HomeMy WebLinkAboutMINUTES - 01151985 - 1.18 CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
BOARD ACTION
Claim Against the County, or District ) NOUCE TO CLUMANT January 15, 1985
governed by the Board of Supervisors, ) The copy oft s ocument 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: M. O. Ratto
245 Pleasant Uiew Drive Coulity Counsel
Attorney: Pleasant Hill;, California 94523 DEC 17 1984
Address:
I
Martinez, CA 94553
Amount: $9..00 By delivery to clerk on
Date Received: December lo, 1984 By mail, postmarked on n nPmhPr ti, »a4
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of� the above-noted claim. y�
Dated: Dec. 10, 1984 PHIL BATCHELOR, Clerk, By (o Deputy
*Joene 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 claimants 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 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 the Board's Order entered in its
minutes for this date.
Dated:,1 . 1.1; 12P", PHIL BATCHELOR, Clerk, By 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.
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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 Boardfs copy of this Claim in accordance with Section 29703.
( ) A warning of claimant Is right to apply for leave to present a late claim was mailed
to claimant.
DATED:_ ,A N,I 16 1-qpq PHIL BATCHELOR, Clerk, By _ , Deputy Clerk
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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)
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B. Claims must be filed with the Clerk of the Board of Supervisors
at its office iniRoom 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 ) Reserve o � er.c� g stamps
Against the COUNTY OF CONTRA COSTA)
or DISTRICT) D01 ;� zrsca�
(Fill in name) -
The undersigned claimant hereby i,lakes claim against the County of Contra
Costa or the above-named District in the sum of $ �i
and in support of this claim represents as follows:
------------------------------------------------------------------------
1. When did the damage or injury occur? (Give exact dat/e and hour}
(j , / Pr �t" yL A
� � p � ,�\'7 plc' G,,� L C, , � �1,s� G, y tet.r P —
/�hC``{�1� ,S'•�ch' > �c( Y'c�c►�c� V i� ti•D -1 S� c.�] v c' 1 I ►� rC�L'at—s-l. �'
--------------------------------------------------------- ------
2. Where did the damage or injury occur? f (Include cit and county) r ,
�c�4�FS — 9J1� CC►ur� � ¢Zr� YIE:V, lb �S . G'L! C' Pt
Ci `�` �t
S n•qd �r�yh� S,'did Or�J ns fQ t,,r /� 1�`Y E c
-------------------------
3. How did the damage or injury occur. (Give full details, use extra
sheets if requ red) II
a ti
UL PI a
Ic t/� S-Ei•� E' �i t^F_ Lh8 L'-� rte. �i"1Eu . UJI o �_-E�� - �JCti�t� �1'�S�--_
4. qE------------------------------------------------------------------
4. What particular act or omission on the part of county or district
officers , servants or employees caused the injury or damage?
CJ
� (� (over)
5. What are the names of county or district officers , servants or
employees causing the damage or injury?
---------d----------=-----------------------------------------------------
6 What amage or injuries do you claim resulted? (Give full extent
of injuries or damages claimed. Attach two estimates for auto
damage) ,
.r F S , rem;-- 2..�-.d •
-- --- --- -- ---------- ------------------ ---------
7. How was the amount claimed above computed? (Include the estimated
amount of any prospective injury or damage. )
f
�c k tt(rc��lc 5 1�1 -e If Cd ccs
---- - �•�_�t►,`_CZ ---------------------------------------
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
• � / g CU
**************************************************************************
i.
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/
C- mant' s Si nat re�
Address
Telephone No. Telephone No. -s�� -/�X5—
**************************************************************************
� o
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 guiltyiof a felony. "
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I
.h CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
BOARD ACTION
Claim Against the County, or District ) NOTICE TO CLAIMANT January 15, 1985
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: Linda J. Goodman
County Counsel
1880 Sixth Street
Attorney: Concord, Ca 94519 DEC 17 1984
Address: Martinez, CA 94553
Amount: $1,500.00 By delivery to clerk on
Date Received: December- 14, 1984 By mail, postmarked on December 12, 1984
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
Dated: Dec. 14, 1984 PHIL BATCHELOR, Clerk, By Deputy
Jolene 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 cepnply 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
XII. 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
(� 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: JAN 1 , ,2,.qE PHIL BATCHELOR, Clerk, By �- ` �� , 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 claimantfs right to apply for leave to present a late claim was mailed
to claimant.
DATED: JAN-1 6 79RS PHIL BATCHELOR, Clerk, By --a CO. 2-X Deputy Clerk
cc: County Administrator (2) County Counsel (1)
CLAIM
CLAIM TO: BOARD OF SUPERVISORS OF CONTRA CC*�Q9WFapplication to:
Instructions to ClaimantDerk of the Board
P.O.Box 911
Martinez,California 94553
A. Claims relating to causes of action for death or for injury to
person or to personal property or growing crops must be presented
It 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 , California 94553.
C. If claim is against a district governqd 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 his form.
44
RE: Cl ai by ) Reser stamps
Against the COUNTY OF CONTRA COSTA) ~ J '
Pk!!D4'�HEAC
or DISTRICT)
(Fill in name) L By lenuty
The undersigned claimant hereby makes claim against th ty Sf 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)
erlc� ')0.
oco J R34 o± a4mO 00 A,
2. Where did th-e( anmag o in 'ury occur n lude .city/and c iinty)
Vn
---------------
3. How did the damage or injury occur. (Give full d ails, use extra
sheets if required) Hour. _+-,
Wl�
. �1 X500 • � _
4. What partic lar act or omissio on the part of county or district
officers , servants or employees cause the injury or damage?
00
(over)
a5
S". `- What are the names of county or district fficers, servants or
em 1 yees cau ing the d mage or injury? N rjy)
Cl
. 30 l"
6. What damage or injuries do you claim res lted? a( ive full extent
of injuries Rr damages claimel. Attac _ two a tim tes for auto
damage) n" - t M ,C/ m
" •
-- ---- — ------------- --- ---- -------- ---
7. How was�--the— amount claimed above computed. (Include thetes imat d
,amoun of any prospectiv in 'ury or damage. ) a0
. � 0 t
- - _ sem- --
8. Names- -and addr-esses f witne ses, doctors and hospi als--------------
14LJYt
a
--- - -- -------- -- ------- -- s-------------------------------
9.- List-th expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT A n
- ' • u&wL
e tz� ZAZ Lt
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
i k Sig urqf
' d es n_
Telephone No. Telephone No. ( ( --7 7
0
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
a.
a'
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'd � -�! '1 �A.. � r 33 ,z 31:x.: ''1 �* 'dl��>.i,+��=9 y>4'• � r '� � r.
