HomeMy WebLinkAboutMINUTES - 08021994 - 1.15 CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
AUGUST 2, 1994
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
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: $362. 59 Section 913 and 915.4. Pleasetera -1 "Warrrn gs"
F
CLAIMANT: SCOTT Judith C. 0
' JUL 1 1 199
ATTORNEY: COUNTY COUNSEL
Date received AAARTINEZCALt '
ADDRESS: 5601 Norris Cyn. Rd. #340 BY DELIVERY TO CLERK ON July 11 . 199+
San Ramon, CA 945.06
BY MAIL POSTMARKED: July 8. 1994
1. FROM: Clerk of the Board of Supervisors 'TO: County Counsel
Attached is a copy of the above-noted claim.
ppH IL BATCHELOR, Clerk \
DATED: 11 9 q 81: Deputy a
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 I
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: o 1�1 �! y 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
( ✓� 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: 2- /gPHII BATCHELOR, Clerk, By ����JOQ „ , Deputy Clerk
T� 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. *For additional warning see reverse side of this notice.
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
tC: County Counsel County Administrator
,.
,
may, -
C1a:M: 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.
� * � � 1F � 9F iI !k iF � � fit• iF 1F �F * � � * * � * i! � * �F �. � !F � 9F �F * � � # �F iE * � !F �
RE: Claim By ) Reserved for Clerk's filin p
REC�I�IED
)
Against the County of Contra Costa )
JUL I 1 1994
or )
CLERK BOARD OF SUPERVISORS
CONTRA COSTA CO.
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 $ 3 Cp 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)
J
GN-- -------- ..� tom_ �GLe�
3. How did the damage or injury occur? (Give full details; use extra paper if &X40-
required) CC -
4. What particular act or omission on the part of county or district offi ers,
servants or employees caused the injury or damage? �Ctic�
co�c�)
D. wnat are the nates of county or district officers, servants or employees causing
the damnage or injury?
--------------------------------------------------------------------
5. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
3. ?dames and Odresses of witnesses, doctors and hospitals..
-------------------------
9.
-------------------------9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
6 - 11-N &U ✓ 0.3/ 9
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
Ad ess
Telephone No. Telephone No. U ) Da��L�l
* * V V V V V W * * �t *
N O T I C E
Section 72 of the Penal Code provides: -- -
"Every person who, with intent to defraud, presents for allowance or for
payment to any state board or officer, or to any county, city or district board or
officer, authorized to allow or pay the same if genuine, any false or fraudulent
claim, bill, account, voucher, or writing, is punishable either by imprisonment in
the county jail for a period of not more than one year, by a fine of not exceeding
one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in
the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by
both such imprisonment and fine.
wn u#wq...xawvm.6bz4z cD
r� o
•2
� y Lnu
L Oji 9 W
i
m
Q s, � wm .
lir`' > ka A o tT
4 els v �"�-f}C!^ ``�a\`tti '�"`•& � b
. t v i
sg r
fill :
f
9
ci >agwauipie�. 3UeW4�!IQ�3 eotaeg S 4S
J
as N N c r
c `�N O
❑ ❑ ❑ ❑ ❑ a ❑ ❑ ❑ ❑ aa❑ o W d Q
m
= a ❑ m J cn w J b \ O n H
6 x O
d r
p N r 7
o O O c O w Y m C cr
>:
UJ o m ° caro oy m G �� �Y ro- roc m U r {� Q
O ii m ro°? c� Lm cN uL ¢r ¢tn ¢ot4. Oa U V U n (n
w
w
J� U
w
as 1 J tco } {� Z
V 2,
cr
d z mmmn.F° w
co
d r
10
m 'E °' w O
m w O a
z z a a
aSOZw �oc�y°=_� d j y FD w r
w w
eu < 'O
v>
t� / Z 9 a o m_ JJj w
$IN oma
0-
N
=9m o wC
L J G
2% d 4 o< N
W o
w CCN
g
r1 T-
Z(o er► w
Q i l Z
cc
Z w
s Z
r Ow w w
wCc
crn¢ I' Q • Z
Oz Q
d
r-- p
1 0• d wp �p N w> r CC
Oa U.
