Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
MINUTES - 06172003 - C17
CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JUNE 17, 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: OVM $25,000. CLAIMANT: ASHLEY LM MAUPIN RT!iq-- ATTORNEY, WILLIAM L. BERG DATE RECEIVED: MAY 13, 2003 ADDRESS: BERG & ASSOCIATES BY DELIVERY TO CLERK ON: MAY 13, 2003 2440 SANTA CL RA. AVE. , ALAMEDA, CA 94501 BY MAIL POSTMARKED- MAY 12, 2003 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETS erk Dated: MAY 13. 2003 By: Deputy - II. FROM: County Counsel TO: Clerk of the Board of Supervisdrs G.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: # C -13y: Deputy County Counsc 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: JUNE 17 , 2003 JOHN SWEETEN, CLERK, By Deputy Clerk WARNING (Gov. code sectidn' 913) Subject to certain exceptions, you have only six(6)months from the date this notice was personally served or deposiv 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: JUNE 18 , 2003 JOHN SWEETEN, CLERK By -Deputy Clei Q -2 9--2003 le.;1,2 CC:C *i K 925 335 1421 P.02 Claim, to: BOM OF SUPERVISMS OF COMM C=A CCCY TO CLAVW A. Claims relating tca Cuaes of action for death or for JnJu:'y to per Son or to per- sonal y pr opeertyor` prey,wing c o � utich accrue n o}r�befor��e+y,�£�ecember� 33, 1.937, Tt st be presented of latert� � 100th day after 1 he p'rc accrual o iad¢te cruse of actio. Claim relating to causes of action f'or'.c4eath or for in,# W person or to pet=Al property or growing crops wd ash accrue on or after .wary i, 1988s must be presented not later than 311 M=tha anter the accormlcar the cause of action. Clai=as relating to any other cause of actio must be presented not later than one year after the accrual of the cause of action. (Govt. Code 5911-2.) B. Mai= =z3t be filed with the Clark or the Bcard of &n*rvisors at its .office in Root. 106, County Administration Building, 652 Pira Street, Hutinez, CA 94553. C. if claim is against a district governed by the Board of Supervisors, rather than the County, the rye of the District should be filled in. D. if ttm claim is against awe than one public entity, separate claims must be filed against each public entity. E. ' Fraud. See .benalty for fraudulent claims, Fes. Code Sec. 72 at the end of this REEzz a �t � * �► � � � +a � sa �ta �tea �r * � a � � e� tt � � ea +� � � a � art � * �a � � � at � Claim By Reserved ,for Clerk's filing stamp } Ashley �ynn Maupin � RECEIVED ` W of t MAY 14 2003 District) CLERK BOARD Of SUPERVISORS trill in nam CONTRA COSTA CO. The Undersi d *1&1=nt Aeby makes claim against the County of Contra Costa or the acbOve District in the sum Of $ over $25.000 and In support. of this claim represents as follows.. 1. When did the damage or, ir,ju y occstr?a (Give est date and your) November 2.1, 2002 at 12:58 p.m. 2. Were did tha damage, ter injury *=Ur*. (Include City and county) In front of Hercules Middle High School, Southbound Refugio Valley Road,Hercules,Contra Costa ...� ....�.,......«�.�........ 3. How did the dame or injury Cacur? (Give Rall, details; use extra paper ifCounty required) Ms. Maupin was preparing to pull away from the curb when her vehicle was was struck by a speeding motorist. She was parked on Refugio Valley Road, which is a one-way street with a 25 mph- posted speed limit. 4. Uhat particular act or omission ca the art of qty or district officers, aceta Or,eq4zyees wed.t .injury or. ? Contra Costa County is negligent f.or .allowing--ve-hicles to.-park on a busy one-way street in front of a high school where there is a lot of traffic. There should be no parking permitted in this area; or traffic control signs, signals, or devices should be installed. rtnat are the names of county or district officers, servants or employees causing the damSe or injury? Unknown at pretent. 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach tuo estimates for auto Vie. Ms. Maupiri sustained a fractured nese, facial lacerations, 67 stitches and her front teeth were knocked out. Her automobile was a total loss. 7. Hoer was the am unt claimed above muted? (Include the estimated amount of any prOspeCtive injury Or e-) No bills received from Kaiser Hospital yet. Future oral surgery will be necessary. This case will lie in the Superior Court, Unlimited Jurisdiction. Names and addresses of witnesses, doctors and hospitals. See attached police report, prepared by the .Hercules Police Department. q. List the expenditures you rade on account of this accident or inJury: DA'f.'"E ITEM AMOUNT 11%21/2002 Ambulance Bill. $1,071.78 11/21/2002 Kaiser Hospital Unknown at present. 01/08/2003 Keith Gronbach, D.D.S. $ 193.00 e e e e e e +v. Code See ' { provides s "The claim sued. by the claimant SES i�IC TC. (Attorney) or s+ on his.behalf." Name and Address of Attorney R< f ht ss Telephone No Telephone No. oe N0TIGE Section 72 of the Pen.21 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 .ane if,genuine, any false or fraudulent claim, bill, account.$ voucher, or writing, is punishable either by imprisor;mwt in the county jail for a period of not owe than one.year, by a fine- of not exceeding one thousand ($1,000),, or by*both suah ip�rLiorknnt and fine,% or by imprisonment in the state prison, by a fine of not exceeding tern thousand,dollars (*1010W, or by both such imprisonment nt and fine. TOTAL. €'.03 1 PROOF OF:SERVICE §1912.5 1.013a,2015:5 ,C.R..0 2008] - 2 . y d n I amem to ed in the Coon of Alameda, State of California:I am elver the.age of 18 3 =afid nota party to the cause herein;my business address.is 2440'Santa Clara Avenue, da,-California 94501. 4` Qri May 12.2003 ;I served`the attaehed 6 NOTICE OF CLAIM cin the interested dies an said cause;by causing an anginal or tnae copy'thereof be enclosed 8 'in a sealed envelope;addressed as follows {' 9 Cle'rkW the B6ird 6f"Supervlsars County Adminlstration Building. 10 651)E"iue Scree#,Rr�ciirr `10iS ,11 M rtme4'CA 94553 I3 MAIL I caused such'envelop with postage thereon fully prepaid to be placed in the `12, mated States mail, ari the City ofAlameda, Cal ifornra * , 13 () B Y ftk! tONAI, SERVICE I caused such eaivelope to b elavered by hand to the offices) ofthe addressees} `.,BY FEDERAL EXP ESS; I caused s€ich envelope to be delivered to Federal Express for F; 15 overnight courier service`to the offiice{s}ufthe addressees) 16 () BY EXPRESS M14IT I caused such envelope to be delivered to an Express,mad picklin box for overnight service tci the oce(s}of the addaressee{s) 17- {}-.,.-BYFACSIMILE I caused a copy of such document to be sen#via 1 - imde to the fficeW 18 ref the address+ (s) 19 I declare under penalty of penury under the laws o .the.State pf Ca 'rforaao Haat fo goiq i true and correct and that this'declaration was executed on M�iy 124226- ,`in . 20' Alameda,California 21 , 22 'iAw U Fain '23, , 24` 25 26- 27 6 27 28x PR©OF.`0F SERVICE TRAFFIC COLLISION REPORT CHP 555 Page 1(Rev.8-97) OP1 042 i Pape of SPEC CONDITIONS rxTa Rwl CITY JUDK:Wt DISTRICT LOCAL REPORT NUMBER WJIM90 FELONY . �EZCQ C-e.S ` RUMAER RlulD Nil&RUN NOR 7 COUNTY REPORTING DISTRICT BEAT � ,,, r'�� — ��/.y\/� MustlEMEAT L C 6,47EP, Cry&-r 7- COLUSiON OCCURRED ON MO. /A�y YEAR WINE{24aK) YbCSC i `OFFICER I.D. MtL9POST INFORMATION DAY OF WEEK TOW AWAY PHOTOGRAPHS BY: ❑NONE FEETIMR,Es OF S M T W F $ IYES [] NO 0 AT WT€1RSECTION WITH STATE HWY REL (Q.-ES t ao2-r'}(• OF -I a- OYES ,NO I 3lLiwhld s,.r, L.i<.,R.S.S. PARTY DRIVER'S LICENSE NUMBER ISTATE • CLASS SAFETY VEH.YEAR MAKFaMOOEUtCOLOR LICENSE NUMBER `STATE Cirt------- ---}- --- - ---- ---- � ppry� NAME fFi@ST,MIDDLE,LAST) 4+A 7 i. >I ,� } OWNER'S NAME SAME AS DRIVER PEDTRRWI STREET ADDRESS - /'4'` !2 e 11L "t✓t{+' #.�-• . (j 1 93 006, OWNef's ADDRESS �SAME AS©RIVER FAR>G@ ICITYISTATE121P 4ER f DISPOSITION OF VEHICLE ON ORDERS OF: y � � OFFICER DRIVER OTHER BICC• SEMR 'EYES HEIGHT WEIGHT BIR7HOATE RACE 1117 CLOT )"" l � z—,;r (f) PRIOR MECHANICAL DEFECTS: NONE APPARENT REFER Tp NARRATIVE OTKR HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER: g. •�r}�,�^'!�' i,•,r"°✓,.�j, 4 "'` 1pl!�—: CHP USE ONLY DESCRIBE VEHICLE DAMAGE V SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE f'-}LINK ®NONE F-1 MINOR L❑–I MOD, C&MAJOR❑ROLL-OVER DIRCOFTRAVEL tON STREET OR HiG Y ,y y�, SPEED LIMIT .,ryCA T-kA Cris �l�[`i..l..Z"e. 1`--��5 sS�- M/l 14 CAL•T TCPMSC. �T Mcn�iz. PARTY DRIVER'S LICENSE NUMBER STATE GLASS SAFETY VttL, YEAR AAAKEW00 L+COLOR LICENSE NUMBER STATE Ea3,R f6Lu <j_11k G4 --------------------- ---------------- DRNER NAME(FIRST,MfOME,LAST) o t-. I !! ``�` OWNER'S NAME �„�,,�, t..� (V S"� Ix SAME AS DRIVER FERES• STREET ADDRESS Tom - (� ... OWNER'S ADDRESS F I '�' "Y''e-"�• - SAME AS DRIVER PARKED CITYMTATEW YEBiatE {�• c^+ � DISPOSITION OF VEHICLE ON ORDERS OF: S OFFICER DRIVER OTHER CK:Y• SEX ]NAIR E'YES.. HEIGHT WEIGHT ! BiRTHDA RACE L� CULT ..+ j �„" Ma. Day Year itc• , I+�� PRIOR MECHANICAL DEFECTS: NONEAPPARENT REFER TO NARRATIVE -. - -_ OTHER HOME PHONE I BUSINESS PHONE VEHICLE IDENTIPiCATiON NUMBER: :t.J f3 - t Vt I _1!5- , CHPUSEONLY DESCRIBE VEHICLE DAMAGE .'h .. SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER VEHICLE TYPLINK Fj NONE MINOR .. MOD. X MAJOR ROLL-OVER R OF TRAVEL I ON STREET OR HIGHWAY SPEED LIMIT CA DOT +r F--,P; UI L�...�C._ P I`T"� )4- CA4T TCPPSC MCAV PARTY DRIVER`S LICENSE NUMBER STATE STATE CLASS SAFETY VE,H-YEAR MAKKE&ODEUCOLOR LICENSE NUM IDER STATE, 3 0aak �" `. ,r+ A„ f` SOUP. LJ7 4 &V&4 ;t y- y..+•r--_ awfil NAME fF.JA'SP,WDDL,JAST} t.�-P1 4... --'-------------------- +. OWNER'S NAME SAME AS DRIVER TW��� STREET ADDRESS 0 15; T-t a OWNER'S ADDRESS VE ��` ,J��-l�t...`� I"V I`�' �y,�y � SAME xAS,�DR�yNER m eD c37Y1S'TA7FJ2!P Z5�� /Y74-r-4, r /4-� {+v 1-T-A w ,.. - DISPOSITION OF VEHICLE ON ORDERS OF: ®OFFICER®DRIVER g OTHER CBt16T SEX HAIR EYES HEIGHT WEIGHT BIRTHDATE RACE t Ma. Oil Year '(,., elle, PRIOR MECHANICAL DEFECTS: NONe APPARENT L7 REFER TO NARRATIVE OTRER HOME PHONE BUSRV$88 PHONE VEHICLE 10ENTIFICATION NUMBEIR:3 FA-f=vo - - 9 CHP Litt ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE 1-1LINK []NONE F�MINOR I OD. []MAJOR[]ROLL-OVER OIR OF TRAV€L T ON STREET OR HIGHWAY [SPEED LIMIT CA DOT CAL•T TCPP'SC MCAw PREPARERS NAME DISPATCH NOTIFIED REVIEWER'S NAME DATE REVIEWED / iCi' YES []NO NIA STATE OF CALIFORNIA TRAFFIC COLLISION CODING CHP 555 Pada 2(Rev.8-97) OPI 042 Page of [DATED,COPSION O. DAY YEAR) TIME(24M NCIC# O€€ICER f.D. NUMBER - 16, OVM4NER'S NAME OVNNER'S ADDRESS ,��f'````'��� NOTI€IED PROPERTY * j YES L] NO DAMAGE DESCRIPTION OF DAMAGE SEATING POSITION SAFETY EQUIPMENT EJECTED FROM VEHICLE OCCUPANTS L-AIR BAG DEPLOYED M i C BICYCLE-HELMET A-00 IN VEHICLE M-AIR BAG NOT DEPLOYED 0-NOT EJECTED B-UNKNOWN N-OTHER DRIVER 1-FULLY EJECTED C-LAP BELT USED P-NOT REQUIRED V-NO 2-PARTIALLY EJECTED D-IAP BELT NOT USED W-YES 3-UNKNOWN { Z i-DRIVER €-SHOULDER HARNESS USED 2 TO 6-PASSENGERS F-SHOULDER HARNESS NOT USED CHILD RESTRAINT PASSENGER 8 5 5 7.STATION WAGON REAR G-LAP/SHOULDER HARNESS USED ZI-IR WHZIE U ED X-NO 8-REAR OCC.TRK.OR VAN M-LAP/SHOULDER HARNESS NOT USED R-IN VEHICLE NOT USED Y-YES 9-POSITION UNKNOWN J-PASSIVE RESTRAINT USED S-IN VEHICLE USE UNKNOWN 7 0-OTHER K-PASSIVE RESTRAINT NOT USED T-IN VEHICLE IMPROPER USE U-NONE IN VEHICLE ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK('}smouLD BE EXPLAINED IN THE NARRATIVE: PRIMARY COLLISION FACTOR TRAFFIC CONTROL DEVICES TYPE OF VEHICLE MOVEMENT PRECEDING LIST NUMBER # OF PARTY AT FAULT +� +� COLLJSION .y A VC 111=ON WiATNO: a:tD A CONTROLS FDNC T tONiNCa A PASSENGER CAR i STATION WAGON A STOPPED ZZ/04__ Y,,". Y B CONTROLS NOT FUNCTItONtNG' !�B PASSENGER CAR W I TRAILER B PROCEEDING STRAIGHT B OTHER IMPROPER DRWINGw C CONTROLS OBSCURED. 1 C MOTORCYCLEI SCOOTER C RAN OFF ROAD D NO CONTROLS PRESENT/FACTOR D PICKUP OR PANEL TRUCK D MAKING RIGHT TURN C OTHER THAN DRIVER' TYPE OF COLLISION ! E PICKUP I PANEL TRUCK Wl TRAILER E MAKING LEFT TURN D UNKNOWN' A HEAD-ON I F TRUCK OR TRUCK TRACTOR F MAKING U TURN FELL ASLEEP` B SIDE SWIPE G TRUCK I TRUCK TRACTOR W/TRLR. G BACKING C REAR END H SCHOOL BUS H SLOWING i STOPPING WEATHERIVARK i TO 2 aMS1 D BROADSIDE I OTHER BUS I PASSING OTHER VEHICLE A CLEAR E HIT OBJECT J EMERGENCY VEHICLE J CHANGING LANES S CLOUDY F OVERTURNED K HIGHWAY CONST.EQUIPMENT K PARKING MANEUVER C RAINING iG VEHICLE I PEDESTRIAN I IL BICYCLE L ENTERING TRAFFIC D SNOWING H OTHER`: M OTHER VEHICLE M OTHER UNSAFE TURNING E FOG!V#SIBILiTY FT. N PEDESTRIAIJ N XING INTO OPPOSING LANE F OTHER-- MOTOR VEHICLE INVOLVED WITH O MOPED 10 PARKED IQi WIND A NON-COLLISION P MERGING LIGHTING B PEDESTRIAN Q TRAVELING WRONG WAY DAYLIGHT C OTHER MOTOR V€HICLE { 2 13 OTHER ASSOCIATED FACTOR(S) R OTHER-: B DUSK-DAWN D MOTOR VEHICLE ON OTHER ROADWAY (MARK I rO 21TEMS) A C DARK-STREET LIGHTS E PARKED MOTOR VEHICLE vt"ar,0"Vwu foa. caa Yg3 D DARK-NO STREET LIGHTS F TRAIN VC:,. E DARK-STREET LIGHTS NOT G SICYCLE B va sEenaa vmurtO drmD YESFUNCTIONING' ANIMAL NO ROADWAY SURFACE H C D ecsccn�xvaurat crr o YES ,I 2 1 3 8f7B HY'TSIIC-ADLRUG I A DRY { FIXED OBJECT: NO (MARK 1 TO 2ITEMS) H WET A HAD NOT BEEN DRINKING C SNOWY-icy, J OTHER OBJECT: E VISION{OBSCl7REMENT: B MBD-UNDER INFLUENCE SLIPPERY(MUDDY OILY ETC.) IF INATTENTION*: C: HOD-NOT UNDER INFLUENCE' ROADWAY CONDMON(S) G STOP$GO TRAFFIC 1 D'HOD-IMPAIRMENT UNKNOWN* (MARK 1 TO 2ITE4iS) PEDESTRIAN'S ACTIONS H ENTERING I LEAVING RAMP E UNDER DRUG INFLUENCE- !A HOLES DEEP RUT' ANO PEDESTRIANS INVOLVED { PREVIOUS COLLISION F IMPAIRMENT-PHYSICAL' B LOOSE MATERIAL ON ROADWAY` 8 CROSSING IN CROSSWALK J UNFAMILIAR WITH ROAD I G IMPAIRMENT NOT KNOWN C O85TRUCTION ON ROADWAY`' AT INTERSECTION K DEFECTIVE VEM.EQUIP.: CITED ' NOT APPLICABLE D CONSTRUCTION-REPAIR ZONE C CROSSING IN CROSSWALK-NOT ,ES I SLEEPY4 FATIGUED E REDUCED ROADWAY WIDTH AT INTERSECTION ENO SPECIAL INFORMATION F FLOODED' _ D CROSSING-NOT IN CROSSWALK L UNfNVOLVED VEHICLE r A HAZARDOUS MATERIAL G OTHER': E IN ROAD-INCLUDES SHOULDER M OTHER` c.g C4 H NO UNUSUAL CONDITIONS F NOT IN ROAD N NONE APPARENT G APPROACHING I LEAVING SCHOOL BUS O RUNAWAY VEHICLE ETCH LICsNt 4t MISCELLANEOUS I IN CATE NORTH i A 1 i AcrSI Jill a` -V.r.. :._._.::.:..