Y`'M 1' M• �+^ €s�y' �j3at—[r.ysiii.c�•M': s� l ': �.t `( '�:' �'
DIAMONDS I/i( A
ESTATES ��<f
pr WATCHES APPRAISED ��
JEWELRY
•a' f� REPAIRS
CALL BROS. JEWELERS
823 SAN PABLO AVENUE ,►
ALBANY, CALIFORNIA 94706
(415) 525-8144 °
November 14 , 1984
•�?� c� Date .,
• ' ✓o aoin fE mart cvncarnr +�j*4�►.
t to III LIT rr#{fig THAT WE ARE ENGAGED 1N THE JEWELRY
U U S Y N ESS. AppraIsing Diamonds, Watches, jewelry and Precious Stones of all descriptions and have .,
ate'a been so engaged in said business for many years. We herewith certify that we have this day carefully
examined the following listed and described articles the property of —
^n,�
Ms . Linda J. Goodmans J
. Address 1880 Sixth Street Concord , California 94519
�rhKe We Estimate the value as listed for Insurance or other purpose at the present current market value.
In making this Appraisal, we do NOT agree to Purchase or replace the articles. .,
� �2Q► ARTICLE DESCRIP T ION APPRAISED VALUE
Ring Ladys 14K. Yellow Gold , Set with 7 Diamonds ,
approximately 10 Points each Round
ham, Brilliant Cut Clarity S . I . Color I-J.
r� n
Estimate To Replace 1 , 500 00 ~
1
r
r The foregoing Appraisal is made and accepted upon the express understanding that NO Liability or
Responsibility is incurred by the Appraiser in giving same.
' � Signedr---
t
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
BOARD ACTION
Claim Against the County, or District ) BICE TO CLAIMANT January 15, 1985
governed by the Board of Supervisors, ) The copy oft s 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: Anisa Gailani
i Count; Counsel
Attorney: Seth J. Feinberg
Russell & Joy! DEC 1 7 1994
Address: One Kaiser Plaza, Suite 2135
Oakland, CA 94612 Martinez, LA 94553
Amount: $50,000.00 By delivery to clerk on
Date Received: December 14, 1984 By mail, postmarked on December 10, 1984
(came in with Fauzia Ahmed claim)
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of,the above-noted claim. J ,. ..
Dated: Dec. 14, 1984 PHIL BATCHELOR, Clerk, By �J 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: f - By: Cti CL Deputy County Counsel
III. FROM: Clerk of the Board TO: 1) County Counsel, ( ) 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 the Board's Order entered in its
minutes for this date.
Dated: JAN Qi, PHIL BATCHELOR, Clerk, By , 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.
I
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 present a late claim was mailed
toAa t.
DATED: � �V t� Ig85 PHIL BATCHELOR, Clerk, By -l� , Deputy Clerk
cc: County Administrator (2) County Counsel (1)
CLAIM
CLAIM TO: BOARD OF SUPERVISORS OF CONTRA CO�T_-�,,Q9WYapplication to:
Instructions to ClaimantC'e,.k of the Board
P.O.Box 911
Martinez,California 94553
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 , California 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 end
of this form. tog
RE: Claim by ) Reserve Tor . ' 'ng stamps
ANISA GAILANI j '
Against the COUNTY OF CONTRA COSTA)
or DISTRICT) CLEC" ?` "''
Fill in name ) By - ilenutY
The undersigned claimant hereby makes claim against the County of Contra
Costa or the above-named District in the sum of $ 50, 000. 00
and in support of this claim represents as follows:
--------------------------------- ------ - --- ----=-------------------
d
1. When did the amage or injury-occur?-- (Give-exact date and hour)
October 16, 1984, approximately 6: 00 pm.
-----------r------------------------------------------------------------
2. Where did the damage or injury occur? (Include city and county)
Pleasant Hill Road, approximately 185 feet south of Purson Lane, in
an unicorporated area of Contra Costa County
---------------------=--------------------------------------------------
3. How did the damage or injury occur? (Give full details, use extra
sheets if required)
Claimant was driving her car north on a one-way segment of Pleasant
Hill Road. She hada head-on collison with a vehicle driving in the
wrong direction.
- -- -- --------------------------------------------.--What-parti--c-u-a----ac-t-o-r omission ---
on the part of county or district
officers, servants or employees caused the injury or damage?
The road was not sufficiently marked as a one-way street.
(over)
..'s What are the names of county or district officers, servants or
employees causing the damage or injury?
Unkown at this time
-------------- ------------------------------------
6 -What dams g a or injuries do you claim resulted? (Give full extent
of injuries or damages claimed. Attach two estimates for auto
damage) Personal injuries, including, but not limited to injuries to
lower right abdomen; right side, back, head, neck; also mi`cellaneous
contusions, -cuts,- and muscle straits.
7. How was the amount claimed above computed? (Include the estimated
amount of any prospective injury or damage. )
Computed on the basis of the nature of the claimant' s personal
injuries and claimant' s attorney' s experience at evaluating personal
injuries.
8. Names and addresses of witnesses, doctors and hospitals. -
Witnesses: 1) Anisa Gailani and Fauzia Ahmed, both represented by the
undersigned attorney.
2) Brian DeLoache, 2041 Miramonte, San Leandro, California
3) Tara Jowitt, 224 Longview Terrace, Orinda, California
Hospital: John Muir Memorial Hospital, 1601 Yanacio Vallev Rd, Walnut Creek
Doctor: Dr. Dana Slauson, 401 Gregory Lane, 05, Pleasant' Hill , CA 94523
-------------------------------------------------------------------------
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
Medical bills are increasing weekly and have been submitted to -
insurance company.
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 Attorney for Claima t
SETH J. FEINBERG, ESQ. Claimants Signature
RUSSELL & JOY
One Kaiser Plaza, Suite 2135 Address
Oakland, CA 94612
Telephone No. (415) 444-6100 Telephone No.
NOTICE
Section '72 of the Penal Code provides:
I
"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 guiltyof a felony. "
APPLICATION TO FILE LATE CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
BOARD ACTION
Application to File Late Claim ) NOTICE TO APPLICANT January 15, 1985
Against the County, Routing ) The copy of this document mailed to you is your
Endorsements, and Board Action.) notice of the action taken on your application by
(All Section References are to ) the Board of Supervisors (Paragraph III, below),
California Government Code.) ) given pursuant to Government Code Sections 911.8 and
915.4. Please note the "WARNING" below.
Claimant: Whitehouse, John Lee and Barbara
County Counsel
Attorney: James M. Harris
York, Buresh & Kaplan DEC 17 1984
Address: 2298 Durant Avenue
Berkeley, CA 94704 Martinez, CA 94553
Amount: Unspecified By delivery to Clerk on
Date Received: December 10, 1984 By mail, postmarked on December 6, 1984
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above noted Application to File Late Claim.
DATED: Dec. 10, 1984 PHIL, BATCHELOR, Clerk, By Deputy
Jolene Edwards
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
( ) The Board should grant this Application to File Late Claim (Section 911.6).
The Board should deny this Application to File Late Claim (Section 911.6).
DATED: VICTOR WESTMAN, County Counsel, By Deputy
III. BOARD ORDER By unanimous vote of Supervisors present
(Check one only)
( ) This Application is granted (Section 911.6).
( This Application to File Late Claim is denied (Section 911.6).
I certify that this is a true and correct copy of the Board's Order entered in its
minutes for this date.
