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Home My WebLink AboutMINUTES - 06242008 - C.29 (4) CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTIONk-We, 9-4 2-06 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. 6�13� � `' you is your notice of the action taken on your claim by the Board of MAY 2 3 2008 Supervisors. (Paragraph IV below), COUNW COUNSEL given Pursuant to Government Code AMOUNT: (of4qfUARTINEZCAUF Section 913 and 915.4. Please note all �f `Warnings". � CLAIMANT:3c VVI �� (..VWPJ Las ATTORNEY: � DATE RECEIVED: MQ 23� 2�8 wundwn 6evllusIJ ADDRESS: BY DELIVERY TO CLERK ON: BY MAIL POSTMARKED: �Tn_ Iw 1P ti X02_ �i FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. oZ3 a JOHN CUL EN, Clerk Dated: By: Deput I1. FROM: iCounty7ounsel TO: Clerk of the Board of upervisors ( his claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). O Other: Dated: Jr'_X� —O By h/1 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: � L�>� JOHN CULLEN, CLER2Byy===beputy Clerk WARNING (Gov. code section 913). Subject to certain exceptions,you have only six(6) months fi-oin 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. Il'you want to consult an attorney,you should do so iuunediately. *For Additiaial Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of per jury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; 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 claimal as own above. Dated: JOHN CULLEN, CLERK By y Clerk CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTIONdue, 9_4 ZtFj Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to California Government Codes. ) you is your notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code AMOUNT: . �� Section 913 and 915.4. Please note all /1 `Warnings". CLAIMANT:s � 1 lZfl (,ti 1�E' l '��r _ Cute ur�w S ATTORNEY: DATE RECEIVED: ADDRESS: BY DELIVERY TO CLERK ON:1ti W1 71 `� BY MAI POSTMARKED: FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. f y� G � �C JOHN CUL EN, Clerk 11 Dated: By: Deput tpQ i u= ac - Il. FROM.: tountyCounsel TO: Clerk of the Board of upervisors ( ) This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). O Other: Dated: By: Deputy County Counsel IIL 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: O This Claim is rejected in full. O Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JOHN CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913). Subject to certain exceptions,you have only six(6) months from the date this notice was personally served m or deposited in the ail 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 Additiaial Warning See Reverse Side oMiis 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 1 t STATE FARM State Farm Insurance Companies a INSURANCE State Farm Insurance Subrogation Services May 13 , 2008 PO Box 2371 Bloomington, IL 61702-2371 Certified Mail-Return Receipt Requested RECEIVED County Administrators Office County Administration Building MAY 2 V 200$ 651 Pine Street, 11th Floor Martinez , CA 94553 CLERK BOARD OF SUFERViSORS CONTR STA CO. RE : Claim Number: 05-BO62-505 �qy� Our Insured: Constance Windmiller I Date of Loss : March 4 , 2008 Your Insured: Contra County B Your Insured Driver: Don D Parker Your Claim Number: Your Policy Number: CLM# 64488 Dear Penny Bailey: It is our understanding that you are self insured. Our investigation indicates you are responsible for this claim. Therefore, we are seeking recovery from you. This letter is to notify you of our subrogation claim and request your cooperation in settling this matter. To assist you in your review, here is a breakdown of the amounts State Farm paid by Cause of Loss : 041/045 - Uninsured Motorist BI $ 042 - Uninsured Motorist PD $ 300 series/400 - Comp/Collision $99 . 23 501 - Rental/Loss of Use $50 . 