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HomeMy WebLinkAboutMINUTES - 05232006 - C.23 CLAI1C BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: MAY 23, 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 California Government Codes. ) you is your notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), (I ice!9 given Pursuant to Government Code AMOUNT: $304.71 APR 19 2006 Section 913 and 915.4.Please note all COUNTY COUNSEL "Warnings". CLAIMANT: CAROL A. HEATH MARTINEZ CALIF. ATTORNEY: UNKNOWN DATE RECEIVED: APRIL 19, 2006 ADDRESS: 2047 NORSE DRIVE, #72 BY DELIVERY TO CLERK ON:APRIL 19, 2006 PLEASANT HILL, CA 94523 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim JOHN CULLEN,C eyO Dated: APRIL 19, 2006 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of 5upervisors ( 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). O Other: 'L Dated: By: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel(1) County Administrator(2) O 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. O Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. DatedJOHN CULLEN,CLERK,By Deputy Clerk WARNI (Gov. code section 913) Subject to certaut 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 attolitey,you should do so unmediately. *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 IS; 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' -944 _ JOHN CULLEN,CLERK By Deputy Clerk This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or Injunction,or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must. be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act 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 wime 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. ago aEno NoonsoresetrrrrerEcrI RE: Claim By. Reserved for Clerk's filing stamp eOL A RECEIVED Against the County of Contra Costa or ) APR 1 0 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$ �J©`� L and in support of this claim represents as follows: 1. When 'd th damage or injury occur? (Give exact date and hour) / 2. Where did the damage or injury occur? (Include city and CoNC..a f2:D AVE., �o yds. L. a fc- a'eC4 1e 3. How did the damage or injury occur? (Give full details;use extT pr if required) 3c y 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? �r— C c- Y\,e \ G +'i ►,,� l�, }„ni t vt In r- >� S�u c 5 What are the names of county or district officers,servants,or employees causing-the damage or injury? VV.K Y� C-- Z0'd TZVT 922 SZ6 1NBWOUNdW ASM 030 LS:60 90OZ-20-add £0'd ld101 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) 1r'►'m u -L Y- v +i f e YVA I-" C Eh c--�,. 7. How was the amount claimed above computed? (Include the estimated amount of any pro active 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 AMOUNT ■raaarsrrassasasaaasraasra ■raaasane ) .Gov.Code Sec. 910.2 provides"The claim shall be )signed by the claimant or by some person on his behalf- SEND-NOTICES ehalf"SENDNOTICES TO: (Attorney) 1 Name and address of Attorney ) ) (Claimant's Signature) (Address)/ / Telephone No. )Telephone No. rsarrrrrrrrraarrs■■....erre-arrrrrarrrurrrrrrarrrrrrr■■rrrrrrarrrrrarrarr.rrerrrarsu 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 Aat (Gov. Code, 55 6500 et seq.) Furthermore, any attachments,addendums,or supplements attached to the claim form,including medical records,are also subject to public disclosure. ■common goal assu■aaaaasss0oraassaaassaaasasssarssssrsasssaasaaaaaarrsarraroanaasaaall NOTICE: Section 72 of the Penal Code provides: Every person who,with intent to defraud,presents for allowance or for payment to any stats 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. £0'd TZVi S££ SZ6 1N3W9UNdW ASId DOD ZS:60 9002-£0-Ndu Customer Invoice FIRESTONE COMPLETE AUTO CARE Service Advisor: 066400 CONCORD 11 MIKE 04/04/2006 715 CONTRA COSTA BLVD 925.689.2710 CONCORD, CA. 94523 HEATH, CAROL 2000 VOLKSWAGEN NEW BEETLE GL [YELLOW] 2047 NORSE DR Mc#: 4HHR926 CA Vin#: PLEASANT HILL, CA 94523 In: 04/03/06 4:49PM Mileage: 38,271 925.687.4717 Or 925.687.4717 Out: 04/04/06 7:42PM Store#029734 RETAIL SALE REG#AG222602, EPA#CAD981999824 Article Unit Extended Job Description Number ID Qty Price Price Total HOUSE TIRE PACKAGE 11 217.49 096008 LEMANS SR BL P205/55R16 89T 55,000 Mile 096008 05 1 79.99 79.99 Warranty DOT# W212LF20906 DISPOSAL FEE/CA RECYCLE FEE 7046655 05 1 1.75 1.75- NEW TIRE WHEEL BALANCE PARTS 7018708 05 1 3.99 3.99 NEW TIRE WHEEL BALANCE LABOR 7018716 05 1 7.00 7.00 RUBBER VALVE STEM 7015040 05 1 3.00 3.00 TIRE DISPOSAL FEE(1) 7075078 05 1 3.00 3.00 TIRE INSTALLATION 7015016 05 1 N/C N/C 7017868 BLACK STEEL WHEEL 16 IN 7017868 05 1 118.76 118.76 ALIGNMENT SERVICE 11 69.99 Symptom:- 05 ALIGNMENT SERVICE 7004578 05 1 69.99 69.99 Road test vehicle before servicing 05 Inspect steering and suspension system including tire 05 condition and air pressure Put vehicle on alignment rack, mount and compensate 05 sensors, and print out the initial alignment readings Align all four wheels, if applicable, using adjustments 05 provided by manufacturer, to manufacturer's specification Print out final alignment readings to verify alignment is 05 within specifications Road test vehicle after completing the alignment 05 - INSPECTION FROM PRIOR INSPECTION VEHICLE NOTES [Inflations vary according to load.Always refer to vehicle placard for half and maximum load.] Technician(s): 05 ISRAEL CONDE Payment History: Summary: MasterCard 7373 304.71 940252 Parts 205.74 Total Tendered 304.71 Labor 81.74 Shop Supplies 0.00 Sub-Total 287.48 Tax(8.25%) 17.23 Total $304.71 1 have received the above goods and/or services. If this is a credit card purchase, I agree to pay and comply with my cardholder agreement with the issuer. Customer Signature Initial here to indicate you have received the Tire Maintenance Warranty Book. All parts are new unless otherwise specified. 13_1 _f") See reverse side for Warrantv Information caCONCORD-RRESTONEz, u01113u AOjul Aj"EJPft1f4 ep aIWa aaS Concord, CA 94520 (925)689-2710 Name Address Telephone Vehicle (VIN) License Technician NBleage Time Printed 4/4/06 6:16 PM Volkswagen : Beetle (Including Type 1/Super Beetle) : 1998-2004 : except Convertible : Standard Suspension (1GB 1GJ G16 G18 G60 G64) Front : Left Front : Right Actual Before Specified Range Actual Before Specified Range -0.5" -1.0'0.0' Camber -0.81 -0.7' -1.0' 0.00 7 3 7.3- 7.2' 8.2' Caster 6.9' 6.9' 7.2' 8.2' 0.021 0.10' -0.08'0.08' Toe 0.06" -0.62' -0.08' 0.08' 16.1' 16.2' SAI 14.3' 14.2' 14.6' 14.6' Included Angle 13.6' 13.6' -1.83'-1.17' Turning Angle Diff. -1.83' -1.17' Front Actual Before Specified Range Cross Camber 0.3' 0.2' -0.5-0.6- Cross 0.6'0.6'Cross Caster 0.3' 0.3` -0.510.51 Total Toe 0.09, -0.42' -0.17' Rear: Left Rear: Right Actual Before Specified Range Actual Before Specified Range -1.0' -1.0' -1.6'-1.3' Camber -1.7' -1.7' -1.60 -1.3- 0.09, 1.6' -1.3'0.09' 0.09 -0.171 0.60' Toe 0.39' 0.37' -0.17' 0.50' Rear Actual Before Specified�RangeTotal Toe 0..48' 0.46' 0.17'0Thrust Angle -0.15" -0.14' -0.33' 0 ��I � I �� 'W a J' .i� �9 � - - .. — (}� •��� IUt ,�Pq r c. 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REQUESTED DISP TO CA LL POT HOLE HOTLINE! /1032 *CLOSE /1628 REOPEN (3128) /1629 HOLD /1631 SUPP HAVE RECIEVED NUMEROUS ADDITIONAL CALLS ABOUT THE POT HOLE, ONE FLAT TIRE (VIA PHILL PD) AND ANOTHER WHO LOST HIS HIBCAP AFTER DRIVER THROUGHT IT. . .R EC RE-ASSESMENT TO SEE IF IT HAS GOTTEN WORSE. . . . /1643 SUPP (3075) TWO MORE CALLERS. . .ONE OF WHICH SAYS HER TIRE AND RIM GOT STUC K IN THE POT HOLE AND SHE HAD TO CALL A TOW TO GET HER OUT. . .SHE DOESNT NEED OR SEEM TO WANT A RPT, JUST WANTS TO LET US KNOW ABOUT THE POT HOLE /1644 DISP K20 #0469 TONY KILLION /1644 *ENRTE K20 /1648 *INQ LIC,K20, /1649 *INQ LIC,K20,: /1653 MISC (3062) K20 , IB CONC AV, 5X3 ' 6" DEEP, SEVERAL FLAT TIRES /1701 ASSTV SEW @ CONCORD AV/DIAMOND B CHUCK CHIN ADV'D, HE IS GOING TO VERIFY LOCATION AND THEN IF OURS, WILL BE 49 /1703 INQ CAR,K20, /1703 INQ CAR,K20,. /1703 INQ CAR,K20,: /1703 INQ CAR,K20,4HHR926, , , , , /1704 MISC (3075) K20 , /1704 MISC (3075) K20 , 4/01/06 TIME: 17:04REG VALID FROM: 09/08/05 TO 09/08/06L IC#:4HHR926 YRMD: 00 MAKE:VOLK BTM :CP VIN :3VWBC21C6YM400364R/O :HEATH CAROL A, 2047 NORSE DR 72 CITY:PLEASANT HILL C,C. :07ZIP#:94523 /1708 *ONSCNE K20 /1710 ASSTV X20 #0466 MELANIE DAGGS @ CONCORD AV/DIAMOND B /1712 *MISC K20 , LAST FOUR PLATES ENTERED WERE INBOUND FM POTHOLE W FLAT TIRE & BODY SMG. ALL DRIVERS ASKED ABOUT REMIB FOR DMGS /1726 *CT:SCNE X20 '/1732 *INSERV K20 /1737 *MISC X20 , THE POT HOLE IS IN PLEASANT HILL /1756 ASSTOS W5 #0187 PAUL JENNY 3038 @ CONCORD AV/DIAMOND B /1759 MISC (3062) W5 , NOT IN THE CITY LIMITS OF CONCORD - REFER TO TO COUNTY ST REETS. VERY TEMP PATCH IN PLACE /1802 *CLEAR X20 NAT , OUTSIDE AGENCY ASSIST. POTHOLE FIXED BY CITY CREW. /1803 *INSERV W5 /2013 CLEAR (3075) SEW NAT /2013 CLOSE a � 6 � �' � � ��+�"a•�a � '� •.4� �.� � a 1s spa .°r�'� Toy KlY `��" 'H� ���.H�",qq"�,y�:.m.� F! + � ^",IH'�, '��a-,g`a,�"�`§�4 " „� '��.,.� �� �, 111�e ^� ���..•y �� t oS M� Ins zoo z �x� s x xH �w ��• m H ;: h ,•" g "ala � ���:� �rY � ...�`:� � ? ° .�� �' �' s. y:.. ` ,-_. _ .. �' z r n ire g " �:�'vu'`e,� �"�k!�4 �w�"w. ��'������",u''vv° �,� x5 °��`�c d��r+� � - e= -a. s _ ✓w•n � If NIA yu loll CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: MAY 23, 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 California Government Codes. ) you is your notice of the action taken on your claim by the Board of LyC� Supervisors. (Paragraph IV below), APR 19 2006 given Pursuant to Government Code AMOUNT: $354.66 Section 913 and 915.4.Please note all COUNTY COUNSEL "Warnings". CLAIMANT: ERIC SJOBERG MARTINEZ CALIF. ATTORNEY: UNKNOWN DATE RECEIVED: APRIL 19, 20066 ADDRESS: 2931 BIDWELL COURT BY DELIVERY TO CLERK ON: APRIL 19, 2006 FAIRFIELD, CA 94534 BY MAIL POSTMARKED: APRIL 18, 2006 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. APRIL 19, 2006 JOHN CULLEN, 1 Dated: By: Deputy II. FROM: County Counsel TO: Clerk of the Board of SlIplervisors (04 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). O Other: Dated: a7 OCo By: �I'76ic 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). This RD ORDER: By unanimous vote of the Supervisors present: Claim is rejected in full. O Other:' I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated://4V146,-�W JOHN CULLEN,CLERK,By [- Deputy Clerk WARN (Gov.code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited ur the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of all attorney of your choice in connection with this matter.If you want to consult arr attorney,you should do so immediately. Tor Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING 1 declare larder 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 l deposited in the United States Postal Service in Nlartinez,California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant,addressed to the claimant as shown above. Dated: — JOHN CULLEN, CLERK By Deputy Clerk BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CL.UnAN1 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 § 911.1) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Adn,irristration 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 fraudtalent claims,Penal Code Sec. 72 at the end of this form. ■■aa/1sARls■sRER1'Raa■ta ■aRREMNa was■s RSVSELtttt■1sRaaaIts■aseepatBEEN its OVER REaBENI RE: Claim By. Reserved for Clerk's filing stamp Against the County of Contra Costa or ) APR 1 9 2006 knmAt m District) 111 in the name) ) CLERK BOARD CO TRAOCOSTA CO.+SORS T WS F� � fl The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ L and in support of this claim represents as follows: 1. When did the damage or injury occur? {Give exact date and Hour) ��i�/off, [�'o� 1�1"i• 1 2. Where did the damage or injury occur? (Include city and county) PC 19`(flc * 5aN Paco gVE I A1614twP f U- CotuT4-C-05TA 3. How did the damage or injury occur? (Give full details;use extra paper if required) 4. What particular act or omission on the pint of county or district officers, servants, or employees caused the injury or damage? M Klvb of POTROL c- N 5 What are the names of county or district officers,servants, or employees causing the damage or injury? 6. What dainage or injuries do your claim resulted? (Give full extcllt of injuries or damages clauned. Attach two estimates for auto damage.) DA-MA(-c-7 'T o �ChV �_E FT QaAW(( PJNEL AQ 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage,) boat 500 C-5TIMI�I G 8. Names and addresses of witnesses,doctors, and hospitals: 9. List the expenditures you made on account of this accident or injury: DATE Ms AMOUNT a u s u asasasaaaasssa*assaaealsaaaassaaa*111111*assoesa*aaasessaasata*aa►atastaaas*saasame .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 s ignature) (Address) Telephone No. }Telephone No. 2()7 ' a■sslam ssssstasssasaasaIla asIsnot su w ash,■tasaasaasas■taaaaaasasasasasaasaasusesassas 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,) Pu thermore, any attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure, agown ssa■sasass■Dasssun.a asss*sassasasas*ssgingiva s*s■1111111111***asrrsessssasNils as On*Fall NOTICE: Section i2 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,%Thing, is punishable either by imprisonment in the County jail for a Period of not more than one year, by a fine of not mcceding 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 botli such imprisonment and fine: 0.4/17/2006 at 10 : 37 AM Job N 91792 AMERICAN AUTO BODY SPECIALISTS, INC. billl License # :AJ223846 American Autobody Specialist, Inc 1950 Walters Court It q1 ' a Fairfield, CA 94533 "4 c (707) 427-3463 Fax: (707) 434-9773 0 PRELIMINARY ESTIMATE . Written By: CINDY SAWYER w w � Adjuster: ° A Insured: ERIC SJOBERG Claim # w w Owner: ERIC SJOBERG ' Policy # Address: 2931 BIDWELL COURT Deductible: FAIRFIELD, CA 94534 Date of Loss: Day: (707) 422-6077 Type of Loss: Business: (707) 344-1752 Point of Impact: 8 . Left Qtr Post Inspect AMERICAN AUTO BODY SPECIALISTS, Business: (707) 427-3463 Location: 1950 Walters Court Fairfield, CA 94533 Insurance Company: Days to Repair 2004 DODG RAM 1500 4X2 QUAD CAB 8-4 . 7L-FI 4D SHORT PW7 Int : VIN: 1D7HA18N845694426 Lic: 7T78385 CA. Prod Date: 04/2004 Odometer: Condition: Good Air Conditioning Tilt Wheel Intermittent Wipers Dual Mirrors Clear Coat Paint Power Steering Power Brakes AM Radio FM Radio Stereo Anti-Lock Brakes (2) Driver Air Bag Passenger Air Bag 4 Wheel Disc Brakes Split Bench Seats Rear Step Bumper 5 Speed Transmission Overdrive Styled Steel Wheels ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1 PICK UP BOX 2* Rpr LT Outer panel 0 . 5 0 . 0 3# RUB & POLISH SCUFFS 1 Incl . 4 WHEELS 5 R&I LT/Rear R&I wheel m 0 . 1 6# MOUNT & BALANCE 1 25.00 7# CHECK FOR TRUE 1 Incl . Incl . 8** Repl RECOND LT/Rear Wheel, alloy 1 165 . 00 m 0 . 3 WF3 94 ** SEND OUT FOR REPAIR ** 1 10# Subl Four Wheel Alignment 1 79. 