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HomeMy WebLinkAboutMINUTES - 08081995 - C18 AIENDED—CLAIM/ C . I � BOARD OF SUPERVISORS OF_CONTRA COSTA COUNTY, CALIFORNIA \August_8,1995 C1a4m An?ins.t the County, or District governed by) BOARD ACTION S:. ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Unknown Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Gary Mosbarger D ATTORNEY: JUL 2 0 1995 COUNTY COUNSEIPate received ADDRESS: 901 Court Street MARTINEZCAUF.BY DELIVERY TO CLERK ON July 19, 1995 Martinez, CA 94553 BY MAIL POSTMARKED: Hand Delivered via: County Counsel I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppHH gg DATED: July 20, 1995 BYIL DepuiyLOR, Clerk . 11FA II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ✓) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: BY: /�- � Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (v ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: IU S 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: _L.Z BY: PHIL BATCHELOR by eputy Clerk CC: County Counsel County Administrator OFFICE OF COUNTY COUNSEL DEPUTIES: r. _-- ! 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 21, 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: [x] 1 . The claim fails to state the name and post office address of the claimant. [] 2 . The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [x] 3 . The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [x] 4 . The claim fails to state the name (s) of the public employee (s) causing the injury, damage, or loss, if known. [x] 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10, 000) . If the claim totals less than ten thousand dollars ($10, 000) , the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10, 000) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. [] 6 . The claim is not signed by the claimant or by some person on is behalf . [] 7 . Other: VICTOR J. WESTMAN, County Counsel By: eputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a, 2015.5; Evidence Code §§ 641, 664) I declare that my business address is the County Counsel's Office of Contra Costa County, 651 Pine Street, Martinez, California 94553; I am a citizen of the United States, over 18 years of age, employed in Contra Costa County, and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as shown above, sealed and postage fully prepaid thereon, and thereafter was, deposited this day in the U.S. Mail at Martinez, California. I certify under penalty of perjury that the foregoing is true and correct. Dated: July 21, 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) .s.s� D � � �¢a • OICTOR J. WESTMAN CONTRA COSTA COUNTY COUNSEL • ' TO �� P.O. BOX 69, CO. ADMIN. BLDG., a MARTINEZ, CA 94553 DATE UBJECT r Y tt tt J 2 3 V 4 C 5 } 6 V!r 4aC�U �- 7cvvo� 0�0 S 1't c� �- Char \1 W � �� i s r Y 8 1 10 aS ck y'i.,\ S /(fo r c)-k� S A-"t}�" 11 � 12 $ dor { / { 14C6 w\ L 16 17 oC 18 lr-f. C�„�G� 1 I co f 20 22 23 25 C �G:``� ^ ' 26 27 A I .PROOF OF SERVICE BY MAIL - CCP 1013a 2015.5 2 I declare that: � �, € ��� 3 I am employed in the County of Contra Costa, I am over the age of eighteen years and not a party to the within 4 cause; my address is q ci; rb 0 4' r ,�__ f.a 4��_d V%4-2- California. On �T J\Y )x,99 , I served the within 6 in said action by placing a true copy thereof enclosed in a 7 sealed envelope with postage thereon fully prepaid, in the United States mail at tgy,, �—m, (6 'A;L, California, g addressed as follows: 10 12 , ass 13 14 15 - { sl 16 I declare under penalty of perjury, that the foregoing is true and correct. �^ 17 15 Executed on � 199 , at V�h' -� 18 California. 19 .� 20 21 [Your Name) 22 23 24 RECEIVED 25 26 ,& 19 1995 27 CLERK BOARD OF SUPERVISORS 8 CONTRA COSTA CO. 28 bLb CLAIM ( g BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Z. August 8, 1995 Cl,:m as?inst the County, or District governed by) BOARD ACTION -� S::pervisors, Routing Endorsements, ) NOTICE TO CLAIMANT Grid 6oard Action. All Section references are to ) The copy of thils 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: $308.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Gary Mosbarger ATTORNEY: county counall Date received ADDRESS: 901 Court Street %Ju� BY DELIVERY TO CLERK ON July 27, 1995 Martinez, CA 94553 Martinez,CA945WMAIL POSTMARKED: July 26, 1995 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: July 27, 1995 BAIL BATCepuYELOR, Clerk 77 11. FROM: County Counsel TO: Clerk of the Board of Supervisors (., )/This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.6). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 7 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 (,/f This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: 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: BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator . ......... ok A.-e-Z -1 Y-.55 3 CLERK E104RD OF SUPERVISOP' CONTRA COSTA CO. a 44YN 2 3 c 1p- O0.yr 4 c_, 6 S 4,c;, CL VA 6 7 oLo e 5* n6 kcL 0--\ e yc e C;S 6 P 9 p 6- 6 A Q44kc L4 ��Jro � /vo4%"c-k . 10 06 ote4-� 4 ;tr,\ 511 P-fL� 1:7,c :7,-co, w 12 over cvoc-i�a 6 C1 Z/o 11-0 13 lvk 11qo 4zc+c/Ll/ 14 ot -7. t�O ts -f 41-,e- ry C 16 ou 4t) r-k (.uAsa,-\.q 17 6 VLe,Y' C q &�Ck L_)0 c,(_c` 6t ck q 18 (so 19 e 14 o �ye 20 T— tir,,s Y-,e yv\,(t 21 1 ct 22 23 0-c�"IL cel 0-0 Ay 24 Cta- a., LJV S Ct �Q a-,.LC-E 4-6 25 CL Y, -3o g 10 26 27 4\ L 28 C Le CNN 4-1 yw ry\ _ .: - -G s�'Kt r4 2 �' x"' '1 ii��''" •t�y,�, 1 /iy�l^ y�` i-i.Sly, c � r--f, -l>1A - tis o v 2 C\a Ct DF ��-S `J a.Y- 3 — _-,, 4 `` `� �I v rCJ(ok-� �'d O� �Cw• 1 5f i S , S ct U � s 7 0.-0 S 0 8 ,y,- g ► �� cs F . 10 d'�. l_QMS'1'1 v Wh v l +�-� 11 12 13 S � l .w�- CJ F va 'r k*cn-, �- 14 1.5 � � P.rC7 c�,-2.C-�- �/ ��C� �D`.e.S V►L�v.� f W t ��U v� 'p J � 16f0 c-ess J 17 18 f'O C14L>sS19 yk 20 ' 0� +U h 2+(' `{� L ctj� � 4Ac10..vSe 21 22 1 '�-sa'1 i S V� R r-R'.•�.Jc_S-zs 23 �.fU C•en@ V re S� bs-�.,..�-► y,.� � � �o (� �o c�S o� E C� w�, c l� 24 ' C p �a e2 t y �r cr,,-� i QMH - v w� 60 V'2 2526 fc)4,e V Set Cor�•,.,p� G� � S 0 27 (� h ,s �, w�eh{ Fd r- �. ki b IQ�-�a� 9 `t�•e r p r o+ ► �r �_ - '�p bac r� IMM, 6'+ + �,� ! n 2 -?rANG j 4 `e -o i 5 SV � S�G��( q�"•� �e�� s V-\ 0- c � V\I, 7 d b I ;-C) v S G Le c�r g b y `�'� ou-P 0.r ri-q_t v �s V-\ j`-Pl.C 6 " 9 ` �S kO Poi-da R0 r -f' :r C . 10 up OVA f 12 � 13 14 e ��, Oct V R- r5 . . gsp 16 of L l V Q 17 C CC)In't p C4 c{! . 18 C .0. t W1 c y S c�ci.f �- a 19 21 °ter Y, v� d- C.� ,j 5� C�r "Ilk 22 23 K�1CSL" e d��k y I 1 24 a 25 26 01 CCS 27 28 C•L Az .4 j r Cv vVt�-�� f u•may\5-r_� .r._ ... . i CiMLED> Facility: CA Page Date: 06/06/95 13:01 42746 FERDIG CONTRA COSTA COUNTY CUSTODY ALTERNATIVES BUREAU Inmate Ledger Sheet As Of 06/06/95 Name (L, F, M): MOSBARGER, GARY D_ Booking #: 95150052 Application O1: 011845 Application State : C Prog Receipt H Date Time Oid Tran Amount Type Transaction Description Fee Balance EH 11008 12/12/94 08:05 44114 $ 50.00 AFEE END/A-FEE/ A.TERRY 12/12 $ 420.00 EH 11570 01/09/95 11:15 39876 S 420.00 MFEE 4\ EHD-TA - $ 0,00 EH 11727 01/ 14:29 42746 $ 140.00 RF D OVERPAID DUE TO A/TERRY $ 0.00 EH 0 06/06/95 12:59 42746 $ 140.00 PCOR UNDS-VIOLATED PRO $ 0.00 EH Program Totals: Application Fee (AFEE): $ 50.00 Maintenance Fee (MFEE): $ 420 Negative Co ection ( COR): $ 0.00 Positive Correction R : 140._ $ - �RCRe�ule Fee (RFEE): S .60 Application Totals: - Application Fee (AFEE): $ 50.00 Maintenance Fee (MFEE): $ 420.00 Negative Correction (NCOR): $ 0.00 Posi Correction (PCOR): $ 140.00 ZRefu (REND): $ .00 Reschedule Fee (RFEE): $ itA�t End of Job JCINMNB ibtit DISCIPLINARY HEARING REPORT DETENTION FACILITY : /MATE: r-Y7 0 Spy l GtZ_ C'AR_� BKG.#95 Sav 5� 1•F;,# • Last First ` HEARING DATE & TIME: INCIDENT DATE &TIME You have been accused of violating the following rule(s) or regulation(s): tri u)A ,ter, o� P2oGR.AS C-- 0(L L 7&4J_ ✓an0 G0 KFG�..! As a result of this charge, you may be subject to one or more of the following penalties: Loss of good/work time, privileges or programs, job or housing transfer, extra work detail, segregation, reprimand, criminal prosecution. INMATE RIGHTS IN DISCIPLINE PROCEDURE: 1) To receive 24 hour prior notice of a disciplinary hearing. This may be waived in order to receive an immediate hearing. If not waived, the hearing will be held within 72 hours of the completed report (excluding weekends and holidays). 2) To receive a copy of the incident report within 24 hours of the completed report. 3) To be present during the hearing process. unless security of the Facility is jeopardized. 4) To present witnesses at the hearing, unless security of the Facility is jeopardized. 5) To represent yourself or have a staff member represent you. 6) To appeal after the disciplinary hearing to the Facility Administrator for review. Such appeal request will be written on the Innate Request Form and filed within 5 days of the Hearing. WAIVER — Check One: I do not want a Disciplinary Hearing and do not contest the charge. I waive the 24 hour prior notice rule and request an immediate disciplinary hearing. I do not waive the 24 hour rule. Other Inmate Signature: Date & Time DISCIPLINARY HEARING: INMATE: Present Not Present Inmate Comments: i v Hearing Officer/Committee Investi 'on: L7 r 1ti K /01 Al5 v Findings: ;Inmate co �edeact as charged nmate did not commit a prohibited act ate committed the following pyrobibited act(s) : Sanctions/,Punishment imposed: -Hearing .Officer: Name Employee Number Committee. Member: Name Employee Number Copy to Tnmate'.by: Approved by Operations Director: 'Distribution:... BAS.(Original) Copies to: Facility Administrator, Inmate Booking, Operations Director, Inmate, gasification, Module where inmate is housed r DET 013:FRM '. t h Rev. 10/90 f i CA Page 1 :16/06/95 12:30 34433 WAGNER CONTRA. COSTA COUNTY DETENTION FACILITY Incident Report Incident Number: 150000322 Incident Date/Timez . 01/21/95 -08:00 Incident Type(s) : VIO/OF PROGRAM RULES Participants: Last Name First Name CCIN Bookman Inv Fac Mod Sec Rm Bed HOSBARGER GARY 070161672 95150052 M CA E 17 . B Incident Occurred > Fac: CA Module: E Section: Location: OTHER CAB, 900 THOMPSON STREET, MARTINEZ Action Taken: RECOMMENDATION: RETURNED TO CUSTODY. SPECIALIST A. TERRY REPORT Disciplinary? Y Inmate Violence? N CS Violence? N Contraband? N Fac Damage? N Sgt. Action: RETURNED TO CUSTODY DUE TO ESCAPE-CF#95-2376. Waiver: Findings: 0 Adjusted Type(s) : Submitted By > OID: 08042 Name: WALKED.. Date: 0112M9.5 9.5 Updated By > OID: 34433 N GNE Dat--- fi --0 . 95 6 Approved By (Sgt) > OID: 34433 Nam NER Date.- ' 02 5 Approved By (OD) > OID: 34433 Name: WAGNER Date: 02/16/95 Narrative: I MOSBARGER, GARY D. VIOLATED EHD RULES/REGULATIONS - POSITIVE U/A TEST. ON 01/19/95, MOSBARGER HAD A D.H. AT THAT TIME MOSBARGER LOST 10 DAYS GOOD TIME AND 10 DAYS WORK TIME FOR TAMPERING WITH HIS ANKLE DEVICE. ON 01/12/95, SUBJECT MOSBARGER CAME IN FOR HIS EHD OFFICE VISIT. AT THAT TIME HE SUBMITTED A U/A TEST WHICH CAME BACK POSI.TIVE FOR MORPHINE AND CODEINE ON 1/19/95. ALSO ON 1/19/95, MOSBARGER AGAIN GAVE A U/A TEST WHICH WAS ADMINISTERED BY ME. WE ARE AWAITING CONFIRMATION OF THIS POSITIVE DRUG TEST (VERIFIED ON PHONE BY PHARMCHEM) . MOSBARGER'S CLIENT HISTORY REPORT INDICATES THAT SUBJECT WAS LOCKDOWN OUT OF RANGE FROM 1045 TO 1222 HRS, A PERIOD OF 1 HR. 37 MIN. , AND AGAIN ON 1/21/95, 1717 TO 1839 HRS. , A PERIOD OF 1 HR. 22 MIN. *** End of Report *** CLAIM C , I � BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA August 8, 1995 ci,:m Avi nst the County, or District governed by) BOARD ACTION 2::rj tl r;:;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: $25,000.00 + ,__5?ction 913 and 915.4. Please note all 'Warnings". CLAIMANT: Toni and Jose Loera W9 a JU1. 