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MINUTES - 06202006 - C.29
CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY • BOARD ACTION: JUNE 209 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 CLAIM AGAINST THE CCC HOUSIN It 3 Supervisors. (Paragraph IV below), given Pursuant to Government Code AMOUNT: $5,000.00 plus Section 913 and 915.4. Please note all Q MAY 1 7 2006 @"Warnings". CLAIMANT- . .BRENDA HOLLY COUNTY COUNSEL MARTINEZ CALIF. ATTORNEY- UNKNOWN DATE RECEIVED- MAY 17, 2006 ADDRESS: 835 CHIQUITA COURT BY DELIVERY TO CLERK ON: MAY 17, 2006 PITTSBURG, CA 94565 BY MAIL POSTMARKED: MAY 15, 2006 FROM-., Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. MAY 17, 2006 JOHN CULLEN,Slqrk-7. Dated: By: Deputy 44F� 11. FROM: County Counsel TO- Clerk of the Board of Su'pervis'ors - O This claim complies substantially with Sections 910 and 910.2. 'This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). Other: Dated: By: 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). IV BOARD 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\1AWe., �a8*Vj9OFlN CULLEN, CLERK, By 4i��Deputy Clerk WARNING (Gov. code section 913) /1*1 Subject to certainexceptions,you have only six(6)months front the date this notice was person*served or deposited in the mail to rile 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 Stites, 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. Ijated,\A r 1,�, JO.1-IN CULLEN, CLERK By � ac---Deputy Clerk Oi�i ICE 'OF THE COUNTY COUNSEL SILVANO S. MARCHESI S-------- COUNTY OF CONTRA COSTA COUNTY COUNSEL Administration Building , _. 651 Pine Street, 91' Floor ' , c SHARON L. ANDERSON Martinez, California 94553-1229 d' CHIEF ASSISTANT (925) 335-1800 f9 ���.:''� '�7 GREGORY C. HARVEY ®� '�'''��"�� VALERIE J. RANCHE (925) 646-1078 (fax) ; ASSISTANTS y NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Brenda Holly 835 Chiquita Court Pittsburg, CA 94565 RE: CLAIM OF BRENDA HOLLY Please Take Notice as Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910.2, or is otherwise insufficient for the reasons checked below: [ ] I. The claim fails to state the name and post office address of the claimant. [ ] 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [X] 3. The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [ ] 4. The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. [ ] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. [ ] 6. The claim is not signed by the claimant or by some person on his or her behalf. Brenda Holly Re: Claim Page Two [ ] 7. You are required to submit your claim on the proper form, which is enclosed. Please resubmit your claim on the enclosed form, including all the required information. Gov. Code, § 910.4. Please be aware that you have only a limited period of time in which to file an amended claim. See Gov. Code, § 910.6. [ ] 8. Other: SILVANO B. MARCHESI COUNTY COUNSEL Monika L. Cooper Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (Code Civ. Proc., §§ 1012, 1013a, 2015.5; Evid. Code, §§ 641, 664) I am a resident of the State of California, over the age of eighteen years, and not a party to the within action. My business address is Office of the County Counsel, 651 Pine Street, 9th Floor, Martinez, CA 94553-1229. On ZJd,gJU /J 2e-04v , I served a true copy of this Notice of Insufficiency and/or Non-Acceptance of Claim by placing the document in a sealed envelope with postage thereon fully prepaid, in the United States mail at Martinez, California addressed to Brenda Holly, 835 Chiquita Court, Pittsburg, CA 94565, as set forth above. I am readily familiar with Office of County Counsel's practice of collection and processing of correspondence for mailing. Under that practice, it would be deposited with the U.S. Postal Service on that same day with postage thereon fully prepaid in the ordinary course of business. I declare under penalty of perjury under the laws of the State of California and the United States of America that the above is true and correct. Executed on �0, at Martinez, California. athleen O'Connell cc: Clerk of the Board of Supervisors (original) Risk Management Page 2 r Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. 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, either by mail or in person. 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. RE: Claim By ) Reserved for Clerk's filing stamp Brenda Holl RECEIVED VZ Against the County of Co osta MAY 17 2006 or CLERK BOARD OF SUPERVISORS The Housing Authority of Contra Costa (District) CONTRA COSTA CO. (Fill in name) The undersigned claimant hereby make.s,.Qlaiin against the County of Contra Costa or the above-named District in the sum of Is Aat4l and in support of this claim r presents as follows: �- - 1. When did e damage or injury ur? (Give exact date and ho out— V'•%A f10, ZQor'�'k�QsLAI\¢[• - . . : VVN:aC-S�: rA 2. Where did the dAmage or mjury occur? (Include city an ounty) 3. How did t damage or injury occur? (Give full details; use extra paper if required) 4. What particular A or or i i non the part of county or district officers, servants or employees caused the i fury or damage? clmform ie Lod" easy ea ,(n 5. What are the names of county or district offKers, servants or employees causing the damage or injury? 6. What damage or injuries do you claihi resulted? (Give full extent o juries or damages claimed. Attached two estimates for auto damage.) Dlyl 7. How wasLffie'aiiLoAt claim ed above omputed? (Include the estimated amount of any prospective injury or damage.) f 8. Nam find addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT ************************************************************************ Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICE TO: (Attorney) or by some person on his behalf." Name and Address of Attorney (Claimant's igna% o` 1— (A dress) o� Pfl CJ Telephone No. Telephone Noq�—-;?Z 7 7�F 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 ($1,000), 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." clmform •� t _ -To-..... C(� (� r a'o-�- _ _ _- c�e_On: 1�_x` ,).s`e 1 ak oir 's *, I* c,�esl ck __ _ I ` r r� wrw •.x �s r s M ,. Cl t cl-J Batt- L"� `per 0 Ck V a � `� my ✓ CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JUNE 20, 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), MAY 