DATE: PHIL BATCHELOR, Clerk, By� Deputy
WARNING (Gov. Code 6911.8)
If you wish to file a court action on this matter, you must first petition the
appropriate court for an order relieving you from the provisions of Government Code
Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such
petition must be filed with the court within six (6) months from the date your application
for leave to present a late claim was denied.
You may seek the advise of any attorney of your choice in connection with this
matter. If you want to consult an attorney, u should do so immediatel .
IV. FROM: Clerk of the Board TO: 1 County Counsel 2 County Administrator
Attached are copies of the above Application. We notifed the applicant of the
Board's action on this Application by mailing a copy of this document, and a memo thereof
has ben filed and endorsed on the Board's copy of this Claim in accordance with Section
29703.
DATED: PHIL BATCHELOR, Clerk, By Deputy
V. FROM: 1 County Counsel 2 County Administrator TO: Clerk of the Board
of Supervisors
Received copies of this Application and Board Order.
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DATED: County Counsel, By
County Administrator, By
APPLICATION TO FILE LATE CLAIM '7
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LAW OFFICES
York, Buresh & Kaplan
JON H.1rORK A PROPESSIONAL CORPORATION (415) 548-7474
SCOTT BURESH 2298 DURANT AVENUE
ANN S.KAPLAN BERKELEY,CALIPORNW 94704
JAMES M.HARRIS
ALAN N J
STEVEN K..AUSTIN December 6 , 1984
CERTIFIED MAIL RECEIV'EI�
Contra Costa County Board of Supervisors
County Administration Building PHIL IIAMIELOR
P.O. Box 911
tERKEOAogp
cas
Martinez, CA 94553 o
Attention: Phil Batchelor
Re: APPLICATION FOR LEAVE TO FILE LATE CLAIM
Government Code S 911.4
Our file reference: Mcbride v. Neal, et al.
83053
Claimants John Lee and Barbara Whitehouse of 4822 Tawny
Court, Oakley, California and State Farm Fire & Casualty Company
at P.O. Box 4011, Pleasant Hill, California hereby apply for
leave to file a late claim with the County Board of Supervisors
for incidence of personal injury and property damage which
occurred on or about March 18 , 1983 at 3801 St. Marys Road,
Martinez, California.
Claimants state their reasons as follows:
I. FACTS
On March 18; 1983, a landslide occurred on property locates
uphill from the home of John Lee and Barbara Whitehouse at 3801
St. Marys Road, Martinez, California. The landslide mass moved
down toward the rear of Whitehouses' residence and pushed it off
of its foundation. Notice of Abatement proceedings due to the
perilous condition of the house was made on March 28, 1983 .
During evacuation of the house a railing in front of the house
collapsed causing Mrs. Whitehouse to fall and injure her leg.
Neighbors to Whitehouses, Judge and Mrs. Thomas F. McBride
at 3890 Serrano Street, became imperiled by the same occurrence.
Causes of the slide included the grading of access roads
across the hillside that channeled surface water into the weak
soils of the slope. Additional geotechnical reports revealed the
existence of abandoned building pads that also affected the
saturation of water into the hill.
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Contra Costa County Board of Supervisors
Attention: Phil Batchelor
APPLICATION FOR LEAVE TO FILE_ LATE CLAIM
Government Code S 911.4
Our file reference: Mcbride v. Neal, et al.
PAGE TWO
December 6 , 1984
Efforts to recover damages led to the filing of a lawsuit by
McBrides against the owner of uphill lots. Whitehouses and their
insurer, State Farm Fire & Casualty Company, intervened in the
suit. Throughout the course of litigation, McBrides were
represented by Thomas Watrous of the firm of Gordon, DeFraga,
Watrous & Pezzagalia, Inc. , 611 Las Juntas St. , Martinez, CA, who
also frequently acts as counsel for the County of .Contra Costa.
Because of Mr. Watrous' position with the County, he inquired
into the responsibility of the County for the grading of the
access roads which were cited as causes of the earth movement.
From information conveyed by the County via Mr. Watrous,
claimants believed the County was not involved in the grading and
refrained from filing appropriate government code claims for
their damages.
On August 13 , 1984 , at a Bench Bar Settlement Conference in
. Contra Costa County Superior Court, Mr. Watrous announced, again
on behalf of the County, that the County of Contra Costa may have
indeed been involved with grading on the subject slope. In
reliance thereon, ' claimants filed their government code claim on
August 20 , 1984, within one hundred days of learning of the
County' s involvement. Said claim was returned by the County on
November 15th as not being timely filed. Hence, the present
application for further consideration as a late claim.
U. BA IS FO I; APPLICATION
A. A public entity is estopped from requiring strict
adherence to the claim filing procedure when the entity itself
has been the source of misinformation that prevented the filing
of the claim.
The present situation is factually similar to Fredrichsen v.
City of Lakewood ,(1971) 6 Cal.App. 3d 353 , wherein the plaintiff
who had been injured in a sidewalk fall refrained from filing a
government code claim because the City had told her (erroneously)
i
I
Contra Costa Count Board of Supervisors
Attention: Phil Batchelor
APPLICATION FOR LRAVR TO i?ILE LATE CLAIM
Government Code S 911.4
Our file reference!: Mcbride v. Neal, et al.
PAGE THREE
December 6, 1984
that the involved area was the responsibility of a private
corporation and not of the public entity. The City' s misinforma-
tion was found to be unconsciounable and because plaintiff relied
thereon, the failure to file a timely claim could not be a bar to
plaintiff' s action.
In the present case, claimants knew that attorney Thomas
Watrous was in contact with County officials and had inquired
concerning the County' s responsibility for grading on the subject
slope. Because of Mr. Watrous' relationship with the County and
the denial of the County' s involvement, the claimants refrained
from filing their claim in a good faith effort to limit the scope
of the controversy and the addition of new parties to the
litigation. Having relied upon the County' s denial of
involvement, the County is now estopped from requiring that
. claimants adhere strictly to the filing requirements of
government code S 945 .4 .,
B. Government code S 946 .6 (c) (1) permits relief from
§ 945 .4 if it is found that the failure to present a claim in a
timely fashion was due to mistake, inadvertence, surprise or
excusable neglect.
In the present case, claimants relied upon attorney Watrous'
inside information with the County and refrained from escalating
the litigation by pursuing an independent investigation of the
County' s possible involvement.
Claimants now argue that their conduct was excusable, that
is, that their actions are those that reasonably prudent persons
would have taken under similar circumstances, and therefore, that
they should be relieved from strict adherence to the provisions
of government code S 945 .4 . See for example, Boas v. County of
San Diego (1980) 113 Cal.App. 3d 355.
Contra Costa County Board of Supervisors
Attention: Phil Batchelor
APPLICATION FOR LEAVE TO FILE LATE CLAIN
Government Code S 911.4
Our file reference, Mcbride v. Neal, et al.
