HomeMy WebLinkAboutMINUTES - 07091996 - C15 CLAIM
CCCONT;A COSTA CO'i^TY, CAL!;;;NIA
' July 9, 1996
Clam A_eirst the County, or District governed by) BOA-.n ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAimANT
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), giver pursuant to jo
n�i
Amount: p62,000.00 Section 913 and 915.4. Please note all ,mss
193)
CLAIMANT: Booker T. Carloss, II JUN, 1 7 1996
ATTORNEY: COUNTY COUNSEL
Date received MARTINEZ CALIF.
ADDRESS: 2830 Magnolia Street BY DELIVERY TO CLERK ON T„nA 12, 1996
Oakland CA 94608
BY MAIL POSTMARKED: TntPro,fficP
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: June 17, 1996 EVIL �eputyLOR, Clerk 0
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
This claim complies substantially with Sections 910 and 910.2.
( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying
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 ) 9 9 BY: Deputy County Counsel
111. FROM: Clerk of the Board TO: County Counsel (1) County Acministrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOAR/; ORDER: By unanimous vote of the Supervisors present
(✓ ) This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date.
Dated: 9 PHIL BATCHELOR, Clerk, By_J� Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately. *For additional warnino see reverse side of this notice.
AFFIDAVIT OF MAILING
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: gtg A (4BY: PHIL BATCHELOR D� __)Deputy Clerk
CC: County Counsel County Administrator
Terrence StarrProbation Department Contra
COUNTY PROBATION OFFICER
Victim/Witness Program Costa
Q 50 Douglas Drive,Suite 202 County
Martinez,California 94553-8500
SE
(510)313-4170 �0w L'_•q
(510)313-4191 FAX
(800)648-0600
s KzRECEIVED
❑ 2555 EI Portal Drive
San Pablo,California 94806-3303
(510)374-3272 o,SrA_couxT c~ JUN .2 1996
(510)374-3049 FAX
(800)648-0600
{
CLERK E43AF
May 8, 1996
Mr. Booker T. Carloss, II
c/o 7B/51
5555 Giant Hiway
Richmond CA 94804
Re: Application for Crime Victim Compensation
Dear Mr. Carloss:
After reviewing the crime report, it appears our office cannot
represent you in filing a claim for compensation with the State
Board of Control.
You have the right to file an application on your own. If you
would like to do so, please contact this office, and we will mail
you an application.
If you have any questions, please contact the undersigned.
Sincerely,
Donna Andersson
Victim/Witness Program Specialist
DA: -�
Claim 'to: BOARD OF SUPERVISORS OF OONTRA COSTA COUNTY It -t s,
INST UMONS To CLAIMANT
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for death or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. Code 5911.2.)
B. Claims must be filed With the Clerk of the Board of Supervisors at its office in
Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553•
C. If claim is against a district governed by the Board of Supervisors, rather than
the County, the name of the District should be filled in.
D. If the claim is against more than one public entity, separate claims must be
oil.., s7a ns eanch r7_11—le entity_
£. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this
Tor M.
ee • eeea • * • • • * * • a * seeee • erts • • f • e • f * rEa * * ee * ee
RE: Claim By ) Reserved for Clerk's filing stamp
[RK
ECEIVED
Against the County of Contra Costa ) �
or ) UN 1 2 1996
District) ARD OF s, _
Fill in name ) NT€�A Cr
The undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $ (n 000, and in support of
this claim represents as follows:
1. When did the damage or injury occur? (Give exact date and hour)
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2. Where did the damag or injury occur? (Incline city and county)
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3. How did the damage or injury occur? (Give full details; use extra paper if
required) �vdersbon, V rCfiw� W14n�F S �r(�5rzi
t h Coftp li+e. ! tQ wa 4o�,.) Grp Ca -i a ks� -W Skv.,
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4. Wihat particular act or omission on the part of county or district officers,
servants or employees caused the injury or damage?
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y{�� (,CU vr1 �'1'Q r \tSr 1P5QtEI`P_A �1erS�.Cf�
Cbmm4ed pqoav� ) �0,cei+ �ravd ow\� 1�tg'AeArf-
(ove
(ee, eNcla5,24 / pV�
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.5'. What are the names of county or district officers, servants or employees causing
the damage or injury?
tLNhV\G v"Ji(- �iC �� v" `t"� ��� CIGi�r .
S. What damage or injuries do you claim resulted? (Give full extent of in�uriesror
damages claimed. Attach wo estimates for auto damage.
L did receive, �Q, V idiir, 0,6i61& �lxc
41(o Q a 0 DJUS IL-S&
�LJ
7. How was the amount claimed above computed? (Include the estimated-amount of any
prospective injury or damage.) YPr �t (�� j,D° IVIur'asq*<aJ0
G'rDss Ni�lia� ,c` - ,O0,av Frat,\A 1,600," ,Dece,4-`6ZtC1�O°vM.�soe ��5��M�)
U0 , d
S. Names and addresses�tof witnesses, doctors and hospitals.
se
al as,
U Torn,
Ic Cct� I ,
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
p a� Iqa(P JB l'2
j � as
Ilk �
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 .�
0A Cori) -�O req-a+ ; Claimants Signature
Telephone No. ����� ��� � � v� Telephone No. KID) - —qS 3�r
UN W W V q # • f * * f f * '9 f #
NOTICE
Section 72 of the Penal Code provides:
"Every person who, with intent to defraud, presents for allowance or for
payment to any state board or officer, or to any county, city or district board or
officer, authorized to allow or pay the same if genuine, any false or fraudulent
claim, bill, account, voucher, or writing, is punishable either by imprisonment in
the county jail for a period of not more than one year, by a fine of not exceeding
one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in
the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by
both such imprisonment and fine.