17 2006 given Pursuant to Government Code AMOUNT: $1,123.68 Section 913 and 915.4. Please note all COUNTY COUNSEL "Warnings". CLAIMANT- FATE FIENORY MARTINEZ CALIF. ATTORNEY: UNKNOWN DATE RECEIVED: MAY 17, 2006 ADDRESS: 847 "C" BROOKSIDE DRIVE BY DELIVERY TO CLERK ON: MAY 17, 2006 RICHMOND, CA 94806 HAND DELIVERED BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County.Counsel Attached is a copy of the above-noted claim. MAY 17, 2006 JOHN CULLEN, C Dated: By: Deputy 11. FROM: County Counsel TO: Clerk of the Board of Supervisors (%411his 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 91 L')). Other- Dated i t 70(oo By: 01 �D I eputy 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). OARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated:,4v7e,,. O!tMHN CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claini.See Government Code Section 945.6.You may seek the advice of all attorney of your choice in connection with this inatter. If you want to consult all attorney,you should do so hunlediately. *For Additional Warning See Reverse Side of This Notice AFFIDAVIT OF MAILING I declare under penalty of perjui-y 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 M.arthiez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:V*" o JOHN CULLEN, CLERK By Deputy Clerk Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code 5911.2.) 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 70-rm. RE: Claim By ) Reserved for Clerk's filing stamp MAY I Against the County of Contra Costa ) 7 2006 or ) CLER{gOgRD CON TRq�OSTpERV/SpRS District) q co. Fill in name ) . The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ // 6 3' and in support of this claim represents as follows: T-"- —_A A s.%- a-,...,►n cr. i.,...r..• '.':,'`cur? _`3-41re, `�ct date and houv%) 1• M1Y�11- Vlu Ville' `!zzag'.� wa aaJ�.ay _ o �. _ - - --- --_ _�`(I 2. Where did the damage or injury occur? (Include city and county) - - 0 , L I r, - Lh=nd 0 e — 3• How did the damage or injury occur? (Give full details; use extra paper if required) Count y drNe-r, We-?5 -- y 6 hock-op 1�n GJri I/t W71; Gnd 1A qr r,�as P��kecl , Gn�,n 1© a+ Is� sOfee fro alri ve yy Coin y f`iil�r 4416 J1 cosi o. �ckE�l ?h 4a �^�`9A4- 6,o1e r eqr end �Iq d �a�`� � 4'�-� 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? BeqCked t,t4o 4,-_ rear (over) '�. MVt3,d 6 GS'C WIC LJCL&U='e, va v.vwaV.7 v. --- -_— --.—---—7 -- -- _ the damage or' injury? e Z(lor=e ! 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. } S � C' ch s'iFz1s 7• How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) ' , 8. Names and addresses of itnesses doctorsand hospitals. Ic �, A,14hnvtti D e e.e-tp 10 . ccs-Cu se 6' 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT C)G't{- Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some Derson on his behalf." Name and Address of Attorney Claimant's Signat Ad ess/ C kli2ltofi Telephone No. Telephone No.510)3 7 7 1 -r0 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 me year, by a fine of not exceeding one thousand ($1,000), 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 l v. 05/11/2006 at 05: 13 PM Job Number: 25244 EAST BAY BODY SHOP License # : 40004074 Federal ID # :562401.674 BAR # AK230518 251 24TH ST RICHMOND, CA 94804-1831 (510) 233-3233 Fax: (510) 233-9761 PRELIMINARY ESTIMATE Written By: LUIS HERRERA Adjuster: Insured: fate flenory Claim # Owner: fate flenory Policy # Address: 847 c brookside drive Deductible: richmond, CA 94804 Date of Lows: Other: (510) 860-0542 Type of Loss: Point of Impact: Inspect EAST BAY BODY SHOP Business: (510) 233-3233 Location: 251 24TH ST RICHMOND, CA 94804-1831 Insurance Company: Days to Repair 2003 MITS DIAMANTE LS 6-3 .5L-FI 4D SED Int: VIN: 6MMAP67PX3T004667 Lie: Prod Date: Odometer: Air Conditioning Rear Defogger Tilt Wheel Cruise Control Intermittent Wipers Climate Control Keyless Entry Theft Deterrent/Alarm Steering Wheel Controls Body Side Moldings Dual Mirrors Electric Glass Sunroof Fog Lamps Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks Power Driver Seat Power Passenger Seat Power Antenna Power Mirrors Power Trunk/Tailgate Anti-Lock Brakes (4) Driver Air Bag Passenger Air Bag 4 Wheel Disc Brakes Leather Seats Bucket Seats Recline/Lounge Seats Aluminum/Alloy Wheels -----------------------------------------------------=------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1 REAR BUMPER 2** Repl RECOND Bumper 'cover 1 313.00 1 . 9 2 . 9 3 Add for Clear Coat 1 .2 4# Subl Cover Car 1 7 .50 X 5# Repl Tint Color 1 0.5 6# Repl Hazardous Waste 1 5. 00 X 7# Rpr Color Sand And Polish 1. 0 ------------------------------------------------------------------------------- Subtotals =_> 325.50 2 .4 5. 1 1 05/11/2006 at 05: 13 PM Job Number: 25244 PRELIMINARY ESTIMATE 2003 MITS DIAMANTE LS 6-3. 5L-FI 4D SED Int: Parts 313 . 00 Body Labor 2 . 4 hrs @ $ 67 . 00/hr 160 . 80 Paint Labor 5. 1 hrs @ $ 67 . 00/hr 341 .70 Paint Supplies 5 . 1 hrs @ $ 32 . 00/hr 163 .20 Sublet/Misc. 12 . 50 -----------------=---=------------------------------ SUBTOTAL $ 991 .20 , Sales Tax $ 476.20 @ 8 .7500% 41 . 67 ---------------------------------------------------- GRAND TOTAL $ 1032 . 87 ADJUSTMENTS: Deductible 0. 00 ---------------------------------------------------- CUSTOMER PAY $ 0 . 00 INSURANCE PAY $ 1032 . 87 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. 2 05/11/2006 at 05 :25 PM Job Number: 33581 ANDY'S AUTO BODY License #:AL186430 Federal ID #: 680242263 135 24th St. Richmond, CA 94804 (510) 232-5749 Fax: (510) 232-8130 PRELIMINARY ESTIMATE Written By: Steve Chmielowski Adjuster: Insured: FATE FLENORY Claim # Owner: FATE FLENORY Policy # Address: Deductible: Date of Loss: other: (510) 860-0542 Type of Loss: Point of Impact: Inspect ANDY'S AUTO BODY Business: (510) 232-5749 Location: 135 24th St. Richmond, CA 94804 Insurance Company: Days to Repair 2003 MITS DIAMANTE LS 6-3. 5L-FI 4D SED Int: VIN: 6MMAP67PX3T004667 Lic: Prod Date: Odometer: Air Conditioning Rear Defogger Tilt Wheel Cruise Control Intermittent Wipers Climate Control Keyless Entry Theft Deterrent/Alarm Steering Wheel Controls Body Side Moldings Dual Mirrors Electric Glass Sunroof Fog Lamps Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks Power Driver Seat Power Passenger Seat Power Antenna Power Mirrors Power Trunk/Tailgate AM Radio FM Radio Stereo Search/Seek Equalizer CD Player Infinity Sound System Anti-Lock Brakes (4) Driver Air Bag Passenger Air Bag 4 Wheel Disc Brakes Leather Seats Bucket Seats Recline/Lounge Seats Automatic Transmission Overdrive Aluminum/Alloy Wheels -------------------- --------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1 REAR BUMPER 2 Repl Bumper cover 1 477 . 