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HomeMy WebLinkAboutMINUTES - 10021984 - 1.33 BOARD pD /F �rypp��}Syy� /gyp 0tr.NTRA1.[�f.1 M COSTA � /�Rp CALIFORNIA i BOARD ACTION Claim Against the County, or District ) NO!rI(E TO CLAIMANT October 2, 1984 governed by the Board of Supervisors, ) The copy of-girs-do-cu-nint-m-aTled to you is your Roucing zndoryttfiencs, and Boars - ' ) - -notice of the action taken on your claim by the Action. All Section references are ) Board of Supervisors (Paragraph IV, below) , to California Government Codes ) given pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". Claimant: Harold M. Child, Jr. 119 Lynn Drive County Counsel Attorney: Brentwood, CA 94513 AUG 3 1 1984 Address: Martinez, CA 94553 Amount: $217.30 By delivery to clerk on Date Received: August 30, 1984 By mail, postmarked on August 28, 1984 I. FROM: Clerk of the Board ot Supervisors County Counsel Attached is a copy of the above-noted claim. Dated: August 30, 1984 J.R. OT.SSON, Clerk, By Deputy __4 Jolene Edwards II. FROM: County Counsel 'IO: Clerk of the Board of Supervisors (Check only one) 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. Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3) . ( ) Other: Dated: By: Deputy County Counsel III. FRIM: Clerk of the Board 4O: (1) County Counsel, (2) ty Administrator ( ) Claim was returned as untimely with notice to claimant (Section 911.3) . IV. BOARD ORDER By ,unanimous vote of Supervisors present ( x) This claim is rejected in full. ( )� Other: I certify that this is a true and correct copy of Board's Order entered Fin minutes for this date. // /J,J Dated: OCT J. R. OISSON, Clerk, By :I U Deputy Clerk WAMING (Gov. Code Section 913) Subject to certain exceptions, you have only six (6) months from the date of this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want, to oonsult an attorney, you should do so immediately. V. FSI: Clerk of the Board TO: (1) County Counsel, (2) County Administrator Attached are copies of the above claim. We notified the claimant of the Board's action on this claim by mailing a copy of this document, and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. ( ) A warning of claimant's right to apply far leave7tpresent l/ a late claim was mailed tb&DATED:- l at,., J. R. OLSSON, Clerk, By �(�`C�a , Deputy Clerk cc: County Administrator (2) County Counsel (1) 00034 CLAIM CT.AIM•T0: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY R Instructions -'_o Claimant A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Sec. 911. 2, Govt. Code) 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 (or mail, to P.O. Box 911, Martinez, -CA) . 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 end of this form. RE: Claim by ) Reser d-a b�'`C e� Ing stamps Harold D1. Child Jr. ) 119 Lynn Dr. Brentwood , CA. 94513 19 84 Against the COUNTY OF CONTRA COSTA) J. R. OLSSON CLS^� BOARD OF SUPERVISORS or DISTRICT) 7�` :4aA COsr�aco�� (Fill in name) ) e The undersigned claimant hereby cakes claim against the County of Contra Costa or the above-named District in the sum of $ $217. 30 and in support of this claim represents as follows: =-----------------------------------=----------------------------------- 1:, When did the damage or injury occur? (Give exact date and hour) July 26, 1984 10e20 A.M. ------- ---T------------------------------------------------------------ 2. Where did the damage or injury occur? (Include city and county) 119 Lynn Dr. Brentwood , CA. 94513, Contra Costa County --------------------- - --------------------- - --H-ow- -d--d---th-e---d-am-ag--e-o--r-injury occur? (Give -- - details, use extra sheets if required) Sheriff rept Sgt. M.Schott mistakenly kicked the locked door open. Lg.fi ought there was a fire in the house but the fire was in the fifi tt € behind ours. We were on vacation at the time. ------------------------------------------------------------------------ 4. What particular act or omission on the part of county or district off}cers, servants or employees caused the injury or damage? Officer misi�kenly kicked open locked door, damaging lock, frame , and door. 00035 (over) 5. , ,-What. are the names of county or district officers, servants .or mployees ,causing the damage or .injury? Serg eant I;,. Schott Sheriff Dept. Contra Costa County - ---- - ---------------------------------- ------------------- 6-.--What-damage-------or--injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage) broken lock bent and damaged door cracked frame ------------------------------------------------------------------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) cost of door and frame 119.30 (Pittsburg Door Co. ) Total 217.30 cost of lock 13.00 (Sears) cost of hanging door 85.00 (Pauls Carpentry) ------------------------------------------------------------------------- 8. Names and addresses of witnesses, doctors and hospitals. Dan lynch 143 Lynn Dr. Brentwwod CA . 94513 See copy of the note he left. Copy attached. ------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 8/28/84 door ana frame ordered - at Pittsburg Door Co. 244.03 Govt. Code Sec. 910.2 provides : "The claim signed by the claimant SEND NOTICES TO.: (Attorney) or b some erson on his behalf. " Name and Address of Attorney Clai a s Signatufl'11 L nn Dr, Brentwood CA Address Telephone No. Telephone No, .634-5542 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, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is guilty of a felony." 00036 Ole T71 �3- 147 VE a, hWAA4s- Or- 71YI5 1A)C1o,9W7— AA)P A--<0 "OW 4,471e,3�7 lct4orn- 41 V 771 7z/,z,v -00037 1. YOU 1-4wt 'I-rvy xa ova 4ursrio-*Vs /)Lf . ,ice To Ct)A17. Cr ,,00L-�� . �f}� �yi✓cf� Z VOov d J 00038 �' CLAIM BOARD OF SOPERVISMS OF CONTRA COSTA aOgM, CALnMRNIA BOARD ACTION Claim Against the County, or District ) NOTICE TO CYAIMATP October 2, 1984 governed by the Board of Supervisors, ) The copy of th s document ma ed to you is your Routing Endorsements, and Board ) notice of the action taken on yuur ciazm ay rhe ' Action. All Section references are ) Board of Supervisors (Paragraph IV, below) , to California Government Codes ) given pursuant to Government Code Section 913 and 915.4. Please note all 'Warnings". Claimant: Bruce Del Kopitar County Counsel Attorney: Linda D. Hurst 279 Front St. , P.O. Box 218 AUG 2 9 1984 Address: Danville, CA 94526 Amount: Unspecified By delivery to clerk on Martinez, CA 94553 Date Received: August 27, 1984 By mail, postmarked on August 25, 1984 I. FROM: Clerk o the Board ot Supervisors oun y Counsel Attached is a copy of the above-noted claim. Dated: August 27, 1964 J.R. CISSON, Clerk, By r. Deputy Jolene Edwards II. FROM: County Counsel 'IO: Clerk of the Board of Supervisors (� (Check only one) ) 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. Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3) . ( ) Other: Dated: By: Deputy County Counsel III. FROM: Clerk of the Board 7O: (1) County Counsel, (2) County Administrator ( ) Claim was returned as untimely with notice to claimant (Section 911.3) . IV. BOARD (H2DEft By unanimous vote of Supervisors present (X 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: J. R. OISSON, Clerk, Deputy Clerk WARNING (Gov. Code Section 913) Subject to certain exceptions, you have only six (6) months from the date of this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. V. FROM: Clerk of the Board TD: (1) County Counsel, (2) County Administrator Attached are copies of the above claim. We notified the claimant of the Board's action on this claim by mailing a copy of this document,, and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. ( ) A warning of claimant's right to apply for leave to resent a late claim was mailed to claimant. DATED: OGT am J. R. OLSSON, Clerk, By' C��c �� ��;Deputy Clerk cc: County Administrator (2) County Counsel (1) CLAIM I THIESSEN, GAGEN & MCCOY RECEIVED A Professional Corporation 2 279 Front Street, P . O. Box 218 Danville, California 94526 3 Telephone: (415) 837-0585 ON CLER BOARD OFSSSUPERVISORS 4 Attorneys for Claimant e C T COSTA Co. ..De 5 6 7 8 BEFORE THE BOARD OF SUPERVISORS , COUNTY OF CONTRA COSTA 9 10 BRUCE DEL KOPITAR, ) 11 Claimant, ) NO: 12 vs . ) CLAIM FOR PERSONAL INJURIES , EMOTIONAL DISTRESS AND 13 COUNTY OF CONTRA COSTA, ) PROPERTY DAMAGE CONTRA' COSTA COUNTY SHERIFF 'S ) 14 DEPARTMENT, DEPUTY SHERIFF ) R. DUSSELL, and COUNTY SHERIFF ) 15 PERSONNEL DOES I through X. ) 16 17 TO THE COUNTY OF CONTRA COSTA, THE CONTRA COSTA COUNTY 18 SHERIFF ' S DEPARTMENT AND TO DEPUTY SHERIFF R. DUSSELL: 19 YOU ARE HEREBY NOTIFIED that BRUCE DEL KOPITAR claims 20 damages from the COUNTY OF CONTRA COSTA, the CONTRA COSTA COUNTY 21 SHERIFF'S DEPARTMENT and employees thereof, specifically DEPUTY 22 SHERIFF R. DUSSELL; in an amount to be shown according to proof. 