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HomeMy WebLinkAboutMINUTES - 03212006 - C.18 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY / BOARD A'CTION:MARCH 21, 2006 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". FEB 17 2006 AMOUNT: $130.51 COUNTY COUNSEL MARTINEZ CALIF. CLAIMANT: .TAMES B. GREENFIELD ATTORNEY: UNKNOWN DATE RECEIVED: FEBRUARY 17/06 ADDRESS: 11 ORINDA VIEW ROAD BY DELIVERY TO CLERK ON: FEBRUARY 17/06 ORINDA, CA 94563 RECEIVED FROM RISK BY MAIL POSTMARKED: MANAGEMENT FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. MARCH 21 2006 JOHN SWE E rk Dated: By: Deputy II. M: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant.The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was,filed late and send warning of . claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: I . i I i Dated: 7 —Zoo(-) By: Deputy County Counsel I1I. 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 (1/1 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. .?/, o2�DilOHN`CLILLEN Dated: CLERK, By , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6)months from the date this notice I as personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You inay 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 Oainiant as shown above. Dated/y��"� 2 � JOHN CULLEN't, CLERK By Deputy Clerk FEB. 15.2005"' 4:34PM SMITH BRRNE`r'qRJMENT 92`.NO.`621421 P•3�1�J2 BOARD OF SUP xvlauto ur �:ul�1,���� r� _ _ , INSTRUCTIONS TO CLArMANT A. A claim relating to a cause of action for death or for injury to person or to personal propelty or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one year I after the accrual of the cause of action. (Gov. Code § 911.2.) B_ Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration'Building, 651 Pine Street,Martinez, CA 94553, C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each j public entity. I E. Fraud, See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. ■9Bog a■RAI 4asa as M a a a use a elm an mum am as a►llema■abeSON t ISO■■■a a amt a■bona III It man a amp a a RE: Claim By: Reserved for Clerk's fd I g stamp RECE,V� Against the County of Contra Costa or ) r t 1 7 2006 Q�frjbA- r&���- 7r, District) CLERK BOARD O (,Fill In the name) CONTRA COSTq CO.V/SpRS • ER The undersigned claimant hereby mak-es claim ragautst the County Contra CostJ or the district in the sum of$ 1 and in upport of this claim represents as follows: 1. When di th/e damage or injury occur? (Give exact data and hour) 2. Where did the damage or injury occur? (Include city and county) kN E ��./ Q(Lc 41bA-, eA J�p H r1�- ea Sn+ 00KN r-y 3. How did the damage or injury occur? (Give full details;use extra paper if required)�w ,l s 7>0 k0 . /4N ' Oil e01" CAIS r1 w—Mutt,. CKAMM pocAt4C O PRc.&A-ku. WA-5 i a"OW W 6 toe CLcS - 4,vl 4. What particular act or omission on thr part o coymy Vdistn t officers, Servants, or employees caused the injury or damp.age? u-b1J I c afl.f/Y�/f PDZ/GLr df-� LE/1^ What are the names of county or dish pct officers,servants, or employees causing the damage or injury? OPA 04 f o LI 6 f-FiG4a� JGod�. (Fr.h .td &L/ 3if FEB. 15,.8006r" 4:34PM SMITH BF1RNE`rINPGMENT92NO 950 P.4/10 � ;,.,� 1421 H.03 I 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for euro damage.) ✓- rr�i+er„ r- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage..) / � l.p dl�s Cowtsro� J"x rinn,�.'r� o rJ ��Z'�'/Oro 8. Names and addresses of witnesses, doctors, and hospitals: Na�� Sre, 01t4AM. /Owccl, 4E-Pr f45100J-r jq-- sao 9-71 .4,4fa C-4 PoL-(cE, Fek/7.7- 0- y'#r{Dcc{ 3s6SSoo3Z 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT ■■■■■arr■■■■a■aaBlip■■■■■■III a■■rra■■a■■■■sound a■■■s■■■■■■■■■■■■.