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HomeMy WebLinkAboutMINUTES - 04012008 - C.12 •- 1 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACT10N: ort/L t 2MUQ 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), dd given Pursuant to Government Code AMOUNT: c� 3 t Z� Section 913 and 915.4. Please note all "Warnings". CLAIMANT: CL t'U 0 XODn hi=,-" r r �^ C ,y Q -� - .zrQ�arrr �,j-,5L�rC(�CVDATE RECEIVED: ADDRESS: 1 � BY DELIVERY TO CLERK ON: BAIL Sera- bu WK 1. G. 9ff�9---------------------------- � FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. 2-�8 JOHN CULLEN, Clerk Dated: reJ By: Deputy II. FROM.: Coun Counsel TO: Clerk of the Board of Supervisors (Tis 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 1.3). ( ) Other: Dated: ra �'oe 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: 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 JOHN CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) months from the ate this notice was personally served or deposited in the mail to file a court;,action on this claim.See Goveimment 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 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 .l 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 Aaej)ded CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY Q BOARD ACTION: Apr 1 L 1 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 MW6E IIl;Z7XXD on your claim by the Board of FEB .2 7 2008 Supervisors. (Paragraph IV below), given Pursuant to Government Code �j COUNTY COUNSEL Section 913 and 915.4. Please.note all AMOUNT: Z°` MARTINEZ CALIF. "Warnings". CLAIMANT: ATTORNEY: DATE RECEIVED: ADDRESS: qt)l COW-f- M.0,F' BY DELIVERY TO CLERK ON: mczrhncz, �� 3 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel �((�_ Attached is a copy of the above-noted claim. �'filU ,t 27 2b JOHN CUL N, Cleric. Dated: By: Deput 11. FROM.: Count' ounsel 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). ( ) Other: Dated: .1' 2 -0 By: Deputy County Counsel 111. FROM.: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. O Other: I certify that this is a true and correct copy of the Board's Order entered in it.s minutes for this date. ' Dated: ©ALO O JOHN CULLEN, CLERK; By eputy Clerk WARNING (Gov. code section 9.13) Subject to certain exceptions,you have only six(6) months from die date this notice was personalty served or deposited in the mail 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 wide this matter. ifyou want to consult an attorney,you should do so immediately. *For Additional Warnir�g 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 pr epaia a certified copy of this Board Order and Notice to Claimant, addressed to the claimant hown above. Dated: �� OZ o 0. JOHN CULLEN, CLERK y ----------Deputy Clerk i CLAiM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: r1,t 2- 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 Section 913 and 915.4. Please note all AMOUNT: ,�-V t "Warnings". .y a -A-T \( �Cr'CL" '�-,5L i�Cc L��DATE RECEIVED: ` i i ADDRESS: BY DELI %1�rl,El: �G 11`�' 1� OJ ' ��) G1 + �5 VERY TO CLERK N: FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the.above-noted claim. JOHN CULLEN, Clerk Dated: I�etQr�C By: Deputy II. FROM.: Cour 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). O Other: i Dated: By: Deputy County Counsel Ill. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD 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;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 claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this matter. If'you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side of'This Notice. AFFIDAVIT OF MAILING I declare under penalty of per jr ry 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: JOIN CULLEN, CLERK By, Deputy Clerk ; FEB. 4. 2003 11 : 23AM CCG RISK MIAN.AGEMLINT P. 2 NO BOARD OF SUMR-MORS OF CONTRA COSTA COUNTY NO- 978 HYMES-OFFOAp IriSTRUCTIQNS TO CLAIlVIANF .5 FEB 2 .200 8 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 Haan 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 ow year after the accrual of the cause of action. (Gov. Code§ 911.2.) I B. Claims must be tiled with the Clerk lof the Board of Supervisors at its office in Room 106, County Administration Building,651 pine Street,Martinez, CA 945 53. I C. If claim is against a district governedi by the Board of Supervisors, rather than the Couuty, the nauae 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. I I I E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. ama■■a&aaxaaa as aaa as allRug Kam a■e WREN aa■aal KAaaa■■a a wpm aaa as Sam lei Raaa aa[t all a Y an I I RE: Claim By: Reserved for Cleric's filing stamp U f tA- Svc G i—n)o I F—T-) RECEIVE® Against the County of Contra Costa or I ) FEB 2 7 2008 (1 iCt) CLERK BOARD OF SUPERVISORS LII a LZ3II]e) CONTRA COSTA CO. I I I The undersigned claimant hereby makes claim against the County of Contra. Costa or the above-immed district is the sum of$ I and iu support of this claim,represents as follows: 1• When dial the damage or injury occur? (Give exact date and hour) ?. Where did the damage or injury occur? ( Cl city aad county) �S1 CU" Sin 'M�r �oS b\VAI �pbVr Cur 's► �Gt 3. How did the damage or injury occur? (Give full retails;use extra paper if required) Orw>zr d Cupn .V0n,cL fir. rmv,z- --inLav,-- Swvnc� J -jam�i,�1C� ►Ylq,�.c,v�� � `fir�. q-� QA 1-k.�' �Yl...� V,���c� U� �V J' ilk SVrra_G( 4- what particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? a01, I I What are the names of county or district officers, sezvauts,or employees causing the damage or injury? I CONTRA C051'A COUNTY 710�0r AECEIVFp I I FEB 2 5 2008 9l-SK MAA]AGEW-,, ; I FEB. 4. 200$ 11 :28AM CCC RISK MANAGEMENT NO. 976 P 3 6. What damage or injuries do your claim resulted? (Cxive full extent of iajuzies or damages claimed. Attach two estimates for auto idamage.) p ,e, AD 00 k nsu r o_c} S V&A-\C'U— Lwo+ on o\IS bgGk der �r\cx face v— 3J \ajzA U. ('\01 yivr i�S 7. Now was the amount claimed above computed? (Include the estimated auxouat oS� C h prospective in ury or damage,) Q�1 y ft, Ove�v�_ kxt-- '�� Y epa\rs C U-Q- \Q Q n I Ccm�1plAoicl I S. Names and addresses of witnesses, doctors,and hospitals. I 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT l- k1.0"76'- 3411 - a_o-z-ver I ILL - aLe a Ming■AKI ME■■R EE S E■REM%VdZE■t REPO MINER11EE stake no■Es■RssnmR■E onwns.E■EaEEg.s anEts..Es■■E ) GoV. Code Sec. 910.2 provides"The claim shall be si�by the claimant or by some person on his behalf. SEND NOTICES TO: (Attorney) 1 IT Name and address of Attomey ) UL QL.VV (Claire 's Signature) �ONNIE PARMER p Qq q rI � S 4' 2008' (Address) ;CLAIMS S�-\aft,Y Vuj8 OA4- i Telephone No. )Telephone No. %'—r1 • t'1 ;1--) i - ■EERE Rona EE MILE REMOVE..S R n.MEgg Ka■Vgg gk■E ng■k.aV gg■EEE■■E KOR EM RIE.Ok■■■PIP■EEE MENU FE I PUBLIC RECORDS NOTICE: Please be advised that this claim farm,or any claim filed.with the County under the Tort Claims Act, is subject to public disclosure under the California Public]Records Art (Gov. Code, §§ 6504 et seq.) Furthermore, any attachments,addendums, or supplements attached to the claim form, including medical records,are also subject to public disclosure. a■E■MEEN M■■■■■MEESE SENIOREEEEEEnsigEEEMR■■ken ER■r■Mrs■rEnnM■nEEERR■EEER■kis E■gksnEMi I NOTICE: Section 72 of the Penal Code provides: I Every pemm 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 is 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. I I I I I i FEB. 51. 2008 9; 32AM CCC RICK MAN.AaEMENT PREPARE A SKETCH OF THE ACC M N-T S�WQ: (Xadicate direction,street r.N O 008 af£c P landmarks,etc....) I.NUMBER VEHICLES.Show direction o travel b ( atmws;indicate which is County ve4,iclo 2.Show path before accident with asoliil lin . ' ---- I v- 3. p 3. Show path after accident with a brokt+n line •■ ■ 4.Show pedestrians by I ! f 5. Show railroad tracks by i L1 6 I DESCRIBE HOW THE ACCIDENT OCCURRED: (Include approximate speeds of the vehicles involved,whether any parties appeared to be;intoxicated,e=-- Add another page if necessaTy.) llo( )r i ns off. �- r s o� � "v),0 U WL C' I �ku 0 I SUPERVISOM INVESTIGATIM .I ACCIDENT REVIEW ENDING: , PREVENTABLE CZ> NOT PREVENTABLE C> ACaDENT REVIEW RECOMMEEMATION- I Employee Signature: I Supervisoes Signature: Data= i bate: .. _�...,.,�, ..�,..�.,a A rnvv FnR MPARTIYI M RECORM . I I I I I Fra. 55. 2008 9: 82AM Cv r_, i ���..i►.e.h iN_;C 11DJEN REPORT N0, f108 P. 2 n DAT&'10-a_Li0_7 TTM-?-Ppm ACCIDENT LOCATION: isar, ;1 r Us �U r r V9HICLE EQUIPMENT NO: LIC.PL�iTE NO: _--- YEARaVJMfTYPE; kJl�'�e OU-NTY=OI_ I)THER.DRIffiR DRIVER IlVFOF.MATTON: DRIVER WFORKA NAME.3iNfY\PS 1 C,. a\Or NAS: e lU f U DEPA.RT'MENT- HONM DRESS_ HOME ADDRESS: \IrC Y HOME PH O NE#: HOME PHONE#: r • `-I - 3- WORD P +ONE#: WORK PH •ONE#: _:M I CSO DRrVER'SILICENSE#: DRIVER'S LICENSE# NC19`4 '_T 1' VEHICLE INFO ATTON• ]F PERSONTAL OR RENTAL VEHICLE: YEAR��MA E:�ODEL: MVLC NAN4E AND ADDRESS OF AGENT: I ' REG]S'TERED O NER_ 'TSS s VvC� ADDRESS PHONE#OF AGENT: - I PHONE46 - WORK PHONE#: POLICE REPORT TAKEN: YES 'd a LICENSE LATE#: POLICE DEPARTMENT: c-. 2AftCEA_..._a. OFFICER'S N &BADGE #:1 1 INSURANCE : COMP ._ ,l- C� roup , i ; ADDRESS ' LIST JNJUREA PERSONS: AGENT: I' -NAME: I. NAME: acto PHt�NE a: PHONE 4P ADDRESS- WITNESS INFQ ATION: 2. NAME: PHUNE#: I PHO ADDRESS: ADDRESS: 3. NAME- 2. NAME: PHONE#: PHONE#: ADDRESS: ADDRESS. 4. N01E: 3. NAME: PRONE 4P PHONE ADDRESS: ADDRESS.-l" SEAT BELT WORN BY COUNTY DYES f Nb SEAT BELT WORN BY FASSENGJtRS?:i CD NO C� (DAMAGE 1TO OTHER VEHICLE: l J Y ` S C 1 W�\,ej U P 1 I i i i Date: 1/25/2008 05:02 PM Estimate ID: 070033007188-3800102 Estimate Version: 1 Supplement: 1(F) 1/25/2008 05:00:36 PM Profile ID: CUSTOMIZED NO SUPPLEMENTS WILL BE HONORED WITHOUT PRIOR INSPECTION OR APPROVAL ***************CALL FILE ADJUSTER TO CONFIRM COVERAGE**************** Mercury Insurance Group 11150 International Dr.Suite 100,Rancho Cordova,CA 95670 (916)636-1534 Damage Assessed By: David Medeiros 25414 Adjustor: CONNIE PARMER (916)636-1534 ext.2259 Supplemented By: David Medeiros 25414 916-844-8427 DIRECT LINE Condition Code: Good Type of Loss: Collision Date of Loss: 10/24/2007 Contact Date: 1/9/2008 Deductible: 500.00 Policy No: AP05299172 Claim Number: 070033007188-3800102 Insured: ISELA MURO Owner: ISELA MURO Address: 529 MARINA ROAD,BAY POINT,CA 94565- Telephone: Work Phone: (925)609-8282 Home Phone: (925)458-9707 Mitchell Service: 918120 Description: 2005 Honda Civic LX Vehicle Production Date: 11/04 .Body Style: 4D Sed Drive Train: 1.71-Inj 4 Cyl 4A FWD VIN: 2HGES16635H529450 License: 6MBA702 CA Mileage: 29,171 OEM/ALT: O Search Code: None Color: BLACK Options: AIR CONDITIONING,AUTOMATIC TRANSMISSION,FRONT WHEEL DRIVE,L-4 ENGINE,4-DOOR Line Entry Labor Line Item Part Type/ Dollar . Labor Item Number Type Operation Description Part Number Amount Units 1 800816 BDY REMOVE/INSTALL L W/SHIELD PILLAR FINISH MLDG Existing 0.3' 2 801030 REF BLEND L ROCKER PANEL C 0.8 3 900500 MCH' ADUL LABOR OP WHEEL ALIGNMENT--4 WHEELS Sublet 90.00' 0.0' S1 4 900500 BDY' ADUL LABOR OP MOUNT&BALANCE TIRE Sublet 18.75' 0.0' S1 5 900500 MCH' REMOVE/REPLACE TIRE New 131.24' INC' 6 Bridgestone Potenza 7 804782 REF BLEND L ROOF RAIL C 0.6 8 801329 REF BLEND L FRT DOOR OUTSIDE C 0.8 9 801351 BDY REMOVE/INSTALL L FRT BELT MOULDING 0.6 # 10 801353 BDY REMOVE/INSTALL L FRT DOOR MOULDING 0.3 # 11 801355 BDY REMOVE/INSTALL L FRT DOOR POWER MIRROR INC 12 801429 BDY REMOVE/INSTALL L FRT DOOR TRIM PANEL INC This estimate has been re-calculated with a modified profile. ESTIMATE RECALL NUMBER: 01/09/2008 14:15:35 070033007188-3800102 . UltraMate is a Trademark of Mitchell International Mitchell Data Version: DEC_07_A Copyright(C)1994-2005 Mitchell International Page 1 of 3 UltraMate Version: 6.0.028 All Rights Reserved i i i Date: 1125/2008 05:02 PM Estimate ID: 070033007188-3800102 Estimate Version: 1 Supplement: 1(F) 1/26/2008 05:00:36 PM Profile ID: CUSTOMIZED 13 801497 BDY REMOVE/INSTALL L FRT DOOR HANDLE 0.7 # 14 900500 BDY. ADD'L LABOR OP HAZARDOUS WASTE Sublet 3.00' 0.0' 15 900500 FRM' REPAIR SET UP&MEASURE CONTROL POINTS Existing 1.0' 16 802826 BDY REMOVE/REPLACE L REAR DOOR'SHELL 67550-S5D-A92ZZ 527.97 3.3 17 AUTO REF REFINISH L REAR DOOR OUTSIDE - C 2.0 18 AUTO REF REFINISH L REAR ADD FOR JAMBS&INTERIOR C 1.0 19 801769 REF REFINISH L REAR OTR HANDLE C 0.5 20 801922 BDY REMOVE/INSTALL L ROOF SIDE MOULDING 0.3 21 801924 BDY REMOVE/INSTALL L ROOF DRIP MOULDING 0.5 S1 22 802026 BDY REMOVE/REPLACE UPR BACK WINDOW MOULDING 73251-S5A-003 8.60 S1 23 802027 BDY REMOVE/REPLACE LWR BACK WINDOW MOULDING 73253-S5A-003 11.07 S1 24 900500 BDY" REMOVE/REPLACE URETHANE KIT New 25.00' INC' S1 25 900500 MCH' ADD'L LABOR OP TIRE DISPOSAL FEE Sublet 5.75' INC' S1 26 802028 BDY REMOVE/REPLACE R BACK WINDOW MOULDING 73252-SSA-003 7.55 S1 27 802029 BDY REMOVE/REPLACE L BACK WINDOW MOULDING 73257-S5A-003 7.55 28 802053 BDY REMOVE/REPLACE ADD TO R81 BACK GLASS 0.3 29 803662 BDY REMOVE/REPLACE L QUARTER OUTER PANEL 04646-S5D-A91ZZ 466.32 13.6 # 30 AUTO REF REFINISH L QUARTER PANEL OUTSIDE C 1.6 31 AUTO REF REFINISH L QUARTER PANEL EDGE C 0.5 32 AUTO REF REFINISH L ADD FOR PILLAR C 0.5 33 803570 BDY REPAIR L QUARTER INNER PANEL S Existing 2.0' 34 outer wheelhouse 36 802383 BDY REMOVE/INSTALL L REAR COMBINATION LAMP INC # 36 802425 BDY REMOVE/INSTALL REAR BUMPER ASSY INC 37 933036 BDY' ADD'L OPR SHEETMETAL PULL 1.0' 38 left rear wheel well 39 AUTO REF ADD'L OPR CLEAR COAT 2.4 40 933003 BDY' ADD'L OPR TINT COLOR 0.5- 41 933005 BDY ADD'L OPR RESTORE CORROSION PROTECTION 10.00' 0.3' 42 933017 BDY' ADD'L OPR FINISH SAND&BUFF 0.00• 1.0' 43 933018 BDY' ADD'L OPR MASK FOR OVERSPRAY 5.00' 0.3• 44 AUTO ADD'L COST PAINT/MATERIALS 342.40' i " -Judgment Item #-Labor Note Applies C -Included in Clear Coat Calc Prior Damage TRUNK i i Add'I Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals It. Part Replacement Summary Amount Body 24.9 75.00 15.00 21.75 1,904.25 Taxable Parts 1,185.30 Refinish 10.7 75.00 0.00 0.00 802.50 Sales Tax @ 8.250% 97.79 Frame 1.0 75.00 0.00 0.00 75.00 Mechanical 0.0 75.00 0.00 '95.75 95.75 Total Replacement Parts Amount 1,283.09 Non-Taxable Labor 2,877.50 Labor Summary 36.6 2,877.50 i This estimate has been re-calculated with a modified profile. I ESTIMATE RECALL NUMBER: 01/09/2008 14:15:35 070033007188-3800102 UltraMate is a Trademark of Mitchell International Mitchell Data Version: DEC 07_A Copyright'(C)1994-2005 Mitchell International Page 2 of 3 UltraMate Version: 6.0.028 All Rights Reserved i i I I • 1 i i r I Date: 1/25/2008 05:02 PM Estimate ID: 070033007188-3800102 Estimate Version: 1 Supplement: 1(F) 112512008 05:00:36 PM Profile ID: CUSTOMIZED I III. Additional Costs Amount IV. Adjustments Amount Taxable Costs 342.40 Insurance Deductible 500.00- Sales Tax @ 8.250% 28.25 Total Additional Costs 370.65 Customer Responsibility 500.00- i i I. Total Labor: 2,877.50 II. Total Replacement Parts: 1,283.09 1 III. Total Additional Costs: 370.65 Gross Total: 4,531.24 I I _ IV. Total Adjustments: 500.00- Net Total: 4,031.24 Less Original Net Total: 3,911.98 Net Supplement Amount: 119.26 1 S1: David Medeiros 25414 119.26 I I Point(s)of Impact 8 Left Rear Side(P) I Insurance Co: Mercury Insurance Company Inspection Site: MIKE'S AUTO BODY/PITTSBURG Address: 3001 N PARK BLVD PITTSBURG,CA Inspection Date: 1/9/2008 I Body Shop: MIKE'S AUTO BODY/PITTSBURG Address: 3001 N PARK BLVD PITTSBURG,CA 94565 Work Phone: (925)432-9910 1 i THIS IS NOT AN AUTHORIZATION TO REPAIR. THE UNDERSIGNED REPAIR FACILITY AGREES TO REPAIR THISIVEHICLE USING INDUSTRY ACCEPTED EQUIPMENT AND METHODS, AND TO COMPLETE AND GUARANTEE SAFE REPAIRS AT A PRICE OF $ , 'INCLUDING ALL CHARGES. NO SUPPLEMENTS WILL BE HONORED WITHOUT PRIOR APPROVAL. I SIGNED: I I i I I I I I I i I This estimate has been re-calculated with a modified profile. ESTIMATE RECALL NUMBER: 01/09/2008 14:15:35 070033007188-3800102 UltraMate is a Trademark of Mitchell International Mitchell Data Version: DEC_07_A Copyright(C)1994-2005 Mitchell International Page 3 of 3 UltraMate Version: 6.0.028 i All Rights Reserved i I I I I Date: 1/25/2008 05:02 PM Estimate ID: 070033007188-3800102 Estimate Version: 1 Supplement: 1(F) 1/25/2008 05:00:36 PM Profile ID: CUSTOMIZED I I Mercury Insurance Group 11150 International Dr.Suite 100,Rancho Cordova,CA 95670 (916)636-1534 I Supplement Delta Report Comparison of Estimate 070033007188-3800102 Supplement 0 and Supplement 1 Damage Assessed By: David Medeiros 25414 Supplemented By: David Medeiros 25414 I Insured: ISELA MURO Owner: ISELA MURO Vehicle Description: 2005 Honda Civic LX Date of Loss: 10/24/2007 I I Line Labor Line Item Dollar Labor CEG Item Type Operation Description Amount Units Unit Changed Entries 4 BOY ADD'L LABOR OP MOUNT&BALANCE TIRE Sublet 20.00 ' 0.0' S1 4 BOY ADD'L LABOR OP MOUNT&BALANCE TIRE Sublet 18.75 '< 0.0' 5 MCH REMOVE/REPLACE TIRE New 85.00 ' INC' T S1 5 MCH REMOVE/REPLACE TIRE New 131.24'< INC' T Added Entries S1 22 BOY REMOVE/REPLACE -UPR BACK WINDOW MOULDING New 8.60 0.0 T S1 23 BOY REMOVE/REPLACE LWR BACK WINDOW MOULDING New 11.07 0.0 T S1 24 BOY REMOVE/REPLACE URETHANE KIT I New 25.00 ' INC` T S1 25 MCH ADD'L LABOR OP TIRE DISPOSAL FEE Sublet 5.75' INC* S1 26 BOY REMOVE/REPLACE R BACK WINDOWIMOULDING New 7.55 0.0 T S1 27 BOY REMOVE/REPLACE L BACK WINDOW MOULDING New 7.55 0.0 T I Global Changes No Deductible,Customer Responsibility,Labor Rate,or Part Adjustment changes were made. I Estimate profile calculation settings(other than labor rates and adjustments)have changed. I I Amount Original Estimate: 3,911.98 Supplement 1 119.26 I Orig Total Tax 117.29 Supp 1 Total Tax 126.04 Net Supplement Amount 119.26 Net Total 4,031.24 I , Program Calc Versions Data Versions Supp 0 6.0.028 DEC_07_A Supp 1 6.0.028 DEC_07_A I I I I ESTIMATE RECALL NUMBER: 1/9/2008 14:15:35 070033007188800102 UltraMate is a Trademark of Mitchell International UltraMate Version: 6.0.028 Copyright(C)1994-2005 Mitchell International Page 1 of 1 i All Rights Reserved I I I I I I 1 i 1 1 ��••'' :<. 