HomeMy WebLinkAboutMINUTES - 11031987 - 1.18 f CLAIM
BOARD OF SUPERV►SORS OF CONTRA COSTA COUNTY, CALIFORNIA
County, or District governed by) BOARD ACTION
Claim Against the •
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT November 3, 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 bJlvo1d.)jgfMjpursuant to Government Code
c.,
Amnt: Unspecified Section PPM 915.4. Please note all "Warnings".
CLAIMANT: CHARLES N. LUNNIE OCT 02 1987
24 11th Street Martinez, CA 94553
ATTORNEY: Richmond, CA 94801
Date received
ADDRESS: BY DELIVERY TO CLERK ON September 30 , 1987 hand del .
BY MAIL POSTMARKED: no envelope
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim. ( /,
r
DATED: October 2 , 1987 gyIL BeputyLOR, Clerk
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: ('� –— / BY: Deputy County Counsel
l
1I1. 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 Superviscrs present
( �) ThisiClaim is rejected in full.
I
( ) Othe 4:
I cetijtify that this is a true and correct copy of the Board's Order entered in its minutes for
this idate.
I Nov 3 1981
Datei: 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 themailto 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.
NOV 4 1997
Dated: BY: PHIL BATCHELOR by eputy Clerk
CC: County Counsel County Administrator
• CLAIM.TO: BOARD. OF SUPERVISORS OF CONTRA CC**rroWXaPPlication to:
Instructions to ClaimantVerk of the Board
&5/
Martinez.California 94553
A. Claims relating to causes of action for death or for injury to
person or to personal property or growing crops must be presented
not ..later than the 100th day after the accrual of the cause of
action. Claims relating to any other cause of action must be
oresented not later than one year after the accrual of the
action. (Sec. 911.2, Govt. Code)
-B. Claims must be filed with .the Clerk of the Board of Supervisors , -.: ""
-at its office in Room 106, County Administration .Building, 651 .Pine
Street, Martinez , California 94553.
C. If claim is against a district governed by the Board of Supervisors,
rather than .the County, the name of the District should be filled in.
D. If the claim is against more than one public entity, separate claims
must be filed against each public entity. .
E. Fraud. See penalty forlfraudulent claims, Penal Code Sec. 72 at end -
of this form.
ARE: -Cla by _ )Reser g stamps
'
RECEIVED
Against the COUNTY OF CONTRA COSTA). i
Cr DISTRICT) f
(Fill in name))
The undersigned claimant hereby makes claim against the County of Contra
Costa or the above-named District in the sum of $
and in support of this claim represents as follows:
1. When did the damage or injury occur?
Wive exact date ani hour]
�. W�iere did t e .damage or in3ury oc ? (Y clude city and county]
_ T1Q_ _
m ' � d aT s use x ra
How did t11 da age.,nor,-�n3ury oc r? (G fu et i , e ,�
sheets i , equire� ,mit gGeQ� r-
_
4.. Wiat .pard ar act or omission on the part of courCty r district-" '.,,.
officers, servants or employees caused the injury or amage?
(over)
5. What are the names of county or district officers, servants or
employees causing the damage or injury? ..
6. Whit damage'or injuries cdo you claim resulted?--:ZGive-buil extent
of injuries or damages claimed. : Attach two estimates for -auto
damage) .
Ll
7. How ass -e amount claimed above computed? Include the estisaate
amount of any prospective injury or damage. )
----------- ----_ ----4-?Z------= ---- ----
6. '►'_mes and addresses of witnesses, doctors and h9spitalsf
-r----
9. List-tie»-eac�pe�rdtt �"' ou made on-account of this:--acc----ident------or--injury:
g rr '� AMOUNT
I
Govt. Code Sec. 910.2 provides:
"The claim signed by the claimant
SEND NOTICES TO: (Attorney) or by someN person on his behalf."
. Name and Address of Attorney /
Cl imant s S gnature
Sf
•
Zddress
Telephone, No. Telephone No.
NOTICE
Section 72 of the Penal Code provides:
"Every person who, with intent to defraud, presents for alltwance or
for payment to .any state board or officer, or to any county, town, '-city
district, ward br village board or officer, authorized .to allow ,orpay
the same if genuine, any false or fraudulent claim, -bill, account, - voucher,
or writing, is guilty of a ftftny. " .
CLAIM /j,
,i
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 November 3 ' 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: $15 , 000 . 00 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT:.
DARLENE MOLINA C.ounty Counsel
c/o Paul M. Curry �2 tigg7
ATTORNEY': Attorney at Law OCT
1401 Lakeside Dr. #700
ADDRESS: Oakland, CA 94612 M�Y D LLIVERRYY�TO CLERK ON September 30 , 1987
BY MAIL POSTMARKED: September 29 , 1987
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim. pH -
DATED: October 2 , 1987 BY1L BATCHELOR, Clerk
eputy
L. Hall
II. 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: 0426 2= /g Lam— BY: y County Counsel
III. FROM: Clerk of the Board / TO: County Counsel (1) County Administrator (2)
I
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER:! By unanimous vote of the Supervisors present
(V This (Claim is rejected in full .
( ) Other:
I
I ceritify that this is a true and correct copy of the Board's Order entered in its minutes for
this 'date.
NOV 3 1981.
Dated: PHIL BATCHELOR, Clerk, By Deputy Clerk
I
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.
i
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.
NOv4 1987 Y/
Dated: BY: PHIL BATCHELOR by Deputy Clerk
CC: County Counsel County Administrator
i
i
CLAIM TO: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
Instructions to Claimant
A. Claims relating to causes of action for death or for injury to
person or to personal property or growing crops must be presented
not later than the 100th day after the accrual of the cause of .
action. Claims relating to any other cause of action must be
presented not later than one year after the accrual of the cause
of action. (Sec. 911. 2 , Govt. Code)
B. Claims must be filed with the Clerk of the Board of Supervisors
at its office in Room 106, County Administration Building, 651 Pine
Street, Martinez , CA 94553 (.or mail to P.O. Box 911, Martinez, CA) .
C. If claim is against a district governed by the Board of Supervisors,
rather than the County, the name of the District should be filled in.
D. If the claim is against more than one public entity, separate claims
must be filed against each public entity.
E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at end
of this form.
************************************************************* **********
RE: Claim by ) Reser c s iling stamps
.._i Ztur -�CA, ��.t'y c L✓ j CEDED
RE
1967
Against the COUNTY OF CONTRA COSTA) CT
or DISTRICT) est � C
ER � C
(Fill in name) )
sr
The undersigned claimant hereby makes claim against the,7C unt of Contra
Costa or the above-named District in the sum of $ J c� 2, YO
and in support of this claim represents as follows:
------------------------------------------------------------------------
1. When did the damage or injury occur? (Give exact date and hour)
--- - S - �- -�.---- --- s ---------------------
2. Wher�did the damage or in3ury occur? (Includ city and county)
--------------- ------------------�xtr How did the damage or i 3ury occur? (G N full details , use extra
sheets if required)
c �(' cl v bet e keel i n -1-o o a r veA) E
- -- ------------------------------------------
4-.--Wh-at---particular-----------act----or---o--mission on the part of county or district
officers, servants or employees caused the injury or damage?
(over)
5,. What; are the names of county or district officers, . servants or
employees causing the damage or injury?
&C Y-L Y-k (?-f 4- G).e a-YX
----------in--ur------- ---------------------------
6 . What damage or jies do you claim resulted? (Give full extent
of injuries or damages claimed. Attach two estimates for auto
damage)
7 ( rnaf�� �!tt CdOe. C/ '
------------ -----------------------------------------------------------
7. How was t e amount claimed above computed? (Include the estimated
amount of any prospective injury or damage. )
-------------------------------------------------------------------------
8. Names and addresses of witnesses, doctors and hospitals.
s Ir
---------------------------------------------------------------------ury:
9. List the expenditures you made on account of this accident or injury:
ITEM AMOUNT
Govt. Code Sec. 910. 2 provides :
-� •� ,� "The claim signed by the claimant
SEND NOTICES TO: (Attor ) or b some person on his behalf. "
Name and Address of Attorney 'vw
Sign ur_Claimant' s
Address
Telephone No. Telephone No. 3 0:27V y V
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. "
SR 1(REV.10/78)(R-1408a) LLJIO�. Uurl-r,r •It DEPARTMENT SE ONLY
Pages 3 and 4 are not required by law but. , your insurance company and K lkf 6 6or.. ..P ES �a�'
® California Casualty
. . _ -
1-. j.
