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MINUTES - 03072006 - C.11
• CLAIIII BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY (/ BOARD ACTION:MARCH 07/06 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: $100.00 JAN 3 1 2006 CLAIMANT: CHRISTINA HEIDERICK COUNTY COUNSEL MARTINEZ CALIF. ATTORNEY: UNKNOWN DATE RECEIVED: JANUARY 31/06 ADDRESS: #1 CORTE DEL SOL BY DELIVERY TO CLERK ON: JANUARY 31/06 MARTINEZ, CA 94553 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. JOHN SWE E rk Dated: JANUARY 31, 2006 By: Deputy II. FROM: County Counsel 'TO: Clerk of the Board of Supervisors (��s claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 1-3 By: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1)' County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. $OARD 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:/"A'rMm7 j4V j014N CCILLE;:�:, 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 frilly prepaid/a�crertified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:/"/*ii 0 11 .1j_), CLERK By Deputy Clerk BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT 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 naive 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 puhHe entity. E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. an no Sam r r r r r r r r r u r t r r r r r r r r r r r r r r r r r r r r r r r/r r r r r r r r r r r r r r r amazon MEMO Ems no r 1 RE: Claim By: // L Reserved for Clerk's filing stamp C��l/'�s71 �1�. /?����✓`i GIS ) PRECEIVE0 SHARON HYMES-OFFORD Against the County of Contra Costa or ) JAN 3 1 2006 JAN District) ICLERK 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$ /DD , .!f— and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) h O,0�1 e (& `1 /'Ori -Z- wDO r 3. How did the damage or injury occur? (Give full details; use extra paper if required) e-0ve-lo p co a.5 z `� Zd �d o`' 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? 5 What are the names of county or district officers, servants, or employees causing the damage or injury? ,/� ►/� 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) 24-P 0 n4 elD d e �y 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) m aii ,Iol ` / I e- 8. 8. Names and addresses of witnesses, doctors, and hospitals: 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT ..r.rrr.rr..rr.rNow. rrr.. ..............................r...emmumo......rr.rr.rrr.r.r, ) Gov. Code Sec. 910.2 provides"The claim shall be ) signed by the claimant or by some person on his behalf" SEND NOTICES TO: (Attornev) Name and address of Attorney ) -41 1 Z. (Claimant's Signature) ) i Co��e vim% Sa/ (Address) Telephone No. )Telephone No. ■..rr■■■■rrrrr■■■■rSam rONE r■■■■rr■r■■rrr■rrrrrrr.rrrr■rMEN MEN rrrr.rrrrrass rrsrrrrrrre PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the County under the Tori 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 form, including medical records, are also subject to public disclosure. ■■rrr■■rrrr■■rrrrrr■Nunn .■rr■■rrr■■r■■rrrr■■r■monsoon■■rrrrrrrrrrrrrrNow rrrrmass SOME 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 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. tf CCd-+ � rs W N R3 .. .. J` XEl cd I � � I AMAC CONSTRUCTION& ESTIMATE RESTORATION 5600 Imhoff Drive Suite E DATE ESTIMATE# Concord, CA 94520 Office: 925-356-2619 1/9/2006 1210 Fax: 925-356-2224 NAME/ADDRESS Heiderick,Christina 1 Corte Del Sol Martinez,CA 94553 PROJECT 1 Corte Del Sol DESCRIPTION QTY COST TOTAL This estimate is to repair existing surface paint damage to front 100.00 100.00 door.Paint color needs to be color matched using Kelly Moore brand exterior paint.Sand and touch up paint on front door. Minimum Service Call Charge$85.00 Paint/Materials$15.00 Thank.you for your business. TOTAL $100.00 SIGNATURE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 6 -It BOARD ACTION: MARCH 07, 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 CLAIM AGAINST SHERIFF WARREN RUPF R Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: $1,000,000.00 FEB 0 12006 CLAIMANT: RUSSELL SLAYTON COUNTY COUNSEL MARTINEZ CALIF. ATTORNEY: RICHARD G. BATES, JR. DATE RECEIVED: FEBRUARY 01, 2006 THE LAW OFFICES OF RICHARD G. BATES'BY DELIVERY TO CLERK ON: FEBRUARY 01, 2006 ADDRESS: 1465 ENEA CTRCLI ; STE. 1040 CONCORD, CA 94520 HAND DELIVERED BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETE rk Dated: FEBRUARY 01, 2006 By: Deputy IX. MOM: County Counsel. TO: Clerk of the Board of Sup isors ( his 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: —2 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). IVjQARD 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. p o�, 301=1N CU LIEN CLERK, By , Deputy Clerk Dated:�% 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: X .:10Hw`CU_LL:EN CLERK By Deputy Clerk BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT 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. CIaims 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. y E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. BEEN amonowso0ormos"Nommoo MEnomunnonommonon0on.MUSE 0aI RE: Claim By: Reserved for Clerk's filing stamp Russell Slayton ) DRIED Against the County of Contra Costa or ) r Lb 0 1 2006 Sheriff Warren Rupf District) (Fill in the name) ) CLERK BOARD OF SUPERVISORS CONTRA COSTA Co. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ 1 , 0 0 of 0 o o_ @}d in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) OR August 2 and Auqust 4, 2005. 2. Where did the damage or injury occur? (Include city and county) In a holding cell in Contra Costa County Jail in the City of Martinez. 3. How did the damage or injury occur? (Give full details; use extra paper if required) See Attachment 4. Whatp articular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? 5 What are the names of county or district officers, servants, or employees causing the damage or injury? 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) S. Names and addresses of witnesses, doctors, and hospitals: 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT 11111111•■11111111■■11111111Noonan 11114111111111111111111111111111111■■11411111111111111111111111111111111111111111111111141111■■..■ ■ 111111111111113 Gov. Code Sec. 910.2 provides"The claim shall be signed by the clai or by some person on his behalf." SEND NOTICES TO: (Attorney) ) Name and address of Attorney ) Richard G. Bates, Jr. ) l ( SBN 1 4 4 8 3 5) ) ( laimant's Signature) The Law Offices of ) Richard G. Bates, Jr. ) 1465 En- ea Circle Ste 1040, Concord, CA 94520 1465 Enea Circle, Ste 1040 ) (Address) Concord, CA 94520 ) Telephone No.925-798-8055 ) Telephone No. 925-798-8055 ■11■11411.11.111111111111 WREN&M1111.1111111111■■11111111111111111111111111111111111111 a+noon Began an 111111111111 mown 0 a a IN an a Now of 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, §§ 6500 et seq.) Furthermore, anv attachments, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. ..............Mann 11.Means ENRON 111111114111111111111.11...........■11111111111111:111111111111111111111111■ .11111111111111i 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. Attachment to Government Claim o f Russell Slayton 3. Claim arose when claimant Russell Slayton who was being held awaiting charges on a misdemeanor at the County jail awaiting arraignment was on August 2, 2005 placed in a holding cell with inmates from the State Correctional System, and was assaulted by these inmates. Even though being injured he was denied medical treatment. On August 4, 2005, he was again placed in a holding cell with inmates from the State Correctional System and again was assaulted and was this time severely assaulted and beaten by inmates from the State Correctional System, awaiting court appearances. 4. Failure to properly supervise, monitor and set up proper policies and procedures to monitor detainee safety, to determine, monitor and implement proper policies and procedures to segregate violent State Correctional inmates from non violent, county misdemeanor inmates. 5. Sheriff Warren E. Ruff and several as of yet unidentified Sheriff deputies. 6. The Claimant suffered serious injuries to his teeth, face and head which have require extensive medical care and treat,the costs of which are as of yet not determined. 7. Medical charge undetermined as of yet, will be provided as they become available. 8. John Muir Hospital, Walnut Creek, County of Contra Costa Heath Care Services Martinez w CLAIM I BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY . BOARD ACTION: MARCH 07, 2006 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE "1'O 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 CLAIM AGAINST COUNTY OF CONTRA COS Pursuant to Government Code Section 913 and 15.4. Please note all "Warnings". AMOUNT: $11000,000.00 FEB 0 Z 2006 CLAIMANT: RUSSELL SLAYTON COUNTY COUNSEL MARTINEZ CALIF ATTORNEY: RICHARD G. BATES, JR. DATE RECEIVED: FEBRUARY 01, 2006 THE LAW OFFICES OF RICHARD G. BATES, JR. FEBRUARY O1 2006 ADDRESS: 1465 ENEA CIRCLE;: STE. 1040 BY DELIVERY TO CLERK ON: , CONCORD, CA 94520 HAND DELIVERED BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEET , I Dated: FEBRUARY 01, 2006 By: Deputy II. FkOM: County Counsel. TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: By: rn .619 _ 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. OARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. ( ) Other: I certify that this is a true and-correct coov of the Board's Order entered in its minutes for this date. Dated:&-�Z_" O D .IO.IiN Cl.!LLEM, CLERK, By 4 , Deputy Clerk WARNING(Gov. code sec on 915)- 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: -Z aiiJOHN CULLENCLERK By Deputy Clerk BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT 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 § 91 L-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 acainst each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. ■■r r summon somas n r r m r n s r MR Oman R E N r E r soon r u s r r e r r o r r r r r r r r r r r r r r r r r r r r r r r r a I RE: Claim By: Reserved for Clerk's filing stamp Russell Slayton ) RECEIVED ) F Against the County of Contra Costa or ) E8 0 12006 3 ) CLERK BOARD OF SUPERVISORS u N l District) CONTRA COSTA CO. (Fill in the name) ) The undersigned claimant hereby makes claim against the County of Contra Costa or the abol,e-named district in the sum of$ 1 , 0 0 0f 0 o o _ @}d in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) ON August 2 and August 4, 2005. 2. Where did the damage or injury occur? (Include city and county) In a holding cell in Contra Costa County Jail in the City of Martinez . 3. How did the damage or injury occur? (Give full details; use extra paper if required) See Attachment 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? 5 What are the names of county or district officers, servants, or employees causing the damage or injury? 6.* What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses, doctors, and hospitals: 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOLTNT er..rr..rr..rrrSimmons..........................rrr...r■rrrrrrrrrrrrrrrrrrrr■ ■ now ONES I Gov. Code Sec. 910.2 provides "The claim shall be ) signeZdi t or by some person on his eha SEND NOTICES TO: (Attorney) 1 Name and address of Attorney ) Richard G. Bates, Jr. ( SBN 1 4 4 8 3 5) ) (Claimant's Signat140- ) The Law Offices of ) Richard G. Bates, Jr. ) 1465 Enea Circle Ste 1 Concord, CA 94520 1465 Enea Circle, Ste 1040 ) (Address) Concord, CA 94520 ) Telephone No.925-798-8055 ) Telephone No. 92.5-798-8055 rrrrrrrrrrrrrrrrrrrrrr.r.rrr...rrrrrrrr.rr..r.rrr...rrrrrrr.rrrrrrrrrr.rrr.r . r.rrr.r1 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, §§ 6500 et seq.) Furthermore, any attachments, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■■rrrrrrr■■rrrrr■•rrrrrrrrrrMEN rrrrrrago rrrrrrrrr.■■r■■rrrrrrrirrrramalgam rr■ In..mammal 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. Attachment to Government Claim o f Russell Slayton 3. Claim arose when claimant Russell Slayton who was being held awaiting charges on a misdemeanor at the County jail awaiting arraignment was on August 2, 2005 placed in a holding cell with inmates from the State Correctional System, and was assaulted by these inmates. Even though being injured he was denied medical treatment. On August 4, 2005, he was again placed in a holding cell with inmates from the State Correctional System and again was assaulted and was this time severely assaulted and beaten by inmates from the State Correctional System, awaiting court appearances. 4. Failure to properly supervise, monitor and set up proper policies and procedures to monitor detainee safety, to determine, monitor and implement proper policies and procedures to segregate violent State Correctional inmates from non violent, county misdemeanor inmates. 