7S i�'.-.r t'.•;:.k: ';,T:.h" 'i"�Ij.':;�,.:.N'y;:�'r'.rJ........�li'i::.iJ�.f:' . A+.3y'�bi'.r' S^'�.Ua t-"1• +Yp+i..,.i:'C:•r.:Z::i.' .:„.f,� ��i... t 'rM1:.Rf-4�'��•�(:;' w,. 3} �`{.'y% '4,� ''�s�`'rf?�"';'"+''k•.�.`'}',;riti�r;?(;'•Njs..-ts...•,:-+'s' AQ, .fin. r-ryga �k,,ry:r,,,..:':.n .e.• ia.•^.,;'.. .. 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'" �` - rs N�,.� 's�•• '�"'a'�; f,°N ' III��• J' ,.:�.,. \ \loom ` \ S`e�epccess ne \ ppF�<eated by APO' - y,.—_-r. � 5r,,.•"•" •'". r rte.^.,`� �._.. ', �' .n1: `,ti .. _ � •� rte_... .�.r�; '•dam �`L{�. ,�,i ^ W. • f' �J 74�`T�J -'.' by;.Y ir. � •X. c t vdin 'it r sf dfdn% L'F • • �I ,t + pi+2t3 WVV 2007 0033 007188 - 38 Mercury Insurance :: NextGen Page 1 of 1 Inquiry CPARMFR MERCURY Loss Check Maintenance inCC�B�Ifr"y ox/21;zaoe Ncx';,r, 'M 1t:SJRA NC EGi70L!P - Close Inquiry I I �..aBilling W .' .:cEa'sFvas ° Underwriting . Support Support ` Claimants 1 Notes i Claims Lon 1 Adjust Claims I Reserves j Payments j Di.aiy I Bien- C,lai.rn . I I Claim Number 2007 0033 007188 -36 Adjuster 020302 Connie Parmer Policy Number AP05299172 Date of Loss 10/24/2007 08:00 AM Named Insured ISELA MURO Claim Status Regular Open Loss Check Issued Maintenance-_-__ i _._--------------.—___--- ---.___— Payee Type Reportable Check Number 460444905 1 Control Code Vendor Code 62526034 � I 1 Payee MIKE'S AUTO BODY/PITTSBURG I Additional Payee AND ISELA MURO ! Address 3001 N PARK BLVD,PITTSBURG,CA 94565 Issued By 020302 Connie Farmer Issue Date 01/17/2008 I � Honored Date 01/30/2008 I Coverage Amount 1 Type Adjuster Code Total Loss I ' COLL 3,911.98 1 Final 025414 N I � 1 Check Amount 3,911.98 In Full Settlement Of CN Claims 1 Backup Withholding 00.00 To Be Authorized By Teresa Tobin j I I Net Check Payee 3,911.98 Authorized By Teresa Tobin ! I I Claimant/Reference ISELA MURO Authorized Date 01/18/2008 i I Comment LV 2005 HONDA CIVIC LX I I I I i i i I I I I https://nextgen.mercuryinsurance.com/NextGenInquiryWeb/cheekListInquiryAction.do 2/21/2008 20.107 0033 007188 - 38 Mercury Insurance :: NextGen Page 1 of I MERCURY1� Nr.JRA tic F. GZOUP _C..LOS4_i'n uiry Billing. , :.+- .'Z.' : .._ Underwriting Support � ._icllni Alli;::'! !.I', . Nev,,i..l[':i`:.i] Claim Number 2007 0033 007188 -38 Adjuster 020302 Connie Parmer Policy Number AP05299172 Date of Loss 10/24/2007 08:00 AM Named Insured ISELA MURO Claim Status Regular Open Payee Type Reportable Check Number 460479848 Control Code Vendor Code 62526034 Payee MIKE'S AUTO BODY/PITTSBURG Additional Payee Address 3001 N PARK BLVD,PITTSBURG,CA 94565 Issued By 020302 Connie Parmer Issue Date 02/02/2008 Honored Date 02/08/2008 Coverage Amount Type Adjuster Code Total Loss COLL 119.26 Additional 025414 N Check Amount 119.26 In Full Settlement Of CN Claims Backup Withholding 00.00 To Be Authorized By Teresa Tobin Net Check Payee 119.26 Authorized By Teresa Tobin Claimant/Reference ISELA MURO Authorized Date 02/05/2008 Comment SUPPLEMENT LV 2005 HONDA CIVIC .. ............ ---......._.... ...... . ......................................_... ............. .. ....................................... .. ....................... . Exit .--._._.-...__.._......_..._...... https://nextgen-mercuryinsurance.coin/NextGenlnquiryWeb/checkListInquiryAction.do 2/21/2008 I I FARM E R S National DO Bou.Cenl 2 Oklahoma City,OK 73120-8992 clauusdocumentsCi farmersinstirailce.coLn Fax : 877-317-1389 I I 03/17/2008 Self Insured Attn: Penny Bailey 651 Pine.St, Room .106 APR 1 6 2008 Martinez,CA 94553 _ CLERK BOARD OF SUPERVISORS Re: Our Insured: Shin Hyang Chung CONTRA COST:%CO. Our Claim#: 099 MD 10112172.12-1-1 Date of lass: I]/30/2007 Your Insured: Contin.Costa County Your Clado#f: 64U66 Amount Owed: $'.2,25.0[) I Dear Painy Bailey: Be advised that due to this accide ni, we have made supe Lmental payments for rental in the amount of 225.M. 'This.-Aditional Iclaim payment has increased the total amount owed to $225.00. I Our support for the additional amount is attached. I I Sincerely, 4id Century Insurance Company I e I I Jennifer Miller Auto Subrogation.Representative 909-801-:1341 � I i I I I � � "dUig QS2WS5GZ i I I I i i i i FAR E R 5 National Docume„i.C�enler RO. Brrx 268992 Oklahoma City,OK 73126-8992 clainisdocumentst<t>farmersinsursuice.com Fax : 877-217-1389 i 03/17/2008 Payment Log Account Number: BB3269503 Date of Loss : 11/30/2007 Insured Shin Hyang Chung Claim Number 099 MD 1011217212-1-1 Loss Type Material Damage Proc-f of. Payment i Date 1 /11/200' 2ayee: SHTN HYANG C UN:, 010 QU-7E,T T Y BODY S FENDER 2.510 MAH"IN LUTHER "KING WAY j)AK7AND, CA, 94612 Paymenr Uescrirtior:: 1'aterial Darrlace PayrrlEn� $1,350.::0 Date 12/1.1./2007 Payee: SHITS HYANG L:UNG C/O QT;A ,I_v BOJ Y Y FE--AMEWR 2510 MA-?IN L THEIR :KING WAY OlLaIAND, CA, 54612 ?aymenZ Description: Material. Damage Paymer. !1$1, 35C.20 Date 12/11/2007 Payee: SHIN HYANI CzvNG C/O CHO.CE AUTOBOD`.' 1 5565 CENTRAL AVE � NEWARK, CA, 99550 �. Payment Description: Material Damage �....- Pay ner._ $=, 350.20 Jath 12/20/2307 Payee: SHIN HYr,NG CHDNG 251 28T-9 :1" APT 706 0AKLAND, CA, 34611 Payment Deccr pt_cn.- Cao I_1-s_or_ P'Lus -2aymert $225.00 H20S5GZ Q ub To-,.al: $1,,5?5.20 Deductible Amount: $0.00 i I Salvage ,$0.00 Total Amount: $1, 575 .20 QH2OS5GZ CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section reference's 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: '�(;,Uc ;CXR; '�'0' Section 913 and 915.4. Please note all "Warnings". CLAIMANT: '3L,HiQS0 ATTORNEY: ,�rcr►9�Q EXW-N12�ga `�� DATE RECEIVED: /� SU9it,�i7E:+2 Y up ADDRESS: 6610 BY DELIVERY TO CLERK ON: �0 ��Sc► ("r� �5112- 1? BY MAIL POSTMARKED: 2— �� FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN Clerk Dated: 060- Ct By: Deputy �E-1 r"c�z ��(ElSyrl iI. 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 sulistantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk, should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). O Other: Dated: By: Deputy County Counsel ill. FROM:: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD 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: Oq Lot iO JOHN CULLEN, CLERK, Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) months froin the date this notice was personally served or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this matter. [f'you want to consult an attorney,you should do so immediately. *For Additional War•rnirg,See Reverse Side of This Notice. AFFIDAVIT OF MAILING .I declare under penalty of perjury that I, ani now, and at all times herein mentioned, have been a citizen of the United States, overage 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully 1) id a cer•titled copy of this Hoard Order and Notice to Claimant, addressed to the clan an.t a shown above. Dated: JOHN CULLEN, CLERK y Deputy Clerk BOARD OF S MMVMRS of CoNnu cosTA couN T'Y IN8 UCTIo1,,,,i�18,T_OG'�A& I A. A claim relating to a cause of action-for death or for injm-y to person or to personal property or growmg crops shall be prw ated� not low time six months aft the wA nW of the came of action A claire re o*g to any otlmr cause of action shall be presented not 11lw tlzm one year aft the Aran, of the cause of notion. (GOV. Cade 1911.2.) B. Claims rnust be fled with the Clerk of the Board of Supervisors at its office in Room 106, County AdwWsiradon Building,651 Pine Street,Martinez,CA 44353. I C. If claim is againg a district governed by the Board of Supervisors, rather than the County, the name of the District should be filed ia. D. If the claim is against more than one public entity, separate claims must be filed against each pablie entity. E. r d. See penalty for fraudulent clums,.Penal Code Sec. 72 at the and of this fa m. I pan 8 soon a sense ease monsoon wNsworbs gongs@ was soffievem&sees Osage wesseswe somas ownew as RE: Gahm Br Reserved for Clerk's filing stamp Mark Johnson; Mamie Johnson; Jordan Johnson; William Johnson; Julia Johnson,' Ra-chelJohnson; Michael -RECEIVED Johnson Agdwt the County of Comma Costa or I ) . FEB 2 5 2008 I7iSt�7'Ct) CLERK BOARD OF SUPERVISORS (Fill in the mama) CONTRA COSTA CO. I � I The undersigned claimant berebY makes claire agsiumSK the County of Contra Costa or the above-named district is the sam of S 20,000,-000.o%nd M support of this claim ropresen as foAows. I 1. When did the damage or injury ocanr? (Give exact date ad hour) First learned on or about September 25, 2007. 2. Where did the damage or injury occu r9 (Ilncluds city ad county) Walnut Creek, Contra Costa I I I How did the damage or injury occur? (Give NO details;use extra paper if required) See attached Exhibit A. 4. What pardcWw act or omission on the part of county or district officers, servants, or employees am=M the k&ry or damage? The Department of Children andl Family Services did not disclose child's pre-adoption abuse. See attached Exhibit A. 5 What are the names of county or district officers, servants,or employees causing the damaor inj ge ury? Reynalda Ganding on information and belief. I 6. Who damage or. injuries do your chalm resulted? (Give full ment of injuries or damages claimed. Attach two estimates for auto damage.) See attached Exhibit A. 7. How was the amount claimed above computed? (Include the estimated amount of any prospeedve lnjm'y or damage.) See attached Exhibit A. B. Names and addresses of witnesses,da Ichors,and hospitals: James Wakeman, Ph.D. , 519 17th Avenue, #210, Oakland, California, 94612. 9, Lint t�ditures you made �of this accident ortgjt i y: 9■ar9■■a5s■999/9.■■■resees■e1108■■89100■906900■■rose ara981988■■aas■.s■s0■■■■n5a■s8a88oi Gov.ICode Sec. 910.2 provides"The claim shall be. silted by tie claimant or by some person an his behalf:" NO,�'tCES TQ;�Atf�lney 1 Mark o n on ehalf of all claimants Nam and address of Attorney ) Richard `Alexander, Esq. Alexander Hawes, LLP ) (C A ipature) 152 N. Third St. , 4600 ) 24.73 Encinal Drive San Jose, CA 95112 (Address) Walnut Creek, CA 94597 I TelephaneNo. 408.289. 1776 )Teleph=No. 925.256.4100 0 0611060169 58r■5ses.9rmoves asspend■$ PUBLIC RiCORDS NOTICE: Please be advised that this claim farm,or nay claim filed witb the County under the Tort Claims Act, is subjectto public disclosune under the Caff Baia Public Room* Act. (Gov. Code, S§ 6500-et seq.) Furthermore, any art abs mtk addanduma.or supplemaw attached to the claim form,including medical records,arc also subject to public disclosure. I I ■■■1111.91190■■5998■r■■r9a■0.9■99■■■aasa95s■■■9s99rson 8sr■■r■■r.rs■■■r■r■r■■■ae11a■■s9■■f • I NOTICE: Seetlou 72 of the Pedal Code provides: Every pems who,with Wow to defraud,presorb for at wmwee or for psymwt to any state board or officer,or to any counW, city, or dimia board or officer. suiwWd to allow or pay the same if genuine, any Use or hudulaW claim,bill,amount vouches,or writing, Is punishable anther by imprisonment in the County jau far a period of not mane dun one year, by a flu of not a Wesftg one thousand dollars (51,000.00). or by both sucb imprisottowt sed foie, or by imprbmunoat in the stn prison, by a fine of not exceeding ten tbousand dollar/ ($10,0001 or by bolt such imprisonment sad fine. I I I Richard Alexander Jeffrey Rickard Jason Baker Alexander Hawes, LLP 152 North Third Street San Jose,CA 95112 408.289.1776 Attorneys for Claimants EXHIBIT A TO CONTRA COSTA COUNTY CLAIM FORM CLAIM FOR FRAUD, MISREPRESENTATION AND VIOLATION OF STATUTORY DUTIES TO: Clerk, Contra Costa County Board of Supervisors County Administrative Building,Room 106 651 Pine Street Martinez, CA 94553 On or about September 25, 2007 Claimants first discovered that Contra Costa County in the adoption of Samuel Jordan Johnson 1"Jordan"J, as explained below, concealed critical information and knowledge, which as a matter of law, should have been provided to Mamie and Mark Johnson as adopting parents at the time of placement in 2001 and'before Jordan's adoption in 2002. Pursuant to Government Code Section 910,claimants, by and through their attorneys Alexander Hawes, LLP,present this Claim for fraud and personal.injuries. Name and Postal Address of Claimants. Mamie and Mark Johnson, individually and as the parents of the individual minors: Samuel Jordan Johnson,a minor, William Johnson, a minor,Julia Johnson, a minor, Rachel Johnson, a minor and Michael Johnson,a minor. All reside at 2473 Encinal Drive, Walnut Creek,CA 94597 Postal address to which notices are to be sent. Richard Alexander Jeffrey Rickard Alexander Hawes, LLP 152 North Third Street San Jose,CA 95112 408.289.1776 Date and Circumstances of Occurrence The misconduct of Contra Costa County adoption officials was first discovered by these Claimants on or about September 25,2007. Claimants Mamie (born April 25, 19571 and Mark Johnson [born July 25, 19591 were married in San Francisco January 9, 1993. There are no natural children of this marriage. The couple has adopted five minor children. All are claimants: Jordan, William,Julia,Rachel and Michael. Claimant,Jordan Johnson,a minor, [August 29,20001 was adopted in 2002 through the Contra Costa County Department of Children and Family Services pursuant to an order of the Contra Costa County Superior Court. Claimant,William Johnson,a minor, [born February 13, 19981 was adopted through the Contra Costa County Department of Children and Family Services pursuant to an order of the Contra Costa County Superior Court. Claimant,Julia Johnson,a minor, Iborn June 19, 19981, was adopted was adopted through the City and County of San Francisco Department of Social Services pursuant to an order of the Superior Court for the City and County of San Francisco. Claimant, Rachel Johnson,a minor, [born October 16, 1999 , was-adopted was through the City and County of San Francisco Department of Social Services pursuant to an order of the Superior Court for the City and County of San Francisco. Claimant, Michael Johnson,a minor, [born June 19,2003],was adopted was adopted through the City and County of San Francisco Department of Social Services pursuant to an order of the Superior Court for the City and County of San Francisco. On or about July 2001,Jordan,age 11 months and a ward of the Contra Costa County Superior Court, was placed for emergency services by the Contra Costa County Department of Children and Family Services with Mamie and Mark Johnson at their home in Walnut Creek, CA. Previously Jordan reportedly had been in foster care in Richmond,CA. At all relevant times since January 1, 1996,California Family Law Section 8817 provides as follows: (a) A written report on the child's medical background,and if available,the medical background of the child's biological parents, so far as ascertainable, shall be made by the department or delegated county adoption agency as part of the study required by Section 8806. (b) The report on the child's background shall contain all known diagnostic information,including current medial reports on the child, psychological evaluations and scholastic information,as well as all known information regarding the child's developmental history and family life. As part of the Adoptive Placement Agreement of May 15,2002 between Mamie and Mark Johnson and Contra Costa County Adoptions, Mr. and Mrs. Johnson were provided with documents by Contra Costa County Department of Health and Human Services. These documents disclose in pertinent part that"Jordan was placed on police hold when the birth mother and Jordan tested positive for drugs upon the baby's birth." Jordan "tested positive for cocaine at birth and hence, was placed in police custody." In addition in February 