92 1 . 9 2 . 9 3 Add for Clear Coat 1 .2 4# Tint 1 X 0. 5 5# Cover Car 1 5 .00 T 0.3 -----------------------------------------------------------=------------------- Subtotals =_> 482 . 92 2 . 7 4 . 1 1 05/11/2006 at 05 :25 PM Job Number: 33581 PRELIMINARY ESTIMATE 2003 MITS DIAMANTE LS 6-3. 5L-FI 4D SED Int: Parts 477 . 92 Body Labor 2 .7 hrs @ $ 69.00/hr 186. 30 Paint Labor 4.1 hrs @ $ 69.00/hr 282 . 90 Paint Supplies 4 . 1 hrs @ $ 29.00/hr 118 . 90 Sublet/Misc. 5.. 00 ---------------------------------------------------- SUBTOTAL $ 1071 .02 Sales Tax $ 601 .82 @ 8 .75000 52 . 66 ---------------------------------------------------- GRAND TOTAL $ 1123. 68 ADJUSTMENTS: Deductible 0.00 ---------------------------------------------------- CUSTOMER PAY $ 0.00 INSURANCE PAY $ 1123 . 68 Can an Insurer require, direct, suggest or recommend that your automobile be repaired at a specific shop? No - Unless the referral is expressly requested by you. SB551 prohibits an insurer from requiring an auto be repaired at a specific auto repair dealer. The insurer can only recomend an auto repair dealer if the insured asks for a referral, or if the insured is informed in advance in writing of the right to choose the repairer of his or her choice. If an insured takes an auto to a shop of his or her own choice, an insurer cannot limit or discount reasonable repair costs based on charges that would have been incurred had the insured gone to the insurer's chosen shop. 2 05/11/2006 at 05 :25 PM Job Number: 33581 PRELIMINIARY ESTIMATE 2003 MITS DIAMANTE LS 6-3.5L-FI 4D SED Int: FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWINZ3 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 ARP6295 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 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JUNE 20, 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 �g �� on your claim by the Board of Supervisors. (Paragraph IV below), MAY 18 2006 given Pursuant to Government Code AMOUNT: $11,473.83Section 913 and 915.4. Please note all COUNTY COUNSEL "Warnings". MARTINEZ CALIF. CLAIMANT: ALLENE E. MOSSMAN ATTORNEY: RODNEY-!-[A. MARRACCINI DATE RECEIVED: MAY 18, 2006 LAW OFFICES OF RODNEY A. MARRACCINI ADDRESS: 1225 ALPINE ROAD, STE. 204BY DELIVERY TO CLERK ON: MAY 18, 2006 WALNUT CREEK, CA 94596 BY MAIL POSTMARKED- MAY 17, 2006 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. MAY 18, 2006 JOHN CULLEN le Dated: By: Deputy 11. FROM: County Counsel TO- Clerk of the Board of Shervisors (%*11�his claim complies substantially with Sections 910 and 910.2. This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). Other: Dated: 5-z!!u(;2 By: A71(f jg,&:X Deputy County Counsel I 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). IV. WARD 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:\)�wV6 #,-240 )OHN CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mail to rile 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 inunediately. *For Additional Warning See Reverse Side of This Notice AFFIDAVIT OF MAILING I declare under penalty of per jui-y that I am now, and at all thues'berein 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 Ouder and Notice to Claimant, addressed to the claimant as shown above. Dated: q2#40JOHN CULLEN, CLERK By ���� Deputy Clerk TO: CLERK OF THE BOARD OF SUPERVISORS R •----� ® CONTRA COSTA COUNTY MAY 1 8 2006 COUNTY ADMINISTRATION BUILDING 651 PINE STREET, ROOM 106 ct s 8OARDof�UpCRxVltiu s MARTINEZ, CA 94553 gojJTRAGOSTACo• CLAIM 1. Allene E. Mossman hereby makes a claim against the County of Contra Costa in the amount of$11,473.83. Claimant's postal address is 1506 East Shore Drive, Alameda, CA 94501. 2. Notices concerning this claim should be sent to Rodney A. Marraccini, Law Offices of Rodney A. Marraccini, 1225 Alpine Road, Suite 204, Walnut Creek, CA 94596. 3. The date and place of the transaction giving rise to this claim are February 10, 2006, at Martinez, California. 4. The circumstances giving rise to this claim are as follows: Claimant filed a Development Plan Application, No. DP003027, Billing Account No. 13714: The County reviewed this plan and charged $15,882.22 for processing the application. Of that amount, there was overcharged $3,346.83 for 46 hours allegedly taken by a county employee to review the application process. This.far exceeds the amount of time necessary to do this review. Secondly, $8,127.00 was expended on outside contract services, without identification of the time, for development plan review, which amount and time far exceeds the time necessary or actually spent to do said work. 5. Claimant's damages are $11,473.83 in overcharges for unnecessary work or excessive work or work not done. 6. The names of the public employees causing these overcharges, although no claim is being made against such parties, are identified in the billing as Lashun Cross and Lorna Villa. 7. As of this date, my claim is in an amount that would place it within.the jurisdiction of the Superior Court based upon the loss. 8. My claim as of this date of$11,473.83 is based as follows: (a) Overcharges for application process: $3,346.83. (b) Overcharges for development plan review: $8,127.00. Dated: March 17, 2006 LAW OFFICES OF RODNEY A. MARRACCINI By Rodney . Marraccini, Attomef for Claimant Law Offices of RODNEY A. MARRACCINI 1225 Alpine Road,Suite 204 Walnut Creek,California 94596 Telephone: (925)943-1850 Facsimile: (925)943-7994 May 17, 2006 Clerk of the Board of Supervisors Contra Costa County County Administration Building 651 Pine Street, Room 106 Martinez, CA 94553 Re: Claim by Allene E. Mossman Dear Sir/Madam: Enclosed please find the original and one copy of a Claim against the County of Contra Costa. Please return the copy marked received in the envelope provided. Thank you for your assistance. Very truly yours, LAW IC S OF RODNEY A. MARRACCINI a rol o ung, eta to RODNEY MA CC I /cy Enclosures 0 rJ J, T fJ �rti t tt� .r+ t{� .:C s� cs'"d N .o QJ O ,n N 1 V _ C:D o o % - � N 00 ti0 M,1 '+ �Bu"'�tC"1'�'i"Tt t� �� •'J 0 -e- a) u -b r! t ,;.t tt i 3 y � � V f.t CLAIM BOARDOF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JUNE 20, 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 VERTSupervisors. (Paragraph IV below), given Pursuant to Government Code MAY 2 3 2006 Section 913 and 915.4. Please note all AMOUNT: $25,000.00 "Warnings". COUNTY COUNSEL CLAIMANT- IVAN EGBERT MARTINEZ CALIF. ATTORNEY- HEIDI COAD-HERMELIN, ESQ DATE RECEIVED: MAY 23, 2006 ADDRESS: STERNBERG & COAD-HERMELIN BY DELIVERY TO CLERK ON: MAY 23, 2006 540 LENNON LANE WALNUT CREEK, CA 94598 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. MAY 23, 200.6 JOHN CULLEN Dated: By: Deputyxv&:to� 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). Other: Dated: By: k-Y-)C gat�bt-•, .