Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
MINUTES - 08061991 - 1.38
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 TOC IMANT August 6, 1991 and Board Action. All Section references are to ) The copy of 'v document mailed to you is your notice of California Government Codes. ) the actiO'o aken c� 1lur claim by the Board of Supervisors (Paragraph IV;'l;elo�, given pursuant to Government Code Amount: $1 , 000, 000. 00 Section 9��nd 9 - ?lease note all "Warnings". jt CLAIMANT: BARNES, Jean ATTORNEY: Christopher T. Cody Seltzer & Cody Date received ADDRESS: 180 Grand Avenue 461300 BY DELIVERY TO CLERK ON July 5 , 1991 Oakland, CA 94612 BY MAIL POSTMARKED: July 3, 1991 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: July 5 , 1991 PHIL BgATCHELOR, Clerk o BY: Deputy 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: J . Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (xj This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: AUG - 6 1991 PHIL BATCHELOR Clerk By4aaAA. , o Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: AUG - 7 1991 BY: PHIL BATCHELOR b I JAAJDeputy Clerk CC: County Counsel County Administrator SELTZER & CODY ATTORNEYS AT LAW CITIBANK PLAZA 180 GRAND AVENUE, SUITE 1300 OAKLAND, CALIFORNIA 94612 RICHARD A.SELTZER (415) 893-6622 Or COUNSEL CHRISTOPHER T.CODY MERVIN N. CiHERRIN MARGARET Z.JOHNS July 3, 1991 CLERK OF THE BOARD OF SUPERVISORS Room 106 County Administration Building 651 Pine Street Martinez, CA 94553 Dear Clerk: Enclosed please find the original claim and two copies for our client, Jean Barnes . Please file this claim accordingly, and return a file- endorsed copy to me in the enclosed return envelope. Your courtesy and cooperation will be greatly appreciated. Sincerely, SELTZER & CODY m Simone D . Grashuis /sdg Enclosures RECEIVED JUL 51991 CLERK BOARD OF SOPFRVISORS CONTRA COSTA C 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 JEAN BARNES ) RECEIVED Against the County of Contra Costa ) JUL 51991 and/ or ) ., Contra Costa County Health Services, SORS CLERK BOARD OF SUPERVI Merrithew Memorial Hos itDistriet) CONTRA COSTA BOARD co. O S Fill in name- The ame The undersigned claimant hereby makes claim.against the County of Contra Costa or the above-named District in the su¢i of $ 1 Million and in support of this claim represents as follows: ------------------------------------------------------------------------------------- 1. When did the damage or-..injury occur? (Give exact date and hour) February 21 , 1991 ,. and thereafter. ----- ---------------------- 2. Where did the damage or injury occur? (Include city and county) Merrithew.' Memorial Hospital, Martinez, Contra Costa. 3. How did the damage or injury occur? (Give full details; use extra paper if required) Plaintif f .underwent breast. reduction surgery. Said surgery was -so.. riegligently performed that the plaintiff. developed acute post-operative wound infection with necrosis . Thereafter, plaintiff was mistreated by the defendant and her infection was ignored and allowed to worsen. cont' d-- 4. What particular act or omission on. the part of county or district officers, servants or employees caused the injury or damage? Plaintiff believes that the breast reduction surgery was performed negligently. Plaintiff' s follow up care was grossly sub-standard. (over) S RE: 'JEAN BARNES CLAIM CONTINUED*** 3 . On 4-20-91 , an independent physician had to perform emergency surgery in order to prevent the infection from spreading further. In the surgery Ms. Barnes had to have both breasts removed as a result of the gross infection and necrosis. AbA�� .tY"yAAAAAA 6L 0 yQ� o 0 N HA A rA N � G O 0 O M 3 V atpG o Ile U` a� Hro N N 00 rA 0 � oo v `�s � 1 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 -vuivir �Uu �c Au UAiS! ttV s.,W1091 and Board Action. All Section references are to ) The copy of this document mailed to you i 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: $200, 500. 00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: GRANT, Taylor Grant , by and through his Guardian ad Litem Galen Grant ATTORNEY: Mary Nolen Law Offices of Pincus & Nolen 2551 received ADDRESS: 2551 San Ramon Valley Blvd. BY DELIVERY TO CLERK ON July 8, 1991 Suite 221 San Ramon, CA 94583 BY MAIL POSTMARKED: July 5 , 1991 Certified P 757 975 816 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PPHHIL BATCHELOR, Clerk p DATED: July 8, 1991 BY: Deputy 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: J 1BY: Deputy County Counsel 1 III. FROM: Clerk of the Board TO: County Counsel (1) County Administr for (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( >e 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: WIJG - 6 1991 PHIL BATCHELOR, Clerk, By A. 0J.1 ° , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You .may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: AUG - 199 1 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator ORIGINAL PINCUS & NOLAN ATTORNEYS AT LAW 2551 SAN RAMON VALLEY BLVD. S.BRUCE PINCUS SUITE 221 TEL: (415)743-8441 MARY NOLAN SAN RAMON,CA 94583 FAX: (415)743-8941 July 3, 1991 RECEIVED Certified Mail/Return Receipt Requested JUL 81991 ` Clerk of the Board CLERK BOARD SUPERVI OR CONTRA COSTA CO. Administration Building --- 651 Pine Street, 1st Floor Martinez, California 94553 Re: Our Client Taylor James Grant, by and through. his Guardian ad Litem, Galen Grant Adverse Party County of Contra Costa Date of Loss 2/19/91 Dear Clerk: The Law Office of Pincus & Nolan hereby presents this claim pursuant to Section 910 of the California Government Code. 1 . The name and post office address of the claimant is: Taylor James Grant, by and through is Guardian ad Litem, Galen Grant, 611 W. Hawthorne Drive, Walnut Creek, CA 94596. 2 . The address to which Claimant desires notice of this claim to be sent is as follows: c/o The Law Offices of Pincus & Nolan, 2551 San Ramon Valley Boulevard, Ste. 221, San Ramon, California 94583 - Tel: 415/743-8441; 3. On or about 2/19/91, Claimant, Taylor James Grant, was injured while leaving a basketball game, in the City of Martinez, County of Contra Costa, State of California. Said injuries and damages took place on or adjacent to the school ' s property and were incurred due to the negligence of the County of Contra Costa and the Martinez School District which failed and refused to provide adequate, or any, security to visiting students, knowing that there were present Martinez High School students who had a propensity to be violent and who intended to inflict great bodily harm to Claimant herein. Clerk of the Board July 3, 1991 Page two 4. As a direct and proximate result of the actions of the County of Contra Costa and the Martinez School District and its agents/employees, Claimant, Taylor James Grant, suffered serious and permanent injury to his person due to a physical assault and battery by members, students and agents of the County of Contra Costa and the Martinez School District. 5. As a further direct and proximate result of the actions of the County of Contra Costa and the Martinez School District and its agents and employees, Claimant suffered severe mental and emotional distress. 5. So far as is known at the time of filing this claim, Claimant has incurred the following damages: a. Medical Expenses Approximately $500.00 and continuing b. Wage Loss Unknown and continuing C. Future Loss of Earning Capacity Unknown and continuing d. Pain & Suffering and Emotional Distress $200,000.00 and continuing. TOTAL DAMAGES TO DATE AND CONTINUING: $200,500.00. 6. Jurisdiction of this matter will rest in Superior Court. DATED: July 3, 1991 PINCUS & NOLAN l r BY• MARY NOLAN, Attorney 'CJ Taylor James Grant, Claimant Y PINCUS & NOLAN ATTORNEYS AT LAW 2551 SAN RAMON VALLEY BLVD. S.BRUCE PINCUS SUITE 221 TEL: (415)743-8441 MARY NOLAN SAN RAMON,CA 94583 FAX: (415)743-8941 July 3, 1991 Clerk of the Board Administration Building 651 Pine Street, 1st Floor Martinez, CA 94553 Re: Claimants Chris McGregor, Travis McGregor, Taylor James Grant Adverse Parties: County of Contra Costa, Martinez School District Date of Loss 2/19/91 Dear Clerk: Enclosed please find the original and three copies of the claims for personal injuries regarding the above parties. Please be so kind as to file-stamp one copy of each claim (against the County and Martinez School District) for each claimant and return same to this office in the envelope provided for your convenience. Thank you for your courtesy and cooperation. Very truly yours, By: 2• r� —? MARY NOLAN MN:db Enclosures RECEIVED JUL 8 1991 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the road of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT August 6 , 1991 and �c,, d A---Lion. 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: $22 3. 58 Section 913 and 915.4. Please note all "Warnings". 4 aXIVE® CLAIMANT: INOUYE, Kenneth ATTORNEY: J U L 15 1991 Date received COUNTY COUNSEL ADDRESS:3813 Palmwood Court BY DELIVERY TO CLERK ON July 10,nAdT$Jtk CAL1R Concord, CA 94521 July 9 , 1991 BY MAIL POSTMARKED: 5' I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: July 11 , 1991 JAIL BAATTCYELOR, Clerkepu 1=1. ..a a 1I. 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: JA Deputy County Counsel -0 . II1. 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: AVG - 6 199 1 PHIL BATCHELOR, Clerk, By rL 0. 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. 0 Dated:-AUG - 1091 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Claimt'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, 19$7, must.be presented not, later-than. the-.1Q0th .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, 19$$, 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 note later than one year.. after the -acerpal..of the cause of adtion. ; (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.:Distriet 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 pepalty..for, fraudulent..claims,..Penal. Code-.Sec.- 72--at- the end of this form, -. .. i.. RE: Claim By } Reserved for, Clerk's filing stamp RECENED Against the County. of :Contra Costa- ) AL 1 0 1991 _ District) _ CLERK.-BOARDOF S.�# 3" . ';.CONTRA Fill in name ) The undersigned claimant hereby makes claim aEainst 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) ----------------------------------- -------------------------- -- 2. Where did the damage or injury occur? (Include city and county) Tr tr r $1 Jpt 6G it G rayZPA ��lr�►fa�4.lei I/ �2d Co,�y/� 6fk X 44 ------------------------------------------------------ --- 3. How did the damage or injury occur? (Give full details; use extra paper if' required) t�lh,le: +rdveI/: fp�� � . p^ To-tIar Mid v��i► �. tl�.. �rG�r - �� Sc!6l%n 7/mom 1�Ivd4-Veh�c18. !r'1. ji► '. ons Siff LrG�o( L? -__�S C """l.�'Q� -00 ti--�./�1`_y�1-W4 :44, Ga GiC::+CG�' Mv1_tJ� - ►��(�. _ -_..-..---------- 4. -What particular actor omission on the part,of county-.or'district officers, i servants ,or employees caused the injury;or.,damage? N o'e-A h o�S Oh � rn#A ( ch s� cJ, ►rG+ S ,� �p -t�C.�. �ti,nt �ra�• �n (over) n %. �. a.,QL. are the names of county or district of•!ic_ers, serv_anss or employees causing the damage or injury? 5. -What damage-or. injuries do:you-claim resulted?s (Give full extent :of injurie's or damages claimed Attach two' est mates f r,- uto damage: 1 15k,4Q 1 ., � �4i� ; t� 16, ?14?10CA/KA^+.• C1 RS;+� 11 1 �/" ak�t ck►-.�'e � �� C,./a �ti Crn�CGrr� 0'f�i/�:01�di�:e. .ES�i/k 4�1J ---_�l �.P�_al a"St,; d xJ.aZ1 . 