HomeMy WebLinkAboutMINUTES - 09141999 - C1 CLAIMI
SEY-M 1
Dalm Against the Cote, or Disteict Goverred by �
ft Boyd of .Ms rs, Routing Endorsemnts, NOTICE TO CLAIMIAN71
d Board Action All Section Were= we to � copy of flis dommit trei>ed to you is your
California Goverrmnl Codes. notice of ft action taken on your dim by the
ward o rsors. (Paragraph IV below, oven
iY` h G rsant to cant Code Section 913 and
r.., � b ate 1 'Warni
res".
O � $ 56.55 `
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aFJtY•f� . Y'
" i6lhael G. Mark
M z DATE r August 3, 1999
€3 SS: 3901 Gen dry town Drive BY DELTVERY TO CLERK 4N;
A, stitch CA 94503
BY ST
OM- Clerk of the Board of Supervisors M. County Counsel
,attached is a copy of the above-noted claim.
HIL BATCHEWR. Clerk
I ted: Bye Deputy
IL FROM- County Counsel M. Clerk of the Board of Supervit rs
This claim complies substantially with Sections 910 and 9€0.2.
}
This claire FAILS to comply substantially with Sections 9€0 and 910.2., and we we so notifying claimant. The
Board carrot act for 15 days (Section 910.9).
Claim is not timely filed. The Clerk should return claim on ground the. it was filed late and scud warning of
claimant's right to apply for leave to present a late claire (Section 911.3).
0there
ted; County Counsel
? a A $
111 FROM.
ierk oardsel t rr for
claimretazr ed nti ely thA rte to lai t tion € ,
BOARDy unanimous vote of the Supervisorspresent:
bis Claim is rejected in full.
Oth
I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date.
Da
ted `" i l3� , €erk, ley ' Deputy Clerk
IMG (Gov_ code section 3)
Subject to certain exceptions, you have only six ( ) 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 in attorney, you should do to
immediately. *For Additional Warning See Reverse Side of This Notice.
AMAX OF MAUXiG
I declare under penalty of perjury that I am now, and at all titres herein mentioned, have been a citizen of the United
States, over age 18; and that today 1 ,deposited in the United Mates postal Service in MAftinez, California, postage fully
prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above.
.ted; r �' y> I is R y %`r 'LAYL,e- ty Clerk
. cmity el County Ainitor
Claim to; BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
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 befog December 31, 187, must be prorated not later than the 100* day after the
accusal of the cause of action. Claims relating to causes of action for death or for injury to perm or to
personal property or gnwing crops and which accrue on or after January 1, 1988, east be presented not later
than six months after the accrual of the cause of action. Claims relating to any other cause of action wast be
presented not later than one year after the accrual of the cause of action. (GovL Code§911.2.�
B� Claris must be filed with the Clerk of the Board of Supervisors at its office an Room 106, County
Administration Building,651 Pine Street,Martine7,CA 94553.
C. 1f Claim Is most a district governed by the Board of Supervisors, rather than the County, the name of the
District should be filled in.
D. Lf the claim is against ur€ar than orae public entity,separate aarras wast be falc;d against each public entity.
Ea 'raud> See penalty for fraudulent claims, Penal Cade See., 72 at the end of this foram.
RE.• Claim by, Reserved for C'lerk's Filing Stamp
Against the County of Contra Costa
or AU G
District t R31 ,
(Fill in Name)
The undersigned claimant hereby makes claim against the County of Contra Costa or the above arced
District in the sum of in support of this claim represents as follows-.
1. Ahem did the damage or injury cur? (Give exact Date end Hou`) _
y �. .:� t
lJ
-------------------------------------------------------------------------------------
adhere did the damage or injury cirri (include C11. andCounty) �
i :,sem.,- ,.fti�.t.r aa.✓{``,., ^ � e.•°,.e.. ,,k',','�-....Ca.-..•;r,.
s
e•s ``.' ,' `x o s ,f� *f rr" 'P"fir,,✓,;, f3„f' ,r ,,��`` �. 3iv' -" - .. '� y j- -- - -------..6 -4®--- - w
..�m w�'`� �.®..m .:w.a,a`^�. S°: a:.'�n�� a"�:°'o -•r,!',s�-::" e.,�' ,e*fe;a"�-.+G' .
