HomeMy WebLinkAboutMINUTES - 03112008 - C.30 February 26, 2008
Deny Claims for Willie Charles Barnes; Brian Hayden Harris;
Terrie Kent; Paula A. Lorentzen; Claudia L. Williams; AAA Auto
Insurance for Dan Bumgardner; John D. Mason; Carl Lee Baity, Jr.;
Jeannette Barnes, Willie Barnes, Charles Barnes III (M); Alyssa Barnes
(M); Aliah Barnes (M); Jacob D. McCllellan; Geannina Perez; and
Fatemeh Mahanloo.
March 11, 2008
Deny Claims for Brian James Douglas; Curtis Lee Morrison; Hui
Quan Chang;
CLAINI"
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: MARCH 11, 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
Supervisors. (Paragraph IV below),
given Pursuant to Government Code
AMOUNT: $109.92 Section 913 and 915.4. Please note all
"Warnings".
CLAIMANT: MAIRA NAVARRO
ATTORNEY: UNKNOWN DATE RECEIVED: FEBRUARY 13, 2008
ADDRESS: 613 JOHNSON DRIVE, BY DELIVERY TO CLERK ON: FEBRUARY 13, 2008.
RICHMOND, CA 94806
BY MAIL POSTMARKED: FEBRUARY 11; 2008
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
FEBRUARY 13, '2008 JOHN CULLEN; le,l
Dated: _ By: Deputy
I.I. FROM: County Counsel TO: Clerk of the Board of Sufervisors
( ) 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).
( ) Clairn is not timely filed. The Clerk should return claim on ground that if was filed late and
send warning of claimant's right to apply for leave to present a late claim (Section 91. 1.3).
( ) Other:
Dated: 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).
1V. BOARD ORDER: By unanimous vote of the Supervisors present:
�f This Claim is rejected in full.
( } Other:
I cerrtify that this is a true and con-ect copy of the Board's Order entered in its minutes for
this date.
Dated: 1\/. JOHN CULLEN, CLERK; By Deputy Clerk
WARNING (Gov. code section 913) `+ `
Subject to certain exceptions,you have only six(6) nnonths from the date this notice was personalty served
or deposited in the mail to file a court action on this claim.See Government Code Sectiai 945.6.You may
seek the advice of an attorney of your choice in connection wide 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 perjury that I am now, and at all times herein mentioned, have
been .a citizen of the United States, over age 1.8; and that today I deposited in the United
States Postal Service in Martinez, California, postage fully prepaid a certified. copy of this
Board Order and Notice to Claimant, addressed to the claimant as shown above.
Dated: 0���_, Z �n Q JOHN CULLEN, CLERK ByA, Deputy Clerk
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANTF—
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, 1
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
/I GC &ILY-71-0
~REC_ A`:
---
Against the County of Contra Costa or )
•y ) FEB 1 3 2008
District) -- _
CLERK BOARD OF stippRlij e.
(Fill 1n the name) ) CONTRA C.OS7��
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)
lC../)-7
2. Where did the damage or injury occur? (Include city and couay)
1) hit fr1 r?L'-k C) Y , Dl�-Y1 el- -,4j / �f\s
'NG
3. How,did,the damage or injury occur? (Give full details; use extra paper if required)
ut
yl.V !� Or► r7 C�,r(-S f�"e�� � •��1 �f1�c� YA4. particular act or omission on the part of county or�istrict officers, servants, or employees
caused the injury or damage? , l
�t4-
5 What are the names of county or district officers, sen ants, or employees causing the
damage or injury? v
6. What damage or injuries do your claim resulted? (Give full extent of injuries oV,damages
claimed. Attach two estimates for auto damage.) e jl 0j-7
19015�le PVCYZ41<�
7. How was the amount claimed above pomp ted? (Include the estimated amount of any
prospective injury or damage,),f g)
8. Names and addresses of witnesses, doctors, and hospitals:
X)�1��
9. List the expenditures you made on account of this accident or injury:
DATE TIME AMOUNT
. ........Emmaus .......... . ...................... mamma.................. .. ...........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: (Attorrnev) 1 /
Name and address of Attorney )
(Claimant' Signature)
1 � --7;�: ��� pl�
(Address)
y� c
Telephone No. ) Telephone No. ( ; J/� qg� I
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
attaclunents, addendums, or supplements attached to the claim form, including medical records, are also subject to
public disclosure.
a Swanson Examumn Mugu Sasso a a 0 an man NOUN noun 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 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 exceeduig 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 imprisoiunent and fine.
BIG O TIRES-RICHMOND
12952 SAN PABLO AVE
EPA#CAL000021346
RICHMOND, CA 94805 (510) 234-1721
ES00020992
CASH SALE
02/11/08 11 : 50
AF222251
SC
**Original**
1 TS-78 225/40RIB 88V TALON GP326 94.99 94.99 MOUNT & BALANCE 17 OR 18"
1.00 MOUNT, BALANCE, NEW STEM. 10.00
* WE ARE NOT RESPONSIBLE 1.00 WHEEL BALANCE LABOR 10.00
* FOR LOST OR DAMAGED LUG 1.00 HAZARDOUS WASTE FEE-TIRE 1.75
* NUTS, STUDS OR HUBCAPS. 1.00 TIRE DISPOSAL L.50
* WHEELS TORQUED TO LBS TIRES PURCHASED/INSTALLED
* TIRES INFLATED TO PSI AT BIG 0 TIRES COME WITH
LIFETIME FREE ROTATIONS,
RE-BALANCE & FLAT REPAIRS
DOWN TO 2/32" OF TREAD.
BUT HAVE NO ROAD HAZARD.
THE CUSTOMER HAS READ AND
AGREES WITH THESE TERMS.
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126 . 55
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CUSTOMER'S ORDER NO. I DEPARTMENT I DATE
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CLAIM
BOAi.2D OF SUPERVISORS OF CONTRA COSTA COUNTY
i
BOARD ACTION: MARCH 11 , 2008
Claim Against the County, or District Govemed by )
the Board of Supervisors; Routing Endorsements, ) NOTICE TO CLAIMANT
and Board Action. All Section refecences are to ) The copy of this document mailed to
California Government Codes. ��) �'�jj you is'you► notice of the action taken
on your claim by the Board of
JAN 2. 8 2008 Superyisors. (Paragraph IV below),
given'�Pursuant to Government Code
COUNTY COUNSEL Section 913 and 915.4. Please note all
AMOUNT: . $287 . 14 MARTINEZ CALIF,
"Warnings"
CLAIMANT: BRIAN JADES DOUGLAS
ATTORNEY: UNKNOWN DATE RECEIVED-; , JANUARY 28 , 200.8
ADDRESS: 170 MIRAMONTE ROAD, BY DELIVERY TO CLERK ON: JANUARY 28, 2008
WALNUT CREEK, CA 94597
BY MAIL POSTMARKED: JANUARY 25 , 2008
FROM: Clerk of the Board of Supervisors T0: County Counsel
Attached is a copy of the above-noted claim.
JANUARY 28 , 200.8 JOHN CULLEI N191M
Dated: By: Deputy
Il. FROM: County Counsel TO: Clerk of the Board of Sd e►•visors
(-j"This claim complies substantially with Sections 910 and 910.2.:.
( ) This Claim FAILS to con-ply 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 9.11.3).
( ) Other:
Dated: By: �2�C�lJ��lk Deputy County Counsel
I:iI. 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: A i JOHN CULLEN, CLERK, By ' _j Deputy Clerk
WARNING (Gov. code section 913) J
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 coot action on this chains.See Governi nellt Code Section 945.6.You may
seek the advice of an attorney of your choice in connection with this matter. ll'you want to consult an
attorney,you should do so inunediatly. *For Additioial Warding See Reverse Side of Tlris Notice.
AFFIDAVIT OF MAILING
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 pre"Mid a certified copy of this
Board Order and Notice to Claimant, addressed to th s shown above.
Dated:'(J`17 ?�Z/'�� JOHN CULLEN, CLERK By s eputy Clerk
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: MARCH 11 , 2008
Claim Against the County, or District Governed by )
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
and Board Action. All Secti The copy of this document mailed to
California Government Cod 7 you is.your notice of the action taken
!JAN 2 9 2008 on your claire by the Board of 9
Supervisors. (Paragraph IV below);
COUNTY COUNSEL given Pursuant to Government Code
AMOUNT: $ 3 . 49 MARTINEZ CALIF. Section 913 and 915.4. Please note all
1 ,000 .00 — For punitive d.amageWarnings".
CLAIMANT: CURTIS LEE 14ORRISON
A 44 2006026179
ATTORNEY: UNKNOWN DATE RECEIVED: JANUARY 29 , 2008
ADDRESS: MARTINEZ DETENTION FACWIDELIVERY TO CLERK ON: JANUARY 29 , 2008
901 COURT STREET,
MARTINEZ, CA 94553 BY MAIL POSTMARKED: JANUARY 28 , 2008
FROM: Clerk of the Board of Supervisors T0: County Counsel
Attached is a copy of the above-noted claim.
JANUARY 29 2008 JOHN CULLEN,
. Cork
Dated: By: Deputy.
I.I. FROM.: County Counsel TO: Clerk of the Board of Sup6visor•s�
(")`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 retuni claire 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 �-1 T"�,� By: 077C� —.002_ 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).
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 tlie'Board's Order entered in its minutes for
this date.
Dated: .:' , ;t� _ .OHN CULLEN, CLERK; By�j 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 chafm.See Government Code Section 945.6.You may
seek the advice of an attorney of your choice in connection widr this matter. if you want to consult an
attorney,you should do so immediately. *For Additional Waning See Reverse Side ofThis Notice.
AFFIDAVIT OF MAILING
I declare under penalty of pen jury that i. am nor .., 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 claim as shown above.
Dated: V Z/ z) J01-IN CULLEN, CLERK By DMuty Clerk
1
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: MARCH 11 , 2008
Claim Against tine County, or District Governed by, )
the Board of Supervisors, Routing Endorsements, ) ; NOTICE TO CLAIMANT
and Board Action. All Section references are to ) The copy of this document mailed to
California Government Codes. ) you is your notice of the action taken
D n your claim by the Board of
u ervisors. (Paragraph IV below
JAN 3 0 ZU08 Daven Pursuant to Goverment Code
AMOUNT: $5 ,000, 000. 00 Section 913 and 915.4.Please note all
COUNTY COUNSEL "Warnings".
MARTINEZ CALIF
CLAIMANT: HUI QUAN CHANG
ATTORNEY: CH ANG C . CHEN DATE RECEIVED: JANUARY 30, 2008
456 MONTGOMERY ST. , JANUARY 30, 2008
ADDRESS: SUITE 1'300 BY DELIVERY TO CLERK ON:
SAN FRANCISCO, CA 94104
BY .MAIL POSTMARKED: JANUARY 29 , 2008
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN CULLEN, r8,�
Dated: JANUARY 30, 2008 By: Deputy Z 00
II. FROM: County Counsel TO: Clerk of the Board of Sg'p'ei•visoi'
( 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 fon- 15 days (Section 910.8).
( ) Claim is not timely filed. Tile 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: I 'U By: Deputy County Counsel
1.11. FROM:: Clerk of tine Board TO: County Counsel (1) County Administrator(2)
( ) Claim was returned as untimely with notice to claimant (Section 911-3).
IV. BOARD ORDER: By unani:nious 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. ��l
Dated: ���ll /i� JOHN CULLEN, CLERK, Bly �- _1 _Deputy Clerk
WARNING (6ov. Lode section 913)
Subject to certain exceptions,you have only six(6) months from the dTte this notice was personally sewed
or deposited in the nlail to file a court action on this claim.See Government Code Section 945.6.You may
seek the advice of an attorney of'yaur 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 times herein mentioned, have
been a citizen of the United States, over age 18; acid that today 1 deposited in the United
States Postal Service in Martinez, California,. postage fully prepaid a certified copy of this
Board Orderand
Notice to Claimant, addressed to the claimant as shown above.
Dated:,DLfKJ . 109__' JOHN.CULLEN, CLERK "�( �s� Deputy Clerk
•t l — y —
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: MARCH 11, 20,08
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: UNKNOWN Section 913 and 915.4. Please note all
"Warnings".
CLAIMANT: SANTINA RAINEY
ATTORNEY: UNKNOWN DATE RECEIVED: FEBRUARY 01 , 20C
ADDRESS: 4935 SAN :PABLO DAM ROADY DELIVERY TO CLERK ON: FEBRUARY 01 ,: 20C
;' 605
EL SOBRANTE, CA 94803 BY MAIL POSTMARKED: HAND DELIVERED.
FROM: Clerk of the Board ol'Supe-visors TO: County Counsel
Attached is a copy of the above-noted claim.
FEBRUARY O1 , 2008 JOHN CULL EN
Dated: By: Deputy. � �r
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 Clerk should return claim on ground that it was filed late and
send waiiiing of claimant's might to apply for leave to.present a late claim (Section 91. 1.3).
( ) Otlier:
Dated: By: ' . Deputy County Counsel
.111. FROM: Clerk of the Board TO: County Counsei (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: O-3/ l/D JOHN CULLEN, CLERK, By Deputy Clerk
WARNING (6ov. code section 913)
Subject to certain exceptions,you have only six(6) months fi-oin the dFtehis notice was personalty served
or deposited in the snail 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. ifyou want to consult an
attorney,you should do so immediately. *For Additional Warning See Reverse Side ofThis 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 1.8; and that today I deposited in the United
States Postal Service in Martinez, California, postage fully iwepaid a certified copy of this
Board Order and Notice to Claimant, addressed to the chin shown above.
Dated: _®T( o� �n Q JOHN CULLEN, CLERK By -Deputy De ut Clerk
l
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: MARCH 11, 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
Supervisors. (Paragraph IV below),
given Pursuant to Government Code
AMOUNT: EXCEED $25,000.00 Section 913 and 915.4. Please note all
JOSEPH ANTHONY PASTOR, KORINA GO=,
"Warnings".
CLAIMANT: KC BRYAN QUICK
ATTORNEY: STEVEN H. HENDERSON DATE RECEIVED: FEBRUARY 05, 2008
LAW OFFICES OF STEVEN H. HENDERSON
ADDRESS: 3024 RAILROAD AVENUE, ' BY DELIVERY TO CLERK ON: FEBRUARY 05, 2008
PITTSBURG, CA 94565
BY MAIL POSTMARKED: HAND DELIVERED
FROM: Clerk of the Board of Supervisors T0: County Counsel
Attached is a copy of the.above-noted claim.
FEBRUARY 05, 2008 JOHN CULLEN, Gi c
Dated: By: Deputy _
I.I.. 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 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: 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,
( ) Other:
I certify that this is a true and correct copyof the Board's Order entered in its minutes for
this date.
Dated: (�_ �' ��/ JOHN CULLEN, CLERK, By \ __`Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exce ptions, ou have only six( months from tine d1te this notice was personally served
.1 Y. Y � P �'
or deposited in the mail to file a court.action on this claim.See Government Code Section 945.6.You inay
seek the advice of an attorney of your choice in connectior.with this inatter. Ifyou 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. f 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: Det'/ i7 /O JOHN CULLEN; CLERK 'By Deputy Clerk
�`—
CLAIM
BOARD O.F.SUPERViS.ORS OF CONTRA COSTA COUNTY
BOARD ACTION: MARCH 11, 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
Supervisors. (Paragraph IV below),
given Pursuant to Government Code .
AN10U.NT: IN EXCESS OF $10,000.0A Section 913 and 915.4. Please note all
"Warnings".
CLAIMANT: PATRICIA KELLY '
ATTORNEY: JOHN KEVIN CROWLEY DATE RECEIVED: FEBRUARY 06, 1008
ADDRESS: TEN ALMADEN BLVD. , STE. 409Y DELIVERY TO CLERK ON: FEBRUARY 06, 2008
SAN JOSE, CA 95113
BY MAIL POSTMARKED: FEBRUARY 05, 2008
FROM: Clerk of the Board of Supervisors. T0: County Counsel
Attached is a copy of the above-noted claire.
JOHN CULLEN, r'
Dated: By: ,06, 2008 By: Deputy
II, FROM.: County Counsel TO: Clerk of the Board of Su ffer•visors
( ) 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: By: Deputy County Counsel
III. FROM: Clerk of the.Board TO: County Counsel (l) 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:f I i �o _7 JOHN CULLEN, CLERK, By ,_Deputy Clerk
WARNI.N i(Gov. code section 913) )
Subject to certain exceptions,you have only six(6) months frorrr tir'e date this nodoe was personally served
or deposited in the mail to file a court actiai 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 yori want to consult an
attorney,you should do so immediately. *For Additional Warr hig See Reverse Side ofTlris Notice.
AFFIDAVIT OF MAILING
.1. 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 .1.8; nd 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 Claimarni, addressed to the claimant as shown above.
Dated: b`c/r7;0/ JOHN CULLEN; CLERK By Deputy Clerk
CLAIM
BOAIW OF SUPERVISORS OF CONTILA COSTA COUNTY
BOARD ACTION: MARCH 11, 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
NOTE: SANTE CLAIM WAS FILED ON FEBRUAY 06, 2008 on your claim by the Board of
Supervisors. (Paragraph IV below),
given Pursuant to Government Code
A1V10lJN"l : IN EXCESS OF $10,000.00 Section 913 and 915.4. Please note all
"Warnings".
CLAIMANT: PATRICIA KELLY
AT'I'ORNEY JOHN KEVIN CROWLEY DATE RECEIVED: FEBRUARY 06, 2008
ADDKESS: TEN ALMADEN BLVD. , STE. 400 BY DELIVERY TO CLERK ON: FEBRUARY 06, 2008
SAN JOSE, CA 95113
BY MAIL POSTMARKED: HAND DELIVERED
FROM: Clerk of the Board of Supervisors. TO: County Counsel
Attached is a copy of the above-noted claire.
