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HomeMy WebLinkAboutMINUTES - 06032008 - C.23 t AMENDED CLAiM � 2S BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION:ime, --3 2M 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 Calilornia Government Codes. ) you is your notice of the action taken on your claim by the I3oard of Supervisors. (Paragraph 1V below), given Pursuant to Government Code AMOUNT-: l o, Section 913 and 915.4. Please note all "Warnings". CLAfIt-IA.NT: Cj�I.�O �Sc� l,, �CI�C�rc�5tri1 ATTORNEY: _ DATE RECEIVED: W- "as �CSD� — I .-...- ADDRI SSLO(� , (XACO GoeST BY DELIVERYTO CLERK ON: RX �b Oq ( Lq BY TVI All- POS'i'MARKED: h ale ('' �i'a150a qd� _ FROM: Clerk of the ll�ard L of Supervisors �C0: Cor.mty Counsel Attached is a copy of the above-noted claire. t JOHN CUL N,,Clerk Dated: By: Deputy )e M&LA-, 11. FROM.: County Counsel T0: Clerk of the Board of Supervisors (,>--fiis claim complies substantially with Sections 910 and 910.2. ( ) This Claim FALLS to coniply substantially with Sections 910 and 910.2, and we are so notifying clainiant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely Filed. 'Che Clei-k should return claim on ground that it was filed late and send warning of claimant's right to apply liar leave to present a late claim (Section 91. .1.3). ( ) Other: -- -- — Dated: By: .Deputy County Counsel Ill. 1.RONI: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( j Claim was returned as untimely with notice to claimant (Section 911.3). W. BOARD ORDER: By unanimous vote of the Supervisors present: C>4 This Claim is rejected in full. � ) Other: I certify that this is a (rue and correct copy of the Board's Order entered in its minutes for this date. Dated: . n JOI-I.N CUL.LEN, CLERK, I3y I_� puty Clerk WAR..NiNG (Gov. code section 913) Sul>lect.to certain exceh.►tious,you have only six((►)mouths fr-om ll a date this notice was personally served or deposited in the mail to file a coint action on this claim.See Government Code Section 945.6.You may sc'elc the advice of an attorney or. om• choice in connection with this matter. 117 you want to consult m attorney,you should do so immediately. *For Additional Wanting See Reverse Side of This Notice. — A.i HDAVIT OF M.AlLINCT — — -- declare under penalty of perjua.y that I am now, and at all times herein mentioned, have been a citizen of the United States, ()ver age 18; and that today I deposited in the United Slates Postal Service in NI:u-liAiez, California, postage fully prepaid a certifier) copy of this Board Order sand Notice to Claimant, addresscd to file clainjPata. sho1vll above. Dated: ..-_ .. .._ j0.1 IN C[.!i-,I.,i N, C'I_..F.IZK By r _ _.Depuf.�. (:.clerk AMENDED CLAIM BOARD OF SURERVISORS.01+ CONTRA COSTA COUNTY BOARD ACTION::-Xthe, 3 Claim Against the County, or District Governed by ) the Berard of Sulrei-visors, Routing Endorsements, ) NOTICE TO CLAIMANT an(.] Board Action. A.II Section references are to ) '.Che copy of this document mailed to Cali(ornia. Government Codes. you is your notice of the action taken on your claim by the Board of Supervisors. (Paragraph 1V below), given Pursuant to Government Code AN,1.0UNT: C l SF "n �` Section 913 and 915.4. Please mote all "Warnings". CLAIMA_N'F� Gc,l o ATTORNEY: DATE RECEIVED:; AI)DRL.SS: t 1L'.. � 'I,(`,�, (,lv)('�5 r BY DELIVERY 7'O CLCItLC ON: Il`; f- BY IV(AtLPOSTNIAFZICED: —, C FRON1: Clerk of the Ward of Supervisors TO. County Counsel Attached is a copy of the above-noted claim. JOHN CUL 1N, Clerk Oated: %�� _ ,��1`� 1�: i> I3y: Deputy i ' ttL-lc'(.t.'+ I.I. FROM- County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially Nvitli 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 (lays (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of clainiant's right to apply for leave to present a late claim (Section 911.3). O Other: Dated: - By: Deputy County-Counsel- 111. ounsellll. FROM. Clerk ol'the Board TO: County Counsel (1) County Administrator (2) O Claim was returned as -mtimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ( j 'Phis 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 CUL.LEN, CLI;-PK, By Deputy Clerk WARNING (Gov. code section 9.1:)-- - — Sulriect to certain excelii.ions,you have oily six(G)months firom the date this notice was personally sewed or tlleposited in the mail to file a com-t action on this claim.See Government Code Section 945.6.You stay seek the advice of ant attorney of your choice in connection with this natter—If you want to consult ant attontey,you shoultl do so inunet.liately. Wor Additional Warnurg See Reverse Side of Mis Notice. AFFIDAVITOF NIAILIN(.� — ---- _- 1 declare under penalty oi' perjury Iha t 1 am now, and at all times hereitt mentioned, have been a citizen of the United States, over Age 18; alld that today 1. deposited ill the United Stales Postal Service. in Martinez, California, postage fully prepaid a rerf.ified Copy of Phis l3oard Order and Notice to Claimant, addressed to the claimant ars shown above. Dated: .—. --.--...__-- -.------...---. J(.)i IN (_'t..11.,i_.I N, CI ERE i3ti — i.:)et)(rty (.'leek. • ■ Government Employees Insurance Company ""E1`"E, 9 EIC00 ■ GEICO General Insurance Company ■ GEICO Indemnity Company APR 2 3 2008 ■ GEICO Casualty Company ■ Criterion Insurance Agency,Inc. BOARD OF SUPERVISORS (Colonial County Mutual Ins.) CLERK CoitITRACOSTA,PER Ono G :ico West box 7 Uj'i 19 --- San Diego, C1 92150-9119 April 3, 2008 Co!'dnty Administration uldg Suite 106 651 Pine Street Martinez, CA 94553-122.9 CLAIM ;UMBER: 0326783980101016 LOSS DATE: 03/06/08 INSURED: Joseph Richardson YOUR INSURED: Contra Casta Counter YOUR CLAI -1 #: Unk YOUR VEHICLE: 1999 FORD TAG 10.21054 Dear Ms,; wail r: Our investigation shows your insuredto be at fault in the accident. Since notifying o:: on March 13, 2008 of our subrogation claim, we have ;{paid additional damages of $119. 09. Please include this in your payment to use Documentation is attachl�d. O�tr Total claim is $1 , 886. 66. TB:iINKS FOR YOUR PROMPT . ATTENTIONe Sincerely? MARY FIREMOON (5618) PAYMENT RECOVERY UNIT. 800-6544-5896 extension .5861 Government Employees Insuranc- Compan. 3.5 PLEASE REFER TO OUR CLAIM NUM-11,`.,, WHEN WRITING OR CALLING ABOUT THIS CLAIM 31.54 CLL14 CLAIM PAYMENT SCREEN REVERSE CLAIM # LOSS ADJR TIME FCC IRS FIELDISSUED 3.26 0783980101016 08 06 08 AA79 12503540 03 94-2521349_ 03 28 08 -CHECK.-# TYP ID CO CHECK AMT FEAT C S AMT EXP FEAT C-S-AMT EXP 102154819 A. LP O1 119 . 09 01COL Y 119 . 09 C-LAIMANT JOSEPH R RICHARDSON USER ID U79Z72 IN PAYMENT OF _ INSURED _ AG ONP TYPE_ COLLISION COVERAGE JOSEPH R RICHARDSON N SUP 1 PAY TO MIK:E ' S AUTO BODY _ ENCLOSURE P=POLICE REP F=FORM LETTER C=CORRESPOND L=PROOF/LOSS MAIL TO MIKE ' S AUTO BODY M=MISC. I=INVOICES 2001 FREMONT STREET R=RELEASES D=DEMAND PRNT CONCORD, CA. 94520 VECTORING IRAN: KEY. c Page 1. of 12 03/27/208 AT 10:08 AM 0326783980101016-01 7852 062407U3 GEICO VISIT US AT GEICO.COM PO BOX 541.2 BAY POINT, CA 94565. (925) 852-1552_ SUPPLEMENT OF RECORD 1 WITH SUMMARY WRITTEN BY: FARZANA RAHIMI 03/27/2008 09:44 AM ADJUSTER: FCC: 03 (92.5) 852-1552 INSURED: JOSEPH RICHARDSON CLAIM #0326783980101016-01 OWNER: JOSEPH RICHARDSON POLICY 44100734971 ADDRESS: 1650 DETROIT AVE DATE OF LOSS: 03/06/2008 AT 1-2:00 AM APT 201 CONCORD, CA 94520-3300 TYPE OF LOSS: COLLISION EVENING: (925) 609-7068 POINT OF IMPACT: 12. FRONT BUSINESS: (925) 956-8846 INSPECT MIKE ROSE AUTO BODY DAY: (925) 432-9910 LOCATION: 3001 N PARK BLVD DRIVE-IN PITTSBURG, CA 94565-0000 REPAIR MIKES AUTO BONY BUSINESS: (925) 686-1739 FACILITY: 2001 FREMONT STREET 4 DAYS TO REPAIR CONCORD, CA 94520 LICENSE # 2004 MITI DIAMANTE LS 6-3.5L-FI 4D SED BEIGE INT: VIN: 6MMAP67P54T004190 LIC: 5LAN995 CA PROD DATE: ODOMETER: 54523 AIR CONDITIONING REAR DEFOGGER TILT WHEEL CRUISE CONTROI, INTERMITTENT WIPERS KEYLESS ENTRY THEFT DTERRENT/ALARM STEERING WHEEL CONTROLS BODY SIDE MOLDINGS DUAL MIRRORS CONSOLE/STORAGE ELECTRIC GLASS SUNROOF 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 SEARCH/SEEK EQUALIZER CD PLAYER INFINITY SOUND SYSTEM ANTI-LOCK BRAKES (4) DRIVER AIR BAG PASSENGER AIR BAG 4 WHEEL DISC BRAKES LEATHER SEATS BUCKET SEATS AUTOMATIC TRANSMISSION OVERDRIVE ALUMINUM/ALLOY WHEELS ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE I.,ABOR PAINT ------------------------------------------------------------------------------- 1 REAR BUMPER . 2 REPL RT PLATE 1 25.68 3 REPL LT PLATE 125. 68 N 4 S01 REPL BUMPER. COVER ES,LS 1 502.02 1. 9 2. 9 5 S01 ADD FOR CLEAR COAT 1.2 6 REAR BODY & FLOOR 7* RPR REAR BODY PANEL 2.5* 1.5 fileMADocuments and Settings\u79sl9\Local Settings\Temp\pdi\0326783980101016-01-... 4/17/2008 Page 2 of 12 8 ADD FOR CLEAR COAT 0. 6 1 03/27/2008 AT 10:08 AM 0326783980101016-01 7852 062407U3 SUPPLEMENT OF RECORD 1 WITH SUMMARY 2004 MITS DIAMANTE LS 6-3.5L-FI 4D SED BEIGE INT: -------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT -------------------------------------------------------------------------------- 9* RPR REAR FLOOR PAN . 1.0* 0.5* 10 R&I FLOOR COVER 0.2 Il R&I REAR TRIM PANEL LOWER 0.2 12 TRUNK LID 13* ALGN TRUNK LID W/O VR-X 0.5* 14 MISCELLANEOUS OPERATIONS 15* REPL COVER CAR/BAG 1 0.0* 0.2* 16# CORROSION PROTECTION 1 10.00 0.2 1'7# SUBL FRONT WHEEL ALOGNMENT 1 69. 99 X 18 OTHER CHARGES 19# P.C. 1 3.00 ---------------------=---------------------------------------------------------- SUBTOi'ALS =_> 636.37 6.5 6. 9 LINE 4 PART PRICE CHANGE TWO NO CORE SLIPS ------------------------------------------------------------------------------- PR10R DAMAGE NOTES: MINOR SCRATCHES BY THE DOOR HANDLE PARTS 563.38 BODY LABOR 6. 5 HRS @$ 72.00/HR 468.00 PAINT LABOR 6. 9 HRS @$ 72.00/HR 496.80 PAINT SUPPLIES 6. 9 HRS @$ 32.00/HR 220.80 SUBLET/MISC. 69. 99 OTHER CHARGES 3.00 ---------------------------------------------------- SUBTOTAL $ 1821. 97 SALES TAX $ 784 .18 @ 8.2500% 64 . 69 ---------------------------------------------------- TOTAL COST OF REPAIRS $ 1886. 66 ADJUSTMENTS: DEDUCTIBLE 500. 00 ---------------------------------------------------- TOTAL ADJUSTMENTS $ 500.00 NET COST OF REPAIRS $ 1386. 66 file://C:\Documents and Settings\u79sl9\Local Settings\Temp\pdi\0326783980101016-01-... 4/17/2008 Page 3 of 12 2 03/27/2008 AT 10:08 AM 0326783980101016-01 7852 06240703 SUPPLEMENT OF RECORD 1 WITH SUMMARY 2004 MITS DIAMANTE LS 6-3.SL-FI 4D SED BEIGE INT: "WE ARE PROI:IBITED '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 !:-IAT 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. " THIS IS NOT AN AUTHORIZATION TO .REPAIR NO SUPPLEMENT WILL .BE HONORED UNLESS AUTHORIZED NOTICE: NEW HIGH STRENGTH STEELS MAY REQUIRE THE USE OF A MIG WELDER FOR PROPER REPAIRS. NEW DESIGNS REQUIRE MEASUREMENT TO PROPERLY ALIGN THE VEHICLE. MAKE SURE YOUR SHOP HAS THE RIGHT EQUIPMENT TO REPAIR YOUR VEHICLE. file://C:\Documents and Settings\u79s19\Local Settings\Temp\0di\0326783980101016-01-... 4/17/2008 Page 4 of 12 3 03/27/2008 AT 10:08 AM 0326783980101016-01 7852 062407U3 SUPPLEMENT OF RECORD 1 WITH SUMMARY 2004 MITS DIAMANTE LS 6-3.5L-FI 4D SED BEIGE INT: 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 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 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. file://C:\1Documents and Settings\u79s19\Local Settings\Temp\pdi\0326783980101016-01-... 4/17/2008 i Page 5 of 12 4 03/27/2008 AT 10:08 AM 0326783980101.01.6-01 7852 062407U3 SUPPLEMENT OF RECORD 1 WITH SUMMARY 2004 MITS DIAMANTE LS 6-3.5L-FI 4D SED BEIGE INT: ESTIMATE BASED ON MOTOR CRASH ESTIMATING GUIDE. UNLESS OTHERWISE NOTED ALL ITEMS ARE DERIVED FROM THE GUIDE ARP6295, CCC DATA DATE 02/01/7.008, 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 (AL'T'ERNATIVE 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 OPEPATIONS. NON-ORIGINAL EQUIPMENT MANUFACTURER AFTERMARKET PARTS ARE DESCRIBED AS AM, QUAL R:EPL• PARTS OR COMP REPL PARTS WHICH STANDS FOR COMPETITIVE REPLACEMENT PARTS. USED PARTS ARE DESCRIBED AS LKQ, QUAL RECY PARTS, RCY, OR USED. RECONDITIONED PARTS ARE DESCRIBED.AS RECOND. RECORED PARTS ARE DESCRIBED AS RECORE. NAGS PART NUMBERS AND BENCHMARK PRICES ARE PROVIDED BY NATIONAL AUTO GLASS SPECIFICATIONS. LABOR OPERATION TIMES LISTED ON THE LINE WITH THE NAGS INFORMATION ARE MOTOR SUGGESTED LABOR OPERATION TIMES. NAGS LABOR OPERATION TIMES ARE NOT INCLUDED. POUND SIGN (#) ITEMS INDICATE MANUAL ENTRIES. SOME 2006 VEHICLES CONTAIN MINOR CHANGES FROM THE PREVIOUS YEAR. FOR THOSE VEHICLES, PRIOR TO RECEEIVING UPDATED DATA FROM THE VEHICLE MANUFACTURER, LABOR .AND PARTS DATA FROM TME 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. file://C:\Documents and Settings\u79s19\Local Settings\"temp\pdi\0')26783980101016-01-... 4/17/2008 Page 6 of 12 CCC PATHWAYS - A P1-:�ODUCT OF CCC INFORMATION SERVICES INC. 5 03/27/2008 AT 10: 08 AM 0326783980101016-01 7852 062407U3 SUPPLEMENT OF RECORD 1 WITH SUMMARY 2004 MITS DIAMANTE LS 6-3.5L-FI 4D SED BEIGE INT: -------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT - ------------------------------------------------------------------------------ ------- DELETED ITEMS------- 2'* REPL RECOND BUMPER COVER ES,LS 1 -392. 00 -1. 9 -2. 9 3 ADD FOR CLEAR COAT -1 .2 ------- ADDED ITEMS ------- N 4 S01 REPL BUMPER COVER ES,LS 1 502.02 1. 9 2. 9 5 Sol ADD FOR CLEAR COAT 1.2 -------------------------------------------------------------------------------- SUBTOTALS =_> 110.02 0.0 0.0 LINE 4 PART PRICE CHANGE TWO NO CORE SLIPS -------------------------------------------------------------------------------- PRIOR DAMAGE NOTES: MINOR SCRATCHES BY THE DOOR HANDLE file://C:\Documents and Settings\u79s19\Local Settings\Temp\pdi\0326783980101016-01-... 4/17/2008 Page 7 of 12 PARTS 110.02 BODY LABOR -0.0 HRS @$ 72. 00/HR -0.00 PAINT LABOR -0.0 HRS @$ 72.00/HR -0.00 PAINT SUPPLIES -0.0 HRS @$ 32.00/HR -0.00 ----------------------------------------------------- SUBTOTAL $ 110.02 SALES TAX $ 110. 02 @ 8.2500% 9.08 ADDITIONAL SUPPLEMENT TAXES -0.01 ---------------------------------------------------- TOTAL SUPPLEMENT AMOUNT $ 119.09 NET COST OF SUPPLEMENT $ 119.09 ESTIMATE 1767.57 FARZANA RAHIMI SUPPLEMENT S01 119.09 FP_RZANA RAHIMI -------- TOTAL ADJUSTMENTS $ 500.00 WORKFILE TOTAL $ 1886. 66 NET COST OF REPAIRS $ 1386. 66 6 03/27/2008 AT 10:08 AM 0326783980101016-01 7852 062407U3 SUPPLEMENT OF RECORD 1 WITH SUMMARY 2004 MITS DIAMANTE LS 6-3.5L-FI 4D SED BEIGE INT: "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. " THIS IS NOT AN AUTHORIZATION TO REPAIR file://CADocuments and Settings\u79sl9\Local Settings\Temp\pdi.\0326783980101016-01-... 4/17/2008 Page 8 of 12 NO SUPPLEMENT WILL BE HONORED UNLESS AUTHORIZED NOTICE: NEW HIGH STRENGTH STEELS MAY REQUIRE THE USE OF A MIG WELDER FOR PROPER REPAIRS. NEW DESIGNS REQUIRE MEASUREMENT TO PROPERLY ALIGN THE VEHICLE. MAKE SURE YOUR SHOP HAS THE RIGHT EQUIPMENT TO REPAIR YOUR VEHICLE. 7 03/27/2008 AT 10:08 AM 0326783980101016-01 '1852 062407U3 SUPPLEMENT OF RECORD 1 WITH SUMMARY 2004 MITS DIAMANTE LS 6-3.5L-FI 4D SED BEIGE INT: 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 tile://C:\Documents and Settings\u79sl9\Local Settings\Temp\pdi\0326783980101016-01-... 4/17/2008 Page 9 of 12 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 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 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. 8 03/27/2008 AT 10:08 AM 0326783980101016-01 7852 062407U3 SUPPLEMENT OF RECORD 1 WITH SUMMARY 2004 MITS DIAMANTE LS 6-3.5L-FI 4D SED BEIGE INT: ESTIMATE: BASED ON MOTOR CRASH ESTIMATING GUIDE. UNLESS OTHERWISE NOTED ALL ITEMS ARE DERIVED FROM THE GUIDE ARP6295, CCC DATA DATE 02/01/2008, AND THE file://CADocuments and Settings\u79s1.9\Local Settings\Temp\pdi\0326783980101016-01-... 4/17/2008 Page 10 of 12 PARTS SELECTED ARE OEM-PARTS MANUFACTURED BY THE VEHICLES ORIGINAL EQUIPMENT MANUFACTURER. OEM PARTS ARE AVAILABLE AT OE/VEHICLE DEALERSHIPS. OPT OEM (OPTIONAL OEM) OR ALT OEM (ALTERNATIVE OEM) PARTS ARE OEM PARTS THAT MAY BE PROVIDED BY OR THROUGH ALTERNATE SOURCES OTHER THAN THE OEM VEHICLE DEALERSHIPS. OPT OEM OR ALT OEM PARTS MAY REFLECT SOME SPECIFIC, SPECIAL, OR UNIQUE PRICING OR DISCOUNT. OPT OEM OR ALT OEM PARTS MAY INCLUDE "BLEMISHED" PARTS PROVIDED BY OEM'S THROUGH OEM VEHICLE DEALERSHIPS. ASTERISK (*) OR DOUBLE ASTERISK (**) INDICATES THAT THE PARTS AND/OR LABOR INFORMATION PROVIDED BY MOTOR MAY HAVE BEEN MODIFIED OR MAY HAVE COME FROM AN ALTERNATE DATA SOURCE. TILDE SIGN (-) ITEMS INDICATE MOTOR NOT-INCLUDED LABOR OPERATIONS. NON-ORIGINAL EQUIPMENT MANUFACTURER AFTERMARKET PARTS ARE DESCRIBED AS AM, QUAL REPL PARTS OR COMP REPL PARTS WHICH STANDS FOR COMPETITIVE REPLACEMENT PARTS. USED PARTS ARE DESCRIBED AS LKQ, QUAL RECY PARTS, RCY, OR USED. RECONDITIONED PARTS ARE DESCRIBED AS RECOND. RECORED PARTS ARE DESCRIBED AS RECORE. NAGS PART NUMBERS AND BENCHMARK PRICES ARE PROVIDED BY NATIONAL AUTO GLASS SPECIFICATIONS. LABOR OPERATION TIMES LISTED ON THE LINE WITH THE NAGS 'INFORMATION ARE MOTOR SUGGESTED LABOR OPERATION TIMES. NAGS LABOR OPERATION TIMES ARE NOT INCLUDED. POUND SIGN (#) ITEMS INDICATE MANUAL ENTRIES. SOME 2006 VEHICLES CONTAIN MINOR CHANGES FROM THE PREVIOUS YEAR. FOR THOSE VEHICLES, PRIOR TO RECEIVING UPDATED DATA FROM THE VEHICLE MANUFACTURER, LABOR AND PARTS DATA FROM THE PREVIOUS YEAR MAY BE USED. THE PATHWAYS ESTIMATOR HAS A COMPLETE LIST OF APPLICABLE VEHICLES. PARTS NUMBERS AND PRICES SHOULD BE CONFIRMED WITH THE LOCAL DEALERSHIP. CCC PATHWAYS - A PRODUCT OF CCC INFORMATION SERVICES INC. 9 03/27/2008 AT 10:08 AM 0326783980101016-01 file://C:\Documents and Settings\u79sl9\Local Settings\Temp\pdi\0326783980101016-01-... 4/17/2008 Page 11 of 12 7852 062407U3 SUPPLEMENT OF RECORD 1 WITH SUMMARY 2004 MITS DIAMANTE LS 6-3.5L-FI 4D SED BEIGE INT: ALTERNATE PARTS USAGE AFTERMARKET PARTS AFTERMARKET SELECTION METHOD: AUTOMATICALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT AN AFTERMARKET PART WAS AVAILABLE: 0 NO. OF AFTERMARKET PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 OPTIONAL OEM PARTS OPTIONAL OEM SELECTION METHOD: AUTOMATICALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT AN OPTIONAL OEM PART WAS AVAILABLE: 0 NO. OF OPTIONAL OEM PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 RECONDITIONED PARTS RECONDITIONED SELECTION METHOD: AUTOMATICALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT A RECONDITIONED PART WAS AVAILABLE: 4 NO. OF RECONDITIONED PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 RECYCLED PARTS NO. OF TIMES USER WAS NOTIFIED THAT A RECYCLED PART WAS AVAILABLE: 0 NO. OF RECYCLED PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 10 fle://C:\Documents and Settings\u79s19\Local Settings\Temp\pdi\0326783980101016-01-... 4/17/2008 Page 12 of 12 file://CADocuments and Settings\u79s 19\Local Settings\Temp\pdi\0326783980101016-01-... 4/17/2008 Photos for claim no 0326783980101016-01 Page 1 of 3 Photo 1. from Estimate for Claim no 0326783980101016-01 Photo date: 27/03/2008 09:33:34:00. Size: 26494 Description: Insured: RICHARDSON, JOSEPH. Policy_no: 4100734971. Claimant: . Vehicle: 4, MITS, DIAMANTE LS. VIN: 6MMAP67P54T004190. Loss date: 03/06/08. Estimator: Farzana Rahimi e �. # $ - Uj B � r.. 14 f 'Z Q' t7 O Ub MY" 7:?.Z :. ���. ► � :� 'I x.1'1`1 r � Photo 2 from Estimate for Claim no 0326783980101016-01 Photo date: 27/03/2008 09:33:34:00. Size: 26505 Description: Insured: RICHARDSON, JOSEPH. Policy—no: 4100734971. Claimant: . Vehicle: 4, MITS, DIAMANTE LS. VIN: 6MMAP67P54T004190. Loss date: 03/06/08. Estimator: Farzana Rahimi file://C:\Documents and Settings\u79sl9\Local Settings\'Temp\pdi\0326783980101016-01-... 4/17/2008 Photos for claim no 0326783980101016-01 Page 2 of 3 . Iva" ^.. r�..<...._.... �.,..+k.$.^...s^'. "'A F;•? ". . ... .,,y.:,, skit S�"r kt"t.x R-F"#ef!!r'' riT,gimt 9 P%4vka Net. . {¢.tsW.Jlap4li .'t'r Axmt UpNa& '+�„ Ata_� a ..; Kti k.+7Rs,f,}: °5S�,TUF'j.1 t!'S $<a •{.. -,. r r'� .:_..,:....::.:.� '.•'.�•� ,. .....:..'s” � .ms's: .. x�:r: .. <m,�n... .. ... � .. �.. n .. " ' x ''il�f't1P" ttd �. p Q • M.+J �5 .'k"ti 3y� '..� �a��•s �'a ..o y.MkA�h� tl*' x.Ti: fi$•.� �A • •e x ..fix. .........:. ,•� Po .... lift�:,:r'.::i.... .. '� .. ..;�:'.� ..astir• Photo 3 from Estimate for Claim no 0326783980101016-01 Photo date: 27/03/2008 09:33:34:00. Size: 25074 Description: Insured: RICHARDSON, JOSEPH. Policy_no:.4100734971. Claimant: . Vehicle: 4. MITS, DIAMANTE LS. VIN: 6MMAP67P54T004190. Loss date: 03/06/08. Estimator: Farzana Rahimi file://C:\Documents and Settings\u79sl9\Local Settings\Temp\pdi\0326783980101016-01-... 4/17/2008 Photos for claim no 0326783980101016-01 Page 3 of 3 f .:'... � ..,� ....did. .�...... ....... .. .......... .......... .,...,.,. FA j �. f , w p„ Q r = V ' n ro .: y x' .. '3. . ... swo. .., ... ¢..fix.:.:. .. -rr. � ......:.... 'R' ....° p .. .. . <. YM�pgy }}�[ r,. 2 7.r.' C,' I fle://C:\Documents and Settings\u79s19\Local Settings\Temp\pdi\0326783980101016-01-... 4/17/2008 E-326(09-06) - P.O.sox 509119 San Diego,CA 92150-9119 - A,Pr MM 1. i i 5 I i. i. 1 i r ■ Government Employees Insurance Company GEIC00 ■ GEICO General Insurance Company ■ GEICO Indemnity Company ■ GEICO Casualty Company ■ Criterion Insurance Agency,Inc. 1-800-841-3000 (Colonial County Mutual Ins.) One Geico .West Box 509119 San Diego, CA 9.21.50-9 July 3 y 2008 JUL 0 9 200,9 County Adm..inistration Bldg Suite -------- 10 6 CLERK BO,4R!:,O�';;;SORS 6.51 Pine Street CONTRA COSTF,CO, Martinez, C , 94553-1229 CLAIM NUMBER: 0326783980101016 LOSS DATE: 03/06/06 INSURED: Joseph Richardson YOUR INSURED: Contra Casta County YOUR CLAIM 9: Unknown YOUR VEHICLE: 1999 FORD TAG #: 1021094 Dear tis.. Baily: Our investigation shows your insured to 'he at fault in the accident. Documentation of our claim was sent to yoil on April 16y 2008. When may we expect payment? THANKS FOR YOUR PROMPT ATTENTION. Sincerelyy MARY .FIREIMOON (S618) PAYMENT .RECOVERY UNIT 800-654-5896 extension 5661 Government Employees :Insurance CompaTiy 35 d � PLEASE REFER TO OUR CLAIM NUMBER WHEN WRI`T'ING OR CALLING ABOUT THIS C.I.A.IM SL54 C.Lu14 A M.FW >,D CLA.l_IN't BOMPOF SUPERVISORS OF CONTRA STA COUNTY B011ltll Claim Against the County, or District Governed.by ) the 130111-d of Supervisors, Routing Endorsements' ) NC)'1'LCI,'I'C) CLn.IItQnN'.l' and Board Action. All Section references are to ) TIM copy of this docunlertl tnailecl to Calit10rnia Governnrenl. Coc.lcs. ) you is your notice of the action taken on your claim by the.Board of Supervisors. (Paragraph IV below), given .Ptirsuant to Government Code A�LC)1.1N l. : j t Section 913 and 915.4. Please noie all "Warnings". CLAJNIAN-I'. n'r'roR_NL)' DATE lz13ciilvru: AD1_)R.I Ss:l.'f 1('. i ` ('-.� BY ul?L1V RY 'r0 C:.LEfZIC ON: BY MAK, POS--CNI/1lZftl_,U: _ { •.1( i RONI: Clerk of the [3F and of Supervisors 1'0: County Counsel Attached is a copy of the above-noted cla.int. t .1OHNCIJL , -N, Clerk ft') Dated: By. Deputy ' .)� .l)..(. ( ((,t_- 11. IKON:. County Counsel TO: Clerk of the.Board of Supervisors DD (tel his claim con.q lies Substantially with Sections 910 and 910.2. JUN 0 6 200 ( ) 1-his Claim FAIL-S tb cou+ply substantially with Sections 910 and 910.2, and lve are so nUUf}'l+ig Clallllatll. 1.he 13oalYl CatrllOt RCL 1.c)rUNTY 15 days (Section 9 10.8). MARTINEZ CALIF. L ( ) Claim is not timely filed. The Clerk should return claim on ground that it was tiled late and send Nvarning of clainta.nt's right Io apply For leave to present a late claim (Section 91 t.3). ( ) Other- Dated: -.-_T �6) 1�' 13y: A1`1 lieputy Courtly Counsel 11.1. FROM: Clerk of the Board TO: Courtly CoLuisel (l) Courtly Administrator (2) O Claim was returned as u111irttely with notice to claimant (Section 911.3)., W. BOARD ORDER: By unanimous vote ol'the Supervisors present: ( ) This Claim is rejected in full. I certify that this is a. true and correct copy of the Board's Order entered in its minutes for this dale. luted: aea.���— JOl.1N CULf_,EN, CLERK, Ry —c��i1t Clerk WARNING (Gov. code section 913) Subject to certain exceptions,yo11 have miky six(6)months 11-0111 tl a t1.11.e this notice was pelso11:illy served or deposited 111 (lie mail to file,,court:IcLiuII vu this cl;iiut.See Goveniment Cude Section 945.6.You inny seek the advice of an n(tonley of your choice in conuec:tion with this nlal.l.e1•. .Ih you want to consult :111 :Illorney,Jou should do so immediately. -*For.Additiomal�aniing See Reverse Side of:Dis Notice. AFFiDAVf1' OF MAILING ------ I declare andel- Immalty of het jury (hat .( .1111 now, and at all ti11les licrcin mentioned, lt:tvc Veen a cilium of (lie United Slatcs, over age 1.3; and that today I depusited in the United Slates Postal Service. ill M-11-ti1►ez, (:::+lifo►Ain, postage fully prepaid a cert.ilied cul►y of I.his (Bosh cI Order mid NvGvv It.) C htin►;Int. ;Idd+cssr.cl to the c1a61111%fit W- slimi'u :tl►uve. ,I011[1 t l. l,l..l'I•, I_.I'.IZ.I: 1.31 CLAiM BOARD OF SUPEItV1.SORS OF CONTRA COSTA COUNTY BOARD ACTION:Jtcn�i � Claim Against the County, or District Govemed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section r fer Hees are to ) The copy of this document mailed to California Government Codes. � 2008 gII� you is.your notice of the action taken 1� on your claim by the Board of MAY 0 .1 Supervisors. (Paragraph IV below), given Pursuant to Government Code COUNTY COUNSEL Section 913 and 915.4. Please note all AMOUNT: mown MARTINEZ CALIF. "Warnings". CLAIMAN L Ll5>orp , �} 1'i CPQ/ DATE RECEIVED: 1_ ADDRESS: R o, 600. q zo BY DELIVERY TO CLERK ON: .7UA, Sun �; CA BY MAIL POSTMARKED: ZO FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. (� JOHN CULLEN, Jerk Dated:.) _ By: Deputy 1 Ct; F i.I. FROM.:( .ounty 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). O Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's.right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: By: t �?� Qo; Deputy County Counsel LII. FROM.: Clerk of the Board TO: County Counsel (l) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARD ORDER: By unanimous vote of the Supervisors present: This 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: D o JOHN CULLEN, CLERK, By uty Clerk WARN]LNG kGov. code section 913) Subject to certain exceptiats,you have only six(6) n►onths from the Yate this notice was petsonalfy served or deposited in the nkail 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 Additialal Warnijig See Reverse Side ofThis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that is ani-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 clan r. �s shown above. Dated. d 10HN CULLEN, CLERK fay eptlty Clerk • C LA.I.NI BOAi.tD OF SUPERVI.SO.RS OF CONTRA COSTA COUNTY BOARD ACTION:cJ tul c 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: � .l`1. V�;( ;!(') "Warnings". CLAIMANT: V"L'olc:lct: 'fi')utI L)"t. (us TV =tT9RNEY C°:`;�}#� ,�!'1• lu' % 1��.� DATE RECEIVED: ADDRESS: i-. [), BY DELIVERY TO CLERK ON: CL/ C A BY MAIL POSTMARKED: /' L;j r.i✓, 1� FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim.. 1 f JOHN CUL E Jerk , Dated: By: Deputy `` ' X21 Lt - /i�Ld `��,(,oft.:: '/. I1.. FROM.: .ounty Counsel TO: Clerk of tiie Board of Supervisors l This claim complies substantially with Sections 910 and 910.2. This Claim FAILS to comply substantially with Sections 910 and 910.2, and we arejso notifying claimant. The Board cannot act for 15 days (Section 910.8). O Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: By: Deputy County Counsel 1.11. FROM.: Clerk of the Board TO: County Counsel (1) County Administrator (2) O Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARD ORDER: By unanmlous vote of the Supervisors present: ( ) This Claim is rejected in full. ( ) Other: i I certify that this is a true and coirect copy of the Board's Order entered in its minutes (61*. 