3e How did the damage or injury occur?Y (iGive W details.use ext-taper if required)
4, What particular act or omin on the part of county or district officers, servants, or t e #
injury or damage?
P° w �a ver y `>
Y� S �,*Z✓s.r �,.a.- a�'� c°;»q8.s" � t". ° �6 � �� '2 S
qi v sew:.,. �p,y..v.,dF....
F paw_' i fOAf
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5, What are the names of ounty or distract officers,servants,or employees eausi g the damage or injury?
��e✓w.. �-.. . "'"ry� ��''�.,''�,`.�'� ,'�..�. '�,a'k„'a "'�»a4 x m .wX � � i6�t" �.,.�� :e''3, Z � % �`�°v"'" �.,�
S What damagpsvr injuries do vou char resulted, (GtV, fa extent of htiuries or datmavft 3raaed. AtUch tWo estinotes rar,
auto damage
"` "�;� � ,�f�d� �,a. f, , � •`,-�` t'���,'�i�',s a,� �- .`.ter" i�.�:,,��,r�"'`'� �.�`.,., -'�z,,; "- c ',�', .rr--
----smmmom,ne-47----------......o..- ---------..--------------a..-----a.,,®Weas---------------
7. Heave was the above claimed amount computed': (tncitadc.thL tsfimted ssaaoun,of any pmspec ve i:tur.v or damage.)
Re names and addresses of witnesses,doctors, and hospitals.
9a List the expenditures you aide or account of this accident or injury:
�...f E` F• i'S. .�....'v�.t ys` a>f'"" .-... f,�.te°` m
v� Cade See.910.2 provides:
"The claim must be signed by the claimant
SEND NOTICES TO. `Attorney) or by some person an his bete W."
Name and Address of Attornev
Claimant's Signature�.
Address y
Telephone No. s Telephone :rtes 77471
N0 T I
Section 72 of the penal Cade provider.
"Every person who,with intent to defraud,presents for allowance or for payment to any state board or officer,or to
any county,ems° or district board or officer,authorized to allow or pay the same of genuine,any fain or fraudulent
claim, bill, account,voucher,or writinis 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 dollars (S1,000), or by beth such imprisonment and
fife,or by imprisonment in the state prison,by a fine of not exceeding ten thousand dollars($10,000), or by both
web imprisonment and fine,
,DPNIAGE REPORT MARKS
07j21/99 at 08 :29 D.R. 20216-0008607
AE 134092 Est : R. LAPOLLA
JIM' S CALIFORNIA AUTO BODY, !NC.
1705 SOMERSVILLE RD.
ANTIOCH, CA 94509-
(925) 754-7600
Owner: MICHEAL MARKS Day Phone : (925) 777-1553-
Address : 3901 GENTRYTOWN Other Ph: ( - -
ANTIOCH CA 94509 Deductible : $ 250 . 00
insurance Cc. :ALLSTATE INSURANCE COMPANY Phone : 925-875-6479
Claim No. : 1664451166-01 Adj . : DONNA HAGIST
99 HOND CRV 4X2 LX 4D UTV BLUE 4-2 . QL-FI
Vin: JHLRD2847XCO07473 License : 4FRF811 CA Prod Date : 2/99 Odometer: 3972
Automatic transmission Power steering Power brakes
Power windows Power locks Power mirrors
Body side moldings Dual mirrors Air conditioning
Rear defogger Tilt wheel Cruise control
Rear window wiper Am radio Fm radio
Stereo Cassette Search/seek
Driver airbag Passenger airbag Cloth seats
Bucket seats Styled steel wheels Clear coat paint
Metallic paint
--------------------------------------------------------------------------------
PART
NO. OP. DESCRIPTION OF DAMAGE QTY COST LABOR PAINT MISC
--------------------------------------------------------------------------------
i GRILLE
2 R&I Grille assy blue 1 0 . 3
3 R&I Molding. 1 0 . 1
4* Repr HOOD/REMOVE FOREIGN MATERIAL I
S* Repr RF FENDER/" 1 . 0
6* Repr LF FENDER/" as 1 1 . 0
7* Repr RF .DOOR/
I IV _7 5
8* Repr LF DOOR/" 1: 0 . 5
9* Repr RR DOOR/" i 67-s
io* Repr LR DOOR/°' VI
il* Repr RR QTR/11
12* Repr LR QTR/11 0=5
i3* Repr ROOF/as as 1 2 . 0
14* Repr LUGG LID/" VP i
15* Rep! SUBLET TO BUFF/POLISH COMPLETE i x 93 . 75
--------------------------------------------------------------------------------
Subtotals ===> 0 . 00 8 . 9 0 . 0 93 . 75
Page : 1
DAMAG8 REPORT VkRKS
,12
07j21/99 at 08 :29 D.V 20216-0008607
:AH 134092 Est : R. LAPOLTLA
JIM' S CALIFORNIA AUTO BODY, INC.