■■■�r■■a■■ar■■r■■rMa■■r ) .Gov. Code Sec. 910.2 provides"The claim shall be ) simed by the claimant or by some person on his behalf." SEND NOTICES TO: ( ttomey) ) Name and address of Attorney ) (Claimant's 'gttature) CII EGJ A (Address) OPAA- . Com- Q 4(�-6 3 ) Telephone No. )Telepbone No. Aa■■■■■■■a■■aENE MOWN Kong ItN■r■■owns a■■■■■amoss■M■■■■■a■■MOWN■■a■a■■Nunn) PUBLIC RECORDS NOTICE: Please be advised that this claim fore , or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthermore, any attachments, addendums, or supplements attached to the claim forin, including medical records, are also subject to public disclosure. beemsa■■■a■■rORION a■■■■■arem■■■■■a46a■■■■■■■■INFO OWN■■■■a■■■■■1■ra■■■a■aawa■■r■■■■NEI r.OTICE: = Section 11 of the Penal Code provides: Every person who, with intent to defraud,presents :or allowance or for payment to any staxe 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, it punishable either by imprisonment in the County jail for a period of not more than one year, by a fine of not exceeding one thousand dollars.($1,000.00), 'or by both such imprisonment and fine, or by imprisonment in the stats prison, by a fine of not exceeding 'ten thousand dollars ($10,000), or by both such imprisonment and fine. TOTAL P.03 To:June Grs■nfi�ld `. PICS.960 P.5/10, FEB. 15..2005 4-34PM SMITH BAP.NEY '3 a • 1/3Ooas V-•RJ TJ1M*--i fz' r,.rrF.■M AUT0M08IL6 CLAIM REP9RT agel Agent copy i 2006 INIU■ANCA 1 y Reporting agent: Judy K. Francis Agent code: 05-2303 Agent phone: (9251 283-5040 I Init. NAT i Claim#: 05-5245-838 Claim office: CIM CENTRAL AUTO CA NO COAST Claim rep: TEAM 4, CAN REP Claim rep phone: 800-440-6175 � INSURED-- -- coverages: A 250/500/100, 05000, 0100, G500, 9, Al, U 100/300, Dl Policy number: 075 6898-FO1-05 Insured: GREENFIELD,JAMES 6 LISEL i i Date of loss; 01-07-06 Address: 11 ORINDA VIEW RD Time of loss: M City: ORINDA St: CA Zip: 94563-1234 Date repotted: 01-13-06 Phone: H 925-294-1994 Contact: JIM GREENFIELD Location of loss; !LINER ROAD City: ORINDA St. CA VEHICLE 1=-- ,- Insured vehicle/year/make/model/bodystyle): 010 740I 4DR VIN: WWR03411OP27867 License number/state: / Involved in loss? YES Prior damage: Principal damage: REAR BUMPER Driveable? YES Driver: GREENFIELD, JWS VEHICLE 2 �--�-•�— - -- ---�---��-�.,�__�—_>>�_ - - �— Year/make/model/bodystyle: POLICE CAR License number/state: / Principal damage: Driveable? Location: Insurance co: UNKNOWN Policy number: Owner: ORINDA PDIICE DEPARTMENT Address: _ City: St: ZIP: Phone: Driver: KIM, OFFICER Address: City: St: Zip: FACTS Phone: — - V2 (POLICE OFFICER) WAS FOLLOWING V1. V1 SLOWED DUE TO AN ONCON NG FIRE TRUCK Police report made? AND V2 REARENDED V1. DRIVER Or, V2 IS OPFICER Ta (I3 11325)• REPORT WAS MADE Dept Where reported: TEROUGH ORINOA PD (IJM(ED935715013576) AND CHP (JiM DC435655009332). Report nw6er: Insured violation? Describe: Claimant violation? Describe: OTHER PARTIES TO-THE LOSS - - ---== Veh No. 1 Name: COOKS COLLISION - PINE - SELEC Address: COOKS COLLISION - PINE - SELEC Facility ID = 03YR 1414 PINE STREET City: WALNUT CREEK St: CA Zip: 94596-3631 Phone: B 925-935-4041 Ext: -Ext.— Comments: ERVICE FIR Party type: SST Policy number: 015 8898401-05 insured's I I Date of loss: 01/07/06 initials I I I FEB- 15,200S 4.35PM SMITH EPRNEY To.