23 This claim is based upon personal injuries , emotional 24 distress, and property damage sustained by Claimant BRUCE DEL 25 KOPITAR on or about May 18 , 1984 in the vicinity of Bear Creek 26 Road in an unincorporated area within the County of Contra Costa, -1- LAW OFFICES THIESSEN,GAGEN&McCOY 00040 A PROFESSIONAL CORPORATION 279 FRONT STREET DANVILLE CA 94526 TEL.8�7-0585 I California, under the following circumstances: 2 On May 18 , 1984 at approximately 5: 30 p.m. DEPUTY DUSSELL . 3 observed Claimant riding a Honda TRX200 four-wheeler in the 4 vicinity above-named . Using Contra Costa vehicle number 2018 , 5 DEPUTY DUSSELL gave chase and pursued Claimant KOPITAR. DEPUTY 6 DUSSELL attemped to "run down" claimant while Claimant was 7 riding the Honda TRX200 and to strike the Honda four-wheeler 8 with his own vehicle. 9 Claimant was assaulted as above-described without just , 10 or legal cause, and without provocation. Further, Claimant 11 was unjustifiably arrested and falsly imprisoned by DEPUTY DUSSELL 12 and other CONTRA COSTA COUNTY SHERIFF PERSONNEL. 13 Claimant sustained emotional distress and property damage 14 as the result of this incident. The amount of this claim is 15 according to proof, but damages to date include the property 16 damage to claimant' s Honda TRX200 . 17 Claimant's address is 2974 Mary Ann Lane, West Pittsburg, 18 California 94565. 19 All notices and other communications with regard to this 20 claim should be sent to Claimant' s attorney, Linda D. Hurst , 21 279 Front Street, P. 0. Box 218 , Danville, California 94526 . 22 Dated: August 24 , 1984 THIESSEN, GAGEN & McCOY A Professional Corporation 23 24 B D. Hurst 25 Attorneys for Claimant 26 -2- LAW OFFICES THIESSEN,GAGEN&McCOY A PROFESSIONAL 00041 CORPORATION 279 FRONT STREET DANVILLE CA 94526 TEL.8�7-0585 1 DECLARATION OF SERVICE BY MAIL 2 I, the undersigned, declare : 3 That I am a citizen of the United States , over the age of 4 eighteen years , and not a party to the foregoing action; that my 5 business address is 279 Front Street, Danville , California. 6 That on August 24 , 1984 I served copies of 7 the within 8 CLAIM FOR PERSONAL INJURIES, EMOTIONAL DISTRESS AND PROPERTY DAMAGE 9 by placing them in the envelopes addressed as follows : 10 11 Board of Supervisors Sheriff, County of Contra Costa County of Contra Costa 651 Pine Street 12 651 Pine Street Martinez, CA 94553 Martinez, CA 94553 13 14 15 16 17 18 19 20 which envelopes were sealed and deposited, postage prepaid, in the 21 United States mail at Danville, California; that there is regular 22 service between the place of deposit and each of the foregoing 23 addresses . 24 I declare under penalty of perjury that the foregoing is 25 true and correct. 26 Executed August 24 , 1984 at Danville, CA LAW OFFICES ESSEN.GAGEN 8 McCOY PROFESSIONAL CORPORATION '9 FRONT STREET MVILLE CA 94526 CherJ9L. Barrett TEL 8370585 CLAIM BOARD OF SUPERVISORS OF CORM COSTA COURNr CALIFOMIA BOARD ACTION Claim Against the County, or District ) NOTICE TO CIAIMARr October 2, 1984 governed by the Board of Supervisors, ) The copyof th s docLment ma ed to you is your k(WLi,iy Lwr-AULzit2tienL5, am Board ) notice of the action taken on your claim by the Action. All Section references are ) Board of Supervisors (Paragraph IV, below) , to California Government Codes ) given pursuant to Government Code Section 913 and 915.4. Please note all 'Warnings". Claimant: Ellis B. Myers, Sr. County Counsei P.O. Box 692 Attorney: San Pablo, CA 94806 AUG 2 9 1984 Address: Martinez. CA 94553 AMOUnt: $86.48 By delivery to clerk on Date Received: August 28, 1984 By mail, postmarked on August 25, 1984 I. FROM: Clerk of the Board of Supervisors County Counsel Attached is a copy of the above-noted claim. / Dated: August 28, 1984 J.R. OLSSON, Clerk, By e",j.4 Deputy Jolene Edwards II. FROM: County Ccunsel TO: Clerk of the Board of Supervisors (Check only one) ( ) 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. 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: 12 y/ By• r % Deputy County Counsel III. FROM: Clerk of the Board TO: (1) County Counsel, (2) County Administrator ( ) Claim was returned as untimely with notice to claimant (Section 911.3) . Q� IV. BOARD ORDER By unanimous vote of Supervisors present ( This claim is rejected in full. (/ \) Other: I certify that this is a true and correct copy of a Board's Order entered in its mineV f2r�, is date. / Dated: J. R. OLSSON, Clerk, �y t,(/ (�CG�1 , Deputy Clerk ���c``►► SING (Gov. Code Section 913) Subject to certain exceptions, you have only six (6) months from the date of this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. V, FROM: Clerk of the Board TO: (1) County Counsel, (2) County Administrator Attached are copies of the above claim. We notified the claimant of the Board's action on this claim by mailing a copy of this document, and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. ( ) A warning of claimant's right to apply for leave to resent a late claim was mailed to unapt. DATED: UUJ Z W4 J. R. OLSSON, Clerk, By y -� , Deputy Clerk cc: County Administrator (2) County Counsel (1) 00043 CLAIM :. .CL-A;[M• TO: BOARD .OF SUPERVISORS OF CONTRA COSTA COUNTY Instructions -co Claimant A. Claims relating,,tg .causes of action for death or for injury to = person,:or •to ,personal property or' growi.ng.,,crops must be presented not later than ,the"`100th day after the accrual of the cause of action".-' Claims relating-to any other cause of action must be presented. not laterAthan1one, %year;.after ,the accrual of the cause of action. (Sec. 911. 21 govt.'._Code,) 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, (6r mail to P,.O. Box 911, Martinez,_ -CA) - 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 t#ian one -public entity, separate claims must be- filed against each public entity. -._ E. Fraud. See penalty.,for. fraudulent claims ,. Penal Code Sec. 72 at end of this form. RE: Claim by R SE fil RECEIVED ECEIVED ing stamps Against the COUNTY OF •:CONTRA,;,COSTA) rit!G x81994 J. R. OLSSON _ or ' - ' ; DISTRICT) .,.ARK BOARD OF SUPERVISORS Z, .` �..`� ..-.. ,. ,, NTRAt�SA C Fill in name) ) e -...----- ---reGr�ls:a�. ., .The undersigned claimant hereby makes claim against theCoun y of Contra Costa or the above-na'med` District in the sum of $ /,� and in support of this claim represents as follows:—r ----=-=-------------=--------------------------------------------------- h. .,Talhen did the damage or injury occur? (Give exact date and hour) - � O 2. Where did the damage or? injur occur? (Include city and. county) _._._ - . —�. -- ------- -------------------------11-----11-------------- How did the damage or injury occur? (Give full details use extra sheets if required) G r 411Y� 4. What particular act or omission on the part of county or district officers , servants or employees caused the -injury or damage? 1<'el �XV1Q1 1'7e 7h�v` fig waS 'r it) 7-he �,de-ec'r ibeh/,,7d /n c ,9/9c ' 7-he �,,.