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MINUTES - 06062006 - C.10
i CLAIM. BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JUNE 06, 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 MS Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all AMOUNT: $248.61 MAY 0 12006 "Warnings". CLAIMANT- DAVID RIEDEL COUNTY COUNSEL MARTINEZ CALIF. i ATTORNEY: UNKNOWN DATE RECEIVED: . MAY 01, 2006 AD:DIZESS: 2053 SCHELL MOUNTAIN WAY BY DELIVERY TO CLERK ON: MAY 01 2006 ANTIOCH, CA 94531 BY MAIL POSTMARKED. HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, Dated: MAY O1, 2006, By: Deputy. It FROM: County COu11Sel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are.so. notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Clahn is not timely filed. The Clerk should return claim oil 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: ouiity Counsel III:. .FROM: Plerk'of the Board TO: o ity Counsel (I) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. OARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. ( ) Other: .1 certify that this is a true and correct copy of the Board's Order- entered in its minutes for this date. i Dated:'✓wv7G 61g, cAi _wOHN CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) 1 Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney,you should do so imrnediate4% *.For Additional Warning See Reverse Side of this Notice. AFFIDAVIT OF MAILING 1 declare under penalty of per juiy that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 1.8; and that today I deposited in the United States Postal Service in Nlartinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. D a t e& ot?W-0,6 JOHN CU:LLEN, CLERK By Deputy Clerk BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAMANT I A. A claim relating to a cause of action for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be.presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street,Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the naive of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each. public entity. i E. Fraud. See penalty for ft audulent claims, Penal Code Sec. 72 at the end of this form. ■eSUN eieeeeeeeemeeeU WENOME Emus aeeeCX M1 RE: Claim By: Reserved for Clerk's filing stamp � Afb� Against the County of Contra Costa or e�FRcoog90 0 1 �Op6 ill in the name) District) (F ) s AS The undersigned claimant hereby makes clairn against the County of Contra Costa or the above-named district in the sum of$ I?3 (o j 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) C C(� C4 . Co/%+Ck CoS+C-'_ CVun i 3. How did the damage or injury occur? (Give full details:use extra paper if required) \\o:� a �'c,: wa.s c` VA2r, z �o� II ono e . Cur c`✓aIs Pov. kok�. Seue.A c er- Ctirs. SJ ".'t �S �v� N�\e - 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? ee n ` ii �c�c \) , i lS �'t �pl� n `t�,' ' r1 eX-c� 5 What are the names of county or; strict officers,servants, or iemployees causing the I `J re cq damage or injury? 4 '`2 J C,,.�-E-e r n arm . i .J 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed: Attach two estimates for auto damage.) I` -Fro,A P6���1`n e� �-;�� WAS Ctse S ' �7 e Cur ec9 Ll 17t, . 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) I Ire S W AV, .Q orn V 8. Names and addre ses of witnesses, Ce doctors anihospital�: �K e �rzctC V 1 o+L re TO^ 'L2�5 J� � JrnO,� $I UO . Cre � Sc dell (V\orrtS -V-L.,4or-e o• D1, _D �o+Cu^6,,J ice � 9. List the expenditures you made on account of t?lis accident or injury: DATE TIME AMOUNT ■ Ka as a a a a a 9 SEEN on mansommuft m RON an Wassongst Kenn EKE EKE ff Buff Examen a Reagan as i ) .Gov. Code Sec. 910.2 provides"The claim shall be ) signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attomev) 1 Name and address of Attorney ) l� �- �� bA01 } (Claimant's Signature) e205 0AY (Address) Telephone No. )Telephone No. �S . 7�� . -7 g(r,3_1 a■ ■m n■n s92921 K g g n■K a■Runs Kann K■e a g n a m a n s a g l a s Kamm m a s r g g s on Kai 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......n..g K a.. . ....ria..n.......a......r.....a...............K m a n n a a m K call NOTICE: Section. 72 of the Penal Code provides: i 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. i 7 454166940998 SATURN OF CONCORD 1330 CONCORD CONCORD, CA 94524 7256760760 . Sale 00004K69 04/0:306 15:29:53 Batch u: 000835 �I�S?ERCARD kkkkkkkkkXXk8Z31 9ppr Code; 043528 10: 000889 total" 24831 Customer Coav THANK YOU Sn T V tN.OF CONCORD IS AT LR N1330 Concord Avenue Concord,CA 94520 (925)682-6400 A Different Kind of Company. B.A.R.#AB-209243 CO.#02 A Different Kind of Car. EP.A.#CAR000065763 ................ ............. ............... ... ................ ............... .. .............................. ................................. ........ ..... • • ° .. ...................................................... ..................... Y •' •. ° a 307390 KELLY FOLLETT 1GSZK5278YZ166776 DAVID H RIEDEL 2053 SCHELL MOUNTAIN WAY ANTIOCH CA 94531 GREY BRONZE 2000 SATURN SL2 2JJL400 LLO 1.9LL4 15915 Business Phone: (925) 603-2126 ® s. s° ° Home Phone: (925) 776-7862 157360/ 157360 6520 11/30/1999 1 GG 4/03/2006 8:32 4/03/200612:23 ---------------------------------------------------------------- --------------- - LINE 1 CUSTOMER STATES THE VEHICLE HIT POT HOLE WITH EST. : $ . 00 RIGHT FRONT TIRE (IN TRUNK) CHECK FOR DAMAGE, REPLACE TIRE IF .NECESSARY. . .ALSO CHECK ALIGNMENT/ SUSPENSION TECH COMM: AS PER INSPECTION TIRE DAMAGE HOLE ON SIDE WALL REPLACED RIGHT FRONT TIRE & PERFORMED ALIGNMENT REPAIR 1 TIRE-REPLACE ETRik.ONE-:'`.;: PC O ODE: E0437 >SALE TYPE: CUSTOMER PA $34 . 50 PRIMARY TECH: 274 PARTS FP PRICE ...:.:::...:RICSC; TYSALE TYPE SN 21012031TIRE;; P,185 .N: ":.:;1 :"`'`''.'::7.3 ":9.;40 CUSTOMER 'PAY $73 . 94 NS WW WHEEL. WEI. 'N..;`.%,;'..-2 ... ::z ::&00 CUSTOMER PAY 1 . 60 REPAIR 2 WHEEL ALIGNMENT.....- CHECK AND:/flR`:"ADJUS:T: OPC E ODE.• 2020E TYPE: T CUS OMER PA. $129 . 95 NET ITEM: M DISPOSAL FEE SALE TYPE CUSTOMER Y - S R PA $2 . 39 $242 . 38 I�`TNE:.:'TOTAL ———————————————————————————— ———--——————— ——————————————— — "COMPLETELY SATISFIED" IS OUR GOAL (PLEASE RETURN SURVEY) LABOR . . . . . . . . . . . . . . . $164 .45 PARTS . . . . . . . . . . . . . . . $75 . 54 NET ITEMS $2 . 39 TAX (CALIFORNIA STAT) $6 .23 CUSTOMER TOTAL . . . . . . $248 . 61 CUSTOMER SIGNATURE PAYMENT (MAST. CARD ) $248 . 61 NOTICE The Saturn of Concord recommended maintenance meets or exceeds factory recommendations. Prevent unforseen breakdown by having your vehicle serviced regularly.Our maintenance schedules.are specially designed to meet the demands of Bay Area road and weather conditions. SATURN OF CONCORD DEFINITELY RECOMMENDING CUSTOMERS! WE STILL NEED YOUR SURVEY!!MH Page 1 WARNING --- -- Motor vehicles contain chemicals known to the State of California to cause cancer and birth defects 6r other rearoductive harm.These chemicals are con;alnGd in many vehicle components and replacement parts. vehicle fluids, and paints and materials used to maintain vehicles, including. but not limitea to, fuel. ail: batteries,brakes,and wheel balancing weights.When you service.clean or maintain your car,you will be exposed to listed chemicals contained in used oil,waste a and replacement fluids,fumes,grease,grime,touch-up paint, certain replacement parts. and particulates from component wear. When we service you car. we I will return used components to you upon request. Used parts and components contain chemicals known to the State of California to cause cancer and birth defects or other reproductive harm. To minimize your exposure when servicing,maintaining or cleaning your vehicle: 1)work in a well ventilated area;2)do not smoke,drink or eat while working; 3)wash your hands when finished or when taking a break; and 4)follow all manufacturer instructions pertaining to proper use and main- tenance of motor vehicles and vehicle components. (Posted in accordance with Proposition 65 to Cai.Health&Safety Code§252,19.5 e!seq.)For WrIltor information about Proiiosir:at 65:Ir!I;:;isvwta.oe111tt1.drg�:l�opli.5.lr!n11. USED MOTOR OIL,ANTI-FREEZE,WASTE THINNER AND BATTERIES ARE REGULATED HAZARDOUS WASTE.YOUR USED MOTOR OIL.ANTI-FREEZE,WASTE THINNER AND BATTERIES ARE BEING LEGALLY TRANSPORTED,STORED AND REPROCESSED. ENVIRONMENTAL COMPLIANCE CHARGE Maintaining and repairing your vehicle inevitably involves the use of chemicals and generation of waste (solvents. oil. caustic lead. asbestos. inc.) that must be stored. managed, and disposed of in strict compliance with federal, state, and local environmental regulations. We support these regulations and also believe our customers do too because they help ensure a safer, healthier environment for everyone. Complying with these regulations increases the cost of service. TO OUR SERVICE CUSTOMERS: Our usual charges for labor are not based on actual mechanic's time, but are simply our prices for particular jobs. You will be charged no more than the estimated price approved by you. However, if we discover that different or actual repairs are Indicated, you will be contacted for your advance approval of a revised estimate. 1. Customer is hereby notified that the said properly is riot insured or Drotectecl to the amount or the 7. Said Dealer is authorized 10 deliver the vehicle described herein or any of ns contents to any actual cash value thereof.or otherwise,against ioss occasioned ov theft.fire or vandalism while person presenting this receipt. the property remains with the dealer. 8. In addition to any and all other legal remedies available.,I atllhorize.Said Dealer to have a 2. Customer states no anicles o'personal propely have oeen left in the vehicle and dealer is not lien on the vehicle described herein for all charges for repairs. including labor and pars, responsible for inspection thereof. storage and!or towing,and to enforce such lied.Said Dealer is hereby expressly authorized 3. The dealer is not responsible for unavailability of pans or delays in parts shipment beyond dealer's control. to sell said vehicle at public auction after giving a ton (10)day written notice.by certified mail to tile legal owner,registered owner,and Deoartment of Motor Vehicles of intent to do 4. Due to the type of service requested some repairs must be suDlel. so.Or.the sale elate,the vehicle shall be sold to the highest cash binder and lite proceeds 5. All charges for repairs including labor and materials furnisned are due and payable simultaneously with of sale must be used first to satisfy the lien plus storage costs and costs incident to sate, the delivery of the within described vehicle or pnor io deliver'!upon the expiration of three(3)days and the balance shall be forwarded to the legal owner,or if none,to the registered owner, after notice that the repairs have been completed.Notice snail oc deemed to[lave been given upor or if tnc address:s unxnov.