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MINUTES - 07201999 - C42
CLAM BOARD OE SUPEMSORS OF cONIRACOSTA eoUND(. CAi UD WA, ARO a JL 2 1999 Claim Against the County, or District Governed by I tM Beard of 'Supervisors, :;Routing Endorserrients, 1 NOTICE TO CLAIMANT and Board Action. All Section:references are to The copy of this doeurnent mailed;,to youis your California Governmrrt Codes. notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV beloW, given :apursuant to Govermlerd Cade Section 913 and 915.4. Please note ail "Warnings". AMOUNT: $5,600.00 tiNTy COUNSEL CLAIMANT: George F. Beardon MARTINEZ CLIF. ATTORNEY Robin Lipetzky DATE RECEI EI). June 21, 1999 Attorney at Law ADDRESS: $311 Bissell Ave. , 2nd Floor BY DELIVERY TO CLERK ON: June 21 1999 Richmond CA 94805-229$ BY FAIL POSTMAR EI). Juni 1$. 1999' L FROM- Clerk of the Board of Supervisors TD. County Counsel Attached is a copy of the alcove-noted claim. PHIL BA R, Clerk , Dated: June 22, 1999 By: Deputy --- K I ROn- County Counsel M. Clerk of the Board of Supervisors This claim compliessubstantially 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 IS days (Section 910.9); Claire 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: M0By AU iLJ1SJQMfA�LDeputy County Counsel ILII. FRObE Clerk of the Board` TQ County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). TV. BOARD ORDER: By unanimous vote of the Supervisors presents 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:. 4 ` __..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: DAVIT OF MA MG 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 I8; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid'a certified copy of this Beard Order and Notice to Claimant, addressed to the claimant as shown above.' Dated: By: PHIL BATCHELOR Deputy Clerk CCs County Cormsen County:kdrninistmtor Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100 ''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. (Gov't 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 Guvotry�aW &�A ON E1JE ) Against the County of Contra.Costa'or� 'i � ) JUN 21 1999 } CLERK BOARD OF SUPERVISORS District) CONTRA COSTA CO. �QF lel in name) .. k } 1 The undersi ned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$5 and in support of this claim represents as follows: 1. When slid the damage or injury occur?(Give exact date and hour) O-MiMan�- Was CC- de h! . o .. 1 = ,5 � - 2. Wh re''did the damage or injury occur?(Include city and county) 3. How did the damage or injury occur? (Give full details;use extra paper if required) —1; _ it € � A0 ID l _. LILU,!;E € E x r .; . 3 4a. 4 What particular actor omission on the part of county or district gfficers, servants, or employees cause€4 the injury or damage? � l �'. rY j ' � �.: des) ic:.:.F 'n e` „ AO 5. What are the names of county or district officers, servants, or employees causing the damage or injury? 6. What dame or injuries do you claim result ?(Give full exte t of injuries or damvges claiiAd. Attach`"" two estimates for auto damage.) ON tx- '. �, .: ec 7. How was the amount claimed above computed?(Include the estimated'amount of any prospective injury or damage.) iLA.0 t & 0� -t - : 0 C> co wt mi OA ell $: PEI^ t wZCO L `.: S. Names and addresses of Wanesses, doctors,and hospitals. ewc ARA 4. V441r, g 9. 3k the expenditures you made on account of this accident or mJ v. DATE TIME AMOUNT ) Gov. Code Sec. 910.2 provides"The claim must be ) signed;by the claimant or by some person on his behalf." SE1tiTD NOTICES TO: mev Name and Address of Attorney ) 1 L a: t ) (Cl imant's Signat<lie, Ge{ F. r ' 8311 1 � It ) ddress ) ) ;;.:� - o _ _ I Telephone No. Vit: fi Telephone No. NOTICE Section 72 of the Penal Code provides: Every person who,with intent to defraud,presents for allowance or the 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. . tm .. .. oft .. mop r 77 94 he i _ } 't � . It ALA oft 14PINg e IRA ------------My oil War s . . O Avon ate W LK WR TO 911 5 IN a - `_ . .. 71WIN �6oiftk OVA 4 - . Of t.r.-ru r 1 1A 4 .. 9 ! 41t r ie tlii 24, h.4 i 41 -00? tw. . pu E an den Y � .� t � .- WM ICT � w CE 1 ,13 Uj -- ,,ow, CZ IWO . ` a a} 'Cl . CLAIM 7►Apt C!P i "l 'MSOM OF CD ! A COSTA CQIMJIL..5AI rM&MA , II ?# Claim Against the County, or District Governed by the Berard of Supervisors, Routing Endor.a rants, NOTICETO CLAIMANT and Board Action. All Section references are to } The copy of this docurnent mai{ed to you is your California Goverment Code& notice of the action taken on your claim by the Board of Supervisors. (ParaWaph IV below3, Oven pursuant to Govemmeml Code Section 913 and JUN 2 2 1999 915.4. Please note all "brings". COUNTY COUNSEL AMOUNT: Exceeds Jurisdiction of Mun c ,-r LIFa CLAIMANT. Janice Marie Boyle ATTORNEY: "Ed Ba.locco, Esq,. DATE RECEIVED. June 21,' 1999 ;.Law Offices of Ed Bal.occo ADDRESS: 3153 Narania Drive BY DEI WERY TO CLERK ON: . 1Ina 71 OW 1999 Walnut Creep CA 94598 BY MAIL POSTMAT 1CM. .i-laUd_-DL1;ypri-ri L FROM: Clerk of the Board of Supervisors. TO County Counsel' Attached is a copy of the above-noted claim. PHIL BA R, Clerk Dated: June '22, 1999 Ay: Deputy II. FROM County Counsel T : Clerk of the Board of Supervis rs (X1 This claim complies substantially with Sections 910 and 910.2. This claire 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 alate claim (Section 911.3). Other: Dated: Vk By Deputy County CounselI qA- ' IEL FRCIM Clerk of the Board TO: unty Counsel (1) County Administrator (Z)' ( ' ) Claire was ret=ed as untimely with notice to'claimant(Section 911.3). TV. BOAR ORD1Lt: 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 slate. Dated: PHIL BATCHELOR, Clerk, By puty Clerk WARNING (Gov. code section 9 )' 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. AFI]DAVIT OF 1t+UUNG I declare under penalty of pedury'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 folly 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 l Cc: County Comsstl County Administrator " REM EIVED JUN 21 1999 2 IN THE MATTER OF THE CLAIM OF ) JANICE MARIE BO`►'LE, ) clEFiKFa�At}FSUr�PER�11St}R 3 ) 4 Claimant, CLAIM AGAINST A PUBLIC ENTITY vs. THE COUNTY OF CONTRA COSTA ) 6 ) 7 ) On behalf of Claimant, .JANICE MARIE BOYLE, Ed Balocco, Attorney at Law, 9 hereby presents this claim to the County of Contra Costa, pursuant to California 10 Government Code Section 910, and represents as follows: 11 Janice(Marie Boyle hereby makes claim against the County of Contra Costa; for 12 personal injuries and for property damage, and in support of said claim, represents 13 as follows: 14 1. Name and address of Claimant: Janice Marie Boyle, 1865 Lolowana Circle, 15 Concord, California'94520. 16 2. Representative: Notices concerning the claim should be sent to Ed 17 Balocco, Est/., Law Offices of Ed Balocco, 3153 Naranja drive, Walnut Creek, 18 California, 94598, who is representing Claimant; Telephone: (925) 937-0220. 19 3. Date, Time,-and Location of Lass: The date, time, and place of the occurrence 20 giving rise to this claim is December 27, 1998, at approximately 0330 a.m., on Marsh Cree 21 Road, County of Contra Costa, California, 3.6 miles(s) East of Morgan Territory Road, 22 4. Cause of Damage/ Iniury Loss: The circumstances giving rise to this claim 23 are as follows: 24 On or about 0330 a.m. an 12-27-98, while driving home from work westbound on 25 Marsh Creek Road, County of Contra Costa, approximately`3.6 utiles east of<Morgan 26 Territory Road, Claimant drove upon a stretch of"black ice on the roadway surface 27 causing the Claimant's vehicle to uncontrollably slide across and into the opposing lane, 28 and up an embankment, flipping and overturning said vehicle over and onto its roof with 1 1 Claimant behind the wheel and wearing her seat belt. To her utter horror, Claimant's 2 sweater which she was wearing caught on fire as a result of the detective employment of 3 the inflatable airbag installed in Claimant's vehicle, spewing extreme heat and fire 4 through the airbag vent holes. 5 A police report confirms that the cause of this collision was other than the driver. 