FEBRUARY 06, 2008 JOHN CULLEN, r-c
Datecl: By. Deputy _
Il. FROM: County Counsel 'ro. Clerk of the Board of Suf ervisors
( ) This claim complies substantially with Sections 910 and 910.2.
( ) 'Chis Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so
no claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim ori ground that it was filed late and
send warning of claimant's right to apply Cor leave to present a late claim (Section 911.3).
( ) Other: --- —
Dated: _ By: Deputy County Counsel
l.11. 1-ROIVI: Clerk of the Board TO: County Counsel (1) County Administrator(2)
( j 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 .irr full.
O Other:
certify that this is a true and correct copy of the Board'.s Order entered in its minutes for
thisdate.
c
Dated:_ l(/0 JOHN CULLEN, CLERK, By�� ty Clerk
—� -
WARNING ( ,ov. code section 913)
Subject to cerlain exceptions,you have only six(6)months(roux lhe�ate this notice was personally served
or deposited in the mail to We a court action on this claim.See Govenunetrt Code Section 945.6.You may
seek lire.advice of an aittomey of your choice ill couuect.iou with this natter: If you want to consult an
attorney,you slio(dcl clo so iuurretliaitel3,. *.For Additional Warning See Reveise Side of Mis Notice.
AFFIDAVIT OI� 1�LAAILINC►
1 declare under penalty of per jury Ibat I am now, and at all times herein mentioned, have
been a citizen of the United States, over age .IS; and that today l deposited in the United
StaIes'`PosI'll Service. ill INtartinez, California, postage fully prepaid a certified copy of this
Board Order mud Noticc to Claimaurt, aiddressed to the claimant as shoW'n above.
l.)ated: ..( /a IUI LN CI.11,1.1_.N, l:I-.{ RK By _._ el)ul_y Clerk:
CLAIM
BOARD OF SUPERViSORS OF CONTRA COSTA COUNTY
BOARD ACTION: MARCH 11, 2008
Claim Against the County, or District Governed by )
the Board of Supervisors, Routing Endorserne tits, ) NOTICE TO CLAIMANT
and Board Action. All Section references are to ) The copy of this document mailed to
California Government Codes. ) you.is your notice of the action taken
on your claim by the Board of
Supervisors. (Paragraph 1V below),
given Pursuant to Government Code
AMOUNT: $4,236.60 Section 913 and 915.4. Please note all
"Warnings"
CLAIMANT: JOSEPH E. EISENBRANDT, JR. .
ATTORNEY: UNKNOWN DATE RECEIVED: FEBRUARY 07, 2008
ADDRESS: 1327 SANTA FE AVENUE, BY DELIVERY'TO CLERK ON: FEBRUARY 07, 2008
MARTINEZ, CA 94553
BY MAIL POSTMARKED: HAND DELIVERED
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN CULLEN, C c
Dated: _ FEBRUARY 07, 2008 By: Deputy _ 1
11. FROM: County Counsel TO: Clerk of the Board of Sup visors .
( ) 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 isnot 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).
( ) Otlier•:
Dated: By: Deputy County Counsel
1.11. 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:,
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: n�lt /�9, JOHN CULLEN, CLERK, By �X_/ Deputy Clerk
WARNING �Gov._code section 913)
Subject to certain exceptions,you have only six(6) months fironl th3date 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 tine 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 Wanting See Reveise Side ofThis Notice.
AFFIDAVIT OF MAILING
1 declare under penalty of per jury that 1 am now, and at all times herein mentioned, have
been a citizen of' the. United States, over age 18; and that today I deposited in the United
States Postal Service in Martinez, California, postage fully prepaid a certified copy of this
Board Orderand [Notice to .Claimant, addressed to the claimant as shown above.
Dated: _0T(D3/6K J01=1N CULLEN, CLERK By g puty Clerk
CLAiM
BOARD OF SUPERVISORS OF CONTRA,COSTA COUNTY
BOARD ACTION: MARCH 11 , 2.008
Claim Against the County, or District Governed by )
the Board of Supervisors, Routing; Endorsernents, ) NOTICE TO CLAIMANT
and Board Action. All Section rel:erences are to ) The copy of this document mailed to
Cali fornia,Government Codes. you is your notice of the action taken
on your claim.by the Boai•d of
Supervisors. (Paragraph IV below),
given Pursuant to Government Code
AMOUNT: $2, 325 . 20 Section 913 and 915.4. ]'lease note all
"Warnings".
CLAIMANT: FARMERS INSURANCE
BY: CHRIS HUGHES
ATTORNEY: for : SHIN HYANG.. CHUNG DATE RECEIVED: FEBRUARY 11 , 2008
UNKNOWN
ADDRESS: P.O. BOX 268992 BY DELIVERY.TO CLERK ON: FEBRUARY 11, 2008
OKLAHOMA CITY,
OK 73126-8992 BY MAIL POSTMARKED: FEBRUARY 08, 2008
FROM: Clerk of the Board of Supervisors T0: County Counsel
Attached is a copy of the above-noted claim.
FEBRUARY 11 , 2008. JOHN CULLEN, C i'Dated: 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. Tile.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 Cour*el
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).
]V. 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: ���I t /o JOHN CULLEN, CLERK, By Deputy Clerk
WARNING (Gov` code section 913) Jate
Subject to certain exceptions,you have only six(6) niontlis from the this notice was personally served
or deposited in the mail to file a court action on this claiin.See Government Code Section 945.6.You may
seek the advice ol'an attorney of.your choice in connection with this matter. ll'you waist to consult an
attoniey,you should do so immediately. *For Additiaial Warning See Reverse Side ofThis Notice.
AFFIDAVIT OF MAILING
[ .declare under penalty ofperjury 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 iii Martinez, California, postage fully prepaid a certified copy of this .
Board Order and Notice to Claimant, addressed to the claimaryMt as shown above.
Dated: D4/�2 �nQ JOHN CULLEN, CLERK B Deputy Clerk
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: MARCH 11 , 2008
Claim Against the County, or District Governed by )
the Board of Supervisors, Routing Endorsements, ). NOTICE TO CLAIMANT
and Board Action. All Secti The copy of this document mailed to
California Government Cod ) you is your notice of the action taken
JAN 2 9 2008 : , on your claim by the Board of
Supervisors. (Paragraph IV below);
COUNTY COUNSEL given Pursuant to Goveimment Code
MARTINEZ CALIF. Section 913 and 915.4. Please note all
AMOUNT: $ '3 .49 .
1 ,000 .:00 — For . punitive damages WarningS".
CLAIMANT: CURTI S LEE MORRI SON
A 44 2006026179
ATTORNEY: UNKNOWN DATE.RECEIVED: JANUARY 29 , 2008
ADDRESS: MARTINEZ DETENTION FACWIDYLIVERY TO CLERK ON: JANUARY 29 2008
901 COURT STREET, .
MARTINEZ, CA 94553 JANUARY 28 , 2008
BY MAIL POSTMARKED:
FROM: Clerk of the Board of Supervisors TO:: County Counsel
Attached is a copy of the above-noted claim.
JANUARY 29 , 2008 JOHN CULLEN, G ri
Dated: By: Deputy
11. FROM.: County Counsel TO: Clerk of the-Board.of Sup6visors
G,�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 retuin claim on ground that it was filed late and
send warning of claimant's rig lit to apply for leave.to present a late claim (Section 911.3).
( ) Other:
Dated: ���rD� By: M 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).
1V. BOARD ORDER: By unanimous vote of the Supervisors present: .
( ) This Claim is rejected in full.
( ) Other:
1 ceitify that this is a true and correct_copy of the'Board's Order entered in its minutes for
this date.
Dated: JOHN CULLEN, CLERK, By Deputy Clerk
WARNING (Gov. code section 913) a '
Subject to certain exceptions,you have only six(6) months from the date this notice was.personally served
or deposited in the nuail to file a couit action on this claim.See Government Code Section 945.6.You may
seek the advice of an attomey of your choice in connection with this matter. if you want to consult an
attoi-iiey,you should do so immediately. *For Additional Warning See Reverse Side ofTltis Notice.
AFFIDAVIT OF MAILING
I declare under penalty of per j-ury that l: am now, and at all tinies 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: JOHN CULLEN, CLERK By Deputy Clerk
r
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: MARCH 11', 2008.
Claim Against the County, or District Governed by )
tine 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
DIven
n your claim Uy the Board of
uperv:isors. (Paragraph IV below),
JAN 3 0 ZUUB Pursuant to Government Code
AMOUNT: $5 ,000,000 .00 Section 913 and 915.4. Please note all
COUNTY COUNSEL "Warnings",
MARTINEZ CALIF
CLAIMANT: HUI QUAN CHANG
ATTORNEY: CHANG C CHEMDATE RECEIVED: JANUARY 30 , 2008
456 MONTGOMERY ST. ,
ADDRESS: SUITE 1300 BY DELIVERY TO CLERK ON: JANUARY 30, 2008
SAN FRANCISCO, CA 94104
BY MAIL POSTMARKED: JANUARY 29 , 2008
FROM: Clerk of the Board of Supervisors T0: County Counsel
Attached is a copy of the above-noted claim.
JOHN CULLEN, r
Dated: JANUARY, 30, 2008 By: Deputy
II. FROM: County Counsel TO: Clerk of the Board of S4ervisors
( .),"Flnis 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 wai ring of claimant's right to apply for leave to present a late claim (Section 911.3).
O Other:
Dated: 'b8� By: Deputy County Counsel
III. FROM:: Clerk of the Board TO: County Counsel (l) 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:
( ) This Clairn 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: JOHN'I CULLEN, CLERK, By Deputy Clerk
WARNING (Gov. code section 91.3)
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 couiht action on this claim.See Government Code Section 945.6.You may
seek the advice of an attorney of your choice in connection wide 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 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 coliy of this
Board Order and Notice to Claiimant, addressed to the claimant as shown above.
Dated: JOHN CULLEN, CLERK By Deputy Clerk
! CLAiNI I
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: MARCH 11, 2008
Claim Against tL"aunty, oi' District Govemed by )
the Boai-d of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
and Board Action. All Section references are to ) The copy of this document mailed to
ent Codes. ) you is youi- notice of the action taken
� LITIEM onY our claim by the Board of
FEB O LOOK Supervisors. (Paragraph IV below),
given Pursuant to Government Code
CO ly�(�gU�1SEL Section 913 and 915.4. Please note all
p�i�WJ IF. $4,236.60
"Warnings".
CLAIMANT: JOSEPH E: EISENBRANDT, JR.
ATTORNEY: UNKNOWN DATE RECEIVED: FEBRUARY 07, 2008
ADDRESS: 1327 SANTA FE AVENUE, BY DELIVERY TO CLERK ON: FEBRUARY 07, 2008
MARTINEZ, CA 014553
BY MAIL POSTMARKED: HAND DELIVERED
FROM: Clerk of the Boai-d of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN CULLEN, C c
Dated: FEBRUARY 07, 2008 By: Deputy
IL FROM: County Counsel TO: Clerk of the Board of Sup�•visors .
(LKfInis 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 Clei-k should return claim on ground that it was filed late and
send wai-ning of claimant's right. to apply foi• leave to present a late claim (Section 911-3).
( ) Other:
Dated: —13 D� By: Deputy County Counsel
i1I. FROM.: Clei-k of the Boai-d TO: County Counsel (1) County Administi-atoi- (2)
( ) Claim was returned as untimely with notice to claimant (Section 91 l.3).
IV. BOARD ORDER: By unanimous vote of the Supei-visoi's present:
( ) This Claim is rejected in :Full.
( ) Other:
I certify that this is a true and correct copy of the Board's.Oi-dei- entei-ed in its minutes foi-
this date.
Dated: JOHN CULLEN, CLERK, By Deputy Clei-k
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 connectioi widi this matter. If you want to consult an
attorney,you should clo so inunecliately. *For Additional Warnijig See Reverse Side of'Tliis Notice.
AFFIDAVIT OF MAILING
I declare wider penalty of perjury that i. ani now; and at all times herein mentioned, have
been a citizen of the United States, over age 18; and that today 1 deposited in the United
States Postal Service in 1VIai tinez, California, postage fully pr el�aid a certified coley of this
Board Order and Notice.to Claimant, addressed to the claimant as shown above.
Dated: JOHN CULLEN, CLERK By Deputy Clei•k
a
CLAIM
BOARD O.F.SU.PERV.iSO.RS OF CONTRA COSTA COUNTY
BOARD ACTION: MARCH 11, 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
Supervisors. (Paragraph IV below),
o w¢ given Pursuant to Government Code
o Section 913 and 915.4. Please note all
AUNT: IN EXCESS OF $10,000.09
0w "Warnings".
rt� CCC .MANT: PATRICIA KELLY
Uj V Li- 2
ATTORNEY: JOHN KEVIN CROWLEY DATE RECEIVED: FEBRUARY 06, 2008
ADDRESS: T& ALMADEN BLVD. , STE. 40BY DELIVERY TO CLERK ON: FEBRUARY 06, 2008
SAN JOSE, CA 95113
BY MAIL POSTMARKED: FEBRUARY 05, 2008
FROM: Clerk of the Board of Supervisors T0: County Counsel
Attached is a copy of the above-noted claim.
FEBRUARY 06, 2008 JOHN CULLEN, r
Dated: By: . Deputy
II. FROM.: County Counsel TO: Clerk of the Board of Supervisors
(W-fl,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).
( ) Other:
Dated: �:� �� '0� By:�_�OZA� ( fa Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (l) County Administrator(2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
I.V. 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: JOHN 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. If you want to consult an
attorney,you should do so iinrnetilately. *For Additional Warning See Reverse Side of'This Notice.
AFFIDAVIT OF MAI.LI.NG
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 1.8; 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: JOHN CULLEN, CLERK By Deputy Clerk
CLATM.
BOARD Or SU.PE.RVISORS OF CONTRA COSTA COUNTY
BOARD ACTION. MARCH 11, 2008 -
Claim Against the County, or District Governed'by )
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
and Board Action. All Section rel:erences are to ) '.Che copy of this document mailed to
California Government Codes. ) you is your notice of the action taken
NOTE: SAME CLAIM WAS FILED ON FEBRUAY 06, 2008 ori your claim by the Board of
Supervisors. (Paragraph 1V below),
given Pursuant to Government Code
Section 913 and 915.4. Please note all.
FtBPOgLNQB EXCESS OF $10,000.00 "earnings".
CNO�U�Nal . Vr
PATRICIA KELLY
A-1.71'OR-NEY: JOHN KEVIN CROWLEY DATE RECEIVED: FEBRUARY 06, 2008
ADDRESS: TEN ALMADEN BLVD. , STE. 400BY DELIVERY TO CLERK ON: FEBRUARY 06 2008
SAN JOSE, CA 95113
BY MAIL .POSTMA.KK.ED: HAND DELIVERED
FRONT: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
FEBRUARY 06, 2008 J.OFIN CULLE.N r
Dated: By: Deputy
11. PROM.- County Counsel T0: Clerk of the Board of Supervisors
(
is claim complies substantially with Sections 910 and 910.2. .
( ) This Claim .FAILS to coniply substantially with Sections 910 and 910.2, and we are so
notifying claimant. The Board cannot act for 15 clays (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 91 .1.3).
O Other.
Dated: 2 - By: 1)qC002h Deputy County Counsel
I.I.I. FROM: Clerk of.the Board TO: County.Counsel (1) County Administrator (2)
( j Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present:
O 'This Claim is rejected in full.
O Other:
1 certify that this is a true and correct copy of the Board's Order entered in its minutes for
this elate.
Dated:_ JOHN CULLEN, CLE.I.ZK, By Deputy Clerk
WARNING (Gov. .code section 91 3)
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.Vol] may
seek the advice of an attorney of your choice in connection with this matter. If you want to consultu]
attonrey,you should clo so inuueclialely, *For Additional Warring See Reverse Side of 7.Iris Notice.
A17FIDAVIT OF N1AI.LING
declare under penalty of per jury that >< ;vu now, ;rad at all tithes herein mentioned, have
been a citizen of the United States, ovel• age I8; and that today 1. deposited in the United
States Postal Service in A1..11-tincz, California, hostage fully prepaid a cert:ilied copy of this
Board Order and Notice to Claimant:, addressed to the claimant as shown above.
Dated: — -__.--..— -.--__—_-- JO1-lN C.t_11_.I_.F�N, CI�F�IZ1C . E3
1 _..__.—.. ._. '_—Depul.y Clerk
CLAIM
BOARD OF SLJPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: MARCH 11, 2008
Claim Against the County, or District Governed by )
tine 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
Con your claim by the Board of
wri Supervisor's. (Paragraph IV below),
=' ofA J
C= =Q . given Pursuant to Government Code
ir: v Section 913 and 915.4. Please note all
�AMBMNT: EXCEED $25,000.00
.�. "Warnings".
C (r: JOSEPH ANTHONY PASTOR, KORINA GOULD� g
L OJANT: KC BRYAN QUICK
0
�TTORNEY: STEVEN H. HENDERSON DATE RECEIVED: FEBRUARY 05, 2008
LAW OFFICES OF STEVEN H. HENDERSON FEBRUARY 05, 2008
ADDRESS: 3024 RAILROAD AVENUE, BY DELIVERY TO CLERK ON:
PITTSBURG, CA 94565
BY MAIL POSTMARKED: HAND DELIVERED
FROM: Clerk of the Board of Supervisor's TO: County Counsel
Attached is a copy of the above-noted claim.
FEBRUARY 05, 2008 JOHN CULLEN, Cl c
Dated: By: Deputy
II. FROM: County Counsel TO: Clerk of the Board of Supei•visol•s
( 6),-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 91 l.3).