2000,before Jordan's birth,the birth mother was reported to have physically abused two of her children; the birth mother was reported as being homeless, having outstanding warrants for drugs,prostitution and stealing, plus two prostitution convictions in 1988 and 1997. The disclosure also reports the birth mother was involved in domestic violence, but is silent whether she was a victim or a perpetrator. .Based on these disclosures, in full reliance that Contra Costa County was in full compliance with California Family Law Code and had made a full and complete disclosure of Jordan's background as required by law, Mamie and Mark Johnson opened their family,their home and their hearts to Jordan in July,2001. Claimants are informed and believe that Contra Costa County concealed critical, relevant and important facts concerning the background of Jordan in violation of Section 8817. On or about September 25,2007,claimants Mark and Mamie Johnson were advised by Dr.James Wakeman,following a detailed examination and testing of Jordan, age 7,that Jordan's behavioral history of setting fires, stealing from family members, sexually abusing a classmate and a child of a family friend, attempted sexual abuse of an older sibling,killing fish in the family aquarium, hoarding of food,urinating into bowls placed on shelves as traps, urinating onto mattresses, removing his clothes at school and other public places,destruction of furniture,involvement in repeated acts of violence and aggression against other children,and physically and emotionally abusing his siblings was due to abuse, neglect,deprivation and failure to bond,among other destructive and intrusive factors, which occurred at the hands of early caretakers before Jordan was adopted by Mark and Mamie Johnson. Dr. Wakeman has diagnosed Jordan as suffering from reactive attachment disorder (disinhibited type),enuresis and child or adolescent antisocial behavior. In an attempt to understand the full nature and extent of the abuse that Jordan suffered before his adoption, Dr. Wakeman asked the Contra Costa County Department of Children and Family Services to provide any and all information concerning Jordan's pre-adoption life, namely all critical information envisioned by Family Law Section 8817, namely all known information regarding the child's developmental history and family life. Contra Costa County Department of Children and Family Services refused to provide any relevant information concerning the birth mother or family members who cared for Jordan before he was delivered to the Johnsons in 2001. Based on Jordan's history,claimants are informed and believe that before Jordan was placed with the Johnson Family he was caused to suffer and endure severe abuse, neglect,failure to bond and other destructive factors and that such facts are At no time after placement or before the final adoption,order of June 18, 2002 did Contra Costa County make a full and complete disclosure of Jordan's background as required by law and that misconduct continues to present. i i i Damage Suffered. In addition to causing Mr. and Mrs.Johnson to suffer severe mental and emotional distress, by going forward with an adoption they otherwise would have refused,the Mr. and Mrs.Johnson have suffered the total and complete disruption of their personal home,family and family life; the acts and omissions of Contra Costa County have impacted claimants' relationships with each other and their minor children,William, Julia, Rachel and Michael by reason of the emotional distress and abuse inflicted on each them by the acts and omissions of the County; in addition Mr. and Mrs.Johnson have had imposed on them the financial cost of providing medical, psychiatric and additional care for each of their minor children.i i As a further direct and legal cause of the concealment of information required by law to be provided to Mr.and Mrs.Johnson,claimants,and each of them,have been caused to suffer severe emotional distress. Under no circumstances should a child with Jordan's profound psychological disabilities and needs have been denied full and appropriate care by placement in an adoptive home that was unaware of the need for major psychiatric medical treatment for this child. Failing to provide timely care has caused him additional and permanent damage. As a direct result of the concealment by the County of Contra Costa of the true and complete extent of Jordan's family's medical background [psychological evaluations, developmental history and history of abuse,Jordan has been denied aggressive psychiatric intervention necessary for appropriate diagnosis,care and treatment. i The concealment of this necessary family background and psychological information from Mr. and Mrs.Johnson has denied, precluded and prevented Jordan from obtaining appropriate psychiatric'placement and therapy causing Jordan's condition to further deteriorate. On information and belief Jordan's condition, having been untreated for this period of time, is on the verge of becoming permanent unless Jordan immediately begins to receive 2417 supervision and care in a licensed residential treatment facility dedicated to providing services for seven year olds suffering from reactive attachment disorder. Mr. and Mrs. Johnson have been quoted charges of$15,000 a month for such care. i In addition to the damages'inflicted on Jordan,the Johnson's children William, Julia, Rachel and Michael all have suffered physical abuse and emotional distress inflicted on them by Jordan. i i i i Mamie and Mark Johnson have suffered emotional distress at the disruption inflicted on their family and adopted children and in addition the financial expense of providing long-term residential)care for Jordan,therapy for their family and counseling for William,Julia, Rachel and Michael. Amount of Claims. Because of the extensive damages suffered and the serious injuries inflicted on all seven individual claimants,thelamount of all claims cannot be fully stated at this time. The actual amount of the general damages for pain and suffering suffered by claimants alone is well in excess of the jurisdictional minimum of the Superior Court and shall be determined by the jury at trial. In addition Jordan and his parents have suffered devastating economic damages, the need for future psychiatric care,treatment in a residential facility,lost wages for life and the cost of permanent lifetime psychiatric hospitalization. Jordan will require lifetime mental hospitalization and supervision at an average cost of$15,000 a month I present dollars] for life,lifetime medications at a cost of $12,000 per year,and medical/advocate supervision at a cost of$10,000 a year for life. The total cost of life care for Jordan, without consideration for inflation for medical services, is approximately $16,000,000 in current dollars. In addition,Jordan will never be gainfully employed and has1suffered a lifetime of lost earnings,reasonably estimated to be in excess of$1,800,000 )estimated lifetime wages for high school graduate). Respectfully submitted, Dated: February 22,2008 I Alexander Hawes, LLP By Richard Alexander Alexander Hawes, LILIP M a j o r I n j u r y T r i a l A t t o r n e y s R E C E.I V E D 152 NORTH THIRD STREET,SUITE 600 SAN JOSE,CALIFORNIA 95112-7711 FEB 2 5 2008 TELEPHONE:408.289.1776 FACSIMILE:408.2 87.1776 CLERK BOARD OF SUPERVISORS www.alexanderinjury.com CONTRA COSTA CO. February 22, 2008 Clerk of the Board of Supervisors County Administration Building 651 Pine Street, Room 106 Martinez, CA 94553 re: Johnson v. County of Contra Costa Dear Clerk, Enclosed please find original and one Claim against the County of Contra Costa. Please stamp the copy"Received"and return in the enclosed postage prepaid return envelope. Cordially, Richard Alexander RA:am Enclosures I I CLAIM BOARD OF.SUPERVISORS OF CONTRA COSTA COUNTY I BOA RD ACTION: 1'it I 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 Section 913 and 915.4. Please note all AMOUNT: "Warnings". CLAIMANT: ka,1)lCn I ATTORNEY: �C`,Ull�'.Ia b-1-t'C.ji,��ZG(,ULCL DATE RECEIVED: ����.C(.i'L--') �� J ADDRESS: .i .`GI"11 IU'�;.�����r�, vU'E` t, 1 �BY DELIVERY TO CLERK ON: .i llLi ' I 66WL'L1t(t_ 0/1 BY MAIL POSTMARKED: �C'1 CC � FROM: Clerk o.f the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. l _ �, JOHN CUL �E Clerk Dated: t,(C7L9�1 �, y� "�� By: Deputy: itt ),- L�(.( 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). I ( ) 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: I i I Dated: By: Deputy County Counsel I Ili. 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 I - I ceitify that this is a true and correct copy of the'Board's Order entered in its minutes for this date. Dated: JOHN CQ, LLEN, CLERK, By, ty Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) months from the dto this notice was personally sewed . I 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 ehoice In connection with this matter. If you want to consult an attoniey,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 Nlartinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimai as hown above. Dated: JOIN CULLEN, CLERK y eputy Clerk I I I G Gargalicana / Graceffa LLP ATTORNEYS AT LAW RECEIVED i f�{9 `l�lf i MAF' 0 1 ?008 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. , February 25, 2008 VIA CERTIFIED MAIL & RETURN RECEIPT Clerk of the Board of Supervisors Contra Costa County 651 Pine Street, Room 106 Martinez, CA 94553 Re: Claim Made by Raymoi►d Boisvert Dear Clerk: Our firm represents Raymond Boisvert. Enclosed please find Mr. Boisvert's claim made against the County and Doctor's Medical Center. Please direct any questions and response to the enclosed to my office. Thank you for your attention to this matter. Very truly yours. j/wa Gargalicana Enc. 11 Embarcadero West,Suite 145 Oakland,CA 94607 T 510.251.2000 F 510.251.2299 www.gandgllp.com 02�19i2008 15:38 CONTRA COSTA COUNTY CLERK OF THE 915102512299 NO.129 D01 BOARD OF SUPFR'VISORS 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. CIaims 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. j D. If the claim is against more than 6ne public entity, separate claims must be filed against each public entity. E. laud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. mass I RE: Claim By: Reserved for Clerk's filing stamp 9qqhvr7d SO i6 VQ-t ) RECEIVED Against the County of Contra Costa of- AM ) MAF? 0 1 2008 M4�Cak (-u L-A District) CLERK BOARD OF SUPERVISORS (Fill in the name) ) CONTRA COSTA CO. The undersigned claimant hereby makes claim. against the County of Contra Costa or the above-named district in the sum of S and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) C��f'o bPir- [�1 � 200 �xa•C,-Q- haus u►'1�/'ti17�{rl 2. Where did the damage or injury occur? (Include city and county) . Pab to , Ca,�.i f 7�'i'Lt et cosh 3. How did the damage or injury occur? (Give full details; use extra paper if required) N tA6,e, see n e n 4. ghat particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? I F l f,,9- 5e gee 5 What are the names of county or district officers, servants,or employees causing the damage or injury? 'R�S�'tPrA. �o�►'nAY� , `�:CtvJ m� .�b'i s V?,r`f's I I I "' • 02%:19/2008 15:38 CONTRA COSTA COUNTY CLERK OF THE 4 915102512299 NO.129 D02 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) 1►Jl -(u�2. ��, .�,mo-ti ar►a.P p(,co�',p,�,�, h4m,s,e4'04r"an , Jhr�O-Mrroht, 7. How was the amouiV clai-inea-above computed. (Include the estimated amount of any prospective injury or damage.) /ym ou * oCc�tXh� � 8. Names and addresses of witnesses, doctors,and hospitals: `Docbr se T'akal.ih)rYut L,awyi4�t�( v�eaa (��r7 j SkAroy, , 9. List the expenditures you made on account o this accident or injury: 0Xr" U DATE TIME AMOMT I � I I rrrrrrrrrrrrrrrrrrrr�rrrrr■rr■■2696/rrrrrr■rrrrrrrrrrrrrrrrrrrrrr■rrrrrrrrr■rrrrrrrrf 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: (Attorney) ) Name and address of Attorney ) gowm/_`Qa «TAJ i • ) (Claimant's Signature) fly" & - aim�— (Address) 67 r barca.�ro YVes-�- I Il ) I � ©A ) I ° ) 7'elep one o�S Ib)��—�'� )Telephone No. I rtopless rrrrrmums ONE Webb rrrreatrrr:r■■rrrrsees sea r■rrrrrrrrrrrrrrr■■rgasses rrrrrrrroI I P[JBLIC 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, §G 6500 et seq.) Furthermore, any attachments, addendums, or supplements attar,lied to dte claim form, including medical records,are also subject to public disclosure. I rrrrrrrrrrrrrrrrrrrrrrrrrrarrrrrrrsrrrrrrrrrrrrrrrrrrrrrrrrrrr■r■■rrrrrrrrrrrrrrr■r■e 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 imprisonmentlin the state prison, by a fine of not exceeding ten thousand dollars ($10,000), or by both such imprisonment and,fine. I I i - ' I Attachment to No. 3 and 4 Claimant: Raymond Boisvert I I I RAYMOND BOISVERT (hereinafter "BOISVERT") was and is, at all times herein mentioned, an individual residing in Contra Costa County, California. 2. Doctors Medical Center (hereinafter"DMC'') was and is, at all times herein mentioned, a I business organization, the form of which is presently unknown, with its principal place of business located in the city of San Pablo, Contra Costa County, California. 3. SHARON HOEY (hereinafter "HOEY") was and is, at all times herein mentioned, an individual residing in Contra Costa County, California. HOEY was employed with DMC in a supervisory capacity until on or about May 2007. During HOEY's employment with DMC, she served as BOISVERT's direct supervisor juntil she left her position in or about May 2007. 4. RESHEA HOLMAN (hereinafter "HOLMAN") was and is, at all times herein mentioned, an individual employed with DMC in a supervisory capacity. HOLMAN served as I BOISVERT'S direct supervisor from Ithe point HOEY left her position at DMC until BOISVERT's constructive termination id or about October 2007. 1 5. For over twenty (20) years, BOISVERT has worked as a registered nurse, traveling to I work at various hospitals across the United States. BOISVERT is highly trained and skilled, and has worked most of his career in the Intensive Care/Critical Care units of hospitals, which requires a high level of knowledge and training. BOISVERT has served in a management/supervisory capacity at several hospitals he has worked for. I 6. In or about January 2007, BOISVERT was hired as an employee of DMC, working as a nurse in the Intervention and Radiology Laboratory (hereinafter -1&R Lab"). In this position, BOISVERT usually worked 4-5 daytime shifts per week, with each shift lasting approximately 12 hours per shift. BOISVERT earned his hourly rate plus additional statutory overtime pay in his position as a nurse working in the I&R Lab. 7. BOISVERT is informed and believes, and thereon alleges that in or about January 2007, HOEY was also hired at DMC as the director of Cardiac Catherization and Endoscopy I I i I Attachment to No. 3 and 4 Claimant: Raymond Boisvert I I I I I Laboratory. In her position as director,1 HOEY also had a supervisory role over the nurses I working in the I&R Lab, including BOISVERT. I 8. In or about April 2007, HOEY discovered that BOISVERT had begun a romantic relationship with another nurse that worked at DMC. BOISVERT is informed and believes, and thereon alleges that HOEY became extremely jealous of BOISVERT's new romantic I relationship. 9. BOISVERT is informed and believes, and thereon alleges that in or about April 2007, HOEY began to willftilly and maliciously accuse BOISVERT of stealing narcotics from the I I&R Lab. HOEY made these accusations to various members of the DMC staff, including but i not limited to RESHEA HOLMAN. HOEY also accused BOISVERT of using the stolen I narcotics to "drug" HOEY. All of these accusations were asserted by HOEY at DMC, and were directed to those that served as a supelrvisor or authority to BOISVERT, including but not I limited to HOLMAN, and were made with malicious intent. . I 10. BOISVERT is informed and believes, and thereon alleges that after HOEY accused I BOISVERT of stealing narcotics from the I&R Lab, DMC launched an investigation into the inventory practices for narcotics contained in the I&R Lab, and found no discrepancies in the I inventory count. The investigation also 'concluded that no narcotics were stolen by BOISVERT I or any other nurses working in the I&R Lab. 11. Nevertheless, BOISVERT is informed and believes, and thereon alleges that on or about May 2, 2007, HOEY spoke with HOLMAN, and again accused BOISVERT of stealing I .narcotics from the I&R Lab. HOEY also accused BOISVERT of using the stolen narcotics to I drug HOEY, and that BOISVERT had physically attacked her. HOEY's false accusations I against BOISVERT were uttered with malicious intent. I I I I i . I Attachment to No. 3 and 4 Claimant: Raymond Boisvert 12. BOISVERT is informed and believes, and thereon alleges that on or about May 2007, HOEY was placed on administrative leave, and HOLMAN took over HOEY's duties, which included directly supervising the nurses in the I&R Lab. 13. In or about ,lune 2007, HOLMAN spoke with BOISVERT about continuing his employment at DMC. HOLMAN offered BOISVERT a position with the medical/surgical floor, which was a night shift position which paid less than BOISVERT'S current position with the I&R Lab. BOISVERT took the position. which he was overqualified for, because he wanted to continue working at DMC as it was close to his residence and provided retirement benefits. BOISVERT began working on the medical/surgical floor in or around June 2007. BOISVERT is informed and believes, and thereon alleges that HOLMAN demoted BOISVERT due to HOEY's false and malicious accusations against BOISVERT. 