14 ATTORNEY: Pelletreau, Alderson & Calt"TVCOV Donald E. Patterson MARTINEZ received ADDRESS: 3260 Blume Drive, Ste 410 bELIVERY TO CLERK ON July 13, 1995 Richmond, CA 94806-5277 BY MAIL POSTMARKED: Hand Delivered via: Risk MQmt. 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PpHHIL BATCHELOR, Clerk Y DATED: JL1_�r 14, 1 c3A5 BY: Deputy 11. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: IP Dated: -7 — 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. BOARDD ORDER: By unanimous vote of the Supervisors present (✓ ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Gated: / / S�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: q g BY: PHIL BATCHELOR bJ1PZs eputy Clerk CC: County Counsel County Administrator RECEIVED JUL 13 10 ✓la: Vie, m ' CLERK BOARD OF SUPtRVISORS CONTRA COSTA CO. 1 CLAIM AGAINST WEST CONTRA COSTA FIRE PROTECTION DISTRICT 2 TO: WEST CONTRA COSTA FIRE PROTECTION DISTRICT 3 The claimants herein present the following claim for 4 damages against the above-named governmental agency and in 5 compliance with Section 910 of the California` 'Government .Code 6 sets forth in detail the following information: 7 A. The name and post office address of the claimants 8 are: Toni Loera and Jose Loera, c/o 3260 Blume Drive, #410, 9 Richmond, CA, 94806 . 10 B. The post office address to which notices in, U oda 11 connection with this claim are to be sent is : Pelletreau, v W ro z � OW � 0 oNQ 12 Alderson & Cabral, 3260 Blume Drive, Suite 410, Richmond, CA o > w " � §Q LLL 13 94806-5277 . ] 005u o 14 Z C. The date, place and circumstances of the Q N N f " L) ° 15 occurrence which give rise to the claim are as follows : January w w16 26 , 1995 at the intersection of Broadway Avenue and 21st Street, p" 17 San Pablo, California. Claimants were the driver and passenger 18 of a vehicle which was struck by a West Contra Costa Fire 19 Protection District fire truck. The claimants vehicle had moved 20 to the side of the roadway and the West Contra Costa Fire 21 Protection District vehicle struck the concrete divider which 22 caused him to veer to the right and strike the rear of claimant' s 23 vehicle. 24 D. A general description of the injuries and the loss 25 incurred, so far as is known at the present time, is as follows : 26 Claimant Toni Loera suffered injuries to her neck, back and -1- I shoulders . Claimant Jose Loera suffered emotional injuries . 2 E . The name of the public employee causing the injury 3 is : Larry Evrard Dawson. 4 F. The amount claimed as of the presentation of this 5 claim is : The amount claimed on behalf of the claimant herein 6 exceed $25,000 . Jurisdiction of this claim would rest in the 7 Superior Court. 8 Dated: July 13, 1995 9 PELRE U, LDERSON & CABRAL 10 Q BY: U N ° 11 ONALD E. PATTERSON o W O Q ¢ 5 m o 12 w � Er o LL Q < � 13 W W N f ¢ O w U 4 m d 14 N ] a o Z N f N 15 W � N w w 16 w w a 17 18 19 20 21 22 23 24 25 26 -2- CLAIM (21 , I e y, BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA CA ugust= 8,_1995/ Cia<m analnst the County, or District governed by) BOARD ACTION "::rj :° S::pervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $1,574.89 Section 913 and 915.4. Please note all "Warnin s% CLAIMANT: State Farm Insurance Companies I • m o Claim Number: 05-6778-623 J U L 2 1 W5 ATTORNEY: - Date received COUNTY Jul 20, 1�T�N ZCALF. OS � ADDRESS: P.0 Box 2357 BY DELIVERY TO CLERK ON Y Antioch, CA 94531-2357 Hand Delivered via: Count Counsel BY MAIL POSTMARKED: Y I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: JAY 21, 1995 QQHHIL BATCHELOR, Clerk , BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. ('W-- 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 — a _ BY: ___ Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( " ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated j,u g I(� PHIL BATCHELOR, Clerk, By Q, , 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. r Dated: BY: PHIL BATCHELOR by _ puty Clerk CC: County Counsel County Administrator OFFICE OF COUNTY COUNSEL DEPUTIES: i•-'`� j `f. 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. MUNIZ July 24 , 1995 VALERIE J. RANCHE DAVID F. SCHMIDT DIANA J. SILVER VICTORIA T. WILLIAMS NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Karen Jones P.O. Box 2357 Antioch, CA 94531-2357 RE: CLAIM NO. 05-6778-623 State Farm Mutual Ins . Co. Please Take Notice as Follows : The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910 .2 , or is otherwise insufficient for the reasons checked below: [] 1 . The claim fails to state the name and post office address of the claimant. [] 2 . The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [X] 3 . The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [X] 4 . The claim fails to state the name (s) of the public employee (s) causing the injury, damage, or loss, if known. [X] 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10, 000) . If the claim totals less than ten thousand dollars ($10, 000) , the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10, 000) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. [] 6 . The claim is not signed by the claimant or by some person on is behalf . [] 7 . Other: VICTOR J. WESTMAN, County Counsel By: Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a, 2015.5; Evidence Code §§ 641, 664) I declare that my business address is the County Counsels 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 24, 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) STATE FARM State Farm Insurance Companies �® INSURANCE RECEIVE® 1901 west 10th Street July 13 , 1995 i Antioch,California 94509 0 Mail:P.O.Box 2357 CONTRA COSTA COUNTY—RISK MANAGEM tW JK BOARD OF SUPERVISORS Antioch,California 94531-2357 651 PINE STREET CONTRA COSTA CO. MARTINEZ, CA 94553 Phone: (510)779-2900 RE: Claim Number: 05-6778-623 Date of Loss: June 20, 1995 Our Insured: Roy E. Woodhouse Total Amount of Loss: $1, 574 . 89 Insured's Payment: $35. 55 RENTAL Our Payment: $1, 539 . 34 Your Insured: CCC-RISK MANAGEMENT P/U #5572 Address: 652 PINE STREET MARTINEZ, CA 94553 Your Claim Number: Dear Gentleperson: I have been informed that you are the insurance carrier for the party shown above as your insured. Our investigation establishes that your insured is responsible for the damage to our policy- holder's vehicle. Please accept this letter as notice of our subrogation rights and contact me as to your position. Sincer ly, Karen J s Claim Specialist (510) 779-2935 State Farm Mutual Automobile Insurance Company KJ/hcb CC: AGENT 2791 Roy E. Woodhouse 107 Begonia CT Martinez CA 94553-5035 HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001 CLAIM NO 05-6778-623 POLICY NO 6923-740-05M4,,,,,, LOSS DATE 06/20/95 DRAFT NO 1 02 433380 PAYEE q DATE 06/23/95 BERNAL AUTO BODY INC & ROY E WOODHOUSE 406 N BUCHANAN CIR AMOUNT $****1,4 7 5. 3 PACHECO CA 94553-5120 TIN 05-680044723 ' ��� COMPREHENSIVECERAGE- FWT, CAC, OR LOMV OUTGOING 390-1 $1,475.34 REMARKS ' '' .�U N 2 3 1995 CREATED BY Vicki Williams �� ANTIOCH CLAIMS STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY �•���•�• 1 ���02 433380 J NORTHERN CALIFORNIA OFFICE BANK OF AMERICA NT & SA 1'1-35/1210 � �' � .., ROHNERT PARK, CA CUSTOMER SERVICE AMERICAS 1233 ' �,�", DATE 06/23/95 iw�u��en CONCORD CA Antioch 02-124 �� z COVERAGE COMPREHENSIVE - FWT, CAC, OR LOMV CLAIM NO 05-6778-623 POLICY NO 6923-740-05M CLAIM UNIT 1y76 2 390-1 $1,475.34 I LOSS DATE 0 6/2 0/9 5 r i� INSURED WOODHOUSE, ROY $, 9F';z`<%•.•'•:';«.:::.g;�>.•:<:z; EXACTLY ONE;THOUSAND FOUR.,;HUNDRED,,;SEVENTY FIVE AND 34/100 DOLLARS $;.....,..:; �. Q �j« + Pay to the Order of. BERNAL '¢AUTb BODY TNC &',` ROY E WOODHOUSE 406 N BUCHANAN ;CIR' V° £ TIN 05-680044723 PACHECO CA 94553-5120 tT- AUTH VWI L APPROVED BY � . LJ 3 � (_n C] , .. ;.<. i CLAIM NO 05-6778-623 POLICY NO 6923-740-05M ;, LOSS DATE 06/20/95 DRAFT NO 1 02 433967 PAYEE rx�` DATE 07/13/95 ROY E WOODHOUSE AMOUNT $*******2 4. 0 107 BEGONIA CT MARTINEZ CA 94553-5035 COVERAGE TIN RENTAL REIMBURSEMENT 501-3 $24.00 REMARKS BALANCE DUE RENTAL CREATED BY Helene C Boersig {,A,{.•Aw STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY 1 02 433967 J NORTHERN CALIFORNIA OFFICE BANK OF AMERICA NT & SA 11-35/1210 ROHNERT PARK, CA CUSTOMER SERVICE AMERICAS 1233 DATE 07/13/95 IN{YAANC� Antioch 02-124 CONCORD, CA COVERAGE ��RENTAL REIMBURSEMENT CLAIM NO 05-6778-623 POLICY NO 6923-740-05M CLAIM"UNIT "176 ,," 501-3 $24.00 LOSS DATE 06/20/95 ' INSURED WOODHOUSE, ROY ;," ***************** EXACTLY TWENTY40UR AND 00/100 DOLLARS h Pay to the as-ar Order of.- ROY E WOODHOUS E s ' �" A 107 BEGONIA CTtk '� � MARTINEZVCA 94553-5035 TIN AUTH KJONE APPROVED BY C — ra 7- 77 ` CD CLAIM NO 05-6778-623 POLICY No 6923-740-05M,,\,,, Loss DATE 06/20/95 DRAFT No 1 02 433381 PAYEE DATE 06/23/95 ROY E WOODHOUSE r AMOUNT $*******4 0. 0 107 BEGONIA CT MARTINEZ CA 94553-5035 , 777' a COVERAGE TIN RENTAL REIMBURSEMENT OUTGOING 501-1 $40.00 REMARKS 4 DAYS LOSS OF USE AT $10 PER DAY. UN 2 3 1995 CREATED BY Vicki Williams 'ANT'S`C: =.__AIMS ...,....w STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY NORTHERN CALIFORNIA OFFICE BANK OF AMERICA NT & SA 11-35/1210 02 433381 J ROHNERT PARK, CA CUSTOMER SERVICE AMERICAS 1233r a ,� ,-- DATE 06/23/95 �wtu.�wc� CONCORD CA ` -'� Antioch 02-124 COVERAGE RENTAL REIMBURSEMENT CLAIM NO 05-6778-623 POLICY NO 6923-740-05M CLAM UNIT 176 `-501-1 $40.00 LOSS DATE 06/20/95 INSURED WOODHOUSE, ROY ff ti 4J ***s**,t ******UACTLY FORTY AND 00/100 DOLLARSIlk dF !< *;t ?t ;;:;;:;•`,.::; : Pay to the Order of. ROY E WOQDHOUSE, 107 BEG6NIA CT °; MARTINEZCA 94553-5035 TIN AUTN VWIL APPROVED BY :7 0 C! ENTEKPKISE K A=CAK--� =NTERPR I SE RENT–A–CA MFANY OF SAN FRANC I SCO M :3�1 h:uC�F TU 7:31 iA– 6:00P 1260 DIAMOND WAY 51i?-•h74-111c) 41 :30A– 6:00P TH "oA– 6:00F �,Or4CC]RJ CFS 5211-5r 26 2331 FR 7:30A– :tICJF SA 9:00A-12:OOP c c - 1 •" , -_ YEAR RENTAL souecE a I.D.a ' NTYPE ..,., _.,.. D c . . J YEAR .. 045041 v o RENTER MILES 4 A A GES F 1 FERENT f T ADDRESS u HOME PHONE NO C IaAf;G! -1r +'(•'?, city. STATE ZIP OFFICE PHONE ORIGINAL VEHICLE CIA r^'Cr - COLOR LICENSE NO. LOCAL ADDRESS PHONE ' CALENDAR DAY ECAfi aDRIVER'S LICENSE ,STATE EXPIRES HOURS d MILE• IN �Db . . HEIGHT WEIGHT EYES HAIR DAYS(! ' AGEar ¢ /� OUT CTAL SECU ITY a EM L YER DRIVEN - , \ 22.99 O / q�''h •r �� (K- - CONDITION AGREED TRILL OMPANY �.O O �(� /�R`EN R ADDRESS- }� IC, ��lR C Y STATE 21P -II}nIII vQ CIr "Q _ •-:r-. DV A ` PHON EXT. J U L 1 Ld 0.0 �� {;n RE CCEPT$ E RENTER REQUESTS DAMAGE WAIVER(OW)AT v RENTER. J'1 �•+ DAMAGE DAILY FEE SHOWN IN ADJOINING COLUMN.SEE /` '�§ ��1 'j�•' Z RESPONSIBILITY REVERSE,THIS IS NOT INSURANCE. J,',i RENTER DECLINES TE RENTER REQUESTS PERSONAL ACCIDENT INSUR� RENTER 8.99/DAIS d i i.... PERSONAL ANCE(PAR AT DAILY FEE SHOWN IN ADJACENT OUT E 1/e 1/4 3/6 / % 3/4 T/e F ACCIDENT INSU N v COLUMN AND HAS READ THE POLICY CERTIFICATE. X C"_l•o(/L)AY RENTER DECLINES R RENTER REOUESTS OPTIONAL SUPPLEMENTAL RENTER, Li F1 IN E 1/s 1/4 3/a /2 % 3/4 T/e F OPTIONAL SUPPLEMENTAL LIABILITY PROTECTION (SLP) AT DAILY RATE [+ LIABILITY PROTECTION(SL SHOWN IN COLUMN.SEE REVERSE. X SLP 5.99D AY ADDITIONAL DR — N PERMITTED WITHOUT ENTERPRISE'S APPROVAL. REPLACEMENT HICLE I request Enterprise's permission to allow AGE LICENSE NO. f,I[l UTHE'R DR T(' DO STATE EXP.'S. (/ AU .. "`. ET TAX S.25 % J OR LICENSE NO. Who Is under my control 'tlireclio ve ll}a r"ted vehicle for me and in my behalf. 1 em responsible o FUEL CHARGE 1�' for their ads while they' drlvin I f ulfill to s and condlllo of this agreement. ;-1.-79/7A�..EON.•...-eW.