Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
MINUTES - 07251995 - C10
CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY. CALIFORNIA July 25, 1995 ci?'m egeinst the County, or District governed by) BOARD ACTION S:; ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT a. i Fr.;rC. 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: urdmoTIM Section 913 and 915.4. Please note all "Wa.rnings—II . CLAIMANT: Tom Wall F�4 3 0 13 ATTORNEY: Date received CCUNTYCOURISEL MARTINEZ CALIF. ADDRESS: 68 Riverview Dr. BY DELIVERY TO CLERK ON June 30, 1995 Pittsburg, CA 94565 BY MAIL POSTMARKED: Hand Delivered via: Risk M=t. 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: June 30, 1995 EaIL �eputyLOR, Clerk 11. FROM: County Counsel TO: Clerk of the Board of Supervisors �o This claim complies substantially with Sections 910 and 910.2. ( his 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: ? S t 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 date. Dated: a„5 1 S PHIL BATCHELOR, Clerk, B "'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 deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney. you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez. California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:4� a(A J� BY: PHIL BATCHELOR b Od, Deputy Clerk CC: County Counsel County Administrator OFFICE OF COUNTY COUNSEL DEPUTIES: CONTRA COSTA COUNTY PHILLIP S. F SHARON L. ANDERSONDERSON 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) 646-2041 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 July 5, 1995 VALERIE J. RANCHE DAVID F. SCHMIDT DIANA J. SILVER VICTORIA T. WILLIAMS NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Thomas Wall 68 Riverview Dr. Pittsburg, CA 94565 RE: CLAIM OF: Tom Wall 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 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 . [] 7 . Other: VICTOR J. WESTMAN, County Counsel By: /eputy 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: July 5, 1995 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) RECEIVED JUN 3 0 1995 Q.'4CLERK BOARD OF UPERVICRS CONTRA COSTA CO. Ladies and Gentlemen: I am writing to inform you of an incident that took place on April 14, 1995. I had to return to Merithew hospital to under-go a CT scan. Due to construction on the hospital I had to park in one of the back parking lots then walk across the lot and enter thru the emergency entrance in the back. As I crossed the lot I had to cross over a gutter; the side walk was block by the construction. The gutter was covered by a metal grate and the asphalt that secured the grate was broken away leaving gaps in the ground cover this proved inadequate for a pedestrian crossing. As I crossed the grate my crutch slipped causing me to fall. This has resulted in re-injuring my right knee. After being seen in the emergency room for my fall,I was informed that nothing could be done except to take pain relievers and put ice on the knee. The next morning I awoke in extreme pain and I called Merithew to speak to my surgeon about the incident and try to determine what I would need to do to take care of my knee. I was informed that the surgeon was unavailable and a message would be left in his box. I requested his number and was refused. I asked why and was informed that he was under contract to perform services only once a week and the policy of the hospital was to wait until he arrived back at the hospital to be apprised of his messages. As a result of not being able to get any help from the hospital. I had to wait in extreme pain and worry before being seen at the clinic; not the surgeon. I had to wait another two days to see the surgeon only to find that additional time will be required before determining how long my recovery will take. I was also required to expend two thousand dollars to date for home care and medicine for this injury. This could extend to three thousand at the present rate of recovery. I am requesting reimbursement for this additional outlay of money. I attempted to take care of this issue many times with no result. I have contacted a lawyer about this issue, but I have decided to make one more attempt at a resolution before preceding by legal means. The reason for going to the hospital was that I had surgery performed on my right knee and began exhibiting side effects. These side effects included weakness to my left side and an unusually large amount of pain. I must tell you that during this whole affair I have had many serious concerns about the attitude of the staff and administration of Merithew. The surgery to my right knee was nearly performed on my left knee due to being improperly documented on my chart. This mistake delayed the doctors in starting surgery and was discovered only by the fact that I raised concern about the procedure. I do not wish to further complicate this issue as I am disabled and I will require the services of the County and Medicare in the future. Since the hospital falls under your jurisdiction as the governing body,I hope this can be resolved swiftly and amiably. I am looking forward to hearing from you soon. sincere RECEIVED 1 2 8 Tom Wall ��Ns bay c y54J-3 6 d' Julie Aumock: After receiving the check for$1608 I consulted the attorney I have been talking to and his advise was not to cash it, especially since the new M.R.I. does in fact verify that the trauma, damage, pain, and frequent collapsing of the knee was in fact due to the fall and that the previous surgery held. The U.C. doctor(for second opinion) as well as Dr. kopoed at Merethew agree that the accident indeed caused the damage. Inclose is a copy of the M.R.I. test as well as the photo of the grade before it was repaired. I am also supplying the media consumer representative with the documents necessary to prove my claim and if bad publicity isn't enough to be treated fairly then I guess a long process of a law suit is the only path left to me and my suit will seek settlement for pain and suffering. Sinc ely � Tom Wall Z CLAIM C, GD BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY. CALIFORNIA - July 25, 1995 Cl?^m against the County, or District governed by) BOARD ACTION ~� ` ,,.ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT a., rr 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 9I5.4. Please note all "Warnings". CLAIMANT: Target Stores ATTORNEY: Date received COUNT?l GC t(JfISE ADDRESS: Central Restitution Office BY DELIVERY TO CLERK ON June 30, 1 5'rgNE"CALIF. P.O. Box 1296 Minneapolis, Minnesota 55440-1296 BY MAIL POSTMARKED: Hand Delivered via: Risk Mgmt. I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: June 30 g, 1995 �bILATCHELOR, Clerk : 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 910.8). ( ) 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: 7 ' T- 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). 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: S 19 2,7- PHII BATCHELOR, Clerk, By , Deputy Clerk `�-`—� WARNING (Gov, code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING 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 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: 4„4,. (9 P.5- BY: PHIL BATCHELOR by eputy Clerk CC: County Counsel County Administrator OFFICE OF COUNTY COUNSEL DEPUTIES: CONTRA COSTA COUNTY PHILLIP S. ALTHOFF SHARON L. ANDERSON 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) 646-2'041 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 July 5, 1995 VALERIE J. RANCHE DAVID F. SCHMIDT DIANA J. SILVER VICTORIA T. WILLIAMS NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Target Stores Central Restitution Office P.O. Box 1296 Minneaplolis . Minnesota 5544 -3178 RE: CLAIM OF: Target Stores Case No. 697- 1275 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 ~ 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: 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: July 5, 1995 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) Target Stores RECEIVE® Central Restitution Office P.O. Box 1296 Minneapolis, Minnesota 55440-1296 I VLA, LA rt!�l JUN 3 O Telephone 1-800-223-3178 CLERK BOARD OF SUPERVISORS ® CONTRA10:.ie,CO. Date: 05/09/95 Case no: 697- 1275 KEVE DAVIS 2ND NOTICE 100 GLACIER DR MARTINEZ, CA 94553 Dear KEVE DAVIS: Our records show that on 04/09/95, LO'WELL THORNTON, an unemancipated minor took possession of merchandise from TARGET, without consent of the owner and without paying for the merchandise, with the intent to deprive the owner of merchandise valued at $ 8.99. Our records also indicate that you have not responded to our previous Notice. We are now prepared topursue this claim as far as economically feasible, which may include seeking a judgement against you pursuant to 490.5 of the Penal Code a copy of which is below. We may institute this civil action unless you pay the following amount. Total Civil Demand Amount...................