95 ------------------------------------------------------------------------------- Subtotals =_> 269. 95 0 . 9 0 . 0 1 04/17/2006 at 10 : 37 AM Job Number: 91792 PRELIMINARY ESTIMATE 2004 DODG RAM 1500 4X2 QUAD CAB 8-4 . 7L-FI 4D SHORT PW7 Int: Parts 269 . 95 Body Labor 0 . 9 hrs @ $ 72 . 00/hr 64 . 80 ---------------------------------------------------- SUBTOTAL $ 334 . 75 Sales Tax $ 269. 95 @ 7 . 37500 19 . 91 ---------------------------------------------------- GRAND TOTAL $ 354 . 66 ADJUSTMENTS : Deductible 0 . 00 ------------------------------------------------ CUSTOMER PAY $ 0 . 00 INSURANCE PAY $ 354 . 66 FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS .FORM: ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR ABBREVIATIONS/S_YMBOLS : D=DISCONTINUED PART A=APPROXIMATE .PRICE LABOR TYPES : 4 B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS : ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT W/ =WITH/; SYMBOLS : #--MANUAL LINE ENTRY %=OTHER [IE. .MOTORS DATABASE INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. MQVP=MANUFACTURER'S QUALIFICATION AND VALIDATION PROGRAM. 2 0-4/17/2006 at 10 : 37 AM Job Number: 91792 PRELIMINARY ESTIMATE 2004 DODG RAM 1500 4X2 QUAD CAB 8-4 . 7L-FI 4D SHORT PW7 Int: Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide DR3TA02 Database Date 03/2006, CCC Data Date 03/2006, and the parts selected are OEM-parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM parts are OEM parts that are provided by or through alternate sources other than the OE/Vehicle dealerships. OPT OEM parts may reflect some specific, special, or unique pricing or discount. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign (-) items indicate MOTOR Not-Included Labor operations. Non-Original Equipment Manufacturer aftermarket parts are described as AM, Qual Repl Parts or Comp Repl Parts which stands for Competitive Replacement Parts. Used parts are described as LKQ, Qual Recy Parts, ROY, or USED. Reconditioned parts are described as Recon. Recered parts are described as Recore. NAGS Part Numbers and Prices are provided by National Auto Glass Specifications, Inc. Pound sign (A) items indicate manual entries. CCC Pathways - A product of CCC Information Services Inc. 3 p "ContraCounty Administrator- Ri3M5 eon Costa ti0old DrieSuite--140' Liability Claims (925).335-1440 Martirez,California,94$53..; :- Fax Number (925) 335-1421 rF Co u- my aG April 06, 2006 `# Eric Sjoberg 2931 Bidwell CT. Fairfield, CA'94534 Re:` Claimant: Eric Sjoberg Insured: Contra Costa County D/Accident: 03/15/2006 Claim No.: 60359 Dear Mr. Sjoberg: The captioned matter has been referred to.my office for investigation and handling t on behalf of the Contra Costa County Department'of Sheriff/Coroner. Lhave enclosed a claim form that must.be completed in order to file a formal claim.., against the County. Be advised^that youhave six months from the accident-date to file a formal claim as stated in the California Government Code beginning with Section 900. This also notifies you that you must comply with the claims presentation and timely suit filing requirements of California law in order to preserve your claim. Our investigation :of your claim does not ariect your duty to comply with time limits set by law, and by investigating, considering, and discussing your claim with you or your representative, we do not waive our right to assert your failure to comply with those time limits as a complete defense to any claim or action you may bring. Should you have any questions,please do not hesitate to contact the undersigned. Sincerely, Penny Bailey Liability Claims Adjuster 925-335-1455 d � Q r 17,O p a� i 4 cl ll� 1. ril Gp a,;:i k F'•, A t S /l 7f • CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: MAY 23, 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 California Government Codes. ) you is your notice of the action taken on your claim by the Board of Supervisors.(Paragraph IV below given Pursuant to Government Code APR 2 1 2006 `()A') Section 913 and 915.4.Please note all AMOUNT: UNKNOWN "Warnings". COUNTY COUNSEL CLAIMANT: MARIA COMES MARTINEZ CALIF. ATTORNEY: UNKNOWN DATE RECEIVED: APRIL 21, 2006 1755 TREE VALLEY BLVD., APRIL 21 2006 ADDRESS: WALNUT CREEK, CA 94595 BY DELIVERY TO CLERK ON: BY MAIL POSTMARKED: APRIL 20, 2006 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. APRIL 21, 2006 JOHN CULLEN, 96� Dated: By: Deputy I1. FROM: County Counsel TO: Clerk of the Board of Su ervisors ( 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). O Other: Dated: /�(�� By:,--w lX/t- Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel(1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3)._ 1V.,$OARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. O Other: 1 certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. pp�I__ Dated:/r lbt � 'C���! JOHN CULLEN,CLERK,By Deputy Clerk WARNl (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 1 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 ill 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 _ JOHN 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 945 53. 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. ■1■so MR 1 UK 1 an 1 a 1 1 1■1!■■1 now a an i all 1 1 1 am 1 1 1 1 1 1 1 1 1 1 1 am C Q am C C an 1 1 an a A 1 1 1 1 1 1!1 1 1 1 1 t I RE: Claim By: Reserved for Clerk's filing stamp RECEIVED Against the County of Contra Costa or " ) APR 2 1 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 L-ijury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full details;use extra 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? 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.) A)A,&& LvZr-lis L'du Cif n P4- ), 1 ��etiJ a� a CC�rS be ne e a -- a_�f >, 4- a.-4 Sc . 7. How was the amount claimed above computed? (Include the estimated" amount of any prospective injury or damage.) A-kA .2,Aa_^jz e( a re ai �re� , '��ie- Gil �)vo S. Names and addresses of witnesses,doctors, and hospitals: 9. List the expenditures you made on account of this accident or injury: DATE ME AMOUNT SLg ",o Ati h 4V ,ga t/ `f f p(moi So tiL(`,J 4v pie pick t p -hYCif h�i�2-L(1GtyX (/ ■a[ssasssssssataa[[aasalaaa\[aasaa[a■sea:■as■■assasssasass[asaatassssasaastsesasl ) .Gov.Code Sec. 910.2 provides"The claim shall be ) signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney) 1 Name and address of Attorney ) 71 ( aimant's Signature) j /7.55' `77ce- (Address) Wa re Or-e_a<, Telephone No. )Telephone leo. s■UZZENERKMIRMEN son NUNN It a m a Munn a MENEM t■■■ata■t t a a s■[a■a s a■1■[[[[[[t t[[[[[was NEWOMENKI 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. ■ansa[[[[[[[[[assump mass■ ■MEN■sass■u■■s■as[[[aassass■sssssssa a ussss a ssaas[assas[1 NOTICE: Section 712 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 file 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. DESCRIPTION RITE-WAY WIRE & WHEEL SPECIALISTS 1119 Alpine Road +. WALNUT CREEK,CALIFORNIA 94596 (925)933.4046 DATE N E _._.. ADDRESS 12875 CITY PHONE DATE OF ORIGINAL INSTALLATION r MAKE O L. ❑ ESTIMATE I SERIAL NO. DATE PROMISED ❑ WARRANTY CONT ACT NATURE OF SERVICE ............... .._...... .......... .-...-._ ...-...-...-.ti..........,........... ............ ......... ............ .................. ...... ............. ...._... ............... .................... ........ • g:......................................----_--- ..... ........ ..-... ... ___ ..../..... ...._�._... ' ................................................. ... ............... -............. -. .-....................... _ ...........1.............................. .........................................................................................................................................«.................................................................. ,.....,.. TOTAL MATERIALS TECHNICAL SERVICE TIME: ❑ SHOP ❑ HOME ❑ PICK UP OR DELIVER ❑SERVICE CALL CHARGE TECHNICIAN DATE COMPLETED TAX CASH OON COM FWORKLETION TOTAL TOTAL MATERIALS SIGNATURE Guaranty on other SICIe Signature above constitutes acceptance of above work as being ' satisfactory and that equipment has been left in good condition COPY THANKYOU CLAIM n BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 1, BOARD ACTION: MAY 23, 2006 Claim Against the Coun(y,or District Governed by ) the Board of Supervisors,Routing'Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section re �°e@ H%f f j�' The copy of this document mailed to California Government Codes. !� l/ L you is your notice of the action taken APR 2 1 2006 on your claim by the Board of Supervisors.(Paragraph IV below), COUNTY COUNSEL given Pursuant to Government Code MARTINEZ CALIF. Section 913 and 915.4:Please note all AMOUNT: PENDING SUBROGATION DEMAND "Warnings". 21st CENTURY INSURANCE CLAIMANT: FOR: ERNESTO MARCELO BY: STEPHEN HELLIWEL.L APRIL 21, 2006 ATTORNEY: UNKNOWN DATE RECEIVED: ADDRESS: P.O. BOX 4397 BY DELIVERY TO CLERK ON: APRIL 21, 2006 WOODLAND HILLS, CA 91365 BY MAIL POSTMARKED: APRIL 20, 2006, FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, e Dated: APRIL 21, 2006 By: Deputy T FROM: County Counsel TO: Clerk of the Board of Su ervisors (,y"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). O Other: Dated: By: m BLS Deputy County Counsel Ili. FROM: Clerk of the Board TO: County Counsel(1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 9113)._ IV. BOARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. O Other`._. I certify that this,is a true and correct copy of the Board's Order entered in its minutes for thins/date. Dated: 0 � �D OHN CULLEN,CLERK,By Deputy Clerk WARNIN (Gov. code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personally sewed 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 shotdd do so immediately. *For Additional Warning See Reverse Side of Tfhis 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-mid Notice to Claimant,addressed to the claimant as shown above. Dated: JOHN CULLEN,CLERK By Deputy Clerk It);4b LLL k 1 bK I'IHNHIaPItN I E 7GJ .53J 14G1�' r BOARD OF SUPERVISORS OF CONTRA UOS.t-A UUUiN i r r7.10-1 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 bow-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 nauze 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. ■■afaaasaaaaamagmas aa■aaaaaaaaasaassaaaNang aaaaaurRaaaaarasaaaQar RE: Claim By: Reserved for Clerk's filing stamp F-V n�_M av'c.0- I C) RECEIVED Against the County of Contra Cos or ) APR 2 12006 District} CLERK BOARD OF SUPERVISORS (Fill mi the name) } CONTRA COSTA CO. The undersigned claimant hereby makes clairrn against the County of Contra Costa or the above-named district in the sum of$ e.,,- and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 3 � fzDo6 7: �5pn� . 2. Where did the damage or mJ ury occur? (Include city and county) S- Ke. LAV1,r c.,ov-Pov-&4tA A-la„ o, c,n+y-d 3. How dial the damage or in�j"ur,, occur? (Give full details;use extra aper if required) CICPLA+t/ Capw-1 e, -a4v�c4.✓S W4,4 JiVlr►p th �/�0/�AAAA� 1911 04 SSG.. ZZ 3 50 VC, ' Wksft,fe- 6� �✓ C0Kd1+t*a" ghCL rew✓-ej,.�J Frh" /"ldrmlta I,. ajixa wws s4eppe-d- 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? n • �G v v4 irh-e ` . 2-2-3 5 0 Vz:.�, 5 What are the names of county or district officers,servants,or employees causing the damage or injury? CitOr\l- 'e s PINK—G7—�bbb V b v 4'( 1 1 1 K 1 bK I'IHNFIUI'ItN 1 6. What damage-,or in}uries do your claim resulted? (Give full extent of ii�lcries or damages claimed. Attach two estimates for auto damage.) Se-e, 04 "+c - A P,ra =3 8,215. D le.+��--o. 7. How was the amount claimed above computed? L (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 fiLMOUNT t E N D 1 C S L)6K6 6ATZON OW,4�AA-M 0 a R l R a a s f a/E l l R a a a a a a E a a a a R!!a!a a a a a a a a f a t a a a a a a a a o a f a a■....■a■■a f a a e a a a l a f a s a awn"will ) .Gov. Code Sec. 910.2 provides"The claim shall be )signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney) 1 Name and address of Attorney ) (Claimant's Signature) } PO. fox Lt3R7 (Address) ;woad (ar.d Its CA 81365 Telephone No. )Telephone No. 5 4 ' L L-- I*A 3 8 5 31 asasarssaRaasRtaas%suaafastsaaaasaasaaaaaaaa2saaaaasaREsa.Eaaa4aisa19aa9aasaaaaaa2aa91 n 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. aafaaaaaasasaasaaasaaass■s.assaa.sasatala■aasaassass■ss•ataaasasaataasaafaus9assuaaas$ 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. s TOTAL P.03 Estimate Screen Page 1 of 10 Estimate Data for Loss #0000385831 This data is current as of 04-20-2006 11:03:24 RefreshPnnt JOB NUMBER: 17908 MIKE ROSE'S AUTO BODY INC - FREMONT ST. LICENSE #:BAR# AA07562 FEDERAL ID #:942621349 WHERE QUALITY COUNTS 2001 FREMONT STREET CONCORD, CA 94520-2616 (925)686-1739 FAX: (925) 686-1744 ESTIMATE OF RECORD WRITTEN BY: BRENNAN ROSE 03/08/2006 03 :14 PM ADJUSTER: DRP UNIT (925) 688-4721 INSURED: ERNESTO MARCELO CLAIM #3308443 OWNER: ERNESTO MARCELO POLICY ##2435651 ADDRESS: 1470 CREEKSIDE DR 31 DEDUCTIBLE: $300.00 WALNUT CREEK, CA 94596-5580 DATE OF LOSS: 03/04/2006 AT 07:45 PM OTHER: (925) 935-8507 TYPE OF LOSS: COLLISION DAY: (925)705-0911 POINT OF IMPACT: 6. REAR INSPECT MIKE ROSE'S AUTO BODY INC - FREM BUSINESS: (925)686-1739 LOCATION: 2001 FREMONT STREET CONCORD, CA 94520-2616 INSURANCE 21ST CENTURY INSURANCE COMPANY BUSINESS: (925)688-4721 COMPANY: 1140 GALAXY WAY DAYS TO REPAIR SUITE #500 CONCORD, CA 94520 2003 HOND CIVIC LX 4-1.7L-FI 4D SED SILVER INT:GREY VIN: 2HGES16563H589565 LIC: 5GJY305 CA PROD DATE: 05/2003 ODOMETER: 38758 AIR CONDITIONING REAR DEFOGGER TILT WHEEL CRUISE .CONTROL INTERMITTENT WIPERS BODY SIDE MOLDINGS DUAL MIRRORS CLEAR COAT PAINT POWER STEERING POWER BRAKES POWER WINDOWS POWER LOCKS POWER MIRRORS AM RADIO FM RADIO STEREO SEARCH/SEEK CD PLAYER DRIVER AIR BAG PASSENGER AIR BAG CLOTH SEATS BUCKET SEATS RECLINE/LOUNGE SEATS AUTOMATIC TRANSMISSION OVERDRIVE ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1 REAR BUMPER 2 O/H BUMPER ASSY 0 0.00 1.5 0.0 3** REPL RECOND BUMPER COVER 1 192.00 INCL. 2.8 4 ADD FOR CLEAR COAT 0 0.00 0.0 1.1 5 REPL BUMPER COVER CAP 1 1.95 INCL. 0.0 http://dilprod.20thcentins.com/pageslestimate.cf-n?comparekey=3308443 4/20/2006 Estimate Screen Page 2 of 10 . 1 03/08/2006 AT 03:18 PM JOB NUMBER: 17908 ESTIMATE OF RECORD 2003 HOND CIVIC LX 4-1.7L-FI 4D SED SILVER INT:GREY -----=------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 6 REPL RT BUMPER COVER BRACKET 1 2.27 INCL. 0.0 7 REPL RT SPACER SIDE 1 4.55 INCL. 0.0 8 REPL RT SPACER UPPER USA BUILT 1 7.13 INCL. 0.0 9 REPL LT SPACER UPPER USA BUILT 1 4.32 INCL. 0.0 10 REPL LT SPACER GROMMET SIDE SPACER 1 1.63 INCL. 0.0 11 REPL ENERGY ABSORBER USA BUILT 1 54.70 INCL. 0.0 12 REPL IMPACT BAR _ 1 110.07 INCL. 0.8 13 ADD FOR CLEAR COAT 0 0.00 0.0 0.2 14 REPL NAMEPLATE LX HONDA 1 8.08 INCL. 0.0 15 REPL NAMEPLATE CIVIC 1 16.63 INCL. 0.0 16 REAR LAMPS 17 REPL RT TAIL LAMP ASSY USA BUILT 1 110.56 INCL. 0.0 18 REPL LT TAIL LAMP ASSY USA BUILT 1 110.56 INCL. 0.0 19 REPL RT TRUNK LAMP ASSY 1 99.52 INCL. 0.0 20 R&I LT TRUNK LAMP ASSY 0 0.00 INCL. 0.0 21 R&I RT LICENSE LAMP 0 0.00 INCL. 0.0 22 R&I LT LICENSE LAMP 0 0.00 INCL. 0.0 23 R&I HIGH MOUNT LAMP 0 0.00 INCL. 0.0 24 TRUNK LID 25 REPL TRUNK LID 1 341.06 1.5 2.1 26 OVERLAPMINORPANEL 0 0.00 0.0 -0.2 27 ADD FOR CLEAR COAT 0 0.00 0.0 0.8 28 ADD FOR UNDERSIDE(COMPLETE) 0 0.00 0.0 1.1 29 ADD FOR CLEAR COAT 0 0.00 0.0 0.2 30 REPL RT LOCK ROD 1 3.13 0.1 0.0 31 REPL CYL & KEYS GROMMET 1 L.53 0.0 0.0 32 j RPL BOTH HINGES 0 .0.00 1.0 0.0 33 REPL RT HINGE 1 42.12 INCL. 0.3 34 REPL LT HINGE 1 30.33 INCL. 0.3 35 R&I TRUNK LAMP 0 0.00 0.1 0.0 36 REPL EMBLEM 1 16.77 0.2 0.0 37 R&I LICENSE MOLDING USA BUILT 0. 