•r:-•-�� •§f-�'!';u: E ECAR a H.BY E'S REP MILE. IN RMISSION NTED FOR VENICE TO LEAVE THE TATE. `"' AGE OUT YES NO ATES AUTH.BY „ . ENTERPRISE'S REP DRIVEN X NO OTHFR STATE PER: IITTED TOTAL CHARGES (. CONDITION AGREED TO NO GASOLINE REFUND DAY MINIMUM '! XACKNOWLEDGMENT OF TERMS AND CONDITIONS I HAVE RENTER. NTER READ ,CONDITIONS. :. , , r. 3ELOW IS CONSIDEREL,TO HAVE BEEN MAOF ON ANY APPLICABLE CREDIT CARD VOUCHER AND I AUTHO IZE DE POS•ITS Dg RREFUNDS E v ?1vx11dK11vv1 o E ERE �L. lf REP X� �Tz , , \)r .•. , T— I WILL DATE/TIME ORIG. AMOUNT PD BY TYPE DATE PD. AUTH a CLOSED BY ourE '/a 1/4 3/9 1/2 a/e 3/4 y/e F CARBY DEP. 1, 127 IN E 1/a 1/4 1/6 1/2 Ve 3/4 y/a F EXT. ADDT'L PAID I CASH CHECK CR.CARD CHn!o TO DEP. BY EXT. ADDTL RECEIPT FOR CASH REFUND. TO DEP. DATE AMOUNT EXT. ADDTL _ RECEIVED TO DEP. BY X EXT. ADDrL CLAIM INFORMATION TO DEP. ADDITIONAL INFORMATION: POL.OR CL rY r�_✓,� � �i r _� INSD. SAME '—•—jttl.ifUl LOSS _. r'� ? •• - .; - DATE THEFT_ACCIDENT.--.1_. . # ; 1. ,,r.. PHONE NAME —.. 41 Fj 4TER RESPONSIBLE FOR AND 'f�'� 1 I V REPAIR SHOP - rHORIZES CHARGES TO THEIR h I'!2 "?I BERNALS AHTn BODY =DIT CARD FOR TRAFFIC TYPE CAR CATIONS LFXLJq INVOICE D045041 Aur ,-; 14, 00 # '; � ON FILE 0023/41) at 09:25 File #10174-0002914 El :�TATF; HnLRm ZN-sTjRic 1V'GF: Coma-aA1VZF LIKE A GO�EIGHBOR, STATE FARM IS THERE • r 1901 W. 10TH STREET l" • ANTIOCH, CA 94509 (51,0) 779=2.900 FAX: (510) 779-2905 D. D. ESTIMATE OF RECORD m' Written By: H. VASQUEZ 06/23/95 "09:25 a.m. X s" Claim -Rep: KAREN JONES # :(510) 779-2935 r D' Insured: ROY E. WOODHOUSE Claim- #0576778-62301 Policy # Address: 107 BEGONIA CT m MARTINEZ, CA 94553-5035 Date 'of Loss: 6/20/95 at 8:40 R Day: . (510) 757-6600- Type of, Loss: COMPREHENSIVE D Other: (. ) 686-1330- Point Of Impact: 16 NON-COLLISION 0 m Inspect Location: Drive-In Repair. BERNAL AUTO BODY (510) 689-0360 r Facility. 406 NORTH"'BUCHANAN CIRCLE l' PACHECO, CA . 94553 License # .93 LEXU LS 400 4D SED 8-4.OL-FI D VIN: JT8UF11E3P015989.4 Lic.//: 3DBE548 CA Prod. Date:. 0/O " Mileage: 40667 `n Cn D M Automatic transmission. Power driver seat' Power passenger seat D Bucket seats . Leather seats Recline/lounge seats Power steering Tilt wheel Telescoping . . Power brakes,. . 4 wheel. disc brakes Tinted "glass D Rear defogger Power windows Intermittent wipers Alloy wheels Power. locks A/c Cruise control Driver airbag Climate control m Power mirrors Special .mouldings Theft deter/alarm z Keyless entry Dual mirrors 2-tone paint n Clear coat paint .' REPR/ PART LBR PAINT NO. REPL DESCRIPTION OF DAMAGE QTY COST HRS HRS MISC 1 FRONT BUMPER 2 R&I Front .Bumper 1 0.00 2.0 0:0 C 3* Repr. Cover 1 0.00 1 .5 ' 2.5 l 4' Add for Clear Coat 1 0.00 0.os 1 .0 5 Repl Molding L 87..62 0.5 " 0.0 6* R&I LAMPS "& 'TRIM 1 0.00 0.6 0.0 D 7 HOOD & GRILLE D 8* Repr Hood 1 0.00 2.5 4.0 m Page: 1 t c, D_ 11 1p Aiunco .. m m i•� z 06/23/95 at 09:25 File #10174-0002914 E1 • �TATF' :C'AR�=N•�URA.NCF: CC�NIr-'A�F::3 Claim #: 05-6778-62301 93 LEXU.LS 400 4D SED 8-4.OL-FI -------------------------------------------------------------------------------- D REPR/ PART LBR PAINT "'i NO. REPL DESCRIPTION OF DAMAGE QTY COST HRS HRS MISC m` ---------------------------------------------------------------------------------- Ti 9 Overlap Major Adjacent Panel 1 0.00 0.0 -0.4 � 10 Add for Clear Coat 1 0-00: . 0:0 0. 7 Oi 11 Repl Grille assy 1 267.84 0.7 0.0 Dr 12* R&I WASHER'NOZZLES 1 0.00 0.2 0.0 13* Repr COLOR TINT 1' 0.00 0.5 0.0 m`. 14* Repr COVER CAR 1 0.00 0.5 0.0 T 0.00 m 15* Repr COLOR SAND &BUFF 1 0.00 0.6 0.0 cn m, --------------------------------------------------------------------------------. —zi Subtotals. ___> 355.46 9.6 7.8 0.00 M l CD D' D M . T D n D_ M M En m z D m r w D N D M Page:----�- D �.. t� .�tbul M v D Q6/23/95 at 09:25 File #10174-0002914 El . ST.AZ F' IF.A.Rk6 ZWSIJ1=:..AW CI=: C�0MI-�AWZES Claim #: 05-6778-62301 « . • 93.,LEXU'LS 400 41) SED 8-4.OL-FI m b U) D -i -r. D C) r D M :r R U Parts 355.46 Labor 9.6 hrs $ 52.00/hr 499.20 Paint 7.8 hrs $ .52.00/hr 405.60 Paint/Materials. :7.8 hrs .$ 22.00/hr 171..60 SUBTOTAL. $ ,1431 .86 Tax on $' 527.06 at 8.2500% 43.48 TOTAL COST` OF-REPAIRS-- - ------- ---1475.34 ` NETsCOST OF�REPAIRS- -�_____ __�$-_-1475.34 ' ALL SUPI'i.B�N!'S Ii�lil�PRitill APPI�IUAL SY A SlATE"FAT�1 I�YITIVE. " Estimate based on tM CM%11WX WI11E.,Wo-asterisk(O items are derived from,the Guide IRM. Database Date 5M ' Double asterisk(-) items irdirate part supplied by a supplier other than the original equipment manufacturer. ETst .,A.product of CCC Information Services Inc. i OS A'.C' \ • 4 4 � n t W4 �` 4k T '2 'r4 •1 � } .t...r v.t.J }f { f , � t •• 444 TOP LEFT PICTURE TOP RIGHT PICTURE R m t; i 'S.' j. �W• 5. Art— BOTTOM rt �yBOTTOM LEFT PICTURE BOTTOM RIGHT PICTURE a 4 R • .,1 J' L �i kt ' t E S.W q, FORM 200-4, REVERSE P.G.S. INDUSTRIES, P.O. BOX 1348, ASBURY PARK, NJ 07712/1-908-919-0707 FAX 1-90£1-919-73* CLAIM O BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA August 8, 1995 Cl;-,4m ar,?-asist the County, or District governed by) BOARD ACTION :` S::;ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and board Action. All Section references are to ) The copy of this document mailed to.you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Goverment Code Amount: Section 913 and 915.4. Please note all " ni T Pam CLAIMANT: Lucretia D. Holecheck Jul 2 5 INS !uv' ATTORNEY: COUNTY COUNSEL Date received MATINEZCAUF. ADDRESS: 5362 Pacheco Manor Dr. BY DELIVERY TO CLERK ON July 24, 1995 Pacheco, CA 94553 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. PPHHIL BATCHELOR, Clerk , DATED: July 25, 1995 BY: Deputy 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: Z rJ BY: Deputy County Counsel 11I. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the 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: P. ' PHIL BATCHELOR, Clerk, By-JiJ_, 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: J BY: PHIL BATCHELOR by �ei� P.Q ` Deputy Clerk CC: County Counsel County Administrator Claim 'to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT "1 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 I J Against the County of Contra Costa ) or ) A District) CLE AR OF SUPERVISORS (Fill in nave ) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows: ------------------------------------------------------------------------------ 1. When did the damage or injury occur? (Give exact date and hour) 53l rac ��co fn� i'las�o� �r �'v� /`�- �5 ���� er� -�'-•y;3a Cl —-------------------------------------------------------------------------------- 2. Where did/the damage or injury occur? (Include city and county) cco J :'_!1 bra LoS�Gc�p��� 3. How did the damage or injury occur? (Give full details; use extra paper if required) � �lS�er�' � �'s allc( Person be-I' ng hi }- � � SaYa� � Sao► 3 fi'n�t� 5' 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? S n U, �T '� ' h q Q r r c- � S cAYFD EC:'� (over) 5. k'rat are the names of county or district officers, servants or employees causing the damage or/injury? zoo �r c�"GS ��L c Ou rr N B r i -r- 1�e�u�� Cc�s� - ----------- ----------------------- --- -------------------------------- 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimat,tes for auto damage. ice rc� 0.- 'b&o r1 p a vi l 5 C�� qQ rr�STe -------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) I Q C-D �C3 r PQ i Y�- I q' O U r 8. Names and addresses of witnesses, doctors and hospitals. r 1�^%v�-� PackeC!0 C A 1'x/555 ------------------------------------------------------------------------------------- 9. List the expe:,ditu."es yo.; mace on acco'..,-nt of this accident or injury: 4Vl1 Gov. Code Sec. 910.2 provides: "h claim m,.:st be signed by the clairL,ant 5 ' N =-E' T0: (A`:c^-e ) or by some person on his behalf." N -e ant Adcress of A'�torne;;• Claimant's Signature 2 Address Telephone No. Telephone No. 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, accost, 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 (41,000) , 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 i:.Yrison:nent and fine. SINCE ® 1953 CONTRA COSTA DOOR CO. 145 MASON CIRCLE ESTIMATE NO. 1 1 8 F 1 CONCORD, CALIFORNIA 94520 (510) 671-7888 DATE + FAX 687-5350 NAME �'J/D/B (2/19, G le JOB SITE ADDRESS6.3 62 �►'��/�e e c� Old A-2 CA ADDRESS CITY NC 11 Iec o ZIP CITY HOME PHONE 68! '-S WORK We are please to offer the following price quotations for your consideration and approval. _CA(-; A) t_>,nr,Pr x We wish to thank you for the opportunity to present our proposal and if we may be of further assistance please do not hesitate to call. Payment may be made in any one of the following ways: ❑ 1. Deposit returned with this Proposal; Balance due upon completion. 0- 2. Payment in full at the time of installation. ❑ 3. Payment applied to one of the Major Credit Cards. Card No. Exp. Date NOTE: This proposal may be withdrawn CONTRA COSTA DOOR CO. by us if not accepted and work completed on/or i3 Staa a Lieens `���1.3 before Y: Accepted: The above prices,specifications and condi- tions are satisfactory and are hereby accepted. You are authorized to do the work as specified.Payment will be made Signature as outlined above. Date For: CCD Form No.150 .. ,. CLi,IM C BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA August 8, 1995 Cl,,,rn•anainsf the County, or District governed by) BOARD ACTION 1:;ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and 6oard Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $2,500.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Jalil Hasaan -lain O D ATTORNEY: JUL 17 �j --'Date received ADDRESS: 2310 Langster Dr. , #9 �AEZCw�Y DELIVERY TO CLERK ON July 17, 1995 Richmond, CA 94806 BY MAIL POSTMARKED: July.12,..1995 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. �pIL BATCHELOR, Clerk DATED: July 17, 1995 : Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( {1 This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 'qBY: 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: (",,, g,SPHIL BATCHELOR, Clerk, ByL4 , 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. C� � Dated 9 / 21 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator ;ttY ,� it -.. r{stttfltt t t�k1}t�l,t01Its I ; tt{tithe+t;tltll{t • C1a_- to: BOROF SUUPERVISORS OF CONTRA COSTA RNTY 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 na.--ne of the District should be filled in. D. If the clam: 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 For=. RE: Claim By ) Reserved for Clerk's filing stamp RECEIVED Against the County of Contra Costa ) 7 or ) District) AM X sOAM OF SUPEWWRS Fill in n g2ffRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full details; use extra paper if required) 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? �v�.r� wnat are the names of county or district officers, servants or employees causing the damage or injury? y? 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) s. Names and addresses of witnesses, doctors and hospitals. C� Cees,- 269—ehot L2 9• List the expenditures y xp 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 n^ c(Claimant's Signature 2 c-7 Address, Telephone No. Telephone No. 