$ 100.00 Payment of the total amount demanded should be made immediate bby check, money order, certified or cashiers check, made payable to TARGET STORES, and sent in the enclosed, self-addressed, envelope. To ensure proper credit please print your name and case number on your payment. Your settlement of our claim(s) againstyou by payment of the amount demanded in this letter does not prevent local authorities from proceeding with criminal prosecution. Any questions in regards to this matter should be addressed to this office, or feel free to call 1-800-223-3178 between 9:00 a.m. and 4:00 p.m. Monday thru Friday. PLEASE USE CASE NUMBER ON ALL CORRESPONDENCE AND PHONE CALLS. Respectfully, TARGET STORES, CIVIL RESTITUTION CALIFORNIA CIVIL SHOPLIFTING LAW SEC'T'ION 1.Section 490.5 is added to the Penal Code to read: (b)When an unemancipated minor's willful conduct would constitute petty theft involving merchandise taken from a merchant's premises,any merchant who has been injured by such conduct may bring a civil action against the parent or legal guardian having control and custody of the minor. For the purposes of such actions the misconduct of the unemancipated minor shall be imputed to the parent or legal guardian having control and custody of the minor.The parent or legal guardian having control and custody of an unemancipated minor whose conduct violates this sub- division shall be jointly and severally liable with the minor to the merchant for the retail value of the merchandise, if not recovered in merchantable condition plus damages of not less than fifty dollars nor more than five hundred dollars plus costs. Recovery of such dam- ages may be had in addition to,and is not limited by,any other pro- vision of law which limits the liability of a parent or legal guardian for the tortious conduct of a minor. An action for recovery for dam- ages,pursuant to this subdiv.,may be brought in small claims court if the total damages do not exceed the jurisdictional limit of such court,or any other appropriate court,however total damages including the value of the merchandise, shall not exceed$500 for each action. A Division of the Dayton Hudson Corporation CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA July 25, 1995 Cl?;m an?i•,st the County, or District governed by) BOARD ACTION S::pervisors, Routing Endorsements, ) NOTICE TO CLAIMANT apt F! rC 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 "War_nings". CLAIMANT: Jerry Savage and Charolette Kelsay ATTORNEY: Rhonda Wilson Rice EL Date received NIAR fYc;CE1N CALIF.�/,Fi7I;VEZ IF ADDRESS: 525 Marina Blvd. BY DELIVERY TO CLERK ON June 29, 1995 Pittsburg, CA 94565 BY MAIL POSTMARKED: June 28, 1995 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PpHHIL BATCHELOR, Clerk DATED: June 29, 1995 BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( �KThis claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (`/) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: )9g PHIL BATCHELOR, Clerk, By , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions. you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * 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. i Dated: 1, 5_ BY: PHIL BATCHELOR by eputy Clerk CC: County Counsel County Administrator v CLAIM AGAINST THE COUNTY OF CONTRA COSTA AND ITS AGENTS AND EMPLOYEES JERRY SAVAGE and CHAROLETTE KELSAY hereby present a claim for damages against M. MALONE of the CONTRA COSTA COUNTY SHERIFF'S Department, the COUNTY OF CONTRA COSTA and its agents and employees. ADDRESSES OF CLAIMANTS: JERRY SAVAGE CHAROLETTE KELSAY RECEIVED 1570 Willow Pass Road Unit Space 7 A 2 9 199E Bay Point, CA 94565 CLERK BOARD OF SU' ADDRESS TO WHICH NOTICES SHOULD BE SENT: CONTRA CO-- JERRY O- -JERRY SAVAGE CHAROLETTE KELSAY c/o RHONDA WILSON RICE COKER & RAMIREZ 525 Marina Blvd. Pittsburg, CA 94565 DATE, PLACE AND CIRCUMSTANCES OF OCCURRENCE: On or about June 8, 1995, at approximately 1:00 o'clock in the afternoon, the claimants, JERRY SAVAGE and CHAROLETTE KELSEY,were away from their home at 1570 Willow Pass Road,Unit Space 7,Bay Point,California. While the Claimants were away from their home,officer M. MALONE along with at least 5 other Deputies from the Contra Costa County Sheriffs Department entered their home without permission. The identity and exact number of the Sheriffs Deputies involved is not known to the Claimants because they were both at work at the time of the entry. The Claimants live in a Mobile Home Park in Bay Point, California. Contra Costa County Sheriffs Deputies forced there way into the Claimant's locked home. Claimant's Neighbors saw the officers attempting to enter the premises and asked why the officers were there. Claimant's neighbors informed the Sheriffs Deputies that Jerry Savage and his wife lived on the premises and that he was not in any manner connected with any illegal activity. The Deputies decided that they were "going in anyway." At no time before, after, or since the entry has the Sheriffs Department served a search warrant on Mr. SAVAGE or Ms. KELSAY or given any explanation regarding their illegal entry. The Deputies did not ask for a key or make any inquiry with the resident manager regarding the current ownership of the mobile home in question. The Deputies completed a thorough search of Claimant's home and left. The Deputies were overheard saying"We got the wrong house." Officer M. Malone left a business card with a neighbor. When the Claimant's returned home they found the front door closed,but unlocked and the drapes wide open. It was clear that someone had been inside their home. They did not note any damage, nor does anything appear to be missing, however, it was clear that many items were displaced. 1 As a result of the actions of the Contra Costa County Sheriff's Department the Claimants are now very frightened and insecure to be in their home. They have suffered great emotional distress and anxiety. PARTIES RESPONSIBLE: M. MALONE, THE CONTRA COSTA COUNTY SHERIFF'S DEPARTMENT and the COUNTY OF CONTRA COSTA and its agents and employees. AMOUNT OF CLAIM: Punitive damages against the individual officers, and compensatory damages against the individual officers and against the County of Contra Costa within the jurisdictional limits of the municipal court. GENERAL DESCRIPTION OF INJURIES AND BASIS OF COMPUTATION OF DAMAGES: By reason of the above-described acts of those officers acting in accord with the policies of the Contra Costa County Sheriff's Department,JERRY SAVAGE and CHAROLETTE KELSAY suffered invasion of their privacy and property rights and were placed in fear and apprehension of further invasions. By reason of the wrongful and malicious acts of these officers the claimants have suffered diminishment of their dignity,embarrassment,feelings of insecurity,loss of confidence in their rights as American Citizens and loss of a sense of personal autonomy. Compensatory damages are computed on the basis of the amount it would take to adequately compensate Claimants for the pain and suffering caused as a direct and proximate result of the Officers' intentional conduct. Punitive damages are based upon the outrageous,wanton,oppressive,and malicious nature of the officers'acts which were done in conscious disregard of the rights,dignity and safety of claimants. Dated: Juneo , 1995. !RtIONDA WILSON RIC for Claimants JERRY SAVAGE and CHAROLETTE KELSAY 2 COKER & RAMIREZ ATTORNEYS -ABOGADOS JOHN DIAZ COKER E�-+ �,® ® A. ARACELI RAMIREZ �L.� !9 RHONDA WILSON RICE JUN 2 9 1995 CLERK BOARD OF SUPERVISORS Clerk, Board of Supervisors CONTRA COSTA CO. Contra Costa County 651 Pine Street Martinez, CA 94553 June 28, 1995 RE : Claim of Jerry Savage and Charolette Kelsay Dear Clerk, Please find enclosed the original and one copy of a claim against the County of Contra Costa. Kindly retain the original and return the copy, stamped received by you, in the envelope provided. Thank you for your help and courtesy in this matter. Sincerely, of Secretay me Enclosures 525 MARINA BOULEVARD PITTSBURG, CALIFORNIA 94565 • (510) 432-7373 y 04 M'1 0 4J M Ci3 Ln Ln LN O 4-3 moi+ OU (1) � as Ts (z �4 � N +-) +► U 0 U1 U) O O m U Q? N �4 4-) 4-) N0r-4 �4 O Ln UUkD tLIG � 7d X00 OD W 66 wQU 0 0 5 U04co 4 CLAIM C -• to BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA July 25, 1995 CYaim Against the County, or District governed by) BOARD ACTION t6.:: ?::rf S::;ervisors, 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: Evelyn Rockeman N ATTORNEY: OUNY Y COUNSEi, Date received R9ARTIIVE�CAUF. ADDRESS: 437 Rincon Ln BY DELIVERY TO CLERK ON June 26, 1995 El Sobrante, CA 94803 June 23 1995 BY MAIL POSTMARKED: , I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BATCHELOR, Clerk t DATED: June 26, 1995 BY: Deputy1,644 II. FROM: County Counsel TO: Clerk of the Board of Supervisors (A 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). Dated: S7 BY: eputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( ") This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: �'�. S PHIL BATCHELOR, Clerk, B 0 �_,n n�, Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, 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 eputy Clerk CC: County Counsel County Administrator Cia-;- to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Clai-ns 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. Claim 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 fn.�... iFv*W* RE: Claim By ) Reserved for Clerk's filing stamp vEt_yN �ac �'�.� A /V ) �ECEI�i�� +37 R 1 tVC0 hl Liv e 5o8 c j1.g4"8o3 6 1995 Against the County of Contra Costa ) � o 2 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 $ Qt.4 K N © L4/114 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) jE*L 5 x 8 2 AN 7-6-1 C 4, 9 4,0 a 3 ------- --- -- - -- 3. How did the damage or injury occur? (Give full details; use extra paper if required) 7-4E Dlq- "-4 C-E 4=7 cr- UeRED "/4157" Ie�It� D I �e k(E.S o � g E, t l F P_FW G ou 2 7- 0 vE e- -F'I-our 6 1) p ©wjr�/ CA,17-o 0L4R.. PReP46�e`T'y AND jEi-_ lZo,4nEP o � � PfdPee r 4AID SE"e-rT- !Y!lcU Dr-owN oNTo 6uR- 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? 3- T 4 PP4IFgp 5 Tcq Cts TNF C eu�TY d> > l�,Co (- ,�}1 N T g 1 t-J P l .VF P-57/0 `T'D D t t/E i 1 ,4 UY D �u 2� P��°� �V C-Nc T� IF R a o r� 5. wnat; are the na---es of counuv or district officers, servants or employees causing - ." the ca:a.ae or injury? a L `('�� P- 4 P p ,4 t-j f5 W 1 S I-I(E L P T6 p -r t4 P—14 lv - © FF M 1 D -r4 I -0 Q G H T t 4E `rH E 15 t� •4G w�.