14. BOISVERT began working on the medical/surgical floor in or about June/July 2007, and typically worked 4-5 shifts per week on the medical/surgical floor, with each shift approximately 12 hours per shift. Immediately after he began working on the medical/surgical floor, BOISVERT noticed serious lapses in nurse supervision and patient care occurring on the floor. BOISVERT witnessed many nurses sleeping while they were supposed to be overseeing patients, and many nurses viewing Internet pornography while on duty at DMC. 15. Starting in or about July 2007, BOISVERT raised his concerns about the lapses in patient care and inappropriate conduct by other nurses to HOLMAN, his direct supervisor. HOLMAN did nothing to correct or eliminate these issues, and they continued to occur while BOISVERT worked on the medical/surgical floor. 16. Due to HOLMAN's apparent lack of concern for these serious issues, in or about August 2007 BOISVERT brought his concerns to Mary Dugbarty, DMC's human resources director, as well as Cathy White, the Chief Operating Officer for DMC. BOISVERT provided them with emails detailing the issues he witnessed on a nightly basis on the medical/surgical floor, such as APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD ACTION 4 of -109 Application to File Late Cla � •II� NOTICE TO APPLICANT Against the County, Routine copy of this document mailed to you is your Endorsements, and Board A! )MAR Q 3 ZOOS' ti ce of the action taken on your application by (All Section References are to ) the Board of Supervisors (Paragraph III, below), California Government Code.)CO*JNTY COUNSEL g iven pursuant to Government Code Sections 911.8 NEZ CALIF. and 915.4. Please note the "WARNING" below. I Claimant:.ArApn Nozr G rd Attorney: r\ �, �' �prtve {n�ar�t� �? q�5 Address: a� n o eY Amount: �� 2�5 ' By delivery to Clerk on: ►"ILr1 3, 2 I Date Received: 3-3—AE) By mail,postmarked on:! h/0 I. FROM: Clerk of the Board of Supervisors TO: . County Counsel Attached is a copy of the above noted Application to File Late Claim. OHN CULIEN' Clerk, B DATED:rnQ';1 DEPUTY lI. FROM: County Counsel T6: Clerk of thejBoard of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6) (� The Board should deny this Application to File Late Claim (Section 911.6). DATED: 61,6108" SILVANO B.MARCHESI, County Counsel, By: /reDEPUTY III. BOARD ORDER By unanimous vote of Supervlsors present (Check one only) " ( ) This Application is granted (Section 9:11.6). K This Application to File Late Claim is denied (Section-911.6). I certify that this a true and correct copy of the Board's Order entered in Its minutes for this date. DATE: O JOHN CU.LIEN, Clerk, By: D PUTY WARNING (Gov. Code §911. 4 If you wish to file a court action on this matter,you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such petition must be filed with the court within six(6) months from the date ,your ap0cation for leave to present.a late claim was denied. 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 lmmedlately. IV. FROM: Clerk of the Board TO: (1) County Counsel (2) County Administrator Attached are copies of the above Application. We notified the.applicant of the Board's action on this Application by mailing a cop),of this document, and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. DATED: 6 b JOHN CULLEN, Clerk,By: DEPUTY V. FROM: 1) County Counsel (2) County Administrator TO: lerk of the Board of Supervisors Received copies of this Application and Board Order. DATED: County Counsel,By: County Administrator, By: APPLICATION TO FILE LATE CLAIM APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD ACTION Application to File Late Claim ) NOTICE TO APPLICANT Against the County, Routing ) The copy of this document mailed to you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to ) the Board of Supervisors (Paragraph III,below), California Government Code.) ) given pursuant to Government Code Sections 911.8 and 915.4. Please note the "WARNING"below. Claimant: �'l lUYll1 t cy--ryw(..l SICTYIO'e+ t .J J Attorney: i-\ AV Address: ���� If1 U-Y- r �) LVe �'1`lClf i 1-i.e ��.li� Amount: i�� 1��' ' By delivery to Clerk on: ma, Ck I Date Received: By mail, postmarked on: I. FROM: Clerk of the Board of Supervisors TO: . County Counsel Attached is a copy of the above noted Application to File Late Claim. DATED:I}��I ii`1 3 () JOHN CULLEN, Clerk, By wuy-k) ltcL%�u��z DEPUTY 1I. FROM: County Counsel TO: Clerk of theiBoard'of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6) ( ) The Board should deny this Application to File Late Claim (Section 911.6). DATED: SILVANO B MARCHESI, County Counsel, By: DEPUTY III. BOARD ORDER By unanimous vote of Supervisors present (Check one only) " ( ) This Application Is granted (Section 911.6). ( ) This Application to File Late Claim is denied (Section-911.6). I certify that tills a true and correct;copy of the Board's Order entered in its minutes for tills date. DATE: JOHN CU.L•LEN',Clerk,By: DEPUTY WARNING (Gov. Code §911.8) If you wish to file a court action on this matter, you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4 (claims presentation requirement). See Government Code Section 946.6..Suchpetition must be filed with the court within six (6) months from the date your apv)cation for leave to present a late claim was denied. 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. IV. FROM: Clerk of the Board TO: (1) County Counsel (2) County Administrator Attached are copies of the above Application. We notified the applicant of the Board's action on this Application by malling a copy of this document, and a memo thereof has been filed and endorsed on the Board's copy of this Claim In accordance with Section 29703. DATED: JOHN CULLEN', Clerk,By: DEPUTY V. FROM: (1) County Counsel (2) County Administrator TO: Clerk of the Board of Supervisors. Received copies of this Application and Board Order. DATED: County Counsel, By: County Administrator, By: APPLICATION TO FILE LATE CLAIM REBUTTLE IN REGARDS TO CLAIM (61280) THIIS IS REGARDS TO THE COUNTY DECISION MADE ON FEBRUARY 12, 2008 This case went before a Judge in Pittsburg California on March 01, 2007 DOCKET: D 213022-7 07 CITATION: 57 178640 At The SUPERIOR COURT OF CALIFORNIA, COUNTY CONTRS COSTA SUPERIOR COURT, PITTSBURG 45 CIVIC AVENUE, PITTSBURG CALIFORNIA RE Ea (94565) FEB 1 9 2008 THE PEOPLE OF THE STATE OF CALIFORNIA CLERJ(BOARD OF SUPERVISORS CONTRA COSTA CO. VS. THE PEOPLE OF THE STATE OF CALIFORNIA RICHARD RAY CROFOOT 7000 HOLLAND TRACK#85 BRENTWOOD CALIFORNIA (94513) On March 012007 Richard Ray Crofoot;was Found not Guilty by the Residing Judge on that date for the violation Of making unsafe turn. Vehicle Code Section 22107. Due to this Judgement the Settlement for Damages to Mr. Anthony-Bemard:Signorelli Personal property should be settled. SUPERIOR COURT OF :CALIFORNIA, COUNTY OF CONTRA COSTA SUPERIOR COURT, PITTSBURG 45 CIVIC ;AVENUE, PITTSBURG, CA 94565 925-427-8170 WWW.CC-COURTS .ORG THE PEOPLE OF THE STATE OF CALIFORNIA, DATE : 03/01/07 VS. RICHARD RAY CROFOOT DOCKET: D 213022-7 01 7000 HOLAND TRACT #85 CITATION: 57 178640 BRENTWOOD, CA 94513 NOTICE OF RENDITION OF JUDGMENT TO THE ABOVE NAMED DEFENDANT: JUDGMENT HAS BEEN RENDERED IN THE ABOVE ENTITLED MATTER AS FOLLOWS; YOUR CASE WAS TAKEN UNDER SUBMISSION ON 03/01/07 YOU HAVE BEEN FOUND NOT GUILTY OF VIOLATING SECTION(S) CVC 22107 TRN'G MVMENTS/SIGNLS NO FURTHER ACTION IS; REQUIRED. �{r' R IaZ= L p _ _ 1 KEN TORRE CLERK OF THE COURT BY: C. PADILLA DEPUTY CLERK \ U FORM: NROJ/NG G\ / STATE.OF CALTFORNTA NARRATIVE/SUPPLEMENTAL PAGE 7 OF J/ DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 08/23/2006 0716 0700 22C7 06-22205 1 OPINIONS AND CONCLUSIONS 2 3 SUMMARY 4 5 V-1 was traveling westbound on Delta Road, just past Sellers Ave. V-2 was traveling behind V-1 6 westbound on Delta road. V-1 began to exit the roadway onto the shoulder in order to make a "u" 7 turn. V-2 continued westbound on Delta Road. V-1 reentered the roadway in front of V-2, turning 8 left in order to complete a "u" turn. P-2 applied the brakes of V-2 to avoid colliding with V-1. V-2 9 struck the left rear bumper and wheel well of V-1. Both vehicles stopped in the middle of Delta 10 Road. 11 12 AREA OF IMPACT (AOI): 13 14 The AOI, where the front end of V-2 struck the left rear of V-1, was approximately 8 feet 7 inches 15 south of the north fog line of Delta Road and 500 feet 9 inches west of the east prolongation of 16 Delta Road. Both vehicle: had been removed from the roadway prior to my arrival. The AOI was 17 determined by vehicle debris and statements.. i 18 19 CAUSE 20 21 P-1 (Crofoot) caused this collision by making an unsafe turn. This is a violation of Vehicle Code 22 Section 22107. The cause was: determined by statements of P-1 and P-2, Witness statements and 23 the damage to both vehicle;,. I 24 i 25= - 26 28 CONTROILEE DDCUMENT Office of tf - =herilf i ontrccosto +::o�ntr PREPARED BY LD NUMBER DATE REVIEWER'S NAME DATE DUSTIN L. BAUGHMAN =2C7 08/23/2006 . T 02/19/2008 at 11 : 51 AM Job Number: 84366 JESS ENTERPRISES License # :AM192339 Federal ID # : 680184158 Estimate is valid for 30 days 2225 C Freed Way Pittsburg, CA 94565 (925) 432;1094 Fax : (925) 432-4386 PRELIMINARY ESTIMATE Written By: Jim Alameda #AM192339 Adjuster: Insured: Jeff Gutierrez Claim # Owner: Jeff Gutierrez Policy # Address: 132 Farioaks way Deductible: Pittsburg Date of Loss: Cellular: (925) 642-1179 Type of Loss: Day: (925) 439-8234 Point of Impact: 7 . Left Rear Inspect JESS ENTERPRISES Business: (925) 432-1094 Location: 2225 C Freed Way Pittsburg, CA 94565 Insurance MERCURY INSURANCE GROUP Company: Days to Repair . 1990 VW CABRIOLET BOUTIQUE 4=1 . 8L-FI 2D CNVT Int: VIN: WVWCB5159LK009562 Lic: 5VWA051 Prod Date: Odometer: Rear Defogger Tinted Glass Body Side Moldings Dual Mirrors Metallic Paint Stone Guard Power Steering Power Brakes Power Windows ,. AM Radio FM Radio . Stereo. Cassette Search/Seek Driver Air Bag Leather Seats Bucket Seats Recline/Lounge Seats 5 Speed Transmission Aluminum/Alloy Wheels ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY' EXT. PRICE LABOR PAINT ---------------------------'---------------------------------------------------- 1 QUARTER PANEL 2 0 Repl LT Quartet panel 1 819. 81 11 . 0 . 2 . 8 3 Add for Stone Guard 0. 5 4# Repl Used back bumper complete 1 450 . 45 3 . 0 2 . 5 5# Blnd Tint to blend LT door 2 . 5 ------------------------------------------------------------------------------- Subtotals =_> 1270 .26 14 . 0 8 . 3 1 02/19/2008 at 11 : 51 AM Job Number: 84366 PRELIMINARY ESTIMATE 1990 VW CABRIOLET BOUTIQUE 4-1 . 8L-FI 2D CNVT Int: Parts 1270.26 Parts Markup $ 819 . 81 +20 . 0% 163 .96 Body Labor 14 . 0 hrs @ $ 75. 00/hr 1050.00 Paint Labor 8 . 3 hrs @ $ 75. 00/hr 622 .50 Paint Supplies 8 . 3 hrs @ $ 35. 00/hr 290. 50 ----------------------------------------------------- SUBTOTAL $ 3397 .22'. Sales Tax $ .1724 . 72 @ 8.25000 142 .29 ----------------------------------------.-----.------- GRAND TOTAL $ 3539. 51 ADJUSTMENTS: Deductible 0. 00 ------------------------------------------- -------- CUSTOMER PAY $ 0. 00, INSURANCE PAY $ 3539.51 Thank you for choosing Jess Enterprises for your auto body repairs . Customer Signature: 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. 2 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Xzolzvf 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 isD our notice of the action taken con oulaim U the Board of Y Y FEB 2 5 2008 Supervisors. (Paragraph IV below), given Pursuant to Government Code COUNTY OOUNSEL Section 913 and 915.4. Please note all AMOUNT: 2 F211-57(0 MARTINEZ CALIF. "Warnings". CLAIMANT: ANUb'tA FEDEQI& SAF ECb f 27Nst�1 ARSE ATTORNEY: DATE RECEIVED: ADDRESS: ?.0' Sox 5-I604y BY DELIVERY TO CLERK ON: 41AAA)C-fLES, C" flal BY MAIL POSTMARKED: 2113 4P FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, Clerk Dated: '�-�26 08 By: Deputy Ceo i - /VeL '1 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). 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 JOHN CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section. 913) Subject to certain exceptions,you have only six(6) montlis from t1n 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 wide this matter. If you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side ofTlnis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that i ain 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 s n above. Dated: _LL JOHN CULLEN, CLERK By \ ut Clerk I i r , CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: ZZ6110f 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 Supervisoi-s. (Paragraph IV below), given Pursuant to Government Code AMOUNT: 2 8Zq•5!s Section 913 and 915.4. Please note all "Warnings CLAIMANT: AIVWLA FEDEQ-lc�rl ATTORNEY: AFM f TNSL401/I�. DATE RECEIVED: ADDRESS: ?0' BOX 6'1609y BY DELIVERY TO CLERK ON: u6 ANC,6,LES, Cry Ical BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copyof the above-noted claim. JOHN CULLEN, Clerk ,�r Dated: 2.[a15(04W By: Deputy _aU iz II. FROM: County Counsel TO: Clerk of the Board of Supei-visors ( ) This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply su'bstantially with Sections 910 and 910.2, and we are so notifying claimant. The Boai-d 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 i Ill. FROM.: Clerk of the Board TOc County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ( ) This Claim is rejected in full. O Other: I certify that this is a true and correct copy of the Board's Ot-der entei-ed in its minutes fog- 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 oin 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. *f+or Additional Warning See Reverse Side ofThis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that l: am now, and at all times herein mentioned, have been a citizen of the United States, oven• 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 clafman.t as shown above. Dated: JOHN CULLEN, CLERK By Deputy Clerk I f 1 insurance _ I SAFECO PROPERTY & CASUALTY INSURANCE COMPANIES i Recovery Management DepL—Pacific Zone Phone: (800)332-3226 Fax (888)268-8840 www.safeco.com I Mailing Address: PO Box 515097 Los Angeles,CA 90051-5097 February 22, 2008 1 I Contra Costa County Clerk Of the Board of Supervisors 1 RECEIVED Room 106, County Administration Building 651 Pine Street FEB 2 5 2008 Martinez, CA 94553 1 CLERIC BOARD OF SUPERVISORS Re: Our Insured: Angela Fed'erigi CONTRA COSTA CO. Claim No: 5125222530007 Loss Date: 11-15-20071 Your Employee: Lucky M. Chesnut Your Claim No: Pending To Whom It May Concern: I We have completed our investigation of the above loss. Our findings indicate that your employee was the proximate cause of this loss. Under the terms of our insured's policy with us, we have become legally subrogated to the right of our insured to recover from your policyholder. As such, we are seeking reimbursement from you for the damages we paid out on behalf of our insured. Enclosed please find the documentation that will support our claim in the amount of $2829.36, this includes our insureds'deductible. The claim form is also attached. If you have extended any payment(s) directly to our insured prior to receiving this demand, kindly notify me of such payment(s). Please forward payment to: SAFECO Insurance Companies, Attn: St. Louis Branch Cashier(Subrogation), P.O. Box 461, St. Louis MO 63166-9970. 1 If you have any questions, please feel free to contact me and I will assist you in any way that can. Sincerely, 1 SAFECO Insurance Company of America I Sue Tffer 1 I Sue Tiffer- Subrogation Representative 866-732-3268 ext. 522065 1 Fax: 888-268-8840 sustif@safeco.com I I I I I I Rev.7/2001 a 1 ®A registered trademark of SAFECO Corporation I I I BOARD OF-SUPERVISORS OF CONTRA COEMA COUNW rN=UM—ONS TO,CLAD LANT A Claim relating to a cause of action for dmtb or hr W7 to Pesm or to Person PMPML7 pr growing crops shall be, presen-Ved not 18M flM ix mwAs aftr the awrval of the =20 Of action. A 61aim relating UP MY Offier Of Rd="b*-Pr'�s='I'd'lot'Bt!T thm Ott year after the a=nd offic owse of acfim (Gvv. Cjvsms must be :Med wilh faze Clerk of tw Board of Supervisors at its off= isi Room 106., if Wim is apiog.