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HomeMy WebLinkAboutMINUTES - 09121989 - 1.35 CLAIM A35 " • •F ' .y 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 12, 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: $757 . 59 Section 913 and 915.4. Please n to all " rnings" bounty ounsel CLAIMANT: NORMA G. PANGILINAN 715 Walnut Ranch Way , AUG U 7 1989 ATTORNEY: Oakley, CA 94561 Date received Martinez, CA 945:53 ADDRESS: BY DELIVERY TO CLERK ON August 4-; 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. August 7 , 1989 PPHHIL BATCHELOR, Clerk DATED: 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: , BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrato (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present i (< 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. n p 12 Dated: SEP �Jy9 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 14 1919 BY: PHIL BATCHELOR by � Deputy 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 Boardeof 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 RE V - Against the County of Contra Costa ) AliGA 1989 �Q or ) / A e CLC K RBATF 1 �r District) P LOR (Fill' in n e ) NT f "F 'O" _Doputy The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ --757 -5'7 and in support of this claim represents as follows: ---------------------------7--------------------------------------------------------- 1. When did the damage or injury occur? (Give exact date and hour) /ZY--------- ------------------ --------------------- --- 2. Where did the damage or injury occur? (Include city and county) ------------ ----=--- scam _t _ _C� ---------------------- 3. How did the damage or injury occur? (Give full details; use extra paper if required) t'r. ,/ ��';� d?%1 c' �`'. > 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? ������ tet.- �r�� --�L�✓ —�-- �����t—�'u-% �--. �=�.`�y (over) 5. What are the names of county or district officers, servants or employees causing , the damage or injury? CD �Ga 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. IVIA ------ --------- -- ---- ---------- --- ----------------------- 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 '/rJ�'vs/�Gterr ' v Ci��/� ' ��1�Z G!'1.t.�j/�(�. d� e9/��l�L' .. fL"'`o/T� /3�A.�; .�• `�G ��✓� ���e��. cu,:.�R :ftp .G���t �A/�/�� ��-, ----------------- ----------------------------------a------------------------=-------- 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 s me person on his behalf." Name and Address, of Attorney- -' 1-1441.CIS 61 Claimant's Signature Address- LI Telephone No. Telephone No.(,_, �9 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' ($10,000, or by both such imprisonment and fine. PATIENT,!p WALNUT CREEK RADIOLOGY MEDICAL 'GRO ' .BUSINESS OFFICE � � ���� ��, JONAS PANG ILINAN �y P.O. BOX,,5016 STATEMENT:OATE a ounlr.NUMeER - 6607—26-89 , nMounrT Pate Plac• of Ssrr-boa 1.OS MEDAN�S COMM HOSP ER 2a.uu r,ys "a; fi SAMC�*30*mY�866` F r r, NORMA PANGILINAN -WALNUT CREEK RADIOLOGY MEDICAL Gt' 715 WALNUT BRANCH WY BUSINESS°'OFf_IGE OAKLEY CA 94561 P..O. BOX 5016 SAN RAMON CA 94.583 Billing questions? Call: 415/866-7160 PLEASE DETACH AND RETURN TOP PORTION WITH PAYMENT _ r e. YOUR ACCOUNT IS PAST DUE ! ! ------------------- ------- PLEASE REMIT BALANCE OF 24 . 00 - ACCOUNT NUMBER DATEOF.STATEMENT " AMtiUNT,PAiD PAYMENTS AFTER THIS DATE WILL APPEAR ON 26866 07-26-89 YOUR NEXT STATEMENT 24.0 PATIENT NAME YtIUR gCCOUNT IS NOMI t�E1.iNgUENT. 'TO AYO Iii „CIILLECTIaDN ACTIVITY PLEASE-4-i,T T 8A1eA CES:" JONAS PANGILINAN 'LtLLO ?AY. NANKYOU, d ' � " Ir�►:ce CHe'ctcsPAY°Il1L1" TA WALNUT 'GREE<K 4R� 11 ADI,OLBGY CA MEDIL ROUP INC A ke,,P r�.t1 a ": _ '- �-"1c,x"r'4d5 „_A .frr7F}-• s`.. '+_ ,C -flj b M.Y 'SYR q R i/ i ' i Y • _7�7/ y p,.4#\y;:-„,; a ucsaxf JK r$a+3 - � , ""' �� �" '�'"k S-, ".<�-� � ;�' 3;�^� I `�n�� q. �',,�� g a4s' yet '� a s. 1 .: z - ., eX�` & ,F �.-^ 'E . `� u`� ce.�t, c ? s 0 , SEE REVERSE SIDE FOR IMPORTANT BILLING INFORMATION -j ADMIT`DATE y.. ( — PATIENT DISCHARGE DATE P NGILLNANO JONAS a QUESTIONS CONCERNING THIS STATEMENT BILL CAN BE ANSWERED BY LOS MEDANOS GQMMUNITY HOSPITAL ENT (411,1412-2200 2311 LOVERiDGE ROAD PITTSBURG.CA 94565 pavMENTS PATIENT AMOUNT CHARGE DESCRIPTION ADJUSTMENTS. DATE 229-32 : .. DISCHARGE E3ALA! C .- I I #�• ., l I , 1� f I 1 _ RETAIN FOR TAX RECORDS AMOUNT HOSPITAL NO: - DUE ARANTOR NAME AND ADDRESS •R•I CILINANi`'- NORKA ?29*32 715 A LT BRANCH, JiYAMOUNT ENCLOSED BILLING DATE AKLEYV CA. 94551 __,. PATIENT "` DISCHARGE DATE " ` ,ADMIT DATE ANSILINANt JONAS 4; 17; 80 , 17; ES.i LOS MEDANOS COMMUNITY HOSPITAL STATEMENT QUESTIONS CONCERNING THIS 2311 LOVERIDGE ROAD•PiTTSBURG,CA 94565 BILL CAN BE ANSWERED BY,' CALLING:(415)432-2200 DATE CHARGE DESCRIPTION PAYMENTS PATIENT AMOUNT ADJUSTMENTS 1 1 DISCHARGE SALAV- CE I I - 1 ! ! i ' RETAIN FOR TAX RECORDS GUARANTOR NAME AND ADDRESS HOSPITAL NO. AMOUNT DUE ANGILINAN♦ NORMA 5-23422 15 WALNUT BRANCH WAY 55..58 A K L E Y 9 C A w 94561 AMOUNT ENCLOSED BILLING DATE 71., Z6 84:, k i 5 r= T r � S• � ".- � ,..: ^ � ., . ter; .=- VII r. v � •;. m 'v fY't ,.{ r n et e.; T 1 4 t t 1A s✓' l'. .per. R e � 1 LETTER # 102 564-35-7399 NG PANGILINAN 64 05/31/89 PATIENT : DAUGHTER * JONAS CLAIM NO : 151-64-902 ---PROVIDER-------DATE-----CHARGE--0TH INS----PAID-- MEDICUS MEDICAL 04-14-89 110.00 0.00 0.00 MEDICUS MEDICAL 04-14-89 70.00 0.00 0.00 MEDICUS MEDICAL 04-14-89 100.00 . 0000 0.00 NG PANGILINAN 715 WALNUT RANCH WY OAKLEY CA 94561 DEAR MEMBER : AFTER CAREFUL CONSIDERATION• WE FIND THAT YOUR CLAIM FOR THE BENEFIT DESCRIBED ABOVE IS NOT PAYABLE UNDER THE TERMS OF YOUR WELFARE PLAN. OUR RECORDS INDICATE THAT YOU DID NOT WORK SUFFICIENT HOURS DURING THE WORK PERIOD THAT ALLOWED COVERAGE FOR THE ABOVE MENTIONED CLAIM PERIOD. YOU HAVE THE RIGHT TO A-PPEAL THIS DETERMINATION. PLEASE REFER TO THE 'PROCEDURE TO BE FOLLOWED FOR THE APPEAL OF YOUR DENIAL ' ON REVERSE SIDE OF THIS LETTER. SINCERELY9 MEDICAL CLAIMS DEPARTMENT RETAIL CLERKS - EMPLOYERS BENEFIT PLANS OF NORTHERN CALIFORNIA LETTER 102 564-35-7399 NG PANGILINAN 02 06/05/89 PATIENT : DAUGHTER * JONAS CLAIM NO : 151-64-902 PROVIDER-------DATE------CHARGE--0TH INS----PAID-- LOS MEDANOS HOSP 04-17-89 55.68 0.00 0.00 NG PANGILINAN 715 WALNUT RANCH WY OAKLEY CA 94561 DEAR MEMBER: AFTER CAREFUL CONSIDERATION♦ WE FIND THAT YOUR CLAIM FOR THE BENEFIT DESCRIBED ABOVE IS NOT PAYABLE UNDER THE TERMS OF YOUR WELFARE PLAN. OUR RECORDS INDICATE THAT YOU DID NOT WORK SUFFICIENT HOURS DURING THE WORK PERIOD THAT ALLOWED COVERAGE FOR THE ABOVE MENTIONED CLAIM PERIOD. YOU HAVE THE RIGHT TO APPEAL THIS DETERMINATION. PLEASE REFER TO THE • PROCEDURE TO BE FOLLOWED FOR THE APPEAL OF YOUR DENIAL• ON REVERSE SIDE OF THIS LETTER. SINCERELY• MEDICAL CLAIMS DEPARTMENT RETAIL CLERKS - EMPLOYERS BENEFIT PLANS OF NORTHERN CALIFORNIA LETTER # 102 564-35-7399 NG PANGILINAN 64 06/17/89 PATIENT : DAUGHTER * JONAS CLAIM NO : 151-64-902 —-PROVIDER-------DATE-----CHARGE--0TH INS----PAID-- REGIONAL AMBULAN 04-14-89 323.50 0.00 0.00 NG PANGILINAN 715 WALNUT RANCH WY OAKLEY CA 94561 DEAR MEMBER: AFTER CAREFUL CONSIDERATION• WE FIND THAT YOUR CLAIM FOR THE BENEFIT DESCRIBED ABOVE IS NOT PAYABLE UNDER THE TERMS OF YOUR WELFARE PLAN. OUR RECORDS INDICATE THAT YOU DID NOT WORK SUFFICIENT HOURS DURING THE WORK PERIOD THAT ALLOWED COVERAGE FOR THE ABOVE MENTIONED CLAIM PERIOD. YOU HAVE THE RIGHT TO APPEAL THIS DETERMINATION. PLEASE REFER TO THE •PROCEDURE TO BE FOLLOWED FOR THE APPEAL OF YOUR DENIAL• ON REVERSE SIDE OF THIS LETTER. SINCERELY9 MEDICAL CLAIMS DEPARTMENT RETAIL CLERKS - EMPLOYERS BENEFIT PLANS OF NORTHERN CALIFORNIA 2311 LOVERIDGE"ROAD,~PITTSBURG, CA 94565 LOS MEDANOS COMMUNITY HOSPITAL ' (415) 432-2200 • •- • fr' Patient NumberR.C. Adm. Date Adm. Time FC Age Date of Birth Sex Marital Status Family Doctor E.RDOctor 5-23162 Ai as 0 9 6/08/79 M 'REYES, D m r Patient Name and Address Rel.,- S.S. No. ;Patient Employer ='Med %cords No. NANt;ILINAN, , NAS -`, . 0000000000 MINOR "` # 01_67 _7.15 VALNUT B AN H MAY Phone NORMA PANGILINAN .MOTHER UAKLEY. CA. '9 856 i. . 6285-3293 PAUL PANf3YLI'NAN FATHER Guarantor Name and Address Relation Guarantor Employer l PANGILINAN, NORMA MOTHER SAFEWAY 715 WALNUT BRANCH WAY OAKLAND OAK LEY, CA. 94561 ACKNOWLEDGMENT OF PATIENT INSTRUCTIONS ,PATIENT INSTRUCTIONS:I acknowledge that 1 have been informed and understand that I have this date received Emergency Medical Care, and not necessarily definite diagnosis or treatment, and have been instructed to contact a physician as soon as possible,for eontinuedr ical diagnosis and care if indicated.I HAVE READ AND UNDERSTAND THE FOLLOW-UP INSTRUCTIONS AND HAVE RECEIV A COPY THEREOF. SUTURE AND CUT INSTRUCTIONS ❑SPRAINS AND FRACTURE INSTRUCTIONS 1. Keep the,dressing and wound clean and dry. 1. If a foot or leg is injured,keep it elevated on two pillows while ;2. _1f"there is.uriusual pain,bleeding,swelling,and/or redness lying down for 24-28 hours._ _`of,the wound report to your doctor or return to the Emer- 2. Apply ice bags intermittently to the injured .area for .the gency Dept. immediately. first 24-hours. Use a towel or cloth between the ice bag and 3. Keep your wound comfortably elevated as much of the time skin to prevent frostbite. as-possible for the next few days. 3. Persistent pain and disability for more than 72'hours are Call your doctor's office to see when he wishes to see you to caution signs indicating that.you should see a physician have the dressing changed or sutures removed.If you have no for further evaluation. family doctor, return to the Emergency Dept. 4. If a cast or splint is applied it is important to elevate the injured extremity. Check fingers and toes for paleness, on numbness, or extreme pain. If this occurs, return to.the _ 4. Wound Checked Days. Sutures Removed /D Days. Emergency Department immediately. ❑ HEAD INJURY INSTRUCTIONS ❑ NECKAND BACK SPRAINS 1.;Allow the patient to sleep as he normally does. However, 1. No heavy lifting for—days or until seen by your physician. ,awaken him every hours(s) and make sure he knows 2. Rest in a comfortable position. his name, the date, where he is, etc. 3. -Local heat with heating pad or hot water bottle for 2. Observe for unusual drowsiness. every•`hours. 