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HomeMy WebLinkAboutMINUTES - 04152003 - C25 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 6110 J*mr BOARD ACTION: APRIL 15 2003 Claim Against the County, or District Governed by ) 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 California Government Codes. notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all"Warnings". AMOUNT: UNKNOWN MAR 1 3 2 0 03 CLAIMANT: SARAH N. ISIBA COUNTY COUNSEL MARTINEZ CALIF. ATTORNEY: UNKNOWN DATE RECEIVED: MARCH 13, 2003 ADDRESS. 3210 MONTE BUENA STREET .5 SAN PABLO, CA. 94806 BY DELIVERY TO CLERK ON: MARCH 1'.. 003 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETEN, I - - SWEETEN.g. I r AH 13, 2003 By: Deputy /Dated. a-Al� ff II. FROM: County Counsel TO: Clerk of the Board of Supervisord 4- -,Olhis 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: 13--63 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. APRIL 15,1 2003 Dated: JOHN SWEETEN, CLERK, By Deputy Clerk WARNING(Gov. code section Qfl 3) 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: APRIL 16, 2003 JOHN SWEETEN, CLERK Bye Deputy Clerk s . This warning does not apply to claims which are not subject to the California Tort Claims Act-such as actions in inverse condemnation, actions for. specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUN'T'Y INSTRUCTIONS TO CLADAANT 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 Tater than six months after the accrual of the cause of action. Claims relating to any other cause of action Faust be presented not 1 a ter than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims Faust 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* Co, If claim is against a district governed by the Board of Supervisors, rather tllaan 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 tris form. RE: Claim By } Reserved for Clerk's filing stamp } R EOmCEIVED Against the County of Contra Costa ) MAR 13 2003 or } CLERK BOARD OF SUPERVISORS Districts CONTRA COSTA CO. .(Fill in name ) The undersigned claimant hereby makes claim against the County of Contra Costa the above-named District in the sum of $ and in support o C4 - _ this claim represents as follows: M) } Si U n L. When did the e or injury occur? (Give exact date and hour) ,4\'.00 a 5D ci r 2. Where did the damage or injury occur? (Include city and county) Crmf/1+1 C ru C) cu, r. �ick 3. How did the damage or in jury occur? (Give full details; use extra paper if required) do L-i V1 wel- -�_ -- VJ C�_s uo -3 ROtt 4. What particular act or omission on the part of county or district officers, servants or .employees caused. the.injury or damage? (over) o Wtea t are tne names of county or district officers, servants or employees causing, the damage or injury? 6 What age or injuries do you claim resulted? (Give full extent" of injuries or domes claimed* Attach two estimates for auto e. 49M T, How was the amount claimed above computed? (Include the estimated amount of any prospective injury or 3. Names and addresses of witnesses, doctors and 'nospitals. R+... 0 - UA C't C)r's - C. _Mftawmo . List the expenditures you made on account of this accident or injury: DATE ITEM. AMOUNT o)c 14 5 C�. rrtA Gov. Code Sec. '910,-.2 provides. "The claim must be signed by the claimant SEND NOTICES TO: (Attorne ) orb some -person on his. behalf.." Name and Address of Attorney • (Claimant Is Signature) (Address) Telephone No. Telephone No. ` ' I V V N 0 T I C E Section 72 of the Penal Code provides "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail.- for a period of not more than one-year, by a fine of not exceeding one thousand ($19 000), or by both such iropriso m* ent and fine-,,-,or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such r isonment and f i ne �.;�..�ctorrs. "c` am PabIoy Pi ; ED G s i .._. y °� .�._'r---A __ ... _ .. `- '��y f .nom_ � -• y rjT- i_. �- �_r_ �. • m you ti-ive, T�)F; me! er. r • C pas truent '),3jc b-e!, T) -)(*ant that you r)p 7a, 1� I '! fol (­OV.O�te rp.:A,'al 1�; I e� f. rjC;r C,le L!,4.,(_1 �,", 6-, , "Z. Ij S t..(I i , �1 1:1 1 !I'M ly, w'.11: e- lb�­ew Ar Ff d pre rc' --r tr 0. Y RT LH Rio KR '-. ROurn. to our ER for re-cneck m- CL I dav tG�E Cm (lays 4 P Work excuse,absence trona wock I V 'a h it s tn.3ny da Y s dAdays #."i, Ar a Y othe c It( 3 days,., N.jA C)t e r I vveekr, -►pares j y Off J w; -IONAL 1N<STP.UC_'1rJ0NS-: A iv 'd f vi w;with YOU1.JCP.._-tor to erl'SUfe%th-11 YOUr-Mld:S tL)1JY Q,U 41! 111! A-.,tic xid-er 46 vears w-Pq-- p or 60 lbs..of IeSS be:. placed in a-cvr seat cwlin%3 tran.sportatiorw in .i vemirte. 1v 11) r--r A IN Y F%N R C)F L FE N1 Sz, R F."r 0 R%N 0 R W"T HAvNN' :tA(.fl'riDoATF''Y lo, U Z ' .. 'r• S j � ,-r_''1 � ' �/tf S�, ' � r� r,,- 1 "t t<:tr ,? , t , PA Tl*F.N T C OF1Y 1 re STATEMEN y � -77 STATIMtNT 00-149-850928 �� 01/08/03 FZ']y BAY IMAGING CONSULTANTS MED OROU.P = tom �v s - 4► '�° T f :. P0 BCrx �14,55 510/235 -.0533 1.1/02/68 E .Ra♦ ` KA WALNUT CREEK EK VA 94598 SERE PAY IRS# 94-2965646 PHONE 9251/296-7156 r :..��:���z� ���` �,w��, �� r� � ���Q AMOUNT PAID PATIENT: T S I BA, SARAH • • ' L 10 .. 00 BILL TO- REMIT TO*. S I j OBAS r BAY I MAG I NG CONSULTANTS MED GROUP OBA 32110 MONTE BUENA S PO BOA 31455 Sari Pablo CA 94806 WALNUT CREEK OA 94598 ;PLEASE CHECK BOX If ABOVE AOURESS IS INCORRECT AND Nt}IGATE CHANGES ABOVE, DETACH HERE AND REIIURN TOP PORTION WITH YOUR PAYMENT USING THE RETURN!ENVELOPE ENCLOSED. .•'�Nmi7 •v"S 11/15/02 E 73510 26 HIP UNILATERAL COMPLETE V43 . 64 39.00 .11/15/02i E1 73610 26 .ANKLE 113 OR MORE 'VIEWS) 959 . 7 35 . 00 11 15/021 E 73660 26 TOE (S) 959 . 7 27 . 00 x 1 i l 1 � ! r 1 _ , E i } yy yy * Tor general questions or to update your insurance of orrnatz n * ax urs at (925) 296-7174 or email us at billingft i.net. * Tease include your account number in email, or ori heck. 11111 1 117; .r.. .�-, s .s ,•��r:.a� wr i, r .k �T •'�`.'�. .-9e.i ,..:_3 � �y�7' y(y;�`.� .�{�py,,}��'+ s: ;x�:s;:ak e."'i:' .c 'hl. y n..4a:K A..! �:•'3 d•n '$ a=t. ;i_ ..0 c: "6 r.ry� r..-. 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R - ._. ...- __.._.. _ ._._.r»_.�_..�.._i__._.._-' .r�.r,..rr,.._rpr+.rr.,wr..wwr�v.�r_.�• wYw..nw.�.4_ae I�i.r-�,••..e a w...r .0.s...»✓,w.,._,rw.s.r�-� .__...n«r __._ar_._rw.,_. r.. ._-_._-,t_,nr. ..•a •-�_r-.._. ..r tin rr-..r_rr r,__. ...._.-_M.„ti._.._,.,.,__._ w.r r..-.•,.rt wj►..�.�.... w,-�_. 1� t �,q?.�;r3!lsc i"t� `r:,rS 3t' � .+t llt r{ 4'i S(E*d - `�►t3r i$� �4 + 1 >r - CMV-4i.ltt,'y ROOM Pill • PATIENT NAME ---- - ACCT.# CA EMER PLAYS*DMC SAN PABLO CMP SARAH N ISIBA 000053677 PO BOX 582663 STE.D-3S MODESTO, CA 95358--0046 STATEMENT DATE PAY THIS AMOUNT PAST DUE DATE ADDRESS SERF?CE REQUESTED 1`06/03 297.00 41/24/03 f k.SERVIC'ES WERE RENDERED AT THE HOSPITAL,THIS BILI,IS SEPARATE FROM YOUR HOSPITAL BILA,. D ' • 67 .6 SARAH N. ISIBA 3210 MONTE BUENA STREET CA EMER PBYS*DMC SAN PABLO CMP SAN PABLO, CA -4806 PO BOX 582663 MODESTO, CA 95358-0046 Please 0 if address or insurance information has changed. Make changes on reverse sine. ■s■■• ■ s ■ �r■ ■ ■ s■ ■ ■■# s■ r • ■ ■ ■ w■ ■ rs ■■ ■r+ ■■■s ■a ■ r ■ ww ■ � ■ w ■ ■ ■ ■■ ■ ■ss ■r ■s • ■ summon F. r r , PLEASE MAKE COPY OF ENTIRE PAGE IF NEEDED FOR INSURANCE THERE IS A$110.00 SER 1110E CHARGE FOR ALL RET111RNED C'HECWS. BILLING OFFICE HOURS: 8 AM-5 PM Phone o- 800 664-7660 Tax 04o- 942494000 Para Espanol o- 1-800-052-8351 Attending Physician ► TURNER, RICHARD M.D. Referring Doctor ► REPPE, CHARLES P.A. .Account Number � 000053677 Service Provider ► CEP *DMC SAN PABLO CAMPUS Patient Name ► SARAH N ISIBA Statement Date � 1/06/03 DATE POS DIAGNOSIS DESCRIPTION OF SERVICES AMOUNT 11/15/02 4 71945 99284 LEVEL 4 EMERGENCY, PHYS CHARGE 270.00 x.1/15/02 4 71945 94760/26 PULSE OX+N�ETRY, SINGLE 22.00 11/15/02 4 71945 81002/26 URINALYSIS, W/O MICRO (PRO EEE 5.00 i As a r urt sy we fil.edl'a claim with your ,insurance carrier, contact them if this claim remain un rocessed. Y�ur account is past due. Please remit Payment today. EMPLOYER PRI RAN INJURY DATE ADMISSION DATE DISCHARGE DATE BALANCE DUE INSURANCE CAL TRANS ALTA BATES MEDICA G 297.00 POS (Mace of Service Codes) 1 - inpatient Hospital 2 - Outpatient Hospital 3 - Doctor's Office 4 - Emergency Room 4 • • co d -luiol COUNTY OF CONTRA COSTA RRT EVERY ACCIDENT AS sc N AS POSaLBLE TO- PUBLIC LIABILITY ACCIDENT Fisk Management Division 2530 Arnold Drive,Ste.