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Home My WebLink AboutMINUTES - 03062007 - C.26 w CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY . /Z 4 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. a you is your notice of the action taken `✓ on your claim by the Board of �.. FEB 0 2 2007 Supervisors. (Paragraph IV below), given Pursuant to Government Code AMOUNT: $250 . 00 COUNTY COUNSEL Section 913 and 915.4. Please note all klARTINEZ CALIF. "Warnings". CLAIMANT: CATHY S . KORA ATTORNEY: UNKNOWN DATE RECEIVED: FEBRUARV 02 , 2 O7 ADDRESS: 410 NORTH CIVIC DRIVE BY DELIVERY TO CLERK ON: FFBRUARY 02 - 2007 #301 WALNUT CREEK, CA 94596 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, 1 or Dated: FEBRUARY 02 , 2007 By: Deputy 11, FROM: County Counsel TO: Clerk of the Board of Si1pervisors (v-)'This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 5` D By: ` }'l c 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). 1V. BOARD ORDER: By unanimous vote of the Supervisors present: (Vr 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/%71104 JOHN CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) 00, Subject to certain exceptions,you have only six(6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney,you should do so immediately. *For Additional Warding 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:/ / X44 B!� a'�� JOHN CULLEN, CLERK By Deputy Clerk 12i12i200E, 11:44 CONTRA COSTA COUNTY CLERK OF THE 4 914153505855 NO.856 D01 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY' INSTRUCTIONS TO CLAPIANI 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 accnW 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 § 9].1.2.) 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 Counter, 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 S - ) .. D yCom. Against the CounTy of Contra Costa or ) FEB 0g 2 007 CLERK District) ON Rq CO -r C VISORS (Fill in the name) ) �Tq C0 } The undersigned claimant hereby rqgLkes claim against the County of Contra Costa or the above-named district in the sum of$ 2 s 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) "\z� DY XT, Z_" Y3ai 3. How did the damage or injury occur? (Give full details; use extra paper if required CO Y�C�ck� r�n,V,-,�,L �a,� vo 0,,SS,�Zs S kv,.0-1 Jru�L-�,, V a. sts' OA_).,�CA C JPC.-J w ar u vn Vk� --513% a--a YC_ cWc o+-� ��s yr C, � «�� c� k i r-,��►�c� � Q �q�X 4. �VUhat particular act or omission on the part of county or district oiricers, servants, or employees caused the injury or damage? 'CVuL�x \_�a�Si-- e s C,�(a-r �( � d t-,i e ok- V.ems-4 G- 5 What are the names of county or district officers, servants, or employees causing the damage or injury? C�� CA�1cY1 v..r�C$S o--`r Y R 0 � cA Qn oa-\ 1p�a.x� hr--a- ww 12/12/2006 11:44 CONTRA COSTA COUNTY CLERK OF THE -� 9141535e5e55 NO.056 DEQ G. What damage or injuries do your claim resulted,? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) ' k Z50 7. I-low was the amount clauned above computed? (Include the estimated amount of any prospective injury or damage.) 5S r. ? I 8. Nunes and addresses of witnesses,doctors,and hospitals: \NN C-:,A Ok'\S 33`A Z�) Y S V cask a 0 c\- �--1 So6r 04 lz� ��-r.��. `c��-`� 3"�-o h1.c�:..►��p 1�Vo► wc�-w�C Ck-a��,r� 9. b�. C'�Y334 1� S ctx. a, 0 o�� P,C�-.�.\ SThrw4q-)Cq `tst the experttures you made oa ftccount o�t is accident or injury: DATE TIME AMOL NT ■.rr a rr■■rrrrrrrrrra■■■■■rrrrrrrr■■■■rrrrrrr�rrr■■r+�rrrrrrrrrrrrMrrrrrrrrrrrrr1.11rrr Gov. Code Sec.910.2 provides"The claim shall be }signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Atton eyl ) Flame and address of Attorney ) Clairna is Signature) } (Address) Telephone No. ) Telephone No.' LS ■rrr�rr■�rr�rrrrrrrrrr.■■■rrrrrrr■..■■rrrrr■r■■■rrrr�rr■rrr■■rrrrr�rrr a rrrrrrr�r�rr� PUBLIC RE,CORDS NOTICE: Please be advised that this claim form, or any claim tiled 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 sOject to public disclosure. .■■■rrr■rrrr�r�r�rrrrrrrr■rrrrrrrrrrrr�r�rrrr�rrrrMrrrrrrrr•rrrr■■�rrrrrrrrr•■■■■��rr 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, aCC01,111t 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 ($],000.00), or by both such imprisonment and mine, or by,imprisonment in the state prison, by a rine of not exceeding ten thousand dollars ($10,000), or by both such imprisonment and fine.