-ror o h , s �/eh-'c % X/P0P�/ tic 'w UO�/'hcv cv To /Y!Y Com pe rL �4 (over) 5', What are the names of county or district officers , servants or -emplgyees causing the damage or injury? P0-Ff A ' u AL'e/ ---------------- ----------------------------- Juri What damage or injuries do you c aim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage) ` n Ck;#fi p P e da �aJ( T Pr ro n-, f/ /0 A00-ow 6767K-, n O 7 ----------------------------------------------------------------- . How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) 6 7rra•41`o,) -From 6em -`op c&M e,r-.e. cc-m per T4s purch4std . $M Names and addresses of witnesses, doctors and hospit �s o e ra,m e W4- ---=------------------------------------------------------------------ �. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT $as SG P-,/, »e ofd — a6 oa FY0 en W or/G To e Govt. Code Sec. 910. 2 provides : "The claim signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf. " Name and Address of Attorney Claimant Signature Adress i^/ VV 111.41 y z p 69 sE� AdI'p-o, x — CA's Telephone No. Telephone No. 2. �-5�7 ? G NOTICE ,. '#Section 72 of the Penal Code provides: u,l . "Every person who, with intent to defraud, presents for allowance or or' payment to any state board or officer, or to any county, town, city str.4;ct,. ward or village board or officer, authorized. to allow-- or pay h same' if genuine,' any false or fraudulent claim, bill, account, voucher, r' or 'tinq, is guilty of a felony. j� „ r. 00045 CONTRA COSTA COUNTY r To Ellis B. Myers DATE August 20, 1984 Q, FROM Administrator' s SUBJECT Claim Form s. Office i . Lw The enclosed form is for your convenience in filing a claim for automobile damage. Please return the claim to the office of the Clerk of the Board of Supervisors. s.. ✓ �. SIGNED PLEASE REPLY HERE TO c% GJ�r� _S �17 . DATE AX 7e C"A Tj� m ' - I SIGNED . ::•�t, INSTRUCTIONS-FILL IN TOP PORTION,REMOVE DUPLICATE(YELLOW)AND FO ARD REMAINING \' ].'... - PARTS WITH CARBONS. TO REPLY, FILL IN LOWER PORTION AND SNAP OUT CARBONS. RETAIN {�r=.I ' TRIPLICATE(PINK)AND RETURN ORIGINAL. { '.y_.N FORM/A103 ®i 00048 r.t 1. ANN w TOP * GEM TOP SALES&SERVICE Roger Davis' A n d Je r v i ce 12637 San Pablo Avenue Assistant Manager ��1 Ol ��� 9y$� Richmond,California 94805 (']� D 415-233-9428 L7 jsa SmLL�.sman ovdca- ►est' c fsZLY'vi n►e- ' r�rder d� zc�d res5 Iw in by LI c P,o. Sox e92 reg. C' phonc-h•Mc �� S �� �K i_ �M� A-04t 1.OlUD1Ca� `leae 7/Lxk maid co I o r C L 5 C-X" U - 5lgi'�a. r� 00047 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD ACTION Claim Against the County, or District ) NOTICE TO CLAIMNT October 2, 1984 governed by the Board of Supervisors, ) The copy of-Ms s document mailed to you is your Routing Endorsements, ana boar., ,Lc1Lv or the action taken on your claim by the Action. All Section references are ) Board of Supervisors (Paragraph IV, below) , to California Government Coles ) given pursuant to Government Corte Section 913 and 915.4. Please note all "War "� Claimant: Eugene Allen Perkins y Counsel 1706 Hargrove street, #3 AUG 31 1984 Attorney: Antioch, CA 94509 Address: Martinez, CA 94553 Amount: $209.18 By delivery to clerk on Date Received: August 30, 1984 By mail, postmarked on August 28, 1984 I. FROM: Clerk of the Board ot Supervisors County Counsel Attached is a copy of the above-noted claim. Dated: August 30, 1984 J.R. OLSSON, Clerk, By ADeputy Jolene Edwards II. FROM: County Counsel : Clerk of the Board of Supervisors (Check only one) (�O 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. 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: rr'r L / K - % �= Deputy County Counsel III. FWN: Clerk of the Board TO: (1) County Counsel, (2) &unty Administrator ( ) Claim was returned as untimely with notice to claimant (Section 911.3) . F WARD ORDER By unanimous vote of Supervisors present This claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of a Board's Order entered in its minutes for this date. Dated: 11T 9 R.R. OISSON, Clerk, BY .. �/ /T �� //LC�r�, Deputy Clerk WARNING (Gov. Code Section 913) Subject to certain exceptions, you have only six (6) months from the date of this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. V. FROM: Clerk of the Board 40: (1) Canty Counsel, (2) County Administrator Attached are copies of the above claim. We notified the claimant of the Board's action on this claim by mailing a copy of this document, and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. ( ) A warning of claimant's right to apply for leave to esent a late claim was mailed to claimant. DATED: Del � ��_ J. R. ORSSON, Clerk, BY �x /�1/iX �'/ll�!!oC . Deputy Clerk cc: County Administrator (2) County Counsel (1) 00048 CLAIM la,14111V4 TU: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY Instructions •.:.o Claimant A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops must be presented not later .than the 100th day after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause ofaction. (Sec. 911. 21 Govt. Code) 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 (or mail to P.O. Box 911, Martinez, _CA) , 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 end of this form. RE: Claim by )Resery ling stamps c=e (Alen Pe�kirc ; I�ECEI�TED 1-70(akg3EQ%re St*.3 j Against the COUNTY OF CONTRA COSTA) �� 36 1984 1. R. OLSSON or DISTRICT) CLERK BOARS O, SUPERVISORS Fill in name) C` N, COSTA CO. ._ .. ...._. .De The -undersigned claimant' hereby Makes claim against the County of Contra Costa os the; bo � t►eid Da,Bt. kot.. the sum of $ and in support o t3s �a #n:`tP3Wiexr ` • alk­fa 'lowFs:. d y� --------------------------- - :- .----------- --------- - ��-- 1. When did the damage or injury occur? -{Give exact date -and hour) Awmhe'Fer-aira-fAiedamUL � 103 Cly - (Oo 30 ftrn e----n-------��-- ' ►_ _ �e or injury occur? (Include city and count }I p-SCU woad C'C� CC1S � ----------------------------._-_-_-_-------- 3. How did the damage or injury occur? (Give full details, use extra sheets if required) CaLLn , , Z (�3S C1 r' cbotvn YaSo noap w��Et1 a. T�`J ss PrI -6he he.r dtrec-G on f.6 -.,hreuj a - - - 8 PrCJke o►�-� c,�� sh�efd. S -�LLrr,ej +,yam j,seense �Ja r244rn ----------------------- �-w�-�h �be_C What particular act or omission on the part at county or district officers , servants or employees caused the injury or damage? . EXCeSs eve. Spm+. (over) 00049 S S. ' What are the names of county or district officers, servants or employees causing the damage or injury? F ------------------------------------------------------=------------------ 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage) j old ------------------H-o-w--w-a--th-e--amo--u-nt--c--a-i-m-ed-above computed---=-=n-c-ud-e-th-e-e--st----=---- imated amount of any prospective injury or damage. ) 8--. N-----ames------and----addresses--------- of w---- it-nesses-, d----- -----octors-------and-------hospitals----.------------- --I-'e rry j emu er a 100 I IC reS� � `y'' CQ I l `�s�- ------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Govt. Code Sec. 910. 2 provides : "The claim signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf. " Name and Address of Attorney Claimant' s Signature I-lo co 14a rcA race 3 Address t wlfim to Telephone No. Telephone No. y15'7`Jy3�$ 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, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account , voucher, or writing, is guilty of a felony. " 00010 WRITE IT! - DON'T SAY IT! 94849 CONTRA COSTA COUNTY }e ' TO Gene Perkins DATE Augnci- 9, 1984 FROM Administrator's SUBJECT Claim Fpm s Office If you wish to file a claim for windshield t damage, please complete the enclosed form and return it to the office of the Clerk of the Board of .Supervisors for processing. i. rf SIGNED x t y PLEASE REPLY HERE • TO Com. C.Q"21 �..al .nATE jet- It r: r r . ` r eY.kc-.41Z. a P -,- •.rte - - 1pa. SIGNED . xFm INSTRUCTIONS-FILL IN TOP PORTION,REMOVE DUPLICATE(YELLOW)AND FORWARD REMAINING _ �i.. 13i�'k PARTS WITH CARBONS. TO REPLY, FILL IN LOWER PORTION AND SNAP OUT CARBONS. RETAIN � . �r TRIPLICATE(PINKI AND RETURN ORIGINAL. 