-rt.it shall be forwarded to the Droartment of Motor Vehicles. the deposit In the United States mail,oostage prepaid,of written notification to that effect addressed Said expenses for sale shall also include a reasonable attornev's foo.which may be necessarily incurred. to the customer at the address given on the reverse side hereof. g. If any such charges rernain unpaid for thirty(30)days after such request for Dayment,Said Dealer 6. If the vehicle described herein is not called for within three(3)oays after such(notice s given,a may also refer such charges to its attorneys for collection and the customer will pay a reasonable storage charge of S30.00 per day will be made for earn day tnereafler. attorney's iee. Saturn Corporation Service Replacement Parts and Accessories Warranty Saturn Corporation warrants only to Retailer that it will pay Retailer for repair or replacement of any malfunctioning Part or Accessory as follows: fD Parts and Accessories installed by Retailer- 12 months or 12.000 miles:from the date of installation. • Parts and Accessories Sold Over-the-Counter-12 months from the date of sale by Retaller. This warranty covers only repairs or replacements made necessary due to defects in material or workmanship. 11 DOES NOT COVER: 0 Conditions resulting form negligence,alteration,accident or use for which the Part or Accessory was riot designed or approved by Saturn. m Damage due to lack of maintenance or use of wrong fuel,oil or lubricants. 0 Loss of time, inconvenience.loss of use of the vehicle or other economic loss. O On Over-the-Counter sales,labor reimbursement for removal of the malfunctioning Part or Accessory from the vehicle and reinstallation. The selling Retailer or any Saturn Authorized Service Provider may perform the repairs or replacements covered under this warranty. These repair or replacements are to be performed within a reasonable time following delivery of the malfunctioning Part or Accessory to the Retailer's place of business. The Retailer must obtain the purchaser's copy of the original sales slip on counter sales, or a copy of the customer service order to validate date of purchase and vehicle mileage as applicable. OTHER TERMS:THIS WARRANTY IS EXPRESSED IN LIEU OF ALL OTHER WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING(WITHOUT LIMITATION)ANY IMPLIED WARRANTIES OR MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE .APPLICABLE TO SUCH PARTS AND ACCESSORIES. THE PAYMENT FOR REPAIR OR REPLACEMENT IS THE EXCLUSIVE REMEDY UNDER THIS WRITTEN WARRANTY.SATURN CORPORATION SHALL NOT BE LIABLE FOR SPECIAL. INDIRECT. INCIDENTAL OR CONSEQUENTIAL DAMAGES. (FOR OTHER THAN INJURY TO THE PERSON) RESULTING FROM BREACH OF THIS WRITTEN WARRANTY..SATURN CORPORATION NEITHER ASSUMES NOR AUTHORIZES ANY OTHER PERSON TO ASSUME FOR IT ANY OTHER OBLIGATION IN CONNECTION WITH SUCH PARTS OR ACCESSORIES. A buyer of this product in California has the right to have this product serviced or repaired during the warranty Period.The warranty period will be extended for the number of whole days that the product has been out of the buyer's hands for warranty repairs. If a defect exists within the warranty period, the warranty will not expire until the defect has been fixed. The warranty period will also be extended if the warranty repairs have not been performed due to delays caused by circumstances beyond the control of the buyer.or if the warranty repairs did not remedy the defect and the buyer notifies the manufacturer or seller of the failure of the repairs within 60 days after they were completed.If,after a reasonable number of attempts,the defect has not been fixed,the buyer may return this product for a replacement or a refund subject, in either case. to deduction of a reasonable charge for usage. This time extension does not affect the protections or the remedies the buyer had under other laws. SOC1-1105-1 AMERICAN SOLUTIONS FOR PUSINE.SS 510 538-996C CLAIM 0 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY / BOARD ACTION: JUNE 06, 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 docurnent mailed to California Government Codes. ) you is your notice of the action taken on your claim by the Board of Supervisors. (Paragraph.IV below), given Pursuant to Government Code AM.OIJ r- $800.00 MAY 0 1 2006 Section 913 and 915.4. Please note all COUNTY COUNSEL "Warnings". . CLAIMANT- BRET NISSEN MARTINEZ CALIF, ATTORNEY: UNKNOWN DATE RECEIVED: MAY 01, 2006 ADDRESS: 1362 REGAN WAY BY DELIVERY TO CLERK ON: MAY 019 2006 BRENTWOOD, CA 94513 BY MAIL POSTMARKED: APRIL 28, 2006 FROM.: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, 1 Dated: MAY 01, 2006 By: Deputy 11. FROM: County Counsel T0: Clerk of the Board of Silpervisors (/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 tiled late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: ' Y' B ty County Counsel 111. FROM: C rk of the Board TO: Clnty Counsel (1) County Administrator- (2) O Claim was returned as untimely with notice to claimant (Section 911.3). . IV. BOARD ORDER: By unanimous vote of the Supervisors present: (t� This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for. this date. Dated: Vw77e 04,ai�CJOH.N 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 filen court action on this chdin.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this matter. If you warm to consult all attorney,you should do so immediately. *For Additional Warnung See Reverse Side of This Notice. AFFIDAVIT OF MAILING declare under penalty of perjury that I ant 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 Nlartinez, California, postage fully prepaid a certified copy or this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: v'''"-e-0."'o?ie9� JOHN CUL.I_,LN, C'LEIZK Ry _ eprrty Clerk BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY ` INSTRUCTIONS TO CLAIMANT A. A claim relating to a cause of action for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board.of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. ................................................a 0 a M 0 M 0 M M M M M............ ......1 RE: Claim By: /-ev Reserved for Clerk's filing stamp ) RECEIVED Against the County of Contra Costa or ) M AY 0 1 2006 District) CLERK BOARD OF SUPERVISORS (Fill in the name) ) CONTRA COSTA CO. ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ 96JO-yU and in support of this claim represents as follows: 1. When did the damage or injury occur? ive exact date and hour) 2. Where did the damage or injury occur? (Include city and county) Deems n ew ism S� �► �ti ; �>L 3. How did the damage or injury occur? (Give full details; use extra paper if required) f� D, AX, �o n 2. `i ; �J� dole IA-.. 1140-.. /'d-rte,, /:9H.Ile a T/om. /—I' j G rc ck 2- i /k-e. /—1 M 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? /`d° � �✓L+-P�t° J(, or., �fo 1/�. /lo GLl.di Gf' �JhV 7� L►i/ � 7�; 5 What are the names of county or district officers, servants, or employees causing the damage or injury? 7 U . 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) Q � -A r-e- :n� l`r M• T How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Q ce J ani nev 4 i re- ( 35-c4 - 31 8. Names and addresses of witnesses, doctors, and hospitals: Kel � �� 136 Z 9e7ti Wl-�( (56 C-Z93 3) '�cX r.e e U t✓S wr, 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT y 7 06 Z/: 6"7� . zt Gov. Code Sec. 910.2 provides"The claim shall be signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney) ) Name and address of Attorney ) (Claimant's Signature) r 6'Z R ei o (AddressKZ Telephone No. ) Telephone No. ( "Y Z S J �_8 y—0111 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, an}, attachments, addendums,or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■..a...■■.......Wigan..................................■■.......i.....woman 9 on a Sam a no No 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. 31VWI1S3 . r�-^ _ �1, -y. C• .!. 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I { I a`LLw` c' . mwj j w.0W i I�NI I 04" •tL; t i I I I •I Lo UA �c 1 , i w v "= a .r :l a ti! � d CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JUNE 06, 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), x` given Pursuant to Government Code. �! Section 913 and 915.4. Please note all AMOUNT: $243.84 MAY 0.1 2006 �� "Warnings". CLAIMANT: DENISE RUSSO COUNTY COUNSEL MARTINEZ CALIF. ATTORNEY: UNKNOWN DATE RECEIVED: MAY 01, 2006 ADDRESS: 2384 WAYFARER DRIVE, BY DELIVERY TO CLERK ON: MAY 01, 2006 DISCOVERY BAY, CA 94514 BY MAIL POSTMARKED: HAND DELIVERED FROM.: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN.CULLEN, C k Dated: MAY 01, 2006 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Sup rvisors ( 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: O County Counsel Ill. FROM: Clerk of the Board TO: Co lty Counsel (1) County Administrator(2) ( j Claim was returned as untimely with ice to claimant (Section 911.3). 1V. JWARD ORDER: By unanimous vote of the Supervisors present: (I This Claim is rejected in full. O Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. :Dated �?�'aAHN CUL.LEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6)months fibrin the date this notice was personally setved or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney,you should do so inunediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of per jury that I alar now, and at all times he►•ein mentioned, have been a citizen of the United States, over .age 1.8; and that today I. deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this 13oard Ordcr and Notice to Claimant, addressed to the claimant as shown above. DatedVwa1G © a-VeW JOHN CULLEN, CI.,ER.K By Deputy Clerk BOARD OF SUPERVISORS OF CONTRA COS'T'A COUNTY INSTRUCTIONS TO CLAMANT A. A claim relating to a cause of action for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be.presented not later than one year . after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be filed with the Cleric of the Board of Supervisors at its office in Room 106, Count),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 native 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. mass aataaaemaaaaanaana �a�a�aaaaaaaaseaete[���araaa¢¢Qeeeaes�t�r��■a�aara�sesia� RE: Claim By: Reserved for Clerk's filing stamp D Against the County of Contra Costa or ) MAY 0 2006 District) C0n'rRH cosr��tirsoRs (Fill in the name) ) The undersigned claim, t hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) -0 -e 2 '. vS O M . 