��----���._--------- 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. W E U-)d ee L 0 L-l R< E T-14 es e.© CIL e`!-r AWS o C� 7. How was the amount claimed above computed? I clu e e ester amoun o any prospective injury or damage.) /A 3. Names and addresses of witnesses, doctors and hospitals. G E JU 6 , F-, ,=—In 14 A/ S©i,t 7-e A?-5 9. . List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT © �.15 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 a (Claimant's Signature Address, /1. 9-4-30 3 Telephone No. Telephone No.('-S IG) 2 Z 3- 27-7-5- 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 impprisonrpent and fine. 'qt _ r V � c ! C7 J CJ ,JU OL V4 oCOI�YI A d N cV 'CS = cC N � i �•' CLAIM C , (o BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA July 25, 1995 CIAO- anzinst the County, or District governed by) BOARD ACTION _ ._ S:;,,ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 6114 FLdrC. 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: Gary D. Masbarger ATTORNEY: Date received r',L)r.Vr Ot;!IctEl�L ADDRESS: 901 Court St. BY DELIVERY TO CLERK ON June 30J,A, , �`995; CAL;F., Martinez, CA 94553 Interoffice BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. a QQ IL BATCHELOR, Clerk ' DATED: JiinP 3, 19c35 B : Deputy I1. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. x•• 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: "`' ~c7- s BY: Deputy County Counsel 11I. 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 Superviscrs 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 C4. ,) Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: O2(o BY: PHIL BATCHELOR by , deputy Clerk CC: County Counsel County Administrator OFFICE OF COUNTY COUNSEL DEPUTIES: ' CONTRA COSTA COUNTY PHILLIP S. ALTHOFF •f'- SHARON L. ANDERSON 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) 646-2041 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 July 6 , 1995 VALERIE J. RANCHE DAVID F. SCHMIDT DIANA J. SILVER VICTORIA T. WILLIAMS NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Gary D. Masbarger Martinez Detention Facility 901 Court Street Martinez, CA 94553 RE: CLAIM OF: Gary Masbarger 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. [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. [l 6 . The claim is not signed by the claimant or by some person on is behalf . [] 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: July 6, 1995 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) r • RECEIVED 6a f `�» .SUN 3 01995 � � � t,n `Z_ C_� ca. ��BC?ARO O�su� tjis.,ray CONTRA COSTA CC3. C'5- (S--G4 591 _ P�:ooa- r-J' 6 F-, 3 �� ho hl 1,4- � Cruet f-P f, V.) �I Yl Q,�_ S 6 C i j 10, 0-1 o S� al {9 c-l l 03y) 5 { � rx s � ►� e, cs �, � �=. y � a« ave 9 40 10 t 1 I ,(`� 4-6 a : U f -�2 1-�°� 1f �r�'i) r`� v�' .; 1 12 13 h i 14 cct t5 n )(c- S S c 16 17 Q1 c C CA o 18 / f 20 t, ,4 Yw '_ 21 22 23 24 25 ' 26 27 28 cil ko 2 3 aCQ pp r V 9 5 10 Gi. C `a 11 12 13 14 r5 a 16 17 18 L� 19 20 21 22 23 24 25 26 27 28 1 ��. �...&' ,� ... � `�„'.. ",�� mow• ;�. ` �.. .. �. �� 1 r ...�' �, ..,,� :.. �3 �l._.� �� ;,� ''�� � 6. CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA �� 7 July 25,,: 1995 Clairm Ageinst the County, or District governed by) BOARD ACTION 2--:r2 _r S;:pervisors, Routing Endorsements, ) NOTICE TO CLAIMANT a,d Foard 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 al.1,-, L��ngs CLAIMANT: Floren Mariano, a minor by & through his Guardian Ad Litem, Florentino Mariano' ATTORNEY: Kenneth B. Tishgart COUNTYcz UNSEL Two Embarcadero Center, Ste. 1705 Date received MAR'INEZcALiF. ADDRESS: San Francisco, CA 94111 BY DELIVERY TO CLERK ON June 29, 1995 BY MAIL POSTMARKED: June 28, 1995 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PpHHIL BATCHELOR, Clerk 17 DATED• Trim 29 1995 8Y: Deputy _ e z. 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). ( ✓r Other: _g" .�. —t, w e tv-�Lu Dated: C0 BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (� This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: 'PHIL BATCHELOR, Clerk, By to , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, 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 JlJL Deputy Clerk CC: County Counsel County Administrator RECENED JUN 29 1995 GOVERNMENT CLAIM CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. Claimant: Floren Mariano, a minor by and through his Guardian Ad Litem, Florentino Mariano Claimant's Date of Birh: 7/6/78 Claimant's Address: 1801 Devon Court, Apt. A Concord, CA 94520 Facts of Incident: On February 13, 1995, as a direct and proximate result of the negligence of Mt. Diablo Unified School District, plaintiff was injured in the gynasium of Concord High School. Claimant's injuries: Broken third and fourth fingers on right hand, permanent deformity. Claim: Claimant avers that Concord High School and Mt. Diablo Unified School District were careless and negligent in and about the way in which they supervised claimant and the premises. Claimant's damages: Claimant claims the above injuries, medical bills and damages for pain and suffering are in the sum of $100,000.00. Notices to be sent to: LAW OFFICES OF KENNETH B. TISHGART Two Embarcadero Center, Suite 1705 San Francisco, CA 94111 415/433-2600 DATED: KENNETH B. T SHGA Attorney for Claimant 1 PROOF OF SERVICE BY MAIL 1 2 I, the undersigned, declare as follows: 3 I am now and at all times herein mentioned have been a citizen of the United States, 4 over the age of eighteen years, and not a party to the within action or cause. My business 5 address is Two Embarcadero Center, Suite 1705, San Francisco, California 94111. On 6 June 26, 1995, I served a true and correct copy of the attached GOVERNMENT CLAIM 7 on the following person(s): 8 Clerk of the Board of Supervisors 651 Pine Street, 1st Floor 9 Martinez, CA 94553 10 by placing it in a sealed envelope, addressed as indicated, with postage fully prepaid affixed 11 thereon, and causing it to be deposited with the United States Postal Service in accordance 12 with the ordinary practice of my place of employment. 13 I am familiar with the practices of my office for depositing mail with the United 14 States Postal Service and attest that the aforesaid document was deposited with the United 15 States Postal Service on June 26, 1994, in the ordinary course of business. 16 I declare under penalty of perjury that the foregoing is true and correct and that this 17 Proof of Service was executed in the City and County of San Francisco, State of California, 18 on June 26, 1995. 19 LIS ARRIS 20 21 22 23 24 25 26 27 28 N Z. zc� 1- 0 oo � Ul ALn0 ) 0 �53J L, ra"lJ�CD 7� r Yrs' N � N N r'* , ' � 4 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA C-' 10 July 25, 1995 Ci?<m An?inst the County, or District governed by) BOARD ACTION S-_;,ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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: $60.43 Section 913 and 915.4. Please note all "Warnings",. CLAIMANT: Terrence L. Johnson @ g ATTORNEY: Date received COUNTY CCIlW8 [., A T N ADDRESS: 304 Dursey Drive BY DELIVERY TO CLERK ON June 19V CR[.+F. Pinole, CA 94564 BY MAIL POSTMARKED: June 29, 1995 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: June 30, 1995 ppHHIL BATCHELOR, Clerk ` BY: Deputy 11. FROM: County Counsel TO: Clerk of the Board of Supervisors (1- This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: i Dated: 7 BY: —� Deputy County Counsel II1. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARDS ORDER: By unanimous vote of the Superviscrs 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 G__� , Deputy Clerk ci- 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 1B; 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 byjpu, P_QJd Deputy Clerk CC: County Counsel County Administrator BOARD OF SUUPERVISORS 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 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. £. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this for--. RE: Claim By ) Reserved for Clerk's filing stamp gys ) RECEIVED 05� y,�2�S'&'y /�/?iuG ,.P1iv04S CA ) ,` �GAAW Against the County ofzContra Costa ) i or > JUN 3 0 1995 District) CLERK BOARD OF SUPERVISORS Fill in name)) CONTR6�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 occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) I So?�r) � � Af pan � !�!le Vii 3• How did the damage or, injury occur? (Give Hill details; use extra paper if required) , y .G,gr7- /�!�'7- %�.9iGc72 7_1,-,FC �' ,ry iZ� 1 �� vL� 7- k) ��' / Alva VA tri, V16-4,1 ,, .�� 6o.T �� oN `,t,sivE -77,ee7. -------------------------- ------------ --- - 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? I-Al,ey /N sir T Z-)ruC i-Z) e_0V5?h-(/C7%D,'1 /,u 71-itt-f_ ACiW 4//5S NdT �d�� Tls2 /.v �,wn�, , �� er/�TIG� o.,/ vv�. ti e 5. wnat are the names of county or district officers, servants or employees causing the da:�_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. do s e % t fear/ev ire. P .J&e- ce)� 6111A,,' 4e V97-11 . 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) .��.�_ arriarr��,?s��,��-��a� �osT r i'�ae� �i���a�c�//ay��� n✓��-eco, $. Names and addresses of witnesses, doctors and hospitals. add�e 1��� lbs"� ����� 5�•; 1�,�,� �,� Sobs-a,7fe.� CA• q5��a 3 �����zz�.