HomeMy WebLinkAboutMINUTES - 06102003 - C.16 CLAIM
BOARD OF SUPERVISORS OF-CONTRA COSTA COUNTY
BOARI`l ACTION. JUNE 1.0, 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 of the action taken on your claim by the
Board of Supervisors. (Paragraph IV below), given
Pursuant to Government Carle Section 913 and
915.4. Please note all"Warnings".
AMC>U IT: $50.00
s
CLAIMANT: CINDY COATS
l *'S
ATTORNEY: UNKNOWN DATE RECEIVED: MAY 06, 2003
ADDRESS: #3 SOBRANiE COURT BY DELIVERY TO CLERK.ON: MAY 06, 2003 _
EL SOBRANTE, CA 94803
BY MAIL POSTMARKED: MAY 05, 2003
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN SWEE rk
Dated: MAY 06, 2003 By: Deputy_
II, FROM: County Counsel TO: Clerk of the Board.of Supervisors
f,
(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: JUNE 1.0, 2003 JOHN SWEETEN, CLERK, By , Deputy Clerk
WARNING(Gov. code section 91 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 Carder and Notice to Claimant, addressed to the claimant as shown above.
Dated: JUNE 11, 2003 JOHN SWEETEN, CLERIC.By Deputy Clerk
Claire to: BOARD OF SUPERVISORS OF CONTRA COSTA Cty.Ftr=
INSTRUCTIONS TO CLADW4T
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrueon or before December 31, 1987,
mutat 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 grouting crops and which accrue can 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 he 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
s Roots 106, County Administration. Building, 651 Pine 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
form.
RE: Claim Ey ) Reserved for Clerk's filing stamp
s.. ,.
Against the County of Contra Costa )
Q
or
District)
Fill in name )
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:
aY.11. �Y+wW+�ureWw�Mw+YYOY�+IM+.wY+wrw•ey+rW.vrwwr._w.r.w.rrw�xnr
1. When did the damage or injury occur? (Give exact date and hour)
2. Where did the damage or injury occur? (Include city and ';unty)
3. How did the damage or in occur? (Give full details` use extra paper if
yip ) ,jam' yy /'7_Jgf � t s PaP { . � ''`�`
required)
•j�jr'y/ y'� ,!y d' '�' `i.. Pk/�(�� i[s���#`" � ` f'�.�J �' .+�hJ ir ,,,s �✓
• '" C s!! 7 O hfi Lf- CJ�n T 5 S� ry 72�� " 40
T7 -
4. What part ou act or cmission on the part of county or district officers,
servants or ,employee; caused. the injury or damage? J. t , :
t cc_d d`ti 'j k txz AL,_ Al
- s
(over)
what are the names of county or district officers, servants or employees causing
the damage or injury?
s�.,'�-.. y M f3 *... ' ;• r . ' s " fi.e��� .� ) „t �,�F�L - i, t} r�i 6 �„:`-�`.. ;"�.::�'
����� f€��"y2�„�,.' p XX'z,,t..�`Z..i.� �..��`k�'�.".�"'l��-��' �,.�'rh�..,s'°�`°-. /. a�i ��s��' 2"`.: �.�'�•:��,.�"1,_......�...
6. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates fair auto damage.. tf Y
�. s. . ' 4Y`s'w{ Y7,
"..". � � €"�,.`�' ,%+, f� ' �'K �-:�`'S,ii. .a.i fj Yom.: E,'., t<i.3 ->s,::,,�s..,�F- ,�` d�-. x�t e .f�Y �£:`s, f..�,'����`'• „:;
i•
�I..i� �, ' f ra•� `� � • '.. ��G�t'v{�.- r��°-. 3P 6�..'*�✓ v:�-k'�-.�.,'.r"•`'.-*� �
7. How was the amount claimed above computed? {Include the estimated anount of any
prospective injury ar �e•� �. -�!���, � ,�' _ ';� � . ~r: ��`' �:,.�� .: �..��;
� 1 € R _-_-
� �_
_Names an addJia, f witnesses, doctors and �iospfttal s. �� �` �
. "'.
` rYf Coit # �. r� f
-- ...�,.r...�....--
9. List the expenditures you made on account of this accident or injury:
DATE I AMOUNT
r 0
Gov. Code Sec. 910:2prov1dest. claimant
"The claim must be signed by the
NOTICg.S TQ: {Attorne } or py some arson on his. behalf."
name and Address of Attorney `
'', '
t t s Signature
CLxAddress
--
Telephone No. Telephone No
* *
N;0TICE
Section 72 of the Penal Cade 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
genuine any
itherlse r raurimentyin
claim, bill, account, voucher, or writing, 1u a fine of not exceeding
the county Jail'for a period of not more than one year, b
one thousand ($1,(300), or by both such imprison ent and fine, or by imprisonment in
the stag prison, by a fine of not exceeding ten thousand dollars {$10,000, or by
both such imprisonment and fine.