�.....,� ..._. .....-.v.. ..,_..:.._ . . ... ..a.wa OSP 061300 STATE OF CALIFORNIA TRAFFIC COLLISION REPORT CHP 555 Page i (Rev. 8-97) OPI 042 Page -Of BPEOWL CONDIYIdWS W."A RR 'NT a RUN CITY 3UDICIAL DISTRICT LOCAL REPORT NUMBER lN31J €IBLCrr! . { c] W . ci,� NUM401I LID NIT& WN (C�O}U,NNTYY REPORTING DISTRICT SEA 7� l E COLLISION OCCURRED ON MO, AY EAR TIME.(mo) NCIC Y OFFICER I.D. MILEPOST INFORMATION DAY OF WEEK TOW AWAY PHOTOGRAPHS BY: ®'NONE (,) FEETIMILES OF S M T WOPS &YES ❑ NO f STATE HWY REL 1 AT INTERSECTION NTH +�. � R: I O u-Es{y(.7r ' OIL(� t"C�r Y,.e— Sfk ❑YES ZI NO DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEH.YEAR MAKEIMOOELICOLOR LICENSE NUMBER STATE PARTY f 1 -3 (.'' > C:. EOUW, Z ��. V E rLk- I� CA. 1 t _-------__------------- ---------- -- oilm NAME tF1R5T;MIDDLE.LASZ) t - ❑ I N s— or-�- 1 OWNER'S NAME SAME AS DRIVER PESE1 STREET ADDRESS TAWI ❑ I f ,,� C-7— OWNER'S ADDRESS IyC,t SAME AS DRIVER PARSED CITYISTATFJZIP t v - L�Com" r DISPOSITION OF vEructE ON ORDERS OF: ;; -v ❑OFFICER DRIVER ❑ OTHER 6acy. SEX NASR EYc I HEIGHT WEIGHT BIRTHDAM I RACE CLw J� Mo. Dap f Year I - ❑ f r I f ro r t`6 zl ✓ PRIOR MECHANICAL DEFECTS: NONE APPAREh7i REFER TO NARRAI7VE DiT_HEAJJHOME PHONE BUSINESS PHONE /A +� VEHICLE IDENTIFICATIONNUMBER. - 3r .1tA y t!) € ..� CHP US!ONLY DESCRIBE VEHICLE 7'DAMAI�GE LJ.V 1 SHADE IN DAMAGED VEHICLE TYPE ARE4 INSURANCE CARRIER POLICY NUMBER �UNK []NONE []MINOR ! t t ❑MOD. ❑MAJOR ROLL-OVER `�y .I DGR.OF TRAVEL ON STREET OR HIGHWAY SPEED LIMIT OOY i +'� I - CAL•T —TCP/PSC—MC/MX 1 PART`DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEH.YEAR MAKEIMOOEUCOLOR LICENSE NUMBER STATE EQUIP. ------------------------_ -----------_---- 0AA"EA NAME(f[R57 MIDDLE,LAST) 11GwWE B NAME �l SAME AS DRIVER NIM .STREET ADDRESS L_.J TAM 11 OWNER'S ADDRESS SAME AS DRIVER PARIES CITYISTATFJZIP u t YEAICtE DISPOSITION OF VEHICLE ON ORDERS OF: - r-1OFFICER F-1DRIVER ®OTHER . SICY• SEX HAIR EYES HEIGHT WEIGHT SIRTHOATIS RACE c I Mo, Dap Year -— PRIOR MECHANICAL DEFECTS: Fl NONE APPARENT r7 REFER TO NARRATN i I STRER HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER: ❑ CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA. , INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE ❑UNk ❑NONE ❑MINOR I ❑MOD. ❑MAJOR❑ROIL-OVER j OR OF TRAVEL ION STREET OR HIGHWAY SPEED LIMIT CADOY CA —To— MCAAX PARTY ORIVER'S LICENSE NUMBER STATE CLASS J$AFETY VEH,YEAR MAKFJMOOOJCOLOR LICENSE NUMBER STATE } EQUIP. t ------------------------ ---------- nota --- ----------DANFA NAME(FIRST,MIDDLE.LAST) ❑ OWNER'S NAME ❑ SAME AS DRIVER FENS- STREE7ADORESS TPJAN L-I OWNER'S ADDRESS ❑ SAME AS DRIVER ?MM CITYISTATF-qJP 11—mu �❑ DISPOSITION OF VEHICLE ON ORDERS OF: ❑ OFFICER❑ DRIVER ❑OTHER SICY- S" HAIR 'tEYES HEIGHT WEIGHT BIRTHDATE RACE ctw f Mo. Day Year t PRIOR MECHANICAL DEFECTS: NONE APPARENT REFER TO NARRATIVE I"" JHOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER: ❑ CHP USE ONLY... DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA - INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE FI LINK 7 NONE O-MINOR i I ❑MOD. ❑MAJOR❑ROLL-OVER r� DMR OF TRAVEL ON STREET OR HIGHWAY SPEED LIMIT > CA OCT CAL-T TOPIPSC MCIMX PREPARER'S NAME _ DISPATCH NOTIFIED REVIEWER'S NAME DATE REVIEWED l Y- YES 0 NO ❑ N/A STATE OF CALIFORNIA TRAFFIC COLLISION CODING CHP 555 Page 2 Rev.5-97 i3P1 042 Pn.'�cf DATE OF C LMON qAO. DAY YEAR) 'IME(3400 NOIC N OFFICER I.D. NI MSER OWNER'S NAME, OWNER'S ADDRESS NOYIFIED I PROPERTY `' YEs [] NO DAMAGE rikiIPl'ION OF DAMAGE SEATING POSITION SAFETY EQUIPMENT EJECTED FROM VEHICLE OCCUPANTS L-AIR SAG DEPLOYED M I C SICYCLE-HELMET A- R VEHICLE M-AIR SAG NOT DEPLOYED 0-NOT EJECTED H-UNKNOWN N-OTHER DRIVER 1-FULLY EJECTED C-LAP BELT USED P-NOT REQUIRED V-NO 2-PARTIALLY EJECTED 0-LAP BELT NOT USED W-YES 3 UNKNOW# 1 2 3 1-DRIVER E-SHOULDER HARNESS USED 2 TO 6-PASSENGERS F-SHOULDER HARNESS NOT USED CHILD RESTRAINT PASSENGER 7-STATION WAGON REAR G-LAP/SHOULDER HARNESS USED -IN t 09 ED X-NO B-REAR OCC.TRK.OR VAN H-LAPfSHOULDER HARNESS NOT USED R-IN VEHICLE NOT USED Y-YES 9-POSITION UNKNOWN J-PASSIVE RESTRAINT USED S-IN VEHICLE USE UNKNOWN 7 O.OTHER K-PASSIVE RESTRAINT NOT USED T-IN VEHICLE IMPROPER USE A U-NONE IN VEHICLE ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK(`}SHOULD BE EXPLAINED IN THE NARRATIVE. PRIMARY COLLISION FACTOR MOVEMENT PRECEDING LIST NUMBER * OF PARTY AT FAULT TRAFFIC CONTROL DEVICES 3 TYPE Of VEHICLE $ 1 COLLISION ( !A vC$ECTM VIOLAMD: C�0 A CONTROLS FUNCTIONING, A PASSENGER CAR t STATION WAGON A STOPPED ! z C YES S CONTROLS NOT FUNCTIONING- B PASSENGER CAR W I TRAILER I B PROCEEDING STRAIGHT I B OTHER IMPROPER CANING': IC CONTROLS OBSCURED C MOTORCYCLE 1 SCOOT€R C RAN OFF ROAD 'D NO CONTROLS PRESENT I FACTOR- D PICKUP OR PANEL TRUCK I D MAKING RIGHT TURN_ C OTHER THAN DRIVER- TYPE OF COLLISION E PICKUP I PANEL TRUCK WI TRAILER IE MAKING LEFT TURN DwUNKNOWN* AHEAD-ON F TRUCK OR TRUCK TRACTOR IF MAKING U TURN E FELL ASLEEP* I B SIDE SWIPE G TRUCK I TRUCK TRACTOR N TRLR. IG BACKING G REAR END H SCHOOL HUS H SLOWING I STOPPING WEATHER IMARK i TO 2ITS1 D BROADSIDE I OTHER BUS I PASSING OTHER VEHICLE CLEAR E HIT OBJECT J EMERGENCY VEHICLE J CHANGING LANES a CLOUDY F OVERTURNED K HIGHWAY CONST.EQUIPMENT K PARKING MANEUVER C RAINING G VEHICLE f PEDESTRIAN IL BICYCLE L ENTERING TRAFFIC D SNOWING I H OTHER: IM OTHER VEHICLE M OTHER UNSAFE TURNING E FOG t VISIBILITY FT. N PEDESTRIAN N XING INTO OPPOSING LANE F OTHER- MOTOR VEHICLE INVOLVED WITH O MOPED 10 PARKED WIND A NON-COLLISION 1 P MERGING LIGHTING B PEDESTRIAN 10 TRAVELING WRONG WAY vlk DAYLIGHT C OTHER MOTOR VEHICLE 1 111 2 3 OTHER ASSOCIATED FACTOR(S) R OTHER B DUSK-DAWN MOTOR VEHICLE ON OTHER ROADWAY (MARK i TO 2 ITEMS) C DARK-STREET LIGHTS PARKED MOTOR VEHICLE A ve atcx+a+wxATaee erte0 YES D DARK-NO STREET LIGHTS F TRAIN E DARK-STREET LIGHTS NOT G BICYCLE B vC sxCTIOw vounot crm YES FUNCTIONING' H ANIMAL: NO I SOBRIETY-DRUG ROADWAY SURFACE C CMOTi6N'A`'r°"C cm YES 1 i 2 3 PHYSICAL DRY € FIXED OBJECT: Nt7 I (MARK f TO 2ITEMS) B WET 13 A HAD NOT BEEN DRINKING C SNOWY-ICY J OTHER OBJECT: E VISION OBSCUREMENT: B HBO UNDER INFLUENCE SLIPPERY MUDDY OILY ITC. F INATTENTION`: C HBO-NOT UNDER INFLUENCE* ROADWAY CONDITION(S) G STOP&GO TRAFFIC D HBO-IMPAIRMENT UNKNOWN-, (MARK f TO 2ITEMS) PEDESTRIAN'S ACTIONS H ENTERING I LEAVING RAMP E UNDER DRUG INFLUENCE" A HOLES,DEEP RUT' A NO PEDESTRIANS INVOLVED I PREVIOUS COLLISION F IMPAIRMENT-PHYSICAL' B LOOSE MATERIAL ON ROADWAY* S CROSSING IN CROSSWALK IJ UNFAMILIAR WITH ROAD G IMPAIRMENT NOT KNOWN C OBSTRUCTION ON ROADWAY* AT INTERSECTIONK DEFECTIVE VEH.EQUIP.: CITED H NOT APPLICABLE D CONSTRUCTION-REPAIR ZONE C CROSSING IN CROSSWALK-NOT YES1 SLEEPY"/FATIGUED _ E REDUCED ROADWAY WIDTH AT INTERSECTION RNO' SPECIAL INFORMATION F FLOODED` D CROSSING-NOT IN CROSSWALK L UNINVOLVED VEHICLE A HAZARDOUS MATERIAL G OT R. E IN ROAD-INCLUDES SHOULDER [M-OTHER" C► '�� �.I H NO UNUSUAL CONDITIONS F NOT IN ROAD N NONE APPARENT APPROACHING 1 LEAVING SCHOOL BUS 1 O RUNAWAY VEHICLE. SKETCH MISCELLANEOUS 0 INDICATE NORTH • d t .. .. _. . . .. ... _w .. .,-.... DSP 96 13009 4 STATE OF CALIFORMA INJURED I WITK /PASSENGERS *:- CHP 555 Page 3 \ .-97 OPI 042 SATE of COLLISION 0. Y YEAR) TIME(2400) NCIC�••.ryry ,r Off1C€R I�+.y NUMB l WITNESS PASSENGER EXTENT OF INJURY("X"ONE) INJURED WAS("W'ONE) ONLY ONLY AOE SEX PARTY FATAL 3EVIERE OTHER VISIBLE COMPLAINT ! NUMBER INJURY INJURY INJURY of PAIN SRN€R I PA PES. ,BICYCLIST OTHER ❑ ❑I ❑ ❑ NAME t O.O.B,I ADDRESS ry rJ r1 t! t" r c n� Q4 94,P�Otj - -g 7—.! (fNJURED ONLYf TRAWPOATED BY: TAKEN TO: j Al - iDESCR#8E#NJURIE3 J ' - �..-c:' vu "rte. ---C`is f'•.,'7"'. 1 „,,.. '"'f,S ti~-`(`"�t 1L c..r_„1 L...r a..--�• .. r( VICTIM Of VSOU _ •NAME 1 O7 O.B,1 ADDRESS 1_ (INJURED ONLY)TRANSPORTED BY: TAKEN TO: f DESCRIBE INJURIES _ - G,,...s=l 44 VICTIM Of VIOLS �` -�� ,sem �� ❑ C� ❑ ❑ ❑ ❑ � ❑ ' ❑ ❑ ❑1 NAME 10.O.S.!ADDRESS (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE NNJURIES 'i i VICT#M OF IACR I # ( ❑ ❑ I ❑ tom! [..�.i ❑ ❑ ❑ Lit ❑ NAME I D.0.B./ADDRESS i ` V( gNJURE.S ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES VIOT#M Of VIDIEi Elr �. ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ C ❑ ❑ ❑ -. � '�•. NAME 10.O.B.7 ADDRESS (INJURED ONLY)TRANSPORTED BY: TAKEN TO: . DESCRIBE INJURIES =nM Of VIOLEN p. ,NAME 10,O,S.1 ADDRESS OKA RES ONLY}TRANSPORTED BY; TAKEN TO: t DESCRIBE INJURIES _i�;' VICT#M�V10LLN � ,+;�I PREPARER'8 NAME I.O.NUMBER MO, qh REVIR`S NAME ${fq4l�w'yU�FCA1yit�RH}S/P��wNUMER .. a l'tikt^3 IA +{JIAG RAI rCHP 555 WOO 00,fYEAR) T'tNI6(am) ,� pY�y t^s OFG.LiSi ,,,."-;�.s. - t✓ SCALE. t ALL IAEA9UREMEN ARE APP;tOXVAA�AND NCi f 1t7 SCALP iJNL�Bl1$TATER —p got t � 5 G&~` i s r�3 •b } .} zp inf. r � � M. Ps, t ! L i + t t NEY1tY 1:� DAY YEAR l.a.r4uM ER PfWPAPSO tS Ls Wf • +�i:r�tti�r4r;� STATE OF CALIFCJRW FACTUAL DIAGRAM CHP 555 Paqe 4 62ev."7) OR 0421. OAS OF ,U3t (W. DAY YEAR) -ntm(24m) �mcic s OFFICER I.O. t�t1MISER -- ALL MEASUREMENTS ARE APPROXIMATE AMD NOT TO SCALE UNLESS STATED (SCALE� ) 4 d • INDICATE NORT4t w •4 tAl r F1 le" (7 I.F PREPAREdS 9Y mQmwR 00. CXhY YEAR r� 4,7 Y . Pae 1 DATE TIME TYPE OFFICER ID CASE NO. 11/21/02 1147 hr Narrative Imboden#613 H02-2171 1 PHYSIO: E-VjMNC F ITCF,1r D 2 3 STA.'CIQNI M 4 A Station Line was established along the East roadway edge of Southbound Refugio Valley Road 5 (RVR). Station 0 +00 was established at Light Pole#5948 in the center divide of RVR and 6 increases as you proceed North on RVR.. It decreases as you proceed South on RVR.. All 7 measurements were taken at a right angle to the station line, and/or at right angles to the East or 8 West roadway edge of Southbound RVR. 9 '10 MEMO PQM-OF REST: 11 (V-1) RJF tire is 6'4" West of the East roadway edge and at Station Line position 0—47'1" 12 RJR tire is 1'7' West of the East roadway edge and at Station Line position 0—53'8" 13 LCR tire is 6'6"West of the East roadway edge 14 15 (V--2) LCR.tire is 8'8" West of the East roadway edge and at Station Line position 0+21'7" 16 LCF tire is 9'11" West of the East roadway edge and at Station Line position 0+13'4„ 17 RCR tire is 6'6"East of the West roadway edge 18 19 (V-3) LCR tire is 14'4"West of the East roadway edge and at Station Line position 0+10'9" 20 LCF tire is 14'4"West of the East roadway edge and at Station Line position 0+2'5" 21 Front and rear right side tires were against the raised West roadway edge 22 23 (V-4) Located on its right side,on the side walk on the West side of RVR. 24 RCF tire is 1'6"West of the West roadway edge and at Station Line 0-46'9" 25 RCR tire is at the West roadway edge and Station Line 0-407" 26 27 PHYSICAL FUDENCE DESCRIPTION[LOCATIQN., 28 I't?VI 29 A) 8'2"parallel gouge marks beginning at Station Line 0+13'3''; 12'9" East of the 30 West roadway edge 31 B) 27' of Sidescrub beginning at Station Line 0-19; 13' East of the West roadway 32 edge, ending 6'2" East of the West roadway edge. 33 C) 21'4"of Striation marks beginning at Station Line 0-27'8'; T1 1" West of the 34 East roadway edge, ending 12'9"East of the West roadway edge. 35 D) Dislodged LCF wheel, strut, and broken"A"Frame piece of V-2 at Station Line 0- 36 30'8"; 3'11"East of the West roadway edge. NAME DATE RF-VIEWED BYol W.T. Imboden#613 11125102 e— '7 Pae 2 .MATE TIME TYPE OFFICER IU CASE NO. 11/21/02 1147 hr Narrative Imboden#613 H02-2171 1 E) Various pieces of vehicle debris located throughout the collision scene beginning 2 at Station Line 0+26'4"ending at Station Line 0-538" 3 4 EA CIS: 5 1,. 0TT* TC`ATIC)N- I was dispatched to this call of a traffic collision with no details at 6 1258 hr. I responded from Hercules Police Department and arrived on scene at 1302 hr. 7 All times, speeds and distances are approximate. All measurements were taken with a 8 Roll-A-Tape. 9 10 SCvFNF,DRSCRIPTION.This collision occurred on Refugio Valley Road(RVR). There 11 were no intersections involved. In this location RVR is a North/South two lane, level, 12 asphalt roadway. A raised concrete island with planted vegetation separates the lanes of 13 traffic. R.VR.is bordered on the East and West by weeds, vegetation and dirt. The 14 Southbound lane of RVR is 19'6"wide with a painted white fog line 5'9"East of the 15 't7tlest roadway edge. The West edge is a 6" raised curb bordered by a 6' wide pedestrian 16 walkway. This area of RVR is designated as a"School Zone"with a posted speed limit of 17 25 MPH. 18 19 PARTIRSo 20 21 Vehicle#1_(Mi stibigbi) was found on its wheels, facing in a Northwesterly direction.on 22' RVR. V-I sustained major front-end damage. Refer to the Factual Diagram for 23 measurements of V-1 at rest. 24 25 Driver 91 (Qureshi) was found standing on the sidewalk on the West roadway edge. She 26 was identified by her valid California Driver's License. D-1 was established as the driver 27 of V-1 by her statements. 