6 Police arriving at the scene observed and noted that there was still a sparkling layer of" 7 black ice " on the roadway surface in the collision location. No roadside warnings of 8 road conditionswere posted. That the "black ice" on the roadway created' and presented 9 a dangerous and hazardous condition to motorists, including Claimant driving on said 10,' roadway; that the dangerous condition created a reasonably foreseeable risk of the kind 11 of injury which was incurred; that said public entity negligently through its employees 12'' created the dangerous condition'and had actual and constructive notice of the 13 dangerous condition a sufficient time prior to the injury to have taken measures to 14 protect against the dangerous condition, but failed to do so, permitting said dangerous 15' condition to exist on its property or on property over which it had control; that said public 16' entity through its employees was negligent in the supervision, maintenance, inspection, 17 and repair of the subject roadway and property over which it had control;;,that said public 18.: entity had constructive notice of icy road conditions at the site of the accident, and in the 19' immediate and adjacent county areas but failed to make required inspections or take 20'' precautionary measures; that as a direct and proximate result of the carelessness and 21 negligence of said public entity and its employees and the above described dangerous 22`' condition, Claimant sustained personal injuries and damages. 23 5. TYRG of Manna elln"u lLossllndebtedness to date 24 So far as is known to Claimant and her attorney, at the time of presentation of this 25 claim, Claimant has sustained the following losses, injuries and damages; multiple 26 bruises over the left breast, the right breast in two areas, the right abdomen and left' 27 abdomen, the right knee and a 3 x 3 cm abrasion over her back, bruises to her body, 28 soreness of her left scalp,',ribs, back, 'abdomen, chest, back and shoulders, medical 2 I expenses which to date entail ihospital emergency care and treatment, health care group 2 therapy, physician's care and treatment, and future medical expenses, leas of earning 3 capacity, present and future, property damage (total loss of vehicle), and general 4 damages cognizable under the law. 5 Claimant suffered emotional distress as a direct and proximate result of the subject 6 accident and related events, and continues to be emotionally stressed'.as a direct and 7 proximate result of the subject accident and related events: 8 6. The names of the public employee(s) causing the Claimant's injuries, damage, 9 or loss are unknown to Claimant and her attorney, Ed Balocco, Esq., who therefore 10 claim that Dries I through 100 are in some responsible for the damages to Claimant. 11 7. Amount Claimed; Claimant's claim is not;a limited Civil case as it exceeds the 12 jurisdiction of the Municipal Court. So far as it is known to Claimant and to her attorney, ' 13 Ed Balocco, Esq., at the time of the presentation of this claim, Claimant has incurred 14 damages in an amount wit in the jurisdiction of the superior court. 15 Dated; this' day of June, 1999. 16 Respectfully submitted by Ed'Balocco, 1 7 Attorney at Law 18 19 Ed al c , a,, Esq. 20 21 22 23 24 25 26 27 28 CLAIM BOR aF SITUMSORS OF CONTRA MSTA COINT'Y, CA>r DORNTA BOARD A00 t J 1.t' 20 1999 Claim Against the County, or District Governed by the Board of Supervisors, Routing Endorsements, NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of this dost mailed to you is your Califorrie Goverment Cogs. ) notice of the action taken;on your claim by the Hoard of Supervisors. tParagraph IV below}, Oven a pursuant to Govermtent Code Section 913 and 915.4. Please note all "Warnings". 0 11V 2 1 199 AMOUNT: $1,000,000.00 COUNTY COUNSEL CLAIMANT: Lamont Brown ATTORNEY: Robert G. Schock, Esq. DATE RECEIVED: June 18, 1999 Law Offices of Robert G. Schack ADDRESS: 1970 Broadway, Ste. 1200 BY DELIVERY TO CLERK ON. June 18, 1999 Oakland CA 94612 BY MAIL POSTMARKED: June 17, 1999 L FROft Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BATC R, Clerk Dated: June 18, 1999 By. Deputy --'�- iL 0'& County Counsel M. Clerk of the Board of'Supervisors This claim complies substantially with Sections 910 and 910.2. ( is 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: DatBy: &fbaputy County Counsel IFILio MClerk of the Board Ca ty Counsel (1) County Administrator (2) ain was returned as untimely with to claimant (Section 911.3). IV, BOARD (IRRDEIL By unanimous vote of the Supervisors present: This Claim is rejected in 'full. O Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: I PHIL BATCHELOR, Clerk, By - c 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 WarningSee Reverse Side of This Notice. DAVIT OF hIA1tLING 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: f By: PHIL BATCHELOR By "_ putt'Clerk CC- County Counsel, County Administrator CLAIM FOR DAMAGES FOR LAMONT BROWN To: COUNTY OF CONTRA COSTA Clerk of the Board 651 Pine Street Martinez, CA 94553 Claimant: LAM'ONT°BROWN Claimant's Address: 2829 -601 Avenue RECEIVED m Oakland, CA 94605 JUN 18 1999 Send Notices To Robert G.';,Schock, Esq. CLERK BOARD Of 9 PERvis RS Law Offices of Robert G. Schock 1974 Broadway, Suite 1200 Oakland, CA 94612 Telephone: (510) 839-7722 Date of Injury: December 17, 1998 Place: 2826 - 6Vh Avenue, Oakland, California Circumstances: On said date and at said place where plaintiff was residing, at , approximately 7:30 - 8:00 a.m. that morning, the claimee STATE OF CALIFORNIA, its agents and employees, including those from the California Youth Authority wrongfully entered the home and physically and verbally assaulted and battered plaintiff. They wrongfully arrested, harassed, falsely imprisoned, and otherwise negligently and intentionally caused claimant great physical and emotional distress. Said claimee and its agents and employees violated claimants constitutional rights as well violated other federal and state statutes, including but not limited to U.S.0 A. § 1983. Said claimee allegedly entered pursuant to a search warrant which- claimees refused to show claimant, such':.search warrant was apparently being directed to Antoine Brown, who was incarcerated at the State of California "Mule Creek" prison facility That said claimee, agents and employees, also wrongfully obtained and used a search warrant for the premises. That the conduct was done in concert with other Governmental Entities, including the Federal Government Marshals. CLAIM FOR DAMAGES FOR LAMONT BROWN June 17 1999 Page- 2- Parties Causing Damages: State,of California, U. S. Government, Contra Costa County, County of Alameda, and their agents and employees in concert broke into the home and assaulted, battered, and falsely imprisoned claimant and, otherwise, wrongfully conducted themselves, Injuries: Claimant's injuries were extreme physical and mental upset at being harassed, falsely imprisoned', threatened, and otherwise physically abused. Damages: General damages in the sum of one million dollars ($1,000,000:00). Punitive damages as to the individual employees. Attorney's fees pursuant to statute and other damages the court deems just. Dated: ,lune 17, 1999. OBERT G. SCHOCK Attorney for Claimant CACUENTS\Brown,Patddalciaims\Patrida Brown.wpd 1' PROOF OF SERVICE - 1013a- C.C.P. §2015.5 2BROWN v CONTRA COSTA COUNTY et al 3 4 I am a resident of the State of California,over the age of eighteen years,and not a party to the within action. My business address is Law Office of Robert G. Schock, 1970 Broadway, Suite 1200, Oakland, California 94612. 6 On June 17, 1999,I served the following document(s)'upon the interested parties by delivering a true copy thereof, addressed as follows, in the manner indicated below: 7 8 CLAIM FOR DAMAGES FOR LAMONT'BROWN 9 ( ) By Facsimile. I transmitted the listed document(s)to the fax number(s)set forth below 10 on this date before'5.00 p.m. { ) By Personal Service. By personally delivering the listed document(s)to the person(s) or office 11 of the person(s) set forth below. 12' (X)' By Mail I placed each listed'document in a sealed envelope with postage thereon fully prepaid,in the United States mail at Oakland,California,addressed 13' as set forth below. I am readily familiar with the firm's practice of collection and processing correspondence for mailing;under that practice 14 it would be deposited with the U. S. Postal Service on that same day in, the ordinary course of business with postage thereon fully prepaid. I am 15 aware that on motion of the party served, service is presumed invalid if postal cancellation date or postage meter date is more than one"(1) day 16 after the date of deposit for mailing in affidavit. 17 COUNTY OF CONTRA COSTA COUNTY OF ALAMEDA 18 Clerk of the Bawd Clerk of Board of Supervisors 65.1 Pine Street' 1221 Oak Street 19 Martinez, CA 94553 Oakland, CA 94612 20 STATE OF CALIFORNIA Department of Control 21 Government Claims P. O. Box 3035 22 Sacramento, CA 95814 23 I declare under penalty of per ury under the laws of the State of California that the foregoing is 24 true and correct. Executed at Oakland, California on June 17, 1999. 25 26' - y Fannie L.I uckley 27 28' A Oo � O � .hU v� r � � d .? .D N _ o U) tD U) O m Cy3 w © CD 'm ' cc No I In I Ir .... R0[3EKT C:7. 