5. Sheriff Warren E. Ruff and several as of yet unidentified Sheriff deputies. 6. The Claimant suffered serious injuries to his teeth, face and head which have require extensive medical care and treat, the costs of which are as of yet not determined. 7. Medical charge undetermined as of yet, will be provided as they become available. 8. John Muir Hospital, Walnut Creek, County of Contra Costa Heath Care Services Martinez CLAIM Il BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: MARCH 07/06 Claim Against thi, 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: UNKNOWN FEB O 2 2000 UN TY CLAIMANT: JOHN A. NAVITSKY jN RT NE CALIF.L ATTORNEY: UNKNOWN DATE RECEIVED: FEBRUARY 02/06 ADDRESS: #65 MARCIA COURT BY DELIVERY TO CLERK ON: FEBRUARY 02/06 BAY POINT, CA 94565 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. JOHN SWE E k Dated: FEBRUARY 02_, 2006 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors (1This 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: 2%?l' ©�P 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. 40ARD 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:r/.tirm40 ojidL JOHN :C'l�I�I F:N f, CLERK, By , Deputy Clerk WARNING (Gov. code siction 0 13) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: etrCAD�o?Mle .1()l�N ClI( lE!�; CLERK By Deputy Clerk - t BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT 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 Cleric 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 naive 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. now 0WEENRERUN RXEREMBERSEMMMEannoEREMBEENEEMONEsoon]KERMEMNEVORMMENNENENNERMEno Ek RE: Claim By: ? �'D ��� Reserved for Clerk's filing stamp a �,- S REC GVED Against the County of Contra Costa or ) /� ) FEB Q 2 2006 (:0 �t- Carw-{ dloot2L District) CLERK C.!?.R:gC+J=;•.!;Pr,{!'95(?R5 (Fill in the name) ) c::�!r!a cus.E ea. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ and in support of this claim represents as follows: 1. Wheii did the damage or injury occur? (Give exact date and hour) 2. Where did the darpage or injury o cur? (Includ city and count ) " P 67,. 0AI 9o,�J ' C4- O ds 3. How id h damage or injury�°ccur (Give full etailuse extra p per if s re�}uired y�c/ GG��:� 4. What particular act or omission on the part of county or district officer , s rynts, or�emplo ees caused the injury or d age? C�mP/l '7/r,Gl h 14C�&a./� W / X �- 5 What are the names of county or district officers, servants, or employees causing the damage or injury? ('oa/T� �p Co✓ -/rl ;" S' 4� v✓A#�s ,2e. PR/'R- r 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) sp 417— pw T- . 7. How was the amount claimed above computed? (Include. the estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses, doctors, and hospitals: 9. List the expenditures you made on account of tlus accident or injury: DATE TIME AMOUNT Gov. Code Sec. 910.2 provides "The claim shall be signed by the claunant or by some person on his behalf." SEND NOTICES TO: (Attorney) Name and address of Attorney ) (Claimant's Signature) (Address) Telephone No. )Telephone No. ■.r............one...... .....■r..................r..................r....MEaaago aanal 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, §§ 6500 et seq.) Furthermore, any attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. . .....................................son Mumma........■mammon...t........an0MEN 0MERMI 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 imprisomnent 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. R 71 oTW�il� All .���� �� �Jl��' ,�� T •"� � T was Ale � 6 2r o�/Lr Gam _ WAY T4 , .�[e� 7A ig C.� // x-e-- ov,- /%. (dic spm ye, 7 Zw C'/�-/le e CSD✓o✓� ,f7n�� P -417 ��`l7� �✓�s �/�� /�n S� �et ...��i�.l ��. � `j E'�� o � %his l � / A a �,,)C(I--A �_ ��✓�fife A4 1 l I r I I � T r n i N N 9 �k C pV Y v 6+ 1 .4f ;1 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD AC'T'ION: MARCH 07/06 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 Sripervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 1j Li 1;/ 15.4. Please note all "Warnings". FEB 0 2 2006 AMOUNT.: $508.00 COUNTY COUNSEL CLAIMANT: DANIEL R. ST. JOHN. MARTINEZ CALIF. ATTORNEY: uNxNowrr DATE RECEIVED: FEBRUARY 02/06 ADDRESS: 1452 SONOMA COURT BY DELIVERY TO CLERK ON: FEBRUARY 02/06 WALNUT CREEK, CA 94597 FEBRUARY 01/06 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. FEBRUARY 02, .2006 : JOHN SWE k Dated: By: Deputy II. MOM: County Counsel. TO: Clerk of the Board of Supervisors ( This claim complies.substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections. 910 and 910.2, and we are.so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section:911.3). ( ) Other: Dated: 3�� By: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as.untimely with notice to claimant(Section 911.3). IV* BPARD 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: V d1 O JOHN:CU111::EN ', CLERK, By , Deputy Clerk WARNING (Gov. code section 13) 17 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:/ CA08drVA .:1O11N Dated://Qv- CULLEN CLERK By Deputy Clerk BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT 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. ■■anMMEMEMEMMEBoom MMEMMEMMrsoEMERMOMMEEMNMEMENMEME�������r�����������i����ss�� RE: Claim By: Reserved for Clerk's filing stamp fro RECEIVED Against the County of Contra Costa or ) F tE3 0 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$ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) A06-U 57 57;4°-;r3 &D /�" 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full details; use extra paper if required) 1911 Ue L X20 4-7 X040 S e44r41j�.. C /r�/Z0 N 7 WOVe SI-14Z-4,0 4. What.particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? 1(.-,0'-7 eA/D(JG/f Gd 'y 7-0 Da �a�3 -.S�fv�LO /�r9✓C �/Sc�� What are the names of county or district officers, servants, or employees causing the damage or injury? �� n L C J/vp�K c At 6. Wiat damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) oN rt241V7 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses, doctors, and hospitals: 9. List the expenditures you made on account of tlus accident or injury: DATE TME AMOUNT BONNE NONE No onammool ) .Gov. Code Sec. 910.2 provides"The claim shall be ) signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attornev) ) Name and address of Attorney ) (Claimant's Si ure) -Z� S9 50/t/��± C 7 (Address) 9 I�il LN U7 Cd-ee- k GA, I`f ?7 Telephone No. )Telephone No. �J ■am0alloamong.oaaamam0atMEN.....EmsaMEMO OEM..aSEEN aaaa■■aEno aaONE was oil aaaamasaamaamanI 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, §§ 6500 et seq.) Furthermore, any attachments,addendums, or supplements attached to the claim fonn, including medical records, are also subject to public disclosure. ■ son aaaaaaaaaaaExam aaaaa ■■aaaaaa■■aaaaaaaaaaaaa■■aaaaaaaaaaraaa■■aaaaaaaaMEN aaaaaaaal NOTICE: Section 72 of the Pedal 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 imprisomment and fine. Member of the Cole Car Company Inc. Serving the Bay Area Since 1963 ' • JAGUAR Sales: 2103 North Main Street Parts & Service: 1421 Lesnick Lane Walnut Creek, CA 94596 Telephone: 925.935.2653 :OLE EUROPEAN WILL ACCEPT PARTS FOR REFUND OR EXCHANGE PROVIDED THE PART IS A NORMALLY STOCKED NON-ELECTRICAL OR :ARBURETOR-PART PURCHASED WITHIN 15 DAYS AND IS ACCOMPANIED BY THIS INVOICE. ALL PARTS ACCEPTED FOR RETURN MUST MEET "HE MANUFACTURER'S CURRENT PACKAGE GUIDELINES AND ARE SUBJECT TO A 20% RESTOCKING CHARGE. SPECIAL ORDERED ITEMS NOT 'ICKED UP WITHIN 90 DAYS WILL BE RETURNED TO NORMAL STOCK. SUBJECT TO WARRANTY TERMS AND CONDITIONS LISTED 7ON REVERSE SIDE. ]ATE ENTERED YOUR ORDER NO. DATE SHIPPED INVOICE DATE JINVOICE .2 AUG 05 2 AUG 05 NUMBER 45856 S **QUOTE** S 0 ACCOUNT 140. 108761 H PAGE 1 OF 1 L I D FARIBA FASIHI P 0 ST JOHN,DANIEL R o N �V v PO BOX 21828 EL SOBRANTE CA 94820-1828 510 223-7383 HIP VIA SLSM. B/L NO. ZERMS F.O.B. POINT 304 CASH WALNUT CREEK -CA : ::.:. . AMOUNT::::: :.::PART:No : ; D£�GRIPTION: LIST. NET: : 0; XR8-:22929. GLASS=TiiiIND :tJPC :> 469:3:5::46.9:35 : 46. ;:35 ROCK..CHI.P TO. CRACK ::::...:. ..:. *: *: .:...:. ... ... I.:N...:�F..::<0:::::I...C..:E.:.:.:::::::.Q...U::..... :::::E...-::DO::::NO PAY;:;:.:. .:lk* :.. ::......... :. . ...::::.::. � �- : - 2 , THANK :. YOU (J — .i FOR . . YOUR . i BUS/NESS! ::. ..:...:::.... ON-RETURNABLE PARTS INCLUDE; CODED_ ARTS,AIR BAGS,DVD'S,AND ASTON MARTIN PARTS 469 . 5 ARTS AND MUST BE PRE-PAID. SUBLET L CORE RETURNS MUST BE RETURNED IN FREIGHT 0, 00 FACTORY PACKAGING AND FLUIDS DRAINED. SALES TAX 38 . 72 $508 . 07i WARNING:Moto veStat-1 Calif—, m cause cancer and birth detects nr other reproduce—barn+.These Cnrnncais are contained,r nanY vewrie components amt,eplacement parts.vehicle fluids,and paints and materials used m ma�man'eidcies.mc1uding, FUSTOMER'S SIGNATURE but not limited to,lust,til rbatterieb,brazes,and wheel batanc{in99 weights.When you aervipP..,lean or maintain your car.you wdl be e.pnsed to listed iicals contained in used ml,waste ann repiacen+em��idlC fh�mes,grease,grime,touchup paint. .edam reWacenieni parts,and p rhrhdates from�mphnent wear.When we s—ce your car,w wail return u! ppnents to you upon request.UseE parts and components contain hemtc8lsknown e the State dl Cartornia to cause cancer and buth detects or othe,repreduch,e harm. To n'areae Your aspowre when rarvicktg,melntabning or cleaning Your YehWe:11 work in a was ventd,ted ,as:21 do bol smoke.drink or ant white workln:31 wash yyour hands when finished or when tekln breek;.eod II fobw as manufacwrsr krsuucllons pa, kl lop p use d maintenance a� to,Yehlchr d h M P' led n / mdanGa with PruVpsihUn 6ti .n ..a. n�.ui, 8 Sntety r Cnde k25)d!).''� m seq.I Fni Imther infnri i��� F PY �:F::.ww w.aClllra.p9.ya'nNti,`)rri^x�. d DIVISION OF SPEEDY AUTO GLASS INC.- �1 i. .74/ T' r 1 '!:` :;r 2 �l 012 NORTH MAIN STREET u0te _ - 0001482 :, WALNUT ALNUT CREEK,CA 94596 925-944-0112 08/12/2005 Federal Tax ID#911270511 Bill To: daniel r. st john Sold To: daniel r. st john 5713 oliver ct, 5713 oliver ct, el sobrante,CA 94803 el sobrante,CA 94803 510-604-0071 510-604-0071 Account No.:0000000 Tax Exempt No: Agent: Claim M Agent#: Agent Ph: Policy Name: Authorization#: Policy Number: Authorized By: Cause of Loss: rock Claim PO#: Date of Loss: 08/08/2005 Location: road Fleet Card Number: Exp: Driver Name: Fleet PO#: Driver License: Network Control#: Unit Number: Vehicle Year: 2001 VIN: Make: JAGUAR License: State: Model: S-TYPE Odometer: Body Style: 4 DOOR SEDAN Verified By: Work required: Part Description Qty List Discount Unit Extended FW02148GTYY 'A'Windshield(Electrochromic Mirror,Heated Wiper Park 1.00 1,906.90 75.00% 476.73 476.73YS Area)(Heated)(So lar)(Atch is moulding)(32.00 LABFW Labor for FW02148GTYY 1.00 25.00 25.00 @ 25.00 25.00 HAH024358 (Adhesive)High Modulus,Non- 10.00 10.00 @ 10.00 10.00YS Conductive,Urethane,Dam,Primer Subtotal 511.73 Tax Amount 40.15 Deductible 0.00 Total Payable: $551.88 Additional Notes: AUTHORIZATION TO PAY I hereby authorize and empower the above-named insurance company to pay this invoice in full settlement,satisfaction and discharge of all loss under the above policy. Upon such payment,all rights I may have for claim and demand for loss and damage described above against the above named insurance company shall be thereby forever discharged. In the event that the above named insurance company does not make timely and/or full payment of this invoice according to its terms.I hereby accept responsibility for such payment and agree to pay all charges reflected on this invoice to Speedy Glass subject to and according to all terms as noted below. Customer's Signature:................................................................................ TERMS:NET 30 DAYS,SERVICE CHARGE OF 1 1/2%PER MONTH(18%PER ANNUM)WILL BE CHARGED ON OVERDUE ACCOUNTS. j � �,�� � �gyp/G%`���1,; -Tc WH L?1r -rl�q 1,4 e 5 I�Z -C e 1C)e -'7r 0 0 4 Z e t4"0X1<'S /OL 0 0 A) � ��f�� � �%'� ��/ :� ��t�-ems- 1,0 711?4) OF 6- 12-1&,fll IrAl ie,�,ed"IeI2 1141, ( 4 4) �r � z, p 0 F 0 d 7r" 6,41 It 41V 0 -V �o Z or I ,rWl� Ile 0 4J LA) 0 LA)�fo A 1,,12 0A1 OR / -f00 / /fob'-' 5' 3 5 N � .� cz, -.—c> \n CP `�t ,. fz CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY C BOARD ACTION:MARCH 07, 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". AMOUNT: $131900.00 FEB 0 6 2006 CLAIMANT: DIANE M. WARREN COUNTY COUNSEL MARTINEZ CALIF ATTORNEY: UNKNOWN DATE RECEIVED:. FEBRUARY 06/06 ADDRESS: 2128 COBBLESTONE MANOR, BY DELIVERY TO CLERK ON: FEBRUARY 06/06 MODESTO, CA 95355 FEBRUARY 03/06 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEET , C Dated: FEBRUARY 06, 2006 By: Deputy II. FkOM: County Counsel. TO: Clerk of the Board of Supe usors (� '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). O 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: 7 alo By: k4,tg 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. ARD 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. D a t e d.,Y,6 r44 Ar 1.OH_N.C.