DATE OF ACCIDENT HOUR
TIME 5+ 61
19 8 7 [3 A.M. P.M.
O ATION F ACCIDENT (STREET OR HIGHWAY) CITY COUNTYpp
PLACELD0JALh :--N.-IER
aKW LNUMBER VEHICLES IN ACCIDENT PERSONS INJURED NUMBER PERSONS KILLED
-t-u�o CZ n o\A e, I ✓tiov►e,
YOUR VEHICLEOTHER VEHICLE
Stopped Legally ther I — Q-ADV Stopped Legally Other w
El in Traffic ❑ Moving El Parked (Explain) ❑ in Traffic ❑ A4oving ❑ Parked ❑ (Explain) 10 Q 011
DRI'ER S NAME(FIRST.MIDDLE LAST) DRIVERS NAME(FIRST.MIDDLE.LAST;
5nprow D P o.
DRIVERS ADDRESS(NUMBER AND LST EET) D IVER S ADDRESS"I ER AND STREET)
Oh etas. f-
CITV�`V`��o STATE ZIP CODE CIT � STATE ZAP CGDE
ZbJDRIVER'S LICENSE (NUMBER AND STATE, ` DoE iZYIRAH DRIV 'S LICEN E(NUMBER. AND STATE) DATE
OF HIIEAR,
T)C)
Wlc0 1 - S 3
OWNER OF VEHICLE YOU WERE DRIVING(FIRST.MIDDLE.L °T) OWNS OF OTHER VEHICLE(FIRST.MI LE.LAST)
• I Co eVt r v`o W �v h S -
ADDRESS BERAND STR �T) /C k \rC l L AD7 K NUMBER AND 9�REE
CITY . STATE ZIP CODE CITY STATE ZIP CODE
t)CIVL.0 M_e C14 a/ S t.
OWNER'S DRIVERS LICENSE (NUMBCR AND STATE) DATE OF BIRTH OWNER'S DRIVERS LICENSE (NUMBER AND STATE) DATE OF BIRTH
/� IMO. V, YEAR) (MO. DAY. YEAR)
(o o ( — (f 14 - to ZZ Z6
VE ICLE YOU WERE DRIVING!YEAR AND MA Ei BOD TYPE OTHER VEHICLE (YEAR ANG MAM,E BODY TYPE
1aFr Voxcv cm - � 4.. GI. q Dw. SPdaK v '- A . / ..
VEHICLE LICENSE ENGINE OR I.D.NUMBER VEHICLE LICENSE ENGINE OR I G.NUN'BER
(NUMBER NSTATE) INU
,, rERAND ST
� t� VO I� O14,7� �)V-19
ESTIMATED COST TO REPAIR D2!UO YOUR VEHICLE ESTIV:TED COST TO REPAIR DAMAGE TO OTHER VEHICLE
JWere You Driving A Vehicle Owned. Operated or �.,./ Was Other Driver Driving a Vehicle Owned.Operated
Leased by Your Employer and With His Permission? ❑ Yes ltd No or Leased by His Employer and With His Permission X Yes ❑ No
EMPLOYER'S NAME EP+ADLOYER S NAME
If Yes If Yes
EMPLOYER'S ADDRESS EMDLOYER S ADDRESS
NAME OF OBJECT(5) OWNER S NAME AND ADDRESS
DAMAGE V�I yloo — M, 6 ew P!r
TO OTHER NATURE OF DAMAGES Q(� tALK ESTIMATED COST TO REPAIR DAMAGE
PROPERTY �O S
NAME AGE
❑ Driver ❑ In Your Vehicle
❑ Passenger Q In Other Vehicle ❑ Pedestrian
N ADDRESS RELATIONSHIP 70 DRIVER DESCRIBE INJURIES
J (DAUGHTER ETC/
R NAME AGE QDriver Q In Your Vehicle
E FO Passenger Q In Other Vehicle ❑ Pedestrian
D I ADDRESS RELATIONSHIP 70 DRIVER DESCRIBE INJURIES
(DAUGHTER.ETC.)
Was a policy of LIABILITY insurance,covering the vehicle you were dri,:.-1g DEPARTMENT USE ONLY
in effect at time of accident? 'vees ❑ No
IF YES GIVE t HERS
CcsoJN POLICY NUMBER
\m is, GU'g 6
I CERTIFY UNDER PENALTY OF PERJURY THAT E ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE.
SIGNED AT(CITY) nn DATE I• A� ��/-'I ` 7' IF7 ,SIGN
(�y�V� .� HERE
r
LIGHT CONDITIONS WEATHER TYPEOF ROADDESIGN POSTED SPEED PAGE a
CHECK ONE' 'CHECK ONE, (CHECK ONE, LIMIT '7
YOUR POLICY NO.: � f0 f / I
AYI-IrGnT CLEAR 1 ONE-WAY
WHAT POLICE DEPT.INVESTIGATED ..Y
2 "1.1 � RAINING TWO-WA- SPEED BEFORE I
INTERCHaNGE ACCIDENT IF ANYONE GIVEN A CITATION,TO WHOM
7 DUSK J SNOWING 3 ,LOOP; ,.aaaeP; DRIVER n
STREET LIGHTED 4 F 4 iROLLECEEWA�'C ESS' S�4-u�Lp M.
CaRK^iE55 OG ,,,wt .f '/�
: STREET NG' LIGHTED I z OTHER PERSONS INSURED BY Q( Vtsa Y ��
11 C:"KNE.. :DOTHER 5 OTHER
TRAFFIC CONTROL ROAD CHARACTER NUMBER OF LANES ROAD SURFACE ..—_
CHECK ONE :CHECK ONE: (CHECK TWO. (CHECK ONE(
- DRIVER NO.1 18 YOU.(CHECK tit COLUMN FOR YOURSELF)1 STOP SIGN t STRAIGHT ROAD 1 I LANE _ _ IRI I
_TOR DRIVER CHE:.K ONE FOR DRIVER CHECK ONE FCR DRIVERCHECK ONE FOR
SIG;JAS 2 CURVE TO RIGHT 2LANES 2 •;:ET x1 ■2 EACs-rQIVER ,1 e2 EACH DRIVER 41 e2 EACH DRIVER
7 OFFICEP -? J 7 7 1 ❑GrC.._'„GD STRAIGHT ❑ S 71URAK N I N GU 9❑TRAFFICGaNE
Ali':Ati CUPVE TO :EFT ArTcS cn;;;WY'
e R R GA:ES r - :•NES i ❑2❑OVERTAKING � 6❑ SLOWING ❑10�STAR PING Fkc):•
LINcl;J DED ICY AND ASSING DOWN PARKED
OR SIGNAL LE.E_
5 OTHER 2 ON GRACE 5 DIV;DED) 5 OTHER 3❑T�JRN C RIGHT ❑ 7 11 TRAFFIC STOPPED FOR ❑11 0 PARKED
NC -?AFFIC MORE -HAN I7�[y�(.MAKING LEF STOPPED FOR
C3'.-,ROL 3 HI:LI'.REST E : LANES •L]I TURN 8 SIGNALS OR SIGNS 12 BACKING UP
WHAT PEDESTRIAN WAS DOING AT INTERSECTION INOT AT INTERSECTION
PEDESTRIAN WAS GOING (.STREET NAME OR HIGP-:.'AY NUMBER) 1E] ❑WITH SIGNAL 5 PARKED VECOMING FROM �-n,NO WALKING IN ROADWAY
HICLE' 9 C3 (AGAINST TRAFFICi
`S W _+^NG CROSSING NOT AT INTER- STANDING OR WORKI`jG
INE CORNER TO SE CORNER OR wESTSIDE TO EASTSICE 2 O AGAINST SIGNAL (i❑ iECTIO-N INO CROSSWALK. TU IN ROADWAY
;,ROSSIrJG NGT ATINTER- PUSHING OR WORK.:^:
OP (STREE'NAME OR...G•+wA•NO':
F
D 3 .140 SIGNAL TO SECTION -IN CROSSWAL'•.'• 11 ON VEHICLE
0 'NALKt,NG IN ROADWAY PLAYING IN
CRCSSIN
C DIAGONALLY 9 TWIT-! ?qAF=IC) 12 � gEIA OV:Av
For the Dr O:ect,or�t yo,; rnzeresI,,,damages anC:Or injuries arising Out of(his accident..1 Is,mporiant that you turnlsn lull details to the Department OI Motor Vehicles as to nature and extent
thereof For this cu:Dose Forms SR-33 and SR-5 are ava.la Dle at I.elo offices C!the Department
j�/�{�
(�(�,R�O Show on the diagram the positions of all vehicles,persons,stop lights.stop
Describe_accident in detai: ` NF signs,and other objects.Also show street names.Attach separate diagram
N� p�± CA •�- (,li�'t/ if necessary.
