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MINUTES - 05062003 - C37
CLAIM l BOARD OF SUPERVISORSOF CONTRA COSTA COUNTY •*-�' BOARD ACTIOI'+l. 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 I-to � 915.4. Please note all"Warnings". AMOUNT: UNKNOt 1N ' CLAIMANT: GREG PRIDE COUNTY CrOUNSm.. ATTORNEY: KELLEY ANN BURG DATE RECEIVED MARCS ],a, 2003 ADDRESS: P.O. BOX 70231 BY DELIVERY TO CLERK ON: MARCH 18, 2003 PT. RICHMOND, CA 94807-0231 BY.MAIL POSTMARKED: MARCH 17, 2003 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETS Dated; M By: Deputy IL FROM: County Counsel TO: Clerk of the Beard of Supervisors (-4"'This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days(Section 910.8). { ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). { ) Other: Dated: By: Lee 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. Dated: MAY 06, 2003 JOHN SWEETEN, CLERK,By _ AR , Deputy Clerk WARNING (Gov. code sectin 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. MAY 07' 2003 Dated: JOHN SWEETEN,CLERK.By Deputy C" Kelley Ann Burg Attorney At Law Telephone No. Mailing Address Street Address: 510-237-7982 P.O.Box 70231 999 W.Cutting Blvd. Facsimile Pt. Richmond,CA 94807-0231 Suite 16 510-237-4797 Pt. Richmond,CA 94804 March 17, 2003 Clerk of the Board of Supervisors County Administration Building t f 651 Pine St., Rm. 106 Martinez, CA 94553 Re: Our Client: Greg Pride D/OIL: September 17, 2002 Dear Sir/Madam: 1 am enclosing the original and one copy of the claim in the above matter. Kindly forward a copy back showing that it was stamped as received. Thank you for your cooperation. Very tru y urs, W Phillip B. Allen Legal Assistant Licensed to practice in California and Hawaii BEFORE THE COUNTY OF CONTRA COSTA IN THE MATTER OF THE CLAIM OF ) ) GREG PRIDE ) GOVERNMENT CLAIM against the Board of Supervisors of Contra ) Costa County ) The undersigned claimant hereby makes claim against the Board of Supervisors of Contra Costa County: CLAIMANT'S NAME: Greg Pride CLAIMANT'S ADDRESS: 16522 nd St. Richmond, CA 94801 ADDRESS TO WHICH NOTICES ARE TO BE SENT: Kelley Ann Burg P.O. Box 70231 Pt. Richmond, CA 94807 Tel. (510) 237-7982 Fax(510) 237-4797 AMOUNT OF CLAIM: Within the unlimited jurisdiction of the Superior Court. See Government Code § 910(f) DATE OF INCIDENT: September 17,2002 LOCATION OF INCIDENT: Brookside Shelter, Richmond, CA FACTS, CIRCUMSTANCES AND BASIS FOR CLAIM: On September 17, 2002, the Claimant was a lawful resident of Brookside Shelter, when he was assaulted by the husband or boy friend of one of the individuals who worked at the shelter. The employees of the shelter were negligent in that they permitted access to the individual who assaulted the Claimant. The basis of the claim is that the employees of the shelter were negligent in permitting the l ............................................................................................................................................................................. ........................................................................................ unauthorized access of the individual committing the assault and in that the employees of the shelter negligently failed to guard against the assault. The County of Contra Costa is liable for the acts of its employees. INJURIES AND DAMAGES: Claimant sustained head, neck and back injuries. Claimant has sustained and continues to sustain substantial medical,hospital and medication bills. In addition,Claimant has sustained great pain and suffering. ITEMIZATION OF DAMAGES: (known at this time) 1. Hospital,physician,therapy and other Unknown at this time. types of medical expenses 2. Loss of earnings and earning capacity Unknown at this time 3. General Damages Within the unlimited jurisdiction of the Superior Court. See Government Code § 910(f) 4. Future Damages: Within the unlimited jurisdiction of the Superior Court. See Government Code § 910(f) Kelley Ann Burg, Esq. Dated: March 17, 2003 By: Kell y Ann Burg, Esq. 1 PROOF OF SERVICE 2 I, Phillip B. Allen, do hereby declare and state: 3 1 am employed in the County of Pt. Richmond, California. I am over the age of 18 years 4 and not a party to the within action. My business address is 999 W. Cutting Blvd., Suite 16, Pt. 5 Richmond, CA. 6 On this day of , 2003, 1 served the foregoing 7 GOVERNMENT CLAIM on the parties in this action,by placing a true and correct copy thereof 8 in a sealed envelope, and each envelope addressed as follows: 9 Clerk of the Board of Supervisors County Administration Building 10 651 Pine St., Rm. 106 Martinez, CA 94553 11 12 I caused each such envelope, with postage prepaid thereon, to be placed in the United 13 States mail at Oakland, California. 14 1 eclare under penalty o erjury that the foregoing is true and correct. Executed on this 15 day of 2003 at Pt. Richmond, California. 16 17 Phillip B. A en 18 19 20 21 22 23 24 25 26 27 28 ♦, y y y F r �o c7 Cd as 'WIWI i' U, a . o wow mom Odom Cl a ` �, fY1�111M.11lf�r•�Mfsl u wm� o..�FT Q {i) CLAIM 4 BQAM OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION; W:.V i, 2443 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 g?r Pursuant to government Code Section 913 and All 15.4. Please note all"Warnings". AMOUNT: CEEDS $10,000. Ah 1. 9 2003 } CLAIMANT: ROBERT P. AMIA1't4NE r.,OUNTY C01J SEL M. ARTINEZ CALF ATTORNEY: UNKNOWN DATE RECEIVED: MARCH 19, 2443 ADDRESS: 1193 TILS4N DRIVE BY DELIVERY TO CLERK ON:MARCH 19, 2443 CONCORD, CA '94520 BY MAIL POSTMARKED: MARCH 18.,_2003 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETEN,C Dated: MARCH 19 a 2443 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors (-v}'''�This claim complies substantially with Sections 910 and 910.2. ( } This Claim FAILS to comply substantially with Sections 910 and 91.4.2, and we are so notifying claimant. The Board cannot act for 15 days(Section 910.8). ( ) Claim is not timely fled. 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). ,vd11 (v}''Other: C 14 C Dated: - y" `" ' 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 correctcopy of the Board's Order entered in its minutes for this date. Dated: MAY 06, ,2003 JOHN SWEETEN, CLERK, By ,Deputy Clerk WARNING(Gov. code section 13) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action}on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *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. MAY 47, 2003 JOHN SWEETEN, CLERIC.By Deputy Cleric Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLADNT 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, 1487, must be presented not later than the 10&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 Cade 411.2.) 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 Against the County of Contra Costa or ._... MAR 1 2 003 District) (Fill in name) ) c z The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of S and in support of this claim represents as follows: 1. When did the damage or injury occur?(Give exact date and hour) 0 2. Where did the damage or injury occur?(Include city and county) C-t coel-D CA L l 1=, 3. How did the damage or injury occur?(Give full details-,use extra paper if required) �- - A T .C.-t�r-V Q-- P C, CJ---A # rn . ................................................................................................................................I............................................................... 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? Dc-r-Anl(�- F I O^J 01C C--q 0 I-r1C--CPP--1 5. What are the names of county or district officers, servants, or employees causing the damage or injury? C-A-NA Ll Wk,(L 0 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) tAtlz"VJ4 gvL-C- 4-m,6 L,4— j L-A vIt 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) blOJOC)0 , 00 8. Names and addresses of witnesses, doctors, and hospitals. 9. List the expenditures you made on account of this accident or injury. DATE IM AM T 4-1— C,'—A i PA Lv I LA- i A —1 P-,O C-1 U i L Gov. Code Sec. 910.2 provides"The claim must be signed by the claimant or by some person on his behalf SEND NQ C) IQ: („Attorney Name and Address of Attomey 26 (Claimant's Signature) (Address) L C-0 A-)Cz 14) C4A Telephone No. Telephone No. NOME Section 72 of the Penal Code provides: Every Person who,with inftw to defraud,presents for allowance or the payment to any state board or officer,or to any county,city,or disbict board or officer,authorized to allow or pay the same if genuine,any false or ftudulent claim,bill,account„ voucher,or writing,is punishableeither by imprisonment in the county jail for a period of not more than one year,by a fine of not exceeding one thousand(S 1,('00).or by both such imprisonment and fine,or by imprisonment in the state prison,by a fine of not exceeding ten thousand doll=($10.O00),or by both such imprisonment and fine. 1 CLAIMANT 2 ROBERT P. AMATRONE 3 1193 TILSON DR. CONCORD, CALIF". 94520 4 925-207-6536 5 CLERK OF THE BOARD OF SUPERVISORS 651 PINE ST. 6 COUNTY ADMINISTRATION BUILDING ROOM 106 MARTINEZ, CA. 94553 7 ON FEB, 25,2003 AT ONE PM I WAS NOTIFIED BY MY ATTORNY THAT S THE A`I'TORNY FOR KAISER HOSPITAL HAD SUBPOENAD A CONFIDENTIAL FILE FROM THE CONTRA COSTA COUNTY A.P.S. DEPT. FOR USE IT THE KAISER ARBITRATION CASE. AS WE WERE UN AWARE OF THE EXISTANCE OF THIS FILE, WE SO MADE SIMILAR ARRANGEMENTS TO VIEW THIS FILE. THE ABOVE STATED DATE WAS THE FIRST TIME I BECAME AWARE THAT 10 THIS CONFIDENTIAL FILE EXISTED.AND THAT DATE WOULD BE THE START OF THE STATUTE FOR FILING THIS CLAIM. 11 AFTER REVIEWING THE REPORT I REALIZED THAT THERE WERE ALOT OF UNFOUNDED, UNTRUTHFULL ALLEGATIONS, REGUARDING, ABUSE, 12 THEFT, STEALING MEDICATION, ETC ALEDGED BY CATHY WARD A COUNTY APS SOCIAL WOREER.UPON FURTHER REVIEW I CAME TO THE REALIZATION, 13 THAT MY EX MOTHER IN LAW HAD BEEN ALLEDGING AND CONSTAN'T'LY FILING THESE REPORTS-JUST GENERALY ALOT OF CHARECTOR ASSINATIONS , I SAW 14 THIS AS NOTHING MORE THAN A DOCUMENTED CLEVER PLOT TO USE MY FATHER AS A PAWN TO TRY AND OVER TURN A CHILD CUSTODY CASE THAT WAS ON GOING DURNING THAT TIME. 15 MY CLAIM WILL SHOW A WRONGFUL RELATIONSHIP BE'T'WEEN ANN MARIE HEAVY MY EX MOTHER IN LAW AND CATHY JO WARD A COUNTY APS EMPLOYEE.A CLOS,. 16 FRIENDSHIP THAT HAD EXISTED FOR MANY YEARS PRIOR TO THE DATE OF REPORT. CLAIM WILL SHOW THAT THE REPORT CONTAINED. FALSIFIED 17 CONFIDENTIAL STATEMENTS BY AN APS COUNTY EMPLOYEE, I WILL SHOW MALICE, BIAS, CONFLICT OF INTEREST, PROFESSIONAL AND NEGLIGANT 18 MALPRACTICE BY CATHY JO WARD A CONTRA COSTA COUNTY EMPLOYEE. IT WILL ALSO SHOW THAT SAID COUNTY EMPLOYEE PERJURED HERSELF DURNING 19 A KAISER ARBITRATION HEARING WHERE SHE TESTIFIED WHILE CINDER OATH ON MARCH 10,2003 AT ONE PM. 20 HAD SHE ACTED IN A PROPER MANNER ONCE SHE REALISED WHO WAS INVOLVE IN THE CASE. CATHY JO WARD SHOULD HAVE TURNED IT DOWN AND HAD THE INVESTIGATION REASSIGNED DUE TO HER LONG TERM FRIEND SHIP WITH 21 REPOR'T'ING PARTY ANNMARIE HEAVY. AFTER VARIOUS ENRIES IN THE REPORT CATHY WARD HAD EDMUND AMATRONE 22 PICKED UP ON A 5150 TO COUNTY HOSPITAL FOR EVALUATION, UNFOUNDED COUNTY HOSPITAL SHORTLY RELEASED EDMUND AMATRONE WITH NOTHING MORE 23 THAN SLIGHT CONFUSION. AS EDMUND AMATRONE DID HAVE KAISER INSURANCE HE WAS TRANSFERED OVER TO WALNUT CREEK KAISER FORCONJESTION IN HIS 24 LUNGS, THAT WOULD LOWER HIS OXIGEN LEVEL IN HIS BLOOD AND CAUSE POSSIBLE CONFUSION. AS HE WAS UNDER KAISERS CARE HE SUFFERED 25 NEGLIGENT CARE FROM TREATMENT AND LACK THERE OF, THAT HE ENDED UP EXPIRING AS A RESULT OF THIS NEGLIGENCE AND MEDELING OF CATHY JO WARD AND HER FRIEND ANN MARIE HEAVY. CONT PG 2 I AS TO MY DAMAGES I HAVE CLAIMED DEFEMATION OF CHARECTOR, SLANDER, LIBEL,IT HAS DAMAGED MY BUSINESS, AS MY FATHER CONTRACTED ALOT 2 OF PROJECTS BECAUSE OF HIS STANDING IN THE COMMUNITY FOR MANY YEARS, IT HAS DAMAGED MY GOOD NAME AND THE GOOD WIMLL ESTABLISHED 3 BY MY FATHER OVER THE YEARS . IT HAS DAMAGED MY STANDING IN THE COMMUNITY, AS ONE NEIGHBOR WAS QUESTIONED REGUARDING ALEDGED 4 ABUSE, AND QUICKLY SPREAD FROM ONE TO ANOTHER. NOW BEING ENTERED INTO PUBLIC RECORD THRU THE ARBITRATION, IT WILL NOW EFFECT FUTURE 5 EMPLOYMENT, PROJECTS, BACKGROUND SEARCHES ETC. 5 THE COUNTY EMPLOYEE TAT WROTE THIS REPORT IS; 7 CATHY JO WARD 2530 ARNOLD DR. SUITE 300 MARTINEZ, CA. 94553 9 A CONTRA COSTA COUNTY EMPLOYEE OF THE A.P.S. DEPT 10 11 THE AMOUNT OF THE CLAIM WILL EXCEED $10,000.00 THE CLAIM WILL NOT BE A LIMITED CIVIL CASE:. 12 13 14 15 16 CLAIMANT: ROBERT P. AMATRONE 17 ENTRY 07-ULA-fR- 18 19 20 21 22 23 24 25 M CL � 0 S z M f ul M $ t> C3 p ca `�.. �•'� ,-sem � �1 G"� H wrrt cr Ln tr CN .0 00 t ru Ul ? ` � Ems-+ tH/} U w .,. nj fit og ko w N -^ • ru " � ; �. C3 'H `� a 0 0 In U 0 c4 tD x El s: W n � z CLAIM ! BOARR OF SUPE ''VISORS OF CONTRA COSTA COUNTY 4+ BOARD ACTION: MAY 06, 2003 Claim Against the County, or District Governed by ) the Boardof Supervisors,Routing Endorsements, ) NOTICE TO CLAIMANT and Board Actions,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 �- CLAIMANT: LAWANA LOVELY COUNTY COUNSEL N4ARTINEZ CALIF. ATTORNEY: UNKNOWN DATE RECEIVED MARCH 20, 2003 ADDRESS: 2139 2139 SEMINARY #105 BY DELIVERY TO CLERK ON: MARCH 20, 2003 OAKLAND, CA 94601 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, Cle Dated: MARCH 20, 2003 By Deputy r II. FROM: County Counsel TO: Clerk of the Board of Supervisors r` (uythis claim complies substantially with Sections 910 and 910.2. { ) This Maim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Beard 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: Darted: 03 By: d . 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. MAY 46 2003 Dated: JOHN SWEETEN, CLERK, By , Deputy Clerk WARNING(Gov. code section'-913)- Subject ection913)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 Governunent 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: MAY 07, 2003 JOHN SWEETEN,CLERK By Deputy Clerk Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Maims 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 1 00th 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 1€16,County Administration Building,651 Pirie 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 Lawana Lovely EM Against the County of Contra Costa or MAR 0 2003 The Housing Authority of Contra Costa (District) `BOARD, `:s <F• r,, (Fill in name) COINTR!kv <' 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. When did the damage or it j`ury occur? (Give exact date and hour) 2. Where did the dam e r injury occur? (Include city and county) 3. How did the damage or injury ? (Gave 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? clmform 5. What are the names of county or district ers, servants or employees causing the damage or injury? 6. what damage or injuries do you cl irn resulted? (Give full extent of injuries or damages claimed. Attached two estimates for auto damage.) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) d 5&A-L--� 8. Names and addresses of witnesses,doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 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 {Claim t s Signator ` sq r } (Address) Telephone No. Telephone No. -70 , ' 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." cimform 03/20/2003 at 12:50 PM Job Number: 78190 LA-TECH AUTO BODY License #:AB220122 Federal ID #:010637644 CUSTOMER SATISFACTION IS OUR #1 GOAL 2311 RHEEM AVENUE RICHMOND, CA 94804 (510)234-5044 Fax: (510)234-0642 PRELIMINARY LSTIM TE Written by: JEAN LOPEZ # Adjuster: Insured: LAWANA LOVELY Clam # Om% r: LAWANA LOVELY Policy Address: Deductible: Date of Loss: Day: Type of Loss: Evening: Point of Impact: Inspect LA-TECH AUTO BODY Business: (510)234-5044 Location: 2311 RIEEM AVENUE RICHMOND, CA 94804 Insurance Company: Days to Repair 1996 HISS SENTRA 4-1.6L-FI 4D SED Int: VIN: IN4AB41D1TC750409 Lie: Prod Date: Odometer: Rear Defogger 'lilt Wheel Tinted Glass Clear Coat Paint Pastier Brakes Driver Air Bag Passenger Air Bag Cloth Seats Bucket Seats Recline/Lounge Seats ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1 FENDER 1 03/20/2003 at 12:50 PM Job Number: 78190 P9ZLn4n=Y ESTIMTE 1996 HISS SENTRA 4-1.6L-FI 4D SED Int: ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 2 Repl LT Fender US built 1 177.00 2.0 2.3 3 Add for Clear Coat 0.9 4 Add for Edging 0.5 5 Add for Clear Coat 0.1 6 HOOD 7 Blnd Hood US built 1.5 8 FRONT BOOR 9 Repl LT Outer panel US built 1 171.73 6,0 2.3 10 Overlap Major Adj . Panel -0.4 11 Add for Clear Coat 0.4 12 Add for Edging 0.5 13 Add for Clear Coat 0.1 14 Add for Inside 0.5 15 Add for Clear Coat 0.1 16 REAR DOOR 17* Rpr RT Door shell US built 3.02.2 18 Overlap Major Non-Adj . Panel -0.2 19 Add for Clear Coat 0.4 20 QUARTER PANEL 21 Blnd RT Outer panel 1.0 22# TINT COLOR 1 0.5 23# COVER CAR 1 6.00 0.3 24# HAZARDOUS WASTE 1 6.95 25# Repl PANEL ADHESIVE KIT 1 27.00 T ------------------------------------------------------------------------------- Subtotals =_> 388.68 11.8 12.2 2 ..................................................................................................................................................................................................... ............ ............... CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: wf136,;...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: $158.74 MAR 2 0 2003 N ,,OUNTY noU SEL CLAIMANT: ERIN BOYKIN t-,,IARTINt�j rAUF. ATTORNEY: UNKNONW DATE RECEIVED: MARCH 20, 2003 ADDRESS: 717 CORAL RIDGE CIRCLE BY DELIVERY TO CLERK ON: MARCH 20, 2003 RODEO, CA 94572 BY MAIL POSTMARKED: MARCH 19, 2003 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETEN, Dated: MARCH 20, 2003 By: ;Deputy 1I. FROM: CountyCounsel TO: Clerk of the Board of Supervisors (This claim complies substantially with Sections 910 and 910.2. This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days(Section 910.8). Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). Other: Dated: By: Deputy County Counsel 111, 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. Dated: MAY 06, 2003 JOHN SWEETEN,CLERK, By ON, Deputy Clerk WARNING(Gov. code section V 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: MAY 07, 2003 JOHN SWEETEN,CLERK By Deputy Clerk ...... ..........................................I......11.11,11,.............. 11.11.1.................... :;.ep. 25 02 12: 18P Cierk of the Hoard 925 335 1913 p. 1 Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY IN-STR12CIJONS TQ C1.AIMANI 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 drops and which accrue on or after January 1, 198s, must be presented not later than six months after the accrual of the cause of actions. Claims relating to any envier cause of action must be presented not later than one year after the accrualof 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 claims 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 fining stamp 71� t Against the County of Contra Costa or ) FMA'.k 2' 0 District) ; x.,: ;rr (Fill in name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ 1� > '� and in support of this claim represents as#`allows: 1. When did the damage or injury occur?(Give exact date and Hour) 2. Where did the damage or injury occur?(Include city and county) 3. How did the damage or injury occur' (Give full details;use extra paper if required) Al . Offh ( P i s re�Ce qp�,c>. T also V)aoe e- G16 �. Sep 25 02 12-. 18p ...... ....................... Clerk of the Hcaart# 825 335 1813 P- 2 4. *hat particular act or Missiononthe part ofcounty or district officers, servants, or employees caused the injury or damage?�k lk vt 1 D X -the-, 04* 5. What are the names of county or district officers,servants, or employees causing the damage or injury? con's ec5to l 6. What damage or injuries do you claim resulted?(Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) wig .JJ-V 11-1p .e Rikt 64Cc-L, coo+ 4y s cAef 7. How was the amount claimed above computed?(Include the estimated amount of any prospective injury or damage.) T Vit.~ 1 A t) 8. Names and addresses of witnesses, doctors, and hospitals. X-00 9. List t expenditures you made on account of this accident or injury. .12ATE I= AUQM I Gov. Code Sec. 910.2 provides"The claim must be signed by the claimant or by some person on his behalf." Ste_.NQTICES T-Q. ttotnev Name and Address of AttorneyC&YLIL) —6-Ln b 1 `r] (CI ant's Signature) Vc r- , CJS } (Address) ) ) Telephone No. Telephone No. ' :***�«��*:*�*�«�**«*���*�:��►�*��«w�.���«�#*�s*s:�s��*«�►�:�*���*�**�,�*��r�����rv�*s*:was****��* NCOCE Section 72 of the Penal Code provides: Every parson who,with intent to deftud,presents for allowance or the psr mut to any state beard or officer,or to any county,city,or district board or tffitxr,'autharized to allow or pay the same if genuine,any false or ftaudulent claim,bill,a=unt, voucher,or writing,is p unishaMe,either by imprisout neat in the county Jail for a period of not more than one year,by a fine of not oneding one thousand(S1,000),yof�r by both:sucb imprisonment and flare,or by i pr or meat in the start prison,try a fine of not -,..,,. 4—n t."tknitcand dollars($10,000),orby both such imprisomrnm and fine. r ; •• " f.�f�/tel%� �ti +{`• �`.j'°�+: f��r f:':'f fF�`� � f f� f r{ / r f r f: i !r/i7/+'}r ��:'w��r/�f/,'+��"}r�f�r. 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'. i cz1', 4 .3 c S d {� 43s'f4 (h•4�' <g sr �f' tg r ,F 7 J q<Yy4"`�,� � X ; # .�' F $ t'°�o}'�}��'I � .^ ''k'�`�P��O' jam, ik �sYq�� }���c s,�.�s� � p s7ta,. �vs �: ; L ,� � x �'s �Y �� t >;�Y ;s^� } f �� fF-. R f�L ti;�` �� .�ri' � �5 2 a4}. 4 - 4>X s , �f ,,iy{,��� t`'� v� I'( P.����;Sf 7 i�� #s 73'�'<S�i`�� �i"}>•Y a;,k ,,:� � ��.�b � � � � ��Y4 � 'y,� �'� `i�.ti���os.' a .5 �� ,:�i S��zs� �� �cP S.�S•�S� if...£t Yt�a f� +F q��•����xa ���� � {��_ �� i��i ,+.0•6i ..( l•B� ..•y Y» �j� � i S cry rr - ,,Sh 9 f.. . 1�`' r M ct � v r CLAIM BUM ►OF SUPERVISORS OF CONTRA COSTA COUNTY ' BOARD ACTION: MAY 06, 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 g-12 1'd` r 915.4. Please note all"Warnings". AMOUNT: UNKN0I7N MAR 2 1t ' ' UNTY CLAIMANT: THOMAS LUM C✓ARTM E-Z CALIF, CC31UNSL ATTORNEY: UNKNOWN DATE RECEIVED: MARCH 21, 2003 ADDRESS: 4081 CLAYTON ROAD BY DELIVERY TO CLERK ON: MARCH 21, 2003 CONCORD, CA 54521 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Beard of Supervisors TO: County Counsel Attached is a copy of the above-noted claim: JOHN SWEETEN, Cler Dated: By Deputy II. FROM: County Counsel TO: Clerk of the Board of'Superviso (3JJ 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 Beard 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). ( ) tither: Dated: �7 .