` .J-L .EN, CLERK, By , Deputy Clerk WARNING(Gov. code section 9FI3 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 fiully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:�� oepw .Jn_t{N C;l!I.LE= CLERK By Deputy Clerk BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAMkNTT 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 ;ear 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. at aaEmboss ONE aaaaaaaaanaaaaaaaaatoaaaaaseaaaIaaaaaoMEN eaaasaaaaaaaERNENKaaacaal RE: Clain By: Reserved for Clerk's filing stamp 1�Vtkrxe t ,t h-cr �1 ) Against the County of Contra.Costa or ) (/ ,gooF 6 2006 District) RH sip (Fill in the name) ) cOSTq co v's°9s The undersigned claimant hereby makes claim against the Countg of Contra Costa or the above-named district in the sum of$ j; ) ��� and in support of this claim represents as follows: 1. 'When didthe amagJe or injury occur? (Give exact date and hour) i)1`3110`, Q_ x,30 Q n,1 2. Where did the damage or injury occur? (Include city and county) V1v i-lcog ip �l�l 1�i l�. N r✓�, (�z r 3. How did the damage or injury occur? (Give fufll%details;use extra paper if required) f� rCtir1 Vii't,m �11�. Cc�t.r�6J Wi'11C,h C.cL o J ' ne_ ��'bi Ik. 1'of ve 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? 5 What are the names of county or district officers, servants, or employees causing the damage or injury? N ` 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) 1'Yly Com 1'0(X'-'-> ecu-k- '_d in 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses of tnTrtnesses, doctors, andel hospitals: "-4)` 15 ,J 1—W, Cyrano., Ru---hey-_oi 0q 1 us5.. �y i N �? s w-- 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT U k Gt�hc�ti` 17 NOR s s s s s s Roman am sass SERUM EKE ME a s s a s a s s s s s s s s s sun RENEE s s s s s s■s s s a a a s s a a a an us a Mason=Val .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) ) Name and address of Attorney ) J L J'tJ )� (Clatmant's Signature) (Address) Telephone No. ) Telephone No. ■■ssssssssasseasassasssasssrassssssssssrsssssssrssssssssssssssssasassssessrssssssesai 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, §§ 6500 et seq.) Furthennore, any attaclunents, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■ •asssassasssssssssassssssasssssssassssssssssssrsssssssssssssasassssssssssox sssasssel NOTICE: Section 172 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 imprisomnent and fine. Send all claims correspondence to: Farmers Insurance Total Loss- COE PO Box 108815 F A RM E RS Oklahoma City OK 73101-8815 FAX: (877)217-1389 Email:clai wdocuments@farmersinsur.ince.com farmersinsurince.com January 18,2006 RE: Customer: DIANE WARREN Claim Number: 1007693307-1-1 Policy Number: 126302902 Loss Date: 12/31/2005 Dear MS. WARREN: The damage to your vehicle has resulted in a total loss. We have evaluated your vehicle as outlined below. This amount is based on the vehicle's actual cash value at the time of the loss. The vehicle's mileage, equipment,and condition are taken into account when determining the actual cash value. The amount of the payment was determined as follows: Actual Cash Value: $6166.00 Sales Tax: $454.74 License Fee Refund: $93.00 Less: Deductible - $1000.00 Total Amount $5713.74 Enclosed is a copy of the market appraisal used to determine the Actual Cash Value of your vehicle. If within 35 days of receiving this settlement you cannot find a comparable vehicle for the gross settlement amount,you may notify us and we will re-open the claim for further evaluation. Additionally,we urge you to contact your agent, if you have not already done so,to make further arrangements for your coverage needs. Please consult your policy for the exact terms and conditions of coverage. If you have any questions in regards to the completion of the enclosed settlement packet,please call 1-800- 445-8055 and ask for Rebecca Holshouser. Sincerely, Farmers Insurance Exchange Timothy Stevenson Total Loss Specialist For;our protection California law requires the following to appear on this form:any person who knowingly presents a false or fraudulent claim for the pa)znent of a loss is gd1yof a crime and may be subject fines and confinement in state prison. Mr-IAIL RIMZ)RALLMMIN!I ;3P%-W; %,%.#hv g vip+%,. SIMPLE INTEREST FINANCE CHARGE ,s:�mber Contract Number R.O.S.Number Stock Number Buyer(and Co-Buyer)Name and Address(including County and Zip Code) Creditor-Seller(Name and Address) Z fou, the Buyer (and Cc-Buyer, it any), may buy the vehicle below for cash or on credit. By signing this contract, you choose to buy the vehicle on credit under the agreements on the front and back of this contract.You agree to pay the Creditor - Seller (sorretimes"we" or"us" in this contract) the Amount Financed and Finance Ci-.erge according to the payment schedule below.We will figure your finance charge on a daily basis.The Truth-In-Lending Disclosures below are part of this contract. New Make Used Year and Model Odometer Vehicle Identification Number Primary Use For Which Purchased personal,family or household 1 0 business or commercial FEDERAL TRUTH-IN-LENDING DISCLOSURES STATEMENT OF INSURANCE ANNUAL FINANCE- .Amount Total of. Total Sale NOTICE.No person is required as a condition of financing PERCENTAGE CHARGE Financed Payments Price the purchase of a motor vehicle to purchase or negotiate any RATE The dollar The amount of The amount you The total cost of insurance through a particular insurance company,agent orbroker.You are not required to buy any other insurance to The cost of amount the credit provided will have paid after your purchase on obtain credit.Your decision to buyer not buy other insurance Y credit as credit will to you or you have made all credit,including will not be a factor in the credit approval process. a yearly rate. cost you. on your behalf. payments as your down scheduled. pay" !n o� _. _C Vehicle Insurance / ) $ is Term Premium A -...: - ,- e $ A Ded.Comp.,Fire&Theft Mos. $ A (e)means an estimate Ded.Collision Mos. $ YOUR PAYMENT SCHEDULE WILL BE: Bodily Injury $ N I/A Limits Mos. $ Number of Payments: Amount of Payments: When Payments Are Due: Property Damage $ A A Limits Mos. $ One Payment of ;1 Medical Mos. $ A One Payment of 41;A Mos. $ N Payments 14 i Monthly,Beginning Total Vehicle Insurance Premiums $—J—,'k Payments 4 Monthly,Beginning U UNLESS A CHARGE IS INCLUDED IN THIS AGREEMENT FOR ? PUBLIC LIABILITY OR PROPERTY DAMAGE INSURANCE,PAYMENT One Final Payment 1 FOR SUCH COVERAGE IS NOT PROVIDED BY THIS AGREEMENT. Late Charge. If payment is not received in full within 10 days after it is due,you will pay a late charge of 5%of the pan of the You may buy the physical damage insurance this contract requires payment that is late. (see back)from anyone you choose who is acceptable to us.You Prepayment.If you pay off all your debt early,you may be charged a minimum finance charge. are not required to buy any other insurance to obtain credit. Security Interest.You are giving a security interest in the vehicle being purchased. Additional Information: See this contract for more information including information about nonpayment, default, any required repayment in full before the scheduled date,minimum finance charges,and security interest. Eluyer,4') Go-Buyer Xl ------ ITEMIZATION OF THE AMOUNT FINANCED Seller X_.- 1. Total Cash Price If any insurance is che-eked below,policies or certificates from the A. Cash Price of Motor Vehicle and Accessories $ named insurance companies will describe the terms and conditions. 1. Cash Price Vehicle $ 7 3 Application for Optional:Credit Insurance 2. Cash Price Accessories $ 0 Credit Life: 0 Buyer' E! Co-Buyer El Both 3. Other(Nontaxable) El Credit Disability(Buyer Only) Describe $ Term Exp. Premium Describe $ A Credit Life "'�Mos. $ B. Document Preparation Fee(not a governmental fee) $ (B) Credit Disability Mos. $ C. Smog Fee Paid to Seller $ (C) Total Credit Insurance Premiums (b) C. Sales Tax(on taxable items in A+B+Q $ (D) Insurance Company Name E. Optional DMV Electronic Filing Fee* $_ -� (E) F (Optional)Service Contract* $ (F) Home Office Address A G. (Optional)Service Contract* $ ' (G) H. Prior Credit or Lease Balance paid by Seller to Credit life insurance and credit disability insurance are not required to obtain credit.Your decision to buy or rot buy credit $ (H) lite and credit disability insurance will not be a factor in the (see dovinpayment and trade-in calculation) credit approval process.They will not be prov:cled unless you sign and agree to pay the extra cost.Credit life insurance is I. (Optional)Gap Contract(to whom paid)* S__ based on your original payment schedule.This insurance may $ (J) no,pay all you c-i-,e on this contract if you make late payments, J. Other(to whom paid)* Credit disability insurance does not cover any increase in your For ne raymentorin't�ieruT!berofpayr,,.-rits.Coverage!orc,,ed:,I)iie Total Cash Price(A through J) insurance and credit disability insurance ends cn the original due ue date for the last payment unless a different term for the 2. Amounts Paid to Public Officials insurance is shown above. A. License Fees A- I'I%'t (A) You are applying for the credit insurance marked B. RegistratiortTransfer/Titling Fees $ I. (B) above.Your signature below means that'ou agree C. California Tire Fees (C) that:(1)You are not eligible for insurance if have * A., reached your 65th birthday. (2)You are eligible for D. Cthi-r S (D) rlienhiliiii incitranno nnl%i if unii oro IAI^rL,;nn fAr0 ti,. tvN,unm!oci vice wntract' � lU! H. Prior Credit or Lease Balance paid by Seller to Credit life insurance and credit disability insurance are not required to obtain credit.Your decision to buy or not buy credit $ "` } (H) life and credit disability insurance will not be a factor in the (see dov:npayment and trade-in calculation) credit approval process.They wi'I not be provided unless you • - sign and agree to pay the extra cost.Credit life insurance is I. (Optional)Gap Contract(to whom paid)' $ f' (1) based on your original payment schedule.This insurance may J. Other(to whom paid)' `1 $ ►1%f: (J) not pay all you owe on this contract if you make late payments. s, Credit disabi'ity insurance does not cover any increase in you- For payment or in the number of payments.Coverage for credit life Total Cash Price(A through J) $ , 'Qinsurance and credit disability insurance ends on the original due date for the last payment unless a different term for the 2. Amounts Paid to Public Officials insurance is shown above. TTr ' rapplying A. License Fees ��'•I`iti '!vL' $ (A) You arefor the credit insurance marked B. Registration/Transfer/Titling Fees $ -i NCI, (B) above.Your signature below means thatyou agree C. California Tire Fees* $ . 75 (c) that:(1)You are not eligible for insurance if you have �t; reached your 65th birthday. (2)You are eligible for D. Other (D) disability insurance only if you are working for wages E. Other $ t}' (E) or profit 30 hours a week or more on the Effective Total Official Fees(A through E) $ .2(2) Date. (y3) Only the Primary Buyer is eliinsurance.DISABILITY INSURI ible for disabilitE MAY 3. Amount Paid to Insurance Companies NOT COVER CONDITIONS FOR WHICH YOU HAVE (Total premiums from Statement of Insurance column a+b)' $ }`'A(3) SEEN A DOCTOR OR CHIROPRACTOR IN THE 4. Smog Certification or Exemption Fee Paid to State $ N A(4) LAST 6 MONTHS (Refer to 'Total Disabilities Not 5. Subtotal(1 through 4) $ 2 4: En50 CQ L(5) Covered"in your policy for details). 6. Total Downpayment You want to buy the credit insurance. A. Agreed Trade-In Value Yr i•.f A Make V%f1 $ F"'�(A) 1 t:==!2�?X � /d� 4 Model Tk< Odom N`A Date Buyer Signatbre Age VIN B. Less Prior Credit or Lease Balance E 3`T is In,t:T.j7 fs $ N%A (B) Date Co-Buyer Signature Age C. Net Trade-In(A less B)(indicate if a negative number) $ `�:_(C) OPTIONAL GAP CONTRACT A gap contract(debt cancella- tion contract)is not required to obtain credit and will not be provided unless you sign below and agree to pay the extra E. Manufacturer's Rebate $ 750, C� (E) charge.If you choose to buy a gap contract,the charge is shown r�•vs F. Other $ tY;';; (F) in item 11.See your gap contract for details on the protection it provides.It is a part of this contract. r i G. Cash $ 1§% (G) Term I° { Mos t' '`' Total Downpayment(C through G) $ 75th.' _(6) Name of Gap Contract (If negative;enter iero on line 6 and enter the amount less than zero as a positive number on line 1H above) You want to buy a gap contract. 