3. Observe for persistent nausea and/or vomiting. 4. Use Aspirin or Tylenol or both for pain medication as 4. Observe for weakness or lack of coordination in his arms prescribed for discomfort. an legs. 5 ry Obsee-for+blurred oi' double.vision. _ GASTROENTERITIS 6 Observe for persistant or increasing headach ,{1n6sua s ] osolid food for hours. 1 % ti 2.,Start on sips of .water and gradually add other non car- :restlessness or abnormal behavior. 7. Observe for any abnorm'al drainage from ears or nose._ bonated fluids. If.vomiting occurs wait two hours and 8. Observe for unequal pupils (one pupil large, ohe small). restart fluids above .Note if patient is usually not awake or arouseable. IN CHILDREN use pedilyte,jello water,apple juice,etc. 9. Observe for areas of skin numbness. No plain water. 10. Observe for convulsions or seizures. Give_ounces every fifteen minutes for hours then 11. Observe for persistant dizziness. _ouncesevery_hours. if any"of these.symptoms should occur within the_gpxt 24 to ❑ once --' VIRAL ILLNESS 36:hour%.please contact your family doctor at once or return 1 'Symptoms may last 10-14 days but should show gradual to the Emergency Department at once. improvement.Return to,the Emergency Room or see your !❑_ SORE THROAT physician if fever persists more than 5 days. A.--Gargle with salt water. 2. a hr lozanoTY09 o1 2r*AGENERAL INSTRUCTIONS MA ignature Of v hySlClan f "' _ ❑ USE MEDICATIONS AS PRESCRIBED OR tNSTRUCTED. „/� _ � fier.Gare Instructions: DO NOT DRIVE OR OPERATE DANGEROUS'MACHINERY s s ,. ❑'WHILE TAKING PAIN MEDICINES OR MUSCLEfRELAXANTS. ug Date of Discharge Time Referred to 1 P 4 � RSE'S 49 SIGNATURE .X g re S rain her r _- ead . 'q eneral ' 1T1 }. ENT SI TURE DATE TIME RETURN Immunization /e (/(ti,AR/LTO WORK / / ❑ DPT ❑ DT ❑TTET OX AOM' PATIENT 2311 LOVERIDGE ROAD, PITTSBURG, CA 94565 LOS MEDANOS COMMUNITY HOSPITAL (415) 432-2200 • •- - Patient Number R.C. I Adm. Time FC Age Date of Birth SexJ Marital Status Family Doctor F--,R.7-,Doctor 5-23422 A :`1i1:17/S9 ` : :f.0902 7 9 �!�?8 79 Patient Name and Address Rel. S.S. No. Patient Employer - Med Records No. PANDILINAN, -,JONAS 0000000000 JAI NOR -01-67 WALNUT BRAaHf.H MAY Phone !NORMA PAN©rLINAN .MOTHER 0AKLEYr :A. 94861 625-3293 `PAt1t- PANHILINAN FATH1. Guarantor Name and Address Relation Guarantor Employer PANOILINAN, NORMA MOTHER SAFEWAY - 715 WALNUT BRANCH WAY OAKLAND ACKNOWLEDGMENT OF PATIENT INSTRUCTIONS PATIENT INSTRUCTIONS:I acknowledge that I have been informed and understand that I have this date.received Emergency.Medical 'Care, and not necessarily definite diagnosis or.treatment,and have been instructed to contact a physician as soon as,possible.for continued medical A diagnosis and care if indicated.I HAVE READ AND UNDERSTAND THE FOLLOW-UP INSTRUCTIONS ND HAVE RECEIVED A COPY THEREOF. ❑ SUTURE AND CUT INSTRUCTIONS ❑SPRAINS AND FRACTURE INSTRUCTIONS 1. Keep the dressing and wound clean and.dry. 1. If a foot or leg is injured,keep it elevated on two-pillows while .2. If there is.unusual pain,bleeding,swelling,and/or redness ..lying down for 24-28 hours... . 'of-the-wound report to your doctor or return to the Emer- 2. Apply'ice bags intermittently to. the-injured area for the gency Dept. immediately. ...,first 24-hours. Use a towel or cloth between.the ice.bag and . 3. Keep your wound comfortably elevated as much of the time skin to prevent frostbite. as possible for the next few days. 3.'Persistent pain and disability for more than 72 hours are Call your doctor's-off ice to see when he wishes to see you to .caution signs indicating that you should see a physician have the dressing changed or sutures removed.If you have no for further evaluation. family doctor, return to the Emergency Dept. 4. If a cast or splint is applied it is important to elevate the -injured extremity. Check fingers_and toes for paleness, on numbness, or extreme pain. If this occurs, return to the - 4. Wound Checked Days. Sutures Removed Days. Emergency Department immediately. _ ❑ HEAD INJURY INSTRUCTIONS ❑ NECK AND BACK SPRAINS 1. Allow the patient to sleep as he normally does.However, 1. No heavy lifting for days or until seen by your physician. awaken him every_hours(s)and make sure he knows 2• Rest in a comfortable position. his name, the date, where (s is, etc. 3. Local heat with heating pad or hot water bottle for 2. Observe for unusual drowsiness. U ery_ 3. Observe for persistent nausea and/or vomiting. 4. Use Aspirrinin oor r Tylenol or both for pain medication as 4. Observe for weakness or lack of coordination in his arms prescribed for discomfort. and/or legs. 5. Observe for blurred or double vision. 1. N❑ ENTERITIS No solid food for—hours. GASTROENTERITIS 6. Observe for persistant or increasing headache, unusual 2. Start on sips of water and gradually add other non car- 7. n abnormal behavior. - .bonated fluids. If vomiting occurs wait two hours and 7. Observe for any abnormal drainage from ears or nose. tart fluids as above. 8. Observe for unequal pupils (one pupil large, one small). restart Note if patient is usually not awake or arouseable. CHILDREN use pedilyte,jello water,apple juice,etc.9. Observe for areas of convulsions or seizures.skin numbness. No plain water. 10. Observe for convulsiGive_ounces every fifteen minutes for hours then 11. Observe for persistant dizziness. ounces everyhours. If any;of:these symptoms should occur within the next 24 to - VIRAL ILLNESS 36 hours,please contact your family doctor at once_or return El 1. Symptoms may last 10-14 days but should show gradual to the Emergency Department at once. improvement.Return to the Emergency Room or see your ❑ SORE THROAT physician'if fever persists more than'5 days. 1. Gargle with salt water. 2. Use t tong*Jj[gl r�AVWa wLp Ir _ GENERAL INSTRUCTIONS 'Signature of X USE MEDICATIONS AS PRESCRIBED OR INSTRUCTED. Physician /� A ra Instruction " DO NOT DRIVE OR OPERATE DANGEROUS MACHINERY i' WHILE TAKING PAIN MEDICINES OR MUSQLE RELAXANTS. `'l• Dat of Discharge f/Time Referred 40 AN q 0 PM U C� NURSE'S iSIGNATURE u X'.- ❑ Suture ❑ Spram ❑.Other ❑ Head ❑.;General PATTEN AGENT SIGNATURE DATE TIME RETURN Immunization TTET DO FDDT / / ❑ DPT DT ❑ 1040-ADMlT ,PATIENT_ _ 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 12 , 19.89 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: $l , 600., 000 . 00 Section 913 and 915.4. . Please note all "Warnings". COunty t+Llunsel CLAIMANT: SUSANNE PETERSON, ETAL c/o Edward M. Mastrangelo AUG 0 7 a98� ATTORNEY: 1320 Solano Ave. #202 Albany, CA 94706 Date received Martinez, C g4553 ADDRESS: BY DELIVERY TO CLERK ON Aul;ust 4, 19 BY MAIL POSTMARKED: August 2 , 19-89 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. Aii� ust 7 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. �V ) 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( 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 1 2 1'989000Deputy Clerk Dated: _ PHIL BATCHELOR, Clerk, By , h . 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 sown above. 0 Dated: SEP 14 1989 BY: PHIL BATCHELOR by4 la Deputy Clerk CC: County Counsel County Administrator NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: nne Peterson c/o and M. Mastrangelo 1320 So o Ave. #202 Albany, CA 06 Re: Claim of SUSANNE PETERSON 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 1 . 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: CTOR STMAN, County Counsel �D ( By: Deputy Coun 6y Co sel CERTIFICATE OF SERVICE BY MAIL C.C.P. §§ 1012, 1013a, 2015 .5: Evid. C. 66 641, 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: , at Martinez, California. cc: Clerk of the Board of Supervisor original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910 . 2, 920 .4, 910. 8) pF E3A EL 11 R� RO 5l CL :,K E3 N c AC)nP� GOVERNMENT CODE CLAIM TO THE GOVERNING BODY OF: COUNTY OF CONTRA COSTA OUR CLIENTS AND CLAIMANTS: SUSANNE PETERSON, GARY HALL DATE OF DEATH: 4-23-89 PLACE OF DEATH: State Route 4 , westbound, . 4 miles east of Willow Pass Road in Contra Costa County DESCRIPTION OF INCIDENT: Claimants ' decedent, Theresa Marie Hall, age 18 , died on April 23, 1989 when her vehicle struck the end of a jersey wall on wesbound State Route 4 , . 4 miles east of Willow Pass Road in Contra Costa County. Prior to impact, the jersey wall was positioned within six inches of the right-hand fog line on State Route 4 . In addition, the end of the jersey wall which was struck by the vehicle of Claimants ' decedent, was parallel or nearly parallel to the fog line and not angled or adequately angled away. Also, there was no barrier( s ) to shield the end of the jersey wall. In addition, there was no or inadequate lighting and signing to reveal or indicate the position of the. jersey wall . As such, the jersey wall was a dangerous condition of public property which caused the death of claimants ' decedent. In addition, the proximity of the jersey wall to the fog line, the failure to adequately angle the jersey wall, the failure to place a barrier( s ) to shield the end of the jersey wall, and the inadequate signing and lighting all constitute negligence on the part of the County of Contra Costa, and their agents and employees, resulting in the death of Claimants ' decedent. A copy of the police report of the incident is attached hereto as Exhibit A . NATURE OF DAMAGES: Wrongful death. AMOUNT OF CLAIM: $1,600 , 000 . 00 ATTORNEYS TO WHOM NOTICES SHOULD BE ADDRESSED: EDWARD M. MASTRANGELO 1320 Solano Avenue, Suite 202 a y, C li or is 94 6 -4. :: A 9 A TORNEY R'CL A ANTS DATED: August 2 , 1989 TE TAR AFFIC 0OL_LISION REPORT = 'PAGE DF SA"CIAL CONL:MYLNUMBER MIT M RUN CIT/ J(lOKlAI DISTRICT NUMBER ...•- ..,. r^' INJURED FELONY FA .r L ❑ Uri NUM8ER HIT A RUN COUNTY REPORTING DISTRICT /BEAT KILLED MIS❑D. r Q N • '? 60v-r'4 ^0vT'4 e COIUSAON OCCUAREB ON Mo, DAY YEAR TIME 2W NCIC• 7;�;S2=tel --------- ------------------•--- `', o2so ,3 MILEPOST INFOZATON DAY OF WEEK \�T�OW/�YVAY PNO OGRAPM59V• f lel ❑ /T �Ir� cf Mf.EPOBT OA CC.! �� T W T F S YEf NO 0j ❑AT IHfERSE WITH �CT1Jg1 � � � STATE MO REL V� !