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 =h imprisonment and fine. 13558 .90 NISSAN 240SY JALIL Pago Sumu ry BODY 5.9& 50.00 295.00T PAINT MATERIALS 217.80T NEW 684.06T REFINISH 10,2@ 50,00 510-OOT HAZARDOUS WASTE 27.23T [1EnAN1C9L 1-5150.00 75.00T _--,- Taxod Labor 880.00 Taxed Costs 245.03 Taxed Parts 684,06 Tx 8.250% 20.21 Tr R.2�0% 56.43 Labor ( 17.6 hrs) 880.00 !dd11 Costs/Materials 245,03 Parts 684.06 Tax 76.64 Grand Total 1885.73 AUTHORIZED AND ACCEPT:YOU ARE HEREBY AUTHORIZED TO MAKE THE ABOVE SPECIFIED REPAIRS. I UNDERSTAND PAYMENT IN FULL WILL BE DUE UPON RELEASE OF VEHICLE, INCLUDING ADDITIONAL SUPPLEMENTAL DAMAGE CHARGES, AND HEREBY GRANT YOU AND/OR YOUR EMPLOYEES, PERMISSION TO OPERATE THE VEHICLE HERIN DESCRIBED ON STREET, HIGHWAYS OR ELSEWHERE FOR THE PURPOSE OF TESTING AND/OR REPAIR.AN EXPRESS– MECHANICS LIEN IS HERBY ACKNOWLEDGED ON ABOVE CAR, TRUCK OR VEHICLE TO SECURE THE AMOUNT OF REPAIRS THERETO. YOU WILL NOT BIS HELD RESPONSIBLE FOR LOSS OR DAMAGE TO VEHICLE OR ARTICLES LEFT IN VEHICLE IN CASE OF FIRE, THEFT, ACCIDENT OR ANY OTHER CAUSE BEYOND YOUR CONTROL. OLD PARTS REMOVED FROM CARS WILL BE JUNKED UNLESS U'1'IIERWlt.E 1NSTRUCTED. A.D.A. #AG161421 INVOICE AUTHORIZED BY DATE I AUTHORIZE ANY AND ALL SUPPLEMENTS PAYABLE DIRECT TO CITY GARAGE BODY & FRAME. I AUTHORIZE CITHY GARAGE BODY & FRAME TO ACT AS POWER OF ATTORNEY TO SIGN SUPPLEMENTAL PAYMENTS. AUTHORIZED BY DATE THANK YOU FOR SELECTING CITY GARAGE FOR YOUR REPAIRS. PSTIKATE R9= MOM: 06-27-95 13:30:34 BstiMate Plus is a tradeaark of Mitchell International Copyright 1991-1995 All Rights RcscrvM JUL 5 ' 95 17 : 2E PAGE . 007, 1558 • MTY GARAGR FRAKE 6 BODY CO. 295 29th street Oakland ,CA 94611 (510) 444-1400 Fax: (510) 444-1402 Visible Damage Quotation #1558 on 06-27-95 JAIII Style Insurer : Lic. Plate: Ad3uster : Paint Code: Appraiser: Phone: Prod. Date: Claimant 90 NISSAN 240SX Profile : STANDARD Insured YIN: Deductible: 0.00 Policy # Mileage: 0 Claim # Options: Labor Oo Description Price Labor Paint Labor Croup Price Group 1 OVERHAUL FRT COVER A.;SY 0.00 2.5 0.0 BODY 2 REPLACE FRT DUMPER COVER 263.26 INC 2.5 NEW 3 REPLACE L FRT UPR BUMPER COVER RRTAINER 16.14 0.0* 0.0 * NEW 4 REPLACE L FRT BUMPER COVER RETAINER 28.25 0.0* 0.0 * NEW 5 REPLACE L FRT BUMPER SUPPORT 73.32 0.0* 0.0 * NEW 6 REPLACE L FRT BUMPER BRACKET 19.94 0.0* 0.0 * NEW 7 REPLACE L MARKER LAMP ASSEMBLY 40.39 INC 0.0 NEW 6 BLEKD ROOD OUTSIDE 0.00 0.0 1.5 K14INiSn 9 REPLACE L FENDER PANEL 242.76 1.5 2.4 BODY NEW 10 REFINISE L FENDER EDGE 0.00 0.0 0.5 REFINISH 11 ALIGN FRONT SUSPENSION -M 0.00 1.5* 0.0 MECHANICAL 12 BLEND L FRT DOOR OUTSIDE 0.00 0.0 1.2 REFINISH 13 R & I L PRT BELT MLDG 0.00 0.3 0.0 BODY 14 R & I L FRT REAR VIEW MIRROR 0.00 0.8 6.0 BODY 15 R & I L FRT DOOR TRIM PANEL 0.00 INC 0.0 16 R & I ROOD TRIM 0.00 0.8* 0.0 BODY * FXTSTTNG 17 ADL OPER CLEAR COAT 0.00 1.8* 0.0 REFINISH 18 ADL OPER MASK FOR OVERSPRAY 0.00 0.3* 0.0 RF.RTNTSH Judgetent Item ESTIMATE RP= KUMM: 06-27-95 13:30:34 BstlNate Plus is a tra&nrk of Mitchell Internatioeul Copyright 1991-1995 A11 Rights Reserved JUL 5 ' 9C 17 : 27 FADE . 00 1 .. CLAIM C I 7 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA �ugus_t 8;=1995' C�?�mrao?�n�L the County, or District governed by) BOARD ACTION S;:;ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $43,649.25 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Virginia Hart and Donald L. Bull, Jr. I , m D ATTORNEY: Donald L. Bull, Jr. JUL 2 1 4993951 Date received COUNTYCOUNSEL ADDRESS: 706 Main St. , Ste. B BY DELIVERY TO CLERK ON July Z41, i jCAUF. Martinez, CA 94553 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 21, 1995 JYIL gep�tyLOR, Clerk ` I1. FROM: County Counsel TO: Clerk of the Board of Supervisors (This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: -7 `Z — BY: Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (� ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: S PHIL BATCHELOR, Clerk, 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: 7-5- BY: PHIL BATCHELOR by -Deputy Clerk CC: County Counsel County Administrator '+Claim-10: BOARD OF ORVISORS OF CONTRA COSTA CWMO p 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 thn 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 Comity, 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 VIRGINIA HART and ) Reserved for Clerk's filing stamp DONALD L. BULL, JR. ) RECEIVED deliVured Against the kKV'X XR ) . 2 0 M 4 SUPERIOR COURT OF THE -COUNTY OF CONTRA COSTA CLERK BOARD OF SUPERVISORS ��X) CONTRA COSTA CO. (Fill in n?�e ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 43 , 649. 25 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) Damage to Virginia Hart occurred on 3/15/1995 at 8 : 50 a .m., Damage to Donald L. Bull , Jr . occurred on 3/17/1995 at 8 : 43 a .m. 2. Where did the damage or injury occur? (Include city and county) Martinez, California . County of Contra Costa ----------------- - 3. How did the damage or injury occur? (Give full details; use extra paper if required) Damage to VIRGINIA HART and DONALD L. BULL, JR. occurred when the lawsuit RAND- INVESTIGATIONS, INC v. VIRGINIA HART and DONALD L. BULL, JR. (case no. C 95-00935) was filed in Contra Costa County Superior Court on March 3, 1995. (continued on attachment ------------------------------------------------------------------------------------ 4. What particular act or omission on the part of county or district officers, servants or e_-jployees caused the injury or damage? Contra Costa County and the Superior Court for the County of Contra Costa failed to pay Rand Investigations for services rendered in the case People v. (continued on attachmnet ) (over) 5. What are the names of co9y or district officers, serva.10 or employees causing the damage or injury? The true names of County of Contra Costa employees or officers causing damage are unknown at this time. The Superior Court ' s determination that Rand Investigation ' s billing was not fundable under Penal Code (continued on attachment ) ------------ 6. What damage or injuries do you claim resulted? (Give Hill extent of injuries or .damage I s claimed. Attach two estimates for auto dame. Damages are currently in the amount that is ' claimed in the lawsuit filed against Ms . Hart and Mr . Bull ( $43 , 649 . 25 ) plus the reasonable (continued on attachment 7.�How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Damages are computed as the amount claimed in the lawsuit ( $43 , 649 . 25 ) plus the costs of defending in this action and reasonable attorney ' s fees billed at $250. 00 an hour. ------------------------------------------------------------------------------- 8. Names and addresses of witnesses, doctors and hospitals. Virginia Hart- P.O. Box 8342 Berkeley, CA 94707 Donald L. Bull , Jr. - 706 Main St. , Suite B Martinez, CA 94553 Francie Koehler- 266 Seventeenth St . , Oakland , CA 94612 ------------------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 4/1;4=fr95 : ;." r !ttorney ' s fees 4 hours at $250/hour n .--._ .,•�.�,u� (answer to complaint) 5/25%95 at=tornev ' s fees 4. 5 hours at $250/hour (discoverv) 6/$% $5 attorney ' s fees 6.5 hours (same rate) (x-complaint) Gov. Code Sec 910.2 provides: i tRA ° "Th claim t e si ed by the claimant SE';� NOTICES T0: (Attorne: ) o b so rs on i behalf." Name and Address of Attorney DONALD L. BULL, JR. 706 Main S. , Suite B 1 mant's i 3ignature) Martinez, CA 94553 706 Main St. , Suite B .Address Martinez, CA 94553 Telephone No. 510-228-9870 Telephone No. 510-228-9870 * * W W * * * * * * 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, acco=t, 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 (S=,000), or by both such imprisonment and fine, or by imprisonment in the state pris x , by a fine of not exceeding ten thousand dollars ($10,000, or by both such imoris=—jent and fine. M ATTACHMENT TO CLAIM OF VIRGINIA HART and DONALD L. BULL, JR Continued from pages one and two: 3. Said complaint alleges that Virginia Hart and Donald L. Bull, Jr. owe Rand Investigations $43,649.25 as payment for investigative services rendered in the capital murder case PEOPLE v. PARI ER, Contra Costa Superior Court case no. 934193-4. Ms. Hart and Mr. Bull assert that Rand Investigations was in fact employed by and under contract with the COUNTY OF CONTRA COSTA and the SUPERIOR COURT FOR THE COUNTY OF CONTRA COSTA to provide above mentioned services in accordance with California Penal Code section 987.9. 4. PARKER. This failure by the Superior Court and/or the County to pay for said services caused Rand Investigations to file the instant action against Virginia Hart and Donald L. Bull, Jr. 5. Section 987.9 was made by the Honorable Judge Douglas E. Swager. 6. costs of defending against this action and for attorney's fees of$250.00 an hour in an amount not presently ascertainable. CLAIM C> , I r. BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA August.-8;_199_5•, Ci�;m an?inst the County, or District governed by) BOARD ACTION S.;ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $43,649.25 Section 913 and 915.4. Please note all g "Wa i n CLAIMANT:Virginia Hart and Donald L. Bull Jr. V ATTORNEY: Donald L. Bull, Jr. JUL 2 1 1995 Date received COUNTYCOUNGEL ADDRESS: 706 Main St. , Ste. B BY DELIVERY TO CLERK ON July 20, lyI�TINEZCAUF. Martinez, CA 94553 y� 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 21, 1995 BYIL DeputyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors V'This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.6). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: LL i Dated: - L -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: qq_�'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 16; 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&ERVISORS OF CONTRA COSTA COU0 - 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 VIRGINIA HART and ) Reserved for Clerk's filing stamp DONALD L. BULL, JR. � RECEIVED W adv M Against the County of Contra Costa ) JUL 2 0 1995 )oxx ) y CLERK BOARD OF SUPERVISORS District) CONTRA COSTA CO. (Fill in name)) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 43, 649. 25 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) Damage to Virginia Hart occurred on 3/15/1995 at 8 : 50 a .m. Damage to Donald L. Bull, Jr. occurred on 3/17/1995 at 8 :43 a .m. 2. Where did the damage or injury occur? (Include city and county) M Martinez, California . County of Contra Costa - - 3. How did the damage or injury occur? (Give full details; use extra paper if required) Damage to VIRGINIA HART and DONALD L. BULL, JR. occurred when the lawsuit RAND INVESTIGATIONS, INC v. VIRGINIA HART and DONALD L. BULL, JR. (case no. C 95-00935 ) was filed in Contra Costa County Superior Court on March 3, 1995 . (continued on attachment ------------------------------------------------------------------------------------ i4. What particular act or omission on the part of county or district officers, servants or-employees caused the injury or damage? Contra Costa County and the Superior Court for the County of Contra Costa failed to pay Rand Investigations for services rendered in the case People v. (continued on attachmnet ) (over) 5. What are the names of WtY or district officers, seres or employees causing the damage or injury? The true names of County of Contra Costa " employees or officers causing damage are unknown at this time. ' The Superior Court ' s determination that Rand Investigation ' s —billing was not fundable under Penal Code (continued on attachment ) ------------ 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Damages are currently in the amount that is ' claimed in the lawsuit filed against Ms . Hart and Mr. Bull ( $43 , 649 . 25 ) plus the reasonable (continued on attachment 7.~How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) Damages are computed as the amount claimed in the lawsuit ( $43 , 649 . 