0.00 0.3 0.0 38 REAR BODY & FLOOR 39# RPR ROUGH PULL REAR BODY PANEL TO 0 0.00 1.5 0.0 SQUARE BEFORE REMOVAL 40 REPL REAR BODY PANEL 1 121.63 INCL. 1.5 41 OVERLAP MAJOR ADJ. PANEL 0 0.00 0.0 -0.4 42 ADD FOR CLEAR COAT 0 0.00 0.0 0.2 43 ADD FOR INSIDE 0 0.00 0.0 0.8 44 ADD FOR CLEAR COAT 0 0.00 0.0 0.2 454 REPL ROUGH PULL FLOOR PANEL TO 1 0.00 1.0 0.0 SQUARE BEFORE REMOVAL http://`dilprod.20thcentins.com/pages/estimate.cfm?comparekey=3308443 4/20/2006 Estimate Screen Page 3 of 10 2 03/08/2006 AT 03 :18 PM JOB NUMBER: 17908 ESTIMATE OF RECORD 2003 HOND CIVIC LX 4-1.7L-FI 4D SED SILVER INT:GREY ------------------------------------------------------------------------=------ NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- N 46* REPL FLOOR USA BUILT W/0 GX 1 520.52 20.0* 1.5 47# RPR ROUGH PULL RT RAIL FOR LENGH 0 0.00 2.0 0.0 48* RPR LT RAIL USA BUILT W/0 GX 0 0.00 S 1.0* 1. 0 49 OVERLAP MAJOR ADJ. PANEL 0 0.00 0.0 -0.4 N 50* REPL RT RAIL USA BUILT W/O GX 1 269.82 S 7.5* 0.8* 51 OVERLAP MAJOR ADJ. PANEL 0 0.00 0.0 -0.4 52 DEDUCT FOR OVERLAP 0 0.00 -2.0 0.0 53 R&I RT TRUNK SIDE TRIM DX & LX 0 0.00 INCL. 0.0 USA BUILT 54 R&I LT TRUNK SIDE TRIM DX & LX 0 0.00 INCL. 0.0 USA BUILT 55 REPL SPARE COVER 1 25.88 0.0 0.0 56# REAR SUSPENSION OPEN 1 0.00 0.0 0.0 57 R&I REAR PANEL TRIM 0 0.00 INCL. 0.0 58 R&I PKG TRAY TRIM GRAY 0 0.00 INCL. 0.0 59 QUARTER PANEL 60* RPR RT WHEELHOUSE USA BUILT 0 0.00 1.5* 0.0 61# RPR ROUGH PULL RT QTR PANEL FOR DO 0 0.00 2.0 0.0 OR GAP AND SQUARE BEFOR REMOVE 62 BLND FUEL DOOR W/O GX 0 0.00 0.0 0.2 N 63 REPL RT QUARTER PANEL USA BUILT 1 439.37 14.0 2.8 64 OVERLAP MAJOR ADJ. PANEL 0 0.00 0.0 -0.4 65 ADD FOR CLEAR COAT 0 0.00 0.0 0.5 66 DEDUCT FOR REAR BUMPER R&I 0 0.00 -1.0 0.0 67 DEDUCT FOR OVERLAP 0 0.00 -1.5 0.0 N 68* RPR LT QUARTER PANEL USA BUILT 0 0.00 3 .0* 2.0 69 OVERLAP MAJOR ADJ. PANEL 0 0.00 0.0 -0.4 70 ADD FOR CLEAR COAT 0 0.00 0.0 0.3 714 RPR ROUGH PULL LEFT QTR FOR BUCKLE 0 0.00 1.0 0.0 72 BACK GLASS 73 R&I BACK GLASS HONDA USA BUILT, 0 0.00 INCL. 0.0 W/O GX . 74 REPL REVEAL MOLDING UPPER 1 8.22 INCL. 0.0 75 REPL REVEAL MOLDING LOWER 1 10.58 INCL. 0.0 76 REPL RT REVEAL MOLDING SIDE 1 7.22 INCL. 0.0 77 REPL LT REVEAL MOLDING SIDE 1 7.22 INCL. 0.0 76 REAR DOOR 79 BLND RT DOOR.SHELL USA BUILT 0 0.00 0.0 1.0 80 R&I RT BODY SIDE MLDG BLACK 0 0.00 0.3 0.0 81 R&I RT BELT W'STRIP USA BUILT 0 0.00 0.3 0.0 82 R&I RT HANDLE, OUTSIDE BLACK USA 0 0.00 0.3 0.0 BUILT http://dilprod.20thcentins.com/pages/estimate.cfm?comparekey=3308443 4/20/2006 Estimate Screen Page 4 of 10 3 03/08/2006 AT 03 :18 PM JOB NUMBER: 17908 ESTIMATE OF RECORD 2003 HOND CIVIC LX 4-1.7L-FI 4D SED SILVER INT:GREY ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 83 R&I RT R&I TRIM PANEL 0 0.00 0.3 0.0 84 BLND. LT DOOR SHELL USA BUILT 0 0.00 0.0 1..0 85 R&I LT BELT W'STRIP USA BUILT 0 0.00 0.3 0.0 86 R&I LT BODY SIDE MLDG BLACK 0 0.00 0.3 0.0 87 R&I LT HANDLE, OUTSIDE BLACK USA 0 0.00 0.3 0.0 BUILT 88 R&I LT R&I TRIM PANEL 0 0.00 0.3 0.0 89 ROOF 90 R&I RT ROOF MOLDING 0 0.00 0.3 0.0 91 R&I LT ROOF MOLDING 0 0.00 0.3 0.0 92 R&I RT DRIP MOLDING JAPAN BUILT 0 . 0.00 0.3 0.0 93 R&I LT DRIP MOLDING JAPAN BUILT 0 0.00 0.3 0.0 94 SEATS & TRACKS 95* R&I RT SEAT BACK PAD USA BUILT 0 0.00 0.2* 0.0 96* R&I LT SEAT BACK PAD USA. BUILT 0 0.00 0.2* 0.0 97* R&I SEAT CUSHION PAD USA BUILT 0 0.00 0.2* 0.0 98* R&I RT SEAT BACK FRAME OUTER USA 0 0.00 0.2* 0.0 BUILT 99* R&I LT SEAT BACK FRAME OUTER USA 0 0.00 0.2* 0.0 BUILT 100 EXHAUST SYSTEM 101 REPL MUFFLER SEDAN USA BUILT 1 184.93 M 0.8 0.0 102# REPL FLEX ADDITIVE 1 8.00 T 0.0 0.0 103# REPL CORROSION-PROTECTION 1 10.00 T 0.5 0.0 104# REPL COVER VEHICLE 1 7.50 T 0.5 0.0 105# RPR CLEAN UP ALLOWANCE 0 0.00 1.0 0.0 ' 1064 RPR COLR SAND & POLISH (MAX4.OHR.) 0 0.00 3.0 0.0 107# REFN TINT COLOR 0 0.00 0.0 0.5 108# MASK INTERIOR 1 7.50 0.5 0.0 1094 RPR FRAME SET-UP (CAR-O-LINER) 0 0.00 3.0 F 0.0 110# REPL SEAM SEALER 1 5.00 T 0.2 0.0 111# REPL SOUND DEADING MATERIAL 1 12.50 T 0.3 0.0 112# REPL UNDERCOAT 1 8.00 T 0.2 0.0 113# SUBL 4 WHEEL ALIGNMENT 1 85.00 X 0.0 0.0 114# REPL HAZARDOUS WASTE MATERIAL 1 5.00 X 0.0 0.0 ------------------------------------------------------------------------------- SUBTOTALS =_> . 2902.80 69.3 21.8 LINE 46 TIME LOWERED TO SECTION UNDER PACKAGE TREY AREA LINE 50 TIME LOWERED TO SECTION, AND SPOT PAINT LINE 63 TIME LOWERED TO SECTION AT ROOF RAIL BY WINDOW AND THROUGH DOG LEG LINE 68 TIME IS PENDING ON HOW BUCKLE PULLS OUT http://dilprod.20thcentins.comJpages/estimate.cfin?comparekey--3308443 4/20/2006 Estimate Screen Page 5 of 10 4 03/08/2006 AT 03:18 PM JOB NUMBER: 17908 ESTIMATE OF RECORD 2003 HOND CIVIC LX 4-1.7L-FI 4D SED SILVER INT:GREY PARTS 2761.80 BODY LABOR 66.3 HRS @$ 54.00/HR 3580.20 PAINT LABOR 21.8 HRS @$ 54.00/HR 1177.20 FRAME LABOR 3 .0 HRS Q$ 54.00/HR 162 .00 PAINT SUPPLIES 21.8 HRS @$ 24.00/HR 523 .20 SUBLET/MISC. 141.00 ---------------------------------------------------- SUBTOTAL $ 8345.40 SALES, TAX $ 3336.00 @ 8.2500% 275.22 ---------------------------------------------------- GRAND TOTAL $ 8620.62 ADJUSTMENTS: DEDUCTIBLE 300.00 ---------------------------------------------------- CUSTOMER PAY $ 300.00 INSURANCE 'PAY $ 8320.62 THIS IS A PRELIMINARY ESTIMATE AND ADDITIONAL CHARGES MAY BE REQUIRED FOR THE ACTUAL REPAIR. CUSTOMER RECEIVED COPY OF REPAIR ESTIMATE / FINAL BILL. DIGITAL IMAGES UPLOADED. http://dilprod.20thcentins.com/pages/estimate.cfm?comparekey=3308443 4/20/2006 Estimate Screen Page 6 of 10 5 03/08/2006 AT 03:18 PM JOB NUMBER: 17908 ESTIMATE OF RECORD 2003 HOND CIVIC LX 4-1.7L-FI 4D SED SILVER INT:GREY FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM: ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS .THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES: B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS: ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE .MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT 0/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RELY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT W/ =WITH/_SYMBOLS: #=MANUAL LINE ENTRY *=OTHER ?IE. .MOTORS DATABASE INFORMATION WAS CHANGED? **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. MQVP=MANUFACTURER'S QUALIFICATION AND VALIDATION PROGRAM. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. http://dilprod.20thcentins.com/pages/estimate.cfm?comparekey--3308443 4/20/2006 Estimate Screen Page 7 of 10 6 03/08/2006 AT 03:18 PM JOB NUMBER: 17908 ESTIMATE OF RECORD 2003 HOND CIVIC LX 4-1.7L-FI 4D SED SILVER INT:GREY ESTIMATE BASED ON MOTOR CRASH ESTIMATING GUIDE. UNLESS OTHERWISE NOTED ALL ITEMS ARE DERIVED FROM THE GUIDE ARG4440 DATABASE DATE 02/2006, CCC DATA DATE 02/2006, AND THE PARTS SELECTED ARE OEM-PARTS MANUFACTURED BY THE VEHICLES ORIGINAL EQUIPMENT MANUFACTURER. OEM PARTS ARE AVAILABLE AT OE/VEHICLE DEALERSHIPS. OPT OEM (OPTIONAL OEM) PARTS ARE OEM PARTS THAT MAY BE PROVIDED BY OR THROUGH ALTERNATE SOURCES OTHER THAN THE OE/VEHICLE DEALERSHIPS. OPT OEM PARTS MAY REFLECT SOME SPECIFIC, SPECIAL, OR UNIQUE PRICING OR DISCOUNT. ASTERISK (*) OR DOUBLE ASTERISK (**) INDICATES THAT THE PARTS AND/OR LABOR INFORMATION PROVIDED BY MOTOR MAY HAVE BEEN MODIFIED OR MAY HAVE COME FROM AN ALTERNATE DATA SOURCE. TILDE SIGN (-) ITEMS INDICATE MOTOR NOT-INCLUDED LABOR OPERATIONS. NON-ORIGINAL EQUIPMENT MANUFACTURER AFTERMARKET PARTS ARE DESCRIBED AS AM, QUAL REPL PARTS OR COMP REPL PARTS WHICH STANDS FOR COMPETITIVE REPLACEMENT PARTS. USED PARTS ARE DESCRIBED AS LKQ, QUAL RECY PARTS, RCY, OR USED. RECONDITIONED PARTS ARE DESCRIBED AS RECON. RECORED PARTS ARE DESCRIBED AS .RECORE. NAGS PART NUMBERS AND BENCHMARK PRICES ARE PROVIDED BY NATIONAL AUTO GLASS SPECIFICATIONS. LABOR OPERATION TIMES LISTED ON THE LINE WITH THE NAGS INFORMATION ARE MOTOR SUGGESTED LABOR OPERATION TIMES. NAGS LABOR OPERATION TIMES ARE NOT INCLUDED. POUND SIGN W ITEMS INDICATE MANUAL ENTRIES. SOME 2006 VEHICLES CONTAIN MINOR CHANGES FROM THE PREVIOUS YEAR. FOR THOSE VEHICLES, PRIOR TO RECEIVING UPDATED DATA FROM THE VEHICLE MANUFACTURER, LABOR AND PARTS DATA FROM THE PREVIOUS YEAR MAY BE USED. THE PATHWAYS ESTIMATOR HAS A COMPLETE LIST OF APPLICABLE VEHICLES. PARTS NUMBERS AND PRICES SHOULD BE CONFIRMED WITH THE LOCAL DEALERSHIP. TC CCC PATHWAYS - A PRODUCT OF CCC INFORMATION SERVICES INC. http://dilprod.20thcentins.com/pages/estimate.cf n?comparekcy=3308443 4/20/2006 Estimate Screen Page 8 of 10 7 03/08/2006 AT 03:18 PM JOB NUMBER:' 17908 ESTIMATE OF RECORD 2003 -HOND CIVIC LX 4-1.7L-FI 4D SED SILVER INT:GREY ALTERNATE PARTS SUPPLIERS 3 RECOND 'BUMPER COVER PART NO. H01100200 PRICE 192.00 FAITH BUMPER SERVICE (408) 986-1226 1085 DI GIULIO SANTA CLARA, CA 95050 http://dilprod.20thcentins.com/pages/estimate.efin?comparekey--3308443 4/20/2006 Estimate Screen Page 9 of 10 8 03/08/2006 AT 03:18 PM JOB NUMBER: 17908 ESTIMATE OF RECORD 2003 HOND CIVIC LX 4-1.7L-FI 4D SED SILVER INT:GREY ALTERNATE PARTS USAGE AFTERMARKET PARTS AFTERMARKET SELECTION METHOD: MANUALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT AN AFTERMARKET PART WAS AVAILABLE: 1 NO. OF AFTERMARKET PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 http://dilprod.20theentins.com/pages/estimate.efm?comparekey=3308443 4/20/2006 Estimate Screen Page 10 of 10 9 http://dilprod.20thcentins.com/pages/estimate.cfm?comparekey=3308443 4/20/2006 Print Selected Images Page 1 of 7 gg U j � I. � �, S E i� �3�p •"�q � j q 5l ' � 1 E m _ t e S yrs q j myl �� Z �` � � ^• la-w f t+ �� �� fit'^ i���j (ti ,k ✓ter � � '� QIP` y} � d t a � :SRt a-d ak ✓ a� �� fi Claim Number: 3308443 Vehicle Year: IF2003 Policy Number: 2435651 JVehicle Make: JFHOND Date of Loss: 03-04-2006 IVehicle Model: JFCIVIC LX Insured: Marcelo Ernesto Vin: IF2HGES16563H589565 Date Inspected 03-08-2006 Vehicle Color: JFSILVER Estimator: BRENNAN ROSE Vehicle License: %JY305 CA Request Number: 3308443 Deliver to: Print Date: 04-20-2006 http://dilprod.20thcentins.com/pages/localprint.cftn?file=3 3 08443-TOOOO.jpg_3 308443-TO(... 4/20/2006 Print Selected Images Page 2 of 7 f TNT 5, r TIME, y' f .:' p LL 3 MENf v i a , ,Q 2 u AR 33 3 h z j sV3 {4M r7 I Y E j Claim Number: 3308443 Vehicle Year: 2003 Policy Number: 2435651 Vehicle Make: JFHOND Date of Loss: 03-04-2006 Vehicle Model: CIVIC LX Insured: JIMarcelo Ernesto 1F2HGES16563H589565 Date Inspected: 03-08-2006 IVehicle Color: SILVER Estimator: BRENNAN ROSE Vehicle License: 5GJY305 CA Request Number: 3308443 Deliver to: Print Date: 04-20-2006 http://dilprod.20thcentins.com/pages/localpn'nt.cfm?file=3 308443-TOOOO.jpg_3 308443-TO(... 4/20/2006 Print Selected Images Page 3 of 7 V4 x s ! J41 W a s y f spm u ,�" t,,,,'✓ e x qay� r f ds an {{2 i�(1�z su'9• i 4 4t 53P A r W Claim Number: 3308443 JFVehicle Year: IF2003 Policy Number: IF2435651 JFVehicle Make: MOND Date of Loss: 03-04-2006 JFVehicle Model: JFCTVIC LX Insured: Marcelo Ernesto Irvin, 2HGES16563H589565 Date Inspected: 03-08-2006 JFVehicle Color: JFSILVER Estimator: BRENNAN ROSE Vehicle License: 115GJY305 CA Request Number: 3308443 Deliver to: Print Date: 04-20-2006 t http://dilprod.20thcentins.com/pages/localpn*nt.cfin?file=3 308443-TOOOO.jpg_3 308443-TO(... 4/20/2006 Print Selected Images Page 4 of 7 I x rI ,i Ira' �' Ytii � ajar' a 5/ C $ 3 iw Y Claim Number: 3308443 Vehicle Year: 2003 Policy Number: 2435651 JFVehicle Make: JFHOND Date of Loss: 03-04-2006 1Vehicle Model: JFCIVIC LX Insured: Marcelo Ernesto Vin: 2HGES16563H589565 Date Inspected: 03-08-2006 1Vehicle Color: I SILVER Estimator: BRENNAN ROSE JFVehicle License: 5GJV305.CA Request Number: 3308443 1FDeliver to: Print Date: 04-20-2006 http://diJprod.20thcentins.com/pages/localprint.cfTn?file=33 08443-T0000.jpg_3 308443-TO(... 4/20/2006 Print Selected Images Page 5 of 7 -40 N mg Rw rlf3 x i. . dry' v , £ f 9 5 dQ� Ns E - V T k95 F z i7 k Claim N 13308443 Vehicle Year: 12003 Policy Number,7F2435651 IFVehicle Make: JFHOND Date of Loss: 03-04-2006 IVehicle Model: CIVIC LX Insured: Marcelo Ernesto I Vin: IF2HGES16563H589565 Date Inspected: 03-08-2006 Vehicle Color: SILVER Estimator: BRENNAN ROSE :]Vehicle License: 5GJY305 CA Request Number: 3308443 1FDeliver to: Print Date: 04-20-2006 http://dilprod.20thcentins.com/pages/localprint.cfm?file=3308443-TOOOO.jpg_3308443-TO(... 4/20/2006 Print Selected Images Page 6 of 7 WOR 'k- k. J YA fi "('I„ — z2 xP �_ p [8 " Y '% — e fZ 7 IM AI y r 1 .113, c t gg 8 � t � x � k a IY .f x 3 Claim Number: 3308443 Vehicle Year: 2003 Policy Number: 2435651 Vehicle Make: I HOND Date of Loss: 03-04-2006 Vehicle Model: CIVIC LX Insured: Marcelo Ernesto Vin:' 2HGES16563H589565 Date Inspected: 03-08-2006 JjVehicle Color: SILVER Ij Estimator: BRENNAN ROSE Vehicle License: SGJY305 CA Request Number: 3308443 Deliver to: Print Date: 04-20-2006 http://dilprod.20theentins.com/pages/localprint.cftn?file=3308443-TOOOO.jpg_33 08443-TO(... 4/20/2006 ARMS - Automated Rental Management SyFtem(Patent Pending) Page 1 of 1 Rental Company: ENTERPRISE RENT-A-CAR C ? 