Loading...
HomeMy WebLinkAboutMINUTES - 08011995 - C14 CLAIM AMMIED BOARD OF SUPERViSDRS OF CONTRA COSTA COUNTY, CALIFORNIA .August 1, 1995 C124T a^.e4nst the County, or District governed by) BOARD ACTION r_::;ervisors,.Routing Endorsements, ) N0710E TO CLAIMANT c— Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount; $500,000.00 + Section 913 and 915.4. Please note all "Warnings". CLAIMAN7: Curtis Hill ATTORNEY: Date received ADDRESS: West County Detention Facility BY DELIVERY TO CLERK ON July 10, 1995 5535 Giant Highway Richmond, CA 94306 BY MAIL POSTMARKED: Interoffice Mail 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim, p�{ DATED: Jul; 10, 1995 8111 �epuLyLOR, Clerk 11. FROM/: County Counsel TO: Clerk of the Board of Supervisors ( 4) 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- I Z- 9 S BY: Deputy County Counsel 111 . FRCN: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. B01-;D By unanim^us vote cf 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 , ' , �. �i(i� . Deputy Clerk WARNING (Gov. code section 913) 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 may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should de 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 16; and that today I deposited in the United StatesP46stal Service in Marti nez, California, postage fully prepaid a certified copy of this Board Order and Nc2ice to-Claimant, aCdressed to the claimant as shown above. Dated: BY: PHIL BATCHELOR by-J + Deputy Clerk CC: County Counsel County Administrator CLAIM AMENDED C, I BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA August 1, 1995 Cio-'m 4^?;est the County, or District governed by) BOARD ACTION -f .: S.;,ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT Po�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: $500,000.00 + Section 913 and 915.4. Please.note,.al.l_"Warnings". CLAIMANT: Curtis Hill ATTORNEY: Date received MaARTINEZ CALL . ADDRESS: West County Detention Facility BY DELIVERY TO CLERK ON July 10, 1995 5535 Giant Highway Richmond, CA 94806 BY MAIL POSTMARKED: Interoffice Mail I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. paIL BATCHELOR, Clerk DATED: July 10, 1995 B : eputy 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: -7- y Z` S.S 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 Superviscrs 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: l�Jq.� PHIL BATCHELOR, Clerk, By l�lY, . 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 byNJO,. d eputy Clerk CC: County Counsel County Administrator o hkA 0ju-_-w-�_ RECEIVE® -. -- -- - -- -- -- --JUL-.1--0-1995 - - - - - -- - T CLERK BOARD OF SUPERVISORS - _ __-CONTRA COSTA CO. I Mr. Curtis Hill 2 West County Detention Facility 3 5535 Giant Highway 4 Richmond,Ca. 94806 5 6 7 8 q 10 Curtis Hill ) 11 Plaintiff ) 12 ) 13 V. ) 14 ) 15 County of Contra Costa, ) COMPLAINT 16 Contra Costa County Public Defenders ) 17 Office, ) 18 and ) 1� Ms. Terri Mockler ) 20 Defendant( s ) ) 22 23 24 The unders•ig:.ed clainia3<t makes, cl iim against the Cozunt�r of Contra ?t; Costa or the above-named Dis.t-rict in the sutra of 500 , 000.00 and ii- 21 7 sl.'.pp'•'.t-rt of this c laint -reprey F f1ts a..`_,- f.-Allows: 28 -y9 -------------------------------------------------------------- 30 1 . When did damage or in-Jury occur: (Give exact date and hour) 31 32 On or about March of 199 5 and thereaf ter. 33 fere .lid at-� 1 J' ry � ( �y p �- r�•�n:•_.u_ r='r _ _ a_� _� . I��_r. tir�� cit- a�.r� 35 36 Martinez., California. Contra Costa County. 37 38 3 . How did the damage or injurer occur? (Give full details; use 39 extra paper if re<rtired) . 40 41 Mal-intent, Malpractice, breach of duties by 42 Public Defender. 43 44 4 . What particular act or omission on the part- of county or 45 district officers. servants, or employees caused the injury or 46 damage? 47 In the month of March 1995 I was assigned Ms . 48 Terri Moc}rler as legal representation. I have been told many 49 timet by her (T. Mockler) that. I was facing 50 years in prison, 50 for Petty Theft' w/prior charges. I informed Ms. Mockler that I 51 had read a pamphlet entitled 18 ways to avoid a strike, and 52 learned of 1192.5 of the Penal Code & 654 which refereed me to 1 4 fi I cross references , one (1 ) of Clem indicated the degree of 2 offenses upon guilty plea determination see 1192 . & 1192 . 5 . 3 After explaining what I had read to Ms . Mockler, she became. 4 extremely belligerent and argumenttive, and eventually resorted to 5 slapping the pamphlet out of mfr hand, and terminated our visit. on 6 that nate. The following Court appearance I requested a Marsden 7 Motion at which time Ms. Mockler freely admitted to the physical 8 & Mental abuse before Judge Swager. Motion Was Denied. I filed a 9 second Marsden Motion informing the courts that I Name been 10 intentionally y .£s_ con-tlnLuous ly lied to and mislead by Ms. Mockler 11 and that I didn't TZ"1ast her or believe In her ability to properly 12 represent IRF'. There was a. third Marsden Motion tiled. before '7ndge 13 Amar sons, at which time I again indicated to the courts that Ms . 14 Mockler has time and time again refused t�� file Motions in ray 15 behalf Wr1ich I feel would have a favorable disposition in 16 reference to+ my case. . 17 Conclusion 18 I feel that everything thing, that Ms. Rockier has done or failed to do, 19 has had a. detrimental affect an my case. This determination is 20 solely do to and based upon the ineffective_ counsel y'riJVide by 21 Ms . mnckler. 22 23 S . What are the names of county or district. officers , servants or 24 employee_ causing the damage or injury • 25 26 Ms. Terri Mockler 27 28 6. What damage or injury do you claim resulted? (give Full extent. 29 of injuries or damage claimed. Attach two estimates for auto 30 damage. 31 32 Loss of Freedom, Loss of rights, Violation of all 33 due process. 34 35 7 . How was the amount claimed above computed? (Include the 36 estimated amount of & prospective injury or damage. ) 37 38 $500, 000.00 General Damages, Mental Stress. 39 140 41 42 8 . Names and addresses of witnesses , doctors and hospitals . 43 44 Not currently Ascertained 45 46 9. List the expenditures you made on account of this injury: 47 Date Item Amount 48 49 Not Currently Ascertained 50 51 52 2 I Gov. Code Sec. 910. 2 provides: 2 "The claim must be signed by 3 the claimant or by some other 4 person on his behalf. 5 6 7 8 SEND NOTICE TO Mr. Curtis Hill 9 West County Detention Facility 10 5535 Giant Highway 11 Richmond, Ca. 94806 12 13 f 14 NAME AND ADDRESS OF CLAIMANT 15 MR. Curtis Hill 16 West County Detention Facility (Claimamt Signature) 17 5535 Giant Highway 18 Richmond, Ca. 94806 19 � 20 21 22 23 24 25 NOTICE 26 7 ._. Section 7.:': of the. Penal 'odeprovides that 26 "Every person who, with the intent- to defraud, presents for 29 allowance or for payment to ant state board or officer, or to any 30 county, citlr or district board or officer, authorized to allow or 31 pay the same if genuine, any false or fraudulent claim, bill , 32 account, voucher, or writing, is punishable either by 33 imprisonment in the county Jail for a period of not more then one 4 ( 1 ) year, by fine of iii}t e:_ceedin_- one ( 1 ) thousand ( $1 , 000 ) , or 35 by both such imprisonment- and fine, or by imprisonment in the 36 state prison, by fine f_if not exceeding ten(10) thousand dollars 37 ($10,000,00) . Penal Code 673 Cruel, corporal or unusual punishment; treatment impairing health It shall be unlawful to use in the reformatories, institution, jails, state hospitals or any other state, county, or city institu- tion any cruel , corporal or unusual punishment or to inflict any treatment i 3 Curtis Hill V. Terri Mockler Terri. Mockler Attorney At Law Public defender's Office 610 Court Street Martinez, Calif. 94553 June 26, 1995 EXTENTION TO COMPLAINT Before my trial I asked Terri Mockler about a defence line up, because I had not been identified by anyone, she did not answer me nor did she assist me concerning that matter; I made the judge aware also concerning Terri Mockler not assisting me. I also questioned Terri Mockler about a 1979 conviction being used as a strike against me in this case by the District Attorney;Terri Mockler said that she saw the documents to prove the strike, Yet after my being found guilty by the court in this case I became aware by the District Attorney's annoucement in court that he did not have the documents to prove the 1979 conviction.Terri Mockler also told me that if they don't have the 1979 documents to strike you, they are going to strike you twice on the 1985 offense, which in fact was consolidated upon my plea. Before the trial I had made Terri Mockler aware that I was going to rely on the judge to use his discretian concerning this matter because I felt that if it was God's will that you would recieve fair treatment. During a court proceeding I made a statement to the judge based on an Appeallate Courts decision that upheld a Superior Courts ruling in which the judge used his power under section 17 of the Penal Code(4/28/1995) .Also George Lumbre on June 20 1995 was resentenced; earlier he had recieved a (6)six year prison sentence. y On June 20, 1995 he was resentenced to (2 )two years in prison,at which time the judge struck the priors against him attorney' s name is Doug Warrick. Terry Mockler said in Judge Arnason chambers that sec 17 could not be used, it was being appealed. I picked a jury May 26, 1995; 1 was to start trial May 30, 1995 on that date I waived jury trial for trial by judge because Terri Mockler insisted to me that I was going to recieve life in prison and that I should take the (4) four years (80) eighty percent admitting strikes. Terri Mockler did not produce any motions, she said my 1985 conviction was not demurrerable. I filed ( 5 ) five motions myself,they were allheard and denied. At a Marsden hearing judge Arnason told Terri Mockler how he was the first to hold consolidation upon a plea, he then assigned an attorney from Willis & Lawrence to assist me in the law he did not dismiss Terri Mockler. The lawyer came to see me we discussed my motions, on June 16, 1995 both attorney' s were present in court,neither of them argued the points and authorities concerning my case;I had to do that myself,I lost the arguement. The motions that I filed were " Plea Withdrawal pursuant to plea J agreement P.C. 1192,1192.5,1192.7; Double jeopardy 5th and 8th Ammendment; Demurrer P.C. 1004 ; Motion to strike priors and Section 17 reducing felony to misdemeanor. All facts are in court transcripts, I am in fear of being sentenced too harsh, due to the lack of concern displayed by my counsel ( Public Defender Terri Mockler ) . I don't have anyone to defend me nor file an appeal; under Penal Code 654 my strike has passed the statutory 1985 to 1995. Double jeopardy P.C. 667 states that prior felony convictions will not be used in plea bargain paragraph (g) . Please review my case, thank you and God bless you. Sincerely and Respectfully Yours Curtis Hill 6/26/1995 s Penal. Codes 1995 Edition Points And authorities Penal code 667 specifically speaks of current conviction Terri Mockler wanted to run my 1985 conviction consecutively, in Paragraphs 6, 7, 8 , speak of current conviction. The next braket is determinations of a prior .felony conviction will be made upon the date of that prior conviction, and is not affected by the sentence imposed unless the sentence automatically, upon the initial sentence , converts the felony or wobblers to a misdemeaner. Penal code 667 . 5 (a) ( c) speaks of 10 Years defendant remain free no additional sentence term will be imposed under this subdivision. There is three tests to declare double jeopardy, I fit two or all of them. Penal code 654 double jeopardy refered me to a cross reference. Degree of offence upon guilty plea Penal code 1192 an 1192. 5, 1192. 7 Penal code 969. 5 speaks of second trial on priors, also plea withdrawal , with courts consent. The law clearly reads correctly Penal code 667 Paragraph (g) states prior felony convictions will not be used in plea bargain. The filing deputies arent using any discretion, and filing invalid prior and they are being use as barganing power, while defendants are admitting strikes at sentencing. My next court date, sentencing 07/06/95 DEPT. 28X Martinez California Contra Costa County. vs C) two S. * t 7f % « cl b a • \ . % lo . UO � � � \ % <\�\�� � >7/##4 CLAIM C., , J / BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA August 1, 1995 as?�nst ,the County, or District governed by) BOARD ACTION -� S::­ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT cif P�_.�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: $1 Million Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Gary D. Mosbarger and Inmates of Contra Costa County Jail ATTORNEY: Date received ADDRESS: 901 Court Street BY DELIVERY TO CLERK ON July 6, 1995 Martinez, CA 94553 BY MAIL POSTMARKED: Interoffice 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppHH gg DATED: July 7, 1995 BYIL DeputyLOR, Clerk + 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 ` S BY: Deputy County Counsel I11. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (�) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: PHIL BATCHELOR, Clerk, B o 4 A dfi.A r . 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. F Dated: QW4 A f_ A , � BY: PHIL BATCHELOR b Deputy Clerk 0 0Z CC: County Counsel County Administrator r - + , •- _.. OFFICE OF COUNTY COUNSEL DEPUTIES: CONTRA COSTA COUNTY SHARON S. ALTHOFF �. ,•..1 SHARON L. ANDERSON »n, 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 7 , 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. Mosbarger MDF 901 Court Street Martinez, CA 94553 RE: CLAIM OF: Gary D. Mossbarger and inmates of CCC jail 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. [] 4 . The claim fails to state the name (s) of the public employee (s) causing the injury, damage, or loss, if known. [] 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10, 000) . If the claim totals less than ten thousand dollars ($10, 000) ; the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10, 000) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. [X] 6 . The claim is not signed by the claimant or by some person on his behalf . [� 7 . Other: VICTOR J. WESTMAN, County Counsel By: 1AA eputy County eounsel 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/pf 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 ��, 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) Claim-to: BOARD OF SUPERVISORS OF CONTRA COSTA 00= INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's filing stamp RECEIVED a—I 1 n"d-Qs JC- CtM�--ra (1JYJ1rk Against the County of Contra Costa °L 61995 or ) f1e✓� F CLERK BOARD OF SUPERVISORS � District) coNTRA C04 0A 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 $ !, 6" OZ/0, a" and in support of this claim-represents-as-followsNM__-_-M�- �_1 ��_� -�Qt - -------------------- 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) CO- 3. how d3. how did the damage or injury occur? (Give full details; use extra paper if required) W \\ F�\� �v��e-� vcrna` V -�a,�,J �� 1/�r��a+ a F ScN� S —_- — f't'+— = — 1_ ��,� —W f 2 G�.