HomeMy WebLinkAboutMINUTES - 09271988 - 1.23 CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 27 , 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $691. 00 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: GARY HOOD
1301 Easley Drive
ATTORNEY: Clayton, CA 94517
Date received
ADDRESS: BY DELIVERY TO CLERK ON August 25 , 1988
BY MAIL POSTMARKED: August 24, 1988
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
��IL BATCHELOR, Clerk
DATED: August 26, 1988 : Deputy erG C
L. Hall
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
( ) This claim complies substantially with Sections 910 and 910.2.
(X) 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 � 1� -Ct— 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 OR R: 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. r� pQ /
Dated: SEP 2 ( 1988 PHIL BATCHELOR, Clerk, By Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6. "
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should .do so immediately.
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 claimants Case shown above.
Dated: SEP r 2 8 190090 BY: PHIL BATCHELOR by Xzet, ty Clerk
CC: County Counsel County Administrator
E Clairr+t.— BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for death or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to- any other cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. Code §911.2.)
B. Claims must be filed With the Clerk of the Board of Supervisors at its office in
Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553•
C. If claim is against a district governed by the Board of Supervisors, rather than
the County, the name of the District should be filled in.
D. If the claim is against more than one public entity, separate claims must be
filed against each public entity.
E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this
form.
RE: Claim By ) Reserved for Clerk's filing stamp
Gaa Hood )
' RECEIVE®
Against the County of Contra Costa )
or ) AU G 2 51988_
N/A District) P TT HOLOR
(Fill in name ) CLE. ON TP JsonsBy,. .. .�........
The undersigned claimant hereby makes claim agains the County of Contra Costa or
the above-named District in the sum of $ 691 .00 and in support of
this claim represents as follows:
-------------------------------------------------------------------------------------
1. When did the damage or injury occur? (Give exact date and hour) Approximately
June 27 or July 5, 1988, at. 6:45 p.m. . The exact date is one of-the two dates
-H ste& The-reason we cannot pin inti which=-day---it was'is=Yiecaute=things=-around`-
m-wife delivered a 6 lb 13 oz ba�yirl.
2. Where did the damage or injury occur? (Include city and county)
Contra Costa County
Pittsburg, CA (Kirker Pass Rd. just south of Kirker Creek Apartments) .
------------------------------------------------------------------------------------
3. How did the damage or injury occur? (Give full details; use extra paper if
required) Damage occured from rocks and slurry seal which was being applied
to Kirker Pass Road. Cars were driving by at 60 miles per hour flipping small
rocks and slurry seal material onto my vehicle.
4. What particular act or omission on the part of county or district officers,
servants or employees caused the injury or damage? Contra Costa County was
negligent by not posting the proper signage needed to protect its citizens.
In addition, there were no apparent staff on duty to supervise this project.
When the slurry seal was applied the people traveling north and south bound
were allowed to drive through it. There was no supervision or traffic control
at all. (See additional sheet) .
(over)
5. Wl.-a*; are the names of county or district officers, servants or employees causing..
. ,. the damage or injury?
Unknown, possibly Public Works Department.
6. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
Broken wind shield, broken head light, chipped paint on front hood and slur seal (tar)
_ splashes on both sides of car, See enclose_ estimate f,.orrLL9J
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.) The repair estimate was figured by the Service
Manager, Jim Ainsworth, upon inspection of my Volkswagen Jetta. Since the car
was purchased from Bowman-and- s-a-convenient distance from my home I am re-
questing that they make all necessary repairs.
----------------------------------------------------------------------------
8. Names and addresses of witnesses, doctors and hospitals.
Linda Hood (wife) which was in the car at the time the accident occured.
P.Q. Box 51 , Clayton, CA 94517
-------------------------------------------------------------------
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
None at this time,.-..r-_-. ._.....__--_.....__..
Gov. Code Sec. 910.2 provides:
i "The claim must be signed by the claimant
SEND NOTICES 30: (Attorney) or by some person on his behalf."
Name and Address of Attorney
N/A Claimant's Signature
No attorney retained at this time 1301 Easley Dr.
Address
Clayton, CA 94517
Telephone No. Telephone No. 672-3326 (hoime) 778-5454 (work)
* * * * * * * T * * * * * * * * *
N 0 T I C E
Section 72 of the Penal Cade 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 ($1,000), 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.
4. (Con't. ) The following day after the damage occured the County attempted
to post the proper signage and provide the proper road supervision.
These signs were home made and unpainted. They were constructed out of
plywood and 1" x 1" legs attempting to make an A frame sign. County
officials are 100% responsible because the project was unsupervised allow-
ing hundreds of people to be subjected to rocks, tar and most of all a
dangerous situation. I am sure that there was thousands of dollars of
damage done to other cars because of your negligence. In all fairness
to the citizens of Contra Costa County and to the people that live in
the surrounding communities, I think it would be appropriate that the.
Contra Costa County Board of Supervisors be required to notify all
citizens of their negligent act, asking the citizens if they have had
any damage to their automobiles because of the road work being conducted
on Kirker Pass Road. It is very sad and unfair that people have to pay
their deductable of..$100.00 to $1,,000.00 on their comprehensive insurance
coverage to have their autos fixes due to the damage caused by. the Countys
negligence. The people of Contra Costa County expect that the City and
County use reasonable precautions and common sense in conducting road
work of this nature.
A ES.TIMATf-OF .RfPA1R COSTS
` OVAI�
CONCORD VOLKSWAGEN 2550MONUMENT Blvd." Phone:-.685-7000
CONCORD,CALIFORNIA 94520
DATE duly 11 "198$
o 00
1301 Easley DL.
NAME ADDRESS pd�� '7
MAKE MODEL Pr _, .-Clayton, C 21P _-,9� 4511
C
INSURANCE CO. PHONE 672-316 'LICENSE
VIN#
DESCRIPTION LABOR PARTS -SUBLET
`I VA S
:I Q
Of
TOTAL
SUMMARY -
Labor�"�Hrs. ..$
Parts '
Material
Tax
Sublet >r�,S
A-Align N-New OH-Overhaul S-Straighten or Repair EX-Exchange RC-Rechrome U-Used TOTAL i "'v
:PARTS PRICES BASED ON STANDARD CATALOG PROCUREMENT PRICE LISTS SUBJECT TO CHANGE WITHOUT NOTICE.
Old parts removed.from cil s;bJilf;be junked unless otherwise instruioed in writing.
Theabove is an estimete-based on our inspection and does not cover additional parts or labor which may be required after the work has been opened up. Oc-
.:.:.casionallvafter work has started worn parts are discovered which are not evident on first inspection.,,Because of this the gfiove prices ars not guaranteed. Parts
prices subject to invoice.
Items not covered by this estimate or hidden will be additional.
-- - -. . CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim AgainsttheCounty, or, Distrk—t governed by) BOARD ACTION
the Board of Supervisors, Routing'Endorsements, ) NOTICE TO CLAIMANT September 27 , 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $902. 73 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: MIKE E. TISCARENO
9 Pettit Lane
ATTORNEY: Martinez, CA 94553
Date received
August. 30, 1988 Risk Manage
ADDRESS: BY DELIVERY TO CLERK ON
BY MAIL POSTMARKED: no envelope
1. FROM: Clerk of the Board of.Supervisors TO: County Counsel
Attached is a copy of the above-noted claim. �l
August 30 1988 ppNNIL BATCHELOR, Clerk .
DATED. P ► BY: Deputy /
L. Hall
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
(X 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).
County Counsel
( ) Other:
AUG 3-0 1988
Mertinez, CA 9455
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 DER: 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' Order ntered in its minutes for
this date.
Dated:
SEP 2 7 1988 PHIL BATCHELOR, Clerk, By. eputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately.
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 an Notice to Claimant, addressed to
the claimant as shown above.
Dated: S IE P 2 8 1 QJW"
BY: PHIL BATCHELOR by y Clerk
CC: County Counsel County Administrator
claim 0t&:-` BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for death or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. Code 5911.2.)
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
arm.
RE: Claim By ) Reserved for Clerk's filing stamp
REVEAr-
or
ainst the County of Contra Costa )) 19881
District)
Fill in name ) c�e� n e E° soAs
NT Uty
The undersigned claimant hereby makes claim against ra osta 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)
5—IR-F5 (:E- Oyeco *,0-5
------------------------------------------------------------------------------------
2. Where did the damage or injury occur? (Include city/ and conty) r
4 C
------------------------------------------------------------------------------------
3. How did the damage or injury occur? (Give full Beta ls; use extra paper if
required) /{ <«,r ve/1�,�/e �(r/�ve,� b y ti//v f�ifyj,�1c,- firs � vhkc tva"/l s -/,-.Q�// �k.4.��
res (�v'C.� (.' 6^d hQS Uehtc(�S �C/,+' r� STS✓t,e T "� �� (� c% C� (jam,
f P
----------- -------------------------------------
4. What particular act or omission on the part of county or district officers,
servants or employees caused the injury or damage? / C/ /
/ Fw.�vre 7z' c_ZPe�� TDA ve 4,
(over)
5. What ar'e the names of county or district officers, servants or employees causing
the damage or injury? JA v 1_D �41,Ile/, d u Ye k•�,<< le
777W. 6A ' d
5. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimatef�or auto damage.
P`.�'�.`/
e Try TI-e d e,,, J P/�+ ✓'/mow/�'�L�y Gl a o/
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.) �e✓ 1ie A/C le r e10 �o Sic p S f��s ,��S
8. Names and addresses of witnesses, doctors and hospitals.
Noe�-
9• List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
Gov. Code Sec. 910.2 provides:
"The claim must be signed by the claimant
SEND NOTICES TO: (Attorney) or by some person on his behalf."
Name and Address of Attorney
Zc �.
Claimant's Signature
-71e �/fl--,,.e
Address
Telephone No. Telephone No. ��
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 ($1,000), 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.
Estimate Report 158789
NAME H 1 LIE- n J`�A•-"teN D _OA 2 S �� woRK PHONE`��4- C� HOME PHON2 Z r t S-29
ADDRESS ` pu-r t T— C,4140-, F_ CITY M A/L1-lzC• t 7 - STATE`-" 21P
YEARSMAKE 1 O"1 PTA EL I I.D.NO. v rl e"C-O tz-7"' S-1 Z Z-8 f-7
PAINT CODE PADPROD.DATEa r TRIM MILEAGE T LICENSE NO.203 1'00 DATE OF LOSS
��
WRITTEN SY INS.CO. FILE NO. CLAIM NO. P.O.NO.
ADJUSTER LIC.NO. PHONE Deductible/Betterment '
Line Re. ► DETAILS OF REPAIR . PARTS LA80R AtNT $t38LfTlMISC
Pb. pair' place N NEW, U -USED.•R=REPAIR _S=.STRAIGHTEN 'R/C:=:RECYCLE IAECHROME/RECORE'
2 7 op�.�
3 —AitiT (We_/CC •
4 X Fteutj- Oct :.
5
6,
7
9 Co C-0 P_ M A T-C t 3L£.N L-) •
10'
11
12.
13
14
15 v S T-u"UL_ r�TA L 'CA A.
16
17
18
19
20-
21 -
22.
23
24
25
26
27
28 7_
I hereby authorize the above work and acknowledge receipt Of copy. TOTALS 1(o I o
Signed X Date PARTS Prices sub%ect tp invoice $
LABO l3 hrs.® $Z-2-2-.
Shop Supplies -� $
PAINTIZ�hrrs.@4 2— $ 235 Z-0 Paint Supplies�Cg $too. $O
®ENT DOCTORS
Towing/Storage $
Sublet/Miscellaneous $
99 Monument
wPlazaA�
Pleasant Hdl, CA M23 EPA/waste Disposal Charge $$
(415) 825-W20 SUB TOTAL $
TAX ....................... $ 2—'7,
( C�
TOTAL $ 2, 73
Form No.1008,VD/E/A,Inc., Caldwell,ID 83805,Cell Toll Free 14100 8359281 REV.946
d CLAIM
' BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT .September 27, 1988
and Board Action. All Section references are to } The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: 1,000, 000. 00 Section 913,and 915.4. Please note all "Warnings".
CLAIMANT: .JOSEPH COX
c/o Boatwright , Adams & Bechelli
ATTORNEY: 1738 Grant Street
Concord, CA 94520 Date received
ADDRESS: BY DELIVERY TO CLERK ON August 29, 1988
BY MAIL POSTMARKED: August 24, 1988
I. FROM: Clerk of the Board of_Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
August 30, 1988 PPHHIL BATCHELOR, Clerk Q
DATED: g SY: Deputy
L. Hall
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).
County Counsel
( ) Other:
AUG 3-0 U 1988
Martinez, CA 9455
Dated: g 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: SEP 2 7 1988 PHIL BATCHELOR, Clerk, By Deputy Clerk
WARNING (Gov.'code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately.
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 claimantasshown above.
/111
Dated:
SEP
P 2 8 1 BY: PHIL BATCHELOR by ��_Z_q4�`DepujtyClerk
CC: County Counsel County Administrator
BOATWRIGHT. ADAMS & BECHELLI
DANIEL E. BOATWRIGHT - ATTORNEYS AT LAW TELEPHONE 14151 687-9121
DALE C. ADAMS 1738 GRANT STREET
F. JOSEPH BECHELLI. JR.
PAMELA J. PLATT CONCORD. CA 94520
RECEIVED
August 23 , 1988
Contra Costa County Board of Supervisors CLERi<BF ARBA F �ERvI s
651 Pine Street C NTR S
Martinez, CA 94553 By •-
JOSEPH COX hereby makes claim against Contra Costa County
Sheriff 's Dept. , for the sum of $1,000,000 .00 and makes the
following statements in support of his claim:
1 . Claimant 's post office address is:
c/o Boatwright, Adams & Bechelli
1738 Grant Street
Concord, CA 94520
2. Notices concerning the claim should be sent to:
c/o Boatwright, Adams & Bechelli
1738 Grant Street
Concord, CA 94520
3 . The date and place of the occurrence giving rise to this
claim are: April 29, 1988, Contra Costa County Detention Center;
Martinez, CA.
4. The circumstances giving rise to this claim are as
follows: At said time and place, employees of Contra Costa
County negligently and carelessly, wantonly and recklessly
arrested claimant falsely and then shoved claimant in such a way
as to cause claimant to fall and suffer serious injuries .
5. Claimant 's injuries are a broken arm and dislocated
shoulder.
6. The names of the public employees causing the claimant 's
injuries are unknown.
7 . Our claim as of the date of this claim is $1,000 ,000 .00 .
8. The basis of computation of the above amount is as
follows:
a
Contra Costa County Page 2 August 23, 1988
Medical Expenses
incurred to date: unknown
Estimated future Medical
Expenses: unknown
Loss of Wages: unknown
General Damages : $1,000,000 .00
TOTAL $1 ,000,000.00
plus Special Damages
Very truly yours,
B TWRIGHT, AD & BECHELLI
. JOSE H ECHELLI , JR.
FJB: lm
cc: J. Cox
CLAIM
f . B6ARD OF'SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 27 , 1988
and Board Action. _All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $5, 000. 00 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: LAREINE E. STEPHENS
2272 Rockne Drive
ATTORNEY: Concord, CA 94518
Date received
ADDRESS: BY DELIVERY TO CLERK ON August 29 , 1988
BY MAIL POSTMARKED: August 26 , 1988
Certified P 916 081 604
I. FROM: Clerk of the Board of.Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
August 30, 1988 PpHHIL BATCHELOR, Clerk
DATED: g BY: Deputy
Hall
11. FROM: County Counsel TO: Clerk of the Board of Supervisors
(� This claim complies substantially with Sections 910 and 910.2.
( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying
claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
Other: County Counsel
( )
AUG 3.0 1988
Martinez CA 946-53
Q i
Dated: O 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 0 ER: 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' Order entered in its minutes for
this dates.
Dated: SEP P 2 7 1988 PHIL BATCHELOR, Clerk, By Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately.
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 of this Board Order an otice to Claimant, addressed to
the claimant as shown above.
Dated: SEP 2 8 Imm
BY: PHIL BATCHELOR by y Clerk
CC: County Counsel County Administrator
1
Claim t6: BOARD 6F SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for death or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. Code §911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in
Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553•
C. If claim is against a district governed by the Board of Supervisors, rather than
the County, the name of the District should be filled in.
D. If the claim is against more than one public entity, separate claims must be
filed against each public entity.
E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this
form.
RE: Claim By ) Reserved for Clerks-filing stamp -
A /1 L' C? z. Step�eA✓S )
RECEIVED
Against the County of Contra Costa ) / ' Iu 2 9 X988
or )
�Pt 0� �n,�nq/ ServrCe,s
CLER P q B TF HELORVISOR3
District) t� F,�n:� o.
Fill in name ) By . . .!.. ... : .. puty
The undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $ 000' C" and in support of
this claim represents as follows:
-----------•--------------------------------------------------------------------------
l. When did the damage or injury occur? (Give exact date and hour)
-----------------------------------------------------------------------------------
2. Where did the damage or injury occur? (Include city and county)
f o L U c y rsre c e.y .Sf'c,,-e to Y- o.v 7re4 f 62 Vd).
—__/1eAr CCYn/er of Trete f f,' vd - DAk ,6r4tl'e, (APprox
3• How did the damage or injury occur? (Give full details; use extra paper if CC'^"'-r
/required) A Cy-e y;v;�J +, �u.y,- ,ate 7`ur'� 5�5'�f+� �'y ve��c�P S� ��
'ytif v✓.ti, 7Tre,4t �rater7/ S
urnJ f
�' Sdc�prc� fXe ve/►�tlF /,, YLie o 4 7`u.-.✓ y4� /�//�w / ��5'fv.�twl �rigft�c r;
C14e,1r-_,0 ✓ YLIve s,i 'PWh1k. Hy V"l-Cff L-'45f�Fw reAr-e"1JC_ ri'1 G C.C. C.IA. y
------------------------------------------------------------------------------------
4. What particular act or omission on the part of county or district officers, 4,vd .Z'
servants or employees caused the injury or damage? l `
/ti'A7e.vf�o,�J �A;lu✓F S't�y �4 $Arr �iS�R �tt Ge7�weeA J�h,�lvS
i
`1v SA �P�y Cv.�'�rv� A_,, s4op ve 4t C ��✓ 9e^Je.-A f ne
(over)
►' 5. Wjat ar,e the names,of, county or district officers, servants or employees causing
.,the damage or injury?
- S lir-w A5 e�r/✓i,vs C ou,vTj' veti;e/f X16. S-Yol) 4; Pwse ,00114 fe 08.57C5-3
5. What damage or injuries do you claiin resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage. '
l
Y"' , 1,9/NJ:�p�/ ��/�rP1,9Sh j Pl9%N r 54, 1fe*-t✓f .
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
�LO'1 6iNA / /�N O`� /►•�l?4i lf�� /7�•�/S� 1'J'1•Pdi f/4�0�f ��� �Or✓�/iVL/rP�
��c,',„� f S. T�T Q,-•�j j llS t' O� �'Pr( rii C,4/ coll,9e fu i/ ¢-,:xe a weeks RAW(
_--__ _�L �_s _ ✓?P=='�f A�.I Y --t��.��F{7�P✓• -----------------------------------
8. Names andel addresses of witnesses, doctors and hospitals. n
Qy'I�Vet's Com' �':_ �o�.✓�� L�lc.�rir2 �N.J (77�1Je.-y- DOC-YLOVS.Ok•AiSer !"Pr�fbve.✓f�
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
• „�:�.�;�N.r..._..,; ��•�, plus u,�kti�•_..,� /�AiSE_�- /iP�1 (PC'
X718 .:A,f r
7 t
/ 6, %led' yt
* * * tY* * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Gov. Code Sec. 910.2 provides:
"The claim must be signed by the claimant
SEND NOTICES TO: ., Attorney orb some son on his behalf."
Name and Address of Attorney
F4 t
(Claimant's Signat
o;?a 7a f oc k,)e O►-,�v-p-
Address
Coricvrd l CA/
Telephone No. Telephone No.
* * * * * * * V V T * * * * * * * * I I V V I I I V I I W I * * *
NOTICE
Section 72 of the Penal Code provides:
"Every person who, with intent to defraud, presents for allowance or for
payment to any state board or officer, or to any county, city or district board or
officer, authorized to allow or pay the same if genuine, any false or fraudulent
claim, bill, account, voucher, or writing, is punishable either by imprisonment in
the county jail for a period of not more than one year, by a fine of not exceeding
one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in
the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by
both such imprisonment and fine.