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b-ec" C - 4 - Oct, -
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Rj&irriond,CA
TIRE EXPRIU.
the pet fdrManC&bUOeSt Cho,e#" 'FAX 4510;z�e-2167
777=x
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-SHIP
SOLO TO
-n a x ty�:s rt. S ,ar+�'k�;s..`•i�.•a X tc'3�-§ �- r' ��
t' _ � '� a3��4����s *. $ �' S�� r� ,x3•'-r'hy � � �, �.: :u. ` � $ �t' `t. ah,�.�� i Y'
",•,ut`� Yrirt�r .a�+t i a .:d-E.t�"a.... atty �� � E,._'�, t , f 3yS..s.�# 'r'° .�.ey.
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WORK TO BE DONE:
� V :ESRIF
�s itl' 13i�.SCF#
f c k
PARTS
Ai3UR = "Tt�TAA,
At#TNt}r# BY IN PERSON� BY PHCN6�
r z t
5Y t0"Pa CAft, T7N1E CALLED BY PHONEitUtd R
E t vY�Yi s C3yf3 t7ttC #welt o 3# Se uatica arnt :ad ams#ref
t kw €i C7ut :ntrsaae in tine t ngina•ssamatsd prig.
TERMS AND CONDITION
Ail eocs.ts are void and ttor:-reft:nda�le after 45 days.No exceptions. n a
Ail saes final.Refund ar exchange
su'oject o a 20%restocking fee Mounted merchandise not returnable .
The wheals shek ld be re targt ed after 25 miles.Trey may ioese;�after the initial ins:a#at#on.
No refunds ore auto accessories and#.gh:'sr g proc'e ct� i
Ali mileage claims must shorn tire rotation records at 5;000 Intervals.
Tire ba#arc rg warranty is go days or 4,000 r fes,whichever comes first. i
Tire manuf cturers warranty does not CflVer hall holes gats,C11t5, rU358�,nflieS or Punct
UF S
special orders and layaways canttat be returned flr ex,=hangec:
Wo offer a store credit fix mer&aridise returred irj Origtrkai condition. ;
Sorry.no cast?or credit card refunds.
3r#sy xways req
a monthly payment.
{;
ES`�IMA►l ED COSTS $
4 he..by ,lih i!ze tree repair gorK to be done ateng wkb ths,r!eeessary materra.s Tire Expross and its
ernp;opsea may operate above v8.nic:e for purposes oftaring,inspection or dsiivery a.'r:y risk.An
exa e s•••ecna,,i s Sen is acknowledged on above vehicle to seCurs the amount of repairs thereto if"ss i
also.4r?.7erstood f t Rre:Express Will not be hold respon sl'o}e tar loss Cr da...age to Vehicle or:arlida's #
•e t vah.cto:f.case of fire r aR o:any ofhar cause beyond Ti;e Exprt�ss tanVoi.ALL PARTS ANA) k
;UEA�.F#Ati#7f3..ARE?VEthtSNLESS'.:?�'OTEa.,P.-RzkIANUFACTUREf7 U USES:}.
�tETURN PARTS
SIGNATURE DISCARD PARTS .D
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CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY (,� •
BOARD ACTION: JUNE 10, 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 Govenunent Code Section 913 and
s: 915.4. Please note all"Warnings".
AMOUNT: $2,300-00
� >
CLAIMANT: GARY NEIL LITYNKY
ATTORNEY: UNKNOWN DATE RECEIVED: MAY 06, 2003
ADDRESS: 576 EDWARDS ST. , BY DELIVERY TO CLERK ON: MAY 06, 2003
CROCKErT, CA 94525
BY MAIL POSTMARKED: HAND DELIVERED
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOAN SWEET , k
.Dated: MAY 06, 2003 By: Deputy
II. FROM: County Counsel TO: Clerk of the Board ofSupervi 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:
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 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: JUNE 10, 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;',anal 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: JUNE 11, 2003 JOHN SWEETEN, CLERK.By Deputy Clerk
claim to: BOARD OF SUPERVISORS OF CONTRA COSTA WJNTY
INST'RUCTI0NS TO CLAI34MU
A. Claims relating to causes of action for deawh 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 I,
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. (Gout. 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, 681 Fine 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, Venal. Code Sec. 72 at the end of tris
form.
* * * * * * * p it * * * * I * * * * * * * * * * * * * * * * * * * * * * * * * * * *
RE: Claim By ) Reserved for Clerk's filing stamp
REIVED
Against tie County of Contra. Costa }
MAY 0 6 2003
or )
tf!'I'4d i CLERK 8 ARD OF,- - ERV 8 RS
Districts cN TRA cc�sra Co,
i11 in name
The undersigned claimant hereby makes claire against the County of Contra Costa or
the above-named District in the sum of 0-0, 62 and in support of
this claim represents as follows:
1. When did the damage or injury occur? (Give exact date and hour)
2. Where did the damage or injury occur? (Include city and county)
3. How ;did the damage or injury occur? (Give full details; use extra pa er f
required� � ,f��' �' r��"'%� .���� � "
4. What particular act or omission on the part of county or district officers,
servants or -employees caused. the injury or damage?
