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HomeMy WebLinkAboutMINUTES - 06171997 - C29 CLAIM C• P-7 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA June 17, 1997 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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 pursuante�rr++nment Code Amount: Exceeds $10,000.00 Section 913 and 915.4: Please note a 1;t;�.T[E„)� ) CLAIMANT: Wai Zeng (aka Wei Zheng) and MAY 2 2 1997 Wai On Chan (aka Huisong Chen) COUNTY COUNSEL ATTORNEY: Charles Hoehn MARTINEZ CALIF. Attorney at Law Date received ADDRESS: 137 Park Place BY DELIVERY TO CLERK ON May 19, 1997 Point Richmond, CA 94801 Hand Delivered BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: May 22, 1997 JVIL BAATTCUELOR, Clerk eputty 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: gVZA 1%wc G6-f& �rT,•.�c� carr u Dated: .� _ 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. 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. * For Additional Warning See Reverse Side Of This Notice. 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 C r Deputy Clerk CC: County Counsel County Administrator CLAIM AGAINST COUNTY OF CONTRA COSTA (CALIFORNIA GOVERNMENT CODE SECTION 910,ET SEQ) 1. Name and address of Claimants: � e Wai Zeng (aka WeiZheng) RECEIVE® Wai On Chan (aka Huisong Chen) MAY 19 1997 Address: 86-1 Houdu Road Ho Nam Room 701 CLERK SUPERVISORS CONTRA COSTA CO.O Guangzhou Guangdong People's Republic of China 510235 2. Address to which notices are to be sent: Charles Hoehn Attorney at Law 137 Park Place Point Richmond, California 94801 3. Date,place, and circumstances of occurrence which gave rise to claim: Claim arises from motor vehicle accident which occurred on November 20, 1996, at approximately 9:00 p.m,, on Highway 1-680, southbound, approximately 510 feet north of Pacheco Blvd. O/C in Contra Costa County, California. Jackey Siu Hung Cheng was driving southbound on said highway. Claimants' daughter, Lishan Cheng(date of birth: 9/25/54), who was married to Mr. Cheng, was a passenger in the vehicle along with David Cheng(date of birth: 8/24/96). Due to highway construction activity,the left and middle southbound lanes were closed off by placement of cones, and Mr. Cheng and other motorists moved into the open right lane. After Mr. Cheng had gone some distance in the right lane, the cones stopped and it appeared that the lane closures had ended and that all lanes were open again. Mr. Cheng changed lanes to his left and had traveled a short distance when he suddenly saw cones just ahead of him, closing down his lane. There was no warning or notice regarding the cones, or that the left and middle southbound lanes would again be closed. Mr. Cheng tried to move back into the right lane but was prevented from doing so by the presence of a large tractor-trailer. His vehicle then struck one or more of the cones and went out of control, off the right side of the highway, and down an embankment. Lishan Chang was seriously injured and died on November 21, 1996, from her injuries and as a proximate result of the wrongful conduct and/or omissions set forth below. Claim is based upon: (a)negligent ownership, maintenance and control of said highway and property at and around the location of said accident;(b)negligent performance, conduct, supervision, direction, monitoring, and control of construction activity and lane closures, including cone placement, at and around said location, including, without limitation,placement of cones in a manner and pattern that was deceptive and misled motorists to reasonably believe that lane closures had ended;failing to warn or notify motorists of further lane closures or that previous lane closures had not ended after it reasonably appeared that lanes had been opened; and failing to adequately and properly monitor, direct, and control the movement and speed of traffic in area where construction activity and lane closures were taking place; (c)negligence in the abovementioned particulars on the part of independent contractors and other persons and/or entities for whose conduct and/or omissions the County of Contra Costa is liable; and(d)that the condition of said highway and property at and around the location of said accident, resulting from the deceptive and misleading cone placement and lack of warning or notice of further lane closures or that previous lane closures had not ended after it reasonably appeared that lanes had opened, constituted a dangerous condition of public property which created a substantial risk of injury to motorists driving on said highway with due care and in a reasonably foreseeable manner. The death of Lishan Cheng was proximately caused by such dangerous condition and was reasonably foreseeable as a consequence of the dangerous condition. Said dangerous condition was created by the negligent or wrongful acts and/or omissions of one or more employees of the County of Contra Costs within the scope of his or her employment, and/or by the negligent or wrongful acts and/or omissions of one or more independent contractors and/or other persons or entities for whose conduct the County of Contra Costa is liable. The County of Contra Costa had actual or constructive notice of the dangerous condition a sufficient time prior to said accident to have taken measures to protect motorists, including Claimants' decedent, against said dangerous condition, but failed to take such measures. 4. A general description of each Claimant's injuries, damages, and loss: Claimants are the parents and heirs of Lishan Cheng, deceased. As a direct and proximate result of the wrongful conduct and/or omissions described above, and the death of Lishan Cheng proximately caused thereby, each Claimant has been deprived of said decedent's love, affection, support, care, comfort, society,presence,protection, services and companionship, and each Claimant has thus suffered pecuniary loss. 5. The name or names of the public employee or employees causing the injuries, damages, and loss, if known: Unknown, as to employees of the County of Contra Costa. Public employees, identified as Caltrans personnel, who were apparently present when the accident occurred include Mohammed Kahn, Carolyn Bolander, and Rahi Kamfar. In addition, Claimant is informed and believes that R.M. Harris, contractor, and an entity called Company of Flash Safety may have been involved in construction activity and/or lane closures at and around the location of the accident. 6. Amount of claim; court jurisdiction over claim: Amount of each Claimant's claim exceeds ten thousand dollars($10,000.00);therefore, no specific dollar amount is stated in accordance with California Government Code Section 910. Jurisdiction over claim would rest in Superior Court. DATED: May 18,1997 Charles Hoehn Attorney at Law Attorney/Representative of Claimants CLAIM ��rq BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA :' ► June 17, 1997 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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: $10,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Nan Hui Choe lamcmirvZIM) ATTORNEY: John C. Ferry 200 Gregory Lane, Ste. B-2 Date received MAY 2 1997 ADDRESS: Pleasant Hill, CA 94523-0646 BY DELIVERY TO CLERK ON May 15 i'1 Co" 491VALIF. BY MAIL POSTMARKED: Hand Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: May 20, 1997 IVIL BATTCUELOR, Clerk eputyII. 12 FROM: County Counsel TO: Clerk of the Board of Supervisors (X,) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days.(Section 910.8). ( ) Claim is not timely filed. 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: S'1i� f� BY: iGA /r •� 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 ( J ) 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: 1997 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. * For Additional Warning See Reverse Side Of This Notice. 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. 1 Dated: def 18 1997 BY: PHIL BATCHELOR by\� Q,,�Z)_Deputy Clerk CC: County Counsel County Administrator C1a 'to: BOARD OF SOPEF7MRS OF CONTRA COSTA CD= D137RUMONS M CL.ADiAN7 A* Mimi 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 actien 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 mare 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. 0 a s * ! • • ! * 11 a 0 a • f f f f 5 • s 0 i ! a i 0 f f s f 0 f • ! • i f E * * f RE: Maim By ` ) Reserved for Clerk's filing stamp RECEIVED Inst t County of Contra Costa ) A �� 1 or ) I T MAY 15 1997 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 $ /0 000 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) A 2 #' q)�©cA J -3100M 2. = did the damage or injury occur? (Include city and county) r e-z COA4[2- C06 Li ' J lac f��Id� 6,f4,/ 5er c eS e �s a1 3. Now did the6mage or injury occur? (Give !till details; use extra paper if ? 9crquired) Oncc tAke �� �lprN�Ay o '- 1�1r 34l��f svpe�v- s.� Ar��a •iv, 11N. � (��c�� a�5�rati � o� a 4Qn5t Q����YQ �cr`�ron���a[ set c��s,� ��e e��J��i �ie% `OILY COb' 01 C9"01+y Gv f0►dIOK 5. e cRA�e EO Mle G>!iy�or SQA . f MZ �„,, 4 _4(&eS/-�Fe S �s .w se �� r 4 o tnQrgssrnetif - i s et f4KW'0-1 rl 4. What particular act or omission on the part of county or district officers, Cf;Sis, servants or employees caused the injury or damage? wq5 der►1 'S P� 'r�bh to pC-MwA eNk b� M� pepa(�M&V� was (o- 25- RO SNA was TeM ?,ofq,r� qll + �`imel . Mi 4 OA'e r n er g "4 Pam \ Mk otv�e4 0� P&e” wa s (over) �' y What are the names of county or district officers, servants or employees causing the. damage or injury? Ari I► �R G�cX 3� ` - /�e�L�i�Vie('I/r`e es ,e _ 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach}two estimates for for auto )damage. / f 4ne'Fmo4lonq( v-Ix5S 'foss oF ,t�e�v�-S /OSS' P9" �)0& G04 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 6 aAOu,(1 �1 SPS 1o�fi I/�� �®q S. Names and addresses of witnesses, doctors and hospitals. -VO be, prov;deJ 1 rtfC 9. List the expenditures you made on account of this accident or injury: DATE IM � f � f f # � f i � f f f A � i � i f • i � • A f • • � � f � f f i A ! � f i � # • Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SM NOTICES TO: (Attorney) or by some Person on his behalf." Name and Address of Attorney 50kN C, FW� Claimants signature A gNS23^DGS{ — Address 54 ix Telephone No. Telephone No. S fl # 000960es09aa9a 1 9 a aTTifef 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 oounty, 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. CLAIM 7 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA June 17, 1997 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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 ��� . Amount: Exceeds 10,000.00 Section 913 and 915.4. Please note all gsy CLAIMANT: Jackey Siu Hung Cheng MAY 2 2 1997 ATTORNEY: COUNTY COUNSEL Date received MARTINEZ CALIF, ADDRESS: 5422 Jade Creek Way BY DELIVERY TO CLERK ON May 19, 1997 Elk Grove, CA 95758 BY MAIL POSTMARKED: Hand Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: May 22, '1997 11i1. BATTCUELOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors Q0 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: A44 Dated: �,i�/��7 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. Dated: JUN 17 1997 PHIL BATCHELOR, Clerk, B , Deputy Clerk I 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. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein meAtioned, 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�sh�own9,pove. � Dated: cJ ( BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator AV CLAIM AGAINST COUNTY OF CONTRA COSTA (CALIFORNIA GOVERNMENT CODE SECTION 910, ET SEO ) I. Name and address of Claimant: � d ` Jackey Siu Hung Cheng 5422 Jade Creek Way RECEIVED Elk Grove, California 95758 MAY 19 1997 2. Address to which notices are to be sent: CLERIC BOARD OF SUPERVISORS Jackey Siu Hung Cheng CONTRA COSTA CO. 5422 Jade Creek Way Elk Grove, California 95758 3. Date,place, and circumstances of occurrence which gave rise to claim: Claim arises from motor vehicle accident which occurred on November 20, 1996, at approximately 9:00 p.m., on Highway 1-680, southbound, approximately 510 feet north of Pacheco Blvd. O/C in Contra Costa County, California. Claimant was driving southbound on said highway and his wife, Lishan Cheng(date of birth: 9/25/54), and son David Cheng(date of birth: 8/24/96)were passengers in the vehicle. Due to highway construction activity, the left and middle southbound lanes were closed off by placement of cones, and Claimant and other motorists moved into the open right lane. After Claimant had gone some distance in the right lane, the cones stopped and it appeared that the lane closures had ended and that all lanes were open again. Claimant changed lanes to his left and had traveled a short distance when he suddenly saw cones just ahead of him, closing down his lane. There was no warning or notice regarding the cones, or that the left and middle southbound lanes would again be closed. Claimant tried to move back into the right lane but was prevented from doing so by the presence of a large tractor-trailer. Claimant's vehicle then struck one or more of the cones and went out of control, off the right side of the highway, and down an embankment. Claimant, his wife, and his son were seriously injured. Claimant's son, David Cheng, died from his injuries at approximately 10:40 p.m. on November 20, 1996. Claimant's wife, Lishan Cheng, died from her injuries at approximately 3:49 p.m. on November 21, 1996. Claim is based upon: (a)negligent ownership, maintenance and control of said highway and property at and around the location of said accident;(b)negligent performance, conduct, supervision, direction, monitoring, and control of construction activity and lane closures, including cone placement, at and around said location, including, without limitation, placement of cones in a manner and pattern that was deceptive and misled motorists, including Claimant,to reasonably believe that lane closures had ended;failing to warn or notify motorists, including Claimant, of further lane closures or that previous lane closures had not ended after it reasonably appeared that lanes had been opened; and failing to adequately and properly monitor, direct, and control the movement and speed of traffic in area where construction activity and lane closures were taking place; (c)negligence in the abovementioned particulars on the part of independent contractors and other persons and/or entities for whose conduct and/or omissions the County of Contra Costa is liable; and(d)that the condition of said highway and property at and around the location of said accident, resulting from the deceptive and misleading cone placement and lack of warning or notice of further lane closures or that previous lane closures had not ended after it reasonably appeared that lanes had opened, constituted a dangerous condition of public property which created a substantial risk of injury to motorists driving on said highway with due care and in a reasonably foreseeable manner. Said dangerous condition was created by the negligent or wrongful acts and/or omissions of one or more employees of the County of Contra Costa within the scope of his or her employment, and/or by the negligent or wrongful acts and/or omissions of one or more independent contractors and/or other persons or entities for whose conduct the County of Contra Costa is liable. The County of Contra Costa had actual or constructive notice of the dangerous condition a sufficient time prior to said accident to have taken measures to protect motorists, including Claimant, his wife, and his son, against said dangerous condition, but failed to take such measures. 4. A general description of Claimant's injuries, damages, and loss: As a direct and proximate result of the wrongful conduct and/or omissions described above, and the death of Lishan Cheng proximately caused thereby, Claimant has been deprived of said decedent's love, affection, support, care, comfort, society,presence, services, consortium, and companionship, and has thus suffered pecuniary loss; and has incurred funeral and burial expenses relating to said decedent. 5. The name or names of the public employee or employees causing the injuries, damages, and loss, if known: Unknown, as to employees of the County of Contra Costa. Public employees identified as Caltrans personnel who were apparently present when the accident occurred include Mohammed Kahn, Carolyn Bolander, and Rahi Kamfar. In addition, Claimant is informed and believes that R.M. Harris, contractor, and an entity called Company of Flash Safety may have been involved in construction activity and/or lane closures at and around the location of the accident. 6. Amount of claim; court jurisdiction over claim: Amount of claim exceeds ten thousand dollars($10,000.00);therefore, no specific dollar amount is stated pursuant to California Government Code Section 910. Jurisdiction over claim would rest in Superior Court. DATED: May 18,1997 JackVy Siu 1,1ung Cheng 1(7 Claimant I CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA June 17, 1997 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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 Gol1v��ernmentCode�� r Amount: Exceeds $10,000.00 Section 913 and 915.4. Please note al 7W R�r CLAIMANT: Jackey Siu Hung Cheng MAY 2 2 1997 ATTORNEY: COUNTY COUNSEL Date received MARTINEZ CALIF. ADDRESS: 5422 Jade Creek Way BY DELIVERY TO CLERK ON May 19, 1997 Elk Grove, CA 95758 BY MAIL POSTMARKED: Hand Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: May 22, 1997 I(,jIL BePuHtyLOR, Clerk , 61 II. FROM: County Counsel TO: Clerk of the Board of Supervisors (RC1 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 910.6). ( ) 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: /a4AV �L� �C� c�liGvuv st F� Dated: Jr'e;k 7'/ 7 BY: Z�Alc� 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 (J ) 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: AN 17 1997 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. * For Additional Warning See Reverse Side Of This Notice. 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 16; 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�showw9ftbove. r J&1 Dated: BY: PHIL BATCHELOR byQA.,BAz.Deputy Clerk CC: County Counsel County Administrator P CLAIM AGAINST COUNTY OF CONTRA COSTA (CALIFORNIA GOVERNMENT CODE SECTION 910, ET SEQ) 1. Name and address of Claimant: Jackey Siu Hung Cheng /� 5422 Jade Creek Way RECEIVED Elk Grove, California 95758 MAY 19 1997 2. Address to which notices are to be sent: CLERK BOARD OF SUPERVISORS Jackey Siu Hung Cheng C N COSTA CO. 5422 Jade Creek Way Elk Grove, California 95758 T' 3. Date,place, and circumstances of occurrence which gave rise to claim: Claim arises from motor vehicle accident which occurred on November 20, 1996, at approximately 9:00 p.m., on Highway I-680, southbound, approximately 510 feet north of Pacheco Blvd. O/C in Contra Costa County, California. Claimant was driving southbound on said highway and his wife, Lishan Cheng(date of birth: 9/25/54), and son David Cheng (date of birth: 8/24/96)were passengers in the vehicle. Due to highway construction activity, the left and middle southbound lanes were closed off by placement of cones, and Claimant and other motorists moved into the open right lane. After Claimant had gone some distance in the right lane, the cones stopped and it appeared that the lane closures had ended and that all lanes were open again. Claimant changed lanes to his left and had traveled a short distance when he suddenly saw cones just ahead of him, closing down his lane. There was no warning or notice regarding the cones, or that the left and middle southbound lanes would again be closed. Claimant tried to move back into the right lane but was prevented from doing so by the presence of a large tractor-trailer. Claimant's vehicle then struck one or more of the cones and went out of control, off the right side of the highway, and down an embankment. Claimant, his wife, and his son were seriously injured. Claimant's son, David Cheng, died from his injuries at approximately 10:40 p.m. on November 20, 1996. Claimant's wife, Lishan Cheng, died from her injuries at approximately 3:49 p.m. on November 21, 1996. Claim is based upon: (a)negligent ownership, maintenance and control of said highway and property at and around the location of said accident;(b)negligent performance, conduct, supervision, direction, monitoring, and control of construction activity and lane closures, including cone placement, at and around said location, including, without limitation,placement of cones m a manner and pattern that was deceptive and misled motorists, including Claimant, to reasonably believe that lane closures had ended;failing to warn or notify motorists, including Claimant, of further lane closures or that previous lane closures had not ended after it reasonably appeared that lanes had been opened; and failing to adequately and properly monitor, direct, and control the movement and speed of traffic in area where construction activity and lane closures were taking place;(c)negligence in the abovementioned particulars on the part of independent contractors and other persons and/or entities for whose conduct and/or omissions the County of Contra Costa is liable; and(d)that the condition of said highway and property at and around the location of said accident, resulting from the deceptive and misleading cone placement and lack of warning or notice of further lane closures or that previous lane closures had not ended after it reasonably appeared that lanes had opened, constituted a dangerous condition of public property which created a substantial risk of injury to motorists driving on said highway with due care and in a reasonably foreseeable manner. Said dangerous condition was created by the negligent or wrongful acts and/or omissions of one or more employees of the County of Contra Costa within the scope of his or her employment, and/or by the negligent or wrongful acts and/or omissions of one or more independent contractors and/or other persons or entities for whose conduct the County of Contra Costa is liable. The County of Contra Costa had actual or constructive notice of the dangerous condition a sufficient time prior to said accident to have taken measures to protect motorists, including Claimant, his wife, and his son, against said dangerous condition,but failed to take such measures. 4. A general description of Claimant's injuries, damages, and loss: As a direct and proximate result of the wrongful conduct and or omissions described above, Claimant sustained serious bodily injuries, including but not limited to right humeral fracture, multiple rib fractures, and injury to cerival spine;incurred medical, hospital, and related expenses to date, and will incur such expenses in the future; sustained loss of earnings to date, and will sustain future loss of earnings/impairment of earning capacity; and sustained and will in the future sustain general damages for pain and suffering, disability, anxiety, and distress. Amount of claim exceeds $10,000.00. 5. The name or names of the public employee or employees causing the injuries, damages, and loss, if known: Unknown, as to employees of the County of Contra Costa. Public employees identified as Caltrans personnel who were apparently present when the accident occurred include Mohammed Kahn, Carolyn Bolander, and Rahi Kamfar. In addition, Claimant is informed and believes that RM. Harris, contractor, and an entity called Company of Flash Safety may have been involved in construction activity and/or lane closures at and around the location of the accident. 6. Amount of claim; court jurisdiction over claim: Amount of claim exceeds ten thousand dollars($10,000.00);therefore,no specific dollar amount is stated pursuant to California Government Code Section 910. Jurisdiction over claim would rest in Superior Court. DATED: May 18,1997 Jac ey Siu Aung Cheng Claimant CLAIM C. Z= BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA June 17, 1997 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of thus 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: Exceeds $10,000.00 Section 913 and 915.4. Please note all CLAIMANT: Jackey Siu Hung Cheng MAY 2 2 1997 ATTORNEY: COUNTY COUNSEL Date received MARTINEZ CALIF. ADDRESS: 5422 Jade Creek Way BY DELIVERY TO CLERK ON May 19, 1997 Elk Grove, CA 95758 - BY MAIL POSTMARKED: Hand Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. BaQ IL BATCVIELOR, Clerk DATED:_ Ma��, 1997 : Depu y II. FROM: County Counsel TO: Clerk of the Board of Supervisors 00 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). (k) Other: /� vnC� lw"01. d? Dated: .� �a 7�y BY: � Deputy County Counsel II1. 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: JUN 17 1997 PHIL BATCHELOR, Clerk, BY-41,A2, � 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. * For Additional Warning See Reverse Side Of This Notice. 