#140 Martinez,CA 94553 OTHER TH-AN AUTO i3IE (925)335-1440 OATE OF[CCUENT THE FflR ACCIDENT Pl.A►CE . L Y i TELEPHONE CONT PERSONNAr1�1;. COUNTY vy\V"4N%-t its, DEPARTMENT DESCRIPTION � I k- cl..t'N OF ACCIDENT NAMIE H k e= ALL a ' STREET ADORESS CITY STATE TELEPHONE k2 L-0- O C PATEN THE VO4AT WAS INJURED DOING V"Ell H INJURY Ja 3 f NATURE ANO EVEN-(OF trl,itJR YMER>E WASREQ TRK€Iwt C3DEAtT* i OF IDOCTOR OR HOSPiTAi_ TELEPH0t* ADDRESS OWNER . PROPERTY KfN0 OF PROff RTY AND EXTENT OF DAMAGE DAMAGE > EST1MA C REPAIR NAME ADORES TELEPHONE C12) N S TELEPHONE WITNESSES NAME IV '"•. ESS TELEPHONE V ©ATE SIGNATURE0 REPORTING PARTY SIGNATUR QF 3UpERvisop DEPARTMENT Tf-LEPHONIE _ TO 8E,COMPLETED BY INVESTIGATOR 81":1'10M INVESTIGATED DATE CoMP`tAINAkTS STATEMENT COUNTY'S INVESTIGATION s,A r E WHE THE R©R OT You r-1 ljV r{MAIM WIL L 9E MADE OF AC CI GENT RE-MARKS AMC)PECOMMENDAT IONS POLfCY QEPORT? WHERE 7fA"_S M-7heT e-r-~ ^7!' i!1"`Si i"'fY'iE_it iLJt t ♦rr+t t' rtt:+'� .•,--. •• •-•••••• ,•• - C 0 T R A C 0 S TA EVERY' AMOFNIT AS Sr�o""o- S POSSotSt—C TO Pti-)RE I-JA81"LIT'y' A�I-IC"Itt")LIN'T, A oo� iO-'HER THAN AU Y-OMOFME� i i4 4 C 7 T I'lol -'io' Jo r • .�.,.j„-.1�..�1�. �.�.!_'^ll....J.---+.1....rc��"-.,.l».j.i__� _ � t l y'1...-Q _':.� � \.✓' �`i` f j k V.4 A I A F, NA I Ntk D'--tt f;Z,. to t�j rA X" lk 0 16� t'.000 TO BE COWL ETED BY iNVESTIGA FOR L!A T. t tV t- 4 A-7 oo", pC a I 74 iL lit�l iL.- 7 fit rb , Y • I LRS 14ED CTR SAN PA.BLO * P1110LE F 2000 'VALE RD SAN pABLO CA 94806-3808 Latter Date; 1/03/03 Customer Service: 804 332-9038 Return Service Requested Account Nunbez: 446025 #B W H G X G G A" .ission Date: 11/15/02 Discharge Date: 11/15/02 Total Charges: 3,300.40 i[fit folio 1111111111111111111AlilI 1Ills till fill I SIBA SARAH N 3 210 MONTE BUENA ST S&N PABLO CA 94806-2129 Re: I S I_BA SARAID_._.._,_...._„_.....�..,�.r.. Your insurance company has been bided. The estimated balance not, covered by your insurance company is $35.00. Please mail your check today. If you have any questions in regards to your estimated balance, please contact me. Sincerely., MS BERNASCCNI 9:00 - 4:30 .. .-- 209 578-6219 671 FUS/129-CEBPL aL' 9 l;9 i F!i1S6^h{�i 19:7 LRilf�J�.'6`3i5 T t?V2 kFi7 CLAIM • BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION; APRIL 15, 2003 Claim Against the County, or District Governed by ) 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 California Government Codes. notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all"Warnings". AMOUNT: $1,736.78 MAR 1 2003 -1L DL CLAIMANT: COLLEEN MAJORS COUNTY COUNSEL tifi.ARTINEZ CA[-Ic ATTORNEY: UNKNOWN DATE RECEIVED: MARCH 11. 2003 ADDRESS: 1770 ADELAIDE ST. , #322 BY DELIVERY TO CLERK ON: MARCH 11, 2003 CONCORD, CA 94520 BY MAIL POSTMARKED: HAM DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. MARCH 11, 2003 JOHN SWEETEN, Cle Dated: By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors & his 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: B : Deputy County Counsel By 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: APRIL 15 2003JOHN SWEETEN, CLERK, By Deputy Clerk A 49 WARNING (Gov. code section'§13) tZ 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: APRIL 16 200�OHN SWEETEN, CLERK By Deputy Clerk This warning does not apply to Claims which are not subject to the California Tort Claims Act-such as actions in inverse condemnation, actions for, specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period ''` within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific, statutes and cases applicable to your particular claim, The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the, statutes of limitations applicable to actions not subject to the California Tort Claims Act. i Y Wtzat are the names of county or district officers, servants or employees causing the damage or injury? D6b&i6, v4 n �✓�Y. 6. What damage or injuries do you claim resulted? (Give full extent of in juries or damages claimed. Attach two estimates for auto fie. as �a 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Names and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT V# V* Gov. Code Sec. '910:2 provides: "Theaim must be signed by the claimant SEND NOTICES TO: (Attorney) or b am% persoli on his. behalf." Name and Address of Attorney SA L la' t'/,q(Signature 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 i f .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. s Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLADiANT 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. (Govto Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its off ice in Room 106, County Anistration Building, 651 Pine Street, Martinez, CA 9 553. Cz Tf 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 roust be filed against each public entity. E0 , Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this form. . RE: Clai By } Reserved for Clerk's filing stamp j } - } BEICEIVED Against the County of Contra Costa or � } .N1AR112003 CLERK BOARD OF SUPERVISORS District) CONTRA COSTA CO. -(Fill in name � The undersigned clat hereby makes claim agai t. the County of Centra Costa or the above-named District in the sum of $ e and in support of this claim represents -as follows 1, When did the e or in jury occur? (Give exact date and hour) 2. Where did the e or injury occur? (Include city and county) /ILA ric ------- 3. How did the damage or injury occur? (Give full. details; use extra paper if required) �$M)A . Aw*.a. YJ%4*07�i"w _�, -ft %e_ 4. 'khat particular act or omission on the part of county or district officers? servants or .employees caused. the injury or damage? c (over) • 03/11/2003 at 12:29 PM Job Number: 40462 MIKE ROSE'S AUTO BODY INC, License #:BAR# 0969527 Federal ID #:942621349 WHERE QUALITY COUNTS 2260 VIA DE MERCADOS CONCORD, CA 94520-4920 (925)689-1739 Fax: (925) 689-0991 PRELIMINARY ESTIMATE Written by: Bruce Hubert # Adjuster: Insured: COLLEEN MAJORS Claim # Owner: COLLEEN MAJORS Policy # Address: 1770 ADELAIDE STREET #322 Deductible: CONCORD, CA 94520 Date of Loss: Evening: (925)686-1558 Type of Loss: Point of Impact: Inspect MIKE ROSE'S AUTO BODY INC. Business: (925) 689-1739 Location: 2260 VIA DE MERCADOS CONCORD, CA 94520-4920 Insurance Company: 3 Days to Repair 1989 HOND ACCORD LX 4-2.OL-2 4D SED GREY Int: VIN: JHMCA563XKC130537 Lic: 2DTH303 CA Prod Date: Odometer: Air Conditioning Rear Defogger Tilt Wheel Cruise Control Intermittent Wipers Tinted Glass Body Side Moldings Dual Mirrors Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks Power Antenna Power Mirrors Cloth Seats Bucket Seats Recline/Lounge Seats ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1 REAR DOOR 2 Repl RT Door shell 1 394.94 4.5 3.3 3 Add for Clear Coat 