CLAIM
1-125
t BOARD OF,SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 27, 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: Unspecified Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: JOAN KAZARIAN
1012 Jensen Circle
ATTORNEY: Pittsburg, CA 94565
Date received
August 29 , 1988 CAO
ADDRESS: BY DELIVERY TO CLERK ON Au g
BY MAIL POSTMARKED: ' August 27, 1988
I. FROM: Clerk of the Board of.Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
IL gATCHELOR, Clerk
DATED: . August 30, 1988 ��: Deputy
L. Hall
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).
( ) other: County Counsel
UG 3;q 1988
A 94553
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' Order entered in its minutes for
this date.
SEP 2 7 1988
Dated: PHIL BATCHELOR, Clerk, By Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately,
AFFIDAVIT OF MAILING
1 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 an Notic to Claimant, addressed to
the claimant as shown above.
LCE,tad: SEP 2 8 198 BY: PHIL BATCHELOR by uty Clerk
CC: County Counsel County Administrator
Caim��: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. Claims relating to causes of action for death or for injury to person .or to per-
sonal property or growing crops and which accrue on or before December 31, 19879
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for death or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. 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.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
BE: Claim By ) Reserved for Clerk's filing stamp
RECEIVED'
Against the County of Contra Costa )
or ) i '� 19881
District) P BAT ELO
Fill in name ) CLE K 8 t.T/ P
By i�:i..'.. eputy
The undersigned claimant hereby makes claim against the County ofContra 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)
--------------------- ------------------------------------------------------------
2. Where did the A� or injury occur? (Include city and county)
QJ
----- - - ------ --- ?= _.� -t.�.e — -------------- -
- -r- --
3. How did the damage o�t� injury occur? (Give full details,. use tra paper if
required)
-------------------------------------------------------- -----------------------------
4. What particular act or omission on the part of county or district officers,
servants or employees caused the injury or damage?
(over)
L -
5.. What are the names of county or district officers, servants or employees causing
the damage or injury?
-----------NMN----------------- ---------------------------------------N-N--
5. What damage or injuries do you laim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage. '
7. How was the amount claimed above comput ? (Include the estimated amount of any
prospective injury or damage.)
p 7.
-•• ,1/ • G�QJ 'tf "��.�
- -----------------r-----------------r-----------r--r--r-•�---r---------�-------..N--
8. Names and addresses of witnesses, doctors and hospitals.
--------------------------------------------------------------------
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
Gov. Code Sec. 910.2 provides:
"The claim must be signed by the claimant
SEND NOTICES TO: (Attorney) or by some person on his behalf."
Name and Address of. Attorney
/ f laimant's Signat
Ad ss
Telephone No. Telephone No.
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 ($1,000), or by both such imprisonment and fine, or by imprisonment in
the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by
both such imprisonment and fine.
COSEL GLASS, INC.
7 106'2-
-
[1
`n (7
>i
1-800-2-4-COBEL
Servicing the ENTIRE Bay Area
AUTO PLATE HOME
RICHMOND OAKLAND HAYWARD
1711 BARRETT AVE. 400 FRANKLIN ST, MOBILE SERVICE
/ 232-1337 834-7841 276-3244
DUBLIN! SAN LEANDRO CONCORD
SAN RAMON
MOBIL SERVICE 1992 REPUBLIC AVE.
MOBILE SERVICE 837-2002 357-0747 827-3900
�c:
V
f
t--ASa"C: GC1L r,,j-v y' CGILIASS
6 C-V C-V, R'4Ek i 1 r^1c0 a c:f IAV c-e
F• z `�•t Q t-ts^g ? G t E-E:-i 43`— 1 433
QUcrt a No.
:` DATE Q p Q yaAt:Cl'
;4 f 08 25-GO fpm
NSURANCE
CO::'Am
�ICiEN'f'$'",
NAME,
+DDRESS`"
KAZARIAN JOAN m,.STATE
.=F=nrrD ztv'.`
ENO.
-NAME
POLICY `
Thank yc,u fcr your Business NLIMaER
VERIFIED BY
STATE LICENSE #494305 )M CODE
"-;DATE OF'
-LOSS
MAKE � MODEL °' CAUSE
x " 11 NO;
Yam2 DOORS, 1 UCTIBLE
1979 �,- SERIALMO.: Cs_ C_>tC>►
TERMS CUSTOMER ORDER SOLD BY SHIPPED VIA SHIPPED FROM DATE SHIPPED
NO.
Quantity Part # r Kit Labor List Sell Net
1 FCW351 Shaded 0. 00 2. 8 Hrs. = 61. 60 457. 00 137. 10 198. 70
Tax 8. 91
a
RECEIVED BY: -
E ALL CLAIMS AND RETURNED GOODS '
e MiJ$T 13E q,CCOMPAMIEDA THtS RECEIPT, a a 207. 61
All material is guaranteed to be as specified. All work to be completed in a All goods and services ordered or received by the above named party,or their
workmanlike manner according to standard practices. Any alteration or principals,are subject to the following conditions which are hereby accepted
deviation from above specifications involving extra costs will be executed only and agreed to by the person ordering or receiving said goods or services.
upon written orders, and will become an extra charge over and above the
® estimate. All agreements contingent upon strikes,accidents or delays beyond All claims and returned goods must be accompanied by this receipt. Terms of
our control. Owner to carry fire,tornado and other necessary insurance. Our payment are ten(10)days net from invoice date. All accounts are commercial
workers are fully covered by Workman's Compensation Insurance. accounts and not open accounts. All delinquent accounts shall bear interest at
the rate of 1'h%per month;an annual percentage rate of 18%.
CLAIM
♦ BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the Cbunty, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 27., 1988 .
and Board Action. All Section references are to The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $238.35 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: CHRISTIE T. NGUY
1911 Espanola Drive
ATTORNEY: Sari Pablo, CA 94806
Date received
ADDRESS: BY DELIVERY TO CLERK ON August 30., 1988
BY MAIL POSTMARKED: August 29 , 1988.
I. FROM: Clerk of the Board of.Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
PPHHIL BATCHELOR, Clerk
DATED: August 30, 1988 Bv: Deputy
L. Hall
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
Q/ ) 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).
County Counsel
( ) Other:
AUG 3-H 19gs
klarilneg, CA 94553
Dated: I BY: ;J 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 0 ER: 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 Orde entered in its minutes for
this date.
Dated: SEP 2 7 1988
PHIL BATCHELOR, Clerk, By 61 Z_-1/_ Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant as shown above.
Dated: SEP 2 8 1988
BY: PHIL BATCHELOR byVt_,9_�_ y Clerk
CC: County Counsel County Administrator
t
Claim BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for death or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. 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
Toren.
RE: Claim By ) Reserved for Clerk's filing stamp
�HkiST/ C— T• �J�v Y )
' RECEIVED
)
Against the County of Contra Costa > d 3 0 1y88
or )
District) P L B T HELD VlriCil
Fill in name ) CLE K NTRF O
By .
C..,........'.. eputy
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)
---- u�us 9=--��� --------- - i U /'----- ----------------------------------
2. Where diQd- the damage or injury occur? (Include cit�r and county)
l� cf'a A� 1e A',W I-ea L� . L°Plt1 ;2 Geu
3. How did the damage or injury occur? (Give full details; use extra paper if
required)
4. What particular act or omission on the part of county or district officers,
servants or employees caused the injury or damage?
(over)
5. " Wt are the names of county or district officers, servants or employees causing,
the damage or injury?
-------------------
6. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
-------------------------------- ----------- -- --
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
-------- -------------------------
8. Names and addresses of witnesses, doctors and hospitals.
-------------------------- ---------------------------------------- ----------
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
Gov. Code Sec. 910.2 provides:
"The claim must be signed by the claimant
SEND NOTICES TO: (Attorney) or by some person on his beha ."
Name and Address of Attorney
, 16_&
{ Claimant' Signat
�Q Address
Telephone No. Telephone No.
* * *
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 ($1,000), or by both such imprisonment and fine, or by imprisonment in
the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by
both such imprisonment and fine.
{
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BAY CITIES GLASS
abbey-owes-r-ord co.
Glass Centers oo ,
Date 3`06Subject `���✓4C-
1:
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778-0800 644.1111 685-8400 280-1899 829.3722 791-2929 782-5753
Mobile Mobile 1555 Galindo Street 10025 So.Tantau Mobile 37276 Maple St. 20525 Mission Blvd.
HAYWARD SO. LIVERMORE OAKLAND PALO ALTO RICHMOND SAN FRANCISCO SAN JOSE
881.8888 449.6200 452.5010 424.8200 529-1991 957.5959 281.1112
Mobile Mobile 2412 Broadway 3876 EI Camino Real 12826 San Pablo 36 Fell St. 463 Blossom Hill
SAN JOSE SAN MATEO SAN RAFAEL SAN RAMON WALNUT CREEK
296.2411 343-5700 485.1230 838-8104 944-0112
360 So.Kiely Blvd. 525 East 4t11 Ave. Mobile 15 Beta Q. 2012 N.Main St. t
Toll Free 800-972-0908
w
CUST"t- ALUMLID GLASS
MOBILE AUTO GLASS SPECIALISTS
LOCATIONS THRUOUT THE BAY AREA
CALL (800) 322-5666 TOLL FREE
iv.ct `T 6
DATE
t5S3 DDYe dawj s
�utad - �o�xe� - .StareQ
SERVING THE BAY AREA SINCE 1941
CLAIM /
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 27, 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $10, 000. 00 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: WESTERN UTILITY CONTRACTORS ETAL'_'
Law Offices of David Hirshik
ATTORNEY: 1600 Riviera Drive #355
Walnut Creek, CA 94596 Date received
ADDRESS: BY DELIVERY TO CLERK ON August 26, 1988 hand del .
BY MAIL POSTMARKED: no envelope
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
August 29, 1988 PpHHIL BATCHELOR, Clerk
DATED: g BY: Deputy
L. Hall
II. FROM/: County Counsel TO: Clerk of the Board of Supervisors
( v) 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).
County Counsel
( ) Other:
') Martinez, CA 94553
Dated: L 0 BY: — eputy 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: SEP 2 7 1988 PHIL BATCHELOR, Clerk, By Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant as shown above.
Dated: SEP 2 8 1988 BY: PHIL BATCHELOR by uty Clerk
CC: County Counsel County Administrator
-�-
[R,4ECEIVED
G 2 gCLAIM AGAINST PUBLIC ENTITYOR
HIL gApTy r1.HTRA C 3T PPOlSd:i:,(GOVT C 905, 905.2, 910, 910.2) ,..
TO COUNTY OF CONTRA COSTA:
WESTERN UTILITY CONTRACTORS AND CONTRA COSTA COUNTY SANITARY
DISTRICT hereby make claim against the COUNTY OF CONTRA COSTA in
a sum as yet undetermined, but which exceeds $10, 000, and which
is within the jurisdiction of the superior court, and makes the
following statements in support of the claim: WESTERN UTILITY
CONTRACTORS AND CONTRA COSTA COUNTY SANITARY DISTRICT have been
sued by plaintiff alleging that she was injured as a result of
WESTERN UTILITY CONTRACTORS AND CONTRA COSTA COUNTY SANITARY
DISTRICT's negligence. WESTERN UTILITY CONTRACTORS AND CONTRA
COSTA COUNTY SANITARY DISTRICT deny the allegations and contend
that they are entitled to indemnity from COUNTY OF CONTRA
COSTA. Defendants, WESTERN UTILITY CONTRACTORS AND CONTRA COSTA
COUNTY SANITARY DISTRICT deny that claim and seek indemnity from
the COUNTY OF CONTRA COSTA.
1. Claimants post office address c/o Law Offices of David
Hirshik, 1600 Riviera Drive, Walnut Creek, California 94596;
(415) 932-0120.
2 . Notices concerning the claim should be sent to Law
Offices of David Hirshik, 1600 Riviera Drive, Suite 355, Walnut
Creek, California 94596.
3 . The date of the incident giving rise to this claim is
July 28, 1987 ; the complaint was filed on May 20, 1988, and
WESTERN UTILITY CONTRACTORS was served sometime thereafter, on
or about July 6, 1988, and CONTRA COSTA COUNTY SANITARY DISTRICT
was served sometime thereafter on or about July 8, 1988. The
place of the incident was a trail way, approximately 150 yards
south of the intersection between Danville Boulevard and La
Serena, in Danville, County of Contra Costa, State of
California.
4 . The circumstances giving rise to this claim are as
follows: Plaintiff has alleged she was injured when she stumbled
and fell on the trail way in Danville, California.
5. Claimant's injuries are: Plaintiff is alleging bodily
injuries to her left ankle, left leg, left hip, and neck.
6. The names of the public employees causing the injuries
are unknown.
7. It is believed that there was at least one witness, a
female with plaintiff at the time of the accident.
a
8. My claim as of the date of this claim is in a sum as yet
undetermined, but which exceeds $10,000, and which is within the
jurisdiction of the superior court.
9. Medical Expenses are approximately unknown; future
medical expenses, wage loss to date, and other damages are
unknown at this time.
DATED: August 25, 1988 LAW OFFICES OF DAVID HIRSHIK
By: ra'-'O-e— �2)'
CAROL W. ADLER
825G940
PROOF OF SERVICE BY MAIL (CCP §1013a, §2015.5)
STATE OF CALIFORNIA )
) ss.
COUNTY OF CONTRA COSTA )
I am a citizen of the United States and a resident of
the county aforesaid; I am over the age of eighteen years
and not a party to the within entitled action and that I am
readily familiar with the business' practice for collection
and processing of correspondence for mailing with the United
States Postal Service; my business address is 1600 Riviera
Drive, Suite 355, Walnut Creek, California 94596.
On August 26, 1988, I served the within CLAIM AGAINST PUBLIC
ENTITY on all parties in said action, by placing a true copy
thereof enclosed in a sealed envelope for collection and
mailing following ordinary business practices, said
correspondence to be deposited with the United States Postal
Service that same day in the ordinary course of business, at
Walnut Creek, California addressed as follows:
Rory D. Jensen
O'BRIEN & SULLIVAN
1500 Newell Avenue, Suite 401
Walnut Creek, CA 94598
I declare under penalty of perjury that the foregoing is
true and correct.
Executed on August 26, 1988, at Walnut Creek, California.
SUSANNE RODELLA
P y
CERTIFICATE OF SERVICE BY HAND DELIVERY
I certify that I am a citizen of the United States, over the
age of eighteen, not a party to this action, and am employed at
LAW OFFICES OF DAVID HIRSHIK, 1600 Riviera Drive, Suite 355,
Walnut Creek, California 94596.
That today I caused to be served the foregoing document
entitled: CLAIM AGAINST PUBLIC ENTITY, by having a true copy
thereof personally served on the Clerk of the Board of
Supervisors, 651 Pine Street, Room 106, Martinez, California
94553 .
I declare under penalty of perjury that the foregoing is
true and correct.
Executed at Walnut Creek, California this 26th day of
August, 1988 .
SUSANNE RODELLA
, CLAIM /
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) ` BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 27 , 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $3 , 343 . 5 9 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: VINCENT DEMARKO JONES
1542 Mariposa St .
ATTORNEY: Richmond, CA 94804
Date received
August 26 , . 1988 trans .
ADDRESS: BY DELIVERY TO CLERK ON Au g
BY MAIL POSTMARKED: no envelope
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim..
August 29 , 1988 PpHHIL BATCHELOR, Clerk
DATED: g BY: Deputy C-
L. Hall
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).
( ) Other: County Counsel
MaFtinezf i 946053
Dated: BY: Deputy County Counsel
J .
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 0 ER: 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.
SEP 2 7 1988
Dated: PHIL BATCHELOR, Clerk, By Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6. '
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately.
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 an Notice to Claimant, addressed to
the claimant as shown above.
nated: SEP 2 8 ,1988 BY: PHIL BATCHELOR by e uty Clerk
CC: County Counsel County Administrator
.--MAIM TO: BOARD OF SUPERVISORS OF CONTRA CO.%TtA �gQDI��
e ur �i i appllcatinn to:
Instructions to Claimant Clerk of the Board
P.O.Box 911
rtinez.Californ 94533
A. Claims. relating to causes of action for death or for injury �o
` person or to personal property or growing crops must be presented
not later than the 100th day after the accrual of the cause of
action. Claims relating to any other cause of action must be
presented not later than one year after the accrual of the cause
of action. (Sec. 911. 2, Govt. Code)
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 , California 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 end
o` this form.
RE: Claim by ) Reserved for Clerk' s filing stamps
)
RECEIVED
Against the COUNTY OF CONTRA COSTA) U 2 1968
v ..
or DISTRICT)
(Fill in name) ) OLE R ° T
"' 03M
- The undersigned claimant hereby makes claim a � "` Contra
Costa or the above-named District in the sum of $ ,S ,L 3 o Srt
and i!n support -of this claim represents as follows: 9 —'- ''—�-
------------------------------------------------------------------------
1. When did the damage or injury occur? (Give exact date and hour)
------------------------------------------------------------------------
2. where did the damage or injury occur? (Include city and county)
s- iH ---------------------
- - -- -------- ---
3. How did the damage or injuryoccur? (Givefull details, use extra
i sheets if required) i ;.�c.s +c..k�� irka custc���t by e Cer��4� a1�ce cicPA�f :��
T 1�- n— 4rons1'crrecl -AC �Ci:(A;nUZZ ��ten}icr� �r,cclit j o(� \�� 12�11GSk.
M,i l `� Qer� V . Ue\ l�(l(i_ ((s,lr�D�` 1 Lr�'.i �!(�,�) Pol ��(t e7C dJa(� f COQ•.,4-01 3UMy 506,-1
P'`�•�ci�y �xiC<<C� �r'�i2 1� N 10['1i}i'�G•4 Orl C' M"{ erc��::�y
h
rL�i =i_ _�LG! 1�Ic�f�t� ut�[� r� Ca���}1 xuGl f4�{Y d�cd ram; have Or,
9 . What particular act or omiiono -the part of county or district
officers , servants or employees caused the injury or damage?
(over)
v... .r... -;...._ __ _.,,. "-rlb w .+:1e-::.r....,r�.'c,...�.a.-..w. -.. w�...-....... =�{�--�'� ���-'s r• --ilYif�C+:.arri.z:.s.itw:�:�—Q'�
5..:,�• What. are.,th.e.,:names of county or district officers, servants or
employees:causing the damage or injury?
_ •,��ro��'�•es�.k�C�I�s - �.l (,�•�rit� �CIiC.Q - 7z(�aj1� me�Lt • o_Q��iCf.r P►���o�, �y8
fJ
w"Ot.tom /1(,)8&'
-------- -- ------------------------------------------------------
6 . What-damage or--------injuries do you claim resulted? (Give full extent
of injuries or damages claimed. Attach two estimates for auto
damage) , css r.� �c rt-� - i) �e cA uv: Keys 30 Ocie Dcic( WL1Ach.
3 �JQIIe� Vat;h i.� � .o�:h2� 1�O�e`rS c1� Li, (-A -Ur).n 124 n�5 LY t kC �+,i�rF. c��an,anc� /ZCr•.iic'
-----=��irS�- Trt��:,�ai< �c:t��k- -$c �k• u.) Qc�r �i4. `l.� .v�i�c;`,nP•
---------------------------------�-------------------------------
7. How was the amount claimed above computed? (Include the estimated
amount of any prospective injury or damage. )
n- ec i ecl'c�;r,� c�►,r�- 3, a�1 SaJ`I �,u" �h ic'�`f )
8. Names and andresses of witnesses , doctors and hospitals.
-- ---------------------------------------------------------------------
9.--List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
Govt. Code Sec. 910 . 2 provides :
"The claim signed by the claiman-
SEND, NOTICES TO: (Attorney) or by some person on his behalf. '
Name and Address of Attorney ��,��. �� .�� �
Claima is Signature
I_S 4
Address
Telephone No. Telephone No.