21ST CENTURY INS Invoice: D159686-2384 Bill To: Billing Detail: 21ST CENTURY INS ATTN:STEPHEN HELLIWELL Rental Period: 3/7/06 to 4/18/06(43 days) 1140 GALAXY WAY STE.500 Billed Period: 3/7/06 to 4/5/06(30 days) CONCORD , CA94520 Description Rate: Amount: RENTER INFORMATION: 43 DAYS @ $24.99 $1,074.57 Renter: MARCELO, ERNEST 1 SALES TAX% %8.25 $88.65 RENTAL INFORMATION: TOTAL CHARGES: $1,163.22 Rental Branch Location: Less Amount Received: $ 13.22 ENTERPRISE RENT-A-CAR(2384) 2266 NORTH MAIN STREET WALNUT CREEK, CA 945963521 AMOUNT DUE.......... $750.00 (925)210-9550 ADDITIONAL CLAIM INFORMATION: Claim Number:385831 Claim Type::Insured Vehicle Condition: Non-Driveable Date Of Loss:3/4/06 Insured Name: Owner's Vehicle:2003 HONDA CIVIC Additional Driver: Repair Facility: MIKE'S AUTO BODY. VEHICLES RENTED Effective Date and Time Year Make Model VIN Mileage 3/7/06 12:06 PM 2005 KIA I SEDO I KNDUP132656725428 2006 Rental Invoice Please Return This Portion with Remittance Make Payment To: Total Charges: $1,163.22 ENTERPRISE RENT-A-CAR(23CC) Less Amount Received: $413.22- Er„ss4 P0.; d 2550 MONUMENT BLVD. Total Amount Due.................... $750.00 - L CONCORD„CA 945203107 / Federal ID:36-3041733 Please include on your check: Pli�d Invoice: D159686-2384 https://www.enterprise.coni/armsweb/closedcustomerfile 4/19/2006 ¥#4 � o t& ` ci gf �� � : 2 � ,i7a*l � do 4L � . � � � � ■ � �� ■ � � ■ � � 2 � . . . � CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION:MAY 23, 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 California Government Codes. you is your notice of the action taken d �gII� on your claim by the Board of D Supervisors. (Paragraph IV below), APR 2 4 2006 given Pursuant to Government Code AMOUNT: UNKNOWN COUNTY COUNSEL Section 913 and 915.4.Please note all MARTINEZ CALIF. "Warnings". CLAIMANT: SYPH NITIVONG V-13801 ATTORNEY: UNKNOWN DATE RECEIVED: APRIL 24, 2006 ADDRESS: SAN QUENTIN STATE PRISON BY DELIVERY TO CLERK ON.APRIL 24, 2006 SAN QUENTIN, CA. 94974 IH84 Low BY MAIL POSTMARKED: APRIL 21, 2006 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. APRIL 24, 2006 JOHN CULLEN, 1 I Dated: By: Deputy 11. FROM: County Counsel TO:Clerk of the Board of Supervisors ( 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). O Other: Dated: 7r� By: Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel(1) County Administrator(2) O 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. O 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 o� ,,�W�JOHN CULLEN,CLERK,ByJW�Deputy Clerk WARNMW(Gov. code section 913) Sul;lect to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited fit 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 nnmediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjuq 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 1%lartiuez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant,addressed to the claimant as shown above. Dated: �°� ��D� JOHN CULLEN,CLERK By eputy Clerk i' BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY . Apr! 'jINSTRUCTIONS TO CLAIMANT L, 706 6 A. A claim relating to a cause of action for death or for injury to pe'son or to personal property or growing crops shall be presented not later than six months aft r the accrual of the cause of action. A claim relating to any other cause of action shall be pre `nted 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. R. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the enc of this form. RE: Claim By: Reserved for Clerk's filing stamp RECEIVED f 7714 A ai tthe Co of Con a Cos APR 2 2006 CLERK BOARD OF SUPERVISORS� District) �� CONTRA COSTA CO. I. (Fill e name) The undersigned claimant h •eby 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) AA-706 M 2. Where did the damage or injury cur? (Include city and county) �[b({� ��C,c�� it ��'L•,�(s�CMCJ �� ./��, R!6/1�`S'r�oalp�� 3. How did the mage or n occur? (Gi e 1 details use ex a er if required) Ake. G04A/ j(la�CAC ;AC C/40, poY167n C'm*?T-- 4. hat Parti act or omission on the part of county or district o facers, servants, or employees caused the injury or damage?� � 5 What are the names of county or district officers, servants, or employees causing t e damage or injury? CVRD&lk 6. What damage or injuries do your claim fe`sulted? (Give full extent of injuries or damages claimed. Attach two estimates�fo�r a�to damage.) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses f witnesses, doctors,and hospitals: 9. List the expenditure ou made on account of this accident or injury: DATE TIME AMOUNT ■■.■■a■r.■.■..■...■............■...r■■...■....■.■..■■monsoon..■.■.■.■..■■ . ■■ ■■■■■■.■i ) 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 ) (Claimant's Signature) �(Address) -� is Telephone No. )Telephone No. ■..r...r.■.......■•■....■......■.......■■....■■■■■■..■..1�i ��i■■ .�iT. .■■■■.......i 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. Runup.............■■noun.......■......................■................... . .■...Nonni 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. -------------------------- RECEIVED RECEIVED APR 2 4 2006 , SYPHANH NITIVONG CSP SAN QUENTIN CLERK BOARD OF SUPERVISORS j SAN QUENTIN, CA •949'%4 cONTRACOSTA CO. APRIL 7 , 2006 TO WHOM IT MAY CONCERN: MY NAME IS SYPHANH NITIVONG. I AM FILING A CLAIM WITH THE COUNTY OF CONTRA COSTA. THE SITUATION I AM IN' IS SERIOUS, DETRIMENTAL TO'MY' HEALTH, AND PRECARIOUS. IN NOVEMBER 2005 , . I WAS INCARCERATED AT THE WEST COUNTY DETENTION FACILITY IN CONTRA COSTA - COUNTY. ON, NOVEMBER 18 , 2U05, I WAS BEING TRANSFERRED BY BUS WITH NUMEROUS OTHER_ INMATES TO THE COURT HOUSE IN MARTINEZ. ON THE WAY, THE BUS GOT INTO AN ACCIDENT IN WHICH I WAS SERIOUSLY INJURED. . THE RESPONSE TIME TO MY INJURIES HOWEVER:; WAS VERY NEGLIGABLE. I WAS NOT SEEN BY ANY MEDICAL STAFF AND NO X-RAYS WERE TAKEN THAT DAY. ONLY SEVERAL DAYS LATER, WAS I FINALLY SEEN BY MEDICAL STAFF. I SUFFERED FROM SEVERE PAIN IN MY BACK, NECK, ELBOW, SHOULDER, AND LEG. EVEN AFTER I WAS SEEN BY A DOCTOR, THE SEVERITY OF MY PAIN CONTINUED. TODAY, I AM STILL IN ALOT OF PAIN. I WOULD LIKE TO BE CONPENSATED FOR PAIN AND SUFFERING, CAUSED AS A DIRECT RESULT FROM THIS ACCIDENT. SINCERE Y, SYPHANH NITIVONG lzj Cy wp GD .r s;°•i . 96th O OLU cli co cl LH zz s NU �...a. tSy ° w a.. U. AOIS I4 r a w r r LU G7 cC � f�•1 d7 •i..i CD 'gi uj O t 1 C-j _ co ; A w �. w BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY j,.� INSTRUCTIONS TO CLAIMANTLt. 7- 0 6 _Ap A. A claim relating to a cause of action for death or for injury to pe'son or to personal property or growing crops shall be presented not later than six months aft r the accrual of the cause of action. A claim relating to any other cause of action shall be pre ented not laterthan 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. -r■■ ■■■rrrr■■r■■■■■r■■■■■r■mango■r■r■■■r■■rrr■rrr■r■rrr■r■■r■rr■■rr■■■■■■■■■■■4 RE: Claim By: Reserved for Clerk's filing stamp RKEIVED A t the Co of Con a Cos APR 2 �L_2006 s District) CLERK BOARD OF SUPERVISORS l (FillA�Qffame) ) 00 RA COSTA CO. :h The undersigned claimant h eby 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) V6 Q EP, J,? 2. Where did the damageor injury cur? (Include city and county) DI 3. How did theage or in occ`u�r? (Gi e 1 details use ex a er if required) 00, T`® crao�7-- 4. at parti act or omission on the part of county or district o ficers, ervants, or employees caused the injury or damage?� FArT 5 What are the names of county or district officers, servants, or employees causing t e damage or injury? �V���,r-•/�� �� �f���� �` 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed, Attach two estimates for a to d 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 hospital 9. List the expenditur you made on account of this accident or injury: DATE TIME AMOUNT # V monsoon ON 0 son 6 ma"0 0 a as MENUMMOOM 5 0 Mosommonsoff Noun 0 so noun on M 0 0 Ransoms M ff 2 0 a W 0 a an so of 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 ) ,SIP[ 0H �rT � ) VF (Claimant's Signature) r/3Z w (Address) )� Ab V44 T-f-7Y� l� / Telephone No. ) Telephone No. f � 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. ■m ■■5....m.no■.nm...8. . .....No.0 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. ECE V9 E® APR 2 <i 2006 SYPHANH NITIVONG CSP SAN QUENTIN CLERKBOARDOFSUPERVISORS` SAN QUENTIN, .CA 949"/4. CONTRACOSTACO. APRIL 7., 2006 . . , TO WHOM IT MAY CONCERN: MY NAME IS SYPHANH NITIVONG. I AM FILING A CLAIM WITH THE COUNTY OF CONTRA COSTA. THE SITUATION I AM IN' IS SERIOUS, DETRIMENTAL TO MY HEALTH, AND PRECARIOUS. IN NOVEMBER 2005 , . I WAS INCARCERATED AT THE WEST COUNTY DETENTION FACILITY IN CONTRA COSTA COUNTY. ` ON.. NOVEMBER 18 , 2005, I WAS BEING TRANSFERRED BY BUS WITH NUMEROUS OTHER INMATES TO THE COURT HOUSE IN MARTINEZ. ON THE WAY, THE BUS GOT INTO AN ACCIDENT IN WHICH I WAS SERIOUSLY INJURED. THE RESPONSE TIME TO MY INJURIES HOWEVER., WAS VERY NEGLIGABLE. I WAS NOT SEEN BY ANY MEDICAL STAFF AND NO X-RAYS WERE TAKEN THAT DAY. ONLY SEVERAL DAYS LATER, WAS I FINALLY SEEN BY MEDICAL STAFF. I SUFFERED FROM SEVERE PAIN IN MY BACK,. NECK, ELBOW, SHOULDER, AND LEG. EVEN AFTER I WAS SEEN BY A DOCTOR, THE SEVERITY OF MY PAIN CONTINUED. TODAY, I AM STILL IN ALOT OF PAIN. I WOULD LIKE TO BE CONPENSATED FOR PAIN AND SUFFERING, CAUSED AS A `DIRECT RESULT FROM THIS ACCIDENT. SINCERE Y, SYPHANH NITIVONG 1 r t 'I+ a�+ •L,yL d i co �:jMj r oc ' o CJ "" { U. Aa r Y� ©dIC -76 : r Y CLAIM n �� BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: MAY 23, 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 California Government Codes. ) you is your notice of the action taken on your claim by the Board of sDSupervisors. (Paragraph IV below), P 2 6 @ given Pursuant to Government Code AMOUNT: $222.33 A R 2006 Section 913 and 915.4.Please note all . COUNTY COUNSEL "Warnings". CLAIMANT: EMILY GEITY MARTINEZ CALIF. ATTORNEY: UNKNOWN DATE RECEIVED: APRIL 25, 2006 ADDRESS: 1055 LARRY PLACE BY DELIVERY TO CLERK ON:APRIL 25, 2006 CONCORD, CA 94518 BY MAIL POSTMARKED: APRIL 24, 2006 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. APRIL 25, 2006 JOHN CULLEN, Dated: By: Deputy 01 Il. FROM: County Counsel TO:Clerk of the Board of Sup rvisors his claim complies substantially with Sections 910 and 910.2. ( ) This Claim FALLS 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). O Other: Dated: j{-_2 7-©CP By: /"��� Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel(1) County Administrator(2) O Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: (Lj This Claim is rejected in full. . O Other: 1 certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated J,6 JOHN CULLEN,CLERIC,By Deputy Clerk, WARM (Gov, code section 913) Subject to ceriaot 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.U you want to consult all attorney,you should do so i n uediately. *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: .IOiIN CUL—EN, CLERK By Deputy Clerk BOARD OF SUPERVISORS OF CONTRA.COSTA COUINTTY INSTRUCTIONS TO CLAIMANT A. A claim relating to a cause of action for death or for ir�uryto 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 Adrniiiistration Building, 651 Pine Street,Martinez,CA 945 53. 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 fi audulent claims,Penal Code Sec. 72 at the end of this form. ■man 0 o a o■o t o a o 0 0 0 o a a t m Room■a a■a ago at NNORMININEEMN o MICE H C C a o 0 0 0 0 0 0\o,■o o l o 0 0 0%0!!!I RE: Claim By: Reserved for Clerk's filing stamp RECEIVE Against the County of Contra Costa or . } APR 2..5 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$;0Z_ 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) CQa -boom `Cyd 1- k\d C4ncoo Cel A 05-x. .3'. How did the damage or �ury occur? (Give fudetails;use extra paper if required) Vie. � GLCIYY1� ` 4; What particular actor ornission on the part of county or district officers, servants, or employees caused the injury or damage? - - no� -C\,kr P6 a &cse WT h* 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 clairned. Attach two estimates for auto damage.) ­h(e �(� (nlo 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 TEvIE AMOUNT ■Ila![![oaasaaaeaesealaeaaaeaaaaa!uaa!■aaaoaaaaal■■a■as■aac[laaaaaasaaaa[acaaaaaaaaal ) .Gov. Code Sec. 910.2 provides"The claim shall be ) signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney) 1 Name and address of Attorney ) } (Claimant's Si ature) ( dress) co'n ad c/i qq Q 4� . ) Telephone No. )Telephone NTo. Iq ,G,T — �O�Q�� (Po ■■aa■a[aaaa![!a[Ann■aa■a■faMIA an Pla[aas as■[t[![i[f[[[[[Ii[[a■•a a■aa[aaa■1i1 t■a Bananas as 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. ■naa0■■■aaaaaamNit a■■ana[■■aaataasIand■■asaaaa[aaasaa[aaaaaaaamslam Its fam%aaass mass ama.1 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 A 3. I was driving East-Bound on Concord Avenue from Contra Costa Blvd. to Diamond Ave in the far right lane. Just after I drove under the 680 overpass,I saw a large pot hole in the lane near the sidewalk side of the lane. I was not able to change lanes to avoid the pot hole. After driving through it,I heard a loud bang and saw my front right hubcap pop off.and roll.away. .I.pulled over to the curb at the intersection of Concord Blvd and Diamond Ave. where 3 or 4 other cars were parked with the same problem(some fixing flat tires). I looked at my tire and it was not fiat,however I noticed that there was a dent in my tire rim. I walked around for about 10 minutes looking for my hub-cap but could not find it. Pictures of the pot-hole and dented tire rim are attached. Page I of 1 s _ E http://us.f2.yahoofs.com/bc/4192ad3e_14f4f/bc/Mail+Attachments/file-1.bin?bflOFTEBN... 4/23/2006 Page 1 of 3 . � �. &�+ Ha .���F $ . \ . MA - ^ ��:�����������������} - � tttp:u.Gƒahofcm/bc419kd3e144f/bc/N4a! ƒAttaclunetsfc»in?nOFTEah2O. 42/206 FINAL BILL 18 COM 04/14/2006 at 09: 28 AM P LETE Job Number: 40460 THANKS FOR CHQOSI%JIM'S JIM'S AUTO BODY INC. License # :AF 178743 Federal ID # : 942227228 EST. 1962 2100 North Main Street Walnut Creek, CA 94596-3708 (925)933-2109 Fax: (925) 933-8015 PRELIMINARY ESTIMATE Written By:. PETE EBY Adjuster: Insured: EMILY GETTY Claim # Owner: EMILY GETTY Policy # Address: 1055 LARRY PLACE Deductible: CONCORD, CA 94518-3115 Date of Loss: Day: (925) 680-4460 Type of Loss: Business: (925) 927-4510 Point of Impact: Inspect Location: Insurance Company: Days to Repair 2000 MAZD PROTEGE LX 4-1 . 6L-FI 4D SED GREEN Int: VIN: JMIBJ2228YO218490 Lic: MLE ANNE CA Prod Date: Odometer: 70000 Condition: Good Rear Defogger Tilt Wheel Cruise Control . Intermittent Wipers Body Side Moldings Dual Mirrors Clear Coat Paint Power Steering. Power Brakes - Power Windows Power Locks Power Mirrors AM Radio FM Radio Stereo Search/Seek CD Player Driver Air Bag Passenger Air Bag Cloth Seats Bucket Seats 5 Speed Transmission Overdrive ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1 WHEELS 2 Repl RT/Front Wheel, steel 14" 1 . 130 . 30 m 0 . 3 3* Repl RT/Front Wheel, spare cover 1 36. 10 4# 'MOUNT AND BALANCE 1 20 . 00 X ------------------------------------------------------------- =_> 186. 40 0 . 3 0. 0 1 04/14/2006 at 09: 28 AM Job Number: 40460 PRELIMINARY ESTIMATE 2000 MAZD PROTEGE LX 4-1 . 6L-FI 4D SED GREEN Int: Parts 166. 40 Body Labor 0 . 3 hrs @ $ 74 . 00/hr 22. 20 Sublet/Misc. 20. 00 ---------------------------------------------------- SUBTOTAL $ 208 . 60 Sales Tax $ 166.40 @ 8 .2500% 13.73 ----------------------------------------------------- GRAND TOTAL $ 22.2_._331 ADJUSTMENTS: Deductible 0 . 00 ---------------------------------------------------- CUSTOMER PAY $ 0 . 00 INSURANCE PAY $ 222 . 33 AUTHORIZED AND .ACCEPTED: You are hereby authorized to make the above specified repairs, I understand that payment in full will be due upon release of vehicle, including additional supplemental damage charges, and hereby grant you and / or your employees, permission to operate the car, truck or vehicle herein described .on streets, highways or elsewhere for the purpose of testing and / or inspection. An expressed mechanic' s lien is acknowledged on above car, truck or vehicle equal to the amount of repairs thereto, you will not be responsible for loss or damage to vehicle. or articles lost in vehicle in case. of fire, theft, accident or any other cause beyond your control . ALL OLD / DAMAGED PARTS REMOVED FROM VEHICLE. WILL BE DISPOSED OF UNLESS REQUESTED OTHERWISE PRIOR TO REPAIRS. REPAIRS AUTHORIZED BY DATE 2 04/14/2006 at 09:'28 AM Job Number: 40460 PRELIMINARY ESTIMATE 2000 MAZD PROTEGE LX 4-1 . 