1�2�`�8_______—_— How_was the amount._claimed above,computed? (Include the estimated tamount of any prospective injury oaf damage.) cam► . S cvs�- air i;i�n�lsl�;`�+off- e�l a c�iv�:tit� kh U6� S r �J �• t�1 JKic !S 1'¢eju�f : 4i 6,Abnw C�.SI=."fir(( .��, I , .: :.�f "k- {n,�.'Z? /'� t}�t1S M• • .0 rt.+ r"�`F�` !Apt.�C ------' _ - -- 8. Names and addresses of witnesses, -dodtors�and -hospitals. - - 9. -Lis t-the^expenditures you made-on account-of this accident or injury: DATE ITEM AMOUNT` # Gov. Code See.= 910:2 provides. "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some erson on his behalf." Name and Address of Attorney - Clai 's ,Signature ?a l41 Q ZAddress) 91Y SI�V Telephone No. Telephone No. (a-76 * •- *-W F V V I I W W I I V V. *' 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 'dfficer, -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: , 1 � J JUL-05-1991 12:56 .FPOM LOF CE14TRAL NO. 'CAL. TO CONCORD P.01 e4 �7 L3Ewa ao�'. Chuck ReevesFM / ,l Shop Manager Lbbey-Owens-Ford Glass Installation Auto-Residential-Commercial LOF Glass Installation 1555 Galindo Street Concord.CA 94520 (415)68543400 (600)972-0908 E . E . � u i 4t5 538 4907 FvrU.IdOly G fti 8 Ll LU �Q _ N `' N© J � 0 7 � � CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Cl-aim Against the County, or District governed by) BOARD- ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT August 6, 1991 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: $271 . 60 _ . lion 913 and 915.4. Please note all "Warnings". CLAIMANT: KASHETA, Lee r 1c 91 ATTORNEY: ;OUt4v COUNSEL MpRtINE7Da �'eceived ADDRESS: 4070 Sequoyah Road BY DELIVERY TO CLERK ON July 3, 1991 Oakland, CA 94605 BY MAIL POSTMARKED: July 2 , 1991 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PPHH gg DATED: July 5 , 1991 BYIL DeputyLOR, Clerk I1. FROM: County Counsel TO: Clerk of the Board of Supervisors � ) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: A 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: 1 certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: A U G - 6 1999 PHIL BATCHELOR, Clerk, By4444& v 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: — 7 �gg� BY: PHIL BATCHELOR by a �l� IG Deputy Clerk CC: County Counsel County Administrator Cleim •tos 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.beforee-December..319 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 thari'one year, afterthe.,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_5ec. .72 at the.end of this -form. 44 RE: Claim By } Re ' . : stamp 1991 Against the County of Contra .Costa . Or CLERK BOARD OF SUPE i CONTRA COSTA C . - .District)— (Fill District:)Fill in name ", The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District -in'-the sum of $ © and in support of this claim represents as follows:. --------------------------_________________ ---------------------_____-_-______-__-_ 1. When did -the damage or--injury occur?, (Give ;exact date and hour) 2. Where did the fe' or injury occur? (Include city and county) -------_-- ��- 3. How did the damage or injury occur? (Give full details; use extra paper if required) o `. ° %:.a:�: - i 7 _ i v _._. ---- -------- - - ---------------------------------------- 4. What particular act or omission on the, part of county :or district,officers,,. -servants. or employees caused the injury or damage? 1 ✓.. ' . 0 ir9 A (over) 5. what are the names of county or.,district aff'icers, servants or employees:c�Lusing the damage or injury.. What damage or: injuries doyouclaim resulted?-.', Give- ektentsof injuries or damages claimed:' Attach-two estimates for' auto damage:' r. How was the+amount--claimed-above computed? ` (Include�the estimated amount of any prospective injury or damage.) 4• 8. - � Names and addresses`of witnesses, doctors and`jhospitals. 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 Clai t's. Signature Address�t Telephone No.. Telephone No � . '�' �' - y�� NOTICE Section, 72-'of the'Perial•'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 moee'than. one year, ,by ,a fine of not exceeding one thousand`- ($11000), or"by, both-such imprisonment. and fine, or by imprisoi•�nent in the state prison, by a fine of not'exceeding 'ten thousand dollars ($10,040, or by both such imprisonment and fine. ' ` 512 MARINA BLVD. PHONE:351-4286 NELSON"SSan Leandro; Calif. 94577 BODY S FAX: (415) 351-7001 BAR No. AA2845 NAME Le//�� . L/ ri �►Pf✓i�`� DATE �1 ADDRESS 0 '70,, FWtta v'lhq G / INSURANCE CITY '4 �-�r.D ��� P'H/�ONE 7 - (0LJUSTER MAKE �U/�/� MODELFj4LL�[S ORIAL MILEAGE LICENSE � ! r ------- Laber S Symbol FRONT OiaSuaj T Labor Mrs. Ports Symbol LEFT O,ss*rL[T labor Hrs. Parts Symbol RIGHT Labor Hrs Ports Bumper(U)Ex-New Fender,Fri.d Ext. Fender,Fri &Eat. Bumper(L)Ex-New Fender Shield Fender Shield Bumper Brkt. Fender Mldg. Fender Mldg. Bumper Gd. Headlamp Heodlamp Frt.System _ __ _ Headlamp Door _ Headlamp:Door Frame Sealed Beam In-Out Sealed Beam In-Out Cross Member Cowl-Post Cowl-Post Stabilizer Windshield Mldg. Windshield Mldg. Wheel Door,Front Door,Front Hub Cop-Sm.-Lge. Door Hinge Door Hinge Hub&Drum Door Glass Door Glass Vent Glass Vent Glass Knuckle Sup. Door Mldg. Door M.idg. Lr.Cont.Arm Door Handle - '" Door Handle Lr.Cont.Shaft Center Post Center Post Up.Cont.Arm Door Rjeor Door Rear Up.Cont.Shaft Door Glass T-CI. poor Glass T-CI. Shock Door Mldg, Door Mldg.. Tie Rod-Ends Rocker Panel Rocker Panel Steering Geor Rocker Mldg: Rocker Mldg. Steering Wheel Floor Floor Morn Ring Guar.Inner Const. Ovor.Inner Const. Grovel Shield Quar.-Ext. I _ .Quar.-Ext. Park.light Quar.Panel Upper Ouar.Panel Upper. Rod.Grille,Cit. Ouor.lower Quar.Panel Lower Rad.Grille,Side Otiar.Midgs. Quar.Panel Mldgs: - Grille Mldg. Quar.-Glass T-CI. _ Ovar-Glass T-Cl. REAR MISC. Bumper Ex.-New Inst.Panel Bumper Brkt. Front Seat Horn Bumper Gd. Front Seat Tracks Baffle,Side Gravel Shield Rear Seat Baffle,lower lower Panel. Headlinirg Baffle,Upper I Floor Top Lock Plate,Lr. Trunk Lid I Tire _%Worn Lock Plate,Up. Trunk Ltd-Hinges Trim Hood Top Trunk Handle Mldgs.. Hery Hood Hinge Tail Light mt 8 MateyfaI Hood Mldg. Tail Pipe-Muffler Ornament t Back Up light Anien a Rad.Sup. Frame Crossmember Rad.Core Gas Tank Windshield T- Hub& Drum Rad.Hoses Axle-Housing Fan Blade I. Spring Fan Belt Control-Arms Water Pump-PulleyA-ALIGN N EW OH-OVERHAUL EX-EXCHANGE Motor Mts.. RC-RECHROME U-USED S-STRAIGHTEN OR REPAIR Trans.linkage SUAUAART Labordd s Nlf INCLUDES ALL PARTS AND.LABOR. IF ON CLOSER ANALYSIS IT IS FOUND , AD- Parts S DITIONAL REPAIRS ARE NECESSARY, YOU WILL.BE CONTACTED FOR AUTHORIZATION. PHONE REVISED AMOUNT __..._-. Tat[ S Z DATE � TIME . PERSON CONTACTED Sublet 0 I I:tz�c f 1 HAVE READ AND UNDERSTAND THE ABOVE ESTIMATE AND TERMS. us Vias:e Hemoval � � -- I AUTHORIZE SERVICE TO BE PERFORMED, INCLUDING 5UBLE T.WORK;AND ACKNOW- LEDGE RECEIPT OF THIS EST'MAT'_'. T OWNER :DATE The Duplicating:'Center-San Leandro d �"' 903 Williams Street • San Leandro, CA 94577 (415) 357-5250 Foreign a Domestic NAME OF OWNER Z r-C � � Estimate of Repairs HOME ADDRESS HOME PHONE BUSINESS PHONE r INSURANCE CO. Y VVR OF CAR MO BODY S Y E I D. NUMBER LICENSE MILEAGE DATE �� -- 8 DESCRIPTION OF DAMAGE PAINT SUBLET PARTS LABOR LABOR HOURS S PARTS LESS i OIN TAX SUBLET ADV. CHGS. / TOTAL S PARTS PRICES SUBJECT TO INVOICE 'L i c� '7 o Y+ i t b IN VIS03 da11v0D SMOSIA83dnS:10 Dab08 Ya313 1661E W Yot /3d + CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Cl&a%n Against the County, or District governed by) BOARD ACTION the Foard of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT Auust 6, 1991 a;-id I::at . .Action. All Section references are to ) The copy of this document mailed t 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: $16 ,456 . 00 Section 913 and 915.4. Please note all "Warnings". �f,vra® CLAIMANT: R� LARIEAU, Adelina n ATTORNEY: 30- Coom .ADDRESS: M RTNE,�IFBYtDELIVERYe 119 Dublin Drive TO CLERK ON July 3 , 1991 Vallejo, CA 94589 BY MAIL POSTMARKED: July 2 , 1991 Certified P 792 599 598 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: July 51991 gaIL BAeTTCYELOR, Clerk v II. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. A S 'b, �P ( } This claim FAILS to comply substantially with Sections 910 and 910 2, an w are so ifying 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: I /JAG Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1)\-/ County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (� This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: AUG - 6 199 1 PHIL BATCHELOR, Clerk, By Deputy Clerk AMA- 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. 0 Dated: AUG - 7 1991 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 an4.4which .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 11 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.,aecrual. 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 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 } Against the County .of Contra Costa.,.;... ) JUS 3 1991 or ) .. CLERK BOARD OF SUPER District} , Fill in name ) CONTRA CQSTA'CO< The undersigned' claimant hereby makes claim against the County of Contra Costa .or the above-named District in the sum of $ 16,456.00 and in support of this claim.represents-as. follows: -----------------------------------------------w_1 When did the damage or injury occur? (Give exact date and hour) May-1985- to January 05,1991 2,w Where dirt-the damage�or-in-ur-y-occur?- (Include-city and-county) CONTRA COSTA COUNTY HOSPIJAL 2500 ALHAMBRA AVE .AL3.-------------UM QQaT$-QQU=--- - --- ---.. 3. How did the damage or injury occur? (Give full details; useextra paper if required) _. Please. see .the attatched pages. , -----------. --------------------'=r—.r----...—.r—..--'---------------------------------��—.rte. 4. What-particular,.ac.t or omission on the...part of county. or- district.officers; 'servants. or employees caused, the injury or,-damage? RACIAL DISCRIMINATION (over) 5. wnac are cne names of county or district -officers, servants or employees causing , the damage or injury? . r: KAREN HESS, MARY OUTLAW AND KATHRYN GRAZZINI RN. S.--What-damage or- injuries d6.-Iyou claim resulted?' (Give full extent of injuries or •damages claimed. 'Attach two estimates for''auto"damage Lost:'in Mpay for: a job.-I•"performed 'for'five years and eight `months T. -How ;was,the amount�claimed-above computed? �(Inelude-the estimated amount`df any prospective injury or damage.) $16,456.00 At the'-. I `r:e'" ed" base pay=was $2413:00 'a month;`I 'increased this aii bbnt-'Iby 1O1: I then-: tobk- the-difference and 'miilt'iplyed it tunes the 68 months I worked outside of my job .classification. ., . --- ------------- ---------- -------- ------ - -- ....... ------------- 8. Names and addresses of witnesses, -doctors and'hospi'tals. 9 — - -expenditures-youmadeonaccount - s - l . List the of this .aecident- or injury: . DATE ITEM AMOUNT _. NONE Gov. Code" 66c. 91A '2 provides;. "The claim must be signed by the claimant SEND NOTICES T0. (Attorney) or by some person on his beh ' Name and Address of Attorney lai 's Signature 119 -DUBLIN DRIVE. . ._ _.- Address - VALLEJO, CALIF . 94589 Telephone No. Telephone No. (707)642-5817 , .. NOTICE Section -7Z.