HomeMy WebLinkAboutMINUTES - 07152003 - C.9 CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BO AC I N: J1ILLY' 15, 20003
y-y
Crlai g nt thc County, or District Governed by
the Board of Supervisors, Routing Endorsernients, NOTICE E T 'CLAIMANT
and Board Action. All Section refer b ces are.to a he copy of this document emailed to y'ou is yowr
California 4cv ent Cocks. notice ofthe action, taken on your claim by the
Board of Supervisors, "Paragraph$� ,6b 11V ybye/bal,ow),W}liven
1�e Awad fib did GoveBn.Yi bent 41�J'3.d� Section l.e..,+ 6d3LhL
915A. Please mete a l " arimirm s
AMOUNT. UN- NC WN -
C A 4AN" `, EERII R a -RAND OF
ATTOR @MY: LN Ktit'01W-IN E, IRE CEIVE . i UNE; 2.00 2003
ADDRESS: 1.3KELSEY STREET Y DELIVERY TO CLERK 02\1. JUNE 10, 2003
BY MAB- POSTINLA2,KED:
FROM: Clerk of the Board ofuper isors TO: County Counsel
Attached is a cony of to d above-rioted csairn,
TUTDated. .n, r s 2v3 By: Deputy .-
--
-
lI FROM; County Counsel . Clary of the Beard ofSupervisor!(
This clam complies sulbstarmti lly with Sections 910 and 10.2.
This Clair FAILS to comply substantially with Sections 910 sand 9101, and we are so notifying claimant. 71 he
Board cannot act for 15 days (Section 910.8),
Cmai-m is not tiinely filed, The Clerk should return czarnn on ground that it was filed fiats and send warning of
claimant's n
gghA to apply for lame to presort a late claim (Section 9113).
A.
thcr.
,� ry n -
Dated, «S.. , �,� �' � y { � � J n Deputy Count casell
111. . Clerk of the Bond TO: County Counsel (l) Cc§�i�ty Ada�iiriistratcr�2�
Claims;was returned as i;ritimlely wird notice to clairnant(Section 91 1,310
IV, BOARD ORDER, By is irrac .s vote of theup-ex-visors present:
( his Llai is r jectcd in falr
I certify that this is a tic and correect copy of the hoard's Order entered in its minutes for this date.
Datedo �v 15, 200: JOHN SWEETENT, C1., K, By � , eDgty Clary
S'A'NING(Gov. code recti 913)<
Subj.ect to certain exceptions, y have nly say (6) monfirls from the datedils ribucc wasperson-ally served or deposit
in the mail tc file a cow action on dhis claim. See Crow-0rinment Code Section 945.6. You may seek the advice of an
attorney of y6ur choice in connection w-.&-, tris ratter. If you want to consult ,i attorney, you should do so
immediat ly. *-For Additional a-ninSee'Reverse Side of` his Notice.
declare
,G r� ,�y? ry 6cy� ,yy+' + yq�v,A:-'F fin,. ry,I"�¢ gF f�{y LINZ� y�¢ynm++ s have
been
,ro rypros �p{. ya Un
+�
dA/ 64S q�d .a Lm penalty`41'}}.. tN.4a�aRh d 1Fbt,�b. G.n`'r no
♦V, b6v'd%&&bt iAd.L L6d.4das/b dah�d'b��i.:E.�rAh�ddb543 t.1,`b+4�.n9 i'.L�b"o-�f V��aX tiro�ar'o�1�eNdL4 1J 3. �L�'ed �b5t o'b��
States, over age 18; anmal that today I deposited in the Un ited States:postal Service in Marttinez, California, postage fully
prepaid a ccrti wed copy ofthis Board Order and Notice to Claimant, addressed to th-.claima-nt as shown
1"
Dat-d: v y NT
, 2003 JOHN SWEETENT, C�,IRi/ y d qty Clerk
a
02,41 i51 ra x,12
Claim tot WAFM OF SUM19M 0 F':
Ag C'1 1 resat-' W U S Of 4 iOn fO death 0?' ��� � �u1.0zor to per-
so-rall propwty w gmwingrp3 and which acme on or More Deoember 311 , 1987
must bi presented not Utw th= the 100th day after ** agzcrml of the 0ausef
gate. claim rej%t4=1 to =.Sea of actim for., h or for Injt W M-Sarl
or to Mrsonal pmpwtv. w SmgIng emps and ?Ahlc4warm on or ` -nY 1
1988, must be gjt rzt later �Zn OiX MMhIsaftr the ccs- Of
Or
. vi n. Mairz relating to &ny -mer Cause Of anti= x«51- be P 5 �
de
one y � after a Go O O Q � - 0 E e>
Bo Llai= m.Mt be fd WMA the Clwk of the i t it3 Of fie iia
C. Is i ,"'4 a district goven.ad b � Board of SupervisoM, r hi gr t
the C", nty$ ofi-strict. ahvad be filled. im"
D. If the clam im i'19b more tkmn. one Public entity p ie Wzt be
filedfl.led air Each public entity
e Fraud. See peanalty for rmutiullent clam Penal, Code 4 72 ME the end of this
fes.
:"or
€ ,
Al
a
}° •' d
SUN I kj zUUj
Dla'trict). I I
{)ARS9 U-PE R
u-,daraignad clalwnt hweby Mkes Claim apinst they ofC4.ntra Costa or
the abboft—mmd
Di3tml of in the s_. 0f � and is Rag°o or" of
this ,,r,�,°� a al 9 p se& fM+.vrs++ m�
i.e
W «�05.# k' ° i.11=1 g«+.m i�,a �. et date ado% hour)
La�* Bim'
2. Ware did the dwzge or Lt�.4ury City and wmty)
How did this damUe or i Occur? (Give AS1. 1 detausj use extM paper i�
,� ,
S
What partiouLv mt W =ission the PWt of W=ty or d"4-strict Off. s
sem. .aM.Layeft cau3ed,the i ' ? w damp?
15103?47308 F.13
eW n a t art v s of comrcy 'qr'-'d1*zt-r1,at ,qMM, servahts or employees cava-ice
"'e ase or iia
-
aWhat damw W lnxnies do you dim resulted? lfivy ft,0111 eAent Of iin juries or
Attach ti for auw damse. rs1P
7. How ,?e , ? (Inclade the estimated awwt of any
pro-spti in jury or e.
q=es and address of witnesses, doctors wd ho it ,a
Li
® List thy. Mendmitums you made ' cc s of this anciddnt or Injury:
DAM n-EM aWU '
. 0 �ka .0. * - ,�S0t iLa
s . Code See. '911M id
Mue claim rust be signedclay et
Nam d of Attorneys
Ad ess
T .
mi •.7 f. the P ,- e 'Pmvidao
very Arson why" vith intent to defraud, presets .i og- for
D t to &117 state or ofd' , or to any wmty, city or daje-. or
`i r, zuthariziow or, pay the Samse $r is � any false ulent
claim,. b , &=0WIts ", or vriting, i bla atther by imprisont in
t * JrI y & ' a W10d Of Wt mm-S LIM •y , bY i,the of mot. exoeeding
e ' q'' d ($1,000), tr by 'boaawd ftniiarI e nt in
the etate Prism, by a Fine of' t ' i dl daUars ($10,0M, r by
b0th auh Uvrisn nt and fines
jUN-1 m20 z 02:41 1510374 308 P,11
06/09/2003 at 1®M PH Job r
25522
PREL19,1WY EST I :T
1990 A= UMM L -2e - ' 20 RM 1- te
Tstigm baq*d iia NOTOt CIASH IMANNIG COUL Vasil Oth"Ago entad all hall art deriyed fXON
tha Oulft ARTHOD Oattbut Dlt§ 121102 lad th Pam W§CM I:g ORUPITU mallcund M? tho
nhiclog Oziii Fav 9141plent ImUctmr. Agttregk ;°I or 00WO Weri4t j'°l 15dic tog th e tht
pox WQr leer Wom",joa per'owd6d Q K0111-01 an hm bony: v9dit e'd or Amy, 1Ivre core frog ab
amny"I W1 agn'aam hw1-Or!g1,xas ° t ftuflu ,twn g9tmArW gilts aa0 amacraw �$ hK
or Oul Iql Wtv Wd pmg at d a"Od as Q, QUI 1"Y Nw, Un or ME Madikorl"16
Para are duck"d as Won, hemd puts art MUM At Rsmo XHS fast War and huts
m prc,7140d Un FaUgnu, hto ''011 sed, poud z gr �1 ital MICAte mum!
Whap A product 09 ebb 3Ybcombbon swim Inc.