0 0.00 0.0 1.3 4 Add for power units 0 0.00 0.4 0.0 5 Repl RT Side molding 1 29.75 0.2 0.0 6 QUARTER PANEL 7 Blnd RT Quarter panel assembly 0 0.00 0.0 1.0 8 R&I RT Side molding 0 0.00 0.3 0.0 9 R&I RT Wheel opng mldg 0 0.00 0.3 0.0 10 ROOF & BACK GLASS 11 R&I RT Reveal molding side 0 0.00 0.3 0.0 12 REAR LAMPS 13 R&I RT Tail lamp assy 4 door sedan 0 0.00 0.5 0.0 14 REAR BUMPER 15* R&I R&I rear bumper-LOOSEN & DROP 0 0.00 0.5 0.0 RIGHT SIDE 1 03/11/2003 at 12:29 PM Job Number: 40462 PRELIMINARY ESTIMATE 1989 HOND ACCORD LX 4-2.OL-2 4D SED GREY Int: ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 16 FRONT DOOR 17 Blnd RT Outer panel 0 0.00 0.0 1.3 18 R&I RT Side molding 0 0.00 0.2 0.0 19 R&I RT Belt w1strip chrome LX, 0 0.00 0.3 0.0 LXI & SEI 20 R&I RT Mirror remote control 0 0.00 0.5 0.0 21 R&I RT Handle, outside 0 0.00 0.3 0.0 22 INTERIOR TRIM 23 R&I RT Door trim front panel 0 0.00 0.4 0.0 24# Repl COVER CAR 1 5.00 T 0.2 0.0 25# TINT COLOR 1 0.00 X 0.5 0.0 26# Subl HAZARDOUS WASTE REMOVAL 1 3.00 X 0.0 0.0 ------------------------------------------------------------------------------- Subtotals 432.69 9.4 6.9 Parts 424.69 Body Labor 9.4 hrs @ $ 65.00/hr 611.00 Paint Labor 6.9 hrs @ $ 65.00/hr 448.50 Paint Supplies 6.9 hrs @ $ 28.00/hr 193.20 Sublet/Misc. 8.00 ---------------------------------------------------- SUBTOTAL $ 1685.39 Sales Tax $ 622.89 @ 8.2500% 51.39 ---------------------------------------------------- GRAND TOTAL $ 1736.78 ADJUSTMENTS: Deductible 0.00 ---------------------------------------------------- CUSTOMER PAY $ 0.00 INSURANCE PAY $ 1736.78 THIS IS A PRELIMINARY ESTIMATE AND ADDITIONAL CHARGES MAY BE REQUIRED FOR THE ACTUAL REPAIR. 2 v 03/11/2003 at 12:29 PM Job Number: 40462 PRELIMINARY ESTIMATE 1989 HOND ACCORD LX 4-2.OL-2 4D SED GREY Int: THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES: B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS: ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RELY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT W/_=WITH/_ SYMBOLS: #=MANUAL LINE ENTRY *=OTHER [IE. .MOTORS DATABASE INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide AEG4408 Database Date 12/2002 and the parts selected are OEM-parts manufactured by the vehicles Original Equipment Manufacturer. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Non-Original Equipment Manufacturer aftermarket parts are described as AM or Qual Repl Parts. Used parts are described as LKQ, Qual Recy Parts, RCY, or USED. Reconditioned parts are described as Recon. Recored parts are described as Recore. NAGS Part Numbers and Prices are provided from National Auto Glass Specifications, Inc. Pound sign (#) items indicate manual entries. Pathways - A product of CCC Information Services Inc. 3 w - Date: 3/11/03 12:58 PM Estimate ID: 5563 Estimate Version: 0 Preliminary Profile ID: CONTRA COSTA COUNTY PR CISION PAINT & CO ISION 1932 ARNOLD INDUSTRIAL PLACE CONCORD,CA 94520 (925)609-8585 Fax: (925)609-9407 Tax ID: 68-0022850 BAR#: AJ112956 EPA#: CAD981388739 Damage Assessed By: Marcos Magdalen Deductible: Owner COLEEN MAJORS Address: 1770 ADELAIDE STREET CONCORD,CA 94520 Telephone: Home Phone: (925)686-1558 Mitchell Service: 917129 Description: 1989 Honda Accord LX Body Style: 4D Sed Drive Train: 2.OL 4 Cyl 4A VIN: JHMCA563XKC130537 License: 2PTH303 CA Mileage: 100,276 Color: GRAY METALLIC Options: 4-DOOR Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units FRONT DOOR 1 718070 REF BLEND R FRT DOOR OUTSIDE C 1.0 REAR DOOR 2 722770 BDY REMOVE/REPLACE R REAR DOOR REPAIR PANEL 67611-SE3-AOOZZ 187.58 7.0 # 3 REF REFINISH R REAR DOOR OUTSIDE C 2.1 4 REF REFINISH R REAR ADD FOR JAMBS C 0.5 5 723210 BDY REMOVE/REPLACE R REAR DOOR MOULDING 75303-SE3-A14 29.75 INC QUARTER PANEL 6 728550 BDY REPAIR R QUARTER OUTER PANEL Existing 0.5*# 7 REF REFINISH R QUARTER PANEL OUTSIDE C 2.0 ADDITIONAL OPERATIONS 8 REF ADD'L OPR CLEAR COAT 1.6* 9 ADD'L COST PAINT/MATERIALS 144.00* 10 ADD'L COST HAZARDOUS WASTE DISPOSAL 3.00* * -Judgement Item # - Labor Note Applies C - Included in Clear Coat Calc ESTIMATE RECALL NUMBER: 3/11/03 12:57:53 5563 UltraMate is a Trademark of Mitchell International Mitchell Data Version: FEB_03_A Copyright(C) 1994-2001 Mitchell International Page 1 of 2 UltraMate Version: 4.8.012 All Rights Reserved • Date: 3/11/03 12:58 PM Estimate ID: 5563 Estimate Version: 0 Preliminary Profile ID: CONTRA COSTA COUNTY Add'1 Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 7.5 40.00 0.00 0.00 300.00 Taxable Parts 217.33 Refinish 7.2 40.00 0.00 0.00 288.00 Parts Adjustments 21.73- Sales Tax @ 8.250% 16.14 Non-Taxable Labor 588.00 Total Replacement Parts Amount 211.74 Labor Summary 14.7 588.00 III. Additional Costs Amount IV. Adjustments Amount Taxable Costs 144.00 Customer Responsibility 0.00 Sales Tax @ 8.250% 11.88 Non-Taxable Costs 3.00 Total Additional Costs 158.88 I. Total Labor: 588.00 II. Total Replacement Parts: 211.74 III. Total Additional Costs: 158.88 Gross Total: 958.62 IV. Total Adjustments: 0.00 Net Total: 958.62 This is a preliminary estimate. Additional changes to the estimate may be required for the actual repair. WARNING: Accidental air bag deployment is possible. Personal injury may result. Avoid area near steering wheel and instrument panel even if air bags have deployed. Dual-stage air bag modules may be present that could contain an undeployed stage. When disposing of a deployed dual-stage air bag,always treat it as a"live"module. See appropriate MITCHELL®AIR BAG SERVICE&REPAIR MANUAL,or OEM information. ESTIMATE RECALL NUMBER: 3/11/03 12:57:53 5563 U1traMate is a Trademark of Mitchell International Mitchell Data Version: FEB_03_A Copyright(C) 1994-2001 Mitchell International Page 2 of 2 U1traMate Version: 4.8.012 All Rights Reserved CLAIM iF BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION,*, APRIL 15, 2003 Claim Against the County, or District Governed by 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 California Govennnent Codes. notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all"Warnings". AMOUNT: UNKNOWN MAR Z 2 2003 CLAIMANT: FLORIDA FOSTER COUNTY COUNSEL MARTINEZ CALIF. ATTORNEY: UNKNOWN DATE RECEIVED: MARCH 11, 2003 ADDRESS: 331 NEWBURY STREET BY DELIVERY TO CLERK ON: MARCH 12, 2003 HERCULES, CAe 94547 BY MAIL POSTMARKED.- HAND DELIVERED BY77 RISK MANAGEMENT FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETEN- Cl Dated: MARCH 12, 2003 By: DeputyAT II. FROM: County Counsel TO: Clerk of the Board of Superviso This claim complies substantially with Sections 910 and 910.2. { pThis Claim FAILS to comly 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: t 2---0 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: )W 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: APRIL 15, 2003 JOHN SWEETEN, CLERK, By Deputy Clerk WARNING (Gov. code section" 13) 7 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.. APRIL 16..