- (r- By; Deputy County Counsel III. FROM: Clerk of the Beard 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. ( ) tither: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: _ _MAY 06, 2003 JOHN SWEETEN, CLERK, By A�— , Deputy Clerk WARNING(Gov. code sectio 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'turning 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 IS; and that today I deposited in the United States Postal Service in Martinez, California,postage fully prepaid a certified copy of this Board Carder and Notice to Claimant, addressed to the claimant as shown above. Dated: MAY 07, 2003 JOHN SWEETEN,CLERK:By Deputy Clerk THOMAS LUM do 4081 Clayton Road Concord, CA 94521 MAR 2 1 2003 In Pro Per C RX BOARD SUPERVISORS Co TRA COSTA CO. CLAIM AGAINST THE COUNTY OF CONTRA COSTA (California Govt. Code Section 910) To: CONTRA COSTA COUNTY,Board of Supervisors, 651 Pine Street,Martinez,California Claimant: Thomas Lum, 4081 Clayton Road, Concord,California 94521 CONTACT Thomas Lum,4081 Clayton Road,Concord, California 94521 Address/Phone of Claimants Telephone: (925)671-0602 Date of incident: September 21, 2002 Location of Bailey Road at a point 1.4 miles north of Myrtle Drive, Incident: County of Contra Costa, California Amount of The amount of damages sought by the claimant as of the date of Claim: the presentation of this claim,is sufficient to establish jurisdiction in the Superior Court of the State of California. These damages consist of general and special damages for the personal injury,loss of past and future wages,loss of future earning capacity,general damages and emotional distress for claimant Thomas Lum arising from an incident which occurred on September 21,2002 on Bailey Road at a paint 1.4 miles north of Myrtle hive,County of Contra Costa, California, Nature of Claimant Thomas Lum suffered injuries including bilateral femur Injuries: fractures,bilateral kneecap fractures, right ankle fracture, right arm fracture,closed head injury,facial cuts,whiplash, and emotional injuries. The amount of damages include,but are not limited to,medical expenses,past and future,lost wages,loss of earning capacity and incidental expenses in amounts which are unknown at this time. Name of Public Public employees,agents, and/or personnel of the County of Employees Contra Costa,presently unidentified, who were involved Responsible: in or had responsibility for the design,construction and maintenance of Bailey Road insofar as it affected the following: 1. Inadequate lane width,inadequate useable shoulder width or recovery area; 2. Failure to warn of limited sight distance; 3. Improper speed for the roadway; 4. Inadequate median width;and 5. Failure to provide median barrier protection or other protection to prevent cross-over collisions; Circumstances At the time and location of the subject accident, claimant was the sole occupant and operator of a motor vehicle at the time of the subject incident. Claimant was southbound on Bailey Road when he was suddenly confronted by an on-coming vehicle which had crossed the center line of the roadway and which caused a head on collision. This vehicle was owned and operated by Johnny Ray Delgado. At the time of the subject incident,Johnny Ray Delgado was legally drunk and was an unlicensed driver. The roadway in the area of the accident and immediately preceding it is a winding,narrow roadway with blind curves and with an ascending grade for the northbound lane and a descending grade for the southbound lane. The posted speed limit for the immediate area of the accident is 45 miles per hour and the roadway has an appreciable traffic volume. The sight distance for both north and southbound traffic is limited because of the curves,the ascending/descending hill and the general terrain adjacent to the roadway. The travel lanes and useable shoulders are narrow and provide inadequate useable shoulder area for motorists to use as a recovery area in the event of an emergency. These conditions created a trap for motorists and a dangerous condition of public property. The County of Contra Costa negligently designed, constructed, maintained, operated,controlled,inspected and supervised said roadway in such a dangerous and defective condition,with -2- irregular and poorly maintained road surface and without adequate guard rails,median divider strips,median barriers or other means to prevent or control vehicles from crossing to the wrong side of the roadway, and without any adequate warning of or means of preventing collisions between vehicles traveling in opposite directions. The high speed of the roadway in addition to the winding,narrow roadway and limited sight distance,along with the inadequate useable shoulder width, or recovery area, which existed at this location created a dangerous condition in that it created a foreseeable risk that vehicles would lose control or would be unable to continue in their own lane,and that such vehicles would cross the median and strike oncoming vehicles in the opposing lanes as occurred in this instance. The County of Contra Costa was negligent in failing to advise and warn motorists of these conditions and negligently failed to warn the motoring public of the dangers presented by these conditions. The County of Contra Costa negligently designed, constructed, maintained,operated,controlled, warned,signed,inspected and supervised said roadway in such a dangerous and defective condition,without providing a safe,useable shoulder or recovery area for motorists to use as a recovery area for emergencies such as attempting to avoid vehicles which have crossed the centerline, even though it had constructive and actual knowledge that motorists travelled at speeds greater than the posted speed limit of Bailey Road. The County of Contra Costa was negligent in failing to advise and warn motorists of these conditions and negligently failed to warn the motoring public of the dangers presented by these conditions. The County of Contra Costa created and allowed to exist, and maintained a dangerous and defective condition of said roadway as aforesaid due to the lack of center median, failure to provide median barrier protection or other protection to prevent cross- over collisions,inadequate lane and useable shoulder width or recovery area, failure to warn of the limited sight distance resulting from the ascending/descending hill,curves and terrain adjacent to the roadway, failure to control speeds given the known speeds in excess of 45 miles per hour on the subject roadway and which created a substantial risk of injury to persons using the said roadway with due care. Said condition was created and allowed to exist by the County of Contra Costa,its employees and others,and the County of Contra Costa had actual or constructive notice of the dangerous and defective condition of said roadway a sufficient time prior to the incident to have corrected the dangerous condition. As a proximate result of the negligence of the County of Contra -3- ....................................................................................................-...-..... ......-... .............................. Costa and its employees,and of the dangerous condition of said roadway, claimant Thomas Lum suffered serious,permanent physical injuries in the accident above-described,,and is entitled to 3 1 damages as described herein. Dated; March 21, 2003 By THOMAS LUM Claimant -4- CLAIMjr &&ARD OF SUPERVISORS OF CONTRA COSTA COUNTY , . BOARD ACTION: MAY 06, ;'2003 Claim Age 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: ,000,000. t, _ wU W1. CLAIMANT' NA'l IAN BANKS ATTORNEY: UNKNOWN DATE RECEIVED. MARCH 24, 2003 ADDRESS: M.D.F. C-MODULE 'ROOM #33 BY DELIVERY TO CLERK ON: MARCH 24, 2003 901 COURT STREET MARTINEZ, CA X4553 or BY MAIL POSTMARKED: MARCH 22, 2003 2175 SOUTH FRANCISCO WAY , CA 945C9 FROM:. Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim, JOHN SWEETEN M� Dated: MARCH 24, 2003 By: Deputy H. FROM: County Counsel. TO: Clerk of the Beard of Supervisors (,)KThis 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 day's(Section 91.0.8), { ) Claim is not timely filed.The Clerk should return claim on ground that it was filed late and sent warning of claimant's right to apply for leave to present a late claim(Section 911.3). { ) Other: Dated: 3 -0B : �-'� �{ �- Deputy County Counsel ISL 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. pp Dated: MAY 06, 2003 JOHN SWEETEN, CLERK, By L _>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. *Far 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 certifiedcopy of this Board Order and Notice to Claimant,addressed to the claimant as shown above. Dated: MAY 07, 2003 JOHN SWEETEN,CLERK By Deputy Clerk r Claim to: BOARD.OF SUPERVISORS OF CONTRA COSTA COUNTY INSIM t''T E)NS TC?CLATIVLA V'I` A. Claims relating to causes of adion`for death or for injury to person or to personal property or growing crops and which accrue on or before December 315 4987,must be presented not later than the 10&day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person onto 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 presonted'not later than one year after the accrual of the cause of action. (Gov't Gide 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 Beard of Supervisors,rather than the County,thename 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 } Against the County ofContra Costa or } MAR 4 )5 ,[� } GtERK S4AAP3 SUPE SORS' f' G{7At District} TRA COSTA C(h (Fill in name) �. � } The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sutra of$ 00 a and in support of this claim represents as follows: 1, When did the damage or injury occur?(Give exact date and hour) L i ' 2. Where did the damage or injury occur?(Include city and county) vaiij IJ tZ, CO'. C.Ojt*Y 3. How did the damage or injury occur? (Give full details; use extra paper if required) IeCkr,-) (Af), `oto � ## ........................................ rl R Re � si A.41 Od ` toc L F 4. What particular act or omission on the part of county or district officers, servants,or employees caused the injury or damage? '_- 5. VA9 are the names ofcounty or district officers servants, or employees causing the damage or injury? cpt' 0 6. What damageor injuries do you claim resulted?(Give full extent of injuries or damages claimed. Attach two estimates dor auto damage.) SV4' e' v,.. -Y 5-t,ccj r i l 7. How was the amount claimed above computed?('Include the estimated amount of any prospective injury or damage.), 15`t C.a 1411 '(V\ J�At 1� r rh,. ,, ;t�A t 8. Names and addresses of witnesses,doctors, and hospitals. zy' "" °art 0 it Xt 9. List the expenditures you made on account of this accident or injury. U IM CO ti'" ca� 1S } Gov. Code Sec.914.2 provides"The claim must be signed by the claimant or by some person on his behalf:" Name and Address of Attorney � } (Claimant's Signature) } (\\Address) �- - Telephone No. _ )Telephone No. N0110E Section 72 of the Penal Code provides: Every person who,with;intent to defraud,presents 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 dulent clams bill,account, voucher,or writing,is punishable either by imprisonment in the county fait for a period of not more than one year,by a face of not exceeding one thousand($1,000),or by both such imprisonment'and fine,or by imprisonment in the;ate prison,by a fine ofnot exceeding ten thousand dollars(S10,000),or by both such imprisonment and fine. _.... ......... ......... ......... ......... ._.._.... ........ . _ ..............._..._._ ......... ......... ......... ......... ......... ......... ......... ......... ......... ............ __ _ ....._. ..................................................... ......... "?Ot-) INke _ t Vv ,IV S,44 { .r4 cr- ''I'll''...111.1..............................................................................................................................................I................................................................... .. .... ................ CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARDACTION: MAY 96, 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. ;a t " ' - 1 notice of the action taken on your claim by the JT 11#' ) Board of Supervisors. (Paragraph IV below), given 2 5 2603 Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". COUNTY COUNSEL AMOUNT: UNKNOWN MARTINEZ CALIF, CLAIMANT: CHRISTOPHER WAINWRIGHT, a minor, by and through his Guardian ad Litem, SONJA BJORK, his Guardian ATTORNEY: ROBERT E. BARNETT DATE RECEIVED: MARCH 25, 2003 ADDRESS: 712 EMPIRE STREET BY DELIVERY TO CLERK ON: MARCH 25, 2003 FAIRFIELD, CA 94533 BY MAIL POSTMARKED: HAND DELIVERED BY ERIN WORKMAN FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETEN, Clerk MARCH 25, 2003 By: Deputy 11. FROM: CountyCounsei 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). w,--other: e>,5-A C&a e?4, doee o wt; Qn-b-e b r —0 ' il& am End'? Dated: By: Deputy County Counsel 111. 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: MAY 069 2003.1 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 per ury 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: MAY 07, 2003 JOHN SWEETEN, CLERK By Deputy Clerk County Administrator Contra Risk Management Division Costa 2530 Arnold Drive,Suite 140 '""'� Liability Claims (925)335-1440 Martinez,California 94553 CV t t Fax Number (925)335-1421 July 7, 2003 -` l" Gregory Jansen Barnett Law Firm 712 Empire Street COPY Fairfield,,CA 94533 RE: Claimant: Christopher Wainwright Insured: Contra Costa County FJU L D/Accident: 09/25/2002 Claim No.: 52889S Ci ' Dear Mr" Jansen: Please accept this letter as acknowledgement of receipt of your letter dated.June 24, 2003 regarding the above captioned matter. Your letter advising that you no longer represent Mr. Christopher Wainwright has been placed in our Risk management claim file as of July 7,2003. Since ely, Sharon Hymes-4fford, Assistant Risk Manager(Liability) (925) 335-1442 cc: Gina Martin- Chief Clerk Silvano Marchesi - County Counsel r I ROBERT E. BARNETT, State Bar No. 44162 Attorney at Law ,. 2 712 Empire Street KEENED Fairfield, CA 94533 3 Telephone: (707) 425-0671 MAR 2 5 2003 4 Attorney for Claimant CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. 5 6 7 8 CHRISTOPHER WAINWRIGHT, a minor, ) 9 by and through his Guardian ad Litem, SONJA ) BJORK, his Guardian, ) 10 ) Claimant, } 11 } CLAIM FOR DAMAGES VS. ) (Govt. Code 910) 12 ) CONTRA COSTA COUNTY AND ) 13 BREAKTHROUGH COMMUNITY PROGRAMS, ) ) 14 Respondent. ) 15 16 TO: COUNTY OF CONTRA COSTA and BREAKTHROUGH COMMUNITY PROGRAMS 17 YOU ARE HEREBY NOTIFIED that CHRISTOPHER WAINWRIGHT, a minor, by and 18 through his Guardian ad Litem, SONJA WORK, his Guardian, whose address is 801 Kentucky 19 Street, Fairfield, California, claims damages from the County of Contra Costa and Breakthrough 20 Community Programs in the amount,computed as of the date of the presentation of this claim,which 21 falls within the jurisdiction of the superior court. 22 This claim is based upon personal injuries which occurred on or about September 25, 2002, 23 in the vicinity of the Breakthrough Community Programs, 5032 Sweatwood Drive, Richmond, 24 California, under the following conditions: Claimant was injured in a fight at a Group Home. The 25 Claimant reported the fight and his injuries to staff members of the group home and was refused 26 medical care on repeated occasions. 27 The name of the County or Breakthrough Community Programs employee(s) causing 28 claimant's injury or loss under the circumstances described are unknown to claimant at this time. The amount of the damages claimed as of the date of this claim is computed as follows: t 1 Medical, incidental and other expenses are unknown to claimant at this time. 2 Estimated prospective damages as far as known: Medical expenses. and pain and suffering 3 are unascertained at this time. 4 Total amount claimed as of this date: Unknown at this time. 5 All notices and communications with regard to this claim should be with: 6 GREGORY J. JANSEN 712 Empire Street 7 Fairfield, CA 94533 (707) 425-0671 Dated: March 24, 2003 9 RE Y J S 10 Attorney lai n 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 -2 - CLAIM BOARD OF JU_EKA_V_1S0RS OF CONTRA COSTA C2KNTY BOARD ACTION:;MAY 06, 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 Governnient Cedes. ) notice of the.action taken on your claire by the Board of Supervisors. (Paragraph IV below),given Pursuant to Government Code Section 913 and 915.4. Please note all"Warnings" .Ail+ MAR W 6 / .... AMOUNT. UNKNOWN COUNTY CLAIMANT: KIMBERLY ELISAN ATTORNEY: BRIAN McCARTHY DATE RECEIVED: MARCH 25 , 2003 ADDRESS: McCARTHY & LEONARD BY DELIVERY TO CLERK ON: MARCH 25 , 2003 7027 DUBLIN BOULEVARD DUBLIN, CA 94568 BY MAIL POSTMARKED HAND DELIVERED FROM; Cleric of the Beard of Supervisors TO: County Counsel Attached is a copy of above-noted claim. JOHN SWEETEN,Cl k Dated: MARCH 25, 2003 By: Deputy II. FROM County Counsel: TO: Clerk of the Beard of Supervisors ( s claim complies substantially with Sections 910and 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). 4" Dated: By: 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 (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. MAY 06 2003 Dated.: JOHN SWEETEN,CLERK.,By ,Deputy Clerk WARNING(Gov. code section 913) if 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 Cade Section 943.6.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 Kanu �ng 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. MAY 07 2003 ,r Dated: � JOHN SWEETEN,CLERK By Deputy Clerk __ 1 McCARTHY & LEONARD RECEIVED 2 Attorneys at Law Brian McCarthy SB#54081 EMAR2 5 2003 3 John Leonard SB#92234 7027 Dublin Boulevard CLERK BOARD OF SUP RMORS 4 Dublin, CA 94568 CONTRA COSTA CO Telephone: (925) 829--5500 5 Facsimile : (925) 829-7812 6 Attorney for Claimant KIMBERLY ELISAN 7 KIMBERLY ELISAN CLAIM AGAINST A PUBLIC ENTITY 9 V. 10 CONTRA COSTA COUNTY, CONTRA 11 COUNTY PROBATION DEPARTMENT 12 13 TO THE GOVERNING BODY OF CONTRA COSTA COUNTY: 14 Claimant KIMBERLY ELISAN hereby makes claim for 15 damages against THE COUNTY OF CONTRA COSTA and CONTRA COSTA 16 COUNTY PROBATION DEPARTMENT and makes the following statements 17 in support of her claim: 18 1 . Claimant' s mailing address is c/o McCarthy and 19 Leonard, 7027 Dublin Boulevard, Dublin, California 94568 . 20 Claimant' s date of birth is March 30, 1971 . 21 2 . NOTICES concerning this claim should be sent to 22 McCARTHY & LEONARD, 7027 Dublin Boulevard, Dublin, California 23 94568, Telephone (925) 829-6500, Fax (925) 829-7812 . 24 3 . The occurrence giving rise to this claim took place 25 throughout the year of 2002 in Contra Costa County. 26 CLAIM AGAINST A PUBLIC ENTITY 1 1 4 . Throughout the year 2002 , CONTRA COSTA COUNTY and its 2 PROBATION DEPARTMENT conducted CORE training of probation 3 officers from various counties in California. The training 4 was conducted by the CONTRA COSTA COUNTY PROBATION DEPARTMENT, 5 its agents and employees and by a private contractor known as 6 Corte Truax doing business as PPC Enterprises, acting as an 7 agent of CONTRA COSTA COUNTY. At various times, persons 8 participating in this training included probation officers and 9 probation office employees from several different counties 10 within California, among others, many of whom were co-workers 11 of Claimant and knew Claimant personally. During this period, 12 Claimant was, herself., an Alameda County Probation Department 13 employee. 14 Plaintiff and her children had previously been victimized 15 by Claimant' s ex-husband whose illegal and criminal conduct 16 against them necessitated the intervention of Alameda County 17 and Contra Costa County Police officers, District Attorneys 18 and Probation Departments. 19 During the aforementioned training of probation officers, 20 certain agents and employees of the Contra Costa County 21 � Probation Department used various documents, including Police 22 Reports, Court documents, Probation Department reports and 23 other documents containing Claimant' s name and identity and 24 the names and identities of her children along with other 25 evidence in Claimant' s case including tape recorded 26 CLAIM AGAINST A PUBLIC ENTITY 2 l conversations containing Claimant' s voice and her 'childrens' i 2 voices . On or about. November 13 , 2002, Claimant discovered I 3 that this invasion of her privacy was taking place when she 4 was informed of these facts by participants in the Probation 5 Department training classes . 6 The conduct of the agents and employees of the COUNTY OF 7 CONTRA COSTA and CONTRA COSTA COUNTY PROBATION DEPARTMENT 8 constituted invasion of privacy, intentional infliction of 9 emotional distress, public disclosure of private facts, 10 negligent infliction of emotional distress and interference 1'1 with advantageous economic relations. 12 5 . So far as is presently known, Claimant was damaged by 13 the conduct of employees and agents of CONTRA COSTA COUNTY and 14 CONTRA COSTA PROBATION DEPARTMENT. 15 6 . Names of the employees and agents of CONTRA COSTA 16 COUNTY responsible for causing Claimant' s injuries and 17 damages . so far as is presently known, are William Grunert and 38 Corte Truax, dba PPC ENTERPRISES. 19 7 . Agents and employees of CONTRA COSTA COUNTY and the 20 CONTRA COSTA COUNTY PROBATION DEBARMENT persisted in the 21 aforementioned conduct even after receiving complaints and 22 warnings from Deputy Probati6n Officers participating in the 23 classes that the materials being used in the classes 24 constituted an invasion of Claimant' s privacy. 5 8 . Jurisdiction of the Claim would rest in Superior 26 CLAIM AGAINST A PUBLIC ENTITY 3 H fr 1 Court unlimited jurisdiction. 2 Claimant reserves the right to amend g portion of 3 this claim pursuant to California statutory and case law, and 4 according to further proof. i 5 DATED: March 24, 2003 McCAR.THY & LEONARD 6 7 9 BRIAN McCARTHY, Attorney ' for Claimant KIMBERLY ELISAN 10 11 1 12 E 13 {I 14 15 16 17 18 19 20 21 22 23 24 25 26 CLAIM AGAINST A PUBLIC ENTITY 4 . CLAIM J� B F SUPER QF CONM COSTA COUNTY BQARU ACTItJ MAY Com, 12 (l 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: $1,530,000. CLAIMANT: EDWARD LEE TUNER ' ATTORNEY: U known DATE RECEIVED: MARCH 26, 2003 ADDRESS: M.O.F. C-MODULE, ROOM #I.1 BY DELIVERY TO CLERK ON: MARCH 26, 2003 901 COURT STRE ', MARTINEZ, CA 94553 BY MAIL POSTMARKED: MARCH 25, 2003 FROM: Clerk of the Board of Supervisors TO County Counsel Attachedis a copy of the above-noted claim. JOHN SWEET 1 Dated: MARCH 26, <2003 By: Deputy II. FROM: County Counsel. TO: Clerk of the.Board of SupervisroIrs { ) This claim complies substantially with;Sections 910 and 910.2. s Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days(Section 910.8). ( } Claim is not timely filed.The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). ( } Other: Dated: 'G% By: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel(1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: , (X) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: MAY 06, 2003 JOHN SWEETEN, CLERK,By ,Deputy Clerk WAKING(Gov. code secti 9I3} Subject to certain exceptions,you have only six.