� co EaOR: �L- .FISP./MILES OF ��`C..U �/�•I �: .. /�,.C. 2ES ❑NO ❑NONE PARTY DRIVER'S UCENSE NUMBERSTATEClA^SB SAFETY VElL YR YAK-E f` /COLOR LICENSE NUMBER STATE V�..J U ✓ C._ /�, v EOUI, t',7� - /l- _ UN �j' 14 '•'` /V'!•`/•I• • �. � DRIVER NAME(FIRST.MIDDLE.LAST) • • . . PEDES. STREET AD KESS OWNERS NAME SAME AS DRIVER TRI AN PARKED CITY/STATE/IIP OWNERS ADDRESS ❑ SAME AS DRIVER - VEWCLE - SKY• SEA HAW.. EYES HEIGHT WEIGHT BIRTHDATE RACE DISPOSITION OF VEHICLE ON ORDERS OP. 94FRCER �F7776 El OTHER CUST MOS. DAY YEAR L'(,� `J ❑ rSc v ,S 6 /,� y 3 ? 71 SON��F.✓T,q c 72�.t Z OTHER HOME PHONE G� BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONE APPARENT REFER.TO NARRATIVE ❑ ❑ W l 'ON (if , ( ) CMP USE ONLY DESCRIBE VEHICLE DAMAGE $MADE IN DAMAGED AREA VEHICLE TYPE INSURANCE CARRIER POUCY HUMBER - -. ❑WK' ❑NONE ❑MINOR .. . �'F` ❑A100. �MAJ011 ❑TOTAL DIR.OF ON STREET OR MGM" SPEED PCF ICC ❑ T s2 .r S 2 7 `H` ❑ , . CMP ❑ PARTY DRIVERS LICENSE NUMBER $TATE CLA59 SAFETY VEK YR. MAKE/MODEL/COLOR UCENSE NUMBED 4STATE DRIVER NAME(FIRST.%%DOLE.LAST) -.. •..•. •..•. . .•,... ❑ PEDES STREET ADDRESS OWNERS NAME ❑SAME AS DRIVER "- '-- - TRIAN - PARKED C7TV/STATE/ZW OWNERS ADDRESS ❑SAME AS DRIVER VEHICLE SICY• SEI HAIR EYES HEIGHT WEIGHT BIRTMDATERACE osposnoN OF VEHICLE ON ORDERS OF: El ❑DRIVER ❑OTHER - - CUST MO. DAY YEAR cl OTHER HOME PHONE BUSINESS PHONE PRIOR MECHANIC JUL DEFECTS: NONE APPARENT ❑ ,REFER TO NARRATIVE ❑ ❑ ( ) ( ) CHPUS VEHICLE TYPE E PKV DESCRIBE VEHICLE DAMAGE _ SHADE N DAMAGED AREA ❑INSURANCE CARRIER POLICY NUMBER tR/L ❑NONE ❑MINOR . ❑ ❑MOD. ❑MINOR ❑TOTAL ^•R^S Mi^;TREET OR HIGHWAY SPEED PCF ICC TRAVEL LUT P. ❑ CMP p PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEIL YR. MAKE/MODEL/COLOR UCENSE NUMBER STATE EODIv. 3 DRIVER NAME(FIRST.MIDDLE.LAST) ❑ PEDES STREET ADDRESS OWNERS NAME ❑SAME AS DRIVER TRIAN ❑ PARKED CITY/STATE/ZIP OWNER'S ADDRESS ❑SAME AS DRIVER VEHICLE - - SKY• SEI NMR EYES HEIGHT WOGM BIRTHDATE PACE DISPOSITION OF VEHICLE ON ORDERS OF: ❑OFFICER ❑DRIVER ❑OTHER C UST MO. DwY YEAR _ _ OTHER HOME PHONE_ - BUSINESS PHONE, PRIOR MECHANICAL DEFECTS? - NONE APPARENT ❑ REFER TO NARRATIVE ❑ ❑ ( , ( ) CMP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA V EHICLE TYPE INSURANCE CARRIER - POLICY NUMBER - ❑UFK. ❑NONE ❑MINOR I ❑MOR ❑MAJOR ❑TOTAL DIR.OF ION STREETORHIGHWAY SPEED I PCF ICC ❑ I ' TRAVEL LIMIT PUC ❑ _ CMP ❑ PREPARER'S NAM,EE / DISPATCH NOTIFIED REVIEWER 9 NAME JDATIE REVIEWED i' - .....9f ..m rtS CI.N*C--[3,N/A_ .. CHP 555-Page 1 (Rev. 7-87)OPI 042 ! - STIATF OR CAUFCRNIA TRAFFIC COLLISION CODING ; '" a 'V,I6ir OATS.OF CO S•.DN DAY, -3 - TME(MOO I NC��•J{2ER OF��.yCER L O NUMBER DAY OWNEWS NAME I ADDRESS - NOTIRED PROPERTY r]yes .El No DAMAGE OFSCHIP71ON OF DAMAGE SEATING POSITION OCCUPANTS SAFETY EQUIPMENT M,C BICYCLE-HELMET EJECTED FROM VEH- 1-DRIVER A-NONE IN VEHICLE L-AIR BAG DEPLOYED 2 TO 6-PASSENGERS B.UNKNOWN M-AIR BAG NOT DEPLOYED DRIVER 0-NOT EJECTED 7-STA.WGN.REAR C-LAP BELT USED N•OTHER V-NO 1-FULLY EJECTED B-RR.OCC.TRK_OR VAN D-LAP BELT NOT USED P-NOT REQUIRED W-YES 2-PARTIALLY EJECTED 3-UNKNOWN 9•POSITION UNKNOWN E•SHOULDER HARNESS USED 1 2 3 0-OTHER F-SHOULDER HARNESS NOT USED CHILD RESTRAINT PASSENGER 456 O•LAP/SHOULDER HARNESS USED O•IN VEHICLE USED X-NO H•LAP/SHOULDER HARNESS NOT USED R•IN VEI4CLE NOT USED Y-YES 7 J-PASSIVE RESTRAINT USED 8-IN VEHICLE USE UNKNOWN K-PASSIVE RESTRAINT NOT USED T-IN VEHICLE IMPROPER USE U-NONE IN VEHICLE ITEMS MARKED BELOW WHICH ARE FOLLOWED BY AN ASTERISK(')SHOULD BE EXPLAINED IN THE NARRATIVE PRIMARY COLLISION FACTOR TRAFFIC CONTROL DEVICES TYPE OF VEHICLE 1 2 3 MOVEMENT PRECEDING LIST NUMBER M)OF PARTY AT FAULT 2 3 S A VC SECTION VIOLATED: OTE�Ea A CONTROLS FUNCTIONING A PASSENGER CAR/STA.WGN. COLLISION NO B'CONTROLS NOT FUNCTIONING' B PASSENGER CAR W/TRAILER 'A STOPPED S B OTHER IMPROPER DRIVING I C C ONTROI.S OBSCURED C MOTORCYCLE/SCOOTER B-PROCEEDING STRAIGHT D NO CONTROLS PRESENT t FACTOR- D PICKUP OR PANEL TRUCK I C RAN OFF ROAD C OTHER THAN DRIVER' TYPE OF COLLISION E PICKUP/PANEL TRK.W/SLR DMAKiNG RIGHT TURN D UNKNOWN• —7—AHEAD-ON F TRUCK OR TRUCK TRACTOR E MAKING LEFT TURN M E FELL ASLEEP' B SIDESWIPE G TRK.t TRK.TRACTOR W/TLR. F MAKING U TURN C REAR END H SCHOOL BUS G BACKING WEATHER(MARK 1 TO 2 ITEMS) D BROADSIDE I OTHER BUS H SLOWING/STOPPING A CLEAR E HIT OBJECT J EMERGENCY VEHICLE I PASSING OTHER VEHICLE B CLOUDY F OVERTURNED K HWY.CONST.EQUIPMENT J CHANGING LANES C RAINING G VEHICLE/PEDESTRIAN L BICYCLE K PARKING MANELIVER D SNOWING H OTHER': MOTHER VEHICLE _ L ENTERING TRAFFIC E FOG/VISIBILITY FT. MOTOR VEHICLE INVOLVED WITH N PEDESTRIAN M OTHER UNSAFE TURNING F OTHER-: A NON-COLLISION O MOPED N)[ING INTO OPPOSING LANE G WIND B PEDESTRIAN O PARKED LIGHTING C OTHER MOTOR VEHICLE P MERGING A DAYLIGHT D MOTOR VEH,ON OTHER ROADWAY OTHER ASSOCIATED FACTOR Q TRAVELING WRONG WAY B DUSK-DAWN E PARKED MOTOR VEHICLE 1 2 3 (MARK 1 TO 2ITEMS) R OTHER:' C DARK-STREET LIGHTS F TRAIN A vc"EcnoN VIOLAno►k CITED D DARK-NO STREET LIGHTS G BICYCLE OYES ONO E DARK- STREET LIGHTS NOT H ANIMAL: B vC SECTION VIOLATION` OTFD FUNCTIONING' OYES' ROADWAY SURFACE SOBRIETY-DRUGAL I FIXED OBJECT: C vc SECTION v1OLATKNi: C TED 2 3 PHYSICAL +� A DRY OYES (MARK 1 TO 2ITEMS) 8 WETJ OTHER OBJECT: ONO A HAD NOT BEEN D"KING C SNuWy-ICY TE"M/�O/Z A/1 D D SUPPERY(MUDDY,OILY,ETC.) -T 2�j[- E VISION OBSCUREMENT: B HOD-UNDER INFLUENCE F INATTENTION' C HBO-NOT UNDER INFLU.• ROADWAY CONDITIONS. G STOP 6 GO TRAFFIC D HBD-IMPAIRMENT UNK.• MARK 1 TO 2 ITEMS PEDESTRIANS ACTION E UNDER DRUG INFLU.• ( I 1 ENTEd�IG;LE!V!NG RASAP }C ANO PEDESTRIAN INVOLVEDpREV10US COLLISIONP`!frl?Fi:EilEriT-PHYSICAL• A HOLES,DEEP RUTS* CROSSING IN CROSSWALK x G IMPAIRMENT NOT KNOWN B LOOSE MATERIAL ON RDWY' BAT INTERSECTION I(J UNFAMILIAR WITH ROAD H NOT APPLICABLE DEFECTIVE VEH.EQUIP.: aTFO C OBSTRUCTION ON ROADWAY• CROSSING IN CROSSWALK-NOT OYES I SLEEPY/FATIGUED D CONSTRUCTION-REPAIR ZONE `'AT INTERSECTION ONO SPECIAL INFORMATION E REDUCED ROADWAY WIDTH D CROSSING-NOT IN CROSSWALK L UNINVOLVED VEHICLEA HAZARDOUS MATERIAL F FLOODED* E IN ROAD-INCLUDES SHOULDER M OTHER*: G OTHER': F NOT IN ROAD N NONE APPARENT H NO UNUSUAL CONDITIONS G APPROACH/LEAVING SCHOOL 8US O RUNAWAY VEHICLE SKETCH WSCELLANEOUS (CO n15=/1(i C TJOnI A R&-4) fCi1/`/U2A2y(L/]LL 1 J I.DIC.Tt '/�//�' ��� I � 'dGFi�/l.I/�l E !7 i/TTt 2 NORTH 1 •• Co�+c024 I A✓//l/1✓EMPnYI GSE WV--2 �un Era ...-.-n l OZ.I_GY nno STATE OF CALICORNA - 1NJ1,lR'ED / WITNESS_ ES / PASSs!r'-�GERS PAGE 3 DAT[Of COy,U31 TME(pE00 k!'A� NCK BER OF 1.0. nf.3 .NUMBER - 3- � bL WRNESB PASSENGER AGE BEI EXTENT OF INJURY( "X" ONE) INJURED WAS ( "X" ONE ) - ►MTV SEAT SAFETY EJECTED ONLY ONLY NUMBER POS. EQUIP. FATAL SEVERE OTHER V1919L5 COMPLAINT INJURY INJURY INJURY OF PAIN DRIVER PASS. PED. BICYCLIST OTHER NAILD.O.B.I ADDRESS TELEPHONE 2►v Efc (INJURED ONLY)TRANSPORTED BY: TAKEN TO: /2EK1o,.1Ac AlVeulCA1.CE d>Q15LO DESCRIBE INJURIES /�- C/TIr�C� T2AC�til A r/C /NTt/2i c�' VICTIM OF VIOLENT CRIME NOTIFIED ❑ ❑ ❑ ❑ o 1010101 ❑ 10T NAME I D.O.B.I ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES 0 VICTIM OF VIOLENT CRIME NOTIFtEO NAME I O.O.B./ADDRESS TELEPHONE ONJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES - ElVICTIM OF VIOLENT CRIME NOTIFIED NAME/O.O.B. ADDRESS _ TELEPHONE ONJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES ElNCTIM OF VIOLENT CRIME NOTIFIED ❑# ❑ d ❑ ❑ ❑ ❑ ❑ o o 101 I NAME;0'0.8.1 ADDRESS TELEPHONE _ INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES " VICTIM OF VIOLENT CRIME NOTIFIED ❑# ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ NAME I D.O.S./ADDRESS TELEPHONE ONJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES 0 VICTIM OF VIOLENT CRIME NOTIFIED PR RE�CJ � � CJ 1.0. �oJ M'"T G JY YEAR REVIEW JSJpI{I{�,la Oji S%j M SOV' O. DAY VE CHP 555-Page 3(Rev.7-87)OPI 042 Y d jJ S 87 43637 'j ATE O/ CALI.ORNIA FACTUAL DIAGRAM PAGN [� DATB Ot,.F CCOLLISION /\{//�`/'� TIME (t�00( 1"-c Q/UMBER OrQI/CENUMBER Q/ YO. , DAV VR.V I 4Z�O / �Z.� 14O J — Z • 8 ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED (SCALE I D Foo V INo1CATE NORTH OG A/ PA VE- E7 C C. i li S P/a✓E 0444 L/,Q 77,Lt 7' s/mf N/Pwc- erdGE `i GEM L-:,�/7' Tt"�2�t�1 (,✓ALL 1. © � ,jam��i�icL rMi'.nAXcr►ENr I j i i T,CsAJi o+ o.,L. AArd 0''401trf. 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Gr I'D,N BER , 'TN/DAY/YT REVI ERS NAM PREPAREMOMNIOAY/YEAR R,'�SL_NA/�}tE J L'!' 3 GGTiiL,�' 88 48641 CHP 556 (Rev. 1.87) OPi 042 7ATE OF CALJFQRNIA IA RRATIVE/8UPPLEMENTAL PAGE 9 DPTEOFIN=DENT/OO'-"Y URE�IC� TIME(2400011 / HCC A OFF ROO� NUMBER 3- aL.S�o 'Z 'X OHE W ONON,E TYPE SUPPLEMENTAL(-)'APPLICABLE) N1iTARRATIVE --S10N REPORT ❑ BA UPDATE O FATAL MT S RUN UPDATE DSUPPLEMENTAL OTHER:OTHER: a HAZARDOUS MATERIALS O SCHOOLSUS ❑ OTHER: CITY r COUNTY IJUDICAL DISTRICT REPORTING DISTRICT lB T WATION NUMBER ?7-0- 03 LOCATION I SUBJECT STATE HWAY RELATED YES NO 1. ©k/ .4 Qb .✓h/G C/Z A 4 L' �v'/� C'c/2�/� 777 77�C C_ . 2. - , a,f,,�T�. 72�) ;oll ✓e--6 3. e -SSD c D V- 1 �-/C.J 6' E--4s> 0-,✓ o.0 4:: �9 T�ti//'O2A2 C'CMt%✓7 .` G,14(-L 7-' '77/e- All /9jvC`fC S. CC 7T/6- !M�'.4C r .. cJ/�: V�ly A/c A2 Z�1 ter=C 7-4 y s. V- r�v,�� A%F,�gc 90 ° ro A 2e�T 7. /�C!.✓l /✓. 8. ,�'o�c E ofE' �c�d-o.� c oc��s o,v ��sc� 7771C 9. . 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A/D 4-1 ,_eo jCz o94 PREPARER�µ i.0. �Ro� �NTN/ZA�E� REVIE'.V ER'S NAME MONTH/DAY/YEAR CHP 556 (Rev. 7-87) ON 042 sir �- JA 3cW TlrlE/SUPPLEMENTAL •PAde DATE GIF INCIpENT� O,C�URENCE�^. TIMNCIC I�JJIrtIE$ O OiE1,EROl.pO� NUA1BE11 �� ')CONE `'f/ OV'X/PONE - TYPE SUPPLEMENTAL or APPl1CASM •NARRATIVE I /f COLLISION REPORT _ a BA UPDATE ❑. FATAL, ❑ HIT iRUN UPDATE ❑ SUPPLEMENTAL` LSU❑J! OTHER: _ ❑ HAZARDOUS MATERIALS ❑ SCHOOLBUS ❑ OTHER: CITY/COUNTY/JUDICAL DISTRICT REPORTINODIBTRICT L CITATION HUMBER 320 — ,, LOCATION/SUBJECT STATE HWAV RELATED 9 NO . Q- � �s �G'c oo �o•�T.��.�c�/� �o. Z c c M � of c��F �N E- 2. TAC KL"7J &-/1' /Z. Z , �l�Gs1C T� Cou.�T` FO/LC=nJSC . 3. /eft TSO C O r �"f f�E 2C'C A�'� 7iT�i4T C/ T P T 4. e O f1" ./J UAC-2,I t Off TC JO C'v/�S OF 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20, 21. 