--.2004OHN SWEETEN, CLERK By Deputy Clerk Flo 7 i r I This warning does not apply to claims which are not subject to the California Tort Claims Act-such as actions in inverse condemnation, actions for. specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific. statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. OFFICE OF THE COUNTY COUNSEL .SE AZ SILVANO B. MARCHESI COUNTY OF CONTRA COSTA ��''._�� :�''-�� COUNTY COUNSEL Admir,,stration Building 651 Pine Street, 91h Floor ' * SHARON L. ANDERSON *� - ' Martinez, California 94553-1229 � -- - CHIEF ASSISTANT (925) 335-1800 + T: l , GREGORY C. HARVEY 0` VALERIE J. RANCHE (925) 646-1078 (fax) ; ASSISTANTS NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Florida Foster 331 Newbury Hercules, CA 94547 RE: CLAIM OF: FLORIDA FOSTER Please Take Notice as Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910.2, or is otherwise insufficient for the reasons checked below: [ ] I. The claim fails to state the name and post office address of the claimant. [ ] 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [ ] 3. The claim fails to state the date,place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [ ] 4. The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. [x] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury,, damage or loss so far as known, or the basis of computation of the amount claimed. [x] 6. The claim is not signed by the claimant or by some person on his or her behalf. [x] 7. Other: The back side of the claim was not submitted. Page 1 SILVANO B. MARCHER COUNTY COUNSEL By: '%. Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P.§§ 1012, 1013a,2015.5;Evidence Code§§641,664) 1 declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553;1 am a citizen of the United States,over 18 years of age,employed in Contra Costa County,and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as shown above,sealed and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California. I certify under penalty of perjury that the foregoing is true and correct. 0, Dated: at Martinez,California. cc: Clerk of the Board of Supervisors(original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM:GOVT.CODE§§910,910.2,920.4,910.8) Page 2 • i Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA CMM INSTRUCTIONS TO CLAD? A. Clams relating to causes of action for death or for injury to person or to pe;-_ 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 l a ter 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 off ice in Room 106, County Administration Building, 651. Pine Street, Martine-Z, CA 94553. Ce If c.laim is against a distrlcit gore" e3 .Jy tthca. 9.ca.a ^f Supe:^visors, rather tl n the County, the name of the District should be filled in. D, If the claim is against more than one public entity, separate clams must be filed against each public entity. E* ' Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of tris form. RE: Cl irk► By } Reserved for Clerk's filing stamp Y.a Against the County of Contra Costa } or } MAR 1 2 2003 Jl� J �" istrict} CLERK BOARD OF SUPERVISORS (Fill- in nalae } CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as .1 ollows: I* when did the damage or injury occur? (Give exact date and hour� GIn x g t a e_c uleAeU' AIM Ite_1,ailea�-s dol 3�1I 2, where did the • damage or injury occur. (Include city and county) 7 �' Q ee4i e:7 a�'G �d AJ 4 �� S -1'D�.� 71 1?-ID/zk- ;-7 le _Z�ee57 3. How did the ge or injury occur? (Give full details; use extra paper if required) �� �o�r r�' �� Q.. off'-ze. -�� d 9�-� c��-�.- L �1°/° 6?tN Ice a..t e�� �-elAe_ .�es is e (tIof!5_5 nlele, *??.e b y ret / aG a IYeA rq�& et9A,� o 4* what particular act or omission on the part of county or district officers, servants or .employees caused. the injury or damage? 7he,<_c k-v,,T Adie C./ y y C� � � f Lt a.f vx_e /Q�?,2c�s" ,� � ,5'e,r-m' a X e rz� 11611_7le /Ot (A vr�titi yJ% (over) V 0 ❑ tiJ ►--� r-., Cl N W Cr) 0 ` � O VI 'd' z w"•� oG � o❑ •� � ` Vii:;-QSiz M O ❑ d ' o w a O as "�► ' _ ' R ��► O 3Uc vzs aEc ''C '"'` .r E- Ifto '� 4 00 0 O f ... ta Go z © � kyr, ❑ c? aw 9 > , ❑ x "�•�' �' v1 x Fes. c!7 c!1 �� ?"' ( G�. O � E- � v' cq 1 ti r t MRLSS oear..un uai.m uran A'iong wiin vur invoice Wimim, wyvw.austarg,ass-net LL Cv Aw Oce To: 1845 Morena Blvd., San Diego, CA 92110 BALKE KATIE . 22083 office Manager THE EAST BA na Blvd. 92110 A _ SERVING 41.148 0 ccounting 800 225-4185 92 5�9 WALNUCREEK -5742 T �800� 282 ,•y,:� ;:;,�,,�. �.,.� ' 41�3 �.:r."1. 141 Pine St. 925 941-14$8 - I 96 Fax� � +i:_sl...,� �"'• �.�'� � `� f Walnut Creek,CA 945 � ice* 35 Gloss Centers* Nationwide � Free Mobile service NAME STREET `� • STREET CITY STATE ZIP CITY t. STATE ZIP ` M.y L r t. � �•.�ft. lir. ..... .,,. ��. .Z.. f••;.d . t it Ivi la •/ • TRAVELERS CHECK AMOUNT CASHIERS CHECK AMOUNTCHECK#%AMOUNT CREDIT CARD.#!AMOUNT INSURANCE.CO. POLICY# DED:AMT. VERIFIED BY REF.INVOICE# j VEHIGLE SERIAL# y YEAR MAKE&BODY STYLE 3 -CAUSE OF:LOSS OQOM_ R 1$7 DATE COMPLETE COST.P.O.# INSTALLER COORDINATOR CLAIM# DATE FLOSS DESCRIPTION PRICE AMOUNTFOR.. OFFICE USE ONLY i._/;1 Y ��i�+••LJ tf�.:.;I�I�J,.���.� �:� t i 1"� �•t'�. 1�• `...•L r ~ ~� •�0�j �' •'�� VX q( em 0 •J \rf '�,.r✓"' ! !1 i l� �' ��� � 4 1� •y �� 't. •, .1%yam` �. • PARTS SUB-TOTAL ORIGINALAUTHORIZED ,� �" P'HO PAT TIM LABOR ES 1MAT•E ;\`+ Y t �..... FREIGHT TEARDOWN ESTIMATE:I UNDERSTAND THAT MY VEHICLE WILL BE REASSEMBLED WITHIN DAYS OF THE DATE SHOWN ABOVE IF I CHOOSE NOT TO AUTHORIZE THE SERVICES RECOMMENDED. SALES TAX REVISED REASON ADDITIONAL AUTHORIZED ❑IN PERSON DATE TIME ESTIMATE COST BY ❑PHONE# SUB TOTAL $ Is DEDUCTIBLE RELEASE AND AUTHORIZATION TO PAY OTHER THAN INSURED OR CLAIMANT The glass has been replaced to my complete satisfaction and I authorize the to pay direct to ALL STAR GLASS CO.the full amount due me under the terms of my policy covering the said automobile,and I TOTAL understand if for any reason my insurance company does not pay this claim,I will be responsible for payment of same.If any AMOUNT action at law or in equity is necessary to enforce the terms of this agreement,the prevailing parry shall be entitled to reasonable attorney fees,costs,and necessary disbursement in addition to any other relief to which he may be entitled. r.. STORE NUMERIC COPY INSURED T A V 1 r% 11Ar d%id r IAA A A A00k1L@"Pff%A ��a"PM_ ■•w .■.www.�. ZADN.No yviab Alk� (OIL= 1b Ashur Benjamin t I Job Number ALIFORNIA AUTO BODY i :150033 Federal ID #680090?80 " WE SPECIALIZE IN PERFECTION " 1225 Parkside Drive Walnut Creek, CA 94596 (925)934-5424 Fax: (925)934-9??? PRE L IMINARY E S T IMATE Written by: LOURDES MALDONADO # Adjuster: Insured: Florida Foster Claim # Owner: Florida Foster Policy # Address: 331 New Deductible: Hercules, CA 9454? Date of Loss: Business: (510)?99-0418 Type of Loss: r Point of Imp4ct: 13. Rollover Ins qct CALIFORNIA AUTO BODY Business: (925)934-5424 Lo �on: 1225 Parkside Drive Walnut Creek, CA 94596 Durance Company: Days to Repair 1986 CHEV NOVA 4-1.6L-2 4D SED Int: VIN: lYlSK1943GZ139880 Lic: Prod Date: Odometer: Tinted Glass Body Side Moldings Clear Coat Paint Power Brakes Cloth Seats Bucket Seats Recline/Lounge Seats Automatic Transmission Styled Steel Wheels ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1 ROOF & BACK GLASS 2* Rpr Roof panel sedan ------------------------------------------------------------------------------- Subtotals =_> 0.00 4.0 0.0 1 03/04/2003 at 11:07 AM Job Number: 77640 PRELIMINARY ESTI hTE 1986 CHEV NOVA 4-1.6L-2 4D SED Int Parts 0.00 Body Labor 4.0 hrs B $ 65.00/hr 260.00 ---------------------------------------------------- SUBTOTAL $ 260.00 ---------------------------------------------------- GRAND TOTAL $ 260.00 ADJUSTMENTS: Deductible 0.00 -------------------------------------------------- CUSTOMER PAY $ 0.00 INSURANCE OAY $. 21601.00. T f 2 CD c~ rc y •..`firitl Blvd, to C" 06 It r .. J 10 p,DvWk S �N P�Gb . 1 v ............ ,t .4 r PAGE NC_ - CONTRA COSTA HEALTH SERVICES TYPE OF = DATE OF BILL ;,* �-�- ! 595 CENTER AVENUE, SUITE 300 3 BILL '�g"""�`' - MARTINEZ, CALIFORNIA 94553 ,c, y I SAL 2/25l �3 vY-.