PAGE FOUR i
December 6, 1984
For the reasons stated above, and in view of substantial
compliance with the government code requirements, claimants John
Lee and Barbara Whitehouse and State Farm Fire & Casualty Company
hereby respectfully request leave to have their claim considered
by the County either under the provisions of Government Code
§ 911.4 or in light of the principles of estoppel outlined herein.
Respectfully submitted,
YORK, BURESH & KAPLAN
9
By: '
4v�-
J s M. Harris, Attorneys for
aimants Whitehouses and
State Farm Fire & Casualty Co.
Enclosure - Copy of returned government code claim form.
RECEIVED
OCT as 1984
GOVERNMENT CODE CLAIM FORM
PHK BATCHELOR
!EERY BOAR C t SUPERVIS025
CONTR cr C
e
TO THE GOVERNING BODY OF: Contra Costa County
(Board of Supervisors)
Claimant: John Lee and Barbara Whitehouse
Address: 4822 Tawny Court
Oakley, CA 94561
Claimant: State Farm Fire & Casualty Co.
Address: P. O. Box 4011
Pleasant Hill, CA 94524
DATE OF INCIDENT: On or about March 18, 1983
LOCATION OF INCIDENT: 3801 St. Marys Road
Martinez, CA
DESCRIPTION OF ,INCIDENT:
Please see page two.
NATURE OF DAMAGES: Claimants seek damages for the loss
of the residence, diminution of value of their lot, personal
injury due to collapse of the railing and inconvenience,
emotional distress and annoyance resulting from the property loss
and physical injury to Mrs. Whitehouse.
AMOUNT OF CLAIM: in excess of $120,000
ITEMIZATION OF CLAIM (List Items Totaling Amount Set Forth Above)
Subrogation claim of State Farm Fire & Casualty Co. $ 103,503
Additional uninsured property loss by Whitehouses 20 ,000
Personal injury and emotional distress claim on
behalf of Whitehouses unknown
Total : $ unknown
ATTORNEYS TO WHOM NOTICES Name: James M. Harris
SHOULD BE SENT,: York, Buresh & Kaplan
2298 Durant Avenue
Berkeley, CA 94704
(415) 548-7474
:r
ADDITIONAL ATTORNEYS TO WHOM Name: Stephen David Kaus
NOTICES SHOULD BE SENT KAUS & KERR
155 Montgomery St. , Ste. 800
San Francisco, CA 94104
(415) 981-7780
DESCRIPTION OF INCIDENT
Grading of fire! access roads on the hillside above 3801 St. Marys
Road before March 18, 1983 contributed to the diversion and
concentration of surface waters into the hillside thus weakening
the soils of the hill and causing the same to slide down and into
the property of Whitehouses. Having been advised to immediately
evacuate the residence due to its damaged foundation, the
Whitehouses were forced to abandon their property and move as
Arany personal belongings as possible to avert further damage to
their possessions. During the course of moving, a restraining
railing on the porch of the residence gave way due to its
weakened condition causing Mrs. Whitehouse to fall and to sustain
personal injury. The residence was subsequently demolished by
County order.
ADDITIONAL COMMENTS AND NOTICE OF TIMELY FILING
Claimants State Farm Fire & Casualty Company and John Lee and
Barbara Whitehouse first became aware of the possible
responsibility of the County and/or its Fire District for the
damages they have sustained on August 13, 1984 at which time
counsel for the County, Thomas Watrous of the firm of Gordon,
DeFraga, Watrous & Pezzaglia, Inc. , advised of a declaration from
the County that such grading had been conducted on the hillside
above the former Whitehouse residence.
The notice of claim herein is therefore filed within 100 days of
the notice by the County of its involvement.
Dated: October 20, 1984 . By : V'
ames M. Harris
A orneys for Claimant
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
BOARD ACTION
Claim Against the County, or District ) NOTICE TO CLAIMANT January 15, 1985
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: Dionisio S. Fajardo
County Counsel
Attorney: George T. Smithwick
Knutsen & Smithwick DEC 17 1984
Address: 39675 Cedar Blvd. , Suite 235
Newark, CA 94560 Martinez, CA 94553
Amount: $25.,469.00 By delivery to clerk on
Date Received: December 10, 1984 By mail, postmarked On December 6, 1984
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim. y0
Dated: Dec. 10, 1984 PHIL BATCHELOR, Clerk, By 4 Deputy
Jolene Edwards
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
(Check only one)
00 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: y: 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
( 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
mites or �s date,
Dated: N � _ PHIL BATCHELOR Clerk By 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 claimants right to apply for leave to present a late claim was mailed
to cl mant.
DATED: JA N 16 1985 PHIL BATCHELOR, Clerk, By ZL -� , Deputy Clerk
cc: County Administrator (2) County Counsel (1)
CLAIM
1 George T. Smithwick, Esq.
KNUTSEN & SMITHWICK RECEIVED
2 Attorneys atlLaw
39675 Cedar Blvd. , Suite 235
3 Newark, CA 94560 DEC 10 11194
Telephone : (415) 651-2880
4 PHK SAMIEIOR
CLERK BOARD OF SUPERVISORS
CCN'. CO;L:C
5 Attorneys for Claimant D
6
7
8 In the Matter of the Claim of NOTICE PURSUANT TO
GOVERNMENT CODE
DIONISIO S. FAJARDO SECTION 910
10 Claimant, Date of Loss: 9/20/84
Claim No. : 84-2701
11 vs. (AC Transit)
12 ALAMEDA-CONTRA COSTA TRANSIT
DISTRICT; ALAMEDA COUNTY;
13 CONTRA COSTA COUNTY; SYLVESTER
WOODS; and DOES I through X,
14 inclusive. /
15 DIONISIO S. FAJARDO hereby presents this claim to the
16 ALAMEDA-CONTRA COSTA TRANSIT DISTRICT; ALAMEDA COUNTY; CONTRA
17 COSTA COUNTY; and SYLVESTER WOODS , pursuant to Government Code
18 Section 910 .
19 1 . The name and post office address of claimant is as
20 follows:
21 DIONISIO S. FAJARDO
22 c/o Knutsen & Smithwick
39675 Cedar Blvd. , Suite 235
23 Newark, CA 94560
2 . Thejpost office address to which claimant desires notice
24
of this claim to be sent is as follows:
25
DIONISIO S. FAJARDO
26 c/o Knutsen & Smithwick
39675 Cedar Blvd. , Suite 235
27 I Newark, CA 94560
28 -1-
NVI EN & SMITHNICK
a+.65!2BB0 � ^ 1
1 3 . On September 20 198 4 , at Newark Boulevard,
I
2 South of Patterson Ranch Road, Fremont, California,
3 claimant received personal injuries and/or damage or loss under
4 the following circumstances:
5 Claimant 'was stopped for traffic in his 1979 Datsun 28OZ
6 automobile when it was rearended by an AC Transit Bus.
7
8
i
9
10
11 4. The general description of claimant ' s injuries and
12 damages , so far as presently known is :
13 (a) Claimant' s 1979 Datsun was totalled, towed,
14 stored and eventually salvaged;
15 (b) Claimant sustained injury to his neck, back, head,
16 knee and other (presently unknown) ;
17 (c) Claimant sustained loss of' wages, plus general .