/-, rel/ zC
(over)
Wnat are the names of county or district officers, servants Or eMP1OYeeS causing
the damage or injury?
C4,
W #AX YA
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 dame.) .�•�
8. Names and addresses of witnesses, doctors and hospitals.��N�
9. List the expenditures you made on account of this accident or injury;
DATE ITEM AMOUNT
Gov. Code Sec. 910:2 provides:
eby
SENO NOTICES TO: (Attorne ) or b elaim some 2ersoneonyhis-ghalfe"claimant
Name and Address of Attorney
Claimant's Si Lure
Address
Telephone No. Telephone No ,��'}
N 0 T I C E
Section 72 of the Penal Code provides:
"Every person who, with intent to defraud, presents for allowance or for
payment to any state board or officer, or to any county, city or district board or
officer, authorized to allow or pay the same if genuine, any false or fraudulent
claim, bill, account, voucher, or writing, is punishable either by imprisonment in
the county jail for a period of not more than one year, by a fine of not exceeding
one thousand ($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.
CROCKETTS PREMIER AUTO BODY
900 SAN PABLO AVE
PINOLE, CA 94564
(510) 741-9001
CD LOG NO 9033-1 DATE 04/15/03
SHOP: CROCKETTS PREMIER AUTO BODY INSP DATE: 04/16/03
ADDRESS : 900 SAN PABLO AVE, CONTACT: MICHAEL DEMELLO
CITY STATE: PINOLE, CA PHONE 1 : (510) 741-9001
ZIP: 94564- FAX: (510) 741-9009
OWNER: LITYNSKY, GARY HOME PHONE: (510) 787-3258
ADDRESS : 576 EDWARDS ST.
CITY STATE: CROCKETT, CA
ZIP: 94525-
LIC# : 5J37724 STATE: VIN: 1FTCR14U6TPB10892
BODY COLOR: GOLD MILEAGE:
CONDITION: ACCTNG CTL# :
*=USER-ENTERED VALUE E=REPLACE OEM NG=REPLACE NAGS
EC=REPLACE ECONOMY UC=RECONDITIONED PRT UM=REMAN/REBUILT PRT
EU=REPLACE SALVAGE EP=REPLACE PXN PC=PXN RECONDITIONED
PM=PXN REMAN/REBUILT TE=PARTL REPL PRICE ET=PARTL REPL LABOR
IT=PARTIAL REPAIR I=REPAIR L=REFINISH
BR=BLEND REFINISH TT=TWO-TONE CG=CHIPGUARD
SB=SUBLET N=ADDITIONAL LABOR RI=R&I ASSEMBLY
P=CHECK AA=APPEAR ALLOWANCE RP=RELATED PRIOR
UP=UNRELATED PRIOR
1996 FORD RANGER XLT 2DOOR EXT CAB 6CYL GASOLINE 3 . 0
CODE : P8324A/D OPTNS I/24JA
OPTIONS :
TWO-STAGE - EXTERIOR SURFACES TWO-STAGE - INTERIOR SURFACES
POWER STEERING REAR STEP BUMPER
OP GDE MC DESCRIPTION MFG. PART NO. PRICE AJ% B% HOURS R
E 0005 01 BUMPER, FRONT F57Z17757AA 222 . 20 1 . 5 1
E 0080 STRIP, FRONT IMPACT F37Z17K833C' 42 . 53 INC 1
E 0009 DEFL, FRONT BUMPER F37Z17626D 129 . 43 INC 1"
E 0018 FILLER, FRONT BUMPER LT F37Z17A861B 9 . 73 INC 1
E 0010 BRACE, FRONT BUMPER LT F37Z17B895A 20 . 00 INC 1
E 0037 BRKT, FRONT BUMPER M LT F37Z17752B 40 . 37 INC 1
1 0030 PANEL, FRONT END REPAIR 0 , 5*1
RI 0030 PANEL, FRONT END R&I ASSEMBLY 2 .4 1
L 0030 1.3 PANEL, FRONT END REFINISH 2 . 3 4
N 0973 HEADLAMPS AIM ADDNL LABOR OPERA 0 . 5 1
E 0103 FENDER, FRONT LT F37Z16006A 200 . 00 1 . 8 1
