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HomeMy WebLinkAboutMINUTES - 04021991 - 1.1 (2) .1 CLAIM i0 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 APRIL 2, 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 "WarnMsCEIVEG CLAIMANT: STURTEVANT, Donald E. MAR 5 1991 ATTORNEY: Abigail. R. Marshall , Esq. COUNTY COUNSEL 2171 Junipero Serra Blvd. #620 Date received MARTINEZ, CALIF ADDRESS: Daly City, CA 94014 BY DELIVERY TO CLERK ON March 4, 1991 BY MAIL POSTMARKED: March 1, 1991 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 DATED: BY: Deputy 1I. 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: 3 I r. '9 I BY: 1 J� S, �. 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: APR 2 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: A P R 9 Mg; BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Ca N`r" Cas-IA- CLAIM AGAINST THE CITY AND COUNTY OF Wi Before completing this form,please read the instructions on the back.You have only 6 months from the date of incident to submit this form and supporting documentation to the Controller or the Clerk of the Board of Supervisors. 1.Claimant's Name and Home Address(Please Print) 2.Send Official Notices and Correspondence to: b o n a 1'd- C S-� .e u A, b (11191-5ha(1 �s eo �5 S-f . a(- I tr� Se.� Rlu�. (Qa a City G,, b%,e Zi Zip le-1,01 Lf 3.Date of Birth 4.Daytime Telephone 5.Social Security Number 6. Date of Incident 7.Time of Incident y0P.-�- 8.Location of Incident or Accident 9.License Plate Number,Claimant Vehicle s /v/05L 10.Basis of Claim (State in detail, the known facts and circumstances attending the incident identifying persons and City departments and property involved,and the cause thereof.Use additional pages if necessary and attach photos if available. See Instructions.)_. c e a C•,es S k.P& -S ed- f `Tl-►ee w�,a c+c(c&A c,(a- u/zA-s 69 e.o r e "I 4f—ad Tei a• -ma i sA In i DI Ur-J -fz) Cin (A- kioLkn e jc+&-J,F- Name;:1_D. Number and Department Type of City Vehicle Vehicle License Number and Vehicle Number rim ;11.Descriptiori.of the:Claimants damage,`inju"ry,or loss - 12.Value of Claimant's Loss or Injury and method of computation (See Instructions) _• � r c a.Q Fisc pees a s W!i 'Ps- _ I T E M S PoinLAMOUNT ICourtJurisdiction: Municipal 0 Superior m,"-- 13.Witnesses(if any) Name Address Telephone L(17 W6 a,,g L" Vey N� �oZ.- 135 1879 2. D7MA14.Signature of Claimant or Representative 15.Date of Claim k - 4 1991 CLERK BOARD 0 SU cRVISORS CRIMINAL P61ALTY FOR PRESENTING A FRAUDULENT CLAIM OR MAKING A CONTRA C FALSE STATEMENT IS IMPRISONMENT FOR NOT MORE THAN 5 YEARS OR FINE OF ckFom z SW NOT MORE THAN$25,000.00,OR BOTH. A N O N OM c; .r cr, N �s N _ t� .,a CA ,.A � kP sy v 0 0 s O v icy N cD d N 4 � t s o d y N rn 04- s „a �• �U d d � CLAIM 4 /0 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 APRIL 2, 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: $1,181.24 Section 913 and 915.4. Please note all "nWparfti�gVVEID CLAIMANT: DAWSON, Shirley LIAR ATTORNEY: California State Automobile Assoc. 99UNW GOUNS9 2055 Meridian Park Blvd. Date received AAARTINIX: C41F, ADDRESS: Concord, CA 94524 BY DELIVERY TO CLERK ON March 1, 1991 (via Risk Mgmt) BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: March 4 1991 PpHHIL BATCHELOR, Clerk 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: I 91 BY: 1)Il ` 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: A PR 2 1991 PHIL BATCHELOR, Clerk, By - Deputy Clerk WARNING (Gov. code s io 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:_ APR 2 1991 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Claim For Damages In accordance with Section 910 of the California Government Code, this is to formally place you on notice of our subrogated claim for the loss described below. Date: DP, — , 1991 RECEIVED ��� , California BOARD 1 SUPERVISORSCONTRA COSTA CO /—�Y(.