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AMENDED C L A'M
Or CON7R4 COSTA CO'!NTY, CA.L !cORNIA July 9, 1996
Claim Against the County, or District governed by) BGA ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAI"1ANT
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 a1 IF,= [ED
CLAIMANT: Elizabeth Mohring JUN 2 0 1996
ATTORNEY: James.C_ Glassford
COUNTY COUNSEL
Date received MARTINEZ CALIF.
ADDRESS: 2033 No. Main Street, Ste. 750 BY DELIVERY TO CLERK ON June 20, 1996
Walnut Creek, CA 94596
BY MAIL POSTMARKED: June 19, 1996
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim, ppHH gg
DATED: BY11 DeputyLOR, Clerk
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
( rte) 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:
L
Dated: � - 2q De:uty County Counsel
I1I. FROM: Clerk of the Board TO: County Counsel(i) County Aoministrator (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.
r
Dated: PHIL BATCHELOR, Clerk, By .J . Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately, *For additional warnino see reverse side of this notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant as shown above.
Dated: BY: PHIL BATCHELOR b eputy Cleric
CC: Cou ty Counsel County Administrator
1
2 RCILERK
ECEIVE®
3 JUN 2010
4
B(ORA COSTTA�CO.
5 Clerk
Board of Supervisors
6 COUNTY OF CONTRA COSTA
651 Pine Street
7 Martinez, CA 94553
8
9 BEFORE THE BOARD OF SUPERVISORS
COUNTY, OF CONTRA COSTA
10
In the Matter of the Claim of
11 Elizabeth Mohring, Claimant,
12 vs .
13 The County of Contra Costa, and
Merrithew Memorial Hospital .
14 /
15 AMENDED CLAIM AGAINST A PUBLIC ENTITY
16 On behalf of claimant, JAMES C. GLASSFORD, a Professional
17 Corporation, hereby presents this amended claim (the original
18 claim having been filed on June 17, 1996 ) to the COUNTY of
19 CONTRA COSTA and Merrithew Memorial Hospital, pursuant
20 California Government Code, Section 910 :
21 1 . The name and post office address of the claimant is :
22 Elizabeth Mohring, 5868 Robin Hood Drive, El Sobrante, CA 94803 .
23 2 . The post office address to which JAMES C. GLASSFORD, a
24 Professional Corporation desires notice of this claim to be sent
25 is 2033 No. Main Street, Suite 750, Walnut Creek, CA 94596 .
26 3 . On or about January 10, 1996, and continuing
27 thereafter, claimant received personal injuries under the
28 following circumstances : claimant sought dental treatment for a
Page 1
7
1 left, upper molar at Merrithew Memorial Hospital . The dentists,
2 doctors, nurses, and staff personnel of the hospital negligently
3 and carelessly cared for and treated claimant, and said care and
4 treatment fell below the appropriate standards of care in
5 California for dentists, doctors, nurses, and staff personnel .
6 More specifically, no consent was obtained for care and
7 treatment (a battery) , and any consent obtained from claimant
8 was based upon only a partial and negligent disclosure of the
9 risks involved in the care and treatment, rather than a full
10 disclosure of said risks; and therefore, any consent given by
11 claimant was not an informed consent. Nonetheless, without
12 claimant' s consent or informed consent, the molar was extracted.
13 The treating dentist was negligent and careless, in that the
14 decision to extract the tooth and the extraction fell below the
15 standard of care for dentists practicing in California; further,
16 the treating dentist failed to refer claimant to a specialist as
17 required by the standard of care. Due to this lack of informed
18 consent and negligence and carelessness, a large hole was
19 created where the tooth had been, leading into the claimant' s
20 sinus cavity. Further, the treating dentist was negligent and
21 careless in his follow-up care, in that he allowed infection to
22 set in at the extraction site and in the sinus cavity. Due to
23 this hole, claimant required further medical treatment
24 consisting of treatment of the infection, two surgeries to close
25 the hole, and copious amounts of pain medication. The treating
26 dentists and doctors in rendering care and treatment following
27 the extraction were negligent and careless, in that their care
28 fell below the appropriate standards of care for dentists and
Page 2
I doctors in California, and they failed to refer claimant to a
2 specialist as required by the standard of care. Due to the
3 lack of informed consent and carelessness and negligence of all
4 of the dentists, doctors, nurses, and staff personnel of the
5 hospital in treating the claimant, claimant continued to suffer
6 from the infection referred to above and required copious
7 amounts of pain medication; claimant underwent an unnecessary
8 surgery on January 19, 1996; further, at some time on or after
9 January 10, 1996, claimant' s left facial nerve was injured and
10 damaged, resulting in excruciating pain. Further, claimant
11 intends to assert all possible causes of action and theories
12 arising out of the above circumstances, including but not
13 limited to, battery for lack of consent, negligence in failing
14 to obtain informed consent, negligence in care and treatment,
15 negligence in failure to give proper care, and negligence in
16 failing to refer to a specialist. As a direct and proximate
17 result of lack of consent and the carelessness and negligence of
18 said public entity and its employees, claimant sustained
19 personal injuries and damages .
20 4 . So far as it is known to claimant and JAMES C.
21 GLASSFORD, a Professional Corporation, at the time of the
22 presentation of this claim, claimant has sustained the following
23 losses, injuries, and damages : injuries to her left, upper jaw
24 and face, consisting of the hole through the jaw into the sinus;
25 infection at the extraction site and into the sinus cavity; the
26 facial nerve injury; medical expenses and future medical
27 expenses; loss of earnings and earning capacity and future
28 earnings and earning capacity; and general damages cognizable
Page 3
I under the law.