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 9113). IV. OARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full, Other-. I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date.- Dated:N��-,!?t%-6046JOHN CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited hi the mail to rile a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice hi connection with this matter. If you want to consult im attorney,you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of per juq 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 acid Notice to Claimant, addressed to the claimant as shown above. Dated:V,*V7C,c4/.0J9&-6 JOHN CULLEN, CLERIC By Deputy Clerk MAY-16-2006 15:42 CCC RISK MANAGMENT 925 335 1421 P.02iO3 " BOARD OF SUMVISORS OF CONTRA,COSTA CqWY INMUCTIONS 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 Doom 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 eacli. public entity. E. Fraud, See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. a■now pass aaa/alts man am a Rs■aasaa am am an a RaRRRaRt■RE$aa Citaasaamong WERE amatopic a[In I RE: Claim.By: Reserved for Clerk's Ung stamp } IVAN EGBERT ) } Against the County of Contra Costa or ) MAY Z 3 } CL�gK. 2006 DistrictRdARD (Fill in the name) ) °ANTRA°osTA Cov�s°Rs } The undersigned claimaiat hereby makes claimagainst the County of Contra Costa or the above-named district in the sum of$ st 2 5, 000.00 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) on or about December 31 , 2005 - January 1 , 2006 2. Where did the damage or injury occur? (Include city and county) 2221 Rancho Road, El Sobrante, California 3. How did the damage or injury occur? (Give full details;use extra paper if required) Runoff flooded Claimant 's property. 4. What'particular act or omission on the parr of county or district officers, servants, or employees caused the injury or damage? County failed to maintain drainage canals/culverts on or around Rancho Road. S What are the names of county or district officers,servants, or employees causing the damage or injury? Unknown. MAY-16-2006 15:42 CCC RISK MANAGMENT 925 335 1421 P.03iO3 . What damage or injuries our claim resulted? Give full extto of injuries or damages 6 g � Y ( claimed. Attach-two estimates for auto damage.) See attached letter. . 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage,) See attached letter. 8. Names and addresses of witnesses,doctors, and hospitals: Yvan and Lesha Egbert 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT See attached letter. aaa saaaaaaaaaaM a a a A a Ran as a R a a Rua aasaaa tit a as a atom aazoos NOME t aaa Wastes a as a a a a a ataaa am .Gov.Code Sec. 910.2 provides"The claim shall be signed by the claimant or by some erson on his behalf ' SEND NOTICES TO: (Attorney) Mame and address of Attorney Heidi Coad-Hermelin, Esq. ) Sternberg & Coad-Herm(alin ) (Claimant's Signature) LLP ) 540 Lennon Lane ) Walnut Creek, CA 94598 ) (Address) ) Telephone No. 925-946-1400 )Telephone No. M a a a ONE a a a a a Kong a a a a ME a am R a It a a a t a a a a a KENN M a a a ata Mala Rasmus asp M a t a a t It no on Rang WE It a a It a MR 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. as was ON a as Mammas on a a us RUN an a a s a a t t BOB Kong as MR KIM a a a a a a a a a tax Re MR KKK E a t a a a MR a a a a t a a a e E NOTICE: Section 72 of the Penal Code Provides: Every person who,with intent to defraud;presents for allowance or for payment to any state board or officer, or to any county, city, or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim,bill, account voucher, or writing,is punishable either by imprisonment in the County jail for a period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000.00), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000),or by both such imprisonment and fine. TOTAL P.03 STERNBERG & C70AD-14ERMELIN LLP ATTORNEYS AT LAW 540 Lennon Lane Walnut Creek,CA 94598 (925)946-1400 Facsimile(925)932-6986 May 17, 2006 Clerk of the Board of Supervisors Contra Costa County 651 Pine Street Martinez, CA 94553 Re: Ivan Egbert Property located at 2221 Rancho Road, El Sobrante, CA 94803 To Whom It May Concern: This letter is submitted as a Claim under Government Code §900 et seq on behalf of Ivan Egbert. My client is the owner of the real property located at 2221 Rancho Road, El Sobrante, California (the "Property") that was damaged as a result of the County's failure to properly maintain Rancho Road. On or about December 31, 2005 during a significant rain storm, substantial rain water flooded the Property causing property damage and loss of use of the Property. The water entered the crawl space under Mr. Egbert's home, destroying his heater and air ducts and forcing him to purchase electric heaters until a new furnace could be purchased. Additionally,the water eroded Mr. Egbert's hillside and driveway (part asphalt and part gravel) which must be repaired. Because the condition of Rancho Road remains unchanged, future flooding is likely. Mr. Egbert's damages include but are not limited to: 1. Furnace Replacement $3,111.80 (receipt attached) 2. Duct Replacement $4,500.00 (proposal attached) 3. Asbestos Removal $2,900.00 (proposal attached) 4. Purchase of Electric Heater and Sump Pump $143.95 (receipt attached) 5. Gravel for Driveway Repair$167.25 (receipt attached) 6. Increased electrical charges based on need to use space heater for period through February 13, 2006 $92.00 (based upon amount above regular bill) 7. Repairs to Hillside $ unknown. 