORNIA BLVD. RICHARD A. ERGO SUITE 875 F�IJ p 991 WALNUT CREEK, CA 94596 FEB U ! JEFFREY E SALISBURY (415) 935-3300 CONSTANCE D S. NELSON K.P. DEAN HARPER JUDY A. BACZYNSKI FAX NO. (415) 935.0371 CLERK BOARD OF SUPER V THOMAS G.F. DEL BECCARO C( �TPA COSTA CO ROBERT R. POHLS JEFFREY H. OCHRACH LISA K. TOMES MATTHEW R. URDAN February 27 , 1991 CHRISTIAN J. HOLMAN LISA B. WILLIAMS KENNETH B. MCKENZIE CHARAN M. HIGBEE CRAIG S. NELSON VIA CERTIFIED MAIL SHANNON BALL JONES RETURN RECEIPT REQUESTED LAURA M. SAGMEISTER Clerk of the Board of Supervisors County Administration Building, Room 106 651 Pine Street Martinez, CA 94553 To Whom It May Concern: Pursuant to California Government Code Sections 910 through 911. 2 , enclosed please find the claim for personal injury submitted on behalf of: Kevin E. Railey. Mr. Railey was seriously injured on November 8, 1990, while performing construction work which subjected Mr. Railey to a peculiar risk of harm. Mr. Railey's damages consist of past and future medical expenses, past and future lost earnings, permanent disability and pain and suffering, which damages total approximately $524, 177. 06 to date. Should you have any questions or comments regarding the foregoing, or the information included in the enclosed claim form, please do not hesitate to contact me. We look forward to your prompt response to this claim. ry truly yours, Ra dal M. Barnum RMB:sav encl. cc: Kevin Railey 878000L.CLK 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 9+553• 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 Kevin E. Railey RECEIVED } Against the County of Contra Costa )_¢ FEB 2 8 1991 or ) District) CLERK BOARD OF SUPERVISORS Fill in name ) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 5 2 4 . 17 7. 0 6 and in support of this claim represents as follows: -------------------------------------------------------------------------------------- 1. When did the damage or injury occur? (Give exact date and hour) November 8 , 1990 at approximately 10: 00 a.m. ------------------------------------------------------------------------------------- 2. Where did the damage or injury occur? I(Include city and county) Intersection of "G" Street and Fitzuren Road, Antioch, Contra Costa County ------------------------------------------------------------------------------------- 3. How did the damage or injury occur? (Give full details; use extra paper if required) See Attachement "A" ------------------------------------------------------------------------------------- 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage> Failure to provide safe guidelines for, provide safe work conditions to, � and/or adequately supervise independent contractor and/or its employees in a situation creating a peculiar risk of harm. (over) 5, - -What are the names of county or district officers, servants or employees causing the damage or :injury? Informed and believed to be the County of Contra Costa ------------------------------------------------------------------------------------ 5. What damage or injuries do you claim resulted? (Give full extent of injuries or .damages claimed. Attach two estimates for auto-:damage. Severe lacerations to ligaments . of left thumb causing .extensive nerve damage and loss of flexibility, resulting in permanent disability 7. ,.How was the amount. claimed above computed? (Include the estimated amount..of any prospective injury or damage.) '.,See.:Attack,i.hent:;_ "B" 8. Names and addresses of witnesses, doctors and' hospitals. . See Attachment "C" 9. List the expenditures you made on account of this accident or injury: <_DATE ITEM AMOUNT See Attachment "B" Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some pggson on his behalf." Name and Address of Attorney Randal M. Barnum (_�Lcocx_�, Bowles & Verna )_ Claimant's Signature 2121 N. California Blvd. , #875 2118 Chickie St. Walnut Creek, CA 94596 Address Antioch, CA 94509 Telephone No. ( 4150935-3300 Telephone No. ( 415) 754-7312 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. G ATTACHMENT "A" Claimant was employed by William McCullough Company who had contracted with either the City of Antioch, County of Contra Costa or State of California to perform certain work on the site. . Claimant's :Left thumb was severely injured when his hand was smashed while claimant was laying underground storm drain. 3 ATTACHMENT "B" SPECIAL DAMAGES 1. Medical Expenses: through February 15, 1991 a. Delta Memorial Hospital - $ 8, 358 . 01 b. James A. Basile, M.D. - $ 2 , 516. 00 C. Sport Health - 1--L,_985.45 total $12,859. 46 2 . Loss of Earnings: through February 15, 1991 808.40/week = $11, 317.60 Future medical expenses, loss of earnings, and other special damages to be determined. GENERAL DAMAGES Pain, suffering, emotional distress and permanent disabilities - $500, 000 TOTAL: $524 , 177. 