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HomeMy WebLinkAboutMINUTES - 09102002 - C34 CLAIM r ROAM OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Sept 10, 2002 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 California Government Codes. ) notice of the action taken on your claire by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all"Warnings". AMOUNT: $6000 CLAIMANT: Susan Linni ATTORNEY: ';Ione DATE RECEIVED: Aug 7, 2002 ADDRESS: 61:61 Minert BY DELIVERY TO CLERK.ON: Aug 7.2002 Walnut Creek, CA 94598 BY MAIL POSTMARKED: I. FROM: Clerk of the Beard of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. i t JOHN SWEE Dated: Aug 1,20{}2 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisor1s ( , `fhis claim complies substantially with Sections 910 and 910.2. ( } This Claim.FAILS to comply substantially with Sections 910 and 914.2, 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 311.3). ( ) Other: f Dated.: By: / '3 ,L Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( } Claim was returned as untimely with notice to claimant(Section 311.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Carder entered in its minutes for this date. Dated. x W�` ' " 3?{ ; JOHN SWEETEN, CLERK, By #' ~: .<: '} ' ,Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned,have been a citizen of the United States, over age 18 and that today I deposited in the United States Postal Service in Martinez, California,postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated _ " ` # $: J{ HN SWEETEN, CLERK By °. Deputy Clerk v �,r € �,. t FAX NO. Aug. 06 2002 0B: 1SAM ?1 CE Of WA V CREEK FAX COVER dale Date: Gy ,fit TO: FROM: � L � -7 Number of pages including this one: Please notify telephone number(925)937-219,1 i�Y this fax is rnissent. Thank you. / , 94-0 FROM FAX tZ. Aug. 06 2002 08:16AM P3 33s Claim to: 'BOOM CF SUPERVISORS OF CDINTRA COSTA C OLINTY ixs'MCTYOx To .DW;T A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing craps and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing cops and which accrue on or after January 1., 1.9880 must be presented not later than six Months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code H. Claim must be filed with the Clerk of the mrd of Supervisors at its office in Room 106, County Administration Building, 651 Fine Street, Martinez, CA 94553- C. If claim is against a district governed by the Board, of 'Superyi�ors; rather tan the County, the mme of the District should b6 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`, Peni:1, Code- Sec: ` z at�the end of this farm. ,s RE: Claim By ) Reserved for Clerk's filing stamp 44 t ) ! dt tt_ytt } t } . Against the qty of Contra Costa or ) District) Ril1 in W77 7 ) The undersigned claimant hereby makes claim jai. the County of Contra Cast or the above-named District in the sum. of $ 0 •. 40 d d in support of this claim represents as follows- � ��� I., When did the damaZe or inj=y occur? (Give exact elate and hour) yet- 40 2. where did the damage or inj ;y oc . (Include city and county) � 3. Row did the damage or injury occur? (Give Rill details; /use extra paper if required) t; i �.,:<- L tom.\ '•,4^C. (t ,,,,, ` 1ti.` r} .. s !✓^ '•e'"�+ � �Iti-r�'✓' `.-S� 4r'y+.. t'4F,,.�4� ...:1 •".��.. +��_,%i'L�' '�'q .� ��,f"� 4+at'e- 4. What particular act or omission on the part of county or district officers, servants or .employees caused. the injury or e? r . LK Xh rr C1M FAX NO. Aug. 06 2002 08'•17AM Pit w►nat are Vie names of county or district officers, servants or employees causirig the damage or injury? 31e, 5. 'hat damage or injuries do you claim resulted? (Give full extent of injuries or 1 damages claimed. Attach two estimates for auto da 4e. `-9" ,, # { �(r.�.. � *•"""'4 ,L.C'��•-�.. ��...+ r++�e..• ,�..�.-+�»,.�..�.,�'�,-'t..._'yo2" `► ,,�„ �.-_�''-'�"'r..+ .*�r --~tel 7. How was the amount claimed above caiputed? (Include the estimated amount of any prospective injury or damage.) 6 8. *tames and addresses of witnesses, doctors and hospitals. 9< List the expendittu*-sas you made on account of this accident or injury: DATE ITE AtSUNT Goo. Code Sec. 910;2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his.behalf." Name and Address of Attorney (Clai nt Is Sigbatury �Adiaress) Telephone No. Telephone No. iF iF iF iF iF * !E It !F !F 1F * 0 1 T W I I WX I NOTICE Section 72 of the Venal Cade provides: "Every person who, with intent to defraud, presents for allowance or for payment to ani` state board or cffi cer, or to any county, city or district board or officer, authorized to allots or pay the .same if .genuine, any false or fraudulent claim, 'bi.11, account, voucher, or writing, is punishable either by i.mpri.sor hent in the county jail, for a period of not more th2n one year, by a fine of not exceeding om thousand ($1,000) , or by 'both such' imprisonment and fine,` or by i=risonme nt in the state prison, by a fine of not exuding ten thousand dollars ($10,000) or by. bath such imprisonment and rine. POM FAX NO. : Aug. 06 2002 08: 16AM P2 1. August 1, 2002 at 8:45 a.m. 2. Between Concord and Pleasant Hill, Contra Costa County, California 3. The big-rig truck rear-ended my vehicle while both were in lane 3 on the freeway. 4. Apparently, the driver may not have seers my car as it is small, traffic was crowded and the truck was so high. 5. Ernest G. Carter Sr. 6. t am claiming damages as listed on answer#g. 7. The amount has not been computed. However, estimates were done for car repair (over $8000); however, the automobile will have to be replaced entirely, damage to my body is not whiplash, however, there is continuing pain and also psychological reasons l claim "pain and suffering". (Contact Dr. Stephen Rader, M.D. at 646-5480 if you wish to verify my condition.). My damages are significant and I am not in a position to sustain them at this time. 8. Mt. Diablo Hospital, 925-674-2333, Emergency Room Dr. Nirav Shah, M.D. Also, an ambulance medic who attend- 2540 East Street ed at the scene of the accident- name Concord, CA 94520 unknown to me 9. 1 am listing the expenditures I will have made as a result of this accident: -cost of replacement of my vehicle, (Blue Book +) for the appropriate car; l ask more than the Blue Book price as the car was in absolutely excellent condition for its age; I'd had it only 3 months — it was in great (used) condition — original owner. Costs for any damage to the driver in front of me as well. -replacement car from date most near the date of the accident -emergency room bill for visit within 24 hours of the accident -ambulance to scene of accident if there is a bill; + cost of police report -items in trunk -new insurance, registration and license plates for car that I get -day + other day(s) of work missed for insurance coverage etc. -any future medical and psychological effects translated into bills that may be incurred -- not likely to be much if any -doctor's follow-up visit requested by ER doctor -cost of estimate for repair of car -transportation to and from work until replacement car is provided -$2000 in pain and suffering, physical and psychological!` Note: I do not have an attorney but feel that, if l did, the claims might be heftier. Please help me resolve this matter generously as it has been a traumatic situation. l am sorry that the accident happened and involved another driver (or two) but am most thankful that nothing worse occurred. God bless you. OFFICE OF THE COUNTY COUNSEL SF,.� SILVANO B.MARCNESI COUNTY-OF CONTRA COSTA � � ��* COUNTY COUNSEL Administration Building 651 Pine Street, 91"Floor SHARON�8� SWARON L. ANDERSON Martinez, California 94553-1229 i(a 5` -'� �a } CHIEF ASSISTANT (925) 335-1800 ( GREGORY C. HARVEY rf y� d t1 s C°J5 " �tii�J1V@i "` � �I fjVALERIE J. RANCHE (925) 646-178 (fax) ad6 a m r � t A55ISTANTS US NOTICE OF LIETIMELINESS AS TO A PORTION OF THE CLAIM TO: Richard J. Simons, Esq. Furtado, Jaspovice & Simons 22274 Main Street Hayward, CA 94541 RE: CLAIM OF JEAN MULGREW GRIBBLE and JOHN MULGREW Please Take Notice as Follows: In regards to the claim you submitted on August 16, 2002, on behalf of Jean Mulgrew Gribble and John Mulgrew, portions of the claim are timely and portions are untimely. The portions of the claim prior to February 16, 2002 that you presented against the County of Contra Costa governed by the Board of Supervisors fail to comply substantially with the requirements of California Government Code Sections 901 and 911.2, because they were not presented within six months after the event or occurrence as provided by law. Because the portions of the claim prior to February 16, 2002 were not presented within the time allowed by law,no action was taken on those portions of your claim. The claim was forwarded to the Board for action only on the timely portions of the claims. The only recourse at this time is to apply without delay to the County of Contra Costa governed by the Board of Supervisors for leave to present a late claim as to the claims which are untimely. See Sections 911.4 to 912.2, inclusive, and Section 946.6 of the Government Code. Under some circumstances, leave to present a late claim will be granted. See Section 911.6 of the Government Code. SILVANO B. MARCNESI COUNTY COUNSEL BY Monika L. Cooper Deputy County Counsel Page 1 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 UNTIMELINESS AS TO A PORTION OF THE 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. Executed in Martinez,California. Dated: September ,2002 xve ' ;kathy O'C, nell w cc: Clerk of the Board of Supervisors(original) Risk Management Page 2 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Sept 10, 2002 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 California Government Codes, notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and AUG 16 2002 915.4. Please note all "Warnings". AMOUNT: Unknown COUNTY COUNSEL I ,�.,4ARTINEZ CALIF CLAIMANT: Mt. Diablo Unified School District&Perry Julien ATTORNEY: Louis Leone DATE RECEIVED: Aug 14, 200.2 ADDRESS: 1450 Maria Ln Suite 310 BY DELIVERY TO CLERK ON: Aug_14,2002 Walnut Creek, CA 94596 BY MAIL POSTMARKED: August 13, 2002 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. �+; T JOH S MY EE S i f Dated; Aug 15, 2002 _ By: Deputy . ....- II. FROM: County Counsel TO: Clerk of the Board of Supervisors { This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.$). ( ) 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: [he_ /',c, 1-e5'�''"� Dated: By: 'y ' ai Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) { ) Claim was returned as untimely with notice to claimant(Section 911.3). IV, BOARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. ;} 3 Dated:, JOIIIN SWEETEN, CLERK, By ° ,Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,California,postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. JOAN SWEETEN, CLERK By Deputy Clerk 1 LOUIS A. LEONE, ESQ. (CSB #099874) STUBBS & LEONE 2 1450 Maria Lane, Suite 310 Walnut Creek, California 945963 RECEIVED �,- Telephone: (925974-8600 4 Facsimile: (925) 74-8601 AUG 4:2 002 5 Attorne�ys for Defendants I MT. DIABLO UNIFIED SCHOOL DISTRICT LLEEOARDOFS PERViSORS 6 and PERRY JULIEN CONTRA c�sr,�CO. 7 SUPERIOR COURT OF CALIFORNIA, 8 UNLIMITED JURISDICTION, COUNTY OF CONTRA COSTA 9 ANNA SILLARD, a minor, by and through CASE NUMBER CO2-01414 10 her Guardian Ad Litem, DANT SILLARD and JESSICA BATRES, a minor, by and Complaint Filed: May 15, 2002 11 through her Guardian Ad Litem, ROBERTO BATRES, CLAIM AGAINST THE COUNTY OF 12 CONTRA COSTA AND STEVEN Plaintiffs SMITH 13 vs. 14 COUNTY OF CONTRA COSTA, MT. 15 DIABLO UNIFIED SCHOOL DISTRICT, STEVEN SMITH, PERRY JULIEN, and 16 and DOES 1 through 30, inclusive, 17 Defendants. 1 18 19 TO: THE COUNTY OF CONTRA COSTA, and its employee, STEVEN SMITH 20 THE MT. DIABLO UNIFIED SCHOOL DISTRICT and PERRY JULIEN, pursuant to the 21 provision of the California Government Code, submit the following government tort claim seeking indemnity and contribution in the above referenced matter. 22 1. The names and addresses of claimant and person to be sent notices: 23 The claimants are the MOUNT DIABLO UNIFIED SCHOOL DISTRICT and PERRY 24 25 JULIEN. All notices may be sent care of their attorneys, LOUIS LEONE of the law firm of 26 STUBBS & LEONE, 1450 Maria Lane, Suite 310, Walnut Creek, CA 94596. 2. Description of Claim: 27 28 This is a claim seeking indemnity and contribution from the COUNTY OF CONTRA CLAIM -1- 1 COSTA and its employee, STEVEN SMITH. The request for indemnity is based upon the 2 allegations contained within the First Amended Complaint filed by plaintiffs, ANNA SILLARD 3 and JESSICA BATRES. A copy of the First Amended Complaint is attached to this claim as 4 Exhibit A. The theory of recovery, again, is for indemnity and contribution based upon the 5 conduct of the COUNTY OF CONTRA COSTA and its employee STEVEN SMITH. 6 3. Public employee causing injury or damage: 7 Unknown employees of the COUNTY OF CONTRA COSTA, including, but not limited 8 to STEVEN SMITH. 9 4. The dollar amount sought: 10 Indemnity and contribution for all damages, attorneys fees and costs incurred by 11 claimants. The amount exceeds the jurisdiction minimum of the Superior Court, County of 12 Contra Costa, State of California. 13 14 August 8, 2002 STU & LEONE 15 16 YOIU�15S . 17 W.'D"61Xs for Claimants BLO UNIFIED SCHOOL DISTRICT 18 and PERRY JULIEN 19 20 21 22 23 24 25 26 27 28 CLAIM -2- y, a x EXHIBIT A k E? 3 f t x E 30 0 2- 1 Michael D. Meadows (State Bar No. 62110) CASPER, MEADOWS$SCHWARTZ 2 A Professional Corporation California Plaza 3 2121 North California Blvd., Suite 1020 Walnut Creek, California 94596 4 Telephone: (925) 947-1147 Facsimile: (925) 947-1131 5 Attorneys for plaintiff 6 7 8 SUPERIOR COURT OF CALIFORNIA 9 COUNTY OF CONTRA COSTA 10 11 ANNA SILLARD, a minor, by and through Case No. CO2-01414 her Guardian Ad Litem, DANT SILLARD, 12 and JESSICA BATRES, a minor, by and FIRST AMENDED COMPLAINT FOR through her Guardian Ad Litem, DAMAGES 13 ROBERTO BATRES, (Negligence) 14 Plaintiff, 15 vs. 16 COUNTY OF CONTRA COSTA, MT. Unlimited.Jurisdiction DIABLO UNIFIED SCHOOL DISTRICT, 17 STEVEN SMITH, PERRY JULIEN, and 18 DOES 1 through 30, Defendants. 19 20 Plaintiff's allege: 21 22 1. Plaintiffs ANNA SILLARD and JESSICA BATRES are miners. At the time of 23 the events giving rise to this complaint, plaintiff ANDA SILLARD was eleven to twelve 24 years old and plaintiff JESSICA BATRES was ten to eleven years old. ANNA 25 SILLARD brings this action by and through her Guardian Ad Litem, RANI SILLARD. 26 27 JESSICA BATRES brings this action by and through her Guardian4 Ad Litem, 28 ROBERTO BATRES. CAS�Ek !i 2002 ,ice 104 2121 N.California ova., $ ' Walnut Creek.CA 94596 First Amended Complaint for Damages Page 1 FAX(925)947-11 1 �+"� FAX{925}947-t 131 T 1 2. Defendant COUNTY OF CONTRA COSTA is a municipal entity, authorized 2 and existing under the laws of the State of California. Defendant COUNTY OF 3 CONTRA COSTA ("COUNTY") operates under its authority the Centra Costa County 4 5 Sheriffs Office. Defendant COUNTY is located within this judicial district. 6 3.. Defendant MT. DIABLO UNIFIED SCHOOL DISTRICT is a public entity, 7 authorized and existing under the laws of the State of California. MT. DIABLO 8 UNIFIED SCHOOL DISTRICT ("DISTRICT") operates under its authority Riverview 9 Middle School and Set Air Elementary School. Defendant DISTRICT is located within 10 this judicial district. 11 4. At all relevant times, defendant STEVEN SMITH ("SMITH") resided within 12 13 this Judicial district. 14 5. At all relevant times, defendant PERRY JULIEN ("JULIEN") was the 15 principal of Riverview Middle School in Bay Point, which is located within this judicial 16 district. 