7. Amount Financed(5 less 6) $ `j" ci u' r` (7) Buyer X 'Seller may keep part of these amounts. OPTIONAL SERVICE CONTRACT(S) You want to SELLER ASSISTED LOAN purchase the service contract(s)written with the following BUYER MAY BE REQUIRED TO PLEDGE SECURITY FOR THE LOAN,AND AUTO BROKER FEE DISCLOSURE company(ies)for the term(s)shown below for the charge(s) WILL BE OBLIGATED FOR THE INSTALLMENT PAYMENTS ON BOTH THIS If this contract reflects the retail sale of a shown in item 1.F and/or 1.G above. RETAIL INSTALLMENT SALE CONTRACT AND THE LOAN. new motor Vehicle,the sale is not subject ,� to a fee received by an autobroker from us 1.F Company Proceeds of Loan From: Term Mos.or Miles f3; unless the following box is checked: r; Amount$ Finance Charge$ 1.G Compan tf!t; ❑ Name of autobroker receiving fee if WA ; a>>+ Total S ''' ' Payable in ' Term Mos.or_._ Miles c„ t< p installments of$ $ applicable:} Buyer X �� fit. from this Loan is shown in item 6D. HOW THIS CONTRACT CAN BE CHANGED. This NOTICE OF RESCISSION RIGHTS contract contains the entire agreement between you and If Buyer and Co-Buyer sign here, the provisions of the Rescission Rights section on us relating to this contract.Any change to the contract must the back giving the Seller the right to rescind if Seller is unable to assign this contract be in writing and both you and we must sign it.No oral changes are binding. to a financial institution will apply. , Buyer,,,X' f %i F'/, �_i' :';?,:. Xj ;Co-Buyer X f Buyer Signs OPTION:.©You pay no finance charge if the=— he;Amount Financed, iter ,-is paid in full oon�obeeloreX Co-Buyer Signs Year "y %SELLER'S INITIALS—t"-1 --2 r THE MINIMUM PUBLIC LIABILITY INSURANCE LINUTS PROVIDED IN LAW MUST BE FYIET BY EVERY PERSON WHO PURCHASES A VEHICLE. IF YOU ARE UNSURE WHETHER OR NOTYOUR CURRENT INSURANCE POLICY WiLL COVER YOUR NEWLY ACOUIRED VEHICLE IN THE EVENT OF AN ACCIDENT.YGU SHOULD CONTACT YOUR INSURANCE AGENT. WARNING: YOUR PRESENT POLJ"'i k.-AY NOT COVER COLI..!S ON DAMiAGE OR MAY NO' PROVIDE FOR FULL REPLACEMENTCOSTS FO!,THE VEHICLE BEING PURCHASED. IF YOU DO NOT HAVE FULL COVERAGE,SUPPLENPIENTAL COVERAGE FOR COLLISION DAfuiAGE MAY BE AVAILABLE TO YOU THROUGH YOUR INSURANCE AGENT OR THROUGH THE SELLING DEALER, H01WEVER, UNLESS OTHERVOSE SPC•CIFIED,THE COVERAGE YOU OBTAIN THROUGH THE DEALER PROTECTS ONLY THE DEAL.Er^,, USUALLY UP TO THE AMOUNT OF THE UNPAID BALANCE REMAINING AFTERTHE VEHICLE HAS BEEN REPOSSESSED AND SOLD. FOR ADVICE.ON FULL COVERAGETHAT WILL PR01'ECTYOU INTHE EVENT OF LOSS OR DA IAGETO YOUR VEHICLE.YOU SHOULD CONTACTYOUR INSURANCE AGENT. THE BUYER SHALL SIGNTO ACKNOWLEDGETHAT HEJSHE UNDERSTANDS THESE PUBLIC LIABILITYTERk4S AND CONDITIONS. SIS X. X Representations of Buyer: Seller has relied on the truth and accuracy of the information provided by you in connection with the Trade-In Vehicle. You represent that you have given a true payoff amount on the vehicle traded in. If the payoff amount is more than the amount shown above in item 6.6 as "Prior Credit or Lease Balance," you must pay Seller the excess on demand. itthepayoff amount is less than the amount shown above in C, Ct un I L, C1. to M) 3 tl C-n ul LLJ iW f a _ O "o CD YP7 fl ��1 �- = - C _ ' t� c a cz �} V J r� V �J �3 1" CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 6. 11 BOARD AC'T'ION: MARC.14 n2 2nnti Claim Against the County, or District Govenied by ) the Board of Supervisors, Routing Endorsements, ) NOTICETO 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: $22747.47 FEB 0 6 2006 COUNTY COUNSEL CLAIMANT: BEVERLY McGEE MARTINEZ CALIF. ATTORNEY: UNKNOWN DATE RECEIVED: FEBRUARY 06/06 ADDRESS: 505 YUBA COURT... BY DELIVERY TO CLERK ON: FEBRUARY 06/06 SUISUN, CA 94585 FEBRUARY 03/06 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN S WEE E rk Dated: FEBRUARY 06, 2006 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: 7--+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. ARD 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: JOf1N C'I,`Ll:,l .N , CLERK, ByA , Deputy Clerk WARNING (Gov. code secti n 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 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 claimant as.shown above: Dated: /yco✓rL`� o� 026W4 JOHN (. U L• LEN', CLERK By Deputy Clerk 02/03/2006 10:52 CONTRA COSTA COUNTY CLERK OF THE 4 917074264057 N0.770 901 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT 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. •rulrseff"No Ams@same■/■a a a■■■sa*010 11�����/���0���11 us*a a maws■■agon ad go*gas us a1 ,I RE: Claim By: Reserved for Clerk's filing stamp RECEIVED Against the County of Contra Costa or ) FEB 0 6 2006 I on .R(t cosk,. CLERK BOARD OF SUPERVISORS (Fill in tfid-nanne) ) CONTRA COSTA(.O. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district is the sum of$ 7 7. 4 -7�and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) O I I 01� O T7 : 2. Where did the damage or injury occur? (Include city and county) SCS N uJD a c�a- , Sw1 su Com— Ci 3. How did the damage or injury occur? (Give full details;use extra paper if required) --444 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? 5 What are the names of county or district officers,servants,or employees causing the damage or injury? 02/03/2006 10:52 CONTRA COSTA COUNTY CLERK OF THE 4 917074264057 NO.770 P02 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages : claimed. Attach two estimates for auto damage.) S C E —A�-c�,G,-e J eS+t-i-vx - -Po (?- aco(` a-vA m e v1�l KJ! 7. How was the amount claimed above computed? (Include the estimated amount of any S K-�Few' prospective injury or damage.) S. Names and addresses of witnesses, doctors,and hospitals: Scv, 5lO`f L4jo,, e--4- Ca �f�i;�85 C767,,`f3,j 7772-� S L1 I O'k ct-- 1 tLi I ci c ZA VZ coo Z 0, l 1,c C �1231z���qs� e ro 3 9. List the expenditures you made on account of this accident or injury: DATE TBE AMOUNT ■15 WIN 206666019966■96660■6966■■1960■r 6666000 a 96066669r66016r9996r66666066666■r666■r666� ) Gov. Code Sec. 914.2 provides"The claim shall be )signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney Name and address of Attorney ) C't,-Q--t I 6 aimant's Signature) 505 4"a- C4 (Address) SL& ISiti — Cck 9 q�Jg �� b �-I Telephone No. )Telephone Na, 7 A-7-53(P H 6666616096690199166■09966■r9699hiss 9690r99r96106166616669166661196666�66s60■■6666r�66� 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, §§. 6500 et seq.) Furthermore, any attachments,addendums,or supplements attached to the claim form, including medical records,are also subject to public disclosure. •■166616991696961169966961691066166/69.1661699660699900169■■■a a 600■5 6666666666966695a NOTICE: Section 72 of the Pen41 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. On January 9, 2006,Contra Costa Sheriff Deputies came to my home to execute a warrant, which at the time they said was a warrant for my son Quincey Quinney for Murder. In the early morning hours I was awaken by what sounded like an automobile crashing through my home. I was not home alone that morning. My daughter,my sister, my I I year old son and my elderly mother were all present that day. What bothers me is not the fact that they were looking for a Murder suspect, but the way they invaded my home, causing physical damage to my property and the mental damage that was suffered my youngest child and my bed ridded mother. I am the mother of a murdered child so I could empathize with the family of the young man that was killed in your county. And I agree that this is an unfortunate situation for anyone to deal with, but I think the way that your Deputies handled themselves that morning was wrong. I not sure what the protocol you use when serving a warrant, but do you give the resident the opportunity to open the door. I ask this because when the Deputies banged on the door, my sister went to the door to open it, not knowing what she was in for. While she was standing at the door to open it,the Deputies rammed the door several times. For some reason they were unsuccessful in destroying the door on their first few tries. At the same time that they were doing this, my sister was standing there screaming,"I will open it for you,", over and over again. She was heard by my neighbors outside screaming this, so why could they (your deputies)not hear this. It took them 1.5 tries to completely bust my door down. I even later heard them joking about how many times it took them to get the door in. One Deputies comment was that it must have been an expensive door, because we, (your deputies again) usually get in with one try. Once inside the situation became no better. I have a sick mother who has suffered from more than seven strokes in the last few years that have left her paralyzed and in bed. Was it necessary to put a gun to her their effort to serve this warrant. Also my 11 year old son was in the kitchen at the time getting ready for school when this happen. The Deputies put a gun to his head. What danger is an 1.1 year old boy to these officers?Not only was he frightened by the way they came into the house, but putting that gun to his head has left him in fear. He has trouble sleeping at night. He tells me his afraid they will come back this time and shoot him. He has never seen a gun in real life other than television and to have one put to his head has left him traumatized. I have always taught my children to trust in our justice system and respect law enforcement officials. He is now more afraid that he will be hurt by police more than he would be helped. When I asked the officers what where they hear for and I was told by one that my son had shot a man to death. Knowing my child, I knew this had to be a mistake. I asked to see the warrant several times, but I was never shown the warrant. What baffles me is that they were there saying that they were looking for a murder suspect and came into my home as if they were Iooking for a murder suspect, but in the end they just wanted to talk to my son regarding who they felt was the real suspect. So why was my family forced to be treated like criminals when they only wanted to question my son. Do you bust down the doors of everyone that you just want to talk to? My son was not charged and never went to court regarding this matter. He was held in Contra.Costa County Jail for three days and then released. One of the officers (Mahoney) said to me, "we know that your son is not the shooter, we just want to talk to him, and that he is not in as much trouble as his friend."Another one of the deputies said that my son may be released, but we will be back. After all that we suffered that morning, did we also have to be threaten and ridiculed. Honestly, I hope that 1 never have to deal with your Sheriff Department again. VACAVILLE DOOR CO. CSL# 814937 ' ��O' �� . 231 BERGEN CT. VACAVILLE, CA 95687 - - --- - - ---� :DUE;DATE` ' '-1NNOICE# .:,<', �I United States _ — ,.;; c,. 1/1=7/2006;.;:::'". ;, 5 - - - - - - -- ,- ............... B Y.. VERL BE �. . _• .. ..... ., .,.. .r.. ..... .. ... .. , ... , e. ....... . .....:a. ...,. : H... 1>.. 05 Y.UBA _ . ,. . • .. e.. 1,a ISU N .CA:9 4585. $U .a_ i pi::; ?: L.,., �. ._�. _ M:: '.: :....,r... ... . :- �.:`: U nite d states<,:•.. .:.. :......:.:::: - 1,; . .r ., a, .,. .. 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':.i::::'� -. .. .. : ... .,.. - i. ......'.:r:�' - a. .....:....:.......ri.. .-.:.., l.. ... .. .. ,.... .. ....:. .'..:::�i • - .. ...... .. . . ..........:...,. . .... .. ... .Y yrs .,.. ..4 .,.. - - . :r;'. i.: 1. .. .,,,.....,............ ,;r - . .....,... -_. .,... .....: a- - -. :... :: .,.,, r i.... ..... :....... .... ...' .. . .. ....,, ,.:..r. , . .. ....:' r .. . ... : ..;,. .. .. ... 1...:: VACAVILLE DOOR CO. CSL#814937 231 BERGEN CT. Estimate VACAVILLE, CA 95687 United States DATE ESTIMATE# 1/16/2006 B I MCGEE,BEVERLY 1 i 505 YUBA CT. L I SUISUN,CA 94585 L I United States I o i ITEM j DESCRIPTION QTY RATE TAX AMOUNT DOOR THERMA TRU BRAND SMOOTH FIBERGLASS 6/0 X 6/8 X 1 1,795.00 j T i 1,795.00 1314"FRONT ENTRY DOOR W/GLASS IN A PRE-HUNG {I 1 EXT.FRAME W/KERFED WEATHER STRIPING,BRONZE SILL AND SWEEPS,KWIK-SET BRAND HANDLES(2 EA.) ONE ACTIVE AND ONE MATCHING DUMMY SET.ONE i I I)SIDE(21L.F.)INTERIOR CASING. { j LABOR i LABOR TO INSTALL DOOR INCLUDING REMOVAL AND 1 625.00 i 625.00 DISPOSAL OF OLD DOOR. I { i Subtotal 2,420.00 7.38% Tax 132.47 Total 2,552.47 ` LLI 0 W' Li O U co ycc uj w 4� t� d r CLAIM BOARD OF SUPER. VISORS OI+ CONTRA COSTA COUNTY BOARD ACTION: MARCH 07/06 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 Pursuant to Government Code Section 913 and EB 0 7 2006 915.4. Please note all "Warnings". AMOUNT: $61834.66 COUNTY COUNSEL MARTINEZ CALIF. CLAIMANT: DAVIDUAND DANA CREWS ATTORNEY: AARON CREWS, ESQ DATE RECEIVED: FEBRUARY 07/06 ROPERS, MAJESKI, KOHN & BENTLEY FEBRUARY 07/06 ADDRESS: 201 SPEAR STREET, SUITE 1000 BY DELIVERY TO CLERK ON: SAN FRANCISCO, CA 94105 JANUARY 30/06 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEE ; Dated: FEBRUARY 07, 2006 By: Deputy II. MOM: County Counsel TO: Clerk of the Board of Supervisors leis claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). ( ) Other: Dated: ����` By: m 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. OARD ORDER: By unanimous vote of the Supervisors present: (t 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:/- d�;'�-a-�l JOHN C'ULI_I N.,� 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 frilly prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as.shown above. 