06 e ATTACHMENT "C" 1. Witnesses: Israel Martinez (address unknown) Ted Rose (address unknown) 2 . Doctors, Hospitals, Treatment Centers: - a. Delta Memorial Hospital 8901 Lone Tree Way Antioch, CA 94509 (415) 779-7200 b. James A. Basile, M.D. 3903 Lone Tree Way, Ste. 210 Antioch, CA 94509 (415) 778-2600 C. Sport Health 2150 N. Broadway Walnut Creek, CA 94596 (415) 945-7309 � GNr f oo- O xmx"^oA „ � s O tom' *d 0 O NN � �' p 3+ Q @ V,Vv O Q Q ' ct Ul 10 CD yr Y' n 6ti fig ,��' •� LSI 01,�.. ai Ln Ka' # A A !A R *A AMENDED CLAIM �• �Z f 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 MARCH 26, 1991 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: Unknown Section 913 and 915.4. Please note all "Warnings". CLAIMANT: ALLEN, Andrea Wilson and David Allen ATTORNEY: E. Gordon Wells Jr. � Wells, Call, Clark & Bennett Date received ADDRESS: 1710 Pennsylvania Ave. , 'Ste. C BY DELIVERY TO CLERK ON March 11, 1991 . (hand delivered) Fairfield, CA 94553 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. March 18, 1991 PPHHIL BATCHELOR, Clerk DATED: BY: Deputy II, FROM: County C unsel TO: Clerk of the Board of Su visors ThisAcl m 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: �j ( �-5 /91 BY: Deputy County Counsel TJ_ 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 (1�) 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: A R 2 fi 1991 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code sec 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: BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator -CART, ,IV' 'u-PER RS C�" :.:: ii LMi.S.lri `_::{1111% 'dSCIC.'IONS. "L' ( L.12!4Nr CiaiuS, re azLlrig :.auses of` act'on`. for de=ath_or for -Ln�ui y Go person. or" 50na_ prODE"` y or ---owing.,.--3AS: and; wtiq_t ac=,ie on or before Decemb; 31, . 987', must- be presented, not later. than she. 100th' day ar"ter the, acorila 1: of, t,'1emouse of. action. Claims rel:ating to causes= of action for death.:or for injury to pe—mon. or to personal:'property,or, growing crops and w#ic�i accrue on or after Januarys, 1988,, must-. be presented: note materthat six months after, the accrual of the,.cause" of action. Claims': relating, to any other cause-of.action..mustbe presented.not later than. one. after the• accrual-.. of" the cause of action. (Govt..: Cede .§9ll..2. ) 3. Claims: must. be filed with. the Cleric. of" the Board" of Supervisors' at its; office in. Rccxa .106,, County. Administration" Buildins3, 651 PiZ�e.. Street, Martinez, CA 94551. C'. T= c?aim, against. district governed. by the Scald of. Supez-visor"s, rather 'Ltan the .County,:, the name 'of the District should,.be rilll ed:.gin. D, t'L e claim is. against,,, than, one..public' entity,,-separate claims:, mist be Filed against each-public entity. E.:_ Fraud— Seg:: e � for zra�dailent.`claims, :?enaL.Code...Sec:. 1Z;.at-=the.:.end'. of this form. AMENDED RE: Claim By, ._ ) A✓ ed:, f C crit's f'i std " ) ANDREA. .hT.I1sC'N' 121LEN 'and ) FECEIVED DAVID' ALLEN"Against` the County-,of.;Contzrra.Costa.-or _ ��ya mAMEZ. CEREJO and CONTRA COSTA : . OF SUPERVISORS -CDUNT�' !District) CONTRA COSTA 00. Eilh:. in. name-),. ) Thee undersigrie3. claimant hereby,.makes- claim. against-, the..County,of_ Contra. Costa.or the above-named; District, in the suet of $- over- $10,000 and..,in,support of- this: claim "r^ep:resents"as follows - Jurisdiction. is proper, -=or Superior Court L. When. did the: damage-: or- injury occur.? (Give. exact- date;' and' hour-); ; Sez�tember::`3 , 1990,' . at. 9 :02 _ 2: inhere did..,the damage or injury, occur.? (include city and county) riexcules Oi:`.-damp ,` near Interstate 80 County of Contra Costa 3. How did' the damage.' or injury occur? - (Give. fu I details;: :use: extra.;paper ;f required} Claimant -was--exiting: I:-80 at..' she. Hercuvles:� off.-ramp.. Claimant was stopo_ ed in. traffic when. she was, rear-ended. by ,a County of Contra_ Costa pick-i7n �rsck 4. What, particular. act or omission, on' part, of county or dist:ict. officers servants., or".ewloyees caused_:the injury or damage? Driver. of: County _-vehicle, was zot� �ayinc. attent.i:c .to: the stooped tra�_i c, ahead ah&�,'waas..travelling goo. cloae and too." _as`. =or Gond ti oris N�i^L are �:1'e =�eS �_ �OL'�'v J _S� :" Of c:C�*'S: S2r Vai]CS Oi"' ter:.- l OV2�S :S.-_-6 tne, aam=ge or _n.lur7 ?. =_`1: L Lt'?rj :Q a3?C DOES 1- '.O 5. What damage or injuries. do you- claim; esulted?. (Give full- extentof injuries or damages- claimed. Attach. two estimates, for auto damage;. Total .Damages : $20-, 000 Neck, 1llaau7ocleueYeteesaaeano el bnPS�_ ntosiaswe . sper andowrftrmi . Damgs 1 _l 7. How was. the amount claimed- above computed? (Include the .est,imated amount of any Drospective injury or damage.) Kiser (emergency) -- $185;. miser (1/7/91) - $100- (aDprox.) ; Daniel Powers, M.D. - .S1,155; William Schlee, D.C. - i,368; Travel to treatment to Kaiser - $5.30; Travel to treatn -r t to William Sci lee, D.C. - $165; Damage to automobile S900; izss of. earnings - $4,0677 .20; General. Damages --.