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HomeMy WebLinkAboutMINUTES - 06132006 - C.28 (2) V Cr t` in C C3 o `- l i 1 1 1 1 o Q� cit C i C) 0 Q z � J D_ CIS ca 1 -��z r cI_,AI.n'l VBOARD OF SUPERVISORS OF CONTRA COSTA COUNTYO. BOARD ACTION: JUNE 13, 2006 Claim Against the Count}, or District Governed by ) the Board of Supervisors, Routing.Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) 'l'he copy of this document mailed to California Government.Codes. ) you is your notice of the action taken . on your claim by the Board of CLAIM AGAINST THE OFFICE OF REVEIVE COLLECTIONS Supervisors. (.Paragraph IN below), 29guy nPursuant to Government Code Al\10[_1N"I : Sect 'on 913 and 915.4. Please note all �7,500.0o MAY 122006 CLAIMNNT: VIRGINIA FULLER COUNTY COUNSEL MARTIN zz MAY 12 A"l TORNEY: UNKNOWN DT1�LCit-:ElVED: , 2006 ADDRESS: P.O. BOX 1111BY DELIVERY TO CLERK ON: MAY 12, 2006 PINOLE, CA 94564-3111 BY MAIL POSTMARKED: MAY 11, 2006 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claire. MAY 12, 2006 JOHN CULLEN, C. Dated: i By: Deputy 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. f ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 1.5 days (Section 910.8). ( j Clainr is not limely tiled. 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 91 1.3). O Other: .Dated �r � I By: ` v r Deputy County Counsel Il. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( )-- Clainr was returned as untimely with notice to claimant (Section 911.3). IVOARD ORDER: By unanrous vote of the Supervisors resent: ( This Clainr is rejected inf lll. ( j Other: certify that this is a true and correct copy of the Board's Order entered in its minutes for . this date. I Dated-\4"e- -44 — M HN CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6)months from the date this uotice was personally served or deposited in the mail to file a court action on this claim.See Governrnent Code Section 945.6.You may seek the advice of an attorney of your choice iu connection with this matter. If you want to consult an attorney,you shordd do so immediately. *For Additional Waruing See Reverse Side of Ibis Notice. AFFIDAVI'C OF MAILING 1 declare under penalty of per 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 l'ostal Service in nlartin!ez. California, postage fully prepaid a certified copy of this Board Order and Nolice.to Claimant, addressed to the claimant as shown above. Daled:vev_ d, o?.d��l?(1N ('UI_.I_I'N, ('L,I IZI� (3}' _ _ _ — _ _ 7epuly Clerk I I I i 04/27/FO06 08:51 CONTRA COSTA COUNTY CLERK OF THE � 915107585854 NO.067 901 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A_ A claim relating to a cause of action for death or for injury to person or to personal property or growing crops shall be presented not later than, six months after the acauai of the cause of action. A claim relating to any other' cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106,. County Administration Building, 651 Pine Street,Martinez,CA 94553- C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D_ If the claim is against more than one public entity, separate claims must be filed against each public entity, E: Fraud See penaltyfor fraudWent claims,Penal Code Sec. 72 at the end of this form. •�r�■�r■rrrrrr�■■r■•■rrr■s■■r■■■■■e�rrr■rrr■�r��■��rrrsrrr■r■■■■rr■■■■■■■.■■■■. RE: Clara By: / Reserved.for Clerk's filing;stamp f lW ) " RECEIVED i Against the County of Contra Costa or-1 ) MAY 1 2 2006 U DiStriCt). CLERK BOARD OF SUPERVISORS Fill ' the name) ) ' CONTRA COSTA CO. d L l0 S The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$1 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) �i NO LC. � i 3. HQw Oi.d the ge r inj oec ( ve fug a s;u e extra if a aired i +� y �i �` io<v � ��-�40� was .lS � otti 1 -.31 - 00�. 4. What parti alar act or omission on the part of county or district officers, servants, or employees caused the injury oramage? •2 t4 O. NOC't C Y QCT t LI Y� u-S hGH t�R- 21�-� Lmeiof �L- tlWhat are the county orfficers, servants,or employees causing the damage ar injury? �' � �� � . l l i� �lC� ec I OIV lis• RM Case l 10 04/27/2006 . 08:51 CONTRA COSTA COUNTY CLERK OF THE } 915107585854 NO.06? P02 6. What da=ge or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attachegbmates for auto damage.) D CU Woar t kc) Re.�"1 I NNC � Glln y f�1 b-t-b ac e- �ct.v� i Qe7. 