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 widr this matter. Il'you want to consult an ittonrey,you slioul(i do so inurretli itely. *For Additional War nijig See Reverse Side ol'Tlris Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I: am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today .1 deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy ol' tliis Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: ! JOHN CULLEN, CLERK By Deputy Clerk BOARD OF SL-P R.VYSORS OF CONTRA COSTA COUNTY 0. INSTRUCTIONS TO CLUNIANT A. A claimi relating to a cause of action for death or for injury to person or to personal property or grosa-i_ v 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 b-- presented not later Iffi an, 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 govcialed.by the Board of Supervisors; rather than the County, th.e name of'flie District should be filled in. D. If the claim is against more than one public entity, separate claims irust be filed against eacl..-i public entity. E. Fraud. See penalty for fraudulent claims,Penal Code Sec, 72 at the end of this form. ■aa■am.aaam2aaa anaal.■aa■■a a a a a a a e a a a a a a a a a a a a a a a a a a a a c e a e a e a a a a a a a a a a a e[a s a c a a RE. Claim By: Reserved for Clerk's filing stamp RECEIVED Aaai.nsr '11e ;'oenrY of Contra Costa or ) MAY 0 1 2008 _ ____District) CLERK BOARD OF SUPERVISORS dill 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 (( 1 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) baa/ao�8 � 2. Where did the damage or injury'occur? (Include city and county) Sc�nom�- ��vd i \/r�11eJo, CA Cour 0 I NAPS 3. How did the damage or injury occur? (Give full details; use extra paper if required) /VS. OasT",s ✓ehide at 0— sfoF, a-t a SOVtcl fed S"3111-0A when She tvcaS S_�ruc_„e_4r)0-1, -1 0.vid Skine.11 iV1\ u. C01_ rJ_LA\Veln 4. What particular act or omission on the part of county or district off cers, servants, or eniDloyees caused.the injury or damage? Rki\vd 2 ho S(V_esa -Po' t' CA-) c)Y1S. Lute -ASD fYNA (��V Scab� S � tvti`i ��s cue� �rnp� leo kou--t- Wl:at are file names of county or district affieers,servants; or employ=ees causing the d=amage or iniury? 6. 'WLat dEanagc or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) S7i%�1C�tsc �o `ol%vi�� - 1'}'JS. pr2s.e.� cod,. in inju(-L� c a, rn Jr G-Ppvlea-bte 7. How was the amount claimed above cornputed? (Include the estimated amount of any prospective injury or damage,.) bq 03,14-41 SWOP GAS t o 14 l L 8. Ivam_es and addresses of witnesses, doctors, and hospitals: 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT -T6- awn s IN R R R a BE a an a man 111 R 9 s an an on ME ass s R■■a a s as NNW am a s a a am s my UK an BE s s a No a s MR s IF sass so l l .Gov. Code Sec. 910.2 provides"The claim shall be signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attbmey) Name and address of Attorney ) Ura.nce .Svbrr�9�e (Cl-' ant's Signature) (Y"10-r ick. Co..s n-o (address) } C- G 4s 8s- Telephone- sTelephone No. )Telephone No. "�f�`(gat� a a R a an Ism MR R i s a ON s a a as R 19 an a a nit s a s 12 as a IN R s R IN UK R a on s s a Ira a a a a am MR a ass a sons mew a R a RIC a 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. ■a a R s a R s a R s a R a a t Kitt s Bonn a arms R s a s a!R s R R s a a■!a s so a a a g s a a 9 s s R s a s a a a s R s s a a s s s■a goal BURNS NOTICE: Section 72 of the Penal Code provides: Every person who, ,vith intent to defraud, presents for aIIowance or for payment to any state board or officer,or to any county, city, or dist ict 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 bofh such imprisonment aizdfin:, 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. ..fie rn V N 00 �t31 N� 4, 4 0 0 cND 1 0 a N �sd3tlNt1 0 oo 2 A t}! j O N CT A 00 0cON N 10 s ` 0 � co N aM ftom u`L d�� p fld 4 Z oU U C—L-A-i,Iti�I J BOARD OF SUPERVISORS OF CONTRA COS-FA COUNTY BOARD ACTION: Claim Against the County, or District Govemed by ) \/e, P, the Board of Supervisors, Routing Endorsements, ) � NOTICE T LAI:MANT and Board Action. All Section references are to ) The copy of this document mailed to California Government Codes. D you is your notice of the action taken j2 v on your claim Uy the Board of JUN U 2 2008 Supervisors. (Paragraph IV below), given Pursuant to Government Code COUNTY COUNSEL Section 913 and 915.4. Please note all AMOUNT: un ocon i' f,, MARTINEZ CALIF. "Warnings". CLAIMANT:�� � SUba-gee, Of Who ATTORNEY: DATE RECEIVED.: ADDRESS: �,� �[ ZO BY DELIVERY TO CLERK ON: CA BY MAIL POSTMARKED: M am s— FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. l JOHN CUL N, Clei;k �n�. ,,� Dated:_Jw�i 2-� By: Deputy r L&L 1.1. 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). O Claim is not timely filed. The Clerk should retuni claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Secti-o/n 911.3). (,i)'Other: � se �tS fS r)01 a ala ono. l ', is / GZGY�[`1Z.o�'tc�.L Dated: By: '(r _Deputy County Counsel Ill, FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as utititnely with notice to claimant (Section 911.3). 1V. BOARD ORDER: By unanimous vote of the Supervisors present:` ( ) This Claim is rejected in full. O Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for. this date. Dated: JOHN CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subject to ceilain exceptions,you have only six(6) months from the date this notice was personally sewed or deposited in the mail to file a court actin on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection witli this matter. il'you want to consult all attorney,you Should do so immediately. *For Additional Warning See Reverse Side ofThis Notice. AFFIDAVIT OF MAILING I declare under penalty of per jury that 1. am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today i deposited in ttre United States Postal Service ill Nfartinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the clainran.t as shown above. Dated: JOHN CULLEN, CLERK By Deputy Clerk RPR-29-2009 15:17 CSRA COLORADO SPRINGS 9 P.01 BOARD U SUPERMO RS OF CONTPU COSTA COUNTY INSTRUCTIONS TO CLABIANT A. A claim relating to,a cause of action for death or for injury to person or to personal property or growing claps shall be presented not later that. six months after the accrual of the cause of X04 aatzon, A ekiri relating to any other cause of action shall be pmsmted not later iban one year after the accaml of the cause of action. (Gov.Cade§ 911.2.) id B. Claims must be filed with the Clerk of the Board of S rvisors at its office in Room IDb fn , (v County Administration BuOding, 651 Pine Street,Martinez,CA 94553. r m w C. If claim is against a district governed by the Beard of Supervisors, rather than the Comty, the ILW) tin=e of the District should be filled in. D. If the claim is-a.g�st.more than. one public entity, sepa_ to claixtas a�nst be led against each B ELuud. See peWty for fraudulent claim,Penal Code Sec.72 at the end of this form ai..ai..as..r:.ear■........aa■r.a.■erone fig X.e.Aver aNro.saaeaasa.ww.ea..r...ear% RE; Claim By: Reserved for Clerk's filing sta=mp RECEIVED Against.the County of Contra,Costa orl) (. =NO008 pistLic) CLARK BOARD OF SUI ERVISCRS CONTRA COSTA CO. Tillm the name) ) The undersigned CWMatst hereby makes claim against the County of Contra Costa or the above named district in the sum of$,7061_� and in sWpart of this claim represents as follows: t. Tamen did the damage or i4 y occur? (Give exact date and hour slid the•datnage or in}ury oceml (Include city and county) Va\ti ,bo,. cA C'ourct4 of S3P,9A 3_ How did the'damage or injury occur? (Give full.details.use extra papm ifregtfi e. ) M.9- Clash's Yeiti c e was 6-t eL 54-0f a:�, a. so 1 tcj f2d S'; U1*l erl sk Loo's "uc_V 40, 6e wj b4`favid ` ir,e tl'i ; a. fou t.Icin. 4. What Particular act or Omission an the part of cotmty or district officers, servauty,or employees e{msed the injury or damage? r itu.r�e A-0 'CY't0, r ,r) SqP Spee. -Pro r- Co f S What,are the names Of C,ottnty or district Offi=,servants,or employees causiW the damage or injury? APP.-29-2008 13:17 CSAA COLORADO SPRINGS 7 r•n= o. W+gt dvmage or injuries do you.* claim resulted? (Give full extent of injuries or damages claimed, Attach two estim.atns for auto damage.) Es*;7l to -Alldw — s. �s�r~� jure sert_t o wa, �r)Jvt QA�rn tF 7. How was the amount claimed above computed? (luvlude the estimated amount of any prospective injury or damage) 8. . Frames and addresses of witnesses,doctors,and hospitals: /A 9. List the expenditures you made on account of this accident or injury: DAT?- TIME -AMOUNT 713 s:a►\at¢1r11.4meRat.smogs Bang•a as aasm err lairs a*PURBEala."REirl1\ NEWWROGNIF at ) .Gov.Code Sec.910.2 provides"The claim shall be )ssiigS,nee1d{by the claimant or by some person on his S5M NOTICES TO: (Attarney ) Name and address of Attorney ) Svbr�� ( n'io riot `�eCc��'m 2-n?J: - (Address) Telephone No. )Telephone No. "C]f!�` � � ■gasps laab■asNoRsuits purses g■■arssba■■■Rasa■als■Raaaaaoff■RRRalarraaasMon of■a■aa■asosarl 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 tlie'Cal mTla Public, Records Act (Gov. Code/ SS 6500 et seq.) gurtheamom,'nay avac3rmwts,eddebdums,or supplements attached to the claim fonn,including medical records,are also subject to public disclosure. ta goalass■alas stabssL■lsla la as&araasalslalgaa 495119Rosas■01 aR RaaRaRslb Y■af■o 4 so so go ffaal NOTICE: Section 72 of the Penal Code provides: Every person who, with iuttt to defraud,prosents 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 eitb= by imprisonment in the County jail for a period of not more than one year, by a fine of not exceeding one thousand dollm(S 1,000.00), or by bobs such imprisonment and fwa, or by imprisonment in the state prison, by a fine of ncrt exDwAirrg ten thousand dollars ($10,000),or by both sw:h imprisonment and fine. TnTAI P.R) THE HERTZ CORPORATION Rental Agreement #: A1452-7704 Invoice Date: 05/08/08 Batch: 1081290 Insured: CASTRO,ADRIAN/MARIA Renter: ADRIANMARIA CASTRO HERTZ LOCAL EDITION PO BOX 26141 OKLAHOMA CITY, OK 73126-0000 TIN: 13-1938568 CSAA INSURANCE ATTN: MAIL CENTER P.O. BOX 920 SUISUN CITY, .CA 94585-0920 Claim #: 01-LW6585-7 Suffix: 03 KOL: XLU Loss Date: 04/22/08 Rental Car: SONATA V6 SUN Rental Veh License #: 5XWZ806 Hertz Local Edition Store: 0725101 NAPA CA Rented On: 04/23/08 Returned On: 05/07/08 Total Rental Days : 0015 FRP: 209 . 00 Extra Days: 000 @.00 . 00 Subtotal: 209 . 00 Upgrade: . 00 Damage Waiver(CDW/LDW) : . 00 PAI : . 00 Fuel and Service: . 00 Customer Paid: - . 00 Time and Mileage: - . 00 Amount Due: 209 . 00 Billing Inquiries : PHONE: 1-888-777-3700 FAX: 405-775-6413 E-MAIL: CUSTOMERBILLINGCwHERTZ. COM I� Q 10 IN �O T O i Q I Q L) CHECK NO: 712 L233695-0—R U Im DATE: 05-10-2008 :0 Uu > NAME AND ADDRESS INFORMATION: W U LLI THE HERTZ CORPORATION PO BOX 26141 OKLAHOMA CITY OK 73126 INSURED: CASTRO,ADR IAN/MARIA PAYMENT INFORMATION/DESCRIPTION: . VENDOR PAYMENT FOR DATE OF LOSS' 04-22-08 I NVO I CElI: A14527704 CLAIM NO_ 01-LW6585-7 BATCH#: 1081290 CLAIMANT: INSURED PAYEE: THE HERTZ CORPORATION AMOUNT: $209 .00 IN PAYMENT OF: A14527704 , 1081290 ADJUSTER: ACH REP ADJUSTER NO: ACH01 KIND OF LOSS: XLU 16610702 DETACH AND RETAIN FOR YOUR RECORDS No. 712 L233695-0-R DATE OF LOSS CLAIM 7URED'S NAME DATE 04-22-08 01—LW6585-7 CASTRO,ADRIAN/MARIA 05-10-2008 POLICY TYPE KIND OF LOSS SUFFIX CLAIMANT'S NAME PAY AUTO XLU 03F INSURED $209 . 00 D.O. ADJUSTER. NO. IN PAYMENT OF BANK OF AMERICA F1-1?7tl LRW ACH01 A14527704 , 1081290 Banl or Ama,ice C.=-r Connection Bonk of America, N.A. TIN: 13-1938568-00 Atlanta. oetato County. Georgia PAY *TWO HUNDRED NINE 00/100* This check must be properly endorsed on the reverse side by all payees. THE HERTZ CORPORATION TO THE ORDER OF c 0 'M HERTZ LOCAL EDITION HLE INSURANCE DEPT 1139 in o PO BOX 121139 DALLAS, TX 75312-1139 U) UNITED STATES U jm Phone: 888 777 3700 X6427 o Fax: 405 290 2645 > E-mail: LCLEMONS@HERTZ.COM w U W CONFIDENTIALITY NOTICE This electronic message contains legally privileged and confidential information intended only for the use of the individual or entity named. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution, copying or other use of this information is strictly prohibited. If you. have received this information in error, please notify us immediately. Thank You. T0: ADAMS KRISTINE FAX: 17078639052 FROM: LORIE E. CLEMONS HERTZ CORPORATION DATE: 2008-05-19 09:24 PAGES: 1 of 2 (including this page) SUBJECT: Rental Agreement No: A15018312 Document: 609087056278 Invoice Date: 2008-05-14 California State ,Tutontob leA\:►'oe ation Inter-Insurance Bureau P.O.Bos 970 Sudcun CitV, Cd 94585-OV-10 May 3.0. 2008 F R. � E� tVED . 1 Clerk of The Board of Supervisors/Contra Costa ; J LJN () 2 2u08 � I County Administration Bld;Rm 106/651 Pine Street ' 1 1 Martinez.California 945,53 CLE-RK BOARD OF SUPERVIS R CONTRA COSTA GD. I RE: Your insured: Dave Spinelli Your Claim No.: 64760 Our Insured: Adrian/Maria Castro Our Claim No.: 01-LW6 JR5-7 Date of Loss: 04/?3;3008 Dear Clerk of The Board of Supervisors/Contra Costa: This will confirm our subrogation interest arising from this loss. We have settled the claim with our insured and based on the following facts.request payment directly to California State Automobile Association Inter-Insurance Bureau (CSAA-iIB): In order to assist with and expedite the evaluation and processing of this subrogation demand. we enclose the relevant documentation in support of our claim. This information may contain personal or privileged information about our insured. and is being provided to you pursuant to California Insurance Code Section 791.13 and may not be used for any unauthorized purpose. Based upon this information.we ask that you issue payment of S Repair Bill 54.462.93 Deductible $0.00 Loss of Use S209.00 Tow/Storatue $0.00 Miscellaneous 50.00 -------- ----------------- TOTAL $4.671.93 Please be be advised that any payment in an amount less than that set forth in this letter that is forwarded to CSAA without its prior authorization as described below will not constitute a full and final settlement and will he accepted as partial pai+ment onit,. Since payments received in the mail are processed by clerical staff and deposited as a matter of course without examination.unauthorized payments for less than the full amount demanded may be processed inadvertently. Although such payments may be demarked as"payment in full"or have other words of similar meaning written on them. their processing will not constitute an accord and satisfaction. as CSAA has not agreed to acceptance of such payments. Only an authorized Subrogation Specialist may communicate,orally or in writing. CSAA's specific agreement to accept an amount less than that demanded in this letter. If you have any questions.please feel free to contact the CSAA Subrogation Department. Sincerely, Subro<uation Recovery Team A 888 900-6520 extension 6298 Fax 707-863-9052 Enclosure r ' {� ..rte'. e\ t , ... ... ... .. .... w'ta - ?w e ..r V: y:r JY . y i t.. .„ 44 i;,::.✓..::'�' ...:: .'�':: .:jam 'fes'.:��•�'F,..: �.;;.. ,;.,' «:z" �� ;a r: 3' _,- ez '.: r.. I .r ,A r .. .... ¢. �.C.sem, ✓: .. .. c .I b A '4F e i Ili �� ��u..:,'•fYTz'':.':<- ,.•^:f;s:��F , ., r "1LJ - e'S , wk E , r.. a„ ^ w A�. 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L '(... -.-6 Date: .516,2008 11:14 AM Estimate ID: 10817 REPAIR ORDER: 8329 Estimate Version: 1 Supplement 1 (F) 5/6,2008 10:4021 AM FINAL Profile ID: CSAA-0RN BODY BEST COLLISION CENTER INC. 19648 8TH ST EAST,SONOMA,CA 95476 (707)9962470 .' Fax: (707)9963004 Tax ID: 26-0015297 BAR#: ARD215694043009 EPA#: 912242987 Damage Assessed By: DINODIGIULIO Supplemented By: GARY SPAHN Condition Code: Excellent lco Date of Loss: 4/2212008 Arrival Date: 4/23/2008 o 0 Corrtact Date: 4123/2008 FINAL TO OWNER 5/612008 N Payer. Insurance Deductible: WAIVED to Policy No: LW65M Claim Number: A01LW6585701 CD1 o Insured: ADRIAN/MARIA GASTRO QOwner: ADRIANIMARIA CASTRO Q Address: 761 1 ST STREET WEST,SONOMA,CA 95476 V . Telephone: Work Phone (999)9998999 Home Phone: (707)540-0075 m p Mitchell Service: 910700 Description: 2007 Toyota Yaris Vehicle Production Date: 1/07 JBody Style: 4D Sed DriveTrain: 1.5L Inj 4 Cyl 4A FWD VIN: JTDBT923X71123W3 License 5ZEV525 CA Mileage: 11,357 OEM`ALT: A Search Code: C86251 Color: black pearl Options: AUTOMATIC TRANSMISSION ALL CRASH PARTS ON THIS ESTIMATE ARE NEW ORIGINAL EQUIPMENT MANUFACTURER PARTS, UNLESS OTHERWISE SPECIFIED. PARTS DESCRIBED AS RECHROMED, REMANUFACTURED OR RECONDITIONED ARE CONSIDERED "REBUILT?' PARTS. CRASH PARTS DESCRIBED. AS "QUALITY REPLACEMENT PARTS" ARE NON-ORIGINAL EQUIPMENT MANUFACTURER AFTERMARKET NEW PARTS. Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units ROCKER/PILLARS/FLOOR 1 001857 REF BLEND L ROCKER PANEL C OS 2 000760 REF BLEND L ROOF RAIL C 0A REAR DOOR 3 001347 REF BLEND L REAR DOOR OUTSIDE C 09 4 001260 BOY REMOVEANSTALL L REAR OTR DOOR BELT MOULDING Existing 09 5 R&R Time Used in R&I Operation 6 001264 BDY REMOVEANSTALL L REAR DOOR TRIM PANEL INC 7 001289 BDY REMOVEANSTALL L REAR OTR DOOR HANDLE 0,3 # S1 8 001315 BDY REMOVEIREPLACE L REAR DOOR WEATHERSTRIP 67872-2170 39.08 OA 9 R&R Time Used in R&I Operation 10 access to blend roof rail-adhesive not reusable ESTIMATE RECALL NUMBER: 05/011200806:40:35 10817 MitchellDataVersion: OEM APR_08_V UltraMateisaTrademark ofMtchellInternational Copyright(C)1994-2008 Mitchell International Page 1 of 4 UltraMate Version: 6.5.017 All Rights Reserved Date: 51 612008 11:14 AM Estimate lb: 10817 REPAIR ORDER: 8329 Estimate Version: 1 Supplement 1 (F) 5162008 10:4021 AM FINAL Profile ID: CSAA-DRN 11 001323 GLS REMOVE/INSTALL L REAR DOOR MOVEABLE GLASS Existing 12 # 12 R&R Time Used in R&I Operation 13 001327 GLS REMOVEANSTALL L REAR DOOR STATIONARY VENT GLASS Existing INC' 14 R&R Time Used in R&I Operation 15 001331 BDY REMOVEANSTALL L REAR DOOR GLASS RUN Existing 02 # 16 R&R Time Used in R&I Operation ROOF 17 001420 BDY REMOVEANSTALL L ROOF DRIP MOULDING 0.3 BACK WINDOW 18 001819 GLS REMOVE/INSTALL BACK WINDOW INC # 19 001509 BDY REMOVE/REPLACE BACK WINDOW REVEAL MLDG 75573-52240 38.73 INC # QUARTER PANEL 20 001851 BDY REMOVEANSTALL L QUARTER MUDGUARD 0.3 21 001876 BDY REMOVEIREPLACE ADD TO R&I BACK GLASS OA 22 001794 BDY REMOVE/REPLACE L QUARTER OUTER PANEL 61602-x2380 547.64 20.0 # 23 REF REFINISH L QUARTER PANEL OUTSIDE C 22 24 REF REFINISH L QUARTER PANEL EDGE C 05 25 REF REFINISH L ADD FOR PILLAR C OB 26 001520 BDY REMOVE/REPLACE L RIVET 2@_0.57 9026946013 1.14 27 001485 BDY REMOVEIREPLACE L QUARTER VENT LOUVER DUCT 62940-AAO30 35.67 INC # LUGGAGE LID 28 . 001821 REF BLEND LUGGAGE LID OUTSIDE C 02 29 001828 BDY REMOVE/INSTALL LUGGAGE LID GARNISH 0.3 30 001566 BDY REMOVE/REPLACE LUGGAGE LID ADHESIVE EMBLEM 90975-02063 24.58 02 MANUAL ENTRIES 31 900500 REF' ADD'L LABOR OF BACK TAPE WINDSHIELD Existing 02` 32 900500 REF* ADD'L LABOR OF MASK INTERIOR JAMS AND OPENINGS Existing O.G' 33 It rear door&deck lid openings LUGGAGE LID 34 001567 BDY REMOVE/REPLACE LUGGAGE LID ADHESIVE NAMEPLATE 75446-2040 20.41 02 35 001568 BDY REMOVE/REPLACE LUGGAGE LID ADHESIVE NAMEPLATE 75442-2260 2x".75 02 REAR LAMPS 36 001736 BDY REMOVE/REPLACE L REAR COMBINATION LAMP ASSEMBLY 8156182550 150.59 INC # REAR BUMPER 37 001751 BDY OVERHAUL REAR BUMPER COVER ASSY 1 A 38 001752 BDY REMOVE/REPLACE REAR BUMPER COVER 52159-82929 186.88 INC 39 REF REFINISH REAR BUMPER COVER C 2A 40 001758 BDY REMOVE/REPLACE L REAR BUMPER SEAL 52592-2220 24.86 INC 41 001760 BDY REMOVEIREPLACE L REAR BUMPER RETAINER 2@0.55 `Y New Non-OEM 1.10 ` INC 42 001762 BDY REMOVE/REPLACE L REAR BUMPER RETAINER 52576 120 41.81 INC # 43 001786 BDY REMOVE/REPLACE L REAR BUMPER SUPPORT 52156-2090 16.09 INC ADDITIONAL COSTS&MATERIALS 44 936014 ADD'LCOST FLEX ADD RIVE 7.00 45 HANDBOOK ITEM(PER BUMPER) MANUAL ENTRIES 46 900500 BDY` REMOVE/REPLACE PANEL BONDING KIT Q New Non-OEM 35.00 ` OA` 47 it qrt panel 48 900500 GLS' REMOVE/REPLACE URETHANE GLUE KIT —NewNon-OEM 25.00 ` OA` ADDITIONAL OPERATIONS 49 933006 FRM ADD'LOPR FRAME/RACK SET UP 1A' 50 933036 FRM ADD'LOFR SHEETMETALPULL 0.00 ` 2A` 51 REF ADD'L OFR CLEAR COAT 2j6 52 933005 BDY ADD'LOPR RESTORE CORROSION PROTECTION 10.00 ` 0.1` 53 HANDBOOK ITEM(A PER PNL) 54 933008 REF ADD'L OFR CHIP RESISTANT MATERIAL APPLICATION 10.00 ` 05` 55 It lower qtr panel a rocker ADDITIONAL COSTS&MATERIALS ESTIMATE RECALL NUMBER: 05/01/200806:40:35 10817 Mitchell Data Version: OEM APR_08_V UltraMate is aTrademark of Mitchell International Copyright(C)1994-2008 Mitchell International Page 2 of 4 UltraMate Version: 6.5.017 411 Rights Reserved Date: 5/6/2008 11:14 AM Estimate ID: 10817 REPAIR ORDER: 8329 Estimate Version: 1 Supplement 1 (F) 5/6,2008 10:4021 AM FINAL Profile ID: CSAA-ORN 56 ADD'L COST PAINT 347.70 57 ADDT COST HAZARDOUS WASTE DISPOSAL 1.83 ' -Judgment Item -Labor Note Applies C -Included in Clear Coat Calc Estimate Totals Add'I Labor Sublet 1. LaborSubtotals Units Rate Amount Amount Totals if. Part Replacement Summary Amount Body 242 67.00 10.00 0.00 1,631.40 Taxable Parts 1,211.33 Refinish 12.7 67.00 10.00 0.00 860.90 Sales Tax 7.750 , 93.88 Glass 12 67.00 0.00 0.00 80.40 Frame 3.0 67.00 0.00. 0.00 201.00 Total Replacement Parts Amount 1,305.21 Non Taxable Labor 2,773.70 LaborSummary 41.1 2,773.70 III. Additional Costs Amount IV. Adjustments Amount Taxable Costs 354.70 Insurance Deductible WAIVED Sales Tax 7.750% 27.49 Customer Responsibility 0.00 Non Taxable Costs 183 Total Additional Costs 384.02 I. Total Labor. 2,773.70 II. Total Replacement Parts: 1,305.21 Ill. Total Additional Costs: 384.02 Gross Total: 4,46.93 IV. Total Adjustments: 0.00 Net Total: 4,462.93 Less Original Net Totat 3,920.82 Net Supplement Amount 542.11 S1: GARY SPAHN 542.11 THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OF THE PARTS, RATHER THAN BY THE ORIGINAL MANUFACTURER OF YOUR VEHICLE. ESTIMATE RECALL NUMBER: 05/01/200806:40:35 10817 Mitchell Data Version: OEM: APR_08_V UltraMate is aTrademark of Mitchell International Copyright(C)1994•2008 Mitchell International Page 3 of 4 UhraMate Version: 6.5.017 All Rights Reserved Date: 5/612008 11:14 AM Estimate ID: 10817 REPAIR ORDER: 8329 Estimate Version: 1 Supplement 1 (F) 5/6/1008 10:4021 AM FiNA L Profile ID: C5AA-DRN Point(s)of Impact 7 Left Rear Corner(P) Insurance Co: CSAA Insurance Body Best guarantees all body repairs and refinish work for a period of 5 years from the date repairs are completed. Body Best shall not be held responsible for claims resulting from abuse, neglect, or normal wear and tear. Refinish panels subject to chemicals, road abrasions, or impact from foreign objects .will not be honored. Body Best reserves the right to .inspect and perform all necessary adjustments. I HEREBY AUTHORIZE THE ABOVE WORK AND ACKNOWLEDGE RECEIPT OF COPY SI GNED X DATE THANK YOU FOR LETTING US SERVE YOU Company Code: Drop Off Date and Time: 4123/2008 Time;10:45 Repair Dates: Promise Date: 5J9/2008 Start Date 42512008 Vehicle Pick Up Date and Time: 5/62008 Completion Date: 51 612008 Is Vehicle Driveable(YM)?: Y Assisted With Rental(YIN)?: Y . ESTIMATE RECALL NUMBER: 051011200806:40:35 10817 Mitchell Data Version: OEM APR-08_V URraMate is aTrademark of Mitchell International Copyright(C)1994-2008 Mitchell International Page 4 of 4 U17aMate Version: 6.5.017 All Rights Reserved Date: 5✓612008 11:14 AM Estimate ID: 10817 REPAIR ORDER: 8329 Estimate Version: 1 Supplement 1 (F) 5162008 10:40:21 AM Profile ID: CSAA-0RN BODY REST COLLISION CENTER INC. 19648 STH ST EAST,SONOMA,CA 95476 (707)996-2470 Fax: (707)9963004 Tax ID: 26-0015297 BAR#: ARD215694043009 EPA#: 912242987 Supplement Delta Report Comparison of Estimate 10817 Supplement0 and Supplement 1 Damage Assessed By: DINO DIGIULIO Supplemented By: GARY SPAHN Insured: ADRIAN/MARIA CASTRO Owner. ADRIAN/MARIA CASTRO Vehicle Description: 2007 Toyota Yaris Date of Loss: 4,72,2D08 Line Labor Line Item Dollar Labor CEG Item Type Operation Description Part Type Amount Units Unit Changed Entries 10 BDY REMOVE/INSTALL L REAR DOOR WEATHERSTRIP Existing 02` 0.4 S1 8< BDY REMOVE/REPLACE< L REAR DOOR WEATHERSTRIP New< 39.08 < 0.4 < OAT< Deleted Entries 3 BDY REMOVEANSTALL L FRT DOOR WEATHERSTRIP Existing 0.2' 0.4 4 access to blend roof rail-partial 0.0 Global Changes Deductible From: To: 500.00 0.00 Labor Rates From: To: Adjustments From: To: Amount Original Estimate: 3,920.82 Supplement 1 542.11 Orig Total Tax 118.34 Supp 1 Total Tax 121.37 Net Supplement Amount 542.11 NetTotal 4,462.93 Program Calc Versions Data Versions Supp 0 6.5.016 APR 08_V Supp 1 6.5.017 APR 08_V ESTIMATE RECALL NUMBER: 5/1/2008 06:40:35 10817 UltraMate is a Trademark of Mitchell International UltraMate Version: 6.5D17 Copyright(C)1994 -2008 Mitchell International Page 1 of 1 All Rights Reserved . . ......::: ,.ewr K, y.r'":• g < :: ... -.zd1x:.. IIF, ss:•.� �� c`2 Tt a , L s .Pi - i�. i < ' r� "a s`= v"N ......,,ter.. �. ,. y q 5A: : I N ,y < t461AM g£ tt:key¢'•` `=t: x. p .. .n.4 ...:...........::. ... .. x x , a„.,.:�^............. .. -':.�:. .F'.ens j.�kA: ...,. ,ate .�i�r:r:::.::;.::.�<•: �:'3:�.� n: aY ,g Y .s• a, 1 .:y y x I III ...........y x= I a Y ., ...<: :.:. ... .. .. .�... of.. ..:... .': ., .x P co tC) CD N ti i CD Q Q rn CHECK NO.: 712 L226253-7-R U M DATE: 05-07-2008 0 Lu .> NAME AND ADDRESS INFORMATION: W U u BODY BEST COLLISION CENTER INC 19648 8TH ST EAST SONOMA CA 95475 INSURED: GASTRO,ADRIAN/MAR I A PAYMENT INFORMATION/DESCRIPTION: DEDUCT WAIVED DATE OF LOSS: 04-22-08 CLAIM NO.: 01-LW6585-7 CLAIMANT: CASTRO,ADRIAN/MARIA PAYEE: BODY BEST COLLISION CENTER INC AMOUNT: $4,462.93 IN PAYMENT OF: CASTRO, ADJUSTER: KELLY KANAR ADJUSTER N0: 35412 KIND OF LOSS: COL 16610702 DETACH AND RETAIN FOR YOUR RECORDS No. 712 L226253-7-R DATE OF LOSS CLAIM INSURED'S I,AME DATE 04-22-08 01—LW65B5-7 CASTRO,ADRIAN/MARIA 105-07-2008 POLICY TYPE KIND OF LOSS SUFFIX CLAIMANT'S NAME PAY AUTO COL 01F CASTRO,ADRIAN/MARIA $4,462 .93 D.O. ADJUSTER. NO. IN PAYMENT OF BANK OF AMERICA M-127e DR2 35412 CASTRO, Bank of America Customer Connection Benk of America. N.A. TIN: 26-0015297-00 Atlanta. Dakalb County. ceergie PAY *FOUR THOUSAND FOUR HUNDRED SIXTY TWO 93/100* This check must be properly endorsed on the reverse side by all payees. BODY BEST COLLISION CENTER INC TO THE ORDER OF HERTZ LOCAL EDITION Rental Agreement No: A15O18312 Phone: 838 777 310L X51,27 . Invoice Date: 05/14/2008 aN: 405 296 2645 Document: 609087056278 [ mail: LCLEMDKA@:[RT2.COM LOCAL EDITION Renter: ADRIANMARIA CASTRO Direct All Inquiries To: Account No. : ********0614 HCC HERTZ LOCAL EDITION REPRINT CDP No. : 1221932 HLE INSURANCE DEPT 1139 CDP Name: HLE CALIFORNIA AAA PO BOX 121139 DALLAS, TX 75312-1139 TAX Id: 13-1938568 ADAMS KRISTINE CSAA-INSURED *ATTN CLAIMS DEPT P O BOX 920 ' SUISUN CITY, CA 94585-0920 RENTAL REFERENCE RENTAL DETAILS Rental Agreement No: A15018312 Rate Plan: IN: HIDA BUT: HID Reservation ID: 6OOOOODOOOD Rented On: 05/12/2608 10:69 LDC# 725101 NAPA, CA Returned On: 05/12/2008 18:00 LOC# 725101 NAPA, CA Car Description: SIR FOCUS BCPZ130 Vehicle No/VIN: 1978881/1FAHP35NXBW184365 CAR CLASS Charged: C MILEAGE In: 4,479 Rented: B OuL: 4,436 Reserved: B Driven: 43 BILLING INFORMATION BILLING DETAILS Claim No: 01-LW6585-7 DAYS 1 @ 19.49 19.49 Policy No: SUBTOTAL 19.49 DaLe of Loss: 2008-04-22 Type of Loss: D TAX 7.75% 1_51 Repair Facility: BODY BEST AUTOMOTIVE TOTAL CHARGES 21.60 USO Authorized Rafe: 25.11O Authorized Days: 1 MISC ADJUSTMENT -21_DO Adjuster: ADAMS KRISTINE Insured: 0 AMOUNT DUE 0.00 USD MISCELLANEOUS INFORMATION IDIAL RENIAL DAYS 1 BILLED TO CUSTOMER 9.00 ADJUSTMENTS 21.00 TOTAL RFNTAL CHARGES 30.60 THANK YOU FOR RENTING FROM HERTZ PLEASE INCLUDE RENTAL AGREEMENT NO. ON YOUR CHECK. REMIT TO: HERTZ LOCAL EDITION HLE INSURANCE DEPT 1139 PO BOX 121139 DAIIAS, TX 75312-1139 UNITED STATES AMOUNT DUE: (1.00 USD Phone: 888 777 37DO X6427 Fax: 405 290 2645 E-mail: I.CLEMONS@HERTZ.COM -aworma Mate Automobile Association inter-insurance Bureau P.Q.Box 920 Suisun City,CA 94585-0920 LO 1sodOOU r ssxno i i w �t t r s.. t i o; 0 N !S Q V O C7 d o � fl o � d w a ANIFINDEA) C.1-AUVII )BOARD UP' SUPERNISURS WCONTRA COSTA COUNTY DOARD ACJjm'__1W,)e, 8 Claim Against the. CoUlItY, or District.Govertied 1).v life Roard of-sulICIVISMS, RQUIJII&I Fn(lorsements, N 011 GE, 'I'(7 C I -incl Boai(I A.ction. All Section refcrelices are to 1.