$12.,054.30 �. Names and addresses% of witnesses, doctors and hospitals. Amel_ Cerejo , David Alien, Andrea Wilson .Allen.,; doctors,. at Kaiser . Hosaital, David Norman, M.D :,, William Schlee, D.C. 9 List the expenditures- you. made on account of this accident or injury: l perr . Ka ±iss Permanente AMOUNT -4..-00, (.approx. ) 9/5/90 Kaiser. Permanente ER S ?> Q,� �,. �: $175.50 1.0/29/90 Daniel Powers, D.. . .� � r� 9-' _ 9/7-10/11/90. M tm,;re3az.� $900.00 William Schlee, D.C. f _ Gov. Code Sed-. j. .._..Y _... f-I d( "The, claim mast,_�be. s� 1ai maat SEND NOTICES TO: (Attorney) or by w. Name- and*-Address- of Attorney �'•�~� E GORDON WELLS , JR. WELLS ,:. .CALL, CLARK &• BENNETT. imant' �t 1710 ..ennsylv�ani-a. Ave, Suite -.0 ANDREA WILSON ALLEN &. DAVID ALLEN Fairfield, CA 9.45533 .-_ __ . _ -�-:201 Pinot dV� Yue . Rodeo, CA Telephone No. (707) 426-5300 Telephone No. (415) 245-0267 N O T I C`E Section 72 of the °enal Code provides.: "Every person who, with intent to- defraud,- oresents. for` allowance or for paymentto any .state beard or officer., or to any county,. city or, district board or off icer, 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 exce-eding ten thousand. dollars ($10,000, or 5y both such imprisonment and fine. C.A FOAN14 PAZZF_NGF_R' - xt3 4 VEHICI_RENTAL AG E'�T nE=341 '=' UA8I1_17-Y INSURANCE Nd ' .�ya� .=1C'L��.STV t .�i•u � •W,4M4�tih"f fes•�1�<C,Y 1. i"' .. ... .�-. . CUSTOMER NAME ` ...�: ter . '� 3' r^''� _ �w.. yq'� - LE NO y T� .c - UCENSE.NO.- '?.p� -+-Sa>'��iw�w�.�y,,,., ,et. 7y�.-1•y.��`�-� /"'+�ro?;„K. fs.`y :�_yyy�,,��y gair •".+•.•.-yea. 1= �'a.Y:+i.•.`Yl..;. a� s-Gk'L}r(Ii....'M '. >if1 N OMEADDRRESS sy+K"�(� �, � i y * t ,M� � � � 4€ r g1Eck RIAEDw yY1ARd+AR.IJNE(iHUC}CSERIES) a - MODEL iNOCOLCR , 4 �y��L'"a"2 a w� ' �:•r i*+�s7^ s ?lis ''.� +w4£F C'� 1'. 1`x - ` h' CI, ,pe-tr+:fiX' ''.x3h.�N: ysem.{=`•.��"�''t'�!` DATE AN'LD.T/IME IN ,SPEEDOMETER 4 - Wj RON- ; wa ..- DATE AND TIME OUT., DHEA S GI ENSE tWA; :SPEEDOMETER v +a . +� ffENOW ';�.a"-± ,'`- `S.`7YC' .}'e+'. 0 ..,. _ ?4r1- / `:/.•�PM. P PC- B RRTH DATE' SOCIAL SECURITY NOS HOME f PkON '4VEgIFlEDa� MINS DRIVEN MAX.PAYLOAD*-'-- ' x ►'F > .. OA I c DUE LDCAL CONTACT� x - a .r ADDRESS s s "'MILES EXPIRATION OF CONTRACT 15 ALLOWED :t 1 1 f� �•.. Ah POSn10N :tyERIF7ED C4AAGEABLE fax DP` .cam MILES �Za 7R[3Vl'ALRATES'DO NOTINCLUDE FUEL= E.1vIPCOYE3i'SDAESS" RK-� K05 NOW - �:• - Z 1 xk?rM - r HQUAS= S L " -PEA HOUR 'CIT " '°!E STATE Z1P REFERRED:BY� "a •*' 4' DAYS 5 $ Y ' w W. $-:�:...::.aa>r ��'i-•''' ONLY•rTH&.13EL'OW=NAMED.PERSON S:ARE AUTHORIZED:AS + EU ADDITIONALTDRIVERS IF NONE PRINT NONE ACRROSSs iS:' c' MONTHS®S SECTION AND HAVE SIGNED CUSTOMER - _ BY '`3- r.,..''t ,k�tt-r.,..'a?a .�>x, �c ..., '..a. tl. a+�x�. ''�"f0U-r• IN--ti .. MILES = /) a PER MILE $ E'` E y --c�+�. .. tiw� ri^u .�,� NAME y��v-..pi`s' ':i. +i7'��. ��-'��.,,.�" ..,,i�,�-t�_ `1�.�,�+A..�> ,-`•�.;�' :. .<.:':, -,. `t -Y7 _ DRIVERS UCENSE► .f - •a`�"' . ky :;� TAL.MILEAGE AND RENTAL CHARGES Me S '" �,• FLIELOALS'05 z" 'r _ $ A^ syy�• -z. ••-•-,. - x.�i�'_"�"�""F'v ,�- ;c- •-.vc.:.--y ='_ s.-.: z : SLIB TOTAL -1`o.t' S �c •> a 9DR1V9ERSMUCENSC#:!-—-' - "' -` COMP_REHENSIVEICOLLISION DAMAGF,,WQ1( lClGD1l1� _ .CA M"Is, T;INSURAN . "_ _RATES . y..�• PEFi'OAY 1� ERlIEEK. ^ :: Su6.TOTAL A - BY.,INITIZN&,1CUSTOMEA ACCEPTS O�Et��1NES COMPREHEN; t t t� SALES TAX t - SIVEICOLLIS►ON'.DAMAGE iV�(AIVEA E RATcS;`LISTED ABOVB1� DECLfNEs _ DECLININGSWAIVER;.CUSTOM CCEP..TS FULL'RESPONSIBILLTYFOR SUBTOTAL $ :�_.. .. �=r.... i ALL LOSS/DAMAGE:TO T,ki�REMED"VEHICLJ='UP.TO $ X" -tea r ' PEFF'OCCURRENCE�-- EGARDLESS OF CAUSE:.NOTICE�WAIVER-'DOES: COVEil �csio� .•����� � $ ( �� M� e ,fie LOSS Ori1>DA GE RESULTING FROM ANY VIOLATION O>✓PARAGRAPH 4 A "� ON PAGE�1 OF THIS AGREEMENT:: $ :.. TOTAL CHARGES I ' NOTICEI-0 F CIJSTONIER'S FiNANCfAL RESPONSiB1L1TY AND;, LESS DEPOSIT ,_ $ . �COMPREHENSIVEICOLLISION DAMAGE WAIVER ,.4 i 71 +"�•{r` :yqy'.. - .. .::: ... >ty -n,...y�yira5.->;* ,Y Customer wilLtie.respcndble for 1=u11.Value.of.tfie vehicle (or other- $ (� r r'amount_wrltten above.it-Customer. has::otherwise,.complied'-with-the, CASHAEFUND CUSTOMER ' s r= -aerms=and"provisions.of this Agreement) regardless-of_fault,'includ- �.. WARNING ing ,loss';-.of; USe; towing;-:-storage- and Impound fees:.:even If ` Comprehensive/Collision° Damage.- Waiver, has..'-been:-.--accepted If: °Read carefully ail coridttinns on tha reverse side 'Customer_o,r any Authorized:Driver,violates the terms'of`paragraph ' You'are responsible for alt traffic'.violations, 4 (g) on the reverse side riONL`YMINIMUM:L1A81LITY INSURANCE IS `" PRQVIDED'4S STATED ON THE:REVERSE SIDE MYour own:Insurance may coverall or.part-of.yourfinancial�respond „ N Customer has read`both.sides,of this agreement.and agrees to ty.,for the..vehicle:Customer may wish-to verify-be ore purchasing the terms arid.conditions thereof:, -g, Comprehensive/Collision Damage Walverr '' "' Customer authorizesw.Llcensee-.�to �proc$sa,a.,credttr card SPwE6. 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Z Ili m n �(�!