HomeMy WebLinkAboutMINUTES - 02052008 - C.7 (2) AMENDED CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY •
BOARD ACTION: FEBRUARY 05, 2008
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
F,,) Supervisors.D Supervisors. (Paragraph IV below),
M D given Pursuant to Government Code
Section 913 and 915.4. Please note all
AMOUNT: $24,441.53 JAN 0 2 2008 "Warnings".
COUNTY COUNSEL
CLAIMANT: GEICO DIRECT MARTINEZ CALIF
ATTORNEY: UNKNOWN DATE RECEIVED: JANUARY 02, 2008
ADDRESS: ONE 'GEICO WEST BY DELIVERY TO CLERK ON: JANUARY 02, 2008
P. 0. BOX 509119 RECEIVED FROM COUNTY
SAN DIEGO, CA 92150-9090 BY MAIL POSTMARKED: COUNSEL
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN CULLEN, Cl ok
Dated: JANUARY 02, 2008 By: Deputy
11. FROM: County Counsel T0: Clerk of the Board of Supe isors
(This claim complies substantially with Sections 910 and 910.2.
( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so
notifying claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and
send warning of claimant's right to apply for leave to present a late claim (Section 911.3).
O Other:
Dated: �'Z -o By: / / Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
O Claim was returned as untimely with notice to claimant (Section 911.3).
(1V. ARD ORDER: By unanimous vote of the Supervisors present:
This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date.
Dated rwary orlDeHN CULLEN, CLERK, By ` Deputy Clerk
WARNING (Gov. code section 913) IV
Subject to certain exceptions,you have only six(6)months from the date this notice was personally served
or deposited in the mail to fde 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. U you want to consult an
attorney,you sliotdd do so utrntediately. 'For Additional Warning See Reverse Side of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty of petjury that I and 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.
Datedp,1*4' �4110
JOHNCULLEN, CLERK By Deputy Clerk
14VV. 1. LUV/ L . IOIIVI U,Wv 11101\ IYIMIMULIYILINI INV.10 IJJ L
oARn aFP SYJPERVfSaRS OF C IM CC3STA Co
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z j vsS �c ars a CLARQ '
onal ra�erty
---
death or for in to ` ersaa ar to Pers P P
A. ,A� claim relating to a cause of action for ne j'�' � 'Zrjjj -��
cra s 'shall b^ presented not later than sig montJas afrer the not later ante
azon.growing P, action shall be.present--d
a.ctian, A c1a1m relating to any othez cause of
after the accrvml ofthf-cause of action
(G-OV. Code § 911.2.)
aims -must be fled with the Clerk of the ward of Supervisors at its office in Room 146, 1 C 0
B. Cl �tOA ,� OJ
Couut�rAdmi�is�raticn Building, 651 Pipe Street,Mar�nez, CA 9455 .
If claim is against a district governed by the Board of Supervisors,
C. rather tln the County, the
e of the District should be f lledan..
If&Z claim is against amore than ane public entity, separate claims must be fled as each
public=EtY.
Fraud. See penalty for fratadulent claims,penal Code Sec.72 at the end of this form.
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Reserved for C1erlk's flizzg stamp LLSS DEC 3 1 WIN
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AgainS,Lhce CO s cf Coat- �o or } c�FR �V j 9 JA IV
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District)
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(Fill the name) J CONT RA 0 S, 'C I SCRS T p-I
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'The undersi�.ed ola� �t hereby des claim against the County of Contra Costa or the above named
district in the sum of$ `j�{ and.in support of t�claiM mpresents as follows: A /}( y
�.+lr4r, 'tn 5` + Y `IS L itil ✓11 1 C . .�r%i^• )9F
1 VThen zEd e damage or uslury bc�cttr7$ { rzve�e t dEti and ho=)
?. Wjere did the damage or injury occur? (InciudE Gltp and coon )
C"6- of z�n�'uzq occur (Give full dLt d1s;use eta paper sf requ�ed)
3. HOW�t'd�e damag
4. What-pardmAar act or Qmi.ssion on the part of comty or district ofdcerr servants, or erapl ogees
Caused the inj n7 or darnage?
S Wiist are the names of cauntY or district of ccers,servants, or �_,=plogees causing the
dam ge or injury? Ci r C'f- occ C.0)-r t .