•lames Gresn(el 2 '►.r` F�►sw AUTOMOBILE CLAIM R 9 P 0 A T page Agent copy January 27, 2006 �w�ue�wc� I :----- 4 Any person who knowingly presents a false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fives and confinement in State prison. I HEREBY DECLARE THAT THE FACTS IN THIS REPORT I REMY DECLARE TART TAE FACTS IN TRI IS REPORT I. ARE TRUE AND ACCURATE. f ARE TRUE AND ACCURATE. Insured sign here Date i river sign here Date to Policy number; 075 8898401-05 Date of loss; 01/07/06 i i I i I i I I I I FEB. 15.2006 , 4:35Prl SMITH BARNEY I NO.960 P.7i10 Date: 1/27/2006 04;48 PM Estimate ID: Auto552 Estimate 0 Preliminary Profile ID: SELECT SERVICE I Cooks Collision on Main St. 2198 N.Main St,Walnut Creek.CA 94596 (925)944.1027 Fax: (925)944.0970 i Tax ID: 94-3344759 BAR#, AH217489 EPA#: CAL000203179 Damage Assessed By: TIM COLLINS Payer: Insurance Deductible: 0,00 Claim Number: 055243838 Owner JIM GREENFIELD Address: 11 ORINDA VIEW RD ORINDA,CA 94563 Telephone: Work Phone: (159)551580 Home Phone: (923)284-1994 Mitchell Service: 919224 Description; 2001 BMW 740 IL Vehicle Production Date: 1/01 Body Style: 4D Sed Drive Train: 4AL In]8 Cy15A VIN: WBAGH834K1DP27867 License: 4SF8778 CA Mileage: 52,498 OEM/ALT: 0 Search Code: 8838148 Color: SILVER Options: ALUM/ALLOY WHEELS,AIR CONDITIONING,POWER STEERING,POWER WINDOWS POWER DOOR LOCKS,POWER PASSENGER SEAT,TILT STEERING WHEEL,CRUISE CONTROL ELECTRIC DEFOGGER,LEATHER SEATS,AUTOMATIC TRANSMISSION TRACTION CONTROL/ELECTRONIC,PREMIUM SOUND SYS,,POWER DRIVER SEAT AM-FM STEREOICDPLAYER(SINGLE) I Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Unita 1 802023 BDY REMOVEIINSTALL REAR CTR BUMPER IMPACT STRIP Exlstlne 0,3+ 2 TRY REFIT POPED LOOSE 3 802026 BDY REMOVEIINSTALL L REAR BUMPER IMPACT STRIP Existing 0,3• 4 REF REFINISHIREPAIR L REAR BUMPER IMPACT STRIP 0.5* 5 AUTO ADD'L COST PAINT 14.00• 6 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL- 7 900500 BDY* ADD'L LABOR OP POLISH REAR BUMPER LT SIDE Existing 0.5` -Judgement Item I I i SPECIAL PARTS NOTICE: ALL CRASH PARTS ON THIS ESTIMATE ARE NEW-OEM(ORIGINAL EQUIPMENT MANUFACTURER) UNLESS OTHERWISE SPECIFIED. PARTS DESCRIBED AS RECHROMED, RECORED, OR REMANUFACTURED ARE EITHER RECONDITIONED OR REBUILT. PARTS THAT ARE DESCRIBED AS QUAL REPL PART, AND ORP CAPA, ARE NON-OEM CRASH PARTS.******* ESTIMATE RECALL NUMBER: V271200616:46:04 Auto552 UltraMate is a Trademark of Mitchell International Mitchell Data Version: DEC_OS_A Copyright(C)1994-2003 Mitchell International i Pape t of 2 UltraMate Version: 5.0.212 All Rights Reserved I ,—'—:-EB. 15..2006 4:35PM SMITH BARNEY N0.960 P.e/io Date: 112712006 04-148 PM Estimate 10; Auto552 Estimate Version; 0 Prailmina'ry Profile ID, SELECT SERVICE Add'I Labor Sublet 1. Labor Subtotals Units Rate Amount Amount Totals 11. Part Replacement Summary Amount — 725— 1 Body 11 .00 0.00 0.00 79.20 Refinish 0,5 72,00 0.00 0.00 36.00 Total ReplacementP arts Amount 0.00 Non-Taxable Labor 115.20 Labor Summary 1.6 115.20 Ill. Additional Costs Amount IV. Adjustments Amount Taxable Costs 14.00 Insurance Deductible 0.00 Sales Tax 8,250% 1.18 1 Customer Responsibility 0.00 Non-Taxable Costs 0.15 Total Additional Costs 15.31 I. Total Labor. 115.20 III Total Replacement Parts: 0.00 Ill, Total Addltlonal Costs: 15.31 Gross Total-, 130-51 IV. Total Adjustments: 0100 Not Total, 130.51 This is a prelimlinamestlMate, Additional chances to the estimate may be-required-far the actual repair. Point(s)of Impact 7 Left Rear Corner(P) Insurance Co: STATE FARM SELECT SERVICE Cycle Time Information Repair Dates: Is Vehicle Driveable(Y/N)?: Y Assisted With Rental(YIN)?,, N ESTIMATE RECALL NUMBER: 1/271200616:48:04 Auto552 I UltraMate,Is a Trademark of Mitchell International Mitchell Data Version! DEC�_p_A Copyright(C)1994.2003 Mitchell International Page 2 of 2 UltraMate Veralon: 5.0.212 All Rights Reserved FEB. 15.2006 4:35PM SMITH EPRIEY fJ0.960 P.9/10 I I NOTICE OF CLAM AGAINST THE CITY OF ORINDA,CALTFO]RNIA (Government Code Sections 910,910.2) RETURN TO: City Clerk City of Orinda P.O. Box 2000 w 14 Altarinda Road Orinda, CA 94563 • (925)253-4221 Claimant's Name: &&ffdP60 Last First M.I, _ Claimant's Address: # oplyi�+ V f.W ,-j Nkunber Street ©per a City state ZIP ?2.0 ti85��qsY &R-) ` rr /S8 o �4� QST 1.1-68 Home Phone N=bcr Work Phone Number I Fax Number Name and address of person to whom notices regarding this claim should be sent(if different than the name and address provided above): I Date of the accident or occurrence: Place of accident or occurrence: Ai,-JE�- _ SDA Cross-streets, if applicable: General description of the accident or occurrence (attach additional pages if more space is needed).