••iill vim:fl > I 0I' I I I v m J V SCD 'cn ca car. cT n .< O N N I w V n. •�. o a cr+ w o 0 0 0 o G o 0 cm C= m --, .S Q- I. - ' . I. CiClol�l�l�1� Cli�l�lr O z a �. ,N I I, I - II I v af�c�O��(+'m>7�nlnlwnl n r L (;'7�',''r I. _ Oj. �►. L I 1 I1 -D. �~n n anis,cai nlmai�Ti' yl m0 �. ^ I � Nj N m<1 DI g tD_1 A >+>_ I^�I I. I i r I �. rn N ml' j_ 1 I j,. I. ( I• I i I ; �-. Ir �. ,j yl..i r. r+. Z .�.: lVi ! I L- I - x ; IUTA+ i I� I -I I I I ❑� I�Cj I-cl d u O I-I C c 10 LO C� CA 1 I I j - f I I I I I I. _ ' t ' �' I 1�. E- �-,--- -- 1--- ---_.1•__ _.,......,.I_.......... - - - _ Vr.:tJc1"':;ENTAL.AGREEMENT F w YA' - t -• - ' MINIMUM'LIABIL)TY INSURANCE :;tw.tli:}Ci�,,, ...rte',l-4zc i'• - r„�.A -� 4.4 CUSTOMER NAME. 1 _ VEHICLE NO— LICENSE.NO L OMEADO9ES,�! �1� VERIFIED' YEAR-CAR CINE(TRUCK SERIES) MODEL AND COLOR y CITY � i STATE-` D E. DATE AND TIME IN I } ? PM C(� SPEEDOMETER DRNER'15.LICENSE NO: STATE ATE r- DATE ANO,TIME OUT �} � p SPEEDOMETER � OUT BIRTH DATE SOCIAL SECURITY NO. HOME?HQNF, VERIFIED - •, 1 r1 r^7� 1. ! �, /..1r7�1/ l�.^; MILES ORIVEN ��1 �1' rr� �• 1 7/ ! V- z V �'%�_�•i�.!-`�'�^H. I V`�� 't ;?V..�' i .MAX.PAYLOAD .. f U�.J I LOCAL CONTACT ADDRESS PHONE MILES DATE DUE ALL EXPIRATION'OF CONTRACT AM EMPLOYER _P,OSITION'l f VEAIFtED CHARGEABLE—, L / ! / PM RENTAL RATES DO NOT INCLUDE FUEL EMP Y`EA'S(ADO�R74ESS PHONE Cilh � ,1 Lug ll/ Q HOURS.@ S PER HOUR S, CITY - CITY STATE . ZP REFERRED BY. DAYS• S $ 1 ;: - 1 ONLY THE BELOW NAMED PERSONS ARE AUTHORIZED AS .."FUEL WEEKS @s $ - ADDITIONAL DRIVERS. IF NONE, PRINT"NONE ACROSS THIS MONTHS@ S S SECTION AND HAVE SIGNED BY CUSTOMER. OUT IN .. .-. .`MILES 0 ¢PER MILE $ NAME ® AGE E E Vi V+.. DRIVERS LICENSE r TOTAL MILEAGE AND RENTAL CHARGES $ NAAAE_ `v .�/_. =1. FUEL GALS S 1 $ 'v y �? :''F F `- SIB TOTAL. $ s DRIVERS LICENSE 0 r1 - 1_ - QEHFIJRI 0� N DAMAC� AIV DVS S:'. • • • ` Y --CJCI3 S17RANE i • RATES. PER DAY WEEK -_ sus TOTAL` BY INITIALING;. CUSTOMER'ACCEPTS OR CLINES.COMPREHEN _ -^ = --• SALES TAX� SiVE/COLLISION.DAMAGE WAIVER-AT THE RA LISTED'ABOVE-BY' DECLINES DECLINING WAIVER, CUSTOMER ACCEPTS FULL R - ONSIBILITY:FOR �'`' SUBTOTAL S. ALL LOSS/DAMAGE TO THE RENTED',VEHICLE UP TO PER OCCURRENCE, REGARDLESS OF CAUSE NOTICE:WA R DOES NOT,,' OVER LESS CREDITS �`• !J� LOSS OR DAMAGE RESULTING FROM ANY VIOLATION.. PARAGIPH 4 S. 3 (g)ON PAGE 1 OF THIS.AGREEMENT.-. r\ _ a TOTAL CHARGES S _::;l ...1 NOTICE OF CUSTOMER'S FINANCIAL RESPONSIBILITY D`- COMP.REHENSiVEICOLLISiON DAMAGE-WAIVER_ `ESS° ' Customer will be responsible for FuiLValue of the vehicle:(or.,other amount written above if-Customer has otherwise complied--With the ;^a ;;;D. CUSTOMER 5 terms and provisions of:his Agreement) regardless.of fauit,�iriclud INITIALS WARNING: .,�- Ing.. loss of use, . towing, storage -and Impound.: fees:- even If � - Comprehensive/Collision Damage Waiver has been accepted If Read'carefuily,all.conditionsv reverse side Customer or any Authorized Driver violates the terms of parag ash •-.,,You are responsible forall traffic violatlons_- 4 (g) on the reverse side. ' aNLY_MfNIMUM L7AB1L1TY INSURANCE-IS ��`—�� �� ' • -� . '��RSE SIDE- .r,ft;,�i Your,own insurance may cover all or part of your financial respo>asr-= --_- bility for the vehicle. Customer,may-wish to verify before'purcnomertiasread bottide3 `tfiis a reement 'nda9reestaj � g ibe.terms and conditions thereof Comprehensive/Coilision Damage:Waiver: u` stocner. authorizes- 4luoc>rss a credit:'card VEHICLE CONOITION. SPAM!a CUSr_1NIT VOUC$er,if.any;in Custo me =" .. OUT a ` a- .-Customer may be.prosecutik*lf.vehicie..is-not returned when; - �N Q y : -due back.'. • _- THIS AGREEMENT AQt7Cf3 NOT EXCEED A 30_DAY PERIOD. CREDIT.CARO CO. _ EXP.GATEVERIFIED' ell -'. auTW ER SIGNATURE� .'',� A �/!/ 1. �. - �:.'. ��� •�/ mac. -- - EXic'NOTO, AC� ti;_OEADATE ::- WffWLS (. .._. - CHECKED OUT BY: CHECXEO IN BY: } L r i � - PREPARED BY: - •1 E !C_'_;: ..E?IT L. vREE',1ENT'. 31-22 ;MINIMUM.LIABILITY�r INSURANCE y I R'1C�N1CtiD CA -41SC5 ^ CUSTOM AME VE HCLE NO UCENSE NO. ,7/- .OMEAOD9E+SS-�j �I;f.{� - VERIFIED YEAR-CAR LINE(TRUCK SERIE% MODEL ANO COLOR CITY 1 TATE' GODE DATE AN TIM DOMETEREiN �/)( SPE 0VER'S LICENSE NO., ATE1. XP.DgTE "S9: SPEEDOMETER DATE AND TIME OUL l3: OUT 1 /..�J/x, ;aM: BIRTH DATE SOCIAL SECUR17Y NO. 1 HOME PHONE VERIFIED MILES DRIVEN. v (� ,MAX.PAYLOAD 1, LOCAL CONTACT ADDRESS, �! J\ —T1' PHONE MILES / \ DATE DUE e' ALLOWED l" l C,U J EXPIRATION OF CONTRACT EMPLO Ai POSITION VERIFIED CHARGEABLE / J. PP ) j MILES RENTAL RATES 00 NOT INCLUDE FUEL ! EMPLOYER'S AVORESS P. J HOURS 0 5 PER HOUR $ CITYSTATE ZIP REFERRED BY DAYS ®a�Z S E ONLY THE BELOW NAMED PERSONS ARE AUTHORIZED AS FUEL WEEKS ®S S ' ADDITIONAL DRIVERS. IF NONE, PRINT"NONE" ACROSS THIS MONTHS®S. g: SECTION.AND HAVE: SIGNED BY CUSTOMER. . OUT IN. MILES (� �' c PER MILE S I I' E E ruMl° AGE:. � f DRIVER CENSE rh h, TOTAL MILEAGE AND RENTAL CHARGES S NAME ,AGE ?L' FUEL GALS.