1705 SOMERSVILLE RD.
ANTIOCH, CA 94509-
(925) 754-7600
Parts 0 . 00
Body Labor 8 . 9 units @ $52 . 00 462 . 80
Sublet/Misc 93 . 75
--------------------------------------------
SUBTOTAL $ 556 . 55
Tax on $ 0 . 00 at 8 . 2500% 0 . 00
--------------------------------------------
GRAND TOTAL $ 556 . 55
ADJUSTMENTS :
Deductible -250 . 00
--------------------------------------------
CUSTOMER PAYS $ 250 - 00
INSURANCE PAYS $ 306 . 55
VISIBLE DAMAGE QUOTA71ION
Estimate based on IMOTOR C1dAS14 ESTIMATING GUIDE. Non-asterisk(*) items are derived from the Guide !RG4461. Database Date 6/99
Double asterisk(**) items indicate part supplied by a supplier other than the original equipment manufacturer.
CAPA items have been certified for fit and finish by the Certified Auto Parts Association.
NAGS Part Numbers, Prices and Labor Times are provided from National Auto Glass Specifications, Inc,
EZEst - A product of CCC information Services Inc.
Page : 2
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CLADI
ARD AOM SE 'DESI14g 1999
Claim Against tt County, cr District Governed by
the Board of Supervisors, Routing Endorsements, NOTICE TO CLAIMANT
and Board Acton. All Section referees we to T�e copy of i s dDcunTnt r iled to you is your
i orrl a Govarmrnt Codes. mice of ft aotim taken on your riaim by the
Board of Supemsors. (Paragraph IV belmm, liven
pursuant to GoverrinantCcSection 913 and
15,4. Please rote all 'Warnings".
c ,:a
A�M
Off: None Spee�fied
CL,AjMANTT. Bi—My M ehae"L 'Rogers, Sr.
A ONE . Daniel GroutATE August 3, 1999
DnSS> 458 ® 7th Streets 13y DEUVERy To CLEM ON. AuLust 3, 1999
CaKand CA 94606
BY "L POSTMAPMED: Hand-del ivered
FROTM Clerk of the Board of Supervisors County Counsel
Attached is a copy of the above-toted cls .
PHIL BA Clerk
Dated: A-ugust 3, 1999 By: Deputy
IL FROG County Counsel TQ Clerk of the Board of Supeis s
This claim complies substantially with Sections 910 and 910,1
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 richt to apply for leave to present a late claim (Section 911.3).
Other:
J.
4 ted: '` - By a Dept' County Counsel
t � �
FROM Clerk of the surdty Counsel (1) County Administrator (2)
( ) Claims returned as untimely with notice to claimant (Section n 9110.
.. BOARD ORDERU By unanimous vote of the Supervisors present:
"his Claim is rejected in full.
" Other.
I certify that this is a true and writ copy of the surd's Order entered in its minutes for this date.
PHIL BATCHELOR, Clerk, By' Dept' Clerk
WARNrNG (Gov. code secti h 913)
Subject to certain exceptions, you have only six (6) months from the data this notice was personally served or deposited
in the mail to file a court action on this claire. See Government Code Section 945.6. You may seek the advice of an
atto ey 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 sof This Notice.
AFFIDAM OF NfAnZiG
I declare ander penalty of perjury that I am now, and at all ties herein mentioned, have beau a citizen of the United
States, over age 19, and that today I deposited in the United Stags postal Service in Martinez, California, postage fully
prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above.
F
a+es3 y: PHIL BATCHELOR By Iputt' Cork
CC: Co=ty Co=sel County Adadnistmor
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W�'iwaia Hs jolution., Jjr., M.D.
