HomeMy WebLinkAboutMINUTES - 02111986 - 1.14 • CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
BOARD ACTION
Claim Against the County, or District ) NOTICE TO CLAIMANT February 11 , 1986
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: LILA G. PERSON Coup
. tY Coy►nsel
Attorney: Brays Egan, Brei.twieser & Costanza JAN
736 Ferry Street 1 7_1986
Address: Martinez, CA 94553 Hand delivered Martinez, CA 94553
Amount: $20, 562 . 00 By delivery to clerk on 1/16/86
Date Received: January 16, 1986 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: Jan. 17 , 1986 PHIL BATCHELOR, Clerk, By fl Deputy
n Cerve 171 i
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: 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
b 4 This claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy f the Board's Order entered in its
mi=t,esl ff19§ti s date.
Dated: rr tt 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 elaima
DATED: X8.1 2 'y PHIL BATCHELOR, Clerk, By (� (if ` _ , Deputy Clerk
cc: County Administrator (2) County Counsel (1)
M ATM
CLAIM 'TO: BOARD OF SUPERVISORS OF CONTRA COWX_,krWWRVapplicationto:
Instructions to ClaimantC!erk 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
this form.
RE: Claim by )Reser fo 1 k',s ID
ng stamps
LILA G. PERSON )
RECEIVE
Against the COUNTY OF CONTRA COSTA) JAI [G 1986
CPI,51 R m
or DISTRICT) PHL IeTHROR
Fill in name ) CLERK I on CO suMC
C A COST
The undersigned claimant hereby makes claim against the County of Contra
Costa or the above-named District in the sum of $ 20 , 562 .00
and in support of this claim represents as follows:
-- ----------------------------------------------
-- ------------- ----
i. Whe----n did the damage or injury occur? (Give exact date and hour
October 16 , 1985 at approximately 12 :45 p.m.
2. Where did the damage or
1n3ury occur? (Include city and county)
On the sidewalk adjacent to 805 Las Juntas Street ,
City of Martinez, County of Contra Costa
- ------------------------------------------------- - ------------------
3. How did the damage or injury occur? (Give full details, use extra
sheets if required)
I tripped and fell due to a jagged break in the sidewalk.
------------------------------------------------------------------------
4. What particular act or omission on the part of county or district
officers , servants or employees caused the injury or damage?
The county did not maintain its sidewalk in a safe condition.
(over)
S., What are the names of county or district officers, servants or
employees causing the damage or injury?
County of Contra Costa and whomever maintains and repairs its sidewalks .
---------------------------------------------------- --------------------
6. What damage or injuries do you claim resulted? Give full extent
of injuries or damages claimed. Attach two estimates for auto
damage) Lacerated right forehead, bruised face , lacerated knees ,
low back injury at L-5 , back pain and pain about both knees.
7--. H-----ow--was-----the--------amount--------claimed---above-------computed?---------(Include----------the-----------estimated---
amount of any prospective injury or damage. )
$20 ,000. 00-general damages Right Hip Pain - Headaches -$562 .00 medical
bills plus prospective damages unknown
---_-_®------------------------------------------------------------------
8. Names and addresses of witnesses, doctors and hospitals. •
D,r , Deborah B. Penrose Dr. Smith
3585 Clayton Road Dierrithew Memorial Pospital
Concord, CA 94519 2500 Alhambra Avenue
Dr. Edward A . Williams Martinez, CA 94553
835 Main Street
Martinez, CA 94553
-------------------------------------------------------------- ----
9. List the expenditures you made on account of this accident-or in--jury----
:
,,...IIug---'-_ ,...« ,.. .....,..., ITEM AMOUNT
10/a6 5 ,l• If".1
Zp�- 5141.11 8/85 Visits to Merrithew
'.-,: ;A Memorial Hospital $349 . 00
11/4/85, 11/21/85 & 122/85 Visits to Dr. Penrose 185. 00
12/ /85 Dr. E. A . Williams-
Co es of bills are attache Glasses repaired 28. 00
J. 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 _
BRAY, EGAN, BREITIVIESER & COSTANZA77 Claimant
736 Ferry Street 1111 Ferry Streef
�:lartinez, California 94553 Address
Martinez, California 94553
Telephone No. (415)228-2550 Telephone No. (415)228-2550
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. "
." L °� Health Services Department
PATI
s
Please direct reply to: .A N 8
724 Escobar Street
+ covKt'i Martinez CA 94553
Date: January 6, 1985
Angelo J. Costanza.,
Attorney 1 l
I,i-LAY. r,JAj%i, J3iP1�IT`"JI_',S::,lt, GO,' AI`I%.A
736 seri;;, St.
11art_i_nez, CA 9)1553-1697
'rl?5 ;1d, LTLA G. ?6
RE: UNIT � 771l1-6
Dear lir. Costanza:
Enclosed herewith please find .copy of billings on the above-named
patient in accordance with your request for the same.
-Y No In addition, this patient has received care from
providers other than Contra Costa County Health
Services. Due to the patient's involvement in the
Contra Costa County Health Plan, these providers
were reimbursed for their services by the Health
Services Department.
Any settlement received for this patient should provide for full
reimbursement of all services rendered and paid for by Contra Costa
County Health Services, 2500 Alhambra Avenue, Martinez CA 94553.
Please inform us when litigation is settled. Thank you.
CONTRA COSTA COUNTY HEALTH SERVICES
/Janet Caldwell
(.Account Clerk III
The CCHP out of Cot_Inty provider charges are not available at this time.
I will send them as soon as the-: ;ire availahle.
Tolual of tie attached is, 349.00.
EnL,
A- P 7 Contra Costa COt.M
• 1 _ N
'Contra Costa County Health Services Is:dividca`
clinic areas. The Infowtion enclosed is from:
7/.:4xx 11t.rtinez Heal th'Center (Hospital)
2500 Alhacbra Avenue. Martinez. CA 94553
Richmond health Center '
38th;and Bissell. Richmond CA. 94805
Ptitsbur9 +Heil th Center
45 Civic Avenge, f4ttsburg. CA 94565
-.Oakley Health Center
260 Juin Street, Oakley. CA 94561
j Brentwood Health Center
• 118 Oak'Street, Brentwood, CA 94513
• / J George Miller Center East
' 3020 Grant Street.,Concord, to 94520
J•> George 1411jer Center West
2861 HillTop Drive; Richmond•. CA 94006
Concord CCRP
3052 Williow Pass- Rd.
Concord, CA 94520
` 2025. Port Chicago HighwtV -
Concord, Cd 9WO
AMHC
21100 Sycamore Dr.
Antioch, CA
RMC
256 - 2Lth Street
Richmond, CA 91,805
i
Fl:,I.CGN) LIL% G. U# 267741-6
i
.If you -believe additional treatment was obtained at any
location, other than the one Indicated above, please request
Est information, and/or..iiling from that Center.
AIIh3E 110:
•
��- A LCONTRA COSTA 4OUNTY`'HEALTH,rSERVICES 1
'~FOO AgHAMBRA AVENUE'--
-MARTIN
f 10/27/6MARTIN�x CALIFORNIA 94553 ?
0 p ( 15)372-4405
PERSONS LILA G "05570999 F 61 19/16/85110/16/851
LILA PERSON MEDICARE "B"
PO BOX 87 56. 016448a
:�` • �VMARTINEZe CA 94553 s 'CONTRA 'COST.A. HEA, 71 500 '
1�
PLEASE RETURN THIS PORTION WITH YOUR PAYMENT -" _+ S
l ;r4 9 r
1�q ' i IN
Sr t .:f71�lOMET .
i
101685 1 SUTURE TRAY 4054641 16.00
101685 .1 ELECTRODE MONITORING 4059205 5.25
101685 1 GLOVES-SURGEONS 4059268 N/C
+� TOTAL CENTRAL SUPPLY 21 .25 .00 .00 .00 21 .25
101685 1 TREATMENT ROOM 4530000 30.00
101685 1 ER INTER EXAM-EST 45324 ... .3
.50
** TOTAL EMERGENCY_ROOM VIS yJ: s atY` 50 ; .00 .00 .00 73.50
rf 1
101685 1 REPAIR2.5-7. 5CM.SIMP 42057 70.00
«* TOTAL EMERGENCY ROOM 140C E. �5 '%70. .00 �'i' ';' .00 .00 .00 70.OG
SUE-TOTAL OF CHARGES '}��'Y'`� ;�'{ s� o�� y ` f* 00 .00 .00 164.75
TOTAL LIAR ILITY 3£h�sv-
-• ;4 tY.'°�6ffeT'iP' ' % .00
X07
lti t f .00 164.75
� f��� Y1 '� 'tF� 4 '!• ��
t !
)wrw I f
r
I
.00 .00 .0'3 104.175 PLEASE REFER TO PATIENT ADDITIONAL PATIENT BILLING MAY BE NECESSARY FOR ANVNUMBER ON ALL INDVIRIES CNARGFS NOT PpSTEO wNEN THIS BILI wq5 PREPARED,OR5570yfC AND CORRESPONDENCE. IF INSURANCE. CARRIERSDO NOT PAY ANY PART OF TME 'C`•
PAV NOS(11/94) AMOUNTS SNOWN UNDER EST IMATEO INSURANCE COVERAGE.
®CONTRA COSTA COUNTY HEALTH SERVICES 0 2500 ALHAMBRA AVENUE • MARTINEZ, CALIFORNIA 94553 • 1415)372-4405
Make checks payable to County Auditor-Controller,
u, MAIL PAYMENTS 0: County Auditor, Room 203, Finance Bldg. 1
625 Court Street
F NAL110/31 /851 Martinez,California 94553
i�
OP Enclose a self-addressed stamped envelope H a return receipt is desired.
,4
PERSONS LILA 6 05573621 F 610/20/E 10/20/8 1 .
;�: LILA PERSON MEDICARE N 8s
Po ecx 87 56 016«80
..._
MARTINEZ. CA 94553CONTRA COSTA NEA 71500
PLEASE RETURN THIS PORTION WITH YOUR PAYMENT $
102085 1 SUTURE REMOVAL SET 40598278 8.35
*+► TOTAL CENTRAL SUPPLY 8.35 .00 .00 .00 8.35
102085 1 TREATMENT ROOM 45300001 30.00
102085 1 UC INTER EXAM-EST 45323102 32.50
�► T07AL EMERGENCY_ROOM VISIT 62.50 .00 .00 .00 62.501'
SUBTOTAL OF CHARGES r'';, .00 .00 .00 70.85
TOTAL LIABILITY „��85 ° ' .00 .00 .00 70.85
!e a F•G
i I
+i
I
I
I
1
I
• � I
. 8: .GO
7t .00 .00 70. H
.PATIENf•/hgth ER '` PLEASE REFER TO PATIENT ADDITIONAL PATIENT BILLING MAY BE NECESSARY FOR ANY
NUMBER ON ALL INQUIRIES CHARGES NOT POSTED Ww(% THIS BILL WAS PREPARED,On
5573621 ANO COR R ESPONOENCE. IF INSURANCE CARRIERS DO NOT PAY ANY PART OF THE 70.S
PAUNOS(11/84) AMOUNTS SHOWN UNDER ESTIMATED INSURANCE COVE R AGE
CONTRA COSTA COUNTY HEALTH SERVICES a 2500 ALHAMBRA AVENUE 9 MARTINEZ, CALIFORNIA 94553 • (4151372-4405
Make checks payable to County Auditor-Controller.
MAIL PAYMENTS TO: County j4uditor, Room 203, Finance Bldg. 1
625 Court Street
C Y C L E 2/14/55 Martinez,California 94553
1
0 P Enclose a"If-addressed st6pd*"dope if a return receipt is desired.,
NOW
PER50N. LILA G 0386988Q f 1 66 851 1 3 i
. I
LILA PERSON ►MEDICARE
PO 80X 87 I 56 016446D
*ARTINEZ� CA 94553 CONTRA COST* NEA 71500 �.
1. t
-07 005810045
PLEASE RETURN THIS PORTION WITH YOUR PAYMENT WNW
$
BALANCE FORWARD .00 .00 .00 .00 .00
110885 1 CHEM CALCI-UM SERUM 40680034 14.40
110885 1 PARATHYROID HOR - 91 4063243 35.00
INTERNTL CLINICAL LAS-WST tl
6511 GOLDEN GATE OR
DU.BLIN.*CA.94568 � •'�;± •i :''*`r' ;
110885 1 VENIPUNCTURE
110885 1 HNDL CR.G OUTSIDE LAB Q69031 N/C
*• TA 0 l CLINICAL LAE :p•�:/i : 00 00 00 49.4C
T N R
1108$5 200 HYDRALAZINE 25MG
789089
110885 200 PROPRANOLOL CT 40M $r r�
7E9088
*•
0TOTAL PHARMACY " x �•`f;:�L00'
.00 .00 64.OVL
*'•• PATIENT MMEBER PLEASE REFER TO PATIENT ADDITIONAL PATIENT BILLING MAY BE NECESSAA FOA ANY
(F�� NUMBER ON ALL INOUIRIES CHARGES NOT POSTED WHEN THIS BILL WAS PREPARED.OR
3 E 5 9 b G J AND CORRESPONDENCE IF INSURANCE CARRIERS DO NOT PAY ANY PART OF THE
PALII405191851 AMOUNTS SHOWN UNDER ESTIMATED INSURANCE COVERAGE.
CONTRA COSTA COUNTY HEALTH SERVICES 0 2500 ALHAMBRA AVENUE 0 MARTINEZ, CALIFORNIA 94553 0 (415)372-4405
®
MERRITHEW MEMORIAL HOSPITAL AND CLINICS
Make checks payable to County Auditor-Controller.
MAIL PAYMENTS County Auditor, Room 203, Finance Bldg.
625 Court Street
CYCLE 2 NT Martinez,California 94553
lop Enclose a self-addressed stamped envelop.If a return mc.ipt is desired.
PFRSONo LILA G 1 03869880 IF 1 6 11/08/85 3
LILA PERSON AEDICARE •EH"
PO e0x 87
56' 016448D
MARTINEZo CA 94553 CONTRA COSTA HEA 71500
r. y} O7 0054810045
PLEASE RETURN THIS PORTION WITH YOUR PAYMENT $
SUBTOTAL CURRENT CHARGES StwT 113 '/0 .00 .00 .00
TOTAL LIABILITY sE-&tr //3.VO 11 .00 .00 .00 //3•/0 )
F�
"Jr., .
:.5.
113: 0 Vo
0 100 .00
•�,p.. l .it.%z
y „
I
S
.AI J�M PLEASE REFER TO PATIENT ADDITIONAL PATIENT BILLING MAYBE NECESSARY FOR ANY
_ AUMPER ON ALL INQUIRIES CHARGES NOT POSTED WHEN THIS BILL WAS PREPARED.OR
+ S R'0]_". ; AND C.ORRESPONOENCE. IF INSURANCE CARRIERS DO NOT PAY ANY PART OF THE 3 )
PAUNC519/851 AMOUNTS SHOWN UNDER ESTIMATED INSURANCE COVERAGE. V
CONTRA COSTA COUNTY HEALTH SERVICES . 4500 ALHAMBRA AVENUE • MARTINEZ, CALIFORNIA 94553 • (415)372-4405
MERRITHEW MEMORIAL HOSPITAL AND CLINICS
v-<0< a
00 m' - < m
n�o3 � m �
<D 7D
_n ...
m m m a m�' a n m j
CTI
mr
M
o v 0
x d
d" m :33
n3a ° a
3 N N' 'no
a m,l
AWN✓O lD Oo Q <N
-N
m m 0 0 0 0 0 ono > p 0 m 0
y O N
' .'..'....'... C Z '
> m 3a a a a a > - ..
n m (T1 w r . . ..
