OFFICE OF THE COUNTY COUNSEL 701 OCEAN STREET, SI ITE 505, SANTA CRI Z, CA (831) FAY: (831) IS. DANA McRAE, COUNTY COUNSEL

Size: px

Start display at page:

Download "OFFICE OF THE COUNTY COUNSEL 701 OCEAN STREET, SI ITE 505, SANTA CRI Z, CA (831) FAY: (831) IS. DANA McRAE, COUNTY COUNSEL"

Dylan Crawford
6 years ago
Views:

0015 COUNTY OF SANTA CRUZ OFFICE OF THE COUNTY COUNSEL 701 OCEAN STREET, SI ITE 505, SANTA CRI Z, CA 95060-4068 (831) 454-2040 FAY: (831) 454-21 IS ( 17 iqf.

Stombler David Brick Deborah Steen Jason M. Heath Jessica C. Espinoza Christopher R. Cheleden Samuel Torres, Jr.

1 0015 COUNTY OF SANTA CRUZ OFFICE OF THE COUNTY COUNSEL 701 OCEAN STREET, SI ITE 505, SANTA CRI Z, CA (831) FAY: (831) IS ( 17 iqf.4 ss ist ant Rahn Garcia Marie Costa Jane M. Scott Tamyra Rice Julia Hill DANA McRAE, COUNTY COUNSEL,-1ssistants Specitrl Coirnsel Shannon M. Sullivan Betsy L. Allen Dwight Herr Miriam L. Stombler David Brick Deborah Steen Jason M. Heath Jessica C. Espinoza Christopher R. Cheleden Samuel Torres, Jr. GOVERNMENT TORT CLAIM RECOMMENDED ACTION Agenda: /07 To: Re: Santa Cruz County Board of Supervisors Rosa Valdivia, Claim No Original document and associated materials are on file at the Clerk of the Board of Supervisors. In regard to the above-referenced claim, this is to recommend that the Board take the following action: 1. - X Reject the claim Rosa Valdivia, Claim No and refer to County Counsel 2. - Deny the application to file a late claim on behalf of and refer to County Counsel Grant the application to file a late claim on behalf of and refer to County Counsel Approve the claim of in the amount of and reject the balance, if any, and and refer to County Counsel 5. - Reject the claim of as insufficiently filed and refer to County Counsel. RISK MAKAGEMENT cc: Lynn Miller, Child Support Services

2 ~~ ~ ~.I 0016 /I /: c: /. PhoneNo:, CLAIM AGAINST THE COUNTY OF SAN'TA CRUZ (Pursuant to Section 910 et Seq.. Govt. Code! HOLLISTER, CA EM, WK.-c* *.. -! i,y -2t.. - TO: BOARD OF SUPERJ'ISORS COUNTY OF SANTA CRUZ \,- r "",. ATTN: Clerk of the Board ".,',. >,'Q, Governmental Center Ocean Street, Santa Cruz, CA '9, /o '2:,-,-) \ : * ' I-.,*** /'".*y,, r Claimant's Name: I r L,, \ ROSA M. VALDIVIA -..,.~ &<:f **.> --.'- 7: _C : ' Address: BLACK FOREST DRIVE e?+ /,> \-- J VEHICLE PARKED IN DEmGNATED CO.PARKING LOT. MY SUPERVISOR, CAITLIN SMITE VIEWED THE VEHICLE AI? ABOUT 8: 30, AiIC,ATTESTED TO SPECIFICALLY LOOKING AT ESTIMATE. (ATTACHEBY SUPtL'EMENTKL MAY FOLLOW Name(s) of public employee(s) causing injury, damage or loss. if known: UNKNOWN, N~LLING TO COME FORWBRD Amount claimed now... $ 1 1i Estimated amount of future loss, if known... $ I UNKNOWN ~ TOTAL... $ [ 1, Basis for above computations: I REFER TO ATTACHED INSURANCE ESTIMATE, r 1 SUPPLEMENTBL MAY FOLLOW. I 8. If the amount claimed is over $10,000, indicate the court ofjurisdiction: I] Municipal Court ~1 Superior court Note: CLAIMANT'S SIGNATURE: Claim must be presented to Clerk, Board of Supervisors, within six (6) months after the act which occasioned the injury. Note: This claim and all attachments become Public Recclrd and are scanned into the World Wide Web (Internet). Americans with Disabilities Act questions or requests for accommodations may be directed to the ADA Coordinator at (TDD ). PER5003