2 5 . So far as it is known to claimant, the names of the
3 public employees causing the claimant' s injuries are Joseph
4 Stokes, D.D. S . , Jerry Mattka, D.D. S . , and Lorre Henderson, M.D.
5 Otherwise, the true names and capacities of the public 'employees
6 responsible for the accident referenced above are unknown to the
7 claimant and JAMES C. GLASSFORD, a Professional Corporation,
8 who therefore claim that Does 1 through 100 are in some way
9 responsible for the damages of the claimant.
10 6 . So far as it is known to claimant and JAMES C.
11 GLASSFORD, a Professional Corporation, at the time of
12 presentation of this claim, claimant has incurred damages in an
13 amount within the jurisdiction of the superior court.
14 Dated: June 19, 1996 Respectfully submitted by
JAMES C. GLASSFORD
15 a Professional Corporation
16
17
fl$ by
J es C. Glassfor
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Page 4
1 PROOF OF SERVICE BY MAIL - CCP 1013a, 2015 . 5
2
NAME OF DOCUMENT( S) : AMENDED CLAIM AGAINST A PUBLIC ENTITY
3
I, Gloria J. Murtaugh, declare that: I am employed in the
4 County of Contra Costa, California. I am over the age of
eighteen ( 18) years and not a party of the within entitled
5 cause; my business address is : 2033 NO. MAIN STREET, SUITE 750,
WALNUT CREEK, CA 94596 .
6
On June 19, 1996, I served the above-named document(s) on
7 the attorneys for the parties in said cause, by placing a true
copy thereof enclosed in a sealed envelope with postage thereon
8 fully prepaid, in the United States mail at Walnut Creek,
California addressed as follows :
9
Clerk
10 Board of Supervisors
COUNTY OF CONTRA COSTA
11 651 Pine Street
Martinez, CA 94553
12
I declare under penalty of perjury under the laws of the
13 State of California that the foregoing is true and correct, and
that this Declaration was executed on June 19, 1996, at Walnut
14 Creek, California.
15
Gtd�
16 Gloria J. Must ugh
17
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JAMES C. GLASSFORD
ATTORNEY AT LAW
A PROFESSIONAL CORPORATION
JAMES C.GLASSFORD 2033 NO. MAIN STREET, STE. 750
ATTORNEY ATLAW WALNUT CREEK, CA 94596 (510) 977-4078
June 19, 1996
Clerk
Board of Supervisors
COUNTY OF CONTRA COSTA
651 Pine Street
Martinez, CA 94553
Re: Elizabeth Mohring
Dear Clerk:
Please find enclosed for presentation to the Board the
original and a copy of a AMENDED CLAIM AGAINST A PUBLIC
ENTITY. Please endorse file the copy and return it to me.
Enclosed for your use is a self-addressed, stamped envelope.
Thank you for your courtesy and cooperation.
Yours truly,
JAMES C. GLASSFORD
aProfessiona br tion
by
es C. Glass d
JCG\vss
Enclosures
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CLAIM
BCA' o: S„cck`Icr.-� or ccNT�A c^sTA C0;!NTY, CALi70;NIA July 9, 1996
_ Claim A_ainst the Ccunty, or District governed by) BOA-. ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Cedes ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuanj� p�&
Amount:Unknown Section 913 and 915.4. Please notelJ� 'Warnings".
CLAIMANT: Elisabeth Mohring JUN 17 1996
James C. Glassford
ATTORNEY. COUNTY COUNSEL
: MARTINEZ CALIF.
Attorney at Law Date received
ADDRESS: 2033 No. Main Street, Ste. 750 BY DELIVERY TO CLERK ON June 17, 1996
Walnut Creek, CA 94596
BY MAIL POSTMARKED: June 14, 1996
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
Aerk
DATED: June 17, 1996 JyILTCHELOR, �": Deputy
11. FROM: County Counsel 70: Clerk of the Board of Supervisors
( ilr 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: /
l
Dated: 'J”, �1 9� BY: 1, • Deputy County Counsel
I11. FROM; Clerk of the Board TO: County Coursel (1) County Acministrator (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 warnino See reverse side of this notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant as Shown above.
Dated: BY: PHIL BATCHELOR by Deputy Clerk
CC: County Counsel County Administrator
RECEIVE®
2
3 1 171996
4 Clerk CLERK BOARD OF SUPERVISORS
Board of Supervisors CONTRA COSTA CO.
5 COUNTY OF CONTRA COSTA
651 Pine Street
6 Martinez, CA 94553
7
8 BEFORE THE BOARD OF SUPERVISORS
COUNTY OF CONTRA COSTA
9
In the Matter of the Claim of
10 Elisabeth Mohring, Claimant,
11 vs .
12 The County of Contra Costa, and
Merritew Memorial Hospital .
13 /
14 CLAIM AGAINST A PUBLIC ENTITY
15 On behalf of claimant, JAMES C. GLASSFORD, a Professional
16 Corporation, hereby presents this claim to the COUNTY of CONTRA
17 COSTA and Merritew Memorial Hospital, pursuant California
18 Government Code, Section 910 :
19 1 . The name and post office address of the claimant is :
20 Elizabeth Mohring, 5868 Robin Hood Drive, E1 Sobrante, CA 94803 .
21 2 . The post office address to which JAMES C. GLASSFORD, a
22 Professional Corporation desires notice of this claim to be sent
23 is 2033 No. Main Street, Suite 750, Walnut Creek, CA 94596 .