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, town, city
district, ward or village .board or officer, authorized to allow or pay
the same if genuine , any false or fraudulent claim, bill, account , voucher.
or writing , is guilty of a felony. "
t-
ICASH
ATE e�%I OOKSk j �G NEVADA COUNTY SHERIFF'S DEPARTMENT BooK R7/IF �
�f ! COUNTY JAIL ( / O
s --� INMATE PERSONAL PROPERTY RECORD
c CHECK �� /, •
MONEY ORDERS ` (•t� _
NAME MATE ILA S RST, MIDDLE) - SOCIAL SECURITY NUMBER
DOB MO. 1DAY YEAR CHARGES
PERSONAL PROPERTY (INVENTORY AND STORAGE)
❑ MEDICATION (LIST) ❑ WALLET ❑ LIGHTER ❑ OTHER (LIST)
❑ OFFENSIVE WEAPONS (LIST) ❑ KEYS MISC. PA-PERS
❑ WATCH MAKE ❑
�'� ❑ MEDALS ❑ DRIVER'S LICENSE
❑ RING ❑ �U jvt�Lt-�GGd`-1
SIGNATURE /'F�C EI vL!LirlpffFICER
SIGNATU E OF INMATE •� SIGNATURE OF RECEIVING OFFd ER DATE AND TIME
CLOTHING(INVENTORY AND STORAGE) DESCRIBE MATERIAL AND COLOR
El'HAT - ❑ BELT ❑ WEATER ❑ SUITCASE (List Contents).,
❑ SCARF ❑ TROUSERS � CKET
❑ COAT SHOES ❑ OTHER (LIST)
❑ SHIRT ❑ BOOTS ❑
❑ TIE ❑ SANDALS ❑
SIGNATURE OF INMATE ! SIGNAJU• OF WlT SING OFFICER DATE AND TIME
ADDITIONAL PROPERTY (INVENTORY AND STORAGE) DESCRIBE AtX'fERIALS, COLOR, ETC.
ADDITIONAL PROPERTY RECEIVED ADDITIONAL CLOTHING RECEIVED ADDITIONAL CASH OR CHECKS RECEIVED
.1
PROPERTY RELEASED CLOTHING R LEASED CASH OR CHECKS RELEASED
SIGNATURE OF INMATE NO SIGNATURE OF OFFICER RECEIVING OR RELEASING PROPERTY
' ❑ EXCEPTIONS
7 ❑ EXCEPTIONS SIGNATURE OF WITNESSING OFFICER DATE AND TIME
LISTED BELOW
1 HAVE RECEIVED ALL MY PROPERTY
EXCEPTIONS EXCEPTIONS ., EXCEPTIONS
------------
J-27
)' !� I aiC ...'�;i5a�' i.'ti. :J• _ '�'f�'�••tf'K�wew�. ... l.1•�- .. - :i ..inc.a .-. „. _..
56,134
BOOKING lRECOR
FB1 NEVADA COUNTY JAIL BOOKING NO.
- _ 7;-: PRIOR NO. Not;E
NEVADA CITY CALIFORNIA
NAME AI IU ALIAS -= - _ __ _- I - - UAIE IU1L BUOAEU
30Di�S VINCENTIjUlARKO #6-'8$ 1430
ADURFSS - CITYSTA LIP CODE TLlfvllUNl NO TIME AkRtSIED
15,42 11MARM54, s'P°.R�GH�idND: =_= : . 94804 415 235-2`W- 1430
BIRTJIDAIE _ ' At;L - kACF SEX HT IGI11 jwc 1l lf• HAIR EYE$ COMPII XION BIRIHPLACE MARITAL STATUS
1-11-50 :28 ' 'ti ' '. t�i :5-�= 11G►" <I_K DRid DARK " ! ll' CA`'':' .y . MARF;IEU
DCCUkAnUN AND EMPLOYER - - - - _ - SOCIAL SECURITY NO. R. UC NQ.AND SLATE
CONSTRUCT 014 Av55 -19-�s87 X01°707 C�0161tQW4 DOLAT0
EMCRGENCYNOIIFICAIION.ADDRESS CItY STATE RELAIIONSHIP 'TEIEPHONL NO
DEBRA JONES - 5 ',-A A.
TY4tFE Q .A.A .
ILLNL S Uk IN1UkY I(-4FORMAi1QN }I
SEE ME:D SHEET
.. ..moi
TATTOOS CROSS Qin Ll+1 SUOULIJER::= = SCARS(NARKS. 1 SCAR LFT TEMPLE:
OFF( ER AND AGENCY ARREST LOCATION - VEHICLE LOCATION
H LLMAN NCSO 1 RUCKE E N.A-*
NO. I CFJARGE FEL CHARGE DEFINITION COURT WARRANT NO. BAIL
146il.1 *12 PR 17410 C%C MISD.1 w, I,IC I rli .lC 17512 2 j000.01("
HOW ARRESTED CASE DISPOSITION/SENTENCE _
-iFANS PORT _. . .
NO.2 CHARGECHARGE DEFINITION
FEL COURT WARRANT NO. BAIL
- - — -
MISDI.. ._. .. -
HOW ARRESTED CASE DISPOSITION/SENTENCE- _
REMARKS OR ADDITIONAL CHARGES 3
WAS TELEPHONE CALL TO BONDSMAN REQUESTED? NUMBER CALLED. WAS TELEPHONE CALL NO.2 REQUESTED?' NUMBER CALLED
PROPERTY RECEIPT RELEASE DATA
DATE ADMITTED
NE:
56.44 P�c�
CASH S CHECKS $
MISCELLANEOUS AND CLOTHING DESCP. NAME
BAGGAGE -
GLASSES -
HOW RELEASED
KEYS
KNIFE SEL' PROP SHLEr
LIGHTER '
PEN _ -
- RELEASED TO
PURSE OFFICER
_ _ _
qw
RING a DEPARTMENT._
WALLET
;.T HEREBY ACKNOWLEDGE RECEIPT OF ALL MY PERSONAL PROPERTY, MONEY AND
W IiTCh- -OTHER VALUABLES, EXCEPT THAT PORTION THEREOF PREVIOUSLY RELEASED BY MY
mORDER.
j' 71 $ CASH
PRISONER'S�[
i CERTIFY THAT THE ABOVE IS A CORRECT ITEMIZATION OF MY PERSONAL PROPERTY..: SIGNATURE X `
I HEREBY AUTHORIZE THE SHERIFF OR JAILER TO RECEIVE, OPEN AND INSPECT ALL DATE RELEASED - - TIME RELEASED
MY INCOMING AND OUTGOING MAIL WHILE I AM CONFINED. I ALSO AGREE NOT ";Y A.M.
TO HOLD THE SHERIFF OR 'JAILER RESPONSIBLE FOR MONEY OR OTHER PROPERTY P.m.
MAILED OR TAKEN TO THE JAIL FOR Mf. T - :- ' RELEASING OFFICER
SIGNATURE X .. . _ - - .. -/t-F _ . REMARKS• - - _.�..• . _ - . _. -
, - .
ACCOMPANYING OFFICER BOOKING OFFICER
HANSEN - - COSTELLO
DISTRIBUTION: WHITE,JAIL OFFICE COPY—GREEN.OFFICE COPY
CANARY.PRISONER'S COPY—PINK.OFFICER'S COPY
PRISONERS COPY
•g„ , �AY�p..4�.[` Zi'. .; r✓;-. tY"�Yef'i�`..a 1
DATE & TIME BOOKED NEVADA 6OUNTY SHERIFF'S DEPARTMENT BOOKING NUMBER
COUNTY JAIL �G� 3
C ASH
�. INMATE PERSONAL PROPERTY RECORD
CHECKS
IN
MONEY ORDERS
1
NAME F IN;
(LAST, IRST, MIDDLE "- �` SOCIAL SECURITY NUMBER
DOB MO. f DAY YEAR CHARGES
/ PERSONAL PROPERTY (INVENTORY...AND STORAGE) 1
❑ MEDICATION (LIST) ❑ WALLET �❑ LIGHTER ❑ OTHER (LIST)
❑ OFFENSIVE WEAPONS (LIST) E] KEYS ` ISC. PAPERS
❑ WATCH MAKE
2 TTS P"
'r 7f1 ie•� ❑ MEDALS ❑ DRIVER'S LICEN E
❑ RING ❑
SIG T OF RECEIVING OFFICER
i
SIGNATUR OF MATESIGNATURE OF RECEIVING OFFICER DATE AND TIME
. ✓ UU
CLOTHING (INVENTORY AND STORAGE) DESCRIBE MATERIAL AND COLOR
❑ HAT ❑ BELT ❑ S(EATER ❑ SUITCASE (List Contents)
❑ SCARF ROUSERS' J PACKETtel
❑ COAT. OES j '~ �� ❑ OTHER (LIST)
[t�SFiIRT �� ❑ BOOTS ��GS
❑ TIE ❑ SANDALS
SIGNATURE OF. 'INMATE SIGNATURE,OF WITNESSING OFFICER DATE AND TIME
4 ADDITIONAL PROPERTY (INVENTORY AND STORAGE) DESCRIBE MATERIALS, COLOR, ETC.
ADDITIONAL PROPERTY RECEIVED ADDITIONAL CLOTHING RECEIVED ADDITIONAL CASH OR CHECKS RECEIVED
/ I
PROPERTY RELEASED n CLOTHING RE EASED CASH OR CHECKS RELEASED
i
i
S GNATURE OF INMATE NO SIGNATURE OF OFFICER RECEIVING OR RELEASING PROPERTY
EXCEPTIONS
EXCEPTIONS SIGNATURE OF WITNESSING OFFICER DATE AND TIME
v ❑ LISTED BELOW � '
;i HAVE RECEIVED ALL MY PROPERTY '
EXCEPTIONS - EXCEPTIONS EXCEPTIONS ,
J-27
- - - '-------PRISONER'S PROPERTY
EL CERRITO POLIC DEPARTMENT -
Arrest No. ��y Time lao�S Date
RECEIVED fromD�2�
at EI Cerrito City Jail the following articles:' /�
Cash $ S -`14
Checks $ i
Knife Keys Pen- i 'letters Wotch-.41—�Belt
i
Hat Glasses Chain Purse Wallet
Bank Book Rings +" Coats Pencil Check Book
Cigarette Lighter Necklace Misc. Papers
Arresting Officers %1i Ski/'; �LI?-. _
4
The above described articles are correct
Inmate-Signature
EI Cerrito, California 19
Received the above described articles:
Signed
IL
Released by
Telephone calls: 5
1. To No.
Date Time
2. To No.
Date Time
This is to certify that i was allowed to make the above calls at the time and
date noted.
Inmate Signature
,p
_ _ V
mu
SECURITY AGREEMENT
�k;y;13G2 HILLTOP HALL
No.: 7170153-1
V-RICHMOND, CA 94806
B YER SOLD BY PHONE NO. CONTRACT DATE
DABRA JONES U234 � 1 111/01/87
24 l CALIF 0 R N I A ST ACCOUNT NO. CREDIT O.K.) NEW ADD-ON i REOPEN LAYAWAY
RdbEO , CA 94572 71033095 1 F K ( I SLE SALE i ACCT.
tPY'
ANNUAL FINANCE Amount Financed Total of Payments Total Sale Pricer ?:' ',•.
PERCENTAGE CHARGE - r;; _'•'
RATE
The cost of your credit as The dollar amount your The amount of credit The amount you will have paid after The total cost of your purchase•. /;".
a yearly rate credit will cost you provided to you or on you have made all payments on credit,including your
your behalf as scheduled down payment of:
,00
1y . 872 $ 590 .618 $ 2 ,684 .91 $ 3 ,'275. 59 $ 3 ,275.59
NUMBER OF PAYMENTS AMOUNT OF PAYMENTS WHEN PAYMENTS ARE DUE
• U Monthly Beginning 12101 d 7
{ 1 14. 59 Monthly Ending 11/01/89
SECURITY: You are giving a security interest in: Y� the goods or property being purchased.
the goods or property purchased under previous contract(s) until such goods
are fully paid for.
LATE CHARGE: If a payment is at least ten(10)days late,you will be charged 5%of such installment or$5.00 whichever is less;such
charge will be not less than $1.00.
PREPAYMENT: If you pay off early you may tie entitled to a refund of part of the Finance Charge.
See your contract documents for any additional information about nonpayment, default, any required repayment in full before the
scheduled date, and prepayment refunds.
Buyer(meaning all persons who sign this contract as Buyer or Co-Buyer,jointly and severally)having been quoted both cash price shown below and a deferred payment price,
hereby agrees to purchase from CRESCENT JEWELERS(Seller),on a deferred payment price basis,underthe terms stated on the face and back hereof,received and accepted
in its present condition,the following:
QUANTITY I STOCK NO. I DESCRIPTION I AMOUNT TOTAL MERCHANDISE PRICE
.- .� S 15 J 1'4 � 4 , i95 4 , 1,97 . 50 7 , 197 . 50
SALES TAX 142 .84
DIAMOND BOND 75.00
-------- --------.._.._........__. ........_....._ __....--
9fftFLvI6rC:WAR0hTY T g a 3 .0 C'
-- - TOTAL CASH PRICE
STATEMENT OF INSURANCE
Neither property nor credit life nor credit disability insurance is required.If such 1• CASH PRICE $-1.00
U�i �+
, 4 15 ._
2. CASH DOWNPAYMENT $
insurance is purchased,it is not required to be purchased or negotiated through any --
particular insurance agents or broker.No insurance coverage is provided unless its DESCRIPTION OF TRADE-IN
box is checked and a charge therefore is rioted below and under Item 4a at right.
Insurance is for a term of 2 4 months from date hereof. Said insurance will be
procured by Seller and will expire on the due date of final installment. --- — . - --
. .
a. Gross $ �0
................_.._ t
COVERAGE2�, b. Less Owing $_ _
I desire Credit Life Insurance $.___„_ 26 . 20
_`f c. Net Trade-in $_.—.
X ._...__..._.�...__G_
�:--
Credit Disability Insurance $._— TOTAL DOWNPAYMENT
Property Insurance $.._._ _ 3. AMOUNT PAID ON YOUR ACCOUN' z 4 15 .34
TOTAL OF PREMIUMS for Insurance Coverages Financed 269 . 5 7 a. UNPAID BALANCE OF CASH PRICE(1 minus 2) ----.-----_,
for Buyer(Insert in Item 4a) $ EXISTING BALANCE TO BE CONSOLIDATED
Less rebate of the unearned portion of:
APPLICATION OF BORROWER Insurance $_--._.0.0
.(�.J...
You are applying for the credit insurance marked above.Your signature below means Finance Charge $_.._._..._ u 11
that you agree that: Diamond Bond $....__.._
1. You are not eligible for insurance if you have reached your 65th birthday. TOTAL CREDIT $ 0 0 ,
2. You are eligible for disability only if you are working for wages or profit 30 b. NET BALANCE TO BE CONSOLIDATED $_ .00
hours a week or more on the Effective Date.
3. Your co-borrower is not eligible for life, or disability insurance. 4. AMOUNT PAID TO OTHERS ON YOUR BEHALF $
4. Received copy of insurance policy. a. Insurance $.-'—269 . 57
68491
] p E 5. UNPAID BALANCE AMOUNT FINANCED (3a + 3b + 4) $ .___
C' G', l n_f6. FINANCE CHARGE $ 590. 68
DATE PRIMARY BORROWER AGE7, TOTAL OF PAYMENTS (5 + 6) $3 , 275 . 59
8. DEFERRED PAYMENT PRICE(1+3b+4+ 6) $3 . 275. 59
NOTICE TO THE BUYER:(1)Do not sign this agreement before you read it if it contains any blank spaces to be filled in.(2)You are entitled
to a completely filled-in copy of this agreement.(3)You can prepay the full amount due under this agreement at any time and obtain a
partial refund of the finance charge if it is$1.00 or more.Because of the way the amount of this refund is figured the time when you pre-pay
could increase the ultimate cost of credit under this agreement.(4)If you desire to pay off in advance the full amount due,the amount of
the refund you are entitled to,if any,will be furnished on request. BUYER ACKNOWLEDGES RECEIPT OF A TRUE COPY OF THIS CON-
TRACT,WHICH WAS COMPLETELY FILLED IN PRIOR TO BUYER'S EXECUTION HEREOF,AND ALSO A TRUE COPY OF ANY CREDIT
STATEMENT SIGNED BY BUYER, AS REQUESTED OR REQUIRED BY SELLER, DURING THE CONTRACT NEGOTIATIONS.
BUYER'S SIGNATORE DATE BUYER'S SIGNATURE DATE
I received a copy of the dla(nond bond terms and conditions(Signature) _
X
NOTICE: SEE OTHER SIDE FOR IMPORTANT INFORMATION
` CLAIM /az�,
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE—rO CLAIMANT $eptember 27 1988
and Board Action. All Section references are to ) The copy of this document mailed to you s your notice df
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $252. 42 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: ARTHUR H. HONEGGER
40.19 Boulder Drive
ATTORNEY: Antioch, CA 94509
Date received
ADDRESS: BY DELIVERY TO CLERK ON August 26, 1988
BY MAIL POSTMARKED: August 25 , 1988
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
August 29, 1988 PpHHIL BATCHELOR, Clerk
DATED: g BY: Deputy
L. Hall
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).
County Counsel
( ) Other:
AU G 2 9 1988
�j Martinez CA 94 53
Dated: ZC ^ 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 0 ER: 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. -
SEP 2 7 1986
Dated: PHIL BATCHELOR, Clerk, By _X4" , Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately.
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 claimantcas shown above.
rG
Dated: L P 2 8 BY: PHIL BATCHELOR by uty Clerk
CC: County Counsel County Administrator
Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIO11S TO CLAIMANT
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for death or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. Code §911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in
Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553.
C. If claim is against a district governed by the Board of Supervisors, rather than
the County, the name of the District should be filled in.
D. If the claim is against more than one public entity, separate claims must be
filed against each public entity.
E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this
form.
RE: Claim By ) Reserved for Clerk's filing stamp
Arthur H. Honegger ) RE
��
ED
7!..
Against the County of Contra Costa )
, n
or ) �h .v �
999,
District) CLE Rs
Fill in name )
e
The undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $ 252.42 and in support of
this claim represents as follows:
-------------------------------------------------------------------------------------
1. When did the damage or injury occur? (Give exact date and hour)
------ On or about AuLust 9, 1988, at approimately 7:10 P.M. -------------
----------- ---------------- -------- ----------------------
2. Where did the damage or injury occur? (Include city and county)
East slope of Kirker Pass Road, near Pittsburg, Contra Costa County
------------------------------------------------------------------------------------
3. How did the damage or injury occur? (Give full details; use extra paper if
required) I was traveling westbound on Kirker Pass Road at a moderate rate of speed.
The_road_had_recently_been_"chip-_sealed,"-and a:_substantial excess :of_gravel remained
on the _road._ Oncoming and adjacent autos threw "up large amounts of gravel, permanently
chipping the paint on the hood of my car.
------------------------------------------------------------------------------------
4. What particular act or omission on the part of county or district officers,
servants or employees caused the injury or damage? Applying a gross excess
of loose gravel to the roadbed. "Ridges" of excess gravel had accumulated in
the center, sides and between lanes on the road. I have taken recent pictures
(enclosed) showing the excess piles of gravel that has been moved to the side
of the road.
(over)
5. What are the namev of county or district officers, servants or employees causing
the damage or injury?
Unknown
---------------------------------------------------------
6. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage. Permanent chipping of
the front of the hood of my car. Gravel also hit the windshield, but there is
no apparent permanent damage at this time. (Pictures enclosed)
------------ -- --- ----- ----------------- -- -
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
Two estimates for repair attached.
------------------------------------------------------------------------------
8. Names and addresses of witnesses, doctors and hospitals.
None known.
9. List the expenditures you made on account of this accident or injury:Repairs to be
DATE ITEM SUNT made upon receipt
of compensation.
Gov. Code Sec. 910.2 provides:
"The claim must be signed by the claimant
SEND NOTICES TO: (Attorney) or by some erson on his behalf."
Name and Address of Attorney
None Claimant's Signature
4019 Boulder Drive
Address
Antioch, CA 94509
Telephone No. Telephone No. 754-7216 (H) ; 757-3553 (W)
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 ane year, by a fine of not exceeding
one thousand ($1,000), 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.
,ti. ,�_. MAKE �" / Y
BOj-// t STYL '0— -, / C Q0
MILEAGE LICENSE
• •
SERIAL NO.
INSURANCE COMPANY CLAIM N
COMPLETE BODY AND FRAME REPAIR
2505 Devpar Court • Antioch,CA 94509 754-4477 ADJUSTER PHONE
NAME 11O,ve-=-�,e /— /19-, HOME # ?S2 - WORK #
REPAIR REPLACE ESTIMATE OF REPAIR COSTS PAINT BODY PARTS SUBLET
FPg �- -O
3.
PARTS PRICES SUBJECT TO INVOICE
�-� HRS. ® $ Per Hr. $
'
PARTS $ ALIGNMENT
/
PAINT MATERIALS $ qO CHARGE A/C
AIM H/L
SUBLET-PARTS $
SUBLET-LABOR $
STRIPE
STORAGE/TOW $
COLOR MATCH
SALES TAX $ `� �G
zf / TWO TONE
GRAND TOTAL S 5J`7 TWO STAGE
ox
THIS ESTIMATE IS BASED ON OUR INSPECTION AND DOES NOT COVER ADDITIONAL ROCK GUARD
PARTS OR LABOR WHICH MAY BE REQUIRED AFTER THE WORK HAS BEEN STARTED.
