HomeMy WebLinkAboutMINUTES - 08012006 - C.11 CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: AUGUST 01 , 2006
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
California Government Codes. you is your notice of the action taken
CLAIM AGAINST 00C, DEPT. OF AUDITOR/CONTROLIPMour claim by the Board of
Supervisors. (Paragraph IN/ below),
Pursuant to Government Code
AA/tOUNT: $37 , 318 . 56 C
'ction 913 and 915.4. Please note all
E UN 2 8 2006 arnings",
CLAIMANT,-MICHAEL DONNELLY
COUNTY COUNSEL
ATTORNEYLAWRENCE W. FASANO,M'J'R ''15'A fP YRE C E I VE D JUNE 28 , 2006
FASANO LAW OFFICE JUNE 28 2006
ADDRESS' 720 MARKET STREET, BY DELIVERY TO CLERK ON. ,
PENTHOUSE, SAN FRANCISCO
CA. 94102-2500 BY MAIL POSTMARKED: JUNE 26, 2006
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JUNE 28 ) 2006 JOHN CULLEN 1
Dated-. By: Deputy
ff FROM: County Counsel TO: Clerk of the Board of upervisors
( 'his claim complies substantially with Sections 910 and 910.2.
( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so
notifying claimant. The Board cannot act for 15 days (Section 910.8).
Claim is not timely filed. The Clerk should return claim an
n 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 4-30-00 By: rV1 CARQe— Deputy County Counsel
111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
O Claim was returned as untimely with notice to claimant (Section 911.3).
IV BOARD ORDER: By unanimous vote of the Supervisors present.,
This Clain) 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:lf�#_,V!C�OWWN CULLEN, CLERK, By Deputy Clerk
WARNIN (Gov. code section 913)
Subject to certain exceptions,you have only six(6)months from the date this notice was personally served
or deposited hi tile mail to file count action on this claim.See Govemnieut Code Section 945.6.You may
seek the advice of an attorney of your choice hi connection with this ujattej-. N you want to consult all
itttoiiiey,you should dosoimmediately. *For Additional Warning See Reverse Side of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty or perjury that I ani now, and at all times herein ineutioned, have
been a citizen of the United States, over age (8_; al,id that today I deposited in the United
Stales Posial Service in INtarfinez, California, postage fully prepaid a certified Copy of this
1.1(),lud 1judermid Notice to Claimant, addressed to the 010111antas shown above.
L),q(e(1:, .10,HN CI1 -1-11�, CLEKIt By Del)LI[y Clerk
City Clerk Stamp(Official use only)
INSTRUCTIONS: Use ball point pen. Make sure all copies
are legible. Be as specific as possible in completing the forms.
Attach any and all available documentation,e.g.,repair 71
estimates,medical bills,photos,etc.
L/oV
cFAK 2006
cOO r�D Oh ,
GOVERNMENT CLAIM AGAINST THE COUNTY OF CONTRA COSTA, C is
co °As
Michael Donnelly presents a claim for damages
(Name of Claimant)
against the County of Contra Costa, California, Dept. of Auditor/Controller in
the sum of$37,318.56
Claimant's Address:
541 Hamburg Cirlce
Clayton, CA 94517
Address of party presenting claim, if other than above:
FASANO LAW OFFICE
720 MARKET STREET, PENTHOUSE SUITE
SAN FRANCSICO, CA 94102-2500
Date of Occurrence: 2/28/2006
Said claim arises from following circumstances: On Feb28,200(the County Auditor-Controller's
Office stated in writing that I must repay wages which the County had paid to me for a shift paw
stat call as an employee for the County.A copy of that letter is attached herewith as Exhibit"A"and
incorporated herewith .
Description of nature and extent of damages or injuries:
The money which the County seeks from me in the sum of$37,318.56, interest on said money and
other money which the County claim from me, loss of pension funds, general damages, and
attorney's fees.
c/o Lawrence WM Fasano,Jr.Esquire
X R"4 / "`o _(41_5) 956-8800 /
Signature of Claimant or Represent Business Phone Residence Phone
Michael Donnelly
Copy to:
City Attorney-Original and One
City Clerk
Claimant
r I-
Contra Costa
Office of Stephen J.Ybarra
1/ \. Auditor-Controiier
COUNTY AUDITOR-CONTROLLER
`t Elizabeth A.ve€igin
h Assistant Auditor-Controller
625 Court Street
Martinez; Cal ifornia'94553-1282
Telephone (925) 646-2181
Fax (925) 646-2649
February 28, 2006
Michael Donnelly
541 Hamburg Circle
Clayton, CA 94517
Deaf Mr. D oris felly,
We recently reviewed the pay of employees in the classification of Nursing
Program Manager for the period of October 1, 2003 through September 30,
2005. We found that you were overpaid shift differential of$27,481.25 and Stat
Call of$9,837.31. The total amount of the overpayment is $37,318.56. This is to
notify you that an adjustment of$1,036.63 will be made in your April 10, 2006
through March 10, 2009 paychecks.
In accordance with Salary Regulation Section 6.5— Pay Errors, upon notification
of an overpayment and proposed repayment schedule, an employee may accept
the proposed repayment schedule or may request a meeting through the County
Human Resources Department to determine a repayment schedule. If you wish
to schedule such a meeting, please call Labor Relations at (925) 335-1780 at
your earliest convenience.
If you do not wish to schedule a meeting, and accept the proposed repayment
outlined above, please sign the attached authorization and return to me at the
Auditor-Controller's Office, Attn: Payroll —Tina, 625 Court Street, Martinez, CA
94553. Upon receipt of your authorization, the Auditor's Office will proceed with
the proposed repayment beginning on your Apfii 10, 2006 paycheck.
If you have any questions, please contact Tina Kaufmann at (925) 646-2167.
Sincerely,
I} f
Tina Kaufmann
Accountant III
C: 42174
Health Services Payroll
i
i
II
Contra Costa County
AUDITOR-CONTROLLER
1, Michael Donnelly, authorize the County Auditor-Controller to deduct the
amount of$1,036.63 from my April 10, 2006 through March 10, 2009 paychecks
for the differentials overpayment.
Signature #42174
Date
FASANo Lawrence W. Fasano, Jr.
Attorney at Law
720 Market Street,Penthouse Suite
San Francisco,California 94102-2500
tel(415)956-8800■fax(415)956-8811
June 26, 2006REC
-` ---
Clerk of the Board of Supervisors JUiV
County Administration Building, Room 106 200
6
651 Pine Street ` RR sQAt r
COr JTr
0F' tl�;c; ,5•
Martinez, CA 94553 �cs7 cU URS
Re: Jeffrey Barnhart; Sharon Shaw;Michael Donnelly
Dear Sir or Madam:
Enclosed please find an original and one copy of Government Claim forms for the above referenced
individuals. Please file the originals and return endorsed filed copies to our office in the enclosed self
addressed stamped envelope. Thank you.
Very truly yours,
FASANO L W OFFICE
Paula J. Eisenberg
Secretary to Lawrence W. Fasano, Jr.
/pJ e
Enclosures
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CLAIM
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BOA-RD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION. AUGUST 011 2006
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
California Government Codes. 1 you is your notice of the action taken
on your claim by the Board of
CLAIM AGAINST CCC SHERIFF' S DEPT. Supervisors. (Paragraph IV below),
R
ven Pursuant to Government Code
ANIOUNT: $100,000.0 0 ection 913 and 915.4. Please note all!UN 2 8 2006 J� ,Warnings".
CLAIMANT. VANES SA HARGIS
COUNTY COUNSEL
ATTORNEY:
PETER C. PAPPAS MARTINEZ CALIF.RECEIVED JUNE 28 , 2006 ,
DATE
LAW OFFICE OF PETER C. PAPPAS
ADDRESS: 2400 SYCAMORE DRIVE #403YDELIVERY-TO CLERK ON: JUNE 28 , 2006
ANTIOCH, CA 94509
BY MAIL POSTMARKED: HAND DELIVERED
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted clahn.
JUNE 28 � 2006 JOHN CULLEN,
Dated: By: Deputy
11. FROM: County Counsel TO: Clerk of the Board of S11111pervisors
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).
O 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)-
O Otlier:
Dated: By: Deputy County Counsel
f
111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2)
O Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present:
M' This Claim is rejected in full.
O Other..
I certify that this is a true and correct copy of the Board's Order entered in its minutes.for
this date.
Dated:Led c0,404OHN CULLEN, CLERK, By Z6�fz�� Deputy Clerk
WARM (Gov. code section 913)
Subject to certain exceptions,you have only six(6)niontlis from the date this notice was personaDy served
or deposited in the mail to rile a court action on this claim.See Government Code Section 945.6.You pray
seek the advice of an attorney of your choice in connection with this ntattei,. If you wort to consult an
attort
iey,yousliotdddosohiiiiiediately. *For Additional Warning See Reverse Side of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty of per jury that I am now, and at all times herein tueutioued, 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
Vottv d Or-der atod Notice to Claimmit, addressed to the claimant as showit above.
Date( IOHN CULLEN, CLERK BVZcr�-r� Deputy Clel
-k
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY ✓
INS IONS TO CLAIKANT
A. A claim relating to a cause of action for death or for injury to person or to personal property or
growing crops shall be presented not later than six months after the accrual of the cause of
action. A claim relating to any other cause of action shall be presented not later than one year
after the accrual of the cause of action.
(Gov. Code § 911.2.)
I
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106,
CountyAdministration 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. i
E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form.'
owes■■■rr■■r•■■■•r•■■■••■r■■■■rroff■r■•r■■ •r■rrrr■■■■Wrangel
RE: Claim By: Reserved for Clerk's filing stamp
I
VANESSA HARGIS j
} EIV D �
Against the County of Contra Costa mit and ) JUN '
) Zoos I.
Co Co Co Sheriff's DepartmentDistrict) Cl
Ex gcAF,o or SU€EvisoRs
(Fill in the name) ) co:NTra(1osTA co.
The undersigned claimant hereby snakes claim against the County of Contra Costa or the above-named
district inn the sum of S_ 100, 000. and in support of this claim represents as follows:
1. When did the damage-or injury occur? (Give exact date and hour)
January 27, 2006 @ 10: 56 p-.m.
2. Where did the damage or injury occur? (include city and county)
4529 Alder Drive, Oakley, CA 94561 (Contra Costa)
3. How did the damage or injury occur? (Give full details; use extra paper if required)
Police failed to adequately supervise the situation and during an
altercation K-9 intentionally bit individual multiple times.
4. What particular act or omission on the part of county or district officers, servants, or employees
caused the injury or damage? }
Failed to adequately protect; failed to properly supervise situation;
failed to control K-9, and allowed K-9 to intentionally btejattack.
5 What are the names of county or district officers,servants,or employees causing the
damage or injury?
Contra Costa County, Contra Costa County Sheriff's Department, city
of Oakley, Oakley Police Department, Officer I. Jones #53211 and
Sgt R. Jensen, #43894
i
.W
6, What damage or injuries do your claim resulted? (Give full extent of injuries or damages
claimed. Attach two estimates for auto damage.)
Three major lacerations to right hand near thumb and wrist, eight
puncture wounds to right thigh, scarring and deformity, surgery possi le.
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
stills discovering, surgery is possible
8. Names and addresses of witnesses,doctors, and hospitals:
L. Enrique, 3701 Lone Tree Way, ANtioch, CA; Sutter Delta Medical
3701 Lone Tree Way, Antioch, CA, and General Vascular-.' Surgery, Ant/
9. List the expendittres you made on account of this accident or injury: 9`0 n c
DATE TNM--- A
_MGIJNT
1 /27/06 to present- ' still discovering
$ 8,000.00 estimated
@was*pwasys
) Gov. Code Sec, 910.2 provides"The claim shall be
)signed by the claimant or by some person on his
behalf"
SEND NonCES TO: (Attomev)
Name and address of Attorney
LAW OFFICE OF PETER C. PAP
2400 Sycamore Dr #40 111 4�?aiy�narit's Signature)
Antich, CA 94509 - 2400 Sycamore Drive, Suite 40
e-mail (Address)
kcsheldon@sbcg.lobal.net, Antioch, CA 94509
Telephone No. ( 925) 7540772-)Telephone No, ( 925) 754-7183 facsimile
too we a"a*1010"1 ago Masao gave pow **go#so **Poo rosse.641
PUBLIC RECORDS NOTICE:
Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act, is subject to
public disclosure under the California Public Records Act (Gov. Code, §§ 6500 et seq.) Furthermore, any
attachments, addendums, or supplements attached to the claim form, including medical records,an also subject to
public disclosure,
0 soft oto a losses 5111061529000*..'tow*so"101010 off too$Iroes sessevores 48960404109 0 9 010641241 off Sao
NOTICE:
Section 72 of the Penal Code provides:
Every person who, with intent to defraud,presents for allowance or for payment to any state board or officer, or
to any county, city, or district board or officer, authorized to allow or pay the same if genuine, any false or
fraudulent claim, bill, account voucher, or writing, is punishable either by imprisonment in the County jail for a
period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000.00), or by both such
imprisonment and fine, or by imprisonment In the state prison, by a fine of not exceeding ten thousand dollars
(S 10,000),or by both such imprisonment and fine.
