Loading...
HomeMy WebLinkAboutMINUTES - 06272006 - C.16 M1 O TO: BOARD OF SUPERVISORS �'� BE °` Contra CostaFROM: JOHN CULLEN, County Ad i t for C DATE: JUNE 21, 2006 �•� =-_ � /\/��� OST'q COUK ,� V O u n ty SUBJECT: APPOINTMENT OF INTERIM CHIEF OF THE EAST CONTRA COSTA FIRE PROTECTION DISTRICT SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATION 1. APPOINT William D. Weisgerber as the Interim Chief of the East Contra Costa Fire Protection District. 2. APPROVE and AUTHORIZE the County Administrator to execute a contract with William D. Weisgerber in an amount not to exceed $70,800 to provide interim fire chief services for the East Contra Costa Fire Protection District for the period July 3 through December 31, 2006. FISCAL IMPACT The East Contra Costa Fire Protection-District 2006/07 budget has adequate provisions for the cost of the contract. CONTINUED ON ATTACHMENT: F1 YES SIGNATURE:ltt L [RECOMMENDATION OF COUNTY ADMINISTRATOR ❑ RECOMMENDATION OF BOARD COMMITTEE [APPROVE ❑ OTHER SIGNATURE(S): ACTION OF BOARD ON oZ '6 APPROVED AS RECOMMENDED OTHER ❑ VOTE OF SUPERVISORS: I HEREBY CERTIFY THAT THIS IS A TRUE AND /� CORRECT COPY OF AN ACTION TAKEN AND UNANIMOUS(ABSENT NGw(/ ) ENTERED ON THE MINUTES OF THE BOARD OF AYES: NOES: SUPERVISORS ON THE DATE SHOWN. ABSENT: ABSTAIN: ATTESTED: JUNE 27,2006 Contact: JOHN CULLEN (925)335-1086 JOHN CULLEN,CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR cc: By: Deputy CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JUNE 27, 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. D ggII�� you is your notice of the action taken on your claim by the Board of MAY 2 5 2006 Supervisors. (Paragraph IV below) given Pursuant to Government Code COUNTY COUNSEL Section 913 and 915.4. Please note all AMOUNT: UNKNOWN MARTINEZ CALIF. "Warnings". CLAIMANT: JACQUELINE MARIE HEIM ATTORNEY: MARTIN J. AMBACHER DATE RECEIVED: MAY 25, 2006 McNAMARA, DODGE, NEY, BEA MAY 25, 2006 ADDRESS: SLATTERY & PFALZER Y DELIVERY TO CLERK ON: 1211 NEWELL AVENUE MAY 24, 2006 WALNUT CREEK, CA 94596 BY MAIL POSTMARKED- FRO 4-. OSTMARKED:FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. MAY 25, 2006 JOHN CULLEN, C rk Dated: By: Deputy IL FROM: County Counsel T0: 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: Jc-?>p-D(o ByqC,�� 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). (1V. ARD 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 = L 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 personalty 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 unmediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjuiy 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 P'Iartinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. DatedJOHN 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 Claim to: BdARA' SU 'ER�'15QI15 OF CONTRA CQS"!� lJhTY a jNSIMCTIMN TOCLAW \ A. _ Claims relating to causes of action for death or for injury to person or to persorial property or growing crops and which accrue on or before December 31, 1987,must be presented not later than the. I OOM day tllRei•the accrual of the cause of fiction. Claims relating to causes of action for death or for injury to person or to personal property orgrowing crops and which accrue on or after January.1, 1088,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. (Gov't Code 911.2.) B• Claims must be filed with the Clerk of the Board of Supervisors.at its oeFict;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 asainst each public entity. E. rand: See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. • *aytrtii#tiwilitifyt/t*vitt#tltti#ttt#ii#rtsiltit•ilii!liitiilti*lititi4lRilttsilisiiititiiir RE: Claim By Reserved for Clerk's filing stamp JACQUELINE MARIE HEIM ) RECEIVED Against the County of Contra Costa or ) MAY 2 5 '2006 District) CLERK BOARD OF SUPERVISORS (Fill in name) CONTRA COSTA CO.. The undersigned claimant hereby makes claim against the Counry of Contra Costa or the above-named district in the sum of Sand in support of this claim represents as follows- A'' um in excess of the $25,000 jurisdictional limit of the Superior Court . - Unlimited Civil Jurisdiction. 1. When did the damage or injury occur? (Givt exact date and hour) June 27, 2003 at approximately 9:00 a.m. 2. Where did the damage or iniury occur? (Include city and county) Intersection of South California Blvd. and Olympic Blvd. in Walnut Creek, Contra Costa_County, California 3. How did the damage or injury occur? (Give full details; use extra paper if required) SEE ATTACHMENT #1 EXHIBIT I Exon"IBIT A Ci information about additional plaintiffs who are not competent adults is shown in Complaint—Attachment 3. Page 1 of 3 Form Approved for Optional Use COMPLAINT—Personal Injury, Property Code of Civil Procedure,§425.12 Judidal Cound of Caliromle S&U, f ns' 9e2-,(f)[Rev-July 1,20021 Damage,Wrongful Death P (TYPE OR PRINT NAME) (SIG ATU OF PLA .I OR ATTORNEY) 982.1(1)[Rev'July 1,2=1 COMPLAINT Personal Injury, Property Page 3 of s Damage,Wrongful Death U s , i �I i i II �I II li I� �I I 11HIHXI 10 m r. oin b. c4 cc o cc o C .® C — vJ C O 2) � • - H mcc t. Q t .,y ^ ; O, Zip, � N , LLJ Q �a d W W 1 3 w O 3 ¢ z = g z z F > x C ¢ o C] N W m o ¢ O z Q w ac W o o z U • � H z Z a 3 cn CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JUNE 27, 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 Epnds on your claim by the Board of MAY 2 2006D� Supervisors. (Paragraph IV below), given Pursuant to Government Code AMOUNT: $1,260. 79 COUNTY COUNSEL Section 913 and 915.4. Please note all $1,309.40 MARTINEZ CALIF. "Warnings". CLAIMANT: KATHLM SANFILIPPO ATTORNEY- UNKNOWN DATE RECEIVED: MAY 25, 2006 1600 FRISBIE COURT #2 ADDRESS: CONCORD, CA 94520 BY DELIVERY TO CLERK ON: MAY 25� 2006 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 25, 2006 JOHN CULLEN er Dated: By: Deputy lw-zalw�l It. FROM: County Counsel TO: Clerk of the Board of S6,pervisors (V)- `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: .t��p .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: This Claim is rejected in full, Other I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date, Dated A, Deputy Clerk a!�eOQOHN CULLEN, CLERK, B/y4g!!7A— D WAIWING (Gov. code section 913) OF Subject to certainexceptions,you have only six(6)months from the date this notice was personalty served or deposited in the mad to rile a court action on this claim.See Government Code Section 945.6.Yon may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an ,ittoi-tiey,You sliotdddosoimmediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I 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 Postal Service in INIartinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated -Xf *; WX JOHN CULLEN, CLERK B ___,Deputy Clerk t 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 CIaims 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 Iater 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. ■raaa0aaaaa0aaaaa■aaa■aaaaa■aa■ava■sa■aaaa■aaaaaraaaasaareeeaaar�aass aaaaaaasaI RE: Claim By: Reserved for Clerk's filing stamp ) Jef A01**'4 ) RECEIVED Against the County of Contra Costa or ) MAY 2 5 .2006 BOARD OF SUPER-V District) CLERK COSTA CO.ISORS (Fill in the name) ) The undersigned clainiant hereby makes claim against the County of Contra Costa or the above-named district in the sum of Sand in support of this claim represents as follows: %i'' 90 59�/_369/'YD 1. When did the damage or injury occur? (Give exact date and hour) /�/o6 /.2 P``lp�. 