�`•_ 1r\ \/925) 313-6500 s t•of UT �1 PATIENT NAME PATIENT NUMBER SEX AGE ADMISSION DATE DISCHARGE DATE DAYS AMOUNT ENCLOSED •OTTER, FLORIDA 74 55445 ' 59102/06/03 02/06/03 1 INSURANCE COMPANY NAME GROUP NO. POLICY NUMBER 3UARANTOR FLORIDA FOSTER PRIVATE PAY NAME 331 NEWBURY 5T AND HERCULES, CA 94547 ADDRESS PLEASE RETURN TOP PORTION WITH YOUR PAYMENT DATE OFOj.Y DESCRIPTION OF SERVICE TOTAL EST COVERAGE EST.COVERAGE EST.COVERAGE PATIENT SERVICE HOSPITAL SERVICES CODE CHARGES INS.CO.NO.1 INS.CO.NO.2 INS.CO.NO.3 AMOUNT 20703 1 CUFF SP ADULT/DT5 40577157 55. 50 56. 50 TOTAL CENTRAL SUPPLY S6. 50 59. 50 20603 1 HYDROS.VDONE/ACET 4 ' 41797499 1. 49 1 . 49 E199296 TOTAL PHARMACY 1. 49 1. 49 10603 1 EMERGENCY ROOM 45300027 95. 00 95. 00 ?0903 1 ER LIMITED VISIT 45324407 50. 00 50. 00 TOTAL EMERGENCY ROOM VISITS 145. 00 14.5- 00 SUB--TOTAL CHARGES 202. 99 #. 202. 99 TOTAL LIABILITY 202. 99 202. 99 9599 7015977--02--0000 ?02. 33 PATIENT NUMBER PLEASE REFER TO PATIENT ADDITIONAL PATIENT BILLING MAY BE NECESSARY FOR ANY 4 NUMBER ON ALL INQUIRIES CHARGES NOT POSTED WHEN THIS BILL WAS PREPARED,OR PLEASE PAY THIS AMOUNT AND CORRESPONDENCE. IF INSURANCE CARRIERS DO NOT PAY ANY PART OF THE AMOUNTS SHOWN UNDER ESTIMATED INSURANCE COVERAGE. Make checks payable to CONTRA COSTA HEALTH SERVICES a: February 5, 2003 Florida Foster 331 Newbury Hercules, CA 94547 (510) 799-0418 Dear Roads and Services On February 6, 2003 1 experienced something one would only imagine in a movie. I was en-route to work driving very cautiously as usual and out of nowhere a deer leaped in the front of my vehicle shattering my windshield, my left side window and denting the hood of my car with its huff. Additional, I am emotionally a wrecked., I am fearful of all cars that pass by me too close and I don't ever want to see a deer or its likeness ever again. Physically I have a scar that is permanently indented on my chin not to mention that I still am wiping off glass particles that remain throughout my body when I sleep there are particles on my pillow and when I shower I rub-off glass every once in a while. I am mentally drained from my devastating accident every time I see any land animal with four legs; cats and dogs in my neighborhood I think of that deer and it scares me. Sincerely, Florida Foster Edna Gurule 1208 Monticello Rd. Lafayette, California 94549 925-283-2593 March 6,2003 My caregiver, Florida Foster, was unable to fulfill her duties on February 6th and 7th, 2003 due to an accident on San Pablo Dam Road at approximately 5:30 p.m. She stated to me that there were no deer warning signs posted which she believes led to the accident hitting and killing a deer. This accident caused major damage to her car and personal injury to her as well. Sincerely, d Edna Gurule CD C.) V% io J3 Se- CeD . 0' CD 0 10 01 13 C').6Z po'a, 0,- 'D 's Tn 7- , 0 0 C�--:� :::F CD rl 7 t::r CD 0-CD 0 ;00-V% CD 0 0 0 CD 0 CD 7:3 --%.0 CD 0 0 7 -4 ra too! 0 CD 0 04 -- Z CD 0 CD C-) 0 ct17� 0, -A 0 CD 0,- 0G ��- CD. 4 CD CD CD 0 CD C)6- .% CD CD 13 QQ Or CD 15 - 5 Z CD P -CD C-) ';Z CD A 0 CD 0 0� CD CD 0 CD cCD C)o 0 cr CD 4 0 CD C)0. CD CD CDCD 0 CD 0'-0 O)o S.-s- C-)-a CD -,% Oo CD CDCD C D !ZA; C) 0 0 --% G C� CD CD si(P CD 7CD No o 0 0 p. ion()D CD 0 -:5-0 0vk CD 0— rt "In so 0 % c CD 0 04 C) "0�D —CD :::r CD CD CD 0 0-% D CD CD 0 CD 0 5D ID 'COD ID 0 �— (0)m 0- CD 'e- Oo -A, ell, CD CD CD 0 =d�a S :::6� A '.m 0 tr r .� fMGw Or 401 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 6.6 ear BOARD ACTION: APRIL 15, 2003 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed toy ou is our y California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given 1EPursuant to Government Code Section 913 and rb ,v art " 915.4. Please note all "Warnings". � - �J" g i . AMOUNT: MORE -THAN $10,000, MAR 1 2 2003 CLAIMANT: TOM LOUKOS COUNTY r,,0 UNSEL MARTINEZ CALIF. ATTORNEY: SIMON KISCH DATE RECEIVED: MARCH 12, 2003 ADDRESS: 1736 FRANKLIN STREET, 10th FLOOR BY DELIVERY TO CLERK ON: MARCH 12, 2003 Oakland, ca 94612 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN S WEETE Dated: MARCH 12, 2003 By: De ut p Y II. FROM: County Counsel TO: Clerk of the Board of Supervisors (LOY�Ts 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 Y g 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 f 2-,o --- 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: (X) 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. APRIL 15 2003 JOHN SWEETENCLERK B Dated: , y , Deputy Clerk p y 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 y attorney of your choice in connection with this matter. If you want to consult an attorne , you should do so i *For 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 postage full California, p g Y prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: APRT ,, 16. 2 D l JOHN SWEETEN, CLERK B yD � eputy Clerk t This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for. specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate 0 limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific, statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSMUCTIONS TO CLADAAN—T 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 100 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 P resented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must bepresented 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 RECEIVED Against the County of Contra CostaPr0*,%;V%d MAR 12 2003 Stu �C-441ILalot District) CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. 00 T-0 The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ and in support of this claim represents as follows: }1 to -)I 1. When did the damage or Injury occur?(Give exact date and hour) ;00Z - 2.. Where.did the damage or injury occur?(Include city and county) i ex Ivit, 3. How did the damage or injury occur?(Give full details;use extra paper if required) ea 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? 5. What are the names of county or district officers, servants,or 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. MCA 8. Names and addresses of witnesses,, doctors, and hospitals. 9. List the expenditures you made on account of this accident or injury. DATE TEME AM A4j1) S fee -s Gov. Code See. 910.2 provides"The claim must be signed by the claimant or by some person on his behalf SEND NOTICES TO: (Attornev Name and Address of Attorney mot%) kk SCH wignature) (Address) t50 Telephone No. 71Telephone No. NOMCE Section 72 of the Penal Code po"ides: Every person who,,with intent to defraud,presents for ailo%wce or the 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 firaudWent claiM bilk- voucher,or writing,is punishable either by imprisonment in the county jail for a period of not more than one year,by an of not exceeding one d(S I,000),or by both such imprisonment and fine,or by henprii onment in the state prison,by a fine of not exceeding ten tho ad dollars($10,,000),,or by both such i4mpri*s P 1�M i C n t and fine- 4 s_ .y R State of California -• T "Instructions read Instructions for Filing a Claim" Board of Control - . Wyou are filing this claim bey�d six months from the incident cue,please GOVE'RNMENT CLAIM see instructions forfiling a tate claim application on the opposite page. SSOC-GC-000E2(Rev,s/ao) Name of Claimant Telephone Number(ndudea m code) CA 55 P-8 S.3 Mailing Address City Slate Zip Code 4t:, a r� � C A �c�►�` Is the claire fled on behalf of a minor?QYes allo If yes,please indicate:Relationship to the minor Date of birth of the minor Name of State Agency against which this claim is filed Incident Date 14 6C-C 0 t Dollar Amount of Claire G.. N S Ch iV-7 r 707P Oti 90o ; ,rdr*-J ANA c Month Day Yr. � Ga 0 a If the amount exceeds$10,000,indicate type of civil case: Explain how the dollar amount claimed was computed. F-1 Limited Civil Case Non-Limited Civil Case (Aftach#gree copies of the supporting documentation ibrft ❑ amount claimed with this f orm.) Describe the specific damage or injury incurred as a result of the incident. A±JackleQ n Location of the incident If applicable include siedt address,crty orae,highwaynumber,post mile numberand drecfion cftra ) Ac%j',N rra itl !rm rec,, Prefen'ed Hearing Location Of an appearance is necessary): ❑Sacramento 0 Los Angeles @�aakJand El San Diego Explain the circumstances that led to the alleged damage or injury.State all facts that support your claim against the state of California,and why you believe the State is responsible forthe alleged damage,or injury.if known,provide the narne(s)of the state employee(s)who allegedly caused the injury,damage or loss.