25 ) plus the costs of defending in this action and reasonable attorney ' s fees billed at $250.00 an hour . ---------------------------------------------------------------------------------- 8. Names and addresses of witnesses, doctors and hospitals. Virginia Hart- P.O. Box 8342 Berkeley, CA 94707 Donald L. Bull , Jr. - 706 Main St. , Suite B Martinez, CA 94553 Francie Koehler- 266 Seventeenth St . , Oakland, CA 94612 ------------------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 4/14/95 attorney ' s fees 4 hours at $250/hour (answer to complaint ) 5/25/95 , attornev ',s 'fees 4. 5 hours at $250/hour (discovery) 6/8/95 'attbrnq&s fees 6 . 5 hours (same rate) (x-complaint) Gov. Code Sec. 910.2 provides: The claimy the claimant SEND NOTICES TO: (Attorne:�) or some ;Fzrsons,0iRgTehalf." Name and Address of Attorney DONALD L. BULL, JR. 706 Main S. , Suite B lalmant's ture Martinez, CA 94553 Address Martinez, CA 94553 510-228-9870 Telephone No. 510-228-9870 Telephone No. 510-228-9870 * * * * * * * * 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. V ATTACHMENT TO CLAIM OF VIRGINIA HART and DONALD L. BULL, JR Continued from pages one and two: 3. Said complaint alleges that Virginia Hart and Donald L. Bull, Jr. owe Rand Investigations $43,649.25 as payment for investigative services rendered in the capital murder case PEOPLE v. PARKER, Contra Costa Superior Court case no. 934193-4. Ms. Hart and Mr. Bull assert that Rand Investigations was in fact employed by and under contract with the COUNTY OF CONTRA COSTA and the SUPERIOR COURT FOR THE COUNTY OF CONTRA COSTA to provide above mentioned services in accordance with California Penal Code section 987.9. 4. PARKER. This failure by the Superior Court and/or the County to pay for said services caused Rand Investigations to file the instant action against Virginia Hart and Donald L. Bull, Jr. 5. Section 987.9 was made by the Honorable Judge Douglas E. Swager, b, costs of defending against this action and for attorney's fees of$250.00 an hour in an amount not presently ascertainable. CLAIM ) 91 g BOARD OF SUPERVISORS OF CONTRA. COSTA COUNTY, CALIFORNIA August 8, 1995 Ct?;m an?inst the County, or District governed by) BOARD ACTION 7::r� S::;:ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Beard 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: $639.28 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Lynn M. Griffin ATTORNEY: Date received ADDRESS: 2690 W. Newell Ave. BY DELIVERY TO CLERK ON July 25, 1995 Walnut Creek, CA 94595 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. QQHH gg � DATED: July 27, 1995 BYIL DeputyLOR, Clerk I1. FROM: County Counsel TO: Clerk of the Board of Supervisors (%,-,�T 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: eputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this dame. Dated: 61M � 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: 7 S BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator JUN-29-1995 15:00 FROM. -CC RISK MANAGEMENT TO �` - 97695033 P.02iO3 --, `o:. BOARD OF ERV ISORS OF COh7RA C=A COUNTY • YhSTRUCTIONS TO CLAIMANT k. Clai=s relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, trust 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 rause 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 91553. 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 RE: Claim By ) Reserved for Clerk's filing stamp LYNN M. GRIFFIN ) RECEIVED Against the County of Contra Costa District) CLERK BOARD OF SUPERVISORS ((Fill, in * ) CONTRA COSTA CO.The undersigned claimant hereby masses claim against the County of Contra Costa or the above-named District in the sum of $ 5639.28 ;P--id in support of this claim represents as follows: 1. When did the damage or injury occur? -(Give exact date and hour) 6/24/95 AT 4:00 pm . r urs r+• � w .-- -- - - - 2. Where did the damage or injury .occur? (Include city and county) WEST BOUND ON OLYMPIC BLVD BETWEEN WILLOW ST-AND ALDER AVE.WALNUT CREEK CONTRA COSTA COUNTY 3. How did the damage or injury occur? (Give full details; use extra paper if required) DAMAGED RIGHT FRONT RIM FROM..IMPACT WITH UNREPAIRED POTHOLE 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? UNREPAIRED POTHOLE, THE CAUSE OF WHICH I BELIEVE TO BE DUE TO SAW CUTS IN PAVEMENT, WATER AND HEAVY EQUIPMENT BY THE ROAD CONSTRUCTION CREW. (SEE INCLOSED PHOTOES) . JUN-29-1995 15:00 FROM/ �:C RISK MANAGEMENT TO ," 97695033 P.03iO3 ":> wryakt are the I7cyes of county or district officers, servants or pioyees causing rt he or injury? GHILOTTI CONSTRUCTION COMPANY 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. DAMAGED RIGHT FRONT RIM AND FRONT END ALIGNMENT 7. How pvasow vas cs the amountive inyt claimed above computed? (Include the estimated amount of any • RECIEPT FOR REPAIR BY or �ER.TIRE SERVICE WALNUT CREEK-.FOR FRONT END ALIGNMENT • ESTIMATE FOR RIM REPLACEMENT BY DEALS ON WHEELS AND ADLER TIRE SERVICE, 8. dames and addresses of witnesses, doctors and hospitals. N/A +9. List the expenditures you made on account of this accident or injury: DATE ITS': AMOUNT 6/30/95 FRONT END ALIGNMENT $45.00 Gov. Code Seca 910;2 provides: nThe claim wast be signed by the Claimant SSD NOTICES TO: (Attorney) or b some per= on his behalf.tt Name and Address of Attorney �& C Signature .2,loqt0 1A), aexEU AtI6 Address. Telephone No. Telephone No Q-21' e� N 0 T I C H 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 x$10,000, or by both s-ah imprisonm�en; and Pint. TOTAL P.03 r . .t E a ,INVOICE NO. 3925 VTREET SHIPPED TO r NO. STREET& NO. STATE ZIP CITY STATE ZIP t CUSTOMER'S ORDER SALESMAN TER7 F.O_.B. DATE LU yC G 6/.: ..�� 7777 77' 77 - 1 INVOICE NO. 3924 o SOLD TO, SHIPPED TO STREET& NO. STREET& NO. CITY STATE ZIP CITY STATE ZIP . CUSTOMER'S ORDER SALESMAN TE MS - F.O.B. DATE ui O V X9-3 is �r,..��" �f! ;`(�. t/t.-�'L-�G'� `� �E='l✓ ��/P it �7�c�:.., ��•:li'C/ � "1 l / Q REDIFORM, l v'v 7L 706/ 01706 sDLERTIRE.&AUTOMOTIVE ti;! Lv�'�{ Time a Receive 1350 PINE STREET, WALNUT CREEK, CA 94596 PHONE:(510)933- 833 BAR NO.AB004459 Promised L__. _ Written By Phone when ready? Yes❑ No .:,_• <;•:Y:;; �:'•�I_�t'.:w:.%;_.:.cr-�-.;:._ � r ;-� � j Address Apt-No. P Res. +'. +i Ciry Zip N Bus. E ee..No. Od P.O.# lys TERMS: CASH CHECK MIC CHARGE - i I hereby authorize the above repair work to be done along with the necessarY mater ESTIMATE AMOUNT$ hereby grant,you an your emp10 .permiss on to ope ate the car,buck o. herein descr+beo on expiessstreets,highways or elsewhere for the purpose of testing TIME OF ADDITIONAL REP gg PH ios epic a oemo etre eh che enaca��iel dte ehdeIddenl oo above ible foloss to s or AIR r:: �••::. ^ - ••�- - - our control.articles the event an attorn Pts retained h foreclose this be^or to ausE Y • ^'^`• � ".� �^ � _ collection of any sums due,I agree to ay costs of collection and reasonable atlornej ESTIMATED COST$ TIME OF ADDITIONAL REPAIR PH Authorized By l 1 REVISED I PARTS LABOR TOTAL EST.BY WHO MADE CALL? ESTIMATE Is -✓ �^"� I PHONE NO. WHO APPROVED REVISED ESTIMATE? --`' APPROVAL DATE TIME CALLED ••-- i o -''-' '' -.: ft• OTY.'' PART NO.AND DESCRIPTION PRICE' AMOUNT .r ^ 1 ALIGNMENT 2 WHEEL RF, LF, RR, LR CASING DISPOSAL WEIG TS AND STE CASING ENVIRONMENTAL TAX RECOMMEN D ER IC &COMMENTS TOTALS TOTAL LABOR TOTAL PARTS TAX TOTAL LABOR TOTAL .. . .......... _...... -- ._......- -.......__.n::n............................. + ................. _ ................. CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA - August B, 1995 cl?im an?inst the County, or District governed by) BOARD ACTION t`:: 2::.rd ,` S;.,pervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $25,000.00 Section 913 and 915. 11It arnings". CLAIMANT: Sherri Gonzales and Genos Williams (a minor) JUL ' 2 ft ATTORNEY: Elizabeth M. Guagenti CWNTYCOUNE£L Jacoby & Meyers Date received MAPMNEZCAUF. ADDRESS: 100 Bush Street, #700 BY DELIVERY TO CLERK ON July 11, 1995 San Francisco, CA 94104 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. ` GATED: July 12, 1995 eeHHIL BATCHELOR, Clerk BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( L� 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). { a' Other: PLe� mr1 d2 .Q w4i(t Dated: 7 -/'3 —S S� BY: AzDeputy 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. BOAX D 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 tjj4AP, CAAAPh an . 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: nAAAA,,Vf ) 9 9S BY: PHIL BATCHELOR by aPO 14Deputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CON'T'RA 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 1069 County Administration Building, 651 Pine Street, Martinez, CA 94553• C. If claim is against a district governed by 'the Board of Super visor s, ;ether 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 Sherri Gonzales ) RECEIVED a,nd �etiv 95ed Genos Williams (a minor) ) JUL I19 Against the County of Contra Costa ) or ) West Contra Costa CLERK BOARD OF SUPERVISORS Unified School District District) CONTRA COSTA CO. Fill in name ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 2 5 , 0 0 0 . 0 0 and in support of this claim represents as follows: -------------------------------- ----------------- 1. When did the dar age or in"uL"y occur? (Give s;;Get date and hour) Janu xX_J._, i 9 5 b�e tin .1.:. j, m _a n d._2s11.0 ---------- 2. . Where did the damage or injury occur? (Include city and county) Pinole EJr. :High School, -1575 Mann DrivePinole, Contra Costa County 3. How did the damage or injury occur? (Give full details; use e paper if required) Genos Williams, a minor, was attending his PE class in the gymnasium of Pinole Jr. High School . He teacher, Mr. Sinclair Porter, was wrestling with him and negligently over extended his lift armi_c�; G1 onat ;ns elbow. ------------------ 4. What .particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Mr. Sinclair Porter, the PE teacher for Pinole Jr. High School, negligently . over extended Genos Williams ' left arm while wrestling with him. (over) 5. What are the names of county or district officers, servants or employees causing . ,-. the damage or injury? 1) Mr. Sinclair Porter, PE Teacher for Pinole Jr. High School 2) Other identities unknownat this time ------------- ---------------------------------------------------------------------- 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Including, but not limited to: Dislocated left elbow/arm ------------------------------------------------------------------------------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Estimated - an itemized listing of medical specials is not available at this time. ------------------------------------------------------------------------------------- 8. Names and addresses of witnesses, doctors and hospitals. 1) Doctor' s Hospital-2151 Appain Way, Pinole, CA 2) Other identities not known at this time ------------------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 1/13/95 Doctor ' s Hospital $188 .50 (Note : . Other expense's not known at time of filing) Gov. Code Sec. 910.2 provides: "The claim must be by the claimant SEND NOTICES TO: (Attorney) or ;some erso on his behalf." Name and Address of Attorney Ms. Elizabeth M. Guagenti Cla t s tune Jacoby and Meyers 100 Bush Street, #700 133 Lotus Court San Francisco, CA 94104 Address Hercules, CA 94547 Telephone No. (415) 399-8951 Telephone No. (510) 245-7254 .N O T I C E Section 72 of the Penal _Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. CLAIM C g )0,- BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA August-8,1-995- , Ci?;m against the County, or District governed by) BOARD ACTION �` S::;:ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Unknown Section 913 and 915.4. Please note fffannn111ll "WarninRgss"". CLAIMANT:Beet L. EllisonY� ATTORNEY:Stanley J. Bell, Esq. JUL 2 j995 Date received ,,p��YCOUNSEL ADDRESS: Two Tranamerica Center BY DELIVERY TO CLERK ON July 19,CNI �INEZCALIF. 