9'"[ FORM to 103 QS A =" 00051 . Delta Glass 615 "A"STREET ANTIOCH,CALIFORNIA 94509 r. NQ01679 (415) 757-5300 xk DATE r— /� 19 '.. , NAME ` C�Civc� (AGR, ADDRESS PHONE NO. Y JOB LOCATION PHONE NO. INS. CO. ON, DESCRIPTION AMOUNT _ 8o z. 3 a3 7f,76 �? / ( � G 3 i7 .• N �- e 000' a cE �E8,TIMATE E I STIM I ATE e ESTIMATE * ESTIMATE ESTIMATE o. Calif. Contractor Lic. 288900& 274322 SINCE 1946 CALIFORNIA'S LARGEST INDEPENDENTLY OWNED GLASS CO. AUTO -•- TUB & SHOWERENCLOSURES * ESTIMATE SUB EDT )in CUSTOM 'S NAME DA STREET 34 JOB NAM V CITY,STATE AND ZIP CODE JOB LOCATION PHONE JOB PHONE ES TE BY .. WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR: Y AKE TlYgEA MODEL This estimate covers only the Labor and Material listed below. Wom damaged parts not \ J ` evident on first inspection may be discovered after the work has been started. Such additional repairs will not be made unless authorized and are not included in this estimate. QUANTITY PARIORIZE O. DESCRIPTION LIST NET LABOR Zoe - LIP s. Axe 437'41�' ,S-5 s JJ i•I aft C4a r?d 1097 ADMIRAL GLASS COMPANY DISTRICT OFFICES TOTAL PARTS 1411: _ SAN DIEGO COUNTY (619) 263-2261 OAKLAND/EAST BAY (415) 935.1551 TOTAL LABOR 00 1316 National City Blvd., National City,CA 92050 2244 N. Main St., Walnut Creek,CA 94596 DEDUCTABLE OR DISCOUNT SEE REVERSE SIDE FOR SERVICE CENTER LOCATIONS TAX ADMsowwot4(7-93) ESTIMATE EXPIRES 30 DAYS.AFTER ABOVE DATE TOTAL d --------10.H53 .. . CLAIM BOARD OF SUPERVISORS OF OMURA C106TA COONTYr CAL11FORNIA BOARD ACTION Claim Against the County, or District ) NOTICE TO CLAIMANT October 2, 1984 governed by the Board of Supervisors, ) The oopy of this document mai ed to you is your Routing Endorsements, and Board ) 'hotic*'or me action raKen on your ciaum by the Action. All Section references are ) Board of Supervisors (Paragraph IV, below) , to California Government Codes ) given pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". Claimant: Walter Retzlaff f .•..,.n� ;1 l;_��d ..;; 106 Megan Court Attorney: Alamo, CA 94507 AUG 3 1 1984 Address: OF! c,:°lrj: ' Amount: unspecified By delivery to clerk on Date Received: August 31, 1984 By mail, postmarked on AucTust 30, 1984 - I. FROM: Clerk of the Board Ot Supervisors oun y Counsel Attached is a copy of the above-noted claim. 1,,� � Dated: August 31, 1984 J.R. M SSON, Clerk, By *ol�n-eEdwards (aDeputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors (Check only one) 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. 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: 7 24ez Deputy County Counsel III. FROM: Clerk of the Board 70: ( ) County Counsel, (2) ounty Administrator ( ) Claim was returned as untimely with notice to claimant (Section 911.3) . BOARD ORDER By unanimous vote of Supervisors present ( This claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of t Board's Order entered in its minutes for this date. Dated: OCT J. R. OESSON, Clerk, By ..tDeputy Clerk SING (Gov. Code Section 913) Subject to certain exceptions, you have only six (6) months from the date of this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. V. FROM: Clerk of the Board TO: (1) County Counsel, (2) County Administrator Attached are copies of the above claim. We notified the claimant of the Board's action on this claim by mailing a copy of this document, and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. ( ) A warning of claimant's right to apply for leave to esent a late claim was mailed to l --2-1 / DATID: 984 J. R. CZ.SSON, Clerk, B � .C� ��-� , Deputy Clerk cc: County Administrator (2) County Counsel (1) 10 D10� 1 4 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY Instructions •:o Claimant A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Sec. 911. 2, Govt. Code) 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 (or mail to P.O. Box 911, Martinez, .CA) . 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 end of this form. RE: Claim by ) Reserved for Clerk' s filing- stamps WA ER pe-tF_ I-AVF ' RECEIVED ) Against the COUNTY OF CONTRA COSTA) or DISTRICT) AUG 3/ 191241 Fill in name) ) J. R. OLSSON C RK BOARD OF SUPERVISORS The undersigned claimant hereby mf akes claim ag $ R f - ntra Costa or the above-named District in the sum o and in support of this claim represents as follows: ------------------------------------------- ---------------------------- 1. When did the damage or injury occur? (Give exact date and hour) h, jo-1 ZZ , Iga4 z Pm -----------T------------------------------------------r----------__---- 2. Where did the d(a�mage or injury occur(?� (Include city andlcounty) On ------------------------------------------ ----------------------------- 3. How did the damage or injury occur? (Give full details, use extra sheets if required) Q � r.cv. �wc.a.`aa.,r Xat -- —— — —----------------————--------------------------——--—--——----———----———-- —— —--——--—————— 4. What—par—--ticular act or omission on the part of county or district officers, servants or employees caused the injury. or damage? \ v G o+ti 4Q�r.yi bl►�ti .Sica,c-1 -bwGC.bCr 1 i+^la '1ca��C. (over) .5. fiat' are the names of county or district officers , servants or employees causing the damage or injury? (/t` -------------- ------------------------ ---------------------------- ---- 6. What damage or uries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage) J ee�.G r W`. .•�S� • i Zrj� 1C� Ve(`� 2.` CS��...2�C ��orv� ►Ja��;`x.25 V \1s6 „�r�G, - ---------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) ------------------------------------------------------------------------- 8. Na1mes and arddressesof witnesses, doctors and hospitals. -------------- ---------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT ************************************************************************** Govt. Code Sec. 910. 2 provides : "The claim the claimant SEND NOTICES TOc ' '(Attorney) or bk 00ne/pe�T%/Jn his behalf. " Name and Address of Attorney Claim Signature 14 C� mea.a ti Address lah•;�,CA �g5�� Telephone No. Telephone No. 8zq= 40 I� ************************************************************************** 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, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account , voucher, or writing, is guilty of a felony. " a t7 7 CLAIM BOARD OF SUPMFISORS OF CONTRA COSTA COUM Y, CAL1170MIA BOARD ACTION Claim Against the County, or District ) NOTICE TO CiAIMNU October 2, 1984 governed by the Board of Supervisors, ) The copy of th s document ma ed to you is your touting Endorsements, and Board ) notice of the action taken on your claim by the Action. All Section references are ) Board of Supervisors (Paragraph IV, below) , to California Government Codes ) given pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". Claimant: Charles C. Wade 16711 Marsh Creek Rd. , Sp 115 County Counsel Attorney: Clayton, CA 94517 Address: AUG 2 9 1984 Amount: $234.90 By delivery to clerk on Martinez, CA 94553 Date Received: August 27, 1984 By mail, postmarked on August 24, 1984 I. FROM: Clerk of the Board of Supervisors County Ccunsel Attached is a copy of the above-noted claim. Dated: August 27, 1984 J.R. OL.SSON, Clerk, By ,,Ccs (o Deputy Jolene Edwards II. FROM: County Counsel TO: Clerk of the Board of Supervisors (Check only one) ( ,() 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. 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: ��_L/ c:� Deputy County Counsel �- III. FROM: Clerk of the Board TO: (1) County Counsel, (2) County Administrator ( ) Claim was returned as untimely with notice to claimant (Section 911.3) . IV. BOARD ORDER By unanimous vote of Supervisors present (l) This claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of toe Board's Order entered in its in f �ttaj,s date. Dated J. R. OLSSON, Clerk, y l �G(/L�/CC�C� , Deputy Clerk �t39 WhTVING (Gov. Code Section 913) Subject to certain exceptions, you have only six (6) months from the date of this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. V. FROM: Clerk of the Board TO: (1) County Counsel, (2) County Administrator Attached are copies of the above claim. we notified the claimant of the Board's action on this claim by mailing a copy of this document, and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. ( ) A warning of claimant's right to apply for leave t resent a late claim was mailed t imant. c DATED: 2 1984 J. R. OLSSON, Clerk, By C (2 s� ; Deputy Clerk cc: County Administrator (2) County Counsel (1) 00055 CLAIM .CLAIM TO: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY Instructions -co Claimant A. Claims relating to causes of action for death or for injury to person or to personal property or grow0ing crops must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Sec. 911. 