- I' eeded):x WAj Aft-(VIAtQ bOW-4 AAlVF - f-b r sloouE-A baw.,J GI Ar t © rn1QA- flier._ QP71r-EA, jeook. Names, if known, of any publi72611 ployees ZS ing the injury or loss; -_ 1. UFTac�- 1�k k,•r. / 3 3. 2. 4. Names and addresses of witnesses: At a,-41 Name Address Phonc 2. UI 3. (� 4. Continue on other side of this form;you must complote both sides and then sign this form. Names and addresses of doctors who treated aid hospitals where injured were treated(if applicable): N(a- .FEB.15_.2006 4*35PM SMITH BPRNEY N0.960 P. 10/10 I II Name Address I Phone 2. CU 3. 4, ( i) General description of the loss,injury or damage suffered; kis A.0,A.4S / T� aa_ m r- �j0-4ti. I Total amount claimed(in dollars); $ 3 O - r The basis of computing the total amount claimed is as follows: Damages incurred to date: Medical expenses: $ Loss of earnings: Special damages for: a, $ b, $ d. S (attach copies of documents which substantiate these amounts, if avollable) I/'We, the undersigned, declare under penalty of perjury that Uwe have read the fore' ' g claim for damages and know the contents thereof; that the same is true of my/our ow knowledge an b sav and except as to those matters whe in ated on information and belief, and assto em webelie t e e. DATED, S'nature claimant • Si slur of claimant RECEIVED in the City Clerk's office this day of , 20_ Signature of City Clerk or official City represcntetive receiving this claim FOR CLAIMS RELATED TO INJURY TO PERSON OR PERSONAL PROPERTY, THIS FORM MUST BE FILED WITH TI3E CITY OF ORINDA WITHIN SIX MONTHS FROM THE ACCRUAL OF THE CAUSE OF ACTION, A CLAIM RELATED TO ANY OTHER CAUSE OF ACTION SHALL BE PRESENTED NO LATER THAN ONE YEAR AFTER ACCRUAL OF THE CAUSE OF ACTION. rEB 15.1.2006 4:33PM SMITH BPRNEY No.960 P.1/10 cifigroupi �� SMITHBARNEY RECEIVED Facsimile FEB 17 2006 BOARD OF Page I of 10 CLERK CONTRA COSTA CO.SUPERVISORS To: Penny Bailey Fax: 925)335-1421 CCC Risk Management Division Phone: (925)335-1455 Fronn'. Jim Greenfield Phone: 416 95515$0 Director—Wealth Management Fax; 159551508 Date, Wednesday,February 15,2006 Re: Claim for auto accident.with OrInda.Police Dept, Penney Please find enclosed my claim against the Orinda Police Dept,regarding a traffic accident on Jan.7,2006, I have also received a Notice.of Claim from the City of Orinda. I have filled both out and sent tolboth jurisdictions, Please coordinate with the City of Orinda, I am not sure whether Contra Costa County or the City of Orinda Is the appropriate jurisdiction for this case. Thank you for your help In this matter. Please call me if you have any questions or quire more information, I would appreciate it If you could give me an update on your progress. Sincerely, Jim Greenf I James B.Greenfleld,Director—Wealth Management 555 California,35th Floor San Francisco,CA 94104 (800)227 5152 C111group Global Markets Inc. 0 2005 CiiJigroup Global Markets Inc. Member SIPC.Smith Barney is 9 division and service mark of CjtIgr6up,Global Marftis Inc,and Its affillate6 and is used and registered throughout the world. CITIGROUP and the Umbrella Device are trademarks and service marks of Citicorp or its affiliates and are used and registered throughout the world, The information contained In this fax message Is Intended only for the''personal and confidential use of thb designated recipients