-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. ($11000); or by•both such--fmprisonment and.fine, or 'by imprisonment-,in the state prison, by a fine of not exceeding ten thousand dollars ($10,0001 or by both such imprisonment and fine. Page 1 #3 . How did the damage or injury occur? (Give full details; use extra paper if required) In April of 1985 there was a meeting of the EKG department . At this meeting we were informed of some changes to take place , as the department was to grow in scope of services provided . Lorri Kurtz - EEG Tech and David Woods - PHD, from the Veteran ' s Administration Hospital had a meeting with Karen Hess - Chief of the Cardiopulmonary Department at Merrithew Memorial Hospital in May of 1985 . They brought several examples of job descriptions with them to assist Karen in upgrading my job. This upgrade was to include added responsibility and a pay raise . At Karen' s request I also worked on a plan for revising my job description, which included a wage survey of other Bay Area Hospitals, so that I could start getting paid for the new jobs . I submitted a complete revised job description to Karen and she assured me that she was working with hospital administration to get things moving. At the same time Karen said that it may take some time to get things approved, and I told her that I had no problem with that as long as the motion of change was in progress . Starting May, 1985 I was then responsible for all EEG (Elector- encephalogram ) testing performed in the department. This responsibility included: Performance of all the tests , preparation of all the parerwork involved in the tests , customer billing, filing of the paperwork and taking the tests to the Veteran.' s Administration Hospital and entering all of the patient information in their computer . All of this was a job in itself - however I was also still responsible for all .EKG ' s (Electrocardiogram) , Halter testing, Stress testing and other normal duties of an EKG tech. After several months I contacted the Contra Costa County Employees Association, Local # 1 to find out if they had been notified about the changes in my job. They informed me that they were- not aware of any changes from Personnel , and if there were to be any ghanges made, the Union should have been notified as to where and when the changes were going to take place . Furthernore the Union was never notified that the present additions to my job were made and were given no chance to represent my interests . After further checking I discovered that Karen had not submitted the paperwork for changing the job description and pay raise . In meeting with Karen on this problem, she told me that she had contacted Chris Daily (Associate Executive Director , Patient Care) reguarding the changes and the plan was being resubmitted. Eighteen months later I was still not getting paid for the extra duties of EEG, yet I was still required to do the testing. At this time I informed Karen that I did not want to do the EEG testing anymore if I was not going to get paid . Karen told me that there was no one else to do the EEG procedures and I would continue to do them or be disciplined, in writing, for insubordination. As a pressure release , Karen told me Page 2 that I could start having weekends off ( I was required to work one weekend a month prior to this) . This was supposed to make me feel better for not getting paid. On October , 1987 I was informed, in a meeting with Karen Hess and Mary Dear, that I would no longer have weekends off but everything else reguarding my job situation would remain the same . At this time I filed a grievance with the Union because I was working out of my job classification and told that If I did not continue to do EEG testing that I would be given written disceplenary action, yet I was not being paid for the work out of my classification. It was my opinion that this action by the hospital staff amounted to modern day slavery. After this grievance was heard, I was given assistance with the EEG testing by another technician but was still not monetaraly compensated. In February of 1988 the hospital purchased an EP (Evoked Potential ) machine. Another technician and I were sent to Irvine Ca. for training and, upon returning, were required to perform four more test procedures . These procedures were also not a part of my job classification. The other tech that went to training with me decided that she did not feel comfortable doing the EP testing and Karen allowed her to not do the tests . About a month after I started doing the EP testing, I went to Karen with several issues: 1 ) I needed help with the tests because of the amount of testing required and the time necessary to do the testing and 2 ) I do not want to do this EP procedure if I am not going to get paid for diong them, such as was my situation with the EEG tests . Again, I was threatened with disceplinary action if I refused to do the EP testing. I then asked what about the other tech that was trained to do this job - Karen said that she did not want to do the testing, this left only me, aad I would do the tests - end of discussion. At this point the problems were beginning to take a toll on me. I was having problems with extreme stress from the job causing headaches and crying fits . I had to leave work several times because the stress of my work and the slave - like conditions that I was working under . On December 28 , 1990 I gave my notice of resignation from my full time job. As of this time nothing had been done about my pay and job classification. At the time of termination I was asked to work in a parttime position, • I settled on working a temporary position for a few days a month. When I quit my fulltime position in the EKG department, my duties had .to be split between the. remaining technicians . When my duties were split amongst the other technicians , they began to complain about the increased workload and not getting paid for all of the procedures that were out of the job classification. It was much to my suprise in May, 1991 when I came to work and saw a memo from a Cardiology staff meeting dated for March, 1991 . The memo stated that New classifications & wages of .Cardiology Tech I and II will be placed into effect on March 14, 1991 . Page 3 I am hereby stating that I feel that the entire Cardiology Department Management Staff had conspired to rid me of my job so that only the technicians of the white race would enjoy .the higher pay status . I further contend that Karen Hess , Mary Dear Outlaw, and Chris Dailey were co-conspirators in an act to racially discrimminate against me by denying me my rights to job classification change and pay rate change that were promised to me, by the three afore named persons , for six years . This was made quite obvious by the fact that I was never given any compensation and yet the White employees were given compensation and a change of classification within seven months. I believe that the actions of this department for six years, and the final outcome, violate several state and federal labor laws including the Civil Rights Act of 1964 - details which will have to be given at a later date if necessary. Now you may wonder why I put up with all of this racial bias for all of these years? The reasons being : 1 ) When I hired into Merrithew Memorial Hospital I came looking for a career that I could work in and grow with until I retire. 2) I liked the people that I worked with (despite the treatment that I rec- eived) and I really believed that they were going to do as promised with my job classification and wages . 3 ) I love my job and all of the knowlege of the various types of testing procedures that I have acquired over the years and 4) I very much like working with the patients and have enjoyed having a good patient to tech- nician relationship over the years . O v O U O Ul ,A �+ M NO O � M a Ar) ,A O � V o � IS N r a Cl co s ON kAA N � � v 'A o W p A 6' 31K s 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 CLQMANT August 6, 1991 and Board Action. All Section references are to ) The copy of. document mailed to you is your notice of ,G1.. California Government Codes. ) the action taken R*kur claim by the Board of Supervisors (Para grap h�IV Belo , given pursuant to Government Code Amount: $120.45 Section .91n and Please note all "Warnings". „�A\;N�9.. CAL 1. CLAIMANT: LLAMAS, Nancy ATTORNEY: Date received ADDRESS: 214 Deer Path Court BY DELIVERY TO CLERK ON July 5 , 1991 Martinez , CA 94553 BY MAIL POSTMARKED: July 3, 1991 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. IL gATCHELOR, Clerk �P� DATED: July 5 , 1991 ��: Deputy 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 Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: AUG - 6 1991 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 No ice to Claimant, addressed to the claimant as shown above. Dated: AUG ' 7 1991 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator 'A C7Zim 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 e crops and which accrue on or beforrDecember 341987, 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,actioh 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 Administr-ation,Building, 651 Pine Street . Martinez.', CA 94553. C. If claim is against .a districtt-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. t BE: Claim By Reserved for Clerk's filing stamp RECEIVED Y , Against the County of Contra Costa JUL 51991 or .- CLEBOARD'0F SUPERVIS RS ' District) CONTRA Cg§IA_CO. (Fill in name) The undersigned claimant hereby.makes claim.against the County of Contra Costa or the above-nained District-, in the sum of $ J20 .44 57 and in support of this claim represents as follows: ----------------------------------------------------------- --------------------------------------- 1. When did the damage or, injury' occur? ' '(Give exact date and hour) , --—----------------- ----- ------J----------------------- 2. Where did the damage or injury occur? (Include city and county) r-------- - -- 3. How did the Lge or injury occur? (Give full details;.-use extra paper if . required) ------------—--- -------—--- ---------------------- ----------------- 4. -What particular act-or omission on the part of-county or dist'rict officers, servants or employees caused the injury or damage? 4auj� a&ajn y #u- &6ad . 'Wa"q n� md r (over)'-,- wnat are the names of county or district officers, servants or employees causing the damage or injury? - ------------------------------- 6. What damage or injuriesdo you claim resulted?. (Give full. extent of injuries or damages claimed. Attach .two estimates for auto damage, 74�7- 7. How was the amount claimed above computed? .(Include the estimated amount of any prospective injury or damage.) . .......... Names and addresses of. witnesses, doctors and hospitals. ----------------- ------------------------------- -------------------------- 9. List the expenditures you made on account of this accident or injury: .' DATE 11tM AMOUNT �/2- ����: ala�,r�..