24 3 . On or about January 10, 1996, and continuing
25 thereafter, claimant received personal injuries under the
26 following circumstances : claimant sought dental treatment for a
27 left, upper molar at Merritew Memorial Hospital . Without her
28 informed consent, the molar was extracted. The treating dentist
Page 1
I was negligent and careless, in that the decision to extract the
2 tooth and the extraction fell below the standard of care for
3 dentists practicing in California; further, the treating dentist
4 failed to refer claimant to a specialist. Due to this
5 negligence and carelessness, a large hole was created where the
6 tooth had been, leading into the claimant' s sinus cavity. Due
7 to the hole, claimant required further medical treatment
8 consisting of two surgeries to close the hole and copious
9 amounts of pain medication. The treatina .dentists and doctors
10 in rendering care and treatment following the extraction were
11 negligent and careless, in that their care fell below the
12 appropriate standards of care for dentists and doctors in
13 California. Due to the carelessness and negligence of all of
14 the dentists and doctors in treating the claimant, claimaint' s
15 left facial nerve was injured and damaged, resulting in
16 excruciating pain. As a direct and proximate result of the
17 carelessness and negligence of said public entity and its
18 employees, claimant sustained personal injuries and damages .
19 4 . So far as it is known to claimant and JAMES C.
20 GLASSFORD, a Professional Corporation, at the time of the
21 presentation of this claim, claimant has sustained the following
22 losses, injuries, and damages : injuries to her left, upper jaw
23 and face, consisting of the hole through the jaw into the sinus
24 and the facial nerve injury, medical expenses and future medical
25 expenses, loss of earnings and earning capacity and future
26 earnings and earning capacity, and general damages cognizable
27 under the law.
28 5 . So far as it is known to claimant, the names of the
Page 2
I public employees causing the claimant' s injuries are Joseph
2 Stokes, D.D. S. , Jerry Mattka, D.D. S . , and Lorre Henderson, M.D.
3 Otherwise, the true names and capacities of the public employees
4 responsible for the accident referenced above are unknown to the
5 claimant and JAMES C. GLASSFORD, a Professional Corporation,
6 who therefore claim that Does 1 through 100 are in some way
7 responsible for the damages of the claimant.
8 6 . So far as it is known to claimant and JAMES C.
9 GLASSFORD, a Professional Corporation, at the time of
10 presentation of this claim, claimant has incurred damages in an
11 amount within the jurisdiction of the superior court.
12 Dated: June 14, 1995 Respectfully submitted by
13 JAMES C. GLASSFORD
a Professional Corporation
14 7
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16 by me C. 's
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Page 3
1 PROOF OF SERVICE BY MAIL - CCP 1013a, 2015 .5
2
NAME OF DOCUMENT(S) : CLAIM AGAINST A_ PUBLIC ENTITY
3
I, Gloria J. Murtaugh, declare that: I am employed in the
4 County of Contra Costa, California. I am over the age of
eighteen ( 18) years and not a party of the within entitled
5 cause; my business address is : 2033 NO. MAIN STREET, SUITE 750,
WALNUT CREEK, CA 94596 .
6
On June 14, 1996, I served the above-named document( s ) on
7 the attorneys for the parties in said cause, by placing a true
copy thereof enclosed in a sealed envelope with postage thereon
8 fully prepaid, in the United States mail at Walnut Creek,
California addressed as follows :
9
Clerk
10 Board of Supervisors
COUNTY OF CONTRA COSTA
11 651 Pine Street
Martinez, CA 94553
12
I declare under penalty of perjury under the laws of the
13 State of California that the foregoing is true and correct, and
that this Declaration was executed on June 14, 1996, at Walnut
14 Creek, California.
15
16 Glori " J. Murtaugf h
17 J
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JAMES C. GLASSFORD
ATTORNEY AT LAW
A PROFESSIONAL CORPORATION
JAMES C.GLASSFORD 2033 NO. MAIN STREET, STE. 750
ATTORNEY AT LAW WALNUT CREEK, CA 94596 (510) 977-4078
June 14, 1996
Clerk
RECEIVED
Board of Supervisors
COUNTY OF CONTRA COSTA 6
651 Pine Street
Martinez, CA 94553 RVISORS
O.
Re: Elizabeth Mohring
Dear Clerk:
Please find enclosed for presentation to the Board the
original and a copy of a CLAIM _AGA.TNST A PTJRL-TC ENTITY,
Please endorse file the copy and return it to me. Enclosed
for your use is a self-addressed, stamped envelope.
Thank you for your courtesy and cooperation.
Yours truly,
JAMES C. GLASS OI f
a Pr'- ession Torp ration
f
by
Jmmb s c. r
J G ss
Enclosures
CLAIM
Or CON7R4 COSTA CO'!N'TY, CA1 Ic02NIA
July 9, 1996
Claim Acainst the County, or District governed by) BGA ACTION
the Board of Supervisors, Routing Endorsements, ) NO?ICE 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
(Parag-aph IV below), given pursuant to Government Code
Amount: Unknown Section 913 and 915.4. Please note all IIs,
CLAIMANT: Sandra Beasley
JUN 13 1996
ATTORNEY: Pamela J Zaid, Esq. COUNTY COUNSEL
Zaid & Della Santa Date received MAFITINEZ CALIF.
ADDRESS: 1777 Botello Dr. , Ste. 100 BY DELIVERY TO CLERK ON June 12, 1996
Walnut Creek, CA 94596
BY MAIL POSTMARKED: June 11, 1996
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: June 13, 1996 J�ll DepuLylOR, 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 5pply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: �'�"��— 7 , g X� BY: Deputy County Counsel
I11. FROM: Clerk of the Board TO: County Coursel (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 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant as shown above.