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or inj occur Give details• use extrtpap if re uired( required) 4. What particular act or omission on the part of county or district officers, servants, or employees cAused the injury or damage? R 5 What are the names of county or district officers, servants, or employees causing the damage or injury? n� 075 PIA4t�5 Ao, 1(:21)391V 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed.-Attach two estimates for auto damage.) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 70-04 ea 2 -40 So? CO3,- Ll S. Names and addresses of witnesses, doctors, and hospitals: 9. List the expenditures you made on account of this accident or injury: DATE TWE AMOUNT ..ss■■ss■■sssss■Sam ssssssssssssssssssssssssssss■essss■■sssssssssssssssssssssssssesssl .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 ) /600 lain is Si ature) i (Address) ) J ) Telephone No. )Telephone No. ■sssssss■ss■sssBonn sago s.s..........^.essssss■■ssss■■s■■ssssssssstssssssssssssROME Muni PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthennore, any attachments, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. s ssssssS suss sssssss s ROMs s s■■■sssssssuss■■ssssss■..s...■sssssssssssssssss sus s ssssssssi 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 comity, 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. ,05/10/2006 at 04 : 54 PM Job Number: 13030 JIM'S CALIFORNIA AUTO BODY INC. License # :AF178743 Federal ID # : 942227228 EST. 1962 2520 Monument Blvd. Concord, CA 94520 (925) 689-6117 Fax: (925) 689-7836 PRELIMINARY ESTIMATE Written By: Brian Mahler Adjuster: Insured: KATHLEEN SANFILIPPO Claim # Owner: KATHLEEN SANFILIPPO Policy # Address: PO BOX 1484 Deductible: PITTSBURG, CA 94565 Date of Loss: Evening: (925) 349-4436 Type of Loss• Point of Impact: Inspect JIM' S CALIFORNIA AUTO BODY INC. Business: (925) 689-6117 Location: 2520 Monument Blvd. Concord, CA 94520 Insurance Company: Days to Repair 1993 MERC TOPAZ GS 4-2 . 3L-FI 4D SED RED Int: VIN: 1MEPM36X2PK627806 Lic: 4WQA900 CA Prod Date: Odometer: Condition: Good Intermittent Wipers Tinted Glass Body Side Moldings Dual Mirrors Power Steering Power Brakes Power Mirrors AM Radio FM Radio Stereo Search/Seek Cloth Seats Split Bench Seats Recline/Lounge Seats 5 Speed Transmission ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1 FENDER 2* Rpr LT Fender 4 door 3 . 0 2 . 4 3 0 Repl LT Molding strip 4 door 1 30 . 20 0 . 3 w/TOPAZ insrt titanium 4 FRONT DOOR 5* Rpr LT Door shell 3 . 0 2 . 3 6 Overlap Major Adj . . Panel -0 . 4 7 0 Repl LT Molding side, adhesive type 1 93 . 15 0 . 3 8 R&I LT Mirror window mount 0 . 6 control electric remote 9 R&I LT Handle, outside 0 . 4 10 R&I LT R&I trim panel w/o power 0 . 7 units ll# TINT COLOR 1 0 . 5 12# COVER CAR 1 5 .00 0 . 1 13# Subl HAZARDOUS WASTE 1 5 . 00 t 1 I x5/10/2006 at 04 : 54 PM Job Number: 13030 PRELIMINARY ESTIMATE 1993 MERC TOPAZ GS 4-2 . 3L-FI 4D SED RED Int: ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT . PRICE LABOR PAINT ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- Subtotals =_> 133 . 35 8 . 9 4 . 3 Parts 133 . 35 Body Labor 8 . 9 hrs @ $ 74 . 00/hr 658 . 60 Paint Labor 4 . 3 hrs @ $ 74 . 00/hr 318 . 20 Paint Supplies 4 . 3 hrs @ $ 30. 00/hr 129 . 00 ---------------------------------------------------- SUBTOTAL $ 1239 . 15 Sales Tax $ 262 . 35 @ 8 . 25000 21 . 64 ---------------------------------------------------- GRAND TOTAL $ 1260 . 79 ADJUSTMENTS : Deductible 0 . 00 ---------------------------------------------------- CUSTOMER PAY $ 0 . 00 INSURANCE PAY $ 1260. 79 *****VISA / MASTERCARD / ATM - ACCEPTED FOR DEDUCTIBLE***** Due to many unforseen circumstances in the repairing of automobiles, we regret that we can only estimate, not promise a completion date and time . 2 • Date: 5/8/2006 10:27 AM Estimate ID: 492 • Estimate Version: 0 Preliminary Profile ID: CUSTOMIZED East Bay Auto Body 620 GARCIA AVE#B PITTSBURG,CA 94565 (925)473-1876 Fax: (925)473-0796 Damage Assessed By: MIKE SAYEDI Deductible: UNKNOWN Owner sanfilippo kathleen Telephone: Home Phone: (925)497-0355 Mitchell Service: 912622 Description: 1993 Mercury Topaz GS Body Style: 4D Sed Drive Train: 2.3L Inj 4 Cyl 3A VIN: 1MEPM36X2PK627806 Options: AUTOMATIC TRANSMISSION Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 208080 REF BLEND HOOD OUTSIDE C 1.1 2 208710 BDY REPAIR L FENDER PANEL Existing 4.5*# 3 AUTO REF REFINISH L FENDER OUTSIDE C 2.4 4 221580 BDY REPAIR L FRT DOOR REPAIR PANEL Existing 5.0*# 5 AUTO REF REFINISH L FRT DOOR OUTSIDE C 1.8 6 AUTO REF ADD'L OPR CLEAR COAT 1.6 7 AUTO ADD'L COST PAINT/MATERIALS 179.40 Judgement Item #-Labor Note Applies C-Included in Clear Coat Calc Add'I Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals 11. Part Replacement Summary Amount Body 9.6 68.00 0.00 0.00 646.00 Refinish 6.9 68.00 0.00 0.00 469.20 Total Replacement Parts Amount 0.00 Non-Taxable Labor 1,115.20 Labor Summary 16.4 1,115.20 Ill. Additional Costs Amount IV. Adjustments Amount Taxable Costs ---179.40 Customer Responsibility 0.00 Sales Tax @ 8.250% 14.80 Total Additional Costs 194.20 ESTIMATE RECALL NUMBER: 3/812006 10:27:41 492 UltraMate is a Trademark of Mitchell International Mitchell Data Version: JAN 06 A Copyright(C)1994-2005 Mitchell International Page I of 2 UltraMate Version: 5.0.214 All Rights Reserved Date: 518/2006 10:27 AM Estimate id: 492 Estimate Version: 0 Preliminary Profile ID: CUSTOMIZED I. Total Labor: 1,115.20 Ii. Total Replacement Parts: 0.00 III. Total Additional Costs: 194.20 Gross Total: 1,309.40 IV. Total Adjustments: 0.00 Net Total: 1,309.40 This is a preliminary estimate. Additional changes to the estimate may be required for the actual repair. li ESTIMATE RECALL NUMBER: 3181200610:27:41 492 UltraMate,is a Trademark of Mitchell International Mitchell Data Version: JAN 06 A Copyright(C)1994-2005 Mitchell International Page 2 of 2 UltraMate Version: 5.0.214 All Rights Reserved CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION JUNE 27) 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 3 1 2006 given Pursuant to Government Code AMOUNT: $372.79 COUNTY COUNSEL Section 913 and 915.4. Please note all MARTINEZ CALIF. "Warnings". CLAIMANT.- BARBARA L. WIDENER ATTORNEY- UNKNOWNMAY 31, 2006 DATE RECEIVED- ADDRESS: 206 PRIMROSE PLACE BY DELIVERY TO CLERK ON: MAY 31, 2006 PLEASANT HILL, CA 94523 HAND DELIVERED BY MAIL POSTMARKED- FROM- Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, r Dated: MAY 31, 2006 By: Deputy 11. FROM: County Counsel TO- Clerk of the Board of SuKervisors %)eThis claim complies substantially with Sections 910 and 910.2, ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). O Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). Other: Dated: By: /"a9&^4___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 9113). IV.,BOARD ORDER: By unanimous vote of the Supervisors present: (vf 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. Datedg. ��pV%2*4040HN CULLEN, CLERK, By ,4/ =��Deputy Clerk WARMING (Gov. code section 913) W 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 immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of pet jui-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 iu Martinez, California, postage fully prepaid a certified copy of this lJoilrd Order and Notice to Claimant, addressed to the claimaut as shown above. Deputy Clerk Date( .10.FIN CULLEN, CLERK By 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 945 531 C. If claim is against a district governed by the Board of Supervisors, rather than the County, the naive of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. ■■000coccocoonoocc0000c000c0000ac000cooceiocc000000000aoeouccom000coococoeeoas RE: Claim By: Reserved for Clerk's filing stamp REC} QS Against the County of Contra Costa or ) e ) MAY. CLERK B(Fill lIl the ame) ) CO } The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of S 57 2, '19 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) CA- 3. How did the damage or injury cur? (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 capsed they or�e? la Luk'e_ �64-k S I, cF Ax �Jz . OU'!! -�-�tk-��am - -. CQ V1( j-" -0 Vlt2. 