1tow was the amount claimed corn uted? (In`l:lude estimatedr amount of any rospective inj or damagVV, t U l 1 T UCC4- I / � �2l +-ti PZ o �'� r �re�/- rev G', 000.1 DO , Mo r kZ iv KLLow M,ALLLa_ms �u s. � -r� S. Names and addresses of vii ssesi co tors,andh spirals: -rh �Q ►a Nig r «c e [lroke i2d D 0MoN I/� S 12 � �vir©r ) q 45-2 o 9, List the expenditures you made onl aeaauunt of this accident or injury- DATE Tak AMOUNT ■r■raps11*Popov rrpoop■■s■■sr■■■■■■■arss■■■■pposoprrprr ■■■s■■■. Gov'Code Sec. 910.2 provides"The claim shall be signed by the claimant or by some person on his j SEND NOTICES TO: (AttornG � 1 Name and address of Attorney (Claimant's Signature) (Address) cp, 6 � �111 Telephone No. }Telephone No. eweffef@fees Yea rYsrsrsorsast■sssaasaaa■sarrsssararr■■ssaassa■move■r■ar a of f f•\•&soars, 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, S5 6500 et seq.) Furthermore, any attachments,addendums,or supplements attached to the claim forint,including medical records, are also subject to � public dirnlosuire. I: ■eseryaffrrrrefwfrrasrnaa�fr■s•r�rpfrrarrrgoes avows rrrrrerefaeieaarareGoa Gap oval dual NOTICE: Section 72 of the Penal Code provides: Every person who,with intent to defraud, presents for al lowance 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 fraudwlent claim, bill, account voucher, or Whiting, is punishable either by imprisonment in the County jail for a period of not more than one year,by a fine sof not exctoding one thousand dallars ($1,000-00), or by both such. imprisonment and fine, or by imprisonment in the state prison, by a fine of not emWing ten.thousand dollars ($10,000),or by both such imprisonment and,fine. 0427/2006 . 08:51 CONTRA COSTA COUNT' CLERK OF THE 3 915107585854 NO.06? P02 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages -}— claimed. Attach two estimates for auto damage.) M�� Wo0 k� Re�i)V YC � /+lhMC)ro ����r�czt2�eGaysz k�/ ci erro co �n%Ir�/ �'Ce�� LLiVCc�rr� 7. 14ow was the amount claimed ave com uteri? (In�lude t},�th estimatedd amount of any rospective inj or damage.. t 01l� Pit l/ 2 �2! e J' ` 'Te-i e /— ��1/ 1`e G'j 000"00 LJ « G4 l� 1N1.®i' �-�2 N ,� /li[C L/LIL�M 8. Names and addresses ofvnp=ses o tors,and hospitals; S t' N , �&r ctC arvke 2124D,lamo'V�, s �� � 6�Cvr y a � a 9. List the expenditures you made ori ureaccount of this accident or injury: DATE TM AMOUNT ■.■.■www*�rrwwrrrrrw■■wr■■■■■■■■■■■■■■■■w■�wwrwwrrw■■■■■■.■■■■■w■■■■wr.■■gap w■w■.■■■. I IGov,Code Sec. 910.2 provides"The claim shall he signed by the claimant or by some person on his }behalf.". j SEND NOTICES TO: (Attorney) ) Name and address of Attorney ) (Claimant's Signature) (Address) ) 7)111 Telephone No. }Telephone No. ��J rr'rrr�rrrrirrrr■r■.s■■o■w.■■.ra.■■.r■ww■.r.■.■a....■.■.■.■rr■wrr..0 rr�r�rrr�r�rrrrr� i PUBL11C 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, i ■•ri'rrr0INrtrrr■rrwr■rwrwwrw■■rrwrrrrrrrrwsoon wrrrw0rrr1rr NOTICE: Sec#on 72 of the Penal Code provides: Every person who,with intent to defraud,presents for allowance or for paymcmt to any state board or officer,or to any county, city, or district board or officer, authorized to allow or pay the same if genuiDe, any false or fraudulent claim,bill, account voucher, or writing, is punishable either by imprisonment in the County jail for a period of fiat more than one year, by a fine of not exccediug 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 ($10,000),or by both such imprisonment and fine. 0427/2,006 '08:51 CONTRA COSTA COUNTY CLERK OF THE 4 915107585854 NO.067 901 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAWANT A_ A claim relating to a cause of action for death or for injury to person or to personal property or grMing crops shall be presented not later than six moatbs after the accrual of the cause of action. A claim gelating to any otbier cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 411.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 1 06, . County Administration Building,651 Pine Street, Martinez, CA 94553- C. If claim is against a district governed by the Hoard of Supervisors, rather than the County, the name ofthe.District should be filled in. D_ If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. 6 0 a9 61 4 0 lafaaaa aaala/aaa9mesa goo Ed ta\a YY r■r■Y■frr.■■ena am man■1 RE: Claim By: / Reserved for Clerk's filing stamp } j Against the Connty of Contra Costa eg- ) I,l District) Gill Wthe name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$:• and in support of this claim represents as follows: 1. Wh did the damage or injury occur? (Give exact date and hour) 7 2. Where did the damage o*IM, r►cciir� (Include city and county) PiNoLe- , coa C0sk 1 i 3. HQw Oi.d the e r in oe ve ful a S.u e e if aired P1 L , 10 Or7 « � �w 1 31 - 200�. 4. What parti alar act or omissioxt on the part of county or district officers, servants, or employees caused the injury or amage? 1 ( 1 1 Nah-� /C.yeCt 1 11tLYe-ro,s 5 What are the Liof county or strict officers, servants,or employees causing the damage or injury? � 'l 1� - Ce Reve.Npie C lec -!OA/ - �1M CSS �- 0 ,` �� - , �� ..��,; _� f =. \ �, M'Y ,� � \ . w � , , �. i 4 . . r .�.. �� � _ � \ �; � ��� ,,, �s� � �� ,� � � :w �., � �. ��, �.� �� � � �. ,�, �� ;�t _� s2 � � ` ;;ti ... =r--�� �i S \ ^ t'f i v .1 � \ d \ 0 ��\ � NN �.... -� V„' �y„O C.l �t? � �� � � mom` ti � � � � ,.:;� � v � ,\ w c d op`�U � cd '>� �'� .� ., c• �� ,�"