named above.This message may be an attorney-client communication;and as;such is privileged and confidential,If the reader of this message Is not the intended recipient or an agent responsible for delivering It to the Intended recipient,you are herab#00fied that you have received this document In error,and that any review dissemination,distribution or copying of this message Is'strictly prohibited,If you have received this communication In error,please notify us Immediately by telephone and return the original message to u§by mail,Thank You. FEB. 15.2008"- 4:33PM SMITH BRRNE'rNR[-JMENT INN 96014c1 P.2/1 - 4nafi.ln'Entoivlo!bn Contra � P. Arnold Drh►e,Suite 140 COSt ^ J;y. Y . nez•Ca(IfOmia 94559 • rll�irtent COU I I Adminlsvivan (?25)935.1450 1=4x Number (925)235-1421 I i I i FAGSIM!L�*TRANSMITTAL 0GANIZi4TION: iAX,NUfhBER:. '4�_ NUMBER OF PAGES TO FOLLOW'.- REMARKS I - ,FROM: Pen �61 I TELEPHONE NO: (925) 335- i��S I CLAIM i D 4' BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: MARCH 21, 2006 Claini 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 VtyPursuant to Government Code Section 913 and FEB 2 2 2006M 915.4. Please note all "Warnings". AMOUNT: $15,208.88. COUNTY COUNSEL MARTINEZ CALIF. CLAIMANT: ROBERT S.. BOWEN, a. ATTORNEY: UNKNOWN DATE RECEIVED: FEBRUARY 22/06 ADDRESS: 2345 HOLLY OAK DRIVE, BY DELIVERY TO CLERK ON: FEBRUARY 22/06 DANVILLE, CA 94506 . BY MAIL POSTMARKED: FEBRUARY 18/06 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. FEBRUARY 22 2006 JOHN SWEE k Dated: ' By: Deputy II. MOM: County Counsel. TO: Clerk of the Board of Supe isors /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: 02► L D G By: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). WIV.�8OARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. ( ) Other: I certify that this is a true and correct'copy,of the Board's Order entered in its minutes for this date. _Dated.-00�VW7 41,, X0`040-JOHN C C1 L L E N, CLERK, By ..et. � , 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 (lie 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:114'r 4 �ZW,6 J 0 H N CL,.LLE\', CLERK By Deputy Clerk i a ` JAN-04-2006 11:18 CCC RISK MANAGMENT 925 335 1421 P.02 BOARD OF SUPERVISORS Uy uun iicA t.va ti INSTRUCTIONS TO CLADIANNT A. A claim relating to a cause of action for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of • action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building,651 Pine Street,Martinez,CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. I ■rrrrrrrrrrMrrrrrsnaps mom an 81 RE: Claim By. Reserved for Clerk's filing stamp Robert S. Bowen, Jr. ) RECEIVED Against the County of Contra Costa or ) FFR 2 2 2006 • District) CLERK BOARD OF SUPERVISORS (Fill in the name) ) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of S 15,208.88 and in support of this claim represents as follows: I. When did the damage or injury occur? (Give exact date and hour) December 31, 2005 - 7 am 2. Where did the damage or injury occur? (Include city and county) 2345 Holly Oak Drive, Danville, CA 94506 - Contra Costa County 3. How did the damage or injury occur? (Give full details;use extra paper if required) Flood - Please refer to the attached letter and photos 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? Failure to properly maintain storm drain - poor design of drain causing blockage with debri-s leading to[flooding 5 What are the names of county or district officers, servants,or employees causing the damage or injury? Not applicable I . JHN-04-2006 11=18 CCC RISK MANAGMENT :, 925 335 1421 P.03 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) Damage to swimming pool i • 7. How was the amount claimed above computed? (Include the estimated amount of any prospect ive injury or damage?) Please .refer to copies of invoices and estimates 8. Names and addresses of witnesses,doctors, and hospitals: The names are: Neal & N a n cy Harr h g to n, John & Barabara Mensendiek, Ms. Cindy Cody, Mr. Lee Ginn, Fireman, Danville Fire Dept. Paul Ivory - please see claim letter for addresses and telephone numbers. 