- �40-e.t-or Axn-9X8027 /�,vo� flay ,4,0� 5',0d-017-& 9• List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT C61z© 9s 7i2� (�7ier�r e� b O 1y3 Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or b ome person on is behalf." Name and Address of Attorney Claiman 's Signature 30/1 D�f UE AR, (Address) Telephone No. Telephone No. 3lb 5 * W I V W V T 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 imrrisorrpent and fine. WCAMERON , o TIRE BAR 900 HOFFMAN BLVD. 900 HOFFMAN BLVD. •RICHMOND, CA 94804 RICHMOND, CA 94804 BUREAU OF CALIFORNIA REGISTRATION' AUTOMOTIVE REPAIR NO.AG 111493 PHONE(510)2.32-6.339 CUSTOMER ACCOUNT NO. TERMS INVOICE cc DATE SOLD TO . SHIP TO SALESMAN N SHANE A TERRANC:.E JOHNSON WORK PHONE NO. _ M 304 DURSEY EHOME PHONE NO. PINOLE, C€� 1 11.10 V 0) I @`._'.Imo. 94564,. r 'URCHASE ORDER NO. CREDIT CARD NO. MAKE&YEAR OF VEHICLE LICENSE'NO.&STATE f VEHICLE NO. VEHICLE SERIAL NO. ODOMETER READING OTHER INFORMATION ITEM NO. QTY SIZE OR PART NO. DESCRIPTION UNIT PRICE EXTENDED PRICE MECH. 8073 1 B7813 NANCO 0 0 44. 59 44. 59 1 1 PASS PASS DAL.ANICE ►,b 1 10. 00 10. 00 55 _600 i Sf—E-1 RUBBER VALVE-Pfd S 0 0 2. 00 2. 00 • TAXABLE AMOUNT 46. 59 PARTS LABOR TOTAL SALES TAX BILLING 84M4^ � STATUS NON-TAX AMOUNT 10. ;0 hereby authorize the above r it we to be done along with the necessa serials.You and your employees may operate above vehicle for purposes of testing,inspe i or liveryat my risk. An expr me an s lien is acknowledged on above vehicle to secure the amount • of repai to.It is also rsto that you will not be held a pon le r loss or damage to vehicle or articles left in vehicle in case of fire,theft or any a aus and ur control. f2Q. 43 ,! 10-:42 � �'�RIF-RP"0 IFRyPT�QB CAPS TO THE BEST OF OUR ABILITY. SIGNATURE PLEASE DOUBLE-CHECK THEM,AS DUE TO THE WAY THEY ARE MADE,WE CAN NOT BE RESPONSIBLE FOR ANY HUB CAPS LOST AFTER THE CAR HAS _ • • LEFT OUR SHOP. PARTS LABOR TOTAL USED PARTS TO BE RETURNED TIME PROMISED AUTHORIZED BY ❑ IN PERSON YES NO ❑ BY PHONE DATE TIMECALLED BY PHONE NUMBER CARS LEFT OVER 3 DAYS AFTER NOTIFICATION OF WORK BEING COM- PLETED WILL BE CHARGED$10.00 PER DAY STORAGE. Lb 4 C� C �1 r � � f lqj 1 ` f UP � . 5 r � � 3 � � 1 h• �r CLAIM C, /o ' BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA July25, 1995 Clam Against the County, or District governed by) BOARD ACTION .6. 2::rf 1;:;;ervisors, 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 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: LaNetra Johnson ATTORNEY: Date received ADDRESS: 945 Trenton Blvd. BY DELIVERY TO CLERK ON June 29, 1995 San Pablo, CA 94805 BY MAIL POSTMARKED: Hand Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PQHH g DATED: June 29, 1995 BYIL Deputy OR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors (✓) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: �,Q ' 3y '�� BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (� This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: ��1�PHIL BATCHELOR, Clerk, By , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: BY: PHIL BATCHELOR by Leputy Clerk CC: County Counsel County Administrator CLAIM C r j� / . BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA R) Julr25, 1995 Clp;m anainst the County, or District governed by) BOARD ACTION :° S;:;ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and 6card Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $10,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: LaNetra Johnson ATTORNEY: Date received ADDRESS: 945 Trenton Blvd. BY DELIVERY TO CLERK ON June 29, 1995 San Pablo, CA 94805 BY MAIL POSTMARKED: Hand Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PQHH gg DATED: June 29, 1995 BYIL DeputyLOR, Clerk 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( (j/ffiis 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: t— Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (4' ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov, code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * 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 1B; 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: (p BY: PHIL BATCHELOR by eputy Clerk CC: County Counsel County Administrator CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA July 25, 1995 Claim onainst the County, or District governed by) BOARD ACTION `_::;ervisors, 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. $20,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: LaNetra Johnson y, ATTORNEY: Date received COUNT.'COU€NSE:L. ADDRESS: 945 Trenton Blvd. BY DELIVERY TO CLERK ON June,29"; 199�5�`�` San Pablo, CA 94805 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. DATED: June 29, 1995 PpHHIL BATCHELOR, Cler BY: Deputy 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( c,}---fhis claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: l-c 3 U BY: Deputy County Counsel Z/ 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. Dated: 1q_-1',5___'PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: BY: PHIL BATCHELOR by eputy Clerk CC: County Counsel County Administrator Clair to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Clai.:s 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 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 paialty for fraudulent claims, Penal. Code Sec. 72 at the end of this RE: Claim By ) Reserved for Clerk's filing stamp d LaNetra JohnsonM4�kLJj RECEIVED West Contra Costa ) Against the County of Contra Costa ) _ JUN 2 9 1995 or ) CLERK BOARD OF.Sisi ; ;lds3un;a 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 $ 10,000.00 and in support of this claim represents as follawm: 1. When did the damage or injury occur? (Give exact date and hour) PLEASE SEE ATTACHED. 2. Where did the damage or injury occur? (Include city and county) PLEASE SEE ATTACHED. 3. How did the damage or injury occur? (Give full details; use extra paper if required) PLEASE SEE ATTACHED. 4. What particular act or omission on the part of county or district officers, servants or e=ployees caused the injury or damage? PLEASE SEE ATTACHED. 5. wnaL are the na.-Des of county or district officers, servants or employees causing the car.-age or injury? PLEASE SEE ATTACHED. 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. PLEASE SEE ATTACHED. 7. How vias the amount claimed above computed? (Include the estimated amount of any Prospective injury or damage.) PLEASE SEE ATTACHED. 8. ?James and addresses of witnesses, doctors and hospitals. PLEASE SEE ATTACHED. 9. List the expenditures you made on account of this accident or injury: DAT£ ITEM AMOUNT PLEASE SHE ATTACKED. Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf." Name and Address of Attorney Claimant's Si ure 945 Trenton Eoalevard San Pablo, CA 134806 (Address) TelephoneNo. Telephone No. (510)231-030,3 * * * * * * * * * * * 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 s cb L=risonment and fine. Claim to: BOAP.D 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 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 nate 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 Fo= R.:: Claim By ) Reserved for Clerk's filing stamp LaNetra Johnson RECEIVED West Contra Costa ) Against the County of Contra Costa ) _JUN 2 9 1995 or ) CVAK OF RO OF 5it 0eP_Q kSOf-s District) cuN A Co5tA �A-,,-r1_/ Fill in name ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 10,000.00 and in support of this claim represents as'follaws: 1. When did the damage or injury occur? (Give exact date and hour) PLEASE SEE ATTACHED. 2. Where did the damage or injury occur? (Include city and county) PLEASE SEE ATTACKED._ 3. How did the damage or injury occur? (Give full details; use extra paper if required) PLEASE SEE; ATTACKED. u. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? PLEASE SEE ATTACHED. 5. wnat are the names of county or district officers, servants or employees causing "he da:�--,4a=. or injury? PLEASE SEE ATTACHED. --- ----------- -- 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. PLEASE SEE ATTACHED. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) PLEASE SEE ATTACHED. $. Names and addresses of witnesses, doctors and hospitals. PLEASE SEE ATTACHED. 9• List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT PLEASE SEE ATTACHED. 44 Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or bv some person on his behalf." Name and Address of Attorney Claimant's S ture 45 Trenton Boulevard San Pablo, CA 94805 (Address) TelephoneNo. Telephone No. -(510)/ 231-0893 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 s-c7 i Yr sonme^t --nd fine. Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for-death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this fog RE: Claim By ) Reserved for Clerk's filing stamp , LaNetra Johnson ) West Contra Costa , RECEIVED ) Against the County of Contra Cosh ? _ JUN 2 9 1995 or ) CLERK BOARD OF SUPE' ,v"iSUna 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 $ 20,000.00 and in support of this claim represents as follows: 1- When did the damage or injury occur? (Give exact date and hour) PLEASE SEE ATTACKED. 2. Where did the damage or injury occur? (Include city and county) PLEASE SEE ATTACKED. 3. How did the damage or injury occur? (Give full details; use extra paper if required) PLEASE SEE ATTACKED. 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? PLEASE SEE ATTACKED. 5. wnat are the names of county or district officers, servants or employees causing the da::.'aae or in jury? PLEASE SEEATTACHED. 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. PLEASE; SEE ATTACHED. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) PLEASE SEE ATTACKED. $. Names and addresses of witnesses, doctors and hospitals. PLEASE SEE ATTACKED. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOM PLEASE SEE; ATTACHED. Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES T0: (Attorney) or b some person on his behalf." Name and Address of Attorney Claimant's S Vture 945 Trenton Boulevard San Pablo CA 3,4805 Address. Telephone No. Telephone No. (510)231-o.193 * * V 7 * * * * * * 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 and fine. June 28, 1995 Board of Supervisors of Contra Costa County County Clerk 651 Pine Martinez, Ca. Dear Sir or Madam: The attached claim form did not have enough room in each of the question boxes for me to adequately respond, therefore, I have chosen to write an answer to each question in this letter. Also, there were four separate and distinct complaints that I wish to address in my complaint. In order to do that, and not file four separate complaint documents, this response will be divided into four sections, with a response to each of the nine questions in each section. I have attached copies of two letters to the Director of the Lake Child Care Center and to Wilda Davisson, Program Manager of the Contra Costa County Child Development Division, written to advise them of my concerns. Also attached is a "Complaint Investigation Report" prepared by the State of California, Health &Welfare Agency, Division of Licensing and Certification, indicating a finding that substantiated my complaint. I would appreciate your consideration in reading this document thoroughly. COMPLAINT#1 My toddler daughter, Danielle Johnson, was given citrus fruits to eat and milk to drink after I requested that she not have them AND after I had submitted a letter from her pediatrician requesting that she not have those food items. As a result she became ill. 1. When did the damage or injury occur? Over a period of two weeks, from January 3 to January 12, 1995, during meal times. 2. Where did the damage or injury occur? Lake Child Care Center, 2700 - 11th Street, San Pablo, Ca., County of West County Costa. 3. How did the damage or injury occur? On December 30, 1994, 1 spoke over the phone to Mrs. Aurora Ruth the director of the Lake Child Care Center. I informed Mrs. Ruth that my daughter had eczema and asthma. I asked if she could accommodate her need for a special diet for a few days until I was able to get a note from her doctor. She said, "no". I informed Mrs. Ruth that my daughter is allergic to citrus acid and I noticed there were oranges on the menu. Equally important was the fact that my daughter also should not have milk, which is written on all of her records. I asked Mrs. Ruth if she would inform her staff of these food restrictions for Danielle. Mrs. Ruth did not mention this information to her staff. Subsequently, Danielle was given oranges and was allowed to drink milk which was expressly forbidden as potentially dangerous to my daughters health. When I complained, Mrs. Ruth told me to let Danielle stay at her former child care center, Las Delta, until I get a notice from the doctor. However, it was not possible for Danielle to stay at Las Delta because Mrs. Ruth had already arranged for her file to be picked up. The result of allowing my daughter to have foods that were known to cause her to become ill was that she did indeed become ill. On Friday, January 13, 1 had to take off work in order to care for my daughter who was having an asthma attack. 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Even though the dietary restrictions required by my daughter's medical problems were written in her file (which Mrs. Ruth had in her possession) and even though I reinforced those restrictions verbally, my daughter was given food and drink by the workers at the Lake Child Care Center that was harmful to Danielle's health and was in total disregard of my concern. 5. What are the names of county or district officers, servants or employees causing the damage or injury? I can only assume that the Director of the Lake Child Care Center is responsible for the actions of her staff, especially when the Director is the one that I directly communicated the revelant information to. That person is Mrs. Aurora Ruth. 6. What damage or injuries do you claim resulted? My 3 year old daughter became ill with an allergy and asthma attach. She had difficulty breathing. I had to stay home on Friday, January 13 in order to care for her. Because Danielle has this medical problem, I already had medicine and a Pulmo Aide, compressor/nebulizer at home to help relieve her condition. The damages claimed is the creation of a medical condition that could have had more serious consequences. My daughters health was injured. The dollar amount that I am claiming is $20,000. 7. How was the amount claimed above computed? It is impossible to put a dollar amount on the life of my youngest child. The amount shown above is my estimation of the extent of the pain and suffering that I and my daughter have suffered. 8. Names and addresses of witnesses, doctors and hospitals. My family and I are members of Kaiser, Richmond, 901 Nevin Ave., Richmond, 94801. My daughter's medical record number is 7935121. Copies of letters from her doctors to the Las Delta Child Care Center are attached. Also, you can contact my supervisor at work, Sheila Gains (540-2798) to verify my calling on Friday, January 13 to advise them that I had to stay home because my daughter was ill. The time that claimed was "Family Sick Leave". 9. List the expenditures you made on account of this accident or injury: The actual financial cost was a missed day at work for me which was charged to my Family Sick Leave balance. I am grateful that my daughter's health problem did not result in a hospital stay or extended illness. 2 COMPLAINT#2 Each day of the first week that Danielle was at Lake Child Care Center, when I arrived to pick her up, I found her slumped over a desk, seemingly about to fall. When I asked if Danielle could lay on a cot when she got sleepy I was told that the Director, Mrs. Ruth, said not to lay her down, to let her sleep on the desk. I felt that at any time, Danielle could have fallen off of the desk and been hurt. 1. When did the damage or injury occur? During the week of January 3 through January 6, 1995. 2. Where did the damage or injury occur? Lake Child Care Center, 2700 - 11th Street, San Pablo, Ca., County of West County Costa. 3. How did the damage or injury occur? When sleepy in the afternoon, my daughter was placed at a desk, resting her head on the top of the desk, without any means of restraint to prevent her from falling while asleep. This was done instead of allowing her to lay down on a cot, which was readily available. 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? My daughter was not allow to rest on a cot when sleepy. There was no logical reason given for this decision. My protests were not responded to until the second week. 5. What are the names of county or district officers, servants or employees causing the damage or injury? The immediate Head Teacher in charge of the classroom where my daughter was assigned was Ms. Cloiridell Jackson. The Director of the center that gave the "no cot" instruction was Mrs. Aurora Ruth. 6. What damage or injuries do you claim resulted? The potential for injury to my daughter caused me personal injury in emotional, mental and psychological pain and suffering. The dollar amount that I attach to this complaint is included in the $20,000 amount indicated in Question #6 under Complaint#1. 7. How was the amount claimed above computed? Please see Question #7 above, under Complaint#1. 8. Names and addresses of witnesses, doctors and hospitals. Please see Question #8 above, under Complaint#1. Also, I spent that week expressing my concerns to my coworkers. Names and phone numbers are: Nafeesa Ahmad Bey (510)540-2384 Chuck Graham (510)540-2797 9. List the expenditures you made on account of this accident or injury: None. 3 COMPLAINT#3 During the week of January 3 through January 6, 1995 1 was required by Mr. Aurora Ruth to pick up my daughter each and every day at 12:30. 1 was told by Mrs. Ruth that that was a regulation for all new children at the center. The stated purpose was to give the child adequate time to adjust to being in a new center. This requirement caused me to take off time from work, hire an additional babysitter (for child care in the afternoons) and to stressed out racing on the freeways back to the center at 12:30, then to the babysitter, then back to work. I subsequently learned that that requirement is not mandatory. Mrs. Ruth's insistence on such a precess was totally unnecessary and caused considerable disorder to my life. 1. When did the damage or injury occur? During the week of January 3 through January 6, 1995. 2. Where did the damage or injury occur? At the Lake Child Care Center, 2700 - 11th Street, San Pablo, Ca., County of West Contra Costa. 3. How did the damage or injury occur? I was forced to leave my employment at midday (my normal work hours are 8 am to 5 pm) for the first week of January as a requirement of my daughter being accepted to attend the Lake Children's Center. 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Mrs. Ruth insisted that I pick up my daughter, mid-day for the first week of enroll- ment at Lake Child Care Center. She stated that I could not enroll my daughter without complying with that requirement. I was led to believe that it was a part of the center's policy. There is no written policy with such a requirement. 5. What are the names of county or district officers, servants or employees causing the damage or injury? Mrs. Aurora Ruth, Director of Lake Child Care Center. 6. What damage or injuries do you claim resulted? lost time and wages from my job. I suffered extensive stress and mental anguish. The financial amount claimed is $10,000. 7. How was the amount claimed above computed? The amount shown above is my estimation of the extent of the pain and suffering that I have suffered as a result of this requirement. 