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Home My WebLink AboutMINUTES - 03062007 - C.26 (10) 1 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY • 02 � BOARD ACTION: MARCH 06 , 2007 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 gnu�l on your claim by the Board of FEB 0 2 2007 Supervisors. (Paragraph IV below), given Pursuant to Government Code AMOUNT: $469 . 81 COUNTY COUNSEL Section 913 and 915.4. Please note all MARTINEZ CALIF. "Warnings". CLAIMANT: JEANINE ELIZABETH BATES ATTORNEY: UNKNOWN DATE RECEIVED: FEBRUARY 02 , 2007 ADDRESS: 426 TERES ITA BLVD. , SAN FRANCISCO, CA 9412y DELIVERY TO CLERK ON: FEBRUARY 02 , 2007 BY MAIL POSTMARKED: POSTMARK UNKNOWN FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. FEBRUARY 02 , 2007 JOHN CULLEN, e Dated: By: Deputy II. FROM: County Counsel TO: Clerk of the Board of S ervisors ( �hislaim 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: 2 — lr By: eputy 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). l.V. 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: Q. a N CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) months from the date this notice was personally served or deposited in the mail to 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. >f you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that 1. am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the 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!/%-X4 JOHN CULLEN, CLERK ByA� Deputy Clerk BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A claim relaying 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.) i. Claims must be filed with the Cleric of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street,Martinez, CA 94553. 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. If the claim is against more than one public entity, separate claims must be filed against each. public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. ■a a a a a a a a a a a a a l a a a a a t It ■a a t a It a a a a an Amu a a a a[N Ina Ian a al■a a am a a a a!ien a it a a a a a a a it a a[a a I RE: Claim By: Reserved for Clerk's filing stamp �D%Lctbet h +� RECEIVED Against the County of Contra Costa or ) FEB 0 2 2007 District) CLERK BOARD OF SUPERVISORS (Fill in the name) I CONTF:n t'-TSTA CO. The undersigned claimant hereby des claim against the County of Contra Costa or the above-named district in the sum of$ VA , 59 1 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) fU (2 h o 3. How did the damage or injury occur? (Give details;use extra paper if required) 4. What particular act or omission on the part of county or district officers, servants, or eraployees caused the injuryor damage? —lh e- c ticac lc-s aae �� dC'n ' '2 �c S'-Ca— o '"°a— t.�� 5 What are the naives of county or district officers, aen ants, or employees causing the damage or injury? Ii 11 A f 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) �ixzk 15 C21�� t 5 N0N P-4-1 PA%a-w W t c--eq i c.csz, t)e t o .c.c.4G - P l a n r,e e t Yc b . c, b�! . 7. How was the amount claimed above computed? (Include the �stunatectj amount of any prospective injury or damage.) epic cr.. 4 VC.c-12-A-A-2-- ts�- � 3� 0 )LL,4-, 6Zee14`e`--(. hunt- t,. 3U c), c� UVC�C X* W c,2n(�- e. `-�� b 021 W 1 ►J 6,— - 7C)-7A-L- 76 8. Names and addresses of witnesses,doctors, and hospital : �I�a�2. �►c,y�- 1� �t..vt�..:-�ry � i,o its-t��.�e � :�rz �rn�- ac�lclet��. gall C(e..1-CR Buck Lf Ora -S ' /J /j V-qW1 twb 9. List the expenditures you made on account of flus accident or injury: DATE TIlvIE AMOUNT ■ ■aaaaa■aa■■aa■ aasun INNER as ■aaa■■■■a■aaaa■aaaaMEMO a■■aa■t aaaaa■aaaaaaaa■aae■aaaaa■:'� .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) V CJ (Address) ) ) Telephone No. )Telephone No. yI s ■ ■ one■■ata■■as■■Ron a■■aaa ■ ■ ■■■aa■alta■■a■aaaa Bonn gas a■a■aa■aaaaaaaaaa aaaa aa■as a a a a■at PUBLIC RECORDS NOTI^E: Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthermore, any attachments, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■ a■aaaataaaaaaa■aa■ aeaa■ ■ ■ MEN a■aaaaaaaaa■a■Has aaaaaaaa■aaaaa■■aaataaaaBoa aaaaaaaaaaat 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. Question: 3 I was riding my bike on San Pablo Dam Rd towards Castro Ranch Rd when I hit the crack shown in the pictures. The cracks were not visible because there was a pack of cyclists ahead of me and two directly in front of me in a single file. We were peddling about 20 miles an hour down the road. The riders in front me shifted to avoid the crack at the same time I couldn't react and my front wheel went directly in the crack blowing out my tire, then bounced me in the middle of the road skidding on my rims. I managed to stay upright and didn't get hit by a car therefore I did not sustaining any bodily injuries. However my front fork was cracked, wheel bent and tire blew out. 1/25/2007 3:48:47 PM MIKE'S BIKES of SAN FRANCISCO 1233 Howard St. San Francisco,CA 94103 (415)241-BIKE (888)696-BIKE www.MikesBikes.com Ref SO* Receipt M 32017 1/25/2007 Store: 005A Assoc: Zack S Cashier: Zack S Bill To: Jeanine Bates 426 Teresits Blvd. San Francisco CA 94127 ITEM# DCS QTY PRICE ATPRICE 22352 BIK 1 808.00 2,808.00 07 Ruby Pro RED 51 Disc 2200 8192 W HL -1 300.00 (300.00) 07 ROVAL PAVE SL Dsr 4100 % Orr 3796 LBR 1 20.00 20.00 HBAR INSTALL 8069 W HL 1 733.00 733.00 heeC.s, Lam-- 07 KSYRIUM ES M10 SHI Disc 3626 % CLI rrY1Q �- 1 4 Units) Subtotal 3,261 00 . T�-- 8.500 %Tax: 275.49 OvuL. S 6 rJ M� � ' I� RECEIPT TOTAL: 3,536.49 Tend: 3,536.49 CrCard: 3,536.49 VIS/MC (� t oo No Refunds on Sale Items �l No Refunds on Bicycles We appreciate your business! 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