9. List the expenditures y+ou made on account of this accident or injury: DATE TIME AMOUNT January 4, 2006 $ 500.00 Coral Pool Service January 23, 2006 $ 242.27 Coral Pool Service February 15, 2006 $ 13,055.00 Golden Gate Pool Plastering •■aa■aaaaaaaaaa■aaaMON aaaaBuss mass mass ass a a aaman a■ataaaaass aaaaaawas Slum aaaaeaaan*aasaI February 9, 2006 $ 1,414.38 Sunshine Pool Service .Gov. Code Sec. 910.2 provides"The claim shall be signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney) 1 Name and address of Attorney } (Claimant's Signature) 2345 Holly Oak Drive, DavilleNCA 5.06 (Address) Telephone No. )Telephone No. H 925-838-6463 W 510-614-4105 C 510-750-0309 ■■■■•■■■r■a■aae■■■enow■WON aa■■a■aa■aaaaaaaamuses Oxman a■aaaaaaaaaa■aal■aaa■aaaaaaaaa■al PUBLIC RECORDS NOTICE: Please be advised that this claim:form,or any claim filed with the County under the Tort Claims Act,is subject to public disclosure under the California Public Records Act. (Gov. Code, §9 6500 et seq.) Furthermore, any attachments,addendums, or supplements attached to the claim form,including medical records,are also subject to public disclosure. ■ama■a■■muss maps use■■■asalsum■owns■■now aaa as aaaa ae■aa man 31031151010 am Salto■am one an ONE a a mean NOTICE: Section 72 of the Penal Code provides: Every person who,with intent to defraud,presents for allowance or for payment to any state board or officer, or to any county, city, or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim,bill, account voucher,or writing, is punishable either by imprisonment in the County jail for a period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000.00), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000),or by both such imprisonment and fine. • TOTAL P.03 i i i I I I • February 17, 2006 Clerk of the Board of Supervisors Contra Costa County County Administration Building 651 Pine Street, Room 106 Martinez, CA 94553 Subject: Claim for mud damage to my swimming pool located at 2345 Holly Oak Drive, Danville, CA 94506 - Please refer to my previous claim No. 53195 filed April 25, 2003 for the exact same occurrence on December 16, 2001 - Liability claims Adjuster— Ms. Penny Bailey. Dear Board of Supervisors: On December 31, 2005 at approximately 7 A.M., the storm drain located in the open space on Holly Oak Drive in Danville clogged with debris resulting in down stream flooding of several properties, including my own in which a large amount of mud and debris dumped into cny swimming pool. Please refer to the twenty-two enclosed photos that show the clogged storm drain and the flooding that occurred to my property and swimming pool. The debris was finally cleared away from the storm drain by the local fire department • within an hour of their arrival on the scene that prevented further flooding and damage. However, as a result of the flood, my pool was filled with mud and debris that has once again stained the plaster to my pool and will require re-plastering. This will now be the third time in 7 years that my pool will have been re-plastered, twice due to flood damage. As a result, Golden Gate Pools has indicated they will now need to remove a layer of plaster and gunite before applying another layer of plaster to my pool. The cost to perform this work is $ 13,055.00—please refer to the enclosed estimate from Golden Gate Pools. In addition, 1 had to contract Coral Pool Company and Sunshine Pool Company to remove the tremendous amount of mud and debris from my pool. The filter grids had also been damaged from the mud and debris that got into the pool's filtration system before the system could be turned off. The total cost for the cleanup and part replacement is $ 2,153.88. Please refer to enclosed invoices from these two companies. 