�� . . . . p
m Darrrrr r
< N
CO
mDmmmmm 0 r
z no _ p
fn m
Ul
m k V MO?'o I? W Z D n' m
y D
"a �3^.da OL
9 d x Ul r, -<
0 n v' o
Z N _ C�
m o�omvmm �
W N -i N fC
0 30o v m
m
m m�_ myy r d.^.^ Z
r fm r r0mm C 0
N C
0> m 0 m m
D D C
< N N O
33 n >
r
°c' >
Z
m m i
c (��
e m e 1V
M Z0
3 0 0 r m 0 0 0 0 0 0 0 p < O < n G
O O m d 0 0 0 0 0 0 0
° ^n-'
Nb a m 3 a a a a a a a fD ° 7
W In D - Q < D
r m m a _
Om m m m D_ m m A m ry m m m a m a:1 D c .
m , N c
W i A A 3 T T T m m v N
m m y
v .. m ..
M m m V RI m o o
O x fn D to T x � Z
mA a D D o d a m i {
3 3 m d n a m o v to
m
• z ,
m w 3
N O m
o
o
7
a �i" e•rs•eesj2i7F�6 A7` �tl°. 1�Yfs`lP•+j''d�r:nw,kAw.e'.'F`en•�'Pn•• a y�,3hL,a •� ., yipsR!°,�°."'l,;iit •.3'r `yPt..
c c t si•1 .n:i•k+ t A r S;;7:
'c y.4✓ �a �•, o r #r
� y +-�}1 s+tt 7 t ,. ,. w` _ r e f v rMw•'4
t r. J0
X
Dr.Debora' Penrose• �, i`
Ca C i;:.A 4678 1 f' •.
X1 NEW p7. -. ]JA
CLAYTON ROAD MEDICAL.GROUP' .�,`3585 CLAYTON ROAD` : CONCORD, CALIFORNIA94519798-1500O EST._P•T, X LD.#68 0000227 O;C,;FARRELL VARNER,-M D ❑ ARTHUR H.GLASER,.M D ❑ WILLIAM G GERBER;M.D zG':PSI +, 1�';•Fps tis '7 '+Z'CAL:'LICF:*C32943' Jt. ' ° "'CAL.LIC. *G31085: ""CA 291 LIC:#G2291,1 W .
ACCT.# NAME`s° t. e.'T t LAST " v FIRST INI.' TYPE SEX 'BIRTHDATE:'=M.D.% `DATE
PER 1
DDRESt: CITY ls" T STATE P TE N MS '
' �.0. ox 87"' :. _ - Mart6eez 'Ca. 4553 1284
BILL TO:(IF NEEDED) NAME AND ADDRESS a 4,;71. r DATE OF INJURY
MEOICAR #' MEDICAL#` SS# EMPLOYER'
561-01-6448 D r .:588=10-0451: 1
jt�SSLIRRAAN�E ` Iy yf MEMBER # GROUP* RELATIONSHIP
�( DESCRIPTION - RVS/CPT-4 MOD . FEE DESCRIPTION RVS CPT-4 MOD FEE DESCRIPTION RVS CPT-4` MOD FEE -
OFFICE VISIT NEW• -ESTAB. OFFICE OB/GYN SUPPLIES cont • - -
Minimal 90030! Total OB Care: 59400 '+
Brief 90000 90040 : ". Dia hro m Fittin .5717G-58
Limited : 90050,
Intermediate 90015 90060 INJECTIONS
Extended 90070 IMMUNIZATIONS-"• - -
PHYSICALS/WELL- 1 DPT..'': 90720 90701
HILD CARE NEW ESTAB. DT(Childl!'.'. 90720 90702
Under 1 Yr. 90754 90764:.
1 -4 Yrs. 90753 90763 dT Adult 90720 ' 90718 LABORATORY RVS Pr;4 =
Influenza`- 90720 ' 90724 LAS ONLv
5-11 Yrs. 90752 "90762
12-17 Ys. 90761 90761 ' MMR'". 90723 90707 UA,Dipstick 81005
Orel Polio Vacme 90720 90712 UA,Routine 81000
Adult Brief . . ', 90010.: 90050
90088/': PPD 86580 WBC 85048
Adult Comprehensive _90020 90080-01. TB Tine•`: r - 86585 : Hematocrit sf` 65014 -.
DMV,Pro-employment 90010 90050 Tetanus-Immune Globulin 90730 90742 Sed.Rate 85650
School/Sports 90010, 90050 52 Monospot 86006-01
- a •(,� MISCELLANEOUS Pregnancy Test 82996
X-RAYS r"•OO Audiometry.Basic 92551 Gram Stain 87205-01
Chest PA " 71010 Audiometry,Booth 92556 Wet Mount 87210
Chest,2 Views' 71020 S iromet 94009 94010 Strep Screen 87081-02
Ribs,1 Side... .71100 RemovaVlmpaetedCemmen 69210 GC Culture 87081-01
? Lumber,Limited. 72100. "' "'= EKG w/Overread .' 93000 87008
L•S Spine 72110 UrineCult. nsitivi 87184
Shoulder,Complete 73030 99018 89008
P S ecimen Collection 99000-01 9000-0
Elbow 73080' SUPPLIES Venipuncture W/ 99019 99009
Wrist,3-5 Views 73110 Suture Pack ::;" 99070 Centritu a 99000-0
Glucose,Stick 82948
Hand,2.3 Views 73130 Su ical Pack.- 99070
Fingers 2.4 Views 73140 Crutches 99070 Occult Blood 89205
90
73570 + Knee Immobilizer,S 99070
Executive 11 80118-
' Knee Com lets 73564 Pap Smear 88155-90
Ankle,3 Views' 73610 Splint,Fin er 99070
Splint Forearm
Foot.3-5 Views 73630 non- lade 99070
Sling,fashioned. 99070-
OFFICE
9070-OFFICE SURGERY RVS. CPTr4 Bum Dressing,L . 99070
6 D Abscess 10060 :' `" `': '. ` Unna Boot/Dome Paste' 99070 • •. "•,: ,
Dest.Skin Lesion Trunk 17100 IV Fluids-: 99070
Some or all of your lab work hes been performed by'ICL•'
Deet.Skin Lesion face 17000 Western,6511 Golden Gate Drive:Dublin,CA 84568.The''
r ,. i ri:Th
ICL charges are:
ase charges
••• •• - ':'••`vi..t ilei are included in our fees.
... ,. ..t.: .. _. .
DIAGNOSIS A::<742.60Courtesy
: y+
DESCRIPTION DESCRIPTION.. -DESCRIPTION Total Fee e/Coupon
0 .70.Special
C
O Abdominal Pain 7890 O CVA.:'..:..:..- -- .. 434 O`1 Pheryngitfs;acute 462 80 Ind.Med.^r 57.
❑ Abrasion.....:'::i•...s I- -9190 0 Cystitis.acute .. . 5950 O Physicel Exam ....... V70
'r ❑ Allergic Rhinitis. , 477 O.Depressive riection ::309.0 0:PID....-.. .....;..,614 9 Adj_Co
O Anemia.unspecified• - 285.9 ❑ Dermetids,contact - ., 882 -0!Pneumonia. ...... 486 e• r
O Angina pectoris , 413 O Diabetes.Insulin•dep . 250.01 0''Pregnancy. ..i:... V221
Adjustment
: 0 Arthritis,unspecified ..........716.9 O Diabetes,@dull onset '.. 250.00 O�Prostatitis,Acute....:...... 6010
O ASCVD ...:r;..:,,.- "'4409 O,.Diarrhea,infectious- '::.:009.3 O.Resh ..,.,.:............: 782.1 �____J•ri:: .:L---_J
a
❑ A,Ihme. - 493 .0%-Dizziness ... - 7804 O Sinusitis:scute ..... 461 w1 •�,
❑ Backache 724.5 O'Emphysema ..:' 492 0 Sprain/strain. ..... 848.9 r ,1
❑ Bronchitis scuta 4 4680 :0.Gastmenteritis,infectious 009.1 O proin,ankle ,.. .... 845.0 ' ❑ C88h 1 •�J '
0 Carbuncle/Funrncle . 680 '0 Headache 7840 strain.Lumber ....... . 847.2 Payment
0 Ceeutitis ..... -, 682.9 O Hemonho ds internal '455.0 ❑ treptococcal sore thrust 034.0 ❑.Vi S.A/MC-•�{y r
❑ Chet pai t no?Cardiae - 786.5 O H .:.-..... 401 O'Syncope or collapse ....... 780.2
0 :;HF .... .,t V i 428.0 0.Influe za - t 487 O;Tendmins.:............:,,.726.90 - 1 :oil °ImUe13l'7 r
I O Conluncttrn scuta . 372.0 O Menstrual disorders 626.9 0;Tonsillitis.acute .......... . 463
1 ❑ Con;onclivita atopic 372.05 O Obesity 278.0 O'URI,acute..:......... . 465.9
0 Cw,tusron -. r 924.9 O Otitis a to s :. - 380.10 O,UTI..r,a...:..'..... . 599 0 = Baie CB �r �:.
❑ COPD .. 496 D DIM.Serous ...............:"38101 O Vaginitis.............. 616.10
n -_ i.`.:
❑ Comosl Abroaion.°::: ...... 9181 ,0 Paoli Ulcer Dl.... ,....... 5337 O,Vuel Inteetion ....... ...:,0799 Due ,; r•,.
DIAGNOSIS Ft I.C.D.A.CODE(IF NOT CHECKED) 4 IDS SI R r
NEXT VISIT STITCHES,REMOVED TION 1
1/ ! ► DAYS
a•.i! t r�.a v i.v ? n
HANDOUTICIRCLE). BRUISES- :.CASTS DIET FEVER' :Irr, VOMITING > ,
CUTS, .UTI ".DIARRHEA ',.SPRAIN. .` OTHER } Ia-`-#
. ... al ..
E a
DATA COPY Wh14A1* a Lf,.:FILE COPY-Yellow '. PATIENT COPY•Pink Ch02016 r
/ 1 X _ t
7 1
Dr. De
borah$.1 Penrose
r • • Cat, Lic # : 4678
❑ NEW PT..,:.'r_ .CLAYTON ROAD MEDICAL'GROUP.''`%i 3585 CLAYTON,ROAD CONCORD, CALIFORNIA 94519;,'._''(415) 798-1500','.;
EST.,
•TAXxI D: #68-0000227 r� H or"C.FARRELL VARNER,M D T. ❑.ARTHUR H.GLASER.M D ❑ WILLIAM G:GERBER`M.D
-• -CALIILICr#032943 :•-CAL.LIC. #G31085 - CALi'LIC,#G2291.1,;, f
s.,
ACCT.
NAME t 'i LAST ,r''. `".FIRST' INI. TYPE SEX' 'BIRTHDATE'M.D.- DATE'';
EKL166 - "PERSO - - - 5
ADDRESS CITY t q`g �. STATE - 21P TELEPHONE' MS
,4
BILL TO:(IF NEEDED)..:`.. NAME AND ADDRESS " DATS,OF INJURY
MEDICARE # MEDICAL# SS#.+ EMPLOYER
INSURANCE ` .,:1, MEMBER # GROUP # RELATIONSHIP
DESCRIPTION AVS/CPT-4 MOD FEE DESCRIPTION,.. RVS CPT-41MODI FEE DESCRIPTION RVS CPT-4` MOD FEE '
_ OFFICE VISIT NEW OFFICE OB/GYN SUPPLIES cont - `
Minimal 9003 Total OB Care.' :' .59400 �..,
`
Brief ''. 90000 90040 : Die hra m Fitting
57170.58
Limited 90010 90050 . I 1?
Intermediate 90015 --.90060 INJECTIONS -�' �`'• °�
Extended _ 90070 '' IMMUNIZATIONS
PHYSICALS/WELL- A 1. DPT�'..` 90720 90701
ILO.y�ARE ,_ __t1EW ESTAB.
DT(Child)*.,:;, 90720. 90702 '
Und_ar 1 Yr. S0754. 90764
1 -4 Yrs. 90753. 90763 dT Adult ti 90720 90718 LABORATORY RVS PT-4
5-11 Yrs. 90752 '90762 Influenza• 90720 . '90724 LAS ONLY '
12-17 Yrs. 90751 . 90781 MMR 90723 90707 UA Dipstick 81005
Orel Polio Vacine 90720 90712 UA,Routine 181000
Adult Brief 90010 90050
PPD 86560
: 90088/
WBC 85048
Adult Comprehensive 90020 .9008 O1 TB Tine':`: . 86585. Hematocrit 85014
DMV,Pre-employment 90010 90050 Tetanus Immune Globulin 90730 90742 Sed.Rate 85650
SchooqS9WI0 50 52 Monospot. 86006-01 '
MISCELLANEOUS Pregnancy Test 82996
77 777
X-RAYS /. Audiometry,Basict. 92551. Gram Stein 87205-01 •
Chest PA 7101 Audiometry,Booth. :, 92556 Wet Mount 87210' ':
Chest,2 Views. `. 71020 S iromet 94009 94010 Strep Screen 87081-0 '
Ribs,1 Side 71100
RemovaVImpacted Cerumen 69210 GC Culture 87081-01
Lumber,Umned .72100 ' EKG'w/Overread 93000 .87008'
Urine 61t./Sensitivity 87184
L-S Spine 72110 -
99018, 99008 < '
Shoulder,Complete 73030 Specimen Collection 99000-01 99000
Elbow 73080 SUPPLIES Venipuncture W/ ., 99019 -99009.
Wrist,3-5 Views _ . 731 10Suture.Peck 99070. entrifu ".`t ' •'.; -
Hand,2-3 Views 73130 Surgical Peck 99070 Glucose,Stick 82948 1
Fingers 2-4 Views. 73140 Crutcheti`; 99070 Occult Blood 89205
73570 Knee Immobilizer 99070' Executive 11 " 80118- 7
Knee Com late 73564 Pop Smear 88155• r
S lint,Fin e6, 99070-
Ankle,3 Views 73610
Foot.3-5 Views 73630 Splint Fi rearm 99070
r
r
Slin :fashioned ' 99070-part
u
+,.
OFFICE SURGERY RVS CPT-4 Bum Dreasin ,L . 99070 c . ,
I B D Abscess 10060 Unna Boot/Dorrle Poste. 99070 t77,777,
Dost.Skin Lesion Trunk 17100 IV Fluids 99070 Some or ell of your lab work has De`erirperformad by ICL
Dost.Skin Lesion Fate '17000.
t - .1 t -*i•? Western,6517 Golden Gate Drive Dublin,CA-s94568 The2'�
k''�P'r.ts.ltFt Y 4 t F,' '' •1rT
1 4 ICL charges ere: Thsae charges
are included in our fees r"F:
r.