��-- ���� `�� Gov.' Code 84c. 91910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO:, (Attorney) orb some person on his behalf." Name and Address of Attorney (Clagmaift's Signature) 6�A (Address) Telephone No. Telephone -No. :q/S f 2-q 0 E<4,5 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 anycounty, city' ordistrict board or officer, authorized to allow or pay the same it 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 imprisdnoi6nt and fine. ADDENDUM TO THE CLAIM OF. I (Prin .your full name) ( 1) Do you use the roadway as part of -a daily'--commute? Yes ( ) No (X) ( 2) Were you aware that construction would be commencing on the roadway? _ Yes ) No ( 3) Was an alternate route available? Yes ( ) No (X) ( 4) Did you read about the impending resurfacing lin the- local newspaper? Yes ( ) No (�) ('5) Did you see warning signs advising of loose gravel and a 25 mile per- hour advisory sign? Yes ( ) No ( ) ( 6) Did the damage. result from another vehicle exceeding the - 25 mile per' hour advisory? Yes ( ) No ( ) (7) Did a vehicle traveling in the same direction...and exceeding the 25 mile"per hour advisory sign attempt to pass you? Yes ( ) No (X) (8) Did a vehicle coming from the opposite direction cause gravel to be thrown onto your car? Yes ( ) No ) (9) Was the vehicle located directly in front of you exceeding the speed ..advisory? _ Yes ( ) No (x ) (10) Did I-you travelthe roadway more than once during the resurfacing prior to the damage sustained to your car? Yes No ( 11) Did you obtain the identity of the car relating to questions 6 thru .9? Yes No If yes, please provide identification below: (12) Please describe in your own words how the gravel caused damage to your vehicle and the angle the gravel was thrown onto the car, along with the specific damaged parts on your vehicle. hu" 4 A� J4 J ji&n Li-d—w — M \-J C/ (13) Were you aware that using the road during the chip seal process might result in damage to your. car? Yes No I declare that the above information is true and correct under the penalty of perjury. V ( ;ignature) 1 (Date) ----' -------------------------------------------------------------------------- •JUL-01-1991 11:54 FROM LOF CENTRAL NO. CAL.ON TO SAN RAMON s P.01 Ubbey-Owens-Ford Co. ESTIMATE LOF-SAN RAMON WORK ORDER ;`` = Glass Centers 15 BETA COURT INVOICE SAN RAMON CA 94583 BAR #AL 143553 SALESMAN DATE Q18 VDIC10 TO: MOBILE JOB W O R K O R D E R 07/ 1/91 ADDRESS CASH-BAY MAKE/MOD ADDRESS V.I.N.# 82 MA7.DA 2D HATCHBACK COUPE C CITY,ST LICENSES IMILEAGE CLAIMANT SPECIAL INST DATE TIME WORK PHONE HOME PHI 07/02/91 8•-11 cusToMER# 415-866-1100 MZT* 415-x1'29-0845 NANCY LLAMAS COMP.DATE CASH T1ME 2010 CROW CANYON PLACE INS/PO M ADP SAN RAmeN• GT QUANTITY ITEM NUMBER DESCRIPTION LIST PRICE SALE PRICE TX 1!0*1, FQ2255T FOREIGN QUARTER GLASS B1. 73 'TX .-I LFTCASH LABOR--FOREf GN TEMP ..RT. QUARTER GLASS I i I Paymt Reference Approval Date Amount Sub 114. 73 ------ ------------�-- -- ------_------ ------ ---------- Tax 5. 72 Balance Total 180. 45 - C/S CROW CANYON & CROW, CA N PLACE �- - - - - - - - - - - - - - - - - - RANCE COMPANY INFORMATION BELOW THIS LINE INSURANCE CO.-M- AGENT xxxxxxx NAMENPNUY - ADDRESS ADDRESS E14 DEER PIRTH COURT ADDRESS ADDRESS - - CITY.ST Cry,ST PHONE# PHONE# POLICY# CLAIM# FmU.5.a c a v3�- ,► �n 5, �W i i i A N N Cm M 6s V N U ONa c0 0 pU m� Eov m 15d ` CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD,.ACTIONC)qJ The Rua-a of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT August 1-04L and oc3rd A---Lion. All Section references are to ) The copy of this document mailed to you i�.-� v of 4 California Government Codes. ) the action taken on your claim by the Board 6f Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $200, 500.00+ Section 913 and 915.4. Please note all "Warnings". CLAIMANT: MC GREGOR, Christopher -ATTORNEY: Mary Nolen Law Offices of Pincus & Nolen 2551 received ADDRESS: 2551 San Ramon Valley Blvd. BY DELIVERY TO CLERK ON July 8, 1991 Suite 221 BY MAIL POSTMARKED: July 5 , 1991 San Ramon, CA 94583 _ Certified P 757 975 816 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PpHHIL BATCHELOR, Clerk a . DATED: July 8 , 1991 BY: Deputy .0� I1. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: BY: ` Deputy County Counsel I11. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) { ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present t><J 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. 0 0 Dated: AUG - 6 1991 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. p� ,Dated: p,u Cj - 199 1 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator PINCUS & NOLAN 19NJ §1N6L ATTORNEYS AT LAW 2551 SAN RAMON VALLEY BLVD. S.BRUCE PINCUS SUITE 221 TEL: (415)743-8441 MARY NOLAN SAN RAMON,CA 94583 FAX: (415)743-8941 July 3, 1991 RECEIVED Certified Mail/Return Receipt Requested JUL 81991 Clerk of the Board Administration Building CLERK D OF SUPERVISORS 651 Pine Street, 1st Floor CONTRA COSTA CO. Martinez, California 94553 Re: Our Client Christopher McGregor Adverse Party County of Contra Costa Date of Loss 2/19/91 Dear Clerk: The Law Office of Pincus & Nolan hereby presents this claim pursuant to Section 910 of the California Government Code. 1. The name and post office address of the claimant is: Christopher McGregor, 2439 Lavender Drive, Walnut Creek, CA 94596. 2 . The address to which Claimant desires notice of this claim to be sent is as follows: c/o The Law Offices of Pincus & Nolan, 2551 San Ramon Valley Boulevard, Ste. 221, San Ramon, California 94583 - Tel: 415/743-8441; 3. On or about 2/19/91, Claimant, Christopher McGregor, was injured while leaving a basketball game, in the City of Martinez, County of Contra Costa, State of California. Said injuries and damages took place on or adjacent to the school ' s property and were incurred due to the negligence of the County of Contra Costa and the Martinez School District which failed and refused to provide adequate, or any, security to visiting students, knowing that there were present Martinez High School students who had a propensity to be violent and who intended to inflict great bodily harm to Claimant herein. 4 . As a direct and proximate result of the actions of the County of Contra Costa and the Martinez School District and its agents/employees, Claimant, Christopher McGregor, suffered serious and permanent injury to his person due to a physical assault and battery by members, students and agents of the County of Contra Costa and the Martinez School District. + ` a Clerk of the Board July 3, 1991 Page two 5. As a further direct and proximate result of the actions of the County of Contra Costa and the Martinez School District and its agents and employees, Claimant suffered severe mental and emotional distress. 5. So far as is known at the time of filing this claim, Claimant has incurred the following damages: a. Medical Expenses Approximately $500.00 and continuing b. Wage Loss Unknown and continuing C. Future Loss of Earning Capacity Unknown and continuing d. Pain & Suffering and Emotional Distress $200,000.00 and continuing. TOTAL DAMAGES TO DATE AND CONTINUING: $200,500.00. 6. Jurisdiction of this matter will rest in Superior Court. DATED: July 3, 1991 PINCUS & NOLAN BY: MARY NOLAN- Attorney(fdr Christopher McGregor, Claimant l 31l . CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA *1rk,FIVF® 1-0(aim Against the County, or District governed by) JU'$OARD AQJID..t the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed t u gi Nlotc e of California Government Codes. ) the action taken on your claim by the Board of-Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $200, 500. 00+ Section 913 and 915.4. Please note all "Warnings". CLAIMANT: MC GREGOR, Travis Mary Nolen ATTORNEY: Law Offices of Pincus & Nolen 2551 San Ramon Valley Blvd. Date received ADDRESS: Suite 221 BY DELIVERY TO CLERK ON July 8, 1991 San Ramon, CA 94583 8Y MAIL POSTMARKED: July 5 , 1991 Certified P 757 975 816 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PPHNIL BATCHELOR, Clerk p DATED: July 8, 1991 BY: Deputy (14q 44L4 .� 11. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: BY: U0Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated. AUG - 6 1991to PHIL BATCHELOR, Clerk, By0Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under .penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the !United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: AUG - 7 1991 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator ORIGINAL PINCUS & NOLAN + ATTORNEYS AT LAW 2551 SAN RAMON VALLEY BLVD. S.BRUCE PINCUS SUITE 221 TEL: (415)743-8441 MARY NOLAN SAN RAMON,CA 94583 FAX: (415)743-8941 July 3, 1991 RECEIVED Certified Mail Return Receipt Requested JUL 81991 Clerk of the Board CLERK BOARD OF SUPERvi O Administration Building CONTRA COSTA CO. 651 Pine Street, 1st Floor Martinez, California 94553. Re: Our Client Travis McGregor Adverse Party County of Contra Costa Date of Loss 2/19/91 Dear Clerk: The Law Office of Pincus & Nolan hereby presents this claim pursuant to Section 910 of the California Government Code. 1. The name and post office address of the claimant is: Travis McGregor, 2439 Lavender Drive, Walnut Creek, CA 94596. 2 . The address to which Claimant desires notice of this claim to be sent is as follows: c/o The Law Offices of Pincus & Nolan, 2551 San Ramon Valley Boulevard, Ste. 221, San Ramon, California 94583 - Tel: 415/743-8441; 3. On or about 2/19/91, Claimant, Travis McGregor, was injured while leaving a basketball game, in the City of Martinez, County of Contra Costa, State of California. Said injuries and damages took place on or adjacent to the school ' s property and were incurred due to the negligence of the County of Contra Costa and the Martinez School District which failed and refused to provide adequate, or any, security to visiting students, knowing that there were present Martinez High School students who had a propensity to be violent and who intended to inflict great bodily harm to Claimant herein. 4 . As a direct and proximate result of the actions of the County of Contra Costa and the Martinez School District and its agents/employees, Claimant, Travis McGregor, suffered serious and permanent injury to his person due to a physical assault and battery by members, students and agents of the County of Contra Costa and the Martinez School District. Y Clerk of the Board July 3, 1991 Page two 5. As a further direct and proximate result of the actions of the County of Contra Costa and the Martinez School District and its agents and employees, Claimant suffered severe mental and emotional distress. 5. So far as is known at the time of filing this claim, Claimant has incurred the following damages: a. Medical Expenses Approximately $500.00 and continuing b. Wage Loss Unknown and continuing C. Future Loss of Earning Capacity Unknown and continuing d. Pain & Suffering and Emotional Distress $200,000.00 and continuing. TOTAL DAMAGES TO DATE AND CONTINUING: $200,500.00. 6. Jurisdiction of this matter will rest in Superior Court. DATED: July 3, 1991 PINCUS & NOLAN BY: MARY NOLAN, / Attorney f � Travis McGregor, Claimant CLAIM • BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim' Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT August 6, 1991 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: $236 .00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: PACIFIC PRECAST CORP. ATTORNEY: JUL 16 Date received COUNTY COUNSEL ADDRESS: 3508 Depot Road BY DELIVERY TO CLERK ON July 10, 1qI_q�tJTINEZ, CALIF. Hayward, CA 94545 BY MAIL POSTMARKED: July 9 , 1991 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. gH , DATED: July 11 , 1991 dILATCELORClerk : Deputy0I 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: 115 191 BY: Deputy County Counsel 0 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. CL Dated: AUG - 6 1991 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to .the claimant as shown above. Dated:AUG - 7 1991 BY: PHIL BATCHELOR by j I 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 Cl-alms 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 1060 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. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 4 * * * * * * RE: Claim By Reserved for Clerk's filing stamp r all RECEIVED Against the County of Contra Costa 0 19�jl or District) r�CLECK-8_0A R_D0 F SUPEF1 (Fill in name) CONTRA OF C The undersigned claimant hereby makes claim against the County of ra Costa or the above-named District in the sum of $ and in support of this claim represents as follows: -------------------------------------------------------------------------------------- 1. When did the damage or injury occur? (Give exact date and hour) ------ ----- ---- ---- ---- -------- ------------------------------------ 2. Where did the damage or injury occur? (Include city and county) S0J-1Jt4oa,V_-) 00 -I'hf,.OA- -V'V.5-r 5CW-tH cF 612. fSorj 1DU1)J5Nrr 147 LX_/ 66-W_W1A- C,15'r+ aWAJI'! -—--------------------------------------------------- ------- 3. How did the damage or injury occur? (Give full details; use extra paper if required)Cain //i P/zootgs or- kfSvz. t ,%. Rdery:.1(,,JA-S fft-_'Arot" sw7t-f&0,10 C#J -7?1LfL.,o2 Avo 4potx 6AA-u4:Z_ Re3Ut,417A4_ZA WOU W A.)a_;11'JLQ,0 —------------------—-------—-- - ------------------------------- 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or, damage? S&Uca HAUC / .t'� OA& 6,jloaf A-r I -7-,,'ner 77hts7 Ffl,^ (over) �. Wnat are the names of county or district officers, servants or employees causing the damage or injury? ------------------------------------------ --___ 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. ,� �vsT , CIL4 tA)AJ05t�tc20. A-_Pr►c4fvD A k-5 IrWO: 9STrI F��L'�AVZ, AL-50 _t- SA�u W j,vrvsr�reza JL�muyc� d,J 6-�?-Ai t f�i ?}fzs nJ va tC4_r RM_-J7h,1 4 JdA,1C. 15 �•`�r�no -------------------------------------------------------------------------------------- 7. -.._-----------------_-----------_- _ 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) I� ''Z,va t'42t f 8. Names-and-addresses-of witnesses, doctors and hospitals. - 9. List�the- - - - - expendituresyoumade onaccountof ,this-accident or injury: DATE ITEM AMOUNT Gov. Code'Sec. 910:2. Provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf." Name and Address of Attorney Claimant's Signature 36"08 D• Aq )W I� Address Telephone No. Telephone No.. �qlS), 782-86?7 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' fihe, •or-by imprisonment in the state prison, by a fine of not exceeding' ten`tho'usand dollars ($10,000, or by both such imprisonment and fine. ADDENDUM TO THE CLAIM OF ;, (Print your full name) ( 1) Do you use the roadway as part of .a daily commute? Yes ( No ( ) ( 2) Were you aware that construction would be commencing on the roadway? Yes ( V1' No ( ) ( 3 ) Was an alternate route available? Yes ( ) No ( 4) Did you read about the impending resurfacing in the local newspaper? Yes ( ) No ( ✓� ( 5) Did you see warning signs advising of loose gravel and a 25 mile per hour advisory sign? Yes ( ✓T ' No ( ) ( 6) Did the damage result from another vehicle exceeding the 25 mile per hour' advisoiy? Yes ( ✓) No ( ) (7) Did a vehicle traveling in the same direction and exceeding the 25 mile per 'hour advisory sign attempt to pass you? Yes ( f No ( ) ( 8) Did a vehicle coming from the opposite direction cause gravel to be thrown onto your car? Yes ( ) No ( ✓� ( 9) Was the vehicle located directly in front of you exceeding the speed advisory? Yes ( ) No ( ,/� (10) Did you travel the roadway ffioro than once during the resurfacing prior to the damage sustained to your car? ,JUST I TuneYes No ( ,,,f 7o D^-mA,667- ( 11) Did you obtain the identity of the car relating to questions 6 thru 9? Yes No If yes, please provide identification below: , ( 12) Please describe in your own words how the gravel caused damage to your vehicle and the angle the gravel was thrown onto the dar—alongwith the—specific damaged partsonyour vehicle. Lzokf 6/ov}•..L-,z- F11DIV) Aig —A—�v7 &zw &-rAzzo tAlors 'E-I-rhtoz- '&r C 1/0 1-5-UAx7' cr cyz- cpfyL no i7m;-- 6eFT a-- mIAle. 12� ff/-r Fyzoj—( oF 5AY�7C LIt-yStftcao (Sex fess. ( 13) Were you aWAkd that using the road during the chip seal process might result in damage to your car? Yea' No I declare that the above information is true and correct under the penalty of perjury. (Signature) (Date) DISCOUNT GLASS 60. 0 U 0 T E 691 W. TENNYSON RD. HAYWARD, CA 94544 DATE: 07-09-91 S87 B200 GOOD FOR 30 DAYS ACCOUNT INFORMATION CUSTOMER ORDERING 0 DISCOUNT GLASS 677 W. TENNYSON RD. BAR#AL 1 1.4 01 887 8200 CITY FART CLF: DESCRIPTION LIST PRICE 1 F598 T WINDSHIELD 461 . 25 156. 85 8. 5 LABOR 64. 75 64.75 1 URETHANE KIT 2. 50 2. 50 INSURANCE INFORMATION AUTOMOBILE INFORMATION SUBTOTAL 224. oe COMPANY . YEAR : 89•-91 TAX 11 . 15 POLICY # MAKE : TOYOTA CLAIM # MODEL : XTRACAB, SRS, PIC TOTAL 235. 3 AGENT STYLE : 2D PICKUP LOSS DTE VEH ID o CAUSE . LIC # LOCATION STATE AUTH BY PROOF L# INSURED ADDRESS CITY, ST HOME WORK ESTIMATE ONLY # # # * *# ### * # # * # #### ADDITONIAL PARTS MAYBE REQUIRED SAFELITE"Glass Corp. ' SG PEEL.I TE r11 I`Ols9_:F^9C�! (® CIP'--..11 It...1+ 278--2.—)53 a S A Cif}f.!TE Cih fi — DO NOT PAY CRISH ►PI_€.:S — LCC 47,L) ':ILF1 A Vi .. RF:-979 } !r'+i Ea}+I Et)_'J t) L I C t, HAY,41--•`RD9 M.. 945.1 i. '000") 41.,:"5 '27, —P353, 1-.=1C::� FC F t,_ ..;t`• "6' CCf.i=. ORIGINAL AUTHORIZEDREVISED REASON ADDITIONAL ESTIMATE BY ESTIMATE COST S $ $ PHONE DATE TIME AUTHORIZED ❑IN PERSON DATE TIME BY P"ONE @ SAFESEAL POSSIBLE ❑ YES ❑ NO DECLINED CUSTOMER SIGN. PART# REPAIRED Year Make Model Mileage Serial# License 4 Reference 4 PICKUP Quantity Part No. Description F '�f`; �B--O c,;NFlE1F �J Irla rif]D5{,I}EL.?� 4E►C�. : :1.'s G'. �.Cr f.-i? 3C'! LAE40R ttf i 45. 00 Ekl.io"rfz FSG NC:T OW SUB TOT1-:: :.. QUOTA' _. VO .;SIC';i PnY f:IMTE — DO ids?'. PPY �r,'W_ES T ! 4 ?;•":ttFir�!C:h:t�il:=}�!T� .it3;� F;I?I`;�.;wSS c I „j jrd •f iS+lr_0 NOT Ci:.HI'.?)LLED .000 1"'i"[f—li:fi SUBTOTAL $ LABOR SUBTOTAL PARTS Replacement has been made to my satisfaction and I hereby authorize the above insurance company to pay direct in full to the above listed firm for said installation. If for any reason the insurance company does not pay for these repairs or replacements, the below signed agrees to pay for said repairs or replacement. DATE SIGNATURE 040 Please Reference Invoice r`NPYif�f 11'�L.i'� i�1'•/a ��:�!'�i.!. �.�+.��.��.� „Y(+. rf=C W.L_.. CHARGE ALL PARTS ARE NEW UNLESS OTHERWISE SPECIFIED CUSTOMER COPY RT-0035 P-1 m > z N W Q 0 CL O (7 C Q Q x o ' Oco W Q C ~ lilfl `\vim=J a G ' °s. f= •�:' Q vai F- 2 W v p 1: ni 0 a z E 4 W L IL I � ^ W 0 u< °^ Q 0 s rr ". o' o = y pp _ W Q O I" I . , 11-24/122 1210 I8) PACIFIC PRECAST CdRP.OAATION 35022148 8 DEPOT.ROAD':,.782-8677. I IA': lARQ,CAlIFrJRNIA;.94545: PA Y lii�ll'lll'li�l'I+�i�I�Il i III�II�, 'llll+'I .GI��,)�ii,,l '1INl+��1111�1 "f' —Uoliars DATE TO THE ORDER OF oTNaw"Coo we 9 wrwala DISCOUNT CHECK AMOUNT l WELLS FARGO BANK Hayward Office Hayward,CA 94541 IN Q N — N E GOT I A B E 6Y . i lam, j +8022L4811' 1: 21,0002481:0 & 22 05429911' MN OICa TOTAL OaDUCTIONI DATA no. D E S C R I P T I O N AMOUNT PARTICULARS AMOUNT NET AMOUNT 1 PACIFIC PRECAST CORPORATION—HArrr ARD, CALIFORNIA DETACH AND RETAIN THIS STATEMENT 01 ICL the j 4744 r;� a `r► + uj uj `cc .. f r ct l� 1 o � d N' Z W 4a ¢Q U a LL oa UC 0 a L"_ r CLAIM • BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT August 6, 1991 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: Undetermined Section 913 and 915.4. Please note all "Warnings". CLAIMANT: pOPP, Sylvia DECEIVED ATTORNEY: JUL 15 1991 Date received COUNTY COUNSEI ADDRESS: 841 Hidden Lakes Drive BY DELIVERY TO CLERK ON July 9 , I94dTINEz, CALF Martinez , CA 94553 BY MAIL POSTMARKED: July $, 1991 Certified P 765 544 166 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. IL gATCHELOR, Clerk DATED: July 11 , 1991 �d; Deputy aA11A 0/d4zy 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: J Dated: BY: Deputy County Counsel_0 .. 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. P Dated: AUG - 6 1991 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. CI Dated: AUG BY: PHIL BATCHELOR by �Lo 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 accrueonor 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 bepresented 'not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office. in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled-'in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal. Code See. 72 at the end of this form. BE: Claim By Reserved for Clerk's filing stamp v',�, �. �a > RECEIVED Against the County of Contra Costa 9 1991 or District) CLERK BOARD OF SUPERVI CONTRA COSTA CO. (Fill in name)- The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows: --------------------------- ----------------------------------------------------- - l.. When did the damage or injury occur? (Give exact date and hour) �!�1JG� !L/ c�27 C// ea-------- I------------------------------- ,2. Where did the damage or injury occur? (Include city and county) 1 �d caaa&�� -4�0 CCXACCcvta OXZX�_ 3. How did.the dams e or injury occur? (Give full details-' use extra paper if required) OLV i vi _�C [or_ 'pa;� car- a4q U"o cy czCc� " W -------- ------------- —---------------------------------------- -- 4. What-particular act-or omission on the part of.-county or district officers, servants or employees caused the injury. or damage? W otc U)I WI (over) D. wnat are. the names of county or district officers, servants or employees causing the damage or injury? 5. What damage or injuries co you claim resulted?y (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. ------------------ --------- 7. How was he amount claimed above computed? -(Include -the estimated amount of any prospective injury or damage.) -------------------------- B. 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 8ee. -910 2 provides: - "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) orb some person on his behalf," Name and Address of Attorney Claimant Signature 8r ! t U F_ �- (Address) Telephone No. Telephone No. G r G gd 7 NOTICE Section 72 of. the Penal- Code provides: _ h 4 f-ey;sfereJ_ Owner U+ "Every person who, with intent to defraud, presents for allowance or for v ehit,I --- 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. ADDENDUM TO THE CLAIM OF. . . in you full name) ( 1) Do you use the roadway as part .of a daily commute? Yes ( ) No ( ) ( 2) Were you aware that construction would be commencing on the roadway? Yes ( No ( 3) Was an alternate route available? Yes ( ) No ( ) ( 4 ) Did :you read: about the impending resurfacing in the local newspaper? Yes ( ) No X ( 5) Did you see warning signs advising of loose gravel and a - 25 mile per hour-advisory sign? Yes ( ) No ( ) ( 6) Did the damage result from another vehicle exceeding the -2,5 mile per hour. advisory? - Yes ( ) No (X) (7) Did a vehicle traveling in the same direction and exceeding the`25' ftile per hour advisory sign attempt to pass you? Yes ( ) No ( ) ( 8) Did a vehicle coming from the opposite direction cause gravel to be thrown onto your car? Yes ( ) " No (X) ( 9) Was the vehicle located directly in front of you exceeding the speed advisory? _.. .. - , . . Yes ( ) : No ( ) . ( 10) . Did you travel the roadway more than once during the resurfacing prior to the damage sustained to your car? Yes ( ) No ( 11) Did you obtain the identity of the car relating to questions 6 thru 9? Yes ( ) No If yes, please provide identification below: ( 12) Please describe in your own words how the gravel caused damage to your vehicle and the angle the gravel was thrown onto the car, along with the specific damaged parts on your vehicle. t - oalc ( 13) Were you aware that using the road during the chip seal process might result in 'damage to your car? Yes ( ) No ( ) I declare that the above information is true and correct under the penalty of perjury. (Sign t re) , lo (Date) e arced Auto C INVOICE aJ IZ N2 421 N. Buchanan Cir. #11 Q► s Pacheco, CA 94553 (415) 685-2023 Mobile Service to Home or Business DAT _ (415] 820-8084 E. (0?-CDC, BILL TO SOLD TO \- n NAME:. NAME: v�C ' �' ' ADDRESS: ADDRESS: Ce A-0 A)L-7, TELEPHONE: _TELEPHONE:_ HOME WORK P.O.