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HomeMy WebLinkAboutMINUTES - 07112006 - C.20 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION:JULY 111 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), JUN 0 7 2006 given' Pursuant to Government Code AMOUNT: $640.40 COUNTY COUNSEL Section 913 and 915.4. Please note all MARTINEZ CALIF. "Warnings". CLAIMANT: VERONICA ROMAN ATTORNEY, UNKNOWN DATE RECEIVED- JUNE 08,1 2006, ADDRESS: # I GOLF CLUB COURT BY DELIVERY TO CLERK ON:JUNE 0$, 2006 PITTSBURG, CA 94565 RECEIVED THROUGH BY MAIL POSTMARKED: INTER OFFICE MAIL FROM RISK MANAGE- FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, C Dated: JUNE 08, 2006 By: Deputy SL 11, FROM: County Counsel TO.- Clerk of the Board of Sullervisors W (,_�This claim complies substantially with Sections 910 and 910.2. This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8), O Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 9113). O Wier: Dated: By: &V��_Deputy County Counsel 1.11. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) O Claim was returned as untimely with notice to claimant (Section 911.3). IV. OARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. O Otlier: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Date dCLk_/_/ o9A"_.. JOHN CULLEN, CLERK, By A lorm Deputy Clerk W & (Gov. code section 913) el' Subject.to certain exceptions,you have only six(6)months from the date this notice was persouaDy served or deposited in the mail to rile a court action on this claim.See Government Code Section 945.6.You nlay seek the advice of au attorney of your choice in connectiou with this matter. If you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side of 11is Notice. AFFIDAVIT OF MAILING I declare under penalty of per jui-y that I am now, and at all times herein mentioned, have been .9 citizen of the United States, over age .18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board 01-deo- and Notice to Claimant, addressed to the claimant as shown -above. Dated: JOHN CULLEN, CLERK By Deputy Clerk op SHARON HYMES-OkMKP BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY JUN 7 2006 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. I£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 aaaaaataaaaaaaaaWIN aaaaMRS aaaaaaaaaeaaaaaaaaaaaaaaaxe aeaaeaaeRaaaaa:aaazaalc RE: Claim By: Reserved for Clerk's filing stamp f�cofllCCA- RECEIVED Against the County of Contra Costa or ) $ 2006 District) CLERK BOARD OFSUPERVISORS (Fill in the name) ) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ tc►A O•9 0 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) on ConcOPr'C,) b\v d \n Conc.wc) 1 C nr -:n Coc\'�-C� Go stz'x- C���-•� . N ecof- o\& o n Ya Alp -VO In 8 0 , ctoSe.-->ro ccx-�cof-c) N+5 S c.v1 . 3. How did the damage or injury occur? (Give full details;use extra paper if required) Lc.uccte. Qe� !hc`3tic-- Dn C—o�C Y-'\O,V)t kap e- ccwse� 60m-OCIC to b0*Nn a*F rtcv�� si �f'ttYlS � � amu.{ iltUf.. tart\Ji ncl c>"a-er i-4-. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? `The. 1 c�C' \OCA-Y o\d , 0�r1 C04'\CLt'c) SD\JCS' Was not co'nt was crx,vsIrtr� &aVynaqt- +0 maAq V-ArNdle-' c , WCs C�\VC3 x n �4-k � ��3�r� +0 PDD \C-C-. 5 What are the names of county or district officers, servants, or employees causing the damage or injury? Y 1 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) ) h� C'in15 aF mk-j 1ckc(S 6YYwJ W-efe., bf. ccw5inci UeV tC\e, �-© Cte�t- 01?� off- a\L�,+1�!">�"�"• . 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) P\-%m5 W reXYk0Q-e6 W'�-) (-"c kk rr2 , vJGtS Cx\ CiYY-�c) S. Names and addresses of witnesses, doctors, and hospitals: CcUC0 k t4e Ck-+h (08-1 - 4-11-1 k:.1 i l ick {0-11 - 32`-1 0 ipa 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT ocp 3Upr �0 � � ■aaaaaaaaaaaaaa an aaa aaa■ra a aaaaa aaaaleaaaaara out as aaaafaaaaaaaa aaaaaara Sara a Mauston 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: (Attorney) Name and address of Attorney ) �/ (Claimant's Signature) ) 1 &.Otc C[ ci- (Address) C, L4 S Co S Telephone No. )Telephone No. C(2-5- - 32-3— o O rmass aaaaaatRuns now ataaaaarwomen aaaaaaataaaaamum aaataaaaaaaaaaaaaaataswam aaaaaataaaae PUBLIC RECORDS NOTICE: Please be advised that this claire farm, or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthermore, any attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■a a a a a a a a a a a a a a a Ron manna a r■a a sum a a a a a a a a a t a a a a Ina a a a a a a a a a mum a a a a a a a r e a a a a a a a a a a small NOTICE: Section 72 of the Penal Code provides: Every.person vvho, 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. Zuropean Auto Repair, idw.. Page 1 Order Date 05/25/06 03 :28 pm BAR #: AH195673640 Work Order No. Started: 05/25/06 03 :28 pm EPA#CAL000179613 Ref: CARLOS SHOWING 1573 Third Ave,. 000021487 Walnut Creek, CA 94596 Phone: 925-944•-5606 FAX: 925-944-5161 ROMAN, VERONICA/ALEX:: 98 BMW 5281 . BR. , Quotes 1 GOLF CLUB CT - Mileage in:89676 out: , 1 05/31/06 01:52pm 640.40 Lic: 5MBB 525/CA L6Cylz2.8 VERONICA/ALEX in person. PITTSBURG CA 94565 Vin . WBADD6321WBW43912 02/98: Home Phone: 925=252-1390 Eq: AT :AC PS FI:, Work Phone: 925-253-7010 Profile: CHECK SUSPENSSION Labor: $98 .00 CUSTOMER REQUEST CK FRONT END [DAMAGE RIGHT SIDE WHEELS] . PERFORM VISUAL INSPECTION UNDER THE CAR , REMOVE ALL WHEELS AND INPECT FRONT AND REAR SUSPENSSION APPEAR TO BE IN GOOD CONDITON , FOUND RIGHT FRONT AND RIGHT REAR WHEELS BEND [INSIDE] . CUSTOMER OK TO SUBLET RIMS FOR REPAIRS. 4 WHEEL ALIGMENT. Sublet: $129.00 CUSTOMER OK TO PERFORM 4 WHEEL ALIGMENT [SUBLET] . REPAIR WHEELS . Sublet: $413° 40 CUSTOMER OK TO REPAIR BOTH RIGHT SIDE WHEELS. Recommendations:_ FRONT BRAKE LEFT 50 % MATERIAL LEFT WILL NEED FRONT ROTORS .REAR BRAKE LEFT 25%. . HEAD LIGHTS $329.00 PARTS. Payments to European Auto Repair, inc. Cost Summary Status: In process Work Order Labor 98 . 00 Parts 0 . 00 Payments: Sublet 542 .40 Subtotal 640 .40 Total $640.40 Payments 0 .00 Bal Due 640 .40 Thank you for choosing European Auto Repair,inc. I hereby authorize the above repair work to be done with the necessary material and hereby grant you and/or your employees permission to operate the car, truck or vehicle herein described on street, highways or elsewhere for the purpose of testing and/or inspection. An express mechanics lien is hereby acknowledged on above car, truck or vehicle to secure the amount of repairs thereto. You will not be held responsible for loss or damage to vehicle or articles left in vehicle in case of fire, accident or any other cause beyond your control. please read warranty information on back page. (Signature) . . . . . C,C11 2 2 � E zm / ) EatoCh \ \ � § ! & ow ! 1w = = � � § � 2 § } � § ■ : � oJp � 22 $ ] e ccM § tea 22 \ / kk � k « Q ow :) nwc © « cc - a z 0 o } § o nnOnnonf � gR G « fR (L Z> k § ¥ ¥ ¥ % § §§ 0Cc ( EE ( EEE \\ \ LL LL ) j2\ kk( z 0, � § ) � G52 /k § ® . �) §ft � � o « cLg ' > w _ e � . / co k � k § 0LL (1) « © u « ■ � « z < 0U) . 2IL0 EBz � $ § & ƒ q § ■ On ooOnnon \ G . . . . •. ... . ... .. . . s � LMLO CL:t tJ ate: o r in Z Z Oh �C !� ? Ln rn ` — Er Q (� O Y : C O c7 -------= o �� -31, . `i oui -• rn'. - Lip 1 �a o � o Y ..«. LA '2fl ..' . n Ln m ""..% ru C3 ------� o C3 .....-��•---�� o a^ {� ... n CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY e2 BOARD ACTION: JULY 11, 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 JUN 0 7 2006 Supervisors. (Paragraph IV below), given Pursuant to Government Code COUNTY COUNSEL Section 913 and 915.4. Please note all AMOUNT: $1,645.85 MARTINEZ CALIF. "Warnings". CLAIMANT: DAVID FERREITI ATTORNEY: UNKNOWN DATE RECEIVED- JUNE 08, 2006 ADDRESS: 674 DUNHILL DRIVE BY DELIVERY TO CLERK ON: JUNE 08, 20066 DANVILLE, CA 94506 BY MAIL POSTMARKED: JUNE 079 2006 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim, JOHN CULLEN, e Dated JUNE )8, 2006 By: Deputy 11. FROM: Coulitycounsel TO: Clerk of the Board of Supervisors (/This claim complies substantially with Sections 910 and 910.2. This Claim FALLS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8), Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911,3), O Other: Dated: By: jjjjr,6� �{tiDeputy County Counsel I 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) Claim was returned as untimely with notice to claimant (Section 911.3). IN7 BOARD ORDER: By unanimous vote of the Supervisors present: 'This Claim is rejected in HL Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dake� JOHN CULLEN, CLERK, By 4z 00 Deputy Clerk WARMNV(Gov. code section 913) Subject to certain exceptions,you have only six(6)mon Ws from the date this notice was personally served or deposited in the mail to rile a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult all attorney,you sliotdd do so immediately. *For Additional Warning See Reverse Side ofTliis Notice AFFIDAVIT OF MAILING I declare under penalty of perjui-y that I am now, and at all times herein mentioned, have been a citizen of the United States, over age .18; and that today I deposited ill the United States .Postal Service in Martinez, California, postage fully prepaid a certified col)y of this Board Order acrd Notice to Claimant, addressed to the clainlantas shown above. Dated: JOHN CULLEN, CLERK By �t�.--Deputy Clerk BOARD OF SUPERVISORS OF CONTRA CQS T A COUNTY ` INSTRUCTIONS TO CLAIMANT A. A claim relating to a cause of action for death or for hijury 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 § W0 112) 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. KEKKK1ttfliXRRNRXNR t=! ■i..l R E k G m c 62C!•RtttlttYii RG UK was an Rttltt■AR a as swam a t■!1 RE: Claim By: Reserved for Clerk's filing stamp } Dw v6 Against the County of Contra Costa or } UU/V 0 District} `.u� ?00 QUP (Fill in the name) } cos, co viso f/ } The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and country) � V�'6��-' IO`l,te 3. How did the damage or injury occur? (Give full details;use extra aper if required) f r o ,,. ��U X10 , 6PG . 4. What'particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage9 to 5 What are the names of county or district officers,servants,or employees causing the damage or injury? i 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 estitriated amount of any prospective injury or dam. e.} 8. Names and addresses nof� itnesses,doctors, and hospitals: 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT N (o— ■ sasanasaassnesse.;lasasa! la.asaaasassasa;astaanta;asses WE an as s;all ago asaRanaaaaanaKai ) .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) (a4 Di�r\Wl } (Address) } _ Telephone No. )TeIerhone NO. sit seat aasasRana asa a aas amaa a a a a a man as gats a a sla Room aKan EN Ct Zs— s as;;asst .Tl t !s t o!f a;sal 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. ■s Emu us a a a a a;a t t axiom Bsa!a anon ME a s a a a t s t a t s;a!K i;■a!!a i s a s t!s s a s a s a t a t now it s a a 111111111192111 NOTICE: Section i2 of the Penal Code provides: Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city, or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account voucher, or 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 imprisosunent and fine. f 1 STATE OF CALIFORNIA p TRAFFIC COLLISION REPORT 11 6 CHP 555 CARS Page 1(Rev 11-03)OPI 061 pop of 6 SPECIAL CONDITIONS wMEA HIT4 RUR CITY JUDICIAL DISTRICT LOCAL REPORT IIUABER lkjuwO 'LONY 0 DANVILLE WALNUT CREEK SUPR. MASERR LED MITA RUN COUNTY REPORTING DISTRICT BEAT 06-10918 MISDEMEANOR 0 CONTRA COSTA 33 61 COLLISION OCCURRED ON: MO DAY YEAR TIME(2400) NCIC f OFFICER I.D. Z LA GONDA WAY 4/26/2006 1040 0700 43759 0 MILEPOST INFORMATION: DAY OF WEEK TOW AWAY PHOTOGRAPHS BY: NONE V WEDNESDAY YES X No M.BRIGGS OAT INTERSECTION WITH: STATE HWY REL X oft 346 FEET SOUTH OF EL CERRO BLVD F. YES X NO PARTY DRIVERS LICENSE NUMBER STATE CLASS NR BAGSAFETYEQUIP. VEH.YEA. MAKE IMODEL/DOLOR LICENSENUMBER STATE j N6129254 CA C M G 1996 FORD CB WHI E031218 CA DRIVER NAME(FIRST•MIOOLE,LAST) X BRUCE WAYNE VINCENT OWNER'S NAME SAME AS DRIVER PEDES- SMELT ADDRESS CONTRA COSTA CO 6813 GEN SERV DIV rwAN 565 LORI DRIVE#46 OWNERS ADDRESS SAMEASORIVER PARKED CITYISTATEIZIP 2467 WATERFORD WAY MARTINEZ CA 94553 VEHICLE BENICIA CA 44510 DISPOSITION OF VEHICLE ON ORDERS OF: OFFICER X DRIVER 07/1ER BIS'• SFR HAIR JEYE'S HEIOfIT WEIGH BIRTHDATE RACE DRIVEN AWAY CLS7 Oaf y� M HB BLU 5-11 245 4/2/1948 PRIOR MECH.DEFECTS X'NONE APP- REFER TO NARRATIVE OTHER HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER: (707)746-1847 (925)313-7052 VEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA TOP YEV INSURANCE CARRIER POUICYNUMBER UNK NONE X MINOR RISK MANAGEMENT Moo :MAJOR ROLL-OVER `.----`� DB2 OF TRAVLL ON STREa CLI IOM WAY SP®LIMIT S LA GONDA,WAY 25 G Dor CAL•T TCPMSC MClMX PARTY DRIVERS LICENSE NUMBER STATE CLASS AIR BM' SAFETY EQUIP. VEIL YEAR MAKE I MODEL/COLOR LICENSE NUMBER STATE 2 1994 BMW 5251BLK IVAJ795 CA DRIVER NAME(F1RST,MIDDLE,LAST) OWNER'S NAME SAME AS DRIVER PEDES- STREET ADDRESS FERRETTI.DAVID OR AMY TRUW OWNERS ADDRESS SAME AS DRIVER PARKED CITY ISTATE IZIP 674 DUNHILL DRIVE DANVILLE CA 94506 VEHICLE XDISPOSITION OF VEHICLE ON ORDERS OF: X OFFICER DRIVER OTHER Bim'- SEX HAIR EYES HEIGHT WEIGH BIRTHDATE RACE LEFT AT SCENE CLST Mo Day Y_ PRIOR MECHANICAL DEFECTS X jNONE APP. :REFER TO NARRATIVE OTHER HOMEPHONE BUSINESSPHONE VEHICLE IDENTIFICATION NUMBER: VEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE W DAMAGED AREA INSURANCE CARRIER POLICY NUMBER UNK NONE X MINOR TOP WV -0VER D DIR OF TRAVEL ON STREET OR HIONWAY SPEED LIMIT MAJOR T CA DOT S LA GONDA WAY 25 CAL•T' TCpmw UCIMI PARTY DRIVERS LICENSE NUMBER STATE CLASS AIRBAG SAFETYEQWP. VEH.YEAR IMAKEIMODELICOLOR B STATE 3 DRIVER NAMUIRST•MIDDLE,LAST) OWNER'SNAME ?g\2 ER PEDES STREET AODfLE58 TRUN OWNERSADDRESS ��yyMB A6 PARKED CITY/STATE f ZIP - VEHICLE DLVOSITION OF VEHICLE ON ORDERS OF: OFFICER ORNER OTHER BICY• SEX mw7m 1HEtONT WEIC4T BIRTHDATERACE .. CLIST Mo DAy Yam PRIOR MECHANCIAL DEFECTS (NONE AFT. '-'REFER TO NARRATIVE OTHER HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER: VEIDCLE TYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA FSURA4CFCARRIER POLICY NUMBER LINK NONE MINOR MOD .MAJORROIL-0VER OF TRAVEL ON STREET OR HIGHWAYSPEED LIMIT G DOT GL•T TCPIPSC MC11VX PREPARERS NAME DISPATCH NOTIFIED REVIEWER'S NAME DATE REVIEWED M.BRIGGS 43759 YES No :X;NTA S' 1So75k 4llvSvO �-D� STATE OF CALIFORNIA ... ... . TRAFFIC COLLISION CODING CHP 555 CARS Page2(Rev.1-03)OPI 061 Paye 2 Of 6 DATE OF COLLISION(MO.DAY YEAR) TMAE(2400) NCIC6 OFFICER I.D. NUMBER 4/26/2006 1040 0700 43759 06-10918 OWNER OWNERADDRESS NOTIFIED PROPERTY YES NO DAMAGE DEWaPTIONOFDAMADE SEATING POSITION SAFETY EQUIPMENT INATTENTION CODES OCCUPANTS L-AIR BAG DEPLOYED MIC BICYCLE-HELMET _ A-NONE IN VEHICLE M-AIR BAG NOT DEPLOYED DRIVER PASSENGER A-CELL PHONE HANDHELD 8•CELL PHONE HANDSFREE B-UNKNOWN ( N-OTHER V-NO X-NO C•ELECTRONIC EQUIPMENT C-LAP BELT USED P-NOT REQUIRED W-YES Y•YES D•RADIO 1 CO 12 3 1•DRIVER D•LAP BELT NOT USED E-SMOKING E-SHOULDER HARNESS USED 2 TO 8-PASSENGERS CHILD RESTRAINTF-EATING 4 5 6 "F-SHOULDER HARNESS NOT USED EJECTED FROM VEHICLE G•CHILDREN B•RR OCC TRK.Oft VAN R-IN VEHICLE NOT USED 7-STA.WGN REAR O•IN VEHICLE USED 0•NOT EJECTED G•LAPlSHOULDER HARNESS USED H-ANIMALS -POSITION UNKNOWN S-IN VEHICLE USE UNKNOWN �. H-LAP/SHOULDERHARNESSNOTUSED I. PERSONNEL HYGIENE 0 2•PARTIALLY EJECTED FULLY EJECTED J-PASSIVE RESTRAINT USED J.READING D-OTHER K-PASSIVE