2, Govt. Code) 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 (or mail to P.O. Box 911, Martinez, _CA) • 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 end of this form. RE: Claim by ) Reserved tamps I VE A11U---70U4 Against the COUNTY OF CONTRA COSTA) J.A. OLSSON Or DISTRICT) CLERK B RD F SUP VISORS T T 11 (Fill in name) ) U The undersigned claimant hereby cakes claim against the County of Contra Costa or the above-named District in the sum of $ _Z3 4. 2 O and in support of this claim represents as follows: -------------------------------------------------------- dam en did the or injury occur? (Give exact date and hour) I}? re 11 3onPM FA xiT ullk)b0 1 0,0 /973 e6- MiDbW9 i �✓A S c 44c, f'r 8V•F°cir� g - Fsk /fit 1, SPS OA) If 6f. 6LCArrivu 4S C-4*<A'ED By focq'•S ON S- µ ----------- ------------------------------ --------------------------- 2. Where did the damage or injury occur? (Include city and county) DN L)ASC c v /Qd bjllEQE C OUA/T y a.1 A4 A T&,10 "/sc- S UFCT11 of A04 wi;N RvcJr,(- oi< (' OA)f4A CosiA CuoAviQ11 APh#ox JQMIcs ' ----H--------------------------------KQ Art- 6.kiw-w-ng6 1Z�:_11� CC., .Q_.AA--- 3. ow did the damage or injury occur. (Give full details, use extra . sheets if required) OA) jH� 1y73 M;G o1iD�t r j�9Arrt/ wADi WAS COM W& NohE 1=-4 os-1 wOAh-, �F05,k &A*i 'T/u& rok RoM kirPW4 AAkAoY 11��'�-P sNE wAS ,4)_UV6 To hoc AFD rWooe-,J '4o'4'6 coasr v­ WWJsynct0 "s CAACKFA AV g roveK yAuZlAc, RocK id NE CCU//T)/ JO& CoAtiat_ ewH c_' rJ - -- --W-h--a-t-p-a-rticular act or omission on the part of county or district officers , servants or employees caused the injury or damage? EMP/_o y6Fs 4i0 ti o r s4 o o 3 6-a'4e-1_ r0 vcf-S 00/p jig O/L riPUGl�s �ilJovG !y a L9 y- Aocfr wF'er Cor ./ ICl4oM TN-E OPA1si6- �i��ci/vw rcJ�LG C.05 wPQE ic6ow/iria cO� (over) TR uc- -S 00006# CwS% .Zoa)t t)00�- 5. 4Wha't are the names of county or district officers, servants or . employees causing the damage or injury? ------------------------------------------------------------------------- 6 . What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage) A y v NAi e y G-LASS � !f/�,� WA�� � BQEi�.Two 0,0 c A, 94-6-13 ------------------------------------------------------------------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) ----- NI-4--- ------ - - ------------- 8. Names and addresses of witnesses, doctors and hospitals. STATE ,�AOn /QJTO SUS I S G 01 ro pAy Fo�P N $,OEA)b -rVOr yr j /J S M ------------------------- --- ---- ------------------------------------i ' (; List the expenditures-you-made on account of this accident or injury dsy DATE ITEM AMOUNT S Govt. Code Sec. 910.2 provides: "The claim signed by ' the claimant SEND NOTICES TO: (Attorney) or by/some Verson on his behalf. " i Name and Address of Attorney aimant' s Signature /b 9// HhAU Ck iM. i S,6 //S Address f z,4Vfax) GA 9 6'i 7 Telephone No. Telephone No. S—7 _ 4 990 ************************************************************************** NOTICE i 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, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is guilty of a felony. " C o ry I Thi tvlAJ© sc',4) CG S wAtlEs 6C EAG C/Jr/-1/u0 ,B A o tvht Il-� F"9c �c�QCJr�c � r.�E c�uti��y -rW r3Ull-,q 711 C / 2cJ� i Co,*41A)C- XRom r//�F _rW;F,L Ah i C S,F4WO4L Xoc,s off'-rs REAS LO tvp Jvis "�D i/Ic �Jl�vasN ;�o �Mc C�1 L T�Q cJ G h (AA 5 C9 o r',v� 4Ao vu6 o oQAle:�e c71`I- r(2 CvC)A. r! Wds ro ecfiST I 1 i i I I ' I i I 1 i I 1 I I . CONTRA COSTA COUNTY TO Charles Wade DATE August 8 , 1984 FROM Administrator' s SUBJECT Claim Form Office I Enclosed is the claim form requested on this date. Please complete and sign the form and return it to the office of the Clerk of the Board of Supervisors for processing. I I I ' i f - I { n SIGNED PLEASE RE LY HERE j Q C �(' 7 gat J TO �(J C S /G D DATE V —�J o fIC y vv `' iA) c o 0.41 gill OA)eJ ,0/REcrloAl ©A),w `0 �,��cK 'lffQouaa JiE COuS% 20Nra4 a4 i n V" I sr- I SIGNED4, r INSTRUCTIONS-FILL IN TOP PORTION,REMOVE DUPLICATE IYELLOWI AND FORWARD REMAINING PARTS WITH CARBONS. TO REPLY, FILL IN LOWER PORTfON AND SNAP OUT CARBONS. RETAIN I �? TRIPLICATE IPINKI AND RETURN ORIGINAL. FORM M103 Pi � I CLAIM BOARD OF SVFMMSORS OF CORM COSTh OyqN. CALnmmIA BOARD AMON Claim Against the County, or District ) NOTICE TO CLAIMANT October 2, 1984 governed by the Board of Supervisors, ) The copy of th s document marled to you is your m)ucing Endorsements, and Board ) notice of the action taken on your claim by the Action. All Section references are ) Board of Supervisors (Paragraph IV, below) , to California Government Codes ) given pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". Claimant: Hugh Watkins 2412 Martinez Avenue County Counsel Attorney: Martinez, CA 94553 AUG 2 9 1984 Address: Martinez, CA 94553 Amount: Unspecified By delivery to clerk on August 27, 1984 Date Received: August 27, 1984 By mail, postmarked on - I. FROM: Clerk o t e Boar ot Supervisors County Counsel Attached is a copy of the above-noted claim. D Dated: August 27, 1984 J.R. OESSON, Clerk, By .�L �� � Deputy Jolene Edwards II. FROM: County Counsel TO: Clerk of the Board of Supervisors (Check only one) ( ) 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. 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: V2. el Z By: « Deputy County Counsel III. FROM. Clerk of the Board 70: (1) County Counsel, (2) County Administrator ( ) Claim was returned as untimely with notice to claimant (Section 911.3) . IV. BOARD ORDER By unanimous vote of Supervisors present (�) This claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of aBoa 's Order entered in its minutes for this date. Dated: J. R. OESSON, Clerk, By ,(( l/ltL �, Deputy Clerk SING (Gov. Code Section 913) Subject to certain exceptions, you have only six (6) months from the date of this notice was personally served or deposited in the mail .to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult anattorney, you should do so immediately. V. FROM: Clerk of the Board TO: (1) County Counsel, (2) County Administrator Attached are copies of the above claim. We notified the claimant of the Board's action on this claim by mailing a copy of this document, and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. ( ) A warning of claimant's right to apply for leave to esent a late claim was mailed to claimant. / DATED: OCT 21 BE J. R. OLSSON, Clerk, By i /�Y/ Deputy Clerk cc: County Administrator (2) County Counsel (1) - CLAIM floos CIiAIM TO: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY Instructions :o Claimant A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Sec. 911. 2, Govt. Code) B. Claims must be filed with the Clerk of the Board of Supervisors. at its office in Room 106 Count ministration Building, 651 Pine ar finez , CA 94553 (or mail to P.O. Box 911, Martinez, CA) 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 end of this form. RE: Claim by ) Resd2rup ing stamps Etc Against the COUNTY OF CONTRA COSTA) Ot:;Ori or DISTRICT) CLERK 2D O` SU PE kviSGRP Fill in name) ) s --• •••-• ... .... „r The undersigned claimant hereby cakes 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) /r:> ---------- -- --------------------------- --------------------------- 2. Where/ did the damage or injury occur? (Include city and county) -------------t----------------------------------------------------------- 3. How did the damage or injury occur? (�Giv�e fudll det/ailes, useQextra sheets if required) f�� ` Lr" Z C/ 7t�ti /� -------------------------------------=---------------------------------- 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? �i,.c-� �-,_,7Q�� ,,.a�..