2. Where did the damage or injury occur? (Include city and county) 6(V 3. How did the damage or injury 0Lrcur. Give full details;use extra paper required) IA3 LL 7b �'�esZ� �G+ l��tc.� t,►� r �� � i,.1LL0 a kkki I d �oVk 4.-' What particular act or omission on the part of county or district officers, servants, or employees 1-21 60 caused the injury or damage? (Ak S�e� 5 What are the names of county or district officers, servants, or employees causing the damage or injury? 1 / �" 1 t� 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) . 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage,) S. Names and addresses of witnesses,doctors, and hos talc: P j6�-t SSJ en v W,, vJ �1Qs11 'YU Com- 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT ■ tataaaaaasaaa0aaAa8asatatttaaaa0aRa0Raaaaaataaataaaaaa5aa0aataaaaa0aa8aaaaaaaaaaaaaI .Gov. Code Sec. 910.2 provides "The claim shall be signed by the=somes behalf."SEND NOTICES TO: (Attorney) Name and address of Attorney J (Clai:maut s ignature) ) (Addre s) C VVS Telephone No. ) TeIephone No. ■a a a 0 tat am tat■tat a a as on am noa a RE t■R ON AN Inn ass It t t It t a a an a am an a a a a a a l I ass a It am on a am Nos NEI PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthermore, any attachments, addendums, or supplements attached to the claim fonn, including medical records, are also subject to public disclosure. ■ ataaaRaaaaaAaaaaaaaaaaa■ ■■aAaaaaaaItaaaaaa5aaIAa0aitaaaaaaaa0aaaaaIto aaaaa2ataaaaataa21 NOTICE: Section 1-2 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. ® 27 11 2771556 TIRE CO. AMERICA'S LARGEST Financing ore Available LAYAWAY ACCT #1350005479 Melle INDEPENDENT TIRE COMPANY DRIE:: 04-25-0006 TIME: 4:10 PM hc L 2384 WAYFARER DR. CLK430 4908 50U7FIF'RONT RU CRE/CONV 208 CHASIS LIVERMORE CA 94551 DISCOVERY BAY CA 94514 MILEAGE: 1 PHONE: 925-449-•6707 905-7fl3-b749 004 JOSE PANTOJA TORQUE SPECS: 080 WORK ORDER# F.E.T. PRICE . AMOUNT 26298 NRM 1 ?25/45ZR-17 91W BMW CONTI SNORT CONTACT BMW .@@ 210.00 21@.@@ WARRANTY: WORKMANSHIP/MATERIALS-LIFETIME COMMENT: INFLATION F:32 R:33 80075 NRM 1 STATE REQUIRED ENVIRONMENTAL FEE .00 1. 75 1.75 8022:4 NRM 1 WASTE TIRE DISPOSAL FEE .00 2. 50 2.50 90219 NRM 1 INSTALLATION & LIFFTIME SPIN BALANCING .00 11.00 11. 00 80402 NRM 1 VALVES, ROTATIONS & LIFETIME REPAIRS INCLUDED .00 ,.00 .00 COMMENT: REPLACE R/F TO SPARE COMING FROM C:AN34 ..3 I. ~ri. V AMERICA'S TIRE COB .' .:. SUNT225.25 0•TAL: S TAX. 18.59 TOTAL. 243. 84 WORK ORDER LAYAWAY REFUND: 25.00 Air Check 3:-84 A# 54638x] DET: 2 18.84 LF RF ❑Return Tires TENDERED: x'43. 84 Change Snows % LR RR ❑ Repair S ❑Rotation ❑ Rebalance jr Wheel Lock Key installed/Pretorque \ Customer Signature Torqued b FtLbs. Fa:dholdbr eck!iuwlnd lea(n�ngrI {;Dods and/or services in the amowit of Ihu I,)w,riowri hereon q r . ` and ayraas to pedr in the ut.•lidatiuus sat forth in the Cardholder's ag;aamont with tho Issuor CCoordinator: tires . com Comments: TAT OR LOCAL TAXE9 AND,WHERE AEOU[RED OR CHARGED, ENVIRONMENTAL OR DISPOSAL FEES ARE EXTRA. CLAIM Jf� BOAItD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION:JUNE 06,. 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 1V below), given Pursuant to Government Code 2006 AMO[JN"[': $626.00 MAY 0 3 Section 913 and 915.4. Please note all "Warnings". COUNTY COUNSEL CLAIMANT: MONA TOM MARTINEZ CALIF Al.'TORNEY: UNKNOWN -DACE RECEIVED: MAY 03, 2006 ADDRESS: 3221 LUNADA LANE BY DELIVERY TO CLERK ON: MAY 03, 2006 ALAMO, CA 94507 BY MAIL POSTMARKED: MAY 027 2006 .FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-doted claim. JOHN CULLEN, 1 Dated: MAY. 03, 2006 By: Deputy 11. FROM: County Counsel TO: Clerk of the Board of S pervisors "Chis claim complies substantially with Sections 910 and 910.2. (�>) This Claim FAILS to comply substantially with Sections 910 and 91.0.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely riled. 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: ru Ill. FROM: Clerk of the Board T ounty Counsel (1) County Administrator (2) O Claim was returned as untimel 1 notice to claimant (Section 911.3). IN/ F(OARD ORDER: By unanimous vote of the Supervisors present: (� This Claim is rejected in full. ( ) Otlier: 1 certify that this is a true and correct copy of the Board's.Order entered in its minutes for . this date. Datedg,�JOHN CULLEN, CLERK,By 2/ Deputy Clerk WARNING (Gov. code section 913)' Subject to.certain exceptions;you have only six(6)months from the date this notice was.personally sewed or deposited in the mail to file a covet 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 attortey,you should d6 so innnediately. *Fur Additional Warnutg See Reverse Side of This Notice. AFFi.DAVIT.' OF MAILING. 1 declare under penalty of pet juiy that I ant now, and at all times herein mentioned, have been a citizen of the United States, over age 1.8; and that today I deposited in the United States .Postal Service in Martinez, California, postage fully prepaid a certified copy of this Roard Order ,end Notice to Claimant, addressed to the claimant as shown above. Dated:✓w�'' e- -07, a2. Ifo .10HN CULLEN, C LE RK 13 Delnity Clerk BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY t' 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 relatincr to any other cause of action shall be.presented not later than cne year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be filed with the Cleric of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street,Martinez, CA 94553. C, If claim is against a district governed by the Board of Supervisors, rather than the County, the naive of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each. public entity. E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. ■aa■■araaaaaaaaaaaaa a a ■a a a a a a.aasaasaaeaeuaaaaaaa MEN are aaaaaaaa Aa aaaaaaaaa sunl RE: Clain By: Z Reserved for Clerk's filing stamp KAP" �e . 3r)-y( LLvP%aoco, } EMCIIVED MAY p 3 � Against the County of Contra Costa or ) ? 06 CLERK[30' SUPERVISORSG Of • � District) CONTRA COSTA CO. (Fill in the name) } The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ (off-b • d and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 1�CbJQ•6�� M�t✓'Gtr yg^� �ob � ''wc✓n�►ro,� 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full details;use extra paper if required) La �. -E•rc� o,�. c�v. Hu✓ . T►�a�i - t1► ova awl 6 aim 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? 5 What are the names of county or district officers,servants, or employees causing the damage or injury? 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) a '� -ke io n t ce,,,. (se, Fi or► a ��u 7. How was the amount claimed above computed? (Include the 'estimated amount of any prospective injury or damage,) 8. Names and addresses of witnesses, doctors, and hospitals: vldl —704b 9. List the expenditures you made on account of this accident or injury: DATE TaJE AMOUNT ■ ■a a a a s s a a a a s a a us Bea ERB non IN m s a s a r a a r a a s s a a s s s a a s a a a i s a a a s a s s ON s a a a a a a a vans an an a s a a at ) .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) 1 Name and address of Attorney ) (Claimant's Signature) (Address) ) Telephone No. )Telephone No. a asaaaaasaaaaaaaaaaaasaa■■ aManama samaaaasaaasaaaaaasassaaaaaaaaaaaaaaBEEN ass aaIrmo amat PUBLIC RECORDS NOTICE- Please VOTICE-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. BRENNENa s a s a a a a a a r a a a a t a a al alas an a s a a a a a s a s a s MIKE a s a e s a a a a a a a a a a a a a a a a a a a a a a a a a Oman Wilmot 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 file of not exceeding one thousand dollars ($1,000.00), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceedincr ten thousand dollars ($10,000),or by both such imprismunent and fine. Selex, Inc. dba �O�G REDWOOD FENCES 575 Boulder 30 0000000 P.O. Box 5430 .o.eo.RG Pleasanton, CA 94566 BORG D Fences o Decks o Retaining Walls o Chain Link (925) 426-9620 Ornamental Iron o Vinyl Fax (925) 461-1486 LIC. 771763 FENCING CONTRACT www.burgfcncc.com DATE q-" JOB NAME M b.ti.4 �� .�.. BILLING �S JOB LOCATION 3_� ta.v►t� JOB CITY ZIP CODELZ-{ CROSS STREET ��n'_RQ_t1_R�L/ PHONE(H)_3_11,TQ(W) 11 GENERAL EXISTING CONDITIONS FAX (Cell) 1. TERRAIN ZFLAT fQ SLOPE ❑DIFFICULT 2. FENCE EXISTS? ❑NO 44 YES STYLE *SZ41-M-4-4— -slid 3. CONDITION OF EXISTING FENCE?A_) w,ted'6,��c CAUSE OF DAMAGE? A N't- 4����<c_ �dh.b 4. VEGETATION )4 NO ❑YES 5. REPAIR EXISTING As__Ai 4_ -A 4 %�_ OF FENCE. 6. REMOVE EXISTING-ArS�-I'_ Cbl LN. FT.OF FENCE. HAUL OFF PROPERTY BY: N�ONTRACTOR ❑OWNER 1 7. INSTALL NEW PRESSURE TREATED POSTS IN_LiLtjOF CONCRETE AT APPROX. 61 ON CENTER. XI 4x4 231 4x6 > 1 ❑6x6 8. INSTALL KICKBOARD ❑NO ;,4 YES SIZE ,C$��T;INSTALL BULKHEAD Ll YES LJ NO SIZE- 9. IZE 9. INSTALL EI NEW_01X4/ay.6�,rREDWOOD RAILS '&CON COMMON ❑CON HEART 10. INSTALL -,XNEW___6fit_ REDWOOD FENCE BOARDS X51 CON COMMON ❑CON HEART 11. INSTALL —N_,t ❑NEW GATES GATE POST SIZE ❑44 ❑4x6 ❑6X6 12. FENCE TOP TO: V RUN LEVEL ❑CONTOUR X)STEP,WITH aTHE SLOPE OF THE GROUND 13. SEAL, CONDITION AND PROTECT FENCE FOR AN ADDITIONAL _11LN. FT.ONE SIDE OF FENCE I —"' LN. FT BOTH SIDES OF FENCE. (OPTIONAL) PLOT PLAN NOT TO SCALE ftist.'r1'cK4-;��• XiS._. ` ..._--; i B/B=BOARD ON BOARD F/S=FAN STYLE(louvered) ���: CTUR PI= P/F L 1- P/r=PRESSURE TREA I ..... f_ -wed k` f _ + �1�+-—�--M ��- cti. ,. yy ____. HOIJ$EOt ff .� 441 - - _ /� _ _,. i �SWnc+IICX +h�{2_ lAl, 40,."QXt +'+ -ri_L',_ -+ -,- i - ~ - - \r VEGETATION r t l ... ......;_ ...... ^ - �I� �cow�eK d. (-� � � i - �- S P OPTION 6 n -7 - •i �- « ...-PROBIT 1.......`.........� TOTAL i IVa 41kh L 16iJ .9Y.C4 S 4S ($500.00 MINIMUM CHARGE) r v -�d n1 ��_(e ($1,000 MINIMUM CHARGE FOR IRON) �_ I (:e Seal and Protect Fence ��,�. (Optional)See 7113 above $� < o�•f�) : Sealert'ac4'#,e�f�5 �1Q One Side ❑Yes ❑No __7 PAYMENT- i o a4r L D�A t, �J.