N �w rO iCW a¢
E v y W w Ow w w 1 a
[] Z d
fl
L/1 O }
i o Z
�zz d d
OW co 0
O2it-p1 � a r w 4
�WW r p _ Q w w ud W
r�WV2 o N v �� U v o
O =' Z
z °a V' o W 'ni w
W A .LCO la)
W 0- LL
W i z W z - Z Occ 0_ d a� oZS o
'izo Qo . d W 4 U O � ° '
_ > jca
d U r a V Z 4 d Q y O Q
H Z N U cr W v ~ m
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
AUGUST 2, 1994
Claim Against the County. or District governed by) BOARD ACTION
the Board of Supervisors. Routing Endorsements. ) NOTICE TO CLAIMANT
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: $200;000.00 Se �tion �91-3 andZ91�5.4�.y, Please note all "Warnings".
Grt
CLAIMANT: HOSS, Patricea Ann Stephens
ATTORNEY: Stuaart H. Blecher COUNTY COUNSEL
165 Noerth Redwood Dr. DatfMhldd5tVWCAL1F.
ADDRESS: Suite 110 BY DELIVERY TO CLERK ON July 12, 1994
San Rafael, CA 94903 Hand Delivered
BY MAIL POSTMARKED:
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
ppH IL ATCHELOR. Clerk
DATED: 13 B1: Deputy
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:
II
Dated: l l qq BY: N 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
(✓) 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.
Gated: r 11751PHIL 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. *For additional warning see reverse side of this notice.
AFFIDAVIT OF MAILING
1 declare under penalty of perjury that I am now, and at all times herein mentioned. have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez.
California. postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant as shown above.
Dated:. _ 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 .D 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 4911.2.)
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
orm.
RE: Claim By ) Reserved for Clerk's filing stamp
CEV
gainst the County of Contra Costa )
or ) JUL 1 21994
District) CLERK BOARD O SS�}PERVISORS
Fill in name ) CONTf,A COSTA CO.
The undersigned claimant hereby makes claim against the County of Contra Costaqr
the above-named District in the sum of $ o a n�poiof�� J
this claim represents as follows:
1. When did the damage or injury occur? (Give exact date and hour)
2. Where did the damage or injury occur? (Include city and county)
3. How did the damage or injury occur? ( ive full details; use extra paper if
required)
c;2
Wha par icul ac o "ss` on on he o coup Y'or~istrict offs c rs,
servants or employees caused the injury or damage?
pit- .A > _
,Ws
�i �2
5. What are the names of county or district officers, servants or employees causing
the damage or injury?
6.7 What damage or in uries do you claim res ted? Give full extent of injuries or
B � Y ( �
damages claimed. Attach two estimates for auto damage.
7. How was the amount claimed above computed? (Include the estimated amount o any
prospective injury or damage. ��� � ✓ /��" /�` '��"e"
i -;��1414
B. Names and addresses of witnesses, doctors and hospitals.
9. List the expenditures you made on account of this accident or injury:
DATE ITEM s AMOUNT '
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
ff Claimant's Si tura
Q Address
Telephone No. Telephone No.
NOTICE
Section 72 of the Penal Code provides:
"Every person who, with intent to defraud, presents for allowance or for
payment to any state board or officer, or to any county, city or district board or
officer, authorized to allow or pay the same if genuine, any false or fraudulent
claim, bill, account, voucher, or writing, is punishable either by imprisonment in
the county jail for a period of not more than one year, by a fine of not exceeding
one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in
the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by
both such imprisonment and fine.
r, ,b
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
AUGUST 2';_x1994
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
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
cti'on ;913and 915.4. Please note all "Warnings".
Amount: $10 000.00 + ® �- � w '
' Wim' ' til
CLAIMANT:HOLLERAN, Patrick Jilt. 13 1994
ATTNNEY:William H. Bachrach COUNTY COUNSEL
Attorney at Law 1A1T1Nfftq.44&ived
ADDRESS: 1 Kaiser Plaza, Ste. 1750 BY DELIVERY TO CLERK ON July 12. 1994
Oakland, CA 94612
BY MAIL POSTMARKED: July 11 , 1994
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above noted claim.
p ppN IL ATCHELOR Clerk
DATED: L 13 I99� 81�: puty
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: �w�, I R �1 q� 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
(✓ ) 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. l
Dated: lqqV PHIL BATCHELOR, Clerk, By i, -4-4. ���/ " 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. 'For additional warning see reverse side of this notice.