00 600-050 - Med Pay/PIP $ Other $ Salvage Recovery $ Amount State Farm Paid $149 . 23 Insured Deductible $500 . 00 Total Claim Amount $649 . 23 Based on the assessment of liability between the parties, State Farm Mutual Automobile Insurance Company is seeking 1000 of the Total Claim Amount listed above . The amount payable to State Farm Mutual Automobile Insurance Company for this loss is $649 . 23 . HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001 Page 2 May 13 , 2008 Please remit payment of this claim and include our claim number on the payment . If you have any questions, please call 877-457-8276 and any member of Team #60 may assist you. Thank you for your cooperation. In order to assist you in evaluating and processing the subrogation claim we are asserting, we may provide nonpublic personal information about our customer. We are sharing this information to effect, administer, or enforce a transaction authorized by the consumer. However, you are neither authorized nor permitted to : (1) use the customer information we provided for 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. Sincerely, ) Stacey L. Van egraft Claim Processor (877) 457-8276 , Team 60 State Farm Mutual Automobile Insurance Company Enclosure (s) PS : There is a $251 . 89 supplement payment pending. RBZ0006Z date : 05-13-08 page : 1 � � •� route to: Steve Lollar STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY AUTO PAYMENTS BY COL claim number policy number 05 -5052 - 505 0986 - 063 - 05 named insured date of loss W=NDM=LLLETZ CONS P_ _E 0 3 — COL 4 O O C denotes consolidated payment E denotes EFT payment P denotes previous data COL: 400 indemnity: 99 . 23 dir rcov: 0 . 00 expense: 0 . 00 payment number payee amount status COL pay cd rsn reporting party 102054993Q CONS'TANCE WINDM 99 . 23 PAID 400 1 Named Insu COL 5 O Z C denotes consolidated payment E denotes EFT payment P denotes previous data COL: 501 indemnity: 50 . 00 di r rcov: 0 . 00 expense: 0 . 00 payment number payee amount status COL pay cd rsn reporting party 102624051) CONSTANCE WINDM 50 . 00 PAID 501 1 Named Insu RBZ00032 date : 05-13-08 , .. , time : 12 : 26 PM ........... _. ........_ __... � E.te to: Lolla t :t e STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY VEHICLE DAMAGE REPORT claim i number date of loss 0 5 —B O (5 2 -5 0'S 03-04-08 -A- Estimate Vehicle Info Vehicle Owner: WINDMILLER, CONSTANCE Vehicle Description: 06 Toyota Tundra 4E) PkupX silver Date: 5/12/2008 04:16 PM Estimate ID: 05-BO62-50501 Estimate Version: 2 Supplement: 1(F) 5/12/2008 04:10:33 PM Profile ID: Pleasant Hill State Farm Insurance Companies 1475 66TH STREET EMERYVILLE, CA 94608 (510) 985-6200 Fax: (866) 638-6498 Damage Assessed By: JOE BRAZ Appraised For: 1TEAM PROCESSOR (800) 440-6175 Supplemented By: JOE BRAZ Supplement Fax: 866-638-6498 Type of Loss: Collision (Spec) Date of Loss: 3/4/2008 Deductible: 500.00 Claim Number: 05-8062-50501 Insured: CONSTANCE WINDMILLER Owner: CONSTANCE WINDMILLER Address: 1910 RAINIER DR, MARTINEZ, CA 94553-4927 Telephone: Work Phone: (510) 934-9339 Home Phone: (925) 335-0113 Mitchell Service: 911752 Description: 2006 Toyota Tundra SR5 Body Style: 4D PkupXCb 6' Bed 128" WB Drive Train: 4.7L Inj 8 Cyl 2WD VIN: 5TBRT341162476369 License: 8A03380 CA Mileage: 11,760 OEM/ALT: A Search Code: B1PP Color: silver Options: ALUM/ALLOY WHEELS, AIR CONDITIONING, POWER STEERING, POWER BRAKES, POWER WINDOWS, POWER DOOR LOCKS, TILT STEERING WHEEL, AUTOMATIC TRANSMISSION, STEP BUMPER, DEEP TINTED GLASS, BED LINER, TRAILER TOWING PKG., PASSENGER-FRONT AIR BAG, 4-DOOR PICKUP, DRIVER-FRONT AIR BAG Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 AUTO BDY OVERHAUL REAR BUMPER ASSY 1.7 S1 2 102467 BDY REMOVE/REPLACE REAR BUMPER STEP TYPE BAR 52151-00O21 430.58 INC 3 102470 BDY REMOVE/REPLACE L