{7eJU <_t/1A P&Z ?10A) Both Sides ❑Yes ❑No Accepted by: _ �z�/OL Customer's Signature Date Submitted by: M Borg Fence Associate_ Approximate Start Date: ' Contractor agrees to substantially commence the work on or about the approximate start or upon reasonable access to the job site being provided to con- tractor by customer but in no event later than 20 days; failure to do so, however,shall not be grounds for terminating the contract. Approximate Completion Date: CONTRACTOR SHALL SUBSTANTIALLY COMPLETE THE WORK ON OR ABOUT THE APPROXIMATE COMPLETION DATE. Owner or tenant has the right to require a performance and payment bond. Contract void unless accepted within 30 days. Please see reverse for additional waivers of responsibility. General Terms and Conditions Professional's responsibilities: BF will complete installation iri a workmanlike manner. BF will not start,conduct,alter,or finish installation except in accordance with applicable law. BF will either not start,or will immediately discontinue installation upon discovery of unforeseen physical or hazardous conditions at your service address. BF is not responsible for property lines,easements,covenants or other legal encumbrances that your service address may be subject to. Your Responsibilities: You agree to pay BF for installation according to the terms and conditions of this agreement. If your service address is subject to any easements,covenants or other legal encumbrances that could affect installation,you agree to let BF know about them before installation. You agree to facilitate the location of underground utility lines. You agree that BF holds no liability for property lines,easements, landscaping,landscaping lighting,sprinklers,drains/water lines,driveway,walks,curbs,concrete,sewer,natural gas,-cable lines or telephone lines. You agree to ensure that work areas are free of preexisting hazards,I.E.,unsafe'physical conditions"or-environmental hazards and building/zoning code violations. You agree to allow BF access to work areas during working hours. You agree to provide power to work areas. You agree not to allow unattended minors at your service address while BF is present. You agree to control pets and keep them away from work areas. You agree that if you,or anyone"else,'-interferes with or delays installation,you will be suliJect to transportation/storage and labor charges at the cost of$50.00/hr or$250.00 a day. You agree that all and any clean-up,moving of personal property or furniture or other work necessary to commence construction will be your responsibility. You agree to detach and attach anything on your fence.You agree that any claims against BF under this .agreements should be made-to BF-within(15)calendar dajy"s of the date you first become aware of a problem. (IIF will attempt resolution of any claim within 30 calendar days of receiving your notice) You agree that this contract.s.,with;you the homeowner only. We will not enter into additional contracts on the same address,nor collect money from,neighbors. Some cities require a permit on fences above 6'..Borg Fence rs not responsible for height of fence if permit is required btit•not obtained. Cutomer initial i Access: Customer will provide access through own property or through adjaccitt`property for Contractor's normal construction equipment,materials and employees to do the work at no cost to BF. BF will not be responsible for property damage or other material which is in the path-of the access provided by customer,either above or below the ground,including but not limited to landscaping or irrigation,drain,sewer,telephone;gas,cable lines or electrical lines. In the event customer authorizes BF use of access through adjacent properties during construction,customer is required to obtain permission from the owners of the adjacent properties for such use. Customer.agrees to indemnify BF and hold it harmless from all claims as well as all loss or liability resulting from use of adjacent properties by BF,provided,however,that nothing contained herein shall excuse BF from liability arising solely from the negligence or willful misconduct of Contractor,its agents,servants or subcontractors. Customer warrants that thejob site will be in a condition for work on the start date. Any clean-up,moving of personal property or furniture or other work necessary to commence construction shall be charged to the customer. Changes and Change orders: BF,at your request;•may arrange-to perforin additional work,subject to'a change order,subject to additional charges payable by you to BF. Any changes to installation i.e.;-a1 sutistitution of materials or an expansion of the scope.of-the work will require you and BF to' first sign a written change order that will become pan of this agreement. Following discovery of previously undisclosed/unidentified legal encumbrances on your premises,building/zoning code violatiorfs,or hidden/unforeseen hazards such as the presence of underground lines,rocks,•. roots,buried debris or any conditions differing from what you represented,BF may ask for change order or discontinue installation without further obligation-to you. if you decline a change order request,y'ou'may terminate'this)agreerrient.andtpay for all work•perforrned and materials used/delivered up to the time of declining chattge.order rcqucst�` Security interests/Liens: If you make a11'paymctits as required under this agreement,no security interest will be placed against your property by BF. if a security interest is placed on your property it creates.a lien,mortgage,or other claim against your property to secure payment and may cause a loss of your property if you fail to pay as requested. if BF is forced to place a licti on your property,you agree to pay$400.00 in addition to your - payment owed to remove the lien for the cost of the lien. After paying on any completed phase of Installation and before making any further payments,you may request from BF a Signed,unconditional release from,or waiver of,any right to place any claim against your property applicable to the work then cotnplctcd. + Notice to owner: Under the Mechanics Lien Law,any contractor,subcontractor,laborer,material man or any other person who helps to improve your property and is not paid-for his labor.services or.material,has aright to enforce his claim against•,your property. Contractors are required by law to be licensed and regulated by the Contractors State License Board. Any.questions concerning a contractor may be referred to the registrar of the board; CSLB PO Box 26000,Sacramento,CA. 95826 i-800-321-CSLB(2752) - www.cslb.ca.gov , j . . r i Insurance: General Liability and Workers'Compensati' id it'surance'is a'vailable;toyou"capon request. Warranty: BF warrants the workmanship of the installation of gate's•for one yeai'from•complction'datc,°labor inclusive. BF warrants posts, found upon examination to be rotted,for 5 years(pressure treated posts only),labor exclusive. This warranty does not cover damage caused by abuse, misuse,neglect,or improper care/cleaning. BF will and does assign any manufacturer warranties to customer for any materials which are or become defective and customer agrees to look solely to the manufacturer for any claims that the materials are defective. Customer acknowledges that wood, by its nature will crack,discolor,expand and/or shrink over time and agrees that BF is not responsible for or obligated to correct these conditions. Cancellation: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY'Ok'OBLIGATION BY DELIVERING WRITTEN NOTICE TO BF BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING: Special Order Cancellation such as Chain Link,ornamental iron,Vinyl,or special order wood is non refundable to us. If possible,BF will return merchandise with a restocking fee of up to 35%of purchase price that you will be responsible for. In the event the merchandise cannot be returned,you will be responsible for the entire purchase price. Special order item: yes no Customer initial BF initial BF=Borg Fence YOUR ESTIMATOR I' t� j' ' / DATE q4 a U& NO 1831 1 * * ALL AMERICAN FENCE CORP. * State Contractors Lic. # 670853 — — — P O Box 3057, Danville, CA 94526-3057. Scheduling office & Deliveries, 925-743-8583 �+ Stepped I 1 ` Sloped I I Scheduling fax, 925-443-7119 /(o' PROPOSAL SUBMITTED TO: ► A NAME �'n!�N _ —C;✓ ADDRESS ,,3Z;,1 CITY / I „ . PHONE MODIFICATION OF THIS ESTIMATE WILL VOID THIS ESTIMATE 6' CONST. COMMON REDWOOD (estimate includes all new materials, labor and disposal of existing wood fence. Construction heart material additional I I _ A i *STYLES* Board on board N Louvered i I Nail-on I I D -earred I I Shadow box I I Side by side X 1 1' Lattice i II .Areas of estimate: Right side Left side N Back I I Left front I I Right front I I Sloe I I MATERIALS: Redwood posts I I 6r Pressure treated posts N I 4x4x8D44x4x10 114x6x8 116x6x8 I I ° X X/ Concrete footing 8"x24" R or 10"x36" I I Solid frame rails X1 1x1x8 Trim DW J 2x6 Cap I 1 1x4x8 Trim I I GATES: 42" 1 1 DD gates I I Dado rails grooved I I FENCE MATERIAL: 1 x6x4 I 11 x6x5 1 1 1 x6x6 I I 1 x8x4 1 1 1x8x5X 1 x8x6 Kickboard 1 x8x81 12x8x8 i:6(6 •�°I. jb` T 6 -t � L:: cis S� �r iXgXb XI• X' //3 ,'pi �——rte— on A — TA h Dgr t�N OAr D jo ►x�'xSrZx9X9 2 DD I I understand that the prices quoted are good for 90)days from the date of this estimate. NOTE: Pressure treated post warranty does not cover bowing or twisting. Workmanship warranty: AIL-American Fence Corporation warranties its workmanship for(1)year. acceptance of proposal will not be processed without the waiver of responsibility initialed (`Vaiver of responsibility) ACCEPTANCE OF PROPOSAL, All American Fence Corp. is to be held The above prices,specifications&conditions are sat- harmless for any drain lines,sprinkler factory and are hereby accepted. I understand alter- Meads, p G.&E.,electrical,lost pets,land- ations reducing estimate in size will incur higher costs. scaping,fiber optic,personal. property, You are authorized to complete this agreement as specified. phone lines or sprinkler lines. We do not accept credit cards Payment in full will be made solely by me and does not Owners initials_ hinge upon any agreement I have made with my neighbors. Extra's: 1 will have payment in full ready for pick up same day the job Jackhammer: lump sum S is completed. There will be a$25.00 charge for any return checks. or to be determined S Green removal: Ivy & overgrown _- vegetation: lump sum S Owners signature I}ate All work to be completed in a workmanlike manner according to standard practices. I understated all waivers & extras. Any alteration or deviation from the above specification involving extra costs will be executed only upon written orders,and will become an extra charge over&above tl._ Y- owner's initials estimate. Our workers arc fully covered by Workman's Compensation Insurance. .y 'a } y .,�f''`:_��-,..fid r,� f � t �y��`F��'•S f•. °t t /ft t f ��� P } 5�{Y...��2: X��77r ',f♦ ��a'lv�� i ,i.h �r �r S:.rr � of-.. j I ~ ✓ r .. I., y, k }:i;"7��` tt �`,s t,••*, ` '` ^: { !'�-. In ,i 1 A }C •f •� t" �SR,4'1 dFki�r} J� 14 � ;, {Y} � .. 