28 29 Yehicle #2_CEard Shwas found on its wheels, facing south on RVR..V-2 sustained 30 major front end damage as well as moderate damage to the left side. Refer to the factual 31 Diagram for measurements_ of V-2 at rest. 32 33 I ver,#?(Mai_ pines was found standing on the west roadway edge of RVR. She was 34 identified by her valid California Driver's License. D-2 was established as the driver of 35 V-2 by her statements. She is also the registered owner of V-2 36 NMvIE. _ SATE REVIEWED BY D2 W.T. Imboden#613 11/25/02 Pa e 3 DATE TITHE T 'I'E OFFICER ID CASE NO. 11/21/02 1147 hr Narrative Imboden#613 H02-2171 1 Yehicle 91(Ford can:pe)was found on its wheels, facing south can RVR. V-3 sustained 2 moderate damage to the left rear corner. Refer to the factual Diagram for 3 measurements of V-3 at rest. 4 5 Party#3 (Santos)was located when she arrived at the scene of the collision, after my 6 arrival. She was identified by her valid California,Driver's License. P-3 was established 7 as the person who parked V-3 by her statements. 8 9 '' ebic3,e 44 t� T nr 7 was found.on its left side, facing South,on the sidewalk on the R10 Western edge of the roadway. 11 12 Parc z;M (Cantillrr�_was located when he arrived at the scene of the collision, after my 13 arrival. He was identified by his valid California Driver's License. P-4 was established as 14 the person who parked V-4. He is also the registered owner. 15 16 PHYSIC A T. F31DEN 17 18 Gouges, scrub marks, striation marks, vehicle parts, and miscellaneous vehicle debris 19 were found at the scene. See Factual Diagram for measurements and position on roadway. 20 21 STATEMENTS, 22 23 Driver 91 was contacted at the scene briefly,prior to being transported by AMR to 24 Kaiser Hospital in Richmond. I was unable to get a statement at that time. She was re- 25 contacted at her home on 11125/02 at 1621 Hr. Qureshi stated she was on her way to work 26 at Hanna Ranch Day Care. She said she was Southbound on RVR at an estimated speed 27 of 30 MPH,passing several cars parked on the west roadway edge. She saw a gold 28 colored car parked on the side of the road just as it pulled out into the southbound lane. 29 Qureshi said she did not have enough time to react and apply the brakes. She remembered 30 colliding with the gold colored car, but she did not know what happened after that. The 31 next thing she remembered was a police officer helping her out of her car. Qureshi could 32 not estimate how close she was to the gold car when it pulled out in front of her. 33 34 Qureshi slid not sustain any visible injuries. She had some torn tissues in her muscles, and 35 was extremely swollen and sore. She was still experiencing stiffness and soreness when I 36 interviewed her. NAN .. TRATE... REVIEWED BY DATE W.T. :lmboden#613 11/25/02 .. Pae 4 DATE TIME TYPE OFFICER ID CASE NO. 11/21/02 1147 hr Narrative Lj!nboden#613 H02-2171 1 2 Mixer#2 was contacted briefly at the scene prior to being transported to Kaiser Hospital 3 in Richmond. S was unable to get her statement at that time. On 11/27/02 at 1345 hr. 1 4 interviewed Maupin at HPD. Her father was with her. Maupin said she was parked on the 5 west roadway edge of RVR facing south. She got in her car to leave, put the car in"drive" 6 and looked over her left shoulder to see if there was oncoming traffic. She could not 7 remember if she had her left tarn signal on or not. She said she might have inched her car 8 forward slightly to see past the car parked behind her. Maupin felt the collision from V-1 9 but could not remember what happened after that. When her car stopped moving, she 10 exited on the passenger side and stood on the curb until help arrived. 11 12 Maupin sustained moderate injuries to her face. Five of her front teeth were knocked out, 13 she had over 50 stitches in and around her mouth, and her nose was broken. She also 14 underwent oral surgery to place metal rods in her mouth to support her remaining teeth, 15 which were knocked loose. 16 18 19 SUMMARY! 20 21 V-1 was Southbound on RVR at a speed in excess of the posted limit of 25 MPH. V-2 22 was parked facing south on the west roadway edge,parallel to the road. There were 23 vehicles parked in front of and behind V-2, blocking D-2's vision. As V-1 approached.V- 24 2's location, D-2 nosed V-2 into the traffic lane to improve her vision of oncoming 25 traffic. At that time the right front corner of V-1 collided with the left front corner of V-2, 26 driving V-2 sideways and forward, into V-3. V-1 spun out of control, continuing south on 27 RVR approximately 59' where the left front of V-1 collided with the left rear of V-4. V-4 28 was parked on the west roadway edge of RVR facing southbound. When V-1 collided 29 with V-4, V-4 impacted the raised concrete curb with its right side wheels. V-4 flipped 30 onto its right side and onto the sidewalk, where it came to a rest approximately 8' south 31 of where the collision occurred. 32 33 INTOXICATION: 34 35 There did not appear to be any alcohol involved with this collision. 36 NATviE .DASA REVIEWED B ' .' DATE W.T. lboden#613 11125/02 Pae 5 DATE 'I ITYPE OFFICER ID CASE NO. 11/21/02 1147 hr Narrative Imboden#613 H02-2171 1 AREA OF IMPAf`"1': 2 3 There were four Areas Of Impact in this collision. AOI 1 occurred when V-1 struck V-2. 4 This was established by driver statements, debris, and Collisions Scrubs located at the 5 scene. AOI 2 occurred when V-2 struck V-3. This AOI was established by the point of 6 rest of V-1 and the damage to V-1 and V-3, as well as the statement of P-3. AOI 3 7 occurred when V-1 struck V-4. This AOI was established by debris in the roadway, 8 sidescrub marks and skid marks on the roadway, tire scrub marks on the sidewalk,vehicle 9 debris on the sidewalk and the point of rest of V-4, as well as the statement of P-4. AOI 4 110 occurred when V-4 struck the raised concrete curb. This was established by damage to the 11 raised concrete curb and tire scrub marks on the raised concrete curb. See the Factual 12 Diagram for measurements and positions on the roadway, 13 14 CAUSE: 15 16 D-2 caused this collision by being in violation of Vehicle Code section 22106--Starting 17 parked vehicles. D-2 was attempting to start her parked vehicle but could not see far 18 enough behind her(North)to determine if there was oncoming traffic. This was due to a 19 vehicle parked directly behind V-2. D-2 pulled partially into the traffic lane to see around 20 the vehicle behind her,putting V-2 into the path of V-1. This cause was established based 21 on statements of both drivers,the point of rest of V-2, damage to V-1,V-2,and V-3, as 22 well as debris. 23 24 An Associated Factor of this collision was the excessive speed of V-1. V-1 was traveling 25 well in excess of the posted 25 MPH speed limit. D-1 had no time to react to the 26 movement of V-2, and was unable to avoid a collision. This Associated Factor was 27 established based on the extent of damage toV-1,V-2, V-3 and.V-4,the length of 28 distance V-1 traveled after the initial impact, scrub marks, gouge marks, striation marks, 29 the amount of debris, and the overall size of the collision scene. 30 31 RF OI W. -NDA11ONS: 32 333 None. 34 35 NAME DATE REVIEWED BY DAVE.' W.T. Imboden#613 11/25/02 �► _. ___ � � � ���� ti�a��t��<�� 1 � #�����z�� s� �� IZ,�4�3 �?tI5#.ar�cey riu� S�€fie� � t��3;57�r28`f fax��316���t �9 288 ���t�er::£�n��. Ei�a� (������ w���v��r c��� r����d��er ��a dam; ���t�������� �������� l��e ��� �� t�alnu�G��€� �A 94��6 fax� ��43:jt)22 '�� ��a�, .� ;� ���GA� � � ��er :�Z;1. w k�rg��da� �t���s.c�r�t l PROOFOYSERME c c102 5,1013x,2415:5 20a ,C R.C. s I am employed rn the County i�f Ajameda,,State cif California. I a n over the age of I$ 3 years;and not a party to the cause herein,my business address,is 2440 Santa Avenue, J� neda,Californ�a 94501 4 (3n `1lav 12 2003 , I served the attached NOTICE . CLAS on the interestedartfes in said cause,by causing an onguaal or true cagy#hereof to be enclosed 8 in a sealed:env elc"e;addressed as S.; 9 Clerk of the B64 d of a ierv� u Cau my Adj Wsratiari Bu ldmg, 10` 151' lneti*et;'Rm '10 ]Martinez,CA:14553 BY IVIAIL I caused'such envelope with postage thereon fully prepaid to be placed in the 12 t3nited States Vii[, %nthe:City,ofAlameda, Cahfor= . � PEFtSt�NAL ER VICE I caused'$'uch envelope to be�iel�vered by hand tooffices) ofthe addessee(s} .BY;h'EDERI.EXPIISS I caused such envelope:to be delivered to' Federal Express fc►r 4 5 otternightc6i6er servmeto the bffic0s)i the addressees} 16': } BY-EXPRESS MAIL I caused such envelope to be delivered to an Express Magi pickup box or overr�zght service tci the oce(s}`ofthe_addressees} (},,BY FACSTNIILE: I caused a copy orf such doodinen_t to 1*sent via facsenile:to the offices) 18 of the addressees} 13+ I declare:u der`penalty of p rlu yyunder the laws of the State of Cal2foin a that,the' ;; foegoiri is# .and correct.and that this declaration'was execu#ed on Mev 12.2003 , 20 z Alameda;California 21 22 Vivian U.�T'on 23 24 25 26 2 28 -1-- PROOF OF SERVICE r+. <. I 11 ,,. . . . . - c .1 , ..''.---, :,�!:� ::�:]J, - ,::�::...:�,,..:, , .11,1111, 11.1111 . ii9aaiiiii-am— ""..'' lll.,� :,�,�:Y:: 1:�::l x 4cfi �+ Ip¢o. IMM .. .w,,�,, r f114�lare x"61 w.r.�..�..u. .,, i'7'E ... [* - . `".. somwom . .11 � ." .111.1 # . m ': ;,, CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY • BOARD ACTION: JUN 17, >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: $17,350-14 ', r CLAIMANT: AFFILIATED FM INSURANCE COMPANY FOR: CONTRA COSTA COUN'T'Y" LAW LIBRARY ATTORNEY: UNKNOUN DATE RECEIVED: MAY 14, 2003 ADDRESS. MAXSON YOUNG ASSOCIATES, INC. BY DELIVERY TO CLERK.ON: MAY 14_,_20Q3 ONE SONSOME STREET, SUITE 950 — SAN FRANCISCO, CA 94104-4429 BY MAIL POSTMARKED: MAY 13, 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 14, 2003 By: Deputy p II. FROM: County Counsel TO: Clerk of the Board of Supe isors G.)"/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: ,.,.1, 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: orcl 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 17 , 2003 JOHN SWEETEN,CLERK., By , Deputy Clerk WARNING{Gov. code secti n 913f 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: j UNE 18 , 2003 JOHN SWEETEN, CLERK.By Deputy Clerk Clain to: BOARD OF SLtPER ISM OF 0241TRA COSTA C7tJtn-r INS�IRUC I-JO 4S To C LADAAN- A. Claims relating to causes of action for death or for injury to person ar to per- sonal property or g awing crops and which accrue on or before December 31, 19871 must be prated not later that: the 100th day af`,,er• the accrual of the cau-se of action. Claims relating to causes of action far.death or for inNry to person or, to pe.wna.11 property or growing crops and which accrue on or after January 1 1.988, must be presented not later t3>arr six m=ths after the ac^rtrd of the cause of action. Clams relating to any other cause of action trust be presented not later than, one year after the =rwl of the cause of action. (Govt. Code S911.2.) B. Claim mit be filed with the Clerk of the Board of Supe.-visors at its office in Roam 106, Coe,rnty Administration Building, 6-31 Pine Street, 3om__tinez, CA 94553. C. If claim is aSairst a district gover-ned by t to Board of Supervisors, rather tl-Lan the County, .,he name of the District srould be fiUedl in. D. If t-he claim is against mare t.'= we pub1 i c entity, separate ci airs =t be filed aga-inst, each public enti y. Fraud. See penalty for fraudulent c,:.ai=, Penal Code we^. "12 at the end o" L h s foz�. RBc Claim By } Reserved for Cleric=s filing --tamp RECEIVED Agaznta �• mer ,��` ��L }. t C=rty of Conti ..a } MAY 1 4 2003 or ) CLEAR VOW-O11-UPERVISORS District) COMA CNIA Co. Fila. in ram } undersigned claimant hereby makes claim agains-t the C,^tmty of Contra Cls to or the above-named District in the s= of 177, 5V- .t Y 2-"d i." supper' Of this o.?aim represents as follows; %. Whew did the damage or injury occur? (Give exact nate and hour) 2. Where did the damage or injury oo;&-? (Include city and county) ,,rr I/ S - 3. How did the dara or injury covin (Give full details; use extra paper if R ,j Y► a i r.I l fli co �. .i v E Der` 1r 'C Ll ! i " 4. What pac-.S ular act or omission can the part of =L—sty or distric' officers, serv,(nts or .eo plo ees caused, the injury or dame? �� wnat etre tz a names of conty or district officer's, servants or employees c ausirxg the age or in jurl? 5. What damage or inJUries do you Aaim resulted? {Give full t of injuries or ( damages claimed. Attachtwo estimates for auto damage. / 7. How was the amount claimed above computed? (Include the estimated a=unt any prospective injury or damage.) :5 r e4_4as - �?. *tames and addresses of t.