505 Sansome St. , 18th Floor San Francisco, CA 94111 BY MAIL POSTMARKED: July 18, 1995 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: July 21, 1995 JAIL DepuiyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 7 Z / 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). 1V. BOARD ORDER: By unanimous vote of the Supervisors present This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or 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: ",, d— J , ��195� BY: PHIL BATCHELOR byJ.111A. Deputy Clerk CC: County Counsel County Administrator r I CLAIM FOR DAMAGES FOR PERSONAL INJURIES 2 TO: BOARD OF SUPERVISORS 3 COUNTY OF CONTRA COSTA 651 Pine 4 Martinez, California 94553 5CONTRA COSTA COUNTY FIRE PROTECTION DISTRICT 651 Pine Street, Room 106 6 Martinez, CA 94553 RECEIVED 7 KNIGHTSEN FIRE DEPARTMENT STATION 94 JUL 19 ? 8 15 A Street Knightsen, CA 94548 CLERK BOARD OF SUPERVI5ORS 9 CONTRA CO5TA CO. a 10 PLEASE TAKE NOTICE that the undersigned hereby serves and makes demand a oWo 11 upon you for the cause and amounts set forth in the following claim: g gig 12 Claimant's Name and Address: d o w 13 BETTY L. ELLISON J! 5111 Sellers Avenue 14 Oakley, California 94561 o „ e .. rA O•Xe � n W Z NJ, 15 Claimant's Mailing Address to which Notices are to be Sent: �dh F ►►►o h 16 Stanley J. Bell, Esquire LAW OFFICES OF STANLEY J. BELL a 17 Two Transamerica Center 505 Sansome St., 18th Floor 18 San Francisco, California 94111 19 Amount of Claim: 20 Special damages and expenses proximately caused by the occurrence 21 described below and general damages are in excess of the jurisdictional minimum of 22 the Superior Court. 23 Date and Place of Occurrence giving rise to the Claim Asserted: 24 On or about the 18th of January, 1995 at 5111 Sellers Avenue in the City of 25 Oakley, County of Contra Costa, State of California. 26 Description of Occurrence: 27 That on or about the aforementioned date and for some time prior thereto, the 28 above-named public entities, by and through their agents, servants and employees, 1 undertook and agreed to diagnose claimant's condition and to care for and treat her 2 and to do all of the things necessary and proper in connection therewith; that said 3 public entities, and each of them, thereafter entered into such care and treatment 4 individually and by and through their agents and employees. 5 That on or about January 18, 1995, said public entities, and each of them, so 6 negligently and carelessly examined claimant and diagnosed or failed to diagnose 7 claimant's condition and so negligently and carelessly treated and physically 8 . transported claimant wtih the use of instrumentalities, medicines and procedures, the 9 exact nature of which is unknown to claimant, and which instrumentalities, medicines 10 and procedures were under the sole and exclusive control and custody of said public 11 entities, and each of them, that claimant's was caused to and did, suffer severe w ° 8~8 12 personal injuries. �� Q ; 13 DATED: July 18, 1995 14 LAW OFFICES OF STAN BELL edo v a15 j 16 By: 3 ST J. L .ea 17 Attorneys for Claimant 18 19 20 21 22 23 24 25 26 27 28 2 1 RE: Claim of BETTY L. ELLISON 2 PROOF OF SERVICE BY MAIL - C.C.P. Sections 1013a, 2015.5 3 4 I, the undersigned, hereby declare that I am a citizen of the United States, over 5 the age of eighteen years, and not a party to the within action. I am employed by the LAW OFFICES OF STANLEY J. BELL. My business address is 505 Sansome St., 18th 6 Floor, San Francisco, California 94111. 1 served a true copy of CLAIM FOR 7 DAMAGES FOR PERSONAL INJURIES by mail, by placing the same in an envelope, 8 sealing, fully prepaying postage thereon and depositing said envalop,e i,, ha D.S. Mail at San Francisco, California on July 18, 1995. 9 10 BOARD OF SUPERVISORS .aa COUNTY OF CONTRA COSTA 11 651 Pine Martinez, California 94553 12 CONTRA COSTA COUNTY FIRE PROTECTION DISTRICT g� 13 651 Pine Street, Room 106 ° Martinez, CA 94553 14 o e elk KNIGHTSEN FIRE DEPARTMENT wo °' 015 STATION 94 U U!w T 15 A Street F,h �" 16 Knightsen, CA 94548 17 I declare under penalty of perjury that the foregoing is true and correct. 18 Executed in San Francisco, California on July 18, 1995. 19 20 l �o. 21 Carol McMahon 22 23 24 25 26 27 28 3 t e a �A b t. 1 + ® cr © W a ' U �A r• d a f1 CLAIM �) BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA ,_August 8; 1995 C1a4m An?inst.the County, or District governed by) BOARD ACTION 1'::;ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and 6oard 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 "WarninQ CLAIMANT: John G. Ellison D ATTORNEY: Stanley J. Bell, Esq. JUL Z 110 Date received COUNTY COUNSEL ADDRESS: Two Transamerica Center BY DELIVERY TO CLERK ON MARTINEZ CALIF. July l9, 1995 505 Sansome St. , 18th Floor San Francisco, CA 94111 BY MAIL POSTMARKED: July 18, 1995 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PPHH g DATED: July 21, 1995 BYIL Deputy OR, Clerk 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: "l ` 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 (Y ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: ,S' PHIL BATCHELOR, Clerk, 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 byy �.a Deputy Clerk CC: County Counsel County Administrator 1 CLAIM FOR DAMAGES FOR PERSONAL INJURIES 2 TO: ARD OF SUPERVISORS 3 COUNTY OF CONTRA COSTA 651 Pine 4 Martinez, California 94553 5 CONTRA COSTA COUNTY FIRE PROTECTION DISTRICT 651 Pine Street, Room 106 6 Martinez, CA 94553 RECEIVED 7 KNIGHTSEN FIRE DEPARTMENT STATION 94 .> . 19 G% 8 15 A Street 4Cniahtsen, CA 9454.$ CLERK BOARD OF SUPERVISORS 9 -CONTRA COSTA CO. a 10 PLEASE TAKE NOTICE that the undersigned hereby serves and makes demand a 11 upon you for the cause and amounts set forth in the following claim: ti e� *49 12 Claimant's Name and Address: w W"I d o 13 JOHN G. ELLISON 5111 Sellers Avenue w "v 14 Oakley, California 94561 O 0 Y C v, � o•� o u 15 Claimant's Mailing Address to which Notices are to be Sent: fs+d��Fy O 16 Stanley J. Bell, Esquire LAW OFFICES OF STANLEY J. BELL a 17 Two Transamerica Center 505 Sansome St., 18th Floor 18 San Francisco, California 94111 19 Amount of Claim: 20 _ SFpivCiiul dui i ic�.gvv anv+ vi Nvn.C.�:.G. rvxii'e ia+�l j �iu:.i.C.vd ✓� lily vcvU. rvnvv 21 described below and general damages are in excess of the jurisdictional minimum of 22 the Superior Court. 23 Date and Place of Occurrence giving rise to the Claim Asserted: 24 On or about the 18th of January, 1995 at 5111 Sellers Avenue in the City of 25 Oakley, County of Contra Costa, State of California. 26 Description of Occurrence: 27 That on or about the aforementioned date and for some time prior thereto, the 28 above-named public entities, by and through their agents, servants and employees, F a. 1 undertook and agreed to diagnose claimant's spouse, Betty L. Ellison's, condition and 2 to care for and treat her and to do all of the things necessary and proper in connection 3 therewith; that said public entities, and each of them, thereafter entered into such care 4 and treatment individually and by and through their agents and employees. 5 That on or about January 18, 1995, said public entities, and each of them, so 6 negligently and carelessly examined claimant's spouse, Betty L. Ellison and diagnosed 7 or failed to diagnose claimant's spouse's condition and so negligently and carelessly 8 treated and physically transported claimant's spouse wtih the use of instrumentalities, 9 medicines and procedures, the exact nature of which is unknown to claimant, and a 10 which instrumentalities, medicines and procedures were under the sole and exclusive .a oWa 11 control and custody of said public entities, and each of them, that claimant's was w i 8 12 caused to and did, suffer severe personal injuries, thereby causing claimant herein to 13 be deprived of the consortium, conjugal society, comfort, affection, companionship, w 14 moral and emotional support of his said wife. rA J 15 DATED: July 18, 1995 E d h H 16 LAW OFFICES OF STANLEY BELL a 17 18 By: STANLEY J. BE 19 Xtorneys for Claimant 20 21 22 23 24 25 26 27 28 2 1 RE: Claim of JOHN G. ELLISON 2 PROOF OF SERVICE BY MAIL - C.C.P. Sections 1013a, 2015.5 3 4 I, the undersigned, hereby declare that I am a citizen of the United States, over 5 the age of eighteen years, and not a party to the within action. I am employed by the LAW OFFICES OF STANLEY J. BELL. My business address is 505 Sansome St., 18th 6 Floor, San Francisco, California 94111. I served a true copy of CLAIM FOR 7 DAMAGES FOR PERSONAL INJURIES by mail, by placing the same in an envelope, 8 sealing, fully prepaying postage thereon and depositing said envelope in the U.S. Mail at San Francisco, California on July 18, 1995. 9 10 BOARD OF SUPERVISORS a COUNTY OF CONTRA COSTA m 11 651 Pine Martinez, California 94553 a$ 12 CONTRA COSTA COUNTY FIRE PROTECTION DISTRICT 13 651 Pine Street, Room 106 H Martinez, CA 94553 0 14 KNIGHTSEN FIRE DEPARTMENT = °� $ 5i STATION 94 15 15 A Street E a `" 16 Knightsen, CA 94548 3 a 17 I declare under penalty of perjury that the foregoing is true and correct. 18 Executed in San Francisco, California on July 18, 1995. 19 20c 21 Carol McMahon 22 23 24 25 26 27 28 3 t 7 CO r H N rncn O v � +•� .j► ��. � H W .,� ? to a N U � W N it „ WOW W ® Q' O 1N a F'' cr ou "o r� f � c �A Udo � N r p C4 V< CLAIM �Z BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA August-8;1995 Ci;k+m Against•the County, or District governed by) BOARD-ACTION S;:,,ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Unknown D OSection 913 and 915.4. Please note all "warnings% CLAIMANT: John G. Ellison ATTORNEY; Stanley J. Bell J U L 2 0 1995 YCOUN3EL MARTINEZCALIF. Date received ADDRESS: Two Transamerica Center BY DELIVERY TO CLERK ON July 19, 1995 505 Sansome St. , 18th Floor San Francisco, CA 94111 BY MAIL POSTMARKED: July 18, 1995 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PpHHIL BATCHELOR, Clerk + DATED: July 20, 1995 BY: 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: L► 5 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: 9 PHIL BATCHELOR, Clerk, By hJA 64,�U . Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. i Dated: C BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator r • 1 CLAIM FOR DAMAGES FOR PERSONAL INJURIES 2 TO: BOARD OF SUPERVISORS 3 COUNTY OF CONTRA COSTA 651 Pine 4 M rtinez, California 94553 5 CONTRA COSTA COUNTY FIRE PROTECTION DISTRICT 651 Pine Street, Room 106 6 Martinez, CA 94553 RECEIVED 7 KNIGHTSEN FIRE DEPARTMENT STATION 94 JUL 9 1995 8 15 A Street Knightsen, CA 94548 CLERK BOARD OF SUPERVISORS a 9 CONTRA COSTA CO. a 10 PLEASE TAKE NOTICE that the undersigned hereby serves and makes demand J owa 11 upon you for the cause and amounts set forth in the following claim: M $ 12 Claimant's Name and Address: w� �� E"! 5 13 JOHN G. ELLISON 5111 Sellers Avenue w "v 14 Oakley, California 94561 0= d0d 41 Q -11 E15 Claimant's Mailing Address to which Notices are to be Sent: Ed vE. C 16 Stanley J. Bell, Esquire LAW OFFICES OF STANLEY J. BELL a 17 Two Transamerica Center 505 Sansome St., 18th Floor 18 San Francisco, California 94111 19 Amount of Claim: 20 Special damages and expenses proximateiy caused by the occurrence 21 described below and general damages are in excess of the jurisdictional minimum of 22 the Superior Court. 23 Date and Place of Occurrence giving rise to the Claim Asserted: 24 On or about the 18th of January, 1995 at 5111 Sellers Avenue in the City of 25 Oakley, County of Contra Costa, State of California. 