(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Goverment Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice, i AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now,and at all times herein.mentioned,have been a citizen of the United States,over age 1$;and that today I deposited in the United States Postal Service in Martinez,California,postage fully prepaid a certified copy of this Board Carder and Notice to Claimant, addressed to the claimant as shown above. Dated: MAY 07, 2003 JOAN SWEETEN,CLERIC.By Deputy Clerk OFFICE OF THE COUNTY COUNSEL SILVANO B.MARCHESI COUNTY OF CONTRA COSTA fi�'.� =f Q� COUNTY COUNSEL Administration Building SHARON L. ANDERSON 651 Pine Street, 9'"Floor '" =_• . Martinez, California 94553-1229 / i* CHIEF ASSISTANT (925) 335-1600 GREGORY C. HARVEY (925) 646-1078 (fax) VALERIE J. RANCHE 3 T' r AssisTANTs t NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Edward Lee Turner M.D.F. C-Module,Room#11 901 Court Street Martinez, CA 94553 RE: CLAIM OF: Edward Lee Turner 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: [ D. 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. [X] 3. The claim fails to state the date,place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [ ] 4. The claim fails to state the name(s) of the public employee(s)causing the injury, damage, or loss, if known. [ ] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars($10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. [ ] 6. The claim is not signed by the claimant or by some person on his or her behalf. [ ] 7. Other: Page 1 Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100 'day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov't Code 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors,rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. 1 RE: Claim By Reserved for Clerk's filing stamp AEOUlAf 40 ED Against the County of Contra Costa or ) LIAR 2 6 2003 ` . { District) Cf R Ca 7R�A0OS' C0 ISORS (Fill in name) �y � � ) The undersigned claimant,hereby makes claim against the County of Contra Costa or the above-named district in the sum of$Z '„i' D 00 and in support of this claim represents as follows: 1. When did the damage or injury occur?(Give enact date and hour) 2. Where did the damage or injury occur?(Include city and county) ." eWo 6A/'/01tZ_ 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,i ervants, or employee ca sed the injury or damage? fi 5. What are the names of co or district officers, servants, or emp oyees causing the damage or injury? U Alt AlAltllle�4o .Kotr Vezille fi. What damage or injuries do you clatr�i resulted? Cave full extent of injuries or damages claimed. Attach two estimates for auto damage.) � 0 7. How was the amount claimed abo com u# nclude the estimated amours prospective injury or P t7 y P P J rY damage. 8. Names and addresses f witnesse doctors, and hospitals. V�� ; r � Al Y41 9. List the expenditures you made on account of this accident or injury. DATE TRVM 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 ) :. �,���%�:r:✓y ms's' .,�^ '', �': ri -". . "�., ( laimanes 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 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 imprisonment 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 state prison,by a fine of not exceeding ten thousand dollars($10,000),or by both such imprisonment and fine. as "' t 3. 4 h {t O W all . q IN M v fell of U � } h A iM? r 3 4Q CLAIM LOA F StT RVIS S OF CQNTRA COSTA COUNTY G •�! BOARD ACTI!L)N MAY 06., 200.E -. r_.._............... i r 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 T1 to T ursuant to Government Code Section 913 and Fj E d 15.4. Please note all"Warnings". AMOUNT. $108.24 M1 R 8 22 03 i 01 { CLAIMANT: DAVID A. HAJOSTEK ARTINEZ CALIF, ATTORNEY: UNKNOWN DATE RECEIVED: MARCH 28, 2003 ADDRESS: 1070 SAN MIGUEL ROAD # 3-3 BY DELIVERY TO CLERK ON: MARCH 281 2003 CONCORD, CA 94518 BY MAIL POSTMARKED: MARCH 20, 2003 FROM:. Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETEN, lgk, Dated: MARCID 28, 2003 By Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( } This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days(Section 910.8). ( } Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). ( } Other: Dated: "" By: 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: (K) 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. MAY 06 2003 Dated: JOHN SWEETEN,CLERK, By Av4e__ ,Deputy Clerk WARNING(Gov.code section 913) V. 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 Waning See Reverse Side of This Notice. ' AFFIDAVIT OF MAILING I declare under penaltyof perjury that I am now, and at all times hercin,mentioned,have been a citizen of the United States,over agar 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. MAY 07 2003 Dated: JOHN SWEETEN,CLERK.By Deputy Clerk MOSS&'MURPHY (51 O)583-1155 GLEN L. MOSS ATTORNEY AT LAW 1297 8 STREET HAYWARD,CA 94541 ................ �'nui t't 0roer: 474341 #' :.::.:....... 1 '.:;i�<.wf�3ti01S 74C�r6�S$i iAJ0SIR, DAVI" 1070 SAN NIGUEL R0 A?t33 CONC090, CA 94516 (925) 984-3935 OAVIO NA3OSlEK 1070 SAN MIWEL Bfl A?T d3 C'O>iCORD, CM 94:16 Sales and returns dl'6 8iih'8Ct to re terns dfid conditions identified on the back, 0isclaimers of warranties and imitations ct renedies on the back or this receipt do not apply it,, California. "` ICIUPL C:ATF COPY "� "� Clain to: BOARD'OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO Ct..ADONT A. Claims relating to causes:of action for death or for :injury to person. or to..per- sonal property or growing craps 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 relaying to causes of action for death or for injury to person or to personalproperty 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 acti66 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 Administratio : 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 dust b-- filed efiled 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 Against—theCounty of Contra Costa ) or ) District) Fill in name)— ) - The undersigned claimant hereby makes claim againsthe County of Contra Costa or the above•-named District in the sum of $ _ b'$ C- and in support of this claim represents.as -follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or Injury occur? (Include city andcounty) 3. How did the damage or injury occur? (Give full details; use extra paper if . required) Sb rr► a rJ 5-ro t.E rotJ G 'E'L L. P t4 a NF- w N t L C X - Ra`t' � -r H 4 F C C,>iE?V T i it S 5 7-1,i.v i nJ (r K i 6-14 7- 4. 4. What particular act or omission on the part of county or district officers, servants or employees caused. the injury or _damage? pl d t ?4 J' Fie v A/ ' 0 te, 7-t4 to 6E r1>46 PO 7`i6S t W 1411 ELSE �►' _ _ _ (over) �. +gnat are the names of county or district officers, servants or employees causing the damage or injury? D e ei—( %e M . L.- o PIE-a- w fts 1'ti,c02E 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. -rfi C. r*,by «.3 t 6 F www _- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 1+0� O 7-0 J30 -1 ..—------_._.___________�_...�_.�.�..�.--...-�..-_..---�.,--�--w--�-___�...._ _._�..�..___........__�_ $. Names and addresses of witnesses, doctors and ho:pi LC1A b9r?ar Y25 to " l1 9. List the expenditures you made on account of this accident or injury'. DATE Gov. Code Sec. 91M provides. "The claim must be signed by the claimant SEND NOTICES TO: (Attorne ) or souse' son on his.behalf." 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CLAIM tx ARD 0F S P &V_ISQ&0FCQnHACQ_ST_A COUNTY J.V BOARD ACTION. MAY 06, 2003 Claim Against the County,or District Governed by ) the Beard 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 ofthe-action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Covennnent Cade Section 913 and 5 e °E s 915.4. Please note all"Warnings" � � a y AMOUNT: UNKNOWN P F), 0 1 2-003 a: CLAIlAANT: DEIORA; D,INGMAN COUNTY COUN V . ffINEZ CALF ATTORNEY- tJNtiNO I DATE RECEIVED- APRIL 01, 2003 ADDRESS: KAREN L. GALLEGOS BY DELIVERY TO CLERK.ON: APRIL 01, 2003 STATE FARM INSURANCE COMPANIES AUTO CLAIM CENTRAL BY MAIL POSTMARKED: MARCH 31, 2003 P.O. BOX 6+01 FROM; Cleric of the Board of Supervisors TO County Counsel Attached is a copy of the above-noted claim. JOHN SWEETJM,,.,,,, Dated: IL,0 2003 By Deputy H. FROM: County Counsel TO:Clerk of the Beard of Supervi rs ( ) 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: x Dated: �` -03 By; t' Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel(1) County Administrator(2) ( ) Cly 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. { ) Otl : I certify that this is a trine and correct copy of the Board's Order entered in its minutes for this date. MAY 06 2003 Dated: , JOHN SWEETEN,CLERK By Deputy Clerk "WARNING(Gov. code secti 913) Subject to certain exceptions,you have only six(b)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'E nun See Reverse Side of This Notice. ' AFFIDAVIT OF MAILING I declare under penalty ofpe&ry 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. MAY 07 2043 s Dated: JOHN SWEETEN,CJLERK.By Deputy Clerk OFFICE OF THE COUNTY COUNSEL 5> Ai~ SuANO B.MARCHES! COUNTY OF CONTRA COSTA ,51�.� ~= C��, COUNTY COUNSEL Administration Building +, 'a `.* a. SHARON L. ANDERSON 651 Pine Street, 911,door « , J,�. Martinez, California 94553-1229 i CHIEF ASSISTANT �r GREGORY C. HARVEY (925) 335-1800 ' O. VALERIE J. RANCHE (925) 646-1078 (fax) ASSISTANTS a {� _ I NOTICE OF INSUFFICIENCY ANDIOR NON-ACCEPTANCE OF CLAIM TO: Karen L. Gallegos State Farm Insurance Companies Auto Claim Central P.O. Box 6401 Rohnert Park, CA 94927-6401 RE: CLAIM OF: DEIDRA DINGMAN Your Claim No. 05-4894-305 Please Take Notice as Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910.2, or is otherwise insufficient for the reasons checked below: [X ] 1. The claim fails to state the name and post office address of the claimant. [X ] 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [X] 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 ($10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. [X] 6. The claim is not signed by the claimant or by some person on his or her behalf. Page 1 Karen L. Gallegos Re: Claim of Deidra Dingman Page Two [XJ 7. You are required to submit your claim on the proper form,which is enclosed. Please resubmit your claim on the enclosed.form. Gov. Code, §910.4. Please be aware that you have only a limited period of time in which to file an amended claim. See Gov. Code, § 910.6. [ ] 8. Other: SILVANO B.MARCHER COUNTY COUNSEL n { Pj By: ,•;,: C �•� J MONIKA L. COOPER Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a,2015.5;Evidence Code§§641,664) I declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553;1 am a citizen of the United States,over 18 years of age,employed in Contra Costa County,and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as shown above,sealed and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California. I certify under penalty of perjury that the foregoing is true and correct. Dated: dJ at Martinez,California. if 4____Q0ft, Kathleen O'Connell cc: Clerk of the Board of Supervisors(original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM:GOVT.CODE&6 910,910.2,420.4,910.8) Page 2 STAT$ FARM Mate Farm Insurance Companies ttlf�tttAti�C�. Auto Claim Central P.O. Box 6401 March 28, 2003 Rohnert Park, CA 94827-6401 Toll Free(800)440.6175 ..... Toll Free Fax: (800)440-6176 M-F 7AM-9PM J Set-Sun 9AM-5PM Clerk/Board of Supervisors :a Contra Costa County f 551. Pine St, Rm 106 € Martinez, CA 94553 ;. RE: Insured: Deidra Dingman Our Claim Number: 05--4894-305 Date of Lass : March 20, 2003 Your Claim Number: Unknown Bear Clerk: We have been informed that you are the insurance carrier for Property at 651 Pine Street . Our investigation of this accident establishes Property at 651 Pine Street was responsible . Please accept this letter as notice of our subrogation rights. The facts of the accident indicate Our customer' s vehicle was damaged due to the parking stop anchoring pole protruding abnormally high which caused damage to her front bumper. We have attempted to contact you and have been unsuccessful . Please call us to discuss this claim. If you have any questions, please call us. Any member of our team can assist you. Sincerely, Karen L. Gallego g Claim Representa e, Team 6 (800) 440-6175 State Farm Mutual Automobile Insurance Company HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001 s y { r i f - y rh t G t } p4} ) 'l+.} :.r+fr: ..?^:v- ..f.. .+fl+r 1-..ow1i::�'? :.1::.:.fl,-.:^2:+. .v/ :%+.?;?•- ::i:•}i`:.+rr.::-.;:?:v:::r::;.:rrv::.:: rr ::..:rl.. f vx"rl+.f'.{f�,{.y}( .......: _ ..:.,•-;.1 i-+:: -.'r 4�.- ..r•i:,..r.::-.r .-...:..... .r...................:..... "r.........:.:•r.- rr..:. •'Y r:i:•-.z•:- ::..:::.:.r-.-.:?.;r,ir.:. : r...........r,:.. ...................} ......... .. 6v:•... :y ...... ..rf...r•f..:.1 r1.%:::'i'..:.::?ry:f1::: , ' �'+r+. r'x r:rxrr.� '-:..: ::..:` .:v.: ?�..::::.�:.r :rnvnx -i,.f.•,... hvry f.f fl;f?: /r .Y.Yf' • Yc d:t ..: :.., s:o:.??a>}rrf-:":r- :<•;:, �,.•.vr„x+,�r} ✓;:;Y:.:;i::.� 5;;;? �;::/' ..,`"s o. "." 8¢'��'r @' 'r .rr:r::r ,, ,iic.✓f..w:;':,;���.:;.y,�i;.; ff l r�%S ?�':a ��s5 �'rk rl:;+i x1 ?” �£r+k 4.v^' xS: r.4:rs fr..:•. ...r F -.r.,r r�rsax t r• xr%r-S. 1f :s:r:„r/r:;r='3✓.f` r' f+r''r' 1rY 'it ';f ::�r{f; ' ''?'s”r.f%i%f' -+r.'?'%;`f�'r�'':r°"rh.'r,,,;'1 ff "ffY f /x.•v+svf .:.:. .., ..: .:.... .+JCBiL :. r : f':. .. •.:.ff fY'Yf/1�• � r� f .... :.... _........... _ m+bb6EFX / „�,i'/:'r:C� r'� :'!+$.^ ✓f�. :•• r:t•'vf?W:•.-.+4'r'x.r.4vumx:r:✓x:.rr. f f y •f f: ii . i .f i it rfi•� ,yp it i it i i i�riG,i •9k+k v i ii �u���i k'•ff.,�� ¢�yp _ ri'`'k><riif f�ji�i *„ ,;q� � �, y io- y ff i i µ { S f ii it ff�� f f 4. r, fj f ,tf k �•R ------------------ .0e , fff f f f >f ;yf >., f 6 f i 9R- f a %�9� . 30 � 0 m , V C� ... ............................................................................... t_s m cu; N 22 !f1 ec> C -4 j C) rn z rn k' 10 k r* tl t. 41 �a CLAIM . lQak QF,&JPE&USQRS OF COUM CQSTA C U TY BC1AR�ACTION. ' .Y 06, 'Z� B w �w i i e• 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 ' f5 3,p : _ r 915.4. Please note all"Warnings". AMOUNT: $6,000. 0 2 CLAIMANT: EDWARD A. ZABRYCKI >A4TiNEZ CALIF ATTORNEY: UNKNOWN DATE RECEIVED: APRIL 02, 2003 ADDRESS: 16 ORANGE BLOSSOM COURT. BY DELIVERY TO CLERK.ON: APRIL 02,_2003 DANVILME, CA 94526 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 SWEET , Dated: APRIL 02, 2303 By+ Deputy H. FROM: County Counsel TO: Clerk of the Board ofSupervisors (This claim complies substantially with Sections 910 and 910.2. } This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days(Section 910.8). ( } Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). ( } Other: Dated: By: '` 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: MAY 06, 2003 JOHN SWEETEN, CLERK,By ��� � .- ,Deputy Clerk WARNING(Gov. code section 9.13) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter.If you want to consult an attorney,you should do so immediately. *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 1 deposited in the United States Postal Service in Martinez,California,postage fully prepaid a certified copy of this Beard Order and Notice to Claimant,addressed to the claimant as shown above. Dated: MAY 07, 2003 JOHN SWEETEN,CLERK.By Deputy Clerk Claim to: BOARD OF SUPERVISORS OF Ct7 M COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Clams 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, 19137, 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 innst be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) . H. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 1036, County Administration Building, 651 Dine Street, Martinez, CA 94553. C. If claim is against a district governed by the Beard 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 aust 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 ) Rese C k,'..s...*` stamp APR 0 2 2003 Against the County of ntra Costa } CLERK 50ARD-0E-`SUPERVISORS or } CONTRA COSTA CO. District) ill in rimae The undersigned claimant hereby makes claim against the ty of Centra Costa or the above-named District .in the sum of $ .� -= and in support of this claim represents as follows 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) lG; C3A^H&E' Bi,tsSom Ca-t.7 !DA uVIc.LE-g Cot-4TI%It CogTA C*uoU'r<r 3. Hoer did the damage or injury occur? (Give full details; use extra paper if required) SES AT-rAcyMnr-r`- 4. What particular act or omission on the part of county or district officers, servants or .employees caused. the injury or damage? 5 *7"7',Q C if M r N- 5. Wnat are the names of county or district officers, servants or employees causing the damage or injury? N .A 5. 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.) :5,Fg 4T i ArHME N7-- 8. Names and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT $JE�4 ATTACftM —tY1r Gov. Code Sec. '910:2 provides: "The claim must be signed by the claimant SEND NOTICES T0: (Attorney) or by some person on his- behalf." Name and Address of Attorney Gla' is Si tore ! O Raata�e Bt-OAXOM Address --- jJAiY V�`MMis b C '• ck_•LJ EI_c - Telephone No. Telephone No C0.5-SeD- 74 11 NO`T'lCE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for a�.lowance 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 imprisoriment 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 ($101000, or by both such imprisonment and fine. .........................._..... . . ........... ...................................................................................... . 4V CONVERSATION NOTES On the day after the flooding of the back yard, 16'December 2002,1 called the Danville City Manager but was passed onto the city attorney, Rob Ewing. 1 made Mr. Ewing aware that;because of the drainage system design of Osage Park and the overflow of the creek caused by the heavy rains resulted in a heavy torrent of water and debris to be directed to the walkway adjacent to my property. The heavy downward flow of water breached my fence and flooded my backyard to approximately 18 inches of water,mud and debris. Water and mud flowed under my house and into the garage. The plastic pool cover that enclosed the pool was covered with mud, water and debris to approximately 24 inches. The force of the water detached the heavy plastic cap to the pool cover box causing damage to the motor and the gear box. The backyard V ditch was covered with mud and debris that reached approximately four feet high. Neighbors carne to the rescue by helping clear the V ditch to allow water to flow. My backyard was covered with debris that needed to be cleared. After 1 made Mr. Ewing aware of the damage, I asked for assistance to clear the mess. Because of the flooding in other areas in the town, assistance was not available. 1 then raised the issue about the projected rain storm the coming weekend. I proposed that the city sand bag the walkway adjacent to my property to divert the flow of water along the walkway to Orange Blossom Way. Mr. Ewing again said that the city would not be able to do it. 1 then raised the issue that I hold the city responsible for the damage and 1 will be submitting a claim for damages. Mr. Ewing responded by stating that the overflow of the creek was the cause of the damage. Therefore the responsibility lies with the County who had responsibility for the creek. Mr. Ewing said that 1 should get in touch with the County and submit my claim to them. Some time later 1 contacted Mr. Ewing and requested a claim form be faxed to me. He gave me the phone number for the County to request a claim form from them. 1 contacted Penny Baily, Liability Section, and requested a claim form. She faxed a copy. She also made me aware of the process used by the county in handling claims. See attached pictures of extent of damage. 2 ., .. CLAIM DAMAGES TO PROPERTY AND EQUIPMENT CLEAN UP OF DEBRI ALBERTO C. RUBIO CO. $500.00 CHECK# POOL COVER MOTOR POOL COVERS INC. 1,147.00 EST. AND GEAR BOX POOL COVER CLEAN CAROLYN ZABRYCKI 300.00 UP OF DEBRI AND MUD FENCE REPAIR 500.00 EST POOL EQUIPMENT DAMAGE 1,000.00 EST (EXTENT OF DAMAGE UNKNOWN UNTIL POOL COVER MOTOR AND GEAR BOX ARE REPAIRED) AIR CONDITIONING EQUIPMENT DAMAGE 500.00 EST TOTAL ESTIMATED COST OF DAMAGE $3947.00 3 U) Contract Addendum O POOL COVERS, INC. � 6stimate I 10 .00 Pool Covers, Ino Quote valid for 60 days from Lioer,se #497480 prepared by 534 Ghia Avenue f -- ! Richmond, CA94804 1,800)662-7565,-(510)233,4141 fax(510) 233.4302, Site Information BUfirrg Information Name __ l Name Street ti€reet " . City ��+�„'� '� zip..! Gsty 1 , Phone-H } '" _ Phone-H ( ) Description of Materials and Labor Each Tota! Authorization for Work Total Name _ -- Deposit Balance Due Upon Completion Date ., 1 .1 .. Estlmatea Orty; Tile above It basad c7i au° insr entior and due€riot cover any iab,,r or rnateri- a s which may br--reqjlred after vrwk �wlz started. q t I s; n Irv'- tC4X 1 Y Y�xu wool Not Y yuu f y. . N77, oc lo e F a 3 I - f, z� I u a v All 3 " l I �} Ic ,r�.:� � ��sd gi, 1• {G k 2. li �� ..... i ��� ` .�5. ;££ FK fir., �u I I W � � :' � ': �' � °-�r" Y 7k3 a � �� � �s `� ���� � ��� R � r�; s �t ,.``aS rir,z � � }, � � � d5 $ I I� � & t� p.y; .� cue.. �aa��:.,, �vez+A< � �� 3 �� � F .j i�4 M�� � W� I�i.�, '� �� ii�� I «_may ,,,� `4'N s w s w ,r- # � „� .«- m � �°`. i r s � k mcz, 3 I i� -4' I f y'af it E sS � Ii 7 l f I'y •f x . y E. a 4 .. Y � s, a sa I 4 ,•Xni 8 + 1 � w I ZEN 1 � I �3b°i- r 5 9 # 7 0 1 PRA IT IR f t E kk . � �•4 ff 6 Y ; { + WAYS, ,ss.;. W w e ca ' fFr�a � i a L � t 'H����''"'" � �'ry "_ s"����,y.