-- a.&strict &e gqvmnzd by Board d Supervisors, MO=&M the CM133-ty- the of the Distict should be Med in- If Ih-. claim is prailIA more flan one eM14. mpwa-- public tatity. Fraud. See p=9ty for fraLidiAexxt dlai=,Pend Code S=72 at the end of flis farm. off A k as an Rua ass a.It Wig PINK 1-1-AWNEXIMISM,It NO 9"NKS"'C"a X a R Rik"a Z It a at ILK K a IX Claim By: IRwernd for Clexes Miarg staff -5-Ar:iF-e,2' 11��&R,9JCL RECEI-VED FEB 2 5 2008 ffit COMAY of Comm CostB or CLERK BOARD OF SUiPEWSORS CONTRA COSTA CO. :FRI in the n=e) The maee pad clai'mmt bm-eb , Mal= clatm a I&ba Ifie County of Cwt Cogta or til, abovrnmned 19ttiM 11 IN--SUM Of S - wd in=Tpcjrt ofeb CwM repmews as fD]10VM L When did tha dw=p or b*ry occur"? (61M MMO 6&,and hour) 2. Where ifid Ihe dmmap or "UM7omm? CMA county) 3. Row cHd ft dazakage C-dve, , or 34jury o=arl? fall deor. mctm paper if mqdr4 A-) A(6.7 17- ::7g7t �mcess --T4.9 Pef, -Y XI1 04. 'WId'padmilar ad or OICI L's M' IL on the part off cou*or di�� S6rvMIt§, or CMP A'C 9':P::516 De/ Mat a the names of comuty or district a�:fficws,mvm&,,or employ=mu-sing flr- dM-91-M'r 4M"Y? `d !b8 'ON INIUMM NSH OX N-1 9002 `5I Whd damage` or W ies do yoty claim resu2±e,,A? (Give fuji extent of iajiuies or damages - -- -c1ai�.tL-••�Aiiarh�two-estimates-for a�dama.�) ��-•�,�T`�- — . 5�. 'o .� - . ��s s����-.- dao•� � ��-- _ `� � How was tlae a=mt claimed above computed? (Include the Wfimafcd amo n t of any prWeaff ve injury or fir) -W �zvNS f-- . —, - �5 7rtil�s Names sod ad.dres=of wj3nesses,dnotars,and hospit 1W 3. List t e di�ues you n3ada•on account of fbis arxident or' DATB T�VIE A�rtOTJNT G6 67A/7� ze,-55 cEailkKlie[RaCCttItamKwan WItu. "Iff.aERREEIIewtaaEEaERaIEERtzUEEENIPRIZEIaatILEEaaIaRtam ).Gov.Cotte Sec.910?provides"Ihe claim shag be signed by the claima or by some p=m on his • )behal£� SEQ NOTICES TO: (Attorne v) I r Na=and address of An=dy (Addrew) Tel.ephDneNo. )TelNo. �-��3 tiaaannow Rea aIan Ban Eall ifaitaanaakit man amair aseat anMEN EaaEAt*its aRua aaanoKRRERIRE.*aaIIaRRaat PUBLIC RREMRDS NOTICE: . please bo adviwd the this claim fcn,or am►elaim filed with 03e Cotmfy tmdar t5s Tart Clauns Act,is aubj rzt In public disclestas undr'ffie CaLifornk Public Rmm& A zL (Gov. Cada 59 6500 e#seq.) Pa themamr, auy stachmmft addendums,or s'spplcma=amchod tD&e claim farm,imehuft modmal rmmd%axe also subject to pubic disclosures 1,amRaaONE It a ORE E a E RE as aE a E a AVas■■Ewa attaoaaa KKK Ewa WE nIr IaEEEtr E R R IaN as a am REa a s REasaa%I Section 72 oftl e Penal Code provides: $Very pem vivo,wM ktent to defids psett for Oown=or far payment in any state board or offi=r,er to any cotes►, city. or district board or off, r4arized to allow or pay the sam if gzaiim:, eay fall: or frandtt mA cls,b" accotmt vouchar, or vd6h&is punishable aim by kpe=nmed is&e County jail far a period of mt mora f1mn me yam, by a fres of not ung one domnd doll n (51,000.00), or by bcnh su:b iaprim meat and fne, or by=' primmnA in the state priscm, by a fine al'not=Beft tin.thous &11ars (S 10,0W1 or by bath smh hapriso=nt and tae. d 168 'ON INAIMM NSH 333 WdH:Z 8002 'SZ NVP Page:- 1 Document Name: untitled ACSINQP HIST Clm# 512 52225 3007 C/I# OPEN CLAIM C/I# 001 Name FEDERIGI, ANGELA RS# Tran Clm class Res# Payment amt Stat Tran-date Dr/Ck/Vou# 003 SALV COLL 001 820. 50- PRO 01-03-08 122710 Pay period Pye# 010 001 Name COPART INC DBA COPART AUTO to AUCTIONS 002 SNGL COLL 001 . 3, 450 . 06 PRO 12-03-07 3370589 Pay period Pye# 001 002 Name FEDERIGI, ANGELA to LAST SCREEN CSU AGENT POLICY HIS1 Next screen (Clm# C/I# Pye# RS# ) Date: 02/22/2008 Time:. 1 : 54 : 07 PM _ . � �� ���` � ,y .. }.�� !�/� ���� � ,r��. .��1/f�'� SFr �*�."'ti �',� .�`�*� �'�l�r:�� � �. -;; .: _! -�� x:1.1171 :�,: �_. —:: we n�� �j.. � . �� 4�h'ti h Tr ' Q t S� 1 ki t � 4. y I i } i I ' I , I i V.3 SAFECO • WORKSHEET .. . :... .,.. -. .._:..;..: ;� .. .. - - :c.b A� cA3�r e.:n Ir%. lf:d"-.a o..hbuhad.tl: - .... . ..... I: : ---- CLAIM`#1VEF1ICLE-f -WNER=�= , 512522253007 nsd- Federre a - 97 Nissan -Ca I When paying a 1® CY 9sa6pity aiways use a SAa LdtaGE BID nmc 40% i a m ent�'Breakdowrr �!:.:�.'�� � State info ACV;°`:;Pro=Tax: " :-::=:r'.:.: : ;' 1$3,388.00 COLLECTOR CARS EDMUNDS Sales.Tax % �.74% $262.06ALL ®east. of IRIS NAC W®rG:fIow : •; _ 3"650:06 Unused:License $0.00 -Additional Information;,. .:. - - :.., . ;nta Title Tran erF $O.OQ Holdbci.Pe�eX4000I Add ees� wed'::'° 0.00 atonal F � -•:- - Tota1 Taxes'•and�F - - - iW M1 al" 'd : S va�'"e.:Bi u.uu i ,� Payments�Alread•'Made�'.:�: 9 _ y. D - - educt1.ble' 200.00 ��ia $ L bil' Perlcenta�'e;'�°�� 100% - nY 9 I CA Owner Retain ❑ -stiow=nir�rilp1e Total w/ no deductions taken = = $3;650:0,6 Pay"'e"ts Total w/deductible $1450':06 Cl Class:::;:;;; COLL (INSD) D Payment Notes pend title/ APD CLMT ❑ Pa nient Notes CPR (INSD) 8 Payment Notes THEFTR CP TT ❑ 9 Salva a Notes ( THEFT (CPR TTRP ISalvage Notes UM PD (INSD) ❑ I 'Additional Comments I I Misc information I . I I I I i i I I . Invoice Display Page 1 of 1 Invoice Display R"Lot#:16115057 Options:Lot Display for Lot#16115057 New Search COPART AUTO AUCTIONS Date 2/22/08 2701 WATERFRONT ROAD MARTINEZ, CA 94553 visit us at www.copart.com PHONE (925) 370-3900 TAX ID# 942867490 FINAL INVOICE + + + + + + * + + * 38.3% RETURN!! + + + + + + + + + Copart Lot# 16115057 78 CA - MARTINEZ Loss Date 11/15/07 Called In 11/19/07 P/U Cleared 11/20/07 SA82 PIP159A Pickup Date 11/21/07 CLAIMS ACCOUNTING Original Title 12/04/07 SAFECO-SWEST PERSONAL LINES Trans Title 12/05/07 P.O BOX 461 Sale Document 12/10/07 SAINT LOUIS, Mo 63166 Loss Type COLLISION Description 97 NISS ALTIMA XE/ GRAY vehicle ID# 1N4Bu31DXvC179143 Claim# 512522253007 License#/ST 4KZ]640 CA Policy# Mileage 150,672 Loss Code Pickup From MIKE ROSE AUTO BODYI Reference# HDOLIN 2260 VIA DE MERCADOS Insured ANGELA FEDERIGI CONCORD, CA 94518 I Owner ANGELA FEDERIGI (92S) 689-1739 ADVANCE CHARGES PAID BY COPART TOW SERVICE . . . . . . . 340.00 . TOTAL ADVANCE CHARGES . . . . . . . . 340.00 COPART SERVICE CHARGES TITLE PROCESSING. . . . . ! . . . . . . 22.50 SALVAGE CERTIFICATE PIP PROGRAM CHARGE. . . . . . . . . . 117.00 TOTAL COPART SERVICE CHARGES. . . . . . 139.50 TOTAL DUE COPART . . . . . . . f . . . . . . 479.50 PROCEEDS FROM SALE . . . . . . . 1300.00CR *Bid Raised By Internet* PREVIOUS PAYMENTS FROM COPART. : . . . . . . 820.50 ------------ NET DUE COPART . . . . . . . . . . . . 5 .00 COPART PAYMENTS DETAIL COPART CHECK# 04509576 112/27/07 820.50 SALE INFORMATION Lot# 16US057 Sold To 380907 DX MOBILE GLASS Sale Date 12/19/07 I 2150 MAIN ST APT 12 Sale'Amount 1300.00 SANTA CLARA, CA 95050 ACV 3388.00 (408) 390-5161 RES# SRGH101004820 Repair Est 4216.00 Return 38.3% Item# 9 Cert# 6746780 Invoice Date 12/27/07 Payment From Buyer 12/20/07 Invoice Amount .00 USD Reported To NICB 12/21/07 Copyright© 1998-2003 Copart, Inc.- http;[ www.copart.com Copart Access is a service for Registered Copart Sellers. Copart Access and the Copart Auction System (CAS) represent proprietary technologies protected by law. Misuse or abuse of any kind will result in membership revocation and possible criminal prosecution. Copart is not responsible for inaccuracies in data reported by CAS and the Copart Access system.The user assumes all risk of data I and errors. http://www.copart.com/cgi-bin/seller/accessfinvdisplay/view.dtw/disp 02/22/2008 1 CCC VALUESCOPE Claim Services Market Report Report Reference Number:. 38561927 Claim reference: 512522253007-002 Loss Incident Date: 11/15/2007 Date Submitted: 11/19/2007 Insured: Federigi Owner: Angela Federigi Policy Number: A02300579 Claim class: COLL Appraiser: VANIER, RICH Introduction SAFECO Insurance Company has conducted an.inspection of your 1997 Nissan Altima GXE 4 door Sedan located in Vallejo, CA. The inspection information was then used to conduct research in your local market to determine the market value of your vehicle. The local market value of your vehicle was defined by the Zip code 94589 -- Vallejo, CA The recommended settlement amount based on the loss vehicle description provided by SAFECO Insurance Company is $3,637.87 Section Title: Section Contents: vehicle Valuation Summary Market valuation summary Vehicle Valuation Allowances Factors affecting the value Vehicle Description Components of the vehicle vehicle Condition Vehicle's pre-accident condition Comparable Vehicles Summary Summary info on each comparable vehicle Comparable Vehicles Detail Comparable vehicles located in market VINguard Vehicle Identification Vehicle configuration information VINguard VIN Vehicle History Vehicle history research Vehicle Model Information Characteristics of the loss vehicle type Valuation Methodology Method used to evaluate the vehicle Local Market Definition Local market basis NHTSA Vehicle Recall NHTSA recall notices Appraisal and Valuation Notes Log notes for this file Valuation request: 38561927 (continued) 1997 NISS ALTIMA GXE Vehicle Valuation Summary Local Market .Value $ 3,280.00 Loss Vehicle Condition + 187.00 Upd Deduction 20% of 395.00 - 79.00 Pre-tax amount $ 3,388.00 Vehicular Sales Tax 7.375% + 249.•87 License/fees (if applicable) j Adjusted vehicle valuation amount $ 3,637.87 Automated sales tax calculation based on applicable state, county and municipal tax rates. vehicle Valuation Allowances Compared to the typical vehicle in the marketplace your vehicle's value was affected by these factors: Odometer 150,672 - 415.00 AT - Automatic Transmission + 146.00 AC - Air Conditioning + 175.00 FM - FM Radio + q5-no ST - Stereo + 29.00 CD - Compact Disc Player + . 58.00 AW - Aluminum/Alloy Wheels + 58.00 These allowances illustrate factors that influence the settlement amount when compared to a typical vehicle. The typical vehicle is a vehicle of the same year, make, and model as the loss vehicle, including average mileage, and all standard and predominant equipment. In cases where a standard or predominant option is superceded by a replacement or upgrade, a corresponding addition will appear for the option to reflect this. The vehicle valuation allowances also reflect proper deductions for all standard or predominant equipment not present on the loss vehicle. These allowances are .illustrative only. The actual Local Market Value is calculated entirely from comparable vehicles with adjustments to reflect the loss vehicle configuration. Vehicle Description DESCRIPTION OPTION Odometer 150,672 Vehicle equipment: Rptd AT. - Automatic Transmission Valuation request: 38561927 (continued) 1997 NISS ALTIMA GXE Vehicle Description (continued) Rptd OD - Overdrive Std PS - Power Steering Std PB - Power Brakes Std PW - Power Windows Std PL - Power Locks Std PM — Power Mirrors " Rptd AC - Air Conditioning Std RD - Rear Defogger Std TW - Tilt Wheel Rptd CC - Cruise Control Std CS - Cloth Seats Std RL - Reclining/Lounge Seats Std BS - Bucket Seats Std DM - Dual Mirrors Rptd WT - Wood Interior Trim Rptd AM - AM Radio Rptd FM - FM Radio Rptd ST - Stereo - Rptd SE - Search/Seek Rptd CD - Compact Disc Player Rptd AW - Aluminum/Alloy Wheels Std BN - Body Side Moldings Std IW - Intermittent Wipers Std TG - Tinted Glass Rptd MP - Metallic Paint Std AG - Air Bag Std RG - Passenger Air Bag Std CN - Console/Storage Rptd IP - Clearcoat Paint Vehicle Condition SAFECO Insurance Company uses Condition .Inspection Guidelines to determine the condition of key components .of the loss vehicle. These guidelines are specific to geographic location, year, and vehicle type. The guidelines describe physical characteristics for each of the vehicle components. Based on these guidelines, SAFECO Insurance C'omnanv determined the condition of the vPhi(-l( prior to the; loss_ Component Condition Value Impact ----------- --------- ----------- INTERIOR Seats Above average $35 TYPICAL VEHICLE DESCRIPTION: Significantly soiled, stained or faded. Small/few tears, holes or burn marks. INSPECTION NOTES: LIGHTLY SOILED AND WORN, FEW SMALL BURN HOLES, NO LARG E RIPS OR TEARS Valuation request: 38561927 (continued) 1997 NISS ALTIMA GXE Component Condition Value Impact Carpets Normal TYPICAL VEHICLE DESCRIPTION: Significantly soiled or stained. Small/few tears, holes or burn marks. Significant wear or bare spots. INSPECTION NOTES: HEAVILY SOILED, STAINED AND WORN, MINOR BARE ON THE DR . IVER SIDE, TRIM PANELS ARE WORN Dashboard Above average $11 TYPICAL VEHICLE DESCRIPTION: Significant cracks, scratches or gouges. Components damaged. Significant wear or fading. INSPECTION NOTES: NOC RACKS, ALL PARTS INACT, CENTER CONSULE IS DIRTY AN D WORN Headliner Above average $14 TYPICAL VEHICLE DESCRIPTION: Small/few tears or fading. Stained or soiled. INSPECTION NOTES: LIGHTLY SOILED AND WORN, DRIVERS SUN VISOR IS DAMAGED,' NO HOLES, TEARS OR SAGGING EXTERIOR Sheet Metal Above average $42 TYPICAL VEHICLE DESCRIPTION: Small/numerous dents or dings. Significant surface rust. INSPECTION NOTES: SMALL NUMEROUS DINGS ON BOTH SIDES, NO RUST, ALL PANEL S ALIGNED Trim Above average $81 TYPICAL VEHICLE DESCRIPTION: Significant peeling or fading. Minimal rust apparent. INSPECTION NOTES: VGRILL IS PEELING AND FLAKING, WHEELS ARE FADED, DOOR HANDLES ARE FLAKING Paint Normal TYPICAL VEHICLE DESCRIPTION: Small/numerous surface chips or scratches_ Minimal peeling or flaking. Significant fading. Evidence of repainting. INSPECTION NOTES: NUMEROUS SMALL SURFACE SCRATCHES, SOME FADING, ROCKS 0 N THE HODD, MINIMAL SURFACE RUST Glass Above average $4 TYPICAL VEHICLE DESCRIPTION: Surface scratches or pitting. Few chips. Seals show signs of wear. INSPECTION NOTES: PITTING WITH ONE ROCK CHIP/CRACK Valuation request: 38561927 (continued) 1997 NISS ALTIMA GXE Component Condition Value Impact ----------- --------- ----------- MECHANICAL Engine Normal TYPICAL VEHICLE DESCRIPTION: Small/few leaks. Belts and hoses show significant wear. Significant dirt and grease in engine compartment. Minimal burn marks around tailpipe. INSPECTION NOTES: SOME SEEPAGE & LEAKS, OIL IS DARK AND DISCOLORED, DIRT Y AND DUSTY. BURN MARK ON THE TAIL PIPE Transmission Normal TYPICAL VEHICLE DESCRIPTION: Fluid discolored. Minor seepage. INSPECTION NOTES: TRRNNY FLUID SLIGHTLY DISCOLRED AND SOME SEEPAGE TIRES Front Tires Normal TYPICAL VEHICLE DESCRIPTION: 5-7/32" of tread present. 41% to 68% of new. No signs of uneven wear. INSPECTION NOTES: 5/32 Rear Tires Normal TYPICAL VEHICLE DESCRIPTION: 5-7/32" of tread present. 