O Other:
Dated: 3-05" By: CA&-W, 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: JOHN 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 snail to file a court action on this clahn.See Government Code Section 945.6.You may
seek the advice of'an attorney of'your choice in connection widi this matter. If you want to consult an
attorney,you should do so immediately. *For Additional War�nir�See Reverse Side of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty of per jury that i am now, and at all tinier 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 Clahnant, addressed to the clairnan.t as shown above.
Dated: JOHN CULLEN, CLERK By Deputy Clerk
CLAIM
HOARD OF SUPERViSORS OF CONTRA COSTA COUNTY
BOARD ACTION: MARCH 11 , 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. �'�-j you is your notice of the action taken
j `JJ on your claim by the Board of
FEB O 2008 Supervisors. (Paragraph IV below),
given Pursuant to Government Code
AMOUNT: UNKNOWN COUNTY COUNSEL Section 913 and 915.4. Please note all
MARTINEZ CALIF. "Warnings".
CLAIMANT: SANTINA RAINEY
ATTORNEY: UNKNOWN DATE RECEIVED: FEBRUARY 01 , 2008
ADDRESS: 4935 SAN PABLO DAM ROADY DELIVERY TO CLERK ON: FEBRUARY 01 , 2008
#605
EL SOBRANTE, CA 94803 BY MAIL POSTMARKED: HAND DELIVERED
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
FEBRUARY O1 , 2008 JOHN CULLENPDated: By: Deputy �
If., FROM: County Counsel TO: Clerk of the Board of Supervisors
(v)"-Tllis 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 waining of claimant's right to apply for leave to present a late claim (Section 911.3).
other: COL I I _Fb r4 la 4+(4 LJat a ?a+ro 1 i 5 ez
Dated: By: r"600x� 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).
1V. 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 coirect copy of the Board's Order entered in its minutes for
this date.
Dated: JOHN CULLEN, CLERK, By Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions,you have only six(6) montlis from the date this notice was personalty 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 widi this matter. if you want to consult an
attorney,you should do so immediately. *For Additional Warning See Reverse Side-ofThis Notice.
AFFIDAVIT OF MAILING
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: JOHN CULLEN, CLERK By Deputy Clerk
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: MARCH 11, 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
Cali fornia Government Codes. ) you is your notice of the action taken .
on yourclaim by the Board of
Supervisors. (Paragraph IV below),
FEB 1 S 2008 given Pursuant to Government Code
AMOUNT: $109.92' Section 913 and 915.4. Please note all
COUNTY COUNSEL "Warnings".
MARTINEZ CALIF.
CLAIMANT: MAIRA NAVARRO
ATTORNEY: UNKNOWN DATE RECEIVED: FEBRUARY 13, 2008
ADDRESS: 613 JOHNSON DRIVE, BY DELIVERY TO CLERK ON: FEBRUARY 13, 2008
RICHMOND, CA 94806
BY MAIL POSTMARKED: FEBRUARY 11, 2008
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
FEBRUARY 13JOHN CULLEN, l
, 2c)08 e'1
Dated: By: Deputy
f1. FROM: County Counsel TO: Clerk of the Board of Sufervisors_
( his claim complies substantially with Sections 910 and 910.2.
( ) This Claim FAILS to comply substantially with Sections 910 and 91.0.2, and we are so
notifying claimant. The Board cannot act for 15 days (Section 910.8).
( .) Claim is not timely 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: 17 — By: vp /����Ci Deputy County Counsel
111, FROM: Clerk of the Board. T0: 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:
( ) 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: JOHN CULLEN, CLERK, By Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions,you have only six(6) montlis from the date this notice was personally served
or deposited in the nail 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 widr this matter. If you want to consult an
attorney,you should do so immediately. *For Additional Warning See Reverse Side ofTlris 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 1.8; and that today 1 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: JOHIN CULLEN, CLERK By Deputy Clerk
CLAIM :
BOARD OF SUPERViSORS OF CONTRA COSTA COUNTY
BOARD ACTION: MARCH 11 , 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
l!! on your claim by the Board of
JAN 2 8'2008 Supervisors. (Paragraph IV below),
COUNTY given Pursuant to Government Code
COUNSEL Section 913 and 915.4. Please note all
AMOUNT: $287 . 14 MARTINEZ CALIF.
"Warnings".
CLAIMANT: BRIAN JAIJES DOUGLAS
ATTORNEY: UNKNOWN. DATE RECEIVED: JANUARY 28 , 2008
ADDRESS: 170 MIRAMONTE ROAD, BY DELIVERY TO CLERK ON: JANUARY 28, 2008
WALNUT CREEK, CA 94597
BY MAIL POSTMARKED: JANUARY 25 , 2008
FROM: Clerk of the Board of Supervisors T0: County Counsel '
Attached is a copy of the above-noted claim.
JANUARY 28, 2008 JOHN putt'
CULLEN I
Dated: By: Deputy _
II. FROM: County Counsel 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 Other:
Dated: J y QD By: LM629-k Deputy County Counsel
1.11. FROM: Clerk of the Board TO: County Counsel (l) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 91 l.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: JOHN 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. If you want to consult an
attorney,you should do so immediately. *For Additional Warning See Reverse Side ofThis Notice.
AFFIDAVIT OF MAILING
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 1 deposited in tine United
States Postal Service in N.I.artinez, California, postage fully prepaid a certified copy of this
Board Order and Notice to Claimant, addressed to the claimant as shown above.
Dated: JOHN CULLEN, CLERK By Deputy Clerk
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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 wiy 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 1.06,
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.
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RE: Claim By: Reserved for Clerk's filing stamp
alarm-,e6 Dow 1417
RECEIVED
Against the County of Contra'Costa or ) JAN 2 8 2008
District) CLERK BOARD OF SUPERVISORS
(Fill in the name) ) CONTRA COSTA CO.-
1
The undersigned claimant herel7 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)
3,246V-7
2. Where did the dams a or /,fury occur? (Include city and county)
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3. How did the damage or injury occur? (Give full details- use extta p per if required)
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4. What particular act or omission on the part of county or dis 'et officers, servants, or employees
caused the injury or damage? ole ��
5 What are the names of county or district officers,servants,or employees causing the
damage or injury? C�rUu�h
6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages
claimed. Attach two estimates for auto damage.) 90A shed rj�5
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.) ��f ' W�Ze�ll
$. Names and addresses of witnesses,doctors,and hospitals: my oylFl / �)01q5
9. List the expenditures you made on account of this accident or injury:
DATE M4EE AMOUNT
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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) t
Name and address of Attorney )
(Claimant's Signa e)
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'f (Address)
Telephone No. 'i Telephone No. 1�21� g u_ONO
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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, S5 6500 et seq.) Furthermore, any
attachments,addendums,or supplements attached to the claim form, including medical records,are also subject to
public disclosure.
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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 some 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.
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www.handsonwheels.com info@handsonwheels.com (415) 731-2224
INVOICE
customer: Brian Douglas date: 11/5/2007
Walnut Creek, CA 94597
(925)945-0148
PARTS
quantily item price each line'total
2 Velocity Dyad rims 36h $59.00 $118.00
72 DT 285 db spokes 0.50 . 36.00
0
0
0
parts subtotal 154
LABOR
2 wheel builds $40.00 $80.00
labor subtotal 80
Parts & Labor 234
Tax (Parts) 8.5% 13.09
Shipping
GRAND TOTAL 247.09
California Pedaler
495 Hartz Ave.
-Danville, CA 9452.6
(92.5) 820-0345
1
11/03/07 Invoice,-,'liivoice # 45143
.5:'34-pm CUstomer..`4.3640
Visa **0********2282 4*/** 7.
AMOUNT: $57.81 'APPROVED: 003348
Sales Person: John
Energy Hammer HEED Man-Orng
1 C 11 .95 each 11 .95*
Energy ZYM LI- Drink Tablets
1 a 4.45 each 4.45*.
Tire Cohti-Gatorskin
2' ,' 18.50 eacl 37.00* I
110 CASH REFUN SUb-Total : 53.40
Required for - ---- ---- -- ------
G Tax[B.251 : 4.41*
Total : 57.81
T H A N K Total Paid: 57.81
Y 0 U I Change: 0.00
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BC)ARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. A claim relating to a cause of action for death or for injury to person or to personal property or
growing crops shall be presented not later than six months after the accrual of the cause of
action. A claim relating to any other cause of action shall be presented not later than one year
after the accrual of the cause of action.
(Gov. Code § 911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106,
County Administration Building, 651 Pine Street, Martinez, CA 94553.
C. If claim is against a district governed by the Board of Supervisors, rather than the County, the
name of the District should be:filled in.
D. If the claim is against more than one public entity, separate claims must be filed against each
public entity.
E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form.
................................................................................
RE: Claim By: Reserved for Clerk's filing stamp
C.U2ri S Le-e, MoAR ► Son/
RECEIVED
Against the County of Contra Costa or j JAN 2 9 2008
C oAl TTL A C o 5Th C o UN rY District) CLERK BOARD OF SUPERVISORS
(Fill in the name) ) CONTRA COSTA CO._
1
The-undersigned claimant hereby makes claim against the County of Contra Costa or the above-named
district in the sum of$ 3. y 9 and in support of this claim represents as follows:
6000-00 P(m1iT iY dA� aA
1. When dia the daminjury or �ury occur?(Give exact date and hour) /- A- o a AR ouN.0 /0 /1 AA
2. Where did the damage or injury occur? (Include city and county) i N LC'L L 9 4,1 Al T T//C
COn! T/ZA Co STA CoU NTY L3erCIVTionl FAC ILirY 47 AA AT Z CAL/ FO/t/t I1�
3. How did the damage or injury occur? (Give full details; use extra paper if required)Ac 7iN 9 u N o L2 T//e
Mi5CONCeP710// THAT /N MAT L'S CouLd (nHV L' 04LY onlc raar9bAvsH, M ,s 7-.9f(e./iNy/Y
Too/ / zz- of /v%;4 e, Ni S Co- w o&AeR CLAIM eJ0 F/L' Wou1 0 12%eT021V TtICAv jr /veve2 /1i9PPPJv
4. What particular act or omission on the part of county or district officers, servants, or employees
caused the injury or damage? T'ML /9c-7- o F ;4 LL O vV/N 9 4 LJN 7 A A 4 C d , u 1VS u P eft v►.Se.L
RRC i ST De P urY 7-3 Su PI'izv i 5e MCnI ,.f! 16e/N S 4LLd W e M TO 1Z e ivy aver CAN T e-e41
w,rNour iv\ 4/f,N y DoCU. MCNT.
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.) 9 d,g Y s w i T N our b R US 14 iN 1 my T e e l 1-l.
CaysIag HeiqdAcffe.s, 411 7-14 e- r-/ZUSTRAT/0N o,& NAv11V � Pe_2Soi/4L PAoPeRT Y T/4 Kc,N FoR
LAC A of T/��9►N � \N 41'Le beiN 9 .ALL0we 10 To PR Ac i►C.e R Aci ST 6eh,%vio2 oN NIC'.
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)by L0,,VIW 9 AT Tf/e /N /v1 AT e CF}N.TeeN Li ST /;Ntl KAlvwlN-
THe COST of PoSrA-g ,bur PUN 17'IV� dA.vig9& S nr- S1,000.00 IS R SAnALL- P(tiC,e FofcTthS
®P-PuTY To PAY To LeARN 7.-//e Less of PIZc) FC5SiOnIgL. b&-dAyi0A. .wirl/ r-eLo4ieS
— 8. Names and addresses of Wit de_se.—doctors, and'hospita19- -`--
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9. List the expenditures you made on account of this accident or injury:
DATE TIME AMOUNT
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;► Gov. Code Sec. 910.2 provides"The claim shall be
j signed by the claimant or by some person on his
;)behalf."
SEND NOTICES TO: (Attornev)
Name and address of Attorney ) (,-2r ,
j (Claimant's Signature) a o ob o 2,G 171
j 90/ COLq
(Address)
C7 V 6S-
Telephone No. ) Telephone No. /►/f¢
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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.
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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
($10,000),or by both such imprisonment and fine.
BOARD OF SUPF,RVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CIAMANT
A. A claim relating to a cause of action for death or for injury to person or to personal property or
growing crops shall be presented not later than six months after the accrual of the cause of
action. A claim relating to any other cause of action shall be presented not later than one year
after the accrual of the cause of action.
(Gov. Code § 911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106,
County Administration Building, 651 Pine Street,Marrdnnez,CA 94553.
C. If claim is against a district governed by the Board of Supervisors, rather than the County, the
name of the District should be filled in.
D. If the claim is against more than one public entity, separate claims must be filed against each
public entity.
E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form.
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RE: Claim By: Reserved for Clerk's filing stamp
CuRTl S Le-e- MOR R, 1 So/i/ _
RECEIVED
Against the County of Contra Costa or j JAN 2 9 2008
C o N TR A C o Sr l4 C o UW T.Y District) CLERK BOARD OF SUPERVISORS
(Fill III the name) 1 CONTRA COSTA CO.
1
The-undersigned claimant hereby makes claim against the County of Contra Costa or the above-named
district in the sum of$ 3. 419 and in support of this claim represents as follows:
-" I 000.00 Paja-,ye d.A/rAyDS
1. When did uie damage or in3ury occur'! (Give exact date and hour) /- a- o S AR ouN o /0 /9 M
2. Where did the damage or injury occur? (Include city and county) /N L.e L L R y y A T 7-#C
CO1iTAA Co STA COuNTY 0ereIVTlod Fi4C►LirY -.4T MAA- 7' e, Z CRL/ FoA/Yiiq
3. How did the damage or injury occur? (Give full details;use extra paper if required)Ac TiN 9 u N a elL r#e
Mi-scavGL' PT/oN TNAT /NMRTC.S CouLd .h qVt' OdLY ode- 7,vorNbAvsy, AIST.9!(E////Vy(Y
7-00K ILL of MiNe, .9 S Co- wo2Ker/ , CLAtAIX CJD f/L' Woo! D /ZeTu2N I"/fLrr� jT Ntft& WAPPeA
4. What particular act or omission on the part of county or district officers, servants, or employees
caused the injury or damage? TN .s c T o L L 0 W 11V g I U li TA A 4 C d , u N S v P eA V t S e L
RRC I ST Qe P UtY Tt7 Su PeRV I SL' MC/� ,.R be/N S ALL,) W G' 10 TO /Z G' N► JVfi G�4N T C'C�N
wrrNvUr /V\ 4,t/Ng 00cu medr.
5 What are the names of county or district officers, servants,or employees causing the
damage or injury? ��� J• A N b M.
6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages
claimed. Attach two estimates for auto damage.) 9 d A Y S w i r!1 o u r b R us H iH 9 m Y T e e l N,
CAV5 /N9 HeadAcHe.S, RNv r14 F/zusr1Z.4Tioy of HAviN 9 PC'_RSoi✓AL PAuPea7Y FA K&_11 POR
ACh of V/ A14 S . W 41Le be/N 9 .AL.c.L)We 10 ry PR ACrI'C-e RHci sr 6ehaviOR ON Me.
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)by Loaxly _q 97 TNe /N /v%.4r e CANTee A LI'S 7- /SND KN0WfA✓_
-r)qe COST of PoSrA.ge,bur PUNirnte dANinges or- SiA0O.00 IS R SAnAi_.c PRiC.e FoRTdiS
DePuTY To P4Y_ To_ LeHRIr T.Ne LesSo.V oF__d_'/Lc'Fa5sio.VAL b&_A�Ay/02 wirN r_eLoVieS .
8. Names ana addresses or wimesses;aoctors, ana n-aspltais: — . �-
Co2 e-Y' A Tu/LNe2 atoo6oab, to:y89o/ Ca.AAZ 5r
9. List the expenditures you made on account of this accident or injury:
DATE TDdE AMOUNT
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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 )
(Claimant's Signature) a o oG o 171
9 0/ A y
(Address)
Telephone No. )Telephone No.
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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.
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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.
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BOARD OF SUPERVISORS OP CONTRA COSTA COUNn
NSTRUCTIONS TO CLAM'
A. A claim relating to a cause of action for death or for injury to person or to persomil property or
growing crops shall be presented not later then six monibs after the accrual of the cause of
action. A claim relating io any other cause of action shall be presented not later than one year
' after the accrual of the cause of action.
(Ciov. Code§ 911.2.)
B. Clai= must be filed with the Clerk of the Board of Supervisors at its office in Room 106;
County Adminiaration Building, 651 Pine Street,Martinez,CA 94553.
C, If claim is against a district governed by the Board of Supervisors, rattier 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.
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RE; Claim By: Reserved for Clerk's filing stamp
)
HUI QUAN CHANG
j RECEIVED
_ t "
Against the County of Contra Costa or ) JAN 3 U 2008
District) CLERK BOARD OF SUPERViSGRS
(Fill in the n=e) )
--
CONTRA COSTA CO.
711e widorsigned claimant hereby makes claim against the'.Couty of Contra Costa or the above-named
district in the sum of&5 _moo.0 0 0 and ut support of this claim represents as follows:
I. When did the damage or injury occur? (Give exact date and hour)
July 30, 2007 at approximately 5:50' p.m.
2. Where did the damage or injmy incur? (Include city and county)
3409 Belmont Avenue, El Cerrito, CA
3. Haw did the damage or injury occur? (Give full details;use extra paper if reTATed)
See attached pages
4. What particular actor omission on the part of county or district officers, servants, or employees
caused the injury or damage?
See attached pages
5 What are the names of county or d istriet officers,servants;or.employees causing the
damage or injury?
Unknown at this time
u I,U-4, _UGo ILI)a-M i MH Uib I H WUN I Y CLERK OF THE 4 915102359151 No.001 DO?
G. What damage or injuries do your claim resulted? (Give fu11 extent of injuries or damages
claimed. Attach two est mates for auto damage.)
See attached pages
7. How was the amount claimed above computed?.! (include the estimated amount of any
prospective injury or damage.)