22. 23. 24. 25. 26. 27. 28. _ 29.-- 30. 9.30. 31. 32. PREPARER'S NAM I.D. ER NTN/DAY/YEAR�'�; REVI ERS NA ME - MONTM/DAV/YEAR r E �,•� . s:b X00 3 CHP 556(Rev.7-87) OPI 042 88 ae6eL �l-z�-8� c '�aso �Q32o 900 4 '198 DATE: 04-28-89 � PAGE CASE: Collision #4-298-89 NARRATIVE: Physical Evidence Inspection VEHICLE DESCRIPTION: 1980 Datson B210 red in color VIN KPLB310214990 California License 1MVY504 SUMMARY NARRATIVE: On 04-26-89 Officer Edinger STO #9003 contacted me regarding a fatal traffic collision he was investigating . Officer Edinger related that he wanted me to inspect the involved vehicle for evidence of paint transfer not related to the front end impact damage . On 04-28-89 I responded to City Auto storage yard in Antioch to examine the vehicle. I examined the. exterior of the vehicle and found no paint transfers . I did observe that the entire front of the vehicle was damaged as a result of impact damage . Twelve photographs were taken of the vehicle at the tow storage facility. - M.J N E L S ON S T 0 1 PROOF OF SERVICE BY MAIL 2 I hereby declare under penalty of perjury that I am a 3 citizen of the United States and over the age of eighteen ( 18 ) 4 years , and not a party to the within action. My business address 5 is 1320 Solano Avenue, Suite 202 , Albany, California 94706 . 6 On this date, I served the attached document in said envelope, 7 postage prepaid, in the United States mail at Albany, California, 8 addressed as follows : GOVERNMENT CODE CLAIM 9 PHIL BATCHELOR County Administrator 10 County of Contra Costa 651 Pine Street, 11th Floor 11 Martinez , CA 94553 12 13 14 15 16 17 Dated at Albany, California 18 August 2 , 1989I C I LEISZ 19 20 21 22 23 24 25 26 27 28 • O D w m 0 D D m a A Z0 9 r D :< o D 0 Z D 0 0 r D ° z T m 0 z ° D n A c A N m z m o '•�\ D Lo D o m Z 0 N 61 0 m r 0 rn00ro PiuI00x N �d rt rr (D > N N O > H rh R� C7 nrtC) t�J > n 0 r m �:$ 0 CD rr (n 'd , rt n rt cn a w N C) rt F- 0 0 rt m F rt w 0 0 n n Q n 8 SV Mfr 9D. } b ` J J 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 12 , 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: $100, 000 . 00 Section 913 and 914 Please note all "Warnings". CLAIMANT: DONALD 4JESLEY PLYLER 71 Scenic Avenues nSE� ATTORNEY: Point Richmond, CA 94801 �°1fn 19g� Date received CA, t 10, 1989 hand del . ADDRESS: BY DELIVERY TO CLERK ON � ;_ 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 14, 1989 YIL BATputyLOR, Clerk 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: 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. oo 3 Dated: Sip Z Z89 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. 0Dated: SEP 14 1989 BY: PHIL BATCHELOR by Deputy, Clerk CC: County Counsel County Administrator n 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 DONALD WESLEY PLYLER ) RWN Against the County of Contra Costa ) AU .1 1 =Vand ) 1 PUBLIC DEFENDER, et al AMrImint) P en- ELOR Fill in name ) G RD sue iSczS N ' ay t)ecuty The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 100,000 and in support of this claim represents as follows: ------------------------------------------------------------------------------------- 1. When did the damage or injury occur? (Give exact date and hour) January 1989, June & July of 1989. ------------------------------------------------------------------------------------ 2. Where did the damage or injury occur? (Include city and county) Richmond, California ------------------------------------------------------------------------------------ 3. How did the damage or injury occur? (Give full details; use extra paper if required) Failure of the Public Defender to act in accordance with various provisions of the Penal Code, Evidence Code, U.S. Constitution, etc. This Claim includes an allegation of ethical misconduct as well as _failure to act in a_manner consistant with the_punpose of_the Public Defen- 4. What particular act or omission on the part of county or district officers, der. servants or employees caused the injury or damage? (1) Misuse of evidence. (2) Failure to return phone calls. (3) Unnecessary delay. (4 ) Requiring claimant herein to do his own legal research in support of additional points and authorities. (5) Characterizing the claimant hereints month long unsuccessful attempt to contact the public d9fender as "PESTERING" the public defender« (6) Being rude to claimanto (7 ) Failure_.to ad4quately supervise deputy-public defAa%r�s. 1 5. What are the names of county or district officers, servants or employees causing the damage or injury? Charles James, Joslyn Jones, Mr. Weiss, Does 1 to 10. ------------------------------------------------------------------------------------ 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Emotional stress and possible conviction because of the aforementioned failings of the public defender. ------------------------------------------------------------------------------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) A wild guess. -------------------------------------- --------------------------------------------- 8. Names and addresses of witnesses, doctors and hospitals. Not applicable at *this time. ------------------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT None Yet, 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 CA— j�oN L LF'iP� Clai 's Signatur 7/ Sc E1v/G Address Telephone No. Telephone No. 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. CLAIM J - 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 12 , 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: $10;.000 . 00 Section 913 and 915.4. P'lease note all "Warnings". CLAIMANT: TIFFANY NELSON County Counsel c/o .Mark B. Abelson, Esq. AUG U 7 1989 ATTORNEY: Campagnoli, Abelson & Campagnoli 120 Montgomery St . #1825 Date received Martinez, �, 4x53 ADDRESS: San Francisco , CA 94104 BY DELIVERY TO CLERK ON August 4, �yt5� 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 7 , 1989 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). Other: I r I c c w Dated: I ' 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 (X) 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 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 11 1989 BY: PHIL BATCHELOR byEq�B9,_Deputy(1Clerk 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, 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. RE: Claim By ) Reserved for Clerk's filing stamp TIFFANY NELSON ) LP 11V t Against the County of Contra Costa ) or ) AU G 1 1989 District) cue K-P ARBF,T ELOR' Fill in name ) NT � ORS By E. ` Deputy 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) --- February 7, -19 8 9 at ap roximate lv 7 :00 a.m. ------------------------- -- 2. _m- ---------------------------- 2. Where did the damage or injury occur? (Include city and county) Willow Pass Road approximately 167 feet west of Balclutha Way (between Loftus Road and Balclutha Way) , Pittsburg, Ca. , Contra Costa County ------------------------------------------------------------------------------------ 3. How did the damage or injury occur? (Give full details; use extra paper if required) See attached ------------------------------------------------------------------------------------ 4. '- What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? ---See-attached-------------------------------------------------------- *Amount claimed exceeds ten. thousand dollars ($10 ,000 . 00) , therefore no dollar amount of claim is included. Jurisdiction over this claim would rest in Superior Court. (over) 17 5. What are the names of county or district officers, servants or employees causing t the damage or injury? At present the name _are } o'dU.. �M_____�__________N_M��______�_ 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. _See attached. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Amount claimed exceeds ten thousand dollars ($10,000 .00) , therefore no dollar amount of claim is included. Jurisdiction over this claim would rest i n S�dL� . .gr_S.s?11rt.-------------------------------------------------------- 8. Names and addresses of witnesses, doctors and hospitals. Zenada Sebastian Santos, 1728 Hanlon Way, Pittsburg, Ca. Shellia Walsh, 1200 W. 18th St. , Antioch, Ca. John Muir Hosp. ,Trauma Physicians,1601 Ygnacio Vly.Rd. , Walnut Creek, Ca. Kaiser Hospital , 200 Muir Road, Martinez , California 9• List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT See attached k04 "40119 C ei'l0.2 provides: el ' a signed by the claimant SEND NOTICES TO: '(Attorne ) on his behalf." Name and Address of Attorney Mark B. Abelson, Esq. ' Campagnoli, Abelson & Campagnol ' �9, 1 t s Signature 120 Montgomery Street #1825 MARK B. BEL ON , ESQ. , Attorney for Claimant San Francisco, Ca. 94104 11 l�a5 A s Telephone No. 4i5 42i i i Telephone No. Lf �7 d 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. 4 Claim by: Tiffany Nelson Page Two 3 . Claimant Tiffany Nelson was westbound on Willow Pass Road and a car driven by Zenada Santos was eastbound on Willow Pass Road at the above location. Ice had formed on Willow Pass Road between Loftus Road and Balclutha Way. The source of the water which formed into ice appears to be a broken water line at Jeff's Food and Liquor, 1805 Willow Pass Road, Pittsburg, California. Mrs. Santos struck the ice on the roadway, ultimately lost control and crossed over the center of the roadway, thus striking claimant Tiffany Nelson's car. 4. The County of Contra Costa and its employees or agents negligently maintained, controlled, repaired, designed, and constructed the roadway and drainage/sewer system so as to allow water to flow onto and remain on the roadway. As a result of said condition the water formed into ice thus causing a dangerous condition. Additionally, the County of Contra Costa and its employees or agents failed to take any steps to remedy the above dangerous condition or in the alternative to warn motorists of its existence. 