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.
Lalifornia, postage fully prepaid a certified copy of this Board Order and Notice to Claimant. addressed to
the claimant as shown above. r
Dated: 3 BY: PHIL BATCHELOR by i �� , .+� Deputy Clerk
CC: County Counsel County Administrator
NOTICE OF CLAIM
TO COUNTY OF CONTRA COSTA, CONTRA COSTA PROBATION DEPARTMENT,
CONTRA COSTA COUNTY SHERIFF'S DEPARTMENT
This claim is presented under Section 910 of the Government Code
CLAIMANT: Patrick Holleran `7 RECEIVE®
ADDRESS: c/o William H. Bachrach, his attorney
1 Kaiser Plaza, Suite 1750 JUL 12 1994
Oakland, CA 94612
CLERK BOARD OF SUPERVISORS
NOTICES TO CONTPA COSTA CO.
BE SENT TO: William H. Bachrach
Attorney at Law
1 Kaiser Plaza, Suite 1750
Oakland, CA 94612
DATE OF OCCURRENCE: Between March 3rd and March 7th, 1994.
CLAIM: Claimant was arrested on an outstanding warrant which warrant was
invalid in that claimant had previously completed all terms of sentence and
probation on two prior matters for which the warrant was still outstanding.
Claimant was incarcerated at Santa Rita jail for five days.
PUBLIC
OFFICIALS: Claimant is unaware of the name of the public employee or
employees causing the injury.
DAMAGES
SOUGHT: The amount of the claim is in excess of $10,000 and jurisdiction resides
in the Superior Court.
Dated:
WILLIAM H. BACHRACH
� aC, 0
to
W O %
O
irH
ir}
�{ \• 0
1-3
ct
r N 0� �.
N Q
.o n o
Ln
p�YJiYI!� X
p �l.
�i t
WILLIAM H. BACHRACH TELEPHONE
L A W O F F I C E 5 (510) 465-19OG
A PROFESSIONAL CORPORATION FACSIMILE
ONE KAISER PLAZA, SUITE 1750 (510) 465-1932
OAKLAND, CALIFORNIA 94612-4305
FILE NO.: 1742
July 11, 1994
Alameda County Claims Office
1221 Oak Street
Oakland, CA 94612
Clerk of The Board
CONTRA COSTA COUNTY
651 Pine, Room 106
Martinez, CA 94553
Re: Patrick Holleran
Dear Clerk of The Board:
I am enclosing a claim on behalf of our client Patrick Holleran, together with an extra
copy for you to date.stamp and return to me in the self-addressed, stamped envelope.
Cordially,
WILLIAM H. BACHRACH
WHB/cw
Enclosure
cc: Patrick Holleran
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
August 2, 1994
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
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: $253,482.20 + Section 913 and 915.4. Plus ntlnin� s".
CLAIMANT: DAVIS, Bridgette JUL 1 1 1994
ATTORNEY: Goforth & Lucas coUNTYCOUNSEL
One Concord Centre Date received MARTINEZ CALIF.
ADDRESS: 2300 Clayton Road, Ste. 1460 BY DELIVERY TO CLERK ON T„lv 11 1444
Concord, CA 94520
BY MAIL POSTMARKED: July 90 1 444
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JQyFI1L BATCHELOR, Clerk /7
DATED: I l 81: Deputy A �/a,,..
U
Il. 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 T0: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BDARD .ORDER: By unanimous vote of the Supervisors present
(+- This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date.
Dated: a � PHIL BATCHELOR, Clerk, By 4 Deputy Clerk, �,e�Q�.��, �,
_fib U � ,
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. *For additional warning see reverse side of this notice.
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 �__�J A �� Q QA Deputy Clerk
CC: County Counsel . County Administrator
�f
F �
O
0 o0
m O
o � 'o,
C) � ox °
TAoo ° m
z° o2r
N fi k
O
� n
b
Y'
N M
Nct
0 Ct 0
� w
7
sal
1 CLAIM AGAINST THE CITY OF CONC RD; RE `VE®
2
3 TO: CONTRA COSTA COUNTY JUL 1 11994
4 ATTN: CLERK OF THE BOARD OF SUPERVISORS CLERK BOARD OF SUPERVISOR
CONTRA COSTA CO.