Dated: BY: PHIL BATCHELOR b puty Clerk
CC: Ccu^ty Counsel County Administrator
2 PELA J. ZAID, ESQ.
SAtaMte Bar No. 115341 RECINED
3 ZAID & DELLA SANTA
1777 Botelho Drive, Suite 100
4 Walnut Creek, California 94596
Telephone: (510) 930-6695
5 FS
Facsimile: (510) 939-5241 cLER AIA CO.
6 Attorneys for Defendant and
Claimant SANDRA BEASLEY
7
8
9
10
IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA
1
11 IN AND FOR THE COUNTY OF CONTRA COSTA
12 DOROTHY VILLMAN, NO. : C95-04814
13 Plaintiff,
14 V' CLAIM AGAINST A
PUBLIC ENTITY
15 CITY OF ANTIOCH, CALIFORNIA;
ALMA JOHNSON; CHARLES JOHNSON;
16 MRS . BEASLEY; and DOES 1 to 10,
17 Defendants..
18
19 1 . The address of Claimant is as follows :
20 909 Fitzuren Road, Antioch, California 94509
0 2 . The address to which Claimant desires notice of this
41
22 claim to be sent is as follows :
23 Pamela J. Zaid, Esq.
Zaid & Della Santa
24 1777 Botelho Drive , Suite 100
Walnut Creek, CA 94596
25 3 . On December 28 , 199S , Claimant was served with a Complaint
20
alleging personal injury" sustained by Dorothy Villman while walking
27 across the creek overpass that accesses 911 to 917 Fitzuren Road and
28
bridges the West Antioch Creek. It is alleged that on November 2 ,
. .
. .
`
u
2 1994 , Ms . Villman tripped and fell intg the creek bed as a result
'
3 of the dangerous condition of the overpass . A true and correct copy
4 of the Complaint is attached hereto.
5 Claimant is informed and believes and thereon alleges that the
6 County of Contra Costa owned or was responsible for the maintenance
7 of the West Antioch Creek and the creek overpass that accesses 911
8 to 917 Fitzuren Road at the time , of Mii�- 'Villmanls accident.
9 4 . It is alleged that Dorothy Villman injured her right
10 ankle, knees and right hand. Claimant alleges that, in the event
11 that liability should be established in this action on the part of
12 Claimant, which liability is expressly denied, such liability will
13 arise solely by reason of the active and primary conduct and
14 negligence of the County of Contra Costa and its agents and
15 employees . The County of Contra is therefore bound and obligated to
16 defend, indemnify and hold .harmless Claimant from and against any
17 and all claims, losses, damages, attorneys, fees, judgments and
settlement expenses incurred or to be incurred in this action by
1m
19
20 S . The name of the public employee (s) causing the injury is
21 unknown to Claimant at this time .
22 6 . Jurisdiction of the claim is alleged to rest in the
23 Superior Court .
24 Claiman _ -Lntends this Claim to be notification to the
2-3 County of Contra Costa that Claimant hereby tenders to the County of
261 Contra Costa the obligation of the County of Contra Costa to defend
2/ Cl.~..^^` , p.r__-_- to Government ---- ---_---- - - - -- --�' ---
28 California Code of Cinil� Procedure Section IO2I . 5 , in that as o
2
|| |
| ( /
2 result of the -negligence of the County of Contra Costa, and its
3 agents and employees, Claimant has been required to defend against
4 the Complaint of Dorothy Villman and hereby demands defense and
5 indemnity from the County of Contra Costa.
6 Dated: June 11, 1996 ZAID & DELLA SANTA
7
8 By
PAMELA J. 7 f r ID
e
I ./-ndant and
9 Attorneys
Claimant
10 SANDRA BEASLEY
11 pjz\405 189\PUBLIC.FNT
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
3
2 PROOF OF SERVICE BY MAIL
3 VILLMAN v. CITY OF ANTIOCH, CALIFORNIA: ALMA JOHNSON; CHARLES
4 JOHNSON; MRS. BEASLEY
CONTRA COSTA COUNTY SUPERIOR COURT NO. : C95-04814
5
6 STATE OF CALIFORNIA
7 COUNTY OF CONTRA COSTA
8 1 am a citizen of the United States of America and an employee
in the County of Contra Costa. I am over the age of eighteen (18)
9 years, and not a party to the within action. My business address is
ZAID & DELLA SANTA, 1777. Botelho Drive, Suite 100 Walnut Creek,
lo California 94596 .
11 On the date set forth below, I served the within CLAIM AGAINST
A PUBLIC ENTITY, by placing a true,, . sealed copy of said document,
12 following the ordinary business practices for collection. in ZAID &
DELLA SANTA' s outgoing mail system on the date set forth below,
13 postage prepaid, addressed as follows:
14 Clerk of the Board
Contra Costa County
15 651 Pine Street, Room 106
Martinez, CA 94553
16 1 am readily familiar with the business' practice for
17 collection and processing of documents for mailing with the United
States Postal Service, and said documents would be deposited with
8 the United States Postal Service at Walnut Creek, California that
same day in the ordinary course of business .
19
I declare under penalty of perjury under the laws of the State
20 of California. that the foregoing is true and correct .