€�u�y� Seo• xs y � t rii�fi 9i i rl � 4� f r 7' k F C ryb £ I } 4 y bdRk J * k 1 + I I n 3 v ✓f k'z��xm� �'', ark*fss ayes s ,�r� q � � w pd '^�,�' ri F 4� g� i i — r CLAIM BQAM.QF--&PK&V-1§QRS QLF CONTRA COSTA COUZL . BOARD A9T-191Y:< MAY 0 , 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 Goverment Code Section 913 and ` = s 915.4. Please note all"Warnings". AMOUNT: UNKNOWN A P R 02 2 3 COUNTY CO;,.iNsEL CLAIMANT: HEATHER HAMILTON k:¢ART dNEZ C,ALiF. ATTORNEY: JACK BLOXHAM DATE RECEIVED: APRIL 022 2003 ADDRESS: LAW OFFICES OF JACK BLt7,1G1AM BY DELIVERY TO CLERK ON: APRIL 02, 2003 319 LENNON LANE, WALNUT CREEK, CA 94598 BY MAIL POSTMARKED HAND DELIVERED BY RISK MANAGEMENT FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-notedclaim. JOHN SWEETEN,Cl rk Dated: APRIL 02, 2003 By: Deputy II. FROM County Counsel TO: Clerk of the Board of Supervisors { } This claim complies substantially with Sections 910 and 910.2. (This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant.The Board cannot act for 15 days(Section 910.8). { } Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). { ) Other: Dated: `"I - ~ o3 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: (K) 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: MAY 06, 2003 JOHN SWEETEN,CLERK,By ,Deputy Clerk WARNING(Gov. code sectio 913) Subject to certain exceptions, you have only six(6)months from the date this notice was personally served or deposited in the snail 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: MAY 07, 2003 JOHN SWEETEN,CLERK By Deputy Clerk OFFICE OF THE COUNTY COUNSEL SIP- SILVANO B.MARCHESI 1✓ '_ Q COUNTY COUNSEL COUNTY OF CONTRA COSTA -• ,,s' Administration Building SHARON L. ANDERSON 651 Pine Street, 91h Floor .�% f` -- .�ti CHIEF AsstsTANT Martinez, California 94553-1229 F , GREGORY C. HARVEY (925) 335-1840 Q; t a 1J1`1¢ p' VALERIE J. RANCHE (925) 646-1078 (fax) AsswAws .� _ •yam �rA C®UK'C� NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: lack Bloxham Law Offices of Jack Bloxham 319 Lennon Lane Walnut Creek,CA 94598 RE: CLAIM OF: HEATHER HAMILTON 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: [ 11. 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. [X] 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 ($10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. [ ] 6. The claim is not signed by the claimant or by some person on his or her behalf. [X] 7. You are required to submit your claim on the proper form,which is enclosed. Please resubmit your claim on the enclosed form. Gov. Code, § 910.4. Please be aware that you have only a limited period of time in which to file an amended claim. See Gov. Code, § 910.6. Page 1 Jack Bloxham, Esq. Re: Claims of Heather Hamilton Page Two [ 18. Other: SILVANO B. MAR.CHESI COUNTY COUNSEL MONIKA L. COOPER Deputy County Counsel CERTIFICATE OF SER'V'ICE BY MAIL (C.C.P.§§ 1012, 1013a,2015.5;Evidence Code§§641,664) I declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553;I am a citizen of the United States,over 18 years of age,employed in Contra Costa County,and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as shown above,sealed and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California. I certify under penalty of perjury that the foregoing is true and correct. Dated: ! ? ' at Martinez,California. Kathleen O'Connell cc: Clerk of the Board of Supervisors(original) Risk Management (:NOTICE OF INSUFFICIENCY OF CLAIM:GOVT.CODE§§910,910.2,920.4,910.8) Page 2 <X- LAW OFFICES OF JACK BLOXHAM 319 LENNON LANE, WALNUT CREEK, CA 94598 * TEL:(925) 279-1388 FAX: (925)279-1380 February 11, 2003 Sent via fax (925) 335-1421 Original Mailed Sharon Hymes-Offord Risk Management Division Office of the County Administrator A 2530 Arnold Drive, Suite 140 APq 0 00mow Martinez, CA 94553 CLUP Q 2QQ3 NOTICE TO CARRIER OF REPRESENTATION Co,TA � t$ $ Re: Your Insured Matt Harris/Contra Costa County Our Client Heather Hamilton Claim Number Unknown * 52 t4 0 q Date of Loss February 7, 2003 Dear Ms. Hymes-Offord: This office represents Heather Hamilton with regard to injuries she sustained in the accident with your insured, which occurred on February 7, 2003. We are informed that your company is the insurance carrier for the party named above, and that your insured was at fault. Please direct all future communications regarding our client to me at this office. Our client hereby revokes any authorizations you may have previously obtained. We do not provide income loss or medical record authorizations, or provide statements from our client. We will provide you with all information relevant to our client's claim at the earliest possible time. Ordinarily, we will provide you with a documented settlement request or demand package after our client has made a recovery or has completed a course of medical care. We would appreciate written cognation of coverage,the limits of such coverage,your claim number, and any other information pertinent to this matter. Please provide a copy of any recorded or written statement from our client. Also, please note that our clients have granted us a first priority lien on any cause of action or any fund obtained from settlement, award or verdict, to secure our fees and costs in this matter. Thank you for your attention to this matter. Very truly yours, LAW OFFICES OF JACK BLOXHAM kk- 44K�afi-.J t JACK BLOXHAM Attorney at Law JB:kb Tax ID 68-0117429 DESIGNATION OF ATTORNEY TO: -( 1kAH a-J,t Irt cs�r ' L2=fS1C_ at _y-nVv4' (24UIZ )ft� Re: Claire Number: 5'2..t.0 a 1� - Date of Loss: - '7-63 Dear Sir/Madam: Pursuant to California Code of Regulations, Title 10,Chapter 5, Section 2695(c), I designate LAW OFFICES OF IACD. BL€)XHAM, JACK. BLOXHAM, ESQ. To handle my claim for personal injuries and damages arising from an accident which occurred on the above date. HEA HER HANUL'TON X f ` (Date) . .... . . . k � � . $ � � \ � � 2 «Va : c E 3 } � LO LO& L $ / .= 0) ® E 5 5 / 0) ¢ '0 () -6 c m0 d f \ M m a : 2 T U W 0 CN r a \ * : : M i . r : r : # : ■ � . � \ / . \ � m � . 2 f \ o } b = Q U r j � � y O \ � � CLAIM BOMR QE S PERV'ISQ►R S OF CO_NIRA Cg§TA C U_Nn BOARD ACTION:r M&Y, 0�6?', 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 M P} < s 915.4, Please note all"Warnings". AMOUNT: $6,022.13 ' APR -0 2 CLAIMANT: SHARON CR%E COUNTY COUNSEL MARTINEZ CALIF ATTORNEY: UNKNOS N DATE RECEIVED: APRIL 02, 2003 ADDRESS: JANE ALVARAW BY DELIVERY TO CLERK ON: APRIL 02, 2003 ATLANTIC , MUTUAL INSURANCE CO. 770 THE CITY BREVE SOS, SUITE 20wy MAIL POSTMARKED: MARCH 20, 2003 ORANGE, CA. 92858-6910 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETE , Dated: APRIL 02, X003 By: Deputy II. FROM: County Counsel TO: Clerk of the Beard of Supervis rs { } This claim complies substantially with Sections 910 and 910.2. ( his Claim FAILS to comply substantially with Sections 910 and 910.2, and vire are so notifying claimant. The Board cannotact for 15 days(Section 910.8). ( ) Claim is not timely Bled. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). { ) Other: Dated. By: _ Deputy County Counsel M. 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. Dated: MAY 06, 2003 JOHN SWEETEN,CLERK, By ,Deputy Clerk WARNING(Gov. code section 91 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: MAY 07, 2003 JOIN SWEETEN,CLERK By Deputy Clerk OFFICE OF. THE COUNTY COUNSEL 51LVANO B.MARCHESI COUNTY OF CONTRA COSTA O COUNTY COUNSEL Administration Building 651 Pine Street, 9'" Floor x /1` " =*_'•, SHARON L. ANDERSON Martinez, California 94553-1229 CHIEF A55lSTANT e _ (925) 335-1800 ai t sz lttt}t s` `t�� GREGORY C.HARVEY (925) 646-1078 (fax) ; 3�;�E:, :r VALERIE J. RANCHE AssisTANTs NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Jane Alvarado Sr. Recovery Representative Atlantic Companies 770 The City Drive South, Suite 2000 Orange, CA 92868-6910 RE: CLAIM OF: SHARON CROWE Your File No. 41-876354-38 Please Take Notice as Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910.2, or is otherwise insufficient for the reasons checked below: [X ] 1. The claim fails to state the name and post office address of the claimant. [X ] 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [ ] 3. The claim fails to state the date,place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [ ] 4. The claim fails to state the name(s)of the public employee(s) causing the injury, damage, or loss, if known. [ ] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000),the 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. Page 1 Jane Alvarado Re: Claims of Sharon Crowe Page Two [X] 7. You are required to submit your claim on the proper form,which is enclosed. Please resubmit your claim on the enclosed form.. Gov. Code, § 910.4. Please be aware that you have only a limited period of time in which to file an amended claim. See Gov. Code, § 910.6. [ ] 8. Other: SILVANO B. MARCHESI COUNTY COUNSEL r' By: MONIKA L. COOPER. Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P.§§ 1012, 1613a,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;I 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. WDated: i ' 0 at Martinez,California. athleen O'Connell 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 y 1 Atlantic Mutual Insurance Company � 11l IC MIl IIS + Centennial insurance Company When It covntt• 770 The City Drive South,Suite 2000 Orange,California 92868-6910 714.740.0888 804.283.0064 toll free www.aMriticmutual.com February 4,2003 Contra Costa County Public Works + W 2475 Waterbird Way Martinez, Ca., 94553 ppb Attn: Risk Management ,ylsa5 Re: Our Insured : Sharon Crowe Our File# : 41-876354-38 Date of Accident : 11-18-02 Your Driver : Michael Stout Location : Black Hawk Rd. Dear Sir: As a result of the above-captioned accident, our insured's vehicle was damaged in,the amount of$6022.13. Since our investigation indicates that your driver was responsible for our insured's damages ( your driver made a u-turn across double yellow lines in front of our insured,) we are enclosing our subrogation documents for your review. Please forward your check in the amount of$6022.13 at your earliest convenience. Very truly yours, Jane Alvarado Sr. Recovery Representative Atlantic Companies 13 C9 3 FEB-26-2003 08:22A PROM: TO:15407694802 P:1/4 21a Stead eadae= 5 S, 2390 N. Main Street Walnut Creek. Ca. 94598, = (925) 934-9300 phone ' (9.25) 934.03:`36 flax Fax Cover Sheet Tyr. From: Fax . Date-.— 2-.0 #of pages Cromp, O �0 ;{ V� Please cat!the Body shop if you have any questions. FEB-20-2003 08:22A FROM: TO:1540769480c P:2/4 132/20/2003 At. 08: 13 AM Job Number; li(,17 WATM STEiaan AUTO DWY License #:AGO80143 Federal IIs #:942673324 2390 NORTH MAIN STREET WALNUT CRFRK, CA 94596 (925) 334-9300 Fax: (925) 931-0336 PRELmmmY ESTINATL Wri ttcn by: Kimbo le" Onthl # Adjuster: Gidget Dalton # Insured: SHARON CROW6 Claim #641076354 Owners: SHARON CROWE Policy # Address: 37 TL:NNIS C:LU13 DRIVE Deductible: DANVILLE, CA 94506 Date of Loss: Day: (925)U31-3081 Type of Loss: Collision point of Impact: 12. Front Inspect WAYNE STEAD AUTO BODY Other: (925)934-9300 Location: 2390 NORTH MAIN :;'fl cc,r WALNUT CREEK, CA 94595 Insurance ATLANTIC MUTUAL INSURANCF Business: (677)21043149x4091 Company: Days to Repair 1996: CAA a 0KV r r.r.t: C ONCOURS 8-4.6L-VI 4D SED tan Int : VIN: iG6Kr5292TU207943 Llo: 3paw670 Prod Dates: Odometesr: Air COr:tlitlioning Hear Defogger 'i'i 1t wheel Crui *e Control Intermittent Wipers Auto Level Climate Control Elec. Instrumentation Keyless Entry Tintod Class Cody side Moldings Dual Mirrors Traction control Clcar Coat Paint Mrr;tatlic: Paint Powcr Steering Power Brakes Power Windows Power Locks Powor Drivor �;ertsa.. Dowear Sr:aal. Power Antenna Power Mirrors Power Trisnk/Tailgatwe. Anti-Lock Brake& (4) Driver Air Baq Passenger Air. 8a3rq 4 Whorl Disc Brakcs Leaathrr Seats Split Bench Seats recline/Lounge Seats Automatic Tran�s�m'�issionl� Aluminum/Alloy Wheels -_wNf)_---__. .�F.. . --- -----rR -Tooi- .._ _. _. _�-rF -- iSR---PRTNfi--- .r._ 1# This is a Supp lemen for 1 Information Labels 2# for New Hood installed in Nov 1 2002 3# Any que,!,t;ions, pleatsc cull 1 Ki.siberiee 4# a shop (925) 934-9300 ext 39 1 S INFORMATION LABELS 6* Rept, Label air bag & coaling 1 10.62 Incl. 7* Repl Emission T abcl Federal 4.6 1 10.62 Incl.. titer t 2 FEB-20-2003 08:22A FROM: TO:15407694802 P:3/4 Q's 1:2.0r PICKING TICKET I lgvo I cE# r,:1_r*r# BILL TO PAGE RiD48:w,16 7017554 SHARON L CROWE SH IP TO I...I CUST T F'c # 37 TENNI; CLUB' DR. GAIL GE DANV I LLE:CA 94506 "� ... rli.RD PART# / DESCRIPTIC.A! t ,_...__ _.._..__»..__......_____......,..�._...— _�.___— --_�Iri ��+Fio... A�rFtIL I_r:;T�_�_. 12554357 LABEL 80IS, �_.�i641�,�;:,9 LABEL �. f TEST r� � lir. ^0� TEST 0.w , ' r ' 1 • i FEB-20-2003 08:228 FROM: TO:15407694802 P:4/4 02/20/2-003 at: 03 : 1.3 AM Job Number: .32617 PRZLIMINARY ISTIMTE 1996 c`mn i).;v r t.LE CONCOUP. 8-4 . 6L-FT 40 SFm tan Tnt: DESCRIP'T'ION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- Bat Tnvoi Cr to follow t.h i r: fxx . 1 9# labels installed 2-14-0:3! ! 1 ---------------------------- -------_------------------------------------------ Subtotals --5 21 .24 0.0 0 .0 Part..: 21 .24 ----------------------------------------------------- SUBTOTAL $ 21 .24 Stiles Tax $ 21 .24 @ 8 .25008. 1 .75 t3HAND TOTAL $ 22 . 99 ADJUSTMENTS: Deductible 0. 00 ---------------------------------------------------- CU`.;TOME.R PAY $ . flfl INSURANCE PAY 5 _?2 . 99 WAYNE ST'F.AD WARRANT., TT` nODY WORK AND TAINT FOR 12 MONTH; FROM DATE REPAIRS ARE COMPLETED. TT T UNDERSTOOD THAT WE ASSUME NO KKS PONS t H 1 t,TY FOR 1,0,1:;.e; 011 DAMAGE BY THEFT 011, FIRE TO VEHICLE OR PARTS PLACED WITH US P014 STORAGK, SAIF; OR REPAIR OR WHTT.F. ROAD TESTING VFHTCT.F. WE PROPOSE TO MARE THP llfOVK REPAIRS UNDER THE TERMS AND CONDITIONS HEREINAFTER SpEt:1 t'1 XD. PRICES QUO'T'ED ARE FOR LABOR ONLY, PARTS AND MATERIALS; ARE ESTIMATED ONLY. PARTS TO BE BILLED AT LIST PRTC:F: AT TTMK. OF PURCHASE WHEN RFPATRS ARK MADE. COPTRS OF P'1j,K1.NC-, '1'1.CKETS (INVOICES) FURNISHED UPON REQUEST. x'A'M'k'A'X A A'A•'A'A•A'A A"A"A'A''A'W'A''A A'•A"A"A"A'"AAA # k k##*#*i****t#**#+#**i#*****tt*#+#*++*+W t*+#**t*+ DO HEREBY DULY APPOINT WAYNE STEAD <.:A01 L1,AC TO ACT^A5 MYlOURWATTtJRNEY 1N�FACT, TO STGN PAPERS AND DOCUMENTS PERTAINING TO THE PRESENT REPATR ONT.Y. $ t C;N h;!.1 DATE ,82/18/83 16:85:43 RRS 11:82603142841624 A,dj:GDAL'PN Claim#:4187!�354 PAGE:882 STArt OF DAUM FVUA TR&FF!C COLLISION REPORT EMICIAL co"W a'a NUME" NIr•RYFI an A1/GIf.7AE fMET111Cr FOCAL RE►DRrRUMSER SFJ IO FELONY �' f W ' 1 1NAMSER NIYE RW CObIf1Y MtE►O111'KNO OIa'fKSCT SEAT y _,tE 1 LEIWON OCCURRES'OM MO. DAY YEAR t+rt(am) NGO r COMER K a MILSP�DSYIYlMDRMATON.. ►AY OMWEEK T6W AWAY PNi/TOORAPNE iY: uor 0Yti Ram J �AT WMASoC9ON WNTN rTATi NPIY'NK 004. of 1�\Wc Y.�I � mN� PARTY mvERYc ut"imms- "A" eLAAts ASITY of rsuu } +..Na/waonrea` " SPMA EUYESR SPATE OIOVEA MAMA(FIRST,WD*Lt, ) PACE& tT AbOKtS• OWNER'S NAME 93 SAME AS VMSA 'RSAN /y,�w�, � &♦�a Y c PARKED -ISTATY Prjo i,^` 5�✓t 7` ONMiNi AO Al" ASOIWAR Of". YY SII NAR irfi mooff S10Nr G•'� ii ATt iE+LCt OMTiOItAP YINCEfOR ORDEiq QI 000MER ER 00"t" ff is-401 k".\" OTNIN 1WMEPIONS avaNtts rlNONE PRIDE MtFNAaCAL Df►EFYE: MOMS A►►AftVWo S!f/tRTONArRArntER ft ) ` t ! �'30 CNPWtOMLY SVEtaCEI OAYAOt SNADIII DAMAAED AM&A VltFC�TY►I DESCIiS , URAME4:AAA MIKA ` P^Ot1�CY,cNiWEER \j 7�'S M00. IR n01A1 DUE TREIrORNW"y�� E Ea P" PDQ �. � .9 PARTY p/i1IRiUC[NSElIUMSER STAW CE,AN UCSMSSWA"R VAN Smyth Wait IRA",NPDDUE,L Ty t STOV Pivots. STASir ADDRIsO 0 RY NAMEr'°"ISAAd AN DRIVER 13 In C17YAMN �E PARKED !iTATE/TJP EArI ADDRSSS (^^ SAME AS SNIPER 94 1-J A . °I..�l. '�,a 1. 'C�.ws". CA ICT. tEI NAR ersi PRbeNr I ...a YD. ,i/ 'A°Ern. Y"AAA �"'�+E rR�rtPfetxaNOPwtPKtcu �nrwDER o"R"R eu 5-0\ !1 5 . ' wIN t� DTMtl6 +�rNwu ``fij({u'�'s�t''N'�l��i``EFRIO�MI PwcRMtenAtrtAEDEPECTE: NONEArrARfHr RErtRTawLRRAmE CJ AX7 }2:. "i"N5\A `"'Kl:7" ,"},1 c�00. CNPUECORLY OEiCIIliI VIMCLSONiAOE SNADtIMDAYAOEOANAA ,M�gyRAMLY CARRIER POLICY MRINR VfNIG,E TYPE r LINK u'JoRWA, R _.. '� YDS, YAlOR DNE Ofuc SYRfAY OR lSONWAY ES11.9IED PCM FCC 'i "TK CNP PARTY ORWtR'E ut]"m wmSER sTATI CLASS iIAPSW VSKVIAR MAKE I MOOfL I COLOR "a NUMSiR STATI DMVSR MAMS(RRST.MIDDLE,LASTt , PEDIs• sTREI1'ADDRpi OYIMERE NAME 0SAME AS ORWAN TMAN PAEttIO CKKYISTATIIW OWNEFS ADONISSr""iSAME AS MY0 MC YfLt j,,,,J My. Sft MAR IYK stwwr t eaw NO. NOAYATI YEAR RACE OISPOSMONOFVINCLSOMORDE#OP: i�'tOflfCS1K �owla t" aftm CUST i ( � (,,,,i 0"18 mowpNONE busomas$momE PRIOR MICMAMCAL09MM70: MOMI AFPAMW "PSRTONAARAWito • W } { , CNP Vol ONLY DESCRIES VENAFA.E OAMAOE aNAO.E YPOIYAOSO YItA NSURANCf CARRIER ►OUCY MUMEER VIlaFEE YYrE � LINK �MONE YNOR f MOO, MAJOR TOTAL ow ON iTRfa70R/EOHWAT E►ff0 cF TRAVIL u Dss ruF DNP I t OISPATCFi MTM 184VEWOWS NAME 1012 RS Ai b•t Divas D NO Pit NIA �2r;�/{sr�x /s"?�3 t 2 - &3-r.Z MW SSS PAGE t (Rall 1.48)OPi 0Q 8S.x8407 8Z!1Q/83 16:86:36 RR5 #:8Z6831492041624 Adj:GDALTON C1aimit:4187!�-'i54 PAGE:883 ! SPF[ tS! NCQRIHQ 'L DATE OP 1COLUSION /� �fi 1 NpC MtJ11�a O YD f[R MO. 11 'DAY 0 ys" - V kS i/ � �" owNsh•swws�ADo:tsss NRT o PROPERTY Q Asx ON* OAMAGE afse�u►naroPDAaA+u SEATING POSITION SAFETY EQUIPMENT EJECTED FROM VEFIICLE OCCUPASM L-AIR SAO DEPLOYED 1A/ SICYC .NC:Net izLcmo M-ALRBAGNOTDEPLOYED i-NOTPI JECT A-NONE IN VEJiCLE DRIVER t•fIIU.Y(EJECTED . 11.:UNKNOWN N-OTHER V,NO z•DARTIALLY 1JHCTED C•LAP BELT USED P•NOT REOU1RED W-YES 0-UNKNOWN t-DRIVER 0•LAP BELT NOT use 1 23 2 TO I-PASSENGERS E-BHOULD"HARNESS USED a1 st PASSENGER 4 5 6 7-STATION WAGON REAR F-SHOULDER ilARMESS NOT USED + --- -- X•NO f•REAR OCC.TRK OR VAN G-W 1 SHOULDER HARNESS USED O•Ili VEllCLE USED Y,Ygg p-POSITIONUNKNOWN N-LAPISHOUEDERNARINSSNOT USE* R-INVEMCWHOrUSED *-OTHER J•PASSIVE RESTRAINT USED S•iN•VEMCLE USE UNKNOWN T K•PASSIVE RESTRAINT NOT USED T-IN YEHKR.E IMPROPER USE U-NONEIN V>=it ITEMS MARi(*O ULOW FOLLOWED By AN ASTERISK(`I SHOULD SE EXPLAINED IN THE NARRATIVE PRIMARY COLLISION FACTOR TRS CONTROL DEVHOES 1 213 TYPE OF YEl#CLf 1 2 MOVIFMENT PRECEDING UST. M1MR(M)OF PARTY ATfAULT COLLISi011 A AVC SECTION NOL.ATED- a Vp ACONTROLS PI)MC11ONNG PASSENGER CAR ISTATION WAGON STOPPE* y [ { NO CONTROLS NOTPUNCTIOMNG• PASSENGER CAR W iTRAiLER PROCEEDING STRAIGHT A �OT140IMPROPER DRIVING': CONTROLS OBSCUREO idOTORCYCLBISCOOTER RAN OI%FROAD NO CONTROLS PRESENT I ACTOR` PICKUP OR PANEL TRUCX ATAKING RIGHT TURN C OTHER THAN ONV ER- TYPE OF COLLISION E%CKUP I PANEL TRUCK W/t"UR E,MAKING LEFT TURN D UNKNOWN• AI+EA*•ON R TRU TRUCK TRACTOR F MAKING U TURN It L A SIDESWIPE TRucKI T K TRACTOR W ITRLR. BACKING REAR ENO SCHOOL $ SLOWINGISTOPPNiG EATH R(MARK 170 2171" BROADSIDE OTHER BU f PASSIW OVER VEHICLE ACMAR )IIT OBJECT EMIGAGE Y VFHIC►.E �CNANRING LADS Ci000Y OVERTURNED KHIG iWAY CC-MST.EQUIPMENT PARKING MANEUVER RAIM4 VFHICLEI PEDESTRIAN t BIOYCLE I ENTERING TRAFFIC StK)YNNO OTHEiT•: MOTHER VEHICLE I OTNER UNSAFE T NG POQtVISI)IsuTY F7. MOTOR V"CLE INVOLVED WITH NPEDESTtgAN )MINTOOPPOSINGLARE OTHER ANON-COLUSION MOPED PARKED WINO PEDESTRIAN 1, NERG(NG LIG//DNG OTHER MOTOR VE"CLE TRAVE UNG WRONG WAY ADAYLIGNT MOTOR KNICLA ON OTH40 ROADWAY 1 2 3 OTHER ASSOCIATE*PACtOWs)13 OTt{ER•- DUSK•DAWN FARM MGM VEHICLE (MARK I TO21T E14) DARK-STA66TUONTS TRAIN AVc mul-M: p OARX-NO STREETU(INTS B YCLE Ne DARK.STREET LIGHTS NOT ANIMAL: Va UFFO vqumoN: r FUNCTIONING' 4 ovaSOSRIETY-DRUG -ROADWAY SURFACE H%ED OSJECT: Vc ON Vq 7140 s Oi�r 1 2 3 PHYSICAL A DAY t rsf (MARK L TO2LTEM51 WET OTHER OBJiiCT: HJIONGT BEEN Domma SNOWY-icy D HBO-UNO£RINFLUENCE SLIPPERY(MUDOY•OILY,ETC.) VISION OBSCUREMENT t }IBD.t+IOY UNDERiNFLYENCS INATTENTION•: (IBD-IMPAIR ENT UNKNOWN' ROADWAYCONDITION(S) STOP IL GO TRAFFOC PE*ESTRIAIi'S INvbLVIUt UNiIER ORUG.INtaLU£NtE• (MARK,TO2 ITEMS) ENTERING/LEAVING RAMP IMPAHINENT-PNYS(CAL 1 l;WNO PEDESTRIAN INVOLVED �PRENOUS COLLISION A HOLES,DEEP RUT' CROSSING IH CROSOWALK UNFAMIUAR WITH ROAD IMPAIRkHENT NOT KN01ltN (� LOOSE MATMAL ON ROADWAY• AT INTERSECTION �(O CTIVE Y HL EOUIP.: pip NOT APPUCAlLE OBSTRUCTION ON ROADWAY` CROSSING IN CROSSWALK-NOT q]7af (SLBEPYIPA TIOUED QCO"TRUODON-REPAIR ZONE 0 AT INTERSECTION L7►a MAI. ION REDUCED ROADWAY MOTH D tROB;ING-NOT INCROSSWALK L UNINVOLVED VEHICLE ANAZAMUSMATERIAL PLOOOIT I IN ROAD-INC{.UM SHOULDER OTTER•: OTHEq`: N071N 0040 NONE APPARENT i NOUNUSVALCONINTlONS APPROACHINGrLEAWHOSCHOOLSUS I I PRUNAWATYINCLE YI Si i T I rfsc I.LA us • «tNCATS►w+crN 1t _._.C.;II :715 CJ,''Jf?•.1' riv ettOar6Af o.�..n.+name .. . 02/tlt/83 16:87:39 RRS #:826831.4Q2841GZ4 Adj:GDALTDH Claim#:41876.354 PAGE:884 . y STATE OF CALIFORNIA ' DATE OF R4CIDEI iT TIME NCIC NUMBER OFFICER I.D. NUMBER 11/18/02 1215 9390 15691 11-134 SK TCN 13LACKHAWK N (Not To Scale) RD w E s V-1 CENTER ISLAND DOUBLE '{ YELLOW LINES V-2 HIDDEN AK 29 S/8 N/$ CONCRETE CURB CONCRETE CURB 18 ft. 20 ti. DOUBLE YELLOW LINES i PREPARER'S N I.D.NUMBER DATE REVIEWER'S NAME DATE R.G.Bianc 15691 11/18/02 .82/18/83 16:87:57 RRS #:82683' '2841624 Adj:GDALTON Claim#:4187 54 PAGE:885 STATE OF CAl FORNIA DATE OF[NMENT TIME N0CNUMgF` OFFICER I.D. NUMBER 11/18/02 1215 93913 25691 11-234 1 NCITIP'ICATION: 2 3 I received notification of this property damage only collision at approx 1310 hours. I responded from 4 the CB?Dublin Area Office and arrived on scene;at approx 1326 hours. s 6 All times,speeds and measurements are approximations. All measurements were made by 7 estimation. 9 io AD121TIO—AL INFORMATION: it 12 I conducted a visual vehicle inspection on V-2 to see if the rear amber lights,brake lights and turn 13 signals were working properly. All lights were properly working. 14 i s D-I did note'that V-I had prior damage to the rear of her vehicle from a previous collision. id 17 18 STATFMNTS FS, ENCE): 19 20 D-1 (Crowe)related that she was driving V-1 on Blackhawk Rd SIB,directly behind V-2 at approx 21 40 mph. D-1 stated V-2 just suddenly stopped and turned to the left. D-1 stated she collided into the 22 rear of V-2 when V-2 was turning. D-I stated D-2 did not use any turn signals before the turning 23 movement. 24 2s D-2 (Stout)related he was driving V-2 on Blackhawk Rd SB, in front of V-1 at approx 45 mph. D-2 26 stated he turned on his rear amber Iights and Ieil turn signal for he was going to turn loft over the 27 double yellow lines. D-2 stated he slowed V-2,swung out to then hid then turned back to the lett 28 and began making his U-turn. D-2 stated as he was twxung he felt an impact to the rear of his 29 vehicle. 34 31 32 SUMMARY.. 