L 0103 FENDER, FRONT LT REFINISH 3 . 1 4
E 01.17 NAMEPLATE, FENDER LT F67Z16720A 7 . 98 0 . 2 1
PAGE 1
04/16/03
X996 FORD RANGER XLT 2DOOR EXT CAB
CD LOG NO 9033-1
ET 0496 ST IPE, FENDER UPPER LT LABOR/PARTL REPLA 0 .3 1
TE 0431 01 STRIPE ASSEMBLY LT PART/PARTIAL, REPL 86 .37 1
BR 0209 PNL,FRONT DOOR OUTE LT BLEND REFINISH 1 . 3 4
RI 0285 W/STRIP,BELT OUTER LT R&I ASSEMBLY 0 . 2 1
ET 0060 STRIPE, FRONT DOOR U LT LABOR/PARTL REPLA 0 .4 1
RI 0229 MIRROR,OUTER STANDA LT R&I ASSEMBLY 0 . 3 1
RI 0253 CHANNEL, FRONT GLASS LT R&I ASSEMBLY 0 . 2 1
RI 0227 HANDLE, FRONT DOOR O LT R&I ASSEMBLY 0 . 6 1
N M15 COLOR TINT ADDNL LABOR OPERA 0 . 5*4
N M17 COVER CAR EXTERIOR ADDNL LABOR OPERA 0 . 3*4
N M58 CLEAN FOR DELIVERY ADDNL LABOR OPERA 0 . 5*1
SB M60 HAZARD. WSTE. REM. SUBLET REPAIR 2 . 00* 1
N M66 COLOR, SAND & BUFF ADDNL LABOR OPERA 1 . 0*4
N M70 COVER CAR INTERIOR ADDNL LABOR OPERA 0 . 3*4
RI CYL, FRT DOOR LOCK LT R&I ASSEMBLY 0 .2*1*
28 ITEMS
MC MESSAGE (S)
01 CALL DEALER FOR EXACT PART NUMBER j PRICE
13 INCLUDES 0 . 6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE
FINAL CALCULATIONS & ENTRIES
GROSS PAR'T'S 758 . 61
PAINT MATERIAL 237 . 60
PARTS TOTAL 996 . 21
TAX ON PARTS & MATERIAL @ 8 . 250% 82 . 19
LABOR RATE REPLACE HRS REPAIR HRS
1-SHEET METAL 64 . 00 8 . 1 1 . 5 614 .40
2-MECH/ELEC 68 . 00
3-FRAME 68 . 00
4-REFINISH 64 . 00 6 . 7 2 . 1 563 .20
5-PAINT MATERIAL 27 . 00
LABOR TOTAL 1, 177 . 60
TAX ON LABOR 0 . 000%
SUBLET REPAIRS 2 . 00
TOWING
STORAGE
GROSS TOTAL 2, 258 . 00
NET TOTAL 2, 258 . 00
ADP SHOPLINK U0080 ES CD LOG 9033-1 DATE 04/16/03 04 : 02 :44PM RG .3 CD 03/03
PXN. Y/00/00/00/00/00 CUM 00/00/00/00/00 GEOCODE 94525
HOST LOG
(C) 1998 - 2002 ADP CLAIMS SOLUTIONS GROUP, INC.
1 . 8 HRS WERE ADDED TO THIS EST. BASED ON ADP TWO-STAGE REFINISH FORMULA.
PAGE 2
04/16/03
'1996 `CORD RANGER XLT 2DOOR EXT CAB
CD LOG NO 9033-1
--------------------------------------------------
'PHIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PAR'I'S SUPPLIED BY A
SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES
APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER. OR
DISTRIBUTOR OF THE PAR'I'S, RATHER THAN BY THE ORIGINAL MANUFACTURER OF YOUR.
VEHICLE .
PAGE 3
04/16/03
Date: 418/03 01:26 PM
Estimate ID: 13943
Estimate Version: 0
Preliminary
Profile ID: BYRON$
BYRON ORRIS INC .
806 ENTERPRISE WAY NAPA,CA 94558.6209
(707)2534615
Fax: (707)253-8314
Damage Assessed By: David Reynolds
Deductible:
insured: GARY LITYNSKY
Address: 576 EDWARDS ST.CROCKETT,CA 94525
Telephone: Home Phone: (510)787.3255
Mitchell Service: 912621
Description: 1996 Ford Ranger XLT Vehicle Production Date: 4/96
Body Style: 2D PkupXCb V Bed 125"WB Drive Train: 3.O1-Inj S Cyl 2WO
VIN: iFTCR14U6TP810892 License: 5J37724 CA
Mileage: 61,677
OEMIALT: a Search Code: LOCATOR
Color: BEIGE MET.