21 Executed on June 11, 1996 , at Walnut Creek, California.
22
23 Debbie Bartman
24
25
26
2 7
28
4
Is IF 1`10 U.4 1 2 : 00 1 A W 0 Ft'Fr I C E:<_3
F
_1,TF�fArZTZj_A3';j'fY_WVr$.0Q-F'TT_7QRN'FM(. t AN AooAF_3:S).. 70 N-F. MR CMRT uSG ONLY
C:A,w Offic,-e of. William J. Dul.`I.r,i (Pat-.- No. 74342 )
34,17 Mt , Diablo Blvd
Lafayette, CA 94549 ( 510 ) 283-9094
I '_
ATT0PNeyF0n(NA&(e3: Plair(rtiff DOROTHY VILLMAN
1` I 5 S
Inaort nSM4 of Court,JudIcIal 0131rict ,beanot poetavrt.If any,and poet addrOAS: 95 COV ID 3:
'n
Contra Costa Country superior Court
1020 Ward Street
P.O. Box 911
Martinez, CA 94553
DOROTHY VILLMAN
DEFENDANT:
CITY OF ANTXOC14, CALIFORNIA; ALMA JOHNSON; CHARLES JOHNSON; MRS- -BEASLEY;
and ,
Ctq[)OESlTO--U._._.
CASG NUMOCA:
COMPLAINT—Pemonal Injury, Property Marnage, Wrongful Death 1) 5 - 04814
=MOTOR VEHICI-15 MOTHEA (3paclly): VreMige..43 Liability
=]Proporly 03(nz9v d Wrongful Death
X]Personal Injury Other Damages(ipocify):
----------------------
-1. This PleAdlng, Including attachments and exhibits, consists of the following number of piges: 4
2. n. Each pinintitt named at)ovc is a competent adult
L- Except plaintiff(narr)a): PER LOCAL. CE 5 THIS
C:D:a corporation qu,*11fled to do buliness In California CASE ISA IGNED TO
an unincorporated entity(describe): DEPT
a public entity (cfascr;be):
a rnfilor L7 an adult
for whom a qu,3rdian or conservator of the estate cr 9 ouardlAn .2d 1111arn has been appointed
other(Spoclfyr
M c)ther(spacify):
Except plaintiff(name):
a corporation qua(Ilied to do business,in California
an unincorporated onilty
(=a publlcontity(de.tcribe):
=A minor (L`)an Adult
= for 2 quardjan or con!s,orvat,,)(of ttij! or a guardian ad lit(irn has noon appoint0d
F-1 Oth4r(SpOcily):
other 0;P,1Ci(Y):
b.
it cjuing tus;ref;-_- ond43,, the fictitious na-MO of(,:P661Y)'
and ha; <-_oMC)11QfA with Iho fiC1
c. (�:3 information nbru# additional W,1;r1z)1lj who ares not comp-at,7nt adults L-3 shown 1ri C(Implaint—
A"achrnonl 2c. Cgntlnurd
IJF_ AID 0FF= ICES
SHORT TITLE: CASE NVIO6ER:
VI;LLMAN V CITY OF nt`V 10CH, CALIFORNXA
COMPLAINT—Personal Injury, property OamaQn; Wrongful death P400 two
3. A. Each defendant turned Abave is a natural pt:rson
® Except defendant(naa)e): (70 Except defendurrt(name):
CITY OF ANTIOCH, CALIFORNXA
C]a business organization, form unknown CD a business organization, form unknown
M a corporation a corporation
Q an unincorporated entity(describe): []an unincorporated entity(describe):
® a public entity(describe): CityfT'a public ont`itp(describe):
other(Specify): Q other(specify):
Except defendant(name): []Except defendant(nbrno). _
{� a business organization, form unknown a business; organization, form unknown
a corporatlon CD corporation
[`] an unincorporated bntity(describe)- an unincorporatbd dnlity(doscribe):
a public entity(d6scriba) a public entity(dewibo):
�..� other(specify): [F]other(spaCify):
b. The true names and caparitics of dofendants sued aS Docs are unknown to plaintiff.
c [1] InformAtlon about additional defenQants who are not natural persons is contained In Complaint—
Attachment 3c.
d. Dclendants who are jo;nad pursuant to Code of Civrf Procedure oection 382 ire (names):
Plaintiff is required to comply with a claim!; statute, and J
a. [ pia;nGff has complied with anplirnt)le claims statutes, pr
b. Q piaintiff Is excusod from complying bocluse(SpOcify).
S. This Cour Is the proper court becau o
(Z at least one def(?ndant now resides in its jurisdictional Brea
[= the principal place of business of a corporation or unincorporated Ja:<soctation Is In Its jun"dictl0nal aros.
Cv 1 In)ury to person or damage to personal pr000rly occurred In Its jurisdictional area.
[ other (spocify):
G. ( J Tho following parn;r;4ph-i of thl, Complaint orn nllpjrrd on inlormatipn end betlet (specify psrag(aDh numbers):
t3 , 10 , PL-1 , r'L-2 and RI,-4
(Continued) PBOs r�'a
1 Sk 5 r-1 0 1-A 1 :2 = 171 L-A W 0 F-f= I C:E S P
AM CASE NUmUEn
VIL.LMM,11 V. CITY 01-- AUTIOCUCALITORNfA
COMPLAINT—Porsonal Injury, property Damage. Wrongful Death (ContlnUad) PA08 tnrqo
7. � The damages r-laimed for wrongful death and the relatlofirlhip', dl plaintiff to the deceased are
litsted in C6mpjaint—Attachment 7 (71 as follows:
8 Plaintiff has Suffarvd
CD loss of use Of property
hosaital and medical expenues general damage
Lo property damage loss of earning capacity
oth.01 daMage WOOD:
9. Relief Sought in this C.-Orripllint is witnin trv,-jtjri$cfictlon of this court.
10. PLAINTIFF: PRAYS
17,.v itidgm4trit for costs of !-,uit: for such rdlief as it;tair,just, and equitable: and for
CM comoensalory darnager,
(Superior Court) according to Proof.