8. Repairs to Asphalt Driveway and Labor for Gravel Driveway $ unknown 9. Loss of Use of Property $ unknown Clerk of the Board of Supervisors May 17, 2006 Page 2 The Egbert claim based on the injury, damage, and/or loss as of this date is in an amount that would place it within the unlimited jurisdiction of the Superior Court. In response to Mr. Egbert's contacting the County about the incident, Scott Edmonds, Public Works Maintenance Supervisor inspected the damage and conditions on Rancho Road. He advised that work would be completed on the road this summer to correct the drainage problems. All notices regarding this Claim should be sent to my office at the above address. Sincerely, 4RN1DI BE & C D-HERMELIN LLP CO AD-HERMELINN HCH:dth Enclosures cc: Client (w/enclosures) Invoice Date Invoice# 2/24/2006 . 35197 Bill To PAA 1 D— Ivan Egbert 2221 Rancho Rd El Sobrante,CA 94803 P.O. No. Terms Project 111431 paid 111431 Quantity Description Rate Amount 1.00 Replaced furnace which was flooded and damaged by water. 3,111.80 3,111.80 Installed new 80%Carrier furnace Model#58CTX070-1-12. Adapt new plenum into machine. Gas and electrical was placed. Installed 2 stage thermostat Hung furnace as high as possible off the ground and replaced duct return. Warranty:5 years parts and labor;20 years heat exchanger. jdep$311 auth 026083 bal$2800.80 auth 010509 MC xxx 2545 exp 01/09 1 Total $3,111 m YOU CAN TRUST YOUR HOUSE TO ONE CALL � DOES IT ALL! "Satisfaction Guaranteed Or Your Money Back" Sears' promise for over 100 years. SEARS provides you and your family: SEARS per+ • Professional installation. Done with permits, properly. NISAT'ING AND AIR CONDITIONING • Liability coverage, performance bonding, workmens' compensation. CAVE MARCONI • Warranties from a company you can trust, now and tomorrow. (see)aw m" • Convenient financing. (6S )3Sg9021 e5 '�` Home Number: t?h� Customer: ! aa `O Job Address: Work Number: Special Information: Irw?, S-I* J S Product _ 1 i i) Pie � Q t LUG' i 04 Lf I I I V A I I i 1 U I I / 1 rl L ivteiLNo / w '[— I�� • \r I I Regular Price(s): r) 6 Sales Price(s)-. Effective Till. This is an estimate or bid, not a contract, please read your contract carefully, it contains many protections for you. Bids are good for 30 days. Sale prices ar o d to time period indicated. Salesperson: Phone Number: v Z _ Sears California License #25455 Performance Bond #4136874, �r n n 1215 10th Street �r+ DO *v 6d�!�s HEATING-VENTILATING-AIR CONDITIONING Berkeley,CA 94710 Hea ng &Cooling,Inca CONTRACT $10.528.1622-510 528.1624 fax., strlCE�sor -. TOLL FREE 800.926.1622 r License No.386411(C-20,HVAC) CUS,TOMER. 77 VA ,.r PROPOSAL NUMBEIVDATE MNL ADDRESS - START DATE(apprm) JOB ADDRESS COMPLETE DATE(appmT . - 903 TELEPHONE - ,,3*�/.�D S FAX ..- ... EAWL - DESCRIPTION OF HVAC WORK INCLUDED IN BASE PRICE(without ptions): �.n �J ,! O.JG der- u�V C>4iC f t�t� /� o CIC-- S r�A.0 i�U,Q.��GG� �!-{A�l c4�a� /�c�,!j NL-w C 1Wcls rmeNACi5r S%In.54 080 (90 5 AMA, Ace- 7 /oaf -�J't?its r 4,ew 1 e= QCs k� ~7°-16y u1 a2 F( EXCLUSIONS: 1)Asbestos removal,if necessary,must be performed by others. 2)Ali carpentry,including wall,floor and ceiling repairs,is excluded. 3)Ali roof repairs are excluded,except for cold patches,as specified. 4)Smoke alarm service,unless specified. STANDARD ffEMS YES NO BY OTHERS WA or USE "Note Regarding Permit EXISTING MECHAP1iCAL PERMIT"See Note If"YES Contractor shall procure permit,but LOW VOLTAGE CIRCUIT pennostatl inspection is the responsibility of Customer. HMEFF FILTER UPGRADE if NO",Customer assumes responsibility for HI-EFF FLUE KIT procuring permit and for inspection. GAS PIPING TO GAS-FL" We Propose to perform the specified work in accordance with the specifications and plans submitted, and to complete it in a workmanUke manner according to standard Industry practices for the sum(excluding price adjustments for Options)of: CONTRACTAMOUNT: $ .9 DOWN PAYMENT: 3 , Payment to be made as follows: 10% t , ' upon signing Contract Upon satisfactory payment being made for any portion of the 0% $0.00 upon completion of equipment order work performed, the Contractor shall, prior to any further payment being made, furnish a full and unconditional release 0% $0.00 •upon completion of from any claim or mechanic's lien for that portion of the work for 9W/o $0.00 Z5 balance due immediately upon which payment has been made. plus/minus adjusi6ent for substantial completion of work under thisContractor carries both commercial general liability insurance Options)if applicable Contract. and workers'compensation insurance. DESCRIPTION OF OPTIONS: CUSTOMER TO INmAL"ACCEPT- ACCEPT DECLINE OR'DECLINE"OF EACH OPTION OPTION#1 #1 Price Adjustment: OPTION#2 #2 Price Adjustment: TOTAL PRICE($1!!t OPTION(S) ACCEPTANCE OF CONTRACT TERMS: The noted prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified,including selected options,if applicable. It is understood and agreed that this work is not provided for in any other agreement. The terms proposed for this Agreement are valid for 30 days. Authorized Signature(s)for Buyer&Co-Buyer. Date; YOU,THE BUYER,MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TOJAIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DAT OF THIS TRANSACTION,SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT.CONTRACTORS ARE REQUIRED BY LAW TO BE LICENSED AND REGULATED BY THE CONTRACTORS STATE LICENSE BOARD. ANY QUESTION CONCERNING THE RESPONSIBILITIES OF A CONTRACTOR MAY BE REFERRED TO THE REGISTRAR,CONTRACTORS-STATE LICEktS BOARD,P.O.BOX 26000,SACRAMENTO,CA 9s826. 