Options: AIR CONDITIONING,POWER STEERING,AM-FM STEREO CASSETTE,PASSENGER-FRONT AIR BAG
DRIVER-FRONT AIR BAG
Line Entry Labor Line Item Part Type/ Dollar Labor
Item Number Type Operation Description Part Number Amount Units
1 AUTO BOY OVERHAUL FRT BUMPER ASSY 1.2
2 200349 BOY REMOVE/REPLACE FRT BUMPER FACE BAR F57Z 17757 AA 222.20 INC
3 AUTO BOY REMOVEIREPLACE FRT ADD W/IMPACT STRIPS 0.3
4 200354 BOY REMOVEIREPLACE FRT BUMPER IMPACT STRIP F37Z 17K833 A 44.20 INC
5 228752 SOY REMOVEIREPLACE FRT BUMPER VALANCE PANEL F37Z 17626 F 116.67 INC
6 201680 BOY REMOVE/INSTALL GRILLE ASSY INC #
7 201940 BOY REPAIR GRILLE MOUNTING PANEL Existing 1.5*#
8 AUTO REF REFINISH GRILLE MOUNTING PANEL C 1.2
9 202080 BOY REMOVEIINSTALL R HEADLAMP ASSY 0.7 #
10 202090 BOY REMOVE/INSTALL L HEADLAMP ASSY 0.2 #
11 200012 BOY REMOVEIINSTALL R PARK/MARKER LAMP 0.2
12 200013 BOY REMOVE/INSTALL L PARKIMARKER LAMP INC
13 200393 SOY REMOVEIREPLACE L INSTALL FENDER STRIPE 0.2
14 200395 BOY REMOVEIREPLACE L INSTALL DOOR STRIPE 0.2
15 900500 BDY* ADD`L LABOR OP TIME TO REMOVE OLD STRIPES Existing 0.3*
16 228734 BOY REMOVEIREPLACE L STRIPE TAPE BODY SIDE ORDER FROM DEALER 86.37
17 205470 BOY REMOVEIREPLACE L FENDER PANEL F37Z 16006 A 200.00 1.8 #
18 AUTO REF REFINISH L FENDER OUTSIDE C 2.5
19 AUTO REF REFINISH L FENDER EDGE C 0.5
20 205550 BOY REMOVE/REPLACE L FENDER BRACE E9TZ 16A024 A 5.30 0.1
21 205790 BOY REMOVEIREPLACE L FENDER ADHESIVE NAMEPLATE E9TZ 16720 C 14.47 0.1
22 206798 BOY REMOVEIINSTALL FENDER SPLASH GUARD Existing 0.3*
23 219290 REF BLEND L FRT DOOR OUTSIDE C 1.0
24 200576 BOY REMOVE/'INSTALL L FRT DOOR MIRROR INC #
25 200580 BOY REMOVEIINSTALL L FRT DOOR TRIM PANEL INC
26 220160 BOY REMOVEIINSTALL L FRT DOOR HANDLE&LOCK CYL 0.5 #
27 220560 BOY REMOVE/INSTALL L FRT OTR BELT WEATHERSTRIP 0.4 #
ESTIMATE RECALL NUMBER: 41810313:25:59 13943
UltraMate Is a Trademark of Mitchell International
Mitchell Data Version: APR_03_A Copyright(C)1994-2000 Mitchell International Page 1 of 3
UltraMate Version: 4.8.012 All Rights Reserved
Date: 418103 01:26 PM
Estimate ID: 13843
Estimate Version: 0
Preliminary
Profile ID: BYRONS
28 220580 BDY REMOVEIINSTALL L FRT UPR GLASS RUN 0.8 #
29 AUTO REF ADIYL OPR CLEAR COAT 1.7*
30 933003 BDY* ADD'L OPR TINT COLOR 0.5*
31 933008 BDY* ADD'L OPR CHIP RESISTANT MATERIAL APPLICATION 12.00* 0.3*
32 AUTO REF ADD'L OPR COLOR SAND r&BUFF 1.5
33 933018 BDY* ADD'L OPR MASK FOR OVERSPRAY 5.00* 0.2*
34 AUTO ADD'L COST PAINTIMATERIALS 220.80*
35 AUTO ADD'L COST SHOP MATERIALS 4.91 *
36 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL 1.73*
*-Judgement Item
#-Labor Note Applies
C -Included in Clear Coat Calc
Add'I
Labor Sublet
1. Labor Subtotals Units Rate Amount Amount Totals 11. Part Replacement Summary Amount
Body 9.8 70.00 17.00 ---6-0-0 703.00 Taxable Parts 689.21
Refinish 8.4 70.00 0.00 0.00 588.00 Sales Tax @ 7.750°tai 53.41
Non-Taxable Labor 1,291.00 Total Replacement Parts Amount 742.62
Labor summary 18.2 1,291.00
lit. Additional Costs Amount IV. Adjustments Amount
Taxable Costs 225.71 Customer Responsibility u 0.00
Sales Tax @ 7.750% 17.49
Non-Taxable Costs 1.73
Total Additional Costs 244.93
1. Total Labor: 1,291.00
11. Total Replacement Parts: 742.62
Ill. Total Additional Costs: 244.93
Gross Total: 2,278.55
IV. Total Adjustments: 0.00
Net Total: 2,278.55
This is a prellminam estimate.
Additional changes to the estimate may be required for the actual repair.