W
3
35103?4?308 P10
06/09/2003 at 01s56 PH Job,, Mmber
2,75821
PREUMIWY ESTIVATE
1990 ACM MM L 6- 07 - Int',
-m ., op, ==MON gri Wa PRICE 1AHM PAINT
1 L 1 0s5
144 COM CAR 5,00 T
IN HAZAR=B WMAL 3 5.00 x
-------------------------------------------------------------------------------
total, 9 Sae � m5
Parts 0.00
Body FAJ= a5 hro 6 4. r 352.00
vd t LW=r 10.5 hra 6 64.00/hr72
paint Supplies 10,5 hro 6 3 30. 315.00
sublot/mise. MOO
----------------------------------------------------
: q 1357.00
Sales Tax 328.00 @ 8.25W% 2706
' TMA 1384,06
D*d
'ct"ble 0.00
a PAY 0.00
1 PAY i384106
ME f OLLMILM 15 A LIST DM
p F OS C 1 ' T
uEsmm WM To EE Jaz 6 PAM TV BE. MAIRM OR REFLNM; MM
- M/SYMM, -16018009MM' "IfMt
DCTAGNOSTIC „ Imo°, U. VIAL & P. A r
LOM S-SnUUMML 7WA= Y.-ZCEUAW= XwXON TAM MScM1A=JSA b
AW'=-A.WACM ASM A. miAmvmvE
PAR'.M MS IMOF, MR-MSCON1=2 A&M MA's Dra FUCEmU."rr
CE MMTIPLIM BY 1 - IS "` UXMISm"TIONAL
AU,MU - j GM5 O - AWOMMMATION
oz%L MZ� TUMM gW=QUAW11TQUAL -RWYwWAL147TRECMM PJAPT 9JAL RFRr,--QUALM
MLACEMEWIL, PART =Mm9wp=m1TIox 2m 3H - ^4 ROMMOVE Am
1 VALL ' _ IR RrwMn M=uSM=1'DXS =
.M rJE—Mg-MIRS
0HWAS _
TSE IT1Wa 6*=CATABASE LINE WM Wt
AWAMM TO LINEE.
s:
r
%/09/2003 at 01:56 M job Number;
SS22
CONTRA COSTA BODY MP
License *:AA137377 Federal ID tt!680146344
2.323 SARRM AVE
RICaMM, CA 94804
(510)233-8290 i (510)233-4271
FL
Written by., 7A=LLN=0
j te-r
tnaurn € €
Owner dMIC VANDIXEPo l °s cy
1-353 KMM STSM Deduct€ €8o
94901 Date of LOW*
venins (51-0)233-3865 Type of Lota4
Point of 1paotm 12. Front
inspect CCWM MGM BODY Hop Sus€ne3s® (510)233-8290
Lafttion., 2323 BARR= AVE
R=HMOM, CA 94804
Company-, a Days to Repair
q °D L 6-2,7L-El Int.EMM
YIN-. J 4r 1 1 '104 U01, 4 22 CA Prod Date., 02/1990 Odweters
.fir condit.10ning Rea Detagger Tilt Wheel
Cruise conTral zn'te=ittent wipers Theft Deterrent/Ala=
'vinted Glass Body SlIe MaIdINS Mal Mirrors
Elect--IElect--Ic class Spoof Clear Coat Faint Power Steering
pcvw a FGWX Windows r Locm
Fover Driver Seat Power Antarala pr Mirrors
Anti-10-ax Brakes ( ) OTIver Air Bag 4 Wheel DiSe Brakes
Cloth Seats Bwket Seats Seats
-------------------------------------------------------------------------------
-------------------------------------------------------------------------------
FROG BUMM
2 P '1 frmt par 2door 1a5
per covtr ms' 2.7
4 AM for Clear Coat .
5 8.00 T
6
r Hood 2 door ,
Add Tor Caen Co&t '1>2
9 ram
10, Rpr V1 Fore= 2 door 2.5
ll avarlap4or Rainn -0.4
2Md for Clear Costo
3
02:40 15103747308 F, lo-f
N e Job Rumor
PRMMRY ESTIVATE
1990 XXV. UMM L 6-2 s — ` 2D RM it',
the All 110000 Det tw nato 12/2M and 06 pggt6 Wgett4 art OH-pirtl wvzacttlrea by ti�E
4'WC1*1 ar(qiaal zqutpweat xackavarw Awei3'x' ` f 0 Mot wwri j—) Wdicaw w w
yybg {{..:g aaAAar@@d pryryb =sggbo2l y�kkint��Iss<DV p�q�}�'tdod jbyQA OTOR gnt�yg ���e pbest EE��vv�ippEE�€td of ppappsy9� have caal froo an
6lttrngtt �w 1 501:tc "a-fr61"�wal �I��apPlew ef{allf0clurg6 al"Itstal PwE 4.a �tIss l bed as AR k
"m arl WOUN ag lawn. lew`L'red pa.rag gib' dwilb" 10 Worn W on, Was W Nutt
zrt p;wytdtd sate witiond Auto gess Spniityatloij, Inn found ";p (11 Ant tt?fkaw Olual
i'S oii C.R v ' av Vtfu of scc 1pto hi$ = Wf ICv® Int,
2Zy
�j
ose
d
06/09/2,003 at job Nwber:
25822
PREUMANY EST&MATE
1990 AcM LMEND L 6-2 r 7L- Int:BEIGE
--------------------------------------------------------------------------
Nio OP. M-W—RIPTEXON qff EXT. PRICE IAM PAINT
13* lrlw Coxm 05
140 COVER
CAR
15.00
154 W. ARDWS PAM.1A."
-------------------------------------------------------------------------------
Parts 0.07
Body Uabor 5.5 s s I S 64, / x' 352
Fa nt Labor j .5 $ 64,00/hr 672.00
it `'$ b- 10.5 hrs @ � 30.00&x :315.00
9�2blet/Hiscigloo
Si Tam $ 1357,00
Sales Tax 328.00 8,2500% 27a C�
GSM TOTAL1
Da,rhzctibbe
----------------------------------------------------
CUMMM PAY 0>00
i %
0:2, .§'j
men
06/012003 t 01>5 "'70b Numberz
CONTRA COSTA BOY SHOP
License *,.AA137377 Federal 11D, *:680146344
2323 BARKTr AWE
MMM, CA 94804
(5.10)233-8290 Fax: (510)233-4271
Written by: JAIME
j > r
Qwmor't ERIC Rmmm
Address: 1355 W
'Rx 94'W1 Date of Loss'.
yo in a (510)233-3865 Type of Loss:
Point of impact: spy. Front
napect COWIERA COSTA BODY SHOP Suainem (510)2J3-a290
Location: 2323 M
R. mo; CA 94804
Company. a Days to x0pair
vm x' 4 1- 2=8104 L i c,. A 2 CA Prod Onto 3 02/!990 od rs t r
y�A i� Conti i t ii on ftar Intermittent
Wipers
� g 'i I t y�e I g
x' uiss Control
arm
11"?m.,ad, GIM83 Body Side Holdin'gI3 DW., mirr"Ors
Electrlc Glais Simroor Clear Coat Paint Power Steer.'na,
Power Brakes Ener win4ows *r Locks
Power Driver seat. Power kntanum Power Mirrors
titi-mak Brakes e4) Driver Air Bag 4 Vhe l Disc EraktS
Cloth Seats st seam ecline/Lot ge Seats
lot's WAels
NO. OP. MMI TIT EWs 'RICE LABOR
A „'+dct�,��r-A'—r N��
---------------------------------------------------------
R : t-rrt bumer 2 door .m
Add for 'ler Coat z,
?=4 8.CY3 T'
7 Q Rear Hood 2 door 2, C® 3<{
for loan' t b.
r Vr rider 2 dont 215
v Overlap Major Ad-!, Perm 1 -0.4
Add for clear coal. ,ek
06 '°'09/2 O 3 at 012 26 PM Job Number-
1990
umber-x990 ACUR LEGEND 2D int;
-------------------------------------------------------------------------------
NOa :gip, D SC I TI N QTY ZXT, PRICE LABOR PAIN":
--------
i6 papl Glasff Acura 2 door i 570- 69 4 >0
10 Cover C x 1 540 fr 00
Subtotal$ 575.69 8fl6 9, 4
Parts 570. 69
Body Labor 8. 6 hra @ 65.00/hr 55 m 00
Paint Labor i 9.,4 hzs I $ 65.00/hr Gil. 0
Pant Stip li a 9<4 hrs 9 $ 2e.00/hr 263. 201
s,ubiat/m, j5C. 5. 00
-----------------------------------------------------
SUBTOTAL 2008.89
SKOR T X 08.69 :a 8425001 6 .21
-----------------------------------------------------
GRAND TOTAL $ 20700
ADJUST N S
Deductible 0400
----------------------------------------------------
CUSTOMER PAY $ V ou
INSURANCE PAY $ 2 76 . ,1
'RE !S A L!$T Oda A EVI MONS OR SYMBOLS TiAT MAY BE USED O
DES P,j WORK TO SE SNE OR PARTS T BE REPAIRED OR R CZ�V: MOTOR
ABBREVIATIONS D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR m d PES
-BOD` OR -DIAGNOS'A"!C — TLCT ICAL F- R aE G-GLASS MM C A�I��;� �=A "1 .°
BOR S TRUCTURAL T-TAXED MISCELLANEOUS X-NON TAXED MISCELLANEOUS PATHWAYS:
A -ADJACEN T; LG ALIGN A/ FTERMARKET BLND=BL' D CAPAwrCERTIFIED AUTOMOTIVE
PARTS ASSOCIATION %%=DISCONNECT AND RECONNECT rST STIMAT EXT. PRICE=UNIT
PRICE U-7TI LIE BY HE QUANTITY INCL=INCLUDED ? ISCw1qISCZLLANE0US NAGS=NATHONAL
AUTO CLASS SPECIFICATIONS NON—ADJ—NON ADjACENT Q/H=0%1ERHAUL OP—OPERATION
NO—LINE NU5FR QTY-OUANTITY QUAL RECYwQUALITY RECYCLED PART QUAL %EPL=QUALITY
REPLACEMENT PART GOND— EC ONDITION EFK EFINISH REPL-REFLAC , R&ImRZMOVE AND
INSTALL R4R—REMOVE AND REPLACE RPR=PXPAIR RT=RIGRT SEC's' S ate.,`XON SitBL=:SUBLET
LT—LES"? W/OwWXT OUT W1 -WITH/ SYMBOLS: URL LINE ENTRY *mOTHER r18 MOTORS
DATABASE INFORtM TION WAS CHANCED, **-DATABASE SINE WITH A aERMA.RKEa NmNC;TES
TlliSeHED TO LINE o
2
06PO912003 at 02526 FN jo�,, tm-mber o
33581
Federal 1D #:680242263
135 24th St,
Richmond, C -94804
(510) 232-5749 'Fax t (510) 232-BI30
Written by: Andy Linan
Adjuster:
I m erc y , candle
AAdwaaa- Q Deductible:
Date of Loss
Day: (510) 233-3865 of Loss.