17 6. Plaintiffs are ignorant as to the true names and capacities of those 18 defendants named in this complaint as DOES 1 through 30. Plaintiffs will amend this 19 complaint to state the true names and capacities of DOES 1 through 30 when they 20 21 have been ascertained. Each of the fictitiously named defendants are responsible in 22 some manner for the events giving rise to this complaint, and the conduct of each 23 fictitiously named defendant proximately caused plaintiff's damages alleged. Each 24 reference in this complaint to "defendant" or"defendants" or to a specifically named 25 defendant refers also to defendants DOES 1 through 30. 26 27 28 CASPER,MEADOWS &SCHWARTZ'. 2121 M.Catifomia Blvd, suite 1020 Walnut Creek,CA 94596 First Amended Complaint for Damages Page 2 TEL:(925)947.1147 FAX(925)947.1131 1 7. At all relevant times, every defendant was the agent or employee of every 2 other defendant. Defendants engaged in the acts and omissions alleged in this 3 complaint within the course and scope of such agency or employment. 4 8. Plaintiffs are informed and believe, and on that basis allege that defendant 5 6 STEVEN SMITH was employed by defendant COUNTY in the Contra Costa County 7 Sheriff s Office, and was assigned to work with children and youth in Contra Costa g County, including plaintiffs. Plaintiffs are further informed and believe, and on that 9 basis allege, that SMITH was provided with a Sheriff's Office uniform by COUNTY, 16 and that SMITH frequently wore this uniform in the presence of children and youth in 11 Contra Costa County, including plaintiffs. Defendant SMITH was known as, and 12 referred to himself as, "Officer Steve" in many of his contacts with children and youth 13 14 in Contra Costa County, including plaintiffs. COUNTY encouraged SMITH to act as a 15 mentor and authority figure to children and youth in Contra Costa County,'including 16 plaintiffs. Plaintiffs are informed and believe, and on that basis allege that, in the 17 course and scope of his employment with COUNTY, SMITH was assigned to provide 18 security services and other functions at Bel Air Elementary School and Riverview 19 Middle School. 20 21 9. Plaintiffs are informed and believe, and on that basis allege that defendant 22 STEVEN SMITH was employed by defendant SCHOOL DISTRICT to provide security 23 and ether functions at Riverview Middle School and Bel Air Elementary School. 24 Among the duties assigned to SMITH by SCHOOL DISTRICT and defendant JULIEN, 25 and undertaken by SMITH, with the authorization and approval of SCHOOL DISTRICT 26 and JULIEN, were participation in special school programs and prevision of after- 27 :school activities, supervision, and transportation. SCHOOL DISTRICT encouraged 28 GASPER,MEADOWS &SCHWARTZ 2121 N.California Blvd., Suite 1020 Walnut Creek,CA 94698 First Amended Complaint for Damages Page 3 TEL:(925)947.1147 FAX{925}947-1131 I SMITH to act as a mentor and authority figure to students of Bel Air Elementary 2 School and Riverview Middle School, including plaintiffs. 3 10. Plaintiffs were familiar with defendant SMITH because of his regular 4 5 presence at Bel Air Elementary School and Riverview Middle School. Plaintiffs and 6 their families trusted and respected defendant SMITH because of his identification 7 with the Contra Costa Sheriff's Office and with their elementary and middle schools. 8 Over a period of several years, SMITH supervised plaintiffs and other school children 9 in a number of activities both during the school day and after school. SMITH also 10 accompanied plaintiffs and other.school children on a number of outings, including 11 trips to movies and theme parks. 12 11. Beginning in the latter months of 2000, defendant SMITH initiated a pattern 13 14 of conduct in which he used his special position of trust and authority in the eyes of 15 plaintiffs to manipulate plaintiffs' behavior for SMITH's personal and sexual 16 , gratification. This behavior continued repeatedly through the fall of 2001. 17 12. SMITH frequently asked plaintiffs, in the presence of other children, to 18 reveal confidential information about their friends and families. SMITH frequently 19 20 asked the plaintiffs, in the presence of other children, if they had boyfriends, and 21 specifically asked whether they had engaged in various specific sexual practices with 22 their boyfriends, or by themselves. 23 13. SMITH encouraged plaintiffs, together with other children, to discuss or 24 fantasize about personal sexual experiences with him, and to speculate about what 25 various sexual practices would feel like. SMITH advised plaintiffs and other children 26 that he was available as an adviser on sexual issues,just as he guided them in other 27 aspects of their lives. 28 CA;PEk MEADOWS 2121 N.Califon-4a Blvd„ sake 102© Wa2nte Creek.CA 94598 First amended Compiaint for Damages Fuge 4 TEL:(525)647-1147 FAX(925)947-1131 1 14. SMITH frequently hugged plaintiffs in the presence of other children at 2 school and away from school. 3 15. SMITH brought plaintiffs and other children to his home and encouraged 4 them to watch pornographic videos with him. SMITH gave plaintiffs sex toys as 5 6 presents. 7 16. On several occasions, SMITH attempted to touch plaintiffs' breasts. On 8 other occasions, SMITH exposed his genitals to plaintiffs and encouraged them to 9 watch him masturbate. 10 17. In the late summer and fall of 2001, on separate occasions, SMITH �1 arranged for plaintiffs to experience oral copulation with a boy who attended school 12 13 with plaintiffs. On each occasion, SMITH transported a plaintiff and the boy to his 14 home, brought them into his bedroom, and directed the boy to orally copulate plaintiff 15 while covering plaintiff with a blanket. On each occasion, SMITH attempted to lift the 16 blanket and to touch plaintiffs' breasts. On each such occasion, other children were 17 present in SMITH's home when he directed plaintiffs and the boy to SMITH's 18 bedroom. SMITH told each of the plaintiffs that the other plaintiff had participated in 19 this conduct. 20 21 18. Plaintiff ANNA SILLARD later reported this conduct to her to an adult 22 relative. This relative contacted the Pittsburg Police Department, which initiated a 23 criminal investigation of defendant SMITH. 24 19. As a proximate result of the negligent, reckless, sexual and non-sexual 25 conduct of SMITH, and as a proximate result of the negligent conduct of defendants 26 COUNTY, SCHOOL DISTRICT, and JULIftiN, as described in this complaint, plaintiffs 27 suffered physical injury and severe emotional distress, confusion, guilt, mental 28 CASP€R,MEADOW$ a SCHWARTZ 2121 M,Catifumia Blvd., Suite 1020 Walnut Cr"k.CA 94596 First Amended complaint for Damages Page 5 TEU(925)547.1187 FAX(926)947.1131 I anguish, humiliation, fear, and anxiety. Plaintiffs have incurred and will continue to 2 incur expenses for the medical and psychotherapeutic treatment of these injuries. 3 20. On or about February 13, 2002, plaintiffs filed Government Claims with the Nit. Diablo Unified School District in compliance with the provisions of the 5 6 Government Tort Claim Act, Government Code § 911 et seq. The District received 7 the claims on February 14, 2002. The claims named the District, the County of g Contra-Costa, Perry Julien and Steve Smith as responsible for the harm sustained by 9 plaintiffs. Plaintiffs' claims were denied by operation of law on February 20, 2902. 10 21. On or about February 13, 2002, plaintiffs filed Government Claims with 11 the Board of Supervisors, County of Centra Costa, in compliance with the provisions 12 of the Government Tort Claim Act, Government Cade § 911 et seq. The Board of 13 14 Supervisors received the claims on February 14, 2902. The claims named the 15 District, the County of Contra Costa, Perry Julien and Steve Smith as responsible for 16 the harm sustained by plaintiffs. Plaintiffs" claims were denied by operation of law on 17 March 12, 2002. 18 22. The conduct of defendant SMITH was despicable, and was conducted with 19 a willful and conscious disregard for the rights and safety of plaintiffs. Plaintiffs will 20 21 therefore seek an award of punitive damages against defendant SMITH. 22 FIRST CAUSE OF ACTION I Negligence 23 (Against Defendants COUNTY, SCHOOL DISTRICT, and SMITH) 24 23. Plaintiff realleges and incorporates by this reference paragraphs 1 through 25 19 as though.fully set forth herein. 26 24. Defendant SMITH, acting within the course and scope of his employment 27 23 with COUNTY and SCHOOL DISTRICT, owed a duty of care to conduct his relations CASPER,MEADOWS &SCHWARTZ 2121 N,California Blvd., Susie 1020 $ @ Walnut Creek,CA 94596 First Amended Complaint for damages TEL:(925)967.1147 FAX(925)947.1131 I with plaintiffs and other students in a reasonable manner, to avoid causing 2 foreseeable harm to plaintiffs. 3 25. At all times mentioned, it was reasonably foreseeable that children would 4 suffer severe emotional harm if an adult responsible for their safety and well-being 6 engaged in the types of inappropriate conduct demonstrated by defendant SMITH, 7 including, but not limited to, hugging plaintiffs in the presence of other children, 8 directing plaintiffs to reveal sexual experiences and fantasies to a group of other 9 children, and encouraging plaintiffs to rely on him as an authority and mentor in the 10 development of their sexuality. 11 26. In engaging in the conduct described in this complaint, SMITH breached 12 13 the duty of care to plaintiffs and proximately caused plaintiffs to suffer injury and incur 14 damages as described in this complaint. 15 WHEREFORE, plaintiffs pray for relief as set forth below. 16 SECOND CAUSE OF ACTION Negligence 17 (Against defendants COUNTY, DISTRICT, and JULIEN) 18 27. Plaintiffs reallege and incorporate by this reference paragraphs 1 through 19 2019 and 25 through 26 as though fully set forth herein. 21 28. Defendants DISTRICT, COUNTY, and JULIEN were entrusted with the 22 supervision and protection of plaintiffs and were subject to a duty to protect plaintiffs 23 from foreseeable harm, including the risk of harm presented by third parties. 24 29. At all times, it was reasonably foreseeable that plaintiffs were subject to a 25 risk that an adult in a position of trust and authority over children would engage in 26 harmful and injurious misconduct with respect to those children. 27 28 CASPER,MEADOWS BSCHWARTZ 2121 W Caitfamia Btvd., suite 1020 Watnut Creek,CA 94596. First Amended Complaint for Damages page 7 TEL. 925)947-1147 FAX(925)947-1131 1 30. Defendants DISTRICT, COUNTY, and JULIEN breached the duty to 2 plaintiffs in failing to properly supervise plaintiffs and to protect plaintiffs,against the 3 risk of harm presented by defendant SMITH. 4 31 Defendants DISTRICT, COUNTY, and JULIEN negligently enabled and 5 6 encouraged defendant SMITH to pursue inappropriate personal relationships with 7 plaintiffs and other children during school hours and in school-related programs and 8 programs sponsored by DISTRICT and COUNTY. 9 32. Defendants DISTRICT, COUNTY, and JULIEN negligently failed to warn 10 plaintiffs of the risks of inappropriate conduct by trusted adults in positions of authority, 11 and failed to warn plaintiffs of the risk of child sexual abuse, and failed to educate 12 13 plaintiffs as to how to protect themselves from personal and sexual abuse. 14 33. Defendants DISTRICT, COUNTY, and JULIEN negligently failed to detect 15 the warning signs of child abuse evident in SMITH's behavior, including hugging 16 plaintiffs and other children during the school day and during after-school programs, 17 and his devotion of extraordinary attention to the daily lives of individual children, both 18 in and out of school. 19 34. As a proximate result of the negligence of defendants DISTRICT, 20 21 COUNTY, and JULIEN, plaintiffs suffered injury and incurred damages as described in 22 this complaint. 23 WHEREFORE, plaintiffs pray for relief as set forth below. 24 THIRD CAUSE OF ACTION 25 Negligent Firing, Retention, Training, and Supervision 26 (Against Defendants COUNTY, DISTRICT, JULIEN, and DOES 1 through 10) 27 35. Plaintiffs reallege and incorporate by this reference paragraphs 1 through 28 19, 25 through 26 and 28 through 34 as though fully set forth herein. CASPER,MEADOWS &SCHWARTZ 2121 N.California Bfvd., WanutCreek,0CA 94596 First Amended complaint for Damages Page S TEL:(925)947-1147 FAX(925}947-1131 1 36. Defendants COUNTY, DISTRICT, and JULIEN were entrusted with the 2 supervision and protection of plaintiffs, and were subject to a duty to reasonably hire, 3 engage, retain, train, and supervise those persons, including SMITH, whose job 4 functions entailed contact with children, including plaintiffs. Defendants DOES 1 5 6 through 10 were employees of defendants COUNTY and DISTRICT, whose job duties 7 entailed the hiring, retention, training, and supervision of SMITH. g 37. Plaintiffs are informed and believe, and on that basis allege, that prior to 9 installing SMITH in his position at Bel Air Elementary School and Riverview Middle 10 School, defendants COUNTY, DISTRICT, JULIEN, and DOES 1 through 10 had 11 actual or constructive knowledge that SMITH demonstrated deviant sexual 12 13 propensities, which presented a foreseeable risk that SMITH would abuse children 14 with whom he came into contact in a position of trust and authority. Defendants 15 COUNTY, DISTRICT, JULIEN, and DOES 1 through 10 breached the duty of care to 16 plaintiffs in negligently hiring and installing defendant SMITH in a position of trust and 17 authority at Bel Air Elementary School and Riverview Middle School. 18 38. Plaintiffs are informed and believe, and on that basis allege, that during the 19 20 time defendant SMITH occupied his position at Bel Air Elementary School and I 21 Riverview Middle School, defendants COUNTY, DISTRICT, JULIEN, and DOES 1 22 through 10 had actual or constructive knowledge that SMITH was abusing his position i 23 of trust and authority to personally and sexually abuse students at Bel Air Elementary 24 School and Riverview Middle School. Defendants COUNTY, DISTRICT, JULIEN, and 25 DOES 1 through 10 breached the duty of care to plaintiffs in negligently retaining 26 defendant SMITH in a position of trust and authority at Bel Air Elementary School and 27 Riverview Middle School. 28 CASPER.MEADOWS &SCHWARTZ 2121 N.Caffoenia Blvd., Walnut c eek cA 94596 First Amended Complaint for Damages Page 9 TEL:(925)947-1167 PAX(925)947.1131 1 39. Defendants COUNTY, DISTRICT, JULIEN, and DOES 1 through 10 had 2 actual or constructive knowledge that children are vulnerable to harm if persons in positions of trust and authority manipulate the behavior of children for their own 4 5 personal or sexual gratification. Defendants COUNTY, DISTRICT, JULIEN, and 6 DOES 1 through 10 were subject to a duty to train all persons placed in positions of 7 trust and authority over children as to the potential for grave harm to children as a g result of such abuse. Defendants COUNTY, DISTRICT, JULIEN, and DOES 1 9 through 10 were subject to a duty to ensure that all persons placed in positions of trust 10 and authority over children receive such training. Defendants COUNTY, DISTRICT, 11 JULIEN, and DOES 1 through 10 breached this duty of care to plaintiffs in negligently 12 failing to train defendant SMITH and failing to ensure that defendant SMITH received 13 14 training in avoiding abusive conduct. 