6tL �0 S , 5 What are the names of county or district officers,servants, or employees causing the damage or injury? -n Ja__ 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates-for auto damage.) rl�Rz , 7. 'How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) , vvt_utk d . 8. Names an addr sses of witnesses, dctors, and os itals: nn Res, Cax ea�2d Poil ►cam, GFI= C mA z aLay 74g-1325- 4n4-firv1 - 8(04-84d LyVwLac 6�'u fns 4[Z- 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT ■ ■oaaoaaoasacmaaONE aeaoaaasaaaaauaaaaoaaaaaaaaaaaaaaaaaaaaaaaoaoaaaaaaaaaa■snow aaar1 .Gov. Code Sec. 910.2 provides"The claim shall be signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attoriey) Name and address of Attorney ) ' ::n (Claimant's Signature) j2-04P PRAV420sc P" (Address) P t—E� T 4-1LL- cA q` 623 Telephone No. ) Telephone No. SON■■■■■■■■■a■■■■a■Nunn■■ ■■■■■■■■■■■■a■■■■a■■Run KOKEENNUMEMEN ENNEREMEMERM Man a ago■East 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■■■■■■■■■■■■■■■■■■■■ ■ ■■■■■■■a■■■■■■■■■■a■■■■■■■■■■■■■■■■■■■a■■■■■■■■■■■■■a■■■a■■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 prisoiz, by a fine of not exceeding ten thousand dollars ($10,000), or by both such imprisonment and fine. May 30, 2006 On Wednesday, April 12,2006, at approximately 5:45 pm, I hit a pot hole on Concord Avenue just east of the I680 freeway overpass, in front of the Ford dealership. The pot hole was filled with water, as it had rained most of the day. I pulled around the corner onto Diamond Boulevard, where several people who had just hit the hole were lined up— most of which had two flat tires and other damage. A Concord policeman, Lt. Chilimidos, was present to take the names of those who experienced damage. I had a front right flat tire on my 1999 9-3 Saab. I called California AAA to have my spare put on so I could go home. The AAA serviceman mentioned that my wheel was bent and that I should take the car to someone to be checked out. The next day I went to Wheel Works to get a new tire. They confirmed that I had a bent wheel that needed to be replaced. They also said that since my car is front-wheel drive, I should have the car looked at by a mechanic, as they believed there was some damage to the right A-arm strut assembly. I took my car to M Auto Service in Pacheco to have it checked and repaired. Following is a list of the costs I've incurred due to hitting this pot hole (receipts attached): New Tire/Wheel Balancing $ 91.98 Repair Bill—M Auto Service $139.00 New Wheel $126.81 Tire Mounting to New Wheel $ 15.00 Total Cost: $372.79 I spoke with Mark Trump of the Contra Costa County Department,and he mentioned that the county had gone out to temporarily repair the hole at approximately 3:30 pm that day. It had rained most of the day, and the attempted temporary repair was thrown all over the sidewalk as drivers hit the hole. The lane should have been closed until a proper repair could have been done. My car up to this point was in perfect driving condition. It is only since I hit this hole that I've incurred the abovementioned damage and charges respectively. Therefore,I am asking to be reimbursed for the total amount of charges that I incurred. I can be reached at(925)685-2873 if you need further information. Thank you. Barbara Widener 206 Primrose Place Pleasant Hull, CA 94523 ` ` w +fr s �.' kC v 't'"r t f ; � r to ,k 3, >s r -. tit? 4 r r 1 %,l" t 1 Sw t 8i L 1 at 4 f J � 3. ,( ✓.. F ;p r r'��.t sL t �i�.# . {n # INR3 #"kkr r 4 ?sfL' k 'SY.t N r v �'� p J 9 .r F k} 2 t,? "11- ,,, ,A g _"`t a-Q '{-' ( n >,�S x�, i s x,}a-z ,t+ ,. /a �y,_,,,_w * K F "`r�Ydit- _grk' �l, I. r� '#, Ag '�i.. 4;r{3{fC ._ 2 t 11­1­`1 sompow=sA..a t ;}tti iw� z' s r w4,t r b >J «k U I } n r as �,' t' # 1 �- r rte " O R ^a ,�'E.l# 1i� r �'t r >zk rf :v9 l r � t $.. i t�,w _fflW, ��^^-- ' t v t',tSi c�� x r 01 MW a4�1ry sa a Rs ir` z t ia�"I, �,I'y��,�,v 7j,- ry s it �� -t 9 Via. t,a � .toa lF t12 '_4�7.. "bx f.; (t�5 ;!M`lq. j � a t ,�I r'"Tdi�'+ryf;{, tet` 3tr" t �}`` h 5 n 'tt t n} �Ih'*M_�,,�A s ' ,Y tN �b "�F.W.A 4(� yt` s F 5 yl 7`:F }` r e€ a�b �, a Xy -�q �rnt t �A ( tarsi W. -- .. _, Yi ,. to 1 } '>'�)y ? - 4 �.Y vin'�'S`G )-. .wMsJ C p r rya i,;t :'1c? ., X o s a r C e- Kl s r ea:� bhp , a 44'f}�¢�1 f r�-.e, kp��ri a^'t F t i" '� 11 r 1y1 � g�?d '� 3'�rt � },s >'. 11111 C t fit,.- �,i "E9�gp'I 7 p^„, Tim{, L.y^v' x»y 4 y d rz . "a te a �4 ' ­�� Ipp 1ti p­1-1Ftp 1 �4r� T, t I t�T o- �f s �� k, ,'��Z _ .. t ss- rt s'"x# �'' t Ya KIT 1, 8,.. N'"W;i h� _1� sf '� rN. E� r#t� GYM ;� ',s:. q,r # 2 -go _ -.. ....._.. r r $ (}A"BAWt� ty )1 r� '[P r � r�M$�Y.fib. +j(,t[.` t .'S^,t%✓� T p' { il,>. . fff... A y ; T1 J. \� ,r f 1V�k�4, �J WOO=> t r 4 "pp-�,�4yy�,, s - is f i c *�. - y`',�a`a r r t. t 8 _ _ �4- t a t `m w t i + �Sw.w.>!Ff m ! , 3"u r e ut t x J..€sv: f f _ 1 i y- G, . . £s"1 r ,_ .r% t��d r Yrs t d4 have a.choice of whetlie for not any work will be performed on your vehicle+cif is?importaT,I', us t tat i provide the �' _ r R u areable to make wformed decisions Therefore we have itemized the parts and seniices by the foflowfng categones CS_., r q t �arY i �a ,4i} r t} € ? �"i _ 9lS C; rw'S F tr 'T1i s?k -:NE , a" r 14. 1*1, 4cr.r'f :y 5 S KNOWS }JFak. y v u a] i c, =,S, N y .t >.l s ry« a my,, `+sw - . I r ' E �a i 3 ? iMPR(gVEDPERFORfiAANCE 'v­­,SQ­` at r 10 PREVEN,'IVEIMAINT iltNCE gfq,j g ,��.,�;„ ti �3 d } ;t i r% La ",, , w# c" Oxy t t y.✓+ t&� t ° a fi�t �� J �6a These are opttonai-hems t r :ttf These are optional-hems��z , ". �r a t Comply with mamtenant"''T.mmeridatibns' the.yehide s�r,.' '-e4Atldress a customer requeshor convenience(st fte rude enhance t,, {PGtigtr al eLgy}pment maaufadu O% -L ge(}o gppe,eltmin�ate noise etc x#4 Wy iF a� omply with orrimendaUonby the;tire ma3t facturer N Although mahy;agermarket manufacturers c mkrrlProved Jk M 3.: Component Isr°diose to aUle end of rts usefu�!Irfe�ust�above the Ri'°^r performance over the ongmal edwpment manufacturer weican.only ± discard specrflcations or weak etc) z s j cvrelyLpon their tes ng results and cannot confmn{he'.c' a. ms df tiva 3i ' rxx re v erfonnance r w ca a tax'° ,$,+ t.z t,v#', :4 tri t�.7a J _� "lye`.: #cKP - _M ,n�? 3 fid✓ li a 1 a :Y'F'€5t�1_ ..c':U .,£ r'tYr_.: t3 f r y: �' ' '�,z r n %r�, r "'p :l zr tit'6i3+'.G a+ '�iK�y"a3. a .. �k ,+ i -11 QTY STOCK NUMBER r`ktY DESCRJPTION ttPARTS� L"gtLABOR/OTHEREXTENSION{ { , - i i° .y '� r w - k4 ��� a p"� fi,ya *4, y - s4� fr'1; `t4`' '`'A?'.><yr�+ '4F n ; r K; M1 §`3 .^`V ,,y�"F+ ' i �' '=r a ., W' fS tit _rF P `ter , ,� s.':a t rv`t-.f -r t ,' m,� a,[,t t < y._�c i`.' i } ,s *� f *� ., ', '.x4 '�'} �"ax•!t' ,r.xt,�Y 'x�v y _ 4f'..3H s r i.K7�"�'w ?t"a'- `�T r .