-.�.7l-tc�,ti. ,�,v.Gt� G,U-�-� �i.e� /�'�.✓J (over) 00061 -. ;. What are the names of county or district officers, servants or .employees causing the :damage or "injury? - -------------------------------------------------------------------- 6-. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage) 410 U $ ------------------------------------------------------------------------- 7. How was _the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) e J I �. ---------------------------------------------------------=--------------- $. Names and addresses of witnnes-ses, doctors and hospitals. 9. List the expenditures you made on t accounof this accident or injury: DATE ITEM AMOUNT Govt. Code Sec. 910.2 provides : "The claim signed by the claimant SEND NOTICES TO: (Attorney) or b 'some ers`oonn mon his behalf. " Name and Address of Attorney laimant' sSignature / A ress /1 _ i Telephone No. Telephone No. ************************************************************************** NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is guilty of a felony. " 0©062 00i0o00 '�, Yom. im. "a C? tr. X15" FJt.-. �'•i jj��1\f•,1'r {-. :m A0.L 1' y t 4lOOo40 0 m 1T1 I.X a 1• L7GD v �. m. 'zp r' pF` 17U 1itJWrU a: 2 µ .� y �WQT' ,m- 00 � JE' +.��.{ ..M:`ti �t• it3t7ltll09C4 r +xt a Z 0>0 t'.�' -�j1_'3 a� ? 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E %c J� f - �'�s. 00063 STATEMENT OF ACCOUNT PAYMENTS AND CHARGES RECEIVED AFTER THE DATE OF THIS STATEMENT WILL BE REFLECTED ON THE NEXT STATEMENT. { .n�alsats5 ?Utt 1t 14uuh;yt( utibpr-risita�r) �sv ars tii /troy rrYr , ` ' +LtAbk MAKS Gnit`l h +- ' 1-AbLL AVLA5" 4 -1u1;146L E�� k .. PATIENT 'V4 A t n l'il s -11(11)1 `, T S MT. i eA 4)V 5 . . 06/04d/G 01 `LI�ILH(yENIGY +k(v, U 4b•ti� ub Q41: s U kktaU VILoe A ku.ou lira/ur/,'U �,l.,,n#A.r„�Ai:t i►i,t.k,.iA�L•p•• c�;�.h . ; u�/�r�/� �1 =cr4� r ;uiAP' . UrA�•ch � •. ,�, �: ilia/lic;l tips)b tit.)/oe/u uC) i6ie/d V . hAJ 51 •LUI VL:C i b. 7u.37 un/u�/i>, ul iti��.'k. 'G u1,�r.L•t:•Ilc. L!?`+.4� '' ua/u2/b U;1 KN t l.UrIT-L:� uo/iid/o ul ;F1i KLL -LLK1'.c,t;lc y.1 .'itl EST. INS. Q .I)V DUE O , l ' STMT. ADM.EOR INFORMATION VgC1tDATEU �I DAT - VTELEPHONE "6 ` 4 DISCHARGE DATE FED. I.D.II 946003847 jj -Ft LI(�li A'),%4 11'(.1 W 'kPATIENT NOiA�ERTStEEFR 6 T 5 LUEABYR ON All INQUIRIES ,• :~ 1 G 1-1 f1 K 1 11-4 K L A Y t: MT. DIABLO HOSPITAL MEDICAL CENTER �cd:i411F%Lill ii .ti4y5 S P.O. BOX 44261 - SAN FRANCISCO,CA 94144 OPERATED BY THE MT DIARLO HOSPITAL DISTRICT ,�__,•_„ W A N 1 � 1 1 1 M i Oo O CID1 W W lA 1 C�..: V ,. C O O O Ly. •�� .. 'A•;:J•r , 1� V' :1• �. 't' P•� ;4... f �' •' . . yq,. � c J - H H ^c.. A > r'; 1� H y V 1 ZLa 04 10 y� 1 f z 4 O O 1 n o o O 1 w 90064 CLAIM BOARD OF SOPEM71SORS OF COP m COSTA CO@11R. CAL11MMIA BOARD Claim Against the County, or District ) NOTICE Ta CLAIMANT October 2, 19 governed by the Board of Supervisors, ) The Dopy of th s document ma ed to you is your "- Ztouring wKiorsements, and Board ) notice of the action taken on your claim by the Action. All Section references are ) Board of Supervisors (Paragraph IV, below) , to California Government Codes ) given pursuant to Government Code Section 913 " and 915.4. Please note all 'Warnings". Claimant: Rudy G. & Dollie A. Wilson County Counsel 766 Vaqueros Avenue Attorney: Rodeo, CA 94572 AUG 2 9 1984 Address: Martinez, CA 94553 Amount: $5,115.00 By delivery to clerk on Date Received: August 27, 1984 By mail, postmarked on August 24, 1984 I. FROM: Clerk-o t e Board ot Supervisors County Counsel Attached is a copy of the above-noted claim. Dated: August 27, 1984 J.R. OISSON, Clerk, By Deputy Jolene Edwards II. FROM: County Counsel TO: Clerk of the Board of Supervisors (Check only one) ( ) This claim canplies 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. Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3) . ( ) Other: Dated,: By: Deputy County Counsel III. FROM: Clerk of the Board TO: (1) County Ccunsel, (2) County Administrator ( ) Claim was returned as untimely with notice to claimant (Section 911.3) . IV. BOARD ORDER By unanimous vote of Supervisors present This claim is rejected in full. ( ) Other: I .certify that this is a true and correct copy of rd's Order entered in its minfor this date. r Dated: PT 2 1984 J. R. OESSON, Clerk, y /11,1e1X--,1 , Deputy Clerk WARNM (Gov. Code Section 913) Subject to certain exceptions, you have only six (6) months from the date of this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in ocnnection with this matter. If you want to consult an attorney, you should do so immediately. V. FROM: Clerk of the Board TO: (1) County Counsel, (2) County Administrator Attached are copies of the above claim. We notified the claimant of the Board's action on this claim by mailing a copy of this document, and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. ( ) A warning of claimant's right to apply far leave to resent a late claim was mailed to claimant. DATED:- 01;1 2 19 4 J. R. OISSON, Clerk, BY' Deputy Clerk cc: County Administrator (2) County Counsel (1) 0 O 0 CLAIM CLAIM TO: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY Instructions to Claimant A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action.' (Sec. 911. 2, Govt. Code) 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 (or mail to P.O. Box 911, Martinez, .CA) , 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 ent'_ty, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims , Penal Code Sec. 72 at end of this form. RE: Claim by ) Reser v f C Is filing stamps RUDY G. WILSON and ) DOLLIE A. WILSON RECEIVED .. Against the COUNTY OF CONTRA COSTA) r,( (� oZ7 `334 or DISTRICT) J. R. OLSSON Fill in name) ) CLERKBOARD TRA OOSSA�CO. ISORS The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 5,115 .00 and in support of this claim represents as follows: ------------------------------------------------------------------------ d 1. When did tY�e amage or injury occur? (Give exact date and hour) Damaged was noticed end of April 1984; Cause of damaged was before that time period. -----------r------------------- --------------------------------- -------- 2. Where did the damage or injury occur? (Include city and county) 766 Vaqueros Ave. , Rodeo, CA. ( Contra Costa County) ----H- -- - ---------------------------------------------- 3. ow---did----the-----dam--age=-o-r-injury occur? (Give full details, use extra sheets if r uired) From Storm Drain 24'! that could be pluged up or resu t om roots of pine trees growing on count property. See attached GCI S inspection service. - =------------------ 4-.---What----particular------------act----or---omission---------on---the---part-----of----c-ounty or district - officers, servants or employees caused the injury or damage? Checking and maintaining storm drain and pine trees. 00066 (over) =5.. - What are the names of county or district officers, servants or employees causing the damage or injury? Contra Costa County ---------=-----------------------------=---------------------- 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage) Concrete slabs directly adjacent to house have settled & now drain towards house. Walks & Patio should be repair. Hot tub & surroundinj concrete deck repaired. ------------------------------------------------------------------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) See attached est. from Dennis and Son Cement ------------------------------------------------------------------------- 8. Names and addresses of witnesses, doctors and hospitals. ------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Aug. 8, 1984 reportlI�II� ************************************************************************** Govt. Code Sec. 910.2 provides : "The claim signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf. " Name and Address of Attorney ` C1 imant' s Signature 766n ea GP ue ,.Added ss ` .