6L-FI 4D SED GREEN Int: FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS. FORM: ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES: , B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS: ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS .ASSOCIATION " D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE .MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT W/ =WITH/ SYMBOLS: #=MANUAL LINE ENTRY *=OTHER [IE. .MOTORS DATABASE INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE.. MQVP=MANUFACTURER' S QUALIFICATION AND VALIDATION PROGRAM. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide ARH5416 Database Date 03/2006, CCC Data Date 03/2006, and the parts selected are OEM-parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are-available at OE/Vehicle dealerships. OPT OEM (Optional OEM) parts are OEM parts that may be provided by or through alternate sources other than the OE/Vehicle dealerships. OPT OEM parts may reflect some specific, special, or unique pricing or discount. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign (-) items indicate MOTOR Not-Included Labor operations. Non-Original Equipment Manufacturer aftermarket parts are described as AM, Qual Repl Parts or Comp Repl Parts ,which stands for Competitive Replacement Parts. Used parts are described as LKQ, Qual Recy Parts, RCY, or' USED. Reconditioned parts are described as Recon. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided. by National Auto Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are , not included. Pound sign (#) items indicate manual entries. Some 2006 vehicles contain minor . changes from the previous year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts data from the previous year may be used. The Pathways estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. CCC Pathways - A product of CCC Information Services Inc. 3 o ' �At�ty �w l r, a .amu l J CLAIM �J BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY . BOARD ACTION. MAY 23, 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 California Government Codes. 109EWM you is your notice of the action taken on your claim by the Board of APR 2 6 2006 Supervisors,(Paragraph IV below), given Pursuant to Government Code COUNTY COUNSEL AMOUNT: $5,000,000.00 MARTINEZ CALIF. Section 913 and 915:4.Please note all JOSE ANGEL GONZALEZ, a minor "Warnings". CLAIMANT: by and through his guardian MARINA GARCIA ATTORNEY: ANTHONY R. LOPEZ, JR. DATE RECEIVED: APRIL 26, 2006 LAW OFFICES OF ANTHONY R. LOPEZ APRIL 26 2006 ADDRESS: 1735 N. FIRST STREET, #275 BY DELIVERY TO CLERK ON: , SAN JOSE, CA 95112 APRIL 25 2006 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, rl Dated: APRIL 26, 2006 By: Deputy �-- 11. FROM: County Counsel TO: Clerk of the Board of Sup rvisors T (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). O Other: Dated: By: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel(1) County Administrator(2) O Claim was returned as untimely with notice to claimant(Section 911.3).. IV.XOARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. O Other: l certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated:e%e-9,3-01ZO,6JOHN CULLEN,CLERK,By Deputy Clerk WARN[Wi(Gov. code section 913) Subject to cettaut 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 or an attorney of your choice ut connection with this matter.If you want to consult an attoivey,you should do so itumediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am uow,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 or this Board Order and Notice to Claiurant,addressed to the chimant as sbown above. Dated: JOHN CULLEN, CLERK By _Deputy Clerk nor 10 06 11:29a Southwest Law Center (408) 995-3237 p. 2 04/10/2006 10:23 CONTRA COSTA COUNTY CLERK OF THE -) 914004411733 NC .987 901 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 propm Y. or growing crops shall be presented not later than six months after the accrual of the cau .e of action. A claim relating to any other cause of action shall be presented not later than one year aft 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 Count, , the name of the District should be filled in. D. if the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims,Penal Code Sec.72 at the end of this form. I RE: Claim By: Reserved for Clerk's filing stamp 1 Jose Angel Gonzalez, a minor by and RECEIVED through his guardian Marina Garcia Against the County of Contra Costain and ) APR f; 2006 Mt. Diablo Unified School CLERK BOARD OF SUPERVISORS District) CONTRA COSTA Co. (Fill in the name) ) l The undersigned claimant hereby makes claim against the County of Contra Costa or the above-n aned district in the sum of$5,000,000.0(and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and how) November 3, 2005. Approximately 11:30 a.m. See Attachment A. 2. Where did the damage or injury occur? (Include city and county) City of Concord. ' Contra Costa County. See Attachment A. 3. How did the damage or injury occur? (Give full details;use extra paper if required) See Attachment A. i 4. What particular act or omission on the part of county or district officers,servants,or empl !yees caused the injury or damage? See Attachment A. 5 What are the names of county or district officers,servants,or employees causing the damage or injury? Including, but not limited to, Teacher Mr. Petrich, substitute teach Mr. Kint, principal Dr. Gay McAdams, all other officers or employees are unknown at t is See Attachment A. ti e. Apr 10 06 11 :29a Southwest Law Center (408) 995-3237 p. 3 04/10/2006 10:23 CONTRA COSTA COUNTY CLERK OF THE 4 914084411733 NC .987 D02 .. 1 6. What damage or injuries do your claim Malted? (Give full extent of injuries or da sages claimed. Attach two estimates for auto damage.) See Attachment A. 7. How was the amount claimed above computed? (Include the estimated arrtotuit ( f any prospective ir>jury or damage.) See Attachment A. 9. Names and addresses of witnesses,doctors,and hospitals: Including, but not limited to, all students present in the classroom. See Attachment A. Children's Hospital Oakland. Dr. Olaf Reinhartz, MD 9. List the expenditures you made on account of this accident or injury' DATE TW AL40LNT See Attachment A. •..�■■■•I•Mrrrrr.rrsr•■rr■r■..•■■■■•r■...■.■...•.■■.•■•■•■■.•.•.•r■■.■..■■•■r■ ll..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: (Attorney) Jose Angel Garcia, a minor by and through his Name and address of Attorney ) Guardian Marina Garcia to _ Anthony R. Lopez, Jr. ) (Claimant's Signature) 1735 N. First Street, Suite ) ) 1500 Pine Street #87, Concord, CA 94520 275, San Jose, CA 95112 ) (Address) ) Telephone No. (408) 4433 )Telephone No. (925) 825-1557 r.r.M.■.■au basis Fee oft-4 Roqueovols*..*eta added r•.•a•r..r.•.r •..■. PUBLIC RECORDS NOTICE: Please be advised that this claim form,or any claim filed with the. County under the Tort Claims Act,is sl bject to public disclosure under the California Public Records Act. (Gov. Code, SS 6500 at seq.) Ftutherm, re, any attachments,addendums,or supplements attached to the claim farm,including medical records,are also& bject to public disclosure. waves ago...........■.....■....wage Ingo r.......,..soon............•■•■..■.■dories .....i NOTICE: Section 72 of the Penal Code provides.- Every rovides.Every person who,with intent to defraud,presents for allowance or for payment to any state board or o (icer,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 imprisonmcat in the County, til for a period of not more than one year,by a fore of not exceeding one thousand dollars($1,000.00), or by b ith such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousan ,dollars ($10,000),or by both such imprisonment and fine. ATTACHMENT A—to NOTICE OF CLAIM AGAINST THE COUNTY OF CONTRA COSTA— CLAIMANT JOSE GONZALEZ—for an incident occurring on or about November 3,2005.[this attachment consists of four(4)pages] Paragraph 3 and 5 — to NOTICE OF CLAIM AGAINST THE COUNTY OF CONTRA COSTA — CLAIMANT JOSE GONZALEZ: At approximately 11:30 a.m., on or about November 3, 2005, claimant, Jose Angel Gonzalez, a minor,was working on a class project in a science class in or around Room 602 of Glenbrook Middle School located in Concord,California. Another student, Michael Christopher Vanevery, began to argue with the claimant. Michael Vanevery then proceeded to grab a blunt object believed to be a pair of scissors, and verbally threatened claimant. Michael Vanevery then proceeded to stand up and stabbed claimant in the chest with a blunt object believed to be a pair of scissors. The substitute teacher,on information and belief is alleged to be Mr.Kint,who was substituting for the regular teacher,Mr.Petrich. The substitute teacher, (on information and belief Mr.Kint)did not attempt to help claimant either before or after the stabbing and delayed in calling for help. When the ambulance arrived, claimant was transported without the assistance and or supervision of school personnel. . Michael Vanevery had a known and/or documented history ofdisciplinary misconduct andphysical violence; Michael Vanevery had a known and/or documented history of apropensityforphysical violence, in general,and in specific to claimant,which was either known or should have been known to school officials including but not limited to the school principal,Dr.Gary McAdam,regular class teacher,Mr. Petrich,and substitute teacher,Mr. Kint and/or others who had a duty to insure the safety of claimant. Claimant's injuries were due to the following(including but not limited to):the general negligence of defendants; defendants liability for negligent supervision, negligent hiring, negligent retention and negligence in the administration of discipline at the of COUNTY OF CONTRA COSTA and its employees, and further for all of the reasons set forth in paragraph 10 of the claim herein: Paragraph 6 and 7 — to NOTICE OF CLAIM AGAINST THE COUNTY OF CONTRA COSTA — CLAIMANT JOSE GONZALEZ: 1. General Damages including, but not limited to, pain and suffering, embarrassment, humiliation, anguish,anxiety,emotional and mental distress,and loss of future earning capacity. 2. Special Damages including,but not limited to,all medical expenses incurred to Jose Angel Gonzalez on or about November 11,2005 and thereafter,relating to the incident,including but not limited to emergency medical treatment and ambulance service, all medical services rendered at Children's Hospital&Research Center at Oakland,psychological evaluation and therapy,and future medical treatment. 3. Prejudgement Interest. 4. Costs of suit incurred herein. 5. Aggravation of injuries. 6. Attorney's fees. 7. Reputation Injury. 8. Out of pocket expenses. 9. Property Damage. 10. Commuting Expenses. 11. Any and all other relief that is just and proper. Paragraph 4—to NOTICE OF CLAIM AGAINST THE COUNTY OF CONTRA COSTA—CLAIMANT JOSE GONZALEZ: COUNTY OF CONTRA COSTA breached a duty to claimant in regard to EACH of the FOLLOWING(including but not limited to): 1 — Government Code`section 815.6 provides that a government entity may incur liability for breach of a mandatory duty imposed by statute: "Where a public entity is under a mandatory duty imposed by an enactment that is designed to protect against the risk of a particular kind of injury,the public entity is liable for an injury of that kind proximately caused by its failure to discharge the duty unless the public entity establishes that it exercised reasonable diligence to discharge the duty." COUNTY OF CONTRA COSTA breached the duty they had to claimant JOSE GONZALEZ in conformity with Government Code section 815.6. COUNTY OF CONTRA COSTA failed to exercise reasonable diligence to discharge the duty or duties they had to protect claimant. 2— Education Code section 49079 imposes on a school district a mandatory duty to inform teachers of a student's record of physical violence. "(a)A school district shall inform the teacher of every student who has caused,or who has attempted to cause,serious bodily injury or injury,as defined in paragraphs(5)and (6) of subdivision (e) of Section 243 of the Penal Code, to another person. The district shall provide the information to the teacher based on any written records that the district maintains or receives from a law enforcement agency regarding a student described in this section." (a) An enactment ... must impose a mandatory, not discretionary, duty ...; (b)The enactment must intend to protect against the kind of risk of injury suffered by the plaintiff...; and (c)The breach of the mandatory duty must be a proximate cause of the plaintiffs injury...." COUNTY OF CONTRA COSTA breached the duty they had to claimant JOSE GONZALEZ in conformity with Education Code section 49079. COUNTY OF CONTRA COSTA failed to exercise reasonable diligence to discharge the duty or duties they had to protect claimant by failing to see that the requirements of aforesaid code section(and/or other applicable laws)were properly enforced, followed or implemented in said County. 3 — Education Code section 44807 establishes that school districts and their employees have a duty to supervise their pupils.It states in pertinent part: "Every teacher in the public school shall hold pupils to a strict account for their conduct on the way to and from school,on the playgrounds,or during recess.A teacher,vice principal,principal,or any other certificated employee of a school district, shall not be subject to criminal prosecution or criminal penalties for the exercise, during the performance of his duties,of the same degree of physical control over a pupil that a parent would be legally privileged to exercise but which in no event shall exceed the amount of physical control reasonably necessary to maintain order, protect property, or protect the health and safety of pupils, or to maintain proper and appropriate conditions conducive to learning." Government Code section 815.6 codifies that breach of a legal duty makes school districts liable: "Where a public entity is under a mandatory duty imposed by an enactment that is designed to protect against the risk of a particular kind ,.,u: 2 PrP 4 of injury,the public entity is liable for an injury of that kind proximately caused by its failure to discharge the duty unless the public entity establishes that it exercised reasonable diligence to discharge that duty." COUNTY OF CONTRA COSTA breached the duty they had to claimant JOSE GONZALEZ in conformity with Education Code section 44807. COUNTY OF CONTRA COSTA failed to exercise reasonable diligence to discharge the duty or duties they had to protect claimant by failing to see that the requirements of aforesaid code section(and/or other applicable laws)were properly enforced,followed or implemented in said County. 