"• DIAGNOSIS + u r 42-61 Counesy
DESCRIPTION ° DESCRIPTION DESCRIPTION Total Fee Coupon c`'f1
✓� L,w sr.70 Specie)
x. - `
❑ ADdominsl Pan. -789.0 ❑ CVA..! - 434 ❑ Phsryngrbs scute - . 482 Olnd Mad
❑ AbrasionO-J^-''n: S .8190 '•Cystitte V70 saute e.!.t.'5950 ,O-Phystesl Exem t -✓ � t�t �'
Ct8
O Ausrgit Rhmnb - 477,'.O Oap enrvs,roactfon q 309.0 'O r PID-. .'.iY 614.9 _ r T'r',Adj.Code- i
O Anomia,pmpeeIf'd 285.9 ❑ Dermatitis,domact .x 892 13:Pneumonts 488 s-i
O Angina pectoris...: - 413 O_Diabetes.insulindep - ti 250.01' O'Pregnanry• V221 ; Adjustment
e - -250.0 " Psts,Abuts s❑"Diabetes adult onset' ( #1I.
O Arthritis,trrspecdd .;-'79
❑ ASCVD - } 4409 ❑•Diarrhea Inlettiwe "r,009.31•O Rech :i.. :,, 782.1 1 - J a.•d L��+.1 _fi'.FJ try`
_ ❑ Asthma 493 0 Dizziness .:1 c- X7804 OiSmuams;stats :481 t t?
O Backache 9 724.5 O'Emphysema - .'492 O:Sprain/strain 848.9 y, + ,�Sf•. jht s�4
❑ Bronchitis scuta ";N4.4660 'O.Gastmentedils.infectious 009.1 M Sprain,ankle 845.0 ❑❑/C66h 2�, -6
❑ CtrbuncN/Firutxle.. + .'680 O Headache 7 "7840 X01 Strain,Lumber . ...: 847.2 .,Payment 118Ck
i
❑ Cellulitis ......:... r 1 882.9 ❑ Hemorrhoids mtemal 455.0 :0-Slrepttxoeesl more throat 034.0 I , -`it d �J^•
❑ Cheer Dein,no4 cardia. . 186.5 ❑"HBP 1 / ° 401,1, ;❑r Syncope or collapse . ..780.2 ❑ VISA/MC .
❑ CHF ......:.:..... j._ 'A28.0 •O`Influents,r...'. fi r f 487 .O:Tendinitis 726.90 y -t �ir�xr'�
❑ Conlunttr i n ruL• .372.0 O Menstrual disordora ::•626.9 ❑ Tonsillius,scuta ... . 463 - - -- y Initial'! -
❑ Conluncth t t utopI, 372.05 O Obesity .?.:.. 278.0 :0:URI,acute":': ....... 465.9
.17 Contusion r•6 4.9 '❑ Otitis esterna ;,380.10 -O,UTI.'.::'. - 599.0 BSI
U COPD "•" . 496 ❑Odne Serous ::i 53 t `30101 ❑i Vegmitu,: .616.10 &_
nCe
❑ Corneal Abrasion::'........, 918E ❑ Peptie,Ulcar Disease 'i 6337 •O:Viral lnfectron 0799 tF Due " 2
DIAGNOSIS Ft LC.DA.CODE(IF NOT CHECKED) * $is DOCTOR'S SIG tU
NEXT VISIT "'r :?" 7 STITCHES,REMOVED . INSTRUCTIONS +
a, '11ILLLL DAYS"
- HANDOUT(CIRCLE) .BRUISES:', STS :DIET FEVER I VOMITING,
J.
CUTS UTI DIARRH . SPRAIN OTHER
7-
DATA
DATA COPY White.rl 5` "FILE COPY Yellow PATIENT COPY-Pink CN02010
{^ ?`r'etv�,e?T. '{s' l -,�' ,� :'Y*'rt akt �1+p•� -�'rf �i
f . . t:• ,,stq L. t r{-�:1� Sy'+ `r- b`lt titrit' !i�tysf;"rS+•. rtai...
poz
X Dr.:Debora.rh.-$L�P�a''enhrr?o'ise�
4.'�TG�` � S''4•1rRr+.MSt i
;•it
_CaL Ltc A X678 0 }
13 NEW PT. ,,. CLAYTON ROAD MEDICAL,.GROUP.- `:3585 CLAYTON ROAD CONCORD,CALIFORNIA 94519 =:`,(4151'798-1500
`TAX I.D. #68 0000227 ❑ C .FARRELL VARNER,M D' O ARTHUR H.GLASER,M D : : 3'WILLIAM G't3ERBER,.M D
EST, PS.�':;•.':•`iv {: i'. r.,tt: t 1�S' +1",x:5; A ;;• l^tt A e' v
CAL:'LICr.#032943.` r ":CAL.LIC: #G31085 CAL LIC,;#G2291ar `
CCT.# NAME ` `''i Y` LAS7=i 't ti` FIRST' "INI:' TYPE .SEX.` BIRTHDATE' M.D:' DATE-
NAME".'-
PERSON. LILA. }•-s - - 5.'
ADDRESS
,: v' - ,:. ,,.. C[fYt tQ�1►�' aa -:.r Ei•,r }'s�' `';.f MS.
} STATE ZIP TELEPHON
BILL TO:(IF NEEDED) NAME AND ADDRESS DATEtOF INJURY t
MEDICARE#,'';: MEDICAL'#lt i SS ' ' EMPLOYER
INSURANCE. '::'': r 7 �'" '' MEMBER # GROUP# RELATIONSHIP
DESCRIPTION RVS/CPT-4 MOD FEE "DESCRIPTION- RVS CPT-4 MODI FEE DESCRIPTION RVSCPT-4 MOD FEE-t'
` OFFICE VISIT ' NE "' OFFICE OB/GYN "'. SUPPLIES cont
i'.
Minimal U' fatal OB Cere% 59400 9.'r
Brief 90000 ' 90040 Disphragmi Fitting : 57170 58 /• I
Limited 90010 '90050 :' �4.r
F.'
Intermediate `.: .90016 .''90060' - INJECTIONS -
Extended^ _ 9W70 IMMUNIZATIONS -:
(PHYSICALS/WELL": . '. 1 DPT--1; 90720 . 90701
R
MILD CA WEW CCTAU.• DT(ChiIS9 90720' 90702
Under 1 Yr. r 90754 :.90764
dT Adult".'_ 90720 90718 LABORATORY RVS PT-4
1 .4 Yrs. 90753 90763
5•1 1 Yrs. 90752 90762' - Influenza`•' 90720 ' 90724 B ONL
MMR .`' 90723 90707 UA,Dipstick 81005` r
12-17 Yrs. 90751. 90761
Adult Brief 90010. i'.90050 Orel Polio.Vocme '- 90720 90712 UA,Routine 81000 Its
86580: WBC 85048
duct Com rah nsH 90020 80-01 713 Tine -`.`: 86585 Hematocrit 85014
DMV,Pro-'employment 90010 ', 90050 Tetanus Immune Globulin 90730 90742 Sed.Rate 85650
School/Sports 90010 52 Monos t 86006-01 `."'
Pregnancy Test 82998
MISCELLANEOUS ....
X-RAYS, cr9 Audiometry,Basic 92551 Gram Stain 87205-01 '
Chest PA 71010 A.dlometry,Booth 92556 Wet Mount 87210
Chest,2 Views 71020. Sirometryl. 94009 94010 Strap Screen 87081-02 n
Ribs.1 Side 71100. RemovaVlm acted Cerumen 89210 GC Culture 87081-01 -
Lumber,Umaed 72100 EKG w/Overread 93(= 87008
._.;:•;.::,- ensitivi 87184
ti
L•S Spine 72110
Urine Cult
Shoulder,Complete 73030 99018 99008
P Specimen Collection 9 -01 99000-03
Elbow 73080SUPPLIES Venipuncture W/ 99019 99009
Wrist 3.5 Views":" 73110 '' Suture Peck 99070 Centrifuge
Hand,2.3 Views 73130
Surgical Peck 99070 Glucose,Stick 82948
Fingers 2.4 Views. .73140 Crutches 99070 Occult Blood 89205 -
Executive ll. 80118-
73570 '- KneeImmobilizer 99070 pap Smear 88155-
Knee Com Plate 73564
Ankle,3 Views 73610 Splint.Finger 99070 -
Splint Forearm `
Foot.3.5 Views 73630 non- taste 99070
Sling,fashioned -" 99070
OFFICE SURGERY RVS CPT-4 ' Bum Dressing,L . 99070
B D Abscess 10060 " Unne Boot/Dome'Paste: 99070
best.Skin Lesion Trunk .17100 IV Fluids 99070 Some or all of your lab work hes'been performed by,ICL=:.
best.Skin Lesion face 17000 "'' {..'' Western,6511 Golden Gate Drive:Dublin CA The
94568
',.
are:
charges `'.These charges`.
ICL t
.. ••
are included in our fees.
DIAGNOSIS r°y=
DESCRIPTION DESCRIPTION'' :?t DESCRIPTION Total Fee Coupon
r 42,70 Spectel V j
❑ Abdominal Pain'..:r: - 789.0 ❑ CVA d::.. .. 434 ❑ Pharyngitis,acute ..... 482 _ ',80 Ind.
❑ Abrasion.....iF 1:v 9190 .D Cystnls,scuts :5950 ❑:Physical Exsm ....... V70
614s )sr Adj_'Co
.S"'a o
❑ Altar&Rhinitis.... - 477 Cl.. DepreuNs reaction '...3090 0 PID....:. de 5
❑ Anemis.unspecified- - -285.9 ❑ Dermatitis,contact ... 6920Pneumonis _ - 486 t t
13 Angms pectoris .. 413 ❑ Diabetes:insulin deg ,. 260.01 '❑iPrapneney _V221 AdJYEt hent
❑ Anhritm unspecified 716.9 ❑ Diabetu;adult onset - 250.00 ❑`Prostetltis.Acute-..... ... 8010
13 ASCVD ...,.....q_: ....r-4409 ❑;Diarrhea.*infectious .0009.3 ❑.;Rosh':........'....... ., 782.1
13 Asthma 493 ❑,Dizziness °.7804 ❑ Sinusitis,elute.. .... '481 -
❑ Backache t .. t. 724.5 ❑,Emphysemtl .: .._... -. 492 Cl.Sprain/strain:........ 848.9
❑ Bronchitis,scuta..+, 1 ✓4880 'O.Gsstroenrodlif,Inlettrdus ''009.7• sin,ankle 845-0 r {: ❑ C88h 3
❑ Carbuncle/Funcnde - _y : 680 ❑ Headache l•F.:I + :'7840 train,lumber ....... ."647.2 �:-paymentd ChBCk w
❑ Cellulitis .....:::.: 682.9 ❑ Hemortholds,internal :'465.0 =Streptococtel sore throat 034.0 :.,-^r} r•,
1❑ Chest pem.not cardiae .•788.5 ❑'HBP''.::::.:. 401. ❑ Syncope or collapse ........ 780.2 - U.-VISA/MC, '
❑ CHF ..........:'., vF428.0 ❑,Influenza't.... C4B7 ❑ 7 endinn4 ...: ... 726.90
t ❑ Con;urctivitro,etme` a 372.0 ❑ Menetrueldisorden •828.9 0,'Tonsillitis.scute,..... 463 ,' <Stt •, In7tlal v.
❑ ConjnnU Ito atop+q - 37205 ❑ Obesity .:=•.:. ; 278.0 Or URl,acute ....:485.9
1❑ Contusron 924.9 ❑ Otitis edema :. .380.10, 13:UTI:...I: _ 599.0 Bala rY R, i
U COPD .. .. - 49e 1Tptitis Serous ,.. : ,-38101 ❑.Vepinnts.: E. 616.10 ACe
Ej�
Ry v
b Corneal Abmion.: ....f..,9181. ❑ Peptle Ul�e Dwu 1 ....,.. 5331 .❑>Yrel Inlecdon. .....:i..l:, 0799 DUe i +
DIAGNOSIS B I C D A CODE(iF.NOT CHECKED) . � DOCTOR'S SI NAT
1 _1 4�f,, r i t tt.y f ✓irit t
•t k �. I x �, 1 - U t i� :{Y'. C F tC�{ ib
u
NEXT VISIT STITCHES REMOVED INSTRUCLIO S : 1
DAYS
HANDOUT(CIRCLE) BRUISES CASTS DIET FENCER! 7i VOMITING '
4 Id.i t1
CUTS UTI:; DIARRHEA ,.SPRAIN •,^' OTHER. c
DATA COPY Whtteii Y. l FILE COPY Yellow. PATIENT COPY Pink s r,a l r CN02010 1
! 4
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
BOARi- ACTION
Claim Against the County, or District ) NOTICE TO CLAIMANT February 1L 1986
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: FARMERS INSURANCE GROUP
County Coumsei
Attorney: Alan J. Zapala, Esq. JAN 10 1986'
Collins & Zapala
Address: 100 Park Center Plaza, Suite 506 Martinez, GA 94553
Amount: San Jose, CA 95113$20, 294. 70 By delivery to clerk on
Date Received: January 10, 1986 By mail, postmarked on January 9 . 1986
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
0
Dated: Tan_ 10, 1_9j6 PHIL BATCHELOR, Clerk, By v Deputy
_-Qn Cervelli
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). cmc �"
Other: JA t t:QJ ) yu:_ &� 4 • 1tL 0
_7iCc
Dated:(.1 .0�.�c.! r_a � '< � :� 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 the ard's Order entered in its
minutes for this date.
Dated: 1 11986 PHIL BATCHELOR, Clerk, By , Deputy Clerk
;m .,
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 leav to p esent a late claim was mailed
DATED: S PHIL BATCHELOR, Clerk, By ti , Deputy Clerk
cc: County Administrator (2) County Counsel (1)
COLLINS 8C ZAPALA
MARK SCOTT COLLINS, INC. ATTORNEYS AT LAW OF COUNSEL
ALAN J. ZAPALA 100 PARK CENTER PLAZA, SUITE 506 THOMAS L.SCHLOTHAUER
MARK S. GLAZER
DOUGLAS F. YOUNG $SAN JOSE, CALIFONIA 96113-2204
ROBERTA E. NALBANDIAN (408) 298-5161
KAREN M. PLATT
January 9, 1986 D IcCEI VIED
CLAIM AGAINST PUBLIC ENTITY
[GOVERNMENT CODE SECTIONS 905 , 905. 2 , 910, 10. 21 01ib 1lAD
"
TO: COUNTY OF CONTRA COSTA ,7 abe1a
BOARD OF SUPERVISORS E'C cost
651 Pine Street , Room 106 e
Martinez, CA 94553
FARMERS INSURANCE GROUP hereby makes claim against the
COUNTY OF CONTRA COSTA for the sum of $20, 294. 70 and makes the
following statements in support of the claim :
1 . Claimants Post Office Address is :
P.O. BOX 3397
Hayward , CA 94540
2. Notices concerning the claims should be sent to :
ALAN J. ZAPALA, ESQ.
COLLINS 8 ZAPALA
100 Park Center Plaza, Suite 506
San Jose , CA 95113
3. The date and place of the transaction giving rise to
this claim are :
December 4, 1985
3917 La Colina Road
E1 Sobrante, CA 94540
4. The circumstances giving rise to this claim are as
follows : At the above time and place, claimant paid its insured ,
JOGINDAR GABHI , $19, 500 for damages to an appurtenant private
structure on the insured ' s property. The insured paid $100
deductible, and claimant is subrogated to its insured ' s claim.