RESTRAINT NOT USED T- VEHICLE IMPROPER USE 3-UNKNOWN U-NONE IN VEHICLE K-OTHER I I ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK{`}SHOULD BE EXPLAINED IN THE NARRATIVE. PRIMARY COLLISION FACTOR MOVEMENT PRECEDING LISTNUMBER(0)OF PARTYAT FAULT TRAFFIC CONTROL DEVICES 1 213 1 SPECIAL INFORMATION I 2 3 COLLISION I VC SECTION VIOLATED: CITED YES A CONTROLS FUNCTIONING I JA HAZARDOUS MATERIAL A STOPPED A 22107 X NO B CONTROLS NOT FUNCTIONING, B CELL PHONE HANDHELD IN USE B PROCEEDING STRAIGHT B OTHER IMPROPER DRIVING' C CONTROLS OBSCURED C CELL PHONE HANDSFREE IN USE C RAN OFF ROAD X D NO CONTROLS PRESENT FACTOR* X X D CELL PHONE NOT IN USE D MAKING RIGHT TURN C OTHER THAN DRIVER' TYPE OF COLLISION E SCHOOL BUS RELATED E MAKING LEFT TURN D UNKNOWN' A HEAD-ON F 75 FT MOTORTRUCK COMBO F MAKING U TURN X 8 SIDESWIPE G 32 FT TRAILER COMBO IG BACKING C REAR END H CELL PHONE USE NOT KNOWN I H SLOWING f STOPPING WEATHER (MARK 1 TO 2 ITEMS) D BROADSIDE I 11 PASSING OTHER VEHICLE X A CLEAR E HIT OBJECT J li CHANGING LANES 8 CLOUDY F OVERTURNED I IK x K PARKING MANEUVER C RAINING G VEHICLE I PEDESTRIAN I IL - L ENTERING TRAFFIC D SNOWING H OTHER': I fm M OTHER UNSAFE TURNING E FOG/VISIBILITY FT. N IN XING INTO OPPOSING LANE F OTHER:' - MOTOR VEHICLE INVOLVED WITH O IX I JOPARKEID G WIND A NON-COLLISION P I IP MERGING LIGHTING B PEDESTRIAN Q 1 10 TRAVELING WRONG WAY X A DAYLIGHT C OTHER MOTOR VEHICLE OTHER ASSOCIATED FACTORS R OTHER': B DUSK-DAWN D MOTOR VEHICLE ON OTHER ROADWAY 12 3 (MARK 1 TO 2ITEMS) C DARK-STREET LIGHTS X E PARKED MOTOR VEHICLE A VC SECT wN VIOLATED pTEO YES D DARK-NO STREET LIGHTS F TRAIN :NO E DARK-STREET LIGHTS NOT G BICYCLE B VC SECTION VIOLATED CITED .YES FUNCTIONING' INO, H ANIMAL: SOBRIETY-DRUG ROADWAY SURFACE C VCSECTKMMOLATED Or= YES PHYSICAL X A DRY I FIXED OBJECT: ".NO Z 3 (MARK 1 TO2ITEMS) 8 WET DI X I A HAD NOT BEEN DRINKING C SNOWY-ICY - J OTHER OBJECT: E VISION OBSCUREMENT: 1 18 HBD-UNDER INFLUENCE D SLIPPERY(MUDDY,OILY,ETC.) X I IF INATTENTION*:K-OTHER I IC HBD-NOT UNDER INFLUENCE' ROADWAY CONDITION($) IG STOP 8 GO TRAFFIC 10 HBO-IMPAIRMENT UNKNOWN• (MARK I TO 2 ITEMS) PEDESTRUW'SACTIONS I H ENTERING I LEAVING RAMP E UNDER DRUG INFLUENCE' A HOLES,DEEP RUT' X A NO PEDESTRIANS INVOLVED 11 PREVIOUS COLLISION F IMPAIRMENT-PHYSICAL• 8 LOOSE MATERIAL ON ROADWAY* 8 CROSSING IN CROSSWALK IJ UNFAMILIAR WITH ROAD G IMPAIRMENT NOT KNOWN C OBSTRUCTION ONROAOWAY• AT INTERSECTION K DEFECTIVE VEH,EQUIP.: CITEDX IN NOT APPLICABLE D CONSTRUCTION-REPAIR ZONE C CROSSING IN CROSSWALK•NOT YES 1 SLEEPY J FATIGUED E REDUCEDROADWAY.WIDTH AT INTERSECTION NO F FLOODED' 0 CROSSING-NOT IN CROSSWALK I IL UNINVOLVED VEHICLE G OTHER*: E IN ROAD-INCLUDES SHOULDER M OTHER*: X H NO UNUSUAL CONDITIONS I IF NOT IN ROAD X N NONE APPARENT G APPROACHING I LEAVING SCHOOL BUS 0 RUNAWAY VEHICLE SKETCH FOR SKETCH 1DIAGRAM,SEE PAGE 3 MISCELLANEOUS WOK:ATE NORTH 4 . Q O STATE OF CALIFORNIA SKETCH DIAGRAM CHP 555 Page 4(Rev.8-97) OPI 042 PAGE 3 OF 6 DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 04/26/2006 1 1040 10700 43759 06-10918 ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED(SCALE= ) La Gonda Way V-1 V2 o = AOI 445 la Gonda Way o� Q PREPARED BY I-D.NUMBER DATE REVIEWER'S NAME DATE M. BRIGGS _ 43759 04/26/2006 r i i STATE OF CALIFORNIA FACTUAL DIAGRAM CHP 555 Page 4(Rev.8-97) OPI 042 PAGE 4 OF 6 DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 04/26/2006 1 1040 0700 143759 106-10918 ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED{SCALE= ) La Gonda Way Vehicle 2 Vehicle 1 445 la Gonda Way (00 PREPARED BY I.D.NUMBER DATE REVIEWER'S NAME DATE M. BRIGGS 43759 04/26/2006 rily✓ �(�S�U d2Q-tXo STATE OF CALIFOWNIA NARRATIVE/SUPPLEMENTAL PAGE 5 OF 6 DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 04/26/2006 1040 0700 43759 06-10918 1 FACTS 2 3 Notification 4 On Wednesday, April 26, 2006, at approximately 1046 hrs., I responded to a reported non-injury 5 collision on La Gonda Way, IFO St. Isadore's Catholic Church, 455 La Gonda Way, involving a 6 County owned vehicle and a parked vehicle. I arrived at approximately 1054 hrs. All times and 7 measurements are approximate and measurements were taken with a rolatape. 8 9 Scene 10 La Gonda Way is a N/S, 2-lane, asphalt covered roadway that traverses through a predominately 11 residential area that includes a Catholic Church complex. There is one traffic lane in either 12 direction and the lanes are separated by a broken line and are bordered by raised concrete curbs 13 with sidewalks. The posted speed limit is 25 mph and several vehicles were parked and 14 unattended at both curbs. 15 16 Parties 17 P-1 (Vincent)was the reporting party of this collision and I met him at the scene. P-1 identified 18 himself with his California Driver's License and provided registration and insurance information 19 upon my request. P-1 said he was the driver and sole occupant of V-1. 20 21 V-1 (Ford)was located on its wheels parked at the west curb approximately 2 car lengths south of 22 V-2. V-1 sustained minor damage to the utility box on the R491'side of the vehicle directly behind 23 the passenger door and was subsequently driven from the scene by P-1. 24 25 V-2 (BMW)was located on its wheels legally parked within 18" of the right hand (west) curb and 26 unattended. V-2 sustained a minor crease on the LF fender, a paint transfer on the LF bumper 27 and a chipped lens to its LF tum light indicator. V-2 was subsequently left at the scene with my 28 business card under the windshield wiper. 29 30 Statements 31 P-1 said he meas driving his vehicle south in the S/B lane of La Gonda Way. He said he steered to 32 his right in order to park at the west curb. As he was doing so he heard something contact on the 33 right side of his vehicle. Upon inspection, he saw the fresh damage to V-2 and then called his 34 supervisor who told him to call the police. 35 36 OPINIONS AND CONCLUSIONS 37 Summary 38 V-1 (Ford) was driven S/B on La Gonda Way by P-1 (Vincent) who was alone in the vehicle, was 39 wearing a 3-point type seatbelt, and had not been drinking. V-2 (BMW) was legally parked and 40 unattended at the west curb, facing south, on La Gonda Way. P-1 steered toward the west curb in 41 order to park. His turn was too sharp and the right side of his vehicle's utility box struck the LF 42 fender/bumper of V-2. PREPARED BY I.D.NUMBER DATE REVIEWER'S NAME DATE M. BRIGGS 43759 04/26/2006 / STATE OF CALIFORNIA NARRATIVE/SUPPLEMENTAL PAGE 6 OF 6 DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 04/26/2006 1040 0700 43759 06-10918 1 2 There were no injuries. 3 4 Area of Impact (AOI) 5 Based on P-1's statements and the point of rest of V-2, the AOI, where the utility box of V-1 struck 6 the LF fender of V-2, was determined to be approximately 6' 8" east of the WCL of La Gonda 7 Way, and approximately 346' 3"south of the SCL prolongation of EI Cerro Blvd. 8 9 Cause 10 P-1 (Vincent) is at fault for this collision. He caused it by making an unsafe turn during his parking 11 maneuver, in violation of 22107 CVC. 12 13 Recommendations 14 None. Op O PREPARED BY I.D.NUMBER DATE REVIEWER'S NAME DATE M. BRIGGS 43759 04/26/2006 Date: 5131/2006 03:12 PM Estimate ID: Auto547 ' Estimate Version: 0 Preliminary Profile ID: STANDARD D&S Body Shop, Inc. 38 Beta Ct A3 San Ramon,CA 94583 (925)820-0552 Fax: (925)837-4047 TAX ID # 68-0302448 BAR# AM186872 EPA # CAL00O3O3583 Damage Assessed By: SARA GOSS Deductible: 0.00 Claim Number: Auto547 Owner DAVE FERRETTI Telephone: Home Phone: (925)518-8773 Mitchell Service: 912224 Description: 1994 BMW 1525 i Body Style: 4D Sed Drive Train: 2.51-Inj 6 Cyl 4A VIN: WBAHD6321RBJ96813 License: 1VAJ795 Mileage: 161,966 OEM/ALT: 0 Search Code: None Color: BLK Options: AUTOMATIC TRANSMISSION "All crash parts on this est are "new" original equipment manufacturer parts, unless otherwise specified. Parts described as rechromed,recored,remanufactured or,reconditioned are considered "rebuilt" parts. Crash parts described as "quality replacement part are non original equipment manufactured aftermarket parts. Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 201040 BDY REMOVE/INSTALL FRT BUMPER ASSY 0.6 2 900500 BDY* ADD'L LABOR OP BUFF TRANSFER FRT BUMPER LEFT SIDE Existing 0.4* 3 202900 BDY REMOVE/REPLACE L PARK/SIGNAL LAMP ASSEMBLY 63 13 1 384 033 24.00 INC # 4 200632 BDY REMOVE/REPLACE L FENDER PANEL 41 35 1 946 927 319.00 3.5 # 5 AUTO REF REFINISH L FENDER EDGE 0.5 6 AUTO REF REFINISH L FENDER OUTSIDE C 2.5 7 207490 BDY REMOVE/REPLACE L FENDER GROMMET 51 13 1 934 160 5.00* 8 225850 REF BLEND L FRT DOOR OUTSIDE C 1.0 9 200247 BDY REMOVE/INSTALL L FRT BELT MOULDING 0.8 # 10 200249 BDY REMOVE/INSTALL L FRT LWR DOOR MOULDING 0.3 11 200767 BDY REMOVE/INSTALL L FRT DOOR TRIM PANEL 0.6 12 227240 BDY REMOVE/INSTALL L FRT DOOR HANDLE COVER Existing 0.2*# 13 227950 BDY REMOVE/INSTALL L FRT OTR DOOR,BELT WEATHERSTRIP Existing 0.8*# 14 900500 REF * REMOVE/REPLACE COVER CAR Sublet 5.00* 0.3* ESTIMATE RECALL NUMBER: 5/31/2006 15:12:01 Auto547 UltraMate is a Trademark of Mitchell International Mitchell Data Version: MAY_06 A Copyright(C)1994-2003 Mitchell International Page 1 of 3 UltraMate Version: 5.0.214 All Rights Reserved Date: 5/31/2006 03:12 PM F ,4 Estimate ID: Auto547 Estimate Version: 0 Preliminary Profile ID: STANDARD 900500 REF * REFINISH/REPAIR TINT COLOR Existing 0.5* 16 900500 BDY* REMOVE/REPLACE STRIPE Sublet 10.00 0.3* 17 INC.STRIPE TAPE REMOVAL 18 AUTO REF ADD'L OPR CLEAR COAT 1.3* 19 933017 REF ADD'L OPR COLOR SAND&BUFF 0.6* 20 AUTO ADD'L COST PAINT/MATERIALS 195.20* 21 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL 5.00* * -Judgement Item #-Labor Note Applies C -Included in Clear Coat Calc Add'I Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 7.5 73.00 0.00 0.00 547.50 Taxable Parts 363.00 Refinish 6.7 73.00 0.00 0.00 489.10 Sales Tax @ 8.250% 29.95 Non-Taxable Labor 1,036.60 Total Replacement Parts Amount 392.95 Labor Summary 14.2 1,036.60 III. Additional Costs Amount IV. Adjustments Amount Taxable Costs 195.20 Insurance Deductible 0.00 Sales Tax @ 8.250% 16.10 Customer Responsibility 0.00 Non-Taxable Costs 5.00 Total Additional Costs 216.30 I. Total Labor: 1,036.60 II. Total Replacement Parts: 392.95 III. Total Additional Costs: 216.30 Gross Total: 1,645.85 IV. Total Adjustments: 0.00 Net Total: 1,645.85 This is a preliminary estimate. Additional changes to the estimate may be required for the actual repair. ESTIMATE RECALL NUMBER: 5/31/2006 15:12:01 Auto547 UltraMate is a Trademark of Mitchell International Mitchell Data Version: MAY_06_A Copyright(C)1994-2003 Mitchell International Page 2 of 3 UltraMate Version: 5.0.214 All Rights Reserved t + Date: 5/31/2006 03:12 PM Estimate ID: Auto547 Estimate Version: 0 Preliminary Profile ID: STANDARD REPAIR AS PER EST $ NOT RESPONSIBLE FOR ANY PERSONAL ITEMS LEFT IN VEHICLE. I hereby authorize the above repair work to be done along with the necessary materials.Employees of D&S BODY SHOP INC. may operate the above vehicle for purpose of testing, inspection or delivery at my risk. An express mechanic's lien is acknowledged on the above vehicle to secure the amount of repairs thereto. You will not be responsible for the loss or damage to vehicle or articles left in the vehicle in case of fire, theft, accident of any othe cause beyond our control. Old parts will be discarded unless instructed otherwise. STORAGE WILL BE CHARGED 48 HOURS AFTER REPAIRS ARE COMPLETED, IN THE EVENT LEGAL ACTION IS NECESSARY TO ENFORCE THIS CONTRACT, I WILL PAY REASONABLE ATTORNEY'S FEES AND COURT COST. ESTIMATE OF REPAIRS AUTHORIZED BY: DATE THE STAFF AND CREW AT D & S BODY SHOP THANK YOU FOR THIS OPPORTUNITY TO BE OF SERVICE TO YOU AND FOR THE CHANCE TO MAKE YOU ONE OF OUR SATISFIED CUSTOMERS. Company Code: Drop Off Date: 5/31/2006 Time:03:00 Repair Dates: Promise Date: 5/31/2006 Start Date: 5/31/2006 ESTIMATE RECALL NUMBER: 5/31/2006 15:12:01 Auto547 UltraMate is a Trademark of Mitchell International Mitchell Data Version: MAY_06_A Copyright(C)1994-2003 Mitchell International Page 3 of 3 UltraMate Version: 5.0.214 All Rights Reserved 05/31/2006 at 03: 07 PM Job Number: 22895 SAN RAMON BODY AND DETAIL SHOP Federal ID # : 942863297 10 BETA CT SAN RAMON, CA 94583 (925) 838-8380 Fax: (925) 838-6254 PRELIMINARY ESTIMATE Written By: J Quigley, Glenn Adjuster: Insured: DAVE FERRETTI Claim # Owner: DAVE FERRETTI Policy # Address: 674 DANHILL DR Deductible: DANVILLE, CA 94506 Date of Loss: Day: (925) 5'78-8773 Type of Loss: Point of Impact: 11 . Left Front Inspect SAN RAMON BODY AND DETAIL SHOP Business: (925) 838-8380 Location: 10 BETA CT SAN RAMON, CA 94583 Insurance Company: Days to Repair 1994 BMW 525I 6-2 . 5L-FI 4D SED BLACK Int:TAN VIN: WBAHD6321RBJ96813 Lic: 1VAJ795 CA Prod Date: 10/1993 Odometer: 161966 Air Conditioning Rear Defogger Tilt Wheel Cruise Control Telescopic Wheel Intermittent Wipers Tinted Glass Dual Mirrors Electric Steel Sunroof Fog Lamps Clear Coat Paint Metallic Paint Power Steering Power Brakes Power Windows Power Locks Power Mirrors AM Radio FM Radio Stereo Cassette Search/Seek Anti-Lock Brakes (4) Driver Air Bag Passenger Air Bag Leather Seats Bucket Seats Recline/Lounge Seats 5 Speed Transmission Overdrive Aluminum/Alloy Wheels ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1 FRONT BUMPER 2 Repl LT Molding 1 22 . 75 0. 3 3 R&I R&I bumper assy 0 . 8 4# Rpr POLISH FRONT BUMPER SCUFFS LT 0 . 5 SIDE 5 FRONT LAMPS 6 R&I LT Signal lamp Incl . 7 FENDER 8 Repl LT Fender 1 319. 00 3 . 0 ' 2 . 5 9 Add for Clear Coat 1 . 0 10 Add for Edging 0 . 5 11 Add for Clear Coat 0 . 1 1 05/31/2006 at 03: 07 PM Job Number: 22895 PRELIMINARY ESTIMATE 1994 BMW 525I 6-2 . 5L-FI 4D SED BLACK Int:TAN -------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT -------------------------------------------------------------------------------- 12 Deduct for Overlap -0 . 5 13 R&I LT Side molding 0 . 3 14 FRONT DOOR .15 Blnd LT Door shell 1 . 1 16 R&I LT Upper molding 0. 3 17 R&I LT Lower molding 525i & 535i 0. 3 18 R&I LT Belt molding outer bright 0. 3 19 R&I LT Mirror outside w/o memory 0. 5 20 R&I LT Handle, outside standard 0. 4 21 INTERIOR TRIM 22 R&I LT Door trim panel vinyl w/o 0. 8 wood trim 525i & 535i 23 MISCELLANEOUS OPERATIONS 24 Repl Cover car/bag 1 0 . 2 25# Rpr TINT COLOR 0 . 5 26# Subl PINSTRIPE - TAPE 1 30 . 00 T 27# Repl COVER CAR FOR OVERSPRAY 1 7 . 00 T 0. 3 28# Rpr COLORSAND AND POLISH 1 . 0 29# Subl HAZARDOUS WASTE REMOVAL 1 5. 00 X ------------------------------------------------------------------------------- Subtotals =_> 383 . 75 9. 0 5. 2 Parts 341 . 75 Body Labor 9. 0 hrs @ $ 75. 00/hr 675 . 00 Paint Labor 5. 2 hrs @ $ 75. 00/hr 390 . 00 Paint Supplies 5 .2 hrs @ $ 35 . 00/hr 182 . 00 Sublet/Misc. 42 . 00 ---------------------------------------------------- SUBTOTAL $ 1630 . 75 Sales Tax $ 560 . 75 @ 8 . 25000 46. 26 ---------------------------------------------------- GRAND TOTAL $ 1677 . 01 ADJUSTMENTS: Deductible 0 . 00 ---------------------------------------------------- CUSTOMER PAY $ 0. 00 INSURANCE PAY $ 1677 . 