See attached pages
g. Names and addresses of witnesses,doomrs,and hospitals:
See attached pages
9. List the expenditures you made on account of this accident or injury:
DATE TIME AMOUNT
See attached pages .
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Gov. Code Sec. 910.2 provides"The claim shall be
signed by the claimant or by some p oa on his
behalf."
SEND NOTICES TO: (Attomev)
Name and address of Atwmey )
Chang C. Chen Es
456 Montgomery STq ) LClaimuarit' i.guature)
Suite 1.300 ) V, �i�,• fpm.
San Francisco, CA
(Address)
J�r
) <
Telephone No. 41-5-397-7956 _)Telephone No.
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PUBLIC RECORDS NOTIM
Please be advised that this claim form,or any claim filed with the Countyunder the Tort Claims Act; is subject to
public disclosure under the Californis Piablio Reoords Art. (Gov. Code, §§ 6500 et seq.) Furthermore, any
attachments,addendums,or supplements attached to the claim form, including medi4al records,are also subject to
public disclosure.
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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 satne if genuine, any false or
fraudulcW claim,bill, account voucher,or writing, is punishable either by imprisonment m the County jail for a
period of not more than one year, by a fine of not exceeding one thousand dollars (51,000.00), or by bath snob
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 4LMF
risorunant and fine.
ATTACHMENT TO CLAIM OF HUI QUAN CHANG FOR DAMAGES AGAINST CONTRA
COSTA COUNTY:
3. HOW DID THE DAMAGE OCCUR?
Claimant's son Jin Zhou Chang was shot by robbers in the carport of an apartment house
where Claimant and his son worked. Police and emergency personnel employed by Contra
Costa County arrived at the scene: and kept Claimant from attending to his wounded son,
prevented Claimant from providing emergency first aid or taking his son to the hospital, and
threatened him with arrest if he touched his own son. :Emergency personnel arrived at the scene
late, over 20 minutes after the 911 call, and provided the wrong treatment for the son's injuries,
handling his care in such a way that worsened the.internal bleeding from the gunshot wounds.
As a result of these errors and ornissions, plaintiff's son died later that evening.
4. WHAT PARTICULAR ERROR OR OMISSION ON THE PART OF COUNTY OFFICERS,
SERVANTS OR EMPLOYEES CAUSED THE INJURY OR DAMAGE?
County officers, servants and/or employees delayed in responding to the 911 call;
prevented Claimant from assisting his son or taking him to the hospital himself, and provided
incorrect medical treatment for the son's injuries.
6. WHAT DAMAGES OR INJURIES DO YOU CLAIM RESULTED?
Claimant's son—his only child—died as a result of the errors and/or omissions of County
officers, servants and employees. The monetary amount of this injury is in excess of$25,000.
7. HOW WAS THE AMOUNT CLAIMED ABOVE CALCULATED?
Calculation not applicable, but reflects loss of care, comfort and society of Claimant's
only child, loss of future support, and emotional distress.
8. NAME AND ADDRESS OF WITNESSES, DOCTORS AND HOSPITALS.
Witnesses:
Hui Quan Chang, Claimant, 1447 Monterey Street, Richmond, CA.
The names and addresses of other witnesses are unknown at this time.
Hospital: Doctors Medical Center, 2000 Vale Road,San Pablo, CA 94806
9. EXPENDITURES ON ACCOUNT OF THIS ACCIDENT OR INJURY:
Medical bills of$4,849.64 received to date
Funeral expenses, as yet not fully calculated.
PROOF OF SERVICE
CHANG v. CONTRA COSTA COUNTY
My business address is. 50 Francisco Street, Suite 460, San Francisco, California
94133. I am employed in the County of San Francisco,where this mailing occurs. I am over
the age of 18 years and not a party to the within cause. On January 29, 2008, I served the
foregoing document(s) described as:
Administrative Claim to Contra Costa County; City of El Cerrito;
City of Richmond; City of San Pablo
on the following person(s);in this action.by.placing:a true copy thereof enclosed in a scaled
envelope addressed as listed below, with postage for Certified Mail delivery fully prepaid:
Clerk of the Board of Supervisors
County Administration Building
651 Pine Street, Room 106
Martinez, CA 94553
I declare under penalty of perjury under the laws of the State of California that the
foregoing is true and correct, and that this declaration was executed on January 29, 2008, at
San Francisco, California.
t
�nnie Reasone�
MAN M M UEIVED
WALKER. HAMILTON &WHITE
JAN 3 0 2008AN 3 0 Z00818
CLcRI<:.t;; F. 1i)I_r-}VISORS
C 0 N MA CC)'-;'i'A CO.
J anuan. 29,
Board of Supervisors
County .Administration Building
651 Pinc Street, Room 106
Martinez, CA 94553
Re: Chang i-. Contra Aosta Count;, et al
To Whom It May Concern:
Enclosed please find an original and 1 copy of a go-\.-ernment claim in this matter.
Please process the claim-and return a copy to us in the enclosed stamped envelope, with
some notation of its receipt in your. office.
Thank you for your help with this.
Sincerely,
lknnic Re:4soner
Paralegal
%ar
Ei.cl: as noted
www.w,.tlkcrhaniiltonwiiite.com
50 I RANCISCO STRFF F. SUITE 460, SAN FRANCISCO, CA 9-41:33-2100 TEL 415 986-3339 FAX 41.5 986-1618
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TRA COSTA CO. —
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BDARD OF SUPERVISORS OF CONTRA.COSTA COUNTY
NS7'RMMONS TO CLA-AN>C
_ A. k clairft relataug to a cause of action-for death or for injury to person or to perso.,tal property or
gmwiug crops shall be presented n.ot later than six months.after the accrual of the cause of
action. A claim relating io any otber cause of action shat! b;Presented not later than one year
ager the accrual of the cause of action.
(Gov. Code § 911.7.) .
B. Clai.Tns must be filed with the Clerk of the Board of Supervisars at its offee in Room 106,
County Administration Building, 651 Pixie Street,Martinez,CA 94553.
C, If claim is agsins a disnict governed by the Board-.of Supervisors, raihe►than the County, the
mine of the District should be 7Zlled in.
D. It the claim is apirm more than one public eattity, separate claims muni be filed against each
public eAntity.
E. Fraud, See penalty for fravduhmt claims,Penal Cada Sec. 72 at the end of this form.
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RE: Claim By: Reserved for Clerk's filing stamp
HUI QUAN CHANG
1
Against the County of Contra Costa or }
District)
(Fill in the name) _ )
The undarsigtued claimant hereby makes claim against the County of Contra Costa or the above-named
district in the sura of 9 5_000. 000 and in support of rhis'claim represents as follows:
1. . Wben did tho damage or injury occur? (Give exact date anal hour)
July 30, 2007 at appro)-:imately 5:50 p.m.
2. Wbere did the damage or injuy occur? (Include city and eouaty)
3409 Belmont Avenue, EL Cerrito, CA
3. How did the damage or injury occur? (Give full details;use extra paper if regi&ed)
See attached pages .
4. What padcular act or orrrission on the partof county or district officers, servants, or employees
caused the injury or damage? .
See attached pages
5 'What aro the names of county or district officers,Servants, or employees causing the
damage or injury?
Unknown at this time
e�li e�-�•:=r_n� lr� •moo t.UIY I NH WtU 1 H CUUN I Y ULERK OF THE ? 91511:-2359151 NO.001 P02
e., What damage or injinies do your claim resulted? (Give Full extent of injuries ar damages
claimed. Attach two estimates for auto damage,}
See attached pages
7. How was 'the amount claimed above computed? (Include the estimated amount of any :
prospective injury or darnag)
See attached pages
S, Names and ajdrasses of witnesses,doctors, and hospital:
See ;attached pages :
9. List the expenditures you made on account of this accident or injury:
DATE TIME AMOUNT
See attached pages
44aes9$aasall 111041aasara1Oka.VaaIaa4519'aa11as■0111111%■Oa4aa141141111a11956a491140604a11a6a91969981
) Gov. Code Sec. 910.2 provides"The claim sW1 be
)signed by the claim. nt or by some pe'on on his
behalf."
SEND YvTa_'MB TO: (Attornev)
N=e " address of A=rney
Chang C. Chen, Esq.
456 Montgomery ST. ) �` �`�� Claimsuiiign�ttcu�) f
Suite 1300 ) y� •,,if <, G�
San Francisco, CA
) (AddsesS)
415-397-7956 )
Teleph=No, - }Telephone No. %ll� /T- J717T�P -
PON gas s9sr■r
PUBLIC REORD$ NOTICE:
Plena be advised that thio clim form, or my claim filed with the County undor the Tort Claims Act, is subject to
pla"blic disclosure under the California Piklio Records Act. (Gov. Code, 99 6500 et seq.) Furthermore, any
an:achments,addendum5,or supplernants attachod to tlia claim fon-i, including medical records,are also subject to
public disclosure,
'4■sVIA fig False a14s5saal%114bad 49aaasa4asaggsyssr441116:4aa■apla5as5a3a''e6IFdreasaVasdigs ss9saa
NOTICE:
Section 72 of the Penal Code provider,
Every person who, with intent to defraud, presents for allowance or for payment to any state board or ofcer,or
tv a.ny couAty, city, or district board or officer, authorised 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 m=than one year, by a fine of not exceeding one thousand dollars (51,000.00), or by bath such
imprisonment and ftno, or by imprisonment in 111E stats prison, by a.fine of not weeding ten thousand dollars
(�10,000),or by both such itnprisorunant find Tina.
ATTACHMENT TO CLAIM OF HUI QUAN CHANG FOR DAMAGES AGAINST CONTRA
COSTA COUNTY:
3. HOW DID THE DAMAGE OCCUR?
Claimant's son Jin Zhou Chang was shot by robbers in the carport of an apartment house
where Claimant and his son worked. Police and emergency personnel employed by Contra
Costa County arrived at the scene and kept Claimant from attending to his wounded son,
prevented Claimant from providing emergency first aid or taking his son to the hospital, and
threatened him with arrest if he touched his own son. Emergency personnel arrived at the scene
late, over 20 minutes after the 911 call, and provided the wrong treatment for the son's injuries,
handling his care in such a way that worsened the internal bleeding from the gunshot wounds.
As a result of these errors and oin:issiorns,plaintiff's son died later that evening.
4. WHAT PARTICULAR ERROR OR OMISSION ON THE PART OF COUNTY OFFICERS,
SERVANTS OR EMPLOYEES CAUSED THE INJURY OR DAMAGE?
County officers, servants and/or employees delayed in responding to the 911 call;
prevented Claimant from assisting his son or taking him to the hospital himself; and provided
incorrect medical treatment for the son's injuries.
6. WHAT DAMAGES OR INJURIES DO YOU CLAIM RESULTED?
Claimant's son—his only child—died as a result of the errors and/or omissions of County
officers, servants and employees. The monetary amount of this injury is in excess of$25,000.
7. HOW WAS THE AMOUNT CLAIMED ABOVE CALCULATED?
Calculation not applicable:, but reflects loss of care, comfort and society of Claimant's
only child, loss of future support, and emotional distress:
8. NAME AND ADDRESS OF WITNESSES, DOCTORS AND'HOSPITALS.
Witnesses:
Hui Quan Chang, Claimant, 144 7 Monterey Street, Richmond, CA
The names and addresses of other witnesses are unknown at this time.
Hospital: Doctors Medical Center, 2000 Vale Road, San Pablo, CA 94806
9. EXPENDITURES ON ACCOUNT OF THIS ACCIDENT OR INJURY:
Medical bills of$4,849.64 received to date .
Funeral expenses,'as yet not fully calculated.
S�.
PROOF OF SERVICE
CHANG v. CONTRA COSTA COUNTY
My business address is 50 Francisco Street, Suite 460, San Francisco, California
94133. I am employed in the County of San Francisco, where this mailing occurs. I am over
the age of 18 years and not a party to the within cause. On January 29, 2008, I served the
foregoing documents) described as:
Administrative Claiin to-,Contra Costa County; City of El Cerrito;
City of Richmond; City of San Pablo
on the following person(s) in this action by placing a true copy thereof enclosed in a sealed
envelope addressed as listed below, with postage for Certified Mail delivery fully prepaid:
Clerk of the Board of Supervisors
County Administration Building
651 Pine Street, Room 106
Martinez, CA 94553
I declare under penalty of.perjury under the laws of the State of California that the
foregoing is true and correct, and that this declaration was executed on January 29, 2008, at
San Francisco, California.
G,.CJ /.
�nnie Reasone�
LIN
WALKS HAMILTON Sc WHITE
January 10, 2008 .
Hui Quan Chang
1447 Monterey Street
Richmond, CA 94804
Re: Deatiz of Jim Zhou Chaiz
Dear Mr. Chang:
I was quite surprised to receive.a fax letter from you in English stating that you did not
understand that you signed a Client Retainer Agreement until January 8 when a copy was faxed
to you at your request. We met for over two hours on Friday and, while I do not speak Mandarin
and you do not speak English, I understood everything was being translated by your friend Dr.
Chang Chen, who is herself an attorney and who made it clear she was representing you. Much
time was spent explaining to you the meaning of the retainer agreement, and you were given a
copy by my paralegal.
Nevertheless, if on speaking with someone else you have changed your mind and do not
want us to represent you, that is perfectly all right. Since, however, your time period to file
government claims expires in a few days, it is necessary that you confirm that you do not want us
to act on your behalf.
Please sign this letter where marked and return it to us. Better yet, if you have another
lawyer,please have that person write to us confirming that he or she is now representing you.
.....�
Very truly yours,
ze
f, Walter H.Walker,III
I am terminating our attorney-client relationship effect immediately. Do not file
government claims on my behalf.
DATED:
Hui. Quan Chang
www.walkerhainiItonwhitc.com
50 FRANCISCO STREE F. SUITE 460. SAN FRANCISCO,CA 941:33-2100 TEL 415 986-3339 FAX 415 986-1618
cc Ctlang C Chen,
PROOF OF SERVICE BY MAIL'
CONTRA COSTA COUNTY
I, the undersigned, declare:
I am over the age of eighteen years, self-employed in the County of El Cerrito,
State of California, and-not a party to the within action. My business address is 1345 El
Cerrito, CA 94530.
On February 5, 2008, 1 served:
Letter of Mr. Hui Quan Chang to the Law Firm of WHW with attachment's
on the parties to this action by placing a true copy!thereof in a sealed envelope with
certified mail and return receipt and postage thereon fully paid, addressed as follows:
j
CLERK OF THE BOARD OF SUPERVISORS
COUNTY ADMINISTRATION BUILDING
651 PINE STREET. ROOM 106
MARTINEZ, CA94553
Executed on Z./���Z ( in L C , CA
I declare under-penalty of perjury under the laws of the State of California that the
foregoing is true and correct.
Margie Li Wei
Chair, Memorial Committee of
Jin Zhou Chang.
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: MARCH 11, 2008
Claim Against the County, or District Governed by ).
the Board of Supervisors, Routing Endorsements, ) NOTICE 7'O 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: UNKNOWN Section 913 and 915.4. Please note all
"Warnings".
CLAIMANT: SANTINA RAINEY
ATTORNEY: UNKNOWN DATE RECEIVED: FEBRUARY 01 , 2008
ADDRESS: 4935 SAN PABLO DAM ROABY DELIVERY TO CLERK ON: FEBRUARY 01 , 2008
#605
EL SOBRANTE, CA 94803 BY.MAIL POSTMARKED: HAND DELIVERED
FROM: Clerk of the Board of Supervisors T0: County Counsel
Attached is a copy of the above-noted claim.
FEBRUARY 0.1 ; 2008 JOHN CULLEN 1
Dated: By: Deputy , i ...
11. FROM.: County Counsel TO: Clerk of the Board of Stt'ervisors
( ) 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 911.3).
( ) Other:
Dated: By: Deputy County Counsel
1.11. FROM.: Clerk of the Board TO: County Counsel (1) County Adminisfrator(2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3),
1V. 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: JOHN CULLEN, CLERK, By Deputy Clerk
WARNING (Gov. code section 913)
Subject to cet-tain exceptions,you have only six(6) months from the date this notice was personally setwed
or deposited in the mail to file a cou11 actial on this claini.See Government Code Section 945.6.You may
seek the advice of an attorney of your choice in connection wide this matter. If you want to consult an
attorney,you should do so immediately. *For Additional Warning See Reverse Side ofThis Notice.
AFFIDAVIT OF MAILING
I declare under penalty of per„jury that 1. am now, and at all times herein mentioned, have
been a citizen of the United States, over age 1.8;. 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: JOHN CULLEN; CLERK By Deputy Clerk
+ i BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLALVIANT
.. .. ......
A.J A claim relating to a cause of action for death or for injury to person or to personal property or
growing crops shall be presented not later than six months after the accrual of the cause of
action. A claim relating to any other cause of action shall be presented not later than one year
after the accrual of the cause of action.
(Gov. Code § 911.2.)
B. Claims must be filed with the Clerk'of the Board of Supervisors at its office in Room 106,
County Administration Building,.651 Pine Street,:Martinez, CA 94553.
C. If claim is against a district governed by the Board of Supervisors, rather than the County, the
naive of the District should be filled in.
D. If the claim is against more than one public entity, separate claims must be filed against each
public entity.
E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form.
ass■■■a■■a a■■■■a■■a am■■MEN OEM■a■a a■e a■a Ina■and man a■■a a a■■a■■a■a■■■INN a KKK BE an a 1
RE: Claim By: Reserved for Clerk's filing stamp
��.�(l��inn► ��,1-�P�I 1 ,
RECEIVE®
Against the County of Contra Costa or ) FEB 0 J Nud
)
District) CLERK BOARD OF SUPERVISOrJS
(Fill in the name) ) CONTRA COSTA CO.
l
The undersigned claimant hereby makes claire against the County of Contra Costa or the above-named
district in the sum of$ k>v\kvn(Dw 0 and in support of this claim represents as follows:
1. )TIen did the damage or injury occur. Give exact date and hour)
occur? (Give
2. Where did the damage or injury occur? (Include city and county) l`j p rc i.)�v
3. How did the damage or injury occur? (Give full details; use extra paper if reqcc`rrok
4. What particular act or omission on the part of county or district officers, servants, or employees
caused the injury or damage?