0 (Municipal and Jultice Court) in the amount of
other(specify):
11. The following USUZw5 of llct;On -VO utt" ,Qd and tii(j -;IntHm4iri1,, above ancly to each: (E. Ch complaint
'nt mu,-t have
one or moto cauSCS Of ACOOn v1tRCt)0(f-)
C:"3 Motor Vohicle
Goneral Nagl;gOi1ce
Intentional Torl
Products UablIll'i
Promises U�Ab;l;ly
Otttor(spocify):
11 am J . 1.)u I Ir.,
. . . . .. . . . . . . . . . . . . . .
(Tyno o, w—1
i-r)VI31 AINT—Portonil in[UrY, Property 03M,3ge, Peau m,�e
:2 - C-:# I I A 1_4 tZ)F Ff* I C:E:E:
ocs
'HORT TITLP--
ASG NUU03F-Ft:
VILLMAN V Cv"N( QF' ANTIOCH, CAL-11PORNIA Alk
CAUSE OF ACTION—Premises Liability
(number)
ATTACHMENTTO MjComplaint L:jCro3s-C;omplaint
(Ullo a sapofate cause of action form for oach of action.)
Prnm.L-1. Plaintiff(name): DOROTHY VULMAN
allago-i the soti of dofundatit,,%were the legit(proximate)ciluso of darfl4qeS to plaintiff.
Ott (darp): Novambn. r 2, 1994 , pl.ilnliff w3!l Injurod on tho followltiq promisej In the fallawfng
fashion(description of promises andciri;tjm.tancvs of inlury); P I a i n t i f f was leaving Lhe
home of her granddaught+r on Titzuron joad -in Anttoohf
California. While walking across the creek 6�4:ipasz that
accesses 1911 to 1917 ritzuren Road (sometimes reported as
911 to 917 Fit2uren Road) and bridges the West Antioch
Creek, she fell into the creek bed .
Prorn.L-2. Count ant—Negilgance The defebdants who negligently own'VA, maintained. manatj*jd and operated
the described promhsas were(names):
CITY OF ANTIOCH, CALIFORNIA; ALMA JOHNSON; CHARLES JOHNSON;
MRS . UASLEY and
CMDoor -- J
Prem.1-4 (:-I Count Two—Willful FnIfure to Warn (Civil-Code %-.ection 846) Tho defendant owners who willfully
or maliciously failod to guard or warn Against a dangerous condition, use, structure• or activity ware
(names),
r-- Does
Piaint;ff. q recroational tzer,wan CDarl invited guest �japayinggui'.-;A-
Prom.L-4. Count Thruo--DanUvrou-s Condition of Pvbilc Prop-efty Th(,, (Wendants who owned public oropPrtY
on which ; dangerous condition existed w(iro 018m0s):
CITY OF ANTTOCS, CALIFORNIA; ALMA JOHNSON; CHARLES JOHNSON;
MRS . BEASLEY and
[� 0005 3
Q. Z3 The defendant public entity hnd MaclvAl =ConslructIV6 notice of the existence of the
dangQ(Ous condition in sufficient t1mo prior to the Injury to have corrected It.
n
b, (X3 The condition was cre,3tod by 6mploYonl of the defend.ant public a tity
n. Allogntions 0I)OL't oti-jor oct(jv1dints Tho dQfE)ndRnt!s who were the agent-, grid employees of tho
other d6fandeints and acted within the SCOPO Of the 990r-IcY wOrc 00mcn):
r7i oocn to - - _
b, Tod
doifendant.-, ,who grct fliblf) to plalnziffs w othcr reasons and rho rca-son;{ for tflCIr lintiliry, ate
de,,scrlbod in attachment Ptern*.L-8.b f—
i.
A Pf)'Q'1*d til the
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ZAID & DELLA SANTA
ATTORNEYS AT LAW
BERNARD J. DELLA SANTA 1777 BOTELHO DRIVE, SUITE 100 FACSIMILE: (510) 939-5241
PAMELA J. ZAID WALNUT CREEK, CALIFORNIA 94596
(510) 930-6695
� JE
DATE: June 11, 19 9 6 J(!R� 1TO: Clerk of the Board
Contra Costa County CLERK BQp 651 Pine Street, Room 106 CONTRA
Martinez, CA 94553
RE: Villman v. City of Antioch, et al.
Case No. C95-04814
Dear Clerk of the Board:
Enclosed please find an original and one (1) copy of each of :
CLAIM AGAINST A PUBLIC ENTITY
These dre furnished for the purpose designated below:
[X] Filing and returning of an endorsed, filed copy in
the self-addressed, stamped envelope provided.
[ ] Filing and returning of an endorsed, filed copy in
the envelope provided after securing signature of the Court .
[ ] Recording . and. returning of an endorsed, recorded
copy to the undersigned in the enclosed, self-addressed stamped
envelope provided.
[ ] My check in the amount of $ is enclosed to
cover filing costs/fees ..
[ ] Other:
Thank you for your cooperation in this matter.