00, JOHN CULLEN Deputy Clerk Dated: 214-!!6_0 a�iy'�¢ _._.._... - , CLERK By BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INS'T'RUC'T'IONS TO CLAIMANT A. A claim relating to a cause of action for death or for injury to person or to personal property or Cr 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 Supeivisors, 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 entiry. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of tlus form. ■v m m g q q q m v m q m m v m m m E e a a m m a e e q 8200 m a a m m e e m m m m m m m m g m m E mass NZENEXENSWE Box Now NEE ME a RE: Clain By: Reserved for Clerk's filing stamp Against the County of'Contra Costa or ) Qc�; 2046 District) (Fill it the name) ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ d 3�11 6 and in support of this claim represents as follows: 1. Wlieii dict fire damage or injury occur? '(Give exact date and nour) /VOv6n•,6E1, d23, aooi— lD••oo�.�. 2. Where did the damage or injury occur? (Include city and county) 3/`/ �!;qG02Al7/�'!/E �q,�d."//E� Com ) 9y/106, Co.-2-iw Cofr�i Coc�,,�/W 3. How did the damage or injury occur? (Give full details: use extra paper if required) , i-�c�vs RAf q VAnJ �asED f► f evD f �D '��M -ry F�2c� Ti-1 E F/t-v„rr �v 0 OPS nI. "b,C-rec.-Ti✓E' RAFA,✓/W'S . Ac.-n'OrJ4 L-EFT TYcz ._70024 P/f/y114GEd AM> iNOPE/zRAGE. 4. VJliat particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? pFF-,'c_ex3; cv��'►—�'riw`l" A- 4,AtL/7 4r/T; J"s47'F"' 5 W1iat are the names of county or district officers, servants, or employees causing the damage or injury? 5�+.To,J 'RRADL e y-8A� �6"r�crnvE 2AFANArJ_'3A- -AFFo`- 1be-beVE i�ALx-L �'lu 2Pt+b{ _bAD�c uNk'No%✓ A 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) ET- T-iVE 'kA FA.-JA.n] WED A 1-lANDNE—1 /Zoi M To FD2cE -7'/�c F2o„Tl- D0o s pPL-Al' �ETEc 711/ 2AF4AIAO s Acr,oMS; LEFT TN6 POOR-S P1?1"A6e p xNO i1voPE2As&e-. 7. Hove was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) —�E2 VENbot 8. Names and addresses of witnesses; doctors, and hospitals: f,A� �,� c�Ews Arsr�y c2�ws sq+. moa �LEy DF--r-tcr;vE TAFAa^d OFP;C-E,( " S 3 i y �4GO" Dv�' 3iy 2460/A D 4'VC unl,,Nvwnj �Fp�/trS3 un,K�nnwN R��l s �f�vk,vOwnl A�D�xsS �n�vi lh- CA IIVSV6 yl�+Nd;I!E CA gysV� OFF;cE2 7Afhol?,A �rFcfidE �!yR�Hy 9. List the expenditures you made on account of this accident or injury: �A' 0i^'"' A CESS i1�t�Rcss t111VX0W4 DATE TIME AMOUNT a 20aaaaaaaa0a0aaaaoaaaeaeemaaaaaaaaaaaaaaaa■saaaaaaaameaaamaaaamaeeaamaeeaaeeaeaaeac� ) .Gov. Code Sec. 910.2 provides "The claim shall be ) signed by the claimant or by some person on his )behalf" SEND NOTICES TO: (Attomev) Name and address of Attorney ) /'1,43' ( t J'— , rtd � f ,4A/ZOAJ GfLEwS €S q, ) (Claimant's Signature) p`Z Q 1 S 0�i9-2 STS G ) J S;d S("i t6 /000 � ) (Address) ry -FgUlI✓c,Sc-,, C4 91-00J 4 IJIII11E �4/1S J C ) p �'1 �) 02 �d Telephone No. �/ ( S Q �ao Telephone No ■■a a a a a a a a e a n e o c o a m a■■a a e anemone a a an a a a am a am a a a an UK an a a am a a an a a a ago am an ass a am a an c a an[ YU�iLtC;iiD-4-1iC.flS tY�uti�.m.: 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, §§ 6500 et seq.) Furthermore, any attachments, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. a ■maaaaasaaaaasesaasNoun amonsoon aaeaaNone woman asaaaeaaaaaaaaaaaccaasaaaaaaaeaeeaamong NOTICE: Section 72 of the Penial 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. Sun ' Valley Doors Windows ant Invoice Sold To: License#726213 18879 David Crews Dated Origined 11/23/2005 800-210-DOOR Latest Printing 12/9/2005 314 Zagora Dr. Phone:(925)-676-6910 FAX: (925)-676-8163 Danville 110 2nd Ave So C-5;Pacheco, Ca. 94553-5551 Due: Office cell-510-847-6867 Jobsite: .: Bill Date F.O.B. Pacheco Job home-648-2470 Hinges->I Hager RC1741 US3 bright brass $36.77 FAX Casing- L H R H Bore Qty Door Size & Type Jamb -7/0 Pcs: A B 2 2/8x7/6x1.75"6 Panel Oak Pr 5.25 Ext fj w/strip Abz In $4536.00 C E F G H J Door Size & Type Jamb K L M N 0 P Q R S l- U V W X Y Dr t Door Size & TypeJambt Jamb z A Ae _. Qty_ Finishing by others included. 1 1 Memphis x Providence mortise entry 3302 2.5 $240.24 Installation included. 1 Memphis x Providence Dummy us3 3302 Pvd $142.80 Exterior trim needed? Not included. Interior Casing % Not indWed. I Lockset needed included. Door disposal+$20.00 each dr - Not included Sub Total $4955.81 Date Ck No Approve Cash Sales Tax 408.85' This estimate is valid for 30 days' 2/9/200'1--53 Labor $1470.00; Estimate Approved SVD Install PP Received: To Order: Completed: yes Delivery TOTAL $6834.66 CHECK THIS LIST CAREFULLY, as these are the materials you are ordering. This list supercedes all —'-2 First Pmt $3500.004 previous lists and blueprints. No returns on special orders and machined items.Restocking charge of - 20%will be added for all resellable items returned. Sun Valley Doors retains ownership of materials listed Sara balance $3334.66 herin until payment in full has been received. last pmt balance CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: MARCH 07/06 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 T gII�� Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". FEB 0 7 2006 AMOUNT: $4,281.87 COUNTY COUNSEL CLAIMANT: JEFFREY JACHE'ITA MARTINEZ CALIF. ATTORNEY: UNKNOWN DATE RECEIVED: FEBRUARY 07/06 ADDRESS: 601 ALMARIDA DRIVE, APT. #A-15 BY DELIVERY TO CLERK ON:FEBRUARY 07/06 CAMPBELL, CA 95008 FEBRUARY 06/06 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. FEBRUARY 07 2006. JOHN SWrk EE Dated: ' By: Deputy II. FkOM: County Counsel: TO: Clerk of the Board of Supervisors (.�iis 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: n Dated: 7—��o By: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER:. By unanimous vote of the Supervisors present: (� This Claim is rejected in full. ( ) Other: I certify that this is a true and correct'copy of the Board's Order entered in its minutes for this date. Dated:1,1eZ �svG JO.HN C'ULLEN CLERK, By , Deputy Clerk WARNING (Gov. code sect fon 91 1) 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: 1"M Oe o&t�: JOAN Cl1LLEN CLERK By Deputy Clerk CD �'.. O rum o a CD or. cr C� U-- LU ...7 U �• R BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY a INSTRUCTIONS TO CLAIMANT 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 Cleric 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. .........................Nunn.....................anommo........NONE anon son noat RE: Claim By: Reserved for Clerk's filing stamp ) FEB 7 2006 Against the County of Contra Costa or ) cttR---- _ 0.1 District) (Fill in the name) ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ r-7and in support of this claim represents as follows: L When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) VAAV---F1NV _ ,� CiOr-X�iRrN Coll A 3. How did the damage or injury occur? (Give full details; use extra paper if required) Ur V-JA-/, 1,�kAeWO ti�_ 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or dama e? j t/ Dim= /G 72 G'fl l� l� 7 /�` �j j/ %/ V //JTZ : /,A/, 5 What are the names of county or district officers, servants, or employees causing the dA 8�4�7�t�"jM damage or inj ury? ����,�J � VZJ/15 rt 5 P d✓v�GdAOL6 aj> 77ai'7' �,V> Pe/vT Iry T4 - 7-fir- "IP kA� m: -n+Yv ,4-'logy �� rj�-�6-_v 4 OW a G 15 F_ - oroa t i rr 7-&) � 70 �z G)p �. NWhat damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) 144� t!�C`C'l �,J,L1�j SZ�/v / ��G ,i► 7. How was the amount claimed above computed? (Include the estimated amount of any^ prospective injury or damage.) Tf�� Gl%lUU/yT /5; 7,�( ,��1�r4(j Tl�P`�G W-- f LU✓J b-( 8. Names and addresses of witnesses, doctors, and hospitals: 9. List the expenditures you made on account of tlus accident or injury: DATE TIME AMOUNT / T � l a an RENEE Sam Round mamas mosams Not ) 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) ) Name and address of Attorney ) / (Claim Zt's atur bDl LIA ) JF) (Address) Telephone No. )Telephone No.LHIJ� 0 a a a a a r a a a a a a a Mann Eno am a a a a a a a a a a a a a a a a a t a a a a a a a a a a r a a a a a a r a a a a a a t a a a a a a Solo Enos 11118111 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, §§ 6500 et seq.) Furthermore, any attaclunents,addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. 0 s a ONE aaaaaaraaaaaraaraaaaaaraaaaaaaraaraaaaaaaaaaaaaaraaaaaaaaaaaaaRoom araaeaaswum e 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 imprisomnent 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. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) 7/v / rI60-3AT1 -PAf v7ke�6r7,> AND -I- P96 v ,A-T?-7-fck1 E-57 (AI/?Tl�� -Y--- 7. How was tie amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 7we- TVl4t/V-¢7 (Or-NJ 7'/vtY� 8. Names and addresses of witnesses, doctors, and hospitals: 1,7 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT /U ,4 WP- x/1,4 ■■aataaaaaaaaaNOUN aaaaaaaaaaaaaaaaaaamonsoon was aaaataaaataaamonsoon ONES aaaaaaaaaafaal 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) ) Name and address of Attorney ) - (Claim atur (Address) Telephone No. ) Telephone No. ■■aaaaaaataataaaaaaaasaaaaaaaaaataaaaaaaaaaaaaaaaaaaaaaaaaaaaMUMMER NONE anana0ago asanI 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, §§ 6500 et seq.) Furthermore, any attacluments,addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■ a0aaaaaraaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaSEE aaaaaaaaaaaaaaaEmmons RESUME son Emmons not 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. II� 1586 Industrial Avenue ✓V/—�/7®O� San Jose,CA 95112 Tel:(408) 293-9881 Fax:(408) 293-9883 igr—vwn r ® ® • • No. 6112 �4 III DAIS ESTIMATE OF REPAIRS ' AS LISTED FOR AND MATERIALS I Z —4C2& VERBAL_AGREEMENTS NOT BINDING-ES'T'IMATES FREE OWNER �- I;NITp MA ADURi:.55 I'IIONE P.O.K i CITY ZIP (:ON'I'ROL# YEAR-AIAKF.' MODEL MILP.A(iE Sf'Rf.\I.NO. -- A('Cl'.a RF.�AIR REPLAcr, DESCRIPTION OF LABOR OR MATERIAL. HOURS 1 REFIN;HRS. MA'1'ERFAI.S SUBLET 91-1 ISO• I e/ � ��►� ', "f2s ' I 9f), ,.s I I - `— I -r-- I I I I I I I I I I I i I I I I I I I I I i I I I I I I I I I I I i I I GA L-0H 1 FF— mi/5/x� Bdil I I I I J i I I I I I I I I I I I I I I I I I I I I I I I I I I 4 I I I I i I I I 1 I ( I Y PAR I S PRICES I3:1SF-.0 ON STANDARD C:11';\LUG PRUC'CRISMFN'r PRICE LISTS SUB1 GC:T"1'(:)CkIAKGP.\\'rruuu'r Ncn'IcE. TOTAL MATERIAL PROCURF.MF.NT AND DELIVFRY CHARGES MAYBE ADDED FOR SPECIAL SERVICE ON ITER1S NOT AVAILABLE LOCALLY. C•�( "'- TOTAL LABOR4 0 OLD PARTS REMOVED FROM VEHICLES WILL BE JUNKED UNLESti OTHERWISE INSTRUCTED IN W'RI'rlN(:. THF.ABOVE IS AN I:STINIATE BASED ON OUR INSPif(' AND DOLTS NUT COVER ADIWI IONAI.1:-%RFS OR LABOR WHICH MAV Br. TO'T'AL REFINISH LABOR j. RE'Q(4RI:f.)AI-17:R 1I-M 11`C1RK HAS Ii!?F:N(")1'E ! _)('C'AtiIU.'S:\LI.}':11'I'rR WORK HAS STARTED.W'UR.N TARTS ARI:DISCOVERED WliI(al:\RENOTEVIDrNrONruzSrrNSP tri .BF.c';\rsFOFTTIIS.THEABOVE PRICES.\Rr•.norcu,\Rnvrrr:D. FREIGHT CHARGES i I ESTININVE TAX (13 ESTIMATED BY: APPROVED BY: AUTHORIZED AND ACCEPTED EPA CHARGES TOTAL ' li\OWNFR Z�j• OR AGENT: DATE: l } r4 M_ 10 _.� LL h moi. 4�1 t v fi i a �a soca f CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY n . i V BOARD ACTION: MARCH 07/06 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 FEB 0 7 2006 915.4. Please note all "Warnings". AMOUNT: $5,000,000.00 COUNTY COUNSEL MARTINEZ CALIF. CLAIMANT: SEAN SABASTIAN LOVEDAY ATTORNEY: M.KELLY COPENHAVER, ESQ. DATE RECEIVED: FEBRUARY 07/06 ADDRESS: THE LAW OFFICE OF M. KELLY COPENHAVFgy DELIVERY TO CLERK ON: FEBRUARY 07/06 265 MILLER AVENUE MILL VALLEY, CA.94941 FEBRUARY 03/06 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. FEBRUARY 07 2006 _. JOHN SWE k Dated: By: Deputy 1I. FkOM: County Counsel TO: Clerk of the Board of Supe isors (,Yfliis 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. Tile 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: 12 Dated: _ -� By: {'Yl 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 'OARD 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,/ ?g6 iv;t °24d°� JOHN.CULLEN, 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: *Y9�6 APX .ZAW*JOHN. C=.ULLEN', CLERK By Deputy Clerk _ BOARD ur NurvnVxntizio wx INSTRUCTIONS TO CLAM&NT 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. (Goy.-. 