26 Description of'Occurrence: 27 That on or about the aforementioned date and for some time prior thereto, the 28 above-named public entities, by and through their agents, servants and employees, 1 undertook and agreed to diagnose claimant's spouse, Betty L. Ellison's, condition and 2 to care for and treat her and to do all of the things necessary and proper in connection 3 therewith; that said public entities, and each of them, thereafter entered into such care 4 and treatment individually and by and through their agents and employees. 5 That on or about January 18, 1995, said public entities, and each of them, so 6 negligently and carelessly examined claimant's spouse, Betty L. Ellison and diagnosed 7 or failed to diagnose claimant's spouse's condition and so negligently and carelessly 9 +rPated and physically transported claimant's spouse wtih the use of instrumentalities, 9 medicines and procedures, the exact nature of which is unknown to claimant, and «a 10 which instrumentalities, medicines and procedures were under the sole and exclusive a oWa 11 control and custody of said public entities, and each of them, that claimant's was ti o� w a 12 caused to and did, suffer severe personal injuries, thereby causing claimant herein to h13 be deprived of the consortium, conjugal society, comfort, affection, companionship, w= "v 14 moral and emotional support of his said wife. rA W k j g-15 DATED: July 18, 1995 0 d N 16 LAW OFFICES OF STANLEY BELL a 17 18 By: SIAN-LEY J. BE 19 Xtorneys for Claimant 20 21 22 23 24 25 26 27 28 2 1 RE: Claim of JOHN G. ELLISON 2 PROOF OF SERVICE BY MAIL - C.C.P. Sections 1013a, 2015.5 3 4 I, the undersigned, hereby declare that I am a citizen of the United States, over 5 the age of eighteen years, and not a party to the within action. I am employed by the LAW OFFICES OF STANLEY J. BELL. My business address is 505 Sansome St., 18th 6 Floor, San Francisco, California 94111. 1 served a true copy of CLAIM FOR 7 DAMAGES FOR PERSONAL INJURIES by mail, by placing the same in an envelope, 8 sealing, fully prepaying postage thereon and depositing said envelope in the U.S. Mail at San Francisco, California on July 18, 1995. 9 10 BOARD OF SUPERVISORS a COUNTY OF CONTRA COSTA m 11 651 Pine Martinez, California 94553 >W' o gig 12 w �' CONTRA COSTA COUNTY FIRE PROTECTION DISTRICT $� 13 651 Pine Street, Room 106 Martinez, CA 94553 w 14 KNIGHTSEN FIRE DEPARTMENT po � o � �& °' STATION 94 U 4 15 15 A Street E" N J 16 Knightsen, CA 94548 17 I declare under penalty of perjury that the foregoing-is true and correct. 18 Executed in San Francisco, California on July 18, 1995. 19 20 21 Carol McMahon 22 23 24 25 26 27 28 3 CLAIM C 1 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA au'gust_8,- 1995 Cia:m analnet the County, or District governed by) BOARD ACTION :` S::;ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Unknown Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Betty L. Ellison J U l 2 0 1995 ATTORNEY: Stanley J. Bell, Esq. COUNTY COUNSELDate received MARTINEZ CALIF. ADDRESS: Two Transamerica Center BY DELIVERY TO CLERK ON July 19, 1995 505 Sansome St. , 18th Floor San Francisco, CA 94111 BY MAIL POSTMARKED: July 18, 1995 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. EV ATCHELOR, Clerk r DATED: July 20, 1995 BY: �eputy 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: 7-2,( ,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 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: ditfiAl q BY: PHIL BATCHELOR by -JVeputy Clerk CC: County Counsel County Administrator 1 CLAIM FOR DAMAGES FOR PERSONAL INJURIES 2 TO: /BOARD OF SUPERVISORS 3 l/ COUNTY OF CONTRA COSTA 651 Pine 4 Martinez, California 94553 5 CONTRA COSTA COUNTY FIRE PROTECTION DISTRICT 651 Pine Street, Room 106 6 Martinez, CA 94553 RECEIVED 7 KNIGHTSEN FIRE DEPARTMENT STATION 94 8 . 15 A Street 9 Knightsen, CA 94548 9 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. 10 PLEASE TAKE NOTICE that the undersigned hereby serves and makes demand a 11 upon you for the cause and amounts set forth in the following claim: V w~I w a 8 12 Claimant's Name and Address: o 13 BETTY L. ELLISON 5111 Sellers Avenue w= "` 14 Oakley, California 94561 v 11 15 Claimant's Mailing Address to which Notices are to be Sent: Gryd�+�F G WT 16 Stanley J. Bell, Esquire LAW OFFICES OF STANLEY J. BELL < 17 Two Transamerica Center 505 Sansome St., 18th Floor 18 San Francisco, California 94111 19 Amount of Claim: 20 Special damages and expenses proximately caused by the occurrence 21 described below and general damages are in excess of the jurisdictional minimum of 22 the Superior Court. 23 Date and Place of Occurrence giving rise to the Claim Asserted: 24 On or about the 18th of January, 1995 at 5111 Sellers Avenue in the City of 25 Oakley, County of Contra Costa, State of California. 26 Description of Occurrence: 27 That on or about the aforementioned date and for some time prior thereto, the 28 above-named public entities, by and through their agents, servants and employees, 1 undertook and agreed to diagnose claimant's condition and to care for and treat her 2 and to do all of the things necessary and proper in connection therewith; that said 3 public entities, and each of them, thereafter entered into such care and treatment 4 individually and by and through their agents and employees. 5 That on or about January 18, 1995, said public entities, and each of them, so 6 negligently and carelessly examined claimant and diagnosed or failed to diagnose 7 claimant's condition and so negligently and carelessly treated and physically 8 transported claimant wtih the use of instrumentalities, medicines and procedures, the 9 exact nature of which is unknown to claimant, and which instrumentalities, medicines 10 and procedures were under the sole and exclusive control and custody of said public a oWa 11 entities, and each of them, that claimant's was caused to and did, suffer severe w��a$ 12 personal injuries. Lot d o 13 DATED: July 18, 1995 w "v 14 LAW OFFICES OF STAN BELL O04) = - rnf � o d in W� 16 By: STANtEY J. BRLL 17 Attorneys for Claimant 18 19 20 21 22 23 24 25 26 27 28 2 1 RE: Claim of BETTY L. ELLISON 2 PROOF OF SERVICE BY MAIL - C.C.P. Sections 1013a, 2015.5 3 4 1, the undersigned, hereby declare that I am a citizen of the United States, over 5 the age of eighteen years, and not a party to the within action. I am employed by the LAW OFFICES OF STANLEY J. BELL. My business address is 505 Sansome St., 18th 6 Floor, San Francisco, California 94111. 1 served a true copy of CLAIM FOR 7 DAMAGES FOR PERSONAL INJURIES by mail, by placing the same in an envelope, R sealing, fully prepaying postage thereon and depositing said envelope in the U.S. Mail at San Francisco, California on July 18, 1995. 9 10 BOARD OF SUPERVISORS a COUNTY OF CONTRA COSTA 11 651 Pine Martinez, California 94553 w W a 12 CONTRA COSTA COUNTY FIRE PROTECTION DISTRICT 13 651 Pine Street, Room 106 Martinez, CA 94553 14 KNIGHTSEN FIRE DEPARTMENT STATION 94 4 15 15 A Street oe= H 16 Knightsen, CA 94548 a17 1 declare under penalty of perjury that the foregoing is true and correct. 18 Executed in San Francisco, California on July 18, 1995. 1.9 20 ri,-Z" , U Q- 21 Carol McMahon 22 23 24 25 26 27 28 3 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA August 8, 1995 �1p�m,aaa�nst• the County, or District governed by) BOARD ACTION ^� r� S-.,,ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Eoard 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 IWalame CLAIMANT; Billy and Rosie Costello JUL Z 1 ATTORNEY: Andy Cohn, Esq. Steven Rood, Esq. Date received SNF UNSEL F. ADDRESS: 600 Grand Ave. , Ste. 410 BY DELIVERY TO CLERK ON July 21, 1995 Oakland, CA 94610 BY MAIL POSTMARKED: July 20, 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 21, 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 -01 q 9J 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, B A 09A Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today 1 deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: q 9S BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Claim 'to: BOARD OF SOPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLADIANT 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_ acerue 'ontor after January 1, 1988, must be presented not later than $ix-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 Billy and Rosie Costello ) RECEIVE® Against the County of Contra Costa ) JUL 2 1 1995 or . ) West Contra Costa Hos i t a 1 District) CLERK BOARD OF SUPERVISORS Fill in name (-Brookside- Hospital ___._ CONTRA COSTA CO. The undersigned claimant:hereby makes claim against the County of Contra Costa or the above-named District 'in the sum of $ suliicient for jurisdiction and in support. of this claim represents as follows: of the Superior Court 1. When did the damage or injury occur? (Give exact date and hour) The first -half of .1995._..(.decedent. received treatment prior to the date of his death, which--occurred--on--or--about May 1-3-,-1.995.-) Where did the damage or injury occur? (Include city and county) Brookside Hospital, San Pablo, Contra Costa County_. 3. How did the damage or injury occur? (Give full_details; ,use extra paper._if required) _ Discovery is. continuing._ Acts and omissions-of Brookside and its employees, agents, independent contractors-,and=members,`of- its-'staff -�in -rendering treatment to decedent Stevestefilo Co L - ; .-,� '` � �-� t 4. What particular 'act``or'omission.on the part of county or district officers, `'_.. servants or employees;caused the"injury' or damage? Discovery is:co�itining. �...�`; �._. . e..� ... .. �..._.�;:.;�.•::� .;a� •... ., __ ,: . _ .- .. �. :. . (over) 5. What are the names of county or,district. officers,"servants or employees causing the damage or injury'.) :4.. Discovery,is. Y_continuing. 6. What damage .'or. injuriesdo you claim'resulted?'d:.(Give"flipextent 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.) w w . . u. .. Not applicable. 8. Names and addresses of witnesses, doctors and hospitals. Brookside Hospital records. Claimants and their family. 9. List the expenditures you made on account of this accident or injury: DATE ITS AMOUNT G Not yet tabulated. '.t' N a Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEID NOTICES TO: (Attorne:•) or by some person on his behalf." - Name and Address of Attorney - Andy Cohen, Esq:_.. . '..:. . . . , - Steven Rood,:...Esq. Claimant's Signature) 600 Grand Avenue, Suite 410 " " Steven,Rood, Esqy Oakland,_CA.__946.10 c/o Billy & Ros e"Costello Address _ w 950 HW-ble-Street y. . ... : . RicYimond, CA 94806 Telephone Nc.(510) .836 s 1 PROOF OF SERVICE BY MAIL (CCP §§ 1013 (A) - 2015. 5) 2 3 4 I am employed in the County of Alameda, State of California. 5 I am over the age of 18 years and not a party to the within 6 action; my business address is 166 Santa Clara Avenue, Oakland, 7 California 94610. 8 On the below-mentioned date, I served the attached: 9 CLAIM FORM AGAINST WEST CONTRA COSTA HOSPITAL 10 on the parties to said matter by depositing a true copy thereof 11 in a sealed envelope with postage thereon fully prepaid, in the 12 United States mail at Oakland, California, addressed as follows: 13 14 Clerk of the Board of Supervisors Marcia Kalapus 15 CONTRA COSTA COUNTY Risk Management County Administration Building BROOKSIDE HOSPITAL 16 651 Pine Street, Room 106 2000 Vale Road Martinez, CA 94553 San Pablo, CA 94806 17 18 I declare under penalty of perjury under the laws of the 19 State of California that the foregoing is true and correct. 20 ' .1 Executed on this day of July, 1995, at Oakland, 21 California. 