.Point of MVkct: 12 . Front
I at ANDY'S AUTO BODY Mamas: `510; 232-51499
xacatim; 135 24t.h St,
Richmond, CA 94804
I
c5agAny; Days to Repair
1990 ACUR LEGEND 6-2,7T,-FI 2D Int:
VXNa j,44KA31J=008104 Llc< Prod Date: Odametar>
Air C ninon tnRear Befogge Tilt Wheel
Cruise Contrc4 Intermittent Wipers Tinted Gases
Body Side Moldings Dual Mirrors Electric Glass Sunroof
'-!oar Coat `faint Power Steering Power Brakes
Power Windows s Power mocks Power Antenna
Power Mirrars Driver Air Bag 4 Wheel Disc Brakes
Cloth Seats nucket Beaus Rocline/Lounge Seats
Al=inur,/Alloy Wheals
-m-
NOo OP. DESC IPTXw QTY EXE', PRIPRICELABORPAIN �.��
-------------------------------------------------------------------------------
I FRONT BUMPER
20 Rpr Sumy,r corer i . 2 ,7
3 Add for Clear Coat I
4 FRONT LAOP
5 R&I RT S..Snal lamp asst' 2 door 0, 3
R6il LT Signal lavmp lampasst' 2 door 0. 3
HOOD
Rpr good 2 door 2 .0 3 . 0
Overlap Major Adj . Panel � -0 . 4
Add for Clear Cgat G. 'i
l
FENDER
I R ® LT sender 2 door 002 2< �
i3 Overlap Major dj , Panel -0. 4
4 add for Clear Coat V4
As WINDSHIELD
I
J UNI—i✓3`e1"'r' Gid=
12,S17 `SAW L N, ° I e
CH
! MONDP 4805
7771
9
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FW1, Ni4 Windthield
Fa s t.°"<.•u:"e UT 6t"?anP, , rami Pr rp,er 0_oc,
s
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O s f %s sod to
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_ ,fits Ruridow.&AdMv tat NO m tor1W wi,# not be O'siod sr. 2 6,xwdoug �, a"
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'' £S �, + r .q•,s> ! r }tae ,� + A�'r t �, r 't x' 242.03 I
¢r�: S �K VffiL S'd 5t5t
1442 YORK STREET
VI0NUa CwA 94801
PHONG": (510) 374-730)9
FAX (3`0u) 374-7308
Fcax
To; r-rom
Fax,, Pages:
t
Date
Urgent or Review ieaso Comment U PEcasc- Roply 0 Mo se Recycle
CLAIM
BOARD V CONTRA TA C � 4
BOARD ACTION- J_ULY 15 , 200-3
Claim Against the Courity, or District Dove n d by )
t=Board of Supervisors,Routing Edd rs .gilts, ) NOTICE TO CLAITM.'-'�,N'T
d Board c-onh. All Section references are to The copy of this do.-CUl ent7aile to you as your
California Government Codes. notice of the action taken on your cdwiurnbv, the
Board of Superv,,
{ .rs a;
' sive ent Cocke ectio .9 and
915.4, PItase tote P-11"Warnings' '
AMLOUNT: $527 - 70
,mss Ryy qqNT ,p:,T AA
ET 11.
NON
.ATTOp,.L\f` ; € N OWN DATE RECEIVED: 1 UNE 10, 2005
D. SS: 2540 ATLANTIC STREFI' Y .WI ER TCLERK 'N"
JUNE ��e 2��3
CONCORD, CA 45�L8
BY
T POSTMARKED: HAND DELIVERE
FROM: Clerk of the:hoard of Sageinsors TO: ty`o nsey
Attached is a copy of the above-noted claim.
:Oh-NT ��
SE Tt, q r
Y
gip qtly
H FROM: qty o°ms l TOr Cleek,offthe Board of Supervi yrs
ti
'rhisciainicotziplies s, tatiw� t Sts aid <2a y
, a r Cla .L..w+'aS -,o cod» .£d ,�ostaritial'�l MAl�1:' s.r�e-do-,is ':J`:O .d 9,.0.2, �&-q .we -w so no' li yi,-L colada d l'��i,. e.fLffiw
Board cannot act for 15 days(Sect-ion 910,8).
Clainn is not timely filed. The, Cledk sho-a1ld return ciainn on ground that..t was --filed bate and send warning of
claimant's right to pl yr for leave to present a fete claim(Section 91131).
Datedj, Deputy yCo`� msen
111. ,p�p��3�: ,Cler° ��?sy"y/t��°�e Board �L�' with
�n o� � ,ty/Co xx sy+tl(11��p Countt�y �.d .nistrator(2)
yC
Claim 9�6�s reta Sed untimely Y7 it notice to 4fL"eL.'sbSetG'.L.i.L(S.3'bS/b.1i..+'n 9 n�s3
lv� �� O DER: y: mans-mous vote of the Supervisors present:
`bus Claim is rejected in MI.
a
I cerffy that this is a tae and co, ct copy of the Board's Order entered in its minutes for this date.
JULY 15J 200 R WE T E�", C-LER17K, By Deputy Clerk
y.
Dat=
W��T4 (Gov. code stir 13
ub*ect to ceft9r,exce�tions, you have only sax ( )itiontdas ft%-;m the date thIs n6tice was personally served or deposited
in�n♦¢{' the q ai� l t --1.10.,+�`Ex¢¢�+,,.�coue..y+5act on �'z}'tvu this clai�y'�'t. yee Govermne gtgCodSA.�,Section
dy � 45,,/{�6.�,5��.�ou r�.��6,y se �q .�ygt'.e{Y,rydv+q�� �:���.
£SYb`^a'-rney of yV lxr Cl:.kohWe in aJ"+odmiec4ion withG�L,kiis ALm63r4'er. 1. you Want o 'wf�iLksult bids fdbto'-A e � you shl o ld do so
5 . alat ly. *For. dditi - Wartring See'llev rs Side of'-is N.
AFFIDAVIT OF 4
deollare under penally of erjiury fhat I am now, and at all dines h-,ieha mentioned, h ve beer.a citizen, ', tide niittd
States, over age ffi A and that today l deposited in d .e nited States Postai Servi,e n h�a �
z, Cal' oia, Psta e fi llY
propaid a cerdfied copyof this Board Order and Notice t "" .mw°it, addressed to the claimasit as shown. above.
t d: JUL .6, 2003 J �" SWEETEN, ,ER,By
OFFICE OF THE COUNTY COUNSEL -' LVANC S.MARESI
ary F CONTRA COSTS ��>}"N �`` ��� COUN. cou�SEm
L '
SHARON ANDERSON
ZY
vas ;ornisa 94553-12 j1 f x� �f o-cs $5 �?p"
0 of C
. HARVEY
,925) 335-s80 � 3 � r Ja{1V a `fir !! VALERIE E. RANCHE
(925; 64P,—!C,78 (fax) i �k s ,, Ass€STAN
NOTICE OF UNTIMELINESS
t
vy
AS TO A PORTION OF THE CLAIM
T0: Janet L. McK rmon
2840 Atlantic Street
Concord, CA 94518
please Take e?Notice as Follows:
n re�a_rds to the claim you submitted cin rune 10, 2003, portions ofyour claim are timely and
portions are untirr<e'y. The portions of your claim prior to December 9, 2002 the..you presented
against the County of Contra Costa governed by the Beard of Saperivisors fail to con,ply substantially
W1 the req uirements of California Govermnent Code Sections 901 and 911.2, because they were not
p resented:wifq n six montes after the event or occurrence as provided by law. 'because the portions of
ffie claim p iC�r to leceber 9, 202 were not presented wt yin the time allowed by lair, n action
was taken on those portions of your claim. The claim was forwarded to the Board for action only on.
the tirnely-oartions of the claims.