9 f( .,�' }�r ,r. y�` r r q t'iz r trK � .! , ver •r t�A ,,lr '' i .,'.�� t.' �. .f .{. 4J['.'t� .ft I'gjr t�1 ��'!#rr •h' .ss."} t`�,d..�;�. Jr-C�' <t f+� i r^tT 0' ;.oma a.;,.. - y.„� �?p{"1$ t ,rpf r'`+'""•' "?.II,{�''i',-+�t� �;"-y. _ ti�116w^,,. 4th"• �.tY� �ls.i?�"�`y.ti.' - RZ-2 7-1 77 •-.a _g;,J �) N Ak �,. . t is a t r \ k� �(1{�tpy', cam--��L `''tri■/ �I' $� '3--��`��,s(: y `�".1�� , 1�'��. t� 1d, }� •' �� yiw � Lir.• S,,y�{` 1�,3'�',��... '10. i.�+s "A"aF��$t. tf''• if ti nS. 1'°i t Y� 'i.�. -(�. GrW } .F(.3- r 't+ ..;',tih ♦. pr .'`+ CLA I lvI BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY • BOARD ACTION: JUNE 06, 2006 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to California Government Codes. ) you is your notice of the action taken D �5 ���� on your claim by the Board of jy � Supervisors. (Paragraph IV below), MAY 0 3given Pursuant to Government Code 2006 Section 913 and 915.4. Please note all AMOt1NT: $239.44 COUNTY "Warnings". . MARTINEZOUNSEL CLAIMJAYME FAIRFIELD CALIF ATTORNEY: UNKNOWN DATE RECEIVED: MAY 03, 2006 ADDRESS: 2418 N. 6th STREET, BY DELIVERY TO CLERK ON: MAY 03, 2006 CONCORD, CA 94519-2145 BY MAIL POSTMARKED: MAY 02, 2006 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, C e Dated- MAY 039 2006 By: Deputy I.I. FROM: County Counsel TO: Clerk of the Board of S16pervisors I/['his claim complies substantially with Sections 910 and 910.2. �(`',) ].'his Claim FAILS to comply substantially with Sections 910 and 91.0.2, and we are so notifying claimant. 'Che 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: ity Counse 1.II.. FROM: Clerk of the Board T unty Counsel (l) County Administrator(2) O Claim was returned as untimely i notice to claimant (Section 911.3)). . IV BOARD ORDER: .By unanimous vote of the Supervisors present: ( This Claim is rejected in full. O Other: 1. certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated`.1A"7-2G 06 , �,f.pA)HN CULLEN, CLERK, By _A'4��Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personalty sewed or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice hi connection with this matter. If you want to consult an attorney,you shotdd do so unmediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of pet jury that I am now, and at all times herein mentioned, have been a citizen of the liuit.ed States, over age 1.8; and that today 1. deposited in the United States Postal Service in 1\`Iartinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. .I0I-1-N CULLFN, CI_,EK.K 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 liinita•tions..applicable to actions not subject to the California Tort Claims Act i i 1 r r� S o" IS) S tJ 0 �J C? p cc { ZO J {i.T U {r:l { f, r ON C E 1 BOARD OF SUPERVISORS OF CONTRA COSTA COLJNTY 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 latter, 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, Coun�,Admi.uistration 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.. VEIN aeeaCs7slaa.taalanaKIM aa■Kansas Kan■aasa12111t1atons Caour aaatt6ltiRaRnalas1saanas RE: Claim By: Reserved for Clerk's filing stamp ro RECEI VEr Against the County of Contra Costa or ) MAY 0 3 District) CLERI(BOARD OF,;; ";,. (Fill In the name) ) CONTRA Cry Tn,• VISORS CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of s..;? 39. 4 y and in support of this claim represents as follows: L. When did the damage or injury occur? (Give exact date and hour) 6P 2. Where did the Barna a or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full details;use extra paper if required) 4. %atparticular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? 0 - 510 5 etare he names of county or district officers,servants,or employees causing the damage or injury? to TS'd TEPT S22 SEG 1N3W9UNdW ASI�i 333 SS:ST 900E-T0---WW IL VK)) JA� OZY'll- �ro At . z0'd -idlol 6. What damage or injuries do your claim resulted? (Give full extent of uijuries 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 dainage.) 8. Names and addresses of witnesses,doctors, and hospitals: 9. List the expenditures you made-on account of thisacciden or injury: DATE TIMEAMOUN Pilo r, fil JV 4 anot Men Kos t![aa[!R man massa afsaft!lRf a!!/tRtRR■=■tR■a alala!!■Rif[[■tlfaR■a■t■R mammal al ) .Gov. Code Sec. 910.2 provides"The claim shall be )signed by the claimant or by some person on his behalf.°' SEND NOTICES TO: (Attorne-,ft ) Name and address of Attorney ) (Cl is Signature) } (Address) Telephone No. )Telephone NT-8,2 r 2 � 9/ —/!Z:r ■sanil bananas aRsssoil Basalt itIna eltlasaasalRrMusson aRa!!■sfasrlassas/aalRs a an a mass asoa, PUBLIC RECORDS NOTICE: Please be advised that this claim form; or any claims filed with the County under the Tort Claims Act,is subject to public disclosure under the California Public Records Act. (Gov. Code, s§ 6500 et seq.) Furthermore, any attachments,addendums, or supplements attached to the claim form,including medical records, are also subject to public disclosure. ■sR■sat■sataalaaRUN ssto%a■was asasaasal■asaasa[aRsse!■as/raaassraaaasrasssKits ralsRast, NOTICE: Section 1-1 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. z0'd tiEVT SSS SZ6 1N3W9dNUW ASId 003 6S:ST 9002-Z0-J,aW 1209 Auto Center Drive Prompt Antioch, California 94509 MEMO,% Professional Bus: (925)777-1700 FAX: (925) 777-1258 LF A S.eNIG@ _ Toll-Free: 1-888444-GLASS - - - BARtr'AG190211 TECH Contractor's Lic. ; 743090 'x` t ACCOU`1T AGENT PURCHASE I 05 NO. INO.: I ORDER NC.:I DATE` -01-2006 GrIJ�fTE i -. .._.. —. ..- __. .. . __.I -- I ... LUSTCMtR ST�,7E TAx-OR�i(E!:nT NO. :USTO'=ERFeD:�I.T,\X �.NO I A�J4'.CC)DE S.S'E:i!.1AN I.0 CiiUCF Ta-:eN 8'+ 'JST,:LLCD=Y i FFDEfLJ.TA:,I D..`JD I JULE _. _.... I-... I 68-8382659 BILL TO: SO'D TO: JAYME FAIRFEILD Wit:FAX 681-1453 INSURANCE - • • • • I INSURANCE CO. . .. POLICY NO ' PHONE INSURAfNO. r O CLA*J NO- CAIJSi:B - PO_lC'f•JAhAL -. ...... -. I OSS LOCATION A3EVT NA.4E - - VERIFIED 6- _. AGEVT PHONE _._. .__... .-.__. _ _-.. DATE OF LOSS DEDUCTIBLE Toyota .. F'ickup 19S@ i I i ' Qty Part Number Color Adhesive Labor Sell Total' 1 FW00598 GB CDM Green/Blue 0.00-211 8 Dam 2.6H 50.00 175.00 22:5.00' Qt Part .Number Description Sell . Total' 1 WFT F598 C Moulding(Upper) 3 I - Passenger can not sit in the right front seat of air bag equipped vehicles fcr 2 minimum of 12 hours.Failure to do so could result in passengers extreme or fatal injury. Customers Initials ilme&Date t.. -. . . ..._.. .__ _ ....... .... ..... - .-_- ..-- __ ;Work Estimate I I authorize GLASS TECH to perform the work listed on this invoice for the ameunt shown below. Amoun'. Signatne_.. ..... _.. _. ...._.. - - __. VISA I AUTHORIZATION To FAYJ. hereby a.d iorze and empov er the abc.-a narred nsurance cams Ty to pay 116is invoice in full sclt'am[1,s..tislaclmr,.`-.rd f,srne•ge of all _ loss under the auove c•ol cy,Lpon such pa,m-ern,all rights I nay have for cram and•deir„-:nd for ess and damage ce=_ckec ab n•:Ega.rs1 I SJ'u bt D t a 1 225. OL71 pe above naiIiec insurance ccr,pany shall ha thereby icrewrd'scnarged.In the evegt anal lh^ab3vc earned 1SUrarce company dces ro'.' B. c_'�''�-° .�/. Tax 14. 44 rake Iirriely ond,'or full mvncn:of'.hs invo ce accorc:ng:o its terms,I herby accept resaons:hiWy for sLcr Faymert and::gree to:nv all charges rallecledonlfrisinvoiccloGLASS TECH subje:ftoand acrardng'oa:ltmrsaAccnditimsa,!1sim':ce. —ERb1S • , Check 239.44 __...._..,., .,.��c,.-.+n�r-c v.V ink-:0 .,..\'i:7'FIA?1��=.:LR'::;Cr.WS�[r,r•,�.r:PEF�•.arra.ir,^:a:,.;.rr,,r ;sF�r•r3'�=.7:11v rr:F"P.C_E r-=,;Ul:'.'�. I L-d Cl%:90 90 LO Aen K41 lip�rF ov 'uN C 4 K �y N L C LA I.M. BOARD OF SUPERVISORS.OF CONTRA, COSTA COUNTY 1 BOARD ACTION: JUNE 06, 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 ) you is your notice of the action taken 1 on your claim by the Board of MAY 0 3 i Supervisors. (Paragraph IV below), 2006 given Pursuant to Government Code COUNTY COUNSEL Section 913 and 915.4. Please note all AMOUNT: $344.04 MARTINEZ CALIF. "Warnings". CLAIMAN-P CYNDEE L. HAMILTON AT"T"ORNEY: UNKNOWN DATE RECEIVED: MAY 03, 2006 ADDRESS: 1813 ARDITH DRIVE, BY DELIVERY TO CLERK ON: MAY 03, 2006 PLEASANT HILL, CA 94523 BY MAIL POSTMARKED: HAND DELIVERED FROM.: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, C k Dated: MAY 03, 2006 By: Deputy ll. FROM: County Counsel TO: Clerk of the Board of Su rvisors This claiin complies substantially with Sections 910 and 910.2. ( ) This Claim FALLS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). O Other: Dated: t o t unset Ill.. FROM: Clerk of the .Board TO: C my Counsel (1) County Administrator(2) O Claim was returned as untimely wi notice to claimant (Section 911.3). l.V. OARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in frill. OOther: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: 4 b,19'&VA1.1N CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subiect 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 count 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 per jury that 1 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 ilnited States Postal Service in )Martinez, Califoruia, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:Vume-- �7,o.Ww_ .1014N Cl!LLEN, CLERK By_ .__ 9epuly Clerk e. 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 tiled 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 Hmifatrons applicable to actions not subject to the California Tort Claims Act BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. A claim relating to a cause of action for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the 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. .....................................................................9 0 0..0.. ■1 RE: Claim By: Reserved for Clerk's filing stamp cid t. 00cri i 4 w ) RECEIVED Against the County of Contra Costa or ) MAY 0 3 2006 District) (Fill in the name) ) CLER CO TRBOARA COSTA CSUPEOVISOAS The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ :344, 09 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) c/oNc/00" C/W +fC/ c oel+q c/0J V+y 3. How did the damage or i ur occur? (Give full details; use extra paper if required)l �a,5 drivit IC/.Cl�J+oo 1i opN� C/Otj �( e4l le/ N�� +0 F00. Pi� N09ci i�N fat h o l�. e1�d �14pp�i iV -c- gho t ►� d 0 J-erQW .�p�-111� DlD ivd.������� 4. What�particular act or omission the of county or district officeers, servan s,or e p oyees caused the injury or damage? 