# DUAN. PART NO.OR SIZE DESCRIPTION LIST PRICE PC NET PRICE LABOR EACH 3.5J TOTAL MATERIALS AND LABOR YEAR A MAKE: BODY STYLE: Lnu Ey- LICENSE NQ.: z - h� — VEHICLE I.D.OR ENGINE NO.: RECEIVED IN GOOD ORDER INVOICE TOTAL LESS DEDUCTIBLE PAID BY INSURED BY. DATE BALANCE DUE �o COMPANY: POLICY NO.: CLAIM NO.: COVERAGE VERIFIED BY: DATE AND LOCATION OF LOSS: CAUSE OF LOSS: �7 SAFELITE"Glass Corp. SAF EL I TE AUTOGLASS. 1aLa1a tl C;b 9__J C3—rF::- BAR#--AG 133972 2C>49 CONTRA COST BVLD 07-05-91 PLEASANT HILL, CA. 94523 415 687-7210 THIS IS A QUOTE ONLY — DO NOT PAY CASH SALES — LOC 493 CLAIM # 2049 CONTRA COSTA BLVD POLICY # PLEASANT HILL, CA. 94523 0000 415 687-7200 SYLVIA POPP ORIGINAL AUTHORIZED REVISED REASON ADDITIONAL 8!}1 HIDDEN LAKES DR ESTIMATE BY ESTIMATE COST $ s s MARTINEZ CA 94553 PHONE DATE TIME AUTHORIZED ElIN PHONE ON DATE TIME BY M 415 682 6907 SAFESEAL POSSIBLE ❑ YES ❑ NO DECLINED CUSTOMER SIGN. PART# REPAIRED Year Make Model Mileage Serial 4 License 4 Reference 4 1981 MAZDA RX7 G 2D HATCHBACK COUPE Ouantity Part No. Description Extension Total 1 FCW380—S SHADED WINDSHIELD 360. 35 160. 36 160. 36 LABOR 49. 00�0 49, 00 ### QUOTE — DO NOT PAY # SUB TOTAL: 209. 36 # # QUOTE — DO NOT PAY # # # QUOTE — DO NOT PAY # SALES TAX : 11. 22 # # QUOTE — DO NOT PAY ### TOTAL: 220. 58 ARRANGEMENT: JOB ADDRESS: JOB DATE: JOB CITY: JOB TIME: NOT SCHEDULED JOB PHONE: SUBTOTAL s LABOR SUBTOTAL PARTS Replacement has been made to my satisfaction and I hereby authorize the above insurance company to pay direct in full to the above listed firm for said installation: If for any reason the insurance company does not pay for these repairs or replacements, the below signed agrees to pay for said repairs or replacement. I ACKNOWLEDGE NOTICE AND ORAL APPROVAL OF AN INCREASE IN THE ORIGINAL ESTIMATED PRICE. DATE SIGNATURE 10 597 ® 00493 CASH SALES —• LOC 493 2049 CONTRA COSTA BL.VD Please Reference invoice PLEASANT HILL, CA. 94523 0000 d)4-_D C3 T F---- 415 415 687-72-'0 >' 599898--000502-599898 CASH CUSTOMER COPY ALL PARTS ARE NEW UNLESS OTHERWISE SPECIFIED INSURANCE OR CHARGE MAILING COPY RT-0035 CJ ! ��4j ilt 10 cs� lY � <"J a !on Ln sma 0 r N �O a. F�� po Q uj : L CZZO i i IM 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 Au gu s t 6 , . 1 9 9 1 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: Undetermined Section 913 and 915.4. Please note all "Warnings". CLAIMANT: SCHLUTER, James D. ft.� VED ATTORNEY: Michael F. Wholstadter, Esq. JUL 1 Date received r.) 1991 ADDRESS: 488 7th Street BY DELIVERY TO CLERK ON July 10, kMi COUNSEL IVIARTINOakland, CA 94607 '-CALIF. BY MAIL POSTMARKED: July 9 , 1991 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BATCHELOR, Clerk o DATED: July 11 , 1991 BY: Deputy (JAV'm 0,9 4 0 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: 11c:, 191 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 fsQ This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: AUG - 6 1991 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: HUG - 7 1991 BY: PHIL BATCHELOR by 0 Deputy Clerk CC: County Counsel County Administrator MICHAEL F. WOHLSTADTER % k--.j:_1. Attorney At Law A ..... I 488 Seventh Street OAKLAND, CALIFORNIA 94607 DATE (415) 839-1612 July 9, 1991 TO SUBJECT Clerk of the Board of Supervisors .. ................................................................................................................................. ........................... .............................................................................................. ....................................... ........................................................................................................................................................................................ Contra Costa County 651 Pine St. , Room 106 Claim of James D. .. Schluter ........................................................................................................ ....................................................................................................................................................... ........................................................... ................................................. ....................... ...................................................................................... Martinez , CA 94553 .................................................................................................................................................................................... .............................................................. ......... .........................................................D e.a..rClerk: . . .................................................... . .. ......................... ........................................ .. ..........................................................................................................................K-indly- file the enclosed claim and return an/Irsed copy to this office in the envelope provided. Thank you. .. .................................................................................................................. ............................................... .... ................ .................................................................................................................... .... ...................... .... ......................................................."............................................................................................................... Very truly yours, ....................................................................................................................................................................................................... ................. ...................................................................................................................I.. ............................................... .... ... ................................................................................................................................................ 156(m4"l A&Z-f ............................................................................................................................................... ........................................................................................... ........................................ Mi chael -Fi; Wohlstad.-IL---e.r ............................... ..................................................................................................................................................... ...... .............................................................................. .................................................................................................................................. .......................................................................................................................................... .................................................................................I........................................................................................................... ............I...................................................................................................................................................... ............................. ...................................................... .................I...................................................................................................................................................................... ................................................................................. ............................................................................r ................. JUL 1 01991 .......................................................... ............................................................................................... . .......... ............................................................................................................................ CLERK BOARD OF SU, -CONTRA COSTA C.61 ------- .......... fb!�ED —7— - El PLEASE REPLY NO REPLY NECESSARY ............. PRODUCT 14M/A��sVlnc.,Groton,Mass 01471.To Order PHONE TOLL FREE 1-800-225-00 CLAIM AGAINST THE COUNTY OF CONTRA COSTA Llerk of the Board of Supervisors RECEIVED 'Contra .Costa. County m 651 Pine $t, Room 106 ► p 1991 Martinez , CA 94553 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. 1. Claimant's Name (print) : Tames D_ Snhi cater 2. Claimant's Address: 4562 Appian Way, El Sobrante, CA 94803 (address) (city, state and zip code) Unknown at this Phone No. (415) 223-5395 3. Amount of Claim: $ time; Superior CourtTu.ri .sd i ction 4. Address to which notices are to be sent, if different from lines 1 and 2: Name (print) : Michael F. Wohlstadter, Esq.(41 5) 039-1612 Address or P.O. Box Number: 488 - 7th Street City, State & Zip Code: Oakland, CA 94607 5. Date of Accident/Loss: January 26, 19 91 6. Location of Accident/Loss: (in front of) 4562 Appian Way, E1 Sobrante, CA 7. How Did Accident/Loss Occur: Claimant alleges the County created and maintained an unsafe condition and negligently failed to warn thereof when the roadway was paved in front of his home leaving an abrupt edge between the surface of the asphalt and existing parking strip; claimant stepped onto the edge of the asphalt which partially gave way, causing claimant' s ankle to turn under. S. Describe Injury/Damage/Loss: Fracture of right ankle 9. Name of Public Employee(s) Causing Injury/Damage/Loss, If Known: 10. Itemization of Claim (list items totaling amount set forth above) : Medical records and billings of $ Doctor' s Hospital (.Pinole) and James McCole, M.D. are currently $ pending. - - TOTAL $ pending 11. Signed by or on behalf of Claimant: 12. Dated: July 9, 1991 2 �bo N yo d r 4 o es t 0 to Ut t, 4. tt CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the. County, or District governed by) - BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT August 6, 1991 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 pul dant to Government Code Amount: $816 .00 Section 913 and 915.4. ROOM note all "Warnings". CLAIMANT: WILEY, Aaron Lamar 3u�_ 1 1991 ATTORNEY: COUNT`I �cALIF MARTINEZ, Date received July 12 , 1991 ADDRESS:118 South 6th Street BY DELIVERY TO CLERK ON Richmond, CA 94804 BY MAIL POSTMARKED: July 1 . 1991 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: July 15 , 1991 PpHHIL BATCHELOR, Clerk BY: Deputy01,4,41JVLO 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: x/15 9, 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 L>.� This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: AUG — 6 1991 PHIL BATCHELOR, Clerk, By : Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I .declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: AUG 7 1991 BY: PHIL BATCHELOR by � Deputy Clerk CC: County Counsel County Administrator L A 74�4' T 0. BOARD OF SUPERVISORS OF CONTRA C0= Instructions ns to Claimant Clerk of the Board " P. O. Box 911 MLartinez. CalifornJ2 94533 A. Clair�s relating .to causes of action for death. or Mor in.Dury 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 tha* accrual of the cause of action. (Sec* 911. 