6. Claimant, Tiffany Nelson, sustained fractures of the left femur, left tibia and fibula and of the pelvis as well as multiple abrasions and bruises and strains/sprains. Claimant has required several surgeries and will require future surgeries. (See No. 9 below for a partial list of damages. ) 9. The following is a partial list of expenditures. At present exact amount of all expenditures is unknown. John Muir Hospital $27, 157. 34 John Muir Trauma Physicians (approx. ) 8, 000. 00 Regional Ambulance 438.00 Alameda/Contra Costa Blood Bank 360.00 Collision Deductible 250.00 Kaiser Hospital Unknown Loss of Earnings Unknown Miscellaneous Expenditures including, but not limited to a damaged baby stroller, Claimant's mother's air fare and related costs in coming to care for claimant's child, automobile rental charges, etc. Unknown Due to the extensive amount of care claimant has received, there may be additional billing. Also, treatment is ongoing so claimant will be incurring additional expenditures and loss of earnings. i CLAIM BOA[i 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 12 , 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: $248 :00 Section 913 and 915.4.0e,tase note all "Warnings". CLAIMANT: PEGGY HAGERTHY 2261 Pine Street ATTORNEY: Martinez , CA 94553 Date received �,� ADDRESS: BY DELIVERY TO CLERK ON August Rl, 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. August 14 19.89 PpHHIL BATCHELOR, Clerk DATED: 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: )r) BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County strator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present DQ 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. c� 0 Dated: En 12 989 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 Er `1" � u� BY: PHIL BATCHELOR by eputy Clerk CC: County Counsel County Administrator ~ Clam;,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 by4the 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 3 � a 1 Against the County of Contra Costa' , ) or AUG 111889 9 District) PH;; �A 0 LOR C1 -K 6D QUA Fill in `name By ... .. .c... .. DF uty The undersigned claimant hereby makes claim4a/inst the County of Contra Costa or the above-named District in the sum of-$ 75a o© and in supportof this claim represents as follows: ------------------------------------------------------------------------------------- 1. When did thedamageor injury occur?.., (Give exact date and hour) -----�— — -r----------------------- -- ---------------------- 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 i required) T C v� —_----------------------------- 4. What particular act or omission on the part of county. or district officers, servants or employees caused the injury or damage? C 7V l (over) 5. What are the names of county or district officers, servants or employees the damage or injury? aW ------------------------------------------------------------------------------------ 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.) 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 Cla s Sig at e Address Telephone No. Telephone No. * 7 V V V T 4� * * V V V V I I VIAF 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 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 ($10,000, or by both such imprisonment and fine. Adoo a3wolsno IIm area . X 68/8Z/L oleo saaaae� !II!ud Ae -Adoo molleA wnlaj pus u61s MOW—o31d300V '00 30N3d V1130—a31d300`d imIlleoueo of loefgns lou si pue sallied oml ueemlaq 3mluoo a sewoosq'eoigo uleyy sll 10"00 epuad Bila(]to 1931130 ue pue luawliedap llpejo eyl Aq peledeooe ueym lesodad anoge OU—30NV.Ld3OOV 00'9t7Z$ 3131dW001V101 lenowalj 9191dwo0 u01lo9J3 ejeldwo0 00'8t z$ o!age� ale as uollo9J3 9191dwo0 Z •uo!}an-i1suoa u!anp pa ewep aq Aue pinogs saull punoa aapun o} sale as aoj alq!suo saa s! AawolsnD sleloadS •Q•O sayoul slsod also �in ( •0 sayoul slsod GIBE) Q 0 sayoul slsod J8w00 sayoul slsod Jawo0 d •Q•0 sayoul slsod pu3 •Q•0 sayoul slsod pu3 •/ 'f "_�'°-P' e2� sals0 ap!Is sa sale0 anua TO l sale0 anua 'Be sale)MIeM-Be sele0 x1em ea / J 'wolloq'. le aouad ejeldwo0 'ld 'u!1 13)IS ;y alManuM/}!j/Ina ,g ofagejeou9dalaldwo0 'ld 'u!1 Z 00'£8 $1!sodaapannbaa uo!jalawoo uo an(] luswAed10swJal ----- (ep!IS)awed ale ---- (6ulnnS)awead ale0 ------ wouoe ------ Ilea 8=13 dol ---- 919aou00 ul IGS slsod leulLWe.L _____ (alaJ3uo0 ul)(uan!Jd)laS-------- PeoedS ------ slsod aul-1 do-qje8 ❑ dn-ahlonu)ji Z ysayy L l l a6ne0 paZ!uenle� ol�ged;o a{r(1S 19 o!jgedlo146!aH 19 14610H118Jan0 Mull u!eLp u!ls!x3 eouadalA1S ❑ AIuOleualeW ale1S X1!0 a!edaU Pellmsulleual n sseippy oN qof— awes of d!4S •8.0•d 8Z9Z-8ZZ 9uo4d £_SS tl6 ale1S yo 'Zau!laevy A1!0 'ON -0'd 'IS auld 9ZZ ssaJPPd ale0 41aa eH A66@d 3 uarl—V ol{esodad 0669-1 C9 (9 l V) 619V6 VO '000MIN388 ,d„ 1ameJd — t, ALm461H 'S31111an =08983= lid a3uvaoaao�N� 40£OLg,'pf10�t 2103 31da01 '398dH3 ON 1b 111/ ANI, 0:1 3ZIN3� f�ll��. „ w ono ayl a r ,!. ld 3OIn2135 ( �f(t�JL9��Ai �ti M.a �111b� l3eJ1UO3/lesWaM '13d811v03 30 3301003V NOdn �-: CLAIM r 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 12 , 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: x4,6...80 Section 913 and 915.4. ple6ijhly 11 ings". CLAIMANT: FRANCES LYNN HULL AKA FRANCES LYNN EVANSs 611 P� 607 3rd Street AUG 15 1989 ATTORNEY: Modesto, CA 95351 Date received Martinez' CA 94553 ADDRESS: BY DELIVERY TO CLERK ON August 8 , 1989 BY MAIL POSTMARKED: August 7 , 1989 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. Au ust 14 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: 15 11, BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Admini" or (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 12 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. O O Dated: SSP 14 1.589 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator .rt•v CLAIM TO: BOARD OF SUPER71SORS OF CONTRA C0R�� Kapplicationto: Instructions to ClaimaACierk of the Board P.O.Box 911 Martinez.California 94533 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 Piiie Street, Martinez, California 94553. C. If claim is against a district governed by the Board of Supervisorso 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 C6 exec.72 at end of form. RE: Claim .by )Reserved for Clerk's -filing stamps -N -HULL, AKA ) _r ECEUED . FRANCRq T.YNN FVANS ) Against the COUNTY OF CONTRA COSTA) AUG 8 1989 ....... or MARTENIZ - DISTRICT) Fa 1n name - The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in.the sum of $ 46 . 80 ( fourty=six<.>do.11ax and in support of this claim represents as follows: and eighty ceMts):;A_ When did the damage or. in3uryoccur? {Give- exact date AUGUST 3 , 19$9 6: 0.0 A.M. 1 .�� • - � 'sem Include cit and ��- -..'�.�^Yd�ie=e did-tFie dam g 3Y ( Y county) NSA 2T;aN,TtZ �,7A L ` CON'i'R : COSTA COUNTY = 3. How did the damage or in�,ury�occur? {Give iuil details, use extra '�� sheets if required) 8/1 /89 1300 hrs.. Transportation=Officer, ::Wall�s booked me into the Marteniz Jail wi.th. my personal property (four ( 4 ) , It packs of Moore Menthol cigg: - and glasses) . upon my. release; from..the j.aa ]_ =� my property could not be found by the: releas iA9; Sargent••on. 8/3/89. t `s �: What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Carelesn'ess -on 'the part`.'of the Intake Officers Mgarding •inmates `� S property.= . _ ;� - (over) •>, J1L FF 5. What are the names of bounty or district officers, servants or employees causing the damage or injury? :Loss: caused :by. book.i;rrg staff at 1360 hrs. 8/1 /89 and releasing Sargent on 8/3/89 'at 6:00 A.M•. . . ------aa T--T------aaaaa.�-T-aaa�.-waa a- Taawaaaw---..-wa---- 4. 6. What samage or injuries do you claim resulted? Give-full extent of injuries or damages claimed. - Attach two estimates for auto damage) LOSS OF PERSONAL PROPERTY: four,�_142) packs of Moore _ cigarettes = $6.80 and glasses = $40.00 __ _ •TOTAh'�AMOUNT $46.80 __ ?. Eow jias the amount claimed above computed? (Include the esta'.mated- amount of any prospective injury or damage, ) ESTIMATED PRICE ,OF._ .GLASSES AND MARKFT PRICE OF _CIGARETTES. "= B. Names and addresses of witnesses, doctors and hospitals. WITNESS: Transportation Officer, Wallis g ; Of f ic„ a 1? s told releasing Sgt.r mahout and --verfied the raisplacement 6f my property. Officer Wallis left <x-r my property at the .intake desk. Filed under "H'• for (full I DO NOT HOLD OFFICER WALLIS RESPONSIBLE FOR THE LOSS. List the expenditures you made do account of this accident DATE ITEM AMOUNT _j ._. **s!*##�lslot!•�k#tom*.ftp+��.?�.;a_d.•.. --. Yr.'rf•�8�''"�s-��aft**�«tR*******«***«*«*�k#«*«*ltRlF*«*#tk i,� Govt. Code Sec. 910.2 provides: -') "The claim signed by the claimant SEND NOTICES TO: (Attorney) orb some person his behalf."._.4' Name and 'Address of Attorney. r 1 Claimant's Signature 607-3rd. St .. Address . - . Modesto, Ca. 95351 . - Telephone No. Telephone No. . P ( 20-9 ) 522-6568-, `'•'~�.-. • • {'d�..��...L Com..� � _"•e Section 72 of the , '►?enal 'Code provides; h "Every,person who, with intent tL) 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. " - 7: 1 `A - u - ' .• 1r � -sy '" Y ..ICI•t+•ti � h � rw.w� — ,:�"`^'"^J'y�?�L-if"fr!.!"'.i+.+rli•'s�e..r_" _ w•^.i:...�.s...-r. e.e.. ^.'•�/ ...w;:..�..-�J.tw-c�.'Ar.:"'••eSJl.�J«':. -...:rY.f�l••'.. .+*i 9 s tT •.� � n r CC) 1 a; n _ � dols �� U r� (aOu (1) p � 9 cid V N � N CO p e' 61 � 1 ON M N �-- N 3 Ln + N � . r- F-� p O �1 P4 .. .. .t: ... A '� is• '���+� *a 0. Q w CA! S c cz U= S� to r O Q P tlf p d � ? r cti O V t�9 3 BOARD OF SUPERVISORS , CONTRA COSTA COUNTY , CALIFORNIA AFFIDAVIT OF MAILING In the Matter of ) Claim of Frances Lynn Hull aka ) Frances Lynn Evans ) ) ) ) ) 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 a Board Order denying claim to .the following : Frances L. Hull W 29618 Unit 2 - 111 L. P.O. Box 213022 Stockton, CA 952.13-9022 I declare under penalty of perjury that the foregoing is true and correct. Dated September 22, 1989 at Martinez , California . Ann C rvelli, Deputy C erk u 3 SEP a9�1989 LE L P P.D of 5! ERVI,CS - - CLAIM / ' BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION i the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT September 12 , 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 Governp Code Amount: $3, 912 . 