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Home My WebLink AboutMINUTES - 09131994 - 1.41 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 13, 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 haunt: $180.88 `� io, 913 and 915.4. Please note all "Warnings". CLAIMANT: BARBER, Terry L. AUo" 0 L 199 ATTORNEY: COUNTY COUNSEL IIARTINEZCAbirte received ADDRESS: 16711 Marsh Creek Rd. #105 BY DELIVERY TO CLERK ON Aug t'I, 1A_34 Clayton, CA 94517 BY MAIL POSTMARKED: Hand T)elivered 1. FRDM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppHHJL ATCHELOR. Clerk �7� DATED: B�ua 7a .� _ 19954 81: �puty Al .(2 1T IJ. 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: b ^`�" `� BY: ADeputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 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. J_ Dated s��,o /3 . /49� PHIL BATCHELOR. Clerk. By�O_ , CDeputy 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 1n 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 clamant as shown above. �_ �, Q ) 1Dated:_ '� /�L , /9 9 BY: PHIL BATCHELOR by Deputy Clerk e q „� CC: County Counsel County Administrator Clai- to: BOAPL .OF •SUPERVISORS OF CONTRA COSTA COUNTY - INSTRUCTIONS TO CLAIMANT A. Claus 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 L 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.aeerue 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.. .12 at, the end of this form ♦NE * � � � iE !F �E iF 9F 1f � �E 1F iF # * � � �! N � * iF � i IF �. 1F !E * � * iF * * # ik � iF � * IE RE: Claim By ) Reserved for Clerk's filing stamp RECEIVED Against the County of Contra Costa ) o ) - 3 r cc4at& District) CLERK BOARD OF SUPERVISORS Fill in name ) CONTRA COSTA CO. The undersigned claimant hereby makes claim aga s 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) 3. How did the damage or injury occur? Give full details; use extra paper if required) 4. What particular act or omission on the part of c ty or district officer se^vants'lo_r employees caused the injury or damage. A),, S4, 20 P4 1`%J(A u (AL�ck,/ (,uC, CTS ; CG rte, /I D. Wnat are the names o1' county or district officers, servants or employees causing the da=-age or injury? 1 at 'dama`"`�'e- or injuries do you claim resulted?: (G ve full extent of in jure) s or damages claimed. Attach two estimates for auto damage. 7. How was the amount cl imed above computed? (Include the estimated amou�t`` f prospective injury or damage.) ----- ------ --=-=. - - ------- 3. Names ang aresses of witnesses; doctors anid' hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT • a Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO .w(.Attorne )`; =a or by some person on his-behalf." . Name and Address of Attorney-')' (Claimant's Si ure r �. Address S , Telephone No. TelelAone Na:2D) I (44,1 P-7 NOTICE. 1 . , 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 officez^; 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 imprisonrjent and fine. ADDENDUM TO THE CLAIM .OF L! (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 `INS } No ( ) ( 3) Was an alternate route available? Yes ( ) No ( 4) Did you read about the •impending resurfacing in.the local newspaper? Yes 1K) No ( ) ( 5) Did you .see warning signs advising of loose gravel and a 25 mile-per hour advisory sign? _ Yes d No ( ) ; ( 6)_ Did the damage ..result from another vehicle exceeding the . 25 mile per hour advisory? ' Yes :O No ( ) (7) Did a vehicle traveling in the same direction and exceeding the 25 -mile por "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 ( ). (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 O No ( ) ( 11) Did you obtain the identity of the ,car relating to questions 6- thru.- O Yes No ( ) If yes, please provide identification below: r U 1-7-IZ5-1 ( 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. 1 L �. l hl S j r t7 i- � G ( 13) Were you aware that using the road during the chip seal process might result in damage to your car? Yes' �) _ NoL'V-X E)VT "� I dec are a he a ove i ormation is true and correct under the penalty of perjur .` • (Signa — (Da -MAIN OFFICE .,• ANTIOCH CONCORD P.O.BOX 3332 LAFAYETTE BENICIA 1140 ERICKSON ROAD 1610 WEST 10th ST. (510)256-6446 P.O.BOX 1543 CONCORD,CA 94520-3702 ANTIOCH,CA 94509-3332 BENICIA,CA 94510-1543 / (510)827-4173 (510)754-0799 (707)746-7804 FAX(510)827-0322 FAX(510)754-5426 FEDERAL #68015256 AUTO-STORES-HOME RESALE#IRS S CHB 219712097-0001 ACCOUNT NO. PURCHASE ORDER NO. DATE + 0'7--29--94 QUOTE 01359 SALESMAN I.D. ORDER TAKEN BY Ordered by : 0 01359 MOB ILF_ BILL TO: CASH SOLD TO: s CA VEHICLE INFORMATION Make : VOLKSWAGEN Model . 1E00, 1300, iii STD, 131 Year : 71 Odometer Licence Vehicle ILD: ❑ FURNISH&INSTALL ❑ FURNISH ONLY ❑ LABOR ONLY Date Promised: QUANTITY PART NO. DESCRIPTION LIST PRICE TOTAL 1 F173 S WINDSHIELD 409. 95 139. 38 139. 38 1 LABOR 30. 00 30. 00 30. 00 INSTALLER NAME DATE PULLED DATE DONE DATE REINSTALLED AMT./HOW PAID Properly cured sealants and/or adhesives,and the'Autoglass are an important part of the safety feature of the TOTAL COST MATERIALS vehicle.We at Dan's Glass,Inc.follow vehicle manufacturers recommendations on sealants and adhesives utilized 1.39. 38 in the installation of the`Autoglass in your car.The cure time of the sealants or adhesives used are controlled by the climate(i.e.,weather)which could be 12 to 24 hours or more.Dan's Glass Inc.,does not recommend you drive SUB-TOTAL your car until the sealants and/or adhesives used have cured properly.Guarantee against water leaks for the life of the car(except for rust or prior damage to glass area).Dan's Glass Inc.is not responsible for any damage to vehicle resulting from any water leak before or after glass work has been completed.This includes carpets,dash SALES TAX 11. 50 area,seats,etc. Reg.From No. Date LABOR RELEASE AND AUTHORIZATION TO PAY OTHER THAN INSURED OR CLAIMANT (Non-Taxable) 30. 00 The glass has been replaced to my satisfaction and l authorize BALANCE 180. 88 to make direct payment to DAN'S GLASS,INC.the full amount due me under the terms of my policy covering the said loss.I understand that if for any reason my insurance company does not pay this claim,I will be responsible for payment of same. DEDUCTIBLE: Insured Date 30-200 THIS WORK HAS BEEN DONE TO MY SATISFACTION–MATERIAL NOT RETURNABLE WITHOUT PRIOR APPROVAL TOTAL 180. 88 Windshield and hanknlass q H r)p FII F r— — i a � o� p � r" p i 'Poo T ` V Ola � t� C U1 3N3 eZ o4 a 3 m q p r �mQ� 0 A tD a�N" a ww J ff: CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 13, 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: $169.08 ipec{ pn 913 and 915.4. Please note all -Warnings". CLAIMANT: BREWSTER, John C. AUG 16 1994 ATTORNEY: COUNTY COU NSE!, MARTINEZCALIFDate received ADDRESS: 3190 Hillview Ct. BY DELIVERY TO CLERK ON August 15, 1994 Concord, Ca 94519 BY MAIL POSTMARKED: August 13, 1994 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. QHII BATCHELOR, Clerk XZ � ) DATED: , " /6�/�J�f�` 81: Deputy 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 910.6). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: l ! BY: Deputy County Counsel 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 ( V 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 datppe. Oated:pde , %3 . JcJ9 PHIL BATCHELOR. Clerk. By_ �f_, 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 Aeposited 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 1n the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to %he claimant as shown above. Dated:\_AQ42t ;/i q�j BY: PHIL BATCHELOR by &L2�. Deputy Clerk CC: County counsel County Administrator " rra - f `" J�lo V ti o �I 1 � Claim 3.o: BOARD OF SUPMM.SORS OF CONTRA COSTA COUNTY • INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury -:o person or to per- sonal property or growing crops and Which accrue on or before December 31, 19879 must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and Which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code 5911.2.) B. Claims must be filed With the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553• C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. l 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 ME—. • s a * � � � * * � e a f a s s �t �t a a • a ; f f �t e f f e s e e • • e a a f • at � � RE: Claim By ) Reserved for Clerk's filing stamp -2 rnnon Lee rrario ) j RECEIVED Against the County of Contra Costa ) or ) AUG 1 51994 District) Fill in name ) CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District'in the sum of $ 3(oa,N 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) CN- U`1u1 ulo I M C;�Lh- L5� -L C—UA-4- fiPa-e13 dei`a�E CrA:LL.0 M' 3. How did the damage or injury occur? (Give full details; use extra paper if required) 1J. 111 dn�lv�r (61V+ or h--,Lj, fequlGf' ccmmu-l2 ,GA bAcunq �l Ped Yom, 0f-ftp_ I oo&C rocLIC,rtw- _J Cu tmd dojh, goad re U' l� (�q CQ1- ,Cc�,uVt &uYCLge ID �'InQ head Vit° h- (a m& t0l.1d.Shei tl � � � 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? p l)-�bYlct &otvvl kw&-43 (D� S� L -ta Crde-1U C6m plc�e up- ( a (e c�itis P hiS h�u�s up Ochercut� ))c GAAD ('.GAS (b,Ssi r� Cu-j& �t t 6wljyq .. one Untmel-, cul Cxt cav� Vr Cir' -�ire iwo Nac ent fwu[ �� rn�. d f)Wr s;d e h eao L I,q jl� W, 4Q- Side 0 f- � ( u`l&hei t� , (over) 5. What are the names of county or district officers, servants or employees causing the damage or injury? �►�L1LlS�— -- 6. What damage or injuries do yo claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. 1 �C�a► ��Sic1e, —(� �- �uY�, �hPi i- �.e.P�.�l�hec�. esh)�c.�s 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. Mod � . Gan MC) 510 W - I�It- 9. List the expenditures you made on account of this accident or ink : DATE ITEM AMOUNT f • e � � * • �r • � � � � � � -a � • � � s � � � a � e • e e ��f • s f f e e s e � � 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 .`l/1z1� • /' ��.. Claimant's Signature) Address �1 S Cl'C &�• Pl l Telephone No. Telephone Nc. A0 CZ lam. eee • a � • f • a • ffe • * e * 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 ($109000, or by both such imprisonment and fine. 70COPY. CO.�1n-, a4 d, Acv)-eg, qV)17W)2(d7qa1l& - /Y ffr�/C. ta � � CC�1zt- , CCS Cwt- 1"eJk _ l Vic-tk,�, Z A2 a,1(4,07 fit f'Y�Cc2 1 �� 61 C/Z 1�tzz? GL -f" 777YYYG ILC Al�� c ci, c �-cam �/a z�, lam- GCS S`D Elto-C,11-dj '� STATE OF CALIFORNIA—BUSINESS, TRANSPORTATION AND HOUSING AGENCY PETE WILSON, Governor DEPARTMENT OF TRANSPORTATION BOX 23660 OAKLAND, CA 94623-0660 (510) 286-4444 TDD (510) 286-4454 i July 29, 1994 Shannon Marlin 5532 Drakes Court Byron, CA 94514 Location: CC-NSH D/I 6-3-94 Regarding: Claim No. D940619 The Department of Transportation rejected the above entitled claim since the site of the alleged incident was not owned controlled or maintained by Caltrans. Our investigation shows that the location of the incident leading to your claim is probably the responsibility of Contra Costa County. (See attached info. ) I am returning a copy of your claim and original receipts and/or estimates; I have made copies for our files. Sincerely, YOLANDA HENDERSON District 4 Claims Officer Attachment STATE OF CALIFORNIA•DEPARTMENT OF TRANSPORTATION CLAIM ,AGAINST DEPARTMENT OF TRANSPORTATION/FOR AMOUNTS $1.000 OR LESS i.D-0271 Page 1 of 2 Front PERSONAL INFORMATION NOTICE ((��'�� AA`` C�` Pursuant to the Federal Privacy Act(P.L.93-579)and the information Practices Ad of 1977(Civil Code Sections 1978,et seq.),noticaT.cuitii s for the request of personal information by this form. The requested personal information is voluntary. The principle purpose of the voluntary information is to facilitate the processing-of this form. The failure to provide all or any part of the requested information may delay processing of this form. No disclosure of personal information will be made unless perm•ssible under Article 6,Section 1798.24 of the IPA of 1977. Each individual has the right upon request arid proper identification,to inspect all personal int rtw tion in any re-o lnta;ned n the individual by an - identifying particular. Direct any inquiries cn information maintenance to the Department of Transportation,Legal Unit,IPA s ON i This form Is to be used when filing a claim against the Department of Transportation as provided in Government Code Sectior 935.7. PLEASE: print or use typewriter when fi11M++�d46A. CAUTION: Claims for road repair(Chip Sealt damage. • sign and date claim form. must be received Within 30 days of the (UNSIGNED AND UNDATED FOat vuLTa oc d;�Q incident. All others within 6 months. STATE JSE ONLY — FILE NUMBER--- — +- 1. NAME: LAST FIRST MIDDLt 6'1 _ HOME ADDRESS RUSrNFS5 PHCflC ( :4;0'a-PHONE ii I:�CJ ceu CITY STATE --_ �Z'.1 coCE "�-----• bu ED TIME OF ItiCIL•EN7 O.,;_O-NC C;4:dT 2. PUT A SPECIFIC TIME AND DATE WHEINI THE DAMAGE FIRST 000URED (� L T�� _�/t� 3, S ATE THE LOCATION OF THE INCIDEi: `iVI THIN ONE-HALF MILE(CITY,COUNTY,HIGHWAY,NEAREST OFF-RANIF,C-ROSS STREET OR POST IAT"). In�l /------- ------- -- -- ('l�y �YLcl �S�_ Cc f _ 41 171 rE._C�f 4_i11C_ dc)A_. ------ ----_ 4. EXPLAIN HOW THE IN:IURY OR 7,A?%AF GE OCCURRED. art•' .o � 11 hAfia1 C !' 010 uma1 9 (1 �C, CG�hdd _ TLu) 'a-1 o jraa clixytC -il(yl a*1,' (x\(b—— 'f +1'-(' LV ---- -- WHAT PARTICULAR ACT OR&AISSION ON THE PART OF CALTRANS OR ITS CONTRACTOR CAUSED THE INJURY OR DAMAGE? fz.r d' UIL 1,OCL&) c��- LI0�0- (CI�L " l-s 1': (CAI iri,l'l�.i.f �-1'1.i�. �G�-J �j�� 4-•�t�� cr�,� I�l.(�-"� h'r�� G� Cc ��,/.i,'l f_.�( �J � �-- ------ WHAT INJURY OR DAMAGE DO YOU CLAIM RESULTED? 161c. hecd 11,gat JIC 04-LT WHAT IS THE DOLLAR AMOUNT OF YOUR C IM FOR DAMAGES? ,(SUBMIT TWO ESTIMATES OR PAID RECEIPTS) 5. INSURANCE INFORMATION IS REQUIRED NAME OF INSURER t " ARE YOU THE REGISTERED OWNER? HAVE YOU SUBM17-1'ED A CLAIM TO YOUR YES NO YES NO F] INSURANCE CARRIER? IF YES, WERE YOU PAID? YES E] FOR WHAT AMOUNT? $NO � y` VEHICLE INFORMATION I I MAKE OF VEHICLE YEAR LICENSE NO. SCF �L'Cb'(�C�_ � X60 �CC 1 HEREBY CERTIFY UNDER PENALTY OF PERJURY,THAT THE FOREGOING FACTS ARF TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. RE OF SIGNA.0T,/�. 1 REVERSE SIDE FOR STATE USE AND FILING INFORMATION ON CLAIMS JLkl--07—'94 17:17 ID:LEHMERS OLDS TEL N0:51082791555 #1619 P01 • ; .' � LEHMER's 3575 M Aetrsla� 1851 Galindo Street• P.O.Bax 5398 Phone 685-44S11 .. uLoselg�LE �� CONCORD. CALIFORNIA 94624 ESTIMATE OF REPAIRS AS LISTED FOR I AROR AND MATERIALS—VERBAL AGREEMENTS NOT BINDING E p TI�MA/TES FREE Owurr.. ...._-.. /,/CJ/l�.V j C- 'jl• _._. o8t0 � 7Lq/ Addreea phone By 8Y sffial tZ 2T 4/ /'f�.J !`/ iu91169 � Poona MlolbBr YNa Br"IlQ Mndrl �� T-_. ._.. ___• — ?"�J Tri NOm Mil—p 4X x QUAN. DESCRIPTION OF LAROR OR MATERAL PARTS LABOR SUBLET PARY.S PRICFS P.ASFD ON RTANDARO CATALOGUE PROCUREMENT PPICC JS i s sumirCT TQ CI IANGF WITHOUT NOTICF PROCUREMENT AND OFLIVFRY CHARSFS MAY EIE ADDED I•UH 5PLf dAL 61.11VK.E O:V irrms,NOT AVAII ARI F I OrAl I V Old 1.,6r U r04luved hurn car.will Le junkrri unlr=othrrwirr.instrocrmi ,y y TOTAL LABOR Th.;th-wr is nil in estimaite Uassd 6r1 uur inspecliur and dor.::not cover:uld,.n t:1 n:.i:e of lahrr whq•.h miV he required,liar 111L work hna ra:r:n fdJeo d lq:r.UCcastt111aI1V allot wutk has slarlad wurn warts ar,: nor rvirlr.m on twst rnsU6un.m.t;tll'au5tl PARTS lez of this the.nhnvr.prinns no rlot qual,eolged. PAINT MATERIALS A••Align N-New OH-Overhaul S-Stralghtrn err Rop:rir I'X Fucllango RC-Rechronle U-Used TAX C� 2,7 R1 MARKS: PAID OUT-Taw A STORACL SUBLET TOTAL 11296-01t77NORICK OKLAHOMA CITY joa-2,1 R==95% LEHMERS OLDS 06-07-94 05: 09PM P001 #48 DAMAGE REPORT MARLIN 06/16/_ 94 at 12 :53 D.R. 17908-0001588 Est: R. EWING MIKE ROSE'S AUTO BODY INC. 2001 FREMONT STREET CONCORD, CA 94520- (510) 686-1739 Owner: SHANNA MARLIN Day Phone: (510) 516-2642- Address : Other Ph: (610) 246-6544- Deductible: $ N/A Insurance Co. : Phone: Claim No. : Adj . : 91 JEEP CHEROKEE WHITE Vin: IJHFJ58SOML597109 -License: Prod Date: 4/91 Odometer: 23082 REPR/ PART LBR PAINT NO. REPL DESCRIPTION OF DAMAGE QTY COST HRS HRS MISC -------------------------------------------------------------------------------- 1*_ Repl WIND SHIELD DANLS—GLASS INSTD- ---.1- 0.00 0. 0 0. 0 X 219.90 2* Repl L FRT HEAD LIGHT HALOGEN 1 28 .00 0.3 0.0 -------------------------------------------------------------------------------- Subtotals =__> 28 . 00 0.3 0. 0 219 .90 Page: 1 DAMAGE REPORT MARLIN 06/16/94 at 12 :53 D.R. 17908-0001588 Est: R. EWING MIKE ROSE'S AUTO BODY INC. 2001 FREMONT STREET CONCORD, CA 94520- (510) 686-1739 Parts (Subject to Invoice) 28.00 Labor 0. 3 hrs $ 52 .00/hr 15. 60 Sublet/Misc 219 . 90 -------------------------------------------- SUBTOTAL $ 263 .50 Tax on $ 28.00 at 8.2500% 2 . 31 -------------------------------------------- GRAND TOTAL $ 265.81 -------------------------------------------- INSURANCE PAYS $ 265 .81 THIS IS A PRELIMINARY ESTIMATE AND ADDITIONAL CHARGES MAY BE REQUIREQUIRED FOR THE ACTUAL REPAIR. Estimate based on MOTOR CRASH ESTIMATING GUIDE. Non-asterisk(*) items are derived from the Guide . Database Date 0/0 Double asterisk(**) items indicate part supplied by a supplier other than the original equipment manufacturer. EZEst - A product of CCC Information Services Inc. Page: 2 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 13, 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: $100.00 Section 913 and 915.4. Please note all `Warnings". r•' CLAIMANT: ByE, Lance R. ATTORNEY: M Date received COUNTY COUNSUL �T'A4'E�CALIF. ADDRESS: 1515 Willow Lake Rd BY DELIVERY TO CLERK ON Ans,st 5M�_ T99 Byron, CA 94514 BY MAIL POSTMARKED: ALgtist 3, 1994 Hand Deliveredvia: Risk Mont. 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. QQ IL BATCHELOR, Clerk �i \ DATED: Ba: Deputy 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( wO 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). t ) Other: Dated: T1 5 1 9 N BY: Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1)' County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARD/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, J, 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 neposited 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 Claimants addressed to The clamant as shown above. //JJ Dated: BY: PHIL BATCHELOR by ( ',��c� Deputy Clerk CC: County Counsel County Administrator r 5-05 o n` cu o g� `i 0 03 4 co 03 !'r i b _ K NICD �� toOAAkf M! C-1 ct CD K .�- fi r^r. •� k- t August 2, 1994 ` Q RECEIVED V Risk Manager Contra Costa County AW - 5W 651 Pine Martinez, CA 94553 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. Dear Sir : I am submitting the following claim against Contra Costa County for the amount of $100 . The claim is based on the following: On Monday, July 18, 1994, at approximately 4: 30 P.M. , my wife (Kelly Bye) was driving our 1992 Toyota Camry Eastbound on Marsh Creek Road. She was several miles West of Vasco Road when she came to the section of roadway that had been covered with loose gravel as part of the chip-seal repaving process . She reduced her speed to the temporarily-posted 25 MPH speed limit. As she travelled on the gravel surface, a mid-size sedan approached in the opposite direction. It appeared to be going well in excess of the 25 MPH limit . As it passed by, it sprayed our car with loose gravel. Some of the gravel hit our windshield and caused it to crack. The cost to replace the windshield was $346 .44 . Our .insurance covered all of the cost beyond a $100 deductible. I believe that the County did not take adequate precautions to protect vehicles from conditions where they are vulnerable to loose gravel kicked up by other vehicles. For this reason, I am requesting reimbursement for the $100 deductible . Attached is a copy of the receipt for the windshield replacement. If there are .any forms or other documentation that needs to be completed, please advise me and send the applicable forms . Sincerely, Lance R. $ye i . : 1515 Willow Lake Road Byron, CA 94514 ( 510 )634-0843 © Auto Glass Corg 71i- ''Customer Service Center 1-800-835-225; r T-r_ <'.{! !TO tJ!_rlti 3 lith. .ft iyi, 7 tJF!t.>, llf ? !!._ _°r) 19-- t= '!9 .. '• t;RL3t 1i�_:'F•1 t:5 1Y t_:tsa' ! t!t F F y i' :s "1`r ;�i`� 11`4SU4 !:.I } t'r!c t tv! 4 .t 't "e:r\ 1._iy, ; (4 1L t��st,1_ RO. i Cr ' (=' (1V.k'(.;i� �,�"�v�- .� 'i L.c - ...• }_.:I_rrt+'.'�» .} :.� °t:i_}>.ta:_. .- . . -i /Y 1:F': f ['041f p Et- � C• r_J.,:,i:: '.['1f�1.:1. -'1''i�'..i J. I �..}L.!`:. }. .i_i a?�.>F•': 10>4-t .. .� 1t._ t.,l.. -1� tl:�', S ;.� ,� t-. .` '7r\ .tt) I ::.L' , s 'R i�YINE: t` 1�_ _ !�'�;t,._..(i ,.� L•:_:k:.r.1,.- _1i ;h ,�F;1�-L. . ..-• Lhl:,_j, lci•.:r• `lU L P-4 Lf11"'RV !:a?tli`l4'`' C£i �!.-._tF,..� Al 11 •f.-Di;N.t ;P.F 1 N t.7!:. U_} T 'F t I 4;t'.. f:E:l._.L 1 N'C L -H'{.: P. K.1 11 f! 1 1?a i':L_ . f ( (F�1� l iJ l t 11} x.313 - �,t!La�! Li tlltll� H:tF;t._C) C C }.I:1 4'.'.'{}`ciF I I ElrU kt1=E'f._T F? _. _�s�.:.• !'__.t .;.. '_. ..;._ . ( i� HT,aUa3�z�.U't'f!!�r - 9 }. J I `lTf F'(38"=7:BLE .,��,� L_, L,t1(, _:t.J.l:• T{.�"( ll._ ">. _>._} W/S L. 3 17 4• .. .. - , FL�t_1C.T1.I�L:F 1c!�i.r� -• .._._.._...__._ . .-__.. -- -- - - --- — - -'- — '- — - - -- - -- - 4v _•igninq belga,=;I hereby`ac(;r«�i g 'that:StIYEIITE Glass Corporatic,rt L i"WELFIE")'has pr?vided.-the above=refererrmd"go.dc y: ani y r:ic>r to ray safisfa tip=r:. 1 hereLy assig,; to S(i�F:LITE vr)y arrd a I I IaiIas and rights that 1 may have unde}�`eriy•f=c"li�f} =fs i.rrsua'anac to recover said balar-,ie due;,and. I hereby,authccrize trf' abova-rasre irFarar:cc cc, palsy, t�� pay S!'tFELI,TE•the.balance duz.1 ri ,, f_r :;aid go:`dd: :ndr,er,itie� 'If s6i.1ucorit ice;�nct paid,in fall.by the aur_-rtiw�.f;irwurar)ce _p},rpany,,,l _rrec._to_PaY._; •�. Tor the balkier. due. i4�•.F> �:-, r �a ... ... - 1 , !: _ .q..f_ ..tea, S :r F .-! A.4--X.41.x.r:.a..?t. X--X..N..:i-.u..x-V-.,c-K--;n N..u;r...y-.a. nl ^ �.. ;. � I TF. 'w Y*, ..r�'•' StG>.Y. 4 Com._. _: ?(1F N L I f:ii..f'�t', t uhtf:,, -•. !-'. t_}. I:'!_)y�. sic}�?�rr"i _ �a,. Sf)Fh_,C C-) :E PI„t.JF I')ilki1 i:_ ;1 ! Cl.... , ;..i t iL ''L_[ r; 'iE 4':F::t ! E t P•l�.t0 i tn;k_ P• U1*1E�E-- � 01-4 r:l _t I l.;: I\ .1I =Fr:e_ '}Il <51.Lt ;at- ! I}-1 r t•'Ji` (1, L} 13 a 5 i.15(.1 (,If"V 1'4't.. :) i I"I{f4..flI.i 1 -• ._ ;(::,. f'a"•,::.I_...I I l-: ! i t, I :_� ,. - 1.... ,.., tut(-,.;?i;`.' •�_. -,'1 !. 96 .1! } 3 1''T): . .. ..:�': 1. :;: «:•�'_-:�•Y: .. .:....; x.p..r>:fi 7: :•r:X N . �4_ w CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 13, 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 (PaJJJ��»lU gra h IY below), given pursuant to Government Code Amount: $517.77 Seco n � 40n Please note all •Warnings". CLAIMANT: California Compensation Ins. AUG 10 1994 Claim 20090326-12 COUNTY COUNSEL ATTOnN E Y: MARTINeZZ CALIF. Date received ADDRESS: P.O. Box 800 BY DELIVERY TO CLERK ON August 10, 1994 Novato, CA 94948 BY MAIL POSTMARKED: August 9, 1994 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PpHHIL BATCHELOR, Clerk DATED: BT: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors (tom This claim complies substantially with Sections 91D 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: 0 BY: �- _ Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). JV. 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 Aeposited 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 1n 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 by0,� Deputy Clerk CC: County Counsel County Administrator Now • �' c«f ^-� 2.©fig e3 Zti --12 Claim 'to BOARD OF OF CONTRA COSTA COMM INSTRIICTIONS TO CUDWT -A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 19879 must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and Which accrue on or after January 1, 19889 must be presented not later than aix 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 ,6911.2.) B. Claims must be filed with the Clerk of the Burd of Supervisors at its office in Roam 106, County Aft' dstratian 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. a f f N e e e e f e it f e e f ■ 1i e f a e e s f f * e rt e e e s s a f +� • s e f s � e RE: Claim By ) Reserved for Clerk's filing stamp CA�►�tea..►�a e�.�..At�`�v sAzrcw sNS, RECEIVED rum v�rtU CA C tfq$q ) Against the ty of Contra Costa 0 Qor District) CLERKOFSUprann OR8Fill n nameCCOSTA CO. The undemigned claimant hereby makes claim aha�`t the County of Contra Costa or the above-named District in the sum of $ $ 7 r7 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) f I (9- , 12:30 PN1 20 Where did the damage or injury occur? (Include city and county) � C9 C7 c7 A-K ��►2aC Q�-� • ) 3. How did the damage or injury occur? (Give Hull details; use extra paper if required) ' F3 Ener<-rc� 2��-� /�..� s�c��l�.�� 1 ..i L✓1�L C�� r%T (cf c fi J Qi Ylwwr -1��..Y M Ate_ 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? FA 2F- P2.Qk PM(-y'' A 2�.g , !�!L V�4 A a"i W<'L�c<,�v�/a� -- T2.� els S ��,•-./��1� �ci►-etc f�!'/J . �}`�c7'j., (over) 5. What are the names of county or district officers, servants or employees causing the damage or injury? UNK•v •J 6. What damage or injuries do you claim resulted? (Give Hill fttent of injuries or damages claimed. Attach two estimates for auto damage. 51?. '?7 . -�.,�� C .��.►s�2�-� 6Y ��ccd,�� ram �ilir�i��eaY�� rr�� i.•A1i.�� • � '� �.�� • iis� .i M�� 7. How was the amount claimed above computed? (Include the .estimated amount of any prospective injury or damage.) j'ti.C•'� t C�-` C v 3't•� �=U� ^C��cr�i'�•+�^�.-moi; ter...._ B. Names and addresses of witnesses, doctors and hospitals. L-tA,.jCt" W t L-,,�tv 9. List the expenditures you made on account of this accident or injury: DATE I7EM AMOUNT O t C (sec %"� , Gov. Code Sec. 910.2 provides: "The claim must be signed by the elaimnt SEND NOTICES T0: (Attorney) or some person on his behalf." Name and Address of Attorney W114mant+s gnature (Address) �( /U V A-r'G �7 tjc�� V Telephone No. Telephone No. (s-MA2 ^22 or� eeeeeee eeeeeeef �' s'�'i ee * N0TICL Section 72 of the Penal Code provides: "Every person who, with intent to defrauds presents for allowance or for payment to any state board or officer, or to any county, city or district board br 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 rine. 1 REVII�.WCO, EI,.LLING ANALYST: r CAL COMP - NOVATO ) 04/20/94 AfIEN.T`s WILLIAMS, LANCE _ DOCUMENT : 4974272 PROVIDER : SUN VALLEY URGENT CAPE MED . CE` CLAIM : 20090326 REFERENCE : 110899 70984 MDOID22894 012 PAGE : 1 RVS/CPT DESCRIPTION DATE MESSAGE CHARGE REDUCTION PAYMENT --------------------------------------------------------------------- 73610 X-RAY EXAM OF ANKLE 02/15/94 600 45 . 00 45 . 00 . 00 977220 EXTREMITY, TESTING 02/15/94 600 45 . 51 4`"'5 . 51 . 00 97721 SUPPLEMENTAL LIMB TESTING 02/15/94 600 23 . 37 23 .37 . 00 97721 SUPPLEMENTAL LIMB TESTING GE/15/',4 .600 23 . 3+ E3 . 37 . 00 99080 SPECIAL REPORTS OR FORMS DE/15/94 E06 40 . OD 40 . 00 . 00 99203 OFFICE/OUTPATIENT VISIT, OE:15/94 600;. 64 . 58 64 .58 . 00 581 -4PT/RVS 90015 CHANGED TO 'Ci9203 REFLECTING SERVICE PERFORMED - SUFFLY CRUTCHES, ALUMINUM Oc./15/94 600 : 0 . 00 50 . 00 . 00 SUPPLY ANKLE. BRACE- AIRCAST 0?f15/94 600 50 . 00 50 . 00 . 00 99213 OFFICE/OUTPATIENT VISIT, ca/2E/94 600 39 . 98 39 . 98 . 00 6v1 -•CF'T/RVS 230060 CHANGED TO T2 ?13 REFLECTING SERVICE PERFORMED DRUG E(I NIAPROXEN 0E/2E/94 635 34 . 00 2 . 20 31 . 80 PA ID 0- THE -THE AMOUNTS: L IS T L'D AS, REDUCTION ARE OBJECTED TO FOR THE FOLLOWING REASONS : 206-MATi:f IRL OR PROCEDURE NOT ?=ORMAL_Y CHARGED FOR 600-A SERVICE HAS -BEEN PREVIOUSLY REVIEWIED 635-MEDICATION/5UF'PLY 'EXCEEDS REASONA5LE ALLOWANCE IF YOU DI.S.AGREE wi,r.i THE REDUCTION( S ) YOU rl'A ' CONTACT RE'VIEWCO A3 'THE A:.'-I:RESS SHOWN GES OW OR THE INFORMATION AND ASSISTANCE OFFICER AT THE NEAREST DISTRICT, OFFICE OF THE DIVISION OF I NDUSTR I AL ACCIDENTS OR YOU CAN APPEAL TO THE WORKERS' COMPENSATION APPEALS BOARD . --_______.._-_-_____--_._ -_.....____________..___-_-___- GM00(dY0 r7G". 30E.^5it0r _r?^ t`rtiAR / -41C . 81 384 . 01 3i . Cv SUN VALLEY URGENT CARE MED . CE RE IEWCG ( Ia:CUIRIES) 1 1 00 COIIti;T RA COSTA BLVD . P . O . BOX i9533 CONCORD, CA. 34523 !RVINE, CA 92777 .1V; Sun Valley Medical CarE �, Al.) �urjeaCare-Occupational Health ;b •. 1100.Contra Costa Blvd.,Concord.CA.94523 IRS#68-0245268 Worrk CComp.Coordinator5 0 825-12748 WORKER'$ COMPENSATION Provider#ZZZ 91375Z PATIENT. PATIENT I.D. FEE TICKET NO, DATE WTI_LtAM'.-5 , 1_410E 1 '1Or`391 315'-±2 '44 O 0 . B . f:):i;'; Si h/:1 .78 09 : 44 001 : 17 %l5:' TREATMENT E.M.CODE AMT TREATMENT CPT AMT TREATMENT CPT AMT INITIAL OFFICE VISIT SURGICAL PROCEDURES SUPPLIES 1 Office Visit, Brief 90000 84 Remove F.B.Subcut 10120 201 Cervical Collar 99070 2 Office Visit, Limited 90010 87 Debridement of Wound 11000 - 203 Cradle Sling 99070 3 Office Visit,Intermed, 90015 BB Burn,Small,Debride&Dress 16020 204 Elastic Bandages -inch 99070 4 Office Visit, Comprehensive 90020 92 Removal F.B. Conjunctiva 65210 220 Knee Sleeve(Neoprene) 99070 95 Removal F.B.Cornea 65220 205 Knee Splint(Small,Med.,Lg,) 99070 ESTABLISHED PATIENTS-OFFICE VISITS 101 Sub-Ungual Hematoma 11740 206 Splint, Finger 99070 9 Office Visit,Brief 90040 31 Procedure Visit, charge -58 207 Splint,Wrist 99070 10 Office Visit. Limited 90050 208 Air Cast Ankle Splint 99070 X11 Office Visit, Intermed. 