NOV. 7. 2007 2: 18PM CCC RISK MANAGEMENT N0. 135 P. 3
J' r
'What damage or in}uties do -your claim resulted? (Crive full e. cnt ofj -�eS or oes
--claimed, Attach-two est,rn s for auto damage.) (}�
��"� � �� � ' % ` ��✓'i�l �K�� ,�.�� ` �Z]t f�Y
T � dude the estim��• ama
7, How was the amount claimed abVe computed. (�
prospective uy or damage.}
�, Names and addresses of witnesses,doctors,and hospitals;
6�
/ \ account of nddem or Bilary:
9. List the ekpendi es you made on Tills AM0! ,
D-ATE
[llz M1L[!}[■zY[z[!zRon zlKnown zzrrKzltzlMzzlf zr!lazzY[ir[Kz![z![r[1r.rr[[s[r1l;scsM rl
C'o�r.Code sec. 910.2 provides "The claim shall-be
} eigaed by the chimmt or by some person on his
- )behalf"
SEI�t"D N QTICES TQ: (Attomev �5 C
hTatae and address of A.ttoraey 5V
Cc is signat=
Telephone No. Eelffphoilo N,0.
zz![[r W.I[!z Rl!K a r[K!Rx fzr zfzl,I
pUDL1C RECORDS NQTICE:
Pleesc be advised that this claim farm,or any claim filed with the Caunty under ffie Tart CiP Act, i-- St2bjeCt to
public &sclosnrc under the C'alTfornia Public Records Act. (Gov. Code, §§ 6 00 et seq.) Furthermore, any
attacbmcnts,addendums, or suppl=mts
attached to the claim form, including medical records, are also snbj ect to
public dis losnre,
tri
Kmum[t!i[lrr[zlz rzl�zz LMl11<zL ii krlkFr r
NOR!!A'lzzw[szl![zzzlRzz[I1Kz aR�lrF[lizz>•l!PlKSlLICE;
Section 72 of the Penal Code proviclEs:
to defraud, p
resent for ellowe.�ce or for payment to spystate
Every person who, with inceboardor officer, or
pt the same if aenuuine, any false or
to azy WUULy, city, or distict board or ofitcer, ais punishable
b allow or pay soumeat in the County jail for a
fraudulent Claim,bill, account I►oucher, or writing is punishable cithcr anby i doll
period of not more than Dae year, by a fine of not axceadbig one thwsaad dollars ($1,000.��), or by bosh such
im risonmen# and rine, or by imprisonment m the stag prison, by a fine of not ece�ing t5n thousand dollars
p c)=ent and fins.
($1 Q,000),ar by both such impri-s -
This loss occurred on 7/21/2007 at approximately 9:30 am at the intersection of Willow
Ave and View Point Dr. Mr. Richard Clark was traveling NB on Willow Rd in lane 1 of
2 and Claudia Williams was making a left turn on to View Point Dr in front of Mr. Clark.
Mr. Clark did not stop at the intersection, as he did not see the stop sign because a tree
branch blocked. The city of Hercules is the cause of this loss for not clearing the branches
from the stop sign to enable a clear view of the stop sign from each curb.
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09-05-07;02; Q1PM; DTG Sub ror-Tion ; 9186692735 # 2/ 13
R E N T A C A R
September 4, 2007
G E I C O
DATE OF LOSS: 07-21-07
OUR CLAIM 573178
CLAIM AMOUNT: $8461.51
r °
YOUR CLAIM .#: 0013407440101139
YOUR INSURED: RICHARD CLARKE
Our records indicate that our rentat vehicle was damaged while in the possession of your insured. Finding that the renter
is insured for this incident, wo expect that payment will be remitted_iri full for the above claim amount. P base contact
me within three (3) days of receipt of this, Letter.
Estimated Cost of Repairs: $ 7196.51
Diminished Value: $ 0.00
Loss of Use: S 0.00
Calculated as D days @"7$34.99
Towing: $ 515.00 .'
Administration: $ .150.00•
Appraisal Fee: $ 0.00
Tax- $ O.DO
TOTAL CLAIM AMOUNT $ 8461.51
If the Total Claim Amount includes the Estimated Repair cost, ,we will receive invoices for the parts, parts delivery
and repair charges. If the total is less than the payments received from you for the estimated cost of repairs, we.wilt
refund the difference to you. If our supplemental costs are greater, you wilt. be billed accordingly. The lossof use,
noted, 4s LaLcutated by dividing the number of repair hours by five and roundingit to the next highest number times
the daily rate. This represents the number of days this vehilce is.unavaitable to us while the car is undergoing
necessary repairs.