Point(s)of Impact
11 Left Front Corner(P)
ESTIMATE RECALL NUMBER: 418103 13:25.59 13943
UltraMate Is a Trademark of Mitchell International
Mitchell Data Version: APR_03_A Copyright(C)1994 0 2000 Mitchell International Page 2 of 3
UltraMate Version: 4.8.012 All Rights Reserved
Date: 4/8/03 01:26 PM
Estimate 10: 13843
Estimate Version: 0
Preliminary
Profile ID: BYRONS
WARNING: Accidental air bag deployment Is possible. Personal injury may result. Avoid area near steering wheel
and instrument panel even If air bags have deployed. Dual-stage air bag modules may be present that could
contain an undeployed stage. When disposing of a deployed dual-stage air bag,always treat It as a"live"module.
See appropriate MITC;HELLO AIR BAG SERVICE&REPAIR MANUAL,or OEM information.
ESTIMATE RECALL NUMBER: 4/8/03 13:25:59 13943
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: APR-03_A Copyright(C)1994-2000 Mitchell International Page 3 of 3
UltraMate Version: 4.8492 All Rights Reserved
. CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: JUNE 10, 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
s Pursuant to Government Code Section 913 and
} 915.4. Please note all"Warnings"
AMOUNT: $900.00 '
CLAIMANT: HZTESH PATEN
ATTORNEY: UNKNOWN DATE RECEIVED: - _mAY 07, 2003
ADDRESS: 5415 NAVAJO COURT BY DELIVERY TO CLERK ON: MAY 07, 2003
ANTIOCH, CA 94531
BY MAIL POSTMARKED: HAND DELIVERED
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN S WEETJ�N rk
Dated: MAY 07) 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: ... L,3 By: Deputy County Counse'
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.
JUNE 10 2003
Dated: JOHN SWEETEN, CLERK, By , Deputy Clerk
WARNING(Gov. code section 9 f 3)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposite
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 full}
prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above.
Dated: TUNE 11 , 2003 JOHN SWEETEN, CLERK.By Deputy Clert
13:40 CCC RISK MANAGMENT 925 335 1421 P.01 _
Cla ire ,to: BOARD OF SUPERVISORS OF ClOh TRA COSTA OYXNTY
INSMUCTIONS :O MAI"MANT
A. Claims relating to causes of action for death or for injury to person or to per-
sona-1
er .soral property or mowing crops and which accrue on or before December 111, 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 uhich accrue on or after January I,
1933, 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 thp.'1 one year after the accrual of the cause of action. (Govt. Cade §911.2.}
B. Claims must be filed with the Clerk of the Board of Supervisors at its _off'ice in
Room 106, County Administration Building, 651 Pine Street, Mwrtinez, CA 94553-
C. if claim. is against a district governed by the Board of Supervisors, rather tl an
the County, the name of the District should be filled in.
D. if the claim is against more than one public entity, separate clai= must be
filed against each public ent:Ity.
E. ' Fraud. Sen penal ty for fraudulent clai
MAR-06-2003 13:40 CCC RISK MANAGMENT 925 335 1421 P.02
5. wriat are tne names of county or district officers, servants or employees causing
the damage or injury?
6. What damage or injuries do you claim resulted? (Give full extent of injuries or
dames claimed. Attach two estimates for auto damage.
7. How uss the amount claimed above =Vuted? (Include the estimated amount of any
prospective injury or damage.)
8. 'Names and addresses of witnesses, doctors and hospitals.
9. List the expenditurres you made on account of this accident or injury:
DATE TTEY Ax' J 1T
iL
Gov. Code Sec. 910:2 provides
"The claim must be signed by the claim-ant
SEND NOTICES TO: (Attorney) or P1 some person on his.behalf."
Name and Address of Attorney
Claisant's Suture
Address
Telephone No. Telephone No.
N O T I C E
Section 72 of the Renal. Cade provides:
"Every person who, with intent to defraud., presents for allowance or for
paYmer: 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 tune year, by a fine of not exceeding
one thousand ($l,(�3Q}, or by both such imprisoriment and fine, or by imprisonment in
the state prison, by a fire of not exceeding ten thousand dollars ($10,000, or by
bath such i prison=wnt and Pine.
TOTAL R.02
04/23/2003 at 04 :18 PM Job Number:
13975
MAGNUS5EN'S FREMONT AUTO BODY
License #:AF216532 Federal ID #:543395425
39700 BALENTINE DR
NEWARK, CA 94550--9456
(510) 360-7166 Fax: (510) 683-9110
PRELIMINARY ESTIMATE
Written by: STACEY GARCIA #
Adjuster:
Insured: SHITAL PATEL Claim #
owner: SHITAL PATEL Policy #
Address: 5415 NAVAJO CT Deductible:
ANTIOCH, CA 94531 Date of Lass:
Day: Type of Loss;
Evening: Point of Impact:
Inspect
Location:
Insurance
Company: Days to Repair
2001 MITE GALANT ES 4-2.4L-PI 4D SED SILVER Int:
VIN: 4A3AA46H61E273934 Lic: Prod Date: 03/2001 Odometer: 51757
Air Conditioning Rear Defogger Tilt Wheel
Cruise Control Intermittent Wipers Keyless Entry
Body Side Moldings Dual Mirrors Fog Lamps
Clear Coat. Paint Power Steering Power Brakes
Power Windows Lower Locks Power Mirrors
Driver Air Bag Passenger Air Bag Cloth Seats
Bucket Seats Recline/Lounge Seats
-----------------------_--_-_---_------_-_°---_--------_--------------__-__-----_-
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
-------------------------------------------------------------------------------
1 FRONT BUMPER
2 Repl Add for fag lamps 2 0.4
3 O/H bumper assy 2 .2
4 Repl Bumper cover 1 187.50 Incl. 2 .6
5 Add for Clear Coat 1.0
6 FENDER
7 Repl RT Fender liner 1 25.63 0.4
8# Repl TINT COLOR 1 0.5
9# Repl HAZARDOUS WASTE 1 3 .00 X
10# FLEX AGENT l 8 .00 Incl.