5CH0CK LAW OFFIC ' (Reply to Oakland Office) June 17, 1999 COUNTY OF CONTRA COSTA COUNTY OF ALAMEDA Clerk of the Board Clerk of Board o,f'Supervisors 651 Fine Street 1221 Oak Street Martinez, CA 94553 Oakland, CA 94612 STATE OF CALIFORNIA Department of Control Government Claims P. O. Box 3435 Sacramento, CA 95814 Re: CLAIMS OFPATRICIAILAMONTINICOLE BROWN To the Clerk: Please find enclosed an original and one copy of: CLAIMS FOR DAMAGES RELATIVE TO THE ABOVE-REFERENCED MATTER We ask that you please (X ) File the original(s) and return the endorsed-filed copies to this office. { ) Our cheek for$ is enclosed to cover fees. Kindly return your receipt. Secure the Judge's signature on the original order and file it with the court. Return conformed, file-marked copies to this office. ( } Have the enclosed Summons issued and return to this office. Additional instructions: Very truly yours, Fannie L. Buckley Secretary to Robert G. Schock &cl ienu/lahay/courticlerk.l" 1970 Broadway,5ulte 1200.Oakland,California 94612 a(510)839-7722•Facoimile(510)839-7752 1390 Willow Paea Rd,5ulte 200 0 Conoord,California 94520•(510)681-1200 CLAIM BOARD .DE SUPER ' ORS DE CONTRA C,'' STA CY LXM CAL Ep'[t32MA BOARD AC110�t JUI 1999 Claim Against the County, or District Governed by 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 Califorriia Goverment Codes. notice of the'action taken on your daim by the Board of Supervisors. Waragraph IV belowl, given JUS pursuant to Govermnent Code Sam,* 913 and COUNTY COUNSEL 915.4. Please note all "Warnings". AMOUNT: $1,0001000.00 mARTI EX CALIF. CLAIMANT: Nichole Brown ATTORNEY: Robert G. Schock, Esq. DATE RECEIVED June 18, 1999 Law offices of Robert G. Schock ADDRESS: 1970 Broadway, Ste. 1200 BY DELIVERY TO CLERK ON: June 18 1999 Oakland CA '94612: BY MAIL POSTMARKED: June -17,1999 L FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. Elated June 18, 1999 �'�-�-- y- PHIL BAIT, LOR, Cle'r� By: Deputy R FROM: County Counsel TO. Clerk of the Board of Supervis s ) 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: Ds#e -'L�' "( $ ���pu�tyCountyCounsel III. OM: Clerk of the Board unty Counsel (1) County Administrator (2) ( ) Claim was returned as untimely wi + Lice to claimant (Section 911.3). IV. BOARD tWER.- By>unanimous vote of the Supervisors present: 641 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 6L 9 WARNING (Gov. code recti(V913) 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 MAII.IINiC I declare under penalty of perjurythat 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 'A _ Deputy Clerk CC: County Counsel County Administrator x CLAIM FOR DAMAGES FOR NICOLE BROWN To: COUNTY OF CONTRA COSTA Clerk of the Board 651 Pine Street Martinez, CA 94553 RECEIVED Claimant: NICOLE BROWN JUN 18 1999 Cla'imant's Address: 2829°-601h Avenue Oakland, CA 94605 CLERK BOARD OF SUPERVISORS CONTRA COM CO. Send Notices To: Robert G. Schock, Esq.` Law Offices of Robert G. Schock 1970 Broadway, Suite 1200 Oakland, CA 94612 Telephone: (510) 839-7722 Date of Injury: December 17, 1998 Place: 2826 - 60'Avenue, Oakland, California Circumstances: On said date and at said place where plaintiff was residing, at approximately 7:30 - 8:00 a.m. that morning, the claimee STATE OF CALIFORNIA, its agents and employees, including those from the California Youth Authority wrongfully entered the home and physically and verbally assaulted and battered plaintiff. They wrongfully arrested, harassed, falsely imprisoned, and otherwise negligently and intentionally caused claimant great physical and emotional distress. Said claimee and its agents and employees violated claimants constitutional rights as well violated other federal, and state statutes, including but not limited to U.S.C.A. § 1983. Said claimee allegedly entered pursuant to a search warrant which claimees refused to show claimant, such search warrant was apparently being directed to Antoine Brown, who was incarcerated at the State of California "Mule Creek" prison facility That said claimee, agents and employees, also wrongfully obtained and used a search warrant for the premises: That the conduct was done in concert with other Governmental Entities, including the Federal Government Marshals, CLAIM FOR DAMAGES FOR NICOLE BROWN June 17, 1999 Page - 2- Parties Causing Damages: ;Mate of California, U. S. Government,Contra Costa County, County of Alameda, and their agents and employees in:concert broke into the home and assaulted, battered, and°falsely imprisoned claimant and, otherwise, wrongfully conducted themselves. Injuries: Claimant's injuries were extreme physical and meatal upset at being harassed, falsely imprisoned, threatened, and otherwise physically abused. Damages: General damages in the sum of one million dollars ($1,000,000.00). Punitive damages as to the individual employees. Attorney's fees pursuant to statute and other damages the court deems just. Dated: June 17, 1999, ROBERT G. SCHOCK Attorney for Claimant C SCUENTSIBrown Patd ta2Gtaims\Patricia Brown.wrp i 1 PROOF OF SERVICE- 1013a- C.C.P. §2015.5 2 BROWN vCONTRA COSTA CO LINTY.-et al. 3 4 I am a resident of the State of California, over the age of eighteen years, and not party to the within action. My business address is Law Office of Robert G. Schock, 1970 Broadway, Suite 1204, 5 Oakland, California 94612. 6 On June 17, 1999,I served the following document(s)upon the interestedparties by delivering a true copy thereof, addressedasfollows, in the manner indicated below: 7 8 CLAIM FOR DAMAGES FOR NICOLE BROWN 9 { ) By Facsimile. I transmitted'the listed document(s)to the fax number(s)set forth below on this date before 5:00 p.m. 10' ( ) By Personal Service. By personally delivering the listed document(s)to the person(s) or office 11 of the person(s) set'forth below. 12 (X) By Mail i placed each listed'document in a sealed envelope with postage thereon fully prepaid,in the United States mail at Oakland,California,addressed 13 as set;forth'below. I am readily familiar with the fin's practice of collection and processing correspondence for mailing;under thatpractice 14' it would be deposited with the U. S. Postal Service on that same day in the ordinary course of business with postage thereon fully prepaid.I am 15 aware that on motion of the party served, service is presumed invalid if postal'cancellation'date or postage meter date is more than one {1) day 16 after the date of deposit for mailing in affidavit. 17 COUNTY OF CONTRA COSTA CO LINTY OF ALAMEDA 18 Clerk of the.Board Clerk of Board of Supervisors 651'Pine Street 1221 Oak Street 19'> Martinez, CA 94553> Oakland, CA 94612 24' STATE OF CALIFORNIA Department of Control 21 Government Claims P. 0, Box 3035 22 Sacramento, CA 95814 23 1 declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed at Oakland, California on June 17, 1999. 24 25 26 Fannie L. Buckley 27 28': t ------------------- w Is 22, t isi is sMis cri is 'rt V r+l t/3 t3 r tv �W 7 eo ti ac s-: is it i .. G4-PL— CLAIM BOARD OF SIMEMORS OF CONTRA COUNTY, CA IEMN A BOMD JC Ly 1999 Claim Against ft County, or District Governed by � Me Board of Supervisors' Routing Endorsements, 1 NOTICETO CLAIMANT aid Board Action. All Section references ate to The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of SuPervisors (Faragrapb IV belov4, given pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: $1,000,000.00 U N 2 199 COUNTY COUNSEL CLAIMANT: Patricia Brown MARTINEZCAUR, ATTORNEY:Robert G. Schock, Esq. DATE RECEIVED: June 18, 1999 Law Offices of Robert G. Schock ADDRESS: 1970 Broadway, suite '1200 BY DELIVERY TO CLERK ON: J ue 18, 1909 Oakland CA 94612 June 17 1999 BY MAIL POSTMARKED. , L FROM: Clerk of the Board of Supervisors TSO: County Counsel' Attached'is a copy of the above-noted claim. Dated June 18, 1999PHIL BATCHELOR, Clerk By: Deputy IL FROM: County Counsel 70 Clerk of the Board of Supervisors (y This claim complies substantially with Sections 910 and 910.2, ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). { ) Claim is not timely filed. The Clerk should return claire 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: 7 411 Deputy County Counsel IIL FROM Clerk of the Board :Finoti unty Counsel (1) County Administrator (2) ( ) Claim was returned as untimelyce to claimant (Section 911.3). 1V. BOARD ORDER.- By'unanimous vote of the Supervisors present: This Claim is rejected in full. O Other: I certify that this is a true'and correct copy of the Board's Order entered in its minutes for this dater Dated: C 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 noticewaspersonally 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: AMDAYTT'&1VUAIMG 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 full, prepaid a certified copy of this Board Order and Notice to CIaimant, addressed'to the claimant as shown' above. Dated: 1. ' By: PHIL BATCHELOR. Byqff,�- & Deputy Clerk Counsel' County Administrator CLAIM FOR DAMAGES FOR PATRICIA BROWN To: COUNTY OF CONTRA COSTA' Clerk of the Board' 851 Pine Street Martinez, CA 94553 RECEIVED Claimant: PATRICIA>BROWN ,SUN 1 $ 1959 Claimant's Address: 2829 - 60" Avenue C1ARD��SUP v► Rs Oakland, CA 94605 Send Notices To: Robert G.