@& f $ IVERS OCENSE r.. `-. -Fa 'SUB TOTAL-. $ . Ery rACCEPTS- �= COMPREHENSiVE1COLL1S10N DAMAGE WAIVER(CLCD CIIMW71 T-INSURARCE,—.---"---- RATES: PEA DAY PER WEEK Fv- x, � �, SUBTOTAL. $ BY INITIALING,,CUSTOMEFI ACCEPTS OR OECLINES COMPREHEN- sALES TAX A ' $ SIVE/COLLISION DAMAGE WAIVER T THE RATES LISTED ABOVE. BY OfiCL1N y DECLINING WAIVER, CUSTOMER ACCEPTS FULL RESPONSIBILITY FOR �f" SUB TOTAL g ALL LOSS/DAMAGE.TO THE RENTED VEHICLE U TO $ ^ CO PER OCCURRENCE. REGARDLESS OF CAUSE. N DOES OT D EA LESS cREDlrs , g LOSS OR DAMAGE RESULTING FROM ANY lj� F"-PA GRI 4 (g)ON.PAGE 1 OF THIS AGREEMENT. 5 t NOTAL CHARGES $ NOTICE-OF`CUSTOMER'S.FiNAN AND` -COZ I^IENS�IVEICOLLISiON DA E}� s LESS DEPOSIT $. � Customerwresponsibir Ful v hide (or:other s (,1 amount Ilio bove if Custo herwis plied with the cases REFUND INITIALS ER r jjaT provisions ou this Agreement) feg fault, includ- Iio;,y UUI ss of use, towing_ storage and impound fes evert 'if WARNING: Co *ehensivelCollision Damage. Waiver has been act epted-iif` • Read carefully all conditions on the reverse side. _fLi,6tomer or.any.Authorized Driverviolates,the terms of paragraph, You are responsible for alf traffic violations. 4 (g) on the reverse Side: ,;x ." ONLY MINIM6M_LIABIL1TY INSURANCE IS PROVIDED AS STATED ON THE REVERSE SIDE:. `^ ur rice may cover`afrbr part of Your_firJanei�l�esg6h:4- F` ~ bility for t F7 -Customer CUStOmer may Wish to vefify`before pufchaSiflg' Customer has read both sides of•this agreement and agrees to . the terms and conditions thereat. Comprehensive/Collision Damage Waiver. Customer: authorizes Licensee to process a credit. card VEHICLE CONDITION " • cUST 1NTc voucher, if any, in Customer's'name. OUT o` Customer'may,be,prosecuted if vehicle is not returned when IN:: -- O due back.. THIS AGREEMENT SHOULD NOT EXCEED A 30 DAY PERI00. CREDIT CARD CO. t7CE`.'OATS VERIFIED ] / ERTENO.TO: AOOIT10NAl DATE INITIALS CASH-OEPOsrr S. HECKE0,01.17 BY. - CHECKED IN BY:. :PREPARED.BY: CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA w Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT MARCH 26, 1991 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 Cade RECE10/E® Amount: Undetermined Section 913 and 915.4. Please note all "Warnings". CLAIMANT: .ALLEN, Andrea Wilson MAR ) 1991 ALLEN, David COON v COUNS , ATTORNEY: MARTINEZ, CALIF. E . Gordnn:.Wells , Jr. Date received ADDRESS: Wells , Call, Clark & Bennett BY DELIVERY TO CLERK ON February 28 , 1991 (hand 1710 Pennsylvania Ave . #C e ivere Fairfield, CA 94533 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PpHHIL BATCHELOR, Cler DATED: March 4, 1991 BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. �v ) 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: BY: I � ti Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Adminis for (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. 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 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: BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: E. Gordon Wells, Jr. Wells, Call , Clark & Bennett 1710 Pennsylvania Avenue #C Fairfield, CA 94533 Re: Claim of ALLEN, Andrea Wilson ALLEN, David 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 insufficient for the reasons checked below: X 1 . The claim fails to state the name and post office address of the claimant. 2 . The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. 3 . The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. 4 . The claim fails to state the name(s ) of the public employee(s ) causing the injury, damage, or loss, if known. 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ( $10, 000 ) . If the claim totals less than ten thousand dollars ( $10, 000 ) , the claim1fails 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. If the amount claimed exceeds ten thousand dollars ($10, 000 ) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. 6 . The claim is not signed by the claimant or by some person on his behalf . 7 . Other: VICTOR J. WESTMAN, County Counsel By' \ / Deputy Co Counsel CERTIFICATE OF SERVICE BY MA C .C.P. 5S 1012 , 1013a, 2015 . 5 ; Evid. C. §§ 641, 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 '. osta 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. Mail) , 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, California . I certify under penalty of perjury that the foregoing is true and correct . Dated: 3-6-91 , at Martinez, Californi . cc: Clerk of the Board of Supervisors (o gina1) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910 . 21 920 . 4, 910 . 8 ) r 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 persona]. 