2l#$ COLOR SAND & POLISH 1 0.5
-------------------------------------------------------------------------------
Subtotals ==s 224.13 4.0 3.6
Parts 221 .13
Body Labor 4.0 hrs @ $ 70.00/hr 280.00
Paint Labor 3.6 hrs @ $ 70.00/hr 252.00
Paint Supplies 3.6 hrs @ $ 30.00/hr 208.00
Sublet/Misc. 3 .00
----------------------------------------------------
SUBTOTAL $ 864.13
Sales Tax $ 329.13 @ 8.2500% 27.25
----------------------------------------------------
GRAND TOTAL $ 891.28
ADJUSTMENTS:
Deductible 0.00
I
04/23/2003 at 04:18 PM Job Number:
13975
PRELIMINARY ESTIMATE
2001 MITS GALANT ES 4-2 .4L-Fl 4D SED SILVER Int:
-----------------°-_----------------------------------
CUSTOMER PAY $ 0.00
INSURANCE PAY $ 891.28
Magnussen's Fremont Autos Body offers a Limited Lifetime Warranty on all
Workmanship. This offer is valid for as long as you own the vehicle and is non
transferable.
THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO
DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MO'T'OR
ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART A=APPROXIMA`T'E PRICE LABOR TYPES:
B=BODY LABOR D=DIAGNOSTIC E=ELtEC'TRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT
LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X:NON TAXED MISCELLANEOUS PATHWAYS:
ADJ=ADJACENT ALGN@ALIGN A/M=AFTERMARKET BLVD=BLEND CAPA=CERTIFIED AUTOMOTIVE
PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT
PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL
AUTO CLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION
NO=LINE NUMBER Q'T'Y=QUANTITY QUAL RECY=QUALI`T'Y RECYCLED PART QUAL REPL=QUALITY
REPLACEMENT PART RECOND=RECONDITION REFN=REFINISH REPL,=REPLACE R&I=REMOVE AND
INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET
LT=LEFT W/O=WITHOUT W/_=WITTY/_ SYMBOLS: #=MANUAL, LINE ENTRY *=OTHER [IE. .MOTORS
DATABASE INFORMATION WAS CHANGED) **=DATABASE LINE WITH AFTERMARKET N=NOTES
ATTACHED TO LINE.
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived
from the Guide ARP6241 Database Date 12/2002 and the parts selected are OEM-parts manufactured
by the vehicles Original Equipment Manufacturer. Asterisk (*) or Double Asterisk (**) indicates
that the parts and/or labor information provided by MOTOR may have been modified or may have
come from an alternate data source. Non-Original Equipment Manufacturer aftermarket parts are
described as AM or Qual Repl Parts. Used parts are described as LKQ, Qual Reay Parts, RCY, or
USED. Reconditioned parts are described as Recon. Recored parts are described as Recore. NAGS
Part Numbers and Prices are provided from National Auto Glass Specifications, Inc. Pound sign
(#) items indicate manual entries.
Pathways - A product of CCC Information Services Inc.