90060 SPLINTS/CASTS 209 Rib Belt 99070 18 Office Visit, Extended 90070 333 1 Short Arm Splint 29125 210 Surgical Tray 99070 010 Office Visit,Comprehensive 90080 335 Short Leg Splint 29515 211 Suture Material X 99070 615 Suture Removal Tray 99070 LACERATIONS-SIMPLE REPAIR CPT BACK CLINIC CONSULTATIONS 212 Steri Strips 99070 25 To 2.5 cm,Scalp,Extrem.etc. 12001 109 1 Initial, Extended 90610 213 Dressing,Small 99070 26 2.6 to 7.5 cm,Scalp,Extrem. 12002 110 Initial,Comprehensive 90620 214 Dressing, Intermediate 99070 28 7.6 to 12.5 cm.Scalp,Extrem. 12004 111 Extended Consultation F/U 90643 232 Dressing, Large 99070 27 To 2.5 cm, Face, Ears,etc. 12011 111 Consultation 90625 215 Eye Tray 99070 31 Procedure Visit, charge -58 217 Eye Irrigation Supplies 99070 MEDICAL PROCEDURES-DIAGNOSTIC 221 Crutch (Aluminum) 99070 LACERATIONS-INTERMEDIATE REPAIR 142 Spirometry 94600 230 Cast Material (Plaster) 99070 35 To 2.5 cm,Scalp,Extrem.etc. 12031 0142 Audiometry 92552 231 Cast Material (Fiberglass) 99070 36 2.5 to 7.5 cm,Scalp,Extrem. 12032 EKG 93000 0234 Tennis Elbow Strap 99070 028 7.6 to 12.5 cm,Scalp,Extrem. 12034 Tennis Elbow Sleeve 99070 40 To 2.5 cm,Neck,Hands,Feet 12041 PHYSICAL THERAPY 239 Thumb Spica Splint 99070 45 To 2.5 cm. Face, Ears,etc. 12051 185 Any Comb. Mod. & Proc. 97200 31 Procedure Visit charge -58 186 Ea.Add1 15 Min. 97201 LABORATORY 087 Eval 97720 311 Urinalysis, HAPRoxEM 1015 X-RAY 088 Ea.Add'I 15 Min. 97721312 Urinalysis, See nG 1000 50 Chest, 2 Views 71020 Back School 97540 1 20 TABLETS 52 Ankle 73610 Add 15 Min. Back School 97541 REFERENCE ANTON,CA 53 Foot 73630 Initial 30 min. 97110 301 Collection 99000 Ax Ae54429 54 Knee 73570 Ea,Add'I 30 min. 97145 346 Culture/S NDC S4SG9-376e-1 87070 55 Toes 73660 Back Booklet 99070 317 CBC LOT402720 ExPu,os 85022 56 Elbow 73080 340 SMAC 25(Lab Scan)- 80019 57 Finger 73140 INJECTIONS/MEDICATIONS/IMMUNIZATIONS HIV Antibody 86689 58 Hand 73130 161 Adult Td 90720 59 Shoulder 73030 Hepatitis B 90731 PHARMACY 60 Wrist 73110 W400 Injection Fee 90030 99070 61 Cervical Spine 72050 99070 62 Lumbosacral Spine 72110 MISCELLANEOUS 99070 Thoracic Spine 72070 0352 Dictated Reports 99080 OkUrl- 017 Review of Medical Records 99081 Ni-3 - 018 Phone Consultation 99048 i1 CrI I1 _ � yr DIAGNOSIS „ ❑Abcess Cellulitis pp �B� �J Chest Wall (Ribs) 922.1 1:1 Wrist 814.00 ❑ 842.00 ❑Ab,. 13f5S��e eq��7�9D �]�JI�� 923.11 D Toe(s) 826.0 ❑Tends' Elbov� 727.09 ❑Allergid �� as ��9999999999SSSSS�� ❑ Finger(s)&Snb-ungual 923.3 ❑ Herniated Disc,Cervico-Thoracic 722.0 ❑Ha ist/Fi genes 727.05 ❑ Burn, nj ite 949.0 ❑Foot 924.20 ❑ Lumbo Sacral 722.10 O Shou Ci 33 726.10 ❑ Burn, F e 941.00 ❑ Ha 923.20 ❑Insect Site. Non-venomous ❑De lue l(n's !!� 727.04 ❑ Fo ead/Neck/Face 920 ❑ Non-infected 919.4 ❑Wound:(PunctuPR ceratin? ❑Fo 943.01 ❑Knee 924.11 ❑infected 919.5 Animal Bite, Eta ❑'Hands, Wrist Fingers 944.00 ❑ Leg 924.5 ❑_Insect Bite,Venomous 989.5 ❑ Face OF 873.40 ❑leg 945.00 ❑Shoulder 923.00 -❑Laboratory Test V72.6 ❑ Finger(s) �!j 883.0 D Bursitis, Elbow 726.33 ❑Toe(s)&Sub-ungual 924.3.-'', (D'Radiculopatlry: Cervical 723.4 1)Foot 892.0 ❑Hand,Wrist 726.4 ❑Wrist 923.2l..'. ❑ Lumbo-sacral 724.4 C]Forearm Q 881.00 ❑ Knee 726.60 ❑ Degenerative Disc Disease 722.6 `" El Rash ( /782T 11 Hand 882.0 ❑Shoulder 726.10 ❑Dermatitis: Allergic/Contact 692.9 ❑Sprain & Strain: Ankle/Foot 845.00 ❑ Leg 891.0 ❑ Carpal Tunnel Syndrome 354.0 ❑ Poison Oak 692.6 ❑Abdominal Wall '' - 8488 ❑Scalp 873.0 ❑ Chemical Exposure,Skin 949.0 ❑Exposure to Communicable ❑Arm/Shoulder 840.9 ❑Toes 893.0 ❑Gas Vapors/Fumes 987.9 Disease V01.9 ❑Cervical 847.0 ❑Upper Arm 880.03 ❑ Concussion 850.9 ❑Foreign Body, Eye 930.9 ❑ Elbow/Forearm 841.9 ❑Wrist 814.00 ❑With Loss of Consciousness 850.5 ❑Soft Tissue 729.6. ❑Finger(s) 842.10 ❑ Conjunctivitis, Chemical 372.5 ❑Fracture:,Ankle 824.8 ❑ Hip/Thigh 843.9 ❑ Contusion: ❑Ankle 924.21 ❑ Finger(s) 816.00 ❑ Knee/Leg 844.9 ❑Arm 923.9 ❑Foot 825.20 ❑Lumbosacral 846.0 ❑ Back 922.3 ❑Hand 815.00 ❑Thoracic 847.1 DIAGNOSIS IF NOT LISTED ABOVE - PLEASE PRINT Y DIAGNOSIS CODE fCE T TODAY'S FE S PHYSICIAN'S SIGNATURENURSE'S SIGNATURE TIME OUT Credit Card/ Sh Don Undo Check REVZEUM—BILLING ANALYS CAL COMP - NOVA 1 03/27/94 PATIENT : WILLIAMS, LANCE DOCUMENT : 4960404 PROVIDER : SUN VALLEY URGENT CARE MED . CE CLAIM : 20090326 70984 MD01031894 012 PAGE : i ------------------------------------------------------------------------------- RVS/CPT DESCRIPTION DATE MESSAGE CHARGE REDUCTION PAYMENT 99213 OFFICE/OUTPATIENT VISIT, O3/16/94 40 . 04 . 00 40 . 04 PAID aPR 5 1994 ---------------------------------------------------------------------------------------- ME00NY0490040 25000567127CAR 4( . 04 0 4+x . 04 SUN VALLEY URGENT CARE MED . CE REVIEWCO f NQUIRI�.S 1 1 00 CONTRA COSTA BLVD . P . O . SO 1 9r3T CONCORD, MA 94563 :�:'vxNE , �"A 9c r 1 0 z 7 Sun Vcffley Medical Care Occupdonal ,\Urgent Care Health Nk'-;; -1100 Contra Costa Blvd.,Concord CA 94523 a (510)825-2000- FAX(510)825-0861 - IRS#68-0245268 Work Comp.Coordinator(510)825-2748 PENSATION Provider#ZZZ 91375Z PATIENT PATIENT,I.D. FEE TICKET NO. DATE "JAMS. LANCE-.' I I os(� 3 1-"?23 .03111.6, 94 W I LL E.C. -2/15 j7 CJ lJ: /25t60 DO I ': ENT E.M.CODE A- TREATMENT CPT TREATMENT :CPT AMT TREATMENT MT AMT INITIAL OFFICE VISIT.,:- SURGICAL PROCEDURES SUPPLIES` Office Visit Brief 90000 841 Remove F.B.Subout 10120 201. Cervical Collar 99070 2 Office Visit Limited 90010 87 Debridement of Wound 11000 203 Cradle Sling 99070 Office Visit Intermed. 90015 88 Burn,Small,Debride&Dress 16020 204 Elastic Bandages inch 99070 4 Office Visit Comprehensive 90020 92 Removal F.B.Conjunctiva 65210 220 Knee Sleeve(Neoprene) 99070 95 Removal F.B.Cornea 65220 205 Knee Splint(Small,Med.,Lg.) 99070 ESTABLISHED PATIENTS-OFFICE VISITS 101 Sub-Ungual Hernatoma 11740 206 Splint Finger 99070 9 Office Visit, Brief 90040 31 Procedure Visit charge -58 207, Splint,Wrist 99070 1 10 Office Visit Limited 9005 208 Air Cast Ankle Splint 99070 /1')Office Visit Intermed. SPLINTS/CASTS 2D9 Rib Belt 99070 Office Visit Extended 0670 333 Short Arm Splint 1 29125 1 210 _Surgical Tray 99070 0 Office Visit Comprehensive 90080 335 Short Leg Splint 1 29515 1 211 Suture Material X 99070 Suture Removal Tray 99070 LACERATIONS-SIMPLE REPAIR CPT BACK CLINIC CONSULTATIONS - 212 Steri Strips 99070 25 To 2.5 cm,Scalp,Extrem.etc. 12001 109 Initial,Extended 90610 1 2131 Dressing,Small 99070 1 26 2.6 to 7.5 cm,Scalp,Extrem. 12002 110 Initial,Comprehensive 90620 214 1 Dressing,Intermediate 99070 28 7.6 to 12.5 cm,Scalp,Extrem. 12004 Ill Extended Consultation F/U 90643 232 Dressing, Large 99070 27 To 2.5 cm, Face. Ears,etc, 12011 111 Consultation 90625 215 Eye Tray 99070 31 Procedure Visit charge -58 217 Eye Irrigation Supplies_ 99070 1 MEDICAL PROCEDURES-DIAGNOSTIC 221 Crutch(Aluminum) 99070 LACERATIONS-INTERMEDIATE REPAIR 14g tj�2!petry 94600 230 Cast Material (Plaster) 99070 35 To 2.5 cm,Scalp.Extrem.etc. 12031, i-1 642 Audiometry 92552 231 Cast Material (Fiberglass)_]99070 36 2. orear �2�2� EKG 93000 0234, Tennis Elbow Strap 9907 5 to".5 m, 028 .;F.T2.5'c.,SE'a'F-Ex-trem. 12034 Tennis Elbow Sleeve 99070 40 To 2.5 cm.Neck,Hands,Feet` *4�)(j 4, PjhIYSICAL THERAPY 239 Thumb Spica Splint 99070 45 To 2.5 cm. Face. Ears etc F1206-1 0' -r85 I'Any Comb. Mod. & Proc. 97200 31 Procedure Visit charge -58 186 Ea.Add'l 15 Min., 97201 LABORATORY 1 087 Eva) 97720 311 1 Urinalysis,-Dipstick 81015 X-RAY 088 Ea.Addl 15 Min. 97721 3121 Urinalysis, Complete 81000 50 Chest,2 Views 71020 Back School 97540 1 52 Ankle 73610 Add 15 Min. Back School, 97541 REFERENCE LAB-DAMON-PLEASANTON,CA 53 Foot 73630 Initial 30 min. 97110 301 Collection/Handling/Interp. 99000 54 Knee 73570 Ea.Addl 30 min. 97145 346 -Culture/Sensitivity- 97070 55 Toes 73660 Back Booklet, 99070 317 CBC 85022 56 Elbow 73080 340 SMAC 25(Lab Scan) 80019 57 Finger 73140 INJECTIONS/MEDICATIONS/IMMUNIZATIONS i;�ifv tibo dy 86689 \,. 58 Hand 73130 161 Adult Td 1.90720- 1 59 Shoulder 73030 - Hepatitis B 1 90731 PHARMACY 60 Wrist 73110 W400 Injection Fee l 90030 ( - . __�/ 99070 61 Cervical Spine 720501 ------ 99070 62 Lumbosacral Spine 72110 MISCELLANEOUS 99070 Thoracic Spine 72070 0352 Dictated Reports 99080 7017 Review of Medical Records. 99081 018 Phone Consultation 99048 ;7 L Ida 4 NIC HA Cki�� DIAGNOSIS •AbF..s/Cellulitis*' "fall (R 922.1 0 Wrist 814.00 0 Wrist 842.00 •Abrasion. Corneal or Scleral- I bo 923.11 El Toe(s) 826.0 0 Tendonitis::'Elbow/-' 727.09 •Allergic Reactions - ., n 5I ub-ungual 923.3 0 Herniated Disc,Cervico-Thoracic 722.0 0 Hand/Wrist/Finger 727.05 • Bue y Site!i U%JX949.@ 924.20 0 Lumbo Sacral 722.10 El Shoulder : 726.10 • Burn, Face, Head 941 bo 923.20 0 Insect Bite, Non-venomous 0 iDeOLiervain's 727.04 0 Foot 945 0 Head/Neck/Face 920 0 Non-infected 919.4 C)Wound:(P6incture,Laceration,' CI Forearm 943.01 '0 Knee 924.11 0 Infected 919.5 Animal Bite, Etc.) • Hands.Wrist Fingers 944.00 0 Leg 924.5 0 Insect Bite,Venomous 989.5;, 0 IF873.40 •leg 945.00 0 Shoulder 923.00 0 Laboratory Test 0_F 883.0 F •Bursitis, Elbow 726.33 0 Toe(s)&Sub-ungual 924.3 0 Radiculopathy: Cervical 723.4 pt, 892.0 0 Hand, Wrist 726.4 0 Wrist 923.21 0 Lumbo-sacral 724A"-'-* 881.00 EI Knee 726.60 0 Degenerative Disc Disease 722.6 '1 0 Hand 882.0 11 Shoulder 726.10 13 Dermatitis: Allergic/Contact 692.9 S K'Ankle'/�. kN-007 0 Leg 891.0. 00 845, d .0 -Mrffx-.� 873.0 949.0 'n Sht 1-9 893.0 692.6 `Sps� n •Carpel Tunnel Syndrome 354.0 1 0 Poison Oak � rO A 64d.m i Wiifr!�� 14-scalp- •Chemical Exposure, Skin 0 Exposure to Communicable 0 Arm/Shoulder----•A;.- 840.9 1 0 Toes-,^,.. T, 0 Gas Vapors/Fumes 987.9 Disease V01.9 0 Cervical 847.0 �-Ubper Arm, 7 880.03 0 Concussion 850.9 0 Foreign Body, Eye 930.9 0 Elbow/Forearm C3 Wrist 814.00 0 With Loss of Consciousness 850.5 0 Soft Tissue 729.6 0 Finger(s) 842.10 •Conjunctivitis,Chemical 372.5 0 Fracture%Ankle 824.8 0 Hip/Thigh 843.9.'-'- •Contusion: 0 Ankle 924.21 El Finger(s) 816.00 0 Knee/Leg 844.9 0 Arm 923.9 0 Foot 825.20 0 Lumbosacral 846.0 0 Back 922.3 0 Hand 815.00 0 Thoracic 847.1 I IAGNCYSI - DIAGNOSIS IF NOT LISTED ABOVE - PLEASE PRINT 7 IS CODE TODAY'S FEE PHYSICIAN'S SIGNATURE , " NURSE'S'S SIGNATURE TIME OUT Credit Card/Cas $ / REVI:E�WESI'..-i.I,NG ANALY; � CAL COMP - NOVA 03/23/94 PATIi�NT : WILLIAMS, LANCE =.... DOCUMENT : 4950438 PROVIDER : SUN VALLEY URGENT CARE MED . CE CLAIM: '220090326 70984 MD01030494 012 PAGE : i ------------------------------------------------------------------------ RVS/GPT DESCRIPTION DATE MESSAGE CHARGE REDUCTION PAYMENT -------------------------------------------------------------------------------- 73610 X-RAY EXAM OF ANKLE 02/15/94 45 . 00 . 00 45 . 00 97720 EXTREMITY TESTING 02/15/94 670 45 . 51 45 . 51 . 04 97721 SUPPLEMENTAL LIMB TESTING 02/;5/94 670 2:3 . 37 23 . 37 . 00 97721 SUPPLEMENTAL LIMB TESTING 02/15/94 670 23 .37 23 . 37 . 00 99080 SPECIAL REPORTS OR FORMS 02/15/94 2206 40 . 00 40 . 00 . 00 99203 OFFICE/OUTPATIENT VISIT, 02/15:94 529 64 . 58 .23 64 . 35 681 -CPT/RVS 90015 CHANGED TO 992'03 REFLECTING SERVICE PERFORMED SUPPLY CRUTCHES, ALUMiNUM 02/15/94 635 50 . 00 14 . 00 3;- . OY- SUPPLY ANKLE BRACE-- AIRCAST 02/1S/94 50 . 00 . 00 50 . 00 99070 SPECIAL SUPPLIES 02/22/94 330 34 . 00 34 . 00 OO 99213 OFFICE/OUTPATIENT VISIT, 02/22/94 39 . 96 . 00 39 . 98 631 -•CPT/RVS 90060 CHANGED TO 919213 REFLECTING SERVICE PERFORMED PAID PR 519904 cw THE ANC,UNTS ! T S T E D AS rEDLfPT'T ON ARE OBJECTED TO S=OP THE F OL L OWIN REASONS : 206-MATERIAL OR PROCEDURE NOT z4GRMALLY CHARGED 330-F.LEASE SUPPL'. THE. IN NUrl9ER FCR THE DISPENSED DRUG, 529-CHARGE 1S INC E CESS OF UNIT VALUEALLOWANCE 635-ME'II CA:T I ONJI'SUPPLY Evc- REASONABLE ALLOWANCE 670-TEST AND MEASUREMENT SHOULD NOT BE BILLED WITH OTHER CPT ' S IF YOU DISAGREE WITH THE REDUCTION( S ) YOU MAY CONiTAICT REVIEWCC AT .THE ADDRESS SHOWN BELOW OR Tt4E INFORMATIONS AND .A"S:. STAtvCE OFcICwPx AT THE NEAREST DISTRICT OFFICE OF THE DIVISION OF INDUSTRIAL ACCIwENTS OR YOU' CAN APPEAL TO THE WORKERS ' COMPENSATION APPEALS BOARID . ---------------------------------------------------------- MEOONY02901 •0225001,647127CAF F w15 . S1 177 . 46 2718 . 21-': SUN} VALLEY URGENT CARE .:i. . CE IRL.VIEW;:.0 i iN#CtUif?iWS) 1 1 -11)10 CONTRA COST A ;7Ldn P . 0 . BOX '19533 CONCORD, CA :1;:523 IRVINE, CA 32713 rf Sun Valley Medical Carte r•.: !Ur ieni dare-Occupd6nalHealth81984 g? 42' f 1 QO Oztra Costa Blvd.,Concord,CA 94523 �T�L"+ �� .,' "' p IRS#68-0245268 Work Comp.Coordinators(5 08255-2748' WOR r-R'S COMPENSATION Provider#ZZZ 91375Z . PATIENT PATIENT I.D. FEE TICKET NO. DATEN W T 1 VA.-T IS. L.rtr`1[F J. 5, �4 J. II 1� Fs ' tom• �=5''r}''r i r.1rt � ;:�:1 1 CDiDT tl � rJ , TREATMENT- E.M.CODE AMT TREATMENT CPT "AMT TREATMENT - CPT AMT INITIAL OFFICE VISIT SURGICAL PROCEDURES SUPPLIES`— I UPPLIES"- - 1 Office Visit Brief 90000 84 1 Remove F.B. Subcut 10120 201 Cervical Collar 99070 Office Visit Limited 87 Debridement of Wound 11000 203 Cradle Sling 99070 3 Mice Visit Intermed. 90015 88 Burn,Small,Debride&Dress 16020 204 Elastic Bandages -inch 99070 Office Visit,Comprehensive 90020 V 92 Removal F.B.Conjunctiva 65210 220 Knee Sleeve(Neoprene) 99070 95 Removal F.B.Cornea 65220 205 Knee Splint(Small,Med.,Lg.) 99070 ESTABLISHED PATIENTS-OFFICE VISITS 101 Sub-Ungual Hematoma 11740 206 Splint Finger 99070 9 Office Visit Brief 90040 31 Procedure Visit charge -58 207 Splint Wrist 1&70 10 Office Visit Limited 90050 --26U Air Cast Ankle Splint 99070 11 Office Visit, Intermed. 90060 'SPLINTS/CASTS 2091 Rib Belt 99070 18 Office Visit, Extended 90070 333 Short Arm Splint 29125 210 Surgical Tray 99070 010 Office Visit Comprehensive 90080 335 Short Leg Splint 29515 211 Suture Material X 99070 „ 615 Suture Removal Tray 99070 LACERATIONS-SIMPLE REPAIR CPT BACK CLINIC CONSULTATIONS 212 Steri Strips 99070 25 -To 2.5 cm,Scalp,Extrema etc', 12001, 109' Initial, Extended` - 90610 213 'Dressing,Small 99070 26 2.6 to 7.5 cm,Scalp.Extrem. 12002 110 Initial, Comprehensive 90620 214 Dressing, Intermediate y99070 28 7.6 to 12.5 cm,Scalp,Extrem. 12004 111 Extended Consultation F/U 90643 1 232 Dressing, Large 99070 27 To 2.5 cm, Face, Ears,etc. 12011 111 Consultation 90625 215 Eye Tray 99070 31 Procedure Visit charge -58 217 Eye Irrigation Supplies 99070 MEDICAL PROCEDURES-DIAGNOSTIC 1 rutch(Aluminum) 99070 {r LACERATIONS-INTERMEDIATE REPAIR 1 142 Spirometry 94600 230 Cast Material(Plaster) 99070 35 To 2.5 cm,Scalp.Extrem.etc. 12031 0142 Audiometry 92552 231 Cast Material(Fiberglass) 99070 36 2.5 to 7.5 cm,Scalp,Extrem. 12032 EKG 93000 0234 1 Tennis Elbow Strap 99070 028 7.6 to 12.5 cm,Scalp,Extrem. 12034 Tennis Elbow Sleeve 99070 40 To 2.5 cm;Neck,Hands,Feet 12041 PHYSICAL THERAPY 239 Thumb Spica Splint 99070 45 To 2.5 cm, Face. Ears, etc. 12051 185 Any Comb. Mod. & Proc. 97200 ' 31 Procedure Visit, charge -58 186 Ea.Add'I 15 Min. 97201. LABORATORY !W, .Eval 97720 311 Urinalysis, Dipstick 81015 X-RAY 'tOW Ea.Add'I 15 Min. ' '1� 97721 ::. 7U 312 Urinalysis, Complete 81000 50 Chest, 2 Views 77020 Back School 97540 - 5a Ankle 73610 Add 15 Min. Back School 97541 REFERENCE LAB-DAMON-PLEASANTON,CA 53 1 Foot 73630 Initial 30 min. 1 97110 301 Collection/Handling/Interp. 99000 54 Knee 73570 Ea.Add'I 30 min. 97145 346 Culture/Sensitivity 87070 55 Toes 73660 Back Booklet 99070 317 CBC 85022 56 Elbow 73080 340 SMAC 25(Lab Scan) 80019 57 Finger 73140 INJECTIONS/MEDICATIONS/IMMUNIZATIONS HIV Antibody 86689 58 Hand 73130 161 Adult Td 90720 59 Shoulder 73030 Hepatitis B 90731 PHARMACY 60 Wrist 73110 W400 Injection Fee 90030 99070 61 Cervical Spine 72050 99070 62 Lumbosacral Spine 72110 -MISCELLANEOUS 99070 Thoracic Spine 72070 ,��0352.• Dictated Reports < 99080� I irNa _ 12. ,X OV b 017Review of Medical Records 99081 tl 1"Y 018 Phone Consultation 99048 DIAGNOSIS ❑Abcess/C I�,/�p - s Wall (Ribs) 922.1 ❑Wrist 814.00 ❑Wrist 842.00 ❑Ate! Ila ltbrlB�I�r 1 �8-E1bt7W 923.11 ❑Toe(s) 826.0 ❑Tendonitis: Elbow 727.09 ❑F)fw% FFFRRR�fff��BBBacIAAibbbrrrf►►bbb�VV995.3 ❑Finger(s) & Sub-ungual 923.3 ❑Herniated Disc,Cervico-Thoracic 722.0 ❑Hand/Wrist/Finger 727.05 ❑Burn,Any Site - 949.0 ❑ Foot 92420 ❑Lumbo Sacral 722.10 ❑Shoulder 726.10 ❑ B ad 941.00 s) 923.20 ❑Insect Bite, Non-venomous ❑ DeQuervain's 727.04 ❑ Head/Neck/Face 920 ❑Non-infected 919.4 ❑Wound:(Puncture,Laceration, orearm 943.01 ❑Knee 924.11 ❑Infected 919.5 Animal Bite, Etc.) ❑ Hands,Wrist, Fingers 944.00 ❑Leg 924.5 ❑Insect Bite,Venomous 989.5 ❑Face 873.40 ❑ leg 945.00 ❑Shoulder 923.00 ❑ Laboratory Test V72.6 ❑Finger(s) 883.0 ❑ Bursitis, Elbow 726.33 ❑Toe(s)&Sub-ungual 924.3 ❑ Radiculopathy: Cervical 723.4 ❑ Foot AR, 892.0 ❑ Hand,Wrist 726.4 ❑Wrist 923.21 ❑ Lumbo-sacral 724.4 rearm ,e 881.00 ❑Knee 726.60 ❑Degenerative Disc Disease 722.6 ❑Rash �\ - _7Z 1 pd A 882.0 ❑Shoulder 726.10 ❑ Dermatitis: Allergic/Contact 692.9 PhSprain &Strai An 8425..00 %C300 v •r �i• 891.0 ❑Carpal Tunnel Syndrome 354.0 ❑Poison Oak ,`692.6 ❑Abdominal if- "'848:6 ❑s4ato, ;-' 873.0 ❑Chemical Exposure,Skin 949.0 ❑Exposure to Communicable ❑Arm/Shoulder 840.9 ❑To4�, 893.0 ❑Gas Vapors/Fumes 987.9 Disease V01.9 ❑ Cervical 847.0 11Uppek Arm.CP 88 ❑Concussion 850.9 ❑Foreign Body,Eye 930.9 ❑Elbow/Forearm 841.9 ❑Wrist e!r� 0 ❑With Loss of Consciousness 850.5 ❑Soft Tissue 729.6 ❑Finger(s) 842.10 �v ❑Conjunctivitis, Chemical 372.5 ❑Fracture:,Ankle 824.8 ❑ Hip/Thigh 843.9 L ❑Contusion: ❑Ankle 924.21 ❑Finger(s) 816.00 ❑Knee/Leg 844.9 ❑Arm 923.9 ❑ Foot 825.20 ❑Lumbosacral 846.0 � S, ❑ Back 922.3 ❑Hand 815.00 ❑Thoracic 847.1' DIAGNOSIS IF NOT LISTED ABOVE - PLEASE PRINT DIAGNOSIS CODE RECE T TODAY'S FEES 7!I C �� PHYSICIAN'S SIGNATURE �l/ ^A r;•,(�IL;L � NURSE'S SIGNATURE TIME OUT Credit Card/Cash $ _,TI)II S c ..., Check $ R'L • )E�WSq`„BI;LING ANALYS CAL �tiOMP — NOVAI 03/16/94 PATIENT : WILLIAMS, LANCE DOCUMENT : 4950431 PROVIDER : SUN VALLEY URGENT CARE "IED . CE CLAIM : 20090326 70984 MD01030794 012 PAGE : 1 -----------------------------._------------__------------------------------_---- RVS/CPT DESCRIPTION DATE MESSAGE CHARGE REDUCTION PAYMENT -----------------------------------------------------------_.-------------------- 73610 X—RAY EXAM OF ANKLE 03/01 /94 45 . 00 . 00 45 . 00 99213 OFFICE/OUTPATIENT VISIT, 03/01 /94 40 . 04 . 00 40 . 04 PAID ,NIAR 2 81994 Cw E{)iJ�iY07 ?0C 0cir0J(sb��is (CAR 8,[ 0< 0 v .,JN VALE iii GErdT CsiEiE MEal . C� REVIEW,CO ( INQUIRIES ) i20 CONTRA roc- A SLV13 . r . O , 8C�`r ? 9E3? SON COR,D, CA rA:-23 IRVINE, CA 92713 E f 1 4 ? 7 SB—'933 EX 5889 44� N i7 Sun"L'*.y Medical Care kr' Urgent Clare-Occupational Health 1,:00,C.ontra Costa Blvd.,Concord CA 9452331 tl�d 8-0245' 8 (510)82.5-2000' FAX(510)825-0861 WORKERS C`OMPE MAR 14 loat NA ON Provider#=91375Z Work Comp.Coordinator(510�82&2748 PATIENT PATIENT I.D. FEE TICKET NO. DATE NWT1_L1 ^MS , 1_407E i I;P 4;1;- 03,`fJ ID . 0 . R 06 OR : 513 001 TREATMENT E.M.CODE AMT TREATMENT CPT ANT TREATMENT CPT AMT INITIAL OFFICE VISIT SURGICAL PROCEDURES SUPPLIES 1 Office Visit Brief 90000 84 Remove F.B.Subcut 10120 201 Cervical Collar 99070 2 Office Visit Limited 90010 87- Debridement of Wound iiOW 203 Cradle Sling 99070 3 Office Visit Intermed. 90015 88 Burn,Small,Debride&Dress 16020 204 Elastic Bandages -inch 99070 4 Office Visit Comprehensive 90020 92 Removal F.B.Conjunctiva 65210 220 Knee Sleeve(Neoprene) 99070 95 Removal F.B.Cornea 65220 205 Knee Splint(Small,Med,Lg.) 99070 ESTABLISHED PATIENTS-OFFICE VISITS 121 §ub-eUnugr ua111emeloma 11740 206 Splint Finger 99070 3i 9 Office Visit Brief 90040 Procedure rocda Visit,charge .58 207 1 Splint,Wrist 99070 10 Office Visit, Limited 9005CLA 2W W), 208 Air Cast Ankle Splint 99070 l 1 )Offi..Visit Intermed. SPLINTS/CASTS 209 Rib Belt 99070 18 Office Visit. Extended 90070 333 Short Arm Splint 29125 210 Surgical Tray 99070 010 Office Visit,Comprehensive 90080 335 Short Leg Splint 29515 211 Suture Material X_ 99070 615 Suture Removal Tray 99070 LACERATIONS-SIMPLE REPAIR CPT BACK CLINIC CONSULTATIONS 212 Steri Strips 99070 25 To 2.5 cm,Scalp,Extrem.etc. 12001 109 Initial, Extended 1 90610 213 Dressing,Small 99070 26 2.6 to 7.5 cm,Scalp.Extrem. 12002 110 Initial,Comprehensive 90620 214 Dressing,Intermediate 99070 28 7.6 to 12.5 cm,Scalp,Extrem, 12004 111 Extended Consultation F/U 90643 232 Dressing, Large 99070 27 To 2.5 cm, Face, Ears,etc. 12011 111 Consultation 90625 215 Eye Tray 99070 31 Procedure Visit charge -58 217 Eye Irrigation Supplies 99070 MEDICAL PROCEDURES-DIAGNOSTIC 221 Crutch (Aluminum) 99070 LACERATIONS-INTERMEDIATE REPAIR 142 Spirometry 94600 230 Cast Material (Plaster) 99070 35 To 2.5 cm,Scalp:'Efrem.etc. lMl 0142 Audiometry 1 92552 231 Cast Material(Fiberglass) 99070 36 2.5 to 7.5 cm,Scalp.Extrem. 12032 EKG 93000 0234 Tennis Elbow Strap 99070 028 7.610 12.5 cm,Scalp.Extrem. 12034 Tennis Elbow Sleeve 99070 40 To 2.5 cm.Neck,Hands,Feet 12041 PHYSICAL THERAPY 239 Thumb Spica Splint 99070 45 To 2.5 cm, Face. Ears,etc. 12051 185 Any Comb. Mod. & Proc. 97200 31 Procedure Visit, char6e -58 186 Ea.Add'I 15 Min. 97201 LABORATORY 1 1 087 Eval 97720 311. Urinalysis,Dipstick 81015 X-RAY 088 Ea.Add'I 15 Min. 97721 312 Urinalysis,Complete 81000 Chest,, 2 Views 71020 Back School 97540 52 Ankle 73610 Add 15 Min. Back School 97541 REFERENCE LAB-DAMON-PLEASANTON,CA 3 Foot 73630 Initial 30 min. 97110 301 Collection/Handling/Interp. 99000 54 Knee 73570 Ea Add'I 30 min. 97145 346 Culture/Sensitivity- 87070 55 Toes 73660 Back Booklet 99070 317 CBC 85022 56 Elbow 73080 340 SMAC 25(Lab Scan) 80019 57 Finger 73140 INJECTIONS/MEDICATIONS/IMMUNIZATIONS HIV Antibody 86689 58 Hand 73130 161 Adult Td 90720 59 Shoulder 73030 Hepatitis B 90731 PHARMACY 60 Wrist 73110 W400 Injection Fee 90030 99070 61S 72050 ) 99070 62 (ToWIT4 7T11 I MISCELLANEOUS 99070 F_ Thoracic YR52 I Dictated Reports 99080 ft Pz 0171 Review of Medical Records 99081 Phone RAIr%W_0018 P,,a Consultation 99048 n 4� 10Q 4 IJ1J_r AP?_-il U_ V Ez U W 9994 DIAGNOSIS 0 Abcess/Cellulitis 682.9 0 Chest Wall (Ribs) 922.1 0 Wrist 814.00 0 Wrist 842.00 0 Abrasion, Corneal or Scleral 871.9 0 Elbow 923.11 0 Toe(s) 826.0 0 Tendonitis: Elbow 727.09 •Allergic Reactions 995.3 0 Finger(s)&Sub-ungual 923.3 0 Herniated Disc,Cervico-Thoracic 722.0 13 Hand/Wrist/Finger 727.05 • Burn,Any Site 949.0 0 Foot 924.20 D Lumbo Sacral 722.10 ...,.,-O'Should r 726.10 •Burn, Face,Head 941.00 0 Hand(s) 923.20 0 Insect Bite,Non-venomous 0 DeQuervain's 727.04 •Foot 945.02 0 Head/Neck/Face 920 0 Non-infected P.Wound:(Puncture,Laceration, •Forearm 943.01 0 Knee 924.11 13 Infected 9195' -- Animal'.Bite' Etc.) •Hands,Wrist Fingers 944.00 0 Leg 924.5 0 Insect Bite,VenomoVenomous98§5' __ `%11 Face 873.40 • leg 945.00 13 Shoulder 923.00 0 Laboratory Test0 Finger(s) 883.0 • Bursitis, Elbow 726.33 0 Toe(s)&Sub-ungual 924.3 0 Radiculopathy: Cervical V-'72374 0 Fool-, 892.0 • Hand, Wrist 726.4 0 Wrist 923.21 0 Lumbo-sacral t i 724.4 0'Forearm 881.00 •Knee 726.60 0 Degenerative Disc Disease 722.6 5" '782.1 0"Hand 882.0 El Shoulder 726.10 0 Dermatitis: Allergic/Contact 692.9 Sprain; StraiCAnkle/F�ot O'Leg 891.0 'fj48:0--- 0 Scalp 873.0 •Carpel Tunnel Syndrome 354.0 0 Poison Oak 692.6 0-Abdorninal'Wall zz •Chemical Exposure, Skin 949.0 0 Exposure to Communicable 0 Arm/Shoulder 840.9 0 Toes 893.0 0 Gas Vapors/Fumes 987.9 Disease V01.9 0 Cervical ':;6417.0 0 Upper Arm 880.03 •Concussion 850.9 0 Foreign Body, Eye 930.9 0 Elbow/Forearm 841:9 0 Wrist 814.00 0 With Loss of Consciousness 850.5 0 Soft Tissue 729.6 0 Finger(s) 84210 •Conjunctivitis. Chemical 372.5 0 Fracture%Ankle 824.8 0 Hip/Thigh •Contusion: 0 Ankle 924.21 0 Finger(s) 816.00 0 Knee/Leg 84 8443'9 •Arm .9 923.9 0 Foot 825.20 0 Lumbosacral 846.01 • Back 922.3 0 Hand 815.00 0 Thoracic 11�847,1 DIAGNOSIS IF NOT LISTED ABOVE PLEASE PRINT t DIAGNOSIS CODE �EP ,TODAY'S E PHYSICIAN'S SIGNATURE NURSE'S SIGNATURE -61_ME OUT I Check htVTEWC'O BILLING ANALYST CAL COMP - NOVAT 03/14/94 PATIENT : WILLIAMS, LANCE DOCUMENT : 494G191 - PROVIDER : SUN VALLEY URGENT CARE MED. CE CLAIM : 20090326 70984 MD01030494 012 PAGE : 1 ------------------------------------------------------------------------------- RVS/GPT DESCRIPTION DATE MESSAGE CHARGE REDUCTION PAYMENT ------------- -------------------------------------------------------------------- 97110 THERAPEUTIC EXERCISES 02/16/94 667 .38 . 13 4 . 92 33 . 11 97145 EXTENDED PHYSIOTHERAPY 02/16/94 10 . 46 . 00 10 . 46 97145 EXTENDED PHYSIOTHERAPY 02/16/94 10 . 46 . 00 10 , 46 - PAID 0 . 46PAID 319194 THE AMOUNTS LISTED AS REDUCTION ARE GBTECTED TO FOR THE FOLLOWING REASONS : 667-CHARGE IS IN EXCESS OF UNIT VALUE/MULTIPLE PROCEDURE RULES IF YOU, DISAGREE WITH THE REDUCTION( S ) YO"� IMAY CONTACT REVIEWCO AT THE ABDRE.CZS SHOWN BELOW OR THE INFORMATION AND ASSISTANCE OFFICER AT THE. NEAREST DISTRICT OFFICE OF THE DIVISION OF INDUSTRIAL ACCIDENTS OR YOU CAN APPEAL TO THE WORKERS ' ' COMPEN :AT I ON APPEALS BOARD . c-OONY0370 60225000747224CAR 519 . 05 4 . ZE 54 . 17 SUN VALLEY .URGENT CARE MED . • CE R EV IEWCO C T NQU i R 1 ES 1 1 00 CONTRA COSTA BLVD . P . G , BOX 19533 CONkr"ORD, CA 94523 IRVINE . CA 92713 (': 14) 753-S933 EX 585" L L [A Sin Valley Medical Care L Urgent Care-Occupational HeWth 5 '�'ga 1100 Contra Costa Blvd.,Concord.CA 94523 825-2000 FAX(510)825-0861 IRS#6� 24*1h Work Comp.Coordinator(510)825-2748 WORKER'S COMPENSATION Pr"Wrv. 91-375Z'' PATIENT PATIENT 1.0. FEE TICKET T-9 4 6 191 DATE MAR 0`5 .,a P TREATMENT E.M.CODE I AMT TREATMENT CPT AMT TREATMENT CPT AMT INITIAL OFFICE VISIT SURGICAL PROCEDURES SUPPLIES 1 Office Visit Brief 90000 84 Remove F.B.Subcut 10120 201 Cervical Collar 99070 2 Office Visit Limited 90010 87 Debridement of Wound 11000 203 Cradle Sling 99070. 3 Office Visit Intermed. 90015 88 Burn,Small,Debride&Dress 16020 204 Elastic Bandages -inch 99070 4 Office Visit Comprehensive SW20 92 Removal F.B.Conjunctiva 65210 220 Knee Sleeve(Neoprene) 99070 95 Removal F.B.Cornea 65220 205 Knee Splint(Small,Med.,Lg.) 99070 ESTABLISHED PATIENTS-OFFICE VISITS 101 Sub-Ungual Hematoma 11740 d206 Splint Finger 99070 9 Office Visit, Brief 90040 31 Procedure Visit charge -5a 207 Splint Wrist 99070 10 Office Visit, Limited 90050 208 Air Cast Ankle Splint 99070 209 11 Office Visit Intermed. 90060 SPLINTS/CASTS 209 Rib Belt 99070 18 Office Visit. Extended 90070 333 Short Arm Splint 29125 210 Surgical Tray 99070 010 Office Visit Comprehensive 90080 3351 Short Leg Splint 29515 211 Suture Material X_ 99070 615 Suture Removal Tray 99070 LACERATIONS-SIMPLE REPAIR CPT BACK CLINIC CONSULTATIONS 212 Steri Strips 99070 25 To 2.5 cm,Scalp,Extrem.etc. 12001 109 1 Initial, Extended 90610 213 Dressing,Small 99070 26 2.6 to 7.5 cm,Scalp,Extrem. 12002 110 Initial,Comprehensive 90620 214 Dressing, Intermediate 99070 28 7.6 to 12.5 cm,Scalp,Extrem. 12004 111 Extended Consultation F/U 90643 232 Dressing,Large 99070 27 To 2.5 cm, Face, Ears. etc. 12011 111 Consultation 90625 215 Eye Tray 99070 31 Procedure Visit.charge -58 217 Eye Irrigation Supplies 99070 MEDICAL PROCEDURES-DIAGNOSTIC 221 Crutch (Aluminum) 99070 LACERATIONS-INTERMEDIATE REPAIR 142 Spirometry 94600 230 Cast Material (Plaster) 99070 35 To 2.5 cm.Scalp,Extrem.etc. 12031 0142 Audiometry 92552 231 Cast Material(Fiberglass) 99070 36 2.5 to 7.5 cm,Scalp,Extrem. 12032 EKG 93000 0234 Tennis Elbow Strop 99070 028 7.6 to 12.5 cm,Scalp,Extrem. 12034 Tennis Elbow Sleeve 99070 40 To 2.5 cm,Neck,Hands,Feet 12041 -PHYSICAL THERAPY 1 239 Thumb Spica-Splint 99070 45 To 2.5 cm, Face, Ears, etc., 12051 Any Comb. Mod. & Proc. 97200 31 Procedure Visit charge -58 186 Ea.Add'I 15 Min. 97201 1 LABORATORY 087 Eval 97720 311 1 Urinalysis, Dipstick 81015 X-RAY 088 Ea.Add'I 15 Min. 97721 3121 Urinalysis,Complete 81000 50 Chest,2 Views 71020 Back School 97540 1 52 Ankle 73610 Add 15 Min. Back School 97541 REFERENCE LAB-DAMON-PLEASANTON,CA 53 Foot 73630 Initial 30 min. 97110 301 Collection/Handling I Interp. 99000 54 Knee 73570 Ea.Add'I 30 min. 97145 346 Culture/Sensitivity. 87070 55 Toes 73660 Back Booklet 199070 1 317 CBC 85022 56 Elbow280 1 1 340 SMAC 25 (Lab Scan) 80019 57 Finger �723140 INJECTIONS/MEDICATIONS/IMMUNIZATIONS HIV Antibody 86689 58 Hand 73130 161 Adult Td 90720 59 Shoulder 73030 Hepatitis90731 B/ PHARMACY ^\ 60 Wrist 73110 W400 InjectiW(X'q0 90030 99070 61 Cervical Spine 72050 99070 62 Lumbiasacral-SPine- 72110 MI W66,0Ebtfs 99070 Th 0%j S&I I if -'Dic te -_�Ieports 908 720=7 U337, 9 A7,o-%evi4 of Medical F!Nqr(W 9081 ne c(;46ftnion X J99048 4 IqCI4-- A N U DIAL SIWI, •AbcesKelkilgiis'. 13 V`Wii6V'/""1 81C00 [3 Wrist 842.00 . 