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HomeMy WebLinkAboutMINUTES - 12081987 - 1.2 ':AMENDED '77 r a. CLAIM l'y BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA %Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT December 8 , 1987 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph 1V below), given pursuant to Government Code Amount: $300 , 000. 00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: T0I4 STOFLE c/o Kent C. Wilson, Esq. ATTORNEY: Wilson & Rose 1350 Treat Blvd. #400 Date received ADDRESS: Walnut Creek, CA 94596 BY DELIVERY TO CLERK ON November 6, 1987 CC BY MAIL POSTMARKED: November 3 , 1987 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: November 9fibILATCHELOR, Clerk g, 1987 : Deputy 9 L. Hall 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. (X This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 111,01A /-;L /J a BY: /�Q,,u/ Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: �s,�r�� By unanimous vote of the Supervisors present (X ) This Claim is rejected in full. ( ) Other: 1 certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: DEC $ 1987 PHIL BATCHELOR, Clerk, By , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: DEC 14 1987 BY: PHIL BATCHELOR by ikz��Uty Clerk CC: County Counsel County Administrator WILSON Y KENT C WILSON BERNARD F. ROSE, Ph.D. ROSE Of Counsel ROSE EUGENE P. RINN ATTORNEYS AT LAW Certified Specialist A Professional Association Workers Compensation November 2 , 1987 County Counsel NOV 01' 1987 Mary Ann McNett Martinez, CA 94553 Deputy County Counsel County Admin. Building P.O. BOY 69 Martinez , CA 94553 RE: TOM STOFLE — 100—DAY CLAIM Dear Ms . McNutt : This will acknowledge your notice dated October 20, 1987 regarding the above. Please allow this letter to serve as an amendment to our previous claim. The information you request is currently unknown. We will need to review the medical records. As soon as you honor our request for the medical records (which was presented to the County on August 14, 1987 and once again requested on September 25 , 1987) we will have the information you request. VeryY pur�I r `Y� 1 S , ESQ. k,t _. ,t a t A« • s URBAN WEST 1 • 4350 TREAT BOULEVARD • SUITE 400 • WALNUT CREEK • CALIFORNIA • 94696 • (415)933-4500 • f CLAIM / BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT December 8 , 1987 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $227 . 93 Section 913 and 915.4. Please note all QaWrAy-rv,0"S61 CLAIMANT: JOSEPH L. TORRES NOV 34 Carter Court ATTORNEY: E1 Sobrante, CA 94803 Maftifiei, CA 04W Date received ADDRESS: BY DELIVERY TO CLERK ON November 3 , 1987 BY MAIL POSTMARKED: November 2 , 1987 1. FROM: Clerk of the 9oard of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: November 9 , 1987 PpHHIL ATCHELOR, Clerk BY: Deputy L. Hall 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 1121/, �j�_ �� BY: //�(�� puty County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with noiice.to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. DEC $ 1981 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 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. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown aboy . • DEC 14 198 Dated:_ BY: PHIL BATCHELOR by _V_ puty Clerk CC: County Counsel County Administrator y. 4 CLAIM TO: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY Instructions to Claimant _1 A. Claims ,:relating- to -causes of action for death or for injury to person or to personal property or growing crops must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Sec. 911. 2, Govt. Code) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez , CA 94553 (or mail to P.O. Box 911, Martinez, _CA) , C. If claim is against a district governed by the Board of Supervisors, rather than the County, ,the name of, the District should be filled in. D. If the claim is against more than one public entity, separate claims must be fileg against each public entity. E. Fraud. See penalty for fraudulent claims , Penal Code Sec. 72 at end 671—t h i s form. i-��, **** RE: Claim by ) Reserve #�q�� L g stamps �'oaer�ti L. %O R-ES x ' NOV 3 1.987 Against the COUNTY OF CONTRA COSTA) / or DISTRICT) ' (Fill in name) ) The undersigned claimant hereby makes claim against the County of Contra :;Costa or . the ..above-named District in the sum of $�,L�� and in support of this claim represents as follows: -------==-----------=--------------------------------------------------- - -- ---------------------------- 1. When did the damage or injury occur? (Give exact date and hour) 2. Where .did the damage or injury occur? (Include city and county) 3 q /r EL 566&6,1J 7 4 - 7 0-3 3. How did the damage or injury occur? (Give full details, use extra sheets if required) /� VoA-) C /C U10 w/ TH DooAes open /� /T wr y tDifakC= > CA)Q--I� — Dc1,4t_ 041 VEK)7- K__�qR_ai_p__a_H1_c_uia_r --------- -act or omission on the part of coy or district officers , servants or employees caused the injury or damage? br c( �JO % .Tu dje at_S f ahce Ircler I J (over) 5. What ar'e the names of county or district officers, servants or employees causing the damage or injury? /vi[ L. 02.EA (A),#77 C A),!; CDeo . AJ: C—�2 �5 a �' ric� -------------------------------------------------- ------------------- 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage) cc Te o*1,7 3 7--. H-----ow-wasth-------e---amount------- dl---aimed----- ab--ove------computed?--------------(Include----the--e--stimated---------- amount of any prospective injury or damage. ) 101-6AI /Rk4AJCo /S 4uTO 2Cf/'�I 2 A776C E-b ------------------------------------------------------------------------- 8. Names and addresses of witnesses, doctors and hospitals. k#ve,w-Ne T6R-XE5 3-Y CAAJ-Ele- c T L-L Sa 54,0+A) %�E/ C/4 11196-3 ------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: "'DATE"" """""""` ITEM AMOUNT O 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 3C aims Signature Address 7�J� Telephone No. 740�zf6&3 — BuslneSS Telephone No. aw--9OZR ':� —Ae+%A-� ************************************************************************** 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. " . • o t f a � Q N !w, [� ��6r Lbm C.6 J y a � • Q ~ O m m D F Y N Q Zp & on. mm=mt o o 6V pp 4 gi �° gerao IS a r- ' rm Q W v a U > UW otm�mLi �ro r Z = r -%,% -0 a r E m .m om pm w 01 $ N g to'-so N $O�d � �{"• U t � grma�oo > m IQfQ d Q � a mm3�°ym 0 °. -$UEom.: m lk M J N - ra o. 4 r0 r � S U_ Y QZ 0 O U a Q a x✓a i AMENDED J Z ' CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Clairh Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT De c emb er 8 , 1987 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $100, 000. 00 Section 913 and 915.4. Please note all " lrar?talf*.COUnSei CLAIMANT: HERSHEL OLDEN NOV 10 1987 c/o Phillip M. Millspaugh ATTORNEY: Attorney at Law Martinez, CA 94553 3616 MacDonald Avenue Date received ADDRESS: Richmond, CA 94805 BY DELIVERY TO CLERK ON November 4, 1987housing auth BY MAIL POSTMARKED: November 3 , 1987 1. FROM: Clerk of the hoard of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. November 9, 1987 ppHHIL BATCHELOR, Clerk DATED: BY: Deputy L. Hall 11. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: J2cf BY: Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present .9S.amxzNO.� (a( ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: DEC 8 1987 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: DEC 14 1987 BY: PHIL BATCHELOR by r putt' Clerk CC: County Counsel County Administrator FIRST AMENDED HOUSING AUTHORITY OF THE COUNTY OF CONTRA COSTA and CLAIM AGAINST THE 0OUI7TY OF CONTRA COSTA l� a) The name and pbst office address of the cl Hershel Olden in C/o PHILLIP M. MILLSPAUGH Attorney at Law 1987 3616 MacDonald Avenue NQS 4 Richmond , CA 94805 e CL nao t By b) The post office address to which the person presenting the claim desires notices to be sent; Hershel Olden C/o PHILLIP M. MILLSPAUGH Attorney at Law 3616 MacDonald Avenue Richmond, CA 94805 c) The date , place and other circumstances of the occurrence or transaction which gave rise to the claim asserted; DATE : August 19, 1987 LOCATION: Housing Project common yard near 317 Verde St .Richmor OTHER CIRCUMSTANCES : Ca. The clothesline pole at or near said address is short and is right by the back door of said premises. As claimant was walking by it his right eye struck it on a bent bolt on it. d) A general description of the indebtedness , obligation, injury, damage or loss incurred so far as it may be known at the time of presentation of the claim; Claimant was visiting his *rather at 317 Verse Street;' Richmond, CA and walked into a low wire or part of a clothesline pole that was protruding out of said pole. Claimant's right eye and related or adjoining nerves were injured; he has numbness in that area as well from the accident.. e) The name or names of the public employee or employees causing the injury, damage, or loss ; Claimant does not know the name of the Public ;#ployee or Employees causing his injuries. f) The amount claimes as of the date of presentation of the claim, including the estimated amount of any prospective injury, damage, or loss , insofar as it may be known at the time, of the presentation of the claim; together with the basis of computat=ion of the amount claimed; 1. General damages in excess of $500, 000 . 00 . 2. Medical bills to date not as yet knoem. 