� S 0.�-� ��va� ►�S 4. What particular act or omission on the part of county or district officers,, servants or employees caused the injury or damage? S (over) 5. What are the names of county or district officers, servants or employees causing the damage or injury? S. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. C,'v � � �rc�y1�S �����Ur�►-.-s v �a�-e r '�2� v s c�( �t �3 ----------------------- ---------------- -------------e4' S C� ------ 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) U v) V-N-CL V� ------------------------------------------------------------------------------------- 8. Names and addresses of witnesses, doctors and hospitals. ------------------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf." Name and Address of Attorney I Climant's Signat � e•( Address Telephone No. Telephone No. f fI V V V V V I V I VT * N 0 T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. ., CLAIM '_, IT BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA -+ August 1, 1995 CIa.im Anainst the County, or District governed by) BOARD ACTION t`.. 2:.:.r� 54-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: $341.52 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Sherrill Lee ATTORNEY: Date received ADDRESS: 3951 3951 La Colina load BY DELIVERY TO CLERK ON July 10, 1995 3NIE10ALIF. E1 Sobrante, CA 94803 BY MAIL POSTMARKED: July 7, 1995 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim, ppHH gg DATED: July 10; 1995 BYIL DeputyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board,of Supervisors ( VKThis 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 —( D — ,7 S� 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 , 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 IB; 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 b , 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 'eause 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 §9].1.2. ) 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. n zf the claim is acainst more than one public entitv. 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 Sherrill Lee ) 3951 La Colina Rd. ) RECEIVE®. E1 Sobrante, CA 94803 ) Against the County of Contra Costa > 1995 or arnfdTp �County of Contra Costa R�s2t) CLEOF SUPRbISORS rill in name ) COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 341.52 and in support of this claim represents as follows: (Three Hundred Forty Two Dollars and 52 Cents) _------------------------------------------------------------------------------------ 1. When did the damage or injury occur? (Give exact date and hour) See Attached page for answer M 2. Where did the damage or injury occur? (Include city and county) See attached page for answer 3. How did the damage or injury occur? (Give full details; use extra paper if required) See attached page for answer 4. What particular act or omission on the part of county or district officers, u"" servants or employees caused the injury or damage? N/A (over) 5. What are the names of county or district officers, servants or employees causing the damage or injury? See attached page for answer ------------------------------------------------------------------------------------- 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. See attached page for answer 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) See Attached invoice/estimate to claim information -------------------------------------------------------------------------- 8. Names and addresses of witnesses, doctors and hospitals. N/A ------------------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 05/08/95 (1) Eagle GSC245/50ZR-16 GoodYear Tire $308.00 without Tax 05/08/95 r -Mount/Dismount_ ,Replace Valve Stem 7.50 without Tax ,! ) i Sales Tax:26.02 Grand �Tot�a*:5341.52 Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SE*:D NOTICES TO: .CU(A-torn ' ) ,or by some person on his behalf." Name and Address'-of Attorney Claimant's Signature 3951 La Colina Road Address El Sobrante, CA 94803 Contra Costa County Telephone No. Telephone Noy 5,1.0 1* 6694431 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="riot 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. Sherrill Lee's Board of Supervisors of Contra Costa County Claim Answers The undersigned claimant hereby makes claim against the County of Contra Costa in the sum of 8 341.52 and in support of this claim represents as follows: 1. The damage occurred on May 6th, 1995 at 8:45 pm. 2. The damage occurred on La Colina Road, El Sobrante which is in Contra Costa County. 3. The damage occurred by the corner of the sewer plate which the cement had worn away thus for it had this sharp metal corner which punctured my right front tire. See enclosed photos of the metal sewer plate and the exposed sharp corner. 4. N/A 5. Contra Costa County was the responsible party for this damage. 6.The damage that I resulted in was two puncher holes on my right front GoodYear Eagle GSC245/50-16 tire. 7. The amount of this claim was computed by the replacement cost of the tire, and the mounting/balancing of the tire when it was installed on my car. See enclosed invoices to back up the total amount of this claim. 8.N/A 9. See enclosed expenditures, which I paid out of my pocket to correct the damage which was done to my right front tire. Claimant's Signatures t i �1 1 Address:3951 La Colina Road. El Sobrante. CA 94803 Telephone Number: Home 510-669-9431 Work 510-236-3333 ::: :::::::::::::.: Bill To: Sherrill Lee 05/08/95 3951 La Colina Rd. 09: 12 am El Sobrante, CA 94803 Phone: 510-669-9431 Date Requested: 05/08/95 Vechical Year/Make: 94 Pontiac Return Parts: Yes Color: White Licence # New Car Model: Formula V-8 Account # Cust Payment Method: Cash Qtv Description Line Total 1 Eagle GSC 245/50ZR-16 308.00 1 Mount/Dismount Replace Valve Stem 7.50 Sub Total: 315.50 Sales Tax: 26.02 TOTAL: $341.52 TIRE AND WHEEL SPECIALISTSm { o LARRY'S TIRE EXPRESS 835 A Street Hayward, CA [415] 581-6020 Computer Wheel Balancing Dunlop,.Fulda Passenger & Small Commercial Customer's Order No. Date 19 _NAME Address t � Sold By Cash Terms Charge On Acct. Mdse.Retd. Paid Out Retail Whlse. QUANTITY DESCRIPTION PRICE AMOUNT . 5-Z> 00, - G leg ow OA9:5110 144 _ V91, .E TOTAL No refunds or exchanges. All sales final. Deposits are non refundable. RECD.BY:_—:�l___ All claims and returned goods MUST be accompanied by this bill. MONDAY THRU FRIDAY 8:00-6:00 SATURDAY 8:30- 3:00 RI �+ u J gyp.. i � -� _v,w•n 'p s�.q' 1�h� ��. i ix �t s���5� .r,�`i:J OL mf M y ri '. . r `fes- wr y L ,,F�. I.•, laCoiine _ a .jai®f t b J)� l - i j • RECEIVED JUL 1 01995 CLER COQ R COSTA CO.pSORS July 6,1995 To: Board of Supervisors Contra Costa County 651 Pine Street, Room#106 Martinez, CA 94553-1293 Attention:Shirley From: Sherrill Lee 3951 La Colina Road El Sobrante, CA 94803 Re: The enclosed documents for my claim against Contra Costa County Dear Shirley, Please find the following which I have enclosed to submit to you as back- up for my claim against Contra Costa County. And they are as follows: 1. Claim form with attached answer page 2. Invoice to show proof of the cost to repair the damage 3. Estimate of the cost before I had the damage repaired. 4. Four Photo's which show the item which caused the damage,the street the damage occured on, and the photo of the tire which was damaged. Just a closing note. . . .I have kept the tire that was damaged and I will keep it til this claim has been settled. So in the event that you would need to see the tire I will be able to provide if you request it. Sincerely, ^ 4je)r-ur�ill Lee 3951 La Colina Road E1 Sobrante, CA 94803 (510)669-9431 I K E s w I ,r. t's R 4� 1-4 .i rr y, 45�' r V -10 4) AA r Q+ w �� `-��� � Qom, ►� ',� c� d � w •� CLAIM C. 14 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA August 1, 1995 (lp+m An?inst the County, or District governed by) BOARD ACTION -� S-_,wervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 6., FC;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: $321-00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Gary D. Mosbarger ATTORNEY: Date received ADDRESS: 901 Court Street BY DELIVERY TO CLERK ON .h,l�Z 7, 1gA5 Martinez, CA 94553 BY MAIL POSTMARKED: TntProffi r-- 1. •a1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. QQHHIL BATCHELOR, Clerk DATED: July 7, 1995 8Y: eputy 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) his 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: —7 ` S BY: 61� 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. BOAR ORDER: By unanimous vote of the Supervisors present (✓ ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: PHIL BATCHELOR, Clerk, By , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you .want to consult an attorney, you should do so immediately. * 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. 1 L�DeputyDated: jBY: PHIL BATCHELOR by 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) 646-2041 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 7 , 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. Mosbarger MDF 901 Court Street Martinez, CA 94553 RE: CLAIM OF: Gary D. Mossbarger 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: [] I . 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. [] 6 . The claim is not signed by the claimant or by some person on his behalf . [] 7 . Other: VICTOR J. WESTMAN, County Counsel By: Deputy 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: Julyll, 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) • • C IV Ev JUL 61.995 . CLERK BOARD OF SUPERVISOR CONTRA COSTA CO, S mctg �o U,e-r- cLo- 2 3Ciww.��-e C® Co Sa" 0 i 4 5 u b j -e d V-e >`,•f v�.es.. i o I� o�-►-e c�Q - rcr� 7 8 I�-eq,,� �-e a ►-, 9 10 y Le � te-�. � � wo�f o� L, 1�-e J.6 / Y 5 12 13 e,�� 14 wo+�5 41^�/ 1-�0► •�j C�Yn y �/ 1'5 ,,/ 16 7_V`� al cI 17 ' mac{v� �o 0 18 2 S �4 0.Y S 10 v Par1 -7 pays 20 21 6 l 22 ,p uO + I � ci -- vti./23 C fc� vl OLS 24 y v a►-►-� ! 25 't'— I 26 � �.e�- ��Y R �— � @ yo v 27 28 ovi-ec CLAIM �' ) BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA August 1, 1995 C1,;In An�4nst the County, or District governed by) BOARD ACTION ;ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT a,,r'. Rr.�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: $100,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Gary D. Mosbarger ATTORNEY: Date received ADDRESS: 901 Court Street BY DELIVERY TO CLERK ON July 6, 1995 Martinez, CA 94553 BY MAIL POSTMARKED: Interoffice I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JaIL BATCHELOR, Clerk DATED: July 7, 1995 : Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( his claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 7 J 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. , 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: 9 S BY: PHIL BATCHELOR by eputy Clerk CC: County Counsel County Administrator Claimto: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented .not later than one year after the accrual of the cause of action. (Govt. Code§911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * RE: Claim By ) Reserved for Clerk's filing stamp e2o, r fl. 1(nas b� i :�_ RECEIVED Against the County of Contra Costa ) 'JUL 6 �g9� or ) CLERK BOARD OF SUPERVISORS District) CONTRA CCSTA 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 $ /07) , WL-0 w 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) t C' ------------------------- - -- --------------------- 3. How did the damage rorr injury occur? (Give full details; use extra paper if required) J _ + (s r-- ',f c6 -------- - i -�- -- ------------------------------- ---- 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? GcUl Y (over) CLAIM ! BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA August T 1995 Ci�;m Da?inst the County, or District governed by) BOARD ACTION S;.,Pervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 6",f �G�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: $1 Million Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Gary Mosbarger ATTORNEY: Date received ADDRESS: 901 Court Street BY DELIVERY TO CLERK ON July 6. 1995 Martinez, CA 94553 BY MAIL POSTMARKED: Interoffice I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppHH gg DATED: July 7, 1995 BYIL DeputyLOR, Clerk Aw�J cl_z f �n 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 — 1 BY: Alz_� eputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (✓) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: ,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: w,, — q 9 BY: PHIL BATCHELOR by .14 Deputy Clerk CC: County Counsel County Administrator OFFICE OF COUNTY COUNSEL DEPUTIES: CONTRA COSTA COUNTY PHILLIP S. ALTHOFF i SHARON L. ANDERSON BRANDON D. BAUM COUNTY ADMINISTRATION BUILDING ANDREA W. CASSIDY 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. MUIVIZ July 7, 1995 VALERIE J. RANCHE DAVID F. SCHMIDT DIANA J. SILVER VICTORIA T. WILLIAMS NOTICE OF INSUFFICIENCY AND OR NON-ACCEPTANCE OF CLAIM TO: Gary Mosbarger MDF 901 Court Street Martinez, CA 94553 RE: CLAIM OF: Gary Mosbarger 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. [] 4 . The claim fails to state the name (s) of the public employee (s) I causing the injury, damage, or loss, if known. [] 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10, 000) . If the claim totals less than ten thousand dollars ($10, 000) , the claim fails to state the I I a 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: Aept&vyC o u=nt y 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,i(, 1995 at Martinez, California. cc: Clerk of the Board of Supervisors (original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOVT. CODE SS 910, 910.2, 920.4, 910.8) Cla." m``to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual- of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553• C. If claim is against a district governed• by the Board of Supervisors, rather than the County, the name of the District should be filled 'in. D. If the claim is against more than one public entity, seem ate 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 or e Is filing p 2. : IMMIYED ,. .Against -the County of Contra Costa ) JUL _ 6 1995 or ) MARDOF PERVISOR s TRA(tY�s�jSPTA M_r District) Fill in rip-me)) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ (w") and in support of this- - - claim representsas-folowsNN_____�_J__1!