'eallo r 923.1 - )".1 826.0 0 Tendonitis: Elbow 727.09 •Abra! r-Se4e --,4T$rkDd� WR H 's -un 1 23.3 led Disc,Cervico-Thoracic 72Z0 0 Hand/Wrist/Finger 727.05 •Allergic Reactions 995.3 gu7� Off ftia' • Burn,Any Site 949.0 0 Foot .20._ 0 Lumbo Sacral 722.10 0 Shoulder 726.10 • Burn. Face, Head 941.00 0 Hand(s) 92 0 ..' Tb in 't Bite, Non-venomous 0 DeQuervain's 727.04 •Foot 945.02 0 Head/Neck/Face 920 Non-infected 919.4 0 Wound:(Puncture,Laceration, •Forearm 943.01 0 Knee 924.11 0 Infected 919.5 Animal Site,Etc.) •Hands,Wrist, Fingers 944.00 0 Leg 924.5 7.Insect Bite,Venomous 989.5 0 Face 873.40 13 leg 945.00 0 Shoulder 923.00 f3 Laboratory Test V72.6 0 Finger(s) 8810 •Bursitis, Elbow 726.33 0 Toe(s)&Sub-ungual 924.3 0 Radiculopathy: Cervical 723.4 0 Foot 892.0 •Hand, Wrist 726.4 0 Wrist 923.21 0 Lumbo-sacral 724.4 0 Forearm 881.00 • Knee 726.60 0 Degenerative Disc Disease 722.6 0 Rash 782.1 0 Hand 882.0 •Shoulder 726.10 0 Dermatitis: Allergic/Contact 692.9 0 Sprain &Strain: Ankle/Foot 845.00 [3 Leg 891.0 • Carpal Tunnel Syndrome 354.0 0 Poison Oak 692.6 0 Abdominal Wall 848.8 D Scalp -873.0- •Chemical Exposure,Skin 949.0 0 Exposure to Communicable 0 Arm/Shoulder 1540.9 0 Toes 893.6 0 Gas Vapors/Fumes 987.9 Disease V01.9 D Cervical 1,,/ 1147.0 0 Upper Arm 880.03 •Concussion 850.9 0 Foreign Body, Eye 930.9 0 Elbow/Forearm 841.9 0 Wrist 814.00 0 With Loss of Consciousness 850.5 0 Soft Tissue 729.6 El Finger(s) 842.10 - • Conjunctivitis, Chemical 372.5 0 Fracture:,Ankle 824.8 0 Hip/Thigh 843.9 •Contusion:0 Ankle 924.21 0 Finger(s) 816.00 0 Knee/Leg 844.9 0 Arm 923.9 0 Foot 825.20 D Lumbosacral 846.0 0 Back 922.3 0 Hand 815.00 0 Thoracic 847.1 DIAGNOSIS IF NOT LISTED ABOVE - PLEASE PRINT DIAGNOSIS CODE RECEPT TODAY'S FEES PHYSICIAN'S SIGNATURE NURSE'S SIGNATURE TIME OUT Credit Card/Cash $ Check $ CLERICAL INSTRUCTION SHEET ' CLAIMANT L by, ( (1/� S 1 CLAIM# ��0�0 3 2 0-( — INDEX LINE _ RESERVE REOPEN MEDICAL CLOSE CASE INDEMNITY RESERVE CHANGE REHAB EXPENSE UNIT STAT INFORMATION METHOD OF SETTLEMENT %OF DISABILITY CAUSE CODE WEEKLY WAGE CHECK REQUEST KIND CODE PAYEE AMOUNT DATE OF SERVICE R�1 � 1 aI 4 MISC. „' E�I�;�L RECEIVED STOP PAY REQUEST: CHECK# AMOUNT$ ISSUE DATE MICHAEL CRESPO BY: OAR1 1994 DATE: TRANSPORTATION AND Dltl(; RIJN]11-LIRSI;NIF,N1' REQUEST You are entitled to reimbursement for travel expense to and from medical treatment necessary as a result of your industrial injury. }'ou may also request reimbursement for your travel expense in connection with vocational ri,!::,hilitation activities. You are entitled to reimbursement for drug expense. Lance Willimas Claim No . : 20090326;�32-8" 4609 Pottrero Ave. Employer : La Cheim School Richmond, CA 94804 Employee : Lance Willimas D/Injury : 2-15-94 MILEAGE Date of Name & Address of Doctors Round Trip Appt. or Rehab. Destination Mileage mi le s a-, "yY Sv 61 V G j.e,r, �y -e_d o 6 4 ( —-- - --- -----_ ._.. G - I c,t,ci 11 i°1 1 eage DRUG REIMBURSEMENT (ATTACH RECEIPTS) -_- Date Pharmacy Doctor I Pr- er-crij)t..inn Name of Drug Amount DARLA PA ' MSR 1 I); uc Expense. ,��.:. 9� /i./i;., Signature — _ � DatE CALIFORNIA COMPENSATION INSURANCE CO. * 504 REDWOOD BOULEVARD P.Q. BOX 800 * NOVATO, CALIFORNIA 94948 415/883-2503 * 800/388-3179 t +; woo Z 1-9 C) u. 0 a 0 , d ; U 0 0 pZ � Q Z� 6 dO S ) woo -Z Q LL � Q2 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 13, 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. fe action taken on your claim by the Board of Supervisors aragraph 1V below), given pursuant to Government Code Amount: $897.89 AUG t91994section 913 and 915.4. Please note all "Warnings". CLAIMANT: Carr, Victoria D. COUNTY COUNSEL MARTINEZ CALIF. ATTORNEY: Date received ADDRESS: 2250 Mt. Whitney Dr. BY DELIVERY TO CLERK ON August 18, 1994 Pittsburg, CA 94565 BY MAIL POSTMARKED: Hand Delivered via: Risk Mgmt. 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppH IL ATCHELOR, Clerk w � DATED: 81: puty 11. FROM: County Counsel 70t Clerk of the Board of Supervisors ( his 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:Z Z- — BY: ( �--" Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARD 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: /3 PHIL BATCHELOR, Clerk, By \1- � � P Q , Deputy Clerk YARNING (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 Goverment Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this natter. 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 1 deposited to the United States Postal Service in Martinez. Lelifornia. .postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated I�f 199BY: PHIL BATCHELOR by �a , l ' ,n Q„a Deputy Clerk CC: County Counsel County Administrator Cla:- 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 RECEIVE® Against the Co my of Contra Costa _AUG 8 1994 1 . 4A District) CLERK BOARD OF Su tRVISORS Fill in name) L CONTPA COSTA CO. The undersigned claimant hereby makes claim against th County of Contra Costa or the above-named District in the sum of $ SW-9` and in support of this claim represents as follows: 1. When did t -d e r` jinjury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) / lka blrj 0 U-A1 M- --- - 3. How did the damage or injury occur? (Give full details; use extra paper if. required) ,�o Win& Colue6rt-'o Co0se �rrG¢tJ�f sho-I up 1J�'I/in/y Q U-f r �i�e/ Rom .es �Jj ��5 6�t &, e' side "eacks xiif y Cp cracted /ny GU1nG�fti(e d G''Ir:�pO :,, 6N My Gi6o� c e44. 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? ,4�� . CQ SSG �A e bra ✓e,( t,)aS Jo o 5e, ��- c C�uSC 41y u f wXen Cars are dry tai t)l ®n 14 wnat are the names of county or district officers, servants or employees causing the da: ge or injury? ------------------------ a'4D-- re 1,d ------------------------------------ 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimatesforauto damage. Aoi('Pn (, m6(5ki-e-ld C h loped ------------------------------ �.�--=--- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) ��S T- -F0 p � t,o o� cif �� ---------------------------------- B. :James and addresses of witnesses, doctors- an'. h0spital.s. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Or Gov. Code Sec. 910:2 provides:. "The claim must be 'fined by the claimant SEND NOTICES TO: (Attorney)_ or by s%w, person On is behalf." Name and Address of Attorney lai s t Si tune a 6 M4, 7— Address) Telephone No. Telephone No. l�l 02 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 Vone,,,�year, by a fine of not exceeding one thousand ($1,000), or by both such'imprisoninerit'iand fine, or by imprisonment in the state prison, by a fine of not exceeding Lten ,Viousand dollars ($10,000, or by both such imprisonment and fine. A 17 Nov4 I JIM' S CAL AUTO BODY, INC. 1705 SOMERSVILLE ROAD ANTIOCH, CA 94509 (01574636 Fax: 50) 754-3614 Visible Damage Quotation #1062 by ANNA REED on 08-12-94 VICKY CARR 2250 MT. WHITNEY DR. Style 4 DOOR Insurer : SELF Lic. Plate: 2KRY189 Adjuster : PITTSBURG, CA 94565 Paint Code: Appraiser: Phone: 458-2973/ Prod. Date: 4/88 Claimant : 88 BUICK CENTURY Profile : STANDARD Insured VIN: 1G4AL5135J6435091 Deddctible: 0.00 Policy # : Mileage: 57369 Claim # Options: # Labor Op Description Price Labor Paint Labor Group Price Group 1 REPAIR HOOD PANEL 0.00* 1.0* 2.8 BODY EXISTING 2 R & I CTR HOOD MOULDING 0.00* 0.3* 0.0 BODY EXISTING 3 REPLACE W/SHIELD GLASS 387.15 2.0 0.0 GLASS NEW 4 COVER VEHICLE FOR OVERSPY 5.00* 0.0 0.0 NEW 5 ADL OPER CLEAR COAT 0.00 1.1 0.0 REFINISH * 6 ADL OPER TINT COLOR 0.00 0.5* 0.0 REFINISH * * Judgement Item Summary BODY 1.3@ 48.00 62.40 PAINT MATERIALS 96.80T NEW 392.15T REFINISH 4.4@ 48.00 211.20 GLASS 2.0@ 48.00 96.00 Non-Taxed Labor 369.60 Taxed Costs 96.80 Taxed Parts 392.15 Tx 8.250% 7.99 Tx 8.250$ 32.35 Labor ( 7.7 hrs) 369.60 Add' l Costs/Materials 96.80 Parts 392.15 Tax 40.34 Grand Total 898. 89 EstiMate CX is a trademark of Nitchell International Copyright 1991, 1994 All Rights Reserved t • - C3 Page ^of Pages Glenn's Auto Body @ Mazzei Pontiac 089'22 1530 W.10th Street Suite B y Antioch,Ca 94509 1811 (510)757-7015 (510)778-1930 NAME - PHONE DATE STREET — ( 1 ) A ` CITY�F• YEAR COLOR MAK MODEL REGISTRATION NO. SERIAL NO. ODOMETER ESTIMATE PREPARED BY INSURANCE CO. - ADJUSTOR REPLACE REPAIR DESCRIPTION I PARTS LABOR REFINISH. SUBLET oced a bnncs :n o GOAoe M .44 . 5 S K TOTALS .1a,-7 10.1r The above is an estimate based on our inspection and does not TOTAL PARTS $ cover any additional parts or labor which may be required after the work has been started. Occasionally, worn or damaged parts are TOTAL LABOR . . . . . . . . . . ... . . . $ 1 -29 .�6 Z) discovered which may not be evident on the first inspection.Because of this,the above prices are not guaranteed.Quotations on parts and TOTAL REFINISH . . . . . . . ... . . . . $��. labor are current and subject-to change. TOTAL 9tf$'tfT !nM'`'. . . . .. . $ �40 AUTHORIZATION FOR REPAIR.You are hereby authorized to ♦C1•�� make the above repairs: TAX . .. . . . .. . . . .... . . ... . . ... $ SIGNED: $ p L' DATE: TOTAL .. . ... . . .. . . ...... . . . $ O�O� PRODUCT 660 Inc,Groton,Mass.01471.To Order PHONE TOLL FREE I-W-225-M - Page of Pages 08923 GLENN'S AUTO BODY 1610 West 10th Street • Antioch,California 94509 • (510)778-1330 NAME - PHONE DATE STREET CITY YEA COLOR MAKE MODEL QL�,�rv, REGISTRATION NO. SERIAL NO. ODOMETER ESTIMATE PREPARED BY INSURANCECO. ADJUSTOR REPLACE REPAIR DESCRIPTION PARTS LABOR REFINISH SUBLET TOTALS The above is an estimate 'based on our inspection and does not TOTAL PARTS .. . . ... . .... . .. . $ P®.cw cover any additional parts or labor which may be required after the work has been started. Occasionally, worn or damaged parts are TOTAL LABOR . . . . . . . . . . . ..... $ r discovered which may not be evident on the first inspection.Because of this,the above prices are not guaranteed.Quotations on parts and labor are current and subject to change. TOTAL REFINISH . . . . . . . . . . . . . . $ AUTHORIZATION FOR REPAIR.You are hereby authorized to TOTAL SUBLET ... .. . . . .... . . . $ make the above repairs: _ TAX .... . $ C�4 �s SIGNED- DATE: TOTAL . ... . . ..... . ..... . . .... $ PRODUCT660 �Inc.,Groton,Mass.01471.To Order PHONE TOLL FREE I-800-225.6380 1 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 13, 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 ar �j 1 , given pursuant to Government Code Amount: $66,865.45 ct mail 4. Please note all •Warnings". CLAIMANT: D.W. Guthrie Painting Partners AUG 0 8 M4 COUNTY COUNSEL. ATTOnNEY: MARTINEZ CALIF. Date received ADDRESS: 1120 Colby Dr. BY DELIVERY TO CLERK ON A„ ,g Gam. J g_AZL Davis, CA 95616 BY MAIL POSTMARKED: Hand DP1 i vPrPrl via- Cn„nt�Z Counsel 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a Copy of the above-noted claim. DATED: Jqll �PutyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. , ( ✓j—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: �rt.�4�- `� BY: — e--�-- Deputy County Counsel —ll 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARD ORDER: By unanimous vote of the Supervisors present (Vi/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 B l y . l . Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You 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 J 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 to 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. n 7lated: 1Lp , i4 , ) M `L BY: PHIL BATCHELOR by �I��,�l�f� �, ) Deputy Clerk CC: County Counsel, County Administrator t OFFICE OF COUNTY COUNSEL DEPUTIES: j. CONTRA COSTA COUNTY PHILLIP S. ALTHOFF r SHARON L. ANDERSON BRANDON D. BAUM COUNTY ADMINISTRATION BUILDING ANDREA W. CASSIDY a- VICKIE L. DAWES P.O. BOX 69 MARKE S. ESTIS VICTOR J.WESTMAN MARTINEZ, CALIFORNIA MICHAEL D. FARR COUNTY COUNSEL 94553-0116 LILLIAN T. FUJII DENNIS C. GRAVES SILVANO B.MARCHESI TELEPHONE (510) 646-2074 GREGORY C. HARVEY ARTHUR W.WALENTA,JR. FAX (510) 646-1078 KEVIN T. KERR ASSISTANTS EDWARD V. LANE, JR. MARY ANN M. MASON PAUL R. MUNIZ August 9 , 1994 VALERIE J. RANCHE DAVID F. SCHMIDT DIANA J. SILVER VICTORIA T. WILLIAMS NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: D.W. Guthrie Painting Partners 1120 Colby Drive Davis, CA 95616 RE: CLAIM OF: D.W. Guthrie Painting Partners 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. [X] 2 . The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [] 3 . The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [] 4 . The claim fails to state the name (s) of the public employee (s) causing the injury, damage, or loss, if known. [] 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10, 000) . If the claim totals less than ten thousand dollars ($10, 000) , the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10, 000) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. [X] 6 . The claim is not signed by the claimant or by some person on is behalf . [X] 7 . Other: The claim fails to state the last date upon which the alleged injury occurred. The statement "continued throughout our phase of the construction project" is vague and uncertain. VICTOR J. WESTMAN, County Counsel By: ?�>CL_ Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a, 2015.5; Evidence Code §§ 641, 664) I declare that my business address is the County Counsel's Office of Contra Costa County, 651 Pine Street, Martinez, California 94553; 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 addressed as shown above, sealed and postage fully prepaid thereon, and thereafter was, deposited this day in the U.S. Mail at Martinez, California. I certify under penalty of perjury that the foregoing is true and correct. Dated: August 9, 1994 at Martinez, California. �J cc: Clerk of the Board of Supervisors (original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOVT. CODE §§ 910, 910.2, 920.4, 910.8) Claim 'to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 02 2 INSTRUCTIONS TO CLAIMANT V,�� / f.�'94 A. Claims relating to causes of action for death or for injury to person or to Cz* �h�p sonal property or growing crops and which accrue on or before December 31, 19872 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 D.W. Guthrie Painting Partners ) RECEIV 1120 Colby Dr. , Davis, CA 95616 ) Against the County of Contra Costa ) - 5 W4 Contra Costa Tounty ) Dept. of Public Works CLERK BOARD OF SUPERVISORS District) CRIYTHA COSTA CO. Fill in name ) The undersigned claimant hereby makes cla' 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) See question column #1 . --------------------- -------- 2. Where did the damage or injury occur? (Include city and county) See question column #2. ----------------------------------------------------------------------------------- 3. How did the damage or injury occur? (Give full details; use extra paper if required) See question column #3 ----------------------------------------------------------------------------------- 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? See question column #4 (over) D.W. Guthrie Painting Partners Attachment to claim form Question column * 1. The damages to our company started on October 1st. 199?, and continued throughout our phase of the constructionproject. Question column 02. The damages to our company occurred during the performance of our subcontract, ie. Clean and Paint Structural Steel, Avon Bridge Rehabilitation and Seismic Retrofit Project No. 0 662-684089-90. Located on Waterfront Road at Pacheco Slough, Martinez, CA. Question column 03, Our claim is for compensation for extra labor, equipment, and materials used, due to the two factors described below 1.1 The Resident Engineer assigned to this project systematically over inspected each and every coat of paint that was applied to the blast cleaned steel, using his own fastidious method, for determining the mil, thickness of each coat of paint. This wrongful inspection method reduced our progress to a. minimum and made it impossible to complete our work in a tamely fashion and within budget. The Resident Engineer refused to follow the method of inspection that is specified to be used per section 59-2. 12 %SSPC-PA2 of trig; Standard Specifications. 59-2.12/SSPC-PA2, reads as follows: I ake file separate spot measurem--c' its, spaced evenly over each 100 square feet area, then take the average of any three of the five ,pots J and triis average can not be less then the -:T;ecified thickness. Also, orhen tinge is a total of over 1000 -quare feet of surface to be measured oni three 100 square foot areas per every 1000 square feet is to be selected for sampling, See attached specification,. .J The Resident Engineer never once, frorn the beginning to the end, inspected our pairsting per the specifications. Instead he employed his own rnethod for gaging the paint thickness by taking one measurement every few feet apart, trip to bottom, and any one low spot would constitute rejection of a whole section, this was consistent for all four coats. The severity of the inspections r could at times vary, according to his mood, and would become especially severe ;when 11m would attempt to go over his head in protest. An accurate recreation of the number of individual mil. tests treat ',mere taken, are as follows. a. There was approndmately 10,200 sq. feet of structural steel to be painted and inspected at this project. b. The Engineer took an average of 1 h separate mil. tests per every 30 sq. foot panel section, per coat of paint. See detail drawing of panel section. c. At 10,200 sq. feet of surface to inspect, that is 5440 separate mil tests per coat of paint. d. 4 coats of paint C, 5440 separate mil. tests = 21,760 separate rail. tests that •,mere taken by the Engineer in the inspection of all 4 coats of paint. e. The prober number of separate mil. tests that should have been taken per section 59-2.12 / S)PC-PA2 is 50 tests per coat or 200 separate test for the entire structural steel section of all 4 coats. f. A. The Engineer took 21,560 separate tests to many, which equates to a 1000 plus % increase to the specified inspection testing, or for every one test that he should have made, he made 1OP) tests instead. 2L T his project 'tris bice to be perforrried during trre early summer months •'==.(' e t s �< f a ia pe .l �r�:�c.!�_(;�; ,,`Y � s an integral part of in .Yee Fish .� JJrrr., )..rrr.�:. ,�.. , �, ri;h i.� 'his contract, in Twhich the period of c:oristruc:tion was to be confined to April 1 thru `cap ? s the t� Y,/, (r� r e ;� set fortrt by the Dept. of j� . .,0. This is Wr ya. 7o kin, P rio:) Fist-1 and Game and is recognized by all agencies as the standard in 1,•rhich cc)nstruction over a, stream or ,va.terT1-7a.v mij..st be scheduled. Thr' County did not give the go ahead to st;Irt the project until July 26th vjhich subsequently put our phase of the project into adverse fall weather conditions, ie., high tides, high �.\nnd's and rain, and the result of which to1e up our containment, necessitating constzant repairs and the combination of the high tides the high winds churning up the water did in fact increase the height of the water, which would flood our containment on a daily basis and slow our blast and recovery operation to a crm,\4. All of these conditions increased our labor, equipment, and material costs, these extra costs were in no way figured into our bid and must be reimbursed f or, respectively. Proper notice was given to the County under section 9- 1.04 Notice of Potential Claim, (see letter dated - 12- 9 j) which did, in fact, put the County on notice of the likelihood of extra costs related to their delays in starting this project. It is our claim that the County's reasons for starting late, ie., the sTrrallow population, are riot justifiable for the folloT/,ring reasons: a. The original Fish & Game permit for this project*ryas issued on 9-17-1990, this gave the County over 2 1/2 years to prepare for any foreseeable situations that 'would arise. b. It is also a known fact that the sThrallow population at this bridge has existed for many years, the nests are quite obvious. Therefore any claim of non-discovery should not be considered. c. Given the amount of time County had to prepare for this project, an aggressive nest prevention program should have been undertaken starting with the removal of all eY?sting nests within the T;•Jork area, prior to the arrival, and the rirttina of that. J portion .f t.ie bridge,, izL�.�z_.. ��., •.l -, ... naa. ntenar..... of tri. L- t Cl � U.S.. s ,.r,1�71 -& IYTt %f'(t ( (i i� i f, r e � ri ri.t._.inper "J � Fi.-�ri ��: v'r.._._i . L i.t. r. .r.>.r_ . n:�_tti.:n,�. At the •JYry le a.st, the County should. hay a. nest prevention prograrn r..... r r.l' r t y '�7 r. into the 'Scope o �J�r _ or bel i.�r ,��t �'�,�1 ) t i,.. uiCI a. �epara fa contract for this ;r7ork 1d�_; rrr:Te�t. o p' og.arras are T„ridel•� used L. ; �, r 1� ;..ii r.1 � throughout the state, of California ;%s th • approved method for the protection of miara.tor?r pHr'ie s pric r ` , C'ristru.ction. T:J Question column -04. The first act or omission that caused damage to our company was the Resident Engineers wrongful inspection method, TNriich Tele did in fact protest to trio Engineer and to the Agency on many occasions, but of�r ��rotests TN¢re consistently given no validity. The Engineer Tvaas vehement in his insisthnce that,he could inspect our painting as he saw fit and with the backing of his department, he was unyielding. This, combined with the time restraint caused by the delays in starting the project, forced us to endure this irresponsible behavior and put us through hell. We state treat it is the agency's responsibility when using Cal. Dept. of Transportation specifications to have a Resident Engineer on site that is k noTAedgeable in Cal. Trans. inspection procedures, therefore the agency Teras negligent and must make just compensation for his actions. It should be further noted that any county agency that uses The Calif. Dept. of Transportation's specifications is equally bound by those specifications as is the contractor. The second act or omission that caused damage to our company Was the County's failure to start the project on time and we further state that the county knew that their delays in starting the project Trlould put the projected completion data. well beyond the extended Fish & Game cut-off date and that their decision to continue should include just compensation for the adverse working conditions we •sere forced to endure. Question column :5 The names of the county or district officers, servants or empioyees causing the damages to our company are as fol 1 o: ,,r:,. Don Gorman Resident Engineer 1l-JJistant F.11T Director Construction Division Question column 4"6 We claim! that the county's actions caused the project to go into time and cost over runs, including extra cost, for the rental of the- heavy equipment, the f uel, the labor, and the materials expended under the condition which were forced upon our company throughout the performance of our subcontract. We further demand that the county drop all demands for liquidated damage, associated with this project and make amends for the actions of trieir Resident Engineer. Question column 07 The amount of our claim was computed from invoices of equipment and material cost over runs, calculations of days of labor and overhead costs related to the fall and winter weather conditions and excessive P wrongful inspection methods. Question column :8 The primp contractor is witness fx) this, also Cal Trans. can be called to verify the specified inspection methods that should have been used and the Dept. of Fish and Game can be called to verify the time periods allowed for working over a waterway, Valentine Corporation 1 1 1 Pelican ;Tay ars Rafael, CA (34901 415 453- 72 California. Dept. of Transportation 1 12 0 ?`'i. Street .Cr?.rriE' 1tIJ CA ttf-n: Doug King 916499-5202 California. Dept. of Fish & Game 7 2,2)(1 Silverado Trail !Jap.-a, CA Question column :9 Our claim is for compensation for the pYtra 'Labor, equipment and mate-rials, used to complete. the work in the above described conditions. Heavl equipment rental overtime $13,299.00 Misc. equipment rental overtime 1,080.85 Extra labor cost; 2 8,3 0 5. 15 Scaffolding overtime 2,654.96 Str.�ra.ge stied overtime 255.00 Security guard overtime 3,400.00 Extra paint 2,691.00 Ext.-a equipment fuel 1,806.40 Total of extra costs $53,492.36 O v erllead 13,37U9 Grand total 366,865-45 SSPC-PA 2 November 1, 1982 Editorial Changes August 1, i991 Steel Structures Painting Council PAINT APPLICATION SPECIFICATION NO. 2 Measurement of Dry Paint Thickness with Magnetic Gages 1. Scope thicknesses from 0.5 to 80 mils (12.5 to 2030 microns) or 1.1 GENERAL:This method describes the procedures more.The plated panels are flat smooth steel 1.125 x 1.125 to measure the thickness of a dry film of a nonmagnetic inches (2.85 x 2.85 cm) in size. They exceed the critical coating applied on a magnetic substrate using commer- mass of steel needed to satisfy the magnetic field of the cially available magnetic gages. These procedures are Type 1 (pull-off) magnets. Shims of plastic or of non- intended to supplement manufacturers' instructions for magnetic metals which are acceptable for calibration of the manual operation of the gages. The types of gages Type 2(fixed probe)gages should not be used for calibra- covered are nondestructive to the film being measured. tion of the Type 1 gages. 1.2 GAGE TYPES: Magnetic gages of two types may 2.2.2 Using the Type 1 (pull-off) gage, measure the be used: thickness of a series of calibration standards covering the expected range of paint thickness. Record the calibration Type 1 — Pull-off Gages (such as Mikrotest, In- correction either + or – required at each standard thick- ness. To guard against gage drift during use, recheck the Pull-Off -Off Gage); and gage at least once during each work shift with one or more Type 2 — Fixed Probe Gages (such as Elcometer of the standards. In case of dispute the buyer and seller Thickness Gage, Minitector,General Electric Type B Thick- should agree on the details and frequency of calibrations. ness Gage, Verimeter, Permascope, and Dermitron). 2.2.3 When the gage adjustment has drifted so far 2. Calibration and Measurement Procedures that large corrections are needed, it is advisable to re- adjust closer to the standard values and recalibrate.When 2.1 GENERAL: the gage can no longer be adjusted into reasonable agree- 2.1.1 ACCESS TO BARE SUBSTRATE: To determine ment with the reference standards, have it rebuilt or the effect of the substrate condition on the gage readings, replaced. access is required to some unpainted areas. Small repre- 2.2.4 Measure (A), the bare substrate, at a number of sentative areas may be masked-off during the painting. If spots to obtain a representative average value. Note the the paint has already been applied to the entire surface, gage is not to be calibrated on the bare substrate. small areas of paint may be removed and later patched.An 2.2.5 Measure(B),the dry paint film,at the number of alternative procedure that may be specified is to provide spots specified in Section 3. separate unpainted reference panels of similar steel and surface condition. 'These would be used as the bare sub- 2.2.6 Subtract the readings (A) and (B) to obtain the strate in the procedures of Section 2.2 and 2.3. thickness of the paint film. NOTE:When an uncalibrated gage is used,it is neces- sary to correct the A and B readings using the corrections together, may differ considerably due to small surface as determined from Section 2.2.2. irregularities. Therefore, three (3) gage readings shall be made for each spot measurement of either the substrate or 2.3 CALIBRATION AND MEASUREMENT — TYPE 2, the paint.Move the probe a distance of one to three inches FIXED PROBED GAGES for each new gage reading. Discard any unusually high or 2.3.1 For Type 2(fixed probe) gages, shims of plastic low gage reading that cannot be repeated consistently. or of non-magnetic metals laid on the appropriately Take the average(mean)of the three gage readings as the cleaned steel base, at least 3 x 3 x 0.125 inches(7.6 x 7.6 x spot measurement. 0.32 cm),are suitable working standads.During calibration hold the gage firmly enough to press the shim tightly 2.2 CALIBRATION MEASUREMENTS—TYPE 1 PULL- against the steel surface. Avoid excessive pressure that OFF GAGES: might indent the plastic or, on a blast cleaned surface, 2.2.1 For Type 1 gages,the preferred calibration Stan- might impress the steel peaks into the under surface of the dards are small, chromeplated steel panels that are plastic. A very smooth plate of mild steel free of mill scale available from the National Bureau of Standards in coating and rust is suitable for the zero thickness standard. 