(If more space is needed,please attach addifional sheets.) State Of California Submit completed claim form and three copies to: Board of Control STATE BOARD OF CONTROL GOVERNMENT CL.AIM GOVERNMENT CLAIMS BRANCH P.O.Box 3035 SBOC-GC-0002(Rev.6100)Reverse Sacramento,CA 95812-3035 Has the claim forthe alleged damagelinjury been filed Policy Number Teiep�number(ndudear-eacode) or will it be filed with your insurance carrier? ( } ❑Yes ONo Mailing Address City. State Zip Code Name of insurance carrier Amount of Deductible Ars you the registered owner? Uj Yes F2 No Make: Model: Year: Name ofiAttomey/Represertative TeeOOneNumber(mdudearea code) �t vloo (5(0) 663 od Mailing Address City State ZP Fc'CA " 0A((:z L'(-hv 6t 2 . Eli Section 72 of the Penal Code provides that"every person who,with intent to defraud,presents for allowance or for payment to any State Board or Officer,or to any county,t n,city,dis ' t,ward, 'loge, rd or odic authorized allow or pay the same if genuine,any false or fraudulent claim,bill,account,voucher,or writing,is guilty o felony.° Signature of aimant Signature of Attomey/Representative Date .0 ------' _ M ar��.� �Z 200_ GOVERNMENT CLAIM Name of Claimant Mr. and Mrs. T Loukos Address of Claimant 14 Sandra Court, Alamo, California, 94507. Tel: 925-855 8853 Claim Information The claim is not filed on behalf of a minor The incident took place on or about December 14, 2002 The dollar amount of the claim is in excess of$10,000 and in accordance with provision of Government Code §910(f) the amount of the claim is not stated. The claim is not a limited civil case The incident took place to the rear of the property at 14 Sandra Court The preferred hearing location is Oakland Claims are being filed against the Department of Transportation (CalTrans), the Town of Danville, Contra Costa County, and the Public Facilities Corporation that is the title holder to the land on which part, or all of, the slide occurred. Circumstances that Led to the Damage The property in question, 14 Sandra Court (Property) abuts San Ramon Creek (Creek). On or about 14 December 2002, during a heavy rainstorm, part of the land to the east of the Property slid into the Creek temporarily damming it. A short while later the Creek overflowed this temporary dam and the resulting rush of water removed a lot of the slide material and a significant amount of material from the Property. However, part of the slide material is still in the old bed of the Creek and the Creek now flows about 50 feet to the west of its old course. I am informed and believe that part of the land from which the slide came is now owned by the Danville YMCA (YMCA) and part of the land is owned by a Public Facilities Corporation (PFC). The land owned by the PFC was paid for equally by the Town of Danville (Danville) and Contra Costa County. Some, or all, of this PFC land is commonly known as Hap McGee Park (Park). I am further informed and believe that the Contra Costa County, the PFC and Danville, and their agents, have improved the land from which the slide came, and this improvement work was wholly or partially responsible for the slide. I am also informed and believe that CalTrans is responsible for the maintenance of the Creek in the area of the Property and that this maintenance work was wholly, or partially, responsible for the slide. I am further informed and believe that during the construction of Highway 680, including the construction of a sound wall in the area of the Property, some, or all, of the land now owned by the PFC and the YMCA, and land adjacent to this YMCA and PFC land, was used by CalTrans, and its agents, for construction activities,_ including the dumping of excess fill generated during_construction. And this construction work Was wholly, or partially, responsible for the slide. Damage The slide and the resulting water flow caused the following damages: 1. A significant portion of the Property was removed 2. Various structures on the Property, including retaining walls were damaged 3. Two large oak trees were washed away. These trees provided shade for the Property and lessened the noise from Highway 680 4. A part of the slide material still sits on the Property 5. The Creek's course is now through the Property rather than abutting the Property 6. The Property has been reduced in value, including being stigmatized, by the occurrence of the slide 7. It is possible that government, or other, regulation, or engineering factors, may prevent the property being returned to its original state. If that should be the case, the value of the property may be negatively affected 8. The Loukos family has suffered from, and continues to suffer from, severe emotional distress Representation Mr. and Mrs. Loukos are represented by Simon Kisch Law office of Simon Kisch 1736 Franklin Street, 10th Floor Oakland, CA, 94612 Tel: 510 663 6400 Fax: 510 444 1704 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY r BOARD ACTION: APRIL 15, 2003 Claim Against the County, or District Governed by ) 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 California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all"Warnings". AMOUNT: $3,000. MAR 14 2003 COUNTY COUNSEL, CLAIMANT: JESSE ELLIS MARTINEZ CALIF, ATTORNEY: UNKNOWN DATE RECEIVED: MARCH 14, 2003 ADDRESS: 165 DIANE AVENUE BY DELIVERY TO CLERK ON: MARCH 14 2003 PITTSBURG, CA-94565 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN S WEE N k Dated: MARCH 14, 2003 By: Deputy IN II. FROM: County Counsel TO: Clerk of the Board of Supe sors koo� his 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). ( j Other: Dated: B `' y 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: APRIL 15, 2003 JOHN SWEETEN, CLERK, By Deputy, De ut Clerk r. 09 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: APRIL 16 2003 JOHN SWEETEN, CLERK By Deputy Clerk This warning, does not apply to claims which are not subject to the California Tort Claims Act-such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period '`" within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific, statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive lights under the, statutes of limitations applicable to actions not subject to the California Tort Claims Act, Y 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. (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, either by mail or in person. 