AFTER THE WORK HAS BEEN STARTED,WORN OR DAMAGED PARTS WHICH ARE NOT
.EVIDENT ON FIRST INSPECTION MAY BE DISCOVERED. NATURALLY THIS ESTIMATE
CANNOT COVER SUCH CONTINGENCIES. PARTS PRICES SUBJECT TO CHANGE
WITHOUT NOTICE.THIS ESTIMATE IS FOR IMMEDIATE ACCEPTANCE. TOTAL
f
This work authorized by:
EsUmste Re ort 183263
Q • = �1 -
2-
ADDRESS v ������,����...y�... �'' 1� STATE ZIP
YEAR MAKE ELS Ln.0 L�1D.NO.
PAINT CODE 'PROD.DATETRIM MILEAGE UCENSE NO. ATE OF LOSS
WRITTEN BY INS.CO. FILE NO. CLAIM NO. P.O.NO.
ADJUSTER r LIC.NO. PHONE -Deductbleffiettermelft
..DETAILS OF REPAIR
pair,
: N U A=-REPAIR S=STRAIGHTEN .
=RECYCLE/ CHROME icDriE ARTS.-,` ,LABOR s AINT.- SUBLfT/�IpSC
,
3
5
7
g_. 3
9
11
13
15
17
19
nq
21
Y.
23
25
6; _._ T
27
I hereby authorize the above work and acknowledge receipt of copy. TOTALS
Signed X Date PARTS ffi/ces sybject to invoice $
LABORTp�ppI�' rs,®7;� $ J`�
Shop
uies
P
A
IN
T
Srs.®��.D� $ ,nom_
CUSTOM AUTO BODY SHOP Paint Supplies $
HERB JACKSON - Mgr. Towing/Storage $
Sublet/Miscellaneous $
1007 West 2nd Street EPA/Waste Disposal Charge $
Antioch, California 94509 $
Phone (415) 757-8747 SUB TOTAL $
$
TAX ....................... $
</4007
TOTAL $ 2=
Form No.1007 W/E/A Inc.Caldwell,ID 83805,Call Toll Free 1804635-9261 REV.9.86
CLAIM
BOARD OF iUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 27 , 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $25, 000 . 00+ Section 913 and 915.4. please note all "Warnings".
CLAIMANT: VIRGINIA HATFIELD
c/o Greta 0. Wilson
ATTORNEY: Attorney at Law
1615 Bonanza St. #303 Date received
ADDRESS: Walnut Creek, CA 94596 BY DELIVERY TO CLERK ON August 26, 1988
BY MAIL POSTMARKED: August 25 , 1988
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
August 29, 1988 ppNNIL BATCHELOR, Clerk
DATED: g BY: Deputy
L. Hall
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).
County Counsel
( ) Other:
f rMartinez, C A 9 35 '3
Dated: BY. NDeputy 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 0 DER: 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.
SEP 2 7 1988
Dated: PHIL BATCHELOR, Clerk, ByWA�a__,,Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately.
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 an Notice to Claimant, addressed to
the claimant as shown above.
Dated- S E P 28 1%JW BY: PHIL BATCHELOR by , eputy Clerk
CC: County Counsel County Administrator
Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
• INSTRUCTIONS TO CLAIMANT'
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for death or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. Code §911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in
Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553•
C. If claim is against a district governed by the Board of Supervisors, rather than
the County, the name of the District should be filled in.
D. If the claim is against more than one public entity, separate claims must be
filed against each public entity.
E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this
form.
RE: Claim By ) Reserved for Clerk's filing stamp
Virginia Hatfield )
)
RECEIVED
Against the County of Contra Costa
and/or ) /.'J G 2 6
Office
Contra Costa Co-nty Lt=Ato AbateneRt *WWDb*) IL 6
Fill in name ) CL`s ONT, a . s-
By � De ty
The undersigned claimant hereby makes claim against a ounty of Contra Costa or
the above-named District in the sum of $Ptobahly -V5Tnm, h It Pxart and in support of
this claim represents as follows: arrant as yet Lrlvuc.
----------------------------------------------- ----------------------------
l.- When did the damage or injury occur? (Give exact date and hour)
--- Jules 28 L 198$ tQJ2LN.L------------------------------------------------------
2. Where did the damage or injury occur? (Include city and county)
____Contra_Costg_County_hfosguig_ALggnIgr� _Offl��.._1Q ['nnrnrr , fornia
3. How did the damage or injury occur? (Give full details; use extra paper if
required) I fell on a very shiny floor; a rug was about two feet away from the door
which I had entered.
------------------------------------------------------------------------------------
4. What particular act or omission on the part of county or district officers,
servants or employees caused the injury or damage? A rug was placed away from
the doorway, exposing a very shiny floor.
(over)
5. What are the names of county or district officers, servants or employees causing
the damage or injury?
Unknown.
-----------------------------------------------------------------------------------
6. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage. I broke my left hand;
I cannot perform my work as a waitress. I have medical expenses.
-------------------------------------------------------------------------------------
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.) I make about $1150 per month as a waitress. I will
be unable to work for 6-8 weeks, perhaps longer. I also make about $80 a month
chauffeuring, which comes to a loss of $160. My medical expenses are (estimated)
$1500.
---------------------------------------------------------- --------------------------
8. Names and addresses of witnesses, doctors and hospitals.
Sharon Garrett, employee : Contra Costa County Mosquito Abatement Office
Dr. Torsten Jacobsen, 2222 East Street, #305, Concord, CA 94520
-------------------------------------------------------------------------------------
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
Gov. Code Sec. 910.2 provides:
"The claim must be signed by the claimant
SEND NOTICES TO: (Attorney) or by some person on his behalf."
Name and Address of Attorney _
Greta 0. Wilson ,
Attorney At Law
Claimant s` ignature
1615 Bonanza Street, Suite 303 2700 Adobe Court
Walnut Creek, CA 94596 Address
Antioch, CA 94509
Telephone No. (415) 930-7711 Telephone No. (415) 754-5179
* * * * V * * * * * *
N O T I C E
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 ($1,000), or by both such imprisonment and fine, or by imprisonment in
the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by
both such imprisonment and fine.
., i
DECLARATION OF VIRGINIA HATFIELD
On or about July 28 , 1988 , at approximately 2 : 30 pm I went to the
Contra Costa Mosquito Abatement Office located at 1330 Concord
Avenue, Concord, California, to get some fish for my fish pond on
our property in Antioch.
When I opened the door to the building and walked in I fell
backwards and landed on my rear end . I noticed that the rug by
the door was about two feet away from the door, leaving part of
the floor exposed . The floor was very shiny.
After I fell I felt a sharp pain in my left hand. I started
sweating and began to feel sick to my stomach . Sharon Garret, an
employee in the office, helped me to the car. She then went back
into the office , got wet paper towels , came back out to the car,
and put the wet towels on my neck and wrist. Later I put ice
packs on my hand , but the pain did not stop so I went to urgent
medical care in Concord where a doctor diagnosed the injury as a
fractured left hand.
I am now under the care of an orthopedic surgeon, Dr. Jacobson.
I am currently unable to perform my waitressing job at Black
Angus Restaurant in Pleasant Hill , nor at my chauffering job. It
appears I will not be able to work for 6-8 weeks , perhaps longer.
To date my medical bills are about $500 and the total medical
expenses will probably total $1500 , perhaps more.
1 PROOF OF SERVICE BY MAIL (C.C.P. 1O13a, 2015.5)
2
3 I, the undersigned, declare:
4 That I am a resident of/employed in the County of Contra Costa,
State of California; that I am over the age of eighteen years and not a party
5 to the within cause; that my business/residence address is: 1615 Bnnan7a
6 Street, Suite 303, Walnut Creek, CA 94596
7
8 That on August 25 1988 , I served the within
9 Claim by Virginia Hatfield Against The County Of Contra Costa and/or
10 the Contra Costa County Mosquito Abatement Office, with supporting
11 Declaration Of Virginia Hatfield
12
13 on the party listed below in said action, placing a true
copy of each document enclosed in a sealed envelope with postage thereon fully
14 prepaid in the United States mail at Walnut Creek, California
15 addressed as follows:
16
17
Clerk Of The CCC Board Of Supervisors
18 County Administration Building
651 Pine Street
19 Room 106
20 Martinez, CA 94553
21
22
23 I declare under penalty of perjury under the laws of the State of
24 California that the foregoing is true and correct
25 Executed at Walnut Creek, California this 25th
26 day of August 1988 .
27
28
Emily onwyn
CLAIM /�145
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County., or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 27 , 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $994. 08 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: ANA MARIA VARGAS
850 Ventura Street
ATTORNEY: Richmond, CA 94805
Date received
ADDRESS: BY DELIVERY TO CLERK ON August 25 , 1,988
BY MAIL POSTMARKED: no envelope
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: August 26, 1988 JpIL BeP�tyLOR, Clerk /, 4,-,a�
L. kall
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).
County Counsel
( ) Other: AUG 2 (i 1988
Mqrt'A@Z, GA 553
Dated: BY: Deputy County Counsel
b1i , ,
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. BOA7DER: By unanimous vote of the Supervisors present
( his 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: 3 E P 2 7 1988 PHIL BATCHELOR, Clerk, By __,.Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately.
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 an Notice to Claimant, addressed to
the claimant Cas shown above.
Dated: SEP 2 8 1988 BY: PHIL BATCHELOR by D Clerk
CC: County Counsel County Administrator
Claim to: BOARD OF SUPERVISORS OF CONTRA-COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for death or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. Code §911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in
Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553•
C. If claim is against a district governed by the Board of Supervisors, rather than
the County, the name of the District should be filled in.
D. If the claim is against more than one public entity, separate claims must be
filed against each public entity.
E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this
form.
RE: Claim By ) Reserved for Clerk's filing stamp
r L ) ...,...�-.....
RECEIVED
Against the County of Contra Costa )
or ) L.1 G 2 519a
District) IL$A FLO ORS
Fill in name ) cLoff+ A
The undersigned claimant hereby makes claim against By oun y 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)
------------------------------------------------------------------------------------
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)
4. What particular act or omission on the part of county or district officers,
servants or employees caused the injury or damage? 1
S C, n.Q / v 12 l
l
(over)
5. What -are the names of county or district officers, servants or employees causing
the damage or injury?
- ----.-NN------ t- t -------------------
5. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
-N------ --N----------------------N- -N-----NN--NN---------
7. How was the amount claimed above eompu �d? (Include the estimated amount of any
prospective injury or damage.)
Pci 1'-;,L f A- C/-e -?,t rl-o
------------------------------------- --- --- ----- --- --------
8. Names and addresses of witnesses, doctors and hospitals.
-------------------------------------------------------------------------------------
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
A
Gov. Code Sec. 910.2 provides:
"The claim must be signed by the claimant
SEND NOTICES TO: (Attorney) or by some person on his behalf."
Name and Address of Attorney
laimant s Signature
Lie r -tea Y�
Address
Telephone No. Telephone No. 05 3 7— $2 541"
* * * * * * * V I W * * * * * * * * T V V I I V I I I V I * * *
NOTICE
Section 72 of the Penal Code provides:
"Every person who, with intent to defraud, presents for allowance or for
payment to any state board or officer, or to any county, city or district board or
officer, authorized to allow or pay the same if genuine, any false or fraudulent
claim, bill, account, voucher, or writing, is punishable either by imprisonment in
the county jail for a period of not more than one year, by a fine of not exceeding
one thousand ($1,000), 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.
UNIQUE
AUTO PAINT AND BODY REPAIR
232-7338
2311 Rheem Ave., Richmond, CA 94804 DATE:
NAME r' CAR YR. & MAKE /y J
ADDRESS �`'y v '� 'g ODOMETER
CITY- \ PHONE
PAINTING LABOR MATERIAL
A
TOTAL
BODY WORK v LABOR MATERIAL
�J
G
TOTAL
PARTS LABOR MATERIAL
TOTAL
TAXABLES
SIGNATURE TOTAL
'e. ♦ ` .fit • �.:. . . ` • � • �.
'ESTIMATE
OF
BODY&FENDER REPAIRING-AUTO PAINTING REPAIR
628-23RD STREET RICHMOND,CA 94804 Phone(415)234-7344
California Bureau of Auto.Repair Lic. #AE 18382
OWNER �/� /"//T i {/ � PHONE 2 —7— ���"7f DATE -Z&1A
ADDRESS �S� (,f,E/J ryi¢ �� 4-ILE NO.
MAKE YEAR BODY MODEL LICENSE NO. MILEAGE ,
oO
Symbol FRONT Lobar Hrs. Par ISymbol LEFT Labor Hrs. Ports JjSymbof RIGHT' Labor Mrs. Parts
Bumper(U) Ex-New Fender, Frt.3 Ext. Fender. Frt. & Ext,
Bumper Brkt. R. L. Fender In-Out,Shield Fender In-Out, Shield
Bumper Gd. R. L. Fender Mldg. W./O. Fender Mldg. W./O.
Fender Mldg. Side Fender Midg. Side
Fender Mldg. Peak Fender MIdg. Peak
Frt. System Heodlomp H-low Heodlomp H- Low
Frame Headlomp Door Headlamp Door
Cross Member Sealed Beam In-Out Sealed Beam In-Out
Cowl- Screen Cowl -Screen
Front Door Front Door
Door Door
Hub 8 Drum Door Key Lock Door Key Lock
Door Gloss T -CL Door Glass T -CL
Door Mldg. Door Mldg.
Spindle R. L. Door Handle In-Out Door Handle In-Out
Center Post Center Post
Lr. Cont. Arm R. L. Rear Door Rear Door
Door Door
Shock Door Glass T -Cl. Door Glaj,/'T-CI n
Tie Rod L-CR Door Midg.&Jamb Door Mei . ", m
Steering Arm R. L. Rocker Panel Rocker�Ponel
Steering Wheel Rocker Mldg. Rock-er Midg.
Horn Ring Quar. Inner Const. Quor. Inner Const.
Gravel Shield-Air Quar.-Ext. L-C-Up Quar.-Ext. L-C-Up
Park Lite R. L. Quar. Quar.
Quar. Mldgs. Quor. Mldgs.
Quar. Pillar Quar. Pillar
Rad. Grille R. L. C. Quor. Mldgs.W/O Quer. Mldgs. W/O
Rod.GriIle Side R. L. REAR MISC.
Grille Brace Bumper Ex.-New Hub Cap S-L
Grille Shell
Fender Tie Bar Bumper Brkt. L. R. Front Seat
Bumper Gd. L. R. Front Seat Tracks R-L
Gravel Shield S� 0 C*
Hood Lock Lower Panel
Hood Top Top
Hood Hinge-Orn. Tire % Worn
Hood Mldg. Floor Pon
Rod. Sup. Trunk Lid Batter
Rod. Trunk Lid—Om. Antenna
Trunk Mldgs. Up Lew Mirror- Remote
Rad. Core A/C Paint& Material
Coolant Tail Light L-R Under Seal
Stripe
Fan Blade 4367
Clutch Fon Back Up Light L. R. TOW 8 STORAGE $
Water Pump- Pulley Frame L. R. Labor Hours (� a
Air Cond. Core
700 00
Parrs 8 a 1j^? O
Dehydrate, Gas Tank-Filler Mot'I. Less----Disc.
Recharge A/C Sublet 8 Net Items
Wheel-13-14-15
Trans. Linkage Toil Gate Sales Tax $
Agreed With TOTAL s
A-Align N-New OH-Overhaul S-Stroighten or Repair EX-Exchonge RC-Rechrome U-Used
Items not covered by estimate or hidden will be additional.
�• CLAIM
BOARD 43F SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 27 , 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $160. 0 0 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: BARBARA E. FARAONE
1771 Sargent Road
ATTORNEY: Concord, CA 94518
Date received
ADDRESS: BY DELIVERY TO CLERK ON August 25 , 1988 Risk Managc
BY MAIL POSTMARKED: no date
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
IL gATCHELOR, Clerk
DATED: August 26 , 1988 ��: Deputy
L. Hall
11. FROM: County Counsel TO: Clerk of the Board of Supervisors
(V) 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).
County Counsel
( ) Other:
Martinez, CA 94553
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
( his 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.
SEP 2 7 1988
Dated: PHIL BATCHELOR, Clerk, By Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately.
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 claimantMao shown above.
Dated: SEP 2 8 #JWo BY: PHIL BATCHELOR by &�y Clerk
CC: County Counsel County Administrator
• t.
G aim-�,o: • BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for death or for injury to person.
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. Code 5911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in
Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553.
C. If claim is against a district governed by the Board of Supervisors, rather than
the County, the name of the District should be filled in.
D. If the claim is against more than one public entity, separate claims must be
filed against each public entity.
E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this
form.
RE: Claim By j Reserved for Clerks filing stamp
RECEIVED
�e�cvr-d CA. Iffs/Y >
Against the County of Contra Costa ) P�tJ G J19-K
or )
District) c� F oA "EtF1
o asFill inname ) oTzfly eputy
The undersigned claimant hereby makes claim ainst the County of Contra Costa or
the above-named District in the sum of $ / V, Op and in support of
this claim represents as-follows L1lL �__________________________________________
1. When did the damage or injury (occur? (Give exact date and hour)
=-
2. Where did the damage or injury occur? (Includ`e city and county) -! L
_lL•1= e7=_ _ __ %TSA =1 _ �_ ✓qC;�_� _o °
- � `
3. How did the damage or injury occur? (Give full details; use extra paper �if
required) 1 -itse
1�•r�r Pass f�! hid,jNSI &r11 ch; eerrle , �1 w %ti
srVC •� sw1s-9�,s we �s 6y � s% a o/� ►e >r�d 1 �✓�
%a s/oa» �� �l1�,
AhaM cJ� * ��9��� s s owa �`D.�/ � 4,�=-- -7�- a-�► - dI":rers
ocular ace or omi sign on M4 t of count orr district officers
Paz' Paz' Y ,
servants or employees caused the injury or damage?
Chi, seal 4ra��n f s9 'r�r foss V le� roe(s
oil 7 Mt j,
(over)
5. What are the namet 'of county or district officers, servants or employees causing
the damage or injury?
C4. Costa Comet Putt, W,, ,- D — e Qnce c��✓:s:a
5. What damage or injuries do you claim resulted? Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
4
-------------- __________________
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
'546JI-Al to es 4=wm4e--� _re lace_4o LM14 ���----------
8.- Names and addresses of witnesses doctors an�hospitals.
�
------------------------------- --------- --------------------------------
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
Gov. Code Sec. 910.2 provides:
"The claim must be signed by the claimant
SEND NOTICES TO: (Attorney) or by some person on his behalf."
Name and Address of Attorney
Claimant's Signature
Addre
Telephone No. Telephone No. Afy-
* * * * * * *
ter,
NOTICE
Section 72 of the Penal Code provides:
"Every person who, Faith 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 ($1,000), or by both such imprisonment and fine, or by imprisonment in F
the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by
both such imprisonment and fine.
TI-h
too
cry c)
C-
cn
CD
CD I
z Iwo
0
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SI- 0
0 71
CD
C7 v f DC in
C7 w m:o 30
-JO
CLAIM
' BOARD OF• SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the r:ounty, or District governed by) BOARD ACTION
the Board of SupE,--visors, Routing Endorsements, ) NOTICE TO CLAIMANT September 27 , 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: �1 9 4. 00+ Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: BARBARA G. ANDERSON
504 H Street
ATTORNEY: Antioch, CA 94509
Date received
ADDRESS: BY DELIVERY TO CLERK ON August 22 , 1988
BY MAIL POSTMARKED: not legible
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED:AU911St 23 , 1988 PpHHIL BATCHELOR, Clerk
BY: Deputy
L. Hall
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).
County Counsel
( ) Other: AUG 2 9 1988
Martinez, CA 94553
Dated: ''? f\. BY: t , 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 0 DER: 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 Boar 's Order entered in its minutes for
this date.
Dated: SEP 2 7 1%8 PHIL BATCHELOR, Clerk, By Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant as shown above.
/&_
Dated: S E P 2 8 1.888 BY: PHIL BATCHELOR by y Clerk
CC: County Counsel County Administrator
' Claim-L:o: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for death or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. Code §911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in
Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553.
C. If claim is against a district governed by the Board of Supervisors, rather than
the County, the name of the District should be filled in.
D. If the claim is against more than one public entity, separate claims must be
filed against each public entity.
E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this
form.
RE: Claim By ) Reserved for Clerk's filing stamp
)
�Q.i�c3rct �. Ig4�c�e,►'�crl ;
FRE !�lVE®
Against the County of Contra Costa2198.
or )
District) LB
E KBPH
TR) F RJ
Fill in name ) [..