��13 _ .�._�� rs.--------------- 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) ------------------------------ - ---------------- 3. How did the damage or injury occur? (Give full details; use extra paper if required) w\?-edk:V1 tog a( M'D i ko hL'L O'k d a r QvhS���- F� (���•��tr..�noJ -�'�-�Cou,�!-S ,�r f'edr�SS C� �� �1+ �`,iv i�e��� mow,;� r�r ----------------------------------- ------- --------- ---------------- ---------- .----- 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? VSCI-A� s (over) 5. 'What are the names of county or district officers, servants or employees causing--- the ausing the damage or injury? (� ��- � Q 6;( / 5 S 2 vt•21r�s Olk 584- Op-rry 1 6. What damage or injuries do you claim resulted? (Give full extent of injuries or, / damages claimed. Attach two estimates for auto damage. Lja, ---- ------ --- �__�__------------------ 7. How was the amount claimed above computed? (Include the estimated amount of any prospective in j - y or damage.) ---- -------------------------------------------------------------..---_ 8. Names and addresses of witnesses-,- doctors and hospitals. J ct ------------------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf." Name and Address of Attorney lr Of dr� Claimant 's Signaturep-d-jn- - Address Telephone No. ; Telephone No. V V * * * f * * � N 0 T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by .both such imprisonment and fine. J -ll CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA 1 August 1, 1995 ClA4- og?inst the County, or District governed by) BOARD ACTION c` `::pervisors, Routing Endorsements, ) NOTICE TO CLAIMANT a,,d 5�.,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: $1 Million Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Gary Mosbarger and Cynthia Lee Ginn ATTORNEY: Date received ADDRESS: 901 Court Street BY DELIVERY TO CLERK ON Jifly h,_ 1995 Martinez, CA 94553 BY MAIL POSTMARKED: TntProffiep I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: July 7, 1995 Ja _ pe I I 'La OIL) IL �ep�tyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( W<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 �Q,l�,c.� /S t146" Gb `LV Dated: — — BY: X1, 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') 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: f 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 A41 A,11_ eputy Clerk CC: County Counsel County Administrator TO: Gary Mosbarger and Cynthia Lee Ginn MDF 901 Court Street Martinez, CA 94553 NOTICE TO CLAIMANT (Of Late-Filed Claim) (Government Code Section 911 . 3) The claim you presented to the Board of Supervisors of Contra Costa County, California, as governing body of the County of Contra Costa and/or District, on July 6 , 1995 has been reviewed by County Counsel and is being returned to you herewith because: Your claim for an injury to person or personal property which arose on or after January 1 , 1988 was not presented within six months of the event or occurrence as required by law as to those events occurring between October 15, 1994 and January 6 , 1995 . (See Government Code sections 901 and 911 .2) Because the claim was not presented within the time allowed by law, no action was taken on that portion of the claim. Your only recourse at this time is to apply without delay for leave to present a late claim. (See Government Code sections 911 .4 to 912 . 2 and 946 . 6) Under some circumstances leave to present a late claim will be granted. (See Government Code section 911 .6) NOTICE OF LATE CLAIM You may seek the advice of an attorney of your choice in connection with this matter. If you desire to consult an attorney, you should do so immediately. PHIL BATCHELOR, Clerk of the Board of Supervisors and County Administrator By D ty Clerk Dated: Enclosure 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 copy of the above Notice to Claimant (of Late Submitted Claim) , addressed to the claimant as shown above. � ll Date: S By Phil Batchelor by ���J Dep-utyxEerk NOTICE OF LATE CLAIM a Ciaim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By ) Reserved :for. Clerk's filing stamp RECEIVED Against the County of Contra Costa ) - t or ) n 61995lli G` , L c) `- rcL;�. _s District) Fill in name ) CLERK BOARD OF SUPtRJ�SORS CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ /d :az1-� and in support of this claim represents as follows: ------------------------------— ----------------------- 1. ------------ ------------------- 1. When did the damage or injury occur? (Give exact date and hour) Www^+ oc_� I�/qa `I . jOL"�. 2. Where did the damage or injury occur? (Include city and county) ---------- �= -----5 -- ------------------------- 3. How did the damage or injury occur? (Give full details; use extra paper if required) j am► L. S4-,� FF V,d C +4S u note r %r-'Ittq k 3 -------- --------------------------------------------- 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? f G �� �� (over) 5. What are the names of county or district officers, servants or employees causing the damage or injury? w �« 59 �` t f-`) Cq)O`� 5� 7n h �o �,c��� e1 (--�--- Y-V V�°2.�C���a (, i cqp Vkodr Q%./ S. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. At h two estimates for auto e. r d 2 CtNlq V IS 7. How was the amour claimed above computed. (Include the estimated amount of any prospective injury or damage.) -—-—------- --- a-3---- ��c 1(S Lp ------------------- 8. Names and addresses of witnesses, doctors and hospitals. _w--------------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf." Name and Address of Attorney zd�� c'laimant's Signature Address Telephone No. Telephone No. Ll ?--4 C-0 �R- N O T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. VN J f� ell, V > s b sf y � � CT' d c� CLAIM C ' BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA August 1, 1995 cl?;m nq?inSt the County, or District governed by) BOARD ACTION S,:,ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT a 6carc. 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: $5 Million Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Cynthia Lee Ginn and Gary Mosbarger ATTORNEY: Date received ADDRESS: 901 Court Street BY DELIVERY TO CLERK ON July 6. 1995 Martinez, CA 94553 BY MAIL POSTMARKED: Interoffice 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: July 7, 1995 PpHHIL BATCHELOR, Clerk BY: Deputy 11. FROM- County Counsel TO: Clerk of the Board of Supervisors ( y) 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: (2 OC 1� 11 y CXY . X01.1 eJ A) 4D o QdAt Ata" a xAgez ux" /9 95 . Dated: — 7 ^ q S 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: q 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 Deputy Clerk CC: County Counsel County Administrator t "1� TO: Cynthia Ginn and Gary Mosbarger MDF 901 Court Street Martinez, CA 94553 NOTICE TO CLAIMANT (Of Late-Filed Claim) (Government Code Section 911 . 3) The claim you presented to the Board of Supervisors of Contra Costa County, California, as governing body of the County of Contra Costa and/or District, on July 6 , 1995 has been reviewed by County Counsel and is being returned to you herewith because: Your claim for an injury to person or personal property which arose on or after January 1, 1988 was not presented within six months of the event or occurrence as required by law as to those events occurring on October 18, 1994. (See Government Code sections 901 and 911 . 2) Because the claim was not presented within the time allowed by law, no action was taken on that portion of the claim. Your only recourse at this time is to apply without delay for leave to present a late claim. (See Government Code sections 911 . 4 to 912 . 2 and 946 . 6) Under some circumstances leave to present a late claim will be granted. (See Government Code section 911 .6) NOTICE OF LATE CLAIM You may seek the advice of an attorney of your choice in connection with this matter. If you desire to consult an attorney, you should do so immediately. PHIL BATCHELOR, Clerk of the Board of Supervisors and County Administrator By: IR De ty Clerk Dated: la 1 Enclosure 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 copy of the above Notice to Claimant (of Late Submitted Claim) , addressed to the claimant as shown above. Date: 7 By Phil Batchelor by � Deputy k NOTICE OF LATE CLAIM claim -,o: 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 See. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's filing stamp G: DECEIVE® Against the County of Contra C sta ) JUL 6 1995 or. ) r\dA V i0tVQ,(S Alaw-e-S uvt .kms h CLERK B Rv Or C: k-I� p res-�-�F fl rn2 District) CONTRA r : ., Fill in name ) -- The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ '. ePJ-Q.=)n,°'V and in support of this claim representsas follows: �� �``��� ----------------------------------------- ---------------- --------- 1. When did the damage or injury occur? (Give exact date and hour) eyhl„� 9roF"- 1&Lt_Larm aMkl� (Jv�e �c�c��s �rgh�s rcJ��� w, � yp�`t" 0.cc- eke ,1- oce.0 red o� ap �� 0CJ 18' --------------------- ca.� ��/; �;,�;,,;,. <<r c .cc.er�,�Q '`i G2i`sss 2. Where did the damage or injury occur? (Include city andcounty) March t�( 5 �lm / 1�� �. , k L", ail q5 a p Y Y 3. How did the damage or injury occur. (Give full details; use extra paper if required) D ./.-e 4,3 o ✓-er-crowar�, Cy VL t k ti t,\ we S �- ►4 Zc_,r �La4 Y—ke r C6}-'{.o„t wka a99�a va er 1►�vt l ad'{ �►, k.1,ac 11 CL �$-eoP -----------------------a cc vo(�-�, _ - - -- h('0,r c Ir l u S (�a w �c�' Dai refs: -� --- P 4. What particular act or omission on the part of county or district officers,, e)r Lp;,j !., servants or employees caused the injury or damage? A� te9 �� 6� 54 tF( 4- J&'t S e rV 17 d f S 0,-A ��f Sup-,,o f Kr d (-S 0�,4 r-e-Ci150. I �Lo a c (3,y\ V k C CM S�--t 1,U ore"�, Ze, O✓-�' .G,ry :"`� tr-Ck 0 F P--P- Vc0. ( Ar er,� /1/v��s ►p r(over) L� Q t�b S C�Po v CSL 6" -e-d yr✓1 G4/S Q CC{ ,fi/qi of . ;Ch, aa_a , S 5. What are the names of county or district officers, servants or employees causingf the damage or injury? O-el �h�(Ca ✓a _o4 1\a D¢�__4 e v_\.k,-,xcK 0,4 R L&aur Oka Ir- 6. e6. What damage or injuries do .you claim resulted?, (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. (�t'd� (30.c� Qrd�J Grp 0.ra b _ G I__ ;� �A�v k�A_a rs R ----------- 1 �� ,-- ---�- -- �- - -- 7. How was the amount claimed abo a computed? (Include the estimated amount of any prospective injury or damage.) 14------------------------------------------------------------------------------- 8. Names and addresses of witnesses, doctors and hospitals. I, Q --------------------------------------------------------------------,vim 9. List the expenditures you made on account of this accident or injury.- DATE njury:DATE I= AMOUNT Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf,." Name and Address of Attorney Claimant's Signature CCYndVk Ov­d �x i�v s.e.( F Address Telephone No. Telephone No. ( l�� (a 9'a ae V IT * * * * * * * * N O T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or .by both such imprisonment and fine. e� O i y I i f }!MA OAKt TA ,'Il i�tt .. qO Ry.rY k. •C, r �I 1 • I CLAIM C BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA August 1, 1995 C1?4m a ?inst the County, or District governed by) BOARD ACTION _ .. ._: S::,ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT c,,d Ef•�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: $10,000.00 + Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Sharon R. Sidney ATTORNEY: William J. Hooy A Professional Law Corporation Date received ADDRESS: 3125 Clayton Road, Second Floor BY DELIVERY TO CLERK ON July 7. 1995 Concord, CA 94519 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. PpHH gg DATED: July 7, 1995 BYIL DeputyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( vJ'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: 1 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, 8 0 ,,., .� Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: 9 BY: PHIL BATCHELOR by (��Deputy Clerk CC: County Counsel County Administrator RECEIVED JUL 71995 CLAIM AGAINST PUBLIC ENTITY (Government Code, Section 910 et seq. ) -CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. TO: Supervisor GAYLE BISHOP, Chairperson, and to the other Supervisors of the County of Contra: Costa, State of California: The claim of SHARON R. SIDNEY ( "Claimant" ) respectfully shows : (a) Name and post office address of Claimant : SHARON R. SIDNEY, 3645 Sanford Street, Concord, California 94520 . (b) Name and post office address to which Claimant desires notices to be sent : SHARON R. SIDNEY, c/o WILLIAM J. HOOY, Esq. , Hooy & Hooy, A Professional Law Corporation, 3125 Clayton Road, Second Floor, Concord, California 94519 . (c) Date, place and other circumstances of the occurrence or transaction, which gave rise to the claim asserted: Claimant, until recently the Housing & Energy , Division Manager in the County' s Community Services Department, was disciplined (by being placed on administrative leave with pay through April 11, 1995, and thereafter without pay) and constructively discharged on or- about June 26, 1995, (when her sick pay, vacation and other benefits all ran out) by JOAN SPARKS, the Department Head, ( "SPARKS" ) and MICHAEL WEEKS, the Department Personnel Officer ( "WEEKS" ) . This all occurred without due process and without due cause in violation of the County' s Personnel Policies and Practices and, among other things, violated Claimant' s Civil Rights . Claimant, then a licensed California General Contractor, started work for the County on July 2 , 1989, as a temporary employee . She was promoted to "permanent" on March 9, 1994 . In her capacity as Housing & Energy Division Manager, she expanded the focus of her division from its then concentration on mere "weatherization" to "full housing rehabilitation" , for disadvantaged persons, finding numerous new sources of funding for projects (e .g. , HUD - $40, 000 ; PG&E - $50, 000; City of Concord - $75, 000) ; renegotiated purchase contracts (cutting costs in half on larger items) ; . and worked to significantly increase the skill levels of her staff . She received at least one (1) award for outstanding service (but in her over five (5) years with the County was never given a formal review by her supervisors) . In short, she was a fine County employee . .Her troubles here began when (as a single woman) she permitted herself to become romantically involved with a male member of her staff (also a single person) . _ This was wholly consensual on both parties part and was conducted on their respective-off duty time . Claimant voluntarily broke it off in the Fall of 1994 for personal reasons . Notwithstanding, SPARKS called Claimant on the telephone on February 10, 1995, and (apparently as a result of a report by DR. WOLF on his examination (s) of her male l ORIGINAL "friend" ) abruptly demanded her resignation "by the end of the day" . When Claimant asked what this was about and for time to think about it, WEEKS came into Claimant' s office and threatened her saying "if you don' t resign .by the end of this business day, you will be fired for sexual harassment and, with that on your record, you will have a very hard time getting another job" . Claimant was aware of several apparently similar incidents involving male supervisors and female County employees, where no adverse action apparently was taken against the former at all . Claimant felt she was entitled to no less consideration. So, she refused to succumb to this intimidation and elected to see this through. But, instead of firing Claimant as they had threatened, SPARKS and WEEKS put her on administrative leave and initiated processes to have her declared "unfit for duty" . What they seized upon was her alleged use of. drugs and alcohol . This claim was patently false, and they had to have known it to be so, when they initiated these proceedings . Certainly claimant never gave them any reason to suspect her of this kind of wrongdoing, and she was never counseled about these aspects in her entire time with the County. The only apparent basis for these claims were false accusations (that she was involved with drugs and alcohol on and off the job) , which were supposedly made by her former male "friend" to DR. WOLF, the County Psychologist, to whom he had reportedly been sent for other problems . DR. WOLF apparently chose to report these statements to the County in complete disregard of Claimant' s privacy rights . Later, when she asked her "friend" why he made such untrue statements, he told her that he "was pissed" and wanted to "cause her some trouble" . Since then and in spite of vigorous and ongoing protests by Claimant, SPARKS and WEEKS strong-armed her into undergoing two (2) separate highly intrusive and embarrassing psychological examinations on these sham charges by DR. WOLF (on threat of summary loss of job) and two (2) separate evaluations by alcoholism counselors (at least one (1) of whom totally exonerated her from these unfair and untrue claims) . The other "evaluator" (chosen by DR. WOLF) has not, to Claimant' s knowledge, reported her findings as yet . Notwithstanding these circumstances, Claimant has been barred, since early February, from going to her office and was, at about that time, required to return all County property (like one would have to do, if they were terminated from employment) . From what she understands, her office has been taken over by her former secretary and substantially all applications for new grants for projects in her areas of responsibility have been put "on hold" . What specifically her staff was told (other than that Claimant would not be returning to work at all) about her situation is unclear. Claimant wrote PHILLIP BATCHELOR, Chief Administrative Officer for the County, on May 25th, asking him to intervene on her 2 behalf . Instead of doing so, he turned the letter over to SPARKS, who attempted . to revise the historical record. On June 13th, Claimant' s counsel wrote to point out her substantial inaccuracies . To date, there has been no reply. . Under the circumstances, Claimant, as a reasonable employee could not be expected to endure such intolerable and aggravated mistreatment; these conditions were intentionally or knowingly permitted to exist; and the County, as a reasonable employer, would have to have realized that Claimant . would be compelled to consider this employment at an end. Claimant, therefore, considers herself to have been constructively discharged, when her pay essentially stopped, on June 25, 1995 . (d) Description of the indebtedness, obligation, injury, damage or loss incurred so far as it may be known at the time of presentation of the claim: At age forty-four (44) years, Claimant has been forced from her permanent position as County Housing & Energy Division Manager. This paid approximately $44, 000/year in salary with full County medical, vacation, insurance and related benefits. This is now gone, along with her vacation, sick leave and related benefits, which she had to use-up during the period of her forced administrative leave. And, given the. current job market and her inability to count on a favorable recommendation from SPARKS and/or the County, her prospects for future employment appear slim. Claimant also will not have access to the County pension benefits that she would have had had she continued on in her job. And, there are substantial intangibles (e .g. , emotional distress over her repeated harassment by SPARKS and WEEKS, blatant sex discrimination, intrusion (s) and disregard of her privacy rights, besmirchment of her reputation and the like) , all of which add significantly to her overall loss . (e) The name or names of public employee or employees causing the injury, change or loss, if known: JOAN SPARKS and MICHAEL WEEKS directly caused Claimant' s losses, but also PHILLIP BATCHELOR let it happen. He also must share in the blame . (f) The amount claimed: The amount claimed will be well in excess of $10, 000, and jurisdiction over the claim will rest in the Superior Court and/or United States District Court, as applicable . DATED: July 6, 1995 . HOOY & HOOY A Professional Law Corporation By WILLIAM J. HOOY, Attornef Nr Claimant SHARON R. SIDNEYJ 3 CLAIM e , BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA „ :August 1, 1995 Cl;-<m egeinst the County, or District governed by) AMENDED BOARD ACTION `':—,ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT Puard. Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $500,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Eben Berriault ATTORNEY: Michael J. Raifsnider Attorney At Law Date received ADDRESS: 564 Market St. , Ste. 602 BY DELIVERY TO CLERK ON July 6, 1995 San Francisco, CA 94104-5446 BY MAIL POSTMARKED: July 5, 1995 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is. a copy of the above-noted claim. DATED: July 7, 1995 EVIL BATCHELOR, Clerkeputy _ 1I. FROM: County Counsel TO: Clerk of the Board of-Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: — 1 c1 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:/J41.,,,t / _ l9 9S 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:1' g BY: PHIL BATCHELOR by eputy Clerk CC: County Counsel County Administrator Clafm 3,o: BOARD 4CERVISORS OF CONTRA CCGrA OW INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury "o person or to per- sonal property or growing crops. and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code 6911.2.) 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. +: 41-14.a claim is a&dint 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 3o m. f f f f • • • 4 • • � i f f i • S ! f ! f � f f • • • ! • ! f • f ! � � f � f f • ! f RE: Claim By ) Reserved for Clerk's filing stamp EBEN BERRIAULT ) RECENE® Against the County of Contra Costa ) JUL 6 1995 or ) 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 $ 500,000.00 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) January 10 , 1995 2. Where did the damage or injury occur? (Include city and county) Merrithew Memorial Hospital and Clinics 3. Bow did the damage or injury occur? (Give full details; use extra paper if required) Claimant sustained internal bleeding and associated personal injuries and distress following .a bilateral vasectomy. �. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Failure to obtain informed consent , as presently known. The right to allege further theories is reserved pending discovery and investigation. Failure to use the degree of 'skill and care required by physicians and/or hospitals in the community. (over) 5. What are the names of colAy or district officers, ser or employees causing the damage or injury? As presently known, Merrithew Memorial .Hospital and Clinic, Kimberly Duir, MD, Walter Carr, MD, DOES 1-50 . 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. General and special damages related to personal injuries and emotional . distress . 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Estimate based upon facts presently known. .. The right to further allege is reserved. B. Names and addresses of Witnesses, doctors and hospitals-. Brookside Hospital Merrithew Memorial Hospital and Clinics 2000 Vale Road 2500 Alhambra Avenue. San Pablo, CA 94806 Martinez, CA 945.53 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT The precise amount ' of special damages is presently unknown, but includes lost wages and medical bills . a • f f � � • f � � � a • f • f f f f a � � � a • • f � s e • f s s • f * fa * � a Gov. Code Sec. 910.2 provides: ' "The claim must be signed by the claimant SEND NOTICES TO: Attorney) ;. 'or by some person on his f." Name and Address of,,Attorney ' MICHAEL J. RAIFSNIDER Attorney at Law/Bar.#100110 r Cla 's Signature 564 Market St . , Suite 602 c/o Michael J. Raifsnider San Francisco, CA 94104-5446 564 Market ,Street ,' Suite 602 Address San Francisco, CA 94104-5446 Telephone No. (415 ) . 398-9001 Telephone No. (415) 398-9001 s �r • fsfs � faffsaf fef NOTICE Section 72 of the Penal. Code provides: "Every person uho, 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 Sail 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. i Z \ § / \ \ / \ $ > ) o Z ! � ƒ a � n2 \ p o w \ § 7 M � ¥ arm \ _ moo N (D nrt �3" : m e. « I « Grro mrtrL 0 0 0 AUL R �f & m . # sA& @ �ƒ J � $ ^ > Ln > � � « xg/�A 7 �2. . � A. APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA August 1, 1995 BOARD ACTION Application to File Late Claim ) NOTICE TO APPLICANT Against the County, Routing ) The copy of this document mailed to you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to ) the Board of Supervisors (Paragraph III, below), California Government Code.) ) given pursuant to Government Code Sections 911.8 and 915.4• Please note the "WARNING" below. Claimant: Yvette Harden, an imcompetent, by and through her Guardian Ad Litem, Diana Harden Attorney: Steven J. Brewer, Esq. Address: 1999 Harrison St. , Ste. 1600 P.O. Box CA By delivery to .Clerk on July 7, 1995 Amount: Oakland, CA 94604-2079 Date Received: July 7, 1995 By mail, postmarked on Hand ; .'Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted Application to File Late Claim. DATED: July 7, 1995 . PHIL BATCHELOR, Clerk, By Deputy II. FROM: County Counsel TO: C erk of the Board of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6). ( ✓) The Board should deny this Application to File Late Claim (Section 911.6). DATED: 7' s VICTOR WESTMAN, County Counsel, By Deputy III. BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( ) This Application is granted (Section 91.1.6). ( ✓) This Application to File Late Claim is denied (Section 911.6). I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. DATE: S PHIL BATCHELOR, Clerk, By Deputy WARNING (Gov. Code S911.8) If you wish to file a court action on this matter, you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such petition must be filed with the court within six (6) months from the date your application for leave to present a late claim was denied. You may seek the advise of any attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. IV. FROM: Clerk of the Boar TO: 1 County Counsel 2 County Administrator Attached are copies of the above Application. We notifed the applicant of the Board's action on this Application by mailing a copy of this document, and a memo thereof has ben filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. DATED:��A „PHIL BATCHELOR, Clerk, By Deputy V. FROM: 1 County Counsel 2 County Administrator TO: Clerk of the Board of Supervisors 'Received copies of this Application and Board Order. DATED: County Counsel, By County Administrator, By APPLICATION TO FILE LATE CLAIM 1 STEVEN J. BREWER, ESQ. - State Bar No. 94889 GWILLIAM, IVARY, CHIOSSO, CAVALLI & BREWER 2 1999 Harrison St. , Suite 1600 P. 0. Box 2079 3 Oakland, CA 94604-2079 (510) 832-5411 4 Attorneys for Claimant 5 6 In the Matter of the Claim of 7 YVETTE HARDEN, an incompetent, by APPLICATION FOR LEAVE 8 and through her Guardian Ad Litem, TO PRESENT LATE CLAIM DIANA HARDEN, [Gov.C. Sec. 911.4] 9 LU Claimant, 3: 10 against RECEIVED W m 11 THE COUNTY OF CONTRA COSTA, 4d iv 0.6JUL 71996 12 Defendant. > 3 / -CLERK BOARD OF SUPERVISORS U J N 13 CONTRA COSTA CO. O ¢ 14 To: The County of Contra Costa ZN U N O w o 15 1. Application is hereby made, pursuant to California = z o � � w a � yU,� a o 16 Government Code Section 911. 4 for leave to present a late claim Ce 17 founded on a cause of action for personal injury which accrued on 18 July 19, 1994 , for which a claim was not presented within the six Q J 19 month period provided by Section 911.2 of the Government Code. For U 20 additional circumstances relating to the cause of action, reference 21 is made to the proposed claim attached to this application. 