The URL can be used to link to this page

Home My WebLink AboutMINUTES - 08291989 - 1.24 ^T AIDO.TC?• BOARD OF SUPERVISORS OF CONTRA CO�TePtuZRYN� appllcatlan to: Instructions to Claimant Clerk of the Board P.d.Box 911 A. Claims relating to causes of action for death or tornnGury�� o�533 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 filledin. 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 of this form. RE: Claim by ) Reserved for Clerk' s,f; 1 . c stamps 01 ECTET' Against the COUNTY OF CONTRA COSTA) JUL Z 61989 BA a or DISTRICT) SU ER (Fill n name) ) s ... cQr�, in . 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? (Giveexactdate and hour) 2. -Where did the damage or injury occur. (Include city and county) - ' i— C�"� ----- --- --- =-=---- -------=----- =------------=- -- 3. How---did-the damage or injury occur? (Give full details , use ext sheets if required) 4 wWhat particular act or omission on the-part of county or district officers , . servants or employees caused the injury or damage? i ��t, a 8. //a .�, �- /:v bed? p. A4w L16 Alhe'l lo4-ci 'o') ew%e"ICIA4r� 44, . -A �� e- � ��`" � jZ,1,0 .��°�_ , (over) '.:5.:.:•? -i a. ar.e._t1ie..:names of county or district officers , servants o 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 st 'm t f �'a�tt��to damage) " es iz7''v%► Q/ � caGV09"e'a _e:G, _30_��2 sv6__i _ lc c _ __i�►' 3_<_1�. '-♦�-'�-.�;>r ia,�_rte A 7 . How was the amount'claimed above computed? (Include the estimated amount of any prospective injury or damage. ) �}Ca' S07 14 s h"G e-, T40, 7"/A �`�7irr)�?�'6! u�s�V' � C,:-rr -'--- /_I--��-- - = ---------------------------------- ----- - � � :a �ad ses of .w" tnes es , doctors Band hos itls • +�= i� ! Aa. I w dmf6- F� d �W. c r d b Sow IAA ---------------------------------------------------------------=-----'---- 9 ... List the expenditures you made on account of this accident or injury: DATE ITEM PMOUNT 1 `� //U o`l�� , .�' w�'Li�' c��i J�=�-7�t's��p s� �►� .2�� . ��t S Govt. Code Sec. 910 .2 provides: "The claim signed . by the claiman- SEND NOTICES TO: (Attorney) or by some oerson on his behalf. ' Name and Address of Attorney Claim nt' s Signatire 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. " '!�'^� -- xY".r.+ide'r^� �i'�i� Y 2^v„�N��y_�: I - f� �Z"`J•_`�Y.S - __ _ �� —_.Fd'.I"" _ 1vi� T/.0 •�PL� �! yB.I .r FSP Q9Y€d _ d /"r. �o-P - mf' •"7�"{i -- a i2 e E '-Ap mc; G`J' +r_`s" P'€cv SF_ - � f �i5v(G�" -�/l�. _ ..S'!�'7t�: �!�"� tr�w'�LEae►-� _ ,fid rAi.Z��f" _ F�/+`f>.rl�,p- - r c..•i'y��j C _ l -- - X79,e -,`:7 Yy t awt c,AA U ��,rf�* �T e-L/ .'iG'�C'e,Y G�6P TF!-.o hA�y N' r� _ t'8'"_Rf-_!' � __—' .•.G _��r)..�� ! "_V b.^'V(��/ ( X�� .. WEEP INMATE.REQUEST CONTRA COSTA COUNTY ENT- ON FACILITY NAME: Vim-/QUO e�aGr�� BK.#: �(°�� Last° First Middle— ' DATE: � MODULE:- ROOM: CHECK 0 N E REQUEST - 'GRIEVA CE' O APPEAL r REQUEST: rd Ahe, lncll.4 e k a�l 6. �t �'`:' ¢I u-2/G'�i yt' �9 m evi s`' e, I l . Aj �� its_------------------------- __ ?- � 6,0 RECEIVED BY: ROUTED TO: O PROGRAMS ® CUSTODY 0 MEDICAL ANSWER: 0 APPROUE94- � . 0 DENIED - (.State reason) 14=w� W t+=—PE �I r r1U f,3 G YQ v C..w--H Za G -MF -n4 lE C-OkT i5 NO �OG�T -O Y�v ► �:�r �L'tC C-�- J A T BY: itTe Employee Name - Employee # Pink kept by inmate,,�Je low to inmate, White to Booking file R 'fie`•-h' -y. -7"� M fY' 1 � . INMATE REQUEST '. CONTRA COSTA CC UNTY DETENTION FACILITY NAME: ` -/ 4" ' YC* f BK.#: $� x Last First 01 Middle DATE: S� ., MODULE: ROOM: CHECK ONE: 6 REQUEST 0 GRIEVANCE , 0 APPEAL REQUEST: t k r sf iF. ' b` £,�1" �'i,F� }�a r�,a�a �-f`£:l.."(�. �.t2..�-'2 ;�r: I,%...; �i"�a`!f�.�•?t.'_ r: a - i p F � C5 -------------------- - -- ------------------------ ------- Z�' RECEIVED BY: ROUTED TO: 0 PROGRAMS CUSTODY 0 MEDICAL ANSWER: 0 APPROVED 0 DENIED -; (.State reason) Oik/FiowN WOES Aocjm. A-- Title - Employee Name - Employee # Pink' kept by inmate, Y,ell.ow to inmate; White to Booking file y, lir ,J I MATE'RE VEST CONTRA COSTA CJUNTY DETENT10N FACILITY NAME: i BK.#: Last r' First Middle 1 DATE: �; �--- ,� '�� MODULE: ROOM: e CHECK ONE: � ]� REQUEST 0 GRIEVANCE O APPEAL REQUEST: 4' F" r ------------------------------------------------------------- RECEIVED BY: ROUTED TO: - O _PROGRAMS CUSTODY 0- MEDICAL ANSWER: APPROVED �.,Z DENIED -Y (,State reason) BY: 7" Title - Employee Name - Emp oyee # Pink kept by inmate, Yeljhow_to inmate, White to Booking file S � to n0�n Ln AZ • yrnp (p � \ ` � 1 `V 1 N NED fl m C . a !~C y C ,y Nt , { o, CLAIM • j �-3 Y .. + ,1.= 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 Augu s t 29 , 1989 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 ,000 . 00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: LAUREEN KOEPPEL ETAL Gouray Gownen11 c/o Law Offices of J. Gregg Riehl AUS 011989, ATTORNEY: 1280 Civic Drive, #111 Walnut Creek, CA 94596 Date received Martinez, CA 945.53 ADDRESS: BY DELIVERY TO CLERK ON July 31, 1989 BY MAIL POSTMARKED: July 28 , 1989 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. August 3, 1989 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). (� ) Other: Dated: iI 2 ci BY: I 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: AUG 2 9 1989 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code secti 3) 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: A U G 2 9 NA 9 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Date: August 10, 1989 To: Laureen Koeppel c/o Law Offices of J. Gregg Riehl 1280 Civic Drive, #111 Walnut Creek, CA 94596 From: Clerk, Board of Supervisors Re: Claim of Laureen Koeppel On July 31, 1989, you filed a claim against the City of Concord with the Clerk of the Contra Costa County Board of Supervisors. The County of Contra Costa Board of Supervisors does not have jurisdiction over the City of Concord and is not the entity with which your claim should be filed. Dated: Phil Batchelor, Clerk By: Deputy Clerk iay ' LAW OFFICES OF J. GREGG RIEHL KIRBY PLAZA 1280 CIVIC DRIVE. SUITE 111 2315 WESTWOOD BOULEVARD WALNUT CREEK, CALIFORNIA 94596 LOS ANGELES. CALIFORNIA 90064 14151 944-0111 12131 470-7888 C I E L-1 July 27 , 1989 -JUL 311989 rH;L BATCHELOR Office of the Clerk of the Board of Supervisors CLERK GOARDOFSUPERVISORS County of Contra Costa B cor:T>.AcosTAco. Deputy 651 Pine Street Martinez , CA 94553 RE: KOEPPEL vs . CONTRA COSTA COUNTY SHERIFF, et al . Our File No: 990 Dear Gentlepersons : Enclosed please find an original and one copy of the Public Entity Claim we are filing on behalf of our clients . Please retain the original and acknowledge receipt by stamping or writing on the copy and returning it to this office in the envelope provided. Thank you for your courtesy and cooperation. Yo rs y ruly, J. a Ri hl JGR: Enclosures /.