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)
----� c - L!q F5 a-----3_-��.f�_rl'1------------------------------------------
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 aper if
required) Excess L.coSk.. < _num ci 6A ,cord t mcsf ly die fLL�n !ca V e 5
Luoc ldQ s s �M d v r e►�c ,, 1 a.vt 5 h s e v d (n r o t `�n�^c�UE(co� �,
Lcmny) �iel� Passed � be.hl�d: 1, 4ka 7y'QC FS T kac;,driVc-v\ 4h,,s Reac( Z hQ_vg_ 1,4-k�cdcx,nYprctOici:
i,+1( thaw nor %ain 0. 51cpp�r�jU- —--
4. What particular act or omission on the part of county or district officers,
servants or employees caused the injury or damage?
/ by b y
�K cE 55 gra,Uf� SInOc�'c^� �tal� b�.eM C.(�cw�Nc( UP �
oce �d� csr �►-) pu.-pe5,,1, i4- i5 a �r Jub cc�vsi,n ha ted i-c�o�t� �(��v �5 . iw�e bc�s�cl�
h k c a.-y rn y w \clow w as b u-oko_,,, , L4, kc y- c3 ray ( 1 �'� b,� In s Jn b h i f wX Y w 1 cl oc�
and vn4 d��v�U fEa.� viELi-) wtZrrov , ecA- cwv, k'P_C_" VLL
Po�ss�ng Cc�.�^S: T iw.pQ.ek a as i�Tk� s�a.v.cl�'�. r��zac (over) bast- bc-((
bEtVL!�
5. What are the names of .county or district officers, servants or employees causing
the damage or injury? V.U e a vvti S a(t I
------ —,..��-------------------------------------------------------------------
5. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
�rok�1 u'ou1,C��Gti e�
7. How was the amount claimed .above computed? (Include the estimated amount of any
prospective injury or damage.)
-Ao t Deal oJlass eco w10�cLv� i s , -kkc 5 e CLr R- +I&k_ (6o o t v-S q i v Gln 4 o vc
-------------------------------------------------------------------------------------
8. Names and addresses of witnesses, doctors and hospitals.
nC F QA-S C�J cA—k i✓l Sv V-'IS v\C u : -V\-P S S C S ; Jv S`,' c v► 4\ -
0C Q L'YTlaY cA(& C S 4 kc,+ uc.'c e Mu s Fcl S vo a.le.i-
cf Q til a_ S-----------------V� �% c I+e 5------------- --------------------------- ---
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
� �- Gov. Code Sec. 910.2 provides:
The claim must be signed by the claimant
SEND NOTICES TO: (Attorney) or by some person on his behalf."
Name and Address of. Attorney
Claimant's Signature
Address
�4.51_n�c1
tci o r V-
Telephone No. Telephone No. x a 5 9
�1 to:3UA�+n �c� 3;ct�P�ti1
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 ($1,000), or by both such imprisonment and fine, or byimprisonment in
the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by
both such imprisonment and fine.
SAFELITE AUTO GLASS
C �(
NAME G' -•��� DATE v?- +v�
ADDRESS YR.&MAKE <-�reA
INS.CO. BODY STYLE 2C11
^ h�
CAQ-
AGENT ESTIMATED BY: `-' v tL—K
ADDRESS ESTIMATE GOOD FOR 30 DAYS
OTY. ITEM/SIZE DESCRIPTION PRICE DISC. AMOUNT
l cl l3�
t
l
s -
MERCHANDISE TOTAL �(
SALES TAX -77
LABOR
SUB TOTAL
CUSTOMER'S SIGNATURE
XGA �Q� LESS DEDUCT
tJ� TOTAL 2��
E Delta Glass 6 1 -' 1
T 101 Railroad Avenue
Mess Antioch, California 94509
(415) 757-5300
DATE > 1_#� 14
NAME ���
ADDRESS PHONE NO,
108 LOCATION _ PHONE NO.
INS. CO. l ' �Yl �C4 -Y)
ON
DESCRIPTION) AMOUNT
I
i . F
I
CLAIM
BOARD OF".SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against`the County, or'District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 27 , 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $195. 5 0 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: DENNIS GARCIA
3917 Warbler Drive
ATTORNEY: Antioch, CA 94509
Date received
August 22 , 1988
ADDRESS: BY DELIVERY TO CLERK ON Au g
BY MAIL POSTMARKED: August 19, 1988
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: August 23 , 1988 gy1L BATCtyLOR, Clerk
L. Hall
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).
( ) Other:
e--,Z
Dated: BY: — .r�- / �_ 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 0 DER: 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: SEP 2 7 1988 PHIL BATCHELOR, Clerk, By Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately.
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
!!^ited 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 an 'Notic to Claimant, addressed to
the claimant as shown above.
^at^d: SEP 218 1968
BY: PHIL BATCHELOR byeputy Clerk
CC: County Counsel County Administrator
Claim to: BOARD OF .SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. Claims relating to causes of action for death or for dn_ to personjmr, :to'per-
sonal property or growing crops and which accrue on or before December 31,1987,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for death or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the acc3rual ,of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. Code §911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors�at its office in
4om..306,--.County...Administration. Building, 651 Pine Street, Martinez,_M $4553.
C. If claim is against a district governed by the Board of Supervisors, rather than
the County, the name of the District should be filled in.
D. If the claim is against more than one public entity, separate claims must be
filed against each public entity.
E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this
form.
RE: Claim By ) Reserved for Clerk's filing stamp
)
Ii
RECEIVED
Against the County of Contra Costa )
or ) I.U G 2 21988
District) ORFill in name ) CL�YNTR*
By
The undersigned claimant hereby makes claim against the County of—Mnra osta or
the above-named District in the sum of $ 1 q D ..= s.�-�
.1' and in support of
this claim represents as follows:
-------------------------------------------------------------------------------------
1. When did the damage or injury occur? (Give exact date and hour)
--------------------`�-`� -- `__�J��1�------------------------------------------
2. Where did the damage or injury occur? (Include city and county)
Cc�__�
3. How did the damage or injury occur? (Give full details; use extra paper if
required)
4. What particular act or omission on the part of county or district officers,
servants or employees caused the injury or damage?
C
��r �
f-�
1 t
(over)
5. What are the names of county or district officers, servants or employees causing
the damage or injury?
_,I'-
6.
5. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed 'Attach two estimates for auto damage.
to
YIC�`��� 1 SLC` ( r
-------------------------------------------------------------------------------------
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
ne
____________________________________________________________________________________
8. Names and addresses of witnesses, doctors and hospitals.
-------------------------------------------------------------------------------------
.
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
. s
' * "*"* *
Gov. Code Sec. 910.2 provides:
. "The claim must be signed by the claimant
SEND NOTICES TO: (Attorney) or by some person on his behalf."
Name and Address of,Attorney
Claimant's Signatwe
Jw V r�
Address
Telephone No. Telephone No. 7.j
N O T I C E
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 ($1,000), 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.
y
ESTIMATE HARMON GLASS Na , 29281
Dri
QUOTATION TO �/q DATE (f
ADDRESS RESIDENCE PHONE '�S�G
CITY BUSINESS PHONE
QUANTITY MATERIALS /, UNIT PRICE AMOUNT
�^ .SLC Ya e 4eG�il�[.-t .
THIS ESTIMATE IS SUBJECT TO CHANGE AFTER 30 DAYS
77.
GLASS ON THE �Q�a ME �3 �}
111'1 East'-12th-Street :-` -
OAKLA ND, CALIFORNIA 94606
.
6 NAMtE. .. - :....,, <• _ - DATE OF ORDER
ADDRESS - - :RES PMDNE -- i .. ✓
'auS PHONE
r .
' INSURANCE CO-/AGENT P013CY NO
ADDRESS
ri s
DELIVERY DIRECTIONS {�./�J- - •� ,+q 's...'�
30 FURNISH 8 INSTALL
ri FURNISH ONLY �`
X •i SOLD BY CASH CHECK C.O.D.COOCHARGE ON ACCT _
5 fl WILL CALL ❑DELIVER
"`r' 1ZE3£8Gi31PT10N131 � �
m
1 �
r a ,t
& DESCRIPTION OF WORK
ik
MOBILE AIM/PM ADDRESS I
01,
.SHOP "IND WTO
^ µ
,DEALER-PAM DATE ORDERO DUE INO '
TOTAL
f STATEMENT.OF AUTHORIZATION AND SATISFACTION MATERIAL
° Repkacement has been made to my satisfaction and I hereby TOTAL U
3~ 'authorize the above insurance company to pay direct in full to the LABOR
=above listed firm for.said installation.If for any reason the insurance
s� company does not pay for these repairs or replacements,the below TAXA
signed agrees to pay for said repairs or replacement.
_SUB
;TOTAL G... �
SIGNATURE ❑sDEPOSIT.
❑.DEDUCTIBLE. ,•,
DATE NOTAL
:RECEIVED.BY - ' -
,
• CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 27, 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $312. 7 1 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: LISA DILLAU
22 East 6th Street #1
ATTORNEY: Antioch, CA 94509
Date received
ADDRESS: BY DELIVERY TO CLERK ON August 22 . 1988
BY MAIL POSTMARKED: August 19, 1988
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
August Pp
23 , 1988 HHIL BATCHELOR, Clerk
DATED: g BY: Deputy
L. Hall
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
•ounty Counsel
( ) Other: ACJ G 2 3 1988
4553
,i
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 0 ER: 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' Order entered in L:ty
for
this date. ry app
Dated: SEP 2 ( 19% PHIL BATCHELOR, Clerk, By - Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately.
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 an Notic to Claimant, addressed to
the claimant as shown above.
SEP.2 8 1989
Dated: BY: PHIL BATCHELOR by eputy Clerk
CC: County Counsel County Administrator
a
r
DATE TIME �-----
)
ORDERED BY ry - CALLBACK ❑
COMPANY NAME
DELIVER BY
QUANTITY DESCRIPTION
{ } E
,k
69
_�— 1
Libbey- wens-Ford Co. Bay Cities Glass
Glass Centers
A member of the Pilkington Group
LOF Glass Center
2012 N.Main Street
Walnut Creek,CA 94596
(415)944-0112
(800)972-0908
0
4
i
Claim tb: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for death or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. 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 See. 72. at the end of this
form.
RE: Claim By ) Reserved for Clerk's filing stamp
)
RECEIVE®
Against the Countof Contra Costa )
or ) AU 2 21988
District) t,
Fill In name ) CLERWPHIA P RV , 5B e
The undersigned claimant hereby makes claim against sta or
the above-named District in the sum of $ 3j , '`] L and in support of
this claim represents as follows:
-------------------------------------------------------------------------------------
1. 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 damage or injury occur? (Give ;K-1-details- use extra par if
required) -r6l5 05 G<J6,71�7�17/Oly'�C, 3ijo �ijr�i c�y O pcJo�r� o)v
a �S!yt. o2Srr�.r��F/" L�os� '! e 1.04e- 16el"?Vc,
/e1,42e
__ The rave/ Was very loose, _.I fie%eve ��w�.s ��e �%s� � -
4. What particular act or omission on the part of county or district officers, e
servants or employees caused the injury or damage?
(over)
5. What-are .the names of county or district officers, servants or employees causing
the damage or injury?
-- � -------------------------------------------------------------------------
5. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
/� for /,z �/,�?/'4d0� 9:05 ,4✓�)
� _--t=_ ��de 2e_es�irna,tz .L hCu��
7. How was the amount claimed ab;�ov computed? (Include the estimated amount-of any
prospective injury or damage.)
�i
Per- fitk& ZOOID al- . U/1z&SO 61'465- (5eee
8. Names and addresses of witnesses, doctors and hospitals.
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
/U
Gov. Code Sec. 910.2 provides:
."The claim must be signed by the claimant
SEND NOTICES TO: (Attorney) or by some person on his behalf."
Name and Address of Attorney
aimant's Signature
E X T-,j S T 4/—
(Address)
oe
Telephone No. Telephone No. al.24,2 `f Z-ZOZ! (P ) W
Section 72 of
"Every ] "„ .. W �40 /26 •l /� for
payment to ai „p -/"& e board or
officer, aut] d ep iudulent
claim, bill, sonment in
the county j; OGl /1'�e � exceeding
one thousand tsonment in
the state pr P )0, or by
both such im
AP4 �S u�
T 1C moo , �s e , iso `i
o c e
kIZI i2 Q _
24
04
h r.� R o _.._.
Zvi
CLAIM 1"2-5
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 27 , 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $1,000, 000. 00 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: WILLIAM DALE CURL, JR. , A MINOR, BY AND THROUGH HIS GUARDIAN AD LITEM
WILLIAM DALE CURL
ATTORNEY: c/o Laurence F. Padway
Padway & Padway Date received
ADDRESS: 515 6th Street BY DELIVERY TO CLERK ON August 22 , 1988
Oakland, CA 94612
BY MAIL POSTMARKED: August 19, 1988
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: August 23 , '1988 EVIL BAeTputyLOR, Clerk
S
L. Hall
I1. FROM County Counsel TO: Clerk of the Board of Supervisors
( 7 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).
County Counsel
( ) Other: AUG 2 3 1988
Martinez 94553
! n
Dated: ! Ci BY: . Deputy County Counsel
1 t
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 DER: 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.
SEP 2 7 1956
Dated: PHIL BATCHELOR, Clerk, By Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6. '
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant as shown above.
SEP 2 8 '1988
Dated: BY: PHIL BATCHELOR by y Clerk
CC: County Counsel County Administrator
1
i
1
LAURENCE F. PADWAY
2 PADWAY & PADWAY
A Professional Corporation
3 515 Sixteenth Street
Oakland, CA 94612
4 (415) 465-1910
5
Attorneys for Claimant
6
7
8
9 CLAIM AGAINST PUBLIC ENTITY
10
11 In the matter of the claim of
12 WILLIAM DALE CURL, JR. , a minor,
by and through his Guardian Ad
13 Litem WILLIAM DALE CURL, �3
14 Claimants,
15 VS.
ao
16 COUNTY OF CONTRA COSTA,
STATE OF CALIFORNIA, �y
17 Does 1 Through 50,
18 Public Entities and
Employees.
19 /
20
21 William Dale Curl Sr. , as Guardian of William Dale Curl,
22 Jr. , a minor, hereby presents this claim to the the County of
23 Contra Costa and the State of California pursuant to Section
24 910 of the California Government Code.
25
26 1. The post office address of Claimants is a follows:
27 3134 Catalpa Street, Martinez, California 94553 .
28
-1-
1 2. The post office address to which Claimant desires
2 notice of this claim to be sent is as follows: Laurence F.
3 Padway, Padway & Padway, A Professional Corporation, 515
4 Sixteenth Street, Oakland, California 94612 .
5
6 3. On August 13, 1988, at the Contra Costa County Fair
7 Ground in Antioch, California, claimant received personal
8 injuries under the following circumstances: Claimant fell
9 through the widely spaced vertical members of the railing of
10 the bleachers, landing on the asphalt surface below.
11
12 4. This claim is based on negligent design and
13 construction and non adherence to public safety of the
14 bleachers.
15
16 5. Claimants received personal injuries in the above
17 accident. The nature and extent of the injures and the amount
18 of damages is not known.
19
20 6. The amount of this claim is $1, 000, 000. 00 per
21 Claimant.
22
23 DATED: August1988.
24 PADWAY & PADWAY
A Professional Corporation
25
26
27 By
LAURENCE F. PADWAY
28 Attorneys for Claimant
-2-
' CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 27 , 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $2 , 666 . 31 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: DARRYL C. BLOOM
5255 Clayton Road #221
ATTORNEY: Concord, CA 94521
Date received
ADDRESS: BY DELIVERY TO CLERK ON August 22, 1988 hand del .
BY MAIL POSTMARKED: no envelope
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: September 23 , 1988 PpHHIL ATCHELOR, Clerk
BY: Deputy
L. Hall
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).
County Counsel
( ) Other: C:I I G 2 3 19A
/' I Martinez, eA 53
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' Order entered in its minutes for
this date.
Dated: SEP 2 7 1988 PHIL BATCHELOR, Clerk, By Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately.
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 Noti to Claimant, addressed to
the claimant acs shown above.E
Dated: 2 8 190XVBY: PHIL BATCHELOR by uty Clerk
CC: County Counsel County Administrator
Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not later than the 100th day after the accrual of'•the:cause pf
action. Claims relating to causes of action for death or'�for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be _presented not later than six,months,-after the accrual..of the{ cause
of action. Claims relating to any other cause of 'action must'be presented not
later than one year after the accrual of the cause of action. (Govt. Code S911.2.)-
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
arm.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
RE: Claim By ) Reserved for Clerk's filing stamp
Against the County of Contra Costa )
) 1?U G.
orO
219.flfl�
District) CLE P LB HE EF1 SQA
Fill in name ) ON S
9y .G.. uty
The undersigned claimant hereby makes claim hist 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)
Q�trri-4-------------------------------------------
2. Where did the damage or injury occur? (Include city and county)
3• How did the damage or in 'ury C cur? (Give full details; use e ra paper if
re ui d).,f (J45 oihq 6 /wtr Loml_-1 /X&On j,j / Soo-,
q, s � !< 1� �Lr � " 7�1/�° L'L �� J" � yOl./ �1frr�
-'i t Cyr Save e't� Gine/ St+rj /'16�riu "S 4*0wha1. ct w twb
-----------------------------------
4. What particular act or omission on the part of county or district officers,
servants or employees caused the injury or damage?
(over)
5. What are the names ofcountyor district officers, servants or employees causing
the damage or injury?
Vvn --------------
-------------- --------
5. What damage or injuries'Two you claim resulted? (Give full extent of injuries or
0►damages
amag � <- rio Attac4 two estimates� fforato, e°��5� cr(�L Over,
CX4 r,
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
—�1
8. Names and addresses of witnesses, doctors and hospitals.
-------------------------------------------------------------------------------------
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
Gov. Code Sec. 910.2 provides:
"The claim must be signed by the claimant
SEND NOTICES TO: (Attorney) or by some person on his behalf."
Name and Address of Attorney^
Claimants Signature
ddress
UhC4,,,/
Telephone No.
p Telephone No.
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, br�to aby 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, i6`-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 ($1,000), 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.
, ^
Damage Report 2068 08/16/88 Page 1
EK P4 K,FR EK 13 do%ILA 0-1:1 13 UZI RED"W" 611;
================================================
1950 ARNOLD IND . PL. , CONCORD, CA, 94520
(415) 680-0707
FEATURING STATE OF THE ART EQVIPTMENT Q TECHNOLOGY IN COLLISION REPAIR
Vehicle Owner : Vehicle : Insurance :
.................................................... ............................ ..................................
DARRYL BLOOM 88 CHEVROLET
5255 CLAYTON RD APT . *221 IROC
CONCORD WHITE
CA 94521 2HNNSTS
Work : (415) 754-0350 Mileage :
Home ' (415) 685-7223 Vehicle ID Number
Date of Loss : O/OO 101FP2180JL155629
-------------------------------------------------------------------------------
-- DAMAGE REPORT Written By JOHN ENDRES -- -------
Item Price Price Metl Mech Oth Paint
-------------------------------------------------------------------------------
C I. Repair A Straighten FRONT HOOD 0.5
C 2. 0npoi, 8 Straighten LEFT DOOR 1.5
C 3. Repair 8 Straighten LEFT ROCKER PANEL 01
C 4. Repair I Straighten LEFT QUARTER PANEL 0.5
C 5. Repair A Straighten RIGHT QUARTER PANEL 1.0
C 6- Uonui, I Straighten RIGHT ROCKER PANEL 0.3
C 7. Repair 8 Straighten RIGHT 0U0k 0.3
C B. Hpoai, I Straighten RIGHT FENDER 03
C 9. Remove X Replace 08oT FRONT HEAD LAMP LOW BEAM $ 22-85 0.3 .