�at�� � • 9`/S7� Telephone No. Telephone No. 7 a,+, 4g 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, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is guilty o ; a felony. " 00067 r.. GENERAL CONTRACTORS (415)849Pul 1055 GCIB INSPECTION SERVICE 408 131h St.. Oakland, CA 94612 79 'i Client Rudy G_ Wilson Date August 8. 1984 J. Fee S175_00 Property Address 766 Vaqueros Avenue r Rodeo i; ',w Realtor Rudy D7i 1 con, Security Pari fir� Phone 799-79$S 4 Pinole I OVERALL STRUCTURE There are several areas of the building we do not inspect. Although we make a ix visual examination, we do not deface or probe into window or door frames or decorative - 'trim. The interior of hollow walls, and underground gas lines, are inaccessible for inspection. We do not move built-ins, furniture, appliances, raise floor coverings, or remove storage. We are not structural pest control inspectors. THIS REPORT IS NOT A BID OR SOLICITATION FOR WORK; NEITHER IS IT A GUARANTEE OF THE BUILDING OR ANY OF ITS +r PARTS. We recommend that the client be present for the inspection. !F jf YES NO NOTE: 1. Termite report — '' 2. Estimated age of building 13 years FOUNDATION SYSTEM Is 3. Access to crawl space — 3. Crawl space, now dry, shows evidence of moisture. Con- 4. Ventilation �L — Crete patios & walks are 11 5. Foundation above grade — cracked and have settled in !• 6. Earth/wood contact back & on north side of i — --X- house. Concrete slabs dir- 7. Footings need repair — �� ectly adjacent to house have 8. Deteriorated sills settled & now drain towards — -X- house. WALKS & PATIO SHOULD Ii 9. Sills bolted to foundation _X_ BE REPAIRED AS NECESSARY TO 10. Retaining walls plumb NA RESTORE PROPER GRADE & DRAIN AGE. Source of excessive 11. Slab/rat proofing — moisture may be a 24" conc- i 12. Visually apparent settling rete storm drain under prop- erty line on north side. f 13. Visually evident cracks — RECOMMEND THAT PROPER COUNTY y AUTHORITIES BE CONTACTED TO 14. Perimeter foundation reinforced concrete . CHECK THIS STORM DRAIN. 't ' ROOFING SYSTEM Hot tub & surrounding concrete 15. Estimated age of roof 13 years deck have also settled. REPAI AS NECESSARY after source of i 16. Type of roof cedar shake moisture (& therefore settle- 17. Evidence of ceiling leakage — ment) has been corrected. - Settlement may also have re- 18. Evidence of skylight leakage — X sulted from roots of pine 19. Evidence of wall stains X trees growing in back of hous r, 20. Repair gutters/downspouts — x 00068 Property Address 766 Vaqueros Ave2 , Rodeo Date Aug. 8 , 1984 Page 2 YES NO NOTE : t STRUCTURAL SYSTEM t 21. Visual deterioration of members _ X 22. Substandard practice _ X i' 23. Changes to structure X 24. Ceiling/wall cracking _ X 25. Deteriorated landings/decks — X :I PLUMBING SYSTEM 26. Supply lines/copper X Toilet in hall bathroom is 27. Supply lines/galvanized X loose. 28. Water heater Hall bath tub & master bath shower & shower door need a. Vented X caulking. b. Pressure release valve X _ Rug on floor in master bath room has water stains. w 29. Low water pressure X RECOMMEND PULLING UP RUG s. 30. Leakage in visible supply lines _ X SEALING & REPAIRING FLOOR 31. Drainage notably slow X BELOW, THEN REPLACING RUG. 32. Leakage in trap/exit lines _ X 33. Tub/shower needs caulking X ELECTRICAL SYSTEM 34. Service size 100 amps 35. Service age original Air conditioner will not turn 36. System altered on. REPAIR AS NECESSARY. 37. Open junction boxes HOUS-r SERVICE CHECK POINTS 38. Heating/electrical _ X 39. Heating/gas X _ 40. Fireplace existing x _ a. Recommend further inspection X 41. Patio/sidewalk deteriorating X — 42. Handrails/guardrails NA } 43. Fireguard system X 44. Deadbolts/burglar alarm x 45. Energy measures recommended X Signed/ /6UJ Inspector F069 DENNIS AND SON CEMENT (707) 448-4497 (415) 232-2183 PROPOSAL and,CONTRACT f State License 354450 Name:— XO/ L.S,2\ --------Address: rw -7; _6/60P�one: "Oro OV! A TOTAL PRICE This proposal mi e in UDlicate. The return to us of one copy with your signature shall constitute a contract. Date submitted: Accepted By: CONDITIONS It is understood and agreed that we shall not be held liable for any loss,damage or delays occasioned by fire,strikes,or material stolen after delivery upon premises,lockouts,acts of God,or the public enemy,accidents,boycotts,material shortages,disturbed labor conditions,delayed delivery of materials form seller's suppliers, force majeure, inclement weather, floods, freight embargoes, casues incident to national emergencies, war, or other causes beyond the reasonable control of seller,whether of like us or different character,or other causes beyond his control.Prices quoted in this contract are based upon present prices and upon condition that the proposal will tz accepted within thirty days. Also general conditions which are standard for specialty contractors in the construction industry. Cracks caused by earth movement cannot be guaranteed. Should any legal action be brought by the parties hereto,to inforce or interpret the provisions hereof,the prevailing party shall be entitled to recover in ad- dition to his costs, reasonable attorneys fees to be determined by the court. NOTICE TO OWNER Contractors are required by law to be licensed and regulated by the Contractors'State License Board.Any questions concerning a contractor may be refer- red to the registrar of the board whose address is: Contractors' State License Board, 1020 N Street,Sacramento,California 95814 "Under the Mechanics'Lien Law,any contractor,subcontractor,laborer,materialman or other person who helps to improve your property and is not paid for his labor, services or material, has a right to enforce his claim against your property. . "Under the law,you may protect yourself against such claims by riling,before commencing such work or improvement,an original contract for the work of improvement or a modification thereof,in the office of the county recorder of the county where the property is situated and requiring that a contractor's pay- ment bond be recorded in such office.Said bond shall be in an amount not less than fifty percent(5007o)of the contract price and shall,in addition to any con- ditions for the performance of the contract, be conditioned for the payment in full of the claims of all persons furnishing labor, services equipment or materials for the work described in said contract. OCA 70 CLAI CONTRA BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA k BOARD ACTION Claim Against the County, or District ) NOTICE TO CLAIMANT October 2, 1984 governed by the Board of Supervisors, ) The copy of this document mailed to you is your Routing Endorsements, and Board ) notice of the action taken on your claim by the Action. All Section references are ) Board of Supervisors (Paragraph IV, below), to California Government Codes ) given pursuant to Government Code Section 913 and 915.4• Please note all "Warnings". Claimant: Todd Lindsey 120 Alamo Square Attorney: Alamo, CA 94507 S t P 1 .:., 1984 Address: Amount: Unspecified By delivery to clerk On September 17, 1984 Date Received: September 17, 1984 By mail, postmarked on I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. Dated: Sept. 17, 1984 PHIL BATCHELOR, Clerk, By � L Deputy UJolene Edwards II. FROM: County Counsel TO: Clerk of the Board of Supervisors (Check only one) (X) 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. 