If you are in agreement with our position as set forth in thisletter and would like to resolve this matter at this
time, please remit payment in full referencing our account number. Make checks payable.to DTG Operations, Inc. and .
send to the address on this document. Feel free to contact'me at 1-800-832-1141, Ext. 2322.
Sincerely,
JESSICA Y II1 GUperu�1%ue 1overy AgentWorldwidc Reservations
Subrogation Department 800-800-1-000
Enc: Qk-At• rt Rental Agreemerfl°O3_%VriLte, Photo(s), Tow Bill
RI Tulsa,OK 74182
918-669?•45.2
Fax 918-669-2733
c]aimnerviceQrltac.crrm -
wDINDEX# Z744722072107
CNT001
09-05-07; 02;01 PM;DTG Sub rot -r i on ;9188692735 # 3/ 13
Ac.:idenVDDamnageilrecldar t Report DTG Operations,Inc.
Ln2L�lOrif'S�VE11fG16
Report Ci on# Repot2ing Sy. Renting i C Mileage: Vin g UniW�¢ 'G Re I
L nae tateo Stets Yaer/Wakk./Mo`, ^ d LDW on RA 9 SLI: / UMP, Othorb
Z fG t "�� i Yes No ( Yea o Yes No
Area Damaged:
Driver InformationCircle one: Renterl Authorvad Driver I Empbyee /Unauthorized
Name: Employee# Location#
Y144-
Mailing Addresa:
City. State: ^ ZplPostdl Coda: Country:
Date f Birth H P 91. Work Phone lft: Cell Phone# Email Address:
41— o - -- ej ozri VC
Driver's U nee#I State: EKplratidate 1CRation Issued? If citation issued,da=ibe offonse:
/f /� Yes
1 nsurance Company/Agent! hone# ottcy. / Claim#:
y_ o _
Cradit Card Insurance Carrier/Card Type/Phone# Ctaim# ..
Rs ter Name(tf different Driver Address/City/Zip/Postai Code i State/Province/Country, Phone-.
lmuZnce Company/Agent I Phone# Policy I Claim# Credit Card Insurance Carrier!Type I Phone is
». Facts of Lo--& Cirdo an ro rials of rental a reemont: Regular/Tour/Cofporate I Govamment/Em to ee
Date of Lo - Time: Location of Acddent: Cit /State/Province
LI
Pauoe Fke ort d Police Report# Police Department/Precinct.' Police Department Phone#_ umber or Occups 1 Car.
ea No c uA t, '2—
Injuries? List all involved in Ihte.acrsdent•
Describe How Acddent Happened:
. t..Jq
,y 1 D S 1
A / =, � XJ
Other PnFtV Circle ono: Owner / Driver/Passenger /Pedestrian I Em to oa
Name: Home Phone# Other Phone#
Address: Street I Apartment 9/ Clty/ State /Province /Zip I Postal Code I Country -
Orivers Ucense#/State Date of Birth' Vehlde Year/Make/Model. Plate#1 State:
Insurance Company/Agent/Phons#: Poficy g I Claim#: Citation Issued?: #of Occupaats In Car
Yes No
Additional lnformation Circle One: P'assert or/ Pedestrian / Witness I Claimant I Owner/Attorne
Name: Phone# O1har PhOn®It
Addr"L Street/ Apartment#I City/ State I Province / Zip /Postal Code
If inju 71describe Injuries:
N 0 ntal I , Rv sl nature below,the undo "d a0cnowled es that they have read the notice on the leve a of this form.
Driver Date: Signature•Reportin pro
N; -::YVJ�•.�. • » ',N,�. ���- 11:M�..y...-, M1 :Z•Y-�C� !•Yi { `f -
�ea+.Nrrl. —r,..� '�� i.R'� It• "� '�.� 'w+ ', _ fir.
Questions or concerns with your Accident/DarnageRnddent event coin bo send via email to ciolmserviceodtag.com or mailed to DTG Operations,Inc.,
Subrogation,5330 East 31st Street.Tulsa,OK 74135, PAYMENTS SHOULD BE SENT TO: Dept 927 TUISti,OK 74182.
Claim Service Phone M.800-832-1141. Fax#is,918-869-2733
GA0072 DTG PERATIDNS,INC 0107M75 Distrbulion: Whits: FAX end location YBllow. PlaCC Ih VehiUe Pink: Renter Copy
Yellow Areas—Must be completed by the CustOrner Blue Areal—To bta compleled by this Customer N applicable