-he Copy of this cloculneill. flialle'd to Call floi ma Govei nment. Codes. YOU IS YOLI.t notice Of the action Laken on YOLII_ claim by the Board of Supervisors..(Paragraph .IV below), given I'Llf-Riant.to Goveinment. Code Section 913 and 9.15A. Please note all ANIIOUN'J.,: ► "Warnings". 0.,A INI A NT. Tle _: ATTURNFY: DA 117 R-FIC-1-11 1VF-�[X- 1.)D I. L',S,rz..':C'[ 1(;.. ....... .1.3 Y 1)F"Ll V I-:RY 'F0 CLE R K. ()N: C C', 1:3Y ce F1 0 N 1: 1 e I-I of the I d,1.1-11 ofSupervisors-- —--— 'Y0: CIOLIIIIY COUIPSCI Attached is a copy of the above-noted claim. .101IN:CULJN,Clerk Dated: tz!f c"_ ).N'.1: County COP I I S e T.(): Clerk. ol'the Board of Supervisors (L.iTlils claim complies substantially with Sections QM and 910.2. 'I'll I S ('lain, 17 A.11–S to comply substantially with Sections 910 and 910.2, at,cl we are.. so notifying c I a I I ia I I t. T1 I e 13o a rd cannot ,I c 1: for .15 (lays (Section 910.3). Claim is iiot hinel"v filed. The Cleik should FC111111 claim on ground that. it. MIS filed late and Send Ivallillig of clailmaill's right t6 applyftv leave to present a la.texhaim (Section 9.11.3). Dated. 0 By: D CI)LI(y County C'01_1119el COUlItYCounsel (l ) COLIlityA(Iiiiiiiist.i-at.()i- (2) 11.1. HUW. : Clerk ol,the Board CO: Claim MIS I-01-11-11Cd as 1-1111,1111ely With notice to claimant (Section 911 .3). W. BOARDORDUR: BYunallill l(..nIS voce of,the Supervisors present: This Claim is rejected in Fill). O Other: I cei til I I -LICalld con-ect copy ofthe Board's Older entered ill its minutes .6or I y that: this ;1 11 I llIq dale. Clerk k H N CV L,LE'N, C. Dated: jo VNIARNING(Gov. code section 91 Subject to Certain excepliolls'you have()ill.),six(6)monflis firom t1fe date this notice was personally seined oi.deposittil ill the mail to file.)court achole oil Ibis Claim.See GovermijeW Code Section 945.6.You may Neck tile advice of'.1i'l attorifey oll'your choice, in connection with this matter. If You wallato consult '111 ()I-llcy,you shollid,di).so im mediately. LTqr Additional NN7,11-111lig Sec 116crse Side of-this Notice. VF F.1 1.)A NIFF 01-, NI NIL I N G 'A'Afffillics hel.c.,ill mentioned, have Ftlechlre finder pellafty.of 1) r I I that taln 11mv, ;tired ')':ill I citizen of file 1jni(.ct1 Sl; Iles, over age and (11.11. Wthly I deposited in the hiited SlInic's Poslalselvice in Pillautillez, FQ I-if i;l,. postage hilly III-eflaid a cedified copy of Illis Umird ()vdcr :md N( tice ( ) ( 1611:11t.. ddlc.4svqJAo Ile (II 111VIfa abovc. el ■ Government Employees Insurance Company GEICO ■ GEICO General Insurance Company RIWEMM ■ GEICO Indemnity Company ■ GE"ICo Casuals Company Regional Office: One GEICO West ■ Box 509119 ■ San Diego, C.A. 92150-9090 June 10, 2008 Clerk of the Board of Supervisors 651 Pine Street Room 106 Martinez, CA 94553 Unfortunately, we are unable to find any records for the correspondence you sent us. Please take a.few. moments to.complete the form below and RETURN BOTH THIS LE I I LR r11vD THE ATTACHED CORRESPONDENCE in the enclosed envelope. As soon as we receive this information, we will be glad to answer your inquiry. Verytruly yours, Mail Classification GOVERNMENT EMPLOYEES INSURANCE COMPANIES 1-800-654-5896 Enclosure: Return Envelope E300 GEICO GEICO Accident Policy No. Claim No. Date Named Insured Phone No. Address of Insured Location of Accident (County) (State) Comments: PLEASE REFER TO OUR CLAIM NUMBER WHEN WRITING OR CALLING ABOUT THIS CLAIM CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA gCOUNTY BOARD ACT1ON:V 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 Gover=nment. 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:..P �O0 Section 913 and 915.4. Please note all "Warnings". `I' �n�-�1►I � CLAIMANT: �UL �� 66JAWt ATTORNEY:r110, DATE RECEIVED: owr�t 2-31 Z(—Db ADDRESS:. PA &X �"®56�r7 BY DELIVERY TO CLERK ON: hlc� BY MAIL POSTMARKED: � Ll ZZ- ZXg S� Qcc n , CA C[4q fl+ FROM: Clerk of the Board of Supervisors TO:. County Counsel Attached is a copy of the above-noted claim. JOHN CUL ( �el Dated: c By: Deputy� If.. FROM.: County Counsel TO: Clerk of the Board of Supervisors ( This claim connplies 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 retui7i 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: e Deputy County Counsel 1.11. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. Other:. I certify that this is a true and correct copy of the Board's Order entered in its minutes for. this date. Dated: ©� o O JOHN CULLEN, CLERK, y eputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) months ti om the ate this notice was personalty served or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connectim will► this matter. Il'you want to consult an attorney,you should do so immediately *Fo.r Additional War�rirx�See Reverse Side ofThis Notice. AFFIDAVIT OF MAILING I declare under penalty of per jury that 1.. ant 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 fWartinez, California, postage fully prepaid a certified copy of this Hoard Order and Notice to Claimant, addressed to the claimant as shown above. 1 Dated: JOHN CULLEN, CLERK By Deputy Clerk Y CLAIM BOARD 0.17 SUPERVI.SO.RS OF CONTRA COSTA COUNTY BOARD ACTION:`:]L-U)e'., 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:..v 15c,c0of f Section 913 and 915.4. Please note all "Warnings". CLAIMANT: tui Lo i f) ATTORNEY: ( EIVED:�C DATE REC ADDRESS: �,��� 1 1�c StrBY DELIVERY TO CLERK ON: !/t BY .MAIL POSTMARKED: i`tl CAc(t-i-c� 7t�� FROM: Clerk of the Board of Supervisors T0: County Counsel Attached isa copy of the above-noted claim. JOHN CULE�4lleek. �.. Dated: 1,G r1�.�.. 3 �;��' By: Deputyfk II.---FROM.: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 91.0.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910:8). O Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: . Dated: By: Deputy County Counsel i1I. FROM:: Clerk of the Board TO: County Counsel (1) County Administrator(2) O Claim was returned as untimely with notice to claimant (Section 911.3). I.V. BOARD ORDER: By unanimous vote of the Supervisors present: ( ) This Claim is.rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JOHN CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of'your choice in connection with this nnatter. If'you want to consult an attorney,you shoukl do so immediately. *For Additioml Warning See Reverse Side of Ibis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that .f. ann now, and at all times herein mentioned, have been a citizen of the United States, over age 18; .and that today I deposited in the United States Postal Service in 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, CLI1RK By Deputy Clerk HEMEA-WED APR 2 3 7008 DiPISORS CLERK BOARD Gam.U, E. CO"!7PNI-il;.6 IA UD A _►�t� �..c��:������ -���,L���� -mss. IV L ha -klb Q- - o 1 7w- - , 0- N 1\ BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. A claim relating to a cause of action for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to 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+.he end o tis Ln . ■o�c000�t�eeee�����e�����a�����a�������������������t�����������r�s���r�������� RE: Claim By: ;,Ji����M �'$fl �t� Reserved for Clerk's filing stamp t t:5 eta", a9 '/ D Against the County of Contra Costa or ) APR 2 3 ?008 b L ,�� S��Q� D1Str1Ct) CLERK BOARD OF cA i ERVASORS GXVI�-Rij.MIST (Fill in the ) mik The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ 150)00 Q_and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) re&eapij z&D 2 o®g as aQ�l� Q 2. Wherp did the damage or inj y occur? (Include city and county) Cpn! Q�gC�S�� �sE;i i6 _\ IC 3. How did the damage or injury occur? (Give full detail • use tra paper if req ' ed) 4. What particular act or omission on the part of county or district officers, servants, or employees caused the Vury or damage?�E �l c.c,i� P_A -C LtRED Wj�, 7ZEJ j 4-- 0 .' 5 What are the names of county or district officers, servants, or employees causing the damage or injury?7DEQ�Lkl M-1 u 1`EZAP-.- y 6., What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.)"b EUSI"r4`ra 1.tti';nlC : -3v. 1'�So l.,owE, ?aaC�C buRl pl 'at z�C(2lFb�D �� Zoo�to �l�.C� 7. How was the amount claimed above computed? (Include the estimated amount of any prospe ti e injury or damage.) \ovv)�� '� S Q C)1.4 r'ip►��, �� j �tilD 8. Names and add\eres es of witnesses, doctors, and hospitals: W%;b Li4� A �tt� �an��,A LoSt Cu u�.z vi Yy S o'.9g` '� '1 ;� ,�cE,:2a 5onl�m r rs� 4A 9. List the expenditures you made on account of this accident or injury: DATE TWE AMOUNT =.a=oaeea¢meo a■as coma No Saa■a■■■■r■s■raaaaa■aaa■aamaaaaaaaMal ) Gov. Code Sec. 910.2 provides"The claim shall be )signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attornev) 1 Name and address of Attorney Q) �'t 20e--le- (Claimant's Signature) k.-J I Arv\ -ul. 16 A\d t,-) i M .'11 ,� Address) , 6 Anl 4LAw-16 Ade Q%%50 PJ Telephone No. )Telephone No. ki)t1-06 ■■■•■aa■■■■■■■■■■■•■r■■■■r■■■■■■■■■■■■■■■rr■rrr■■■rr■■■■■■rr■■■r■■■■a■a■■r■■■■aa■■aai 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 s a.4L attachments, addendums,or supplellllirluFalla..:.whaled to the cla+*n form, including medical records, are also subject to public disclosure. ■■■■■0aaaaaa■aa■■■■a■a■■aaa■a■■a0aaaaa5a0a0aaa0aa■aa0aa0aa0aa■00aaaa■oil aaa0a■0aa0aasI NOTICE: Section 72 of the Penal Code provides: Every person who,with intent to defraud,presents for allowance or for payment to any state board or officer, or to any county, city, or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account voucher, or writing, is punishable either by imprisonment in the County jail for a period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000.00), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000), or by both such imprisonment and fine. BOARD OF SUPERVISORS OF CONTRA. COSTA COUNTY. INSTRUCTIONS TO CLAIMANT A. A claim relating to a cause of action for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of . . action. A claim relating.to.any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. SEEM amass no Masao so WSW as RE: Claim By: ;���1�'aWl �'$fl1d��,� Reserved for CIerk's filing stamp ) Against the County of Contra Costa or } �a U�i�r '.P,CC��1��•�c�District) (Fill in the name) ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ 150,Qv Q �and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. Wherp did the damage or ink occur? (Include city and county) C-6 nl-� o� 3. How did the damage or injury occur? (Give full detail • use tra paper if req d) S t(18Ct Acta .SI A.mME.1) �A1r- i ir< 4 4. What particular act or omission on the part of county or district officers, servants, or employees caused the jury or damage?- E--P Y�9.6 1UA CuV�FEQ !Nle, _lEPOM 5 What are the names of county or district officers,.servants, or employees causing the damage or injury? j, ��L�J 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) t��tJ�S+rJ "t'o �-►�k_,r �tifi i ofit ' N'�a\taC)dER looc� „tel i,�1R i rlCe� 3i`�'�So i:ow ���S 'S�iC(L�5 E- �Z�C� �►�rKRh1A 7. How was the amount claimed- above- computed?. (Include. the -estimated amount of any prospe tiXe injury or damage.) AvAou�4}l `1� 5 � o til � ►�►s� �v��i�Sjrl 8. Names and addres es of witnesses, doctors, and hospitals: t,J;- L �t �ses, ot, was i+-► CoWIVA C-04A coax 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT Gov. Code Sec. 910.2 provides"The claim shall be,- signed esigned by the claimant or by some person on his behalf." SEND NOTICES T0: (Attomey) ) Name and address of Attorney (Claimant's Signature) (Address) 6 Ar4 QL4w_6 6 9mve W%,504 Telephone No. )Telephone No. ldn tie 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 supploin, nts attached.to the claim form, including medical records, are also subject to public disclosure. 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. N {ti o 000 110 w - � G N O B ,e SC731{PSSt o a'a e.s, o i.= a� Ws u-1 c / t Or, c� cg Ir i7 T�W i � , V14 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION:J (.��1✓ ( Z�OS Claim Against the County, or.District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section r r I' tfj ) The copy of this document mailed to California Government Codes. you is your notice of the action taken APR 23 2008 on your claim by the Board of Supervisors. (Paragraph IV below), COUNTY COUNSEL given Pursuant to Government Code MARTINEZ CALIF. Section 913 and 915.4. Please note all AMOUNT: RAA "Warnings". CLAIMANT: UtS M, - ATTORNEY:n/Gv DATE RECEIVED: f' �c,P. Z31 2LOff ADDRESS: f��O�I �� S „2Q BY DELIVERY TO CLERK ON: a ( 23 2C V L1: d BY MAIL POSTMARKED: FROM: Clerk of the Board of Super•.visors T0: County Counsel Attached is a copy of the above-noted claim.. JOHN CUL , Clerk ` Dated: hli a By: Deputy , iI. FROM: County Counsel TO: Clerk of the Board of Supervisors N ( 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 ]5 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warming of claimant's right to apply for leave to present a late claim (Section 91.1.3). O Other: Dated: �_a By: �.� Deputy County Counsel III.. FROM: Clerk of the Board TO: County Counsel (]) 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. 1 Dated: 0643/09 JOHN CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) months tibnn tine lite this notice was personally served or deposited in tine 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 widr this matter. If you want to consult an attorney,you should do so immediately. *Fo.r Additional Warning See Reverse Side ofThis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that 1. ani now, and at all tinnes 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 claima .t shown above. Dated: o JOHN CULLEN, CLERK By Deputy Clerk l� ' CLAiM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY l30AR.D'ACTI:ON:1-J Wje— C):3 . 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 Goveinment 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: Section"Warnings". CLAIMANT: �tyL(C) ( ��5` ��1 U1ti)n ATTORNEY:0/61. DATE RECEIVED: t. —T ADDRESS: �, (llcl �`E t Cl ed BY DELIVERY TO CLERK ON: tAl)-i L- iv , V `'b-1 BY N1AIL POSTMARKED: �Ct_ C1q-&0 FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. / 1� r� JOHN CUL , Clerk Dated:�l,bucl ,��-�� �C By: Deputy If. 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 [If. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARD ORDER: By unanimous vote of the Supervisors present: ( ) This Claim is rejected in.full. O Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JOI-IN 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 witli this matter. lf'you want to consult an attorney,you should do so immediately. *Fo.r Additio+ial Warning See Reverse Side ofThis 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, over age 18; and that today 1 depositedin 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 claimam.t 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 for death or for injury to person or to personal property, or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be fled 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. MEMO a0onRNona 0omen amompoormol RE: Claim By: Reserved for Clerk's filing stamp .. . Against the County of Contra Costa or ) APR 2 3 2008 strict) cl_EiTi<50771 7C,?!JPERVISORS (Fill in the name) ) cora%RA GOIST.a ro. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ > and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) cl--gl Z4no 2. Where did the damage o j or- ur? ,(I lude city and county) 3. How did the damage o i�occur? (Give full details; use extra pa er if requi ed) I r 4. What pa icular act or omission on the art of county or district officers. servants, or employees caused the injury or damage? 5 What are the names of county or district officers, servants., or employees causing the damage or injury? ZX0 72/ 15 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) _ amu , ' 7. How was the amount claimed above computed? (Include tie estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses, doctors, and hospitals: 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT ■.■■■rrrrrrrrrrrrrrrr■■rr■a.■■a■■rrrrrrrarrrrrrrr■rrr.■rrrrrrrrrrrarrrrrrrrrrrrrrrrr� 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 Signature) (Address) Telephone No. ) Telephone No. .r...........................rr.rrrrrrrrrrrrrrrrrrrrrr■rrrrrrrrrrrrrrrrrrrrrrarrrrrrt 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, 5§ 6500 et seq.) Furthermore, any attachments, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. own rrarrarrrrrrarrrrr■■rrrwon rrrrrrrrrrar■rrr.....■ra■■rrrrrrrrrrrrrrrrrarrrrrrrrarrl 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 jai] 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. Concord Shelter Statement and complaint and appeal Attention: Mr.Roberto 04-21-2008 Mr. Roberto this is to inform you of my rights under the contractual by-laws of the State of California and to inform "D",Kipp and Debbie of the in house meeting for Wednesday April 23,2008 at 12:00. As per our conversation at 9:35 on 04-21-2008 concerning,the incident of fairness and client right at the Concord Shelter under the riling contractual administration via employees named suffixes and aka (s) "D", Kipp, and Debbie not to supersede the Civil Judicial Authority to fore go with, if needed.This.problem was and isn't a condition of the client misunderstanding of the rules per say. This and other problems of surreptitious retaliations and abuses of clients is solely the errors and disregards of regulations in contrast and as a whole to over zealous and unsupervised, untrained. studio topical temperamental personnel with over inflated mental dispositions that's out of control. (1). I am the client filing (a). a complaint of abuses (b). mismanagement and neglect (c). a County and State a complaint for arbitrary hearing against the conduct of said employees "D"and Kipp of the Concord Shelter in accordance with non-compliance with the provision of the County of Contra Costa, State of California and HUD funding and tax payers rights to Shelter without harassments and under State of California patients and shelter rights. (2). I the client under no way at this time, but with all rights reserved to me. Reserve the rights in every way, but not at this time should these explanations be mistaken or be taken as a threat or to be a bellicosity. Nor is this to be mistaken as the law suet at this time,or to be bellicose in any way. This is just a summary of the facts and problems surrounding the client(Au(Yustus M. Brown II) authorized stay at the Concord Shelter. It is intended to be submitted for the sole proper of and in the form of a complaint at a point to only request for a hearing into the abusive conduct, harassments,temper tantrums,disregards for other people, disrespect, falsifying situations, inappropriate behavior, bipolar conduct of said staff employees and to enforce the client rights under the previsions the Contractual rights of the primary contractual granter to the subcontracting holder of which does not supersede the client rights under the County and State or Federal contractual agreement as to be specified. Facts in chorologica} order from the on set of the first retaliation of staff employees named above, (at this point excluding Debbie)for reason and focus on "D" and Kipp counselor, monitor and possible case worker at the Concord Temporary Shelter.{Exact titles of said or unknown.} 1 ' A As stated: on the evening of which may have been March 17`x' the client was asked to come into a conference meeting with said counselor Kipp after Mr. Kipp failed to adhere too two prior appointments set by him. Before hand the client did verbose with Kipp about these scheduled meetings and or appointments and talked with "D"about the incompetents and neglecting behavioral of the worker. The client asked ''D"to change his counselor for reason the Mr. Kipp showed signs of unconcern and this was and is stalemating the client progress to get into him own independent housing through the resources of this facility. ".D"abusively refused the client request to appoint the client to another counselor. On the night of approximately April 17`l'the client was asked by the counselor Kipp to come into a conference meeting of which the client did comply and went into conference room with the counselor as instructed. During the interview the counselor begin to ask the client question about the client drug usages, first. The client explained to the counselor(Kipp)that he does not use drugs. The counselor then looked at the client and tilted his head and hat back and then he stated, "Now Mr. Brown I don't believe that you have not ever had a problem with drugs ever,you may not have had a problem with it but everybody has used at some point.Now I know that some where in your life you have used drugs like everyone else. Now you can't just set up here and tell me that you have never used drugs.F am not buying that Mr. Brown"the client told the counselor that he could believe whatever lie pleased. "You asked me a question and I answered you, stated the client to the counselor. The client asked the counselor was this a drug rehabilitation center?The counselor answers the client, "no this is not a drug rehabilitation center". But what this is, it's a shelter where we help you to get out and to reestablish yourself. "We Help you with housing and other things". The client explained to the Counselor that these things were ok, but inquiring about his pass drug usage did not have anything to do with this intake into case management. The reason that the client did reply to the Counselor was for two reasons 1.the counselor had was already showing signs of angrier against the client because of the request for the change made iii front of him earlier. 2 the client felt some what disrespected by the counselor because the client is a Pastor and the counselor at times shun him, by properly uses profanities in an attempt to surreptitiously disrespect the client. Kipp asked the client where he was going to look for work and to interviews. The client told hint that it could be anywhere form San Francisco to Los Angeles depending on who call and where he would have to travel to. He asked the client what was the name of some of the places that he was going to and the client began to name out to the counselor the names of Aerotek staffing in Alameda and Solutions Staffing out in Campbell and places in San Francisco and the client conveyed these places are all round the Bay Area. Mr. Kipp then turned to the papers in front of him to write these Company names down and he asked the client to spell Solutions and the client helpingly did so. Tile client then voluntary told him that he was waiting on a job form the BNSF Railroad of which they was offering to pay the client $125,000.00 with a$20, 000.00 sign on bonus. The counselor then turned and began to stare at the client hard and angrily and with discontent. Mr. Kipp first said, with an up rising in his voice, "then if these people are offering you this kind of money, then why in the fuck are you not working. The client told Mr. Kipp that the economy was low right now and when that happens is that more company put on a Hiring freezes and that the client can't go in and make them hire him. 2 Mr. Kipp then holding his head down and rubbing it under his cap asked the client what kind of Jobs are you looking for? The client explained to the counselor that I was looking for work during logistics, Maintenance Machinist, printed circuit PNP,NPN. At this point the counselor looked up and said I am not going to write all that shit down here. The counselor was showing signs of being irritated and deposes. The clients just set and look at Mr. Kipp and was thinking to his self that all Mr. Kipp has to do is to give the client the pen and paper and the client could write all these things down for his. The client understood that if the counselor could not spell a simple little word like "solutions", then he may be having a problem with hearing and/or understanding the English alphabet. Rule violations At this point the counselor(Mr. Kipp) began to look at the client with anxiety and discontentment and harshly asked the client about his financial income because this information wasn't in the client folder. The client told the counselor that he had supplied this information when lie first arrived at the shelter and that this paper work should be in the folder,but there wouldn't be any problem with during another take and summiting it again. After a few minutes into during the intake the counselor(Mr.Kipp)asked the client about how much money did he spent on transportation during the month and the client told Mr. Kipp that he could spent about$192.00 dollars a week depending on where and what routes lie had to travel. The client also told the counselor that he had;gone to all of the Bay Area and Los Angele county transit authorities and applied for disability discount cards and that this would cut down on the amount of money that he was spending per week to almost one third. Now here is where the second set of hostility came in and it was positively unexpected, but not surprising behavior of the counselor because he has shown this attitude before and this became a fight with the individual about 2 months ago. The client did and do understand that the counselor to have a violent pass and he have a criminal background and a prison record. Now this is what came out of the counselor mouth as he was looking down at the paper. "Now he Brown what you are telling me about what you spend for transportation for I mother-fucking week is not making any mother-flicking sense"He raised up his head and looking the client sharply and in discontent and that the client was attempting to deceive him. M.r. Kipp went on to say,you gon set up here and tell me some stupid as shit like you spend $192.00 