5 What are the names of county or district officers, servants, or employees causing the damage or injury? NlA 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.)YJ(2� yI of gV).ed I 100+ 0 WW►CV7 r�,qui �d -1-1r� N�,�d j ,� -{-ob� ,��p l a cue d• d-&d +I (e,9 f V)- uvJa ���Ylj// r��a,►Ve �h/a( Idbl� 1N v�y ►z�, ON ►y ov-e, 7. I�owawas thenamourit Claimed above computed? (Include the estimated amount of any prospective injury or damage.)'T%IJ'0 d a M aped --ti(tjCjre � q U i r i(may a 1/ -Pour, +0 b� fe/vIacid �r imcrl- vN IV -W-e/ ra►v. 8. Names and a dresses of witnesses, doctors, and hospitals: (i O NGQ(d \PO 11 Cii wd r+(YJelI-A+ 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT 4/1310b �'-32 339, a4 ..................................................................................... Gov. Code Sec. 910.2 provides "The claim shall be signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney) 1 Name and address of Attorney ) (Claimant's Signature) > l�► 3 ►��1-W! f (Address) Telephone No. )Telephone No.CCI2SJ &0q— Fj1 O�— ..........................................soon......................................N PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthermore, any attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. 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 ($10,000), or by both such imprisonment and fine. .,..... t - - - WOF;I'. OhDER: :.'• .r':'.:.:;:'';`�:...';. '; FZF,ESTONE:'COMIaLETE AU TCi CAC,E SER IGE AD'JISO�.° ;. :• ........a.. r :..,....:..,_.:_. 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IF.ES.:'W.I.i,l l' 11h1I:.. ACIiAGE..,.,: "_. 1,.. •K.. ..:.......... .... .. :......... ...:...... :.:::.: :;':: ...,,2 ':2....,;:. 9: X741'.710'::;.. ` .. ..:” , FUZT:OM :HF►i.::wulgI;:, EL�. BL..: - : :�::1.'<';=04.1= 10 : 1. '::4;.;> : :;53 :9 :: ; ::::: ;;: : 15;''36 :: , ` . ..... .:.,...... . 7; r 19.,/6�..1�::99 .;4$''000 :iM1� 'Wa.rrai. . ,..... . % I. H e.. 1t YI 11-11 .:.:....... y . ...;. .;:•.1.::;.:; ;� D —•' - ...,... ,... _ . :;. :. .I�,,� . DIS .O A FEEfCfl..RE Y� {a SEE.,✓.....:... i:;;.:,.:;� 1':: .7 ,7:..; ... .. .. .. ........:.. .. ... ... ....,-.:n'� .. .,:�.. .. . fiE.WH Ef✓. E. ' ,.%... ... . .. 7$1$7@9 . . :4: tt.�J`3 :: .: :P �:9. ' : ... .. F . _:::.. 1�tE�t..Ti FiE Wt�EE AL. .,,_ }� :.r� ��• L .y RhIGE. j AiIiQ .�.:..:. 0$7$18719 4�N ': VEHICLE &SPECT•®CN o o INSPECT ALL ITEMS :. x;.:::•: YHY=REPAIR'DR'REPLACEMEHT`SUGGESTED;`-.:''';:':`;:' ''` .WHY.REPAf 0RREPLACEMEHT`flE011IflED:.' . Model...:.:. .,.. : ....�. :a,..........:...s:.�..; _......- .. . Year.;':: .-'-;�aMake.; `-' •' - _,.. . �1 .CLOSE:TO-END OF.USEFUL`:CIFE:='..'i::.'.�::rvir;>'•i':6'`=:':'`•t::;=`.: :':'.�A)�MOILON6Eri;PERFORMS.INTEFJDED,PURPOSE<::-'.. 2)ADDRESS;CUSTOMER'NEEp;;CDNVENIENCE.OR REDUESTi `'' ;E)DOES;NOT:MEET•DESIGWOECIFICATION�` { I I 3)COMPLY WITH:MANUFACTURER:RECOMMENDATIONk� :`;;;C)+MISSING I I I' I I; 4).TECHNICIAN'RECbMMENDATION BASED:ON:EXPERIENCC; s.:;a;: �1�,:; :-.tis;�a - <:ai':;:•�.. 'MILE%!GE `Y MUFFLER/ :. - ':f'i MPS 1 2� 4 �RANGER i• _i';..:,y:� _ .PIPES ❑CLAMP 3 ❑ :n .:SI K•r:. ..._... .. ze•' LIC::#:�..;F.,�:.>.::........:..�:.. ':,:�:. r7rans'•s�'-'e::circle :�A'uto.".�r7r_' • g - ISUAL INSPECT,:,.,.'Acc SUG'REO. I(SEM 112[9 ;'POWER STEERING''" '�'+ '• ...:..�....,:;.,.�,..;,........:.....,::..:.;...'. DREW . .. .... :.. ..:... _$FEI=4;RATiNG�.,rNSPECi'E PRE SURE RETURN .... S .-.. .. .. .r. ..... ...... ,i....... ,.. ... . ...... ... ...:... ''i:r, U JS NT` i �FRONT EAR : IRESI ACC"SUt3 RE4 .WHY•RECOMMENDED=: IDLER'ARM' - LB ^' " PITMAN ARMol :t - ..RR: - _ ,r....a.. c,._:,_•:.;•,r..:,":.:• .: - CONTROL ARM �P'.';: ; •.i r ".•RF,':`:`.•.-i:`-;'tl:'-�,. ;.BUSHINGS. _ - _ SWAY.BAR' LF.,: BUSHINGS I 32 LINK PINS TIE ROD ENDS Ol1T ^LIN :.❑R IN, ❑;R OUT-. ',] SLEEVE(Sl SERVICE RECO' ENDED-BASED UPON TIRE CONDITIONS'; ❑L UPPER`J❑R UPPER T INSPEC _- •, tR� :;WHY RECOMMENDED �"::.-.. . 's��' HL-.LOWER ❑R�:LOWER'-' SPEC-!'��� 'ACTUAL 't BELLOWS BOOTS i OTATION.. :.. ..,. ... ...:.,�'..:. ..,--..... ....:.r:-.. .. - irl�.'l :Ajit., ;1�, I :a!;' :�....,:'-1"�;�>:,:.;;;?:CV.BOOTS'. ,lr;:,.:.;•❑LOUT, ❑',L•IN. ❑R.INI'!'+` ❑:R OUT :.:., 1. r .._. ...t ...:. ;°i':^ ; l 1` ❑FRONT ALEFT ❑RIGHT.:+ z7r: ALZkNCESTRUTS ` :`�''%:= ;:.;:. .,.: yl —.J REAR ❑LEFT ❑f31GF1T'..' I :::.;,::,:;,'�:: ��,,.,...,e.,.,..._',,."-: .r'• :�;:.�,.c':.,:-i�-`:�:'_.=,�. :.;:%:'..�.:��'��?:����:.`.r:_.� ❑FRONT ❑LEFT 'RIGHT;' •.:..:,.�. ,!•..,e....... -❑THRUST..::...........xMOM 120 WZ0.__ ,.:. ..,..:..., -SHOCKS i ❑REAR ❑LEFT ❑RIGHT.., "' VISUAL MEW 'INSPECT Acc SUG.'REG' I�VISUAL ``:SCHED: .. ../.+. ..,'p,,A.':_..:.. :_.. . t. .=�; I FRONT PADS c=<: LF RF INSPECT. ACC SUG'RE01 MAINT v 'W CQM }L. HY:RE MENDED` ..,.. .. ... FRONTCALIPERS ��®�� ,:. N/A .. .:;; ,:,.,: ,• .; ;;, .s:, i�-,...• cs:imalatl32nosRema�nin 'Es..m'ateC32ntl'sP,emainio FR R LF...ROTOR RF ROTOR FRONT ROT S' �. O C '.'�'�•���' ��'�� �si SPEC,,::.�'' ''�'.ACTUAL� !` '.� SPEC. �'�.ACTU I ;:^4'"?':::'i;:,.::.:•'1-:.,:..::.;.y HARDWARE IINI:L•IGHTS.::'"�Y�':.• :' ::'S:``;','',;'�k,: 'N/A...;;❑:BR,AKE':.'.;•'❑ ❑;PARKING: t.r•,. '::;��.,:'> ', ENT'FILTER. . :.., M.:�izi„�;.^: sr,.;.:,::::••:�....:.;:.:,;_.t:•.':.......:..:.�.::.:_.:.�:..:.':,:'. :.,y',y, � LL`` ,,A ..,. BRAKE HOSES) ��LF ❑RF.� ]REAR ....,..'. .T..,..... ... RALUIN ;.•}•.. ..._.t max_. y;NOT':, REAR SHOES/ LR RR 4 h• ":i PAD -r AUTO:;+: MAN.:.==n; INSP; S a' CALIPERS/ '2:11: ��� �” REAR �� <'; n i� I •z~;T `:s2= WHEEL CYL.'' -Estim,.�.d 32nd's Re i in Esti•nated32nd's Re is n.n �'�� ma n :... :...r:,..:;. �:x>::': ...;:.:;:::r•.s:!=;c:: REAR D i''`: .`r- LR.DRUM'::'/-..ROTOR: .. 1.. R :' :'!::::'.:: :.:.';.: ROTORS'.. ❑ :.: :; ..- ..:..:,..,•. .:.:...,. HARDWARE/ '. RR DRUM / ROTO :.:.... : SPEC.. ACTUAL' SPEC. ACTUAL p� ADJUSTERS:'. OWER;ST:R.. . LUIDFLEVEL=;�•: I':.+' �1:.�,n,,:, :�=:: •i�.;;;.??;-.;�t;`., .•�"'.,': 'ATR' FLUID. ;ti x S E CYL.,, l =VEL SCHED. :..❑.:V.•.:�.',: t•.. ❑'ALT;:: P..S,;til.':':BELTS:.:. :a<.:; " INSPECT' WHY:°RECOMMENDED :,:,::•.•-...'...:'._..,.,.:,.:,....:..:s:::"s... '; , BRA F . ..:....:.:..:.. :: OOLANT'H05ES;s; t.:" ,:. •'": 'N/A.;, UPPER'.:;. :LOWER; : ':BYPASS:;I];HEAT;ER.; KE .LUID "im ;',!^ .::::":s,'':;> SPARI PLCIGS - D1TM f' "' .. :,.� .:.a,•:- GOOD= MAERGIN4L: BAD,vt TART l CHARG a.. . .. ......_ ,:�s ...-:..,: -.... _ PCV VALVE ST AT ERY ❑':P.,OS.�± OXYGEN,SENSOR ..,. " N/A i❑;GABLE'ENDS/CABLES.` ,.❑FIOL'D,:DOWNS � CCESSORIES ±: ::":::.i ,;..,' ' :;:.❑:NEGi.. . . k ;. '+: PLUG WIRES': AT rERY...GARD;:•:; "T:.; N/A ❑.CORROSION;: FUEL FILTER i Hubcap Windshield Scratches/. OTES: Missing? Y N Cracked? Y N Dents? Y N VALVE CLEARANCE ADJUSTMENT. State Inspection Due TIMING BELT'. 'fear .. i CABIN , 3stomer Information-The vehicle inspection or couites�i'check'being performed are visual .AIR FILTER spections only.Some insoectiori items or components on your.vehicle'may require an additional !OTHER FILTERS )or charge for proper inspection.This includes a road test of vehicle. DIF F. OTHER FLUIDS ❑TRANS:.CASE M irkened inspection boxes are either eX luded or not applicable to a vehicle inspection ; . courtesy check. - TRANS.SERVICE' COOLANT SYS. Iurtesy.Check-Visual'inspection-of items-'in shaded area. FLUSH Istomer Will receive a completed inspection form @ final transaction of payment. I -'Inspection Boxes Definitions- i ACC =Acceptable SCHED. Scheduled SUG = Suggested MAINT: Maintenance IF...E:FAILED;TO PROVIDE A,P.RINTOUT,.O.F YOURVEHICLES "= NotA Applicable MANUFACTURER SCFiEDU.LED:;M.AI(VTENANCE:PL.EASE SEE REQ ='Reglaired N/A` ' PP.. YOUR SALES,ERS•ON:,.F. : INSPECTED BY RE-INSPECTED BY %.uzoLviiiW1 111VUWe hlKt,I VIVO UUMrLt:Tt AU I.V UAKt ,ervlce Aavlsor: 066756CONCORD'•` 03. RICH 0.4/13/2006 " 715 CONTRA COSTA:BLVD 925.689.2710 CONCORD, CA., 94523 HAMILTON, CYNDEE 1997 SATURN SL2 1813 ARDITH DR Lic#:-5KSE944 CA Vin #: PLEASANT.HILL, CA:.' 94523 In: 04/13/06..8:32AM Mileage: 139,260 925.917.0520 Out: 04/13/06 11:08AM Store#029734 RETAIL SALE . R.EG#.AG222602, EPA#CAD981999824' Article Unit Extended Job Description-- — _—.---___ -- Number_ID——Qty—— Price — Price -_Total ---�— ------- FUZION TIRES WITH UNI-T,, PACKAGE 03 322.92 041710 FUZION HRi W/UNI-T BL BL 185/65R1.5 88H 041710 04 4 53.99 . . 215.96 40,000 Mile Warranty 4 qty DOT#' HYAPFW01006 DISPOSAL FEE/C A.RECYCLE;FEE .; �f 7046655 :04 4111. . 1.75. 7.00 NEW TIRE,WHEEL BALANCBRARTS-:�L,�i 70,18708 04 4 °3.991 15.96 NEW TIRE WHEEL BALANCETfA'13O•R``' 7018716 04 4,-E; ;` .. .7 0 28.00 RUBBER.VALVE"STEM ' '. °7015040 04" `� ' i�4 :n3�00 ", 1200. ',.;;:.; 70.59005 PROTECT TIRE REPAIR.&..E2EPLACEMENTQ59005 , 04 4 800 `.�.=.4`'32.00 PLAN S,.f 'Jwr'.Sy.;��,-- 'Y',R�A~ ,] {a�',7a�' 1y71S 'a _ �'.. TIRE DISPOSAL-FEE 1 �' } ' i 04 4 ', 3.00 " 12.00 )- , t.. ��; ►70 078 , J �, rt }, � vlr pr`Ak TIRE INSTALLATION.,, �;:� .Y . ...a.. Lt..>. .' NT.. t?7`;,1i 4 .;'=°''= N/C ;: N/C COURTESY CHECK " : _ ". �=,t:.a,ry.��,1l�< W ' .h,rrS!'r� .�.] /.;, a:•t:'i'� l 'M1,t�' a��.:� OURTESY CHECK ' r C r "`, :.^E > ��& a: r 70469 0 04 � Technician is')': i ; �• :;� _ 1 :s:� a' ' ., y,; ,; ;� r::.yr�\3 04 CHRISTOPHER CLAVIDQ � �' c7'6 �•xx:,es3�,.'. ' ,s r,:' ;:. .. r... •" '� re;;�;::.;:•�;it:_i��ar4���,;,,r.: ��:;:.:,�,� c. '�: ? „a�'.;.;s .p;�, f;�. {s�.i is+.y:QS?F •-3,r:.,r, •11 `.r.•r^i.: .. IL.h,'.1n �:�•1��.:�3':....J.' }1'-: i.:':� R:�r •,11r4 � '. rr.�:. r t'� Rl�r�� L!'`4 ..Te'\ .'f I• .¢::• z``=5 e!�'`'• :: '.,,G11. ;'p°•il!y;.�iy,a"u'•.1';:uk:n1�� ,.t.i,;..,.. r.'a.� Payment History sum See �! X, � `:L .'' �: �' 'f' t ;c�ti„d:...i��':':!;:•.ra�-�,;•sir_ +.ys: '�. Visa 8379 1;344.04 �011.044' $�r ' Pa +y.. 275.92 .yw_ :.s '�s':r :ki 1. . ;+'moi•:: . �i; '.i K.::'�''' s.' i 'F&7�y'r+:4 z :i ° psi .k4�;4r fr kc ,.tea ' c a Total Tendered .- 34':4«04'- - "'''� ,;' ; �' _xLatio�f 47.00 ;i''li•.k;.y�l r9:'+y'�::. n:r, :St fib 0.00 .. � & y _S, F.�„I: +.t}'v i],`*Fi f t::7j?!q 'S .,e'� ,rei:;.•: �t+'-\:;J�' ie`�'-h3•D,:�- h : tal 322:92 � O .� ;Tax 8.25/o) �x. :; a to ;:• ` „r:,. .. >' fi ,x�.:.:... 21.12 ,t.'.:te i.'r++'. •:3.. %�i}r ~�iS^"��;R' - ..efY.:,L'�:..;�5+•��'.r.•lj,.•., _..,..-�.:$�i"�+!`:''r" -"{qi.:i;.r•.ikafj ll,.7• —�y T y:y,. .:7;+ .: ;r' ' {r'.Total $344.04. :: ?�`3,....�.,-•,'.`-�•'X+,l.`;'y,• ..� 1-:JFu:. .t��r,.,�",.,u:',C�.,..a...3e..�r.��i:�..k-*�%f' �t:i4_y1�:k,.'la�fi:'.;��:•;�.,. I have received the above goodsyand,Pry ery 068s.. tis is��cre it ' ; ti. .��F�gi'F!: ar%. y;5f�•>.(:r:::::' �r.� ' �, card purchase, I agree`to pay'art' comply with my=cardholder-�'J agreement with the.lssuer. .,;:�- F��.��.>�;;��: :�; ;,.;;;:�<<r :+� .;;.::�'��xY;.:: •r, ,::�: _ - g r'ii"i G'..?{G�� .. 4Y.� ..!F'L.Z, ;i` ;:'l.>^i}..1.?'YiY,` �'�..*}y.:c'• ,i:�i:i?'-�'�.;J., _...�..;,r.�,.::, .. ;�. ..'� til'� :`,.r .5'`, _ '.•.C:.i,� 'r U I Customer S nature 9.. : I - 1 Initial here to indicate you have Tire Maintenance Warranty Book;• `��'°-_-..