15 40. Defendants COUNTY, DISTRICT, JULIEN, and DOES 1 through 10 had 16 actual or constructive knowledge that children are vulnerable to harm if persons in 17 positions of trust and authority manipulate the behavior of children for their own 18 personal or sexual gratification. Defendants COUNTY, DISTRICT, JULIEN, and 19 20 DOES 1 through 10 were subject to a duty to reasonably supervise defendant SMITH 21 to avoid the risk of such harm. 22 41. Defendants COUNTY, DISTRICT, JULIEN, and DOES 1 through 10 23 breached these duties of care in negligently supervising SMITH in his contacts with 24 plaintiffs and other school children. Defendants COUNTY, DISTRICT, JULIEN, and 26 DOES 1 through 10 negligently enabled and encouraged SMITH to form inappropriate 26 . personal relationships with plaintiffs and other children. Defendants COUNTY, 27 28 DISTRICT, JULIEN, and DOES 1 through 10 negligently enabled and encouraged CASPER,MEADOWS &SC14WARTZ 2121 N.Califafta Blvd.. Suite 1020 Walnut Creek.CA 94596 First Amended Complaint for Damages page 10 TEL:(925)947-1147 FAX(925)947-1131 1 SMITH to regularly participate in social activities with plaintiffs and other children, and 2 to transport plaintiffs and other children for such social activities, and to entertain 3 plaintiffs and other children in SMITH's home. COUNTY, DISTRICT, JULIEN, and 4 5 DOES 1 through 10 had actual or constructive knowledge that SMITH pursued 6 inappropriate personal relationships with children, participated in social activities with 7 children, and entertained children in his home. SMITH'S known conduct created a g reasonably foreseeable risk that SMITH would subject children, including plaintiffs, to 9 personal and sexual abuse. 15 42. As a proximate result of the negligence of defendants COUNTY, 11 DISTRICT, ,JULIEN, and DOES 1 through 10 in hiring, retaining, training and 12 13 supervising defendant SMITH in a position of trust and authority over plaintiffs, 14 plaintiffs suffered injury and incurred damages as described in this complaint. 15 WHEREFORE, plaintiffs pray for relief as set forth below. ..16 FOURTH CAUSE OF ACTION Sexual Battery -Civil Code § 1708.5 1 (Against Defendant SMITH) 18 43. Plaintiffs reallege and incorporate by this reference paragraphs 1 through 19 213 11 and 14 through 19 and 22 as though fully set forth. 21 44. In engaging in the conduct described in this complaint, defendant SMITH 22 committed numerous acts of sexual battery against plaintiffs, rendering SMITH liable 23 to plaintiffs under Civil Code section 1708.5. 24 45. As a result of SMITH's acts of sexual battery, plaintiffs suffered injury and 25 incurred general and special damages as described in this complaint. 26 46. The conduct of SMITH, in sexually battering plaintiffs was malicious and 27 despicable, or done in conscious and reckless disregard to plaintiffs' rights to personal 28 CASPER,MEADOWS &SCHWARTZ 2121 N.California Blvd.. Walnut Suite CA°94596 First Amended Complaint for Damages Page 11 TEL(925)947.1147 FAX(925)947.1131 I safety, and subjects SMITH to exemplary damages pursuant to Civil Code section 2 1708.5(b). 3 WHEREFORE, plaintiffs pray for relief as set forth below. 4 FIFTH CAUSE OF ACTION 5 Lewd and Lascivious Conduct With Children 6 (Against Defendant SMITH) 7 47. Plaintiffs reallege and incorporate by this reference paragraphs 1 through 8 19 as though fully set forth. 9 48. In committing the acts described in this complaint, defendant SMITH 10 engaged in abusive lewd and lascivious conduct with plaintiffs. This conduct was 11 unlawful, and in violation of numerous provisions of the California Penal Code, 12 13 including Penal Code sections 288(x) and 266j, and subjects defendant SMITH to civil 14 liability. 15 49. As a proximate result of SMITH's unlawful, lewd, and lascivious conduct, 16 plaintiffs suffered injury and incurred damages as described in.this complaint. . 17 50. SMITH's unlawful, lewd, and lascivious conduct was malicious and 18 despicable, or done in conscious and reckless disregard to plaintiffs' rights to personal 19 safety, and subjects SMITH to exemplary damages. 20 21 WHEREFORE, plaintiffs pray for relief as set forth below. 22 SIXTH CAUSE OF ACTION Intentional Infliction of Emotional Distress 3 (Against Defendant SMITH) 24 51. Plaintiffs reallege and incorporate by this reference paragraphs 1 through 25 19 as though fully set forth. 6 52. The conduct of defendant SMITH was despicable and outrageous and 27 28 done with a wanton and reckless disregard of the consequences to plaintiffs, and was CASPER,MEADOWS &SCHWARTZ 2121 N.Callfomia Blvd., Suite t020 Walnut Creek,CA 94556 First Amended Complaint for Damages Page 12 TEL:(925)947.1147 PAX(925)947.1131 . 1 done with knowledge that it was highly probable that plaintiffs would suffer severe 2 humiliation, mental anguish, and emotional and physical distress. 3 53. As a proximate result of SMITH's conduct, plaintiffs have suffered severe 4 humiliation, mental anguish, and emotional and physical distress. 5 5 54. SMITH's conduct was malicious and despicable, or done in conscious and 7 reckless disregard to plaintiffs' rights, and subjects SMITH to exemplary damages. 8 WHEREFORE, plaintiffs pray for relief as follows. 9 1. For general damages, according to proof; 10 2. For special damages, according to proof; 11 3. For exemplary damages against defendant.SMITH; 12 13 4. For costs of suit incurred herein; 14 5. For further relief as the court may deem just and proper. 15 16 Dated: June 25 2002 i 17 Michael D. Meadows CASPER,MEADOWS&SCHWARTZ 18 Attorneys for Plaintiff 19 20 21 22 23 24 25 28 27 28 CASPEk MEADOWS sSCHWARTZ 2121 N.Califbmia Btvd., SU40 1920 Wa'.no creek.CA 94598 First Amended Complaint for Damages page 13 TEL:(925)947.1147 FAX(925)947-1131 1 PROOF OF SERVICE(C.C.P. §§1013, 2015.5) 2 RE: Sillard/Batres v. County of Contra Costa, et al, 3 1 am a citizen of the United States and am employed in the County of Contra Costa, State of California. I am over eighteen (18) years of age and not a party to the above-entitled action. 4 My business address is 2121 North California Blvd., Suite 1020, Walnut Creek, CA 94598. On the date below, l served the following documents in the manner indicated on the below- 5 named parties and/or counsel of record: 6 FIRST AMENDED COMPLAINT FOR DAMAGES 7 9 U.S. MAIL, with First Class postage prepaid and deposited in sealed envelopes at Walnut Creek, California. 9 Cl FAcsimiLr= TRANSMISSION from (925) 947-1131 during normal business hours, complete and without error on the date indicated below, as evidenced by the report 10 issued by the transmitting facsimile machine. ❑ Hand-Delivery Via Courier 11 © Other: 12 Louis A. Leone Attorneys for Defendant Mt. Diablo Unified School Stubbs & Leone District and Perry Julien 13 1450 Maria Lane, Ste. 310 Walnut Creek, CA 94596 14 Telephone: (925) 974-8600 Facsimile: (925) 974-8601 15 1 declare under penalty of perjury under the laws of the State of California that the foregoing 16 is true and correct and that I am readily familiar with this firm's practice for collection and processing of documents for mailing with the U.S. Postal Service. 17 18 Dated: June 25 2002 19 Sharon Adrien 20 21 22 23 24 25 26 27 28 CASPER,MEADOWS S SCHWARTZ 2121 N.Califemla Blvd., SW4e 1020 Walrwt Creek,CA 94596 TEL:{925}947.1147 FAX(925)947-1131 I Re. SIL.L.ARD V. MT. I lAl3LO U.S.D Contra Costa County Superior Court, Action No. CO2-01414 2 PROOF OF SERVICE 3 1,the undersigned,declare that I am employed in the City of Walnut Creek, State of 4 California. I am over the age of 18 years and not a party to the within cause; my business address is 1450 Maria Lane, Suite 310, Walnut Street, California. 5 # . On August , 2002, 1 served the following documents: CLAIM AGAINST THE 6 CCIUNTY CIF CO RA CCISTA AND STEVEN SMITH on the following interested party(s) in said cause: 7 Board of Supervisors 8 County of Contra Costa 651 Pine Street Street, Room 106 9 Martinez, CA 94553 10 VIAS -CCP 63 1013"1. 2D16.5 [X] By placing a true copy thereof enclosed in a sealed envelope(s),addressed as above, 11 and placing each for collection and mailing on that date following ordinary business practices. I am readily familiar with my firms business practice of collection and 12 processing of correspondence for mailing with the United States Postal Service and correspondence placed for collection and mailing would be deposited with the United 13 States Postal Service at Walnut Creek,California,with postage thereon fully prepaid, that same day in the ordinary course of business. 14 [] By placing a true copy thereof enclosed in a sealed envelope(s),addressed as above, and depositing each envelope(s), with postage thereon fully prepaid, in the mail at 15 Walnut Creek, California. VIA OVERNIGHT MAIL.tCCIURIER - CCP 44 1031(c), 2015.6 encl 16 [] By placing a true copy thereof osed in a sealed envelope(s),addressed as above, and placing each for collection by overnight mail service,or overnight courier service. 17 1 am readily familiar with my firm's business practice of collection and processing of correspondenceldocuments for overnight mail or overnight courier service,and that it 18 is to be delivered to an authorized courier or driver authorized by the overnight mail carrier to receive documents,with delivery fees paid or provided for,that same day, 19 for delivery on the following business day. VIA FACSIMILE - CCI' 66 1013(e) CRC 2008 20 [ ] By arranging for facsimile transmission from facsimile number 925-974-8601 to the above listed facsimile number(s)prior to 5:00 p.m. I am readily familiar with my firm's 21 business practice of collection and processing of correspondence via facsimile transmission(s)and any such correspondence would be transmitted via facsimile to 22 the designated numbers in the ordinary course of business. The facsimile transmission(s) was reported as complete and without error, and a copy of the 23 transmission report is attached. VIA HAND-DELIVERY -CCP §§ 1011. 2016.6 24 [] Byplacing atrue copy thereof enclosed in a sealed envelope(s),addressed as above, and causing each envelope(s) to be hand-served on that day by EXPRESS 25 NETWORK, INC. in the ordinary course of my firm's business practice. I declare under penalty of perjury that the foregoing is true and correct and that 26 this declaration was executed on August,11,2002, at Walnut Creek, California. 27 28 Robyn G org CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Sept 10, 2002 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 California Government Codes. ) notice of the action taken on your claim by the F,!I�, �� Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all"Warnings". AMOUNT: Unknown COUNTY cOUNISEL NIARTNEZ CALIF. CLAIMANT: Jean &John Mulgrew ATTORNEY: Richard Simons DATE RECEIVED: Au-Q 16,2002 ADDRESS: 22274 Main St BY DELIVERY TO CLERK ON: Aug 16, 2002 Hayward, CA 94541 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEEPlkerk Dated: Aug_19. 2002 By: Deputy177; i II. FROM: County Counsel TO: Clerk of the Board of Supervisors�•V P",+.-a I't y('`Phis claim�omplies 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 Beard 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). . 2✓ct�'°mac' 2-- � �' t`��r �"�c "�s�t"9 Y L 7'Ti Ire f 00—f Dated: P '~c` By:, f f'r 7 Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) { ) Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: { ) This Claim is rejected in full. ( Other: I eFrtify that this is a true and correct copy of the Board's Order entered in its minute for this date. Dated: ? P % HN SWEETEN, CLERK, By puty Clerk f WARNING (Gov. code sec ion§nr Subject to certain exceptions, you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned,have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California,postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: ' #: %'� '�tLiHN SWEETEN, CLERK By "" ' '' Deputy Clerk iE i I RICHARD J. SIMONS, ESQ. State Bar No. 072676 2 FURTADO, JASPOVICE&SIMONS A Law Corporation 3 22274 Main StreetRECEIVED E Hayward, California 94541 (510) 582-1080 Telephone 8 (510) 582-8254 Facsimile AUG 16 � CLERK BOARD OF SUPERVISORS 6 Attorneys for Claimantsii CONTRA C05TA��. JEAN MULGREW CRIBBLE and JOHN MULGREW 7 i 8 BEFORE THE BOARD OF SUPERVISORS OF THE COUNTY OF CONTRA COSTA it i 10 i JEAN MULGREW DRIBBLE and 11 JOHN MULGREW, NOTICE OF CLAIM (Government Code §910 and 12 Claimants, Code of Civil Procedure §364) 13 I 14 i TO THE BOARD OF SUPERVISORS OF THE COUNTY OF CONTRA COSTA AND TO THE 15 CLERK AND SECRETARY THEREOF: 16 € Claimants JEAN MULGREW GRIBBLE and JOHN MULGREW present the following 17 claim: 18 i 1. The name and post of address of claimants is as follows: Jean Mulgrew 19 Gribble and John Mulgrew, c/o Furtado, Jaspovice & Simons, A Law Corporation, 22274 20 21 Main Street, Califonia 94541. 22 1 2. All notices regarding this claim should be sent to the address set forth above. 23 ` 3. The occurrence which gives rise to this claim occurred between the dates of 24 February 8 and February 21, 2002, at the Contra Costa Regional Medical Center, Inpatient I 25 I Psychiatric Unit, 2500 Alhambra Avenue, Martinez, California, a health center and general 26 FURTADO.JASPOVICE & SIMONS A LAW CORPORATION 22274 MAIN STREET riAYWARC.CALIF. 94341 592-14090 35, `y i 1 ? acute care hospital owned, controlled, and operated, by the County of Contra Costa, through 3i 2 i the Contra Costa Health Services Department. 3 4. Claimants are the surviving parents of Donald James Mulgrew, whose date of 4 5 birth was October 8, 1962, and whose date of death was February 21, 2002. At the time of i i 6 his death, Donald James Mulgrew was unmarried, and had no children, either living or I 7 deceased. On February 8, 2002, decedent Donald Mulgrew was admitted to the Contra Costa Regional Medical Center Psychiatric Inpatient Ward for signs and symptoms of i 9 psychiatric illness. Decedent remained hospitalized as an inpatient at said facility, under 10 ' the care and treatment of the employees of the Contra Costa Regional Medical Center, until 11 his death on February 21, 2002. During the time that decedent was under the care of the 12 13 employees of the County of Contra Costa and Contra Costa Regional Medical Center, 33 33 14 ` decedent developed deep vein thrombosis, pulmonary embolism, and other signs and 15 symptoms of potential life threatening medical processes. The respondent County of Contra 16 Costa, acting through its agents and employees, was professionally negligent in the medical 17 care, management, and treatment of decedent during his hospitalization, and further 3 18 ' negligent in the failure to medically evaluate decedent for signs and symptoms of systemic 19 or other medical illnesses or processes, and specifically in failing to diagnose, evaluate, or 20 21 treat decedent for signs and symptoms of possible vascular or pulmonary disease, including E 22 shortness of breath, dizziness, fainting, and dehydration. Respondent County of Contra 23 Costa County, acting through its agents and employees, was further negligent in failing to i 24 perform adequate physical examinations and monitoring of decedent during his 25 1:11 hospitalization, and to care for, or refer him to care, for signs and symptoms of dehydration, 26 deep vein thrombosis, and pulmonary embolism. As a result of the negligence of FURTADO JASPOVICE ' & SIMONS A LAW CtiReoaAT,." '3 22274 MAIN STRRET HAYWAR 0.CALIF. 94541 582•s�80 13 9.I.61 12 ij I ii respondent, acting through its agents and employees, decedent died of bilateral pulmonary 2 emboli from thrombophlebitis of the left lower extremity, on February 21, 2002. 3 1 1 5. As a result of the professional negligence of the agents and employees of 4 respondent, action in the course and scope of their agency and employment, as set forth g above, claimants have suffered the loss of the love, comfort, society, and affection of 7 decedent, and incurred expenses for his funeral and burial, and further suffered a loss of 8 the value of his domestic services. 6. The names of the agents and employees of the respondent whose 10 professional negligence was a cause of the death of Donald James Mulgrew, and of the 11 € damages set forth herein by claimants, is unknown to claimants at this time. 12 13 7. The amount of this claim exceeds $10,000.00, and jurisdiction of this claim Ei 14 I will rest in the superior court. t 15 8. This claim is submitted pursuant to Government Code §910, and claimants s 16 hereby further advise respondent of their intention to commence legal action for 17 1 i professional negligence, based upon the facts set forth herein, 90 days from the date of this 18 fi claim, pursuant to CCP §364. 