dollars a week riding the bus and you expect for me to believe that bullshit''.No body spend $192.00 dollar a week for transportation. The client asked the counselor why he was talking to him in this matter. The counselors reply was, "you gon set up here and tell me some dumb ass shit like this", "this isn't making any sense to me Mr. Brown and fuck it. I' am not going to even continue with this intake". "Fuck it". "Tomorrow you can talk to"D". He then raise up from the desk and put the folder on top of a shelf like file cabinet, he then looked around at Mr. Kipp then looked around at me and said"man oh man fuck this"He then said, "come on Mr. Brown I not dealing with you come on and get the fuck out and go somewhere. The client told Mr. Kipp that the client did not have any problems with him and that the client never had any problem with him in the pass. The client asked the counselor what he was thinking about during. The client was very concerned for his safety for the reasons that counselors demeanor had escalated to point that the angry and violate look that counselor had in his eyes. Mr. Kipp; reply was to this extent, "you need to go on somewhere else before I put you out''.Now look at me like that one more time!!! 3 He said this with an upraised and temperamental and threatening fashion asking for violent. He stated this in the highlight of him anger with an intent to intimidate. On Friday April 18`x'the client called "D"and he asked her about assigning him once again to a new counselor. This is how this conversation went. With her as she came to the phone yelling and screaming out of control and judgmental "Mr. Brown I understand that you have not been here and no one have seemed you". I told you that you are not going to change counselors,you're going to stay under Kipp and why you don't like Kipp anyway. He is a really good person and everyone else get's along with him. The client bought it to"D" attention that Kipp have had arguments with other clients on several occasions and a fight with someone. The client wasn't relaxed with Mr. Kipp's conduct. Then "D"replied,you are telling me about everybody, Mr. Brown look at what you have to do for yourself. Then the yelling and screaming started once again. "I am trying to work with you Mr. Brown and you don't even be here some nights" so don't you try to tell me about my staff I know my staff'. The client told her that he have been there every night and that Ile could prove this by the sign in list and the wake up list and that the staff people see me leave out at 5:30 a.m. every morning going to his Church for morning Prayer and he sometimes do not get back to shelter until 9:30- 10: 00 P.M. In contrast: On some Church nights Pastor Willie or some events can run a little late and it is to my understanding that there was some kind of a agreement that this was alright if the person frorn the Church walk you into the facility. Now while client was talking to "D"she for no reason at all started to accuse the client of screaming and yelling at her on the phone. She then became angry for no reason at all once again and just hanged up the phone on the client. By first saying"look Mr. Brown F am not going to put up with you yelling in my ear". The entire point of my concern is the fact that the client wasn't even talking into him cellular phone at this time. The only thing was coming through on that cellular at that time was the client receiving what she was saying. It's like someone was having another conversation with her,but it wasn't the client speaking to her. The client was just listening. At this point she just hanged C►p the phone, thinking that the client was talking*to her. The client waited for about 30 minutes and called"D"back and this time she had somewhat claimed down. This was and totally different mind set. Then she started comely telling the client that he was missing out on all of these programs and not coming to this in house meeting on Thursdays nights and not during some kind in house meeting on Tuesday's. The client explained to"D"that he has been attending these meeting and that the client has some the papers singed off for some of these so meeting. "D"then said well ok Mr.Brown now you know that I will work with you". "This is what we are going to do,we are going to forget all this and start these things all back over and since you have an income you should not be under Kipp anyway". "You should be in case management so that we can get you into your own place. How long have you been here, let me see, I am looking in your folder and you have been here since 2-24-28-08". "You should have been in your own place by now because you have an income". "So this is what we are going to do. For get all about all this other stuff and we are going to start this all over so we can get you caught up. But you are going to have to attend these meetings Mr. Brown. So I am going to assigned you to Charles and lie is a little tougher than Kipp.Now. I don't won't any more trouble out of you about this, now, Mr. Brown''. The client agreed with this because of all fairness. 4 Harassments and abuses On Saturday 19, 2008 a colleague and the client came into the Concord Shelter from Church and Mr. Kipp was standing in the hallway from the entrance way, he just stood there staring at the Client with a serpentine angry. About 15 minutes later Mr. Kipp walked into the Dinning room and told the client that he had some papers for him at front desk to sign. The client asked him to give me a few minutes and he would come up there and take a look at it. When the client went up to the front desk his co-worker pulled out some papers and told the client he had 5 infections in her hand and Mr. Kipp has written you up and he asked her to give them to the client to sign them. The client respectfully and cautiously explained to her that he the(client)wasn't refusing to sign these papers and that the client had talked to "D"about this issue and she told the client that we were going to forget about and drop all these things and we were starting this stuff all over. The co-worker replied that this was ok and that if"D''and the client had talked about it,then takes it up with "D". It was my understanding that Mr. Kipp did not like the fact that the client did not sign these papers thathe maliciously wrote up and out of his anger he rushed to the telephone and then called"D"printing a spurious picture that the client was being insubordinate to him request. Then Mr. Kipp came send his co-worked running into the dinning room and handed me a paper stating that 1 should see`'D"on Monday at 10:30a.m of which I did so. On Monday 04-21-2008 at 9:05a.m. "D" was walking by the office and the client spoke to her 'good morning''. "D" looked the client dead in the face with irritate and already fashioned and unashamed with out remorse and refused to speak back to him. "D"then turned her back and walked around the corner. The client was talking on my new cellular phone and the client walked out doors and was talking to a follow comrade. "D"came to the door and said `'look Mr. Brown if you are going to talk to me,you going to have to hang up that cell phone or you won't be talking to me". As the client was walking toward her she looked at the client once again and said; "Don't come in here talking on that cell phone". But the client was already putting the phone up plus his appointment wasn't with her until 10:30, so what was the point of all this anxiety. Metamorphosis Standing in the office with "D" she then began accusing the client of doing the very same things that she told him that she were going to do way with and start back over. "D" snatched up the 5 infractions that Mr. Kipp had written up and stated to shaking uncontrollably in the clients face,yelling"you have 5 infractions and get out for three days". Then all the client said was look"D"you and I have already talked about these things and you were the one of whom said that we were going to forget about this and start all back over. Then "D"out of nowhere for some other reasons unknown to a non-psvcholo2ical novice or possibly anvone else. "D"through the papers down on the desk and loudly said to the client, "you don't talk back to me, when i tell you that you're not your out.The client then stated;that he had a right to defend the acquisitions and to remind her of what she said to him prior.Then "D" jumped form the chair and went into some kind of mental metamorphosis this was even more terrifying than anything that the client has encountered. "D"just out of nowhere started to yelling. and screaming,you don't talk back to me, when i say something that's it. i replied, I have a right to defend myself and tell you what you said don't 19 5 She was violently angry and ".D"run over to the door and jerked it open and started calling for Debbie. Then "D" said you don't set up in here and tell me nothing gets out and I am putting you out for three days. Client asked her why you are doing this?When you said that you were placing me under Charles and that there wasn't a problem with this anymore. When Debbie came into the room "D"was steal yelling! He is refusing to leave and he's talking back to me. All the client said in front of Debbie was this woman is telling me that I violated some rules, after she told me that she was forgetting about them and we were to make a new plan. Debbie asked for client to get a statement form the place where I went to interview and FAX it back over to her to prove to them that the client was at an interview on 04-17-2008. the client did at the shelter on Thursday April 17 at about 7:30 where lie did truly talk to Mr. Kipp upon his arrival. At that time Mr. Kipp told the client not to worry. However Mr. Kipp did explain to the client that he had indeed missed the meeting. The client explained to Mr. Kipp that he made every attempt to get to the meeting. Check the bus schedule for the bus 4108. Let's look at the problem and the circumstance around this problem. The interview was out in San Jose-Campbell for 4:30 p.m. and to get from Campbell to the Bart station and bus back to the shelter in Concord is going to take 2.5 to 3 hours then you have to set there and wait on the 108 for an hour so by the time I get to the shelter it was already after 7:30 p.m. and the fact that I should not have to put my potential job in jeopardy like this going out there asking them for a excuse to show to someone that the client had been out there. Makes things look like the client in some kind problem form prison or something. This kind of inquiry, it just don't look good to new employers asking for things like this. The only thing that I am trying to do is to get on my feet. I can get a apartment but the problem is getting a job to show the landlord that I make over $1,700.00 month. This can and will work with my Social Security benefits, or I can just move into a room with a roommate. The hold things about this I am not disrespectful to people. The Lord has shown me how to love and understand people and how to stay out of some of their ways. In simulations like this one where there Is a close proximity of complexities. Sometimes regardless you can't see it coming. This statement is honest and true to the best of my knowledge and memory. Augustus M.Brown H 6 1�t CLAiM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACT10N'--� 1,u, -e W$ 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. �� ou is your notice of the action taken 6 n your claim by the Board of APR 5 2QQ8 upervisors. (Paragraph IV below), given Pursuant to Government Code AMOUNT: COUNTY COUNSEL Section 913 and 915.4. Please note all MARTINEZ CALIF. "Warnings". CLAIMANT: Robef+ C-� � tS ATTORNEY: 'yC(__ DATE RECEIVED: ! ti Rr d Cab,*Oo ADDRESS: p,00. 0% BY DELIVERY TO CLERK ON: PIA rd, 2_ 21cog Ckq %'�0D BY MAIL POSTMARKED: )'ROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN CU N, Clerk- ' Dated: 2� �g By: Deputy r uwL iL FROM: County Counsel 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: �� ,v By: ! �Deputy County Counsel 1.11. FROM.: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IVBOARD ORDER: By unanimous vote of the Supervisors present: This Claire is rejected in full. Other: I certify that this is a true and coirect copy of the Board' rder entered in its minutes for this date. Dated: QVQa JOHN CULLEN, CLERK, By Deputy lerk WARNI.N (Gov. code section 913) Subject to certain exceptiars,you have only six(6) months fi,0111 the ate 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 attoniey,you should do so inunediately. *For Additiaial War rrirrg 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, 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 clainra shoivn above. Dated: `� JOHN CULLEN, CLERK B De uty Clerk C C LA I.NI BOARD OF SUPERVI:SORS OF CONTRA COSTA COUNTY BOARD ACTION`, L(J):C. -(Y,3 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 yotrl• 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: ATTORNEY: 4L DATE RECEIVED: � w ADDRESS: BY DELIVERY TO CLERK ON: I ZIC - C^'j ���f S�l BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. �' JOHN CU N,.Clerk•-- - Dated: r 1U ti "� > �7-� Z'1�: By: II. FROM.: County Counsel TO: Clerk of the Board of Aupervisors ( ) This claim complies substantially with Sections 910 and 910.2. ( ) .This Claim 17AILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15'days (Section 910.8). O Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). O Other: Dated: By: Deputy County Counsel - 1.11. FROM.: Clerk of the Board TO: County Counsel (1) County Administrator(2) O Claim was returned as untimely with notice to claimant (Section.911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ( ) Titis 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 oC your choice in connection with this matter. If you want to consult an attorney,�?ou should do so inunecliatel3,. *For-Addidonal Wannirxg See Reverse Side ofThis Notice. AFFIDAVIT OF MAILING I declare tinder penalty of• perjury that I: am now, and at all times herein mentioned, have . been a citizen of the United States, over age 18; and that today I depositedin the United States Postal Service in N'iartinez, California, postage fully prepaid a certified copy o'f 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 INS T RTJCTIONS 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 snail be presented not later than orae 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 fi-audulent claims, Penal Code Sec. 72 at the end of this form. 0eaa2a8saceaamaaasaeesemo11m15a0meee0aaaa■a110eaacaaaeisaaea1Aaasaaaaa0aem2aaaa0saac RE: Clain By: Reserved for Clerk's filing stainp ) RECEIVED Against the County of Contra Costa or ) APR 2 5 2008 ) District) CLERK BOARD OF SUPERVISORS (Fill in the name) ) CONTRA COSTA Co. Thee undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ � `�° and in support of this clain represents as follows: 1. When did the damage or injury occur? .(Give exact date and hour) (05�7 MD1' v.. 617 In rxAf Sx1 '015 ?. Villere did the damage or ii ury occur? (Include city and county) 6 S(o M 0 rarro— !'3 L.6. �cx 4,1.0.tfi c , 3. How- did the damn age or injury occur? (Give full details; use extra paper if required) yof i h� e�, r�e`t ti v40 ��i k64t^ ajulo r 0\"A eyra j�2 SzFor".e GLoS-e+. 4. What particular act or omission on the part of county or district officers, servants; or employees caused the iniury or damage? ` rat are the names of county or district officers, servants, or employees causing the damageor injury? (7-0 tv, ���'-3�3— zG-z i 13 e r c-U'19 ek5 42 51 1 -5—`L(, 3 6. What damage or injuries do your claim resulted? (Clive Rill extent of injuries or darnages claimed. Attach two estimates for auto damage.) -7 0 L f C zt 5 i .Z ej W1— S Com.e, 7. How was the amount claiined above computed? (Include the estimated amount of any prospective injury or damage.) S. Naples and. addresses of witnesses, doctors, and hospitals: 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT m e m m R e m m a m m e e m a R m m e R m R m m of m is e e e e a R a e m e e C e m a on Comm m m m m m m R R s■a m R a m m m m e WEBB rang Blame MCME of ) 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 ) -- f� T� (Claimant's Signature) )Ro6e7r } (Address) Telephone No. ) Telephone No. S[0 - yo l`i 5 m m m R m s m a R m m e a m m Garcia m m m R m m C U m e R R m m n m m m e Ems R MEREN m R m R a m n m m n e m m n m m m e n m m m e MIR Sam CM C RUEUMI 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, addendurns, or supplements attached to the claim farm, including medical records; are also subject to public disclosure. G Bounce ale Been G c e m e a R Blame m m e m m m R R e R R C e m m m emu age m e e m m a R m m m e R a m e R s e E m e R v m R e R use m m re m m e R I NOTICE: Section 72 of the Penal Code provides: Even-person who, iv nth 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 allovv or pay the same if genuine, any false or fraudulent claim, bill, account voucher; or writing, is punishable either by imprisonment in the Count},,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 imprisoiunent and fine, or by imprisomnent in the state prison. by a foie of not exceeding ten thousand dollars ($10,000), or by both such imprisoninent and fine. CLAiNI BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: f,U1P� 03�aoS Claini 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: s '13S. 75 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Ch ri-6 ATTORNEY: a' DATE RECEIVED: ADDRESS: �Qaio� LaW r—mc-e- Pcad BY DELIVERY TO CLERK ON: Cts Del V�� r GA 460b BY MAIL POSTMARKED:AM l Jl!� FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted,claim. Ltd JOHN CUL E,° Clerk Dated: Op 0 0-a-19 By: Deputy q - � i.I. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. .( ) Tills 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 rete i 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: '0 9--- By: /T1&9-&?S___Deputy County Counsel 1.11. FROM.: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 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 cor7-ect copy of the Board's Order entered in its minutes for this date. Dated: 9(00� o 4 JOHN CULLEN, CLER. �By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptiats,you have only six(6) months from thed to this notice was peisonallyserved 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. 11"you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side ofThis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I. am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in M.artinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant a Anown above. Dated6 o JOHN CULLEN, CLERK y uty Clerk Co,( CLAIM BOAi.ZD OF SUPERVISORS OF CON'r.RA 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 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� `�J� "Warnings". CLAIMANT: C rlf/ ATTORNEY:A/t.-L. DATE RECEIVED: �-(,�;)tI,L( %LC-'oS ADDRESS: XLt .( (,ltt�. BY DELIVERY TO CLERK ON: K- AL 6111 G&� BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted:claim. JOHN CUL14ETXI Perk Dated: ) •irl 1� �'� �- y By: Deputym�u*L tits_ �l 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 warping of claimant's right to apply for leave to present a late claim (Section 911.3). O 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). 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 or deposited in the nimil to file a court action on this chiinn.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connectior wide this matter. II'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 her jury that I am now, and at all times herein mentioned, have been a citizen of tine United States, over age 1.8; and that today I deposited in the United States Postal Service in N ..lartinez, California, postage frilly prepaid a eel-tilled copy of this Board Order and Notice to Claimant, addressed to the claimnan.t as shown above. Dated: JOHN CULLEN, CLERK By Deputy Clerk L5 I ! ® ;■,/18/2008 FRI 17:30 FAX 9258386629 San Ramon Valley Fire 001/012 ® 13 � a ■ate I . ` �PTI►ON ti SAN RAMON 'VALLEY moo, FIRE PROTECTION DISTRIC o SHARON HYMES-OFFORD DATE: ! April 18, 2008 APR 2 1 2008 TO: Sharon Hymes-Of ford COMPANY: Contra Costa County Risk Management FAX NUMBER: 925-335-1421 Number of pages including this cover sheet: 11 FROM: Robert Leete Administrative Services Direc mD `1;11 , �.D PHONE NUMBER: 925-838-6617 APR 2 3 2008 FAX NUMBER: 925-886-4689 .NQ CSF '`J �'-H'I'SORS Ci.ci�i.RnA CONTN• COSTA-0- Comments: Claim for driveway damage cause by fire truck. ' Please call me regarding how to proceed with this claim. Thanks, Bob This message is intended for the use of the individual or entity to which it is addressed and may - cnntain-information that is confidential and exempt from disclosure under applicable law. If the -le intended recipient, you are hereby notified that any dissemination is in violation of the Privacy Act. Please telephone us immediately at original to us at the following address: 1500 Bollinger Canyon Road, iular postal services. Thank you, San Ramon Valley Fire Protection 04/18./200.8 FRI 17:30 FAX 9258386629 San Ramon Valley Fire 003/012 I i Chris&Lisa Durand 1622 Lawrence Road Danvilhe-CA -94506- April 94506 April 18,2008 i Mr.Richard Price Assistaut Chief San Ramon Valley Fire Protection District 1500 Bollinger Road San Ramon, CA 94583. f RE: Damage to asphalt driveway at 1622 Lawrence Road,Danville,CA Dear Chief Price; I'm writiug to request reimbursement for repairs to my driveway located at 1622 Lawrence Road in Danville, CA. As we discussed on the phone earlier this month,the District's new hook&ladder trick was in our neighborhood on or around March 6-8, 2008. It was observed backing into our driveway to turn around and cau$ed some damage: I'm including an estimatc and requesting reimbursement in the amount of $73 8.75. Also included for your review are photos of the area that was damaged. I sincerely appreciate the response I received from you and other SRV Fire District Staff to my initial inquiry. I to ok forward to your reply—please contact me if you have any questions. Thank you for your courtesy and consideration. Regards, Chris Durand 925 648-5017 home 510-517-8898 cell 04/18./2008 FRI 17:30 FAX 9258386629 San Ramon Valley Fire 2004/012 DPI GENERAL CONTRACTOR INC FACSMILE T7tANSMJTFAL SHEET T0: FROM! Chris and Lisa Durand Arnie Faveta ATTN: DATE 04/H108 _ Tt FAX NUMBER: PHONE NUMBER: (925)64B-5139 r(Sf o 2 -'t7--fr- RE: PAGE'S INCLUDING COVE l)nderground&Repave Driveway. 3 UROENT__ FOR REVIEW X_ PLEASE COMMENT PLEASE REPLY_ NOTES/COMMENTS Hi Chris )etlached the Proposal fox,Mect ie Conduits Trench and Repave Driveway: If you have any quc5tion pleas*call mo at(925)260-3405 77tank you, Arnie =-Frivol` w - 752 Pleasant Ave Livemore,CA 94551 OFFICE(925)449-4516 FAX(925)449-8455. 04/.18./200,8 FRI 17:30 FAX 9258386629 San Ramon Valley Fire �005/012 BILI,TO:Chris and Llaa Dur*nd ATE, ARM 19108 WORK PERFORMED AT: 1622 Lawrence Rd Danville Ca DATE PERFORMED: JDPWOB NUMBER: 1622 NVOICL9 NUMBER: 40208 Prqpgml021 ESCRIPTION OF JOB PERFORMED: Remove and Replace`Approx 55 Square feet of Asphtilt Concrete EQUIPMENT HOURS DESCRIPTION RATE TOTAL Roller 2 3 Tons Roller $35,00 $70.00 TRANSPORT .2 F550 FORD TRUCI $50.00 $100.00 UEI,OAS OR DIESEL 25 GALLONS $5,00 $126.00 FaBORERS HOURS DESCRIPTION RATE TOTAL AVELA 2 � OPERATOR 75.00 $150,00 RMANDO2 LABOR $45.00 $90.00 terial 12"Asphalt Concrete one ton $65,00 $65.00 Thank you for your business! 15% OH Labor: $57,00 w ment: 00 15% OH Material: $9.75 Total Amount Quote: 5738.75 J 04/-18-/200-8 FRI 17:31 FAX 9258386629 San Ramon Valley Fire 006/012 j n'li �M4 q tN' g vz- Ilk 040 5 Ml: On J�w Z:1 V11 Ox, IN ,VX M94 • Ali I rrko T qn, Ap 04/18-/2008 FRI 17:32 FAX 9258386629 San Ramon Valley Fire 2007/012 `Li, �:r;I..i���;'�: (:;i�;'.'j �l:iil:: i'IT•,..�±.y::'l'.-.yu:••,�I:: ,,I. �y:�::y.r�"7.::a:^••„c;i •nlr;rstt`)...f..,,y.,,:1R';• ,u:r.rww. ,{�...T,. s "•►1 � ""'•I ��.I ;;):,<.v.t�i.Ijr�n,,.y4J1 �..,•'v:.r,:.a,,.k• �I ldiil:^•IS:,,l�'l{"}i''"N.'i I�;Wl,r+l,:c..'iil,a iq:r:IJ+«.Ir;:`':i}•��': .,F ..�1, i � ,'iyl•l;•,1, 's "sd.5 i�' i MS :; '1 (I, kr:PS 7 ,f"' � �. �. �^ �; ,:SfM":ia m► :�',,y�tX �iy;': ��S. .,,,;:. n�.•..-:�;.Vit;t..::ii.S.,, p- 'e',;;,:r,.fl: :1;71d'S!W{t� �,1,. 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Ir ,ry t L"Y wy•{p�� 7 1 .L.:9 �Y(}1� a.•��•y�� �Y. 11 1'' .:I:I f � ,)1 'trl ,,1r4.?I L i ..m•i•veYW:Y.^.I�Wr1�S!`.ihi� 1 j!,.•7§a��1'�VJ •rLX::,.y.,•a"T,!„�,4N'..rt"=:,.1.•,t:1:1)�'r'.!�''Jrt,�:,l,r;i�l'I..i.�!t„�.,Ir.l:l.t;:�111:,..•:Wc';v':.Ial:J�,:l:.':;::,^,.)1.:.,.�•i.w':l:':A:...^. 04/18/20-08JR1 17:38 FAX 9258386629 San Ramon Valley Fire 2012/012 Wage l of 1 Price, Richard From; Chris Durand [chris_durand@nsawireless.com] Sent: Friday, April 18, 2008 3:35 P.M To: Price, Richard Cc: 'Chris Durand'; Idurand600@aol.com Subject; Damaged Driveway-1622 Lawrence Road Danville, CA Attachments: SRVFPD Driveway letter.pdf; Driveway Estimate.pdf; Side view of driveway-raised soil 3.jpg; Looking down driveway 1.jpg; Looking up driveway l Jog; Looking up driveway 2.jpg; Side view of driveway-cracked paving.jpg; Side view of.driveway-raised soil 2.jpg Hello Chief Price; Attached please find a letter, photos and estimate pertaining to our damaged driveway. Thanks! Chris Durand, V.P. NSA Wir.eless,'Inc, lirsfkJ)Bam-11 15 IsI.floor 12647 Alcosta Bbid Suite 110 Sart Rar»on, CA .94 583 (?§ce:92,5-244-18 90-L tt 224 EaX. %25-355-0672 Mobile: 510-517-8898 C'ertifted Veteran Owned Small Business State o.f Coliforniit Class A (:ontractor's License #867615 State of Califbrni.a Real Estate Broker's License CONFIDE,NTIAGITYNOTIC,E: This electronic mail transmission is confidential, may be privileged and .should be react or retained only by the intended recipient.. If'you have received this transmission in error, please immediately notify the.sender and delete it from your system. 4/18/2008 CLAII'd BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION:(Jttnb � Claim Against,the County, or District Governed by ) the Board of Supervisors, Routing NOTICE TO CLAIMANT and Board Action. All Section refer The copy of this document mailed to California Goverrunent Codes. ) Al 29 you is your notice of the action taken 1008 on your claim by the Board of COUNTY COUNSEL Supervisors. (Paragraph IV below), MARTINEZ CALIF given Pu;•suant to Government Code AMOUNT: �-� mbr Section 913 and 915.4..Please note all ' "Warnings". CLAIMANT: .AL octau'; ATTORNEY: r1a) DATE RECEIVED: oq ' l ' ADDRESS: ` � a yyy BY DELIVERY-TO CLERK ON: ��yyJJ��//�////✓✓�1''� U r C4q BY MAIL POSTMARKED: ., r r FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN CULE. , C` '1lerk Dated: � - g By: Deputy .Q u L U4� [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). O Claim is'not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply.for leave to present a late claim (Section 911.3). ( ) Otlier•: Dated: `� _C)s<;), 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:OV0P JOHN CULLEN, CLERK, B Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) months from he date this notice was personally served or deposited in the null to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attomey of your choice in connection widr this matter. Ef'you wa'nt to consult an attorney,you should do so ininrediately. *For Additioial Warr hrg See Reverse Side of'This Notice. AFFIDAVIT,OF MAILING I declare under penalty of perjury that i. ant 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 Ntartinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the clainna s shown above. Dated: DGS C JOHN CULLEN, CLERK By 7T uty Clerk (�D C LA 1NI BOAi.tD OF SUPERV.i.SO.RS OF CONTRA COSTA COUNTY BOARD ACTION:'d , ZCOC� 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 j�'�r>i - Section 913 and 915.4.Please note all AMOU �).NT: .