-2Y LAW OFFICES OF J. GREGG RIEHL KIRBY PLAZA 1280 CIVIC DRIVE, SUITE III 2315 WESTWOOD BOULEVARD WALNUT CREEK. CALIFORNIA 94596 LOS ANGELES. CALIFORNIA 90064 14151 944-0111 12131 470-7888 CLAIM AGAINST CONCORD POLICE DEPARTMENT, CONTRA COSTA COUNTY SHERIFF ' S DEPARTMENT, CITY OF CONCORD, & CONTRA COSTA COUNTY NAME & ADDRESS OF LAIMANTS : Laureen Koeppel , individually, and as mother of , Niheen Koeppel , Louis Koeppel , and by. Koeppel , minors 'w 690 Detroit Ave. , #32 JUL0 1 19 � oncord, CA 94520 89 SEND NOTICES TO C,E, ,tLe aw Offices of J. Gregg Riehl '0 0N Mr7LO � 1280 Civic Drive, Suite 111 8yc u� F`11-3Ons Walnut Creek, CA 94596 PLACE & DATE OF OCCURRENCE: Concord City Jail Concord, California January 30 , 1989 CIRCUMSTANCES OF OCCURRENCE: Claimants are the widow and children of Kenneth Koeppel . On January 29 , 1989, Mr . Koeppel was taken into custody and confined in the Concord City Jail . While in custody, Mr . Koeppel committed suicide by hanging himself inside of his cell causing injury and loss to claimants . Officers on duty knew, or should have known, of decedent ' s past suicide attempts and of his suicidal tendencies . The failure of the officers on duty to take steps to prevent a suicide was negligent , intentional , and in violation of statute. Said officers failed to follow established procedures and guidelines for care and control of prisoners and failed to properly observe and monitor decedent ' s condition while in custody. Said officers also failed to provide or arrange for necessary medical care which would have prevented this injury and loss to claimants . All of the actions of the officers were in the line of duty and within the scope of their authority and responsibility as peace officers , and as agents , employees and representatives of the above public entities . The acts and omissions of said officers was due in part to the Concord Police Department and the Contra Costa County Sheriff Department negligent hiring, staffing, training, supervision and monitoring of its employees . DESCRIPTION OF DAMAGE OR LOSS : 1 ) Claimants have been deprived of the earning capacity and future earnings potential of decedent which would have contributed to the support of the family and enhanced the quality of their lives ; w - - 2) claimants are further damaged by the loss of services decedent would have performed within the home; 3 ) claimants have lost all aspects of a familial relationship, including a father figure and husband, and the society, comfort , care, protection and companionship that decedent would have provided, and loss of consortium; 4) claimants have lost the moral and practical training, advice and discipline of decedent ; 5) claimants have incurred funeral and burial expenses paid in memory of decedent ; and 6) claimants have been denied the certainty of future gifts from decedent . TOTAL AMOUNT OF CLAIM: $5 , 000 . 000 . 00 BREAKDOWN OF AMOUNT OF CLAIM: $2 ,000 . 000 . 00 special damages 1 $3 , 000.000.00 general damages DATED• J. GRE G EHL Attorn y f r Claimants N o 104 4-4 O 44 a O Q 4J u W ."4 O cn �4 U Ln N Ln m I:r U �4 4J M 4J U N Ci U ,.C: O �4 4WU4JU t� LH LH O O (D N rl U N >j•rq C" U 4J a -H - q q, 4-) 4-I �:5 r- �4 LH O Ln O U RECE,41VED11F 'JUL 3 11989 0)a °' PH;,BATCHELOR_ In CLERK GOARD OF SIiPERVISi?RS �+ m B CONTRA COSTA CO. .................... De ut LL W � Q O a W N N O W Q Li !i U rh - > � LL \J Q LL �r YQU O �J m wW Uw Q Y W J U cr U O m N Z Q 3 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 August 29 , 1989 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: $150. 0 0 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: DENISE BOGARD 0. 0unty CounSe4 7-16th Street #A ATTORNEY: Richmond, CA 94801 AUG d 11989 Date received ADDRESS: BY DELIVERY TO CLERK ON Juf - �R ZI0994553 BY MAIL POSTMARKED: July 28, 1989 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. August 3 , Au 1989 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). ( ) Other: 77 Dated: BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Adminis for ( ) ( ) 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: AUG 2 9 1989 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code se ion 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:_ 1989 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator /.� Y 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, :.thea 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: C aim BY ) Reserved for Clerk's f,- iili-,g_stamp - R 0V Against the County of Contra Costa ) L 3 _1489 or ) P A ^H' OR District) CEI NTRR O PCRVIS Fill in name ) By Puts 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) :0061 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) "00�.,44&0, 11b6i �fvloO' lve7— lo 101,W Y 0/1--' f 14 511 60r 01V QN 740 OP Ti9_&I_� 4e zZ4 1C /V-1-/W ---------------------------- 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 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. F - ------------------------------------------------------------------------------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.,)01 8. Names and addresses of witnesses, doctors and hospitals. 94 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 ignature (kddreS3) 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 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. t CLAIM �•o� 7 + 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 August 2 9 , 1 9 8 9 and Board Action. All Section references are to ) The copy of this document mailed to yo is your notice o California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $75 . 00 Section 913 and 915.4. - Please note all "Warnings". CLAIMANT: OLGA B. BROWN County Counsel 1155 12th Street 89 ATTORNEY: Oakland, CA -7 UG ,9 Date received �I tlf� �,/� 84553 ADDRESS: BY DELIVERY TO CLERK ON July .i�,l BY MAIL POSTMARKED: July 28 , 1989 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 3 , 1989 BY: Deputy L. Hall II^� . FROM: County Counsel TO: Clerk of the Board of Supervisors N ) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: / �{ /21 , BY: I 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: A U G2 ,9 198 9 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: AUG 2 9 1989 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator /. 2 Y 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: Vlaim By ) Reser e4--for- Cler cl s-t i in stamp EC, Wrc-0imDu Against the County of Contra Costa ) J U L 3- 1-1989 or ) PH" 13AT^ ELOr C. HR S- PF.RV SORS District) r,Ta ' By _. .. .4. tY. Fill in name ) - - - The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ rf' .Q® 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) A-- 3. How did the damage or injury occur? (Give full details; use extra paper if required) / CkY.P-k 7_0ok (�41,2766V el/% 0/j �lf� leox &1h/moi a/� /✓J ��j ege 0/t/ 14NO ��g (1A1W6� #1T 7fr� C'6W�NT /�/ooh 4� �v . ------------------------------------------------------------------------------------ 4. What particular act or omission on the part of county or district officers,. servants or employees caused the injury or damage. 7_25e_ i%/^/ (over) 5. What are the names of county or district officers, servants or employees causing the damage or injury? -------------------- �' - = C=--- 5. What damage or. injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. r",6/ .