`Schock, Esq. Law Offices of Robert G. Schock 1970 Broadway, Suite 1200 Oakland, CA 94612 Telephone: (510) 839-7722 Date of Injury December 17, 1998 Placer 2826 - 601' Avenue, Oakland, California Circumstances: On said date and at said place where plaintiff was residing, at approximately 7:30 - 8:.00 a.m. that morning, the claimee STATE OF CALIFORNIA, its agents and employees, including those from the California Youth Authority wrongfully`.entered the home and physically and verbally assaulted and battered plaintiff. They wrongfully arrested, harassed, falsely imprisoned, and otherwise negligently and intentionally caused claimant great physical and emotional distress. Said claimee and its agents and employees violated claimants constitutional rights as well violated other federal and state statutes, including but not limited to U.S.C.A. § 1983. Said claimee allegedlyentered pursuant to a search warrant which claimees refused to show claimant, such search warrant was apparently being directed to Antoine Brawn, who was incarcerated at the State of California "Mule Creek" prison facility That said claimee, agents and employees, also wrongfully obtained and used a,,search warrant for the,premises. That the conduct was done in concert with other Governmental Entities, including the Federal Government Marshals. CLAIM FOR DAMAGES FOR PATRICIA BROWN June 17, 1999' Page- 2 - Parties causing Damages: State of California, U. S. Government, Contra Costa County, County of Alameda, and their agents and employees in concert broke into the home and assaulted, battered, and falsely: imprisoned claimant and, otherwise, wrongfully conducted themselves. Injuries Claimant's injuries were extreme physical and mental upset at being harassed, falsely imprisoned, threatened, and otherwise physically abused. Damages: General damages in the sum of one million dollars ($1,000,000:00). Punitive damages as to the individual employees. Attorney's fees pursuant to statute and other damages the court deems just. Dated: June 17, 1999. J—A� ROBERT G.'SCHOCK Attorney for Claimant CACLIENTS\Srown,PatridaXCIaimsTatricia Brown.wpd' PROOF OF SERVICE - 1013a- C.C.P. §2015.5 2 BROWN v' CONTRA COSTA CCIUNTY. et al.' 3 ' 4 I am a resident of the State of California,over the age of eighteen years, and not party to the within action. My business address is Law Office of Robert G. Schock, 1970 Broadway, Suite 1200, 5 Oakland, California 94612. 6 On June 17, 1999,I served the following document(s)upon the interested parties by delivering a true copy thereof, addressed as follows, in the manner indicated below: T 8CLAIM FOR DAMAGES FOR PATRICIA BROWN 9' ( ) By Facsimile. I transmitted the listed document(s)to the fax number(s)set forth below on this date before 5:00 p.m 10' ( ) By Personal Service. By personally delivering the listed document(s)to the person(s)or office 11 of the'person(s) set forth below. 12 (X) By Mail I placed each listed document in a sealed envelope with postage thereon fully prepaid,in the United States mail at Oakland,California,addressed 13 as set forth below. I am readily familiar with the firm's practice of collection and processing correspondence forailing;under that practice 14 it would be deposited with the U. S. Postal Service'on that same day in the ordinary course of business with postage'thereon fully prepaid.I am 15 aware that on motion of the party served, service is presumed invalid if postal»cancellation''date or postage meter date is more than one (1) day 16 after the date of deposit for mailing in affidavit: 17 ' COUNTY OF CONTRA COSTA COUNTY OF ALAMEDA 18 Clerk of the Board Clerk of Board of Supervisors 651 fine Street 1221 Oak Street 19 Martinez, CA 94553 Oakland, CA 94612 20'' STATE OF CALIFORNIA Department of Control 21 Government Claims P. 0. Bax 3035 22 Sacramento, CA 95814 23 I declare under penalty ofpedury under the laws of the State of California that the foregoing is true and correct.' Executed at Oakland, California on June 17 1999, 24' 25 26 Fannie L.Buckley 27' 28 t- Y 4 6L� ED CO 0 m 960 � CL - CA CA0 d o � oiv ii: has K- F� S11 ti "CD L irr . u E �y a x� CLAIM BOARn OF S1TPFRMf.?1SC OF CONTRA COSIA CQUMy CA1,Tik"QENIA „IWC Claim Againstthe County, or district Governed by 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 California Goverrmnt Codes. } notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), gives pursuant to Governrmpt Cotte Section 913 and 915.4. Please note all "Warnings". AMOUNT: Not Specified J UN 17 199 CCUN -. LCLAIMANT: Felicia Deionn Gaines MARTINEZ CALIF. ATTORNEY: DATE RECEIVED. June 16, 1999;'. ADDRESS: 355 DiMag io Avenue BY DELIVERY TO CLERK ON: ,Tune 16, 1999 Pittsburg, CA 94865 BY MAIL POSTMARKED: Hand-Delivered 3 FROAL Clerk of the Board of Supervisors M. County Counsel Attached`is a copy of the above-noted claim. PHIL $A LOR, Clerk Dated: June 16, 1999 By: Deputy .,� `�� / � 61 Ii. FROM. County Counsel TO: Clerk of the Board of Superviso s ( 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. Aputt'County Counsel I M Clerk of the Board TQ 616ity Counsel (1) County,Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). TV. BOARD SER: 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: Q20tPHIL BATCHELOR, Clerk, By -" ,� Clerk - � Deputy WARNING (Gov. code section 13) 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. DAVIT OF MARM 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 40A,,— il2t� Deputy Clerk CC County tounitI County Administrator rlaim'tos BOARD OF SUPERVISORS OF CONTRA COSTA COUN'T'Y INSTRUCTIONS TO CLAIMANT A. 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 before December 31, 1987, must be presented not later than the 10&day after the accrual,,of the cause of action. Claims relating to causes of actionfor 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. (Gov't 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 ofth s f 990 RE: Claim By Reserved for Clerk's filin ARE)of SUpERViSORS 0 Co57A Co. f} ) FSUQ;StA_7H4-34nS 30 a VO l 313 Against the County of Contra Costa or ) 6661 Nnr I District) (Fill in name) ) A13+ + ' 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) 9 140 l ' 2. Where did the damage or injury occur?(Include city and county) f ,r -eq � f 3. How did the damage or injury occur?(Give full details;use extra paper if required) .ag / 0I ze-;el � � " r ' PW r!e, S ' 4. What particular actor omission on the part of county or district officers, servants, or employees,caused the injury or damage? /7 i y-Ao r A2, 5. What are the names of county or district officers, servants, or employees causing the damage or injury? 50 n cm- 6. What damage or injuries do you claim resulted?(Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) y ,, ln � - r ' a 7. How was the amount claimed above co uted?(include the estimated amount of any prospective injury or damage.) t ` ' V/ r- e' 4,V CJ lel ter_ 8. Names and addresses of witnesses, doctors, and hospitals. 9. List the expenditures you made on account of this accident or injury. DATE ' T1ME AMOUNT Gov. Code Sec. 910.2 provides "The claim must be signed by the claimant or by some person on his behalf." SEND NOTICES TO: Attorne Name and Address of Attorney ) (Cl aiman s ignature) (Address Telephone No. _ )Telephone No. ' NOTICE Section 72 of the Penal Code provides: Every person who,with intent to defraud,presents for allowance or the 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 fire of not exceeding one thousand(S 1,€00),or by both such imprisonment and fine,or by imprisonment in the state prison,by a fine of not exceeding ten thousand dollars($10,000),or by both such imprisonment and fine. CLAIM BOARD OFASIMEMSORS OF CONM COSTA CCL, '*CALTIK'C)Rl IA A July 20 1999 BOARDClaim Against the County, or District Governed by the Board of Supervisors, Routing Endorsements, l NOTICE TO CLAIIUTAW aW Board Action. All Section references are to 1 The copy of this document railed to you is your California Government Codes. twice of the action taken on your claim by the Board of Supervisors.. (Paragraph IV belovO, liven pursuant to Government Code Section 913 and 915.4. Please dote all "i!i►arninge. AMOUNT: $25,000.00 JUN 14 i 999 COUNTY COUNSEL CLAIMANT:Hamid 'Hashemi MARTINEZCALIF. ATTORNEY. c/o Caroline Na.sseri DATERECEIVED: June 11, 1999 Habbas, Amendola & Nasseri 400 June 11, 1999 ADDRESS: 210 North Fourth Street, Ste. BY DELIVERY TO CLERK ON: San Jose CA 95112 BY MAIL POSTMARKED: t, 1„x19,, 1999 L FftOAL Clerk of the Beard of