�es,,�)}dc tors+�and i=pitals. List the expenditures you made on account of this accident or injury: OATS ITEM AMOUNT r yv �'L Iz � ° S Gov. Code Sec. 910»2 provides: "The claim must be signed by the claimant MW NMC= TO: (Attorne ) or ty awe 2ts= an his,behalf,' Name and Address of Attarney �jj fir+ t'S Signature) Telephone No, Telephone No, NOTICE Section 72 of the Penal Cade provides: "'Eve y person who, with intent to defraud, presents for allewence or for Payment to any state board or offic'ser, or to any county, city Cr district board or officer, WIthorized W alloys or pay the same if Muine, any false or fraudulent alaim, bill, amt, ""=her, or writing, is punishable either by imprisonment n the county jail for a period of not more than one year, by a fine of not exceeding cine tht� 41,000), or by both such imprim�t and fine;- or by imprisonnent in the state prison, by a fine of not exceeding test thou swid dollars MO OW t or by both sum imprisonment and fine. ASSOCIATES,M. One sansome Street; sate 0500 San ,�rarz sv CA 94104-4429 � i ..J Tei: (415)392-60.34 '`Ak ;413;3092-002`3 rztern a€c I�eI s2e_:s :cerse#2607078 Peter Collin Assistant Vice President Direct Coal:(41 w)228-6406 Email:pete.collins a@maxsonyour,.g.coni May 8, 2003 CONTRA COSTA COUNTY BOARD OF SUPERVISORS Clerk of the Board of Supervisors, Room#106 County Administration Building 651 Pine Street Martinez,CA 94553 Re: Property Damage Claim.Notice Our Assured: CONTRA COSTA COUNTY LAW LIBRARY Date of Incident: January 28,2003 Location: 1020 Ward Street,1st Floor Martinez,California Nature of Loss: Water Damage Demand: $17,350.14 Your File No.: Please Advise Our File No.: 02.007373.00-C To Whom.It May Concern: We are independent adjusters representing Affiliated FM Insurance Company, insurers of the Contra Costa County Law Library. As a result of a leaking and/or deteriorated pipe on the 2nd floor of the referenced facility, water damages were incurred to the Contra Costa County Law Library at approximately 10:00 a.m. on January 28, 2003. Please find attached our claire form properly executed. A payment to the Law Library was made in the amount of$12,350.14 net of the $5,000 deductible. We are hereby placing demand to Contra Costa County for the damages sustained. Including our insured's deductible, the wholes loss is $17,350.14. All claim support documentation is attached as well as the claim form and copies of the Proof of Loss, Subrogation Receipt and settlement check. WVJW.i':kaXsony0Ung.CGf?i Atianta.Boston^Ct.scago-Cai;as-Hcustor>Los Angeles e Mia5-m-New'.'o 3<4 Por:iand-San Pre^cisco.Seattie Buenos Aires a Hcr.o:<c.g-Lima a London a Mex co City-Santiago 4 St,Thomas Page Two Contra Costa County Board of Supervisors May 8,2003 02.007373.00.0 If in agreement, please remit settlement proceeds in the full amount payable to Affiliated FM Insurance Company, the insurers of Contra Costa County Law Library. If you require further information, please advise. We look forward to resolving this matter without any unnecessary litigation. Very truly yours, MAXSON YOUNG ASSOCIATES,INC. � P' CIAO / Pete Collins �`� PC:fcs Assistant Vice President Enclosures cc: Naomi Little CONTRA COSTA COUNTY LAW LIBRARY Michelle Chavez DRIVER ALLIANT INSURANCE SERVICES Maria Monaghan AFFILIATED FM INSURANCE COMPANY (Your File No.: 1-4384) 02.007373.00.0 Amount of Policy SWORN STATEMENT Policy Number TE 053 in Driver Alliant Insurance Services PROOF OF LOSS Agency Name - issued j Expires 07Z,01/02.-. I 07101/03 Agencv Location San Francisco,CA To the AFFILIATED FM INSURANCE COMPANY of Van Nuys CA By the above indicated policy of insurance you insured SPIP/CONTRA COSTA COUNTY LAW LIBRARY against loss by All Risks of direct physical loss or damage upon the property described under Schedule"A according to the terms and conditions of the said policy and all forms,endorsements,transfers and assignments attached thereto. 1. Time and Origin: A loss occurred about the hour of o'clock. M.,on the 28th day of Tanuary 20 03 . The cause and origin of said loss were: Water Damage - -- 2. Occupancy: The building described,or containing the property described was occ.ipied.^.t the time of the loss as follows,and for:o 01-her purpose whatever: Law Library 3. Title and Interest: When this policy was acquired and at the time of the loss the interest of your insured in the property described therein was sole and unconditional ownership,and no other person or persons had any interest therein or incumbrance thereon. (State exceptions, if any.) No Exceptions 4. Changes: Since the said policy was acquired there has been no assignment thereof, or change of ownership, use, occupancy, possession, location or exposure of the property described, or of your insured's interest therein. (State exceptions, if any.) No Exceptions 5. Total Insurance: The total amount of insurance upon the property described by this policy was,at the time of the loss, S as more particularly specified in the apportionment attached under Schedule "C", besides which there was no policy or other contract of insurance,written or oral,valid or invalid. 6. The Cash Value of said property at the time of the loss was...........................................$ 7. The Whole Loss and Damage as stated under Schedule"B"was ................................................................................................................S 17.350.14 8. The Amount Claimed under the above numbered policy is ..........................................................................................................$12,350.14 The caid inc- did no, criginate b: nmv act, dts:gn Jr Y7ocurei tent ott t'ite gart of yo... insured, or Lnls affiant, aoihing has beta done by or with the privity or consent of your insured or this affiant, to violate the conditions of the policy, or render it void;no articles are mentioned herein or in annexed schedules but such as were in the building damaged or destroyed,and belonging to,and in possession of the said insured at the time of said loss;no property saved has in any manner been concealed,and no attempt to deceive the said company,as to the extent of said loss,has in any manner been made. Any other information that may be required will be furnished and considered a part of this proof. The furnishing of this blank or the preparation of proofs by a representative of the above insurance company is not a waiver or any of its rights. FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM: Any person who knowingly presents false or fraudulent claim for the payment of a Ioss is guilty of a crime and may b ,subject to fines and confinement in state prison. r n ('� ( State of , f -�y�'..L,:+....' ` (ir�2 i�Ot 7 County of � �iad- l _,�c � � �, Insureu Subscribed and sworn to before me this I Lvz h..1 k A),- day of jJyr 20 3 1 _ �' Notary Public SUBROGATION RECEIPT RECEIVED FROM THE AFFILIATED FM INSURANCE COMPANY, the sum of Dollars Twelve Thousand Three Hundred Fifiv dollars and Fourteen cents ($12,350.14) in full settlement of al claims and demands of the undersigned for loss and damage by Water Damage occurring on the 28th day of Jan�tarv, 20 03, to the property described in Policy No. TE 053 issued through the Driver Alliant Insurance Services Agency of said Company and as security for such a payment,the undersigned hereby pledges to the said Company. In consideration of and to the extent of said payment the undersigned hereby subrogates said Insurance Company, to all of the rights, claims and interest which the undersigned may have against any person or corporation liable for the loss mentioned above, and authorizes the said Insurance Company to sue, compromise or settle in the undersigned's name or otherwise all such claims and to execute and sign releases and acquittances and endorse checks or drafts given in settlement of such claims in the name of the undersigned, with the same force and effect as if the undersigned executed or endorsed them. Warranted no settlement has been made by the undersigned with any person or corporation against whom a claim may lie, and no release has been given to anyone responsible for the loss, and that no such settlement will be made nor release given by the undersigned without:he written consent of the said Insurance Company and the undersigned covenants and agrees to cooperate fully with said Insurance Company in the prosecution of such claims, and to procure and furnish all papers and documents necessary in such pro;eedings and to attend c)urt and testify-if the Ire;.rance Company deems such to be necessary but it is understood the undersigned is to be saved harmless from costs in such proceedings. ,, 7 / 1� IN WITNESS WHEREOF, _ f has hereto set hand and seal this_-�day of~ r'e_ l 200 WITNESS: OFFICER [NOTARIZATION TO BE COMPLETED ON LOSSES WHERE LOCAL LAW REQUIRES IT.I FOR INDIVIDUALS FOR CORPORATIONS St e of California ) State of California ) 1 ) ss. ) ss. County o res- ��fK ) County of ) On the `%� daY o /� t', 20 On the day of 20_ before me came y before me came to me known to be the individual ribed in and i to me known,who,being by me duly swom,did depose and say that who executed the foregoing instrument, d he/she knows the seal of said corporation;that the seal affixed to acknowledged that said instrument is such corporate seal;that it was so affixed by executed same. order of the Board of Directors of said corporation;and that he/she signed his/her name thereto by like order. NOTARY PUBLIC CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT State of California County of Contra Costa On ,;, , before me, Mary F. Lascano, Notary public. Personally appeared, /y,-L "'t - - Rer�ana4}4owa4o-me or proved to me on the basis of satisfactory evidence to be the person(p) whose name(,s') is/are subscribed to the within instrument and acknowledged to me that HV/She/Tbey executed the same in Ws/Her/Tl*ir authorized capacity(i ), and that by Vis/Her/TMr signature(o) on the instrument the person(c), or the entity upon behalf of which the person(,) acted, executed the instrument. Witness my hand and of(`icial seal. MARY F. IASCANO Commission# 1384363 Notary Public — Callfornia l Contra Costa County 1&MyCorrTn,E4')kesDec11.Mi Title or type of Document '�L�r ✓cty �ca r� Document Date �' Number of pages Signers other than named above, /"`� _ LA ! REG I Afflllatad FM Insurappe;Company = r. u P.O.'Sox 75OE} jo, start RI 02919 :. IF YOU IIAVE ANY,QUESTIONS, PLEASE CALL: PLEASE EXECUTE AND RETURN `THE ENCLOSED FORM(S) =M.D. MONAGHAN _ FORMS ENCLOSED: 818-704-1133 EXT'.297 Statement of Settlement or Proof of Loss Subrogation INSURED: SPECIAL PROPERTY INSURANCE PROGRAM(SPIP) Loan Receipt LOCATION OF LOSS: MARTINEZ CA Other TYPE OF LOSS: LIQ DAMAGE-OTHR THAN SPRNK LEAK-LOCATION .� ACCOUNT NO: 0017011 CLAIMS OPS.OFFICE: LOS ANGELES POLICY NO: OOTE053 CLAIM NO: L4384 FM LOSS NO*- . - DATE OF LOSS: 1128/2003 TRANSACTION ID: P0024990 CHECK NO: 086231 CHECK DATE: 4/18/2003 AMOUNT: —$12,350.94 M.T.S.INSURANCE SERVICES LLC 19867 PRAIRIE AVENUE SUITE 250 CHATSWORTH,CA 91311 n,. ,..11408 6 2 3 1110 r»0 1900445i: 5563411' VE MAR 2 7 20ol !Mf"N vUUNG ASSOC., INC, 1v1AXSON YOUNG, Associates, Inc. One Sansome Street, Suite 950 San Francisco, CA 94104-0213 Ma.rwh 12, 2003 Peter Collins Assistant 'Vice President RE: Mater Damage Loss of January 28, 2003 Assured: SPIPICONTR.A COSTA COUNTY LAW LIBRARY Policy No.: TE 053 Assured's Broker Driver Alliant Insurance Services Your file No. 02.007373.00.0 Dear Mr. Collins, This is a follow up to your letter requesting supporting documentation from vendors. Please find enclosed all documentation received for water damages incurred on January 28, 2003. I have enclosed copies of all bills and checks as we have already paid :hem. The Service Master bill and the ceiling the replacetncnt costs have be:n picked up by Contra Costa County. 1 am enclosing a copy of the Service Master bill but I don't have a copy of anything having to do with the ceiling tiles. If there have any questions regarding what the County is going to cover I have been instructed to have you contact Sharon Offard at 925-335-1442. Ms Offard handles the County Contract dealing ..� with property loss. If you have any questions regarding this claim please call me. Very truly yours, 1 Little Administrative Assistant Centra Costa County Public Law Library 1020 Ward Street. ':st Floor Martinez, California 94553 ' Phone ( 925 ) 646 - 2 ' 3 Fax ( 925 ) 646 2 438 x><s Ys ems & Space, inc. P.O.?ax!735 Pleasanton,CA 94565 Partners in Progressive voice:925.426.5955•fax:925.426.0882 Storage Solutions vt-v-systemsnspace.com 71 . ,. _ _ _ - .'lam a a ...,..�... �w._ -. . a•./�.. . - - --..----....------ -------_,_„--- -----_...--- ---------------,-------------------------, - L .Y _ .,...J. � . _ a run.-� , .-__ - a _ a .✓ ...._...w DUE UPON TL IM A -I ED io bf-,completed by Systems& S1 :office: V i Warranty? Y ' -'arvice Date Reported': Ti Me: Extended Warranty A greement? Y I1 Jab Marne: ' ..i, rJ.- ' 'r /�, y Vendor PO#: Job Contact: v'r'-C, 7treet Address- SSI So n. i tele:Dk Ione 7f`. rC ". y J/may•?"tJ ....'Gi l/i .... Material: 5 3 Stun in rosin lrr: F!cor#: Is s stern Type: sail For Appointment? Yes �No \ S Billing Address if different then above:) \'` S �Var-rye: 'Contact: 4 Street Address: tS Ci State: Zp: --------------- Parts To - ieieQhone#: FSales Tax:; Client PO. #for Service Call: i - 19 F l Freian Customer`s Problem: �.r"ubtotc : r 'r LABOR$120.00 PER HOUR: 'r^ (2 HOUR MINIMUM) r Subtotal: :.., . To be completed by Service Rep: Description of prabiem: ;��./r --, ,, - ,' TOTAL MATERIAL f TOTAL LABOR: I�.�.�.f J, J ;-�,J ..r_,.'s' .-•" ,g." .+.`ori,,. r^ TOTAL CHARGES: � ._• =�� ,--y � i Service Rep: The completed work is done tc my sstisfacticn. 1 Any additional problems? y y have reviewed the charces to be billed to my account. Sco of work completed: Customers Signature r X. ; / =�•y r ' = ,_— r Please Print Return visit re-auired? a Ernlain: i �f Date' Please furnish information on , Extended Warranty Agreement: Hours including travel): Yes No � Svsterris & Space, Inc. • 500 Boulder Ccurt, Suite B • Pleasanton, CA 94566 • v: 925.426.7955 f: 925.426,0882 em, ail: ser iiCv'�'systernsnsuace.ccm • ,veb: www"systernsinsuace,carn r iYY ['sti1 all Systems Space, Inc. P.O.Box f7w6 Pleasanton,CA 94566 fax:925.426.0882 Partners in Progressive storage Solution v.;s{stemsnspace_cam _-_...._....