� Gam/ ZIZ6)fc'� b/,,9-1v �s: 00 ------------------------------------------------------------------------------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) l 2) ------------------------------------------------------------------------------------- 8. Names and addresses of witnesses, doctors and hospitals.j ,Dl,,, : ------------------------------------------------------------------------------------- 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 i igna e Ad ess 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 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. ' C O co Gu A a d f CLAIM i BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA a Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT Aup4 s t 29 , 1 9 8 and Board Action. All Section references are to ) The copy of this document mailed to yo is your notice o California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $1, 500. 00 Section 913 and 915.4.CWMIV QftiojejWarnings". CLAIMANT: NORTHERN CALIFORNIA JOINT POLE ASSOCIATION' AUG d ,1989 215 Market Street #1201 i rtirtea, CA yg553 ATTORNEY: San Francisco, CA 94105 Date received ADDRESS: BY DELIVERY TO CLERK ON July 28., 1989 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 3 , 1989 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). ( ) Other: Dated: l � BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administra or (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER-, By unanimous vote of the Supervisors present (Ilef 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:A11G 2 .9 1989 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: P11G 2 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator 23 Pvazlc wcXW EEeA1ZU4arr � . (�,�o - CONTRA COSTA CCUIM DATE: July 17, 1989 TO: Ron Harvey, Risk Management, County Administrator's Office FROf4: S. Clifford Hansen, strative Services Officer SUBJECT: Northern, Californiaoint Pole Association Attached for your review is correspondence fresdi subject organization regarding the pole that was damaged by a County vehicle on May 18, 1989 on Neroly Road. The correspondence includes a damage estimate of $1500. I have, informed the Association that I am forwarding this correspondence to you and that all future correspondence should be mailed directly to you. Please keep me informed Q--'\to the disposition of this issue. If you have any .questions or need adcucional information, please contact me at 4470 extension 341. SCH:jeo harvey.t7 attachment cc: J. M. Walford, Public Works Director M. Mitchell, Deputy Public Works Director P. McNamee, Maintenance R. Gilchrist, Accounting VV IVY /, / IQ PV i /.�Zey NORTHERN CALIFORNIA JOINT POLE ASSOCIATION VM 215 MARKET STREET RE" WP 3 SAN FRANCISCO,CALIFORNIA 94105 wl Alto June 12, 1989 Pn po CLE K 011 County of Contra Costa Department of Public Works 635 Walnut Boulevard Brentwood, CA 9451--.--5 Attention: Ruben Esquivel Refer: Dump Truck: #6848 - CA License No. E085735 Date of Loss: 5/18/89 Driver: Bernard Romiti Gentlemen: On May 18, 1989, an accident occurred on Neroly Road 13 poles west of Empire Road in Oakley, Contra Costa County, California. In this accident , a Dump Truck: reported to us as being owned by Contra Costa County Public: Works Department and operated by Bernard Romiti , was involved in the damaging of public Utility facilities. These facilities are jointly owned by PG&E and Pacific Bell , whom we represent. This is to respectfully advise you of this Association 's intent to bill on behalf of these owning companies for damages arising from this accident. If this claim is being handled by an insurance carrier and/or- adjuster , please advise us their name, address, and claim number. We will be happy to contact them regarding the billing. On the otherhand , if our bill is to be presented directly to Contra Costa County Public Works Department , please advise the correct person handling our claim, and advise if the address is other than the above to forward our claim. The formal notification of our intention is attached as required under Government Code Sections 900 et. seq. Your early reply and cooperation will be appreciated. Sincerely, Williar� - rgis Exec_Lt•tive .irectar WS/sg Encl . NORTHERN CALIFORNIA JOINT ASSOCIATION 215 MARKET STREET (4/5)362-2972 SAN FRANCISCO,CALIFORNIA 94105 June 12, 1989 CLAIM AGAINST THE CONTRA COSTA COUNTY PUBLIC WORK.*S DEPARTMENT� Northern California Joint Pole Association presents a claim for damages against the Contra Costa County Public Works Department , as provided in Government Code Sections 900 et. seq.CLAIMANT 'S NAMES: � PG&E and Pacific Bell . Send all notices to their agents: No. California Joint Pole Assn. 215 Market Street , Room 1201 San Francisco, CA 94105 Attn: William Sargis Executive Director- DATE OF OCCURRENCE: May 18, 1989 PLACE OF OCCURRENCE- Neroly Road 13 poles west of Empire Road in Oakley, Contra Costa County, California. CIRCUMSTANCES CAUSING CLAIM: At approximately 14:50 P. M. , a road maintenance vehicle registered to Contra Costa County Public Works Department and operated by Bernard Romiti , struck and damaged jointly owned public utility facilities, necessitating repair and replacement. The Dump Truck #6848 bearing CA License No. E085735 was operated by Bernard Romiti . DESCRIPTION AND iTEMIZATION OF DAMAGES. A 30 'Joint Pole was broken, necessitating replacement and repairs. ESTIMATED AMOUNT OF CLAIM: $1 ,500. 00 ** **Please note this is an estimated amount only. Billing is made on an actual cast basis and will be forwarded with itemizations after processing. NORTHERN CALIFORNIA JOINT POLE ASSOCIATION -- b _ Williaf Sa is Execut ector AND ELECTRIC COMPANY 62.6332 (Rev 6.5W P A C I F I C G A S PHOTOGRAPH IDENTIFICATION SHEET ATTACH NO PHOTOS ABOVE THIS LINE + '� u'Z�� tr � . � t n,Satt� °{�.. $ :Cry, �n, ,'1"T'" 1 b • 6241 t s 7 j t' W 4 sa4,�a�.*,yw � '-.,• 14F�7"»,.�yj�'`�•�-�'"n��n att� � , y'��; 07 ' t i t Dist. or Local A/R No Divn.Claim No. G.O. Claim SUBJECT ____________Pole Accident Employee Injury _________Company Car Accident TYPE OF '^Third Party Injury ______ {ether Company PJD DAMAGE -----',third party Death ,________.:_Third Party PID , ".f Ori Date PHOTO NO taken by V ldo� CAMERA FACING: N• E. S. W. SHOWING: Explanation by: Date of Accident: t Contra J.Michael Walford Public Works Director Costa Public Works Department County 255 Glacier Drive Milton F. KubicekDeputy Director Martinez, CA 94553-4897 Maurice E.Mitchell July 18, 1989 Deputy Director William Sargis Northern California Joint Pole Association 215 Market Street San Francisco, CA 94105 Dear Mr. Sargis: We are in receipt of your letter dated June 12, 1989 regarding the accident on Neroly Road on May 18, 1989. We also received your bill (#8467) in the amount of $680.68. The County is self-insured and we have forwarded your correspondence and bill to the County's Risk Management Division for review. Future correspondence should be mailed directly to Ron Harvey, Risk Management Division, 651 Pine Street, Martinez, CA 94553. If you have any questions, please contact Ron Harvey at 646-2126. Very truly yours, S. Clif&iid Hansen Administrative Services Officer Administrative Services Division SCH:j eo neroly.t7 cc: R_—Har-V4P_y_,_Risk Management P. McNamee, Maintenance R. Gilchrist, Accounting PUBLIC RICEM DEPAROMEN'P CCNIIRA QOibTA COUNTY DATE: July 17, 1989 TO: Ron Harvey, Risk Management, County Administrator's Office FRCiK: S. Clifford Hansen, strative Services Officer