4— School districts and their employees may be held liable under the legal theory of negligence for injuries sustained on school grounds during, before or after school and school sponsored activities. California law has long imposed on school authorities a duty to supervise at all times the conduct of the children on the school grounds and to enforce those rules and regulations necessary to their protection. COUNTY OF CONTRA COSTA breached the duty they had to claimant JOSE GONZALEZ in conformity with the legal theory ofnegligence for injuries sustained on school grounds during,before or after school and school sponsored activities. COUNTY OF CONTRA COSTA failed to exercise reasonable diligence to discharge the duty or duties they had to protect claimant by failing to see that the requirements of aforesaid applicable laws were properly enforced,followed or implemented in said County. 5— Negligence has been defined in a number of different ways as: 1) the omission to do something which a reasonable man would do; 2)the doing of something which a prudent and reasonable man would not do;or 3)the failure to exercise ordinary care under the circumstances,by either failing to act to protect or assist another or doing something which created an unreasonable risk of invading someone's interest. Donnelly v. Southern Pacific Company, 18 Cal.2d 863, 118 P.2d 465 (1941); People v.Young,20 Cal.2d 832, 129 P.2d 353 (1942). COUNTY OF CONTRA COSTA breached the duty they had to claimant JOSE GONZALEZ in conformity with the legal theory of negligence for injuries sustained on school grounds during,before or after school and school sponsored activities by 1)the omission to do something which a reasonable man would do;2)the doing of something which a prudent and reasonable man would not do;or 3)the failure to exercise ordinary care under the circumstances,by either failing to act to protect or assist another or doing something which created an unreasonable risk of invading someone's interest. COUNTY OF CONTRA COSTA failed to exercise reasonable diligence to discharge the duty or duties they had to protect claimant by failing to see that the requirements of aforesaid applicable laws were properly enforced,followed or implemented in said County. 6— School districts and school district employees have a variety of legal duties which involve protecting others against unreasonable risks.Their duties vary depending on who is involved,the location and the time. They must provide reasonable supervision of students during school hours. No supervision or ineffective supervision may constitute a lack of ordinary care and be a breach of their legal duty. Dailey v.Los Angeles Unified School District,2 Cal.3d 741, 747, 87 Cal.Rptr. 376(1970). COUNTY OF CONTRA COSTA breached the duty they had to claimant JOSE GONZALEZ in conformity with the legal theory of negligence for injuries sustained claimant as COUNTY OF CONTRA COSTA failed to provide reasonable supervision of students,to wit, claimant, during school hours. The E'•=,C 3 of 4 aforesaid acts of COUNTY OF CONTRA COSTA constituted no supervision or ineffective supervision and constituted a lack of ordinary care and breach of their legal duty in accordance with Dailey v.Los Angeles Unified School District, and/or other cases in accord. COUNTY OF CONTRA COSTA failed to exercise reasonable diligence to discharge the duty or duties they had to protect claimant by failing to see that the requirements of aforesaid applicable laws were properly enforced,followed or implemented in said County. 7— COUNTY OF CONTRA COSTA.breached its legal duty, and/or failed to do what they were supposed to do. The breach was a substantial factor in bringing about claimant JOSE GONZALEZ injury,damage,loss or harm and therefore was the proximate cause of claimant's injuries. See Skinner v.Vacaville Unified School District,43 Cal.Rptr.2d 384,37 Cal.AppAth 31,42(1995)and or other similar cases. Claimant JOSE GONZALEZ would not have been injured and harmed,and/or would have been less severely injured and/or harmed if the breach and/or breaches of duty had not occurred in regard to claimant by COUNTY OF CONTRA COSTA. 8— COUNTY OF CONTRA COSTA at all relevant times herein breached its legal duty to claimant, and/or failed.to do what they were supposed to do, in failing to adequately train, instruct, supervise, hire, advise,warn,or notify appropriate personnel as to how to handle events or situations as those alleged to have occurred to claimant JOSE GONZALEZ. d 0 CIO LO aco a . l �� �� �` P uy ����_, � � ���� .�N lJ Qq4 ♦ `..� Vhf. ��M O � � �1? � J O � 6W � �� � � u, �� 1/��7�- � ® � .SCJ � , '"" Cl �dT- N ��� Fes'° ;� X66 � ��'� "' ` J1 5, � l.., �'! os.. {� � O �% /� r„"i/�` O �, C"' O S w 0 � '/� �� /^�^�'i �T � S ® `�,,, �� _ L '' � �.. .�' <9 c.� N d O� ��� oma GNV Q� N. Cw-fly �x � /-� �N ',� O� .� CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY r v BOARD ACTION: MAY 23, 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 California Government Codes. you is your notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), APR 2 6 ' 1` given Pursuant to Government Code AMOUNT: $5,000.00 COUNTYCOta',;�-;' � Section 913 and 915.4.Please note all - "Warnings". CALF.' CLAIMANT: OFFICE OF RISK AND INSURANCE MANAGEMENT ATTORNEY: UNKNOWN DATE RECEIVED: APRIL 26, 2006 ADDRESS: 707 THIRD STREET, STE. I-3EV DELIVERY TO CLERK ON:APRIL 26, 2006 WEST SACRAMENTO, CA 95605 APRIL 25, 2006 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. APRIL 26, 2006 JOHN CULLEN, 1 Dated: By: Deputy IL FROM: County Counsel TO: Clerk of the Board of Sopervisors ('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). O Other Dated: q,d_-7-0(p _ By: - Deputy County.Counsel III. FROM: Clerk of the Board TO: County Counsel(1) County Administrator(2) O Claim was returned as untimely with notice to claimant(Section 911.3). 1V. 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 correct copy of the Board's Order entered in its minutes for this date. Dated:/ ��JOHN CULLEN, CLERK,By Deputy Clerk WARN INZI(Gov. code section 913) Subject to certain exceptions,you have only six(6)months front 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 uumediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of per ju'q 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: O JOIIN CULLEN, CLERK By eputy Clerk r, BOARD OF SUPERVISORS OF CONTRA COS'T'A COUNTY � INSTRUCTIONS TO CLAIMANTI' APR Z 6 2 A. A claim relating to a cause of action for death or for injury to person or to persoi Lte cbsrd�ao' growing crops shall be presented not later than six months after the accrual of action. A claim relating to any other cause of action snail be presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) 8. 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 entit),, 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. sesaasas■Res as¢aaeta an Rosanna man ea an easaaseessessaaaa¢sesaaaeaa. RE: Claim By: Reserved for Clerk's filing stamp o{Lficp Tr0urun(;',0 .M an ag�m�nfi � Against the County of Contra Costa or ) co (A Cpunfiy. 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$ 17000 .00 and in up ort of this claim represents as follows: Q Wf a mounfi, dso W bore repair E%tjjmatLo tnvolcf as 1. When did the damage or injury occur`! (Give exact date and hour) AwI 5, �Owo at- 11, -30 01•m. 2. Where did the damage or injury occur? (Include city and county) i��rtlpez , c�nfifa cOs1"d covnfiy 3. How did the damage or injury occur? (Give full.details;use extra paper if required) coluptl \Iar wds PdctIry out °f FgOm loft 04 4N.Ct 4111 V @ b VAL. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? O svfq' W 0} to what WZ �erind ret. What are the names of county or district officers, servants, or employees causing the damage or injury? Kilo�Q'fI 7e'd TEPT S22 SEG 1N9WJdNUW ASIA ODD T2:ST 9000-6T-ddH 20;d}-iCiol , 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto dama e.) vowaue to oar drier &o rear door, rootos 010H. wa� in� o� r�� �lr Qs��mdfi� �n�o��Q 7. How -as ie amour clauna ed ove cornpu ed? (Include the estimated amount of any prospective. T-1 Wq___yesfi YMU grn0rfi of \09 0M. 00, S. Names and addresses of wi es doctors, and hospitals: Mar� shoQ'Tma Co[ , bt E&Co�dr, Martire2- . 3�11'���iZ .9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT, sfii�► wQifi �n� ®n rP�dir orf Orm a1-iap ■Oman■saaaa■■esants saasssaaa■■raaaaa•■s.■■■a•■■r■saarssssa•■■aasasrsa■■roil■■aawoman Rol ) .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 } � , staff Cervices. ?4n01Yst (Claimants Signature) 701 Third stmut, qg I -3m (Address) wesfi sacTgm erre cAg �or Telephone No. )Telephone No. 3.75 _ �QSt asuaaassaaassasaaasasa■saa■aa■■u■■■■■■■s■■•■■..■■a v■srass■•■as■ruaasaausassaa■aane 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■•ss■aaaa■.aasossBONN aaaso esaa.■ussaasessaraaaarsssaaBoston■■sass■■■■ssmonsoon■■■■1 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 xTiting, 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"1 1EPT S22 SEG 1N9WOHNUW ASIS 3D9 900E-GT-dJU C4,J, t C. 2 x e { h f a_ w ,_ 3, hf r t . fi T Y k+y !R Y ip,2k N 9Y i,.t} S * !T t AfS It I[�x t" 2", f +�" F�`.��rs;moi r. x���. ' ern "-5 t � yr yc'p f� � r �. SAY` A•y" 'y,�,f"S2' i kx�, ,� c�, : r 4 �'�8-E ��ilu._.`�d� t i�•fl fi �N��T^s»d xt4a�2h .1 i LM� b`R n n`� e a •1'mss - ✓�r G a c d� s � �4"i5tt S" L`i'fa mit t 4 3"at�Y fir« 5., s vat y -r f�nx ss x a,3; .�rf�e«+`xt- "t `L,.. .rpk,.a"5a �f2w's. �'i f x r h3 :. �d 'F4r+. .�' § t'`fit. Y + �3 �'tk�, wm }t x �,x _ -S..•'x�a. - s }x 4 1 s.. IR Mimi . x t S' "�' a G. i .�•_ <'f� �-, �, +rrr. .�a;� +�, k,ash�„�"h ' ,t "�n�e ��,s ��• �, � s �,,>s xr RTay{ 5�y���rp��s ��• T+�. r �r — �y �• 'ria `�� �����,#�ct5�.�s������a��' ,Yrs. w c s - CJ w S' co ^ cr ,. r CC U2 LA yew k. LA p G� L) !� 1' t CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY � 1r BOARD ACTION: MAY 23, 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 California Government Codes. ) you is your notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code AMOUNT: UNKNOWN APR 2 Section 913 and 915.4.Please note all 8 2006 "Warnings". CLAIMANT: PAUL,WILSON CMARTINEz OUNTY F. COUNSEL ATTORNEY: UNKNOWN DATE RECEIVED: APRIL 28, 2006 ADDRESS: 6602 CLAREMONr AVENUE, BY DELIVERY TO CLERK ON: APRIL 28, 2006 RICHMOND, CA 94805 BY MAIL POSTMARKED: APRIL 26, 2006 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, GI Dated: APRIL 28, 2006 By: Deputy r II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant.The Board cannot act for 15 days(Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). O Other: Dated: L{ � By: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel(1) County Administrator(2) O Claim was returned as untimely with notice to claimant(Section 911.3). 1V.,BOARD ORDER By unanimous vote of the Supervisors present: (Vf This Claim is rejected in full. O Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Date&'? - ,'240.'JOHN CULLEN,CLERK,By Ak/ eputy Clerk WARNI (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 courtaction 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:� aodc JOHN CULLEN,CLERK By Deputy Clerk f 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 propertyor 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 ft audulent claims,Penal.Code Sec.72 at the end of this form. a a sasa as as!I'm a sanaa■.■■a INN l Anna so am as a s eeus as sl Ila a G GG Cam a an s s ss,ass a a s a as a a%ai RE: Claim By: Reserved for Clerk's filing stamp ) Against the County of Contra Costa or ) '°R cCFRcoo�Av District) NTRa co`�'A (Fill in the name) 9S 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) 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) 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? U , _ ov-tom. _ _. .. AJA . t i 1 �r 1 r ' r , ,u1 r � i i, ,ter• 4t ,..,4 `fir' '� aT �j ,► lw AL , t S i q , i r F t ei 4 R� f ; .r r / + r ON ) + R r,#�,1. �.►.. -'•t 9�o o r r T' r /�� '•� � .' ��� `� �t� x � .m .., ��, "^ ' • � � � . � � t. � �/ .. at f` 1 �� r.. 4 t � I ♦ x; ,, i f f owl ,f\ �4- Al �k44 i t �t '�� f y a 4 �♦ i Air ., ,, ►: 1 . fcr. �a"`i,a •i"V� �" w l + a< a 4 + Q'1 i 4++ t r i � f 1 r � \ " ..rte' • i r • i �yyy� J � ♦r � ' ' ` j � T A J► �yy�+�`+ I i YR lop M* I f • i,�,• t +r i'��, •� 'ice � s � �'� ,�'�� • e . X11,''^a - i r ,.. _ � „-, . ,• i � �� -�. ��""; - , .� � j �� r �f 4y _� � �... � Y ������ v t� } .. �i J � ,�wy � �� � 1 .. ,� '""• �, •.�` �. ��� ?e - J - w + . yy r� ; } { t /yi! � �i 1 � 'YI 3. �� (� i y, _.may 4 `f .h 4 rt ..+�y�y,�[7 f r _' 1 t t f f ,� i r � � ,,' 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage:) CAX old- e o �C' Sl Y �r ,►�v���, 7. How was the amount claimed above computed? (Include the estimated amount of any prospective ujury 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 AMOUNT R a a a a a a CC K IS a C.0_a a it a it a a a 9 C a;a a a W,-1■nut an Iran run r aown■a r Q■a a a a a a Q■1 RRIERIVII WILUKKE as no a a of .Gov. Code Sec. 910.2 provides"The claim shall be signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney) 1 Name and address of Attorney (Claimant's Signature) e (Address) ) Telephone No. )Telephone No.(,S-(U ■aasasssaaaasaaa Ilan was no a IN a Nunn wasillsismaxfflt fix Nunn sasassasr PUBLIC RECORDS NOTICE: Please be advised that this claim form., or any claim filed with the County under the T ort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthermore, an), attachments, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. 0 sommuss a In no Kaska Room gas Real BERRI 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 imprisorunent and fine. 04/21/2006 at 10:13 AM Job Number: 78190 LA-TECH AUTO BODY License #:AB220122 Federal ID #:010637644 CUSTOMER SATISFACTION IS OUR #1 GOAL 2311 RHEEM AVENUE RICHMOND, CA 94804 (510) 234-5044 Fax: (510) 234-0642 PRELIMINARY ESTIMATE Written By: Adjuster: insured: paul Willson Claim # owner: paul willson Policy # Address: Deductible: Date of Loss: Day: (510) 326-2416 Type of Loss: Point of Impact: Inspect LA-TECH AUTO BODY Business: (510) 234-5044 Location: 2311 RHEEM AVENUE RICHMOND, CA 94804 Insurance Company: Days to Repair 2000 CADI ESCALADE AWD 8-5.7L-FI 4D UTV Int: VIN: UNK Lic: Prod Date: Odometer: Air Conditioning Rear Defogger Tilt Wheel Cruise Control intermittent Wipers Climate Control Keyless Entry Theft Deterrent/Alarm Rear Wiper Dual Mirrors Roof Console Woodgrain Luggage/Roof Rack Fog Lamps Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks Power Driver Seat Power Passenger Seat Power Mirrors AM Radio FM Radio Stereo Cassette Search/Seek Equalizer CD Player CD Changer/Stacker BOSE Radio Anti-Lock Brakes (4) Driver Air Bag Passenger Air Bag Positraction Leather Seats Bucket Seats Heated Seats Automatic Transmission 4 Wheel Drive Overdrive Aluminum/Alloy Wheels ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1 PILLARS, ROCKER & FLOOR 2 Repl RT Pad w/Denali, Escalade 1 109.74 3* Repl RT Extension front w/Denali, 1 60.99 1.0 1. 0 Escalade 4 Repl RT Mount bracket front 1 8 .07 ------------------------------------------------------------------------------- Subtotals =_> 178.80 1.0 1. 