2 , Govt., Code) B. -Claims,"must"be- filed`with `the Clerk of the Board of Supervisors at its office in Room 106 , County -Administration Building, 651 Pine Street,, Martinez , California 945531 C. If claim is against a rdistrict 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 , P en a.1 Code Sec. 72 at end o z thi s form. RE: Claim ty ) Reserved for Clerk' s filing stamp; RECEIVED . vift P.0. oK n Aaaist -.1-le "2COUNTY OF CON'T'RA COST,-%/ JUL0 '21991 . Ir—.I 7"..1 111_7 I I P F P V or DISTRICT) CLE :A R D =FEP "0 0 SU (Fill in name) �7CONT:RRA:COSTA - The undersigned claimant hereby makes claim against 4e aunty 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) -------------------------------------------------- -Phe&r"M L the amage or injury occur? (Include city and county) .. detail use extra sheets kf requited)7l 3 a 7 m How id the damage or injury occL5-�? �(G�'V Ie f if t de Lai Vt- A ?E,�SoNlk , - � _rb . 1 - � ; ° r r �`_y 9 . What-particular-act or 6r-hision--on-the-part--o-f__c_o_u_n_tyordistrict` -offic&rs , servants or employees caused the injury or damage? - - NA ft��___\TD OF _,;Cv�tc-6 (Aver) `.:5..:.:•f zat: officers , servan are...the...names of county or district ts or 1 employees::causing the damage or injury? :.. _----------..._ .------------------------------------`------------_ 6 . What' damage or injuries do you claim 'resulted? (Give full extent of. injuries ordamagesclaimed. Attach two estimates for auto damage �� ►�_ t7 �o_w'�sTl ► _ ._�t� ,ioAupt _ ;;aim_ ' ;� r,,� ' Wk -- _ _ --- _ ."__ _ ____ -_ - _ was the; amount claimed-abc5ve computed? (Inblude tile es-ir'iate 7- amount of any prospective injury or da..-nage. ) U4&tR-' , �a G 150. `plAcfA,(ON�} S'C1.1�J•r •(00,caaAli r ►�bt.1�? 8._ Dames and-addresses-of-witnesses -doctors-- a-hosTals.- -----=_=--- 9 . List-the-expezid%tures-you-made-on-account-of t lis acc�de t-or-anjury- : DATE 1 TE.M AMOUNT r ' ***t.*******************"7t'**********'**ye'**'7t7r**it*'*yefeyt'}'•k***•k*'7t�c'*************'**'t Govt. Code Sec. 910 . 2 Provides : "The claim signed by the claimar SEND NOTICES TO: (Attorne.vY or by some person on his behalf. Name and Address of 'Attorney C aimant s S- nature Address 4 ' Telephone No. - , t Telephone No. t = � *�l•*****•:t'********** t***�r*****yr***�ti:************************ick^** t*******x*tlri. NOTICE Section 72 of the Penal Code provides: "Every person who, with intert to defraud, presents for allowance or "t -or 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, accounts, vouchez or writing, is guilty of a felony. " fry; r v0 "r Uj N O a.a Qi f.. e7' uj D CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT August F,--I 9 9 1 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $1 , 225 . 00 Section 913 aad 915.4. Please note all "Warnings". CLAIMANT: WOODARD, Ernest q%EIVE® ATTOP.NCY: J U L 5 1991 :oUNTY C0MA received ADDRESS: 4321 McGlothen Way MARTINEZ, eUIBELIVERY TO CLERK ON July 3, 1991 Richmond, CA 94806 BY MAIL POSTMARKED: July 2 , 1991 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PpHHIL BATCHELOR, Clerk DATED: July 5 , 1991 8Y: Deputy L lo-.4 11. 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: / f�� BY: IA_Q Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (� This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated:AU G - 6 1991 PHIL BATCHELOR, Clerk, By , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you .should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now', and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: AUG - 7 199 1 BY: PHIL BATCHELOR by o Deputy Clerk CC: County Counsel County Administrator TO. BOARD OF SUPERVISORS OF CONTRA COST ry RArHR�irnAl apDllcatlon to: Instructions to Claimant Clerklof the Board P. 0, Box 911 Martinez,Calil=12 945.33 A. Cla ino�s relating to causes of action for �death or =or InDury to pers6n 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 aft-er the accrual of the cause or action. (Sec. 911. 2 , Govt.- Code} % B. Claims must be- filed with -the Clerk of the Board of Suvervisors at its office in Room 106 , Ccunt.y .Administration Building, 651 Pine Street, Martinez ,, Calif"ornia 945331 Nor 6- A C>/__�>/0 EE;S C. If claim is against a district -coverned, by the Board of Sunervisors , rather than the* County, the -name of the District should be led in. D If the claim is against more than one public entity, seoarate claims must be filed against each .public entity. E. Fraud. See penalty for fraudulent claims, Pen4l Code Sec. 72 at end of this form. REE: Claim by ) Reserved for Clerk' s filina Stam-..)E -RECEIVED Against the '7COUNTY OF CONTRA COSTA)_ 3 or DISTRICT) -CLERR WARD OF SUPER J. (Fiil in name) CONTRA COSTA C -- J 4-y The undersigned claimant hereby makes claim acain the 2n!. ; zContra Costa or the above-named District in the sum of 71 and in support of this claim represents as follow s`: RP-,,4,f/Ser 4 -- ------------ ---------- r- -- ---- ----- ------- 1.- When ,did the damage or-injury-occur? (Give exact date and hour) ---- 512 11,7 Where HE Ehe_ZRFn��e---o-r--i�n-j-u-r-y--o-c-c-u-r-?---(-In--c-l-u-de---c-i-t-y--an-d---county___ 2. YT 4X -------------- ---------- --- ------------- 37- How did the-damage-or injuryoccur? (Give full details, use extra - sheets if requited) 44 AO(2DF- ----- ------ - -T -- ----------- --------------------- - 4 .- What particular-act or-omission-on ithe part-of county or district- - officers , servants or employees caused the injury or damage? (over) zat.. ar.e.,the,..names of county or district officers , servants or 1 employees::causing the damage or injury? ,c,� 6eW � ------------------- - ------------------------------------------- _ _ 6. What damage or i-nj-uries do you claim resulted? (Give full extent- _ of, injuries or damages claimed. Attach two estimates for auto Iamage) x645 a��' �"`- �t^°�P' - 4*4- 7 . -How was the amount claimed above-computed? --------- -------- 7 . estimated amount of any prospective injury or damage. ) ell 8.--Names and addresses o wi .4 ses , doctors and hosbitals. / -----_-_--_------------------------_---------------------------------------- f 9 . List the expenditures you made on account othis accident or injury: DATE !Ted AMOUNIT Govt. Code Sec. 910.2 provides : "The claim signed by the claimar. SEND NOTICES TO: (Attcrne.v) or by some oee son on his behalf. Name and Address of "Attorney Claimant' s Signature- dress Telephone No. - ; t Telephone No. or,' .,,.NOTICE Section, 72 of the Penal. Cade provides: "Every person who, with intert to defraud, presents for allowance or for payment to any state. board or officer, or to any county, toum, city district, ward or village board or officer, authorized to allow or pay the same if genuine , any false or fraudulent claim, bill, account , vouchex or writing; is guilty of a felony. " v �A6 J V 14- �. . Q s CC) ©y i W �" AMENDED RECEIVED CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA J U L ''J"2 1991 COUNTY COUNSEL Clairr. Against the County, or District governed by) BOARD rA81;T09Z. CALIF. the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT August 6 , 1991 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 915.4. Please note all "Warnings". r!'`'"'""'T GRIMAL , Roslynn for Marcos ATTORNEY: Date received ADDRESS: 333 40th Street BY DELIVERY TO CLERK ON July 19 ,- 1991 Richmond , CA 94805 BY MAIL POSTMARKED: July 18 , 1991 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: IL gATCHELOR, Clerk J u l y 2 2 . 19 91 ��: Deputy 0 III.. •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: 2Z/�1 I BY: + J- Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD 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: QU G - 6 1g � PHIL BATCHELOR, Clerk, ByAAA Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult .an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: AUG - 7 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator C2?;:m to: " _ " BOARD OF SUP0w=RS OF CONTRA COSTA COONTY DIMUCTIONS 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 B/yy\ Reserved for Clerk's filing stamp • �— } RECEIVED Against the County of Contra Costa ) JUL 4 9 or } 1991 CO.0(2- Tu vZMLA IP, trict). CLERK��osURS_co i —(Fill in name) } . The undersigned claimant hereby makes claim against t'r "ounty of Contra Costa or the above-named District in the sum of $ �-------------- Zea �1 'and in support of this-- -claim represents as follows: �'vr��.��-�-e�,,, t/y-,� ��T (f 'r""' 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) eT INE-7. C�¢ . 3. How did the damage or injury occur? (Give full details; use extra paper if required) a-Ac6A 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? tenses ah F chic! nod �,rlC Y2K was ml c�,� �6 Any n fs nvw ,p oa44-� y (over)/" (S(F67tnerltl c �a� 5. What are the names of county or district officers, servants or employees causing the damage or injury? - 6. What damage or injuries do you claim resulted? (Give full extent of injuriesor damages claimed. Attach two estimates for auto damage. j Yp- Frau rpt - , h� 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. �M----� F loo r- e n " cA Cf+' 'i-1� 4 o—+.e—, 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 Penson on his behalf." Name and Address of Attorney aimant's Signature Address Telephone No. Telephone No.023 5 -7Y2 0 J5 /—6 720 NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents'fcr 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. TO: CLERK OF THE BOARD OF SUPERVISORS COUNTY ADMINISTRATION BUILDING FROM: Roslynn A. Gr'imal ` (2arent of Grimal, Marcos) 333 40th Street Richmond, CA 94103 (415) 233-7828 wk. 557-6720 DATE: JULY 1, 1991 RE : Injury to : GRIMAL, MARCOS (Diablo Unit/Contra Costa County Juvenile Facility, Martinez) COMPLAINT : On May 12, 1991 at 6 : 00 pm, my son Marcos Grimal, who is detained at the Contra Costa Juvenile Facility in Martinez , was participating in sports when another youth ran into him and dislocated his pinky finger . Marcos' finger was dislocated, his reaction was to immediately relocated his finger himself, which he did. The counselors who were supervising at the time instructed him to see the nurse, a male nurse, who examined Marcos and gave him an ice pack . When I visited Marcos that following day he complained of pain I noticed bruising and swelling in his finger. I asked Marcos what was being done for the swelling and pain, he told me, "they give me ice packs and tylenol . " I visit Marcos almost every day at the Hall and each day that I visited him, he continued to use an ice pack and complain of pain. On Friday, May 17 Marcos was secretly removed from the Hall and taken to the County facility to be housed. Marcos was examined by the physician at County and was told that they needed to X-ray, inject and re-set his finger . When I visited Marcos that same day he informed me what the physician told him and I was quite concerned to find out that it took approximately 1 week to find out that there was a serious enough problem. I am quite concerned that nothing was even done form him other than an ice pack. The following Monday, May 20, 1991 Marcos was returned to the Contra Costa County Juvenile Facility. Marcos is a very active young man who participates in all sports . He has indicated to me that he no longer has any feelings in his pinky finger. On approximately June 14 1 requested the date of Marcos' s injury as I needed to fill out some papers . I requested the information from the Admission' s staff . The admission staff contacted the nurse on duty, Nurse Dana, who then informed them that there was no notation of any injury to Marcos' finger . At that point I became quite concerned. The staff asked me if I wanted to speak to the nurse I decline because of past verbal altercations I had DATE : JULY 1, 1991 page 2 of 3 RE : Injury to : GRIMAL, MARCOS (Diablo Unit/Contra Costa County Juvenile Facility, Martinez) with Nurse Dana in the past . The week of June 16 Marcos was taken off sports and