13 20 Dated:August 15, 2002 UF�U�TACDOOOVICE&SIMONS 2122 23 RICH RD J. SIMONS Attorneys for Plaintiff 24 i 25 ' E. t. 26 FURTADO.JASPOVICE & SIMOMS 111 A LAW COR7 PORAT;ON 23274 MAIN $TRH.HT HAYWARD.CALF. pdSQt E 582•tOtt1 3Ef•69tt E iE I f"4 CLAIM ? BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Seat 10,2002 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 California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and AUG 2 .1 915.4. Please note all "Warnings". AMOUNT: $1752.75 #� COUNTY COUNSEL MARTINEZ CALL CLAIMANT: Heilig A. Commiskey ATTORNEY: DATE RECEIVED: Aup 19, 2002 ADDRESS: P.O. Box 272832 BY DELIVERY TO CLERK ON: Aug 19, 2402 Concord, CA 94527-2832 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEET;i�, eek F Dated: Aug 20,2002 By: Deputy �Z�� � ss - .e--e-r II. FROM: County Counsel TO: Clerk of the Board of Supervisors (This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: w � f Dated: �._- °'_ By: �` 0 =2 Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: (; This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. r , Dated. , vti`_.j<, {;. JOHN SWEETEN, CLERK, By 9` ' ' ` tf -Deputy Clerk WARNING(Gov. code section 913) Subject to certain exceptions, you have only six (6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned,have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,California,postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated. _i "F `> JOHN SWEETEN, CLERK By i i' Deputy Clerk r 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 yqg,,Ll& A 6MML6KEY 0. 3 2"128 3 ) RECEIVED Against the County df Contra Costa or ) AUG 1 9 =2 ) District) �Lci{ €�A Or St1PRl�1R (Fill in name) ) - 'r,NMA Q0siA c0: 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: L When did the damage injury occur?(Give exact date and hour) � q� r = A017 4/k r 2. Where did the damage or injury occur?(Include city and county) 7PYEZ GAA 3. How did the damage or injury occur?(Give full details, use extra paper ifrequired p'c 7 v A C 71 Y d1 414 0400ND PURIA(4 ` 4114-5 5() q Z " )krInO jU '4191j SUIZ 4607D AfW-' NY e4;r 5 p.4° ,> ` • SNE- H*Z E,&W476' ` 0A?1,, e4R 15 AVO YE-7- 7_Y/5 0414RY 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? -t /' -„ tr~VC 7ZAC 011AR 466" S. What are the names of county or district officers, servants, or employees causing the damage or injury? /0'711 MO t S. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) - $ 7"f ChWO erg"V-0 4WIZV 4615,E 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 5Ar#kVJzvV cam AC45 AM614; 41,,E 8. Names and addresses of witnesses, doctors, and hospitals. d MAW#O� V41 M k /4 ra 'Im .I5A t/, J 04k,? eolA mei4r4wfe4�2AAC ' 9. List the expenditures you made on account of this accident or injury. f TATE T AMQLTNT 0 Gov. Code Sec. 910.2 provides "The claim must be SEND NODl� } signed by the claimant or by some person on his behalf." � T{�� (Attot�,gv Marne and Address of Attorney ) V�4 } laimant's Signature) � (Address) �.. eweae eq, Z. Telephone No. Telephone No. 4/0 71 NOTICE Section fit 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(S 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(S 10,0 0),or by both such imprisonment and fine. y . t i - V LJ _(D G7 LO LO It It CIS ca C13 M m � ocrj � c GGA ro (2 a cc -j til } = otl o C) ll V) ca 04 t +- Mo ° ca coc cu -o op -• cd cos, ; t PLEASE READ THIS CONTRA COSTA COUNTY SPAY/NEUTER CLINIC 66 646-4484 Pre-operative Instructions: !• All animals are admitted for surgery between 7:30 a.m. and 8 a.m. and released between 3 p.m. and 4:30_ 2.m. Dogs must be leashed and cats must be in boxes or suitable contai er Withhold food after 7:30 p.m. on the night before surgery. No food after 2:30 p.m. for dogs over 70 lbs. Cats need to be left indoors with no fond intake overnight. Notify clinic personnel if animal has exhibited any signs of illness or has demonstrated a decrease in appetite. Dogs - the D.H.L.P.P. and RABIES vaccine must be current. Cats - the F.V.R.C.P. vaccine must be current. Animals with noticeable dirt on their coats should be bathed the day before admittance. Cance of at least 24 hours prior to scheduled surgery will avoid a "No-iishfee. Pos - perative Instructions: Recovery from Anesthesia: Most dogs exhibit no effects of the anesthesia, except for some mild tranquilization. In cats, the effects of anesthesia may not dissipate for 24 hours. Responses to external stimuli (light, noise, movement) may be exaggerated, and the cat should be allowed to recover that evening in a small quiet, darkened area. Feeding is delayed until the following morning except for water and broth. Some fully recovered dogs may accept a small handful of food that evening. Do not feed if any vomiting occurs which is usually a temporary side effect of the anesthesia. Sufficient healing occurs after one week during which animals should be confined or leashed. Daily walking, is advised. Incision area may show some temporary swelling, particularly in the female cat, which rarely requires any treatment. We will gladly recheck at no charge. There are no external sutures and licking is rarely a concern, however, some male dogs may require the use of an "E-collar". No bleeding or discharges from any incision should be tolerated. Call the clinic. All animals are examined before release so the need for further veterinary services would be rare. Activity should be restricted for dogs at least one week. Cats should be kept indoors for up to seven days, following surgery. Pre-op/5M 11ACnV 6/29102• .. MONTE VISTA VETERINARY HOSPITAL Page 213 1488 WASHINGTON BLVD CONCORD,CA 94521 (925)672-1100 MICHAEL&ANGEL COMMISKEY Client ID:6714738 P.O. BOX 272832 Invoice#:12397 CONCORD, CA 94527 Instructions THE RABIES VACCINATION YOUR PET HAS JUST RECEIVED HAS BEEN MEDICALLY TESTED TO BE EFFECTIVE FOR A PERIOD OF 3 YEARS. Reminder # � 42102/03 Leptosporosis Vaccine Juvenile $ f 06/01/03 rvo Virus (16/29143 Int final Parasite Floatation ' ' Se 46/29143 Bor Ila Injectable Vaccine £ * 06/29/03 Annua ea Exam r ` ` + , 06129/03 Hearwor Antigen In Hospital live i 12/17/04 DHLPP {3 0 }Adult _ ...... �_. t, (}6129105 Rabies Adu#t dear f Tis `} Patient Ili: 6714738-2 Weight: 10.40 pounds Patient Nam MARY Birthday: 05/26/93 Species: FELINE Sex: Spayed Female ' s Breed: DOMESTIC SHORTHAIR �.yy((k�� Staff Name Description Quantity Total �` j�`j�`''��'' Wti 16/29/02 Annual Health Exam PETER J. MANGOLD, DVM 1.00 $0.40 6129/02 Annual Health Exam 1.40 $40.40 I 6129/02 OSHA Regulatory Fee-Syringe 1.00 $1.35 6129102 OSHA Regulatory Fee-Hospitalization 1.00 $2.10 } 6/29102 Hospitalization Half Day (<6 Hours) 1.00 $13.50 6129102 Cystocentesis Bladder 1.00 $27.20 f 6129102 OSHA Regulatory Fee-Xrays 1.00 $3.20 is 6129102 Radiographs First Two Views Or Less 1.00 $123.80 j 6129102 Venipuncture 1.00 $7.10 6129102 General Health Profile 1.00 $76.54 6129142 FELVIFIV TEST 1.04 $45.00 (patient Subtotal: $339.75 06/12/03 FELV Adult 06/29/03 AnOual Health Exam 46129103 Intestinal Parasite Floatation 12117104 FVRCP Adult(3 year) 06129105 FELVIFIV TEST Invoice Total: $699.95 Weight Management--Caring Far Maur F'et 60 million dogs and cats#n the U.S.are overweight ar obese. #f Iefk untreated,obesity can lead to many#with problems, including: Heart C?iseme and€3reathing F'robisms,Arthritis Jo int Prot#ems, D#,betas met#ltus. 'Through you efforts and the help of our Healthcare Team,your pet can be healthier,happler anti more active. VETERINARY EMERGENCY C 1410 MONUMENT BLVD. CONCO"s CA-94520 925-798-2904D Sade • I0:60110175s86116"0 Ref #; 0009 06/29/02 15:2$:27 Batch#: 89 VISA XXXXXXXXXXXX4792 RPPrCode: OUR' I nu#t 000009 Tow : 1584.00 Customer Copv i r rr ,F .:.r 41l�".---.--. ,t a}.,T`X.S,'y r rc i% ,b r t r,<0.,y a>^."s r1. t r t ,: x �.:+� :r r rf *_a n } E' ;, „ary fir.. +} t r -'n r �' r f.. r Y >f< a +'. 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Abbott, C.V.M. 1410 Monument Blvd., Suite 108 Concord, CA 94520 925/7982900 1 E • i CONTRA COSTA VETERINARY EMERGENCY CLINIC, INC. 94113 MONUMENT BOULEVARD,SUITE 108 CONCORD,CA 945201 57641 (9*?S)798-2900 EMER.FEE LAST NAME (FIRST NAME MI#7pLE N EXAMINATION/ `' 1 j r � F %.±J' CONSULTATION STREET ADDRESS _ APT#' MEDICATIONS/ r, RX CITY - Y ATF,, INJECTIONS I ADMISSION DATE&TIME HOME PHONE OTHER PHONE CURRENT VACCINATIONS ELECTRO x-, - . -�y�r b :.' 4 CARDIOGRAPHY PATIENT NAME ?SPE CtE r.BREED S SPAYED GE COLOR SEDATION/ - �- Ii ANESTHESIA NEUT. CASH CHECK ; VISA Fn/C RADIOGRAPHY . 5 PAYMENT 0 O O FAMILY VETERINARIAN PREFERENCE LABORATQRY --, AUTHORIZATION FOR MEDICAL AND/OR SURGICAL TREATMENT _? I HEREBY AUTHORIZE THE DOCTOR ON DUTY(AND ASSISTANTS THE DOCTOR MAY DESIGNATE)TO ADMINISTER TREATMENT AS IS CONSIDEREDGERY THERAPEUTICALLY AND/OR DIAGNOSTICALLY NECESSARY ON THE BASIS OF FINDINGS DURING THE COURSE OF SAID EVALUATION.I ALSO CONSENT TO THE ADMINISTRATION OF SUCH ANESTHETICS AS ARE NECESSARY AND SURGICAL PROCEDURES OF AN EMERGENCY NATURE. 1 HEREBY CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE AUTHORIZATION FOR MEDICAL AND/OR SURGICAL TREATMENT,THE REASONS l TREATMENT WHY SURGERY IS CONSIDERED NECESSARY,ITS ADVANTAGES AND POSSIBLE COMPLICATIONS IF ANY,AS WELL AS POSSIBLE ALTERNATIVE MODES OF TREATMENT,WHICH ARE EXPLAINED TO ME BY THE DOCTOR.I ASSUME FINANCIAL RESPONSIBILITY FOR ALL CHARGES INCURRED TO PATIENT,CONSENT FLUID TO RELEASE OF MEDICAL INFORMATION,AND AUTHORIZE DIRECT PAYMENT TO THE CONTRA COSTA VETERINARY EMERGENCY CLINIC,INC. THERAPY ; I UNDERSTAND THAT EMERGENCY PATIENTS MUST BE REMOVED FROM THE CLINIC DAILY BY 8:00 A.M.THOSE RECEIVED ON SATURDAY OR SUNDAY MAY,IF NECESSARY.,BE HELD UNTIL MONDAY AT E 00 A.M. T IF I FAIL REMOVE SAID ANIMAL BY THAT TIME i WILL BE RESPONSIBLE FOR ADDITIONAL CHARGES. DRESSINGS t a X r, SIGNATURE OF OWNER OR RESPONSIBLE AGENT WITNESS HOSPITALIZATION ALL PRICES OF TAXABLE ITEMS iNCINCLUDEREIMBURSEMENT FOR SALES ALLERGIES AND/OR MEDICATIONS NASAL CANNULA TAX COMPUTED TO THE NEAREST MILL. OXYGEN THERAPY ENTERING COMPLAINT: SPECIAL ;PROCEDURES TEMP. #{y '`� HA. <�, A.R. x/,;. M.M. sa. 'W:.... 1lVT. Q HISTORY PHYSICAL FINDING Q DIAGNOSIS (4)TREATMENT MISCELLANEOUS Presented for above -- a:+T•°s'+;f''4'nted' -for Evaluation t?G�a �-4r- Iia a '-- ` to It 'have plix-�'u-3'e ,t TIs�`?:8.A�al Csl._.I;harg, f--orthepass. f�pw .A7t3..§z.€'v lrcb%.p�. uRA Ee }`���z i�!- lent , ,_<., . . '. METHOD}{ tj.ssue der-sity s'eDararlpg col.o & X51 ta .sler- small iii!"L kidney DEPOSIT 6. t _. xreferral 9 cht-sem s w,)!-, .fie LV f F .V Sega tiva BALANCE ME OD - DUE �j TOTAL METHOD HOD 4_qe:bovge Present a PAYMENT pt 1-V e4thetev pleeed, t R at t tr CK: ul lym. phojwpenla, Sl toxic .ty Of sl hemacor�.,era;ur l. Te.l.i*oii, :-ylht owner -- platy to proceed with aur: ;,pry ,,/R ytril !cc sq =-yidtgr ,. r t�rlcon with {3'rd,2nr £.L:T°L en.11-n-2:, arc.us _ plan to 7a va su- ;',Po"3 =7£ ,orn pro . lln" _.3.3.= u°a DISCHARGE WITH: CALL YOUR REGULAR VETERINARIAN TODAY LEASH CARRIE1 FOR AN APPT.ON X-RAYS fir`-'. LAB SAMPLES ! RX _� - DATE t / VETEI�3MAR1kAN > BATEc� TIME P1vI:'+ _ ', : .t RELEASED TO. tl OWNERIAGENT „_.✓ TECHNICIAN ' CLIENT COPY NAME Co 3 key. "Mary" RECORD PAGE t Ace/Ketal-qt 0,3m1sl r lium Q 3mis41;'; in6ibation & isoflurane maintananca clipli/prep - transfer to surgery extend analgesia as Bugrenex E3 14mis img6- nth ag nepdtad lam— resting comfortably . rathaz grumpy this WQ*AIng Telcom =- message left f Ketofen 2mg1k2 i r tpr q4h + weights -- note I urination carefully offer free choice-food/water Tel.com wiht owner concerning status -- Mr. Commisk.ey mentioned I legal aspects of involvement with t e County - Escusseil abnormal. renal parameters suggesting ectopic ovarian tissues, LaA"Y Would In legal field If In.rgrastod ia per-suing 1-15P%- NXISM Visited with ewner. reqtteseed histopath sample � uvar±Ull XW ft5Sue Sell with owner for family inspection - to be presnted to MonteVista tomorrow- -- ----- cap oxo rrocapIv- Fluids jswitch meds to oral. - Clavamox lml po bid `orb/VAL syrup 1£3mg sorb tot 12mis val s ru - apply 0.4mis to inns ever 6-8 horus as neeiled For discomfort 5txm w eating/drinking - elect to discharge wiht owners for continued care remove iv catheter **recommend re-chekc with Monte Vista in the morning ® call for appt after gam with Dr.MangoI M ED **TLC tonight -« no running, jumping, stairs **free choice food/water - note consumption 0 DWIGHT A.GAUDET,DVM CJ JULIE D.Smirti.DVM Aw # R.JEFFERY TOUOROfF,DVM DiplomareAmerfran College oflWrerinarySurgeons Diplomafe Amerkan Collegeofwertinary Surgeons n Luton E.VLF-RUM.DVM SHARON ULLMAN,MS,DVM DiplmnairAmerican Colkgeof%wrinarysurgtmna DiplrmfafeAratricanCollege ofVeftrinarvSurgeons 0 WILL F.J6HNSON,DVM 0 ELISABETH F.RICHARDSON,DVM DipimnareAmericanColkgeofWterinarpSurgeons j,{ Dirlrxnate American College nfVeierfnary Surgeems Q ANDREW J.STAATZ,DVM 1I1� 0 CHARLES M.WALLS,DVM DipGrmae American College rd'Veteru,ury Surgeons WWW.VSaS erV.CC?t DiplornateAmericanCollegeofVeterinarySargeoras / MARTIN L.AIT'KEN,DVM Diplomate American College nfVeferinarvSurgenns Q SHARON D.Gorr mipD,VMD El 251 No.Amphlett Blvd.•San Mated,CA 94401 •(650)696-8196•(800)834-7874•Fax:(650)696-8191 X 1410 Monument Blvd.•Suite 100•Concord,CA 94520•(925)827-1777 •(800)834-7874•Fax:(925)827-2364 ❑901 East Francisco Blvd.•Suite C•San Rafael,CA 94901 •(415)256-1777•(800)834-7874•Fax.(415)256-1222 Hospital C5�Vjr <�- eterinarian etCr 1+':M- oef 4901=0 Date__ `/'—CI'z-.. Address W-4 MV47` �`Iity, State ate.' 7p `94r.,3�Z�1 Telephone `Z- •" ' `" " .ell _Cia `s Name/ t� rr'� et's Name. V Address��� &6KA -AI-4 6—jtlty, State a 0llr�f�! +✓111- - Zip r Y6 2-0 Breed # f / Age !{ .s'r Sex_J Telephone3 ` Clinigal Diagnosis: '7 i,� La,r echi Diagnostic/Surgery Report: ALICA 774 t ,kr- -cefr` ,« t � :� r'GY /C r ft4e 6# T`/ c r` —rx r r r�mems/ vrr�f !`ttrfr ..� r Int ✓.red+ ,�' t'�/' �' w oerS 7 t�rle'rs�"�ne�s.s. L.ra.+'�rev �-�'Trt �-�.�: �'�-/herr-G Ll,kr�rr �-•d f'e�'S�Q !� rrcy��ct��.5�,��k s��, t Reco rnmen ded Foil ow-Up: 40097 yG .fit/ FIVI -S A" 7" CWY.4I�'h tz . ,se t ,►�3/r'`rlt�� 7 / ti'rs p lel"Q /' ' d77ls�tu-rhe T`o t�. r4 til' Kd2 ,rt ftst Its r tt' ,�s-tri, ,r i x �`'! 6 i i�rs, dt►� . car t' mla' . i 711/02 MONTE VISTA VETERINARY HOSPITAL Page 1 / 1 1488 WASHINGTON BLVD CONCORD,CA 94521 s (925)672-3100 MICHAEL&ANGEL COMMISKEY / l . ` 714738 P.O. BOX 2728326 f t ` invoice#:12416 CONCORD, CA 94527 �y Patient ID: 6714738-2 Weight: 10.40 pounds Patient Nam MARY Birthday: 05/26193 Species: FELINE Sex: Spayed Female ! Breed: DOMESTIC SHORTHAIR i > Description Staff Nairne Quantitdotal 711102 Office Exam-Recheck No Charge PETER J. MANGOLD, DVM 1.00 $0.00 7/1/02 Biopsy 1 Tissue w/Microscopic 1.00 $119.25 �'f M70'2-- V1- SM TABLETS(#10 `� $78.00 Patient Subtotal: $197.25 Reminder 06/12/03 1=ELV Adult 06/29/03 Annual Health Exam 06/29/03 Intestinal Parasite Floatation 12/17104 FVRCP Adult(3 year) 06/29/05 FELV/F'IV TEST Invoice Total: $197.25 Total: $197.25 Balance Due: $197.25 Previous Balance: ($1.35) Balance Due: $195.90 Check Check#: 1638: ($195.90) Less Payment: ($195.90) Balance Due: $0.00 Weight Management—Caring For Your Pet 60 million dogs and cats in the U.S.are overweight or obese. If left untreated,obesity can lead to many health problems, Including: Heart Disease and Breathing Problems,Arthritis&Joint Problems, Diabetes mellitus. Through you efforts and the help of our Healthcare Team,your pet can be healthier,happier and more active. CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Sept 10. 