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,;genal Code Scc. 72 at the end of this form. a a a a0mamma aamaamaamcanaamanaanouaaaaonneamnaamaomnmmmnaaemaanommamong among anoml RE: Clain By: Reserved for Clerk's filing stamp Against the County of Contra Costa or ) FEB ? »n� District) (Fill in the name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the slam of$5 M i llrov-,, Dell and in support of this claim represents as follows: 1. "When did the damage or injury occur? (Give exact date and hour) �/ ay Ins 2. Where did the darnage or injury occur? (Include city and county) q 6a N c S ry rd Pr\►� , �z Ck0�- l C 64 Y F o S 3. How did the damage or injury occur? (Give full details; use extra paper if required) 4. )What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? � i S a 4Q 5 NYhat are the names of county or district officers, servants,or employees causing the damage or il�jury•? V Y\ 0o, \ D D cS 4i(Y—Q— , 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) �v Ir- �fie. QL /p„d i Y1 -e,��Q �n�u�(► es + Sev.��e SV-., 6QS - 60(Ai ►�- ►n���� 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damagz.) es-h ,r,r.�� . 8. Names and addresses of witnesses, doctors,and hospitals: On Y,41j�,J �Yti`e 1 2�C C - - n a Intl ►1�� l5 `�Y G�- U C S�, 9. List the expenditures you made on account of this accident or injury: DATE TME AMOUNT aomammtmmaaaaasaanaameaaaasmaamaaaaaaaamaaaaaamOmanommaamaaam.aeamoaaaaaamootaaaaemamai ) .Gov. Code Sec. 910.2 provides"The claim shall be )signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attornev) ) Name and address of Attorney ) (Cl ' is Signature) l\e.,n nom }-. Co ream ) aGS CnAte-r VY (Address) ►1 I . L -94,941 Telephone No.(qts) 3 1 )i elephone No. IrJ � q f eaaamaaaaeaa■a6maae"Rang Dana son aeaaaaoaamaaa Sax maAeamatatmaalaaaaaPamamemaaaamtraaaaat 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, §s 6500 et seq.) Furthermore, any attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. a i t a m a a t a a m a r m r m■a m DUNKS m t a a t a a a m t m a D a m m a a a a a a■a e t a■a s a a a m a t a t a m a a t a a a r a r man a a 9 a a t a a i NOTICE: Section 72 of the Penal Code provides: Evc•.ry•person who, witl; intent to deifraud, 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 fuie of not exceeding one thousand dollars ($1,000.00), or by both such imprisorme.m a„d fin::, or by imprisocunent in the state prison, by a fine of not exceeding ten thousand dollars (510,000),or by both such imprisonment and fine. TOTAL P.03 ATTACHMENT A Dependent was confined to his bedroom following a disciplinary incident, from which he was able to exit through a window, with a suicide note in his pocket, and attain access to the roof. Once the dependent was on the roof and visible from the ground. an unsupervised group of other dependents were permitted to verbally abuse, taunt, and encourage the dependent to jump, which he did. After an appreciable period of time, without any adult supervision, or restraint, the dependent did indeed jump, landing on the ground, with resultant severe and serious bodily injury. The County of Contra Costa is responsible because it owns, manages, operates, and/or supervises the facility and/or its employees, and is responsible for the health, safety, care and welfare of the residents of the facility. The County of Contra Costa is responsible because it certifies the habitability of the facility and/or fitness for particular use. The County of Contra Costa is responsible because it took charge of and/or placed and/or accepted the person of this individual. S , , PROOF OF SERVICE BY MAIL I am a resident of the County of Marin. I am over the age of 18 years and I am not a party to this action; my business address is 265 Miller Avenue, Mill Valley, California 94941. On February 3, 2006, I caused the NOTICE OF CLAIM TO: COUNTY OF CONTRA COSTA, CALIFORNIA to be served upon the parties herein by placing a true copy thereof enclosed in a sealed envelope with postage thereon fully prepaid in the United States mail addressed as follows: Clerk of the Board of Supervisors Room 106 County Administration Building 6.51 Pine Street Martinez, CA 94553 I declare under penalty of perjury that the foregoing is true and correct and that this declaration was executed on February 3, 2006 at Mill Valley, California. M. Kelly Copen ver cca�rn ick- UPrte Ol 10, lo� rn ion � r <- 0QVT Lo r� J. AMENDED CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: MARCH 07/06 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 0 9 2006 AMOUNT: $5,000,000.00 COUNTY COUNSEL MARTINEZ CALIF. CLAIMANT: SEAN SABASTIAN LOVEDAY ATTORNEY: M. KELLY COPENHAVER DATE RECEIVED: FEBRUARY 09/06 ADDRESS: THE LAW OFFICE OF M. KELLY COPENHA BY DELIVERY TO CLERK ON:FEBRUARY 09 06 _ 265 MILLER AVENUE, .- MILL VALLEY, CA 94941 FEBRUARY 08/06 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. FEBRUARY 09 2006 JOHN SWEE N Dated: By: Deputy 1I. FROM: County Counsel TO: Clerk of the Board of Super 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). O Claim is not timely filed. The Clerk should return claim on grc.und 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: Z-� D`�(o By: �'? irti Deputy County Counsel il. 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. OARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. O Other: — I certify that this is a true and con-ect copy of the Board's Order entered in its minutes for this date. Dated: Wz'X-0!' 4'0 OHN CUL.LEN, CLERK, By 11PIA44A,, Deputy Clerk__ WARNING (Gov. code section 913) 17 Subject to certain exceptions, you have only six (6) months from +he 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 pet jury that I am now, and at all times herein mentioned, have.been a citizen of the United States, over age 18; and that today I deposited in the 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:/7&4-*A &4 -141%]OHN CCI_LL.ENf, CLEKK.By Deputy Clerk i F The Law Office of RECEIVED M. Kelly Copenhaver FEB 0 9 200 265 Miller Avenue, Mill Valley, CA 94941 Phone: (415) 388-5297 CLER , ARD GF8UPERVISORS Fax: (415) 383-7667 CONTRA COSTA CO. February 7, 2006 Clerk of the Board of Supervisors Contra Costa County Room 106 651 Pine Street Martinez, CA 94553 Re: Correction to Sean Sabastian Loveday's Claim Dear Madam/Mister Clerk: This letter is to correct an inadvertent mistake in the Mr. Loveday's claim against the Contra Costa County dated 2/3/06. The correct address of where the injury to Mr. Loveday occurred is La Cheim, 5860 McBryd Avenue, Richmond, CA 94805. The street name is mistakenly written as "McBryrd" on the claim. Thank you for your attention to this correction. Please feel free to call with any questions. Sincerely, /37Z�- !. M. Kelly Copenhaver, Attorney at Law i 4 t F 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 Iater than on% year after the accrual_ of the cause of action. (Gov. Co'- § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 10051 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. aanneaaaaatt+macarecanaVann aaaacraaaaaaanaaaamaaaanoravaraamaasasnaaaaaaaaaaaaonus RE: Claim By: Reserved for Clerk's filing stamp sem; S c� ,{ as-k ctLove-J- ) Against the County of Contra Costa or ) District) (Fill in the name) )' The undersigned claimant hereby makes claim against the County of Contra Costa or fne above-named district-in the spam of S5i 11�.�and in support of this claim represents as follows: 1. Vllen did the damage or injury occur? (Give exact date and hoer) / , q Jos 2. Where did the damaee or injury occur? (Include city and county) `1 3. rlo;v did the damage or i-�jury occur? (Give firL details;us--extra page:if req Or LzA oma.), 4. IWhat particular act or omission on the part of county.or district officers, servants, or employees caused the injury orc'�arnage? fn- S 0. 5 1,hat thce names of coun_t;• or ds._ict of cern; servants, or employees causing the damage or injury? U claimed. Attach two estimates for auto damage.) , I ,,Z -P_�n.4 inU'( e.s j rv.e,lre S. V_', 6 L . bdd + - ►n vY� , 7. How was the amount claimed above computed? (Include the estimated amount of any prospectiveujuxy or damage.} S. Ni amen and addresses of witnesses,doctors,and hospitals: Ort YvLc)_j rJ 0,- - -i M ►� LID�Q5 , 'AY C--,-k c - U C Ste, 9. List the expendituros you made on account of this accident or injwq: DATE TIIv EAMOUNT P in a P a a s P a a a C a a a a e aa'e M u s lim a up not P a a a P 6 a a Q p a P P a P P a a man e n v PPP on'Y liana PPY Psa a as a a a amps mama, ) .Gov. Code Sec. 910.2 provides"The claim shall be signed by the claimant or by some person on his behalf." SEND NOTICES TO: fAttornev) 1 Name and address of Attorney ) (Cla' is Signature) t� �4leA_ (Address) q4� 41►1 l C, Telephone N o.(44 3.2 t� )Telephone No. MUNN P a 0 P 0111151111%muse Is an a a a P at sun Q 1 a a a a P P a a 6 9 muumuu a a a a RON t a 1A a P a C P a 0 a a P a a sits a a no a a$a Q P 1 PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the Count} under the Tort Claims Act, is subject to public disclosure under the California Public Records Act, {Gov, Cod:, §t� 6500.e. seq.) Furthermore, any attachments,addendums, or supplements attached to the claim form,; izcludin�medical re=cords, axe also sutlect to public disclosla e. S a 9 Y a a Y a a a s a a a e P NXINVUR on a a n a a a a a a a H F a a a s a a a A P a P a a a a P 8 Q a P S a P a a a a 4 P P a E 4 a nae P a a buys a a 9 a% NOTICE: Section 72 of the Penal Code provides: I<•''Ur•Y person Elio, with i tclit to defraud, presents for c1lwvanc;,. or for payment to any state board or ofricer, o.- TO rto a_Iy cotL"tiy, city, or district board or officer, authorized to allow or pay the same if genuuie, any false or £alidulent claim, bill, account voucher, or writing, is punishable either by imprisonmert in the County jail for a period of not more than one year, by a fine of not exceeding one thousand doIIars (SI,000.00), or by both sucl: r50rune ?Sid fine, Or lby imprlsomlent In the stat: prison, by a fine ofriot exceedl1n c, ten thousand dollars (S 110,000);or by both sucl, imprisorLnient and fine. TOTED P.0 PROOF OF SERVICE BY MAIL I am a resident of the County of Marin. I am over the age of 18 years and I am not a party to this action; my business address is 265 Miller Avenue, Mill Valley, California 94941. On February 3, 2006, 1 caused the NOTICE OF CLAIM TO: COUNTY OF CONTRA COSTA, CALIFORNIA to be served upon the parties herein by placing a true copy thereof enclosed in a sealed envelope with postage thereon fully prepaid in the United States mail addressed as follows: Clerk of the Board of Supervisors Room 106 County Administration Building 651 Pine Street Martinez, CA 94553 I declare under penalty of perjury that the foregoing is true and correct and that this declaration was executed on February 3, 2006 at Mill Valley, California. M. Kelly Copei ver r v ► Q 3' C cc LLJ LU C-i a rn u o LLJ ¢arc - �..�. CC +.i:•iii -._ � d_ = {/S W _1 U - 049 -. ti'ao is lyl � V :. 3f• Q � r- q} U Po om U- C Q�3 Q Q O< Q . � a� � j ' CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY \ BOARD ACTION:MARCH 07/06 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 29.94,316 Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and FEB 02006 915.4. Please note all "Warnings". AMOUNT: UNKNOWN COUNTY COUNSEL, MARTINEZ CALIF. CLAIMANT: CALIFORNIA STATE AUTOMOBILE ASS. FOR: :.. OMID AND CHERIE CHAVEZ MOKRI ATTORNEY:- BY: ANDREA KUHN DATE RECEIVED: FEBRUARY 03/06 =--UNKNOWN ADDRESS: P.O. BOX 920 BY DELIVERY TO CLERK ON: FEBRUARY 03/06 SUISUN CITY, CA 94585-0920 FEBRUARY 02/06 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. FEBRUARY 03 2006.: JOHN S WE rk Dated: , By: Deputy II. FkOM: County Counsel, TO: Clerk of the Board of Sup@6isors ( ) 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: 2--3-d Ca . By: V 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. JIpARD ORDER: By unanimous vote of the Supervisors present: W 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: IM 4 JOHN 'CUJLLE'N'; CLERK, By . , Deputy Clerk WARNING (Gov. code secion 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 frilly prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated d .ZOO 1-nH CCILLEN;� CLERKBy Deputy Clerk OFFICE OF THE COUNTY COUNSEL sE L SILVANO B. MARCHESI COUNTY COUNSEL COUNTY OF CONTRA COSTA Administration Building ,; _ 1 "-_ -4`•� 651 Pine Street, 9'" Floor SHARON L. ANDERSON o; CHIEF ASSISTANT Martinez, California 94553-1229 GREGORY C. HARVEY (925) 335-1800 VALERIE J. RANCHE (925) 646-1078 (fax) '�a .� �_''_�;- � - .;� ASSISTANTS ,•�,�' �OSrA`COUl'1'C� NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: California State ALItOIll.Oblle Association P.O. Box 920 Suisun City, CA 94585-0920 Attn: Andrea Kuhn RE: CLAIM OF CALIFORNIA STATE AUTOMOBILE ASSOCIATION Your Insured: Omid & Cherie Chavez Mokri Your Claim No.: 09-202182-7 Please 'Take Notice as Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910.2, or is otherwise insufficient for the reasons checked below: [X] 1. The claim Tails to state the name and post ol'Iice address ol.,the claimant. [X] 2. 