41% to 68% of new. No signs of uneven wear. INSPECTION NOTES: 5/32 Value Impact $187 ---------------------------- ---------------------------------------------------- The condition inspection guidelines provide information based on vehicle age, vehicle type, and geographic location. Your vehicle has been identified as being located in the California region as an older passenger car. The. Condition Inspection Guidelines, and .all dollar adjustments, are determined by surveys, inspections, and interviews with dealerships across the United States. The Typical Vehicle Description illustrates the condition characteristics of a typical vehicle in Normal Wear condition. ------------------------------------------------------------------------------- Valuation request: 38561927 (continued) 1997 NISS ALTIMA GXE Comparable Vehicles Summary The following comparable vehicle(s) were used to determine this, market value by computing the arithmetic mean of the adjusted values of the comparable vehicles. Details on these comparable vehicles are in the Local Market Comparable Vehicles section. Type Comparable vehicle Price Adj Val ------------------ --------------------------------------- --------- ------- Verified Sold 1997 NISS Altima Xe $3,799 $3,606 Verified Sold 1997 NISS Altima Xe $2, 999, $2,719 Verified Sold 1997 NISS Altima Xe $2, 999 $2,520 Verified Sold 1997 NISS Altima Xe $4,199 $3,364 Verified Sold 1997 NISS Altima Xe $3, 999 $3,868 Private Advertised 1997 NISS Altima Se $3, 000 $2,906 Dealer. Vehicle .1997 NISS Altima Gxe $4,999 $3,979 ARTTHMRTTC'. MEAN i Valuation request: 38561927 (continued) 1997 NISS ALTIMA GXE Comparable Vehicles Detail The local market comparable vehicles are compared to the loss vehicle, and adjustments are made for differences in equipment, odometer, model, etc. The Price, Asking Price, Take Price or List Price displayed below (as applicable) may differ from the advertised price where CCC obtains different price information from the seller The Adjusted Value represents the price of the comparable configured exactly as the loss vehicle. Loss Vehicle Verified Sold Dmv Verified Sold Dmv Verified Sold Dmv -------------------+-------------=----- ------------------- ------------------- 1997 Nissan 11997 Nissan 1997 Nissan 1997 Nissan Altima Gxe JAltima Xe Altima Xe Altima Xe 4d Sed 14d Sed 4d Sed 4d Sed 4-2.41-Fi 14 4 4 Auto Trans-OD JAuto Trans j 5-Speed 5-Speed AM/FM Stereo Seek `AM/FM Stereo With Compact Disk 1with Tape And Cd Cruise Control JCruise Control (No Cruise Control) (No Cruise Control) Air Bag JAir Bag IAir Bag Air Bag Power Locks IRear Defogger Rear Defogger Rear Defogger Power windows IPassenger Air Bag Passenger Air Bag Passenger Air Bag Rear Defogger ITilt Wheel Tilt Wheel Tilt Wheel Passenger Air Bag Air Conditioning* Tilt Wheel JPower Windows*, Air Conditioning* 1power Locks- Aluminum/Alloy Aluminum/Alloy Wheels* I Wheels* Miles: 150,672 1137,360 102,301 91, 116 Verified 9/15/2007 Verified 10/01/2007 Verified 9/29/2007 Location: Berkeley Livermore Redwood City Distance From:Vallejo 19 41 45 Dealer: Toyota Of Berkeley Diversified Vehicle Hansa Auction City Phone Number: 510/845-2530 1 925/606-5300 650/367-7788 Plate# 4fdn549 Plate# 3vvj078 Plate# 3ssu555 Sold $ 3,799 Sold $ 2,999 Sold $ 2, 999 Adjustments ------------------- Model/Year + 125 + 125 + 125 Options - 87 + 510 + 510 Mileage - 231 - 915 - 1,114 Adjusted Value $ 3;606 $ 2,719 $ 2,520 Valuation request: 38561927 (continued) 1997 NISS ALTIMA GXE Comparable Vehicles Detail (continued) Loss Vehicle Verified Sold DMV Verified Sold DMV Private Advertised ----------------------------- ------------------- ------------------- 1997 ------------- ----- ----- ------------------- 1997 Nissan 11997 Nissan 1997 Nissan 1997 Nissan Altima Gxe JAltima Xe Altima Xe Altima Se 4d Sed 14d Sed 4d Sed 4d Sed 472.41-Fi 14 4 4 Auto Trans-OD I5-Speed 5-Speed 5-Speed AM/FM Stereo Seek AM/FM Stereo Seek With Compact Disk With Tape Cassette . Cruise Control. I (No Cruise Control) (No Cruise Control) Air Conditioning Air Bag IAir Bag Air Bag Air Bag Power Locks IRear Defogger, Rear.Defogger Aluminum/Alloy Power Windows IPasspnaPr Air Rao PassPnaPr Air Rao WhPPIs Rear Defogger ITilt Wheel Tilt Wheel Cruise Control Passenger Air Bag I Fog Lamps Tilt wheel I Power Locks Air Conditioning*. Power Windows .Aluminum/Alloy Rear Defogger Wheels* Passenger Air Bag Rear Spoiler Tilt Wheel Miles: 150,672 71,020 110,672 134, 000 Verified 8/25/2007 Verified 8/30/2007 Pub Date 9/09/2.007 Location: Redwood City San Jose Oakland Distance From:Vallejo 45 59 23 Dealer/Publication: Brdwk Auto Cntr/Vol Steadfast Motors L1 S.f. Examiner Chron Phone Number: 650/364-0100 408/768-3109 510/388-9048 Plate# 3sku841 Plate# 4jij486 Sold $ 4,199 Sold $, 3,999. Ask $ 3,000 Adjustments ------------------- Model/Year + 125 + 125 - 275 Options + 510 + 510 +. 481 Mileage - 1,470 - 766 - 300 -------- -------- -------- Adjusted Value $ 3,364 $ 3,868 $ 2, 906 Loss Vehicle Dealer Vehicle -----------------=-+------------------- 1997 Nissan 11997 Nissan Altima Gxe IAltima Gxe 4d Sed I4d Sed 4-2 .41-Fi 14 Auto Trans-OD I5-Speed AM/FM Stereo Seek I With Compact Disk I Valuation request: 38561927 (continued) .1997 NISS ALTIMA GXE . Comparable Vehicles Detail (continued) Loss Vehicle' Dealer Vehicle -----=-------------+------------------- Cruise Control ICruise Control Air Bag IAir Bag Power Locks JPower Locks Power Windows (Power Windows Rear Defogger (Rear Defogger Passenger Air Bag IPassenger Air Bag Tilt Wheel ITiit Wheel Air Conditioning* IAir Conditioning* Aluminum/Alloy I Wheels*_ I Miles: 150,672 179,148 Pub Date 9/29/2007 Location: San Jose Distance From:Vallejo 57 Dealer: Steadfast Motors Phone Number: 408/244-9988 Stock#1712 Ask $ 4,999 Adjustments ------------------- Options + 306 Mileage - 1,326 1 Adjusted Value $ ' 3,1979 * Option adjustments are made in comparison to the typical vehicle. Typical vehicle options that are not present are enclosed in parentheses. * Adjustments are determined by surveys, inspections, and interviews with dealerships across the United States. * Adjusted Value represents the value of the comparable vehicle configured exactly as the loss vehicle. * Ask Price is the asking price of the vehicle. * Sold Price is the price actual selling price provided by the California Department of Motor Vehicles orlother sources. * The Price, Asking Price, Take Price or List Price displayed above (as applicable) may differ from the advertised price where CCC obtains different price information from the seller. I Valuation request: 38561927 (continued) 1997 NISS ALTIMA GXE I VINguard Vehicle Identification VIN: 1N4BU31DXVC179143 I Insurer Description VINguard Analysis ---------------------L----------- --------------------------------- Year 1997 1997 Make Nissan Nissan Model Altima GXE Altima BU31 BU31 Body style 4d Sed 4d Sed Engine 4-2.41-Fi 4-2.41-Fi Trans Automatic Transmission Overdrive I Restraints AIR BAGS (DRIVER+PASS.) Air Bags (Driver+Pass.) Curb Weight 2,856 Odometer 150672 Note: 17% higher than typical vehicle This vehicle was assembled in SMYRNA, TN AutoCheck Vehicle History Report l AutoCheck Vehicle History Report Experian Automotive Report Run Date: 11/19/2007 1 ------------------------------------------------------------------------------- Key: N = No Problem Found I I = Problem Found I = Information Found ------------------------------------------------------------------------------- TITLE CHECK I THIS VEHICLE CHECKS OUT. AutoCheck database for this 1997 NISSAN ALTIMA GXE (1N4BU31DXVC179143) shows no historical events that indicate a significant automotive problem. These problems can indicate past automotive damage or warnings associated with the vehicle title. Problems Checked Resullts Found I I . I I Abandoned N No Abandoned Record(s) Found Damaged N No Damaged Record(s) Found Fire Damage N No Fire Damage Record Found Grey Market N No Grey Market Record Found Hail Damage N No Hail Damage Record Found Insurance Loss N No Insurance Loss Record Found Junk N No Junk Record(s) Found Valuation request: 38561927 (continued) 1997 NISS ALTIMA GXE AutoCheck Vehicle I History Report (continued) Rebuilt N No Rebuilt Record(s) Found Salvage N No 'Salvage Record(s) Found PROBLEM CHECK I THIS VEHICLE CHECKS OUT. AutoCheck database for this 1997 NISSAN ALTIMA GXE (1N4BU31DXVC179143) shows no historical events that indicate a significant automotive problem. These problems can indicate past automotive damage or warnings associated with the vehicle title. Problems Checked Results Found NHTSA Crash Test Vehicle N NoINHTSA Crash Test Vehicle Record(s) Found Frame Damage N No Frame Damage Record(s) Found Major Damage Incident N NolMajor Damage Record(s) Found Manufacturer buyback/lemon N No Manufacturer Buyback/lemon Record(s) Found Odometer Problem N Nolodometer Problem Record(s) Found Recycled N NolRecycled Record(s) Found. Salvage Auction N No Salvage Auction Record(s) Found Water Damage N NolWater Damage Record(s) Found ODOMETER CHECK THIS VEHICLE CHECKS OUT. For this 1997 NISSAN ALTIMA GXE (1N4BU31DXVC179143) no indication of odometer rollback or tampering was found. AutoCheck determines odometer rollbacks by searching for records that indicate odometer readings less than a previously reported value. Other odometer events can report events of tampering, or possible odometer breakage. Date Reported Odometer Reading 1997-01-13 13 1997-01-13 1997-12-30 l 1998-12-28 1999-01-05 1999-01-25 1999-11-30 40,564 1999-11-30 40,564 1999-12-09 40,616 1999-12-31 2000-02-05 40,848 2000-04-18 2000-04-20 2001-02-13 67,323 2001-02-20 67,403 2001-03-21 68,489 2001-03-24 68,512 2001-04-20 2001-04-24 2003-04-15 2003-04-25 I Valuation request: 38561927 (continued) 1997 NISS ALTIMA GXE- AutoCheck Vehicle History Report (continued) 2004-02-03 l 2004-02-13 2nns-nl -17 11(,. 093 I I . i I 2007-01-27 1411,558 I VEHICLE INFORMATION INFORMATION FOUND. AutoCheck found additional information on this vehicle. These records will provide more history for this 1997 NISSAN ALTIMA GXE (1N4BU31DXVC179143) . i . Problems Checked Results Found Accident N No Accident Record(s) Found Corrected Title N No Corrected Title Record(s) Found Driver Education N No Driver Education Record(s) Found Duplicate Title N No Duplicate Title Record(s) Found Emissions Safety Inspection Y Emissions Safety Inspection Record(s) Found Fire Damage N No Fire Damage Record(s) Found Lease Y Lease Record(s) Found Lien Y Lien Record(s) Found Livery Use N No Livery Use Record(s) Found Government Use N No Government Use Record(s) Found Police Use N No Police Use Record(s) Found Fleet N No Fleet Record(s) Found Rental N No Rental Record(s) Found Fleet and/or Lease Y Fleet and/or Lease Record(s) Found Fleet and/or Rental N No Fleet and/or Rental Record(s) Found Repossessed N No Repossessed Record(s) Found Taxi Use N No Taxi Use Record(s) Found Theft N No Theft Record(s) Found I FULL HISTORY I Below are the historical events for this vehicle listed in chronological order. Report Run Date: 11/19/2007 I Event Event Odometer Data Event Date Location Reading Source Detail 1997-01-13 NM 13 Motor Vehicle Dept TITLE 1997-01-13 CHAPARRAL, NM 00000000 Motor Vehicle Dept REGISTRATION EVENT/RENEWAL 1997-12-30 CHAPARRAL, NM 00000000 Motor Vehicle Dept REGISTRATION EVENT/RENEWAL 1998-12-28 NM 00000000 Motor Vehicle Dept TITLE 1999-01-05 CHAPARRAL, NM 00000010 Motor Vehicle Dept REGISTRATION Valuation request: 38561927 (continued) 1997 NISS ALTIMA GXE AutoCheck Vehicle History Report (continued) I .- EVENT/RENEWAL 1999-01-25 NM 00000000 Motor Vehicle Dept TITLE 1999-11-30 PACIFIC S, 40,564 Auto Auction REPORTED AT AUTO AUCTION 1999-11-30 PACIFIC S, 40,504 Auto Auction AUCTION ANNOUNCED AS FLEET/LEASE 1999-12-09 CA 40,6116 State Agency PASSED EMISSION I INSPECTION 1999-12-31 CONCORD, CA 00000000 Independent Source VEHICLE IN DEALER I INVENTORY 2000-02-05 CA 40,848 Motor Vehicle Dept ODOMETER READING FROM DMV 2000-04-18 ANTIOCH, CA 00000000 Motor Vehicle Dept REGISTRATION EVENT/RENEWAL 2000-04-20 ANTIOCH, CA 00000000 Motor Vehicle Dept TITLE 2001-02-13 PACIFIC S, 67,323 Auto Auction REPORTED AT. AUTO ATTC..TTON I 2001-02-20 CA 67,403 State Agency PASSED EMISSION INSPECTION 2001-03-21 CA 68,489 State Agency PASSED EMISSION INSPECTION 2001-03-24 CA 68,512 Motor Vehicle Dept ODOMETER READING FROM DMV 2001-04-20 VALLEJO, CA 00000000 Motor Vehicle Dept REGISTRATION EVENT/RENEWAL 2001-04-24 VALLEJO, CA 00000000 Motor Vehicle.Dept TITLE 2003-04-15 VALLEJO, CA 00000000 Motor Vehicle Dept REGISTRATION EVENT/RENEWAL 2003-04-25 VALLEJO, CA . 00000000 Motor Vehicle Dept TITLE 2004-02-03 VALLEJO, CA 00000000 Motor Vehicle Dept REGISTRATION EVENT/RENEWAL 2004-02-13 VALLEJO, CA 00000000 Motor Vehicle Dept TITLE 2005-01-17 CA 116,093 State Agency PASSED EMISSION INSPECTION . 2007-01-27 CA 141,558 State Agency PASSED EMISSION INSPECTION AutoCheck Vehicle History Report Terms and Conditions: Experian's Reports are compiled from multiple sources. It is not always possible for Experian to obtain complete discrepancy information on all vehicles; therefore, there may be other title brands, odometer readings or discrepancies that apply to a vehicle that are not reflected on that vehicle's Report. Experian searches data from additional sources where possible, but all discrepancies may not be reflected on the Report. Valuation request: 38561927 (continued) 1997 NISS ALTIMA GXE AutoCheck Vehicle History Report (continued) These Reports are based on information supplied to Experian by external sources believed to be reliable, BUT NO RESPONSIBILITY IS ASSUMED BY EXPERIAN OR ITS AGENTS FOR ERRORS, INACCURACIES OR OMISSIONS. THE REPORTS ARE PROVIDED STRICTLY ON AN 'AS IS WHERE IS' BASIS, AND EXPERIAN FURTHER EXPRESSLY DISCLAIMS ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE REGARDING THIS REPORT. YOU AGREE TO INDEMNIFY EXPERIAN FOR ANY CLAIMS OR LOSSES, INCLUDING COSTS, EXPENSES AND ATTORNEYS FEES, INCURRED BY EXPERIAN ARISING DIRECTLY OR INDIRECTLY FROM YOUR IMPROPER OR.UNAUTHORIZED USE OF AUTOCHECK VEHICLE HISTORY REPORTS. Experian shall not be liable for any delay or failure to provide an accurate report if. and to the extent which such delay or failure is caused by events beyond the reasonable control of Experian, including, without limitation, 'acts . of God' , terrorism, or public enemies, labor disputes, equipment malfunctions, material or component shortages, supplier failures, embargoes, rationing, acts of local, state or national governments,: or public agencies, utility or communication failures or delays, fire, earthquakes, flood, epidemics, riots- and strikes. These terms and the relationship between you and Experian shall be governed by the laws of the State of Illinois (USA) without regard to its conflict of laws provisions. You and Experian agree to submit to the personal and exclusive jurisdiction of the courts located within the county of Cook, Illinois. VINguard VIN Vehicle History VINguard has decoded this VIN without any errors. ISO Vehicle History: ISO response indicates no history for this VIN. * WARNTNC, - VTNrn3arc3 has dF-tP. 'tP[j nrior PvPnt(s) in this vPhir.le's history_ * Please review the information detailed below. ******************************************************************************* Collision History Information:' Collision incident reported by SAFECO Insurance Company on 10/12/2001 Claim # 466663651608-001 in Pleasanton, CA Repair estimate: $2,709 Miles: ; 76,567 Damage Location: Left Rear Collision incident reported by SAFECO Insurance Company on 11/16/2007 Claim # 512522253007-001 in Lafayette, CA Repair estimate: $4,295 Miles: ;150,672 Damage Location: Total Loss Valuation request: 38561927 (continued) 1997 NISS ALTIMA GXE VINguard VIN Vehicle History (continued) Previous Vehicle Sale Information: This vehicle inspected by CCC on 12/31/1999 Miles: 40,604 Location: Concord Honda, in Concord, CA Vehicle Model Information For the 1993 model year, the Aitima was introduced as a replacement for the Stanza. Since that time, the Aitima has become a very popular compact sedan. The 1997 Nissan Altima; is virtually identical to the 1996 version, with the only changes being the addition of new emissions equipment. The front-wheel drive Altima comes in base XE, GXE, SE, and top-of-the-line GLE trim levels, and all are powered by the same 4-cylinder, 2.4-liter, 150-horsepower engine, that offers above average acceleration. However, at higher speeds, this engine cans be rather loud and rough. The Altima offers excellent handling and steering capabilities. The interior cabin, although not the roomiest or most refined of compact sedans, is adequate. Braking is superb and rates at the top of its class. Probably the stongest attribute of the Altima is its relatively low price tag, even when well equipped. The Altima is a fun car to drive and plays the dual roles of family sedan and sport sedan equally well. A mid-year model will be introduced that will offer federally mandated side impact protection, along with; two new exterior colors, and the addition of leather seats as standard equipment to the GLE model. --------------= Valuation Methodology This CCC Valuescope Market Report was prepared for SAFECO Insurance Company by CCC Information Services Inc. CCC has been preparing market reports for the insurance industry since ;1981. CCC physically inspects vehicles for sale at vehicle dealerships in the local markets, and subscribes to local newspapers and automotive publications in these markets. CCC also obtains vehicle sales prices from the California Department of Motor Vehicles. CCC maintains vehicle databases containing these inspected dealership vehicles, the dealer and private party advertised vehicle information, and a database of California DMV registration sold transactions. When SAFECO Insurance Company requests a CCC Valuescope Market Report from CCC, they provide CCC the VIN (Vehicle Identification Number) of the loss vehicle. Decoding this VIN identifies the exact vehicle for which the local market value will be done. See the VINguard Vehicle Identification section. SAFECO Insurance Company also provides CCC the vehicle owner's Zip code. This identifies the local market that will be used to determine the market value. See the Local Market Definition section. Valuation request: 38561927 (continued) 1997 NISS ALTIMA GXE --------- Valuation Methodolorjy (continued) --------------------- Finallv. SAFRCO Tnsiirance Comnanv nrovides CCC with the ronfirnuration of the loss vehicle including equipment; odometer, condition, maintenance, etc. This information is the starting point for determining the local market value. Using this information, CCC searches its databases to find comparable vehicles in the local market. Vehicles located are compared to the loss vehicle, and adjustments are made for differences such as model, equipment, and odometer. The comparable vehicles are used to determine the Local Market Value. See the