_ __ •. __ _ _
V,4”--_____`ti..W_`ieU _ __ _ _ __ D My Vehicle
•- - - -J' --� - - -- D Other Vehicle W+E
,�//�� V ..� �/ / `•"�\ v -1 - ���/"�, p4,Q_+�� VV D Third Vehitle S
Pecintrim
Stop SWO
Stop Light
ame s► and A ress(es of Wi ess s
�x¢-----
--------- - �- 4� _--------------------------------..
0 � 4
------------------------------------------
-----
Who you conside�resp�for accident and describe in detail why?
Irl� I� r
-- - =- - - - -- - ---- -- ------ moo-- - - /
Do you i tend to ti e a claim against anyone involved in this accident to recover damages? *'YES ❑ NO V
If answer is yes,please give names and addresses of pe ns against whom you would file such a claim..
1.�
------------ _-- _ --- --- -------- --------------------------
� SIGNATURE �
TRAFFIC COLLISION'REPORT � � PAG[ Z Of
SI/E/C��I/K/�\CONDREO\A^;y 1 T N FA NIT 1 RUN C/ITVAJDICIAL DISTRICT NLy/(q
I JI V i�l� 1 INJ D FEI�v ✓1�' /�V` �r'
NVMRER NIT►D.RUN CO BrOgTWG DISTRICT T
' C:.USI OCC RED(IM YQ. DA.JI� T1H (ypori I K�
o -----------------------------------------------------------
YIL(POSTINFORMATON DAT OF-[ K TO-AW�A/T. PHOTOGRAPHS B.:
< S M T W�F S O.n II tNo 1 Y (/l
U ����iL11l1i 116..•444 L�� .r
O AT INTERSECTION WITH �/ /(/ /� STATE HOYL
L �1�. Q
D- �� / • �\ I EU C� L�i�� C3 TES NO L 1 ! ❑NON[
PARTY S RICE SE NUMBER B1ATF CU S SAF Tti V V YAKS I40 COLOR UCFNSE NUMBER Ti
L� �L�-!l E fI (� l�� I ,
°Rlv(R RRS• IDOL E.LAS
PTN.AN
EDES ST ([T ADORES 1/ /��,///� OWNER'S NAME LAME AS DRIVER
11 L
PARKED R %IAN
STATE%SI► / OWNER ADDRESS C AS DRIVER
VE
O E
BIC T S AIR V rE5 HEIGHT WEIGHT •ATHDATE PACE DISPO ITION OF VEHICLE ORDERS OF: OFRCfR DRVFR OTHER
gin e
OTHER ►HO BUSINF SS PHONE POR 4[CNANICAL DEFECTS: NONE APPARENT Q REFER TO NARRATIVE
❑ / �i / �G'•� c ) �v`�� RICHP US[ONLY DESCRIBE VEwCLE DAMAGE SHADE IN DAMAGED AREA
�j, AL:L CEA/gRI I /F(�OLIC. UM/B�.A� VEHICLE TYPE
TOTAL Moc. MAJOR 13 ID El
DIR jM;4;j;GH`WAYL.� `/r �i/ /l/ SPE F ICC ❑ '
EL K� �iJE
CHP ❑
PARTY DRiJLS LQS I(uM�� IS,-
PEDES.
E Ct�S F V .vR. MAKE/YOLCL//COLOR
� UC (5[ UMBFq �SlA7E r
2 CTI( ��v
DRIVER E(FlRST.MiCDLE.LA ��. J'
�nlnl C�'dr1 1s�J F,►.r� Jct �-j�-�L nd �
R,.NSTREET ADDRESSE�NA-1
vEMI-E CITY:S T( IP OwHL.95 ADDRE 55 n J)S u+C AS/OF��'E R/! /
B:CT 5 A nA:R `S WE,:.rT B:Rin^11 PACE OSP-':ION OF VEnrCI Jh JR^CRS DF: OFFICER Dj;ORv[q [3 OTHER
L
M LIST
OTHER MOM PHOHE
( PRMNI
IOR ECHACAL DE CE CTS: NONE APPARENT gEFFR TO NARRATIVE
C3c 4).1 AJ 4L � - 2�U
CHP USE Oh:• DESCRIBE vErVC LE CAMAGE SruLDC W DAMAGED AREA
SJR ANCE CAR R.ER ; POLICY NUMBER VEr1CLE TYPE
r p t11( p NONE MINOR
II✓,1 ' �� T� OM°° ❑MAJOR pTOTLL
pRv TRF ET ORV V�IAL.I. SPI rl �aaIc.� A1C,,
PARTY DRIVERS UCENSE NUMBER STATE C.ASS SAFETY VEH.YR MARE rMODEL,COLOR LICENSE NUMBER STATE
EQUIP.
I
3
. . . . . . . . . .
ORNER NAME(FIRST.MIDDLE.LAST
PEDES STREET ADDRESS OWNER S NAME ❑SAME AS DRIVER
TTI AN
PARKED GTT.STATE.ZIP DWlEq 5 ADDRESS D SAVE AS DR.:ER j
VEHICLE
/ICY. S[i NAIR EYSS -EIGHT WEIGHT BIR TnDATE RACE DISPOSITION OF VEHICLE ON ORDERS OF. OFFICER ❑DRIVER ❑OTHER
C LIST MO. DAY YEAR
❑
OTHER HOME PHONE BUSINESS P.•ONE PRIOR MECHANICAL Df FTCTS: NON(APPARENT p REFER TO NARRATIVE ❑
❑ ( ) _ ( ) CHPUSE ONLY DESCRIBE Vf•IICL[DAMAGE SHADE W DAMAGED AREA
04SURANCE CARRIER POLICY NUMBER VE,CLE TYPE
p 11K Q NONE []MINOR
QMOO. Q MAJOR TOTAL
DIR OP ON STREET OR"IG—Al SPEED PCs ICC ❑ '
TRAVEL LIMIT PUC ❑
CHPJ ❑
PRE RERS E I RE VI rw ER 5 RAMI DATE RIE VIE WED R
J
CHP 555-Page 1 (Rev. 7.87) OPI 042
ry vVE.-a-rvrVr• VV(✓n v - JL PAGE -1=71
All
pE[O.
" 'OWNER'$NAM[:ADDRESS
NOTRED
PROPERTY E j— 1:3ND
DAMAGE DESCRPTON OF DAMAGE
U�j 15L
SEATING POSITION OCCUPANTS SAFETY EQUIPMENT M I C BICYCLE•HELMET EJECTED FROM VEH.