01 2 00 id z3 m I � 1 Lo t� V� cc pi k^ 1 j _ Cd z� c 5 1 1 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JULY 11, 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 �vnvl on your claim by the Board of JUN 0 9 2006 Supervisors. (Paragraph IV below), given Pursuant to Government Code AN/IOUNT: $2,000.00 COUNTY COUNSEL Section 913 and 915A. Please note all MARTINEZ CALIF. "Warnings'?. CLAIMANT: HERMELINDA HIDALGO ATTORNEY- UNKNOWN DATE RECEIVED: JUNE 09, 2006 ADDRESS: 929 GLADE COURT BY DELIVERY TO CLERK ON:JUNE 09, 2006 ANTIOCH, CA 94509 RECEIVED THROUGH BY MAIL POSTMARKED: INTER OFFICE MAIL RISK MANAGEMENT FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, e Dated- JUNE 09, 2006 By: Deputy M FROM: County Counsel TO: Clerk of the Board of SreFvisors ( 'his claim complies substantially with Sections 910 and 910.2. This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). O Other: Dated: By: In Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) O Claim was returned as untimely with notice to claimant (Section 911.3). IV. WARD ORDER: By unanimous vote of the Supervisors present: (p,**' 'nis Claim is rejected in full. Other.. I cei-tify that this is a true and correct copy of the Board's Order entered in its minutes for this date, Dated-C" / � *646- JOHN CULLEN, CLERK, By A#�eeputy Clerk WMUAN_&�(Gov. code section 913) Subject to certain exceptions,you have only six(6)mouths from the date this notice was personally served or deposited in the mail to rile a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in comiection with this inatter. If you want to consult an attorney,you should do so immediately. *For Additional lftrning See Reverse Side of Uiis Notice. AFFIDAVIT OF MAILING I declare under penalty of per jur-y that I am now, and at all times herein mentioned, have been .4 citizen of the United States, over age IS; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. JOHN CULLEN, CLERK By/_ A��Depuly Clerk ' BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLA IANT A. A claim relating to a cause of action for death or for injury to person or toersorial 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 narne 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. f R Y R t R R R 1 R R t t R R R t!R R R At ■■■G R t t R t@ R an on NMI R R R R R R Ina R MR an Q an R AIN RE A;R R R R R R R R Asa R R R 1 RE: Claim By: Reserved for Clerk's filing stamp } 146 NF.r-t N nA to tUAL.C-70 ) } RECEIVED ) Against the County of Contra Costa or ) JUN 0 0 2006 CO NTf—A G0 STA W o,,,)-TX District) CLERK BOARD OFSUPERVISORS (Fill in the name) } CONTRA COSTA CO. The undersigned claimant hereby makes claire against the County of Contra Costa or the above-named district in the sum of$ 24W°=' and in support of this claim represents as follows: I. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) r4-p'rit t_0 r� (- r,n EV ` s VA(ZV- -3. How did the damage or injury occur? (Give full details;use extra paper if required) Sc� �� F t--Vmo car 00+ i'4 f"TA-1�rt� 10f C�aVr&A b "su t 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injuni 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 clam. 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 Y estimated amount of any prospective injury or damage.) S. Names and addresses of witnesses, doctors, and hospitals: 1-1 pLVo tt's.-M E-UjEf) VolT) "1 402-1- 9. oZ29. List the expenditures you rnade on account of this accident or injury: DATE TIME yAMOUNT ZS �r dj as a a2 RRo a a 2 aaaaa aan via aaan MEN■na■aa■■a■■a[aa■s■ao as SEE an u■■[Inn a Ina ass song.a R■■an o a ansl ) .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 ) ff (Claimant's Signature) q 2-1 C w;Y)P. CT (Address) ) T Gi2� 4411_3 L -7 Telephone No. )Telephone No. � � ■.[■[[■[s r s[[[[■[a■s■■■a s UK a ■■[!a[![[[a[s[R s R[[[R[[[■[R■[a■■a[[R[[[[[r[[[in NKV soon R R a■t 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. ■sa[ssRossaoonaussllBosun■ iass own KNEES BRIBER aa[tntsa■ouo[RORaBRul Rlosn BENZ■■r pump RBa[{ 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. ncc me - CONTRA COSTA CONTRA COSTA REGIONAL (" HEALTH SERVICES MEDICAL CENTER DIAGNOSTIC IMAGING DEPARTMENT i X-RAY INSTRUCTIONS t v-- Please report to the Diagnostic imaging Department at: 0 Contra Costa Regional Medical Center, 2500 Alhambra Ave., Martinez.Phone: 9251370-5320 0 Pittsburg Health Center, 22311 Loveridge Rd., Pittsburg. Phone: 9251431-2370 Date:'_Z> _cy' Time: C) for x-ray of: ` ok INSTRUCTIONS:- If you cannot keep this appointment, please telephone as soon as possible so that another patient may be scheduled at this time. Note: Please do not bring children with you unless you have another adult to take care of them. Please advise the technologist if you are pregnant. Thank you. XR-17 (3-04) CLAIM �G�� BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION:JULY 11, 2006 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of this document mailed to California Government Codes. you is your notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code AMOUNT:. $372.79 JUN 0 9 20 Section 913 and 915.4. Please note all "Warnings". COUNTY COUNSEL CLAIMANT-. JOE AMADED MARTINEZ CALIF ATTORNEY: UNKNOWN DATE RECEIVED.- JUNE 09, 2006 ADDRESS: 206 PRIMROSE PLACE BY DELIVERY TO CLERK ON: JUNE 09, 2006 PLEASANT HILL, CA 94523 BY MAIL POSTMARKED: JUNE 08, 2006 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, e Dated. JUNE 09, 2006 By: Deputy_ ! 1I. FROM: County Counsel TO: Clerk of the Board of Supervisors -)"r"his claim complies substantially with Sections 910 and 910.2. This Claim FALLS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). O Other. Dated: By: Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) O Claim was returned as untimely with notice to claimant (Section 911.3). IV BOARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated.(Jklko, 444a JOHN CULLEN, CLERK, By Deputy Clerk WA-F-KINW(Gov. code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mail to rile a court action ou this claim.See Government Code Section 945.6.You may seek the advice of an attoruey of your choice in connection with this matter. If you want to consult au attoi,tiey,You should dosoimmediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of per jury that I am now, and at all times herein mentioned, have been i citizen of the United States, over age 18; and that today I deposited iu the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as sboi-vii above. Dated: Ila AeAA61OHN CULLEN, CLERK By z4vxDeputy 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 9455 3. 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. an of a anus aaas a cu ca a a Unaam anis as C am ac anaaacaaas Van a M=tine a menaaa as R■aams[c amc cant RE: Claim By: Reserved for Clerk's filing stamp RECEIVED Against,the County of Contra Costa or } } JUN 0 9 2006 V OF MA171A- 60 50J- --fi t) CLERK BOARD OF SUPERVISORS (Till m the name) } CONTRA COSTA CO. } The undersigned claimant hereby mares claim against the County of Contra Costa or the above-named district in the sum of$_3 7 2 a"1 y and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) .2404" PtY1 2. Where did the damage or injury occur? (Include city and county) (20AJCDkZ, CA- , COJJ712A-e05TP COtk/JTJ 3. How did the damage or injury occur? (Give full details;use extra paper if required) 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? t-AAfE-SHOUL-D tIA4)P- bSE711 ft,%E�D -31� 7v 7 JE �,rzt:_: b n-t e Nock 1-HE DAM, 6 11 MUSED 7b AAU 7"bk vE7-4rae..r�' S. 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.) R I y t4T" 1:74o MT' 7-70,6 ! 1�--AP—m A66CF-A 4bLy SM14T) I W 0 E'EL.. _PA"� �i� . - 7. How was the amount clai ned above computed? (Include the estimated amount of any prospective injury or damage,) ACrt t k,. OH-4K.4 E5 INOAtAED $. Names and addresses of witnesses,doctors, and hospitals: L:'.'C 4!C. /M/DE Sr (f&,KZAab AXj C.E eLr=7A.AjOR, C701VZA-e_ Z 7% 13ZJ5 A+77-Y ASI m g(P4-sem Z-"n ' Iff-hM 1c;Mu`J 1-1-65-2.0 9. List the expenditures you made on account of this accident or injury: DATE TEYM AMOUNT ATrA ED ass none litingue MR mangs sailwasailm own a a Know man mots a Ross maul .Gov. Code Sec. 910.2 provides"The claim shall be } signed by the claimant or by some person on his }behalf." SEND NOTICES TO: (Attorney) Name and address of Attorney } } (Claimant's Signature) (Address) } PSA T" 41 LJi CA- q 4ETZ8 Telephone No. )Telephone No. �` > �8�—2$ T ■.ttssstetsu stssssssaaaitaaasassssasusossMira sKong ssssssmillions rsnssutssRan man URNS sRoss PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the County under the Tart Claims Act, is subject to public disclosure under -the California Public Records Act. (Gov. Code, s§ 6500 et seq.) Furthermore, any attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. i t 1 z t t s s t t i t s t t t t t t s t i n an R t t MR t s it t t t s t t■t t t i t t[R t t i t t t t t i t t t t t t t i t RUNK was Russ t Irani 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. June 8, 2006 On Wednesday, April 12,2006, at approximately 5:45 pm, my wife hit a pot hole on Concord Avenue just east of the I680 freeway overpass, in front of the Ford dealership. The pot hole was filled with water, as it had rained most of the day. She pulled around the corner onto Diamond Boulevard, where several people who had just hit the hole were lined up—most of which had two flat tires and other damage. A Concord policeman, Lt. Chilimidos, was present to take the names of those who experienced damage. My wife had a front right flat tire on my 1999 9-3 Saab. She called California AAA to have my spare put on so she could go home. The AAA serviceman mentioned to her that the wheel was bent and that we should take the car to someone to be checked out. The next day we went to Wheel Works to get a new tire. They confirmed that she had a bent wheel that needed to be replaced. They also said that since the car is front-wheel drive,we should have the car looked at by a mechanic,as they believed there was some damage to the right A-arm strut assembly. We took the car to M Auto Service in Pacheco to have it checked and repaired. Following is a list of the costs we've incurred due to hitting this pot hole(receipts attached): New Tire/Wheel Balancing $ 91.98 Repair Bill—M Auto Service $139.00 New Wheel $126.81 Tire Mounting to New Wheel $ 15.00 Total Cost: $372.79 My wife spoke with Mark Trump of the Contra Costa County Department, and he mentioned that the county had gone out to temporarily repair the hole at approximately 3:30 pm that day. It had rained most of the day, and the attempted temporary repair was thrown all over the sidewalk as drivers hit the hole. The lane should have been closed until a proper repair could have been done. My wife's car up to this point was in perfect driving condition. It is only since she hit this hole that we've incurred the abovementioned damage and charges respectively. Therefore, -we are asking to be reimbursed for the total amount of charges that we incurred. I can be reached at(925)685-2873 if you need further information. T yo e Amadeo 206 Primrose Place Pleasant Hill, CA 94523 .. 1 : I 1:. t I 1-1 \ tr r \ {"$E �t.4:.3 G.t".4 \ r i i lt`f'>n K, fir.. Ai i4}t' t--ty .� +lii 1.'. '.. kf y IN i s 1 l f. i' ' t 3 1S q r - - - �t{ 9 11 ^jt:;:. 3 y a tz` ,,v% f 3 f (r�q ' S?,f)z,( d t .� i Nqt l F S ty fly, N1 ( 3."i t� ' d.it A £ C . P k ii ' r s YI tn4 ­11 `Ta i"" ., rr rno �i` S , t "r,i�r+y t i y I r_ �` _ �� �r�y ¢ t udf .v tfo .. ♦i ,y 3k'rr" ti 3rl My � P>d 1 "' }1 �i...I}+i 'L yZ „J z r \y --ux "r�5r� W s h a t� ,. s a3 �I'r r 1 � d-.: m-^m crS 1-" 't, ) t - I'� 4 C,i6si t x .. - T7..a-9.ng.4'dp.'w^M,�13_ W V y r'\) '�'� - it .-.--'--111i1.1­I _. .. ... i "' i ui a "_t1 8.=. .#'"ttz+"`.:m (�? {'r 1 R c s ti .lTr r rM-k'N +t !'" i"y t -iL! its— V xis l ll 11 ... :. - ...:..i, t) try: $ N U'w vF ' 1�� F 1 AS Yi A PF I =� s•�' ed ori your vehicle It Is Important to us that we,provlde the; .} f< , - - u have a choice of whether or not any work"will be perform u are able to`.make Informed decisions Therefore we have Itertiized the parts'and4servlces by the following categone� �: : . '" \ I., E r t.I 4 s `�.�Y,! PROS'xEL7P�F'iF01f#tiA, r 'NGE, Ir i r >:+'� a ._ .'`pq-yEt {tEf}�AA1N {IIJCE .*�Wt..�*c a� w "�.tr, r a �' k srt ,a fedi a r )� -Theseiare opttonatAtems °_ F; � 5'4C , ,.�These are opttona'IA,te ' ,' 10, t ',"`l"^i't; r ul , Complyvnth maintena1.nce recornmendations by the vehicles{ +?s '.Atldress a cuseI m nat noise etc,J,,.� ice(�s�1t1 ,, �de en#henot,I 7 RinllP.#?;t 1 q(�ment.marwiaota �D i-, tr ,�� „� g Yy"'�it tltie men,--,iu rsc�lrr'G+'IrilP,rbvedj t'{mac r' r "Com Iy ILth acommendations6 y e ire ma✓A btu M�0 4 Y p s rii" Corr'Iponent is diose to the end of its useful iiia Oustra¢ove'the i i}� perf8rmance over 3tAe(origlna­11 11l'egwpment m1.anufacturer we can only � „ A ,�x rely upon their testing results tandcannot confmn their claims of \ -; discard specrficabon orTweak;etc) 'r t h-. 7v!-r 4 u 5 ' )1 r t 4k "� , r _-Y -,i m-r pertormance ,,yrth +x,sr k{q,'. 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Sv�,Y{:r sit .sa � ;��1'{ r-fs '.t1kr s .`��ti,`!k` zA"r ,itsl� r s 1µi , i v I hereby authorize the cepa-work to tie done along u ORIGINAL ESTIMATE ADDiTIQNAL COSTS# o f SALES TAX kyr } ; 11hahe necessarymaterials Wheel Works+and its' » - - , ++ r i .. I.1em to ees ma o erete above vehiclefor u roses w:= 4 1 • ` x.(I� r. f f t P. Y Y P P e '.— a: of testing Inspection or delivery at my Ols An REVISED ESTIMATE` fREASQN, w'�E ,'tarx5 ' `'' t 3"` " mn express mecha_riic s lien is acknowledged on above , ! Y 1i '. t - i ,l 1 SHL yl y , e^ e' E1�1'4� 4 f �YIiY=jY € vehicle to secure the amount of repairs thereto it is c i , , r 4 rn c aiso'iundersroodahor wheeLworks warnot bA�inerd:: °_ -- �` - ° '$` at>the .ifem¢ed,;arts and se � 1. 1. I acknowledge th p r4ices responsible for loss,'oridamage to,vehicle oe articles gUTHQRIZED A �;. 1. left=in vehicle incase of hre ithett orrafi other, 4 ” ?it r z Petfarihad on my vehicle are the ttems,that I authorized.' cause be dndiWhaetlVlloFks'controCALL PART,S.I '? 'BY .,' : a u rx.., 'M' 1 agree to paylfhe amount shown on:ithls mvolce'and , . rYt rhN PERSI.ON❑ xPHDi*)E i acknowled a taken esion of my vehicle and all ' AND MERCH7tNDIS1.ARE NEW UNLESS NC)TED TIMET r. ,t ALLEDiBY PHONE!:NQ g ge that all items lest at (R'MANUFACTURED U-USED) I s DtllATE C r persdn'al aiticl also acknpwled i : - r t' + , a<r I'r` Wheel W is done at my own risk andL'Ipwill hold them �, ” ❑flETl1RN;PA9TS b 6ISCkRD1. PARTS ' 1 '; 5 I S 1 'r har S m vent ,;IDBS'` X 4 I acknowledge notice and oral approval of X �, clr:ninrriac. ;n:; ����. :, «,v 1111, ,,,.. 1111.,.-t. . _. .. 1111.-1111_,__..�__.., .ry s, s =ljlr3dU X8YSS303N 3HV S3IVOIGNI 1531 NO3HO 0OWS 3H11VH1 S1N3vusn('OV HO SHIVd3H LOO-OZ6 (008)IVO MJO3 SIH l UGHO Ol O3033Nht�VWNO3a3dOlkLI�1OVdH03HO!ROWS43SN301]H3H1ONV3SOOHOAVVno),,MV]1,8 OOOZ'ON INaOd — c ---- - -- -- - -- - - -- -- -- ---00 --- --------------------- ------ -- - -- -- ---- -- -- -- -- - --- CD N CIT\ REM ®I O O c Z CL u c.)ii Cu 21 Ur=¢U -a '� R p� rn R - a a a a -. m is Imo- c% 3 0 N Fes- ~ y • o V - 1 a a� t F Q mF fn = U, to c v ENN a W vV J 2 LU ' \ W WZ G ---- -- -- -- -- -- -- �z m n o z _ CC m C 3 _a Z 40. a V ¢ z Enc aL y Cl) of o i o o = m Q U d f") a Cep o E o O ul vi w � ¢ LL N Ln `� ¢ o Q ( UI Q Q W p UJ 1- 2-. u� 1 a 3 U Z Ir M W 7 Q a 1 w I- IM i W Q U a _ ��} Q �� in ow - fir _ v O Lf) a-i y a z ' - �3-, c W ¢ m H �' Ar- 21 - UJ V N v w a L ,a \ o -61 5 Z w > a E - o xyl R cir cn L O O a Z CD C/) Q N 0 omc-c&'/1 ;, .v a�: a <u a s y ® �C Z LLI 1 d o E> �" CV } i c cc a SCO W i3 l O 91 LL L N W !A LU •�•-� d a 2 �3 '' �� a2 o m Q q II �ar ��y_�� 1= uI O A T k d Z C) 54J,/ to I t,O � -- z — -> I ¢w L u� 5 _ . E N w- O 4 U _ o n mvz s .i z U UJ 1 I 1 I I I ----------------------------------------------------------------------------L--- -------------------1'-- I I ul C'3 W Q U7 2 I I 1 ¢ U W a G� In p amQ a a 'mj o m 1¢. 