SUBJECT: Northern California oint Pole Association Attached for your review is correspondence from subject organization regarding the pole that was damaged by a County vehicle on May 18, 1989 on Neroly Road. The correspondence includes a damage estimate of $1500. I have informed the Association that I am forwarding this correspondence to you and that all future correspondence should be mailed directly to you. Please keep me informed as to the disposition' of this issue. If you have any questions or need additional information, please contact me at 4470 extension 341. SCH:j eo harvey.t7 attachment cc: J. M. Walford, Public Works Director M. Mitchell, Deputy Public Works Director P. McNamee, Maintenance R. Gilchrist, Accounting �� bo v f | ' - . . ' NORTHERN CALIFORNIA JOINT ASSOCIATION 215 MARKET STREET (4/5)362-2972 SAN FRANCISCO,CALIFORNIA w/m � July 14, 1989 ' Contra Costa County . Public Works Department 1801 Shell Avenue Martinez , CA 94553 Attention: Ron Harvey, Risk Management Refer: Driver: Bernard Romiti Date of Loss: 5/ 18/89 Dear Mr. Harvey: Enclosed is our Bill No. 8467 in the amount of $680. 68 which represents PG&E 's costs to repair and replace their portion of damaged public facilities resulting from the accident that occurred on May 18, 1989 in . Oakley. Also attached for your review is an itemized breakdown of their charges, and detail sheets. As noted on our bill , we have not received Pacific Bell 's bill relating to this claim. If and when these additional charges are received in our office, we will submit our revised bill for your consideration. Your company 's draft hhould be made payable to the Northern California Joint Pole Association in the above amount and forwarded to the above referenced address. �. Should you have any questions concerning' this billing please contact me . at the above telephone number. ' , ` Sincerely, .� ° wz � � za gzs . Executi�e �irector WS/sc Encl . cc: Contra Costa County _. Administrative Services Division ' Public Works Department 255 -Glacier Drive Martinez , CA 94553-4897 ` Attention: Mr. S. Clifford Hansen Administrative Services Officer . . . ' NORTHE RN CALIFORNIA JOINT ASSOCIATION u5mAuKETSTREET (415)362-2972 SAN FRANCISCO,CALIFORNIA 94/05 ' Contra Costa County Public Works Department 1801 Shell Avenue Martinez , CA 94553 AtteOtiuU: Ron Harvey ' ' 8467 . . REFER: Driver : Bernard Romiti Date of Loss: 5/18/89 ` Replace Joint Pole facilities located on Neroly Road 13 poles west of Empire Road in Oakley, California. Materials and supplies: $ 178. 74 Labor: 709. 84 Construction Equipment Expense: 45. 00 Tool Expense: 17. 00 � 950. 68 LESS: Joint Pole Credit _27{}. 00 ' TOTAL AMOUNT OF BILL: $ 680.68 ' ��.. ***To date we have not received Pacific Bell 's charges , when and if received we will send a revised bill. . . PLEASE MAKE CHECK PAYABLE TO THE NORTHERN CALIFORNIA JOINT POLE ASSOCIATION AND FORWARD TO THE ABOVE ADDRESS. , ` ` ` ` . ^ - ' NORTHERN CALIFORNIA JOINT POLE ASSOCIATION 215MARKET STREET (415)362-2972 SAN FRANCISCO,CALIFORNIA 94105 ^ ' Contra COILta County BILL 1\10. 1.31467 Public Works Department 1801 Shell Avenue nartinez , CA 94553 AtteOtiuO: Run H .irVuy ' 8467 . . REFER: Driver : Bernard Rami ti Date of Loss: 5/18/89 ` Replace Joint Pole facilities located on Neroly Road 13 poles west of Empire Road in Oakley, California. Materials and supplies: $ 178. 74 ' Labor: 709. 84 Construction Equipment Expense: 45. 00 Tool Expense: ' 4: 950. 68 LESS: Joint Pole Credit ` TOTAL AMOUNT OF BILL: $ 680. 6B ' ***To date we have not received Pacif�c Bell s charges when -and if received we will send a revised bi Il . . . PLEASE MAKE CHECK PAYABLE TO THE NORTHERN CALIFORNIA JOINT POLE ASSOCIATION AND FORWARD TO THE ABOVE ADDRESS. ` ` ` ` ' —` `—"—^— -- - -- —7" 3r adPac�fic Gas and Electric Comgany SUNDRY$ALES INVOICE ', 918256342113050365130568068YY COPIES 4 DSC Number Y1nvoice Date C C- 365135-6 7/01/891 68068 BERNARD ROMITI CO CO PUBLIC WORKS DEPT 68068 UJC TJG 635 WALNUT BLVD BRENTWOOD CA 94513 5365135-6 C89-6221 PLEASE PAY THIS $680.68 AMOUNT Please return this portion with payment-Bring entire bill when making payment in office. --------------- ---- making inquiries contact BERNARD R O M I T I ()uf Unice at 800 SECOND ST DSC Number..__:', ANTIOCH CA 94509 UJC-5365135-6 (415) 757-2200 JULY 1 , 1989 ACCIDENT REPORT NO C89-6221 WO 316181C DESCRIPTION AMOUNT COST TO REPAIR COMPANY FACILITIES DAMAGED 5-18-89 REPLACE WOOD POLE JOINT POLE S/S NEROLY RD 13 W/0 EMPIRE RD OAKLEY LABOR : HOURS 10 . 5 OT 66'.48 TOOL EXPENSE 17 . 10 CONSTRUCTION EQUIPMENT 3. 0 HOURS 45 . 00 MATERIALS AND SUPPLIES 178. 74 1-35 ' WOOD POLE MEALS 46 . 36 JOINT INTEREST CREDITS 270 . 00- NOTICE MAKE PAYABLE TO: NORTHERN CALURCIA JOINT POLE AMAL AMOUNT NOW DUE $680:68 M, MAIL TO: . 215 MARKET ST. r` UJC 5365135 , I 61-4657 (10-62) , . k 1 Z ) • �� N N 1 m O (�� N Do U o ❑a='EI zN aWo _j zI NN pp wF 4 Z y 1 Zf' QO N O N N <U JaZ OZ ry n OZ �O y�� tmp t(pp UO <20 Y >Z w0NN WW Z�"a N O mt0 N (O N < II II z jQN ZR m z <� W Z �n Tz <-s 01- : W OO y m �. 1� (� (� (� 7 F m W� Z QON F W a d N Q N N f6 N 1NA 'F-•IU O❑W _ _ m�( U M EE RQ O m o W� N N zwm} 1 0onmo ❑.8. U�ZjOO O> WQ N j0 00 >. � O U ap o-LL LLU_ < m m N 0 Fm U7 tL _ QoN 8 IL O2w ^ N nW Wnz_I V Io �d Woo m C7 I�'t o wOc70 v�u) W 7 o >z Qm z U .YZ °ED z OF _jo E III ZZ :5 c) 0.t , < W <Ii 00 do dD YrL Oa 3: 1111 m p U a ' W n A IC m UN wW N N bO _ U,UNHUSSIGHt'HOU)t0H Io mO Q�}w � N 0.aN. r } o W O ^ < N (� J N \• tN0 O N W O O c0 W O �• N N < N Q U _�s Ix V �� " UL c1 i T � r cc m_ U Qo - - �� 3 Y 3} '\ N )D N N m O O Z O a zJQ -) 1� Q <� o " ; Q FTFIESErn8"'8^8 ;'`� _. w ,� a III tjJ a 0 m m m m m m m m m ' m m a - S w t,1 N W V7 m 1t) m f7 n_ N C) 1O m N i Q y O .1 > o c°) U 0 a r) z i W < Na. E' l ` ap ` Z w O U � c cc I ..� >' i�r in a N n n m N O !tu - n `. ` z - U < zm IQ 2 00 H L- N 'O z O t0 w �. z a cc co 1tn /_� I L �1 C z C% z V Q Z I I o w ci o o w ¢ Z� cc ; ��!` i n o o uj Z ✓' o' o> o Uw n HPI X M n e`v �� a �'L: <��) In y� 0 \� r I''a 1 ~O a^ m^ O O U w W3 ('Jy^ } ^ `i_ W UW z \ Fry "me Z O W � .7 u n >O < 1 • •� 1 fib' o � o �C ° O n - o ai N .0 CC a d o Q A r r v r E ; a 4 i j r N w r ° G ,� m NPa G r p W 3 N C� w r LL Q C N Q a1 O i rl\ Z a to o > 3 u o ' t� ry w x ct a p a- o `J' x r m u LLN (di U w 0 c M cs 0 4 v N Y� U 3 2 O ; rprOr Nr U r� Or Or Nr or Or�r Or 0Ul r vE u Or Or Nr Q 7 V ov. ar O K N 0 N O ° V w a oT °° ul p � w t r 6 u W so 4 ,, 1Ul N U co Q � p v m O fi j E 1d � .a O CO CD OCa N Z CO %S) cA V1 0 t" `o CO �U' N p m EN 2 a W w 00 60 J W UCC) C) > LOLO E 0 o uj w. zw tu z z 51.1 0 w CC LU o Ln z - 0 z is 0 Z 0 .i zn- ts-0 cr- > JU Cl a: < C) cj to cr- LL. 0 iz I uj 0:0 WUJ C, a"c3 to 0 CI w z x u M. u IR C4 W k\,U) CC > > 0 LLA < 10 CC cc se 0 W CC kil | � � NORTHERN CALIFORNIA � JOINT POLE ASSOCIATION o5MARKET STREET (4/5)362-2972 ~ SAN FRANCISCO,CALIFORNIA 94/05 July 14, 1989 ' Contra Costa County Public Works Department ' 1801 Shell Avenue Martinez , CA 94553 ` ~ Attention: Ron Harvey, Risk Management Refer: Driver: Bernard Romiti . Date of Loss: 5/18/89 Dear Mr. Harvey: Enclosed is our Bill No. 8467 in the amount of $680. 