3. Future .14edical bills not as yet known. 4. Loss of wanes , employment , or earning capacity not as yet known . 5 . The total of all. special. damages including past , present and future is estimated by the undersigned to be , or will , or may be approximately $100, 000. 00 . I DECLARE UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Executed this day of October 1983 , at Richmond, California. t]%RSHEL OLDEid r CLAIM �r z BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT December 8 , 1987 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Governmwftq* Counsel Amount: $1229. 74 Section 913 and 915.4. Please note all "Warnings". NOV i u 1987 CLAIMANT: RUDY CONTRERAS 34 Dimagio Avenue fvlu,-Inez, CA 94553 ATTORNEY: Pittsburg, CA 94565 Date received November 3 , 1987 hand del. ADDRESS: BY DELIVERY TO CLERK ON BY MAIL POSTMARKED: no envelope I. FROM: Clerk of the hoard of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. November 9 , 1987 ppHIL BATCHELOR, Clerk DATED: BY: Deputy L.Hall Il. FROM: County Counsel TO: Clerk of the Board of Supervisors XThis claim complies substantially with Sections 910 and 910.2. { ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: i Dated: /���/�, �� 7 BY: Deputy County Counsel ry 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) { ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (X) This Claim is rejected in full. ([�) Other: I certify that this is a true and correct copy of the Board' Order entered in its minutes for this date. Dated: DEC 8 1987 PHIL BATCHELOR, Clerk, By � Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: D E C 14 1987 BY: PHIL BATCHELOR by i Deputy Clerk CC: County Counsel County Administrator •'CLAIM TO: BOARD OF SUPERVISORS OF CONTRA CORS WYapocationto: Instructions to ClaimantVerk of the Board MartineZ,Cialifomia94553 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 1061, County Administration Building, 651 Pine Street, Martinez, California 94553. C. I£ claim is against a district governed by the Board of Supervisors, rather than the County, the name of the Distract=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. **,t::•,t*t**�,t*+e*r***:fire*��*t,t,�t:**+t*,�*�f***��rt*:*rem**,rt****tr**tt*tr.***t RE: Claial by )Reserved for Clerk's filing stamps SCE E � All Against a COUNTY OF CONTRA COSTA) or DISTRICT) • wan (Fill in name ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ )Z n-) 7z/ ,(,n and in support of this claim represents as follows: 1. When did the dama or injury occur? (Give exact date and hours © - 77 . ate #• l6 pn. 4, A 1) AZL; Jaf _ _��__?Y,�=1 ----------- Y. ere I Erle damage or injury ccur? nclude city and county) 3. How did th mage 14 occur? (Give ul�det-ai s, use extra sheets if required T________........ 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? �' �( `5 (over) 5. What are the names of county or district officers, servants or employees ca sing the damage or njury? 6. What aamage o ;juries: do you aim resulted? ZGive- full extent of injuries o damages - Attach two estimates for autoL damage) -oma AN Slj -ems 7. How was the amount claimed above computed? (Include the estimated amount of any prospective inju7 or damage. ) L� &3 L� -7. Z Lt hien 7N M+ , �) v L° Z7' f s +oNt>' a;L 1 , 0-0 1 . q. R o S pit ft-l-. ---------------------------------=--------------------------------------- 8. Names and addresses of witnesses, doctors and hospitals. DE W0.S I?& S w1 � 1"1J T T — T------ -- —r —T-T—�•-- 3 Mt the, expenditures you made on account of this accident or zn�ury: � 1T£ ITEM AMOUNT c� L{ lx .� Yh ULo- e �a 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 14<k ,rIU/, C a ant's Signature ddress G � Telephone No. — —� Telephone No. ,i *t*r*�►t*tR�t*sttt*t�**�t+*t,ttr�t•�*ttR**:*r►tr,r*�r�r�r*�**�**,t*+��t*:*�*�tt►aw**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. " F. z {'•':"'� ar wy o y„ ilk $t� t, r fR1 1 MT rD IAHLO HC!mP F(gED C£id3 E#t t <� I1'PF OF.B7l'L K„DATE;C� BILL r^. �',°!Q• Bx 44 E �^ `ts } r ur 'a x z a s� `7 ! < ++°' 1 OA O ''..I 2 >:. r ae -fit 'f .y ♦ a , r ° '°' HZ u r^» _ r .WRFY Rltt . t � c .+•... 1<' 3a ,�rJ �”` 94• ' 3.•� SAN FRAN(7: SGOT CR. 941,44-v rvri P1ry 415 67 #- 102 ,s -� MT.'DIABLO HOSPITA MEDT l t NTER ssao EAST ST..CONCORD;:6Ai 445"l b ;27 OPERI4TfA•5Y• EMT.DIABLO 1464M Ct DISTRICT,r PATJENT NAhAE "` PATIENT NUMBER'c;; SE ' ,AornisslOH-)ATE'z; DlsafiAadE oaTE ,=vAxs , i CONTRERAS ,RU Y 301275795 7 '' ' 3 r ' L�a :tl •' a•. •,.. • • • RUDY xCOPiTRERA� w i I PATI ENT -'FAY ii r r 862 E 12TH ST. r � W. PITTSBURG, CA 94565 �s ` UNIDENTIFIED PHYSICIAN DETACH HERE AND RETURN TOP PORTION WITH YOUR REMITTANCE TO INSURE PROPER CREDIT $ OF <;DESCRIPTION Q1 f SERVICE _TOTAL f E .COVERAGE= EST COVERAGE 'EST.;COVfRAGE EST*"COVERAGE,ES Nk'AT-PATIENT Y HOSP.ITALSERVCES r;CCJD,E -,, _ BARGES . ANS CO.NO..1. fNS.'CO 'NO 2' i7NS.CO:NO 3 a1NS±C0 NO'114t _, ,>O ANWUNT_ 1 i 3 )ETAIL OF CURRENT CHARGES, PAYMENTS AND'. ADJUSTMENTS /OB IOOlERMD FEE 9190'9 "127: OrJ 127= 001ERMD FEE * 9190517 136. 00 136. 00 F/06 1003ERMD FEE 9199040 162. 00 1 162.01? ►708 1001DIFFERENTIAL 5035010 15.90..' ; 15. 90 i%06 001HEMOGRAM 5035015 19. 107n { 14. 10 1/:08 001PROTHROMBIN TI 504561 ? 23. 30x; 23. 30 1/015 001APTT 504,.5730 zq. z0 j i 224. 50 )70e {001 LYTES + BUN 501267 ?O 3o '"` ' 1 �, i 70. 50 s *08 i001ARTERIAL BLD r, 79.51: 1/06 1001GLUCOSE FAST INx 2 65 1. 1/08 001CREATININE L� .t 29 TO x " 70 1!018 001TYPE AND SCR fi 63. 60 61. 6(: I OS 001HAND CO)'iPLE " fi 9$, b.4 ; '; =3 ' ° 98. 6= 1`%08 001 BEDSIDE EX.r, "" ' '"` 3:b7 3 `:! ,4� e_L 63. 6: 1/:08 0r?lARTERIAI 8< fe `4, M. "1r.6fJ w _,1. 60, 1/08 001 STAT CHARD . 26tl 1 1j:t 26. 5 I,/OB 001ANTIVENIN k 151 . 30 a — 1/O _ Y = ' I/08 001NACL 0.9% s �r v ti 1z 1 30. 4= S. 00INACL_- 0e9% w 30.140 I/Q8 001NORMOSOI_ µ 30se �y,Ems» fic 40 '•r,< ,{� ..'-s""' g.,x x � j � S x'`t5^ 'a5' �v IE ,..r r<."` �ALA CE FOR WRRD " " a _ ` ' ^" � *�� T UMM RY OF CURRENT CHARGES...-- LAB—CLING 3004060 AWz�S�w ,,*t 1 r� i., ( 375.85 RAD DIAL-, 3204140 1 162. 3i , PHARMACY' 2524170 ? 242. 58 , 2442. 58 ER PHYSI•ClV 42 0 427,(7'0 ' .e _ ' i I , 427.00 UB- 0TAL OF CUM 'CHARGES _. 1207. 74 i"x,, l a. t%1"207.74 T O T A L S f 1207. 74 � - .._— T---------i---- —'. ! '-1207 e 74 v T i'T'- PATIENT AMOUNT IS DUE WITHIN 10 DAYS OF THIS STATEMENT DATE. ADDITIONAL PATIENT NT BILLING �• < t y/'Ikryr Lr. . ,{ MAY BE REQUIRED.BECAUSE OF CHARGES REFERRED TO THE BUSINESS OFFICE AFTER THIS BILL WASPREPARED -,aD�Au r *,u1'; • r;� 3012757955 PLEASE RETOARN THAS STATEMENT FOR USE INSURACE COVERAGE ETAX PURPOSES.OSEDIFFERED OM OUR ESTIMATE. i HAV M1'YRT�!:C1 CUNT, y.2Ci7 74 W. FED. TAX NO. 91-6003847W r - A PATHOLOGISTS RADIOLOGISTS NEPHROLOGISTS ELECTRONYSTAGRA►HY ��,'jj��,�E�(�N,La7(�Y R 5 D BY A LETTER,SEE R. HUNT. M.D. DIABLO VALLEY R.VERTAL.M.D. J. HARRIS, M.D. ' E JIVC VI' gf% IV[NTIt7lKIIVIY NI ENCS LABS. M. ABLE, M.D. RADIOLOGY MEDICAL GROUP T. WEISS.M.D. SAN FRANCISCO, CA. D. TROXEL, M.D. RADIATION ONCOLOGY P. FANG.M.D. 'ELECTROMYOGRAPHY D.BEERI INE. M.D. R fARMFI M n Otl0038 tlf10A tl AdQJ SIHl NIV13tl ONV 3yV#3U-3SV31d O O F a 2 LU z3i CJ O LN O S p Q q W 7 = 7 IW Q 7 U IQ2 q. •• ; O J p q w Q m Q O>2 .LL ZU� 4qo � J a ¢ U a V �?¢ ./ W ! a zv�¢ En JQO � T W V Z W //�• LL ��V Ia p O O o zrux WNW o - Y E U in aaa i O O > Y F- >�a 00 V as c1d N c J crtld N y! w O O z °I J } C1 Q ZVz~ m a 2 -- O cr tt Iqzo Q Q �I W > W o~LZ O m w in r a Y Is a ¢ i J ro ZEW� z "zJo �> a a = y > I woJo i N ''� beOit uixFi S w r w J II ►+ x `•'V � ' 0 Cl O U m it w3SY w W = X 0 z rd 0 ° `� OZrI 7L1.~ 70tt13 !' + -+ Z-O w ~VVVV w T, . trrr w I-w c� o 3ZE E EX x A w o co wIa > YJ"z F V3LL n crw(rw aEw o -j"oo t m .:s:al o vmEv ; o ¢ mea` o CCD cxww w ►r z 3 U JOU (7 ZFV z° az to > w J In it w Z o U) W Q Q ¢wu 4 Z /D M-lu ° ! w ILU" >xO I QD 0- w IK zw OE '0 EQo m O @ wcn0, QOZ +n 3► ,Cw d U I JZ7 V+ wwJc oa.W it J3a> C > 0 � 14T< cr Jltoct , CLAIM / 2 BOARD OF ;SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA r Claim Aguinst the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT December 8, 1987 and Board Action. All Section references are to The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $100 , 000. 00 Section 913 and 915.4. Please note altrnin s L " csun?y Counsel CLAIMANT: KENNETH SMITH NOV 1 U 1987 C/o David Weintraub, Esq. ATTORNEY: 408 Tennessee Street Martinez, CA 94553 Vallejo, CA 94590 Date received ADDRESS: BY DELIVERY TO CLERK ON November 4, 1987 hand del . BY MAIL POSTMARKED: no envelope I. FROM: Clerk of the JIoard of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. pH gg DATED: November 9 , 1987 EVIL DeputyLOR, Clerk L. Hall 11. FROM: County Counsel TO: Clerk of the Board of Supervisors to This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 46 t1 BY: J ! Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (Y) This Claim is rejected in full. Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: DEC 8 1987 PHIL BATCHELOR, Clerk, By i Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in'Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. vfo�//Jwe� Dated: DEC 14 1987 BY: PHIL BATCHELOR byDeputy Clerk CC: County Counsel County Administrator CLAIM TO: BOARD OF SUPERVISORS OF CUNTxA CUb'1A t.vvna . - Instructions to Claimant Return original application tc Clerk of the Board 651 Pine St.. Room 106 Martinez, CA 94553 A. Claims relating to causes of action for death o=• for injury to person or to personal property or growing craps 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) S. 