work because of his injury he sustained almost a month ago. Finally on June 26, 1991, Marcos was examined by Dr . Ross . Nurse Anna informed me that Marcos had an excellent examination . After asking several times what was meant by an "excellent examination" I never did get an explanation but she said the Doctor requested an X-ray of his finder . (Nurse Anna said something to the effect that he had a fractured finger) Nurse Anna also told me that Marcos refused to take the X-ray and the Doctor did not write a prescription for Marcos for that reason and that there was nothing more they could do. Nurse Anna said that the youths were responsible for their own health and they need to take that responsibility to follow-up on their own because there were too many youths for her to do that for him. (meaning that after Marks injury, if the ice packs and tylenol did nothing to heal his finger and stop the pain that he should have requested stronger pain pills or i .e . X-ray or something else . It seems to me that the nurse should have followed-up and requested that the doctor look at Marcos' s finger immediately or at least, as soon as possible . (1 or 2 days) . I asked Nurse Anna, on June 12, at 6 : 00 pm how many youths needed her assistance? (the date that Marcos received his injury) She could not answer . I asked Nurse Anna where the youths informed of this procedure, (that they were responsible for their own health) she said no . I then said if they were not informed, then how were they to know that they had that responsible especially when their parents took care of these things before . Nurse Anna' s response was that, "Well the county just does not have enough money to educated the youths in these rec,.ards . " On July 1, 1991, I requested that Nurse Anna speak with Dr. Ross again and request he write a prescription for an X-ray of Marcos' finger and that the X-ray be taken at Kaiser rather than County Hospital because I have medical coverage thru Kaiser and that I myself would follow-up and make sure Marcos got any medical services needed. Nurse Anna said she could not guarantee the Doctor would write the prescription but she would request it . CONCLUSION : 1. It is in my opinion that there was some negligence on the part of the Nursing staff at the Juvenile facility which led to the DATE : JULY 1, 1991 page 3 of 3 RE : Injury to : GRIMAL, MARCOS (Diablo Unit/Contra Costa County Juvenile Facility, Martinez) direct result of the following injury: a) There is no sensation in the pinky finger . b) The pinky finger is deformed. c) Unnecessary pain and suffering. - f • r 'j �:a A l 7h� O a cn jwA rA vA cd G� 75 N � s U s O c � CS .a � U. T� v N fi =r'� 0 '� CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA f Claim Against the County, or District governed by) . BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT August 6, 1991 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: Undetermined Section 913 and 915.4. •: Please note all "Warnings". CLAIMANT: D?4^::4O'"1 ' f! GRIMAL, Marcos by Roslynn Grimal ATTORNEY: JUL 15 1001 Date received -OUNTY COUNSEL ADDRESS: 330 40th Street BY DELIVERY TO CLERK ON July 9 , 199X;ZTINEZ, CALIF. Richmond, CA 94805 BY MAIL POSTMARKED: July 6 , 1991 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: July 11 , 1991 PpHHIL BgATCHELOR, Clerk (L 0JAAi a BY: D putt' 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 �5 I`1� BY:1 Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) .Claim was returned as untimely with notice to claimant (Section 911.3). 'IV. BOARD ORDER: By unanimous vote of the Supervisors present ( ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: 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: BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator NOTICE OF INSUFFICIENCY AND/OR . NON-ACCEPTANCE OF CLAIM TO: Roslynn Grimal 330 40th Street Richmond, California 94805 Re: Claim of Marcos Grimal 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: 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. x5 . 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 Co my Counsel CERTIFICATE OF SERVICE BY MAI C.C.P. 99 1012, 1013a, 2015 . 5 ; Evid. C . §§ 641 , .664 ) My business address is the County Counsel' s Office of Contra Costa County, Co. Admin. Bldg. , P.O. Box 69, Martinez, California, 94553, and I am a citizen of the United States, over 18 years of age, employed in Contra Costa County, and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non Acceptance of Claim by placing it in an envelope(s ) addressed as shown above (which is/are place(s ) having delivery service by U.S . Mail) , which envelope(s ) was then sealed and postage fully prepaid thereon, and thereafter was , on this day deposited in the U.S . Mail at Martinez/Concord, Contra Costa County, California. I certify under penalty of perjury that the foregoing is true and correct. Dated: 7-15-91 . , at Martinez, alifornia cc: Clerk of the Board of Supervisors (ofinal ) Risk Management 90 , (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910 . 2, 920 . 4, 910 . 8 ) ► 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 341987, 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 kc,51-Yk) ofcos R EC E IVE D ! Against the County of Contra Costa ) or JUL 9 1991 ) GCS �Uv.?r+nA� ' trict) CLERK BOARD OF SUPERVIS Fill in name ) CONTRA COSTA CO. The undersigned claimant hereby makes claim aizainst t'- 7ounty of Contra Costa or the above-named District in the sum of -and in support of this claim represents as follows: ----------------- 1. When did the damage or injury occur? (Give exact date and hour) 2. There did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full details; use extra paper if required) *x, .4 lr�9 ba-10 u. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Villues on c ccs rto� vlL �ex (over)AM C � 5 5. What are the names of county or district officers, servants or employees causing the `damage or injury? --------___-_-_ 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. ---- ---------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses, doctors and hospitals. Cl r ©res d V-1 -- e-A tf -i n 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 some pealsonon his behalf." Name and Address of Attorney aimant's Signature 3 0 / Address ):; Telephone No. Telephone No.c23 5 " 7Y2 0 7 6 720 t NOTICE i 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 ($10,004, or by both such imprisonment and fine. TO: CLERK OF THE BOARD OF SUPERVISORS COUNTY ADMINISTRATION BUILDING FROM: Roslynn A. Grimal (Parent of Grimal, Marcos) 333 40th Street Richmond, CA 94103 (415) 233-7828 wk . 557-6720 DATE : JULY 1, 1991 RE : Injury to : GRIMAL, MARCOS (Diablo Unit/Contra Costa County Juvenile Facility, Martinez) COMPLAINT : On May 12, 1991 at 6 : 00 pm, my son Marcos Grimal, who is detained at the Contra Costa Juvenile Facility in Martinez, was participating in sports when another youth ran into him and dislocated his pinky finger . Marcos' finger was dislocated, his reaction was to immediately relocated his finger himself, which he did. The counselors who were supervising at the time instructed him to see the nurse, a male nurse, who examined Marcos and gave him an ice pack . When I visited Marcos that following day he complained of pain I noticed bruising and swelling in his finger . I asked Marcos what was being done for the swelling and pain, he told me, "they give me ice packs and tylenol . " I visit Marcos almost every day at the Hall and each day that I visited him, he continued to use an ice pack and complain of pain. On Friday, May 17 Marcos was secretly removed from the Hall and taken to the County facility to be housed. Marcos was examined by the physician at County and was told that they needed to X-ray, inject and re-set his finger . When I visited Marcos that same day he informed me what the physician told him and I was quite concerned to find out that it took approximately 1 week to find out that there was a serious enough problem. I am quite concerned that nothing was even done form him other than an ice pack . The following Monday, May 20, 1991 Marcos was returned to the Contra Costa County Juvenile Facility. Marcos is a very active young man who participates in all sports . He has indicated to me that he no longer has any feelings in his pinky finger. On approximately June 14 I requested the date of Marcos' s injury as I needed to fill out some papers . I requested the information from the Admission' s staff . The admission staff contacted the nurse on duty, Nurse Dana, who then informed them that there was no notation of any injury to Marcos' finger . At that point I became quite concerned. The staff asked me if I wanted to speak to the nurse I decline because of past verbal altercations I had DATE : JULY 1, 1991 page 2 of 3 RE : Injury to : GRIMAL, MARCOS (Diablo Unit/Contra Costa County Juvenile Facility, Martinez) with Nurse Dana in the past . The week of June 16 Marcos was taken off sports and work because of his injury he sustained almost a month ago. Finally on June 26, 1991, Marcos was examined by Dr . Ross . Nurse Anna informed me that Marcos had an excellent examination . After asking several times what was meant by an "excellent examination" I never did get an explanation but she said the Doctor requested an X-ray of his finger . (Nurse Anna said something to the effect that he had a fractured finger) Nurse Anna also told me that Marcos refused to take the X-ray and the Doctor did not write a prescription for Marcos for that reason and that there was nothing more they could do. Nurse Anna said that the youths were responsible for their own health and they need to take that responsibility to follow-up on their own because there were too many youths for her to do that for him. (meaning that after Marks injury, if the ice packs and tylenol did nothing to heal his finger and stop the pain that he should have requested stronger pain pills or i .e . X-ray or something else . It seems to me that the nurse should have followed-up and requested that the doctor look at Marcos' s finger immediately or at least, as soon as possible . (1 or 2 days) . I asked Nurse Anna, on June 12, at 6 : 00 pm how many youths needed her assistance? (the date that Marcos received his injury) She could not answer . I asked Nurse Anna where the youths informed of this procedure, (that they were responsible for their own health) she said no . I then said if they were not informed, then how were they to know that they had that responsible especially when their parents took care of these things before . Nurse Anna' s response was that, "Well the county just does not have enough money to educated the youths in these regards . " On July 1, 1991, I requested that Nurse Anna speak with Dr . Ross again and request he write a prescription for an X-ray of Marcos' finger and that the X-ray be taken at Kaiser rather than County Hospital because I have medical coverage thru Kaiser and that I myself would follow-up and make sure Marcos got any medical services needed . Nurse Anna said she could not guarantee the Doctor would write the prescription but she would request it . CONCLUSION : 1 . It is in my opinion that there was some negligence on the part of the Nursing staff at the Juvenile facility which led to the •DATE : JULY 1, 1991 page 3 of 3 RE : Injury to : GRIMAL, MARCOS (Diablo Unit/Contra Costa County Juvenile Facility, Martinez) direct result of the following injury: a) There is no sensation in the pinky finger . b) The pinky finger is deformed. c) Unnecessary pain and suffering. o m CO 1