8S,04,1A-2:. November 1, 1982 Editorial Changes August 1, 1991 Because of the stronger magnetic field of the Type 2(fixed 4. Accuracy probe) gages, the small, National Burea of Standards 4.1 GAGE ACCURACY: All of the above magnetic calibration standards, acceptable for Type 1 (pull-off) gages, if properly adjusted and in good condition, are gages, shall not be used with Type 2 gages. inherently accurate to within ± 15% (most gages within 2.3.2 It is IMPORTANT to confirm the gage setting by ± 10%). It should be noted that this is only the accuracy measuring the shim at several other areas of the bare built into the gages themselves. substrate. Readjust the gage as needed to obtain an 4.2 ITEMS WHICH AFFECT GAGE ACCURACY: Much average setting representative of the substrate. larger, external errors may be caused by variations in 2.3.3 Spot measurement of paint: With the gage ad- method of use of gages or by unevenness of the surface of justed as above, measure the dry paint film as specified in the substrate or of the coatings.Also,any other films pres- Section 3. The gage readings indicate the paint film ent on the steel (rust or mill scale or even a blast cleaned thickness. profile zone) will add to the apparent thickness of the ap- 2.3.4 Recheck the gage setting at frequent intervals plied paint film. Thus, for accurate use of the magnetic during a long series of measurements. gages, some knowledge is required of the nature of the surface being painted and of its effect on the gage read- s. Number of Measurements for Conformance ings. For this purpose the gage operator must have access to a Thickness Specification to at least small areas of the unpainted substrate as in Section 2.1.1. As a minimum, he must know whether he is 3;1 NUMBER OF MEASUREMENTS AND MINIMUM measuring only paint,or paint plus mill scale,or paint plus THICKNESS: Make five (5) separate spot measurements steel surface roughness. (average of three readings, see Section 2.2) spaced evenly over each 100 square feet(9.3 square meters)of area to be 5. Notes' measured. The average of five spot measurements for 5.1 While every precaution is taken to insure that all each such 100 square foot area shall not be less than the information furnished in SSPC specifications is as ac- specified thickness. No single spot measurement in any curate,complete,and useful as possible,the SSPC cannot 100 square foot area shall be less than 80% of the speci assume responsibility nor incur any obligation resulting fied thickness. Any one of three readings which are aver- from the use of any material, paint, or method specified aged to produce each spot measurement may under-run by therein. a greater amount. The five spot measurements shall be made for each 100 square feet of area as follows: 5.2 PRINCIPLES OF THE MAGNETIC GAGE: Each of these gages can sense and indicate only the 'distance 3.1.1 For structures not exceeding 300 square feet in between the magnetic surface of the steel and the small area, each 100 square foot area shall be measured. rounded tip of the magnet that rests on the top surface of 3.1.2 For structures not exceeding 1,000 square feet the paint.This measured distance,from the top surface of in area, three 100 square foot-areas shall be randomly the paint, must be corrected for the thickness of any ex- selected and measured. traneous films or other interfering conditions on the sur- 3.1.3 For structures exceeding 1,000 square feet in face of the steel..Such correction is made,as described in area, the first 1,000 square feet shall be measured as Sections 2.2 and 2.3. It might be noted that many disagree- stated in Section 3.1.2 and for each additional 1,000 square ments in thickness reports arise from different concep- feet of area or increment thereof,one 100 square foot area tions of this correction,or of just what is measured by the shall be randomly selected and measured. gages under various conditions and methods of use. 3.1.4 If the dry film thickness for any 100 square foot 5.2.1 Type 1 (pull-off) gages use a type of spring area(Sections 3.1.2 and 3.1.3)is not in compliance with the balance to pull a small permanent magnet from the sur- requirements of Section 3.1, then each 100 square foot face of the painted steel. The magnetic force holding to area shall be measured. the surface varies inversely as a non-linear function of the 3.2 Other size areas or number of spot measurements distance between magnet and steel, i.e., the thickness of may be specified in the procurement documents as ap- the dry paint film (plus any other films present). propriate for the size and shape of the structure to be Normally, Type 1 gages are not adjusted or reset for each new series of measurements. In fact, adjustment is measured. not advisable unless the gage is to be very carefully 3.3 THICKNESS LIMITS: Some paints are especially calibrated with National Bureau of Standards calibration sensitive to high or low film thickness. In all cases, limita- standards as indicated in Section 2.2.1. In normal use the tions on maximum or minimum film thickness specified in gage may not require adjustment for months. the manufacturer's instructions shall be followed. Shims of sheet plastic or of non-magnetic metals which are permissible for calibrating Type 2, fixed probe gages, should not be used for calibration of Type 1 gages. Such shims are usually fairly rigid and curved, and do not nna r ,h. +�y s, t r�f ��l cz W n- z$ -.'+ .l ',tt t yry 4 SSz,✓x..nF n N.r}:.di a ¢ y i' + ,r Y t. � r.l� Y Ss �ai. t :t•., 't .r 7h f <r¢yy = .2s.,Y F jk.�.k �.k 4 t � i .n c ti, �- K »• � � t xY �P F k5� �l�t 1 bt'J•,E,�4, 5 1 .y 4,�+ '+� L t1 i �i J{s� d - •A �, tq r ls+ F r � ., F + +/7 z 3!t� i. } • r - ,� R ,�i �'e Fr '�' a' +��f��+a�'�1Y�1 Nf� 'i cl t t J7 S t .' -� 1 5 S w r'' r 1 � t ° �y�..t�:Y• At+. � ., >�" ?t». "r" r ,i.°t! �1 l tt 4 ! 1 r s.t { .� q z '� ..f yt .+► ijLu'2 k . tt + h 1 ! t 4 ,. S � x.,15 � �i.?5�• rt i ,!j`', t F r � i .:'` F '- �t{ ,tU ir+. + ? 4'' ,c..L"�ti.e4; s •: ?F` a"k�jn�d :�_ • _ .t r r af.'^ � z S,. 2 w t S � _.J� .r < 'S t'x d .t� '°a }✓� 1". y UCk'"'i' 4 t5{ S r't r.. F k tl' r #' t t ,;e 4 xF'•t sYss'^' r`L }'S\1..:�S�. Y...�a\5 Y�:L ;��.('t� _ r � ;y♦ Ii ; 4.�.� Y •.t t ,.�v .r� ,S • � ilii �' !. ,w. �: .' � c. a •• � yiai ¢T lttCe �sfY. Aw P �r •a rr i' Yi t 3, < •ii •• •. i fa til._• i PAINTING SECTION 59 59-2.06 Hand Cleaning.—Wire brushes, either hand or powered, ' hand scraping tools, power grinders, or sandpaper shall be used to re- move all dirt, loose rust and mill scale, or paint which is not firmly bonded to the surfaces. Pneumatic chipping hammers shall not be used unless authorized in writing by the Engineer. 59-2.07 (Blank) 59-2.08 (Blank) 59-2.09 (Blank) 59-2.10 (Blank) 59-2.11 Paint.—The paint systems for new or existing structural steel or other metal surfaces shall be as. specified in the special provi- sions or as shown on the plans. 59-2.12 Painting.—Painting of new structural steel shall be done at the following stages of construction unless otherwise specified in these specifications or in the special provisions or approved in writing by the Engineer: Structures, other than sign structures, shall be blast cleaned and painted with the total thickness of undercoats before erection. After 6i erection and before applying subsequent paint, all areas where paint G has been damaged or has deteriorated and all exposed unpainted 'A3 surfaces shall be thoroughly cleaned and spot painted with under- ' coats to the specified thickness. :�� When sign structures are to be painted as specified in Section 59- 5, "Painting Sign Structures," cleaning and painting may be per- --� formed prior to erection or after erection, at the option of the Con- tractor. After erection, any damaged paint shall be repaired to the satisfaction of the Engineer. Surfaces exposed to the atmosphere and which would be inacces- sible for painting after erection shall be painted the full number of applications prior to erection. All blast cleaning, except that performed within closed buildings, and: all painting shall be performed during daylight hours unless the terms of the contract prohibit work being performed during daylight hours. At contact surfaces of stiffeners and of built up members, open seams: which would retain moisture shall be caulked with non-sag polysulfide' or polyurethane material conforming to the provisions in Federal Speci-: fication TT-S-230, Type 1I, or other approved material before the appli- cation of finish coat paint. '.ti:<.The dry film thickness of the paint will be measured in place with a calibrated magnetic film thickness gage according to Steel Structure Painting Council Specification SSPC-PA2. The thickness of each application shall be limited to that which will result in uniform drying throughout the paint film. Succeeding applications of paint shall be of such shade as to contrast with the paint being covered. (59-5) s• .0 � r .tet.... CONFIDENTIAL COUNTY COUNSEL' S OFFICE CONTRA COSTA COUNTY MARTINEZ, CALIFORNIA MEMORANDUM Date: August 5, 1994 To: Jeanne Maglio Clerk of the Board of Supervisors"j� FROM: Victor J. Westman, County Counsel By: Brandon Baum, Deputy County Counsel RE: Claim by D.W. Guthrie Painting Partners Please treat this as a claim received on July 12, 1994 . Thanks, BB (6 -2041) . �dP _ RECEIVED AUG - 5694 CLERK BOARD OF SUPERVISOR$ CONTRA COSTA CO. V �Q f. PUBLIC WORKS DEPARTMENT ' CONTRA COSTA COUNTY 7'V c';� r1V�G<-ML�r' Date: July 11, 1994 To: David Schmidt, County Counsel �1. L r„ VVV From: Joseph P. Murphy, Assistant Public Works irecto , Construction Subject: Avon Bridge Rehabilitation & Seismic Retrofit, Proj. No. 0662-6R4089-90 Attached is a letter from Valentine Corporation regarding a claim on our Avon Bridge Rehabilitation project. For this project, the prime contractor was Valentine Corporation, while D.W. Guthrie was the painting subcontractor. Guthrie has chosen to file a claim for damage directly against the County by using the County standard claim form. It appears that Valentine will file a claim as the prime contractor on behalf of Guthrie. Our project files contain background information and prior Department responses on this matter. We can review this info when the Valentine claim is received. I responded to the Valentine letter on July 8, 1994, that we will respond when we receive their claim. JPM\tt g ACONSTICORRESWBR-D,S.MEM attachment , cc: J. M.Walford, Public Works Director D.Graves,Administration D. Gorman, Construction GENERAL ENGINEERING CONTRACTORS AGC�� ,.��,,A©�;_ g CALIFORNIA VALENTINE June 24, 1994 RECEIVED Contra Costa Count y J�JL — -4 5 Public Works Department 255 Glacier Dr. r. , Martinez, CA 94553-4897 Ci0RST uG1 Attention: Mr. Don Gorman Subject: Avon Bridge Dear Mr. Gorman, Attached find documents that describe a claim against Contra Costa County by "D.W. Gurthrie Painting Partners," our painting subcontractor on the subjt.�ct project. Valentine Corporation intends to file a claim against Contra Costa County, documents for Valentine Corporations claim will follow within the next three weeks. Sincerely, Don Pheif Vice President V----cc: File VALENTINE CORPORATION 111 PELICAN WAY•SAN RAFAEL,CA 94901 •P0.BOX 9337•SAN RAFAEL,CA 94912.(415)453-3732•FAX(415)457-5820 CLAIM ' I BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 13,1994 .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: $500,000.00 Section 913 and 915.4. Please note all %Mrnw, (n �L1J{' CLAIMANT: RAMIA, Robert and Mary Patricia AUG 17 199! ATTOnNEY: Thomas P. Greerty COUNTYCOUNSEL MAFITINEZCAUF. Date received Attorney at Law ADDRESS: 706 Ferry St. BY DELIVERY TO CLERK ON Aust 15, 1994 Martinez, CA 94553 Hand Delivered BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. Bapp IL BATCHELOR, Clerk P > .DATED: : Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. (6W 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: Ali. .t" {'7 1ggH 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. BOARDD 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 YARNING (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 Sri attorney, you should do so immediately. *For additional warnino see reverse side of this notice. AFFIDAVIT OF %AILING 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:_ ' 1 c.�T�9 q T BY: PHIL BATCHELOR by_� , �► :'. O 9Deputy Clerk CC: County Counsel County Administrator OFFICE OF COUNTY COUNSEL DEPUTIES: • CONTRA COSTA COUNTY PHILLIP S. ALTHOFF SHARON L. ANDERSON 7!p •_ BRANDON D. BAUM COUNTY ADMINISTRATION BUILDING ANDREA W. CASSIDY o =' VICKIE L. DAWES P.O. BOX 69 MARKE S. ESTIS VICTOR J.WESTMAN MARTINEZ, CALIFORNIA MICHAEL D. FARR COUNTY COUNSEL 94553-0116 LILLIAN T. FUJII DENNIS C. GRAVES SILVANO B.MARCHESI TELEPHONE (510) 646-2074 GREGORY C. HARVEY ARTHUR W.WALENTA,JR. FAX (510) 646-1078 KEVIN T. KERR ASSISTANTS EDWARD V. LANE, JR. MARY ANN M. MASON PAUL R. MU&IZ August 17 , 1994 VALERIE J. RANCHE DAVID F. SCHMIDT DIANA J. SILVER VICTORIA T. WILLIAMS NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Thomas P. Greerty 706 Ferry Street Martinez, CA 94553 RE: CLAIM OF: Robert and Mary RAMIA 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. [X] 3 . The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [X] 4 . The claim fails to state the name (s) of the public employee (s) causing the injury, damage, or loss, if known. [] 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10, 000) . If the claim totals less than ten thousand dollars ($10, 000) , the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10, 000) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. [X] 6 . The claim is not signed by the claimant or by some person on is behalf . [] 7 . Other: VICTOR J. WESTMAN, County Counsel By: fGVt-Pik-(J� ��►n.�� Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a, 2015.5; Evidence Code §§ 641, 664) I declare that my business address is the County Counsel's Office of Contra Costa County, 651 Pine Street, Martinez, California 94553; 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 addressed as shown above, sealed and postage fully prepaid thereon, and thereafter was, deposited this day in the U.S. Mail at Martinez, California. I certify under penalty of perjury that the foregoing is true and correct. Dated: August 17, 1994 at Martinez, California. cc: Clerk of the Board of Supervisors (original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOVT. CODE §§ 910, 910.2, 920.4, 910.8) N O m N N N � Q a `A 30 _m v � a U a CD OUl N 7 � w� ¢' ICA 0 'n 6 �vv M s 7 � r � l3Q Z W- 0 y d 4 U N �Wr4 d ° 02 O = 4 r � THOMAS P. GREERTY ATTORNEY AT LAW 706 FERRY STREET MARTINEZ,CALIFORNIA 94553 510-370-8400 FAX 510-370-0778 RECEIVE® August 15, 1994 151994 Supervisor Tom Powers /0 P yN Chariman of the Board of Supervisors CLERK BOARD OF SUPERVISORS Contra Costa County CONTRA COSTA CO. 651 Pine Street, Room 106 Martinez, CA 94553 Re : RESIDENCE OF ROBERT & MARY PATRICIA RAMIA at 1760 Newell Avenue, Walnut Creek, CA Dear Mr. Powers : I have been retained by Robert and Mary Patricia Ramia, residence of 1760 Newell Avenue, Walnut, to present a claim to Contra Costa County for $500, 000 . 00 as a result of the negligence of the County in authorizing and approving the construction and habitability of the property at 1760 Newell Avenue, Walnut Creek. The negligence has resulted in improvements which are not saleable and resulted further in mental suffering to each of the Plaintiffs . Please address all correspondence respecting this claim to this office . Very truly yours, THOMAS P. GREERTY TPG/kmo CC: Robert and Mary Patricia Ramia CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 13, 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: Unknown : ITT ction 913 and 915.4. Please note all "Warnings". CLAIMANT: RATH, Mary A. AUG Q g 1994 ATTORNEY: COUNTY COUNSEL MARTINEZ CALIF. Date received ADDRESS: 1760 Cherry Hill Dr. BY DELIVERY TO CLERK ON August 5, 1994 Byron, CA 94514 BY MAIL POSTMARKED: Hand Delivered 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppN IL eATCHELOR, Clerk DATED: B1: Deputy 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. ( ti-r 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 70: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. 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:_, �3, 1`J J4 PHIL BATCHELOR, Clerk, By�l a,oah0 . ) . 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 Aeposited 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 inediately. *For additional warning see reverse side of this notice. AFFIDAVIT OF NAILING 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_ l ,PLS c_ Ql Deputy Clerk cc: County Counsel County Administrator OFFICE OF COUNTY COUNSEL DEPUTIES: CONTRA COSTA COUNTY PHILLIP S. ALTHOFF i; SHARON L. ANDERSON BRANDON D. BAUM COUNTY ADMINISTRATION BUILDING ANDREA W. CASSIDY `•moo= VICKIE L. DAWES P.O. BOX 69 MARKE S. ESTIS VICTOR J.WESTMAN MARTINEZ, CALIFORNIA MICHAEL D. FARR COUNTY COUNSEL 94553-0116 LILLIAN T. FUJII DENNIS C. GRAVES SILVANO B.MARCHESI TELEPHONE (510) 646-2074 GREGORY C. HARVEY ARTHUR W.WALENTA,JR. FAX (510) 646-1078 KEVIN T. KERR ASSISTANTS EDWARD V. LANE, JR. MARY ANN M. MASON PAUL R. MUNIZ August 9 , 1994 VALERIE J. RANCHE DAVID F. SCHMIDT DIANA J. SILVER VICTORIA T. WILLIAMS NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Mary A. Rath 1760 Cherry Hill Dr. Byron, CA 94514 RE: CLAIM OF: Mary A. Rath 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. [X] 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10, 000) . If the claim totals less than ten thousand dollars ($10, 000) , the claim fails to state the J. 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 is behalf . [X] 7 . Other: The claim fails to state any dollar amount for the claim. VICTOR J. WESTMAN, County Counsel By: 1j'e-puty y: Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a, 2015.5; Evidence Code §§ 641, 664) I declare that my business address is the County Counsel's Office of Contra Costa County, 651 Pine Street, Martinez, California 94553; 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 addressed as shown above, sealed and postage fully prepaid thereon, and thereafter was, deposited this day in the U.S. Mail at Martinez, California. I certify under penalty of perjury that the foregoing is true and correct. Dated: August 9, 1994 at Martinez, California. cc: Clerk of the Board of Supervisors (original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOVT. CODE §§ 910, 910.2, 920.4, 910.8) Y Cla,_- to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Clams 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 publie ,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: orRE: Claim By ) Reserved for Clerk's filing stamp RECEIVED ) Against the County of Contra Costa ) — 5 W or ) CLERK BOARD OF SUPERVISORS District) 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: 1. When did the damage or injury occur? (Give exact date and hour) 2. ere di 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) u. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage?. <Y � D. wnat are the nates of county or district officers, servants or employees causing the da.-�--age or injury? -------------------------------------- - ------—-------------------- 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.) ---------------------------------- $. Names and addresses of witnessEs; doctors and-hospitals. ---------------- - 9. List the expenditures you made on account of this-accident or injury: DATE ITEM AMOUNT .s ' Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES T0; "TA (Attorne )�. or by some person on his behalf." Name and Address of Attorney aimant's Signature Address Telephone No. Telephone No. I ( S N O T I C E Section 72 of the Penal Code- provides: -- - "Every person who, with intent tQ defraud, presentsfor 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 sam&LIPL-k6hine, any false or fraudulent claim, bill, account, voucher, or writing, 1P.,pu ar stable either by imprisonment in the county jail for a period of not more than Eon ye ; 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 excefd16gE't"dMU8usan'd dollars ($10,000, or by both such imprisommnt and fine. ADDENDUM TO THE CLAIM OF , (Print your full name) ( 1) Do. you use the roadway as part of a ,daily -commute? Yes ( V"), No ( ) ( 2) Were you- aware'-that construction would be commencing on the roadway? / Yes No ( ) ( 3) Was an .alternate route available? Yes ( ) No ( y ) (4) Did -you .read about the impending resurfacing in the local .newspaper? Yes ( ) No ( A ( 5) Did you see warning signs advising of loose gravel and a F, "25- mile per hour advisory sign? Yes ( v ) No ( ) ( 6) Did the damage result from another vehicle. exceeding the ...25 mile -per- hour advisory? _. Yes ( Y ) No ( ) (7) Did a vehicle traveling in the same direction and exceeding _. . the- -25 mile per-hour advisory -sign attempt to pass you? Yes A No ( 8) Did a vehicle coming from the opposite direction cause gravel to be thrown onto your carOl r\A-�-V 0-tL GA-6Z_-�_ ) Yes ( ) No ( ) ( 9) Was the vehicle located directly in front of you exceeding the speed advisory? Yes ) No �/ r . ( 10) Did you travel. the. roadway more than once during the resurfacing prior to the damage sustained to your car? Yes ( y ) 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, +,'--,xown onto the car,' along with' the specific damaged par". - .'on your vehicle. 0 fes, 44 l bCx �� o ( 13) Were you aware that using the road during the chip seal process might result in damage. to your carr Yes"'( No I declare that the above Information is true and correct ��• " der �th--- "" ty t-of ,perjury. :r `r_LLis b c a n 5 Q G-�--- ( ' gnature) (D te) ? CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 13, 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 Mount: Unknown ,--,Section Section 913 and 915.4. Please note all *Warnings". n CLAIMANT: VERGA, Henry ATTORNEY: NUG 1 � 199 OUNTYC UtlSr Date received ADDRESS: 2520 Ryan Rd, Apt. 4Mpp?INEZ BY DELIVERY TO CLERK ON August 17, 1994 Concord, CA 94518 BY MAIL POSTMARKED: Hand Delivered via: Risk Mgmt. 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. , IVIL eATCHELOR. Clerk GATED: 12 611: Deputy 8t.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 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: 9 y BY: Deputy County Counsel 311. 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 �„ Q 0",oJ , 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 Aeposited 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 warnino see reverse side of this notice. AFFIDAVIT OF MAILING 3 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 to the United States Postal Service in Martinez, Ialifornia, postage fully prepaid a certified Copy of this Board Order and Notice to Claimant, addressed to 'the claimant as shown above. 1 Dated: , % BY: PHIL BATCHELOR by , r� ) Deputy Clerk tC: County Counsel County Administrator OFFICE OF COUNTY COUNSEL DEPUTIES: _ CONTRA COSTA COUNTY PHILLIP S. ALTHOFF I; SHARON L. ANDERSON ' _ "r' BRANDON D. BAUM COUNTY ADMINISTRATION BUILDING ANDREA W. CASSIDY VICKIE. L. DAWES P.O. BOX 69 MARKE S. ESTIS VICTOR J.WESTMAN MARTINEZ, CALIFORNIA MICHAEL D. FARR COUNTY COUNSEL 94553-0116 LILLIAN T. FUJII DENNIS C. GRAVES SILVANO B. MARCHESI TELEPHONE (510) 646-2074 GREGORY C. HARVEY ARTHUR W.WALENTA,JR. FAX (510) 646-1078 KEVIN T. KERR ASSISTANTS EDWARD V. LANE, JR. MARY ANN M. MASON PAUL R. MUNIZ August 19 , 1994 VALERIE J. RANCHE DAVID F. SCHMIDT DIANA J. SILVER VICTORIA T. WILLIAMS NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Henry Verga 2520 Ryan Road, Apt 43 Concord, CA 94518 RE: CLAIM OF: Henry Verga 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. [X] 4 . The claim fails to state the name (s) of the public employee (s) causing the injury, damage, or loss, if known. [X] 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10, 000) . If the claim totals less than ten thousand dollars ($10, 000) , the claim fails to state the i, V. 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 is behalf . Ll 7 • Other: VICTOR J. WESTMAN, County Counsel By: Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a, 2015.5; Evidence Code §§ 641, 664) I declare that my business address is the County Counsel's Office of Contra Costa County, 651 Pine Street, Martinez, California 94553; 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 addressed as shown above, sealed and postage fully prepaid thereon, and thereafter was, deposited this day in the U.S. Mail at Martinez, California. I. certify under penalty of perjury that the foregoing is true and correct. Dated: August 19, 1994 at Martinez, California. CC: Clerk of the Board of Supervisors (original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOVT. CODE §§ 910, 910.2, 920.4, 910.8) 0 w z 00 w t d' i CA rM f C ON o Er aR - U' • w - Ln • Ir - C] %~ N - 1'4'1 � � • 1C'4p1 oMtn z. c c• cc c�no�'o OYll s Hopkins LO ILo N rn 1 t , 1 RECEIVE® AUG 11,;'1994 U , ct., CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. 2520 Ryan Road , Apt 43 Concord , CA 94518 August 15 , 1994 Contra Costa County Risk Management 651 Pine Street , 6th Floor Martinez , CA 94553' Attn: Liability Claims Manager Dear Sir: Please take this letter as notice of intent to make a claim against Contra Costa County and other responsible parties for personal injury and property damage that arose out of a highway defect . This accident occurred near the intersection of Highland and Tassajara in San Ramon on August 6, 1994. Please contact me at 609-7298 to discuss this further. Sincerely, ! f Henry 'Verga Certified Mail CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 13, 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: Unknown Section 913 and 915.4. Please note all *Warnings". CLAIMANT: WILSON, Ruth ,"�� ATTORNEY: Anthony Brookman, Esq. AUS 0 2 Alan .M. Talbot, Esq. Date received pu COUNTY .1994SEL ADDRESS: 1990 N. California Blvd. , X1740 BY DELIVERY TO CLERK ON Walnut Creek, CA 94596 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. Bqpp IL ATCMELOR Clerk DATED: : puty 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( #4 e 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 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely .with notice to claimant (Section 911.3). 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: 13, ) PHIL BATCHELOR. Clerk, By nod l'�l,oc QQA.aJ . 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 warnino 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, ever age 18; and that today I deposited 1n the United States Postal Service in Martinez. California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to Zhe claimant as shown above. Dated: it BY: PHIL BATCHELOR by , �� Deputy Clerk CC: County Counsel County Administrator •Y. Ciaim 1o: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury -o 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 To. RE: Claim By ) Reserved for Clerk's filing stamp RUTH E. WILSON ) ) RECEIVE® Against the County of Contra Costa AUG - 1 1994 . FLOOD CONTROL DISTRICT CLERK BOARD OF SUPERVISORS � ) 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 $.. to be determined and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2/12/94 at approximately 9: 10 a.m. 2. Where did the damage or injury occur? (Include city and county) 983 Rosemary Lane, City of 'Oakley, County of Contra Costa, California 3. How did the damage or injury occur? (Give full details; use extra paper if required) , SEE ATTACHMENT A 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Contra Costa County Flood Contr.ol__District failed. to properly maintain and repair the water heater in the apartment. (over) 5. What are the names of county or district officers, servants or employees causing the damage or injury? Unknown at present. 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. SEE ATTACHMENT B. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Based on medical bills and reports. 8. Names and addresses of witnesses, doctors and hospitals. SEE ATTACHMENT C. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Only medical bills as noted above. Gov. Code Sec_ . 910.2 provides: '-q "The claim be signed by the claimant SEND NOTICES TO: (Attorney) orb som ; n on lf." Name and Address of Attorney ANTHONY R. BROOKMAN, ESQ. ALAN M. TALBOT, ESQ. BROOKMAN & TALBOT, INC. Attorney for Claimant 1990 N. California Blvd. , #740 Walnut Creek, CA 94596 Address Telephone No. (5 10) 932-4008 Telephone No. g x TVg w x at 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 ($10,0009 or by both such imprisonment and fine. Claim of Ruth E. Wilson ATTACHMENT A 3. Claimant was in her residence located at 983 Rosemary Lane, Oakley, California when, upon awakening at approximately 4:00 - 5:00 a.m. on 2/12/94, she discovered her carpet was wet with water approximately 2-3 inches deep, caused by a leaky water heater. Claimant placed a "911" call at approximately 4:00 - 5:00 a.m. The Oakley Fire Department responded to the call and attempted to pump the water out of the apartment. The carpet was still apparently wet when at approximately 9:10 a.m. on 2/12/94, claimant stepped on the still wet carpet and slipped and fell, fracturing her left leg in four places. Claim of Ruth E. Wilson ATTACHMENT B 6. Claimant's right leg was fractured in four places, requiring surgery. The full extent of claimant's injuries are still to be determined. Approximate amount of damages incurred to date are as follows: Medical expenses incurred to date: $ 41,760.66 Estimate of future medical expenses is to be determined. Claimant still getting treatment. Loss of Wages: None General Damages: To Be Determined. Claim of Ruth E. Wilson ATTACHMENT C 8. American Medical Response West (ambulance), P. O. Box 7780, Fremont, CA 94538 Delta Memorial Hospital, 3901 Lone Tree Way, Antioch, CA 94509 Lone Tree Convalescent, 4001 Lone Tree Way, Antioch, CA 94509 Charles S. Brisbin, M.D., 575 School Street, Pittsburg, CA 94565 Ananth Shenoy, M.D., Inc., 3501 Lone Tree Way, Ste 2, Antioch, CA 94509Riad Laham, M.D. (anesthesiologist), 410 W. Main St., Ste. F, Merced, CA 95340 Ramaknishna P. Gollapudi, M.D., 3505 Lone Tree Way, Antioch, CA 94509 Allen Workman, M.D., 3700 Sunset Lane, Antioch, CA 94509 1 CERTIFICATE OF SERVICE BY HAND-DELIVERY 2 I, the undersigned, declare under penalty of perjury: that I am a citizen of the Unites States 3 and over the age of eighteen years; that I am not a party to the within action or proceeding; that 4 my business address is 1990 N. California Boulevard, Suite 740, Walnut Creek, California 94596; that on the date set forth below, I served a true and correct copy of. 5 NOTICE OF CLAIM AGAINST CONTRA COSTA COUNTY FLOOD CONTROL DISTRICT 6 7 8 by personally hand-delivering said document(s), to the parties listed below as follows: 9 10 Clerk of the Board of Supervisors 11 Contra Costa County 651 Pine Street, Room 106 12 Martinez, CA 94553 13 14 15 16 17 I declare under penalty of perjury of the laws of the State of California that the foregoing 18 is true and correct; that if called upon to testify to the facts herein stated, I could do so 19 competently. 