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 1 8 1997 BY: PHIL BATCHELOR by �QiDeputy Clerk CC: County Counsel County Administrator CLAIM AGAINST COUNTY OF CONTRA COSTA (CALIFORNIA GOVERNMENT CODE SECTION 910,ET SEO ) 1. Name and address of Claimant: Jackey Siu Hung Cheng 5422 Jade Creek Way RECEIVED Elk Grove, California 95758 MAY 19 1997 2. Address to which notices are to be sent: CLERK BOARD OF S! r_"SORS Jackey Siu Hung Cheng COPITRA COSI A CO. 5422 Jade Creek Way Elk Grove, California 95758 ' 3. Date,place, and circumstances of occurrence which gave rise to claim: Claim arises from motor vehicle accident which occurred on November 20, 1996, at approximately 9:00 p.m., on Highway I-680, southbound, approximately 510 feet north of Pacheco Blvd. O/C in Contra Costa County, California. Claimant was driving southbound on said highway and his wife, Lishan Cheng (date of birth: 9/25/54), and son David Cheng (date of birth: 8/24/96)were passengers in the vehicle. Due to highway construction activity, the left and middle southbound lanes were closed off by placement of cones, and Claimant and other motorists moved into the open right lane. After Claimant had gone some distance in the right lane, the cones stopped and it appeared that the lane closures had ended and that all lanes were open again. Claimant changed lanes to his left and had traveled a short distance when he suddenly saw cones just ahead of him, closing down his lane. There was no warning or notice regarding the cones, or that the left and middle southbound lanes would again be closed. Claimant tried to move back into the right lane but was prevented from doing so by the presence of a large tractor-trailer. Claimant's vehicle then struck one or more of the cones and went out of control, off the right side of the highway, and down an embankment. Claimant, his wife, and his son were seriously injured. Claimant's son, David Cheng, died from his injuries at approximately 10:40 p.m. on November 20, 1996. Claimant's wife, Lishan Cheng, died from her injuries at approximately 3:49 p.m. on November 21, 1996. Claim is based upon: (a)negligent ownership, maintenance and control of said highway and property at and around the location of said accident; (b)negligent performance, conduct, supervision, direction, monitoring, and control of construction activity and lane closures, including cone placement, at and around said location, including, without limitation,placement of cones in a manner and pattern that was deceptive and misled motorists, including Claimant, to reasonably believe that lane closures had ended;failing to warn or notify motorists, including Claimant, of further lane closures or that previous lane closures had not ended after it reasonably appeared that lanes had been opened; and failing to adequately and properly monitor, direct, and control the movement and speed of traffic in area where construction activity and lane closures were taking place; (c)negligence in the abovementioned particulars on the part of independent contractors and other persons and/or entities for whose conduct and/or omissions the County of Contra Costa is liable; and(d)that the condition of said highway and property at and around the location of said accident, resulting from the deceptive and misleading cone placement and lack of warning or notice of further lane closures or that previous lane closures had not ended after it reasonably appeared that lanes had opened, constituted a dangerous condition of public property which created a substantial risk of injury to motorists driving on said highway with due care and in a reasonably foreseeable manner. Said dangerous condition was created by the negligent or wrongful acts and/or omissions of one or more employees of the County of Contra Costa within the scope of his or her employment, and/or by the negligent or wrongful acts and/or omissions of one or more independent contractors and/or other persons or entities for whose conduct the County of Contra Costa is liable. The County of Contra Costa had actual or constructive notice of the dangerous condition a sufficient time prior to said accident to have taken measures to protect motorists, including Claimant,his wife, and his son, against said dangerous condition, but failed to take such measures. 4. A general description of Claimant's injuries, damages, and loss: As a direct and proximate result of the wrongful conduct and/or omissions described above, and the death of David Cheng proximately caused thereby, Claimant has been deprived of said decedent's love, affection, support, care, comfort, society, presence, protection, services, and companionship, and has thus suffered pecuniary loss; and has incurred funeral and burial expenses relating said decedent. 5. The name or names of the public employee or employees causing the injuries, damages, and loss, if known: Unknown, as to employees of the County of Contra Costa. Public employees identified as Caltrans personnel who were apparently present when the accident occurred include Mohammed Kahn, Carolyn Bolander, and Rahi Kamfar. In addition, Claimant is informed and believes that R.M. Harris, contractor, and an entity called Company of Flash Safety may have been involved in construction activity and/or lane closures at and around the location of the accident. 6. Amount of claim; court jurisdiction over claim: Amount of claim exceeds ten thousand dollars($10,000.00);therefore,no specific dollar amount is stated pursuant to California Government Code Section 910. Jurisdiction over claim would rest in Superior Court. DATED: May 18,1997 Jacket' Siu Hdng Cheng Claimant • CLAIM C. 2-f BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA June 17, 1997 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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: Exceeds $10,000.00 Section 913 and 915.4. Please note all CLAIMANT: Jackey Siu Hung Cheng �LL�� L� (as successor in interest of Lishan Cheng, deceased MAY 2 2 1997 ATTORNEY: Date received COUNTYCOUNSEL ADDRESS: 5422 Jade Creek Way BY DELIVERY TO CLERK ON May 19, 1997 MARTINEZ CALIF. Elk Grove, CA 95758 BY MAIL POSTMARKED: Hand Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of.the above-noted claim. DATED: May 22, 1997 �aIL �ep�HtJ! Clerk /1 II. FROM: County Counsel TO: Clerk of the Board of Supervisors (X) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days.(Section 910.8). ( ) Claim is not timely filed. 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: Aig WII.(/hU 64 1W,10 A&—&,1 Dated: -S--27 -17 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, 17 X997 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. * For Additional Warning See Reverse Side Of This Notice. 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 1 8 1997 BY: PHIL BATCHELOR b QA Deputy Clerk CC: County Counsel County Administrator CLAIM AGAINST COUNTY OF CONTRA COSTA (CALIFORNIA GOVERNMENT CODE SECTION 910, ET SEO. 1. Name and address of Claimant: Jackey Siu Hung Cheng (as successor in interest of Lishan Cheng, deceased) 5422 Jade Creek Way Elk Grove, California 95758 �H� RECEIVED 2. Address to which notices are to be sent: Jackey Siu Hung Cheng MAY 19 1997 5422 Jade Creek Way CLERIC BOARD OF SUPERVISORS Elk Grove, California 95758 ONTRA COSTA CO. 'J, ,(?e-� �&--) 3. Date,place, and circumstances of occurrence which gave rise to claim: ' Claim arises from motor vehicle accident which occurred on November 20, 1996, at approximately 9:00 p.m., on Highway 1-680, southbound, approximately 510 feet north of Pacheco Blvd. O/C in Contra Costa County, California. Claimant was driving southbound on said highway and his wife, Lishan Cheng (date of birth: 9/25/54), and son David Cheng (date of birth: 8/24/96)were passengers in the vehicle. Due to highway construction activity, the left and middle southbound lanes were closed off by placement of cones, and Claimant and other motorists moved into the open right lane. After Claimant had gone some distance in the right lane,the cones stopped and it appeared that the lane closures had ended and that all lanes were open again. Claimant changed lanes to his left and had traveled a short distance when he suddenly saw cones just ahead of him, closing down his lane. There was no warning or notice regarding the cones, or that the left and middle southbound lanes would again be closed. Claimant tried to move back into the right lane but was prevented from doing so by the presence of a large tractor-trailer. Claimant's vehicle then struck one or more of the cones and went out of control, off the right side of the highway, and down an embankment. Claimant, his wife, and his son were seriously injured. Claimant's son, David Cheng, died from his injuries at approximately 10:40 p.m. on November 20, 1996. Claimant's wife, Lishan Cheng, died from her injuries at approximately 3:49 p.m. on November 21, 1996. Claim is based upon: (a)negligent ownership, maintenance and control of said highway and property at and around the location of said accident; (b)negligent performance, conduct, supervision, direction, monitoring, and control of construction activity and lane closures, including cone placement, at and around said location, including, without limitation, placement of cones in a manner and pattern that was deceptive and misled motorists, including Claimant, to reasonably believe that lane closures had ended;failing to warn or notify motorists, including Claimant, of further lane closures or that previous lane closures had not ended after it reasonably appeared that lanes had been opened; and failing to adequately and properly monitor, direct, and control the movement and speed of traffic in area where construction activity and lane closures were taking place; (c)negligence in the abovementioned particulars on the part of independent contractors and other persons and/or entities for whose conduct and/or omissions the County of Contra Costa is liable; and(d)that the condition of said highway and property at and around the location of said accident, resulting from the deceptive and misleading cone placement and lack of warning or notice of further lane closures or that previous lane closures had not ended after it reasonably appeared that lanes had opened, constituted a dangerous condition of public property which created a substantial risk of injury to motorists driving on said highway with due care and in a reasonably foreseeable manner. Said dangerous condition was created by the negligent or wrongful acts and/or omissions of one or more employees of the County of Contra Costa within the scope of his or her employment, and/or by the negligent or wrongful acts and/or omissions of one or more independent contractors and/or other persons or entities for whose conduct the County of Contra Costa is liable. The County of Contra Costa had actual or constructive notice of the dangerous condition a sufficient time prior to said accident to have taken measures to protect motorists, including Claimant, his wife, and his son, against said dangerous condition, but failed to take such measures. 4. A general description of Claimant's injuries, damages, and loss: Claimant's wife, Lishan Cheng, died on November 21, 1996, as a proximate result of injuries sustained in said accident. Prior to her death, Lishan Cheng incurred medical and hospital expenses in excess of$10,000.00 as a direct and proximate result of the wrongful conduct and/or omissions described in paragraph 3 above. Claimant is said decedent's successor in interest(as defined in Section 3 77.11 of the California Code of Civil Procedure) and succeeds to said decedent's claim and cause of action for recovery of said medical and hospital expenses. 5. The name or names of the public employee or employees causing the injuries, damages, and loss, if known: Unknown, as to employees of the County of Contra Costa. Public employees identified as Caltrans personnel who were apparently present when the accident occurred include Mohammed Kahn, Carolyn Bolander, and Rahi Kamfar. In addition, Claimant is informed and believes that RM. Harris, contractor, and an entity called Company of Flash Safety may have been involved in construction activity and/or lane closures at and around the location of the accident. 6. Amount of claim; court jurisdiction over claim: Amount of claim exceeds ten thousand dollars($10,000.00);therefore,no specific dollar amount is stated pursuant to California Government Code Section 910. Jurisdiction over claim would rest in Superior Court. DATED: May 18,1997 Jac a 14u ng Siu n g Chen g Claimant Declaration of Jackey Siu Hung Cheng Pursuant to California Code of Civil Procedure Section 377.32 I, Jackey Siu Hung Cheng, declare: 1. The name of the decedent is Lishan Cheng. 2. Lishan Cheng died on November 21, 1996 in Walnut Creek, California, as the result of injuries sustained in a motor vehicle accident on November 20, 1996. 3. No proceeding is now pending in California for administration of the decedent's estate. 4. Declarant is the surviving husband of the decedent and is decedent's successor in interest(as defined in Section 377.11 of the California Code of Civil Procedure) and succeeds to the decedent's claim and cause of action for medical and hospital expenses incurred by decedent prior to her death, as a proximate result of the abovementioned accident. No other person has a superior right to commence such claim or action. I declare under penalty of perjury under the law of the State of California that the foregoing is true and correct. Executed this 18th day of May, 1997, at Point Richmond, California. JacW Siu Hfmg Cheng Declarant T, 'er-7 r -AA :�1 STATE OF CALIFORNIA • DEPARTMENT OF HEALTH SERVICES 39607005393 CERTIFICATE OF DEATH L I SHANZENG I CHENG DAra ­01-1, 13. M _11—I al F 6 09/25/1954 42 D. T.I..1— I M­­­ DECCDCNT Cn ­T­ hi a 517-82-0379 non[ Married I 14 Chinese Self-employed 17.­­ Homemaker Own,Home. 2 121,11, USUAL 5422 Jade Creek Way 22 Elk Grove I Sacramento 95758 2 CA 21*1— z", Alice Cheng - Sister-in-law 7336 Pebble Beach Drive, El Cerrito, CA 94530 ­—ST 29. slou.a Jackey I Siu Hung Cheng _o 32. 33 LI.Z, I ...I,_ wcoarAnoN, Z Wa i enq China .J Wai On Chan I China r../eD/cc.•: afMamOMflY f Sunset View Cemetery, 101'Colusa Avenue, El Cerrito, CA Cl 8U NOT EMBALMED ALR fi A. AlaMttOw Ellis-Olson Mortuary I A S;7 Do-73-4' I j_4A=,"_ LOCAL 01 ­A1 fKca. NCA Ej E] JOHN MUIR HOSPITAL CONTRA COSTA t16 1601 YGNACIO VALLEY ROAD WALNUT CREEK 107.M­ M*Vna.Da A.H.C. 01 arlanrri 1...MAI.