I•DRIVER A-NONE IN VEHICLE L•AIR BAG DEPLOYED 0=NOT EJECTED
2 70 6•PASSENGERS B•UNKN'�WN M-AIR BAG NOT DEPLOYED DRIVER t•FULLY EJECTED
7•STA.WON.REAR C•LAP bFLT USED N•07HEA V•NO
2•PARTIALLY EJECTED
/•RFL OCC.IRK_OR VAN D•UIP BELT NOT USEC P-NOT REOUIRED W-YES
3-UNKNOWN
/•POSITION UNKNOWN E•SHOULDER HARNESS USED
I 2 3 0.OTHER F-SHOULDER HARNESS NOT USED CHLD RESTRAINI PASSENGER
4 5 6 G•LAP I SHOULDER HARNESS USED 0•IN VEHICLE USED X•NO
H•LAP:SHOULDER HARNESS NOT USED R•IN VEHICLE NOT USED Y•YES
7 J-PASSVE RES?RWNT USED S•IN VEHICLE USE UNKNOWN
K-PASSIVE RE57RAINT NOT USED T-IN VEHICLE IMPROPER USE
U-NONE IN VEHICLE
ITEMS MARKED BELOW WHICH ARE FOLLOWED BY AN ASTERISK(•I SHOULD BE EXPLAINED IN THE NARRATIVE
PRIMARY COLLISION FACTOR TRAFFIC CONTROL DEVICESTYPE OF VEHICLE 1 2 ,3 MOVEMENT PROCEDING
LIVT NUMBER([)OF PARTY AT FAULT 3
AvC S 'TI N U D � DEi A CONTROLS FUNCTIONING A PASSENGER CAR STA WON. COLLISION
��1 No B CONTROLS NOT FUNC?IONING- B PASSENGER CAR W!TRAILER A STOPPED
• B OTHER IMPROPER DRIVING• C CONTROLS OBSCURED C MOTORCYCLE l SCOOTER B PROCEEDING STRAIGHT
NO CONT VOLS PRESLHT(FACTOR' Er
OR PANEL TRUCK C RAN OFF ROAD
C OTHER THAN DRIVER' TYPE OF COLLISION PANEL TRK W/TLR D MAKING RIGHT TURN
D UNKNOWN- A HEAD-UN R TRUCK TRACTOR E MAKING LEFT TURN
E FELL ASLEEP' B SIDESWIPE K TRACIua W/TLR. F MAKING U TURN
C REAR END I-::.CHOOL BUS G BACKING
WEA7HER(MARK I TO2ITEMS 1 OQ.D BROADSIDE I OTHER BUS H SLOWING I STOPPING
CLEAR E HT OBJECT J EMERGENCY VEHCLE I PASSING OTHER VEHICLE
B CLOUDY F OVERTURNED K HWY.CONST.EOUIPMENT J CHANGING LANES
C RAINING G VEHICLE/PEDE57RIAN L BICYCLE K PARKING MANUEVER
D SNOWING H OTHER': MOTHER VEHICLE I L ENTERING TRAFFIC
E FOG!VISIBILITY F•7. MOTOR VEHICLE INVO�VED WITH N PEDESTRIAN M OTHER UNSAFE TURNING
F OTHER': A NON-COLLISION 0 MOPED N)ING INTO OPPOSING LANE
G WIND B PEDESTR.AN 0PARKED
LIGHTING C OTHER MOTOR VEHICLE P MERGING
DAYLIGHT D MOTOR VER.ON OTHER ROADWAY OTHER ASSOCIATED FACTOR Q TRAVELING WRONG WAY
B DUSK•DAWN E PARKED MOTOR VEHICLE (MARK t TO 2 ITEMS) R OTHER:•
C DARK•STREET UGHTS F TRAIN A vC S[Cn-�VIOLATION: CITED
D DARK•NO STREET UGHTS G BICYCLE NO❑No
E DARK• STREET LIGHTS NOT H ANIMAL: vc i[cna.v AT c1T>c
FUNCTIONING' S/, LU� �ts
U SOBRIETY•DRUi;
ROAD WAY SURFACE I FIXED OBJECT: PHYSICAL
I A DRY C VC S[cnoN VIO�AT)". CITEc
�vts (MARK t T021TEiT51
B WET J OTHER OBJECT: 0" A HAD NOT BEEN DRINKING
C SNOWY-ICY D
D SLIPPERY(MUDDY,OILY,ETC.1 E VISION OBSCUREMENT: B HBD UNDER INFLUENCE
F INATTENTION• C HBD-NOT UNDER INF LU.
ROADWAY CONDITIONS G STOP L GO I'AFFl:- D HBD-IMPAIRMENT UNK.•
1 MARK t TO 2 ITEMS) PEDESTRIANS ACTION E UNDER DRUG INFLU.•
H ENTERING/LEAVING RAMP
NO PEDESTRIAN INVOLVE C' F IMPAIRMENT•PHYSICAL'
A HOLES.DEEP RUTS G IMPAIRMENT NOT KNOWN
1 PRE NOUS COLLISIONB CROSSING IN CROSSWALK J UNFAMILIAR WITH ROAD I
B LOOSE MATERIAL ON RDWY.• AT INTERSECTIONCITED H HOT APPLICABLE
I(DEFECTIVE VEFL EOUIP.:
C OBSTRUCTION ON ROADWAY. C CROSSING IN CROSSWALK•NOT ^YES I 1 SLEEPY/FATIGUED
D CONSTRUCTION-REPA!R ZONE AT INTERSECTION ❑"'�' SPECIAL INFORMATION
E REDUCED ROADWAY WIDTH D CROSSING•NOT IN CROSSWALK L UNINVOLVED VEHICLE j A HAZARDOUS MATERIAL
I
F FLOODED' E IN ROAD•INCLUDES SHOULDER M OTHER':
G OTHER•: IF NOT IN ROAD INNONE APPARENT
NO UNUSUAL CONDITICMS G APP OACH/L4AVING SCHOOL BUS 0 RUNAWAY VEHICLE
SKETCH i YSCEL-✓+EDUS
1 '
i w�
V"� NOR�N
1,
A
J�
CHP 555 - Page 2 ( Rev 7 -67 )OPI 042
RATE OFAALIFORNA r
INJU14EDJ/ WITNESSES / PASS' aERS./J PAG
L.L. LI/ / \LLl nMl � NCIt�'17 Ii1 OF E NUMBER M
(�J U
EXTENT OF INJURY ( "X" ONE INJURED WAS ( "X" ONE )
M'ITNESS PASSENGER PARTY BEAT SAFETY
ONLY ONLY AGE SEX FATALSEVERE OTHER VISIBLE COMPLAINT NUMBER bS. EOUI►. EJECTED
NJURY INJURY INJURY OF PAIN DRIVER PASS. IED. BICYCLIST OTHER
tt ❑ ❑ ❑ 13 13 ❑ ❑ ❑ ❑ ID
NAME%D.O.I.I ADD!� / I .J�1 ,d_�}I 134' �7 —, TELEPHONE
(INJURED ONLY)TRANSPORTED BY.J TARE U / L'.�7
DESCRIBE INJURIES W, Ll
VICTIM OF VIOLENT CRIME NOTIFIED
❑ 3 1 ❑ ❑ ❑ ❑ o ❑ o
NAME r D.D.S.I ADDRESS /j './ - ` ' TELEPHONE
(INJURED ONLY)TRANSPORTED BY: /,� �
DESCRIBE INJURIES
2c ILI
VICTIM OF VIOLENT CRIME NOTIFIED
Dot 1 0- 1 1 ❑ Q ❑ ❑ I ❑ ID D D ❑
NAME:D.O.B./ADDRESS TELEPHONE
ONJURED ONLY)TRANSPORTED BY:
DESCRIBE INJURIES
I
VICTIM OF VIOLENT CRIME NOTIFIED
❑" ❑ ❑ ❑ ❑ ❑ D ❑ D ❑ Jill
NAME'D O.B I ALCRES% TEA--INE
ONJVREO ONLY)TRANSPORTED BY: IAnEN TO.
DES:RISE INJURIES
I
VICTIM OF VIOLENT CRIME NOTIFIED
❑7 ❑ ❑ ❑ ❑ ❑ ❑ ❑ I0 ❑ I Q j Ii
NAME C O B ADDRESS TELEPHONE
(INJURED ONLY)TRAN5PORTED BY: 7A EN TO
i
DESCRIBE INJURIES
I
VICTIM OF VIOLENT CRIME NOTIFIEL I
❑# ❑ ❑ ID ❑ ❑ ❑ D ❑ ❑ ❑
NAME•D.O.B.1 ADDRESS TELEPHONE
I
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
DESCRIBE INJURIES .-
ElVICTIM OF VIOLENT CRIME NOTIFIED
IRE►A NAME ( p.WE
l w0� MBAR REVIE wERS E .+ MO. _ DAY YEA
U 'l
CHP 555-Page 3 (Rev. 7.87) OPI 042 �,
. 'FACTUAL DIAGRAM 7
YO?(I✓�O�O V w V� r'( ' (�� nL I ✓(� I� nUMw( ' E30
ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED (SCALE
P O/i✓7- 0,4' //7 Piz G T WAJ
t,✓,t-,f 7 6 0 6 — /°R 0 ,4 O 1V 619 r/ O/Y O F D/9 N V/d t d'-
3 0 U,4 C
30U,4t V17A0 /aNp /-f fsrt T J'OuTri o/" T/re,
/✓447-.r -r,0 6,4- P/7 VZ o/y6/9i1Ply 0�
noic wre
I nowt»
fn NE✓t/✓ NNt✓t/✓
(�SPH,9Ar) I C/9SP..'/I T)
I
D.r'C G/`f/iY o, l o 4/o /Vo/tr/l,
Of /�/T.e•.RY'e't�/Jn/.