A.`��, �6X\'V
5 What are the names of county or district officers, sen?ants, or employees causing the
damage or injury? C L►o�>�-C,z
6. 'WhFt damage or injuries doy our claim resulted? (Give full extent of injuries or damages
claimed. Attach two estimates for auto damage. Q 0 Q_X N �
O
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)� S
S. Names and addresses of witnesses, doctors, and hospitals:
J6 CC<e� W
9. - List the expenditures you made on account of this accident or injury:
DATE TIME AMOUNT
CJ"
VLUAJ n
• d a a N a a a a a t a C a■■t a a a Mason a Q a.■a a a a a a.a a■■Y.a a a a s a R a a a a a a a a a.a a i■■a a a a a a a a a a a a a a a a e a a a
.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 1
Name and address of Attorney )
(Claimant's Signat re)
Win)
c Av °CriW?l \din) �_A W (0,_>-
` (Address)
0\0\¢ 0'
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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 forin, including medical records, are also subject to
public disclosure.
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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.
CLAIM
BOARD OF SUPERVISORS OF CONTRA-COSTA COUNTY
BOARD ACTION: MARCH 11 , 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
Supervisors. (Paragraph IV below),
given Pursuant to Government Code
AMOUNT: $2, 325 . 20 Section 913 and 915.4. Please note all
"Warnings".
.CLAIMANT: FARMERS INSURANCE '
BY: CHRIS HUGHES
ATTORNEY: for : SHIN HYANG CHUNG DATE RECEIVED: FEBRUARY 11 , 2008
UNKNOWN
ADDRESS: P.O. BOX 2.68992 BY DELIVERY TO CLERK ON: FEBRUARY 11, 2008
OKLAHOMA CITY,
OK 73126-8992 BY MAIL POSTMARKED: FEBRUARY 08, 2008
FROM: Clerk of the Board of.Super•visors TO: County Counsel
Attached is a copy of the above-noted claire.
FEBRUARY 11 , 2008 JOHN CULLEN, C rl of
Dated: By: Deputy A� �-
fl. 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 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: By: Deputy County Counsel
IIf. FROM.: Clerk of the Board TO: County Counsel (1) County Administrator(2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
a
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: JOHN 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. ll'you want to consult an
attorney,you should do so immediately. *For.Addltianal Warning See Reverse Side ofTlris Notice.
AFFIDAVIT OF MAILING
I declare under penalty ofper jury that 1. ann 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.N.tartinez, California, postage fully prepaid a certified copy of this .
Board Order and Notice to Claimant, addressed to the claiman-t as shown above.
Dated: . .JOHN CULLEN, CLERK. By Deputy Clerk
I
National Document Center
. F A R M E R S W. Box 268992
Oklahoma Cin; OK 73126-8992
claiiiisdocuments@fart-nersiiistir-,ince.com
Fax : 877-217-1389
02/08/2008
Clerk of Board of Supervisors
County Administration Building El
Attn: PennyBailey
651 Pine St,Room 106
Martinez,CA 94553 FEB 1 1 ZOOS
Re:Our Insured: Shin H Chun CLERK SOARD OF sUPERVISORS
Yang g CONTRA COSTA CO.
Our Claim#: 099 SUB 1011217212-1
Date of Loss: 11/30/2007
Your Insured: Contra Costa County
Your Claim#: 64066
Deductible Amount: $750.00
Loss of Use Amount: $225
Total Amount Owed: $2,325.20
Dear PennyBailey.
We have made payment to our insured for damages resulting from this accident.Our
investigation has established that the above loss was caused by the negligence of your insured.
By virtue of our subrogation rights this letter is to advise you that we expect payment from you
for the amount of damages within 14 days of the receipt of this letter.
Be advised that no partial payment,which is less than the full amount claimed herein,will be
considered in anyway an acceptance of'benefits,a novation or an accord and satisfaction of
this claim without the express written release of our claim executed by an individual who
identifies himself/herself as a member of our subrogation department.Therefore,our legal
rights to enforce collection on the remaining amount of the claim shall not be waived or
estopped due to a partial payment by you or someone acting on your behalf.
If you need additional support for our claim or require further information,please call me at
909-801-3341 with your FAX number so that the requested information can be sent to you.
Sincerely,
Mid-Century Insurance Company
f
Jennifer Miller
Auto Subrogation Representative
)emfer.miller@farmersinsurance.com
ATTAGIN ENT(S)
t7 T 800 L 0 F3-4
C
-'OY
BO.ARD OF SUPER 871SORS. OE" -FRA.COSTA com-rry
.T1!
STR I U
MONS TO C11AM1AU
A. i%. clairri relatinc,to a uausc., of action for death or for injury to person or to personal property=or.
"D
growin,v crops -shall be, preserited not later that six months after the accrual. Of the cause of
actiori, A claim redaling, to any other c-atise., of action shall be presented not latex Tb.an one "?"ear
aft-zr the accrual of the cause of action-
(Gov.. Code § 911.2.)
ti B. Claims must be fi3d with the Clerk- of the Board of &yervisors at its office, is Room 106,
Co Lmtr Administration Building,651 Pine.Street,Maxtinez,CA 94553.
C. V claim is against -1 district governed by the Board of Stipen-isors. rather than the County, the
name, of the District should be filled.in,
D. If the claim is against more: than. one public eatiri, separate claims mu,;t be filed agaias-t each
public entity,
E. Fraud. See penalty for fraudulent claims,:Penal Code Sec. 72 at the. end of this fox-m.
man Inw...x1saf•••.MINMER.M1.2 OEM. Karl..Tit at
R13; Claim By: Reserved for Clerl's adn.g StWnD
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I R,E(0,11-16,1 V I:
Id
Against the CoLmt,of Contra Costa.or
9 F F B 1 1 2008
CLERK BOARD OF SUPERVISORS
,'ill i.n de_ t ajxid) CON'TRA,COSTA CO.
The uiad=-simed ulaimair, hereby males claim agailist tJ32 Contity of Contra Costa or the above-uarned
distnot in The sum of$ and iu support of this rlaim represents as follows:
1. 'hen did ibe damage or injury occur? (Give --).act date and hoar)
1) -N�Ie7e did the darnage or injury occur? (Include city and cotmty)
3. How did the damage or injury occur? (Give,fht details;use vxtra paper if Teqalxed)
4. What'pardcular act or on2ission on the part of count3l or district offl cers, servants, or employees
oax-tsedthe injury or damage?
i 'What are the names of county or district office-L-3,servants; or amplo3laes causing the
damage,or inj ury?
P,
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v 1 800 0 `d34
6. dzkaage or iajuries do yo-Lu Claim .resulted? (Give full extnt of qjuries or damages
claimed. Attach two estimates for auto dw-nage.)
If.*n A 6
7How was th, amount Chhned abQVe COmpirced? (Inclilde idle estimated amount of any
prospecd ajury or damage..)
10,10W/F /AY il el,&-t-
8. Names and address--s of witnes.ses, doctors, and hospitals:
9. Ust the expenditures you made on accouat of this aucideat or. injury:
DAXE 712V1--, AMOUNT
7;-/
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Gov, Code Sec. 93.0.2 provides"Ile claim shall b-,
signt!d by the c3aimant or by some person oa his
behalf."
SF-.,N7)N0'FlQL_S_TQ:
-Nnine and address of.Attornzy
(Clabri=I's Signature)
(Address)
Telephone No. Telephone No YJ/I 33O
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PUBLIC RECORDS NOTICE:
Please be aelviszd that this claim Borm, or,any vlaiin filed wit h the County ander the Tart Claims Act, is subject to
public dis-closure, under the CAif'ornia Public Rezor&v Act (Gov. Code, §5 6500 el seq.) Furdw-rmore, any
attachmfTits,addendn-ius, or suppleratnts attached to tine claim form, including juadiral records, are also fwbjecitto
public disrlomre.
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NOTICE:
Sectio,n 72 of the Penal Code provides:
Every person with intLat to dtfra*4 presents for allowance.or for payujent to auy.stat..-board or officer, or.
to an county, city, or district board. or officer, authorized to allow or pay the same if genuine, soy false or
fraudulent-,!Mm, bill, acwunt voucher, or-writfiig is punishable either by imprisonment in the Cottnty jail for a
period of not more tbwl one year, by a flne of not exceedirig one, thousand do!'Iars ($1,000-00). or by both such
impriso=)-czt. and Bile, or by irnprisoninent in the state prison, by a fine of not exceeding ten tzu thousand dollars
(s'10,000),or by botfi such im- T)rizonmew*and fine.
q
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7
12/11/2007 AT 12:48 PM 1011217212-1-1
39224 OU9K029F
MID-CENTURY INSURANCE COMPANY
MARTINEZ SERVICE CENTER
SUPPLEMENT HOTLINE (925)335-5405
PO BOX 268994
OKLAHOMA CITY, OK 73126-8994
(707)280-0116 FAX: (877)217-1389
ESTIMATE OF RECORD
WRITTEN BY: RICK TRAN 12/11/2007 11:29 AM
ADJUSTER: RICK TRAN (707)280-0116
INSURED: SHIN HYANG CHUNG CLAIM #1011217212-1-1
OWNER: SHIN HYANG CHUNG POLICY #0177580323
ADDRESS: 251 28TH ST APT 706 DATE OF LOSS: 11/30/2007 AT 01:00 PM
OAKLAND, CA 94611 TYPE OF LOSS: MD
EVENING: (510)836-2877 POINT OF IMPACT: 9. LEFT T-BONE (LE
OTHER: (510)529-5194
INSPECT 251 28TH ST APT 706 EVENING: (510)836-2877
LOCATION: OAKLAND, CA 94611 HOME
REPAIR 8 DAYS TO REPAIR
FACILITY: LICENSE #
2006 HOND CRV 4X2 LX 4-2.4L-FI 4D UTV SILVER INT:GRAY
VIN: JHLRD685X6C014075 LIC: 5UGB100 CA PROD DATE: 02/2006 ODOMETER: 18168
CONDITION: GOOD
AIR CONDITIONING REAR DEFOGGER TILT WHEEL
CRUISE CONTROL INTERMITTENT WIPERS KEYLESS ENTRY
REAR WIPER BODY SIDE MOLDINGS DUAL MIRRORS
CLEAR COAT PAINT POWER STEERING POWER BRAKES
POWER WINDOWS POWER LOCKS POWER MIRRORS
AM RADIO FM RADIO STEREO
CASSETTE SEARCH/SEEK CD PLAYER
ANTI-LOCK BRAKES (4) DRIVER AIR BAG PASSENGER AIR BAG
FRONT SIDE IMPACT AIR BAG 4 WHEEL DISC BRAKES TRACTION CONTROL
CLOTH SEATS BUCKET SEATS AUTOMATIC TRANSMISSION
OVERDRIVE STYLED STEEL WHEELS
-------------------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
-------------------------------------------------------------------------------
1# ***ALL SUPPLEMENTS MUST BE 1 0.00 0.0 0.0
PRE-APPROVED BY ADJUSTER***
2 FRONT BUMPER
3* R&I DROP BUMPER COVER * 0 0.00 0.5* 0.0
4 FRONT LAMPS
5 R&I LT HEADLAMP ASSY U.K. BUILT 0 0.00 0.4 0.0
6 FENDER
N 7 BLND LT FENDER U.K.. BUILT 0 0.00 0.0 1.0
8 R&I LT WHEEL OPNG• MLDG 0 0.00 0.3 0.0
9# R&I LT MUDGUARD 0 0.00 0.2 0.0
10 FRONT DOOR.
1
12/11/2007 AT 12:48 PM 1011217212-1-1
39224 OU9K029F
ESTIMATE OF RECORD
2006 HOND CRV 4X2 LX 4-2.4L-FI 4D UTV SILVER INT:GRAY
-------------------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
-------------------------------------------------------------------------------
N 11 REPL LT DOOR SHELL 1 578.00 4.5 3.2
12 ADD FOR CLEAR COAT 0 0.00 0.0 1.3
13 REPL LT BLACK OUT TAPE 1 17.03 0.3 0.0
N 14 REPL LT UPPER MOLDING EX, LX U.K. 1 55.47 0.3 0.0
BUILT
N 15 REPL LT LOWER MOLDING 1 50.03 0.3 0.0
16 REAR DOOR
N 17* RPR LT DOOR SHELL 0 0.00 0.5* 2.1
18 OVERLAP MAJOR ADJ. PANEL 0 0.00 0.0 -0.4
19 ADD FOR CLEAR COAT 0 0.00 0.0 0.3
20# REFN BASE COAT REDUCTION 0 0.00 0.0 -0.5
21 R&I LT BELT W'STRIP 0 0.00 0.3 0.0
22 R&I LT UPPER MOLDING EX, LX U.K. 0 0.00 0.3 0.0
BUILT
23 R&I LT LOWER MOLDING 0 0.00 0.3 0.0
24 R&I LT HANDLE, OUTSIDE LX, EX 0 0.00 0.3 0.0
25# SUBL HAZARDOUS WASTE 1 5.00 X 0.0 0.0
26# COVER CAR 1 10.00 X 0.0 0.0
27# CORROSION PROTECTION 1 10.00 X 0.0 0.0
-------------------------------------------------------------------------------
SUBTOTALS =_> 725.53 8.5 7.0
LINE 7 : METALLIC SILVER FINISH. DIFFICULT TO MATCH. REPLACING LT DOOR SHELL.
LINE 11 : DOOR CRUSHED TOWARDS BOTTOM. DAMAGE THROUGH EXTERIOR PANEL.
LINE 14 : MOLDING PUSHED IN
LINE 15 : MOLDING PUSHED IN
LINE 17 : METALLIC SILVER FINISH. DIFFICULT TO MATCH. REPLACING LT DOOR SHELL.
PARTS 700.53
BODY LABOR 8.5 HRS @$ 70.00/HR 595.00
PAINT LABOR 7.0 HRS @$ 70.00/HR 490.00
PAINT SUPPLIES 7.0 HRS @$ 30.00/HR 210.00
SUBLET/MISC. 25.00
----------------------------------------------------
SUB'TOTAL $ 2020.53
SALES TAX $ 910.53 @ 8.7500% 79.67
----------------------------------------------------
TOTAL COST OF REPAIRS $ 2100.20
ADJUSTMENTS:
DEDUCTIBLE 750.00
----------------------------------------------------
TOTAL ADJUSTMENTS $ 750.00
NET COST OF REPAIRS $ 1350.20
2
12/11/2007 AT 12:48 PM 1011217212-1-1
39224 OU9KO29F
ESTIMATE OF RECORD
2006 HOND CRV 4X2 LX 4-2.4L-FI 4D UTV SILVER INT:GRAY
FARMERS' NON-OEM SHEET METAL PARTS WARRANTY
WHEN YOU HAVE YOUR VEHICLE REPAIRED AFTER AN ACCIDENT AND THE REPAIR ESTIMATE
INCLUDES THE USE OF CERTAIN NON-OEM SHEET METAL CRASH PARTS (PARTS NOT MADE BY
OR FOR YOUR VEHICLE'S ORIGINAL MANUFACTURER) , FARMERS WILL STAND BEHIND THOSE
PARTS FOR AS LONG AS YOU OWN THE VEHICLE. IF A SUPPLIER OF A PART LISTED IN
YOUR REPAIR ESTIMATE OR THE SHOP THAT PERFORMED THE REPAIRS ON YOUR VEHICLE IS
UNABLE TO RESOLVE A LEGITIMATE COMPLAINT ABOUT THE QUALITY OF THE NON-OEM
SHEET METAL PARTS USED IN THE :REPAIR, WE WILL MAKE EVERY EFFORT TO SEE THAT
THE PROBLEM IS CORRECTED.
PARTS COVERED BY THIS WARRANTY ARE LIMITED TO HOODS, FENDERS, DOOR SHELLS,
TRUCK BEDS, BOX SIDES, TAILGATES, LIFT GATES, QUARTER PANELS, REAR OUTER
PANELS, BODY SIDE PANELS, TRUNK LIDS AND DECK LIDS.
FOR ASSISTANCE, CONTACT YOUR NEAREST FARMERS CLAIMS OFFICE OR AGENT.
DISCLAIMER
THIS WARRANTY AND ANY REPRESENTATIONS MADE HEREIN ARE NON-TRANSFERABLE AND ITS
BENEFITS EXTEND ONLY TO THE PARTY OWNING THE VEHICLE AT THE TIME OF THE
REPAIR. IT IS NOT PART OF YOUR INSURANCE POLICY AND DOES NOT CONSTITUTE AN
EXTENSION OF COVERAGE THEREUNDER.
IF THERE IS A SUPPLEMENT NEEDED FOR THE REPAIRS TO THIS VEHICLE, WE MUST BE
NOTIFIED BY CALLING FARMERS SUPPLEMENT HOTLINE NUMBER GIVEN ON THE FACE OF
THIS ESTIMATE. FAILING TO DO SO MAY RELINQUISH US FROM PAYING ANY ADDITIONAL
DAMAGES ON THIS REPAIR.
IF YOU HAVE COVERAGE FOR DAMAGE TO YOUR VEHICLE UNDER THIS POLICY IT IS OUR
OBLIGATION TO INFORM YOU THAT 'UNDER CALIFORNIA CODE OF REGULATIONS, TITLE 10,
CHAPTER 5, SECTION 2695.8.D.2.:E, YOU HAVE THE RIGHT TO SELECT THE VEHICLE
REPAIR FACILITY OF YOUR CHOICE.