REAR OTR BUMPER STEP PAD 52164-00010 25.98 INC 4 900500 BDY* ADD'L LABOR OF DRILL OUT HOLES FOR REAR PARKING SENSORS Existing 1.0 * S1 5 900500 BDS* ADD'L LABOR OP REMOVE AND THEN REINSTALL PARK SENSORS Sublet 162.50* 0.0 * S1 6 CAMPWAYS 228-9310 * Judgement Item ESTIMATE RECALL NUMBER: 3/25/2008 10:20:45 05-8062-50501 Mitchell Data Version: OEM: APR_08_V0507 UltraMate is a Trademark of Mitchell International Copyright (C) 1994 - 2008 Mitchell International Page 1 of 3 UltraMate Version: 6.5.017 All Rights Reserved Date: 5/12/2008 04:16 PM Estimate ID: 05-BO62-50501 Estimate Version: 2 Supplement: 1(F) 5/12/2008 04:10:33 PM Profile ID: Pleasant Hill Estimate Totals Add'L Labor Sublet I Labor Subtotats Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 2.7 72.00 0.00 0.00 194.40 Taxable Parts 456.56 Bdy-S 0.0 72.00 0.00 162.50 162.50 Sales Tax a 8.250% 37.67 Non-Taxable Labor 356.90 Total Replacement Parts Amount 494.23 Labor Summary 2.7 356.90 III. Additional Costs Amount IV. Adjustments Amount Total Additional Costs 0.00 Insurance Deductible 500.00- Customer Responsibility 500.00- 1. Total Labor: 356.90 II. Total Replacement Parts: 494.23 III. Total Additional Costs: 0.00 Gross Total: 851.13 IV. Total Adjustments: 500.00- Net Total: 351.13 Less Original Net Total: 99.23 Net Supplement Amount: 251.90 S1: JOE BRAZ 251.90 P oint(s) of Impact 6 Rear Center (P) ESTIMATE RECALL NUMBER: 3/25/2008 10:20:45 05-6062-50501 Mitchell Data Version: OEM: APR_08_VO507 ULtraMate is a Trademark of Mitchell International Copyright (C) 1994 - 2008 Mitchell International Page 2 of 3 UltraMate Version: 6.5.017 All Rights Reserved Date: 5/12/2008 04:16 PM Estimate ID: 05-BO62-50501 Estimate Version: 2 Supplement: 1(F) 5/12/2008 04:10:33 PM Profile ID: Pleasant Hill Inspection Site: Elite A/b 2180 MARKET ST.Concord.94 Address: Elite A/b 2180 MARKET ST.Conco rd.94520.925-687-3117 Inspection Date: 3/25/2008 Body Shop: ELITE AUTO BODY & COLLISION CENTER Address: 2180 MARKET STREET CONCORD, CA 94520 Telephone: (925) 687-3117 Fax phone: (925) 687-4747 wwww**ww*wwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwww For your protection California Law requires the following to appear on this form: Any person who knowingly presents a false or fraudulent claim for payment of a loss is quilty of a crime and may be subject to fines and confinement in state prison This is an estimate. Repair facilities must inspect the vehicle to determine if any repairs not listed are required, and to contact State Farm before making such repairs. Repairer also is responsible for conducting any necessary inspection and safety checkes prior to and after completing repairs. wwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwww ESTIMATE RECALL NUMBER: 3/25/2008 10:20:45 05-6062-50501 Mitchell Data Version: OEM: APR_O8—V0507 UltraMate is a Trademark of Mitchell International Copyright (C) 1994 - 2008 Mitchell International Page 3 of 3 UltraMate Version: 6.5.017 ALL Rights Reserved 1 y 271031200 #' t ',�'" ''.iL,. .fin,� ..'�' •;V jR qz 2710312008 ti.--4 Y � 4f y l F a 1� 27/0312008 �r s �r 1� bY.ap��yiRlst•� ..-� ray, `. `\ N^ ,.. _ �� 'M 1C �D! d. .� tr t k..- � `k Y' T.�F ��' . � � 1' ,gym Y �- � � r.�r: r —— � ..gab+. W"a +...^? �'�� #' aA t ,M 3,„.,_ All �At •. Y{ k f , T �'�w �r� �f �> • ray �;�,. ,� � w-- - '> -- ��. `>:7" w . _� � � �f'f%., �- 1„y� w lit MNI * #' A TrTv r y. i VOW 4O *. �9 •p s a<3 P 5 �`( �,f - - - is .i opoo ` fill, �..�..