2002 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 California Government Codes. } notice of the action taken on your claim by the MUGBoard of Supervisors. (Paragraph IV below), given 4 , Pursuant to Government Code Section 913 and 2 219-02 915.4. Please note all "Warnings". AMOUNT: $30,000,000 COUNTY COUNSEL MARTINEZ CALIF. CLAIMANT: Robert Young& Inmates, Class Action ATTORNEY: None DATE RECEIVED: July 31, 2002 ADDRESS: 901 Court St BY DELIVERY TO CLERK..ON: July 31, 2002 Martinez, CA 94553 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWE � T,�CI Dated: July 31, 2002 By: Deputy ir r ; .... � II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( 4-Tis claim complies substantially with Sections 910 and 910.2. { ) This Claim FAILS to comply substantially with Sections 910 and 910.2., and we are so notifying claimant. The Board cannot act for IS days (Section 910.$). ( } 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: c `"` By: Deputy Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( } Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: { This Claim is rejected in full. { } Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JOHN SWEETEN, CLERK, By ' { ':. 3 ;Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned,have been a citizen of the United States, over age 18; and that today 1 deposited in the United States Postal Service in Martinez, California,postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:' , J r `JOHN SWEETEN, CLERK.By y� J.1 Deputy Clerk 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 10&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. 11 : Claim By Reserved for Clerk's filing stamp } Against the County of Contra Costa or '` b strict) (Fill in name) } The undersigned claimant hereby makes claire 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) 1 2. Where did the damage or injury occur?(Include city and county) 3. How did the damage or injury occur?(Give full details;use extra paper if required) /; } : I W OTIN, ....._.._ - �. t�°`� F t 41"L yg 3 r .�.} {S�f t` tk to£ #•.�. £.. �'�`4 � r ! AID a . ' i 74. s c t f"t. .. 01�.' + "• .�...�;...l4v r,�.'»✓ s' .,... :Y.4 F .. ................... EG � '� � � � ��: .k•.. �...x `.fit:�'.t�'?�..-- ro5 �- ........- 'SL,, 5 34: +k� ��<� T�,:..L^•, '' F�.�4 R' ° ,.� i � i an •.° 1''•&o �b � .'C. ��.� �..r.. 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"^.,f 1 �P iT:i G i 1 ::Hi R-."pr.�..�wmk � 'R... ..:i� 5 •. y,,� rix'•, g L .. q R t ° p T 5 4 ..�:h C�.Yee.'- E Z;>�`..r k. _;BFwa � ,£. s,... : 3 •. .. - ' `'�t €£ pis # g, x t orz-, �,�,.. a.•3^� `�.�2} _}tet.: 5 S 71. ,u ," 1 ........n�4..,. $ai" Z ^: & .U«......°x« �> :~a..... . r �I. .W EMfi st Al i ' f .Thi 3i £ f Y ` � ` ' E.. ..;: .t.` ': i s. .. w F" 1 k - s �7 >ii hh „n i . r b # a} •. "> "rx '3 vi 3,:3. ... C" . 1 .° '^ Kr. IS? :. 1 _ .. ::a q �' r...:; � _...: .:..✓: �.,.. f ..:c ,�.:...ak .'t:.S ; .! #\� ' 3.9' 'a }t (::y^t t'. ..'„: f i• c t v r7a kY owl .. ?C wf ..:f S t„ ...,, :.m,,,,, <:.:: 'S >L.. S ,..:Lf'• ........:' :w, i;{- - -': y c t 5 - ..... ..:... .. .:....:, ,... ter. s } r ••.- s t - ,€�,:- c3 t`"�w.� �'.a S far 4 .r ,n : n , { • ..A E :ell 1 SW .: . - 14,LOU out n .. On Kano ns i . ,,rrp�t,, zz -: .,». Fh• :- y 'F:`. yt a t ' 3 : { •i?: •i?: i.....•ii: 4:: �........ '4. 'What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? ONO<t A -T-kf.4'T1 ot,,L C m"1 't.m C t -r,0`,ov i6f,4, Okdl 1 z i gr ik< i ` a1l. e 5. 'What are the names of county or district officers, servants, or employees causing the damage or injury? rt t t Ia M : sZ„ L."T. b� tt cc Tf'u ` T � f 6. 'What damage or injuries do you claim resulted?(Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) C c6 c_k.,6 V r o 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) i $ q R S"`l tvvt eT- z S. Names and addresses of witnesses, doctors, and hospitals. 9. List the expenditures you made on account of this accident or injury. DAIS Uhm AMQUNT Gov. Code Sec. 910.2 provides"The claim must be S signed by the claimant or by some person on his behalf." T+M,N�}T CZ~S TG: (A=M-- v Name and Address of Attorney ) (Claima s Si e) , ;, // ' v/ Telephone No. f Telephone No. ***���*s��**�*«�►*�******�*�*�����*���*asp#*�*s#s**�***��:*�*�«**�**�*��*�***#��** **�*��** NOTICE Section 72 of the Penal Bode 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 fudulent 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($10.000),or by both such imprisonment and fine. The :Beard of Supervisors ���t�� John Sweeten Clerk of the Board Cosh and County Administration Building County and 651 Pine Street,Room 106 {925}335-1900 Martinez,California 94553-1293 County nth j John Gloa,1 st District �.J t..1 1 �/ Gayle B.U#Ikerna,2nd District Donna Gerber,3rd District Mark DeSauinier,4th District Federal Glover,5th District September 30, 2002 Mr. Robert Dee Young ROI Court Street Martinez, CA 94553 Dear Mr. Young: The Board of Supervisors denied your claim at the September 10, 2002 board meeting. Your request was for this office to provide a list of witnesses. No one presented testimony, so we are unable to process your request. Sincerely yours, Gina Martin, Chief Cleric of the Board . a t. T, t .s ,�' .✓{ M'' ... .. ...._.._ .. ...,$............ .,+..wxc! ... J sT !..., ......:: ... ..,.:...... ._ a .:.-:�Y:. �Mr..'Y.:&` ...... .. ?:. ; q/tfe .tµ gra lv"'h d �.`r �•I R r I� f �` {`• fi t , ::...y t { r: � � a t t €a r .. ro� T n. J5 �tr ... .....:..... .......... :.::�...... -.: ... MIR A '::.... ....... ...... ........:..: ....... :. ::....... ....:.::. .:..... ,... ..::: ..:.:::..�.. :::: ::.. :.:.:.. SEP 1 9 2002 ..... -..... ..... ........ ................ ........ CLE14K1 BOARD OF SUPEfRVISDRS LUf\Ysra7 $Rfa CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Sept 10,2002 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 California Government Codes. } notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AUG 0 2 2002 AMOUNT: $100 OUN-r y vOUNSEL CLAIMANT: Lamos Sturgis �-AARTINEZ CALIF ATTORNEY: None DATE RECEIVED: Aug 1, 2002 ADDRESS: 901 Court St BY DELIVERY TO CLERK.ON: Aug 1,2002 Martinez, CA 94553 BY MAIL POSTMARKED: 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWFIN� k' Dated: Aug 1 2002 By: Deputy %' y i ' 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( 4-1his claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( } Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). ( } Other: Dated: By: � " .` �- - Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( } Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: 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. f # JOHN SWEETEN, CLERK, By . . 3 s ` , Deputy Clerk Dated: k.�� azo , A WARNING (Gov. code lection 913) Subject to certain exceptions, you have only six (6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned,have been a citizen of the United States, over age 18, and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. 0 ,< . : � f t :._JOHN SWEETEN, CLERK B ° 1 " y's.� f f Dated ,. : y Deputy Clerk 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 accrete 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 filedwith the Clerk of the Beard 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. 1, If the claim is against more than one public entity, separate claims must be filed against each public entity. .K 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 RECEIVE7111 Against the County of Contra Costa or } KBOAPD 002 District) (Fill in name) } [CLeRK CONT Theundersigned claimant hereby makes claim against the County of Contra Costa:or the above-named district in the sum of S._. and in support of this claim represents as follows: I. When did the damage or injury occur?(Give exact date and hour) 2_ Where did the damage or injury occur?(include city and county) 3. How did the damage or injury occur? (Give full details; use extra paper if required) C�..:l..:. ..�El( yf ��, �`::�.'S :..�...:'�- _;:�."#' ";- ? ,;,3.:J f'� i t �,7�'t`�.r i:rss.i''.'£ Gc;/3 c-Fp �'1�'• f ao'-�e:t/...f.: ff ( 3 ! ... j.'E,.:.•��SFr:... '�"ct p -�'� �e:.�,�.. �r�,r. >>�- CJ:.h s :. -�`� � r.�..,.��.G.,S � .s .�•'. n. e �OYIC -- s.'j"yP �''..r 3 kz :.a t: i`ty 2f T r r jc:.�.£ t s t` yj E )ckS ( g an A .'£�Z�s f f i*" o"S 6.e.:$:. }o>t.l. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? i f f c is Sw 't., �C r e f.:5/ ?G.f... ,'� S f.e•. .,r.. y X /. :., .'-y ,..8 'r �l zz;5I 411/ 5. What are the names of county or district officers, servants, or employees causing th damage or injury? r' 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach r . two estimates for auto damn e.) 4> d :r c ft "7 r >'s f[/t�.'i •, r! ,L`C n.. s`f,�. /. y ,, >ti�> 9 ;^y j j < 9'f D'y .. r r e. < % .:�¢'4i fi�r7.0 a i �.t.,=Y.:6. 4✓w7G iE.T'f/arft; k i i:.' <!<,1`'d€^'i" .poi tf5',•.s: fC c. 7. How was the amoiunt cratmed above omputed? (Include the estimated amount of any prospective injury or ,damage.) ,.. •1 .. ! f ..,.r�', �° %'i`' r.��%, �r;a{.. .ter.•. Y: � o, •:.1:. SJ L'CA.<.<. ;,:;C! ::- `! �r"� .. r.t 'F.:!'...£''`r--C:.;.;f- < .,.....•f��'.,(A Y'rf... 8. Names and addresses of witnesses, doctors, and hospitals. oz 9. List the expenditures you made on account of this accident or injury. DATA, TIME AMOUNT Vo yr j } Gov. Code Sec. 910.2 provides"The claim must be signed by the claimant or by some person on his behalf:,' SEND NOTICES TO (,Attorney Name and Address of Attorney (Claimant's Sign e) (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 fine of not exceeding one thousand($1,0W),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 OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Sept 10,2002 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 California.Government Codes. notice of the action taken on your claim by the oard of Supervisors. (Paragraph IV below), given rsuant to Government Code Section 913 and �i UG 2 20 15.4. Please note all "Warnings". AMOUNT: More than$25,000 COUNTY COUNSEL !AARTI NEZ CALIF, CLAIMANT: C. Evans 11; N. Evans; T. Evans; H. Evans; A. Evans; C. Evans ATTORNEY: None DATE RECEIVED: July 331, 2002 ADDRESS: 546 17`h St BY DELIVERY TO CLERK'.ON: July 31, 2002 Richmond, CA 94801 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. Dated: July 31,2002 By: Deputy # A... 11. FROM: County Counsel TO: Clerk of the Board of Supervisors {>:Kiiiis 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: bated: rf�. - By: Deputy County Counsel III, FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) { ) Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ( ) This Claim is rejected in full. ( ) Other: I,certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated t` '' ? F�f >'-JOHN SWEETEN*, CLERK, By £,f r`. ' w De ut Clerk S: ?. 5!• :s p Y 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 snail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States,over age 18; and that today I deposited in the United States Postal Service in Martinez, California,postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated j .: :rY x =rJOHN SWEETEN, CLERK By,.L,' ° < d Deputy Clerk Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS Td CLAI1vL NT 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 tater 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 fine 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 Mr.Charles Evans 11, Mrs.Nicola L. Evans(Parental) RECEIVED Tera[yn .,Teary M.,Armse N.&Charles T.Evans(Mineral . Against the County of Contra Costa or ) JL 3 12002 District) CLERK 8{}A#i1)Ofi su V1 ORS (Fill in name) ) TA O The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of Unli ite- Civil a than $25.0001 and in support of this claim represents as follows: 1. When did the damage or injury occur?(give exact date and hour) Thursday, February 44, 2002 1430hrs 2. Where did the damage or injuryoccur?(Include city and county) 545 17th Street Richmond, California 94801 — Contra Costa County 3. How did the damage or injury occur?(Give hail details;use extra paper if required) Supervisory Multidisciplinary 'Team & Continuing Services Social Workers requested lave enforcement assistance and forcibly removed four (4) children from their residence without proper authority or exigent circumstances. (See "Damagelinjury Details for Question,3" Attachment) 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? Removed children without legal authority or exigent circumstances Conspired to continue deprivation of State and Federal civil liberties Falsified official Department documbnts Omitted to follow CWS MPP Diva 3' 5. What are the names of county or district officers, servants,or employees causing the damage or injury? Clarence Johnson, Rodney Harvey, Donna Thoreson, Melissa Connelly, ' Savannah McKenzie,ie, Freston Gilmore, Linda Ray and others. 6. What damage or injuries do you claim resulted?(Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) Violation of Civil Rights Secured by 42 U. C. § X1983 Violation of Civil Rights Secured by California Constitution Article f Section 7 & 13 7. How was the amount claimed above computed?(Include the estimated amount of any prospective injury or damage.) Nature of damagestinjury Court Cases involving similar facts 8.Names and addresses of witnesses,doctors, and hospitals. NIA 9. List the expenditures you made on account of this accident or injury. DATE TIME AMOLM NIA N/A N/A ) Gov. Code Sec. 910.2 provides "The claim must be )signed by the claimant or by some person on his behalf." SEND NOTICES TO: Claimant Name and Address of Attorney ) r (Claimant's Signature) N/A546 17th street Richmond Ca. 94801 (Address) Telephone No. NIA )Telephone No, (,510) 216-7779 NOTICE Section 72 of the Penal Code provides: Every person who,with intent to defraud,presents for allowance or the paymem 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 falsee or fraudulent claim,bili,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 imprisontnent in the state prison,by a fine of not exceeding ten thousand dollars($10,000),or by both such imprisonment and fine. ..:.:....:.:...:.:.... xMr. "Charles Evans Ii ... ::... > :> < Mrs. Nicole I1. ::.... 54b l7`'Street1. Richmond,Ca 94$02 :.: (5 10)215-7779 s::> > 'v July 30, 2002 Damage/Injury Details for (question 3 • 08-09-2001 Call from Clarence Johnson requesting investigative meeting for 08-15-2001 08-09-2001 Charles Evans II requested meeting as soon as possible 08-10-2001 Meeting held—no abuse, Clarence Johnson informs of recommendation for closure + 08-24-2001 Call from Clarence Johnson identifying"red flags"need to discuss case plan • 08-30-2001 Mr. Evans disagreed with case plan but signed after intense pressure by Mr. Johnson. Mr. Johnson will give copy of VIi M after processing and send details on classes i 11-15-2001 Rodney Harvey visited residence to schedule a meeting, will meet 11-16-2001 • 11-16-2001 Mr. Harvey inquired about case plan completion. Mr. Evans had no case plan. 0 11-2001 thru 12-2001 Mr. Evans cannot get copy of case plan or explanation of services • 0?-29-2002 Mr. Harvey brings copy of someone else's case plan attached to a page with both parents signatures. Mr. Evans states he is in total disagreement with the current situation and will not proceed any further voluntarily. Did not allow Mr. Harvey in home,children had the flu and wife was recovering from cesarean birth 2 weeks prior. Spoke to Donna Thoreson who stated that the Department will file a petition within 2 weeks. + 02_14-2.002 Armed law enforcement raid of home removing children 6, 4, 2 and I month. Decision to remove came from a Disposition Meeting due to"Non-Compliance"to a voluntary case plan. All children were returned within 2 weeks and the case was dismissed by Juvenile Courts based on the Parents Motion to Dismiss being granted. The injury here is that there was absolutely no reason whatsoever to subject these children and their parents to this type of trauma and violation of their civil rights.Not only is it unreasonable, it is not legal. Mr.