WE ARE PROHIBITED BY LAW FROM :REQUIRING THAT REPAIRS BE DONE AT A SPECIFIC
SHOP. YOU ARE ENTITLED TO SELECT THE AUTO BODY REPAIR SHOP TO REPAIR DAMAGE
COVERED BY IIS. WE HAVE RECOMMENDED A REPAIR SHOP THAT WILL REPAIR YOUR
DAMAGED VEHICLE. AS YOU HAVE .AGREED TO USE OUR RECOMMENDED REPAIR SHOP, WE
WILL CAUSE THE DAMAGED VEHICLE TO BE RESTORED TO ITS CONDITION PRIOR TO THE
LOSS AT NO ADDITIONAL COST TO 'YOU OTHER THAN AS STATED IN THE INSURANCE POLICY
OR AS OTHERWISE ALLOWED BY LAW. IF YOU EXPERIENCE A PROBLEM WITH THE REPAIR
OF YOUR VEHICLE, PLEASE CONTACT IIS IMMEDIATELY FOR ASSISTANCE.
AUTO BODY REPAIR CONSUMER BILL OF RIGHTS
A CONSUMER IS ENTITLED TO:
1. SELECT THE AUTO BODY REPAIR SHOP TO REPAIR AUTO BODY DAMAGE COVERED BY THE
INSURANCE COMPANY. AN INSURANCE COMPANY MAY NOT REQUIRE THE
REPAIRS TO BE DONE AT A SPECIFIC AUTO BODY REPAIR SHOP.
3
12/11/2007 AT 12:48 PM 1011217212-1-1
39224 OU9K029F
ESTIMATE OF RECORD
2006 HOND CRV 4X2 LX 4-2.4L-FI 4D UTV SILVER INT:GRAY
2. AN ITEMIZED WRITTEN .ESTIMATE FOR AUTO BODY REPAIRS AND, UPON COMPLETION OF
REPAIRS, A DETAILED INVOICE. THE ESTIMATE AND THE INVOICE MUST INCLUDE AN
ITEMIZED LIST OF PARTS AND LABOR ALONG WITH THE TOTAL PRICE FOR THE WORK
PERFORMED. THE ESTIMATE AND INVOICE MUST ALSO IDENTIFY ALL PARTS AS NEW, USED,
AFTERMARKET, RECONDITIONED, OR REBUILT.
3. BE INFORMED ABOUT COVERAGE FOR TOWING SERVICES. THE INSURER SHALL PAY
REASONABLE TOWING AND STORAGE CHARGES INCURRED BY THE INSURED TO PROTECT THE
VEHICLE AND PROVIDE REASONABLE NOTICE TO AN INSURED BEFORE TERMINATING PAYMENT
FOR STORAGE CHARGES SO THAT THE INSURED HAS TIME TO REMOVE THE VEHICLE FROM
STORAGE.
4. BE INFORMED ABOUT THE EXTENT OF COVERAGE, IF ANY, FOR A REPLACEMENT
RENTAL VEHICLE WHILE A DAMAGED VEHICLE IS BEING REPAIRED.
5. BE INFORMED OF WHERE TO REPORT SUSPECTED FRAUD OR OTHER COMPLAINTS
AND CONCERNS ABOUT AUTO BODY REPAIRS.
COMPLAINTS WITHIN THE JURISDICTION OF THE BUREAU OF AUTOMOTIVE REPAIR
COMPLAINTS CONCERNING THE REPAIR OF A VEHICLE BY AN AUTO BODY REPAIR SHOP
SHOULD BE DIRECTED TO:
TOLL FREE (800) 952-5210
CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS
BUREAU OF AUTOMOTIVE REPAIR
10240 SYSTEMS PARKWAY
SACRAMENTO, CA 95827
THE BUREAU OF AUTOMOTIVE REPAIR CAN ALSO ACCEPT COMPLAINTS OVER ITS WEB SITE
AT:
WWW.AUTOREPAIR.CA.GOV
COMPLAINTS WITHIN THE JURISDICTION OF THE CALIFORNIA INSURANCE COMMISSIONER
ANY CONCERNS REGARDING HOW AN AUTO INSURANCE CLAIM IS BEING HANDLED SHOULD BE
SUBMITTED TO THE CALIFORNIA DEPARTMENT OF INSIIRANCE AT:
(800) 927-HELP OR (213) 897-8927
CALIFORNIA DEPARTMENT OF INSURANCE
CONSUMER SERVICES DIVISION
300 SOUTH SPRING STREET
LOS ANGELES, CA 90013
THE CALIFORNIA DEPARTMENT OF INSIIRANCE CAN ALSO ACCEPT COMPLAINTS OVER ITS WEB
SITE AT:
WWW.INSURANCE.CA.GOV
THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A
4
12/11/2007 AT 12:48 PM 1011217212-1-1
39224 OU9K029F
ESTIMATE OF RECORD
2006 HOND CRV 4X2 LX 4-2.4L-FI 4D UTV SILVER INT:GRAY
SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES
APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR
DISTRIBUTOR OF THE PARTS, RATHER THAN BY THE ORIGINAL MANUFACTURER OF YOUR
VEHICLE.
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 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. NWCPP=NATIONWIDE
CRASH PARTS PROGRAM.
5
12/11/2007 AT 12:48 PM 1011217212-1-1
39224 OU9K029F
ESTIMATE OF RECORD
2006 HOND CRV 41:2 LX 4-2.4L-FI 4D UTV SILVER INT:GRAY
ESTIMATE BASED ON MOTOR CRASH ESTIMATING GUIDE. UNLESS OTHERWISE NOTED ALL
ITEMS ARE DERIVED FROM THE GUIDE ARG4466, CCC DATA DATE 10/01/2007, AND THE
PARTS SELECTED ARE OEM-PARTS MANUFACTURED BY THE VEHICLES ORIGINAL EQIIIPMENT
MANUFACTURER. OEM PARTS ARE AVAILABLE AT OE/VEHICLE DEALERSHIPS. OPT OEM
(OPTIONAL OEM) OR ALT OEM (A.LTERNATIVE OEM) PARTS ARE OEM PARTS THAT MAY BE
PROVIDED BY OR THROUGH ALTERNATE SOURCES OTHER THAN THE OEM VEHICLE
DEALERSHIPS. OPT OEM OR ALT OEM PARTS MAY REFLECT SOME SPECIFIC, SPECIAL, OR
UNIQUE PRICING OR DISCOUNT. OPT OEM OR ALT OEM PARTS MAY INCLUDE "BLEMISHED"
PARTS PROVIDED BY OEM'S THROUGH OEM VEHICLE DEALERSHIPS. 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 EQIIIPMENT 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 RECOND. 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 M 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.
6
12/11/2007 AT 12:48 PM 1011217212-1-1
39224 OU9K029F
ESTIMATE OF RECORD
2006 HOND CRV 4X2 LX 4-2.4L-FI 4D UTV SILVER INT:GRAY
ALTERNATE PARTS USAGE
AFTERMARKET PARTS
AFTERMARKET SELECTION METHOD: AUTOMATICALLY LIST
NO. OF TIMES USER WAS NOTIFIED THAT AN AFTERMARKET PART WAS AVAILABLE: 0
NO. OF AFTERMARKET PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0
OPTIONAL OEM PARTS
OPTIONAL OEM SELECTION METHOD: MANUALLY LIST
NO. OF TIMES USER WAS NOTIFIED THAT AN OPTIONAL OEM PART WAS AVAILABLE: 0
NO. OF OPTIONAL OEM PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0
RECONDITIONED PARTS
RECONDITIONED SELECTION METHOD: 14ANUALLY LIST
NO. OF TIMES USER WAS NOTIFIED THAT A RECONDITIONED PART WAS AVAILABLE: 0
NO. OF RECONDITIONED PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0
RECYCLED PARTS
NO. OF TIMES USER WAS NOTIFIED THAT A RECYCLED PART WAS AVAILABLE: 7
NO. OF RECYCLED PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0
7
12/11/2007 AT 12:48 PM 1011217212-1-1
39224 OU9K029F
ESTIMATE OF RECORD
2006 HOND CRV 4X2 LX 4-2.4L-FI 4D UTV SILVER INT:GRAY
VEHICLE RECALLS
THE NATIONAL HIGHWAY TRANSPORTATION AND SAFETY ADMINISTRATION (NHTSA) HAS
ISSIIED 1 SAFETY-RELATED RECALL NOTICE(S) THAT MAY APPLY TO THE SELECTED
VEHICLE.
NHTSA ID: 06V270000 ISSIIED: / / NO. OF VEHICLES: 01190000
EQUIPMENT:OTHER:OWNERS/SER.VICE/OTHER MANUAL
ON CERTAIN PASSENGER VEHICLES AND MOTORCYCLES, THE OWNER'S MANUALS
CONTAIN INCORRECT CONTACT INFORMATION FOR THE NATIONAL HIGHWAY
TRAFFIC SAFETY ADMINISTRATION'S (NHTSA) VEHICLE SAFETY HOTLINE.
THE LANGUAGE IN THE OWNER'S MANUALS IS NOT IN ACCORDANCE WITH THE
CURRENT MANDATORY REQUIREMENTS.
HONDA WILL SEND A POSTCARD TO DEALERS AND OWNERS WITH THE CORRECT
NHTSA VEHICLE SAFETY HOTLINE INFORMATION AND WITH INSTRUCTIONS TO
INSERT THE CARD INTO THE "REPORTING SAFETY DEFECTS" SECTION OF THE
OWNER'S MANUAL. THE RECALL IS EXPECTED TO BEGIN IN EARLY AUGUST
2006. OWNERS MAY CONTACT HONDA AT 1-800-999-1009, ACURA AT
1-800-382-2238 OR HONDA MOTORCYCLES AT 1-866-784-1870.
8
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OIC.IAI oma City..,nK 73126-89')2
elaimsdocuments(4)fi.r.inersinsura,.ice.com
ax : 877-217-138')
01/18/2008
Payment Log
Account Number: BBB269503
Date or Loss: 11/30/2007
Insured Shin Hyang Chung
Claim Number 099 MD 10112172:2-1-1
=moss Type Material. Damage
Payment
of
Date
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Date 12/11/2007
Pa•t ee. SHIN HYANG C11,.; ` C/O
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Total Amount: $2, 325.20
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1662 U.S.POSTAGE P82230995
FARM E RS" 9239 $ 01 . 310 FEB 08
SUBROGATION/SALVAGE CENTER OF EXCELLENCE 5 6 0 4 f .�`' '..'"a 92374
PO BOX 268992
OKLAHOMA CITY OK 73126-8992
i
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RECEIVED
-
FEB,1 1 2008
CLERK BOARD OF SUPERVISORS
CONTRA COSTA CO.
i
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1662 U.S.POSTAGE pa223099.5�
FARM E R5 9239 001 .310 FEB 08 : .
SUBROGATION/SALVAGE CENTER OF EXCELLENCE 5604 92374
PO BOX 268992
OKLAHOMA CITY OK 73126-8992
r
RECEIVED
FEB 1 1 2008
CLERK BOARD OF SUPERVISORS
I CONTRA COSTA CO.
C'LAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: ' MARCH 11, 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
NOTE: SAME CLAIM WAS FILED ON FEBRUAY 06, 2008 on your claire by the .Board of
Supervisors. (Paragraph 1V below),
given Pursuant to Government Code
Section 913 and 915.4. Please note all
ANIOUNT: IN EXCESS OF $10,000.00 "Warnings".
CLAI.NiANI': PATRICIA KELLY
ATTORNEY: JOHN KEVIN CROWLEY DATE KECEIVED: FEBRUARY 06, 2008
ADDRESS:. TEN ALMADEN BLVD. , STE. 400 BY DELIVERY TO CLERK ON: FEBRUARY 06, 2008
SAN JOSE, CA. 95113
BY NIAIL POSTMA.KKED: HAND DELIVERED
FROM Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claire.
FEBRUARY 06, 2008 JOHN CULLEN r c
Dated: By: Deputy Z7
11. .FROM.- County Counsel TO: Clerk of the Board of Su f ervisors
( j This claim complies substantially with Sections 910 and 910.2.
( ) This Claim .FAILS to coinply substantially with Sections 910 and 910.2, and we are so
notifying claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claire is not thnely filed. The Clerk should return claim on ground that it was filed late and
send warning of claimant's righl to apply for leave to present a late claint (Section 911.3).
O Other:
Dated: By: Deputy County Counsel
R.I. .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. BOARI) 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: _ JOFIN CULL.EN, CLERK, By Deputy Clerk
WARNING (Gov. code section 91-3)
Subject to terrain exceptions,you have only six(6)months from the date this notice was personally sewed
or deposited in the mail to file a conn.action on this claim.See Gover nietit Code Section 945.6.You may
seek the advice of an al.torirey of your choice in connection withthis matter. If you want to consult yr
attorney,you should do so immediately. *For Additional Warning See Reverse Side of'17ris Notice.
AFFIDAVIT OF MAILING
declare tinder 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. iu Ntart.inez, California, hostage fully prepaid a certified copy of this
Bomd Order ,red Notice. to Claimant., addressed Io the clairuant as shown above.
—_ Dej)uly Clerk
U
• 02/07/2008 10:30 4082984484 G e PAGE 03/05
Feb. 5. 2008 B:OBPM :'T" dQ�•�',rc. NO, 0908 °, E
CC�Rkeo 4O0p
PATRICIA KELLY, ) ��Aljq�oFs,�p V
°STq oR��spy
Claimant, ) F SONAL INJURIES
vs. )
(Section 910 of the California
CITY OF PITTSBURG, COUNTY OF ) Government Code)
CONTRA COSTA and Does 1 -50 )
)
Respondents. )
YOU ARE HEREBY NOTIFIED that PATRICIA KELLY,whose address is 2215 Oak
Hills Circle#67, Pittsburg CA 94565, claims damages from the City of Pittsburg and the
County of Contra Costa(hereinafter City/County), in an amount in excess of$10,000 and in
excess of the jurisdictional minimum of the Superior Court and which is not stated for that
reason.
This claim is based on personal injuries accrued by PATRICIA KELLY(hereinafter
"Claimant')on or about August 11, 2007, in the City of Pittsburg, County of Contra Costa,
State of California,under the following circumstances: Claimant was riding her bicycle can
Harbor Street in Pittsburg across the rail road tracks between East Santa Fe Avenue and
East 10O'Street, Upon crossing overthe tracks,she was thrown overthe handle bars of her
bicycle sustaining injuries to her, ribs,shoulder,arm,leg and person. Plaintiff was thrown
from her bicycle because the asphalt nearand around the tracks was ill maintained. At that
time large gaps between the concrete and tracks existed and boards had been laid across
the roadway in an attempt to bridge the large gaps. Despite the repair attempt,large gaps
still existed in the roadway and the roadway was unstable and unsafe to passers by..The
agents,representative and employees of the CITY/COUNTY negligently operated,maintained,
02/07/2008 10:30 4082984484 PAGE 04/05
Feb. 5. 2008 3:09PM y No. 0908 P. i
supervised, repaired, replaced and controlled said roadway in such a way so as to cause
such injury as hereinbefore deseribad, The name of such agents, representatives and
employees are currently unknown to the clairmant. Subsequent to plaintiffs injuries, the
roadway was properly repaired,
Claimant is informed and believes that the CITY/COUNTY and its employees also
negligently designed,constructed,altered,selected,repaired,approved and maintained the
described roadway which caused the injury to the Claimant. At the time of the injuries to
Claimant,such condition posed an unreasonable risk of injuryto Claimant. The aspects of
the roadway,which posed such unreasonable risk of injury included,butwere not limited to,
gaps In the roadway,boards across the roadway,no warnings signs,and Inadequate training
and supervision of the CiTY/COUNTY agents and employees,and inadequate maintenance.
Claimant is further informed and believes and thereon alleges that the CiTY/COUNTY had
notioe of such dangerous conditions sufficiently in advance of the incident to avoid or limit
Claimant's injuries,butfailed to take reasonable and adequate steps to eliminate,mitigate,
protect orwam ofthe'unreasonable risks of injury arising therefrom. Ciaimantwas injured and
as a direct and proximate result of such dangerous condition.
The CITY/COUNTY and Its agents and employees acted negligently in all of the
foregoing,and Claimant was injured as a direct result of said negligent acts and omissions.
The name of the public employees causing Claimant's injuries under these
circumstances is not known to Claimant. The names of employees working in and about the
area,orotherwise supervising the operation and workthereof,orwho controlled the operation
i
thereof,or who otherwise acted negligently as alleged herein are presently unknown to this
i
Claimant.
i
' f
I
2 I
i
PAGE 05/05
02/07/2008 10:30 4082984484
No. 0900 4
3,09i'IV,
Claimant is informed and believes that she will continue to sufferfurtherdamagesfrom
the described conduct of the CITY/COUNTY. The total amount of such injuries is presently
unknown,except thatall of such damages are withinihe unlimited jurisdiction of the Superior
Court.
All notices or other communications with regard to this claim should be sent to
Claimant in care of JOHN KEVIN CROWLEY, ESQ.,Ten Almaden Blvd, Suite 400, San
Jose, California 95113 (408)286-1200,
�r
Dated:January 11,2008
r
J'QHN KE CROWLEY
Attorney for Claimant
3
CLAIM
HOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: MARCH 11, 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
Supervisors. (Paragraph IV below),
given Pursuant to Government Code
AMOUNT: $4,236.60 Section 913 and 915.4. Please note all
"Warnings".
CLAIMANT: JOSEPH E. , EISENBRANDT, JR. .