Supervisors TO: County Counsel Attached is 8 copy of the above-noted claim. PHIL B HIWI.OR, Cler Dated June,;14, 1999 By: Deputy. R FROOM County Counsel TO. Clerk of the Board of Supery ors This claim complies 'substantially with Sections 910 and 910.2. This claim FAILS to comply substantially with Sections 910 and 9I0.2, and we are so notifying claimant. The Berard cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was Bled 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 M. FROM Clerk of the Board TQunty Counsel (1') County Administrator (2) (' ) Claim was returned as untimely with notice to claimant (Section 911.3). IV, BOA= ORDEF4 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: 910 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 ftkR NG 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 19; and that today I deposited in the United States Postal Service in Martinez, California, postag* fully prepaid a certified copy of this Board Order and N dce to Claimant, addressed to the claimant as shown above. Dated: 2 By: PIEL BATCHELOR By 1/ — �.Devuty Clerk CC: County Counsel County Administrator VICTOR J.WESrTMAN Y DEPUTIES:; COUNTY COUNSEL PHILLIPS.ALTHOFF a JANICE L.AMENTA NORA G.BARLOW ' B.REBECCABYRNES' SILUANO B.MARCHESi /Q+ ANDREA W.CASSIDY IAC- STA„ Wy MONIKA L.COOPER CH IEF ASSISTANT COUNTY COUNSEL ;: VICKIE L.DAwES O' IFF�C '1 M. COUNSEL MARKES.ESTIS SHARON L.ANDERS©NMICHAEL D.FARR �xltIsTFr�i 'i LILLIANT FUJII ASSISTANT COUNTY COUNSEL DENNIS C.GRAVES JANET L HOLMES M .1229 KEVIN T KERB GREGORY C.HARVEY BERNARD L.KNAPP ASSISTANT COUNTY COUNSEL EDWARD V.'LANE,JR. BEATRICE LIU MARY ANN MASON GAYLE MUGGLI PAUL R.MUNIZ: OFFICE MANAGER VALERIE J.RANCHE STEVEN P.RETTIG DAVID E SCHMIDT PHONE(925)335-1800 DIANA J.SILVER BARBARA N.SUTLIFFE FAX(925)646-1078 JACQUELINE WOODS NOTICE OF.INSUFFICTENCY ANDIOR NON-ACCEPTANCE OF CLAIM TO: Caroline Nasser] Habbas, Amendola&Nasseri 210 North Fourth Street, Suite 100 San Jose, CA 95112 RE: CLAIM OF: Hamid Hashemi 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 sept. ] 3. The claim fails to state the date,place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [ ] 4: The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. { ] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000),the claim fails to State the amount claimed as of the date of presentation,the estimated amount of any prospective injury, damage or loss so far as known,or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars`($10,000), the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. [ ] 6. The claim is not signed by the claimant or by some person on his behalf Page 1 [XX] 7. Other: The claim ia'ils to describe any duty or obligation of the public entity and any action giving arise to the claim. PLEASE NOTE: CONTRA COSTA COUNTY DOES NOT OPERATE OR CONTROL LAIDLAW TRANSIT SCHOOL BUSES. VICTOR J. WESTMAN, County Counsel By: 3De"County10!ou'nselA" CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a,2015.5;Evidence Code§§641,664) 1 declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553,I am a citizen of the United States,over 18 years of age,employed;in Contra Costa County,and not a party to this action. I served a true copy of this Notice of insufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as shown above,sealed and;postage'-'.fully prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California. I certify under penalty of perjury that the foregoing is true and correct. Dated: June 22,'1999,at Martinez,California. cc: Clerk ofthe Board of Supervisors(original) Risk Management (NOTICE OF INSUFFICU NCY OF CLAIM:GOV"1 (,Y)I)C�§910,9102,920.4,910.8} Page 2 VICTOR J.W) STMAN DEPUTIES: w PHILLIPS.ALTHOFF COUNTY COUNSEL- q JANICE L.AMENTA NORA G-BARLOW S.REBECCA BYRNES SILVANO B.MARCHESI ANDREA W.CASS#DY C 17 RA t.{�5 �4 TY MONIKAL COOPER CHIEF ASSISTANT COUNTY COUNSEL VICKIE L DAWES OFFIC !l "tom UNSEL MARKE$E8TI5 SHARON L.ANDERSON MICHAEID.FARR 1 .. �lN!$TR7�81 # #1 ULLIANT.FUJII ASSISTANT COUNTY COUNSEL g DAN NIS,GRAVES LES MA#ANg�(E229 KEVlNTKERR GREGORY 0.HARVEY BERNARD L.KNAPP ASSISTANT COUNTY COUNSEL EDWARD V.LANE,JR. BEATRICE LIU MARY ANN MASON GAYLE MUGGLI PAUL R,MUMz OFFICE MANAGER VALERIE J.RANCHE STEVEN P.RETTIG DAVID F SCHMIDT PHONE 925 DIANA J.SILVER )335 7 8Q0 BARBARA N.SUTLIFFE FAX(925)646-1078 JACQUELINE Y.WOODS NOTICE OF °INSUF,EICIENCY AND. NON-ACCEPTANCE OF CLAIM TO: Caroline Nasseri Habbas, Amendola&Nasseri 214 North First Street, Suite 400 San Jose, CA 95112 ISE: CLAIM OF: Hamid hashemi 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: The claim fails to state the name and post office address of the claimant. J 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [ ] 3. The claim fails to state the date, place or other circumstances of the occurrence or transaction which,gave rise to the claim asserted. [ ] 4. The claim fails to state the name(s) of the public employee(s) causing the. 'injury, damage, or loss, if known. ] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimedas 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 claire fails to state whether jurisdiction over the claim would rest in municipal or superior court. Page 1 TheLawofficesof Sacramento Office Walnut Creek effxe 801`12 Streei,Suite'500 Habba Amen d 'a Naas 1990 Norte California Blvd.,Suite 830 Sacramento Cahforma 45814 Walnut Creek,California 94596 Telephone Dumber(916)924-8787 A e'andCagwknal m v Telephone Number(510)934.8787 Facsimile Number(916)325-9620 Facsimile Number(5 10)932-8616 210 North Fourth Street, Suite 100 San Jose, California 95112 Oakland office 7,677 Oakport Street,Suite 105 Oakland,California 94621 Telephone(408)278-04$0 Telephone Number(510)568-8787 Facsimile{408)27$''04$$ Facsimile Number(5'10)533-7005 June $, 1999 RECEIVED County Of Contra Costa Board Of Supervisors JUN 11 1999 651 Pine Street, #106 Martinez, Ca 94553 CLERK Bt?Al p pP SUPERVISORS Attention: Beard Of Supervisors Dear Sir/Madam Enclosed,please find an original and two copies of the government claims filed on behalf of our client, .Hamid Hashemi. Please file the original claim, endorse a copy and mail it back in the enclosed self' addressed envelope to: Habbas,Amendola&Nasseri,2117 North Fourth Street, Suite 100, San Jose, CA 95112. Thank you for your cooperation and courtesy in this matter. Very truly yours, Y Toni.L. Pangelina Paralegal nieUwOfficesof Sacra t fti aWalnat geek Ofticp 80l I Su' e e 500 t� rs 1990 North California Blvd.,Suite 830 Sacramento California 95814c` 3r' S L&r 3Gt � ' Walnut Creek,California 94596 Telephone Number(916)9244 787 �4t�ar1��emdC'ow;��Ic>�sc�Irnv, Telephone Number(510)934-8787 Facsimile Number(9'16)325-9620 Facsimile Number(510)932-8616 210 North Fourth Street, Suite 100 San Jose,California 95112 Oakland ce 7677 Oakport Street,Suite 105 Oakland,California 94621 Telephone(408)278-0480 Telephone Number(5 1,0)568.8787 Facsimile(408)278-0488 Facsimile Number(510)533-7005 June 8, 1999 County Of Contra Costa Board Of Supervisors 651 Pine Street,#106 Martinez, Ca 94553 Attention: Claims Clerk Re: Personal Injury Incident of January 15, 1999 CLAIMANT'S NAME: Hamid'Hashemi CLAIMANT'S ADDRESS: 850 Seaview Drive El Cerrito, Ca 94530 AMOL NT OF CLAIM: Claimant is still currently receiving medical care and incurring medical expenses as a proximate result of her injuries. It is believed that the total claim value will not exceed $25,000.00 ADDRESS TO WHICH NOTICE IS TO BE SENT: 210 North Fourth Street, Ste.100, San Jose, CA 95112 DATE OF ACCIDENT: 1-15-99 LOCATION OF THE ACCIDENT: Ashbury Avenue,El Cerrito 8,June, 1999 COUNTY OF CONTRA COSTA ATTN:County Clerk June 8, 1999 Page Two COUNTY EMPLOYEE: Linard Ray White OCCURRENCE: Claimant was traveling along Asbury Avenue at the intersection of Stockton Avenue. Claimant proceeded through the subject intersection,when he was suddenly hit by a Laidlaw Transit School Busbeing'operated by employee,Linard Ray White. DESCRIPTION OF THE INJURY: Claimant sustained injuries to his beck,,neck and mouth. MEDICAL TO DATE: American Medical Response Paramedics Alta Bates Hospital Berkely, Ca Indigo health Center (510)653-8727 Dr. Swartz Oakland, Ca GENERAL DAMAGES: Claimant's injuries are not fully resolved. It is believed the general damages claim will not exceed $25,000.00 TOTAL DAMAGES: Claimant believei the claim ot exceed $25,009;'00 l F,fF Dated.:'. RtJLINE A ERI Attorney for Claimant Signed on behalf of Claimant v �✓cr (D - +`2w, r 0 ;13 3 > 3 0 G 0 N_.. Qo C Cb N N _s CD - F CA 0 . O 0 CO ro 0 -a l r -� CSD c G7 .a tTi ru 8 1 4 1f F f / a t�s� j F ,° t L.N t. CLAIM B4OQ. RD OF SUPERMORS OF CQMA=1A W=. CAS M-ENLA BEIARD�tllt� Jur ��, 1999 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to l The copy of tNs document rre led to you