5 Pursuant to Section 910 of the Government Code, caimis presented
to the County of Contra Costa, California, as follows:
6 (a) The name, mailing address and phone number of the
claimant:
7
8 Bridgette Davis, 3326 William Way, Pittsburg, CA 94565, (510)
427-7659
9 (b) The date, place, time, location and other circumstances
10 or transaction which gave rise to the claim asserted:
11 Date: 2-25-94 Time: 5: 45 p.m. Place:
North California Boulevard or 20 feet south of Cole Avenue, Walnut
12 Creek, California.
0
U N 13 Circumstances:
W a UM0Z Count One: Negligence: Claimant was travelling
u � oaa 14 northbound on North California Boulevard within the City of Walnut
o x ° 5 W 4 Creek in stop-and-go traffic when she was struck from behind by
g9 UONp 15 defendant. As a proximate result of the County's said negligence,
p WMo claimant sustained the below-outlined injuries.
Z N u 16
L) ° 17 (c) Nature of claimants injuries:
18 Traumatic cervical thoracic and lumbar strain/sprain, left hip
strain/sprain, suboccipital neuritis, left foot injury
19 (d) Location of Incident:
20 North California Boulevard or 20 feet south of Cole Avenue,
21 Walnut Creek, California.
22 (f) The name or names of the public employees or employees
causing the injury, damage, or loss, if known:
23 Terry Sue Huie
24 (g) A general description of the indebtedness, obligation,
25 injury, 'damage or loss incurred so far as it may be known at the
time of presentation of the claim:
26 Claimant sustained bodily injuries, property damage and
27 incurred loss of wages as a result of the incident which is
described in Section (b) .
28
I (h) The amount claimed as of the date of presentation of the
claim, including the estimated amount of any prospective injury,
2 damage, or loss, insofar as it may be known at the time of the
3 presentation of the claim, together with the basis of computation
of the amount claimed:
4 1. Kaiser Permanente. . . . . . . $ 292. 00
5 2 . Gregory S. Castillo, D.C. , $2,825. 00
6 3 . Scott P. Fackrell, D.O. , . $ 365. 00
7 4 . Timothy Shea, DPM, . . . . . . $ Unknown
8 5. Future medical care. . . . . . $ certain
9 5. Wage loss . . . . . . . . $ Unknown
10 6. Future wage loss. . . . . . . . $ Unknown
11 7. Property damage . . . . . . . . $ Unknown
0 12 8. General damages. . . . . $250. 000. 00
N
�
z ° < 13 TOTAL. . . . . . . $253,482.20+
w a U 0 z
u o a o 14
o x OgFQ I declare under penalty of perjury that the foregoing is true
3
E-1 Z U U 15 and correct.
5 ° 0 `" 6
oN o 16 Executed at Concord, Califor 'a, on my 8, 1994.
OU 17 FO & CAS
18
19 MICHAEL D. GOFORTH,
20 Attorney for claimant
21
22
23
24
25
26
27
28
1
2 CERTIFICATE OF SERVICE BY MAIL
3 The undersigned, at Concord, California, certifies to be
4 true, under penalty of perjury as follows:
5 That she is a citizen of the United States, is employed in
6 Contra Costa County, California, is over the age of eighteen (18)
7 years and is not a party to this action or proceeding.
8 That her business address is Goforth & Lucas, One Concord
9 Centre, 2300 Clayton Road, Suite 1460, Concord, California 94520;
10 telephone number being (510) 682-9500.
11 That she served a copy of the attached:
12 CLAIM AGAINST THE CITY OF CONCORD
0
U � o v 13 by placing said copy sealed in an envelope addressed as
ma W & z follows:
L o o f a 14 Clerk of the Board
� � - -
o x o > W a 651 Pine Street, Room 106
g a o o N p 15 Martinez, Ca 94553
Ovo a
oN a 16 with postage thereon fully prepaid, and thereafter was deposited
U 17 in the United States mail at Concord, California, County of Contra
18 Costa. That there is delivery service by United States mail
19 between the place of mailing and the place so addressed. That the
20 date of deposit in the mail and t date xecution of this
21 certificate was July 8, 19
22 ---
23 Patricia Silve ra
24
25
26
27
28