11 J ¢ .wQ ~ W U = e Cro 0- m N~ m U: � 3 N Q N N I I W 2 h O 3 � Iw Erand m IIw � a m 2 o Ij - o 111111¢ II `�Z U) y W Q C j o E O b W L U I c60_UO 1 rfi W EL i - "ETIRE -RAC, ® INVOICE ' Performance Specialists _ INVOICE NUMBER INVOICE DATE PAGE 71.01 `orden Parkway 240353801 /-6 5/181 South Bend, IN 46628-8422 PURCHASE ORDER NUMBER Phone:(574)287-2345 800: (800)428-8355. Customer Service: Ext.360 1 Fax:(574)236-7707 5/18/06 8:06 :28 BILL TO: SHIP TO: 2026285-000 2026285-000 AMADEO, JOSEPH M AMADEO, JOSEPH M 206 PRIMROSE PL 206 PRIMROSE PLACE PLEASANT HILL CA 94523 PLEASANT HILL CA 94523 1630 SHIP METHOD: UPS GROUND SHIP-TO PHONE: 925-685-2873 CACH Plan 178906 Team AWHEEL Wave 006 Prcl 18 ORDER DATE SALES REP.NAME/PHONE EXT. TERMS MAKE,MODEL AND YEAR WHSE OPER. 5/17/06 NEAL-EXT. 624 MASTER CARD 9-3 CONV 99 SB NEA PART NUMBER QUANTITY QUANTITY DESCRIPTION UNIT EXTENSION LOC. ORDERED SHIPPED - PRICE SP174067BS 1 1 90 15X7 5-110 ET40 MM SPIDII 99.0c 99.0 A1. - 174067115600 174067115600 AL651 1 1 90 MM 72.2-65.1 CENTER RING NIC F-6 B12 5 5 . 90 BC12X1.5 26UL 52TL 17H SL19 NIC H-3 44 B12 REQUIRED LUGBOLT FOR VEHICLE TOTAL THIS ORDER 99.0 FREIGHT CHG/ALLW 27.8 MASTER CARD PAYMENT 126-81- weight 26 TOTAL AMOUNT DUE $.0 ALL PAST DUE ACCOUNTS ARE SUBJECT TO A FINANCE CHARGE OF 1'/:%PER MONTH,WHICH IS AN ANNUAL PERCENTAGE RATE OF 18%. Ed'CG i0i zil'E ti t_fit 1+9, V EXP �l l iq.i ljjt .'•�+ .i. ...J .. 3!7L_J I'1 i...... ...._'!:.t Tp; 3 t+ ``;{� 1 THE �i�Llil_ 'CI i_iii : i (!i_d �E nr to °� - st :�✓ it f7 Y a:u 1.5N�'" w % Awa 3.4"x N�� ` , '� �t�,p��,av �i `� n`V�e�n �a✓1� Yhiyw� � '.. n vs It 13� Ct 'fit ,�... r»,.��...._ ....,rv, .:.. ........: b n�'.w"S&Es M....1",.v„ ,t h f ..,, +,< »,..,.. .._ *+`;a. ,.,.,•,c..w,. ,.,,. "..'"+`.,u ;. .t a 1­1, i i, ., ,.. _ I acknowledge notice and oral approval of any increase in the original estimated price. X. QTY. DOT# _ TERMS:(NET 10th PROX.)PAST DUE CHARGE IS COMPUTED BY A"PERIODIC RATE"OF 1 _P-A, MONTH ON UNPAID BALANCE WHICH IS AN ANNUAL PERCENTAGE�0 QTY. DOT# 18%—tF NEL�SSARY TO INSTITUTE LEGAL ACTION TO ENFQFiCE COLLECTION.OF THE AMObNT DUE UNDER THIS INVOICE. QTY. DOT# BUYER AGREES TO PAY ALL NEC93SARY COSTS AND ATTO#NEY'S FEES. QTY. DOT# VEHICLE RECEIVED By PLEASE SIGNQTY... DOT#. GGG TOLL FREE CUSTOMER SERVICE 877-GO-2-BIGO(877-462-2446) NO REFUNDS ON DEPOSITS CUSTOMER MUST PRESENT COPY OF INVOICE FOR WARRANTY OR SPECIAL ORDERS MAJOR BRANDS SHOCKS STRUTS ALIGNMENT SUSPENSION �®. t } 4 0 i.4 Q I t 'i a V� 1 C 0 .:,. ca N CD +si 6 4 4) 4 alet c to tt k ct o N d N �yCA 0 � . �cr. Nv f a V � d ,F:0 o 0 1�, a CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JULY 111 2006 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of this document mailed to California Government Codes. you is your notice of the action taken ' on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code AMOUNT: UNSPECIFIED R!UN 0 9 2006D� Section 913 and 915.4. Please note all "Warnings". CLAIMANT: CLAUDIA COALE COUNTY COUNSEL MARTINEZ CALIF. ATTORNEY: UNKNOWN DATE RECEIVED- JUNE 09, 2006 ADDRESS-. 4337 JANA VISTA BY DELIVERY TO CLERK ON: JUNE 09, 2006 EL SOBRANTE, CA 94803 HAND DELIVERED BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JUNE 09, 2006 JOHN CULLEN I Dated-, By: Deputy 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ("' iis claim complies substantially with Sections 910 and 910.2. This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days,(Section 910.8). Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911 3). O Other: Dated: (C - By: /7?C,4?41xA, Deputy County Counsel 111, FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) Claim was returned as untimely with notice to claimant (Section 911.3). IV., WARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: O&OCJOHN CULLEN, CLERK, By Deputy Clerk WARANW(Gov. code section 913) el Subject to certain exceptions,you have only six(6)mouths front the date this notice was personaffy served or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this matter. IF you want to consult an attorney,you should do so immediately. "For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of per that I am now, and at all times herein mentioned, have been .4 citizen of the United States, over age IS; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Daled: Zoe' 024W41OHN CULLEN, CLEtW By Deputy Clerk :N BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY k` INSTRUCTIONS TO CLAIlV.ICANT A. A claim relating to a cause of action for death or for injury to person or to P­efsonal fro brty-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. ■R R R R R r R R R R K R R R R R■K R K K swum R K K R K K R R t!!R C[[[!t R R R R■G K Razor R R[R R[R R R R R R R E E R[!R[R R RE: Claim By: Reserved for Clerk's filing stamp } a u-CA a (f-o C4L_Je- bra 0 tt n � �• � �� Against the County of Contra Costa or 04 , 09 20 Q �o District} oo�r o o� 6 (Fill in the name) � a cQ soy's The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ L)Lis5DQ,c r F,ea6nd in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) f6 6 2. Where did the damage or injury our? (Include city and county) Word- s�reerj CAP Pram Me 65'. GLCro.ss 7-�i e- �r�r e erg �/V.' 7`h � car , Tv e1-ert A-2 r, '"ac.i/i��, fig, ez f Co-A mos ,,- Cou 3. How did the damage or injury occur? (Give full details;use extra paper if required) ,T 5 rain eet /Vt Q h kt-1 � Fe.l{, o n r►1 kyi e e A-� �' J �� -�} - /v w erg l�h a n Th 2 n CrQ 2 S'/c!e L�/ar�r< � 1,,.,/e 4��� e pp yslclan 0- vniSSC�d clq pfi k w v v 4. What particular 1�o�ommission on the part of county or district officefs, servants, or empi�o�es caused the injury or damage? /01 :7: hav� p��-t-�r sono fi �►-�..a.re�a�e.e'C a 5 What are the names of county or district officers,servants, or employees causing the dame a or in ur ? (�/a,5 h 0 7- r p g J y• J7t� �5' f0 p e r^C y .. . LvQ� jold .,b� J'l �Ien� t !eld C.CJ erns �c�51er' ,"-r0 ;A �Y7Z� 'aha -GC �-va respon�i.�i -e , hai QplesanhZf,fir';5 6. What damage- or injuries do your claim resulted? (Give full extent of injuries or damages - claimed.--Attach two estimates-for auto damage.)-- ea- 1- , .,,K q ti k t-e,/ o F wo r G s e-e- m y /Y 4 74, '9 0 /C-e- rr\. Y a rk kC2a on -ki-ot- 7-D6k 7'11-10 /h on-M,5� 7D' /L�eq/. . 7. How was the amount claimed computed? (Include the estimated amount of any prospective injury or damage.) T5-,,_F1-er-,-c1__ �' "A 0(2UY1 & 0, /7,11015 -Fore- /'I,\ QrL y kLe Aeaz-ed Y OQ �ra ; A,, - IL S. Names and addresses of witnesses,doctors, and hospitals: /JP 7OAm J-p1le,5, os's OIL /Py I It ry_) /,-to C, ("Qre 9. List the expenditures ydu made-on account of this accident or injury: DATE TEVM AMOUNT d1l 4/V -7 6 r k ,Z ,,� .p a k J3 6 0 9 a 9 2 a a a Is it 2 a a a 0 a a a a 2 a a a 0 a It K IN Ross msxxmnvxzunx a Itsmatiallman 2 a a 2 a a a!a a X ff X I ) Gov. Code See. 910.2 provides"The claim shall be ) signed by the claimant or by some person on his behalf." SEND NOTICES TO: (AttorneN,) Name and address of Attorney (Claimant's Signature) E L13 3 4 z_ (Address) Telephone No. Telephone No. flt) 0'/ CC//) 5-/0 �6,-6 6, /�0 t-in 0 a a Sumitomo SIR an t a a r a s r a a r r a r a r a annumanzwxxnzzxmvz 1111111talzu 2 Kit K MAKER115981111111 PUBLIC RECORDS NOTICE- Please be advised that this claim f6rm, or any claim filed with the County under the Tort Claims Art, 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. N a own 0 mass a a Una a r r r a a a t a r t r r a 3111r on malillonallan assommazitan ZUNI so 19 stop us all NOTICE: Section 712 of the Penal Code provides: Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city, or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account voucher, or writing, is punishable either by imprisonment in the County jail for a period of not more than one year, by a 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. CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JULY 11, 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), UN 12 2006 given Pursuant to Government Code ANIOUNT: $1, 270.62Section 913 and 915.4. Please note all COUNTY COUNSEL "Warnings". MARTINEZ CALIF. CLAIMANT-. MATTHEW COOK ATTORNEY" UNKNOWN DATE RECEIVED- JUNE 12 , 2006 ADDRESS: 529 VAN BUREN PLACE BY DELIVERY TO CLERK ON: JUNE 12 , 2006 SAN RAMON, CA 94583 BY MAIL POSTMARKED: JUNE 09, 2006 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, Vei­4 Dated: JUNE 12 , 2006, By: Deputy H. FROM: County Counsel I TO: Clerk of the Board of Supervisors ( -his claim complies substantially with Sections 910 and 910.2. This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910,8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). O Otber- Dated: By: _Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) Claim was returned as untimely with notice to claimant (Section 911.3). IV BOARD ORDER: By unanimous vote of the Supervisors present- 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: " , ?,9,QgOHN CULLEN, CLERK, By Deputy Clerk WARPKN_�Gov. code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mad to rile a court action on this claim.See Government Code Section 945.6.You may seek the advice of au attorney of your choice in connection with this matter. If you want to consult mi attorney,you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of per that I am mow, and at all bines herein mentioned, have been q citizen of the United States, over age 18; and that today I deposited in the United States Postai Service in Martinez, California, postage fully prepaid a certified copy or this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: Za *AAWZ .10.HN CULLEN, CLERK By zk_64- '44_�uty Clerk June 9, 2006 Contra Costa County County Administration Building 651 Pine Street, Room, 106 Martinez, CA 94553 Attention: Clerk of the Boards of Supervisors Subject: Claim no. 60283 Vehicle;damage on March 22, 2006 Regarding: Damage reimbursement To Whom It May Concern: Enclosed please find our claim for reimbursement for the damages to our car per the aforementioned claim. We have included two (2)quotes for the repair of the vehicle along with pictures taken right after the accident. If you have any questions or need additional information, please call me at(510)773-8190. Thank you. Very truly yours, r Matt Cook o� 3 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 fiaudulent claims,Penal Code Sec. 72 at the end of this form. !!!!!!!!!!!!!!!!!!Q!i! NNEMMURNAM onus Q!C E 6!!I t i!Q■!NC Q!C D!G!!!!!!!!!!!!!!!L!!!as RE: Claim By: Reserved for Clerk's filing stamp Against the County of Contra Costa or j JUN 1 z District) CLERK BOARn Or rr �l;rf`I(8OR8 (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$_V and in support of this claim represents as follows: 1)2-+c> VZ I. When did the damage or injury occur? (Give exact date and hour) N�RRLH '2-2-! 200 4� � 17...•=t 5 Pr,.� 2. Where did the damage or injury occur? (Include city and county) 1 I M Pr(1 Kms,- P # S 4�Jr M c a� G►- 3. How did the damage or injury occur? (Give full details;use extra paper if required) CO3 OTV6* LX-- c�a. CM - Wt+LL- P,rr �--� A-r- -Mv— VACOON1. 4. %af-particular act or omission on the part of county or district officers, servants, or employees caused the injury or dama-se.? 5 What are the names of county or district officers,servants, or employees causing,the damage or injury? � C.�rtc� � w1rS Giv�„i �S� l�ct�,r.�tv�.-r�� I S f�.flr•� C�L.tu� Sr�"��— Seesoc..��. 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..) E:5,T1 Mk,(r_ f:i� V__11;1t.) %A-"P. 8. Names and addresses of witnesses,doctors, and hospitals: < > 9. List the expenditures you made on account of this accident or injury: DATE TBJE AMOUNT a MR an ORIN nNunn a K Gov. Code Sec. 910.2 provides"The claim shall be signed by the claimant or by some person on his behalf SEND NOTICES TO: (Attomev) Name and address of Attorney _(Cl ` ant's Signature) A- (Address) Telephone No. Telephone No. t o) wagon assuffmallwas a a a a a R a l a a R a a a a a a a a t a Naga RUN sows 0 as Be PUBLIC RECORDS NOTICE: Please be advised that this claim f6rin, 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 anus R226915*2as Kwastuss a a RUN Run sunwasnannusuz IN usans swans asuffasaawsw a RE a sawassuffunal NOTICE: Section 72 of the Penal Code provides: Every person who, with intent to defraud, presents for allowamce 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. 06/07/2006 at 12:53 PM Job Number: 62848 MAGNUSSEN'S CAR WEST DUBLIN Federal ID #:911995582 TOYOTA & LEXUS APPROVED REPAIR FACILITY 6077 DUBLIN BLVD DUBLIN, CA 94568 (925)829-5571 Fax: (925)829-4610 PRELIMINARY ESTIMATE Written By: Bill Crawford Adjuster: Insured: DANIELLE COOK claim # Owner: DANIELLE COOK Policy # Address: 529 VAN BUREN PL Deductible: SAN RAMON, CA 94583 Date of Loans Other: (925)833-1101 Type of Loses Other: (925)251-6350 Point of Impact: Inspect Location: Insurance Company: Days to Repair 2002 VOLV V70 5-2.4L-FI 4D WGN GREEN Int: VIN: YVISW61IR421211295 Lic: 5RJL820 CA Prod Dates odometers Air Conditioning Rear Defogger Tilt Wheel Cruise Control Telescopic Wheel Intermittent Wipers Auto Level Climate Control Keyless Entry Rear Window Wiper . Theft Deterrent/Alarm Steering Wheel Controls Body Side Moldings Dual Mirrors Traction Control Fog Lamps Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks Power Mirrors Power Trunk/Tailgate AM Radio FM Radio Stereo Cassette Search/Seek Anti-Lock Brakes (4) Driver Air Bag Passenger Air Bag Front Side Impact Air Bag 4 Wheel Disc Brakes Cloth Seats Bucket Seats 5 Speed Transmission Overdrive Aluminum/Alloy Wheels ------------•------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT --------------m FRONT BUMPER 2* Rpr Bumper cover RT SIDE H/L 1.0 2.4 3 Add for Clear Coat 1.0 4 0/H bumper assy 2.4 5 Repl RT Outer molding 1 31.41 Incl. 6 FRONT LAMPS 7 Repl RT Headlamp assy 1 348.08 0.4 e Aim headlamps 0.5 9# TINT COLOR 1 0.5 10# Subl HAZARDOUS WASTE 1 5.00 X 11# FLEX ADDITIVE 1 10.00 T 12# OPEN FOR ADDITIONAL DAMAGE 1 ----------- -------------------------------------------------------------------- Subtotals ==> 394.49 4.3 3.9 1 06/07/2006 at 12:53 PM Job Number: 62848 PRELIMINARY ESTIMATE 2002 VOLV V70 5-2.4L-FI 4D WGN GREEN Int: Parts 379.49 Body Labor 4.3 hrs O $ 82.00/hr 352.60 Paint Labor 3.9 hrs ® $ 82.00 /hr 319.80 Paint Supplies 3.9 hrs 0 $ 40.00 /hr 156.00 Sublet/Misc. 15.00 -------------------------------=-------------------- SUBTOTAL $ 1222.89 Sales Tax $ 545.49 @ 8.7500 Is 47.73 ---------------------------------------------------- GRAND TOTAL $ 1270.62 ADJUSTMENTS: Deductible 0.00 ---------------------------------------------------- CUSTOMER PAY $ 0.00 INSURANCE PAY $ 1270.62 Magnussen's Car West Auto Body Inc. warranties all body and paint repairs for life. FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM: ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORM: TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES: B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS: ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT - W/_=WITH/_ SYMBOLS: #=MANUAL LINE ENTRY *=OTHER [IE. .MOTORS DATABASE INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. MQVP=MANUFACTURER'S QUALIFICATION AND VALIDATION PROGRAM. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. c 2 06/07/2006 at 12:53 PM Job Number: 62848 PRELIMINARY ESTIMATE 2002 VOLV V70 5-2.4L-FI 4D WGN GREEN Int: Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide ERN9712 Database Date 04/2006, CCC Data Date 04/2006, and the parts selected are OEM-parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM (Optional OEM) parts are OEM parts that may be provided by or through alternate sources other than the OE/Vehicle dealerships. OPT OEM parts may reflect some specific, special, or unique pricing or discount. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign (-) items indicate MOTOR Not-Included Labor operations. Non-Original Equipment Manufacturer aftermarket parts are described as AM, Qual Repl Parts or Comp Repl Parts which stands for Competitive Replacement Parts. Used parts are described as LKQ, Qual Recy Parts, RCY, or USED. Reconditioned parts are described as Recon. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not included. Pound sign (#) items indicate manual. entries. Some 2006 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts data from the previous year may be used. The Pathways estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. CCC Pathways - A product of CCC Information Services Inc. 3 04/06/2006 at 01 : 48 PM Job Number: 21932 B & S HACIENDA AUTO BODY License 4 :AG161460 Federal ID 4 : 942464067 Quality isn ' t expensive it ' s priceless 3687 OLD SANTA RITA RD #27 PLEASANTON, CA 94588 (925) 847-8789 Fax : (925) 847-0804 PRELIMINARY ESTIMATE Written By: Fred Sanchez Adjuster : Insured: DANIELLE, COOK Claim # Owner: DANIELLE COOK Policy # Address: 529 VAN BUREN PL Deductible: SAN RAMON, CA 94583 Date of Loss: Day: (925) 36"]-7593 Type of Loss: Point of Impact: Inspect Location: Insurance Company: Days to• Repair 2002 VOLV V70 5-2 . 4L-FI 4D WGN BLUE Int : VIN: YV1SW61R4212:11295 Lic: 5RJL820 CA Prod Date: Odometer: Air Conditioning Rear Defogger Tilt Wheel Cruise Control Telescopic Wheel Intermittent Wipers Auto Level Climate Control Keyless Entry Rear Window Wiper Theft Deterrent/Alarm Steering Wheel Controls Body Side Moldings Dual Mirrors Traction Control Fog Lamps Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks Power Mirrors Power Trunk/Tailgate AM Radio FM Radio Stereo Cassette Search/Seek Anti-Lock Brakes (4) Driver Air Bag Passenger Air Bag Front Side Impact Air Bag 4 Wheel Disc Brakes Cloth Seats Bucket Seats 5 Speed Transmission Overdrive Aluminum/Alloy Wheels ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT . PRICE LABOR PAINT -------------------------------------------•------------------------------------ 1 FRONT BUMPER 2* Rpr Bumper cover w/lamp washer 1 . 0 2 . 4 w/fog lamps primed 3 Add for Clear Coat 1 . 0 4 Repl Add for h ' lamp washer 1 0 . 2 5 Repl Add for fog lamps 1 0 . 3 6 O/H bumper assy 2 . 4 7 Repl RT Outer molding 1 31 . 41 Incl . 8 FRONT LAMPS 9 Repl RT Headlamp assy 1 348 . 08 0 . 4 1 04/06/2006 at 01 : 4.8 PM Job Number : 21932 ` PRELIMINARY ESTIMATE 2002 VOLV V70 5-2 . 4L-FI 4D WGn BLUE Int : -------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT -------------------------------------------------------------------------------- 10 Aim headlamps 0 . 5 11 FENDER 12* Rpr RT Fender w/o XC 0 . 5 2 . 0 13 Add for Clear Coat 0 . 8 14 R&I RT Body side mldg 0 . 2 15 HOOD 16 Blnd Hood to CH# 487900 1 . 3 17 WINDSHIELD 18 R&I RT Washer nozzle 0 . 2 19 R&I LT Washer nozzle 0 . 2 20# Repl car cover 1 5 . 00 X 0 . 2 21# Repl flex coat additive 1 8 . 00 T 224 color tint 1 0 . 5 23# Rpr Color sand & polish 1 . 5 24# hazardous waste 1 3 . 00 X ------------------------------------------------------------------=------------- Subtotals =_> 395 . 49 8 . 1 7 . 5 Parts 379 . 49 Body Labor 8 . 1 hrs @ $ 78 . 00/hr 631 . 80 Paint Labor 7 . 5 hrs @ $ 78 . 00/hr 585 . 00 Paint Supplies 7 . 5 hrs @ $ 33 . 00/hr 247 . 50 Sublet/Misc . 16 . 00 ----------------------------------------------------- SUBTOTAL $ 1859 . 79 Sales Tax $ 634 . 99 @ 8 . 75000 55 . 56 ---------------------------------------------------- GRAND TOTAL $ 1915 . 35 ADJUSTMENTS : Deductible 0 . 00 ---------------------------------------------------- CUSTOMER PAY $ 0 . 00 INSURANCE PAY $ 1915 . 35 1) All work is guaranteed for the life of your ownership. We warranty workmanship and paint . 2) Life time guarantee on our 2 Stage Paint and 5 (five) Years on Single Stage paint . 3) All sublet repairs are warranteed for 1 year, wheel aligments have a 30 day warranty. 4) Damage due to improper care or act of nature will Void guarantee . EPA # 000000184 . Accepted by__ ----Date -------------- Year Make Model ---- - ---Model--------------- Authorization to begin repairs_ --------____--------___Date 2 04/06/2006 at 01 : 48 PM Job Number : 21932 ' . PRELIMINARY ESTIMATE 2002 VOLV V70 5-2 . 4L-FI 4D WGN BLUE Int : FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM: ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR ABBREVIATIONS/SYMBOLS : D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES : B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS : ADJ=ADJACENT ALGN==ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT . PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT 0/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QT`.C=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT W/ =WITH/ SYMBOLS : #=MANUAL LINE ENTRY *=OTHER [IE . .MOTORS DATABASE INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE . MQVP=MANUFACTURER' S QUALIFICATION AND VALIDATION PROGRAM. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT . Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide ERN9712 Database Date 03/2006, CCC Data Date 03/2006, and the parts selected are OEM-parts manufactured. by the vehicles Original Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM (Optional OEM) parts are OEM parts that may be provided by or through alternate sources other than the OE/Vehicle dealerships. OPT OEM parts may reflect some specific, special, or unique pricing or discount. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign. (-) items indicate MOTOR Not-Included Labor operations. Non-Original Equipment Manufacturer aftermarket parts are described as AM, Qual Repl Parts or Comp Repl Parts which stands for Competitive Replacement Parts. Used parts are described as LKQ, Qual Recy Parts, RCY, or USED. Reconditioned parts are described as Recon. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National .Auto Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times . NAGS labor operation times rare not included. Pound sign (#) items indicate manual entries . Some 2006 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts data from the previous year may be used. The Pathways estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. CCC: Pathways - A product of CCC Information Services Inc. 3 County Administrator Contra Risk Management Division Costa 2530 Arnold Drive, Suite 140 County Liability Claims (925) 335-1440 Martinez, California 94553 COU Fax Number (925) 335-1421 March 28, 2006 ST'4 COVN Matthew Cook 529 Van Buren PI San Ramon, CA 94583 Re:. Claimant: Matthew Cook Insured: Contra Costa County D/Accident: 03/22/2006 Claim No.: 60283 Dear Mr. Cook: The above:'captioned matte;:•has been referred to my office for investigation and handling on behalf of the Contra Costa County Department of Agriculture. I have enclosed a claim form that must be competed in order to file a formal claim against the County. Be advised that you have six months from the accident date to file a formal claim as stated in the California Government Code beginning with Section 900. This also notifies you that you must comply with the claims presentation and timely suit tiling requirements of California law in order to preserve your claim. Our investigation of vour claim does not affect your,duty to comply with time limits set by law, and by investigating, considering, and discussing your claim with you or your representative, we do not waive our right to assert your failure to comply with those time limits as a complete defense to any claim or action you may bring. Should you have any questions, please do not hesitate to contact the undersigned. Sincerely, d ... Penny Bailey. Liability Claims-Adjuster 925-335-1455 I o � v N �N � d m CP ""'•• � N O �d7 O N V� 6 E a o 0 00 V r f/ <u �� ����AA��ti rt• � s r� Rr ,040C� .. A y Y • e .� .q. ..� qy f��#J!'�" � ��., � Ail',✓ - ()j,(* L a c..� Cyd CIO ilk 4.0 IN It a , ���tib pY'� ki•$, �?�A�.�i�.� fi� � � ��A ` ���� \ \ �~q' � - }+ - � 1 s CN 13 0 �s t ! f P �{ter,,-1,'' _ ;•� ,� �g�r -�;' + :F + +r„ '' ('•'�f �r i 4 P '� � ��"r1 t, Af,�a*` �'i' `k..`i� 70 c w `/�,� ,.. -� 4r1`�t"f\ t• `t �+ nC�.. tJ . 1 (` j'�r " N L•.'•� � .. rt - ��`} A r ,y`ft� t 'C��r,_ � 7:vl-6 t'� ,.� ye �\ � l'•: -'%%"�i:- �r • _ , r G�s,�, gip.; �-,v � >�� � �r�`-� �� -, .� � 9 ` r m n k L 5 _J 77 if fi All t , 'c r � k= o F t t � ��� °+" �' �+ ,F ': j t�ts �• � r/# �� .... ...._. _ fi t � �� ��5 ,.sem+:, yyXX,�a �[�s�ps"�+; ,��-. � .� = = � _ rcq ,�- _ M/f�� � _.-- � � � . ��. A�� .%.� 1 rte�� S$'`v r .'ti. • � ' l. � fi �� � � J ,� �/ 5 �.�pig r rii �; �� � ,.,-. 1 � ," r �k^.. �-r,�. �. :���' ���� f«' � �r �. ,�,; �11�� f� � i ���r� .�`, ,�� �.� Xf ;, a June 9, 2006 COPY Contra Costa County County Administration Building 651 Pine Street, Room 106 Martinez, CA 94553 Attention: Clerk of the Boards of Supervisors Subject: Claim no. 60283 Vehicle;damage on March 22, 2006 Regarding: Damage reimbursement To Whom It May Concern: Enclosed please find our claim for reimbursement for the damages to our car per the aforementioned claim. We have included two (2) quotes for the repair of the vehicle along with pictures taken right after the accident. If you have any questions or need additional information, please call me at(510)773-8190. Thank you. Very truly yours, J. Matt Cook 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 eacli. public entity. E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. RNA S■S U■MR t U■I It AN S U It U URN MR S■U U R C S U AN S i U S S Z S S S U S S S Sr.X Kit II an USE a IN U SSS I IV UK MR L I S R t RE: Claim By: Reserved for Clerk's Mina stamp Against the County of Contra Costa or ) ) District) (Fill in the name) )' The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$�NA-9)5- -VEand in support of this claim represents as follows: 1 2--4r, 04 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) 1 C711 1 M aft"Ir FL*c4-z- I S.4,1 CAM o. 11 AA-X-e4t.0 CI A-> 3. How did the damage or injury occur? (Give full details;use extra paper if required) COJOT Vett-r-- r aT;6. Wf-- Cvt-- wr�Lc- Pkszyc - � arr- -rr VkcuoM sk� ArrAert,�� 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damagz? 5 What are the names of county or district officers,servants, or employees causing the damage or injury? t� C�2 a � w k5 G►V E„� ��� A�rc'.r�--�� 1� -f�.o�.� C�.L►u� 5 Ef,�� - S��o c..~-. +k' k-Abr-r�5c- TAJO. 6. What damage- or injuries do your claim resulted? (Give fall extent of injuries or damages claimed. -Attach two estimates for auto damage.) fyto-jr- awq -L-m-AA4c -r& C r(ZZ'__A 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: 9. List the expenditures you made-on account of this accident or injury: DATE TIME AMOUNT a a a Ran Sax Man am a an an WIN a a a an Is man as a saxm Runs gnu an as an an snags xx an MR affellssull MR MR x a Rants a a 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: (Attorne-0 Name and address of Attorney (Cl s Signature) (Address) CAL Telephone No. )Telephone No, Man 11131sult MR a a 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. a none on 1 211113111111111 swilasman 9 IS 1111%swig 2 0 a on 0 1111mammullnum a Una mass a 51121 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, an e y false or fi-audulent 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 0 imprisonment and fine, or by imprisonment in the state pris by a fine of not exceeding t n thousand dollars ($10,000),or by both such imprisonment and fine. 06/07/2006 at 12:53 PM Job Number: 62848 MAGNUSSEN'S CAR WEST DUBLIN Federal ID #:911995582 TOYOTA & LEXUS APPROVED REPAIR FACILITY 6077 DUBLIN BLVD DUBLIN, CA 94568 (925)829-5571 Fax: (925)829-4610 PRELIMINARY ESTIMATS Written By: Bill Crawford Adjuster: Insured: DANIELLE COOK Claim # Owner: DANIELLE COOK Policy # Address: 529 VAN BUREN PL Deductible: SAN RAMON, CA 94583 Date of Losse Other: (925)833-1101 Type of Loss: Other: (925)251-6350 Point of Impacts Inspect Location: Insurance Company: Days to Repair 2002 VOLV V70 5-2.4L-FI 4D WGN GREEN Int: VIN: YVlSW61FZ421211295 Lic: 5RJL820 CA Prod Date: Odometer: Air Conditioning Rear Defogger Tilt Wheel Cruise Control Telescopic Wheel Intermittent Wipers Auto Level Climate Control Keyless Entry Rear Window Wiper . Theft Deterrent/Alarm Steering Wheel Controls Body Side Moldings Dual Mirrors Traction Control Fog Lamps Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks Power Mirrors Power Trunk/Tailgate AM Radio FM Radio Stereo Cassette Search/Seek Anti-Lock Brakes (4) Driver Air Bag Passenger Air Bag Front Side Impact Air Bag 4 Wheel Disc Brakes Cloth Seats Bucket Seats 5 Speed Transmission Overdrive Aluminum/Alloy Wheels ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1 FRONT BUMPER 2* Rpr Bumper cover RT SIDE U H/L 1.0 2.4 3 Add for Clear Coat 1.0 4 O/H bumper assy 2.4 5 Repl RT Outer molding 1 31.41 Incl. 6 FRONT LAMPS 7 Repl RT Headlamp assy 1 348.08 0.4 8 Aim headlamps 0.5 9# TINT COLOR 1 0.5 10# Subl HAZARDOUS WASTE 1 5.00 X 11# FLEX ADDITIVE 1 10.00 T 12# OPEN FOR ADDITIONAL DAMAGE 1 ------------------------------------------------------------------------------- Subtotals ==> 394.49 4.3 3.9 1 06/07/2006 at 12:53 PM Job Number: 62848 PRELIMINARY ESTIMATE 2002 VOLV V70 5-2.4L-FI 4D WGN GREEN int: Parts 379.49 Body Labor 4.3 hrs O $ 82.00 /hr 352.60 Paint Labor 3.9 hrs a $ 82.00 /hr 319.80 Paint Supplies 3.9 hrs ® $ 40.00 /hr 156.00 Sublet/Misc. 15.00 -------------------------------=-------------------- SUBTOTAL $ 1222.89 Sales Tax $ 545.49 ® 8.7500 96 47.73 ---------------------------------------------------- GRAND TOTAL $ 1270.62 ADJUSTMENTS: Deductible 0.00 ---------------------------------------------------- CUSTOMER PAY $ 0.00 INSURANCE PAY $ 1270.62 Magnussen's Car West Auto Body Inc. warranties all body and paint repairs for life. FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM: ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK. TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES: B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS: ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE R.PR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT W/ =WITH/_ SYMBOLS: #=MANUAL LINE ENTRY *=OTHER [IE. .MOTORS DATABASE INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. MQVP=MANUFACTURER'S QUALIFICATION AND VALIDATION PROGRAM. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. 2 06/07/2006 at 12:53 PM Job Number: 62848 PRELIMINARY ESTIMATE 2002 VOLV V70 5-2.4L-FI 4D WGN GREEN Int: Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide ERN9712 Database Date 04/2006, CCC Data Date 04/2006, and the parts selected are OEM-parts manufactured by the vehicles original Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM (Optional OEM) parts are OEM parts that may be provided by or through alternate sources other than the OE/Vehicle dealerships. OPT OEM parts may reflect some specific, special, or unique pricing or discount. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign (-) items indicate MOTOR Not-Included Labor operations. Non-Original Equipment Manufacturer aftermarket parts are described as AM, Qual Repl Parts or Comp Repl Parts which stands for Competitive Replacement Parts. Used parts are described as LKQ, Qual Recy Parts, RCY, or USED. Reconditioned parts are described as Recon. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not included. Pound sign (#) items indicate manual entries. Some 2006 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts data from the previous year may be used. The Pathways estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. CCC Pathways - A product of CCC Information Services Inc. 3 -04/06/2006 at 01 : 48 PM Job Number : 21932 ' B & S HACIENDA AUTO BODY License # :AG161460 Federal ID # : 942464067 Quality isn ' t expensive it ' s priceless 3687 OLD SANTA RITA RD #27 PLEASANTON, CA 94588 (925) 847-8789 Fax: (925) 847-0804 PRELIMINARY ESTIMATE Written By: Fred Sanchez Adjuster : Insured: DANIELLE COOK Claim # Owner: DANIELLE COOK Policy # Address: 529 VAN BUREN PL Deductible: SAN RAMON, CA 94583 Date of Loss: Day: (925) 367-7593 Type of Loss: Point of Impact: Inspect Location: Insurance Company: Days to Repair 2002 VOLV V70 5-2 . 4L-FI 4D WGN BLUE Int : VIN: YV1SW61R42121.1295 Lic: 5RJL820 CA Prod Date: Odometer: Air Conditioning Rear Defogger Tilt Wheel Cruise Control Telescopic Wheel Intermittent Wipers Auto Level Climate Control Keyless Entry Rear Window Wiper Theft Deterrent/Alarm Steering Wheel Controls Body Side Moldings Dual Mirrors Traction Control Fog Lamps Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks Power Mirrors Power Trunk/Tailgate AM Radio FM Radio Stereo Cassette Search/Seek Anti-Lock Brakes (4) Driver Air Bag Passenger Air Bag Front Side Impact Air Bag 4 Wheel Disc Brakes Cloth Seats Bucket Seats 5 Speed Transmission Overdrive Aluminum/Alloy Wheels -------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT . PRICE LABOR PAINT -------------------------------------------------------------------------------- 1 FRONT BUMPER 2* Rpr Bumper cover w/lamp washer 1 . 0 2 . 4 la/fog lamps primed 3 ;Add for Clear Coat 1 . 0 4 Repl Add for h ' lamp washer 1 0 . 2 5 Repl :Add for fog lamps 1 0 . 3 6 O/H bumper assy 2 . 4 7 Repl RT Outer molding 1 31 . 41 Incl . 8 FRONT LAMPS 9 Repl RT Headlamp assy 1 348 . 08 0 . 4 1 • 04/06/2006 at 01 : 48 PM Job Number : 21932 PRELIMINARY ESTIMATE 2002 VOLV V70 5-2 . 4L-FI 4D WON BLUE Int : ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT . PRICE LABOR PAINT ------------------------------------------------------------------------------- 10 Aim headlamps 0 . 5 11 FENDER 12* Rpr RT Fender w/o XC 0 . 5 2 . 0 13 Add for Clear Coat 0 . 8 14 R&I RT Body side mldg 0 . 2 15 HOOD 16 Blnd Hood to CH# 487900 1 . ? 17 WINDSHIELD 18 R&I RT Washer nozzle 0 . 2 19 R&I LT Washer nozzle 0 . 2 204 Repl czar cover 1 5 . 00 X 0 . 2 21# Repl. f:lex coat additive 1 8 . 00 T 22# color tint 1 0 . 5 23# Rpr Color sand & polish 1 . 5 24# hazardous waste 1 3 . 00 X -------------------------------------------------------------------------------- Subtotals =_> 395 . 49 8 . 1 7 . 5 Parts 379 . 49 Body Labor 8 . 1 hrs @ $ 78 . 00/hr 631 . 80 Paint Labor 7 . 5 hrs @ $ 78 . 00/hr 585 . 00 Paint Supplies 7 . 5 hrs @ $ 33 . 00/hr 247 . 50 Sublet/Misc . 16 . 00 ---------------------------------------------------- SUBTOTAL $ 1859 . 79 Sales Tax $ 634 . 99 @ 8 . 75000 55 . 56 ---------------------------------------------------- GRAND TOTAL $ 1915 . 35 ADJUSTMENTS : Deductible 0 . 00 ---------------------------------------------------- CUSTOMER PAY $ 0 . 00 INSURANCE PAY $ 1915 . 35 1) All work is guaranteed for the life of your ownership. We warranty workmanship and paint . 2) Life time guarantee on our 2 Stage Paint and 5 ( five) Years on Single Stage paint . 3) All sublet repairs are warranteed for 1 year, wheel aligments have a 30 day warranty. 4) Damage due to improper care or act of nature will Void guarantee . EPA # 000000184 . Accepted by-----------------------------------Date -------------- Year Make Model ---- --------------------- -------------- Authorization to begin repairs---------------------------Date 2 • 04/06/2006 at 01 : 48 PM Job Number : 21932 ` PRELIMINARY ESTIMATE 2002 VOLV V70 5-2 . 4L-FI 4D WGN BLUE Int : FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM: ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR ABBREVIATIONS/SYMBOLS : D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES : B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT LABOR S=STRUCTURAL, T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS : ADJ=ADJACENT ALGN==ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT . PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT 0/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT W/ =WITH/ SYMBOLS : #=MANUAL LINE ENTRY *=OTHER [ IE . .MOTORS DATABASE INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE . MQVP=MANUFACTURER' S QUALIFICATION AND VALIDATION PROGRAM. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT . Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide ERN9712 Database Date 03/2006, CCC Data Date 03/2006, and the parts selected are OEM-parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM (Optional OEM) parts are OEM parts that may be provided by or through alternate sources other than the OE/Vehicle dealerships. OPT OEM parts may reflect some specific, special, or unique pricing or discount . Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign (-) items indicate MOTOR Not-Included Labor operations. Nen-Original Equipment Manufacturer aftermarket parts are described as AM, Qual Repl Parts or Comp Repl Parts which stands for Competitive Replacement Parts. Used parts are described as LKQ, Qual Recy Parts, RCY, or USED. Reconditioned parts are described as Recon. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications . Labor operation times .listed on the ].,rie will the NAGS information are MOTOR suggested labor operation times. NAGS labor operat ;r: r..._ _ not included. Pound sign (#) items indicate manual entries . Some 2006 ven_cles :_or.ta_n rico= changes from the previous year. For those vehicles, prior to receiving updated d,- .a fray i:e vehicle manufacturer, labor and parts data from the previous year may be used. The Pathways estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. CCC: Pathways - A product of CCC Information Services Inc. 3 County Administrator Contra • Risk Management Division Costa 2530 Arnold Drive, Suite 140 Martinez, California 94553 County Liability Claims (925) 335-1440 Fax Number (925) 335-1421 �E:--- _•;oma March 28 2006 co Sr'9 couN' Matthew Cook 529 Van Buren PI San Ramon, CA 94583 Re: Claimant: Matthew Cook Insured: Contra Costa County D/Accident: 03/22/2006 Claim No.: 60283 Dear Mr. Cook: The above captioned matter has been referred to my office for investigation and handling on behalf of the Contra Costa County Department of Agriculture. I have enclosed a claim form that must be completed in order to file a formal claim against the County. Be advised that you have six months from the accident date to file a formal claim as stated in the California Government Code beginning with Section 900. This also notifies you that you must comply with the claims presentation and timely suit filing requirements of California law in order to preserve your claim. Our investigation of vour claim does not affect voter duty.to comply with time limits set by law. and by investigating, considering, and discussing your claim with you or your representative, we do not waive our right to assert your failure to comply with those time limits as a complete defense to any claim or action you may bring. Should you have any questions, please do not hesitate to contact the undersigned. Sincerely; `' Penny Bailey Liabilitv Claims Adjuster 925-335-1455 � 1 Z5 C +nOR �x �CUt�v•�T UN" fn u�'n c mo a� 01 vv oa Ems' V U Ln Ln�v o.t° c U (D °N-'rn CD d cciiv °) i r �� 000 UUU 4 • Y k( F r {' Oyu'` �*`5` s ;.,-, a �t� x� r� i i - { t�Y �,• "� �` yam. r lk S dIR,��,jjJJ '..7 17 i �j� f rr Nlr'i �4,. � dye �'{�jr�t�~'� "•�� �� 1 {t f c 7� ;�{ #,{ S,. 3 f L r �i � "A P A Y'•j�t;y•ty1 rr �. s .�. �.s ���. r pig,", �- n x a ' t j� ,� I.°_'YJ.7�i,V tr..'r`yYf �t •i �t a W:��-"�~, Jam. ,t $ t r, r��"•-`�� 1 � fit' �.�4�.� `l- ¢ , t} � �'' k� rt �' a -{/��g� K `k4 •1�.vrtt^...-W1f.°.f.+/..✓''+'f' w �4 � �t'�111 t ��r ¢ �R' t�v�a�'4� W,n'(.#tt'b.v r",*fid✓baa ;a'r�'•� ,.4 u , i k i�x v j{ N S1 b a � ,. Vic. ... .. `ase .' �-'R � — ,5 v ➢,��� i.�r`' k R y�I $ xg � z f mr ri .i &� OUT, ;�*�- mE� ..� ,. ..., �� � „y„�yk .a ���.�k ae»*c' 4 � � ✓o.�.�y�5� r � � ?�� 3 R yt _ `4a 4�a pp e, z a e . T• '. 1i c,n ,.. t A.a✓g� Ay..f4 43 .rC. nr a c RN z e ,n s ,rr a a + n .r� 3!DVISOd sn O of p 0 N 9 �. LO - CLO 0) !: c U)o Cl- o cn > U315'dH UJ L � ' q D� LLJ cc fr LLI U -7 o Y it 00 en t ' LH o kn CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JULY 11, 2006 Clain't Against I lie County, or District Governed by q 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), JUN 12,2 D given Pursuant to Government Code COUNTY COUNSEL Section 913 and 915.4.Please note all AMOUNT: 345 .00 MARTINEZ CALIF. "Warnings". CLAIMANT: CHRISTOPHER E. DODD ATTORNEY- UNKNOWN DATE RECEIVED: JUNE 12 , 2006 ADDRESS: 1846 ELKWOOD DRIVE .BY DELIVERY TO CLERK ON: JUNE 12 , 2006 CONCORD, CA 94519-1122 JUNE 09, 2006 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: 'County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, le k Dated: JUNE];` 12 , 2006 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 arid 910.2. This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910,8). O Claim is not timely filed, The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). O Other: Dated By: Deputy County Counsel Ill. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) Claim was returned as untimely with notice to claimant (Section 911.3). IV BOARD OR-DER: By unanimous vote of the Supervisors present: This Claim is rejected in full. O Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Date / A60 % 60 JOHN CULLEN, CLERK, By eputy Clerk WA91MGov. code section 913) Subject to cerfain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the tuail to rile a court action oil this claim.See Government Code Section 945.6.You may seek the advice of I-ill attorney of your choice in connection with this inatter. If you want to consult an attorney, -Additional Warning See Reverse Side of This Notice. ttorney,you should do so iminediately. *For AFFIDAVIT OF MAILING I declare under penalty of per juty that I am now, and at all times herein mentioned, have , been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: AeQAOa JOHN CULLEN, CLERK By puty Clei-k Q2 =-/-------- BOARD OF SUPERVISORS OF CONTRA COSTA COLFNTY NbT06:INSTRUCTIONS TO CLADIANT 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 § g 11.2.) 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 eacli. public entity. E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form.. sss■ssssssssssasasmmsessssssmsssessassseseersssssss= IN asun senssssrRssssssssessss1 .z RE: Claim By: Reserved for Clerk's filing stamp Against the County of Contra Costa or ) JON C� Glt t �.� _ _ CQC _� ©� District) (Fill in the name) pvL �j X053 The undersigned claimant he e makes claim against the County of Contra Costa or the above-named district in the sum of$� #-00 and in support of this claim represents as follows: .a. 1. When did the damage or injury occur? ( ive exact date andh ur) { Ae �b ,�© w �OPWLX 2. Where did the damage or injury occur? (Inclu e city and county) o 3. How did the damage or injury occur? (Give full details;use extra paper if requireka— Ga� I- 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? 0� 5 What are the names of county or district officers servants, or employ es causing the ��"+ �- .17 damage or iii ur ? ` V a� &W What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) - r ✓ C -P VLJD �c . 7. How was the amount claimed above computed? riudoe the estimated amount of any prospective injury or damage.) { Z- C(q M�WYk4 8. Names and addresses of witnesses,doctors, and hospitals: --1�- 9. List the expenditures you made on account of this accident or injury: DATE � TIlvIE AMO UNT ' ►� k' ��c ��a itiiQ 0 XYlim�nes^hr�s�ar a��C�"a :�s a�a■ ■a aiY�`r fGlilGia� i'.Z&'4UlmaVW ) .Gov. Code Sec. 910.2 provides"The claim shall be ) signed by the claimant or by some person on his behalf." f SEND NOTICES TO: (Attorney) d 41vt1 ar Name and address of Attorney ) -So U4(ct_ Signature) c (Address) CnWOKAZ Telephone No. )Telephon No. b ■■II ■t"-'Lara a. ■ Y` .1 � ■.�..■�r Lt M a X Xk=1 X t l t R ff M t t t t if a I t t K t t a t 5 t t K t 9 K X s at A: PUBLIC RECORDS NOTICE: Please be advised that this claim farm., 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 I n I N I I t I I I I I l I I I I i I I I I i I i i I I i I I I I I I I/I I I I I i I I I!I I I/I I I I I I I I I I I I I as f i i I I W I I I I I I I I I I i 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 clam', 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. �L �'�`�� G✓ ( �0�� j 4 6L4 A �a *PW4 CtINTRA COSTA REGIONAL MEDICAL CENTER 1 f1 CONTRA COSTA HEALTH CENTERS G� I 1 . PATIENT COMPLAINTIGRIEVANCE4 �, DD NOT PLACE iN ART Date of�Coo plain2Time lob'Patlent ❑ Visitor 0 Other How C plaint Received: Written El Phone ❑ fn-Person ❑CCHPj ID: Imprint 't ID/ & do �� r Complaint Taken By: card or include Warne, record number, date of berth;address and phone number. ;SITE 13 ❑2B Surgery Suite 10 ❑ 5D-5urgioal 21 ❑Mary 30 ❑BHC 32 ❑ PHC t i ❑ MAW 29 ❑5D-Pediatrics 22Grounds/Hallways 310 CNG 330 RHC 3 0 3D-Critical Care Unit • 23 ❑Laboratory 37 Q AHC 38 01 Bay Point 5 O 3E-Intermedlate Care 14 5/3B,EmergericyDbot 24 0 Lobby . °39 O`NRCFi 2 ❑4A-Medical 9::D SC-Psych.ER Services 25❑Pharmacy 4 ❑ 413-Medical 15 ❑Martinez,FPC/Spec Clinic 26 ❑Rehab Therapy 50 ❑ Mental Health 7 ❑4C-Psychiatric 18 ❑Cardiopulmonary. 51 ❑Public Heatlh 8 ❑41)-Psychiatrfo-e. 20 ❑Diagnostic Imaging 27 ❑Other 52 ❑ Home Health 6 ❑5A&B-Perinatal/Newborn53 ❑Other 44 O 5G-PostPart/Med/Surg PEPARTNIENT CODE 201 ❑Appointment unit 206❑Financial Counseling 2'110 Mental Health . 215❑Public Health . 2020 CCHPStaff, 207 Housekeeping 212 Q Nursing 2170 Registration 203❑ Dental 208:❑Laboratory. 21.3 U pharma221.❑Therapcy ,220❑Business office Staff 204❑ .iagnostic-imaging:• 209❑Medical Records 214❑ Provider. y, ry 205 Emergency Dept 210❑Medical Social Services ❑ Family Practitioner(280) 222 01 No Specific Dept involved O Specialist (281) 219❑'Other CHECKAPPLICABLE PROBLEMS ACCEPTABiLITY ACC(ILITY PROBLEMS 401 ❑ Cancelled Clinics QUA[t1)-OF CARE/PRO'VIDER 301 Emergency Coverage 403 ❑ C4mf6rf/surroundings. 541 [" ouitesjr/Concern for patient. 302 ❑ Handicap 404 O Communication Problems 502 Q ffiagnosWTreatment Concems 303 ❑ Hours of Operation too limited 405 0 isciimination w503 ©'Treatment 6plariatlon a04 ❑ Waiting Time Appointment 407 tZ Scope of Service too lirr4ted 505 ❑ Unhappy with 166k of MD continuity 305 ❑ Transportation 408 ❑ Staff Attitude(non-providers) 504 Q Other Quafityof Care Issues 306 O Urgent Care Coverage 409 ❑ Translation Problems Provider!Name:, 807 0Waiting Room Time for Services 414 ❑ Other Acceptability.issues 309 ❑ Advice Nurse Telephone Line 415:O Benefit/Coverage changes too busy/not answered 416 0/Patient Requested Fcrrris/hot completed MISCELLANEOUS . 