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 Jesse Ellis � RECEIVED� Against the tounty of Contra Costa MAR 1 4 2003 or CLERK BOARD OF SUPERVISORS The Housing Authority of Contra Costa (District) CONTRA COSTA CO. (Fill in name) The undersigned claimant hereby makes cluirr, against the County of Contra Costa or the above-named District in the sum of$ 3;o o o and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) :�e_t. 5 a o 03 //#f 3 0 PNI 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full etails; use extra paper if required) 14 v`� UJ 6-t. .Y- Qa., + 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? clmform 31-3163 --'-n S Ik at U) I&,-n OaL lqll ���, S. X003 Cary�t --� �o v�n y ro o ►� �- 1+ L4 (LU U VYI (L ca e r kC n Y%v►)o r e. S e..w:r�cS Y�l�cti e h�n�. I-v Oj Sf6 0 �� o n e- --� C�a-S S ►`C.. Fre r�e l� S�� I�.. �'So►1�p y S��-reo Radio S�o�S M 5. What are the names of count ;ordistrict,officers, servants or employees causing the damage or injury? - U v►� i� �n r �.a 5 - s i,, cc� da 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. 1 � Ccs `' ' y °�' "�' `��� g ) �Y �'C� Vo�,Q-ou n ate ah Ke-onmore,e - ��..eh , �yi5/ n� sof � I p an�� a-Ia-Sgie. rYe.Y\� S��t�.� 1� l t S�� a _ �� o ��55�t`f� �2e-o r J e s 4 c-.. -er `� she r ea � 7. How was the amount claimed abo e computed. (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses, 1 �'e.- +'►'a a- m f i (oU ib i.�+'1�. f-��z.., P�lS ��r � � eta- 5�,� }�h a yl.e,._ - — (cid-5) 4-3 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 3 boo r Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICE TO: (Attorney) or by some person on his behalf." Name and Address of Attorney $IVR� (Claimant's Signature) (Address) uL14 0---,A Telephone No. Telephone No. 9 4 3 q 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." clmform AMENDED ------ CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: APRIL 15, 2003 Claim Against the County, or District Governed by ) the Board'bf Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and /=Tay 915.4. Please note all "Warnings". AMOUNT: EXCESS OF 4-'109000. • MAR 14 2003 CLAIMANT: TOl� LOUKOS COUNTY COONS2L ATTORNEY: AIARTINEz 'W`TE RECEIVED: MARCH 14 2 SIMON KISCH 003 ADDRESS: UW OFFICE OF SIMON KISCH BY DELIVERY TO CLERK ON: .MARCH 14, 2003 1736 FRANKLIN STREET, 10th FLOOR OAKLAND, CA 94612 B Y MAIL POSTMARKED: HAND DELIVERED BY DON F FZ.OM, COUNTY FROM: Clerk of the Board of Supervisors TO: County Counsel U UNSEL Attached is a copy of the above-noted claim. JOHN SWEETEN, V Dated: MARCH 14, 2003 B De ut By: Deputy_ 44tC-.__ II. FROM: County Counsel TO: Clerk of the Board of Supervisor 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: f3 Dated: / 7-03 By: Deputy Count Counsel p Y Y 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: APRIL 15, 2003 JOHN SWEETEN, 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: APRIL 16, 2003JOHN SWEETEN, CLERK By Deputy Clerk S This warning does not apply to claims which are not subject to the California Tort Claims Act-such as actions in inverse condemnation, actions for. specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific, statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. MAR 1 4 2003 C 0 U N T Y C t.j L LAWFFICE OF SIMON K I S C H MARTINEZ CALIF. ATTORNEYS AT LAW SIMON E.KiSCH TELEPHONE (510) 663 6400 THE CALIFORNIA BUILDING CELL PHONE: (510) 459 0256 1736 FRANKLIN STREET 10T"FLOOR FACSIMILE: (510) 4441704 OAKLAND CALIFORNIA 94612 March 13, 20003 Laura Lockwood Office of the County Administrator 651 Pine St, 6th Floor � l Martinez, CA, 94553-1290 '?00, C CO Re: Claim of Mr. and Mrs Loukos Dear Lockwood, It was a pleasure speaking to you yesterday. Enclosed is an amended claim form for the slide at Hap McGee Park. This form includes the Government Claim, this was used as the PFC does not have its own claim from, and an amended attachment. Thank you for your attention to this matter. Yours Sincerely Simon Kisch 1 PROOF OF SERVICE I, the undersigned, declare that I am an active member of the State Bar of California, and not a party to the within action. My business address is The California Building, 1736 Franklin Street, 10th. Floor, Oakland, CA, 94612. On March 13, 2003 1 served the following documents: (1) State of California — Government Claim (with 2 page attachment), original by placing this document in a sealed envelope, postage paid, deposited with the U.S. Mail, addressed as follows: Laura Lockwood Office of the County Administrator 651 Pine St, 6th Floor Martinez, CA, 94553-1290 1 declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on March 13, 2003 at Oakland, California. Simon Kisch state of California Please read "Instructions for Filing a Claire" Board of-Control - ffyou we filing ibis claim beyond sa months from the inddent dai%.please see instructions forfiling a late claim application on the opposite page. GOVERNMENT CLAIM sBOC-GC-0002(Rev.6100) G Name of Claimant Telephone Nurnber(aducitamcode) (325) 65S P R53 Mailing Address City S'` B ZpCode S f Co Is the claim filed on behalf of a minor?UYes 2No If yes,please indicate:Relationship to the minor Date of birth of the minor Name of State Agency against which this claim is filed Incident Date 14 6--C o t Dollar Amount of Claim ar G3o i� ��� o� Month Day. Yr. QKeaitm- CA(. v o If the amount exceeds$10,000,indicate type of civil case: Explain how the dollar amount claimed was computed. (Attach three copies ofthe supporting docurnentationfort e ID Limited Civil Case Non-Limited Civil Case amount claimed with this fornn. Describe the specific damage or injury incurred as a result of the incident. Location of the indent(if applicable,include strut address,cfty orcoun y,highway number post mile numberand dire on dtavel.) p = 1 Ich8pj✓r C-t c- Pteftr'ed bearing Location(tf an appearance is necessary): ❑Sacramento 0 Los Angeles @dao"V'J'and D San Diego Explain the circumstances that led to the alleged damage or injury.State all facts that support your claim against the State of Califomia,and why you believe the State is responsible forthe alleged damage,or injury.if knovvn,provide the name(s)of the State employee(s)who allegedly caused the injury,damage or loss.(If more space is needed,phase attach additional sheets.) 1 State Of California Submit completed claim form and three copes to: Board of Control STATE BOARD OF CONTROL . GOVERNMENT CLAIM � � GOVERNMENT CLAIMS BRANCH P.O. Box 3035 SBOC-GC-0002(Rev.6100)Reverse Sacramento,CA 95812-3035 Has the claim fiorthe alleged damagetnjury been filed Policy Number Telephone number(mc�dearea code) or will it be filed wig your insurance.carrier? ( } ❑Yes ❑No Mailing Address city.. Stage Zip Code Name of insurance carver Amount of Deductible Are you the registered owner? . Uj Yes ❑No Make: Model: Year: Name ofiAttomey/Represertative TelepfioneNWnber(indudeareaoode) (5(o} G G 3 6 od Mailing Address city Sate ZIP C7(-CA 0 C30 0A((:Z L AN 3 Section 72 of the Penal Code provides that"ev petson who,with intent to defraud,presents for allowance or for payment to any State Board or Officer,or to any county,town c v,his#tictPan rd,orvilia ,bo r officer,a riz hoed to al w or pay the same if genuine,any false or fraudulent claim,bill,account,voucher,or writing,is guilty of a fe n .