22 23 2 . The reason that no claim was presented during the period 24 of time provided by Section 911. 2 of the California Government Code 25 is that the claimant, Yvette Harden, was mentally incapacitated 26 during all of the six month period specified by Section 911. 2 for 27 presentation of the claim and was without a guardian or conservator 28 of her person during all of the six month period, and by reason of 1 this disability failed to present a claim during that period, all 2 as more particularly shown by the attached declarations of Dr. Gary 3 Miller and Dr. Jeffrey Englander. 4 5 3 . This application is being presented within a reasonable 6 time after the accrual of this cause of action, as more 7 particularly shown by the attached declarations of Dr. Gary Miller 8 and Dr. Jeffrey Englander, and Steven J. Brewer. 9 LU 3 10 WHEREFORE, it is respectfully requested that this application w Ce 00 11 be granted and that the attached proposed claim be received and 12 acted on in accordance with Sections 912 . 4-913 of the Government Q Q o 13 Code. U N OQ14 cn Ln } 6_ W o °' c� 15 Dated: vk� (off 1`�y GWILLIAM, IVARY, CHIOSSO, Z o CAVALLI & BREWER U Ca } a o 16 � � d j Q 17 By � 18 STEVEN J. 014EWER, ESQ. Q Attorneys Mr Claimant J J 19 �7 20 NOTE: The address to which notices relating to this application 21 are to be sent is: 22 Steven J. Brewer, Esq. 23 GWILLIAM, IVARY, CHIOSSO, CAVALLI & BREWER 1999 Harrison Street, Suite 1600 24 P.O. Box 2079 Oakland, CA 94604-2079 25 26 27 28 2 CLAIM AGAINST CONTRA COSTA COUNTY (a) NAME AND ADDRESS OF CLAIMANT: Yvette Harden, by and through Diana Harden, Guardian ad Litem 1747 Paseo Laguna Seco Livermore, CA 94550 (b) SEND ALL NOTICES TO: Steven J. Brewer, Esq. GWILLIAM, IVARY, CHIOSSO, CAVALLI & BREWER 1999 Harrison Street, Suite 1600 P.O. Box 2079 Oakland, CA 94604-2079 (C) DATE OF OCCURRENCE: July 19 , 1994 PLACE OF OCCURRENCE: Marsh Creek Rd. (1. 6 miles east of Deer Valley Rd. ) , unincorporated area in Contra Costa County, CA CIRCUMSTANCES OF OCCURRENCE: On the above day and place, Yvette Harden, was driving a 1982 Honda automobile eastbound on Marsh Creek Road. The county was in the process of chip-sealing the road. Yvette Harden was coming upon a very small crest in the roadway when she lost control of her vehicle when it slid on slick oil and loose gravel that was left on the roadway by the county. Her vehicle veered toward the right and left the roadway. Her vehicle was launched over an embankment and while airborne struck a wire strand fence. It hit the bottom of the embankment and then rolled several times before coming to a rest. Claimant alleges that the section of Marsh Creek Road where this accident occurred constituted a trapped dangerous condition of public property which created a reasonably foreseeable risk of injury in that motorists were unable to adequately control their vehicles due to the slick oil and loose gravel that the county left on the roadway. Contra Costa County had notice of these conditions and failed to adequately warn motorists of these conditions and failed to correct said conditions by measures which include but are not limited to posting adequate warning signs. Claimants reserve the right to 1 amend this claim upon discovery of additional information. (d) GENERAL DESCRIPTION OF INJURY, DAMAGE OR LOSS INCURRED: Yvette Harden suffered serious and permanent injuries, including, a C7-T1 fracture of her spinal column which severed her spinal cord. - She suffered serious head injuries, including, brain stem damage, motor function damage, disturbance of thought patterns, and memory loss. (See Declaration of Jeffrey Englander, M.D. ) (e) AMOUNT OF CLAIM AND BASIS OF COMPUTATION: General damages: $10, 000, 000 Special damages: $3 , 000, 000 (Loss of income) Medical Expenses: $12 , 000, 000 (medical and attendant care for her lifetime) Pain and suffering. Property damage. Interest as allowed by law. Costs of Suit. DATED: July , 1995 GWILLIAM, IVARY, CHIOSSO, CAVALLI & BREWER STEVEN J.03REWER, ESQ. Attorneys for Claimant Receipt of a copy of the within claim is hereby acknowledged this day of , 1995. 2 1 GWILLIAM, IVARY, CHIOSSO, CAVALLI & BREWER 1999 Harrison St. , Suite 1600 2 P. O. Box 2079 Oakland, CA 94604-2079 3 (510) 832-5411 4 Attorneys for Plaintiff 5 6 In the Matter of the Claim of 7 YVETTE HARDEN, an incompetent, by and through her Guardian Ad DECLARATION OF STEVEN J. BREWER 8- Litem, DIANA HARDEN, IN SUPPORT OF APPLICATION FOR LEAVE TO PRESENT LATE CLAIM 9 Claimant, w w 10 against m 11 THE COUNTY OF CONTRA COSTA 12 Defendant. 3 / U Q ¢ °' 13 o � �` o N Q Q a g o NN � N � 14 �_ Z o o 15 I, STEVEN J. BREWER, declare: >:- a o 16 1. That I am the attorney of record for petitioner in this j ¢ 17 case. As such, I am familiar with the facts set forth herein and 18 am competent to testify thereto if called as a witness. Q J 19 2 . I have been retained to represent Yvette Harden through U20 her guardian ad litem Diana Harden, in this personal injury case. 21 This case involves an automobile accident in which Yvette Harden 22 suffered serious and permanent injuries, including a severe closed 23 head injury. 24 3 . An application for leave to present a late claim, that is 25 timely presented is required to be granted if the person who 26 sustained the alleged injury, damage or loss was physically or 27 mentally incapacitated during the entire six month period for 28 presenting such a claim and by reason of such disability failed to 1 present a claim during such time. California Government Code 2 Section 911. 6 (b) (3) . 3 4 . The injuries that Yvette Harden suffered caused her to 4 become mentally incapacitated as defined by California Government 5 Code Section 911. 6 (b) (3) . (See Declarations of Jeffrey Englander, 6 M.D. and Gary Miller, D.O. ) Yvette Harden is mentally 7 incapacitated to the extent that she is unable to attend to her 8 business affairs with the care and diligence ordinarily expected of Ce 9 persons in average good health. (See Declarations of Jeffrey LU 3 10 Englander, M.D. and Gary Miller, D.O. ) Ce co 11 5. Yvette Harden has been mentally incapacitated from the 12 time of the accident, July 19 , 1994 , until the present. (See UQ N 13 Declarations of Jeffrey Englander, M. D. and Gary Miller, D.O. ) As O ~ o N < 14 a result, Yvette Harden did not have the ability to bring a claim `r'p 0 Z .y o 15 against Contra Costa County within the requisite six month period U w a 0 16 for bringing such a claim. CeQ j 17 6. During this six month period, Yvette Harden was without Q18 a guardian ad litem or conservator of her person. J J 19 7 . On June 30, 1995, Diana Harden was appointed guardian ad U 20 litem of Yvette Harden. (See Exhibit 11111) . 21 8. Yvette Harden through her guardian ad litem, Diana 22 Harden, brings this application for leave to present late claim on 23 July 7 , 1995, less than a year after the accident. 24 9 . Yvette Harden has brought this application through Diana 25 Harden, immediately after Diana Harden was appointed her guardian 26 ad litem. Diana Harden has exercised reasonable diligence and 27 brought this application with reasonable promptness. 28 2 1 10. If petitioner Diana Harden' s application for leave to 2 present late claim is granted, Contra Costa County will not be 3 prejudiced. 4 11. Attached hereto as Exhibit 111" is a true and correct copy 5 of a court order appointing Diana Harden guardian ad litem of 6 Yvette Harden. 7 I declare under the penalty of perjury under the laws of the 8 State of California that the foregoing is true and correct and that Ce g this Declaration was executed on July �o , 1995 at Oakland, W 3 10 California. Ce M 11 _ 12 STEVEN J. R WER, ESQ. UJB 013 N Q Q a o 6 14 D Lu Zs 15 } a 16 j ¢ 17 Q 18 J J 19 U 20 21 22 23 24 25 26 27 28 3 STEVEN J. BREWER, ESQ. (State Bar I.D. No. 94889 1 GWILLIAM, IVARY, CHIOSSO, CAVALLI & BREWER -.;; 1999 Harrison Street, Suite 1600 ((( 9 , 2 Oakland, CA 94612 D 3 (510) 832-5411 JUN b Attorneys for Plaintiffs St u , 4 co�,r� COUPI n, 3Y COsrA cc)CLEPK 5 SUPERIOR COURT OF CALIFORNIA, COUNTY OF CONT kTa,CQ TS,�A �U7 6 7 YVETTE HARDEN, an incompetent 8 adult, by and through her Guardian ad Litem, DIANA HARDEN 9 and DIANA HARDEN, individually, W (C g5o ® 2g5 3 10 Plaintiffs, No. w C° 11 vs. ORDER FOR APPOINTMENT OF GUARDIAN AD LITEM 12 CONTRA COSTA COUNTY, AND FOR AUTHORITY TO Does 1 through 50, inclusive, EMPLOY COUNSEL QQ 13 [C.C.P. Sec. 373 and U N Defendants, Probate Code Sec. 3302) O N 0 / 6 w , ORDER Z s 15 or U p o a Y The Verified Petition of Diana Harden to be }; a o 16 Q < 17 appointed as Guardian ad Litem of Yvette Harden, an Q18 incompetent adult, to prosecute the above-entitled action, on J 19 behalf of Yvette Harden, was considered by this Court on this U20 date. On proof made to the satisfaction of the Court, the 21 Court finds that the appointment is expedient. 22 IT IS ORDERED that the Petition of Diana Harden be 23 granted and Diana Harden is appointed Guardian ad Litem of 24 Yvette Harden, an incompetent adult, to prosecute the above- 25 entitled action for Yvette Harden. 26 Dated: 1995 h C h j'YVi 1. Judge of the Superior Cour 27 28 1 GWILLIAM, IVARY, CHIOSSO, CAVALLI & BREWER 1999 Harrison St. , Suite 1600 2 P. O. Box 2079 Oakland, CA 94604-2079 3 (510) 832-5411 4 Attorneys for Plaintiff 5 6 In the Matter of the Claim of 7 YVETTE HARDEN, an incompetent, DECLARATION OF JEFFREY by and through her Guardian Ad ENGLANDER, M.D. IN SUPPORT OF 8 Litem, DIANA HARDEN, APPLICATION FOR LEAVE TO PRESENT LATE CLAIM 9 Claimant, LU w 10 against m 11 THE COUNTY OF CONTRA COSTA 12 Defendant. 3 Q J 13 / N 14 I, Jeffrey Englander, M. D. , declare as follows: Ow o � " 15 I am a physiatrist licensed to practice by the State of w C < 0 16 California and was the treating physician for Yvette Harden from j ¢ 17 August 20, 1994 to December 27, 1994 . Q 18 2 . The facts set forth in this Declaration are personally J 19 known to me and if called as a witness in the above-entitled C7 20 action, I can competently testify hereto. 21 3 . On July 19, 1994, Yvette Harden was involved in a solo 22 motor vehicle accident. Emergency care was provided at John Muir 23 Hospital from July 19, 1994 to August 20, 1994 whereupon Ms. Harden 24 was transferred to my care at Santa Clara Valley Medical Center. 25 26 27 28 1 3 . As a result of the accident on July 19, 1994, Yvette 2 Harden suffered the following catastrophic injuries, which from the 3 accident date, have left her physically and mentally incomplete: 4 o closed head injury with contusions of the left 5 midbrain, bilateral temporal and bilateral pariental areas. 6 o C7 ASIA Class C quadriplegia with unilateral locked 7 facets C7 on Ti with halo removed. g o Left oblique scapular fracture and left comminuted oc 9 proximal humeral fracture LU w 10 o Left cranial nerve III Horner's syndrome. W C° 11 (See Exhibit 1, a true and correct copy of the transfer 12 Discharge Summary from this declaring physician dated 12/27/94, V < 13 attached hereto and incorporated herein by reference. Exhibit 2, N 14 a true and correct copy of a letter authorized by this declaring w m y 15 physician dated 11/4/94) S Z O ti } o -9 16 4 . Yvette Harden was mentally incapacitated and disabled to > ` 17 the extent that she was unable to attend to her business affairs 18 with the care and diligence ordinarily expected of persons in _J 19 average good health. She remained mentally incapacitated to this U 20 extent during the entire time that I treated her, from August 20, 21 1994 to December 27, 1994 . 22 23 24 25 26 27 2s 2 1 5. It is my opinion thatw Yvette Harden^ is permanently, I ` S 2 disabled and will continue to be mentally incapacitated in the 3 future given the severity of her closed head injuries. 4 I declare under the penalty of perjury under the laws of the 5 State of California that the foregoinis true and correct. !&v 44 ti c — 6 Executed this 10 "day of ems, 1995 in 7 California. sW+� Je6A Mir-el a er, M. D. � 9 LU 10 m 11 12 013 J � N � N Q o 14 ✓1 v � P C } C W z 15 2 oti V y " 16 j 17 Q 18 J 19 V 20 21 22 23 24 25 26 27 i 28 3 06/29/1995 13:25 408-685-2028 SCVMC REHAB MEDICINE PAGE 02 BANTA CLARA VALLEY MEDICAL CENTER ♦♦♦♦ ♦ ♦♦♦♦ 751 South Bascom Avenue ♦ ♦ ♦ • San JOBS, California 93128 ♦ ♦ ♦ ee♦♦ (408) 299-3100 e♦♦♦ a ♦♦♦e PATXZMTs HARDEN, YVETTE CART NO. 1 1 086 20 74 DISCHARGE SUXXARY ATTENDING PSY8ICIANt Jeffrey Englander, MD A=188I0X DATES November 30, 1994 DISCHARGE DATES December 27, 1994 Di8CSAAG2 DIAGN0529i 1. Status post closed head injury on July 19, 1994, after motor vehicle accident with contusions of the left midbrain, bilateral temporal and bilateral parietal areas. 2 . C7 ASIA class C quadriplegia with unilateral locked facets C7 on Tl with halo removed after 12 weeks. 3 . Status post fasciocutaneous gluteal flap with primary closure on October 14, 1994, for a grade 4 sacral decubitus ulcer with six weeks bed rest postoperatively. 4. Probable left upper extremity brachial plexopathy. 5. Left oblique scapular fracture and left comminuted proximal humeral fracture, deemed a nonsurgical lesion by orthopedics. 6. Status post gastrostomy tube on August 20, 1994 , which has been discontinued. 7. Status post tracheostomy July 1994, now discontinued. 8 . History of a grade 2 cervical carcinoma with recent normal Pap smear. 9. Left cranial nerve III Horner's syndrome. 10. Neurogenic bowel and bladder. 11. Urinary tract infection,. Escherichia coli, now resolved. 12 . History of cholelithiasis. 