®Face PSge CONTRA COST NTY SHERIFF'S DEPARTMENT CA0070000 • Beat 51
Confi❑Supp/uatier. O.Box 391,Martinez,California 94553-0039 '-
L]Supplen.inral ❑D.V. ❑HRO ®Arrest ❑si
1.OR No: 2.City Code 3.Crime/Classification 4 Detail 1.243B S.More
08-24'11 Oak/57 Battery on Peace Officer-Misd.(243B') 2 148 Persons
6.Day/Date/Time of Occurrence 7.Date/Time Reported 8.Employee No.
Friday 012706 2256 012706 /2256 43894 9.Reclassi.
10.Address/Location of Occurrence (cation
4529 Alder Drive,Oakley ❑
11. 'PRI LJ VIC WIT LJ MSP RUN EJ SUS LEAD 0 OTHER
12.Name(L,F.M) 13.Race I Sex/Age 14.DOB 15.Drlver License No.
Anonymous/Refused
16.Address(Zip Code)
17.Home Phone
18.Employee 2y nr School 19.Work Phone
20.Hair 21.Eyes' 22.Ht 23.Wt. 24.AKA/Maiden Name - - 25.Social Security No.
26.Further Description(Scars.Tattoos,Mannerisms,Clothing,Etc.) - 27.Booking or Cite No.
28. U PRI N VIC Lj Vv1T U MSP Lj RUN SUS L Lj OTHER
29.Name(L,F,M) - 29.Race I Sex I Age 30.DOB 31.Driver License No.
Sprgeant.R.Jensen#43894 /" /
32.Address(Zip Code) 33.Home Phone
34.Employed By or School 35.Work Phone
C.C.C.S.O./Oakley P.D. 625-6700
36.Hair 37.Eyes 38.Ht. 39.M. 40.AKA I Maiden Name 41.Social Security No.
42.Further Description(Scars,Tattoos,Mannerisms,Clothing.Etc.) 43.Booking or Cite No.
44. Lj PRI N VIC Lj WIT LJ MSP Lj RUNLJ SUS rj LEAD OTHER
45.Name(L,F,M) 46.Race/Sex/Age 47.DOB 48.Driver License No.
People of the State / /
49.Address(Zip Code) 50.Home Phone
51:Employed By or School - 52.Work Phone
53.Hair 54.Eyes 1 55.Ht 56.Wt. 57.AKA/Maiden Name 5&S ocial Security No.
59.Further Description(Scars.Tattoos,Mannerisms,Clothing,Etc.) 60.Booking or Cite No.
62.Veh/Ves 63.Lie No.(State) 64.Year 65.Make 66.Model 67.Body Style 68.Color Top Black
® s Cl Vict 7J87634 2004 GMC P/U Bottom
69:Status 170.Registered Owner 71.R.O.Address "
❑ Left Mitzy Mejia" 907 Wainfleet Ct.,Antioch
❑ Impound "72.Towed to or Released to 73.Who has Keys?
0 Stored Continental Tow Continental Tow
74.Evid 75.F/P 76.Dispo of Evidence 77.Missing 78.Damaged
O Yes • No O Yes • No None. N/A N/A
79.Brief Synopsis of Incident "
I responded to the report of a loud party. When I arrived I observed there was a loud party
at 4529 Alder Dr. While in the process of attempting to cite/tow an illegally parked
vehicle in front of the residence I encountered Gomez. Gomez claimed to be the driver of
the vehicle. Gomez refused to provide me with identification and he refused to move out of
my way so I could cite/tow the vehicle. Gomez was subsequently arrested per 148 P.C. Gomez
resisted attempts to arrest him and he was pepper sprayed as. a result. -While I was in the -
process of towing the illegally parked vehicle Gomez' girlfriend, Hargis, approached Oakley
P.D. officers at the scene including a K-9 officer. Hargis refused to comply with lawful
orders to move out of the roadway. While I attempted to move Hargis out of the raodway and
away from the K-9 officer Hargis pushed me and moved toward the K-9 officer. I pushed
Hargis to the ground as she moved toward the K-9 officer. Hargis was subsequently bit by
the K-9 who perceived her to be a threat to the K-9 officer.
80.Distribution "' 81.Additional Routing
C3 D [I DA ❑ DE C3 El C1 SIR ❑ V '
❑ Investigation ❑ Vice ❑ Narcotics ❑ Juv ❑Coroner 82.Reporting Deputy(Print) 83.Datefrime Written 84 Dispo
❑ Property Ck. ® ACS ❑ Intell. ❑ R.O. ❑ SHC R.Jensen 013006 0030 CLR
® Patrol Captain® Compl.Ofc. ❑ Marine Patrol❑ W Unit ❑ Other 85.Approving Supv(Print) 86.Supv No. 87.Date
R.Jensen 43894 013006 1 of 5
3611211/94
WFace Page CONTRA COST�WNTY SHERIFF'S DEPARTMENT CA0070000 • Beat 51
Continuation
❑supplemental P.O.Box 391,Martinez,California 94553-0039 ❑D.V. ❑HRO ®Arrest ❑sl
1.DR No: 2.City Code 3.CrimelClassfication 4.Detail 1.2438 S.More
06-2401 Oak/57 Battery on Peace Officer-Misd.(2438') 2. 148 Persons
6.Day/Date/Time of Occurrence 7.Date/Tune Reported 8.Employee No.
Friday 012706 2256 012706 / 43894 9.Reclassi-
fication
10.Address 1 Location of Occurrence ❑
4529 Alder Drive, Oakley
11. PRI LJ VIC Lj VAT LJ MSP Lj RUN N SUS Lj LEAD I OTHER
12.Name(L,F.M) 13.Race/Sex/Age 14.DOB 15.Driver License No.
Gomez, Michael Angelo W /M /19 041886 D4759923
16.Address(Zip Code) 17.Home Phone
559 Norcross Ave., Oakley 625-1095
18.Employed By or School 19.Work Phone
20.Hair 21.Eyes 22.HL 23.Wt. 24.AKA/Maiden Name _ 25.Social Security No.
BRO BRO 508 175 561-89-0376
26.Further Description(Scars,Tattoos,Mannerisms,Clothing,Etc.) _ 27.Booking or Cite No.
28, U PRI LJ VIC U VMT U MSP RUN M SUS LEAD Lj OTHER
29.Name(L,F,M) 29.Race I Sex/Age 30.DOB 31.Driver License No.
Hargis,Vanessa Marie W ! /20 .082085 D7654818
32.Address(Zip Code) 33.Home Phone
3130 South San Francisco Way,Antioch 727-7051
34.Employed By or School 35.Work Phone
36.Hair 37.Eyes 38.HL 39.WL 40.AKA/Maiden Name 41.Social Security No.
BRO BRO L502 110
42.Further Description(Scars.Tattoos,Mannerisms,Clothing,Etc.) - 43.Booking or Cite No.
44, Lj-PRI LJ VIC Lj Vv1T LJ MSP Lj RUN SUS' Lj LEAD Lj OTHER
45.Name(L,F.M) 46.Race/Sex/Age 47.DOB 48.Driver License No.
Kuryla,Jarod David W /M /20 062285 D4385764
49.Address(Zip Code) 50.Home Phone
4529 Alder Drive, Oakley
51:Employed By or School - - 52.Work Phone
53.Hair 54.Eyes 1 55.Ht. 56.WR. 57.AKA/Maiden Name 58.Social Security No.
BRO. BRO 508 150
59.Further Description(Scars,Tattoos,Mannerisms.Clothing,Etc.) 60.Booking or Cite No.
62.Veh/Ves 63.Lic No.(State) 64.Year 65.Make. 66.Model 67.Body Style 68.Color Top
❑ S❑ Vict Bottom
69.Status 70.Registered Owner 71.R.O.Address
❑ Left
13Impound 72.Towed to or Released to T3;Who has Keys?
C] Stored
74.Evid 75.F/P 76.Dispo of Evidence 77.Missing 78.Damaged
0 Yes O No O Yes 0 No
79,Brief Synopsis of Incident
Not used
80.Distribution 81.Additional Routing '
❑ B 0 C] DA El DE ❑ L C3 [1 SR El
❑ Investigation ❑ Vice ❑ Narcotics ❑ Juv ❑ Coroner 82.Reporting Deputy(Print) 83.Date/Time Written 84.Dispo
❑ PropertyCk. N ACS ❑ Intell. ❑ R.O. ❑ SHC R.Jensen 013006 0030 CLR
® Patrol Captain N Compl.Ofc. ❑ Marine Patrol❑ OV Unit ❑ Other 85.Approving Supv(Print) 86.Supv No. 87.Date
R.Jensen 43894 013006 2 of 5
3611211/94 ,
lZ Continuaion CONTRA COSTA NTY SHERIFF'S DEPARTMENT CA0070000 •
Beat 51
P.O.Box 391,Martinez,CA 94553-0039
❑ Supplemental .
❑D.V. ❑ HRO ®Arrest ❑SI
1.DR No. 2.City Code 3.Crime]Classification 4.Detail 1. 243B 5:Reclassi
06-.2401 Oak/57 Battery on Peace Officer-Misd,(24313'). 2. 148 fication
TT'Ew7nMme 1.Date Ung.Report B.Employee No. ❑
Sergeant R.Jensen#43894 012706 43894
77 ress I Location ol umurrence 10.Suspect's Name(L,F,M)
4529 Alder Drive, Oakley Gomez, Michael Angelo
11.Property Description:
Impounded,Recovered,Found,Lost,Stolen-Item Number,Article,Quantity.Brand/Make/Manufacturefs Model Number,Serial Number,Miscellaneous Description,Location Where Taken,Value,Include
Total Loss-LIST IN FOLLOWING ORDER:A)CurrenW.,Notes:B Jewelry:C Furs;D)Vehicles:E)Office Equipment:F)Radio.TVs etc.:G Firearms;H)Household Goods:l)Misc.
12.Recovered Property 13.Narrative/Statements
On 012706 at approximately 2302 hours I was detailed to the report of a very very loud
party at a residence near the intersection of Alder Dr/W Cypress Road. The pr was anonymous
and refused to disclose a phone number for contact. The caller did add that this is an on
going problem. When I arrived in the area I saw approximately 20 young adults/teens
standing in the front yard of 4529 Alder Dr. I have responded to this residence several
times in the recent past on the report of similar incidents. As I drove up to the front of
the residence I could here loud music coming from the residence (the front door was
.standing open, I was at least 100 feet away from the residence when I first heard the
music) and the subjects I saw in the front yard were starting to go into the house. By the
time I got out of my patrol vehicle the subjects that had been in the front yard had gone
into the house and the front door of the residence was closed. I saw that there was at
least one illegally parked vehicle in front of the residence. A black GMC truck license #
7J87634 was parked blocking the sidewalk and the driveway of the residence (the front tires
were in the driveway, the rear tires were on the street) .
I walked up to the front door of the residence and could still hear loud music inside. I
could also hear numerous voices in the residence as if there was a large gathering inside.
I knocked on the front door of the residence in an attempt to contact the resident. When I
knocked on the front door I announced I was the police. After I knocked on the door the
music quieted and the large group also quieted down, however no one answered the front
door. I knocked several times without a response.
I then walked toward. where I saw the truck was illegally parked. It was my intent at this
time to cite and tow the vehicle. I saw there was a subject later identified as Gomez
standing next to the drivers side door of the vehicle. I told Gomez to get away from the
truck. Gomez asked me why he had to get away from the truck. I told him I was going to tow
it. Gomez told me he was going to move the truck. I asked Gomez if he owned the truck and
he told me he was driving the truck but it was not his. As I spoke with Gomez I saw he had
a set of keys in his hand (I later determined these keys did in fact belong to the
truck) . I then asked Gomez to show me some identification. Gomez told me that he did not
have to show me -his identification. In fact Gomez. insisted he knew his rights and told me
he knew he didn't need to show me any identification. I then told Gomez to get away from
the truck and he just laughed and told me he didn't have to get away from the truck because
he was going to move it.
About this time I saw a few subjects_ come out of the residence and walk up to where I was
talking to Gomez. For my safety I told the subjects to move away from me and I called for
an assist officer. I then told Gomez again to show me some identification and he refused. I
told Gomez to move away from the truck and he refused. I made several requests for Gomez to
show me identification and move out of the way and each time he told me he knew his rights
and didn't have to do either. It was apparent to me that this incident was going to
escalate so I called for a code three cover officer.