is your California Government Codes. I notice of the action taken on your claim by the Board of Supervisors. (Paragraph IVbelov4, given pursuant to GovernrrIent Code Section 913 and 915.4. Tease note all "Warnings". AMOUNT: $240.00 JUN I 7 1999 COUNTY COUNSEL CLAIMANT: Rickey R. McNeal MARTINEZ ATTORNEY: DATE RECEIVED June 16, 1999 ADDRESS: 2901 Center' Street BY DELIVERY TO CLERK ON: June 16, 1999 Richmond CA'i 94804 BY MAIL POSTMARKED' June 15, 1999 L FROK Clerk of the Board of Supervisors Ta County Counsel Attached<is a copy of the above-noted claire. PHIL BAT DOR, Clerk Dated: June 17, 1999 By: Deputy K FROM: County Counsel TO Clerk of the Board of Supervis rs ( ) 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: r Dated: ✓ By Deputy County Counsel III. Oft Clerk of the Board M. my Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDEEb 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 �, lqqq PHIL BATCHELOR, Clerk, By. is 1 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 MAI NG 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 puty Clerk Cc. County counsel County Administrator Claiat xEa t )10AXD O! SvptRvXSORS OY CORM COSTA COSY Z1T$ MOXB Claims r*latinj to causes of action for death or for injury to person car to personal property or growing crops and which acorns on or before December 31, 1907, asust be presented not later than the .140th day Defter the accrualof the cause of action. Claims relating to causes of action for death or for injury to parson or to personal property or growing crops and which accrue on or after JAnuary 1, 1989, must be presented not later than six months after the accrual Of the cause of action. Claimer relating to any other cause of action must be presented tmot later than one year after the accrual of the cause of action. (0*v't t od+e $11.2.) Claims must be filed with the Clerk of the DE©ard of Supervisors at its office in Room YQe, County Administration 3uuilding# +651 'Pine Street,:; Xartin*z, CA 94SS3. 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 t-he claim is against scree than one public antitys separate claims must' be filed against each public entity. Z. rXagdYz See penalty for fraudulent claims, Penal Code Sac. 72 at the and of this form. RE: claim 8 Reserved for Clerks filing stamp , ¢ k M_1 F RECEIVED pyNyn�YiYY�Y Y1�IYf YYn YrfYf Against the. County of Contra Costa) JUN 16 1999 E CLERK BQARt?fl SUKAVIS©RS rV ivo Distric:t) COWRWA cOSA (Fill in' name) . The undersigned Claimant hereby makes claim against the Cc►un of Contra Costa or the above:-named District in the sum of $,,f_,LZ �UAQi - and in support of this claim represents as follows 1. When did the damage or in—jury occur? (Give "act data and hour) 1. Sher* did` the damage or injury occur? (Include City 'and county) .X � ` t&C , . _ }y • >' F$ �' '4i ."9. f F. k '1. �F o:•aY v A 3. Nov did the damage or injury occur (Give full details; use extra paper if required) 4. 'What ' articular act or omission on the wart of county or district officers, servants or employee r� caused,th� 0 damage. v o. .°:> :`"ffii &:rt 5 .a-r epi 4 B (ovtr) S. chat are the names of county or district officers, servants or employsos ,causing the damage or injury? 6. what damage or injuriesdd you claim' resulted? (diver' full extent of injuries or damages. claimed. Attach two estimates for auIL CJNOIVNIAI a c c..o 1. ;, C s'„ ?. IIow vas the amount claised above computed? (Include the estimated x amount of any pros cave .inj ,or damaq .) ' of ( _ S. Names and addresses of itn*sses, doctor's and hospitals. 94 Dist the expenditures you =ad* on account o thie accident or injury. 2z= 'AMOUNT Gov. Code Secr924.2 provides "The claim must be signed by the claimant or by some person an his Name and Address of Attorney (Claimantls Signature) X01 t (Address) j Telephone Na. Selep Ione No °° k v' , Section 72 of the 'Penal Conde provides: Zvery person w'bo, with itetent to defraud, presents for allowance or .for payment to any state board or officer, or to any county, city or district board 'or officer, authorissed to allov or pay the same if genuine, any false or fraudulaint claim!, bill, account, voucher, or writing, is punishable neither by imprisonment in the county jail for a period of not more than once year, a► fine at not �excooding one thousand 02#000)t both by bcsuch imprisonment and tine, or by .imprisonment in the state;, prison, by a fine of not +exceeding ten thousand dollars (510,000, or by bath such imprisonment and fin* STATE OF CALTFORTA STATE ECARD OF CONTROL ' P. C. ox 303 S,acramentot CA 93812-3035 (916) 323-3564 ATSS 473- 564 June 3, 1999 RICKS`. R MCNEA 01 COURT ST .-17-1 MARTINEZ, CA 94553 Re: MCNEA r RICK`!` Clain Nu er: G34542B Code: Your claim was presenter to the State Board of Control (Board) on Play 20, 1999 • we have r'avia.wod the claim and determined that the Board has no jurisdiction to ecce t theclaimfor consideration for the following reason(s) t The entity that. yoW allege caused the damages or injuries is a2.1 a State Government A.:;ency. The Board will talo no further~ action on your claim. Sincerely Government Claims Division State Board of Control (1 5 -:. No jurisdiction r. Jac©b Rosenberg M . D . PAX C-0m s TO: Public Defenders Office FAX'` 925-335•-8010 COURT DATE: 013/11/99' CLIENT: Richard McNeal FROM:: Jacob A. Rosenberg, M.D. DATE: 03/09/99' A total of three (3) pages are being faxed with this cover sheet. 2299 Bacon St., Suite #b"• Concord, CA 94520 . 'Phone 9251591-9806 • Fax 925/691-9807 ,Jacob Rosenberg,, Board Certified Pain Manager ent and Anesthesia March 9, 1999 RE: PATIENT: RICHARD McNRAL tear Sirs: This letter is regarding Richard McNeal who apparently has a court` date on Thursday, March 11, 1999. S have been treating Mr. McNeal along with Dr. David Wren for .low back pain as a result of a Workers' Compensation injury which occurred last year. Mr. McNeal has 2-level disc disease and requires a 2-level lumbar fusion for his low !back pain andradicular pain clown his ley. This has boon demonstrated' on both MRI scan (an x-ray test) as well as on disco- graphy (,an injection test) which reproduces the patient's pain by injecting into the disc. I believe that currently Mr. McNeal is having enormous social problems that are at least partially as a result of his Workers Compensation' injury. The history that both I and Dr. Ween have obtained from Mr. McNeal is that he had a significant alcohol problem eight years ago with some drug abuse at the sane time. lie' is quite clear, however, that he has been clean and sober for over five years. When I first saw Mr. McNeal several months ago, I noted that he was quite depressed At least a si,gnificarit''portion of the depression is because he was having difficulty in .his marriage and he felt that his wife was unwilling,to help him deal with his pain and disability. He was suffering from a siynificant loss of self-esteem because he could no longer 'work and he felt largely 'i.rrel avast in the house. He told me that the most impor-- tart thing to him at that time were his children and his wife, and he was very concerned, that his marriage was going to end as a result of his physical impairment. In the time that` I have known Mr. 'McNeal , I have never seen his wife nor have T had her express any concern, despite the fact that he was looking at having a,-major surgical procedure so that he can , return to some sort of emp'loyment'. After the discography was performed on him some two weeks ayo, Mr. McNeal returned home and was apparently asked to leave his house. 'This, combined with his previous depression and indeed with his 'past' history of drug and alcohol abuse, led him to relapse with drug and alcohol abuse. 