68 which represents PG&E 's` costs to repair and replace their portion of damaged public facilities resulting from the accident that occurred on May 18, 1989 in Oakley. Also attached for your review is an itemized breakdown of their charges, and detail sheets. As noted on our bill , we have not received Pacific Bell ' s bill relating to this claim. If and when these additional charges are received in our- office, uroffice, we will submit our revised bill for your consideration. Your company 's draft ihould be made payable to the Northern California Joint Pole Association in the above amount and forwarded to the above referenced address. ' .Should you have any questions concerning this billing please contact me at the above telephone number. ' Sincerely, -- Willi argis . Execut�v� Director WS/sc Encl . cc: Contra Costa County Administrative Services Division Public Works Department 255 Glacier Drive Martinez , CA 94553-4897 ` Attention: Mr. S. Clifford Hansen Administrative Services Officer ` ` ~ ' NORTHERN CALIFORNIA JOINT POLE ASSOCIATION znMARKET STREET w/PauImz SAN FRANCISCO,CALIFORNIA 94105 ^ ' Contra Costa County Public Works Department 1801 Shell Avenue ' Martinez , CA 94553 AtteOtiOD; Ran Harvey . . REFER: Driver : Bernard Romiti Date of Loss: 5/18/89 Repl ` Joint Pole facilities located on Neroly Road 13 poles west of . .Empire Road in Oakley, California. Materials and supplies: $ 178. 74 Labor: 709. 84 Construction Equipment Expense: 45. 00 Tool Expense: ' � 950. 68 LESS: Joint Pole Credit �-27{L. )0 TOTAL AMOUNT OF BILL: � 680.68 ' ' .. . ***To date we have not received Pacific Bell 's charges when�and if received we will send a revised bilk . . PLEASE MAKE CHECK PAYABLE TO THE NORTHERN CALIFORNIA JOINT POLE ASSOCIATION AND FORWARD TO THE ABOVE ADDRESS. . '. ' ` ` ` ` . NORTHERN CALIFORNIA JOINT ASSOCIATION 55wAnmsSTREET 015)362-2972 ~ SAN FRANCISCO,CALIFORNIA 94/05 Contra Costa County PJLL_N1O. 041Z ' Public Works Department 1801 Shell Avenue Martinez , CA 94553 , Attention: Ron Harvey ' REFER: Driver : Bernard Romiti Date of Loss: 5/18/89 Replace Joint Pole facilities located on Neroly Road 13 poles west of Empire Road in Oakley, California. Materials and supplies: $ 178. 74 Labor: 709. 84 Construction Equipment Expense: 45. 00 Tool Expense: 17�00 $ 950. 68 LESS: Joint Pole Credit270-t{}0 TOTAL AMOUNT OF BILL: $ 680.68 ' ' ***To date we have not received Pacific Bell 's charges when and if received we will send a revised bill� PLEASE MAKE CHECK PAYABLE TO THE NORTHERN CALIFORNIA JOINT POLE ASSOCIATION AND FORWARD TO THE ABOVE ADDRESS. ' ` : d. Pac:fTe Gas,and Electric, �Com any SUNDRY,SALES INVOICE i 918256342113050365130568068YY COPIES 4 D&C Number Invoice Date C1 UJC-5365135-617/01/891 68068 BERNARD ROMITI CO CO PUBLIC WORKS DEPT 68068 UJC TJG 635 WALNUT BLVD BRENTWOOD CA 94513 5365135-6 C89-6221 PLEASE PAY THIS .$680.68 AMOUNT Please return this portion with payment- Bring entire bill when making payment in office. ---------------------------------------------------------------------------------------7--------------- When making mquaies contact oui ollice al BERNARD R OMIT I 800 SECOND ST D&C Nuniber ANTIOCH CA 94509 UJC-53G5135-6 (415 ) 757-2200 JULY 1 , 1989 ACCIDENT REPORT NO C89-6221 WO 316181C > DESCRIPTION AMOUNT,... COST TO REPAIR COMPANY FACILITIES DAMAGED 5-18-89 REPLACE WOOD POLE JOINT POLE S/S NEROLY RD. 13 W/O EMPIRE RD OAKLEY LABOR: HOURS 10 . 5 OT 66?.48 TOOL EXPENSE 17. 10 CONSTRUCTION EQUIPMENT 3 . 0 HOURS 45 . 00 MATERIALS AND SUPPLIES 178. 74 s 1-351 WOOD POLE MEALS 46 . 36 JOINT INTEREST CREDITS 270 . 00- . NOTICE 70 . 00-. NOIICE MAKE PAYABLE TO: NORTHERN CALIF&M 1 JOINT POLE NWAL AMOUNT NOW DUE $680:68 MAIL TO: 215 MARKET ST. UJC 5365135 . SANF 9-Mgl 94 1WPAYABLE 61-4657 (10-82) F- N O .: �� W cP eo� � �r D m ror'N�j 1� m 11 cn D \ C. !�, _+ o� � A m� 0 Z p c jai Z 8 Z. z m p tmii `' `^ ^ C ((pn 0 m m c Z y Z D 1 (, ,\� m _ {��NA _ m wX "� U) t o f �l 9 7'[f \\ IN p D N �i �. \ -i iz 71 1 : �- IV •D r"O r 1 1 Z' `Z p r _ _� 4 z i O n yJ Z h (` T� / m 00 CD :01) °° A O U c; •� - , ti m U) ? ° m > G ''1 J� ° (('� _ o c y 1 < r` cm v r m Z O v io v j .o to - ;,�� LI ,n m rel o D 70 1 C C A mZ c C� o m "-1> W ami �.' W o o a m ao m w a �N iC 1 0 IT f _ m rm- �(.�. 8o�o8g808o8$eo8o < O J-4 Z Z fr' D ( m N N .� Q D Q Q Z •� Oa P O O N ' p } 0 co D ro \ 7t �O O 3' m _ _Oo C'l Y N 0 N 0 (A N � '.•,, N D HAP m N V v fn o m o, a'� �' m S o p { N JC 1 Ba em e0) Ie�e�B BISEB m OrV Ehm m m Q a) N N Q (�'� m m U m o v o w m °i °D m o m A 37 A m V D m m m D n> A o �=" m m —00 7"C 11 11 = v 2, o 0 0 0 0 o c n r �> I �' m � m m C o to v ca ro :1 u O (T) 1� m i, .� rpm z D O i a r,y N Z Z r p 3 0_ Cm 03 em z< h Cu wD p� u u n �o cm ` ° o a CD> 00m O rn mD uuu Pm� m yi rn D M �1� P D�� °Dr- zNj( V mL yl .. N m�O K r Op o u v u v v m 31 m; 1 o9ze� pm m m m m m m ao m Z i. it y { Dm u u to N V W T f 1` aA O OLD NOD c p e o Q Io90 Nm NNS nK D1 0 � mC) cmn� N KK �� 0 8Yi1 0 X N N N N N N N N o Nm C p { 9� 0 CD m A�, '0Z N Qi �'i w u o �n� �tn +CT uu W to Z0 O� CZ Dn py �D Z[� NA �AC z< Z OuD DA Sr omi m ami aPi N) o Wiz 0w om aA Z-< {CZ MT N v�x mZ cZ+z \ g < z n NZ N `V ❑� �� oy _ 0 0 0 `8 o o o '" aa' 0 ON O , m� ON O� u+a Z a kp CD U-, COP, r 1 m sow Ul N 0 W dNN UN Z Z w' m CD A s � 2 P O Y c p ' f� M N O R a p G 7o u m G \ ) kp ° �N � �` C• C N-`O .40 A c .A° '` r F aN-1O �O a (f. V m \ w 0 O c 2 -N p m y d � Z O pr C. C6 10 l " M ro 1 1 -N . �b tJ n p wt„� �•C �F"� O 7 L h b r �} ( m ^ o � K J+ w 3 N d _ G w r .► 9 �~: ON d C 9 w 6 N. N � a o v �► ?. t!? 0 3 , d ° - ' L m O N '• Om<m O O�^ I. OD N� m /p O < r ��QIsY1 ; MM ° a D m O m m z G o� 9 m ni m v - n r ' m � , 2 m O D z N 9 Y N CD D 2 ti m!I I m111 ^� m I \� o o-� D m m m \ \ C m t� n g\m m rn v ` O m O w J' O PL•� m r 3 _ y p 1'^ Fn m CC x < m O D 1<1 . ao n PD c O D �t Z CD � O z O m a m Z C ca m G m v co CAM s �� is aux•,. <C7 D Y Ra e Z � C l7 0 r- 0 ;P -lip % 1 � N O fn CmZ C Y a Gi m C m o5 S o pmp -� a v �w :5,C0m Z m a Z O VAI d V 1 m r tl �V a y �• � !�V '�' Pi Y t ✓'ra 'G�j• t a w��` i �,/n'J, "• �': /y� i, j! fi i• 1 t 3 .�^d- j �'i !"t"r - �{r'� �•t 'a rf r if 1�' 'r�'t4 v : �'T r rW 7' e� O W C7 ! — . NORTHERN CALIFORNIA JOINT ASSOCIATION zowwkRuerSTREET (41Y MOM ' SAN FRANCISCO,CALIFORNIA m/m July 14, 1989 Contra Costa County Public Works Department 1801 Shell Avenue Martinez , CA 94553 Attention: Ron Harvey , Risk Management Refer: Driver : Pete Martinez . Date of Loss: 5/3/89 Dear Mr. Harvey: On June 9, 1989, we submitted our Bill No. 8408 in the amount of $3,912. 42 forwarded to you by S. Clifford Hansen , Administrative , Services Division reflecting the costs incurred by PG&E only for damages . resulting from the above referenced accident on Clifton Road east of Byron Highway in Byron , California. We are now in receipt of Pacific Bell 's charges for their portion of damages, and are forwarding our revised bill reflecting the combined costs. A copy of the Pacific Bell 's itemized breakdown is also enclosed for your review. ' Your draft in payment of this claim at $3,912. 