�` �"F7 _,; ..{ 5. c X44 Q P- rf � rf 6 �z } spt� y � W"W6 - -,z it �.. e x - z ., r s 4 t k �. rj.r',' ;" x i "` x{j r Ie4t--Y, _,, k o>34t F , ::P < ,i,. ^S< �9r-'^i•1. ",C 1 -.r Kai. S tx 3 '€''"} g;,F %A 1°. ri':1'e4 %3. ' _ei t 4•..., r r"•r a' '�: -- S��".. .}..,,:y.. '`,'" /� #a'.f t� t+ . ^'f *s;I n ,:a#a`r r,I + Iy- � ...•+3 a ,* :� '"` cfl :;'{ t_ .tr+v a >*t } , i{}'I 3i r ct�t"`�'�a t,:�� StA i. G t: 'M'{.. x\ �, 3t? 'z:' .r ..,; ,,, yi' s{,,;a s !' x:��`%y+n v¢r .4 t :*fj r t, ter" 4'{�`d ?fix 1 # ry 4 >«P�r::..'� a,` TS �4 y #in$!><•r'!'E : .t't-� :i a .;� rwr�s Y ,tat: ..x.-, eti y � :-K f 2 P '� r b`'�w�'? � ,, �gs ''3 :�2' a.x a., i .,, "{ r i 3:�:t� -1 3 r��+'T -. t�t/.jc "1 z '1f t 1 ;4'V r };; t .t -v, t �'" `„'t%�.a-.*`,T, ''s:�+. .2f' ow.;k -'c� 5yr�". X3 w$ s, m 7„�.,'."� s� .,,;r l rtYr- yr u'; .rte .kt t ryfrs a,.: i a'> as a.£ ,,fi ",..::,• r i. s -..s a c ._. '{ '.,'.s- Cer i<" i .. ,ri4 ya,;,�' w of sty.-��3 i '}x.: r t -x cal ,,,t S" x A r a ., s' ..k9';.?a w�t,?% s .s r c,r£. } d�.44.: ","8,,tt,d,r t -:`',S, .t. -' {-. r t.:' •6 "F2 a ,�„.,::s' ( �� t`,F i' v z siF- t.,;s.r #' .'<: a ;::+ Y ° 4'llt..t "t,� l`J t t 3 .e:`Ct L 1 t.c'. -,,l_I_1 J..1 Ct i.. 3?9.5 v ,.,s a �>^ * �, .Y* rt �`+'x. ` 3 t :Y< i a,.a, :5 r Ct :., a ,y 3 .,. ;i, :;.L ;Yo- i `t - rr: a.-n s x xt.a-Rrx.- ! €.*h,#may r. ,- +- :, ~• - r.:, '4k,. 51.: E., ? , '�'` �,. rs.,:t r yiS.e�S,,Y t ,.I,.x-r y ii >•1! r 'r d4 r .:^t '� P`vZ T 4'.."•:il.:.' xx .ert'^.r E'.a, t',�r, ru 3�4` ; . .f. .s:..', �' V.: ,.r.,,+- s n-;:;.�,{ 1 i --.; P k`:f>.. sut ,-:s.:� - iKx'-.>r' t -.. e � ;- X r.{�5-ak ',i-� k a> A:::>t y�,-:-r 7•a ' 1 V 5,.,��_y> ,,, 3 R t�i,BBEH ,�f ��'`R � to � � � w v..u. ,->..;.:r.,.4.*;..'�7w .v,,'."t}"• „r �:.... s r„. .k ms. k ,,.fi':•r ,.�s,.`. °3> '`r vw.�.. ..,rir T'� ._' ,,. r _. �� ,,y€.. 4n,%k r*:.�i Q- ,Er.. �; �,. '3< {1+ I �.Z k _ iih 4: EE .{t.y./.5�,' ��,iP,5,`5 � �Y tp,,tr'..:'1}�,4r 4,.,5%+={^.�,;.y^t t.:.r'^"t 14.,i. i��' t v1 „?,�i r✓.P �' %:w ✓''< �'� �Fx`f., f`�_i l+ =•-, !e, i a-yF6 7L C X 1 �1 .S t..l Vjt ''" 1'"5+.:1 1`F r g a"}`It-7 fC.`L't.,. f C#.,.:d '�C,' +.)��,� a a': 3 /.4. y',142 f Ss^'?Y r ,j;- J 4 ? .3,'� ,'["ri.r ;,. 4{ s.. -.� ry ;�Y L, �,.;FA� P�',.f,S.+n._.: r. >XE�t#+s•6 s dya ;t': §t �;Tpt+ ,�a.'.,` +s �.: d£ )F J'S .. t Z'0.'` .;j .,..F .t--- i'{t�--,;,�:p'T y t 'M`u,t A,,., i.-;' p i fnryr;.t'.' .it b7, t�!-..,,bt4`��E^�._"E E....:t::1 L.rt�r ``'',.3 r rt,. 'S',f -Yr�'I tra�<,'fi, t*"- , t -.�' a�f.1'fr t'F^r t,.. � ( (1 1 '1.»!.r tix t l�y_,.V`Tr'7F �. [ SRr C F. w,..7 �. .?F > 2 4! t 'Y�s;.rR- �' ..r., S 9,.r i ?. a,;6 i 4 `W. x.. 'n`` f� x s xr '.£r„ 3akr'> 4S$ ,.a e`" a ��..+, ..,' S!.r,."# i { r•F p?wk w; { />�,c}'`" c .,, p3:{: c;."z t S n tt,4 t t aEi , t r .� , ; w i t r i a ��� f i 3+ `-.r x zs. t t > ;$,..- rk y .t > r..A�.r Ir.k. a b4 ".: r''} .rr 1'{4'"r y�r.--_yr`u' t?rn t" ,r� „k'�`'` 3`.i''x�twtt"� .T t'u l E� t r k m r � ate, e re t a '• ¢ ;, ru A. "' t �qTr f z3 a /,e i,a; kt^..s,3,1s f '�y�tt `fe?� Sy^ '.1 LL v x >c it ..., Z,..�,.} .+l.a..« r t,r,5. :. F � 4 f.1,.9{�";4 lyl -y r ?F?i'Tkkwy 7 949 -3 r c.�t, xGY �t,^2 art'rr tx .re 7rr ,5f s �. ^f ,'_'? t" -e o � > t F�,.:a i•,.tt t S ..yy. 83r r> .... _,t Y _ `!d pir 'fie; r r SSA `'' v '. s a 'r.�.,F .y€j �3, "`t -,:a" d{ r-'•. ".'�...i'�, r=f >4 ,,�0 . �{��( t�� ,:t:... ��^ry� '' a p�-,i'•`, +�uir ,.>s' 4.,:y 1 u 'r ,:i" .s �C° 3>'{;- 5a -Sd-F .,dY w>.«>Ih, q t s.. nrTfH .vy a -t. r Wt-1. t` �ti ty 1L11'-3�"f ,.a, ". :,}r f`r' tv^.s.:'. ;,,'✓ �' h'i,;`T .Y X" ,r:� g..yt"`a..a .� l i �d�+ t7, ,*, F .,,� S-. .t.i nq 'r �._.:�' , i` '� - ',. .,,r '�"t' +e�°, '. - ra.,ti:'. 1 t-�Y r'�+1i.,:,#3 1'tttk`:�'Is.t," h, '"`E a.X'" r. 6 £ ,k: u f' i r m zr ys �,- r 4yy .Y. az%• J =r a zs t `{ y-, 3 4 `:i#i- �- A n a rzs ^a R` n d„k� {-,��,.. iF.. "4� �i t k r P`',;, . Y r��9. A .l .r.0 §,,, ,t a x t e ...,.,z k r t t ._,,r,,, �., i v 1 r-.,::, ,.,"t�`,rt ,�. td ti" +"?s J t e`ri{ c+rs"' 1 -, �,r , 1 n','i r'` - # + `4 7i x 3, r'_ r •i{;..#r= .-i jr' `- ,. 'r'^ ry,...T r P E t.:3" ,x„ ''j ta-�'P t yk"F.8 as Cr^Td uu,7,,�'Sh°r"`-ft , ! ��t.?n t jt€°ta4W�3F mj �I#-IEL=�l #� I}FHf �x r: tt11 t t.'x .Frr l �r :€'�,,'` <fi r 4�ti §.� "�- j¢€ ! t ya ,�. is a;5"i P S +t r, - 4� t r' �t t d. k lP- +1 MW i.p A a }ia��, �i"1 ����� lY , 1t�l t..t'. 4:1�`���t'Pine 9 i ` J�. ' r f i ,.taa 4Ks_�r ax s�; t3e��. u 1 a. % r -4:W q7 'xr ``,,{�01.119 {{ yy(��,}} r',yyr-'.. k t -:_h(. }ttF 4_ r`�r,t; L ,c a,i.,iw", !lrYg. 2"4 ryy " �Y L £ I, f v' ; r'. aH r t 4' ,r trF t� r .3 11+a �:S i+l,� L..I M4 �i�is l"l i-i. r ,t.t P F arts eta,'s43 KS !- k 1, '' 4 E, ='t.si`E'� ,,Y.;Thr k r ::s, F 1..SSS ty-s,; {. F i ill = "' ,1�.- 'm 1 r�< ra �3 t t '.t dmovr# x, 1 1� u +r r` :ra <s'tx F�:r a t t�' e r a -sr 4�`x r't , r�nI K"l l t 1 d 1""" i f�` r .x y3"-i`c r? = J ,,V_ } -. „ �'"�a a r< S R , x S p f M 1 .la `S ., 5'.? .r^>,. ; '' f t•rr4, ., f .tt� s. '3, c it,: 5 ?t ! ,ti 1 ` J` r;" :„; �';"'?4 y, �,� g�sQ' c'��"",,afr` "�"' ,,z„1.` 't;' 'e td. ,.,..x. "�'.._.,..,4 7`..,.,y,.:><6ti:. j..a, .:9._999,ix:t �t,,r ti ', 3;,,.`4",:7, :,. ,:3 ^sh:..,,rte_-,twr s t t, t:. C Ras 7.r 1rfr.'`i a `�3- �. �`�' -%A. 1F x,.� Y.r :3 c r` r _ a i az {.,E. yi+ n'�F e4 :�M ,ci :v,h i X a fi`4a 3 isr':, YR'L R ti�`"* y a `7 " 'f F' } {, w F:} I, ,{".tom F l wit, yJr F i }r ;�� xeyj `t M r,'"ox f"`3a .. 7 r �. �� 1 " T>'"•,.;at 'RP. ` !' �°+1'.':1nS ; m{r's"�. at's' .�'•,9 a c r ;,ta ,�,'r„' `t a"-N-.t � t' I;'_ r:.- `� •:.,"`. .::.C'` > .- tit. 'C.^`�';' .,�` 5;4, it .+;�`'v� - c'`r��. •".i: ,n-� x u. t"a { .. 2t F._ f '}', ."s 1 s i ,�+.Ir �,?, ,,. i ,�, .. >:1 .s,,� ,� - .,tom. .*'?S -`,,I #ati ":.:. �9, ,> i x ?,T' s,F,.R_" f ;-a .,. r 4,r,ez '€ s,9� ru..,.y.r: mer« :.t�,. ..3-h `� b., S.tatC ';-'. ar S.- ,rs .a:- - ' r`u-an#X (sa t x'Y y.: Y4•4- q ,_ k .a Vea"F r '",..f 1, "f":� c„,*"F .4,3x. 'R✓w. .' -r4' ``yy t 4.- 9 -,.,p,j ... x..+ . y .t-. . t k i 9 %. 4,. S ,:4i L .r ".< l tij... } pF.- ;:fi, - y � {fir ''n - {"F g r ^S'c_.a z ,. >_ `Pn..,3t.''a>!' r: 7 T 'rr C- e �% ."`kr£:4,'C.75.. 'JK ;# ^+ a"$,`> r `&o- w ' -aj ,- t�' s r ,r e r ,r , r ,sem Via. r > .. -, >.- .rK., '.. .. yr e, sr>•r> _..r .'. '� -r^ +«,,w�- .rJL, ^i -os f a*.#: � 1} �' �:'W; .. s;...:'i#kC ;X.rc's S•*' r ,:i" {may. .- _ :;�'t sf*:, F,,..�^ 3" "P-' a .::-'' s�,,:. ,1 x s ,, .r', r 1 a;'s„n.i 7 � t �r " sw,.' ,"r ` � c - • }. r t t 5r aF '"z�' .,' i `� h......, � :. n�5+ .,,a„ �"kf*.' +' �., Et' i F " `" yy;; r S •4,. ,,... ,,+. ':: :..,' s - _ a vn' m ,,' ,...;s� y� l k.± ,"',. '. .E$k.^es..a: 1 .• G.. i. g -fu #r x 's •.3 � r51. j,y,., u M_ ,a,q,; , ..'r ax. zc i<r '. .�,rF.S. p T ,.4.%Y. rr-.' fz .,*r s Y` x i#!-.s" x ,.L•3 Y'` -,.t�g�..:.'a.3 2,n'� :.3 .�+ ,yr,, nit-.:,,F-+-,�x`; - , '»w,. t r .,,a. 't..., '.a. ,. .:;, � 'ti, .--.>Etv k" �r %,a;a'=,. t `> ria d. .� - r r x 64,"- . -.r„ .r,,,t ,z�. x .��,. vim. - +s.s t 65 , trr Tr ,:...c� t Y 4,?s,.&,.t k,rtN n ,�.,,. !'n rz $ !2 , 5 , n 3` .a'r Sc #. y `,;. :,46 "i.# s. _�-3;..;}SK .4�. r r`s« `" u ;'sfv -a. r� "~. '4'r `. "r`t .' n r;h' ?•: ,y ��?r '�. y', 'S'r '� n rw >:, -Der•.+ . '.'� '` ,iw y- 4 r'..�..;.; ',' *.^4. ?^ 15 -c�`p. l a i'-".a. ,:� a a.rr.trxt :_ -;*', ;i rr7.�, t ;,f+ .....� .,' -t ,ar'6.,:-✓r v.; a S�>: =fY�`£�t i. 's. ,..',E#":::.' "zp:ter „k t p S asr .r t, .ja:i. ,.