33 34 D-2('Stout)was driving V-2 on Blackhawk Rd SIB,at a stated speed of 45 mph. D-I (Crowe)was 3s. driving V-1 directly behind V-2 at a stated speed of 40 mph. D-2 began slowing V-2 in order to make 36 a U-turn to the left over the double yellow lines, D-2 began turning to the left from the SIB lane over 37 the double yellow lines to make his U-turn. Due to D-I's unsafe speed for conditions,D-I failed to 38 observe V-2 slow down and turn to the left. The left front of V-1 then collided into the left rear of V- 39 2 within the SIB lane of Blackhawk Rd. After impacts,both vehicles were moved from Blackhawk 40 ltd to the exit lanes of Hidden Oaks Dr. ARWARER's N I.D.NUMBER DATE REVIEWER'S NAME DATE R.C.Bram 15691 11/18/02 82/18 83 16:80:31 RFS #:82683141 2841524 Ad j:GDALT111t Claim#*41877'54 MGM% STATE of CALIFORW DATE oP INCIDENT TIME NCIC NUMBER OIWER I.D. NUMBER 1'I/W02 1215 9390 15691 11-134 1 .AREA OF IMPACT (A.O.I.): 2 3 The A.O.I. (V-1 vs V-2)was located approx 700' SIS roadway prolongation line of bidden Oaks Dr 4 and approx I V E W roadway edge tine ofBtackhawk Rd S/B. 5 6 7 CAMEE: 8 9 D-I (Crowe)caused this collision by being in violation 22350 VC(unsafe speed for conditions). 10 1 i The summary,A.O.I'S.and cause were based upon my collision investigation, statements and vehicle 12 damage. 13 14 15 RECO-MM N-DATIONS: 16 17 1 recommend that the Pleasanton Muni Court file and charge D-1 (Stout)with the following; 18 19 N 12951(a)CVC No Ca. Driver's License present at scene. 20 r PRSPAREWS NAMY, ID.NLnVMER. DATE PEVIEWER'S NAME DATE R.G. ffiancW 15691 ,------ 11118/02 ''I'll...I......I...................................................................................................... ..........................-..,...................I.......... ............................................. financial Detail Page I of I CULL Collision Activity for Claim Number 41876354 Claimant Suffix 001 Recording Suffix 01 D-0:aiment Totals lix--P-e1 $101.00 ILosses - 11$4,880-12 IRecovery ll_ Expenses -(06, 31,32,33,34, 35,41,42,44,46) Service Iss Date Paid Payee Check No Dates Payment Type FinalType Add By 03/11/03 $11.00 CHOICE POINT 58127 1450042403 F98P ALL OTHER EXPENSES-(35) y C F53KPWIP I2/03102 $90.00 Golden State Appraisal 954568493 910042433 F981 APPRAISAL FEE EXPENSE- Y C F53GRDIP Company (32) Losses -(02,03,04,07, 16, 17) Service Iss Date Paid Payee Check No Dates Payment Type Fin-alType Add By 02/20103 (jj�2.,,�Vayne Stead Cadillac Body 94267_3324 450041281 F98APayments-(02) Y C F53GRDIP Shop 12117/02 $460.39 Wayne Stead Cadillac Body 942673324_450037421 EMAPayments-(02) Y C E!Q�F2�IR- Shop 11125/02$4,396.74 SHARON L CROWE 145574402 450036261 F98APayments-(02) Y C F53ARBI.P- Reserves Add Resv Chq Chg By Status Reserve Type Date Back Forward Mai>Et Menu1Hel & FAD7s I Claims Home [MwjjttC.#qqjdj http://claims.atlanticos.com/Aclaim/Reports/index/Claim—Financials—Detail.eftn?Requesttir 03/25/2003 i e i MYus�' 'J R� r> � a'+� 12o uo r 400 C 15 a am 2. v . am c d dv ao ttr��tr3 t ' AMENDED CLAIM ROAN OF P S F CONIM C S'I`A CONY BOARD ACTION: MAY 06, 2003' Crim 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 & o 'k, AMOUNT: t 4 913.4. Please note all"Warnings' ?s >2'k, > AMOUNT: 3 800. t i'R 0 u 2003 CLAIMANT: FLORIDA FOSTER RRss OC)UNS EL ATTORNEY: UNKNOWN DATE RECEIVED: APRIL 03, 2003 ADDRESS: 331 NEWBURY, BY DELIVERY TO CLERK.ON: APRIL 03, 2003 HERCULES, CA. -94547: SENT THROUGH INTER BY MAIL POSTMARKED: OFFICE Maw Rv SxARC OFFORD FR. RISK MGMT FROM: Clerk of the Beard of SupeMsors TO: County Counsel Attached is a copy sof the above-noted claim. JOHN SWEETEN,%&alvc— H. Dated: By: Deputy FROM: County Counsel. TO:Clerk of the Beard 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 carmot'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. L4-3- 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. MAY 06 2003671 Dated: JOHN SWEETEN,CLERK,By r ,Deputy Clerk WARNING(Gov.code sectio 13) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter.If you want to consult an attorney,you should do so immediately. *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. MAY 07 2003 Dated: JOHN SWEETEN,CLERK By Deputy Clerk 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 craps 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 craps 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 Fine Street, Martinez, CA 94553= C. If claim is against a district governed by the Board of Supervisors, rather that: 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 f0 m. RE: Claim By } Reserved for Clerk's filing stamp ) Against the County of Contra Costa } AP l � j or strict) Fill n name' The undersigned claimant hereby makes clai - At�nthe County of Contra Costa or the above-named District in the sum of ,�___ and in support of this claim represents ,as follows: 1. When did the damage,or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) 7;7,e 4,eeli5:teA/ A14 !e I-o4 k 7�, AIPAk- 61X. 3. How did the damage or injury occur? (Give full details, use extra paper if required) ,,Oh E le_ dx c i✓ A"a 4. What particular act or omission on the part of county or#district officers, servants or .employees caused. the.injury or damage? � t b n a-kVk I ea s tiz e a xea.i e 'r� e ; s & se c's a,-c re ,11�j/t 04- (4or lith ............................................................................................... ................ ........................................................................................ ................................ ...................................................................................................... . .................................. wnar, are ttie names of county or district officers, servants or employees causing II.-Ohe damage or injury? 5. What damage or injuries do you claim resulted? (Give full extent of injuries or M A—le AAll- damages claimed. Attach two estimates for auto damage. 7-he da-111-Urf �b 4z/- A4e lfoaal V 1,0,4 Oleelo, dA4Va =Va �&IV jdile` AkA 'sllteld- 70 4,9 A A 140114 dIZ 7 Aw" was qt-h, ve compu, "r JTnc u'JetJ9estimates M'rof any prospective injury or damage.) The mo "W 8. Names and addresses of witnesses, doctors and hospitals. yodmle5 CA List the expenditures you made on account of this accident or injury-. DATE =1 AMOUNT OL 7-- 7� 7 tW. Code See. 910:2 provides: 1�:-] "The claim must be signed by the claimant SEND NOTICES To-. (Attorney or son on his.q hql-alf- -9a--m—e and Address of At ey (Claimant's Signature) CA—d&-e—ssT TJ 9,11�7- Telephone No Telephone No. N 0 T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraudt presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer2 authorized to allow or pay the same if genuinev 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 ($ItOOO). or by both such imprisonment and fine?- or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000t or by both such imprisonment and fine. . . �\�\��\ . . . . . . . ���\ � . . ���\�d��� ����< y����\��� �\���\�d2��\ 22�\ �\�\ ������« / �\�����\ ���/ � \�����������.���d. . :�: . . . . . . �\�«�°�©��� � RMS s r�,w..► `. APR 0 3 2003 -F SUPERVISORS APR 2 G 03 .................. CLAIM BQAU S PZ&VISQOF CONTgA C T COUNITy BUA]2D ACTION: MAY 06, 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 I * �� Pursuant to Government Code Section 913 and Din 915.4. Please note all"Warnings". APR 0 7 20,03 AMOUNT: $5,000,000. CCIUI'qr�COUNSEL CLAIMANT: FLORENCE TORBA k1A.1J 1.k1EZ CALF MABEL "PAV' ATIUISON ATTORNEY: UNKNOWN DATE RECEIVED. APRIL 04, 2003 ADDRESS: P.O. BOX 32 BY DELIVERY TO CLERK ON: APRIL 04.__20Q3 CLAYTON, CA 94517 , BY MAB.POSTMARKED: _ HAND DELIVERED FROM; Clerk of the Board of Supervisors TO County Counsel Attached is a copy of the above-noted claim. APRIL 07, 2}03 JOHN SWEET l Dated: By Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( } This Claim PAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days(Section 910.8). ( } Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). { } Other: Dated: By: Deputy County Counsel M. FROM: Clerk of the Board TO: County Counsel(1) County Administrator(2) ( } Clamor 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 correctcopy of the Board's Order entered in its minutes for this date. MAY 06 2003 Dated: JOHN SWEETEN,CLERK.,By ,Deputy Clerk WARNING(Gov. code secti n 913' it 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 penury 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: MAY 07, 2003 JOHN SWEETEN,CLERK By D u Clerk Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAt��NT 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 I001'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 trust be filed with the Clerk of the Board of Supervisors at its off=-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,Renal Code Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp y MA 15 5 Against the County of Contra Costa or } APR 4 2D03 District) 7.1O)Sl�TRt`i vOS fs�v�.}. CLEERK-00057777ERV ISO RS (Fill in name) ) } The undersigned claimant hereby snakes claim against the County of Contra Costa or the above-named district in the sum of S,5* 4Af 11+'o n and in support of this claim represents as follows: I. When did the damage or injury occur?(Give exact date and hour) , 10 _09 - 0a aro ebx,0,C?J-e( #` ►Vt. C oila4e,a( dantiaye ensu ecl la4- ,ycC,(:f-y-en4- 2. Where did the damage or injury occur?(Include city and county) Dcl� e /� g�tn 6-00 1<0i-ler ( worry lQoa, e-ar Cao. fro +n Cour.► GozF� C � d c:crn#-�'r,u e,4u� v ►- laCafistis � 5 -emmc 'r,;, #n; tcr►' ° c � X4nst 3. How did the damage or injury occur?(Give full details;use extra paper if required) S ee A TTA G 1{AA NT -3 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? See AT—IACHM9�Jr LI (fa 1pa,5e,5) 5. What are the names of county or district officers, servants,or employees causing the damage or injury? b u4 ter +oma5 l-feAa-vsora S4-#-+etc -t- nrn� 6. What damage or injuries do ou c'rstm sa ted (Crave 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.) C....>e-e AM"l"'rACk#M C'N-r 7 (one- Pa�ew) 8. Names and addresses of witnesses, doctors, and hospitals. 9. List the expenditures you made on account of this accident or injury. DA'T I= AM—QM 2 ego a 4i 15'd 44f-o CA 44( Co n stJ 4 30 Ar^eces.serv+er Gov. Code Sec. 910.2 provides"The claim must be } signed by the claimant or by some person on his behalf" ND N' Dame and Address of Attorney } (Claimant's Signature) ' 600 IL -VZ (Address) } Telephone No. )Telephone No. s*******w*******�****s*sw*****�*w+�*ww�t**s�*�r**s**��►***�*�*#*�***�****:�**�w********�w**ter* NOTICE Section 72 of the Penal Code provides: Every person who,with intent to defraud,pmts for aDowance 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 fraadutent 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(S 1,0001 or by both such imprisonment and fine,or by imprisonment in the state prison,by a fine of not exceeding ten thousand dollars(S10,000),or by both akh imprisonment and fine. ATTACHMENT 3 How damage/injury occurred. • Sheriffs failed to protect our lives and property. • Mabel"Pat"Atkison had to helplessly watch Florence Torba being mistreated, having witnessed her first being brutally kicked by Bruce Borjesson and then herself being discounted as a witness by the sheriffs for no justifiable reason as they irrationally protected the criminals. She felt empty and alone and in shock at the injustice as she was left to manage the care of our ranch alone. • At Martinez,Florence Torba's health was endangered by being placed in an unsanitary environment where she was probably exposed to airborne pathogens as well as other disease potential. • At Martinez,Florence Torba did not eat,drink anything, or sleep while she was held to try to best protect her health. • At Martinez,Florence Torba was locked in a crowded room all night with an average of 16 other women. • At Martinez,Florence Torba stood up by the door all night long(approximately 9.5 hrs.)to minimize contact with the unhealthy environment. • At Martinez,Florence Torba was given no blanket or other covering by the Sheriffs Department and was made to stay in a chilling draft for hours. She was shivering uncontrollably and probably on the verge of hypothermia by the time she was released. • At Martinez, Florence was exposed to the agonized cries of a male who had taken cocain as announced by a smiling Sheriff. • At Martinez,Florence Torba suffered pain all night from her hand, especially the first joint of her third finger which became engorged with blood. • Our valuable time has been consumed trying to work our way out from under the actions and omissions of three Sheriffs(failure to take action against criminal acts against us)and collateral damage resulting there from. Our attention should not have to be directed toward government employees supposedly there to protect the citizens. We should be free to engage in our desired pursuits of gardening, caring for our trees,tending to the needs of and spending time with our animals,tilling and mowing our land in preparation for the fire season,beautifying and improving our property,and biking and hiking for our health instead of becoming embroiled in problems with the Sheriffs' Department because they distort the truth of a situation. ATTACHN ENT 3 - Continued • "Pat"Atkison had to go through the anxiety and turmoil and physical ordeal involved in having Florence Torba released from the Sheriffs which involved running around from place to place for a period.of 3.5 hours. "Pat"is handicapped with crippled feet and must endure pain in order to walk. • The county has held$25,000 of our money since October 10,2002. • Bruce Borjesson filed for a Restraining Order against Florence Torba as a result of the Sheriffs actions. ATTACINT 4 Particular acts/emissions on the part of county Sheriff's caused the injury/ mage. • Sheriffs searched us both on our own property. • Sheriff's abducted Florence Torba from our property. • Sheriffs dragged Florence Torba into harms way onto the property of her attacker where she could have been shot,over massive protests from both of us. • On 10/9/02,Florence Torba was 66 years old(67 in February 03)and"Pat"was 65 yrs. When the sheriffs were forcibly taking Florence Torba away,"Pat" begged them to let her drive Florence Torba down the approximately 300 feet to our gate because of her age and family history of heart attack,but they refused. • Sheriffs prevented Florence Torba from seeking timely medical attention for her injuries which could have resulted in tetanus. • Sheriffs refused Florence Torba additional clothing and confined her in car with air conditioning on causing her to be chilled. • Sheriff's failed to arrest Bruce Borjesson for his attack on Florence Torba. • Sheriffs failed to make a Citizen's Arrest of Bruce Boz esson(and take him in) for his attach,on Florence Torba at our request,but instead we feel manipulated the Citizen's Arrest charge to protect him. • Sheriffs allowed trespass and vandalism of our property to be continued by Bruce Bozjesson and his accomplices. • Sheriffs refused to take evidentiary pictures of Florence Torba's injured left hand at the scene. • Sheriff's subjected Florence Torba and"Pat"Atkison to humiliation at the crime scene by dragging Florence Torba off in front of Bruce Boz esson and his accomplices as they smirked and laughed and then held.Florence Torba bleeding in the car on Bruce Borjeson's place with her hands restrained behind her for approximately 2 hrs. while a party-like atmosphere went on between the Borjessons and the Sheriffs with much laughter and gaiety. Sheriff Butler took many pictures of them even though nothing had:happened to them. Florence Torba had broken no laws and did nothing wrong, yet was forcibly taken away from her home. ATTAiC14N'i W 4 - Continued • The Sheriffs subjected Florence Torba to a terrifying experience,being taken off into the darkness by two unknown males,trapped in a lacked car,injured,and with her hands restrained behind her back. • At Martinez, Sheriff'Henderson ridiculed Florence Torba and engaged in spreading lies by commenting to a nearby El Cerito policeman-did you hear about how she attacked someone with a tractor? • At Martinez,as Florence Torba was taken into the inner room,bath Sheriffs were behind her,and Sheriff Butler said to Sheriff Henderson,"She doesn't know what she's in for" • At Martinez,Florence Torba was subjected to invasion of privacy,degradation, and rude treatment. +► Sheriff's had no concern.for Florence Torba's injuries. Sheriffs ignored evidence that supported us as victims. * Sheriffs effectively removed us from the area of our ranch that was being taken over by force. Sheriffs tried:to find support evidence to make real something that did not happen, and did not see anything that was contradictory, • Sheriff's took away Florence Torba's freedom. • We think Contra Costa.Sheriffs have willingly conspired to violate our Civil Rights by covering hate crimes against us and by assessing and supporting false charges against Florence Torba. k ATTACHMENT 6 Damage/injuries that resulted. • Damage claimed is emotional, spiritual,and damage to our security due to the actions of Sheriffs J.Butler and Thomas Henderson on October 9, 2002. (Humiliation, injustice, supporting criminal actions against us, lowered self esteem) • Physical aging of Florence Torba due to physical ordeal suffered while trapped by the Sheriffs. The emotional, spiritual,and damage to our security is ongoing and will have a deleterious effect on our emotional state for the rest of our lives. Nervous pain and suffering of varying degrees has resulted from the Sheriffs' actions of 10/9/02,and subsequent collateral damage. • We are currently unable to graze horses on our ranch:because we are unable to repair our fence because Sheriffs' actions allowed Bruce Borjesson to build a fence on our property. • Damage to our assets has resulted due to actual loss of our time caused by the Sheriffs' actions and collateral damage and to forced reordering of our priorities to deal with Sheriffs'actions and collateral damage stemming from the Sheriffs' actions of I0/9/02. • Ramage to our assets has also occurred due to our inability to work because of our impaired nervous and spiritual state resulting from the Sheriffs' actions of 10/9/02. • Physical aging of"Pat"Atkison because of the anxieties and increased demands placed on her by the Sheriffs' actions of 10/9/02. • False records-clear all County and State etc, records of False Charges against Florence Torba. • Prosecute all crimes committed against us. • A Restraining Order was issued against Florence Torba for a false story which was supported by the Sheriffs. Further, our legitimate request for protection against Bruce Borjesson was denied,again probably justified by what we feel is the Sheriffs' protection of Bruce Bor esson. We want this unjustified Restraining order cleared. ATTACIB El'+T 7 How amount claimed was computed. * The amount claimed was computed because of the sheer magnitude and nature of the Sheriffs' actions and the permanence ofthe damage. Manifestations of the damage to Florence Torba's health which are not yet present but may appear in the future(such as diseases of unknown incubation periods)are not included as part of this damage claim, Only the anxiety of forcible exposure to disease is included here. * No detailed estimate of the time loss and damages to assets has been made but is included as part of the amount claimed. Method of Computation: If we were given a choice of (1) turning back the clock and returning to the state we were in before the Sheriffs exerted their damaging influence on our lives on 10/9/02 or (2) $5 million,we would by far choose #(I). This tells us our damage claim is a conservative figure, -:._. . .. MINDED - CLAIM ` CQMA CQUAQQQU 1'+l. 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 ofthe.action taken on your claim by the Board of Supervisors.(Paragraph IV below) given Pursuant to Government Code Section 913 and s . 915.4.Please note all"Warnings". AMOUNT: $1,530-010 � JI) VA 15 700,. CLAIMANT: EDWARD L. +`IMER C£ Ut TY S Ns IAt 4Tjt4EZ CA,Up. ATTORNEY: UNKNOWN DATE RECEIVED: APRIL 15, 2003 ADDRESS: M.D.F. C-MODULE., ROOM #11 BY DELIVERY TO CLERK ON: APRIL 15, 2003 901 COURT,STREET MARTINEZ, CA ,94553 BY MAM POSTMARKED: INTEROFFICE MAIL FROM MR SILVANO B. MARCHESI, COUNTY' FROM; .Clerk of the Board'of Supervisors TC?: County C;ou�rtsel COUNSEL Attached is a copy ofthe above-noted claim. JOHN SWEETE r Dated: APRIL 15 a 2003 By: Deputy II. FROM: County Counsel' TO Clark of't he Board of Supervisors ( -lim 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 mot act for 1.5 clays(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: fir , 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: Ibis Claim is rejected in full. O other: I certify that this is a true and correct'copy of the Board's Order entered in its minutes for this date. Dated: MAY 06,' 2003 JOHN SWEETEN, CLERK,By Deputy Clerk WARNING(Gov.code section 913Y 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.actioi on this claim.See Government Coda 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 faMiSee R everse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of per,jury 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 Yachted States Postal Service in Martinez,California,postage fully prepaid a certified copy of this Board Carder and Notice to Claimant,addressed to the claimant as shown above. Dated: MAY 07, '2003 JOHN SWEETEN,CLERK.By lay Clerk Office of the County Counsel Contra Costa County 651 Pine Street, 9th Floor Phone: 335-1800 Martinez, CA 94553 Fax:646.1078 CONFIDENTIAL ATTORNEY-CLIENT COMMUNICATION Date: April 15, 2403 RE f. To: Gina Martin, Clerk of the Board APR 15 200,E From: Silvana B. Marc esi Count Couns I ERKa OF$V y e n� eo�t��c �oi:rsi�Rs By: Gregory C. Harvey, Assistant Cou_ ylCounsel Subp Claim of Edward L. Turner Please treat the attached correspondence as an amended claim and handle in the usual mariner. Thanks. 1:tTORT\CASESkFORMStMEMO}MEMSTNO.WPD CONFIDENTIAL ATTORNEY CLIENT COMMUNICATION ...... . ......... __. ..... ........:.........:......... -:..... .,�....�:wf...k.. �$.�,,,,.,�... .».,.. ._..uta. �K-........,.-:.,,.........,......,... ...._... .......rr.,...,..........,.. ... .. 6...W.. t / i ..........,.....:....,,,.. ............:.:.:.:.....:. ......................:... ........,„„.,w....;,..,.. ..._._...:. .......----.----..:..,.:.:+.:.:....w.,....... .... :.,:.:...: r ... ......................... ..................... ....,,...rr.,....:. ........... „..aeG... ... ....r{M.w.A 4 ,}F' ...•. .,••,......,,...r. �^ F a $ •Y r ..•x of t t�>. ............... •}'0f. . i f ............... ..r...... {. ,... x•..,.... ....... ...,.......................__.... ..................... -..................... or- 7 t ZiL• Y`'F } w..ALt.2,... ^...� } r ty 4 k.r. ?... ....:. ....... ................,,......... oe } t ✓ a t �``cry s 7 - t } i _._._ .....,,.,�...................................... x.