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: 2 Deputy County Counsel III. FROM: Clerk of the Board TO: (1) County Counsel, (2) ounty Administrator ( ) Claim was returned as untimely with notice to claimant (Section 911.3)• IV. BOARD ORDER By unanimous vote of 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 mint6el fqr �tktis date, r � Dated: G yii4 PHIL BATCHELOR, Clerk,� ���� �C ��r��,��, Deputy Clerk WARNING (Gov. Code Section 913) Subject to certain exceptions, you have only six (6) months from the date of this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. V. FROM: Clerk of the Board TO: (1) County Counsel, (2) County Administrator Attached are copies of the above claim. We notified the claimant of the Board's action on this claim by mailing a copy of this document, and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. ( ) A warning of claimant's right to apply for leave t present a late claim was mailed to cy}. imant. DATED: ��+' 2 }984 PHIL BATCHELOR, Clerk ���� /.��jy/,.c , Deputy Clerk cc: County Administrator (2) County Counsel (1) 00071 CLAIM Ci.JjTM TO: ' BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY r Instructions -:o Claimant A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Sec. 911. 2, Govt. Code) 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 (or mail to P.O. Box 9111 Martinez, CA) . 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 end of this form. RE: Claim by ) Reser g stamps DD1� L /N DSS ) Again6t the COUNTY OF CONTRA COSTA) CLER 0-11V or 5 or DISTRICT) Ff.f(} Fill in name) ......................pe ur. ) The undersigned claimant hereby cakes 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) #761d-e.c tq Z Z 31000 Pm -----------•'•----------- ---- ------ — ------ ---- --- ------ --- — — ' 2. Where did the damage or---in—jury—occur?-- (Include—city—and—county)--- Pn V a t&4_1 AgeteL A&wzo etntt4, e&de4_ ------------------- -------------------- ----How- d--i-d--th-e---d-am--a-g-e--o-r--i-njury occur? (Give u-- details, use extra sheets if required) ,,- W Gy� CAJj _" 1e64eQ . C � u J� guw-L kntd P ,C �R 5(u eu Tt (d JtauLtsut v� d--� (z vy c,k - - - &t&d amd Yr1Llm G h.�,�1 , - --------------------------o------------------ ------z------------- ----- 4. What particular act or mission on the part of county or district . officers , servants or employees caused the injury or damage? 00072 (over) .y�...- ._.. -... _ ..r... ....�-, .-r. ...s..a. ... " . ...'..v... • � _ `.�\ •t-nr.ice- n .. r.-_ .. .. ...-..._ S. :.Wiliat ,are the names 'of county •or •district 'officers , servants or ,;employees causing the damage or injury? 6--. Wh------ atda----mage-----or---in--j---uries----do---you-------claim----------resulted?-----(Give-----full----------extent---- of injuries or damages claimed. Attach two estimates for auto damage), V�-- ------------------------------------------------------------------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) Z ------------------------------------------------------------------------- 8. Names and addresses of witnesses, doctors and hospitals. K,_CL4 160 L/ v VkQ 6LIL �U-.LU 6'a,X15 ------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Govt. Code Sec. 910. 2 provides : "The claim signed by the claimant SEND NOTICES TO: (Attorney) or b some erson on his behalf. " Name and Address of Attorney Claimant' s SignaiYure Address Telephone No. Telephone No. _ ��j� — (6 qS 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, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is guilty of a felony. " 00073 INVOICEIwimm No. STRICTLY MOBILE GLASS 64 MONUMENT PLAZA PLEASANT HILI„ CA 94523 (415) 676-MS9 I SOLD TO SHIP TO 44A ACUSTOMER'S ORDER - SALESMAN TERMS SHIPPED VIA. - F.O.B. DATE ol ZI Ft r Is; Xp Is Pp (� ® 75726 POLY PAK (50 SETS) 71P726 mini . - ... . 00074 ALI reolvel glass,lne. 400 FRANKLIN STREET. P.O. BOX 657, OAKLAND. CA 94604.(415) 834-7841 Aug. 27 , 1984 Todd Lindsey 120 Alamo Sq. Alamo, CA Replacement windshield for 1983 BMW Model 320i FCW 328 Shade Labor and Material $260.44 Judith McKay Cobel Glass 000, 75 AMENDED * CLAIM q CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTIY, CALIFORNIA BOARD ACTION Claim Against the County, or District ) NOTICE TO CLAIMANT October 2 , 1984 governed by the Board of Supervisors, ) The copy of-ga—sdom-m—n—tm-aTled to you is your Routing Endorsements, and Board ) n Lue u4 cne au,-ton careen on your claim by the Action. All Section references are ) Board of Supervisors (Paragraph IV, below) , to California Government Codes ) given pursuant to Government Code Section 913 and 915.4. Please note all Claimant: Robert Polanco 4619 Mira Loma Attorney: Castro Valley, CA 94546 AUG 23 1984 Address: Via County Counsel Amount: Unspecified By delivery to clerk on August 22, 1984 Date Received: August 22, 1984 By mail, postmarked on I. FROM: Clerk of the Boar of Supervisors County Counsel Attached is a copy of the above-noted claim. Ldc�-� Dated: August 22, 1984 J.R. OISSON, Clerk, By46e� Deputy o enEdwards II. FROM: County Counsel : Clerk of the Board of Supervisors (Check only one) (` ) 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. Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3) . ( ) Other: Dated: - By: Deputy County Counsel III. FRCM: Clerk of the Board TO: (1) County Counsel, (2) County Administrator ( ) Claim was returned as untimely with notice to claimant (Section 911.3) . IV. BOARD OBER By unanimous vote of Supervisors present ( This claim is rejected in full. ( ) Other: I certify that this is a true and correct copy oft Board's Order entered in its minuftjfor % date. � ` Dated: k`! Jr. R. OLSSON, Clerk, By � / C lC� (�C/Deputy Clerk MING (Gov. Code Section 113) Subject to certain exceptions, you have only six (6) months from the date of this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. V. FROM; Clerk of the Board TO: (1) County Counsel, (2) County Administrator Attached are copies of the above claim. We notified the claimant of the Board's action on this claim by mailing a copy of this document, and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. ( ) ALTiman 4w,arning of claimant's right to apply for leave to resenn/t� a late claim was mailed 1 t DATED: u 1%4 J. R. OESSON, Clerk, By / .CL. '-ill � s'�, Deputy Clerk cc: County Administrator (2) County Counsel (1) CLAIM CLAIM TO: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY Instructions -.:o Claimant A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Sec. 911. 2, Govt. Code) 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 (or mail to P.O. Box 911, Martinez, .CA) , 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 end of this form. RE: Claim by )Reser e�Cl� �� g stamps ( g/4 Loma -��-� ) 4 Against the COUNTY OF CONTRA COSTA) J. R. OtS OJ CLEV BOARD OF Sl!?c^V;50^n5 or p p — DISTRICT) '7RA BY- . . Fill an n me) ) 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 dad the damage or injury occur? (Give exact date and hour) . --------———T——--—----——-------------——---—————--——----—---—---c- ---;—--— 2. Where dad thee or injury occur/ oTlQude c an �unty)---- ------------------------------------------------ ------- -------. How did the damage or injury occur? (Give full details, use extra sheets if required) J -----------/------------------------------------------------------------ 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? (over) �. e _ Z �4�0 � . 4- � 00077 - . 5.,'�What are the names of county or district officers, servants or ;. employees causing the damage or injury? --.--W--a--d-a-m-a-g-e--o-r--i-n-ju-r-ie--s-d-o--y-o--u--- -im---r-e-s-u-l-te--d----(G-iv-e--u-- -ex-t-en-t ---- of injuries or damages claimed: Attach two estimates for auto damage) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) ------------------------------------------------------------------------- 8. Names and addresses of witnesses, doctors and hospitals. ------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Govt. Code Sec. 910.2 provides : "The claim signed by the claimant SEND NOTICES TO: (Attorney; or by someertson on his behalf. " IL Name and Address ^_ Attorney G Clai'mant's Signature . �6 A dress Telephone No. Telephone No NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or . for payment to any state board or officer, or to any county, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is guilty of a felony. " ji cc W 61 ir JU .J cu� aW CW M, AaW05 Lu M J, oi!?Q Ill s smo IN z oi ti N S� co I-L 25 lu 0 41 00 �cv a I f ie z Ly 0007'8