__...._..,.._..»_...._...._..-...._--_ --..-__...._------_....- -_- _.--_____-_-...__.___..._.._._-__- _ UUi StERVICE CALL CIIJFR !`L RN11 i .J _ To be completed by Svsterns .,ce office: Y r --- Warranty. qat2-Regio ted: Time: Emended Warranty Agreerrrent Y . Vendor PO Job Contact: ,g y";v _ S.ree`Address: /L"L' SSI SO : If- Zip: - Telephone 75" S - Material: _ i Svstem in room System Tv e: t�, �,wC��, t`( ��. j S Call For Appointment? Yes No S Billing Adr;ress (if different then above:) is !Name: S Contact: Street Address: Citv. SlGL�. L'o. f a,-S Cchone S-; Tele L Client FCS. .or Service Caii: Custorners Problem.: )� 11rj {y i'+�1�'r6 ! �• (.� �-+/ _,i f t ! LABOR 5120.00 PER hOUP: (2 HOUR MINIMUM) - Subtctai: To be Completed by Ser-,ice PteP: TOTAL MATERIAL• f _ Aoil l TOTAL LABOR: - TOTAL CHARGES: I Service,Rev: ! The completed work is cc:'e tc -v Smis action. I have reviewed the i,Iargt=-5 t.' zc zii;EC tc m,,' ac--cu"i x / �L r ~` _ -V ^ 'Sc cleted: Customer's &gnat) e ��e cr work ccm � X. Please Print Re`urn visit required? E,tUlain: - l�_— _ Nate - i - — Please furnish information on Extended Alarranty Agreement: Hours (incl;;dina tr-:vel)_ S No JC _ r,tCr�, n3✓aC2 Com r/e 7: ~ 52 6 014�CPr GJri, �Uit.o �I�dScltCi, Cr �+ YU 1Gnc_ 'v%. , '�St sCuC�.CCm CottTTTA COSTA COUNTY G447036 Kenneth J. Corcoran, County Auditor - o ter 625 Court Street ' Martine. CA 94553 925) 646-2191 t VENDOR NAME VOCR N0, CHECK DATE CHECK NO, R,EMIT T ANCE ADVICE SYSTEMS & SPACE INC 00593 03/05.'03 447036 INVOICE DA7EBESC�,�71C I 10 U R 0RDER NCJ DISCO '�Cl 7�K`�11 NET AFTER DISCOUNT` 03/03/03 0006737-?N/00067 v I��1 C0 480.00 1 I 1 l i I 1 4 a i i X L� w' TOTAL: � C0 CONTRA COSTA COUNT`( 1vo(zs wails trees Bank crleC,�No. t2`,C{8.} Main Street Kenneth 11. Corcoran, County Auditor- Controller Ma inex.CA.X555 G447036 625 Court Street Martinez. CA 94553 (925) 646-2191 Date: 03/05/03 Pay Amount. '*'*—",•.3480.00 Pay Four hundred eizhry and 00/100 Dollars FROM THE AUCrTC`n5 77,CLVING FUND FOR PROPERTY,a C'CS.;IGSTS CR SERVICES AS 1TE.'aiZED Vendor No: 00593 IN PUBLIC VOUCHER CN is:LE:4 ABOVE OFFICE VolD six Mr AF,,,ER `o the SYS i EMS &SPACE INC �ATeoF ssus Order Of PO BOX 1736 Kenr, J.Corcoran Pt,E,ASANTC}N, CA 94565 ?'3 CCUNTY AL' TOR-CONTROLLER 2 j-A r,,rRFr=CENT DRIVE, -uIT_ h 1 i �7 w pL,EACraNT k-?3Lt_. CALIF"G'riNir"+ BILL.TO DATE INVOICW# Contra Costa COu11r} LaW Libran _- . _003 SS? Attn;.Alice %McKenzie 1020 Ward Street. 1=L1 ,Martinez. C.•, 9-1553 INVOICE TE.RMS�._. Net 15 Item Qty Service,- Description Rate Amount Amount .tc' i i;'_3'200r Clne6:o-computer after water leak 125.00 125.40 Onsite Serv .p p C"-,,-"K tape backup Travel Cost l 1t2 ;?nC! Tra%el costs 50.00 50,00 S4btGtat �__ S175.40 Sales Tax (8.25%) 54.40 Payable to Liffev Network Solutions. !nc.� Finance charges will be applied to }_ Thank youPor this opportunit;��to serve:,ou. all over due balances. Total St7�.o0 t✓ CONTRA COSTA COUNTY G447038 Ke- -eth J. Corcoran, County Auditor Her 155 Court Street Martinez. OA 94553 (9 25} 646-2191 VENDOR NIANIE "ENOOR INC. CHECK DATE CHECK NO, ==—MITT ANCE ADVICE LIFF EY NE` WORK SOLUTIONS 11716 031"05/03 447038 INVOICE DATE DESC=!P710N SOUR ORDER NO.1 DISCOUNTNETAFTER DISCOUNT 03/0"103 851 W w I 175.00 I I II � 1ff i i 11 , 4 TOTAL: -3 115.00 F N tk M'.:M :XSI • 75 11-241225 Wtrc Banx Check No.CON RA COSTA COUNTY 210(8, Main Sere et Kenneth J. Corcoran, County Auditor 'Cuntrolier MaMneZ-CA.94553 G447038 625 Court Street Martinez, CA 94553 (925) 646-2191 Date: 03/05103 Pay Amount: .,..*—**'S175.{00 Pay One hundred seaenry five and CYJ/100 Dollars FROM-s HE AUC fTCRS;;EVCL*,-'r G FUND FOR PROPERTY,GOODS,RIGHTS rA SERVICES AS ITEM!ZEC Vender No: 11716 N PUBLIC VOUCHER CN F:t E `I,:@OVE OFFiCF '/0!0 Six MONTHS AFTER i o Tire LIFFEY NETWORK SOLU T IONS CATE OF ISSUE Order Of 25-A CRESENT DR 7311 Kenril ;.Corcoran COUN t .,C� CR-CONTR.CLLE.R PLEASANT RILL CA 9452:3 3' " 80 70 3C3,i' I: = 2 :OCC 2 2 2 S 0 c ? .1100000 1 "r SOD,;'' n,/7 LOCATIONS-USA LOCATIONS-CANADA ��� �� � San Francisco.Ca papas,TX Toronto,ONT NewYork City, NY Mos Angeles,CN Halifax, Chic = REPROCESS0115 Chicago, IL Minneaoclis,hdN Edmonton, n,.ALTA Denton, MA Kansas Ory,KS Montreal.QUA Denver,CO Seattte,WA Vancouver, 60 WEST COAST:1384 ROLLINS ROAD • BURLINGAME,CALIFORNIA 94010- (800)437-9464 • (650)401-7711 - FAX(650)401.8711 EAST COAST: °611 Yr'ATER STREET MIDDLESEX, NEW YORK 14507 - (888)437-9464 - (585)554-4500 - FAX(585)554-:114 E-MAIL. docrepsLdocumentreprocessors.com WEB ADDRESS.http:ltw.,w.documentreprocessars.com Feb. 4, 2003 COUNTY OF CONTRA COSTA ,SOB NAME: Library - Wet Materials Law Library inCiudinc Leather Voiumes 1020 Ward Street Martinez, CA 94558-1360 Attn: Alice McKenzie Tel: 925-846-2783 Naomi Little FAX: 925-648-7438 INVOICE To invoice you for vacuUm freeze drying, reboxing and return of water damaged materials Quoted at 200 lineal feet: actual footage 210-220 lineal feet. Packed out by our staff on Jan. 28, 2003 Returned and reshelved by our staff on Feb. 4, 20013 Packout/Retum and Resheive quote S 3,000.00 Incoming f=reight included Vacuum f=reeze Drying 200 lin feet 1.2 cu'1jIf 240 240 cu ft @ $ 60.00 per cu t S 14,400.00 Discount 10% S (1,440.00) Reboxing to new cartons 0 stns c@x S 8.00 per ctn S - Return Shipment included Tofai invoice $ 15,960.00 erms: Net on Receipt Federal ID: 94-3948652 Thank You Remit: Document Reprocessors of California LLC, 1384 Rollins Road, Su iingame, CA 94010 In USA &. CANADA 2.4 hour assistance 1-800-4-;CRYING (437-9464) "IF IT'S WET, WELL DRY IT" OUR PLANT —YOUR SITE IM A I L E �^.iD i i CQNT A COSTA COUNTY G447860 Kenneth Corcoran, County Auditor - Controller 625 Court Sheet martinez, CA 9455; (925) 646-2191 VENDOR NAiME VENDOR NO. CHECK DATE C,-eux NO. ri"E-,,"vlIT T ANCE ADVICE DOCUMENT REPORCESSING 04988 03/07/03 44,17860 INVOICE DATE I DESCRIPTION OUR ORDER NO.I DISCOUNT Tr'.XENJ NET AF I ER DISCOUNT i 03/03/03 DR 1/28r03 .00 15,960,00 4 I l { i I I i a _ TOTAL: 00 15,960.00 11-2 412 2 5 We:ls Fargo 0anx Check No.CONrRA COST COUNTY t2T«�, MainStreet Kenneth J. Corcoran, DOUnhy Auditor^ Controller Maranez.CA.,ry45S3 G447860 625 Court Street Martinez. CA 94573 (925) 646-2191 Date: 03/07/03 Pay Amount: *"*******$15,960.00 Pay T7rreen thousand nine hundred sixry and 00/100 Dollars :RCM THE AUC!:CRS REVCL'PNG FUND FOR rrRCPERTY.GCCCS.RIGHTS CR SERVICES AS ITEMIZED Vendor No: 04988} "i PUBLIC VCUG:: CN FILE'`d ABOVE CFFICE VOID six MCNT'HS A S=R To The DOCUMENT REPORCESSiNG DATE OF ISSUE Order Of 1384 ROLLINGS R.CALD CCUNTY AUr71TOR-Co ROLLER BURLINGAME CA 94010 t� .-- .. .^ ,. - . . r— 1 . C Of INVOICE0 w.�"fix 9(34 � '2bt �` ; ,AC INE:,IA 50;;.68 f -90,20 DEPOT cerdumber i95u02028-0,C?1 Y_ Order Summary Shipping Address Billing Address Cusror. r;ninrmation 00001 ,-C L 00001 "x. C�std, .et~: 35813064 C3ntzc.: PHILLEATRA GAYI_CF 1020 WARD S7 FL 1 1020 WARD ST FL 1 Phone 925-546-2783 MARTINEZ CA 94553-1360 MARTINEZ CA 94553-1360 Comments Canon Count 1 Adc;ua.-a,!nic.mat,on First time customer orders 0154,'010/039 deliver 2.118103 c.osed 2117103 14-Fe- 2003 Thank You Deiivery 7_�ate: 17-Fed-2003 Item [details Quantity Line 2 2 ]tem Number ,Description � Jnr Total 1 7 1 0 2846.25 C`JITDR,iS".C593.LCb,FL`PNL P. CH - 2ac as i I I ! I f 'r! Merchandise Total" zS?.09 Z rtun 4 trC7u lr»' vvttt r�rr�y'. !; Delivery Charce 0 00 Vott hUVC J77V (Jlt@Sl1O11S c700;11 Subtotal 299.99 .Viotti Vi-de .please coil :ts Sales Taxt 8.25%) 24.75 tall free at (888) GO-DEPOT Order Total 324.74 1 Charged To: 1-1711 voll 'now 1,ott CCIn Shot) SPS . * •••, •*, "E$L 324.74' 3 1lrutl:e a tiuv% oil-line Balance Due 0.00 ut WTV141'.OFI+rCEDEPOr.C,OA! ec 94"57--X _,_- _ - _., ��27 a7 123 r>"r✓,„r _.�,.. CONTRA COSTA COUNTY G447037 Kenneth '. orcoran, County Auditor - Controller 625 U t wtrei Martinez. CA 94553 (925) 646-2191 VENDOR NA"IE VENDOR N0- CHRC:K DATE CHECK NO. 7,E-MIT-1 A���CE ADVICE 0F=;ICE DEPOT 48880 03/05/'034417037 INVOICE DATE E 1: OUR QRIDER NQ.I DIS QUI`! ;KEN� NET AFTER DISCOUNT 03103/03 145502028.40 ! 4 324.74, i � a I l s i I 1 � r i l ,A 1 L E D I TOTAL: � �G 324.71 111111 Will CONTRA COSTA COUNTY 712101-2A ) mainSWeiis trrca48ank Check No. 7270!8) main Stet: Kennett; J. Corcoran, CWunty Auditor-Controller Stanme7-CA.g4SS3 G44037 625 Court Street Martinez, CA 94553 (925) 646-2191 Date: 03105iO3 Pay Amount: .......— *-324.74 Pay 7rree hundred nwenry racer and —.41100 Dollars PRCM-iE AUDITORS Ay'!CLYING FUND FOR PROPERTY.GOODS.R3GHTS CR SERVICES AS ITEMIZED Vendor No: 088807 IN PUBLIC VCUCHGP.CN r.Lw:N ABOVE.OFFICE ifl 51x MONTHS AFT ER To The Of=RCEDEPOT DATE OF ISSUE �crt Orcer Ofr- C Kcnn,�XJ.Corcoran PO SOX .020 DES MOINES, IA ~0368 COD,il Y AitJ1!C?E�-CONTROLLER }} C S 17 !._ I + 41 Cc, �tt�tli7 M znt :C? N , r SN t I � _ �In� �_.,���.�,�,..,.__.-.-•--�------'"-�- cliFEi { ISI lvi_ z Q 'ti,+ ' c �3 i I �2 { _i r -- © :n fi , , J Q C4' I �I GI '.NV r O 6.- - .cG,cot c'E. c- oA i f 4, IZIZI � �},,. mil r -.r•�i r t7 u„I 103/1212003 WED 9.31 FA 9252°°1570 ServiceMaster Concord 41002/010 x CEi W.eo »= KO �RVD `/��9 �PI' ��yy'' i1i�! y��\j !{��1� t/�,1�� �!1�{ CC}NCaR1 , �Ai.#F{JFiN1R452G3 sats tt y "'LAW l RY «cc cC7L rNT r /SuL r� s t�t=Y i C�JNTr A .cC3s t aururY s T�iARINEZ, CA. ;w94a . ............._. 2tta9...Ak?N LD I;1�iCU T,. TAL wA�°. . 3 } 4 27 C }MCORt �900;ACCOUNT NO. SHIP VIA COL PPD DATFSHIPPEn TERMS INVOICE DATE. PAGE�� I , i y � QTY, s s EXTENDED PRICE •'s ► i BACK ITEIM i M ESCRIPTION UNIT MICE r� 1 i ? 1 1 LAW L25RARY WTR CL 4441 . 18 I 01 4441 . 18 i i i i i fi ,J 1 czG ` SALFa . O MISC. CHARGES fY (/ SALEES TAX M UGHV THANK YOU TOTAL444 . nu 0 ?1 r a 9 *9881570 8ervice�laster Concord X003/010 ServiceMaster Disaster Restoration Services 565OF Imhoff Drive Concord,CA 94520 92.5-288-0479 92,(5'-2�8'{8�-1(5�70�}}{� { TAX ID#94-3 02452 f. N/A N/A WATER $0,00 E � Insured: LAW LIBRARY CON'1`R COSTA COUNTY Home: (925)646-2783 1 Property: 14020 WARD ST. � MARTINEZ,CA 94553 r ' Estimator. HOAC-F,CHARLES Business: (925)288-0479 r I Business: 5650 P-!MHOFP DR. CONCORD,CA 94520 x Date of Loss: 41/28/03 Date Received: 01128/03 j Date Inspected: 41128/03 Date Entered: 43/10/03 f � f E � Price List: CAEB2B3A Restoration/Service/Remodel with Scrvicc Charges Factored In Estimate: L4WLIBRARY # 0.32 FAQ* 9214181550 Servicehster Concord ?004%010 ServiceMaster Disaster Restoration.Services 56502=TinhofirD rive Concord,CA 94520 925-288-0479 925-288-1570 TAX 1D#94-3102452 ,.^. LAWLTBRARY -� Room: LAW LIBRARY LxW-.xE 4610" x 30'0" x 810" I,216.00 SF WalL- 1,.80.00 S"Ceiling 2,596.00 SF Waits&Ceiling, ?,380.00 SF Floor 153.33 SY Flooring 152,00 LF Floor Perimeter 368.00 SF Long Wall 240.00 SF Short Wail 152.00 LF C:il.Perimeter Emergency service call-during business hours 1.00 EA 0.00 100?0 100.20 � i Dehumidifier unit(per day)-Large-No 3.00 DA 0.00 65.00 195.00 I(rnonitonng I ONE DE?FOR 3 DAYS Dehumidifier unit(per day)-XLarge-No 2.00 EA 0.00 100.00 200.00 monitoring I ONE 2000LGR DR FOR 2 DAYS Drying fan(per day)-No.monitoring 19,00 DA 0.00 26.78 508.82 j .EIGHT AIR MOVERS FOR 7-VO DAYS. THREE ATFL MOVERS FOR ONE DAY. � Block and pad furniture in room-Lane amount 1.00 EA 0.00 42.46 42.46 Water extraction from fluor-Heavy 1,380.00 SF 0.00 0.54 745.20 J Apply and-microbial agent 1,380.00 SF 0.00 0.57 234.60 General Laborer-per hour 3.00 FIR 0.00 45.22 135.66 THREE TECH'S FOR 1 HOUR, WIPED DOWN WALLS AND BOOKS.FfE VES } Equipment scup,take down,and monitoring 1.00 HR 0.00 45.22 45.2' ((hourly charge) 01130/03:CMCKED DRYING. MOST OF THE AFFECTED AREA DRY NOW EXCEPT FOR.A SMALL SI'OT 4_DROX, 10 X 10 WHWERE THE BOOKSHELVES ARE.. WE REMOVED SOME EQUIPMENT AND R.EPOSM-,ON-ED RF.MAWING EQUIPMENT. (Equipment setup,take down,and monitoring 1,00 HR 0.00 45.22 45.22 (hourly charge) 02/3 i/03:CARPET IS ALL DRY NOW. REMOVED ALL EQUIPMENT.EMPTIED WATER.CIOLLECTED FROM D14. � CIean and deodorize carpet 12,160.00 SF 0.40 0.18 2,188080 j CLF-A P-D 95'X l2g'A.1Z:t;A.Ar-TER NORMAL BUSINESS 14OURS. f LAWLMRARY 03/1212003 Page: 2 J 03x12 2003 "ED 0 32 Ft'il 023"41570 Service aster Concord 100051010 ServiceMaster Disaster Restoration Services 5650F linhoffDrive Concord,CA 94520 925-283-0479 925-288-1570 TAX Mtt 94.3102452 1,216.00 SF Walls 1,380.00 Sr-Ceiling 2,596.40 SF Walk,&Ceiling 1,380.00 SF Floor 153.33 S'Y Flooring 152.00 LF Floor Perimeter 368,00 SF Long Wall 240.00 SF Short Wait 152.30 LF Ceil.Perime= 0.00 Floor Area 0.00 Total Area 0.00 interior Watt Area 0.00 E-tcrior Wall Arca 0.00 Exterior Perimeter of f Woos r 0.00 Surface Area 0.00 Nu-nocr of Squares 0.00 Total Perimeter Length j 0.00 Total Ridge Length 0.00 Total Flip Length 0.00 Area ofFacc 1 I L4WLIBIL LY 0311212003 Pagc: 3 i- _Vv� ;JLd U1. mi jZ3166i3fU 006/010 ServiceMaster Disaster Restoration Services 565OF Imhoff Drivc Concord,CA 94520 925-288-0479 925-288-1570 TAX ID#94-3102452 ss tars L zc Ite=Total 4.441.18 � HOAGE CHARLES. LAWI i$t ,y 03/22./2003 Page: 4 3i 003 'WED q;31 FA. VI15241570 "erV Ce,AaSLer �on.Cot�a �,uul, ulu Eeb - 20. 