�. y ; ......... .. ....:.: ... ........................... y/Y ......................... Y £'. RS•..f :. 44 Y ; '%00(JY L]�' { yv'>+N'-� . ............ . ........ ....... F .... _ . M _._:_:. } f . r -mw.±.w...+.............� ...... -.... L C jokw f q �y^��a4. � ..,:; ,k i.:. 'f it ;t �¢.;`; _..r .�^•, .:. . ...:.:..,,� 4° . � . 4 Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAZ ANT 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 105, 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 � APk Y 5 2003 Against the County of Contra Costa or ) 41'f District)D1Strlct) CLERK 4 :k?{P.:gii�!$DfiS ,�' CCONTRAA COSTA 6. (Fill in name) ) k Al The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$1,S" 0and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur?(Include city and county) .`!" i/day +may. ";ha G` >.' f.. .�' f �4% ab y!i f< .a• 3. How did the damn a or injury ocqur?(Giv full detail • use ext a p per�frequi ed) ,• {:;, -1A AOA # d` t da A� oaf.' C?'{ .,,. ' kyNyTf"' •' )". fi �G✓`f,JF[,.:•,t * // O ,.: a;z 4. What particular act or omission on the part of co pty or district officers, s rvants or empt ees clused the injury or da e? t�'1` el � , sr ' `. 5. What are the names of county or distract afficer�, se ants, ar ernplo ees causing the damage ar tnlury7 i."' t:. d. f- <'ti Arr i{ •r ff� u 9 i{,. ;;� ; f>. '''4 x 4. A..!.k✓d ! 3�i yjY 6. What damage or injuries do you clairnr resujt l ( i e fulf�xtent of injuries or damages claimed. Attach two estimates for auto damage.) 7. How was the amount claimed qbove computed? (Include Pe estimated amount of y prospective injury or damage.) 41. I `r a ,eA H 8. Names an*d addresses ofwttnesses, 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 behalf." SEND NOTICES TO: �Attomey Name and Address of Attorney ) 'all iivi (Claimant's Signature) (Address) $�'Y.y p.� }'.'� t>S� .✓fi I4 y YY� >t� Telephone No. )Tr ph� o { NOTICE Section 72 of the Penal Code provides: Every person who,with intent to defraud,presents 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 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 fire of not exceeding ten thousand dollars($10,000),or by both such imprisonment and fine. ......................................... . . .... ... . . . . . .. ..... f ' Q , F Sk a w �Sa AMM k T } ommot k Y p k .. Y NN vs . . AMD CLAIM BOAU OF SgZL4N§QRS OF ONTRA C STA COUNT BOARD ACTION: MAY 063 2003' Claim Against the County,or District Governed by ) the Board of Supervisors,Routing Endorsements, ) NOTICE TO CLAIMANT and Berard 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 N below), given t :_ f' °°' s Pursuant to Government Code Section 913 and j 915.4.Please note all"Warnings" 42 ;.;P r.. N ', ' AMOUNT: $6,045.12 `-�..d UNTY 0 0 NS L CLAIMANT: ATLANTIC'.MUTUAL INS CO. ATTORNEY: UNKNOWN DATE RECEIVED APRIL 14, 2003 ADDRESS: JANE ALVARADOB'Y'DELIVERY'TO CLERK ON: APRIL 14, 2003 P.O. BOX 14046 ORANGE, CA '92863-144b BY MAIL POSTMARKED: APRIL 10 2003 FROM., Clerk of the Beard of Supervisors TO County Counsel' Attached is a copy of the above noted claim.. Dated: CBy:15, 2003 Deputy_ JOIN SWEETS r C y H. FROM: County Counsel : TO: Clerk of the Board of Supervisd s ( 's claim complies substantially with Sections 910 and 910.2. { .} This Claim FAILS to comply substantially with Sections 910 and 910,2, and we are so notifying claimant.The Board cannot act for 15.days(Section 910.8). { } Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). { ) .Other: Dated: By: 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 W. { ) Other: I certify that this is a true and correct*copy of the Board's Order entered in its minutes for this date. Dated: MAY 06, 2003 JOHN SWEETEN,CLERK,By Z V Deputy Clerk WARNING(Gov. code section 9.13) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court_action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this matter..If you want to consult an attorney, you should do so immediately. *Far Additional W See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty ofperjury 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 prepaida certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: MAY 07, 2003 JOHN SWEETEN,CLERK By Deputy Clerk __ Claim to: BOARD OF SUPERVISORS OF CONTRA COS'T'A 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, 198'7, must be presented not later than the I00 h 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 tater 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 office1n 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 4 7-1-AN� r`C tlel u714 4 L. X-45" 0-6 Reserved for Clerk's filing stamp + Ire ( 6 , `i �'l� to 3 ��7 7 .7 ung ALVAW A Ao ea"A, I- `31rs3 } RECEDE Against the County of Contra Costa or ) APR x 42003 District) ct CO q CQ$A VISORS (Fill in name) ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$_r O 5%la-and in support of this claim represents as follows: 1. When did the damage or injury occur?(Give exact date and hour) lI-t9 -0 �k la isP,,) 2. Where did the damage or injury occur?(Include city and county) 'I?LACk fho,w14- ��. �j� � WqLNu7 Cer_5,e — CCA)7*A (-0s7`A VatrA)r/Y 3. How did the damage or injury occur?(Give full details;use extra paper if required) DAM—=k Di= Coxx7-RA a,6,rrfuTy VFAiC 1-F— MlqDFA SGrf.7b CA) l{ `l"(4 RX ,i:A) �)7— 0F A'rl r i' S rf 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? A1C' i oFp- or C 4oly, Ccn5 nl "4rri7/ U4�-Ni c i-E tel#-D E U D A CIO 1+N D - L L C&H L. U—Tu RA) c:)v-k -.) _...qLc 5. What are the names of county or district officers, servants,or employees causing the damage or injury? DP, i O F 0--o"TY-A 0--a5 7-4 G.,o I/rU TY 0 F#i L- 4-,9 c dlS M,Scram L B, S 7"o u 7— 6. What damage or injuries do you claim resulted?(Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) , ,+mC+6 '�C, t is fY7uTu�4 r' Su,� �S t� C:9 ��Lr, G A,14 ;CH 737-416 0 0 ',00 e/5f /z�- f T°�ii ij-mouN3 ;'i.aAt5 Ttfv- x!;(40-Pb`s 41000- 00 1>F—Pae r't,8L_F-, ) 7. How was the amount claimed above computed?(Include the estimated amount of any prospective injury or damage.) 5-91E FJ t Lo S f'R a AE tr /Z C v LnOT79 a-'P PU44';AL C-0, 8. Navies and addresses of witnesses, doctors, and hospitals. 9. List the expenditures you made on account of this accident or injury. AMOUNT 316, -7V 00 Gov. Code Sec. 910.2 provides"The claim must be } signed by the claimant or by some person on his behalf." SEND NOTICES TO: 6 m Name and Address of Attorney ) (Claimant's Signature) ) V" 0 66Y- 1 1�,0416 (Address) 3 - } r y Telephone No. )Telephone No._ '���f- 740 #/. **********s*****«s***sss*#*************s*#*s*R•***s*s**ss***s.***s****s****s*�***«********* NOME Section 72 of the Penal Code provides: Every person who,with intent to ddfraud,presents for alloaanoe 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 claire,bill,account, voucher,or writing,is punishable tither by imptisonment in the county,jani for a period of not more than one year,by a fine of not exceeding one thousand($1,00OX or by Both such imprisonment and fine,or by imprisonment in the state prison,by a fine of not exceeding tern thousand dollars($10,000),or by both such imprisonment and rune. - - . OFFICE OF THE COt3NTY COUNSEL COUNTY COUNSEL COUNTY OF CONTRA COSTA SILWANO BMARCHES! Administration Building SNASON L.ANDERSON 651 Pine Street, 9P Floor ►;' • �` CmEF AssisTANT Martinez, California 94553-1229 GREGORY 925 335-1800 ht ': �d'� VALERIE J. RANCHE (925) 646-1078 (fax) '`*- �: Assismrrs NOTICE OF INSUFFICIENCY AND/pR NON-ACCEPTANCE OF CLAIM TO: Jane Alvarado Sr. Recovery Representative Atlantic Companies 770 The City Drive South, Suite 2000 Orange, CA 92858-6910 RE: CLAIM OF: SHARON CROWF Your File No 41-875354-38 Please Take Notice as Follows: The claim you presented against the Comty oontra Costa or District governed by the Board of Supervisors fails to comply substantial�I w th ie requirements of California Government Code Section 910 and 910.2, or is otherwise insuffic ft forme reasons checked below: X [X] 1. The claim fails to state the Ane a©d post office address of the claimant. [X] 2. The claim fails to state the post office address to which the person presenting the claim desires notice's to be sent. [ ] 3. The claim fails to state the date,place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [ 4. The claim fails to state the name(s)of the public employee(s)causing the injury,damage, or loss, if known. [ ] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars($10,000). If the claim totals less than ten thousand dollars($10,000),the 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. Page i Jane Alvarado Re: Claims of Sharon Crowe Page Two [X] 7. You are required to submit your claim on the proper form,which is enclosed. Please resubmit your claim on the enclosed form. Gov. Code, § 910.4. Please be aware that you have only a limited period of time in which to file an amended claim. See Gov. Code, § 910.6. [ ] 8. Other: SILVANO B. MARCHESI COUNTY COUNSEL MONIKA L. COOPER Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P.§§ 1012, 1013a,2015.5;Evidence Code§§641,664) I declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553;I 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. Dated: d. 03at Martinez,California. athieen O'Connell cc: Clerk of the Board of Supervisors(original) Risk Management (NOTICE OF INSUFMCIENCY OF CLAIM:GOVT.CODE§§914,910.2,920.4,910.8) Page 2 Financial Detail Page l of 1 0L +��-- Activity for Claim Number 41876354 Claimant Suffix 001 Recording Suffix 01 Payment Totals .91.. $101.00 Losses - $4,880.12 f ecove $0.0gj Expenses -(06,31, 32,33,34, 35,41,42,44,45) iss Date Paid Payee Check No Service Payment Type Fina#Type Add By Oates 03/11/03 $11.00 CHOICE POINT x$1 108450042403 Eoel-i-OTHER EXPENSES-(35) Y C U3KPW1P 12103/02 $80.00 Golden State Appraisal g5g56849a 910042433 Fri APPRAISAL FEE EXPENSE- Y C F53 RD1 P Company (32) Losses -(02,03,04, 07, 16,17) iss Date Paid Payee Check No Service Dates Payment Type FtnaiType Add By 02!20103 $22.99 Shop Wayne Stead Cadillac Body 9427 -M 450041281 FNAPayments-(02) Y C F53 FPjP 12117102 $460.39 Shap a Stead Cadillac Body 94 5L3_3.2_4..450037421 F98APayments-(02) Y C F53fiRDIFP 11/25102$4,396.74 SHARON L CROWE 1455Z4-49-2-450036261 F.,g-OAPayments-(02) Y C EQAR81 P Reserves Add Date Resv Chg Chg By Status Reserve Type =�= . Forwgrd I 1V�a n Men del��FA s Claims Hume Aft t c H m http://claims.atlanticos.com/Aclaim/Reports/index/Claim Financials Detail.efin?Requesttir 04/10/2043 .......................................................................... ............ ........................................ ........................... Financial Detail Page I of I RtVv---'-'-'Rental Reimburse t r = um r Activity I umber 41876354 Claimant Suffix 001 Recording Suffix 02 F—Paymen Liises - Recovery $x.00 Losses -(02,03,04,07, 16, 17) Is$Date Paid Payee Check No Service Dates Payment Type Final Type Add By 12123102 $165.00 Enterprise Rent-A-Car 363041733_ 450037729 F98A Payments-(02) Y C F53KPW1 P 12, Reserves Add Date Resv Chg Chg Ry Status Reserve Type _"aticc RHO �j Forward —Main Me U _S1 Home FAtwitc-ijo U71 Help &FAQ 7 http://claims.atlanticos.com/Aciaim/Reports/index/Claim—Financials—Detail.cfm?Requesttir 04/10/2003 y Date: 1 1120102 10:07 PM PF Estimate ID: 02-33612 Estimate Version: 0 Committed Profile ID: CUSTOMIZED GOLDEN STATE APPRAISAL COMPANY 21740 DEVONSHIRE BLVD SUITE 100 CHATSWORTH,CA 91311 (818)718-9871 Fax: (818)718-9874 Damage Assessed By: KASHKA CLAY Appraised For: GIDGET R.DALTON THIS IS NOT AN AUTHORIZATION TO REPAIR. ALL COSTS OF REPAIRS .ARE THE SOLE RESPONSIBILITY OF THE VEHICLE OWNER, WHO ULTIMATELY MUST AUTHORIZE ALL REPAIRS. NO SUPPLEMENTS WILL BE HONORED WITHOUT THE PRIOR INSPECTION BY PROPERTY DAMAGE APPRAISERS. Condition Code: Good Type of toss: Collision � Date of Loss: 11118102 Deductible: 1,000.00 Fife Number: 02-33612 Claim Number: 41876354 Insured: SHARON!CROWE Address: 37 TENNIS CLUB DRIVE DANVILLE,CA 94506 Telephone: Home Phone: (925)837-3081 Mitchell Service: 913492 Description: 1996 Cadillac DeVille Concours Body Style: 4D Sed Drive Train: 4.61-Inj 8 Cyi AO VIN: 1 G6KF5292TU207943 License: 3PAW670 CA Mileage: 62,562 OEMIALT: O Search Code: None Line Entry Labor Line Item Part Type/ Dolfar Labor Item Number Type Operation Description Part Number Amount Units 1 TO BDY OVERHAUL FRT COVER ASSY 2.2 2 300001 BDY REMOVE/REPLACE FRT BUMPER COVER 3549390 GM PART 420.51 INC 3 AUTO REF REFINISH FRT BUMPER COVER C 2.1 4 300006 BDY REMOVEIREPLACE R FRT OTR BUMPER COVER MLDG 3549388 GM PART 105.46 INC 5 300710 BDY REMOVE/REPLACE FRT BUMPER LICENSE BRACKET 3527318 GM PART 8.24 INC 6 300720 BDY REMOVE/REPLACE R FRT BUMPER GUIDE 3534030 GM PART 3.97 INC 7 300780 BDY REMOVEIREPLACE FRT BUMPER REINFORCEMENT 3546958 GM PART 353.80 INC # 8 300790 BDY REMOVEIREPLACE R FRT BUMPER IMPACT ABSORBER 22177042 GM PART 148.26 0.3 # 9 300008 BDY REMOVE/REPLACE GRILLE 3548187 GM PART 221.29 INC # 10 301140 BDY CHECK/ADJUST HEADLAMPS 0.4 11 301160 BDY REMOVEIINSTALL L HEADLAMP ASSY 0.3 12 301190 BDY REMOVEIREPLACE R COMBINATION LAMP ASSEMBLY 1652:2822 GM PART 232.80 INC 13 301470 BDY REMOVEIINSTALL L SIDE MARKER LAMP INC # 14 301480 BDY REMOVE/REPLACE R CORNERING/MKR LAMP LENS&HOUSING 5978660 GM PART 106.20 INC # 15 300013 BDY REMOVE/REPLACE HOOD PANEL 25648107 GM PART 747.97 1.4 # 16 AUTO REF REFINISH HOOD OUTSIDE C 3.0 17 AUTO REF REFINISH HOOD UNDERSIDE C 1-5 ESTIMATE RECALL NUMBER: 11120/02 22:07:24 02-33612 UltraMate is a Trademark of Mitchell International Mitchell Data Version: OCT_02_A Copyright{C)1994-2002 MRohell international Page 1 of 4 UltraMate Version: 4.8.011 All Rights Reserved Date: 11/20/0210:07 PM Estimate ID: 02-33+512 Estime"Wersion: 0 Committed Profile 10: CUSTOMIZED 18 301770 BOY REMOVEIREPLACE HOOD INSULATOR RETAINER 20064875 GM PART 16.20* 19 $1.32 X 12 20 301860 BOY REMOVE/REPLACE HOOD SECONDARY CATCH 25861089 GM PART 12.63* INC 21 302120 BOY REMOVE/REPLACE UPR COOLING RADIATOR MOUNTING PANEL 25704407 GM PART 36.20 0.3 # 22 302170 BOY REMOVE/REPLACE COOLING SIGHT SHIELD 3543913 GM PART 15.95" 0.3* 23 303890 BOY REMOVE/REPLACE R FENDER PANEL 3637202 GM PART 391.53 2.4 # 24 ALTO REF REFINISH R FENDER OUTSIDE C 1.6 25 AUTO REF REFINISH R FENDER EDGE C 0.5 26 303,300 BOY REPAIR L FENDER PANEL Existing 0.5*# 27 AUTO REF REFINISH L FENDER OUTSIDE C 1.6 28 300851 BOY REMOVEANSTALL R FENDER SIDE MLDG INC 29 300852 BOY REMOVEANSTALL L FENDER SIDE MLDG 0.3 30 300321 BOY REPAIR FRONT BODY RADIATOR SUPPORT -S Eng 2.0*# 31 AUTO REF REFINISH RADIATOR SUPPORT 1.5 32 312870 REF BLEND R FRT DOOR OUTSIDE C 0.9 33 313190 SOY REMOVEANSTALL R FRT REVEAL MOULDING 0.6 # 34 313210 BOY REMOVE/INSTALL R FRT DOOR FRONT BELT MLDG 1.1 # 35 313230 SOY REMOVE/INSTALL R FRT DOOR REAR BELT MLDG 0.3 36 313250 SOY REMOVE/INSTALL R FRT DOOR MOULDING 0.3 37 313270 BOY REMOVE/INSTALL R FRT REAR VIEW MIRROR INC # 38 300528 BOY REMOVEANSTALL R FRT DOOR TRIM PANEL INC 39 313950 BOY REMOVEIINSTALL R FRT DOOR HANDLE 0.3 # 40 936012 ADD'L COST HAZARDOUS WASTE DISPOSAL 3.00 41 936014 ADD'L COST FLEX ADDITIVE 10.00" 42 933002 REF ADD'L OPR CLEAR COAT 0.5* 43 933003 REF AtOD'L OPR TINT COLOR 0.5* 44 933017 REF ADD'L OPR FINISH SAND AND BUFF 0.5* 45' 933018 REF AOD'L OPR MASK FOR OVERSPRAY 5.00* 0.2* 46 933020 REF ADD'L OPR PAINTED STRIPE 175.00* 0.7* 47 AUTO AOD`L COST PAINT/MATERIALS 350.00" *-Judgement item #-Labor Note Applies C - Included in Clear Goat Calc Remarks ATLANTIC MUTUAL COMPANIES 1325 ELECTRIC RD P.O.BOX 4625 ROANOKE,VA24015 877-210-3149X4091 540-7694802 FAX Add'I Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 13.0 63.00 0.00 0.00 819.00 Taxable Parts 2;821.01 Refinish 15.1 63.00 180.00 0.00 1,131.30 Sales Tax 8.250% 232.73 Non-Taxable Labor 1,950.30 Total Replacement Parts Amount 3,0533.74 Labor Summary 28.1 1,950.30 ESTIMATE RECALL NUMBER: 11120102 22:07:24 02-33612 UttraMate is a Trademark of Mitchel International Mitchell Data Version. OCT 02 A Copyright{C}1994-2002 Mite wH frolematfonai Page 2 of 4 UftraMate Version: 4.8.011 Al Rlgtft Reserved Date: 11/20/02 10:07 PM Estimate ID: 02-33612 Estimate Version: _ Committed Profile 10: CUSTOMIZED Ill, Additional Costs Amount IV. Adjustments Amount ................... .. Taxable Costs 360.00 insurance Deductible 1,000.00- Sales Tax 8.250% 29.70 Customer Responsibility 1,000.00- Non-Taxable Costs 3.00 Total Additional Costs 392.70 1. Total Labor: 1,950.30 It, Total Replacement Parts: 3,053.74 Ill. Total Additional Costs: 392.70 Gross Total: 5,396.74 IV. Total Adjustments: 1,000.00- Net Total: 4,396.74 Inspection Site: BODY SHOP Inspection Date: 11/20102 Body Shop: WAYNE STEAD CADILLAC BODY SHOP Address: 2390 N.MAIN STREET WALNUT CREEK,CA 94596 Telephone: (925)934-9300 Fax Phone: (925)934-0336 IT IS UNDERSTOOD THAT THE ABOVE SHOP, IF ONE IS LISTED, AGREES TO COMPLETE AND GUARANTEE ALL REPAIRS LISTED ABOVE FOR THE AMOUNT LISTED UNLESS A DIFFERENT AMOUNT IS LISTED HERE $ BY: DATE: ************************ADDITIONAL INFORMATION*********************** VEHICLE IS: REPAIRABLE { ) A BORDERLINE TOTAL ( ) A TOTAL LOSS { 1 REPAIRS ON THIS VEHICLE SHOULD TAKE DAYS TO COMPLETE Deductibles ARE NOT addressed or included in this estimate/appraisal.! ! The repairer should check to see if the deductible is applicable to the loss and, if so, collect it from the vehicle owner prior to the release of the repaired vehicle. This repair estimate/appraisal MAY have been prepared based on the use of one or more aftermarket crash and/or other parts supplied by a source other than the manufacturer of your vehicle. Parts used in the repair of your vehicle other than parts from the original ESTIMATE RECALL NUMBER: 11/2010222:07:24 02-33612 UttraMate Is a Trademark of Mitchell International Mitchell Data Version: OCT_02_A Copyright(C)1994-2002 Mitchell Intemational Page 3 of 4 UltraMate Version: 4.8.011 All Rights Reserved Date: 11110/0210:07 PM ..... ..... .1 Estimate#D: 02-33612 Estimate Version: 0 Committed Profile ID: CUSTOMIZED manufacturer are required to be at least equal of like, kind, and quality in terms of fit, quality, and performance to the replacement parts available from the original. manufacturer. Warranties applicable to these aftermarket crash and/or other parts are provided by the parts manufacturer or distributor rather than your own motor vehicle manufacturer. For your protection California law requires the following to appear on this form. Any person who knowingly presents a false of fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement' in :state prison. 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. Dua#-stage air bag modules may be present that could contain an undeployed stage. When disposing of a deployed dual-stege air bag,always treat it as a"Iive"module. See appropriate MITCHELLO AIR BAG SERVICE&REPAIR MANUAL,or OEM Information. ESTIMATE RECALL NUMBER: 11/20/02 22:07:24 02-33612 UttraMate is a Trademark of Mitchell International Mitchell Data Version: OCT 02 A Copyright(0)1994-2002 Mitchell international Page 4 of 4 UitraMate Version: 4.8.011 Ail Rights Reserved 12/16/2002 17:35 FAX 818 718 9874 GULDEN STATE APPRAISAL �rtuvt Golden State Appraisal Compan;* 21740 Devonshire Street,Suite . Chatsworth,CA 91311 818/718&9871 -FAX 8181718-9874 FACSIMILE TRANS1MISSSIM COVER SHEET J ►ATE: y ATTENTION: 10 COMPANY: REFERENCE NUMBER(S): Claim No. GSA Reference No. / . . . stimate copy for the referenced claim: supplement copy for the referenced claim: • Status keport for the referenced claim: HARD COPY TO FOLLOW BY MAIL. Number of pggest67f6 :�-_.'.. M ESSAG1E: `� r� Thank yaU. PkAse csutxtt this oirce is the event you do not reccire the number ofp mes indicated. _...... ......... .. ......... ......... ......... ......... __...._.. ... ... ........ ....._....... _........ ...-_..._. ........... ........_...._.._..... . ......... ......... ................_. 1G/10/ZVVZ 11 :.15 YAA Old 118 V574 GOLDEN STATE APPRAISAL 16002 Date: 12/6/02 04:19 PM Estimate ID: 0243612 Estknats Vernon:. 1 Supplement: 1 (F) 1216102 04:19.13 PM Profile 10: CUSTOMIZED GOLDEN STATE APPPAISAL COMPANY 21740 DEVONSHIRE STREET SLATS 100 CHATSWORTH,CA 91311 (818)716-9871 Pax: (818)71$4874 Demap Assessed By. KASHKA CLAY Appraised Por: GiDGET R.DALTON Supplemented By: KASHKA CLAY THIS IS NOT AN AUTHORIZATION TO REPAIR. ALL COSTS OF REPAIRS ARE THE SOLE RESPONSIBILITY OF THE VEHICLE OWNER., WHO ULTIMATELY MUST .AUTHORIZE ALL REPAIRS. NO SUPPLEMENTS WILL BE HONORED WITHOUT THE PRIOR INSPECTION BY PROPERTY DAMAGE APPRAISERS. w**w++##**#+****+****###****#*ww#*wrw**ww*w++w+**#****w**w##**ww#*www Condition Coda: Gond Type of Lou: CoMkbn Data of Loan: 11116102 Deductible: 1,000.00 File Number 02-33612 Claim Number: 41876364 fromed: SHARON CROWE Address: 37 TENNIS CLUB DRIVE DANVILLE,CA 94506 Telephone: Home Phone: (925)837.3081 Mitchell Service: 913492 Deaoription. 