ATTORNEY: UNKNOWN DATE RECEIVED: FEBRUARY 07, 2008
ADDRESS: 1327 SANTA FE AVENUE, BY DELI IVERY TO CLERK ON: FEBRUARY 07, 2008
MARTINEZ, CA 94553
BY MAIL POSTMARKED: HAND DELIVERED
FROM: Clerk of the Board of Supervisors T0: County Counsel
Attached is a copy of the above-noted claim.
JOHN CULLEN, C c
Dated: FEBRUARY 07, 2008
By: Deputy _
II. FROM: County Counsel TO: Clerk of the Board of Sup6visors .
( ) 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. Tile 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: 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 91.1.3).
I.V. BOARD ORDER: By unanimous vote of the Supervisors present:
O This Claim is rejected in full.
( ) Other:
I certify that this is a true and con-ect copy of the Board's Order entered in its minutes for
this date.
Dated: JOHN CULLEN, CLERK, By Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions,you have only six(6) months lirom the date this notice was personally served
or deposited in the nail 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 Addi6(xial Warniiig See Reverse Side ofTliis Notice.
AFFIDAVIT OF MAILING
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 18; and that today I deposited in the United
States Postal Service in Ntartinez,.California, postage fully prepaid a certified copy of this
Board Order and Notice to Claimant, addressed to the claimant as shown above.
Dated: JOHN CULLEN, CLERK By Deputy Clerk
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
rNISTRUCTIONS 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.
Rams son Munto RNMENERNMEMMENNEKINecmet
RE: Clain By: Reserved for Clerk's filing stamp
RECEIVED
Agamist the County�of Cn-dra Cot�Qor ) L
tJ.,C�►wt- �t�u, ) FEE 0,17 2008
District) CLERK BOARD OF SUPERVISCiS
(Fill in the name) 1 CONTRA COSTA CO.
1
The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named
district in the sum of$ Ll. ;2_� ,,. j,0 and in support of this claim represents as follows:
1. When did the damage or injury occur? (Give exact date and hour)
Q.C,•()A
2. Where did the damage or injury occur? (Include city and county)
3. How did the damage or injury occur? (Give full details;use extra paper if required)
N-C Cc,C ksx� a C Y , \w-M (cl (3, go sh k
VMS � WAV -}o coo l�oot� 'K,�. lo, S��.t��tES geh�rc�. ��
4. What particular act or omission on e part of county or district otlicers, servants, or employees
caused the injury or damage? AL J„k&t_ V)C\IA VQvTJ\-64 \tel f'e pme& t _WoS
N&& -%( kx ��� -\-b Q*P qccw��*
5 What are the names of county or district officers, servants, or employees causing the
damage or injury?
noq -:pfaAK -Do\\Qo
6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages
claimed. Attach two estimates for auto damage.) Gl&C\\Qd
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
■ ME a[a![a a!■a■■■INNS a llamas EWE![![[[[![!![[[!!![![[■a■■[[[![[[f t[f!.[[[f[on a a a■[[a e■■■t
.Gov.Code Sec. 910.2 provides "The claim shall be
signed by the claimant or by some person on his
behalf."
SEND NOTICES TO: (Attornev) 1
Name and address of Attorney
G (Claimant's Signature)
(Address)
Telephone No. )Telephone No. A'q 6-� z �-- `lc� 6
. [![![[[..[[[!.woman Ross laaaasun[rine[a[![[a[Nunn mass■■aa[[[a!![[![[aawas sun a[[![alat
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.
■ BENSEEN[[.!t■■■[[tat![. a■a Roblin[■■■■■■■[■[!■[[.■■■[[![[![[[!![![[t[![t■■ man■■[■■!■[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 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.
Cad
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CALIFORNIA HIGHWAY kP:TAULI
STATE OF CALIFORNIA _. 5001. Bl-.-m Road +
DEPARTMENT OF CALIFORNIA HIGHWAY PATROL .S 6'0 & I�1h��Jay 4
COLLISION REPORT INFORft ATIOINjart•nez 9 California 9451
CHP 418(Rev.9-05) OPI 065
i.
j DATE TIME
►z_ -p�
Aso _
NCIC NUMBER OFFICER'S I.D.NUMBER
YOUR VEHICLE WAS REMOVED TO:
I
A copy of the collision report can be obtained from the address above and will normally be available within
8 days from the date of the collision. A request by mail is preferred and must include: date,time,NCIC
number,and Officer's I.D.number printed above. The certification for purchase information(see reverse)
must also be completed,signed and attached to your written request with your check for payment. Make
your personal check or money order payable to the California Highway Patrol(CHP)for$10.00.
Reports may also be obtainea'in person during the office hours-stamped above. Please call to determine if I,
the report is ready. In the event the cost exceeds$10.00,you will be notified. Reports are retained 4 1.
i years.
I � ,
12/19/2007 at =12 : 43-, PM Job Number:
97164
ADVANCE AUTO BODY, INC. (,(
License # :BAR AC171433 Federal ID # : 680280418
917 Howe Rd
Martinez, CA 94553
(925) 370-7789 Fax: (925) 228-05881
PRELIMINARY ESTIMATE
Written By: MARK LINDEN � I4 D V
Adjuster:
Insured: HEIDI EISENBRANDT Claim # I
Owner: HEIDI EISENBRANDT Policy #
Address: 1327 SANTA FE AVE Deductible:
MARTINEZ, CA 94553 Date of Loss:
Evening: (925) 788-9665 Type of Loss:
Point of Impact:
Inspect
Location:
Insurance
Company: Days to Repair
1996 MAZD B2300 4X2 4-2 . 3L-FI 2D LONG Int: r
VIN: 4F4CR12A4TTM24984 Lic: 6M84094 CA Prod Date: Odometer: 102367
Intermittent Wipers Dual Mirrors Clear Coat Paint
Power Brakes Anti-Lock Brakes (2) Driver Air Bag
Rear Step Bumper 5 Speed Transmission Overdrive
-------------------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
--------------------------------------------------------------------------------
1 REAR BUMPER
2 O/H rear bumper 1 .2
3** Repl A/M Face bar step type gray 1 375. 00 Incl . 0 . 0
4# COMPLETE ASSEMBLIE 1
5 PICK UP BOX
6 Repl LT Outer panel 6 foot bed 2WD 1 704 . 37 8 .5 3.2
7 Add for Clear Coat 1 . 3
8 Deduct for Rear Bumper R&I -0 . 6
9 Repl Splash shield brace 1 8 .74
10 R&I R&I box assy 2 . 5
11# Repl STIRPE TAPE ON BEDSIDE 1 20. 00 0 . 4
12# Subl Hazardous Waste 1 3. 50
13# Repl Car Cover 1 5. 00 0 .2
14# Rpr Tint Color 0 . 5
15# Repl Undercoating 1 6. 00 0 . 3
16# Repl Weld thru Primer 1 3 . 00 0 .2
--------------------------------------------------------------------------------
Subtotals =_> 1125. 61 13 .2 4 . 5
1
12/19/2007 at 12 : 43•TPM Job Number:
97164
PRELIMINARY ESTIMATE
1996 MAZD B2300 4X2 4-2 . 3L-FI 2D LONG Int:
Parts 1125 . 61
Body Labor 13 .2 hrs @ $ 75. 00/hr 990 . 00
Paint Labor 4 . 5 hrs @ $ 75. 00/hr 337 . 50
Paint Supplies 4 . 5 hrs @ $ 30. 00/hr 135. 00
----------------------------------------------------
SUBTOTAL $ 2588 . 11
Sales Tax $ 1260 . 61 @ 8 .2500% 104 . 00
-----------------------------------------------------
GRAND TOTAL $ 2692 . 11
ADJUSTMENTS :
Deductible 0 . 00
- -------'--------------------------------------------
CUSTOMER PAY $ 0 . 00
INSURANCE PAY $ 2692 . 11
I authorize Advance Auto Body Inc.3to perform the needed repairs to my vehicle.
Repairs include parts, labor, and diagnosis . The above estimate is based on our
inspection and does not cover additional parts or labor which may be required
after the work has started. Worn or damage parts, not evident on first
inspection, may be discovered and you will be contacted for authorization for
additional work.
Parts prices aresubject to change without notice.
ACKNOWLEDGEMENT: I have read and understand the above estimate and authorize
repair service to be performed, including sublet work and acknowledge receipt
of this estimate . An express mechanics lien is hereby acknowledged on the above
vehicle to secure the amount of repairs completed.
This Estimate Authorized By:
Signed: Date:
Work Accepted By:
Signed: Date:
POWER OF ATTORNEY: I do hereby appoint the aforementioned business as my
attorney in fact to accept on my behalf any and all checks, drafts, or bills of
exchange for deposit to the aforementioned business ' account for credit on my
account for repairs on my vehicle which had been released and accepted.
i
Signed: Date:
2
Quote Print Preview Page l of 1
Quote
ACE TIRE CO
3450 Pacheco Blvd.
Martinez , CA 94553
. 925-229-4466
1996 Mazda B2300
Eisenbrandt, Heidi Mileage: 102,439
Home: 788-9665
Type Description Qty/Hrs Part No Unit Price Extended Price
Flat Alignment 95.001
Labor SPRING-Remove&Replace- 2.20 95.00 209.00
Leaf Spring,Both Sides,Rear
Part Leaf Spring Rear 2.00 AB 159.95 319.901
Worksheet Supplies Hazmat Tax Total
Part$ 319.90 10.00 26.39 356.29
Labor$ 304.00 1.25 0.00 305 2
Quote Total 661.54
C) 2008 Mitchell Repair.Information Co., LLC.
http://www.oiidemand5.com/mri c/quote/quotepri nt/quoteprint.htm 2/4/2008
t
ATDOnline-Retail Quote Page 1 of 1
IDeale.r Infcrtriation
!Address
Ace Tire Co.
i 3450 Pacheco Blvd
iI Martinez, CA 94553 I
Mark Schrader/Tide Ebding
January 28, 2008
Contact Customer Address
Phone: (925)229-4466
Fax: (925)229-4532
Email: acetireco@sbcglobal.net
Web:www.acetreco.com
i
I
�Prod.uct Description Qtu Retail Extended
107000164 P205/60R15 FRS BW GT FIREHAWK 90H 50K 1 $84.85 84.85 I
I
CTUT CA TIRE USE TAX 1 $1.75 1.75 f
MOUNT&BALANCE MOUNT AND BALANCE 1 $15.00 15.00 }
Sub Total .$1.01... f
Parts Tax
Total r $108.60
Tire Quotes Are complete with all applical taxes and mounting and balancing labor,this includes new lvawe-ste s,
free rotation and balance,free flat repair and air pressure check for the life of the tires
15
P205/60R15 FRS BW GT FIREHAWK 90H 50K
http://www.atdonl i ne.com/atdonli ne.asp?m=Retai lQuote&view=pri nt&sa=Templ ateContr... 1/28/2008
01/21/2008 at 12 : 12 PM Job Number:
21975
MARTINEZ AUTO BODY SHOP
License # :BAR ABO85474 Federal ID # : 942574428
615 ALHAMBRA AVE
MARTINEZ, CA 94553
(925) 228-3689 Fax: (925) 372-6546
PRELIMINARY ESTIMATE
Written By: KELLY SHAVER ®� 4�
Adjuster:
Insured: HEIDE EISENBRANDT Claim #
Owner: HEIDE EISENBRANDT Policy #
Address: 1327 SANTA AVE Deductible:
MARTINEZ, CA 94553 Date of Loss:
Day: Type of Loss:
Evening: Point of Impact: 7 . Left Rear
Inspect
Location:
Insurance
Company: Days to Repair
1996 MAZD B2300 4X2 4-2 . 3L-FI 2D SHORT TEAL Int:GREY
VIN: 4F4CR12A4TTM24984 Lic: 6M84094 CA Prod Date: Odometer:
Condition: Good
Intermittent Wipers Tinted Glass Dual Mirrors
Clear Coat Paint Metallic Paint Power Brakes
Anti-Lock Brakes (2) Driver Air Bag Rear Step Bumper
Bedliner Automatic Transmission Overdrive
-------------------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
-------------------------------------------------------------------------------
1 PICK UP BOX
2 R&I R&I box assy 2 . 5
3 Repl LT Outer panel 6 foot bed 2WD 1 704 . 37 8 . 5 3 .2
4 Add for Clear Coat 1 . 3
5* Rpr LT Inner panel 6 foot bed 2 . 0 2 . 0
6 ` Overlap Major Adj . Panel -0. 4
7 Add for Clear Coat 0 . 3
8* Rpr LT Wheelhouse 1 . 0
9 Repl LT Stone guard front 1 16. 55 0.2
10 Repl LT Stone guard rear 1 24 . 50 0.2
11# Rpr Weld Damage to Frt Pnl & Spot 0. 5 0 . 6
Paint
12# Rpr Repair Rr Sill @ Welds & Spot 0 . 5 0. 6
Paint
13# Refn Spot Underside of Bedpanel 1 . 0
14# R&I Bed Liner 0. 5
15# Repl Corrosion Protection 1 5. 00 T 0.3
16# Repl Weld-Thru Primer @ Bedsde Pnl 1 7 . 95 T 0. 5
17 REAR LAMPS
1
f • '
01/21/2008 at 12 : 12 PM Job Number:
21975
PRELIMINARY ESTIMATE
1996 MAZD B2300 4X2 4-2 . 3L-FI 2D SHORT TEAL Int:GREY
-------------------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT . PRICE LABOR PAINT
-------------------------------------------------------------------------------
18 R&I LT Combo lamp assy Incl .
. 19 REAR BUMPER
20 R&I R&I bumper assy Incl .
21 STRIPE TAPE
22* Repl LT Stripe tape short bed 1 174 .20 0 . 4
23# Mask Vehicle Exterior for 1 5. 00 T 0.2
Refinish
24# Color Tint to Blendable Match 1 0. 5
25# Hazardous Waste Disposal 1 5. 00 X
--------------------------------------------------------------------------------
Subtotals =_> 942 . 57 17 . 8 8 . 6
Parts 919. 62
Body Labor 17 . 8 hrs @ $ 80. 00/hr 1424 . 00
Paint Labor 8 . 6 hrs @ $ 80. 00/hr 688 .00
Paint Supplies 8 . 6 hrs @ $ 36. 00/hr 309. 60
Sublet/Misc. 22 . 95
----------------------------------------------------
SUBTOTAL $ 3364. 17
Sales Tax $ 1247 . 17 @ 8 .2500% 102 . 89
----------------------------------------------------
GRAND TOTAL $ 3467 .06
ADJUSTMENTS:
Deductible 0. 00
-----------------------------------------------------
CUSTOMER PAY r34677- 06")INSURANCE PAY
If you have coverage for damage to you vehicle under this policy it is our
obligation to inform you that Under California Code of Regulations, Title 10,
Chapter 5, Section 2695. 8 .d.2.e, you have the right to select the vehicle
repair facility of you choice.
We are prohibited by law from requiring that repairs be done at a specific
shop. you are entitled to select the auto body shop to repair damage covered
by us . we have recommended a repair shop that will repair your damaged
vehicle. As you have agreed to use our recommended repair shop, we will cause
the damaged vehicle to be restored to its condition prior to the loss at no
additional cost to you other than as stated in the policy or as otherwise
allowed by law. If you experience a problem with the repair of you vehicle,
please contact us immediately fo'r assistance.
AUTO BODY REPAIR CONSUMER BILL OF RIGHTS
A CONSUMER IS ENTITLED TO:
2
01/21/2008 at 12 : 1.2 PM Job Number:
21975
PRELIMINARY ESTIMATE
1996 MAZD B2300 4X2 4-2. 3L-FI 2D SHORT TEAL Int:GREY
1 . SELECT THE AUTO BODY REPAIR SHOP TO REPAIR AUTO BODY DAMAGE COVERED BY THE
INSURANCE COMPANY. AN INSURANCE COMPANY MAY NOT REQUIRE THE REPAIRS TO BE DONE
AT A SPECIFIC AUTO BODY SHOP.
2 . AN ITEMIZED WRITTEN ESTIMATE FOR AUTO BODY REPAIRS AND, UPON COMPLETION OF
REPAIRS, A DETAILED INVOICE. THE ESTIMATE AND THE INVOICE MUST INCLUDE AN
ITEMIZED LIST OF PARTS AND LABOR ALONG WITH THE TOTAL PRICE FOR THE WORK
PERFORMED. THE ESTIMATE AND INVOICE MUST ALSO IDENTIFY ALL PARTS AS NEW, USED,
AFTERMARKET, RECONDITIONED, OR REBUILT.
3. BE INFORMED ABOUT COVERAGE FOR TOWING SERVICES. THE INSURER SHALL PAY
REASONABLE TOWING AND STORAGE CHARGES INCURRED BY THE INSURED TO PROTECT THE
VEHICLE AND PROVIDE REASONABLE NOTICE TO AN UNSURED BEFORE TERMINATING PAYMENT
FOR STORAGE CHARGES SO THAT 'THE INSURED HAS TIME TO REMOVE THE VEHICLE FROM
STORAGE.
4 . BE INFORMED ABOUT THE EXTENT OF COVERAGE, IF ANY, FOR A REPLACEMENT RENTAL
VEHICLE WHILE A DAMAGED VEHICLE IS BEING REPAIRED.
5. BE INFORMED OF WHERE TO REPORT SUSPECTED FRAUD OR OTHER COMPLAINTS AND
CONCERNS ABOUT AUTO BODY REPAIRS .