13 . Gluteal dysesthesias. BRIEF HOSPITAL COURSE: For complete history and physical, please see history and physical- dictated November 30, 1994 , and history and physical dated August 22, 1994 . The patient was transferred from Red Bed status on November 30, 1994 , after six weeks of bed rest for a primary closure -of a grade 4 sacral decubitus ulcer with a flap. The patient was placed on a gradually increasing schedule. There was no further breakdown of the skin. The patient's skin, including the prior pinholes, was completely resolved. A picture was taken on Friday, December 23 , demonstrating that there are no open lesions on the skin. The patient did complain of dysaesthesias around the gluteal area which were there even prior to. surgery. This increased once the patient was weaned off her"trazbdone. -The patient .was replaced back ' on the trazodone. In addition, the patient has been educated and knows that further weight shifts every 30 minutes and when her gluteal region hurts do help relievg the pain as well as the pressure. EXH161T �- 06/29/1995 13:25 408-885-2028 SCVMC REHAB MEDICINE PAGE 03 DISCHARGE...SUMMARY HARDEN, YVETTE : December 27 , 1994 -2 1 086 20 74 The patient's skin, postoperatively, has been free of infection. In addition, the patient has not developed any pulmonary infection. The patient did have bacteriuria which was asymptomatic. A urodynamics study was canceled because of this. The patient was placed on a seven-day course of Macrodantin. Repeat follow-up urinalysis demonstrates that the patient has 1 wbc with clear urine and no growth on the cultures. Neurologically, the patient has continued to progress. She still has distal movement especially in her right lower extremity greater than her left lower extremity distally. The left upper extremity does have some return. An EMG was done to further determine how much more return has occurred as compared to the previous EMG done in September. At the time of this dictation, the EMG results are still pending the final report. The patient has begun developing spontaneous voidings in between her catheterizations. The bacteriuria was treated and resolved. However, she still continued to have spontaneous voids with large PVRs. Urodynamics were ordered but were canceled secondary to the bacteriuria. A renogram was done as well as a 24-hour urinary collection. The patient was fluid restricted to 800 cc of fluid a day because of her ICP. The patient was also limited in her oral caloric intake to 1200 calories per day with a regular diet. This was supplemented with vegetables as well as cut-up fruit portions which have been included in her total caloric intake. This was .so the patient could achieve her goals of being as independent as possible and to be able to fit in a small enough wheelchair that could maintain accessibility out in the community. The patient' s weight on discharge is 191 pounds. The patient's tracheostomy was discontinued. She was placed on an incentive spirometry for prevention of atelectasis . The patient's lungs remained clear on auscultation throughout her course.: The patient was transferred on December 23 , 1994 , to Red Bed status having completed her discharge goals and awaiting placement. Much discussion and time has been spent with the family to help them achieve their goal of bringing the patient home for discharge. Unfortunately, the plans to sell the house have not been finalized. In the meantime, the patient is being discharged to a skilled nursing facility, St. Joseph's, which is closer to the family's home as well as near the patient's mother's work until a permanent discharge environment can be identified. ` EQUIPMENT ON DISCHARGE: 1. A 19-inch manual wheelchair. 2 . A Jay cushion. 3 . A Jay back. 4 . A full electric bed. 5. If the patient was going to go home, she should have a commode. LABORATORY: 1. EMG, final report pending at time of this dictation. 2 .. December 1.5 , 1994 , a renogram was done which demonstrated probable left extrarenal pelvis but no obstruction was identified . 3 . December 24 , 1994 , urinalysis was clear with' 1 wbc, no growth on cultures. 4 . December 22 , 1994 , WBC 6 . 6 with 45% neutrophils, hemoglobin 12 . 7 , hematocrit 36. 2, platelets 280, ESR 43 , sodium 138 , K 4 . 3 , chloride .103 , CO2 27 , glucose 137 , BUN 11, creatinine 0 . 5 , albumin 4 . 2 . 06/29/1995 13:25 40B-865-2026 SCVMC REHAB MEDICINE PAGE 04 DISCHARGE SUMMARY HARDEN, YVETTE December 21, 1994 -3- 1 086 20 74 DISCHARGE MEDICATIONSt 1. Macrodantin 50 mg p.o. b. i.d. with food. 2. D-S-S 250 mg p.o. b. i.d. 3 . Senokot 2 tabs p.o. 8 hours before daily bowel training program. . 4. FeSO4 325 mg p.o. b. i.d. with meals. S. Multivitamins 1 tab p.o. q.d. 6. Trazodone 25 mg p.o. q.h.s. 7. Dulcolax suppository p.r.n. DIET: 1200-calorie, regular diet; 1800-cc fluid restriction per day. FUNCTIONAL STATUS ON DISCRARGE: The patient has maintained her goal of skin tolerating the activity program. The patient's goal of maintaining 'her optimal weight is ongoing. The patient has met her goals of being able to direct self-care with cues as well as knowing her activity schedule with cues. The patient has met her goal of being emotionally and behaviorally stable at discharge. She is mod assist with indoor mobility in a power chair. She is max assist times two of transfers. She is mod assist of upper extremity dressing in the wheelchair. She is modified independence with self-feeding and hygiene. The patient has met her goal of family being able to perform intermittent catheterization. FOLLOWUP APPOINTMENTSs 1. The patient is being discharged to St. Joseph's Skilled Nursing Facility today. � 2. The patient will be followed by the primary care physician at St. Joseph's. 3 . The patient is to return to the brain injury clinic at Valley Medical Center approximately one month after discharge. At that time, urodynamics will be re-evaluated. In addition, the patient will be - re-evaluated whether to transfer her care to a rehab clinic closer to her home. 4 . If the patient does go home, home health for OT followup on equipment and a home assessment physical therapy for followup and speech therapy for re-eval of cognition is recommended once the patient is discharged from St. Joseph's to a final discharge destination. Jeffrey Englander, MD Attending Physician Agnes Wallbom, MD Resident in Physical Medicine and Rehabilitation AW/jr d: 12/27/94 t 12/27•/94 .#3264., 3267/2 06/29/1995 13:25 406-885-2028 SCVMC REHAB MEDICINE PAGE 05 BANTA CLARA VALLEY XZDICAL CENTER •••• • •••• 751 South Bascom Avenue • • • • San Jose, California 93128 • • • •••• (408) 299-5100 • • • • PATIENT: HARDEN, YVETTE CHART NO. : 1 086 20 74 DISCHARGE SUKKARY ATTENDING PHYSICIAN: Jeffrey Englander, MD AMISSION DATE: November 30, 1994 DISCPJMGE DATES December 23 , 1994 DISCHARGE DIAGNOSIS: For complete discharge diagnoses please see original history and physical dated November 30, 1994 . HOSPITAL COURSE: The patient is a 28-year-old right handed female originally admitted to this Ward on 8/22/94 . She with the belted driver of a vehicle which apparently rolled over on 7/19/94 . The patient was discharged and readmitted status post fasciocutaneous gluteal flap with primary closure on 10/14/94. She was on continued bed rest for a period of approximate 6 weeks for healing, and was readmitted on November 30, 1994 for further .medical management and rehabilitation. The patient is currently being discharged to red bed status. Jeffrey Englander, MD Agnes Wallbom, M. D. Attending Physician Resident, PM&R AW:mc d 12/23/94 t 12/26/94 j 3234/2 t t n.: Dedicated to the Health ® Physical Medicine and Rehabilitation "of the Whole CommunitySANTA CLARA 751 South Bascom Avenue / San Jose,California 95128 V (408)885-2000 MEDICALCENTERFAX(408)885-2028 Conal B.Wilmot,M.D. November 4, 1994 Chairman Director,Spinal Cord Injury Alameda District Attorney's Office Michael H.Berlly,M.D. Oakland, California Chairman-Elect Director Neuromuscular Institute RE: YVETTE HARDEN Electromyography(EMG) SCVMC `1 086 20 74 Malcolm B.Lawton,M.D. VO WHOM IT MAY CONCERN: Deputy Chairperson Director,General Rehab Director,Outpatients - This is to confirm that Yvette Harden,.,is a patient under Electromyography(EMG) my care and that she suffered a closed head injury on 7/19 94 secondary to a:-.-,motor vehicle accident._ It is my- Peter /._._ Y opinion that her injury has caused her to bd permanently isC.Werner,M.D. disabled and that she will never be able to return-'>to Associate Chief Spinal Cord Injury her original state of employability. Electromyography(EMG); Sincerely, Jeffrey Englander,M.D. Associate Chief Director, Brain Injury Jeffre Engl �nder�, M.D. "Benjamin Mandac,M.D. Associate Chief, PM&R Associate Chief Director, Pediatric Rehab JE: j s Electromyography(EMG) Maureen Dunlap,M.D Associate Chief Spinal Cord Injury Electromyography(EMG) g Carol H.Corelis Manager EXHIBIT ' Valley Medical Center is a Division of the Santa Clara Valley Health and Hospital System s , 1 GWILLIAM, IVARY, CHIOSSO, CAVALLI & BREWER 1999 Harrison St. , Suite 1600 2 P. O. Box 2079 Oakland, CA 94604-2079 3 (510) 832-5411 4 Attorneys for Plaintiff 5 6 In the Matter of the Claim of 7 YVETTE HARDEN, an incompetent, DECLARATION OF GARY MILLER, by and through her Guardian Ad D.O. IN SUPPORT OF APPLICATION 8 Litem, DIANA HARDEN, FOR LEAVE TO PRESENT LATE CLAIM 9 Claimant, LU 10 against m 11 THE COUNTY OF CONTRA COSTA 12 Defendant. Q 3 Q U Q 13 J �� o N F- O O O Q & 14 N } o ¢ I, Gary Miller, D.O. , declare as follows: Owg = U _ a c 15 1. I am a doctor of osteopathy licensed to practice by the w U ° 16 ° State of California and, as of the date of this declaration, am the Q ] 17 treating physician for Yvette Harden. Q 18 2 . I have been Yvette Harden' s treating physician from J J 19 3 December 27 , 1994 until the present. C7 20 3 . The facts set forth in this Declaration are personally 21 known to me and if called as a witness in the above-entitled 22 action, I can competently testify hereto. 23 4 . On July 19, 1994 , Yvette Harden suffered, in addition to 24 other injuries, a severe closed head injury secondary to a motor 25 vehicle accident. 26 5. As a result of her injuries, she remains to date 27 28 � � � 1 incapable of seeing daily to her physical requirements and unable 2 to handle her own mental affairs. Through the period of time that 3 I have been her physician it is recognized that she suffers from 4 short term memory loss starting with the date of the accident to 5 present. Ms. Harden remains mentally confused and unable to focus 6 on responding to questions asked of her regarding her current needs 7 or physical state. If Ms. Hardens responds, the words are 8 unintelligible and not responsive to the question and therefore, 9 communication is very difficult due to her loss. She appears in a LU 10 retarded state acting confused, disoriented, subject to fits of 00 11 depression and tantrums in a childlike manner to the environment 12 surrounding her. (See Exhibit 1, A true and correct copy of a Q3 0 13 3/4/95 one page Report prepared by declarant, attached hereto and Q Q N 0 14 incorporated herein by reference. ) 0LU a = U _ Z .y o � 15 6. Yvette Harden is mentally incapacitated and disabled to Q Q o 16 the extent that she is unable to attend to her business affairs j 17 with the care and diligence ordinarily expected of persons in Q18 average good health. She has been mentally incapacitated to this J 19 extent the entire time that I have treated her, from December 27, V 20 1994 to the present. 21 7. Further, it is my opinion that Yvette Harden is 22 permanently physially and mentally disabled. 23 I declare under the penalty of perjury under the laws of -the 24 State of California that the foregoing is true and correct. 25 Executed this 3 day of July, 1995 in , 26 California. 27 - Gary Miller, D.O. 28 2 - zY$Ex 52120SO P. ©3 1 . Date patient last seen by you: VlslmL A,4%— V4113 ev 3. Condition is: ( ]acute, expected duration ( LI chronic, expected duration 4. Current medication, nursing care, therapy, special diet, special equipment, and/or prosthesis special treatment recommendations: IL S. Is the patient able to remain in 14s our► home? [ YES [ ) NO If yes, with assistance (Vrl without assistance- (" ] Si^Q "("19'If no, which is preferable? [ ) Board and Care Home �,� � �S"'.�"` �' Cu�,.k. y a,f• [ ]ComHospital � ``. Q'o�.ey►G. C��.��-c�..� N o7r�'�/ P 9 y 9 ;e0'4W'-* (L-T Nursing Home V d C , 6 - 5 'f i yG 6. ¢ional Status: (Circle as appropriate) LO 1) Adequate Useltontrol Limited Use/Control No Use/Control Upper Extremities' R L R L R l Lover Extremities' R �, L R L�, CID Bovel/bladder k,p �� avx-i 'r\ ` C! Vision zv � POOR FAIR G OD Hearing Speech Limitations are caused bj (t--rPain [y]'Stren�h tlKecreasedrange of motion ; 7. Mobility (check one): [Bedfast [ j Chairbound [ j Semiambulatory [ ] Ambulatory 8. ' dental Status (describe); 9. Comments: Please indicate any contraindications or limitations to patient activity that you advise (e.g., endurance, lifting, bending, reaching, etc.) • � C�dtl poll-, . Q�c.wY ►w }Q ��Lr �(! � �sf �i1.�����1l�a.D��'c c '"�`� �Q/ GARY L. MILLER, D.O. 675 Hartz Ave., Suite 207 Danville, CA 94526-3856 Physician, 5 Signatore n''" w CLAIM `-_ , I / BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA August 1, 1995 Cia;m aeinst the County, or District governed by) BOARD ACTION S:.,Pervisors, Routing Endorsements, ) NOTICE TO CLAIMANT a.,�• �L: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: $10,000.00 + Section 913 and 915.4. Please note all "Warnings". 3 CLAIMANT: Catherine Freis �j 0 5 (�y� ATTORNEY: Ronald L. Briggs COUNTY COUNSEL Date received MARTINEZ CALIF. ADDRESS: 3411 Mt. Diablo Blvd. BY DELIVERY TO CLERK ON July 5, 1995 Lafayette, CA 94549 BY MAIL POSTMARKED: June 29, 1995 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: July 5, 1995 EgIL BATCHELOR, 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). a ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: ? — - S BY:��.� — De uty 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. BOARDS 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: / 192SPHIL 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: IC71 C1 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator RONALD L. BRIGGS [:F ® ;Attorney of Low. 3411 Mt. Dioblo Boulevard Lofoyette, California 945495 1995(510) 283-5551 A CO ISORS June 28, 1995 Contra Costa County Board of Supervisors 651 Pine Street, Suite 106 Martinez, CA 94553-3152 Attention: Clerk of the Board of Supervisors NOTICE OF CLAIM AGAINST CONTRA COSTA COUNTY Gentlemen p This claim is presented by CATHERINE FREIS for injuries sustained"in "an automobile accident which occurred:on December. 30, 1994 on Muir Road in the County of Contra Costa. Claimant CATHERINE. FREIS has sustained injury in excess of $10,000.00. Jurisdiction over this.claim would rest in Superior Court. On the above date, CATHERINE FREIS was a passenger m a vehicle being driven by Robin Freis as it descended the hill on Muir Road, eastbound, heading toward Pacheco. Ai iliai i mand place, the vehicle hit black ice, s!