As Officer Jones drgveh front f the residence I told Gomez he was under arrest
14.Distribution 15.AddRional Routing
❑ B ❑ C ❑ DA ❑ DE ❑ L ❑ O ❑SR [IV
❑ Investigation ❑Vice ❑ Narcotics ❑an, ❑Coroner '
❑ Property Ck. ®ACS ❑Intell. ❑R.O. ❑SHC 16,Reporting Deputy(Print) 17. ter imentten 18.Dispo
R.Jensen 013006 0030 1CLR
®Patrol Captain
❑ Other ®Compl.Ofc. ❑ Marine Patrol ❑ DV Unit 1 Approving upv(Print) upv o. 1. ate age
R.Jensen 43894 013006 3 of 5
36112 11194
A COSTA•NTY SHERIFF'S DEPARTMENT CA0070000
® Co-tinuadon CONTRA Boat 51
P.O.Box 391,M::rtinez CA 94553-0039
❑ Supplemental _ ❑D.V. ❑ HRO ®Arrest ❑SI
1.OR No. 2.City Code 3.Gime/Classification - 4.Detail 1. 2438 S.Reclassi
06-2401 Oak/57 Battery on Peace Officer-Misd.(24313') 2. 148 fication
6.Victim Name 7.Date Ong.Report 8.Employee No. ❑
Sergeant R.Jensen#43894 012706 43894
9. ares/ ocatan o ccurrence 10.Suspect's Name(L.F,M)
4529 Alder Drive, Oakley Gomez, Michael Angelo
11.Property Description:
Impounded,Recovered,Found,Lost,Stolen-Item Number,Article,Quantity.Brand/Make/Manubcturefs Model Number,Serial Number,Miscellaneous Description,Location Where Taken,Value,Include
Total Loss-LIST IN FOLLOWING ORDER:A Curren Notes:B)Jewelry:C)Furs;D)Vehicles;E)Office Equipment;F)Rada,TVs etc.:G Firearms;M Household Goods;I Misc.
12.Recovered Property$ 13.Narrative/Statements ..
and to turn around and put his hands behind his back. Gomez refused to Comply with my
orders. I told Gomez three more times he was under arrest and to put his hands behind his
back and he refused to comply. As Officer Jones walked toward my location I grabbed Gomez
by the upper torso and attempted to pull him to the ground. At the same time I told Gomez
to put his hands behind his back. Gomez resisted my attempt to take him to the ground, and
refused to put his hands behind his back, so I stood him up and pinned him with my upper
torso against the truck. At this time I drew my pepper spray and deployed short bursts of
pepper spray to Gomez face. I then forced Gomez to the ground and told him to put his hands
behind his back. It was only at this time did Gomez comply. Myself and Officer Hutchison,
who arrived at the scene to assist, secured Gomez in a patrol vehicle without further
incident.
I then called for a tow truck to tow the truck that was illegally parked. As we were
waiting for a tow Officer Jones had his K-9 partner Bessi out of the car to assist in scene
security (There were still a large group of people in the residence) . while I was in my
patrol vehicle completing tow paperwork I heard Officer Jones telling a female, who was
later identified as Hargis, to move away. I looked up to see Hargis standing in the street
between two cars parked in front of 4529 Alder Dr. Hargis was standing only a few feet from
where I was seated :in my vehicle.
I then got out of my car and stepped between Hargis and Officer Jones. I told Hargis she
needed to move back toward the sidewalk and used my body to direct her toward the sidewalk.
At this time Hargis told me she didn't have to move out of the way and put her open hands
on my upper torso and used them to push away from me. At the same time she moved back
toward the street and Officer Jones. I turned around and grabbed on to her and at the same
time pushed her down. Hargis fell toward Officer Jones and was subsequently bit by his K-9
partner Bessi, who apparently perceived Hargis to be a threat to Officer Jones - see
Officer Jones report. Hargis was then taken into custody without further incident.
An ambulance responded to the scene to treat Hargis for the dog bite and treat Gomez for
the pepper spray exposure. Ultimately AMR transported Hargis to Sutter Delta Hospital for
treatment of the dog bites prior to being booked at the M.D.F. Officer Hutchison
transported Gomez to County Hospital prior to being booked at the M.D.F.
Additional information:
1) I towed the GMC truck per 22651(H) and (B) C.V.C. - see my tow form.
2)The person in control of the residence, Kuryla, was cited .per 4.2.010 Oakley Muni Code
regaring the noise complaint.
3) I left a parking cite in the black GMC P/U that I towed for violating 2250OF C.V.C.
4 A wallet I n in Gomez was unintQntionallv left he scene andwas not
14.DistributionC1 ❑ DE El L C1 O [1 SR [IV
15.Additional Routing
C] 8 C] C DA
❑ Investigation ❑Vice ❑ Narcotics ❑ Juv ❑Coroner
❑ til ACS 0 Intell. ❑R.O. [3 SHC 1 Reporting Deputy(Print) to ane Written 1 ispo
Property Ck,
R.Jensen 013006 0030 CLR
®Patrol Captain
E] Other ®Compl.Ofc. ❑ Marine Patrol C3 IN Unit 1 Approving upv(Print) upv o. 1. ate age ,
R.Jensen 143894 1013006 4 0, 5
36112 11/94 !
® Continuation CONTRA COSTA COUNTY SHERIFF'S DEPART MENT,CA0070000 •.
Beat 51 '
Supplemental P.O.Box 391,Martinez,CA 945.53-0039 — ... ......
❑
❑D.V. ❑HRO ®Arrest [_]SI
1.DR No. 2.City Code 3.Crime I Classification 4.Detail 1. 2438 S.Reclassi
06-2401 Oak/57.. Battery on Peace Officer-Misd-.(2436') .. 2. 148 (cation
o.Vcurn Name 7.Date Ong.Report - 8.Employee No. ❑
Sergeant R.Jensen#43894 012706 4389.4
. caress I Location ot uccurrence 10.Suspects Name(L.F,M)
4529 Alder Drive,Oakley Gomez, Michael Angelo
11.Property Description:
Impounded,Recovered.Found,Lost,Stolen-Item Number,Article,Quantity Brand/Make/Manufacturefs Model Number,Serial Number,Miscellaneous Description,Location Where Taken.Value,Include
Total Loss-LIST IN FOLLOWING ORDER:A)Currency,Notes:B)Jewelry'.C)Furs;D)Vehicles;E Office Equipment:F)Radio,TVs etc.:G)Firearms;H)Household Goods;1)Misc.
12.Recovered Property$ 13.Narrative/Statements
transported to the M.D.F. with Gomez. I secured the wallet and placed it into
safekeeping at Oakley P.D. The white/black wallet contained $4, Gomez' C.D.L. , a Wells
Fargo Gold Check Card, a Shell gas card with Jeanette Gomez' name on it, a kaiser medical
card, a 2004 International Union of Petroleum and Industrial workers membership card, a bay
Area Training Corporation,card, several other misc cards.
5) Several items belonging to Hargis were placed into safekeeping as well. The items
include, a large black purse, a black blouse, misc cosmetic items, a Sprint cell phone, a
samsung cell phone, a shoe, birth control pills, $14.16,, a gold wallet, a student I.D.
card, a Bank of the West MC Debit card, (4) gift cards, misc photos and papers.
6) While searching Hargis' purse I found a C.D.L. belonging to Lori Martin with a D.O.B.
of 051182 (C.D.L. #D300383) . I placed this C.D.L. into evidence at Oakley P.D. and will
attempt to contact Martin to determine why Hargis has her C.D.L.
Gomez was booked at the M.D.F. per 148 P.C. Hargis was booked at the M.D.F. per 243 (B) and
148 P.C.
Report referred to the D.A. for further action.
14.Distribution 15.Additional Routing
❑ B ❑ C C1 DA El DE El ❑ O ❑SR ❑V
❑ Investigation ❑Vice ❑ Narcotics ❑Juv ❑ coroner
❑ PropertyCk. ®ACS ❑Intell. ❑R.O. ❑ SHC 16.ReportinglMputy( rmt) tel ime Written 18.Dispo
R.Jensen 013006 0030 CLR
®Patrol Captain
®Compl.OFc. El Marine Patrol ❑ DV Unit 19.Approving Supv(Print) upvo. 1. ate ge
E] Other R.Jensen 43894 013006 5
or 5- i
36112 11/94
❑ continuation CONTRA COSTA COUNTY SHERIFF'S DEPARTMENT CA0070000 Seat 51
P.O.Box 391,Martinez,CA 94553-0039
® Supplemental D.V. ❑ HRO ®Arrest ❑SI
1.OR No. 2.City Code 3.Crime/Classification 4.Detail 1. 2438 S.Reclassi
0672401 OAK/57 Battery.on Peace Officer-Misd._(243.6') . .2. 148 nation
ictim Name 7.Date Ong.Report 8.Employee No. ❑
People of the State 01-27-2006 53211
9.Address Location ol Uccurrence 10.Suspect's Name(L,F,M)
4529 Alder Dr./Oakley Hargis,Vanessa Marie
11.Property Description:
Impounded,Recovered,Found,Lost,Stolen-Item Number,Article,Ouantity,Brand/Make/Manufacturefs Model Number,Serial Number,Miscellaneous Description,Location Where Taken,Value,Include
Total Loss-LIST IN FOLLOWING ORDER:A)CurrenW.Notes:B)Jewelry:C Furs;D)Vehicles;E Office Equipment; Radio,TVs etc.:G Firearms;H)Household Goods;l)Misc.
12.Recovered Property$ 13.Narrative/Statements
On 01-27-2006 I was working uniformed patrol in my marked OAKPD canine patrol car. At
about 2308 hours OAKPD Sgt. R. Jensen requested a cover unit to his location, where he was
investigating a report of a loud party.
Responding from the intersection of Deer park and Walnut Meadows Dr. I began driving Sgt.
Jensen's location. At about 2310 hours I heard Sgt. Jensen request a code 3 cover unit. I
was approximately 1 block away and arrived within seconds of his code 3 request.
I stopped my patrol car in front of 4529 Alder Dr. My overhead emergency lights were
activated and working properly. I got out of my patrol car with K9 Bessi on a 6 foot lead
and ran toward Sgt. Jensen and a WMA, later identified as GOMEZ.
GOMEZ was standing in front of Sgt. Jensen and shouting, I did not hear what GOMEZ was
saying. When I was about 4 feet away from Sgt. Jensen, I heard him giving verbal orders to
GOMEZ to turn around and stop resisting.
I heard GOMEZ tell Sgt. Jensen he did not have to do anything. GOMEZ' was now standing in
an aggressive manner with his fists closed. GOMEZ began to physically resist Sgt. Jensens
attempt to handcuff him. Sgt. Jensen sprayed GOMEZ with pepper spray after giving him
several warnings to comply or be peppered sprayed. Sgt. Jensen took GOMEZ to the ground
and handcuffed him without further incident.
GOMEZ was placed into the rear seat of OAKPD officer Hutchison's patrol car. I began to
walk K9 Bessi back to my patrol car when I heard several subjects yelling. I looked in the
direction of the yelling and saw several subjects walking out of 4529 Alder Dr.
I saw a WFA (Later identified as HARGIS)walking towards Officer Hutchison's patrol car
from the residence where the party was being held. I made eye contact with HARGIS and
identified myself as a K9 officer with OAKPD and told her to stay on the front yard and not
to come into the street.
HARGIS looked at me a shouted, "I don't have to listen to you", "I'm trying to stop a
fight" . I told HARGIS that no one was fighting and told her again to stay on the front
lawn.
HARGIS began walking directly towards me. I began to-take up the slack on the 6 foot lead
and had about 3 feet taken in as I again told HARGIS to stop because I did not want her to
get bit.
K9 Bessi was now barking at HARGIS. Sgt. Jensen walked up to HARGIS and placed himself
between her and I. I heard Sgt. Jensen verbally order HARGIS to step back and let us
continue our investigation.
I heard HARGIS v "I don't have listen to v " . I then saw HARGIS l w hands n
14.Distribution 15.Additional Routing
❑ B ❑ C ❑ DA ❑ DE ❑ L 11 ❑SR El _ -
❑ Investigation ❑Vice ❑ Narcotics ❑Juv ❑Coroner '
❑ PropertyCk. ❑ACS ❑Intell. ❑R.O. ❑SHC 16.Reporting Deputy((Print) 1 tel ime Written 18.Dispo
I.Jones 1/28/2006- 1952 CLR
El Patrol Captain
E] Other ®Compl.Ofc. ❑ Marine Patrol ❑ OV Unit 1 Approving upv(Print) upv o. 1. ate Page
R.Jensen' 143894 012906 1 or 3
3611211/94
® Continuation CONTRACOSTOUNTY SHERIFF'S DEPARTMENT CA0070000
Beat 51
P.O.Box 391,Martinez,CA 94553-0039 .... .. .
® Supplemental ❑D.V. ❑ HRO ®Arrest ❑SI
1.DR No. 2 City Code 3.Crime/Classification 4.Detail1. 243B 5.Reclassi
06-2401 OAK/57 Battery on Peace Officer-Misd.(24W) , 2. 148 nation
im me 7.Date Ong.Report, 8.Employee No. ❑
People,of the State 01-27-2006 53211
9.Address i Location ol Uccurrence 10.Suspects Name(L,F,M)
4529 Alder Dr./Oakley Hargis,Vanessa Marie
11.Property Description:
Impounded,Recovered,Found,Lost,Stolen•Item Number,Article,Quantity Brand/Make/Manufacturees Model Number.Serial Number,Miscellaneous Description,Location Where Taken,Value.Include
Total Loss.LIST IN FOLLOWING ORDER:A)Currency,Notes:B)Jewelry:C Furs;D)Vehicles;E)Once Equipment:F)Radio,Ns etc.:G.Firearms;H.Household Goods;t Misc. .