42 should be forwarded to the Association at the above referenced address. We apologize for any inconvenience this may have caused , and look forward to your' prumpt consideration of this matter. ' ' Sincerely, . ` � ^ Willia gis Executie \Director \� ] WS/sc ~~ Encl . . cc: Contra Costa County Administrative Services Division Public Works Department 255 Glacier Drive ' t � Martinez , CA 94553-4897 Attention: Mr. S. Clifford Hansen . Administrative Services Officer . , / ~ | ' ' | | � NORTHERN CALIFORNIA JOINT POLE ASSOCIATION zoMARKET STREET W5)MOM _ SAN FRANCISCO,CALIFORNIA 94105 - Contra Costa County Public Works Department 1801 Shell Avenue Martinez , CA 94553 Attention: Ron Harvey REFER: Driver : Pete Martinez Date of Loss: 5/3/89 ` Replace Joint Pole facilities located on Clifton Road east of Byron . Highway in Byron , California. Materials and supplies: $ 345. 73 Labor: 2 ,480. 08 Construction Equipment Expense: 1 ,040. 00 ' Tool Expense: TOTAL AMOUNT OF BILL: $3,Y12. 42 ' ' ' PLEASE MAKE CHECK PAYABLE TO THE NORTHERN CALIFORNIA JOINT POLE ` � ASSOCIATION OND FORWARD TO THE ABOVE ADDRESS. k � ` ` - . . ! ' ! ' � � NORTHERN CALIFORNIA ' ��KY�~� KA~�U��Y� JOINT�� ' zow*uaoTSTREET (UmWS^o ' SAN FRANCISCO,CALIFORNIA 94/05 - ` Contra Costa County BILL_NO. 84089E Public Works Department 1801 Shell Avenue Martinez , CA 94553 Attention: Ron Harvey REFER: Driver : Pete Martinez Date of Loss: 5/3/89 Replace ` Joint Pole facilities located on Clifton Road east of Byron Highway in Byron , California. ~ Materials and supplies: $ 345. 73 Labor: 2,480. 08 Construction Equipment Expense: 1 ,040. 00 Tool Expense: - 46. ' TOTAL AMOUNT OF BILL: $3,912. 42 ' , ' PLEASE MAKE CHECK PAYABLE TO THE NORTHERN CALIFORNIA JOINT POLE ASSOCIATION AND FORWARD TO THE ABOVE ADDRESS. ' ' ` . t � ` ` ` AI 103PI4-821 PAC IFIC "v" BELLSM A Pacific Telesis Group Company Mail Payment to: (- PACIFIC BELL SECURITY DEPT . CUSTOMER COPY 633 FOLSOM ST . , ROOM 200 Bele 07/03/89 SAN FRANCISCO , CA. 94107 CWEID No. 44CR 190215 L J 9B9440215 Total Amount Due: F $ 618 . 96 NORTHERN CALIFORNIA JOINT POLE ASSOC. 215 MARKET STREET , ROOM 1201 SAN FRANCISCO , CALIF . , 94105 ACCOUNT OF : CONTRA COSTA COUNTY PUBLIC W L 1591 Payment Due By: PLEASE RETURN THIS PORTION OF BILL WITH PAYMENT DUE UPON RECEIPT - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - For Duestions Cell CWEIO No. JAN RAO DATE 415-542-2464 44CR190215 WF7097X 159 07/03/89 FOR THE COST OF REPAIR TO PACIFIC BELL POLE (S) DAMAGED AT LOCATION: CLIFTON CT . RD . , E/0 BYRON-TRACY HWY , BRENTWOOD DATE' OF DAMAGE : 05/08/89 CHARGES : PACIFIC BELL LABOR 4 . 00 HOURS $242 . 96 MATERIAL : INTEREST IN JOINT POLE $376 . 00 1 POLE 45 FT . 24 MG 40% PB A � TOTAL AMOUNT DUE $618 .`96 MAKE PAVANMAIL T NORTHERN 1 215 r' SAN FRANCI 0, C 4 CG BC 044 AC 000 Pacific Bell 07/03/89 REPORT JCW014 PAGE 1 21 :25 ARCyRPT NOCAL PROGRAM JOF710 WORK DETAIL FOR CWBO 44CR190215 CONTRA. COSTA COUNTY PUBLIC WORKS DEPT . 1801 SHELL AVENUE MARTINEZ , CA 94553, . Y FOR THE COST OF REPAIR TO PACIFIC BELL POLE (S) DAMAGED AT LOCATION . CLIFTON CT . RD . , E/0 BYRON-TRACY HWY , BRENTWOOD DATE OF DAMAGE : 05/08/89 LABOR/ENGINEERING DATE RC/FC REGULAR AND EXTRA HRS HOURLY RATE SUB-TOTAL 05/08/89 42XB 2 . 00 $60 . 74 $121 . 48 05/08/89 42XB 2 . 00 $60 . 74 $121 . 48 LABOR/ENGINEERING TOTAL $242. 96 MATERIAL DATE RC/FC QUANTITY COST P/U SUPPLY EXP SUB-TOTAL 05/08/89 1C 1 376. 000 " $376. 00 POLE 45 FT . 24 MG 40% PB MATERIAL TOTAL $376. 00 TOTAL AMOUNT DUE $618. 96 NOTICE MAKE PAYABLE TO: 'CAWGRINtA y 4t."T POLE ASSN. 11/1 A1.- TO: 215 MARKET ST. SAN FRANCISCO, CA 94105 � NORTHERN CALIFORNIA JOINT POLE ASSOCIATION zoMARKET STREET (415)362-2972 SAN FRANCISCO,CALIFORNIA y*/m July 14, 1989 ' Contra Costa County Public Works Department 1801 Shell Avenue Martinez , CA 94553 Attention: Ron Harvey , Risk Management Refer: Driver : Pete Martinez . Date of Loss: 5/3/89 Dear Mr. Harvey: On June 9, 1989, we submitted our Bill No. 8408 in the amount of $3,912. 42 forwarded to you by S. Clifford Hansen , Administrative Services Division reflecting the costs incurred by PG&E only for damages resulting from the above referenced accident on Clifton Road east of Byron Highway in Byron , California. We are now in receipt of Pacific Bell 's charges for their portion of damages, and are forwarding our revised bill reflecting the combined costs. A copy of the Pacific Bell 's itemized breakdown is also enclosed for your review. ' Your draft in payment of this claim at $3,912. 42 should be forwarded to the Association at the above referenced address. We apologize for any inconvenience this may have caused , and look forward to yourprompt consideration of this matter. ' ' ~ Sincerely, ' .. William gis Ex�cutiv� �irector WS/sc Encl . . cc: Contra Costa County Administrative Services Division Public Works Department _ 255 Glacier Drive t � Martinez , CA 94553-4897 Attention: Mr. S. Clifford Hansen Administrative Services Officer , � . i � / . ! NORTHERN CALIFORNIA DOXNT POLE ASSOCIATION zoMARKET STREET (41n362-2972 . SAN FRANCISCO,CALIFORNIA 94/05 Contra Costa County BILL NO. 8A0QR Public Works Department 1801 Shell Avenue Martinez , CA 94553 Attention: Ron Harvey REFER: Driver : Pete Martinez Date of Loss: 5/3/89 Replace ` Joint Pole facilities located on Clifton Road east of Byron ' Highway in Byron , California. Materials and supplies: $ 345. 73 Labor: 2 ,480. 08 Construction Equipment Expense: 1 ,040. 00 Tool Expense: TOTAL AMOUNT OF BILL: $3,112. 42 ^ ` ' PLEASE MAKE CHECK PAYABLE TO THE NORTHERN CALIFORNIA JOINT POLE ASSOCIATION OND FORWARD TO THE ABOVE ADDRESS. ^` t � ` ' | _ ^ / NORTHERN CALIFORNIA JOINT POLE ASSOCIATION z/xMARKET STREET (4/5)362u972 SAN FRANCISCO,CALIFORNIA 94/05 Contra Costa County BILL NQ_840f�'�F Public Works Department 1801 Shell Avenue Martinez , CA 94553 ` Attention: Ron Harvey , REFER: Driver : Pete Martinez Date of Loss: 5/3/89 Replace ` Joint Pole facilities located on Clifton Road east of Byron . Highway in Byron , California. Materials and supplies: $ 345. 73 Labor: 2,480. 08 Construction Equipment Expense: 1 ,040. 00 Tool Expense: TOTAL AMOUNT OF BILL: $3,Y12. 42 ' , ' ' PLEASE MAKE CHECK PAYABLE TO THE NORTHERN CALIFORNIA JOINT POLE ` ASSOCIATION MND FORWARD TO THE ABOVE ADDRESS. ` ` A1103P14—B21 P�4eIFle BELLS. A Pacific Telesis Group Company Mail Payment to: r PACIFIC BELL SECURITY DEPT . CUSTOMER COPY 633 FOLSOM ST . , ROOM 200 081e 07/03/89 SAN FRANCISCO , CA . 94107 CWBO No. 44CR190215 L J 9B9440215 Total Amount Due: $ 618 . 96 NORTHERN CALIFORNIA JOINT POLE ASSOC. 215 MARKET STREET , ROOM 1201 ` SAN FRANCISCO , CALIF . , 94105 ACCOUNT OF : CONTRA COSTA COUNTY PUBLIC W L 1591 Payment Due By: PLEASE RETURN THIS PORTION OF BILL WITH PAYMENT DUE UPON R E C E I P T _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ — _ _ _ _ _ __ — _ — . For Dueslions Cell CWBO No. JAN RAO DATE 415-542-2464 44CR190215 WF7097X 159 07/03/89 FOR THE COST OF REPAIR TO PACIFIC BELL POLE ( S) DAMAGED AT LOCATION: CLIFTON CT . RD . , E/0 BYRON—TRACY HWY , BRENTWOOD DATE' OF DAMAGE : 05/08/89 CHARGES: PACIFIC BELL LABOR 4. 00 HOURS $242 . 96 MATERIAL : INTEREST IN JOINT POLE $376 . 00 1 POLE 45 FT . 24 MG 40% PB N' 0 T I C TOTAL AMOUNT DUE $618 . 