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. !#AAt#!#A################t#A###A###A####!!!A##!!##!#!#!!!!!##!!!!!!!t!t! RE: Claim by )nese oped ing stamps KENNETH SMITH ; RECEIVED Against the COUNTY OF CONTRA COSTA) gPJoV ?987 *AfqA lOR or DISTRICT) cYF1 in name ) er .. . .. .. OpUty The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ loo , o 0 0 and in support of this claim represents as follows: rr rrr .r ----r r-r-�..-� r rr.rrrrrrr rrrrrrrrrrrrrrrrrr r rrr rrrr .- 1�1�ien dz<d the damage or In�u=y occur? TGive exact date and 5ourf July 28, 1987, to July 31, 1987 r -.rrr r rr rrrr--r-- .,rte---��--.r-� r rrrr.,rrrrrrrrr rr rr rrrr '�:r �ilFiere did tFie damage or �nlury occur? ?Include city and county Contra Costa County Jail, Martinez, Contra Costa County, California. rT rrrrrrrrrrr--rr r-rrr--r r.*rrrrrrrrrrrr .rrrr r rrT rrrrrrrrrrrrrr 3. How did the damage or Injury occur? ?Give dull details, use extra sheets if required) claimant was brought to the jail from EI Cerrito on or about 7/28/87. He complained of pain and asked several times to see a doctor. He was not allowed to see a doctor until 7/31 /87, when it was discovered that he had a broken bone in his arm. rrrr rr rrrrrr r rr rr rrr rrrrrrr rrrrrr r rrrrrr r rr rr r rrrr rr Tr rr rrrrr Mhat particular act oz omission on the part o county or �fistr�ct officers, servants or employees caused the injury or damage? Claimant was not allowed access to proper medical care for three days. County employees knew or reasonably should have known that his arm was seriously injured. (over) 5. What are the names of county or district officers, servants or' employees.-causing the damage or injury? Unknown at this time. Attempting to ascertain. 6. What 8amage or injuries do you claim resulte�'T ZG�ve �u�� extent of inj,pries or damages claimed. Attach two estimates for auto damage) Actual damages unascertainable at this time. General damages, pain, suffering and emotional distress are claimed. ----B-o-w--w-a-s- h-e--a-m-o-u-n-t--c-l-a-i-m-e-d--a-b-o-v-e--c-o-m-p-u-t-e-d-?-- (Include-the--------- estimate amount of any prospective injury or damage. ) N/A - ------------------------------------------------- --------------------- 8. Names and addresses of witnesses, doctors and hospitals. Attempting to ascertain --------------------- VS. List the expenditures you mode on account of this accident or injury: DAT r' ITEM AMOUNT Attempting to ascertain r i t,►attr**atx*x�r�,rtvr:«t***tt***x**�r*ie�tt,�*tt,t*****t*rtt*ttr"****�rw**tr*ttt�e�"ttt* 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 DAVID l;go Claimant s Signature �nCoW0- 408 TennesseeStreet Address Vallejo. California 94590 Telephone No. (7071 644-4004 Telephone No. •tart••a:�**�*a•t•,efrlr,r:t,r�*kwt�,r3e�:tt*rf***t*f�i�tt*r****�t**ttr*Rt:�****• 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 SUPERV150RS OF CONTRA COSTA COUNTY, CALIFORNIA . Claim Against the County, or District governed by) BOARD ACTION 'vf the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT December 8 , 1987 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $116 , 763 . 00 Section 913 and 915.4. Please note all "Ware8Un"ty COUnS61 CLAIMANT: LOUISA CAMBZON c/o Dennis O' Brien NOV 10 1987 ATTORNEY: Law Offices of O' Brien and Sullivan 1500 Newell Avenue #401 Date received Martinez, CA 94553 ,ADDRESS: Walnut Creek, CA 94596 BY DELIVERY TO CLERK ON November 5 , 1987 Risk Man. BY MAIL POSTMARKED: no envelope 1. FROM: Clerk of the hoard of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. Novem er 9 , 1987 PpHHIL BATCHELOR, Clerk DATED: BY: Deputy L. Hall 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. XThis claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 1a BY: IYeputy County Counsel I1I. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( N This Claim is rejected in full. (' )\ Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: DEC 8 1987 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: U E C 14 1987 BY: PHIL BATCHELOR by Z_rlputy Clerk CC: County Counsel County Administrator TO: PUBLIC WORKS DEPARTMENT 255 GLACIER DRIVE ` MARTINEZ, CALIFORNIA 94553 LOUISA CAMEZON hereby makes claim against tip PTTRTjQD . d DEPARTMENT in the sum of $216,763 .00 and makeseREGRI JED AAO" P statements in support of the claim: NOV 5 1987 CL ° ARD 1 . Claimant' s address is 633 Garden CreekL 1. T.�c California 94526 . 1 2 . Notices concerning the claim should be sent to Claim- ant' s attorney, DENNIS O'BRIEN, Law Offices of O'BRIEN AND SULLIVAN, 1500 Newell Avenue, Suite 401, Walnut Creek, Cali- fornia. 3 . The date and place of the occurrence giving rise to this claim are July 28, 1987 on the Southern Pacific Right of Way Trail, commonly known as "Iron Horse Trail" , at or near La Serena Avenue and Danville Boulevard, at or near APN 198-074-005-2, in the unincorporated area of Alamo, County of Contra Costa, State of California. 4 . The circumstances giving rise to this claim are as follows: At the above time and place, Claimant was walking on the trail which was in an unsafe condition due to construction work being done in the area. The construction work was not adequately marked and/or fenced off. There was a ditch that had been part of 1 the trail which was, at the time of the accident giving rise to this claim, unmarked and dangerous Said ditch contained loose dirt, gravel and dirt clods which caused Claimant to slip and fall causing her serious injuries. 5 . Claimant ' s injuries include a fractured left ankle in three places, bruises and lacerations on her left leg, a sore left hip and neck pain. 6 . The names of the public employees causing the Claimant 's injuries are unknown. 7 . My claim as of the date of this claim is $1,763 .00 . 8. The basis of computation of the above amount is as follows: A. Medical Expenses Incurred to Date $ 1,763 .00 B. Estimated Future Medical Expenses $ 5,000 .00 C. Estimated Loss of Wages $ 10 ,000 .00 D. General Damages $200 ,000 .00 TOTAL: 216 ,763 .00 Dated: November 2, 1987 DENNIS O'BRIEN Attorney for Claimant CLAIM BOARD OF-SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA I'laim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT December 8, 1987 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $216, 763 . 00 Section 913 and 915.4. Please note allo'lr"goounS©1 CLAIMANT: LOUISA CAMEZON NOV 10 1981 c/o Dennis O' Brien ATTORNEY: Law Offices of O' Brien & Sullivan Martinez, CA 94553 1500 Newell Avenue #401 Date received ADDRESS: Walnut Creek, CA 94596 BY DELIVERY TO CLERK ON November 2 , 1987 hand del . BY MAIL POSTMARKED: no envelope I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. November 9 , 1987 ppHHIL ATCHELOR, Clerk DATED: BY: Deputy L. Hall 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 711 /1/� BY: eputy County Counsel III. FROM: Clerk of the Board l— TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (X) This Claim is rejected in full. (� �) Other: I certify that this is a true and correct copy of the Board' Order entered in its minutes for this date. A Dated: DEC 8 1987 PHIL BATCHELOR, Clerk, By ,.Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: flEC 14 1987 ' DL j / BY: PHIL BATCHELOR by � Deputy Clerk CC: County Counsel County Administrator RE EI TO: CLERK OF THE BOARD P 021987 COUNTY OF CONTRA COSTA 651 PINE STREET, ROOM 106 cxvt NT MARTINEZ, CALIFORNIA 94553 DOW ey .. LOUISA CAMEZON hereby makes claim against the COUNTY OF CONTRA COSTA in the sum of $216 ,763 .00 and makes the following statements in support of the claim: 1 . Claimant' s address is 633 Garden Creek Place, Danville, California 94526 . 2 . Notices concerning the claim should be sent to Claim- ant' s attorney, DENNIS O'BRIEN, Law Offices of O'BRIEN AND SULLIVAN, 1500 Newell Avenue, Suite 401, Walnut Creek, Cali- fornia. 3 . The date and place of the occurrence giving rise to this claim are July 28, 1987 on the Southern Pacific Right of Way Trail, commonly known as "Iron Horse Trail", at or near La Serena Avenue and Danville Boulevard, at or near APN 198-074-005-2, in the unincorporated area of Alamo, County of Contra Costa, State of California. 4. The circumstances giving rise to this claim are as follows: At the above time and place, Claimant was walking on the trail which was in an unsafe condition due to construction work being done in the area. The construction work was not adequately marked and/or fenced off. There was a ditch that had been part of 1 `i Y the trail which was, at the time of the accident giving rise to this claim, unmarked and dangerous Said ditch contained loose dirt, gravel and dirt clods which caused Claimant to slip and fall causing -her serious injuries. 5 . Claimant' s injuries include a fractured left ankle in three places, bruises and lacerations on her left leg, a sore left hip and neck pain. 6 . The names of the public employees causing the Claimant' s injuries are unknown. 7 . My claim as of the date of this claim is $1,763 .00 . 8 . The basis of computation of the above amount is as follows: A. Medical Expenses Incurred to Date $ 1,763 .00 B. Estimated Future Medical Expenses $ 5,000 .00 C. Estimated Loss of Wages $ 10 ,000 .00 D. General Damages $200 ,000 .00 TOTAL: $216 ,763 .00 Dated: November 2 , 1987 DENNIS 0 N � Attorney for Claima 2 f + CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA `,e aim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT December 8, 1987 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Governm0.