1 am hereby submitting my claim for$ 15,208.88 to recover my out of pocket expenses for the mud removal, damage to my pool equipment and re-plastering of my pool. This does not account for the amount of time I have personally spent cleaning up my property or the loss to my landscaping. Following is a list of people that were present on December 31, 2005 and were witness to the flood: • Mr. & Mrs. Neal Harrington, 2335 Holly Oak Drive, Danville 94506 Tell: 925-838-9300 Mr. & Mrs. John Mensendiek, 2355 Holly Oak Drive, Danville 94506 Tel: 925-552-7383 i I ' I I • Mr. Lee Ginn, 2348 Holly Oak Drive, Danville, 94506 Tel: 925-838-2713 Mr. Paul Ivory, Danville Fire Department, Danville, 94506 Tel: 925-838-6600 Ms. Cindy Cody, 9869 Divorna Drive, San Ramon, 94583 Tel: 925-415-6311 If you require any additional information, please let me know. Thank you. Since ely, J Robert S. Bowen 2345 Holly Oak Drive Danville, CA 94506 Tel: H 925-838-6463 W 510-614-4105 Email: robert.bowen@crownwms.com cc: Mr. Grover A. Perrigue, Attorney Marshall & Perrigue Law Firm • • I i GOLDEN STATE POOL PLASTERING INC. PROPOSAL SUBMITTED TO: 242 NORTH I STREET ------- ". �f ---------------- - ---------------- LIVERMORE, CA 94550 CLIENT 93 A { • OFFICE- 925-443-7946 --=------ Y ----- - -------- FAX.• 925-443-7940 STREET .LICENSE #708261 ----- -- - ;-CA---- CITY, CA___CITY,STATE AND ZIP CODE Date:--- =I -06 HOME PHONE WORK PHONE i INDICATE WITH X IF BELOW ITEMS ARE INCLUDED OR NOT INCLUDED I INCLUDED NOTINCLUDED A. Is SPA included with Pool ❑ i B. Drain pool and drill hydrostatic relief holes. R ❑ C. Remove existing coping and replace with Ft. of ❑ D. Remove existing tile and replace with Ft. of ❑ E. Prepare surface for plaster(i.e. sandblast). F. Apply bond coat. ]" ❑ • G. Plaster Pool_y_ Spa Color3m- Size: 137 �f ❑ H. Install Ft. of trim tile ( I. Remove and Install16o Ft. of mastic. Color: V­ ® ❑ J. Crack repair: Rust repair ❑ Er K. Other: jut SV,,o 2 R­t�M M" � ...�, �. ❑ L. Other: ❑ ❑ All crack repairs are warranted for 30 days. When structural cracks are discovered which are not contracted for the Buyer shall bear all costs to repair the same. Buyer agrees that all cracks not contracted for will be cosmetic repairs only and carry no warranty. Optional items which may or may not be included such as but not limited to depth markers,recessed steps,light rings,cup anchors,etc.must be listed below to be part of this contract.(Old tile trim can not be salvaged.) Tile repairs and plaster patche are guaranteed for 30 day only. Info: Owner to stop water when pool is full and maintain thereafter. Please note: Do not shut off water for any reason until the water in the pool and or spa has reached the middle of the tile. PAYMENT SCHEDULE: DUE AT PLASTER:$ 3Gu- ------------- DEPOSIT $ [DU START: i3=4,e4•G DUE AT PREP: $--- R95-.5- FINISH:--___I DUE AT TILE & COPING: INSURANCE INFORMATION:WORKMANS COMP:STATE COMPENSATION FUND 415-577-3000-POLICY#044-0022577-04 COMMERCIAL GENERAL LIABILITY INS:CA.INSURANCE CENTER(925)299-1112-POLICY#A00100034800 To cancel this Contract,You the Buyer must notify the seller at the above address by certified mail or fax no later than midnight of the third (3)business day following the date of this transaction. If canceled within this period all deposits will be refunded;with no penalty. ALL WORK IS WARRANTED FOR THREE YEARS AGAINST DEFECTIVE MATERIAL AND FAULTY