13/a G Authorized Signature for ,� r 1 Contractor and SRN: 6r L OA�,L 1 L� �j tot/,�CM On file Date: 1tam Knoll Systems Corp. Cooling & Heating Services CA Lic. #784349 Proposal # 111560 Proposal Date: 2/24/06 SUBMITTED BY: Raul Galvez Knoll Systems Corp. 5375 Clayton Rd. Concord, CA 94521 Toll Free: 1-877-625-6655 SUBMITTED TO: Ivan Egbert 2221 Rancho Rd Ell Sobrante, CA 94803 We Herby submit specifications and estimates for: Estimate for replacing existing duct system which was damaged by flooding. Total $4,500 Warranty: 5 years parts and labor *Customer must first hire an asbestos abatement company to remove the existing asbestos ducting. This estimate does not include the cost of asbestos, -ibatemeja.. F';r IASbestos z",batealenc, you cw-i call Environmental Remedies at 925-519-6354* We propose to perform the above work in accordance with the drawings and specifications submitted, and to complete it in a workmanlike manner according to standard practices for the sum of: $4,500 Down Payment of$450 Payment to be made as follows: 10% ($450)upon signing contract; 90% ($4,050) upon completion of duct installation ♦ Authorized Signature t�Z4� date_4"L/O Acceptance date 5375 Clayton Road • Concord, CA 94521 • Phone (925) 681-0477 • Toll Free 1-877-625-6655 • Fax (925) 682-0793 • knollsystemscorp.com Ar -B, 999 Canal Blvd.,S Richmond,CA 94804 S Phone: 510-236-0300 Fax: 510-236-0833 ' e'PA PERFORMANCE PROPOSAL ABATEMENT SERVICES INC To Customer: Ivan Egbert 4/19/06 2221 Rancho Road date: EI Sobrante, CA 94803 Page: Two Architect/Engineer: Job Name 2221 Rancho Road,Asbestos Ducting Location El Sobrante, CA Project Performance Abatement Services, Inc.(hereinafter designated as"CONTRACTOR")proposes to furnish all materials and tabor required for the application of the following(hereinafter designated as the"Work")for the amount stated below: The following proposal is an all-inclusive rate to perform the specified abatement services at the above referenced project. Our quote is based on providing all labor, materials, equipment and insurance. Owner to provide water and power for the duration of the project. Scope of Work: Set-up, abate and disposal of asbestos ducting running in the crawl space within the above listed project. PAS's proposal is based on job walk information 4/17/06 with yourself. Scope includes abatement of asbestos insulated ducting running from the heating unit area though out the crawl space area. No clearance included PAS and owners rep. to visually walk the project after the abatement. Clarifications: PAS has not included third party final air clearances. Power and water to be provided by others. .No other asbestos or haz waste included. Payment at completion. Add. Alt. Third party final air clearance, $500.00 per clearance PAS Base Bid Price $2,900 Please sign below and return to indicate your acceptance of this proposal. In the event CONTRACTOR's price is included within your bid,then CONTRACTOR's bid will be deemed to have been accepted. This proposal is subject to change and will be withdrawn if not accepted within 30 days of the above dale;it is subject to and includes all terms and conditions described herein (and such other terms as may be mutually agreed upon). Contract Price$ PERFORMANCE ABATEMENT SERVICES, INC. Acceptance Date: By: By: Title: William J.Elbert,Est/Project Manger Customer Name: By: Title: Approval Date: 11-99 PROFORMAKI —�f MRInsertAS Address and Phone Numbers PROPOSAL PERFORMANCE here ABATEMENT SERVICES INC Page Two CLARIFICATIONS • Power and water supplied by others, within the work zone • PAS proposal is based on job walk information given by Ivan Egbert • All mis. Items to be moved by other prior to PAS set-up. • PAS to wrap and cut ducting in sections • Schedule based day time, single shift, no overtime included • PAS to complete project within 1-2 shifts • Other haz wastes not included, third party final clearances by others • PAS has not included LD's • Isolation of systems, electrical, mech, alarm, sprinkler, plunbing by others • PAS has parking and staging space within proper location of the work space • Manifest to be signed by owner • PAS set-up may cause minor paint damage to walls. • Lay-out of abatement scope by others, owner • Add Alt. Hourly rate for work out of scope or beyond the time allowed, $65.00 15% mark-up on supplies and equipment for C.O. type tasks. • Based on a 10 day notification to Bay Area Air Control • Inaccessible asbestos not included • Heating unit to be removed by others In the event CONTRACTOR's price is included within your bid,then CONTRACTOR'S bid will be deemed to have been accepted This proposal is subject to change and will be withdrawn if not accepted within 30 days of the above date;it is subject to and includes all terms and conditions described herein (and such other terms as may be mutually agreed upon). Contract Price$ PERFORMANCE ABATEMENT SERVICES, INC. Acceptance Date: By: By: Title: William J.Elbert,EstJProject Manger Customer Name: By: Title: Approval Date: a'am^t.e 11-99 PROFaBMaHc Plant Hazardous Services, Estimate 3716 San Pablo Dam Road, Suite#1 El Sobrante, CA 94803 Date Estimate# 4/13/2006 166 Name/Address Job Site Home Owner 2221 Rancho Road Ivan El Sobrante,CA 94803 2221 Rancho Road El Sobrante,CA 94803 Terms Job# Due on receipt Item Scope of Work Total Asbestos Plant Hazardous Services would like to submit an estimate for the TSAI removal work to be performed at 3,989.00 the residence of 2221 Rancho Road,El Sobrante. Work to include removal of all ACM insulated ducting under house to furnace;registers to be removed. Price includes all straight time labor,materials and disposal of waste. All utilities are to be provided at no charge to Plant Hazardous Services. Exclusions: Overtime labor rate,permits and fees,scaffolding,air clearances,and reconstruction. Please Sign and Return Tota 1 $3,989.00 Phone# Fax# 510-223-2465 510-223-2475 F- � L" M CL O7 07 O C)7 CTI O O M .. iF •)F a) C M MQ) Nr O L-� a)OD. r +�+ Nm Y. - t.[) N tt") co OD O N L H - U ++ CD - O DON � co c 4- > O = co L cCn 0 • C>-0 C5 '^ 4- (a +, O m a r •3E w �F W 3\ s= �F �� •- r 0O CL 4- ¢ w O to M O cl (D 0 � N � -1.1o a O co > > 0 co mor o Ul R3 L • � Jo irr � c 3 too o mti � s= nom tet. CO H U LCI J Ei? O 4- L U 4--• -1E C iE O 4- roN � � n a�io 04-cu CD CD o + nt>o ¢ ate) 0-0 `° o �••� I�U 41 o N N ++ > EH = U a-o L a)— I- N V x C 4- t0 N L CO L O L L N x x D O. W W CD W o >, m 4- 3f N X O • >4- CO n ++ I W CD 4-J U O M0 O W o > aw CD O a)N .L I 0 x o NL CU L c UT a W o -o -o 41 '1-- L U L L r r Ln O K [D 0 0 0 4-c L c c a 0 7 Ln L L ��1 W -*- LC) X CO W W •- . - •a) a) -C D W cr N 'n Q Qr7 N K O i L 4- W CO N W CC.) 