Your only recourse at t�:is time is t apply merit csut delay to the c my�f s�ntra Costa gt v-npd
by he Board of Supervisors ter leave to present a`ate claire as to the claims w ich are untimely. See
Sections 911.E to 91.2.2, inclusive, and Section 946.6 of tie Government Cede. Unde-r some
ci curnsta_nces, leave to present a late claire will be granted. See Section 911,6 of the Goverment
Code,
fou--nay seek ,he advice of an attorney of your choice in connection with this matter. 1f you
desire to consult an attorney, you should do so immediately.
SILVAN'O B. MAIC EST
COWNTY COUNSEL,
By,
Janet L. Hoimes
Deputy County Counsel
CERTI-1CATE OF SERVICE BY MAIL
(C.C.P. §§ 1:012, 1013a,2015.5;Evidence Code§§64-":,664)
1 declare tl.at my b..sincss address is t-he County Counsel's Office of Contra Costa County,651 Prue Street,Martinez,Ca jfornia
94553;:arr.a ctt:zer of he€ sited States,over 18 years of age,employed<r.Contra Costa County,and not a party to this actior. I
served a trmc copy of this N 1ICE OF JN'1'IME-T-1NE-SS AS T 0 A PORTION OF THE CLAIM by placing it it,an, enve�cue
addressed as shown move,sealed a.d postage fully prepaid thereof.,and`hereafter was,deposited this day in.the J.S.bail at
Mart:rez,Ca:forma.
I certify under penalty of ae u_y that the foregoing is:rue and correct. Executed in Ma:finez,Ca`:for ria..
Dated: du're 11,2003
P
t a.,ye
cc: Clcrk oft°e Boa* o S pery:sons(original)
Rise Man..agement
.P
Claim top: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
TR,UITIONS TO QLALV, �T
L•
A. Claims relatsn to causes of action for death or for injury to person or to`pensonal propel, or ��-ri
crops and which accrue on or before December 31, 1987, msusa be presented not later than. the 1€ day
after the accrual oft e cause of action. Claims relating to causes of a,-,,ion for death or for €nigra'to
yrs r rsproperty r � s ? r fi r _ _ ik must e
presented not later than six months after the accrual of the cause of action. Claims relating to any other
apse of action must be presented not later than one year after the accrual of the cause of action.
(Gov't Code 11,2,)
B. Claims m ust be filed wif Supervisors s , gun ,
Administration Building, 651 Pine Nlnnez, CA 94553.
C. If claim is against a district governed by the Board of SuperAsors, rather than the County, the name of
the Distrix should be filled in,
D. REthe claim is against more than one public entity, separate claims must be filed against. each public
entity,
E. Fraud. See penalty for °au use a clairns,Pena' Code Sec. 72 at the end of Ns fog.
: Claim By Reserved for Clerk's fling stamp.
F7R—En
J
Against the County of Contra Costa or � Qf a �'
} d
,¢� ,fig �xg� �, ViJ '�� i
" _ Gid' s istr ct), v. "\ a1` ,',r;v'V,r�'._t; jvfiv'aJ�`�`',
Mil it name)
The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district
in the sum. of 970 and in support of this claim represents as folIlows:
1. When did the damage or injury =r?rGive exact date and hour)
If-
2.
e b
There did the damage or injury or ( cle city and county) :
}ar i ne C,A
3. How did the damage or injuryoccur?(Give fill details,use extra paper if required)
g Y c" 4 + 7
coo-
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lbu u
9
at,
�N
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i"V
v f . y
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4
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tb
a;fa :g a s rfa
at
4, What, pa-kola a Or 0 M- ssion on the pan of county or district officers, servants, or e iployees caused the
injury of damage
4 r
CAL } 3
s &ounty or district offlc , s s, p y s using the damage or L �
a
6. What damage or injuries d o you claims: f s�Ite "? (ave 1,l ent o injuries or damages claimed. ,attach
two
estim mes for auto
,az
7. How was the amount claimed above computed? (Include the estimated amount o°f y prospective injiury or
. Names a4dddress e sus& doctors, and hospitals.
PA D-V f4 CaJA
I m. ale)64ii =Wihis
reexpendnftreTy�R aa or mjury
AE
ATE JIME
Gov. Code Sec. 910.2 provides "The claim must be
signed by the claimant or by some person or,his behalf
LEIN n
Name end Address of Attorney
(Claimant's Signature)
(Address)
Telephone No.-- Telephone No.
ffi 0****4
Sovdon'72 of the P e,fid:
Every penin who,with intent to deftud,pmts for&UoAance or the payment to ary mie board or officer,or to any
county,Wdtyq or rai'rot board or officer,authormad o
to aow of pay the s&- e if gmuLne,any fain c�h w cla ,bUL a : t,
you--her,or writin&is purdsbbl e either by imp.i sonment unty, j t for a pezi od of not MTC th&n M t yam,by a fir.--of not
ex moda ng e.,ne thousand( 1 t, ,or by both Bch pr;somn ent and fmc,or by impri so=wt in the eni son,by a fine ad=t
exceodog t= d doUars or by both such imprisoment and mem
Animal Services Department
48410 Im-hoff Place
Martinez, CA 94553-43593
inn,: Michael GRoss A
Lt. Gomez
A_?rhnal Control rvi-Xs
RE,a Shelby & Monre?mac Kinnon
ears: Jerry& Jane.Mc Kinnon
Teta legit lr is.o anIgUire as to the problern your office is havingin responding to the Public
1-fearing that,was bed on Januar 23, 2003 at 1:00 pin at.b coy nra Costa co-anty
A nrr:sdratio.n Building, bated at 651 Prone Street in Room 108. Ad.b conclusion,of
.bis p bli r � n , s.n , 3 � Officers
iUong with our arnq'r)were°inf°o _ed that "would be an additional 7-10 days before
.verdict on.our case would be de6.ded and we ould be notified. f this date n suc
n otic vee- .sy or w Atte as bee,receive . Our��� :ri es attorney as ca ses your
officosever
Shelby mind Monroe nava been. --inyoux custody s.nce {we ber 24, 2003, wbich is an,
extremely longiiength of t-r e, Since Lt. Goetz had so politely refased the i'sol ..iork
boafding ofMonroe& Shby at Encina Vet Hospitalan W.C. until the hearing.hat
was to take place gni 4-6 weekslater. At that time as ver,distu!bed witb Officer
Poly who rmnutes before had just taken me back to the veterinary, fkc ity(room)to
CallCallm rpzy wars. as.o my babies getting Kennel Cough. A.which time e showed€ane
the vac6 nation wbicb he had gi"VM my dogs, which in to n v,,mas afbllirlevaccination
'Which .due only vaccines III the reffigeration. Officer Foley.bent were or,. .ell
Me'he n ius. of not bad his glasses on, Aft-.becotnihng flipped out, and then finally
bei able.o talk.o U Gomez and telling bion I wanted to give my b bies their
ord .ins ,, and EFA Caps, and¢mann SDma—int, Food., since Lt Gom, ez said their
Were required to staYuntil. e hep2mg which they asswred seeoul b no longer
¢pan 6 weeks.
Monroe& Sbelby have bee,- :l edfrom heir nowt diets, their moirthly Heart
Gxasa d, twLLQ.e a-vveek teeth brushing, their m,ontltr Advantage, their roub.,€,,eXCIMM
d sociafization. ivith people airid other fde d . At this point T am not experier-Ie
with teffect that 01 of this-has had on my b b e wb .n y have beer. In quaraminee
for this extended length oftime. So I have r tared. e serrices of an Yludmal Behaviior
Expert 11-0 detennine the d&-nage h y:°n .v been done.
2SLtce yo:h]. office is or some reason wLs..%id or just uZ1{'ble to ZSa..4_dle this situation, A
will ease that it is cesswry for e to retain r or,tioun it em s i i J.
to asyIA'st 7me and my ami-ly ir.retried.n-g the other h,—,',f, of my fw��members
ftm your La it ty.. If no response to the hewffilg results by this Thursday
Febr a*- r 13, 2003, 1 will assume that the neat steps should be put into acti
AR
; mim-els are or should be entitled to the night of a quick a speedy tnal and
also du n-rote s,
jr—met t 1,. mc Killion
Tis letter is being hand eelivered to; ANLNUL SERVICES DEPARYMMENT
4849 Ih Place
Martinez, Ca 64553-4393
ATTMLQAES,, w .
Atm mal S nvis a, 'rectol-
Ltz OM
EZ
ACCEPTED BY.-
141-1i M-11 S s emrfine t Office Person
Contra Cost. County Animal Services
4849 Imhoff Place, Martinez, CA 94553
(925) 645-2995
R calpt Number, R03-005537 Receipt Date,Tu n s Feb ary 11, 2003
2840 ATLANTC ST
CONCORD, CA 9451
rad::Card N4-.1
Rvice?y,ed FY^: : Gp .LD_MC€ C'hack o: 1QL N6864330 ph0nr_° 635-0657
:tem; € # e €� p Amount,
; aiATE 79902-0230
A"_�CINAT:m A22040 T02-023681
EXAM A22040 7036001594 .00
?