Additionally , claimant has incurred adjuster' s expenses of
$694 , 70. The damage to the claimant ' s insured ' s appurtenant
private structure was caused by a landslide and/or other earth
movement. The slide originated on land owned by the East Bay
Regional Park District , within the County of Contra Costa.
Claimant is informed and believes the East Bay Municipal Utility
3
District water lines and the West Contra Costa Sanitary District
lines contributed to the damage resulting from the slide and/or
earth movement.
5. Claimant ' s injuries are $20, 294. 70, as described
above.
6. The names of the public employees causing the
claimant ' s injuries are unknown.
7. The claim, as of this date,, is $20, 294. 70.
8. The basis of computation of the above amount is as
follows :
Payment of insured ' s material damage claim . . . . . .$19, 500. 00
Insured ' s interest . . . . . . . . . . . . . . . . 100. 00
Adjuster' s service and expense . . . . . . . . . . 694 . 70
TOTAL $20, 294. 70
Dated : January 9 , 1986
Alan a
On behalf of Claimant
i
' J
1 PROOF OF SERVICE BY MAIL (CCP 1013a , 2015. 5)
2
3 I declare that :
4
5 I am employed in the County of Santa Clara , California. I ami
6 over the age of eighteen years and not a party to the within
cause ; m business address is 100 Park Center Plaza Suite 506
7 � Y > > )
g San Jose , California.
9
10 On January 9, 1986, I served the within CLAIM AGAINST PUBLIC
11 ENTITY [GOVERNMENT CODE SECTIONS 905 , 905. 2 , 910, 910. 21 on the
12 FOLLOWING COUNSEL in said cause , by placing a true copy thereof
13 in a sealed envelope with postage thereon fully prepaid , in the
14 United States mail at San Jose , California addressed as follows :
15
16 COUNTY OF CONTRA COSTA
17 BOARD OF SUPERVISORS
18 651 Pine Street , Room 106
19 Martinez , CA 94533
20
21 I declare under penalty of perjury under the laws of the State of
22 California that the foregoing is true and correct , and that this
23 declaration was executed on January 9, 1986, at San Jose ,
24 California.
25
26
Ju -ie Hansen
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COMM, CALIFORNIA
BOARD ACTION
Claim Against the County, or District ) NOTICE TO CLAIMANT February 11, 1986
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: FIRE INSURANCE EXCHANGE
Attorney: Alam J. Zapala, Esq.
Collins & Zavala JAN 2 1 138b
Address: 100 Park Center Plaza, Suite 506
Amount: San Jose, CA 95113 By delivery to clerk on Martine Z, GN• 945 3
$20, 294. 70
Date Received: January 17, 1986 By mail, postmarked on January 14, 1986
I. FROM: Clerk of the Board.of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
Dated: Tan_ 17, 198 h PHIL BATCHELOR, Clerk, By (7 Deputy
Ann Cervelli
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).
(jC) Other: `Z ZL& a
i
c " )
Dated: By: - 16& (,C Deputy County Counsel
III. OM: Clerk of the Board TO: (1) gunty 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 ardis Order entered in its
minutes oir l��.s date. (L
Dated; 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 lean to p sent a late claim was mailed
to claimant.
DAT : F'E B 1 1986 PHIL BATCHELOR, Clerk, By ° , Deputy Clerk
cc: County Administrator ,(2) County Counsel (1)
COLLINS SC ZAPALA
MARK SCOTT COLLINS, INC. ATTORNEYS AT LAW OF COUNSEL
ALAN J.ZAPALA 100 PARK CENTER PLAZA, SUITE 506 THOMAS L.SCHLOTHAUER
MARK S. GLAZER
DOUGLAS YOUNG SAN JOSE, CALIFOBNIA 95113-2204
ROBERTA E. NALBANDIAN (408) 298-5161
KAREN M. PLL ATT RECEIVED
JAN 17 1386
January 14 , 1986 , BAYC"ROR
1ERK �7 OF S W5013
Cf TRA COS �
CLAIM AGAINST PUBLIC ENTITY LB
VJ 4W P."M A. Dewft I
[GOVERNMENT CODE SECTIONS 905 , 905. 21 9101) 910. 21
TO: COUNTY OF CONTRA COSTA
BOARD OF SUPERVISORS
651 Pine Street , Room 106
Martinez, CA 94553
FIRE INSURANCE EXCHANGE hereby makes claim against the
COUNTY OF CONTRA COSTA for the sum of $20, 294. 70 and makes the
following statements in support of the claim :
1 . Claimants Post Office Address is :
P.O, BOX 3397
Hayward , CA 94540
2 . Notices concerning the claims should be sent to :
ALAN J. ZAPALA, ESQ.
COLLINS & ZAPALA
100 Park Center Plaza , Suite 506
San Jose , CA 95113
3. The date and place of the transaction giving rise to
this claim are :
December 4, 1985
3917 La Colina Road
E1 Sobrante , CA 94540
4. The circumstances giving rise to this claim are as
follows : At the above time and place, claimant paid its insured,
JOGINDAR GABHI , $19, 500 for damages to an appurtenant private
structure on the insured ' s property. The insured paid $100
deductible, and claimant is subrogated to its insured ' s claim.
Additionally , claimant has incurred adjuster ' s expenses of
$694, 70. The damage to the claimant ' s insured ' s appurtenant
private structure was caused by a landslide and/or other earth
movement. The slide originated on land owned by the East Bay
Regional Park District , within the County of Contra Costa.
Claimant is informed and believes the East Bay Municipal Utility
D'i'strict water lines and the West Contra Costa Sanitary District
lines contributed to the damage resulting from the slide and/or
earth movement .
5. Claimant ' s injuries are $20, 294. 70, as described
above.
6. The names of the public employees causing the
claimant ' s injuries are unknown. _
7. The claim , as of this date, is $20, 294. 70.
8. The basis of computation of the above amount is as
follows :
Payment of insured ' s material damage claim . . . . . .$19, 500. 00
Insured ' s interest . . . . . . . . . . . . . . . . . . 100. 00
Adjuster' s service and expense . . . . . . . . . . . . 694. 70
TOTAL $20 , 294.
Dated : January 14 , 1986
Alan J a
On beha Claimant
1 PROOF OF SERVICE BY MAIL (CCP 1013a , 2015. 5)
2
3 I declare that :
4
5 I am employed in the County of Santa Clara , California. I am
6 over the age of eighteen years and not a party to the within
7 cause ; my business address is 100 Park Center Plaza , Suite 506,
8 San Jose , California.
9
10 On January 14 , 1986 , I served the within CLAIM AGAINST PUBLIC
11 ENTITY [GOVERNMENT CODE SECTIONS 905 , 905. 2 , 910, 910. 21 on the
12 FOLLOWING COUNSEL in said cause , by placing a true copy thereof
13 in a sealed envelope with postage thereon fully prepaid , in the
14 United States mail at San Jose , California addressed as follows :
15
16 COUNTY OF CONTRA COSTA
17 BOARD OF SUPERVISORS
18 651 Pine Street , Room 106
19 Martinez , CA 94533
20
21 I declare under penalty of perjury under the laws of the State of
22 California that the foregoing is true and correct , and that this
23 declaration was executed on January 14 , 1986, at San Jose ,
24 California.
25
26 GC
6yce Stum o f r
1 CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
BOARD ACTION
February 11 , 1986
Claim Against the County, or District ) NOTICE TO CLAIMANT
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: JOHN J. FLORES Coulty COLnsel
Attorney: 3777 Willow Pass Road JAN 15 1986. _
Space 69
Address: Pittsburg, CA 94565 Martinez, CR 94553
Amount: $147 . 00 By delivery to clerk on
Date Received: January 13, 1986 By mail, postmarked on January 11, 1986
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
Dated: Jan. 14, 1986 PHIL BATCHELOR, Clerk, ByC Deputy
AnCCervelli
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:
!>'''C, By: r__ ,�;_-_ ._ �_>, 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
QQ This claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy f:the(fard's Order entered in its
minutes for th's date.
Dated: 1 1 149 PHIL BATCHELOR, Clerk, By , Deputy Clerk
xlp�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 lea to esent a late claim was mailed
tFE BSs
DATED: PHIL BATCHELOR, Clerk, By01 � , Deputy Clerk
cc: County Administrator (2) County Counsel (1)
10S. BOARD OF SUPERVISORS OF CONTRA C0§;,L0rdV*9WKapp11cat1on to:
Instructions to ClaimantClerk of the Board
.O.Box 911
Martinez.Califomia 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 pause .
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 Distript 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.
R�**�*�:�t*:,��w�t�*rt**��t�*���t�*�t***�**�#��t�*�**�r�*art*�*t*�**r►�t�*�f*�w*
RE: Claim by )Reserved for Clerk's filing stamps
:DECEIVED
Against the COUNTY OF CONTRA COSTA) JAN 03,1986
)
or DISTRICT) �9AMMoR
(Filln name )
IRK bo of
co cosy
The undersigned claimant hereby makes claim against a County of Contra
_ Costa or the above-named District in the sum of $
and in support of this claim represents as follows:
�. When did the damage orn3ury occur? Give exact date and fiourj
r. WFere did the damage or 1n3ury occur? (Include caty and county
g 3 ry occu=?--ZG ve- u�S- etai�s;-use ext=a-
3. Now did t dams a or in u
sheets if equired)
4. What particular act or tmission on the part of aunty or district
officers, servants or employees caused the injury or damage?
(over)
564 What are the :names of county or district officers, servants or
employ es causing the damage or injury?
6. Wfiat damage or 1ajurio you claim resu3te�?NZGIve-dull extent
of injuries of damages claimed. Attach two estimates for auto
damage) -
7. Bow was the amount c lime above computed? Zlnclude the im
estate
amount ,of any prospective njury or damage. )
-�� .
---+- -i- r-- ++ ifri-+r+r +-+++r-+r r++rr r-++++
8. Names and address of whin saes, doctors and hospitals.
--- r- -rr- --T-e--------------------------r--T-r--+-+-----Fv -r---.
tie�expen� s you made on account of this accident or in3ury:
Ct :r ry ITEM AMOUNT
MIN AN"
�-
r -{ 7"P
rV' **• ���'>�'�'�,t�t�#��.�'s�t*`�'��* *�s�t�r�#:���t- ��t��**�*��::1�1��:*�te�*�*�*�e+t*1�i�*�w:�r�t�t*
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 a. ant s Si natur
dress
Telephone No. Telephone No. �
�rtR*:*rr,�>��r*���r**:��r*f***��:::,k*�,t*�t>tff*��rrtt*�r*���w:*�t*�*�r******>R���r:f**•
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."
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
BOARD ACTION
February 11, 1986
Claim Against the County, or District ) NOTICE TO CLAIMANT
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: Ian McNeill
County Couns,t
Attorney: - -
JA N 15 1986
Address: 101 Timberline Court MartjnLQz
Amount: Danville, CA 94526 By delivery to clerk on CA 94553
$400. 00
Date Received: January 14, 1986 By mail, postmarked on January 13 , 1986
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
Dated: Jan. 14, 1986 PHIL BATCHELOR, Clerk, By a Deputy
n Cerve i
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: 777_ , s� 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 " the ard's Order entered in its
minutes fr s date.
Dated: B 11 19BE PHIL BATCHELOR, Clerk, By ° , Deputy Clerk
A4J
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 70: (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 lea to01.
late claim was mailed
to claimant.
DATED: p 1qp PHIL BATCHELOR, Clerk, By , Deputy Clerk
cc: County Administrator (2) County Counsel (1)
f
ti ,T ►i
CLAIM-TO: BOARD OF SUPERVISORS OF CONTRA COR;_L�rrq9Xapplication to:
Instructions to ClaimantC!erk of the Board
P.O.Box 911
Martinez,Califomia 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.
RE: Claim by )Reserved amps
RECEIVED
JAN 14, 1986
Against the COUNTY OF CONTRA COSTA)
hat 1AYCKHOR
or DISTXILCT; E cc I RA V. ors
(Fill in name- )
The undersigned claimant hereby makes claim against the County of Contra
Costa or the above-named District in the sum of $ y00.��:
and in support of this claim represents as follows:
-------------------------------------------------------------- ----
l. When did the damage or injury occur? (Give exact date and-hour ---
LZ:ca
27 Where did the damage or injury occur? (Include city and county)
10! i m b r- I C1 n v ► (C4tin�z � SZ, die-�Cc--►�e C )
---------------------------------------------------
---------------
3: How did the damage or injury occur? (Give full details, use extra
sheets if required)
�, ,,� G►-c,�.�t0-r11��C-��. .,��wC awn l�-ec c.�°.�..1` , CLQ-�
4. What particular .act or omission on the part of county or district
officers , . servants or employees caused the injury or damage?
)nC
(over)
-5. 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? ZGive full extent
of injuries or damages claimed. Attach two estimates for auto
damage)
-- - - - - --
-- -------------- ------- --------------- ----------------------
--H
7. ow 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.
---------------------------------------------------:--------------T-:----
9. �s-s • he -eg��dtuT
es you made on account of this accident or injury:�TBLI_....� ITEM AMOUNT
lu op
**�****•***�It#:,'*#**.dF'1t**** ************tt+++,�.+ „��*«::iricio �xxx***+k**f;1t*tRtb*****�k*
Gov Code Sec. 910.2 provides :
"T a claim signed by the claimant
SEND NOTICES TO: (Attorney) orb s me (Porson on his behalf. "
Name and Address of Attorney '
Claimant' s Signature
'n MT3ceJu k)E C-T-
Address
Telephone No. Telephone No. l5)
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. "
v
October 23, 1985
DANA LUND LANCSCAPING AND MAINTENANCE
206 Estates Drive
Danville, CA 94526
Lic. C27-429094 Phone: 837-8364
Mrs. Janet McNeil
101 Timberline Court
Danville, CA 94526
This price we submit is effective for six months beyond
the date shown above:
Repair Landscaping Damage: (275 sq. ft. )
Removal of existing plant material.
All grading necessary for contour and drainage.
Complete composting and rototilling of the entire area to be
landscaped.
Groundcover planted 12-16 inches apart. (Baccaris pililularis
"Twin Peaks" )
Redwood fiber mulch to cover all bare ground surfaces.
One application of chemical pre-emergent to control future weed
growth.
One application of fertilizer over the entire yard.
Price: 400.00
Dana A. Lund 837-8 4
THANK YOU FOR YOUR INTEREST IN OUR SERVICES.
AMENDED
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
BOARD ACTION
February 986
Claim Against the County, or District ) NOTICE TO CLAIMANT
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: DONALD E. PRYDE and DANIEL HENRY PRYDE
luns
Attorney: Marc =Beuret
Haims , Johnson, MacGowan & McInerney JAN 2 8 1986
Address: 490 Grand Avenue
Oakland, CA 94610 Martmei, CA 94553
Amount: Indemnity & Contribution By delivery to clerk on
CERT P 664 185 469
Date Received: January 28, 1986 By mail, postmarked on January 27 , 1986
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
Dated: Jan. 28 , 1986 PHIL BATCHELOR, Clerk, By Deputy
n Cervelli
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
(Check only one)
�K) 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, (2) County Administrator
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER Py unanimous vote of Supervisors present
( This claiaa.mAis rejected in full.
( ) Other:
I certify that this is a true and correct copy " the ard's Order entered in its
minutes for this date.