18 damages; and
19 (d) Other unknown damages.
20
i
21
i
22
23
24
25
26
27
28 -2-
SMITHWICK
• 1 5 . The name or names of the public employee or employees
2 causing the injuries and damages, if known, are as follows:
3 SYLVESTER WOODS, Bus Driver (Cal . Driver' s License #J05917-82;
Date of Birth: 5/2/43)
4 DOE I through V, inclusive
5 6 . At the time of presentation of this claim, claimant
6 claims damaces in the amount of $ 251469 .00 , including
7 approximately $ unknown due to prospective injuries
8 and damage , computed on the tasis of the following:
9 (a) : Medical Expenses $919 . 00 and continuing
10 (b) Wage Loss 2 weeks (unknown) and
11 continuing
12 (c) Property Damage $9 , 000 . 00 (estimated)
(d) Towing, storing, loss of
13
use $550 .00 (estimated)
14 i (e) Incidentals Unknown
15 i (f) General Damages $15,000 .00 , or
16 according to proof .
KNUTSEN & SMITHWICK
17
18Dated: By i / /.
X3XXr-X.TXXAttor -7s for Claimant
19 George T. Smithwick
20
21
22
23
24
25
26
27
28 -3-
.i
3-
I
1 DECLARATION OF SERVICE BY MAIL
2 I am over the age of 18 years, employed in the County of
3 Alameda, State of California, and not a party to the within
4 action; my business address is 39675 Cedar Blvd. , Suite 235,
5 Newark, CA 94560 .
6 On _ December 6 , 1984 I served the following
7 documents: Notice Pursuant to Government Code Section 910
8
9
10 on the following as addressed:
11 Alameda-Contra Costa Transit District
508 16th Street
12 Oakland, CA 94612
13 Board of Supervisors
Contra Costa County
14 651 Pine
Martinez , CA 94553
15 Board of Supervisors
County of Alameda
16 1221 Oak Street
17 Oakland, CA 94612
Sylvester Woods
18 4317 Blondwoods
19 Union City, CA 94587
20 in said action, b}, placing a true copy thereof enclosed in a
21 sealed envelope, with postage thereon fully prepaid, in the
22 United States mail at Newark, California.
23 I declare, under penalty of perjury, that the foregoing is
24 true and correct.
25 Executed on December 6, 1984 at Newark, California.
26
27
28
-• A sm IT)I
'K
A
r-
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COMM, CALIFORNIA
i BOARD ACTION
Claim Against the County, or District ) NOTICE TO CLAIMANT January 15, 1985
governed by the Board of Supervisors, ) The copy oft s 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: Kenneth Dale and Corina Jones
I Coullty Counsel
Attorney: Mitchell A. Stevens
Andersen & Bonn!ifield DEC 17 1984
Address: P.C. Box 5926
Concord, CA 94524 Martinez, CA 94553
Amount: $100,000.00 By delivery to clerk on
I
Date Received: December 12, 1984 By mail, postmarked on December 10, 1984
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
l
Dated: Dec. 10, 1984 PHIL BATCHELOR, Clerk, ByDeputy
Pioene 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 claimants 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 T0: (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 the Board's Order entered in its
minutes for this date.
Dated: A N 1 5 1985 PHIL BATCHELOR, Clerk, By Deputy Clerk
WARNING (Gov. Code Section 913)
Subject to certain exceptions, you have only six (6)-months fx= 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 Is right to apply for leave to present a late claim was mailed
to claimant.
DATED: JAN 1 G 1225 PHIL BATCHELOR, Clerk, By � , Deputy Clerk
cc: County Administrator (2) County Counsel (1)
CLAIM
RECEIVED
rki!BATCNE:04
,CjERK S �11 pr Z
LBY Der W r
Claim of KENNETHiDALE JONES )
and CORINA JONES, ) CLAIM FOR PERSONAL INJURIES
(California Government Code)
VS . )
CONTRA COSTA COUNTY )
TO: CONTRA COSTA COUNTY BOARD OF SUPERVISORS:
I
You are hereby notified that KENNETH DALE JONES and
CORINA JONES, 2394 St. George Drive, , Concord, California,
claim damages from CONTRA COSTA COUNTY , in an amount,
computed as of the date of presentation of this claim, of
$100, 000 plus medical .
This claim is based on personal injuries sustained
by KENNETH DALE JONES and CORINA JONES on or about September
14, 1984, while in the unincorporated area of Contra Costa
County, Delta Judicial District, Marsh Creek Road, 2 . 8 miles
east of Morgan Territory Road, under the following circum-
stances :
CONTRA COSTA COUNTY failed to. properly maintain a
portion of Marsh Creek Road and the shoulder thereof
(specifically that area approximately 8 ' N/of the north ,
roadway edge of Marsh Creek road and 2. 8 miles E/of
Morgan Territory road) . Said area contained a fire
hydrant 7 ' N/of the roadway edge with a 12" steel stand-
pipe protruding approximately 6" above the ground.
Said steel standpipe constituted a dangerous condition
in that it protruded so far above the ground that it
came in contact with the undercarriage of claimants '
vehicle , stopping claimants ' vehicle abruptly, causing
the hereinafter mentioned injuries to claimants.
"1
i
r
i
The injuries sustained by claimant KENNETH DALE JONES ,
as far as known as of the date of presentation of this claim,
consist of soft tissue injury to neck, back and shoulders ,
lacerations to body, and shock and emotional distress.
The injuries to CORINA JONES consist of lacerations , con-
cussion, soft tissue injury to neck, shock and emotional
I
distress. Said injuries have caused permanently disability
I
to both claimants.
The amounts claimed, as of the date of presentation
of this claim, are computed as follows:
Expenses for medical treatment. . . . . . . . . .$Unknown
General damage. . . . . . . . . . . . . . . . . . . . . . . . . .$100 ,000
All notices or other communications with regard to '
this claim should be sent to claimants ' attorney, MITCHELL
A. STEVENS, ANDERSEN & BONNIFIELD, 1355 Willow Way, Suite
#255, Concord, CA 94520.
Dated: December /Z , 1984.
'T ANDZV7;r�D
By
MITCHELL A. STEVENS
......,,,..,Tcn�c nr rnNTRA C0fi=.0 MYaoolication to:
j
✓/ CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
BOARD ACTION
Claim Against the County, or District ) NOTICE TO CLAIMANT January 15, 1985
governed by the Board of Supervisors, ) The copy oft s 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: Ronald Douglas Chappel
County Counsel
Attorney: Joseph G. Baxter
Box 37 DEC 17 1984
Address: Duncans Mills, CA 95430
Martinez, CA 94553
Amount: Unspecified By delivery to clerk on
Date Received: December 13, 1984 By mail, postmarked on December 11, 1984
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
Dated: Dec. 13, 1984 PHIL BATCHELOR, Clerk, By 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: � 4,7-J By: 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
(�) 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: 'JAN 1 PHIL BATCHELOR, Clerk, By , 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 to present a late claim was mailed
to claimant.