0 1 04/21/2006 at 10:13 AM Job Number: 78190 PRELIMINARY ESTIMATE 2000 CADI ESCALADE AWD 8-5.7L-FI 4D UTV Int: Parts 178 .80 Body Labor 1.0 hrs @ $ 68 .00/hr . 68.00 Paint Labor 1.0 hrs @ $ 68 . 00/hr 68 . 00 Paint Supplies 1.0 hrs @ $ 35.00/hr 35.00 ---------------------------------------------------- SUBTOTAL $ 349.80 Sales Tax $ 213. 80 @ 8 .7500% 18 .71 ---------------------------------------------------- GRAND TOTAL $ 368.51 ADJUSTMENTS: Deductible 0.00 -----_.---------------------------------------------- CUSTOMER PAY $ 0.00 INSURANCE PAY $ 368 .51 THIS ESTIMATE HAS BEEN PREPARED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. PART PRICES ARE SUBJECT TO INVOICE. ANY WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OF YOUR VEHICLE. THIS ESTIMATE DOES NOT INCLUDE COSTS OF REPAIRING ANY HIDDEN DAMAGE FOUND ON TEAR-DOWN. THIS BODY SHOP IS NOT RESPONSIBLE FOR ANY EXISTING UNRELATED PRIOR DAMAGE OTHER THAN STATED ON THIS ESTIMATE OF REPAIR. ***NOTICE*** DUE TO MANY UNFORSEEN CIRCUMSTANCES IN THE REPAIRING OF AUTOMOBILES, WE REGRET THAT WE CAN ONLY ESTIMATE, NOT PROMISE, A COMPLETION TIME. YOUR UNDERSTANDING IS GREATLY APPRECIATED! 2 04/21/2006 at 10: 13 AM Job Number: 78190 PRELIMINARY ESTIMATE 2000 CADI ESCALADE AWD 8-5.7L-FI 4D UTV Int: FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM: ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES: B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS: ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT 0/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART COMP REPL PARTS==COMPETITIVE REPLACEMENT PARTS RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT W/ =WITH/ SYMBOLS: #=MANUAL LINE ENTRY *=OTHER [IE. .MOTORS DATABASE INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. MQVP=MANUFACTURER'S QUALIFICATION AND VALIDATION PROGRAM. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide DRIGC92 Database Date 04/2006, CCC Data Date 04/2006, and the parts selected are OEM-parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM (Optional OEM) parts are OEM parts that may be provided by or through alternate sources other than the OE/Vehicle dealerships. OPT OEM parts may reflect some specific, special, or unique pricing or discount. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign (-) items indicate MOTOR Not-Included Labor operations. Non-Original Equipment Manufacturer aftermarket parts are described as AM, Qual Repl Parts or Comp Repl Parts which stands for -Competitive Replacement Parts. Used parts are described as LKQ, Qual Recy Parts, RCY, or USED. Reconditioned parts are described as Recon. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not included. Pound sign (#) items indicate manual entries. Some 2006 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts data from the previous year may be used. The Pathways estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. CCC Pathways - A product of CCC Information Services Inc. 3 04/21/2006 at 09: 01 AM Job Number: 8393,4 CONTINENTAL AUTO BODY & PAINT WORKS License # :AF228187 Federal Ib # : 481305743 1011 San Pablo Ave Albany, CA 94706 (510) 524-0563 Fax: (510) 524-0934 PRELIMINARY ESTIMATE Written By: Jose Carrillo Adjuster: Insured: PAUL WILSON Claim # Owner: PAUL WILSON Policy # Address: Deductible: Date of Loss: Cellular: (510) 326-2416 Type of Loss: Point of Impact: 3 . Right T-Bone (R Inspect CONTINENTAL AUTO BODY & PAINT WO Business: (510) 524-0563 Location: 1011 San Pablo Ave Albany, CA 94706 Insurance Company: Days to Repair 2000 CADI ESCALADE AWD 8-5 . 7L-FI 4D UTV Int: VIN: 1GYEK63R9YR191786 Lic: Prod Date: Odometer: Air Conditioning Rear Defogger Tilt Wheel Cruise Control Intermittent Wipers Climate Control Keyless Entry Theft Deterrent/Alarm Rear Wiper Dual Mirrors Roof Console Woodgrain Luggage/Roof Rack Fog Lamps C1ear ,Coat Paint Power Steering Power Brakes Power Windows Power Locks Power Driver Seat Power Passenger Seat Power Mirrors Anti-Lock Brakes (4) Driver Air Bag Passenger Air Bag Positraction Leather Seats Bucket Seats Heated Seats Aluminum/Alloy Wheels -------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ---------------------------------------------------7---------------------------- 1 PILLARS,. ROCKER & FLOOR 2 Repl RT Extension front w/Denali, 1 60 . 99 Escalade 3 Repl RT Pad w/Denali, Escalade 1 109. 74 4 Repl RT Mount bracket front 1 8 . 07 5 Repl RT Front molding 1 311 . 17 ------------------------------------------------------------------------------- Subtotals =_> 489. 97 0 . 0 0. 0 1 04/21/2006 at 09:01 AM Job Number: 83931 '- PRELIMINARY ESTIMATE 2000 CADI ESCALADE AWD 8-5 . 7L-FI 4D UTV Int: Parts 489. 97 ---------------------------------------------------- SUBTOTAL $ 489. 97 Sales Tax $ 489. 97 @ 8 . 7500% 42 . 87 ----------------------------------------------------- GRAND TOTAL $ 532 . 84 ADJUSTMENTS: Deductible 0. 00 ---------------------------------------------------- CUSTOMER PAY $ 0. 00 INSURANCE PAY $ 532 . 84 The above estimate is based on our inspection and does not cover additional parts or labor which may be required after the work has started. Worn or damage parts, not evident on first inspection, may be discovered and you will be contacted for authorization for additional work. Parts prices are subject to change without notice. ACKNOWLEDGEMENT: I have read and understand the above estimate and authorize repair service to be performed, including sublet work and acknowledge receipt of this estimate. An express mechanics lien is hereby acknowleged on the above vehicle to -secure the amount of repairs therto. This work Authorized By: Signed: Date: Work Accepted By: Signed: Date: 2 04/21/2006 at 09: 01 AM Job Number: 8393.;, PRELIMINARY ESTIMATE 2000 CADI ESCALADE AWD 8-5 . 7L-FI 4D UTV Int: FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM: ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES: B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS: ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT 0/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT W/ =WITH/ SYMBOLS: #=MANUAL LINE ENTRY *=OTHER [IE. .MOTORS DATABASE INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. MQVP=MANUFACTURER' S QUALIFICATION AND VALIDATION PROGRAM. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING'OR DISCOUNT. Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide DRIGC92 Database Date 04/2006, CCC Data Date 04/2006, and the parts selected are OEM-parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. Asterisk (*) or Double Ast=erisk (**) indicates that the parts and/or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign (-) items indicate MOTOR Not-Included Labor operations. Non-Original Equipment Manufacturer aftermarket parts are described as AM, Qual Repl Parts or Comp Repl Parts which stands for Competitive Replacement Parts. Used parts are described as LKQ, Qual Recy Parts, RCY, or USED. Reconditioned parts are described as Recon. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not included. Pound sign (ft) items indicate manual entries. Some parts tha� are described as AM, Qual Repl Parts or Comp Repl Parts may be OE Surplus parts or other OE parts offered at a special pricing discount. For further clarification please review the Suppliers List attached to this estimate, .or consult the appraiser or estimator. Some 2006 vehicles contain minor changes from the previous year. For those vehicles, pr--or to receiving updated data from the vehicle manufacturer, labor and parts data from the previous year may be used. The Pathways estiinaLor has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. CCC Pathways - A product of CCC Information Services Inc. 3 r t 'E2 .r C pm z.00 p -A MO '10 14) LA V ` cLArnl BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: MAY 23, 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 California Government Codes. ) you is your notice of the action taken 1110 "I'm\j3 on your claim by the Board of Supervisors. (Paragraph IV below), APR 2 8 2005 given Pursuant to Government Code AMOUNT: UNKNOWN COUNTY COUNSEL. Section 913 and 915.4.Please note all MARTINEZ CALIF. "Warnings". CLAIMANT: DAVID WILKES T-23206 D-1-45 ATTORNEY: UNKNOWN DATE RECEIVED: APRIL 28, 2006 ADDRESS: SAN QUENTIN PRISON BY DELIVERY TO CLERK ON: APRIL 28, 2006 SAN QUENTIN, CA 94964 BY MAIL POSTMARKED: APRIL 26, 2006 FROM: Clerk of the Board of Supervisors TO: County.Counsel Attached is a copy of the above-noted claim. APRIL 28, 2006 JOINCULLEN, Dated: By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Sup rvisors (v)'*'This claim complies substantially with Sections 910 and 910.2. ( ) This Claim PAILS 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). (4-Ofher: The rr Co -4, I orz � �v rV tSerS f / o Rt AMo17 Dated: By: m C4�:� Deputy County Counsel I1I. FROM: Clerk of the Board TO: County Counsel(1) County Administrator(2) O Claim was returned as untimely with notice to claimant(Section 911.3)- IV. D ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full O Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated:m 4f!?, JOHN CULLEN,CLERK,By Deputy Clerk WARNI (Gov. code section 913) —Y' 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 clai►it.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 attonuey,you should do so omnediately. *F'orAdditional 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 Alartinei, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant,addressed to the claimant as shown above. :Dated: >72W _��o JOHN CULLEN,CLERK By eputy Clerk �TEWAL C®DE 83201 C IyLL—'i�iGHrs crrxzE-d Co-IVP-IA-rAIE Too TW.�_P� . _.D_oF S�IP_�viS���_`E��-TNS�t_r_y�F �cMr_►�oN�� � o F o_�a�i ►J.i.i.K T 23206)SAN-Qu N_T_�:N�lr�NSAN duEN_rr.N,ca9_y9_�y : _NTR-k Co5Tq, c0tI T. BAR® of -6uPEk_v_i_6oR5o MAyo_IK,of Pichr nd- v< ` yAU arA-hareL noi. ed;aha- ,_Dfl�iD_►�iI.K�_S,_ DISABLED CrTiZEN,_od _(N &�N42- uSC 13 ` av_E_a_f: I�f�'o NC�T _IJ.f_te� CRUEL dijS11E�1._T Ni5hu�7eI.t t �i5_�ir'liwif,��. _to,�_c►� ,`u�rdet- CoI,QP of �� hori�'yo l _CGN:i$ -,lel , 6 ecf, sfafeC��IN (93Z�e f©- R�chrnonj PSD o�ncEP._S_�To�Ti�cKS®I�( X378)-CG�iv�n'i#1343),(Z %D_AIJ_� AsFRMicNAE.L),(cS oIFF_iSERS_D-dQT�_AN(�C�ooIZE) f�R#Ob-1_T.z95�9AII.ow.E.D_R_�,.1_ r _M�ND vro/Rr_ioido The/ cRiM—scOED!c-*NcE-�Li-kVf_iW- C_E_TA-PE T`4JH.s�/S�aDi:5�'+� LY,��A_C/IiA�.Y, 8r;_urAL�i—�'�TEnI,_Ki_CKED,_C.hloK_€D-o_ulT�'CA1l_�D_N!����'��y THS' STORE ASST MA ��� LP�EMPI_�YEE ecTW meq sTo a "�NoTC6 WERE TAKE8(�_ -b�_C 6P��o�' B►,o��!GoLF'6Ai�I��.i.z.E l3uMf�,��could NOT WAI._i�.,_r_�.e i�'I��I_t�c�.�JbCE' � s�Rt —r_o o�s�Nos��1Ab soy,r rhe �T00iC Fx7�y_S of m_y 9 swau _ -T-' il-M�/ AP!Y)o -6-f i,I Wil How th0I, 5fi.l_ID�er from is-,- t-4%i... zy Dr_i-v_E FSP_ Tal C�l.�i fried fo s_QP 7e�ep WHER Fo��m I ANI(� O� MENrAL� i II9�eaD)N.i I_{_�Ior 6.als_WE�_My coMPeain�'S�I c% EST!.-To-ft Bl�TCER.CNA��.ES�c 4is WQ.. s"ee_STo�E e .�o SIA is arc sro 1,36-5g So�RE CA FU7�c!j �d�. _ Cc�M_PI.A� DE P T_o_�' eo—dL,0 E o3i sT . ATM ? i.5,s TORE NQS A:His o��!_OF BEATi.�I�_S�S�ECTE_D sNaPLLr_PS. Ar J. I o° �P _DANT NI�V� fi-. uN I) CN9D-OT 1e_ Coag r fe S -o_ ri n_rJ_e17 10 T_. eiVat�ARREST RELiEE �Yrot�Cf IyTN LLM aMN � T_ Ilo►�__E T A_ iD TNF_T' CN �C � aJE_ o, d oR_mE BEcouL the_ 5AW TNS uTN o `oho-T H- ff 7P-7i—BE i0-BEAR- 09 Tho R .VE_SAVE T_ �. eeviL c® _FoLd �� � �o TN_�.s_c ►� i��Nr"�E:�-U �r co�X— RECEIVED APR 2 8 2006 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO- DEA , CLERK '&AR- of SliPfvlsocs �ACHEb i`j—& comp) iyr mo TwE MA-®P OF :EPI.EASE—Eic�(APDTo-ApProP;-ArE.D_�Pr- 71 M_E_�ECi g' ? /i11(D a n A OF cu, 0m_c- G e S ` a cs =3 'iii a b 9 41 ri+ r QL oc a� � t o d ► � v r 1 ii 2 2 CLAIM n • BOARD OF SUPER`7ISORS OF CONTRA COSTA COUNTY BOARD ACTION: MAY 23, 2006 Claim Against the County,or Distridt 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 California Government Codes; )ms C�gd�� you is your,notice of the action taken on your claim by the Board of u t'/ Supervisors. (Paragraph IV below), APR 212006 given Pursuant to Government Code Section.913 and 91.5.4.Please note all AMOUNT: $239.81 COUNTY COUNSEL "Warnings". MARTINEZ CALIF, CLAIMANT: KENNIESHA COOPER ATTORNEY: UNKNOWN' DATE RECEIVED: APRIL 26, 2006 ADDRESS: 1460 B, HUMPH DRIVE BY DELIVERY TO CLERK ON: APRIL 27, 2006 SUISUN, CA 94585 RECEIVED TMU INTER BY MAIL POSTMARKED: OFFICE MATT - RISK MANAGEMENT FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, le Dated: APRIL 27, 2006 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Su ervisors (t, 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). 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). O Other: Dated: d2 � By: C�puty County Counsel III. FROM: Clerk of the Board TO: ` County Counsel(1) County Administrator(2) O 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:57A �,6W4JOHN CULLEN,CLERK,By. _ Deputy Clerk WARN (Gov.-code section 913) 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: �/' °?� JOHN CULLEN,CLERK B Deputy Clerk <, BOA.RD OF STJI'ERVISCIPRS OF CONTRA,COSrl'A COU11'TY XfjaIRUC'Z'JQNS TO .A. claim relating to a cane: of action for death or for injury to person or to persons 1 property of growiug crops shall be. pzese:nted not later than six months after the accrual of the cans(, of action. A claim relating to any other c2cuse of action shall be,presevted nGt lir than one year . after the accrual of the caiusn cf action. (Gov: Code § 911.2.) Claims must be filed with the Clerks of the Board of Supervi:,ors at its office is Room 106, County Administration Budding,651 :Dine Street,Martinet CA 94553. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled irk. If the claim is against more -Ihm one public entity, separate claims must be filed against each, public entity. F-mud. See penalty for fraudulent claim,Penal Code Sec, 72 at the end of this form. ■0 R1ata■a■aaaaRRala a ala al raa7alitaamail a■RRRaa■t■aaat■alit RbQQARa RRa■iR as tltiaa■ad RI B: Claim By. Reserved for Clerk's flag stamp RECEIVED Uasimt tihc County of Contra CoE:� or ) APR 2 6 2006 Penny Bailey CLERK BOARD OF SUPERVISORS APR 2 5 2006 CONTRA COSTA CO. Fill in itke name) ) y ,he undersigned claix S L hereby makes claim.against th."County of Coa�-a Costa or the above-named astrict in the sum of$ �?. q `fir _and ill support of this claim represents as follows: Whend the damage or injury o ccw:? (Give exact date and hoia) L4TIz10 (.r, 6- art u-v d t':co Pte, '.. Where did the damage or ux ury occur? (Include city and countl) , i'_I � tq.��} 4'b 1U a0Y-% c�r4 0—a r:'►� ''o�1Cc'�� �v r)t� Clg :�� J-W (AT ri 3. How did the damage or i imy occue':�- (Give full details;use extra paper if required} o,4— r + qq 1 �. What particular act or oro�,_�iotf on t:b e:part of cotimty or dis�tn.et officers, servants, or employees 9 caused the inju-,y or dmna.ge? . T4 rc�j ? 5 What are the names of county or dim ict officers,servants,or=ployees causing the damage or injury? 