COMPLAINTS WITHIN THE JURISDICTION OF THE BUREAU OF AUTOMOTIVE REPAIR
Complaints concerning the repair of a vehicle by an auto body repair shop
should be directed to:
Toll Free (800) 952-5210
California Department of Consumer Affairs
Bureau of Automotive Repair
10240 Systems Parkway
Sacramento, CA 95827
The Bureau of Automotive Repair can also accept complaints over its web site
at:
www.autorepair.ca.gov
COMPLAINTS WITHIN THE JURISDICTION OF THE CALIFORNIA INSURANCE COMMISSIONER
Any concerns regarding how an auto insurance claim is being handled should be
submitted to the California Department of Insurance at:
(800) 927-HELP or (213) 897-8927
California Department of Insurance
Consumer Services Division
300 South Spring Street
Los Angeles, CA 90013
3
f
01/21/2008 at 12 : 12 PM Job Number:
21975
PRELIMINARY ESTIMATE
1996 MAZD B2300 4X2 4-2 .3L-FI 2D SHORT TEAL Int:GREY
The California Department of ]Insurance can also accept complaints over its web
site at: www. insurance .ca.gov
All supplements must be pre-approved before any work can be completed.
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 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. NWCPP=NATIONWIDE CRASH
PARTS PROGRAM.
4
01/21/2008 at 12 : 12 PM Job Number:
21975
PRELIMINARY ESTIMATE
1996 MAZD B2300 4:X2 4-2 .3L-FI 2D SHORT TEAL Int:GREY
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from
the Guide AEH5320, CCC Data Date 01/01/2008, 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) or ALT OEM (Alternative OEM) parts are OEM parts that may be provided by or
through alternate sources other than the OEM vehicle dealerships. OPT OEM or ALT OEM parts may
reflect some specific, special, or unique pricing or 'discount. OPT OEM or ALT OEM parts may
include "Blemished" parts provided by OEM's through OEM vehicle dealerships, 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
Recond. 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. .
5'
CLAIM
HOARD OF.SU.PERVI.S.ORS OF CONTRA COSTA COUNTY
BOARD ACTION: MARCH 11, 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
Supervisors. (Paragraph IV below),
given Pursuant to Government Code
AMOUNT: IN EXCESS. OF $10;000.09 Section 913 and 915.4. Please note all
"Warnings".
CLAIMANT: PATRICIA KELLY
ATTORNEY: JOHN KEVIN CROWLEY DATE RECEIVED: FEBRUARY 06, 2008
ADDRESS: TEN aLmAnEV BLVD. , STE. 40BY DELIVERY TO CLERK ON: FEBRUARY 06, 2008
SAN JOSE, CA 95113
BY MAIL POSTMARKED: FEBRUARY 05, 2008
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
FEBRUARY O6, 2008 JOHN CULLEN, r
Dated: 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 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: 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).
I.V. 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 Orderentered in its minutes for
this date.
Dated: JOHN CULLEN, CLERK, By Deputy Clerk
WARNING (Gov. code sectioh 913)
Subject to certain exceptiais,you have only six(6) months from the date this notice was personally served
or deposited in the mail to file a couit action on this claim.See Government Code Section 945.6.You.may
seek the advice ofan attorney ol'your choice in connection wide this matter. lf'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 pies jury 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: JOHN CULLEN, CLERK By Deputy Clerk
)
PATRICIA KELLY, )
Claimant, ) CLAIM FOR PERSONAL INJURIES
vs. )
(Section 910 of}LTa ^_.a_-_:
CITY OF PITTSBURG, COUNTY OF ) Government Co e) D
CONTRA COSTA and:Does 1 - 50 ) FEB 0 6 200$
Respondents. )
CLERK BOARD OF SUPERVISORS
CONTRA COSTA CO.
YOU ARE HERE=BY NOTIFIED that PATRICIA KELLY,whose address is 2215 Oak
Hills Circle #67, Pittsburg.CA 94565, claims damages from the City of Pittsburg and the
County of Contra Costa,(her einafterCity/County), in an amount in excess of$10,000 and in
excess of the jurisdictional minimum of the Superior Court and which is not stated for that
reason.
This claim is based on personal injuries accrued by PATRICIA KELLY (hereinafter
"Claimant") on or about August 11, 2007, in the City of Pittsburg, County of Contra Costa,
State of California, under the following circumstances: Claimant was riding her bicycle on
Harbor Street in Pittsburg across the rail road tracks between East Santa Fe Avenue and
East 10t"Street. Upon crossing over the tracks,she was thrown over the handlebars of her
bicycle sustaining injuries to her , ribs, shoulder, arm, leg and person. Plaintiff was thrown
from her bicycle because the asphalt near and around the tracks was ill maintained. At that
time large gaps between the concrete and tracks existed and boards had been laid across
the roadway in an attempt to bridge the large gaps. Despite the repair attempt, large gaps
still existed.in the roadway and the roadway was.unstable and unsafe to passers by. The
agents, representative and employees of the CITY/COUNTY negligently operated,maintained,
1
supervised, repaired, replaced and controlled said roadway in such a way so as to cause
such injury as hereinbefore described. The name of such .agents, representatives and
employees are currently unknown to the claimant. Subsequent to plaintiff's injuries, the
roadway was properly repaired.
Claimant is informed and believes that the CITY/COUNTY and its employees also
negligently designed,constructed,altered,selected,repaired,approved and maintained the
described roadway which caused the injury to the Claimant. At the time of the injuries to
Claimant, such condition posed an unreasonable risk of injury to Claimant. The aspects of
the roadway,which posed such unreasonable risk of injury included, but were not limited to,
gaps in the roadway,boards across the roadway, no warnings signs,and inadequate training
and supervision of the CITY/COUNTY agents and employees,and inadequate maintenance.
Claimant is further informed and believes and thereon alleges that the CITY/COUNTY had
notice of such dangerous conditions sufficiently in advance of the incident to avoid or limit
Claimant's injuries, but failed to take reasonable and adequate steps to eliminate, mitigate,
protect.orwarn of the unreasonable risks of injury arising therefrom. Claimant was injured and
as a direct and proximate result of such dangerous condition.
The CITY/COUNTY and its agents and employees acted negligently in all of the
foregoing, and Claimant was injured as a direct result of said negligent acts and omissions.
The name of the public employees causing Claimant's injuries under these
circumstances is not known to Claimant. The names of employees working in and about the
area,orofherwise supervising the operation and workthereof,orwho controlled the operation
thereof,orwho otherwise acted negligently as alleged herein are presently unknown to this
Claimant.
2
Claimant is informed and believes that she will continue to sufferfurther damages from
the described conduct of the CITY/COUNTY. The total amount of such injuries is presently
unknown,except that'all of such damages are within'the unlimited jurisdiction of the Superior
Court.
All notices or other communications with regard to this claim should be sent to
Claimant in care of JOHN KEVIN CROWLEY, ESQ., Ten Almaden Blvd, Suite 400, San
Jose, California 95113 (408) 286-1200.
Dated: January 11, 2008
'JOHN KEVfITCROWLEY
Aitorney for Claimant
3
PROOF OF SERVICE BY MAIL - [CCP SECTION 1013(a)3, 2015.51
I, the undersigned, declare that I am now and at all times herein mentioned
over the age of eighteen years, a resident of and employed in the County of Santa
Clara, California, and not a party of the within entitled action or cause. My business
address is Ten Almaderi Blvd., Suite 400, San Jose, California 95113-2226.
On the date indicated below, I served a true copy of the documents:
CLAIM FOR PERSONAL INJURIES PURSUANT TO CALIFORNIA
GOVERNMENT CODE SECTION 910
by personal delivery to the address:
Contra Costa County .
Clerk of the Board
651 Pine Street #106
Martinez, CA 94553
City Clerk of the City of (Pittsburg
65 Civic Avenue
Pittsburg, CA 94565
(By Facsimile Machine [FAX]) By personally transmitting a true copy
thereof via an electronic facsimile machine between the hours of 8:00
a.m. and-5:00 p.m.
X (By U.S. Mail) I am readily familiar with this office's business
practice for collection and processing of correspondence for mailing
with the United States Postal Service and that this document with
postage fully prepaid will be deposited with the United States Postal
Service this date in the ordinary course of business.
By personal service.
I declare under penalty of perjury that the foregoing is true and correct, and
that this declaration was executed at San Jose, California.
----
Dated: February 5, 2008
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CLAiM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: MARCH 11 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
Supervisors. (Paragraph IV below),
given Pursuant to Government Code
AMOUNT: EXCEED $25,000.00 Section 913 and 915.4. Please note all
"Warnings".
JOSEPH ANTHONY PASTOR, KORINA-.GOULD,
CLAIMANT: KC BRYAN QUICK
ATTORNEY: STEVEN H. HENDERSON DATE RECEIVED: FEBRUARY 05, 2008
LAW OFFICES OF STEVEN H. HENDERSON FEBRUARY 05; 2008
ADDRESS: 3024 RAILROAD AVENUE, BY DELIVERY TO CLERK ON:
PITTSBURG, CA 94565.
BY MAIL POSTMARKED: HAND DELIVERED
FROM: Clerk of the Board of Supervisors. T0: County Counsel
Attached is a copy of the above-noted claim.
FEBRUARY 05JOHN CULLEN, Cl
, 2008 c
Dated: By: Deputy _
I.I. 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 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: 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: JOHN CULLEN, CLERK, By Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptiois,you have only six(6) montlis 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. *Four Additional Warning See Reverse Side of This Notice.
AFFIDAVIT OF MAILING
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: JOHN CULLEN, CLERK By Deputy Clerk
i
STEVEN H. HENDERSON - SB #88620
JILL STERN-HENDERSON - SB #148172
Attorneys - Abogados
3024 Railroad Avenue
FEB
3 Pittsburg, California 94565 .._
(925) 427-1771 QFAk `� '9
=} FAX- (925) 427-4282 coNTRACoS�pFR
Srq
Attorneys for Claimants,
6 Joseph Anthony Pastor, Korina Gould, KC Bryan Quick
7 CLAIM AGAINST PUBLIC ENTITY
JOSEPH ANTHONY PASTOR, KORINA GOULD,
KC BRYAN QUICK,
Claimants,
I i vs.
12 CITY OF PITTSBURG, CONTRA COSTA COUNTY,
and DOES 1 through 20, Inclusive.
14 Defendants.
i,
Claimant(s) JOSEPH ANTHONY PASTOR, KORINA GOULD, KC BRYAN QUICK,
16
hereby present this claim to the City of Pittsburg and County of Contra Costa pursuant to
17
Section 910 of the California Government Code.
18
1. The name and post office address of KC Bryan Quick is as follows: 619 West
17`f' Street, #A, Antioch, CA 94509, (925) 727-6618
20
2. The name and post office address of Korina Gould is as follows: 125 East 10'h
21
22 Street, #9, Pittsburg, CA 94565, (925) 470-3803
3. The name and post office address of Joseph Anthony Pastor: 5920 Jersey Island
23
24 Road, Oakley, CA 94561, (925) 684-0811.
4. The post office address to which claimants desire notice of tliis claim to be sent is
as follows: Steven H. Henderson, Esq., Law Offices of Steven H. Bien,! rson, 3024
Railroad Avenue, Pittsburq, CA 94565.
27
5. Claimants are ignorant of the true names and capacities of dlefendants sued
2S
herein as DOES 1 through '.10, inclusive, and therefore sue these defendants by such
fictitious names. Claimants will amend this claim to allege their true names and capacities
when ascertained. Claimants are informed and believe and thereo , ''. ;fie that each of the
fictitiously named defendants is negligently responsible in some manner for the
occurrences herein alleged, that claimants' injuries as herein alleged were proximately
4 caused by the negligence of these defendants.
6. At all times herein mentioned, Does 1 through 10, were operating as the agents,
6 servants, and/or employees of each of the remaining defendants, and were at all times
7 herein mentioned, acting within the purpose and scope of said agency, service and/or
h employment.
`) 7. On or about August 8, 2007, at approximately 5.00 p.m. on northbound Bailey
i
Road, approximately .8 miles south of Willow Avenue, in the City of Pittsburg, Contra Costa
County, California, claimants sustained personal injuries as a result of the following
12 circumstances- Claimant KC Bryan Quick, driver, and claimants Korina Gould and Joseph
I.) Anthony Pastor, passengers, were traveling on Bailey Road within the speed limit in the
14 2004 Chevrolet Impala of Claimant KC Bryan Quick. Claimant KC Bryan Quick was
15 caused to lose control of the vehicle due to a dangerous condition which existed on the
16 roadway. The dangerous condition consisted of worn, warped, and uneven pavement,
17 which was preceded by a pothole.
S 8. Claimants are informed and believe and upon such information and belief allege,
that Defendant CITY OF PITTSBURG and the COUNTY OF CONTRA COSTA, and DOES
20 1 through 20, inclusive, owned, maintained, controlled, and managed the above referenced
2 roadway where claimants sustained injury.
22 9. As a direct and proximate result of the carelessness and negligence of
23 Defendant CITY OF PITTSBURG and the COUNTY OF CONTRA COSTA, and DOES 1
2-1 through 20, inclusive, and each of them, as herein alleged: Claimant: KC Bryan was injured
25 in his health, strength and activity, sustaining injuries to his body including, but not limited i
26 to, acute closed head injury and acute rib.fractures; and shock and injury to his nervous
27 system and person. Claimant Korina Gould was injured in her health, strength and activity,
'x I sustaining injuries to her body including, but not limited to, left knee in ,
injury
and shock and
injury to her nervous.system and person. Claimant Joseph Anthony Pastor was injured in
•,f
i his health, strength and activity, sustaining injuries to his body includ.ng, but not limited to,
injury to his neck shoulders, back, head-, and shock and injury to his nervous system and
person. All of which injuries have caused and continue to cause claimants great mental,
4 physical and nervous pain and suffering, all to their general damages ir a sum to be
ascertained at the time of trial.
6 10. Claimants' damages exceed' $25,000.00 and the court of appropriate jurisdiction
7 is Contra Costa Superior Court, Unlimited jurisdiction.
s 11. As a further proximate result of said conduct of Defendant CITY OF
9 PITTSBURG, and the COUNTY OF CONTRA COSTA, and DOES 1 through 20, inclusive,
Ili and each of them, the claimants were required to and did employ physicians and surgeons
I i to examine, treat, and care for them and did incur hospital and incidental expenses; that
I claimants are informed and believe, and based thereon, allege, that there will be some
I. additional medical expenses, the exact amount-of which is unknown.
14 12. As a further proximate result of said conduct of Defendants, and each of them,
15 claimants were prevented from attending to their usual occupation and sustained a loss of
16 earnings thereby in an amount as yet unascertained, and claimants are informed and
17 believe, and thereon allege, that they will thereby be prevented from attending to said usual
18 occupation for a period in the future and will sustain a further loss of earnings.
I`> I declare under penalty of perjury under the laws of the State of California that the
20 following information is true and correct, and that this declaration was executed on
21
2222 February 5, 2008
VEN H. HENDE,'RSON
23 Attorney for Claimants
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25
26
27
28
PROOF OF SERVICE
1 am employed in.the County of Contra Costa, California. I am over the
age of eighteen (18) years and not a party to the within cause. My business
4
address is: 3024 Railroad Avenue, Pittsburg, CA 94565.
6 On the date shown below, a copy of the attached document(s):
Claim against Public Entity
7
was served on the interested parties in this action by placing a true copy thereof in a
8 sealed envelope, addressed as follows:
9
10 Clerk of the County Board of Supervisors
Attention: Emy Sharp
11 651 Pine Street, [Room 106
Martinez, CA 94553
12
13
[x ] (BY PERSONAL SERVICE) By causing each such envelope to be
14 delivered by hand, as addressed.
15 [] (BY CERTIFIED MAIL By placing said envelope, with postage thereon fully prepaid
for first-class mail, for collection and mailing at my place of business following
16 ordinary business, practice. I am readily familiar with the ordinary business practice
17 for collection and processing of mail. In the ordinary course of business, mail is
deposited with the United States Postal Service on the same,day as it is placed for
18 collection.
19 1 declare under penalty of perjury under the laws of the United States that
20 the foregoing is true and correct.
21
Executed this 5th of February, 2008, at California.
22
23 . Steven H. Henderson, Esq.
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25
26
27
28
CLAIM
BOARD OF SUPERVISORS OF CON"CRA COSTA COUNTY
BOARD ACTION: MARCH 11_ , 200 �.��
Claim Against the County, or District Governed by )
the Board of Supervisors, Routing Endorsements, )
NOTICE TO CLAIMANT
and Board Action.All Section references are to ) The copy of this document mailed to
California Government Codes. . ) you is your notice of the action taken
oil your claim by the Board of
Supervisors. (Paragraph IV below),
given Pursuant to Government Code
Section 913 and 915.4. Please note-all.
AMOUNT: $109.92 "Warnings", '
CLAIMANT: MAIRA NAVAR O
ATTORNEY: UNKNOWN DATE RECEIVED: FEBRUARY 13, 2008.
ADDRESS: 613 JOI NSON DRIVE, 'BY DELIVERY TO CLERK ON: FEBRUARY 13, 2008.
RICHMOND, CA 94806
BY MAIL POSTMARKED: FEBRUARY 11, 2008
FROM: Clerk of the Board of Supervisors T0:' County Counsel
Attached is a copy of the above-noted claim.
JOHN CULLEN le 1
Dated: FEBRUARY 13, 2008 By: Deputy
IL. FROM.: County Counsel TO: Clerk.of.the Board of Su6ervisor•s
( ) 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. 'file 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).
( ) Other:
Dated: By. 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 91 l.3).
W. BOARD ORDER: By.unanimous vote of the Supervisors present:
( This Clairn 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: 03/(t/0 lb JOHN CULLEN, CLERK, By Deputy Clerk
WARNING (Gov. code section 913) —�
Subject to certain exception,you have only six(6) rironths 1i'orn the date this notice was personally served
or deposited in the mail to file a court action on this chiim.See Government Code Section 945.6.You may
seek the ,,)dviee of'an attorney of your choice in connection wiflr this matter. If'you want to consult an
attorney,you should do so immediately. *For Additiaial 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 1.8; 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 claimmit as shown above.
Dated: _ Dylvole)q JOHN CULLEN, CLERK � Deputy Clerk
I