22 23 24 Nancie Lualhati 25 26 27 28 STEVEN ROOD EIVE® ATTORNEY AND COUNSELOR AT LAW The Warren Building 2 166 Santa Clara Avenue [CLERK780AOFSUPERVISORS¢ Oakland, California 94610 COSTA CO. ! (510) 658-2500 Facsimile: (510) 658-2838 July 20, 1995 Attn: Claims CLERK OF THE BOARD OF SUPERVISORS County Administration Building 651 Pine Street, Room 106 Martinez, CA 94553 Re: Costello and West Contra Costa Hospital/Brookside Dear Clerk: Enclosed please find the original and one (1) copy of the completed Claim Form in connection with the above-referenced matter. Please file the original with the appropriate agency and return the file-endorsed copy to us in the envelope provided. Thank you for your attention to this matter. If you have any questions, please feel free to call. Very truly yours, Nan ieualhati Sec eta to Steven Rood, Esq. N:btc Enclosures SASE {.\clerk) .. /'... CLAIM C , 7 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA August 8, 1995 Clp;m aneinst the County, or District governed by) BOARD ACTION _r�4 :` S::,Iervisors, Routing Endorsements, ) NOTICE TO CLAIMANT arid, Buard Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Unknown Section 913 and 915.4. Please note all "War CLAIMANT: Armand A. Bergeron ' JUL 2 5 1995 ATTORNEY: i,i e-i(5 Date received M�iNEZCIWF ADDRESS: 3653 :its Road BY DELIVERY TO CLERK ON July 24, 1995 Oakley, CA 94561 BY MAIL POSTMARKED: Hand Delivered via: Risk Mgmt. I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. gH DATED: July 25, 1995 JqILATCELOR, Clerk : Deputy I1. FROM: my Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: Z� 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:_ BY: PHIL BATCHELOR by 14 Deputy Clerk CC: County Counsel County Administrator C,a= moo: BOARD OF SJPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Clai:.s relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for-death or for injury to person • or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §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 for= * * * * * * * * * * * * * * a * * * * * * * * * * a * * * * * * * * * * * * * * * * * R£: Claim By ) Reserved for Clerk's filing stamp RECEIVED AgaiREF the County of Contra Costa_ ) JUL 2 41995 or ) District) CLER CONTRA DOSORS COSTA Fill in name ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full details; use extra paper if required) 4. What particular act .or omission on the part of county or district officers, servants or employees caused the injury or damage? 5 � ��? ' ► ADDENDUM TO THE CLAIM OF � t (Print your full name) ( 1) Do you use the roadway as part of a daily commute? Yes (Y—)-,, No ( ) ( 2) Were you aware that construction would be commencing on the roadway? Yes ( ) No ( 3) Was an alternate route available? Yes ( ) No ( 4) Did you read about the impending resurfacing in the local newspaper? Yes ( ) No (IK4 ( 5) Did you see warning signs advising of loose gravel and a 25 mile per hour advisory sign? Yes (Y-4 No ( ) SLS ( 6) Did the damage result from another vehicle exceeding the 25 mile per hour advisory? Yes ( No ( ) 3b-916 v4zQ-, (7) Did a vehicle traveling in the same direction and exceeding the 25 mile per hour advisory sign attempt to pass you? Yes ( ) No (8) Did a vehicle coming from the opposite direction cause gravel to be thrown onto your car? Yes CA No ( ) ( 9) Was the vehicle located directly in front of you exceeding the speed advisory? �� Yes ( ) No ( ) ( 10) Did you travel the roadway more than once during the resurfacing prior to the damage sustained to your car? Yes lNo ( 11) Did you obtain the identity of the car relating to questions 6 thru 9? Yes ( } No ( -A --tom If yes, please provide identification below: ( 12) Please describe in your own words how the gravel caused damage to your vehicle and the angle the gravel was thrown onto the car, along with the specific damaged parts on your vehicle. caz ON- ( 13) were you aw e that using the road during the chip seal process might result in damage to your car? Yes ( ) No I declare that the above inf mation is true and correct under the penalty of perjur . ( Signature) -z 2 `- (Date) r. CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA August 8, 1995 the County, or District governed by) BOARD ACTION S::;;ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and SDard 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: La Rue Matney ATTORNEY: ;�'� , ate received ADDRESS: 1670 Tice Valley B ginezt0k941 �, Y DELIVERY TO CLERK ON July 27, 1995 Walnut Creek, CA 94596 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 27, 1995 BTIL DepuLYLOR, Clerk V 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: Z G o - 5 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. 1 Dated S 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:4. BY: PHIL BATCHELOR by A 4 eputy Clerk CC: County Counsel County Administrator Cla_- to: BOARD OF SJPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Clai-s relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for-death or for injury to person • or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code 5911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. . If claim is against a district governed by the Board of Supervisors, rather than the County, the name -of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this FO RE: Claim By ) Reserved for Clerk's filing stamp RECEIVE® Against the County of Contra Costa_ ) 7 or ) CLER COtVTRA�OST7uA CO ISORS District) Fill in name ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ /,�.�� °��. �_�__ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) �/Z]1 0fD(l JCL.ACV (�2' 3. How did the damage or injury occur? (Give frill details; use ex ra paper if required) � � j 16a, &Z RL _4�. . a u. What particular act or omission on the part of county or district officers, se.-vants or employees caused the injury or damage? _ coeevt, 7. wnat are the names of county or district officers, servants or employees causing; the da:--age or injury? n D_ -n Ll 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach�� .estimates for uto��''�a- � Ce 7. How was the amountclaimedabove computed? (Include the estimated amount of any prosprec/Jtiveinjury o/vu�adamage �.c.�-� ' /1% S-AJC.• o /.. ��u> �Q WA, A HAI 11 4, r 7, $. Names and addresses o , witnesses, doctors and hospi s. 9. List theexpendituresyou made on account of this accident or injury: DATE - .ITEM- - ,_ AMOUNT 1 ;, 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 O�- (Claimant's Signature r6 T ✓ Address. Telephone No. Telephone No. 3 " 3 (:i-�� 7 NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for Payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and 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:rrxentt and fine. CLAIM �p d .. / BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA August 8, 1995 Cl?;`T n6?hist the County, or District governed by) BOARD ACTION ": -,::.rj S::;:ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $361.60 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Carol Blackwell ��a � ATTORNEY: � - J�� 4appovate received ADDRESS. 5460 Sandmound Blvd. �neZ,GP11� BY DELIVERY TO CLERK ON ,hely 27,, 1995 Oakley, CA 94561 " BY MAIL POSTMARKED: July 2.6,. 1995 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. QQHHIL BATCHELOR, Clerk DATED: July 27, 1995 BY: Deputy dd' 40 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 tate claim (Section 911.3). ( ) Other: Dated: 7 r e7 ) 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. BOARDS ORDER: By unanimous vote of the Supervisors present ( ,/) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated:�,u �Zlt5 7/ HIL BATCHELOR, Clerk, By 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: S BY: PHIL BATCHELOR by eputy Clerk CC: County Counsel County Administrator Clain: 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, 19871 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, 551 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 for=. RE: Claim By ) Reserved for Clerk's filing stamp -0, L n ZC Against the County of Contra Costa ) or ) `� District) RD of guPERVISORs Fill in name ) C1�REC� 6RA COSTA Co. The VIndersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 21 and in support of v , this claim represents as follows:'R����-,y- 1. When did the damage or injury occur? (Give exact date and hour) -Low P 2. Where di the damage or injury occur? (Include city and county) <17 f 3. How did U14 dams a or injury occur? (Give etails; use extra papep �l � required) � S �'2. 'CO--\_� r4 I �. e ------------ veer ma l lY 4. ldh to particular act or omission on the part of county or district-officers -D e' servants or employees caused the injury or damage? �. wnat are the names of county or district officers, servants or employees causing the ta:��be or in jur-�=? . � Q���f 'J-•_J.L\. , e Ess R 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. j Q,�1 C�( 0—A Q)V--,i -- 7. How was the 11 amount claimed above uted? Include the estimated amount of any y prospective injury or damage.) E&43 B. Names and addresses of witnesses, doctors and hospitals. 0 Acs- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT �n Cep y TY)o n CS Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES M .f:(Atto_r•ne ) or by somepe &Sr i,qn his behalf." Name and Address of Attorney Claimant's Signature Address, Telephone No. Telephone No(SDD l `i * * * s * * -- 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 suzh imprisonijent and fine. ADDENDUM TO THE CLAIM OF Cmo U A" ),n (Print your full name) ( 1) Do you use the roadway as part of a daily commute? Yes � No ( ) ( 2) Were you aware that construction would be commencing on the roadway? Yes ( ) No (>C) ( 3 ) Was an alternate route available? Yes ( ) No ( 4) Did you read about the impending resurfacing in the local newspaper? Yes ( ) No (�) ( 5) Did you see warning signs advising of loose gravel and a 25 mile per hour advisory sign? Yes ) No ( ) ( 6) Did the damage result from another vehicle exceeding the 25 mile per hour advisory? Yes ( ) No (7) Did a vehicle traveling in the same direction and exceeding the 25 mile per hour advisory sign attempt to pass you? Yes ( ) No ) ( 8) Did a vehicle coming from the opposite direction cause gravel to be thrown onto your car? �p( j< p�U.�P'�• Yes ( �} No (�) (9) Was the vehicle located directly in front of you exceeding the speed advisory? Yes ( ) No ( 10) Did you travel the roadway more than once during the resurfacing prior to the damage sustained�to y ur car? W e4 e, ,! Q�� dc-' '1 ( ab�i�re�3, ( 11) Did you obtain the identity of the car relating to �t gamowrtd questions 6 thru 9? aAZw WKNA ed Yes ( ) No (�) Gbwn a"Pve- nom If yes, please provide identification below: K-ARO .3* 0+ [2 CO-d (-e{'al r Jo n b Grp i n •��s �-ce�, . ,( 12) Please describe in your own words how the gravel caused damage to your vehicle and the angle the gravel was thrown onto the car, along with the specific damaged parts on your vehicle. Coca - s i`n 1' -� on bo-1-\. \Gh* -e- ccae ► nAnd Lqnip-C Q(2-6 3-;� a dh-,- ro.3 i n Is A U) imish i e-l� O-Ce- -L dofi+ i,A-3oLAn -�- 4—Kc, o h,k ,oS ---o 4u-rn t fvko C 7 azIr-s , ( 13) Were you aware that using the road during the chip seal process might result in damage to your car? Yes ( ) No ( ) I declare that the above information is true and correct under the penalty of perjury. ( Signature) Ci Tate) - » . . , G. ROSE SONS - 230 Chestnut Street JOB WORK ORDER Brentwood, California 94513 DATED OROER (510)634.5609 Fax: (510)634-9693 CUSTOMER'S ORDER NO. PHONE STARTING DATE BILL TO ORDER TAKEN BY ADDRESS ❑ DAY WORK CITY ❑ CONTRACT ❑ EXTRA JOB NAME AND LOCATION Joe PHONC 0 LZ ti � cln S ( , "I+ I ` - "cl l� e,7L N vy 1