%a?r. �+x ;^ ..a Ya*r '., t' tt>�. ..J„r .i' y+,y ., tai€:.:t .,r..:, t' 9"t f�, ."M -s fi.;rack',;.. .�i s�1, a; ,;;-"m .-q` a, " ° f.r. t fir;;, c r..�j ' :. C� r� yq. ,tia; 2 33 t ay 1h��:kr.... a �:.t_:g : tt try. ,� 4.-,�0 at,a `kx' p�y`�/p x i S aYm Y a".atpy i ... Ls �i,. 3 S,,0 .,l r.,f 3 '"ts r ''"`S r. ..+� .;a _.-,�� ., 'f t3 .'^a •`">�4' r,. .,.1 �s,,.I , n',bO �' T1V• � 's(t V .L{ ,�*,$,�z 5::Y,_ wdty S- y, F'y :.. yQ''.3h' "^�^�'°>' :.d.. i v-T.,,. t•;"i:e4 .aiA^ r.3 .'#'.-n .j-''' -$" , :;. �^F�,: r .s� :.,t,;tom „-,v ; i,f }51! �' t T L�11•f�t�j ,t�iriS:� tf�� "�C' ii�,�3"'i7' q }, •2 ' ;gyp, ?4-„y' 3 A-.'.B ``�}!p,., „_ k1 Avl. Y.ifl,�.`a 2 ,e.>r_:.... �:: " p✓ f*t t : '`a'4 '.`S-.,, 4Ati<°.it y`r-wj '.-s',ST� �.'..F +,` nkC"�'`vr^`�s, '•"T`�xi ; rx` k„., cF:Pi fiG1-AVEOLDTIRES• ��O �Q, s, ' ''"� ` A; - H*yrlan:ar`hdi'q et�atlo ma or r.. .4,, r . <: * =. r ' rM� � ,u a,� -,a +E1 .§�4,,;;..,.y', _, ,.: fyPt�u4i 1,1;K tie e9u ttuts-on*eachwheel'after u„. ! .rt r, (�. ,; WheelaWorksumil rowde:this'sernce ",@ I I A ;.€ 9 y, ,. 20 tnlles,�after th(s installationt� •+ Q., .-,' , , Pe •, free of ttarge By signing belowlacknowletlge;this,as noticelthat't,musf+re ''" ' " < „ x t`"= �.3 .4z,�ri,%"" ,:��v :� a 1 .r , .,,- ,; ,torque,al`A vehicles tug nuts after 20;miles k, � x F 2 fter this installation and the impoftattce,of re torquing the lug nuts t«�r y r �, r �y °�� " , y` r z Ii, .� �, w:.>r•,',, my ,. ..T �&�^Ma....;.- .,.f13. ,r-.,& i a .'% n. at,,:r - .cc S, ._S ° 7 } day ¢, ,-.. ,¢x-i L �,' w•wzxa.,T a7v „},._. f{}� ALf'A T�"�8 ,�'kF -Sxtaww "'t s"r' Td;fj�t'z. a'la1"w. `�li z .... -Y -®R1g11 ESTtM'fiTT TOT R SAND L480R h � � Iw .:_ " .ai"+ax, t„k...#' w.ems:,.. L'S rexw,n3vM,w:raK-.r,. �u.s nM ��-'r�; sG•ri,,.+`; c.'? 1%7 .,.�t '«•t^r*'Cs`< .�r` y ?.- I hereby authorize the repalr:wodt to be'done along r� r 0NGMAL ESTIMATE i AQDITIONAL C '>� SALES TAX k ,, ,4 ,.,i ,,,7, s wrththe necessary matertals'Whee1 Works and its 1 p wT �'C Y OSIS s „a x x + ,; employees may''dperate above vehlGe}for.u ..,. et 4° S i i _,x r , ' 4 .i? c� v itin O' apt ,< ,: ., �..: ., •,. z, r z l n r.11 a s Yp _ P eS i U.:., �.i.F :k. 5> A' ? i ..'S • • ) "rti. > f)an '� of testing m 'I"- on or delivery at my,nsk Annq 01 is`� r, { REVISED ESTIMATE �, tvx , r 11 expressmechamcslienlspacknowledgedonabove'" REASON t tcj 3,rfF{ ;� � yr - - x !. ,1vehicle to sedure',the amount`of r" irs tltereto.''IYi' •r< e u 1 A , t� it F ° r a., t ;. .,. ,, eP� ,, :. .5,. r � - { we j rx 3+."4f'¢!.�; i ' .r! 1... , .�tY x' s k,'� also,understood:that Wheel-Works will not be Held: iso-s�xl .yl'Sr�.+:>,. t':a Ytf,§;r...g:5 ry- ,.'s Q_k i r �, a1",w}j(ir>£T`p3''' ♦t,:% r$q, � h 1.��R\�1.(k1. 9®IVa. ."'z'* 3 -, 'Yr 4 a? t.t�`. ,i:,:n $.. „,15 tirN:.,k,.ctttk 3 1 (responsible for loss or damage to vehlcls'or anlcies€s}.,,: "` 4 x.�., , „ ., AUTFIORIZED, .;,r rj tM ; { .:i� x ,. _< 41 acknowled e';ttia The QYa leftvn vehicie.in•case:of Ure theft'opan = s` k x r , ek{ � yP. t , z az t,a ,� it A 9,,,,.�ty, �ademzed parts and services b 5 „ , _, .,, :� ,..,yother J�`f,..w _ t n fi. 3 ,.;,:. +- .:;9r ,''e "�.. r,_r:,e-P';.i�`.'` 4 r'b'.,:a ,performedion myvehldeare,'the.ftems,that-I"authonzed.t?7 cause,be ond:WheelhWorks control-ALL^PARTS p r BY, "'46 --�'. i .s ,.,= a ..a:,,r - ,t t,C,, i Y �.......,.F ......_.: ,.,a:,,- s,' .z,:,;,,,'x, ,q.,r.`«r, r y r. ," "' : t` 4NtPERSON<4sy,,'.., a;: I agree;.,to pay,ihe.amount-shown.,on.,ahisamv i :.,t,-�,, z D . PHONE M a is`.. ,_ „,. ..., ,.,w.,, - R Dice and AND MERCH7tNDiSE ARE NEW UNLESS NQTED -, f h ,_,, acknowledge,tak}_n - sslo of m tvehlcle, '`^ (R MANUFACTURED U USED) 'i` :irt� DATE TIME ,4" ,u x + CA = E ,y,z.,., and.:all t _1§f a t y LLED BY xnt FHONSNO x Persohal,V om ackn wle ' r '.` is Viz,. �t.x 3 i>ff , F as x:'` ' � ,:: kz�x '#^ ter•- dgethatallltemsleft.at .s.. '4❑RETURN-PARTS i .[}'Ul$CARU;PgRT$ •€i ;.;%x sr4a, x i a a~r F r "x + - - -.h ss eWheeL:Vd Is donetat e.,own nsk{and will hoid them- 1 ty5 L t ; T as i.4 y r e t t t .s. a._ g z % r-„,, Sin v.rT�of « x �.;.i t.....,,,,.` t7 k e3"LP,£t `'Y, L ssast,a >t 'F\" '+" 1" SS ."....-..w trr acknowled a;Duce and oral approgal of 4 ^ #( -#r d fat9 s " J ,.Ia .v :.y�-, ! , r..9;ti ,xarrotu.msv'l g a se. r �ri 6 yr i-,S s -t IDx ?'.{ t �r�' h• f- n � F + P i`�r, _cirnrn-n rRC <.__„a.M_,,.,...s:•,:..z,. ,,...<, _;s_ yr.an<7nnrobcsi ; r6,',..,..._:.,.:._ ..__`--,.�.fe .''`+,��";;�., �_�",., W ...,-.: €'Xsv�,�,,. ,,,.r"d zts;.x3,..C,-r,s,.; ..a'y.,...�3 e?'k>s�,..c,-°x,.'�...,., d'Jl3dU LdVSS303N 38V S31VOIGNI 1S31 NO3HO DOWS 3H11VH1 S1N3W1S(1foV 130-SHIVd3a LOLO OZ6 1008)lld0 Wa03 SIHl d3Od0 Ol 03033N INV VY80=183d 01.1111IOVd NO3HO OOWS 03SN3011 H3H1ONV 3SOOHO AVW noA'MVl J,8 N OOOZ'ON WliO3 00 �•` = t o ---- -- -- - - -- - -- - ------ --- -- -- -- --_ --- ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ o cc o 0 N Z _ dodo a d a m m U m c 3 m _ U UiLL y UF-QU 23 QF -E1 UU Q> m CIL d U. R r ... J to O = a0 R O F C7 Hm — to 3 w N o r� w • `- R F R F- d .��fV� `o i� Q m 1- to S U to fA m Y J r z u m W \ w m y Cal ocZ. (/�\ — J� 3u o Qw; = 4),o A�'. a► o Hg" �^' J � QQ Ud Z m U¢ Q o O LU LL W Z U- ZIs In w g o t Z to wto Q N°-° n o CY) 1 LU � O o�o n p.. r.-^';g w Co 0 O 0 V W w I In U i o LZ 1 U ON C) Q t � T 0 W \� Q LO W L N w ¢ m N n �. 3 _ do �\ 3 y J12 �.� z O WT F`i+ - z o n z n CO c•.. Z _�„ o ❑❑ 0E a • W a �E� J� W V CN i J W Q Cc$ W a _ m IL .. -.. 3a. 00 a; ¢ui ¢ cu U) Q W ...� uZ�� J c c U O) w X, m a O� U o Z g � W p t �� 1 N n,E o �mm=z oa c o< a o z vi - ¢ _�N'o E.Ocn cw ¢m cw ¢m UU) s i 1 i ____-_..________________________________ _________________ --------- I r. Ji - -. ___________________1__ !7 � _ I w ¢ - 1 (n 2 1 I 1 Q U I I W U _ U) amF - CO) Q 2 o a LL F J U � . O ro�F �.�. W `ESO j It .. a 3 Q co. Lu ❑ m'm O Z O ¢ ¢ �3 - H- w mm m ¢ w a c« ¢ D z 00 ` r - F z ¢ w cc 0 J 0, muj .. C' O aDim�: on CSC -U m Q a y THETIRE RAC 0 INVOICE Performance specialist INVOICE NUMBER=INVC ICE DATE PAGE 5 7101 Vorden Parkway 240353801 5 Z 19,/Q'6 1 $5uth Send,IN 46628-8422 PURCHASE ORDER NUMBER Phone:(574)287-2345 800:(800)428-8355 Customer Service:Ext.360 Fax:(574)236-7707 5/18/06 8:06:28 BILL TO: SHIP TO: 2026285-000 2026285-000 AMADEO, JOSEPH M AMADEO, JOSEPH M 206 PRIMROSE PL 206 PRIMROSE PLACE PLEASANT HILL CA 94523 PLEASANT HILL CA 94523 1630 SHIP METHOD: UPS GROUND SHIP-TO PHONE: 925-685-2873 CACH Plan 178906 Team AWHEEL Wave 006 Prcl 18 ORDER DATE SALES REP,NAME/PHONE EXT TERMS MAKE,MODEL AND YEAR E _OPER.. 5/17/06INEAL-EXT. 624 1 MASTER CARD 'CONV 99 SB NEA PART NUMBER QUANTITY QUANTITY DESCRIPTION UNIT EXTENSION LOC. ORDERED SHIPPED PRICE SP174067BS 1 1 90 15X7 5-110 ET40 MM SPIDII# 99.00 99.0( A- I 174067115600 174067115600 AL651 1 1 90 MM 72.2-65.1 CENTER RING NIC F-6'j B12 5 5 90 BC12X1.5 26UL 52TL 17H SL19 NIC H-3 44 B12 REQUIRED LUGBOLT FOR VEHICLE TOTAL THIS ORDER 99.0C FREIGHT CHG/ALLW 27.81 MASTER CARD PAYMENT 126-81- TOTAL AMOUNT DUE $.0( Weight 26 ALL PAST DUE ACCOUNTS ARE SUBJECT TO A FINANCE CHARGE OF 11^PER MONTH,WHICH IS AN ANNUAL PERCENTAGE RATE OF 18%. ----—----- M) THEt 111T� _7 0 P:17 -D 342714815889 KG 0 TIRES STtIRE 10 iauS PoNTRA i_'fj"Tfl D-4'. PLEA' g I _3004T H'I'L, CPI 541523 CREO I SOLE E_ Tr-H 4 TR,kNS' 01 01 b: (if_T 4&3' Itjtj EXP 04KE -1k., 43 (',u A XXXXXXVXXXXX46L9 I p "T $ 00 1 'E-1'3'0D 3'4 7 I 8GREF 13 PflYTHE 0&0f Ht-KiNT F'Ofl T tip -,Cl i_-i - R, q 4 -1 itip floREEIIEJNT )TY N�scf3'ptloifl f-USTOMER 00PY i"@@ M* TlK­ 110-11ff 18" fflfM-0V 3"90 11 go [Itl : IT G NT F,E A 13k 00 0. 