WORKMANSHIP. Work damaged by others,acts of God,earthquake and/or earth movement voids remainder of warranty. We propose: hereby to furnish material and labor-complete in accordance with above specifications, for the sum of: • ���^"'t.2t-� `Nw4 Sc-t- Ct-'�Ky dollars($ qU i c/ —PJote: this proposal may be withdrawn by us if not accepted within 30 days. Authori ign ure ACCEPTANCE OF PROPOSAL: The above prices,specifications and conditions are Signature Date: satisfactory and are hereby accepted. You are authorized to do the work as specified. j Payment will be made as outlined above. In the event that litigation is required to enforce the terms of this contract,the prevailing party will be entitled to attorney's fee. OWNER ACKNOWLEDGES&ACCEPTS ALL TERMS. Signature Date: i i - i CORAL POOL SERVICE,INC. STATEMENT 3463 GOLDEN GATE WAY LAFAYETTE, CA 94549 61/23/06 • (925) 283-0300 ACCT: . REPAIR., I I i BOB BOWEN Total Due $ 242.27 2345 HOLLY OAK DR. Amount Paid: $ DANVILLE CA 94506 I - I PLEASE RETURN THIS PORTION WITH PAYMENT I REFERENCE CHARGES REDITS BALANCE 01/23/06 INV.#414-13,CHEM. :.45.98 . 45.98 01/23/06. .'INV.#`41413 LABOR 739.50 ' 739:50 .01/23/06 PAID W/CARD . :.. 500.00 -500.00 01/23/06.. 1/2 HR CREDIT LABOR 47:00 j. 47.00 . 01/23. /0611, (MADE NEW W:O. TO.VAC:AGAIN) 0.00 Sales Tax , 3.79 . 3.79 Ir i . . I 242.27 . I Shank Tou I i I I i I I ROBERT S.'BOWEN; JR. .:..-.. 11-4288 JANET:BOWEN;..TRUSTEES .1210:41ts'. 430 5: THE BOWEN.FAMIL'Y:TRUST 0208365708.. 2345 HOLL•Y:OAK M. AA :..: DANVILLE, CA 94506 Date 01 I • Y.�-�4��+;,��''V j Dollars �e :l Wells Fargo Barik N.A. ` ' : ,_ a 'California'' • wellsfargo.com rr ` 'Memo~.:_• - - _ ----- — -- ----=-------- -— ::•..._, .._:. :.. .•, IIS; s:4 �::: . ';'?,•: ':..: ;: :::.;.'.' i �.•�•.2 L04:2 11-2�N 20.133"13 5;7:0.8,, i • I i I . 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C) M �a m t—�U ¢spa.cn a¢.c�+¢ � ¢ �x to CL W > J ti.. w'' -y,,- LL 1- o� r C i 0-i o � W y a w waw o o a 2 a =a^„ H� w Lu W Z ll.l C U(W.�Z O d U w 7Us r 2 _ C► a o I e w O ee Or O Y ^gOWa O� 3 n W 3 O I QWWp as W V f J Zrrx V C Q v ! v Q Z p \ aOU 0J V N V 0- ; � ^� O m~a0 «—o 2 ,u w r oc ��0 — c V W r W a 4 U �J O r Z ix ` N ,1 a r u L 7 V) o� 0 aw<< O r �00 Z m o o us t� = V 0CWa s `mE E—e .� Z : r 00 M 5 a Glu 3 m ' N N == W� .0 E OQ O Y 4 (� \ W < W H r 0 Z �� za ` Z6�� = � 0 O O 3 O m v O OW D T .r C � � Z o d �� N 1\ J. w`.:. a; rr 02/09%06 'rKU 09:29 FAX 1 925 672 4440 Cm001 S"&laine PooeSeevcce Invoice • REPAIRING&SERVICING RESIDENTIAL&COMMERCIAL POOLS&SPAS P.O.BOX 127 CLAYTON.CALIFORNIA 94517 (540)672-4440. Date:. February 09, 2006 Bill To: 9�f Bob&Janet Bowen 2345 Holly Oak Drive Danville, Ca 94506 P.O. Number Terms Project j 838-6463 Contract Pool Clean-Up I Date Description Hours Rate Amount January- Feb. Pool/Spa Mud& Debris Clean-Up Job: Total labor to complete clean-up job. 10.00 75.00 750.00 Rental of Trash &Sump pumps. 200.00 200.00 Filter Job: Installed 11 new filter grids for the Swimquip DPD filter. Total time&materials to complete job. 11.00 28.58 314.38 Chemicals installed to balance out pool/spa water. I 150.00 150.00 Total $1,414.38 i Ptease Retum This POO= Name Invoiced Amount Paid S 0-30 days 32.60 days 61-90 days >90 days Total $1,414.38 $0.00 $0.00 $0.00 $1,414.38 {� I i I i i -ellF .. r or v IF _ , „ HC' ,r .+Ar .y 1 .. .i '�i` � „ ',fid•:`�.: - n, ,°.. .. i a t� ',t• 'alt ``yy,, F'� i..,,. �;. ..,..; 'dry IL , : .. ..... .:. X14 ,y�• ,r , . .fid,;�" .1ti ,,.y. >=w. i'���_.�' *t•�3':�.•, .� _ �\ �'�1� � � � �•R. - � ' >n. R.a_. . a s r, s. Y� .r a- :v( "�t:� ..y. � � .y,•• ...4,.• ter' _ K... t ` ' '.,,'L.<.� -!'• ':f�'„'K;K�{w IY- •y. ��� .i4.x1 fir'!.:•. j;<..g '.,y. ` .. 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