2002 11 :06AM S,,MQUTR FURN.MEDIC 660 299 9096 '4o. "148 R . VI S e M-\----ASTER rvice deal Redwood City Office: Concord CJff9ce: 2737 fair Oaks Ave. 5650 wF Imhoff thrive \ Zedwood City, �„ 94603 oncord, CA, 94520 Phone: (650)299-9080 phone: (925) 288-0479 - Fax: (650) 299-9036 Fax: (925) 288-1570 FRO THE DESK OF Fax Tra smittal Form T d: ri L- -�' Organization Name- <� Phone number Fax Number: /C>.' _ C Urgent Date/Time sent: ❑For Review C please Comment # of pages including cover page Opt ease Reply _ 1116� Message. 1 I i I 1 � v 1 I}is �;cex RE",5%(tI"�T `11 ServiceMaster Disaster ServiceMASI' 3 Services Restoration Services 5(`>5��-t'Imhoff Drive CleanGleeConcord,CA 9.1520 800/1180-T!DY{9439) WORK �( 925/288.04-9 Fax:9251288-15-0 Insured/Customer: (r, YyiD.O.L. Job Site: ,;-Z Claim# City, State, Zip: ,1C-t� '�S Phone# l/We hereby authorize ServiceMaster to proceed with disaster restoration services at my home or business as necessary. 1. 1 agree to pay a deposit of , reflecting my insurance coverage deductible (or agreed upon deposit), to be credited toward Service4laster's final bill for services. 3. I authorize my insurance carrier, , to pay ServiceMaster directly from my insurance proceeds. I authorize my insurance carrier to include ServiceMaster's name on any payment to me/us for the disaster restoration services that ServiceMaster perforins under this agreement. If ServiceNtaster is included as co-payee. I agree to endorse and forward any and all drafts issued covering all services rendered by ServiceMaster on this loss immediately upon the receipt of such draft(s). 4. Payment for any work that is not included in my insurance proceeds is my responsibility. This may include my insurance coverage deductible or any work I authorize beyond the scope of the insurance coverage afforded for my loss. If for any reason my insurance company denies coverage, I assume responsibility for all charges incurred. for services rendered by ServiceN faster on this loss. 5. :x.11 past due amounts not received immediately upon receipt of insurance drafts(s), and/or receipt of Service:Ylaster invoicing, shall bear interest at the rate of 1.5% of the balance due, annual rate of 18%. In the event any collection actions or legal proceedings must be instituted to recover amount due, ServiceMaster shall be entitled to recover the asst of collection including reasonable attorney's fees. Me have read and understand this authorization and agree to all terms and conditions as set forth. J I Customer's Signature. -~ Date: I i s Disaster Restor. ,n Sc rviceNlaster Disaster ServzceMAS .LService Restoration Services 4...J�GI b �i�,0•E� imElc>tf Drivr C;ancvrd,CA 9a 4;20 800/=i80=t'1€ Y 1 tad 39) 9,25/2884+79 WORK AUTHORIZATION 92 9/2st�t17`c� Insured/Customer: D.O.L. Job Site; Claim# City, State, Zip: Phone# IAVe hereby authorize ServiceMaster to proceed with disaster restoration services at my home or business as necessary. 1. 1 agree to pay a deposit of , reflecting rnv insurance coverage deductible (or agreed upon deposit), to be credited toward Servicelfaster's final bill for services. 3. I authorize my insurance carrier, '� ,o pav 5erviceVfaster directly from my insurance proceeds. I authorize my insurance carrier to include ServiceMaster's name on any payment to me/us for the disaster restoration services that ServiceMaster performs under this agreement. If ServiceMaster is included as co-payee, I agree to endorse and forward any and all drafts issued covering all services rendered by ServiceMaster on this loss immediately upon the receipt of such draft(s). 4. Pavment for any work that is not included in my insurance proceeds is my responsibility. This may include my insurance coverage deductible or any work I authorize beyond the scope of the insurance coverage afforded for my loss. If for any reason my insurance company denies coverage, I assume responsibility for all charges incurred for services rendered by ServiceMaster on this loss. -+. All past due amounts not received immediately upon receipt of insurance drafts(s), and/or receipt of ServiceMaster invoicing, shall bear interest at the rate of 1.5% of the balance due, annual rate of 18%. In the event any collection actions or legal proceedings must be instituted to recover amount due, ServiceMaster shall be entitled to recover the cost of collection including reasonable attorney's fees. IAVe have read and understand this authorization and agree to all terms and conditions as set forth. r f / f ' "' Date. i Customer's Signature t � % .._,rf'1--- x� —' ServiceMASTERDisaster Rt'stor^..aw..1n ServiceMaster Disaster Clean ]�r�,r-� Services Restoration Services V LG(rTr 5650-F Imhoff Drive Concord.CA 94520 800/480-IIDY(8439) 925/28"479 Fax:9251288-1570 WATER DAMAGE EMERGENCY SERVICES PROCEDURES TO OUR VALUED CUSTOMER Thank you for allowing SERVICEMASTER the opportunity to be of service to you. Please take a few minutes to read this information,as it will acquaint you with our services.To help you better understand our services we would like to take you through a typical restoration procedure. • After we have made an examination of the job site, we will discuss our findings with you as well as a proposed plan of corrective action. • You will be asked to sign a Work Authorization. If you have insurance coverage for this loss,we will ask to collect your deductible or an agreed to deposit to be applied towards our final bill. • Our initial service begins with moving the furniture and contents from the affected area. Excess water will be extracted from your carpet(or other floor covering). Carpeting will be pulled back and the wet or damaged padding will be removed. Your carpeting may be dried on-site or taken off premises to be driers at our facilities depending on the particular claim. • Anti-microbial may be used to prevent the growth of bacteria and mildew. • Air movers will then be positioned to dry the affected areas. Depending on the amount of moisture involve,it may be necessary to place dehumidifiers to aid in the drying process. Your SERVICE MASTER technician will instruct you on this equipment usage. • The average time to complete the drying process will vary from two to seven days. Over the first few days we will he in contact with you to verify that the drying is progressing as planned.This may mean telephone contact or an inspection by one of our technicians to measure moisture levels and reposition the equipment as necessary. • On our final emergency service visit,one of our specialists will check to insure that proper drying of the affected areas is complete. After this has been completed, the equipment used in the drying process will be removed. An appointment will be scheduled with you to reinstall your carpet over new padding in the affected areas. Your carpet will then be cleaned in the affected areas and your furniture returned to its proper position and placed on pads to protect it and the carpet. Finally when our work has been completed, we will that you complete a Certificate of Completion form and give it to a technician. SERVICEMASTER.knows that our reputation for good service depends on you! The work we will be performing for you will be seen by our General Manager Charles Home.All scheduling of appointments and fie handling will be overseen by our Jobs Coordinator they will be happy to assist you with your scheduling needs. Just call them at the phone number listed above. Copies of our Work Authorization and Certificate of Completion are attached for your review. ),7z, CUSTOMER RESPONSIBILITY FORM Instructions related to the restoration of your property Dehumidifiers: Dehumidifiers reduce the humidity, which in turn increases the rate of drying. Please don't turn off"or move dehumidifiers without first calling our office. Please empty water recovery buckets at least once every 24 hours or as directed by the restoration technician. Airmover s: Airmovers are designed to increase the rate of evaporation, which in turn increases the rate of drying. Please don't turn off or move airmovers without first calling our office. If carpet is flapping on edges please shut off the air mover and contact our office immediately. General: Please do not open the windows unless instructed by the technician, as this may delay the drying process. Please minimize entering the affected rooms. Do not allow children to play with or around operating drying equipment. The dwelling should have an initial temperature setting between 69-72°F for maximum drying and to prevent or inhibit bacteria and fungus growth. Safety and Health: If dehumidifiers or air-movers must be moved, they must be shut off'and unplugged as it may be hazardous to move these units while they are operating. Exposed tackless strip is a danger even when covered. Please take care when walking near tackless strip:The floors may be slippery when wet. Please take extreme care if walking on or near wet flooring materials. Equipment Responsibidiv: The customer understands that they are responsible for loss or theft of the fallowing numbered drying equipment while in their care and custody. Turbo Dryers): # P #-w _-# 144 Dehurnidifier(s): # s # Ir-D 1 # # # Other Equipment on-site: Equipment Placed Date: / Technician-`�,v,--)+i Customer Equipment Removal Date:_-- -- Technician Customer I have read and understand the information above about equipment operation, responsibility and safety precautions. Location: -�2it I �,� �1Z-1 Signature:_ r� Date: -4Zd� �l �VL'.��'Jt�3� L1 Disaster ReStoi'�L�r1 ServiceMaster Disaster Services Restoration Services Clean 565(7-F Imhoff Drive Concerti,CA 94520 800/480-TIDY(8439) 925/288-0479 Fax:925/288-1570 CERTIFICATE OF COMPLETION Date : 01/28/03 Loss Location: 1020 WARD ST. Insured name: LAW LIBRARY MARTINEZ, CA CONTRA COSTA COUNTY This is to certify that repairs made by SERYICEMASTER, at the above-mentioned property have been completed in a workman like manner to our complete satisfaction. These services were necessitated by a water loss suffered on 01/28/03 r-- Insured/ Customer•r' G- a e` C. Print dame JUS L y i t L c Date ( r ' ServiceMaster Rep: Title: Date Comments: 4 , + ServiceMaster Disaster r z Disaster tt�:st[�r�"''`�t� Serv.zceYVAS.1_,J( Services Restoration Servicr:s Clean 5650-F irnhoff Drive' Clea L Concord.CA 94520 800/480--MDY(8-139) 925/28£3.1)-479 Fax:925/288-1570 CERTIFICATE OF COMPLETION Y 1 Date : "ICS Loss Location: Insured narle: Claim number: Policy number: This is to certify that repairs made by SERVICEMASTER, at the above-mentioned property have been completed in a workman like manner to our complete satisfaction. These services were necessitated by a water loss suffered. on 1 2 o 3 Insured / +Customer: Print Dat 1 / 3 ServiceNtaster Rep: Title: Date_,! Comments: Beni By; New Sale Invoice Z`�It�lf�i`��tV WIES-r i BILLING Acr-ouNT# 1000803"175� NFW SALE :NVOICE# 6014600488 ORDERIN 927783 INVOICE DATE 03/14/2003 P.O. Sex 194778 .99 i 5t.t'xui, MN 551$4-0779 AMOUNT DUE 142 CUSTOMER SERVICE: 118001328-4880 x For payment IrtsulLttrcns Orld cantnex information Ste roverse PA4E i of r SALES REPRESENTATIVE 'ORDER DATE SHIP DATE DELI VEF1Y s PURCHASE nFDeA�P�� 0311312003 J.03/14/2003 621695321 MATERIAL i DESCRIPTION QTYI pICE TAX i TOTAL f1 13517383 CALIFORNIA CITATION GUIDE 1 1 132 00 10.891 142.89 S# j 1 � i 1 f . r t r � _ 1 THANK Yew TOTAL 142.99 ll1 RE I URN BOTTOM PORTION WITH PAYMENT NEW SALE INVOICEX 8014800486 VENDOR$ 4/1428973 SILLING AC OUNTA 1000803175 AMOUNT" OuF. 112.89 AMOUNT ENCLOSED West Gtoae P*ym*nt Genixr P_0. 9ox 6.292 CONTRA COSTA COUNT^+ Carol Sttaarn, IL 501976292 LAW L18PARY 1020 WARD ST IST FL MARTINEZ CA 94553-1360 6014600486 0000000001213000130000000 200.30314 ZINV 000014289 01310 100080-3 '75 Z Sent 3y: ^.CC RLL; 42t 646 d13b y FAX TRANSMITTAL ue a Dat. Mart :7-003 77, r Pages(Includes �C 1, �r� Col 25 3 - � ;: -, _ .. L�`rsY►;a C'{xtra•�,t��riist���}i33�:.�,aw Isi�brcuy, _ WAIS Document Re.rievai Pate 1 of? CALi`Qt2NIA CODES BUSINESS AND PROFESSIONS CODE SECTION 6363-5-164 6360 . A law library established under this chapter snail be free o the judiciary, to state and county officials, to members of the State Bar, and to all residents of the county, for the examination of books and other publications at the library or its branches . The board of law library trustees may permit the removal, of ugh books and other publications from the library and ie.s branches as _v considers proper, subject to such rules, and, in its discretion, he giving of such security, as it may provide to ensure the safekeezing and promm t return thereof, but no security shall be required of members of the judiciary or county officials. The board may provide for the levying of fines and charges for violation of the rules, and may make Charges to Cover the cost of special ser-vices, SUCn as '? making of photo copies of pages of library books, and messenger service. The board of law library trustees may require persons other than members of the judic>ary, county officials, and members of the bar resident in the county, to pay such dues as the board may fix for __^_e privilege of removing books and other publications from the library. With the approval of the board of supervisors, the board of 11 a library trustees may charge indiviauao members of the bar resident n the county fees for the removal of books and other publications =rcm the library. These fees shall not exceed, the cost of providing toe service. 