12.Recovered Property$ 13.Narrative/Statements
Sgt. Jensens chest and push him. After pushing Sgt. Jensen, HARGIS stepped off the
Sidewalk, and quickly moved straight ahead, between two vehicles and directly into me and
K9 Bessi. -
K9 Bessi as trained, interpreted this act, as an act of aggression towards me and went
into handler protection. K9 Bessi engaged HARGIS biting her on her right hand. I saw
HARGIS pull away from Bessi's bite, releasing her hand.
K9 Bessi re-engaged HARGIS biting her in the upper right thigh. HARGIS then began to grab
Bessi's snout. I gave HARGIS several commands to stand still and stop grabbing Bessi.
After about 10 seconds, HARGIS stopped grabbing Bessi's snout and I gave Bessi the command
to release HARGIS, which she did.
I requested a code 2 ambulance to give HARGIS medical treatment for her injuries. Sgt.
Jensen handcuffed HARGIS. HARGIS was seen by AMR and transported to Sutter Delta Hospital
in the city of Antioch.
I followed the ambulance to the hospital and recontacted HARGIS who was now in the
emergency room being given additional medical treatment for her injuries. I admonished
HARGIS her Miranda rights by reading them from my department issued Miranda card. I asked
HARGIS if she understood each of her rights, she said, "I do" . I asked her if she wished to
speak to me know, she said, "I'm not a criminal, I'm a good person" .
I again asked HARGIS if she wanted to talk to me about what had happened earlier. She
said, "Yes, I'll talk" . I asked HARGIS how old she was and she she 20. I asked her to
tell me how long she had been at the party.
HARGIS stated she arrived at the party with GOMEZ (Her boyfriend)and she believe that they
were there at the party for about an hour or two. I asked HARGIS if she had anything to
drink at the party.
HARGIS told me she had drank several beers, possibly 3-4 and some vodka. During my
interview with HARGIS I did not smell the odor of an alcoholic beverage, but her speech was
slightly slurred.
I asked HARGIS if she felt the- effects of the alcohol she had consumed earlier, she said
yes. I asked HARGIS if she heard me tell her to stay on the front lawn and not come out
into the street, because I have a K9 and did not want her to get bit.
HARGIS told me she did hear me tell her to stay on the front lawn, but all she wanted to
do was stop a fight. HARGIS stated that she is against fighting of any kind and when she
gets her mind set on something, like stopping a fight no one can stop her.
I asked HARGIS if she heard me--tell her that therewas no fight n v on the front
14.Distribution 15.Additional Routing
❑ B ❑ C ❑ DA ❑ DE ❑L ❑ O ❑SR ❑V
❑ investigation ❑Vice ❑ Narcotics ❑ Juv ❑Coroner -
❑ Property Ck. ❑ ACS ❑Intell. ❑R.O. ❑SHC 1 epor"ng pury(Print) 17.Date/Time Written Ia.Dispo
I.Jones 1/28/2006- 1952 CLR
❑ Patrol Captain
❑ Other ®Compl.Ofc. El Marine Patrol ❑ DV Unit 19.Approving upv nnt) 20.Supv No. 1.Date22age
R.Jensen 143894 012906 2 of-3 .
3611211/94
® continuation CONTRA COSTA COUNTY SHERIFF'S DEPARTMENT CA0070000 Beat 51
P.O.Box 391,Martinez,CA 94553-0039 - "'. . _.
® Supplemental 1 11D.V. ❑ HRO ®Arrest ❑SI
1.DR No. 2.City Code 3.Crime I Classification 4.Detail- 1. 2438 5.Reclassi
0672401. OAK/57 Battery.on Peace Officer.-Misd.(24313') 2. 148 fication
6.Victim Name 7.Date Ong.Report 8.Employee No. ❑
People of the State 01-27-2006 53211
9.AddressLocation of Liccurrence 10.Suspect's Name(L,F,M)
4529 Alder Dr./Oakley Hargis,Vanessa Marie
11.Property Description:
Impounded,Recovered,Found,Lost,Stolen-Item Number,Article,Quantity Brand/Make/Manufacturefs Model Number,Serial Number,Miscellaneous Description,Location Where Taken,Value,Include
Total Loss-LIST IN FOLLOWING ORDER:A Curre .Notes:B)Jewelry;C)Furs;D)Vehicles;E)Office Equipment:F)Radio,TVs etc.:G)Firearms;H Household Goods;l)Misc.
12.Recovered Property$ _11 3.Narrative/Statements .
lawn. HARGIS said she did hear me say that, but again she had her mind set that she wanted
to see her boyfriend (GOMEZ)who was in the back seat of officer Hutchison's patrol car.
I asked HARGIS if she remembered pushing Sgt. Jensen. HARGIS said she did not remember
touching Sgt. Jensen and apologized to me if she had. I asked HARGIS if she believes the
alcohol that she consumed at the party at 4529 Alder Dr. had impaired her judgment at all
during this incident. HARGIS stated, "I know it did, I'm a good person and have never been
in trouble before" .
HARGIS sustained a 2 1/2" laceration to her right palm, 1/2" laceration to her right hand
near thumb and four puncture wounds to her right upper thigh. -I took 6 .digital photos of
HARGIS and her injuries.
OAKPD officer R. Canady relieved me at the hospital and took HARGIS into his custody. I
downloaded the digital photos into the 2006 report photos file.
EVIDENCE:
1. (61 DIGITAL PHOTOS - DOWNLOADED INTO 2006 REPORT PHOTOS FOLDER.
14❑D Distribution❑ c ❑ DA ❑ DE ❑L ❑ O ❑SR ❑V 15.Additional Routing
i Investigation ❑Vice ❑ Narcotics ❑Jw ❑coroner
❑ Property Ck. ❑ACS ❑Intell. ❑R.O. ❑SHC 16.Reporting Deputy(Print) 17.Date/Time Written 18.Dispo
I.Jones . 1/28/2006- 1952 CLR .
❑ Patrol Captain
® Compl.Ofe. ❑ Marine Patrol ❑ DV Unit 1 Approving upv(Print) upv o. ate age
3
❑ Other R.Jensen 43894 012906 3' of
3611211/94
CLAIM � fI
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION:
Claim Against the County, or District Governed by )
the Board of Supervisors, RoL g I NOTICE TO CLAIMANT
and Board Action. All Section T ev�m The copy of this document mailed to
California Government Codea s. JUN 2 8 2006 you is your notice of the action taken
on your claim by the Board of
COUNTY COUNSEL Supervisors. (Paragraph IV below),
MARTINEZ CALIF. given Pursuant to Government Code
ANIOUNT: �t e?Lutimo Section 913 and 915.4. Please note all
"Warnings",
CLAINIANT: Wo-,�
ATTORNEY: DATE RECEIVED-
ADDRESS: P, b, 00x - .BY DELIVERY TO CLERK ON:
9,ir/,C-Z ABY MAIL POSTMARKED:
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN CULLEN,
Dated: By: Deputy—M�
County Counsel Clerk of the Board of Supervisors
11. FROM: TO.
T'his claim complies substantially with Sections 910 and 910.2.
(w)-Ifhis Claim FAILS to comply substantially with Sections 910 and 910,2, and we are so
notifying claimant: "flee 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).
Otlier.
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).
JV BOARD ORDER: By unanimous vote of the Supervisors present:
This Claim is rejected in full.
O Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date.
o?,0-44HN CULLEN, CLERK, B y Deputy Clerk
Dated
VV—ARNIN (Gov. code section 913) V
Subject to certabi exceptions,you have ouly six(6)months from the date this notice was personally served
or deposited ill the mail to rile a court action oil 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 humediately. *For Additional Warning See Reverse Side of This Notice.
AFFIDAVIT OF MAILING
I declare uutler penalty of pet jui-y that I all] 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 Uuited
States .Postal Service in Alartinez, California, postage full.), prepaid a certified copy of this
Board Om-deraml Notice to Clainvatit, addressed to the claimmit as shown above.
D,iledjIa, Z#-a-6r JOHN CULLEN, CLERK By Deputy Clerk
OFFICE OF THE COUNTY COUNSEL SILVANO B. MARCHESI
COUNTY OF CONTRA COSTA d+ � ''_�e�+ COUNTY COUNSEL
Administration Building ,,:
651 Pine Street, 91" Floor —`,Q SHARON L. ANDERSON
Martinez, California 94553-1229 Q' _ CHIEF ASSISTANT
a _ w
(925) 335-1800 �1 'V. '` u;a t111���: =- GREGORY C. HARVEY
(925) 646-1078 (fax) ®;-_' ' VALERIE J. RANCHE
'. _ ASSISTANTS
NOTICE OF INSUFFICIENCY
AND/OR
NON-ACCEPTANCE OF CLAIM
TO: Walter Laniel
P.O. Box 642
Danville, CA 94526
RE: CLAIM OF WALTER LANIEL
Please Take Notice as Follows:
The claim you presented against the County of Contra Costa or District governed by the Board of
Supervisors fails to comply substantially with the requirements of California Government Code Section
910 and 910.2, or is otherwise insufficient for the reasons checked below:
[ ]
I. The claim fails to state the name and post office address of the claimant.
[ ] 2. The claim fails to state the post office address to which the person presenting the claim desires
notices to be sent.
[X] 3. The claim fails to state the date, place or other circumstances of the occurrence or transaction
which gave rise to the claim asserted.
[ ] 4. The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or
loss, if known.
[ ] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000).
If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount
claimed as of the date of presentation, the estimated amount of any prospective injury, damage
or loss so far as known, or the basis of computation of the amount claimed.
[ ] 6. The claim is not signed by the claimant or by some person on his or her behalf.
[ ] 7. You are required to submit your claim on the proper form, which is enclosed. Please resubmit
your claim on the enclosed form, including all the required information. Gov. Code, § 910.4.
Please be aware that you have only a limited period of time in which to file an amended claim.
See Gov. Code, § 910.6.
Walter Laniel
Re: Claim of Walter Laniel
Page Two
8. Other:
SILVANO B. MARCHESI
COUNTY COUNSEL
By:
Monika L. Cooper
Deputy County Counsel
CERTIFICATE OF SERVICE BY MAIL
(Code Civ. Proc., §§ 1012, 1013a, 2015.5; Evid. Code, §§ 641, 664)
I am a resident of the State of California, over the age of eighteen years, and not a party to the within action. My
Z
iness address is Office of the County Counsel, 651 Pine Street, 9th Floor, Martinez, CA 94553-1229. Oil
,! '7; ?-0& -Acceptance of Claim by
I served a true copy of this Notice of Insufficiency and/or Non
(pl.dcQ the document in a sealed envelope with postage thereon fully prepaid, in the United States mail at
Martinez, California.addressed to Walter Laniel, P.O. Box 642, Danville, CA 94526, as set forth above. I am
readily familiar with Office of County Counsel's practice of collection and processing of correspondence for
mailing. Under that practice, it would be deposited with the U.S. Postal Service on that same day with postage
thereon fully prepaid in the ordinary course of business.
I declare under penalty of perjury under the s of the State of California and the United States of America that
the above is true and correct. Executed on at Martinez, California.
Kathleen O'Connell
cc: Clerk of the Board of Supervisors (original)
Risk Management
/*
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. A claim relating to a cause of action for death or for injury to person or to personal property or
growing crops shall be presented not later than six months after the accrual of the cause of
action. A claim relating to any other cause of action shall be presented not later than one year
after the accrual of the cause of action.
(Gov. 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.
son......................Emmons..:...:.................monsoon............... .l
RE: Claim By: Reserved for Clerk's filing stamp
)
RECEIVED
Against the County of Contra Costa or ) JUN 2 8 2006
District) . CLERK BOA RDOFSUPERUISORS
(�l in the n�,mef ) 6 � ) CONTRA COSTA CO.
The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named
district in the sum of$ f fi -n and in support of this claim represents as follows:
&A,1 I1dn DO I0-v-6 Z 29—P-6
1. When did the damage or injury occur? (Give exact date and hour)
2. Where did the damage or injury occur? (Include city and county)
Aki,�o e-A.; �l � CA
3. ow did the damage or injury occur? (Give full details; use extra paper if required)
.l J M gid" DOA t h (3--eA� -t) Gam- t hc� �
4. What particular act or omission on the part of county or district officers, servants,,or employees
caused the injury or damage? ,d,f-k' ?t', �j -rove. LAp
mo-rioccW 3P
,4S j�
5 What are the names of county or district officers, servants, or employees causing the , ) f
damage or inJ m Y? 2HJ-� r!`^ 0""; � 1JJI t C 1✓v (fCY'� L�O����,,n�
DOh �reS�N` J4 �; �10� AC - lir,sqZ
A �la,be � o 0cm 4
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6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages
claimed. Attach two estimates for auto damage.) Lt � Cj� h Y-- 02... (gD-4
0"C' `aI1c0, 5,e ,,Ito, jo)�
7. How was the amount claimed above computed? (Include the estimated a ount, any
prospective injury or damages) � / , ` /�' 5 �t of
8. Names and addresses of witnesses, doctors, and hospitals:
9. List the expenditures you made on account of this accident or injury:
DATE TIME AMOUNT
WI// Pic C^C'
.....................................................■.............................■1
Gov. Code Sec. 910.2 provides "The claim shall be
signed by the claimant or by some person on his
behalf."