2260 Gfadstosze Drys Suite
Pitt�burg, CA 94565 (9 25) 427-5454_
April 2: 1999 ,
Mr, t 1;ouo WrriQ
Contra Costa county
610 Court Street
101 rtinez, CA ,94553
Dear tvlr, Warrick,
I';a1ici� I Rodg rs was examin a as per hi s usi €� ntr ly v s " in U Febfuary anid �as
found n to have large sacral cfec>c bdus Dicer over Isisutt€cks it two places. rhes
wounds' have been. €' 't we (ot a long time and are subUy 'heaiing witirl twice daily
dressing c8hainges as provided 3y,his careta ey. His hronic pain syndrome treated with
Dilaudid meg three times a day and spastic paraplegia nai y to, infectious ori
destnuction atTIO was imanaged with Valium 10 mg on a twice or three finnes a day
basis'. His., y r a for r-no tabiliay,xll sleep at 5 mg a day as faun to; be stable,
Nlrn F�pdgers a�a reexamined in iaie 'Ward£ of 1999 with the finding o< talo now perirle I
wccerations of 'I,to 3 c;r; and 1 x 5 to 2 Cm in the area just below his previousiy known
decubitus, ulcer These wounds appeaIr to be infected and rec uir€e- :_-keansing nd
application of antibiotic therapy,
As regards Mr, Rodgers longer terra care; he re coir s -,,wice daily dressing Shan ess a
fiotation'syste.m bed, and continued medication as described above. The very l trge
,na ,ral .f op itus' €if ap rox miatel 3 x 5" rapidly deteriorate to €f not co #si�stently
treated with Rife €v€a'ly ressi changes an all faa c���c� � 3:�s� �1��;� ��� andantiI�i ti care aping provided at ho.rne at the € sent tlme.
If any further information is required, please Call or write nay office
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$r CH MAGNETIC IMAGING
Ant3lr Cafiforwa 94509
(92S) 757-2100 Fax (925) 757-2101
------------
NAME.- ROGER `$ WILLIAM (MICHAEL) DATE. 06/18/99
DATE OF URTM 09/03143
WPM NUMBM. 19470 ItEF + .#= E : WILLIAM JOHNSON,;.`, NLDx
IMAGJNG O ~HIE wAHUL3a E
aRule out tear.
Shoulder coil technique provided the following 4>fiquenc �s
("l) Coronal oblique SE TR550 T1TE15 with 5 rnrn sections,
( ) Coronal oblique SE TR2000TE 15/80 with 4 mm
e tions; ( ) Transaxial MPGRTR600 TEI 5 FA20 with 5 mm sections; €rye=) TransaxW
S a 1 600 TEI 5 with 6 mm sections; and ( ) Parasagittal FSE TR7000T 100 EF with
4 mm sections and chemical fat saturation.
EMINA: There is a pi�rtlal thickness tear of the
above the mi p rtion of the hUfTl ral head,, TNs area of the
tendon is also below sones large bony spun at rlie
8Cr0MiQCJaViCUlaf Joint which appears to have caufied sorno irripingernerit and
ultimately the tear. The muscles f the rotator cuff are intact, bort thO—(e is an unusual
arrangement of the subscapularis tendon which splits to enclose the biceps tendons
The biceps tendon is not in its groove at the €sisal level of the glenaid and the groove
is undeveloped at that level,, however, it eventually reaches the groove lower €Sow€f,
No bony abnormality is seen. There appears to be fairly accurate cartilage fining of
the joint so that if there is arra degenerative arthritis, It is riot severe
ex x
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, Partial tear, supraspinatus tendon,
Thank you for referring this patient to AMI,
06/18199
, 06/18199
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s ir#£fib&aztss.wf<#.3yg,''rue 3 OEM'�&,N RAtr4ON l+fELt—C Y W...°ro'`o. "z,..,,.•*
Nbuary 21, 1985
5050 l ' `+ y
rtiyago, Illinois 60640
Attention; Paul Front
Claim Adjuster
Claim hunbert 11593586
War Mrs Froati
I have Weated Nuchael &>gex is August, 198 for a left GUM
deadbitus macer. The patient' relates that the Witing injury to the
ischia. decubitus ulcer was dutomVile accident: which, resulted in a
soft tissue injuryand severe bruise to this area lTiis certainly
could be the inciting factor for a KNOW ulcer in a paraplegic.