=d and rolled; causing injury to CATHERINE FREIS. The occurrence of black ice on this steep hill was a frequent occurrence of which the County had knowledge and notice. Notwithstanding this notice, the County and its employees,`whose names 'are unknown, failed to take action to close the road, treat the icy condition-or put up warning or caution signs,.all of-which led to the injury to the claimant. The claimant sustained injury to her neck and back, as well as multiple cuts'and'bruises, the'full'nature and extent o*' which cannot be determined at this time. The claimant has suffered and will continue t9 suffer severe and irreparable injuries, which has resulted mi Contra Costa County June 28, 1995 Page 2 physical and emotional pain, suffering, physical and emotional distress and which will require further medical care and disability. All notices and communications concerning this claim should be sent to Ronald L. Briggs, Attorney at Law, 3411 Mt. Diablo Boulevard, Lafayette, California, 94549. Dated: June o2 , 1995. RONALD L. BRIGGS Attorney for CATHERINE FREIS t. �f• w ;i CL o � U o ea C�3 � CO o O D cl) � CLAIM C, BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA J August 1, 1995 Ci?'m AQ"nst the County, or District governed by) BOARD ACTION S::Gervisors, Routing Endorsements, ) NOTICE TO CLAIMANT o = FC�irC 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: Michael Christiansen ATTORNEY: Date received ADDRESS: 17 Bud Court BY DELIVERY TO CLERK ON July 7, 1995 Pleasant Hill, CA 94523 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: July 7, 1995 PpHHIL BATCHELOR, Cler BY: Deputy_' II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 7— g S 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). 1V. BOARD ORDER: By unanimous vote of the Supervisors present {f j This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: 12c7,51PHIL BATCHELOR, Clerk, ByOal, eg,444, 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. L s Dated: BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Cla .m to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to ,person • or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause Of action. Claims relating to any -other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code' 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 again-st each public. entity E. Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 a the end of--this� _ F.ry R£: Claim By ) Reserved for Clerk's filing stamp RECEIVED Against the County of Contra Costa ) JUL _ 7IM or Ct.ERK 80 ARD OF Co.MflRS District) Fill in name ) The undersigned-claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows: � 1. When did the damage or injury occur? (Give exact date and hour) -5- 2. Where did the damage or injury occur? (Include city and county) A ey-4-1 a Lj:�;E ►'�1£l� Sti Cs �.�-rc D ,___ � �-°•c-'��4 t�1v?� Cs�. C,a. em. 3. How did the damage or injury occur? (Give full details; use extra paper if required) �Ie�ticl,�z, "L0aS 3Evay " S%JMpeb " 84 CAU�JTZ-t ej/e"L _4_-- WL*A_J i-A-E- 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? tJ£44icLE WAS get-JC1 n.3-Q1►%Pe-D S-►Fpf,O w^, b - C�GAe AN0 cDU_LDQ mc( Viet4rCA e— LAJAV­Q- cam,N� cJ��c.1� w�S C�2.C��►JcQ n�.`-t �'�`� CG3 ""`.r� r ' 5. wnat; are the na.,nes of county or district officers, servants or employees causing the da iage' or injury? DQ&QA �iLXV--- AA:4-;kC(2! 5. What damage orinjuries doyouclaim resulted? (Give,.full extent of injuries or damages claimed. Attach two estimates for auto damage. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) $. Names-and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury,. DATE ITEC? UNT Gov. Code Sec. 910»2 provides: "The claim must be signed by the claimant SEND NOTICES TO; (Attorney) or someerson n 1 Name and Address of Attorney Claimant's Signature uD c�-- Address. Rpr Telephone No. Telephone No. ga Z /Jr * +� N O T I C E Section 72 of the Penal Code,provides: "Every person who, with intent 'to defraud," presents for tallowance dr,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 ($10,000, or by both such im.riso..v ye-nt and fine. RECEIVED C©Si'�tom.pq�3. 5$rtiC'z `•�� ,�;s-_ ;� 3� �e+�i2�� JUL - 71995 ' ft ,-$Z . �U3 f_0 C�9 0CLERK BOARD OF SUPERVISORS CMR I ST I ANSEN J CONTRA COSTA_CO_. D .R . 25789-~0000117 4t-'-j4 TP �j �,et G� Est : M . LAMBORN / 10CATIONS FOR YOUR CONVENIENCE OY'' 5C0M_-0qt-7: 1581 OAK PARK BLVD EASANT HILL , CA 94523-- ( 510 ) 939-1160 Day Phone: ( SIO ) 680-2815- Address: 17 BUD COURT Other Ph: ( ) -- - PLEASANT MILL CA 94523 Deductible : $ N/A Insurance Co . : Phone: Claim No . Adj . 84 CHRY NEW YORKER FIFTH AVE 4D SED BLK/SILV 8-5 .2L-2 Vin: 1C3BF66P2EX519035 License: 3DMF454 CA Prod Date: 1/84 Odometer ; 120954 Power steering Power brakes Power windows Tinted glass Bumper guards Dual mirrors Air conditioning Rear defogger Climate control Padded landau roof Clear coat paint Two tone paint Metallic paint ------------------------------------------------------------------------------------- REPR/ PART NO . REPL DESCRIPTION OF DAMAGE QTY COST LABOR PAINT MISC --------------------------------------------------------------------------------- 1 FENDER & LAMPS 2.4r O Re LKQ LT Fender +30% 1 2 .5 2 .5 ......._............ 3 Add for 2-Tone Refinish 1 1 .0 4 Add for Clear Coat 1 1 .0 5 Add moldings 1 0 .2 6 Add moldings rocker 1 0 .3 7 Repl LT -Molding wheel opening 1 34 .25 0 .3 8 FRONT DOOR 9* Os Real -1,KQ _TJ Door asst' x-30 a 1 2 .5 2 .3 � ............_.... 10 � ,±&p Major Adjacent Panel 1 ~0 .4 11 Add for 2-Tone Refinish 1 0 :n 12 Add for Clear Coat 1 0 .4 13 Add pwr units 1 0 .5 14 Add R&I w 'strip 1 0 .7 15 Add R&I mirror remote 1 1 .7 16* CLEAN USED PARTS 1 2 .0 .............................. 17* PIN STRIPED TAPE 2 PNLS 1 18* TWO WHEEL ALIGNMENT 1 X 50 .00 19* Refin BLEND HEADER 1 1 .0 .............................. 20* Refin BLEND LT REAR DOOR 11 .0 _...................... 21* Refin COVER CAR 1 5 .00 0 .2 22* Refin COLOR TINT/MATCHING 1 0 .5 .............................. 23* Refin CORROSION PROTECTION 1 10 .00 0 .2 Page= 1 DAMAGE REPORT CHRISTIANSEN 07/07/95 at 10 : 22 D .R . 25789--0000117 BAR # AJ180161 Est: M . LAMBORN If:::�?I;Il:::;a;;�C::�:U o:^::y�If.:::::u II,,,,II u:::::a; '"u"' �:�::y;q,....1i....IL.,.�C::;:u II�?C•r.::�:u IG:�a• '"��'" NOW 2 LOCATIONS FOR YOUR CONVENIENCE 1581 OAK PARK BLVD PLEASANT HILL , CA 94523-- ( 510 ) 939--1160 -____._.-__--____-____-_-__-____--___-____-___-___-________w__________-__-_____-__ REPR/ PART NO . REPL DESCRIPTION OF DAMAGE (QTY COST LABOR PAINT MISC Subtotals ==> 66 .25 10 .7 10 .7 50 .00 Page: 2 DAMAGE~ REPORT CHRISTIANSEN 07/07/95 at 10 =22 D .R . 25789—•0000117 BAR # AJ180161 Est : M . LAMBORN .... if:::i NOW 2 LOCATIONS FOR YOUR CONVENIENCE 1581 OAK PARK BLVD PLEASANT HILL , CA 94523— ( 510 ) 939-1160 Parts ( Subject to Invoice ) 66 .25 Labor 10 .7 units @ $52 .00 556 .40 Paint 10 .7 units @ $52 .00 556 .40 Paint/Materials 10 .7 units @ $22 .00 235 .40 Sublet/Mist 50 .00 _..__...._._._..__-.._-.,......__..._.._-.._—.w_._._...___w-...._..._...__...._..___ SUBTOTAL $ 1464 .45 Tax on $ 301 .65 at 8 .2500% 24 .89 --------------------------------------------- GRAND TOTAL. $ 1489 .34 -------------------------------------------- INSURANCE PAYS $ 1489 .34 THIS IS AN ESTIMATE ONLY. ANY ADDITIONAL ITEMS NEEDED OR ANY PARTS PRICE INCREASES WILL BE AN ADDITIONAL CHARGE TO THIS ESTIMATE. EPA h 00009908 Estimate based on MOTOR CRASH ESTIMATING GUIDE. Non-asterisk(*} items are derived from the Guide DR3NA82. Database Date 4/95 Double asterisk(**) items indicate,part supplied by a supplier other than the original equipment manufacturer. EZEst - A product of CCC Information Services Inc. Page.. 3 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA August 1, 1995 st the County, or District governed by) BOARD ACTION S-_,;ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT a,-d �L: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: $15,000.00 Section 913 and 915.4. Please note all "Warnings CLAIMANT: Cora Acosta ATTORNEY: Michael P. Karr, Esq. J Date received ADDRESS: 731 J Street BY DELIVERY TO CLERK ON July 7, 1995 Sacramento, CA 95814 BY MAIL POSTMARKED: Hand Delivered via: Risk T1Qnt. I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: July 10, 1995 JAIL BAATTCHELOR, Clerk uty11. 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: 7—/U — BY: z2 Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned. as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. , Dated: PHIL BATCHELOR, Clerk, By, Deputy Clerk 71 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 b eputy Clerk CC: County Counsel County Administrator BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY IN'ST'RUCTIONS 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 ofthis f or RE: Claim By ) Reserved for Clerk's filing stamp CORA A QS.TA ) RECEIVED Against the County of Contra Costa ) jLL " 71995 or ) �u►•. CLLR CSN rmA COSTA CO.� RS D OF SU SO District) Fill in name ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $15, 000. 00 and in support of this claim represents as folloris: 1. When did the damage or injury occur? '(Give exact date and hour) 3/17/95 at 10: 25 a.m. 2. Where did the damage or injury occur? (Include city and county) I-80(e/b) in Vallejo, Solano County 3. How did the damage or injury occur? (Give full details; use extra paper if required) I was in the number two lane going east bound on I-80 when the white van , who was travelling in..the lane to the right of me , changed lanes in front of my vehicle . I swerved to the left to try to avoid her while applying my . brakes . I lost control of my vehicle and spun around and hit tjye _k 4. What particular act or omission on the part of county or district officers, se.^vants or employees caused the injury or damage? CVC 21658 (Unsafe lane change) :ova.^j 5. wnaL are the names o1' county or district officers, servants or employees causing the damage or injury? r Teri Leeann Stonehan , employed by the Contra Costa County 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. (see attached) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) (see attached ) 8. dames and addresses of witnesses, (doctors and hospitals. - see attached) witness #1 - John Fox 503 Napa Avenue , Rodeo , CA 94572 witness# 2 - Jim Stewart ( 510) 603-8670 witness #3 - Larry Brown 100 Glacier Drive , Mtz , CA 94553 9. List the expenditures you made on account of this accident or injury: DATE .ITEM AMOUNT (see attached) != u yH Gov.` Code Sec. 910:2 provides: .0 ,-,JiThe"_'`� claim must be signed by the claimant SEND NOTICES TO: (Attorney) " ` -or­by some person on his bye/half." q Name R and Address A R R , f Attorney SQ rneyICH 731 J Street Claimant's Signature Sacramento , CA 95814 206 Glenview Circle Vallejo CA 94591 Address. Telephone No. (916)44Z-8625 Telephone No. ( 7 0 7) 554-6915 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. CAPITOL LAW OFFICES OF DOUGLAS K. HALLEN & ASSOCIATES 7311 STREET,SACRAMENTO,CA 95814 PHONE:(916)447-8625 FAX:(916)447-6550 y DOUGLAS K.HALLEN MICHAEL P.KARR June 28, 1995 CONTRA COSTA COUNTY RISK MANAGEMENT DIVISION 651 Pine Street, 6th Floor Martinez, CA 94553-1290 Attention: Liability Department SUBJECT.- FORMAL NOTICE OF CLAIM RE. Claimant: CORA ACOSTA Date of Loss: 03/17/95 Place of Loss: I--80 (E/B), Vallejo, California Your Driver: Teri Leeann Stonehan Your Vehicle: 1990 Ford Aerostar (license plate #E112037) Type Of Loss: Bodily Injury, Motor Vehicle; Negligence Dear Risk Management Clerk. Our client, CORA ACOSTA, suffered serious bodily injury when your driver, while in the course and scope of employment with the County of Contra Costa, negligently operated the above referenced motor vehicle. Shortly before the accident, our client was travelling in the number two lane going eastbound on I-80,your driver was to her right in the number three lane. At the time of impact,your driver attempted to change lanes right in front of our client, thereby causing said vehicle to collide with the front end of our client's vehicle. A traffic collision report was prepared by the California Highway Patol, a copy is attached. (Your driver was cited for CVC 21658). After the accident, our client was transported by Solano Ambulance to Kaiser Hospital. She was treated by the emergency room doctor for jaw, neck, back, and chest pain, as well as multiple facial lacerations, and blurry vision. X-rays were taken to rule out the possibility of fracture, and the results confirmed this. Ms. Acosta was released from Kaiser that same day with a perscription for motrin, an ice pack for her jaw, and a patch for her eye. She was also given instructions to return to urgent care when needed. Ms. Acosta was evaluated three days after the accident by her private physician who reffered her to Roger F. Carlson, M.D.for her blurred vision. Ms. Acosta was also seen for pain in her jaw by Diane R. Murakami, D.D.S. who refered her to Craig McDow, D.M.D. She also recieved physical therapy treatment for her intermittent neck and back pain. June 28, 1995 RE. Claimant: Cora Acosta page 2 Medical specials are as follows: Solano Ambulance 0311711995 $599.42 Kaiser Hospital 0311711995 $971.00 Jennifer Ross, M.D. 0312011995 $ 65.00 Roger Carlson, M.D. 0312111995 $ 75.00 Diane Murakami, D.D.S. 0312211995 $ 25.00 Craig McDow, D.M.D., M.S. 0312211995 $ 50.00 Grove Andersen Ghiringhelli P.T. 0312911995 to 0313111995 $206.00 Start Clinic 0411111995 to 0511611995 $620.00 Total medical/ specials approximate $2,611.42. Documented wage loss equals $2,102.91. Wherefore claimant, CORA ACOSTA, herewith submits this claim for medical expenses, loss of income, and general damages in the sum of$15,000.00. Respectfully Submitted, DOUGLAS K HALLEN& ASSOCIATES MICHAEL P. KARR, ESQ. MPK.•rh TRAFFIC COLDS{ON REPORT CHP 5,55 PAGE a (Rev 2-42) OPI 042 91 e _ ►AGE of sniaAL.aaOma/I NUMBER HTARUN cm JUDICIAL DISTINCT LOCALRtroRTgwBER ` NAR{[O FELONY. ❑ � 51 U 5 � M M1101 Hr A RUM COUNTY, REPORTING c"I Cr BEAT 3 ROLLED M� L19 COLLISION OCCURRED ON MO. DAY YEAR nME(at-o) Nac t OFFICER L 0. i ------�Q-----f--------------------------- 3 7 2 WL[POfT NFIORMATION DAY Of WEEK TOW AWAY PHOTOORAPHIS BY: F OF g _ _ Z S- S M T W T S Ov- E]ND 0AT IITERSECTION WRTN STATE HWY REL ®°R' FEETMOM 41 Of I° f G ores ONO �►aME PARTY ORNERY LICENSE NUMBER STATE CLASS SAFETY VSK YEAR MME,MODEL$COLOR LICENSE NUMBER STATE 1 taut►. 