2299 Bacon St. Suite #6 . Concord, CA 94520 Phone 925/691-9806 ` Fax 925/691-9807 uc_rv't � Re: Richard McNeal March 9, 1999 Page. 2 At the current time, what Mr. McNeal needs is to undergo a behavioral management program 'aimed at controlling his drug and, alcohol problem. He has already been through an acute detoxifica- tion by being placed in jail and, in fact, really needs very little' of any sort of acute detoxification work. He does, however, neea, behavioral management and Workers' Compensation has refused to pay for °this. it is my understanding that he does have Kaiser insur- ance and that this will cover this problem. In summary, the history that I have for Mr. °McNeal is that he has been clean and sober for the last five years, working quite dili- gently and raising a family. He was: injured about one year ago and since that time has had significant problems in his marriage at least partially because he was no longer able to bring in any income or only a small: income on Temporary Disability. Because of this, his marriage has continued. to 'deteriorate, leaving the; patient extremely depressed because he has felt that he would not have access to his children and because of the sense of failure that he suffered becausehe was not being. a "breadwinner" any longer. This culminated in his wife asking him to leave their house and that resulted in a relapse for drug and alcohol. At this point, I' feel the most compassionate course for this gentleman and in fact the most effective course for society would be to enroll him in a> behavioral management' program.' ` If you have questions', I` would be happy to answer them, and I' can be reached on March 11, at (510) 523-4040. I declare under penalty of perjury that the information accurately described the information provided to me and except as noted herein that I believe it to be true. I further declare' under penalty; of perjury that I have 'not violated the; provisions of California Labor Cade Section 139.3 with regard to the evaluation of this patient, the <preparation of the report or the dictation of any procedure. Sincerely, J ob A: Ros berg, M.D. JAR:`tm LLJ ui 111 Nom " A f d 1 JLLJ �' ... C13ca < , co C CC s i M r 1.. w cLL CL o " 1 ycr O _ r cr CLF CC 1 j V •'S ,. 111 YFU5 be 0) 1i Vj j,J �,,,,. tiff$ F1� .r r�... 0 O a - z} CO 1�1^1OL ' ,y'� +C �R• ..i bpi t1 f4 ,e"," j yW k CD a a m 1 } w a 00 cc 0 cc 12 N-. h 111 t` dcc r y M5. � I 1 t Ct ► TFL.A CC>SSTA Cd►7LTI'q r V { ) NMATE REQUEST FOR INFORMATI 'N )MEDICAL REQUEST i From: ! gkg#`�2 �a ( Date: 1 Housing AssignmenitXt: Check One: bequest { ) Grievance { ) Appeal { ) Other Request: _ lam ., l. A r .«c't b p Dateec'd: f / Ree'd By: L •r ..•� i Routed-To: ANSWER: ( ) APPROVED { )DENIED-(state reason) 8y. Date: Pink:Kept by Inmate Yellow:Reply to Inmate Mile:To Booking i DET024IRM 1/2/91 uj ui co `L ul uj ' 2. 0 Al Ca fel co h-t a 7 cr. p LL cc t 4 r vs Z t C c *t d LL Crcc x E n� i aLL < m .04 o m W .Z rcr %R 's CL EL _ n * C, itujj LL cr *.,:. EZ cr t }O !i 0 {� fr ti? iv "� ro C+ Z Contra.Costa County Detention Facilities per, DISCIPUNAWHEAIIINGREPORT, . I)ETE T , FACIL17Y INMATE. J14C/V. .. I C fa 1C 1 BrICC7. }'Tr. 'c eJ I.R.# Last Fiat t HEARING DATE & TIME: i'�; Af ? T "17 L,61 INCIDENT BATE & TIME Youhave been. acQused of violatinghe following' rule(s) or regulations),.; 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, .fob or housing transfer, extra work detail', segregation, reprimand, criminal prosecution. INMATE RIGHTS IN DISCIPLINE PLOC�. ED-URE: i) 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 completedreport (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 r on the Inmate Request Form and filed within 5 days of the Hearing. WAIVER -, ,C One 4 Cl I do not want a Oiscipi nary 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. s Other , �t "-J #7 T % /67 Inmate Signature. ' �^ ��' Date & Time DISCIPLINARY HEARING: .: INMATE: Present [ -Not Present ZnmateComms: {,QA, . yt - r. 4 yl Hearing Officer/Committee Investigation': e. c�, r Findings: Inmate committed the act as charged a Inmate did not commit a prohibited act Q Inmate committed the following probibited act(,$) Sanctions/Punishment imposes(: I Hearing officer: Na . t�oee Nuxrcber Committee Member: i � ,. Name Employee Number Copy to Inmate by: ' Approved' by Operations Director: k Distribution: SAS(Original) Copies to: Facility Administrator, Inmate Booking,operations Director, Inmate,Classification, Module where inmate is housed SFT n11-FRM Rev.1/9(91 .. , F t,>._ �� _ ,;, �,,, A d � � g is 4 "�, ' ;�. � � �.. ,�""""' t { i4 i !� S£ �,,� �` w� y '� �� ,. �. i o �� ` } � .� ;� .d :, t yp :3.- :a 1 � �.% .,� �,, z CIAIM BOARD OF SLTXJ SQM OF CONTRA MSTA COUNTY CALIEDENTA BfIO ACTId�t JtII.Y Claim Against the County, or District Governed by } the Board of Supervisors, Routing Endorsentents, 1 NOTICE TO CLAIMANT end Board Action. All Section references ar The copy of this docu hent rrailed to you is your California Goverment Codes. ) notice of the action taken an your claim by the r4 2 1 IS419 9 Board of Supervisors. !Paragraph IV belov4, given c o s !. pursuant to Goverment Code Section 913 and mAR: ,t3E2 GA aF-.IF915.4. Please note all "Warnings". AMOUNT: Approximately $18,000.00, including ongoing pain and suffering expenses CLAIMANT: Kim K. Schneider ATTORNEY: Judith L. Carlisle DATE RE June 17, 1999 Favaro, Lavezzo, Gill, Caretti & Heppe l,, P.G. ADDRESS: 300 Tuolumne St. , Suite .A BY DELIVERY TO CLERK ON: June 17,, 1999 Vallejo, CA 94590 BY MAIL POSTMARKED: June 16 1999 L FRONE Clerk of the Board of Supervisors To- County Counsel Attachedis a copy of the above-noted claim. PHIL BAT94LOR, Clerk) Dated: June 18, 1999 By: Deputy & FROM County Counsel TO: Clerk of the Board of Supervisoff 0 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 Poard 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: 7r2kiramPuty County Counsel III. OK- Clerk of the Board TO. unty Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice toclaimant (Section 911,3). IV BOARD ORDEIL 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: 2-ID,A�H9 PHIL BATCHELOR, Clerk, By r = Deputy Clerk WARNING (Gov. code sectio 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 Ibis' Notice. AFFIDAVIT OF MAII NG 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 IS 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_ 7l Deputy Clerk C : County Counsel County Administrator TOWN; OF DANVILLE oaim t+a: 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 personal property or growing crops and which accrue on or before December 31, 1987, must be presented';not later than the 100n day after the accrual of the rause 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 sic months after the accrual of the cause of action. Claimsrelating 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 gine 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 claim 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' KIM K. SCHNEIDER - ) y RECE[YED Against the County of Contra Costa JUN 1799 19 and./or CLERK 81 A OFOF SUPERVISt1RS TOWN OF DANVILLE District) CON1 RA t3 T (Fill in Name) The undersigned 'claimant hereby makes claim against the County of Contra Costa or the above named District in the sum of S f ccordi prong and in support of this claim represents as follows: (This is not a limited civil case.) 1. When did the damage or injury occur? (Give exact nate and Hour) 3/24/99 at' 9:25" p•m• (approximately) 2. Where slid the damage or injury occur? (include City and county Corner of Sycamore Valley Road and Camino Ramon: DanvilleContra_Costa_County-- 3. How dirt the damage or injury occur? (Give fluff details;use extra paper if required' After stopping at a red 'light' at the intersection of Sycamore Valley Road and Camino Ramon, Claimant proceeded north into the intersection when the light turned green. Claimant was hit on the left side ,by Officer David White who ran through the red light heading east on Sycamore Valley Road. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? Danville Officer White ran a red light. 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D 06`£7 suoTauoTpam uoTadTaosaaa 66/7Z/£ fq PTud 88'06$ ssaT) 6W§'70'1$ sTAV JVO €u4u9d 66/9Z/ Ltit 1Z3 hall :kKnfuv ao juapt33e stgj}o juno33e uo apeua nog saan4tpu3dxa ag;IS!-1 -6 - umour samaas u -- saoaoop Pup T�uas oo}I- ouaaauzg aaauaO_ un €eaTpay zTn :ugor umOu4un samuu — saaATap aaueTnqury aaodaa peaudaad 90CCI# qj 'uOTTd •X aa3T3.;0 — 1014ed APmgSTH eTuaOJT€uD` €osE€epoapad '7 uoauy — saaoTIQ aoT€od a€€TAua zagt3 -sle;tdsoq pue s ioj3op Isassau;lmjo sassaappe pun sausv 'S •(aaup 0:100'000'Z$ ATaauuuTxoxddu) ,saSem 90 ssoT (jooad+ oa SuTpa000u) 2uTaajjns pup uTud pup ! (jooid oa 2uTpa000u 'umouAun) 'aouu€ngmv/€voTpam !(aauuuzxoaddu) 00`57$ rsSnap uoTadTaosaad .00-OD£$ 2uTgaoTo pup saesuTB aoj aunome pa4 mT3sa 6L'8'70'1$ `€uauaa oan€ !00'009' T$ ' 09€€a404) oanv ` Aumup m.Unful ani}aadso.ed auu}o;unotun pa#ewe}sa aq3 apnlaul) 4pajndtuo3 junowe pawEeJ3 3 oge'agj sem,NEFH 4'' ------------------------------------------------------------------------------------- pagou:jav aaS {-asaump O}ns 3OJ S.a}BUle;sa OM}qae}}d waiza ti,j 3A!O). 4pajins3a wirla nog op satinft![.lo sa3eump:..jeqA*, -9;. ----------------- -------- 3uaiu�xada(j ao Todra-[*EnuaC-azta-To aaTgM pTAea aaa jjp Ziinfut.la a3Ewep aqj 2uisne3 saagordwa ao'sjue.uas's la3!jjo j3u;sip ao,tjunoa jo saweu ag;3JU jegA .S ATTACHMENT TO CLAIM OF KIM K. SCHNEIDER 6. (a) Personal injuries, including bruising, torn muscles, loss of mobility in neck. Treated initially at John Muir Medical Center Emergency Room and with private physician thereafter. (b) Claimant's 1998 .Ford Ranger 4 x 2 Supereab was totaled (valuedat $14,600.00 by Claimant's insurance carrier). (c) Claimant's clothing was destroyed and glasses broken (d) Rental car expenses 3/26/99 to 4/25/99 - $1,048.79(receipt attached) (e) Prescription drugs (receipt attached) (f) Medical/ambulance expenses (statements received to date attached) (g) Loss of wages (approximately 4-5 days to date) (h)' Insurance deductibles (automobile deductible - $500.00)` (i) Pain and suffering including ongoing neck discomfort and loss of mobility Attachment to Claim of Kim K. Schneider A VIS AVIS b"S it IS 11 11 11 It It i1 II It ti+ v7 I. .p..