Dated: 1 t PHIL BATCHELOR, Clerk, By v 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 lea to p ent a late claim was mailed
to alaiman
DATED: PHIL BATCHELOR, Clerk, By ° , Deputy Clerk
cc: County Administrator (2) County Counsel (1)
HALMS, JOHNSON, MacGOWAN ted? McINERNEY
ARNOLD B. HAIMS ATTORNEYS AT LAW
GARY R.JOHNSON
CLYDE L. MACGOWAN 490 GRAND AVENUE
THOMAS MCINERNEY
JAMES P.SLATER II OAKLAND, CALIFORNIA 94610 TELEPHONE
LAWRENCE A. BAKER
RANDY M. MARMOR (415) 835-0500
PAUL D.HILES
CLIFFORD CAMPBELL
MARC P. BOURET •'
JOHN K.KIRBY
ROBERT J. FRASSETTO
SETH J.SCHWARTZ -
WILLIAM B.WATERMAN
BETH M. ALONSO
ROBERT L. SALLANDER,JR.
CAROLINE N. VALENTINO
January 27, 1986
Clerk of the Board of Supervisors
Room 106 , County Administration Building
651 Pine Street
Martinez , California 94553
Re: Amended Claim of Donald Pryde
(Donaldson vs. Pryde)
Dear Clerk:
Please process the amended claim to clarify the item stated
in your Notice of Insufficiency from county counsel dated
1/23/86.
Please endorse file a copy and return it to me in the
enclosed envelope.
Very truly yours,
HAIMS, JOHNSON, MacGOWAN & McINERNEY
BY:
Marc P. Bouret
MPB/vmc
Encl.
CERTIFIED - RETURN RECEIPT REQUESTED
RECEIVED
JANX/1%6
►H1l6ATCHEI R
F2 0AP(1Or R r ra
9 C JTRA C T
W
1
2
Re: CLAIM BY DONALD E. PRYDE AMENDMENT OF CLAIM OF .
3 AND DANIEL HENRY PRYDE DONALD E. PRYDE AND
AGAINST THE COUNTY OF DANIEL HENRY PRYDE
4 CONTRA COSTA SERVED 1/8/86
5 TO: The Clerk of the Board of Supervisors
6 Claimants Pryde herein submit an amended claim to cure any
7 confusion in the original claim. Number Six (6) is amended to
8 add the following addition:
9 "Although the complaint attached as Exhibit "A" was not
10 served, claimants entered a voluntary appearance to said
11 complaint in Contra Costa Superior Court on January 9 , 1986.
12 Therefore as to Government Code Section 901 , the date of
13 appearance may be deemed the date of service for the pur-
14 poses of question Six (6) . "
15 The prior claim submitted is hereby incorporated herein by
16 reference as though fully set forth.
17 DATED:
18
19 Claimant' s Attorney
20 Marc P. Bouret
21 Haims, Johnson, MacGowan & McInerney
22 490 Grand Avenue
23 Oakland, California 94610
24
25
26 RECEIVED
27 JAN-219, 19e6
28 .►It BATIC RON
lE nva C ngpR9
HALMS,JOHNSON. Tits.CO OG
dacGOWAN d?McI.NERNEY
ATTORNEYS AT LAW
490 GRAND AVENUE
OAKLAND,CALIFORNIA 94610
(415)835-0500
HAIMS, JOHNSON, MacGOWAN 0 McINERNEY
ARNOLD B.HAIMS ATTORNEYS AT LAW
GARY R.JOHNSON
CLYDE L.MACGOWAN 490 GRAND AVENUE
THOMAS MCINERNEY
JAMES P.SLATER II OAKLAND, CALIFORNIA 94610 TELEPHONE
LAWRENCE A.BAKER
RANDY M.MARMOR (415) 835-0500
PAUL D.HILES
CLIFFORD CAMPBELL
MARC P.BOURET
JOHN K.KIRBY
ROBERT J.FRASSETTO
SETH J.SCHWARTZ
WILLIAM B.WATERMAN
BETH M.ALONSO
ROBERT L.SALLANDER,JR.
January 7 , 1986
Clerk of the Board of Supervisors
Room 106 , County Administration
Building
651 Pine Street
Martinez, California 94553
Re: Claim of Donald E. Pryde and Daniel Henry Pryde
Donaldson vs. Pryde, et al.
Dear Sir or Madam:
Please file for record the enclosed claim of Donald E. Pryde
and Daniel Henry Pryde against the County of Contra Costa,
returning an endorsed copy of same to in the envelope provided.
Your cooperation and assistance in this matter is appreci-
ated.
Very truly yours,
HAIMS, JOHNSON, MacGOWAN & McINERNEY
By:_
MARC P. BOURET
MPB/kes
Enc.
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
CLAIM TO: BOARD OF SUPERVISORS OF CONTRA CO§;_.brrFoXapplicationto:
Instructions to ClaimantC!erk of the Board
(.6-i bio 6
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.
RE: Claim by )Reserved for Clerkli filing stamps
DONALD E. PRYDE and DANIEL
' RECEIVED
HENRY PRYDE
Against the COUNTY OF CONTRA COSTA)
or DISTRICT) PHlL BATCHELOR
CLERE""T
f.D of RVI$pRS
Fill in name ) RACo g.
o w.
The undersigned claimant hereby makes claim against the County of Contra
Costa or the above-named District in the sum of 4 indenmity and contribution.
and in support of this claim represents as follows:
------------------------------------------------------------------- ---
l: When did the damage or injury occur? (Give exact date and hour
March 15, 1985; exact time unknown.
2. Where did the damage or ury occur? (Include city and county)
Approximately -- westbound Moeser Lane, East of Lexington Street, El Cerrito,
California.
-•t•-------------.--- .-..--�.----•r---------------r---- .. --------
3. How did the damage or injury occur? (Give full details, use extra`
sheets if required)
Plaintiff Gudrun Donaldson is making a claim against claimants in litigation en-
titled, "Donaldson vs. Pryde, et al. ," Contra Costa Superior Court Action No:
297299,• filed on November 14, 1985. (PLEASE SEE ATTAC1iED)
4. What particular act or-omission on the part of county or-district
officers, servants or employees caused the injury or damage?
Please see response to No. 3 above.
(over)
5: , T,4hat are the names of county or district officers, servants or
employees causing the damage or injury?
Unknown.6
do _ _-------------------------------you---cla----im---r-----esulted.
--?-- (Give full extent----
. What damage or injuries
of injuries or damages claimed. Attach two estimates for auto
damage).
See attached copy of plaintiff's unserved complaint identified as Exhibit "A" and incor-
porated by reference as though fully set forth for purposes of identification only, and
withaut ----------------
7. How was the amount claimed above computed? (Include the estimated
amount of any prospective injury or damage. )
In&Tmity, contribution, declaratory relief, attorney fees and costs.
-------------------------------------------------------------------------
8. Names and addresses of witnesses, doctors and hospitals.
Please see response to No. 3 above
-------------------------------------------------------------------------
9. List the expenditures you made on account of this accident :or injury:
DATE ITEM AMOUNT
Indemnity, contribution, declaratory relief, attorney fees and costs.
Govt. Code Sec. 910.2 provides :
"The claim signed by the claimant
SEND NOTICES TO: (Attorney) _ or by some pArgapn on his behalf. "
Name and Address of Attorney
Gary R. Johnson, Esq. TiffLant s 1gna C L�
Marc P. Bouret, Esq.
HAIMS, JOHNSON, MacGO[NMN & McINER EY Ad d re s (� n
490 Grand Avenue
' ephonelNo rnia (416ff835-0500 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. "
3. CONTINUED:
That while the claimants have denied any fault which con-
tributed as a proximate cause to the alleged injuries of
Donaldson as stated in the court action, in the event the claim-
ants are held liable, or any of them, to Gudrun Donaldson, any
such liability will be wholly or partially caused by the faults,
neglect or legal responsibility of the governmental entity, which
contributed as a proximate cause to the accident which is alleged
to have occurred in the court action; that the cross-complainants
assert a right of contribution or equitable indemnity against the
governmental entity, or any of them, for the liability, fault or
legal responsibility of the governmental entity contributing to
the damages alleged.
That the claimants allege that an actual controversy ekists
between the governmental entity and the claimants, and each of
them, under the circumstances heretofore alleged; the claimants
contend that the governmental entities may have a liability to
the plaintiff and, unless all joint and several obligations,
rights, and duties arising out of the accident, which is the
subject of this litigation, or the relationship among the parties
are determined in one action, there will be a multiplicity of
actions to resolve these disputes, all of which can be resolved
in one judgment in this action; that if this relief is not
granted to the claimants, the claimants will be subjected to
unreasonable burdens and/or irreparable injuries if multiple
actions are required to resolve the issues and contentions
involved herein.
i
V -I_ 1985
1 GAIL DONALDSON, ESQ.
CINDY GILMAN J. Ri, I.aJL�if.,.t t�is.Ily Ciet�
2 WEIN & GILMAN 0:TA COUN-i,r
A Law Corporation
3 3929 - 24th Street
San Francisco, CA 94114 •
4 Telephone: (415) 282-9955
5 Attorneys for Plaintiff, GUDRUN DONALDSON
6
7
8 IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA
9 FOR THE COUNTY OF CONTRA COSTA
10 GUDRUN DONALDSON, ) 279299
NO.
11 Plaintiff, )
COMPLAINT FOR DAMAGES
12 v. ) (PERSONAL INJURY)
13 DONALD E. PRYDE, DANIEL )
HENRY PRYDE, CITY OF EL )` )
14 CERRITO, BAY AREA RAPID )
TRANSIT DISTRICT, COUNTY )
15 OF CONTRA COSTA, and )
DOES 1 through 25 , inclusive, )
16 )
Defendants. )
17 )
18 Plaintiff complains of defendants , and each of them, and
19 alleges as follows:
20 FIRST CAUSE OF ACTION
21 1 . Defendants, DOE 1 through and including DOE 25 , are
22 sued herein under Section 474 of the California Code of Civil
23 Procedure. The true names or capacities, whether individual,
24 corporate, associate, or otherwise of said defendants are un-
25 known to plaintiffs , who therefore sue said defendants by such
26 fictitious names. Plaintiff will amend this Complaint to allege
------ . ......
F
1 their true names and capacities when ascertained.
2 2 . Defendant, CITY OF EL CERRITO, is, and at all times
3 mentioned herein was, a municipality within the State of Cali-
4 fornia, Contra Costa County, maintaining and controlling the
5 public streets and thoroughfares within the City of E1 Cerrito.
6 3. Defendant, BAY AREA RAPID TRANSIT DISTRICT, herein-
7 after referred to as BART, is, and at all times mentioned herein
8 was, a special rapid transit district duly organized and exist-
9 ing under the laws of the State of California with. its office
10 for the transaction of business in Alameda County, California.
11 At all times herein mentioned, defendant BART was in the busi-
12 ness of operating a rapid transit system in, inter alis, Contra
A
13 Costa County, California. '
14 4. Defendant, COUNTY OF CONTRA COSTA, is, and at all
15 times mentioned herein was, a county duly organized and existing
16 under the laws of the State of California.
17 5 . Plaintiff is informed and believes, and thereupon
18 alleges that defendant, DONALD E. PRYDE, at all times relevant
19 herein, resided in the City of E1 Cerrito, Contra Costa County,
20 State of California.
21 I 6. Plaintiff is informed and believes and thereupon
22 alleges that at all times relevant herein, defendant, DANIEL
231 HENRY PRYDE, was a resident of the City of E1 Cerrito, Contra
244 Costa County, State of California.
25
7. At all times relevant herein, each of the defen-
26 � dants named herein, including DOES 1-25 , were the agents, ser-
. I�-
i.
2
� r
I vants, and employees of each of the other defendants, and were
2 acting within the scope of their agency, service and employment.
3 8. At all times mentioned herein, defendants, DONALD
4 E. PRYDE, DOES 1-3, inclusive, were the owners of that certain
5 1984 Volkswagen vehicle, California license number 1LCR736,
6 hereinafter referred to as defendant's vehicle.
7 9. At all times relevant herein, Moeser Lane approxi-
8 mately 50 feet east of Lexington Street, was a public street in
9 the City of E1 Cerrito, Contra Costa County, California.
10 10 . On or about March 15, 1985, at or about the hour of
11 2 : 45 p.m. , defendant, DANIEL HENRY PRYDE, and DOES 5-6, inclu-
12 sive, were operating the defendant 's vehicle in a westerly
13 direction on Moeser Lane approximately 50 feet east of Lexington
14 Street . At that time and place, plaintiff GUDRUN DONALDSON was
15 preparing to cross Moeser Lane in a southerly direction in the
16 marked pedestrian crosswalk .
17 11. At said time and place, defendants , DANIEL HENRY
18 PRYDE and DONALD E. PRYDE, and DOE 5 through and including DOE
19 10 , so negligently and carelessly owned , operated , maintained,
20
drove, entrusted, and controlled said vehicle in a westbound
21 direction on Moeser Lane so as to cause the vehicle to collide
22 with the plaintiff, GUDRUN DONALDSON, resulting in the hereinaf-
23 i ter described serious and permanent injuries to plaintiff.
24I 12 . As a proximate result of the negligent , careless
25I and unlawful conduct of the defendants and each of them, plain-
26 � tiff was hurt and injured in her health, strength and activity,
i
3
r
I sustaining severe shock , fractures to the facial bones, scapula,
2 ribs, pelvis and leg, and suffering other injuries all of which
3 said injuries have caused and continue to cause plaintiff great
4 mental, physical and nervous pain and suffering, to her general
5 damage in a sum within the jurisdiction of the Superior Court.
6 13 . As a direct and proximate result of the negligent
7 careless and unlawful conduct of the defendants and each of
8 them, as aforesaid, plaintiff was compelled to and did employ
9 physicians and surgeons, psychiatrist, neuropsychologists, and
10 physical therapists to treat and care for her, thereby incurring
11 medical expenses in an amount unknown to plaintiff at this time,
12 and plaintiff prays leave of Court to amend this complaint when
J
13 the exact amount of said expenses has been ascertained . Plain-
14 tiff is informed and believes, and thereon alleges , that said
15 injuries are permanent in nature, and that she will incur fur-
16 ther medical expenses in the future, and therefore asks leave to
17 amend this complaint when the exact amount of such future ex-
18 penses has been ascertained.
19 14 . At the time of the events described herein plain-
20
tiff was gainfully employed. As a further proximate result of
21 defendants ' negligence and by reason of the injuries sustained,
22 plaintiff was prevented from attending her usual occupation and
23 i has thereby sustained loss of wages, . and she will incur future
24loss of wages to her damage, and she prays leave to amend this
?5 ! complaint to insert the exact amount when the same is ascer-
26 1 tained.
it
r
4
i)
h r
I WHEREFORE, Plaintiff prays for judgment as hereinafter
2 set forth.
3 SECOND CAUSE OF ACTION
4 1 . Plaintiff, GUDRUN DONALDSON, complains against
5 defendants, CITY OF EL CERRITO and DOE 11 through and including
6 DOE 15 , and each of them, and for a Second Cause of Action
7 incorporates herein by reference as if fully set forth Para-
8 graphs 1 through and including 10 of the FIRST CAUSE OF ACTION.