` 1�-1C "Warnings". CLAIMANT: I : CcwC«t ATTORNEY: DATE RECEIVED: 1 r � .r • i ADDRESS: ��� ra�.( �� -�-'lel•;% BY DELIVERY TO CLERK ON:fl�. �Z 'd ' haul'L:); - ,- BY MAIL POSTMARKED: �� L'iV FROM: . Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. (( JOHN CUL E , Qlerk. Dated:l a�l�'•. � ' " By: Deputy CTUAL,h.t c,.-- II. %;II. FROM: County ounsel TO: Clerk of the Board of Supervisors ( ) T'Iiis claim complies substantially witli Sections 9 t0 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. Tile Clerk should retum 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 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) O Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: O This Claim is rejected in full. O Other: 1 certify that this is a true and correct copy of the Board's Order entered in its minutes for. this 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 personalty served or deposited in the mail to file a couit action on this claim.See Government Code Sectim 945.6.You may seek the advice of an attorney of your choice in connection wide this matter. ll'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 1: am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in (Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the clainmit as shown above. Dated: JOHN CULLEN, CLEiZK By Deputy Clerk BOARD OF SUPERVISORS OF CONTRA COS'T'A COUNTY I ISTRUCTIONS TO CLAIMANT A. A claim relating to a cause of action for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street,Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the naive of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. ■■aaExams aaanaaMEN aaMRaaaaaaaman SEE aaaaaeaaaaaERE aaHERB asaaaaEBNaaaaaaraasaaaaI RE: Claim By: Reserved for Clerk's filing stamp MJ-7erly- &Afrlo, 0 ¢i��))` a 6" :Y 4c' 3...3 Against the-County of Contra Costa or ) APR 2 9 2008 District). - CLERK 80AH Oi ". i. JRS (Fill in the name) ' co TRA.C.C.I 17A Co. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum ofor M0Wand in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) Febv" 2S, -2002 avounk. : la 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full details;use extra paper if required) .. Owe_ 0-P veh �cli�� "o-pp. ayvp 4. `T�That particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? V<-, +b Cad° Cac at, 4-axo i +t-t 2 + e-e co, r 4t Pl y f ,q a rQ- 414- +4-1-e i4+4-1-e Io Cts D c4ilAi c-1,\ co'k."-secip c6c"a--0 �.. 5 What are the names of county or district officers, servants, or employees causing the damage or injury? -P0 r l 6. What damage or'injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) t_V.�.�— $ i�' p-0- +V i' t I-ruC w9s `l.I`� 0- -3-o go �P � ©�-t-Lfc , nc>w +-- L�c)oyrobes ooh of�en. 7. How was the' amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) wey +— J-p tWo Cx'0 0 S�® �5' , a►'��; L 8. Names and addresses of witnesses, doctors, and hospitals: 9. List the expenditures you made on account of this accident or injury: DATE TR\4E AMOUNT ■ Monosson sssssssOman sesssassesesssssssssssssssssessassssssassssasssssssnit sassessssssl .Gov. Code Sec. 910.2 provides "The claim shall be signed by the claimant or by some person on his behalf." SENT NOTICES TO: (Attorney) Name and address of Attorney ) Alike r4a C-14 } (Claimant's Signature) ct (Address) ) L7 y�s s" Telephone No. ) Telephone Nogg O ■f■■t■■s s■t Runs■Run■Boom■ t■■■man s s s■■i i y t■■■■■i t■RE■■■■summon t■■s t s s■■s■■ ■■t s s s■■R s■1 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, §§ 600 et seq.) Furthermore, any attachments, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. ■■sssssssassssMason sWERE ssasssssessssssssssesassssaesssssssssssasssssssssman ssssssssl NOTICE: Section 72 of the Pedal 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. p Date: 4/25/2008 02:53 PM Estimate ID: 218 Estimate Version: 0 Preliminary Profile ID: CUSTOMIZED East Bay Auto Body 620 GARCIA AVE,PITSBURG,CA 94565 (925)473-1876 Fax: (925)473-0796 Damage Assessed By: Mike Sayedi Deductible: UNKNOWN Owner: garcia alberto Telephone: Home Phone: (925)709-0121 Mitchell Service: 915528 Description: 1999 Dodge Dakota Sport Body Style: 2D PkupXCb 6'Bed 131"WB Drive Train: 3.91-Inj 6 Cyl 2WD VIN: 1 B7GL22X8XS140646 Options: AIR CONDITIONING,AUTOMATIC TRANSMISSION Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 501517 REF REFINISH PICKUP BED COMPONENTS C10.0 2 501518 REF REFINISH ADD FOR TWO TONE 2.3 3 501832 BDY REPAIR R PICKUP BED SIDE PANEL ASSY Existing 3.5*# 4 501833 BDY REMOVE/REPLACE L PICKUP BED SIDE PANEL ASSY 4883723AA 1,135.00 12.0 # 5 501593 BDY REMOVE/INSTALL TAILGATE ASSEMBLY INC 6 933006 FRM ADD'L OPR FRAME/RACK SET UP 2.0* 7 900500 BDY* REPAIR PULL AND SQUARE THE REAR END Existing 2.5* 8 AUTO REF ADD'L OPR CLEAR COAT 2.5 9 933003 REF ADD'L OPR TINT COLOR 0.5* 10 933018 REF ADD'L OPR MASK FOR OVERSPRAY 10.00 * 11 AUTO ADD'L COST PAINT/MATERIALS 459.00 * " -Judgment Item #- Labor Note Applies C - Included in Clear Coat Calc ESTIMATE RECALL NUMBER: 4/25/2008 14:51:23 218 Mitchell Data Version: OEM: MAR_08_A UltraMate is a Trademark of Mitchell International Copyright(C)1994-2008 Mitchell International Page 1 of 3 UltraMate Version: 6.5.016 All Rights Reserved Date: 4/25/2008 02:53 PM Estimate ID: 218 Estimate Version: 0 Preliminary Profile ID: CUSTOMIZED Estimate Totals Add'I Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 18.0 70.00 0.00 0.00 1,260.00 T Taxable Parts 1,135.00 Refinish 15.3 70.00 10.00 0.00 1,081.00 T Sales Tax @ 8.250% 93.64 Frame 2.0 90.00 0.00 0.00 180.00 T Total Replacement Parts Amount 1,228.64 Taxable Labor 2,521.00 Labor Summary 35.3 2,521.00 III. Additional Costs Amount IV. Adjustments Amount Taxable Costs 459.00 Customer Responsibility 0.00 Sales Tax @ 8.250% 37.87 Total Additional Costs 496.87 I. Total Labor: 2,521.00 II. Total Replacement Parts: 1,228.64 III. Total Additional Costs: 496.87 Gross Total: 4,246.51 IV. Total Adjustments: 0.00 Net Total: 4,246.51 This is a preliminary estimate. Additional changes to the estimate may be required for the actual repair. THIS IS PRELIMINARY ESTIMATE. ADDITIONAL CHANGES TO THE ESTIMATE MAY BE REQUIRED FOR THE ACTUAL REPAIR The above estimate is based on our inspection and does not cover additional parts or labor which may be required after the work has started. Worn or damage parts, not evident on first inspection, may be discovered and you will be contacted for authorization for additional work. parts prices are subject to change without notice. POWER OF ATTORNEY: I do hereby appoint the aforementioned business as my attorney in fact to accept on my behalf any and all checks, drafts, or bill of exchange for deposit to the aforementioned business' account for credit on my acount for repairs on my vehicle which had been released and accepted. ACKNOWLEDGEMENT: I have read and understand the above estimate and authoreze repair service to be performed, including sublet work and hereby acknowledged on the above vehicle to secure the amount of ESTIMATE RECALL NUMBER: 4/25/2008 14:51:23 218 Mitchell Data Version: OEM: MAR-08_A UltraMate is a Trademark of Mitchell International Copyright(C)1994-2008 Mitchell International Page 2 of 3 UltraMate Version: 6.5.016 All Rights Reserved Date: 4/25/2008 02:53 PM Estimate ID: 218 Estimate Version: 0 Preliminary Profile ID: CUSTOMIZED repairs there to. This Estimate and Power of Attorney, Authorized by: Signed: Date: Work Accepted by: ESTIMATE RECALL NUMBER: 4/25/2008 14:51:23 218 Mitchell Data Version: OEM: MAR_08_A UltraMate is a Trademark of Mitchell International Copyright(C)1994-2008 Mitchell International Page 3 of 3 UltraMate Version: 6.5.016 All Rights Reserved 0-1 /.:5/2008 ar 02 : 27 PM Job MIKE ROSE'S AUTO BODY OF PITTSBURG Fede_a1 IC il 9426213•. 9 W'r:ERE QUAL 7T` -0"N'_'S 3001 NORTH PARI: BLVD Tm.-- nCPG 9456_5 ( 925; 432-990 Fu., . 25; =_'32-9936 PRELIMINARY ESTIMATE Writt_'rl By: BRENNA`d FOSE Adjuster : Insured: ALBERTO GORCH Claim # Owner: `:LBERTO GORC=i Policy # Address: 1192 RED LEAF WY Deductible: PITTSBURG, CA 94565 Date of Loss: Car: (925) 709-0121" Type of Loss : Point of Impact: 8 . L e f ;zt. Pos., Inspect MI <E ROSE S A 'I'j BODYOF PITTSBCBusiness: ( 2`) � Location: 3001 NORTH PAP. BLVD 'I TSBURG, CA 94565 Insurance Company: Days Lo Repai DiODC DAKOTA 4:�2 CLUB CAB 6-3 . 9L.-F-1 2D P/U 6�1HI'_'E In VIN: 1B7GL22X8X51.40646 Lic: 7`,1197 :'3 CA Prod Date: 10/"1998 Odometer: Ir_ .errnittent Wipers Dual Mi rr:ory Privacy, C;l ass 1. ._ar: Coat Paint Powe._. Steerii Powei BrBrakes_. CI Radio FM Sre `,s Scar h/See}; Ar L.i-_. c.. Bra',e Dr1v r Air Bag P_:SSence_ Al:. :::aC( Benc'� Seats 5 Speer: �E�rdri,:' __ =t 1.d St-ee- Wheels ------------------------------------------------------------------------------- OP. DESORIPTI 0N Q71' EXT . PRI(:'E L -R 'C ------------------------------------------------------------------------------- 1 REAR BUMPER, R&I R&I bumper ass; 0 0 . 00 -) . 5 0 . 0 REAR LAMPS 4 R&I LT Tail lamp asst' 0 0 . 00 In•^.l . � . 0 R.&I R Tail lamp asst' 0 0 . 00 PICK UP 30 : 7 P.epl Li' Sid_ panel 61%2 fool. bed _. ._565 . 00 Add for Clear Coar_. 0 0 . 00 0 . 0 1 . e 9 Add for Inside 0 0 . 00 0 . 0 1 . C' Add fol- Clear Ccat 0 0 . 000 . 0 o . 3 1 Rpr LT Outer panel 6 1/2 foot bed 0 0 . 00 3 . 0 Ire :' . =2* Rpr RT Side panel 6 1/2 foot bed 0 0 . 00 3.0 3 . 13 Overlap Major Nora-Ad! . Panel 0 0 . 00 0 . 0 -0 . ?. 1.4 Add for Clear Coat 0 0 . 00 0 . 0 0 . 6 15 R&I Fuel door 0 0 . 00 Inc- 0 . n 1 C!0'8 at 02 . 27 P-M yob °clamber . r PRELIMINARY ESTIMATE 1999 DODG DAKOTA 4X2 CL--3 CA r-� . 9L- I 2D P/U GdH:TE 1.1L : ------------------------------------------------------------------------------- NO. OP. DESCR_PTION Q''Y E}:T . PP.1 :E T., R. P.�_fJ'I' ------------------------------------------------------------------------------- F_ B1nd Fuel door 0 C? . 0'-� 0 . 0 0 . 2 _7 2&I RT Splash shield front 0 0 . 00 0 . 0 . 0 1S R&I LT Splash shield f-ont 0 00 0 -1 19 R&I R&I -a.i qa':e asst' 0 . 00 L11.c . 0 . C ?� R.&I P.&1 box asst' 0 . 0 ? ?1 Rpr ROUGH PUI_•L BED TO `;QUARE 0 0 . 00 0 2% + Rep1 COVER CAR 7 . 50 T 2 3 ff R.epl CORROS-ON PROTEEC�1'101\1 1 10 . 00 T 0 . _ j , 0 :4? TINT COLOR ]. 0 . 00 ?; ,� . 5 :� . 0 255 TRUCK SE'- UP AND N'IEASURE 1 :. . 00 . 0 i•' 0 . 0 ub1 HAZARDOUS WAS 1 E 1 C`) 0 . 0 XXv1XX X XrS%1XX-'"`�".r:�.��.?:V.._l._.: �..y 1 0 . 10 0 . � X XX INNEER S"1`R.UCTURE OPEN] 0 . 0 0 ? . J 2?#E ESTIMATE OPEN D7 NDIN --A=- DC-W, 0 0 0 . 0 (_)l"% l.! 0 . 0 ------------------------------------------------------------------------------- Su,btota s I587 . 50 =arts Body Labor . 4hrs %`� . 1.J0 /hr -1-68f) . 00 Pa-nt Lac or :_7. . 17i-s FL-arcie Labr,or 3 . 0 11rs a i _ rl/i10 t Sl.lppll .-S __ . / 17iJ @ 3,0' . Sublet/Mise . 22 . ---------------------------------------------------- S�='BTOTAL S 117 '. !. . 00 Sales ----------------------------------------------------- ADJUl'TMENT c� . Deductible 0tf,) ---------------------------------------------------- CUSTC`! ' ER PAY . C?0 INSURANCE PAi' 4880;• . 5:1 T::--S -S A PRELIMINARY ESTIMATE AND ADDITIONAL CHARGES MAY REQUIRED I <.. T: _CTUAL REPAIR. at 02 : 27 PM Job ['Jumbo_-: � 79,E PRELIMINARY ESTIMATE 1999 DODG DAKOTA 4X2 CLuB CAT" 6-3 . 9T.-FT 2D P/l; °JHITE InL : F;-) : :OUR PROTECTI0N C'ALIFOP,NIA T_.A`:^d P.EQU'P.E:3 Tl E F0 T01-'I^;ING "''i 7;PPE'A='•. N IS 0P.M .!'•1`i r'=RS,J1d �TI1O KIvOv9i:NGLY PRES7N`f S c ALSE r_;R F'Rr';U=)Ui l[•]T CL=:::I[-1 FOR THE rT`:`: h'E[l'I' !J; . LOSS IS GUILTY OF A CRIME AND VLA'. BE SUB,-C- '?'O FINES ANiD .ONFTI'dEM_,',NT I ' STATE -'RISOiv. ''-HE F''O= .IOWTNG IS A LIST OF ABBREVIATIONS OR SYZMBOLS TEAT MA` BE USE=; TO DE.r':C:_'.iBE WORK TO BE DONE OR PA='\TS TO LLREPA_I %.-;D OR REPLACED: %_STC)R %?ATIO"�S/SYMB'OLS : D=DISCO'\'7'IT,,lUED PASA-APP-1O; TMATF PR.I'f-H T' _ _- _ . =LOD'i' �A CR. D=DIA;�NOSTIC E=ELL1�-''ICA', _= i:.A._'`L L—'GLASS M=JEC[-[A''.` ICAC P-'_' l''i'[ —�;T R r '.,'=TAXED (� ?a i t ' T F;.`. I —, L a. i' S I, `.[---'0 P. : _ LT :� � L LLL. 'E ;JS ..-TIC ED I'] SC L'_[1F.0 _ P=:- �N:= ALGN=Al,IGN A%:�'=. 1"I'FR �ARI•:l 'I' F'•L'�LC BT..Ei`:D (__'APA=�-w,TI.7T_�D ..;� ['' _:C;T `, E PART ASSOC Irl7 ION D&R=DISC'ONNE CT AND R.ECOI'''N CT EST-ESTIMATE 77T . PRICE=UNIT P_•. .CE MULTIPLIED ..`r' THE QUA_.TITY I JC?J=INCJJDr.,.. ',I IS C=MISC:;,'LI.:,, .=0IJ- [d:,:��._�=['•:A.: II •L•1:�. AUTO C:LAS:S SPECIFICATIONS NONI-70J=N'10`: ADJACENT 0/II=OVER:IAUL OP=,_-)PERATTO'[d ;;l r!=]:.,TT'dE NU 9BER Q'I'Y=QUANTITI' QUAL RECYCLEDPAR.`I' ';)_. T�. p_- �U "- .L ;'�C:EMENT PART COMP REPT, PARTS=COh9PET.-TINE RE PL �C'EMF ]T PAR.'I'S R.�I;C''Ot•]D---?._:C'ONDITION REFN=REFINISH REPL=REFL `_CE AND' -1\1ST% CLAIA1 BOARD OF SUPERVISORS OF CON'CRA COSTA COUNTY BOARD ACTION: t,t,n,t- 03� 2-0 Claim Againstthe County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section refeEencEls The copy of this document mailed to California Government Codes. fta you is your notice of the action taken on your claim by the Board of APR 2 3 2008 Supervisors. (Paragraph IV below), COUNTY COUNSEL given Pursuant to Government Code AMOUNT: .31 gql �q MARTINEZ CALIF. Section.913 and 915.4. Please note all "Warnings". CLAIMANT: P-L -I}i�Gi. USf�6V ATTORNEY- il/GL DATE RECEIVED: &PrtL- , �y ADDRESS: BY DELIVERY TO CLERK ON: CA BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is:a copy of tine above-noted claim. n a JOHN CUL E .lerk., Dated: 0.: County K, By: Deputy I.I. FRCounsel TO: Clerk of the Board of Supervisors ( his claiiii complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). O Claim isnot timely filed. The Clerk should retu-rt claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late clairn (Section 911.3). O 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). 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 seised 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 attonrey,you shoukl do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING 1 declare under penalty of perjury that I am now, and at all times herein mentioned, have leen a citizen of' the United States, over age 18; and that today I deposited in the United States Postal 'Service in lWartinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claima as shown above. Dated'. JOHN CULLEN, CLERK fay Deputy Clerk CLAIM HOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: J ur1c! . ?j 2_C'() 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 GovernmentCodes. ) you is your notice of the action taken on your claire by the Board of Supervisors. (Paragraph IV below), given Pursuant'to Government Code AMOUNT: 3�.�'�tl Section 913 and 915.4. Please note all "Warnings". CLAIMANT: CSL4A .�rr-1 Ycr- VUSITf7GV ATTORNEY: a; DATE RECEIVED: %2wi C L.- � t ; ��•'z'�� ADDRESS: 61 ZZC1 BY DELIVERY TO CLERK ON: {•LIQ-' JiLCSLCi LY��yr C1 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CUL �lerk., ^ Dated: 1,vZLc' :[ )-b ' By: DeputyE L1l Vii'- GtLC��Gc(;L 1.1. FROA. County Counsel TO: Clerk of the Board of Supervisors ( ) This claire 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 tirnely 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 Boai-d TO: ' County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimatrt (Section 911.3). 1V. BOARD ORDER: By unanimous vote of the Supervisors present: ( ) This Claim is rejected in full. O Other: [ 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 fi-onklne 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 a.dvim of an attorney of your choice in connection with this matter. ft''you want to consult an attorney,you should do so immediately. *For Additional Warming 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, Aver 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 APR. 9. 2008 8 30A CCC RIS'( MANAGEMENT N0. 816 P. 2 BOARD OF SUPERVISORS Off'COIR-4 COSTA COUNTY INSTRUCTION—_'F O CLARYlAI�" A. A. claim relating to s pause of action far death or for injury . .person or to personal property or growing crops shall be presented aot later than six months after the accrual of the cause of action. A alarm-relating to any other cause of anion shall be presented not later thaa ane 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., a*a a■aa a ai an am SEEN BE an Ian RE am%am ssaf Yaass[/Ism RE'■a man■a•Big RRRE a■Ra=Kasss■a SC<RI RE: Claim By. lteseived for Clerk's filing stamp Against the County of Contra Costa or } APR 2 1 2008 Dz5�1Ct) CLERK BOARD OF SUPERVISORS CCN I RA C OSTA CO. (FiU in the n e) )\ J The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district is the sum of$ M?1. , ,I and in support of this claim represents as follows: L When did the damage or injury occur? (Wve exact date and aur) 44,C4,(,� 2. Where did the damage or injury occur? (Include city and county) r 3. How did the damage or injury occur? (Give full details;use extra paper if required) servants or ein to ees 4. What particular act or omzssrox On c part of county or district officers, � y caused the injury or damage? VC-4A Id�-- WZ L�Iwa� 5 What are the names of county or district officers, servants, ar employees causing the t damage or injury? &-&M C'/L 4za44c1, (&dll APR. 9. 2008 8:30AM CCC RISK MANAGEMENT N0, 816 P. 3 6. W t d -nage or injuries do your claim resulted? (Give full extent of injr�ries or damages claimed. Attach two estimates for auto damage-) D 7. Now was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage) d f wi ess" a - docto s and hospitals: / 8. N es w �drsseso to. P `6'�Y( ���� 9� � V1 aO7 9. List the expanditues you mad• on ac unt o f s a dea or=M: DATE TWE AMOUNT [ Aaa■■ERIN■a[l[■a a a[a URN[[a KIN up a■K a a PENN a■Ewaa mama do am am amp Ra[[PENILE SINE■a as■a an aas a■1 .Gov. Code Sec. 910.2 provides"The claim shall be signed by the claimant or by some person oa his behalf SEND NOTICES TO: (Attbme Name and address of Attorney } Z/92 } (Cldm nt's SipatClre) C/'Jo (Address) Telephone No. ) Telephone No. ■[WILYa[[a[Raaf[Ivan aOman Pamen RRar[[[t•Raa[[[[[IL r[R ■[1■aaa[[fWILaYY[■Raa[a■RaYalfea[1 PUBLIC RECORDS NOTIM Please be advised that this claim form, or any claim filled with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Art. (Gov. Code, §§ 6500 et seq.) Furthermore, any attachments;addfmdums,or supplements attached to the claim form,including medical records,are also subject to public disclosure. a*Kam Ewa aaada[RaIL[a[Rump aa[gnat a[[FEE know YEMEN[o WNW MRnKRZ9 MEN ReaY[[[[a man[■R RiaaRaaa[ 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 cmiaty, city, or district board or ofccr, authorized to allow or pay the same if genuine, any false or fiaudulmt 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 (51,000.00), or by both such imprisonment and fine, or by imprisonmeut in the state prison, by a fine of not exceeding ten thousand dollars ($10,000), or by both such imprisonment and fine. Go 0 O N ,N O O U CHECK NO: 712 L162506-4—R m DATE: 04-01-2008 O LU > NAME AND ADDRESS INFORMATION: ED U W KOSTADINOVA, ILIYA/STOYANKA,KOSTADI 1450 CREEKSIDE DR #79 WALNUT CREEK CA 94596 INSURED: KOSTAD I NOVA, ILIYA/STOYANKA,KOSTAD I N PAYMENT INFORMATION/DESCRIPTION: DATE OF LOSS: 03-04-08 DEDUCTIBLE PAYMENT CLAIM NO: 08-KX0704-9 CLAIMANT: KOSTADINOVA, ILIYA/STOYANK PAYEE: KOSTADINOVA, ILIYA/STOYANKA,KOSTADI AMOUNT: $500.00 IN PAYMENT OF: DEDUCTIBLE PAYMENT ADJUSTER: MATT WRIGHT ADJUSTER NO.: 33807 KIND OF LOSS: COL 15610702 DETACH AND RETAIN FOR YOUR RECORDS No. 712 Ll 62506-4-R DATE OF LOSS CLAIM INSURED'S NAME DATE 03-04-08 08—KX0704-9 KOSTADINOVA, ILIYA/STOYANKA,KOSTADIN 04-01-2008 POLICY TYPE KIND OF LOSS SUFFIX CLAIMANT'S NAME PAY AUTO COL 01S I KOSTADINOVA, ILIYA/STOYANK $500.00 D.O. ADJUSTER NO. IN PAYMENT OF BANK OF AMERICA LV2 33807 DEDUCTIBLE PAYMENT Bank of America Cuctomor connection —, Bank of America, N.A. Atlanta, Dokalb County, Georgia PAY *FIVE HUNDRED 00/100* KOSTADINOVA, ILIYA/STOYANKA,KOSTADI This check must be properly endorsed on the reverse side by all payees. TO THE ORDER OF O .00 O IN co -- O O U CHECK NO.: 706 L082728-7—M m DATE: 03-05-2008 D 1swou NAME AND ADDRESS INFORMATION: KOSTADINOVA, ILIYA/STOYANKA,KOSTADI 1450 CREEKSIDE DR #79 WALNUT CREEK , CA 94596 INSURED: KOST AD I NOVA, ILIYA/ST OYANKA,KOST AD I N PAYMENT INFORMATION/DESCRIPTION: DATE OF LOSS: 03-04-08 REPAIRS LESS $500 CLAIM NO: 08-KX0704-9 CLAIMANT: KOSTADINOVA, ILIYA/STOYANK PAYEE: KOSTADINOV, ILIYA/STOYANKA,KOSTADI AMOUNT: $2,235-01 IN PAYMENT OF: KOSTAD I NOV, ADJUSTER: SCOTT DUNN ADJUSTER NO.: 18939 KIND OF LOSS: COL 1561o702 DETACH AND RETAIN FOR YOUR RECORDS No. 706 L082728-7-M DATE OF LOSS CLAIM INSURED'S NAME DATE 03-04-08 08—KX0704-9 KOSTADINOVA, ILIYA/STOYANKA,KOSTADIN 03-05-2008 POLICY TYPE KIND OF LOSS SUFFIX CLAIMANT'S NAME PAY AUTO COL 01P KOSTADINOVA, ILIYA/STOYANK $2,235.01 D.O. ADJUSTER NO. IN PAYMENT OF BANK OF AMERICA M-1278 Bank of America Cuctomor Connection ,11 CPS 18939 KOSTAD I NOV, Bank of Americo, N.A. Atlanto, Dekalh County, Georgia PAY *TWO THOUSAND TWO HUNDRED THIRTY FIVE 01/100* KOSTADINOV, ILIYA/STOYANKA,KOSTADI This check must be properly endorsed on the reverse side by all payees. TO THE ORDER _ OF Date: 3/542008 12:37 P M Estimate ID: P08KX0704901 Estimate Version: 0 Committed Profile ID: CSAA default California State Auto Association PO BOX 920,Suisun City,CA 94585-0920 (925)524-0533 Fax: (707)863-00512 Damage Assessed By: SCOTT DUNN Date of Loss: 3/4/2008 Deductible: 500.00 Policy No: KX07049 Claim Number. POSKX0704901 Insured: ILIYA/STOYANK KOSTADINOVA Owner. ILIYA/STOYANK KOSTADINOVA Address: 1450 CREEKSIDE DR#79,WALNUT CREEK,CA 94596-0000 Telephone: Work Phone: (925)818-0365 HomePhone: (925)932-0939 0* 0 0 N Mitchell Service: 911533 1 0 Description: 2003 Nissan 35OZ o Body Style 2D Cpe Drive Train: 3.5L Inj 6 Cyl 6M RWD VIN: JN1AZ34E43T007573 License: LEBED N Mileage: 96,729 V OEMUALT: A Search Code: CONTRACOST m ** SPECIAL PARTS NOTE: ALL CRASH PARTS IN THIS ESTIMATE ARE "NEWT' O W PARTS (OEM) UNLESS OTHERWISE SPECIFIED. PARTS DESCRIBED AS RECHROMED, W RECORED, OR REMANUFACTURED ARE EITHER "RECONDITIONED" PARTS, OR W "REBUILT" PARTS. CRASH PARTS DESCRIBED AS "QUAL REPL PART" ARE NON-OEM AFTERMARKET PARTS. ** Line Entry Labor Line Item PartType( Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 100952 BOY REMOVEIREPLACE FRT BUMPER COVER Remanufactured 291.52 2.2 # 2 AUTO REF REFINISH FRT BUMPER COVER C 2.8 3 100962 BOY REMOVE/REPLACE FRT BUMPER ADHESIVE EMBLEM 62890-CD000 30.57 0.1 4 100984 BOY ACCESSANSPECT L FRONT COMBINATION LAMP ASSEMBLY Existing 0.0*# 5 AUTO BOY CHECK/ADJUST HEADLAMPS 0.4 6 101003 BOY ALIGN HOOD PANEL Existing 1.5* 7 101059 BOY REPAIR L FENDER PANEL Existing 1.5*# 8 AUTO REF REFINISH L FENDER OUTSIDE C 2.2 9 101061 BOY REMOVE/REPLACE L FENDER FRONTLINE R 63845-CD000 44.32 INC # 10 101075 BOY REMOVE/REPLACE L FENDER ADHESIVE EMBLEM 63890-CDOOA 24.38 0.2 11 100387 BOY REPAIR FRONT BODY RADIATOR SUPPORT Existing 1.5*# 12 100011 BOY REMOVEIREPLACE FRTWHEEL ORDER FROM DEALER 785.57 0.3 13 100067 BOY REMOVEANSTALL L ROCKER MOULDING 0.5 14 931125 BOY ADD'L LABOR OP MOUNT&BALANCE TIRE Sublet 18.00* 0.0* 15 900500 BOY* ALIGN FRONT ALIGNMENT Sublet 59.95* 0.0* 16 936008 ADD'L COST PAINT/MATERIALS 213.00' 17 936012 ADD'L COST HAZARDOUS WASTE DISPOSAL 3.00' 18 936014 ADD'LCOST FLEX ADDITIVE 7.00" 19 AUTO REF ADD'L OPR CLEAR COAT 1.6 20 933005 BOY ADD'L OPR RESTORE CORROSION PROTECTION 10.00' 0.1* 21 933018 REF ADD'L OPR MASK FOR OVERSPRAY 0.2* ESTIMATE RECALL NUMBER: 03/05/2008 12:26:34 P08KX0704901 UltraMate is a Trademark of Mitchell International Mitchell Data Version: FEB_08_V Copyright(C)1994-2005 Mitchell International Page 1 of 3 UltraMate Version: 6.0.28 All Rights Reserved Date: 3/512008 12:37 P M EstimatelD: POSKX0704901 Estimate Version: 0 Committed Profile ID: CSAA default * -Judgment'Item #-Labor Note Applies C -Included in Clear Coat Calc Add'I Labor Sublet I. LaborSubtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 8.3 75.00 10.00 7795 710.45 Taxable Parts 1,176.36 Refinish 6.8 75.00 0.00 OAO 510.00 Sales Tax g 8.250% 97.05 Non Taxable Labor 1,220.45 Total Replacement Parts Amount 1,273.41 LaborSummary 15.1 1,220.45 III. Additional Costs Amount IV. Adjustments Amount Taxable Costs 220.00 Insurance Deductible 500.00- Sales Tax 8.250% 18.15 Customer Responsibility 500.00- Non-Taxable Costs 3.00 Total Additional Costs 241.15 I. Total Labor: 1,220.45 II. Total Replacement Parts: 1,273.41 111. Total Additional Costs: 241.15 Gross Total: 2,735.01 IV. Total Adjustments: 500.00- Net Total: 2,235.01 THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OF THE PARTS, RATHER THAN BY THE ORIGINAL MANUFACTURER OF YOUR VEHICLE. Insurance Co: CSAA Insurance NOTE: YOU HAVE THE RIGHT TO SELECT THE BODY SHOP THAT WILL REPAIR YOUR VEHICLE. THIS IS NOT AN AUTHORIZATION BY CSAA FOR REPAIRS. NOTE: YOU HAVE THE RIGHT TO SELECT WHICH BODY SHOP WILL REPAIR YOUR VEHICLE. THIS IS NOT AN AUTHORIZATION BY CSAA FOR REPAIRS. AS THE OWNER OF THE., VEHICLE YOU ARE THE ONLY PERSON WHO CAN AUTHORIZE REPAIRS. YOU MUST GIVE THIS ESTIMATE TO THE REPAIR FACILITY AND THAT FACILITY MUST ACCEPT THIS ESTIMATE BEFORE YOU AUTHORIZE REPAIRS. THIS ESTIMATE CANNOT BE CHANGED WITHOUT CSAA' S CONSENT AND APPROVAL. CSAA IS NOT OBLIGATED TO PAY FOR ANY ADDITIONAL DAMAGE UNLESS CSAA INSPECTS THE ADDITIONAL DAMAGE AND APPROVES ANY CHANGE BEFORE THE REPAIRS ARE STARTED. ANY QUESTIONS CONCERNING THIS ESTIMATE ARE TO BE DIRECTED TO THE CSAA REPRESENTATIVE WHO HAS PREPARED THIS ESTIMATE RECALL NUMBER: 03/05/2008 12:26:34 POSKX0704901 UltraMate is a Trademark of Mitchell International NitchellData Version: FEB_08_V Copyrig ht(C)1994-2005MitchelIInternational Page 2 of 3 UltraMate Version: 6.0628 All Rights Reserved Date: 31 512008 12:37 PM Estimate ID: P08KX0704901 Estimate Version: 0 Committed ProfilelD: CSAA default ESTIMATE. ESTIMATE RECALL NUMBER:03/05/2008 12:26:34 POSKX0704901 UltraMate is a Trademark of Mitchell International ItitchellData Version: FEB_08_V Copyright(C)1994-2005 Mitchell International Page 3 of 3 UltraMate Version: 6.01028 All Rights Reserved 00 0 N M N M O I� CHECK NO: 712 L152472-1—R 'U m DATE: 03-27-2008 O W > NAME AND ADDRESS INFORMATION: w U W KOSTADINOVA, I'LIYA/STOYANKA,KOSTADI 1450 CREEKSIDE DR #79 WALNUT CREEK CA 94596 INSURED: KOST AD 1 NOVA, ILIYA/STOYANKA,KOSTAD I N PAYMENT INFORMATION/DESCRIPTION: DATE OF LOSS: 03-04-08 ADDITIONAL REPAIRS CLAIM NO.: 08—KX0704-9 CLAIMANT: KOSTADINOVA, ILIVA/STOYANK PAYEE: KOSTADINOVA, ILIYA/STOYANKA,KOSTADI AMOUNT: $1 , 155.58 IN PAYMENT OF: KOSTADINOVA, ADJUSTER: SCOTT DUNN ADJUSTER NO.: 18939 KIND OF LOSS: COL 16610702 DETACH AND RETAIN FOR YOUR RECORDS No. 712 L1 52472-1 -R DATE OF LOSS CLAIM INSURED'S NAME DATE 03-04-08 08—KX0704-9 KOSTADINOVA, ILIYA/STOYANKA,KOSTADIN 03-27-2008 POLICY TYPE KIND OF LOSS SUFFIX CLAIMANT'S NAME PAY AUTO COL 01F KOSTADINOVA, ILIYA/STOYANK $1 ,155.68 D.O. ADJUSTER NO. IN PAYMENT OF . BANK of AMERICA 64-1276 CPS 18939 KOSTAD I NOVA, Bank of America Customer Connection 61, Bonk of America, N.A. Atlanta, Dckalb County. Georgia PAY *ONE THOUSAND ONE HUNDRED FIFTY SIX 68/100* KOSTADINOVA, ILIYA/STOYANKA,KOSTADI This check must be properly endorsed on the reverse side by all payees. TO THE ORDER OF Mar 26 2008 2428PM CSAA 925-524-0529 - ---....