20 Executed on August 1, 1994, at Walnut Creek, California. 21 22 23 KURT,4'-KELLERSBERFAR 24 25 26 27 28 1 1 PROOF OF SERVICE BY MAIL -- CCP. &2015.5 & M13(a) 2 I, the undersigned, declare under penalty of perjury of the laws of the State of California: 3 4 That I am a citizen of the United States and over the age of eighteen years; that I am not a party to the within action or proceeding; that my business address is 1990 N. California 5 Boulevard, Suite 740, Walnut Creek, California 94596; that on the date set forth below I served a true copy of- 6 CLAIM AGAINST CONTRA COSTA COUNTY FLOOD CONTROL DISTRICT 7 8 9 by depositing said copy in the United States Mail, at Walnut Creek, California, in a sealed 10 envelope, postage thereon prepaid, addressed as follows: 11 12 VIA CERTIFIED MAIL - RETURN RECEIPT REQUESTED Clerk of the Board of Supervisors 13 Contra Costa County 651 Pine Street, Room 106 14 Martinez, CA 94553 15 16 17 18 19 20 21 22 At said time, there was regular delivery of the United States Mail between said places of deposit and address(es). 23 Executed at Walnut Creek, Contra Costa County, California, on August 1, 1994. 24 25 26 SHARON HANNEY 27 28 LAW OFFICES OF BROOKMAN & TALBOT INCORPORATED SACRAMENTO OFFICE WALNUT CREEK OFFICE SUITE 200 SUITE 740 COURT PLAZA BUILDING WALNUT CREEK PLAZA BUILDING 901 H STREET 1990 NORTH CALIFORNIA BOULEVARD SACRAMENTO, CALIFORNIA 95614-9996 WALNUT CREEK, CALIFORNIA 94596-3711 i TELEPHONE (916)441-4314 TELEPHONE (510) 932-4008 FAX: (916)441-1670 FAX: (510)937-1828 I Please direct reply to: Walnut Creek Office August 1, 1994 Clerk of the Board of Supervisors Contra Costa County 651 Pine Street, Room 106 Martinez, CA 94553 HAND DELIVERED RE: RUTH WILSON v. CONTRA COSTA COUNTY Dear Clerk: Enclosed please find Claim against Contra Costa County Flood Control District and Contra Costa County Consolidated Fire District (2 separate claims) regarding Ms. Wilson's accident of 2/12/94. Thank you for your cooperation. Very truly yours, BROOKMAN & TALBOT, INC. . Sharo=anney, Secretary to Alan M. Talbot /sh Encls. 4 �� ,Ft ;t N 0 A o � $�WW �a, o c.� rr �� .�' ° � �,A o� � �, � � �, �� v �� .� U � �^ �n � � � � � 3d Ga a d" u� � d W O C) d � v �`� � �` � � �G � � 3 Claim 'to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury .-.o 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. r 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. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * f * * * * * * * * * * * * RE: Claim By ) Reserved for Clerk's filing stamp RUTH .E. WILSON ) RECEIVED Against the County of Contra Costa ) �x ) �1G - 21994 FLOOD CONTROL DISTRICT DiC ) CLERK BOARD OF suPERV1SORS Fill in name ) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ . to be determined and in support of this. claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2/12/94 at approximately 9 : 10 a.m. 2. Where did the damage or injury occur? (Include city and county) 983 Rosemary Lane, City of Oakley, County of Contra Costa, California 3. How did the damage or injury occur? (Give full details; use extra paper if required) SEE ATTACHMENT A 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Contra Costa County Flood Control District failed to properly maintain and repair the water heater in the apartment. (over) 5. What are the names of county or district officers, servants or employees causing the damage or injury? Unknown at present. 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. SEE ATTACHMENT B. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Based on medical bills and reports. 8. Names and addresses of witnesses, doctors and hospitals. SEE ATTACHMENT C. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Only medical bills as noted above. 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 p �A ANTHONY R. BROOKMAN, ESQ. ALAN M. TALBOT ALAN M. TALBOT, ESQ. BROOKMAN & TALBOT, INC. Attorney for Claimant 1990 N. California Blvd. , #740 Walnut Creek, CA 94596 Address Telephone No. (5 10) 932-4008 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. Claim of Ruth E. Wilson ATTACHMENT A 3. Claimant was in her residence located at 983 Rosemary Lane, Oakley, California when, upon awakening at approximately 4:00 - 5:00 a.m. on 2/12/94, she discovered her carpet was wet with water approximately 2-3 inches deep, caused by a leaky water heater. Claimant placed a "911" call at approximately 4:00 - 5:00 a.m. The Oakley Fire Department responded to the call and attempted to pump the water out of the apartment. The carpet was still apparently wet when at approximately 9:10 a.m. on 2/12/94, claimant stepped on the still wet carpet and slipped and fell, fracturing her left leg in four places. Claim of Ruth E. Wilson ATTACHMENT B 6. Claimant's right leg was fractured in four places, requiring surgery. The full extent of claimant's injuries are still to be determined. Approximate amount of damages incurred to date are as follows: Medical expenses incurred to date: $ 41,760.66 Estimate of future medical expenses is to be determined. Claimant still getting treatment. Loss of Wages: None General Damages: To Be Determined. Claim of Ruth E. Wilson ATTACHMENT C 8. American Medical Response West (ambulance), P. O. Box 7780, Fremont, CA 94538 Delta Memorial Hospital, 3901 Lone Tree Way, Antioch, CA 94509 Lone Tree Convalescent, 4001 Lone Tree Way, Antioch, CA 94509 Charles S. Brisbin, M.D., 575 School Street, Pittsburg, CA 94565 Ananth Shenoy, M.D., Inc., 3501 Lone Tree Way, Ste 2, Antioch, CA 94509Riad Laham, M.D. (anesthesiologist), 410 W. Main St., Ste. F, Merced, CA 95340 Ramaknishna P. Gollapudi, M.D., 3505 Lone Tree Way, Antioch, CA 94509 Allen Workman, M.D., 3700 Sunset Lane, Antioch, CA 94509 1 CERTIFICATE OF SERVICE BY HAND-DELIVERY 2 I, the undersigned, declare under penalty of perjury: that I am a citizen of the Unites States 3 and over the age of eighteen years; that I am not a party to the within action or proceeding; that 4 my business address is 1990 N. California Boulevard, Suite 740, Walnut Creek, California 94596; that on the date set forth below, I served a true and correct copy of: 5 NOTICE OF CLAIM AGAINST CONTRA COSTA COUNTY FLOOD CONTROL DISTRICT 6 7 8 by personally hand-delivering said document(s), to the parties listed below as follows: 9 10 Clerk of the Board of Supervisors 11 Contra Costa County 651 Pine Street, Room 106 12 Martinez, CA 94553 13 14 15 16 17 I declare under penalty of perjury of the laws of the State of California that the foregoing 18 is true and correct; that if called upon to testify to the facts herein stated, I could do so 19 competently. 20 Executed on August 1, 1994, at Walnut Creek, California. 21 22 23 KURT J. KEL SBERGER 24 25 26 27 28 1 1 PROOF OF SERVICE BY MAIL -- CCP. &2015.5 & U013(a) 2 3 I, the undersigned, declare under penalty of perjury of the laws of the State of California: 4 That I am a citizen of the United States and over the age of eighteen years; that I am not a party to the within action or proceeding; that my business address is 1990 N. California 5 Boulevard, Suite 740, Walnut Creek, California 94596; that on the date set forth below I served a true copy of: 6 CLAIM AGAINST CONTRA COSTA COUNTY FLOOD CONTROL DISTRICT 7 8 9 by depositing said copy in the United States Mail, at Walnut Creek, California, in a sealed 10 envelope, postage thereon prepaid, addressed as follows: 11 12 VIA CERTIFIED MAIL - RETURN RECEIPT REQUESTED Clerk of the Board of Supervisors 13 Contra Costa County 651 Pine Street, Room 106 14 Martinez, CA 94553 15 16 17 18 19 20 21 22 At said time, there was regular delivery'of the United States Mail between said places of deposit and address(es). 23 Executed at Walnut Creek, Contra Costa County, California, on August 1, 1994. 24 25 26 f SHAR N kANNEY 27 28 CLAIM Ml BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 13, 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 Mount: Unknown Section 913 and 915.4. Pleaseote�al•1-"Wa�ni-ngs"": UJ CLAIMANT: WILSON, Ruth Mb4 ATTO;NEY: Anthony R. Brookman, Esq. COUNTY COUNSEL Alan M. Talbot , Esq. Date received MARTINEZCALIF. ADDRESS: 1990 N. California Blvd. , #741Y DELIVERY TO CLERK ON August 1, 1994 Walnut Creek, CA 94.596 BY MAIL POSTMARKED: Hand Delivered 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. 6app IL ATCHELOR,. Clerk DATED: : puty a ll. FROM: unty 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: \S Cu.r- Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARDD ORDER: By unanimous vote of the Supervisors present (V/) 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 -cerUin exceptions. you have only six (6) months from the date this notice was personally served or neposited 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 BAILING 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 1n 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: j BY: PHIL BATCHELOR by ��Q�u �� Deputy Clerk T CC: County Counsel County Administrator Claim�.o: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury 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 Roam 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. # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # RS: Claim By ) Reserved for Clerk's filing stamp RUTH E. WILSON ) RECENE® 4 Against the County of Contra Costa ) l 1994 . CONSOLIDATED FIRE DISTRIE tract) [CLEROKBUARDOFSUPERV19ORS Fill in name ) CONTRA COSTA CO. M- The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ .to be determined and in support of this claim represents as follows: I. When did the damage or injury occur? (Give exact date and hour) 2/12/94 at approximately 9 : 10 a.m. 2. Where did the damage or injury occur? (Include city and county) 983 Rosemary Lane, City of Oakley, County of Contra Costa, California 3. How did the damage or injury occur? (Give full details; use extra paper if required) SEE ATTACHMENT A 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? The Oakley Fire Department failed to properly pump the water out of the apartment and led claimant to believe the carpet was dry enough to safely walk on. 5. What are the names of ct ty or district officers, serva: , or employees causing the damage or injury? A. J. Mendoza, M. Farjado, J. Parson, A_ Espinoza, and M. Tovar 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. SEE ATTACHMENT B 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Based on medical bills and reports. 8. Names and addresses of witnesses, doctors and hospitals. SEE ATTACHMENT C 9. List the expenditures you made on account of this accident or injury: DATE IT"M AMOUNT Only medical bills as noted above. Gov. Code Sec. 910.2 p vides: "The claim must be ds d by the claimant SEND NOTICES TO: (Attorney) or some erson behalf." Name and Address of Attorney ANTHONY R. BROOKMAN, ESQ. ALAN M. TALBOT, ESQ. RC �"— BROOKMAN & TALBOT, INC. 1990 N. California Blvd. , #740 Walnut Creek, CA 94596 Address Telephone No. 510-932-4008 Telephone No. i if • iF x I fr c $ 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 ($1090009 or by both such imprisonment and fine. Claim of Ruth E. Wilson ATTACHMENT A 3. Claimant was in her residence located at 983 Rosemary Lane, Oakley, California when, upon awakening at approximately 4:00 - 5:00 a.m. on 2/12/94, she discovered her carpet was wet with water approximately 2-3 inches deep, caused by a leaky water heater. Claimant placed a "911" call at approximately 4:00 - 5:00 a.m. The Oakley Fire Department responded to the call and attempted to pump the water out of the apartment. The carpet was still apparently wet when at approximately 9:10 a.m. on 2/12/94, claimant stepped on the still wet carpet and slipped and fell, fracturing her left leg in four places. Claim of Ruth E. Wilson ATTACHMENT B 6. Claimant's right leg was fractured in four places, requiring surgery. The full extent of claimant's injuries are still to be determined. Approximate amount of damages incurred to date are as follows: Medical expenses incurred to date: $ 41,760.66 Estimate of future medical expenses is to be determined. Claimant still getting treatment. Loss of Wages: None General Damages: To Be Determined. Claim of Ruth E. Wilson ATTACHMENT C 8. American Medical Response West (ambulance), P. O. Box 7780, Fremont, CA 94538 Delta Memorial Hospital, 3901 Lone Tree Way, Antioch, CA 94509 Lone Tree Convalescent, 4001 Lone Tree Way, Antioch, CA 94509 Charles S. Brisbin, M.D., 575 School Street, Pittsburg, CA 94565 Ananth Shenoy, M.D., Inc., 3501 Lone Tree Way, Ste 2, Antioch, CA 94509Riad Laham, M.D. (anesthesiologist), 410 W. Main St., Ste. F, Merced, CA 95340 Ramaknishna P. Gollapudi, M.D., 3505 Lone Tree Way, Antioch, CA 94509 Allen Workman, M.D., 3700 Sunset Lane, Antioch, CA 94509 1 CERTIFICATE OF SERVICE BY HAND-DELIVERY 2 I, the undersigned, declare under penalty of perjury: that I am a citizen of the Unites States 3 and over the age of eighteen years; that I am not a party to the within action or proceeding; that 4 my business address is 1990 N. California Boulevard, Suite 740, Walnut Creek, California 94596; that on the date set forth below, I served a true and correct copy of: 5 NOTICE OF CLAIM AGAINST CONTRA COSTA COUNTY CONSOLIDATED FIRE 6 DISTRICT 7 8 9 by personally hand-delivering said document(s), to the parties listed below as follows: 10 11 Clerk of the Board of Supervisors Contra Costa County 12 651 Pine Street, Room 106 Martinez, CA 94553 13 14 15 16 17 18 I declare under penalty of perjury of the laws of the State of California that the foregoing 19 is true and correct; that if called upon to testify to the facts herein stated, I could do so competently. 20 Executed on August 1, 1994, at Walnut Creek, California. 21 22 23 2,o:4-//� KURVJ. KELLERSBEKMR 24 25 26 27 28 1 1 PROOF OF SERVICE BY MAIL -- CCP, X2015.5 & 41013(a) 2 I, the undersigned, declare under penalty of perjury of the laws of the State of California: 3 4 That I am a citizen of the United States and over the age of eighteen years; that I am not a party to the within action or proceeding; that my business address is 1990 N. California 5 Boulevard, Suite 740, Walnut Creek, California 94596; that on the date set forth below I served a true copy of. 6 CLAIM AGAINST CONTRA COSTA COUNTY CONSOLIDATED FIRE DISTRICT 7 8 9 by depositing said copy in the United States Mail, at Walnut Creek, California, in a sealed 10 envelope, postage thereon prepaid, addressed as follows: 11 12 VIA CERTIFIED MAIL - RETURN RECEIPT REQUESTED Clerk of the Board of Supervisors 13 Contra Costa County 651 Pine Street, Room 106 14 Martinez, CA 94553 15 16 17 18 19 20 21 At said time, there was regular delivery of the United States Mail between said places of deposit 22 and address(es). 23 Executed at Walnut Creek, Contra Costa County, California, on August 1, 1994. 24 25 26 SHARON HANNEY 27 28 r << � N W F C> � J £ y V �N � w o 0 yd Olt VU � s n- O � 3 • 1 7 LAW OFFICES OF BROOKMAN & TALBOT INCORPORATED SACRAMENTO OFFICE WALNUT CREEK OFFICE SUITE 200 SUITE 740 COURT PLAZA BUILDING WALNUT CREEK PLAZA BUILDING 901 H STREET 1990 NORTH CALIFORNIA BOULEVARD SACRAMENTO, CALIFORNIA 95814-9998 WALNUT CREEK, CALIFORNIA 94596-3711 TELEPHONE (916)441-4314 TELEPHONE (510) 932-4008 FAX: (916) 441-1670 FAX: (510) 937-1826 Please direct reply to: Walnut Creek Office August 1, 1994 Clerk of the Board of Supervisors Contra Costa County 651 Pine Street, Room 106 Martinez, CA 94553 CERTIFIED MAIL - RETURN RECEIPT REQUESTED RE: RUTH WILSON v. CONTRA COSTA COUNTY Dear Clerk: Enclosed please find Claim against Contra Costa County Flood Control District and Contra Costa County Consolidated Fire District (2 separate claims) regarding Ms. Wilson's accident of 2/12/94. Thank you for your cooperation. Very truly yours, BROOKMAN & TALBOT, INC. Sharon Hanney, Secretary to Alan M. Talbot /sh Encls. '-Claim 'to: BOARD OF SUPERVISORS OF CONTRA COSTA OOUM INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury ...o person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code 5911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * RE: Claim By ) Reserved for Clerk's filing stamp RUTH E. WILSON ) } RECEIVE® Against the County of Contra Costa } ON ) - 2 CONSOLIDATED FIRE DISTRIf trict) CLERKBOARDOFSUPERVISORS Fill in name ) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ to be determined and in support of this claim represents as follows: I. When did the damage or injury occur? (Give exact date and hour) 2/12/94 at approximately 9 : 10 a.m. 2. Where did the damage or injury occur? (Include city and county) 983 Rosemary Lane, City of Oakley, County of Contra Costa, California �- 3. How did the damage or injury occur? (Give Rill details; use extra paper if required) SEE ATTACHMENT A 4. What particular act or omission on the part of county or district officers, servants or employees caused the in)ury or damage? The Oakley Fire Department failed to properly pump the water out of the apartment and led claimant to believe the carpet was dry enough to safely walk on. 5. What are the names of ck ty or district officers, serva: , or employees causing 'the damage or injury? A. J. Mendoza, M. Farjado, J. Parson, A_ Espinoza, and M. Tovar 6 _ 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. SEE ATTACHMENT B 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Based on medical bills and reports. 8. Names and addresses of witnesses, doctors and hospitals. SEE ATTACHMENT C 9. List the expenditures you made on account of this accident or injury: DA'T'E ITEM AMOUNT Only medical bills as noted above. 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." Ne and ddress of Attorney ANTHONY AR. BROOKMAN, ESQ. ALAN R TALBOT ALAN M. TALBOT, ESQ. Atr-orney_ r BROOKMAN & TALBOT, INC. 1990 N. California Blvd. , #740 Walnut Creek, CA 94596 Address Telephone No. 510-932-4008 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 ($109000, or by both such imprisonment and fine. Claim of Ruth E. Wilson ATTACHMENT A 3. Claimant was in her residence located at 983 Rosemary Lane, Oakley, California when, upon awakening at approximately 4:00 - 5:00 a.m. on 2/12/94, she discovered her carpet was wet with water approximately 2-3 inches deep, caused by a leaky water heater. Claimant placed a "911" call at approximately 4:00 - 5:00 a.m. The Oakley Fire Department responded to the call and attempted to pump the water out of the apartment. The carpet was still apparently wet when at approximately 9:10 a.m. on 2/12/94, claimant stepped on the still wet carpet and slipped and fell, fracturing her left leg in four places. Claim of Ruth E. Wilson ATTACHMENT B 6. Claimant's right leg was fractured in four places, requiring surgery. The full extent of claimant's injuries are still to be determined. Approximate amount of damages incurred to date are as follows: Medical expenses incurred to date: $ 41,760.66 Estimate of future medical expenses is to be determined. Claimant still getting treatment. Loss of Wages: None General Damages: To Be Determined. Claim of Ruth E. Wilson ATTACHMENT C 8. American Medical Response West (ambulance), P. O. Box 7780, Fremont, CA 94538 Delta Memorial Hospital, 3901 Lone Tree Way, Antioch, CA 94509 Lone Tree Convalescent, 4001 Lone Tree Way, Antioch, CA 94509 Charles S. Brisbin, M.D., 575 School Street, Pittsburg, CA 94565 Ananth Shenoy, M.D., Inc., 3501 Lone Tree Way, Ste 2, Antioch, CA 94509Riad Laham, M.D. (anesthesiologist), 410 W. Main St., Ste. F, Merced, CA 95340 Ramaknishna P. Gollapudi, M.D., 3505 Lone Tree Way, Antioch, CA 94509 Allen Workman, M.D., 3700 Sunset Lane, Antioch, CA 94509 1 CERTIFICATE OF SERVICE BY HAND-DELIVERY 2 I, the undersigned, declare under penalty of perjury: that I am a citizen of the Unites States 3 and over the age of eighteen years; that I am not a party to the within action or proceeding; that 4 my business address is 1990 N. California Boulevard, Suite 740, Walnut Creek, California 94596; that on the date set forth below, I served a true and correct copy of: 5 NOTICE OF CLAIM AGAINST CONTRA COSTA COUNTY CONSOLIDATED FIRE 6 DISTRICT 7 8 9 by personally hand-delivering said document(s), to the parties listed below as follows: 10 11 Clerk of the Board of Supervisors Contra Costa County 12 651 Pine Street, Room 106 Martinez, CA 94553 13 14 15 16 17 18 I declare under penalty of perjury of the laws of the State of California that the foregoing 19 is true and correct; that if called upon to testify to the facts herein stated, I could do so competently. 20 Executed on August 1, 1994, at Walnut Creek, California. 21 22 23 A/ KURT J. KELLIRSBERGER 24 25 26 27 28 1 1 PROOF OF SERVICE BY MAIL -- CCP, X2015.5 & 41013(a) 2 I, the undersigned, declare under penalty of perjury of the laws of the State of California: 3 4 That I am a citizen of the United States and over the age of eighteen years; that I am not a party to the within action or proceeding; that my business address is 1990 N. California 5 Boulevard, Suite 740, Walnut Creek, California 94596; that on the date set forth below I served a true copy of- 6 CLAIM AGAINST CONTRA COSTA COUNTY CONSOLIDATED FIRE DISTRICT 7 8 9 by depositing said copy in the United States Mail, at Walnut Creek, California, in a sealed 10 envelope, postage thereon prepaid, addressed as follows: . 11 12 VIA CERTIFIED MAIL - RETURN RECEIPT REQUESTED Clerk of the Board of Supervisors 13 Contra Costa County 651 Pine Street, Room 106 14 Martinez, CA 94553 15 16 17 18 19 20 21 At said time, there was regular delivery of the United States Mail between said places of deposit 22 and address(es). 23 Executed at Walnut Creek, Contra Costa County, California, on August 1, 1994. 24 25 f' 26 SHARONA NEY 27 28 CLAIM +1 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 13, 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: $75,000.00 + Section 913 and 915.4. Please note all •WarninnP327T gs". CLAIMANT: WILSON, Kent c. and Cheryl K. 0 ATTO;NEY: Michael J. Cochrane AUG 17 1994 Nelson & Leighton Date received COUrmCOUNSEL ADDRESS: 939 Hartz Way, Ste. 210 BY DELIVERY TO CLERK ON A„gg,et 19, 12arTINEZCALIF. Danville, CA 94526 BY MAIL POSTMARKED: Hand Delivered 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted claim. PpHHATCHEIOR, Clerk IL ` OQ � DATED: AA/1A,rt o /��_�q, 81: puty �3e 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). 1 ( ) Other: Dated: �� l BY: �l Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARDD 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: °I PHIL BATCHELOR, Clerk, By . , Deputy Clerk YARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or Aeposited 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: y Q� Deputy Clerk BY: PHIL BATCHELOR by �,c,� y 'Ct: County Counsel County Administrator Claim to: BOARD SUPERVISORS OF CONTRA COSTA CC* 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 onto 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 f r Clr s=ingsp KENT C . "&:'CHERYL K';-WILSON } } x RECEIVE Against the County of Contra Costa or ) 1 2 1994 SOD -1--i District) CLERK o�T�A��s A�i�IS % Fill in name ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District )1ff)tUXXAKW $ excess of $75 ,00cand in support of this claim represents. as follows: 1. When 'lid the damage or injury occur? '(Give exact date and hour) Exact date and. time unknown, Damage to real property has manifested within the six months preceeding the filing of this claim_:: 2. Where did the damage or injury occur? (Include city and county) 543 SILVER OAK LANE, DANVILLE CA 3. How did the damage or injury occur? (Give full details; use extra paper if required)Claimant has observed damages to "their townhouse units manifesting in interior and exterior. wall cracks and seperations, differential floor movements, lateral movements of fencing and decking, heaving, shifting & cracking of foundation elements . 4. What particular actor omission on the part of county or district officers, servants or employees caused _the injury or damage?The Geologic Hazard Abatement Dst and its employee, John LaViolette, investigated claims of damages at claimants unit in March, 1993 and designed a repair plan for claimants unit Claimant is informed and believes that the scope of repair was inadequate , negligently proposed, and otherwise deficient, and is contributing to the damages observed at their residence . �. wnat are the names ofounty or district officers, serves or employees causing the damage or injure? Geologic Hazard Abatement District; John LaViolette. -------------------------------- 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Damages to foundation at Claimants townhouse unit; damages to interior of townhouse unit manifesting in wall cracks, out of level floors; damage to fencing and decking. ------------------------------ 7• How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.)Es tima ted cost of repair in excess of $75 , 000 . 00 is based upon discussions with. licensed soil engineer and engineering and general contractor. B. Names and addresses of witnesses, doctors and hospitals. Claimants are witnesses to the damages in their units , as is John LaViolette of the Geologic Hazard Abatement District. ------------------------------- .��--- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT --- NONE TO DATE Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some pgotion half." Name and Address of Attorney MICHAEL J. COCHRANE NELSON & LEIGHTON aimant s Signature 939 HARTZ WAY, STE , 210 DANVILLE CA 94526 939 HARTZ WAY, STE , 210 Address DANVILLE CA 94526 Telephone No. (510) 837-8019 Telephone No. (510) 837-8019 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. CLAIM �•�I BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 13, 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: Unlrnown Section 913 and 915.4. Please note a OW 'i CLAIMANT: WATTLES, Robert and Warren o AUG 2 2 1994 ATTORNEY: Fortune & Healey �IFdTYCOUNSEI. Anthony 0. Ricucci Date received COUNT COONS F. ADDRESS: One Embarcadero Ctr. , Ste. 1340 BY DELIVERY TO CLERK ON August 22. 1994 San Francisco; CA 94111 BY MAIL POSTMARKED: August 19-1994 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the sbove•noted claim. ` ppN IL B8ATCHELOR. Clerk DATED: 81: peputy , , &.1-t 11. FROM:: County Counsel TO: Clerk of the Board of Supervisors ( V1 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: i Dated: J�rt' y BY: u---�- l Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARD 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. /I 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 Aeposited 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. i 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 1n the United States Postal Service in Martinez. Lalifornia, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to %he claimant as shown above. ! �, � Dated: BY: PHII BATCHELOR by �!�j�j Deputy Clerk CC: County Counsel County Administrator i Claim 3.o: BOARD OF SUPERVISORS OF CONTRA COSTA OOUN7Y INSTRUCTIONS TO CLAIMANT i A. Claims relating to causes of action for death or for injury o 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. i D. If the claim ids against more tran 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 To. � e e � � � � ,� � �* * e � • � s * a � e � � +� � � e * e • e s * a � e e a e e � � � +� RE: Claim By ) Reserved for Clerk's filing stamp RnhPrt U7at-'1 Pc' warren Waff l r%Q ) RECEIVED ) Against the County of Contra Costa ) AUG 2 2 I or ) CLERK BOARD OF SUPERVISORS + District) CQNTf1.A COSTA CO. Fill in name The undersigned claimant hereby makes claimt�inst the County of:Contra. Cbstai br` the above-named District in the sum of $ indaemnk,X, and in support-of sum un n wn this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) . Plaintiff (;Jack Isaacs) injured -4/8/93 5 : 30 p.m. Complaint served on Wattles !6/2/94 2. Where did the damage or injury occur? (Include city and county) Stone Valley Rd. ( e-b) east at exit of Rte 680 , Contra Costa County 3. How did the damage or injury occur? (Give full details; use extra paper if required) Plaintiff Isaacs ' vehicle rear-ended by vehicle driven by Warren Wattles ati,exit ramp stop sign area. Accident occurred because of poor design of road and exit ramp creating 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Poor design ,of resod, exit route, inadequate number of lanes for traffic and conditions described in "attachment"to this form. (over) 5. What are the names of county or district officers, servants or employees causing the damage or injury? Presently unknown to claimants . 