96 MAKE PAYAF311�1E: T®: A cd�c1Q"l jem TO- 215 'tF215 MA i; ` 94105 .. SAN FRANCIS r i . BC 044 AC 000 Pacific Bell 07/03/89 REPORT JCW014 PAGE 1 21 :25. ARC-iRPT NOCAL PROGRAM 0OF710 WORK DETAIL FOR CWBO 44CR190215 CONTRA. COSTA COUNTY PUBLIC WORKS DEPT . 1801 SHELL AVENUE MARTINEZ, CA 94553 - FOR THE COST OF REPAIR TO PACIFIC BELL POLE (S) DAMAGED AT LOCATION: CLIFTON CT . RD . , E/0 BYRON—TRACY HWY , BRENTWOOD DATE OF DAMAGE : 05/08/89 LABOR/ENGINEERING DATE RC/FC REGULAR AND EXTRA NRS HOURLY RATE SUB-TOTAL 05/08/89 42XB 2 . 00 $60. 74 $121 . 48 05/08/89 42XB 2 . 00 $60 . 74 $121 . 48 LABOR/ENGINEERING TOTAL $242.96 MATERIAL DATE RC/FC QUANTITY COST P/U SUPPLY EXP SUB—TOTAL 05/08/89 1C 1 376. 000 $376. 00 POLE 45 FT . 24 MG 40% PB MATERIAL TOTAL $376. 00 TOTAL AMOUNT DUE $618. 96 NOTICE MAKE PAYABLE TO: ' .P,ld CA�IF�RI�A ��• &IJ T POLE ASSN. 215 MARKET ST. SAN FRANCISCO, CA 94105 AMENDED ll CLAIM o� y : 'ARD 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 August 29 , 1989 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: $750, 000 . 00 Section 913 and 915.4. P1 astZ?6ta�ta&J "Warnings". �Y U CLAIMANT: PAUL REDICAN COUro c/o Michael D. Goforth, Esq. AUG 198 ATTORNEY: 1 Concord Centre 2300 Clayton Road #520 Date received ��4'�iC1F;Z, CA 94 53 ADDRESS: Concord, CA 94520 BY DELIVERY TO CLERK ON August 11, 1989 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, ppHH gg DATED: August 14, 1989 BYIL DeputyLOR, Clerk J 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: Dated: /�q BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County dministrator (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: A U G 2 9 1989 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code secti 13) 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: AUG 2 9 1989- BY: PHIL BATCHELOR by Deputy Clerk 7-7 CC: County Counsel County Administrator CLANM 7.0i BOA"-O OF SUPERVISORS OF CONTRA COSTA COUNTY 6,��_ �3 • YZi ; Instructions to Claimar� Return original application tc Clerk of the Board / 2 G/ 651 Pine St., Room 106 Martinez. CA 94553 A. Claims relating to causes of action for death or-"for injury to 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 of this form. �*:«e««�«««!*:+e,tr,�«�««:�«�«:�tf::are::«:,��«�««««:««««««:+#*«t«t►:::t**�*tt RE: Claim by )Resery lerk'a filing stamps Paul Redican ) r A .: Against the COUNTY OF CONTRA COSTA) 11989p or Housing Authority DISTRICT) tctc•. ,:e raver /,-F l.aR (Fillin name) �"�{6 nputY The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in .the sum of $ 750.000.00 and in support of this claim represents as follows: �. lahen did the damage or injury occur? (Give exact date ani Eurj 2-14-89 Time: 23:10 �. f�ifiere aid-tie �nmage or in3ury occur? �Inciude city and countyT 3816 Willow Pass Road, Apt. C Concord, County of Contra Costa, California 3. Sow did the damage or in3ury occur? ZGive �uiI details, use extra sheets if required) Claimant was severely lacerated by a sliding-.glass door which was not constructed with safety glazing material as required by code. 4. khat particular act or omission on the part. o� county or district officers, servants or employees caused the injury or damage? The Housing Authority of the County of Contra Costa failed to adequately inspect said premises prior to making housing assistance payments on behalf of Leasee, Kim Browning. (over) 5, .'&At 'are the names ,county or district office; , servants or' e�tp oyees causing the damage or injury? Housing Authority of the County of Contra Costa 6. What damage or ins-uries �o you claim zesu�te�? -�G�veu�l extent of inj ies or damages claimed. Attach two estimates for auto damage Severe bodily injuries including a punctured lung, broken ribs and heart lacerations. ----------------------------------------------------------------- 7. Eow was the amount claimed above computed? (Include the estimated - amount of any prospective injury or damage. ) Medical treatment, wage loss, general damages --------------------------------- ---------------------------------------- B. Names and addresses of witnesses, doctors and hospitals. John Muir Hospital , 1601 Ygnacio Valley Road, Walnut. Creek, CA Kaiser Hospital-Walnut Creek, 1425 South main-Street, Walnut Creek, 'CA �. List the expenditures you made on account of this accident or NRUi: DATE ITEM AMOUNT Pending Govt. Code Sec. 910.2 provides : "The claim igned by the claimant SEND NOTICES TO: (Attorney) or b rson on his behalf. " Name and Address of Attorney Michael D. Goforth, ESQ. Cla t s Signa ure One Concord Centre Paul Re d i c a n 2300 Clayton Rd. , Ste. 520 Address Concord, CA 94520 - P. O. Box 1605 , Antioch , CA 94509 Telephone No. 415-682-9500 Telephone No. 415-439-2088 :t�+r::tt:�*ie+t��r****�,rf#�*:�:rf::t::s�r�:f::tf•frr�r�tf*t*�***��::*f*,r:+tom**** 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. " CLAIM $OARD 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 August 29, 1989 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: $750, 000. 00 Section 913 and 915.4. Please note all "War�ip�1� '"Cou ns a' CLAIMANT: PAUL REDICAN �ss66�� c/o Michael D. Goforth., Esq°:! AUG 01 1989 ATTORNEY: One Concord Centre 2300 Clayton Road #520 Date received Martinez, CA 94553 ADDRESS: Concord, CA 94520 BY DELIVERY TO CLERK ON July 28 , 1989 BY MAIL POSTMARKED: July 27 , 1989 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim, pPH BATCHELOR, DATED: August 3 , 1989 B�jIL Clerk r 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: Dated: I y 1 T R BY: ( Deputy County Counsel �T III. FROM: Clerk of the Board TO: County Counsel (1) County Admin' rator (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: ALIG 2 .9 1989 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: AUG 2 9 1989 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: ul Redican c/o ' chael D. Goforth, Esq. One Co ord Centre 2300 Clay Rd. , #520 Concord, CA 2` Re: Claim of PAUL REDICAN Please Take Notice As Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code section 910 and 910 . 2, or is otherwise insufficient for the reasons checked below: x I. The claim fails to state the name and post office address of the claimant. 2 . The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. 3 . The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. 4 . The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000) . If the claim totals less than ten thousand dollars ($10,000) , the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10,000) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. 6 . The claim is not signed by the claimant or by some person on his behalf . 7 . Other: VICTOR J. WESTMAN, County Counsel By: Deputy tounty un 1 CERTIFICATE OF SERVICE BY MAIL C.C.P. §§ 1012, 1013a, 2015 .5; Evid. C. §§ 641 , 664 ) My business address is the County Counsel's Office of Contra Costa County, Co. Admin. Bldg. , P.O. Box 69, Martinez, California, 94553, and I am a citizen of the United States, over 18 years of age, employed in Contra Costa County, and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non Acceptance of Claim by placing it in an envelope(s) addressed as shown above (which is/are place(s) having delivery service by U.S. Mail) , which envelope(s) was then sealed and postage fully prepaid thereon, and thereafter was, on this day deposited in the U.S. Mail at Martinez/Concord, Contra Costa County, California. I certify under penalty of perjury that the foregoing is true and correct. Dated: G , at Martinez, California. cc: Clerk of the Board of Superviso riginal) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910 . 