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: C1aim. By ) Reserved. for Clerk's filing stamp ANDREA WILSON ALLEN and ) DAVID ALLEN > -RECEIVED 10 Against the County of Contra Costa ) FSUPERV]I orAMEL CEREJO and CONTRA. COSTACOUNTY District) 2MpgCOSTA 0. Fill in name) ) The undersigned claimant hereby, makes claim against the County of Contra Costa or the above-named District in the sum of $ over $10 , 0 0 0 and in support of this claim represents as follows: Jurisdiction is proper for Superior Court -------------------------------------------------------------------------------------- 1. When did the damage or injury occur? (Give exact date and. hour) September 5:- 1990__ at-9_:Q4 -a---- ----- --------------------------------- 2. Where did the damage or injury occur? (Include city and county) Hercules Off-Ramp, near Interstate 80, County of Contra Costa ------------------------------------------------------------------------------------ 3. How did the damage or injury occur? (Give full details; use extra paper if required) Claimant was exiting I-80 at the Hercules off-ramp. Claimant was stopped in traffic• when she was rear-ended by a County of Contra Costa Pick-Un. truck. ------------------------------------------------------------------------------------ 4. . What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage. Driver of County vehicle was not payinq attention to the stooped traffic ahead and was travelling too clos ]..a-nd too-'fast for_ conditions (over) _f. 5. What are the names of county or district officers, servants.or employees causing the damage or injury? AMEL CEREJO and . DOES- I-10 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages-claimed. Attach two estimates for auto damage. Tota 1 'Damages $20, 000 Neck, mid-back and low back injury, aswpll as pain and numbne$s into ,hip; as' well as upper and lower extremities . Damages to plaintiffs ' 7. -How .was the amount claimed above computed?- (Include the-estimated amount of any prospective injury or damage.) Kaiser (emergency) - $185; Kaiser (1/?/91) - $100 (approx.) ; Daniel Powers, M.D. - .$1,155; William Schlee, D.C. - 1,368; ,Travel to treatment to Kaiser' $5.50; Travel.-to treatment to William Schlee, D.C. $165;' Damage to automobile - $900; Loss of earnings - $4,067.20; General Damages - $12,054.30 8. Names and addresses of witnesses, doctors and -hospitals. Amel Cerejo, David Allen, -Andrea Wilson .All.en, doctors at Kaiser Hospital, David Norman, M.D., William Schlee, D.C. 9. List the expenditures you made"on account of this accident or injury: ATEITEM AMOUNT lgl - Kaiser Permanente —`70 . 00 (approx. ) 9/5/90 Kaiser Permanente ER $ 185 .00 Travel expense• $175.50 10/,29,/`9,0.�-,...,Dani-.e=1 1ewers, M.D., 1 ,155 .00 Auto repair: $900.00 9/7-10/11/96 Lt;Rjn Sc�ilee, D.C. 1', 368 .00 Gov. Code Sec. -910':2 provides: "The claim must be signed by the e aimant SEND NOTI S :TO: (Attcrney) or s_Wne person on his behalf." Name and 9d9bs's;:of 'A, for ey q}j r 16 Ai(�<1 E. GORDON-=-WELL- °; WELLS , CALL, CLARK & BENNETT aimant' Signat 1710 Pennsylvarri-a -Ave, Suite C Fairfield, CA" 94533 Addr s Telephone No (707) 426-5300 Telephone No. * �t * * * 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 fora 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.' r .r A 'tam s'�t,j,.; :. ,4 rrw. w,. 4.� ec+:'7 K ,.}r•r ti.. ,.. w;ty... _ vM1vn:, .5 '.n d [-0 s t a ° ? .e ' a i rhT ar b w' i a Fc ,rr t sr�K a s"? 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SCREWS..WASHERS CLEANING SOLVENT . c y IIQQIIANT rl 110c s r9Yc4T NICs wi2c runC TFRumAI f CFAI FR:F!FrTRICAI TAPF FTr.MAXIMUM CHARGE$5.00 ...,s„,� _._....,.. ,.x A...a•.r�y��s::.. O� - .. - - - - O r-I `i> mr oo mo6�aT WD p-Ci mai re�ir t>nr a e a ni y� .a: �':� on�fio ,o n.�cp Gtr cod N m O y s ^a nc =3S orn> w x; r ZO o m n« r � a aNtl_^�g� agies^� 6�3p.N 0.� Du) > m m y F„ M '" • -i by _v•'^ 3"� ..s`=� noe 3 s (170"� • m r< O•< WQ •n 3' ^R.3a n a&"i r trit ta.. M �. ,� Q D mom•.' . c m m z - a` "z so v 3'^ '• CD m Dsoaq a-tee O MM. En t team O. O� - m -� :' yr i�$ A s r tt^'R :«s2s- m x oIT vOi vci .. .. F D Z y "" O m L •- 3k AW-.r3� .9.00->?34 mm - -i - a0 p. t > z as U , a S' ^>d a ; n n " O a ,a n - ;RA400 A to # m o PC L c - m 8$ R^a��aYAsr�g &8o oma- •!, w na �. ITT D ".• < n.. ^»D z ' ' E a a D O 37 "'{ A /9 a "•} ,?i ; m D Y'O x lilt 1 m o _ r e= den Z y D !A ITt to T, D D w y r 1 O �1e� m { O C; O z ui T*1 ' (A n m n t ^. 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Z N iT a.. 3 Km C7 p r ,J D 17Tr V� jd AA K Y � r § ?1 7 xT a�sT C.K zm n �c r r�o D # _ ' 4 D (D N> m m m m m o ` �.- '�17 Z o A N oz �C m b < Ffl D O + O .y-'_ ,.+,. o p N ca f sa SA O ! 00 O00 (rif�n M r I y ma m > MD Q ` V <O D i t '"' �• 7 m ❑n n Z 45 c n a 7f O t UDi D • O tDtsrDv {�••-��, m �o m M-< r • Z •1 •{+ v yD `-� a � N G) C oo �} O Q= { t lVJ v O r 3 m m , - O m b w D m -a uicr To r ,. -• m D m O k > _ m S i 2 m m O cn cn < O < m O r; 1C D N D � 'm a o ; i' z ... u� .._ m te Q { x m �. yQ �m z z� 4m � m w t:i cs1 en cs1 y f ; O � t co 01 I W C � —�` _ 1.FFE3 Ell ED , 1 v o a.�r ---y - v v -� £ c on n m no '�n n r r e ..4 I D ,Imo n✓ -„ z R a m o 'i> ass cA+n mg rs �> mT O i i'+ M -R z z z cn�c >< i z z v v l O y r rn rn o r z ci rn u'+ z- ^i ci 'z - m ,'T1 Zr S ) ; i _ :c sm m n > m I N r; O x > z N ❑ O ❑ ❑ ❑ ❑ ❑ ❑ ❑ 'O ❑ OY W f 590-14165 NORICK OKLAHOMA CITY SHOP SUP?LIES INCLUDES THE FOLLOWING ITEMS BASED ON 5%OF THE LABOR CHARGES,THESE ITEMS MAY INCLUDE NUTS{BOLTS,SCREWS.'WASHERS.CLEANING SOLVENT, CHEMICALS,LUBRICANT,GLUES 6 CEMENT.MISC.WIRE ENDS,TERMINALS.SEALER.ELECTRICAL TAPE.ETC.MAXIMUM CHARGE 55.00 �r r t ?77-- t .ti F 7.