A1781199 T03-001595 D0 3
BOARD SMALL A220408 WANED $118 .00 79 ,00
BOARD SMALL A173799 WANED $118 .00 79 .00
� � FEE A220408 VWAVED$45.0 0 1 .00
MPOUND FEE A178799 WAVED$45.0 .n0 1 00
oea; geesDue:
Payments: C'aSh: $0.10
C'heak: $0.00
Credit Card: $0.00
Total Payments Received, $0.00
Thank Yowl
CharoCC,8: $0:00
BallanceDue: $0.00
Animal I rmatio
A178799 SHELBY .-5 WONTHS ODF AGE, Est m DOB-111 /1999 PAYED, P T BULL, WHITE AND S—Ra N, DOG
A220406 MONROE - 1 YEAR^ MIONTHIOFF AGE. Eeim OB-!1/2911999NEU T ERE-0, P . SULL, BLUE SMOKE AND
1 HTE DOG
Treatment Information.,
Type- Animal# Description: Medications Cost. Treat Date,
VACC1NAT� A178799 SHELL) VAC-11",D H- P ?02-0236-80 11924/02
EXAM x;178799 SHE:L ) see memo T03-001595 ^4117/03
VAC0;:NATE A220406 M.ONRC 4AC'C DH:':1P 702-0239-81 11924/02
P A220408 kxCNR` see memo 703-001594 01/17/03
Tussday-Saturday 0:00M. -6:03P'g Wednesday":C:LOAM-7:00pm*
Z;tws CLOSED 8 urdays,Mo ndays,anc�c#Bays
ay/'N9u?arC1 n!o:°ebrdas-Fr?dsy7W a.s°,^. `2 a Now 0 D.m.-4:30p.,�.;Scma8aturdaya 9:00 em.-12 N wn
Cark:cdaib MART NEZ Trsnaac#:cn Date:02/19/03 Pnrd Da:a:C-2/11/03 �:\cFa�aErt2\crys4s?1 saz\ra;ai3s4.rr'
TOTAL MEMICAL PEES: .
4Uesdsy-Saturday 6:00pm! * Wedneadey 10:00FM-7:00PW
SPay/Ns6larCPnic:Mnnd -Friday 7ZO P.rr.-12:00,Noon!4.%' 430 p.m.;�ea�eAsa �e,s�.N s p.-?� gco.l
::ark:cde^ MARTNEZ T€en wc'"ton Oso:021',1/€3 Pr r;g Z£e:
MEDICAL HISTORY
P0956W A178799 Cage N
C KIN O , JANET L SHELBY S WHITEARO
2840 ATTIC ST PIT BULL
CONCORD, CA 94518Bites
(92S) 6850657
TREAT DATE r.*O TREAT T mV y'7, S MEDICATION DOSE Y KDAY T" T TMP BY
2003-01-17 NORMA! EXAM1 m ., w 1 . n LMm
. 00
see memo
!/17/03 Per Dr S dere visual exam bright and alert ok to hold, wound above etre
appears to be healing well . Rmo-bin
2/n/03wer dr sanders visual exam. e mon noted above L eye . Visual exam on
2/6/03 . On exam today 2/11/03 exam shore semicircular lesion 4-5 cm drove L
eye--raised and erythematous, slight scabbing along dorsal margin. No other skin
lesions seen. Dax- raumatic, arasi ic, fungal, inflammatory. Plan: recheck i
two days , bjs-wv
2002-11-24 NORMA- VACCINATE VACC DHLPP 1 a 00 1 . m 1 . . 0 . 00 DFO
�4
4�f
.r
-MEDICAL HISTORY
A220406 C" . No:
C" K11,070N, j N T L MON-ROE N BLUE SMO /WHITE
2840 'LANIC' ST PIT BULL
CONCORD; CA 94518 Bites
(925) 6850657
-
E_ i ��' _ T TREAT :/s TYPE C, r� �
Q 4/DAY W„�_- "SMP BY
see "'emc
1/®7/03 Pel. Dr Shore vlsu m exam a-nd alert, ok to bold Moran
2002-11-2,� NORMA : = A-C-C D-MPP 1a00 t _ . G CC 1)F 0
E CI A VETERINARY HOSPITAL
2803 Ygnac vc3 Valley Rd.
Walnut Creek, CA 94598
(925) 937-5000
Janet Mc Kinnon invoice
2840 Atlantic Street ?gate : 2/11/03
Concord, CA 94518 Number: 0324018 Page : 1
Client : 6850557
Patient ; Shelby
RABIES due 0/00/00 Db4LPP due 0/00/00 HWTSST due 0/00/00
DHPP due 2/22/05 ANNUAL due 0/00/00 LEPTC due 2/12/03
:CORD due 11/27/03
Weight : 48 Lbs on 4/17/0:
i
Performed on 2/11/03
Exam and Consultation 49. 50
Disp : CEPHALEXIN CAPSULE 500 20 . 62
Diso . PACTODERM OINT. 21 15(; 21 . 25
Adult Screen 93 . 15
Ultrasound Urine Collection 2530
Culture if
Patient : Monroe �
RABIES due 7/02/04 DH LPP due 0/00/00 H"v7�EST due 0/00/00
a DHPP due 2/22/05 ANNUAL due 0/00/00 r EPTO due 2/12/03
TORN due 11/27/03
Weight : 74 Lbs 14 Oz on 9/06/02 78 Lbs on 7/1 /01
Performed on: 2/11/03
exam&Cor sul t-Ltd,. (General) 41 . 00
Disc CEPHALEXIN CAPSULE 250 14 .46
Dis . CEPHALEXIN CAPSULE 500 20 . 62
Adult Screen 93 . 15
Ultrasound :rine Collection 25 . 30
Culture if
Performed on: 2/12/03
D sp : DEN SYS:/SAM-E 225MG 102 . 10
Subtotal a 506 �43
Total : 506 ,45
Balance Due
As of
Previous Balance : 00 2/13/03 >>>>>>>>>>>> : 505 ,45
CI A VETERINARY HOSPITAL
2803 vg^ate:±; Valley ode
Walrut Creek, CA 94598
lk9251/ 937-5000
et Mc Ki—n onz Invoice
2840 At-Lam tic Street Date 2/ . 1/03
Conco-rd, CA 94518 Numaber: 032401-8 Page : 2
Client : 6850657
'7-,ha-n-k you :fog: t'--,e opportunity to serve you today
2803 Ygracio Talley Rd.
walnut Cream,, CA 94598
(525), 937-5000
; a iet Mc Kinno- Invof^e
2840 At"l an—i c Street Date : 2/2 4/03
concord, CA 54- 518 Number: 0325290 Page : 1
Client . 6850657
--Da tient . ei-by
/nn/00 �3 0/00/0-
a
/00
; T S duennPP due 0/00/00 ':-W-E due f0
q - due 2/22/05 ANNUAL cue 0/00/00 LEPTO Uwe 2/12/03
E
30-'R e: du,e 1/27/03 a
We ht : 4. 8 Lbs on 4/17/0-.
Performed o-n; 2/24/03
D sp; SACTCDER I'DINT, 2-0c 15(3 2 n 25
i.:tbtC>ta1 a 2_S. � 25
Total .- 21 ,25
Balance Due
As of
Pr•e l'o-as Dala wce . 157 � 74 /24/03 >>>>>>>>>>>> : 178 . 99
Thank you for t:~-e oprortunit—y to serve you today?
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»'.
CLAIM
BOARD OF SUPERVISORS Off`CONTRA COSTA COUNTY
k
BOA ACTION. JUL? 15, 200:1
Claim Against the County, or District Govermed by )
the Board ofS r,-Wv:sors, Routing Endorse ent , 'N'0110E TO CLAIMIANIT
and Board Action. A:: Sectson references are to The copy of th:s document t a::ed to you:s your
Califorma Governm ent Codes. notice of the action taken on your cla€rra by the
od of Su ry:cors. arag, ���below), g:v
u
g rsuatit to Govern-me-,,al,
e y ode Section 913 and
i
7' 5A. Daease nose aal "Warnings".
1a'?"nings".
A OUNT , 05.15
ATT 0 IRNEY UNK-(3>f� DATE RECEIVED: JUNE 11, 200-Q
ADDRESS; 'J-05 WHEAr 1 11 mf� 1 �' � '; JUNE1 s 200:3
5�K`` -DOD, 94513 BY
Y Axe POSTMARKED: ,DUNE 4� 200
FROM., Clerk of the Board of Supervisors TO, County Counsel
Attached:s a copy of the above-noted olain,
Dated: M-N-E ill 2003 y: Deput
FROM,, CoYanzy Lo se: or: oft Lard fS e :sobs
Tris mIama co lies sub stanl.al,:y with Scotions 910 and X10,2.
s;
This Claim FAILS to comply substan-1.4 ,lly�r�t,, Sect Ons ��f3 ��d ��G,29 :d�� # s� ��s�°� ' ^��h at, " �
b1my6 W r 1
Board. came t act for 1 days (Section 9z0. )>
Clams is not timely filed, The Clerk should rblutnn claim on g.—O.,that it was filed late, and send Waning of
cla: .annt,s rivat to a by for leave to Present a late claim (Section 9t 1.3).