—TO .17Taa I—AL— im BLUNT-FORCE INJURIES OF THE HEAD A14D CHEST DAY 96-1680 i J5 U.To In MOTOR VEHICLE ACCIDENT DAY CAUS6 OU.TO ICI OCAfN 2 W —.To W. I ol 1..107 Da1121 11 1...Us.1— "T Z"I ol Z11l �2o. E-1 121. =L07 1 PUBLIC ROADWAY 21 F cA... 1/20/1996 12, 0 PASSENGER EJECTED IN SOLO MOTOR VEHICLE ACCIDENT i:v. I.—ANrm 7 SOUTHBOUND HIGHWAY 680, NORTH OF PACHECO BOULEVARD OVERCROSSING, MARTINEZ, CA 94553 ki 126.1 ­7 1.'.—­7 11/22/1996" rLOYD 3UODGRAS5. DEPUTY-CORONER ? E L STAT9 JA 10? IC D IC 1630 LG 230847 lie This is to certify that this document is a true copy of the official record filed with the .... .. Office of Vital-Records and Statistics. S Kimberly Belshe.Difector and State Registrar of Vital Records and Statistics r 4 X11' 1 c t 4 by: N GEORGE B.(PETER)ABBOTT.JR..M.D..M.P.H..CHIEF DATE ISSUED OFFICE OF VITAL RECORDS AND STATISTICS This copy not valid unless prepared on engraved border di.,4ANg.,31 an'd J _297,e of Registrar. —.1 17 .. . . . .. ... ..�.,, ` ,,� :u_�EIr � � � ',�'�f�\� �s.:l ..•�JZ'.\� d� \... � a�"� '��j� 3 =s✓l '�., 4 •. l t 3q .� �'a 3a' •�aC,�'"•��,�� '�„?1'It'J'� {� �{; � � F- M;p� ..n.\ K"F� '�-�.ma� �.�� vim:< _».� % r 'r` rw., �.a. � �5..� .� ��•� ..ter v� --„,,�' � l STATE OF CALIFORNIA DEPARTMENT OF HEALTH SERVICES _ AFFIDAVIT TO AMEND A RECORD 3?6 0-7&050%� M^ 0 EIRTN ® ...— El FEIwL OFATH NO rxeslafts,wwtTaus.OR utrxAnDHs STATE/LOCAL 1. 2. a_. Fgt,t REGISTRAR USE ONLY PART I INFORMATION TO LOCATE RECORD—TYPE OR PRINT IN BLACK INK ONLY F_ NAME AS IT 1.NAME—FIRST IGNENI 2.MIOOLE '3.LAST IFAwllvl _— S,- APPEARS ON ' RECORD 1 LISHAN ZENG CHENG 4. SEX I S.DATE OF EVENT—MM/DO/CCYY G.CITY OF OCCURRENCE '7.COUNTY OF OCCURRENCE IY' ADDITIONAL F 11/21/1996 Walnut Creek'--' - ' 1 INFORMATION I Contra Co$td '�j: TO LOCATE 6.FATHER'S NAME AS STATED ON ORIGINAL ...�- .. 19.MOTHER'S NAME AS STATED ON ORIGINAL RECORD _ -' - •ski Wai Zeng Wai On Chan` PART II STATEMENT OF CORRECTIONS—NO ERASURES'. WHITEOUTS_OR ALTERATIONS. I` 110.CERTIFICATI 11.INFORMATION AS IT APPEARS ON ORIGINAL.RECORD� 12.INFORMATION AS IT SHCULO-APPEAR RZ 10 517-82-0379624-78-9589 f?�� LIST ONE , - - ��'• ITEM PER LINE ( - ` ! f;i� i ky: —r — REASON FOR 13. Incorrect information provided by family - CORRECTION �� 1 AFFIDAVITS I ' AND We, the unaersigned, hereby certify under penalty of perjury that we have personal knowledge of the above I acts SIGNATURES and that thR information given above is true and correct. 14.SII(G,,NATURE OF FIRRsr PERSON 15. 15.TITLE/RELATIONSHIP TO PERSON IN PART 1 16.DATE SIGNED—MM/DD/CCYY TwoPERSONS I► I r'v)I,iQ.v.e.Q.�S I. -L.D�I. I Funeral Director 12/13/1996 0. MUST SIGN 17 AGE IR.ADDRESS.TREET.[.ITV,.4TATl...I THIS FORM Adult ; 727 San Pablo Avenue, Albany, CA 94706 _ 19.SIGN RE OF SECO�Q PERSON 120.TITLE/RELATIONSHIP TO PERSON IN PART 1 :21,DATE SIGNEO—MM/00/CCYY USE I / } Funeral Director Secretary 12;13/1956 BLACK INK ONLY 22.A 23.ADDRESS ISTREET.G:T'.STATE.LPI ZLW Adult 727 San Pablo Avenue, Albany, CA 94706 Mod STArVLCCAU .4.SIGNATURE OF STATE OR LOCAL REGISTRAR :2S,DATE ACCEPTED Fi Q RE a:STRA TION—MM/CD CCYY REGISTRAn dfME OF THE STATE REGISTRA4 n(� USE ONLY �` ► Of VITAL STATISTtG I U 1 Z 1 L7 7 9 7 SUIT of C1117001"A.oltAE114111 OI AM-4 St CY1CrS TNnCt tY still V!(AIRAW 230851 .u�uu�uggpUptl ,'.. ��., :. -' � � - ��..��cu�t`\��•ttthmtt r F IIIUpthf This is to certify that this document is a true copy of the official record filed with the T lhrry Office of Vital Records and Statistics. S.Kimberly Belshe.Di ector and State Registrar of Vital Records and Statistics �� ' GEORGE B.(PETER)ABBOTT,JR..M.D.,M.P.H.,CHIEF D TE S o SAN 1 pi.,A,llR, OFFICE OF VITAL RECORDS AND STATISTICS $ a This copynot valid unless prepared un rn•raved border di-s” 1Y 1ng seal and signature of Registrar. P P' SP g [h \�L.rr.nnN``�.ryr:4vyrrrv.r,wrw4rd-v1dr,+-.-srYi�Fjwbevrr!`!•Iwervmrmr.v4r.rir'�rirwridrbwSrwlYwYztdylrrew•rrrvrrk4YYrkYl�l•+>reea�rYkrbw+�•.�r;rY�irkrrrrkrp'r v»�x•�{{Ke,�;vKrr.�h♦r4W �vl � -1r11 • CLAIM (i'O;L- ! BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA June 17, 1997 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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: $25,000.00 + Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Kirsten Fox ���II�g� ATTORNEY: Robert D. Winston MAY- 2 0 1997 Kirsher, Winston & Boston Date received N3E ADDRESS: PO Box 177 BY DELIVERY TO CLERK ON May 17, IJVN7YL NTY ZCCOUNSE Mount Shasta, CA 96067 BY MAIL POSTMARKED: Interoffice mail Envelope May 5, 1997 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: May 20, 1997 ��jIL BAATTCepuVELOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors (xJ 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:AS. li�kl . 1wLLO Li(/4% iLi 5- 3 Dated: � 7 BY: 001. w w 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 (J ) 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 Dated: GMW'� 199T PHIL BATCHELOR, Clerk, Be , , 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. * For Additional Warning See Reverse Side Of This Notice. 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: Ju� 199 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Law Offices of Kenneth M. Stern 5850 Canoga Avenue #400, Woodland Hills, CA, 91344 (818) 716-1101 and RECEIVED Kirsher, Winston & Boston, LC P.O. Box 177, Mt. Shasta, .CA 96067 (916) 926-3444 r MAY 1 3 1997 f 3i Attorneys for Kirsten Fox and Plaintiffs' Class CLERK BOARD OF SUFEFstf€s:,P;S CONTRA COSTA CO. .� CLAIM AGAINST PUBLIC ENTITY In re the Claim of CLAIM KIRSTEN FOX, Class Claimant, on behalf of persons similarly situated - To: o n�Y C, �S�g �O U Y\.t4 KIRSTEN FOX hereby makes claim, on her own behalf and on behalf of the class which she represents, against the above- named public entity, and makes the following statements in support of the claim: 1. Class Claimant's post office address is c/o Kirsher, Winston & Boston, L.C. , P.O. Box 177, Mt. Shasta, CA, 96067. 2. Notices concerning this Claim should be sent to: same as above. 3. The date and place of the occurrence or transaction giving rise to the claim are: continually during the past four (4) years. 4. The circumstances giving rise to this Claim are as follows: Members of the class which Class Claimant represents were wrongfully, and in violation of Code of Civil Procedure §527(h) , charged and required to pay court filing fees as a condition of commencing or defending civil actions under Title 7, Chapter 3, of the Code of Civil Procedure, in which the petitions or complaints alleged violence or threats of violence, and the amounts so wrongfully collected were thereupon held and converted by, and distributed to, the above-named public entity. 5. The damages of the members of the class which Claimant represents are: economic, including but not limited to refund of the aforesaid court filing fee, plus interest thereon, and fees, costs and expenses in bringing an action to recover the same; and other economic losses resulting from violation of the class members' rights under the California and United States Constitutions, the statutes of the State of California and of the United States, and under contract. 6. The names of the public employees causing Claimant's injuries are: unknown to Claimant. 7. The Claim of behalf of the class which Class Claimant represents are, as of this date, is in an amount that would place it within the jurisdiction of the Superior Court, i.e. , in excess of $25,000.00, and in an amount to be proved at trial. 8. Class Claimant and her attorneys file this Claim without prejudice to, and without waiving, their contention that no Claim under the Government Code is required for this type of action. Dated: 5/3L9 Robert D. Winston, Attorne or Claimant and Claimants Class • e PROOF OF SERVICE BY MAIL I, the undersigned, declare that: I am employed in the County of Siskiyou, State of California. I am over the age of 18 years and not a party to the within entitled cause. My business address is 205 North Mt. Shasta Boulevard, Suite 400, Mt. Shasta, California, 96067 . On May 5, 1997, I served the attached Claim by personally placing the same in the United States mail, in a sealed envelope, postage prepaid, and addressed as set forth on the attached mailing list. I declare under penalty of perjury that the foregoing is true and correct and that this declaration was executed on May 5, 1997, at Mt. Shasta, California. Robert D. Winston Kirsher, Winston & Boston A Law Corporation P. O. Box 177 Mount Shasta, CA 96067 US, County of Contra Costa Len Le Tellier P.O. Box 911 Martinez, CA 94553-1233 CLAIM • 1 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA June 17, 1997 claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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: $280,000.00 Section 913 and 915.4. Please note all "Waft T 111V[EflD CLAIMANT: Willie C. Gross, Jr. H-99233 MAY 2 2 1997 ATTORNEY: MOD-6309 COUNTY COUNSEL Californi=a Medical Facility Date received MARTINEZCALIF. ADDRESS: State Prison BY DELIVERY TO CLERK ON May 21, 1997 PO Box 2000 Vacaville, CA 95696-2000 BY MAIL POSTMARKED: No Postmark I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. HH r DATED: May 22, .1997 JAIL BATCHELORepuity .., Clerkj If 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: _ / 3 7 BY: Deputy County Counsel T 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: JUN 17 1997 PHIL BATCHELOR, Clerk, By � ��,Q.2�,�, 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. * For Additional Warning See Reverse Side Of This Notice. 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. JUN 18 1997 Dated: BY: PHIL BATCHELOR byl � LJDeputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY , INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops 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. (Gov't 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. T1 . YF +-hc .^.l a to ic ana+r+r.f- nvilil. i re ftn+--1 i- r must be filed against each public: entity. E. Eraud.. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp Wz'111e C 8055 , TR. E Against the County of Contra Costa) or ) MAY District) (Fill in name) ) VISORS . The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $20_0000_-Q._-0,> and in support of this claim represenL.s as follows: 1. When d'd the damage o in }pry occur? (Give exact date and hour) �Q 4 1.�4 �/ �:�c.e� dy' 9T,ccL QGtYC.t 1�+, ` f t , ay3.�A►11 fig...-.1�, 113!/�T aL lC�,'Pr►:, fi?ma3 ����/„ ic..L 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full details; use extra paper ifIquired) > 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? (over) 5. What are the names of county or district officers, servants or employees causing ,,the damage or injury? Ap i '6 ae&MJ, if`p/N"a„� 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. ) b 7. How was the amount claimed above computed? (I clude the estimated amount any prospect anjuory r damage. )$/90,w p 7 ac!=J , 8.,,NamQes and addresses of witnesses, doctors and hospitals. Dr Re ^. filef the n;rrnct?r7iti�rca int, -mane on -moll 1t of this aAcident or injury. DATE TIME AMOUNT Gov. Code Sec. 910.2 provides "The claim must be signed by the claimant or by some person on his SEND NOTICES TO: (Attorney) behalf. " Name and Address of Attorney ; V-Z 14. q,�� /&-IM �T, �`$ :� 1� ) (Claimant's Signature) (Address) Telephone No. ) Telephone No.w a ••tl�iti�*�**�*****tk1k1Y�**#*�*i+k*ie�A**1tA+Ro�ir#A�4tF*�iriei�ir�*i�#iew*fii�IlAw iw 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. t' Cp - -� 7- cs _ 4e << t Ae . _ � y ;< O o << - -- 14 Ad �����GCk:xCll IF/77 ex Ve- 927 a - - _ � e !l p�-� 3 5 ��_ � _,G� _ - -- 6 —,c � --,�!_J -�J+��r•� . -- r,-�"�u—ter �------ - - z 422_- i ROW �,. a• s / / f f / RECEIVE® 'DEC - 2 1997 CLERK BOARD OF SUPERVISORS r0J�:C%L - -- — - -- - �comTRA COSTA CO.__ � � 6 E k j CC? 11 J t } ,- = r r r r' d ~ 1 c� R cv � x uj C �\ f t ' h o- n Q L � 1 Itz C r i d ZO �j rl� r� 1 � g r � P v� � CLAIM Q1 41 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA �- June 17, 1997 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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: $83.00 Section 913 and 915.4. Pleas pmat"b CLAIMANT: Roy Gregory Harris K-35237 MAY 2 0 1997 ATTORNEY: COUNTY COUNSEL Date received MARTINEZCALJF, ADDRESS: PO Box 689 BY DELIVERY TO CLERK ON May, 14, 1997 D-301 Soledad, CA 93960-0689 BY MAIL POSTMARKED: May 13, 1997 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. BdQQ IL ggATCVELOR, Clerk DATED:_ May 20, 1997 : Depu y II. FROM: County Counsel TO: Clerk of the Board of Supervisors NThis 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: �' 2 7 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. n Dated: 17 1997 PHIL BATCHELOR, Clerk, By fit, ,-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. * For Additional Warning See Reverse Side Of This Notice. 