1096 Cadillac DeViife Concours Body Style: 40 Sed Drive Trait: 4.61.Inj 8 Go AD VIN: 1GSKF6292TU207943 License: 3PAW670 CA Mileage: 62,562 OEM/ALT: O Search Code: None Line Entry tabor Lina Item Part 7YPa Dollar Labor Item Number Type Operation Description Patt Number Amount Units I AUTO 90Y OVERHAUL FRT COVER ASSY 22 2 300001 BDY REM10VEREPLACE FRT BUMPER COVER 3549390 GM PART 470.51 INC 3 AUTO REF REFINISH FRT BUMPER COVER 0 2.1 4 300006 BOY REMOVEfREPLACE R PRT OTR BUMPER COVER MLDG 3649388 OM PART 105,46 INC 5 300710 BOY REMOVFfREPLACE FRT BUMPER LICENSE BRACKET 3527318 GM PART 6.24 INC 6 300720 9DY REMOVEfREPLACE R FRT BUMPER GUIDE 3534030 GM PART 3.97 INC 7 300780 ODY REMOVEfREPLACE FRT BUMPER REINFORCEMENT 3546958 GM PART 353.00 INC # 8 300790 BOY REMOVEJIitEPLACE R FRT BUMPER IMPACT ABSORBER 22177042 GM PART 148.26' 0.3 9 9 300008 BDY REMOVEIREPIACE GRILLE 3648187 GM PART 221.29 INC 10 301140 BOY CHECKIADJUST HEADLAMPS 0.4 11 301160 BOY REMOVEANSTALL L HEADLAMP ASSY 0.3 12 301190 BDY REMOVE/REPLACE R COMBINATION LAMP ASSEMBLY 16522822 GM PART 232.80 INC 13 301470 BDY REMOVFANSTALL L SIDE MARKER LAMP we # 14 301480 SOY t'2EMOVEIREPLACE R CORNERWGIMKR LAMB LENS&HOUSING 597SWO GM PART 108.20 INC 0 i 5 300013 BOY REMiOVFJREPLACE HOOD PANEL 25648107 GM PART 7L7.97 1.4 S 16 AUTO REF REFINISH HOOD OUTSIDE C 3.0 ES11MATE RECALL NUMBER: 11/2010222.,07-.24 02.33612 U*WaM Is a Trademark of Mitchel kawrAtional Mitr"l Date Version: OCT 02 A CopwW(0)1994-2002 Mitchell krtematlonal Page 1 of 4 Uwalulate Version: 4.d.flt 1 Al Rigfrts Reserved vvLwcn mercer ArrnAtaAL wiUUJ + Data. 121 6102 04:19 PM Estimait ro 02-33612 Esdmaf Vection: 1 Supplement: 1 (F) 1216102 04:19:13 PM Prolk 10: CUSTOMIZED 17 AUTO REF REFINISH HOOD UNDERSIDE C 1.5 18 301770 8DY REMOVEJREPLACE HOOD INSULATOR RETAINER 20064875 GM PART 16.20' 19 $1.32 X 12 20 301860 BOY REMOVEIREPLACE HOOD SECONDARY CATCH 25681089 GM PART 12.63' INC S1 21 302110 8DY REMOVEANSTALL COOLING RADIATOR Emoting 1.4'# 22 302120 BDY REMOVEIREPLACE UPR COOUNG RADIATOR MOUNTING PANEL 25704407 GM PART 36.20 0.3 # 23 302170 8DY REMOVEIREPLACE COOUNG SIGHT SHIELD 3543913 GM PART 15.95` 0.3` S1 24 303310 MCH REMOVEJREPLACE EVACUATE b RECHARGE A1C •M 1.4 $1 25 300300 MCH REMOVEIINSTALL AIR CONO CONDENSER -M Existlng 1.7•# 26 303890 BDY REMOVFJREPLACE a FENDER PANEL 3637202 GM PART 391.53 2.4 # 27 AUTO REP REFINISH R FENDER OUTSIDE C 1.5 26 AUTO REF REFINISH R FINDER EDGE C 0.5 29 303900 BDY REPAIR L FENDER PANEL Existing 0.5's 30 AUTO REF REFINISH L FENDER OUTSIDE C 1.6 S 1 31 303980 13DY REMOVEIREPLACE L FENDER LINER EXT 25643306 GM PART 9.15 02 32 300851 8DY REMOVElINSTAU_ R FENDER SIDE MLOG INC 33 300852 BDY REMOVE/INSTALL L FENDER SIDE MLDG 0.3 34 300321 BDY REPAIR FRONT BODY RADIATOR SUPPORT -S Existing 2.0'# 35 AUTO REF REFINISH RADIATOR SUPPORT 1.5 Si 36 306350 MCH ALIGN FRONT SUSPENSION -M 1.51 S1 37 310430 8DY REMOVEIREPLACE HIGH NOTE HORN ASSY 12368063 GM PART 37.85 0.3 38 312870 REF BLEND R FRT DOOR OUTSIDE C 0.9 39 313180 BDY REMOVEANSTALL R FRT REVEAL MOULDING 0.8 0 40 313210 BDY REMOVFANSTALL R FRT DOOR FRONT BEET MLOG 1.1 # 41 313230 BDY REMOVEANSTALL R FRT DOOR REAR 13ELT MLOG 0.3 42 313250 BDY REMOVEANSTALL R FRT DOOR MOULDING 0.3 43 313270 BDY REMOVEIINSTALL R FRT REAR VIEW MIRROR INC # 44 300528 8DY REMOV94NSTALL R FRT DOOR TRIM PANEL INC 45 313950 BOY REMOVEANSTALL R FRT DOOR HANDLE 0.3 # 46 936012 ADO"L COST HAZARDOUS WASTE DISPOSAL 3.00' 47 9311014 ADD'L COST FLEX ADDITIVE 10.00 48 933002 REF ADD1 OPR CLEAR COAT 0.5' 49 933003 REF ADVL OPR TINT COLOR 0.51 50 933017 REF ADE7 L OPR FINISH SAND AND BUFF 0.51 51 933018 REF ADD'L OPR MASK FOR OVERSPRAY 5.00' 0.2' 52 933020 REF ADVL OPR PAINTED STRIPE 175.00` 0.7` 53 AUTO ADUL COST PAINTIMATERIALS 350.00' Judgement Item #-Labor Note APPOSS C -Included in Clear Coat Calc Remarks ATLANTIC MUTUAL COMPANIES 13:.5 ELECTRIC RD P.U.BOX 4625 ROANOKE,VA24015 87;`210.31+49X4091 540-7694802 FAX ESTIMATE RECALL NUMBER: 11120102 22:07:24 02-33812 UltraMate is s Trademark of Mitchell International Mit.-hall Data Version: OCT .Q2_A Copyright(C)1994-2002 Mitchell krtemational Page 2 of 4 Uiu*Mete version: 4.8.011 A8 Righb Reserved vv1trntq O'Att AYYKAISAL AOft 19004 r t7atG: 17J W02 04:19 PM Letimata td: 02-33612 Estimatie Version. i Suppternen� '(F) 1218102 04:19:13 PM Pro*10: CUSTOMLIEt) Addy !, Labor Sublet t.aDcr Serb#off Units Ftaf� �..., _,R,_,,,,, Totals f! Amount Amount Body 14.9 63' . Part Rape oema w Summa 15.1 63.00 0.00 835.70 �' Amount Mec4 hanwafi 190.00 0.00 1,131.30 Taxable Pates .6 83.00 0.00 0.00 299.80 Sales Tax �' Non-Taxable Labor z,3ss.80 T 8 2S0% 23+6.61 °b't t�e�ace'mern Pars Anwunt Labor Summary 34.6 3.104.63 2.358.90 lff. Additional Costs Tax3bis Casts Amount 111. Adjtretrner ts Safes Tax 9250% 320 M3wsnce Deductible Amourrr 299,,770 Norr-Taxable 09M 3.00 Cusbavner Respateibttryy i,000.00- Total Additional Costa 392.70 1• Total Labor, It. Tout Repiso meat Pans! 2.359.90 til. Total AddWonal 09,ts. 3.104.63 Gross Total: 392.70 5.857.13 JV Total A e , Not Total: 1,000.00- Less 0691nal Not Total: #,x.13 Net Suppternent Amourn: 674 .39 S1: KASHKA CLAY t ,` 468.39 Inspection Sita: g=y SHOP IrApeo M Dere: i 1120102 Body St1op. WAYNE STFJW CACgLLAC conn SHOP Address: 2390 N.MAW sTjgM WALNUTCREEK, TeCA bM588 Tela: tom) ' f 00 Fax Phone: X23)OU-0338 ES'114AATE RECALL NUMBER: i it20102 22.07:24 02-3361., Mlhahell Voka Veisfon: tiitrsdl�Lats Is a Trademark of Mitchell Interna of Uttr Mata Version: 48.01 A 0°pYrtOht(C)ti$t-2002 Mkohen k tj Mafional AN Ri9ft Reserved Pag! 3 of 4 ..... 12/16/2002 17:36 FAX 818 718 9874 GOLDEN STATE APPRAISAL WJ UU5 Date: 121610204;19PM Ex/mats ID: 02.33512 Extimate Version: 1 Supplement: 1(F) 1216102 04:19:13 PM Profile ID: CUSTOMIZED IT IS UNDERSTOOD THAT THE ABOVE SHOP, IF ONE IS LISTED, AGREES TO COMPLETE AND GUARANTEE ALL REPAIRS LISTED ABOVE FOR THE AMOUNT LISTED UNLESS A DIFFERENT AMOUNT IS LISTED HERE $ BY: DATE: **w*wwww*+tw****t*tt*ww**w,r*wwwwwrr*w,e**w*k*t*w**w+*w,�rw+,�t+w**www*rw ***************k*ww*****ADDITIONA.L INFORMATION*** }*w*w*****+wwww*ww* VEHICLE IS: REPAIRABLE ( ) A BORDERLINE TOTAL ( ) A TOTAL LOSS E } REPAIRS ON THIS VEHICLE SHOULD TAKE DAYS TO COMPLETE Deductibles ARE NOT addressed or included in this estimate/appraisal! ! The repairer should check to see if the deductible is applicable to the loss and, if So, collect it from the vehicle owner prior to the release of the repaired vehicle. This repair estimate/appraisal MAY have been prepared based on the use of one or more aftermarket crash and/or other parts supplied by a source other than the manufacturer of your vehicle. Parts used in the repair of your vehicle rather than parts from the original manufacturer are required to be at least equal of like, kind, and quality in terms of fit, quality, and performance to the replacement parts available from the original manufacturer. Warranties applicable to these aftermarket crash and/or other parts are provided by the parts manufacturer or distributor rather than your own motor vehicle manufacturer. For your protection California law requires the following to appear on this form. Any person who knowingly presents a false of fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison, WARNING: Accidental air bag deployment is posstble. Personal k+}tny may result. Avoid area near steering wheel ani instrument penal oven if air begs hove deployed. Dual4ts9a air bag M044"may be present that could contain an undeployed stage. When dispo"V of a deployed duel-stege air bag,always treat it as a live"module. See appropriate MITCHELL&AIR BAG SERVICE 6 REPAIR MANUAL,or OEM information. ESUMATE RECALL NUMBER: 11120/0222;0724 02-33612 ftaMate is a Trademark of Mtehel Nft4T;#Wnal Mitchel Hata Version: OCT_02_A Copyright(C)1994-2002 Mitchell Intemationai Umduate Venrian: 4.8.011 ASRiglds Reserved Page 4 0l d rnA o.ro t 10 ao r 4 UULULN bLA E AYYHAISAL 10 006 Dee 09 02 10: 178 BODY SHOP 14123446748 12/06/2002 PICKING TICKET PT3„2 10:03:07 PAGE 1 INVOICE* `BUST# BILL TO SHIP TO SOLD BY R044472 22711 GEORGE KOZAK GAIL GE 1137 PTARMIGAN DR CURT POS' #1 WALNUT CREEK t SCA 94595 QORD FART# 1 DESCRIPTION SIN QOH AVAIL i..IST 3. P016,52 P RECON RR SUM V 0 an.00✓� 1 59751.516 REFLEX AS 2.689 106 1? 1 12.50 i. 220e i P07 ASSORSER 7.840 115 2 5 141.47✓ 1 22081908 AB.03ORPER 7.840 115 3 1 102.47" 1 25536713 REINFORCE 7.831 TEST 0 0 21.46 1 29836712 REINFORCE 7.831 TEST 0 0 21.46 1 2 T005407694802 P:1/4 FES-20=2003 O8:22A FROM: r ...... Y Wapw St aC J3a4 Shop . 2390 N. Main Street Walnut Creek. Ca. 94596' '• (925) 934-9300 phone (925) 934.03.`36 tax. Fax Cover Sheet To: ("I ' From: _._ _........ Fax #: � a Z Date:_ pages _ Lro Yv e, PO ;� Htwj Ea): OY-\ V-�OC)6 cz v�r e�vi d Please call the Body shop if you have any questions. FEB-20-2003 08:22A FROM: TO 1'5487694802 P:2-14 02/20/2003 at. 08: 13 AM _ Job Number: 32617 IMTM STEAD AUTO WDY License #:AG080143 Federal ID #:942673324 2390 NORTH MAIN STRCXT WALNUT CARER, CA 94596 (325) 934-9300 Fax: (925)934-0336 tt''RF"Fi7:bLt1371R? >rST22�►TS Written by: Kimb*rleat Oa hl # Adjuster: Gidget Dalton # Insured: SHARON CROWS Claim #41076354 Otsm+er: SHARON CROWE Policy # Address: 37 TENNiv CLUB DRIVE Doftcttble: DANVILLE, CA 94506 Date of Loss: Day: (925)U37-3081 Type of Loss: Collision Point of Impact: 12. Front Inspect WAYNE STEAD AUTO BODY Other: (925)934-9340 Location: 2390 NORTH MAIN S'PitcL,t' WALNUT CREEK, CA 94596 Insurance ATLANTIC MUTUAL INSURANCE Husinass: (877)210-3149x4091 Company: Days to Repair 1996 CA01 DKVTt.f<E CONCOURS 8-4.6L-FI 4b SET► tan Int: VrN: 3G6Kr5292TU207943 Lic: 3paw670 prod Date: Odometer: Air Coraciit.ioning Hear I)cfoggcr Ti It Whool Cruile Control intermittent Wipers Auto Level Climate Control Elec. Instrumentation Keyless Entry Tinted Class toady Side Moldings Dual Mirrors Traction Control Clctar Coat. Paint Mctal lic Paint Power Steering Power SraXes .Power Windows Power Locks :Tower t)r"ivvr 1.9cost. Ptawfir PeAtKontlor St!Ht, Power Antenna Power Mirror.N Power Trrank/Tailgate Anti-Look Brake (4) Or•i vcr Air bag Passenger Air bag 4 Whool Disc Brake. Leather Seats Split Bench slats Recline/T,ounge Seats Automatic Transmission Aluminum/Alloy wheels #IT OR PATNT O. -------------CSF.".._ __.. -_ -__R _._- s- -�CFr ------------- 1# This is a 5upplemen for 1 �. ►. Information Labials 2# for New Hood installed in Nov 1 2002 3# Any quti:•:tionw, please call 7 Kimberlee 4# a shop (923) 934-9300 ext 39 1 INFORMATION LABELS 6* Repl Label air bag 6 cooling } 10.62 Incl. w/Concours 7* Rep Emission Label P'cdcral 4.6 1 10.62 T.nC.I. liter "t 2 .... TO:15407694802 P:3'4 FES-20+-2903 08:22A FROM: l - .....^.-�.:. � ;..-..X .• ._,.r•:rr+wr.w,.�'�''-�--"•.'....ate PICKING TICKET PT12 INVOICE# cu.-:,T# BILL TO SHIP T::1 8048:-:16 71)175','--;4 SHARON L s_:ROWE GAIL GE 17 TENNIS OLUs DR. C ST PO# DANVILLE_CA 94506 ..,T#N __. •.... . . +DORD PART# ! DESCRIPTION BIN QOH, AVAIL LIST t 1 12554357 LABEL S.elo s TEST q 1 10- 62 1 25640S39 LABEL A-t.)E TEST 0 1 10. 62 j FEB-20-2003 08:22A FROM: TO:15407694802 P:4/4 02/20/2003 al. 08 : 1:3 AM Job Number: :32617 PR.EI+IMINARY ES',JI•IMlkn 1996 CA01 DEV G[•LE CONCOURS 8-4 . 6L-FT 41) F;h;i) tan Tnt: NO. Op. DESCRIP'T'ION QTY EXT. PRICE LABOR PAINT Pit Tnvoi ce to follow I.h i o: rax. 1 9# labels installed 2-)4-Oa! ! 1 Subtotals =_:> 21 . 24 0.0 0.0 Pdr3.;; 21 .24 ---------------------------------------------------- SUBTOTAL a 21.24 Sales 'Tax $ 21 .24 @ €3.25000 1 .75 GRAND "TOTAL a 22.99 ADJUSTMENTS: Derjuctible 0. 00 CU$TOMER PAY INSURANCE PAY WAYNF 8TRAD WARRANT.; TT'S nODY WORK AND PAINT FOR 22 MONTHS FROM DATE REPAIRS ARE COMPLETED. TT TS UNDERSTOOD THAT WE ASSUME NO BKSPONS i H i LTY FOR I.O:i ; OR DAMAGE HY THEFT OR FTRE TO VEHICLE OR PARTS PLACED WITH US FOR STORAGE, SALK OR REPAIR OR WHTT'R ROAN 'TESTING VF.HTCT.F. WE PROPOSE TO MAKE THF. AROVP, REPAIRS UNDER THE TERMS AND CONDITIONS HEREINAFTER SPEC.l FI X.D. PRICES QUOTED ARE FOR LABOR ONLY, PARTS AND MATERIALS ARE ESTIMATED ONLY. PARTS TO BE BILLED AT LINT PRTCF, All TTMF: OF PURCHASE: WHEN REPATRS ARE MADE. COPTF.$ Ot' P'I.CKING TICKETS (INVOICES) FURNISHED UPON REQUEST. Y:A•k.k.kkka.A••k'k k'k'k A'•A'•A''k'k'k k x'kA'W•k''A'kA ** *******************#**##***##*###**•Y*##********* ___ _ DO HEREBY DULY APPOINT WAYNE STEAD (;AD1I,I..AC TO ACT AS ATTORNEY INT FACT, TO STCN PAPERS AND DOCUMENT$ PF,RTATNINC 'DC7 THE PRESENT REPATR ONT.Y. S I GNKV DATE MEFF# : 1146 aim# : 41.876354 Name: CRO E, SHARON Slide 10: L R 3l idb 9: -'.,T RR ' :A t�rYt�iV�� Slide 11 : R RR CORNER Slide 12: RT FRNT INNER CORNER RT FRNT CORNER `S t �v , MEFF#: 2146 aim4 : 41876354 Name: CROWE, SH1RUN 311d�! 5': -R FENDER & HOOD Slide 6: RT F CORNER r '. x � n5. b k to V F 9L k 4� Slide 7 RT FRNT CORNER WJ MEASURMENTS Slide 8 LT FRNT CORNER .7 lilt u Y nageMa t e de 41 876354 e Appraise, � K SNaIne` i C e SHARONTED �a r t t 2t1. 1.0inr 0 N' G s� s k T r M Slide 3.. R pRMT :. Slide 4 'FENDER i �1;{n v AXIVIN - Automated Mental Management System (Patent Pending) Page 1 of 1 Rental Company: ENTERPRISE RENT-A-CAR @* Claims invoice: D128994-2384 Bill To: Billing Detail: ATLANTIC MUTUAL INS ATTN:GIDGET DALTON Rental Period: 11125/02 to 12/6102(12 days) P O BOX 4625 Billed Period: 11/26102 to 1216102(11 days) ROANOKE , VA240150657 ..�_._..... Description Rate Amount RENTER INFORMATION: 11 DAYS @ $22.99 $252.89 Renter: CROWE,SHARON 1 SALES TAX% $8.25 $20.86 Address: 37 TENNIS CLUB DR DANVILLE, CA 94506 TOTAL CHARGES: $273.75 Home Phone: (925)837-3081 less Amount Received: $108.75 '33 30 Office Phone: AMOUNT DUE.......... $165.00 RENTAL INFORMATION: ? ANGE Rental Branch Location: � ' . , ENTERPRISE RENT-A-CAR(2384) 2266 NORTH MAIN STREET WALNUT CREEK, CA 945963521 CLAIM INOR Claim Num .4187635 Claim Type:i Vehicle Conditions:Unknown Date of Loss: Insured Name: Owner's Vehicle: Repair Facility: Rental Invoice Please Return This Portion with Remittance Make Payment To: Total Charges: $273.75 ENTERPRISE RENT-A-CAR(23CC) Less Amount Received: $108.75 2550 MONUMENT BLVD, Total Amount Due.................... $165.00 CONCORD,CA 945203107 Federal ID:36-3041733 Please include on your check: Invoice:D128994-2384 https://www.enterprise.com/armsweb/closedcustomerfile 12/18/2002 8Z/10/83 15:85: 3 RR5 #:87b831 1624 f j:Gl?ALT[►N Cle►itn .418?F+ PAGE:SW TRAFFIC COLLISIC3N>BEPC?RT } tKalu COtNK1OM MINI" "Ma 14Nk cm . JUOW1w.t-nmr I.Oct"KpQ Rlwq=jK K LAU ft, rwrrtK fSY•OUN OEtAfFT "paKrw lawnwT SWAT r l%A min 4m*"CUMNa.O" Nov Orr TtAK ust f f w) "coil *Mtd*t a il/LtlOOY WlOAIAATq",, «..� r....«.««..«..«r..�«....�.rr«�r..r�..... "Vol-wt" V*W AWAY "fiYOtlt/1►"M tY: b. U OYi,S j AT MtrYRtt 7lak YRYk NTATt kwV W aK: it t Oi ��\� � L3aiq �►aNt PARTY mv"*UD#Iat+-w"ft $TAM CLAtO A*S" V97 t/AytttMaaNLrcewaK t"GWAKStlr NTArf 00 c MVXR MAMt t VtNIT.YNOL., y ca Sal vc.\ fTaft fAirrr"DAISS O MSOM"AYt ®sun ra OltY A tAKKta. ^JJ.I'1FS''"OZW "aw" YtM4t p(y^aY. �j`t"1t MANN j} tYti MQay"lf,, MfO}O(M�' 1i�`p, Y 1i KAC(t X10M Oi YtIfCLt Ok OKOtKt4Mi 0Or"cla WPAVSN OOw9ft `Wi 1 1. v� S-cK► t'�f: Li � o� 1„1 y � . 1...1 aT"M "O"OMONt OUrUitia►tMllt A**#AWt'"AMCAL"NMI MOWN AMAANWO AMATOMAAKATYN� 0 0% lbil- (}��}Q,,, CMifrrtakLT otffcNOtYtrtCLOOAMAAt wAatwaAMAataAAu UKAr+>:tf:rAKltit racxYaurttr► .... vtrNcuCrnt. :... as AralToir aNf,M O"TKttCaKN�AY t.. . ►Ci 1C0� Oki PARTY tKS4Ct"IOt rAAfitK tTAifl CtA#t tAOtrY vitt Tam MOMMUM A STAW &M .� P � . \SAT. . , :\ �, „ . OKWtK MMW(NOW1,WOOLS,L.:T) VMS-. SUr ADMISS a K'O"AM6 01"M ONVU InN fAfIK;O lt:TATtd LV ,,,,} �a}AkaAit�s �- SAME As OWSA YtNt16A ` 1.5�" W #5 ``""++'\•.ali... (`-t:-3'-,3 Nov. •tt IL40 fYsf aaral�n #wtla"r ta. •"W". rauu y omit raNrnD"airtewLt aN oKttAa ar. *—yon+cgs iii�p om frau OrNIA %0M`f�O"m ,p 1 OUtDt"*"O"f irrioK MtaKUOe"OtptCYtl HOW AM~, KOfKTOMNtAMA 0 ""S ) ..l ~ `�� • ���� blV fckEOit.Y OCMCNt6 YtMCLt OAYAaL f1tROt1M aAYAafaLlltA VeofNCtt TYit UKAMCt aAKNtt11 ►OUC7 rNJY1i#fk 4/iK frQkt K '* y' MANiR AL 0114 ap fYKttY'00'NaWMAY Nptto rail° A y PARTY NOYSO's L MMS ww"m STAYt I CCA$0 WM VM VSAA YAKt tMaatL t aataK iMM W AUCS ttATt KOM oft"* MANNfAKtT,1M004t.LAtTr itDti tT"S""amms Owwxtwwt 0Mt SAAS ONVO TAIArt #AMC* a!+(rflORIZO aw"tfet ADmS$ '"3AMLAtaNYtK NC YNLf 0 tlCT. itt flAlN tr" NWNf %Vgj* 1 tun tro, fSI aAOMY" TAA YVK" KACt dtiattTOrtOpVttOCtia"aKOtKSO►: f�aiAalEK af"�aT"E11 aTktK f/N""WM\t OU&WAIMPHO"t /NOR MSCkANCALO[itCq: MONAMAKWf KN/tKTOMAAKATVt tlfiCOltOtiCNrtYtNCIN OAMAOt tl"Aai W OAYAOt6 ARfA "IUKANCO CAAk98 MYCY NUMOSA YtNCl9?0 _ , ,Y tialiZtop"f100. LAJo" TOTAL DKOE O"STKtiTliRON004WAY UWfNPCP we TKAVSL pUa aMr jj A GH NOi IED •t MA"t aAYN K xna C3YE$d to C$wAl 14eel$-1 ' le-7-7i 12 ` 65-'"Z CHP ttt PAG9 T {ROV TJt)ON 04 tt tt6t7 OZ/10/63 16:06:36 RRS #:826831.1624 Adj:GDALTON Claim#:4187+ PAGE:883 IN TRA SreAurnANu .. rr PATI OA yPOLUSION n o f 1 NGC o MO l Y T O OWNBtYi N.M1[1. IFLNt • NO CM PAOPHIYY ---_ .,, TO w OAMAIGE OA11LArDlSdx Of OA"-49 SEATING POSITION SAFETY EQUIPMENT we � Y_ i aptiml EJECTED FROMVE141CLE L-AIR SAG DEPLOYED I-NOT 67E02ED A-MONS iN VEMCLI X-ASR SAO NOT DEPLOYED DRtYEA 1-FULLY RACTO C-VNXNO f CEO P-NOT AEOUlAE11 V.Np 1•r.AR`IALLV EJECTED T•DRIVER D•LJLII 9ELT NOTiI8F.4 W-YES 1.UWNOW14 1 2 3 1 TO I.PASSENGERS H•SHOULDER NARNESS USED PASSSIMER -SHOULDERHARt4E33NOTUSED Cltt�b!ltstftAtll! � 5 g r»BTAfMON3YAGONREAR X•NO I-R£AR OCC TRK OR VAN -LAP/lIHOtMIDER H AIMGS M USED G-yt VPJICLE USLUy Y-YES i-P(*10NUNKNOWN 'LAPf3MI43It3}EPIffA/tNEiiN41USEtI K-01VE-valmoro ED o-OTHER J-PASSM RESTRAINT USED S-IN VI OCL.E togs kMmW" 7 -PAMI3IVEAESTAAMNYM&iTUSED T»MIttE1SC3iIIAPACPEAUSE E' mmsIAARUOBELOW POLLOWIIDIYANASTERISK(•IENDUEDEEKXPLAMIOINTH&NAARA 3VE. LIST EGDFWCAYT ALRT TRAFFIC GONYRGL DtvtcEs i 2 3 TYPE Df VENCLE i 2 3 'VSCOTSPREICEDlNG I V4SE073ONVIOLATEO: CONTROLSPUNCILONMM PASSENCHtu1CApISTATIONWAGON I IASTOPPSO mmo CQNiRtHts NGT FUNC1tCRING• tASSENGER CAA W 1TRA7LEltISPROCIAVING STRAIGHT �+ B OTHER IMPROPER OPIVWNG tSONTROLS O8irm-0 M OTORCYCLE/SCOOTER A1►NCFF D NO CC31/T14OLS PRESENT lFACTOfM• ANEL TRUCK AUIKING RMCdif TupN 01HEp THAN DRIYE1t' TYPE OF COLUSION EL YRUC:K W/TRAK-ER M+A10140 LIFT YUAN (1ul8CNOVAJ' 71HEAII-OM RueKTRACTOR MiAKINGUWAR a 310EEWHPE K TWTOftWITRLR. BACKING "us END BttOADSIDE PASSMNtt OTHER VEMMC:LE CLEAR IIT oSJKT #MMEAGE VE1Il i CNA"NO LANES CLOUDY ov"TURNECI HIGHWAY C ST."MINT PARKING mAHEUVIp RANNNG VIMCLE I PEOUTHAN L AICYCLIL EI'ITEfINCM TRAFPMC SNON9NG OTHER': orm"VINtCI E OTNEB WSAFE POWNG FOGtVMSISq.1YY FT. MOT5lVFW"C MN VEOW11; PEDESTRIAN I4NDMNYDOPPO3WGLANE OTHER•t ,iLNON-ic"S" MOPED PAAKED WIND PEDESTRIAN Lh tAEAliIttQ C7"m MOTOR VEMCLE TRAVEUNO WRONG WAY OAYUGHT MOTOR V11w=ON OTNEN ROADWAY OTHER ASS=AUO PACMOR(S) *TNER': DUSK-DAWN plam; r�VEMEGt£ (1AW 1 TO 2ITM) DARK-STAE STI UMTS ?4AtN YpLATlbll: pO DARK-NOVQTUGHISMt WYCLE ao DARK-STAEEY 3 aws NOT ANIMAL: e V &A a+: peso M ROADWAYI�" NG PI7t60 ECT: f 8� i 2 3 plveryYA xua A DRY I o (IMARK 1 TO2ITEMS I In T OTHER macs s MAD NOT SEEM DRINKING Lo SNOWY-HCY "� SLIPPERY t MUDDY.OR.Y.IT*.) vIIlON OIi3CLIREMtEHfY. NSD•UNDER x4Ft uENCIM MNATTENTIO1•: M190-t#T I[pEAUN'LttE[4Ct ROADWAY CONOITiOf1(SIHSD•IM!►ANMLENT L+MlKNOWMI EO"W"ItS II4VOLYEO ATOP i GO TfIAiF1C PUNDO OAU4 WFLUENCE (MARK s TO 1 MTfMS:M ENTERMNG r LEAPING RAAMP A NO PiIOESTRIANlNVOLYED MMiPAMtM1EMfT-PNYSfCAt' —w"S.DEEP Rut- CROSSING IN GRW WALK PREVIOUS GDLLMSION MI�AMOMY irl KNOW14 LOOSE i[ATEAIALONROAMNYAY* 737RtYEIMECIIOM .. 3iWAM:UAR"TH ROAD WTOVEY OU!.: pyo AOT UCASLE OSSTRUCT31-45; OADWAY• CROSSING IN CROSSWALK-NOT flri[s SLUPY/iAlIQUED �CONSTRUCTION-REPAIR IONS AT INTERSECTION 0- iPEC4A ; T4ON RE(HLtCEDfI0A0WAXYMIOYN CIlOSS1NQ-NOTINCROSS"LK UlINVOLYEOVEHICLE ANAZARDOUS MATERIAL FLOODED• 1IRROAD.INCLUDISS"OULDIR 41NER" It OTHER*: I IE NOT IN ROAD INNONE APPARENT NO tf OJWAL CONDITIONS APMHlCACMNG ILEAVIM SCWOL SUS I j0ffi*AWAVWJ*CLI SUTCA tr u 0 +u ttt irwF.Ci� e/w-.Jul+hw h•6 •. .. 82/18/83 16:87:39 RRS E:826831d 1624 Adj:GDALT0H Claim#:4187 .. PAGE:884 STATE Of CALIFORNIA ` DATE OF 24=ENT TIME NCIC NUMBER OFFICER LD. NUMBER 11/18/021215 9390 15691 11-134 SKETCH QLACKKHAWK N (Not To Scale) RD W E S V-1 CENTER ISLAND .� DOUBLE YELLOW LINES V-2 HIDDEN OAK 28 S/8 N/8 CONCRETE CURB CONCRETE CURB DOUBLE 1 YELLOW LINES PREPARER'SNA�& I.D.NUMBER DATE REVIEWER'S NAME DATE R.G.Biancff' 15691 11/18/02 82/18/83 16:87:57 RRS #:8268314 1624 Ada:GDALTDH Claim#:4187A PAGE:885 STATE of CALIFORNIA DA'M OF INWENT TIME NCIC NUMBER OFFICER IT NUMBER 12/18/02 121$' 9390 15692 11-134 1 NC3TIT CA 'LQN. 2 3 I received notification of this property damage only collision,at approx 13 10 hours. I responded from 4 the CLIP Dublin Area Office and arrived on scene at approx 1326 hours. 5 6 All times,speeds and measurements are approximations. All measurements were made by 7 estimation. 8 t o lJ:i i I NAL INFOMMAT Y i'y 11 12 I conducted a visual vehicle inspection on V-2 to see if the rear amber lights,brake lights and turn 13 signals were working properly. All lights were properly working. 14 15 D-I did note that V-l had prior damage to the rear of her vehicle from a previous collision. 16 17 18 STATEMENT/ 0 ESSENCE): 19 20 D-1 (Crowe)related that she was driving V-1 on Blackhawk Rd SB,directly behind V-2 at approx 21 40 mph. D-I stated V-2 just suddenly stopped and turned to the left. D-1 stated she collided into the 22 rear of V-2 when V-2 was turning. D-1 stated D-2 did not use any turn signals before the turning 23 movement. 24 25 D-2 (Stout)related he was driving V-2 on Blackhawk Rd SIB, in front of V-1 at approx 45 mph. D-2 26 stated he buried on his rear amber lights and left turn signal for he was going to turn left over the 27 double yellow lines. D-2 stated he slowed V-2,swung out to the right and then turned back to the left 28 and began making his U-turn. D-2 stated as he was turning he felt an impact to the rear of his 29 vehicle. 30 31 32 SUMMARY• 33 34 D-2('Stout)was driving V-2 on Blackhawk Rd SIB,at a stated speed of 45 mph. D-1 (Crowe)was 35 driving V-1 directly behind V-2 at a stated speed of 40 mph. D-2 began slowing V-2 in order to make 36 a U-turn to the left over the double yellow lines. D-2 began turning to the left from the S/B lane over 37 the double yellow lines to make his U-tum. Due to D-I's unsafe speed for conditions,D-1 failed to 38 observe V-2 slow down and turn to the left. The left front of V-I then collided into the left rear of V- 39 2 within the S/B lane of Blackhawk Rd. After impacts,both vehicles were moved from Blackhawk all Rd to the exit lanes of Hidden Oaks Tar. PREPARER'S NAY& LI).NUMBER DATE REVIEWER'S NAME UA"TE R.G.Bianc15691 11/18/02 82/18/83, 16".88.31 RRS #:8268314 1624 Adj:GDALTON Claivl#:41876" PAGE:806 STATE of MIFORNIA DATE Or--b4CM6NT TIME NCX NUMBER OMCER Lo. NUMBER 11/18/02 1215 9390 15691 11-134 i AREA UFIIKPACT {A.U.Ia: z 3 The A.U.I. (V-1 vs V-2)was located approx 700' S/S roadway prolongation line of Hidden Maks Dr 4 and approx 11'E(W roadway edge line of Blackhawk Rd SA3. 5 6 7 CAE: 6 9 D-1 (Crowe)caused this collision by being in violation 22350 VC(unsafe speed for conditions). 10 i i The summary,A.U.I"S. and cause were based upon my collision investigation,statements and vehicle 12 damage. 13 14 is 1?EL{?MMENI?EI.T'.IQn 16 17 1 reconunend that the Pleasanton Muni Court fila and charge D-i (Stout)with the following; 18 i9 ■ I2951(a)CVC No Ca.Driver's License present at scene. 20 PREPAREWS NAM I:I7.NUM8@R DATE REVIEWER'S NAME DATE R.G.RianeW 15691 __.`-... 11/18/02 i ------------------- MINE 10/�I IIINNI ON Nllmjm�ll"E'N"Em. SO IN CLAS F NT C U may 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 sof 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 Seco°' 913 and 915.4.Please note all"Warnings". COUNTY COW,4U AMOUNT: $l,300.03 A UNEz6ALI . CLAIMANT: STAT, FARM 1N,tJRANCE`CO MPANI FoR r DtIDRA DINGMA,, ATTORNEY: UNKNOWN'-.''' DATE.RECEIVED: APRIL 22, 2003 ADDRESS. P.O. BUX 6403BY DELIVERY TO CLERK ON. APRIL 22, 2003 ROHNERT PARK, CA .94927-6403 BY MAIL.POSTMARKED: APRIL 15, 2003 FROM; Clerk of'the Board of 9upesrvisM to: County Camel ' Attached is a copy of ft above-noted claim. JOHN SWEETEN l Dated: _ APRIL 22., 2003g I?eputy H. FROM: County Counsel TO: Clerk of the Board of Supervisofs (This claim complies substantially with Sections 910 and 910.2. ( .