SEND NOTICES TO: (Attorney)____) j
Name and address of Attorney )
(Claimant's Signature)
(Address)
Telephone No. ) Telephone No.riZ7)
PUBLIC RECORDS NOTICE:
Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act, is subject to
public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthermore, any
attachments, addendums, or supplements attached to the claim form,.including medical records, are also subject to
public disclosure.
....................................................................................1
NOTICE:
Section 72 of the Penal Code provides:
Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or
to any county, city, or district board or officer, authorized to allow or pay the same if genuine, any false or
fraudulent claim, bill, account voucher, or writing, is punishable either by imprisonment in the County jail for a
period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000.00), or by both such
imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars
($10,000), or by both such imprisonment and fine.
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'CLERK OF T7'
J L•A-`t D O Jt, Iw;' S /6 L ViVT
Room 10
COUP;T Y ADMII'�.. 1L7G.:
651 PI TE STREET, MARTIT1 12, CA
94553
WALTER LANIEL
P..O. 64.2
DANV'ILLE, CA 94526
GREETINGS TO OUR COVETED BOARD OF .SUPERVISORS,
IT IS MY :r'LEA5URE TO BE ADDRESSING SUCCI AND DISTINGUISHED
GROUPOF PUBLIC SERV.A.NTS.
I MAS CURIOUS TO KNU EXACTLY WHAT THAT IT IS THAT Y','�UR
BOARD SU T ERVI SE,S?
THE TAY SCALE MUST BE LUCRATIVE TO RETAIN SUCH A 'TALENTED GROUP.
SHOULDNT THE TAX PAYERS ''F CONTRA COSTA COUNTY BE UPON THEIR
KNEES EACH AND EVERY MORNING THANKING THE CREATOR FOR SUCH
WONDERFUL, EMPLOYEES OF THIS C AUNTY?
OR POSSIBLY ANY AND ALL PRAYERS OF THE LOWLY `dORKING CLASS
OF THIS COUNTY GOES DIRECTLY TO THE BOARD ':`F SUPERVTSOR'S.
0' MIGHTY BOARD ',F SUPERVISORS .Hi 7E MERCY', UPON US THE SinFuL
AND WRETCHED TAX PAYERS..
DOES THE BOARD OF SUPERVISORS SUPERVISE RUPF, WARREN, E. ,
WHILE RUPF RUNS Ai�!UCH THROUGHOUT THE COUNTY BLACK TKAILING
AND EXTORTING THE INCCMES OF AKERICA THR^UGH THE KIDNAPPING,
OF THE SONS AND DAUGHTERS OF THE, TAX PAYERS?
TO 'THE FINANCIAL ILLICIT GAINS OF WALNUT CREEK AND THE COUNTY
EMPLOYEES?
DOES THE BAORD SUPERVISE THE SELF CONFESSED COMMUNIST'
EMPLOYEES OF i-iAR PENS, i4HILE TH Y BREAK AND ENTER ,AlgD ROB
AMERICA BLIND?
r
A
THE KRIMLIN AND EVERY T7 RRORIST NATION Tsar rrr OUT THE WORLD
14UST BE VERY HAPPY 'WITH. YOUR BOARDS .FE�7FORMAP,,CE.
ARE THE RUSSIANS OFFERING YOU 1:4ONEY TO OPERATE THIS COUNTY
IN THE MANNER OF WICH THAT ITS BEING RUN?
dHOM EXACTLY ARE YOU PEOPLE AND WHERE EXACTLY .ARE YOU FROM?
I KNOW .RHO I AM AND WHERE IM FROM.
ANY WAY THE PURPOSE OF THIS CORRESPONDENCE IS TO FILE AND JUSTIFIABLE
CLAIM .FOR DAMAGES AGAINST CONTRA COSTA COUNTY AND THE STATE
OF CALIFORNIA FOR THE DAMAGES AND LOSSES OF LIFE THAT I HA71E
ENDURED SINCE 98 AND TO DATE.
WARREN :AND OTHER PUBLIC SERVANTS STRIVING TO OVERTHROW THE
PUBLIC BORN AND BRED IN C.ALIF;?RNIA JUST TO SET UP AND
EMBARRASING AUSTjIAN IMIG.RANT IN SACRAMENTO HAVE BROUGHT
ABOUT -SERIOUS AND IRREVERSIBLE DAT, AGES AND LOSSES AGAINST
MY ESTATE OF WHICH WAS IN THE .?BUILDING FOR AND ENTIRITY
OF MY LIFES TI111E.
IT -Ax'}'EARS T.-IAT TODAYS PUBLIC SF.RVAn 'TS OF THE COMMUSNIST HAVE
NO T.='OUP,LE IN CLAIMING OT ERS HARD ;:;
AND qHOM IS THE DERANGED OLD MOTHER RUSSIA BAG? MRS RAINEY?
I HAIE 30 MUCH DOCUMENTATION OF THE CRIMINAL CONDUCT OF
WAaREN RUFF, E. , THATIST IS DIFFICULT TO ORGANIZE AND PUT INTO
CHRONOLIGICAL ORDER.
SINCE THAT WARSEN BROKE AND ENTERED INTO MY PRIVATE RESIDENCE
OF fICH THAT I FILED A CLAIM FOR DAYAGIS FOR, AND UP UNTIOL
THAT WARREN SUCCESFULLY BROUGHT ABOUGHT THE DECEASE OF MY DAD,
TO THE GRIND LARCENY OF MY BU55INES3 IN ALAMEDAo THE THE ATTEMPT TO
FRAME ME FOR AND RUSSIAN INIGRANT WITHIN 4AL1vUT CRE EXt AND WARVENS
ATTEMPTED THEFT OF MY VEHICLE AND THE CONSTANT DAILY HORRASMENT
AND THREATS AGAINST MY LIFE BY THE 7UBLIC SER10TS , ALONG WTTH
THE HEALTH PROBLEAS THAT HAVE BEEN INDUCED BY THE EMPLOYEES
OF THIS COUNTY AGAINST MY PERSON AND OTHER UNE33ARY
HARDSHIPS BROUGHT ABOUT BY THE PUBLIC SERVANTS F0jL
POLITICAL MOTIVES AND GREED FOR EASY FINANCIAL GAIN AT TTE F-5LIC3
EXPENSE AND UP UNTIL TO DATE.
I AM MAKING AND CLAIM FOR DAMAGES AGAINST THE CI71 OF 4kLNUT CREVX ,
CONTRA COSTA COUNTY, AND THE STATE OF CALIFORNIA IN THE AMOONT OF
ONE BILLION, FIVE HUNDRED MILLION DOLL R$ AND ZERO CENTS.
IBILLION 5HUNDRED MILLION DOLLARS AND ZERO CENTS.
FOR EVERY DAY THAT AFTER CHRISTMAS THZ YEAR01 , OF WICR THAT
RUPF ILLEGALLY BROKE AND ENTERED MY RESIDENCE AND FALSELY I"NPRISON'T',D
MY FERSON IN ORDER TO MURDER MY DAD I AM CLAIXI14G $1 ,000.00
DOLLARS A DAY IN DAMAGES FOR CRUEL AND UNUSUALL HARDSHIPS OF
RICH THE PUBLICS 5ERV4NTS HAVE BROUGHT AGAINST MY PERSON
JUST TO ATTEMPT TO SACRIFICE MY PE23ON THE FIROT BORN MALE OF
MY ESTATE,
SINCE THAT YOU CLAIM TO BE THE SERVANTS OF THE PUBLIC YOU CAN CALCULATE
THE SUM YOUR SELVES,
SINCERLY, LANIEL, WALTER
P. S. o I AM SURE THAT YOU SILL FIND MANY CREATIVE VAYS IP WICH TO ATTEMPT
TO DIECREDITE AND TO RENOUNCE THIS STATEMENT FURTHER. THA,,,,-,K YOU.
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CLAIM,
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: AUGUST 01, 2006
Claim Against the County, or District Governed by
the Board of Supervisors, RoutingEndorsements, NOTICE TO CLAIMANT
and Board Action. All Section references are to The copy of this document mailed to
California Government Codes, you is your notice of the action taken
CLAIM AGAINST AUDITOR/CONTROLLER. on your claim by the Board of
)ervisors. (Paragraph IV below),
or4en Pursuant to Government Code
9'eftion 913 and 915.4. Please note all
i,
AMOUNT: $14 , 127 . 59 JUN 2 8 2006 ke arnings".
CLAIMANT:JEFFREY BARNHART COUNTY COUNSEL
MARTINEZ CALIF.
ATTORNEYLAWRENCE W. FASANO, JR. DATE RECEIVED: JUNE 28 , 2006
FASANO LAW OFFICE JUNE 281 2006
ADDRESS' 720 MARKET STREET) BY DELIVERY TO CLERK ON. _
PENTHOUSE, SAN FRANCISCO JUNE 26 , 2006
CA. 94102-2500 BY MAIL POSTMARKED:
FROM- Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JUNE 281 2006 JOHN CULLEN, e
'Dated: By: Deputy
11. FROM: County Counsel TO: Clerk of the Board of StIpervisvi a V
(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).
Olher..
Dated:
By: MCQ� Deputy County Counsel
/P
Ut. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
Claim was returned as untimely with,notice to claimant (Section 911.3).
V.IV OARD ORDER: By unanimous vote of the Supervisors present:
This Claim is rejected in full.
O Other:
I certify that this is a true and correct copy of the Board's Order entered if] its minutes for
this date,
Dated: IN ( 4!e N, CLERK, By Deputy Clerk
WA N Gov _X OHN CULLEN, V
(Gov, c
code section 913)
Subject to certain exceptions,you have only six(6)months front the date this notice was personally served
or deposited in the mail to rile a court action oil this clai'll.See Goverument Code Section 945.6.You may
seek the advice of all attorney or your choice ill connection with this inatter. If you want to consult all
attorney,you should do so hit it iediately. *Tor Additional Warilhig See Reverse Side of']rlds Notice.
AFFIDAVIT OF MAILING
I declare under penalty of peijui-y. that I am now, and at all thnes herein Mentioned, have
been a citizen of the United Slates, over age .18; and that today I deposited in the United
States Postal Service in Martinez, California, postage fully 1, prepaid a cel rifled copy of this
Ostler sinal Notice to Claimant, addressed to the claimmit as shown above.
Dated 6 10.1-IN CULLEN, CLERK By 01 Deputy Clerk
City Clerk Stamp(Official use only)
INSTRUCTIONS: Use ball point pen. Make sure all copies
are legible. Be as specific as possible in completing the forms.
Attach any and all available documentation,e.g.,repair
estimates,medical bills,photos,etc.
GOVERNMENT CLAIM AGAINST THE COUNTY OF CONTRA COSTA, CALIFORNIA
Jeffrey Barnhart presents a claim for damages
(Name of Claimant)
against the County of Contra Costa, California, Dept. of Auditor/Contoller in the sum of
$14,127.59
Claimant's Address:
P.O. Box 5751
Vallejo, CA 94591 JUN 2
8 lU
Address of party presenting claim, if other than above: Ct - 80 fib.
qRD
FASANO LAW OFFICE C°NTRACCSUp ,
ST `R:'!c
A CC,' "ORS
720 MARKET STREET, PENTHOUSE SUITE
SAN FRANCSICO, CA 94102-2500
Date of Occurrence: 2/28/2006
Said claim arises from following circumstances: On Feb28,2006 the County Auditor-Controller's
Office stated in writing that I must repay wages which the County of Contra Costa had paid to me
for a shift differential and hazard pay as an employee for the County.A copy of that letter is attached
herewith as Exhibit"A"and incorporated herewith .
Description of nature and extent of damages or injuries:
The money which the County seeks from me in the sum of$14,069.53, interest on said money
other money which the County claim from me, loss of pension funds, general damages, and
attorneys fees.
C/o Lawrence WM Fasano,Jr.Esquire
(415) 956-8800 /
Sign t e f Cl mant o epresentative - Business Phone Residence Phone
Jef ey Barnhart
Copy to:
City Attorney-Original and One
City Clerk
Claimant
z
Contra Costa County
Office �� /r�—o n
'Stephen r`.Ybar
j; Au u'tc,-Co itro'I er
"' SS C6 -°Y AUDITOR-CONTROLLER ��
+1..�Oit°� & ! ., rn �,�. tit E'azzbetE^A.