8. Names and addresses of witnesses, doctors and hospitals. My distress was expressed to my coworkers. Names and phone numbers are: Nafeesa Ahmad Bey (510)540-2384 Chuck Graham (510)540-2797 4 9. List the expenditures you made on account of this accident or injury: Date Item Amount 1/3/95 Child care/mileage $60. 1/4/95 Child care/mileage $60. 1/5/95 Child care/mileage $60. 1/6/95 Child care/mileage $60. $240. COMPLAINT#4 Mrs. Aurora Ruth inappropriately contacted my supervisor. The documentation required to enroll Danielle included a copy of my (State of California, Department of Health Services) paystub. After providing the two most recent ones, Mrs. Ruth questioned the amounts shown because they differed from an earlier stub provided to the Las Delta Child Care Center. Although I explained the reason for the difference, Mrs. Ruth choose to call my supervisor. When she did so, I was astounded to find out that she took it upon herself to ask my supervisor (at that time, Mr. Chuck Graham), to consider changing my lunch hour to a half hour so that I could leave earlier to pick up Danielle a half hour earlier. Neither Mrs. Ruth nor anyone else has the right to make any kind of work-related request to my supervisor, especially without my knowledge or permission. 1. When did the damage or injury occur? During the week of January 3, 1995. 2. Where did the damage or injury occur? The physical location would be at my place of employment, at 2151 Berkeley Way, Berkeley, Ca. 3. How did the damage or injury occur? Unauthorized contacted was made with my supervisor, on my behalf, without my knowledge or permission. 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Specifically, Mrs. Aurora Ruth, Director of Lake Child Care Center, called my immediate supervisor to make a request for a change in my working hours in order to accommodate her personal preferences. This unauthorized intrusion into my personal life caused me extreme stress and personal mental injury. 5. What are the names of county or district officers, servants or employees causing the damage or injury? Please see Question #4 above. 6. What damage or injuries do you claim resulted? am claiming $10,000 in compensation for the incredible insult and injury suffered by the acts of Mrs. Aurora Ruth. 5 7. How was the amount claimed above computed? The amount shown above is my estimation of the extent of the pain and suffering that I have suffered as a result of the unauthorized action on the part of Mrs. Aurora Ruth in relation to my employment. 8. Names and addresses of witnesses, doctors and hospitals. My distress was expressed to my coworkers. Names and phone numbers are: Nafeesa Ahmad Bey (510)540-2384 Chuck Graham (510)540-2797 9. List the expenditures you made on account of this accident or injury: None financial. The above information represents my best effort to respond to the questions on your form. The total amount claimed for all complaints is $40,000. 1 would appreciate being informed of the next step on the process for proceeding with this claim. I can be reached during the day at (510)540-2023. Thank you for your consideration. Yours truly, LaNetra Johnson 945 Trenton Blvd. San Pablo, Ca. 94806 Attachments Letter to Mrs. Aurora Ruth, February 7, 1995 Letter to Ms. Wilda Davisson, April 11, 1995 Letters from Kaiser physicians, various dates. Letter from Aurora Ruth, Director, March 2, 1995. Letter from Cloiridell Jackson, Head Teacher, March 10, 1995 Complaint Investigation Report, Division of Lic. & Cert., March 10, 1995 6 • February 7, 1995 ,, Mrs. Aurora Ruth, Director Lake Child Care Center 2700 - 11 th St. San Pablo, Ca. 94806 Dear Mrs. Ruth: Thank you for providing child care for my daughter, Danielle Johnson, from January 3 to January 12, 1995. However, this letter is to inform you that I am extremely unhappy with the treatment I received from you and your staff during my brief interaction with your center. The following items are serious areas of concern. My child's health and diet concerns: On December 30, 1994, prior to Danielle's starting, you and I had a conversation regarding her diet. I shared with you that she has eczema and asthma. I asked if you could accommodate her need for a special diet for a few days until I would be able to get a note from her doctor. You said "no". I said "she is allergic to citrus acid and you have oranges on your menu". Equally important is the fact that Danielle also should not have milk, which is written on all of her records. I asked if you were going to give them to her anyway. I am aware that you did not talk to your staff to inform them that she could not have oranges or milk.. Subsequently, Danielle was given oranges to eat at lunch and I noticed dried milk on her upper lip when I picked her up. When I complained, you stated that I should let Danielle stay at Las Delta until I get a notice from her doctor. However, that was not possible because you had arranged to have her records picked up from Mrs. Ramona McCoy (at Danielle's prior day care, Las Delta). When my child's health is being considered, I do not understand the lack of cooperation on the part of you and your staff. Inappropriate contact with my work supervisor: The documentation required to enroll Danielle included a copy of my paystub. You requested that I provide my two most recent ones, which I did. However, you questioned the amounts shown because they differed from an earlier stub provided to the Las Delta Child Care Center. I explained the reason but you stated that you were going to call my supervisor about it. That was extremely disrespectful. Then, when you did call, I was astounded that you actually asked my supervisor to consider changing my lunch hour to a half hour so that I could leave earlier to pick up Danielle a half hour earlier. Exactly what gives you or anyone else the right to make any kind of work- related request to my supervisor. I consider such behavior totally out of line. Mrs. Ruth, I consider it to be basic respect for any questions in regards to my work schedule to be discussed with me. First week pick up schedule: During the week that Danielle was at your center, you insisted that I pick her up at 12 noon each and every day for that week. The explanation given was so that Danielle would have adequate time to adjust to being there. This requirement caused me to take off time from work. I have since learned that that requirement is not mandatory. Your insistence on such a process was totally unnecessary and I cannot imagine why you caused such disorder to my life. A transition period should be geared to assist the child and the parent. It was very difficult for me to schedule working half a day for a whole week. Attitude of your staff: During that first week, when I picked up Danielle, she was slumped over on a desk, asleep and about to fall. I asked Ms. Jackson if Danielle could lay on a cot when she got sleepy. I was told that "Aurora said not to lay her down, to let her sleep on the desk". The next day that I picked up Danielle I commented to Ms. Jackson that I really didn't feel that Danielle and I were welcome at the center. Ms. Jackson didn't reply, she simply shrugged her shoulders. I understand that childcare work is difficult and usually underpaid, but it is important that the staff to maintain pleasant and courteous manners towards the children, parents and other people. Totally rude treatment on the last day at Lake Child Care Center: On the last day, I signed Danielle out as usual and asked Ms. Jackson if she had been informed by Mrs. Ruth that today was Danielle's last day. Her reply was "uh hum". stated that I needed to pick up the change of clothes that I had kept there for Danielle. I proceeded to go and get them from the room where they were kept. Ms. Jackson stopped me by shouting to Ruth, "bring me Danielle's change of clothes in that bag in my room". Ruth is another teacher and did not respond. Ms. Jackson got up, stormed down the hall to the room and did not return for awhile. They were taking too long and I needed to leave so I walked down to the room and found them both standing there looking at me as I entered. Danielle's bag was in Ms. Jackson's hand, ripped. She said it got snagged and tore. She didn't even apologize for ripping the child's bag which happened to be Danielle's favorite one. I just said it was OK, took the torn bag and said "Thank you for your services. Have a good evening". I was actually surprised when Ms. Jackson showed no regrets after ripping the bag. She could have offered to repair the bag. Overall, my experience at Lake Child Care Center was very negative. We were made to feel very unwelcome and that is the reason that 1 transferred my daughter, Danielle Johnson, to Maritime Child Care Center. Thank you for taking time to read my concerns. I wished our experience together had been more rewarding for Danielle. Good luck with your future clients. Sincerely, Ms. LaNetra Johnson cc: Joan Sparks, Program Director Wilda Davison, Program Manager Janissa Rowley, Assistant Manager Page 1 of 2 April 11, 1994 Wilda Davisson, Program Manager Contra Costa County Child Development Division 2730 Maine Avenue Richmond, Ca. 94804-2807 Dear Ms. Davisson: Thank you for the phone call and for having Aurora Ruth, Director, and Cloiridell Jackson, Head Teacher at Lake Child Care Center, respond to my letter of concern that was submitted to Mrs. Ruth on February 7, 1995.. Unfortunately, the responses did not address my concerns and the letter from Mrs. Ruth actually contained fabricated content. Specifically, 1. I never said that your service offered was of quality and comfort. 