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Injuries to plaintiff Isaacs presently unknown claimants entitled to indemnity for any damages awarded to plaintiff . 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) unknown presently. 8. Names and addresses of witnesses, doctors and hospitals. unknown presently. 9. List the expenditures you made on account of this accident or injury: not applicable- DATE ITEM AMOUNT ( indemnity claim) Gov. Code Sec. 910.2 provides: ' "The clam must be signed by the claimant SEND NOTICES TO: (Attorney) orW' scoe person on his behalf." Name and Address of Attorney , ANTHONY O, RICUCCIClaimantf''QQs Signature FORTUNE & HEALEY R��N�o$TU�TICUC CI , ESQ . LAW OFFICES FORTUNE & HEALEY ONE EMBARCADERO CTR.,SUITE#1340 One Embar cadeerso Ctr. , Ste 1340 SAN FRANCISCO, CA 94111 San Francisco, California 94111 Telephone No. ( 415 ) 5 4 4 j-:06-1 0. Telephone No. ( 41 ) 5 4 4-3 010 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. ATTACHMENT (Claim by Robert & Warren Wattles) As a result of the acts and omissions of the County of Contra Costa, California and its employees and agents, (including Cal Trans) the section of Stone Valley Road just east of the off-ramp from northbound I-680 is dangerous and poses unreasonable risk of injury to motorists exercising due care. The danger rises from the fact that in a very short distance Stone Valley Road is reduced from two lanes to one lane. In addition the stream of traffic at this point from the off-ramp is introduced. Thus, a total of three lanes of traffic merge into one eastbound lane. As a result of this funneling of traffic from three lanes to one lane in a distance which does not meet reasonable design standards, the traffic bottlenecks, and is forced to come to sudden halts, resulting in numerous rear-end accidents, including claimant's accident with plaintiff, Jack C. Isaacs, in Contra Costa Superior No. C94-00631. The County and its agents and employees failed to erect the proper warning signs and other regulatory measures to advise the motorists of the suddenly slowing or stopping traffic. Absence of signs was one cause, but not the sole cause of the dangerous condition. The condition constitutes a trap for a motorist utilizing the roadway in a reasonable fashion in that traffic suddenly halts without adequate prior warning. When Stone Valley Road was widened at or about the I-680 overpass, a third lane for merging traffic was eliminated. This changed was not reasonable, violated design standards and created a dangerous condition of public property. If the widening and funneling features were designed, such designs were not reasonable and the designs could not have been reasonably approved. If in fact the design of this roadway was properly approved, conditions have changed substantially since the time of the design in that traffic volume has increased tremendously, creating an extremely dangerous condition of rapidly moving, merging traffic in an area which is not adequate to provide for safe merging. 1 PROOF OF SERVICE BY MAIL 2 (C.C.P. sections 1013a, 2015. 5) 3 I declare that: 4 I am a citizen of the United States and am employed at the 5 Law Offices of Fortune & Healey in the City and County of San Francisco, California; I am over the age of eighteen years and am 6 not a party to the within action; my business and employment address is One Embarcadero Center, Suite 1340, San Francisco, 7 California, 94111. 8 That on August IS, 1994, I served a true copy of the original of the attached: 9 TORT CLAIM AGAINST COUNTY OF CONTRA COSTA 10 on all of the attorneys of record in the action, by depositing a 11 true copy of the original thereof enclosed in a sealed envelope with postage fully prepaid, in the United States mail at 12 San Francisco, California, addressed as follows: 13 Kerry M. Gough, Esq. GOUGH & COHEN 14 The London Building at Jack London Square 160 Franklin Street, Suite 200 15 Oakland, California 94607 16 Clerk of the Board of Supervisors, Rm 106 County Administration Building 17 651 Pine Street Martinez, California 94553 18 I declare, under penalty of perjury, that the foregoing is 19 true and correct. 20 EXECUTED ON August 1%, 1994 at San Francisco, California. 21 22 KARIMA CRITTENDEN 23 24 25 26 27 28 -!1 Yqt 66��C (I+.s •d gi5�5t%�A Yet V�' o-� R � R v 7 ~ ,5Q 34�V U F a 04 6 S. Qw � v d5 " p4m W Zv 72' � ° ami ti �k, 24 0 i " w o CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 13, 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: $600.00 10 IV- g ction 913 and 915.4. Please note all •Warnings". CLAIMANT:GRAND, Dennis and Annan 1 g 1934 ATTORNEY: COUNTY COUNSEL MAFITINEZ CALIF. Date received ADDRESS: 370 E. Lassen #55 BY DELIVERY TO CLERK ON August 18, 1994 Chico, CA 95926 BY MAIL POSTMARKED: August 16, 1994 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppHHJL BeATCHELOR Clerk �, J p 0 DATED: 7 B1: Deputy ' �c r II. FROM: Co my 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 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (A 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. yy / Dated: NLat n PHIL BATCHELOR, Clerk, By �d� ( �a �� Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or neposited 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:— / � C� BY: PHIL BATCHELOR by \ . ( A,6.1Deputy Clerk CC: County Counsel County Administrator i Claim '.o: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Clam relating to causes of action for death or for injury ..o person or to per- sonal property or growing crops and which.accrue' an 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 an or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code 5911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Roam 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 riled against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 'at the end of this To—m. e * f * * � e � * * � e e � e a +� e e e a s • e • a e f e • • e �I • �t �t • fee • a RE: Claim By ) Reserved for Clerk's filing stamp RECEIVED Against the County of Contra Costa—) A98 18 094 or ) CLERK BOARIYOF SUPERVISORS District) 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 $ I� i� and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. Where` d the damage or injury occur? (Include city and county) -A-f)_k�i Coffxrc Con"- -c-0�1L-L COOLLf__ Las(r LpL\b&A Co_,,&o�-Co, 3. How did the damage or injury occur? (Give full details; use extra paper if required) \-u.&. Lkose,& vas t�aS car � ©T) +tle ` s 4e. c.� 4'h �' C Qv -rte. v�c,S n r nr\4 y bc 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? ir,'vu bur �, n co v s►- ,� e.✓1f-- (over) 5. What are the names of county or district officers, servants or employees causing the damage or injury? r /'i o8e a' Vy\Q-- F xb YYcm e, lus} ►1 ►m e u�tkap( � zc� ? b. What damage or injuries do you claim resulted? (Give full extent of injuries or• ow— Ck, damages claimed. Attach two estimates for auto damage. �-porgy-dF Oor UC1 ' � ,F�vt'.✓� Sid� D�. V) Qnd �n �� ?�v� Sim. �� r►tie rrs C w .� L-�- ��n ��- 7. How was the amount claimed above computed? (Include the estimated amount of any$,�P� �� prospective injury or damage.) i S. Names and addresses of witnesses, doctors and hospitals. ks-:k'.e.vA- �Vpv uow. iC�c� 'fSl 1�tw�tY1 Cep(>h�. C.o s�-a� QUA Ful �e'J n�.s +� ►�I h I- i t--h CA h P e r t d , r- c W KO ��,`-vu 1.� Lv rc� Vie_ ire�o �� u1 i K'hesseL_ -)In da m q.�-c. d_vv,— C su Pa vl �-y br s5. t�1�1d -S�-.Y=�'��- -a - ,f, 9. List the expenditures you made on account of this accident or injury: 'd'y`e- 1VO(1 `7,1 me,? DATE ITEM AMOUNT w/ �4. r - cry OV-P V n ��S • Va r) U-Y-t,s 0 >'�� l�(t nor) -r Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney orbY ARM7_e erson on his behalf." Name and Address of Attorney : 1v (Claitlat s S t j (Address) Telephone No. Telephone No. e �t �r • �tfaIr 0 W- _. _ On _ ex 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 ($109000, or by both such imprisonment and fine. I-1840 Park Avenue Chico, CA 95928 (916) 342-1328 PAINT&BODY WORKS Name _ Z Date f�', Written By Address 7 r State 61e f Zip Z Ins. Co. Home Phone , S`z/7 Bus. Phone Deductable Make �/�!/�� Model I.D. No. Appraiser _ Prod. Date e2*e Mileage Lic. No. Colo Phone Phone j PAIR PLACE PUC BODY SHOP LABOR PARTS PAINT j2 3 4 L, 5 ' 6 — i 17 -8 ' I 10 11� 12 �13 114 15 16 17 118 19 :20 21 122 TOTALS FRAME-MECHANICAL I ( REMARKS SUBLET LABOR @ Per Hr. MATUS @ U 1 Per Hr.- PARTS r:PARTS SUBLET TOW-STORAGE TOTALI I FRAME & MECH. AUTHORIZATION PAINT& 1840 Park Avenue TAX ON FOR REPAIR BODY Chico, CA 95928 TOTAL )k1W ORKS (916) 342-1328 REPAIR ESTIMATE GOOD FOR130'DAYS-PRICES SUBJECT TO INVOICE ESTIMATE OF REPAIRS AS LISTED FOR LABOR AND MATERIALS VERBAL:AGREEMENTS NOT BINDING-ESTIMATES FREE 1 097 OWNER DATE f� ADDRESS:-/- �'-1�-<' Avenue PHONE `, EST.NO. :v Chico, CA 95926 `* INSURANCE CO. . / ORDER NO. ADDRESS { PHONE ° -,LICENSE NUMBER (YEAR-MAKE MODEL MILEAGE MOTOR NO. SERIAL NO. ``• r Q AN. DESCRIPTION OF LAQOR OR MATERIAL PART NO. MATERIAL LABOR or • 1 i i - PARTS PRICES BASED ON STANDARD CATALOG PROCUREMENT PRICE LISTS SUBJECT TO CHANGE WITHOUT NOTICE. TOTAL PROCUREMENT AND DELIVERY CHARGES MAY BE ADDED FOR SPECIAL SERVICE ON ITEMS NOT AVAILABLE LOCALLY. MATERIAL OLD PARTS REMOVED FROM CARS WILL BE JUNKED UNLESS OTHERWISE INSTRUCTED IR!WRITING. U THE ABOVE IS AN ESTIMATE BASED ON OUR INSPECTION AND DOES NOT COVER ADDITIONAL PARTS OR LABOR WHICH TOTAL LABOR MAY BE REQUIRED AFTER THE WORK HAS BEEN OPENED UP.OCCASIONALLY AFTER WORK HAS STARTED WORN PARTS ARE 0 TOTAL MATERIAL DISCOVERED WHICH ARE NOT EVIDENT ON FIRST INSPEC ION.,BECAUSE OF THIS THE ABOVE PRICES ARE NOT GUARANTEED. ESTIMATE TAX ESTIMATED BY APPROVED BY AUTHORIZED AN EPMD PAID OUT-TOW&STORAGE r SUBLET REPAIRS BY OWNER TOTAL OR AGENT DATE R.MFORM. 4L429 s j 1 I CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 13, 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 kwunt: $356.12 Section 913 and 915.4. Please note al`p}Wa 811T CLAIMANT: Morehouse, Cheryl AUG z 2 1994 ATTOnNEY: COUNTY COUNSEL Date received MARTINEZ CALIF. ADDRESS: 2293 Flagstone Way BY DELIVERY TO CLERK ON Augisr 22, 1494 Concord, CA 94521 BY MAIL POSTMARKED: Aijglist 20, 1994 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PpIL BATCHELOR, Clerk DATED: Bq: Deputy _,d_c.t ,� 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: r BY:� Deputy County Counsel 111. FROM: Clerk of the Board. TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (V1 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 C�& a Q 0A _� 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 Aieaosited 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 I CC: County counsel County Administrator CIN117-1 r j ~• (D G Q V c� � .� 9 C ='" 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 } yz. R 'IV Against the County of Contra Costa ) or ) AUG-2 219% (Fill in name District)) CLE R CONT- CORS COSTA CO�SO The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 35 . 1� and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 30 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full details; use extra paper if required) 1,v45 d rl vl rl '1 dDu�� {-Z. Q,9`P�. `��'�l /''dao/ 601 74a�l.� r��y 9j,7 , of s�eQ' o� �v RPh u��hg�sdiiey 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damag ?. AvA e, f .� D. wnat are the names of county or district officers, servants or employees causing the da.-.,be 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.) � .I' 7�� ` B. Names and addresses of witnesses, doctors and hospitals. Fla 5 �_.._----- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT f dov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: ;'.`r,(Attorne ), orb some person on his behalf." Name and Address of Attorney Claimantts Signature (Add es) Telephone No. Telephone No. N.`OTI CE 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 ($10,000, or by both such imprisarunent and fine. ADDENDUM TO THE CLAIM OF Cwt'l °e, (P)cint your full name) ( 1) Do you use the - roadway as part of a daily commute? Yes ( ) No (�) ( 2) Were you aware that construction would be commencing on the roadway? Yes ( ) No O ( 3 ) Was an alternate route available? Yes ( ) No (�) (4) Did you read about the impending resurfacing in the local newspaper? Yes ( ) No (5) Did you see warning signs advising of loose gravel and a 25 mile per hour advisory sign? Yes (�) No ( ) ( 6) Did the damage result from another vehicle exceeding the 25 mile per hour advisory?, :Yes ( ) No ro (7) Did a vehicle traveling in the same direction and exceeding the 25 mile per hour advisory sign attempt to pass you? Yes ( ) No (�) (8) Did a vehicle coming from the opposite direction cause gravel to be thrown onto your car? Atayke_" Yes ( ) / No ( ) ( 9) Was the vehicle located directly in front of you exceeding the speed advisory? Yes ( ) No (�) at SPEEDY we care Fax: S X85-9 P CONTRACTOR LICENSE r7811I. STATE SALES TAX# R.R R E ACCQUNT AE�ENT `PO1R�1•#AE GATE 'tf3'-'�.C.,.C��4 =:�� .�$�;.$•��. CUSTOMER STATE TAX OR EXEMPT NO. CUSTOMER FEDERAL TAX I.D.NO. - SOURCE . SALESMAN I.D. ORDER TAKEN BY INSTALLED BY FEDERAL TAX I.D.N0. 10, 1 127 05 11 BILL TO: SOLD TO: PROOFINSURANCE OF • INSURANCE CO. POLICY NO. INSURANCE CO. PHONE NO. CLAIM NO: CAUSE 8' POLICY NAME LOSS LOCATION AGENT NAME VERIFIED BY AGENT PHONE DATE OF LOSS DEDUCTIBLE VEHICLE INFORMATION .1'h t f `T tom;_t(7. t NAME MOaEt YEAR pC371�5 >0[1UMETER t lOfif NSE - VEI{iCO E 1. NO7. 1 Lf :•'T13t0 18y 50 '. )CAM • r 40„ 1,VI Z81. bo. :.).r Fa1.62. t,.,: �•.�;.�,.�:,�.�.3�.js.yf.`a#••#4•�`E•�T• x,,s.•,.•�•$E•�kk�•'��.°df•'•3i�^:fi•�•�-•I;•#•�•�•�r�•�•#•�s�:•r¢aAt.t{..�'-�••��•}'r�-3w'•ai•�� •kf•#•tf-�Y••�•.�.��•t�•.r��••�.•�•r�?••1%.'F'F•YE••t2•k-•#•3��•_ws. z�•� �* tt t T S +f 41 T,, .. A. R E C E I pg-�i T q n 0 T P 'py Y •�..fi- •"sa•�'4 P£•'E•#•3£••�•v'r•�•��••#.••iti••Y•3fi•�•�€:•�•�•�`vf�•'t3•�if•-$i•?.=ff••3f'.gg.•1�..;;•`:•�E-•�.v"T'�'�'3'•�•�•�.-�•,�r•t'•'r••r�,-••�,••i�•�,1•Ka.•Sz,.ly•::,�;^�i.•3F.•}f^s�••�•-�n.?.:'�•3�vf•d'�31••'t�•�fr•3£•3t••35�••�f••S4• -WORK AUTHORIZATION "authorize e above work to be done together•with the necessary material, but request that you t of,the services be the amount reflected on this invoice. STATE OF WINDSHIELD ❑ NOT REPAIRABLE/REPLACEMENT NECESSARY ❑ REPAIR TRIED AND REFUSED BY: ❑ DAMAGE IN CRITICAL SIGHT AREA ❑ OWNER ❑ THE REPAIRMAN ❑ REPAIRABLE — REFUSED BY OWNER AUTHORIZATION TO PAY I hereby authorize and empower 4he.above-named insurance company to pay this invoice in full 00 settlement;.satisfa.ction and discharge of all loss under the above policy. Upon such payment;all rights I may have for claim and demand for loss and' damage described above against the above named insurance company shall be thereby forever discharged. In the event that the above named insurance 1 t y�CY 332. t°� company does not make timely and/or full payment of this invoice according to its terms, I hereby accept 0. Tw15 Tax ;24. 109 responsibility for such paymerit"and agree-to pay.all charges reflected on this invoice to Speedy Auto Glass subject to and according to all terms and conditions,on the reverse side of this invoice. . TERMS TERMS: NET 30 DAYS,SERVICE CHARGE OF 1�R%PER MONTH(18%PER ANNUM)WILL BE CHARGED ON OVERDUE ACCOUNTS TRANSACTION IS SUBJECT TO TERMS AND CONDITIONS ON REVERSE SIDE N A T I O N A L G L A S S E S T I M A T E CUSTOMERS NAME JOB NAME Cxeh JOB ADD ESS VEHICLE YEAR, MAKE & MODEL ru 0�� V PHONE NUMBER DESCRIPTION /OF WORK FAX NUMBER wt DVv 11,59 3�cW �qO. '70 D0 r C912� q go.I 2 6 1 0 M O N U M E N T C T " D " C O N C O R D , C A L I F O R N I A 9 4 5 2 0 ( 5 1 0 ) 6 8 5 - 1 2 6 0 DATE: Om 11 X � / ,/q PREPARED BY: CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 13, 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: $362.89 Section 913 and 915.4. Please note all "Warnings". CLAIMANT:Marlin, Shannon Lee ATTORNEY: AUG 16 1994 CCUNTYCOUN$E®ate received ADDRESS: 5532 Drakes Ct. MARTINEZ CALIF.BY DELIVERY TO CLERK ON August 15, 1994 Discovery Bay, CA 94514 BY MAIL POSTMARKED: August 12, 1994 1. FROM: Clerk of the Board of Supervisors 70: County Counsel Attached is a copy of the above-noted claim. ppN IL ATCHELOR, Clerk DATED: 8Y: 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: Laj&L ,A19 Ll BY: Deputy County Counsel 111. FROM: Clerk.of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( V� 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. Q Lq!QOA Dated: 'l 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 Aeposited 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 ani 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 Postai 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. (d Vated: - BY: PHIL BATCHELOR by (2 �, VA _ Deputy Clerk CC: County Counsel County Administrator V1 0,- 9 —ern Lo n� SS i1 9 J Cla:- 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 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 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 RECEIVE Against the County of Contra Costa 5 1994 a District) CLERK BOARD OF SUPERVISORS Fill in name ) CONTRA COSTA CO. 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 occurs (Give exact date and hour) /'✓�a y ��l 199 5�� ,Z 7�, /°l9 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full details; use extra paper i re,quired) 7r�✓��ih oi'I �uf-Sl'1 Cr�� 1, i O� ©Srn 771,19 �'iC iG.�e t1 r ,�s arc c� dna �vrv� 77 ��------------- ------ - -- ----------------------------- 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? , ;over) D. wnat are the names of county or district officers, servants or employees causing the a.-^age or injury? -----------------------------*7--------—-- ------------------------------ What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. &7U G/�� /,-7 Vf.ic/e __-------------------------- ------------------=- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) KA.&c5+ b-' repla-CQol , "T,tio --------------------------- ------------------------------ $. Names and addresses of witnesses, .doctors and hospitals. ------------------------------ ---_�________�_.._�__.. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) - or by some er n s behalf." Name and Address of Attorney - s igna DAA Address Telephone No. Telephone No.,52O&'°Z * T 9 V V IT N 0 T I C E Section 72 of the Penal Code provides: "Every person who,. with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonrient and fine. 1 fb' ee G �T= 7 1 GIgss (�Sinq. Bob Larson Ann Larson Don Larson JOced Atte° a c , Q, a Mobil Service to Home or Business i Serving Alameda&Contra Costa Counties 421 N.Buchanan Cir.#11 Pacheco,CA 94553 ....... (510)685-2023 . s 14 //////11AL/TOGL�4155 N DOMA G 1 r9�1-ii b -•84@@.Fax 510•-1685-9 175. at SPEEDY we care CONTRACTOR LICENSE fs781I1 STATE SALES TAX #` ' 9696 AGCC+UNt AGENT Ptll3CHASE DATE 7—°=8-9.�l- @-_D T NO. NO.: OlRbEA.:E!t0. CUSTOMER'STATE.TAX OR EXEMPT N0. CUSTOMER•FEDERAL TAX I.D.N0. - SOURCE SALESMAN LD. ORDER TAKEN BY INSTALLED BY FEDERAL TAX LD.NO. 10 . DAL F 1-1270511 BILL TO: SOLD TO: ,JOHN BRE'WSTER., 3190 HIL.L_VIEW cT CONCORD.- CR 94519: Hm:887 5135 INSURANCE PROOF OF LOSS INSURANCE CO. POLICY NO, INSURANCE CO. PHONE N0. CLAIM NO. .CAUSE& ✓ POLICY NAME' LOSS LOCATION AGENT NAME VERIFIED BY. ' AGENT PHONE DATE.OF LOSS DEDUCTIBLE VEHICLE INFORMATION NAME MOgEkYEAR C?C10METER kI ENSE YEkitQ(E I:D NO WF1.y 0_fAft Color KIM tabor ti-At Sell Ne t DT 1136 0. 12111b, ;t. t 1. 510 237. 10 , ,5 '}�.�'•#•'fq.'�'.�,.�"�•'�"�"�'�'-i�rs�••�{•a�"�•.}Q•'y�'•}�•�f"�•,�'.�"�'�'gf•'yf"�'•�"�"t£"�"�'•�'.�"�••�"�"�^•f("�'•�•.�'•�{"�"�'•�"�"�"f{'•�"�"�'�"$"r�'•�..�.•�„}{'.}('.�S'•�,^M••�'•#•'H"�'�'•fq•'i4"�' . T .H . I .O I` S ',. NCl. T_ A REC.• F ' I. P ;T.. -'D0 N0T .'p :A Y. VVORK` N 'AUTHORIZATIO ' I hereby authorize the above work to be done together with the necessary material,but request that you contact me if the cost of the.services exceed the amount reflected on this invoice. STATE,OF WINDSHIELD Ll NOT REPAIRABLE!REPLACEMENT-NECESSARY' ,❑ REPAIR TRIED AND REFUSED BY: ❑ DAMAGE IN CRITICAL SIGHT AREA ❑•OWNER El THE REPAIRMAN E] REPAIRABLE- REFUSED BY OWNER AUTHORIZATION TO PAY I hereby. authorize and empower the above-named insurance company to pay this invoice in full settlement,satisfaction and discharge of<all loss under the above policy. Upon such payment,all rights I may have for claim and'demand for'loss.and-damage described above against the•above-named Subtotal 161. 91 insurance company shall be thereby forever.discharged.. In the event that the above named insurance. �. company does not.make timely and/or full payment of this invoice according to.its terms, I hereby accept S. 25% 'Tax 10. 71 responsibility for such payment and agree to pay all charges reflected on this,invoice to-Speedy Auto' Glass subject to and according to all terms and conditions-:on the reveise side'of this invoice. TERMS 3� a Cash 172. 67. .TERMS:'NET 30 DAYS,SERVICE CHARGE N 1'h%PER`MONTH jl PER ANNUM) ILL BE CHARGED ON OVERDUE�A OUNTS. • 1 TRANSACTION IS SUBJECT TOITERMS-AND.CONDITIONS ON REVERSE SIDE+'' CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 13, 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: $200.00 + n Section 913 and 915.4. Please note all "Warnings". CLAIMANT: KIRCHNER, Jan AUG 1 1994 ATTORNEY: COUNTY COUNSEL MARTINEZ CALIF. Date received August 18, 1994 ADDRESS: P.O. Box 790 BY DELIVERY TO CLERK ON El Cerrito, CA 94530 BY MAIL POSTMARKED: Hand Delivered 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is r copy of the above-noted claim. IL ATCHELOR, Clerk DATED: iq: puLy 11. FROM: County Counsel 70: 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: S_ BY: �.�.. Deputy County Counsel 311. 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 (V) 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. 9�. ( ��1 Q �J Gated: I � 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 Ateposited 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 warnino 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. i iDated: _� BY: PHIL BATCHELOR by. A, A - p�, �, deputy Clerk CC: County Counsel County Administrator �'ECEBVED fume Ai imp-k JUL 2 8 1994 " 1 81994 Jan Kirchner Ute- : P.O. BOH 798 CLERK BOARD OF SU RVISORs EI Cerrito, CR 94538 CONTRA coSTA CO. Phone: 518/848-3832 Risk Management 7/25/94 RTT: Julie Rumoc, Claims Adjuster 651 Pine Street Martinez, CR 94553 Dear Julie, This is in regard to an event that happened 6/29/94 at about 2PM. I had just dropped off a fellow worker at her house on the Rrlington and was proceeding home to my office in Berkeley. Heading north on Arlington Rue. and not wanting to make a U-turn, I took a left into Rrlington Court in Kensington. I haue.been driving for many, many years, am quite mechanically adept and haue good spatial judgment. I steered what 1 thought was a normal, safe arc -to make the turn, given my line of site and all the conditions one considers when making a turn. Well, the turn landed me on the edge of a curbing that is not at all visible when one starts this turn. To make a long story shorter, the impact blew out both passenger side tires instantly and nicked the rims badly. We managed to salvage the rims, but needed a tow and two new tires. (There was also an afternoon of time wasted in the middle of my work day) From what I have learned, I should at the very least be paid back for the tow D tires. The tow truck driver responded that he had towed at least four(4) cars from this same corner for the same reason. The lady who lives in the second house (#63 Arlington Court) spoke up after seeing what had happened and said that many other cars have hit the curbing in the same manner. She also remarked that there used to be red pole marking the curb. I assume it was removed because of your recent paving project, but never replaced. This was a harrowing eHPerience. It's impossible to see the curbing as one turns in. Rn accident waiting to happen and it happens a lot! Please replace the marker or moue the curbing. Also, please be in touch about how I can get reimbursed in a timely manner. I'm glad nothing more serious happened and no one got hurt this time. Thank you for your attention in this matter. I look forward to hearing from you soon. Sincerelyir Jan Kirch Enc: Bilis for Towing and Tires/labor R �;:GYi a �• I f,f�> • O r Ir•��''. 1"1. .A rr�<M,<�9 qya a t�acHr,i�T'` f �.r,, n srtr M,d".,rf,wrw 1 }' �ti4,i• I' i y 77i l i , � u.I/+• p 1. y } '� I •A•xt:S � Y+ 7 - �r 1�,1h�[ Ylp� k I ��1�1,�'S a3t5 I� Few s SC4 9�: tiviR P t {tt a ktp� q 3t�) ��+�'("14f a.u,�a,!v��e !7 ,(� ��tiY A�'(r7 1 �`��R4'F• d e �rtR 'aafr '�7t 1� rkr='te�af�rS"'"ar.� A�1f'� VI li 1,r.. �re'Sw '$'YA •.� r�fYrd Lf `lf Yat s}�{`{pbk t�+1f< t3 ft f�F,� 3ri y��iiy il`y 2-,�trl� j,FH"i31 y'�'fi .I JY'"� 41 '3f Yk . , rn,.rir'� I�'�� htar��''9 7 �d��f�� 1 �nil�ropl.�':4'C�y lH 3s.( s��i1 Y.tGn ul„x ��'� �IF'�I >�'�I�4�ri�y a•l tid�. CYS �o-AY",,l y } �� ahy4 e(�i l h, a�lj y ti t!ti a{�1 lrmFY,rpu S3etr,orf wf lrh� 75}j4j 1, �,fit Jt aj°��'ff�arr a kit ��s r/.,� i 5g�nx�F,j, fy4>y��5f2Cy��'`LE ItYYf��.r✓r5,."?%�' rr�rlr�.� c�!'a:; yt � ��1�11rL^�`"'Y,,�'M1 fti� �1r•7�1�y�'�;F�`t�iy�� kf fl k�f i�,X I{s3 i Y'4 pt e��.en�$��1'�j�1t�A+tltl �. '� Y�fn�4 7`I�5a v ste,h�t��'��'tSd��ly��,,.ig7�,d9jri(w�,,.i'ry,...znf':P,.+�,J.�I�.''.�a�t,i�,.lYiGilt��.r.l�.`f giu,/ 'u:•a�r_�r!..,�'��r,�.�t.��ltt�'�nYyi' �u:. I ALBANY 12004 I TUNE-UP TIRE SERVICE BRAKES 742 SAN PABLO AVE.•ALBANY,CA 94706 MICHELIN ALIGNMENT Phone:525-6427 SUMMIT {I t BALANCING FIRESTONE I BATTERIES YOKOHAMA f� �I Cuslomefs Order No. DATE � 1� SOLD TO ADDRESS /U. -�'�r' �b `C'zY`' 6 q. CASH i CHARGEMAKE LICENSE NO. SPEEDOMETER n� .. .._, C� +' DUAN. SIZE OR NUMBER d ARTICLES PRICE AMOUNT ,i • Total Sale ., Z Tire Repair 1: i Balance • Mount& Balance o �O i Rotation Misc. Labor o Total Labor Sales Tax State Recycle Fee Z O Pay This Amount Terms and Conditions Payment due IOth of month following date of purchase.Past due,unpaid balances are subject to a service charge of Iia%per month.All taxes are NET.NO special or cash discounts are to be taken unless specifically indicated on invoice or Statement,and then only if taken within the time stated herein.If Seller deem it advisable to institute legal proceedings to recover merchandise or enforce collection at the unpaitl balance,the Buyer agrees to pay the expense of such proceedings,including such 'reasonable counsel fees as may be fixed by the court.The title to mid property shall remain in Vendor until the full purchase price is paid.Time is of the essence in this contract. '\ VENDOR BUYER'S BY SIGNATURE 1 41 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 13, 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: $10,000.00 + fir,,, ction 913 and 915.4. Please note all •Warnings". CLAIMANT:KIMBERLY, Jennifer June AUG 18 1994 ATTO;NEY:Robert P. Hamilton, Esq. COUNTYCOUN Scadden, Hamilton & Ryan MARTINEZCAL . received ADDRESS: 580 California St. , Ste. 1400 BY DELIVERY TO CLERK ON August 18. 1994 San Francisco, CA 94104 BY MAIL POSTMARKED: August 17, 1994 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. 1p1H11 ATCHELOR, Clerk , DATED: Bl: Deputy `t _ .n ll. 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: — l q — er q BY: Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARD ORDER: By unanimous vote of the Supervisors present ( X This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Gated: 3, lq94PHIL BATCHELOR. Clerk, By A�_ . ��_a JA ,, , Deputy Clerk �...�. YARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or ileposited 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 to the United States Postal Service in Martinez. California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to %he claitunt as shown above. Dated: �Q / I _ BY: PHIL BATCHELOR by� (TA �. 11�g_� Duty Clerk CC: County Counsel County Administrator 1 SCADDEN, HAMILTON & RYAN ROBERT P. HAMILTON, ESQ.., CALIFORNIA STATE BAR NO. 115744 2 580 California Street Suite 1400 3 San Francisco, California 94104 (4 15) 362-5116 4 Attorneys for Claimant JENNIFER JUNE 5 KIMBERLEY 6 7 8 9 DARLENE BONANNO, by and ) CLAIM FOR EQUITABLE through ROBERT BONANNO, her ) INDEMNITY 10, guardian ad litem, ) [Section 910 of the Government Code] 11 Plaintiffs, ) 12 vs. ) 13 COUNTY OF CONTRA COSTA, et j RECEIVE® al. , 14 ) 15 Defendants. j lives�"c 18 1994 . 