These patients are =11 areg�likely to Suffer a breaklownof tissue
due to Wre minor t raux", t ka Fati nts are not paraplegic.
{ other wails Mr, Rxe o beirxj paraplegic dDes have a prCpanzity towards 4
decubitua ulcers Wt apparently the incitinq factor to 0fonea�ia�
of his rt i lar ulcer was the t rauAsustained during Cho
automobile cQi enty as April 17, 1984.
l� or i any °- an be of forther asaistance, please feel
free to aat, rk no.
-7111
civil,
CAI
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June 30, 1999
Bally Michael Rogers, Sr.
01 West 1 Oh Street
'
Antioch Cts 94509
Dear,fir, Rogers:
This acknowledges year Jaime 24, 1999 concerning your nie is ul ca rc while in custody at
the Grants Costa Maim Jaid in Martinez. It is nay aaadcrstUnding you We.rc i.a Jail' fi-0€11 MaLh 9,
1999 until your release to the 1Ionic Supervision Program on March 15, 191)9. Your letter
describes a pre-existing open -ulcer on your buttocks that rNuired a special bed to facilitate
t
healin o You further indicate that you developed two aadditionaal "alcer wounds" due to sleeping
1
on an inappropriate mattress and "two herpes wounds" due to,the x: mattresses not being clebana
a` Additionally you indicate that the jail physician told you that you should be transferred to
a;
Meritlaew Hospital, but this transfer did not occur prig to your rselea€sc. You also express
} concerns about your pain medication and tlae methods used to empty yoaar urine bag.
a=
Your letter referenced enclos,,A c€arn:spondencye from your p,Crsoaaaal playsic;iaaa to your attorney,
but it was not included with the letter we received. By rceicrenci€ g your aaaorney, you imply that
you may be makin a claim against the jail for your treaatmant. This is as nccourse that is open to
you. Medical complaints that are specific can also be addressed to the Medical Board of
California., Central Complaints and Control Unit, 1426 Howe Avenue, Suite 54, Sacramento CA
95825,
The Board ofCorrec:tioa}s is as regulatory, but mac:t an °'inVest:!gatory" U-c€icy. Wedoiluthavvdw-
mandate, expertise or resources to personally investi-ate the claims you €na ke or to sanction
facilities, However, by copy of this hp tier, I am lorwarding thfio inlor€aaaatioaa you provid�A to the;
frail manager and requesting him to rcviQw your t€°caam gait and respond to us° I will provide: you
with farther follow-up alter receiving that i€�I�raaaaatioaa.
Sara rely,
f'
udrey J,Ptandarls
ield Rcpres€�ntativs;
Facilities and Services Division
cc: Lieutenant Steve Fuqua, Facility Manager
CC Ropa°a doc,6/30l9R
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MEDICAL BOARD CV, CMAFORMA
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141fl, HOWE AVE, SUM- F33
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June Ile 10`�q
BILLY ROC-1F,RS
501 114, 10T111 CIT.
<}t. {y�.,.i.c Fy.p 5;'fly e DOCTOR
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Thl ackno-vq,`—ed . e yo-ut ray. z.f: c::sa'F`esp— d� -,ce regard-ing the
tile "Lliformation you
have provided r"andtrail ., be conducti.nq a tho$"s"`%kFtq'h analysis. £Teas e
tt:.ffwwp enclosed brochure fo� .� eE�t',:S� z.��..��%'� about the rx-:$:'lpl Get.3.lit ryoce'-.-aisF2
if you have additional, imformation re ar y €; your complaintt pleAae
pend It imed;n lel y, Rc!,E r to the cont of number shown above. in your
correnpolidence or conY;actiT, with us. You w1111 be advised of the
st2:°ctur, o6_ Y£Your complain-1 at varloustaq.,s of t-he C"C.?mpla-Int v cean,
We appreciate your .alk- i$'nce aml would like to, 11— f:.r bi n o `,+q
your concerns to Our attention,
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Office the Director
William
Director, Health Services Department
370.5007 HWVOY
370-5099 FAX
. tio - - A
StafUep r
;. Donna 5n)5 Center 200 EJKen Stuart,2920 Diamond Blvd-#200
Wandel Brunner, M.D, 597 Center;#200 v Aft Lathrop, 50 Glacier Dr., 3�Floor
t-A"it Camhi. 591 Center,#100 Lew Pascalli,4333 Pacheco Mvd.