C 10. kpnai, A Straighten FRONT 8UMr[8 CUv[x
C 11. Kemmwp I Replace ALL DECALS V 69-55
C 12. Remove X Re-Install ALL NECESSARY TRIM 0.5
C 13. Refinish COMPLETE ACRYLIC URETHANE 26.0
C #. Refinish 2-STAGE 8.0
C 15, Paint Material Supplies $ 300.00
: 16. Sublet Repairs RENT A CAR $ u^s ho
DAMAGE REPORT SUMMARY
METAL LABOR $ , 575 . 40 . . . . 13. 7 hours @ $ 42 . 00 per hour
PAINT LABOR $ 1 ,428 . 00 . . . . 34 . 0 hours 0 $ 42 . 00 per hour-
PARTS
ourPARTS $ 92 . 40
PAINT MATERIALS $ 300 . 00
SUBLET $ 245 . 00
SALES TAX $ 25 .51
DAMAGE REPORT TOTAL $ 2^666 . 31
===============================================================================
Insurance Payable Repair Total $ 0 - 00
Customer Payable, including Deductible $ 2, 666 . 31
ESTIMATE OF REPAIRS
Martinez Auto Body Shop
701 ESCOBAR STREET— MARTINEZ,CALIFORNIA 94553
Telephone 228-3689 • ALL WORK GUARANTEED
Ow n e r Dole /� - (�
Address S ,A! 41`0 ` I`�� /� P 1• �� ►hero ERI. No.
Insurance Co. Order No.
MA.! Ac Y(AR MODE, BODY yIYIE MOTOR NUMBER LICENSE EAGE UAIE OF ASSIGNMENT
Cj[/ccC
SY^^` FRONT ouRs PARTS SYMBOL LEFT LAS PARTS SYMBOL RIGHT LABOR PARTS
FENDER ,
6 3R.1 FENDER SHIELD FET.Z:,Ek SHIELD
FENDER MLDG FENDER MLDG
?., r••%�P HEADLAMP HEADLAMP
HEADLAMP DOOR HEADLAMP DOOR
F�a•st SEALED BEAM SEALED BEAM
c ;.E•npEa COWL COWL
wHFE, DOOR FRONT DOOR. FRONT
DOOR LOCK DOOR LOCK
GOOR HINGE DOOR H.NGE
r• .:;.r,E DOOP GLASS DOOR GLASS
.N C.;E BJP VENT GLASS vENT GLASS
IP ARM SMAFI DOOR MLDG5 DOOR MLDGS
DOOR HANDLE DOOR HANDLE
ARM SHAFT CENIEP POST CENTER POST
LOOP REAR DOOR REAR
a r• ._ «.E,C -.00R �.,LaSS DOOR GLASS
:,C)OP MLDG DOOR MLDG
E P^L-1 ROCKER PANEL ROCKER PANE(
'EE11 _,FAP ROCKER MLDC• ROCKER MLDG
SEER NG w"Ht, SILL PLATE SRL PLATE
"i^PN Petit.. FLOOR FLOOR
3RA'.E, S-t E.D FRAME FRAME
PAR. ;,GH' DOG LEG DOG LEG
GRItLE QUAD PANEL OUAR PANEL
OUAR MLDG GUAR MLDG
OJAR GLASS GUAR GLASS
r ^ MISC.
INSI PANEL
FRONT SEAT
FRONT SEAT A0J
M RQOR REAR HEADLINING
«C,R•v BUMPER TOP
BAF<<E S DE TIRE
BAFFLE .CWER BUMPER BRKT
BAFF;E „PIER BUMPER GO BATTERY
LOCK PLAIE LR GRAVEL SHIELD AINI c
LOCK PLATE JI LOWER PANEL �yy�.(-y
HCOD 'OP ' � nl
Fl OOR rr �
HOOD « NGE TRUNK LID te►erSMw.�= S G 7 .?�=
HOLD MLDG TRUNK LOCK
TRUNK HANDLE MRRRFINR S
TAIL LIGHT n C C,
RAI. SJP TAIL PIPE PARTS YU
RA'. CORE GAS TAN%
RAD:O AN'ENNA FRAME
RAD HOSE
WHEEL T W�G i SUBLET REPAIRS
" (ic,
FAN BLADE HUB & DRUM
wA!ER PUMP TOTAL
CLAIM /
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 27, 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $125 , 000. 00 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: CHARLES HOWARD STANLEY ETAL
c/o Robert J. Athey
ATTORNEY: Ring., Athey & Lane, Inc .
P.O. Box 97 Date received
ADDRESS: Walnut Creek, CA 94596 BY DELIVERY TO CLERK ON August 26, 1988 hand del .
BY MAIL POSTMARKED: no envelope
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: August 26, 1988 PpHHIL BATCHELOR, Clerk
BY: Deputy
L. Hall
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
ounty Counsel
( ) Other: AU G 2 G 1988
Marfinez, CA 94553
Dated: BY: 1 ,---IIeputy 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 DER: 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. c1pO
Dated: SEP 2 ( 19M PHIL BATCHELOR Clerk By_ L��
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
45.6.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.
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 an Notice to Claimant, addressed to
the claimant as shown above.
SEP 2 8 1988
Deted: BY: PHIL BATCHELOR by Clerk
CC: County Counsel County Administrator
R�EC
�'IVED
G 2 6 1988_
CLAIM AGAINST CONTRA COSTA COUN
1 1u'.�Ce.A A .
PHIL BATCHELOR
CL K BO D OF S RVISCRS
CO
ACID
2 By Deputy
TO: Contra Costa County and to Contra Costa County
3 Flood Control and Water Conservation District
4
5 CHARLES HOWARD STANLEY and CAROL ANN STANLEY hereby make claim
6 against Contra Costa County and Contra Costa County Flood Control
7 and Water Conservation District for the sum of $125,000 , and make
8 the following statements in support of the claim:
9 1 . Claimants ' post office address is 3 Blade Court, Walnut
10 Creek, CA 94595.
11 2 . Notices concerning the claim should be sent to Robert J.
12 Athey, Ring, Athey & Lane, Inc. , P. O. Box 97, Walnut Creek, CA
94596 .
13
14 3 . The date and place of the occurrences giving rise to
15 this claim are: every winter in which a downpour of medium to
16 heavy intensity occurs.
17 4 . The circumstances giving rise to this care: Claimants
18 bought their house and lot at 3 Blade Court in Walnut Creek on or
19 about January 21 , 1986 . Almost immediately after moving in that
20 month, and in the weeks following, said property flooded in
downpours which resulted from the overflow of a drainage creek
21
22 running parallel to and across the lower end of said property.
23 The creek, and improvements along and in said creek, including a
24 culvert on Claimants' property, were and are the property of and
25 subject to a drainage easement belonging to the County of Contra
26 Costa, and maintained by its Flood Control District. Claimants
VG.ATHEY& LANE. INC.
A PROFESSIONAL
LAW CORPORATION
1437 NORTH BROADWAY
P.O. BOX 97
VALNUT CREEK.CA 94596
(415) 9350550
have discovered that the culvert does not channel the water fast
1
enough, causing a back-up onto Claimants ' property. The County
2
has continued to permit development upstream and to allow new
3
construction to drain water into the system, exacerbating the
4
problem, constituting a continuing nuisance, and consistently
5
damaging Claimants ' property thereby.
6
7 5 . Claimants ' Damages: Claimants' real property has lost
8 market value of at least $100 ,000, due to the danger of continual
flooding. Further, in 1986 , the County approved a design for
9
10 improving the said drainage system in an attempt to prevent
further flooding. The best estimate obtained at that time was
11
12 $91 , 920 . The County elected to have the upstream developer
13 deposit $30 ,000 into a fund for eventual improvement of the
drainage system, rather than construct the needed improvements.
14
15 The flooding has caused soil erosion, destroyed bushes and
16 ground cover, deposited silt, soil and debris on Claimants'
17 property, and is causing decay in Claimants ' wooden fence.
18 6 . The claim as of this date is $125 , 000 .
19 7 . The basis of the computation is that that amount is
20 estimated to be the 1988 cost of re-designing the drainage
21 system. In the alternative, that figure represents diminution
in the market value of Claimants ' property if the system is not
22
repaired to prevent the flooding from reoccurring.
23
24 ,.-
DATED: August , 1988 .
25 RING, A LANE, INC.
26 ROB;AT J. HEY
JG.ATHEV LANE, INC.
At rney or andIn behalf of
&
A PROFESSIONAL Claimants Charles Howard Stanley
LAW CORPORATION and Carol Ann Stanley
1437 NORTH BROADWAY 2
P.O. BOX 97
VALNUT CREEK.CA 94596
14151 9350550
CLAIM
9bARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 27 , 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $2 , 200 . 00 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: CITY OF RICHMOND
2600 Barrett Ave. '
ATTORNEY: Richmond, CA 94804
Date received
ADDRESS: BY DELIVERY TO CLERK ON August 22, 1988 Risk Manage
BY MAIL POSTMARKED: no envelope
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim. '
August Pp
t 23 , 1988 HHIL BATCHELOR, Clerk
DATED: BY: Deputy
L. Hall
II. FROM/: /County Counsel TO: Clerk of the Board of Supervisors
( v) 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). .
County Counsel
( ) Other: AUG 2 i W8
Martinez, CA 94553
Dated: '"�i� <� c� 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.
SEP 2 7 1988
Dated: PHIL BATCHELOR, Clerk, By Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6. '
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately.
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 a Not' a to Claimant, addressed to
the claimant as shown above.
SEP 2 8 1986 '
Dated: BY: PHIL BATCHELOR by put Clerk
CC: County Counsel County Administrator
city d
Personnel Depart entw"Vo� 00
11•v v �G eP�rl
0�
� 0�Page
August 17, 1988 e�
iRON
Ron Harvey J
Contra Costa County
Risk Management Division
651 Pine Street 6th Floor
Martinez, Ca 94553
RE: CITY OF RICHMOND
ACCIDENT DATE: JUNE 29, 1988
Dear Ron:
Please recall a recent telephone conversation wherein we advised you that a
City of Richmond vehicle was damaged in an accident. The vehicle was being
driven by one County Deputy Matt Rubin involved in a "Hot" pursuit chase.
According to our Police Department's report, the accident occurred as a
result of a driver error when deputy Rubin driving in reverse, applied
his brakes and swerved hitting a curb going in excess of 15 m.p.h.
As we advised you, the vehicle could not be repaired by our Corporation
Yard and was therefore taken for repairs to Nelson Chevrolet. The estimate
for repairs was approximately $2200.00.
We will be forwarding the repair bill to your office for payment as agreed.
If you have any questions regarding this matter, please give me a call.
Very truly yours
Louise Gigliotti
Risk Management Anlayst
LG:np
cc: Bob Pierce, Public Works Department
2600 Barrett Ave. P. O. Box 4046 Richmond California 94804 telephone: 415 620-6602
CLAIM
v
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 27, 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $1, 505 . 07 Section 913 and 915.4. Please note all ."Warnings".
CLAIMANT: FREDERICK J. HANKE
4069 Carson Street
ATTORNEY: Concord, CA 94521
Date received
ADDRESS: BY DELIVERY TO CLERK ON August 22 , 1988
BY MAIL POSTMARKED: August 16, 1988
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
IL gATCHELOR, Clerk
DATED: August 23 , 1988 gb: Deputy
L. Hall
I1. .FROM; County Counsel TO: Clerk of the Board of Supervisors
Y ) 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).
County Counsel
( ) Other:
+ i Martinez, CA 94553
Dated: D BY: Deputy County Counsel
l .
I11. 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: SEP 2 7 1988 PHIL BATCHELOR, Clerk, By Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6. "
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately.
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 a Notice to Claimant, addressed to
the claimant as shown above.
Dated: SEP 2 8 1988 BY: PHIL BATCHELOR by Deputy Clerk
CC: County Counsel County Administrator
TIC INSTITUTE FOR INTERDISCIPLINARY SCIENCE, INC.
RQN "NywEY August 16, 1989
pUG 17 1988
Ron Harvey
Liability Claims Manager RECE
IV E
Risk Management
County Administration Building
651 Pine Street, 6th Floor G 2 219$8
Martinez, CA 94553
p L BAT LR
ERS
AS
Dear Mr. Harvey, °LF' TR A o ty
sy
On March 22, 1988 while stopped at a red light at the corner
of Ygnacio Valley Road and Wiget Lane, I was struck by a fully
loaded dump truck belonging to Contra Costa County and Driven by
one of your drivers (your file # IA 88 157) . A police report was
made out at that time and a gentleman from the county came by to
take several photographs of the damage. On April 4, 1988 I
received a letter from you asking me to fill out a claim form and
to try and get an estimate for the repair. I apologize for the
delay in getting back to you. I was in the process of buying a
house and finally moving throughout April and May and being
without a car while mine was getting repaired was not a good idea
at that time. As I am now settled I would like to proceed with
this matter at this time.
I went to two places for estimates. The first place would
not give me an estimate because their parts books only went back
8 years and they were not interested in getting on the phone to a
dealer for prices. The second place I went was a large Ford
dealership here in Concord, Don Young Ford, Inc. at 1800 North
Main Street. I did manage to get an estimate from them. As you
can see from their enclosed estimate the potential bill comes to
$1,505.07. Let me know if there is anything I should be doing in
order that we can proceed with this matter.
Please note I have now moved to concord. My business address
is the same, and my new home address is as follows;
4069 Carson Street
Concord, CA 94521
Sincerely,
Frederick J. Hanke, Ph.D.
TIC Institute for
325 N. Wiget Ln, Suite 130
Walnut Creek, CA 94598
work (415) 934-6292
home (415) 825-4928
325 North Wiget Lane P.O. Boz 31477 Walnut Creek, CA 94598 TEL: (415) 934-6292 FAX: (415) 934-7021
7.
C,laim.to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not later than the 100th day after the accrual of the cause .of
action. Claims relating to causes of action for death or for injury, to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not -
later than one year after the accrual of the cause of action. (Govt. Code §911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in
Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553•
C. If claim is against a district governed by the Board of Supervisors, rather than
the County, the name of the District should be filled in.
D. If the claim is against more than one public entity, separate claims must be
filed against each public entity.
E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this
form.
RE: Claim By ) Reserved for Clerk's filing stamp
Fredew,f�Ck J, Oavi ke ) RECEIVED
Against the County of Contra Costa ) AUG_2 219A;
or )
District) CLE K PH
AT S EVD
Fill in name ) BY 5 ucY
The undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $ /SdS 0;1
and in support of
this claim represents as follows:
-------------------------------------------------------------------------------------
1. When did the damage or. injury occur? (Give exact date and hour)
---------------------------------------------------
2. Where did the damage or injury occur? (Include city and county)
GsC(s C4
3. How did the damage or injury occur? (Give full details; use extra paper if
required)
4. What particular act or omission on the part of county or district officers,
servants or employees causedthe/injury or damage? / J
ne +rVLIC dNiVtA .S?lA''dl/
bu� �f olld ��v/ i�il 70rh St(rlj�S� IL,,&*WJ h) k+/Gr.1 Ale .i- f 4e-
1'r'Yl�q t� C/1 �o/ti ✓G`n t way w+u� bv� 0 a c..4,+i,.., wi.3 (over) 1-ss ve .
5. What are-.the names of county or district officers, servants or employees causing
the damage or injury?
------- 4 ---11
-------------------- ------
5. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
�2}�='�,---- - A&
-at-fPsa =t-�=��-- ~� �A✓� . �o✓�r� o� cam/' ash"waCz,
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
C-s r Y W r7Jrvt C1�i 4 q tr�
8. \Names and addresses of witnesses, doctors and hospitals.
------�===------------------------------------------------------------------------
9. List the expenditures you made on account of this accident or injury:
DATE/ ITEM / AMOUNT
Gov. Code Sec. 910.2 provides:
. "The claim must be signed by the claimant
SEND NOTICES TO:. ,.(Attorney) or by some person on his behalf."
Name and Address of Attorney /7�
Claimant's Signature
Lln K Cf Ca
Address
Telephone No. Telephone No.
N O T I C E
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 a b�OO rGQp*ent in
the county jail for a period of not more than one year, by It �� exceeding
one thousand ($1,000), or by both such imprisonment and fine, o�b`y`?imprisonment in
the state prison, by a fine of not exceeding ten thousand dollAM(IT�OAQ�d,, or by
both such imprisonment and fine. n}
Risk, '
,r,i'�1`i�s�'Z{ I,l
.
r Elan
°
1 _ • •
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MEN ME�101
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MEQMEN
MME IN
- - _ C�L�®�®■®■:
®■■ �■�■�■�■
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0■■ �I■�■®■e■
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m■■ IMEMINEWIMEW m
I hereby authorize the above work and acknowledge receipt of copy. I
��■�■®■�
.. /
:°- r_,
..
PAINT hrs.
c.,
SuppliesPaint
Sublet/MiscellaneousTowing/Storage $
DON YOUNG FORD, INC.
EPAIWaste 181't �: Disposal
-
Pho
�/l
County Administrator Contra
Risk Management Costa
County Administration Building
651 Pine Street,6th Floor County
Martinez,California 94553
Liability Claims (415)646-4155
Safety (415)646-2203
.r„ ,
Vocational Rehabilitation (415)646-2239 �` ..•
Workers'Compensation (415)646-2926
April 4, 1988
F. Joe Hanke
1275 University Avenue, No. 1
Berkeley, CA 94702
RE: Our File - IA 88 157
Date of Loss: 3/22/88
Dear Mr. Hanke:
You will find enclosed a claim form which should be filled out
and returned to the Clerk of the Board of Supervisors. Your claim
can be processed faster if you include a couple of repair estimates.
I apologize for the inconvenience. If you have any questions,
feel free to call me at 646-4155.
Sincerely yours,
1
RON HAR
Liability Claims t- i ger
RH:la C
Enclosure
CLAIM
BOARD OF SJPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 27, 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $450. 00 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: PAUL D. WEBB
1682 Clayton Road #2
ATTORNEY: C6.ncord, CA 94520
Date received
ADDRESS: BY DELIVERY TO CLERK ON August 25, • 1988
BY MAIL POSTMARKED: August 24, 1988
I. FROM: Clerk of the Board of ,supervisors TO: County Counsel
Attached is a copy of;�the above-noted claim.
August 26, 15`88 PpHHIL BATCHELOR, Clerk
DATED: BY: Deputy
L. Hall
II. FRO
M- County Counsel TO: Clerk of the Board of Supervisors
( 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).
County Counsel
( ) Other: AUG 2 9 igo8
6qft1!iJJe2:, CA 4553
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. BOARDORDER: 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: SEP 2 7 1988 PHIL BATCHELOR, Clerk, By Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6. '
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately.
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 aNotic to Claimant, addressed to
the claimant as shown above.
Dated: SEP 2 8 1988
BY: PHIL BATCHELOR by u y Clerk
CC: County Counsel County Administrator
^: M TO: BOARD; OF SUPERVISORS OF CONTRA CO%TAUrR8Fiyi 11 application to,,
Instructions to Claimant Clerk of the Board
P.O.Box 911
A. Claims. relating to causes of action for death or zo=nin ur rnl 9 533
person or to personal property -or ert y en
` p p p p y or growing crops must be 'presented
not later than the 100th day after the accrual of the cause of
action. Claims relating to any other cause of action must be
presented not later than one year after the accrual of the cause
of action. (Sec. 911. 2, Govt. Code)
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, California 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 end
FF this form.
************************************************************************
RE: Claim by . ) Reserved for Clerk' s filing stamps
1
RECEIVED
Against the COUNTY OF CONTRA COSTA)) [:.'JG 2 5'19K
or DISTRICT)
(Fill in name) )
CLEOZTSOAE v ops
BY ..
- The undersigned claimant hereby makes claim against e ounty of Contra
Costa or the above-named District in the sum of
and inn support of this claim represents as follows :
-1-.--W--h-en---d-id---th--e-d--am--a-g-e--o-r---- �r
---------------- -
injury occur? (Givee-Ra-H ate
and hour)
2. Where di
/fse-a_J3 or injury occur? (Include city and county)
i How did the damage or injury occur? (Give full details , use extra
sheets if required)
- - - - - --- ---
4 What particAi2)�CtV_o__r_omission1 Lon the part ofcounty or district
officers , servants or employees caused the injury or damage?
over) .
5..:: What: are.,the....names of county or district officers, servants
`( �1 ems loyees_causing `the damage or injury?