�-.. .. .8.:0.4•p+�sA ^.n.. ' 03/07/2008 16:52 FAX 9256710309 STATE-FARM _ 1� 001 BOA" OF SUPERVISORS OF CONTRA COSTA COUNTY E � vc_oaS INSTRUMONS TO CLAWI--NT o 5 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 tb= accrual of the cause of actiozL A claim Te-latin.g to any other cause of action sha11 be presen ed not later Haan one yeor after the accrual of the cause of action. t (Gov. Code § 911.:?.) B. Claims trust be filed with the Clerk of the Board of Supervisors t t its office iu Room 106, County Administration Building,651 Pine Street,Martinez,CA 9455"' . C. If claim is against: a district governed by the Board of Supervisors, i ether than the Counry, 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. i F. Fraud, See penalty for fraudulelat claims,Penal Code Sec. 72 at the a>d of this form. ■no.■■s=■■r.s■.ss■■ ■■■.■e■■as■■sslss.■6••...2111■/o.■ns■.m■■■.Vw■.11..me.1 RE: Claim BY. Reserved for Cle rk's filing stamp } Against the County of Contra Costa or } District) } (Fill in the name) ) f The undersigned claimant hereby makes claim against the County of Conga Com or the above-named district in the sum of S and in support of this claim represei is as follows: 1, When did the damage or injury occur? (Give exact date and hour) C( •30 A.M . 314 1 Ob i ?. Where did f6e damage or injury occur? (include city and county) �S 1 s�� S 1' fA ,nem. , CA e or in occur? (Give full details;use extra I apes if required) 3. -How did the damage jam' yr Co J�.� 0\-*- ',nsUreC\ Lis �-ke8 o-� "� 4. What particular act or omission on the part of county or district o ficers, servants, or emplo—y-ee+s caused. the,injury or damage? 1oov- emOoce �C,� t+l- 4c to v- ` ►h5 J r eA ' 5 What are tht names of county or district officers,servants, or eaap ogees causing the damage or injury? "w ^ �-i . � p,� Off• +t'15 ure�S � la•�-�- a, n o-to �,1��5,n2 5 S Ca 03/07/2008 16:52 FAX 9256710309 STATE-FARM 2002 5. da nage or injuries do your claim resulted? (Give full extm.t of injuries or damages claimed. Attach two estimates for auto damage.) C.o . J 7. How was the amount claimed above computed? (Include the r stimated amount of any prospective injury or damage.) g. Names atzd addresses of witnesses,doctors,and hospitals: �0 C*J� 9. List the expenditw:es you mad:on account of this accident or injury: DATE `_MOW ■ ■■■ 99 a■■r■.■ ■■f■■■an..■■■•f■■s s■■■■1■of•••■a•a t..s a ■■■■.s t■ ,as.. ■a■■■a■■ s■.a s■s t .Gov. Code Sec. 910.2 provides"Tl.e claim shall be signed by the claimant or by some 1-erson on his behalf." SEND NOTICES TO: (Attorney) � Name and address of Attorney Q, } (Clalmaa�Qi)pL=ro) �jar) rf`+ } (Address) Telephone No. Telephozze No. CC7 ■ aaa .•a■■a, I•■■a■a■.■ar■a■ ■a■a■■■.. ...■.■r•r■■s■a■�■■■a■.■■•■■ss..s a■ago•a•a■•a a..a t PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the County under I•e Tont Claims Act, is subject to public d nts, a dums or supplements attacbed to the claim form,incndcr the California Public Records AcL (Gov. luding me dical reca ds, w-also subject e Ore,attachments, P public disclosure. r■■aa a..■s■■■IIs.■%. "allow M . a pass saaa.■ata■a 111.5 s■a as.ase■■ .■ataaa at■ss■.a a■■a..■sl NOTICE: Section i2 of the Penal Code provides: o, with intcat to defraud,presents for allowance or for paytneo:to any state,board or officer, or Every person wh to any county, city,, or district board or officer, authorized to allow or pay t} same if genuine, any false or fraudulent claim, bill, account voucher, or writing, is punishable ne t er by iinpr dol ar�1 t in a orCounty both such period of not more than one year, by a fine of not exceeding ten thousand dollars imprisonment and fine, or by imprisonment in the state prison, by a fine of nc t exceA.ding ($10,no), or by both such imprisonment and fine. C13/07/2008 16:52 FAX 9256710309 STATE-FARM 2003 b X37 t�s r Contra Doug Parker A&A i'l- costa Lead Sta4onery Engineer County (925)313.7052 FAX dpark�gsd.co.contra-costa.ce-u9 General Services Department Statlonary Engineers ONWon 2467 Waterblyd Nlay Martinez,CA 94553 Ge (/ f /j �3S C/ s S :. c� La 03/07/2008 16: 52 FAX 9256710309 STATE-FARO! Q004 I _rb j I j,�� reap QjAAPer of w �Y