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. , JUN ]: 8 199 L_L�Dated: BY: PHIL BATCHELOR byC�"eputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY ' INSTRUCTIONS TO CLAIMANT A: Claims relating to causes of action for death or for injury to person or to personal property or growing crops 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. (Gov't 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 Roy Gregory Harris. K-35237 ) Against the County of Contra Costa) Qy or 1997 t CLERK B Sheriff's Department District) OgRDOF (Fill in name) ) CONTRq COS q COVISORS The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ Ri-on and in support of this claim represents as follows: January 13. 1997 at apnroximately h-nn am 1. TThcn .i—id twhe dama rs or i nji-i '" /Give eya,7 - date anf hour) Contra Cn.ata (rnmt t c Shari f t c ]lent " Mai n Tai J ., Marri nal 2. Where did the .damage or injury occur? (Include city and county) Please See_Attarharl T1aritment/Statamant 3. How did the damage or injury occur? (Give full details; use extra paper if required) 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? (over) 5. What are the names of county or district officers, servants or s z employees causing the damage or injury? 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. ) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) 8. Names and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury. DATE TIME AMOUNT Gov. Code Sec. 910.2 provides "The claim must be signed by the claimant or by some person on his SEND NOTICES TO: (Attorney) beha " Name and Address of Attorney ant gnature) 1QLt til - - 689 (Address) Telephone No. ) Telephone No. NOTICE Section 72 of the Penal Code provides: Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, 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. STATEMENT OF FACTS On January 6, 1997 at approximately 9-9:30 a.m. I was sentenced to a term of 2 years State Prison. 1 was to surrender to the custody of the Sheriff of Contra Costa County, to be subsequently transported to the California Department of Corrections at San Quentin State Prison. On the morning of above stated date, the surrender to;...c.ustody of the Sheriff consisted of bodily search,placing into custody, in which all personal property on the individual is given to a Bailiff, who in turn lists the inmate's property on a property/clothing reciept. The inmate is asked to verify such property as listed and a signature is required, then the inmate is given a copy of such reciept. This reciept is proof that she/he has had property upon surrender into custody, and then this property is placed into a "safe" within the jail. On the morning of January 13, 1997 at approximately 4:00 a.m. , the claimant was awakened by the Sheriff's Deputies and told that he was being tran- sported to San Quentin State Prison (California Department of Corrections) . After being taken to the booking area, signing releases for the money, clothing and other personal property, at approximately 5:30 a.m. , fed breakfast, we were secured and transported,_.to San Quentin State Prison. Upon arrival at San Quentin's R&r (recieving and release), it was discovered by the recieving officer (C/O Wright and myself) , that the Deputy responsible for the transpor- ting had separated the claimant's legal_papers, placed them on a shelf. (This was done as said by the recieving officer. It was also discovered that the plastic bag containing the personal property surrendered by the claimant upon turning himself in at CCC Jail, was'nt among the property that was brought to San Quentin by the transporting Deputy. Contra Costa County Property/Clothing Reciept#272764 Dated 6 Jan 1997 @ 0930 Hrs. Items: Wallet, this wallet contained: Driver's License, Regional Transit Card, Social Securi.tyy Card, Bank of the West Versateller Card, Bart Tickets and other items (miscellaneous) Fanny Pack Containing; Pen, Knife, Breath Spray Visine and Lighter. Value Wallet; Pierre Cardin $40.00 Driver's License $12.00 Regional Card (repl). $5.00 Bart Tickets (4) $16.00 Fanny Pack $15.00 Total $83.00 A search for these items through all property brought to San Quentin by the transporting officer proved negative results. t+1 f rS d ' N• N• ¢� GJ r C-) C` O tI3 CD G N O a O 'lop 43 � UO .O Sri � j i i* cs N O ON NA a, Qv c�7 •. o . c � +r. '•.y,.. U • CLAIM ` • �9 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA June 17, 1997 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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: $3,218.18 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Pacific Bell. - Claims K.A. Seger ATTORNEY: Date received MAY 0 1997 ADDRESS: 3235 North Texas Street BY DELIVERY TO CLERK ON Fairfield, CA 94533 a MARTIN COUNSEL BY MAIL POSTMARKED: Hand )� "ver d vi C#41Fk pmt_ I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: May 20, 1997 �aIl �ep�HtyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors NAI 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'Z-� 17 BY:�O'•(,QA 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: &M 17 1997 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. * For Additional Warning See Reverse Side Of This Notice. 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 18 1997 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator CLAIM AGAINST THE: COUNTY OF CONTRA COSTA Pacific Bell presents a claim for damages against the above-named entity as provided in Government Code section 900 et. seq. Claimant's Address Pacific Bell - Claims 3235 North Texas Street Fairfield, CA 94533 Date of Occurence 01-29-97 Location Morgan Territory Road, at the new culvert near Marsh Creek, Clayton Circumstances of Incident A 300 pair, underground telephone cable was damaged by a backhoe. The area had been properly marked on three different occassions. Description of Damage A 300 pair, underground telephone cable was damaged requiring the cable to be completely spliced back together again. Person(s) Causing Damage Supervisor: Ruben Esquivel (510-313-7038) Amount of Claim $3,218.18 Date of Claim 09 May, 1997 Pacific Bell's Case-File KS76-1116 r K. A. Seger Claims Manager (707) 428-2426 M_MAY CO 161997 RD OF SUPERVISORS TRA COSTA CO. A1103P14-821 PACIFICWAA "JULLS. A Pacific Telesis Group Company Mail Payment to: PACIFIC BELL — CLAIMS CUSTOMER COPY ROOM 209 Date 05/07/97 140 NEW MONTGOMERY STREET CWBO No. 46CR171116 SAN FRANCISCO , CA . 94105 ; KS761116 Total Amount Due: F $ 3 , 218 . 18 COUNTY OF CONTRA COSTA . DO NOT PAY 651 PINE STREET wRj Kp pNEBILL MARTINEZ , CA 94553 ' L 1591 Payment Due By: PLEASE RETURN THIS PORTION OF BILL WITH PAYMENT DUE UPON RECEIPT _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ For Questions Cell CWBD No. JAN RAO DATE 415-542-0269 46CR171116 159 05/07/97 FOR THE COST OF REPAIR TO PACIFIC BELL PLANT FACILITIES DAMAGED AT LOCATION : POLE 5—MORGAN TEN , CLAYTON DATE OF DAMAGE : 01 /29/97 ADDITIONAL INFORMATION CONTACT : SEGER , KEVIN A 707 428-2426 CHARGES : PACIFIC BELL LABOR 29 . 00 HOURS $2 , 279 . 69 CONTRACTOR $938 . 49 TOTAL AMOUNT DUE $3 , 218. 18 BC 046'. AC 000 Pacific Bell IRS FEDERAL TAX .ID #94-0745535 CALIFORNIA TAX ID #D-0001234 05/07/97 REPORT JCW014 PAGE 1 19 : 24 ARC-RPT NOCAL PROGRAM JOF710 WORK DETAIL FOR CWBO 46CR171116 COUNTY OF CONTRA COSTA 651 PINE STREET MARTINEZ , CA 94553 FOR THE COST OF REPAIR TO PACIFIC BELL PLANT. FACILITIES DAMAGED AT LOCATION : POLE 5-MORGAN TEN , CLAYTON DATE OF DAMAGE : 01 /29/97 LABOR/ENGINEERING DATE RC/FC REGULAR AND EXTRA HRS HOURLY RATE SUB-TOTAL 01 /29/97 42XJ 29 . 00 $78 . 61 $2 , 279 . 69 LABOR/ENGINEERING TOTAL $2 , 279 . 69 ADDITIONAL EXPENSES 01 /29/97 45R CONTRACTOR $938 . 49 TOTAL AMOUNT DUE $3 , 218 . 18 -FF0I .PACIFIC BELL (TUE) 04. 22' 97 06:25/ST. 06:23/N0. 3560819415 P 4 IRISH CONSTRUCTIC AEMR TO: r v0% _ 2"1 WMAYL VENM"'3ACRAM2WM 9945 P.O.am 5" 0 C IE 0Xff%ACMU UCW=Ida MO ROSEMEAD,CAgi77c (914)29"930 KX PACIFIC BELL wwoATE 02/Z1/97 2600 CAMINO RAMON R SAN RAMON, CA 94583 'k ' �%"• ��MO' 107941 ATTN: C. AANENSON Kh 3N800S pil + FINAL i SEQa#: 1901.32 CONTRACT: 51-464, 6/01/44 PAGE: 1 1sroM6as COMER W Cua"n0 Ww 20-7—OR-.0120—Q WIL923680 704701�3p2 LOCATION: MORGAN TERRITORY ROAD POLE 7 CLAYTON EXCAVATE AS NECESSARY TO EXPOSE CABLE FOR REPAIR. MAKE MINOR ASSOCIATED REPAIRS AS REQUIRE+? BY TH COMPANY REPRESENTATIVE. PLACE AND OR REPLACE BOXES AND OR LIDS AS REQUIRED BY THE COMPANY REPRESENTATIVE. BACKFILL AND RESTORE AtL DISTURBED SURFACES To FORMER CO(01T BETTER. CONTRACTOR TO PROVIDE ALL NATE STAR?'ING DATE: ,COMPLETED DATE: + i + L T S f T- ff r IN $ICE 38.49 l Ij UNDERGROUND UTILITY CONSTRUCTION•COMMUNICATION ENGINEERING&CONSTRUCTION Tanya:FM 30 days,1 A%per month(LAX annum)Interest charged on past due accounts.d not paid per tatme,reasonable anorn0lra' f. hies,collection coats or charges will be CdOed. Aim e. Oro ��� ���1{'iArf!!rU:�■� .. Z .:,r Mfi!.iii SO Z th! �,► ti 3±1i! 1. •' ri i u ! .r{Fh{!C, 4 0", Y lrllt,4,f,�;�,�,.'yy',rQ���� r: fT Ile nyr," ! 1 011.�.5�"r����tT..�,��i'`t!' �;=1 lid Itsi:r�!,i�C�•Y HIE 1.5 ��� �lii�t: ;a d w -a tJ Aa O qrr k3 sF 00 ° -48 fA rn. ."a L o 60 in all Dlm J s '•5 : n� 8 ny m m $ D Cn z O O O 70 �j o to X m y m o 7D V m A O L O o Or. I co T$3) N ZO o r T: y N -::x� -�--- --- - -- Ate.• -�_. ._ _ _ ._ � � m ciz — r- r-- _ w S .� _� Tnl o,o MTC NT'1 J,>,I 1S C;7GIi -17-19 -')Hd 6S:5;T L66T-90499 ;FEB-06-1997 15:59 PAC BELL 1025 SHHRY -C1R Z)lb b(b C(Ul + -44 le Cc — Z U cc W M• W ZZ. �. y it OLU 'S lAr dog ZLL _ �,•, I a 1:: ::, w 4 FW d C3 low a i .. ' x w Xz ? • L �M: WNW 13 LU r: ul a IL CL W .� tN. � -' • LLA M' %4 Nb EL Cl z LU , : �. 0 : a= . , 4 ,:1 ,. . IL ff 0 `t ;..w.•': Qtl f��'i? + Spig Cz cr C3. cq • NO O ; O 40 ,'• } - . fl r >lm O�aIca 8 4nma m n - _ CO) m Alt 00 O%O 0 i:.Y �•. � AGw �'� '"• n m m 0 Z - - • �' � •' t� © Z — rr — W - : x JD ari Jit �. crc•cT ,SFT—caA_a» t•-q 1,4 TAJJ. QJfi RLC • �tl!-4�b-177( 1J�JC f-FA, tstLL 110GJ SfTY<T L 1 K :.alu v r v i i ui r.uc ll s x IGO cr Z U m w w Z 1-- 0 Z ( �O 4'. w _ � zd - -- -. - w w U R� U LL: -- SLu Go or- LLcr Zw M� UO �¢co J UO w fi v < _y F y G vi Q O t a�o bo z _ Q x m ui U y O o sw Un Q a Qa O' U9 �� �8 LLLL V EC— cn Ar: ZZ) ¢ f. ..Jz LLA '4.a V a 4 A y4z") ~ uiW p 2 JLa LLI ::«., . .i vuj mo a. Lu NLL �LU ; J 1"2 OF Q .v 71 a v Z q a~ E 40 z ic 0 o 4 " O IL OK Q fa 'H Vf O �'. .%t Lug..,,� !;, W Claims 3235 North Texas Street Fairfield,California 94533 A Pacific Telesis 3?If fdnAumock (707)428-2426 RECE�VE� MAY 15 1997 09 May, 1997 MAY 1-61�f 4 rERVISOftS CLLR CON RR COSTA CO. COUNTY OF CONTRA COSTA Risk Management 651 Pine Street Martinez, CA 94553 RE: PROPERTY DAMAGE CLAIM Gentlemen: We are sending you the attached claim notice pursuant to Section 910 of the Government Code. Very truly yours, l K. A. Seger Claims Manager (707) 428-2426 enclosure file: KS76-1116 CLAIM AGAINST THE: COUNTY OF CONTRA COSTA Pacific Bell presents a claim for damages against the above-named entity as provided in Government Code section 900 et. seq. Claimant's Address Pacific Bell - Claims 3235 North Texas Street Fairfield, CA 94533 Date of Occurence 01-29-97 Location Morgan Territory Road, at the new culvert near Marsh Creek, Clayton Circumstances of Incident A 300 pair, underground telephone cable was damaged by a backhoe. The area had been properly marked on three different occassions. Description of Damage A 300 pair, underground telephone cable was damaged requiring the cable to be completely spliced back together again. Person(s) Causing Damage Supervisor. Ruben Esquivel (510-313-7038) Amount of Claim $3,218.18 Date of Claim 09 May, 1997 Pacific Bell's Case-File KS76-1116 K. A. Seger Claims Manager (707) 428-2426 CLAIM AGAINST THE: COUNTY OF CONTRA COSTA Pacific Bell presents a claim for damages against the above-named entity as provided in Government Code section 900 et. seq. Claimant's Address Pacific Bell - Claims 3235 North Texas Street Fairfield, CA 94533 Date of Occurence 01-29-97 Location Morgan Territory Road, at the new culvert near Marsh Creek, Clayton Circumstances of Incident A 300 pair, underground telephone cable was damaged by a backhoe. The area had been properly marked on three different occassions. Description of Damage A 300 pair, underground telephone cable was damaged requiring the cable to be completely spliced back together again. Person(s) Causing Damage Supervisor. Ruben Esquivel (510-313-7038) Amount of Claim $3,218.18 Date of Claim 09 May, 1997 Pacific Bell's Case-File KS76-1116 K. A. Seger Claims Manager (707) 428-2426 CLAIM C, �9 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA June 17, 1997 .. N Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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 t Amount: $826.61 Section 913 and 915.4. Please note al rning �� CLAIMANT: Charles M. Goldberg MAY 2 2 1997 ATTORNEY: COUNTY COUNSEL MARTINEZ CALIF. Date received ADDRESS: 253 Yale Road BY DELIVERY TO CLERK ON June 21, 1997 Menlo Park, CA 94026 BY MAIL POSTMARKEDVed EX May 21, 1997 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. Y BY DATED: May 22 1997 gpVHIL BATCHELOR, Clerk : 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: , v� 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. 4 Dated: JUN 17 1997 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. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein map tinned, 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 18 1997 BY: PHIL BATCHELOR by CL"�eputy Clerk CC: County Counsel County Administrator 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 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 Coanty, 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. * e � e � e * e * e e f. � • a s * * a e e e a � � a 1t * e a � � e e e a e e * � e * � RE: Claim By ) Reserved for Clerk's filing stamp Charles M. Goldberg ) RECEIVE® Against the County of tra Costa ) MAY 2 1 1997 or ) F SUPERVWAM Distric_ t) CLERKCONT RABOARD OCOS A 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 $ s� . g 82-b-bl and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) December 21, 1996. at 7pm. 2. Where did the damage or injury occur? (Include city and county) San Pablo Dam Road at Hillcrest. -r��_-_Nw----NSN--- 3. How did the damage or injury occur? (Give full details; use extra paper if required) See attached. 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? See attached. (over) 5. wnat are the names of county or district officers, servants or employees'causing the damage or injury? Unknown. 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. See attached. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) See attached. $. Names and addresses of witnesses, doctors and hospitals. William Schenck and Nydia ?Martinez 152 Lombard Street, ;707 San Francisco, CA 94111 9. List the expenditures you made onaccount of this accident or injury: DATE ITEM AMOUNT - See attached. Gov. Code Sec. 910.2 provides: "The claim must be signed byAte claimant SEND NOTICES TO: (Attorney) _ or by some person on his. f." Name and Address of Attorney (Claimant's Si tore 253 Yale RQad- JIgn;n CA 94026 Address (415) .322-0211 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. , Attachment to Contra Costa County Claim Form 3. How did the damage or injury occur? The damage occurred as a result of road construction on San Pablo Dam Road which was not properly covered subsequent to the work stoppage. The construction left a severely uneven ridge/pothole in an open lane which caused a blow out, bent wheel, and misalignment on my automobile. 4. What particular act or omission on the part of the county or district officers, servants or employees caused the injury or damage? The county failed to provide supervision to ensure that incomplete construction was adequately covered so as to prevent incidental damage. 6. What damage or injuries do you claim resulted? The incident caused a blow out, bent wheel, and misalignment on my automobile. Attached are an estimate and the actual cost of the repairs. 7. How was the amount of the claim above computed? Actual: Estimate: One wheel (BMW Alloy 7.5X17) $404.95 $455.00 plus tax. One tire (Pilot SX 235/40ZR/17) $265.50 $319.95 plus tax. Mount and balance $ 24.16 $ 24.16 Four wheel alignment $132.00 $132.00 $826.61 $931.11 (see attached receipts) 8. List the expenditures you made on account of this accident or injur, See above and attached receipts. Ar 9500635 1 1 9 2 8 3 2695 SOUTH EL CAMINO REAL SAN MATEO, CA 94403 *DICE* (415) 349-90.77 ,HARLIE GOLDBERG 332 RUBY STREET ZEDWOOD CITY CA 94062 PAGE 1 -IOME: 415-364-1426 BUS: 415-396-3618 SERVICE ADVISOR: 75 MICHAEL KINNEMAN COLOR YEAR MAKE/MODEL VIN UNIT NO. MILEAGE IN/OUT TAG WHITE95 BMW M3 WBS2F932XSEH00635 3JTR329 26966 26966 T5675 DEL DATE PROD. DATE WARR. EXP. PROMISED PO NO. PAYMENT INV. DATE 04JUN94 01APR94 14 :54 03MAR97 DISCP 03MAR97 R.O. OPENED READY OPTIONS: DLR:16264 08 : 00 03MAR97 16 :47 03MAR97 LINE OPCODE TECH TYPE HOURS LIST NET TOTAL A CHECK. PASSENGER- REAR .WHEEL WAS DAMAGED, PRICE ON WHEEL AND TIRE, CHECK CAR FOR DAMAGE AND PULL-ING SSB'`SEE STORY BELOW 84 C 0 . 00 0 . 00 PARTS: 0 . 00 LABOR: 0 . 00 OTHER: 0 . 00 TOTAL LINE A: 0 . 00 WHEEL IS BENT AND TIRE IS DAMAGED. RECOMMEND NEW TIRE AND WHEEL. WHEEL IS 0 , 319. 95 EACH P TAX AND INSTALLATION.. TIRES NEED TO BE ORDERED ONE WHEEL IN STOCK. **************************************************** B CUSTOMER STATES PASSENGER SIDE WINDOW CHANNEL SEAL TORN AND DEFORMED CND CHECK ALL WINDOW SEALS ON PASSENGER SIDE 84 W94 (N/C) FC: PART#: COUNT: CLAIM TYPE: AUTH CODE: PARTS: 0 . 00 LABOR: 0 .00 OTHER: 0 . 00 TOTAL LINE B: 0 . 00 CHECKED WINDOW SEALS. UNABLE TO FIND PROBLEM. CHECKED SEALS FOR LEAKS, NO LEAKS. WINDOW SEAL IS OK. C CUSTOMER STATES THE DRIVER SEAT HEATER IS INOP CAUSE: BOTH SEAT HEATING ELEMENTS WERE FAULTY 5211-090-;REP BOTH :HEATING._ELEMENTS FOR L/R FRONT ' SPORT SEAT - i - 22 W94.:,, (N/C) 1 64-11-8-391-280 SEAT HEATER (NIC) 1 64-11-8-391-281 SEAT HEATER (N/C) FC: 6411221500 PART#: COUNT: CLAIM TYPE: AUTH CODE: ORIGINAL FINAL REVISED DESCRIPTION TOTALS ESTIMATE 5 ESTIMATE S LABOR AMOUNT DATE TIME PHONE#OR IN PERSON AUTHORIZED BY ADDITIONAL AMOUNT PARTS AMOUNT 5 0 REASON R ISD AL GAS, OIL, LUBE s SUBLET AMOUNT DATE TIME I PHONE'WIN PERSON AUTHORIZED BY A DITIONAL AMOUNT MISC. CHARGES s TOTAL CHARGES KTasn"' REVISED TOTAL LESS INSURANCE s SALES TAX I ACKNOWLEDGE NOTICE AND ORAL APPROVAL OF AN �'A�CIKNOO�LEDGE RECIEPT OF VEHICLE AND I HAVE NCREASE IN THE ORIGINAL ESTIMATE EVEA COPY OF THIS INVOICE PLEASE PAY THIS AMOUNT BAR a AH037608 EPA 0 CAD 981683881 CUSTOMER WARNING: ,alifornla Hearth&Safety Code Section 25249.6-Proposition 65:Some of the materials being removed and used during the servicing of vehicles are known to the State of California '0 cause cancer.birth defects or other reproductive harm. CALIFORNIA EMISSIONS REFEREE STATIONS INFORMATION i,. Customer'may be sent to a Referee Station by the Bureau of Automotive Repair if: 1. Motorist's vehicle failed the initial inspection when he/she thinks it shouldn't have. 2. Motorist has a dispute with repair facility(e.a.,cost/quality of repair work is in dispute). �" `�' •"" ".dt `+ Q�ci.�bs-GBits_j�.ad;ijty(Z reoairs at��ade,._wlil be CHARLIE GOLDBERG 532 RUBY STREET REDWOOD CITY CA 94062 PAGE 2 HOME: 415-364-1426 BUS: 415-396-3618 SERVICE ADVISOR: 75 MICHAEL KINNEMAN COLOR YEAR MAKE/MODEL VIN UNIT NO. MILEAGE IN/OUT TAG WHITE 95 BMW M3 IWBSBF932XSEHOO635 3JTR329 26966 26966 5675 DEL DATE PROD. DATE WARR. EXP. PROMISED I PO NO. PAYMENT INV. DATE 04JUN94 101APR94 14 :54 03MAR97 DISCP 03MAR97 R.O. OPENED READY OPTIONS: DLR:16264 08 :00 03MAR97 16 :47 03MAR97 LINE OPCODE TECH TYPE HOURS LIST NET TOTAL SUBL DAN ROGER 00064 PO#25833 W94 (NIC) PARTS: 0 . 00 LABOR: 0. 00 OTHER: 0 . 00 TOTAL LINE C: 0. 00 CHECKED AND TESTED FOR DRIVERS SEAT BACK HEATER NOT WORKING. I FOUND BOTH TO HAVE TOO HIGH AN OHMIC, VALUE. I WAS NOT ABLE TO FIND ANY TEST PROCEDURE IN ANY BMW PUBLICATION, MICROFLIM OR COMPACT DISC. I VERIFIED WHAT I COULD USING THE ETM AND THE REST WAS A COMPARISON OF THE OTHER SEAT. I FOUND THAT BOTH SEAT TOP AND BOTTEM :HEATERS WERE BAD FOR THE DRIVERS SEAT. PARTS WERE AVAILIBLE FROM THE SPECIAL ORDER SHELF FOR ANOTHER CUSTOMER. 4- D 4 WHEEL FRONT END ALIGNMENT 4WA NEED TO REPLACE TWO TIRE BEFORE PERFORMING 4WAY ALIGNMENT 84 C 0 . 00 0 . 00 PARTS: 0. 0.0 LABOR: 0.-00''_ OTHER: 0. 00 TOTAL LINE D: 0. 00 ROAD TEST CAR, FOUND CAR' S STEERING WHEEL IS OFFSET, L/R TIRE IS WORN TO WEAR BARS, RECOMMEND TO REPLACE THE TIRE BEFORE PERFORMING 4 WHEEL ALIGNMENT. **************************************************** E** *CHANGE OIL AND FILTER-NO. ADDITIVES (NOT AN OIL SERVICE) LOF *CHANGE OIL AND FILTER—NO ADDITIVES (NOT AN OIL SERVICE) 84 C 44 . 00 44 . 00 1 11-42-1-730-389 FILTER:: INSERT > 12 . 82 12 :82 12.82 7 15-40 15/40 PENNZOIL 2 .30 2 . 30 16 . 10 HW-LOF HAZARDOUS WASTE DISPOSAL CHARGE FOR OIL AND FILTER. 84 C 2 . 06 2.06 PARTS: 28 . 92 LABOR: 46 . 06 OTHER: 0 . 00 TOTAL LINE E: 74 . 98 FINAL ORIGINAL REVISED DESCRIPTION TOTALS ESTIMATE$ ESTIMATE$ LABOR AMOUNT JDATE TIME PHONEa OR IN PERSON AUTHORIZED BY ADDITIONAL AMOUNT PARTS AMOUNT S REASON R VIS D O AL GAS, OIL, LUBE $ SUBLET AMOUNT 00 DATE TIME PHONE,OR IN PERSON gUrHORIZED BV ADDITIONAL Ah70UNT MISC. CHARGES ® s TOTAL CHARGES REASON REVISED TOTAL LESS INSURANCE SALES TAX I ACKNOWLEDGE NOTICE AND ORAL APPROVAL OF AN I ACKNOWLEDGE RECIEPr OF VEHICLE AND 1 HAVE INCREASE IN THE ORIGINAL ESTIMATE RECIEVED A COPY OF THIS INVOICE PLEASE PAY J j THIS AMOUNT BAR,AH031 r08 EPA x CAD 981683881 CUSTOMER .,r.Ctions or iemecies:IT0 Guyer nas under other laws. WARNING: •nm,d Health°.Safety Code Section 2529 6-P-r,DGsn1Dn 65 Sem?�f: i_ a:?pals being removed and uses eunnq ine,szr.,:,:nr.Gf vehicles are known to the State Of Ca4iornla se cancer.( daiects er oiner: p rrductr•._ ia:rn CALIFORNIA EMISSIONS REFEREE STATIONS INFORMATION -.:.stornEr may he se:ri ..:f;r.;�','SintiOn b,'T:'?P u;e?-3u r,' ai.;J"lrrl�-n Ren IT :i: ivtotor'si s vehicle a:,cc'The'nitia.Inspection when n6s-e t-..U'fi6-:snouidn'i have. 2. Motonsi has a dispute with repair facility(e.g.,costiquaut)(of repa;r work Is in dispute'. --- 1ARLIE GOLDBERG :2 RUBY STREET :DWOOD CITY CA 94062 PAGE 3 )ME: 415-364-1426 BUS: 415-396-3618 SERVICE ADVISOR: 75 MICHAEL KINNEMAN COLOR YEAR MAKE/MODEL VIN UNIT NO. MILEAGE IN/OUT TAG +ITE 95 BMW M3 WBSBF932XSEHOO635 3JTR329 26966 26966 T5675 DEL DATE PROD. DATE WARR. EXP. PROMISED I PO NO. PAYMENT INV. DATE �4JUN94 101APH94 14 :54 03MAR97 DISCP 03MAR97 R.O. OPENED READY OPTIONS: DLR:16264 98 : 00 03MAR97 16 :47 03MAR97 INE OPCODE TECH TYPE HOURS LIST NET TOTAL :HANGED OIL AND FILTER. CK, BRAKE LINING SENSOR FP=3MM TO ROTOR/ RP=3MM '0 ROTOR. CK DRIVE BELTS (OK) , CK COOLANT CK TIRES (L/R TIRE IS WORN, COMMEND NEW TIRE) , AND CK EXHAUST 'SYSTEM. **************************************************** ** S. I . BULLETIN 72 0196 CODE 152 . SUPPLEMENTAL RESTRAINT SYSTEM CONTROL MODULE (ZAE) SERVICE ACTION. :AUSE: PER UPDATE WP#4/ (CODE152) PERFORM SI 720196LABEL CODE 152 84 W94 (NIC) 1 65-77-8-369-828 CONTROL UNIT (NIC) FC: 0065012100 PART# : 0065012100 COUNT: CLAIM TYPE: AUTH CODE: 'ARTS: 0 . 00 LABOR: 0. 00 OTHER: 0. 00 TOTAL LINE F. 0. 00 ZEPLACED AIRBAG MODULE. RECODE USING DIS . CK FOR FAULTS, CLEARED FAULTS JSING DIS . SIXED. >>>>>>>>>> CUSTOMER SERVICE SURVEY <<<<<<<<<< In the next few weeks you will receive a call regarding the QUALITY of our service. If you feel you cannot rate us an "EXCELLENT" score, Contact your Service Advisor or our Service MANAGER,_ BRIAN STEGNER PLEASE note anything less than "EXCELLENT" is a failing score. FINREVISED AL ORIGINAL DESCRIPTION TOTALS ESTIMATE 5 ESTIMATE$ LABOR AMOUNT 46 . 06 DATE TIME PHONE OR IN PERSON AUTHORIZED BY ADDITIONAL AMOUNT PARTS AMOUNT 28 . 92 S REASON VI L GAS,OIL, LUBE 0 . 00 • SUBLET AMOUNT 0 . 00 ® VATE 11ME PHnNf�OR IN PERSON AUTHORIZED BY ADDITIONAL AMOUNT MISC. CHARGES 0 00 ® s TOTAL CHARGES 74 . 98 HFASIIN I I REVISED TOTAL LESS INSURANCE 33 . 00 II SALES TAX 2 .39 I ACKNOWLEDGE NOTICE AND ORAL APPROVAL OF AN TIA�CIKNOWLEDGE RECIEPT OF VEHICLE AND I HAVENCREASE IN THE ORIGINAL ESTIMATE EVED A COPY OF THIS INVOICEPLEASE PAY j THIS AMOUNT 44 . 37 BAR a AH031608 EPA M CAD 981683881 CUSTOMER NJ z VIA Ile, 9500635 1 2 0 5 1 42695 SOUTH EL CAMINO REAL 0 -� SAN MATEO, CA 94403 *INVOICE* (415) 349-9077 _ CHARLIE GOLDBERG 532 RUBY STREET REDWOOD CITY CA 94062 PAGE 1 HOME: 415-364-1426 BUS: 415-396-3618 SERVICE ADVISOR: 75 MICHAEL KINNEMAN COLOR YEAR I - MAKE/MODEL VIN UNIT NO. MILEAGE IN/OUT TAG WHITE 95 BMW M3 WBSBF932XSEH00635 13JTR329 27981 27981 T6773 DEL DATE PROD. DATE WARR. EXP. PROMISED PO NO. PAYMENT INV. DATE 04JUN94 101APR94 13 :30 08APR97 CASH 07APR97 R.O. OPENED READY OPTIONS: DLR:16264 07 :36 07APR97 17:28 07APR97 LINE OPCODE TECH TYPE HOURS LIST NET TOTAL A *MOUNT<.AND::BALANCE 2 ;.TIRES MB2 *MOUNT AND BALANCE 2 TIRES 44 .00 44 :0:0 1 22100 VALVE STEM 1 .00 1 . 00 1. 00 2 23300 WEIGHT $TIKS 1 .50 : 1. 50 3 . 00 PARTS: 4 . 00 LABOR: 44 .00 OTHER: 0 . 00 TOTAL LINE A: 48 . 00 MOUNTED BALANCED TWO NEW,. T. IRES B 4 WAYS ALAIGNMENT 4WA 4 WHEEL FRONT END ALIGNMENT 91 C 132 . 00 132 . 00 PARTS: 0 . 00 LABOR: 132. 00 OTHER: 0. 00 TOTAL LINE B: 132 . 00,-,A-- C CUSTOMER WILL BRING TIRES G00 CUSTOMER SUPPLIED TWO TIRES AND ONE WHEEL 99 C 0 . 00 0 . 00 PARTS: 0. 00 LABOR: 0. 00 OTHER: 0. 00 TOTAL LINE C: 0 . 00 D REPLACE LEFT REAR TIRE, TWO NEW TIRES TO FRONT, CUSTOMER SUPPLIED, LEAVE BENT..WHEEI IN TRUNK, CUSTOMER NEEDS FOR INSURANCE C SEE LINE A 91 C 0 . 00 0 . 00 PARTS: 0. 00 LABOR: 0.00 OTHER: 0. 00 TOTAL LINE D: 0. 00 FINISHED WHEEL SWAP AND TIRE ROTATION. LEFT THE LEFT REAR WHEEL IN TRUNK AS:, SPARE 'DONE OK; FINAL ORIGINAL REVISED DESCRIPTION TOTALS ESTIMATE$ ESTIMATE$ LABOR AMOUNT =. VIbLD TIME PHONE#OR IN PERSON AUTHORIZED BY ADDITIONAL AMOUNT PARTS AMOUNT S ,L GAS, OIL,LUBE $ SUBLET AMOUNT DATE TIME I PHONE.OR IN PERSON AUTHORIZED BY ADDITIONAL AMOUNT MISC. CHARGES s TOTAL CHARGES REASON REVISED TOTAL LESS INSURANCE e SALES TAX I ACKNOWLEDGE NOTICE AND ORAL APPROVAL OF AN 1 ACKNOWLEDGE RECIEPT OF VEHICLE AND I HAVE INCREASE IN THE ORIGINAL ESTIMATE RELIEVED A COPY OF THIS INVOICE PLEASE PAY THIS AMOUNT BAR#AH031608 EPA a CAD 981683881 CUSTOMER OJJ iJeA 1431LIM S1UJI51.1 101410 EIAINA OSle iQw no,S Due sIq5u j2t5GI:;i,,!o@dS nQA SGA15 AjUUI.112!