32, 3 c,4 c- G DRIVER HAVE(FIRST.MIDDLE.LAST) _ JT-A- An. REET ADDRESS OWN[RY NAYS [TAME AS ORWER T/f STATS/21P OWNERY ADDREp BAYS As DRN[R I E3 SICY- SEX NMR EY S HEIGHT WRIGHT SIM BIRTHDATE RACE DISPOSITION OF VEHICLE ON ORDERS OP. QOFRCER DRIVER ❑OTH eusT ❑ - $'- a 6 D NL D,e. OTHER HOME PHONE BUSINESS PHONE 1 PRIOR MECHANICAL DEFECTS: NONE APPARENT® RERRTO NARRATIVE ClCPO , 3749- 4eY;;' �,rfo ) CNP USE ONLY DESCRIBE VEHICLE DAMAGE SHAZE IN DAMAGED AREA VEHICLE TYPE INSURANCE CARRIER SOUCY NUMBER _ []UNIL ®NON[ ❑MNOR . OI j 0M00. aMAJOR O.T. pR OP ION SlIM!►IRHONWAY SPEED PCF DOT O CA 0 ICC O PUC O TRAVEL E PARTY DIIv[RYLICENSE NUMstR STATE CLASS SAFETY VEKYEAR MAKS IMODEL/COLOR LICENSENUMBER STATE 2 _ Sou►. C s DRIVER NAME(FIRST.MIDDLE.LAST) © PEDES STREET ADDRESS OWNERS NAME ©SAME AS DRIVER TRIAN ❑ o G � • PARKED CITY f STATRI ZIP OWNER'S ADDRESS (SAME AS DRIVER ' VENICLE (� - SICY. SEX I NMR EYES HEIGHT WEIGHT MO. '1111 OATI I YEARRACE DISPOSITION Of V[NICLIE ON ORDERS of:� ®OFFICER ❑DRIVER ❑OTHEA CLIST ❑ te oEf -L i G OTHER MOMS PHONE BUSINESS PHONE PRIOR MECHANICAL 0EFECT7: NONE APPARENT® REFEIITONAMIATIVE[] 13 (;,a1 O 7 / - G CIN USE ONLY DESCRIBE VEHICLE DAMAGE SHAOE N DAMAGED AREA INSURANCE CARRIER. ►OLICYNUMBER VEHICLETVPE ❑UNI(. []NON[ E]WNOR !/NNCNONW 0/ _ []MOD ®MAJOR OTOTAL DM OF ON STRC .NMR MIGHWAY SPEED PC f DOT a CA to Ice E] *UC C . TRAVEL LIMIT. /'i _ PARTY ORNERY LICENSE NUMBER STAIN CLASS SAFETY VEIL YEAR MME/MODEL/COLOR ENSE NUMBER STATE 3 EQUIP. DRIVER NAME(FIRST.WOOIE.LAST) ❑ PIECES- STREETAOORESS OWNER'S NAME ❑SAME AS DRIVER TRIAN PARKED CITY(STATS I IIP OWNERS ADORESS ❑SAME AS DRIVER VEHICLE IICV- SEX HMR EYES MEIGMT WEIGHT SIRTHOATE RACE DISPOSITION OF VEHICLE ON ORDERS OF: aOFFICER ❑DRIVER OOTHTR CUST MO. : DAY N YEAR OTHER NOME PMONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONE APPARENT❑ REFER TO NARRATIVE ❑ ( , ( CMP USE ONLY DESCRIBE VEHIttE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER - POLICY NUMBER VEHICLE TVP[ . . E'UN/C 1-1 NONE 1:1 MINOR i 0000. 0MAJOR 0TOTAL C:::�DIR.Of l(WITRICTORHIG"WAY SPEED PCF DOT 1] CA 0 KC E] PUCE? TRAVEL . LIMIT REPARER S NAME DISPATCH NOTIFIED RENEWERS NAME A (}-� JDATE REVIEWEDC, �/S� ®VES E] NO O N/A � ' v�)LAN 1 ICJ► i0-11D TE1— l� STAT%OF CALIFOIV" TRAFFIC COLLISION CODING DATE OF COLUSION TtlE(um I NCH:NUMSt11 FlICEII L D - NUMStII Mo. DAY 7 YEAR /D L S- S� OWNSKS NAM%I ADORES% - 1 NOTIFlED PROPERLY ❑rEs ❑N DAMAGE DESCIUMON OF DAMAG% SEATING POSITION SAFETY EQUIPMENT u/ Al YU)F_HFtMFT EJECTED FROM VEHICL OCCUPANTS L-AIR BAG DEPLOYED 0-NOT EJECTED A-NONE IN VEHICLE M-AIR BAG NOT DEPLOYED DRIVER T-FULLY EJECTED B-UNKNOWN N OTHERV-))O 2-PARTIALLY EJECTED C-LAP BELT USED P-NOT REQUIRED W-YES 2-UNKNOWN 1-DRIVER D-LAP BELT NOT USED 1 2 3 2 TO 6-PASSENGERS E•SHOULDER HARNESS USED PASSENGER 4 5 6 T-STATION WAGON REAR F-SHOULDER HARNESS NOT USED CHILD RESTRAINT X-NO, 6-REAR OCC.TRK OR VAN G-LAP/SHOULDER HARNESS USED Q-IINN VEHICLE USED Y-YES 6-POSITION UNKNOWN H•LAP/SHOULDER HARNESS NOT USED R- VEHICLE NOT USED 7 0-OTHER J-PASSIVE RESTRAINT USED 8-IN VEHICLE USE UNKNOWN K-PASSIVE RESTRAINT NOT USED T-IN VEHICLE IMPROPER USE U-NONE IN VEHICLE ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK(•)SHOULD BE EXPLAINED IN THE NARRATIVE PRIMARY COLLISION FACTOR TRAFFIC CONTROL DEVICES Z 3 TYPE OF VEHICLE 1 Z 3 MOVEMENT PRECEDING UST NUMBER (I)OF PARTY AT FAULT COLLISION K AVC SECTION VIOLATED: agrEs ACONTROL'8 FUNCTIONING APASSENGER CAR/STATION WAGON ASTOPPEO / Z/ 6` No B CONTROLS NOT FUNCTIONING' B PASSENGER CAR W/TRAILER X DI B PROCEEDING STRAIGHT + B OTHER IMPROPER DRIVING•: CONTROLS OBSCURED C MOTORCYCLE/SCOOTER RAN OFF ROAD X D NO CONTROLS PRESENT/FACTOR• D PICKUP OR PANEL TRUCK D MAKING RIGHT TURN C OTHER TITAN DRIVER• - TYPE OF COLLISION E PICKUP/PANEL TRUCK W/TRAILER E MAKING LEFT TURN D UNKNOWN• HEAD-ON F TRUCK OR TRUCK TRACTOR F MAKING U TURN E E FELL WEEP JB SIDESWIPE I IGTRUCK/TRUCK TRACTOR W!TRLR. GBACKING IC REAR END I JH SCHOOL BUS SLOWING/STOPPING WEATHER( MARK T OEM ) D BROADSIDE I OTHER BUS I PASSING OTHER VEHICLE ACLEARE NTT OBJECT J EMERGENCY VEHICLE X J CHANGING LANES X B CLOUDY F OVERTURNED ((HIGHWAY CONST.EQUIPMENT K PARKING MANEUVER C RAINING G VEHICLE/PEDESTRIAN L BICYCLE L ENTERING TRAFFIC I)SNOWING Fl OTHER•: MOTHER VEHICLE OTHER UNSAFE TURNING E FOG/VISIBILITY FT. MOTOR VEHICLE INVOLVED WITH N PEDESTRIAN XING INTO OPPOSING LANE F OTHER•: ANON-COLLISION MOPED PARKED IGWIND PEDESTRIAN P MERGING LIGHTING OTHER MOTOR VEHICLE TRAVELING WRONG WAY X A DAYUG14T D MOTOR VEHICLE ON OTHER ROADWAY OTHER ASSOCIATED FACTOR(S) OTHER•: B DUSK-DAWN E PARKED MOTOR VEHICLE Z 3 (MARK T TO 2 ITEMS) CDARK-STREET LIGHTS TRAIN AvcsEcno"OLAT" aTED D DARK-NO STREET LIGHTS 81CYCLE 13YEs ❑N DARK-STREET LIGHTS NOT ANIMAL: Bvcsi"ONVIOLA'nON: a�0 FUNCTIONING• []YES ROADWAY SURFACE ❑NO SOBRIETY-DRUG FIXED OBJECT: p7S0 1 Z 3 PHYSICAL )(A DRY � ( /` C vc sECTwN vatAnoN: �Yts (MARK T TO 2ITEMS) B WET Af 147 7114-y- rlOTHER OBJECT. ONO �( X HAD NOT BEEN DRINKING sN+owY-ICY D D SLIPPERY(MUDDY.OILY,ETC.) E VISION OBSCUREMENT: B HBO-UNDER INFLUENCE F INATTENTION•: HBD-NOT UNDER INFLUE14 ROADWAY CONDITION(S) G STOP i GO TRAFFIC HBO-IMPAIRMENT UNKNOI (MARK 1 TO2ITEMS) PEDESTRIAN'S INVOLVED E UNDER DRUG INFLUENCE A NO PEDESTRIAN INVOLVED H ENTERING!LEAVING RAMP F IMPAIRMENT-PHYSICAL A HOLES,DEEP RUT• CROSSING IN CROSSWALK I PREVIOUS COLLISION IMPAIRMENT NOT KNOWN UNFAMILIAR WITH ROAD B LOOSE MATERIAL ON ROADWAY• B AT INTERSECTION NOT APPLICABLE C OBSTRUCTION ON ROADWAY` I(DEFEC7IYE YEH EQUIP.: aTEO CROSSING IN CROSSWALK-NOT QrEs I SLEEPY/FATIGUED D CONSTRUCTION-REPAIR ZONE ATINTERSECTION Omo SPEGAL INFORMATION E REDUCED ROADWAY WIDTH ID CROSSING-NOT IN CROSSWALK L UNINVOLVED VEHICLE AHAZARDOUS MATERIAL FLOODED• IN ROAD-INCLUDES SHOULDER M OTHER•: G OTHER•: IF NOT INROAD xlx IN NONE APPARENT X JH NO UNUSUAL CONDITIONS IG APPROACHING/LEAVING SCHOOL BUS 10 RUNAWAY VEHICLE SKETCH MISCELLANEOUS I- SO EIB DATE _ WIOF SPR/N6S ST, WOMCAIiNDNTN �::^�5 �S R s f K j 5Ao NsT ST. o C CHP 655 PAGE 2( Rev 1.86)OP1042 STATE OF CALIFORNIA INJURED ! WITNESSES / PASS' 'GERS PAGE 3 DATE'wF COLL ISIOA TIME(24001 NCIC NUMBER OFFICER 1.0, NUMBER =i - zzz - 9� id . 395105 ' EXTENT OF INJURY( "X" ONE) INJURED WAS( "X" ONE ) WITNESS PASSENGER AGE SEXPARTY SEAT SAFETY EJECTED r ONLY ONLY NUMBER POS. EOUIP. FATAL SEVERE OTHER VISIBLE COMPLAINT DRIVER PASS. PEO. BICYCLIST OTHER INJURY INJURY INJURY OF PAIN A ❑* 1 ❑ ❑ ❑ © ❑ ❑ ❑ ❑ ❑ 112 L NAME I D.O.B.I ADDRESS TELEPHONE CD AAC o .cw Gi G (INJURED ONLY)TRANSPORTED BY: TAKEN O: Ar-V' DESCRIBE INJURIES - 0 or it co.4Y7wr 0 VICTIM OF VIOLENT CRIME NOTIFIED ❑# ® ❑ ❑ ❑ ❑ I ❑ I ❑ lo I ❑ I ❑ G o NAME I O.O.B.I ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: ., TAKEN TO: I `(DESCRIBE INJURIES - VICTIM OF VIOLENT CRIME NOTIFIED ❑� 0 a ❑ 1 ❑ 1 ❑ 1D ❑ ❑ ❑ 1 ❑ 1 ❑ F o I NAME I D.D.S.I ADDRESS TELEPHONE �t z - y -s- -o - o 7 ONJUREO ONLY)TRANSPORTED SY: TAKEN TO: DESCRIBE INJURIES VICTIM OF VIOLENT CRIME NOTIFIED ❑# 10 ❑ ❑ ❑ ❑ 111 a iD 1 ❑ 10 a NAME I O.O.S.I ADDRESS ELEPHONE / I 7 7/ (INJURED ONLY)TRANSPORTED BY: TAKEN TO: - DESCRIBE INJURIES EIVICTIM OF VIOLENT CRIME NOTIFIED ' ❑# © ❑ ❑ ❑ ❑ 10111101 ❑ ❑:. / NAME/0.0.8./ADDRESS TELEPHONE ,jgr,V 14 c- - Z GG rz _ ONJUREO ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES VICTIM OF VIOLENT CRIME NOTIFIED ❑# ❑ ❑ ❑ ❑ ❑ ❑ ❑ 81 d O NAME I O.O.B.I ADDRESSTELEPHONE ' ✓O f L / • -$ /O O.G / 7I ONJUREO ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES VICTIM OF VIOLENT CRIME NOTIFIED PREPARE.'.NAME 1.0.NUMBER MO. DAY YEAR REVIEWERS NAME MO. DAY YEAF. o ri 9 /� - - CHP 555-Page 3(Rev. 7-87)OPI 042 87 43637 FACTUAL DIAGRAM y r Y .OAT•OF COLLI/IONT1— (7400) lmctc NUM01fR 1.0. INU-S'a" .. , •l o. _j awr /) rw. Ps' � ,-a z-S'• �.�`f _ joff", /�.T/�p �� ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED (SCALE 8O1-c 16, INOICArm NORTH 1 �yO STxn-c_ T O/C x t AND fwd C�Yiti/y LiNk ris,✓cc Vit// D.E,B,crJ /c,01-7-oc e:cws. /0"14 ,j0 JrT. yvr >v •rc fry.� DRAWN Br - O.NUM6ER I MO, DAV rN. EVI¢WtR•S NAME MO. OAV VR. CHP 555—Page 4 (Rev 11-85)OP1 042 c a1r cwwvntaw NJURED / WITNESSES / PASSF"IGERS PACE r OAR Or COLLISION' TIME(2400) NCIC NUMBER OFFICER 1.0. NUMBER 3 = -� c7 EXTENT OF INJURY( "X" ONE ) INJURED WAS ( "X" ONE ) WITNESS PASSENGER six SEX PARTY I SEAT SAFETY EJECTED ONLY ONLY FATAL SEVERE OTHERVISIBLE COMPLAINT NUMBER POS. EQUIP. INJURY INJURY INJURY OF PAIN DRIVER PASS. PED. BICYCLIST OTHER © O /w L] ❑ ❑ El ❑ ❑ ❑ ❑ im - S B O NAME 10.0,0./ADDRESSTELEPHONE �� i « 9 -?72-0 7z ;INJURED ONLY)TRANSPORTED BY: TAKEN TO: 3ESCRISE INJURIES ' VICTIM OF VIOLENT CRIME NOTIFIED �# ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 4AME/O.O.B./ADDRESS TELEPHONE ;INJUREO ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES VICTIM OF VIOLENT CRIME NOTIFIED '21# 2- ❑ .,4 ❑ ' ❑ 1 ❑' 1 ❑ 10 10 101 ❑ ❑ VAME 10 O.B./ADDRESS TELEPHONE Ji sio zz - INJURED ONLY)TRANSPORTED BY: TAKEN TO: IESCRIBE INJURIES VICTIM OF VIOLENT CRIME NOTIFIED ®# 3 1 ❑ 1 11M ❑ ❑ ❑ ❑ 10 10 10 07 ❑ NAME/O.O.B./ADDRESS TELEPHONE !.a V i o i T p S 7 z0,8 71 - INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES - VICTIM OF VIOLENT CRIME NOTIFIED ❑# a a ❑ ❑ 1 ❑ 1010101 ❑ 101 NAME 1 D.O.S.1 ADDRESS -- TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES VICTIM OF VIOLENT CRIME NOTIFIED ❑# ❑ ❑ o ❑ ❑ ❑ ❑ ❑ ❑ I ❑ NAME/O.O.S.I ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES ElVICTIM OF VIOLENT CRIME NOTIFIED PREPARER'S NAME - I.D.NUMBER p _ MO. DAY QYEAR REVIEWERS NAME MO. DAY YEA / �o jr CHP 555-Page 3 (Rev.7-87)OPI 042 87 43637 FACTUAL DIAGRAM .AGB OAT<Or COLLI{ION TIME (1400) NGIC NVMBER OrIIC. .O. NUMBER MO. CAV VR. ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED (SCALE - 1 INOICATC NOq TN , ; } s i i r i i DRAWN BY 11.0.NUMBER I MO. OAY YR, IgEV1EWGR•5 NAME �' MO. OAY R, CHP 555—Page 4 (Rev 1185)OPI 042 STATE OFCAUrORNIA NARRATIVE/SUPPLEMENTAL CHF'556(Rev 7-90)OPI 042 Page G DATE OF INCIDIENTIOCCURRENCE TIME(2400) NCIC NUMBER OFFICER I.D.NUMBER NUMBER 'r ONE W ONE TYPE SUPPLEMENTAL rX-APPLIICABLE) []Narrative ©Collision report ❑BA update ❑Fatal ❑Hit and run update Supplemental ❑Other: ❑Hazardous materials ❑School bus ❑Other: CITY NTYIJUDICIAL DISTRICT REPORTING DISTRICT/BEAT ICITATIONNUMBER -LOCATIONISUBJECT STATE HIGHWAY RELATED ❑Yes ❑No 2. otifF_<Gl/�� y-/ /_OG.v-T�Q erJ r-.y.� ,CT fNnlut✓J�--G p/ s'/.PT_80 .�T 3. 4. 5. 6. 7. o� 8. 9. 1 Q. VE ow 12. 13. 14. 15. Ile,1ivo P.4rlif.c�l.£,c- 16. <. 17. w o 19. Ti5/iL,�it tOrG,Q_ �i�1T.� wAr 20. c.oL . D,sr Li ray P.¢sst.✓�.cc.r� 21. 22. - 23. r 24. 25. 'a s L w.-* Ac.c o ss ry 'e`er,.� .>a...a .:✓.va�.y� i,v r�/.� C/v .s' 26. 27. 28. - 29. 6L_.4 tf F.G.4G,bc�; PL a 30. r�/�.d _7.✓� C/�J�/1�J .0 Ai°i°,COx .�5�0 .�-r ``'/i.�_�./.L �`'/.tOX nVe 31. STI¢ o PREPARER'S NAME AND I.D.NUMBER DATE REVIEWER'S NAME DATE Use previous editions until depleted. 90 57541 STATE OF CALIFORNIA - NARRATIVE/SUPPLEMENTAL CHP 556(Rev 7-90)OP1042 Page 7 DATE OF INCIOENTXKCURRENCE TIME(2400) NCIC NUMBER OFFICER I.D.NUMBER NUMBER /7- S 1 1 /o zS- 9,rl, i S/05� 'X'ONE 'X`ONE TYPE SUPPLEMENTAL rX-APPLICABLE) ®Narrative ®Collision report ❑BA update ❑Fatal ❑Hit and run.update []Supplemental ❑Other: ❑Hazardous materials ❑School bus ❑Other: CAT /COUNTY/JUDICIAL DISTRICT REPORTING DISTRICT(BEAT ICITATIONNUMBER LOCATION/SUBJECT STATE HIGHWAY RELATED ❑Yes ❑No 2. 3. 4. �iir,u✓d .Cv.✓ 5. 6. 7. F - 8. - At 9. 0.-- Y�eL�_QLl��_/�6Grd f T�/Z let 10. 11. _219 /W f. oc�iL,rJ 12.. 13. e- 14. 15. m E 16. .s*T !✓ T 1 PLL L7��n' i,,:�„�'�1yJ?'-� . 17. 18.- f s 19. �- 20. 21. Aa 41r 22. N -2 L✓A-c riLiY[/�Li LG_ E/,,� -�G> �J/ice�`-us- ?-_ G,� ALtD 23. !�L'G�—i,✓ .<,Gs.cs r Z. 4 yr L i 24. 25. - - - Z 26. v ,t.vr- 27 .a rw• 'r 4.✓ V-2- sV17- r 28. wir-� rin � � O.✓a %Ov.✓ �t},1Qu.✓�] V-Z Cvv/441 T'Ob✓.s',Cd 29. 30. 31. PREPARERS NAME AND I.D.NUMBER DATE REVIEWER'S NAME DATE Use previous editions until depleted. 90 57541 ;TATEOFCA IF,ORNIA "lARRATIVE/SUPPLEMENTAL HP 556(Rev 7-90)OPI 042 Page 8 GATE OF INCIOENOCCU9RENCE TIME(2400) NCIC NUMBER OFFICER I.O.NUMBER NUMBER T/ 'lf ONE 'X'ONE TYPE SUPPLEMENTAL rX-APPLICABLE) ©Narrative O Collision report ❑BA update I ❑Fatal ❑Hit and run update Supplemental ❑Other: ❑Hazardous materials ❑School bus ❑Other: CITYICOUNTY/JUDICIAL DISTRICT REPORTING DISTRICUBEAT CITATION NUMBER LOCATION/SUBJECT STATE HIGHWAY RELATED ❑Yes ❑No ' 2. L r 3. w�f fiL.4_v,��t r 6 Al/.,✓ ra64-- pJ' [iJ �yCT �r4v^J /daic�rAir-.e ,a✓e S/trw rte' YA.II .ri �11J' � e 5. �lfRc GT 2 rd G.d!1'f , Z 09:7--r. TeY,V- F.L e e 4z Z7,r— 6. 7. _ 8. 9. /o 10. 7 11. /r rs�K 1'/.t Ace eF rsot sP�/ v 12. 13. 14. V,, .�,�-r -�,gaitt,,yl,� F1 2•Bo w�i,� ry 3! 4-,V ,d - 15. G_ r-L/zy�t �.�� if/B -'-8b A i G 16. a.,�-S Gni.✓/a✓6 Qi✓ V-/ �y4 ,i T..,� " z G,y /v.,�c£ - 17. G.�/iN.rtG.r� ti�Te' TiVi'� At - 18. "a 0S✓00%-4": 0 y D 27e& L�r-- D C p�j Z7G.G eA Y 19. .rr1��� .4,,�G*1�tti) sl.vfl. .r/�rr-i,✓s- ri/z /tip X411 ��J,�' � i / 20 R ory `�/� ��� e� ry 21. 22. 23. 24. t LAJ - Aela.t 77c>- 25. p 6r 26. 27. 28 29. 30. 31. j PREPARER'S NAME AND I.D.NUMBER DATE REVIEWER'S NAME DATE Use previous editions until depleted. 90 57541 STATE OF CALIFORNIA ' NARRATIVE/SUPPLEMENTAL A CHP 556(Rev 7-90)ON 042 Page DATE OF INCIDENTIOCCURRENCE tTI�ME(24010) NCIC NUMBER OFFICER LO.NUMBER NUMBER Z 1� J s O— 03: /O -)`ONE 'X'ONE TYPE SUPPLEMENTAL rX-APPLICABLE) ®Narrative Q Collision report ❑BA update ❑Fatal ❑Hit and tun update ❑Supplemental ❑Other: ❑Hazardous materials ❑School bus ❑Other: CITY=UNTY/JUDICIAL DISTRICT REPORTING OISTRICT/BEAT rCIFATIONNUMBEF LOCATIONISUBJECT STATE HIGHWAY RELATED ❑Yes ❑No 1. .f iv ✓ 2. i e10 LIZ C-9 eA 3. 4. 6. eXaJ5V114Xd Ai4AGrr2r,_'CLJ e- 7. Ty/ rg E19 V-A-10 /41 G L'u 1,zzl 6. .CSL V-2.- 41*1 9. F �'buiv-t.n t rs..t .0-r .rip`l - tvi�i✓tiss s-�.�}-T6�r!+�cs1�����>�"S 10: c o 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. { 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. PREPARER'S NAME AND I.D.NUMBER DATE REVIEWER'S NAME DATE Use previous editions until depleted. 90 57541 O v �r s a 64 A, .Z__..was _l�,cad•�_ . - hose.-._ . - a u�olk eel v , tic Pry _ _P)*r- del,v« -nu.r�l net -29 W117 fta !! oe7 nc —✓_Gt _O� �g-_. _m v_ld�.c Ca,�rc-� X15 Al i'/Yoa�'7L -7t-t- �_�. f- ORIL ve Le v mn t__rn. i i '