&Mn.Charles Evans 11 • 546 17'b Street • Richmond,Ca.94801-2804 • (510).215-7779 CLAIM # f BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Sept 10.2002 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 California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all"Warnings". AMOUNT: Unknown CLAIMANT: William Hansen ATTORNEY: None DATE RECEIVED: Aug 7,2002 ADDRESS: 15 Avalon Ct BY DELIVERY TO CLEF.ON: Aug 7. 2402 Alamo, Ca 94507 BY MAIL POSTMARKED: August 6, 2002 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETF r� , t 7 f Dated. Au 7 2002 B : De ut '` ' � - D Y 13 y 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ()This claim complies substantially with Sections 910 and 910,2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910,8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). ( ) Other: Dated: ' ' A By: -__'' ' Deputy County Counsel III. FROM: Clerk.of the Board TO: County Counsel(1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ( , This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated. t JOHN SWEETEN,CLERK, By s # ;''';'_._.j Deputy Clerl 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 rnmediately. ' For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING declare under penalty of perjury that I am now, and at all times herein mentioned,have been a citizen of the United sates,over age 18; and that today I deposited in the United States Postal Service in Martinez, California,postage fully repaid a certified copy of this Board Carder and Notice to Claimant addressed to the claimant as shown above. } FF gated. ` ' s �t' f r _JOHN SWEETEN, CLERK By '`` i' ' s�� Deputy Clerk Claim to: BOARD OF SUPERVISORS OF CONM COSTA COUNTY INSTRUC CIONS Tn C1LA]XkNT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or gnawing crops and which accrue can or before December 31, 1967, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for.death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1958: must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later ,than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. G. If claim is against a district governed by the Board of Supervi30r3, 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 Ser. 72 at the end of this form. RE: Claire By ? Reserved for Clerk's filing stamp Against the County of Contra Costa } 202 or ) C3 EBY,90 ��r�StIP�R��tSQRS District) Tr~CO. P"# l a.n name5 ) 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 diad the damage-or injury occur? (Give exact date and hour) I A /AV 0,i C'. Tho e rr. ter'' /f On 15. B. Where did the damage or injury occur? (Include city and county) Ala M Cr- ', - the 3. How did the damage or injury occur? (Give foal details; use extra paper if required) 4. What particular act or omission on the part of county or district officers, servants ser employees caused. the injury or e? �- y over) 5, wnar. are ttze names of county or district officers, servants or employees causing the damage or injury? Jf- 2,S-- 5 i 3 -7 / 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto doge. T ' 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) . � , $. Names and addresses of witnesses, doctors and Hospitals. /V! q. Dist the expenditures you made on account of this accident or injury: LATE ITEM AMOUNT IL* � Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES T0. (Attorney ) or by some person on his. behalf." Name and Address of Attorney (Claimant's Signature Address - `7- Telephone No. Telephone No. NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state beard 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 ,fail 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 ($10,0000 or by both such imprisonment and fine. LIC.#352884q?MaMw O. r� FENCE & WALL Since 1977 N 10343 1-800-780-1774 • NO. 510/799-2355 • Fax 510/799-4405 MAILING: P.Uw BOX 427•RODEO, CA 94SS72 ESTIMATE & CONTRACT TO: ��� k Date: i Atk�'.s PA Phone Bus. Res. � WIRE DIAMETER LINE POST LENGGTLL H HEIGHT FEN TAKE DMTING NOD GAUGE TERM,POST. SPACING LINE STAKES SET BY CUSTOMER HAUS.AWAY O=ING _Lc!'-? FENCE YESSZ, Nt7`1 WALK DRIVE TYPE STYLE DIAMETER DIAMETER TE GATE OF WOOD OF FENCE LINE POT TOP MAIL set Ir }t t( C€ Ira ' Completed: WE PROPOSE TO FURNISH LABOR OR MATERIALS IN ST ICT ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AS FOLLOWS: umms CtTHEtwsE NOTED oN THis coNTMCT,WE HAVE A ONE YEAR GUARANTEE ON ALL WOAKMANSHF! DIAGRAM INSTALL APPROXIMATELY 6}' LINEAL FEET III IREARII III III — OF � HIGH 4jEh&L�I�ENCEjtt SET ALL POSTS IN CONCRETE ON eC CENTERS OR LESS. USE � "�� X Y POSTS (radweQd) and 2 x 4 RAILS (redwood) WITH 1, k5 BOARDS Building PRICE: FOR THE TOTAL SUM OF . drilla' TERMS. fff FRONT I I _1 IEJ SUBMITTED: f, } �� CONDITIONS Materials remain property of Creedlvo Fence & Wali until payment Is made, ESTIMATCIR: - 5 it Is understood and agreed that we shall not be held liable for any loos,damage MANAGER: or a occasioned dq We,strikes,or material stolen attar delivery upon premises, or the public enemy, accidents, boycotts„ mate", (MW be K 10 Irxlno;Wrieu opprovat) shortages,disturbed labor conditions,decayed delivery of materials from"tar's isfh ,k #i .T# tir'r suppsers, force maieure, Inclement weather. floods, freight embargoes, causes F CLIw R. ss r f 'yn Incident to national emergencies, war or other ca beyond the reasonable control of Sailer, whether of like or different character, or other causes beyond his control.Prices gusted In this contractare based upon present prices and upon FROM FENw L x£� condition that the proposal w49 be accepted within thirty days. Also general THIS PROPOSAL IS SIIBMffMD IN Cli#P`I.ICATE.THE RETON TO US OF ONE Copy WII'H conditions which etre standard for specialty contractors in the construction industry. YOUR SIGIiMRE SHALL CONSTITWE A CONTRACT. NO VC-R#AL A RELMENTS ARE Property line layouts are responsibility of owner. 250% of above contract will be BINDING IF NOT WRITTEN IN IMIS CONTRACT. charged the buyer if above contract is cancelled by the buyer. Euyear agrees to pay d court costs, iegal andfor collection charges required If the terms Indicated are not adhere to. ACCEPTED. 'MPAU-To include 1 par month on the unpaid balance. CUSTOMER X Creative f abce & Wall shall have no liability for damaged sprinkler or Pee) (Sionatun) other underground uncle. WHITE-O iginal/Contract Copy YELLOW-Customer Copy PINK�Estimators Copy MANILA-Job Cady CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Sent 10, 2002 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 California Government Codes. j notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given ursuant to Government Code Section 913 and 15.4. Please note all "Warnings". 9 2002 D, AMOUNT: Unknown COUNTY COUNSEL CLAIMANT: GHC Investments MARTM�Z CALIF ATTORNEY: None DATE RECEIVED: Arxg,8, 2002 ADDRESS: 4340 Stevens Creek Blvd##240 BY DELIVERY TO CLERK.ON: Aug 8, 2002 San Jose, Ca 95129 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. A � t JOHN SWEETS 4 er& Dated: Aub 8. 2002 By: Deputy f. II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ,.)'This claim complies substantially with Sections 910 and 910.2. { ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( j Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). ( ) Other: Dated: " '� - By: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ( _ This Claim is rejected in fall. { ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: .- Jj,, f 3< 's' JOHN SWEETEN, CLERK, By s" L Deputy Clerk ` WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned,have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California,postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: z i n ; ; tJOHN SWEETEN, CLERK_By t f yf. ter_ . ;, � y Deputy Clerk H� 5� RE'CED`ED Car'eet�br�a� Homes �ast�tx��€rti#��� � -- AUG $ Z002 RK BOARD OF SUPERVISC v�F TRA COSTA CO. County of Contra Costa Contra Costa County Flood Control and Water County Administration Building Conservation District 651 Pine Street 255 Glacier Drive Martinez, California 94553 Martinez, California 94553 Re: Claim for Refund of Illegally Collected Drainage Fees Tentative Tract Map No. 7725 Ladies and Gentlemen: I. The claimant is GHC Investments, LLC ("GHC"), whose address is 4340 Stevens Creek Boulevard, Suite 240, San Jose, California 95129. 2. Notices concerning this claim should be sent to GHC, c/o Timothy M. Quinn, Development Manager, Greenbriar Homes Communities, Inc., 4340 Stevens Creek Boulevard, Suite 240, San Jose, California 95129. 3. On March 17, 1994, the County of Contra Costa and Walt Foskett entered into a Development Agreement, recorded on March 28, 1994, as Document No. 94-085527 in the Official Records of Contra Costa County, which governs the development of Mr. Foskett's land as described in Exhibit A to the Development Agreement. The "Project" to be developed on Mr. Foskett's land, described in the Development Agreement, is Tentative Tract Map No. 7725. GHC is the current owner of the Project and the successor in interest to Mr. Foskett. Section 4.03(2)(g) of the Development Agreement prohibits any action by the County to "establish, enact, increase, or impose against the Project any fees, taxes (including without limitation general, special and excise taxes), assessments, liens or other monetary obligations other than (i) those specifically permitted by this Agreement (including Processing Fees) and (ii) any County-wide taxes and assessments," On March 1, 1994, the District adopted Ordinance No. 94-20, effective April 30, 1994, which imposed drainage fees on Drainage Area 76. The drainage fees imposed by Ordinance 94-20 are barred by § 4.03(2)(g) because they were established and enacted after the Effective Date of the Development Agreement, were not specifically permitted by the Development Agreement, were not taxes or assessment and were not imposed on a County-wide basis. 4340 Stevens Creek Boulevard,Suite 240,San Jose,California 95129 v Phone_(438)984-5900 • Fax:(408)555-1860 wwwg:eenbr a-hornes.com County of Contra Costa and Contra Costa County Flood Control and Water Conservation District July 10,2002 Page Two Nevertheless, in November, 2001, the County's Public Works Department demanded that GHC pay drainage fees before GHC would be allowed to record its final subdivision map for Tentative Tract Map No. 7725. GHC showed County employees a copy of the Development Agreement and, after reviewing it, the County agreed that GHC was correct, the requirement that GHC pay drainage fees was withdrawn and the final subdivision map was recorded without the payment of any drainage fees. On July 8, 2002, the County's Public Works Department demanded that GHC pay drainage fees in the amount of$33,500 before any building permits would be issued for houses to be built on the lots created when the final subdivision map for Tentative Tract Map No. 7725 was recorded. GHC again showed County employees a copy of the Development Agreement but this time the County refused to abide by the prohibition against new fees set forth in § 4.03(2)(g). 4. GHC paid the amount of drainage fees demanded, $33,500, on August 7, 2002. 5. The public employees demanding the payment of the drainage fees were Dean H. Eckerson and Karen Fernandez. 6. GHC claims that it is entitled to a refund of all of the drainage fees paid together with interest from the date of payment to the date of a refund. Very truly yours, GHC INVESTMENTS, LLC A Delaware limited liability company By: Greenbriar Homes Communities, Inc. A California corporation, Its Manager By: Timothy M. Guinn. Development Manager CLAIM. BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Sept 10,2002 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 California Government Codes. } notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given t' #� Pursuant to Government Code Section 913 and AUG 15 2-002 915.4. please note all "Warnings". AMOUNT: $6,95 COUNTY COUNSEL. MAHTINEZ CALIF CLAIMANT: Weldon Wiggins ATTORNEY: None DATE RECEIVED: Aug,12, 2002 ADDRESS: 910 Court St BY DELIVERY TO CLERK ON: Aug 12. 2002 Martinez, CA 94553 BY MAIL POSTMARKED: August 10, 2002 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWE# ,W Cl Dated: Aug,12 2002 By: Deputy; II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( phis 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. FROM: Clerk ofthe Board TO: County Counsel (1) County Administrator(2) ( } Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER.: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. ( } Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated.. f'h:.� f'di. ' ` { JOHN SWEETEN, CLERK, By `` f `' rim ,Deputy Clerk WARNING(Gov. code section 913) Subject to certain exceptions, you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18, and that today I deposited in the United States Postal Service in Martinez,California,postage fully prepaid a certified copy of this Board Order and:[Notice to Claimant, addressed to the claimant as shown above. Dated: s{ '{` $. f f `' : JOI IN S WEETEIv, CLERK By f f' JS`, ;�r t. �- Deputy Clerk Claim:to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY q INSTRLT TIONS TO CLA.;i IMI A. Claims relating to causes of action for death or for injury to person or to personal property or growing craps and which accrue on or before December 31, 1987, must be presented not later than the 140 `day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or,growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov't Code 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553, C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud'. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp a- RECEIVED Against the County of Contra Costa oo } UG 12 2002 CLERK BOARD CF 5tjr r, (Fill inn e} _ ) CONTfJA CO TA n3 v a"v^ Q" The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ (,c r f and in support of this claim represents as follows: 1. When did the damage or injury occur? (Clive exact date and hour) JA 2. Where didthe damage or injury occur? (Include city and county) ---t,46 3 G, 3. How did the damage or injury occur? (dive full details; use extra paper if required) a ► t PS • ( `� } ,y�{^+ ,_spy ( y. (/ fjyy.... �,�Y'FF+� \ � ) �'~ {i ,{)5 y y `jsj(�• s4{ .. �� '�� �. 8 td 3s't � ��.°.'� 5�"4.yt��,�.R.-. 0.- � .+` ��- 90.-i.,_'Y' (.,::�.\ •T G '"4' - f X�i� � ll 1 \J,. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury to or damage? } j A— 7 Oct �-j 5. What are the names of county�r district officers, servants, or employees causing the damage or injury? ti—Lsc �%r� r c Vit _ tu"r >�3 ; �1 � F L/ 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for�auto da,}{ymage.)AP : �'V f Z. ey s'✓"�. w'7�G� tl G���t dTt-- fb�� � "6s\�L�C;3-4 < �\J 1v/1�'.�7"�g.."✓-� l-�"'f�i'�.�.� A 11-Is 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) pitlt #� lr ,,L cis 8. Names and addresses of witnesses, doctors, and hospitals. Jt tri s^ `SA' I co u 9. List the expenditures you made on account of this accident or injury. DATE ME AMOUNT Gov. Code Sec. 9113.2 provides `The claim must be signed by the claimant or by some person on his behalf." SEND NOTICES TO. ('Attorney Name and Address of Attorney ) � s (Clai 's Sign re) 6{ ;,�'�'.J't 5 (Address) Telephone No. )Te ephone No. NOnCE 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 (5 3,000), 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. _o ,"'Finteen corporation b-iDE-MARTINEZ DETENTION FA . L.ITY 08-. :4 Invoice Z6615129 PICK LIST Name: WELDON WIGGI€ S IU 0: OZOIZ566 B1 yrrk; N_ .N _Iter______ Fr•i ce A;� ., unt. CENT STAMPS (SPK' Z0:a0 0. is . ;C7 31" OF STAMPS 3.70 •40 c LEGAL ST A #� Z 2.30 .6-0 i 13A`€`MEA� � COOKIES �CO K IE S i,,,u_Z,> 5006 2-50 3 RAMEN SFCY CHCKEN 0910 0.92 -: .76 2 COFFEE SOZ S0 1 BEEF SALAMI 50Z 13'so 1 .80 17J 1 REFRIED BEANS .4!I 5005 i .zo a .20 BURY STEAK 1 !