2, 920 .4, 910 . 8) LAW OFFICES GOFORTH & LUCAS ONE CONCORD CENTRE MICHAEL D. GOFORTH 2300 CLAYTON ROAD. SUITE 520 CHRISTOPHER R. LUCAS CONCORD. CALIFORNIA 94520 14151 682-9500 TRANSMITTAL MEMO REFER TO FILE NO: DATE: July 26 , 1989 RECEIVE J U L 2 81989 PNit BATCHELOR C(.FRfC 60r.RD Or SUPERVISORS TO: Clerk of the Board CGY>.ACO. 651 Pine Street 8 Deer Room 106 Martinez, California 94553 SUBJECT: Claim by Paul Redican against Contra Costa County Housing Authority regarding the incident of 2-14-89. ENCLOSURES: An original application for claim and one copy, one return envelope. ACTION: Please file the original application and return a conformed copy of the application to our office in the enclosed postage paid envelope. Very truly yours, Law Office of Goforth and Lucas BY: CLAIM%-T D: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY (p c((,: a 3 Instructions to Claimant Return original application tc�' Clerk of the Board 651 Pine St., Room 106 Martinez, CA 94553 A. Claims relating to causes of action for death or for injury to 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 of--t is form. +tatartaa*atia*taataaaaaaa*a:aa*at,�aaaaarra+tat*aa�r**rttrtsrrtt*�rttt*aRt#�ttttt* RE: Claim by )Reserved for Clerk's filing stamps Paul Re d i c a n r EEE V Against the COUNTY OF CONTRA COSTA) ) or Housina Authority DISTRICT) PHi Al', Fl_J . (Fill -in name ) C ERK8 T FSJ: vim The undersigned claimant hereby makes claim agains the County of Contra Costa or the above—named District in the sum of $ 750.000.00 and in support of this claim represents as follows: When did the damage or �n3ury occur? Give exact date and �iourf 2-14-89 Time: 23: 10 '�:- Wfiere did tFie damage or �n3ury occur? Include city and county] 3816 Willow Pass Road, Apt. C Concord, County of Contra Costa, California 3. Bow did the damage or injury occur?- Giveu�I details, use extra sheets if required) Claimant was severely lacerated by a sliding glass door which was .not constructed with safety glazing material as required by code. 4 -------��T�i�--��--...WE t particular act oz omission on the part o county or distr�et officers , servants or employees caused theinjury or damage? The Housing Authority of the County of Contra Costa failed to adequately inspect said premises prior to making housing assistance payments on behalf of Leasee, Kim Browning. , (over) •5. What' are the names of county or district officers, servants or' ' employees causing the damage or injury? Housing Authority of the. County of Contra Costa 6. What damage -or injuries do you claim resu�te�? ZG�ve �u�l extent of inj ries or damages claimed. Attach two estimates for auto damage Severe bodily injuries including a punctured lung, broken ribs and heart lacerations. --------------------------------------------------------------------- -- 7. How was the amount claimed above computed? (Include the estimate amount of any prospective injury or damage. ) Medical treatment, wage loss, general damages ------------------------------------------------------------------------- 8. Names and addresses of witnesses, doctors and hospitals. John Muir Hospital , 1601 Ygnacio Valley Road, Walnut. Creek, CA Kaiser Hospital-Walnut Creek, 1425 South main Street, Walnut Creek, 'CA �S. List the expenditures-you made on account of this accident or injury: DATE ITEM AMOUNT Pending Govt. Code Sec. 910.2 provides : "The claim signed by the claimant SEND NOTICES TO: (Attorney) or by some on his behalf. " Name and Address of Attorney - _ Michael D. Goforth, ESQ. �C3aimant s Signatur One Concord Centre 2300 Clayton Rd. , Ste. 520 Address Concord, CA 94520 Telephone No. 415-682-9500 Telephone No. tt:•t�t:ft+r*�r*�*�,��r:��:�t�e,�*rt*r*t�+rpt#t�:,r*�t*«�t*:**,r*:art****�:�*�*�:******** 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. " CO �. � - \ o \ / \�\\ � & \ � .4, 9$$ � r � C co � q o � \off ,4 Cl- a2 » m00 % , k & / � 0 & � o{ % \o2 / U. \% f } 0 � z\\ \ OU 0 10, u : O o 0 U � CLAIM County Counsel BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA A U G 0 1' 1989 Claim Against the County, or District governed by) C the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT Augu s L �4 9 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: $68 . 00 Section 913 and 915.4. , Please note all "Warnings". CLAIMANT: MANUEL CISNEROS 910 Polk Street ATTORNEY: Albany., CA 94706 Date received ADDRESS: BY DELIVERY TO CLERK ON July 31, 1989 BY MAIL POSTMARKED: July 29, 1989 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. Au gust 3 , 1989 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). ( ) Other: Dated: Jq j�q BY: I Deputy County Counsel 11I. FROM: Clerk of the Board TO: County Counsel (1) County A m rator (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: A U G 2 9 1989 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code sect 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: A U G 2 9 1985 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator A y 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 Cle— R amp V Loy Against the County of Contra Costa ) J 3 11989 or ) /r EA Eic2 C! JP S' E ' 5 .5 District) a . .orae Fill in name ) The undersigned claimant hereby makes claim agai st. the County of Contra Costa or the above-named District in the sum of $ _ and in support of this claim represents as follows: 7-1 o ------------------------------------ G -5-- � 1. When did the damage or injury occur? (Give exact date and hour) ere did the damage or injury occur? (Include city and county) 4-9b z _ _---------�� ' -- � ---�a Z,r__ 3. How did the dama7eor injury occur? (Give full details; use extra paper if required) )P/9/fK/1fy e R R 61'N ;//C G _5-1p'14 GST sib W 19 6 '07; /VF�,F/� SL �`- ,Orc% _`� 7- Y k-G,3o alb 6 /V/ �`"p`�rti� �r act,Ir bmi cion on e "art county or district officers,lqcl servants or employees caused the injury or damage? _ y (over) 5. What are the names of county or district officers., servants or employee s'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. ----------- -------------------------------------------------------------------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) g ------------------------------------------------------------------------------------- 8. Names and addresses of witnesses, doctors and hospitals. ---------------- pP-ar =--_�-5��=�"?_4a-----------=------------------ 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT tai k � Ivr Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attornev) or by some person on his behalf." Name and Address of Attorney Claimant's Signature ddress) oilf Telephone No. Telephone No. C�/ 6 1 71 N 0 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. RECEIVEDFE . AL 3 i 1989 PHIL BATCHELOR CLERK BOARD OF 5UPUMSOPS CON T M COSTA CC. 6 ................................. De �; ;``" '% ^. C, -� ra •Y.qt (� '�rye `� '� .r•�,