Local Market Definition section. After the Adjusted Value for the comparable vehicles are calculated (see the Local Market Comparable Vehicles section) , CCC calculates the Local Market Value as the average of the Adjusted Values of the comparable vehicles. Local Market Definition The local- market value for your; 1997 Nissan Altima GXE 4 Door Sedan was defined by ZIP code 94589, -- Vallejo, CA. Adjacent markets were also searched as secondary sources to locate comparable vehicles. Details of the specific markets searched follow. . The state of California is composed of 24 distinct local markets. The following 8 zones were used in the preparation of this CCC Valuescope Market Report. East Bay, CA - Primary local market vehicle database. In this market, CCC maintains a database of 54,156 dealer advertised, and 3,791 privately advertised vehicles taken from 28 local papers or magazines_ Bay Area, CA - Secondary local ;market vehicle database. In this market, CCC maintains a database of 34,547 dealer advertised, and 2,657 privately advertised vehicles taken from 19 local papers or magazines. Marin County, CA - Third local market vehicle database. In this market, CCC maintains a database. of 6,387 dealer advertised, and 432 privately advertised vehicles taken from 8 local papers or magazines. Other markets searched - San Joaquin Valley, San Jose, ,Chico, Santa Rosa and Ukiah/Ft.Bragg In these markets, CCC maintains a database of 70,701 advertised vehicles taken from 62 local newspapers or magazines. From these 8 local markets, comparable vehicles were selected based on the year, make, model, body style; and engine configuration of your vehicle. Adjustments were made to the value of each comparable vehicle to compensate for differences in year, model, body style, engine configuration, packages, options, and mileage. Valuation request: 38561927 (continued) 1997 NISS ALTIMA GXE Local Market Definition (continued) For your vehicle's CCC Valuescope Market Report, CCC identified 7 advertised vehicles as comparable to your vehicle, and used their values to determine the Local Market Value. ____________________________ ;NHTSA Recall Notices The National Highway Traffic ;Safety Administration has issued 1 safety related recall notice that may apply to the above valued vehicle. For additional information or assistance, call- CCC customer service at 1-800-621-8070 and follow the automated operator's instructions. Please use your valuation request number for reference. NHTSA ID: 96V185000 Issued' 10/01/1996 No. of vehicles: 36,000 Certain buckle assemblies were produced with a "buckle base" that was improperly heat treated. This can cause the "buckle base" to be hrittlp failing to cc-imnly to FMVSG no_ 209. "spat hplt assemhlips_ " i i i i i i in the event of a collision, these seat belts may not restrain an occupant increasing the risk of injury. Dealers will inspect the buckle assemblies and replace them if necessary. Owner notification: Owner notification is expected to begin during October 1996. i Appraisal and Valuation Notes The loss vehicle has been valued' as an older vehicle in the California region with 17% more than average miles of 128,900. i Included in our backup are similar models to the loss vehicle. Proper adjustments were made for this valuation. Your primary valuation market selected for comparable vehicles is EAST BAY, CA i We extended the search into surrounding markets for additional comparable vehicles. i This valuation has been prepared in accordance with the California Fair Claims Settlement Practices Regulations. (C) Copyright 2007 CCC Information Services Inc. All rights reserved. Various aspects of our Market Report are covered by one or more pending patent applications. The trade names and/or trademarks used herein are owned by their respective trademark owners. EMAL i i i i i i i i i i i i i I • - I I I I • I , I I ' I 11/19/2007 AT 07:31 PM 512522253007-002 15836 1 OC7W2LLN I SAFECO INSURANCE COMPANY ICONCORD OFFICE RICVAN@SAFECO.COM IP 0 BOX 515097 LOS ANGELES, CA 90051-5097 (925)381'2938 FAX: (888)268-8840 I ESTIMATE OF RECORD I WRITTEN BY: RICH VANIER 11/19/2007 07:31 PM ADJUSTER JACCHR (925)381-2938 I INSURED: ANGELA FEDERIGI I CLAIM #512522253007-002 OWNER: ANGELA FEDERIGI i POLICY # A02300579 ADDRESS: 1457 N CAMINO ALTO #220 DATE OF LOSS: 11/15/2007 AT 08:10 AM VALLEJO, CA 94589-25651 TYPE OF LOSS: COLLISION OTHER: (707)246-9925 1 POINT OF IMPACT: 12. FRONT DAY: (925)603-2332 1 INSPECT MIKES AUTO BODY DAY: (925)689-1739 LOCATION: 2260 VIA DE MERCADOS REPAIR_SHOP CONCORD, CA 94520 REPAIR MIKES AUTO BODY DAY: (925)689-1739 FACILITY: 2260 VIA DE MERCADOS 1 5 DAYS TO REPAIR CONCORD, CA 94520 LICENSE # 1997 NISS ALTIMA GXE 4-2.4L-FI 4D SED GRAY INT: VIN: 1N4BU31DXVC179143 LIC: 4KZJ640 CA PROD DATE: ODOMETER: 150672 AIR CONDITIONING REAR DEFOGGER TILT WHEEL CRUISE CONTROL INTERMITTENT WIPERS TINTED GLASS BODY SIDE MOLDINGS WOOD INTERIOR TRIM DUAL MIRRORS CONSOLE/STORAGE CLEAR COAT PAINT METALLIC PAINT POWER STEERING POWER BRAKES POWER WINDOWS POWER LOCKS POWER MIRRORS AM RADIO FM RADIO STEREO SEARCH/SEEK CD PLAYER DRIVER AIR BAG PASSENGER AIR BAG CLOTH SEATS BUCKET SEATS RECLINE/LOUNGE SEATS AUTOMATIC TRANSMISSION OVERDRIVE ALUMINUM/ALLOY WHEELS ------------------------------------------------------------------------------- NO. OP.. DESCRIPTION QTY EXT. PRICE LABOR PAINT -------------------------------=---------------------------=------------------- 1# SEE ESTIMATE FROM MIKES AUTO 1 4295.63 X BODY PACE SHOP ( (SUBTOTALS =_> 4295.63 0.0 0.0 I ----------------------------- ---------------------------------------- ESTIMATE NOTES: 1 TOTAL LOSS UPI) ESTIMATE IN FILE1 I I ' I 1 i I I I I I i i I I I 11/19/2007 AT 07:31 PM 512522253007-002 15836 OC7W2LLN ESTIMATE OF RECORD 1997 NISS ALTIMA GXE 4-2.4L-FI 4D SED GRAY INT: I PARTS . 0.00 SUBLET/MISC. 4295.63 SUBTOTAL $ 4295.63 ---------------------------------------------------- TOTALICOST OF REPAIRS $ 4295.63 I ADJUSTMENTS: DEDUCTIBLE 200.00 -----'---------------------------------------------- TOTALIADJUSTMENTS $ 200.00 NET COST OF REPAIRS $ 4095.63 I I *** COPY OF ESTIMATE PROVIDED TO CUSTOMER *** ****NO SUPPLEMENT WILL BE PAID WITHOUT PRIOR APPROVAL*** I **** SUPPLEMENTS WILL REQUIRE ALL INVOICES FOR THE ENTIRE REPAIR **** I ' 'WE ARE PROHIBITED BY LAW FROM REQUIRING THAT REPAIRS BE DONE AT A SPECIFIC AUTOMOTIVE REPAIR DEALER. YOU ARE ENTITLED TO SELECT THE AUTO BODY REPAIR SHOP TO REPAIR DAMAGE COVERED BY US. WE HAVE RECOMMENDED AN AUTOMOTIVE REPAIR DEALER THAT WILL REPAIR YOUR DAMAGED VEHICLE. IF YOU AGREE TO USE OUR RECOMMENDED AUTOMOTIVE REPAIR DEALER, 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 US IMMEDIATELY FOR ASSISTANCE. ' ' I I AUTO BODY REPAIR CONSUMER BILL OF RIGHTS I 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. 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 AND STORAGE 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. I 4. BE INFORMED ABOUT THE EXTENT OF COVERAGE, IF ANY, FOR A REPLACEMENT RENTAL VEHICLE WHILE A DAMAGED VEHICLEIIS BEING REPAIRED. 5. BE INFORMED OF WHERE TO REPORT SUSPECTED FRAUD OR OTHER COMPLAINTS AND 2 I ' I I I I I I I I I I 11/19/2007 AT.07:31 PM 512522253007-002 15836 OC7W2LLN ESTIMATE OF RECORD 1997 NISS ALTIMA GXE 4-2.4L-FI 4D SED GRAY INT: CONCERNS ABOUT AUTO BODY REPAIRS.1 I 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: I 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 I I 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) 897-8921 CALIFORNIA DEPARTMENT OF INSURANCE CONSUMER SERVICES DIVISION 300 SOUTH SPRING STREET LOS ANGELES, CA 90013 THE CALIFORNIA DEPARTMENT OF INSURANCE CAN ALSO ACCEPT COMPLAINTS OVER ITS WEB SITE AT: WWW.INSURANCE.CA.GOV 12/29/00 I LAST REVISED - JANUARY 03, 2001 COPYRIGHT CALIFORNIA DEPARTMENT OF INSURANCE DISCLAIMER I I I I I I ' I I i I I I I I I I I 3 I I I I . I I I I i I I 11/19/2007 AT 07:31 PM 512522253007-002 15836 OC7W2LLN ESTIMATE OF RECORD 1997 NISS ALTIMA GXE 4-2.4L-FI 4D SED GRAY INT: I FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM: I ANY PERSON WHO KNOWINGLY PRESENTS, FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIME AND AY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. I 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 QUANTITYlINCL=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=REFINISHIREPL=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: 4=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. I I I I I I I I I I I I I I I I I 4 I I 11/19/2007 AT 07:31 PM 51252225300.7-002 15836 OC7W2LLN ESTIMATE OF RECORD 1997 NISS ALTIMA GXE 4-2.4L-FI 4D SID GRAY� INT: ESTIMATE BASED ON MOTOR CRASH ESTIMATING GUIDE. UNLESS OTHERWISE NOTED ALL ITEMS ARE DERIVED FROM THE GUIDE.AEF3789 DATABASE DATE 10/2007, CCC DATA DATE 10/2007, 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 RELY 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 II , • I 1 • I I I I I I I 11/19/2007 AT 07:31 PM 512522253007-002 15836 OC7W2LLN ESTIMATE OF RECORD 1997 NISS ALTIMAIGXE 4-2.4L-FI 4D SED GRAY INT: I ALTERNATE PARTS USAGE I AFTERMARKET PARTS I AFTERMARKET SELECTION METHOD: AUTOMATICALLY LIST I NO. OF TIMES USER WAS NOTIFIED THAT AN AFTERMARKET PART WAS AVAILABLE: 0 I NO. OF AFTERMARKET PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 I OPTIONAL OEM PARTS I OPTIONAL OEM SELECTION METHOD: AUTOMATICALLY LIST I NO. OF TIMES USER WAS NOTIFIED THAT AN OPTIONAL OEM PART WAS AVAILABLE: 0 I NO. OF OPTIONAL OEM PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 I I RECONDITIONED PARTS I RECONDITIONED SELECTION METHOD: AUTOMATICALLY LIST I NO. OF TIMES USER WAS NOTIFIED THAT A RECONDITIONED PART WAS AVAILABLE: 0 1 NO. OF RECONDITIONED PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 I I RECYCLED PARTS I NO. OF TIMES USER WAS NOTIFIED THAT A RECYCLED PART WAS AVAILABLE: 0 I NO. OF RECYCLED PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 I I I I I I I I I I I I I I 6 I I I I I I M. CLAiM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: ,L I x009 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 �:gII on your claim.by the Board of Supervisors. (Paragraph IV below), FEB 171008 given Pursuant to Government Code Section 913 and 915.4. Please note all AMOUNT: l �SZ ` SC( COUNTY COUNSEL "Warnings''.. MARTINEZ CALIF. CLAIMANT:(J-v`✓ to Pr Cil 3 ATTORNEY: DATE RECEIVED: a5/o g ADDRESS: iDE << t NG BY DELIVERY TO CLERK ON: T_S�d� Cb, BY MAIL POSTMARKED: 2� /ayDib — Cot ?o� FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, Clerk Dated: a./asjo w By: Deputy CC(r'c z Ale lsr� II. FROM: County Counsel 70: 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�L '" 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 eputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) months from the Ite this notice was personally served or deposited in the nmil 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 inimediateiy. *For Additiaial Warning See Reverse Side ot'T1iis,Notim AFFIDAVIT OF MAILING I declare under penalty of perjury y 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 tine 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 a wn above. Dated: JOHN CULLEN, CLERK By Deputy Clerk CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION:b ,L I coos 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 Put•suant.to Government Code AMOUNT: y l I Z Sc( Section'913 and 915.4. Please note all "Warnings''. CLAIMANT: ATTORNEY: DATE RECEIVED: -��5�03 ADDRESS: E ti` L r�r r� rG fvG� BY DELIVERY TO CLERK ON: i���`cr �r�c���t 2NSUtLf�rL�C Cb, T— BY MAIL POSTMARKED: 2 D' COV D') - ,) Zak. FROM: ,) Za1- FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, Clerk Dated: a /asjo ,�­ By: Deputy cc(cc.� z. ke Ls(,_ 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 91.1.3). ( ) 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 rejectedin full. O Other: I certify that.this is a!true and correct copy of the Board's Oi-dei- 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) rnontlrs from the date this notice was personally served or deposited in the n-tail 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 wide this matter If you want to consult an attorney,you should do so ininiediately. *For Additiaial Warring 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 STATE FARM State Farm Insurance Companies 6% INSURANCE r� State Farm Insurance Subrogation Services February 21, 2008 PO Box 2371 Bloomington, IL 61702-2371 Clerk of the board of Supervisors County Administrations B1dgs �Room 106 651 Pine Street RECEIVE® Martinez, CA 94553 FEB 2 5 2008 CLERK BOARD OF SUPERVISORS RE: Claim Number: 05-B044-164-BLM CONTRA COSTA CO._ Date of 'Loss : January. 9', 2008 Our Insured: Joe Hagan Your Insured: City of Pittsburg Your Policy Number: Your Claim Number: Dear Penny Bailey: Enclosed is the additional documentation you requested. Please review and remit payment ;::Of our 'claim or` call• if you have questions . Per your request I have faxed the completed claim form on 2/21/08 and have mailed the original release copy. In order to assist you in evaluating and processing the subrogation claim we are asserting, we may provide non public personal information about our customer. We are sharing this information to effect, administer, or enforce a transaction authorization authorized by the consumer. However, you are neither authorized nor permitted to: (1) use the customer information we providefor any purpose other than to evaluate and process the subrogation claim or (2) disclose or share the customer information we provide for any purpose other than to evaluate and process the subrogation claim. Thank you for your cooperation. Sincerely, Demetria K. King Claim Processor (877Y ..457-8276 , Team 60 State -Farm Mutual Automobile Insurance Company . HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001 County Administrations Bldgs Room 106 Page 2 February 21, 2008 Enclosure BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLA DANT A. A claim relating to a cause of action for death or for injury to person or to personal propert3 or growing crops shall be presented not later;than six months after the accrual of the cause of actiom. A claim relating to any other causeof action shall be presented not later than one year after the accrual of the cause of action- (Gov. Code § 911.2.) S Claims most 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 fo= ME ME ot%No calf aaaa■a■tRTEN aft Amman WE a aRat■R RXmXPBEEN NOR■tamankK a■agraaaaacaaa ci mi RE: Claim By: Reserved for Clerk's filing stamp RECEIVE® Against the County of Contra Costa or ) FEB 2 5 2008 CLERK BOARD OF SUPERVISORS District) CONTRA COSTA CO. (Fill in the name) ) q4— Ib �( The undersigned claimant hereby makes clahin against the County of Contra Costa, or the above-named district in the sum of S and in support of this claim represents as follows; 1. When slid the da n ge or inju,-y occur'? (Clve exam date and hour) 2. Vvli= did the damage or injury occur? (Include city and county) IO P�4-.s 3. How did the damage or inJury occur? (Give fill detail ;use extra pa er if required) -.Q. � d M.Y 4_ What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? DM�g Lem - 5 V�Iat are the names of county or district officers,servants, or employees causing the damage or injury? (1n- � /,� ��" � Z 'd SSZ 'ON A]AHMN Kli 3�D Wd90 :� 8006 'OZ '83i W^a danage or injuries do your claim, resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage_) �k3lrn� ( '�U OL, 1 S U-Zwl2� 7. Tow was the amount claimed above computed? (luclude the estimated amount of any prospective injury or damage.) S. Names and addresses of witnesses, doctors, and hospitals: 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT ■ ■!lallalYalY=■YEARN WEIR PENN atloss KOREA llalalaBEAR laaalamok RO{Y{{RR{{tR YY R MEN RAI!lRY YI! ) .Gov. Code Sec. 910.2 provides"The claim shall be ) signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attomey) ' e, C 6 -'s LQ e+1LVU"bg -W Name and address of Attorney ) Amo U Jt-Q�.� �a., Wa _tial (Claimant's Signature) PO ; 23-11. to ill -13 1 (Address) ) ) Telephone No. ) Telephone No. 8 -1 1 - 14,S 1 — 8 a 1 (o aaaa■{!l■a■YYkill AY{YMEANER now!{l!tail!!!■!alaERROR lalYANYY{{■{Y!R{lAEggs BEERS YIYI!{{!1 PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim Sled with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code; §§ 6500 et seq.) Furthermore, any attachments, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. A BERN l{laa!!l EmsMRS!!Y Y Y R■ME Y R Y R Y R R R R R R R R R R'{!{R a■A a a i a a l l l l l!l!!!!Y Y Y R R ERR MANERRVEF 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 immprisorment and fma. 