.AssiS'a.nt Audita Cont Qiig_
62E, court Street f/
:'Ma-inor. California 94553-1282.
Ei,ephone (92_-5) 646-2181
Fax (92--`;) /�'
� nr
February 28, 2006
Jeffrey Barnhart
P. O. Box 5751
Vallejo, CA 94591
Dear Mr. Barnhart,
We recently reviewed the pay of employees in the classification of Nursing
Program Manager for the period of October 1, 2003 through September 30,
2005. We found that you were overpaid shift differential of$58.06 and hazard
pay of$14,069.53. The total amount of the overpayment is $14,127.59.
In accordance with Section 6.5— Pay Errors of Contra Costa County's Salary
Regulations, our office must recover overpayments for the 2-year period
immediately preceding the discovery of the pay error. Please remit a check to:
Contra Costa County
Auditor-Controller
Attn: Payroll —Tina Kaufmann
625 Court Street, Room 103
Martinez, CA 94553
If you have any questions, please contact me at (925) 646-2167.
Sincerely,
SLI
Tina Kaufmann
Accountant III
C: 49431
Health Services Payroll
FASANO Lawrence. W. Fasano, Jr.
Attorney at Law
720 Market Street,Penthouse Suite
San Francisco,California 94102-2500
tel(415)956-8800■fax(415)956-8811
June 26, 200611.PN'�I I
Clerk of the Board of Supervisors JU/V
County Administration Building, Room 106 6 2006
651 Pine Street CLERK B0ARp OF,3 pL
Martinez, CA 94553 CoNr' CosrA�oVISORs
Re: Jeffrey Barnhart; Sharon Shaw;Michael Donnelly
Dear Sir or Madam:
Enclosed please find an original and one copy of Government Claim forms for the above referenced
individuals. Please file the originals and return endorsed filed copies to our office in the enclosed self
addressed stamped envelope. Thank you.
Very truly yours,
FASANO LA-1W OFFICE
Paula J. Eisenberg
Secretary to Lawrence W. Fasano, Jr.
/pj e
Enclosures
QABARNHART ET AL\Comm\clerk 6.266.wpd
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CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: AUGUST 01 , 2006
Claim Against the County, or District Governed by )
the Board ofSupervisors, Routing Etidorseiiieiits, ) NOTICE TO CLAIMANT
and Board Action. All Section references are to The copy of this document mailed to
California Government Codes,
you is your notice of the action taken
on your claim by the Board of
JUN 2 8 20 1 06 Supervisors. (Paragraph IV below),
given Pursuant to Government Code
AMOUNT: $100000.00COUNTY COUNSEL Section 913 and 915.4. Please note all
, ,
MARTINEZ CALIF. "Warnings".
CLAIMANT. SHAWNTEL L. MERRIWEATLER
ATTORNEY: UNKNOWN DATE RECEIVED: JUNE 28 , 2006
ADDRESS: 583 56th STREET, #A BY DELIVERY TO CLERK ON:JUNE 28 , 2006
OAKLAND, CA 94609
BY MAIL POSTMARKED: JUNE_26 , 2006
FROM-. Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JUNE 28 , 2006 JOHN CULLEI
Dated: BY: Deputy *
X
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).
O 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: fn^CJQP, -Deputy County Counsel
111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2)
O Claim was returned as untimely with notice to claimant (Section 911.3).
I YVOAJW ORDER: By unanimous vote of the Supervisors present:
This Clairn 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.
Dat aOeAg�JOHN CULLEN, CLERK, By Deputy Clerk
W 1. G (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 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 inatter. If you want to consult an
attorney,you should do so hurnediately. *For Additional Warning See Reverse Side of This Notice.
AFFIDAVIT OF MAILING
I declare untler penalty or per that I am now, and at all times herein mentioned, have
been a citizen of the United States, over age 18; and that today I deposited in the United
States Postal Service in Martinez, California, postage full.), prepaid a certified copy of this
U0111-d Order mid Notice to Claimmit, addressed to the claimant as shown above.
IJalet IOHN CULLER CLEM By Clerk
10,
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. A claim relating to a cause of action for death or for injury to person or to personal property or
growing crops shall be presented not later than six months after the accrual of the cause of
action. A claim relating to any other cause of action shall be presented not later than one year
after the accrual of the cause of action.
(Gov. 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 See. 72 at the end of this form.
MORON a I
RE: Claim By: Reserved for Clerk's filing stamp
A�yl AA J-f0J+LLr_
Against the County of Contra Costa or
7V
District)
(Fill in the name)
The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named
district in the sum of$ and in support of this claim represents as follows:
1. When did the damage or injury occur? (Give exact date and hour)
2. Where did the damage or injury occur? (Include cityand county)
Uy4y-o, Qh4k N)-ul f' AUC gv, ,
M 0,f AXA (M&4%,Kkt CA
UJ
3. How did the damage or injury occur? (Give full details; use extra paper if required) (-1JnAV0,_ cws+q_(Put
VOJSt_ I Merl'ttnm)_Y\?v .
4. What particular act or omission on the part of county or district officers, servants, or employees
caused the injury or damage? VC6 ,La V� COrAI * Q�
� (� of
f
5 What are the names of county or district officers,servants, or employees causing the
damage or injury?
cu
i
6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages
claimed. Attach two estimates for auto damage.)
m l sSuU( bu- on b i r+ ) b+ . 61 clue. �0,(3 c me(i,5WrKkq i
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
Pa's n and SU-0-tr I n�
8. Names and addresses of witnesses, doctors, and hospitals: v C ovn � A
3_0J 54- POJIC I CJ o,.
C-bon,t- 1'Y1vjea,+WY - Hoq 32 h-,5 ltil Do._Oaf\ �, C14 gLi ,DT
9. List the expenditures you made on account of this accident or injury:
DATE i= AMOUNT
s pit C-11tsS
) Gov. Code Sec. 910.2 provides"The claim shall be
) signed by the claimant or by some person on his
behalf."
SEND NOTICES TO: (Attorney)
Name and address of Attorney
(Cl ant's Signature)
b q 9
58 3 5 lob l .
(Address)
Telephone No. )Telephone No.L51D� 3S5 (o 2;,b
PUBLIC RECORDS NOTICE:
Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act, is subject to
public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthermore, any
attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to
public disclosure.
..............................................................:..............Now....�
NOTICE:
Section 72 of the Penal Code provides:
Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or
to any county, city, or district board or officer, authorized to allow or pay the same if genuine, any false or
fraudulent claim, bill, account voucher, or writing, is punishable either by imprisonment in the County jail for a
period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000.00), or by both such
imprisonment and fine,-or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars
($10,000), or by both such imprisonment and fine.
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CLAIM,
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: AUGUST 01 , 2006
Claiin 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
California Government Codes. you is your notice of the action taken
CLAIM AGAINST CCC, AUDITOR/CONTROLLER on your claim by the Board of
Supervisors. (Paragraph 1V below),
Pursuant to Government Code
AMOUNT: $4 288 .68 ection 913 and 915.4. Please note all
, 1.!UN 2 8 2006 Warnings".'J�
CLAIMANTSHARON SHAW COUNTY COUNSEL
MARTINEZ CALIF
ATTORNEYLAWRENCE W. FASANO, JR. DATE RECEIVED:
JUNE 28 $ 2006
FASANO LAW OFFICE
JUNE 28 , 2006
ADDRESS: 720 MARKET STREET, BY DELIVERY TO CLERK ON.
PENTHOUSE,, SAN FRANCISCO . JUNE 26 , 2006
CA. 94102-2500 BY MAIL POSTMARKED:
FROM- Clerk of the Board of Super-visors TO: County Counsel
Attached is a copy of the above-noted claim.
JUNE 28 ) .2006 JOHN CULLEN,
Dated. By: Deputy
11. FROM: County Counsel TO: Clerk of the Board of SLrpervisors
( his claim complies substantially with Sections 910 and 910.2.
This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so
notifying claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and
send warning of claimant's right to apply for leave to present a late claim (Section 911.3).
Othei-
Dated: (e- By: —f"KCQ-&, Dep uty 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).
lV.,,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 r 4".4014N CULLEN, CLERK, By 40, Deputy Clerk
W WARNI ((Gov. code section 913)— C/
Subject to cert,11hi exceptions,you have only six(6)months frout the date this notice was personally served
or deposited in the mail to rile a court action on this claim.See Government Code Section 945.6.You may
seek the advice of all attorney of your choice it, connection with this matter. If you want to consult an
, I -Additional Warnhig See Reverse Side of This Notice.
.Itto trey,you should do so immediately. *For
AFFIDAVIT OF MAILING
I declare ulider penalty of peljui-y that I am now, stud at all times herein mentioned, have
been a citizen of the United Stites, over age 18; and that today I deposited in the United
States Postal Service ill Mal-fillez, California, postage fully prepaid a certified copy of this
j.jo,jj-(1 (judermid Notice to Claim.-mt, addressed to file chlinlailtas shown above.
I-Mled IOI-IN CIJI-LEH, CLERI� By ��eputy Clerk
City Cle -tamp(Official use only)
INSTRUCTIONS: Use ball point pen. Make sure all copies
are legible. Be as specific as possible in completing the forms.
Attach any and all available documentation,e.g.,repair
estimates,medical bills,photos,etc.
GOVERNMENT CLAIM AGAINST THE COUNTY OF CONTRA COSTA, CALIFORNIA
Sharon Shaw presents a claim for damages
(Name of Claimant)
against the County of Contra Costa, California, Dept. of Auditor/Controller— —in
the sum of$4.288.68.
Claimant's Address:
1970 Pine Street
C4 2006
Martinez, CA 94553 or,
Address of party presenting claim, if other than above:
STA coZ"Ons
FASANO LAW OFFICE
720 MARKET STREET PENTHOUSE SUITE
SAN FRANCSICO, CA 94102-2500
Date of Occurrence: 2/28/2006
Said claim arises from following circumstances: On Feb28,2006 the Cour ly Auditor:Controller's
Office stated in writing that I must repay wages which the County of Contra Costa had paid to me
for a shift 12M and hazard VU as an employee for the Counly. A copy of that letter is attached
herewith as Exhibit"A"and incorporated herewith .
Description of nature and extent of damages or injuries:
The money which the County seeks from me in the sum of$4,288.68 , interest on said money and
other money which the County claim from me, loss of pension funds, general damn es, and
attorney's fees.
ek, Lay.-i-ence WM Fasano,Jr. Esquire
X V'ej�_ .(415) 956-8800
Signature of Claimant or Representative Business Phone Residence Phone
Sharon Shaw
Copy to:
City Attorney-Original and One
City Clerk
Claimant
Contra Costa County
s�..a Stephen J.Ybarra
Office of ���
-- Auditor-Controller
COUNTY AUDITOR-CONTROLLER - {
• Elizabeth A.Verigin
Assistant Auditor-Controller
625 Court Street
Martinez, California 94553-12$2 A Kms"
Telephone (925) 646-2181
Fax (925) 646-2649
February 28, 2006
Sharon L. Shaw
1970 Pine Street
Martinez, CA 94553
Dear Nis. Shaw,
We recently reviewed the pay of employees in the classification of Nursing
Program Manager for the period of October 1, 2003 through September 30,
2005. We found that you were overpaid hazard pay of$2,114.27 and shift pay of
$2,174.41. The total amount of the overpayment is $4,288.68. This is to notify
you that an adjustment of$119.13 will be made in your April 10, 2006 through
March 10, 2009 paychecks.
In accordance with Salary Regulation Section 6.5— Pay Errors, upon notification
of an overpayment and proposed repayment schedule, an employee may accept
the proposed repayment schedule or may request a meeting through the County
Human Resources Department to determine a repayment schedule, If you wish
to schedule such a meeting, please call Labor Relations at (925) 335-1780 at
your earliest convenience.
If you do not wish to schedule a meeting, and accept the proposed repayment
outlined above, please sign the attached authorization and return to me at the
Auditor-Controller's Office, Attn: Payroll —Tina, 625 Court Street, Martinez, CA
94553. Upon receipt of your authorization, the Auditor's Office will proceed with
the pre-,osed repavment.b.eginning on your April 10, 2005.pa,y -heck..
If you have any questions, please contact Tina Kaufmann at (925) 646-2167.
Sincerely,
Tina Kaufmann
Accountant III
C: R25666
Health Services Payroll
_------ _
e
Contra Costa County
AUDITOR-CONTROLLER
I, Sharon Shaw, authorize the County Auditor-Controller to deduct the amount of
$119.13 from my April 10, 2006 through March 10, 2009 paychecks for the
differentials overpayment.
Signature #R25666
Date
FASANO Lawrence W. Fasano, Jr.
Attorney at Law
720 Market Street,Penthouse Suite
San Francisco,California 94102-2500
tel(415)956-8800 U fax(415)956-8811
June 26, 2006
E
Lac
Clerk of the Board of Supervisors JUJV
County Administration Building, Room 106 0 2006
CLE OF
651 Pine Street 5 5 C
COPdrA Ccj— Ivj URS
Martinez, CA 94553 Co.