DATED: JAN 1 P 1=7 PHIL BATCHELOR, Clerk, By Q_(9. -��c�- , Deputy Clerk
cc: County Administrator (2) County Counsel (1)
rr.STM
-''CLAIM, TO: BOARD OF SUPERVISORS OF CONTRA COP*Q9WRXapplication to:
Instructions to ClaimantC!erk of the Board
&4rl
Martinez,California 94553
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 J00th 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 , California 94553.
i
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
ofthis form.
RE: Claim by )Reserved or Clerk's filing stamps
RONALD DOUGLAS CHAPEL )
> RCEI �
Against the COUNTY OF CONTRA COSTA)
OEC 13199
or DISTRICT)(Fill in name)
The undersigned claimant hereby makes claim a Contra
Costa or the above-named District in the sum of $in excess of $15 , 000
and in support of this claim represents as follows:
1. When did the damage or injury occur? (Give exact date and hour]
September 5 , 1984
'�.--Where did-the damage-or injury occur? (Include city and county)
(a) W/B SR-24 , Central Lafayette
(b) County Jail
3. How did the damage or injury occur? (Give full details, use extra
sheets if required) o
U)
Arresting officer CUNNINGHAM intentionally placed handcuffs too tight, a)
refused to do anything about this , and attempted to crush claimant ' s
skull when he complained. Arresting officer took claimant ' s wallet , �4
containing his bail money, thereby makin it difficult for claimant to be
4. What particular act or omission on the part of county or district
officers, servants or employees caused the injury or damage?
, See above.
(over)
. 5.r What are the names of county or district officers, servants or,
, employees causing the damage or injury?
Officer Cunningham.
6. What damage or injuries do you claim resulted? (Give full extent
of injuries or damages claimed. Attach two estimates for auto
damage)
Injuries to wrists, skull, emotional distress , denial of basic rights .
-------------------------------------------------------------------------
7. How was the amount claimed above computed? (Include the estimated
amount of any prospective injury or damage. )
Dollar amount of ,injuries is difficult to ascertain. . However.,
any interference with said basic rights must be treated seriously.
-------------------------------------------------------------------------
8. Names and addresses of witnesses, doctors and hospitals.
Ron Chappel Jose, and ) Lafayette Tow
3037 SW Flower .Terrace Brian Hamilton)
Portland OR 97221
. J. Nardil , Sheriff ' s Dept. Linda Martin
Guerneville , California
i
-------------------------------------------------------------------------
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
Amount not known with certainty at present time.
I
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 /
laimant s Signature
JOSEPH G. BAXTER ffTT�,o�t.�-y �/P,r PUVA.) CX4fJ9 Z
Box 37 Address
Duncans Mills CA 95430 Box 37 , Duncans Mills CA 95430
Telephone No. 707/865-1311 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. "
_ T i
� CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA =Nff, CALIFORNIA
BOARD ACTION
Claim Against the County, or District ) NOTICE TO CLAIMANT January 15, 1985
governed by the Board of Supervisors, ) The copy ot 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: Calif State Automobile Assn Inter-Ins Bureau
2055 Meridian iPark Blvd. Cotility Counsel
Attorney: Concord, California 94520
DEC 1r1984
Address:
Martinez, CA 94553
Amount: $726.07 By delivery to clerk on
Date Received: December 14, 1984 By mail, postmarked on December 13, 1984
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
Dated: Dec. 14, 1984 PHIL BATCHELOR, Clerk, Byc,L .,/ Deputy
Jolene Edwards
II. FROM: County Counsel T0: 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: Deputy County Counsel
III. FROM: Clerk of the Board TO: 1) County Counsel, (9 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 the Board's Order entered in its
minutes for this date.
Dated: ! r, 0.n PHIL BATCHELOR, Clerk, By , 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 claimants right to apply for leave to present a late claim was mailed
tot.
DATED: JA�'19^5 PHIL BATCHELOR, Clerk, By , Deputy Clerk
cc: County Administrator (2) County Counsel (1)
CLAIM
f
Claim For Damages
I
In accordance with Section 910 of the California Government Code, this is to formally place you on
notice of our subrogated claim for the loss described below.
Date: December 5, 19 84
• Contra Costa Public HI alth Dept.
1111 Ward Avenue Concord, , California
Martinez, California 94553
i
Claim is hereby made and filed against the Contra Costa County Public Health Dept.
as follows:
Name of Claimant:
Name of
State Automobile Association Inter-Insurance Bureau
Address of Claimant:
(Send notices to this address) 2055 Meridian Park Blvd., Concord, Calif.
Date of Occurrence:
Pleasant Hill Senior Citizen's Center PA
Place of Occurrence:
� i
.. � ,, .L �--.
Nature and Amount of Damages .
Items Making up said Amount:
Name of Public Employee(s) By C.enW
causing said Damage(if known): Norma, Roe
Facts & Details:
Ms. Cumming's 1978 Olds Delta Royale parked and unattended in Senior Citizen's
Center Parking Lot when 14s. Roe, driving Contra Costa's Public Health Dept. Van #
5920, collided into and caused damage to the right rear of Nis. Cumming's car.
California State Automobile Association
Inter-Insurance Bureau
By: <-
F1688 (REV.5-78)
assi nment of claim and
subrogation agreement
In consideration of the payment to the undersigned of N the sum of 4kkt30r Ef,
❑ a sum estimated to be
``V_'�}'`,�tl `_;� x tet., c 'f�`•.' .
Dollars, being the full amount of loss and damage insured against under an automobile insurance policy, number
353531-7 issued to the undersigned by the CALIFORNIA STATE AUTOMOBILE ASSOCIATION
INTER-INSURANCE BUREAU, said loss and damage having occurred on or about the 22nd day of
October 19 84 the said undersigned hereby assigns and transfers to said Bureau
said claim in the above amount plus additional claim for damage resulting from said accident, not
covered under said policy of insurance, in the amount of$ , constituting ® a total claim
❑ a total estimated
(.
71,
in the amount of $
Said Bureau is hereby subrogated in her place and stead to the extent of the above amount of the said
total claim and is hereby authorized and empowered to sue, compromise or settle in her name or other-
wise to the extent of said total claim for loss and damage, and to endorse in my name any check made payable to
me therefor, and collect and receive any money payable thereby.
The undersigned covenants that she ha s not released or discharged any such claim or demand against
such party or parties and that she will furnish to said Bureau any and all papers and information in her
possession, necessary for the proper prosecution of such claim.
Dated at Ct�'i_;C(.'F:�_ C f i this r' ( � day of
v^
� � l
WITNESS
F1433 (REV.7-77)
+ TmIS DRAFT MUST BE PROPERLY
ENDORSED ON THE REVERSE SIDE i
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SNAPPY CAR RENTAL claim ab-35353
Zj- :r--
r-b-P, I ,
M5 MITCHELL DRIVE
WALNUT CREEK,CALIFORNIA 94598
4415)945.1800
PRIMARY LIABILITY I
RENTAL AGREEMENT - No. 047—
AGRtjkMENT NUMBER
CULT: 'ER PHONE VEHICLE N
HC)r,'L ADDRESS —_�J CITY STATE LICENSE NO.