9 2 . On or about March 15 , 1985, and prior thereto,
10 defendants, CITY OF EL CERRITO, and DOE 11 through and including
11 DOE 15 , negligently and carelessly, designed, built, owned,
_. 12 leased, maintained, repaired, controlled and operated the inter-
13 section of the Linear Park pedestrian and bicycle path and
t
14 Moeser Lane, approximately 50 feet east of Moeser Lane 's inter-
15 section with Lexington Street, and the approaches thereto, in a
16 dangerous condition in that the marked pedestrian crosswalk
17 across Moeser Lane was placed in such a way that it was not
18 visible to oncoming traffic and said defendants failed to place
19 a signal , sign, marking or device on said area of Moeser Lane
20 which was necessary to warn of the dangerous condition which
21 imperiled both the safe movement of vehicular traffic on said
22 area of Moeser Lane and which imperiled the safe movement of
23 persons crossing at the said crosswalk and which dangerous
24 condition was not reasonably apparent to and would not have been
25 anticipated by the plaintiff.
26 ) 3 . The agents, servants and employees of defendants,
,
5
r
1 CITY OF EL CERRITO, DOE 11 through and including DOE 15 , had
2 constructive notice of the dangerous condition of the said_
3 intersection of the Linear Park pedestrian and bicycle path and
4 Moeser Lane in that the condition had existed for a long period
5 of time and was of such an obvious nature that defendants in the
6 exercise of due care, should have discovered the condition . and
7 its dangerous character.
8 4 . On March 15, 1985, plaintiff GUDRUN DONALDSON was
9 preparing to cross said crosswalk at the intersection of the
10 Linear Park pedestrian and bicycle path and Moeser Lane. As a
11 proximate result of the dangerous condition of the said inter-
12 section and defendant CITY OF EL CERRITO's failure to protect
13 against said dangerous condition, while preparing to cross
14 Moeser Lane in the crosswalk , plaintiff was struck by an automo-
15 bile driven by defendant, DANIEL HENRY ,PRYDE, causing serious
16 and permanent injuries.
17 5 . As a proximate result of the dangerous condition of
18 defendants ' property, plaintiff was hurt and injured in her
19 health, strength and activity, sustaining severe shock , frac-
20 tures of the facial bones, scapula, ribs, pelvis, leg, and other
21 injuries all of which said injuries have caused and continue to
22 cause plaintiff great mental, physical and nervous pain and
23 suffering , to her general damage in a sum within the jurisdic-
24 tion of the Superior Court.
25 6. As a direct and proximate result of the negligent,
26 careless and unlawful conduct of the defendants and each of
6
t
i
I them, as aforesaid, plaintiff was compelled to and did employ
.2 physicians and surgeons, psychiatrist, neuropsychologists, and
3 physical therapists to treat and care for her, thereby incurring
4 medical expenses in an amount unknown to plaintiff at this time,
5 and plaintiff prays leave of Court to amend this complaint when
6 the exact amount of said expenses has been ascertained. Plain-
7 tiff is informed and believes, and thereon alleges, that said
8 injuries are permanent in nature, and that she will incur fur-
9 they medical expenses in the future, and therefore asks leave to
10 amend this complaint when the exact amount of such future ex-
11 penses has been ascertained.
12 7. At the time of the events described herein plain-
13' tiff was gainfully emplo/ed. As a further proximate result of
14 defendants ' negligence and by reason of the injuries sustained,
15 plaintiff was prevented from attending her usual occupation and
16 has thereby sustained loss of wages, and she will incur future
17 loss of wages to her damage, and she prays leave to amend this
18 complaint to insert the exact amount when the same is ascer-
19 tained.
20 8 . On or about June 18, 1985 , plaintiff herein duly
I
21 filed with defendant, CITY OF EL CERRITO, an administrative
22 claim for and on account of the personal injuries of plaintiff,
23 GUDRUN DONALDSON, on or about march 15 , 1985. This administra-
24 tive claim was denied on July 15, 1985 .
25I WHEREFORE, plaintiff 'prays for judgment as hereinafter
26 set forth.
7
f
I THIRD CAUSE OF ACTION
2 1 . Plaintiff, GUDRUN DONALDSON, complains against
3 defendants, BAY AREA RAPID TRANSIT DISTRICT and DOE 16 through
4 and including DOE 20, and each of them, and, for a Third Cause of
5 Action incorporates herein by reference as if fully set forth
6 herein Paragraphs 1 through and including 10 of the FIRST CAUSE
7 OF ACTION.
8 2 . On or about March 15, 1985, defendant, BAY AREA
9 RAPID TRANSIT DISTRICT, and defendants, DOES 16-20, -negligently
10 and carelessly designed, built, owned, leased, maintained,
11 repaired, controlled and operated the intersection of the Linear
12 Park pedestrian and bicycle path and Moeser Lane, approximately
13 50 feet east of Moeser Lane's intersection with Lexington
14 Street, and the approaches thereto, in a dangerous condition in
15 that the marked pedestrian crosswalk across- Moeser Lane was
16 placed in such a way that it was not visible to oncoming traffic
17 and said defendants failed to place a signal, sign, marking or
18 device on said area of Moeser Lane which was necessary to warn
19 of the dangerous condition which imperiled both the safe move-
20 ment of vehicular traffic on said area of Moeser Lane and which
21 imperiled the safe 'movement of persons crossing at the said
22 crosswalk and which dangerous condition was not reasonably
23 apparent to and would not have been anticipated by the plain-
24 tiff.
25 3 . The agents, servants and employees of defendants,
26 BAY AREA RAPID TRANSIT DISTRICT, DOE 16 through and including
i 8
F
I •
1 DOE 20 , had constructive notice of the dangerous condition of
2 the said intersection of the Linear Park pedestrian and bicycle
3 path and Moeser Lane in that the condition had existed for a
4 long period of time and was of such an obvious nature that
5 defendants in the exercise of due care, should have discovered
6 the condition and its dangerous character .
74 . On March 15, 1985 , plaintiff GUDRUN DONALDSON was
8 preparing to cross said crosswalk at the intersection of the
9 I Linear Park pedestrian and bicycle path and Moeser Lane. As a
10 proximate result of the dangerous condition of the said inter-
11 secticn and defendant BAY AREA RAPID TRANSIT DISTRICT' s failure
12 to protect against said dangerous condition, while preparing to
13 cross Moeser Lane in the. ;crosswalk , plaintiff was struck by an
1'
14 automobile driven by defendant, DANIEL HENRY PRYDE, causing
15 serious and permanent injuries .
16 5 . As a proximate result of the dangerous condition of
17 ( defendants ' property, plaintiff was hurt and injured in her
18
i health, strength and activity, sustaining severe shock , frac-
19 ( tures of the facial bones, scapula, ribs, pelvis, leg, and other
20 injuries all of which said injuries have caused and continue to
21 cause plaintiff great mental, physical and nervous pain and
22 suffering , to her general damage in a sum within the jurisdic-
23 tion of the Superior Court.
24 6 . As a direct and proximate result of the negligent,
25 careless and unlawful conduct of the defendants and each of
226 � them, as aforesaid, plaintiff was compelled to and did employ
I
9
I
i
i
1 physicians and surgeons, psychiatrist, neuropsychologists, and
2 physical therapists to treat and care for her, thereby incurring
3 medical expenses in an amount unknown to plaintiff at this time,
4 and plaintiff prays leave of Court to amend this complaint when
5 the exact amount of said expenses has been ascertained. Plain-
6 tiff is informed and believes, and thereon alleges, that said
7 injuries are permanent in nature, and that she will incur fur-
8 ther medical expenses in the future, and therefore asks leave to
9 amend this complaint when the exact amount of such future ex-
10 penses has been ascertained.
11 7. At the time of the events described herein plain-
12 tiff was gainfully employed. As a further proximate result of
13 defendants ' negligence and by reason of the injuries sustained,
14 plaintiff was prevented from attending her usual occupation and
15 has thereby sustained loss of wages, and she will incur future
16 loss of wages to her damage, and she prays leave to amend this
17 complaint to insert the exact amount when the same is ascer-
18 tained.
19 8. On or about June 18, 1985, plaintiff herein duly
20 filed with defendant BAY AREA RAPID TRANSIT DISTRICT, an admin-
21 istrative claim for and on account of the personal injuries of
22 plaintiff, GUDRUN DONALDSON, which occurred on or about March
23 15 , :1985. This administrative claim was denied on August 9,
24 1985.
25 WHEREFORE, plaintiff prays for judgment as hereinafter
26 set forth.
10
f
1 FOURTH CAUSE OF ACTION
2 1 . Plaintiff, GUDRUN DONALDSON, complains against ,
3 defendants, COUNTY OF CONTRA COSTA, and for a Fourth Cause of
4 Action incorporates herein by reference as if fully set forth
5 Paragraphs 1 through and including 10 of the FIRST CAUSE OF
6 ACTION.
7 2 . On or about March 15, 1985 , and prior thereto,
8 defendants, COUNTY OF CONTRA COSTA and defendant DOES 21-25 ,
9 negligently and carelessly, designed, built, owned, leased ,
10 maintained, repaired, controlled and operated the intersection
11 of the Linear Park pedestrian and bicycle path and Moeser Lane,
-- 12 , approximately 50 feet east of Moeser Lane 's intersection with
13 '' Lexington Street, and the approaches thereto, in a dangerous
14 condition in that the marked pedestrian crosswalk across Moeser
15 Lane was placed in such a way that it was not visible to oncom-
16 ing traffic and said defendants failed to place a signal, sign,
17 marking or device on said area of Moeser Lane which was necessa-
18 ry to warn of the dangerous condition which imperiled both the
19 safe movement of vehicular , traffic on said area of Moeser Lane
20 ' and which imperiled the safe movement of persons crossing at the
21 said crosswalk and which dangerous condition was not reasonably
22 � a arent to and would not have been anticipated b the lain-
PP P Y P
23 + tiff .
24 3 . The agents, servants and employees of defendants,
25 COUNTY OF CONTRA COSTA and DOE 21 through and including DOE 25 ,
26 Thad constructive notice of the dangerous condition of the said
I
I
r
11
j
I intersection of the Linear Park pedestrian and bicycle path and
2 Moeser Lane in that the condition had existed for a long period
3 of time and was of such an obvious nature that defendants in the
4 exercise of due care, should have discovered the condition and
5 its dangerous character.
6 4. On March 15, 1985, plaintiff GUDRUN DONALDSON was
7 preparing to cross said crosswalk at the intersection of the
8 Linear Park pedestrian and bicycle path and Moeser Lane. As a
9 proximate result of the dangerous condition of Moeser Lane and
10 defendant COUNTY OF CONTRA COSTA's failure to protect against
11 said dangerous condition, while preparing to cross Moeser Lane
12 in the crosswalk , plaintiff was struck by an automobile driven
13 by defendant, DANIEL HENRY PRYDE, causing serious and permanent
s•
14 injuries.
15 5 . As a proximate result of the dangerous condition of
16 defendants ' property, plaintiff was hurt and plaintiff was hurt
17 and injured in her health, strength and activity, sustaining
18 severe shock , fractures of the facial bones, scapula, ribs,
19 pelvis and leg , and other injuries all of which said injuries
20 have caused and continue to cause plaintiff great mental, physi-
21 cal and nervous pain and suffering, to her general damage in a
22 sum within the jurisdiction of the Superior Court.
23 6. As a direct and proximate result of the negligent,
24 careless and unlawful conduct of the defendants and each of
25 them, as aforesaid, plaintiff was compelled to and did employ
26 physicians and surgeons, psychiatrist, neuropsychologists, and
12
F
1 physical therapists to treat and care for her , thereby incurring
2 medical expenses in an amount unknown to plaintiff at this time,
3 and plaintiff prays leave of Court to amend this complaint when
4 the exact amount of said expenses has been ascertained. Plain-
5 tiff is informed and believes, and thereon alleges, that said
6 injuries are permanent in nature, and that she will incur fur-
1 they medical expenses in the future, and therefore asks leave to
8 amend this complaint when the exact amount of such future ex-
9 penses has been ascertained.
10 7. At the time of the events described herein plain-
11 tiff was gainfully employed. As a further proximate result of
12 defendants' negligence and by reason of the injuries sustained,
13 plaintiff was prevented from attending her usual occupation and
14 has thereby sustained loss of wages, and she will incur future
15 loss of wages to her damage, and she prays leave to amend this
16 complaint to insert the exact amount when the same is ascer-
17 tained.
18 8. On or about June 18, 1985r plaintiff herein duly
19 filed with defendant, COUNTY OF CONTRA COSTA, an administrative
20 claim for and on account of the personal injuries of plaintiff,
21 GUDRUN DONALDSON, on or about March 15, 1985 . This administra-
22 tive claim was denied. on or about July 16, 1985.
23 IIHEREFORE, plaintiff prays judgment as follows:
24 ` 1 . General damages;
25 +4 2
I . especial damages according to proof,;
2611111 3 . All losses of earnings, according to proof;
f.
1
l
13
J
1 4 . Costs of suit; and
2 5. Any further meet relief.
3 l �f c
4 DATED:' (. / l /
5
7 GAIL DONALDSON
8
9
CINDY GILMPI
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
14
r
APPLICATION TO FILE LATE CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
BOARD ACTION
Application to File Late Claim ) NOTICE TO APPLICANT February 11, 19
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: WILLOW .PARK MARINA HOMEOWNERS ASSOCIATION
- County Caunsef _
Attorney: Daniel E. Angius JAN 15 1986
400 Montgomery Street , Suite 1111
Address: San Francisco , CA 94104 Martinez, C-A"94553
Amount: $10, 000, 000 . 00 By delivery to Clerk on
Date Received: January 14, 1986 By mail, postmarked on Jasivary iinrPgriah i P
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above noted Application to F le Late Claim.
DATED: Jan - 14 - 1 9Rh PHIL BATCHELOR, Clerk, By QDeputy
An
II. FROM: County Counsel T0: Clerk of the Board of Supervisors
( ) The Board should grant this Application to File Late Claim (Section 911.6).
SX) The Board should deny this Application to File Late Claim (Section 911.6).
DATED: :�;L.�,C:_ ( ,ICTOR WESTMAN, County Counsel, By7c.< -Deputy
1117 BOARD ORDER By unanimous vote of Supervisors present
(Check one only)
( ) This Application is granted (Section 911.6).
(x) 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: EER 111986 PHIL BATCHELOR, Clerk, By L L Deputy
WARNING (Gov. Code §911.8)
If you wish to file a court action on this matter, you must first petition the
appropriate court for an order relieving you from the provisions of Goverment Code
Section 945.4 (claims presentation requirement). See Goverment 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 immediately.
IV. FROM: Clerk of the Board T0: 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: PT�Lg86 PHIL BATCHELOR, Clerk, By jonolIdUOL Deputy
V. FROM: 1 County Counsel 2 County Administrator TO: Clerk of the Board
of Supervisors
Received copies of this Application and Board Order.
DATED: County Counsel, By
County Administrator, By
APPLICATION TO FILE LATE CLAIM
LAW OFFICES OF
DANIEL E. ANGIUS
400 MONTGOMERY STREET.SIIITE 1111
SAN FRANCISCO. CALIFORNIA 94104
TELEPHONE (415) 892.1808
January 13, 1986
Clerk of the Board of Supervisors
Contra Costa County
651 Pine Street
Martinez, California 94553
RE: Claim of the Willow Park Marina Homeowners Association -- -
Dear Clerk:
Enclosed herewith please find the original and one copy of an
Application to Present Claim on behalf of the Willow Pakk Marina
Homeowners Association. Kindly stamp the copy "received" and return
it to this office in the envelope that we are enclosing.