636 .. The board of supervisors of the county in which the _ata a y is established shall provide sufficient quarters for t-e ,.:se of the library upon request of the board of law library trustees, except that the board of supervisors need not provide such crua=ers when the board of law library trustees determines it has suffi.c t_.t funds, over and above those necessary for operation and maintenancs expenses, to provide its own quarters . Such provision may include, with the room or rooms provided, suitable furniture, window shades, floor coverings, lighting, heat and telephone and janitor service. 6362 . .3 . The State Librarian shall periodically supply to each 'law library established under the provisions of this c-anter, and requesting the same, infor-nation regarding newly published materia-' s to aid such libraries _... u_eir selection of new materials . 6363 . Whenever a law __bran/, and a board of _rustees to govern :he same, is in ex .stence under the provisions of any law, ogler than the Law superseded by zhis chapter, in any county, or city and count-/, in this State, this chapter shall not be considered a repeal of any legislation under which such library was established and 's now governed, but shall be deemed to confer upon such library :,he benefits of Sections 6321, 6322, 6322 .1, 6326, 6341, 6345, 6346, 00 hitn://ww.le,-7into.ca.i-tov/c:�i-fir,/%vaisaa:c"WAISdocID=5775316790-x0+0+0&-W,AlSac._. 3/I3/2 � WAIS Document Retrieval Pa-e - of? 6346.3, and 6347. 6364. it is discrerionary with the board of supervisors of anv county, to provide by ordinance for the application, of the provisions of this chapter to the Bouncy. httr)_//tivw%v.ieginfo.ca.c7ovlc2i-bin/waisaate?WAISdoclD=57725,16790+0+0+0&,WAI ac... 3/1-Y.2003 STATEMENT OF VALUE AND LOSS SPIPJCON'TRA COSTA COUNTY LAW LIBRARY MARTINEZ, CALIFORNIA Water Damage Loss of Tanuary 28,2003 Recapitulation of Verified Detail: VALUE LOSS Loss as determined: a) Restore documents and books $15,960.00 $15,960.00 b) Repairs and replacement of computer equipment $499.74 $499.74 c) Repairs to electronic filing system $480.00 $480.00 d) In-louse labor for cleanup $175.50 $175.50 e) Replacement books 5234.90 $234.90 TOTAL: $17,350.14 $17,350.14 LESS DEDUCTIBLE: ( $5,000.00) NET LOSS: 12 � fcs 3.31.2003 02.007373.00.0 � Y V p w p U) Z 0m 0 � O p C Q W --oL 12 tS7 �» F— try U) (/} :D p ' CA LL cu E U 0 d W o C7 d N p UmUUcc� � n) S r:• CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY • BOARD ACTION: JUNE 17, 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 g s ' 915.4. Please note all "Warnings". < ? AMOUNT: UNKNOWN CLAIMANT: Tmms DALion CALIFORNIA STATE AUTOMOBILE ASSOCIATION ATTORNEY: FOR: CHARLES SOMMERS DATE RECEIVED: UNKNOWN MAY 1 , 2lt1 ADDRESS: P.O. BOX 920 BY DELIVERY TO CLERK ON: MAY 14, 2003 SUISUN CITY, CA 94585-0920 BY MAIL POSTMARKED: MAY 13, 2003 FROM: Cleric of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. MAY 14 2003 JOHN SWEET N k Dated: By: Deputy II, FROM: County Counsel TO: Clerk of the Board of Supervisors (,y4—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: - c 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 17 , 2003 JOHN SWEETEN, CLERK., By , Deputy Clerk WARNING(Gov. code section 913) Subject to certain exceptions, you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned,have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California,postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JUNE 18 , 200 3JOHN SWEETEN, CLERK.ByAv_�_ Deputy Clerk MPY-12-2003 14:07 CCC RISK MANE GHENT 925 335 1421 P.01.1 Claim to. BOARD OF SUPERVISORS OF CWRA COSTA CL"3UM ItSrRUCTIONS `TC) C LAI}ALW A. Claims relating to causes of action for doth 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 amps 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 off Ice in Room 1.06, County Administration Building, 651 Dine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the, rye of the District should be filled in. D. If the claim is against more than one public entity, separate claims must b-- ,11'.461-ed efiled against each public entity. E. ' Fraud. See penalty for fraudulent alaims, Penal, Code Sec. 72 at the end of this form. RE: Claim By } Reserved for Clerk's filing stamp Lades tom } MA H RECEIVED Against the County of Contra Costa ) or } MAY 1 4 2803 Districts 6IL K BOARD OP SUPERV So Fill i n name } CONTRA COSTA CO. The undersigned claimant hereby races claim against the County of Contra Costa or the above-named District in the sum of $ rte i r and in support of this claim represents as follows: 1. When did the owe or injury occur? (Cave exact date and hour) 'Vr 14 f ani..If�MwYY.sas w ---------rwrra— 2. There did the damage or injury occur? (Include city and county) Ave 3. Flow did the damage or injury occur? (Give full details; use extra paper if required) Set a44etcke1( IayiL, �t rt� �Cit 4. What particular act or omission on the part of county or district officers, servants or ,employees caused,the.injury or damage? Wkl vl 04w,-t tys veld C It'G cC wi r r-IiS MPY--12-2003 14:0? CCC R i 5 MRWIGaMEN 92 335 1421 : wnat are the names of county or district officers, servants or employees causing the damage or injury? 6. What damage or injuries da you claire resulted? Give full extent of injuries or damages chimed. Attach two estimates for auto damage. MAL- 12cf �5 1141 7. How uas the amount c=laimed above computed? (Include the estimated amount of any prospective injury or damage.) 8. Fames and addresses of witnesses, doctors and hospitals. 9. List the expenditums you made on account of this accident or injury.- DATE STEM AMOMT GOV. Cade flee. '910:2 provides: "The claim must be signed by the claimant SES ACES M: (Attorney) or by sow Person on his. behalf." ." Name and Address of Attorney A _ Claimant t s Sigrlature ?V Box qty S.2: E 31f,5477 Address Telephone No. Telephone NO � 4:96 6 e_K) x131?r� 17 9rIF I 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 impriso iment in the county jail, for a period of not more than one.year, by a fine of not exceed Ing one thousand ($1,000), or by both such ImJprisomedt and fire;-'or by imprisonment in the state prison, by a fire cif not exceeding ten thousand dollars ($10,000, or by bath such imprisonment and fine. TOTPL P.0Z STATE CF:e.b - 13 12003 1 .22PM No 3762 P 2/21 Tie'iu +uuL ugivm IxtPORT CHP 555 CARS PaQ6 9(Rov"$)OPI 042 P-P 1 a 7 SKO L OONORIONS MAVM m ITY JU CCAL WSTF40r LOCM.RPEORT NUMO�T (our� 'x.D /e�aseRcs evv xt I LAFAYETTE WA.LNUTCREW ,rr�� COuNly .. ft"cay Q Dt$TRW SEAT. .. ! y* U 1 CONTRA COSTA 901 i+ COLLis*NoCOIRRECON: MO PAY VW TWE 04W4 N=* OffR:ElTLD: Z MT.DIABLO BLVD. EB 1212712002 1045 h0APOsTMFO/tA r4N: DAY Of WEEK TOWAWAY PHOTOGRAPHS SY, !"'1 mow FRIDAY Yes L .NO {� AT!NTERS€ nON WITH: STATE HWYREL OW 99.6 FEET EAST Of VRLAGE CIRCLE �� YES X'No PARTY DRTVER'S LICINBE NUMBER STATE CLASS SAFETY VEN.YEARLMWA MODEL!COtS,)Fl LKENSE NUMBER STATEN4831965 CA Q2 4 DR.a... t1 B I i 18347 CA DRMM NAMECFIRB'T.MAS.LAST) ON DUTY EMERGENCY VEHICLE X. DAVID DUANE THYS OWNER'S WIGL SOMAS DRtvER r STREET ADORESS CITY OF LAFAYET TE ANER _I 3675 MT.DIABL)BLVD. t)WNEASADORESS "SAME ASD LK ARM OrfViSTATErZIP 3675 MT.DIABLO BLVD. LAFAYETTE CA 94549 " I.AFAYETTE rA 94549 OIS+dOLUTKxw OE P VE: ON OROEAS OF: j OFFtcm as stint HAR J!"S IM,Q+ff WEIGHT � aWHOAT9 PACE LAMORINDATOWWG-(925)284-7575 # vew PRIMMECN.DEFECTB j"DWAPP. AEfSF.TONlt1WATIVR M BRN BLU 6.0 #85 12f1 if3958 W PRIM OTHER HOME PRONE BUS#"PHONE yet*= VYTICAT"NUMMR: {925}283»3680 (925)283-3684 cW UK ONLY DESCAISE VEHX'AE OAATAOX SHADE*1 OAtA%M AREA INSURANCECARAiER POucyNUMBER VEHX,T.ETYPE f 7UNK i---jNONE MINOR SELF'CITY OF LAFAYETTE NONE 48 '. MAJOR RCLLdVER M OF TRAP!-. ON Sl*0T M HIOiWAY sPEeaiwrT CA D E MT.DIABLO BLVD. 35 CALdT TOWSC W AU —, I it ARTY ORNER'S UCENSE NLWMR STATE GLASS SAFETY VEN,YEAR MAKEtMODEttCOWR UCBNSENumm SYATL 2 J0013550 CA C G 02 __ DODGE PICKUP GLD - 6X29371 CA ORSVEA NAM Wjf"T,MMI,LAM . X CHARLES THOMAS SOMMERS awuERSNAME r ,SAME ASORVER PEDE& SrMST ADOWSS L rRIAN 3489 PENNSYLVANIA COMMON OWNER s ADDRESS C�SAME AS DWEA PARKED CRYI STATE 1 zp VEFttOi. j�' FREMONT CA 94535 DISPONTMOFVBHOOLSON01WERSOF: �Fmcm fl"]ORWAOTHER 6lCY- SEN HAIR EYES NEKiHT WEKSNT BATTNDATE RAS {---} t . ea s: MQ c,a Y+ LAMORINA TOWING- 925 84-7575 M BRN BJiN 6.02 200 031071#942 W fR+oRMecww>catosrEcra Apr+. REf�emHA+ Tne OTHER HOME PHONE busmss PHONE voucLa IOENTiFI ro"NUMBER: _1 (514)505-0403 (510)796-5601 cw uu Ot$Y DESgK"WHICL s"DAMAC4€ SHADE IN OAMA(WAMA WSUPAW-fCAARIER poucYt+L'i.#SSR YEW=TYPE uw NONE M AAA B363477 22 EmOD Rati nr+eR DSR OPTRA ON&MET"OR H)D WAY SPEED uW CA oar E MT.DIABLO BLVD. - 35 CAL.•T TcP*$c MCRAk PARW ORNE"LWANAS NUMBER STATE CtA$3 SAFETY WH.YEAR MAKE I MODELt COLOR ucemSE MAWR STATS 3 ORNER NAMEIFIRST.MIDDLE,LAST) OWNER'S NAME SAME AS ORIVER TRW'- STREET ADDRESS OHNe"ADDRESS i••_'"WASDRNER PAMt,'tTY l STATE f M0 _�.• iMSR="ON Of VW=1 ON ORDERS Of: :OFFICER' ,DRNER i attttA'tT CUCAT '58X i141R EYES HEkD1T W&GHT WRTt YE Yvvr RAGE �-^.. .• ___ . PRIOR MECHANC7AL DEFECTS NOW APP .. REfER TO NARRATME OTWER' NOME PHONE BUSINESS PHONE VE111CY.E fOENT1fICA71CN11ANNEER: Citi US@ONLY DESCRIBE VEHIOM DAMAGE SHADE W GAAWDEC AREA 04VRANCE CARRIER PoLrV NUMBER VEHICLETYPS MAJOR , •:ROLL-OVER OTR OF TRAVEL ON STABEY OR M"AY SPEEDLtMiY CA j. CAL-T tepi 4C MC.1MX PftEPAREA'$NAME DISPATCH NOTtBiEO EMS ME WI�tSTON L.JAMISON 009050 YES 00 *A � o STATE OfFeb - 10*' 2003 1 ,23PM No-3762 P• 3/21 CNP 555 CARS P z LM OPI 042 P•9a 2 of rM OF CMUMN(h*.WAY MR) l.D 12127/2002 3{4 932q 009850 ov"R TipIED PROPERTY AYES NO DAMAGE may Tmo,sl>aucl� $EATIN0 POSITION SAFETY EQUIPMENT EJECTED I"VEF31CU OCCUPANTS MIC BICYCLE-HELMET L-AIR SAG DEPLOYED 0-NOT EJECTED A-NONE IN VEHICLE M-AIR BAG NOT DEPLOYED 1.FULLY PJ'I meo B-UNKNOWN N-OTHER DRIVER 2-PARTLALLY E=TED I Z 3 1-DRIVER C-LAP$ELT USED P-NOT REOUIRED V•NO 3-UNKNOWN D-LAP LIEU NOT USED W-YES 5 2 TO e-PASSENGERS E.SHOULDER HARNESS USED CHILD RESTRAINT x-STA.WON REAR F-SHOULDER HARNESS NOT USED ZS-14VWITTSED PASSENGER $-RR.DCC TRK.OR VAN G-LAPMHOULDER HARNESS USED R-IN VEHICLE NOT USED X-NO 7 9- ED POSITION UNKNOWN H-LAPiSHOULDER HARNESS NOT USS-IN VEHICLEUSE UNKNOWN Y-YES 0-OTHER J-PASSIVE RESTRAINT USED T-IN V OGLE IMPROPER USE K•PAMPM RESTRAINT NOT USED U-NONE IN VEHICLE ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK(')SHOULD BE EXPLAtNED IN THE NARRATIVE. L HARRY COLLMON FACTORTTtaFFIC CO>fTROL CEVLOL- 1 2 3 TYPE VEHICLE 1 2 3 MrD�lcA HT PRBClCMM3 L1fLT NUMBLftt OF PARTY AT FAULT CaLigKIN A V06*cTt v$mAm COW Fives A t:ONTROLSf A R! ATI {;O A STOPPE29 22105 Cl9 T15 f IsSL INaG` P CAR W! iL:ER X B 9 OTHER IMPROPER DRNING- C LS Rik C MOT L9 i SCOOTER C RAN FF ROAD X D NO C01f ROLLS PRESENT 1 FACTOR' D PICKUP OR PANEL TRUCK D MAKI4 RIGHT TURN . OTHER IRAN DRIVER` TYPE aF COLL ION PICKUP I P Wl TRmL_Eft LEFT'Ttm D UNKNOWN• AHEAD- N F ORT OR X F MA U RN FELL E$ SK3E fi 1 TRUCK TPAC TOR Wl TRLR C REAR 14 SC BUS 14 SLOWING f BTOpPiNo WEATHER MARK 1 TO2ITEMS X Cf E 1 OTHER I P OOi VEHK:Le A CLEAR E HTt J EMI_ HIC J S X 8 CLOUDY F OVERTURNED K HKIHWAY EQUIPMENT K PARKaNeMANF.WEft RAINLNG D VIEHiCL>wlf DESTRIAN L BICYCLE L ENTERLNGT iC D SNOWING H TITER• � OTHER VEHICLE M O U E TURNING E FOG! L ITV PEDE TRW N Xl INTO OW NE F OTHEm-- MOTOR Voock E INVOLVgD VWTH f} MOi+EO O PA 9 WIND A u.0 Lg' P M fi LIGHTING 8 PEDESTRIAN L2 TRAVEUNG W WAY X A pAYLIQHT X C 0`*"MOTOR vEHLCL 1 2 OTHER ASSOCIATED FACTORS R OTHERt B DUSK- D T O ROADWRY 1 TO2ITEMS C DARX•STREET LIGHTS E PARKED MOTOR VEW E A vC aKcnewv Aym Corso Yes ID t5#Rlt,NosT Li(4HTS F TRAIN N0 E DARK-STREET LIGHTS NOT O BICYCLi 23nowrcur«v ar>� Yi:4 FUNCTiONINC" H ANIMAL: No rAUG ROADWAY SURFACE C vcax .main arm of 9 1 2 3 (PHYSICAL A DRY I fwEDOBJECT: tits {MARK'ITO2ITEMS) X S `niET• D 3D A HAD NOT C WY- Y ,I OTHER OBJECT: E VISION IS NSD• NDERINF 0 SLIPPERY(MUD OILY ETC. X INA'ITEIYTION-: HW-NOT INF ROADWAY CO"DRIONIS7 t2 STOP 00 FIC D -I Ut�Nt M M9ARK#TO 2 ftFiMLS PI5L aTRIWS ACTIONS H - 11LD1 RAMP E A HOL OELR+RU X A VEL3 I PR ,f)l S F IMPA .PRY l3 L.• 8 LOOSE MA AY" B CROSSING IN O WASWALK J UNFAM TAR WR H ROAD G IMPAN66W NOT N aSST'R T Y' AT THE VEH.EQUP,: CITED NOT APPLICABLE _ D 2© C CROSSING iu CROSSWALK-NOT veno i SLEEPY J FATIGUED E REDUCE s*ADwAY W TH AT INT€€LSECTKA NO IiMCLAL INFORNATKLN F F DED• D CROSSING-MLT IN CROSSWALK L UNINVO VED E A $MA G OTHER". E IN ROAD-I CL DES SHOULDER M OTHER•: 8 CELL PHONE SJ USE X t# NO AL CaNDIT10N3 7 X 11 NDNE ARENT >« CELL PHONE NOT 94 USE 0 APPROACHING t LEAVINO SCHOOL BUS I I IO,-AUNAWAY!jtLME X Xj D CELL PHONE NONEILW.NOW SKETCH MISCELLANEOUS DOT iNtlICATCNORTII cp C 'tIy STATE QGebfl > ,2003 1 :24PM No 3762 P. 4/21 Qt_*L-4jQaeM3ft Opt OQ moo• 3 OATS OF CO"WON 9RON{MO.OAY YMM TMPW) NCIC>r OFFICER I.D. NUMMR 12/27/2002 1045 9330 009050 wrtl sa N A0e sex "TeNT OF WURY(W OW INJURED WAS(.TC ONS) NA*Y wAY SANETY ONLY OILY FATAL S&M idem vams wMM AWr � NOS. EOMI. fig= tKAJAY vtAw *UUAY CN PRAM flium PASS. NEO, MMV T LiT1KN 44 M - 0 � � `�' ' C I t G NAME 10,0.13.I ADDRM TELEPHONE DAVID DUANE THYS (121t 111958) 3675 MT.DIABLO BLVD. LAFAYEWE CA 94549 (925)2$3-3680 (INJUMD ONLY)TRWSPORTED BY: TAKEN TO: AMERICAN MEDICAL RESPONSE JOHN MUIR HOSPITAL,WALNUT CREEK,CA. D�scJ�la atuUrale3: FAIN IN LOWER BACK AND NECK I VICTIMOF VIOLENT C14VE NOTIFIED NAME10.OJILIADDRESB TELO+t" ROPERT W.&QU§0 Q 21061 52 PO 90 1177 LAPA CA 94549 -"t-292425 2 (IN.IUREDONLY)TRANV0RTEIS9Y: TAKt 1T4z DESCRIBE INJURIE. VICTIM OF wOLENTCR NOTwmD NAME/O.O.S.r ADDAM TELEPNONE (INJURED ONLY)TRANMVI TED$Y: TAKEN TO: DESCRIBE INJURIES VICTIM OF VIOLENT CRIME NOTIFIED NAME i D.O.S.f AODW.W TeLEPHONE (WUtED ONLY)TRANVORTED BY: TAKEN TO: DESCRIBE INJURY;$: �~-� VICTIM 4F VIOLENT CRIME NOTIFIED (` NAME!0.01L iADOREN TELEPHONE (tNJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJUPJW: VICTIM OF VIOLENT CRIME NOTIFIED (� s t NAME t 0.13.8.JA0DR08 TELEPHONE (INJURED ONLY)THANBPORTTHD IVY: TAXFN TO: OfisSCRIBE iNJURMS: i VICTIM OF VIOLENT CHIME NOTIFIED I'REPARER S NAME 1.0.NUMBER MO, DAY YEAIx REVif iMEi3$NAME Mb. DAY YE W JN.'I C1t�1 I.J1�LMT 11 t109{Y .