• �..•::, .; • " ' r `/�_ All parts are new unless.otherwise specified. - 0. 0 Page l of l See. ':.:.;: :� reverse sid�e`for Warranty :... .,:! Information CA FIRESTONE MC LASER-9 48.11-804-6 9 REV.02105 Inv1 N051115 LIMITED WARRANTY- MasterCare` Service & Parts , WHAT IS WARRANTED AND FOR HOW LONG?.Auto parts purchased at any Firestone Tire and Service Center location are warranted to be free from defects for period of six(6) months or 6,000 miles, whichever comes first, and all auto service work performed at such location is warranted for the same period. Some parts and services'- are warranted for longer periods as listed below. Tires and batteries are warranted separately and not covered by this warranty. This warranty applies to parts installed and service performed on private passenger cars and light trucks. "MasterCares Tri le Guarantee" This MasterCai e0 Triple Guarantee is given by Bridgestone/Firestone,.Inc. It is only offered through participating company-owned Firestone MasterCare®stores. Price Match Guarantee: Tires:This Price Match Guarantee extends to the Customer, within thirty(30) days after the date of purchase, a 150%refund of the difference between a current locally- advertised lower price on a similar make/model tire and the price of a tire purchased from a Firestone Tire and Service Center. Customer must provide a current local ad. This guarantee excludes clearances, closeouts and catalogs. This refund may not be combined with any other offer or used to reduce outstanding debt. Service: Firestone Tire and Service Centers will match any comparable service advertisement and/or bona fide service estimate. Service is defined as parts and labor. Customer must provide a current local ad or a comparable current written service estimate. Fixed Right Guarantee: This limited warranty extends to the Customer the option of a refund of the,Customer's money for the specific service work performed by us which proves to have been improperly performed during the six (6) month-six thousand mile warranty period. If the automotive repair or service is improperly performed, we will, at the.customer's option,re-perform the work at no additional charge for parts or labor(except as noted in the"Exclusions"section, below)or, at.the Customer's option,.refund the Customer's money for the specific service work perf--rmed by us.This refund is not to be combined with any other offer or to reduce outstanding debt. On Time Guarantee: ; This On Time Guarantee extends to the Customer a 10%discount on the total of parts and labor off their next visit to any company owned Firestone location, if the store fails to complete tire and/or service work within the time promised, as agreed upon prior to completion of tire and/or service work performed.The.subsequent second visit must occur within one year of the original service. Minimum discount is$5.00 and maximum discount is$25.00. This discount is not to be combined with any other offer or to reduce outstanding debt. Auto parts which prove to be unserviceable during the warranty period, except as identified below, will be replaced free of any additional charge for parts'or labor. except as noted under"Exclusions", below. LIMITED WARRANTY ON: PARTS LABOR Steering&Suspension Parts Lifetime 6 Months j 6,000 Miles Universal Joints(Excluding CV Joints' &Boots) Lifetime 6 Months j 6,000 Miles Performance Gas Shock Lifetime Lifetime Gas Truck Shock(1') Lifetime.(1) Lifetime(1) Performance Gas MacPherson Strut or Cartridge Lifetime Lifetime New or Remanufactured Starters and Alternators 24 Months/24,000 Miles 6 Months/6;000 Miles MasterCare®Premium Brake Service-Brake Shoes;Disc Pads,Calipers -- " and/or Wheel Cylinders,brake installation hardware(2) Lifetime-(2) " Lifetime(2) Service Includes: Brake System Flush and Clean/Adjust Rear Axle(3) 24 Months/'24,000-Miles(3) 24 Months;/.24;000 Miles(3) MasterCare°Plus Brake Service-Brake Shoes,Disc Pads(2) Service Includes: Brake System Flush and Clean/Adjust Rear Axle 24 Months/24,000 Miles'(2) 24 Months%24,000 Miles(2)' MasterCare Standard.Brake:Service-Brake Shoes,Disc Pads 12 Months/ 12,000 Miles 12 Months-/,12,000 Miles MasterCare' Plus T/A or 4-Wheel Alignment Service Includes:Tire Rotation and Four.Wheel Balance(4) 12 Months/.12;000 Miles(4) 12 Months/ 12,000 Miles(4). MasterCare'Premium T/-A.or.4-Wheel Alignment. .:._ ,.....7. . .. ...:....._.:.....:.:.-•...- , -_.... .. .. Service Includes: Tire Rotation and Four Wheel Balance(4) Lifetime(4) Lifetime(4) MasterCareo Plus Tune-Up` 4; 6,or.8 Cylinder I j Service Includes: Bosh Platinum,2 Spark;:lugs and Fuel System Cleaning 12 Months/12,000 Miles 12 Months/ 12,000 Miles MasterCare3 Premium.Tune-Up-4, 6,or,8 Cylinder Service Includes: Bosh Platinum 2 Spark plugs, Fuel Filter and Fuel System Cleaning,Air Filter 24 Months/24,000 Miles 24 Months/24,000 Miles MasterCare®Premium Wheel Balance(4) Lifetime(4) Lifetime(4) ALL LIFETIME WARRANTIES ARE ONLY VALID FOR AS LONG AS THE ORIGINAL:CUSTOMER OWNS THE VEHICLE'.`1 (1) Performance Gas Truck Shocks, installed on a commercial use vehicle, are also warranted.;against.-defects and wear-out for'1 year from date of purchase or 100,000 miles, whichever occurs first, labor included. (2) Costs of additional brake system components, including master cylinders, rotors, drums and all additional labor, are warranted fora period of six(6)months or 6,000 miles, whichever comes first, but are not included in the Lifetime, 24 month/24,000 mile, or 12 month/12,000 mile warranties. (3) Costs of brake system flush/adjust rear axle is only warranted for 24 montfis/24,000 miles with MasterCare Premium Brake service. (4) Lifetime balance is only warranted so long.as originally balanced tire remains:on wheel. Exclusions: Replacement of anti-freeze or clamps is not included in.the warranty on belts/radiator hoses. Cost of refrigerant and recharging of the air conditioning system is not included with the warranty on air conditioner parts or air.conditioner compressors. Cost of additional brake system components;'ihcluding rotors and drums and/or labor to restore Brake System to its safe proper operation is not included with the warranty on Brake Shoes;Disc Pads, Calipers and/or Wheel Cylinders and all other hardware. Batteries are covered by a separate warranty from the manufacturer. GENERAL PROVISIONS(Applicable to all warranties).. WHO IS COVERED BY THE WARRANTIES LISTED IN THIS DOCUMENT? This warranty covers only the original"purchaser of the installed parts and/or-services. WHERE WILL THE WARRANTIES BE HONORED?Take.your•car to.the.Firestone.Tiret Service Center which sold the warranted parts and/or service work, to any other Firestone Tire &SerGice'Center, or'a participatiii authmized;Dealer location'"iii•N United States. HOW CAN A CLAIM BE MADE UNDER THE WARRANTIES?The original invoice from the store at which the original work was performed must be presented in order to get the benefit of the warranty. ,. WHAT OTHER CONDITIONS APPLY?The obligationsundertaken in these warranties are offered only on the above items and conditions, and may not be enlarged or altered by anyone. This warranty document`does'-not.gly to products or vehicles used for commercial, racing or off-road purposes, or to.damage caused by abuse or accident. TO.THE EXTENT PERMITTED BY LAW BFS RETAIL&COMMERCIAL OPERATIONS, LLC AND ITS FIRESTONE TIRE &SERVICE CENTER LOCATIONS DISCLAIM LIABILITY FOR INCIDENTAL AND CONSEQUENTIAL'.DAMAGES. Some states do not allow the e9clusion or limitation of incidental or consequential damages, so the.above limitation or exclusion may not apply to:yob: CONSUMER RIGHTS: This warranty gives.you:specific legal rights, and you may also have other rights which vary from state to state. GIVEN BY: Firestone Tire:&Service CCenter identified.in stamp or, if none, by Bridgestone/Firestone North American Tire, LLC;"535 Marriott Drive, Nashville, TN 37214. Your satisfaction is important to us. If for any reason, you are not satisfied ath.the service you receive, contact the Manager of the store where your service was provided. If you feel your, problem has not been handled to your complete satisfaction, or you the address of the Firestone Tire &Service Centers nearest you, please call Firestone Consumer Affairs, 1-800-357-3872. NOTICE:A buyer of this product in California has the right to have this product serviced or repaired during the warranty period. The warranty period will be extended for the number of whole days that the product has been out of the buyer's hands for warranty repairs. If a defect exists within the warranty period, the warranty will not expire until the defect has been fixed. The warranty period will also be extended if the warranty repairs have not been performed due to delays caused by circumstances beyord the control of the buyer, or if the warranty repairs does not remedy the defect and the buyer notifies the manufacturer or seller of the failure of the repairs within 60 days after they were completed. If after a reasonable number of attempts, the defect"has not been fixed, the buyer may return this product for a replacement or, a refund subject, in either case: to deduction of a reasonable charge for usage. This time extension does not affect the protections or remedies the buyer has under other laws. CA FIRESTONE MC LASER'=,948.11-804.69 REV.02/05 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JUNE 06, 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 oil your claim by the Board of Supervisors. (Paragraph IV below), MAY 0 given Pursuant to Government Code A_MOUN'l': UNKNOWN x 2006 Section 913 and 915.4. Please note all COUNTY COUNSEL "Warnings". C.LAINIANT: WENDY STEPHENS MARTINEZ CALIF. ATTORNEY: BRIAN McCARTHY DATE RECEIVED:' MAY 04, 2006 MCCARTHY & LEONARD ADDRESS: 7027 DUBLIN BOULEVARD BY DELIVERY TO CLERK ON: MAY 04, 2006 DUBLIN, CA 94568 RECEIVED THROUGH FAX BY MAIL POSTMARKED: FROM.: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. MAY 04, 2006 JOHN CULLEN, ler Dated: By:. Deputy 1.1. FROM: County Counsel T0: Clerk of the Board of S pervisors ( lis 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). i�-�`v"`yn04 ► �•� r' eLk ch�uld return claire '' ' '* �uasfilPd I t nd (vYClai►�. e�t►me y filed. ' of rlaimant'c ribll to apply for leave to orP¢Pnt a IatP �laiinT�a�ti��� o -- (*�tller: See- It4ir-r OM l►.