-- —._...... -- P. 1 Date: 312612008 01:55 PM Estimate ID: POBKX0704901 Estimate version: 2 Supplement 2(F) V2812008 01:54:68 PM Profile ID: CSAA default 000 �N California State Auto Association N M PO BOX 920,Suisun City,CA 94585-0920 O {925)524-0533 Q Fax: (707)863-9052 Q ` U Damage Assessed By: SCOTT DUNN } Supplemented By: SCOTT DUHN m 0 W Type of Loss; Collisloo Lj l Date of Loss: 31412008 U Deductible: 500.00 W Policy No: KX07049 Claim Number: PCSKX0704901 Insured: ILIYAISTOYANK KOSTADINOVA .Owner. ILIYAISTOYANN KOSTADINOVA Address: 1450 CREEKSIDE DR#79,WALNUT CREEK,CA 94596-0000 Telephone: Work Plione: (925)818-0355 Home Phone: (825)932-0939 Mitchell Service: 911593 Description: 2003 Nissan 35OZ Body Style: 2D Cpe Drive Train: 3.5L Imj 6 Cyt 5M RWD VIN: JN1A234E43TOO7573 License: LEBED Mileage: 96,729 OENUALT: A Search Code: CONTRACOST ** SPECIAL PARTS NOTE: ALL CRASH PARTS IN THIS ESTIMATE ARE "NEW" PARTS (OEM) UNLESS OTHERWISE SPECIFIED. PARTS DESCRIBED AS RECHROMBD, RECORED, OR RE14ANUFA•CTURED ARE EITHER "RECONDITIONED" PARTSr OR "REBUILT" PARTS. CRASH PARTS DESCRIBED AS "QUAL REPL PART" ARE NON-OEM AMRMARKET PARTS.** Line Entry Labor Line Item PartTypel, Dollar Labor Item Number Type Operation Description Part Humber Amount Units 1 100852 BOY REMOVEIREPLACE FRT 13UMPER COVER Remanufactured 291.52' 1.9 # 2 AUTO REF REFINISH FRT BUMPER COVER C 2.8 3 100962 BOY REMOVEIREPLACE FRT BUMPER ADHESIVE EMBLFJN 62890-CD000 30.57 0.1 91 4 100965 BDY REMOVEIREPLACE FRT BUMPER ENERGY ABSORBER 62090-CD000 64.10 INC # 525 . 100966 BDY REPAIR FRT BUMPER REINFORCEMENT Existing 1.0' 6 100984 BDY ACCESSANSPECT L FRONT COMBINATION LAMP ASSEMBLY Existing 0.0`# 7 AUTO BDY CHECKIADJUST HEADLAMPS OA a 101003 BDY ALIGN HOOD PANEL Existing 1.5" 31 9 .101683 MCH REMOVEIREPLACE EVACUATE 8 RECHARGE AIC -M 1A %1 10 101664 MCH REMOVEIREPLACE AIC REFRIGERANT RECOVERY •M 0.3 M 11 100122 BDY REMOVEIINSTALL R FENDER ASSY 1.0'0 51 12 100123 BDY REMOVEIINSTALL L FENDER ASSY 13 101059 BDYREPAIR L FENDER PANEL Existing 14 AUTO REF REFINISHL FENDER OUTSIDE C 2.2 15 101081 BDY REMOVEIRF�LACE L FENDER FRONT LINER 63845-CDOOD 04.32 INC # 16 101075 BDY REMOVEIREPLACE L FENDER ADHESIVE EMBLEM 63890-CDODA 24.38 0.2 51 17 100387 BDY REMOVEIREPLACE FRONT BODY RADIATOR SUPPORT 62500-CD700 353.16 5.0 # 18 AUTO MCH REMOVEIREPLACE ADD TO R&R MECHANICAL COMPONENTS -M 1.5 # This estimate has been re-calculated with a modMed pmtlle. ESTIMATE RECALL NUMBER: 0310SMODS 12:26:34 PGSKX0704901 UltraMate Is a Trademark of Mitchell Intematlonal Mitchell Data Version: MAR 08!V Copyright(C)1994-2005 Mitchell International Page 1 of 3 UltraMate Version: 6.0.029 All Rights Reserved Mar 26 2008 2: 28PM CSAR 925-524-0529 p, 2 Date: 3/2612008 01:55 PM Estimate ID: POSKX0704901 Estimate Version: 2 Supplement 2(F) 3/2612006 01:54:58 PM Profile ID: CSAA default 19 100011 BDY REMOVEIREPLACE FRT WHEEL ORDER FROM DEALER 785.57 0.3 20 100067 BDY REMOVEIINSTALL L ROCKER MOULDING 0.5 21 931125 BOY ADVL LABOR OP MOUNT&BALANCE TIRE Sublet 18.00* 0.0* 22 900600 BDY* ALIGN FRONT ALIGNMENT Sublet 69.95* 0.0* 23 936008 ADVL COST PAINTlMATERIALS 21.3.00, 24 936012 ADVL COST HAZARDOUS WASTE DISPOSAL 3.00' 25 936014 ADD'L COST FLEX ADDITIVE 7.00* 26 AUTO REF ADD'LOPR CLEARCOAT 1.6 27 933005 BDY ADD'L OPR RESTORE CORROSION PROTECTION 10.00* 0.1* 28 933016 REF ADD'L OPR MASK FOR OVERSPRAY 0.Y "-Judgment Item #-Labor Note Applies C-Included in Clear Coat Calc Add'I Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals 11. Part Replacement Summary Amount Body 14.5 75.00 10.00 u 77.95 1,175.45 Taxable Parts 1,593.62 Refinish 6.6 75.00 0.00 0.00 510.00 Sales Tax 8.250% 131A7 Mechanical 3.2 75.00 0.00 0.00 240.00 Total Replacement Parts Amount 1,725.09 Non-Taxable Labor 1,925.45 L.aborSummary 24.5 1,925.45 III. Additional Costs Amount IV. Adjustments Amount Taxable Costs 220.00 Insurance Deductible 500.00- Sales Tans @ 8.250% 18.15 Customer Responsibility 500.00- Non-Taxable Costs 3.00 Total Additional Costs 241.15 1. Total Labor: 1,926A5 0. Tota I Replacement Parts: 1,725.09 III. Total Additional Costs: 241.15 Gross Total: 3,891.69 IV. Total Adjustments: 500.00- Net Total: 3,391.69 Less Original Net Total: 2,235.01 Net Supplement Amount: 1,156.68 S1: SCOTT DUNK 1,129.66 S2: SCOTT DUNN 27.02 THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OF THE PARTS, RATHER THAN BY THE ORIGINAL MANUFACTURER OF YOUR VEHICLE. This estimate has been re-calculated with a modified profile. ESTIMATE RECALL NUMBER: 0310512008 12:26:34 POSKX0704901 UltraMate Is a.Trademark of Mitchell International Mitchell Data Version: MAR_08_V Copyright(C)1994-2005 Mitchell International Page 2 of 3 UltraMate Version: 6.0.029 All Rights Reserved Mar 26 2008 2: 28PM CSAR 925-524-0529 p, 3 Date: 3/28/2008 01:55 PM Estimate ID: PCSKX0704901 Estimate Version: 2 Supplement: 2(F) 3126!2008 01:54:58 PM Profile ID: CSAA default Insurance Co: CSAA Insurance NOTE: YOU HAVE THE RIGHT TO SELECT THE BODY SHOP THAT WILL REPAIR YOUR VEHICLE. THIS IS NOT AN AUTHORIZATION BY CSAA FOR REPAIRS. NOTE: YOU HAVE THE RIGHT TO SELECT WHICH BODY SHOP WILL REPAIR YOUR VEHICLE. THIS IS NOT AN AUTHORIZATION BY CSAA FOR REPAIRS. AS THE OWNER OF THE VEHICLE YOU ARE THE ONLY PERSON WHO CAN AUTHORIZE REPAIRS. YOU MUST GIVE THIS ESTIMATE TO THE REPAIR FACILITY AND THAT FACILITY MUST ACCEPT THIS ESTIMATE BEFORE YOU AUTHORIZE REPAIRS. THIS ESTIMATE CANNOT BE CHANGED WITHOUT CSAA'S CONSENT AND APPROVAL. CSAA IS NOT OBLIGATED TO PAY FOR ANY ADDITIONAL DAMAGE UNLESS CSAA INSPECTS THE ADDITIONAL DAMAGE AND APPROVES ANY CHANGE BEFORE THE REPAIRS ARE STARTED. ANY QUESTIONS CONCERNING THIS ESTIMATE ARE TO BE DIRECTED TO THE CSAA REPRESENTATIVE WHO HAS PREPARED THIS ESTIMATE. This estimate has been re-calculated with a modified profile. ESTIMATE RECALL NUMBER: 031051200812:26:34 PD8KX07049D1 UltraMate is a Trademark of Mitchell International Mitchell Data Version: MAR 08_y Copyright(C)1994-2005 Mitchell International Page 3 of 3 UltraMate Version: 6.0.029 All Rights Reserved t� it x: ii Q �II p% F.O. • , � � � V it I�J�I :awwry: f " , .. . . F L x k � • s a' < s � •�� �. �,;•�I ISI IIS, is . :. a !F .�•6S'a:. � ' :xr a < . .,. E Aim < a n x: w E r' x , P I $ . , a" a tt< •:gip n < '° q" sx Z k h Y t tt Aid 31 , y eyn t k i �m ' • ~fir .,F_ �a — dSO ��� SO WR z �.._ e >• �.+E , �''sS eta t R Ar�%'Y%{� E ;v IN _AA v".ik 'g3 F J z F s oda { h,� r �A 3Aa sa ,: ayitrw.n+w"'+ *a ;, �Ea e s•1 F,�y�,,n,. �' r' e - frit. VAR i .. "of MANew V I .F IS x x WO •x i(� e' .'n < Ijl i > i r a,. t e < • ',�..•� �ir .�:.. .,<. ...'.: may i. n 1 g� " {ff S M� 41 21, iz � ME d t - a �.3 zw n f pE t w, Y - 4+ g, S Aft . 7y Y �xk gym . .. Ar Tdi €• 6 ' ri "§ = t« wait Y �t ~yam ,„ # Wit„ �,•., �1n Na � q� �s r n '. 'r H � ................ jp 'Y .sow T.. : JAY non . I V y �r a� l .. r Now w oft y s 9: (j p P. p w' f g TA r" G a:. s' a 'z f �Xy1�r Piy / .A... " Not TAW A<. �y :' 5. 6. r. E' M Ism F� P , e t A. e�,a.• gip,. .�E;+�-:�:. w. y I A , r .... ,: .mss.. .k P I MAR W AWS plum I THE Won;. .. :. . yj ..F ,a n n ; f Via.. ...... .: .� � ,...:... '.p:.: 4. a=. OW its, �fr'� x� Ric 5. led 10 All •• . saw z Apo; i Y L? F a a. NSA. NN Won s< !y UP .. ::. owl WIT 71-11 Pon. too oz. ............ ............... F' d, �f ..:. Vit:.. ._ �• ���`., '<', k;=,5. v :. .... x +s. , Hsi :..s .�, e`. .. ... .. In op kit -.:...... n..x. i Al � k0 , .. .. =n " ......,. r. Ara IRA , �•z n� : .. .. .... : "V s 9" gN zF r , " k i _ i , H Y :F {�z r. .. ......a V ,.?,X ,. .:n�:e. ,;s' ".'gig �: .�,.•e'��•���`.".. ote , 3 d< .sin. i ,rsx =x: *IMS .. . ..:..:5, .'.': ......: •r x . s: r .: ..x ..:. ... ?: ,. :.. .i a: s ' „ ....... -....„•..,,°pyx.:: ..... b... e' n.. F.: 3 ' s ,P g. s....„,..� .. m� a, n r RAI x: y41x �� I'll ( ILII, II �I I6 �V '.a 4 .$.@>� .. n• :;-'��'( ILII Y 1' . �W v its Al • .,ate': ..,., 8�.. �* � w, e Yr x s m8 t' .k 3d Y4e 7 `5 � i � �• � � :y } \ � \ § \ \\ WATE OF aLIFORNIA TRAFFIC COLLISION REPORT CHP 555 CARS Page 1(Rev 1-03)OP1061 Page I cc 4 SPECL4L CONDITIONS Imusm mmo, KTAA RRun CRY ,AA)ICIAL DISTRICT LOCAL REPORTER NUMB ONY 0 WALNUTCREEK WCDANVILLE. xueeaKTun MBOLNEAN01"ME OR COUNTY REPORTING D'STRICT BEAT 08.5289 0 El CONTRA COSTA I COLUSIONOCCURREDDIA MO DAY YEAR TIME(UM) NCIC If OFFICER IO. Z CREEKSIDE DR 3/4/2008 1646 0712 P378 ALBEPOST)N-ORMATION: DAYOFWEEK TOWAWAY PHOTOGRAPHS BY: . jNONE TUESDAY YES X No J 0 AT 1.4TEASECTION WRH: STATE HW REL X'OR: 500 FEET SOUTH OF S.MAIN ST YES L7 NO PARTY DRIVER'S LICENSE NUMBER STATE CLASS AIRBAG SAFETY EQUIP. VEFI YEAR Il410E/MODEL/COLOR LICENSE NUMBER STATE 1 E06DI999 CA B M G 2002 FORD BUS TAN 1099218 CA DRIVER NNAE(FIRST.WJDDLE.LAST) THOMAS HARRY NELSON OWNER'S NAME gAMEASDRrVF.R P•�N STREETADDRESS CENTRAL CONTRA COSTA TRANSIT AUTH. I i I ASPEN DR#15 OWNER'S ADDRESS DSAMBASDRIVER PAA�EEDE CITY/STATE/aP 2477 ARNOLD IND.WAY CONCORD CA 945210VIE -- PACHECO CA 94553 DISPOSITION OF VEHICLE ON ORDERS OF: ❑OFFICER 1 DRIVER OTHER CUSr SEX HAIR EYES HEIGHT wEIGHr BRTHDATE RACE DRIVEN E. VA Day Yew _ M BRO GRN 5-11 195 5f23/1952 PRIOR MECH.DEFECTS NONE APP. ! REFERTONARRATIVE OTHER HOMEPHONZ BUSWESS PHONE VEHICLE IDENTIFICATION MAJOER: Ll (925)676-1976 VEHICLE TYPE DESCR BE VEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCECARMER PCXJCYNUMBER DUNK X NONE MINOR CRA WFORD AND COMAPNY CA 9799181 12 MoD MAJOR ROLL-OVER � Q DFi OFTRAVEL ONSTREETOCHIGHWAY SPEEDUMIT G Oi D S CREEKSIDE DR 25 CAL.T TCPIPSC MCROc pARTY CRACAS LICENSE NUMBER $TATE CLASS AIR 80.0 SAFETY EQUIP, VEH.VEAR MAKE/MOCEL/COLOR LICENSE NUMBER STATE 2 2003 NISSAN 35OZ BLK LEBED CA DRIVER NAME(Fl)WF.MIDDLE.I" OWNERS NAME SAMEASDRNER PEDES S(REETADDRESS KUSTADINOV,ILIY�] TRLAN OWNERSADORESS SAME AS DRIVER PARKED crrY/sTATerrP 1450CREEKSIDEDR.#79 WALNUTCREEK CA 94596 WEHICLE D;SPOSInCN OF VEHICLE ON ORDERS OF., 0OFFICER IY OIRIVER QOT}ER BI(Y• Sp( HAIR EYES HEIGHT WEIGHT &RTHDATE RACE PARKED L. W Me Du/ YeW PRIOR MECKM4MCAL DEFECTS NONE APP. •REFER TO NARRATIVE OTHER HOME PHONE BU$lHESS RHONE VEHICLE IDENi61G11ON NUMBER (925)932-0939 VEHICLE TYPE DESCRIBE VEINML9 DAMAGE SHADE IN OAMAG£DAREA INSURANCE CAPMR POLICY NUMBER 0LINK I (NONE ff]MMM AAA KX-07-04-9 01 MOD E J OR ROLL-AVER OIR OF TRAVEL ON STREET OR HIGHWAY SPEED LIMIT G DOT S CREEKSIDE DR 25 CAUT TCPRSC MCIMDC PAR" ORIVER'SUCENSENUMBER STATE CLASS AIRBAG I SAFETY EQUIP. VEH.YEAR M41fE)MOGELICOLOR LICENSE NIALBER STATE 3 DRIVER NANEIFIF131,MIOCL.E,LAST) 11 OWNERS NAME n SANE AS DRIVER PEW-- STREETADDRESSFUAN U OWNERS ADDRESS ❑SAME AS DRIVER PARKED C(T•/)5TATEIIIP VEH:CLE DISPOSITION OF VEHICLE ON ORDERS OF: Ll OFFICER DRIVER THER ScY. SEX }VUR EYES HEIGHT WEIGHT I BRLTHDATE RACE CLIST Mo On Yew PRIOR MECHANCLAL DEFECTS NCNEAPP. r—rEFER TO NARRATIVE OTHER HOME PHONE BUSIN£SSPHOEAL VEHICLE IDENTIFICATION NIDADER: VEHICLETYPE DESCRIBE vemcL"EDAMAGE SHADE IN DAMAGED AREA INSLFLANCE CAmw POLICY NUALBER WLK LNU�AEM MOD C IEA.,ORH.RONLO'LO'VER D18 OT'TRAVEL ON STREET OR HIGHWAY SPEEDUMIT CA 001 CAL-T TCPiPSC NCTAX PREPARERSNAME DISPATCH NOTIFIED REVIEWERS ME RE/ M.ADAMS P378 --"YES NO F]. `r STATE OF CALIFORNIA NARRATIVEISUPPL.EMENTAL PAGE 4 OF 4 DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 03/04/2008 1646 0712 P378 08-5289 1 Notification: 2 On 3/4108, at 1702 hours, I was dispatched to a counter report for a possible hit and run collision. 1 3 arrived at the front counter at 1705 hours and contacted the witness Hamond. Ali times, speeds 4 and distances are approximate. No measurements were taken. 6 6 Statements: 7 W-1 saw V-1 (Bus)approaching the bus stop S/B on Creekside Dr. V-1 moved towards the right 8 hand curb as it pulled to a stop. V-1 struck the left front of V-2 as it pulled to the curb. V-1 picked 9 up a passenger and continued S/B on Creekside Dr. D-1 made no attempt to look at the damage 10 or contact the owner of V-2. 11 12 Summary: 13 Prior to this collision,V-2 was parked S/B on Creekside Dr.at the W curb line. V-1 was SB on 14 Creekside Dr. V-1 was a small transit van type bus. V-1 pulled to the curb in an attempt to stop. 16 The right side of V-1 struck the left front of V-2 as the bus came to a stop. 1fi 17 V-2 sustained damage to the left front bumper and light assembly. 18 19 On 3/11/08, 1 spoke with Victoria Brown of the Contra Costa Transit Authority. Brown indicated 20 that a Thomas nelson had been driving that rout on 3/4/08. Brown indicated that there was no 21 damage to the bus and that Nelson was not aware of any collision. 22 23 Cause: 24 D-1 caused this collision when he turned V-1 from a straight course and moved towards the W 25 curb line in violation of CVC 22107, unsafe turning movement. 26 27 Based on the damage to V-2, it is possible that D-1 did not know that he struck V-2 and would not 28 be in violation of CVC 20002. 29 30 Case closed. PREPARED BY I.D.NUMBER DATE REVIEWER'S M. ADAMS P378 03/04/2008 l STATE OF CZFORNLA INJURED/WITNESSES/PASSENGERS CHP 555 CARS Pae 3 Rev 1-03 OPI 061 Page 3 of 4 DATE OF COLLISION(MO. DAY YEAR) TtME(2400) NCIC:C OFFICER 1.0. NUMBER 3/4/2008 1646 0712 P378 08-5289 WITNESS PASSENGER Af�E SEX EXTENT OF INJURY('X'ONE) INJURED WAS('X'ONE) PARTY SEAT AIR SAFETY �JECTED ONLY Or0.Y NJNBER POS. BAG EQUIP. FATAL SEVERE Oi HER VISIBLE COF PAINT DRIVER PASS. PED. BICYCLIST OTHER INJURY INJURY INJURY OF PAIN X1 r} M ❑ ❑ ❑ ❑ ❑ ❑ 7 ❑ ❑ NAME!D.O.B.I ADDRESS TELEPHONE BRUCE HAMMOND (925)935-6369 (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES; VICTIM OF VIOLENT CRIME NOTIFIED a# 2 ❑ 1 IF I E I ❑ ❑ ❑ ❑ ❑ c �� ❑ NAME I D.O.B.I ADDRESS TELEPHONE VICTORIA BROWN 2477 ARNOI.D INDUSTRIAL WAY CONCORD CA 94520 (925)676-1976 (INJURED ONLY)TRANSPORTED BY: TAKEN TO: I DESCRIBE INJURIES: VICTIM OF VIOLENT CRIME NOTIFIED ❑ ❑ ❑ ❑ ❑ 1 [3 1 ❑ ❑ G [=i NAME/D.O.B./ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED W. TAKEN TO: DESCRIBE INJURIES: VICTIM OF VIOLENTCRIME NOTIFIED ❑# ❑ ❑ ❑ 0 CI ❑ D ❑ ❑ NAME I D.O.B./ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: VICTIM OF VKILENT CRIME NOTIFIED ❑# o ❑ ❑ ❑ I ❑ I ❑ I ❑ 10 ❑ NAME f O.O.B.I ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: VICTIM OF VIOLENT'CRIME NOTIFIED NAME 10.09./ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: VICTIM OF VIOLENT CRIME NOTIFIED PREPARER'SNAME I.D.NUMBER M0. DAY YEAR REVIEWER'S IAO. DAY YEAR M.ADAMS P378 314!2008 STATE OF CA''FORNIA TRAFFIC COLLISION CODING CHP 555 CARS Page2(Rev.1-03)OPI 061 Pape 2 Of 4 TE OF COWSION WO.DAY YEAR) TIME(24M NCIC# OFFICERI.D. NUNEER /4/2008 1646 0712 P378 08-5289 OWNER OWNCR ADDRESSNOTIFIED PROPERTY DYES DNO DAMAGE DESCRIPTION OF DAMAG! SEATING POSITION SAFETY EQUIPMENT INATTENTION CODES OCCUPANTS L-AIR BAG DEPLOYED MICBICYCLE-HELMET A-CELL PHONE HANDHELD M-AIR BAG NOT DEPLOYED DRIVER PASSENGER A•NONE IN VEHICLEB-CELL PHONE HAH0.SFREE 8-UNKNOWN N-OTHER V-NO X-NO C-ELECTRONIC EQUIPMENT C•LAP BELT USED P-NOT REQUIRED W-YES Y-YES D-RADI07CD 1 2 3 1•DRIVER D-LAP BELT NOT USED E-SMOKING 2TOa-PASSENGERS E-SHOULDER HARNESS USED CHILD RESTRAINTEJECTED FROM VEHICLE F-EATING 5 6 7-STA,WGN REAR F-SHOULDER HARNESS NOT USED O-IN VEHICLE USED O-CHILDREN G•LAPISHOULDER HARNESS USED 0-NOT EJECTED 8-RR OCC TRK OR VAN R•IN VEHICLE NOT USED H-ANIMALS H-LAPISHOULOER HARNESS NOT USED 1•FULLY EJECTED 9• POSITION VNKNOWN J-PASSIVE RESTRAINT USED S-IN VEHICLE.USE UNKNOWN 2-PARTIALLY EJECTED I- PERSONNEL HYGIENE 7 0-OTHER T-IN VEHICLE IMPROPER USE 3-UNKNOWN J-READING K-PASSIVE FiESTRANT NOT USED U-NONE IN VEHICLE K-OTHER ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK(7 SHOULD BE EXPLAINED IN THE NARRATIVE. PRIMARY COLLISION FACTOR MOVEMENT PRECEDING UST NUMIER i#)OF PARTY AT FAULT TRAFFIC CONTROL DEVICES ] 2 3 SPECIAL INFORMATION 1 2 3 COLUSFON I VC$ECTTON VIDLATED: CITED)SES A CONTROLS FUNCTIONING JA HAZARDOUS MATERIAL A STOPPED !I A 22707 �O B CONTROLS NOT FUNCTIONING` B CELL PHONE HANDHELD IN USE B PROCEEDING STRAIGHT j B OTHER IMPROPER DRIVING' C CONTROLS OBSCURED C CELL PHONE HANDSFREE IN USE: C RAN OF•F ROAD }ffI X 10 NO CONTROLS PRESENT/FACTOR' X X D CELL PHONE NOT IN USE j D MAKING RIGHT TURN C OTHER THAN DRIVER' TYPE OF COLLISION E SCHOOL BUS RELATED E MAKING LEFT TURN D UNKNOWN' A HEAD-ON F 75 FT MOTORTRUCK COMBO F MAKING UTURN X 8 SIDESWIPE G 32FTTPAKERCOMBO G BACKING C REAR END H H SLOWING ISTOPPING WEATHER (MARK 1 TO 2 ITEMS) D BROADSIDE I I PASSING OTHER VEHICLE X A CLEAR E HITOBJECT J J CHANGING LANES B CLOUDY F OVERTURNED K x IK PARKING MANEUVER C RAINING G VEHICLE/PEDESTRIAN IL L ENTERING TRAFFIC D SNOWING H OTHER-: Im M OTHER UNSAFE TURNING E FOGIVISIBILLTY FT. IN N X(NG(NTOOPPOSING LANE F OTHER:' MOTOR VEHICLE INVOLVED WITH 10 IX 0 PARKED G WIND A NON•COLLISION IP P MERGING LIGHTING B PEDESTRIAN IQ 0 TRAVELING WRONG WAY X A DAYLIGHT C OTHERMOTORVEHECLE OTHER ASSOCIATED FACTORS R OTHER': B DUSK-DAWN D MOTOR VEHICLE ON OTHER ROADWAY 1 2 3 (MARK 1 TO 2 ITEMS) C DARK•STREET LIGHTS IX E PARKED MOTOR VEHICLE A vwsLrna+Mcww. 016DYES D DARK-NO STREET LIGHTS F TRAIN _ HNO E DARK-STREET LIGHTS NOT G BICYCLE 8 vesccrc"VIOtATea ugo {(({_--�.((YES FUNCTIONING' H ANIMAL: L• SOBRIETY-DRUG ROADWAYSURFACB VGtcCfa"VX ATM WED PHYSICAL x A DRY I FMEDOBJECT: C u 1 2 3 (h1ARK1T021TEtAS) 8 WET D LJ X A HAD LOT BEEN DRINKING C SHOWY•ICY OTHEROBJECT: E VISION OBSCUREMENT. B fiBD-UNDERINFLUENCE D SLIPPERY(MUDDY,OILY,ETC.) F INATTENTION•: I IC HBD-NOT UNDER INFLUENCE' ROADWAY CONDTTION(5) G STOP&GO TRAFFIC D HSD-IMPAIRMENT UNKNOWN' (MARK 1 TO 2 ITEMS) PEDESTRIAN'S ACTIONS H ENTERING I LEAVING RAMPE UNDER DRUG INFLUENCE' A HOLES,DEEP RUT' X A NO PEDESTRIANS INVOLVED 1 PREVIOUS COLLISION F IMPAIRMENT•PHYSICAL' Y' B LOOSE MATERIAL ON ROADWAB CROSSING IN CROSSWALK J UNFAMILUIR WITH ROAD 0 IMPAIRMENT NOT KNOWN C OBSTRUCTION ON ROADWAY' AT INTERSECTION K DEFECTIVE VEH.EQUIP.: CITED X H NOT APPLICABLE D CONSTRUCTION-REPAIR ZONE C CROSSING IN CROSSWALK-NOTYES I SLEEPY/FATIGUED E REDUCED ROADWAY 140TH AT INTERSECTION NO F FLOODED' D CROSSING-HOT IN CROSSWALK L UNINVOLVED VEHICLE G OTHER`- E IN ROAD-INCLUDESSHOULDER M OTHER': X H NO UNUSUAL CONDITIONS F NOT INROAD X X N NONE APPARENT G APPROACHING i LEAVING SCHOOL BUS 1 10 RUNAWAY VEHICLE SKETCH ,r'+� MISCELLANEOUS �Ljl TYPE OF COLL:B -•- SPEC.COND: "mule NORTH PCF:22107 V 2 CASE STATUS:C CLOSED BY:P378 1 coPlEs ro:CHP IPJ n313d8 T INDEXED BY: APPROVED BY: is V CLAiNI — BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: u�z.3, ZfX�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. you is your notice of the action taken �� on your claiin.by the Board of n Supervisor's. (Paragraph IV below), APR 22008 given-.Pursuant to Government Code AMOUNT:; 2 COUNTY COUNSEL Section 913 and 915.4. Please note all MARTINEZ CALIF. "Warnings". . CLAIMANT: la,201bob kattAb, c%�GWvV m tic, X1, '1 T�r SOW We or--6�U�1����� ATTORNEY:-) L: DATE RECEIVED: �1-trporr col�P�'r�.� ep�l.-t�� ADDRESS: ,.�6,�q OCL4OY',f �1 �� .� � BY DELIVERY TO CLERK ON: r 'n/ ay ()A Wt 61q- pl&2f BY MAIL POSTMARKED: d FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN CUL Jerk. ' Dated: 25 Lc� By: Deputy 11. FROM.: County Counsel TO: Clerk of the Board of Supervisors (r)'fills claire complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). O Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). O Other: Dated: `��oZ By: �� Deputy County Counsel 1.11. FROM.: ' Clerk of the Board T0: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARD ORDER: By unanirnous vote of the Supervisors present: This Claire 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: 44 jq, JOHN CULLEN, CLERK, Byputy Clerk WARNING (G v. 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 attomey of your choice in connection with this matter. If you want to consult an attorney,you should do so immediately. *For ti Addional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that 1. am now, and at all times herein mentioned, have been a citizen of• the United States, over age 1.8; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the inran. •hown above. Dated: _ JOHN CULLEN,. CLERK By Deputy Clerk Com CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: d (,l.ne, Claim Against the County, or District Govemed 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 1V below), given Pursuant to Government Code AMOUNT: Section 913 and 915.4. Please note all "Warnings". CLAIMANT: (Lrzabe.�) Kaf tne, &- tarot.m 11161 lc(�iv) ►:.i wcuAV01, ATTORNEY: L: OLL171`05 DATE RECEIVED: A-li- err .CE, ( �; (c�ri1T;�� _ C77 ADDRESS: Ca ` t Sf. illL' BY DELIVERY TO CLERK ON: /-f�,�l"t,c 26, !� , 0: i4AhiJ, BY MAIL POSTMARKED: 6W FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. / ) JOHN CUL lerk Dated:C L ,��.I' l 2b f2_cu B De ut t'-f-I G'�G Yi t'; I.I. FROM.: County Counsel TO: Clerk of the Board of Supervisors ( ) Tills 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 Ill. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 9113). I.V. BOARD ORDER: By unanimous vote of the Supervisors present: O This Claim is rejected in full. ( ) Other: I certify that this is a true and 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. ff'you want to consult an attorney,you should clo so immediately. *For Additional Wanting See Reverse Side ol'This Notice. AFFIDAVITOF MAILING I declare tinder penalty of perjury that 1.. am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today ] deposited in the United States Postal Service in r4artinez, 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 V '. BOARD OF SUMMVISORS 01 CONTMA CEPA MUM TA CL A. A CwM avl**to a CMw of icaim fear da*07 for kjMy to pM=OE to pasowl pMPoAy M So *A be pueazd not latest &= Sjjr Muft Mft ft 2 of emw of ectim A eWim relating to say D&W Cma of=ion shill be prmnbd not k1a the one yaw aft the aMM9 of tae cam of Awon. (fir. Cob#911.2.) B. Ciai= mug be fM with th@ Cjwk of to Road of SqWW=s at ate of&c in Rom flo6, aa1Uvd0o B%likft 651 Pine StMA Madmz.CA 94553, C. If CWM is spim a district jpv%=d by the Board of aur s, radw thm the Comty, the D. if tw claim is Wi0a mom fto one pW&C emy, OVWM claim Am be Med affim nth ' publio erd¢ity. E. ZMVL Ser pWty for ftuldew s,Pt l Co4e Ste. 72 at e4 of this f 06500000000a no DC a000 c00%Q 080000060000000003OpppapWvq,pppa 0000000000000 Doe Clam Ry: , fi9fi't~l °s Aim p i Elizabeth 'Malone , Guardian Ad ) . f i.icemiQr-_S _ RECEIVED et al . See Attachement "A", ) hr------� ApFutt CauzycfZ Cwtj ) APR 2 5 2008 'est) CLERK BOARD OF S:JP`�r,' vORS 0'911 in dw amp) CCi: COST:`.GQ. The i 9mw h"cby cia a ' st the C'o y ®r dasdct jUt =M of$See A t t a c of 9 Y9 f®Mas s: ' • i 1. did to dMume or,4wy (Giw exad&e wd bm) See Attachment 2. Whm did the damp or 4wy ? city jMd C=jay) See Attachment "A" 3, How did ft dMW or Udwy ? (01ve find dews.UM wita pqw sfsaprad) See Attachment 4. 19sr act or o1nissim oo thepwt t of County or dishict®ffism, ,os mpboyes See do c me �a 5 Mg.am tba Mg=of county mx dwat o or 1O catf *e d orW See Attachment A CI arfia� LAW OFFICES OF JOHN L. BURRIS www.johnburrislaw.com John L. Burris John.Burris@JohnBurrisl.aw.com Ben Nisenbaum Ben.Nisenbaum@JohnBurri.sIaw.com Adante D. Pointer Adante.Pointer@JohnBurrisLaw.com ATTACHMENT "A" Claimant objects to the CONTRA COSTA COUNTY AND CITY OF OAKLEY'S Claim Form because it requires information which constitutes an invasion of the Claimant's privacy and which is not required to be provided by the Claimant under California Government Code Section 910. For example, California Government Code Section 910 does not require that the Claimants provide their home and work numbers, driver's license number, date of birth, auto insurance name and policy number, a diagram of the location of the incident, any statements by the Claimants as to their reasons "for believing the City is liable for your damages, "or a description of" all damages which you believe you have incurred as a result of the incident." Therefore, Claimant submits the following information in support of his/her Tort Claim pursuant to Government Code Section 910: CLAIMANTS' NAME: ELIZABE77I,114LONE, Guardian Ad Lilem.for SOPHIA ROSP, BRENNf9N; 11A TT BRENN.4N, TED BREMNAX Nl(.'K BREA 'AA1 ESTATE OF.I.- MES BRENNAN CLAIMANTS' ADDRESS: C/O LAW OFFICES OFJOHN L. BURRIS. Air j)orl Corporate Centre, 7677 Oakport Street, Oakland, CA 94621 CLAIMANTS' TELEPHONE NUMBER: C/O LAW OFFICES OF.IOHA7 L. BURRIS., ESO. (510) 839-5200 ADDRESS TO WHICH ALL NOTICES ARE TO BE SENT: LAW OF,1-,I( OF.IOHN L. BURRIS, Airport Corporate Centre, 7677 Oakport Street, Suite 1120, Oakland, CA 94621 PLEASE NOTE: COUNSEL REPRESEATT.S(:'LAIR ANTS AATD ALL C1ON7;4CT SIIO(.!LD BE illbl DE Gi"ITH HER ATTORNE}'OA'L DATE OF INCIDENT: October 27, 2007 LOCATION OF INCIDENT: 1000 blockof'LAe Oak:9renue "A GENERAL DESCRIPTION OF THE INDEBTEDNESS, OBLIGATION, INJURY, DAMAGES OR LOSS INCURRED SO FAR AS 1T MAY BE KNOWN AT THE TIME OF PRESENTATION OF THE CLAIM" AND "THE NAME OR NAMES OF THE PUBLIC EMPLOYEE OR EMPLOYEES CAUSING THE INJURY, DAMAGES, OR LOSS, IF KNOWN: [Per Government Code Section 9101: AIRPORT CORPORATE CENTRE • 7677 OAKPORT STREET,SUITE 1Y0 • OAKLAND,CA 94621 • TEL(510)839-5200 • FAX(510)839-3882 DESCRIPTION OF INCIDENT: This incident took place on October 27, 2007 at approximately 11:56 p.m on the 4000 block of Live Oak Avenue. Deputy Ian,Jones pursued a vehicle, which he allegedly observed. collide with another vehicle and leave the scene of the collision. Deputy .Jones later claimed to observe decedent James Brennan in an area near the vehicle Deputy ,Zones had been pursuing. At the time of this incident, Deputy .Jones had a police dog K-9 unit present in his vehicle. Deputy Jones also possessed on his immediate person non-lethal weapons including OC spray. In the course of arresting decedent, Deputy,Tones later alleged that decedent resisted arrest. Although Deputy Jones had no reasonable factual basis to believe that decedent was armed with any weapon and never observed decedent with any weapon, Deputy Jones shot and killed decedent. Deputy Jones later alleged that the reason he shot and killed decedent was because decedent had allegedly, earlier during the purported struggle, attempted to obtain Deputy.Jones' firearm. At the time of the shooting, decedent was several feet away from Deputy Jones. Plaintiff alleges that Deputy .Zones fired one shot at decedent directly into decedent's head. killing decedent. Plaintiffs allege that Deputy .Zones was negligent in flailing to use non-lethal weapons that were immediately available to him. Plaintiff further alleges that the use of lethal force by Deputy ,Jones was extraordinarily disproportionate to the threat from decedent that he allegedly faced. Decedent's son. 