}. y..p.. i .s r a r,,i�.vr, i`°I. fir. w0 O C7 c�T•n.-i t a�'.ri �t .tt Sz, 40 iv AL3 H. t J CA .— ...ys C, to y„ IV, ?'Cary '',7 t17'�..�ii . 4J Lli G LO In C•t-1 4., i r�,w-i �1}� •:L L ,"r ._ i... ,Ln y! :.5.�. ��,''•! ILI 2 5� �+2:L ham• SIA V SIAV JOHN MUI2 MEDICAL CENTER _. PHAPMUCY i601 Yvmio Valley Rd.,Walnut Creek,CA 94599 JOHN ITEMIZER PRESCRIPTION LIST MUIR MCCICAL Chis is not a t=ipt ofpayment) CIENTE LRS 94=1461843 Pharn2.L,isc.#HSP 41346 RX 893759 03/24/99SC Dr. J.S. CHILES Wr: ►C �,K iSH} V10 Totals 12.50 Pt,*- 12.50_ RX 893760 03/24/99SC Dr. J.S. CHILES mor: t i C �;M35 €G (SB) Total': 19.20pt: 19.20 RX 893761 03/24/99SC 8r. JAL. CHILES y c IPSI IU,50E}•-5lMG (11) TTo'ta1`s 12.20 # pt: 12.2 rtern,aetu !Ns 31.30278 3 rwt�► Blue Cross P.O. BOX 70000 f VAN NUYS, CA EXPLANATION OF BENEFITS ♦ © California 91470-0001 A,u 9twCross A«ssadabor, arm@ SSUE DATE PAGE E037835 Apei 1 19, 1899 0111 OF 001 Sequence Number: 680360801-100 19990720 Subscriber's Name: CATHERINE A. SCHNEIDER CATHERINE A. SCHNEIDER Identification Number: 547866576 247 ANGELA AVE Group Number: 00036T ALAMO, CA 94507 Group Name: PPB CLASSIC $25 CO-PAY Product: Individual Prudent Buyer Claim Number: 99106906660 Claim Received Date: 04115199 Claim Processed Date': 04/16199 THIS CLAIM WAS 'PROCESSED IN 1 DAY. Patient's Name: KIM SCHNEIDER Provider of Services: JOHN MUIR MEDICAL FOUNDAT Service Date: 04102199 Place of Service: Office Total Billed: $7'0. 00 Patient Acct. Number: Blue Cross Paid: $15. 37 To: JOHN MUIR MEDICAL FOUNDAT It is your responsibility to pay: $25.00 It is not your responsibility to pays $29. 63 THANK YOU FOR USI1+G A NETWORK PARTICIPATING PROVIDER. COINSURANCE SERVICE TYPE OF SERVICE TOTAL AMOUNT PATIENT APPLIED TO COPAYMENT BLUE CROSS DATE(s) BILLED NOT ALLOWED SAVINGS' DEDUCTIBLE AMOUNT PAYMENT 04102199 Medical Visit 70.00 29.63101 25.00102 16.37 TOTAL THIS CLAIM 7€1.00 0.00 29.63 0.00 25.00 15.37 DETAIL MESSAGE`. 01 - This is the amount in excess of the allowed expense for a participating provider. The member, therefore, is not responsible for this amount. 02 - This amount is the Home and Office copayment amount specified by the terms of the member's benefit agreement. FOR INFORMATION CALL: CUSTOMER SERVICE DEPARTMENT AT: (800) 333-0912 MAIL ALL INQUIRIES BLUE CROSS OF CALIFORNIA OR CLAIMS TO P.O. BOX 9051' OXNARD, CA 93031-9051 WE SUGGEST THAT YOU RETAIN THIS COPY FOR ;YOUR INCOME TAX RECORDS. r NhfiS1EP SEE REVERSE' SIDE FOR IMPORTANT INFORMATION gistered Mark of the Swe Cross Assocmof PLEASE DO NOT STAPLE IN; i]S .ARES i r PICA HEALTH INSURANCE CLAIM FORM PICA ;71- i. MEDICARE MEDICAID CHAMPUS CHAMPVA GROUP FECA OTHER la INSUREDS I.D.NUMBER (POR PROGRAM IN ITEM ) (Medicare HEALTH PIAN BLK LUNG } (Medicaid 3 I (Sponsor's SSN) o(VA fife#) (SSN:of ID) E. (SSN)., K (10) 2 PATIENT'S NAME(Last Name,First Name,Middle Initial) .1.'PATIIENT SD BIRTH YATE SEX 4 INSURED'S NAME(Last Name,First Name,Middle Initial) MM 11247M F ] SCHNEIDERrKIM 5.PATIENTS ADDRESS,No. Street) 6.PATIENT RELATIONSHIP TO INSURED 7 INSURED S ADDRESS(No.,Street) 47 ANGELA AVE Self S"'—F' ChlldC Other 47 ANGELA AVE CITY STATE 6.PATIENT STATUS... CITY —]—STATE LAMO Single C71. MarnedK Other MA '( F ZIP COBE TELEPHONE(includeArea Code) ZIP CODE TELEPHONE(INCLUDING AREA CODE) Employed.. Fuli-TimerPart-lime _f 4.e.07 425') a-,!Q--070 Student st dem 4.507 5 )820--0- -7-01 t 9 OTHER INSURED'S NAME(Last Name,First Name,Middle Initial) 10,IS PATIENTS CONDITION RELATED TO: I I.INSURED'S POLICY GROUP OR FECA NUMBER 80671 a.OTHER INSURED'S POLICY OR GROUP NUMBER a.EMPLOYMENT?(CURRENT OR PREVIOUS)' a.INSUREDS DATE OF BIRTH mM DO (� '_j NO �1 '�3! MYY SEX YES ���7 � F 1 I b:OTHER INSURED'S DATE OF BIRTH SEX b.AUTO ACCIDENT? PLACE(State) b.EMPLOYER'S NAME OR SCHOOL NAME - MM DO YY M,.. F 1:1 YES 0 NO I� i c EMPLOYER'S NAME OR SCHOOL NAME' c OTHER ACCIDENT? c INSURANCE PAN NAME OR PROGRAM NAME �v£s 1 No AMBULANCE PATIENT PAY U` d INSURANCE PLAN NAME OR'PROGRAM.NAME 10d.RESERVED FOR LOCAL USE d IS THERE ANOTHER HEALTH BENEFIT PLAN? YES 11 NO it yes,return to and complete item 9 a-d READ SACK OF FORM BEFORE COMPLETING&SIGNING THIS FORM, 13.INSURED'S OR AUTHORIZED PERSON'S SIGNATURE I authorize 12 PATIENT'S OR AUTHORIZED PERSON'S SIGNATURE I authorize the release of any medical or other information necessary payment of medical benefits to the undersigned physicianor supplier for to process this claim I also request payment of governmentbenefits either to myself or to the party who accepts assignment services described below. below SIGNED _ _ DATE _ SIGNED 14 DATE OF CURRENT ILLNESS(First symptom)'.OR 15 IF PATIENT HAS HAD SAME OR SIA',,,.,R ILLNESS i6,DATES PATIENT UNABLE TO WORK IN CURRENT OCCUPATION MM DO YY INJURY(Accldent)OR GIVE FIRST DATE MM DD YY MM DO YY MM DD YY PREGNANCYtLMP) FROM TO 117 NAME OF REFERRING PHYSICIAN OR OTHER SOURCE 17a.10NUMBER OF REFERRING PHYSICIAN 18.HOSPITALIZATION DATES RELATED TO CURRENT SERVICES I - MM. DD' :`YY 'MM DD - YY FRO 4 999 TOO-1 '2 1999 9 RESE '-RVED FOR Lr"'AL USE ^20 OUTSIDE LAB? $CHARGES YES �NO 'I '21 DIAGNOSOIS OR NATURE OF ILLNESS OR INJURY.(RELATE.ITEMS 1.2:3 C)R 4 TO ITEM Zit: 3Y_�':Ei I, 22 MEDICAID RESUBMISSION' CODE ORIGINAL REF NO 1 .1� 3 h _ — 23.PRIOR AUTHORIZATION NUMBER 24 A B C D E F G H J K DATES)OF SERVICE Place Type PROCEDURES SERVICES OR SUPPLIES DAYS EPSOT From To DIAGNOSIS RESERVED.FOR of of (€xplzi Unusual Circumstances) CODE S CHARGES OR F''r ily EMG COB 'C MM DD YY Mixt DO YY Service Service CPTIHCPCS MODIFIER UNITS Plant', i. 24 9 3 24 '9 —60:362'. 2--;1 3C.* 00 1. LF4OO 2'I 4 99 % -z4 1 99 41 A038 231 45 00 5 SLE000 AM 99 24 94' 7231 35 tit.' 1 SLF000 4 5 6 25 FEDERAL TAX 10 NUMBER SSN £IN 126PATIENTS ACCOUNT NO: 2- ACCEPT ASSIGNMENT? 28.TOTAL CHARGE 29 AMOUNT PAtD 30.BALANCE DUE # ,.jFor govt claims see back) 4b--C C>-45Cf90c)1 ❑ `99103-'-01131 1 L_,YES yrs No s 3800() � 38��oo 31 SIGNATURE OF PHYSICIAN OR SUPPLIER 32 NAME AND ADDRESS OF FACILITY WHERE SERVICES WERE 33:PHYSICIAN'S,SUPPLIER'S BILLING NAME.ADDRESS.ZIP CODE INCLUDING DEGREES OR CREDENTIALS RENDERED(If other than home of office) B PHONE w (I certify!hat thestaterr*nt on the reverse apply to INS W and are made a part thereon) CONTRA COSTA GCl/SRVFPD 1601 YGNAC:IO VALLEY RD WALNUT CREEK CA 94598 iSIGNED DEFAUL r r PHY DATE 04/!111.999 PIN rf ;GRP,2229455532... (APPROVED BY AMA COUNCIL ON MEDICAL SERVICE 8/88J PLEASE PRINT OR TYPE FORM HCFA-)500 (12-90-) APPt7pVEU OMB-0938-0008 FORM OWCP-1500 FORM RRS-t 500 E I PROOF OF SERVICE 2 1, Christine L. Clark, declare that: 3 1 am employed in the County of Solano, State of California. I am over the age of eighteen years and not a partyto the within action. My business address is 300 4 Tuolumne Street, Suite A, Vallejo, California 94590. 5 On the date below, I served the attached: 6 CLAIM OF KIM'K. SCHNEIDER 7 on the parties to this action by placing a true copy thereof in a sealed envelope, 8 addressed as follows: 9 Clerk of the Board of Supervisors Contra Costa County 10 Room 106, County Administration Building a 651 Pine Street 11 Martinez, CA 94553 n m F _ w ° 12 Rob Ewing F p c9 N N M 13 Danville City Attorney U v < 510 La Gonda Way N '-0 14, Danville, CA 94526 o -� .,a - J ZZ z (BY CERTIFIED`MAIL - RETURN RECEIPT REQUESTED) I placed each 15 x_ w � ri such sealed envelope with postage thereon fully prepaid for first-class mail, < $ J 16 certified with return receipt requested, for collection and mailing at Vallejo, < California, following ordinary business practices. I am readily familiar with my x > 17 business' practice for collection and processing of correspondence for mailing with 18 the United States Postal Service, and correspondence is deposited daily with the United States Postal Service in the ordinary course of business. 19 (BY PERSONAL SERVICE) I caused each such envelope to be delivered by 20 hand to the addressee(s) noted above. 21 (BY FACSIMILE) I caused said document to be transmitted by telecopier to the 22 number indicated after the address(es) noted above. l declare under penalty of perjury under the laws of the State of California that 23 the foregoing is true and correct. 24 Executed on Tune , 1999, at Vallejo, California. 25 26' 27 R19TINE L CLAAK 28 s� 14 11 tk 4A Ua 6� Lairs N r. VIMrn cr P ' A fu to t°