wH/Tt
Y-.-LLO W//Nt
H1.44 GA/9A,F AVE/VUf
llI
D0u13 t Yt[,coW X
+( h C-3
O
'Y t
h'
l �7OP I
r SIGN 1
� I
I
'r✓I//Tt
INS
1
I
II
30TH Aa.,90W/9Yr /4oO/-/19[ T. DA/VV/clt, f
Q0U4t'V/1R4) (1111
Dwwwn wr i.D, h.iM�Ew MO. Dw• •w. IwLVIL wiwS hwM[ MO. Ow• IR
M• �/—z4/,ec 6
CHP 555-Page 4 IRe: II-E5; GPI 042
CTAT■ OI SCA LIIDRNIA
�NAR RATIVE/SUPPLEMENTAL PA�E-L=J -
IDAT[ OI ORIGIhAi INCIDCNT TIM[�(••2/-ab)
IMOI�DAY
% Oh[ % ON[ IT+►■ SU►►L[w[NTAL ( % AI►LICA[L[)
1 RRATIVE COLLISION REPORT i �� BA U►DAT! t_� FATAL 1 HIT & RUN UPDATE
rn
.L.— SUPPLEMENTAL I LSI OTHER' J L—' HA2. MATERIALS SCHOOL BUS OTHER:
CITY/CONh TY/JUDICIAL DISTRICT R►T. DISTRICT:[[AT CITATION NUM�[R
LOCATION/SU[J[CT I1T^T[ —I "-Al IILAT[C
NO
//!! YES
2 GL✓i ivy --'5,' U_ 1✓�I-- 11L /✓.L
3
5.
1 66.
i
7.
1=
8. L /I :� I��L)A
r G1 9. l
10. ;ZMJ Lit,/ - 2 . ;V1AA�,�-� .2
113. / —A 3LJLZZ--� LJ �7 4 �
A.
20. l�iJi 7�-1 - / y ✓C�.� -
i21 ,
22.. � � l�Ll %�-1 fL.f� ..1 "�/1.../i c51._ i�� �1�". 1� t�/ '�✓�-
zz-
23.
24h -r �J-7J� Lr�>fa�_. 1`✓D �1/L '�J% `�—
.26.
r --
129.
30. rYl: r✓�, --
�3,. '
IPw[ [
� u o. D we vie wcws NAMe Mc. DA+ +R.
CHP 556 !Rev 12.84) OPl 042 Use previous editions until depleted.
STATE O• LA LI•pwN1A .
NARRATIVE/SUPPL E(JI ENTAL ►AGEL
MO•[ OI.OR IN Av SIN NT Yw TI /( INCIC�M�� �•/{ Q� MVM[[w --_-
/L/L////L///_LLL\\\■■■- I�I�I�Iso
%" ONE % ONE �Tlla SUPPLEMENTAL ( X- A►ILICASLE) -•�
I-^
A R R ATIVE COLLISION RE►ORT .-J BA U►DATE FATAL Lr MIT 91 RUN UPDATE
SUPPLEMENTAL LJ OTHER: u HAZ. MATERIALS ' SCHOOL eUS � OTHER:
CITY�C OUN TY(JUDI CIAL DISTRICT RPT. Dlf iwlCTl[E AT CI iA TION MUM[ER
I
LOCATION/EV[J[CT II[TAT[ NIGNMAY RELATED
_
Y E 5 NO
6 AAL7
2
3.
Lamh 4iV,4AL
4. rXL-�W-4 .
go
5.
7.
6 � I
„. /
✓,a L .
,4 _
18
6� lJ� �` �'I✓✓�t:_�r_ �l_.i1� if`' �r f f��! I" � it f-N. � i ��,_J . r-:`_.
�-- -
1
121 r
23. Z.04 X71 LJ
24 Y6,
125. --a/�a�� ! K/.L�� L�}J� /,LTJ/ N _ 1�Y'J'
�2 7. --
129. L
±30.
.31.
►w 'E AM[ ^ A �� w D Y �wE VIE w[w'x HAMS iMO, DAY
CHP 556 (Rev 12.84) OPI 042 Use previous editions until dep;e!ed.
•r Ara oP.cw��Ir owryu I "7
NARRATIVE/SUPPLEMENTAL PAGE
rO^
rE�� IOAv IQ D�Tvw� T";
tAo� ryC Sry��D I yD� IryuMaaw . �O
"!t" ryE "%"ONE TYP■ *V—LaMEryTAL ("%" AP►LICAaLa)
T •wr—'11
G HIT a RUN UPDATE
ARRATIVE I�OLLISION REPORT C BA UPDATE � FATAL
SUPPLEMENTAL I OTHER: i�l NAI. MATERIALS ^, sCHOOL Bus OTHER:
CITY/COUNTY/JUDICI^L DI5TRICr �"'T, on TwICTIa CAT CITATION ryuMSFR
LOCATION/suaia CT isTATE NIGH—Y RELATED
I - . , 4 . I/ / - 4 / r' YE NO
2.
6. �/l1 LJ--IL/V'J�
7. �c./!t% -AilT's
8.
112.
113. Of
114 eo-
ii6
16. /1/l119
.� i77 ✓ —
i 20 c,_/i G 4t"
X22. - J,4 J:: / L/
2- T
124 4
'25. - Q— ,O�,401 ✓a
27.
?W701, Aocl
j2 S.
JA - =
I30.
►R! R NAM[ � �� II IJ ■R yD/� pAv � 1REV1l WE R'} NAME IMO. DAY Y
y
CHP 556 (Rev 12-84) OPI 042 Use previous editions until dep;eted. 9`
STATE 4w CALIFORNIA
NARRATIVE/SU4pPPLE/My ENTAL PAGE
IMOIE`.rE—/IDAY IN` / T r'V I TIM%'I• , NCI VM\L � �/ NUYwLw --'
///✓�IIy/!Y^J S I/ \
� I
' Y pNt % ONE STYPE SUPPLEMENTAL (. ...% APPLICASL[) ,
NARRATIVE COLLISION RE►ORT i Lam' BA U►DATE �! FATAL HIT & RUN UPDATE
I
I
r^
SUPPLEMENTAL L_I OTHER: L_ HA.. MATERIALS SCHOOL BUS OTHER:
CITY/COUNTY/JUDICIAL DISTRICT "PT. DISTRICT;'EEAT (CITATION NUMEER
LOCATION CT I{TAT[ NIGNwAY w[LATEO +I
_ I
YES r NO
2.
,
4 At A
5.
r
ke
10.
✓- a�5 A'.
12. �
13 J �� 72) r
I14
V-
19.
19. /YI V - ,4�i�r /�
120. 71
22ff.
1 25LJ 2f , CN �e ILXl UC• LI w ►1 L.� :_LJIJ
X26. 10 1 414
27 �-
28.
3 0 � ✓/ �/�LV L.� .�J/ /Ll� f�� L� !� /U/V_
(r31.
�R�/ l'./IQ � D r �SI�iwEvlE we R'f NAM[ iMo. DwY --
II. �
C v/�. r w
CHP 556 (Rev 12-84) OPI 042 Use previous editions until depleted.
ETAra�P•'cwu PowN1A
NARRATIVE/SUPPLEMENTAL PAGE
MA TE�INA} IM CID IT80
it
_
O• DAY I
"■ ONE % ONE TVP! SUPPLEMENTAL ' X" APPLICA\LEI ~
CNARRATIVE COLLIE ION REPORT LJ BA UPDATE FATAL J HIT & RUN UPDATE
!
I
rte- SUPPLEMENTAL :.J OTHER; L.' HA2. MATERIALS 7 SCHOOL BUS OTHER:
(CITY/COUNTY/JUOI DIAL DIET wICT .IT DIfTRICT,\!AT (CITATION MUM■!R
LOCATION/EJ\JE CT fTATI HIONWAV RELATED
YES NO
1
2
r
3.
4
5.
6.
8 i
9.
10.
�11
12.
13.
I14
I15
16.
,17
111 8 - —
Ito i I
21 0.
121
122.
123.
124. I
i
25.
126. I
127
— --'
121 I
30. '
31.