311 O Appointment Unit Phone 417 (i Patient Notification Problem 801 ❑ Address/Phorie Change Line busy 418 ❑ Confidentiality, privacy 802 ❑ General Correspondence 312 ❑ Parking Problems CLAiMS/BILL PROBLEMS. . 805 ,O mplaint about another patient 313 ❑ Unable to Reach Provider 703 ❑ Lost Valuabies/Property 807 5; Change/Update Information 314 ❑ Unable to Reach Non-Providers 704 CV/Out of Plan services 808 ❑ BAC Policy Problem 308 ❑ Other Access Issues 706 [� Other Claims or,Billing Issues 806,,❑j.Other non-classifiable issues OMBUDSPERSON I DEPARTMENT MANAGER FOLLOW-UP PRINT name of employee resolving complaint: PRINT name of employee complaint referred to: date-__j�-/ Follow-up performed: Response within 30 days? OYes ONo: DATE COMPLAINT RESOLVED: date F/R /5 nc� G w o�— ��eTu� �ELy , ,� �- i �- , m � o�v��1 � �� 01W P-( 4v MuuF4 a �wQc el'�-- dt wo'1 F�VE ✓�1'`� iwY .Av �nX�c 0.,m ..................... --- ---- .......... ...................... .................. .............. ............. ------------ ..............ik) ---- .. -1-FoR w� o ................ �7 � FPR �T�Yh �AjT � r£NnERd,F�rcy .. f . . �uuR��i -cd� � Yz�e t�� �yeW Ati�. . . ......... .... .......................... Dv--- ................... ............... .............................. 0(� NIJFJ- �� N ............. . ........... . ............. cc ' - _ out 4,fC........... c r", �� �� ��5- dos� �a3 ��C� ��t``� G�'� ua S BAR:AD239200 FCC COLLISION CENTERS - MILPITAS RO#013484 EPA:CAL000293699 1416 SOUTH MAIN STREET Date: 2/6/2006 MILPITAS,CA 95035 Time: 10:52:20AM (408)-263-9999ax: ( ) F408 -263-6402 Final Bill Page 1 of 5 Make: 2005 Chevrolet METLIFE AUTO&HOME CHRISTOPHE DODD Model: C1500 4X2 SILVERADO PO BOX 419029 1846 ELKWOOD DR Style: 4D PIU ST LOUIS,MO 63141 CONCORD,CA 94519 License: 7W25170 Color: GREY Adjuster: Team, Claims Resolution Home: (925)689-2245 VIN: 2GCEC13T251312678 Ins.Co.Phone (800)854-6011 x Work: (925)646-5549 Mileage: 8,519 Claim#: SLB44359 6 Est.: JOHN KIM Hat No.: METLIFE Date of Loss: 12/17/2005 Scheduled: 2/1/2006 Arrival: 2/1/2006 Unit No.: Source: *** Thank you for coming to our shop for your repairs. *** Line Line Items Price Labor Paint Other 1 Overhaul O/H bumper assy[FRONT BUMPER] 117.80 BI j 2 Repl OPT OEM Bumper chrome w/o heavy duty 363.450 [FRONT BUMPER] 3 Repl OPT OEM Cap w/o heavy duty[FRONT 106.290 74.40 R BUMPER] 4 Add for Clear Coat[FRONT BUMPER] 12.40 R 5 Repl OPT OEM Air deflector w/o fog lamps w/o 92.720 [FRONT BUMPER] 6 Repl LT Filler[FRONT BUMPER] 17.55 D 12.40 B 7 Repl LT Mount brace 1/2 ton[FRONT BUMPER] 21.33 D 18.60 B 8 Repl OPT OEM LT Park/turn/side [FRONT LAMPS] 79.870 18.60 B 9 Repl A/M FLEX ADDITIVE 5.00 A 10 Repl A/M CORROSION PROTECTION 13.95 A 12.40 B 11 Repr TINT COLOR 31.00 B 12 Sublet HAZARL)OUS WASTE REMOVAL [FRONT 5.00 L LAMPS] 13 Repl LT Support;[FRONT LAMPS] 20.60 D 18.60 B 14 Repl Aim headlamps [FRONT LAMPS] 31.00 B 15 R&I RT Headlarnp assy[FRONT LAMPS] 24.80 B 16 R&I RT Park/turn/side[FRONT LAMPS] 18.60 B 17 Repr Radiator support 310.00 B 62.00 R 18 Repr LT Fender Chevrolet US built 248.00 B 136.40 R 19 Overlap Minor Panel[FENDER] -12.40 R! 20 Add for Clear Coat[FENDER] 49.60 R 21 Refin DEDUCT FOR SPOT PAINT -31.00 R 22 R&I LT Fender liner all w/heavy duty 24.80 B 23 Blend LT Outer panel 74.40 R 24 R&I LT Body side mldg Chevrolet black 18.60 B 25 Repr CLEAN AND RETAPE MLDG 12.40 B 26 R&I LT Belt w'strip 18.60 B 27 R&I LT Mirror w/o folding type 24.80 B 28 R&I LT Handle,outside w/o luxury pkg 24.80 B 29 R&I LT R&I trim panel 24.80 B 30 Paint Materials 153.40 P ' e BAR:AD239200 FCC COLLISION CENTERS - MILPITAS RO#013484 EPA:CAL000293699 1416 SOUTH MAIN STREET Date: 2/6/2006 MILPITAS, CA 95035 Time: 10:52:20AM (408)-263-9999 Fax: (408)-263-6402 Final Bill Page 2 of 5 Make: 2005 Chevrolet METLIFE AUTO&HOME CHRISTOPHE DODD Model: C1500 4X2 SILVERADO PO BOX 419029 1846 ELKWOOD DR Style: 4D P/U ST LOUIS,MO 63141 CONCORD,CA 94519 License: 7W25170 Color: GREY Adjuster: Team, Claims Resolution Home: (925)689-2245 VIN: 2GCEC13T251312678 Ins.Co.Phone (800) 854-6011 x Work: (925)646-5549 Mileage: 8,519 Claim#: SLB44359 6 Est.: JOHN KIM Hat No.: METLIFE Date of Loss: 12/17/2005 Scheduled: 2/1/2006 Arrival: 2/1/2006 1 Unit No.: Source: *** Thank you for coming to our shop for your repairs. *** Totals Total$ Parts,Aftermarket(A) 18.95 Parts,Domestic(D) D3.00%($1.78) 57.70 Parts,Reconditioned(0) 642.33 -------------- Parts Total 718.98 Labor,Body(B) 1,010.60 Labor,Refinish(R) 365.80 -------------- Labor Total 1,376.40 Paint(P) 153.40 Sublet Labor(L) 5.00 -------------- Other Total 158.40 -------------- Subtotal 2,253.78 SALES TAX (Rate=8.250%) 71.97 Total 2,325.75 Deductible 500.00 Insurance Total 1,825.75 Customer Due 500.00 REPORT OF TRAFFIC ACCIDENT DfVIvUSE ONLY > OCCURRING IN CALIFORNIA A Public Service Agency READ IMPORTANT INFORMATION ON BACK � � AS APPROPRIATE,PLEASE TYPE OR PRINT IN BOXES 6 , � , SOFVEHKLES OATEOFACGDEM ACGDEMLOCATION-CnYJCOUNTY tAONLYj FONIVATE PROPERTY L:1.1tA !`4. VYesNo TIME OF ACCIMNT , G FOR EMPLOYER Hour opped '�' 0 M @ M1 ovin9 ❑st ❑Parked ❑Pedestrian ❑Bicyclist ❑Other(E.c.RoLLAwAr1Yes o ❑ In Tl�ffiC n DR�IV!ER LICENSE NUMBER STATE D R'S E FIRST,M A$j) r � ! ' O . ML OR , 'S TREETADDRESS �)) \\"\\ `•+ NO DATEOFBIRTH 043 U. CITY/ STATE ZIPCODE TELEPHONENUMB/ERS t z 1./ �'t �,.. Wk( r'� Hm VEHICLE(YEARANDMAKE) VE CLEUCENSEPLATEORVEHICLE DENTIFI NUMBER STIP y SOVERST50 Cl V ' U/�. `1 Yes No Q £ ER�ERS OR COMPANY DATE OFeiRTM 'Z ADDRESS CITY STATE ZIPCODE AO. INSURANCE COMPANY NAME TA TORBROK{ERJATTHETjI THE ACCIDENT POUCYNUMBER /( •, �{�''� COMPANY NAiCNUMBER�POIJCYPEUIHOLDER)M.E� -ice 25322 From: To': DRMNG FOR EM YER Moving ❑Stopped in Traffic ❑Parked ❑Pedestrian ❑Bicyclist ,❑Other(EG.RO LAIMAY) FlYes Na DRIVER'S NAME(FIRST MIDDLE.LAST) DRIVER LICENSE NUMBER STnE ODRIVERSSTREETADDRESS DATE OF BIRTH a CITY STATE ZIP CODE TELEPHONE NUMBERS HVk( } Hm x VEHICLE(YEAR AND MAKE) VEMtCLE LICENSE PLATE OR VEHICLE IDENTIFICATION NUMBER STATE CAM S OIV'FR$T50 T N Yes No VEHICLE OWNER-PERSON OR COMPANY DATE OF BIRTH a ADDRESS CITY STATE ZIPCOOE INSURANCE COMPANY NAME(NOTAGENT OR BROKER)AT THE TIME OF T14E ACCIDENT POLICY MUMBEtt COMPANY NAIC NUMBER I POLICY PERIOD POLICY HOLLWR NAME From: To: NAME AND ADDRESS OF INDIVIDUAL INJURED OR DECEASED �., ` JAL ❑ InjuredDriver 0 Passenger (� ❑ Deceased ❑ Bicyclist ❑Pedestrian NAME AND ADDRESS OF INDIVIDUAL INJURED OR DECEASED G ❑ Injured ❑ Driver ❑Passenger ❑ Deceased ❑ Bicyclist ❑Pedestrian OTHER ERTY D(TELEPHONEPctES FE F- ETc.) S Ri750 r 0 Yes Na - PROPE TY/l?'NMER'�AANQADORESS �i►. ,SOD F � -�� Ate"tJ rvE`', *563 If underpenafty afperfuJy under the laws ofthe State ofCellfornla that the Information entered on this document Is true and correct �^ PRINTED i S L No Ak Ix V 50005)YiWW []ADDITIONAL INFORMATION ATTACHED A` YOUR CALIFORNIA INSURANCE INFORMATION DO NOT DETACH'I DMV FILE NUMBER VEHICLE The Departmentmaysend this part to the Insurance company indicated.Itnotfullycompleted,itwill be assumed vou were not insured for the accident and your license will be suspended. NAME OF INSURANCE C O WAVY(NOT AGENCY OR 6ROKERAGF4 THAT WJED THE LIABUTY POLICY COVERING THE OPERAT-CM=YOUR VEHICLEF-Z tF pP C NUMSIER r ^� �7{,,,i POLICY �.,3Y:i�I IFr,m: �� / ! S T4: �' -` �-DRIVER LICENSE NUMBtH N DATE OF ACCIDENT IN OR TEAR(CITY CR TOWN) C F4 ) (DRIVER OF YOUR VEHICLE) lt/tEl U Ni (YEAR AND HAKE R ,..,T) VEHICLE 14ENTI14CATI4N HUMR VEH ER STATE DRIVER AQ R S_ OWNER ADDRES5 fULL M OF PQi-iCY HW'DER A . A ADDRESS SR iA OEY.52005}WWW lorlz:5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If the policy was not in effect,this form must be completed and returned to the Department within 20 days. The undersigned company advises that with respect to the reported accident, the policy reported on the reverse side: ❑WAS NOT IN EFFECT ❑Was not a liability policy ❑Did not cover the vehicle/driver ❑Number is not a company policy number Policy Number _ policy Pzriodfrom to SignatureMAILTO: Department of Motor Vehicles Title Financial Responsibility P.O.Box 942884 Date Sacramento, CA 94284-0884 SR TA MY 5=51 WWW c� cs� � ... (Z7 r� V Z� L13 �� Cf.) cc Ckscs � AA 1 tr o a N O n i m rA ru q � �� --�- o — — a o 4 Q �J � ;r, •, .1 �' rP�+.'N r �'�M,�.,L�[ ''�' i,q• qr-y r �vt •,� � � '�' �e� �py r.,1, - 'Vri it n xt. v.. °�" - r} ( n * ♦' � y 'r'��P'' 1 ° _•.u�'s '4c� "� i a"f,3F.�� a. �f rr�"`.� r . d l M' <�,1�(.•'k! s hl!- „ i f �d�t�q ,�y 4 do a Contra Costa C1� _ LJ Regional Medical Center - Y i �. Emergency t• a a .. Basic Emergency Medical Services Physician On Duty .... - , .. _..._ _.�._. ... a _ f r a� ,j�. T,♦ 'j5yl� rY��fJ " A Y of d� �•R,5`t i�$ — ' � Ili � 1 tk Am 4 s j 'r r � tea: ay tic i,;.+"t! 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All Section references are to ) The copy of this document mailed to California Government Codes. you is your notice of the action taken - on our claim b the Board of JUN 1 Y Y 200& t Supervisors. (Paragraph IV below), COUNTY COUNSEL given Pursuant to Government Code Section 913 and 915.4. Please note all T1Y COUNSEL AMOUNT: TO BE DETERM� "Warnings". CLAIMANT: JEREMY JOHN KING ATTORNEY: THOMAS P. GREERTY DATE RECEIVED: JUNE 14, 2006 ADDRESS: 917 LAS JUNTAS ST. , BY DELIVERY TO CLERK ON: JUNE 14, 2006 MARTINEZ, CA 94553 HAND DELIVERED BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, er Dated: JUNE 14, 2006 By: Deputy 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days(Section 910.8). ( ) Claim .is not timely filed. The CIerk 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: t� By: � Deputy County Counsel 1I1. FROM:: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( } Claim was returned as untimely with notice to claimant (Section 911.3). IV. OARD ORDER: By unanimous vote of the Supervisors present: (v 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: 4. f$�4/,j AHN CULLEN, CLERK, By eputy Clerk W I (Gov, code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited inn'the mail to rile a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of per jury that I am now, and at all tunes herein mentioned, have been a citizen of the United States, over age .18; and that today I deposited in the United States _Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order mid Notice to Clalnimit, addressed to the claimant as shown above. r Dated: Qe*0.0JOHN CULLEN, CLERK By Deputy Clerk Claim io:- BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY I INSTRUCTIONS TO CLAZIANI A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be.presented not later than the I Oe day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov't 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. RE: Claim By Reserved for Clerk's filing stamp JERUV JOHN KING E D J0 1 4 2006 Against the County of Contra Costa or CLERK BOARD OF SUPERVISORS CONTRA COSTA Co. District) (Fill in name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ TBD and in support of this claim represents as follows: 1. When did the damage or injury occur?(Give exact date and hour) ON OR ABOUT DFimmFR 15, 2005 2. Where did the damage or injury occur? (Include city and county) 917 CAMINO RICARDO, MORAGA, CALIFORNIA 3. How did the damage or injury occur? (Give full details;use extra paper if required) (SEE ATrAcT4ENT 3) 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? (SEE ATTACHMENT 4) 5. What are the names of county or district officers, servants, or employees causing the damage or injury? (SEE ATTACHMENT 5) 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) _ (SEE ATTACHMENT 6) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) (SEE ATTACHMENT 7) 8. Names and addresses of witnesses, doctors, and hospitals. (SEE ATTACHMENT 8) 9. List the expenditures you made on account of this accident or injury. DATE TRE AMOUNT 12/15/05 ATTORNEY FEES & COSTS 12/15/05 OTHER ASSOCIATED EXPENSES ss******s*t*******+t*****s****ss*****t**********s*s*******s**t*****************ss*****s*tt* ) Gov. Code Sec. 910.2 provides "The claim must be ) signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney Name and Address of attorney ) THOMAS P. GREERTY, ATTORNEY AT LAW ) ) 917 LAS JUNTAS ST., MARTINEZ, CA 94553 ) (Claimant's Signa re) 917 CAMINO RICARDO, MORAGA, CA TELEPHONE: (925) 3-70-8400 ) (Address) Telephone No. )Telephone No. 1-7f,7 ssssssss**t*ssssss+�t*ssssssstt**ss*t***sss*sttt*tsstssss'sssstsss*s*ssssss*ssssss*ss*t*sst* NOTICE Section 72 of the Penal Code provides: Every person n who,with intent to defraud,presents for allowance or the 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(S 1,000),or by both such imprisonment and fine,or by imprisonment in the state prison,by a fine of not exceeding ten thousand dolllars(SI 0,000),or by both such imprisonment and fine. ATTACHMENTS Attachment:3 On or about December 15, 2005, Detectives Goldberg, Barnes and Pate of the Contra .Costa County Sheriffs Department, "COUNTY", seized and falsely arrested CLAIMANT on a street and seized a tan colored jacket that CLAIMANT was wearing. During this arrest, CLAIMANT[' was physically subdued and struck. The jacket CLAIMANT was wearing, which actually belonged to his mother, was later used as apiece of key evidence in obtaining a search warrant of his parents'residence and an arrest warrant for the CLAIMANT. Attachment 4 COUNTY based their affidavit on evidence that was known by generally accepted police standards to be entirely circumstantial and misleading relying only on statements made by persons who were not witnesses to the crime and did not interview CLAIMANT'S parents who would have provided them with statements that would have cleared CLAIMANT. Although COUNTY had contact with the parents during the search of their residence, COUNTY made no attempt to interview parents. COUNTY was under extreme pressure by the residents of Lafayette to make an arrest because this was a "high-profile" crime and because CLAIMANT was a semi- homeless person, he was vulnerable to factual manipulation by COUNTY. COUNTY acted without probable cause in arresting and holding CLAIMANT. Attachment 5 Agents and employees of COUNTY are Sheriff Rupf and the aforementioned persons, Detectives Goldberg, Barnes, Pate and Falwell of the Contra Costa County Sheriffs Department as well others who remain unknown at this time to CLAIMANT. Attachment 6 During the arrest,booking process and incarceration by COUNTY, CLAIMANT suffered extreme anxiety, loss of society and companionship, humiliation and injury to reputation. Attachment 7 At this time no monetary value to the aforementioned injuries has been computed for the aforementioned injuries. Attachment 8 County Regional Medical Center, Martinez Detention Facility, Office of the District Attorney and Contra Costa County Sheriffs Department, Lafayette Police Department whose names and addresses are known to County. CLAIM o� BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY , BOARD ACTION: JULY 111 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), AJUN 1 ` 2006 given Pursuant to Government Code AMOUNT: $1, 200. 