'Ted Brennan, arrived on the scene shortly alter hearing gunfire. Ted Brennan immediately saw three police deputies using excessive force against his brother. Matt Brennan. Matt Brennan had arrived at the scene of the shooting before Ted Brennan. Ted Brennan also saw his father lying in a pool of blood ten feet away from where his brother was being beaten. Ted began screaming and the deputies handcuffed him and arrested him. Decedent's brother, Stephen Brennan. was arrested at the scene of the incident for allegedly interfering with the investigation. Following the incident. James Brennan was taken to Sutter Delta Memorial Hospital. where he was pronounced dead. DESCRIPTION OF CLAIM: Claimant alleges that the conduct of individual employees, agents and/or servants of the CONTRA COSTA COUNTY AND CITY OF OAKLEY constitute Federal constitutional violations, which includes the use of excessive and/or arbitrary force that lead to the wrongful death of the victim. Also, State statutory violations, which include false imprisonment. assault, and battery, and the intentional infliction of emotional distress. negligent infliction of emotional distress, and negligence. Claimant alleges that individual employees, agents and/or servants of CONTRA COSTA COUNTY AND CITY OF OAKLEY are responsible for Claimant's injuries, and acts and/or omissions committed within the course or scope of employment under the theory of respondeat 2 superior. Respondeat superior liability includes but is not limited to, negligent training, supervision, control and/or discipline. Individual employees, agents, and/or servants of CONTRA COSTA COUNTY, include but are not limited to, WARREN RUPF. Sheriff for the CONTRA COSTA COUNTY SHERRTF'S DEPARTMENT, DEPUTY TAN .ZONES and DOES 1-100, and/or each of them, individually and/or while acting in concert with one another. Individual employees, agents, and/or servants of the CITY OF OAKLEY. include but are not limited to, CHRIS THORSEN, Chief of Police for the CITY OF OAKLEY, DEPUTY IAN JONES, and DOES 1-100, and/or each of them, individually and/or while acting in concert with one another. Claimant alleges that the use of excessive and/or arbitrary force included. but was not limited to, the use of force in a manner foreseeable likely to cause death, injury and/or serious bodily harm. Claimant alleges that the wrongful death action included, but was not limited to, actions and/or breach of duty upon failing to exercise due care by placing another at risk of death. Claimant alleges that false imprisonment and/or wrongful detention included, but were not limited to, imprisonment without probable cause, and failure to follow proper procedures resulting in false imprisonment. Claimant alleges that the assault included, but was not limited to, unwanted contact causing Claimant to experience a reasonable apprehension of immediate harmful or offensive contact likely to result in death or serious bodily injury. Claimant alleges that the battery included, but was not limited to, subjecting the Claimants to harmful or offensive contact with the intent to cause death or physical injury. Claimant alleges that intentional infliction of emotional distress included, but was not limited to, extreme and outrageous conduct resulting in physical injury to the victim. which placed the claimants within the zone of danger of physical impact. The physical abuse caused Claimant to reasonably tear for a family member's safety. The physical abuse resulted in the death or injury of Claimants' family member resulting in the suffering of severe emotional distress with attendant physical manifestations. Claimant alleges that negligent infliction of emotional distress included, but was not .limited to, breach of duty upon failing to exercise due care by causing emotional distress to others. Claimant alleges that negligence included, but was not limited to, breach of duty upon failing to exercise due care by placing others at risk of death, injury, or serious bodily harm. Claimant will allege other causes of action subject to continuing discovery. DESCRIBE INJURY OR DAMAGE: 3 Claimant has, or may have in the future, claims for general damages, including. but not limited to, claims for pain, suffering and emotional distress in amounts to be determined according to proof. Claimant may have and/or may continue to have in the future, claims for special damages, including, but not limited to, claims for medical and related expenses. lost wages, damage to career, damage to educational pursuits, damage to property and/or other special damages in amounts to be determined according to proof. Claimant may have. and/or may continue to have in the future. damages for permanent mental injuries, permanent mental scarring and/or other psychological disabilities in an amount according to proof. NAME OF PUBLIC EMPLOYEE(S) BELIEVED TO HAVE CAUSED INJURY OR DAMAGE: See description of the incident, above. DEMAND FOR PRESERVATION OF EVIDENCE: Claimant does hereby demand that CONTRA COSTA COUNTY AND CITY OF OAKLEY including. but not limited to, CONTRA COSTA COUNTY AND CITY OF OAKLEY POLICE, DEPARTMENT, its employees. servants and/or attorneys, maintain and preserve all evidence, documents and tangible materials which relate in any manner whatsoever to the subject matter of this Claim, including until the completion of any and all civil and/or criminal litigation arising from the events which are the subject matter of this Claim. This demand for preservation of evidence includes, but is not limited to, a demand that all public safety entities preserve all tapes, logs and/or other tangible materials of any kind until the completion of any and all civil and criminal litigation arising from the subject matter of this claim. AMOUNT OF CLAiM: This claim is in excess of$25,000. Jurisdiction is designated as "unlimited" and jurisdiction would be in the United States District Court and/or Superior Court of the State of California for the County of Alameda. DATED: April 225. 2008 JOHN L. BURRIS, ESQ. Attorney for Claimant 4 C LA INI BOARD OF SUPERV.I.SORS OF CONTRA COSTA COUNTY BOARD ACTION: Claim Against the County, or District Governed by the Board of Supervisors, Routing NOTICE TO CLAIMANT and Board Action. All Section refe The copy of this document mailed to California Government Codes. APR 2 9 ZWB you is your notice of the action taken oil your claire by the Board of COUNTY COUNSEL. Supervisors. (Paragraph IV below), MARTINEZ CALIF. given Pursuant to Government Code AMOUNT: Section 913 and 915.4. Please note all ,Warnings". CLAIMANT: NeV``11f, ATTORNEYD(,(v(d CP MP DATE RECEIVED: -)er ADDRESS:C�J an,4crne--fi, o J- rBY DELIVERY TO CLERK ON: N47 9 0 �{�G2f1.GLSG�, CA 1�/ BY MAIL POSTMARKED: 5. �25 FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN CUL N,,,C,l`erk ti Dated: a �g By: Deputy A&VU IL FROM.: County ounsel TO: Clerk of the Board of Supervisors (0/This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply. substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. Tile Clerk should return claim on ground that it was filed late and send warning of claimant's right.to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 41'31)—ao 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). 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: V(pJOHN CULLEN, CLERK, By e Clerk WARNI.N (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 claainr.See Governnneirt Code Section 945.6.You may seek the advice of an attorney of your choice in connectiai wide this matter. Ifyou want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side ofThis Notice. AFFIDAVIT OF MAILING I declare under penalty of per jury 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 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 clainranhown above. Dated;C Yn JOHN CULLEN, CLERK By uty Clerk a , CLAIM BOARD OF SUPERVISORS OF CON-1711A 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 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 "Warnings". CLAIMANT: ��'bt: -111 ATTOP,NEY:f)6t,t t'j r l DATE RECEIVED: — v .C_ ADDRESS:(y,-:,1A,X ;��C1J 1`>i l))E? `�� �j - "BY DELIVERY TO CLERK ON: fV111 vi l r b(I c �C(' (al C;)� j�I BY MAIL POSTMARKED: hala tc FROM: Clerk of the Board of Supervisors T0: County Counsel Attached isa copy of the above-noted claim. JOHN CUL N, Clerk Dated: ,i.! .+ � ZC -, B Deputy l'l - itizc Y I Y I1.. 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). O Claim is not timely filed. The Clerk should return claire on ground that it'was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). O Other: Dated: By: Deputy County Counsel 1.11. FROM: Clerk of the Board T0: County Counsel (1) County-Administrator(2) O Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARD ORDER: By unanimous vote of the Supervisors present: ( ) Tliis Claim is rejected in full. ( ) Other: [ certify that tliis 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 9.13) Subject to certain exceptims,you have only six(6) months from the date this notice was personally served or deposited in the nuril to file a court action on this claim.See Governmeirt Code Section 945.6.You may seek the advice ofan;attorney ofyour• choice in connectim with this matter. 11'you'want to consult an attonrey,you should do so immediately. *For Additional Warning See Reverse Side of'This 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, over age 18; and that today .1 deposited in the United States Postal Service in iNiartinez, 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 LAW OFFICE OF RECE11VED DAVID C. ANDERSON [:AP:R2 9 2008 ATTORNEY AT LAW 450 SAN SOME STREET, 3RD FLOOR CLERK BOARD OF S!P_RVISORS SAN FRANCISCO,CA 94111 CONTRA RA GOSIA CD TELEPHONE:(415)788-1588 FACSIMILE: (415)788-1598 Direct Dial: (415)835-7135 Email:david@dcandersonlaw.com April 25, 2008 Board of Supervisors c/o The Administrator of the County of Contra Costa 651 Pine Street, l 11h Floor. Martinez, CA 94553 RE: Neville Hawkins v. County of Contra Costa Dear Sir/Madam: Enclosed please find a Letter of Representation and a Notice of Claim in the above matter. Thank you and please feel free to call me should you have any questions. Sincerely, David C. Anderson DCA/cls enclosures 1:VI wkins-17Cbonrd supervisors Itr wpd I � Board of Supervisors c/o The Administrator of the County County of Contra Costa 651 Pine Street, 11`h Floor Martinez, CA 94553 RE: NOTICE OF CLAIM AGAINST THE COUNTY OF CONTRA COSTA, CONTRA COSTA COUNTY SHERIFF'S OFFICE, AND SHERIFF/ CORONER WARREN E. RUPF CLAIMANT'S NAME: Neville Thomas Hawkins CLAIMANT'S ADDRESS: c/o David C. Anderson, Esq., 450 Sansome Street, Third Floor, San Francisco, CA 94111. CLAIMANT'S TELEPHONE NUMBER: c/o David C. Anderson, Esq., (4.15) 788-1588. ADDRESS TO WHICH NOTICES ARE TO BE SENT: c/o David C. Anderson, Esq., 450 Sansome Street, Third Floor, San Francisco, CA 94111. PLEASE NOTE: CLAIMANT IS REPRESENTED BY COUNSEL AND ALL CONTACT SHALL BE MADE WITH I-IIS ATTORNEY. ' DATE OF THE INCIDENT: February 20, 2008. LOCATION OF THE INCIDENT: Contra Costa County Superior Court, Dept. 52, Martinez, CA. CIRCUMSTANCES GIVING RISE TO THE CLAIM: On February 20, 2008,Neville Hawkins was present in Dept. 52 of the Family Law Division of the Contra Costa County Superior Court where he was attempting to arrange for a postponement of a court appearance in a family law matter wherein he was a party. He approached the Deputy District Attorney and began discussing the proper procedure for obtaining a continuance of the hearing, which was scheduled for February 28, 2008, when two bailiffs, Deputy Sheriff Rodriguez and Deputy Argo, Badge No. 71.720, suddenly grabbed him in a violent manner.and told him he must leave the courtroom, begat: pushing him out the door, threw him up against a wall outside the courtroom, and finally released him. The conduct of the Contra Costa County Sheriffs Department employees identified in this claim caused Neville Hawkins to be assaulted, battered, suffer severe physical and emotional injuries, and also resulted in the depravation of his"constitutional, statutory, and common law rights as citizens and victims of violent crime, and to suffer retaliation for the attempted exercise of those rights. DESCRIPTION OF INJURIES AND DAMAGES: 1. Physical injuries; T 2. Emotional distress; 3. Past and future medical expenses; 4. Past and future loss of income; 5. Attorney's fees; 6. Statutory damage., 7. Costs in amounts to be determined according to proof. POTENTIAL CLAIMS The acts and/or omissions as alleged herein give rise, or may give rise, to causes of action or claims on behalf of the Claimants which include, but are not limited to: 1. Battery; 2: Assault;. 3. Negligence; 4. Violations of civil rights; including but not limited to rights under the Fourth and Fourteenth Amendments to the United States Constitution; 5. Violations of California Civil Code Sections 52, 52.1; 6. Violations of 42 U.S.C. Sections 1983, 1985-86, 1988; 7. Unconstitutional customs and policies; 8. Inadequate training, supervision, discipline and/or hiring; and 9. Violations of the California Constitution. NAMES OF PUBLIC EMPLOYERS) BELIEVED TO HAVE CAUSED INJURY OR DAMAGE: Contra Costa County Sheriff/Coroner Warren E. Rupf; Contra Costa County Bailiffs/Sheriff Deputies Rodriguez and Argo; and potentially other presently unknown officers and/or employees. AMOUNT OF CLAIM: Jurisdiction is in the Superior Court of the State of California for the County of Contra Costa and/or United States District Court for the Northern District of California. . DATED: y Dv DA 1D ANDERSON Attorney,for Claimant K9DCA\Grime(Brayton 9350)\c1aim.wpd ' APR. 1 9. 200$ .8: 10 AM CCC RISK MANAGEMENT ,, NO. 816 P. 2 BOARD OF SUPERNqSORS OF CONM COSTA COUNTY INSTRUCTIONStO CLAP4LN1_T A/7/ A. A claim relating to a cause of action for death or for injury to,person or to personal propzei�or growing crops shall be presented not lata than six monibs after the acm-LW of the, Cattle of action.. A claim relating to any other cause of acn"on shall be presented not law than one year after the acmial 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 Fine,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, DIf the, claim is against more -d= one public entity, separate claims must be filed against each. public entity. H. Fraud. See penalty for fraudulent claims, P onal Code Svc. 72 at the end of this form. Runs RE: Claim By. Reserved.for Clerk's filing st=p Against the County of Coniza.Costa or APR 2 1 2008 District) CLERK BOARD OF SUPEFWSORS 1U in the iwaae) CONTRA COSTA CO. The undmsiped claimant hereby makes olaim against the County of Contra Costa or the above named district in the sum of$ and in support of this claim represents as follows: I. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) 3. How did the damar.,or iajury occur? (Give full details;use e=a paper if required) rz 4. &Warti6zir act p or omission on e part of county or district officers, servants, or cjaployees caused the'Jury or damage? /0 What are the names of county or district offi=s,'Smauts,or employees causing the damage or injury? AP'R. 9. 2008 8:30AM CCC RISK MANAH-W-NT N0. 816 P. 3 6. W damage or iujuri.es do your claim resulted? (Give full extent of in3uries or damages e, claimed. Attanh two estimates for auto damage.) ���/• e 7. Hour was the amount claimed above computes? (Include the estimated amount of any prospective ivjnry or damage.) l e71oin - doe and hospitals: 8. � es anal ad sses of wits to l�iCt'o7t� '�1 07 4 � A -1Q-9. List the expert 'tures you mad ac unt o s acc� en or injury: DAVE TIMI✓ AMOUNT an a a a Ismiff aNIL RUN arILK rZEN saaarRpm■Ran PRE gun■Ra■aUBaaa■MEW a■BEa■ala■Itss■sa■amaaItUKm&a■a1 -Gov. Code Sec. 910.2 provides"The claim shall be signed by the claimant or by some person on bis SnTLD NOTICES TO: (Attbme Name anis address of Attomey (Claimant's Signaxare) �. �6Ghx Sao (Address) ) f Telephone No. }Telephone No. Xeff aawKit ■rass■■alt a.alaaBEaasBaaaa�l■arasla■raasaaa its ■agar■aresl■aYreaxa■arra■aea■ears PUBLIC RECORDS NOTICE: Please be advised Vat 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 supplemeuts attached to the claim form, including medieaI records, are also subject to public discloa• a. Basal Baa■■aaaaB■tar■earl ars ar aYssalaaaaal s■■afs■a■B■war Baa aafaaarla saaaaa■sr Bata lama{ NOTICE: Section 72 of the Venal Code provides' Every person who, with intent to defraud,presents for allowance or for payment to any state hoard 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, billy 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 imprisonmeut in the stat.- prison, by a fine of mat exceeding ten thousaud dollars ($10,000), or by both such imprisonment and fine. 0 0 N N O gO U CHECK NO.: 712 L162506-4—R m DATE: 04-01-2008 0 Lu NAME AND ADDRESS INFORMATION: lKOSTADINOVA, ILIYA/STOYANKA,KOSTADI 1450 CREEKSIDE DR #79 WALNUT CREEK CA 94595 INSURED: KOSTAD I NOVA, ILIYA/STOVANKA,KOSTAD I N PAYMENT INFORIIOATION/DESCRIPTION: DATE OF LOSS: 03-04-08 DEDUCTIBLE PAYMENT CLAIM NO.: 08—KX0704-9 CLAIMANT: KOSTADINOVA, ILIYA/STOYANK PAYEE: KOSTADINOVA, ILIYA/STOYANKA,KOSTADI AMOUNT: $500.00 IN PAYMENT OF: DEDUCTIBLE PAYMENT ADJUSTER: MATT WRIGHT ADJUSTER NO.: 33807 KIND OF LOSS: COL 16610702 DETACH AND RETAIN FOR YOUR RECORDS No. 712 Ll 62506-4-R DATE OF LOSS CLAIM INSURED'S NAME DATE 03-04-08 08—KX0704-9 KOSTADINOVA, ILIYA/STOYANKA,KOSTADIN 04-01-2008 POLICY TYPE KIND OF LOSS SUFFIX CLAIMANT'S NAME PAY AUTO COL 01S I KOSTADINOVA, ILIVA/STOYANK $500.00 D.O. ADJUSTER 1,10. IN PAYMENT OF BANK OF AMERICA J11L.,76 Bank of America Cumomor Connection 511 LV2 33807 DEDUC B AY Bank of America, N.A. Atlanta, Dokalb County, Georgia PAY *FIVE HUNDRED 00/100* This check must be properly endorsed on the reverse side by all payees. KOSTADINOVA, ILIYA/STOYANKA,KOSTADI TO THE ORDER OF 0 o I O N CD1 O M O a U CHECK NO.: 706 L082728-7—M m DATE: 03-05-2008 D Lu > NAME AND ADDRESS INFORMATION: Lu U iU.11 KOSTADINOVA, ILIYA/STOYANKA,KOSTADI 1450 CREEKSIDE DR X79 WALNUT CREEK CA 94596 INSURED: KOST AD I NOVA, ILIYA/ST OYANKA,KOST AD I N PAYMENT INFORMATION/DESCRIPTION: DATE OF LOSS: ' 03-04-08 REPAIRS LESS $500 CLAIM NO.: 08-KX0704-9 CLAIMANT: KOSTADINOVA, ILIYA/S.TOYANK PAYEE: KOSTADINOV, ILIYA/STOYANKA,KOSTADI AMOUNT: $2,235.01 IN PAYMENT OF: KOSTAD I NOV, ADJUSTER: SCOTT DUNN ADJUSTER NO: 18939 KIND OF LOSS: COL 16610702 DETACH AND RETAIN FOR YOUR RECORDS No. 706 L082728-7-M DATE OF LOSS CLAIM INSURED'S NAME DATE 03-04-08 08—KX0704-9 KOSTADINOVA, ILIYA/STOYANKA,KOSTADIN 03-05-2008 POLICY TYPE KIND OF LOSS SUFFIX CLAIMANT'S NAME PAY AUTO COL 01P KOSTADINOVA, ILIYA/STOYANK $2,235.01 D.O. ADJUSTER NO. IN PAYMENT OF BANK OF AMERICA 61-I175 Bank of America C—tomor Connection 511 CPS 18939 K05TAD I NOV, Bank of America, N.A. Atlanta, Ookalb County, Georgia PAY *TWO THOUSAND TWO HUNDRED THIRTY FIVE 01/100* KOSTADINOV, ILIYA/STOYANKA,KOSTADI This check must be properly endorsed on the reverse side by all payees. TO THE ORDER OF Date: 3/5/200812:37 PM Estimate ID: POSKX0704901 Estimate Version: 0 Committed Profile ID: CSAA default California State Auto Association PO BOX 920,Suisun City,CA 94585-0920 (925)524-0533 Fax: (707)863-0052 Damage Assessed By: SCOTT DUNN Date of Loss: 3/4/2008 Deductible: 500.00 Policy No: KX07049 Claim Number. POBKX0704901 Insured: ILIYA/STOYANK KOSTADINOVA Owner. ILIYA/STOYANK KOSTADINOVA Address: 1450 CREEKSIDE DR#79,WALNUT CREEK,CA 94596-0000 Telephone: Work Phone: (925)8186365 HomePhone: (925)932-0939 0 0 0 C14 Mitchell Service: 911533 u� 0 C* Description: 2003 Nissan 35OZ CD Body Style: 2D Cpe Drive Train: 3.5L Inj 6 Cyl 6M RWD VIN: JN1AZ34E43T007573 License: LEBED N Mileage: 96,729 CJ OENUALT: A Search Code: CONTRACOST m ** SPECIAL PARTS NOTE: ALL CRASH PARTS IN THIS ESTIMATE ARE "NEW" D 512 PARTS (OEM) UNLESS OTHERWISE SPECIFIED. PARTS DESCRIBED AS RECHROMED, RECORED, OR REMANUFACTURED ARE EITHER "RECONDITIONED" PARTS, OR "REBUILT" PARTS. CRASH PARTS DESCRIBED AS "QUAL REPL PART" ARE NON—OEM AFTERMARKET PARTS. ** Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 100952 BDY REMOVE/REPLACE FRT BUMPER COVER Remanufactured 291.52` 2.2 # 2 AUTO REF REFINISH FRT BUMPER COVER C 2.8 3 100962 BDY REMOVE/REPLACE FRT BUMPER ADHESIVE EMBLEM 62890-CD000 30.57 0.1 4 100984 BDY ACCESS/INSPECT L FRONT COMBINATION LAMP ASSEMBLY Existing 0.0*# 5 AUTO BDY CHECK/ADJUST HEADLAMPS 0.4 6 101003 BDY ALIGN HOOD PANEL Existing 1.5* 7 101059 BDY REPAIR L FENDER PANEL Existing 1.5*# 8 AUTO REF REFINISH L FENDER OUTSIDE C 2.2 9 101061 BDY REMOVE/REPLACE L FENDER FRONT LINER 63845-CD000 44.32 INC # 10 101075 BDY REMOVE/REPLACE L FENDER ADHESIVE EMBLEM 63890-CDOOA 24.38 0.2 11 100387 BDY REPAIR FRONT BODY RADIATOR SUPPORT Existing 1.5*# 12 100011 BDY REMOVEIREPLACE FRTWHEEL ORDER FROM DEALER 785.57 0.3 13 100067 BDY REMOVE/INSTALL L ROCKER MOULDING 0.5 14 931125 BDY ADD'L LABOR OP MOUNT&BALANCE TIRE Sublet 18.00* 0.0* 15 900500 BDY* ALIGN FRONTALIGNMENT Sublet 59.95' 0.0* 16 936008 ADO'L COST PAINT/MATERIALS 213.00* 17 936012 ADD'L COST HAZARDOUS WASTE DISPOSAL 3.00' 18 936014 ADD'L COST FLEX ADDITIVE 7.00* 19 AUTO REF ADD'L OPR CLEAR COAT 1.6 20 933005 BDY ADD'L OPR RESTORE CORROSION PROTECTION 10.00" 0.1* 21 933018 REF ADD'L OPR MASK FOR OVERSPRAY 0.2* ESTIMATE RECALL NUMBER: 03/05/2008 12:26:34 P08KXOT04901 UltraMate is a Trademark of Mitchell International Mitchell Data Version: FEB_08_V Copyright(C)1994-2005 Mitchell International Page 1 of 3 UltraMate Version: 6.0A28 All Rights Reserved Date: 3/5/2008 12:37 P M Estimate ID: P08KX0704901 Estimate Version: 0 C om m itted ProfilelD: CSAA default * -Judgment Item #-Labor Note Applies C -Included in Clear Coat Calc Add'l Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 8.3 75.00 10.00 7755 710.45 Taxable Parts 1,176.36 Refinish 6.8 75.00 0.00 OAO 510.00 Sales Tax (9 8.250% 97.05 Non Taxable Labor 1,220.45 Total Replacement Parts Amount 1,273.41 Labor Summary 15.1 1,220.45 III. Additional Costs Amount IV. Adjustments Amount Taxable Costs 220.00 Insurance Deductible 500.00- Sales Tax 8.250% 18.15 Customer Responsibility 500.00- Non-Taxable Costs 3.00 Total Additional Costs 241.15 I. Total Labor: 1,220.45 II. Total Replacement Parts: 1,273.41 III. Total Additional Costs: 241.15 Gross Total: 2,735.01 IV. Total Adjustments: 500.00- Net Total: 2,235.01 THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OF THE PARTS, RATHER THAN BY THE ORIGINAL MANUFACTURER OF YOUR VEHICLE. Insurance Co: CSAA Insurance NOTE: YOU HAVE THE RIGHT TO SELECT THE BODY SHOP THAT WILL REPAIR YOUR VEHICLE. THIS IS NOT AN AUTHORIZATION BY CSAA FOR REPAIRS. NOTE: YOU HAVE THE RIGHT TO SELECT WHICH BODY SHOP WILL REPAIR YOUR VEHICLE. THIS IS NOT AN AUTHORIZATION BY CSAA FOR REPAIRS. AS THE OWNER OF THE VEHICLE YOU ARE THE ONLY PERSON WHO CAN AUTHORIZE REPAIRS. YOU MUST GIVE THIS ESTIMATE TO THE REPAIR FACILITY AND THAT FACILITY MUST ACCEPT THIS ESTIMATE BEFORE YOU AUTHORIZE REPAIRS. THIS ESTIMATE CANNOT BE CHANGED WITHOUT CSAA' S CONSENT AND APPROVAL. CSAA IS NOT OBLIGATED TO PAY FOR ANY ADDITIONAL DAMAGE UNLESS CSAA INSPECTS THE ADDITIONAL DAMAGE AND APPROVES ANY CHANGE BEFORE THE REPAIRS ARE STARTED. ANY QUESTIONS CONCERNING THIS ESTIMATE ARE TO BE DIRECTED TO THE CSAA REPRESENTATIVE WHO HAS PREPARED THIS ESTIMATE RECALL NUMBER: 03/05/2008 12:26:34 P0SKX0704901 UltraMate is a Trademark of Mitchell International Kitchell Data Version: FEB_08_V Copyright(C)1994-2005 Mitchell International Page 2 of 3 UltraMate Version: 6.OA28 All Rights Reserved Date: 3/5/2008 12:37 P M Estimate ID: POSKX0704901 Estimate Version: 0 Committed ProfilelD: CSAA default ESTIMATE. ESTIMATE RECALL NUMBER: 03/05/2008 12:26:34 P08KXOT04901 UltraMate is a Trademark of Mitchell International Mitchell Data Version: FEB_08_V Copyright(C)1994-2005 Mitchell International Page 3 of 3 UltraMate Version: 6.OA28 All Rights Reserved i IO ` O N Go N M O CHECK NO.: 712 L152472-1—R I� m DATE: 03-27-2008 IL(MU) NAME AND ADDRESS INFORMATION: KOSTADINOVA, ILIYA/STOYANKA,KOSTADI 1450 CREEKSIDE DR #79 WALNUT CREEK CA 94596 INSURED: KOSTAD I NOVA, ILIYA/STOYANKA,KOSTAD I N PAYMENT INFORMATION/DESCRIPTION: DATE OF LOSS: 03-04-08 ADDITIONAL REPAIRS CLAIM NO: 08—KX0704-9 CLAIMANT: KOSTADINOVA, ILIVA/STOYANK PAYEE: KOSTADINOVA, ILIYA/STOYANKA,KOSTADI AMOUNT: $1 , 155.58 IN PAYMENT OF: KOSTADINOVA, ADJUSTER: SCOTT DUNN ADJUSTER NO.: 18939 KIND OF LOSS: COL 16610702 DETACH AND RETAIN FOR YOUR RECORDS No. 712 L1 52472-1 -R DATE OF LOSS CLAIM INSURED'S NAME DATE 03-04-08 08—KX0704-9 KOSTADINOVA, ILIYA/STOYANKA,KOSTADIN 03-27-2008 POLICY TYPE KIND OF LOSS SUFFIX CLAIMANT'S NAME PAY AUTO COL 01F KOSTADINOVA, ILIYA/STOYANK $1 , 155.68 D.O. ADJUSTER NO. IN PAYMENT OF BANK OF AMERICA 61_I$7e Bank of America Cumomor Connection etl CPS 18939 KOSTAD I NOVA, Bank of Amer-ca. N.A. Atlanta. Dekalb County. Georgia PAY *ONE THOUSAND ONE HUNDRED FIFTY SIX 68/100* KOSTADINOVA, ILIYA/STOYANKA,KOSTADI This check must be properly endorsed on the reverse side by all payees. TO THE ORDER _ OF -- Mar 26 2008 2: 28PM CSAR 925-524-0529 P. 1 Date: 3126!2008 01:56 PM Estimate ID: P08KX0704901 Estimate Version: 2 Supplement: 2(F) 3/26/2008 01:54:66 PM Profile ID: CSAA default Co00 California State Auto Association N Cl) PO BOX 920,Suisun City,CA 94585-0920 o (925) 624-os33 Q Fax: (707)863-9052 Q U U Damage Assessed By: SCOTT DUNK } Supplemented By: SCOTT DUNN m O j Type of Loss: Collision JEW Date of Loss. 3/4/2008 Deductible: 500.00 Policy No: KXOTD49 Claim Number: P08KX0704901 Insured: ILIYAfSTOYANK KOSTADINOVA Owner. ILIYAISTOYANK KOSTADINOVA Address: 1450 CREEKSIDE DR#79,WALNUT CREEK.CA 94596-0000 Telephone: Work Phone: (925)818.8365 Home Phone: (925)932-0939 Mitchell Service: 911533 Description: 2003 Nissan 3502 Body Style: 2D Cpe Drive Train: 3.5L ln)6 Cyl 5M RWD VIN: JN1A234F-43T0075" License: LEBED. Mileage: 9029 OEMlALT: A Search Cotte: CONTRACOST ** SPECIAL PARTS NOTE: ALL CRASH PARTS iN THIS ESTIMATE ARE "NEW" PARTS (OEM) UNLESS OTHERWISE SPECIFIED. PARTS DESCRIBED AS RECHRCbiED, RECORED, OR REL-MNUFACTURED ARE EITHER "RECONDITIONED" PARTS, OR "REBUILT" PARTS. CRASH PARTS DESCRIBED AS "QUAL REPT+ PART" ARE NON-OEM AFi'E1dMARKET PARTS.** Line Entry Labor Line Item PartTypet, Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 100952 BDY REMOVEIREPLACE FRT BUMPER COVER Remanufactured 291.52* 1.90 2 AUTO REF REFINISH FRT BUMPER COVER C 2.8 3 100962 BDY REMOVEIREPLACE FRT BUMPER ADHESIVE EMBLEM 62890-CD000 30.57 0.1 91 4 100965 BpY REMOVEIREPLACE FRT BUMPER ENERGY ABSORBER 62090-0000O 64.10 INC # 52 5 . 100986 BDY REPAIR FRT BUMPER REINFORCEMENT Existing 11.0* 6 100984 BOY ACCESSANSPECT L FRONT COMBINATION LAMP ASSEMBLY Existing 0.0*# 7 AUTO BDY CHECK(ADJUSr HEADLAMPS OA 8 101003 BDY ALIGN HOOD PANEL Existing 1.5" 91 9 .101683 MCH REMOVEIR15PL.ACE EVACUATE&RECHARGE AIC -M 1A 51 10 101684 MCH REMOVEIREPLACE AIC REFRIGERANT RECOVERY -M 0.3 11 11 100122 BDY REMOVEIINSTALL R FENDER ASSY 1.0*10 31 12 100123 BDY REMOVEIINSTALL L FENDER ASSY 1.0*# 13 101059 BDYREPAIR L FENDER PANEL Existing 1.5`# 14 AUTO REF REFINISH L FENDER OUTSIDE C 2.2 i5 101061 BDY REMOVEIREPLACE L FENDER FRONT LINER 53845-CDOOD 44.32 INC # 16 101075 BDY REMOVEIREPLACE L FENDER ADHESIVE EMBLEM 63890-CDOOA 24.38 0.2 91 17 100357 BDY REMOVEIREPLACE FRONT BODY RADIATOR SUPPORT 82500-CD700 355.18 5.0 # 18 AUTO MCH REMOVE/REPLACE ADD TO R&R MECHANICAL COMPONENTS -M 1.5 # This estimate has been re-calculated with a modified profile. ESTIMATE RECALL NUMBER: OVOR2008 12:26:34 POBKX0704901 UltraMate Is a Trademark of Mitchell International Mitchell Data Version: MAR 08_V Copyright(C)1904-2005 Mitchell International Page i of 3 UltraMate Version: 6.0.029 All Rights Reserved Mar 26 2008 2: 28PM CSRR 925-524-0529 p, 2 Date: 3126/2008 01:55 PM Estimate ID: POBKX0704901 Estimate Version: 2 Supplement 2(F) 3/2612008 01.64:58 PM Profile ID: CSAA default 19 100011 BDY REMOVEIREPLACE FRT WHEEL ORDER FROM DEALER 785.57 0.3 20 100067 BDY REMOVEIINSTALL L ROCKER MOULDING 0.5 21 931125 BOY ADI7L LABOR OP MOUNT&BALANCE TIRE Sublet 18.00" 0.0" 22 900500 BOY" ALIGN FRONTALIGNMENT Sublet 59.95' 0.0" 23 936008 ADD'L COST PAINTIMATERIALS 213.00' 24 936012 ADD'L COST HAZARDOUS WASTE DISPOSAL 3.00' 25 936014 ADD'L COST FLEX ADDITIVE 7.00" 26 AUTO REF ADD'LOPR CLEARCOAT 1.6 27 933005 BDY ADD'L OPR RESTORE CORROSION PROTECTION 10.00' 0.1" 28 933016 REF ADD'L OPR MASK FOR OVERSPRAY 0.2" *-Judgment Item #-Labor Dote Applies C-Included in Clear Coat Calc Add'I Labor Sublet 1. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount_ Body 14.5 75.00 10.00 77.95 1,1T5A5 Taxable Parts 1,593.62 Refinish 6.8 75.00 0.00 0.00 510.00 Sales Tax 8.250% 131A7 Mechanical 3.2 75.00 0.00 0.00 240.00 Total Replacement Parts Amount 1,725.09 Non-Taxable Labor 1,925.45 L.aborSummary 24.5 1,925.45 Ili. Additional Costs Amount IV. Adjustments Amount Taxable Costs 220.00 Insurance Deductible 500.00- Sales Tax 8.250% 18.15 Customer Responsibility 500.00- Non-Taxable Costs 3.00 Total Additional Costs 241.15 1. Total Labor. 1,925.45 0. Total Replacement Parts: 1,725.09 Ill. Total Additional Costs: 241.15 Gross Total: 3,891.69 IV. Total Adjustments: 500.00- Net Total: 3,391.69 Less Original Net Total: 2,235.01 Net Supplement Amount: 1,156.68 Si: SCOTT DUNN 1,129.66 S2: SCOTT DUNN 27.02 THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OF THE PARTS, RATHER THAN BY THE ORIGINAL MANUFACTURER OF YOUR VEHICLE. This estimate has been re-calculated with a modified profile. ESTIMATE RECALL NUMBER: 031051200812,26:34 POS"0704901 UltraMate Is a Trademark of Mitchell International Mitchell Data Version: MAR-08_V Copyright(C)1994-2005 Mitchell International Page 2 of 3 UitraMate Version: 6.0.029 All Rights Reserved Mar 26 2008 2: 28PM CSRR 925-524-0529 p, 3 Date: 3/26/2008 01:55 PM Estimate ID: PCBKX0704901 Estimate Verslon: 2 Supplement: 2(F) 3/26/2008 01:54:58 PAN Profile ID: CSAR default Insurance Co: CSAR Insurance NOTE: YOU HAVE THE RIGHT TO SELECT THE BODY SHOP THAT WILL REPAIR YOUR VEHICLE. THIS IS NOT AN AUTHORIZATION BY CSAA FOR REPAIRS. NOTE: YOU HAVE THE RIGHT TO SELECT WHICH BODY SHOP WILL REPAIR YOUR VEHICLE. THIS IS NOT AN AUTHORIZATION BY CSAA FOR REPAIRS. AS THE OWNER OF THE VEHICLE YOU ARE THE ONLY PERSON WHO CAN AUTHORIZE REPAIRS. YOU MUST GIVE THIS ESTIMATE TO THE REPAIR FACILITY AND THAT FACILITY MUST ACCEPT THIS ESTIMATE BEFORE YOU AUTHORIZE REPAIRS. THIS ESTIMATE CANNOT BE CHANGED WITHOUT CSAA'S CONSENT AND APPROVAL. CSAA IS NOT OBLIGATED TO PAY FOR ANY ADDITIONAL DAMAGE UNLESS CSAA INSPECTS THE ADDITIONAL DAMAGE AND APPROVES ANY CHANGE BEFORE THE REPAIRS ARE STARTED. ANY QUESTIONS CONCERNING THIS ESTIMATE ARE TO BE DIRECTED TO THE CSAA REPRESENTATIVE WHO HAS PREPARED THIS ESTIMATE. This estimate has been re-calculated with a modified profile. ESTIMATE RECALL NUMBER: 031051200812:26:34 PDSKX0704901 UltraMate is a Trademark of Mitchell International Mitchell Data Version: MAR_08 V Copyright(C)1994-2005 Mitchell Intsmatlonat Page 3 of 3 Ultramate Version: 6.0.029 All Rights Reserved r .:�. �i c 9 • � .8. s�. .s ' a F 5 ISO, S Y 9 r. A. ';; . 3. .14 T... :r ... :;i:.. ex MI. toot,•.F t im ; r' t a .:. r �I �� �I. •i"Twn1C :e ..r..: .;n.: .i• 0-7 v F:.::. gyp°' . , t � 11AN a a JIM ° ov lits r k a ` r a4 p z ati i dY+' r' x{affi ' ffi'e? TA WPM MIS ? R4h'Y 11 �' j moi# 4 ' � _< i! • _ MAPS*k `•z Rift- Inn of All 14 j k'` fir fit' `` La 9� y L1 4th ,z. W n £m NO WM a� +l j # '$•�V,V �,,T�� £ 3 R� r lir gt�Ny�, wf D Y s x 3 '{ £4? -- :a' 3, ;- 40", � � c SM Ada', lbws a �� io t�.y..• �.' t Y: , t, W 4 1 - ffi4 ''. 1 - ;ns•. �.. =kflI' . 1" Ep i c •fir $, a AOL � ..�.. p� '_ ',��;,:'tea <s> �• �,,..� 5a ..of qS �e aH gni � i jR r t fI NINE �a MA M q' ..s ,� it.•� E_; ',. �.r»r its ym�} E 3 ITT w AT- 41 r 1 .sem ems` F JF o r 1 •a"k,. E � �"spa �, �r,� *Wl9 alf ° a MIS ix r K � s 2Y 1 'TSN 9 S N r, i �, m3�1 d-s�, •• LAO �.t r' ullp u+w�u lik.'u u " e } ... .` . ,. � `• i,� III �� II � I�� III � i� •`< ,,. r �> e I p Tyr •`s w� 7 " 3:'�• .s .dP;�rAge x ,III' Fl,f y I .n J , t V b ti , a Pr E q trtr�� x* ' S , >d < 9•A F�:`,�. ..fie,y �;,r.•,,: ,::+ x . '...., ,.• � �� �'.. '`a.� - �tti. ,r", gra r , ff . ORIN 8y" .' k y,r ilk a Y . .::� � " �€.. eKK; ...e... •... � ... .. .. ....... Wim, •.x�, y t , :i �� ...h,.c` :so-: > ,^ .:..,.•z .... ....:..... t ... Y':.' 't S: ...<:: ..< �& �o-� �.. 3•��:. �,asp WPA „t44 � :��5: --gg .>..... -my r. .., ,_,. i Ali Si Ne " 3 x $� rp : ; ;' , r .3 a a n,° yj, AM aftz l .;r .e ..'rya. :�:�1* (:�£�:1, �li•� ":• `��.6�er�w�.i'g;43I:"��p% k : ,s " :d < r 3• 4 } u•. e ..;���'::s ...sem ..ce#,a�:i•� .:�g Wit.`, k�.::._:�• ' Lv r. We. '•} ::per '}�.� p �.:;..:a••:�� 'Cq;KA': .N �:.: �' �'IJ�^.e#)s -'<i�-.+^'cgs.•.,:...�°fC :': .,U,g NE mm"la 1 F.: !r 3.. , Y Ae y x 3 IFI! ail ez ow Ak va A. F:?a .... - ...';;ask'_::•:...�:.. i. 9. a .:r,. r� t mw. .. ra: h s.. n x. " .. .;y :' � ti's:• '.. .,^ a:.�. .. .. : .. •0 � J :i�js�,° gR: s.. �R e:• , :T rte'• :': :r ...��. ... e.: W k yy«« :.. .. , . ....:.... ,.gig...... za y. x. p.. , r a ... .... x.: p. " x . x: S F, n:. # .. . M: M �# p..:.. $" •a:� -..m-. „i� •%'rte.:-r �. '" • " w.r.. �W >s r.: k x 'IN, IIrI , � g ( yy i m�,r y�Illl k!� Il llj, r y,� 4 v " +m ".::. 14 It • .x ��♦ ���• ��x s y a ` j .. #'�'Ate. . � ki: .. '*+<�",°6;.f �; � f •• � � �°"*'mak e t A £ Q "mom �* } �is �.� •: e } . . . Nou . NA a + �z x rc � Y 00- w p. �41yA t . + a r. xg &TATE OF aLIFORNIA TRAFFIC COLLISION REPORT CHP 555 CARS Page 1(Rev 1-03)OPI 061 Palo I d 4 SPECIAL CONDITIONSNUBUi MRa aux CITY 1/DICIAL DISTRICT LOCAL REPORT NUMBER wuam Fawn 0 I—� WALNUTCREEK WCDANVILLE:. IML—el-ThNH COUNTY REPORTING D'STRICT BEAT 08-5289 LaSDLNFA4OR 0 CONTRA COSTA . . I COLLISION OCCURRED OM' MO DAY YEAR TIME CPIBD) NCIC It OFFICER I.O. z CREEKSIDE DR 3/4/2008 1646 0712 P378 MBEPOST IHFORMATtON: DAYOFV&FK TOW AWAY PHOTOGRAPHS BY: 21 q~ TUESDAY YES X NO J U QAT INTERSECtION YYITH: STATE Y4WY REL X oR: 500 FEETSOU77[OF S•MAINST [—I V9S L-�]NO PARTY DRIVER'S LICENSE NUMBER STATE CLASS AIR EAG SAFETY EQUIP. VEHYEAR IME/MODEL/COLOR LICENSE NUMBER STATE I E0601998 CA B M G 2002 FORD BUS TAN 1099218 CA DRIVER NAMECF4113T,MIDDLE,GASH i. THOMAS HARRY NELSON DWNERSNAME I J SAME AS DRfM L PIEDES, STREErADOHESS CENTRAL CONTRA COSTA TRANSIT AUTH. TRIAN III ASPEN DR#15 OWNER'S ADDRESS LSAMCASCRIVER F—EEDE CITY/S'TATEJaP 2477 ARNOLD IND.WAY CONCORD CA 94520 VEPPCL PACHECO CA 94553 DISPOSITION OF VEHICLE ON ORDERS OF: Ej OFFICER IY DRIVER LOTHER CILCY SEX HAIR EYES HEIGHT WEIGHT DIRTHDATE RACE DRIVEN 1.-J Col Y— M BRO GRN 5-11 195 5/23/1952 PRIOR MECH.DEFECTS )NONE,APP. REFER TO NARRATIVE OTHER HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION MAMBER: (925)676-1976 VEHICLE TYPE DESCR'eE VEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCECAARIER POUCYNUMSER L UNX 11C�NONE nmatOR CRAWFORD AND COMAPNY CA 9799181 12 ( MGDFILWOR ROLLOVERQ Q DIT OFTRAVEL CNSTREET OR HIGHWAY SPEED LIMIT CA DOT S CREEKSIDE DR 25 CAL•T TCPiPSC MCJRIX PARTY DRIVERS LICENSE NUMBER STATE CLASS AIRBAG SAFETYECWIP• VEH,YEAR MAKE/MODEL/COLOR LICENSE NUMBER STATE 2 1 2003 NISSAN 35OZ BLK LF13ED CA DRIER NAME(FIRST•MIDDLE.LAS7) OWNERS NAME r SAMEAS DRIVFF PEDEr, . STREET ADDRESS KUSTADINOV,ILIY}j TRAM O%TIERS ADDRESS F-1SAMEAS DRIVER PARKED CITYISTATE IaP 1450 CREEKSIDE DIC##79 WALNUT CREEK CA 94596 VEHICLE DISPOSITION OF VEHICLE ON ORDERS OF: D.OFFICER InDMER OOTHFR BICY• SEX HAR EYES HEIGHT WEIGH WRTHOATE RACE PARKED �_f1 CL.1 T MO Iw Year PRIOR MECHANICAL DEFECTS NONE APP. 'REFER TO NARRATIVE 1 OTHER HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER r i (925)932-0939 VEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAG£DAREA INSURANCE CARRIER POLICY NUMBER DUNK 1 DME [qNINOR AAA KX-07-04-9 01 1[]- `IOR ROLL-OVER DIR OF TRAVEL ON STREET OR HIGHWAY SPEED LIMIT CA DO[ S CREEKSIDE AR 25 CAL T TCPJPSC Mcm pART y DRIVERS LICENSE NUMBER STATE CLASS AIRBAG SAFETYEOUIP. VEH.YEAR MAKE/MODEL/COLOR LCENSENUMBER STATE 3 DRIVER NWFAFBLST,MIDDLE.LAST) C--1' ElOWNER'S NAME f SAHB AS DRIER �PFDE STREETADDRESS U OWN£R'9 ADDRESS �$qME AS DRIVER PARKED CITY/STATE/21P VEHICLE f DISPOSITION OF VEHICLE ON ORDERS OF: OFFICER ORNPF THER 1 4 Ltif SEX RiVR EYES HEIGHT WEICM A0 BIRTIIDATE YaQ RACE. Day PRIOR MECHANCIAL DEFECTS NONE APP. FER TO NARRATIVE OTHER now PHONE SUSINESSPHONE VEHICLE IDENTIFICATION WINDER: VEHICLElYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER UNK - Lr.AIraE C OMINOR MOD (MAJOR ROIM.OVER DIR Or TRAVEL ONBTREES OR xIG}ry/AY SPEED LIMIt CA OOT CAL•Y TCP/DSC MCrMX PREPARERS NAME OI SPAWN N=FIEO REVIEWERS ME RtE M.ADAMS P379 —;YES [.JNO LrNA 1 STATE OF CALIFORNIA NARRATIMSUPPLEMENTAL PAGE 4 of 4 DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 03/04/2008 1646 0712 P378 08-5289 1 Notification: 2 On 3/4/08, at 1702 hours, I was dispatched to a counter report for a possible hit and run collision. 1 3 arrived at the front counter at 1705 hours and contacted the witness Hamond. All times, speeds 4 and distances.are approximate. No measurements were taken. 5 6 Statements: 7 W-1 saw V-1 (Bus)approaching the bus stop S/B on Creekside Dr. V-1 moved towards the right 8 hand curb as it pulled to a stop. V-1 struck the left front of V-2 as it pulled to the curb. V-1 picked 9 up a passenger and continued S/B on Creekside Dr. D-1 made no attempt to look at the damage 10 or contact the owner of V-2. 11 12 Summary: 13 Prior to this collision,V-2 was parked S/B on Creekside Dr. at the W curb line. V-1 was SB on 14 Creekside Dr. V-1 was a small transit van type bus. V-1 pulled to the curb in an attempt to stop. 15 The right side of V-1 struck the left front of V-2 as the bus came to a stop. 16 17 V-2 sustained damage to the left front bumper and light assembly. 18 19 On 3/11/08, 1 spoke with Victoria Brown of the Contra Costa Transit Authority. Brown indicated 20 that a Thomas nelson had been driving that rout on 3/4/08. Brown indicated that there was no 21 damage to the bus and that Nelson was not aware of any collision. 22 23 Cause: 24 D-1 caused this collision when he turned V-1 from a straight course and moved towards the W 25 curb line in violation of CVC 22107, unsafe tuming movement. 26 27 Based on the damage to V-2, it is possible that D-1 did not know that he struck V-2 and would not 28 be in violation of CVC 20002. 29 30 Case closed. PREPARED BY I.D.NUMBER DATE REVIEWER'S M. ADAMS P378 03/04/2008 l STATE OF CALJFOPNEA INJURED!WITNE=SSES f PASSENGERS CHP 555 CARS Page 3 Rev 1.03 OPI 081 Peg° s °' a DATE OF COLLISION(W. DAY YEAR) TIME(2400) NGC At OFFICER I.D. NUMBER 3/4/2008 1646 0712 P378 08-5289 WITNESS PASSENGER AGE SEX EXTENT OF INJURY('X'ONE) INJURED WAS{'X'ONE) PARTY SEAT AIR SAFETY Y ONLY NUMBER POS. BAG EQUIP, EJECTED FATAL SEVERE OTHER VISIBLE COMPLAINT IN,ARY WJURY IN OF PAW DRIVER PASS. PED. &CYCLIST OTHER Lxj# ] ❑ M L� l� ❑ ❑ C i] ❑ ❑ NAME I D.OB.I ADDRESS TELEPHONE BRUCE HAMMOND (925)935-6369 ONJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES VICTIM OF VIOLENT CRIME NOTIFIED C 2 ❑ F C ❑ ❑ ❑ f� C ❑ ❑ NAME/D.O.B.!ADDRESS TELEPHONE VICTORIA BROWN 2477 ARNOLD INDUSTRIAL WAY CONCORD CA 94520 (925)676-1976 (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: VICTIM OF VIOLENT CRIME NOTIFIED , ❑ o ❑ a ❑ [,� ❑ a ❑ ❑ NAME!D.O.B./ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES; VICTIM OF VK)LENT CRIME NOTIFIED NAME/D.O.B.IAODRESS TELEPHONE (INA)RED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: VICTIM OF VIOLENT CRIME NOTIFIED f-Jl# i o ❑ ❑ ❑ j ❑ ❑j ❑ 10 1 ❑ I u NAME 10.0.8./ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: r1 '� (''� �'''� VICTIM OF VIOLENT CRIME NOTIFIED ❑ ElED !i LJ I ❑ ❑ 1 LJ I ❑ NAME I O.O.S./ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES VICTIM OF VIOLENT CRIME NOTIFIED PREPARER'SNAME LD.NUMBER M0. DAY YEAR REVIEWER'S AAO. DAY YEAR M_ADAMS P378 3/4/2008 \ t 4 • �'.O OO O t +"R OS. alox � O O !x CO � �9 O 4 1 a C� A- 'Y , S' I-PU N �40 % Up n CS M� N Om menti c m ORA p0 g - A Ult • O v 0 � �\JI ! Y �- 7 4J �-- y y ♦ -o r Oil � v � o CC'S o ea � vviol %�s 0 7' , ! p� co 0 N ,r O ,tC li s C ti d ..s 1f' 1� 0 U LL z Oyu, 00 W ti Q r O Cr O) i U cn o. O :N, r Q Cf= tr, r n � CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION:IJ ung 2�8 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: Jl� )"t1 ATTORNEY: .l� r DATE RECEIVED: l (,t2-C , �9 ADDRESS: BY DELIVERY TO CLERK ON: Q) BY MAIL POSTMARKED: (a FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-oted claim. JOHN CUL N, Clerk , Dated: 2� 2c By: Deputy dam-, [I. FROM.: County Counsel TO: Clerk of the Board of Supervisors (LI This claim complies substantially ' ith 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: a if ,6 0 By: /7/? 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: fl 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 wide this matter. If you want to consult an attorney,you should do so immediately. *For Additional Warnipg See Reverse Side ofTliis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claim as shown above. Dated: 23 JOHN CULLEN, CLERK B Deputy Clerk CLAIM BOARD OF SUPERVISORS OF CON"i.RA COSTA COUNTY BOARD ACTION:�J "n-e.- �, 2G� j 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 AMOUN"t: � j� "Warnings". CLAIMANT: jc-'rr F ATTORNEY: IZ (li DATE RECEIVED: 1��al-('t ` 21 ADDRESS: L[(0 ���L211 7 �%". � Efd6 BY DELIVERY TO CLERK ON: NMI) f til`IqBY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. 1JOHN CUL NV Clerk /i1 , Dated: 1 �Lt ' By: Deputy 'ltPi�4L((�t��cG2 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 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 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 nail to file a court actiai on this chiim.See Government Code Sectiai 945.6.You may seek the advice of an attorney of your choice in connectiai wide this matter. if you want to consult an attoi-iiey,you sliould do so immediately. *For Additionil Warning See Reverse Side of'Tliis Notice. AFFIDAVIT OF MAILING I declare under penalty of per jury that 1. am now, and at all times herein mentioned, have been a citizen _of the United States, over age 18; and that today i deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified coley 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 for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be-presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106,- County 06;County Administration Building, 651 Pine Street, Martinez,CA 94553. .C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fr=.ud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. ■■ee�ee.■eeeeee.e�eeee.■eeeeeeeeieeman eoeeeeeeeeeeeoaae000eeeeeeeeeeeeeeeeeeee0eei 3 RE: Claim By: Reserved for Clerk's filing stamp DF-29 u Rh odes ) ` Pr , Against the County of Contra Costa or ) APR 2 1 2008 COUn-N C) MGV41nCz . District) cr.rr�l<�OAHOOi=;;..1� F;v,SORs (Fill in the name) I CONTRA COSTA co. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ 2 7G W and in support of this claim represents as follows: 2- 1. When did the damage or injury occur? (Give exact date and hour) 04 /13/2COO ' _'_50 2. Where did the damage or injury occur? (Include city and,county) Alves 1►A,.1 e 12)0gP01r)+ , Coni-rcn Cos�ci Covnky 3. How did the damage or injury occur? (Give full details; use extra paper if required) T)t21v1nC1 15mp14 AN A i HI-r T"D pofiwhOlE S ON Thi ntgh+ Side ©-F +hc PoaC4- 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage?r.r;IE— tiE,w �1� �ofiWti,)GIC S uv eierf SSPE .Z ria ��l1 oyn l I -r oice o O N rc St Gi�_7 900101. 5 What are the names of county or district officers, servants, or employees causing the damage or injury? .UN�I� , b. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) t Tttf- 12>:M OF "\4 C Rp- `V�(l�S C 42 KR e!?61 A-N b M�,j 'IBJ Ski 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses, doctors, and hospitals: T/ TI PrNJA G-1 i BSa�•l 'FI O C)C•A-67-a C44t I oG 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT /0 '00 „270,00. SON 00000000000000000Oman 0sons 000000000000000000000now 0000000000.000000000000000 0.200001 ) 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 Signature) -10 zeofi-zo C1 IV 10 (Address) Telephone No. ) Telephone N00`72-5) 0amamMEN 000000000000000000000000000000000000000000000500 MEE.........................I PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act, is subject to public disclosure ur�dcr ;-l:c California Public.Recards Act. (Gov. Code, §s 6500 et seq.) Furthermore. anv attachments, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. 055000000 a 0000000 a0a0a000550000500a0a0000050000000a00a0550050000a0000000a000000000001 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. INVOICE 0073 THE BEAT STOP BUSINESS MON- SAT.: 9AM - 7PM HOURS: � SUN. 10AM - 5PM TIRES AND RIMS Tel: (925) 709-9700 Fac: (925) 709-9707 2155 Willow Pass Rd., Bay Point, CA 94565 / DATE / YEA_R NAME &14 LICENSE No. MAKE ADDRESS` Z ODOMETER MODELU 17 '0 CITY STATE ZIP RES. PHONE SOLD ° ( CASH CH�A,,RGE BALANCE DUE CELL QUANTITY \ JJ DESCRIPTION r • UNT v •• Customer must check the vehicle and equipment installed or purchased at the time that BALANCE DUE Z z the job is completed.Any problems or matters should be brought up to the ;1 management's attention at that time. SALES TAXV • Customer must make sure the warranty,receipts and boxes are given �� to them after completion of the job. LABOR 0 L+ • The Beat Stop warrants the equipment that was purchased here _31and has no liability on equipment that was purchased elsewhere or that belonged to customer. TOTAL • 30 days store warranty on all car audio&accessories,NO MONEY BACK, Exchange or store credit only,customer must have all parts in original packages. DEPOSIT There will be 25%fee on all parts or packages that are missing. Also,there will be 25%restocking fee on all special orders that are cancelled. f() BALANCE DUE 2- • Customers assume all responsibility for all audio and video equipment that they request to be installed and or modified in their vehicle. • The Beat Stop does not provide any kind of warranty on tires. / Rims have a factory warranty only. • The customer is responsible for the balancing of their rims&tires, therefore The Beat Stop is not responsible for any warranty on the rims&tiresC U ST_ 'M E R'S SIGNATURE • NO returns on mounted rims&tires. o� I hereby authorize you to perform the service and furnish the necessary materials. I understand any cost quoted heretofore is an estimate only. REGARDING ENGINE STATIC: Your employees may operate vehicle for inspecting,and delivery at my desk. You will not be responsible for loss or damage to vehicles or articles Auto stereo sound products are susceptible to left in it. I agree to pay reasonable storage on vehicle left more than 48 hours after notification that repairs are completed. reproducing various noises generated by the I AGREE THAT YOU HAVE AN EXPRESS LIEN ON THE DESCRIBED VEHICLE FOR THE CHARGES FOR PARTS AND LABOR FURNISHED UNDER THIS REPAIR automobile's ignition and electrical systems. ORDER INCLUDING THOSE FROM ANY PRIOR REPAIR ORDERS ON THE VEHICLE. IF I FALL TO PAY SUCH CHARGES,I AGREE THAT THE VEHICLE MAY BE The Beat Slop install an in-line static suppressor. HELD UNTIL AL.0?HE CHARGES ARE PAIDA IN FULL. IN THE EEVVEENNT OF LEGAL ACTION TO COLLECTION AND FEES INCLUDING REASONABLE ATTORNEY FEES. Any static not eliminated by an in-lin suppressor �/'.r� is will be attempted abnormal and suppressor of it will be attempted for an additional charge if X requested. - ,. (no suniect) rage i of j From:19255652129@mymetropcS Com To:perrylovebug@aol.com Subject:(no subject) Date:Tue,15 Apr 2008 7:29 pm i.. xt t.',:.. i?f•.:::i:,s Fil,i n61 ;V'•jG:.pC-1"45 _.'tr.. Ki �- .-,4ii=dei:✓+' . I w. 1. ��.�, Nz. f s, '''�'{�'. : _r'ik.�j�e/. :,� girls �d+•� , 4� Y_ �a• :��� u3::•:aFP,:;. 'td r:a r. ,• .CJI 'v 'ti..'�.,(.nY t Y`'Y•u Nf . � 5,,i:<`�[ °.;J•`')}iii;.,•!:••':..aY;ri'sty; iw�:t_�i'��a.,.y��'nti'':'�`�z'.;;(a�.�IT '•.(?:;r.r�•:�:` r '•i�rx�..:t,.iiMiii2Sn i L.fi3±'*,'ii%!ss��iebY✓,r-P'.;;t� • `.A,Anr''�j e¢�'',Hy.M1�:,. ''k�r.},:;s�i�����:iii":":1:•. ' } Vit, t.. 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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: © �G�Of Section 913 and 915.4. Please note all 1 "Warnings" CLAIMANT:Jo Y ti Paam ATTO,RNEY:c 0� 1) `k-u Uf- �r) DATE RECEIVED: - Ivu50n— �lVex a7 - bona.�Of5' I ADDRESS: rBY DELIVERY TO CLERK ON: BY MAIL POSTMARKED: Sari rm4a5o, C14 g 4t 33 FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN CUL N, Jerk , �"� �.�o�y;L�/L, Dated: °�'C � By: Deputy �1i(i i.I. FROM: County Counsel 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: a Dated: A�-oZ�r 01;1'-,2 /71( 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 puty Clerk WARNING Gov. code section 913) Subject to certain exceptiats,you have only six(6) months from the Ite, this notice was personally served or deposited in the niail 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. 1f'you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of per jury that 1 am 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 prepaid a certified copy of this Board Order and Noti•e to Claimant, addressed to the claimant as shown above. Date JOHN CULLEN, CLERK By uty Clerk EMISON ■ HULLVERSON ■ BONAGOFSKY LLP ATTORNEYS AT LAW 425 PACIFIC AVENUE TEL: (415) 434-21 11 SAN FRANCISCO, CALIFORNIA 94133 FAX: (415) 434-2112 WWW.EHBLAW.COM April 18, 2008 fTe Clerk of the Board of Supervisors County Administration Building A,DR 2 1 2008 651 Pine Street Martinez. CA 94553 F VISORSf3 i'A C0�0. VIA CERTIFIED MAIL—RETURN RECEIPT REQUESTED Re: Jo Dee Schmidt's and Paul Schmidt's Notice of Claims To Whom Tt May Concern: This firm represents Jo Dee Schmidt and Paul Schmidt. On October 20, 2007, Jo Dee Schmidt was injured when she was attacked by a bull or cow while on public property known as Acalanes Ridge, in the City•of Walnut Creek, County of Contra Costa, and possibly within the East Bay Regional Parks District. This letter constitutes her Notice of Claim to each of the foregoing entities; each of which is being sent under separate cover. Please direct all communications regarding this Notice to me. 1. Claimants' Names: Jo Dee Schmidt and Paul Schmidt. Claimants' Address: 3474 Moraga Blvd, Lafayette CA 94549. Claimants' Daytime and Evening Phone Number: 925-299-1433. 2. Claimant's Attorney: John Hullverson, Emison Hullverson & Bonagofsky LLP, 425 Pacific Ave., San Francisco, CA 94133. Tel: (415) 434-211 1. Fax: (415)434-2112. 3. Claimant's Date of Birth: Jo Dee Schmidt: March 19, 1963:. Paul Schmidt: March 3, 1958. 4. Claimant's Social Security Number: Jo Dee Schmidt: 482=86=5886; Paul Schmidt: 480;74- 3177 April 18, 2008 Page 2 5. Date of Incident: October 20, 2007. 6. Time of Incident: Approximately 2:45 p.m. 7. Location of Incident or Accident: Acalanes Ridge, Walnut Creek Open Spaces, Walnut Creek, California. 8. Claimant Vehicle License Plate 9, Type and Year: Not Applicable 9. Basis of Claim: On the afternoon of October 20, 2007, Jo Dee Schmidt Nvas walking on a publicly accessible trail on Acalanes Ridge in the Walnut Creek Open Spaces in Walcott Creek, California. While walking along a trail, she was attacked by a bull or cow that was ranging loose in the publicly accessible area. Ms. Schmidt suffered severe physical and emotional injuries and was taken to John Muir IIospital. Ms. Schmidt's injuries have greatly impacted every aspect of her life including her ability to work. Mr. Paul Schmidt has suffered loss of consortium due to the injuries to his wife, Jo Dee Schmidt. Acalanes Ridge is within the possession, custody, or control of one or more public entities, including but not limited to the City of Walnut Creek, County of Contra Costa, and/or the East Bay.Regional Parks District, who ]eased the land to a cattle rancher without requiring appropriate separation between the cattle and the people who used the trails. .Each and every one of these entities knowingly and or negligently permitted to exist a dangerous condition of public property, willfully and/or maliciously failed to warn of the known danger of free- roaming cattle within the public trail areas, knowingly and unreasonably increased the risks of use inherent in the trail, and failed to prevent the dangerous animals frorn interacting with people on the trails. Therefore, the City of Walnut Creek, County of Contra Costa, and/or the East Bay Regional Parks District are liable for Jo Dee Schmidt's and Paul Schmidt's injuries and damages for the foregoing reasons. 10. Description of Claimant's injury, property damage or loss: April 18, 2008 Page 3 Ms. Schmidt has suffered severe and varied personal and emotional injuries resulting from trauma to her person, the extent of which injuries are still not yet fully known. She has incurred medical bills of approximately $100,000.00 and continuing, and she has been unable to work since the accident. Mr. Schmidt has suffered loss of consortium as a result of the severe injuries suffered by his wife, Jo Dee Schmidt. There was also damage to Ms. Schmidt's personal property including the clothing and shoes she was wearing at the time of the incident. 11. Total amount claimed: Jo Dee--rd Paul-Sc,•hmidt's dan;ages each e-ceed $10.000. Jurisdiction is unlimited, and their case would reside in Superior Court. 12. Witnesses: 1. "Dan" from Pleasant Hill. Address and telephone number currently unknown. 2. "Rob," address and telephone number currently unknown. 3. John Hoover, address unknown. Telephone: 510-715-0017. As Jo Dee and Paul Schmidt's attorney, 1 look forward to receiving your response to this Notice and thank you for your attention to this matter. Sincerely, Jo Hullverson JEH/kva CLAiM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION:J Lt1)e: 3 . 2 CZ:S Claim Against the County, or District Govenled 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: �G�.I+ Section 913 and 915.4. Please note all ► "Warnings". , CLAIMANT:JC) UL's C�'LIy�CG > f�l,U, cX 11 ry1lC }" ATTQRNEY.id)0 ` h Ue-I_,'9L_)n DATE RECEIVED: 21.i r)cLqef-5, 'y ADDRESS:. BY DELIVERY TO CLERK ON: 1 (�_ �i 2 , 5 tac 'Ove F ! � BY MAIL POSTMARKED: �tij H,,^ ,i'L6t 5tA C1q q y.l-33 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. - JOHN CUL N, .leek Dated: SLC all f_lo }`� By: Deputy E�C'L II. FROM.: County Counsel TO: Clerk of the Board of 5upervisors ( ) Tris 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 iII. FROM: Clerk of the Board TO: County Counsel (]) 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 ally six(6) mouths 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 ol'your choice in connection wide this matter. [f'you want to consult an attorney,you should do so immediately. *For l AdditiaiaWarning See Reverse Side of This Notice, AFFIDAVIT OF MAILING I declare under penalty of perjury that 1. ann now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in 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, CLEiZK By Deputy Clerk O wC co CD C- -0 .@ 0 Cl- ILO d- 0 C3 O J ul C:3 .7 m