You will notice that such Application is presented in accordance
with Government Code Sections 911.4 et sec. . Kindly advise as to the
disposition of such Application at your earliest convenience.
itVery rul o s,
DANIEL E. A
DEA: jb
Enclosures
w
RECEIVED
JAM fit 1986
LP 8A`CkEIOR
1ERK n Of *VISORS
C �p J.
A'
DANIEL E. ANGIUS .DECEIVED
Attorney at Law
Suite 1111 JAN400 Montgomery Street 41986
San Francisco, California 94104 PHneATC.HEIOR
Telephone (415 ) 392-1808 «="' 'r^o,s ISMS
APPLICATION TO PRESENT CLAIM
TO CONTRA COSTA COUNTY;
1. Application is hereby made by Claimant The Willow Park Marina
Homeowners Association to present what the County contends to be a
"late" claim under Section 911.4 of the Government Code. The claim is
founded on the facts set forth in the original Claim, a' copy of which
is attached hereto as Exhibit "A" and incorporated herein by this
referenced.
2. Claimant respectfully submits that the County was, and is, in
error in taking the position that the Claim and Amended Claim were not
filed within the time permitted for the filing of claims. The
controlling statutory period for presenting such claim is one year
from the date the cause of action accrued. See Government Code
Section 911. 2. The subject Claim was filed within such statutory
period.
3. Claimant ' s cause of action against the County accrued when it
became aware of the acts and omissions of the County which give rise
to a cause of action against it. Government Code Section 901; Leaf v.
City of San Mateo (1980 ) 104 Cal.App. 3d 398, 163 Cal.Rptr. 711.
4 . As is set forth in the subject Claim, Claimant first had
notice of the acts and omissions giving rise to the Claim against the
County during October, 1985 - well within one year of the filing of
the instant Claim.
5: Claimant's failure to discover the facts alleged in the claim
at an earlier date was a product of "excusable neglect" as that term
is used in Government Code Section; 911.,6. The deficienci'e's described
in the subject Claim were latent deficienicies which were only
discovered through extensive engineering and architectural analysis.
As it is versed in neither architectural nor engineering sciences,
Claimant was not in a position to discover the basis of' its claim
against the County until such time as its engineers and architects
completed their analysis of the subject property. The county was not
prejudiced by Claimant 's failure to discover such deficiencies at an
earlier date.
6. This application is presented within a reasonable time after
the accrual of the cause of action as shown by the accompanying
declaration of Daniel E. Angius, which is incorporated herein by this
reference.
WHEREFORE, it is respectfully requested that this application be
granted and that the attached Claim and Amended Claim be received and
acted upon in accordance with Sections 912. 4 - 912. 8.
Dated: January 10, 1986 By:
qa,sa- - -- - - —
DAN L E. A GIUS
Attorney for Claimant
DECLARATION
.I, Daniel E. Angius, declare:
1. That I am an attorney at law duly licensed to practice before
the Courts of this State and represent Claimant, The Willow Park
Marina Homeowners Association.
2. During or about the summer of 1985, Claimant authorized the
engineering firm of Interactive Resources, Inc. to conduct an
investigation with respect to the Willow Park Marina Condominiums.
During October, 1985, such firm released its report. Such report
revealed that the construction of various components of the subject
project did not comport with the minimum requirements of the Uniform
Building Code. Such report further suggested that the County, and its
authorized agents, knew or should have known at the time of
construction that the subject project was not constructed in
compliance with the Uniform Building Code, all as is set forth in
Exhibit "A" hereto.
3. Claimant is not an engineering or architectural firm. As
the deficiencies described in the subject Claim are latent, Claimant
was not in a position to discover the existence of such deficiencies
and the basis of its claim against Contra Costa County until such
time as the reports referenced in the preceding paragraph were
released to it. The undersigned is informed and. believes that the
County was not prejudiced as a consequence of any delay that resulted
as a consequence of Claimant's failure to discover the basis of its
claim at an earlier date.
I declare under penalty of perjury that the foregoing is true and
correct and that this declaration was executed on January 10, 1986, at
San Francisco, California.
DANI L E. A IUS
_.-_=jam TO: BOARD Or BOPSRVISORS Cr CONTRA C*7-8i9Q%PP110M0n to:
Instructions to ClaimantC1erkolt*Board
F.O.Box 911
• rune;,CaiifomL oI3S3
A. Claims relating to causes of action for death or"Por 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)
E
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 tTis form.
�**tit*::t�**��****����*****:�r�t**��**+�*�t�::*.**:err:��*�•*:��*���*:***��*
RE: Claim by )Reserved for Clerk's filing stamps
The Willow Park Marina )
Homeowners Association ) R CEIVED
Against the COUNTY OF CONTRA COSTA) DEC a M5
)
or DISTRICT)
►Mll Mt
(Fill o�.
n name , ) ,cit eo 0,o►s WKrewRoes
Co.
The undersigned claimant hereby makes claim against e f Contra
Costa or the above-named District in the sum of $ 10 ,000 ,000
and in support of this claim represents as follows:
I. When did the damage or in3ury occur? Give exact date ana hour]
SEE ATTACHI E14T ",A" , ITER NO. 1.
'�. Vhere sib tfie sama,'ge or n3ury occur? Zlnc�ude city and county)
SEE ATTACHMENT "'A" , ITEM NO. 2.
-�
------------------------
-- ------------ T--- - -- -------------
3. Bow did the damage or in�ury occur? Giveu�S setaIs, use extra
sheets if required)
SEE ATTACHMENT "A" , ITEM NO. 3.
T: " i�hat partcu�ar act or om�ss�on on the part off-county oz-asst=ict --
officers, servants' or employees caused the injury or damage?
0
SEE ATTACHMENT "A", ITEM NO. 3.
(over)
� employees causing the damage or injury?
Messrs. Carl J. Jamison, R.N. Giese, David Squires, Rudy Krantz and
Charlie Platt.
�. ivfiat damage or In3urlea ao you cIalm resulted? ��IveuII extent
of- injuries or damages claimed. Attach two estimates for auto
damage)
SEE ATTACWT. NT "A" , ITEM NO. 6 .
----------------------------- ------ --
?. Bow Was the amount claimed above computed? (Include the estlmate�
amount of any prospective injury or damage. )
SEE ATTACHMENT "A" , ITEM NO. 6.
�. Names and addresses o� witnesses, doctors and hospitals.
SEE ATTACHIMENT "B" .
�. fist the expenditures you made on account of this accident or In3ury:
DATE ITEM AMOUNT
SEE ATTACF11ENT "A" , ITEM NO. 6 .
op
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
DANIEL E. ANGIUS, ESQ. Claimant's Signature
Suite 1111 Post Office Box 1395
400 !1ontgomery Street Address
San Francisco, California 94104 Bethel Island, California 94511
Telephone No. (415) 392-1808 Telephone No. (415) 684-2281
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. "
1
- ATTACHMENT "A" TO CLAIM OF
WILLOW PARK MARINA HOMEOWNERS ASSOCIATION
1. The Willow Park Marina Homeowners Associtation
(hereinafter referred to as "Association" ) discovered the facts
.I
giving rise to its cause of action against the County of Contra
Costa and certain of its employees in the Building
Inspection/Engineering Department including, but not limited to,
Carl J. Jamison, R.W. Giese, David Squires, Rudy Krantz and
Charlie Platt, during October, 1985. Such discovery was made by
the Association upon consultation with the engineering firm that
it had retained to evaluate the condition of the Willow Park
Marina Condominiums (hereinafter referred to• as the "project" )
during October, 1985.
2. The legal description of the subject project is as
follows:
a. All of Subdivision 4314, filed September 12, 1973, in
Map Book 163, at Page 1, in the office of the County Recorder of
Contra Costa, California.
b. All of Subdivision 4482, filed August 2, 1978, in Map
Book 215, Page 15, in the office of the County Recorder of Contra
Costa County, California.
3. As designed and constructed the subject project fails to
meet the minimum requirements of the Uniform Building Code. The
Association is informed and believes that the County and its duly
authorized employees, as identified above, acted in concert with
those responsible for the development, design and construction of
•
1
the subject project in order to (a) permit the .subject project to
be constructed in a defective condition and not in conformity with
the requirements of the Uniform Building Code; (b) cause the
subject project to receive, among other things, building permits
-and a certificate of occupancy from Contra Costa County
notwithstanding such deficiencies and the project's failure to
meet the requirements of the Uniform Building Code; (c) permit the
subject condominium units to be sold to the general public and be
thereafter occupied for residential purposes, and, among other
things; (d) conceal all of the foregoing facts from purchasers of
the subject units to keep them from learning about the defective
and deficient conditions at the project and that the design and
construction of same did not meet the minimum requirements of the
Uniform Building Code.
The Association is further informed and believes that the
County, and the individuals identified above, approved at all
appropriate times the construction and occupancy of the subject
project. The Association is further informed and believes that
such approvals were issued by the County and the individuals
identified above with knowledge of the fact that the design and
construction of the subject project were deficient and failed to
meet the minimum requirements of the Uniform Building Code. The
Association and its constituent members purchased the condominium
units in the subject project in reliance upon, among other things,
the approvals and occupancy certificates issued by the County and
the individuals identified above.
f
' The Association is informed and believes that it will cost
in excess of $8,000,000 in order to implement the remedial work
that is required to correct the foregoing conditions.
6. The damages sustained by the. Association have not yet
been calculated. Such damages will, however, reflect the cost to
remedy defective conditions associated with (a) the pile
foundation system; (b) 2-hour area -separation -walls; (c) 1-hour
occupancy separation ceilings; (d) 1-hour unit party walls; (e)
1-hour floor-ceiling assemblies; (e) absence of fire stopping; (f )
the chimneys; (g) roofs; (h) windows; (i ) siding; ( j ) electrical
systems; (k) structural framing; (1) multi-joists; (m) floor
joists; (n) roof framing, and, among other things; (o) shear
walls.
The damages sustained by the Association also include
relocation and inciderytal expenses associated with the foregoing
deficiencies and the procedures adopted to repair same.
To date, the Association has expended in excess of $250,000
for interim repairs respecting the roofing structures, drainage
facilities, siding, pile foundation system, decks and the
engineering expenses associated therewith.
T,.
t10R ROOFING COMPANY c/o ALAN MORGAN & ASSOCIATES c/o
!'elford, Esq. Jeffrey N. Haney, Esq.
.meter, Scott, Weiberg & Delehant Rebecca Barry Aherne, Esq.
,ite 200 Bishop, Barry, Howe & Reid
.AO University Avenue 465 California Street, 11th Flooi
acramento, California 95825 San Francisco, California 94104
PACIFIC GAS & ELECTRIC COMPANY c/o
Robert R. Rickett, Esq. _ BANISTER ELECTRIC c/o
Pacific Gas & Electric Company Douglas R. O'Connor, Esq.
Post Office Box 7442- - 650 California Street, Suite 2600
San Francisco, California 94120- San Francisco, California 94108
BETTER HEATING AND COOLINGG" BUREAU c/o
Timothy M. McMahon, Esq. RAYMOND VAIL & ASSOCIATES c/o
Archer & McComas John W. Bergholt, Esq.
1299 Newell Bill Place, Suite 300 Severson, Werson, Berke & Melchio:
Post Office Box 8035 One Embarcadero Center, 25th Floo:
Walnut Creek, California 94596 ` San Francisco, California 94111
BANK OF VIERICA c/o
Winslow Christian, Esq. i INDEPENDENT PLUMBING c/o
Louis Bachleder, Esq. Luke A. Torres, Esq.
Bank of America Carroll, Burdick & McDonough
555 California Street, 7th Floor 49 Quail Court, Suite 300
Post Office Box 37000 ! Walnut Creek, California 94596
San Francisco, California 94137
RANDLETT, CLEGG & FOULK c/o JASON CHARTJER c/o
Arthur V. Pearson, Esq. 0 Chester -G. Moore, Esq.
Murphy, Pearson, Bradley & Feeney low, gall &:Lynch
445 Bush Street, Suite 700 950 Menlo *R enue
San Francisco, California 94108 Menlo Pa ".California 94025 t
rk,
SCSEDULE "B"
OBERTS PACIFIC, INC. c/o UNITED STATES FIDELITY c/o
441liam K. Houston, Jr. Michael Pisias, Esq.
-4 McNarmara, Houston, Dodge, McClure i Ney Suite 700
=E 1211 Newell Avenue, Suite 202 177 Post Street
Post Office Box 5288 San Francisco, Calif . 94108
Walnut Creek, California 94596
,.t t
WILLIAM BOYD REAL ESTATE c/o LAWRENCE ULLRICH c/o
John Lees , Esq. David 0. Lars-on, -Esq.
Gibbons , Lees, & Schaefer Moore, Clifford, Wolfe, Larsc
1601 North California Blvd. and Trutner
Walnut Creek, California 94596 201 19th Street
Oakland, California 94612
VALLEY REAL ESTATE c/o
Edmund L. Regalia , Esq.
Miller, Starr 6 Regalia
One Kaiser Plaza, 16th Floor
Oakland, California 94612-3683
H. F. LAURITZEN c/o
D. Jean Hastings, Esq.
Capps, Staples, Ward , Hastings b Dodson
1280 Boulevard Way, Suite 204
Post Office Box 5607
Walnut Creek, California 94596
DELTA REAL ESTATE CORPORATION c/o
Mark W. Hudson, Esq.
Kenneth F. Strong, Esq.
Sedgwick, Detert, Morand Arnold
111 Pine Street
San Francisco, California 94111-5673
AMENDMENT TO CLAIM OF THE WILLOW
PARR MARINA HOMEOWNERS ASSOCIATION
COMES NOW, Claimant THE WILLOW PARR MARINA HOMEOWNERS ASSOCIATION
and files its Amendment to the Claim filed with Contra Costa County
on December 2, 1985, as follows:
1 Claimant does not know the precise date of the acts and
omissions . which gave rise to the herein claim. Presumably, such acts
and omissions on the part of the County and its duly authorized agents
occurred during the period commencing with presentation to it of the
plans, drawings and specifications respecting the Willow Park Marina
Condominiums and concluding with the issuance by it of, among other
things, occupancy certificates respecting the subject project.
Claimant is informed and believes that the foregoing period commenced
during January, 1973, and concluded during 1979.
Claimant discovered. the facts giving rise to its claim against
the County during October, 1985, upon consultation with the
eng'neering firm that it had retained to evaluate the condition of
the Willow Park Marina Condominiums.
Date: December 13, 1985 By: J
ANIE IUS
Attorney for 1 imant
IRE CEI MED
DEC30, 1985
MIK SATCHEL
fec A�Q
9 TRA Cos O
U
"-IrJ
r
APPLICATION TO FILE LATE CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
BOARD ACTION
Application to File Late Claim ) NOTICE TO APPLICANT February 11, 1986
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: CHARLES WILLIAM JONES, JR. A MINOR,
CUU«<v ^Oplr:
Attorney: Mary 11. Burke
Law Offices of Mary M. Burke JAN '2 2 1986
Address: 125 West Richmond, CA 94801
Point Richmond, CA 94801 MartlneZ
Amount: $7 , 000, 000. 00 by delivery to Clerk on , CA 940.�3
Date Received: January 21, 1986 ,By mail, postmarked on Jan unzaadable
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above noted Applicati to 'le Late Claim.