: Patrick Godley, 20 Allen St, Ginger Maneiro, 597 Center,*255
t Chuck Deutschman, 597 Center,#32� � County Administration., 651 Pine St., Floor
Frank Pu lisi,Admin A Fr ncie Wise, 597 Center,#200 A
.. Steve` rernain, MI.D., Admin A Lj Materials Management
> s€l: Kelley, 2 slen t. H O payroll, 2530 Arnold Dr., 150
Mary Foran,20 Allen St. Risk Management..-
:. Lee Ann Adams, 2530 Arnold,# 120
Mckie Dawes; 651 Pine t., 9�Fioo Attn: �� arvey
rive, #140
2530 Arnold D
Fel
ACTION REQUIRE,
As requested .
Prepare a response& Forward I
Response
for ray Signature
For Your Distribution
{$ Return Copy for my File
As
Disc d
t<
WA
roma Dates
1
2"
ti
AMLICA ION IM ftLE LATE CLAIM SEPT� �SER 14, 199
BOARD A °I
Application, to File Late Claim NOTICE 70 A10FUIAN"r
Against the County, Boutin The copy of this w— irLe- to YVu is
Mndorsements, and Board Action.) notice of the action taken on your application b
(All Section Aeferenae3 are t ) the Board of Supervisors (Paragraph III, below),
Cal.ifornia ve t e.) ) given pursuant to Government Code Seetion-s911.8 and
915.4. Fl e note the " below.
Attorneys
AddMMS2 246 Avocado Place
Amount.. By Brentwood CA 94513delivery to Clark on August 3, 1999
Date Received.- August 3; 1999 By mail, po3tmarked on August 2, 1999
perk d r Isors 'ug t el
Attached is a copy of the above rated Application to File Late Claim.
DATED:: Angus 3, 1999 FFML BA.' , Clerk, Deputy
I g t 'int Clark or the d of =upervisor
C The -d should rant this Application to File Late Claim (Section 911.6).
�) The Board should deny this Application to File Late Cl (Seolpqn 911.6).
N (�
DAA � �� t ;�
De;ut
rS
mon vote o Superyr° present
(Check one only)
TMIs Application is grated (Section 911®6).
This Application to File Lite Claim is denied (Section 911.6).
I certify that this is a true and correct copy of the Boards Order entered in its
minutes for this date.
F
'Aid (Gov® Code 1911.8)
If You wish to .file & 00urt aftiOnthis matter,, t first petition the
priate 0OWt for an order relievingprovisions of Governmt Code
Sootion 945.4 ttati t). S" GovWr&Mt Code Section 945.6. Such
petition t be filed with the within gix ( ) mmths from the date your application
for leave to t a Late claim was denied.
You y seek the advise of any attorney of your chojoein 00MMajon with this
matter. f t to oonsult an Atte should do so imediatel
r so
r
Attached am copiesof the above Application. We notif d the applicant of the
Board's action on this Application mailing a OOPY of this documentv and a wmo thereof
has ban filed and endorsed on the Boardfa copy of this Claim in accordance with Section
29703.
A te " BATCi, � 9 Clarks Dep t
ty A st for r Clerk of is
Received oopies of this Application and Board Order.
of Supervisors
DATM County Corel, By
County A g ni3trator,
MPPLICA`I FILE LATE CLALM
1 RECEIVED
AUG 3 199911y
' � k
t1VA4'D OF vU$'''E M'SJORS
July 28, 1999
The Board of Supervisors
County r-huf strtoo Building
51 Pies tr y Room W 6
'Nkfutffiez, CA 94553-1,293
Dear Ms. Stally,
Flus letter is a forgo -upfolgow-up to the phone conversation e had on`uckla , July 27, s 999.
1 would like to apply to Me a We claim., Due to mis -mmuni tion Ith the Risk
M e ndfc-e, our claim was not mitted on time. The date of the accident was
ear 2, 199&
Your prompt attention to this matter v;,mald be greatly appreciated.
Sincerely,
Rick Melgoza
t
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0'�e
" ly
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