3 0017 '08/0.7/200? at O k15 PM Oby0095q GE160 South Bay Visit us at GE1CO.comU For Supplements Call: (800) P.O. BOX San Diego, CA (408) Fax: (800) ESTIMATE OF RECORD Written By: JOHN HUGHES 08/07/ :15 PM Adjuster: A224 EXT: FCC : Insured: ROSA VALDIVIA Owner: ROSA VALDIVIA Address: 1470 BLACK FOREST DR HOLLISTER, CA Evening: (831) Business: (831) Inspect BODY SHOP by GENE COCHETTI Location: 403 FRONT STREET SALINAS, CA Repair UNKNOWN Facility: Claim # Policy # A Date of Loss: 08/02/2007 at 1200 AM Type of Loss: Collision Point of Impact: 3. Right T-Bone (R Business: (831) DRIVE - IN 4 Days to Repair License # 2005 NISS 3502 ENTHUSIAST 6-3.5L-FI 2D CNVT silver 1nt:grey VIN: JNlAZ36A15M Lic: 5UIX854 Condition : Ex c e 11 en t CA Prod Date: Odometer: Air Conditioning Rear Defogger Tilt Wheel Cruise Control Intermittent Wipers Keyless Entry Theft Deterrent/Alarm Dual Mirrors Console/Storage Power Convertible Top Traction Control Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks Power Driver Seat Power Mirrors AM Radio FM Radio Stereo Search/Seek CD Player Anti-Lock Brakes (4) Driver Air Bag Passenger Air Bag 4 Wheel Disc Brakes Positraction Cloth Seats Bucket Seats 6 Speed Transmission Overdrive Aluminum/Alloy Wheels NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT --_ REAR LAMPS 2 R&I RT Combo lamp assy DOOR 4* Rpr RT Outer panel Add for Clear Coat 0.8, 6 Add for Edging R&I RT Belt w'strip 8 R&I RT Mirror assy w/heated R&I RT Handle, outside 0.4 1

0018 0324248890101011-01 Oby0095q N N 10 11 12* 13 14 15 16 17 18 19 20 21 22 23* 24 25* 26# 27 28# R& I Blnd Blnd Rs, I R&I R&I Rep1 RT R&I trim panel QUARTER PANEL RT Quarter pnl assy Overlap Major

4 Oby0095q N N * * 24 25* 26# 27 28# R& I Blnd Blnd Rs, I R&I R&I Rep1 RT R&I trim panel QUARTER PANEL RT Quarter pnl assy Overlap Major Adj. Panel Add for Clear Coat Add for Edging Xei door chrome silver Fuel door chrome silver FENDER RT Fender FRONT LAMPS XT Headlamp assy REAR BUMPER F.&I bumper mver FRONT BUMPER R&I bumper cover C 377e r Car C cmp 1 et e OTHER CitWRGES E.P.C : LOOSEN FOR R/QTR. REPAIRjREFINISH Line 25 : LOOSEW OR FSNDER BLEND - I ~ i n e Prior Damage Notes: NONE Parts Body Labor Paint Labor Paint Supplies Other Charges SUBTOTAL Sales Tax hrs Ca $ 70.00/hr $ jhr $ /hr $ $ %

5 /07/2007 at 04:15 PM '5480 ESTIrnTE OF Fa3coRD ObyOO 95q 2OC5 NI2S 3502 ENTHUSIAST 6-3.5L-Fi 2D CNVT silver 1nt:grey THIS IS NOT AN AUTHORIZATION TO REPAIR NO SUPPLEMENT WILL BE HONORED UNLESS AUTHORIZED BY GEICO DIRECT "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." NO SUPPLEMENT WILL BE HONORED UNLESS AUTHORIZED BY GEICO DIRECT ***FOR ALL SUPPLEMENT REQUESTS CALL*** THIS ESTIMATE IS NOT AN AUTHORIZATION FOR REPAIRS 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. 3

6 /07/2007 at Ok15 PM Obv0095q FOR YOUR PROTECTION FORM : CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES: B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS: ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTYzQUANTITY 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. Estimare based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide ARF3716 Database Date 07/2007, CCC Data Date 07/2007, and the parts selected are OEM-parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM vehicle dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount. OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle dealerships. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign (-) items indicate MOTOR Not-Included Labor operations. Non-Original Equipment Manufacturer aftermarket parts are described as AM, Qual Repl Parts or Comp Repl Parts which stands for Competitive Replacement Parts. Used parts are described as LKQ, Qual 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. 4

FARMERS INSURANCE EXCHANGE

FARMERS INSURANCE EXCHANGE DALY CITY CLAIMS SERVICE CENTER HELPPOINT CLAIM SERVICES BY FARMERS FOR SUPPLEMENT CALL, (800)-282-7033 Estimate of Record Claim #: 8001121533-1-3 Written By: ANTHONY JAYAKODDY,