71 'ZU- .Eli= gzg 'A ugggi X 'A RAMv, 'v Ft' F as qm Z�-'Qr On- 'm 00 30 "EK 5 N K€+v ,� �sy R f`t;/l b_,i A., 1� j'-`1 1:-,1-10.icl'-�.k k)"I.t-_'I" -A-X`ii-)(_ -A )k •)u it- J'o x-)v"t Jf­[E'_I::.'I_'� WL'Rv RIF­0 i (,.1 ck' I u C)kA f- p i, kA I acknowledge notice and oral approval of any increase in the original estimated price. QTY. DOT# TERMS:(NET 10th PROX)PAST DUE CHARGE IS COMPUTED BY A"PERIODIC RATE"OF 1.5"-PER- S MONTH ON UNPAID BALANCE WHICH-IS AN ANNUAL FERCENTAGEp_�� SARY TO OTY. DOT# INSTITUTE LEGAL ACTION TO EN CE COLLECTION.OF THE NT DUE UNDER THIS INVOICE. QTY. DOT# BUYER AGREES TO PAY ALL, DIPARY COSTS, �� AN �WN­M FEES, QTY. DOT# VEHICLE RECEIVED PLEASE-.-SIGN.-; QTY:'* DOT#:­ UABOP—­` I "AX TOLL FREE CUSTOMER SERVICE 877-GO-2-GIGO(877-462-2446) NO REFUNDS ON DEPOSITS CUSTOMER MUST PRESENT COPY OF INVOICE FOR WARRANTY OR SPECIAL ORDERS S MAJOR BRANDS Sn"OtiftonvS TRUTS ALIGNMENT SUSPENSION �` CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: 27, 2006 - Claim Against the County, or District Governed by ) the Board of Supervisors, Ro C= NOTICE TO CLAIMANT and Board Action,. .All Section retires are The copy of this document mailed to California Government Code JUN 0 1 2006 you is your notice of the action taken COUNTYCOUNSEL on your claim by the Board of MARTINEZ CALIF. Supervisors. (Paragraph 1V below), given Pursuant to Government Code AMOUNT: AMOUNT UNKNOWN. WILL DETERMINE UP Section 913 and 915.4. Please note all DOCTORS RELEASE AND PROGNOSIS ON- "Warnings". CLAIMANT-. ROXANNE HENSON (MOTHER) . ORION TAYLOR (SON ATTORNEY: UNKNOWN DATE RECEIVED: JUNE 01, 2006_ ADDRESS: 130 FIG TREE LANE #1A BY DELIVERY TO CLERK ON: JUNE 01, 2006 MARTINEZ, CA 94553. RECEIVED THROUGH INTER BY MAIL POSTMARKED: OFFICE MAIL FROM RISK MANAGEMENT FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JUNE 01� 2006 JOHN CULLEN, e Dated: By: Deputy ILFROM: County Counsel TO- Clerk of the Board of Supervisors 0,16iis 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: /'Y'? 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 9113). IV. )BOARD ORDER: By unanimous vote of the Supervisors present: (e*f 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 Q! 41�6VJQOHN CULLEN, CLERK, By eputy Clerk WAIbNING (Gov. code section 913) Subject to certain exceptions,you have only six(6)niontlis from the date this notice was personally served or deposited in the mail to file a court action ou 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 perju)-y 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 Stites Postal Set-vice in A'hartinez, Califoriiia, postage fully prepaid a certified copy of this Board Order and Notice 10 Claimant, addressed to the claimant as shown Above. Date( JOHN CULLEN, CLERK By eputy Clerk t BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY SHARON HYMES-OFFORD INSTRUCTIONS TO CLAIMANT MAY 1 2pog A. A claire relating to a cause of action for death or for injury to person or to personal properly 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.) 4.,r Nk B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room. 106, 0008 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 entiq,. E. Fraud. See penalty for fraudulent claims,Penal Code See. 72 at the end of this form. E E R R R E R E R R S R R R C R R R E E G IS R E R G.I G.G G C E E E E E R E R[E I t S R C R E G 2 a z M a X e 6 s R■C E R E R nit ZRKRN 2 us l I RE: Claim By: Reserved for Clerk's filing stamp ((p *o2to �-� , ) RECEIVED Ota62n) Against the County Contra Costa or ) JUN 04 2006 District} CLERK BOARD OFSUPERVISORS (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$z lt _ fandi sGtCu�Pport of this claim represents as follows:, to ml, a e 1. When did the damage or injury occur? (Give exact date and hour) Pn Oil ,. 2. Where did the damage or injury occur? (Include city and county) VU� INt t/v�n--1 Cr'� r_a_ &4-T14 Gt" LNC, . o 1 � i' C1c s7 1 �iifrequ=ke owdidthe dama a or injury occur? (Give full details;use extra papcP} I'I'lc� t� t`P4,rM 6k Cil 5T 0,0Vk_SU t ort ;roam . Th P cor - zo s � ��m�� � v� a rs- amd e �: � ) 4. %at�particular act or omission on the park of county or district officers, sets, or employees caused the injury or dam 1L � �� A00f. re 5 What are the names of county or is ct cers,servo,or employees cwll_ausing e� ° damage or injury? �� - - � ;�,,�. ��( 4�JesUd Soy J� Xqfw 6. WhaC dania e�uriour claim iiextent of injuries ies of damages i .t b I Attach two-estimates for auto damage.) � A_ Caw 4Ir� 0 7. 061 ow was the amount clamed above coin used? dude the estimated amount oany. ++ , prospective inj r d41 '4' e.} � _"t � `i' `(� nat'� &OC;VOCS r6OQ6(�, WAa_t)0__( rX 8. Names and addresses s and hos itals: See re-part ._or- more- W 1 -41 � Sed Act Yto.�vt�s . 9. List the expenditures you made on account of this accident or injury: DATE TaJ E AMOUNT UL hard o . R R R R R C R R a S Q[Q G R 8 R!Q![R R!@ R R R!R[R!R Q!!!�:i!C S S�i 1���� L!t■!!K R!!w R R R R Q Q R!!!!![!R!R!!!4!R Q! ) .Gov. Code Sec. 910.2 provides"The claim shall be ) signed by the claimant or by some person on his behalf" SEND NOTICES TO: {Attornev) ) Name and address of Attorney } } (Claimant's Signature) 130 r� .040_ e— /I rl } (Address) } Telephone No. }Telephone No. V6–-F— R.R•!!R!!!!!!!:E[R!!ER!!lRRY■■RRlRR[RRERaEERRlEEERERERREERRRRE[EEl ERER R!lR RRE ERRIRRRRt PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the County under the Tart 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 R R E a E E a R[E[EER■Raw R a R R R E ■ ago E E t i R R■R R R R R!R R sit a E R!R E[I R E R R!R E!!R R R R i!ERE E EEE.!!R a!REE 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 ($14,000),or by both such imprisonment and fine. #3 cont. L C PA0 YV .....partially amputated Orion Taylor's right 4h fingertip. Orion and myself were leaving the Pharmacists consultation room and as we were exiting, I turned to find the door had slammed shut on his finger. This door needed to be buzzed open by an employee(the gentleman whom filled out the incident report) to release his fingertip. When the door was released, I grabbed Orions hand and noticed his fingertip was hanging off, rushing him to emergency with the pharmacist. Page 1 of 1 02/13/06 ,' M075779611 _ TAYLOR,ORION W Contra Costa Regional Medical Center-Emergency Department 3-B BEAUCHAMP,)ON,MD 2500 Alharnbra Avenue,Martinez,CA 94553 I i i M® Dischartge Instructions MR# M008807315 Impression: Partial amputation of his finger tip Additional Instructions: Keep the splint on and the hand clean and dry until he is seen in clinic; Return to the Emergency Department if he has any problems The care you received here has been given on an emergency basis only. You may need further tests or care after your release from here. If your condition worsens unexpectedly, return here. If you feel your recovery is not proceeding as expected, contact your regular physician or call the Advice Nurse at: 1-800-495-8885. Si su condicion empeora regrese aqui, Si siente que su recuperacion no avanza como se expecta pongase en contacto con su doctor regular o enfermera de consejo 1-800-495-8885. FOLLOW-UP AS DIRECTED BELOW: Return to the Emergency Department in: days. Follow-up in the following Specialty Clinic: Dr. Cominos in Plastics Clinic next week (Note: If we were unable to schedule this appointment for you at this time, our Appointment Unit should contact