DATED: Jan. 21 , 1986 PHIL BATCHELOR, Clerk, By6 Deputy
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
( ) The Board should grant this Application to File Late Claim (Section 911.6).
(x) The Board should deny this Application to File Late Claim (Section 911.6).
DATED: �,e,`L q�( VICTOR WESTMAN, County Counsel, By� .ty
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:.I:FR 111986 PHIL BATCHELOR, Clerk, By 06mq Oadw
iLo
Deputy
WARNING (Gov. Code 5911.8)
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 immediately.
IV. FROM: Clerk of the Board T0: 1 County Counsel 2 County Administrator
Attached are copies of the above Application. We notifed the applicant of the
Boards 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: FEB 12 X986 PHIL BATCHELOR, Clerk, By 0Deputy
V. FROM: 1 County Counsel 2 County Administrator TO: Clerk of the Board
of Supervisors
Received copies of this Application and Board Order.
DATED: County Counsel, By
County Administrator, By
APPLICATION TO FILE LATE CLAIM
}
Law Office
MARY M. BURKE
125 W. Richmond Avenue
Pt. Richmond, CA 84801
(415) 237-8317
TRANSMITTAL. MEMO
TO BOARD OF SUPERVISORS DATE 1/17/86
COUNTY OF CONTRA COSTA
SUBJECT In the Matter of CHARLES WILLIAM JONES , JR
against the County of Contra Costa
ENCLOSURES APPLICATION FOR LEAVE TO PRESENT LATE CLAIM
REQUESTED ACTION Please file and return conformed copy
in the enclosed enclosed envelope.
THANK YOU.
MARY M. BURKE
1 - KARY M. BURKE
LAW OFFICES OF MARY M. BURKE
2 125 West Richmond Avenue
Point Richmond, CA 94801
3 Telephone: (415) 237-8317 RAP-44CEIVEli
4 Attorney for Charles William Jones Jr. n
5
nwc taTCHROR
^�
CIE R 00"M OF 1PEWiSCM
6 JTQ/ L I I....
7
8 In the Matter of the APPLICATION FOR
Claim of CHARLES LEAVE TO PRESENT
9 WILLIAM JONES , JR LATE CLAIH
Against the County
10 of Contra Costa
11
12 TO BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY:
13 1. Application is hereby made for leave to present a late
14 claim under Section 911. 4 of the Government Code. The claim is
15 founded on a cause of action for the wrongful death of Charles
16 William Jones which accrued on January 13 , 1985 , and for which
17 a claim was not timely presented. For additional circumstances
18 relating to the cause of action reference is made to the proposed
19 claim attached hereto as Exhibit A and made a part hereof.
20 2 . The reason for the delay in presenting this claim is the
21 late discovery on the part of the claimant ' s mother of the cir-
22 cumstances of the death of the claimant ' s father as more particu-
23 larly set out in the declaration of Jessie Lee Jones attached
24 hereto as Exhibit B and made a part hereof. The County of Contra
25 Costa was not prejudiced by the failure to timely file the claim
26 as shown by the declaration of Jessie Lee Jones . (Exhibit B)
27 3. This application is presented within a reasonable time afte
28 the accrual of the cause of action as shown by the declaration of
I Jessie Lee Jones . (Exhibit B)
2 WHEREFORE, it is respectfully requested that this application
3 be granted and that the attached claim be received and acted upon
4 in accordance with Sections 911. 4 to 912 . 2 inclusive of the
5 Government Code.
6
Dated ���f�-.� -�,� � ,��� ,1986
7
8
9 On Behalf of the Claimant
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
CLAIM TO: BOARD OF SUPERVISORS OF CONTRA C(*TArR9Yapp1ice"on to:
Instructions to ClaimantVerk 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 eatiEy, separate claims
mv.st he 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
_CHARLES WILLIAM JONES. JR. a minor. by , I�:CEI'�'ED
his mother, JESSIE LEE JONES )
Against the COUNTY OF CONTRA COSTA) DECA, 1985
or DISTRICT) u Q SATCMHQR
J_C,2�,
C 1
Fill in name ) 051 o'C"
The undersigned claimant hereby makes claim against the County of Contra
Costa or the above-named District in the sum of $ 7,000,000.00
and in support of this claim represents as follows:
------------------------------------------------------------------- ----
1. When did the damage or injury occur? (Give exact date and hour
October 8, 1984 through January 13, 1985
2. Where did-the dama a or (I
occur? n
iniurv` _"
claude__._.�-i_-,„
cityan__d---._county)_________
?
Contra Costa County Hospital, Martinez
_r--------------------------------------------- - ----.r- -_--.._-_-_---
3. How did the damage or injury occur? (Give Iuli details, use extra .
sheets if required)
Contra Costa County Health Services failed to provide CHARLES WILLIAM JONES, SR
with necessary medical treatment and care.
4. What particular act or orris-cion on the part of county or district
officers, servants or employees caused the injury or damage?
On October 8, 1984, CHARLES WILLIAM JONES, SR was�taiagnosed as needing immediate
heart surgery. Because he did not have medical insurance, the surgery was not
scheduled and he was released from the hospital. On January 3, 1985, he was re-
admitted with severe chest pains. He died January 13, 1985 of heart failure.
* admitted to Contra Costa County Hospital and (over)
EXHIBIT A
� 5. What are the .names of county or district officers, servants or .
employees causing the damage or injury? Supervisors: Nancy Fanden, Sonne
McPeak, Tam Powers, Robert Schroder and Tom Torlakson;Adninistrative Officer: Indi
Batchelor; Director of Health Services: Mark Finucane
6. What damage or injuries do you claim resulted? Give full extent
of injuries or damages claimed. Attach two estimates for auto
damage)
Claimant has been dprived of his father.
K--Rw7. How was the amount claimed above computed? (Include the estimated
amount of any prospective injury or damage. )
Estimated amount for loss of love, care, comfort, society, protection, support
and services of his father
------------------------------------------------------------.-------------
6. Names and addresses of witnesses, doctors and hospitals '
Dr. Roger Barrow
rnntra Costa Countv Hospital, Martinez
tinez
9. List the expenditures you made on account of this accident or injury:
ITEM AMOUNT
ne
i.F.i•.S _I �'.
Lyyyy yyyy y yy yy.Ly yyJ. J. Y y y yi y yyy.Yy`y LJ.y yy ay+ y+yyyyy y+yy yyyyyyyyyyy.L 1
Govt. Code Sec. 910.2 provides :
"The claim signed by the claimant
SEND NOTICES TO: (Attorney) or by some person on his behalf. "
c
Name and Address of Attorney
MARY M. BUM Claimant.114,Signature
IAW OFFICES OF MARY M. BURKE f ' (' _
125 West Richmond Avenue Addres h
Point Richmond, CA 94801 N +C.��. 9(1 o 1)
Telephone No. (415) 237-0317 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. "
1 _ MARY M. BURKE
LAW OFFICES OF MARY M. BURKE
2 125 West Richmond Avenue
Point Richmond, CA 94801
3 Telephone: (415) 237 8317
4 Attorney for Charles William
Jones , Jr.
5
6
7
8 In the Matter of the
Claim of CHARLES WILLIAM
9 JONES, JR. by his mother,
JESSIE LEE JONES , against DECLARATION OF
10 the County .of Contra Costa / JESSIE -LEE JONES
11
12 I , JESSIE LEE JONES , declare:
13 1 . I am the mother of CHARLES WILLIAM JONES , JR. Attached
14 hereto as Exhibit C is a photocopy of his birth certificate.
15 2. The father of CHARLES WILLIAM JONES , JR. is Charles William
16 Jones who died at Martinez Hospital on January 13, 1985 .
17 3. It was known on or about January 15 , 1985 to CHARLES WILLIAM
18 JONES, JR. and to me that Charles William Jones had died and we
19 attended his funeral.
20 4. Neither CHARLES WILLIAM JONES , JR. nor I knew, however , of
21 the circumstances or cause of Charles William Jones' death until
22 I read newspaper articles from the West Contra Costa Times and the
23 Oakland Tribune on or about November 13 , 1985 which described a
24 lawsuit filed on November 12 , 1985 by Reginald Jones and Twana
25 Jones . Attached. hereto as Exhibit D/1 ,D/2 are photocopies of said
26 newspaper articles .
27
28
EXHIBIT B (2 pages
. 1
I I declare under penalty of perjury that the foregoing is true
2 and correct and that this declaration was executed on Januaryf;
3 1986 in Richmond, California.
4 (�
5 - --
V - IE LE J 0 E\S
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
-2-
CERj FICTATE OF. LIVE BIRTH (15
1�
PIRTH CERTIFICATE NUYDCR TATE O CALIFORNIA
LOCAL R[OISTFATION DISTRICT ANn Ci RTI►ICATE YUMDER
• 57:1(L
1A.—NA MEOF CHILD•—FtR/T 1B IDi;E 11C. LAST
_Charles William j Jones, Jr.
THIS - 2A. TuI■SIRTN,unuT,THIN. 3tl. II YYLTVLt.10$'CHILD 4. RINTH1wt14HT 5A. DATE OF BIRTH—MuNTtl.DAY,YEAR I DY. HH9UR
CHILD 2. SEX STc, 1 1■t,tr■,STC.
Ma l e S i ng Le,. 1 -- 3288 a„r, October 30,., 1978 1 1040
OA. PLACE OF BIRTH—NAMR or H■SPIIAl d0. STREET ADDRESS to tt[T,NuMR[R,OR LocanoHl
P�E Alta Bates Hospital } 3001 Colbx Plaza at Ashby
p1 H !C. CITY OR TOWN I SD. COUNTY
(
Berkeley ! Alameda
MOTDFER 7A. 015TH NAY[or Moryu—nSST 178. NBODLZ _ ; !�2C LAST B.STATE 0,'RIRTN i. AGE OF MOTHER
CHILD Je_>_,sie Lee I Jones Cal ifernia 22
FADFER IOA. NAME OF FATHER—FIRST :10S. RIDDLE 71-0C. LAST It. STATEDI BIRTH 12. AGE OF FATHER
}
CHILD Charles William_ I Janes _ Mississippi 19
NA RENTS I conn THAT I WAYS R[rlocD?wc[TAT• BSA. ARENT OR OYNER ipIMANT—iiDnATUNC I130. StLATl6Nil/F f0 CMILD113C. YaT[Strl[t[t Aro aroMCo
:kRTIFICA- "I IHIOAMATIDM ANS THAT IT It T■wt AMR r
TION GO■tLCI T)TMt[[[T O/Ni CNO■1R44L } O 1 Mother ' 11-1 ria _
( CuiL�T THAT 1 ATIINgtO THIS SI■TN I 4A• FHY51 AN IOR DTII PtbO tl0 TTtNOt NIS SIRTIII—D[ORE[00 TITLE AND TIPS{RAN[ 148. can uR S
ATTEND ANR TMIT TR CMILD[IAt totN AL YS AiI���
AN T'S THA wan, olit AMS FMCA STAt to. SIGNATURE 1
:ERTIOFNCA- 14C. ADDRESS I�•r 1 alhnamoort ogam, ., IUD. TTCMDArrt uc[Nct wur■u
1EGU[51 OMIf510N FROM . 3300 to 9', e. , A 31324
LOCAL is. DUTH—LMTt■DATA of DtATN 14. LOCAL REGISTRAR—SIGN �. 17. DATA ACCCPTRDFOt 2[6/51[11I0”
IEGMTRAR NOV 9 197 ;
EXHIBIT C
in
. to
vi W ,+J
ti C, V1�.
rr tr Q -.."�x�y �+ tiQ Oma; ''�+h ..b �?t.+ i?S, ,n �.. A7 ••t
be a��C3 @� � e� �.� e� 1.136114 p � ep' ta
jj
� ct
j b p. fp it
° (7 ° ` CO �'.'J .►* �+4 `G N rv.+ O O s
^ _ �y p ., g,¢� t
►.. . `p�,p, j :.yZj
m`� � � c 5�.�� �.`°' ��.�'-�a a.✓'��•o ,; ,��-► Wig,,
�y
SLo
�p
`e • cC •'et
•'moi.L.
:3.O fM;ffi pipp G °p cD Al'C �
o C
° 5.g i
�Poa _8m ' � m m � ro
71
Ir
. :. 8. s
CD CD
' m
cL
�i �{c�r�'•► V.. �'fir• 1"1CE
ow.
ow
10,
yg�]� •_; � i� �i �i l _ •y,g�+ �_- j T t}�.c��1yJ"p,i�s �'��"" y� S. @@.,
^�WE.i...y" ._.... �... :.p• _.iii �. .. '.�i ee,,,�$ ea�T•i.-_ - ��3'-f- ��¢g�dli�}�''G!�C�{ice - a t
'V�.u.a._ •� d,, h .�`, iii .�� k
Q CD
EXHIBIT D/I
z/a zIgIHXR
' 1. _ -. - - -� �- __•t: .-; .-...-.•�-.-;.i _-•_l
PO
in
NX3 Fa
• r!Y7 �'_ '
y,owCIO V-4
Cd
cts U0
OE.r O
rh
tn
W aO N y l
FWQ
.a+ �y V d -Rl.u•.� m A
d 1..44 V
y p4 �-
H eC. �® in y u i..A
Q y C 't3'V.d n 'G!1-40
Q'
F'y y Q�.y.�y-� 00� --Q� LA .Q�.
cc VTM_ p
05,
�S N
on
12' Yu o '
v
ca* 00
91
u u... �+ ea 40i 9 s :
u pQ
l� V..p0 `a,p , 'o�N u 0p .Q.S Q it r St 4 r
�` s•+V�: � G y•"�.� �- p QJ..0.�N v Z.�0.i=: � 'r i ;f's
cr
Cj
cm
dl.Oi C O1 d O Ci+r U
ca cd
low
ca
�
O
.�
J3
v.s. COV-44
End
moi•. O 01�'d ,..� Vc•- - L
Cd
ca ca
y� u
�„„•,.� _ ;vl F"..0«a.-. v1�. V w to .. l � _-..
1 PROOF OF SERVICE .BY `1IL,
3 I am employed in the City of Richmond,- Contra Costa County,
4 State of California. I am over the age of eighteen years and no
y. 5 a party to the within entitled action. My business address is
6 125 West Richmond Avenue , Point Richmond, CA 94801.
7 On .Tnni� 17 1 Agh I served the within
8 APPT.IGATTON FOR TRAVF. TO PRESENT LATE CT-ATM
9
1C on the BOARD OF SUPERVISORS OF. TNF rnTTNTY nF LpNTRA rngTA
12 in said action, by placing atrue copy thereof enclosed in a
13 sealed envelope with postage thereon fully prepaid, in the
14 United States mail at Richmond, - California, addressed as
15 follows:
16 CLERK OF THE BOARD OF SUPERVISORS
COUNTY OF CONTRA COSTA
17
P.O. . BOX 911
KARTINEZ , CA 94553
18
19
20 I declare under penaltyof perjury that the foregoing is
21 true and correct.
22 Executed on January 17. 1986 at Point Richmond,
23 California.
24
25
- MARY M. BURKE i `
26 NAME SIGN TURE
27
28
i