^tI�'� --r- •-^--- �` .+fi f -. x q h W` ,s/Y+ x )n 1 z '+ r'. 'S �.� INVOICE ti e4 .r•.° y 7r+ I NO F—,n m 7l LLO �F n ! Y., y t+s,e' 'T2 s,J r� w _' 3+-;• y p#x ,+: 'YVILE 2E+C�U1EO)YLE2-',?�1 �LI2 x 'i � a 3280 Auto Plaia Phone"222 4444 9 4S MEF RICHMOND:CALIF.94806 ` : 'r NAME `p" •,.t a r '?r r : y .:" ADDRESS } tib•.: i `+ , r >k `" v- `' €'" ,t ,•�:`y, • ,.s Os: rg1 f a MDSE, SOLD MDSE. pE TURNED :,-.__SALESMAN -ORDER NOr. CODE L CASH- `CHARGE CASH CREDIT OTY. PART,NO. DESCRIPTION ,,,c t" ;LIST NET - TOTAL NET A d rh. n ; T111 .S:r, & -le ,r �D 8.£+i � fi s b >• r.�-, .! .FA o f i r a t B4n >: tr r" pp� i 'St + Ifr S i.t4 `:' may. 1J, '�r 4 rrd,tie 4 kl;.. ' tg�gW it ,idkt"' ,. +xl Cr*rr {2. #.•,'- h ?.`1 X Y. + Y 4s ,, ti b v' Eigrxy S4i �yq/ � +' � ri JI ,,�r.�w'' T. a- ..§ �+,.: - � J.". t �. '`` ,µ, jl+ v�s'y+'r f��..,r'+ r t � 4-,; ? � ✓�.. S ''S t ACCT '`�• ACCOUNT: NO KEY AMOUNT KEY ";,COST,-,; ..�` PARTS-INT., '3470 �❑ "`�y,;`+ ; ,'3f {.•,,ay,t,', fi3ACCOUN7;:. N0. KEY ,AMOUNT , KEY ''� COST.,", t '¢. •' ..1 :t* q:� }Z x f t:... RETAIL'' ,";,,tr 3420 WHSLE: TAXY" 3400 O z 41.�• ,r .+c :.'a,a.i. + �t ❑ 4\�ti�xs, u�`.tt+ '` w'a WHSLE,r fTAX ,3405. ❑ 69 "' ,{.^ ,, yix; r } ❑ +� n Vit` i `£;. ❑ "x :'i F. 75 ❑ i '� �,h w;� re )t k} s r .,..• 'r s'? n r+E '.„'.A Via . STK ;.r�F'"'w rely raa✓J, v.TAX.,, 2�CJO Q i :''_` "ti •J,5!•F�j� 9 1( QF::.. L STKCHAF 1120 F x *r Oa,. BYC D" °i5 '. �' N��r Asir + t TH AN.K NOTICE 20%HANDLING CHARGE ON REFUNDS.:NO RETURN ONIOI+O s• r 'r' '� + ELECTRICAL OR SPECIAL ORDERS.NO REFUND AFTER 30 711 CALIFORNIA PASSENGER`' T VEHICLE RENTAL AGREEMENT. ;A -� � .kxw}t �:' .F t `••3�8{D>AuF�►�$�)'a�kS ,l , � ���� ' : , g��' MINIMUM LIABILITY INSURANCE '!.t r .. 't �.. t •-S rX."F t # dil�i.f73$tup{RL�j 1r .rY•?4i7fir a > S 3 y s! c ��ad �� �lsr s� � . - ,�� � 004,35 NO. : , CUSTOMER AM �• ' IMS - VEHICLE NO ' LICENSE NO. v HOME ADDBE6 At ti t , VERIFIED YEAR-CAR LINE(TRUCK SERIES) MODEL AND COLOR, . rt^a t rj�[�-`�� Sr ,•, t�l�•(/l `l\ 4,. •�� i t L � t t �.�` �ry� .... .. - ;'✓'. .. STAT IP E SPEEDOMETER DATE AND JIME,IN l lv/ 4 / l r-Y• ! ', t;,. IN /J / ... / ) 1� 1 (7 J`AM `x�.�� y/" (�'PM . ., • t DR ER' LICENSENO s i STATE x t :rs +{r} ATE DAl rE AND TIME OUT i j��\J ��/J] SPEEDOMETER f IrbAM �r '`°'. f .�'� a'•�'� t �t,»;� 4 sJ .OUT ,'.,.,��// f { PM -BIRTH DATE SOCIAL SECURITY.NO HOME?H VERIFIED 4 MILES DRIVEN I MAX.PAYLOAD LOCAL CONTACT 3 ADDRESS t , ¢ PHONES MILES DATE DUE s e r� /' /� : EXPIRATION OF CONTRACT,:•; r c^t',. �, ALLOWED �„Jt./ r r +t a rs :-fir o c^'•".er nx ' , .. .,1: AM EMPLOYER` y ,P SITION VERIFIED CHARGEABL 'I /' I PM a d .r't .�"* i. _ "rS .MILES '+ ..__.....__ y�Fyrt r ,in.:e, r ,�., ��.. s r-��., t �. � RENTAL RATES DO NOT INCLUDE FUEL ' s EMPL YE S ADDRgE�S� Sia i e PHONE r_"*� I a 's +` a 1/i JF .if IPA t; a,, .� .�' x HOURS:. $ '^i PER HOUR $ / iilSJJ RCITY FERRED BYt . DAYS: @$ $ _"f" •��i a stf . s WEEKS P, ,ONLY THE BELOW NAMED PERSONS,ARE AUTHORIZED AS. f FUEL§ y ADDITIONAL DRIVERS.IF NONE;.PRINT" NONE..,ACROSS THIS ' r r 'MONTHS®$ $ SECTION AND HAVE SIGNED BY�CUSTOMER + MILES ® 6 PER MILE $ tAS b. s3 .'- Tom. x.`,.t :.. ,<'• LLF; $ $ "' ,� , S•� ♦Ft NAME b- .,y AGE a F,,,,E E Y }.: t ..,.,•,�,.. .,s.,." t c DRIVERS LICENSE d + } I , ; TOTAL MILEAGE AND RENTAL CHARGES' $ 3 n d NAME i c A .v is ° FUEL GALS. $ '. I tb ( $ +� ru "{"t` i. 1 s,yi - .3,..:y+c'w 4•`-,t.x t� -` � tiro F F :., j. $ . tgDRIVERS LICENSE q a.y.0 SUBTOTAL_ r: ' w GOMHENSI 9L N DAMA AIV DW) A�CGEPTSrt ep �i/CiDV.•. SI�',�ANCi - �n ,, t7' a,a -" �'"f' '�'t^'§�, •. ,''•t.'4* �" gtat �`?"1`'..sr'�z` i' r ,•"' rJ..=-1 1 na r - ``�,.. t a,�. „ ,� �s�'` s{..aa �' _. I �£ RATES r: PER DAY+_! f�WEEK` s suB BY INITIALING 'CUSTOMER:ACCEPTS,OR, CLINES;:COMPREHEN SALES.TAX $ f+ SIVE/COL-LISION DAMAGE,WAIVER AT`THE.RA LISTED ABOVE BY DECLINE$;t y DECLINING-WAIVER 'CUSTOMER ACCEPTS FULL;R ONSIBILITY FOR S / SUB TOTAL"' '; r ALL'LOSS/DAMAGE TO THE;RENTEDWEHICLE UP TO Y PER:OCCURRENCE,REGARDLESS:OF CAUSE"NOTICE.,WA R DOES NQ 'COVER LESS,CREDITS': ) 3 , $ • i $ LOS,,S''�OR-DAMAGE:-RESUL'T1�IG FROM ANY VIOLATION PARA7GR#1PHf4 @@ Y r (g)ON PAGE,j OF:THIS AGREEMENT `' x a 4 yv TOTAL CHARGES $ ,NOTICE-OF CUSTOMER'S FINANCIAL RESPONSIBILITY AND. LESS DEPS;;, a � kr.zCOMP.REHENSIVE./COLLISION.DAMAGE WAIVER �� $ r...#. .,� ,' ^.,,, yy .'•. ,� L iF rCustomer wlllNbe responsible.for.FulLValue of thewehicle ( mother t f, amount written above If Customer=has otherwise complied,,, rlth the CAShrREfUND =, CUSTOMER $ rt a INITIALS terms:and provisions of-this;Agreement) regardless-of fault rnclud- ing M loss/of use ,,towing; ;'storage` and:f impound'':�:fees:'en if`,'WARNING ti I � Com rehensive/Collision Dama a Waiverx'has >been-Acce `t d=ifd' O,Read carefully-all conditions t reverse side .' Customer.