you within 1-3 days. If you are not contacted, please call 1-800-495-8885.) Follow-up in the Family Practice Clinic in: Z3- e 1 o 203 _. RION W Contra Costa Regional.Me&-al Center-Emergency Department 2500 Alharnhra Avenwe,tvlartiner,CA 93553GORDON MD Discharge Instructions ` tri# M008807315 Impression: PARTIAL AMPUTATION DISTAL RT 4TH FINGER 2/13/06 Additional Instructions: HEALING WELL THUS FAR. NO EVIDENCE OF INFECTION. RETURN IN 24 HRS FOR ONE MORE WOUND CHECK. AFTER THAT, LIKELY ABLE TO CHANGE DRESSINGS AT HOME. KEEP 2/21 APPT FOR RE-CHECK THANKS The care you received here has been given on an emergency basis only. You may need further tests or care after your release from here. If your condition worsens unexpectedly, return here. If you feel your recovery is not proceeding as expected, contact your regular physician or call the Advice Nurse at: 1-800-495-8885. Si su condicion empeora regrese aqui, Si siente que su recuperacion no avanza tomo se expecta pongase en contacto con su doctor regular o enfermera de Consejo 1-800-495-8885. FOLLOW-UP AS DIRECTED BELOW: Return to the Emergency Department in: days. Follow-up in the following Specialty Clinic: (Note: If we were unable to schedule this appointment for you at this time, our Appointment Unit should contact you within 1-3 days. If you are not contacted, please call 1-800-495-8885.) Follow-up in the Family Practice Clinic in: CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY .1 BOARD ACTION: JUNE 27, 2006 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT. and Bo,ard 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 Super-visors. (Paragraph IV below), given Pursuant to Government Code J AMOUNT: $538.00 �U(gN237�D�0 5 2006 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: MARISSA COLLINS COUNTY COUNSELMARTINEZ CALIF. ATTORNEY: UNKNOWN DATE RECEIVED: JUNE 05, 2006 ADDRESS: 373 RODEO AVENUE #2 BY DELIVERY TO CLERK ON: JUNE 05, 2006 RODEO, CA 94572 RECEIVED THROUGH INTEF BY MAIL POSTMARKED- nPPTr.F MATT, FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted.claim. Dated: JUNE 05, 2006 JOHN CULLEN, By: Deputy ' It. FROM: County Counsel TO: Clerk of the Board of Supervisors v ( 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). J 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. ,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. Dateg:26�-WJV JOHN CULLEN, CLERK, By ,Deputy Clerk w4f4ING (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 fit comiectiou 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 peualty of perju)-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 Martinez, California, postage fully prepaid a certified copy of this Boaud 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 CLAIMANT A. A claim relating to a cause of action for death or for injury to gersori or fo personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause,of action shall be.presented not later than one year . after the accrual of the cause of action. (Gov. Code § 911.2.). B. Claims must be filed with the Cleric of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street,Martinez,CA. 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. R■■■■saxanz■XERM.\.■tt ■.■.■■..X/t Con o a ME to Innse ll■G G Q CCq O G QQloIo�an t a a at was X OR a RE: Claim By: Reserved for Clerk's filing stamp ) mAf�ggA �o[.c-tNS } 373 �oDEo Aus. aRo��o � cry ��s�.�} RECEIVED Against the County of Contra Costa or ) JUN Q 512006 District) CLERK BOARD OF SUPERVISORS (Fill in the name) ) CONTRA COSTA CO. } The undersigned claimant hereby mares claim against the County of Contra Costa or the above-named district in the sum of$ .5 3 S• and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) MAY 3, a o ca to $; 30 .-A„,x 2. Where did the damage or injury occur? (Include city and county) C0nAr Cos? C -0 3. How did the damage or injury occur? (Give full details;use extra paper if required) ---AS X WA':;; AW AV4 OV 71AIE W%AOLC ria -r .c , ,oAb, a+�p URovtr -%9.0uc��1 (tatinNN-co ! 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? NEC-tLEC i To AGS(A\Q. t,nnt L �,( ►'VASA NvvG R. 5 What are the names of county or district officers, servants, or employees causing the damage or injury? u,v ry©LQ ti 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages _. claimed.--Attach-two estixnates for auto damage.). 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) -- p`1.t7FE3SlOtvAL 2S£RC2C1�6� 8. Names and addresses of witnesses,doctors, and hospitals: CflLCATVAIA 'j owv,�o�n 51 4a C o.d�se pc. 1&Co - HE(�G�� uS, C.A. cjLA54i7 9. List the expenditures you made on account of this accident or injury:. DATE TIME AMOUNT LA- o(o ago oraanaaanaaananlsession 2wagons raatarses[[=![!:[:aataartaattraeaat[saaa a mass Ellison 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: (Attornev) ) Marne and address of Attorney ) } } (Claimant's Signature) ) } (Address) } } Rnl,�a1 Com- O4519 Telephone No. )Telephone No. C 5 i o� a L--) 5- 3 5to 1 !at[atrtaeiaa!!t alnlataai a a a aataaattaaaanazea lr[!at!la aa[!aa[ata[Rtt tan a Ra![ataaaatl 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. !t!i t!t a!t[a e a i a i n•!ata[a al Usk t a a t t a a a a a a!a s a s a a a a a n a a n a t a a n R[a!a t a a a![a s a an a signals all NOTICE: Section 171 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 prisoia, by a fine of not exceeding ten thousand dollars ($10,000),or by both such imprisonment and fine. 1 • .0 ON 1lNU� 1� - No 14 c-, ovv.�lJ ~� . tSPE<<Ali`( 4c1 rvl 1-�T .. N.pj1CC ,) ROf)"C i C-1 ED. ._ i C.6 'u... Co z I r cm r t .— r F- I Z _-_`-- --- ------•- --------- ---- IL 00 �9 o a 40 0 W CL Ln w 1 W o 1^ w U _ a N a U, Q W z - V o Z ( ' ¢ �Q L = W O I Q Q, p z LL w �� U O cn t) U V`i a N o LU z 1 W ir W � m to 0 _, CIO 4 O _ t I U m U Z Q U 00 C3 NIM -t O t� 107 O O .:. CJ f V' O CO O O ¢ L N , r • t 'nom,r ':� .:3 ® 'zzjr a CO p -� 4 M cp s as � rl a i 2 c` 7 4 ts, 6 d b �. a N cfl y� J r ti tic} P `�✓ :Ai, 2 r i� CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION. JUNE Z 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 ���� Super-visors. (Paragraph IV below), given Pursuant to Gov*ernment Code JUN 0 6 Section 913 and 915.4. Please note all AMOUNT: UNKNOWNCOUNTY C "Warnings". OUMSEL MARTINEZ CALIF CLAIMANT. NANCY S. GILBERT ATTORNEY: UNKNOWN DATE RECEIVED: JUNE 062 2006 ADDRESS: 1123 CHESHIRE CIRCLE BY DELIVERY TO CLERK ON: JUNE 06, 2006 DANVILLE, CA 94506 RECEIVED THROUGH BY MAIL POSTMARKED: INTER OFFICE MAIL FROM RISKMANAGEMENT FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, C Dated: JUNE 062 2006 By: Deputy 11, FROM: County Counsel TO- Clerk of the Board of Sup6rvisors 01"This claire 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: B y: 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. LARD 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. DateQ �-elx OHN CULLEN, CLERK, By Deputy Clerk WAJWING (Gov. code section 913) V Subject to ceplain 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 hi connection with this matter. If you want to consult an attorney,you should do so immediately. *For Additional Warniug See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I ain 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 N-lartinez, California, postage fully prepaid a certified copy of this .130ard Order and Notice to Claimant, addressed to the claimant as shown above. .Dat JOHN CULLEN, CLERK By Deputy Clerk BOARD OF SUPERVISORS oF CONTRA.CQSTA COUNTY RISTRTJCTI9Li§10 9AQ%&a 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 latv 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 Mai idistratioa BOding,651 Pine Street,Martinez,CA 94553, C. If claim is against a district governed by the Board of Supervisors, rather t m the County. the :name of the District should be filled in. b. If the claim is against more than, one public entity, separate claims mast be filed against each public entity. E, Fraud. See penalty for fraudulent claims,Penal Code Sec.72 at the and of this form.. !t##RRRR#Ri#R#i#R!