20'd TZVI Scc ses 1N3WJdNtu >151a 333 0b:07 9002=0-8dd 6. What damage or injuries do your -rami resulted? (Give full extent of injmies or damages claimed. -Atiachtwo estimates for allsto damage:) - i�nh `r rti� l i Y� ' C�y,,w►2 ' 0,�y �vt�u�- 5 daw was cley��.Thu m GeX S�— ' �1��4 pFF. 7. How w the amount claimed above computed? (Include the estimated amount of any pxospec-five injury or daarvoi;e,) �� Cad �a��In►�:y � 02��� r S. Names and addresses of vaitaesses,coctors,Find.hospitals: Nonf.� 9. List the expenditures yau.rna&on&,-count of this accident or injury: DATE ME MKIME zcgab-aa�-157)0 �jLQ '�'� ��Q /��, fir, �Pf�u;�e '�23oc •ssscs■■■■■■rtos■■ssAr sirsas�P^y.as �sn�■■■sirs■s■■w■.ossa �srRfi .s■Csr ■a a",s _ .G ov. Code Sec. 910.2 provides"-11e:claim.shall be e rtes vv+ 2N�Di —`l75 13 sigmed by the claimant or by some person on his SEND NOTICES TO: (Attorzie_y) Name and address of Attorney ) Claimant's Signature) (Addn'ss) ./(I p _ ( W Telephone No. )T';:lephoneNo. b� > s■■arrasaaasa■araasau exam.mi,u■araulsrr■raasa■as■aaaaras■■aaaltaaaarrrraaa■■■sasrsraast PUSL'l;C RECORDS NOTICE: Pleuro be advised that this claim:Soros, or any ,.lain filed with the Co=ty under the Tort Claims Act, is subject to public disclosure under the Califoraia Public, P.aoords Act, (Gov. Codi, S5 6500 et seq.) Furthermore, an7 attaeb�meuts,addeadums,orsuppl�ouents attar'liedtothe claim form,includuag=dical records, are also subject to public disclosure. aa=%mum araaaa■•arasrsa■rltrs■mar■LAI 11a7p■Stamm aasaasaMUM asr.aaa■rrssMalta r■aFIX■aa■a■■.■art . l�oTl`cE: Section 72 of the Penal Code provide Every person who,with intent to d elraud,pre,5ents for allowance or for payment to any staf-board or officer,or to any county, city, or district hoard or offi=, auffiorized to aLlow or pay tl:c same if ganuine, any false or fraudulent claim,bill, account voucher, or wri6i&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 do1ars ($1,000.00), or by both such imprisonment and fixe, or by imprisonment!n the state prison, by a fine of net exceeding t= thousand dollars (510,000),or by both such impiisoumeut and fine. Za'd TZVT SEE SZ6 1N3WJbNUW ASl:?l ZM 0b:OT 9002-£T-&dd �L- Ilk GBI Clmtnga Drive 671 Or-3mga DFivo Vacmwllki,CA 95687 Vacaville,CA 95687 (707)449-8900 (707)455-4500 EPA#CAL00014857e EPA#CAL000224187 SAFqtl xk[)I63427 SAS#AD216027 ;UaT<r.40 NO. INVOICEN1,_198 4685Tt NO,2 WALTER AMELING 6 3902 'IZIM106 CHCS 953 MlLskw 630 979 "SLUE/I KENNIESHA W COOPER—GlIDEPINGS COW 1456 A HUMPHERY DR. 7.W I MAKF�MODEL OELIVE7 642"44,65164 FAIRFIELD, CA 94585 1,?00DGEjlNTP.EPID/4D - vl�11CLE Lo PR...... DN DATE SOH 0 4 6 R 4 4 R 6 f5 1 8 1 4 F, E.iqo, P.C.Mol r RAR*�AQ91 639.7.8 CUSTOMERI.kRiOY.'MAdkbGES;RECb VING. �ORIGINAL ESTIMATE OF $§h 00' 1�,YO.�;66:REVISED:ESTIMATE 17:OIF,', 3239 95 TkQ ON ,r, KCOOPER- J COMMENTS TOTALS' ....... ...... ....... �*r'NEXT-(RECO.ftNDEO':.�SERVICE-", *;0610612006 11111166978 Mil 26CHZ-LdF CODE ` .4: A II II F To J :WE HERE:ATMOGE',CHRYSLER,JEEP OF VX AQ'LLE- r :.,TOTAL l.LABOR, - ANO,iNISSAN,OF VACAVILLE LOOK FORWARD Td,RRQVIDIN(� Tk j. S.;.,1:4 52:95' 'S-UBtJ.7.' [YOU AND YOUR VEHICLE WITH CONTINUOUS. QUALITY SERNkL .00 -40TA Si ii L G.,Q,. TOTAL MIS(-:,CH5-;ll. 0400 TOTAL MEO ib$SJV4;3"ipk,f -0 00 N, '"OPEN SATIJ00AY"t" : :, IF.. I-., .i.. 1. 1. .., TOTAL.TAX`.� 3 `W an; i To I 1-acknow' gei rci-�ce di4 oral ior�plo4j;of ntrease ir TIAL, NNF.NbEit 39 e�,'odginal:eitimaud-price. ii II 1 ETOM'FR."SIGN RE iiMM PR; V I sh - i.: M. M4 d! 4 d p 1, 'J 4-: 4. % q ,c6m I. I Z j, L ,PAGE.20F2 C cils1rol"IER 0 Nval E J.104,45 Char i• 4 •, .I I I' i �• v9" :x`5 P1 ts'"a`�, .r a; ,•�'';+ �'�,, r�. 6 r. r � ry,, � r'"t f"'" I` y �h:l3atf;`�.�f�h�,'�b "� d a+tJ�y+r��,r.. r �;r;a. i.'i 1 � �,• .�."�r tMf S ,�eE ��°;�9 r�rrf Kt,,�`.t F I t�' i�l'�??�'`''r..���^47 Cyt ,� "��. '� � l c3'`-� � � r ��. ,6 r1. 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",>�'� ''?;.SA�a r �s:�I.. r .,�� .,.�7' � �y�°1., i i,.�,�A11f;�•/^ •.��i.' ,1 }}�1 4}-j<'^�jt.',lx�i3 t"� 4Fxyy��XSi��� f�jr�('.1��p�( �r�r;�. :� 1 ra�i + � .�} 7 µM .� ,,��;li��� •� a r�yr'gs�9�;1 �' � �'�,� h �,.�{.`Y�,r�t���u�t�l^. ,i ,'.;;.r4-9 i^"^::,.."1���,.0^� � �e"" �g ��+ t��"� It f 7 •'tf� d t'{'.,J'}{J�,.'�.+{'rf���.��'�,!�1�I +,TL•°,y0l�}4 �ryu r G+yc.MtiF�h}fe�Auret1', 1 t +�,�5�l��e M"3 Or k(,I f!r,..�1 F.y�I:�h�iiUr'��,'�dS��aIl7d��q �i(.,�trt,%�ditl,y"��pi�:rrJ11:1,+y�Rj�i'�' ��"J�;�riarl„���b'�)`�!'�ll� ��3..{�"trti,.+"j,�lr b�T¢,Fy���}5t7;�N�...�..rd.x:.1y}'4u�k'�G w�r�@I5R!:�r�•3,,�3:'�t�f`. �f:r;��t�y,�fi"t7 •'pa AMENDED CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY i BOARD ACTION: MAY 23, 2006 j I 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. 20 91HI j notice of the action taken on your claim by the L4�°J Board of Supervisors.(Paragraph N below),given MAY 12 2006 Pursuant to Government Code Section 913 and 915.4. Please note all"Warnings". COUNTY COUNSEL AMOUNT: UNKNOWN MARTINEZ CALIF. DATE RECEIVED: MAY 11, 2006 CLAIMANT: SYPHANH NITIVONG V 13801 I - H - 84 L BY DELIVERY TO CLERK ON: MAY 11, 2006 ATTORNEY: UNKNOWN BY MAIL POSTMARKED: MAY 10, 2006 ADDRESS: SAN QUENTIN STATE PRISON SAN QUENTIN, CA 94974 FROM: Clerk of the Board of Supervisors TO`. County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN,C c Dated: MAY11, 2006 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of SupervisorT (Vfhis claim complies substantially with Sections 910 and 910.2. O 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). O Other: Dated: 0(,p By: ✓n Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel(1) County Administrator(2) O Claim was returned as untimely with notice to claimant(Section 911.3). IV. $PARD ORDER: By unanimous vote of the Supervisors present: (t)/ This Claim is rejected in full. O 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 e4 Deputy Clerk WARN 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 shoulddo go 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: 094WJOHN CULLEN,CLERK By �' f Deputy Clerk BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY Apri - ,j INSTRUCTIONS TO CLAIMANTJ (f A. A claim relating to a cause of action f'or death or for injury to pe'son or to personal property or growing crops shall be presented not: later than six months aft r the accrual of the cause of action. A claim relating to any other cause of action shall be pre ented 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. was■■■■r■■r■■■■■■r■■■•■■■mass■■■gas rr■■r•■■■s■r■■ra■■ r■r■■■now aI RE: Claim By: Reserved for Clerk's filing stamp A ai t the Co of Cont a Cos ��1 District) �4 (Fill ' e name) ) j 75 ,� The undersigned claimant h eby 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 occurs (Give exact date and hour) �bd&&Jk 1F " �f A^AA-TW M 2. Where did the damage or injury cur? (Include city and county) 3. How did the age or injury occur? (Gi e 1 details use ex a er if required) /r � �F � 5`l�Cc. c� 1 � /;Aca �' tf 4v ll(* ACC/ 4. What parti act or omission on. the part of county or district o facers, ervants, or employees caused the injury or damage?dC F�' � 5 What are the names of county or district officers, servants, or employees causing tie damage or injury? 1� 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates�fo�rc a�to a age.) 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: a -L��� , 9. List the expenditures you made on account of this acct ent or injury: DATE TIME AMOUNT man■■■■■Nussbaum mom was moo■Noun■•■■■■Nam■■■■■■■■■■■■■■■■■■■■■■mass■■■■■■now ■■■■■•■■■■ Gov. Code Sec. 910.2 provides "The claim shall be signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney) 1 Name and address of Attorney ) (Claimant's Signature) O 5A d G ) (Address) )_ A&44 _ M 1Y 7 Y� Telephone No. ) Telephone No. 1 EPSON■■■■■■■■■■NOOSE■■■■■■■�■■■■■■■i■■■■■■■■■■■■■■■■■■1.8000�■■■ ■106a0 0■■ 0■■■■■■■■1 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. ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■•■■■.■■■■■■•r■■■■■■t 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. ■ - o - ate REQ ® • • - • MAY 7 1 2006 F 9�r3 OF my. . Claim No.: I request a fee waiver so that I do not have to pay the$25 fee to file a government claim with the Victim Compensation and Government Claims Board. I cannot pay any part of the fee. Claimant Information 0 S�/�NRNf/ Nr ;1/eNG; V-138x! © 1 Tel: Last name First Name M/ © 1 Claim Number(if known): Em to ment Information 0 My occupation: -My employer: Employer's Mailing Address City State Zip My spouse's or partner's employer: Employer's Mailing Address City State Zip If you are an inmate in a correctional facility, please attach a certified copy of your trust account balance, enter your inmate identification number below and Skip to step �. Inmate Identification Number.' Financial Information I am receiving financial assistance from one or more of the following programs. Yes No If no, proceed to step If yes, check all that apply,then skip to ste SSI and SSP: Supplemental Security Income and State Supplemental Payments Programs CaIWORKS: California Work Opportunity and Responsibility to Kids Act Food Stamps County Relief, General Ralief(GR), or General Assisiance (GA) © Number in my household and my gross monthly household income,if it is the following amount or less: Number Monthly family income Number Monthly family income 1 $969.79 © 6 - $2,626.04 0 ❑ 2 $1,301.04 _ 7 $2,957.29 0 [_ 3 $1,632.29 © 8 $3,288.54 0 4 $1,963.54 0 There are more than 8 people in my family 5 $2,294.79 Add $331.25 for each additional person. Number: Total Income: If you checked a box in step 0 Athrough I, complete steps 0 through (D. Then skip to step My income is not enough to pay for the common necessities of life for me10 Yes No and the people in my family, and also pay the filing fee. --- If yes,fill in ste s0 through 12). State of California Sovernment'ClaimsTorm P.O.California Victim Compensation a nd Government Claims Board Box 3036 Sacramento, CA 25812.3035 For Office _ . . Use Only Claim No.: Is your claim complete? Q New!Include a check or money order for$25 payable to the State of California. Complete all sections relating to this claim and sign the form. Please print or type all information. Attach receipts, bills, estimates or other documents that back up your claim. Include two copies of this form and all the attached documents with the original. Claimant Information 0 ' a -a&t © Tel: Last name First Name I M/ a Email: Mailing Address City State Zip Best time and way to reach you: p�e✓L Is the claimant under 18? Yes © No If YES, give date of birth: 0 MM DD YYYY Attorney or Representative Information Yn Pro Pei 0 Tel: Last name First Name I MI Email: iV Mailing Address City State Zip Relationship to claimant: Claim Information Is your claim for a stale-dated warrant(uncashed check)or unredeemed bond? Yes '71' No State agency that issued the warrant: If NO, continue to Ste ®. Dollar amount of warrant: Date of issue: 0 Proceed to Ste a I MM DD YYYY ® Date of Incident: Was the incident more than six months ago? YesNo If YES, did you attach a separate sheet with an explanation for the late filing? B Yes 8 No State a encies or employees against whom this claim is filed: Dollar amount of claim: If the amount is more than $10,000, indicate the type [Limited civil case ($25,000 or less) of civil case: I ❑ Non-limited civil case over$25,000 Explain how you calculated the amount: t e r IN MI. _ I SIM, FOR mwv�v SYPHANH NITIVONG CSP SAN QUENTIN SAN QUENTIN, CA 94974 APRIL 7, 2006 TO WHOM IT MAY CONCERN: MY NAME IS SYPHANH NITIVONG.. -I AM FILING A CLAIM WITH THE COUNTY OF CONTRA COSTA. THE SITUATION 1. AM IN IS -SERIOUS, DETRIMENTAL TO MY HEALTH, AND PRECARIOUS. IN NOVEMBER 2005 , I WAS INC'.ARCERATED AT THE WEST COUNTY DETENTION FACILITY 'IN CONTRA COSTA COUNTY.. ON NOVEMBER 18, 2005 , I WAS BEING' TRANSFERRED. BY BUS WITH NUMEROUS OTHER INMATES. TO THE COURT HOUSE IN MARTINEZ. ' ON THE WAY, THE BUS GOT INTO AN ACCIDENT IN WHICH I WAS ' SERIOUSLY INJURED. THE RESPONSE TIME TO MY INJURIES HOWEVER, WAS :VERY NEGLIGABLE. I WAS NOT SEEN BY ANY MEDICAL STAFF AND NO X-RAYS WERE TAKEN THAT DAY. ONLY SEVERAL DAYS LATER, WAS I FINALLY SEEN BY MEDICAL STAFF. I SUFFERED FROM SEVERE PAIN IN MY BACK, NECK, . ELBOW, SHOULDER, AND LEG. EVEN AFTER I WAS SEEN BY A DOCTOR, THE SEVERITY OF MY PAIN CONTINUED. TODAY, I AM STILL IN . ALOT OF PAIN. I WOULD LIKE TO BE CONPENSATED FOR PAIN AND SUFFERING, CAUSED AS A DIRECT RESULT FROM THIS ACCIDENT. SI CER LY SYPHANH NITIVONG • � ISI�7 i a r. Y .h • F CODoo N P--4 `_°O aswo C)w fl Wfn o� cc E'! R -.a OL c_ 3 ter. liiED 5 V-71 cl VA v A n ty- � �� �LL..r✓// y �� 4 AMENDED CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA:COUNTY BOARD ACTION: MAY 23, 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 California Government Codes. you is your notice of the action taken jxgmy� .lo.your claim by the Board of Supervisors. (Paragraph IV below), MAY 12 D 200& given Pursuant to Government Code COUNTY'COUNSEL Section 913 and 915.4.Please note all AMOUNT: UNKNOWN "Warnings". MARTINEZ CALIF. CLAIMANT: DAVID WILKES T-23206 D-1-45 ATTORNEY: UNKNOWN, DATE RECEIVED: MAY 12, 2006 ADDRESS: SAN QUENTIN PRISON BY DELIVERY TO CLERK ON: MAY 12, 2006 SAN QUENTIN, CA 94964 BY MAIL POSTMARKED: MAY 11, 2006 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. MAY 12, 2006 JOHN CULLEN, r Dated: _ By: Deputy IL FROM: County Counsel TO: Clerk of the Board of Sup rvisor (✓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). (VKOther: 7Ile Ct.4-LArn_�nal and t-k ?1O'(tec t" ....X� / 1 Pe_p&r WI//e�� at- S�GDAlti 1— pqbIIL e/!h4q Orr? LOn7Y� Dated: By: //m Deputy County Counsel 11I. FROM: Clerk of the Board TO: County Counsel(1) County Administrator(2) O Claim was returned as untimely with notice to claimant(Section 911.3). IV. ARD ORDER: By unanimous vote of the Supervisors present: (I<This Claim is rejected in full. O Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated' -M. �tA OHN CULLEN,CLERK,By Deputy Clerk WARNIN (Gov. code section 913) ' Subject to certain exceptions,you have only silt(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.Von may seek the advice of an attorney of.your-choice in connection with this matter.if you want to consult an i 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 NoticeQ to Claimant,addressed to the claimant as shown above. Dated: JOHN CULLEN,CLERK By Deputy Clerk Ia { I ° DA I"D WMES 232-0L,� 4"T,d �l-50a q � RECEIVE® SAN 6MEIMN, CA,qft y. MAY 1 ? 2006 i CLERK BOARD OFSUPERVISORS a CONTRA COSTA CO. ' CAFFMAVI T or DAvr D WrL ICES] i - io r, D;Avf0 t4l116 S, Do DECIME rNl: rollor<mc. 10 T WAS informed BY arlx LrohAl ['u//N m corrP /i)/ ,,7/ 1z on MR412314. `flfASf Allo, me Io AMEND;add new D15c'6VEf,Y k ihe- or't7oL 1 C07 PiT 0L � ec' t5 -re tFCC of CirY A'TIa,PryrZ 14 10Ty OF RbHMoND Ig0j M9AkkA WAY 60"M, -i�© -SOX *Y6e R;4W1 1, CAY ►s tyro)W- bsr�# T�K;SIYA A- . AJJo£' Ass,c,rY A-TraeagY.)W rofE My AMP.NE)l CMOS r;N£ Ae£iq 16 4iy64-467j. C'fuOTEp THE kECofD you sE'E< DoEs Nor Exsr 1wiplEAl r/E(j.PD� NoR 15 aN �.. 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