Re: " Jeffrey Barnhart; Sharon Shaw; Michael Donnelly
Dear Sir.or Madam:
Enclosed please find an original and one copy of Government Claim forms for the above referenced
individuals. Please file the originals and return endorsed filed copies to our office in the enclosed self
addressed stamped envelope. Thank you.
Very truly yours,
FASANO LAW OFFICE
&M
Paula J. Eisenberg
Secretary to Lawrence W. Fasano, Jr.
/pje
Enclosures
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CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION 23 - I- Ob
Claim Against the County, or District Governed by
the Board,of Supervisors, Routing Endorsements, NOTICE I TO CLAIMANT
and Board Action. All Section references are to The copy of this document mailed to
California Government Codes, you is your notice of the action taken
on your claim by the Board of
Supervisors. (Paragraph IV below),
given Pursuant to Government Code
W LL:
C=3 (1)— Section 913 and 915.4. Please note all
2 Z;OLMOUNT: "Warnings".
0M
cQ OVLA.IMANT.- M.Arvtn beW15;
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ir
�- I Cr -
IITTORNEY� DATE RECEIVED:
0:9
ADDRESS: BY DELIVERY TO CLERK ON:
Oq 94BY MAIL POSTMARKED:
rW
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN CULLEN, CI k
t,
Dated: BY: Deputy
11. FROM: County Counsel TO: Clerk of the Board of Supervisors
( 41"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).
O 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).
O Other:
Dated: By: f'Y76" u.�._ Deputy County Counsel
111. FROM: Clerk of the Board TO: County Counsel (1) Comity Administrator(2)
O Claim was returned as untimely with notice to claimant (Section 911.3).
IV. DOARD ORDER: By unanimous vote of the Supervisors present:
This Claim is rejected in full.
O Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date.
Dated: 9)HN CULLEN, CLERK, By 0
Deputy Clerk
WARMNq(Gov. code section 913)
Subject to certain exceptions,you have only six(6)mouths from the date this notice was personally served
or deposited hi the mail to rile a court action on this claim.See Government Code Section 945.6.You may
seek the advice of an attoruey of your choice hi connection with this inatter. If you want to consult Mi
attorney,you should do so innuediatelly. *For Additional Warning See Reverse Side of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty or peijuty that I ani now, and at all times herein mentioned, have
been a citizen of the United States, over age .18; and that today I deposited hi the United
States Postal Service in A-larthiez, California, postage fully prepaid a certified copy of this
Board Order arid Notice to Claimant, addressed to the claimant as shown above.
Dated, 0z _�.IOHN CULLE1\4, CLERK By Deputy Clerk
JUN-26-2006 06:43AM FROM-510 534 2115 +510 534 2115 T-173 P.003/003 F-297
INSTRUCTIONS TO CLAMANT
A. A claim relating to a cause of action for death or for injury to person or to personal property or
growing crops shall be presented not later than sig: months after the accrual of the cause of
action_ A claim relating to any other cause of action shall be.presented not later tha,1 one year
after the accrual of the cause of action.
(Gov. 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 945 53.
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 az the end of this form.
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RE: Clain By: Reserved.for Clerk's filing stamp
Z6&2.1�5. -- RECEIVE
) D
)
Against the County of Contra Costa or ) JUN 2 9 2006
District CLERK BOARD OF-SUPERVISORS
CONTRA COSTA CO.
(F`:ill in the name) )'
The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named
district in the sum of$ and in support of this claim represents as follows:
1. When did the damage or injury occur? (Give exact date and hour) 3/ '7 ��
2. Where did the damage or injury occur? (Include city aad county)
3. How did the damage or injury 7 (Give full detail ;use extra paper if required)
4 5;c .tet T,ea
4. What'particular act or omission on the part of county or district officers, servants, or employees
caused the injury or damage?
y
5 What are the names of county or district officers,servants,or employees.causing the
damage or injury?
pmoa of not more than one year, oy a nne of nor exceeawng our uiuuaauu uui,cia ----
impruonmeat 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.
JUN-26-2006 06:44AM FROM-510 534 2115 +510 534 2115 T-173 P.004/004 F-299
6. Vhat damage or injuries do your claim resulted? (Give full. extent of injuries or daazages
r ' claimed. -Attach-two eestim for auto e.)
7. How was the amount claimed above computed? (Include the estimated amount of any
P
prospective injury or damage.)
9. Names,and addresses of witnesses,doctors, and hospitals:
9. List the expenditures you roads-on account of this accident or injury:
DATE Me AMOTJNT
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) .Gov.Code Sec. 910.2 provides"The claim shall be
)signed by the claimant or by some person on his
behalf."
BEND NOTICES TO: tAttornev„1
Name and address of Attorney ) `G
(Cl ` is Sigh )
) (Addy
,�
Telepho=No. )Telephone No(,if
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PUBLIC RECORDS zvOTICE;
Please be advised that this claim form,or any claim filed with the County under the Tort Claims Act is subject to
public disclosure under the California Public Records Act, (Gov. Code, 136 6500 et seq.) Furthermore, any
aa=bnamts,addeadums, or supplements attached to the claim form, including medical records, are also subject to
public disclosure.
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NOTICE:
Section 72 of the Penal Code provides:
Every person who,with intent to defraud, presents for allowance or for payment to any, state board or offices, or
to say county, city, or.fimiat board or offices, m4wrized 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 dollars ($1,000.00), or by both such
imprisonment and fine, or by imprisonment im the state prison, by e.flue of not exceeding ten thousand dollars
($10,000),or by both such imprisonment and fine.
JUN-26-2006 08:43AM FROM-510 534 2115 +510 534 2115 T-173 P-002/003 F-297
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RECEIVED
{ JUN 2 9 2006
CLERK BOARD OFSUPERVISORS
CONTRA COSTA CO.
■ ■ ■
�1111n0 N-26-2006 06:43AM FROM-510 534 2115 +510 534 2115 T-1T3 P-001/003 F-29T
■�■%
2530 AmoidQrna,Suite 140 _
Martinez.CA 94553 Contra
Phone:(925)335-145Q Risk Management
F=(925)3357421
s
Fax
To: From: a rl A i,4
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Phone: a of Pages to
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Re; CC:
yogr Request Cl Far Review C] please Cotntne Pleas4 ReplyM For your info
•Comrnentso •
ANY PROBLEMS WITH THE TRANSMISSION'OF THIS FAX,#LEASE GALL
ease(Vote: ..
The fnformatton contafned In lbws fa='mlfe mage may be com denitat aoftr leg* FMTeged
Information intended only for the use of the individual or enemy named above. Ir the reader of this
msswgo is ,riot the [mended raclpient you are hereby noWed that the copying. dissemination or
ds r&gon of confidentfaf Informatfon is sttfotty ptvhibit ad.
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION:
Clain Against the County, or District Governed by
tlLV Board of Supervisors, Routing Endorsements,
NOTICE TO CLAIMANT
aWopoard Action. All Section references are to The copy of this document mailed to
g�) 2 (-75160rriia Government Codes. you is your notice of the action taken
C=3 0 N
0 Luon your claim by the Board of
Z Supervisors. (Paragraph IV below),
z bc given Pursuant to Government Code
:)< $
02 Section 913 and 915.4. Please note all
d=
MOUNT: "Warnings".
CLAIMANT: 4 Jbkt4'tprl
ATTORNEY- DATE RECEIVED:
ADDRESS: 13 35 40 L'uj 01W br, BY DELIVERY TO CLERK ON:
(2
b0VtbLQ'1 C) qL00b BY MAIL POSTMARKED: —5
FROM, Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN CULLEN, CIV., I
Dated: By: Deputy— C�A4��
II. FROM: Cwnty Counsel TO: Clerk of the Board of Super-visors
(j,)r 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).
O Clain is not timely filed. The Clerk should return claim on ground that it was filed late and
send warning of claimant's right to apply for leave to present a late claim (Section 911.3),
Other,
Dated: -7-3-0(,o By: Deputy County Counsel
111, FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2)
Clain was returned as untimely with notice to claimant (Section 911.3).
.1V. OARD ORDER: By unanimous vote of the Supervisors present:
This Clain 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:jed 6)HN CULLEN, CLERK, By .--Deputy Clerk
WARN�IN�(Govc'ode section 913)
Subject to certain exceptions,you have only six(6)ulontlis froul the date this notice was personally served
or deposited in the mail to file a court action on this claim.See Government Code Seeflon 945.6.You may
seek the advice of all attorney of your choice in connectiou with this matter. If you want to consult an
attorney,you should do so hiunediately.. *For Additional Warning See Reverse Side of Ilds Notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjur-y 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 ill Alartillez, California, postage fully prepaid a certified copy or this
Board Ordermid Notice to Claimant, addressed to the claimant as shown above.
Dale& a2 _cq4�.10.14N CULLHIJ, CLERK By�����eputy Clerk
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. A claim relating to a cause of action for death or for injury to person or to personal property or
growing crops shall be presented not later than six months after the accrual of the cause of
action. A claim relating to any other cause of action shall be presented not later than one year
after the accrual of the cause of action.
(Gov. 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.
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RE: Claim By: Reserved for Clerk's filing stamp
}
RECEIVED
Against the County of Contra Costa or ) JUL 0 '3 2006
) CLERK BOARD OFSUPERVISORS
District) CONTRA COSTA CO.
(Fill in the name) )
The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named
district in the sum of$ "0 D and in support of this claim represents as follows:
1. When did the damage or injury occur? (Give exact date and hour)
Dec, 3i t 2.005 0115
2. Where did the damage or injury occur? (Include city and county)
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3. How did the damage or injury occur? (Give full details;use extra paper if required)
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4. What particular act or omission on the part of coutity or district officers, servants, or employees
caused the injury or damage? -X Jyate
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5 What are the names of county or district officers, servants, or employees causing the
damage or injury?
6. What damage or injuries do your claim resulted? (Give fall extent of injuries or damages
-claimed. Attach two estimates f auto damage.) re�apioLocfv
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7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.) '
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9. List the expenditures you mde on account of this accident or injury:
DATE TIME AMOUNT
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) Gov. Code Sec. 910.2 provides"The claim shall be
) signed by the claimant or by some person on his
behalf."
SEND NOTICES TO: (Attorney)
Name and address of Attorney
'i ZL
} ant' Signature)#iM
J (Address)
�
Telephone No. Telephone No. C12 7 t!5�
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PLTLIC RECORDS NOTICE:
Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act, is subject to
public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthermore, any
attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to
public disclosure.
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NOTICE:
Section 72 of the Penal Code provides:
Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or
to any county, city, or district board or officer, authorized to allow or pay the same if genuine, any false or
fraudulent claim, bill, account voucher, or writing, is punishable either by imprisonment in the County jail for a
period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000.00), or by both such
imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars
10,000), or by both such imprisonment and fine.
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CLAIM
BOARD Of SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION. OfO
Claim Against the County, or District Governed by )
the Board of Supervisors, Routing Endorsements, )
_j NOTICE TO CLAIMANT
o WCBoard Action. All Section references are to The copy of this document mailed to
2 §,4fornia Government Codes. you is your notice of the action taken
0
ON 0 on your claim by the Board of
W
>-z Supervisors. (Paragraph 1V below),
ZCC given Pursuant to Government Code
08:�MOUNTI- UA k r)0W Section 913 and 915.4. Please note all
"Warnings".
CLAINIANTI-
ATTORNEY,Vj'cfor DATE RECEIVED:
an Law f-im
ADDRESS: to( BY DELIVERY TO CLERK ON:
3701 bcafy BY MAIL POSTMARKED.-
tsm 6rm cuw, (A qq i 19
FROM- Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-iicqed claim.
JOHN CULLEN,
Dated: 10 By: Deputy-
11. FROM: County Counsel TO- Clerk of the Board of Supervisors
(/This claim complies substantially with Sections 910 and 910.2.
( ) This Claim FAILS to comply substantially with Sections 910 and 910.2; and we are so
notifying claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and
send warning of claimant's right to apply for leave to present a late claim (Section 911.3),
Other:
Dated: By: Deputy County Counsel
111, FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2)
O 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 iii 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 N CULLEN, CLERK, By jt,±,�Deputy Clerk
Ir_ .. 11--11------------------
Tw=_aIN (tG77. code section 913)
Subject to certain exceptions,you have only six(6)inonflis from the date this notice was personatly served
or deposited in the mail to rile a court action on this claim.See Government Code Section 945.6.You may
seek the advice of an attorney of your choice it, connection with this matter. If you want to Consult an
attoruey,you should do so inunediately. *For Additional Warniul;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 Atartitiez, California, 1-iustage fully prepaid a certified copy of this
ljo-,,rd (juder mid Notice to Claimant, addressed to tfie claim ant as sliowii above.