-A SIUJ nOA 01 NtCC2'IOU ACILI SUOIJP_IILU!j JO SUCiSnIO)(2 aAGCe alll OS SaD&WED E jew-apput jo uctle,;Ltiq jo Licisnioxa Pw to sispi Sweijem paildwi ue 6uol mou uo 3tionetwill m0119 IOU 00 Sale)s OLUOS '131100tid SIH_L Oi 312V011ddV :� 3HI E)Niampm liItiVHHVM OilldVNI HO SS3bdX3 kNw �0 HOV3HS \i,V HOJ 3101H3A DHI JO 3sn JO SS01 80 lNll*JQ SSO1 9Nmn13N1 'S39VVVVO 1VI1N=nO3SN00 ONV 1V1t,130I3NI S3Cn13X3 A93b3H '3Nl 'V3I8:31AJV HiUON =iQ AMA19 (39NIVINOO N13H=­'-' -k_;NVbk3VtA 53HdX3 3Hi JO NOI1V8nO 3H1 01 0311VVI-1 131 :30 03I-IdI,14I 3H1 ONIOn-iONI 'S3I1NVbHV/\A 0311dV4I ANV _A0 NO1.LVHnG 3HI 'jonaOdd SIHi NO AiNVbI8VM SS3HdX9 83HIO ON S3)4VVY ­3NJ'VOI83WV H18ON JO MW8 3UI _L3Ij3U­!V L41JON;0 hWIS aqj awcooq apew-aie sjuaw-oouldai uotum oul oouawv -WON JO MNS jo AII!Ipsuodsaj aqj Alloqm 5u1eq(s)i.:ed pies anidai io lieclai 01 uopoap au U sued iojabje4j 1not4im Aluenem siqiiq P81aA03 SOUCISS000e jo(s)per.+2s a3eloan.* 81BP aLl BUIA%OLIS lapjo ilea.aj jvUl6jjO aLli jo tioneivasaid uodn jelgap 01powolne MV49 p9zjjoqjnp ue of paluesaid aq Isnw al!qowolnu MNS at4l true W4_�1489N�� 0—Tym I ew, Cm 91+.+V� *INVOICE* (415) 349-9077 CHARLIE GOLDBERG 532 RUBY STREET REDWOOD CITY CA 94062 PAGE 2 HOME: 415-364-1426 BUS: 415-396-3618 COLOR— YEAR SERVICE ADVISOR: 75 MI EL KINNEmAN R MAKE/ VIN MILEAGE IN/OUT TAG UNIT NO. XS 0063 5 3 WHITE 95 BMW M3 WBSBjF9j32XSEH '981 .27981� 6=773 DEL DATE PROD. DATE WARR PO NO PAYMENT INV. DATE 04JUN94 9 CASH 707APR97 R.O. OPENED :READY OPTIONS: DLR:16264 07:36 07APR97 17:.28 07APR97 LINE OPCODE TECH TYPE HOURS LIST NET TOTAL EST: 198 .00 07APR97 07 :40 SA: 75 ,SURVEY <<<<<<<<<< >>>>>>>>;:i;> CUSTOMkk;-SERV-ICE .- In the next few weeks You will recelve- a call -regarding the QUALITY of our service. If you feel you cannot rate us an "EXCELLENT" score, contact Your Service Advisor or our Service MANAGER, BRIAN STEGNER PLEASE note anything less than "EXCELLENT" is a failing score . ORlIG31NAL FINAL F,V, ESTIMATE$ REVISED DESCRIPTION TOTALS DATE TIME 1--141�...N PERSON ESTIMATE Ill LABOR AMOUNT .1 -7 6 7777- N PERSON AUTHD�RJZED By ADDITIONAL AMOUNT PARTS AMOUNT 4 . 00 — ...... GAS, OIL, LUSE -amgm-TTAL 0 - 00 $ SUBLET AMOUNT 0 .00 DATE TI E HONE#0 IN RSON AUTHORIZED BY A DITIONAL AM LIN MISC. CHARGES 0 . 00 0io REASON $ TOTAL CHARGES 180 . 00 REVISED TOTAL LESS INSURANCE $ 0. 00 I ACKNOWLEDGE NOTICE AND ORAL APPROVAL OF AN SALES TAX INCREASE IN THE ES I ACKNOWLEDGE RECIE T OF VEHICLE AND I HAVE 0- 33 ORIGINAL TIMATE RECIEVED A COPY OF THIS INVOICE PLEASE PAY > > THIS AMOUNT BAR#AH031608 EPA CAD 981683881 180.33 TBAVARIAN 275 CONSTITUTION AVE,Ponmk UTH. NH 03801 (803)427.2002 f r® autospOC'. Y' 1-800-535-2002 t CUSTOMER NO BILL CHA'rtiLIE GOLDBERG TO, 253 YALE-'RD � !`iEl�1i_t) F'Af,l:, GA 94l�?25--52'.%7 Ft f%. LISA IUNG SHIP WELLS F;ARGO L�ANF:./ RC;E,O TQ: 400 .HAMILTON AVE F'A[ C Ai._"i U, Lata 34:';GJi1 _ 1415-::2 2 -121421 1 f� -1[415-396-36,1,p- DATE 15-96 6,1,p-DATE OF ORDER NQ n PAYMENT METHOD, j+A TIME SALESMAN SHIP DATE SHIP VIA -1--/07/97 w ;' MASTERCARD `"'31�t1 18; 04 ALEX 13/10/97 UPGCOM OTY ITEM NO. DESCRIPTION UNIT PRICE QTY.SHIPPED TOTAL PRICE 1 b 9. 1 .y 22'7 194 E;MW WHEEL-7,';X17 `,LLOY :9`_'+. !%?!? 1 :9`x, 1 CAI :t CATALOG' SERIES 3/97 !?i. !CilCi 1 0.. l flit i; )�^� .. t ti)M�l 1. r.. �'•. :C' 'i.:3 .Ni ,lJ r dt-1- .e. L.. ..et„ - w,:f..._O•� # lFIANk:: YCJU t?R YOUR QRDER ' *ALEX HOCK-w- • TOTAL MERCHANDISE SALES TAX SHIPPING&HANDLING9. 95 �J TQTAG r .. ...�.., w.tu......�....u.y. .-....- - ... ....... _ -�..� _�... �. ._... ._ lY 'iwa..�r � .SIf4Ln,i�Y f EXPIRATION DATE AUTHORIZATION NO. CHECK AMOUNT CHECK NO. 404. 95 :-];78995 � '=ter. J � M- - Q L—SALE AMOUNT— ORDER NUMBER ^ CHAF':LIE_ GOLDF�L FG— UNIVERSAL CHARGE CARD E '-5—: YALE RD R," 7 p 6,MENLO PARE:::,CA 94025'"522 9V I MASTERCARDY', EXP DATE CHARGE CARD c'v I r/!!f 7/97L, QUANTITY DESCRIPTION UNIT COST AMOUNT DATE OF SALE E BAVARIAN ALRDSPORT c h-1!_I a:Cl i'r'a t—�• - �f��, !(1 U1 R, 275 CONSTTTUTION AVENUE,PORTSMOUTH,NH 03801 C H A N T TYPE AUTHORIZATION ORDER SHIPPING/HANDLING SALE CODE NUMBER CHARGES TAX X PHONE !.?5_ '<' :'8'^'-j f }(.:ii}, The is—of dw md Wend eeo on e,t,nam Is eumakz,a to ppaayy tl+e errwum sMwn es Toro.Won "I TOTAL proper presenuabn.I promise to pey such TOTAL(together wnh any other charges due Vrereonl wI, m and in atcordartce wrtn me agreemem go.—g the use of such—d. db wnr ;Tere"anaaNlieelSpecial PACKING SLIP West Chippewa Avenue c u �B w INVOICE DATE h Benda AN=46614.37,,29 Y (2t 28t�-2345 15208301 3/1 1/.19 ,m`er.Servig`e�s1/� T7 r ,> tNUMNE 0453665-000 .,,`*�'.'� ri•�,lr. �� 1,i�101 .�r � �..n _ ac y f : BILL TO; SHIP TO: - 0453665-000- y.. 04.53665-000, GOLDBERG, CHARLES, M. GOL•DS'ERG.. CHARGES. i . 253.;'YALE 'RD WEiLS FAR&0%RCB0 400• iAMILTON' AVE. ' MENLO PARK SCA;. 94025 AT TN: EISA JUNG` PALOA'L'TO CA_94301 _663 PG P.O.NUMBER: SALES REP NAME TERMS, MAKE MODEL&YEAR WRH: 97 BOSH fXT394 MAST,EV ARD R A PART NUMBER° r QUANTITI!: OUANTIi1f UNIT ` � DES IPTIO_N `LOC U �>' >'EXTEN ION r• ORDERED SNIPPED` WGT Rj ' z P PRICE xw �7MXX3Sx 2 , 2 22` 235/x40tRr:T7 MI PILOT't SX F MXX3 . AY 0 260:00 . 520.`0 s 49644 Jt q TOTAL;` THIS O-BOER f 520. 0 k � g ,fR I6HT CHf /�-AALL1� � ` _ 11;.0 `-"PAID`` •. .' ..:01 . APP IED 531 . 0 t� ' a� �a a `, T �' `��'a'Sr _ �•��$ t �� 4 �`��f rtEJ t F a�4'�1n, �t 4h� t d� S d �. �n7 L t �c ��- t -I\ ,ay # p•� L � �U. �3\ b . �A. e y [ r y..... y r i Ii r 5 "r t y a� r,.? a +;4•.'?� n G ''`"� t ...,.� ���,� .. fir.+ Yi- �.-,•_•,� S a# .ta ��X. USA Airbill Nramkbe9 - 3532 431976 Reci[p]ient's Cop rq -t; 153n,2128 7413:, From Express Package Service Packages under15016s. Da be Zia,nsomea`ras. RUN FedEx Priority Overnight FedEx Standard Overnight FedEx 2Day* Date 5/20/Q7 ❑INen business morning) fJem business afternoon) ❑(Second business day) J ❑ Sender's ^�^� y NEWFedExFirstOvernight FedExLenerRate na,...lable. Name C�23�*l-em Goldberg dberg Phone( 4n8) 227-6232(—6232 ❑(E rl est next business morning delivery to select locations) Minimum charge: (Higher rates apply) One pound FedEx 2Day rate. OeptJRoor/Sufte/RDom - - company L L s?l� N^. C Q * ' G C j Express Freight Service Packages over1501hs. Deoelate°nsu`mearea: ❑Fi Overnight Freight ❑FedEx 2D%Freight ❑FedEx Expras aver Freight (Next business-day service (Second bua s-day IUP to 3 busmess-day service for any distance) service for any distance) based upon distance) !T,,: Pi_AZA r. Address c':_ fl_A L�i 3' ., F (Call for delivery schedule.See back for detailed descriptions of freight products.) „ �. Packaging FedEx FedEx FedEx Fedi e City `'K r'1- 1 State �- Zi G G 3 Letter ❑Pak ❑Box ❑Tube t�Pkg, P L clarad value nmrt 5500,—J EaYour Internal Billing Reference Information Special Handling Aap am Md IShOper'a Does this shipment contain dangerous goods? ❑Yes sax l Yes°mx"reation T ❑D Ice ❑Cargo Aircraft Only Dryrte,g UN)845111 kg 904 CA Re"plents (Dangerous Goads Shipper's Declaration not required) Name Julie Aunoek C/O Phone( 510) 335-1-442 Payment 11 L]ObtainRecipient Clerk of the Boand of SUpe=Vi90rS Oept/Roor/Suite/Room y , FedEY,Account No. BillSender Caslt/ Company �toro. y 06 r CA ty Ad A7 n int rata-on BLl�7d ing to: ❑fAc...mno in --- ❑ o.Recipient Third Parry reditCard ❑Check ecron t will be tulledl (Enter FedEx account nor Credit Lard no.below)J 651 Pine ST. Address (To'HOLD'at FedEx location,print FedEx address here) City mlar—tino State�_zip 9455 Total Packages Total Weight Total Declared Value' o IC For HOLD at FedEx Location check here For Saturday Delivery check here s .00 ❑Hold Weekday Hold Saturday INotavailable arall J—hems) (Ett change.Net available toalllocalionsl (Not available with ❑INot available with FedEx First Overnighter (Not available with FedEx First Overnight When declaring.value higher than Sloo per shipment,you payen additional charge.See SERVICE FetlEx First Overnight) FedEx Standard Overoight) or FedEx Standard Overnight) CON MONS,DECLARED VALUE AND DMR OF LIABILITY secnon for lure,irromealion. redit Card Auth. LA Release Signature 3 5 3 2 4 3 1 9 1 6 Your signatureauthorizesFederal Express todeliver this ship- ment without obtaining a signature and agrees to indemnity and ha' aludrhhaar�mless Federal Express from any resulting claims,est1Or1$? 2 .7 2 Rev.Oata 6,r9E (C$IOO-46800 GO'�dEX PRTEo E6usac, GEII Feck® STANDARD OVERNIGHT WED emp# 173902 20MAY97 16:36 AA Trk# 353 2431 976 Form 0001 LETTERDeliver y OAK 21MAYg97 94553-CA-US WA OCR F AMENDED CLAIM I BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA June 17, 1997 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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 Gov ���� Amount: Amount not given on this amended :Secti_on 913 and 915.4. Please note all "Wa claim. Amount from first claim was $15,000.00 MAY 2 2 X997 CLAIMANT: Rosie Sumler ATTORNEY: COUNTY COUNSEL Date received MARTINEZ CALIF. ADDRESS: 97 Treatro St. , Unit 282 BY DELIVERY TO CLERK ON May 21, 1997 Pittsburg, CA 94565 Hand Delivered via: Housing Authority BY MAIL POSTMARKED: g Y I. FROM: Clerk of the Board of Supervisors ' TO: County Counsel Attached is a copy of the above-noted claim. DATED: May 22, 1997 IVIL BAATTCUELOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors Q 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 art 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 � 7 BY: Deputy County Counsel -7 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 0—) 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 17 1997 PHIL BATCHELOR, Clerk, By�u 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. 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. * For Additional Warning See Reverse Side Of This Notice. 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: Juk I $ ] BY:­PHIL BATCHELOR by )Deputy Clerk CC: County Counsel County Administrator r CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA June 17, 1997 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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: $159000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Rosie Sumler ATTORNEY: MAY 2 0 1007 Date received May 19, COUNsEL ADDRESS: 97 Treatro St. , Unit 282 BY DELIVERY TO CLERK ON INET ► _ Pittsburg, CA 94565 BY MAIL POSTMARKED: May 16, 1997 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. gg tH� DATED: May 20, 1997 BQQ YIL DeputyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors (A 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: 5b.l l! , 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. 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. * For Additional Warning See Reverse Side Of This Notice. 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 j Claimto: HOARD OF SUPERVISORS OF OON?RA C0.STA CCANI'Y INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury '-o 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 rC2'.fltV. the r;?Ma of +F'� ✓t✓tr.ib~ ,s 1 V S ii1 u i1C Sled in. D. If the claim is against more than one public entity, separate claims mist. be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this f orm. # $ # # # # # f # # # # # # # # # i # # # # # # # # # # # # # # # # # # # # # 14 # REa Claim By ) Reserved for Clerk's filing stamp } Rosie Sumler ) Hntigina Authority } RECEAVED Against the County of Contra Costa ) or ) MAY 2 11997 Vra ; r District) CLERK BOARD OFS ERVWgW 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 sura of $ and in support of this claim represents as follows: . 1. iWhen didthedamage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) -- ---- J Ali `'--�'-- Y 3. How did the damage or injury occur? (Giv details ,us r per f r quired) ; 4. What particular act or cmissiori on the part of county or district officers, servants or. employees caused the injury or damage? It 51.� What are the names of unty or district officers, servants or employees calasirg-1. the damage or injury? 6. What damage or in uries do you claim s ted? (Give full extent of injuries /or F damages I e e , Attac two esti tes for auto At 7. Hou was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) a c -,L O• j1i C1LJt'J G+r,wl w:1�41 \rJ.Iti� V.. t'Y+wAL...:.•f..J, ��%�yV� � /_ f g. --------------- List the lexpenditures�you madeon account ofthis accidentorinjury: DATE ITEM AMOUNT Gov. Code Sec. 410.2 provides; "The claim must be signed by the claimant SEND NOTICES TOs (Attorne ) or by some erson on his behalf." Name and Address of Attorney , Claimant's 5� ture Address Telephone No. Telephone No. i # # * # # NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for ,:ay-.xnt 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 f,ae 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 ($1,000), or by both such. imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars 010,000, or by both such imprisonment and fine. j � i X/k loo i i i ; 1 1 Claim 10: BOARD OF SUPERVISORS OF CONTRA C WTA COUM INSTRUCTIONS M CLADiANT A. Claims relating to causes of action for death or for injury -.o person or to per- sonal property or growing crops and which accrue on or before December 319 1987, must be presented not Later than the 100th day after the accrual of the cause of , action. Claims relating to causes of action for death or for injury to person or to personal, property or growing crops and which accrue cn or after January 1, 19880 must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. {(;ovt, Cade §911.2.) B. Clai= must be filed with the Clerk of the Board of Supervisors at its office in Roco 106, County Administration Building, 651 Pine Street, Martinez, CA 945530 C. if claim is against a district governed by the ward of Supervisors, rather than the County; the *ame 0f tl:�_ft Dist:ict should be filled in. Tia If the claim is against more than one public entity, separate claims must be filed against each public_enti.ty. . E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this TO RE: Claim By ) Reserved for Clerk's, filing stamp Rosie Sumler ) RECEIVED- R' ECEIVED 7 . . horit ) Against the County of Contra Costa } ' M1 91991 or {: ) District) CLERK$OARQ 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 $ /, ,0 r ,0 e2/3 and in support of this claim represents as follows: .