16 CLAIM OF JENNIFER JUNE ) CLERK BOARD OF SUPERVISORS KIMBERLEY, ) CONTRA COSTA CO. 17 ) VS. ) 18 ) COUNTY OF CONTRA COSTA; ) 19 CENTRAL CONTRA COSTA COUNTY ) TRANSIT AUTHORITY; ) 20 SUPERVISORS, EMPLOYEES, ) OFFICIALS (NAMES UNKNOWN) ) 21 ) 22 23 TO THE BOARD OF SUPERVISORS OF THE COUNTY OF CONTRA COSTA; 24 CENTRAL CONTRA COSTA COUNTY TRANSIT AUTHORITY; SUPERVISORS, 25 EMPLOYEES, OFFICIALS (NAMES UNKNOWN) : 26 You are hereby notified that JENNIFER JUNE KIMBERLEY 27 (hereinafter claimant) , whose address is 1305 Willow Street, 28 Martinez, California 94553 , claims indemnity and/or contribution S O A D D E N HAMILTON -17 F:\DOC\SSNV\70194004\12371.1 & RYAN 1 for any judgment entered against claimant from THE COUNTY OF 2 CONTRA COSTA and THE CENTRAL CONTRA COSTA TRANSIT AUTHORITY. 3 This claim is based on a lawsuit filed against claimant on 4 or about February 2 , 1994, ,arising' out of an incident which 5 occurred on November 16, 1993 under the following circumstances: 6 At approximately 7: 15 a.m. , plaintiff DARLENE BONANNO 7 (hereinafter "plaintiff") was on route on foot from her home to 8 work in the city of Martinez, California. Plaintiff intended to 9 board a bus operated by CENTRAL CONTRA COSTA TRANSIT AUTHORITY at 10 its regular stop on the north side of Pacheco Boulevard near its 11 intersection with De Normandie Way. Said bus stop was designed 12 to serve people, such as plaintiff, from the south side of 13 Pacheco Boulevard, so that to get to said bus stop, it was 14 necessary for such people to cross Pacheco Boulevard to get to 15 the bus stop. COUNTY OF CONTRA COSTA and CENTRAL CONTRA COSTA 16 COUNTY TRANSIT AUTHORITY are the owners or controllers of the 17 adjacent properties consisting of Pacheco Boulevard and the bus 18 stop and waiting area adjacent. to Pacheco Boulevard near its 19 intersection with Ne Normandie Way. The name or names of the 20 public employee or employees responsible for the control and 21 management of the above-referenced properties are unknown to 22 claimant at this time. 23 On the occasion of the plaintiff's injuries, plaintiff's 24 route from her residence to the bus stop required her either to 25 cross Pacheco Boulevard at the intersection with Morello Avenue, 26 and then to proceed along the north side of Pacheco Boulevard 27 over unpaved, uneven and potholed ground; or to proceed along the 28 south side of Pacheco Boulevard to a crosswalk at De Normandie S C A D D E N HAMILTON -2- F:\DOC\SSW\70194004\12371.1 8C RYAN I 1 that is not controlled by traffic signals. The route via the 2 north side of Pacheco Boulevard was blocked- by one or more large 3 trucks and/or trailers parked along the north side of Pacheco 4 Boulevard. Said trucks belonged to and were parked by ROBERT 5 DUNCAN and ROES 1 through 10, inclusive, with the permission of 6 MELVIN E. & L. WILLIAMSON TRUST, and ROES it through 20. 7 Plaintiff was therefore forced to cross Pacheco Boulevard at its 8 intersection with De Normandie Way in order to reach the 9 aforementioned bus stop. 10 At the time and place referenced above, claimant was stopped 11 in her vehicle in front of the cross-walk waiting for plaintiff 12 to cross Pacheco Boulevard. After. plaintiff stepped two to three 13 feet into the roadway, claimant's vehicle was rear-ended by a 14 . vehicle operated by JEREMY JOSEPH McCLAIN. The impact caused . 15 claimant's vehicle to enter the crosswalk and strike the 16 plaintiff, inflicting alleged severe personal injuries on the 17 plaintiff. 18 On or about February 2, 1994, plaintiff and her appointed 19 guardian ad litem, ROBERT BONANNO, filed a lawsuit against 20 claimant, and others, arising out of the aforesaid incident. 21 Claimant was served on or by February 23 , 1994 by regular mail. 22 An Amended Complaint was filed on or about July 15, 1994. The 23 said Amended Complaint, Action No. C-94-00510, is hereby 24 incorporated herein by reference. Claimant incorporates herein .25 by reference for information purposes only plaintiffs' Amended 26 Complaint as though fully set forth herein, although by so doing 27 this claimant is not admitting the truth of the contents of any 28 matter alleged therein. S C A D D E N HAMILTON & RYAN -3- F:\D00SM70194004\12371.1 1 THE COUNTY OF CONTRA COSTA, THE CENTRAL CONTRA COSTA COUNTY 2 TRANSIT AUTHORITY, and other private entities were active 3 participants in the transaction and occurrence which proximately 4 caused the alleged personal injuries and damage to the plaintiff, 5 and claimant has denied in her Answer to plaintiffs' Complaint, 6 and continues to deny, any responsibility on her part. If 7 claimant is held liable to plaintiffs herein, such liability 8 would be solely or partially due to the active negligence of THE 9 COUNTY OF CONTRA COSTA, THE CENTRAL CONTRA COSTA COUNTY TRANSIT 10 AUTHORITY, and other private entities, and would not be the 11 result of any other direct act or omission on the part of the 12 claimant. 13 Claimant is informed and believes, and based thereon alleges 14 that she is, or will be, entitled to indemnification for any 15 liability imposed upon the. claimant herein. WHEREFORE, claimant 16 claims equitable indemnity from THE COUNTY OF CONTRA COSTA, THE 17 CENTRAL CONTRA COSTA COUNTY TRANSIT AUTHORITY, and other private 18 entities, as follows: 19 1) In the event of judgment being entered against 20 claimant, judgment shall be paid in full, together with 21 reasonable costs and attorneys fees, by each of the above- 22 referenced parties; 23 2) In the event of judgment being entered against 24 claimant, said judgment be paid in full by, or in proportion with 25 the negligence of each of the above-referenced parties; 26 3) For claimants costs herein incurred; and 27 4) For such other and further relief as is just a proper. 28 S C A D D E N HAMILTON -4- F:\D0C\SSW\70194001\12371.1 & R Y A,N 1 The amount of any potential judgment against claimant is 2 purely speculative and cannot be ascertained at this time, 3 . however, plaintiff has claimed damages well over $ 10, 000. 4 Jurisdiction over the claim would rest in the Superior Court. 5 All notes ,or other communications with regard to this claim 6 should be sent to Robert P. Hamilton, Esq. , SCADDEN, HAMILTON & . 7 RYAN, 580 California Street, Suite 1400, San Francisco, 8 California 94104 . 9 10 Dated: August 10, . 1994 SCAD E , HAM TON RYAN 11 12 ROPAT P. RAMILtON Attorney(s) for Claimant 13 14 15 16 17 18 19 20 l 21 22 23 24 25 26 27 28 S C A D D E N HAMILTON. SC RYA N -5- F:\DOC\SSW\70194004\12371.1 1 (PROOF OF SERVICE BY MAIL -- 1013a, 2015.5 C.C.P. ) 2 STATE OF CALIFORNIA ) SS. 3 COUNTY OF SAN FRANCISCO ) 4 I am employed in the aforesaid county; I am over the age of eighteen years and" not a party to the within entitled action; my . 5 business address is: 580 California Street, Suite 1400, San Francisco, California 94104 . 6 On August 17, 1994, I served the within: 7 CLAIM FOR EQUITABLE INDEMNITY [Section 910 of the Government Code] 8 on the -interested parties in said action, 9 by placing true copies thereof enclosed in a sealed envelope 10 addressed as stated on the attached mailing list. 11 X by placing the original X a true copy thereof enclosed, in sealed envelopes addressed as follows: 12 i 13 BOARD OF SUPERVISORS OF THE CENTRAL CONTRA COSTA TRANSIT AUTHORITY 14 2477 Arnold Industrial Way Concord, CA 94520 15 CONTRA COSTA COUNTY 16 651 Pine Street', Room 106 Martinez, CA 94553 17 X I caused such envelope to be deposited in the mail at San . 18 Francisco, California. The envelope was mailed with postage thereon fully prepaid, via First-Class/Certified Mail/Return 19 Receipt Requested. 20 Executed on August 17, 1994 at San Francisco, California. 21 X (State) I declare under penalty of perjury under the laws of the State of California that the above is true and correct. 22 (Federal) I declare that I am employed in the office of a 23 member of the bar of this court at whose direction the service was made. 24 25 , - TERRYL LYNN,GARSON 26 27 28 S C A D D E N HAMILTON & RYAN FADOORPH\70194004\21241.1 *.�ttattaattttttaaa � .Yaattttvattttaa ® vim nu = ilt ;'iInn 111 n Won Q5� e'o.Sr�`-, ah I,v (1�.; ?n Id�g•W ��9I � a o 1Y N t15 rl� u 5 d a co ,g (�fno CM� 0 p u � o ar Q u N o d N6 O � d' F Q z o z < F o 0 w HW H < w 4 A a � >4o �{ x P4 U ° Zx L cb ° °z O +J� z U N ON z � v�i � � U O U a Z � 4 LL O I CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 13, 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 1V below), given pursuant to Government Code Amount: $2,000,000.00 Section 913 and 915.4. Pleaselnote"al.1 Ya"'rnings". CLAIMANT: GILLIES, Maxine J. W 0 2 199 . ATTORNEY: 6:OUNTYCOUNSEL Date received MARTINEZ CALIF. ADDRESS: P.0. Box 5 BY DELIVERY TO CLERK ON Aijgystl 1, 1994 Alamo, CA 94507 BY MAIL POSTMARKED:, J11 ;z 29- 1994 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. IL AT%LOR, Clerk DATED:_ n,..�$ ,� . J994- ia: �puty � . ('�►� . 0 �.� 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ✓f This claim complies substantially with Sections 910 and 910.2. r ( ) 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: ��Z/ y BY: Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). JV. 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:J, PHIL BATCHELOR, Clerk, By ( '�c,c� . Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, ywhave 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 3 declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today 1 deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Lated:_ / )Ct 9 BY: PHIL BATCHELOR by ��.�..�. ,Qf� _Deputy Clerk CC: County Counsel County Administrator t-' o ,,,. o �lot (D O p cl 1 s Qo 0 N � ' tf" • . -, u� , cP 1p ` @ 0 n � o o) r� t� wo' o r' 0 .o �t 2 fC O� � 2Y, ` t v G E i Claim . to Board of Supervisors, Contra Costa County. cLAiaiaNlr RECEIVED : NAME Maxine J. Gillies ADDRESS . .P.0. .Box 5 L A Y Alamo,." CA 945d�,;:., CLERK BOARD OF SUPERVISOR$ ,TELEPHONE NO.. 5 i o-9 4 4-19 3 0 corurA cosra Co. 1. Person to whom claimant' desires notices.to be-sent if other than above: Name Telephone No. Address 2. Date, place, and time of occurrence or transaction which gives rise to this claim: DATE From Feb 9 1994 to the TIME present time. PUKE Meredith Memorial. Hospital and Gontra Costa Uounty. 3. Specify the particuliar act or omission and circumstances you believe caused injury and/or damage: Denial to me of request mental therapy. Subjected me to incarceration-like condition�hgthooEffi h �'qu��rii lme�iL�� t a Amtr� ttfi� tto April 199'a (See attachment) _ 4. Name(s) of any employee of Solano County you believe caused the injury, damage or loss: Comhination of Beryl Barlev; Mark Finucane; Frank Puglisi; L 5. -zscription of, property damages: no direct property damage. o. -wner of property damaged: Present location of damaged property: 7. Description of personal injury, if any: Deterioration in mental health from combination of worse than prison conditions and denial of mental health therapy. a. Is there any other person with property damage or personal injury: Name and address of other.person: Rodney Stich experienced mental distress and financial harm from having to assume responsibility for my well- being. 9. :lames, addresses and telephone numbers of witesses, doctors, hospitals, etc.: (1) Rodney Stich. 1209 Running Springs Rd. # 6 . Walnut Greek. CA 94595 (2) (3) 10. Amount claimed as damage$ with computation and supporting bills, receipts, or- estimates. of cost (please attach copies of documents to this claim) . Estimated damage to mp, $ 2,000,000. 11. any additional information that you believe might be helpful in considering claim: WARNINGI IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIMI (Penal Code 72; Insurance Code 556) I have read the, matters and statements made in the above claim and I know the same. to true of my own knowiedge, except as to those mattersstated upon information or beli and as to such matters I believe the same to be true. certify under penalty of perj that. the foregoing is true and correct. SIGNED THIS�27 DAY OF July 19_, AT Vkz C ;RMt1Q 1-F r Addendum to claim for Maxine J. Gillies against Contra Costa County: Included in my claims against the County of Contra Costa are the following: *Subjecting me to incarceration-like conditions at Merrithew Memorial Hospital; locked in my room at night, without access to toilet facilities; disturbing sounds of screams at night, instead of helpful therapy. * Refusing to allow me to sign important papers after I admitted herself voluntarily to the hospital, expecting to obtain treatment. One of the consequences was being faced with $35,000 in debt as my Chapter 7 bankruptcy filing was about to be dismissed without providing relief. * This subjected me to mental distress instead of mental therapy. * Charging me with being gravely disabled, and seeking to force me into a permanent incarceration-like confinement, similar to what I was forced to experience, and giving the county officials the right to move me to any part of the state that they wished. *After the court ordered the county to release me,I expected, and I repeatedly requested mental therapy, as did Rodney Stich, who held power of attorney over me. *The refusal to provide me with mental therapy caused a worsening of my mental condition, which is worsening at this time. Maxine J. Gillies T ^ I 5 July 29, 1994 PO Box 5 Alamo, CA 94507 RECEIVED', Risk Management AUG _ I W Contra Costa County 651 Pine Street, 6th Floor Martinez CA 94553 Certified P 246 738 152 CLERK BOARD OF STPERVISORS CONT. ,-a CQSA CO. Dear Sir/Ms: I am forwarding to you the claim by Maxine Gillies. I have power of.attorney over her affairs. Si er dney Stich 41 . CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 13,1994 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 Lodes. " the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $1,000.00 Section 913 and 915.4. Please note all "Warnings". AUG 19 1994 CLAIMANT: Gibb, Judy L. COUNTY COUNSEL MARTINEZ CALIF. ATTO;NEY: Date received ADDRESS: 13600 Marsh Creek Rd. BY DELIVERY TO CLERK ON August 19, 1994 Clayton, CA 94517 BY MAIL POSTMARKED: August 18, 1994 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. �qQ g8 DATED: ll DepuLylOR, Clerk 11. FROM/: County Counsel TO: Clerk of the Board of Supervisors (n This claim complies substantially with Sections 910 and 910.2. r ( ) 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). i ) Other: Dated: 93 T By: Deputy County Counsel Ill.. 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. BOARDS ORDER: By unanimous vote of the Supervisors present (✓) This Claim is rejected in full i ) Other: . I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: 13 199 PHIL BATCHELOR, Clerk, By �d, ,�A A�c SA . Deputy Clerk YARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or .Aeposited 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 reverseside 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: j �(-, rig _ BY: PHIL BATCHELOR by" ` �aQ� Deputy Clerk CC: County Counsel County Administrator Cat I . p c' p 1 a. 1 Clai- to: BOARD OF S!RERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Clai= relating to causes of action for death or for injury to person or to per- sonal property or growing crops and whichlaccrue'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, 1998, 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.-accrval 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 om Ro106, 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 RECEIVED Against the County of Contra Costa ) or ) AUG 191994 District) CL.frRK BOARD OF SUPERVISORS Fill in name ) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 11 000. o o 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) r 3. How did the damage or injury occur? (Give fl details; use extra paper if �L required)pl lD_-Y-5t,_ QJ'� )e-00o(, WoL_s i U�-- /06 ►� ►'�" aAA J W O-S w-,- CA n.2.-, t v C6o k-)O � . G. j-vt C,l�, SSe�I ��- w, -•e 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? , LA •�-�"�_� was `I-t�.e PDs�e of 0'L9 w�� U W, � rDa A U_X ` k a �(U ►tie., *, _ t_t t Z b ''�-� 2 w g S�c.�, caw y\A t V tlk)— D k's pa+v_ �cverj �. wnat are the names of county or district officers, servants or employees causing .. e da..-.-age or in jury? 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach, two estimates for auto damage." �Qs� 5 pry w.+,,N C6A a ,.CA C_.0 S UA_; P-�, 4 C�e.w�� y� p o_�&,� 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 01(6("✓C C� +-.y,© eS.�=� � � LtCas_ bo( -1 Sk.o-PS_ fie- s - Malo.q(v a A,9L `�e� O S -=pr ( D9 .(�S Pius `�'he, v��►�QSIM e Eot � �.5-7 . es f)nkaP6_ aL4& 8. Names and addresses of witnesses, doctors and hospitals. ------------------------ ---------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910.2 provides: �I "The claim must be signed by the claimant SEND NOTICES'�T6:a5� :.(Attorne ) or by some person on his behalf." Name and Address-"of Attorney Claimant'sSignature) Address Telephone No. Telephone No. S /0 q7 - /S 6WL) 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,11 or writing, is punishable either, by-imprisonmerit 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 me both such imprisonnt and-`fine. • ADDENDUM,_TO THE CLAIM OF J"W A- G ( F36 (Prifit your full name) ( 1) Do you use the roadway .as part. of '-a- daily commute? Yes (X ) No ( ) ( 2) Were you aware- that construction- would be 'commencing on the: roadway?.. Yes ( ) No (X ) ( 3) Was an alternate route -available?_. Yes ( ) No ( X ) (.4.) Did. you, .read about the impendin4' resurfacing in the local newspaper? Yes ( ) No ,( x ) (5) Did you see warning, :signs_advising-.of :`lo-ose'. 'gravel and a 25't mile per hour advisory. sign? Yes No ( 6) Did the damage.; resultfrom ,another .veh'icle 'exceeding the 25 Mlle per hour advisory? w..... Yes No ( ) ;. (7) _1.Did. .a vehicle,..traveling.._in::the.-same. direction .and exceeding the 25 `mile per hour, advisory ,sign attempt to pass you? Yes ( ) No 0c) ( 8) Did a vehicle coming from the opposite direction cause gravel.,:to be thrown onto your car? Yes (x ) t No ( ) ( 9) Was the vehicle located directly .in front of you exceeding the speed advisory? • t Yes ( ) No (�( ) t ( 10) Di'd ,you . tr..avel . the roadway more than once during the resurfacing prior to the damage sustained to your car? Yes ( ) No ( x ) J `-4,tw S P.( CU OL"+- Kt,-h1-,--� h Lko ( 11) Did you obtain the Identity of the clar relating toLi- i fo -questions 6 thru 9? Yes ( ) No O( ) If yes, please provide ._identification below: ( 1'2) 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. ,9'. e�•yu-e� til.�2, -P .r `l�ln p.�.r-�,�41� �u.L�u �'1�-� �r D�,L.t�,e.� J� wecs 4ic. J sh� T.e, S-i Ee.. 45-Iae �,.1 c� ►�.R� eel V.�off- '�►� -�►�,,� - u�� ltilti bree)L fpr)► : 19 c.�c-i I-e�. 2-o aS j Go- hu V�n-e, c0D r-5 `M,-L D*4"- r' W g-- l 1-t 2 ni- ►u-�-( ( 13) Were you aware tAat using the road during the chip seal W-2.LR. 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. (Sig a e ate) �- DAMAGE REPORT GIBB 08/12/94 at 07 :45 D.R. 17908-0002116 Est: R. EWING MIKE ROSE'S AUTO BODY INC. v \ 2001 FREMONT STREET CONCORD, CA 94520- (510) 686-1739 Owner: JUDY GIBB Day Phone: ( ) 672-3645- Address: 13600 MARSH .CREEK RD Other Ph: ( ) 947-1525- CLAYTON CA 94517 Deductible: $ N/A Insurance Co. : Phone: Claim- No. : Adj . : 87 FORD MUSTANG GT 3D WHITE 8-5 . OL-HO Vin: 1FABP42E9HF143046 License: Prod Date: 2/87 Odometer: 0 Power steering Power brakes Tinted glass Body side moldings Bumper guards Dual mirrors Tilt wheel Fog lamps Positraction Cloth seats Bucket seats Recline/lounge seats Aluminum wheels ------------------------------------------------11-------------------------------- REPR/ eF PART LBR PAINT NO. REPL DESCRIPTION OF DAMAGE QTY COST HRS HRS MISC 1 HOOD 2 Refin Hood 1 0.00 0.0 3.0 3* Repr PREP ROCK CHIPS 1 0. 00 0.0 0.8 4* W/S SUBLET DAN'S GLASS 1 0.00 0 .0 0.0 5* - Refin LT_ W/S POST 1 0.00 0.0 0.5 6 DOOR 7 Refin LT Outer panel to 10/87 1 0.00 0.0 2 .3 8 Overlap Major Adjacent Panel 1 0.00 0.0 -0.4 9* Repr R&I NECS 'PARTS FOR PAINT 1 0. 00 1 .5 0.0 10* Repl LT Bdy sd mldng GT WHIT w/rd i 1 87 .40 0 .3 0.0 11 QUARTER PANEL =12 Refin LT Outer panel 1 0. 00 0.0 2.5 . 13 Overlap Major Adjacent Panel 1 0.00 0.0 -0.4 14 Repl LT Frnt mldng w/grnd effct GT 1 70. 90 0 .3 .0.3 15* Repl LT Rr mldng LX WHIT w/rd strp 1 31.43 0.3 0.0 16* R&I GROUND EFFECTS 1 0.00 1 .2 0.0 17* COVER CAR FOR OVERSPRAY 1 0.00 0. 1 0.0 T 4 . 00 18* COLOR TINT 1 0.00 0 .3 0.0 --------------------------------------------------------------- ---- Subtotals =_=> 189 .73 4 .0 8.6 4 .00 Page: 1 DAMAGE REPORT GIBB 08/12/94 " at 07 :45 D.R. 17908-0002116 Est: R. EWING MIKE ROSE'S AUTO BODY INC. 2001 FREMONT STREET CONCORD, CA 94520 (510) 686-1739 Parts (Subject to Invoice) 189 .73 Labor 4 . 0 hrs $ 52 . 00/hr 208.00 Paint 8.6 hrs $ 52 . 00/hr 447 .20 Paint/Materials 8.6 hrs $ 25.00/hr 215.00 Sublet/Misc 4 .00 -------------------------------------------- SUBTOTAL $ 1063.93 Tax on $ 408.73 at 8 .2500% 33.72 -------------------------------------------- GRAND TOTAL $ 1097.65 -------------------------------------------- INSURANCE PAYS $ 1097 .65 THIS IS A PRELIMINARY ESTIMATE AND ADDITIONAL, CHARGES MAY HE REQUIREQUIRED FOR THE ACTUAL REPAIR. Estimate based on MOTOR CRASH ESTIMATING GUIDE. Non-asterisk(*) items are derived from the Guide DR2JC85. Database Date 7/94 Double asterisk(**) items indicate part supplied by a supplier other than the original equipment manufacturer. EZEst - A product of CCC Information Services Inc. Page: 2 •MAIN C - a B LAFAYE7TE BENICIA CONCORD oRo 1140 eMCKWN ROAD 1410 WE4T loth ST. 4310)256-5444 PO.OOX 1643 CONCORD.CA 4;520-3T02 ANTIOCH,CA 784 94 3332 BENICIA,CA 04510.18 (310)921.4173 1310) (701)745.7601 FAX 1310)627-0322 FAX 1410)764-1;25 _ AUTO-STORES-HOME ' RESALEMEEIRRALJRSS CHS 21-712097-00 ACCOUNT NO PVRcHASE ORDER NO DATE T 1 j; IESMAry I h ••~-_ r)NDFn TAKEN(}Y 1 (AY`(�r r c>u t•Y_�- N tZIY;,E rt .Sl {' I*I1.1N SILL TO: - fl)!►'>' t El-�)• St)Lb tO: .)IfI�Y t1Af' GN;rRK VAX `•fI':' 17:11 y t.i1 Vul 1 I'i_t; f iJP'(=lFitAt t f .f(;►n! ew m:ln :.:ail f ORD Mo 6 tr A l�illf�f(11d+i r T--,Il-1 iii C:UFiF'ti-1, yG' -)C!lJ M t7 1,tp 7' r Vt�)I x,(:1r,�' �)1• U FURNISH a INS IALL U FURNISH ONLY CJ LABOR ONLY 1f.4tt e 4'1^}(m i r cd 08 1!?,-94 �lVANTITY PART NO. DESCRIPTION list PRICE TOTAL77 . . ri g. 00 Q15, 00 et!_r. (6N 1 FC► � 1 I 1147��Ft'T}A`E DAl(•Pu{LF.D I�ObN[ DATE REINSTAII7D ii;n+ PAIp I;perly cured sealants and/or adhesives,and the'Autoglass are an important part of the safetyleatute of the TOTAL COST MATERIALS hfcie.WeofDAn'sGlass.Inc follow vehicle manufacturer&reCofnmendationsonsealantsand adhf3sivesuV1404 1..5'f. 47 the installation of the'Autoglass in your Car.The cure time of the sealants oy adhesives used are controlled by - --- -"` — Clirnate(1.9.,weather)Much could be 12 to 24 hours Or more Dan's Glass Inc.,does not recommend you drive SUB-TOTAL ur or until the 6edlanis and/or adhesives used have cured properly.Guarantee against water leaks for the Iifi the car.(exoept for rust or prior damage to glass area).Dan's Glass Inc.is not responsible for any damage td Ricle resulting from any water leak before or after glass work has been completed-This includes carpets.daslj SALES TAX (Z. 50 an,116816,etc- - LA OR -----__- (Non-Taxable) 4$. 0z LIAse AND AUTHORIZATION TO PAY OTHER THAN INSURED OR CLAIMANT -_ ----- ----•-- _ ._._.____� yIR""ps0esntap(aoeatoMysaffoloollonamIauthwlre.-, _ - -_ BALANCE 206„117 MNre dlrsol .j�+�ent to DAN'6 GLASS.INC.tho full omotarl due me under,the tarma of e.l undmtartd that if for any mean my Insuram%� M piny company does nthis clalm,I will l�mponatW for perwrit' DEDUCTIBLE: ured Dar. 0 room*I"nm la Ta Air UMVMM-+tut W ellf IIEYWAW VW!">>lPPO7uu -- TOTAL "•'r.^rr�.l�'Mi`� �,:.�, :. f�=w� ,�.,-, - �,��4�� , y�ly�'.yj.,�yl��d�'��`j"rYY'.oRFsE's"+'..S'4�P'+i0.y5(N,�:"�' .s �f Y�is,."ay,� �;`.�i;a"t..r yak H rN;;,i,,lis,-% cs'4k�sy�+tµ,�,��r - - .r1 ,c>:co'�,t�j,,v_,�g'#�iri-y'"`>,� t �'^� ,�w"u^".- `�•:. 1 LEE'S BODY SHOP Body and Fender Repair and Painting 1405 STRADELLA COURT, WALNUT CREEK, CALIFORNIA 94596 PHONE: (510)934-7681 • FAX:(510)934-4074 CONSUMER NO. 16805 �// OWNER ( r ADDRESS 153(t, `�r TE 19 l MAKE _ YEAR MODEL COLOR IDENTIFICATION NO. MILEAGE LICEN191E NO. .: ., ,.: .;SFRY:Ei'L.:. �:::: :;.;:;.;:::h::o:: ::g11.6(7=(:il::::.:.:: ::.;..... F..RONFOFCAEi;;;;::.:.1tEY.:EERS:.::.:::.... F?AR3 >;;:;:;:::fROPf1i?F:CAR;>;:: KY::#d3iS.:. PARTS.•::::::.:::::::FliQ117:OF:GA#is::>:s:KE .::HftS:...: :::::::.:..............:........................................................... FRRTS::::::. rem............:.::.::::::::::..: ......... : ::::... ..........,Wemaa ::,::::::.:::::::::. tM1i M#...::.,.............:::::: Bumper Headlight Headlight Bumper Brlt. Parking Light Parking Light Bumper Guard Fender,Front Fender,Front Grill Fender MId . Fender MId . Grill Guard Wheel,Front Wheel,Front Gravel Shield Hub&Drum Hub&Drum Knuckle Door Front Door Front Knuckle Sup. Door Glass Door Glass Lc Cont.Arm Vent Glass Vent Glass Up:Cont.Arm Door"Mktg. Door Mktg. Cross Member Door Handle Door Handle Front End Center Post Center Post Tie Rod ' Door,Rear Door,Rear Shock Absorbers Door Glass Door Glass Crank Case Vent Glass Vent Glass Steering Wheel Door Mktg. Door MId . Horn Ring . Door Handle Door Handle HornRocker Panel Rocker Panel Windshield , �j -Rocker Mktg. Rocker Mkdg." Cowl Floor Floor Quarter Panel Quarter"Panel Water Pump Quarter Mld : Quarter Mkdg. Rad.Support Fender,Rear Fender,Rear Rad.Core Fender Mldg. Fender Mktg. Rad.Hose Fender Skirt Fender Skirt Baffle,Side Fender Shield Fender Shield Baffle,Upper Tail Light Tail L' ht Baffle,Lower Back-Up Light Back-Up Light Fan Blade Wheel,Rear Wheel,Rear Fan Belt Hub&Drum Hub&Drum Hood Paint Material Paint Material Hood Hinges Hood Mldg. REAR OF CAR Ornament Rear Window Name Plate Bumper Lock Plate,Lr. Bumper Brkt. Lock Plate,Up. Bumper Guard Motor Mts. Gravel Shield Lower Panel Floor MISC. ITEMS Trunk Lid Top Trunk Hinge Frame Trurik Handle LABOR i j-O HRS.@ Springs License Light IDENTIFICATION PARTS ' KEY Seats Tail Pipe PAINTING Tires Gas Tank N NEW TOWING R REPAIR Tubes OH OVERHAUL Hub Caps A ALIGN, TAX P PAINT // / S SUBLET TOTAL �(e �y t0 (J The above is an estimate based on our inspection and does not cover additional pars or labor which may be required after work has begun.Occasionally,when work is opened up,we discover worn,broken or damaged parts not evident in the first inspection.Quotations on parts and labor are current and subject to change. ESTIMATED BY WORK AUTHORIZED BY. ESTIMATE ^TIMw CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 13, 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: Unknown n ction 913 and 915.4. Please note all -Warnings". IIAc' CLAIMANT: CYR, Melissa AUG 1 1 199 ATTORNEY: COUNTY COUNSEL MARTINC-ZCALIp. Date received ADDRESS: 112 De Normandie Way BY DELIVERY TO CLERK ON August. 11. 1994 Martinez, CA 94553 BY MAIL POSTMARKED: August 10, 1994 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: B1': puty � 11. FROM: County Counsel 70: Clerk of the Board of Supervisors (0*10'This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: I t a1 o► y BY: Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARDS ORDER: By unanimous vote of the Supervisors present (v/) This Claim is rejected in full. ( ) Other: I certify that this is a tau and correct copy of the Board's Order entered in its minutes for this date. Dated)3 , le?PHIL BATCHELOR, Clerk, By � f , 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 Aeposited 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: - / 9� _ BY: PHIL BATCHELOR by� , Deputy Clerk CC: County Counsel County Administrator t� V o , Ij 4 L -o A♦ Cla to. BOARD OF SUPERVISORS OF CONTRA COSTA CD= 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 Yui - � ) Reserved for Clerk's filing stamp All 1 ) ) Against the County of Contra Costa ) 1 1994 or gORScD of SC � District) CLERK BOAR, O- cp�T 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 damage or injury occur? (Include city and county) 3. How did the damage r in-.occur?^ �(-G�'ve details; use extra paper if required) J (,e�C�CL ( 1'Y� j'YtQi�'� ✓�"" ------ ---�_----------- ----------------------- ----------------- 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage9 (,vkk�& WP�9 V cver) �. wnat are the names of county or district officers, servants or employees causing the edam ge 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.) 71, <zi-, - RQ Names and addresses of witnesses, doctors and hosnitals. ----------------------------- -- --------------------�.�---------------------- 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 personon his behalf." Name and Address of Attorney aiman s gnature IL (Address) gpP7 3 Telephone No. Telephone N64Q0 ' a?.2!J— 19 � 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 ($10,000, or by both such imprisonr.,ent and fine. J L j i - V i L ADVANCED AUTO GLASS Q U O T E #93 421 N.BUCHANAN CIR. #11 PACHECO, 94553 DATE: 08-09-94 510 685 2023 GOOD FOR 30 DAYS ACCOUNT INFORMATION CUSTOMER- INFORMATION 0 CASH SALE MELISSA CYR 112 DENORMANDIE WY MARTINEZ, CA. 94553 PHONE: 229 1315' QTY PART CLR DESCRIPTION LIST PRICE EXT PRICE --- ------ --- ------------------------------- -------- -------- ----------- 1 W1003 T WINDSHIELD 438 . 