} This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15-days(Section 910.8). ( ) Claim is not timely filed.The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). ( ) Other: Dated. By: �'` ' *. Deputy County Counsel M. FROM: Clem of the Board TO:. County Counsel(1) County Administrator(2) ( ) Clam was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: (x) This Clan 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: MAY 06, 2003. 30HN SWEETEN, CLEI By ,Deputy Clerk WAWWG(Gov.code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personally seared or deposited in the mail to file a court action on this claim. Sec Govemment 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 inunediatel : *For Additional Waarnin See Reverse Side of This Notice. t AFFIDAVIT OF MAILING I declare under penalty of porjury 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: MAY 07, 2t)C}3 IC)HN SEEE'I`EN,CLERK B uty Clerk ` s UATIg State Farm Insurance Companies 8212003 1NSURANCE WTy Cc7uNSEL MARTI EZCALIF. Claim Central Subrogation 6400 State Farm Drive Ap r i l 14 , 2003 P.O. Box 6403 Rohnert Park, CA 94927-6403 Kathleen O' Connell Board Of Supervisors Of Contra Costa County Admin Bldg 651 Pine St 9th Floor Martinez, CA 94553-1229 RE: Claim Number: 05-4894-305 Date of Loss : March 20, 2003 Our Insured: Deidra Dingman Dear Ms. O'Connell : State Farm Mutual Automobile Insurance Company, on behalf of Subrogee, Deidra Dingman hereby makes a claim for $1, 300 . 03 and makes the following statements in support of claim: 1 . Notices concerning this claim should be Sent to: State Farm Insurance Companies PO Box 6403 Rohnert Park, CA 94927-6403 2 . The date of the accident occurring on March 20, 2003 at Parking Lot-651 Pine St . , at 10 :30 am. 3 . The circumstances giving rise to this claim are as follows: Insured backed ,up vehicle, there was a curb stop that was hazardous and had piping sticking out damaged car. 4 . The injuries reported consisted of the following: S . Our total claim is as follows : Company' s Net Payment $800 . 03 Insured' s Deductible Int $500 . 00 Total Property Damage $1, 300 . 03 HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001 Board Of Supervisors Of Contra Costa County Admin Bldg Page 2 April 14 , 2043 NOTICE: This form is to provide notice of our claim for damages in accordance with the statute . If this form is not acceptable for compliance with the statute, please rush the necessary form to my attention for proper filing. In order to assist you in evaluating and processing the subrogation claim we are asserting, we may provide nonpublic personal information about our customer. We are sharing this information to effect, administer, or enforce a transaction authorized by the consumer. However, you are neither authorized nor permitted to: (1) use the customer information we provide for any purpose other than to evaluate and process the subrogation claim, or (2) disclose or share the customer information we provide for any purpose other than to evaluate and process the subrogation claim. State Farm Mutual Automobile Insurance Company Dated: April 14, 2003 By m loyee,Name CY _Fqployee Titleq VC , F / { Employee Phone Number Sincerely, Tammy P. FT icaro Claim Representative (800) 444-6177 x7 State Farm Mutual Automobile Insurance Company TF PS: Another claim form has been forwarded to our insured to sign and mail back to us . We will forward this asap. Thank you. t :. Clgi4 to BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY W= C ONS IQ 0., a A. Claims relating to Wises of action for dearth 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 I0&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,roust 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 911.2J. B. Claims roust be filed with the Clerk of the Board of Supervisors at its officein Room 106, County Administration Building,651 Pine Strut,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. Fr. See penalty for fraudulent claims,Penal Code,Sec.72 at the end of this form, r+�s*ws***ss*****s*sty**ss+e**stsss+�*s*:Msrt+srs****sss*+r***s,r+s*+�tss*sss+r***+eat***s�cr+ts*s+►*s* RE: Claim By Reserved for Clerk's filing stamp } Against the County of Contra Costa or } District) (Fill in name) } The;undersigne , ` 'rrro��tnf by makes claim against the County of Contra Costa or the above:-named district in the sum d in support ofthis claim represents as follows:1. When did the damiury ear?(Give exact date and hour) 2. Where.did the damage or injury occur?(include;city and county) tfie✓ r - tnI 3. How did the damage or injury occur? Give full details;use extra paper if required) \J ILI �� x 2 -- .4 4. What particular act o omission on the part ofcounty or di!strict aflrcers,servants,or employees caused the • injury or damage? S. What are the Warnes of coon o � � `f �T ty r dtstnct ificers, servants, or employees causing the damage or injury? 6. What damage or injuries do you claim resulted?(Give fell extenrtofin"cries or damages claimed.Attach r damag��� 03. 7. damage.)w* as thetlatnral strive ed?(trrchide the esti tLiLSf�2 pective injuryor 3 8. Names and addresses Of witnesses,doctors,and hospitals. (A. Ot_� 9. List tris expenditures youPAIL made on account of this accident or injury. L4 r aCO #Miliilili#!##!####ii######ii#######!##*#+!#iiia####i##1k# int##T#!i#�tfi#!F##int######i##!t►!h# Gov.Code Sec. 910.2 provides"The claim must be signed by the claimant or by some person on his behalf." Name and Address of Attorney � a • ,�f�!`-•� f _ (/,�`g ' ) (Cl Wt's Signature) w 0-3 . IU_k%qqV3I_ 1 11 X_ Telephone No.6 ##ii#:#!##ii*ss�r#ss##+t res#♦##•## s# !##Telephone N CE EVOY Pasoa Who.with intent to&&AU4 PnMDtS for&&Man=yr tDe�to an county.city.or district board or otl6+",aetborUW to aitow or y start baric!or oMca.or to say• voucher,or vMd A&is punirhable citta Pay tM same if gee,say false or fraudtdmt claim trio, txceednr�ten,thousand do w%CS lo,O�Oo) �b .ncoom in the state p6son.by a fim ornog rr,rrr,r�aw RB Z 0 0 0 3 H date: 04-14-03 page : 1 STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY AUTO PAYMENTS policy number named insured date of loss I;►xwc;mz m j I--)IE:xL F A 03 --20 ---03 C denotes consolidated payment E denotes EFT payment P denotes previous data payment number payee total amount issued status E 102887692K STEWART' S BODY SHOP 800 . 03 04-04-03 PAID Date: 4/1/03 05:03 PM Estimate ID: 05-4894-30501 Estimate Version: 2 Supplement: 2(P) 4/3/03 08:04:48 AM FINAL Profile ID: STATE FARM Stewart's Body Shop, Inc. 12540 SAN PABLO AVE. RICHMOND, CA 94805 (510) 235-3515 Fax: (510) 235-9022 Tax ID: 68-0032104 BAR#: AJ112826 EPA #:CAD981385321 OVER 50 YEARS SERVING THE BAY AREA Damage Assessed By: Lowell Biagi Supplemented By: Lowell Biagi Condition Code: Good Type of Loss: Collision Date of Loss: 3/20/03 Arrival Date: 3/31/03 Contact Date: 3/25/03 Payer: Insurance Deductible: 500.00 File Number: 3257 Claim Number: 05-4894-30501 Insured: DEIDRA DINGMAN Address: 969 SEASCAPE CIR RODEO, CA 94572-1812 Telephone: Work Phone: (925) 335-1224 Home Phone: (510) 245-7568 Mitchell Service: 910754 Description: 2002 Toyota Camry LE Vehicle Production Date: 8 /02 Body Style: 4D Sed Drive Train: 3.01. Inj 6 Cyt4A VIN: 4T1BF32KX2U541538 License: 4ZNA995 CA Mileage: 10,138 OEM/ALT: 0 Search Code: 894806 Color: 1CB/SILVER Options: Alum/Alloy Wheels, Air Conditioning, Power Steering, Power Brakes, Power Windows, Power Door Locks, Tilt Steering Wheel, Cruise Control, Electric Defogger, AM-FM Stereo Cassette, Automatic Transmission, Power Driver Seat, AM-FM Stereo/CDPlayer(Singte), Passenger-Front Air Bag, Power Remote Mirror, 4-Door, Driver-Front Air Bag. Line Entry Labor Line Item Part Type/ Dotter Labor Item Number Type Operation Description Part Number Amount Units 1 000030 BOY OVERHAUL FRT COVER ASSY 2.4 # 2 000032 BOY REMOVE/REPLACE FRT BUMPER COVER 52119-AA904 199.37 INC # 3 AUTO REF REFINISH FRT BUMPER COVER C 2.4 S1 4 000107 BOY CHECK/ADJUST FRT HEADLAMPS 0.4 5 000114 BDY REMOVE/REPLACE R FRT COMB LAMP LENS 81130-AA060 189.72 0.3 # 6 000409 BOY REMOVE/REPLACE R FENDER LINER 53875-AA010 58.59 INC 7 **SEE REMARKS** 8 000410 BDY REMOVE/REPLACE L FENDER LINER 53876-AA010 58.59 INC ESTIMATE RECALL NUMBER: 3/31/03 09:34:56 05-4894-30501 UttraMate is a Trademark of Mitchett International Mitchell Data Version: MAR_03_A Copyright (C) 1994 - 2002 Mitchell International Page 1 of 4 UltraMate Version: 4.8.012 ALL Rights Reserved Date: 4/1/03 05:03 PM Estimate ID: 05-4894-30501 Estimate Version: 2 Supplement: 2(P) 4/3/03 08:04:48 AM FINAL Profile ID: STATE FARM S2 9 000413 BDY REMOVE/REPLACE R FENDER CLIP 90467-07164 5.28 * INC 10 4 AT $1.32 EA. s2 11 000414 BDY REMOVE/REPLACE L FENDER CLIP 90467-07164 5.28 * INC 12 4 AT $1.32 EACH S2 13 900500 BDY* REMOVE/REPLACE ENGINE UNDER COVER CLIPS New 10.00 * INC 14 000582 BDY REMOVE/REPLACE R ENGINE UNDER COVER 51441-06030 68.51 INC 15 000583 BDY REMOVE/REPLACE L ENGINE UNDER COVER 51442-06020 78.74 INC 16 936012 ADD'L COST HAZARDOUS WASTE DISPOSAL 1.50 17 936014 ADD'L COST FLEX ADDITIVE 10.00 18 AUTO REF ADD'L OPR CLEAR COAT 1.0 19 933003 BDS* ADD'L OPR TINT COLOR 5.00 * 0.2 20 AUTO REF ADDfL OPR COLOR SAND & BUFF 0.7 21 933018 BDS* ADD'L OPR MASK FOR OVERSPRAY 5.00 * 0.2 22 AUTO ADD'L COST PAINT/MATERIALS 85.00 * * Judgement Item # - Labor Note Applies C - Included in Clear Coat Calc Remarks CAR IN FOR REPAIRS 3-31-03. DONE 4-1-03. "REPAIR AUTHORIZATION AND DIRECTION TO REPAIR SECURED, FINAL BILL" ESTIMATE RECALL NUMBER: 3/31/03 09:34:56 05-4894-30501 UltraMate is a Trademark of Mitchell International Mitchell Data Version: MAR_03_A Copyright (C) 1994 - 2002 Mitchell International Page 2 of 4 UltraMate Version: 4.8.012 All Rights Reserved Date: 4/1/03 05:03 PM Estimate ID: 05-4894-30501 Estimate Version: 2 Supplement: 2(P) 4/3/03 08:04:48 AM FINAL Profile ID: STATE FARM Addll Labor Sublet 1. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 3.1 60.00 0.00 0.00 186.00 Taxable Parts 674.08 Bdy-S 0.4 60.00 10.00 0.00 34.00 Sales Tax @ 8.250% 55.61 Refinish 4.1 60.00 0.00 0.00 246.00 Total Replacement Parts Amount 729.69 Non-Taxable Labor 466.00 Labor Summary 7.6 466.00 III. Additional Costs Amount IV. Adjustments Amount Taxable Costs 95.00 Insurance Deductible 500.00- Sales Tax a 8.250% 7.84 Customer Responsibility 500.00- Non-Taxable Costs 1.50 Total Additional Costs 104.34 I. Total Labor: 466.00 II. Total Replacement Parts: 729.69 III. Total Additional Costs: 104.34 Gross Total: 1,300.03 IV. Total Adjustments 500.00- Net Total: 800.03 Less Original Net Total: 753.78 Net Supplement Amount: 46.25 S1: Lowell Biagi 24.00 S2: Lowell Biagi 22.25 Point(s) of Impact 1 RIGHT FRONT CORNER (P), 11 LEFT FRONT CORNER (S), 12 FRONT CENTER (S) ESTIMATE RECALL NUMBER: 3/31/03 09:34:56 05-4894-30501 UltraMate is a Trademark of Mitchell International Mitchell Data Version: MAR_03_A Copyright (C) 1994 - 2002 Mitchell International Page 3 of 4 UltraMate Version: 4.8.012 All Rights Reserved Date: 4/1/03 05:03 PM Estimate ID: 05-4894-30501 Estimate Version: 2 Supplement: 20) 4/3/03 08:04:48 AM FINAL Profile ID: STATE FARM Insurance Co: State Farm Insurance Companies Inspection Site: STEWART'S BODY SHOP Address: 2920 Hill Top Matt Rd. Inspection Date: 3/25/03 Richmond, CA 94806 Telephone: (510) 262-4900 Fax phone: (510) 262-4905 Body Shop: STEWART'S BODY SHOP Address: 12540 SAN PABLO AVE RICHMOND, CA 94805 The above is a estimate based on our inspection and does not cover any additional parts or labor which may be required after the work has been opened up. Occasionally after work has been started, worn or damaged parts are discovered, which are not evident on the first inspection. Because of this the above prices are not guaranteed, and are for immediate acceptance only. **Special Parts Note. ALL crash parts on this estimate are "NEW" parts (OEM) unless specified. Parts described as Rechromed, Recored, or Remanufactured are either "Reconditioned" parts or "Rebuilt" parts. Crash parts described as "ttual Rept Part" are non-OEM aftermarket parts.** I AUTHORIZE STEWART'S BODY SHOP TO REPAIR ABOVE SAID VEHICLE AS ITEMIZED PER THIS ESTIMATE. X DATE: - Cycle Time information Drop Off Date: 3/31/03 Time: 08:00 Repair Dates: Promise Date: 4/1/03 Start Date: 3/31/03 Pick Up Date: 4/1/03 Completion Date: 4/1/03 is Vehicle Driveable (Y/N)?: Y 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 undeptoyed stage. When disposing of a deployed dual-stage air bag, always treat it as a "Live" module. See appropriate MITCHELL(R) AIR BAG SERVICE & REPAIR MANUAL, or OEM information. ESTIMATE RECALL NUMBER: 3/31/03 09:34:56 05-4894-30501 ULtraMate is a Trademark of Mitchell International Mitchell Data Version: MAR_03_A Copyright (C) 1994 - 2002 Mitchell International Page 4 of 4 UltraMate Version: 4.8.012 ALL Rights Reserved t� a t �" t• t: :s --:: ?:hes j ILL .:. .: . v: -k .; ... .. .... .. R h: J{ :;:::• i ! r:� ffs,,7% f6�iJ rr'`� r B f xf; `F `91n r oa N C4 4 rv_r' i °fir':'"% ..gam oov wx xi f . Alae, k s f' ri �f a f , r� ���� : � ��\� �� j ����� :��/ ��x ��` ���« � ��\ . : ���x y y�> � � a«m ® ..� - � � � .��_», « � . � ��. . �, v ����« . v :.��a y y» \ � . �. . . . . . <���... � .... �=ate % � �32d���\ -- . . . ,mz . .� \��? � � ® ?m��\ � / � � � ^ � � �� ` . �\� �? <: © 3 �« a <�\���\ � � ��� � �� ��/ � ° �� \�\ . y � �2. / \� � �\ �^ �\ � . �\ � ;\ � �����» � � � � .�2 �� ����^ : ��» �/������ . . ��~©«<` ����y z �����\ . � _ ���w 3 . . k ^ ���� ^ . � � \������ � � w ` 2 : . � # � � ■ �; ■ : :§ � . ; y }» � :����a :����: _ :» :.��aG »/ � � zz . �����..�m^/\ . . . j,� . . . ��° . ` ��� . . . � ��/^ �/�/ � ����: ��± � �< ./ / � <�: « � � ��` . , 2 \ . . � � � \ \ � � � \ \ z . , \ Z : { . . . \, / / �7 . � �� d` \ � `�� ^ �\��` ` . \ � /< � ��~� w���\ < � \ \ � /����/ . \ � 2\© \ \ \\���\� � . \ � : �/\ ~ \ \ . . �� < � `:/ ^ � � \ 6 = ��; > . . . % y . $ . � . . �� : .� / � �� /��� . . .» � . � / \ �� . �\ ����$\ � �\ \ . �e� � . � , r ��� �\ \ \ � ���~�� ^ � ~ \ « ® . ± .\ �<.< < �� f` \ ? �� . . } ����� : Office of the County Counsel Contra Costa County 651 Pine Street, 9th Floor Phone: (925)335-1800 Martinez, CA 94553 Pax: (925)646-1078 Hate: April 22, 2003 APR rt To: Clerk of the Board of Supervisorsor°rr nsurn� Attn: Bmy Sharp, Deputy Clerk From: Silvano B. Marchesi, County Counsel By: Monika L. Cooper, Deputy County Counsel t (-1.0 ; :t,,,_ Re: Government Tort Claim of State Farm Insurance Companies for Deidra Dingman We received the attached from State Farm Insurance Companies. Please process it as an amended government tort claim. Thank you for your assistance. Attachment CONFIDENTIAL ATTORNEY CLIENT DOCUMENT ......... ......._. ......... ....... ... __ _. _ �7Ptn °,846 ?536 . .. 166-852A f W U 1670 670 UU 0 5 State Farm Automobile Insurance Co. � . $ N P. 0. Box 6403 ?1 - Rohnert Park, CA 94927-6403 FIRST CLAbb � ►� ....................- .................................... .............--- - ........... w U 4- ' N T L B ARU OF UPERVI ORS QFC;C?NIRA CgLSTA COUNTY,CALIFORNIA B¢A,RD ACTIC}1N MAY 06r 2€03 Application to File Late Maim ) NOTICE TO AEPLICrANT' 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 Supervisor4(Paragraph III,below), Calif�c to CoverCtet Code. l given pursuant to Government Code Sections 911.8 and 915.4. Please note the"WARNING"below. Claimant: KENNETH & ASHLEY ULMIIt ,a Vv, jt fK5 It 3 Attorney: UNKNMN ImARj Address: 1233 ARNOLD DRIVE COUNTY CUUN E'L MARTINEZ, CA 94.553 'v-lA€T1 ,.%w€ : Amount: $825.00 By delivery to Clerk on: MARCH 24, 2003 Date Received: MARCH 24, 2003 By mail,postmarked on:. HAND DELIVERED I. FROM: Clerk of the Board of Supervisors TO: County Co nsel Attached is a copy of the above noted Application to File Late Claim, DATED: MARCH 24 2003 t : JOHN SWEETEN,Clerk,By. DEPUTY 11. FROM: County Counsel TO: Clerk of theMoar 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 911.0. DATED: Ca SILVANO B.MARCHESI,County Counsel,By: EPUTY U1. BOARD ORDER By unanimous vote of Supervisors present (Check one only) { ) This Application is granted(Section 911.6). ( } This Application to File Late Claim is denied(Section 911.6). I certify that this a true and correct copy of the Board's Order entered in its minutes for this date. MAY 06, 2003 DATE: ,T£J►kHN 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 aication for leave to present a late claim was denied. You may seep 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 TO: (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 nailing 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: MAY 07 2003 JOHN SWEETEN,Clerk,By: DEPUTY V. FROM: (1)County Counsel (2)County Administrator TO: erk of the Board of Supervisors Received copies of this Application and Board Carder. DATED: County Counsel,By: County Administrator,By: { AEPPLIC&UQN M FILE LATE CLAIM T} ai4-- qb` , Claim to.* BOARD OF SUPERVISORS OF CONTRA COSTA COUNTr IkMMUCTIbNS TO CLATMANT 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, roust 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 rause of action. (Govt. Code 5911..2,) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the Claim is against more t*aan one public entity, separate claims roust be filed against each public entity. E. ' Fraud. See penalty for fraudulent claims, Penal. Code Sew. 72 at the end of this form. RE: Claim By } Reserved for Clerk's filing stamp i Against thd csunty of Contra Costa } MAR 2 4 2003 or } CLEFKOTRCSTEtilt District} CNA A � Mill in name } The undersigned claimant hereby mattes claim ar�gainst the County of Contra Costa or the above-named District in the sum of � �,�� and in support of this claim represents -as follows; 1. When did the damage or injury occur? (Give exact slate and hour) c f fh '^1. -6(c 2. Where did the damage or injury oaCu . (Include city and county) M 3. How did the damage or injury occur? (Give (hill details; use extra paper if required) 4. What particular act or omission on the part of County or district officers, servants tom*.employees carred_ the injury or damage's vr _ # z w,.. 0'd Z b t S££ Sib 1N3WE)U iW >iS I N 000 tS:£T 20"d _Iblpl j. wnat are the names of county or district officers, servants or employees causing the damage or injury? r 5. What damage or injuries do you claim resulted? (Give f"ul.l, extent of injuries or dames claimed. Attach two estimates for auto damage. Ac 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) � R i 8. Names and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury% DATE ff E gip##p AMMU Goi. gide Sec. 910;G provideW "The claim must be signed by the claimant SEND NOTICES TOO (Attorne ? or by some 22Etzon his,beha]"f." Name and Address of Attorney LA, t SSignature) Address r Telephone No. Telephone No. ea * * eeI I W I I V V 9 WTV * aa * aa * * T W W I IF V I W 9 * air 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 tine of not exceeding one thousand ($1,000), or by-both such imprisodment and Pine;:-or by Imprisonment in the state prison, by a fine of not exceeding ten thousand dabs ($I0v=t or by bath such imprisonment and fine. S0'd TZVT SEE Ses INdWOdNdW ASId 000 TS:2T R00Z-02-NUW Kenny & Ashley M. Ulmer 1233 Arnold Drive Martinez, CA 94553 Contra Costa County County Risk Management To Whom It May Concern: During August & September, 2002, some road work occurred on Aspen Drive in Pacheco, which is where my apartment was, at 111 Aspen Drive, #27. This road work was actually making the condition of the road worse, and it had been going on for some time. Each time I left my driveway, the bottom of my car would scrape badly on the concrete, due to the huge holes and ditches that were dug by the workers. These holes had been dug, and remained un-filled for a very long period of time. The road's condition was so bad that my fiance and I had to use only 1 car during that period, because his 1969 Ford Mustang scraped too badly, and he was afraid that some major damage was going to be done to the parts under the car if he continued to drive in and out of the driveway. At about 10:00 AM on Friday, September 6, 2002, myself and two other women were on our way to hair appointments for my wedding, which was to be that afternoon. This particular day had been the first day 1 had seen workers out on the road in a long time. As I carefully & slowly left the driveway, my car scraped as usual, and I hear a crack. At the time, I thought it was just another one of the terrible sounds we would hear on a regular basis while exiting the parking lot. One of the workers who was standing by saw what had happened, and got a bad look on his face, like something bad had happened. He said something to another worker, who replied something I cold not hear and then he just waved me on. I assumed by that that I was OK to at least drive to my hair appointment. As soon as I reached my appointment, my bridesmaids got out of the car to survey the damage they showed me the front bumper of my car. The entire bumper had been broken off, and was hanging by a very small piece of plastic. The car was not driveable, so a nearby friend tied it on until I could figure out what to do with it. I had to go about my day, so I prayed that it would stay, which, of course, it did not, and the small piece of plastic could not hold the weight of the bumper. I finally had to put my entire bumper in my trunk. I would like to be reimbursed the $825 estimated cost, which 1 received from a local body shop. Sincerely, 00v / � � Ashley UlVer _ .... . ... .. .... _:::.. .-- ... . NOV-19-02 11 :22 PM SCOTLAND YARD BODYWORKS 707 558 0292 P, 01 rtr t A/C}bCk___ Haiti e— ADD f;1TY .S.TA,E 'ZW .. } .�] YIN N� .. ?xr,'.6 21 ?f2OD JAI I: »I CY c!)T)4- ._ .... AAMNT ' !tic.C ...S,.,pd..Z.,...�Sd• ADDRESS, AQ,1 AILS Or REPA34i PARTS INDEX LNE A ,F r S=Straighten A=Aftf:rmsficet N=how PI LAt30R HOURSoPARTS S R/G* YCIefl9ec#ttnm ecare U 2 Use4 A=Rebuift eCt)t+ PAW FRAMt MECH �+ I Y 6 yN tt 111 . 14 [17 ' - w 20 _a 22 24 1 1 �i. t01�CAR13EDLiNLt ESs:�TtWRw1SE[NSYRUCTED TOTALS p f} WORK WAS SEEN ST3.1;J. AUCtTtONALt.Y OAMAGGD ON wOnN PARTS AFl t40T QY1t)Eur oN t'1Rsf jfs,FEcno N.T;4I DAMAOt 14U ORT'30tk+MCT CA-.VW 01A L 6ODY .....- ARTS OR LA00"W"ZH MAY at AkC)MED.AtL#-ART;PRICES Aft SinJEC1 TO iNvoiC., A Si�tha 4 z6 thg above.work and.-ttkrwwied_gis recCiol 01 tnpy. B PAN 0 FRAME nis.0 3 PARTS Papas SuPPO to*"C* ,z P:1tr:t Si:wr:lt i7G3• t; mony supi)tiet_. ,hrs.W_ . if1>uing;Surage Jeff tqs►1erlG?aatr SUB TOTAL......... ..... illS HQWE Rt3 iJlY3T !i ". r, MARTINEZ CA 4x533 TAX °,fo on S_ IHt7hi (925) 229-6+10 EPA!waste0,eposatChaW_ FAX (973) ZZS•6505 --- TO 2 .......................