'l-he claim falls to state the post office address to which the persoll presenllllg the clallll desires notices to be sent. [X] The clallll fails to state the date, place or other circumstances of the occurrence or transaction which (,ave Ilse to the claim asserted. [X] 4. The claim fails to state the nanle(s) of the public employee(s) causing the ill'Llry, damage, or loss. ifknown. [X] 5. The claim fails to state whether the a1110LIllt claimed exceeds ten thousand dollars (`(;10.000). If the claim totals less than ten thousand dollars (` 10,000). the claim falls to state the amount claimed as of the date of presentation, the estimated amount Ofany prospective injury, damage or loss so far as known, or the basis of computation of the am0L111t claimed. [X] 6. The claim Is not signed by the claimant or by some person on his or her behalf. California State Automobile Association Re: Claim Page Two [X] 7. YOU are required to submit your claim oil the proper form.. which is enclosed. Please resubmit your claim oil the enclosed lorni. llleludin,,, all the required information. Gov. Code_ § 910.4. Please be aware that you have ollly a llllllted perlod Oftinle 111 which to file an amended claim. See Gov. Code, § 910.6. 8. other: SIIA"AN(:) 13. MAIZCl-IES1. COUNTY COLINSFI. Lav morlika L. Cooper Deputy County COLI sel C.'ERTIFICATIE (_)I- SI:,RVIC'E BY MAIL (Code Civ. Proc., tiff 1012. 101 M. 2015.5: I;vid. Code. §§ 641. 664) 1 ani a resident of the State of California, over the age ofei_hteen rears, and not a party to the Nx ithin action. My business address is 011ice of the County Counsel. 651 Pine Street. 9th Floor. Martinez. CA 9455')-1229. On February .. 2006. 1 served a true Copy of this Notice of InstltTiciency and/or Non-Acceptance ot'Clainl by placing the document in a sealed envelope with postage thereon fully prepaid, in the United States mail at Martinez., California addressed to California State Automobile Association. 1'.0. Box 920. Suisun Cit)". CA 9=1585-0920. as set forth above. 111111 readily f'anifliar with OffICC Of C OUIIIV Counsel�s practice of Collection and proce,,sing of correspondence for mailing. Under that practice. it would be deposited with the U.S. Postal Service cm that same day with postage thereon fully prepaid in the ordinary Ccnu-se ol'business. declare under penalty of perjury under the laws of the State of California and the United States of America that the above is t1-LIC and correct. ESCCllted on February 3. 20Kil at Mill-tinez. Cali lornia. Kathleen ('Connell cc: Clerk of the 130ard of Supervisors (original) Risk Manaucnlent Page 2 California State Automobile Association Inter-Insurance Bureau RECEIVED P.O.Box 920 I Suisun City.CA 94585-0920 � February 2, 2006 FEB 0 3 2006 CLERKBOARD OF CONR COSTA CO- County Administration Building;Clerk of the Board of Supervisors 651 Pine Street, Room 106 Martinez,CA 94553 RE: Your.Insured: Contra Costa County Your Claim No.: 59826 Our Insured: Omid And Cherie Chavez Mokri Our Claim No.: 09-2C2182-7 Date of Loss: 01/14/2006 Dear County Administration Building;Clerk of the Board of Supervisors: "This is notice of our subrogation interest arising from this loss. We are in the process of settling the claim directly with our insured. We will forward copies of the repair bills as soon as they are available. Sincerely, Ami U)AI XLJWt. Claims Representative 888-900-6520 extension 5407 Enclosure F268K tApr 2002) . @.w ar i,�\ C © et « � « - .� $ \� Ki z z o »n � \ . q ---------- ~ ƒ. . � \ � , t occk . ®Ak ON . \ ° © ka att 6} . «\f ' AMENDED --------- CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY • /t'fjaYe�i c�..Aa aG BOARD ACTION: 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 CodeIs ��� notice of the action taken on your claim by the r Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and FEB 14 2000, 915.4. Please note all "Warnings". COUNTY COUP�"�t AMOUNT: $637.61 MARTINEZ GA6F.- CLAIMANT: CALIFORNIA STATE AUTOMOBILE ASS. FOR: OMID AND CHERIE CHAVEZ MOKRI ATTORNEY: BY: CARLA LORENZ DATE RECEIVED: FEBRUARY 14/06 ADDRESS: P.O. BOX 920 BY DELIVERY TO CLERK ON: FEBRUARY 14/06 SUISUN CITY; CA 94585-0920 FEBRUARY 09/06 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEE ft Dated: FEBRUARY 14, 2006 By: Deputy — &z4_,-1 tr II. MOM: County Counsel, TO: Clerk of the Board of Supervisors (v6liis 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: r i Dated: /5 2006 By: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County A istrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. $OARD ORDER: By unanimous vote of the Supervisors present: (v.r 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 JOHN CULLEN CLERK, By , Deputy Clerk WARNING (Gov. code section 91 ) 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 frilly prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated- -Y�6( -&Q)6 JO H N C U L L EN ;, CLERK By Deputy Clerk California State Automobile Association RECEIVEDInter-Insurance Bureau y P.O.Bos 920 1 FEB 4 2006 Suisun Cite, CA 94585-0920 February 8, 2006 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. Contra Costa County County Administration Bldg( Clerk of the Board of Supervisors, 651 Pine St,Room 106 Martinez,CA 94533 RE: Your Insured: Contra Costa County Your Claim No.: 59826 Our Insured: Omid And Cherie Chavez Mokri Our Claim No.: 09-2C2182-7 Date of Loss: 01/14/2006 Dear Contra Costa County: This will confirm our subrogation interest arising from this loss. We have settled the claim with our insured and based on the following facts,request payment directly to California State Automobile Association inter-Insurance Bureau (CSAA-IIB): In order to assist with and expedite the evaluation and processing of this subrogation demand,we enclose the relevant documentation in support of our claim. This information may contain personal or privileged information about our insured,and is being provided to you pursuant to California Insurance Code Section 791.13 and may not be used for any unauthorized purpose. Based upon this information,we ask that you issue payment of$637.61 Repair Bill $637.61 -------------------------- TOTAL $637.61 ---------------- ---------------- Please be advised that any payment in an amount less than that set forth in this letter that is forwarded to CSAA without its prior authorization as described below will not constitute a full and final settlement and will be accepted as partial pnvntent onlj�. Since payments received in the mail are processed by clerical staff and deposited as a matter of course without examination, unauthorized payments for less than the full amount dernanded may be processed inadvertently. Although such payments may be demarked as"payment in frill"or have other words of similar meaning written on them, their processing will not constitute an accord and satisfaction, as CSAA has not agreed to acceptance of such payments. Only an authorized Subrogation Specialist may communicate,orally or in writing, CSAA's specific agreement to accept an amount less than that demanded in this letter. Sincerely, U Subrogation Specialist 888-900-6520 extension 6233 Enclosure ABOARD OF SUPERVISORS OF CONTRA COSTA COUNTY � �a'(4 oq_2C Z I FZ `-7 INSTRUCTIONS TO CLAIMANT 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 Counq, 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. .now//\/!////i///t//i i///\ban■■on■/■■i■■■///■■■//■■■/■■/■f R■/F/■Massa■■/■///■us RE: Claim By: Reserved for Clerk's filing stamp } } Against the County of Contra Costa or ) } District) (Fill in the name) ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district ' the sura of$ ( -31, & and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact daze and hour) j'��/Zoo(o •`O O PA, /l �h7YG�- Ob7G`. 2. Where did the damage or injury occur? (Include city and county) -P1140 � 3. How did the damage or injury occur? (Give full details; use extra paper if reaired) 6141 5 WU- CWkzGe Gt+2-365 Monis, '5 - Aveuvkc-4" 7Ac 6a, A. v r' Cin hrAs ��� , iw,6t, on o It i`f o w r l�a�✓/ced r/e�t r'cl ;i� iii o l� d,4 9 gS-6q, 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? w ^ - � as GX&s/kg A_ Geo9 � � e-S �c- om ie 66 J , aA 5 What are the names of county or district officers, servants, or employees causin t45 damage or injury? //1 a�� /✓ 5AJ7 a. C05 A /n4 za'd ZZVZ SES SZ6 iN3W9tiNUW Acid D99 V2:zti 9002-Z2-NUf 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto dams e. c ~�- .�a �� l eV-�- rear rh �� �a.s�b I -�z' 2ca° 6 I Ics�c�5�. (.See -�+� e� �5-�,�e-s) 7. How was the amount claimed above computed? (Include the estimated amount of any nrostiective iniury or damage.) M y ��sIsY�cCe C-0-WP CtA FrlCA- and �,As-d 066++6 130c(� Sip .es4'mr--&e- -a repa.,Y-s- 09-ZC Z 1 $Z- 7 . S. Names and addresses of witnesses,doctors, and hospitals: 0,jiy oF At"lole f l�i 49,E 01A lei 9. List the expenditures you made on account of this accident or injury: DATE TRY[E AMOUNT /f i4/c(e ■asmosasasmannonoun aMMssrasMsaaaaarseMMeaa■sssasreMrsarrrMssrresrassMasnonaaransasass ) .Gov. Code Sec. 910.2 provides`'The claim shall be )signed by the claimant or by some person on his )behalf" 5 A A d,-5 5-btbro9 SEND NOTICES TO: (Attorneyl ) �1 �i,e C�av Z Name and address of Attorney } } AKOIA, &D r- S A- } (Claimant's tore) (Address) TX ('11-f.-AT q 4f S ) Telephone No. ) Telephone No. �''r'J�D d—�O JZD n ■■mraromrmrnamrsana0srrarammnnnaMMammaa■rssMonssaMMssnnnnsssnnnsaaannanraman mam■ramal 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, §§ 6500 et seq.) Furthermore, any attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. a manommuns an am a am Z us on MENKE Nunn mans Masson 0 5 son sun ONE son a No Moan WommonooKon an a memo assal 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. 20'd TZbT S22 SE6 1N3WOUNdW ASId 333 S2:ZT 900E-T2-Ndf Date: 1/31"2006 12:42:19 pm Estimate ID: A092r_2182701 Estimate. Version: 1 Supplement: 1 (P) 1/31/2006 12:42:09 PM Profile ID: CSAR EUROPEAN , O O N Mike Roses Auto Body o` 'walnut Creek 2280 Borth Main Street Walnut Creek, CA. 94596 (925) 979-1'739 C14 Fax:(925) 279 4334 N Damage Assessed By BRUCE HUBERT Appraised For: Linda Palmer U Condition Code: Type Of Loss: Collision m Date of Loss: 1/14/2006 Arrival Date: 0 Final Lo Owner: LJJ Payer: Insurance Claim Paid: W Policy No: Claim N'imber: A092C2182701 V Deductible: WAVED W File Number: P Owner: OMID .AND CHERTE CLIA MOKRI Insured: OMID AND CHERIE CHA MOKRI Claimant: Addreso: 2562 BUENA VISTA AVE WALNUT CRYIEK, CA 94597-0000 Telephone: Work Phone:(510) 981-4049Home Phone:(925) 933-5788 Mitchell Service: 911368 Description 2000 Volkswagen New Beetle GLS Ve^icle ProdLICti'_.n Date: / Body Style: 2D HB Drive Train: 2.0L Inj 4 Cyl 4A F'WD VIN: 3 VWCC21 CX YPI4 2 0 301 License: GLOVER CA Mileage: 0 OEM/ALT: A Search Code: C94596 color: SILVER Options: Alum/.Alloy Wheels,Air Conditioning,Power Steering,Power Windowo,?cwer Door Locks,Tilt Steering Wheel,CCUise Control,EleCtriC Detogger,AL:tomatiC ^ransmission,AM-FM Stereo/CDPlayer(Singl=_) "SPECIAL PARTS NOTE: ALL BRASH PARTS ON 'PHIS ESTIMATE ARE "NEW" PARTS (OEM) UNLESS OTHERWISE SPECIFIED. PARTS DESCRIBED AS RECHROMED, RECORED, OR REMANUFACTURED AEE EITHER. "RECONDITIONED" PARTS OR ESTIMATE RECALL NUMBER: 1/31/2006 12:41:05 A092C2"82701 UltraMate is a Trademark of Mitchell International Mitchell Data Version: JAN_06 V Copyright (C) 1994 - 2003 Kitchell Int?rnationai Page 1 of 5 UltraMata Version: 5.0.214 All Rights Reserved Date: 1/31/2006 12:42:19 pm Est-,mate ID: A092C2182701 Fstimate Version: 1 Supplement: 1 (P) 1/31/2006 12:42:09 PM Profile ID: CSAA EUROPEAN "REBUILT" PARTS. CRASIi =ARTS DESCRIBED AS '•QUALITY REPLACEMENT PARTS', ARE I7ON-ORIGINAL EQUIPMENT MANUFACTURER AFTERMARKET PARTS.- Line Entry Labor Line !tem Parr. Type/ Dol l ar Labor CFG item Number 'I'VCc Op Description Part Number Ain punt Units Unit 1 10446' EDY REMOVE/REPLACE L REAR MARKER LAME? ASSEMBLY 1C0 945 073 B 10.13 =NC #0.2T 2 9C0500 REF' REMOVE/REPLACE FLEX ACDITIVE -Qual Repl Part 7.00 * 0.0* T 3 101308 BUS' OVERE=AUL REAR COVER ASSY 3.8 #3.8 4 101926 BDY REPAIR REAR BUMPER COVER, Existing 1.0*#3.8 5 AUTO REF REFINISH PEAR BUMPER COVER C 2.3 2.3 6 AUTO RFF ADD'L OPR. CLEAR COAT 0.9 7 933003 REF ADD'L OPR TINT COLOR 0.5* 8 AUTO ADD'L COST PAINT/MATERIALS 93.90 T 9 ALTO ADD'L COST HAZA=.DOUS WAS"CE DISPOSAL 3.93 ' - Judgemant Item # - Labor Note Applies C - Included in Clear Coat Calc Recycler InfOCmation Section: Prior Damage Remarks - PRELIMINARY ESTIMATE „ ** CUSTOMER WISHES TO CASK SETTLE ** Add'1 Labor Sublet I. Labor Subtotai3 Units Rate PL110unt AmOUnt Totals 11. Part Replacement Summary Amount Body 4.8 60.00 0.00 0.00 288.00 Taxable Parts 17.13 Bdy-S 0.0 60.00 O.CO 0.00 0.00 Pasts Adjustments 0.00 Refinish 60.00 0.00 0.00 222.00 Glass 0.0 60.00 0.00 0.00 0.00 Glass Ad3ustments @ 0.000 0.00 Mechanical 0.0 60.00 J.00 0.00 0.00 Sales Tax @ 3.250 1.41 Fr acne 9.0 60.00 C.00 0.00 0.00 @ 9.250 0.00 ESTIMATE RECALL NUMBER: 1/31/2006 12:41:05 A092C2182701 U1traMate is a 'trademark of Mitchell International Mitchell Data Version: JAN_Or,_V Copyri.cht (C) 1994 - JC03 Mitchell International Pace 2 of 5 U1traMate 'Version: 5.0.214 All Rights Reserved Date: 1/31/:1006 12:42:19 pm Est--mate ID: A092C2182701 Es-.imate Version: 1 Supplement: 1 (P) 1/31/2006 12:42:09 PM Profile ID: CSAA EUROPEAN Taxable Labor Non-Taxable Parts Parts Adjustments 0.00 Labor Tax @ 0.000 0.00 N:.,n-Taxable Labor Non-Taxable Ldbor51U.00 Class Adjustmerits @ O.00D 0.00 Labor Surnnary 8.5 510.00 Total Replacement Parts Amount 18.54 III. Additional Costs IV. Acjustments Amount Taxable Costs 99.90 Insurance Deductible 'WAIVED Betterment 0.00 Sales Tai: @ 0.250 8.24 Appearance Allowance 0.00 Related Prior Damage 0.00 Customer Reupon5ibility 0.00 Non-Taxable Costs C.93 Total Additional Coss 1f,�9.07 I. Tota Labor: 510.00 II. Tota_ Replacement Parts: 18.55 III. Tutal Additional Ccsts: -09.07 Gross Total: 637.61 IV. Tctal Adjustments: 0.00 Net Total: 637.61 Less Oriqinal Net Total: 0.00 Net S inplem.ent. Amount: 637.61 S1: BRUCE HUBERT 637.61 Related Prior Camage Labor Sub=Otals Units Rate -otals RL-Body 0.0 60.00 0.00 RT.