42 Section 913 and 915.4. Plea to all "Warnings". �i°/17ty CLAIMANT: NORTHERN CALIFORNIA JOINT POLE ASSOCIATION 215 Market Street ATTORNEY: San Francisco , CA 94105 ,�j�� 198,9 Date received �, C ADDRESS: BY DELIVERY TO CLERK ON ALigLiSt � 89 Ji/sk Manage. BY MAIL POSTMARKED: no envelope 1 , I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: August 14, 1989 gyiL 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). ( ) Other: Dated: �ML ' �j BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County A nis or (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. p o Dated: Er 1 2' 19 09 PHIL BATCHELOR, Clerk, By d 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 paAbove. Dated: SEP 1 4 19$j BY: PHIL BATCHELOR by eputy Clerk CC: County Counsel County Administrator � � NORTHERN CALIFORNIA JOINT POLE ASSOCIATION u5MARKET STREET (4/5)362-2972 SAN FRANCISCO,CALIFORNIA 94/05 ~ July 14, 1989 Awl 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 BY _-__- 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 prompt consideration of this matter. Sincerely, W-1 111gz� Execu�iv� 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 znum`uKErSTREET. (4/5)362-297 SAN FRANCISCO,CALIFORNIA 94105 Contra Costa County BILL_NO. 8400 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: $3,912. 42 PLEASE MAKE CHECK PAYABLE TO THE NORTHERN CALIFORNIA JOINT POLE ASSOCIATION AND FORWARD TO THE ABOVE ADDRESS. NORTHERN CALIFORNIA JOINT POLE ASSOCIATION 215 MARKET STREET (415)362-2972 SAN FRANCISCO,CALIFORNIA.94105 Contra Costa County �_��-L=1 ��#)- PAQ-8,t 1801. Shell Av nue Martinet , CES45 5' Attentiqn: Ron Harvey RE ERR Driver a Veto mar.k :icez Date 64 Losac 5/3/PV Roplac*w Joint Pole. a•::ac.i .L"i.ties 1ocated €gin plifton Road eclt ,of Byron Hi ghway is n Byron California. Labor-. 2,400.08 Con5tr°1?r:`tiLin Equipment Exp&5e; 1po4o. 00 t"•'L..E'ASE MAKE CHECK PAYABLE BLE TO THE 00WHERN 'CALIFORNIA JOINT POLE ASSOCIATION ANIS FOi='WARIJ TO THE; ABOVE ADDRESSv Al 103P14-821 j PACIFICVAABELLS. A Pacific Telesis Group Company Mail Payment to: (— PACIFIC BELL SECURITY DEPT . CUSTOMER COPY 633 FOLSOM ST . , ROOM 200 Dote 07/03/89 SAN FRANCISCO , CA . 94107 CWBONo. 44CR190215 L J 989440215 Total Amount Due: NORTHERN CALIFORNIA JOINT POLE ASSOC . $ 618 . 96 215 MARKET STREET , ROOM 1201 SAN FRANCISCO , CALIF . , 94105 ACCOUNT OF : CONTRA COSTA COUNTY PUBLIC W L 1 591 Payment Due By: PLEASE RETURN THIS PORTION OF 131LL WITH PAYMENT DUE UPON RECEIPT — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — - — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — - For Questions Call 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 TOTAL AMOUNT DUE $618 . 96 N ..OT IC <c �, MAKE PX � NORTHERN`;c'�9,lIdIA JOINTPO ' Std. �1� � r 1� i �` — i MAIL TO: - 215 MAR SAN FRANCISCO, CA 94105 I BC 044 AC 000 Pacific Bell 07/03/89 REPORT JCW014 PAGE 1 21 :25. ARC-iRPT NOCAL PROGRAM JOF710 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/O 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 NEOTIcE MAKE PAYABLE TO: NORYMN fAllARIMA MINT POLE ASSN. TO: X15 MARKET ST. SAN FRANOISCQ CA 94105 PUBLIC WO00 LEPAIMEW CONTRA COSnk COUNTY I]ATE: June 29, 1989 TO: J�p� hda, Risk Management Division, County Administrator's Office FROM: S. Clifford Hansen, Administrativ Officer SUBJECT: Northern California Joint Pole Association Attached for your review is a bill in the amount of $3,293.46 for damages to facilities owned by PG&E and Pacific Bell. The damages were allegedly inflicted by a County vehicle. This pole is located in the County right of way. We do not know if there is an agreement between the parties regarding damage to poles in our right of way. I have informed the Joint Pole Association that the bill has been forwarded to your office. Please keep me informed as to the disposition of this issue. If you have any questions, please contact me at 4470 extension 341. SCH:ly Jt.Pole.t6 Attachment cc: J. Michael Walford, Public Works Director M. Mitchell, Deputy Public Works Director P. McNamee, Road Maintenance R. Gilchrist, Accounting - - . , NORTHERN CALIFORNIA JOINT ASSOCIATION zoMARKET STREET wo)WOo2 SAN FRANCISCO,CALIFORNIA 94105 June 9, 1989 Contra Costa County Public Works Department ` 1801 Shell Avenue Martinez , CA 94553 Refer: Contra Costa CountyTruck Driver: Pete Martipez Gentlepersons: This refers to an incident that occurred on May 3, 1989 on Clifton Road east of Byron Highway in Byron , which resulted in damage to facilities jointly owned by PG&E and Pacific Bell , whom we represent. From the reports received in this office advising us of the incident , we ' understand the above referenced vehicle, owned by we countt '^,' and operated by Pete Martinez , damaged public utility facilities necessitating their repair and replacement. Under the circustances which caused the damage, it is our opinion the joint owners of these facilities have the right to recover from you their cost of repairs. We are therefore, enclosing our Bill No, 8408 in the amount of $3,293. 46 for the cost of repairs incurred by PG&E only with a copy of their itemized breakdown of costs. To date we have not received Pacific Bell 's charges when and if received we will send a revised bill . 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 also attached as required ^� under Government Code Section 900 et. seq. Your early reply and cooperation will be appreciated. Sincerely, ~ ---~~-r - Willi is ` Execut 5 v e irector WS/sc Encl . r ' NORTHERN CALIFORNIA JOINT POLE ASSOCIATION 215 MARKET STREET (415)362-2972 SAN FRANCISCO,CALIFORNIA 94105 S T A T F M E N l Contra Costa County E�ILL f�lgii # 19.9 Public. Works Department _ �._..._._. ._._.____._._..__. 1801 Shell Avenue Martinez , CA 94553 6 9Zi gjc f3!Nc:1S REFER: Driver 2 Fete Martinez Date of Losse 5/3/99 Replace Joint Pole facilities located can Clifton Road east of Byron Highway in Byron , Contra Costa County, California. Materials and supplies: -# 329. 73 Labor: 21237. 12 Construction Equipment . Ex pense e 1 ,040. 00 Teal Expense: _.— 4L. fL LESS: Joint Pole Credit: - ;fhL.t?Cl TOTAL AMOUNT Off'. B I LL e -��:�,.^_•.93. 46 ***To date we have not received Pacific Bell 's charges if and when received we will send a revised bill . PLEASE MAKE CHECK PAYABLE TO THE NORTHERN CALIFORNIA JOINT VOLE ASSOCIATION AND FORWARD TO THE ABOVE ADDRESS. NORTHERN CALIFORNIA JOINT POLE ASSOCIATION 215 MARKET STREET (415)362-2972 SAN FRANCISCO,CALIFORNIA 94105 . Contra Costa County Public Works Department ISO! Shell Avenue Martinez , CA 9450'3- fit;?ES REF~lYR: Driver er 3 Pete i"hr'f:ineZ Date nf Coss: ' 5/3/89 Replace Joint Pole facilities loc :_at ed on C:E i f tpn Road east of Byron di€1hwat ' in Byron , Cont.r sus Costa County, Cali rar ni a. Material'm and supplies: S 329. 73 Labor: 2,237. 12 Construction lrtion Eclui pment: Ex petirr4..r.u S ,040.00 Tool Expense;pen e; _.._. Wit;. � L *3,653. 46 4ESSv Joint: Pole fir ed i ti< TOTAL AM(til.:1NT OF E:111-t...: '-$35,'"93. 4 6 ***To t.late we have not received Py€ 1 f i c Bell s :S::;har"qes if and when received we will send a revised bill . PLEASE lNlAt;-.E CHECK PAYABLE TO THE NOR7HERk Gr"fit..:[l~f.:lRN I A ,7i".1I NT POLE ASSOl::i AT T Ohl AND FORWARD TO .1_L.,E APOVE ADDRESS, NORTHERN CALIFORNIA JOINT POLE ASSOCIATION 215 MARKET STREET (415)362-2972 SAN FRANCISCO,CALIFORNIA 94105 June 9, 1.989 CLAIM AGAINST THE CONTRA COSTA COUNTY PUBLIC WORV.'S DEPARTMENT iiaorthern California Joint Pole Assoc.i ati on 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 F'G',',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 DATIH OF OCCURRENCE: May 3, 1989 PLACE OF OCCURRENCE: Clifton Road east of Byron Highway in Byron , Contra Costa County, California„ CIRCUMSTANCES CAUSING CLAIM: At approximately 2.-35 P. M. , an employee, whi I e operating a vehicle registered to Contra Costa County Public Works Department , was moving with its boom in the air and hit Pacific_ Bell cable causing splitting a 45 ` Joint Pole. The Contra Costa County Boom Trr C1% was operated by Pete Martinez . DESCR I F'T I ON AND T-I-EM I ZAT I ON OF DAMAGES: A 45 'Joint Pole was split. , necessitating replacement and repairs. E STIMA7'ED AMOUNT_ OF CLAIM: $3,293. 46 Actual PG&E Cast Only $1 ,000.00 Estimated Pacific: Bell Costs **Please note this is the amount for PG&E only. To date we have not received we will send a revised bill when and if received. Billing is made on an actual cost basis and will. be forwarded with itemizations after processing. NORTHERN CALIFORNIA ,J O I N"T POLE ASSOC I AI"I ON bvo William ar is Executive Director 13' Gr nd4E? Pacific Gas and Eltectvic Company SUNDRY SALES1 INVOICE 9147523421130503651109329346YY !COPIES 4 I I D&C Number Y Invoice Date - I CI UJC-5365119-2 5/27/891 1 329346 1 JPA-CONTRA COSTA CO PUBLIC DEP PETE MARTINEZ 329346 I UJC J 215 MARKET RM 1201 SAN FRANCISCO CA 94105 . j 5365119-2 I I I C89-7084 PLEASE 1 PAY THIS $3,293.46 1 AMOUNT I Please return this portion with payment-Bring entire bill when making payment in office. ------------------- ------- --- -- -—- --------------------------- - - ----c ------------- = - - -- - -- - When making inquiries contactJPA-CONTRA COSTA CO PUBLIC DEP our office at NCJPA 215 MARKET,RM 819 D&C Number SAN FRANCISCO CA 94105 UJC-5365119-2 (415) 362-2972 MAY 27, 1989 ACCIDENT REPORT NO C89-7084 WO 314450C DESCRIPTION AMOUNT COST TO REPAIR COMPANY FACILITIES DAMAGED 5- 3-89 CLIFTON RD 13/P/E/O BYRON HWY REP 451JT POLE LABOR : HOURS 24 . 0 ST 11 . 5 OT . 5 DT 2, 178 . 42 TOOL EXPENSE 46. 61 CONSTRUCTION EQUIPMENT 20 . 0 HOURS 1 , 040 . 00 MATERIALS AND SUPPLIES 329 . 73 1-45 ' CL5 POLE MEALS 58 . 70 JOINT INTEREST CREDITS 360 . 