Very truly yours,
jw/*
Debbie Bartman,
Secretary to Pamela J. Zaid
3b\
Enclosures
CLAIM
BOA' o: s_�:��Is�-� Or CON7R4 COSTA COUNTY, CAL170;NIA July 9, 1996
V a'.m A_eir.st the County, or District governed by) BGA ACTION-
the
CTIONthe Board of Supervisors, Routing Endorsements, ) NOTICE TO CLA',MANT
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
CZlifornia Government Codes ) the action taken on your claim by the Board of Supervisors
(Parag,aph IV below), given pursuant to Government Code
Amount: $50,000 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: Alan Simonis dba Golden
Valley Produce
ATTORNEY: Peter C Papppas
2400 Sycamore Drive Date received
ADDRESS: Suite 40 BY DELIVERY 10 CLERK ON .i,rna 19, 1 QC)h
Antioch, CA 94509 Hand Delivered
BY MAIL POSTMARKED:
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim. 88
DATED: June 13, 1996 all DeputyLOR, Clerk
11. FROM: County Counsel 70: Clerk of the Board of Supervisors
(� This claim complies substantially with Sections 910 and 910.2.
( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying
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:
X/�
Dated: �� -- i7 f q BY: / Deputy County Counsel
/ U
I11. FROM: Clerk of the Board TO: County Coursel (1) County Acrinistrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
(v/ ) This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date.
Dated: PHIL BATCHELOR, Clerk, B ,Deputy Clerk
61
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately. *For additional warnino see reverse side of this notice.
AFFIDAVIT OF MAILING
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: 1n BY: PHIL BATCHELOR b � Deputy Clerk
CC: County Counsel County Administrator
Claim lo: BOARD OF SUPERVISORS :)F CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for death or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. Code §911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in
:pvN% , County Administration Building, 651 Pine Street, Martinez, CA 94553.
firs floor, Duty Clerk
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
ALAN SIMONIS dba GOLDEN )
«f. RECEIVED
VALLEY PRODUCE )
Against the County of Contra Costa ) L
12 1996
or )
FLOOD CONTROL & WATER District) CLERK BOAV OF SUPERVISORS
Fill in name
CONTRA COSTA CO.
)
The undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $ 50 , 000 . and in support of
this claim represents as follows:
_._-._------------------------------------------------------------=----------------------
1. When did the damage or injury occur? (Give exact date and hour)
On or about May 1996
2. Where did the damage or injury occur? (Include city and county)
Damage to Crop of corn, anticipated and advised.
3. How did the damage or injury occur? (Give full details; use extra paper if
required)
Codemming of property.
------------------------------------------------------------------------------------
4. What particular act or omission on the part of county or district officers,
servants or employees caused the injury or damage?
0
Unknown (over)
5. What are the names of county or district officers, : wants or employees causing
the damage or injury?
i
Unknown
6. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
_ Unkown
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
Per acre and crop.
_---_____—_________________________________________________________________________
8. Names and addresses of witnesses, doctors and hospitals.
VIc Castello
-------------------------------------------------------------------------------------
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
u'
Gov. Code Sec. 910.2 'provides:
"The im mustixbe signed by the claimant
SEND NOTICES TO: (Attorney) o o e 'ers n on is- behalf."
Name and Address of Attorney
LAW-OFFICES OF PETER Claiman 's ignature
C. PAPPAS Peter C. Pappas
2400 Sycamore Drive
Suite 40 Address
Antioch, CA 94509
Telephone No. 510 754-0772 Telephone No. 510 754-0772
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 ($109000, or by
both such imprisonment and fine.
1 PETER C. PAPPAS
ATTORNEY AT LAW
2 2400 SYCAMORE DRIVE,SUITE 40
ANTIOCH,CALIFORNIA 94509
3 TELEPHONE (510)754-0-r72
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5 ATTORNEY FOR
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7
8 Claim By
9 ALAN SIMONIS dba GOLDEN
10 VALLEY PRODUCE,
11 Against
12 CONTRA COSTA COUNTY
FLOOD CONTROL & WATER
13 CONSERVATION DISTRICT,
14 Defendants ,
15 /
16 PLEASE TAKE NOTICE that ALAN SIMONIS dba GOLDEN VALLEY
17 PRODUCE hereby makes a claim for damages based upon the
18 following:
19 That the Flood Control Agency intends to damage a portion of
20 the corn crop by riping it our of the ground.
21 It is estimated that the costs for damages will be $50, 000.
22 The responsible individual or agency is Contra Costa Flood
23 Control .
24 All correspondence or notices regarding the above plaintiff
25 . , should be mailed to the LAW OFFICES OF PETER C. PAPPAS, 240
26 Sycamore Drive, Suite 40, Antioch, 09
27 Dated Jun 11 , 1996
28 PETER C. PAPP S
1 PROOF OF SERVICE
2 1 , KRISTEN SHELDON, declare that: I am employed in the County
of Contra Costa in the State of California. I am over the age of
3 eighteen years and not a party to the within cause. my business
address is 2400 Sycamore Drive, Suite 40, Antioch, California
4 94509 .
5 On June 12 1996, 1 served the within:
6 COMPLAINT FOR DAMAGES
7 on all interested parties in said cause, by delivering a true
copy as follows:
8 x
(By Mail) I place a true copy thereof enclosed in a
9 sealed envelope with postage thereon fully prepaid.
I deposited said envelope in the United States mail
10 at Antioch, California.
11 (By Hand) I place a true copy thereof enclosed in a
sealed envelope. I caused such envelope to be
12 delivered by hand to the offices of the addressee.
13 (By Facsimile) I sent a true copy thereof via
telephone facsimile transmission to the following
14 number(s)
15 Each envelope (if applicable) was addressed as follows:
16 Donna Dawkins
Supervising Real Property Agent
17 255 Glacier Drive
Martinez , CA 94553
18
19 1 declare under penalty of perjury, pursuant to the laws of
the State of California, tha�#:—tbe foregoing is true and correct,
20 and that this declaration was exe-bAkted on June 12 1996 at
Antioch, California.
21
22 KRIST SHELDON
23 Secretary to PETER C. PAPPAS
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