-r I-a t m Zcldt h ,e qr en ahc�-C�n rJlo��-t°�s `'eServc -fhe r�yh�' � Cd+��CS��e �a� .Dated: / 5-0-0(e By: J�V 41,6LA Deputy County Counsel 11.1. FROM.: ' Clerk of the Board TO: County Counsel (r) County Administrator(2) O Claim was returned as untimely with notice to claimant (Section 911.3). IV�ARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in fill. ( ) Otller: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated:\IAa'Goto 0L-2"A0HN CULLEN, CLERK, By 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 erail to file a court action on this claire.See Government Code Section 945.6.You may seek the advice of arr attorney of your choice in connection with this matter. ifyou want to consult an attorney,you shotdd do so immediately. *For Additional Warning See Reverse Side of Tlris Notice. AFFIDAVIT OF MAILING I declare under penalty of per jury that 1. am now, and at all times herein mentioned, have been a citizen of the United States, over Inge 18; and that today I deposited in the United Stales .Postal Service in f.%lartinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to file claimant as shown above. Dated:Vm,"e, Ox. 0_6 JOHN CULLEN, CLERK By epuly 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 tiled 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 ,norj9es it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act OFFICE OF THE COUNTY COUNSEL 5E--L SILVANO B.MARCHESI COUNTY COUNSEL COUNTY OF CONTRA COSTA Administration Building SHARON L. ANDERSON 651 Pine Street, 9'" Floor : _ Martinez, California 94553-1229 � .-`. , .=- '�d CHIEF ASSISTANT GREGORY C. HARVEY 925 335-1800 -- $� " ( ) �; �1 ii1'1111.�i �:F. , VALERIE J. RANCHE (925) 646-1078 (fax) '�`'. _-_ AssIsTANTs ST'9 COUls� STATUTORY WARNING PURSUANT TO GOVERNMENT CODE SECTION 911.3 TO: Brian McCarthy, Esq. McCarthy & Leonard 7027 Dublin Boulevard Dublin, CA 94568 RE: CLAIM OF WENDY STEPHENS Please Tale Notice as Follows: The claim you presented to the Contra Costa County Board of Supervisors on May 4, 2006 was reviewed by the County Counsel. The portion of the claim prior to November 4, 2006 was not presented within six months after the event or occurrence as required by law. Because you allege late discovery of the claim, the claim is "timely on its face" and will be reviewed and acted upon by the Board of Supervisors within the statutory time period. To preserve the rights of the County, its departments and employees to challenge the validity of your late discovery claims, you are warned pursuant to statute that, if your delayed discovery argument is improper, your claim is late and is being returned because it was not presented within six months alter the event or occurrence as required by law. (See Gov. Code, §§ 901, 911.2.) Because the claim may not have been presented within the time allowed by law, we warn you that, to preserve your right in the event you claim is determined to be late, you only recourse at this time.is to apply without delay to the Contra Costa County Board of Supervisors for leave to present a late claim. (See Gov. Code, §§ 911.4 to 912.2, inclusive, and 946.6.) Under some circumstances, leave to present a late claim will be granted. (See Gov. Code, § 911.6.) SILVANO B. MARCHESI COUNTY COUNSEL By: 11-7nama Monika L. Cooper Deputy County Counsel Page 1 Brian McCarthy, Esq. Re: Claim of Wendy Stephens Page Two CERTIFICATE OF SERVICE BY MAIL (Code Civ. Proc., §§ 1012, 1013x, 2015.5; Evid. Code, §§ 641, 6641) 1 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 Coun _tyCounsel, 651 Pine Street, 9th Floor, Martinez,.CA 94553-1229. On ! 20-O& , I served a true copy of this Notice of Untimeliness as to a Portion of the Claim by placing the d •ument in a sealed envelope with postage thereon fully prepaid, in the United States mail at Martinez, California addressed to Brian McCarthy, Esq., McCarthy & Leonard, 7027 Dublin Boulevard, Dublin, CA 94568, as set lorth 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 ✓ _ 2�D at Martinez, California. athleen O'Connell cc: Clerk of the Board of Supervisors (original) Risk Management _:\' C��\r.I: F t•:,^.\Ci, _N1;`. : z:tute \�t e11S.Wp' Page 2 Ili Hill McCARTHY & LEONARD MAY O 4 2006 Brian McCarthy SB#54081 John Leonard SB#92234 CLERIiEOARDOFS !PE l -RViSORS Attorneys at Law I CONTRA COSTA CO. 7027 Dublin Boulevard Dublin, CA 94568 Telephone : (925) 829-6500 Facsimile : (925) 829-7812 Attorneys for Claimant WENDY STEPHENS WENDY STEPHENS Claimant CLAIM AGAINST PUBLIC ENTITIES v COCNTY OF CONTRA COSTA, CONTRA COSTA REGIONAL MEDICAL CENTER, CONTRA. COSTA REGIONAL HEALTH 'FOUNDATION, EDWIN CARLSON, M.D. Respondents . TO THE C:OVERNING BODIES OF THE COUNTY OF CONTRA COSTA, CONTRA COSTA REGIONAL MEDICAL CENTER and CONTRA COSTA REGIONAL HEALTH FOUNDATION: Claimant WENDY STEPHENS hereby makes this claim for damages against COUNTY OF CONTRA COSTA, CONTRA COSTA REGIONAL MEDICAL CENTER, CONTRA COSTA REGIONAL HEALTH FOTUgDATION and makes the following assertions in support of her claim. 1. . Claimant ' s address is oMcCarthy & Leonard, 7027 Dublin Boulevard, Dublin, CA 94568 . 2 . NOTICES concerning this claim should be sent to McCARTHY & LEONARD, 7027 Dublin Boulevard, Dublin, California 94568, 'Telephone (925) 329-6500, Fax (925) 829-7812 . 3 . Claimant --'s date of birth is November 22 , 1961 . 4 . The occurrenr_e giving rise to this claim took place at ConLr'a Costa Regional Medical Center in Contra Costa County on or about July 16 - 18, 2005 . CLAIM AGAINST PUBLIC ENTITIES T 1 1 ldild.l S . At said time and place, Claimant was admitted to Contra. Costa Regional Medical Center for CB/GYN surgery. RESPONDENTS neg.ligently treated CLAIIvIA-NT` S condition, causing CLAIMANT unnecessary pain and suffering, disfigurement and the need for additional surgical intervention. G . The identity of all agents and employees of RESPONDENTS responsible for Claimant' s injury are currently unknown. one physician responsible for treatment was Edwin Carlson, M.D. 7 . Claimant did not become aware of the injury caused by Respondents or the ne!aligent nature of the me�-dical treatment until on or about November 9 , 2005 . 8 . Jurisdiction of this claim rests in the Superior court , unlimited jurisdiction. Claimant reserves the right to amend any portion of this claim pursuant to Califoznia statutory and ca.se law, and according to proof . DATED: May 4 , 2006 McCARTHY & LEONA-RD .AaT I McCie�RTHY, Attorney for Claimant WENDY STEPHENS CLJM41 AGAINST PUBLIC ENTITIES 2 9258297812 t',1; I!I!lll a- - -' - - r MCCARTHY & LEONARD ATTORNEYS AT LAW 7027 DUBLIN BLVD. DUBLIN, CAL,IFQRNIA 94568 BRIAN McCARTHY TEL. (925) 829-6500 JOHN LEONARD FAX (9 2 5) 829-781.2 FACSIMILE COVER SHEET DATE : May 4 , 2006 Yh HARD COPY TO FOLLOW FAX ONLY TO: Emy COMPANY: Contra Costa Board of Supervsors FAX NO: 335-1913 FROM: Brian McCarthy RE : Six Month Claim MESSAGE : Faxed herewith please fired a Six Month Claim for Wendy Stephens . There are 3 pages in this transmittal , including this page. IF YOU DO NOT RECEIVE ALL 'PAGES PLEASE CALL 925-829--6500 . This message is intended for the use of the individual or entity to which it is tranomitted and may contain information that is privileged, confidential and exempt from disclosure under appl.l.:able laws. if the reader of this communication is not. the Intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error please notify us immediately py telephone and return the original communication to the address above via the U. S. Postal Service. McCARTHY & LEONARD Brian McCarthy SB#54081 N/ - John Leonard SB#92234 Q 0 6, 7Attorneys t Law027DublinBoulevard 9c�YTq 2��6 Dublin, CA 94568 ccsT-40, ��so9S Telephone : (925) 829-6500 Facsimile (925) 829-7812 Attorneys for Claimant WENDY STEPHENS WENDY STEPHENS Claimant CLAIM AGAINST PUBLIC ENTITIES v COUNTY OF CONTRA COSTA, CONTRA COSTA REGIONAL MEDICAL CENTER, CONTRA COSTA REGIONAL HEALTH FOUNDATION, EDWIN CARLSON, M.D. Respondents . TO THE GOVERNING BODIES OF THE COUNTY OF CONTRA COSTA, CONTRA COSTA REGIONAL MEDICAL CENTER and CONTRA COSTA REGIONAL HEALTH FOUNDATION: f Claimant WENDY STEPHENS hereby makes this claim for damages against COUNTY OF CONTRA COSTA, CONTRA COSTA REGIONAL MEDICAL CENTER, CONTRA COSTA REGIONAL HEALTH FOUNDATION and makes the following assertions in support of her claim. 1 . Claimant' s address is oMcCarthy & Leonard, 7027 Dublin Boulevard, Dublin, CA 94568 . 2 . NOTICES concerning this claim should be sent to McCARTHY & LEONARD, 7027 Dublin Boulevard, Dublin, California 94568, Telephone (925) 829-6500, Fax (925) 829-7812 . 3 . Claimant' s date of birth is November 22 , 1961 . 4 . The occurrence giving rise to this claim took place at Contra Costa Regional Medical Center in Contra Costa County on or about July 16 - 18, 2005 . CLAIM AGAINST PUBLIC ENTITIES 1 5 . At said time and place, Claimant was admitted to Contra Costa Regional Medical Center for OB/GYN surgery. RESPONDENTS negligently treated CLAIMANT' S condition, causing CLAIMANT unnecessary pain and suffering, disfigurement and the need for additional surgical intervention. 6 . The identity of all agents and employees of RESPONDENTS responsible for Claimant' s injury are currently unknown. One physician responsible for treatment was Edwin Carlson, M.D. 7 . Claimant did not become aware of the injury caused by Respondents or the negligent nature of the medical treatment until on or about November 9, 2005 . 8 . Jurisdiction of this claim rests in the Superior Court, unlimited jurisdiction. Claimant reserves the right to amend any portion of this claim pursuant to California statutory and case law, and according to proof . DATED: May 4, 2006 McCARTHY & LEONARD RIAN McCARTHY, Attorney for Claimant WENDY STEPHENS CLAIM AGAINST PUBLIC ENTITIES 2 I RECEIVED McCARTHY & LEONARD M AY 0 8 ?006 ATTORNEYS AT LAW 7027 DUBLIN BLVD. CLERK BOARD OF SUPERVISORS DUBLIN,CALIFORNIA 94568 CONTRA COSTA CO. BRIAN McCARTHY TEL.(925)829-6500 JOHN LEONARD FAX(925)829-7812 May 4, 2006 Contra Costa Board of Supervisors Attn: Emy 651 Pine Street, Rm. 106 Martinez, CA RE: Six Month Claim of Wendy Stephens Dear Emy: I enclose the original of the Six Month Claim submitted to the County of Contra Costa on behalf of my client Wendy Stephens. This Claim was faxed to you today. Please return to me a copy of the first page of the Claim with your Board of Supervisors receipt stamp on it. I have enclosed a self-addressed stamped envelope for this purpose. This will confirm our telephone conversation of May 3, 2006, in which you informed me that this claim is deemed submitted upon your receipt of a fax copy. Please feel free to call me if you have any questions. Sincerely, Brian McCarthy BM:kg Encl: (3) 1 v, t_ a. 4-4 Q -A vI (� CL Lf) ,0-11 � U N h W H N ram 0 00 O� t W Q � CD 4.4 d" W OVA } -° r"