- 12/2 wA-mop"e6 . 10=. .2003 1 :24PM NQ•3762 P> 6/21 �A+C r.�un�►c,�r+�a�1 auznar Dim my Mdcs esu a+enw�[ +�t. �+��rr�sxrw��,�awo�ras .eussx�►x�c t+ a� � mom z %t #t. its Y a ` vie tern " G/ate V(44 'a. Ova '` "8F vyu&t cip., alb 10-W Afty,6,g,"4 �u :.a.HUMrct �w. unr rrzx� "NAM w wr taut f 'ya/F. OSP 0 n e,b0 200? 1 ;25PM N� 3762 P. 6121 STATE OF CALIFORNM AnDA PAGE OF AT F INCIDENT 7#M RM NLIfi�B��t CSF#C��t I.D. NUMBER 12/27/2002 1045 9320 009050 1 FACTS 2 Notification: Approx. 10348 hrs. 1 responded from the City of Pleasant Hili to a traffic 3 collision call. 1 was advised that this involved a Lafayette Police Dept. Vehicle. l arrived at 4 approx. 1106 hrs. Parties involved were at the scene. 5 6 Roadway Description: Mt. Diablo Blvd. at this location is a 2-way roadway surfaced with 7 asphalt. Two lanes travel eastbound and two lanes travel westbound with the addition of a .& left tura lane. The eastbound and westbound banes are separated with double/double, 9 yellow Botts bots. The traffic lanes are separated with whits Botts bots. The roadway is 10 fairly flat and straight. No traffic controls are posted. The roadway was damp from prior 11 rain. For details of this location see the diagram. 12 13 Parlles» P-1 (Thys)was contacted inside the paramedics unit at the scene receiving 14 medical attention. He Identified himself as the driver of V-1 and had in his possession a 15 Calif. Driver License. No passengers observed. V-1 sustained moderate damage to its left 16 front fender and wheel. No mechanical defects noted on inspection. V-1 was moved prior 17 to my arrival. The drivers' seatbelt appeared to be operating. 18 P-2 (Sommers)was contacted at the scene. He identified himself as the driver of V-2 and 19 had in his possession a Calif. Drivers License. No passengers observed. V-2 sustained 24 moderate damage to its' right front fender. No mechanical defects noted on inspection. 21 See the diagram for V-2s POR. 22 23 Phygical Evidence. Skidmarks were located on the eastbound lanes. See the diagram for 24 location and measurements. 25 26 Othgr Factual_Information: P-1 was an on duty Police Officer at the time of this collision. 27 28 29 -PA-WA-RED BY 1,D.NUMBER DATE REVIEWER'!NAME DATE WINSTON L. JAMISON 009050 12127/2002 Pe, 010•. .2033 1 �25PM Naa3162 P. 7✓2' STATE OF CALIFORMA INARW PAGE 6 i DATE OF INCIDENT TIME NIC RMIR OF IREIR I.D. NUMBER 12/27/2002 1045 9320 009060 1 STATEMENTS 2 P-1 (Thys)related that he was stopped next to the curb on the eastbound side of the 3 roadway. He observed a vehicle traveling westbound at a stow rate of speed. Thinking 4 that the driver was possibly intoxicated he waited until the vehicle passed his location. He 5 started and attempted to make a U-turn without looking. He reached to tura on the 6 overhead emergency lights when he felt the impact of V-2 striking his vehicle. He stated 7 that he did not see V-2 as he started into the roadway. 8. t�-2 (Sommers) related that he Was traveling eastbound in the#1 lame. His speed was 9 approx. 15-20 mph when he observed the patrol vehicle stopped next to the curb. He was 10 approx, Ata'from the patrol vehicle when It started. V-1 suddenly turned into his path. He 11 was not able to stop as contact was made. 12 Witness_#1 (Roloson)related that he was parked on the was#bound side and a short 13 distance from the impact area. He observed the patrol vehicle stopped at the curb and V-2 14 approaching. V-1 suddenly pulled from the curb and Into the path of V-2. 15 16 OPINIONS AND CONCLUSIONS 17 Summary. P-1 was stopped next to the curb bordering the eastbound lanes. P-2 was 18 approaching V-1 s location from the rear in the#1 lane. As V-2 started to pass V-1, P-1 19 started Into the lanes attempting a U-tum. V-1 traveled into the path of V-2. P-2 was not 20 able to avoid striking the left side of V-1. 21 22 Polnt of IMct: Approx. Off east of the east edge of Village Circle. And approx. 25.7° 23 north of the south edge of the roadway. 24 25 Intoxication: None. 26 27 Cause. P-1 (Thys) is at fault for this collision. He is in violation of 22107 VC unsafe 28 turni .P.ab , 10 2083 1 :26PM Ne-3762 P. 8/21 STATE OF CALFORMA Ma 16= swimr AWE 7 OF DATE OF NCIC NUMBER OF t Et 1. NUMBER 12/27/2002 1046 9320 00w50 1 RECOMMENDATIONS 2 Norge. f� PREPARED 8Y 1.57 NUMMI: ATIw REVIEWEWS NAME DATE WINSTON L. JAMISON 009050 9212712002 .. rYtN"' 3 "! Rental Agreement D661372 -- 2393 DUPLICATE 3391 MT DIABLO BLVD) ascription Rate-- Amount t ■rrr� LAFAYETTE CA 94549-4065 20 DAYS @ 47.99 959.8 t*1 0 20 DAYS DW @ 14.99 299.$ j > 20 MAYS PAI @ 3.00 60. 20 DAYS SLP 0 9.95 _ 199.0 Bili To. SALES TAX% 8.25' 79.84 a"M—aamift s t.aamw my FUEL 8.0 ra■rrr�wrr AAA INS-SUISUN CITY WALNUT CRTC ATTN., DALNOI6I»TH0MAS-3178* v BOX 920 y SUISUN CITY CA 94585-0926 W L.i Dat - Out Date In -t2/12/2'TIa2-12,a£PM ---1115/as 3�42P-- - Renter Horne Phone µ CHARLES SOMMERS 510-505-0403 Address Office Phone 8489 PENNSYLVANIA CMN city State Zip FREMONT CA 94536-6351 Driver License State Expires J0013550 CA 3/07/03 008 3/07/42 Additional Driver TOTAL CHARGES 1606.44 Name ESS AMOUNT RECEIVED 567.4 NO OTHER DRIVER PERMITTED Age Driver License State Expires AMOUNTDUE. .. . . . . .. ..... 11110, 1038, Color License No. Claim #/Policy #/P.O. # - WHITE 6V122890 36E368477 7$47.99/DAY ing Inquiries Call Fed Tax 10 # Model Unit # Insured 5 284-2111 36-3041733 03 S 15E XH9130 ing Information Date of Loss Type of Loss PLUS SALES TAX ` Type of Car Repair Shop BUTLER- NTI Thank You For Choosing Enterprise DUPLICATE COPY PLEASE DISREGARD IF ALREADY PAID Cl a1 ■ ! a ar in ■t a 0 a1 111 ■ ■ a ! a of as a # 111 a a # a ■ Please Return This Portion with Remittance AWUNT DUE.. .. .. . .. . ... . 110. 1039.98 Remit to: Paid by: ENTERPRISE BENT A CAR ATTN: ACCTS RECEIVABLE AAA INS-SUISUN CITY WALNUT CRK PO BOX 5666 ATTN: DALNOKI*THDMAS-3178* CONCORD CA 94524-0666 BOX 920 SUISUN CITY CA 94585-6920 03/01 AAA13WC Rental 006613A�reement Amount 98 0P2393 Sent 8y: .CSAA;: 888 8888; Jan-18-03 4:22PM; Page 113 Date: 0111512003 04:21 PM Estimate ID: 32-E353477 Estimate Version: 4 supplement. i(F) 0111512093 03:45:30 PM Profile ID: CUSTOMIZED M CSAA P.O.Box 920 Suisun City,CA 94565-0920 =� Fax: (707)863-0052 r C) Damage Assessed By: Derma Head USupplemented By: Deanna Head in Type of Loss: Collision Date of Loss: 12!2712002 Deductible. WAIVED Claim Number: 32-E363477 218 insured: Charles Sommers Mitchell Service: 913530 Description: 2002 Dodge Pickup R1500 Body Style: 40 PkupCrw V Bed 140"WS Drive Train: 4.71,In]8 Cyl 4WD VIN: 107HAISN62J202886 License: OX29371 CA Mileage: 7,000 OEM/ALT: A Search Code: BERK Options: 4WD OR AWO,ALUMIALLOY WHEELS,AIR CONDITIONING,POWER WINDOWS,POWER DOOR LOCKS CRUISE CONTROL,AM-FM STEREOICD PLAYER(SINGLE),AUTOMATIC TRANSMISSION Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Park Number Amount Units 1 AUTO BOY OVERHAUL FRT COVER ASSY 1.7 2 300013 BOY REMOVEIREPLACE FRT BUMPER COVER 5073001AB 487.00* INC 3 AUTO REF REFINISH FRT BUMPER COVER COMPLETE C 2.2 4 300014 BOY REMOVEIREPLACE FRT BUMPER STEP PAD 55077342AS 19.50* INC 5 300024 BOY REMOVFJREPLACE R FRT BUMPER SUPPORT BRACKET 55077220AS 55.75* INC 5 300025 BOY REMOVEIREPLACE L FRT BUMPER SUPPORT BRACKET 55077221AS 55.75* INC 7 301425 BOY REMOVEIREPLACE FRT BUMPER LICENSE BRACKET 55077i58AD 23.70* INC 8 300038 BDY REMOVE/REPLACE FRT UPR BUMPER COVER 5073002AB 207.90* 9 300046 BOY REMOVE/REPLACE R FRT BUMPER BRACKET 55077370AS 60.95 10 900500 FRM* ALIGN PULL AND SQUARE Existing 1.5* 11 FRONT END 12 300062 BDY REMOVE/REPLACE GRILLE 550771$5AD 177.00* 0.4 # 13 300078 BOY REMOVEIREPLACE GRILLE EMBLEM(ADHESIVE) 5073290AS 25.20 0.1 14 302000 BDY REMOVEIREPLACE R FRT COMBINATION LAMP ASSEMBLY 55077120AS 192.00* 0.4 15 AUTO BDY CHECK/ADJUST HEADLAMPS IIA 16 300100 REF BLEND HOOD OUTSIDE C 1.3 17 300215 BDY REMOVEIREPLACE R FENDER PANEL 55276208AS 212.00* 1.5 # 18 AUTO REF REFINISH R FENDER OUTSIDE C 2.0 f9 AUTO REF REFINISH R FENDER EDGE C 0.5 20 301009 REP BLEND R FRT DOOR OUTSIDE C 1.1 21 301975 BDY REMOVEIINSTALL R FRT BELT MLDG 0.2 22 304031 BOY REMOVEAN5TALL R FRT DOOR MIRROR 0.2 # 23 301033 BDY REMOVEIREPLACE R FRT DOOR ADHESIVE MOULDING ORDER FROM DEALER 39.00 0.2 24 301039 BDY REMOVE/REPLACE R FRT DOOR ADHESIVE EMBLEM 55077335AA 25.00 01 25 301045 BDY REMOVEIINSTALL R FRT DOOR TRIM PANEL INC 25 301077 BDY REMOVEANSTALL R FRT OTR DOOR HANDLE 1.2 # 27 931083 MCH REMOVEIREPLACE TIRE **Qual Rept Part 193.89* 0.2* 28 RIGHT FRONT TIRE 29 936013 ADD'L COST SPCL PAINT MATERIALS 8.00* ESTIMATE RECALL NUMBER: 0IM51200315:42:46 32-E363477 UttraMate Is a Trademark of Mitchell International Mitchell Data Version: JAN_03_A Copyright(C)1994-2002 Mitchell International Mage 1 of 3 UltraMate Version: 4.8.012 AN Rights Reserved Sent By: CSAR;. : 883 8888; .tan-18-03 4:23PM; Wage 213 Date: 0111612003 04:21 PFA Estimate ID: 32-E363477 Estimate Version: 1 Supplement: 1(F) 0111512003 03:45:30 Pill Profile 10: CUSTOMIZED 30 FLEX ADDITIVE 31 PER BUMPER 32 AUTO REF ADVL OPR CLEAR COAT 2.O 33 933003 REF ADDI OPR TINT COLOR 0.3* 34 933018 REF ADVL OPR MASK FOR OVERSPRAY 5.00* 0.1* 35 AUTO ADD'L COST PAINTMATERIALS 21610* 36 AUTO ADD`L COST HAZARDOUS WASTE DISPOSAL 3.00 *-Judgement Item #-Labor Note Applies C-Included In Clear Goat Calc Add'l Labor Sublet €. Labor Subtotals Units Rate Amount Amount Totals 11. Part Replacement Summary Amount Body 6.3 64.00 0.00 - 0.00 403.20 Taxable Parts 1,773.84 Refinish 9.5 64.00 5.00 0.00 613.00 Sales Taxroti 8.250% 146.34 Frame 1.5 64.00 0.00 0.00 86.00 Mechanical 0.2 64,00 0.00 0.00 12.80 Total Replacement Parts Amount 1,920.18 Non-Taxable Labor 1,125.00 Labor Summary 17.5 1,125.00 W. Additional Costs Amount IV. Adjustments Amount Taxable Costs 224.20 Insurance Deductible WAIVED Sales Tax @ 8.250% 18.50 Customer Responsibility 0.00 Non-Taxable Costs 3.00 Total Additional Costs 245.70 1. Total Labor: 1,125.00 11. Total Replacement Parts: 1,920.18 M. Total Addillonal Costs: 245.70 Gross Total: 3,290.88 IV. Total Adjustments: 0.00 Net Total: 3,290.88 Less Original Net Total: 3,040.88 Net Supplement Amount: 250.00 S1: Deanna Head 250.OD THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF REPLACEMENT PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUTACr RER OF YOUR MOTOR VEHICLE. MRRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MNUI'.ACTU tER OR DISTRIBUTOR OF THESE PARTS RATHER THAN THE MANUFACTURER OF YOUR VEHICLE, Body Shap: Butler Conti NOTE: YOL7 HAVE THE RIGHT TO SELECT YOUR REPAIR. FACILITY. ESTIMATE RECALL NUMBER: 011151200315:42:46 32-E363477 UltraMate Is a Trademark of Mitchell International Mitchell Data Verson: JAN 03_A Copyright(C)19-94-2002 Mitchell International Page 2 of 3 UltraMate Version: 4.8.012 All Rights Reserved Sent By: CSAA:. . 888 8888; Jan-16-03 4:23PIN, Page 3J3 Date: 01M61200304:29 PM Estimate ID: 32-E363477 Estimate Version: 1 Supplement: 9(F) 01M51200303:45:30PM Profile ID: CUSTOMIZED THIS IS NOT AIRY AUTHORIZATION BY CSAR FOR REPAIRS. PRESENT THIS ESTIMATE TO THE REPAIR FACILITY BEFORE YOU AUTHORIZE REPAIRS. THE LABOR RATE IS ADJUSTABLE TO THE SHOPS HOURLY RATE. ALL SUPPLMaNTS OR CHANGES MUST BE APPROVED BY CSAR BEFORE REPAIRS ARE STARTED. 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'9lve"module. See appropriate MITCHELL4D ATR BAG SERVICE&REPAIR MANUAL,or OEM Information. ESTIMATE RECALL NUMBER: 011151200315:42:46 32-E363477 Uttrafte is a Trademark of Mitchell International Mitchell Data Version: JAN ()3_A Copyright(C)9934-2002 Mitchell International Page 3 of 3 UltraMate Version: 4.&dl2 AN Rights Reserved JRN 14 2003 11:01 FR BUTLER—CONT I--DODGE 925 284 2971 TO 17078639052 P.02/02 S"��rC4 QUGte 01/14103 Advisor 3796RJ Year 2002 Customer SOMMER$,CHARLES Ro Num 47890 make DODGE Date 01/03/03 Madel RAJA 100 VIN 1 D7HA7 6N82J202888 R" FR Part Number Description Loa Qty Code Price Pdoogty 1 CH 55077103A8 BUMPER-FRONT 1 2 487,00 487.00 1 CH 5073002AD FASC1R FRONT BODY 1 2 207,00 207-00 1 CH 55077342AB PAD-FRONT"FASCIA 1 2 10.84 19.60 1 CH 55077504AB BRACKST-FASCIA BODY 1 2 23,46 23.45 1 CH 55077220AS BRACKV-6UMPER BODY 1 2 55.75 55.75 1 CH 55077221AS BRACKET-BUMPER BODY 1 2 55.75 55.75 1 CH 5073276A$ GRILLE-RADIATOR BODY 1 2 177.00 177.004 1 CH MT7120AS HEAD AMP-HEADLAM BODY 1 2 192.00 192.00 1 CH 95276208AS FENDER FENDER BODY 1 2 212.00 212.00 1 CH 163106435 T1REP285t70Ft17 BODY 1 2 19189 193.80 1 CH W77378AS BRACKET-FRONT BL! BODY 1 2 60,95 60,95 1 CH 5607M8AA BRACKET BODY 1 2 23,70 23.70 7trta1 1,71)E3.0� 05 1 e-e-r-1-, t Aj < 64 %t X95" Ada- 4E3 page 1 TnTA4 PAG _IIP Page 1 of 1 r. r sp9, file:HC:\Program%20Files\CSAR DMS_CACFIE\32-E36347-7\A_32-E36347-7 01-COL I... 5/12103 . . Page I of I IS . �. - i��< f /C& oAam%20FIGJCSAA DM -C ACHE 32-E l 47 7�A-3 £3 4 7 0l.CO£-1... 5/I Page 1 of 1 t file://C:\Progr %20Files\CSAA DMS_CACHE\32-E36347-7\A 32-E36347-7 01-COL I... 5/12/03 Page I of I file:/IC.1Prograrr%2OFilesICSAA ISMS_CACHEl32-E36347-71A_32-E36347-7_0l-COI,_I... 5/12/03 Page 1 of 1 file://C:\?Prograrn%20Files\C AA—17MS—CACHE\32-E3f347-7\A-32-E36347-7 01-COL—I... 5/12/03 t. F s?� A: �w ENS . '•r.^s.K. V y LA tw'7 vs 4 ) PAZ cl c b g I Ct