40 131 . 52. 131 . 52 1 LABOR 45 .00 45 .00 INSURANCE INFORMATION AUTOMOBILE INFORMATION SUBTOTAL 176. 52 --------------------- ---------------------- COMPANY : YEAR : 88 TAX 10. 85 POLICY # : MAKE : FORD TRUCKS ------------------- CLAIM # : MODEL : F100 TOTAL 187 . 37 AGENT STYLE : , 350 ,F600 LOSS DTE : VEH ID: CAUSE . LIC # : LOCATION: STATE : AUTH BY : IN PROOF L# : OUT :- INSURED : MISC ADDRESS : CITY, ST : HOME WORK e HAVE A GREAT DAY ! Page 1 of 1 pD O m D D o 0 W o o r0 m X M =O � O -� fJ D m M) OA cn m z m v r c O m p >, � p m T z O umi D m v 0 z c :0700 0 T O m O c p U m � m U O m m � U) U) 0 0 r z cf) < r m Lr (� Oo Cf)4 D m m m ocn m m U) L t -0 x x x x x x x m (� � r L V1 0 CE) CD D m U pommzc p ^ CDQ 2z Oz � Z ( , CD Ommm$D O0ymom M sm;y0= - OOZ2 z =SDC m DOCr-, E O ID >'MQm rcm=a5 ` L/ C41 m f/lsf Z m -n 2 Cb Fo>)io8o m 70 D O D 0 r ms�oao _V m x D X m _I U) cp D x 33 0 r Dmc�> z m ' �^ Z p V) O=Emco 0 ,(1�l ]7 � m p N W rn A cam -j Ln 0 D _I �'O"� oo m \-1 O T Rel N N m n �✓ T D ao6o A DmY Z < � CD 00 CO DymDy mr 00 Ln Cn cnm `! m gOOm w N D�cmz°c C7 C7 n D � '� m m>aSim C yzm�0y O 92y =m C�O>m� mm60�o x=msM= mM<n>Eo,m yi3cimJ < 025, cm zcm�m0 5>>F)80> M c m m m omc mnnn� � N U) JIN { N GW r yo C oc `o Q D 7o r A I D m m -1 r "' m p 03 3 2� 0 m x m m Z Z 0 Ln mO D D C Z 0 -� p x0 30 W <D O XX IX o m a m C: 00 r r 0 > m ° X O 0 m CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 13, 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: $75.000.00 + Section 913 and 915.4. Please note all 0, 21W a - CLAIMANT:CHINN, Gaynor and Momi AUG 17 1994 ,ATTORNEY:Michael J. Cochrane COUNTY COUNSEL Nelson & Leighton Date received MARTINEZ CALIF. ADDRESS: 939 Hartz Way, Ste. 210 BY DELIVERY TO CLERK ON August 12, 1994 Danville, CA 94526 BY MAIL POSTMARKED: Hand Delivered 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. QQ IL BATCHELOR, Clerk DATED: B�: Deputy 1I. FROM: County Counsel TO: Clerk of the Board of Supervisors (VIf This claim complies substantially with Sections.910 and 910.2. r ( ) 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:—BY: Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARDS 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: 3 PHIL BATCHELOR. Clerk, By_ ACL , 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 Aeyosited 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 1n 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. , 1)ated: BY: PHIL BATCHELOR by J Deputy Clerk CC: County Counsel County Administrator Clam to: BOA SUPERVISORS OF CONTRA COSTA CCXW 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 ) Resery for C e k's fi 'ng stamp GAYNOR & MOMI CHINN TCLLERK ECEIVED Against the County of Contra Costa. ) 12 1994 orDistrict) OARD OF SUPERVISOR Fill in name ONTRA COSTA CO. &It,/ The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District )1KX $ excess of $75 ,00(�nd in support �W, of this claim represents as follows: 1. When did the damage or injury occur? '(Give exact date and hour) Exact date and_ time unknown, Damage to real..property has manifested within the six months preceeding the filing of this claim:: 2. Where did the damage or injury occur?(Include city and county) 541 SILVER OAK LANE, DANVILLE, CA 3. How did the damage or injury occur? (Give full details; use extra paper if required)Claimant has observed damages to their townhouse units manifesting in interior and ex.terior .wall cracks and seperations, differential floor movements , lateral movements of fencing and decking, heaving., shifting & cracking of foundation elements . 4. What particular act or omission on the part of county or district officers, servants or employees caused _the injury or damage?The Geologic Hazard Abatement Dst. and its employee, John LaViolette , investigated claims of damages at claimants unit in March, 1993 and designed a repair .plan for claimants unit Claimant is informed and believes that the scope of repair was inadequate, negligently proposed, and otherwise deficient, and is contributing to the damages observed at their residence . D. wnat are �.ne na----es of *LnT-y or district officers, servants or employees causi n8 the da:;-age or injury? Geologic Hazard Abatement District; John LaViolette. ------------------------------------------------------------------------------------ 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Damages to foundation at Claimants. townhouse .unit; damages to interior of townhouse unit manifestinc in wall cracks, out of level floors; damage to fencing and . decking. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.)Estimated cost of repair in excess of $75 ,000 . 00 is based upon discussions with. licensed soil engineer and engineering and general contractor.. B. Names and addresses of witnesses, doctors and hospitals. M N N Claimants are witnesses to the damages in their units , as is John LaViolette of the Geologic Hazard Abatement District. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT NONE TO DATE �bov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some wimn on h's half." Name and Address 'of Attorney MICHAEL J, COCHRANE NELSON. & . LEIGHTON - laim n ' Signature) 939 HARTZ WAY, STE . 210 DANVILLE CA 94526 939 HARTZ WAY, STE , 210 Address DANVILLE CA - 94526 Telephone No. (510) 837-8019 Telephone No. (510) 837-8019 N 0 T I C E Section 72 of the Penal Code provides: - "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any- false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Septudbex 13, 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: $25,000.00 Section 913 and 915.4. Please note all rrt CLAIMANT: RODRIGUF�, Jose Luis AUG 2 3 1994ATTORNf Y: Mir tin T. Gonsalves COUNTY COUNSEL 511 West 3rd St. Date received MARTINEZCALIF. ADDRESS: Antioch, CA 94509 BY DELIVERY TO CLERK ONS ist 231 10A4 BY MAIL POSTMARKED: Hmd TplivPUX via: Risk Mgnn_ J. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted claim. �i 8qpp IL gATCMELOR, Clerk DATED: ya��,cc �, l�9 : Deputy ll. FROM:: County Counsel TO: Clerk of the Board of Supervisors (v) This claim complies substantially with Sections 910 and 910.2. r ( ) 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: _ry Z U BY: Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARD ORDER: By unanimous vote of the Supervisors present (VThis 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:` o b4 „ p.,,,, /3./49�PHIL BATCHELOR. Clerk. Bye , �l��rQ �,j . Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months free+ the date this notice as personally served or Aeposited in the mail to file a court action .on this claim. See Government Code Section 945.6. Tau way seek the advice of an attorney of your choice in connection with this matter. If you ant to consult an attorney, you should do so immediately. *For additional warnino see reverse side of this notice. AFFIDAVIT OF MAILING 2 declare under penalty of perjury that I an now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited 1n the United States Postal Service in Martinez, Lalilornia, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. p BY: PHIL BATCHELOR by+ _Deputy Clerk CC: County Counsel County Administrator CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 13, 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: Unknown Section 913 and 915.4. Please note all *Warnings". CLAIMANT• RODRIGUEZ, Jose Luis ATTORNEY:Martin T. Gonsalves 511 West 3rd St. Date received COUNTY COUNSEL ADDRESS: Antioch, CA 94509 BY DELIVERY TO CLERK ON August 4, 19944ARTINEZCALIF. BY MAIL POSTMARKED: Hand Delivered via: Risk Mgmt. 1. FROM: Clerk of the Board of Supervisors .TO: County Counsel Attached is a copy of the above-noted claim. ppMMIL BATCHELOR, Clerk DATED: f cf 9 81: Deputy 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. (vor 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: V—5 —1 BY: Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) I ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. 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 geposited 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 tC: County Counsel County Administrator MARTIN T. GONSALVES ATTORNEY A'P L:1w August 15, 1994 RECEIVED Contra Costa County AUG 2 31994 Office of County Council P.O. Box 69 CLERK N�o� S �soRs Martinez, Ca. 94553-0116 OTOA co Attention: Julie Aumock Re: My client: Jose Luis Rodriguez Dear Ms. Aumock: This letter shall serve as an amendment to my client's Governmental Tort Claim. It is written U in accordance with the August 5, 1994 Notice of Insufficient and/or Non-Acceptance of Claim sent to this office by Brandon D. Baum. By way of correction, please be advised that my client is Jose Luis Rodriguez whose address is c/o 511 West Third Street, Antioch, Ca. 94509. All notices to be sent to the claimant should be sent to that address. Although at this point, we are uncertain as to the exact extent of Mr. Rodriguez's damages, I'do hereby submit a claim in the amount of$25,000.00. When at such time as Mr. Rodriguez's injuries have completely healed, I will be in a better position to evaluate the exact extent of his claim. If you have any questions please contact me. Y t 1 i T ONSALVES Attorne At Law MTG:rla cc: Jose Rodriguez 311 �1'r:��r 3RD S•rRI':r:T AN7'IOGH. CA A-�50f) (510) 757-8:300 FAX. (51.0) 757-9418 Cir �� MARTIN T. GrONSALVES A 7"F0 I2 N H:S' AT L A W July 26, 1994 RECEIVED Gary Christopher Azevedo 414 906 Andrews Drive CLERK BOARD OF SUPERVISORS Martinez, Ca. 94553 CONTRA COSTA CO. Re: My client: Jose Luis Rodriguez D.O.A. 07-12-94 Dear Mr. Azevedo: This office has been retained by Jose Luis Rodriguez to pursue a personal injury claim against you for injuries Mr. Rodriguez sustained in the July 12, 1994 automobile collision with your vehicle. According to the Antioch Traffic Collision Report, a photo copy of which I hereby enclose for your review,you are clearly at fault for this injury in that you ran the red light on North Bound Somersville Road in Antioch, California. I also note from the Police Report that you were driving a vehicle owned and operated by your employer, Contra Costa County. I would presume that you were operating within the course and scope of your employment at the time of this collision. Under California Law,your employer would be equally responsible for your liability in this matter. I suggest F that you immediately contact your employer and advise them that I have been retained by Mr. Rodriguez. I would ask your employer to then contact me so that I can begin the process of resolving Mr. Rodriguez's claim. I would like to start by arranging a settlement of the property damage in this matter and would ask for your prompt cooperation. If I do not hear from you within two weeks, I will presume that you do not wish to cooperate and will be forced to file a law suit against both you and your empl�yer so that I can begin the process of resolving this matter as promptly as possible. Yo s y, 1 k NSALVES Attorney At Law MTG:rla cc: Jose Rodriguez 511 W E--',T 3 Rn STREET ANTIOCH. CA 94509 (.510) 757-8300 FAX (510) 757-9418 12 1 "T 1 OFFICE OF COUNTY COUNSEL DEPUTIES: CONTRA COSTA COUNTY PHILLIP S. ALTHOFF N SHARON L. ANDERSON '""' BRANDON D. BAUM COUNTY ADMINISTRATION BUILDING ANDREA W. CASSIDY `a VICKIE L. DAWES P.O. BOX 69 MARKE S. ESTIS VICTOR J.WESTMAN MARTINEZ, CALIFORNIA MICHAEL D. FARR COUNTY COUNSEL 94553-0116 LILLIAN T. FUJII DENNIS C. GRAVES SILVANO B. MARCHESI TELEPHONE (510) 646-2074 GREGORY C. HARVEY ARTHUR W.WALENTA,JR. FAX (510) 646-1078 KEVIN T. KERR ASSISTANTS EDWARD V. LANE, JR. MARY ANN M. MASON PAUL R. MUNIZ August 5, 1994 VALERIE J. RANCHE DAVID F. SCHMIDT DIANA J. SILVER VICTORIA T. WILLIAMS NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Martin Gonsalves, Esq. 511 West 3rd Street Antioch, CA 94509 RE: CLAIM OF: Jose Luis Rodriquez Please Take Notice as Follows : The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910 . 2, or is otherwise insufficient for the reasons checked below: [x] 1 . The claim fails to state the name and post office address of the claimant. (x] 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. [x] 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10, 000) . If the claim totals less than ten thousand dollars ($10, 000) , the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10, 000) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. Ll 6 . The claim is not signed by the claimant or by some person on is behalf . [x] 7 . Please take note, your letter to Gary Azevedo was transmitted to our risk management department. Once received, it must be treated as a claim against the County for personal injury. VICTOR J. WESTMAN, County Counsel By:� Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a, 2015.5; Evidence Code §§ 641, 664) I declare that my business address is the County Counsel's Office of Contra Costa County, 651 Pine Street, Martinez, California 94553; 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 addressed as shown above, sealed and postage fully prepaid thereon, and thereafter was, deposited this day in the U.S. Mail at Martinez, California. I certify under penalty of perjury that the foregoing is true and correct. Dated: August $, 1994 at Martinez, California. CC: Clerk of the Board of Supervisors (original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOVT. CODE §§ 910, 910.2, 920.4, 910.8) CLAIM _BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA ySepteinber 13, 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: $100,000.00 Section 913 and 915.4. Please note all • niW CLAIMANT: CASILLAS, Rudolph aur z .1 1ss4 ATTORNEY: Maurice Moyal, Esq. GC?LINT'Y COUNSEL. Date received MARTINEZCALIF ADDRESS: 1899 Clayton Rd. , Ste. 100 BY DELIVERY TO CLERK ON Auizust 11, 1994 Concord, CA 94520 BY MAIL POSTMARKED: Hand Delivered via: County Counsel J. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. 8qpp IL BATCHELOR. Clerk DATED: : 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 day4 (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). 7V. 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: /3 PHIL BATCHELOR, Clerk. By ,�,- Q . Deputy Clerk 0 YARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or zleposited in the mail to file a court action on this claim. See Government Code Section 945.6. lrau 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 3 declare under penalty of perjury that I am now, and at all times herein wentioned, have been a citizen of the United States, over age 18; and that today I deposited 1n the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claiwant, addressed to tht Claift nt as shown above. / 4 BY: PHIL BATCHELOR by J • tel� � Deputy Clerk LC: County counsel County Administrator CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 13, 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 :,6'k tte�aa (P &graph IV below), given pursuant to Government Code Amount: $100;000.00 seion 913 and 915.4. Please note all "Warnings". CLAIMANT:CASILLAS, Rudolph AUG 1 1 1994 COUNTY COUNSEL ATTO;NEY:Maurice Moyal, Esq. MARTINEZCALIF. Date received ADDRESS: 1899 Clayton Rd. , Ste. 100 BY DELIVERY TO CLERK ON August 11, 1994 Concord, CA 94520 BY MAIL POSTMARKED: Hand Delivered 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. c ppH JL ATCHELOR, Clerk DATED: B1: Deputy 11. FROM: County Counsel 70: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. ( Vf 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: 11 , I q a ti BY: � Deputy County Counsel I11. FROM: Clerk of the Board 70: 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: OHIL 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 Aeposited 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 to 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 Ih +xxxxx.x.xux�su CIa ' V F 0 2.7 O9L1cL <C) a �U CONFIDENTIAL COUNTY COUNSEL' S OFFICE CONTRA COSTA COUNTY MARTINEZ, CALIFORNIA MEMORANDUM Date: August 22, 1994 TO: Clerk of the Board of Supervisors Attention: Shirley Casillas FROM: Victor J. Westman, County Counsel By: Brandon Baum, Deputy County Counsel �►�j RE: Claim of Rudolph Casillas This additional information was provided by Mr. Casillas ' attorney. Please attach it to the original claim and resubmit to County Counsel as an amended claim. Thanks, BB. MAURICE MOYAL MAURICE MOYAL A Professional Law Corporation (510)686-0200 Ph.D.(Accounting) MOYAL BUILDING FAX:(510)686-0204 Admitted to Dist. 1899 CLAYTON ROAD,SUITE 100 of Columbia Bar CONCORD,CALIFORNIA 94520 D.C.Bar#370624 CA State Bar#052648 Colonel,U.S.A.(Ret) August 17, 1994 AUG �! 2 2 1994 AUG 2 3 1994 COUNTY COUNSE�. ilta : /' MARrINEz c, ,p,. CLERK B ~` `, COOAt OF A COST P6RViSORS Brandon Baum A Cp• Deputy County Counsel Office of County Counsel Contra Costa County P.O. Box 69 Martinez, CA . 94553-0116 Re: Claim of: Rudolph Casillas Dear Mr. Baum: I have received your letter of August 11, 1994, which requests further details on the claim for damages by Rudolph Casillas against the County of Contra Costa for injuries he suffered while incarcerated at the County Jail in Martinez, California. 3 . I wish to supplement the claim filed by informing you that Mr. Casillas was stabbed on or about Saturday, July 9, 1994, in the afternoon. The stabbing occurred in the yard of the County Jail Facility. The person who stabbed Mr. Casillas was another inmate of the Contra Costa County Jail. 4 . The claimant does not know the names of the Sheriff Officers who were assigned to patrol the yard where Mr. Casillas was stabbed. It is anticipated that during discovery proceedings, we will be able to identify the names of the officers who had the duty and responsibility to patrol the yard for the safety and security of the inmates. Sincerely, MAURICE MOYAL PROFESSIONAL W CORP O TION AI o�� MAUR CE MOYAL MM/aj cc: Irene Wright RUDOLPH CASILLAS CLAIM FOR PERSONAL INJURIES V. [GOVT CODE SECTION 910, ET SEQ] CONTRA COSTA COUNTY, �rcl.P AND DOES 1-20, RECEIVED Defendants. AM I 104 CLERK BOARD OF SUPERVISORS ONTRALCOSTA CO. TO THE CONTRA COSTA BOARD OF SUPERVISORS 651 Pine Street, Martinez, CA 94553 . The Law Office of Maurice Moyal, represents Rudolph Casillas c/o Irene Wright, 600 Wilbur Avenue, Apt. 1048, Antioch, California 94509, who was tortiously and negligently made to suffer injuries to his physical and emotional well-being. These injuries occurred while Mr. Casillas was an inmate in Module B of the Martinez Detention Facility. Another inmate stabbed and slashed Mr. Casillas' throat with a sharp object. Subsequent to the battery Mr. Casillas was then deprived of prompt medical attention resulting in the exacerbation of his injuries. Claim is made against Contra Costa County for $100, 000. 00 representing future damages pursuant to Government Code Section 910 et seq. Jurisdiction over the claim will be in Superior Court. All communication with regard to this claim should be sent to claimant's attorney Maurice Moyal, Esq. , 1899 Clayton Road, Suite 100, Concord, California 94520. y DATED: O � D RU LPH C SILLAS 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. H 6 . The claim is not signed by the claimant or by some person on is behalf . [J 7 . Other: VICTOR J. WESTMAN, County Counsel By Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a, 2015.5; Evidence Code §§ 641, 664) I declare that my business address is the County Counsel's Office of Contra Costa County, 651 Pine Street, Martinez, California 94553; 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 addressed as shown above, sealed and postage fully prepaid thereon, and thereafter was, deposited this day in the U.S. Mail at Martinez, California. I certify under penalty of perjury that the foregoing is true and correct. Dated: August \'L, 1994 at Martinez, California. CC: Clerk of the Board of Supervisors (original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOVT: CODE §§ 910, 910.2, 920.4, 910.8) OFFICE OF COUNTY COUNSEL DEPUTIES: ';._.. CONTRA COSTA COUNTY PHILLI P S. ALTHOFF i; SHARON L. ANDERSON g7r BRANDON D. BAUM COUNTY ADMINISTRATION BUILDING ANDREA W. CASSIDY .�a- VICKIE L. DAWES P.O. BOX 69 MARKE S. ESTIS VICTOR J.WESTMAN MARTINEZ, CALIFORNIA MICHAEL D. FARR COUNTY COUNSEL 94553-0116 LILLIAN T. FUJII DENNIS C. GRAVES SILVANO B.MARCHESI TELEPHONE (510) 646-2074 GREGORY C. HARVEY ARTHUR W.WALENTA,JR. FAX (510) 646-1078 KEVIN T. KERR ASSISTANTS EDWARD V. LANE, JR. MARY ANN M. MASON PAUL R. MUNIZ August 11, 1994 VALERIE J. RANCHE DAVID F. SCHMIDT DIANA J. SILVER VICTORIA T. WILLIAMS NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Rudolph Casillas c/o Maurice Moyal , Esq. 1899 Clayton Road Suite 100 Concord, CA 94520 RE: CLAIM OF: Rudolph Casillas 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. [X] 3 . The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [X] 4 . The claim fails to state the name (s) of the public employee (s) causing the injury, damage, or loss, if known. [] 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10, 000) . If the claim totals less than ten thousand dollars ($10, 000) , the claim fails to state the AMENDED ' CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 13, 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: $2,753.00 + Section 913 and 915.4. Please note all "Warnings". CLAIMANT: pICCHI, Roger A. ATTORNEY: Steinhart & Falconer AUG 17 1994 333 Marke$ St. , 32nd Floor Date received COUNTY COUNSEL ADDRESS: San Francisco, CA 94105-2150 BY DELIVERY TO CLERK ON Al_ Is 15 M4FMNEZCAUF. BY MAIL POSTMARKED: Hand Delivered via: County Counsel 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. QQHHIL BATCHELOR Clerk DATED:_ acrd /Zlc?-7 z 8T: Deputy .Il. FROM: County Counsel TO: Clerk of the Board of Supervisors (� This claim complies substantially with Sections 910 and 910.2. r ( ) 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: $ 17 1(; q BY: =--__ Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARD ORDER: By unanimous,vote of the Supervisors present (r�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: 3 9 PHIL BATCHELOR. Clerk. By . Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or Aeaosited in the avail 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 Zhe ,ciaimant as shown above. Dated:— �A j )�q BY: PHIL BATCHFLOR by �. , �A �dQ � Deputy Clerk �=` J CC: County Counsel County Administrator 1� CONFIDENTIAL COUNTY COUNSEL'S OFFICE CONTRA COSTA COUNTY MARTINEZ, CALIFORNIA MEMORANDUM Date: August 15, 1994 TO: Jeanne Maglio, Clerk of the Board of 'Supervis rs FROM: Victor J. Westman, County Counsel By: Gregory C. Harvey, Deputy Count ns RE: Claim of Roger Picchi Please treat the attached document as an amended claim. Thanks . gAUGo- CEIVED 1510 ,LERKBARD OF gt1PERVISORS CONTr�A COSTA CO. STEIN HART & FALCONER A PARTNERSHIP INCLUDING PROFESSIONAL CORPORATIONS ATTORNEYS 333 MARKET STREET, THIRTY-SECOND FLOOR FACSIMILE(415)442-0856 SAN FRANCISCO, CALIFORNIA 94105-2150 FACSIMILE(415)442-0839 1l�p (415) 777-3999 y ieVVVV��f'® , pt�G 1 2 1994 C�NTy,OUNSEL August 9, 1994 r�>a>rx cnuF. ECEI�IE® ; VIA CERTIFIED MAIL RETURN RECEIPT REQUESTED AUG 151 Victor J. Westman, Esq. CLFR3{BOARD OORS County Counsel CONTRA COSTA CO. Contra Costa County County Administration Building P. O. Box 69 Martinez, California 94533-0116 Re: Claim of Roger Picchi, Lessee of Site CH-5, Buchanan Field Airport 1500 Sally Ride Drive, Concord, California 94520 Dear Mr. Westman: We are writing in response to your Notice of Insufficiency and/or Non- Acceptance of Claim dated August 1, 1994, and sent in response to my letter dated July 19, 1994, to the County Department of Public Works. Mr. Picchi had not intended to make a formal claim for damage to his trees by that letter. We will do so at this time since it appears that is how the County prefers to handle this matter. A draft copy of that claim is enclosed. In any case, we disagree with the County's reasons for rejecting our previous statement of estimated damages or "claim" set forth in my letter of July 19, 1994, viz: 1 . That the claim fails to state the name and post office address of the claimant; and 2. That the claim fails to state the date, place or other circumstances of the occurrence or transaction giving rise to the claim asserted. G f STEINHART & FALCONER August 9, 1994 Victor J. Westman, Esq. Page 2 The reference line in your letter is to the "Claim of: Roger Picchi," so the County is obviously on notice of the identity of the claimant. He is the county airfield's lessee, as indicated in my letter, and receives correspondence at his office there. We assume you know that address, and the location of his office was specified in my letter, but we have also set forth that information above for your use. On May 18, 1994, Mr. Picchi personally observed and took pictures of the spraying of the use of Starthistle herbicide discussed in further detail in my July 19, 1994, letter to the County-Department of Public Works. He believes this may also have taken place prior to and for some days following that date. As described in my letter, this spraying took place on his property boundary. Please refer to my July 19, 1994 letter for further particulars or contact me with any requests you may have for more specific information. Please note that my July 19, 1994 letter contains a number of inquiries concerning environmental contamination at the airfield and connected with a variety of ongoing activities there. If we do not receive a response to these inquiries, Mr. Picchi will be forced to hire a consultant to investigate, determine and report on these matters. While the county's cooperation would be appreciated and could obviate the need for such an investigation, it does not appear to us at this time that such cooperation will be forthcoming: If this impression is incorrect, we hope you will contact us soon so that we may forego that investigation. If you wish to resolve this claim informally, please contact me no later than August 15, or we will have no choice but to formally file a claim concerning the damage caused by use of the Starthistle herbicide. Very truly yours, Eric urence ELL:ems cc: Mr. Dick R. Awenius Airports Lease Manager Mr. Roger Picchi P.S. Mr, Awenius: Mr. Picchi and I request that you copy me on all further correspondence in this matter. ELL a it `�'_:_• . 1 STEINHART & FALCONER ERIC L. LAURENCE, State Bar No. 130167 2 333 Market Street, 32nd Floor San Francisco, California 94105-2150 3 Telephone: (415) 777-3999 "/?44PIR Facsimile: (425) 442-0856 4 Attorneys for Roger A. Picchi 5 6 SUPERIOR COURT FOR THE STATE OF CALIFORNIA 7 FOR THE COUNTY OF CONTRA COSTA 8 9 In the matter of the claim of Roger A. Picchi, an Case No. 10 individual, ) 11 Claimant, ) 12 VS. RECEIVED 13 Contra Costa County; and DOES 1 through 10, ) AUG 151994 14 inclusive, ) ) Defendants. ) CLERK BOARD OF SUPERVISORS 15 ) CONTRA CQSTA CO. 16 Roger A. Picchi ("Picchi") hereby presents his claim to Contra Costa County pursuant 17 to section 910 of the California Government Code: 18 1. The name and post office address of Mr. Picchi is as follows: 19 Buchanan Field Airport 20 1500 Sally Ride Drive Site CH-5 21 Concord, CA 94520 22 2. The post office address to which the undersigned desires any response 23 to or notices of this claim to be sent is as follows: 24 Eric L. Laurence Steinhart & Falconer 25 333 Market Street, 32nd Floor San Francisco, California 94105-2150 26 27 3. Within the last year, property leased and owned by Mr. Picchi and 2811 located at Site CH-5, Buchanan Airfield, 1500 Sally Ride Drive, Concord, CA 94520 has 8/9/94 -1- F:\-CLIENT-\Q-Z.LIT\ULTRAMAR\PICCHI.ccc\COMPLAIN.OLD 1 suffered damages to trees planted by him as a result of the use of an herbicide applied by or 2 on behalf of Contra Costa County on May 18, 1994 and at times following that date. This 3 herbicide is not normally allowed to be used in the State of California without a special 4 permit. 5 4. So far as it is known to Mr. Picchi at the date of filing this claim, he has 6 incurred damages in an amount in excess of$2,753 due to the destruction of trees and plants 7 on his property. 8 5. Contra Costa County and other defendants, including Does 1 through 9 10, whose names are currently unknown, caused said injury and damage. 10 6. At the time of the presentation of this claim, Mr. Picchi claims damages 11 in an amount in excess of$2,753, covering the replacement cost of the trees destroyed on the 12 basis of estimates from his contractors. It may also be necessary to remediate the affected { 13 soils at some additional unknown cost. 14 Dated: August 1994 STEINHART & FALCONER 15 16 By: Eric L. Laurence 17 Attorneys for Roger A. Picchi 18 19 20 21 22 23 24 25 26 27 28 8/9/94 —2— F:\-CLIENT-\Q-Z.LIT\ULTRAMAR\PICCHI.ccc\COMPLAIN.OLD