2. 1 never said that my choice of Lake was a good one. 3. 1 never said the staff was supportive or caring. 4. Nor did I speak about the activities the center offered because I was never informed of any. If I had held any of the above opinions, I would not have felt (as I did) that it was important to the physical and mental health of my child that I place here in a better environment. That was why I moved Danielle to the Maritime Child Care Center. The treatment received at Lake was rude, uncaring and deliberately ignorant of the dietary restrictions of my child. I cannot understand how Mrs. Ruth could have read my letter of February 7 and responded as she did in her letter. I am still waiting for a response to my unanswered questions. 1. Why was Danielle given citrus fruits to eat and milk to drink after I requested that she not have them AND after I had submitted a letter from her pediatrician requesting that she not have those food items? 2. Why did Mrs. Ruth make inappropriate contact with my supervisor, requesting,a,; change in my work hours so that I could pick up Danielle earlier? 3. Why was it mandatory 'that I pick up Danielle at 12:00 each day for the first week that she attended Lake Child Care. Since no other center has that requirement, how is it allowed at the Lake Child Care center? Is it policy? If so, by this letter, I am requesting a copy of that policy. 4. Why was Danielle slumped over on a desk, about to fall, each day when I picked her up for that week at Lake Child Care? I await a conscientious and relevant response to this letter. Again, thank you for taking the time to read my concerns. Yours truly, Mrs. LaNetra Johnson, Parent Page 1 of 1 cc: Phill Bachelor Joan Sparks Kaiser Foundation Hospitals Sheila G.Manderson,R.N. 1330 Cutting Boulevard Flospital/ilealth Plan Administrator Richmond,California 94804-z,65 Donald P. Fischer,M.D. The Permanente Medical Group,Inc. Physician-in-Chief 901 Nevin Avenue Gayla DI Maggio Richmond,California 94801-3195 Medical Group Administrator (510)231-4600 I<MSCR PERIVIANC-NTC January 5 , 1995 TO: Lake School RE: Danielle Johnson MR# : 7935121 This is to verify that Danielle suffers from eczema and asthma. She needs to avoid the following foods : citrus , chocolate, and milk and milk products . Signed: Moyra Siu, M.D. Department of Pediatrics MS: ds PHYSICIAN'S REPORT-DAY CARE CENTERS (CHILD'S PRE-ADMISSION HEALTH EVALUATION) tt STATEMENT TO PHYSICIAN born tv I(�I ( .�"� ; 1 C 7 is being studied for readiness to enter N E CHILDI (BIRTH DATE) This Day Care Canter provides a program which extends from t r {NAME OF DAY CARE CfiNTE;') a.m.to '7: days a week. The daily activities include vigorous outdoor play. The schedule includes morning and afternoon snacks, a noon meal, and a nap atter lunch. Please provide a report on above-named child using.the form below. I hereby authorize release of medical information contained in this report to the above-named Day Care Cerate. - W1190. /1 .22 .9-3 t S1GNArupr PARENT.GUARDIAN.O OT R RESPONSIBLE PARTY) (GATE) PHYSICIAN'S REPORT Above-named child s a is not physically and emotionally able to participate in the Day Care Canter described above. C-IMMCNTS: .__.. ANY PHYSICAL CONDITIONS RECUIR/IN�G SPEC:AL ATTENTION IN THE DAY CARE CENTER: /LL A4 DEDICATION PRESCRIBED OR SPECIAL ROUTINES WHICH SHOULD BE INCLUDED IN THE DAY CARE CENTER FOR CHILD'S CTIVITIES: 1 �i1vtN II M c �e mm A,t „i�c A,c A mm TYPE' I Gry I BY 1 !TEAD I INCUR- I IMPRESSICN I TYPE- I GIVEN I BY READ , aY INCUR. 'iMFRE55:C� oPP+rnwl _ll I D Fay O Pvo-m-w- I I I i Q Poa SKIN � o•�/f✓! I b /� I C/ � nIV 1 o N-: o°"_ I ! D N" TESTS n Po .Lb—! D P. I ❑ aoo a.m { i I i DP� ' o N-q D Or- 1 fI +c CHEST X-RAY Irr.wession: O norrral D abnormal Signature./ (Necessary if skin;est posrttve) . Fim tate:4i_/` Persson+s Iree of comn=+caWe tuberculosis O yes C no Agency It required for school entry,must be Manmux uniess exceoacn granted by local health department. DGES CHILO HAVE ANY OBVIOUS OCULAR ABNORMAUr:E37 - DOES VISION SEED TO BE ADEQUATE W EACH hYE7 IMMUNIZATION H ORY: (It a completed yellow"Calitomia Immunization Record,PM-298`is unclosed.this section need not be filled out) VACCINE Date each dose was given(month and year at a minimum) 1st 2nd 3rd ( 41h 51h Polio -z r' Sy 1 b S 5'2_ DTP or Td g I G � 9� O /� 6 1513 Rube Aa �0 G 5 3 PWSIC:AN'S SIGNATURE - R PHYSrCtAN ASSLSTANT,MJRS£PRACTITIONER Mumps ADDRESS r rr.rr•n-• +nr �rT• pq Hib(K&-ro "WkwratT"b) f y TELEPHCNE ( C: r, LtC oI(7.W PXWdu.fr♦q CONTRA COSTA COUNTY CHILD DEVELOPMENT CENTERS MEDICATION AUTHORIZATION Section 11755 . 1 - Education Code provides that any child who is, required to take, during the regular school day, medication prescribed by a physician, may be assisted by the program nurse or other designated personnel if the Center program receives ( 1) a written statement from such physician detailing the method, amount and time schedules by which such medication is to be taken; and ( 2) a written statement from the parent or guardian of the child indicating the desire that the program staff assist the child in matters set forth in the physician's statement. PHYSICIAN'S REQUEST - ADMINISTRATION OF MEDICATION AT SCHOOL Child's Name, (lleOee dohn5cn Birthdate 'Mara7) 3,_M2, Address_ � �?tJ,�A g4m(I Physical - condition for which medication is given Name of Medication Dosage and method of administration t " Possible reaction that needs to be reported to hys cian �'��/ /a 7 Physician's Signature Physician's Address KAISEqF:F' Date of request 5 l idpfty',�;ilian's- ' elephone 14EDICATION TO BE C N INUED UNTIL 4 ¢ >9G�Lt� ✓v (Please return f orm to parent or chi d development center) PERMISSION FROM PARENTS FOR STAFF TO ADMINISTER MEDICATION I understand that the County Child Development Center is not legally obligated to assist in the administration of medication to my child; therefore, I agree that the employees of this program will be free of any and all liabilityhat-mi ht esult from these arrangements . I/we, the parent(s) of C` 1�1,cLOX� request that a member of the County Child Develf ment staff assist in the administration of medication to our child_ I will notify the Center program if the medication is changed or is no longer -—----.1 - - - — .TELEPHONE ADVICE RECORD THIS IS A ❑ REQUEST ❑TRANSFER \ "' '--,,PATIENT " F L TI N DEPT. , LOC. `USE HEA TH 1 —AN CARD IMPRINT IF POSSIBLE h p NAME t p�Gq DOCT RI T NUMBER O AT(LOCATIO R EM)t. :'DEPT. E t" DATE 4 TIME, > . _ _ `� 9... ❑`A. '. .�..1_BIRTH.�.L:' �k_ s i �Bi((S G' 3 P.M. DATE PREP IGNATURE) 1 � } •� 3CHECK ONE;•)) •. w COVERAGE p,J�`l 't ❑ D.I. � ❑APPT. ADDRESS AGE WEIGHT HOME PHONE NAME OF CALLER �^ 1 t 1• '} TIME OF CALL .❑ `! . `PHONE P" -MACY t" * PH RMQSY N NUMBER IS r, CALL DATA I<L* Pedi. oni Med. AF rev ` -4 nAr7yv PROTOCOLS USED ❑ Advice Accepted ❑ Rejected INFORMATION GIVEN DO YOU CONCUR WITH ADVICE GIVEN ❑ Yes ❑ No &L, 11L C 4 4 a d&A_,e= M.D. REMARKS (� AUZEFAA L jeiy. 90333(REV. 10-79) 3/2/95 Mrs. LaNetra Johnson 945 Trenton Blvd. San Pablo,Ca. 94806 Dear Mrs. Johnson, Your letter of concern came to m,2 as a total surprise. I am very sorry that you 'felt the way you did. We ,believe that the service offered to you and Danielle was one of quality and comfort. Your request for Danielle's transfer was given high priority because of your urgent need of childcare. I kept an open communication with Mrs. Ramona McCoy, ( site supervisor for Las Deltas Infant Toddler Program) prior to her transfer. We were ready when you came to Lake. We were glad when you told us that your choice of Lake was a good one. You talked about how the staff is supportive and caring to Daniell..-2 and what varied activities the Center offers. Hopefully the service at Maritime Children Center meet your current needs. If you have concerns please contact Mrs. Wilda Davisson, Program Manager, CHild Development Division at #(510) 374-3994. Sincerely; Aurora E. Ruth �s March 10, 1995 Ms. LaNatra Johnson 2151 Berkeley Way Berkeley, CA 94704. Dear Ms. Johnson, My manger called me today to inform me that you were upset about your child's brief enrollment at Lake Children's Center and with my performance as Head Teacher in her classroom. I am very surprised to learn that you are upset with me. I wish that you had met with me to teil me about anything that I was doing that bothered you. I am especially surprised since I cared for your older daughter, Lenora, when she was enrolled at the YMCA after school program while I worked there. am very sorry that you were dissatisfied'with the care we gave Danielle at Lake. can assure you that if I had known about your concerns I would have done everything in my power to meet your daughter's needs. hope that Danielle is happy at Maritime. She is a bright and very well-behaved child. Sincer ULakeChilidren's �1 kson, ea eacher Ce cc: Wilda Davisson, Manager STATE OF CALIFORNIA-HEALTH AND WELFARE AGENCY T( DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING COMPLAINT INVESTIGATION REPORT COMPLAINT CONTROL NUM ER This is an official report of an unannounced visit/investigation of pla' r ei din our office on 0 f � and conducted by Evaluator r FACILIYNAM FACILITY FACILITYTYPE. FACILITY REPRESENTATIVE S ADDRESS - TELEPHONE -,CAPACITY CENSUS MET W H TIME IN TIME OUT TODAYS ATE MET 4VH TIMEIN PUBLIC ❑ CONFIDENTIAL /'�z ALLEGATION(S):. I INVESTIGATION FINDINGS:-- ' 0 0 Qy Substantiated ❑ Inconclusive ❑ Unfoun ed i ❑ Needs Further Investigation Estimated Days of Completion SPECIFIC DEFICIENCIES ! RECOMMENDATIONS/CORRECTIONS r -� oAllv �1 i t J 15 S G� Gt)s�I%c Ate, T YitG 'A�LU 7��C t-e U u PV Failure to co�rt the deficiency(fes)cited above by may result in civil penalty assessmen s of $50 or more per day. LICENSING ANA ST SIGIA TELEPHOW, ( ) 1 acknowledge receipt.of this form and understand my ��' appeal rights as explained on the back of this form. NAME OF SUP son TELEPHON'. SIGNATURE - GATE Distri ut : Origina. gency Duplicate:Licensee Triplicate:File. Page of UC 9099(io921 �.' CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA AmeNDcJuly 25,' 1995 Ci?;m aaeinst the County, or District governed by) BOARD ACTION -f S::,ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT a F(,.