`� ` 929 a( .80 .. Y TOR TILLA CH"I"PS 02,112 1 .35 7O 1 HOT FRIES a002 HOT CHEESE CRUMP HISS 5oCS 1 .21110 i FRUIT PUNCH 0013 1 .65 -7 .65 1 TEA/LEMON 0014 1 .65 i .65 1 LEMONADE URIN#:: MIX 0016 1 .60 W. .60 MAYONNAISE (5PK) 0020 o.90 .6o 2 JALAPENO PEPPER .70Z 0025 o.65 30 RIFFLE. CHIF"W 6- ::u5 .6�.s• - .65 S 866: 1 .50 - .50 S ENV o 9Xi� ( t 0()-24 0.61 ,rte: LET YELO 9) 0030 I . io I BABY POWDER 42 1 .0a s?S 1 INSULATED COFFEE MUG 744 2.60 -:.60 i COCOA BUTTER 1 i OZ 0048 t .00 00 i IRISH SPRING 3.20Z 0061 O.3 .3 1 LADY SFU ST#;: 1 .5OZ 0063 2.96 x:.04. 1 TOOTHBRUSH 0077 � 0.95 1 COLGATE TOOTHPASTE 0078 1 .33 1 DOVE SOAP 4.75OZ 0705 1 .41 -41 I PETRO JELLY 40Z 49 1 .44 - .44 1 IVORY 4.50Z 703 0.82 S' i MARS ALMOND BAR i 08100: 0.72 -.7Z i SKITTLES 2. 17OZ Ot�;'Z7 0.7z .72 50 Base Sales _. C. Previous Balance: $ 100.00 Deb i tek:: .oo Tart. . 1 New Balance: $ 26. 1:2-- To to 1 : S7 Signatut-e: ------------------ _ _--------------------------- Contents ....r.--- _-.......__.____....,.___-..___.. -C:,stents must be checked bePore ,opening bag. Open bags t-ece i ve n cned si t. 691 F.Supp. 1336 Page 3 of 3 An appropriate judgment will be entered. M.D.Ala.,1988. Vanscoy v. Hicks 691 F.Supp. 1336 END OF DOCUMENT Copr. (C)West 2002 No Claim to Orig. U.S. Govt. Works http://web2.westlaw.corn/result/text.wl?RecreatePath=/Find/default.wI&RS=WLW2.77&VR 8/5/02 ✓lAil� � �..mak -. CONTRA Cos COUNTY DETENTION FACILITY (-.,..J NMATE REQUEST FOR INFORMATION { }MEDICAL REQUEST TO: s £ From:2:. t s (DCO ) Date: J`` ] w. / :. Housing Assignment:._ y { Check One: Vequest { pwkrieyance { }Appeal { ) Other yip Request. t <. .4 77 { S i' .. '... ] y t _ x ] ] r Date Rec'd Rv' Routed To: ANSWER: ( )APPROVED { )DENIED-(state reason) By: Date: Pink:Kept by Inmate Yellow:Reply to Inmate White:To Booking DET 024:FRM 1/2/91 _ _ . ... •.may f3 CONTRA COST COUNTY DETENTION FACILITY { ) INMATE REQUEST FOR NF•ORMATION { }MEDICAL REQUEST To, t y J Y,Y n* of Stiff (GD$) Date: Housing Assignment �4�.� Check One: ( ) Request (��Grlevance { )Appeal ( ) Other Request. M < -f } p # q F ' is - � #st •,F �"' 41f v :4 [3aW Rac'd. v `' c:' R c!d R11: i M Routed To: AM WER: { )APPROVED (ice DENIED-(state reason) By: :•..f< z. Date. / Fink:Kept by Inmate Yellow:Reply to Inmate White:To Booking v DET 024:FRM 1/2/91 _ CONTRA COSTA COUNT LIETEI TIO FACILITY { j INMATE REOPEST FOR INFORMATION ( )MEDICAL REQUEST k FrOIt1 k-/' , Bkg# � �Houslrtug:Assignment Cheek One: { } Request } nevanee ( )Other .� f ) l Request: V. s ; k i y � S 7r x # t Yk {{ t s < < 4 AW riec V: 1 1"9 '1"I Bl1' V s N:: .e...s b• Routed To: S R: ( )APPROVED ( } DENIED-(state reason) r r r By: a l r'N w C.�! a DElte r Pink.Kept by Inmate Yellow:Reply to Inmate x F ite:T6 Booking DET 024:FRM 1/2/91 / •,v x?i� iX, CLAIM BOARD QF SUPERVISORS OF CONTRA COSTA CC3UNTY BOARD ACTION: Sent 10,2002 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 California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all"Warnings". AUG AMOUNT: unknown � � `' COUNTY COUNSEL CLAIMANT: Robert Aita MARTINEZ CALIF ATTORNEY: None DATE RECEIVED: Aug 13, 2002 ADDRESS: ours St BY DELIVERY TO CLERK ON: Aug l3, 2002 Martinez--, CA 94553 , dye- BY MAIL POSTMARKED: August 10, 2002 1. FROM. Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWF,.ETk Dated: Aug 12, 2002 By: Deputy 11, FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( } This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). ( ) Other: i Dated: By: Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: J This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Rk i JOHN SWEETEN CLERK B 3 �'� i 4 s r� � �.__ , Deputy Clerk Dated ��"' �" 1` ��'.� � f , ,r���, i �,�yi 9 f y WARNING(Gov. code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18, and that today I deposited in the United States Postal Service in Martinez, California,postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. i s Dated E,, L " y °.. y 4x `� ' r Deputy Clerk . _ OxN SWEETEN, CLERK B �� I ���- Crim to: BaAR1) OF �ISdRS fly' a0N'S7tA tI>STA COUNTY INSTRUCTIONS TC CLAIM A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the acorual of the cause of action. (Govt. Code 5911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. Tf the clatm is against more than one nubl,ie 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 orm. e e * a � � � s * e • e �t a * e s e ct e e e a e e e e a a a a e s �► a +� e a e e � e e RE: Claim By } Reserved for Clerk's 1M stamp ECEIVED AUG 13 2002 nst the unt of Hera ata } � Ct,ERf�BOARD OF SUrER1�lSORu or ) CONTP,n,Crs CO. District) 71 11 In name The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows: 1. When did the damage or min juury occur? (divey exact date and hour) �.r.r..rw�.rr�.r_.r__...rr....ia. wwr wrrrrrraw.r 2. mere did the damage or injury 000ur? (Include city and oounty) „ ' ll 'ICGFcIj"`dc�� ;6% ?j L3trj7g ALS 3. How did the damage w injury occur? (Give full details; use extra paper if required) , 4. What particular act or omission on the part of county or district offioers, servants or employees caused the injury or ? Vic-='Wu s y cV R�t --re A G'” (over) +What are the names of oomty or district officers, servants or employees causing the damage or injury? 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. 12e �'lqtoq acs` " ; '40va orl-44 ice /�eWr-'A14= ""IT- 1-0'r4;, ` d 0'r4;. 0-4.s�r 1"A,? . ro-r4,L c*e�'r A17 _Nw_aY—NfYriii_MiYiYlfiNfi! _!N_�YiiiN_MVrN__— ___w_!—_+►y!_ilY_ 7. How Was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) $. Names and addresses of witnesses, doctors and hospitals. CiI6- rJ- 1441, ; 04'C" 0 C� N—---_..--------YN_—.fiN___.—_---------i.+M—_-----_--_---------ai--l-1`.►--- ---! 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMQ T 7114/d;Z rs � �oAle:`' u ,3 , tis 7: J-3 4r �rir3• �'� /:�t, ..��% 3 I76,.� 9-iAJ r Gov. Code Sec. 910.2 provides: "The claim most be signed by the claimant SEND NOTICES TO: (Attorney) or some REson on his behalf." Name and Address of Attorney tffariain-Efs +gnat (M—mss) 0 12 ` Telephone No. Telephone No. ;,o -77 2 R 8 7 eeeeeea eee • eeee see NOTICE Seetiaan 72 of the Penal. Code provides: "Every person who, with intent to defraud, presents-for allowance or for payment to any state board or officer, or to any oounty, 'eity 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 ($1090000 or by both such imprisonment and tine. 07,091,67 212 c s-7- ,1`•4' eo .�"; • r � i:.s� � °�� - � -'` �:� �' �°'�d�.,€�,.i`�s' 1r'�,mss POT— A" eu,,4:741, r.. . ....f' •AT�,:'�. .. PR C` r—c"FIF17 6?to d2t,> `�"t=�,.�. x�x ,1�; �t.;�a`Y�{ ��G`� � '. � t 1�.�ick.. � ��-• �f��-�� �+`';`� ���i s`�.� Q A 42 Ons not, yflar r25 Q 4 W AN x`14 to a � CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Seat 1.0.2002 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: unknown AUG0 CLAIMANT: Jeffrey McCoy COARTINUNTY OCALIF. L ATTORNEY: Doris Bostick DATE RECEIVED: Aug 12, 2002 ADDRESS: 595 Dowling Blvd BY DELIVERY TO CLERK ON: Aug 12, 2002 San Leandro, CA 94577 BY MAIL POSTMARKED: August 10,2002 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWI TEC,W Dated: Aug 13,2002 By. De ut p y Lei 3y II. FROM: County Counsel TO: Clerk of the Board of Supervisors W ( "ihis claim complies substantially with Sections 910 and 910.2. { ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.$). { ) 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: eve. �r Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( } Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: { ) This Claim is rejected in full. { ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: z J,,4r; `' OHN SWEETEN CLERK B E t� '" { y a - �;Deputy Clerk WARNING(Gov. code section 913) Subject to certain exceptions, you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. ' For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,California,postage fully prepaid a certified copy of this Board Order and Notice to Claimant addressed to the claimant as shown above. f�F t:' 3 J Dated: : JOHN SWEETEN, CLERK By �.- ` ' ? , -- Deputy Clerk Aug 09 02 12: 18p Clerk of the Board 825 33n iz�ij P. Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRt&TIO7 S TO aAI=MAI�1'1 A. Claims relating to causes of action for death or for injury to person or to personal property or growing craps and which accrue on or before December 31, 1987, must be presented not later than the 100e'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 921.2.) 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 JEFFREY r3CCOY ) } CONTRA COSTA SHERIFF DEFT. �RECEIVEID) I` Against the County of Contra Costa or } AUG 12 2002 CONTRA COSTA SHERIFF DEPT. District) ST�t (Fill in name) ) tK rA VISRS The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sunt of and in support of this claim represents as follows: V7ITHIN THE LIMITED JURISDICTION OF THE COURT 1. When did the damage or injury occur?(Give exact date and hour) FEBRUARY 24 , 2002 2. Where did the damage or injury occur?(Include city and county) WILLOW PASS ROAD, BAYPOINT, CA, CONTRA COSTA COUNTY 3. How did the damage or injury occur?(Give full details;use extra paper if required) Mr. McCoy was stopped for a red light on Willow Pass Read in Bay Paint, when the police vehicle skidded and rear ended Mr. McCoy' s car causing sufficent damages to his vehicle and injury to his body. Aug 03 02 12: 18p Clerk of the Burd 325 335 1913 p. 3 fi. What particular act or omission on the past of county or district officers, servants, or employees caused the injury or damage? The police officer failed to stormed due to his inattention to the traffic and caused the injury and property damage to Mr. McCoy S. What are the names of county or district officers, servants, or employees causing the damage or injury? Unknown at this time . 6. What damage or injuries do you claim resulted?( sive full extent of injuries or damages claimed. Attach two estimates for auto damage.) Auto damage and physical injuries to Mr. McCoy' s back, neck and other soft tissue injury as well as strain. Auto damage ($2374 , 37) Personal injuries within the limited jurisdiction the oust 7. ow was t ie amount claimed above computed?(Include the estimated amount of any prospective injury or damage.) Auto damage is the average of two estimates for damages (conies of estimates attached) Personal injury within limited jurisdiction of the courts . 8. Names and addresses of witnesses, doctors, and hospitals. Contra Costa Heath Services , 595 Center Ave. , Suite 300 , Martinez , CA 94553 9. List the expenditures you made on account of this accident or injury. DATE TE AMt�Ul`TT 7/18/02 $85 .40 TDavment for medical services Gov. Code Sec. 910.2 provides"The claim must be } signed by the claimant or by some person on his behalf" SENI>NO ICI✓ TU: (Attorney Name and Address of Attorney } DORIS BOSTICK, ESQ } /Jx ` 2111 BELL & BOSTICK, LLP } 7 (Cla'imant's Signature) 595 DOt+rLING BLVD } ' SAN LEANDRO, CA 94577 ,✓� ddr r 510--638-2292 } TelephoneNo. )Telephone No. NOUCE Section 72 of the Penal Code pro}ides: Every person wbo,with intent to defraud,presents for allo%=ce or the payment to any state board or officer,or to any caounry,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 on:year,by a fine of not exceeding one thousand(S 1,0100),or by both such imprisonment and fine,or by imprisonment in the rate prison,by a fine of not exceeding ten thousand dollars(S 10,000).or by both such imprisonment and fine. CONTRA COSTA ,0 HEALTH SERVICES Eur r � C = 925 CONSENT TO SERVICES AND CONDITIONS OF SERVICES AND OF ADMISSION Patient it) MEDICALISURGICAL TREATMENT CONSENT.The undersigned consents to any medical treatment,including but not limited to x-ray examinations,laboratory procedures,medicallsurgical procedures,Injections,and blood transfusions, considered advisable or necessary by the attending physician or by other of the hospital's medical staff, Including physician residents and independent contract physicians; and further agrees to the provisions expressed on the reverse side of this farm. TEACHING PROGRAM:The undersigned understands that Contra Costa Health Services,Contra Costa Regional Medical Center and Contra Costa Health Centers are teaching institutions and that residents,interns,and health care students,under the supervision of professional staff, may be involved in providing medical and/or health care. CONSENT TO RELEASE MEDT-CAL LABELS.The undersigned authorizes the Contra Costa County Department of Social Services to release information concerning the status of the patient's Medi-Cal application,and to send the patient's Medi-Cal labels to the Contra Costa Health Services Department. I also authorize the above Agency to send Contra Costa Health Services a Letter of Authorization,to allow the Medi-Cal program to be billed for any medical services I have received at a county facility that may be covered by the Medi-Cal program. FINANCIAL AGREEMENT:The undersigned promises to reimburse the County of Contra Costa for any hospital care and/or medical services provided to the patient at any time within 365 days of the date indicated below,which services are not covered by Medicare,Medi- Cal,insurance or any other health care compensation carrier,at the rates established by the Contra Costa County Board of Supervisors.The undersigned further agrees to use any damages or indemnity paid to or on behalf of the patient as a result of the injury or illness which necessitated this care to reimburse the county up to the amount billed,but not to exceed the rates set by the Board of Supervisors. The undersigned waives the statute of limitations on this matter for a period of 10 years.This agreement and waiver is binding on the undersigned,his or her heirs, assigns,administrators,and executors. The undersigned authorizes the Social Security Administration to release to Contra Costa County Health Services Department information concerning the status of the patient's Social Security benefits,including the type of benefit,amount receiving,and the effective date.I also authorize the above agency to release information about the patient's Medicare benefit, including the effective date. ASSIGNMENT OF BENEFITS.The undersigned authorizes,whether he/she signs as agent or as patient,direct payment to Contra Costa County of any insurance benefits otherwise payable to or on behalf of the patient for this hospitalization and/or these outpatient services, including emergency services if rendered,in an amount not to exceed the County's regular charges.A photocopy of this authorization shall be considered as effective and valid as the original. The undersigned authorizes and directs the attorney,claims adjustor, insurance company and any person(s),company or corporation who may effect a settlement or payment of any claim for damages or indemnity that the patient may have arising from the injury or illness which necessitated this hospital care and%or outpatient services, to deduct the amount of the charges of these services from any sum due the patient and to pay that amount directly to Contra Costa County and the undersigned hereby assigns that amount to Contra Costa County. RELEASE OF INFORMATION FOR REIMBURSEMENT.The undersigned agrees that.to the extent necessary to determine liability for payment and to obtain reimbursement,Contra Costa County may disclose portions of the patient's record, including his/her medical and psychiatric records, to any person or corporation which is or may be liable for all or any portion of the charges, including but not limited to insurance companies, health care service plans. �rorkers` compensation careers, Social SecurityAdministration, and peer review organizations. The undersigned certifies that he/she has read both sides of this document, received a copy thereof, and is the patient,the patient's legal representative,or is duly authorized by the patient as the patient's general agenf"to execute this document and accept its terms. ,✓ DATE S GNATb e O 'PATI=NT OR PAA-1;NT'S A CPRE/a I(ITATIVE WITNESS TO SIGNATURE �,_—• IF PATIENT"S REPRESENTATIVE.PeLATIONSHIP TO PATIENT If patient unable to sign,STATE REASON: IoR463.1(#',l41} Side 7 `ONTRA COSTA REGIONAL MEDICAL CENT CONTRA COSTA HEALTH CENTERS BASIC ADULT CARE PROGRAM! PLEASE NOTE SOME CHANGESHAVE BEEN MADE IN THE APPLICATION. The application process will not be considered complete until you receive written notification by mail at the address you listed Can the application. PLEASE KEEP THIS PAGE FOR FUTURE REFERENCE. RIGHTS AND RESPONSIBILITIES + I understand that I am applying for Basic Adult Care (BAC), not State Medi-Cal. • I agree that, if asked, I will file a Medi-Cal and/or Supplemental Security Income (SSI) application and that my BAC coverage will be discontinued if I fail to apply and follow through with the application process. I agree to appeal a denial to my Medi-Cal or SSI if I am disabled. • I understand that if I become eligible to receive Medicare, Medi-Cal or any other program coverage or medical insurance, including third party liability settlements, my Basic Adult Care will be discontinued effective the date that I become eligible to receive the program coverage and/or insurance. • 1 also understand that if Medi-Cal coverage requires me to share in the cost of services, I will be responsible for the share of cost amount. • I consent to allow the Financial Counseling Office to verify any of the information on this publication. • I understand that receipt by mail of eligibility determination is a part of the application process.