Other:
:-z
Dated D qty
;- r' ,. .... � qty�o's�. Counsel
FROK Clerk-of the Board TO: county Counsel (1) Coanty Adannhllgstrator(2)
Clahr.was r tanned as untimely with.not:.-;e to claimant(Sect:or 911 3)0
aid. BOARDOBER: By unanimous vote of the Sq 0,—,,:sora present:
11us Chinn:s rejected in fail.
ti ) Other,
V.., fy that this is a true aid correct'co y oft e Board's Order entered in its minutes for this date.
,.
TT
`�:y jr2003 JOHN SVVEETENT , CLEHCK, By
Deputy Clerk
WA NTI (Gov,, code section 91�)
ab;ect to certain exceptions,you have only smx (6)rr.ontIns ora the date this notice was personably seems'edl or deposited
In the m
a:.- to ale a court actiwq mon this claim. See Goverziment Code Section 945.6. You may seek the advice of an
at or .dy of ybur choice in co ection with this matter. If you grant to consu.It an attorney, you should do so
A=,edlat ly. For Additional War ng See Reverse Side of'1h:s Not:o�b
A FD)AVIT OF MUNI G
I declare-wader penalty of perjury that I am now, and at air times herein mentioned, have been a citizen ofthe United
States, over age 18. and that today I do os:ted ki th-e ,it d Stags Postal Service it Malar ti ez, California,postage fatly
pry aid a o rdfiod copy off-his Board Order and Notice to Cla-'cant, addressed to the cla�r-Pant as shown above.
ULY 15, 2003
Dated. "" J SWEET INT, By eputy Cork
Clairc M.RM Oir" M-TERrISORS CF CCNTRA MITA COMM77
INKRUCTIONS TO CLAUNTY
A. Claims relating to causes of action for death or fop injury to person or to per
property or gmwing crops and ut.ich accrue on or before December 31, 1987,
must be presented not later thazi tape 100th day after the accrual of the cause of
action. Claims relating to causes of action far-death or for inuwq to person
or to personal property or growing crops and -which accrue on or aft aq january 1,
1988, most be presented not later than six months after the accrual of the cause
of action® Clains relating to any other cause of action must to presented not
later than one year after the azar ual of the cause of aNion. (Govt� Code §911.2.)
B. Clams must be filed with toe Clerk of the Board of Supervisors at its .office in
Room 106, County Adninistration Building, 651 Fine Street, �%rtinez, CA 94553.
C. If claim is against a district &Dverned by the Board of Supervisors, rather ttain
the County, QR name of the District should be filled in.
D. if the claim is against urre than one public entity, separate ofms must bee
filed against each public entity.
Fraud. See penalty for fraudulent claims, Penal, Code Sea. 72 at the end of this
form.
RE: claim By Reserved for Clerk's filing stomp
R fit!
Uga-Er-m- J U N
or
District)
J En. n-ma-unne),A
. .... .. ... ..............
The u-nd-ersigned clatmant hereby nakes claim against the County of Ontra Costa or
toe above-nazed District in the sum of $ and in support of
this claim represents as follows.-
-------------
1. 141en did the dazagp_or ip�uz-y occur? (Give exact date wad hour)
2. Where did the damage or injury tour? Unclu 0 city and county)
T
How did the d or injury cccur? (Give full details; use extra paper if
required)
vs,an la: I)
h What particular act or oaassion an the part of county or district officers
servants Weaployees caused, the injury an damage? gj
_j, a Ion K
�7i
a Wrbzt are We rimes of county or district officers, servants or
the damage or injury?
mfr G WaKmagKor ffin JU.-ies do you
claim resulted? ti SsE ; full extent of injuries o:
damages Claimed. Attan Wo estimates for auto 4am"e.
..e
w ax�
7. How was the v] t claimed abve computed? (include
the estimated amowd of any
prospective injury or tee.)
e
Names and addresses ofi tresses, doctors and hospitals,
List t expenditures you made on account f this accident or as rl;h
DATE ZTEM 1INT
� V� Code Sec. 9-10; v des:
Aa h claimant
SEND N .-ICES TV 01.1 b1q 5 n ma his MATTAN
y (e9.1ad h 6e Fignatuyy
4
;AKessi
m
JAW4 1-5
Telephone o. Tele ftne No.
01T E
Section 72 of the Pane, Code provides:
"Every parson Vlno� with intent to defraud, presents for 011cmance or for
payment to any state board cr officer, or t, any county, city or distr,_c:, board 0-r
ob f intr, authorized to allcor or pay he same if .genuinne, any false or fraudulent
claim, bill,
3R"" cc b� e �.r ;�8 try n �` '�+ either `mprc� nt in
� res; %. � �+.�:*� :.�.� �a¢,e`�,aa � ate„ writing,a. $ s �;��f : �� .s. � :,��;.+a �� d�'�'t�.,hhx�
the county jail-for a period of rot more than tie-year, by a fmnnf not exceeding
,One thousand ($ r00 r � T�,�t {caK: gg r oyc § f � r b 5 r rz t in
"� ea..� �«d�� a k+,°� E�s,S Wo:.h ��oasa m' r .b,�kds�3w ,m.�bc�w w' b 5.2� s.�caa �,s �^ a��h�a es
e qar g+,cp�:, bar sae not exceeding ten thousand
dollars ($10,000, bn
�^�� �G�R'aiX :! �sx34.,i h a+� F not d2var MG¢. . d d lbs 4n .:S C lv.a, n � �'�`+ �i
3
both such imprisonsent and fine.
...................
,€ e4g2 A
o who- it m y conn'ML,
On--,nay 21, 2003 at, 4:00 pm my velhicle and boat tr r tires sustained d a e due to road.work
maintenance. T�s damage oc� red while drivni ray ve cie to���� y boat, northbound o $4
Byron g moray Ln the town of Byron. As I pass the Byron school I not-."ced my ve ese tlhro* i
-,AT ,t T 1-ho ,.was rocks from the roadway. :' s corA ad €,t I reached Kellogg creek.
°gad, As I proceeded nortli onhiighvmy 4 it became almost, L possible to d ve .y veEc e. mer
p . �vWr � . r '4 saw y tires - r rs3 er re c d G a
t o rubber substance. I was able to ger`fie veEcIC home, but not able to drive over ter.miles
per haour� The t&-on the dont tires was so heavy it just nmde the ishole froxyt and of she vel,cle
slake. I have made z=emus-,Ihotae cis regarding flEs Witter. First to the C-EP to try arxi gig an
cl ear a e To only be told that they wool nog send anyone out to tags a report, Next I
contacted the c- ty oa contra costa and left a message fbs some one to call me Sack regarding
this ratter. I did receive a c or 5-22-2003 +om a Pat Gfies in the oubl c works department.
Mx Giles was very apologetic for the damage to my tires and said that it was his crew that was
patching the road that day and for reason the patch did not stick. He did advise me to
cordae` P rmy'Baily mom risk manage en- and that she-v�Tould be able to h=elp me fiath'- My
v l�- le acid tea¢B=ras v -yen r�Placed and have enclos-d a copy o that invoice. Please feel
m--to contact me with any questions.
I Zara You
4,n De' ado ;925; 240-6384
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05-23-2003 TIME; 2:53 PM
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1219 NRM 4 FIEE FLAT REPAIRS, AIR CHECKS & ROTA'HiD'N�� so .mo 1 02,;
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TATE OR'FOCAL TAXES ANO*FMER %=Ren OR ONARaSO,exasomMuMA- L OR DISPOS U FEES ARE EXTRA.
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY � ,>
BOARD ACTION; ULY 15, 2003
Claim Against the County, or District Governed by �
the Boamd, of Supenvisors, Routing Endorsements, ; NOTICE TO CLAIMANT
nd Board Action. All Sectrorr ref-renccs are to ; bloc copy�ft�rs document:b�:b���� youis your
California ovomment codes. notice of the action taken on your claim by the
Board of Supervisors, crag.h xbelow), iver-
as''e ant to one er:t Code Section 913 and
915.4. Blease note all "Warnings".
AR OU T� $5540 . 47
CL M- AINT> TOUTS - THOMAS
ATTNTEY, ; NNKN0WN DATE RECEIVED. JUNE 12 � 2003
ADDRESS. 522 LISA COURT BYDEL DIERYTO L RKOM JUNE 122-2,003
EL SOBRANTE, CA 94503
Y MAwI,P 0 S T M A 11K ED: HAND DELIVERED
FROM: Clerk of the Board of Supervisors TO: County Clow e1
Attached is a copy ofthe above-noted claim.
JOHN SWEETEIN, 0w
Dated: J13NE 12 9 2003
By: Deputy-
, FROM,, County owns l TO: Clerk,oft�e Board Of S-1.
This claim car p ie s sta Bally with Sections 91.0 and%10,2.
This S to comply substantially with Sections 910 -nd 910.2, and we are so notifying The.
Bond cannot act for 15 drys (Section 910.8).