00- N OTIOE MAKE PAYABLE TO: NORTHERN CALIFARN JOINT POLE ASSN. r MAIL TO: 215 MARKETTSTAE AMOUNT NOW DUE $3,293.46 SAN FR1ANCiSM EA 94103 UJC 5365119 THIS BILL IS NOW DUE AND PAYABLE 1-4657 (10-82) �M° C " 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 12 7989 and Board Action. All Section references are to ) The copy of this document mailed to you 1 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: $12,641.69 Section 913 and 915.4. Please note all "Warnings". County Counsel CLAIMANT: WELLS FARGO BANK, N.A. AUG 2 9-1989 ATTORNEY: David H. Gartshore Jordan, Keeler & Seligman Date received Martinez, CA 94553 ADDRESS: One Embarcadero Center, Ste. 840 BY DELIVERY TO CLERK ON August 28, 1989 (Via Counsel) San Francisco, CA 94111-3613 BY MAIL POSTMARKED: August 23, 1989 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: August 28, 1989 PpHHIL BATCHELOR, Clerk BY: Deputy II. FROM: County Counsel T0: 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: 29 171 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 af•the Board's Order entered in its minutes for this date.D Q 12 Dated: r �`I09 PHIL BATCHELOR, Clerk, By d 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. O Dated: SEP 14 AM BY: PHIL BATCHELOR by � Deputy Clerk CC: County Counsel County Administrator JORDAN, KEELER & SELIGMAN ATTORNEYS AT LAW ONE EMBARCADERO CENTER SUITE 840 SAN FRANCISCO,CALIFORNIA 94111-3613 (415)397-4600 luunxy TELECOPIER(415)392-2059 AUG G n /1 1989 MartinC Martinez, A 945558 August 23, 1989 Cer+.-0PIgy 378 hyo Phil Althoff Deputy Counsel Contra Costa County Administration Building 961 Pine Street Martinez, California 94553 Re: Amended Claim by Wells Fargo Bank for Indemnity (Melinda Douglas v. Wells Fargo Bank, Contra Costa County, Case No. C8902619 ) Dear Mr. Althoff: In response to your Notice of Insufficiency of Claim (purportedly mailed August 9, 1989, but received by this office today, August 23, 1989) , a copy of which is attached, Wells Fargo Bank, N.A. hereby submits this Amended Claim for declaratory relief, indemnity, and fees in compliance with Government Code §§ 910 and 945. (a) Claimant is Wells Fargo Bank, N.A. , a national banking association with its principal place of business at 111 Street, San Francisco, California 94103 ("Wells Fargo") . (b) All notices with regard to this claim should be sent to claimant's attorney, David H. Gartshore, law offices of Jordan, Keeler & Seligman, One Embarcadero Center, Suite 840, San Francisco, California 94111-3613 . (c) On or about April 12, 1989, Contra Costa County, through the District Attorney's Family Support Division, caused the issuance of a Notice of Levy and Writ of Execution directing Wells Fargo to withdraw the sum of $12, 641.69 from all accounts, including account number 633 55 97068 among others, at Wells Fargo Bank in Richmond, California. Account number 633 55 97068 is entitled "Freddie Douglas Guardian for Melinda Douglas. " (d) The Notice of Levy and Writ of Execution were issued pursuant to a judgment against Freddie Douglas, as judgment debtor, in favor of Contra Costa County, as judgment creditor. JORDAN, KEELER &SELIGMAN Phil Althoff August 23, 1989 Page 2 (e) Although the Notice of Levy and Writ of Execution were facially valid, the guardian for Melinda Douglas contends that the County's execution against account number 633 55 97068 violated California Code of Civil Procedure Section 699.720(a) (10) , as Melinda Douglas' account was established as a guardianship account. (f) On or about June 26, 1989, Melinda Douglas, through her guardian, filed a complaint in the Superior Court against Wells Fargo and Contra Costa County for, inter alia, breach of contract and negligence in withdrawing the funds from Ms. Douglas' account. (g) Accordingly, Wells Fargo seeks indemnity from Contra Costa County for any judgment entered against Wells Fargo in the Superior Court action by Ms. Douglas and for reasonable attorneys fees and costs of suit incurred in defending the action. (h) The names of public employees causing the loss to Wells Fargo are presently unknown, but are believed to be personnel in the District Attorney's and County Clerk's offices. (i) Wells Fargo's losses exceed $10, 000. 00 and jurisdiction over its claims will.rest in the Superior Court. Very truly you s, David H. Gartshore DHG:bp Certified Mail/Return Receipt Requested Certificate No. COOKBDATR 56/1 NOTICE OF INSUFFICIENCY AND OR NON-ACCEPTANCE OF CLAIM TO: Wells Fargo Bank, N.A. c/o David H. Gartshore O Law Offices of Jordan, Keeler & Seligman 1 Embarcadero Center #840 AUG 2 31989 San Francisco, CA 94111-3613 JORDAN, KEELER & SELIGMAN Re: Claim of WELLS FARGO BANK, N.A. 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 1 . 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 Coun ns CERTIFICATE OF SERVICE BY MAIL C.C.P. 95 1012, 1013a, 2015 .5; Evid. C. 99 641 , 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: _�\s , at Martinez, California. cc: Clerk of the Board of Supervisors iginal) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910.2, 920.4, 910.8) .,4d�t`���J�••-^tet . ,.3 :Z :i � lCV 4 vwl l ci M ct' C5' ON N N o � N w O O N N .00 � rA� r4 �.� N ap 0 �� � a 0 s 0D 4 M �n 4 W J i d 4 ca N �r t¢ a o O Z m N Y Q 2 G LL 4 O 0 i CLAIM F 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 12 , 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: $20 . 00 Section 913 and 915.Q0L#1t`sCvGdW,"J "Warnings". CLAIMANT: RONALD P. STOVALL AU U 15 1989 901 Court Street ATTORNEY: Martinez , CA 94553 Martinez, CA 945,53 Date received ADDRESS: BY DELIVERY TO CLERK ON August 14, 1989 BY MAIL POSTMARKED: August 11, 1989 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. August 14 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: BY: l Deputy County Counsel 7—T 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 1 2 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 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: 14 19$g BY: PHIL BATCHELOR by o Deputy 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, 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. RE: Claim By ) Reserved for Clerk's filing Stam Against the County of Contra Costa ) AUG 1 41989 or .0 El, District)' B UtN Fill in name ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 0 O and in support of this claim represents as follows: ------------------------------------------------------------------------------------- 1. When did the damage or injury occur? (Give exact date and hour) ----- �- ---d_� 1101"AN --------- ------------------------------------------- 2. Where did the damage or injury occur.- (Include city and county) ------------ �-- \_�_C�o�^C�---_�►_ c"'N _ r�1 L 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? \tee S cAQS -k f VIC\� (over) 5. What are the names of county or district officers, servants or employees causing the damage or injury? ` �=----- b. 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.) Q *Tame+-- and addresses of wifnAsses, don'fnrs and hospitals, f\C:��+Z � J �� rn U� �, -1-}.e.v1 5 ,:�e �. 1 k'� .� S��� m►4 I e c 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 t5 V-n '15 Claimant's Signature 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 fora 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. . J sz- QrN_.-�-- C,�.J\ --n - �'—�•�."'�c' ue _ _ A._J. ca ✓`--�-' V _�!V Qs(�.�C�LY�/li`1 li _ 3� �v✓4.Y1�� - � � � �\.`1 - � �� C`�.�.. t�•u.c� �..:.� Com; ��C�e..k AN -At SC U ' ,%cy\i-4 CL .�Cy.�-a . U 1 } 1 tn 41 7�b'o ` l •+pl�J O ASS, APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD ACTION Application to File Late Claim ) NOTICE TO APPLICANT September 12 , 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: ALBERT WUTZKE County CounsO c/o Michael J. Easle Attorney: Curtis Johnson and Associates AUG 15 1989 3240 Lome Tree Way #202 Martinez, CA 94553 Address. Antioch, CA 94509 Amount: $30 ) 682 .,70 By delivery to Clerk on August 10, 1989 hand del. Date Received: August 10 , 1989 By mail, postmarked on no envelope I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted Application to File Late Claim. DATED:Augu s t 14, 19 8 9 PHIL BATCHELOR Clerk, By 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). The Board should deny this Application to File Late Clam ,,ection 911.6). DATED: 15 q VICTOR WESTMAN, County Counse , By Deputy III. BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( ) This Application is granted (Section 911.6). Oo<) 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. DATE: SEP 12 1999 PHIL BATCHELOR, Clerk, By Q4xlao AA4L4Deputy 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 att2Mey,attorney, u should do so immediately, 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: S�P 14 PHIL BATCHELOR, Clerk, By o 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 BOARD OF SUPERVISORS , CONTRA COSTA COUNTY , CALIFORNIA AFFIDAVIT OF MAILING In the Matter of ) APPLICATION TO FILE LATE CLAIM ) ALBERT WUTZKE ) ) ) ) ) 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 a Board Order denying application to file late claim. to the following : Albert Wutzke c/o Michael J. Easley Curtis Johnson and Associates 3240 Lone Tree Way #202 Antioch, CA 94509 I declare under penalty of perjury that the foregoing is true and correct. Dated September 14, 1989 at Martinez , California . CL a-4AX--,e9 Ann Cervelli, Depu y Clerk 3 CURTIS L.JOHNSON AND ASSOCIATES 1 ATTORNEYS AT LAW 3240 LONE TREE WAY,WfTE 202 ANTIOCH,CALFORN1A 94509 2 (415)77944556 RnK Na E D { 3 { 4 ATTORNEYS FOR AUS 1 0.19-89,11 Claimant ALBERT WUTZKE �1 /ih PHO 5 B HE�OR GLZ A R StJ VISO;i� S 0— IL l gy ,• Deputy 7 8 9 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 10 Claim by: 11 Albert Wutzke APPLICATION FOR LEAVE 12 TO PRESENT LATE TORT CLAIM against 13. County of Contra Costa 14 15 TO THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY: 16 1. Application is hereby made for leave to present a late tort 17 claim under Government Code § 911.4 . The claim is founded on a 18 cause of action for negligence - personal injury, which accrued 19 on August 17, 1988, and for which a claim was not timely 20 presented. For additional circumstances relating to the cause of 21 action, reference is made to the claim attached hereto as Exhibit 22 A. 23 2 . The reason for the delay in presenting the claim is the 24 mistake, inadvertence, surprise, and excusable neglect of the 25 claimant as more particularly shown in the declaration of claimant 26 1 Albert Wutzke, attached hereto as Exhibit B. The