&.SPft Counsel Amount: Unspecified Section 913 and 915.4. Please note all "Warnings". CLAIMANT:MARY EILEEN TRONVIG NOV 10 1981 c/o David W. Falconer of Barrett, Penney & Byrd Martinez, CA 94553 ATTORNEY:1900 Point West Way #274 Sacramento, CA 95813 Date received November 4, 1987 ADDRESS: BY DELIVERY TO CLERK ON BY MAIL POSTMARKED: November 2 , 1987 Certified P 056 749 816 1. FROM: Clerk of the Jeard of Supervisors `TO: County Counsel Attached is a copy of the above-noted claim. November 9 1987 PpHHIL BATCHELOR, Clerk DATED: ' BY: Deputy L. Hall I1. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. (� This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so-notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: &a/- /o /QZ� BY: /1r Deputy County Counsel oel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present lx ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: D E C 8 1987 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: DEC 14 1987 BY: PHIL BATCHELOR by r ( Deputy Clerk CC: County Counsel County Administrator RECEIVED CLAIM AGAINST CONTRA COSTA COUNTY NOV 4 1997 i A R 1 . This claimant' s name and address is: D Mary Eileen Tronvig, 1460 Piedra Drive, Walnut Creek, CA 94596. 2 . Post Office address for notices in connection with this claim: c/o David W. Falconer of Barrett, Penney & Byrd, A Professional Corporation, 1900 Point West Way, Suite 274 , Post Office Box 13160, Sacramento, California 95813. 3. Circumstances giving rise to Claim: On September 21 , 1987, Claimant' s automobile was rear ended by an automobile driven by Rosa Olivia Grajeda at the intersection of Treat Boulevard and Coggins Drive located in the County of Contra Costa, State of California. At that time, the intersection was under heavy construction by County maintenance crews who negligently failed to properly control the intersection thereby creating hazards to drivers approaching Treat Boulevard from Coggins Drive. The Claimant had just made a right turn onto westbound Treat Boulevard from southbound Coggins Drive when the Claimant observed a red traffic signal and stopped believing it was for her. At that time, a vehicle driven by Rosa Grajeda collided with the rear of the Claimant' s vehicle. The County failed to properly control this intersection when it barricaded the southbound lanes of Coggins and redirected south- bound traffic to the northbound lanes of Coggins thereby creating circumstances where southbound traffic would believe the signal controlling Treat Boulevard was in fact controlling Coggins south- bound traffic. 4 . General description of obligations: This Claimant contends that Contra Costa County is responsible and legally liable to the Claimant for the injuries she sustained as a result of the accident as described in Paragraph 3 of this claim. 5. Names of public employees causing injury, damage or loss: The specific names of individuals acting for or on behalf of the County of Contra Costa are presently unknown. 6. Amount of claim as date of presentation of this claim: Claimant claims all damages sustained by her as a result of the r s accident as described in Paragraph 3 of this claim. DATED: November 2, 1987 Signed on behalf of Claimant by her attorneys: BARRETT, PENENY & BYRD A Professional Corporation �✓ . .- Com'��% _-'�t./��., DAVID W. FALCONER CERTIFIED MAIL - No. P 056 749 816 RETURN RECEIPT REQUESTED CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION tte Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT December 8, 1987 and,Board Action. All Section references are to The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Unspecified Section 913 and 915.4. Please note all "Warnings" County Counsel CLAIMANT: JASON SHAW c/o Tiffany Franchetti NOV 10 1987 ATTORNEY: 1 Market Plaza #1210 San Francisco, CA 94105 Date received Martinez, CA 94553 ADDRESS: BY DELIVERY TO CLERK ON November 6, 1987 BY MAIL POSTMARKED: November 4, 1987 Certified P 454 095 877 I. FROM: Clerk of the.Guard of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. November 9 , 1987 PpHHIL BATCHELOR, Clerk DATED: 8Y: Deputy /, L. Hall 11. FROM: County Counsel TO: Clerk of the Board of Supervisors (�(f This claim complies substantially with Sections 910 and 910.2. (/ )\ This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: � bL/Q BY: y County Counsel Ill. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (X) This Claim is rejected in full. (/ `) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: D E C 8 1987 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: *DEC 14 1987 BY: PHIL BATCHELOR by puty Clerk CC: County Counsel County Administrator RECEIVED Nov r 1981 IN THE MATTER OF THE CLAIM OF ) Q so�u1� t JASON SHAW ) CLAIM NO. AGAINST THE COUNTY OF CONTRA COSTA ) i I i Jason Shaw who resides at 1160 Christie Road (P.O. Box 633) , j Rodeo, California , 94572 , hereby makes this claim against the il �I County of Contra Costa and its Board of Supervisors in the sum of �i $1 , 000 ,000 .00 and in support of said claim represents as follows : i IIi, 1 . Date of Wrongful Acts : 1! On or about August 3 , 1987 . I I 2 . Place of Wrongful Acts : Christie Road , in Contra Costa County, approximately 1 .8-1 .9 miles south of John Muir Parkway, also known as State Highway 4 . 3 . Nature of Wrongful Acts : � I i On or about August 3, 1987 , at approximately 11 :00 a .m. i Pamella Shaw, while driving her 1979 Honda Civic on Christie Road , and Jason Shaw while riding in said automobile, li approximately 1 .8-1 .9 miles south of State Highway 4 , were struck j I. �! by another car driven by a male individual who identified himself I! as Fereti John Finau, 1730 Marlesta Road, Pinole, CA 94564-2007r jl and who was driving a car with license plate number 2DGR954 owned by Mira Vista Lincoln Mercury. I ! At the time of the accident, there were no posted traffic signs warning drivers on Christie Road of the deceptive condition 'ranchetti&Franchetti I and concealed trap which existed on said road and , in particular , one Market Plaza teuart Street Tower i uite 1210 an Francisco,CA 94105 i 115)777-2200 j I it it I � I it i i{ at the portion of the road where the accident occurred in that i inter alia , the road was a well-travelled, single lane, hilly road- with blind spots; there was significant loose gravel present I I on the road; there were blind curves preventing drivers from i jlseeing on-coming traffic; there were no shoulders on which to it j iipull off in order to avoid on-coming traffic; and the speed limit on the road of 55 miles per hour was unsafe and deceptive given 1! j; the condition of the road . i! II At the time of the accident, Christie Road and , in particular , the site of the accident constituted a dangerous ,, condition which was under the control and authority of the Contra i Costa County, of which the County had notice and the funds to li " alleviate. Said dangerous condition consisted of, but was not ,ilimited to , the following : The concealed trap described above as ; well as the single lane, well-travelled, road consisting of ; curves, hills, trees and shrubs creating blind spots with no I� shoulders on which to pull off in the advent of on-coming traffic I ;land the presence of significant amounts of gravel on the poorly Ili surfaced road and a speed limit of 55 miles per hour . I, I, At the time of the accident, Contra Costa County was I ( responsible for the maintenance of Christie Road and had failed i ii nto properly maintain said road, and in particular , the site of i the accident, notwithstanding it had the funds to do so and notice of the need for maintenance, including but not limited to, allowing significant amounts of loose gravel to build up on 'ranchetti&Franchetti I ! Ine Market Plaza teuart Street Tower { uite 1210 an Francisco.CA 94105 1 j 115)777-2200 — 2 — I� i i� L i Ithe surface of the road , failing to maintain shoulders on which Zito pull off for on-coming traffic on the single land road, �Ifaiing to maintain signs warning of the above dangerous I ' condition of the road, failing to maintain a safe surface on ; said road and failing to prune shrubs and trees. !i lackAt the time of the accident, Contra Costa County invited ! i iIthe reliance of travelers on said road and ! i1 , particularly, the 1; portion of the road on which the accident occurred , by having Minter alfa, a 55 miles per hour speed limit on said road , which '; speed limit was unsafe given the above-described dangerous U ! (! condition of the road . ,I At all times Contra Costa County was aware of the ' above-described conditions on Christie Road and knew or should j '; have known and easily could have foreseen that a driver of a car ! on Christie Road , particularly traveling northbound at the site i of the accident, could not safely negotiate said road and l'iportion thereof given the condition of the road , the 55 mile per hour speed limit and the lack of warning signs , and that a ' significant risk created by said dangerous condition, as jIdescribed in the preceding paragraphs, would be a head-on !I collision, such as that which caused the injuries complained of ' herein. An accident such as that which occurred herein was I foreseeable whether or not both drivers were driving with due j care. ! I 'rancheiti&Franchew