NAM R Y—�
I / i1.0 N / ' / � _IRE VIE WCR�S NAME IMO. UAY
CHP 556 (Rev 12.84) OPI 042 Use previous editions until depleted.
r
Approximately 1450 hours, I was north-bound on Danville Boulevard driving marked
Sheriff's patrol unit 412610. As I approched the "T" intersection with Hillgrade Ave.
I noted a motorcycle driven by a white male (NFI) driving south-bound. As the cycle
passed me I noted the cycle to accelerate at a high rate of speed, passing a slower
moving south-bound vehicle. It appeared the motorcycle accelerated to speeds in ex-
cess of 75 miles per hour plus. I continued north-bound on the boulevard (approx-
imately .50 yards), activated my emergency equipment (full light-bar with wig-wag
headlamps), and began to make a u-turn at the intersection of the Boulevard and Hill-
grade Avenue. As I began to make the u-turn, I noted. a vehicle stopped at the art-
erial stop sign for the east-bound traffic on Hillgrade Avenue, and realized I could
not complete my turn. I placed the patrol unit in reverse, while maintaining visual
contact with the suspect vehicle, and began backing the unit. At approximately 2 to
3 miles per hour, I felt an impact to the rear and realized I had been struck by a
south-bound vehicle. I exited my patrol unit and determined there where no injuries
to either party. I advised my dispatch I was involved in a minor traffic accident
and requested CHP and my supervisor to respond to my location. The vehicles were
moved from the roadway without incident. . *Note* Prior to making my u-turn, I noted
the vehicle that struck me had been south-bound on the boulevard and had stopped just
north of the intersection with Hillgrade. California Highway Patrol officers arrived
and took control of the scene. Sergeant Dussell arrived at the scene and took the
necessary information and photos.
'OLICYNO:
,(,::2v California CasualtyD` REPAIR ESTIMATE
CITY STATE ZIP
:�LAIM NO.
La EXAMINER'S NAME
SATE �l
INSURED CLAIMANT PHONE NO.
�tAJ 11i�..J/r,•
t
Aq •• ''CMI E pT�111FICAiI f�l BE �. ���' CLIC TA E(_
c
ti �'7f"ic_�1Z v L
PAINT
_INE RE-PAIRARE- �Z DESCRIPTION OF WORK EF. OL INC LABOR SUBLET PARTS
El
1
2
7
v
5
6 �# ��l.Y�u
� 1 1
7 C tt� ti�•tti�=� ��
f
8
10 61(_Lc,k :1� l iLC .� CJS (fin
12 .'\/1
13
14
15
! 16
17
18
19
I720
REPAIR SHOP t DEDUCTIBLE TOTALS
ADDRESS / ALLOWANCE
GROSS PARTS
3ITY DEPRECIATION
SHONE N0. TOTAL $ %DISCOUNT _
f NET PARTS G
AGREED PRICE BY: f
t LABOR HRS. C$ ' ` o
=STIMATE PREPARED BY: PAINT 8 SUBLET
DEPRECIATION BASED ON: / TAXES
THIS IS NOT AN AUTHORIZATION TO REPAIR NOR AN ADMISSION OF LIABILITY GRAND TOTAL
JO SUPPLEMENT WILL BE HONORED UNLESS AUTHORIZED BY CALIFORNIA CASUALTY. COLLECT FROM OWNER c�
'L-338(1/87) WHITE COPY:FILE YELLOW COPY:SHOP PINK COPY:CUSTOMER CAL,CASUALTY PAYS y
i
POLICY NUMBER I MO.8 DAY/ CLAIM NUMBER ADJ. OFF DRRAFTT N
U
MBER
ISSUE DATE I LINE C.C. AMOUNT
INSURED 1,
VOID 90 DAYS
FROM ISSUE DATE
` 1
UPON A CEPTANC
PAY TO THE ORDER OF'-
California Casualty ' -
+ (DRAFT DRAWN ON COMPANY MARVED:'2)
C (• J`'�LrZ?pRNIA CASUALTY INDEMNITY EXCHARGE C
-PXYADLE T;isUGy, a t i` Li'
FIRST IN BANK CALIFORNIA CASUALTY INSURANCE CO. i
OF CALIFORNIA 11-57/657 CALIFORNIA CASUALTY 8 FIRE INSURANCE-CQ. '
SAN MATEO,CALIFORNIA 1210
PL-300(7186) CALIFORNIA CASUALTY GENERAL INSURANCE CO~ COUNTERSIGNATURE REQUIRED OVER$5.000.00
FILE COPY
POLICY NUMBER I MO.It DAj/ CLAIM NUMBER ADJ. OFF DRAFT NUMBER ISSUE DATE I LINE C.0 AMOUN;,o-"
1-1-? �c c 2 8 8 31 "C �-� I i C 7
INSURED
VOID 90 DAYS
�- FROM ISSUE DATE
UPON ACCEPTANCE
PAY TO THE ORDER OF:
California Casualty
(ORAFT ORAWWON COMPANY MARKED X 1
`V. ❑CALIFORNIA CASUALTY INDEMNITY EXCHANGE
PAYABLE THROUGH
I FIRST INTERSTATE BANK ❑ '
' CALIFORNIA CASUALTY INSURANCE CO. '' J
11-57/657
�
1.57/65 ..
I i OF CALIFORNIA I
s SHN MA7E0,CALIFORNIA 1210 ❑CALIFORNIA CASUALTY d FIRE INSURANCE CO
PL-300(7186) ❑CALIFORNIA CASUALTY GENERAL INSURANCE CO. COUNTERS;3NATURE REQUIRED OVER 15,000.00
t
V � _
i
l
4
FILE COPY
I -_
�OLICv iJ0
(41/0 California Casualty OFFICE ADDRESS
°` REPAIR ESTIMATE
CITY STATE ZIP
CLAIM NO.
l EXAMINER'S NAME
DATE [[[///
INSURED CLAIMANT _1 PHONE NO.
R A OD �M E ID NTIFIGATI9N UMBER LI TATE
PAINT
LINE RE- RE
PAIR PLACE DESCRIPTION OF WORK EF. OL INC LABOR SUBLET PARTS
1 --
4 Y Lv��tc, l'�6 t•� , � c_t,` ( 4
6 x
8 LL C- 66,
10
12
13
14
15
16
17
18
19
20
REPAIR SHOP DEDUCTIBLE Z�' TOTALS
ADDRESS 4- ALLOWANCE
CITY �- DEPRECIATION GROSS PARTS
PHONE NO. L� TOTAL $ G� %DISCOUNT
AGREED PRICE BY: NET PARTS
LABOR HRS. .
ESTIMATE PREPARED BY: L _
� PAINT 8 SUBLET
1 .�
DEPRECIATION BASED ON: l TAXES
THIS IS NOT AN AUTHORIZATION TO REPAIR NOR AN ADMISSION OF LIABILITY GRAND TOTAL f
NO SUPPLEMENT WILL BE HONORED UNLESS AUTHORIZED BY CALIFORNIA CASUALTY. COLLECT FROM OWNER
PL-338(1187) WHITE COPY:FILE YELLOW COPY:SHOP PINK COPY:CUSTOMER CAL.CASUALTY PAYS
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 November 3 , 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
(ParagraphV bel4ow) given �ursuant to Government Code
Amc�nt: $1, 000 , 000 . 00 Section 914Y41�. ' ease note all "Warnings".
CLAIMANT. WILLIAM COLLEN KING OCT 2 1987
c/o Eddy Paul Balocco, Esq. Martinez, CA 94553
ATTORr;:Y: 2224-A Oak Grove Rd #265
Walnut Creek, CA 94598 Date received
ADDRESS: BY DELIVERY TO CLERK ON October 2 , 1987 hand del .
BY MAIL POSTMARKED: no envelot)e
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: October 2, 1987 JgIL BATCHELOR, Clerk
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: l JBY:� 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
(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.
' NOV 3 1987
Dated:
DatePHIL BATCHELOR, Clerk, By r � , 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: NOV 4 1987
BY: PHIL BATCHELOR by putt' Clerk
CC: County Counsel County Administrator
CLAIM .TO: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
Instiuctions to Claimant Return original application to
Clerk of the Board
651 Pine St., Roan 106
Martinez, CA 94553
A. Claims relating to causes of action for death or-',for injury to
person or to personal property or growing crops must be presented
not later than the 100th day after the accrual of the cause of
action.' Claims relating to any other cause of action Must be
presented not later than one year after the accrual of the -cause
of action. - (Sec. 911.2, Govt. Code)
8. Claims rust 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
oT LFiis form.