00 COUNTY COUNSEL Section 913 and 915.4, Please note all MARTINEZ CALIF. "Warnings". CLAIMANT: ADRINE ROBINSON ATTORNEY: UNKNOWN DATE RECEIVED: JUNE 14, 2006 ADDRESS: 97 WATER STREET BY,DELIVERY TO CLERK ON: JUNE 14, 2006 BAYPOINT, CA 94565 HAND DELIVERED BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors. TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, r Dated: JUNE 14, 2006 By: Deputy_ _ II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 9.10.2. { ) 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 its 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: r Dated: 6_/S -04o By: 4 ' Deputy County Counsel 1I1. FROM.: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV,�BOAR.D ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated:Qf JOHN CULLEN, CLERK, By ����eputy Clerk or W (Gov, code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice Was personally served ' or deposited i n'the mail to file a court action on this claim.See Government Code Section 945.6.You may seek tate advice of an attorney of your choice hi connection with this matter. If you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side of Diis Notice. AFFIDAVIT OF MAILING I declare mider penalty of pet jury that I am now, and at all times herein intentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addresser) to the claimant as shown above. Dated: �'��_��� JOHN CULLEN, CLERK By ���eputy 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. NUNN woman mass monsoon 0 None a 0 Nano an mummamona at RE: Claim By: Reserved for Clerk's filing stamp RECEIV ED Against the County of Con Costa or JUN L1 4 2006 District) CLEP,, BUpw ' �- colyr -)OF OSORS OARL ' COSTA Co. (Fill in tlWnarne) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of 0 -and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) �� -/, zoo 6, 6�606,V q-'4�&0J 2. Where did thedamageor iniury occur? (Include city and county) 3. How did the damage or injury occur? (Give full details; use extra p aper 1 re u red) W.tG 0-Ad, eLC4_d�) ot, 4/, 4. Orticular act or o1hission on the part of county or district officers, servants, or employees caused the injury or damage? , a- y #10t� d_�� 222 5 What are the names of county or district off servants, or employees causing the damage or injury? /? 6. What damage or injuries do your claim resulted? (Give full extent of injuries s amages 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.) 0-, 8. es and addresses of witnesses, doctors, and hospitals: a 5 he.vYt.2. LG d&A& A lc of ' �r2 �Ja rt�.-Jtc.,' cl tt 9. List the expenditures you made on acc nqo -Vis accident or injury: DATE TIME AMOUNT means amen anaaaaammusrtans ala Enemas man an a me a sawn a a a among ml ) Gov. Code Sec. 91.0.2 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 } (Cl mart's Signature) } 9'7 (Address) ) Telephone No. ) Telephone No. .� ��tD v ■m a m m■■m l m m w■s■■■■■■■■■■■■■■■■■a •■■m m m m r m■■■■o O m e m a s s■ ■ ■u m m/s s m 1 PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthermore, any attachments, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. 00aa9a0aaaaa0aa0aa0aa0000a50aaa0aaa00aaaa0a0a000aa0000a0aaa00aaa000aa00a0a0a0a.a a a 0 1 NOTICE: Section 72 of the Penal Code provides: Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city, or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account voucher, or writing, is punishable either by imprisonment in the County jailfor 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. 670066 CUSTOMER'S ORDER NO. DATE NAME ADDRESS- CITY,STATE,Zil P _ SOLD BY CA ` C.O.D. CHARGE ON ACCT. MDSE.RETD. PAID OUT i I I QUAN. DESCRIPTION PRICE AMOUNT 2 Z, 3 4 5 PC hAdrd 6 7 8 9 10 1' 12E RECEIVED BY a-�- 4705 KEEP THIS SLIP FOR REFERENCE oF.*K S„�q THE COUNTY OF CONTRA CO TA A- t _��p,� \ • �c����' ,�)C=�t'a'i(.t� .�' sr�'F OF cnu 'ap MUIR STATION 1980 Muir Rd. Martinez, CA 94553 Emergency 911 Non-Emergency(9 5)G4 -2441% WARREN E.RUPF Muir Station Business(923)•3 2541 Sheriff RESOURCE CARD Alcoholics Anonymous—........................ (925)939 4155 Animal Control............................................ (925)646-2995 Adult Protective Services.:...*—...----. ......1-877-839-4347 Children's Protective Services.........................(925)646-1680 Conflict Resolution Panel.................................(925)798.6132 Contra Costa Crisis Center(24Hrs)...............1-800-833-2900 Discovery Counseling Center..........................(925)837-0505 District Attorney....................................... (925)646-2625 Rape Crisis..... .....-1-800-670-7273 Sheriff's Dispatch............................................(925)646-2441 STANDI Offenders Program...........................1-888-215-5555 Sheriff's Records...vpp...........�r.,.......................(925)335-1570 C.F.# C ( 1 1 l 7 Date Officer's Days Off( M T W TH 5 7,00' b i J CUSTOMERS;ORDER NODATE NAME ADDRESS # y� f t CITY,ST TE ZiP 3,4 } rr SOLD BY CASH `r6.0.1);,, CHARGE .ON ACCT.,I MDSE.REM 1, PAID OUT QUAN DESCRIFTIQN PRIDE AMPLI s- z � i a• f �F �3 I' ;�� E.t ILII r i s E'014- 17 9 10 ' 12 RECEIVED BY p95�a a7os KEEP THIS 1 SLIP FOR REFERENCE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JULY 11, 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 V � oii your claim by the Board of JUN' 4 2006 Supervisors. (Paragraph IV below), given Pursuant to Government Code AMOUNT: $75 .00 COUNTY COUNSEL, Section 913 and 915.4. Please note all MARTINEZ CALIF.. "Warnings". CLAIMANT: JERROD : N: ,WILLIAMS ATTORNEY: UNKNOWN DATE RECEIVED: JUNE 14, 2006 ADDRESS: 5041 LONGHORN WAY BY DELIVERY TO CLERK ON: JUNE 147 2006 ANTIOCH; CA 94531 ' BY MAIL POSTMARKED: JUNE 13, 2006 FROM: Clerk of the Board of'Supervisors TO: County.Counsel Attached is a copy of the above-noted claim. JOHN CLTLLEN, r Dated: JUNE 14, 2006 JO Deputy II. FROM: County CounselTO: Clerk of the Board:of Suervisors ( 'us claim complies substantially with Sections 910 and 910,2. ( ) This Clain; FAILS to comply substantially with Sections 910 and 910.2, and,we are so notifying claimant. The Board cannot act for 15 days (Section 910.8), ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). O Other. Dated: (: _l 67 Q By: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV, BOARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full: ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: /'t � OHN CULLEN, CLERK, By eputy Clerk W Gov. code section 9I 3) Subject to certain exceptions,you have only six.(6)mondts from the date this notice was personally served or depositedui'the instil to file a tout action on this claim.See Government Code Section 945.6.You may seek the advice or an attorney of your choice in connection with this inatter. If you want to consult an , torney,you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I .declare under penalty of pet juiy that I am now, and at all times herein mentioned, have been at citizen of the Unitech States, over urge .18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a'certified copy of this Board Order and Notice to Claimant, addressed to the claimant ars shown above. Dated: ce, X"AJOHN CULLE.N, CLERIC Br� --Deputy Clerk t BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAMANT A. A claim relating#o a cause of action for death or far i�ijury to person or to personal property or- growing rgrowing 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 shallbe.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 1.06, County Adn.iihistrati.on 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. ■■KK![![![■![■[[![R Run USSR■R c[C amen[![C![[[[[i![[!am X m C C[C[[![[!![[[[[!![!!!!=C RE: Claire By: } Reserved for Clerk's Bing stamp Go } RECEIVED } Against the County of Contra Costa or ) JUN 14 2006 rirl644� /° 'k- i District) CLERK BOARD OF SUPERVISORS ill in the name CONTRA COSTA CO ) The undersigned clamant hereby makes claire against the County of Contra Costa or the above-named district in the sum of$ 7� - 00 and in support of this claim represents as follows: 1. Whon did the damn e or injury occur? (Give exact date and hour) pol � f 2. Where did the damage or inj y occur? (Include city and county) �. Haw did the ge o injury occ ? (Dive full details;use extra paper if required) 'skiff 4_. RJhat particular act or omission o e part of county or district officers, servants, enlplofees caused the' jury or damage? rA (W s kta w0,1 ovie 5 What are the names of county or district officers, servants, or employees causing the damage or injury? 1 + i 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 cla med�ab �e COMPu ed? (Include the estimated amount of any prospective injury or dainage.) bt"Iv t itreto J 8. Names and addresses of witnesses,doctors, and hospitals: ��"'� �tSd r� ���t�iis�de��ryirn�ury: 9. List the e� itui-es youxiade on ac ount o 1 D TE ME AMOUNT a as manna aaaaxa[atta[tamx[acratt[ttma:testaxataataaaaa[[,[t[[a[ma[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: (Attomev'f 1 Name and address of Attorney } (Claimant's Signature) M } (Address) An Telephone Na. )Telephone No. [aaaaaran[taax[aaaaa[aaaxataaan[ataaa=[aar[aaacaxtaxttaaaanaaanaataccaaaaagas caacataa1 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 forma, including medical records, are also subject to public disclosure. ■[Mus Buys nsKERNERRUN aanaa■ [ arm aaat■a[[aanxaa[taa[x[a[anaa[t[a[atttaaa[a[axan a Mata its all 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 file, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000),or by both such imprisori went and foie. f r {/7w f �gf y dot K y N ?p d' Cv mo 5WL �� SECOND--AMENDED CLAIM BOARD OF SUPERVISORS OF.CONTRA COSTA.COUNTY C. V BOARD ACTION:JULY 11, 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 NOTE: FIRST AMENDED CLAIr2a'FlIpervisors. (Paragraph IV below), ON MA'Y 23, 2006, ven Pursuant to Government Code JUN e, AMOUNT: UNKNOWN 4 2006 ection 913 and 915.4. Please note all COUNTY COUNSEL "Warnings". CLAIMANT: SYPHANH NITIVONGMAflqALIF. I-H-84 L ATTORNEY- UNKNOWN DATE RECEIVED: JUNE 13, 2006 ADDRESS: SAN QUENTIN STATE PRI,<MNDELIVERY TO CLERK ON: JUNE 13, 2006 SAN QUENTIN, CA 94974 BY MAIL POSTMARKED- DATE INVISIBLE FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JUNE 13 � 2006 JOHN CULLENrl-lk Dated: By: DeputyZ�rz� 11. FROM: County Counsel TO: Clerk of the Board of Spferviso'rs 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: 251�-e, ry-) Ccq r-, Dated:' Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) O Claim was returned as untimely with notice to claimant (Section 9.11.3)). IV. _BARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. O Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: /4 *?A0JCJ014N CULLEN, CLERK, By / ��eputy Clerk W IN61'(Gov. code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in' the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice or 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 OFFMAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified-copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: _4Z g* .2 .410. JOHN CULLEN, CLERK By Deputy Clerk OFFICE OF THE COUNTY COUNSEL SILVANO B. MARCHESI COUNTY OF CONTRA COSTA -_�� COUNTY COUNSEL Administration Building 651 Pine Street, 91h Floor —`,a SHARON L. ANDERSON Martinez, California 94553-1229 a;' _ `- b CHIEF ASSISTANT GREGORY C. HARVEY (925) 335-1800 (925) 646-1078 (fax) VALERIE J. RANCHE ASSISTANTS An ,y •C�` co June 16, 2006 Syphanh Nitivong, V-13801 I-H-84-L San Quentin State Prison- San Quentin, CA 94974 Re: Government Tort Claims of Syphanh Nitivong Dear Mr. Nitivong: We are in receipt of your latest amended claim dated June 6, 2006. There seems to be some misunderstanding. Your previous claims were not rejected as late. They were found to substantially comply with the requirements of government code sections 910 and 910.2. On May 24, 2006, you were notified that the Board of Supervisors acted on your claims and rejected them in full. Your only recourse at this time is to file a court action on the claims within the required time period. See the notice you were sent for more information. Your most recent claim dated June 6`h will be rejected as late. The action on your recent amended claim does not affect the time requirements of your previously filed and rejected claims. Thank you for your attention to these matters. Very truly yours, SILVANO B. MARCHESI COUNTY COUNSEL By:_ V 6a� Monika-L'. Cooper Deputy County Counsel t • 6 Phay7b Mltlyon . y- �3 RECEIVED . n 6 � nom. - . • r A JUN 13 2006 CLERK BOARD OFSUPERVISORS A1v%s1VDg(J CONTRA COSTA CO. I eAto DF SUP921/1Sa0-S DC' CdMrl2A COSM COLWTY e,L4 MAMA T: SY10XAA19 ALIT I VOx6 Y-13061 At►rF�.�� oa 6 7H� CLQi�A.srP 6la.�EcT.'wvs rd 7"H.e AM056 ACrJAIS 10,10MO MAY .2 1,zaeA (1Wes .44t ' -fza . aLdv,E. ctal4Qad r SYPHRN'd Y--13861 su..W hevscb�J 1'i1�5 74- a Jwve. rte„se_ of ae,4m as follows: -lam C1a,, mwv$ eece`v�d `rte 8 rz/ .ac/.e„ da d IN6y 2 .?Qo6 T�era6.�t Raj edi a kJS ctai w1 siza-103 `77"d La- d5d net 1,je h,s C1a;m tcr: hln -rA /LIed�JrS /zu, ,d�.- Jt j a T,,wly 4Sk%anr 7AAS RePla .Se- PS .Vd1W eWA.1 1r1 Frl-or, its Ga,`m LuAm T;w- aS Sul'Dar/std ;m "litBlf-R wYllaeAAd �.+area�tser- A HleAb AkC"m kc" in-Pr;sao ;&Axtl Se"erait.l WAY be Idej a,4 a.&V T`,,., duriw9 i,%-tkwceraha^, ar op,,.r,6 aywL Year ap-mr release 6r drsr;mree. A Clam maY be 06CAP-Ie d&/,a ldltr )G& a `3Lr- 1k1kre- D/ 1a.. f;fJor-i J's Srict, ?la,/ d uws iu.4 a(,Si rwaUe- beAre i,G/ rAka_. L,11`1ar Cel e-'t 3376 6)A6)aAdC7),Amteavw, a,i 11--/8-v" 72 - ;AJur.Y h40#0.a, See .ExE1/,811/.4 a �,B hier�-,&, TLS- PCaim am.5 �'i/,�.� al mar- /l-2e.aZ AvA le M i's 7 6JAYS begre -/-&- Lo me'n?'A T,.� 46,4--W T6 Aide.AWS Cld 1.v►s 5a 74_ a.cr4ao s Taken A-V 77e.. Asamd taus-$ Sa,s.nt. A W U"SJ1/'edl -..4 ha 1 2.eC�wr►fxlan.CCii. Weregre,. ),ds CIa. Stea,,td be- keC m4S d e.W1e,n wuasle tL&5,zrd.%S his C 1 cd m-,7A baiw►a..h see_ Labor "e— 33a'7fa?.C2?d..A (3). ,,� - WEST OFFICE Pub.1 i'C"D of n d€ i` nt ra Supervising Afforneys 3,34"I'l3issell Avenue /� ichmond,CA 94806 {,,,J Susan A.Hatcher 510-412-4900 jj'�� Michael J.Kahn 510-412-4901 Fax 1J►�U n avid C.Coleman Public Defender ro COURT APPEARANCE INFORMATION FOR PUBLIC DEFENDER CLIENTS You are being represented by the Public Defender's Office and you are probably receiving this form at a court appearance called`Counsel and Plea.'The court has been informed that our office is representing you,a plea has been entered,we have received `discovery'(police reports and other information), and the court has scheduled further appearances in your case. Your case has probably not yet been assigned to a specific attorney in the office. If you are now IN JAIL and have not waived time,your case will be assigned in about two days.After that time you should call the office at#21 to arrange to speak with your attorney, If you are NOT IN JAIL your,case will-be assigned to a specific attorney before the first court date that appears below. Please call this office at the above number to find out who your attorney is. It is important that you speak with your attorney before the first court appearance to discuss your rights and your case. DO NOT DISCUSS YOUR CASE WITH ANYONE OUTSIDE OUR OFFICE. The judge has scheduled the following date for your case: �1 -- 6 at for a Readiness Conference in the Superior Court in Richmond.YOU DO NOT APPEAR N THIS DATE. c6 o at This appearance will be in Superior Court in Richmond. On that date a preliminary hearing will take place or be scheduled.YOU MUST APPEAR ON THIS DATE OR A BENCH WARRANT MAY ISSUE. email:defender@pd.co.contra-costa.ca.us • web:http://www.co.contra-costa.ca.us/depart/pubdef/ a!r lea t lop t7 a :« n. co ui LU N =� n ui G`J LL CD p 43 (!"� mer' o g 1 LU Q P> a marcc m o D {t' �..�► �. des � �C.2 Lti1 V'J v cr ce A a Y¢ Y N .A Y to v Lo bw CID G 4 ® d J n �f 1