* • I understand that I have a right to an informal hearing if I am dissatisfied with actions taken. • I agree to inform the Financial Counseling Office (in writing) within 10 days if there are any changes to my income, possessions, number of persons in the household, or change of address. + 1 understand that when medically appropriate, I may choose to be hospitalized at Delta Memorial Hospital if I live in East County, at Brookside Hospital if I live in West County, or at Contra Costa Regional Medical Center without regard to where I live, when I am referred for elective inpatient care by a county physician. + 1 declare under penalty of perjury that the answers I have given are true and correct. IF I DELIBERATELY MAKEFALSE STATEMENTS OR WITHHOLD INFORMATION, I MAY LOSE MY BAC COVERAGE, BE BILLED FOR ALL SERVICES RECEIVED AND BE PROSECUTED FOR FRAUD. Patient's copy to be given to the patient by a Financial Counselor or Registration Clerk upon receipt of a completed Basic Adult Care Application. r. CLINIC Patient's Signature Signature of rIn�ncial.Counselor/Registration Clerk DATE r *If application process is not completed by applicant receiving mail at the address listed on the application, Health Services Department will bill the applicant in full for all services received. That may include assignment to a collection agency. FINANCIAL COUNSELING OFFICES ARE LOCATED IN THE HEALTH CLINICS AT: 550 School Street 2500 Alhambra Avenue 38th & Bissell Pittsburg, CA 94565 Martinez, CA 94553 (925) 370-5570 Richmond, CA 94805 (925) 427-8162 Family Practice Clinic (925) 370-5582 (510) 374-3330 Outpatient Speciality (925) 370-5580 Emergency Dept. (925) 370-5581 AR18A-7 (2/99) Distribution:Original-Fin.counselor Copy-Patent Date: 4/11102 02:49 PM Estimate ID: 763 Estimate Version: 0 Preliminary Profile ID: Mitchell GOMEZ AUTO BODY 2160 PIEDMONT WAY PITTSBURG,CA 94565 (925)252.9933 Fax: (925)252-9929 Damage Assessed By: GILBERT GOMEZ Deductible: UNKNOWN Owner JEFFREY MCCOY Telephone: dome Phone: (926)382-4221 Mitchell Service: 912479 Description: 19139 Chevrolet Caprice Body Style: 40 Sed Drive Train: 6.01-Inj 8 Cyl AO VIN: iG18U51E5KA12234 Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units i 228660 REF BLEND L QUARTER PANEL OUTSIDE C 1.0 2 228830 BOY REPAIR R QUARTER MUTER PANEL Existing 6.0*# 3 AUTO REF REFINISH R QUARTER PANEL OUTSIDE C 2.4 4 230130 BOY REMOVE/REPLACE L QUARTER PROTECT MOULDING ORDER FROM DEALER 428.60 0.2 6 230170 BOY REMOVE/REPLACE R REAR QUARTER PROTECT MOULDING ORDER FROM DEALER 37.90 0.2 6 231270 REF REFINISH LUGGAGE LID OUTSIDE C 2.6 7 231360 BOY REMOVE/REPLACE LUGGAGE LID NAMEPLATE 20260428 GM PART 24.10 0.2 8 231380 BOY REMOVE/REPLACE LUGGAGE LID NAMEPLATE 20606499 GM PART 24.10 0.2 9 294670 BOY REMOVE/REPLACE REAM BODY FINISH PANEL 10096397 GM PANT 311.10 1.0 # 10 AUTO REF REFINISH FINISH PANEL C 1.0 11 236580 BOY REMOVE/REPLACE R COMBINATION LAMP LENS 16504134 GM PART 90.90 12 235600 BOY REMOVE/REPLACE R BACKUP LAMP LENS 16504136 GM PART 412.20 13 235620 BOY REMOVE/REPLACE R COMBINATION LAMP BEZEL 6931050 GM PART 99.75 14 235640 BOY REMOVE/REPLACE R COMBINATION LAMP HOUSING 16504678 GM PART 89.80 INC 16 236560 BDY REMOVE/REPLACE R MARKER LAMP ASSEMBLY 914192 GM PART 17.40 0.2 16 236800 REF REFINISH REAR CTR FILLER C 0.8 17 236810 REF REFINISH R REAR OTR FILLER C 0.5 1S 236320 REF REFINISH L REAR OTR FILLER C 0.6 19 AUTO BOY OVERHAUL REAR BUMPER ASSY 1.6 20 236910 BOY REMOVE/REPLACE REAR BUMPER FACE BAR 14008748 GM PART 239.10 INC 21 AUTO BOY REMOVE/REPLACE REAR ADD W/IMPACT STRIPS 0.2 22 236940 BDY REMOVE/REPLACE REAR BUMPER IMPACT CUSHION 14081644 GM PART 48,50 INC 23 936012 ADD'L COST HAZARDOUS WASTE DISPOSAL 3.00' 24 AUTO REF AOD*L OPR CLEAR COAT 2.2 25 933003 REF ADD*L OPR TINT COLOR 0.5* 26 933018 REF ADD'L OPR MASK FOR OVERSPRAY 4.00* 0.5* 27 AUTO ADD'L COST PAINT/MATERIALS 287.50* ESTIMATE RECALL NUMBER: 4111102 14:49:19 763 UltraMate is a Trademark of Mitchell International Mitchell Data Version: APR_02�A Copyright(C)1994-2000 Mitchell International Page 1 of 2 UltraMate Version: 4.7.007 All Rights Reserved Date: 4111102 02:49 PM Estimate ID: 763 Estimate Version: 0 Preliminary Profile 10: Mitchell * -Judgement Item #-Labor Nate Applies d -Discontinued by the Manufacturer C -Included in Clear Coat Calc Add1 Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 9.8 60.00 0.00 0.00 588.00 T Taxable Parts 1,023.35 Refinish 12.0 60.00 4.00 0.00 724.00 T Sales Tax @ 8.000% 81.87 Taxable Labor 1,312.00 Total Replacement Parts Amount 1,105.22 Labor Summary 21.8 1,312.00 Ill. Additional Costs Amount IV. Adjustments Amount Taxable Costs 287.50 Customer Responsibility 0.00 Sales Tax @ 8.000% 23.00 Non-Taxable Costs 3.00 Total Additional Costs 313.50 1. Total Labor: 1,312.00 Il, Total Replacement Parts: 1,105.22 lit. Total Additional Costs: 313.50 Gross Total: 2,730.72 IV. Total Adjustments: 0.00 Net Total: 2,730.72 This Is a Preliminary estimate. Additional changes to the estimate may be required for the actual repair. This .are an estimate based on an initial examination of your vehicle. There may be damage that cannot be seen until work has begun on the vehicle and adjustments in time and materials may be necessary. SIGNED DATE ESTIMATE RECALL NUMBER: 4111102 14:49:19 763 UltraMate Is a Trademark of Mitchell International Mitchell Data Version: APR 02_A Copyright(C)1994-2000 Mitchell International Page 2 or 2 UltraMate Version: 4.7.007 All Rights Reserved Date. 4/1112002 01:45 PM Estimate 10: 1261 Estimate Version: 0 Preliminary Profile 10- 60 QUALITYAUTO BODY & PAINT 2250 Freed Way Ste.D Pittsburg,CA 94565 (925)252-1168 Fax: (925)252-1170 Tax IO: 94-2746815 BAR M AA209125 EPA* CAL000216016 Damage Assessed By: Gary Pahule Deductible: UNKNOWN Insured: Jeffrey McCoy Address: 4284 Scenic Pittsburg,CA 94565 Telephone: Home Phone: (925)382-4221 Mitchell Service: 912479 Description: 1989 Chevrolet Caprice Brougham LS Body Style: 40 Sed Drive Train: 5.01-In)8 Cy€AO VIN: IGIBUSIESKA122234 License: 2LMA295 CA Mileage: 264,789 Line Entry Labor Une Item Pan`.Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 228830 BDY REPAIR R QUARTER OUTER PANEL Existing 4.5*# 2 AUTO REF REFINISH R QUARTER PANEL OUTSIDE C 2.4 3 230170 BDY REMOVEIINSTALL R REAR QUARTER PROTECT MOULDING Existing 0.2* 4 230290 BDY REMOVEIINSTALL R REAR QUARTER MOULDING Existing 0.2* 5 230340 BDY REMOVEANSTALL R REAR QUARTER WIOPENING MLDG Existing 0.2* 6 231270 REF BLEND LUGGAGE LID OUTSIDE C 1.2 7 231360 BOY REMOVEIREPLACE LUGGAGE LID NAMEPLATE 20260428 GM PART 24.10 0.2 8 231380 BDY REMOVEIREPLACE LUGGAGE LID NAMEPLATE 20606499 GM PART 24.10 0.2 9 900500 BOY* REPAIR PULL REAR CORNER SECTION Existing 2.0* 10 234570 BDY REMOVEIREPLACE REAR BODY FINISH PANEL 10096397 GM PART 311.10 1.0 # 11 AUTO REF REFINISH FINISH PANEL C 1.0 12 235620 BOY REMOVEIREPLACE R COMBINATION LAMP BEZEL 5931050 GM PART 99.75 0.5* 13 236800 REF REFINISH REAR CTR FILLER C 0.8 14 236810 REF REFINISH R REAR OTR FILLER C 0.5 15 236820 REF REFINISH L REAR OTR FILLER C 0.5 16 236830 BDY REMOVERNSTALL REAR BUMPER ASSY 0.6 17 AUTO REF ADO"L OPR CLEAR COAT 1.8 18 933003 REF AD L OPR TINT COLOR 0.5* 19 933005 FRM ADD'L OPR FRAMEIRACK SET UP 1.5* 20 933018 REF ADD'L OPR MASK FOR OVERSPRAY 5.00* 0.3* 21 AUTO ADD'L COST PAINT/MATERIALS 243.60* 22 AUTO ADUL COST SHOP MATERIALS 31.20* 23 AUTO A€JO'L COST HAZARDOUS WASTE DISPOSAL 5.00* ESTIMATE RECALL NUMBER: 4111/2002 13:16:22 1261 UltraMate Is a Trademark of Mitchell International Mitchell Data Version: APR 02_A Copyright(C)1994-2000 Mitchell International Page 1 of 2 UltraMate Version: 4.7.007 All Rights Reserved Date: 411112002 01:45 PM Estimate ID: 1261 Estimate Version: 0 Preliminary Profile ID: 60 Judgement Item #-labor Note Applies C-Included in Clear Coat Calc AddI Labor Sublet 1. Labor Subtotals Units Rate Amount Amount Totals ll. Part Replacement Summary Amount Body 9.6 60.00 0.00 0.00 576.00 Taxable Parts 459.05 Refinish 9.0 60.00 5.00 0.00 545.00 Sales Tax 8.250% 37.87 Frame 1.5 65.00 0.00 0.00 97.50 Non-Taxable Labor 1,218.50 Total Replacement Parts Amount 496.92 Labor Summary 20.1 1,218.50 111. Additional Costs Amount IV. Adjustments Amount Taxable Costs 274.80 Customer Responsibility 0.00 Sales Tax 8.250% 22.67 Non-Taxable Costs 5.00 Total Additional Costs 302.47 1. Total Labor: 1,218.50 Ii. Total Replacement Parts: 496.92 III. Total Additional Costs: 302.47 Gross Total: 2,017.89 IV. Total Adjustments: 0.00 Net Total: 2,017.89 "Chis is a nreliminm estimate. Additional chanties to the estimate may, be required for the actual repair. Point(s)of Impact 5 Flight Rear Comer(P) ESTIMATE RECALL NUMBER: 41111200213:16:22 1261 UltraMate Is a Trademark of Mitchell International Mitchell Data Version: APIs 02_A Copyright(C)1994-2000 Mitchell International Page 2 of 2 UltraM ate Version: 4.7.007_ All flights Reserved s , APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY CALIFORNIA BOARD ACTION Sept 10,2002 Application to File Late Claim ) NOTICE TO APPLICANT Against the County,Routing ) The copy of this document mailed to you is your Endorsements, and Board Action. ) notice of the action taken on your application by {All Section References are to the Board of Supervisors (Paragraph III,below), California Government Code.l 97 iven pursuant to Government Code Sections 911.8 and AUG 1 6 2002 15.4. Please note the"WARNING"below. Claimant: Gwenette Ary COUNTY COUNSEL Attorney: F. Anthony Edwards MARTINEZ CALIF Address: 1850 Mt. Diablo Blvd Walnut Creek, CA 94596 Amount: Unknown By delivery to Clerk on Aug 15, 2002 Date Received. Aug 15, 2042 By mail,postmarked on Aug 13. 2002 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted Application to File LatF-�tr.. DATED: Aug_15, 2002 JOHN SWEETEN, Clerk, By �. 1�, ,r ��; Deputy Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors { } The Board should grant this Application to File Late Claim(Section 911.6). (-'J The Board should deny this Application to File Late Claim(Section 911.6). r� DATED: "�' - SILVANO MARCHESI, County Counsel, By � , Deputy III. BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( ) This Application is granted(Section 911.6). ( This Application to File Late Claim is denied(Section 911.6) I fertify that this is a true and correct copy of the Board's Or entered in its minutes for this date. DATE. °, t} 1 t { ���,,, JOIINSWEETEN Clerk 13 ` ��,�.;o ��'��'��r � Y- r � �� Deputy Clerk WARNING(Gov. Code §911.8) If you wish to file a court action on this matter, you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4(claims presentation requirement). See Government Code Section 946.6. Such petition must be filed with the court within six(6)months from the date your application for leave to present a late claim was denied. You may seek the advise of any attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. IV. FROM: Clerk of the Board TO: (1)County Counsel (2) County Administrator Attached are copies of the above Application. We notified the applicant of the Board's action on this Application by mailing a copy of this document,and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. DATED `j JOHNSWEETEN, Clerk,By Deputy Clerk V. FROM: (1) County Counsel (2) County Administrator TO: Clerk of the Board of Supervisors Received copies of this Application and Board Order. DA'T'ED: County Counsel, By County Administrator, By APPLICATION TO FILE LATE CLAIM SOBEL,, FIN'T`A & EDWARDS A LIMITED LIABILITY PARTNERSHIP Phone (925) 947-1600 ATTORNEYS AT 1.AW Fax (925) 947-1990 1850 SIT. DIABLO BOULEVARD SUITE 650 WALNUT CREEK, CA 94596 E-mail:edwardslawC&bigplanet.com F. Anthony Edwards, Esq. August 13, 2002 RECEIVED Contra Costa County AUG 15 2002 Board of Supervisors CLERK BOARD OF SUPERVISORS County Administration Building CMTRA COSTA CO. 651 Pine Street, Rm. 106 Martinez, CA 94553-1293 Re: Claim of Gwenette Ary Petition to File Late Claim pursuant to Government Code 911.6(6) Petition is here by made to submit the claim of Ms. Ary for the following reasons: 1. Ms. Ary was terminated from her employment on October 23, 2001. 2. On May 20, 2002, a claim was filed on behalf of Ms. Ary. Technically, the claim was 28 days late. 3. The reason for the claim being late was due to the fact that Ms. Ary was sick at the time suffering from depression and respiratory problems. 4. As a result of the above,petition is hereby made on behalf of Ms. Ary to submit her claim 28 days late pursuant to the provisions of Government Code 911.6(b). The granting of this petition will not result in any prejudice to the county. The claim of Ms. Ary is hereby submitted as Attachment A. Call me if you have any questions or concerns regarding this matter. Y y rs Y 'VVA S i FAE/wcw iEIBEL, PINTA & EDWARDS A LIIIdt D LIABILITY PARTNERSHT Phone(925)947-1600 ATTORNEYS AT LAW Fax(925)947-1990 1850,MLT.DIABLO BOULEVARD S=650 WALNUT CREEK.,CA 94596 E-mail:cdwardslaw@,bigplanet.com F. Anthony Edwards, Esq. May 20, 2002 Margaret Lehre LEA Health Service Personel Contra Costa Health Services 2002 597 Center Ave., Suite 260 Martinez, Ca 94553-4669 i� ?!/lSCi�,. CCI 3 Re: Claim for Wrongful Termination Gwenette Ary Dear Ms. Lehre: We have been retained to represent Ms. Gwenette Ary, your farmer employee in her claim for wrongful termination against your agency. Consistent with statutory requirements we are submitting this claim in letter form on behalf of Ms. Ary. Ms. Ary was hired by your agency in Sept. 1997. On October 23, 2001 her employment was terminated after she came back from medical leave of absence. It is the position of Ms. Ary that your agency, as her employer was under a duty to accommodate her disability once she returned from medical leave of absence. Obviously, it is also Ms. Ary's position that her medical condition was a disability as defined by the California Family Medical Leave Act. Because her employment was terminated instead of accommodated it is Ms. Ary's position that she was wrongfully tenninated and that your agency is liable for back pay, front pay and incidental damages. Any response regarding Ms. Ary's claim can be forwarded to our office at the above stated address. If you have any questions or concerns regarding the nature, scope and extent of the claim Ms. Ary is presenting against your agency, kindly contact me at your earliest convenience. Moreover, if you believe that this claim has not been presented in conformity with any statute or policy, kindly also contact me. A-, HO-ourEDWA.RD , F. FAE/wcw CC: Gwenette Ary ATTACHMENT A