RE: Claim by )Reserved for Clerk's filing stamps
WILLIAM COLLEN KING )
)
Against the COUNTY OF CONTRA COSTA) OCT 211987
and the SHERIFF 'S DEPT . , DOES 1 to 100 ) 5!aqc_� ,h
or DISTRICT) °'"LDna s t°"v�soRs
Fi n name—7— A
The undersigned claimant hereby makes claim against the County of Contra
Costa or the above-named District in the sum of $ 1,000,000
and in support of this claim represents as follows:
-- --- T ----- -------- — ----
dna the damage or �n3ury occur? ZGive exact ate and �iourj
June 27, 1987 , at approximately 0330 hours . Discovery open.
'�:--i�Fi"ere"did`tFie`damage"or`In ury"occur?""�inCiude"city
County Jail, Martinez, County of Contra Costa.
-r-----_31a_--
3. How did the damage or In�ury occur? ZGive dull details, use extra
sheets if required) While being processed and booked in the Martinez County
Jail, Claimant was, without provocation or cause, suddenly and unexpectedly
assaulted, battered, attacked, grabbed, shoved, and slammed against a wall by an
anknown deputy sheriff on duty in the booking area, and thereafter threatened,
intimidated and harassed by said assailant in said area.
�. fiat particu3ar act or omisslon on the part o� county oz dastr�ct
officers, servants or employees caused the injury or damage?
See Answer No. 1 on Addendum attached and made part hereof.
(over)
5: h'`nat are the names of county or. district officers, servants or'
employees causing the damage or injury?
See Answer No. 2 on Addendum attached and made part hereof.
6. N�iat damage or Injuries coo you claim resulted? ?Give buil oxtent
of inj fes or damages claimed. Attach two estimates for auto
damage A general description of the injuries incurred so far as it is now
known, is as follows: bodily bruises ; headaches ; neck pain; upper body
pain, and severe emotional distress .
------------------------------------------------ -------------- ---- ---
7. How was the amount claimed above computed? IInclude the estimated
amount of any prospective injury or damage. )
See Answer No. 3 on Addendum attached and made part hereof.
------------------------------- ---- ------
�. Names and addresses of witnesses, doctors and hospitals.
The names and addresses of County deputy sheriffs and other County personnel
on duty in the County Jail area where Claimant was assaulted and battered,
harassed and intimidated, who subdued and restrained the assailant, and/or
viewed the incident, including other civilians in the immediate area, are un-
known at this time. Discovery remains open. Claimant reported the incident to
Dr*. David C . Ziegler, 956 Moraga Road, Lafayette, California.
---- ------ ----- ------�
uU---
. List tae expenditures you made on account of this acc dent or n
D In �,,..t.� .,,..,. .. .,. ..._..�.. ITEM AMOUNT
To date, medicals #emain open.
t
tt�+ *��t:: +t*:•�r. �f* ,
.,. ::�.,. .. ..,,,,, . .,.. Govt. Code Sec. 910.2 provides:
"The claim signed by the claimant
SEND NOTICES TO: (Attorney) orby some ptrson on his behalf. "
Name and Address of Attorney
EDDY PAUL BALOCCO, ESQ. C aat 5ignatute
143 Midhill Drive
2224-A Oak Grove Road ## 265 Addresi
Walnut Creek, CA 94598 Martinez, California 94553
Telephone No. (415) 937-0220 Telephone No. (415) 229-4225
�t:t**t�*�*t�*a���::t�*t+r**e��rr�+r�*+r:��*�r�r�R«*�t***:�*ft:+►r��f*+t���r���R�t**+r,►
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."
ADDENDUM TO TORT CLAIM BY WILLIAM COLLEN KING
AGAINST THE COUNTY OF CONTRA COSTA AND THE
CONTRA COSTA COUNTY SHERIFF' S DEPARTMENT
No. 1 : The County , its officers , servants or employees ,
Does 1 to 100 negligently and carelessly at the times and places
stated herein:
(a) failed to safeguard claimant from excessive bodily
force , abusive conduct , harrassment and intimidation;
(b) failed to properly supervise the processing and
detention of claimant arrested and beina booked on misdemeanor
charges at the County Jail in Martinez ;
(c ) condoned the use of excessive force and authority
upon the claimant ;
(d) inflicted severe and emotional distress upon
claimant ;
(e) failed to properly train, supervise , and educate
County personnel in the handling and processing of persons
charged with misdemeanor violations , including the claimant ;
(f ) authorized and condoned wrongful acts and conduct
on the part of its public employees toward claimant who was
detained in its jail facility;
(g) failed to take notice and/or properly screen those
County personnel with abusive tendencies with respect to
processing and booking persons who had .been arrested, such as
claimant herein;.
(h) failed to implement procedures enabling personnel
to take effective action to guard against mistreatment and abuse
such as claimant suffered;
all of which acts as hereinabove stated proximately caused
claimant ' s injuries and damages . Discovery remains open.
No. 2 : The name of the public employee involved in the
assault-. and battery upon claimant and .causing the injury, is
unknown at this time. The names , identities , and capacities of
other public employees who may in addition be responsible for the
injuries.-and damages herein claimed are unknown to claimant at
this time and claimant therefore claims that Does 1 through 100
are in some way responsible for the damages sustained and
suffered by claimant. Discovery remains open.
No. 3 : The amount claimed as of the date of presentation of
this claim is $1 , 000 , 000 which includes $500 , 000 as estimated
amount of any prospective injury , damage , or loss . The basis of
computation of the amount claimed is as follows :
An estimate of present damage plus permanent disability
which may be involved in this injury; including pain and
suffering for the rest of his life ; future medicals ; impairment
of earning power ; impaired enjoyment of life ; emotional distress
for the rest of his life ; susceptibility to future injury; but
not necessarily limited thereto. Discovery remains open.
CLAIM
f 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 November 3 , 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 cl1im by the Board of Supervisors
(Paragrap�, b6tr()QYW pursuant to Government Code
Amount: $72 . 00 Section 9 and §§115.4 1917 ease note all "Warnings".
CLAIMANT LESLIE C . JOHNSON OCT
1380 Gilman Street Martinez, CA 94553
ATTORNEY: Berkeley, CA 94706
Date received
ADDRESS: BY DELIVERY TO CLERK ON September 30 , 1987
BY MAIL POSTMARKED: September 28 , 1987
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim. -
October 2 , 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 cl:. ground that it was filed late and send
warning of claimant's right to apply for leave to pres: ! to claim (Section 911.3).
( ) Other:
Dated: BY: uty County Counsel
111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
VT his .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. p
Dated: O 3 1907 PHIL BATCHELOR, Clerk, By ' Deputy Clerk
i
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�a�oye.
NOV 9 r
Dated: 1OV BY: PHIL BATCHELOR by �W_,e�eputy Clerk
CC: County Counsel County Administrator
r- 7 vr^n P^T Pr, . COr S TP `;I fir. CQ?�"r?.c. �.'�cm'
E _ '�eiu� �'t. 111€ aPDliCr.lie^ !�
•
_--tions tc C-1 an �IerK of the 6o2rC
C. Box 911
F
M
r artinez. Caliiornig 94:33
t Cla:_::s rE�_G� -
_nc c causes o- .._cCion -Cr CEG:... cr _C. _. ,u_v to
Jerson or uc nerso.^.__ ^rz)perty cr Cro ^
w_nc CrOs must bey:Drese.^wed
no: !a-Ler .1 a.5 ..he IC10th Cam' aftery--he accrual Of the cause Of
action. C'Gims relating to a.nv other cause cF act_on must be
oresen`_d not la�e_ L_.l .. o.:E year after the accrual o_ the cause
c` action, :Sec . 91_ . 2 , Gov... Code;
B. Claims nmuSt be --filer-z' 4,-itn tie C_er?: or theBoard' Cr c •OErV=5Or5
in room. 106 , Ccs: _,.'nC , 601 P-ine
Street M_rt_nez , Ca:_rcrr._� 9�..3 .
=_a=n" _s aca=..St a C_S�r=. t ^JEr�.ec C._ t E JJGrG OL S :Oert'�SO_'e
_ .the- =.:a_: the �c .^.-_ , ,._ e n.a:1e Of _nE be "fill." ed in .