- - - - -- -- - -- ---
6. What damage or injurie/ you claim sulted?--(Give full extent-
of injuries or dam es claimed. Attach two estimates for auto
damage) L(� PJ
�� t
---------------------------------------------------------------------------
7. How was the amount claimed above computed? (Include the estimated
amount of any prospective injury or damage. ) ell
ao wa— ac,
--- - -- -------------
-- --- - - --- - ------- ---------- - ---- -------
8. Names and 'addresses of witnesses , doctors and hospitals--------------
-----------
-------
K--L'I%-s List the expenditures you made on account of this accident or injury.
r` --M'TE ITEM AMOUNT
i
• � i
F'
Govt. Code Sec. 910.2 provides :
"The claim signed by the claiman-
SEN NOTICES TO: (Attorney) or by some person on his behalf. '
Name and "Address of Attorney5
?_ai ant' s; Sig r?,� � e �=
Address, C
Telephone No. Telephone No.
i NOTICE
Section 72 of the Penal Code provides:
"Every person who, with intent to defraud, presents for allowance or
for payment to any state board or officer, or• to any county, town, city
district, ward or village board or officer, authorized to allow or pay
the same if genuine , any false or fraudulent claim, bill, account , voucher.
or writing, is guilty of a felony. "
._.... ... -- -..w.+....xyc....�e$�+....'��«.-a.::.a:..�.:r.e.'..._ca.• _...-'.::..__....�ti�a.a%..r � '"r ayini�Clii.�...-�a��'��' .i ..�,i:_____ —
38niVNiOIS 32VWN1 {X •.r,
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,. . ;:x.. sv-19no0 -inv4;-883M :3WVN ,
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0�
Alilt�b�.NOUNMa ViS0� VIUN
CLAIM
B,-,RD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 27 , 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $263. 28 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: CALIFORNIA STATE AUTOMOBILE ASSOCIATION INTER-INSURANCE BUREAU
P. O. Box 5001 Policy #B1-08-32-1
ATTORNEY: Antioch, CA 94509
Date received
ADDRESS: BY DELIVERY TO CLERK ON August 2S ,. 1988
BY MAIL POSTMARKED: August 24, 1988
Certified P 785 347 991
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
All gust 26, 1988 PpHHIL BATCHELOR, Clerk
DATED: g BY: Deputy
L. Hall
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
ounty Counsel
( ) Other: AU G 2 G 1988
Martinez. 4553
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: SEP 2 7 1988 PHIL BATCHELOR, Clerk,
Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately.
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 an otice to Claimant, addressed to
the claimant as shown above.
Dated: SEP 2 8 1988
BY: PHIL BATCHELOR by puty Clerk
CC: County Counsel County Administrator
Giaitii For Damages
In accordance with Section 910 of the California Government Code, this is to formally place you on
notice of our subrogated claim for the loss described below.
.�. W-01"
RECEIVE® Date: August 11th 19 88
WWO• NJ G 2 51988 Antioch
California
A.; H OF
CLEP. 8 TRA 0 ��'�Fp'],�'�(;
uty
By
Claim is hereby made and filed against the County of Contra Costa
as follows:
Name of Claimant:
California State Automobile Association Inter-Insurance Bureau
Address of Claimant:
(Send notices to this address) P. 0, Box 5001. Antioch, CA 9450)9
Date of Occurrence:
July 29, 1988
Place of Occurrence:
Kirker Pass, Pittsburg. rA 94565
Nature and Amount of Damages
Rocks rrarked windczhiald
Items Making up said Amount:
windship1d
Name of Public Employee(s)
causing said Damage(if known):
(;,p„�nt-3t �u��r�M��PtQAQPsQ
Facts & Details:*
Gravel was kicked up by vehicles driving on freshly paved road, causing
windshield to get pitted.
California State Automobile Association
Inter-Insurance Bureau
By:
F1688 (REV.5-78)
, . -s,.- ° assi nment of claim and
�.�'..
subrogation agreement
In consideration of the payment to the undersigned of 0 the sum of Two Hundred Sixty—Three
❑ a sum estimated to be
and28/100--------------------------------------------------------------------------------
Dollars, being the full amount of loss and damage insured against under an automobile insurance policy, number
B1-08-32-1 issued to the undersigned by the CALIFORNIA STATE AUTOMOBILE ASSOCIATION
INTER-INSURANCE BUREAU, said loss and damage having occurred on or about the 28th day of
July 19 88 the said undersigned hereby assigns and transfers to said Bureau
said claim in the above amount plus —0— additional claim for damage resulting from said accident, not
policy 263.28 g ® a total
covered under said otic of insurance, in the amount of$ , constituting 1771a total estimated claim
in the amount of $ 263.28
Said Bureau is hereby subrogated in their place and stead to the extent of the above amount of the said
total claim and is hereby authorized and empowered to sue, compromise or settle in their name or other-
wise to the extent of said total claim for loss and damage, and to endorse in my name any check made payable to
me therefor, and collect and receive any money payable thereby.
The undersigned covenants that he ha s not released or discharged any such claim or demand against
such party or parties and that they will furnish to said Bureau any and all papers and information in
possession, necessary for the proper prosecution of such claim.
Dated at 1��CA �� this U day of
J
� 1
WITNESS
F1433 (REV.7-77)
THIS DRAFT MUST BE PROPERLY r
ENDORSED 1ON THE REVERSE SIDE I 1
coa
M °ga ..
cw
1--ab00
a
Cal
cn
t✓ iE� ti: \ l Il?
it
4+ s= 2
cc
44
Fj
U ". t.. C
a
og
o r V
Im Y <
Z Z
W Q Q
O .I'.•• O d owo
x it 0
DAN'S CONTRA COSTA GLASS
MOBILE GLASS 9ER VICE rt �. i;2 i L C 1"3
Specializing in Auto Glass
Residential& Commercial A,��� ��.!•I 19��
1140 ERICKS �'ROAD
CGN.COR43,,CA 94520
(415) 827-4173
NAME (J DATE
�^ 11 / � 1
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AL
`= CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September-'27 , 1988
and Board Action. All Section references are to ) The copy df this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $169 . 9 6 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: CALIFORNIA STATE AUTOMOBILE ASSOCIATION INTER-INSURANCE BUREAU
P. O. Box 5001 Policy # K4-40-28-1
ATTORNEY: Antioch, CA 94509-0951
Date received
ADDRESS: BY DELIVERY TO CLERK ON August 23 , 1988
BY MAIL POSTMARKED: August 22 , 1988
Certified P 785 347 999
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: August 23, 1988 JbIL ELOR, Clerk
gATCH: Deputy
L. Hall
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).
( ) 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).
County Counsel
( ) Other:
Martinez, CA 94553
Dated: ? (>� BY( / . i Deputy County Counsel
J
1II. 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. BOAZT
DER: By unanimous vote of the Supervisors present
( his 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: SEP 2 7 19� PHIL BATCHELOR, Clerk, By kZ Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6. '
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant
as shown above.
SEP C P 2 8 10JING
BY: PHIL BATCHELOR by puty Clerk
CC: County Counsel County Administrator
assi nment of claim and RECEIVED.
subrogation agreement ALIG 23 1988_
CIEn A A
�J
In consideration of the payment to the undersigned of ❑® the sum y.-
a sum estimated to be
and96/100---------------------------------------------------------------------------------
Dollars, being the full amount of loss and damage insured against under an automobile insurance policy, number
K4-40-28-1 issued to the undersigned by the CALIFORNIA STATE AUTOMOBILE ASSOCIATION
INTER-INSURANCE BUREAU, said loss and damage having occurred on or about the 25th day of
June 19 88 the said undersigned hereby assigns and transfers to said Bureau
said claim in the above amount plus —0— additional claim for damage resulting from said accident, not
169.96 ® a total
covered under said policy of insurance, in the amount of$ , constituting ❑ a total estimated claim
in the amount of $ 169.96
Said Bureau is hereby subrogated in their place and stead to the extent of the above amount of the said
total claim and is hereby authorized and empowered to sue, compromise or settle in their name or other-
wise to the extent of said total claim for loss and damage, and to endorse in my name any check made payable to
me therefor, and collect and receive any money payable thereby.
The undersigned covenants that he ha s not released or discharged any such claim or demand against
such party or parties and that he will furnish to said Bureau any and all papers and information in his
possession, necessary for the proper prosecution of such claim.
Dated at this day of 19—
WITNESS
9 .WITNESS
F1433 (REV.7-77)
Claim For Damages
In accordance with Section 910 of the California Government Code, this is to formally place you on
notice of our subrogated claim for the loss described below.
Date: August 9, 119 88
Antioch , California
Claim is hereby made and filed against the County of Contra Costa
as follows:
Name of Claimant:
California State Automobile Association Inter-Insurance Bureau
Address of Claimant:
(Send notices to this address) P• 0. BOX 5001, Antioch, CA 94509-0951
Date of Occurrence:
June 25, 1988
Place of Occurrence:
Kirker Pass
Nature and Amount of Damages
pitted windshield
Items Making up said Amount:
windshield
Name of Public Employee(s)
causing said Damage(if known): County Road Maintenance
Facts & Details:
Loose gravel on freshly paved road was kicked up and cracked insured's
windshield
California State Automobile Association
Inter-17yfance Bureau
F1688 (REV.5-78)
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`�.: DAN'S CONTRA COSTA GLASS
MOBILE GLASS SER VICE u 11
Specializing in Auto Glass «r
•_ Residential& Commercial
1140 ERICK,SONtOAW
CONCORD, CA 94520
(41 S) 827-4173
DATE
NAME (.( L s��f""
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ADDRESS F.O.B. INYOiCE NO. /BY p C.O.D.
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INSURANCE AGENT PHONE( } ( ~
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CLAIM
BOAPD- OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District.governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 27, 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $303 . 39 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: CALIFORIIIA STATE AUTOMOBILE ASSOCIATION INTER-INSURANCE BUREAU
P. O. Box 5001
ATTORNEY: Antioch, CA 94509 Policy # 67-72-68-5
Date received
ADDRESS: BY DELIVERY TO CLERK ON August 25, 1988
BY MAIL POSTMARKED: August 23 , 1988
Certified P 785 347 992
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim. eeHH gB
DATED: August 26, 1988 BYjL DeputyLOR, Clerk
L. Hall
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).
County Counsel
( ) Other: AUG 2
Martinez, CA 94553
ZZ&ADated: BY eputy 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. BOARDER: 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 rder entered in its minutes for
this date.
Dated: SEP 2 7 1988 PHIL BATCHELOR, Clerk, By Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid .a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant as shown above.
Dated: S E P 2 8 1988 BY: PHIL BATCHELOR by y Clerk
CC: County Counsel County Administrator
assignment of claim an RECEIVED
``✓ subrogation agreement AUG 25196
P E R 1 RS
GL A.
8
In consideration of the payment to the undersigned of 51 the sum of ree undred Three
❑ a sum estimated to be
and39/100---------------=----------------------------------------------------------------
Dollars, being the full amount of loss and damage insured against under an automobile insurance policy, number
67-72-68-5
issued to the undersigned by the CALIFORNIA STATE AUTOMOBILE ASSOCIATION
INTER-INSURANCE BUREAU, said loss and damage having occurred on or about the 1st day of
July 19 88, the said undersigned hereby assigns and transfers to said Bureau
said claim in the above amount plus —0— additional claim for damage resulting from said accident, not
covered under said policy of insurance, in the amount of$ 303.39 , constituting ® a total claim
❑ a total estimated
in the amount of $ 303.39..
Said Bureau is hereby subrogated in their place and stead to the extent of the above amount of the said
total claim and is hereby authorized and empowered to sue, compromise or settle in their name or other-
wise to the extent of said total claim for loss and damage, and to endorse in my name any check made payable to
me therefor, and collect and receive any money payable thereby.
The undersigned covenants that he ha s not released or discharged any such claim or demand against
such party or parties and that they will furnish to said Bureau any and all papers and information in
possession, necessary for the proper prosecution of such claim.
Dated at 'n this day of 04L)C•UT 7"_
WITNESS
F1433 (REV.7-77)
Claim for Damages
In accordance with Section 910 of the California Government Code, this is to formally place you on
notice of our subrogated claim for the loss described below.
Date: August 3 _, 19 88
Antioch , California
Claim is hereby made and filed against the Kounty of Contra Costa
as follows:
Name of Claimant:
California State Automobile Association Inter-Insurance Bureau
Address of Claimant:
(Send notices to this address) P. 0. SOX 5001, Antioch, CA 94509
Date of Occurrence:
July 1, 1988
Place of Occurrence:
Kirker Pass, Pittsburg, CA 94565
Nature and Amount of Damages
Rocks cracked windshield
Items Making up said Amount:
windshield
Name of Public Employees)
causing said Damage(if known): County Road Maintenance
Facts & Details:
Gravel was kicked up by vehicles driving on freshly paved road, causing
windshield to get pitted.
California State Automobile Association
Inter-Insurance Bureau
By:
F1688 (REV.5-78)
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G. ROSE & SONS -
230 Chestnut Street JOB WORK ORDER
Brentwood, California 94513 DATE OF ORDER
(415) 634-5609
CUSTOMER'S ORDER NO. PHONE STARTING DATE
BILL TO ORDER TAKEN BY
� 1 1
ADDR s� ❑ DAY WORK
❑ CONTRACT
CITYIT (
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JOB NAME AND LOCATION
RIPTION OF WORK / JOB PHONE
Ar,'r(7,e,/v L))/ Z2
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TOTAL MATERIALS 1 `
TOTAL LABOR /�
TAX ��✓
DATE COMPLETED WORK ORDERED BY TOTAL AMOUNT $
I herebv acknowledge the satisfactory completion J
of the above described work. ❑No one home ❑ Total amount due ❑ Total bJlmq to
In,above work or be maned when
lob finished
Signature TERMS 30 DAYS
Any portion of the previous balance remaining unpaid 30 days after the end of the month follow-
ing purchase will be subject to a finance charge of 1 and one-half percent. (18 percent per annum).
APPLICATION TO FILE LATE CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
BOARD ACTION
September 27 , 1988
Application to File Late Claim ) NOTICE TO APPLICANT
Against the County, Routing ) The copy of this document mailed to you is your
Endorsements, and Board Action.) notice of the action taken on your application by
(All Section References are to ) the Board of Supervisors (Paragraph III, below),
California Government Code.) ) given pursuant to Government Code Sections 911.8 and
915.4. Please note the "WARNING" below.
Claimant: SANDRA D. STACY, A MINOR County Counsci
c/o David S. Thomas , Esq of Rockwell & Thomas
Attorney: 1610.- "A" Street AUG 2 G 1988
Antioch, CA 94509
Address: Martinez, CA 94553
Amount: $500, 000. 00 By delivery to Clerk on August 25, 1988 hand del
Date Received: August 25 , 1988 By mail, postmarked on no envelope
I. FROM: Clerk of the Board of Supervisors 70: County Counsel
Attached is a copy of the above noted Application to File Late Claim.
DATED: August 25 , 1988 PHIL BATCHELOR, Clerk, By Z' _ Deputy
L. Hall
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
( ) The Board should grant this Application to File Late Claim (Section 911.6).
( -L"y- Th Board should deny this Application to File La 'm Uon .6).
DATED: VICTOR WESTMAN, County Counsel, Deputy
, &- V - 1-1-i
III. BOARD ORDER By unanimous vote of Supervisors present
(Check one only)
( ) his Application is granted (Section 911.6).
( This Application to File Late Claim is denied (Section 911.6).
I certify that this is a true and correct copy of the Board's Order entered in its
minutes for this date.
SEP 2 7 1988
DATE: PHIL BATCHELOR, Clerk, By Deputy
WARNING (Gov. Code 3911.8)
If you wish to file a court action on this matter, you must first petition the
appropriate court for an order relieving you from the provisions of Government Code
Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such
petition must be filed with the court within six (6) months from the date your application
for leave to present a late claim was denied.
You may seek the advise of any attorney of your choice in connection with this
matter. If you want to consult an attorney, u should do so immediatel .
IV. FROM: Clerk of the Board TO: 1 County Counsel 2 County Administrator
Attached are copies of the above Application. We notifed the applicant of the
Board's action on this Application by mailing a copy of this document, and a memo thereof
has ben filed and endorsed on the Board's copy of this Claim in accordance with Section
29703.
DATED: SEP 2 8 1988 PHIL BATCHELOR, Clerk, By
Deputy
V. FROM: 1 County Counsel 2 County Administrator TO: Clerk of the Board
of Supervisors
Received copies of this Application and Board Order.
DATED: 'County Counsel, By
County Administrator, By
APPLICATION TO FILE LATE CLAIM
1 DAVID S. THOMAS
ROCKWELL & THOMAS
2 1610 "A" Street HdWft)
Antioch, CA 94509 �1 C'
3 Telephone: (415) 757-4545 Il:'JG 251988
4 Attorneys for SANDRA D. STACY,
a minor, by and through aE�►c P" C I P F o;,c
5 RONALD G. STACY, her natural s c r
By
puty
father.
6
7 IN THE MATTER OF APPLICATION FOR LEAVE TO
THE CLAIM OF PRESENT LATE CLAIM
8 SANDRA D. STACY, a minor, (Government Code §911.4)
9 Claimant,
10 vs
11 COUNTY OF CONTRA COSTA/
12 TO: BOARD OF SUPERVISORS, CONTRA COSTA COUNTY:
13 1. Application is hereby made for leave to present a late
14 claim under §911.4 of the Government Code. The claim is founded
15 on a cause of action for personal injury and property damage
16 which occurred August 29, 1987, and for which a claim was not
17 timely presented. For additional circumstances relating to the
18 cause of action, reference is made to the proposed claim attached
19 hereto as Exhibit "A" and made a part hereof.
20 2. The reason for the delay in presenting this claim is
21 that the claimant was a minor during all of the period when the
22 claim should have been presented is shown by the Declaration of
23 Ronald G. Stacy attached hereto as Exhibit "B" and made a part
24 hereof.
25 3. A further reason for the delay in presenting this claim
26 is the mistake, inadvertence, surprise, and excusable neglect of
1
LAW OFFICES OF
ROCKWELL i THOMAS
ANTIOCH,CALIFORNIA
TELEPHONE 7574545
1 claimant and her attorneys DAVID S. THOMAS, as more particularly
2 shown in the declarations of claimant's father, RONALD G. STACY,
3 and attorney DAVID S. THOMAS, attached hereto as Exhibits "B" an
4 "C, " respectively, which are .incorporated herein by reference.
5 The County of Contra Costa was not prejudiced by the failure t
6 timely file the claims as further shown by the declaration o
7 attorney DAVID S. THOMAS in Exhibit "C. "
8 This application is presented within a reasonable time
9 after the accrual of the cause of action as shown by the
10 declarations of claimant and attorney DAVID S. THOMAS.
11 WHEREFORE, it is respectfully requested that this
12 application be granted and that the attached claim be receive
i3 and acted upon in accordance with Section 912 .4 through 912 .8 0
14 the Government Code.
15
16 DATED: August 24 , 1988
17
18 ROCKWE L & THOMAS
19 �
BY:
20 D D S. THOMAS
Attorneys for Claimant
21
22
23
24
25
26
2
LAW OPHCES OF
ROCKWELL 8 THOMAS
ANTIOCh,CALIFORNIA
TELEPHONE 757-4515
1 DAVID S. THOMAS
ROCKWELL & THOMAS
2 1610 "A" Street
Antioch, CA 94509
3 Telephone:. (415) 757-4545
4 Attorneys for SANDRA D. STACY,
a minor, by and through .
5 RONALD G. STACY, her natural
father.
6
7
IN THE MATTER OF CLAIM FOR PERSONAL INJURIES
8 THE CLAIM OF AND PERSONAL PROPERTY DAMAGE
SANDRA D. STACY, (Government Code Sections
9 a minor, 905, 905.2 , 910, 910.2)
10 Claimant,
11 VS.
12 CONTRA COSTA COUNTY
13
TO: CONTRA COSTA COUNTY BOARD OF SUPERVISORS:
14
SANDRA D. STACY, a minor, hereby makes a claim against the
15
COUNTY OF CONTRA COSTA for personal injuries for the sum of
16
$500, 000. 00, and makes the following statements in support of her
17
claim;
18
1. Claimant's mailing address is Post Office Box 181,
19
Oakley, California 94561.
20
2. Notices concerning the claim should be sent to DAVID S.
21
THOMAS, ESQ of ROCKWELL & THOMAS, 1610 "A" Street, Antioch,
22
California 94509.
23
3 . The date and place of the occurrence giving rise to
24
this claim are August 29, 1987, in the westbound lane of Camino
25
Tassajara Road, approximately 506 feet west of its intersection
26
with Leema Road in the unincorporated area of Contra Costa
1
LAW OFFICES OF
ROCKWELL&ANTIOCN CALIFORNIIAA � T-A---
TELEPHONE 757-4515
1 County, near the City of Danville, State of California.
2 4. The circumstances giving rise to this action are a
3 follows:
4 Claimant was riding as a passenger in a 1983 Toyota pickup
5 being operated by STEVEN WILLIAM DINELLI, along and on the
6 westbound lane of Camino Tassajara Road at the above-describe
7 location, which is along and on a curve in said road. The road
8 near said curve has a posted speed limit which is too high fox
9 the conditions existing in the area of said curve, the sign
10 warning vehicle operators of the existence of the curve are
11 placed too near to the curve, and the edges of the roadway in the
12 curve are negligently constructed and maintained. As result o
13 the foregoing conditions, STEVEN WILLIAM DINELLI failed to
14 negotiate the left hand curve and the Toyota pickup left the road
15 and turned over throwing claimant out of the vehicle and causing
16 the injuries described hereinafter. Claimant is informed and
17 believes and based thereon alleges that, said road is owned,
18 managed and maintained by the County of Contra Costa.