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All Section references are to The copy of this document mailed to California Government Codes. Ex�gg(�2 you is your notice of the action taken on your claim by the Board of MAY 2 4 2006 Supervisors. (Paragraph IV below), given Pursuant to Government Code COUNTY COUNSEL Section 913 and,915.4. Please note all AMOUNT: DAMA(3ES WIT WMT1Wffi&ION.OF "Warnings". THE SUPERIOR COURTq .UNLIMITED CLAIMANT: GLORENA BECKER ATTORNEY* MICHAEL D. MEADOWS DATE RECEIVED. MAY 24, 20Q6 GASPER, MEADOWS, SCHWARTZ & COOK ADDRESS: 2121 N. CALIFORNIA BLVD. PY,DELIVERY TO CLERK OMMAY.24, 2006 STE. 1020 WALNUT CREEK, CA 94596 BY MAIL POSTMARKED.- HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. MAY 249 2006 JOHN CULLEN, ler Dated By: Deputy It. FROM: County Counsel TO: Clerk of the Board of S7p'erviso, rs (/r1_1iis 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 Otlier. Dated: By: CDeputy 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). IV. POARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. Otlier. I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Date 40 000WAOHN CULLEN CLERK B CLERK, � __ eputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of au attorney of your choice in connection with this matter. If you want to consult an littollicy,you should do so innmediately. *For Additional Warning See Reverse Side of 11iis Notice. AFFIDAVIT OF MAILING I declare ander penalty of per jur-y that I am now, and at all times herein mentioned, have been a citizen or the United States, over age 18; and that today I deposited hi the United States t'ostal Service in Nlartincz, Califu 1-11 ia, postage felly prepaid a certified copy of this Board Order arid Notice to Claimmit, addressed to the clainiant as s1lowl, above. CLERK By Deputy Clerk 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.) C B. Claims roust 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. i C. If claim is against a district governed"by the Board of Supervisors, rather than the County, the t 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 tlaisns,Penal Code Sec. 72 at the end of this form.' rao�.seroo.osarrrorrsu oaaago,aroo.rrrQueen ralong wagon roaaoroarasarar.aarareoNuevo I RE: Claim By: Reserved for CIerk's Ming-stamp GLORMU BBCxat } } tI Ism.Vt Against the County,of Contra Costa= } MAY e 4 Z006 • ) CLERK SOARD OF S(JP, (Fill in the name) District) CONTRA cosrA�ov�scRS The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of S * and in support of this claim represents as follows: *Damages within the jurisdiction of the Superior Court, unlimited. 1. When did the damage or injury occur? (Give exact date and hour) Parking lot on north side of Lafayette City Library, 952 14,D-raga Rd., Lafayette, CA March 21, 2006 at 7:30 pm 2. Where did the damage or injury.occur? (Include city and county) Parking lot on north side of Lafayette City Library, 952 Moraga Rd., Lafayette, CA 3, How did the damage.or injury occur? (Give full details; use extra paper if required) Claimant tripped over.a concrete barrier at the.front of a handicap parking space because the exterior lights were out immediately adjacent to the area where the incident occurred»and the poor visibility prevented claimant from seeing the barrier. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? -_Failure to maintain exterior lighting creating a signifeant risk of harm because pedestrians couldn't see hazards. 5 What are the names of county or district officers,servants; or employees causing the damage or injury? Unknown 6. W6 damage or injuries do your claim resulted? (Give full extent of injuries or damages t claimed. Attach two estimates for auto damage.) Fractures, to claimant's right wrist and right elbow; and fracture of the left elbow; multiple contusions and abrasions..Lou term disabili from claamant:'s:-.employment as a second grade teacher with th ._.Oakland $ni ie S h of istrict. 7. How was the amount claimed move computed�l `t(Inc�lu`�e the estimated amount of any. prospective injury or damage.) Damages in an amount that exceed minim m jurisdiction of court. i 8. Names and addresses of witnesses, doctors, and hospitals: Raiser Medical Center, -Walnut Creek, CA I , 9. List the eupenditures you merle on account of this accident or injury: i DATE TTIvE AMOUNT Medical bills to date havebeen requested aaaaon-mo a aIto a WEaaasa'as am on sun a■.aa"S am a a as a's*-Nam owe as ON a a a•a a awe los oo a a a as s a aga.gaa'D sot t Gov. Code Sec. 910.2 provides"The claim.shall be ) signed by the.c aimant'or by some person on has behalf" 1 SEND NOTICES TO: (Attorney) ) Name and address.of Attorney ) MICHAEL D. MEADOWS } CASPER, MEADOWS, SCHWARTZ & COOK ) (Claimant's Signature) 2121 N. California Blvd., #1020 ) MICHAEL D. MEADOWS Walnut Creek, CA 94596 } (Address) ! 1 Telephone No. (925) 947.=1147 )"Telephone No. ,*GOOD wogs gap aaaaesasowe*aaaalaaa.aaaaa'sono"a a was aasaaaaaas asaoaa eaoaams a.a a-Y;agaav4ea,e1 . 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 Recrds Act. (Gov. Code, §§ 6500 et seg.) Furthermore, any attachments, addendums, or supplements attached to the claim form, including medical records, are also subject-to public disclosure. a-ss aaaa.9aaso noon aas0aiea'anaaaga8'a Dosssg sia�aa-906404 DosageDDoa.aaa.asgao a soo moo as a we►e a at 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 period of not more than one year,- by a fine of not exceeding one thousand dollars (S1,000.00), 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. TO: BOARD OF SUPERVISORS Contra FROM: WILLIAM B. WALKER, M.D. Health Services Director Costa C., 3o �a- o DATE: June 20, 2006 'coiiK`� County s'A SUBJECT: Settlement Agreement with Doctors Medical Center San Pablo SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATION: APPROVE and AUTHORIZE the Chair of the Board of Supervisors to execute the settlement and release agreement between Contra Costa Health Plan (CCHP) and Doctors Medical Center San Pablo in the amount of$89,586.91. FISCAL IMPACT: This settlement and release agreement will save the county the further expense of time and funds associated with this pending action. BACKGROUND: Doctors Medical Center San Pablo filed a Demand for Arbitration (Case No. 74 193 M 01056 04 TNC) against CCHP alleging the plan failed "to reimburse...pursuant to contract rates for services to..." six patients. This settlement and release agreement will resolve the aforementioned action. CONTINUED ON ATTACHMENT: NO SIGNATURE: ) ------------------------------------------------------------------------------------------------------------- , zl!