♦ Claim is hereby made and filed against the as follows: Name of Claimant: California State Automobile Association Inter-Insurance Bureau Address of Claimant: (Send notices to this address) �O6-S- 0 / - S 1 i4 W Gl)l Date of Occurrence: w�wv` © / - / 6— c7/ Place of Occurrence-122 otA97-'\�q t4A `"'✓� Nature and Amount of Damages ✓ l q31 Iter7vgMaking up said Amount: Nam of Public Employees) causing said Damage(if known): Facts=tails: , ct- ;YtQo� CL California State Automobile Association Inter-Insuranc Bureau By: F1688 (REV.5-78) Cai�.ornia Sta`e �tortio6i+ �+J INSURED ❑ CLAIMANT FROM D O _ FILM NEGATIVE ❑ POLAROID DATE — z JAN 16 '90 Mari ': J. Hel;k. HOUR �) \J ❑ A.M. BY LOCATION t .I r+l MAKE O CRt YEAR f E �:/.;--,:,,,-• -_ I v—' l C J LICENSE NO. ?A 2� DATE ' HOUR ❑ A.M. BY LOCATION MAKE OF CAR—YEAR LICENSE NO. DATE HOUR ❑ A.M. ^r BY LOCATION MAKE OF CAR—YEAR LICENSE NO. F1440(Rev.4-901 . - vtii:0'0:11-•::,t�f.:��r:":�v� ���?Se•'•,-.�•'rF'i+h'i•?i;I:T,Ri�a�.. -- - --�::b�.m:':-'�.:•',-5:'i-;_:r-:t.�..n�. 'ibe�:,r :�«l.-_ 'bier �.:.-1 x4' ,stn Mrf .•. ..e:::.r. awRR pyo - .Ky{, ,,�,.�.'�::4:q. �� `•4• ;Y is�Q.+;r:9:�...RN Yad;•- ..gF,'i,I,.. ..^.:.::.r. E - .: .. ....:. ... .. .. ..�:.,.....J3..:.....1�..a.^�u.�':_�..�y�.�j•_r:.!:�s .,c ��''4�SrlY'.� ��"��.y ,';m: i min?,,tr.T3��• „a:��.� .. . _.... �+ •..,x{"-.-_� _ir...lam.lL:.R..: t`:.� :i,Ln.Y ems, �-J.�uCLR. :•��� � ' ..._.:' +.:' .... kt - ''Yi�ti� ��1}!. S'-•.._�0.4.. ,, .315.-�... !yr :l+j•`..R_-�'�'? �• . ' ia�;i`•.a'-•:. i;L�"�:SLS?:)4��r.{'v:x"'�,,i.' J .;R++;�.''.��t:*,'f. 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''t� - "••1`':f�.iw:.li �fa'}r;ij'"�'7:ki ei"y'. 9.; �.w� � sem: 'tc �rw`:.9.rr" :a'.r�•:- -..,:I I . �d'tiJ ?:r'v- T���. •�i�'4.fit= '��..:, a '-pa-C:.' . < : .' +i.i�•� i.. . .. ......,, . . .�. ,. . �., .:- .. �....._. .fit: .-i1j3... :�1:•z w,. •... _iiva'::� _ v�.5•,,�.,�,...ry,J��.�: -J.3[L�.e,7���'���~ i•.�i•+���i���riY�.•-'"�1�� . _ �•K',.-�- r:-4,_v1.u.$.Sis':xV'.al.�u'F.x:��T y,�j';[S�R•-: ,.I'::' _ _ - �,.Y E�-:+til.!•���''' -,sa1A 5,,.•,,,1.,,•1�• _ 301S 3SH3h3H 3H1: :SHOON3 '-AlH3d01id'313J,Sf1W V,HO:SIHl';`^::arab: . °'�Y _�u...v n':'.-::'�• - 7?:Gi^:'i.:_._'.;F'ro1F.:.;ti..'.o!•-:,r:���::`=','63'+5,:wT?'.;2•+7�r�:'''�:? r �• assi nment of claim and "'� g subrogation agreement g In consideration of the payment to the undersigned of the sum of a sum estimated to be Dollars, being the full amount of loss and damage insured against under an automobile insurance policy, number 66- KSaY''f issued to the undersigned by the CALIFORNIA STATE AUTOMOBILE ASSOCIATION INTER-INSURANCE BUREAU, said loss and damage having occurred on or about the 16 /11` day of 0(ft4'U'-0-'Y" 19-1-L, the said undersigned hereby assigns and transfers to said Bureau '"— s (d claim in the above amount plus additional claim for damage resulting from said accident, not a total covered under said policy of insurance, in the amount of$ � ' OJ , constituting ® a total estimated claim in the amount of$ 117(3/' a il- Said Bureau is hereby subrogated in place and stead to the extent of the above amount of the said total claim and is hereby authorized and empowered to sue, compromise or settle in name or other- wise to the extent of said total claim for loss and damage, and to endorse in my name any check made payable to me therefor, and collect and receive any money payable thereby. The undersigned covenants that 54P- ha5Z not released or discharged any such claim or demand against such party or parties and thatV-e— will furnish to said Bureau any and all papers and information in -'e-&- possession, necessary for the proper prosecution of such claim. Dated at ��t7 ! �� this `d of r WITNESS F1433 (REV.7-77)