__..__.___—_......_. ._--..�.r._ 1. When did the dame or injury occur? (Give exact date and hour) J_ 2. Where did the damage or injury occur? (Include city and county) 3. Bow did the damage or injury occur? (Giv f4 details ,us per f r guired) „ � Aj '�l , 4. What particular act or cmission on the part of county or district officers, servants or employees caused the injury or damage? RECEIVED M,Ay I ' 199?' Q 5. What arQ the names of cPunty or district officers, servants or e.=ployees causing the dam,-^e or injury? _ j_ 1, ` V1, 111 ) 6. Wi'hat damage or injuries do you claim rv 'slted? (Give full extent of injuries or damages 1 e , Attac two est igates �or auto damage �e c mc, `L �u , -,:;,� (e,, t-', , e -c \ �� i `�_ 11-� ,/,i.'Y"�Yi.7. Now was the amount claimed above computed? (Include the estimated amount of any prospective in ury or dz e.)�c`d�bla�14 k �- �'4 `� �� K'� 3g.�b f P��aMe�°C5 ?6�6. Qr�eYIC �Om �3`l"1 tf �S �Q. rClL1rS6� 0-0 , O d Ar �K,b 3C>b, o6 _ I�R0 LO ,� �� '�e�sbr,�� Z�,��' �° I �}�.c e �r , �!°5[fS. e.:r .,.....ti.ter•, �0C tc �.y.u, L...ypi� 9.'List the ex-penditures�you made on account of this accident or injury: DATE ITEM kVJNT 136 hl e n-Ible- c•� 63, d d 07 e 4n�e4- Ad Gov. Code Sec. 910.2 provides: "The claim must be signed by the elaiir..ant SEND NOTI7--S T0: (Attorney) or by some person, on his beiaif. , Naze and Address of Attorney (� --�C1�Im3rit's Slgr. t.17`e 171 (A d Telephone NO. Telephone No. NOTICE Section 72 of the Penal Code provides: "�ver`y° person who, with intent to defraud, presents for ally anee or for ;,ay-�:nt to any state board or officer, or to any county, city or district board or authorized to allow or pay the .^^ if genuine, any f i ::e u- fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonLn,--nt in the county jail for a p:°riod of not more than one year, by a not exceedirg one thousand ($1,000), or by both such imprisonment .annd fine, or by imprisonment in the state prison, by a fine of not exceeding tern thousand dollars ($10,000, or by both such imprisonmeant and fine. .• - ,` anLn er SY � � r :D '!57 w CA a i s.. .� ' O O �. 1.0 O cd O W) r . b �i W) O CA � < U .� • � � Qi N N �' 4 UUP ' _ 4._� t 311 Af KSS. � t •. .�-�•..w,�•.w.- ,_^'r'-'.a ...... -.:r....: .. - 'tom-�iq.. .... _ - yrh'y�.�VYt"�j'�7"'� APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA June 17, 1997 BOARD ACTION Application to File Late Claim ) NOTICE TO APPLICANT Against the County, Routing ) The copy of this document mailed to you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to the Board of Supervisors (Paragraph III, below), California Government Code.) ) given pursuant to Government Code Sections 911.8 and 915.4. Please note the "WARNING" below. Claimant:California State Automobile Association T11;CM11W7,J) Dennis E. Teequarden, Claim No. 03-X38605-4 Attorney: MAY 2 2 1997 Richmond-Hilltop COUNTY COUNSEL. Address: monA MARTINEZ CALIF. District Office Amount: PO Box 6060 By delivery to Clerk on May.1 5,, 1997 San Pablo, CA 94806-6060 Date Received: May 15, 1997 By mail, postmarked on May 14, 1997 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted Application to File Late Claim. )ATED: May 22, 1997 PHIL BATCHEtAR Clerk y By Deputy II. FROM: County Counsel 70: Clerk of the Board of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6). 00 The Board should deny this Application to File Late Claim (Section 911.6"). DATED: �'�7_�7 VICTOR WESTMAN, County Counsel, By[,����-if Deputy III. BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( ) This Application is granted (Section 911.6). (x) This Application to File Late Claim is denied (Section 911.6). I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. DATE: JUN 17 1997 PHIL BATCHELOR, Clerk, BY QDeputy WARNING (Gov. Code 5911.8) If you wish to file a court action on this matter, you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such petition must be filed with the court within six (6) months from the date your application for leave to present a late claim Was denied. You may seek the advise of any attorney of your choice in connection With this matter. If you grant to consult an attorney, you should do so immediately. IV. FROM: Clerk of the Board T0: 1 County Counsel 2 County A=InistratOr Attached are copies of the above Application. We notifed the applicant of the Board's action on this Application by mailing a copy of this document, .and a memo thereof has ben filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. DATED: JUN 18 1997 PHIL BATCHELOR, Clerk, Deputy V. FROM: 1 County Counsel 2 County Administrato TO: Clerk of the Board of Supervisors Received copies of this Application and Board Order. DATED: County Counsel, By County Administrator, By APPLICATION TO FILE LATE CLAIM 7-0 , %e ,�Q e �� , RECEIVE® assignment of claim and ` "'•� subrogation agreement MAY 1 5 1997 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. the sum of " !� In consideration of the payment to the undersigned of Z'4"S-A iuo ❑ a sum estimated to be ' Dollars, being the full amount of loss and damage insured against under an automobile insurance policy, number 2' 1&6')s� issued to the undersigned by the CALIFORNIA STATE AUTOMOBILE ASSOCIATION INTER-INSURANCE BUREAU, said loss and damage having occurred on or about the /�7.Z=d, day of �Lc,sr e— 19--61L, the said undersigned hereby assigns and transfers to said Bureau,gSAA 316 .__said claim in the above amount plus �- additional claim for damage resulting from said accident, not covered under said policy of insurance, in the amount of$_45 YIJ10 , constituting ® a total claim � 9 ❑ a total estimated in the amount of $ Said Bureau is hereby subrogated in At,'S 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_ i 5 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 _ha _ not released or discharged any.,such claim or demand against such party or parties and that KCO- will furnish to said Bureau any and-all papers and information in It�S Possession, necessary for the proper prosecution of such claim. Dated at Rt'c-& W_' Ca_ this 1-3--VL day of 19f- WITNESS F1433 (REV.7-77) .4 - . ` . ` '��U��^�� ��f�� ����������� . `~'~-'' ' ' For ~~.~. . .~.��.~~~ In accordance with Section 910 of the California Government Code,this is to formally place you on notice ofour subrogated claim for the loss described below. Date: e 3 . 10_ 9��---- INSD� TEE�UARDEN DENNIS EOR CLAIM NO: O3-X3B6O5-4 California SPA 31OO8 Claim iehereby made and filed against the . as follows Insured/Claimant's: California State Automobile Association Inter-Insurance Bureau Address mClaimant: (Send notices to this address) <:2 Reference File Date of Occurrence: Place of Occurrence: Nature and Amount of Damao!/ Items Making up saidWhount: 17 Name of Pdblic Employee(s) causing said Damage(if known): Facts & Details: California State Automobile Association Inter-InsuranceInter-Insurance Bureau By: Q,,, 7777- >,. caiiforr is ,Mate Automobiie,Association�;`66f. 1n`surarice 3 f +�.J� p t 03,4, 4...�G7 ^t ' -. � 4 >R La_ 'DATE OF tOSS r CLAiM .� f „a_ INSUREDS NAME x - - c _ DATE `45 1 49b�y 0,3 .X,38b'O 4 IEEGUAftI7El�4 IaENNT C, aR� SALLY r� $ a .06 '1!3 96' F -r r -•�-�. C��A»IIMAN1T'S��p�ME �ry.`T,1 h�t h i A _ y,.,�.-ry - t i TYPEL K DOF LOSS Ml, :.sj�. is Ff` {t xy. yy. _t `.1 E4..'1Y 1"'4 tF 14; t� IVh7T G:IiCI�S ft, 'SPAY' i. .JO ��I O 1 �y f } 3 t .i ... # _ ti. "� \.sL 1 a c F.�,l: 3 ." F hi � G - ..n •c+-- .A .t i 73J J S �j,N x Q I P YCC- F.� a > 3 i���9�.� �w�t ���3TaN{RI~i'fi�,TF25 Iva, �Erj� �« � � '� eankoTAmerlcaNT&SA . g 11-35 x" .a � '3 e :. t - .� 3Sd5n Montgomery Sireet '.i w Jl�lE ; I NalJSA4 I} NlthlDRED I T GI uNE 4 ril atJ#CA 94104 m� P,4Y .rt 4 o y} T,Ira003 ton (nw �^ �..I WAR:7 `5 '.iia v4'>.SHOP- roc. T7E?EL VUIRVDEN ND,MENN I EtNDMENVT TO t x s AUTHOPoZ_ED 5GNAT Y�Rr ARL:P i� ^ 4t 7 T :6RoEFR ZC Hh1ClI�J2 C# 9.4$t7S x y tYk N Tiiti1EG4TIA$�E ft a 06-10-1996 07:37AM FROM TO 7583268 P.02 f •T•CWP+F27 y MOE> f SHOR TNC THE SOTH YEAR SERVING THE BAY AREA ! )ATE IN: B .A .R . REG . # A3112826 PARTS ORDERED : '0 BE DONE: SUPPLEMENT : 12540 SAN PABLO AVE . RICHMOND CA . 94805 ( 510 ) 235-351S Fax : ( 510 ) 235-9022 AA 161.E narrtavct QLAo t &,L �L4rl i 010- 3 by JERRY STEWART on 06-03-96 )ENN:LS TEEGUARDEN 732 WESTWOOD CT Style LE 4DR SEDAN Insurer : CALIF.STATE AUTO ASSN Llc. Plate: 3FE0619 Adjuster JOE F€NTON ICHMONO, CA 94803 Paint Code: 6M17FC47 Appraiser: JEAN MURPHY hone: 223-1821/ Prod. Date: 3-93 Claimant : 3 TOYOTA CAMPY LE Profile = AAA Insured : YES IN: JT2SK12E9P0163217 Deductible: 0.00 Policy # : D/L:5/12/96 ileage: 0 Claim it : 03—X386054 ptions: Mitchell service: 918747 .no Entry LabOT Line Item Part TYPe/. Dollar Labor CEG ee NUmbOT Type Operation DescriptionPart Number Awouot Unit Unit 1 823790 REFIN BLEND R REAR DOOR OUTSIDE 1, I C 4s9' 2.2 2 824186 BODY R & I R REAR BELT MLDG F,3 A* 4--3' 1.3 3 800351 BODY R & I R REAR DOOR TRIM PANEL INC 0.4 4 800353 BODY R & I R REAR OTR DOOR HANDLE 0.4' 1.5 S 900500 AD/RE* ADL LABOR ROPE OFF BACK WINDOW MOLDING J-Ar 6 900500 AD/RE* ADL LABOR CORROSION PROTECTIVE COATINGS SUBLET 5.00s 0,32 T 7 900500 AD/REt AOL LABOR COVER EXTER AF VEHICLE TO PREVENT OVERSPRAY SUBLET 5.002 s T 8 829190 BODY REPAIR R QUARTER OUTER PANEL EXISTING 9 AUTO REFIN REFINISH R QUARTER PANEL OUTSIDE ZCf.2-4' -2.4 0 800818 800Y R & I R COMBINATION LAMP 0.4 ' 0.4 1 900500 BODY ; R & I ANTE. BEZEL EXISTING 0.3* 2 840250 BODY OVERHAUL REAR COVER ASSY 2,2,- 2,2 3 840296 BODY REPLACE REAR BUMPER COVER 52159-06900 157.82 INV' 2.2T 4 AUTO REFIN REFINISH REAR BUMPER COVER C. 2.2-"' 2.2 5 933002 REFIN AOL OPER CLEAR COAT (,9 6 936013 ADL COST SPCL PAINT MATERIALS O.00x T 7 ( FLEX ADDITIVE 3 AUTO ADL COST PAINT MATERIALS T 2 Judgement Itea e 7 2�• LS iTIMAYE RECALL NUMBER: 06-03-96 14:19:28 S g I' t J.F. �J EstiMate Plus is a trade■prk of Mifthpll International i cmpyTight 1991-1996 All Rights Reserved ` JCS 5 V, 06-10-1996 07:38AM FROM TO 7583268 P.03 10553 93 TOYOTA CA?!RY LE TEEGUARDEN A Page., 2 Add'1 Labor sublet I. Labor subtotals Units Rate Amount Amount Totals II. Part Replacement summary Amount BODY , 15.1 53,00 800.30 Taxable Parts 157.82 REFINISH 7.1 53.00 376.30 Sales Tax P 8.2502 13.02 AD/REF/COS 0.7 53.00 10,00 47.10 Total Replacement'Parts Amount: 170.84 Nontaxable Labor 1223.70 Labor Sum®ary Totals; 22,9 1223,70 III. Additional Costs Amount Iv. Adjustments' Taxable Costs 166.20 Sales Tax 0 8.250% 13.71 Customer Responsibility: 0.00 Total Additional Costs: 179.91 I. Total Labor: 1223.70 II. Total Replacement Parts: 170.04 III. Total Additional Costs:. 179.91 Gross Total: 1574.45 IV. Total Adjustments: 0.00 Net Total: 1574.45 THE: ABOVE IS AN ESTIMATE: BASED ON OUR INSPECTION AND DOES NOT COVER ANY :DDITIONAL FARTS OR LABOR WHICH MAY BE REQUIRED AFTER THE WORK HAS BEEN PENED UP _ OCCASIONALLY AFTER WORK HAS STARTED , WORN OR DAMAGED PARTS ARE ISCOVERED , WHICH ARE NOT EVIDENT ON THE- FIRST INSPECTION . BECAUSE OF THIS HE ABOVE PRICES ARE NOT GUARANTEED, AND ARE FOR IMMEDIATE ACCEPTANCE ONLY . I AUTHORIZE STEWART 'S DODY SHOP TO REPAIR ABOVE SAID VEHICLE AS ITEMIZED PER THIS ESTIMATE . X DATE — — J i STIMATE RECALL NUMBER: 06-03-96 14119;26 EstiMate Plus is a trademark of Mitchell International CoprriyhL 1991-1996 All Rights Neservod TOTAL P.03 'OLOR CODEX PAGE f! COST CHART PAGE 11 'LE•AR COAT Y/N .TYPE- OF PAINT ENAMEL/ URETHANE PAINT TUMF, CALCULATIONS POT/BLEND (INC. CLEAR COAT) . FULL PAINT PANEL HOURS PANEL EXTERIOR INTERIOR OVERLAP 2. 3. l TOTAL `TOTAL Y LESS OVERLAP COLOR HOURS REhIINDER : : COSTS Consider Spot Paint REFINISH HOURS . '( � �.3. . . - .. . � COSTS . When Spot Painting one panel, SPOT/.BLEND HOURS materials are calculated from 011e full panel rate chart N, T?.L WORK HOURS � � . ? ► 2 Y When cak-ulatina two tone materials,.. SMC (FIBERGLASS) WORK HOtiRS. DO NOT add the total paint time to figure the materiels. FLEX PAINEL WORK HOURS TOTAL TYL4TERt?Z COST S t �f CLEAR COAT CALCULATIONS 1. BUNMER 2 3-:i.2 OR .4= 4 g .2. FIRST PANEL 2 X.4= / INTERIORS X .2= REMAINING `Z X.2= TOTALS I. TOTALS 2. 17 (2.5 MAX) TOTAL ! r TWO TONE- EXTERIOR PANELS THREE STAGE (TNC CLEAR COATI FIRST PANEL X .5 = FIRST PANEL X.7_ REMAINING X .3 =— REMAINING -X .4 TO'T'AL TOTAL. r r� cam. A 1 �5' _ �f • ?r-. t ✓. • .,t k a -� �- � "e'.�\ "`� R" r""..• `to .._.^- �_;}'•� I • :fir?r.. • S ✓ 4.: tt, Q 0 uj a 400 o o pw � ,s Wao ® x o 0 p1 w O Y O a e��pgg� m u a26 u K 3:Y a O n a a z a N N`