DRIVER'41.ICENSE NO. STA7T EXP. DATE AGE YEARe—
MAKE
/-._:': 0
RENTER'S INSURANCE CO ODOMETER MrjD E L COLOR
j
S7] rZ;7I l '—C
DUE BACK DAT `R ❑ F,
IN
If
T THIRTY (30) DAYS OF RENTAL ❑ ❑ ❑ ❑ DATE HIS CONTRACT IS TERMINATED AFTER ATE 1 '6' 1
VIOLATION OF ANY TERMS OF THIS AGREEMENT VOIDS ALL �00 U T
I COVERAGES PROVIDED HEREIN. DEPOSITS
THIS VEHICLE IS COVERED FOR PUBLIC LIABILITY AND DATE RECEIPT NO. AMT. CHECK CAST-
PROPERTY DAMAGE INSURANCE BY SNAPPY CAR RENTAL. 1i/-I- 4L;(e'�-
LIABILITY DOES NOT PROTECT THE RENTER OP.
DRIVEF IF DRIVER IS UNDER 21 YEARS OF AGE.
PAYMENT FOR THE DEDUCTIBLE WAIVER IS SOLELY THE
RESPONSIBILITY OF THE CUSTOMER, NOT THE INSURANCE
Co.
CHARGES
DEDUCTIBLE WAIVER NOT INSURANCEL
THISVEHICLEISCOVEREC.BVCOLLISION
IN CONSIDE",ATIOIN OF PA'YVENT OF SANL-. CC;%'PREHE: SIVE COVERAGEWITH MILES $
PER DAYE!VTHE CUSTOMER SNAPPY CAR REN-AL [�_";�T;-_E RENTER:I A $596-eO DE _1 - RDOES
INC AGREES NP.TTO HOLr,THE CUS70!-IE;RZSPON- NOT-4:ZIL�70 PLjRCH;-SE THE DEDUCT-
S I B LE F C-AANY PHYS I CAL 1)-^.0 A G ET 0-,H F VE Li!C L E IBLE PROTECTION ANC ACCEPTS FULL DAY(S)C'
AS A RESUL T OF FIRE THEFT.CC)*-LIS ION.UPSET OR RESPONSIE!LITN FOr-, A%V AND ALL
OTHER CAUSE COVERED BY A S7A`:)
� ARD POLICY DAt,IAGE TO SA;-VEHICLE BJ7 NOT TO
OR POLICIES OF COMPREHENSIVE AND COLLISION i C
ExCEEC THE j��() THE�-,Z�)Jr71BLE PER WEEK1,S)CS
ACIDENT VEHICLE
AUTOMOBILE INSURANCE. PROVIDED THAT THE1;�ZDEPATED IN C DN'-OR11,17y WITH THE
VEHICLE IS OPERATED IN CON';:0RM'TY t%:;Ttl. THE TER'.-;
..-S 0177HE REN'TA.-AG;:EEMEN7.ANY MONTHS)Ca' $
TERMS OF THE RENTAL AGREE",IEN7. PAV'"ENI PAVI,!�""-T DUE HE;EJNEZt,."
SHALL BE
SHALL BE DUE AND FAYAE E AT THE EXPIRATION I
P"VAS'-E A, THE Ey-ir.-.TION OF THE
OF THE RENTAL AGREEMENT i RENAL AGREEIVE1`47.
TOTAL TIME &MILEAGE $
X x
CU570t.IE SI-a'v-'7,;PE CLS70hS1CN4-JF4E SALES TAX $ Z
VEHICLE MAY NOT BE USED OR DRIVEN CAR MUST BE RE-
BY ANYONE UNDER 21. TURNED IN THE DEDUCTIBLE WAIVER IS 17 0,�;> I
• VEHICLE MAY NOT BE REMOVED FROM STATE WHERE RENTED SAME CONDITION
WITHOUT\WRITTEN PERMISSION FROM LESSOR. IN WHICH YOU RE- i MISC.CHARGES IS
• TRAFF(ELV%OLATIONS ARE THE RESPONSIBILITY OF CUSTOMER. CEIVED 17 OR YOU
• 24-HOUR*LOTICE IS REQUIRED FOR PICKUP. WILL BE CHARGED
• RATES BASED ON CALENDAR DAY ONLY. I ACCORDINGLY—5&j TOTAL CHARGES S
• ACCIDENTS OR MECHANICAL PROBLEMS,CONTACT OFFICE. ?V!1 r 5
• SHOULD DEPOSIT BE R E QUIRE D.CONTRACT SHALL TERM INA tt ! I
24 HOURS AFTER BASIC RENTAL CHARGE EXCEEDS DEPOSIT. AttrTrM"15--eV E R LESS CREDITS IS
• FLAT TIRES MUST BE REPAIRED OR REPLACED.
NET CHARGES $ 5er IF;
Customer Xi A Lessor VEHICLE CONDITION
Contents on Delivery
1 . 1 1 r t7
This will serve as authorization for SNAPPY CAR RENTAL to receive direct LESS DEPOSIT:V F
E!
payment from BALANC $ 0-
CLEAN
I..... L
Insurance Company for all authorized calendar rental days which I had the INT DUE FRIOM INS.S.�CO.
use of said SNAPPY'S rental vehicle. DAMAGE
X y Initials DUE FROM/TO RENTER
$
I HAVE READ AND AGREE TO BE BOUND BY THE TERMS AND : EXT REFUND PAID
CONDITIONS CONTAINED ON BOTH SIDES OF THIS RENTAL AGREE- IDAMAGE $ $
MENT AND AGREE TO RETURN VEHICLE TO SNAPPY CAR RENTAL Date Date Date
Ck. No. :]Ck. No. Ck. No,
INC.AT THE ABOVE LOCATION ON OR BEFORE DUE BACKDATE.
TIRES RATES ARE BASED ON CALENDAR DAY. ANY
X
FRACTION OF A CALENDAR DAY SHALL BE
Cultorner's Signature GNAPPY Authorized R niiItwe GLASS CHARGED AS A FULL DAY.
Page 1
LEHVIER'S
lors Si:taei F 0 5,
P:
1 '524
CONCORD, CALIFOF.Nif, 9-
JLIC[%S! NC
C'
7,?;;
a "HUtAE
Iss a:*—_
Labor Labor Labor
PARTS SYK PARTS SYMI. PARTS
4 Hours Hours Hours
lFender Fender
Rail Fender Ornament
Fender Ornament
Fender Shield Fender Shield
Fende! Nlidg. Fender Mldg_
Gd. Head!amp Headlamp
2�1 System Headiamp Door Headlamp Door
�Fia a ISeated Beam Sealed Beam
;Cress 1.'E-nber lCowl Cowl
jDoor, Front IDoor, Front
Wheel IDoor Lock Door Lock
Hub Cap IDoor Hinge Door Hinge
Hub& Drum Door Glass Door Glass
Knickle Vent Glass Vent Glass
Kno--kic Sup. Door Midg. Door Mldg.