=oran `Authorized-Driver;wiolates,the terms of a�a �a �°wYou are xesponsfble for'ali traffic violations{ j = Y ,'•a : IPM d pNLY MIMIMUM'LIABIL.ITY INSURANCE w 14 (g)�on the,reverse Q, _ t, � tQVit � ,vERs�siDE ,� �' Nu4Yourrown'insurance.may coverall or.part of your financialrespolsr $tomer^has rai!'6oth sll`esf#flus s Seeir►en ,"nd,agrgest; blllty'f*.the,vehicle; Customer.:may,wish to verify before: 6d'660 gtheierms aions.4hereij �` s Comprehensive/Collision Damage Waiver.'! gd process a :credit card ` VEHICLE,CONDITION ,^ r SPAREa ;;°CUSTttNIT• VOUCner, if eny, in Custol $Rrug�ltle OUT �F " s¢ k { oK` „L� .= Customer may be!prosecuted It vehicle Isnot retumed when " a�d'� IN zj' •� f .Y ;' �. s,{�• p z dl1e`baClt _4 .. c a". c :, �`�i•' z:T IS ACREEMEN t1 :NOT EXCEED A 30 DAY'PER10IX i yr a REDITcCARD co.., IJfPF DATE i t < VERIFIED ex, ;"YY •' ' ''' r`` /l r` ..* t��fr•"� '.r'S .0 ,r•.i _ I° � •* yx 4 L zvL U �XS CUSTOMER SIGNATURE >. 1 ^, EXTEND TO ADDITIO ' ,. DATE ,;y INITIALS S'SI acv. -�1../ ? '. 'r rh ,' +ri:�.;� ''t•'. CASH DEP v CHECKED OUT BY: f • CHECKED IN BY , its x L.+ 9 rr *''• . `�J I.f a a i t v# •� i t �t' F .r+ f_,� ryt#"yrc t � f� •?'(k a tY e. k�Y.l� PREPARED BY y i. t r t r,.+ 1 t,'$ +:'",�a;",t't r j'.rT rw g ✓ y"r. ra.. +F, �.ytx �^ ��i f '>�t �� r � � 6 �-� + +., ,'"��,x'k .:"s h r .ts.1 ,F �.,'.'n Y s &r .k"K 3x?+%��.,. !,.4enitso.. �11.. ` •. x . �� ..tvi n`C+.§� FORM FD-22-CAL NORICK OKLAHOMA CITY"22Cw kyy�'4 , ,.r ya.y.f �.,. , ... . .. t,-. r , ., T �� {a"�S•�s y.,, R._$ .. r,. 'I a t ,. «. ..{..,'PAGE 2 2. :tl ° 5> y4 a k tSizk �F. CALIFORNIA PASSENGER -- �-�� _ . .,• : :: . VEHICLE RENTAL AGREEMENT ���To�mc'�f�®® 3280 AUtO Plaza s . RICHMOND, CA-94805 MINIMUM LIABILITY INSURANCE ' AurHflRtZED SYSTEM MEMBER (415 222-4444 0 00525 i it<F ° CUSTOMS AME.'• VEHICLE NO. LICENSE NO. � � TOME ADD E S VERIFIED YEAR-CAR LINE(TRUCK SEERMODLAND COLOR r 1990 IES) < CITY �TA7 (71�p 9 � O�OPE .. IN ATE AN TIMI IN SPEEDOMETER (44//x/// V+ D@JV,ER'S�LIIC)ENSE NO.( AT EX DATE SPEEDOMETER DATE AND TIME OUT � 3- OUT BIRTH DAfT,,EIl.t I . SOCIAL SECURITY NO.,-,,, HOME PHONE VERIFIED MILES DRIVEN 2 ���L� + MAX.PAYLOAD LOCAL CONTACT, ADDRESS DATE DUE PHONE i ALLOWED ' EXPIRATION OF CONTRACT AM EMPL R ✓ ,POSITION VERIFIED CH ARGEA MILESBLE / / PM r RENTAL RATES DO NOT INCLUDE FUEL EMPLOY R S ADDRESSNlr ^ p`j ku HOURS ® $ PER HOUR $ �< CITY:, STATE ZIP REFERRED BY ._r, DAYS @$�71 L $ vv ONLY THE BELOW NAMED PERSONS ARE AUTHORIZED AS FUEL WEEKS @$ $ ADDITIONAL DRIVERS. IF NONE:, PRINT"NONE'.'ACROSS THIS MONTHS @$ $ SECTION AND HAVE SIGNED B`f CUSTOMER. OUT IN MILES @ ¢PER MILE eG,: NA AGE. E E i '/4 Y4 Ds CENSE x^:,.. 1/2 112 TOTAL MILEAGE AND RENTAL CHARGES• $ d NAME ``AGE 3/4 3/4' FUEL GALS.@$ v,,I' $ DRIVERS LICENSE M .. SUBTOTAL $ ,COMPREHENSIVE/COLLISION DAMAGE WAIVER(C/CDW) ACCEPTS o o 0 t "� C/CDW' IS N07`INSURANCE, _ -Y p $ - a�.Fltr '4"�4- e, i{ ' '° .; �3I �*"E` }�t'3h, 'G".4 '.: X : .RATES: PER DAY_ PER WEEK, ,,. .+rss SUB TOTAL $ BY,INITIALING,;CUSTOMER ACCEPTS OR DECLINES COMPREHEN- SALES TAX $ SIVE/COLLISION.'DAMAGE WAIVER AT THE RATES LISTED ABOVE. BY DECLIN DECLINING WAIVER,"CUSTOMER-ACCEPTS FULL RESPONSIBILITY FOR a7rr SUB TOTAL $ S ALL LOSS/DAMAGE TO THE RENTED VEHICLE U TOA PER.00CURRENCE, REGARDLESS:OF CAUSE: N DOES CO,ER LESS CREDITS $ LOSS OR DAMAGE RESULTINI, FROM ANY I FPA GR 4 (g)ON PAGE 1 OF THIS AGREEMENT ~ ' $ s A„ TOTAL CHARGES $ NOTICE'OF CUSTOMER'S.FINAN AN K LESS DEPOSIT $ COBAPR HENSIVE/COLLISION,DA ER , ;. e .Custom r rbe responsibl r Fu hicle (or other amount ' ten above if Custo erwls plied with`Jf CASH REFUND CUSTOMER fault, Includ- $ r a provisions of this°'Agreement) Peg INITIALS !t^'ry. i I of use,� towing, ::storage `and` impound ee even,If WARNINGS Co ehensiyelColhslon;-Damage, Waiver .has :been acceptedif °3Read carefully all conditions.on the reverse slde C tomer or.any Authorizedbriverlvlolates the i}erms of paragraph ° You are resp nslble'for aII traffic vlolattons y ° ONLY.MINIM M LIABILITY INSURANCE IS } (g) on the reverse side: `. 2 , z �. � ':;PROVIDED AS'STATED ON,THE REVERSE SIDE x io� I i s rance may Cover"a'Wo' rpart ofyouur fly ncl�l 2ppon^'- t ' ' butt for thee ehlcle. Customer may wish t0 od Customer-has read both sides of this agreement and agrees to y y fy efCtre purChasing the terms and conditions thereof.:', '. Comprehensive/Collision Damage Waiver.'` ''' °` °. ,1 Customers authorizes Licensee:to, process, a;:.credit ,card VEHICLE CONDITION,r s . BFARE 8 cusT°I nvoucher,.if any,:In.Customer's name.,-! OUT _. ' " o.K ,�;Y~a ,Customer may be, rosecuted if vehicle.is not returned when IN �_ :z ❑ �tl,: ,.:due back . . ; a7rA r, U HIS AG MENT SHOULD NOT EXCEED A 30 DAY PERIOD. CREDIT CARD CO ~EXP�DATE VERIFIED E%TND TO EAD64TIONAL DATE INITIALS 7 .i J CASH DEPOSIT $ CHECKED OUT BY: CHECKED IN BY: l !PREPARED BY: k In FORM FD-22-CAL NORICK OKLAHOMA CITY(FDs L) PAGE 2 a W% -