Claim is ncot tirrrely filed. The Clerk should return clam on. ground that it was filed late and send&ming Of
claimant's right to apply for leave tc present a late claim(Section 9113),
otnea;
` � &
our y; u
sel
1Ia. : Clerk oft e Board T o Comity Counsel(A3 County Adm irrd.strator(2)
Claire was retied aswqtimi ely with notice to claimant (Section 911.0.
IVB BOA ORDER; By unanimous vote of the Supervisors present:
0 Tees Claim is rejected in sl.
Other, -
L CA dna that this br,true and corr.ect'copy 0.AA'`eZ:.e Board's &.Pr&h`As'i entered n its minutes for this date.
Dated: 1; L5, 2003 JOHN, Ea 4
' TAILN " (Gov, code section` 'l )
Subject to cov ors exceptions, you have only six ( )mor.fqs from the date this ndtice was personally screed or deposited
in the grail to file a c °t action on this claim. See Govermnent Code Section 945.6. Your ay seek the advice of an
attorney of your choice in connection with,this ratter. If you want to consult an attorney, you should do so
i=-, - ediately. *For Additional Wan-ifing Wan-iiSee Reverse Side of This Notice.
- AFFIDAVIT OFINJATTl $n
1 decIare unor pellalty ofperjury that I am r-Low, and at all V.,mes herein mentioned,ha�,e been a citizen o the U11Ated
States, over age 18; &nd that today b deposited ire t1he United States Postal Service is &rtinez, €alifo ia,, postage 'ly
prepaid a certified copy of this Board Order and Notice to Claimvnt, addressed to the claim rit as shown above.
16,
2003
Dated: _ LOHINT TETE , CLERK By Deputy Clergy
Clair. Ito.
BOARD 0F. SUMPERVISORS OF 01DAITRA COSTA Wul,"I"Y
Aa C,'Iaims relating 1`0 CU3eS Of 9-CIZlon for death or for inv`ury to person or to per-
on.al property Or growing crops and which accrue on or before Decembeir 3111, 1-987,
meat be pme ente not, 1.ater tw the 10 th day afte.- he .%ce .]. of the Wase of
ac
SAO . � ai= relating to causes of action forAeath or for injury person
U 'ZO p perry or o it crops and °A .ai accrue r on r of &,I -y 1�
gat be presented not. later than six months after the ccl of the cause
f action. Claims relating to aany other ruse of action = t' be presented not
-e-- t h Wn One yea,- f e accrue of the cause of C`ti . (Gov't. Code §911.2.)
G B Clainm must be filed with, the Meek of the Boaard of SupexvII_so.--st its of five Jr
m 2068 y Administrationtiili in s 651 Diane Street, rti ez, A 014551 3-
C. If claim is against a d stT'ict, governed by the Boaof Supervisors, rather than
6,,he Cov-r l.yz 11,hey name of the M sari t howl A , e,I 1 .
D. If the clam i int, ire than e7le public ent4"'., senarate clalms mffustl be
firmed against each public entity.
E. ` e r and See penalty for r� ud° ent alai=, genal Code Secy 72 " the end of this
f
orm.
a i rme � <;
se Reserved or ergs fiII-in st p
ED
Against ae m�yContra '` } �
or
s 03
} .
Y,de±aZi trGb dr S...vcc.210 11M f't4gt.
h
�e
Lw . ale +bha t •. � `
&.fie =dens- ed he above-ramed District
i t � � y yes claim, st Vn lwnty f d Cosmo or
this claim represents as fo
.'a d d 1the ,=--a e or i a„` y cur (Give e *. date and 3a�'�`-I
_.. '3 v�.ti:�.vam2' y`era��.u,.�,evJ+eaesn•sar...2u. 'f � n.� �y6#✓ 1.
2� 'Where did Vhf damage or llrji " - a�? (1-na e city and ammty)s��
,a,
.Ye...rc�azxea..«>.a. � °�-� F„`Si. F;e+.e,<J's,`-73.- p4'„-rn,bil�;. ,. y,.• ,`y¢' .t✓'.�*.�r-�r. �„a�'r-�.a�°'ursm,- ^' ..♦<` <*
3. How d1 d the doge or i e jj - c°, ( e. � i use erre Wiper i-
2,- r ✓% " 'r F/;",* 6 _.. -x^�-*w ,./ `°�'N . 4s'_t.,,✓ir t"; '"„<.f/"4 .f sl ;.,. ''% ..__..+`
� n i p rtlir t,.,�� i n w. the t of county or di t ie, oaficersp
tsr, .employees caused, t1he injury me? yx
�f,: ✓.r;✓ •”' _� � r"'.`v pr'.^. y F,d':.o _��-. °-.',-,�,.� ! '.... y d }.;rJ'`< sr:;'lea-"»� a{y:•
V p
(over)
5_ wn _ are the names O, co' ty or district officers, serval ts or Ploy s cause•
the damage
yr
x.
,e
What da-mge or InjI.I`i s, do you claim restated? (Give gull extent a.f injuries or
dames Claimed. Attach e t-I fob auto damage.
/ .tit. a°-'✓ t ,.. �^J .� !
i
1Aow was the �a�t ci- �s� d� w a s �' ' A. o
4 above mpu n t-mat ed. mo :.c Die t
prosp of;ve in�'r y � s
r
Names and adds else's of witnesses, doc"Clors and hcs italz
—®.—a+a,„a---v.--.®.m—n,.—---------
m L st she a i u_' s you made '."tea: c unx, of w�� s accI dent �r �n�=Y-.
DATE M E11-1 A1,10MNIT
3 �$ 4 KI $§
z Go-V. Cade Sec. 910;2 providest.
o
-The c im =,us t bme, signed by the c3la in-1—an
SEO `a` TCS (A or-iey) bf6me vney-on z` . S AY 3a
d �, e, ma .
Name and Address o s
�. r
e hppryryne No. Telephone� No.
T T C E
Section. 72 of the Ilenal Code provides:
"Every person wina, with inte'n't o den �l p s °ems for @ i0 � n for
h as a� k ae .s„ Ct:W d. �v`
Payment to any stale v -d .sella ow fi rg ,ter any _-oLn y ty r district s d or
�.s�t,s 4dn adw as =s � � �m .i ,r, i,
officert authorized too or pay the Mme if .genuine, any faIse or fudulent
ala—Im. bi , o-_o ma,, voucher, or writing, Is unish b"Ie i 'her by imprIasommnt, ,n
the county -Jail- for a period oll" n IC, mare ,mn cne yewar, by a 40i e of not exceeding
one t ousand ($1,000),, or by ,both Imoern k' and '!Ine�` by m ris - nt in,
3' e �" '6"5a ` 7q a` wia + 6a �`- r'•w 4�Cnar°t °`�; E .:e�a Lca:.tido "'3a �Gg
same i ono by a f ct exceedi ten � � � doll � � � y
bosh such i rico rnentM &gid ftp'3a
STA` EDFCA FORN ®BJS'NESS MANSPORTA' ONAlNDHO SING AGENCY GRAY DAVIS,Dover-o
DEPARTMENT OF TRANTSPORTATION
111" GRAND AVE�TUE doP. 0. BOX 23563
OAKI .ND, CA 94623-,,-;660 rlewyourpouerf
PHO (510) 233-5307 Be energy efficient!
FAX(5101236-4633
T (3t03) 735-2929
kpri14, 2003
LOUIS D. THOMAS
5-22 LISA COU '
EL TNTE, CA. 94803
ezz rn hoa5<
Claim No. D3
The DeDar ent cf'i'r—msporyation has rejected your clai . After a very thorough h.1vesti atio at
has been deternnined fh t Caltrans was not responsible for the damage incurred. Our investigat or.
4-dscates the site of the all.-Red in6dent was not owned, controlled or mamtained by Caltrans,
herefore another agency or entity is responsible for the ri aintv1111ance of this area. Wherein tie
County of Contra Costa should be contacted directly concerning tie nand1ling and investigation
of this clam.
Coim, ty of Contra Cost:
255 Glacier Dive
Martinez, Ca 94553-4897 -a
Attn: Pubic �J�ar�s wept. �e6-- :�
(925) 335n:080
" ere'ys
HARJINDF,R RAI
District C'airns Officer
"Caltrwns 7,Mprcoe8 mobility across California"
?�+; '" ;� �� �'.' �l �std• �+e t 3#u'" �""? '�'
DEPARTMENT OF TRANSPORTATION
:s u Box 2
DISTRICT 4 CLAIMS PROCEDURES for DAMAGE CLAMS
NOT ENEXCESS OF41110MAGALNST TRY,STATE OF CALIFORNIA
as s yes -- a -.may be presented to the
Dis-ct Claims Offlicer by miming,or presenting in person,a com. leted clairn farm to:
allfor &Department of Tranzpertadm3
District 4 CWma Officer
II I Grand vemie
P.O.Box 23660
Oakland,CA 94623-0660
Goverment Code section 935,7 authorizes the Deparfu:ee t 'fra spo at�; to adjust and pay clay a
himh are not in excess of S 1,000.00 without p:lor presentation and approval of the State Board of Control.
mere are time l tato s for presenting your claim.Most claims have a six-month time hint, some have a
one-year time limit(Govezmnient Code section 911.2). When the claim is not presented to the clams office
witlin the six month pm t, a writter.application may be=de to the State Board of ontzo'>' for zCave to
saes-M, at. Said application should b prevented � to the Stag Board, of Control s r&u
Aot d ' L-A?staging the reason for the delay inpresenting your claim. The Dopa emu of Transpertadva
cannot handLe handclaims involving Persona injuries. 'rhose are also to be presented to the State Board of
Control at the address listed below:
State Board of Control
630 K Street,4t�Floor (95814)
P.O.Boa 3035
Sacramento,CA 95812®3035
The following is a brief explanation of hoer a claii-i:s processed:
I, Aja to CYc+��with your claft-n '2urnZ er will be sent notifying you that your. claim has
been received.When quip abort your cosim this cla€r a n; ber m2ast be used.