#RRi*man NUM 2RUna ago#R#tlRal##tls RR#R#Raegbix#RRlRi lis/!!RR#RI RE: Clain By: Restmd for Clerk's filing Against the County of Contra Costa or ) CL q UN Q 6 2006 ff �' I- All • � �rV�'F? o' SlJa, Dict) o�sra o�fs (Fill in the name) )' cQRS The undersigned elaimaat hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ and in support of this claim represeuts-as follows: . . 1. When did the damage or irr ury occur? (Give exact date and hour) 2. Where dud the damage or injury occur`t clad✓city and coua. 3. . How did a l or occur? (Cline details;use extra p req e 4. What'partrc ar or omission on the part ofcounty or digot of ofticers, servants, or employees caused the injury or damage? / S S What dfrthc names of county or district officers,servants,or ezmployms causing the damage or Wury?`� / L it)i?rA-'r f �o cc )4L,4 f n M/C' *A T7bT. CC'S:` C7A IN=4I.RIHWH1J )IRD4 'Yl't QT:CT ❑9tP;1—T.C_1H.I 6. What d=aze or injuries do your claim resulted? (Give frill extent of injuries or damages cIaiLaed -Attach two estimates forto daama.ge:) �- 7. How was the amount claimed ave computed? (Include the estimated Xunt prospective qury o daxnage,)�� S. Names and addresses of witnesses, doetors, �tals: tures you rnader as accou 9. List List the exTT4t of this rY. �© UATN � •Aad j ?'c• aC c�3 — • tiv ■asaca:ra rat Afata saasanaas Sala Ilan aassAasssNA a■N■Ar■eaaasases ala AntaattasteNiiataRN s/ ) ,Gov. Code Sec. 910.2 provides"The claim shall be— ))sipz d by Aha claimant or by some person on his )beh l l n . SMZ NOTICES TO, rAtt=ev1 T) Name and address of Attomey } ' aimant's Signature) (Address) Teiephonc No. )Telophase No. a.aaranasaesatssNtsaiarataRYaANUS■aneUnSnNsaaaaass2a■satta■some s■sats■fans■a■aNNaatanl PUBLIC RECORDS NOTICE: Phase be advised that this claim form,or any claim filed with tine County,under the Tort Claims Act, is subjeot to public disclosure under the Califanaia Public Retards Aot, (Gov. Codo, 56 6500 et seq.) Furthermore, any atzac ments,addendums,or supplements attached to the claim form,including medical roeords, are also subject to public disclosure. ■faasfn-tAMAneNaaanus all Ana cleat Ueatltasatsastsas raN■astnat■A■■f■naae►cess■n MENU 3/18116211 NOTICE: Section 71 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, cid, or district board or officer, authorized io 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 ($10,000),or by both such imprisonment and fine. T717T CS C` C?� I Nal.IrtHN!-9.! ?ICT�! "1'1'1 CAT. :t^T. gP1p;1—T,�—t-tiJ 000•d Izo# 000zr�o/oo "I dove Y:Ihcr you do jor me." U B L I N Tpi". TOYOTA SERVIC'1:x PARI$ TOYOTA SCION ti0C'IL'IY See Us On The Web 6450 Dublin CI, 94568 WWW.toyotadublin.com DUBLIN, Service(925)5)55t51•06.06 20 M4N, 01 Parts(925)551-0600 G41tD CUSTOMER No. ADVISORo. INVOICE DATE INVOICE No. 8 3 P 4 S BRIAN BARKER 3089 6153 06/01/06 TOCS572100 LABOR RATE LICENSE M. MILLAOF COLOR S 0 No. NANCY G GILBERT I APPLY 34,209 BLACK/ 1123 CHESHIRE CIRCLE YEARJMAKEIMODEL DELIVERY DATE DELIVERY NOL S DANVILLE, CA 94506 03/TOY0TA CAMRY 4D 10/21/03 6,153 VEHICLE I.0•No, SELLING DEALER NO, PROOUCTION DATE 4 T 1 B F 3 0 K 0 ,' 0 0 5 5 1 7 7 _ F.T.E.No. P.O.No. R.O.DATE __ 05/30/06 RESIDENCE ON BL' INES PHONE MMENTS 925-648-1161 819-1499 JOB# 1 CHARGES............................•••........................... ................... LABOR.................................................................... ....... J# 1 :31TOZ-03. :30K INTERVAL DELUXE iTECN(Sri3580;r;:';i;'�;;;'..:: .,-.,r; :;-;:•, "°;'^68:60 REPLACE ENGINE OIL AND FILTER, ROTATE TIRES. REPLACE AIR FILTER.REPLACE NON PLATINUM SPARK PLUGS.REPLACE ENGINE COOLANT,REPACK REAR WHEEL BEARINGS9TERCEL.PASEO) INSPECT: FUEL LINES AND CONNECTIONS,GAS CAP GASKET.EXAUST PIPES. BRAKE LININGS.STEERING LINKAGES,RACK AND PINION FOR LEAKAGE, TRANS AND DIFFERENTIAL FLUIDS.DRIVE SHAFT BOOTS&BALL JOINTS. FRONT BRAKE PADS HAVE 7MM REAR BRAKE PADS HAVE 6MM REMAINING PARTS------OTY...FP-NUMBER...............DESCRIPTION....................UNIT PRICE- 1 90915-YZZD1 FILTER, OIL 5.95 5.95 1 90430-12028 GASKET 1.62 1.62 1 17801.OHOIO ELEMENT SUB-ASSY, A 20.46 20.46 1 00272.1LLAC-01 ANTIFREEZE 17.95 17.95 6 60P 5W30/QT 1.75 10.50 TOTAL PARTS 56.48 JOB# 1 TOTALS................ LABOR 68.60 PARTS 56.48 JOB#k IJOURNAL.PREFIX' TOGS JOB#.-,1 TOTAL 12508 JOB# 2 CHARGES•••••............. .:..... ......................• ••- . LABOR............................................ . J# 2.28TOZ :MISCELLANEOUS ;" TECK(S):3580 `;:':;.:INTERNAL. CUST. REQUESTED TO HAVE THE SMALL LUG NUTS REPLACED WITH MATCHING LUG NUTS. INSTALLED HATCHING LUG NUTS JOB# 2 TOTALS.................................................... JOB# 2 JOURNAL PREFJ TOCS 'JOB# 2 TOTAL 0.00 JOB# 3 CHARGES.................................................................................. LABOR.......-•-•-•..............................................••••............... J#`3 12TOZ;._.. TIRES/WHEELS TECH( 358 :;,,>. ..:..:.::.:::::.: :.: ;< ::;..35:;00 ../ / MOUNT AND BALANCE 1 NEW TIRE. AS PART OF INSPECTION TECH. FOUND THE RIGHT REAR TIRE IS �•`'` ALSO DAMAGED. RIGHT REAR TIRE HAS A LARGE BUBBLE IN THE SIDE WALL AND IS NOW IN TRUNK. �, 1 REPLACED THE RIGHT FRONT TIRE AND RIM AND REPLACED THE RIGHT REAR TIRE. PUT SPARE BACK IN TRUNK. t1� PARTS.....iQTY FP-NUMBER---- •-••--••.DESCRIPTION....................UNIT PRICE- 1 PT533.03020.01 WHEEL KIT. PAINTED 383.00 383.00 \ I' 1 OTCOO-00850-DU P205/65RIS 92V 119.00 119.00 I DT000.00B50•DU P205/651115 92V 119.00 119.00 TOTAL - PARTS 621.00 PAGE 1 OF 2 CUSTOMER COPY (CONTINUED ON NEXT PAGE)04:49pm V00'd iZ0# ��:91 900Z/ZO/90 :Woad AMENDED CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA,COUNTY BOARD ACTION: JUNE 27, 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. GST you is your notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), UN d 2006 given Pursuant to Government Code AMOUNT: $1,260. 79 COUNTY COUNSEL Section 913 and 915.4. Please note all $1,309.40 MARTINEZ CALIF. "Warnings". CLAIMANT-. KATHLEEN SANFILIPPO ATTORNEY- UNKNOWN DATE RECEIVED- JUNE 12 , 2006 ADDRESS: 1600 FRISBIE COURT #2 BY DELIVERY TO CLERK ON: JUNE 12 , 2006 CONCORD, CA 94520 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JUNE 12, 2006 JOHN CULLEN%, e®r4, Dated: By: Deputy 11. FROM: County Counsel TO: Clerk of the Board of Su f ervisors (V) This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). O Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3)., Other: Dated: By: �( t/l _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..,AOARD 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: 47 10"CHN CULLEN, CLERK, By �eputy Clerk WARMING(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 mad to Me a court action on this claim.See Government Code Settion 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 By Deputy Clerk JUN 1 2006St j — --r ClpK�Q jo h J