-Refinish U.0 60.00 0.00 RL Taxable Labor 0.00 GST - E Tax @ 0.000 0.00 Labor Tax @ 0.000 0.00 Labor Tax 0.00 R1,-Non-Tnxable Labor 0.00 Related Prior Canape Labor Summary 0.0 0.00 ESTIM:,TE RECALL NUMBER: 1/31/2006 12:51:05 A092C2182701 U1traMate is a Trademark of Mitchell Interna:ional Mitchell Data version: JAN_06_V Copyright_ (C) 1994 - 2003 Mitchell Interna-ional Page 3 of 5 UltraM.1te 'Version: 5.0.214 Ali Rights Reserved Date: 1/31/2006 12:42:19 pm Estimate ID: A092C2182701 Fstim3te Version: 1 Supplement: 1 (P) 1/31/ 006 12:42:09 PM Profile ID: CSAA EUROPF-AN Part Replacement Summary Amount RL-Taxable Parts 0.00 GST - E Tax @ 0.000 0.00 Sales Tax @ 8.250 0.00 Sales Tax @ 8.250 0.00 RL-Non-Taxable Parts 0.00 Related Prior Damage Part_ Summary 0.00 Related Prior-Tota_ Labor: 0.00 Related Prior-Tota' Repl3cemen= Parts: 0.00 Related Prior-Damage Total: 0.00 Unrelated Prior Damage Labor Subtotals Units Rate 'totals U'4-Bodv 0.0 60.00 0.00 UN-Refinish 0.0 60.00 0.00 UN-Taxable Labor 0.00 GST - F. Tax @ 0.000 0.00 Labor Tax @ 0.000 0.00 Labor Tax @ 0.000 0.00 UtJ-Non-'Taxable Labor 0.00 Unrelated Prior Damage Labor Summary 0.0 0.00 Part Replacement Summary Amount UIJ-Taxable Parts 0.00 GST - E Tax @ 0.000 0.00 sales Tax @ 8.250 0.00 Sales Tax @ 8.250 0.00 U!J-Non-Taxable Parts 0.00 Unrelated Prior Damage Parts Summary 0.00 ESTIMATE RECALL NUMBER: 1/31/2006 12:41:0.5 A092C2'_82701 U1traMate is a Trademark of Mitchell International Mitchell Data Version: JAN_06_V Copyright (C) 1_994 - 22003 Mitchell International Page 4 of 5 U1traMate Version: 5.0.214 All Rights Reserved Date: 1/3=/2006 12:42:19 pm Estimate ID: A092C2182701 F.s-imate Version: 1 Supplement: 1 (P) 1/31/2006 12:42:09 PM Profile TD: CSI.\ EUROPEAN Unrelated Prior-Total Labor-: 0.00 Unrelated Prior-Total. Replacerrent Parts: 0.1i0 Unrelated Prior-Damage Total: 0•'10' T Total does not Include overlap or 'labor adjust:nent:s THTS ESTIMATE HAS BEEN PREPARED RASED ON THF USE OF CRASH PARTS SUPPLI .D BY A SOURCE. OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OF THE PARTS, RATHER THAN BY THE CRIGINAL MANUFACTURER OF YOUR VEHICLE. Points) of Impact Insurance Co: CSAA-DRN Address: Telephone: Fax Phone: Body Shop: Mike ..ose-N. Main-Walnu: Creek Inspection. Si;e: None Address: 2288 N. Main Acdress: Walnut Creek, CA .94596 Telephone: Inspection Date: (925) 937-4776 Fax Phone: (925) 279-4334 State Lie. NO: Company Code: Drop Off Date: Repair Dates: Promis" Date: Start Date: Pick Up Date: Completion Date: Is vehicle Driveable 'Y/N)?: Assisted With Rental (Y/AI)?: ESTIM)'TE RECALL NUMBER: 1/31/2006 12:41:05 A092C2182701 U1tr2Mate is a Trademark of Mitchell International Mitchell Data Vors.i.on: JAN 06 V Copyricht (C) 1994 - 2003 Mitchell international Page 5 of 5 Ultratlate Version: 5.0.214 All Rights Reserved w x < mw 4. ,. d TA, T. Oft la 44 11ION 'I MOP .r. R. $�a s-r , r f`m� Ai�• i m W � -r3 ;per s..ix:.fin".�v. � ^:eA��•• R 9 tT7-- lot sop oil "I .: F< c„ RaK'. M; u Po , , .. .. ...ry,�z'°. r: .h t a:m' a a,. .. a :: .... NP, `y f. i f tt R a a T , w r„ Y- y n �e rt` IDi Leda, x: ` x a=: t L'. ��'&�::Yg:; •q ..F s.s:..qua}��T ¢. '.'{)p,'}�: ,:_:y�: x a. tea. :°. ,��.��� •� M x M �nr^< w .. .a ..«�.> ....,,<.:..�. ._•-.mom„... �.:;.: > p x 9y S g' ad , r.x ` m i� "t "9. vat " z° ';'r. F r.. XN < >B� w: µ. x r: tt. 10 r i; M. A. x r. . < ti x .tea:.x. ... ..,,«..... ..... ....... px� .a ....� r .mow :. ..' " , N : r Q w f` �x 4ti v r ^ �x xr g yflir rr _ WT :::... ....: .. y., i < h :. �...:�'&'',•.v ms's '.. �• < i ^ :. x> a. � t 3 4 is .::.. 6- y P i:. �a „.;: s � �: .. ,fix. ;. ��&'� .�'�,•. .... ..... lilt .. ....... .. V day 1. ^ x . x s /� .r' t 4ITp r AN , r •. a. /^ M sem.' a.; �1 "ley. j' <'ta 3.w.,r. �< � �'• _:t'a'i' Y: R .n ' r a t AA 9 {,9513 IN S9'Y -.;.• ark.::: <x k.r--,<� Xfta < .• ,, i�niy,�r• _,.. rr�lilrir�"I� �Ili���,+rill'I�illill'iil e d ti I� is •; < r.., :. .. .. .. . � pA 'H '•V�«'.(�' �..'�, � ,ems� � :��5....�:. � , < , . .... �.... .�.��.:.Y. .. .rte., r n; e: xx a 0 �s < .;�R e..•: x:23.3:. '. Date: 1/31/2006 12:42:19 pm Estimate ID: A092C2182701 Estimate version: 1 Supplement: 1 (P) 1/31/2006 12:42:09 PM QD Profile ID: CSAR EUROPEAN O O N Mike Roses Auto Body of Walnut Creek 2280 Korth Main Street Walnut Creek, CA 94596 (92.5) 979-1739 N Fax:(925) 279-4334 OQQQ Damage Assessed By BRUCE HUBERT Appraised For: Linda Palmer U m Condition Code: Type of Loss: Collision Date of Loss: 1/14/2006 Arrival Date: 0 Final to Owner: W Payer: insurance Claim Paid: W Policy No: Claim Number: A092C2182701 V Deductible: WAIVED UJ File Number: P Owner: OMID AND CHERIE CRA MOKRI Insured: OMID AND CHERIE CRA MOKRI Claimanc: Address: 2562 BUENA VISTA AVE WALNUT CREEK, CA 94597-0000 Telephone: Work Phone:(510) 981-4049Home Phone:(925) 933-5788 Mitchell Service: 911368 Description 2000 Volkswagen New Beetle GLS Vehicle Producti0n Dare: / Body Style: 2D HB Drive Train: 2.OL in! 4 Cyl 4A FWD VIN: 3VWCC21CXYM420301 License: XLOVER CA Mileage: 0 OEM/ALT: A Search Code: C94596 Color: SILVER Options: Alum/Alloy Wheels,Air conditioning,Power Steering,FOWer windows,POwer Door Locks,Tilt steering Wheel,Crulse Control,ElectriC Defogger,Automatic Transmissior.,AM-FM Stereo/CDPlayer(Single) "SPECIAL PARTS NOTE: ALL CRASH PARTS ON THIS ESTIMATE ARE "NEW" PARTS (OEM) UNLESS OTHERWISE SPECIFIED. PARTS D-ESCRIBED AS RECHROMED, RECORED, OR REMANUFACTURED ARE EITHER "RECONDITIONED" PARTS OR ESTIMATE RECALL NUMBER: 1/31/2006 12:41:05 A092C2182701 U1traMate is a Trademark of Mitchell International Mitchell Data Version: JAN_06_V Copyright (C) 1994 - 2003 Mitchell International Page 1 of 5 U1traMate Version: 5.0.214 All Rights Reserved Date: 1/31/2006 12:42:19 pm Estimate ID: A092C2182701 Estimate Version: 1 Supplement: 1 (P) 1/31/2006 12:42:09 PM Profile ID: CSAR EUROPEAN "REBUILT" PARTS. CRASH PARTS DESCRIBED AS "QUALITY REPLACEMENT PARTS" ARE NON-ORIGINAL EQUIPMENT MANUFACTURER AFTERMARKET PARTS.- Line Entry Labor Line Item Part Type/ Dollar Labor CFG Item Number Type Op Description Part Number Amount Units Unit 1 104462 BDY REMOVE/REPLACE L REAR MARKER LAMP ASSEMBLY ICO 945 073 B 10.13 INC k0.2T 2 900500 REF' REMOVE/REPLACE FLET( ADDITIVE 1'Qual Repl Part 7.00 ' 0.01 T 3 101308 BDY OVER AUL REAR COVER ASSY 3.8 k3.3 4 101926 BDY REPAIR REAR BUMPER COVER Existing 1.0'x43.8 5 AUTO AEF REFINISH REAR BUMPER COVER C 2.3 2.3 6 AUTO RFF ADD'I, OPR CLEAR COAT 0.9 7 933003 REF ADD'L OPA TINT COLOR 0.51 8 AUTO ADD'L COST PAINT/MATERIALS 99.90 ' T 9 AUTO ADD'L COST HAZARDOUS WASTE. DISPOSAL 0.93 1 ' - Judgement Item d - Labor Note Applies C - included in Clear Coat Calc Recycler Information Section: Prior Damage Remarks PRELIMINARY ESTIMATE 1f CUSTOMER WISHES TO CASH SETTLE 11 Add'l Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 4.8 60.00 0.00 0.00 288.00 Taxable Parts 17.13 Bdy-S 0.0 60.00 0.00 0.00 0.00 Parts Adjustments 0.00 Retinish 3.7 60.00 G.00 0.00 222.00 Glass 0.0 60.00 0.00 0.00 0.00 Glass Adjustments @ 0.000 0.00 Mechanical 0.0 60.00 0.00 0.00 0.00 Sales Tax @ 8.250 1.41 Frame 0.0 60.00 0.00 0.00 0.00 @ 8.250 0.00 ESTIMATE RECALL NUMBER.: 1/31/2006 12:41:05 A092C2182701 U1traMate is a Trademark of Mitchell International Mitchell Data Version: JAN_06_V Cnpyr.ig ht (C) 1994 - 2003 Mitchell. International Page 2 of 5 UltraMate Version: 5.0.214 All Rights Reserved Date: 1/31/2006 12:42:19 pm Estimate ID: A092C21_82701 Estimate Version: l Supplement: 1 (P) 1/31/2006 12:42:09 PM Profile ID: CSAA EUROPEAN Taxable labor Aon-Taxab_e Parts Parts Adjustments 0.00 Labor Tax @ 0.000 0.00 Non-Taxahle Labor Non-Taxable Laborbl O.nO Glass Adjustments @ 0.000 0.01) .Labor Summary 3.5 510.00 Total Replacement Par:.s Amount 18.54 III. Additional Costs IV. Adjustments Amount Taxable Costs 99.90 Insurance Deductible WAIVED Gatterment 0.00 sales Tax @ 8.250 0.2.1 A.ppearancp Allowance 0.00 Related Prior Damage 0.00 . Custcmer Responsibility 0.00 Aon-Taxable Costs 0.93 TO:al Add_tional Costs 109.07 I. Total Labor: 510.nO II. Total Replacement Parts: 18.54 III. Total Additional Costs: 109.07 Gross Total: 637.61 IV. Tota'_ Adjustments: 0.00 Net Total: 637.61 Less Original Net Total: 0.00 Net Supplement Amount: 637.61 SI: LRUCE HUBERT 637.61 Related Prior Damage Labor Subtotals Units Rate 70tals RL-Body 0.0 60.00 0.00 RL-Refinish 0.0 60.00 O.n0 RL Taxable LaL•Or 0.00 GST - E Tax @ 0.000 0.00 Labor Tax @ 0.000 0.00 Labor Tax 0.00 RL-Non-Taxable :,abor 0.00 Related Prior Damage Labor Summary 0.0 0.00 ESTIMATE RECALL NUMBER.: 1/31/2006 12:41:05 A092C2182701 UitraMate is a Trademark of Mitchell Interna=ional Mitchell Data Version: JAN 06 v Copyright. (C) 1994 - 2003 Mitchell. International Page 3 of 5 UltraMate Version: 5.0.214 All Rights Reserved r Date: 1/3=/2006 12:42:19 pn Estimate ID: A092C2182701 Rsti:nate Version: 1 Supplement: 1 (P) 1/31/2005 12:42:09 PH. Profile ID: CSAA EUROPEAN Part Replacement Summary Amount RL-Taxable Parts 0.00 GST - E Tax @ 0.000 0.00 Sales Tax @ 8.250 0.00 Sales Tax @ 8.250 0.00 RL-Non-Taxable Parts 0.0.0 R lated Prior Damage Parts SumTary 0.00 R@_ated Prior-Total Labor: 0.00 Related Prio--Total Replacement Parts: 0.00 Related Prior-Camage Total: 0.O0 Unrelated Prirr Damage Lab:)r Subtotals Units Rate Totals UN-Body 0.0 00.00 0.00 UN-Refinish 0.0 60.00 0.00 UN-Taxable Lator 0.00 GST - E Tax @ 0.000 0.00 Labor Tax @ 0.00n 0.00 Labor Tax @ 0.000 0.00 UN-!Jon-Taxable Labor 0.00 Unrelated Prior Danage Labor Surmary 0.0 0.00 Part Replacement Summary Amount UN-Taxable Parts 0.00 GST - E Tax @ 0.000 0.00 sales Tax @ 8.250 0.00 Sales Tax @ 8.250 0.00 UN-Ilon-Taxable Parts 0.00 Unrelated Prior Damage Parts Summary 0.00 ESTIMATE RECALL NUMBER: 1/31/2006 12:=1:05 A092C2182701 Ultr-Mace is a Trademark of Mitchell Interna-ions_ Mitchell Data Version: JAN 05 V Cnpyright (C) 1994 - 2003 74itchell. Tnternazional. Page 4 of 5 U1traMate Version: 5.0.21-4 A11 Rights Reserved 1 Date: 1/31/2006 12:42:19 pn Estimate ID: A092C2162701 Estimate Version: 1 Supplement: 1 (P) 1/31/2006 12:42:09 1114 Profild ID: CSAA EUROPEAN Unrelated Pricr-Total Labor: 0.013 Unrelated Prior-Tota] R=placement Parts: 0.00 Unrelated Prior-Danage Total: 0.00* * Tot'al does not include overlap or labor adjustments THIS ESTIMATE HAS BEEN PF.-.PARED RASED ON THF USE OF CRASH PARTS SUPPT,TFD BY A. SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES APPLICABLE TO THESE RE'11LACEMEN.' PARTS AHE -'RCVIDED BY THE MANUFACTURER. OR DISTRIBUTOR OF THE PARTS, RATHER TI[API BY THE CRIGITJA:. MANUFACTURER OF YOUR VEHIC!.E. Point(s) cf Impact Insurance Cc: CSAA-DRN Address: 'telephone: Fax Phone: Bcdy Shop: Mike F.ose-N. Main-Walnu- Creek --nsp?:tion site: TJone Address: 2288 N. Main Address: Wainit Creek, CA 94596 Telephone: Inspection Date: (925) 937-4776 :ax Phone: (925) 279-4334 State Lic. No: Company Code: Drop Off Date: Repair Dates: Promise Date: SLarCate: Pick JP Date: Completion: Date: Is Vehicle Driveable ('1/N)?: Assisted With Rental ;Y/N)?: ESTIMATE RECALL NUMBER: 1/31/2006 12:41:05 A092C2182701 U1traMate is a Trademark of Mitchell International Mitchell Data Version: JAN_06_V rnPyr.icht (C) 1994 - 2.103 Mitchell Internat.iona.l Page 5 of 5 U1traMate 'Version: 5.0.214 All Rights Reserved .... .,. x . x x r. x �Y Al ROOM ..... mv "lit . ... .. Pv. max. ... . . ... .. � ... ��.a: .. �.. .... .. ..„ ri 6.. n y n. .G y.. E Y ... .:.. ...:..n•',ex..... ..: .,.: :; x.... �„'_`�.,��` .4:�,° °dew �'X�. K. F� ,,.• w Y•. x n^< :ts` x , axJ 'x $$�w CW Rawx xA..... ..::.fit ..n::x•' -;....a..... ....... .. '�,:;d"F NlSli�ZRIIQ I 'M q _ E 1 e� w pp sR 00 u., x... . " a Son i. n , (y a W �3. :,.... .. r. e.. Al ..<. .. x . r. .; w < 6.. my.. • a i; " < r q„ :i� i_Sx`° m 'sg• ��Y°:. 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