ZKIV Deputy Clerk
Dated 0?? JOHN CULLER CLERK By
VELAN LA W FIRM
A PROFESSIONAL CORPORATION RECEIVED
3701 Geary Boulevard, Suite 101
San Francisco, CA 94118 JUL 0 3 2006
Phone: (41 S) 379-9300 CLERK BOARD OF SUPERVISORS
Fax: (41 S) 379-9343 CONTRA COSTA CO.
June 30, 2006
VIA CERTIFIED MAIL NO. 7003 3110 0000 9586 0513
Clerk of the Board of Supervisors
Contra Costa County
County Administration Building, Rm. 106
651 Pine Street
Martinez, CA 94553
Re: Our Client: Yelena Miller (passenger)
Date of Injury: January 6, 2006
Agency: County Connection
Location; Concord, CA
Dear Clerk:
Enclosed is our Government Claim pertaining to the above-entitled incident as to Yelena Miller. .
Please return to us a copy of this document in the enclosed self-addressed postage paid envelope
indicating that this was filed or received by your office. Thank you.
WVeryruly yours,
(Ms.) Will C. Bonvie
Enclosures
cc: Martha Huey, Claims Adjuster
05-'=-2-006 25:00 COP-TPP CO COUNTY C-E.PK OF THE 91415-rD9 143 NO.1-7 [Pei
BOARD OF SL':x"lCRVIS. F95% OFCONTRA C()STA
I7Fi,,...;,ST7C`d."1�B?.�.,,;�f-:tAII1d.t NT
A, A claim relating to a ;,ruse of action for d=*. or for injtr-j to person or tc personal property or
growing crops shall be presented not later Than six Months after the accrual of the cause of
aVdan. A claim rtlating to AM tither esus: of actiOr_ shall be pre88nt&e .not late-t Lan One year
after the accrual of the cater Of action.
(Gov.Code g 911.2)
B. Claims muse he filed with the Clerk of the Board of Supervisors at its office in koorri 106,
County Administraabon Building, 651 Pine Street, Mml nez,CA 94553.
C. If claim is agai:ns: a district governed by the board of Suparvisors, rather than the Count ,, the
name of the District should be filled in,
D, If the cW= is against more than one public entity, separate claims mist be filed a aiinsi each
public entity,
1~. rraud. See penalty for Eraudulent claims,Proal Cade Sec. 2) Ax the end.of tivs form,
Y 666 866•8!664 866 Y8p6m i Yob o6oB 6 f66o0r b 84 d 6 6680 6196060 666&.6o 06 o B■i 6■■L 00 oi6."a"no
P2:
Claim By: keservea f�:Clerk's filing stomp
1
YELENA MILLER '
' RECEIVED
a, yn, the County of Gooses Cc+sta Or JUL 0 3 2006
District} CLERK BOARD OF SUPERVISORS
(fill in the nam-.) CONTRA COSTA Co.
1
The undersigned elairnant hereby snakes claim against the County of Contra Costa or the above-n=tec
dist"ict in the sung of$unknown and in support of this claim represents as follows:
also See Attachment 1
1. 't%hen did,the damage or injury occur? (Give exact dot and hour)
January 6, 2006, at $: 03 P.m.
2. Where did the damage ar injury Occur? (Include ci,.y and county;
Concord, Contra Costa County aboard a county bus
3. How did tine damage or injury occur? (Cove full details;use ex= aper if re ed)
Claimant was riding a CountymeConnection bq
Line 124 when bus suddenly stopped, knocking her
onto fl oor .
4, What particular act or umission or..the part of country or district of�ic"ezx, servants, or eD-1ployees
caused the injury or damage?
sudden stopping of bus
"What Are the names of county or diEtrict ofztccrs, servants, Or employees caushn the,
damage or ir;inry?
County Connection - bus driver name unknown
05/22/2006 15:00 CONTPA CA COUNTY :LERk. OF THE 4 31415Z79371.4* NO.I.57 02
6. What damage or injuries doy our claim resulted'?? (Give full extent o: injuries or damage's
claimed, Attach two estimates fo:auto damage.)
under investigation
7. How was the amount claimed above -6mputed, (Inchide the estimated amount of any
prospective Wury w damage.)
under investigation
8. Names and,addresses of vvitnesse&,doctors,and hospitals:
underinvestigation
9, Lir the expenditures you made on account of this accident or injurT
KATIE �&T1
AMOUNT
under investigation
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v, Code Sec. 910.2 provides"The claim shall be
fpsi ;d by 6e claimant or by some Person on his
SEND NOTICES 7
Name and address of Anorney
Victor LiPovetsky, .E�q. (Cllaiuu „tls Signature)
Velan Law Firm Victor LiPOvf\tsky, Attorney
3701 Geary Blvd. S. 101 )
San Francisco, cA 94118 ) (Address)
Telephom No.41 5--�2q-9 Telephme'Nlo.-
owes @No *love
I PUBLIC RECORDS NOTICE:
Pieue be s4viod that this claim form,or any claim filed with the County under the Tort Claims Act is subject to
putific disclosure mider thc-Califomip, Public Records Am, (Gov, Code,
Sf 6500 et seq.) Furthermore, any
attachments,adclendums,oT 6upplamonts attached to the cWni form, including medical records,are also subject to
public disclosure.
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NOTICE:
Section 7,12 of th,,,Penal Code provides:
livery person who,with intent to deftaud,presents for ahowance or for payment to any state board or officer,or
to any county, city, or district board or officer, authorized it allow ar pay dje,same if genuine, a _ny i� 1;,.- -
1
fraudulent Maim, bill, account Youcher, or writing, is punishable either by irripriscirimcni in the Courity iail !-*,,T
period of not more than one year, by a fine of not exreading one thousand dollars ($i„000.00), or by b�ot"l �-C7,
imprisonment and fine, or by imprilonmant in the statr, prison;hy e fine of riot exceeding Tan thousand dol:iu.
($10,000), or by both Such imprisomnent gild fine.
1 THE VELAN LAW FIRM
A Professional Corporation
2 Victor Lipovetsky (SBN. 170962)
3701 Geary Boulevard, Suite 101
3 San Francisco, California 94118
Telephone: (415) 397-9300
4 Facsimile: (415) 397-9343
5 Attorneys for Claimant
YELENA MILLER
6
7
8
9 GOVERNMENT TORT CLAIM
10
11 YELENA MILLER,
CLAIM FOR DAMAGES
12 Claimant, (PERSONAL INJURY)
13 V. [Government Code section 910]
14 COUNTY OF CONTRA COSTA, ATTACHMENT 1
COUNTY CONNECTION; and DOES 1-
15 100, inclusive;
16 Respondents.
17 To: COUNTY OF CONTRA COSTA, COUNTY CONNECTION
18 You are hereby notified that Claimant, YELENA MILLER, claims damages
19 from Respondents, City and County of San Francisco, San Francisco Municipal
20 Railway "Muni" and Does 1 to 100 inclusive individual) jointly, several) or
("Muni"), Y� 1 Y, Y�
21 vicariously for personal injury as follows:
22 Claimant's name is YELENA MILLER and her address is c/o 3701 Geary Blvd.,
23 Suite 101, San Francisco, CA 94118;
24 Claimant requests that notices regarding this claim be sent to her attorney of
25 record: Velan Law Firm, 3701 Geary Blvd., Suite 101, San Francisco, California 94118;
26 telephone: (415) 379-9300.
27 This claim for damages arises from an incident, which occurred at approximately
pproximately
28
GOVERNMENT TORT CLAIm
1 8:04 A.M., on Friday, January 6, 2006, on Concord Blvd., near the intersection of
2 Bailey Road, Concord, California, enroute to the Concord BART Station.
3 Basis of Claim and Description of Injury
4 Claimant provides the following detailed facts and circumstances of the incident.
5 In addition, Claimant provides a description of personal injury and damage or loss.
6 At that time and location, Claimant was aboard a County of Contra Costa
7 Municipal Bus, County Connection, specifically southbound on the Line #124 Bus,
8 Coach Number unknown and name of bus driver unknown, operated by the County of
9 Contra Costa. Claimant was a passenger in the bus.
10 After she had boarded the bus at Concord Boulevard and Bailey Road, while
11 she was sitting in the bus holding on the bus driver suddenly and without warning
12 unexpectedly stopped the bus. As a result of unexpected movement she fell down
13 on the floor of the bus. The force of the bus stopping abruptly and unexpectedly
14 caused Claimant to be thrown off balance and fall down causing serious injuries.
15 As Claimant was in a position of peril and obviously injured, the County of Contra
16 Costa employee/bus driver, who is presently unknown to Claimant, noticed or
17 should have noticed Claimant, but proceeded to operate the bus in a callous
18 disregard for her safety.
19 Dangerous Condition of Public Property
20 Claimant incorporates all statements described herien as though fully set forth
21 herein.
22 Claimant is informed and believes that the Respondents' employee/bus driver as
23 well as other drivers on that line knew of the dangerous condition. The bus driver had
24 created the dangerous condition of public property by his or her own actions as
25 described above. Respondents allowed the dangerous condition to exist and go on.
26 Respondents have failed to properly hire, train, and supervise the said bus driver and
27 his or her actions. Respondents by disregarding their responsibilities have created a
28 hazardous condition in operating a public bus.
2
1 Respondents and the bus driver were aware of the above-described careless
2 and reckless condition, and should have been aware. Plaintiff is informed and believes
3 that the bus driver proceeded in an unsafe manner on the day of the incident . Despite
4 numerous and multiple accidents and injuries, the Respondents failed to properly hire,
5 train, and supervise city employees/bus drivers in the safe operation of the County
6 municipal buses so as to guard the public from safety hazards and injuries.
7 Negligence
8 Claimant incorporates all statements described herein as though fully set forth
9 herein.
10 Claimant claims that respondents were negligent in that respondents owed a
11 legal duty to use due care, but failed to do so thereby breaching their duty, and
12 proximately causing Claimant's injury. The negligence consisted of misfeasance or
13 nonfeasance. There was active negligence, i.e., the bus driver negligently stopped the
14 bus and knew or should have known of the danger and failed to warn claimant. As the
15 driver approached the subject area, the dangerous condition is clearly visible to that
16 driver. A driver who drives that line regularly must have known of the danger. The bus
17 driver knew, or should have known of the danger and failed to warn Claimant.
18 Failure to Warn of Dangerous Condition
19 Claimant incorporates all statements described herein as though fully set forth
20 herein.
21 Claimant claims that respondent had either actual or constructive notice of a
22 dangerous condition and failed to warn and protect Claimant against the harm suffered.
23 The bus driver failed to warn the passengers of the dangerous condition.
24 Respondents failed to warn the public of the dangerous condition in that that
25 they do not engage in proper hiring, do not properly investigate drivers' background
26 upon hiring, do not properly train and supervise the bus drivers. Respondents'
27 disregard to warn the public constitutes a hazard to the public bus passengers.
28
3
1 Negligent Hiring
2 Claimant incorporates all statements described herein as though fully set forth
3 herein.
4 Respondents were negligent in not properly hiring and investigating the driver's
5 background. Respondents did not properly train the driver and did not inquire that the
6 driver does not engage in such callous/reckless conduct.
7 The name or names of the public employees causing the injury, damage, or loss
8 is unknown to Claimant. However, as to said employees, Claimant claims that the
9 negligence of said employee is imputed to respondent herein based on the doctrine of
10 respondeat superior.
11 The name or names of the independent contractors causing the injury, damage,
12 or loss is unknown to Claimant. However, as to said independent contractors, Claimant
13 claims that the negligence of said independent contractors is also imputed to
14 respondent herein based on the doctrine of respondeat superior, agency-principal or
15 vicarious liability principals.
16 Damages
17 Damages to be sought by Claimant include damages for medical expenses,
18 rehabilitation, and other economic losses according to proof; and non-economic
19 damages for pain and suffering according to proof.
20 Jurisdiction over this claim will rest in the Superior Court of the State of
21 California, Unlimited Jurisdiction.
22 Dated: June 30, 2006 V LA LAW FIRM
23 o ssional Corporation
24
Victor Lipove y Attorney for Claimant,
25 YELEN MILLER
26
27
28
4
PROOF OF SERVICE BY MAIL C.C.P. 1013a
I, WILLY C. BONVIE, certify and declare as follows:
I am over the age of 18 years, employed in the City and County of San Francisco, State of
California, and am not a party to this action. That on 3 ° J, 2006, a true and
correct copy of the following documents:
CLAIM AGAINST THE COUNTY OF CONTRA COSTA - on behalf of Yelena Miller
CLAIM FOR DAMAGES (PERSONAL INJURY)
[Government Code section 910]
were served by mail by placing the documents in the United States Postal Service with First
Class postage prepaid thereon addressed as follows:
VIA CERTIFIED MAIL NO. 7003 3110 0000 9586 0513
Clerk of the Board of Supervisors
Contra Costa County
County Administration Building, Rm. 106
651 Pine Street
Martinez, CA 94553
I certify and declare under penalty of perjury under the laws of the State of California that
the foregoing is true and correct. Executed this-0th day of &I.A/, 2006, at San Francisco,
California.
WILLY C. BONVIE
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