2
ADVANTAGE BODY SHOP
41945 ALBRAE STREET
FREMONT, CA 94538
OFFICE: (510) 353-0500 FAX: (510) 353-0555
STATE OF THE ART COLLISION REPAIR
CD LOG NO 8928-1 DATE 04/23/03
SHOP: ADVANTAGE BODY SHOP INSP DATE: 04/23/03
ADDRESS: 41945 ALBRAE STREET CONTACT: JOHN MUNCE
CITY STATE• FREMONT, CA PHONE 1 : (510) 353-0500
ZIP: 94538- FAX: (510) 353-0555
OWNER: SHITAL, PATEL
ADDRESS : 5415 NAVAJO CT
CITY STATE: ANTIOCH, CA
ZIP: 94531-
LIC# : 4UHE883 STATE: CA VIN: 4A3AA46H61E173934
BODY COLOR: SILVER MILEAGE: 51, 741
CONDITION: ACCTNG CTL#:
PROD.DATE: 03/01 PAINT CODE:
*=USER--ENTERED VALUE E=REPLACE OEM NG=REPLACE NAGS
EC=REPLACE ECONOMY UC=RECONDITIONED PRT UM=REMAN/REBUILT PRT
EU=REPLACE SALVAGE EP=REPLACE PXN PC=PXN RECONDITIONED
PM=PXN REMAN/REBUILT TE=PARTL REPL PRICE ET=PARTL REPL LABOR
IT=PARTIAL REPAIR I=REPAIR L=REFINISH
BR=BLEND REFINISH TT=TWO-TONE CG=CHIPGUARD
SB=SUBLET N=ADDITIONAL LABOR RI=R&I ASSEMBLY
P=CHECK AA=APPEAR ALLOWANCE RP=RELATED PRIOR
UP=UNRELATED PRIOR
2001 MITSUBISHI GALANT GTZ 4DOOR SEDAN 6CYL GASOLINE 3 . 0
CODE: G1533D/C OPTNS C/24FHJKROPQL
OPTIONS:
TWO-STAGE - EXTERIOR SURFACES TWO-STAGE - INTERIOR SURFACES
HEATED REMOTE CONTROL MIRRORS MOONROOF
REAR SPOILER ANTI-LOCK BRAKE SYSTEM
TRACTION CONTROL SYSTEM ALARM SYSTEM
CRUISE CONTROL FRONT SIDE IMPACT AIRBAGS
AUTOMATIC TRANS
OP GDE MC DESCRIPTION MFG.PART NO. PRICE AJC B% HOURS R
E 0006 COVER, FRONT BUMPER MR465772 187 . 50 2 . 6 1
COVER TORN AND NOT REPAIRABLE
L 0006 13 COVER, FRONT BUMPER REFINISH 3 .6 4
E 0118 SKIRT, INNER FENDER RT MR972840 25 . 63 INC 1
PAGE 1
04/23/03
2J01 MITSUBISHI GALANT GTZ 4DOOR SEDAN
Cts LOG NO 8.928-1
N M03 FLEX ADDITIVE ADDNL LABOR OPERA 8 . 00* *4*
L M15 COLOR TINT REFINISH 0 .5*4*
I ' M60 HAZARD. WSTE. REM. SUBLET REPAIR 4 . 00* *1*
I OPEN TO TEARDOWN REPAIR 1*
7 ITEMS
MC MESSAGE (S)
13 INCLUDES 0 .6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE
FINAL CALCULATIONS & ENTRIES
GROSS PARTS 213 . 13
OTHER PARTS 8 . 00
PAINT MATERIAL 114 . 80
PARTS TOTAL 335 . 93
TAX ON PARTS & MATERIAL @ 8 .250% 27 . 71
LABOR RATE REPLACE HRS REPAIR HRS
1-SHEET METAL 63 . 00 2 . 6 163 . 80
2-MECH/ELEC 80 . 00
3-FRAME 63 . 00
4-REFINISH 63 . 00 4 . 1 258 . 30
5-PAINT MATERIAL 28 . 00
LABOR TOTAL 422 . 10
TAX ON LABOR 0 . 000%
SUBLET REPAIRS 4 . 00
TOWING
STORAGE
GROSS TOTAL 789 . 74
NET TOTAL 789 . 74
ADP SHOPLINK IJ1362 ES CD LOG 8928-1 DATE 04/23/03 03 : 54 : 19PM R6 . 3 CD 04/03
PXN: Y/00/00/00/00/00 CUM 00/00/00/00/00 GEOCODE 94538
HOST LOG
(C) 1998 - 2002 ADP CLAIMS SOLUTIONS GROUP, INC.
1 . 1 HRS WERE ADDED TO THIS EST. BASED ON ADP TWO-STAGE REFINISH FORMULA.
--------------------------------------------------
THIS ESTIMATE IS BASED ON LOWEST POSSIBLE COST CONSISTENT WITH QUALITY WORK,
AND AS SUCH, IS GUARANTEED. ITEMS NOT COVERED BY THIS ESTIMATE OR HIDDEN
WILL BE ADDITIONAL. REPAIRS NOT PERFORMED BY OUT FACILITY, BUT NOT LIMITED
TO GLASS, UPHOLSTERY, AIR BAGS, AND SOME MECHANICLA WORK WILL BE LISTED AS
"SUBLET" ON THE ESTIMATE OF REPAIRS . THESE REPAIRS CARRY THE SAME GUARANTEE
AS ALL OTHER REPAIRS PERFORMED BY OUR ORGANIZATION.
PAGE 2
04/23/03
2001 MITSUBISHI GALANT GTZ 4DOOR SEDAN
CD"LOG NO 8928-1
IP YOUR. INSURANCE COMPANY REQUIRES THE USE OF PARTS PROVIDED BY AN OUTSIDE
SOURCE OTHER THAN THE MANUFACTURER, THE CUSTOMER WILL BE INFORMED UPON
APPROVAL OF ABOVE SAID REPAIRS.
PAGE 3
04/23/03