�f?a will be done. °3i 1s o r practice, where possible, to complete our invest-ga con witl it
y0 days of acknowledging a clairn..,
3 Y3'a, > rr .; once a cla3arn is assigned a claim n=ber it then goes to a Claa,.".,s Officer
heis-, e then deter:.: es whether or not the claim reeds ftr-her investigatirg by field per ownel. if the
clay:. has to go to the field for far ner investigation, no `Sm _ �� made co�c�
P 9 - At such time uoon. receivuiR the investigation
report froom thz-field,tl:en and only than wi l a decision be made to eatber accept or reject the claimm by
the Clam Officer.
4, r c has been, made you will be notifiedin tln-g whethe—a claim has been accepted or
refected along with ether instructions.
5. &=,gted c< i=will he;followed by a letter of release to be signed by the claim t.Ther,forwarded to
'"'he State Board of Control for payrnent".
r f gam_will be followed by a letter of denial with 5artaher L--structions if the c aLm n;Chooses to
appeal'his or her case with Use State Board of Control
_0` R®
"MOST COMMON NUSTAKES MASE INFILNG Wg ;,.: .. MCT CLABAS FORM- .
The followmz items are the biggest reasons csai:i forms are seat back to ffic clam p., <e �-mike see
before ya=a put your claim fog in an envelope that the following� . >.: mpleted:
Signatum/Date aro needed to procesa the clain:1 forme
2. DateiTLme of cident are required iters an.t1le clam.fomes.
�nf f6 tion rC r. a0n to iavtstigate tle incident, -e spec f c i.e.,frveway,
direction(northbounid,southbou-nd),what'-&Ue YOU wm m u fe time of the incident,bet-ween ghat on
r&=/off r&mp,City and County.
4, TO O DRi W-MteW csti=tes or one Paid rec6pt on damage is required.
Fa'�Ure to cOmPlefe,the abOvC will Ifimtely result in,you elate being dellaye'd.
The face Mal this bri0f MUM&Of the laftialprocedure to be followed seHing a claim aai fil the
SM6 of California has bees funnished to you or fat Me ifive6d9aAam of any claim is andmakwo is got
to be token's an admission mf,fa n any respect on the Part of Me gate or of any of ft officers u'r
OmPleyees, nor is the fact that this informal statement hag been fire shed�o you to be coxorked as a
waiver of any requirements imposed any law or any defense which may be available to the State of
CaliVornia ig connection w h any claim that might be fg1jed against
__ _
STATE a E F Com,FO NLA s DEFkRTMENI TRANSPORTATION
CLAIM AGAINST DEPARTMENT OF TRANSPORTATIONFOR AMOUNTS $1,000 OR LESS9
X 74(REV.2W)
niiO—N-ALINFORMATI IONNOTICE
Pm.oc:t to tI t Fe&r&I Pnvecy A-�(rl. 91-'379) A,-of:v'7" vs :mss i ,,Z2 c>s is"reed ovv,5 `:---max"sf br a
info icn L-y ..s fimr_ lhc,m-a4ved p0mcm::hoar:tires is vrI=Ar+ ate nci*purpow oft:".,e✓ohms wy i ror..oyOn is to mcmum thi p asL.a o€rk s fo to
v,i&&�l cr eny pw,oftm=, zed mfor &soet-my deie;promwmg of this fam, No dsselosum x DOJ�->'nfi a,7m, be,:, mi-M psrrassi e.md&.A.r:icte 6,smicv,
?-M.24 ofd:z A.of SWh --140 Wan preptrt ;ri =:cry.to ulsmd s;i pemw i sss€dim in sny re�m=srtsrret on tm L-I&vidus�by
sm
;dcn0,fi`-g, �.• it sa Y.noires or,infb in= to yotrIPA Dffioer
Time film is�o bo L,Js mvr, a c4eim agarsti e s?of Trw-SW60mr as p-ovate�t Gavem y r 3�.�.
SSE: 0 pnt or m a *tW � m!fann. CAUTION: CWS fa mad mpwr(alAp a danaps
#ABY raodwd i"I d 3&^�;- I Wwn
(UNS*NED AND UNDA TED FORMS WlL NOT BE PROCESSED)
STAB E ONLY
U&NESS PHONE 1AO E PHOS
a
Cz ar STATS ��;�
_ TIME i C'DENT -s A. 'SATE OF INCIDENT
2.PUT A SPEVFi 'AWE AND DATE WHEN" �DAMAGE FIRST OCCUR ED
7
f
3,S T ATE T?E LOC e'f i N F Ts sE�NCf,DEN° '17:3N ONE-;:AL^M �Ci7-t�COUN7,r,flc-f'v,,AY,FNc'm-&7-c,-F- w Liro srREE-`aoR
b. I N Halfq THE W? . v"dP DOGE OCCURRED
r ' 3
�,if -,1CULAR Afi- !?S&CNIN THE PART OF CA17RANS OR ITS CONTRACT 0
T CTT CAUSES THE WURY OR DAMA
y P + y f
WHAT.
tf3 a UYOUR CLAIM >6 ,fs'� E ? (SiJ is ?r 3 e a4S OR r'zfaID P CEIPT—s) r
d✓ f• c d')A-4 Yeti
. E OF; SURE
5.INSURANCE:?kFt"`„RMATION IS REaUIRE HAVE VOLUSUBMITTED A CLAW TO yo
✓ r, y,
ARE YOU THE REGISTERED OWNER? YEES NO YOUR INSUR.W .�CARRIER4! � S �a
' NTS
IM YES. WEREY-0-PA,D? � YESN�
IFOR T AMOUNT?
i
VEHICLE INFCRNAKI�ON
I HEREt3v"'ERTIFV VJYDER r ENA,t til OF PERJURY, THA s`THE 0REIGar.ING FA CTS ARE TRUE AND CORRECT TO ThE SES`1 OF WY a{!+!OVY'L�Dl, AND BEL
\ f j✓ EE @ i TAND FILING INFORMATION ON CLAIMS
STATE OF CAUFORMA 4!DEPARTMENT OF TBSP ;NON
CLAIM AGAINST DEPARTMENT OF TRANSPORTATIONFOR AMOUNTS $1,000 OR LES
-02274,RDi.2197;
FOR STATE USE ONLY(BELOM
DATE CL4 RECE ED AMEWED BY: OWMC CLAWS OPS#SER S;G::'z€ATURE APPRM� _
t(���y,�ppO;;22Ny
CONTRACT_CONTNGENCY RESPON SLtd =�
61
: 6 MALE eE.s"'d.._ rjcp
{� AOBJECT
'sy���y+H 4epF � _. ....__ ENC.
rya. .y_..y-- -- - - - •__._ __...._. .._ _._......-.-..._. -. _ ._..__.. -
FA n,Js vSt�Fd 5'd-6£4 UNT F2-: vENC.W%l'm>4.2!'SEN" N'UM�4eR be.i
f 3✓ E fi/£ !7 my OPersonal 9Y i P i �+ fit s area s'CO'`a.N:s z`' �{c f x e '
vo ft penbd andpufie of&''o exp 're stated abovo.
FOR CLAIMS ONE THOUSAND DOLLARS ($1,000) OR LESS
CLAIMS OFFICER
Department of Transportation23
,
€sxf�#
(_A 94623-06M5 g
FOR. CLAIMS OVER ONE THOUSAND DOLLARS ($1,000)
You mosl flie °ahn the al'' t Soad of ' or2tro! `n ailk-N`sa. of yo" have any
questions about v �r.ns of more than one thousand do iays, €': or vW;ft-a:
STATE BOARD OF CONTROL.
POS"OFFiCE BOX 3035
cS,.A%'1'..R,AEN�0, C'A 95812-3035
PHONE:. fWG) 323-3584
x ze fact that this statamv?t as ffia prowdture to be Iolb ed<n asswting ca ciasm,agairs ffie State of"Cavi b.m,,a
�,as�Aeto fumIst.er,tt {e3ia ??ski s:f??ewestf gd �€ a`?y cf sm is{�%^�������f3 a �4o�to�s$ak�� a adz
a rnisWon of€labM4:r arty respect an the pad of the state or any of its OMCOM of employees; nor xs
fae that tsps nrornnat�,,oaf statlennent has been s':fmisheC to y00 to be constmed its A waiver of an
f imposed by lames, ov any ;defense whh ch may be av a ab e to the St8te Of
Connection with any that Might be flied against ito
12952 SAM PABLO Aw.o.-,.-
w;
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