Lr, C c n t. Arm-Shatz �5_oof Handle Door Handle
L-ce:ise Frame Brkt. Center Post Center Post
.Llp Cont. A,,r, Shaft i !Door, Rear Door, Rear
thozkDoor Glass Door G;ass
Windshield Door Mldg. Door Mldg.
lRocker Panel A' Rocker Panel
iAe Rod jRocker Midg. Rocker tAldg.
s!ee'-:nq Gear
_--i [_ - i I I Sill Plate Sir!Plate
jS-.ceri,ig Wheel jFloor Floor
n !Frame r ;ne
IH Ing t
lc:evel'Shield I IDag Leg Z-9 Leg
jPark Light u t
lQuar. Pane
JCjar. Pane!
Cuar. Midg.,-,,4-T
!Grille louar. Mldg.
iCival- Glass Quar. Glass
lFender, Rear
IFende, 1%4;dg. IFender Midg.
Fender Pad Fender Pad
InSt. Panel
Burnpe,L.,
rZ p4.( /9 Front Seat
(Ba-"le, Side /-L-,,IBumper Rail 4/i cc Front Seat Ad
j'Falfle, lower ri Bumper Bt*t.S57,r(P j A- Trim
Upper Bumper 4&4,&11ex S-8r C..;: I Headlining
Lock Plate, Lr. Gravel Shield Top�jaT
Lock _ e, Up. Lower Panel Tire
Hood Top Floor Tube
Hood Hinge Trunk Lid Battery
.Hood Midg. I ITrunk Lock Paint
Hood Letters Trunk Handle Undercoat
Ornament Tail Light Polish
Rad. Sup. Tail Pipe Misc. Materials.
Rad. Core IGas Tank AUTHORIZATION FOR REPAIRS
Radio Antenna lFrame You are hereby authorized to make the e
Rad. Hoses Wheel specified repairs.
Signed
Fan Biad_e lHub& Drum Labor-Mrs.-:
Fan Belt Back Up Lite
I-
Walei'Pump Wheel Shield Parts-3 A
Motor License Frame-Brkt.
ed
Tax
Sublet
A-A:ign N-New OH-Overhaut S-Straighten or Repair EX-Exchange RC Re;.hromeU-Used
This estimate is based on IoAest possible cost is
%QnAisten lity work, and as such.
qua-anteed, !terns not covered by this estimate or en w i I I with
hadditional.I TOTAL
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CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COMM, CALIFORNIA
BOARD ACTION
Claim Against the County, or District ) NOTICE TO cuamANT January 15, 1985
governed by the Board of Supervisors, ) The copy oft s ocument 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: Fauzia Ahmed , County Counsel
Seth J. Feinberg
Attorney: Russell & Joy DEC 17 1984
One Kaiser Plaza, Suite 2135
Address: Oakland, CA 94612 Martinez, CA 94553
Amount: $100,000.00 By delivery to clerk on
Date Received: December 14, 1984 By mail, postmarked on December 10, 1984
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
Dated: Dec. 14, 1984 PHIL BATCHELOR, Clerk, By b � 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: - U Deputy County Counsel
III. FROM: Clerk of the Board T0: 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 the Board's Order entered in its
te.qe.
Dated:T � loj 1b V PHIL BATCHELOR, Clerk, By 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 warnig of claimant's right to apply for leave to present a late claim was mailed
DATED:toJhaJ�nnt
b X985 PHIL BATCHELOR, Clerk, By , Deputy Clerk
cc: County Administrator (2) County Counsel (1) 5
CLAIM
IM TCO: BOARD OF SUPERVISORS OF CONTRA COP*rF0 Kapplication to:
Instructions to ClaimantC!erk of the Board
.O.Box 911
j Martinez,California 94553
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 late= 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, California 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
muse be Afiled against each public entity.
E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at end
his form.
RE: Claim by )Reserved o ' iling stamps
FAUZIA AHMED )
RECEIVED
Against the COUNTY OF CONTRA COSTA) DEC IV 1984
or DISTRICT) PHIL BATCHELOR
LERM.BOARD UPERVISORS
(Fill in name ) CONTRA ACP_ ,,,
The. undersigned claimant hereby makes claim against the County of Contra
Costa or the above-named District in the sum of $ 100, 000. 00
and in support of this claim represents as follows:
---------------------------:---------------------------------------
1. When did the damage or injury occur? (Give exact date and hour]----
October 16, 1984 , approximately 6: 00 pm.
----- ----------------------------
�. Where aia the aamage or injury occur? tInclude city and county)
Pleasant Hill Road, approximately 185 feet south of Purson Lane, in
an unincorporated area of Contra Costa Countv
37-AN-aid
---------
------------------------------------- - mum;---T ------------3. How did the damage or injury occur? (Give ?all details, use extra
sheets if required) Claimant was a passenger in a car headed north
on a one-way segment of Plaesant Hill Road. The car had a head-on collison
with a vehicle driving in the wrong direction.
------ -----------------------------------------------------------------
4. What particular act or omission on the part of county or district
officers, servants or employees caused the injury or damage?
The road was not sufficiently marked as a one-way street.
(over)
-5. What are the names of county or district officers, servants or
. • employees causing the damage or injury?
Unknown at this time.
6. -What damage or injuries do you claim resulted? Give full extent
of injuries or damages claimed. Attach two estimates for auto
damage) Personal, injuries, including, but not limited to injuries to
right knee (fractured & lacerated) , face (lacerated) , chest, neck, right
eke--&- shoulder, back; also miscellaneous contusions, cuts, & muscle strain:
- - ------------------------------------------------------------------
7. How was the amount claimed above computed? (Include the estimated
amount of any prospective injury or damage. )
Computed on the basis of the nature of claimant' s personal injuries and
claimant' s attorney' s experience at evaluating personal injuries.
-------------
8. Names and addresses of witnesses, doctors and hospitals.
Witnesses: 1) Fauzia Ahmed & Anisa Gailani, both represented by the
undersigned attorney
2) Brian DeLoache, 2041 Miramonte, San Leandro, California
3) Tara Jowitt, 224 Longview Terr. , Orinda, California
Hospital: John Muir Memorial Hosp. , 1601 Ygnacio Valley Rd. , Walnut CreekCA
Doctor: John Wilhelmy, 130 La Casa Via, #103, Walnut CrP-ek, CA 94548
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
Medical bills are increasing weekly, and have been submitted to
insurance company.
Govt. Code Sec. 910.2 provides :
"The claim signed by the claimant
SEND NOTICES TO: (Attorney) or by some . erson on his behalf. "
Name and Address of Attorney Attorne 4-r4-Claim`at�
SETH J. FEINBERG, ESQ. le$8 s
RUSSELL & JOY
. One Kaiser Plaza., Suite 2135 Address
Oakland, CA 94612
Telephone No. (415) 444-6100 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. "
�9