Ine Market Plaza teuart Street Tower uite 1210 an Francisco.CA 94105 �i I 115)777-2200 ! - 3 - I i !j The foregoing dangerous condition, concealed trap, lack of I� ( maintenance, invited reliance and lack of warning of such Icondi.tion was a cause of the above-described automobile accident I, i I11, involving Pamella Shaw and her son Jason Shaw. !! I I I j' 4 . Damages The foregoing automobile accident caused Jason Shaw to lisuffer injury to his person, including but not limited to , linjury to his back and nervous system. The accident also caused ihim to suffer severe emotional distress. He additionally jsuffered the loss of tutoring for two weeks resulting in i jdifficulty in school causing further worry/stress . Ii The parents, Alvin and Pamella Shaw, have suffered financial ';losses as follows because of this accident : ! ' Medical costs for Alvin Shaw The total amount of these expenses is unknown at this time. 15 . Names of Employees (known at this time) a. Dan Pellegrini , Superintendent for County Roads L b. Scott Edmonds , Road Supervisor for Christie Road I C. Al King ii ij j I I� I I! ij I I ' I i i Franchetti&Franchetti One Market Plaza Steuart Street Tower Suite 1210 ! San Francisco,CA 94105 (415)777-2200 - 4 - i J ii ;I 6 . Notice to be sent to: jTiffany Franchetti Franchetti & Franchetti One Market Plaza Steuart Street Tower Suite 1210 San Francisco, CA 94105 (415) 777-2200 i' Dated: November 4, 1987 Franchetti & Franchetti Tiffany Franchetti , Attorneys for Jason Shaw I i i i i� �i I ii i� I� ii i I 'ranchetti&Franchetti I'I ine Market Plaza teuart Street Tower uite 1210 an Francisco,CA 94105 115)777-2200 i - 5 - CLAIM /Z BOARD OF S{JPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT December 8 , 1987 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Unspecified Section 913 and 915.4. Please note all "Warnings". ALV IN SHA17 CLAIMANT: C/o Tiffany Franchetti 1 :Market Plaza #1210 ATTORNEY: San Francisco, CA 94105 Date received ADDRESS: BY DELIVERY TO CLERK ON November 6, 1987 BY MAIL POSTMARKED: November LF, 1987 Certified P 454 095 877 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: November 9, 1987 gpIL BAATCtyLOR, Clerk L. Hall II. FROM: County Counsel TO: Clerk of the Board of Supervisors iX) This Claim complies substantially with Sections 910 and 910.2. ( )�) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: /Vy, ! /�7—�— BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: D E C 8 1987 PHIL BATCHELOR, Clerk, 8y Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: D E C 14 1987 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator I w RECEIVED NOV 1987 'I INTHE MATTER OF THE CLAIM OF ) liAT OR l a Qw By ... jty II ALVIN SHAW ; IM N0. AGAINST THE COUNTY OF CONTRA COSTA ) I; I I i� Alvin Shaw who resides at 1160 Christie Road (P.O. Box 633) , ! Rodeo , California , 94572 , hereby makes this claim against the i j! County of Contra Costa and its Board of Supervisors in the sum of ' $1 , 000 ,000 . 00 and in support of said claim represents as follows : ) I i. 1 . Date of Wrongful Acts : I On or about August 3 , 1987. ! 2 . Place of Wrongful Acts: i; Christie Road , in Contra Costa County, approximately 1 .8-1 . 9 i + miles south of John Muir Parkway, also known as State Highway 4 . Ii +, 3 . Nature of Wrongful Acts: !, On or about August 3 , 1987 , at approximately 11 : 00 a .m. Pamella Shaw, while driving her 1979 Honda Civic on Christie ! Road , and Jason Shaw while riding in said automobile, I� approximately 1 .8-1 . 9 miles south of State Highway 4 , were struck ] i, !i by another car driven by a male individual who identified himself ] I as Fereti John Finau, 1730 Marlesta Road, Pinole, CA 94564-2007 , I! and who was driving a car with license plate number 2DGR954 owned ! by Mira Vista Lincoln Mercury. At the time of the accident, there were no posted traffic signs warning drivers on Christie Road of the deceptive condition ranchetti&Franchetti I and concealed trap which existed on said road and , in particular , ne Market Plaza i teuart Street Tower 1 uite 1210 an Francisco,CA 94105 i .15)777-2200 j -1- i i� at the portion of the road where the accident occurred in that � inter glia , the road was a well-travelled , single lane, hilly ! i road with blind spots; there was significant loose gravel presenti on the road; there were blind curves preventing drivers . from " I seeing on-coming traffic; to were no shoulders on which to pull ii i' off in order to avoid on-coming traffic; and the speed limit on I I the road of miles per hour was unsafe and deceptive given the fcondition of the road. i; At the time of the accident , Christie Road and , in I I' particular , the site of ' the accident constituted a dangerous it condition which was under the control and authority of the Contra Costa County, of which the County had 'notice and the funds to alleviate. Said dangerous condition consisted of , but was not I limited to , the following : The concealed trap described above as i well as the single lane, well-travelled , road consisting of I� curves , hills , trees and shrubs creating blind spots with no i shoulders on which to pull off in the advent of on-coming traffic, i and the presence of significant amounts of gravel on the poorly i ,I I surfaced road and a speed limit of 55 miles per hour . III At the time of the accident , Contra Costa County was responsible for the maintenance of Christie Road and had failed j ito properly maintain said road , and in particular , the site of the accident, notwithstanding it had the funds to do so and notice of the need for maintenance, including but not limited to, I allowing significant amounts of loose gravel to build up on the 'reMarNtPlazahe!!i surface of the road failing to maintain shoulders on which to Me Market Plaza � J Iteuart Street Tower suite 1210 Ian Francisco,CA 94105 415)777-2200 I -2- • I it pull off 'for on-coming traffic on the single land road, failing it to maintain signs warning of the above dangerous condition of thei j road , failing to maintain a safe surface on said road and failing: i to prune shrubs and trees . At the time of the accident , Contra Costa County invited the reliance of travelers on said road, and particularly, the portions of the road on which the accident occurred , by having inter alia ,1 i a 55 miles per hour speed limit on said road , which speed limit ii l was unsafe given the above- described dangerous condition of the i! ki road . i i At all times Contra Costa County was aware of the above-described conditions on Christie Road and knew or should 1 have known and easily could have foreseen that a driver of a car on Christie Road , particularly traveling northbound at the site of the accident, could not safely negotiate said road and portion, thereof given the condition of the road , the 55 mile per hour j speed limit and the lack of warning signs , and that a significants risk created by said dangerous condition, as described in the �! preceding paragraphs, would be a head-on collision, such as that 1 I li which caused the injuries complained of herein . An accident such) as that which occurred herein was foreseeable whether or not both' ( l I s drivers were driving with due care. The foregoing dangerous condition, concealed trap, lack of I maintenance, invited reliance and lack of warning of such condition was a cause of the above-described automobile accident 'ranchetti&Franchetti Inc Market Plaza ii involving Pamella Shaw and her son Jason Shaw. 1 teuart Street Tower uite 1210 an Francisco.CA 94105 115)777-2200 I -3- I � ill I I I it I I I; I 4 . Damages �I The foregoing automobile accident caused Alvin Shaw to suffer) it I; loss of consortium, including but not limited to, the loss of his I I j wife' s love, companionship, comfort, affection, society, solace I IIand/or moral support, loss of his wife' s physical assistance in II the operation and maintenance of the home and lost wages because ii of time missed from work to take care of his wife. Alvin Shaw has suffered financial losses as follows because of this accident: I; 1. Loss of wages I I 2 . Expenses for people to perform the services around �j the home normally done by Pamella Shaw. The total amount of these expenses is unknown at this time. I 5 . Names of Employees (known at this time) i+ a. Dan Pellegrini , Superintendent for County Roads I � b. Scott Edmonds, Road Supervisor for Christie Road ;1111 C. Al King I I , ii 6 . Notice to be sent to : Tiffany Franchetti Franchetti & Franchetti it One Market Plaza Steuart Street Tower Suite 1210 San Francisco, CA 94105 (415) 777-2200 I Dated: November 4, 1987 Franchetti & Franchetti 'ranchetti&Franchetti Tfffa y" ranchetti , Attorneys ineMarket Plaza for Alvin Shaw teuart Street Tower uite 1210 an Francisco,CA 94105 t15)777-2200 I � -4- C /`� CLAIM 9 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT December 8 , 1987 knd Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Unspecified Section 913 and 915.4. Please note all "Warning; unty Counscl CLAIMANT: PAMELLA SHAW NOV 10 1987 c/o Tiffany Franchetti r� ATTORNEY: 1 Market Plaza #1210 Maifinez, CA 94553 San Francisco, CA 94105 Date received November 6 , 1967ADDRESS: BY DELIVERY TO CLERK ON BY MAIL POSTMARKED: November 4, 1987 Certified P 454 095 877 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: November 9 , 1987gtlIL AT%LOR, Clerk : L. Hall II. FROM: County Counsel TO: Clerk of the Board of Supervisors (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. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: �fJy, L,2 Z9& BY: &44� eputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( This Claim is rejected in full. (/ )- Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: DEC 8 1987 PHIL BATCHELOR, Clerk, By uty Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez. California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: -DEC 14 1987 BY: PHIL BATCHELOR byZw__ic��Puty Clerk CC: County Counsel County Administrator i RECEIVED Li I' � jIN THE MATTER OF THE CLAIM OF ) NOV 19B� , PAMELLA SHAW ) M CL CON AR 1 ' l (AGAINST THE COUNTY OF CONTRA COSTA ) I I j f ) IPamella Shaw who resides at 1160 Christie Road (P.O. Box 633) , i; Podeo, California, 94572 , hereby makes this claim against the bounty of Contra Costa and its Board of Supervisors in the sum of $1 ,000, 000 . 00 and in support of said claim represents as follows : I I 1 . Date of Wrongful Acts : i On or about August 3 , 1987 . 2 . Place of Wrongful Acts : i Christie Road , in Contra Costa County, approximately 1 . 8-1 .9 'i !miles south of John Muir Parkway, also known as State Highway 4 . i 3 . Nature of Wrongful Acts : j I. ' On or about August 3 , 1987 , at approximately 11 :00 a .m. I IPamella Shaw, while driving her 1979 Honda Civic on Christie Road , and Jason Shaw while riding in said automobile, j approximately 1 .8-1 .9 miles south of State Highway 4 , were struck ',by another car driven by a male individual who identified himself j as Fereti John Finau, 1730 Marlesta Road, Pinole, CA 94564-2007 , j is � ,and who was driving a car with license plate number 2DGR954 owned ii 'by Mira Vista Lincoln Mercury. At the time of the accident, there were no posted traffic i igns warning drivers on Christie Road of the deceptive condition Igggnd concealed trap which existed on said road and , in particular , 'ranchetti&Franchetli Me Market Plaza ;teuart Street Tower suite 1210 .an Francisco.CA 94105 415)777-2200 I - 1 - I i I at the portion of the road where the accident occurred in that nter alia, the road was a well-travelled, single lane, hilly , i oad with blind spots; there was significant loose gravel present i Ion the road; there were blind curves preventing drivers from is seeing on-coming traffic; there were no shoulders on which to I I pull off in order to avoid on-coming traffic; and the speed limit i .on the road of 55 miles per hour was unsafe and deceptive given i !the condition of the road . I At the time of the accident, Christie Road and , in I I particular , the site of the accident constituted a dangerous I condition which was under the control and authority of the Contra Costa County, of which the County had notice and the funds to alleviate. Said dangerous condition consisted of, but was not !limited to, the following : The cancealed trap described above as I� i well as the single lane, well-travelled , road consisting of Curves , hills, trees and shrubs creating blind spots with no I' I shoulders on which to pull off in the advent of on-coming traffic and the presence of significant amounts of gravel on the poorly I! i �urfaced road and a speed limit of 55 miles per hour . At the time of the accident, Contra Costa County was i responsible for the maintenance of Christie Road and had failed i o properly maintain said road , and in particular , the site of he accident, notwithstanding it had the funds to do so and otice of the need for maintenance, including but not limited to , llowing significant amounts of loose gravel to build up on the i I 'ranchetti&Franchetti urface of the road, failing to maintain shoulders on which to Me Market Plaza teuart Street Tower uite 1210 an Francisco,CA 94105 j 415)777-2200 2 - iI - i I pull off for on-coming traffic on the single land road,. failing Ko maintain signs warning of the above dangerous condition of the , goad , failing to maintain a safe surface on said road and failing do prune shurbs and trees. li i At the time of the accident, Contra Costa County invited the reliance of travelers on said road , and particularly, the portion r , of the road on which the accident occurred, by having inter alia , a 55 miles per hour speed limit on said road, which speed limit was unsafe given the above-described dangerous condition of the I road . I i At all times Contra Costa County was aware of the above-described conditions on Christie Road and knew or should have known and easily could have foreseen that a driver of a car i; I, On Christie Road, particularly traveling northbound at the site ii of the accident, could not safely negotiate said road and portion i thereof given the condition of the road , the 55 mile per hour I speed limit and the lack of warning signs, and that a significant i risk created by said dangerous condition, as described in the preceding paragraphs, would be a head-on collision, such as that which caused the injuries complained of herein . An accident such j 9's that which occurred herein was foreseeable whether or not both rivers were driving with due care. The foregoing dangerous condition, concealed trap, lack of maintenance, invited reliance and lack of warning of such ondition was a cause of the above-described automobile accident 'ranchetti&Franchetti Ine Market Plaza i teuartStreet Tower ,nvolving Pamella Shaw and her son Jason Shaw. uite 1210 an Francisco.CA 94105 115)777-2200 3 - t � .i i i j ii 4 . Damages I! The foregoing automobile accident caused Pamella Shaw to i suffer damage to her car in an undetermined amount and injury to her person, including but not limited to , injury to her back and I i nervous system. The accident also caused her to suffer severe emotional distress . '! I 11' i; Pamella Shaw has suffered financial losses as follow because o`f this accident: 1 . Medical costs j �j 2 . Loss of wages I H 3 . Expenses for people to perform the services around i! the home normally done by Pamella Shaw. i 4 . Damage to her automobile and expenses for I replacement transportation. j The total amount of these expenses is unknown at this time as i they are in the process of being estimated and/or are still being I incurred . Prospective injury or damages cannot be estimated at I � I L s time due to claimant ' s unstable condition. 5;. Names of Employees (known at this time) i� ii a . Dan Pellegrini , Superintendent for County Roads I b. Scott Edmonds, Road Supervisor for Christie Road i C. Al King i i I I I I ranchetti&Franchem >ne Market Plaza Steuart Street Tower quite 1210 , pan Francisco.CA 94105 415)777-2200 - 4 - i II. i� I 6. Notice to be sent to: Tiffany Franchetti Franchetti & Franchetti One Market Plaza Steuart Street Tower Suite 1210 San Francisco, CA 94105 (415) 777-2200 i i v. Dated: November 4 , 1987 Franchetti & Franchetti i li Tiffany Franchetti , Attorneys for Pamella Shaw ii I' ii i' i I � i i it ii ii it it i I i 'ranchetti&Franchetti 1ne Market Plaza teuart Street Tower uite 1210 an Francisco,CA 94105 115)777-2200 � I - 5 - APPLICATION TD FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY. CALIFORNIA BOARD ACTION Application to File Late Claim ) NOTICE TO APPLICANT December 8 , 1987 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" belo�Gz unty Couns`! Claimant: PHYLLIS BRUTSCHE NOV 10 1987 c/o Suzanne Q. Maltin, Adams ,. Wenzel & Plank Martinez Attorney: 111 West Street #900 , CA 94,553 San Jose, CA 95113 Address: Amount: $1, 609. 53 By delivery to Clerk on November 6 , 1987 Date Received:November 6, 198 7 By mail, postmarked on no envelope I. FROM: Clerk of the Board of Supervisors 70: County Counsel Attached is a copy of the above noted Application to Fre t Claim. DATED:November 9 , 1987PHIL BATCHELOR, Clerk, By Deputy L. Hall II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6). ( The Board should deny this Application to File Late Claim (Section 911.6). DATED:A,49 /. j 1q?' VICTOR WE.S"l4V, County Counsel, By puty i II. BOARD ORDER By unanimous vote of Supervisors pr6sent (Check one only) ( ) This Application is granted (Section 911.6). OC/) This Application to File Late Claim is denied (Section 911.6). I certify that this is a true and correct copy of tine Board's Order entered in its minutes for this date. DATE: DEC 8 1987 PHIL BATCHELOR, Clerk, By r Deputy WARNING (Gov. Code i911.8) 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 imnediatel . V. FROM: Clerk of the Board T0: 1 County Counsel 2 County A nis ra or 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: UFC 1 199 PHIL BATCHELOR, Clerk, Byi1 • 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 `` l l I ADAMS, WENZEL & PLANK Attorneys at Law RECEIVED 2 A Professional Corporation 111 West St . John Street , Suite 900 1987 3 San Jose, CA 95113 NOV 6 ( 408) 292-7220 PHIL 9ATCHEL0H By 74 K BOARD OF SUPERVISORS NTRA COSTA CO By .. ty 5 Attorneys for Claimant 6 7 8 9 10 In re the Matter of the Claim of ) Government Code §911 .4 11 PHYLLIS SRUTSCHE, ) APPLICATION TO PRESENT 12 Claimant , ) LATE CLAIM 13 V. ) ) 14 THE CONTRA COSTA REDEVELOPMENT ) AGENCY, ) 15 ) Respondent . ) 16 ) 17 TO : THE CONTRA COSTA REDEVELOPMENT AGENCY: 18 1 . Application is hereby made for Leave to Present 19 a Late Claim under Government Code 5911 .4. The incident which is 20 the subject of this Application occurred on July 2, 1987, for 21 which a Claim was not timely presented . For additional 22 circumstances relating to the Cause of Action, reference is made 23 to the proposed Claim which is filed/served herewith, and 24 incorporated herein by reference as though fully set forth. 