19 5. As a proximate result of the above set forth facts,
20 claimant suffered serious injuries including bruises, contusions
21 and severe scaring to her face.
22 6. The names of the public employees causing said injuries
23 are unknown.
24 7. The claim of claimant SANDRA D. STACY is in the sum of
25 $500,000. 00.
26 8. The basis of the computation of the above amount is as
2
LAW OFFICES OF
ROCKWELL 8 TNOYAS
ANTIOCH,CALIFORNIA
TELEPHONE 75?AU5
I follows:
2 Items Amount
3 Medical Expenses to date: $ 4, 076.00 (approx. )
4 Estimated future medical expenses: $ 50, 000. 00
5 Future economic losses: $ 100,000.00
6 General damages: $ 345,924.00
7 TOTAL: $ 500, 000. 00
8
9
10 DATED: August 24, 1988
11
12
SANDRA D. STACY, a minor, by and
13 through RONALD G. STACY, her
natural father.
14
15
16
17
18
19
20
21
22
23
24
25
26
3
LAW OFFICES OF
ROCKWELL A THOMAS
ANTIOCH,CALIFORNIA
TELEPHONE 757-4515
1 DAVID S. THOMAS
ROCKWELL & THOMAS
2 1610 "A" Street
Antioch, CA 94509
3 Telephone: (415) 757-4545
4 Attorneys for SANDRA D. STACY,
a minor, by and through
5 RONALD G. STACY, her natural
father.
6
7 IN THE MATTER OF DECLARATION OF
THE CLAIM OF DAVID S. THOMAS
8 SANDRA D. STACY, a minor
9 Claimant,
10 VS.
11 COUNTY OF CONTRA COSTA/
12 I, DAVID S. THOMAS, declare as follows:
13 1. I am an attorney duly licensed to practice before all
14 of the courts of the State of California, and I am a partner of
15 the law firm of ROCKWELL & THOMAS, the office which has been
16 retained by RONALD G. STACY on behalf of claimant in this matter.
17 2 . On or about June 1, 1988, I had an office conference
18 with RONALD G. STACY and MARILYN STACY, the parents of claimant
19 SANDRA D. STACY, who is a minor, concerning the automobile
20 accident in which SANDRA D. STACY was injured on August 29, 1987 .
21 During the course of this conference, we discussed the
22 possibility that it might be appropriate to file a claim against
23 the governmental entity, which owned and controlled Camino
24 Tassajara Road.
25 3. Subsequent thereto, we investigated this matter and
26 have come to the conclusion that it is appropriate and necessary
1
LAW OFFICES OF RHEA
ROCKKWELLL&6 TT HOMAS
ANTIOCH,CALIFORNIA
TELEPHONE 7574US
1 to file a claim against the County of Contra Costa in connection
2 with the ownership, control and maintenance of said road.
3 4. It appears that the County of Contra Costa will not be
4 prejudiced if our application for leave to file late claim is
5 granted because I am informed and believe that the County of
6 Contra Costa was put on notice of the existence of the accident
7 which is the subject of this claim by one of the other minors
8 who was injured in the accident, namely ROGER J. FULOP, JR. , who
9 I believe filed a claim against the County of Contra Costa on
10 about November 25, 1987.
11 I declare under penalty of perjury that the foregoing is
12 true and correct except as to those matters I declare under
13 information and belief, which I am informed and believe are true
14 and correct.
15 Executed at Antioch, California on August 24, 1988.
16
17 `l`�
DA ID S. THOMAS
18
19
20
21
22
23
24
25
26
2
LAW OFFICES OF
ROCKWELL 6 TNOUA$
ANTIOCH,CALIFORNIA
TELEPHONE 757.4545
1 DAVID S. THOMAS
ROCKWELL & THOMAS
2 1610 "A" Street
Antioch, CA 94509
3 Telephone: . (415) 757-4545
4 Attorneys for SANDRA D. STACY,
a minor, by and through
5 RONALD G. STACY, her natural
father.
6
7
IN THE MATTER OF DECLARATION OF
8 THE CLAIM OF RONALD G. STACY
SANDRA D. STACY, a minor
9
Claimant,
10
VS.
11
CONTRA COSTA COUNTY /
12
I, RONALD G. STACY, declare as follows:
13
1. I am a resident of the County of Contra Costa, State of
14
California and I am the natural father of the claimant in this
15
matter.
16
2 . The claimant is a minor, age 16; her birth date is
17
December 25, 1971.
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3 . On or about August 29, 1987, claimant SANDRA D. STACY
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was a passenger in a certain 1983 Toyota pickup which was
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traveling along and on the westbound lane of Camino Tassajara
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Road, approximately 506 feet west of its intersection with Leema
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Road, in the unincorporated area of Contra Costa County, State of
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California. At that time and place, said Toyota pickup was
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operated by STEVEN WILLIAM DINELLI, who failed to negotiate the
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left curve in that area of the roadway, causing the vehicle to go
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off the road, overturn and throw claimant SANDRA D. STACY out of
LAW OFFICES OF
ROCKWELL A THOMAS
ANTIOCH,CALIFORNIA
TELEPHONE 7574515
I the pickup. I am informed and believe, and based thereon
2 declare, that a contributing cause of said accident was the
3 failure of the roadway in the area of the curve to be properly
4 marked with appropriately placed warning signs, for the area to
5 have a properly posted speed limit, and for the edges of the road
6 in said area to be properly constructed and maintained.
7 4. Neither my wife nor I were not aware that there might
8 be any liability attributed to the County of Contra Costa because
9 of the condition of the road. We were further not aware of the
10 government claims presentation requirements under California law.
11 Our daughter's medical expenses were being reimbursed by Great
12 American Insurance Company, the insurance carrier for the 1983
13 Toyota pickup. Because of our foregoing belief or lack of
14 information, we did not attempt to consult with a lawyer until
15 our meeting with Mr. Thomas described below.
16 5. I have never filed a claim for damages against a
17 government entity prior to the subject accident.
18 6. On or about June 1, 1988, my wife and I met with
19 attorney DAVID S. THOMAS of ROCKWELL & THOMAS, and asked him to
20 advise us on this matter. I became aware of the possibility of
21 filing a claim against the Contra Costa County and the
22 requirements relative to filing such claims for the first time
23 when Mr. Thomas informed me about such requirements at said
24 meeting.
25 7. At said meeting, Mr. Thomas informed me that he would
26 investigate this case and determine whether it appeared
2
LAW OFFICES OF
ROCKWELL A THOU"
ANTIOCH,CALIFORNIA
TELEPHONE 757ANS
I appropriate to file a claim against the Contra Costa County.
2 I declare under penalty of perjury that the foregoing is
3 true and correct except as to those matters as to which I have
4 declared under information and belief, which I am informed and
5 believe are true.
6 Executed at Antioch, California, on August 24, 1988.
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O ALD G. STACY
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LAW OFFICES OF
ROCKWELL 6 THOMAS
ANTIOCH,CALIFORNIA
TELEPHONE 7575
APPLICATION TO FILE LATE CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
BOARD ACTION
Application to File Late Claim ) NOTICE TO APPLICANT September 27 , 198
Against the County, Routing ) The copy of this document mailed to you is your
Endorsements, and Board Action.) notice of the action taken on your application by
(All Section References are to ) the Board of Supervisors (Paragraph III, below),
California Government Code.) ) given pursuant to Government Code Sections 911.8 and
915.4. Please note the "WARNING" below.
Claimant: LAURA BRITO, AS GUARDIAN AD LITEM FOR MICHAEL: GEORGE GUEVARA
c/o Law Offices of Steven H. Henderson
Attorney: 3715 Railroad Avenue Suite D
Pittsburg, CA 94565
Address:
Amount: Unspecified By delivery to Clerk on August 29 , 1988
Date Received: August 29 , 1988 By mail, postmarked on not legible
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above noted Applicationto F le 1,.Ate Claim.
DATED: August 30 , 1988 PHIL BATCHELOR, Clerk, ByWDeputy
L. Hall
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
( ) The Board should grant this Application to File Late Claim (Section 911.6).
(� The Board should deny this Application to File Late Clon 91 Q.
DATED: VICTOR WESTMAN, County Counsel, Deputy
III. BOARD ORDER By unanimous vote of Supervisors present
(Check one only) CQuRs (
( ) his Application is granted (Section 911.6). A U G 3-U 1988
( ) This Application to File Late Claim is denied (Section 911.6). Ma rtInez, CA 94553
I certify that this is a true and correct copy of the Board's Order entered in its
minutes for this date.
DATE: SEP 27 10 PHIL BATCHELOR, Clerk, By Deputy
WARNING (Gov. Code 5911.8)
If you wish to file a court action on this matter, you must first petition the
appropriate court for an order relieving you from the provisions of Government Code
Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such
petition must be filed with the court within six (6) months from the date your application
for leave to present a late claim was denied.
You may seek the advise of any attorney of your choice in connection with this
matter. If you want to consult an attorney, u should do so immediatel .
IV. FROM: Clerk of the Board T0: 1 County Counsel 2 County Administrator
Attached are copies of the above Application. We notifed the applicant of the
Board's action on this Application by mailing a copy of this document, and a memo thereof
has ben filed and endorsed on the Board's copy of this Claim in accordance with Section
29703•
DATED: SEP 2 8 1988 PHIL BATCHELOR, Clerk, By eputy
V. FROM: 1 County Counsel 2 County Administrator 70: Clerk of the Board
of Supervisors
Received copies of this Application and Board Order.
DATED: 'County Counsel, By
County Administrator, By
\ APPLICATION 70 FILE LATE CLAIM
1 STEVEN H. HENDERSON
ATTORNEY-ABOGADO
2 3715 Railroad Avenue
Suite D
3 Pittsburg, California
94565
4 (415) 427-1771
5 DECEIVE®
Attorney for Claimant
6
7
In the Matter of the BAF EPR ISCRS
8 Claim of CLERK B�?R .
ey
9 LAURA BRITO, as Guardian
ad Litem for MICHAEL
10 GEORGE GUEVARA
11 Claimants, APPLICATION FOR LEAVE TO
PRESENT LATE CLAIM
12 vs. [Gov .0 § 911.4]
13 COUNTY OF CONTRA COSTA, and
STATE OF CALIFORNIA DEPARTMENT
14 OF TRANSPORTATION, DOES I
through 10, inclusive,
15
Respondents.
16 /
17 TO COUNTY OF CONTRA COSTA:
18 1. Application is hereby made for leave to present a
19 late claim under § 911.4 of the Government Code. The claim is
20 founded on a cause of action for wrongful death, which accrued
21 on September 8, 1987, and for which a claim was not timely
22 presented. For additional circumstances relating to the cause
23 of action, reference is made to the proposed claim attached
24 hereto as Exhibit A and made a part hereof.
25 2. The reason for the delay in presenting this claim is
26 that the claimant was a minor during all of the period when
27 the claim should have been presented as shown by the declara-
28 tion of Steven H. Henderson, attached hereto as Exhibit B and
1 made a part hereof.
2 3. The additional reason for delay in presenting this
3 claim is the mistake, inadvertence, surprise, and excusable
4 neglect of claimant and his attorney, Steven H. Henderson, as
5 more particularly shown in the declaration of Steven H.
6 Henderson, attached hereto. The County of Contra Costa was
7 not prejudiced• by the failure to timely file the claim as
8 shown by the declaration of Steven H. Henderson, attached
9 hereto as Exhibit B and made a part hereof.
10 4 . This application is presented within a reasonable
11 time after the accrual of the cause of action as shown by the
12 declaration of Steven H. Henderson, attached hereto as Exhibit
13 B and made a part hereof.
14 WHEREFORE, it is respectfully requested that this appli-
15 cation be granted and that the attached claim be received and
16 'acted upon in accordance with §§912 .4 - 912-8 of the Govern-
17 ment Code.
18 DATED: August 25, 1988
19 �-
20
EVEN H. HENDERSON
21 On Behalf of Claimant
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1 STEVEN H. HENDERSON
ATTORNEY - ABOGADO
2 3715 Railroad Avenue
Suite D
3 Pittsburg, CA 94565
415/427-1771
4
5Attorney for Claimant.
6
7
In the Matter of the
8 Claim of
9 LAURA BRITO, as Guardian ad Litem for
ICHAEL GEORGE GUEVARA
10
Claimants, CLAIM FOR DAMAGES
11
VS.
12
COUNTY OF CONTRA COSTA, and
13 STATE OF CALIFORNIA , DOES I
through 10, inclusive,
14
Respondents.
15 /
16 1.
17 LAURA BRITO, as Guardian ad Litem for MICHAEL GEORGE
18 GUEVARA, hereby presents this claim to the COUNTY OF CONTRA
19 COSTA, STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATION, and
20 DOES 1 through 10, inclusive, pursuant to Government Code §
21 910, et seq.
22 11.
23 The name and post office address of Claimant is as fol-
24 lows:
25 LAURA BRITO
1479 Valenzuela Court
26 Pittsburg, CA 94565
27 III.
28 The post office address to which Claimant desires notice
EXHIBIT A
1 of this claim to be sent is as follows:
2 Law Offices of Steven H. Henderson
3715 Railroad Avenue, Suite D
3 Pittsburg, California 94565
4 IV.
5 At all times herein mentioned, the COUNTY OF CONTRA COSTA
6 and STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATION were
7 public entities and at all times herein mentioned DOES 1
8 through 10, were employees and/or agents of the above-named
9 public entity and were acting in the course and scope of their
10 employment and/or agency.
11 V.
12 On or about September 8, 1987, MICHAEL GEORGE GUEVARA'S
13 father, JESUS JORGE GUEVARA, aka GEORGE ALDRETE, was caused to
14 be injured and killed in an automobile accident proximately
15 caused by a dangerous condition that defendants, and each of
16 them, allowed to exist at the intersection of Cummings Skyway
17 and Interstate 80, Contra Costa County, California, having
18 known or should of having known of the existence of the danger-
19 ous condition and of the defective warning conditions and the
20 combination thereof at said location. At all times herein
21 mentioned, defendants, and each of them were in possession and
22 control of said intersection.
23 V I.
24 At all times mentioned herein, the COUNTY OF CONTRA COSTA,
25 STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATION and defendants
26 DOES 1 through 10, allowed the dangerous condition to exist
27 despite the fact that the dangerous condition created a
28 reasonably foreseeable risk of the kind of injury which was
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1 incurred by decedent.
2 VII.
3 At all times herein mentioned the COUNTY OF CONTRA COSTA,
4 STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATION and defendants
5 DOES 1 through 10, negligently failed to provide a signal,
6 sign, marking or other device which was reasonably necessary to
7 am of the dangerous condition which endangered the safe
8 movement of traffic, said dangerous condition having been one
9 that would not have been reasonably apparent to, and would not
10 have been anticipated by, a person exercising due care.
11 Furthermore, at all times herein mentioned, the COUNTY OF
12 CONTRA COSTA, STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATION
13 and defendants DOES 1 through 10, undertook to install traffic
14 signs, with knowledge that there would be public reliance
15 thereon, however negligently failed to make safe the dangerous
16 condition.
17 VIII.
18 At all times mentioned herein, the COUNTY OF CONTRA COSTA,
19 STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATION and DOES 1
20 through 10, failed to take reasonable action to protect against
21 the risk of injury created by the condition in an unreasonable
22 manner.
23 IX.
24 At all times mentioned herein, the COUNTY OF CONTRA COSTA,
25 STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATION and defendants
26 DOES 1 through 10, negligently allowed others to maintain the
27 intersection, which did not have adequate warning signs,
28 lights, guards, or other precautions and was a danger to
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1 traffic.
2 X.
3 At all times herein mentioned, the COUNTY OF CONTRA COSTA,
4 STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATION and DOES 1
5 through 10, had actual and/or constructive notice of the
6 existence of the dangerous condition which existed.
7 XI.
8 At all times herein mentioned Employees of the State of
9 California Department of Transportation, acting in the course
10 and scope of their employment, negligently diverted decedent's
11 vehicle from his intended route along State Route Highway 4,
12 and directed him to drive Cummings Skyway, which roadway is
13 unsafe for vehicles such as that driven by defendant, in that
14 it includes a one mile down grade to an abrupt stop and a sharp
15 turn at the t-intersection with Interstate Highway 80. When
16 the brakes on decedent's vehicle failed to function on that
17 downgrade, the configuration of the roadway and lack of exit
18 ramps made it impossible for the decedent to gain control of
19 the vehicle and to avoid the collision which caused his death.
20 The route which the decedent would have taken, but for the
21 diversion of his vehicle by the employees of the State of
22 California Department of Transportation, would not have caused
23 an inevitable accident when and if the brakes failed to
24 function. Since the employees of the State of California
25 Department of Transportation were allowing local traffic to use
26 State Route Highway 4 beyond the point where the decedent was
27 forced to divert to Cummings Skyway, said employees were
28 negligent in not permitting the decedent to also use State
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1 Route Highway 4 as a safer route for his vehicle.
2 Observation of the vehicle should have been given notice
3 to the employees that the use of Cummings Skyway would be
4 unsafe and could result in the type of accident which did in
5 fact occur.
6 XII
7 As a result of the aforementioned hazardous condition
8 which the Respondents, and each of them allowed to exist,
9 Claimant has suffered great emotional damage; physical damage;
10 loss of financial support; loss of contributions and services;
11 loss of society, comfort, companionship, care, training, and
12 advice. The amount of these damages has not yet been ascer-
13 tained, due to the extreme severity of Claimant's injuries.
14 XIII
15 Therefore, Claimant, LAURA BRITO, as Guardian ad Litem for
16 MICHAEL GEORGE GUEVARA, seeks relief for the damages sustained
17 as a result of the negligent failure of the County Of Contra
18 Costa and Does 1 through 10, to properly maintain safe roadway
19 conditions.
20 Dated: January 18, 1988.
21
22 STEVE H. IiEkEfERSON
23 Attorney for Claimant
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1 STEVEN H. HENDERSON
ATTORNEY-ABOGADO
2 3715 Railroad Avenue
Suite D
3 Pittsburg, California
94565
4 (415) 427-1771
5
Attorney for Claimant
6
7
In the Matter of the
8 Claim of
9 LAURA BRITO, as Guardian
ad Litem for MICHAEL
10 GEORGE GUEVARA DECLARATION OF STEVEN H.
HENDERSON IN SUPPORT OF
11 Claimants, APPLICATION FOR LEAVE TO
PRESENT LATE CLAIM
12 vs. [Gov C § 911.4]
13 COUNTY OF CONTRA COSTA, and
STATE OF CALIFORNIA DEPARTMENT
14 OF TRANSPORTATION, DOES I
through 10, inclusive,
15
Respondents.
16 /
17 I, Steven H. Henderson declare:
18 1. I am an attorney duly licensed to practice law in
19 the State of California and I represent LAURA BRITO, as Guard-
20 ian ad Litem for the claimant MICHAEL GEORGE GUEVARA. Michael
21 George Guevara, the son of the decedent Jesus Jorge Guevara,
22 aka George Aldrete, was born on February 27, 1987, and was at
23 all times herein mentioned a minor.
24 2 . A Governmental claim was originally prepared in this
25 matter on or about January 18, 1988, in draft form. Due to
26 the mistake, inadvertence, surprise, and excusable neglect of
27 myself and my staff, the six month's claim period for pres-
28 enting this governmental claim was not calendared. Hence, the
Exhibit B
a
1 draft claim, a copy of which is attached hereto as Exhibit A
2 and presented herein as the proposed claim for damages was not
3 filed in a timely manner. The fact of failure to comply with
4 the six months claim period was discovered on August 25, 1988 .
5 The file was calendared for a one year filing date for the
6 statute of limitations.
7 3 . The defendants in this action were well aware of the
8 incidents which took place and a timely claim was previously
9 filed with the State of California Department of Transporta-
10 tion by John A. Pettis & Associates on behalf of Maritza
11 Guevara, Vanessa Karla Guevara,a minor by Maria Teresa
12 Guevara, her Guardian at Litem, and George L. Guevara for
13 claims arsiing out of the same facts.
14 I declare under penalty of perjury that the foregoing is
15 true and correct to the best of my knowledge, that I have
16 personal knowledge of the contents of this declaration and
17 that this declaration was executed on August 25, 1988 at
18 Pittsburg, California.
19 /
20 =
STEVEN H. HENDERSON
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