° WV Signature of Ciai Signature of Attorney/Representative � t3 Daly �j A r-14 2003 GOVERNMENT CLAIM Name of Claimant Mr. and Mrs. T Loukos Address of Claimant 14 Sandra Court, Alamo, California, 94507. Tel: 925-855 8853 Claim Information The claim is not filed on behalf of a minor The incident took place on or about December 14, 2002 The dollar amount of the claim is in excess of$10,000 and in accordance with provision of Government Code §910(f) the amount of the claim is not stated. The claim is not a limited civil case The incident took place to the rear of the property at 14 Sandra Court The preferred hearing location is Oakland Claims are being filed against the Department of Transportation (CalTrans), the Town of Danville, Contra Costa County, and the Public Facilities Corporation that is the title holder to the land on which part, or all of, the slide occurred. Circumstances that Led to the Damage The property in question, 14 Sandra Court (Property) abuts San Ramon Creek (Creek). On or about 14 December 2002, during a heavy rainstorm, part of the land to the east of the Property slid into the Creek temporarily damming it. A short while later the Creek overflowed this temporary dam and the resulting rush of water removed a lot of the slide material and a significant amount of material from the Property. However, part of the slide material is still in the old bed of the Creek and the Creek now flows about 50 feet to the west of its old course. I am informed and believe that part of the land from which the slide came is now owned by the Danville YMCA (YMCA) and part of the land is owned by a Public Facilities Corporation (PFC). The land owned by the PFC was paid for equally by the Town of Danville (Danville) and Contra Costa County. Some, or all, of this PFC land is commonly known as Hap McGee Park (Park). I am further informed and believe that the Contra Costa County, the PFC and Danville, and their agents, have improved the land from which the slide came, and this improvement work was wholly or partially responsible for the slide. I am also informed and believe that CalTrans is responsible for the maintenance of the Creek in the area of the Property and that this maintenance work was wholly, or partially, responsible for the slide. I am further informed and believe that during the construction of Highway 680, including the construction of a sound wall in the area of the Property, some, or all, of the land now owned by the PFC and the YMCA, and land adjacent to this YMCA and PFC land, was used by CalTrans, and its agents, for construction activities, including the dumping of excess fill generated during construction. And this construction work was wholly,-or partially, responsible for the slide. I am further informed and believe that Cal Trans, one of its agents or another State agency or one of its agents, installed water bearing pipes through part or all of the slide area and its vicinity and the installation of these pipes and leakage from these pipes was wholly or partially responsible for the slide. Damage The slide and the resulting water flow caused the following damages: 1. A significant portion of the Property was removed 2. Various structures on the Property, including retaining walls were damaged 3. Two large oak trees were washed away. These trees provided shade for the Property and lessened the noise from Highway 680 4. A part of the slide material still sits on the Property 5. The Creek's course is now through the Property rather than abutting the Property 6. The Property has been reduced in value, including being stigmatized, by the occurrence of the slide 7. It is possible that government, or other, regulation, or engineering factors, may prevent the property being returned to its original state. If that should be the case, the value of the property may be negatively affected 8. The Loukos family has suffered from, and continues to suffer from, severe emotional distress Representation Mr. and Mrs. Loukos are represented by Simon Kisch Law office of Simon Kisch 1736 Franklin Street, 10th Floor Oakland, CA, 94612 Tel: 510 663 6400 Fax: 510 444 1704 APPLICATION TO FILE LATE CLAIM • % 9-- BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD ACTION APRIL 15, 2003 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 take4' 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: PERRY CASTRO Attorney-, UNKNOWN MAR 10 2003 Address: 2047 C ARNOLD QQUNTY COUNSEL INDUSTRIAL WAY CONCONkRTINEZ C t UF MARCH 10 2003 Amount: CA 94520 ydelivery to Clerk one $50070OOsOOo. (500 Million) Date Received: By mail,postmarked on: HAM ])ELIVERri.ED I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted Application to File Late Claim. DATED. MARCH 10, 2003 JOHN SWEETEN, Clerk,By: DEPUTY II. FROM: County Counsel TO: ClerVof the'lBoard of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6)' The Board should deny this Application to File Late Claim (Section 911.6). DATED. -- SILVANO Bo MARCHESI, County Counsel,By: PUTY 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). 1 certify that this a true and correct copy of the Board's Order entered in its minutes for this date. DATE: APRIL 15, 2003 JOHN SWEETEN,Clerk,By: DEPUTY WARNING (Gov. Code §911.8) 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 advice of an attorney of your choice in connection with this matter. If you want to consult an attorney,you should do so immediately. IV. FROM: Clerk of the Board TO0* (1) County Counsel (2) County Administrator Attached are copies of the above Application. We notified the applicant of the Board's action on this Application by mailing a copy of this document,and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. DATED: JOHN SWEETEN,Clerk,By:, DEPUTY V. FROM: (1) County Counsel (2) County Administrator 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 This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within-which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT i 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 100 '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. :::**:**�.:*:**«*s*.:#**:*:*s*s.***:sss**:ss:•sss�*:s*s*:ss*s*:*s:**s*****s:***s*:*:.:*:*s RE: Claim By Reserved for Clerk's filing stamp PC U �_ z��5 Z!� 0 - RECEIVED F K' I 2=0(Z_ L I ZI I'n/&Q�7: i.,,,a`• L°oi��o�;�/ MAR 1 0 2003 Against the County of Contra Costa or .• CA 94,a"z e) ) J� l CLERK BOARD OF SUPERVISORS /JZz'(' /lE�}(,�/� District) CONTRA COSTA CO. (Fill in name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$;!�)a,,,i,�1��,,,�nd in support of this claim represents as follows: 1. When did the damage or injury occur?(Give exact date and hour) 2-00 2-- 01,;�ec 2. Wheredid the damage or injury occur?(Include city and county) <�F-,v TcF-/( If oh'r1219 Coj Ti9 4'F=��o iu�G /�•C���'c/f� �'�`�o 3. How did the damage or injury occur?(Give full details;use extra paper if re wired) (!!S7X 0 400,v _T �,�4, rAAZ_ aAe4t id-C/f� ��� ;��.�C���C=�/� �� �/LL G'-1� T�O�ti�f G��L oe.C��z�z� c�►�L, r 4. Whatparticular act or onussion on the part of county or district officers, servants, or employees caused the injury or damage? -7/ C= S. What are the names of co my or district officers, servants, or employees causing the damage or injury?* I 6. What damage or injunes 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 TRVIE AMOUNT Gov. Code Sec. 910.2 provides"The claim must be signed by the claimant or by some person on his behalf" SEND NOTICES TO: Attorney Name and Address of Attorney (Claimant's Si natu ig to, C? .�;� r A (Address) Telephone No. Telephone No. NCM VE Section 72 of the Penal Code provides: Every person who,with intent to defraud,tents for allowance or the 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 bnprisonment in the county jail for a period of not more than one year,,by a fine of not exceeding one thousand(S 1,,000),,or by both such imprisonment and fine,or by imprisonment in the"t prison,,by a fine of-not exceeding ten thousand dollars($10,000),or by both such u*npn*so iment and fine.