25 2 . The reason for the delay in presenting this Claim 26 )AMS.WENZEL&PLANK PRO.ESS)ONA.CORAORATION 1 WEST ST.JOHN STREET SUITE 900 AN JOSE CA 95113-1186 1.081 292.7220 1 is the mistake, inadvertence , surprise and excusable neglect of 2 the Claimant, as more particularly set forth in the Declaration 3 of PHYLLIS BRUTSCHE, filed herewith. 4 3 . Respondent THE CONTRA COSTA REDEVELOPMENT AGENCY is 5 not prejudiced by the failure to timely file the Claim, as shown 6 by the Declaration of PHYLLIS BRUTSCHE, filed herewith, and 7 incorporated herein by reference as though fully set forth. 8 Dated : October 23 , 1987 ADAMS, WENZEL & PLANK 910 By SUZAIqNE Q. MALTIN 11 Attorneys for Claimant 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 DAMS.WENZEL&PLANK ..o.Essow. Co.....no. I I WEST ST.JOHN STREET SUITE SOO IAM JOSE CA 9S1I3-1I84 1.09.292-7220 1 ADAMS, WENZEL & PLANK Attorneys , at Law 2 A Professional Corporation 111 West St . John Street , Suite 900 3 San Jose, CA 95113 ( 408) 292-7220 4 5 Attorneys for Claimant 6 7 8 9 10 In re the Matter of the Claim of ) 11 PHYLLIS BRUTSCHE, ) DECLARATION OF CLAIMANT PHYLLIS BRUTSCHE IN 12 Claimant , ) SUPPORT OF APPLICATION TO FILE LATE CLAIM 13 V. ) [Government Code 9911 .41 14 THE CONTRA COSTA REDEVELOPMENT ) AGENCY, ) 15 ) Respondent . ) 16 ) 17 I, PHYLLIS BRUTSCHE, declare: 18 1 . I am the Claimant in the above-referenced 19 proceeding , and I make this Declaration in Support of my 20 Application to file a late Claim pursuant to Government Code 21 9911 .4. 22 2 . On or about July 2 , 1987, I was informed by Jason 23 Lawry Barkley that my'Mercedes Benz automobile had been damaged 24 when a water valve cover struck the underside of my vehicle . Mr . 25 Barkley advised me that my vehicle had sustained considerable 26 )AMS.WENZEL 6 PUNK worts slo w• cow.o w.now WEST ST.JOHN STREET SUITE 900 \N DOSE CA 95113'1184 --081292-)220 1 damage as a result of the impact . He further indicated that the 2 valve cover which caused the damage to my vehicle was marked 3 "CCWD ." . 4 3 . On August 7 , 1987, I filed a Claim with the 5 Contra Costa Water District for the amount of the repairs I was 6 required to have made to my vehicle . A true and correct copy of 7 the Claim I filed, exclusive of exhibits , is attached hereto as 8 Exhibit "A" and incorporated herein by reference as though fully 9 set forth. On August 25, 1987, the Contra Costa Water District 10 forwarded a letter to me which stated that my claim had been 11 received and referred to the Water District ' s Insurance Adjuster . 12 A true and correct copy of that letter is attached hereto as 13 Exhibit "B" and incorporated herein by reference as though fully 14 set forth. 15 4. I had no further communication from the Contra 16 Costa Water District until October 6, 1987, when I received a 17 letter from the George Hills Company, Inc . , which is the 18 insurance adjuster for the Contra Costa Water District . A true 19 and correct copy of the letter is attached hereto as Exhibit "C" 20 and incorporated herein by reference as though fully set forth. 21 The letter sets forth that the Contra Costa Water District ' s 22 investigation had revealed that the District had no 23 responsibility whatsoever for my damages and that my claim was 24 being referred to the general contractor who was doing the road 25 construction at the time the accident occurred . 26 5 . I made every effort and followed the proper AMS.WENZEL&PUNK ROI[SSIOM1ICO.00..iIOH WEST ST,JOHN STREET SUITE 900 N JOSE CA 95113-1 IB4 u061 292-7220 . 1 proceaure to ensure that my Claim was filed timely with the 2 proper governmental agency. Based upon the letter I received 3 from the Water District, I believe that my claim should have been 4 presented to the CONTRA COSTA COUNTY REDEVELOPMENT AGENCY. As 5 set forth above , I did not receive notice of this fact until only 6 recently, and therefore make an application to submit a late 7 claim to the proper COUNTY authority. Due to the fact that 8 Respondent herein received notice of my pending claim by a copy 9 of George Hills Company ' s letter dated October 6, 1987, no 10 prejudice should result to the COUNTY by my presentation of this 11 late Claim. 12 I declare under penalty of perjury that the foregoing 13 is rue and correct and that/this Declaration was executed on 14 i' ,'<�" atifornia . 15 16 17 ---PHYLLIS BRUTSCHE Claimant / 18 19 20 21 22 23 24 25 26 IAM$,WENZEL&PLANK +oresslo.a co wo+.nor. WEST ST,JOHN STREET SUITE 900 IN JOSE CA 95II3-I104 14091 292-12 20 zz y 7- - -- i n FX HIB - 1��x - �a-o 44 Ip t s QR,� fix-/ Lvo Cott,�zry Cost, ?�Jrc�i. dam i - 'w August 25, 1987 Contra Costa Water District 1331 Concord.-Avenue P.O.Box H2O Concord.CA 94524 Ms. Phyllis Brutsche 415/674-8000 104 Santa Clara Drive 4151/439-9169 Danville, California 94526 Directors SUBJECT: AUTO PROPERTY DAMAGE CLAIM Craig Randall Owner - Phyllis Brutsche President BettDriver - Jason Lowry Barkley Vice P. sidentBoatmn D/L - July 2, 1987 Vice President Donald P. Freitas Ronald E.Butter Dear Ms . Brutsche: Daniel L.Pellegrini William"Ed"Seegmiller This letter is to acknowledge receipt of your claim dated General Managcr August 7 , 1987. John S.Gregg,P.E. Assistant General Manager Your claim has been referred to our insurance adjuster, Ms . John E.Devito Julie Aumock, George Hills Company. Executive Director to the Board You should be hearing from Ms. Aumock soon, however, if you have any questions, or need further information regarding this matter you may contact her at: George Hills Company P.O. Box 4096 Walnut Creek, California 94596 ( 415 ) 935-3060 Sincerely, Vickie Behrens Personnel Assistant vmb cc: Julie Aumock H EXHIBIT t 4 ceorge Wilb Comany., Jnc. G7L AMran ce44d ujfter� and Claim000adminiitratoro Established 1954 AAILING ADDRESS: P.O. BOX 4096 WALNUT CREEK, CALIFORNIA 94596 (415) 935-3060 REPLY TO: Walnut Creek October 6 , 1987 OUR FILE: 5-80699-22 Phyllis Brutsche 104 Santa Clara Drive Danville, California 94526 Re: Our Client: Contra Costa Water District Date of Loss : 07-02-87 Dear Ms. Brutsche: Our office represents Contra Costa Water District as their claims adjusters-administrators under their self-insurance program. The claim which you filed with the Water District was referred to our office for handling. My investigation has revealed the damage done to your vehicle occurred during road construction and the valve can cover which caused the damage had been put in place by a subcontractor, who was working for Gallagher & Burke, Inc. the general contractors for the construction project. The project is under the auspices of the Contra Costa County Redevelopment Agency. Since Contra Costa Water District was not working in the area at the time of your loss and had no responsibility whatsoever in the placement of the valve can cover, it is my opinion the Water District will not be liable for your damages. You may wish to assert your claim against Gallagher & Burke, Inc. , Post Office Box 7227, Oakland, California 94601, to the attention of Jo Lequidlequid. By copy of this letter, I am notifying Gallagher & Burke, Inc. , as well as the Contra Costa County Redevelopment Agency of your pending claim. Si.a erely, GEORGE HILL OMPANY, INC. Julie Aumock, Adjuster JA:bj cc: CCWD, Attn: Vickie Behrens County Public Works , Jerry Raycraft MR I(''f117 id .�5 G E 7TT►��s 9 i) C�� Home Office:OACIgAnty Public Works , Lowell Tunison 9 YJ v 300.27th Street• Oakland, CA 94612 ` tl]iB 777! (415) 465-1313 ranch Offices: HICO: 586-0 Rio Lindo Avenue, Chico, CA 95926................(916) 345-6106 SANTA ROSA:1400 Guerneville Road,Santa Rosa,CA 95406.........(707)576-7599 ACRAMENTO:2011 Arden Way,Sacramento, CA 95825.............(916)927-3171 STOCKTON:4212 N. Pershing Avenue,Stockton,CA 95207...........(209)474-0414 AN FRANCISCO:X05 Th;rd SL'ee!. San Francisco,CA 94107 .14:51 781-1172 VALLEJO: -05 Lassen Street.Vaileio.CA 94591 ...................1707; i 1 ADAMS , WENZEL & PLANK Attorneys at Law 2 A Professional Corporation 111 West St . John Street , Suite 900 3 San Jose, CA 95113 ( 408) 292-7220 4 5 Attorneys for Claimant 6 7 8 9 10 In re the Matter of the Claim of ) ) 11 PHYLLIS BRUTSCHE, ) PROPOSED CLAIM FOR DAMAGES 12 Claimant , ) Government Code §911 .4 13 V . ) 14 THE CONTRA COSTA REDEVELOPMENT ) AGENCY, ) 15 ) Respondent . ) 16 ) 17 TO : THE CONTRA COSTA COUNTY REDEVELOPMENT AGENCY: 18 The undersigned Claimant , PHYLLIS BRUTSCHE, hereby 19 makes claim against the COUNTY OF CONSTRA COSTA REDEVELOPMENT 20 AGENCY in the sum of $1 , 609 . 53, and in support of this claim 21 represents as follows : 22 1 . The damage occurred on July 2 , 1987 AT 11 : 30 a .m. 23 2 . The damage occurred on Northbound Buskirk Road, .150 24 feet south of the Northbound Buskirk Road on ramp to Interstate 25 Highway 680 in an unincorporated area of Contra Costa County, 26 1ANIS.WENZEL&PLANK 00"53FONAL COASORAT104 WEST ST.JOHN STREET SUITE 900 ,N JOSE GA 9S'13-1 184 14081 292-7220 1 California , in the Walnut Creek Judicial District . 2 3 . The damage occurred as follows : Jason Lowry 3 Barkley was driving a 1981 Mercedes Benz automobile owned by 4 Claimant PHYLLIS BRUTSCHE on Buskirk Road, when a truck ahead of 5 the Mercedes ran over and tossed up a metal CONTRA COSTA COUNTY 6 water hole or valve can cover . The cover was thrown into an 7 upright position and began to come toward the Mercedes . Mr . 