'd SSZ 'ON 1N3W3MM �SId 33) N90 :� 8006 '06 '833 I J' I , I I CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: A portQ , Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, j NOTICE TO CLAIMANT and Board Action. All Section references ai•e to ) The copy of this document mailed to California Government Codes. ) you is your notice of the action taken �gIIon your claim by the Board of I Supervisors. (Paragraph IV below), FEB 2 9 2008 given Pursuant to Government Code Section 913 and 915.4. Please note all AMOUNT: Zl� COUNTY, CALIF.SEL "Warnings". CLAIMANT: (fit K�� MERR�T ATTORNEY: KIN DATE RECEIVED: 2.12q([1 I ADDRESS: Icl,00 ►3AOCsER PHss,v"( BY DELIVERY TO CLERK ON: I AN't�oCH� �A aK63{ BY MAIL POSTMARKED: N (A FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claire. JOHN CULLEN, er k Dated: 212A log By: Deputy— ff. eputyII. 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). ( ) Other: I I Dated: f 3� �' 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: 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. I Dated: 04L, Loc JOHN CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have;only six(6) months from the ate this notice was personally served a or deposited in the mail to file a covet ction on this chiim.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 War nirg See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of per jui,y that i. am now, and at all times herein mentioned, have been a citizen of. the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this .Board Order and Notice to Clainiant, addressed. to the claimant as shown above. Dated: JOHN CULLEN, CLERK By uty Clerk I I CLAi. I BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY. AA BOARD ACTION: Claim Against the County, or District Governed by ) the.Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. A11.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: 2A$ 00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: iA,rTORNEY: bilk DATE RECEIVED: 2I 2� ADDRESS: 1 CtM pA55 W BY DELIVERY TO CLERK ON: III LA C9 AN^C►oC H� t"A °t X16 31 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, Dated: �?t( �� By: Deputy _J ► V� 1�1 • II.. FROM.: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially;with Sections 910 and 910.2. I ( ) 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 91.1.3). ( ) 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). 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. if you want to consult an attorney,you should do so hnnnediately. *For Additional Warning See Reverse Side of'Tliis 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 O1/1.4/2008. at 04 : 09 PM Job Number: 76703 PLEASANT HILL COLLISION REPAIR CENTER License # :AA187241 Federal ID # : 680370217 1581 Oak Park Blvd Pleasant Hill, CA 94523 (925) 939-1160 Fax: (925) 939-1280 PRELIMINARY ESTIMATE Written By: Aaron Silva Adjuster: Insured: Nikki Merritt Claim # Owner: Nikki Merritt Policy # Address: 1900 Badger Pass Way Deductible: Antioch, CA 94531 Date of Loss: Business: (925) 646-6119 Type of Loss: Point of Impact: Inspect Location: Insurance Company: Days to Repair 1993 LEXU LS 400 8-4 . OL-FI 4D SED Int: VIN: JT8UF11E8P0171040 Lic: Prod Date: Odometer: Air Conditioning Rear Defogger Tilt Wheel Cruise Control Telescopic Wheel Climate Control Keyless Entry Theft Deterrent/Alarm Tinted Glass Body Side Moldings Dual Mirrors Console/Storage Fog Lamps Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks Power Driver Seat Power Passenger Seat Power Antenna Power Mirrors Power Trunk/Tailgate AM Radio FM Radio Stereo Cassette Search/Seek Anti-Lock Brakes (4) Driver Air Bag Passenger Air Bag 4 Wheel Disc Brakes Leather Seats Bucket Seats Recline/Lounge Seats Automatic Transmission Overdrive Aluminum/Alloy Wheels ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- "1# Rpr Polish Tree fall out 2 . 8 ' # RT rear Qtr of Vehicle 1 complete ------------------------------------------------------------------------------- Subtotals =_> 0 . 00 2 . 8 0 . 0 1 I 01/14/2008 at 04 : 09 PM Job Number: 76703 PRELIMINARY ESTIMATE 1993 LEXUI LS 400 8-4 . OL-FI 4D SED Int : Parts 0 . 00 Body Labor 2 . 8 hrs @ $ 78 . 00/hr 218 . 40 -!-------------------------------------------------- SUBTOTAL $ 218 . 40 -7-------------------------------------------------- GRAND TOTAL $ 218 . 40 I ADJUSTMENTS: IDeductible 0 . 00 --'-------------------------------------------------- CUSTOMER PAY $ 0 . 00 INISURANCE PAY $ 218 . 40 I FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM: I 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. I 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=ALIGNA/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 UINIQUE PRICING OR DISCOUNT. NWCPP=NATIONWIDE CRASH PARTS PROGRAM. I I I I I I I I I I 2 . I I 01/21/2008 at 01 : 58 PM Job Number: 31033 ANTIOCH AUTO BODY, INC. License # : 37962 Federal ID # : 680336031 1401 VERNE ROBERTS CIRCLE ANTIOCH, CA 94509-7915 (925) j757-3586 Fax : (925) 757-5246 PRELIMINARY ESTIMATE Written By: SERGIO GONZALEZ ' Adjuster: Insured: RAY MERRITT Claim # Owner: RAY MERRITT Policy # Address: 1900 BADGER PASS WAY Deductible: ANTIOCH, CA 94531 Date of Loss: Day: ( 925) 757-2408 Type of Loss: Day: (925) 522-7605 Point of Impact: Inspect Location: Insurance Company: Days to Repair 1993 LEXU LS 400 8-4 . OL-FI 4D SED BLACK Int : VIN: JT8UF11E8P0171040 Lic: 3TGY496 CA Prod Date: Odometer: 226010 Air Conditioning Rear Defogger Tilt Wheel Cruise Control Telescopic Wheel Climate Control Keyless Entry Theft Deterrent/Alarm Tinted Glass Body Side Moldings Dual Mirrors Console/Storage Fog Lamps Clear Coat Paint Two Tone Paint Metallic Paint Power Steering Power Brakes Power Windows Power Locks Power Driver Seat Power Passenger Seat Power Antenna Power Mirrors Power Trunk/Tailgate AMI Radio FM Radio Stereo Cassette Search/Seek Anti-Lock Brakes (4 ) Driver Air Bag Passenger Air Bag 4 Wheel Disc Brakes Leather Seats Bucket Seats Recline/Lounge Seats Automatic Transmission Overdrive Aluminum/Alloy Wheels ------------------------------------------------------------------------------- NO. OP . DESCRIPTION QTY EXT . PRICE LABOR PAINT ------------------------------------------------------------------------------- 1# Subl POLISH EXTERIOR FOR TREE 1 250 . 00 X SCUFFS I ------------------------------------------------------------------------------- Subtotals =_> 250 . 00 0 . 0 0 . 0 1 01/21/2008 at 01 : 58 PM Job Number: 31033 PRELIMINARY ESTIMATE 1993 LEXU LS 400 8-4 . OL-FI 4D SED BLACK Int : Parts 0 . 00 Sublet/Misc. 250 . 00 ---------------------------------------------------- SUBTOTAL $ 250 . 00 ---------------------------------------------------- GRAND TOTAL $ 250 . 00 ADJUSTMENTS : Deductible 0 . 00 ---------------------------------------------------- CUSTOMER PAY $ 0 . 00 INSURANCE PAY $ 250 . 00 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 : ACJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT . PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT 0/H=OVERHAUL OP=OPERATION NO=LINE NUMBER. QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE R.PR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT W1 =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 . 2 01/21/2008 at 01 : 58 PM Job Number: 31033 PRELIMINARY ESTIMATE 1993 LEXU LS 400 8-4 . OL-FI 4D SED BLACK Int : EsLimane based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from rhe Guide AEB8900, CCC Data Date 12/01/2007, and the parts selected are OEM-parts manufactured by file vehicles Original Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM ;Op-_ional OEM) or ALT OEM (Alternative OEM) parts are OEM part; 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 mai have come from: an alternate data source. Tilde sign (-) items indicate MOTOR Not-Included Labor operations. Nen-Original Equipment Manufacturer aftermarket parts are described as AM, Qual Repl Parts or Comp Repl Parts which stands foi Competitive Replacement Parts. Used parts are described as LKQ, Qua! Recy Parts, RCY, or USED. Reconditioned parts are described as R.ec:ond. Recur^_d parts are described as Recore. NAGS Part [cumbers and Benchmark Prices are provided by National Auto Gass 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. mound sign (t) _;.ems 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 comp-ete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. 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'� "C'�L .f „ -•.yA.�11 �"i '�'�, � L� 9 �+»,..."`"" V r" 1;."��'�'1�''� y � c i '�:,,r��,�i'l�x .,'-4"'l� .t\ e'-� ��t� fi .^ _s 5,,,.. �7��'•".+��j�s• .`: 1'E-�ti,��'- �� ��", a '�.,..�....,, +� r h`l. �t�± r - �.. �`� ��•' „� - ,'1r �,fr�"`*�"'7'�'�Rte'� �'` �t�1j�,�'ix�f _rte,.- �: t''s 4 �°�\ r "• . .�T �,t , „f-- 4 .All����v'ry ra��st'�'I ��j�� 'aI�s+' �`C. "•p v< �ti�* r,. r�'�^'y,. t� ;. :.� y. :.�*� ;.'*-- � "i",� 'ry j!`-��/1�'gym,-1:;, `p� �„-�=-+�c?1-a'';%==��••� � -' '' ,�. -«mom ..fir' .i*�,�3t•�.�����(r���. riti �.��r i s• i� �, _„���f iis` _ .' �,-=v'''. itowl"' :�►,� Ti! I AMENDED CLAIM BOARD O.F SUPERVISORS OF CONTRA COSTA COUNTY j BOARD ACTION' i- f S 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. ) I you is your notice of the action taken j on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Z� � Section 913 and.915.4. Please note all fIMOUNT: 2i 3 "Warnings". CLAINIANY.,$)tLn 4-lyGduo. ATTORNEY: raj-jjU.l S •01,S DATE RECEIVED- AD 1 ECEIVED-AD1 R -ESS: ���,�i, _�(�; �j! Z BY DELIVERY 1'O CLERK ON: ;,-2 �.l l I GkitrJwrYcr Ci BY"MAIL POSTMARKED: �- FROM: Clerk of the Board of Supervisors TO: County Counsel j Attached is a copy of the above-noted claim. JOHN CULL , Clerk. 5 J .Dated: By: Deputy I.I. l IZONI: County Counsel TO: Clerk of the Board of Supervisors I ( ) This claim complies substantially with Sections 910 and 910.2. ( ) This Claire FAILS to coiiiply substantially with Sections 910 and 910.2, and we are so notifying claimant. 'The Board cannot act for 15 days (Section 910.8). i ( ) Claim is not timely tiled. 'Ellie 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: I j j Dated: j By: Deputy County Counsel. 1.11. FROM: Clerk of the BoarLl . TO: County Counsel (1) County Administrator(2) O Claim was returned as untimely with notice to claimant (Section 911.3). I W. BOARD ORDER: By unanimous vote of the Supervisors present: ( j This Claim is rejected in full. O Other: i I I certify that this is a truejand correct copy of the Board's Order entered in its minutes for this date. I Dated: JOHN CU.LLEN, CLERK, By Deputy Clerk . WARNING (Gov. code section 9�13j Subject to terrain exceptions,you halve 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 yr attorney,you should do so immediately. *For Additional Warnuig See Reverse Side of 17ris Notice. AFFIDAVI'E OF MAILING 1. declare under penalty of per;j6q that 1 am now, and at all times herein mentioned, have been a citizen of the United St"Iltes, over age 18; and that today 1 deposited in the United States Postal Service in A arlinez, Calilornia, postage I•ully preliaid a certified copy ol• this Board Order and Notice to Clai'nrant, addresser) to the claimant as shown above. I Da(ecl. ._ __. JOI1N CUT-, EN, CI-,I_"AK 13)• Del)uty Clerk I ,I I I j I F A R E R National rJacument Center 4.»0�.,.. k's NO. Box 268992 (Nklaho ua City,OK 73126-8992 claunsdocuments@)farmersinstir ance.coin Fax : 877-217-1389. i 02/22/2008 Self.insured Attn: Penny Bailey ( E E:13VED 65.1 Pine St, Room 106 Martinez,CA 94553 I FEB 2 7 7008 Re: Our Insured: Shin Hyang Chung CLERK BOARD OF S+JPEFVISORS Our Claim#: 099 SUB .1011217212-1 CONTRA COSTA CO. Date of Loss: 11.1/30/2007 Your Insured: Contra Costa County. Your Claim#: 64066 Amount Owed: $12,325.20 I Dear Penny Bailey: I We previously informed you ofour subrogation claim. Please review your file and advise us if you are now in a position to consider our claim. i If we do not receive payment within 7 days of receipt of this letter,we will assume that we. have your permission to arbitrate' If you are not a participating company with Arbitration Forums Inc., we will file a lawsuit against your insured. I.f 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 JennilerMiller Auto Subrogation Representative) 909-801-334.1 jennifer.millerCQ farmersinsurance.com i . . I i ; i KC4F30KZ .µ. CLAiNI BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: :or �--f �-� 2C'd� Claim the Against ai A n g 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: -~ i'° J11LL� Section 913 and 915.4. Please note all "Warnings". CLAIMANT:' L' LOU-- t''C`C��� <J► ATTORNEY: DATE RECEIVED: ADDRESS: q("I C�LL� ` � � �' �1~'' BY DELIVERY TO CLERK ON: BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claire. JOHN CUL N, Cleric Dated: �' ')I�'i,lC�l�(, 27 2�%Z'C By: Deput R. FROM: County ounsel 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'war ring of claimant's right to apply for 1'eave 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). 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 certain exceptions,you have only six(6) moritlrs from tlr.e 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 ofTlris Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am no'w, 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: JOHN CULLEN, CLERK By Deputy Clerk ' BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. A claim relating to a cause of action f6r 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 , > RECEIVED Against the County of Contra Costa or ) FEB 2 2008 mtra C®ska V un. ,11 District) CLERIC BOARD OF SUPERVOORS (Fillin the name) ) CONTRA COS1A CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$QA Vl i tl i on and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) Xn, 22&7-W r `�n�.e.�,�� AG.\�� INN-]SE 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give Ail] details; use extra paper if required) 4. What particular,act'or omission on the part of count,Y or district officers, servants, or employees caused the injury or damage?L'Pr^Lain Menenihers e4 CD,Co Cou c� 5her;f de.. Without cae..te, �1al,�c��s1�`, ,�„t ra�nc� ®n nr 1 11 rPaS �,� � arl��� hr ° SAP �t� bet—0, 0o?�A� . ZS,o7 C�uS'\nWA �1���e°�r�se��AVTA �rrnankn� '�n v� � m� E r' k havds I wr\s�. SAL mr f Son best m \-S , `� 9 5 What are the names of county or district officers, servants, or employees causing the damage or injury? ��C ,�����I 1. e�u�LaQ� 'Ro- Sek on �2-�1-�1 , -zc�ul.� AGutl *-� ' 61 E -De� 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for autodama e.)[o,.Co,Cnun 7N�r12�►ent��y E : tit l�a�d Mid liV►2�S' JJ��✓1 � ✓ia1anf�i ��d !�e err 2Dbl-AuQ- 20..?ndl. 7. How waste amount claimed above computed? (Include the estimated amount of any 11 prospective injury or damage.) �iavcn �iaG1 n 0v¢Si�,� �'muSL1IaL3�i0A 17raL/ G�c/�. e{ -Z Ny1 '�,h, �\\k aLC.wrtJ1� \ af5 1 A16 6M 'ko �.� di, `4 „ 1.140. 11m o -T—WI ittm4 +I T-Y\ 1=!ak vn\t halfdS i Names and addresses of witnesses, doctors, and hospitals:UPOn My Reldf--140 ML\-&,JQA (\un&A.A+- ori %�,lDt)l a(� 'tsne'6,r M" i��'�C1L 1lEa.✓�S E. MD Lama >E� rr� ill a11ck ;Uk w.\aac� ;Mo- Soma. N���, "tAv-; J, 11%) r Ayl Wi fl. y, 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT -InCAr"egLad —5611 unii u x{. 2008 10 ■■rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr� Gov. Code Sec. 910.2 provides "The claim shall be signed by the claimant or by some person on his behalf."'; SEND NOTICES TO: (Attorney�_� Name and address of Attorney ) (Claimant's Signatur6 (Address) ) Martne2 , Lai. °lyssa Telephone No. ) Telephone No. 1ALSS. SID) 232- 'S 2--�`B Mgh.ee- ■■r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r l 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. M r r r r r r r r r r r.r r r.r r r r r r r r r r r 0 r.r r r r r r r r r r:r r r r r r r r r r r r r.r r r r■:■r r r r r r r r r r r r r r r r r r r r l 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. R�',4Mr. Earl- L�� a� ,R.42-DD ovs%�� /s�. 2y zoo8 �D Mlve cv", zi cn-1 55I �n nn .� E��LZRA zol467 d sea!Duf_,.Sarple 1;qa;/ ------- __---__-.. --- - -- —LY_L✓LL �a���r/�GL rF.9��°�r��_._.�[��_e�d�__�..>t .�`?_^._��--1�uf i__1�L'e;v�P�� f ---- 0--- -LC� -Lk An his . -- _���n�--.��.��o_���u�, .z d,� as �/�_✓_. As �� was �%f1 - _- - - a Xartaau-W_ on 1, a Ig-4_.L r,s�._Xe_r���_:�_--�v,.�a.�_L f—r✓l ac�,a_.�i,�.- - nerL -ac, Illsa-�-�----��:;�1-�•__r- �.-- -.�4.s_._',_ ura.s_��;� ._�sr���_. Lip n9aod- gat - _ _......_._.. _. . _ Q_� . 7�'IaO.�L-.r__-'�L�_ ..L:l�f�..�__�/l�/'I�•..� .:�ff'/(2�h/n __ �i��a. �/�s_�__ �1'i�l__�L/�1�`... _.. . .. - --------.--11�]_,YD_r!_.tuL'dT1�1�-.-Flo_.r✓_.---. ._ C7�1�07 .a 04!i �a-cl&� - i— i _.-_____-=- --��--� --- 2�, 2�1, � �.�as'_�te�e����� -����,�� W�.5�_�_nu►�,_���u5�..---�-T _ anmiya1VL._ Q6av_�drz .__�o,�/a . ZLreaso_ia..l�1A��m/_app% �__ •��°,>> _ ' �o�l; � � _ L..wCJ le /Ca, -'e!W. Aftic-s a4, -�- -------- �����GU��f'/i:^'.�=_� ���2-e�0��7r�-Y,ipJ/��,.���e:l(�li,�(' _G��:r�.�_�! ��C� �� �/,.Jt�%•._�f•_%� %!=-�����• ..