Board of 1 Supervisors of Contra Costa County was not prejudiced in the 2 defense of the claim by the failure to timely file the claim as 3 shown by the declaration of claimant's attorney, Michael J. 4 Easley, attached hereto as Exhibit C. 5 3 . This application is presented within a reasonable time 6 after the accrual of the cause of action as shown in Exhibit C. 7 WHEREFORE, it is respectfully requested that this application 8 be granted and that the attached claim be received and acted upon 9 in accordance with Sections 912 .4-912 .8 of the Government Code. 10 DATED: August 10, 1989 11 CURTIS L. JOHNSON AND ASSOCIATES 12 WQ13 By MICHAEL J. EAStgY 14 Attorney for Haimant 15 16 17 18 19 20 21 22 23 24 25 26 2 CURTIS L.JOHNSON AND ASSOCIATES ATTORNEYSAT LAW 3240 LONE TREE WAY,SURE 202 ANTIOCH.CAL60RNIA 94509 (415)T/99456 1 CLAIM BY ALBERT WUTZKE AGAINST THE COUNTY OF CONTRA COSTA 2 tem #3 he claimant,. Albert Wutzke .had contacted the Contra Costa 3 ounty Energy Division regarding the weatherization of his ome pursuant to their Free Weatherization program. On August 4 7, 1988, workmen arrived at his home at 3838 Stone Road in ethel Island. .They had been working for about twenty 5 ninutes putting insulation in the claimant's attic. The workmen brought in a blower hose with an electrical cord 6 attached to it and tied the cord to side of a seven-foot aluminum step ladder, just below the bottom rung. 7 he end of the hose, with cord attached, was hauled up the 8 adder to the attic of the home. The claimant was concerned bout the hose being too big to get into the corners of the 9 attic. He then stepped up to about the third rung of the adder to observe and speak to the workmen. Client advised 10 he workers that he was coming up when he his head was about foot from the bottom of the attic. 11 he workers were about 25 feet from entry hole to the attic. 12 t the time of the incident the claimant was looking to his left side. and could see the hose and cord running across the 13 attic floor and could see the workers. One of the workers pulled on the . cord. This caused the ladder to topple. The 14 claimant fell on his leg, an approximately five foot fall, nd fractured his leg. 15 he ladder had fallen from the attic entrance and was lying 16 on the floor of the house. The claimant yelled for help and is neighbor, Greg Maciel, came and helped him to the couch. 17 The workers finished their job before coming down from the 18 attic. They apologized for what happened and left. Nothing ore was heard from them. 19 The ladder in question was a seven foot aluminum step ladder, 20 with rubber padding on the legs. The floor was carpeted. At the time of the accident the ladder was fully opened. .21 The claimant required surgery for his leg fracture. Since the 22 surgery he has experienced on going pain. His present doctor, Dr. Hildebrand of Lodi, California, recommends additional 23 surgery. 24 Item #8 cont. 25 Los Medanos Hospital Dr. L. Hildebrand 2311 Loveridge Road 330 W. Lodi Avenue 26 Pittsburg, CA 94565 Lodi, CA 95240 CURBS L JOHNSON AND ASSOCIATES ATTORNEYS AT LAW 3240 LONE TREE WAY,SUffE z2 ANTIOCH.CAUFOR1ik 945M 010 7144450 5. What are the names of county or district officers, servants or employees causing the damage or injury? The names of the county employees are unknown. They are believed to be employed by the Contra Costa County .Energy Division and were sent to the claimant' s home on _August 17, 1989 pursuant to the Free Weatherization 6. what damage or injuries do you claim resulted? (Give full extent 'of injuries or Program. damages claimed. Attach two estimates for auto damage. Claimant suffered a 1 e g . fracture, bruising, pain, and suffering. Medical expenses included the charge for a hospital stay and operation, convalescent care, and use of a 7. How was the amount claimed above computed? (Include the estimated amount of any pcvnses.. ncrialExpeIncured - $10,682 .70 Pain and Suffering - 10 , 000 . 00 Future Surgery (est. ) - 10 ,000 . 00 ---------------- �' �---------------------—����_ 8. Names and addresses of witnesses, doctors and hospitals. Witness- Greg Maciel Medical— Michael Russell, M.D. D.H. Gustafson, M.D. 3836 Stone Road 3006 Railroad Avenue 2230 Gladstone Drive Bethel Island, CA 94511 Pittsburg, CA 94565 Pittsburg, CA 94565 - ------------------------------------------------------ cont nUQd.Q.U_=A9b d. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 8/17 -8/24/88 Hospitalization and Surgery $9 , 992 . 70 8/24 -8/27/88 Convalescent Care 312 . 00 8/28 Wheel Chair Rental 124 . 00 Gov. Code Sec. 910.2 provides: "The claim must be sign the claimant SEND NOTICES TO: (Attorney) or b so er n be 1 " Name and Address of Attorney Michael J. Easley C aiman ' Signature Curtis Johnson and Associates Michael J. Easl , Attorn for Claimant 3240 Lone Tree Way, Suite 202 Curtis Johnson and Associates Antioch, CA 94509 Address 3240 Lone Tree Way, Suite 202 Antioch, CA 94509 Telephone No: (415) 7179-9456 Telephone No. (415) 779-9456 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 fin of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fin. Claim to: BOARD OF SQPERVISORS 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 19 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 forma RE: Claim By ) Reserved for Clerk's filing stamp Albert Wut z ke RECIME Against the County of Contra Costa ) or ) ,1 _, 1.180 District) AT Fill In name ) CLE X BH TF.� T pR o n� By J... The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 30 , 682 .70 and in support of this claim represents as follows: ------------------------------------------------------------------------------------- 1. When did the damage or injury occur? (Give exact date and hour) August 17, 1988 at approximately mid-day, exact time unknown .. � -- -- - --- -- - -- ---- -- -------------- 2., Where did the :damage or injury occur? (Include city and county) 3838 Stone Road; Bethel Island, Contra Costa County, California 3. How did the damage or injury occur? (Give full details; use extra paper if required) SEE ATTACHED - 4. What particular act or omission on thepart of county or district officers, servants or employees caused. the injury or damage? County employee pulled on an electrical cord, which he had attached to the side of a ladder. The claimant was standing on the ladder at the time. Pulling on the cord caused the ladder to fall. . (over) AU EXHIBIT B 1 DECLARATION OF ALBERT WUTZKE 2 I, ALBERT WUTZKE, hereby declare: 3 1. I am the claimant in this matter. I have personal 4 knowledge of the matters contained herein and if called I can and 5 will competently and truthfully testify thereto. 6 2 . On August 17, 1988, I was involved in the accident and 7 sustained the injuries described in the attached claim. 8 3 . In or about September of 1988, I consulted with Attorney 9 Mark Murphy of Antioch about my legal rights arising from this 10 accident. 11 4 . In or about November of 1988, I received a letter from 12 Attorney Murphy explaining that he was unable to represent me. At 13 no time was I informed as to what legal rights I had or what 14 actions I should take. 15 5. I was unable to give further attention to my claim because 16 of the many problems that were going on in my life at this time. 17 At the time of the accident, I was taking care of my elderly wife 18 at home. She had suffered a stroke and required assistance with 19 most of her day-to-day activities. My ability to assist her was 20 further complicated by my injuries from the accident. 21 6. In late November through the present, I have been involved 22 in a dispute with my former landlord regarding the condition of 23 my home and sums owed to me for work I performed. 24 7 . On January 4, 1989, I was compelled to admit my wife to a 25 convalescent home. Since that time, I visit her on a daily basis. 26 CURTIS L JOHNSON 3 AND ASSOCIATES ATTORNEYS AT LAW 9200 LONE TREE WAY,SURE 2D2 ANTIOCK CAUFOPMA905W (413)7/99.756 1 8. Since the time of the accident, I have had to deal with my 2 own medical care. My doctor has advised me of the need for further 3 surgery. I have spent much time dwelling on the surgery and my 4 ability to pay for it. 5 9. All of these matters have taken my undivided attention and 6 taken my attention away from my claim. 7 9. On April 13 , 1989, I consulted with my present attorney. 8 It was at this point that I was first informed as to the need to 9 file my claim within six months of the accident. 10 10. I believe my failure to file a timely claim is due to my 11 mistake, inadvertence, surprise, and/or excusable neglect brought 12 on by the above mentioned factors. 13 I declare under penalty of perjury that the foregoing is true 14 and correct and that this declaration was executed on August 10, 15 1989, at Martinez, California. 01 16 17 18 19 20 21 22 23 24 25 26 CURTIS L JOHNSON 4 AND ASSOCIATES ATTORNEYS AT LAW 3240 LONE TREE WAY,SUITE 2172 ANTIOCH,CAUFORNLA94509 (415)7199456 1 EXHIBIT C 2 DECLARATION OF MICHAEL J. EASLEY 3 I, MICHAEL J. EASLEY, hereby declare: 4 1. I am the attorney for claimant Albert Wutzke. I am 5 licensed to practice law before all Courts of the State of 6 California. I have personal knowledge of the matters contained herein and if called I can and will competently and truthfully 8 testify thereto. 9 2 . I have been unable to discern any prejudice that would 10 result should this late claim be accepted. The County of Contra 11 Costa will have an identical opportunity to investigate this 12 matter, as the claimant does. Furthermore, by acceptance of the, 13 late filing, the County will not forfeit any rights or remedies 14 which it would have had if the claim was timely filed. 15 3 . This application is being filed within the one year period 16 provided by Government Code § 911.4 (b) . 17 I declare under penalty of perjury that the foregoing is true 18 and correct and that this declaration was executed on Au t 10, 19 1989, at Antioch, California. ' 20 21 22 23 24 25 26 CURTIS L.JOHNSON 5 AND ASSOCIATES ATTORNEYS AT LAW 9200 LONE TREE WAY,SURE 202 ANTIOCH,CAUFORNIA945M (418)7794ft