8 Barkley was unable to avoid the cover due to the traffic 9 conditions . There were road crews , equipment and on-coming 10 traffic such that avoiding the cover without causing a major 11 traffic accident or injury was impossible . The cover bounced 12 underneath the .Mercedes and tore the underside of the front end. 13 A true and correct copy of the Propety Damage Report from the 14 California Highway Patrol regarding the matter is attached hereto 15 as Exhibit "A" and incorporated herein by reference as though 16 fully set forth. 17 4. The incident described above was caused by the 18 dangerous condition which existed at the time the damage occurred 19 to the Mercedes . The CONTRA COSTA COUNTY REDEVELOPMENT AGENCY 20 had road work in progress on the subject road at the time the 21 incident occurred . The incident was caused by the negligence of 22 THE CONTRA COSTA COUNTY REDEVELOPMENT AGENCY, and its 23 contractors , subcontractors , employees , agents and officers . 24 5 . The name of the contractor who was hired by 25 Respondent THE COUNTY OF CONTRA COSTA was Gallagher & Burke, Inc . 26 Said contractor was performing the road repairs under the JAMS.WENZEL&PUNK .110f E45Ox.Y CO MI OR. 10. I WEST ST,JOHN STREET SUITE 900 AN JOSE CA 95113-ItS4 1e09r 292-7220 1 direction of and as an employee and agent of Respondent . 2 6 . The automobile was damaged to the extent that it 3 could not be driven and had to be towed . The damages were as 4 follows : replacement of a bumper, a lower cover panel, a lower 5 radiator grill , an engine lower pan and engine lower gasket , 6 fluids , including oil and transmission fluid, muffler, heat 7 shield, transmission pan, transmission filter . The estimate for 8 the repairs dated July 2, 1987 is attached hereto as Exhibit "B" 9 and is incorporated herein by reference as though fully set forth. 10 A copy of the invoice indicating that the repairs were performed 11 and paid for in full , dated July 31 , 1987, is attached hereto as 12 Exhibit "C" and incorporated herein by reference . The repairs 13 were at a cost of $1 , 609 . 53 . 14 7 . Exhibits "B" and "C" hereto indicate how the 15 amount of damages claimed herein was computed . 16 8. Claimant is unaware of the names of any witnesses 17 to the incident . 18 9 . Claimant has expended the sum of $1 , 609 . 53 to 19 repair the vehicle . Said charge was incurred on or about July 20 31 , 1987 . 21 10 . Any and all notices regarding this claim should be 22 sent to the attorneys for Claimant , Suzanne Q. Maltin, ADAMS, 23 WENZEL & PLANK, 111 West St . John Street , Suite 900, San Jose, C 24 95113 , ( 408) 292-7220 . 25 26 JAMS.WENZEL6 PLANK .RO.ES sio M. CaVOR.iiO I WEST ST.JOHN STREET SUITE 900 AN JOSE CA 95113-I194 IAOSF 292-7220 1 11 . Claimant ' s address is 104 Santa Clara Drive, 2 Danville, Ca 94526 . 3 Respectfully submitted, 4 Dated : October 23 , 1987 ADAMS, WENZEL & PLANK 5 SY SUZAONE Q. MALTIN 7 Attorneys for Claimant 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 DAMS.WENZEL&PLANK RRO.[S]�O xAI CORVOn/.�iON I WEST ST,JOHN STREET SUITE 800 AM JOSE CA 95t13-1184 �A091 292-7220 {TwTa eewMw TRAFFIC COI~LISION REPORT—Prop Damage Only 1rigimi to officer;copy(iee) to inuoiued party0es) ]re CIAL CON OITION] M S w CITT 1 1UOICIAL DISTRICT MUM.6. •^ ! COUNTY ` ^ Ra.ORTINO DISTRICT �+\[^T^ R[ropTINO OIr MN 1L.•t�+:Zf �£1 i..'r i.LSA ` i^. C7'1� 4 i } `l-CSJ .� � � r C-� COLLIOLOp OCCYRRROOM: } MO. OAT VRA. TIM{ S.O] NCIC a ~Or RICER 1.0. le { � _ DAT or REIN TOW .ww♦ .Tw TE MWT w[LATCD re-!'AT INTCw.6CTIGM IT. r V ` r; �— �. Y ❑-v[{ ❑Ne ❑T[] b"O l MAMC PIR{T.MIOOL[. LAST) MON[ MUYw[w .N TCM ►ARTY O ewlv[w woowl aS clrY ZIP coot } I U �i I ,i` i{�Y1_ �l� — 1 o r) I �-i,ti G `/ re O. O.IVAR ]LICKNil/.[1 MUMS STAIN [Iw TND.Tp {[x INOICAT[ ❑ �I l�i,1 �L ! O I . I I -Z ` /1)ty. or, NORTH •NO VeM VIN TR MANE/MODEL LIC[NSe NUM[pp STAT[ VN..TYw[ ❑ S?) l'!n r4 a 1 15/,,!<- 9 I ncTc. COLOR DI"IECTIo. oN/ACRE STR[[T pylAr&*WAV SrSao LIMIT ❑ ' Tw AVeL r� l.�t, f iC L, orN6A V..,CLE 0.Y... I R6Moveo To ►AgYY M.Y. IIR S"YIDOL(,lAfT •NOMI NUY[eD S 0RI16. .DOw[S. CITY Slr COD[ N.RRATIVIIYISCILLANIDYS rl O• Dw1V[w S LIC[MSL MUM66w STATSp$RTNOAT[ .ex ❑ I 'Move. VIN Yp MANp/MOD[L LIC[M S[ NYMpew {TATA V.M.TYrI - ❑ •ICTL- COLOR01nac LON Oi 0 N/ACRO{1 .TR[[T OR NIONWwVi {r[(O LIMIT ❑ lyi� VL--7ri�t`� �J�✓��l� OTM[R V[HICL[OAYAO[ R[YOVIO TO C3 U p AD[ .[x NAM[ ADORES MORE NYMp611 PANT' NO. Z ` AOI l[x NAMI AOORESS - PNONe NYMpew PANTY MO. F C PROP. NwMD ..owls] IAM.D[D rwo-wwr' owN 6w H./'�•r1_�1 1. x.5 T•7� l t'l l t � I YI F 7 5001 Biun R-ad AJItA?7ii41C7, CA 915"" IMPORTANT — READ CAREFULLY Keep this report. This is your record of this accident. To comply with California Vehicle Code (VC) Section 20002 (duty where property damaged), you must either: a. Give the owner or person in charge of such property the name and address of the driver and owner of the vehicle; or in the absence of the owner, b. Leave a written notice in a conspicuous place on the other vehicle or damaged property, giving the name and address of the driver and owner of the vehicle involved and a statement of the circumstances. This information is necessary for the completion of your state SR-1 Form, Report of Traffic Accident, and your insurance report. VEHICLE CODE SECTION 16000 The driver of a vehicle involved in an accident resulting in damage to the property of any ONE party in excess of the amount stated in VC Section 16000 or in the injury or death of any person MUST submit a SR-1 Form to the California Department of Motor Vehicles within 15 days. Note: Failure to comply may result in suspension of your driver's license. Form SR-1 may be obtained from the Department of Motor Vehicles, the California Highway Patrol, any police station, motor vehicle club, or insurance agent. If city or state property is damaged, you will be contacted regarding possible liability. J/ II Cr ...wwwnna���www 85 92847 X. 1 owta o.r/eDu+a+ar (uaa( race wurwaw orneaw 1.0. r1 -w •woa 100 ewv . 1. / </ 3. � ��/. li /�4- �/ iilP �i�ice/ ` / ✓1 �l�l SSS ��GG ! K']�/ �� 4. s. +o r - �- 6. e 7. 8. 9. 10. - 12. ` v 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. �wvw ra wwra �.0. uraaw ro. ew♦ vw. wavu wa w'a rwra ro. owv •w, r J &RINGS & BERTINO BODY SHOk Body 6 Fender Repairing b Painting-24 Hour Tow Spice-Undertealing 1413 Cariback Ave. Phone 935-61170 WALNN�LR CREEK, CALIF. %5% �'7 -NAME �'�""", ' V -L'9 O `�" J r- 1.L1 -!i�•[ 'k- DATE / —�• -�`� ADDRESS PHONE -f ;z'� INSURED BY ADJUSTER PHONE Leber Lanett Labor Labor Lobw Labor Sysnb.i FRONT Parts S S ►las. Ymbel LEFT S Mrs. Parts Symbol RIGHT S Mrs. Parrs �1 Bw•pw Brkt. Fonder, Fn. Forder, Fri. B..P" Gid. Fender Shia Fonda, Shield Fri. System Fandw Mldg. Fenlon Midg. From• Mood lamp I Hoed lamp Cress Member j Hoed lamp Dew Hood lamp Doe Stabiliser 5006J Beam Sealed Boom Wheol Cowl Cowl Hub Cap Windshield Windshield Hub 6 Drum Dow, From j Dow, Front Knuckle Knuckle Sup. Dow Hinge Dow Hinge U. Cont. Arm-Shah Dow Gloss Dow Glass Vent Glass Vent Glass Up. Com. Arm-Shah Dow Mldgs. Dow Midg. Shock i Dow Handle Dow Handle Spring Cotter Post Cotler Post Tie Rod Dew Rear I Dew Roar Stowing Goat I I Dow Gloss i Dow Gloss Steering Wheel Dow Midg. I Dow Midg. Hwn Ring Rocker Parcel I Roc kor Penal Gravel Shield Rocket Midg. Rockw Midg. Park. Light Flow tp Flow Fr]ms `! I Frain• Rad. Grit I. L �%0 A'1<'� r.�' ,4 �I Dog Log .j Quo.. Po Owr. PoAI L/, rr /t n' Qua- Mldg. Ossa.. Midg. Ouw. Glass Ouw. Glass Fandet. Rear j j Fender, Roar ,v mo Plata Feeder Midg. I Fendv, Midg. Horn I F•ndw PS4 Fender Pad Baffle, Side - . w MI SC. Baffle, Lower r . 'I Inst. Panel Ball is, Upper (f B'rpes .� •4f v From Seat Lock Piet., Lr. /e --- I Fnent Seat Adj. I It Lock Plate Up. Gravel Shield I ! Trim w1 n kito V71 Lgwet Pam Me ad lining g Hood Hinge-- r.i L1 Top Hood Mldg. Tr nk Li& Two R Worn j Ornament I Vunk Light I Tube j Rod. Sup. I Trunk Hand is Battery I j Red. S' Q Tail Light I / Pe int A.e:okz�p-s Tail Pipe r Undercoat &I- )-e- _A1 Rod. - - Rad. ,Ly.� ,V� Gas Tank I __ Fan 81od• Fro ms AUTHORIZATION FOR REPAIRS Fon Belt Wheel You are hereby authorized to maks the above Water Pump, Hub d Drum I scecrtied repafvs. Man Mrs. " ! •G As is Signed Clutch Linkage I� Sprrrg GROSS PARTS I i ... ...5 DISCOUNT J NET PARTS �5-1f, • '� t / t ` 6Li. / t - Al 7I SALCS TAX O MAKE L YEAR "Jl STYE I MODE L��qq I,�a>;oaQcy.L' 1 �(J TOTAL LABORG7� JL SERIAL NO. LIC. NO.E "r"-� MILEAGE GRAND TOTAL ., A • Align N - Hew ON - Overhaul S - Stroight.n or again ' /t,�.•-+I.L- .�t_� G1 u(/u Qi _ Mat.niol Subisct to Price Chong. •. p A z O ( P O m N �4 n O N A c D m i r m o c m � r m m v -1 P A A m N N fl r D m A N D z 9 D no onoomod�..l 1�Z T ; v X AX C a3N»Ln�m qW'��.a�ONyff N za i1= o -03-?.r•• o r�000�O Q� !S a .ri`K G,w n. Oi'^yC OCO r " w• z urn°o� "' �.<AtA y On1wq_. rA�,�N .ye0� 90 N � G O � � '�J � � .t.•�.�ry nDp �O `'R` '7C Om no• n r eV` ti q'q.�:om<d^ w•j pO rn 2 O 3,.0 },no nNCo' I 9 DO O N •p CC P A Y C 0 /W1� cs O N D LA 3 z O Z cn o m A ° S . m 0 3� Z = N a zrn m .�1 or O < V fi T 0 O ❑ �a. m V m MM 10n :C3 ➢ 3 a O q trn O O P O M r; r m < D.{ z Kox ;O r ID m-f u�+ AD A V -t t^ z C, } `Kl Co Az O N o ,V E� zr P cl ; CD X ' o m 1 c, f 974116 NORiCK OKLAHOMA CIVY � .+