�rd. Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $10,000.00 + Section 913 and 915.4. Please note all "Warnings" 0 CLAIMANT: Diana Darnell $mer ATTORNEY: James E. Reed .SUN 2 9 T95 Nichols, Catterton, Downing & Reed Date received c®UNITYCOUNSEL ADDRESS: 3 Altarinda Rd. , Ste. 201 BY DELIVERY TO CLERK ON .h,ne 9.9, 19�� RTINEZ CALIF. Orinda, CA 94563 BY MAIL POSTMARKED: ,Tune 2..8_ 1995 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. pp gg DATED: June 29, 1995 Ball DeputyLOR, Clerk 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: Le —30 BY: � Deputy County Counsel III.. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (V-f 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:_ IPHIL BATCHELOR, Clerk, By Deputy Clerk kJ WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional. Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: BY: PHIL BATCHELOR by 0,_J_A,_0L.104uty Clerk CC: County Counsel County Administrator CLAIM BOL U SUzE;VIcncS OF CONTRA. COSTA COjNTY, CAL,rORNIA AHMED July 25, 1995 Cie<- t-z4^tt the County, or District governed by) /' � BOARD ACTION ::1-f r_:ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT c A.cticn. All Section references are to ) The copy of this document mailed to you is your notice of Califc.rnia G-,vern! ent Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Am:Lin,t: $10,000.00 + Section 913 and 915.4. Please note all •Warnings CLAIMANT: Diana Darnell AT70RNEY: James E. Reed Nichols, Catterton, Downing & Reed Date received c� ACC'RI`�. 3 Altarinda Rd. , Ste. ZO1 BY DELIVERY TO CLERK ON Trnnp 29, 19g5 Orinda, CA 94563 BY MAIL POSTMARKED: Ji nP 28, 1 AA5 1. FRD!': Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppY 11 ATCHELOR, Clerk / /J DATED: June 29, 19Q5 B1: Deputy J� 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). ( ) Clair is not timely filed. The Clerk should return claim on ground that it was filed late and send warring of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Gated: Lt 30 `� -� EY: Deputy County Counsel 311 . Fns"': Clerk of the Ecard TO: County Counsel (1) County Aaministrator (2) ( } Claim ties returned as untimely with notice to claimant (Section 911.3). Eq ur.ar4. _.:S vete cf the S ^erviscrs present �r { v/S Tris Claim: is rejected in full . ( ) Ot^e-: I certify that this is a true and correct copy of the Board's Order entered in its minutes for tris date. f Date:: 5 C� PHIL BATCHELOR, Clerk, By j Deputy Clerk `J WARNING (Gov. code section 91:) Sutject 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 mayseek the advice of an attorney of your choice in connection with this matter. If you want to Consult an a:tc fj, you should do so irtnetiately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare uncer pena'.ty of perjury that I ar. now, and at all times herein mentioned, have been a citizen of the United States, over ace JB; 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 Clur.,ant as shown at:ve. r Ce:ed Q I q 1� BY: PHIL BATCHELOR by.� 4uty Clerk L Ccurty C:u-.se; �'_` County Adr.'nistratcr NICHOLs,CATTERTON,DOWNING&REED,INC. A PROFESSIONAL LEGAL CORPORATION WELDON C. NICHOLS(1902-195)1 201 D/A FINANCIAL BUILDING GUY B.CATTERTON(1919-19941 THREE ALTARINDA ROAD SHASTA COUNTY OFFICE MERTON R. DOWNING(1935-1991) P.O.BOX 857 ORIN DA, CALIFORNIA 94563-2601 43130 MAIN STREET JAMES E. REED CAROL VERES REED (510) 254-7893 FALL RIVER MILLS,CALIFORNIA 96028 (916) 336-5050 ORINDA TELEFAX(510) 254-3259 BERKELEY OFFICE (510) 845-3893 p, OAKLAND OFFICE R1 , 1 June 28, 19953871 PIEDMONT AVENUE OAKLAND,CALIFORNIA 94611 (510) 654-1828 (510)444-2590 JUN 2 9 1995 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. Clerk, Board of Supervisors County of Contra Costa 651 Pine Street Martinez, CA 94553 To.: Sheriff' s Department, Contra Costa County Notice- of Claim (California Government Code H900, et seq) , (a) Name of Claimant : Diana Darnall Beer, Executrix, of the Estate and Heirs of Muriel Darnall, 115 Hawk Lane, Boulder, CO 80309 (b) Notices Should Be Sent To: Diana Darnall Beer, Executrix of the Estate and Heirs of Muriel Darnall, c/o Nichols, Catterton, Downing & Reed, 3 Altarinda Road, Suite 201,Orinda, CA 94563 (c) Date of Accident : January 30, 1995, at approximately 10 : 55 a.m. , in the Walnut Creek/Contra Costa County area, on I680, 500 feet north of S . Main off-ramp, Walnut Creek, California Highway Patrol Local Report #1-366 . The Contra Costa County Sheriff' s Department negligently directed drivers of vehicles involved in the accident to park thereby placing all occupants of all the vehicles in harm' s way. California Highway Patrol improperly regulated accident scene by allowing vehicles to remain on roadway after accident while writing report which caused an unwarranted hazard leading to another accident . CalTrans improperly maintained roads allowing them to become in a slippery condition after rainfall causing hydroplaning. t June 28, 1995 Page 2 (d) Claim is for damages as a result of wrongful death. (e) Names of California Highway Patrol Officers and CalTrans employees and the Deputy Sheriff from the Contra Costa County Sheriff' s Department causing the damages are unknown at this time. (f) Amount of claim is in excess of $10, 000 . 00, and jurisdiction will rest in the Superior Court . NICHOLS, CATTERTON, DOWNING & REED By Ja es E. Reed - Attorneys for Diana Darnall Beer JER:sb REGISTERED MAIL/ RETURN RECEIPT c. i O •ri W O U Ln Ln - rtf c►' O -F-) a) 10 o a) S4 �C N U 4-) U fu ul O tH PU O a) P7 >1 ri .� .Jw •4 P SZ 4-) a) 0 r-i H U U LO� (d a U z a w w cx , o�S ' o z z ¢ m m gam �- p Q m 0 z aZ ¢ ® (� AW 4Qo Ir z M LL a u • O F0 m a Ln F K • � w Q 0 2 Z . 0 —0 H " ~ H • • N U ui a 0 FMS CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA July 25, 1995 Cl; Aaainct the County, or District governed by) BOARD ACTION _ -_:r. _r c;,pervisors, 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 "Warnings". CLAIMANT: Mable Adams JUN 26 5395 COUNTY COUNSEL MARTINEZ CALIF. ATTORNEY: Jacoby & Meyers Law Offices 100 Bush St. , Ste. 700 Date received ADDRESS: San Francisco, CA 94104 BY DELIVERY TO CLERK ON June 26, 1995 BY MAIL POSTMARKED: June 23, 1995 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppHH g v DATED: June 26, 1995 BYIL Deputy OR, Clerk II. FROM: ounty 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: uty County Counsel 6A�III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( 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 certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: BY: PHIL BATCHELOR bXJA, 4,PR OOA, Deputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553• f i..or3 o„ th—n- C. If claim is against a district governed by tr1e Board G� supe:v iJVl J, 1 c:Va.v. 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 MABLE ADAMS RECEIVE® Against the County of Contra Costa ) or ) JINN 2 6 1995 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 $ 25 , 000. 00 and in support of this claim represents as follows: _---------------------------------------=-------------------------------------------- 1. when did the cauage or injury occur? (Give exact :atc cnd ::ou^) January -_2- tea.m. 7 , 1995, at a roxil�_1000 ------------- =---•-----------r __ -T e : ------------.���------- 2. . Where did the damage or injury occur? (Include city and county) ikist�?_ �=iveN O n. d., County o-.alam€ .��-- �. 3. How did the- damage or injury occur? (Give l details; use e paper if required) Claimant was a passenger in Alameda/Contra Costa Lions Central Committee for the Blind, Inc. bus. The bus collided into, the rear of a .parked vehicle . 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Driver of the bus was -negligent' and reckless in the operation of the bus . The driver of the bus caused this accident. (over) 5. What are the names of county or district officers, servants or employees causing ' the damage or injury? r Melva Lean Hicks ------------------------------------------------------------------------------------ 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Claimant. sustained injuries to her ribs contusion EstiTau $ under 8 8 $ 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Amount of medical bills is unknown at this time 8. Names and addresses of witnesses, doctors and hospitals. Kaiser Hospital-Oakland Bonner Medical Group 280 W. MacArthur Blvd. 3022 E. 12th Street, Ste. 210 Oakland, CA 94611 Oakland, CA 94601 ------------------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 2/21/95 Oakland Police Dept $ 10 . 00 (police Report) Gov. Code Sec. 910.2 provides: "The claim must be s' ed by the claimant . SEND NOTICES TO: (Attorney) or by some rs on his beh " ��— Name and Address of Attorney JACOBY & MEYERS LAW OFFICES Clai Signature 100 Bush Street, Suite 700 San Francisco, CA 94104 100 Bu Stre uite700 , SF C 94104 Addre Telephone No. (415) 399-8951 Telephone No. (415) 399-8951 * * 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. C } -4 P, -r4 t 44 O a H Ln rd Sd Lnd' N N ON •A � U 4J f� to 44 kO Odd N 0 oLn UP4U �o r a~. a � v N ' N N d o 3m � G CD N olL "d