` --r_-- -- RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE" APPROVE OTHER SIGNATURE(S): ACTION OF BOARD ON APPROVE AS RECOMMENDED OTHER VOTE OF SUPERVISORS �� I HEREBY CERTIFY THAT THIS IS A TRUE AND CORECT COPY OF AN V/ UNANIMOUS(ABSENT //do"n�►' ) AND ENTERED ON THE M NUTESION OF THEEN BOARD OF SUPERVISORS ON THE DATE AYES: NOES: SHOWN. ABSENT: ABSTAIN: / n_ , ATTESTED vX77e, �O oC��G CONTACT: Richard Harrison,CCHP JOHN CULLEN,CLEPK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR CC: Richard Harrison,CCHP Frank Lee,CCHP BY ,DEPUTY SETTLEMENT AGREEMENT AND RELEASE Recitals A. On September 29, 2004, DOCTORS MEDICAL CENTER SAN PABLO (hereafter"Hospital")filed a Demand for Arbitration with the American Arbitration Association, Case No. 74 193 M 01056 04 TNC, against CONTRA COSTA HEALTH PLAN (hereafter "Health Plan"), a division of the Health Services Department of the County of Contra Costa, alleging that Health Plan failed "to reimburse hospital pursuant to contract rates for services provided to" six patients. A copy of Hospital's Demand for Arbitration is attached hereto as Exhibit A. B. Hospital and Health Plan desire to resolve the pending action and the claims included in Hospital's Demand for Arbitration in Case No. 74 193 M 01056 04 TNC ("Arbitrated Claims") without further expenditure of time or expense of litigation and, for that reason, have entered into this release and settlement("Agreement") of the Arbitrated Claims., Agreement Hospital and Health Plan agree as follows: . I Health Plan agrees to pay Hospital a total of $89,586.91 to settle Hospital's Arbitrated Claims, representing, $70,542.65 for the Dennis Sparks account; $15,882.52 for the Jason Banaag account; $2,161.74 for the Elaine Ridge account; and $1,000,00 for the Kenneth Aguirre account. Health Plan will make no payment on the Toni Chou account, with Hospital reserving all rights against the patient for that matter, and Health Plan will make no payment on the Debra Siino account. 2. Upon receipt of the Health Plan's payment of $89,586.91, the Hospital shall waive and forever release the County of Contra 'Costa, Health Plan, and their agents and officials, with respect to and from any and all claims, demands, liens, agreements, contracts, covenants, actions, suits, causes of action, obligations, debts, expenses, attorneys' fees, damages, judgments, orders and liabilities of whatever kind which are the subject of the Arbitration or arise out of or, relate to the subject of the Arbitration. Upon receipt of the settlement funds identified herein, the Hospital also will dismiss the Arbitrated Claims with prejudice_ 3. The parties agree to cooperate fully and to execute any and all supplementary documents and to take all additional actions that may be necessary or appropriate to give full force to the Agreement's terms. 4. Nothing in this Agreement shall be deemed as an admission of liability, fault, responsibility, or guilt of any kind relating to the Arbitrated Claims. The parties acknowledge that each disputes the issues raised in the underlying arbitration proceeding. This Agreement constitutes a compromise and settlement of the Arbitrated Claims in this matter only and is not intended to reflect an agreement.regarding the interpretation of the contract or contracts at issue in the underlying arbitration. The terms of this Agreement may not be used in any other proceeding or claim. 5. No waiver of.any breach of any term or provision of this Agreement, shall be construed to be, or shall be, a waiver of any other breach of this Agreement. No waiver shall be binding unless in writing and signed by the party waiving the breach. 6. The provisions of this Agreement are severable. If any term or provision of this Agreement shall, to any extent, be held to be invalid or unenforceable, the remainder of the Agreement shall not be affected. 7. This Agreement is governed by and shall be interpreted in accordance with the laws of the State of California. 8. This Agreement constitutes and contains the entire agreement and final understanding concerning the Hospital's claim for relief against Health Plan concerning the Arbitrated Claims. It is intended by the parties as a complete and exclusive statement of the terms of their agreement. It supersedes and replaces all prior negotiations and all agreements proposed or otherwise, whether written or oral, concerning the subject matter hereof. Any representation, promise or agreement nor specifically included in this Agreement shall not be binding upon or enforceable against either party. This is a fully integrated Agreement. 9. This Agreement may be executed in counterparts, and each counterpart, when executed, shall have the efficacy of a signed original. Photographic copies or signatures transmitted by facsimile of such signed counterparts may be used in lieu of the originals for any purpose. 10. In entering into this Agreement, the parties represent that they have relied upon the advice of their attorneys, who are attorneys of their own choice, and that the terms of this Agreement have been completely read and explained to them by their attorneys, and that those terms are fully understood and voluntarily accepted by them. 11. The Parties represent and warrant that they have full power and authority to 2 execute, deliver, and perform under this Agreement, and that any necessary consent or approval has been obtained. I have read the foregoing Agreement and I accept and agree to the provisions it contains and hereby execute it voluntarily with full understanding of its consequences. DOCTORS MEDICAL CLINIC SAN PABLO DATED: By: FORM APPROVED: DATED: RALPH BELTON& ASSOCIATES By: Carrie McLain Attorneys for Doctors Medical Clinic San Pablo THE COUNTY OF CONTRA COSTA on behalf of CONTRA COSTA HEALTH PLAN DATED: JUNE 20, 2006 By. John Gioia, Chair Hoard of Supervisors for Contra Costa County ATTEST: John Cullen, Clerk of the Board of Supervisors and County Administrator JUNE 20, 2006 DATED: By: eputy 3 RECOMMENDED FOR APPROVAL: DATED: By_ Richard T. Harrison Chief Executive Officer Contra Costa Health Plan FORM APPROVED: DATED: Silvano Marchesi Contra Costa County Counsel By: Rebecca J. Hooley Deputy County Counsel Attorneys for Contra Costa Health Plan 4