C. __ ...__ _G_:T� iS ac Ginst al_-re _.. cn;— ,-%,..�.__C Er:t-'�� , sE;JGr ate c.G- �C
�.
aca_r.st ^�.ol.c E."_i --
-ral,d ee -.)ena_ty for Pe::=_ C--7,,= Sec . c- era
:
****** **x*t******x x*************s r ***r *t **x f
E. Cla yResIRIUV
,* _ �- l inc sta::l:s
-
13AD
r.ca_n S_ -he '.)TT'_ T1' . OF C 0 1 z T-. C-70`1ST
`CONT ?
ROOM
or C=STF.1CT
in name) '
Tl,le under_ cned clainnant here: fakes aca_ns` the -" Contra
cf Conra
OSt: cr the above-named ii�c=_ _c � In _" c-Su% ZZ
anG ir: SUDO^r OL ti 1S c_a1P _G^ F Sr_.t aS LC__OµS .
1 . i'%hen 1 t}iE Ga' GE Or T ;l?' O^c'±'_' (�_vE Exact :a to aI'iC :four :
�E�zv�`�ir/ 8•'3 a �"� -- 9-•�0��
' .--V;here-did the day, ce or injur ' oc^'��' (ynclua�city and count%•;----
C��� Cosmo ����a� �y iN �C/,�
y
3. now cid the damage or infury occur? ( i:�E �L' � QZta ls , usede ra
sheets if required)
- -------------------------------------------
4-.---What----pa---rt--icular-------act----or---omission- on the part or county or district
officers , servants or emrloyees caused tp r.=u
/ r} or camaae?
AI Y -�EYz� �D t�P. c� � G/d�J�3
16-Ilk 44 p DEQ B707 C�7�1E3.
over.,
iS ;What: a.re.. the. names of county or district officers , servants or
em,,)Iovees. causinc the carnaaE or ir._ury? `
1
- �tec?T-.--what camaQe or injuries ac voL clzi �: resu ' exten
of injuries or a.,�ae�p claimed. Attach twc es-imGces For auto
da::,age Z05S O� /0;7/ ' Shot5 lw&II�vAl -{a�Z Z V"°
-------------------------------------------------------------------------
How was the amount cla-,,ed above cenoL_ed? (_nom'ude t_^.e estir.iated
amc:.-t c` a^%- _ respective _r_fury or damage `B(I j/
----------------- --------------------------------------------------------
t . Names -nc a-=-esses c_ witnesses , Goc'^-s ana
y
;:les you :nage on-account. c--- -rs acciaeP.t-or nDury
r ^�rTE i !TEM 'TiQJr�n'
-3/9 7 /P� '51VOes
�°�
I�2 p/FiVTS(, tN's,��p� 14 Wee)
AYAt
�IE ��/YGti JKJGITiGR. �-.7
icic�k� icYc****xx****x#***#*�k**##xs
Govt. Code Sec . 910 . 2 provides :
"The c'a-1 m sicned by the cla-L -.
SEND NCIT CES- TO: (r:`-crnev) or 'J•', some r)erso- on his behalf .
Na:-ne and Address er :ttcrney
gOa:.m /G ' R;c-:azure
dress
3r cy 7 f
Telephone No. Telephone No.
Cs�lS-U�;ZS-- „Z3o
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, y
_ cit
district, ward or village board or officer, authorized to allow or pay
r
the, same if genuine , any false or fraudulent claim., bill , account , vouche*
or writing , as Guilt}- of a felony. 11
t
CONTRA COSTA DETENTION FACILITY
LJIS1
CLOTHING RECEIPT
'
DATE: D9/03/87 REC: 115447
TIME: 2310 FACILITY: MDF
NAME (L, F, M): JOHNSON LESLIE
BOOKING NBR: 87020975) AV
SHIRT;BLOUSE PANTS/SKIRT
[] COAT/JACKETHOES/BOOTS
[� SHORTS/PANTIES -SHIRT/BRA
:EgS6CKS/ HAT/PURSE
WEATER/SWT. SHIRT HDRESS
OTHER
�J
I �U
o �
1,117
INMATE SIGNAfU ,A
DATE: ;_ �HAVE RECEIVED ALL OF MY �D
CLOTHING.
REL OFC: SIO
X
INMATE SIGNATURE
0
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 November 3 f 9 8 7
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice o
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $25 , 000. 00 Section 913 and 915.4. Please note all "Warnings".
County Counsel
CLAIMAfJ: STEVE AND JANICE CALDERA
c/o Eugene M. Hannon OCT 02 1981
ATTORNEY: Attorney at Law
1934 Contra Costa BouleveMdrUIX2, (;Ai9�i53
ADDRESS: Pleasant Hill , CA 94523 BY DELIVERY TO CLERK ON September 30, 1987
BY MAIL POSTMARKED: September 29 , 1987
I. FROM: Clerk of the.Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim. -
October 2 1987 EaIL BATCHELOR, Clerk
DATED: eputy
( 4,
L. Hall
II. FR
OM: County Counsel TO: Clerk of the Board of Supervisors
This claim complies substantially with Sections 910 and 910.2.
This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying
claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claim;is not timely filed. The Clerk should return claim on ground that .it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: BY: .440eputy 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
V/) Thisib aim is rejected in full.
( ) Other,:
I .
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this 'date.
I NOV 3 1987
Dated: PHIL BATCHELOR, Clerk, By . Deputy Clerk
i
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.
NOV 4 1987
Dated: BY: PHIL BATCHELOR by Deputy Clerk
CC: County Counsel County Administrator
r
i it J
NOTICE OF CLAIM a
TO: BOARD OF SUPERVISORS , CONTRA COSTA COUNTY r=
STEVE and JANICE CALDERA hereby make claim against
Contra Costa County for a sum in excess of $25 , 000 . 00 , and make
the following statements in support of the claim:
1 . Claimants ' address is 5824 Pine Hollow Road ,
Clayton , California 94517 . Claimant , STEVE CALDERA, is employed
by the County of Contra Costa as a security officer at the
Merrithew Memorial Hospital , located at 2500 Alhambra Avenue ,
Martinez , California . Claimant , JANICE CALDERA, is married to
Claimant , STEVE CALDERA.
2 . Notices concerning the claim should be sent to
EUGENE M. HANNON, Attorney at Law, 1934 Contra Costa Boulevard ,
Pleasant Hill , California 94523 .
3 . The date and place of the incident giving rise to
this claim is June 25 , 1987 , at , on , and/or near Merrithew
Memorial Hospital .
4 . The circumstances giving rise to this claim are as
follows : Administrators , co-employees , and/or superiors of
claimant (all being employed by Contra Costa County) fraudulently
concealed and failed to disclose , among other things , that a
" runaway" patient from Merrithew Memorial Hospital , whom Claimant
STEVE CALDERA was ordered to apprehend , was infected with a life-
threatening contagious and/or communicable disease. During the _
course of subduing the patient and apprehending the patient ,
Claimant STEVE CALDERA was covered with and exposed to the
{
I
infected patient ' s blood and saliva. Claimant JANICE CALDERA is
pregnant , and the outrageous conduct complained of in this
incident has seriously affected , among other things , her marital
relations and her mental health and condition . Since Claimant
STEVE CALDERA had not been forewarned of the unusual and deadly
risk inherent in apprehending this patient , he did not have the
opportunity to take standard precautionary measures in the course
of fulfilling his employment responsibilities during this
incident .
5 . Claimants ' injuries , as presently known , are:
(a) Severe emotional distress for both Claimants ;
(b) Loss of consortium for both Claimants ;
(c) Other damages unknown at this time .
6. The names of. the public employees causing the
claimants ' injuries are unknown and/or are not fully ascertained
at this time , but Claimants are informed and believe that the
County of Contra Costa owns and operates the Merrithew Memorial
Hospital property , and , among other things , had the County
properly supervised , managed , and hired its employees , proper
precautionary procedures and measures would have been implemented
and followed , and Claimant STEVE CALDERA would have been made
aware of the risks inherent in apprehending the runaway patient
and could have taken precautions to prevent exposure to the
subject disease . Instead, each Claimant now must endure the
agony , and uncertainty , and the related attendant mental stress
of testing and waiting a long time before it is finally
-2-
determined whether Claimant STEVE CALDERA has contracted a deadly
disease , and further , whether claimant JANICE CALDERA and the
unborn child of this married couple are likewise at risk .
7 . The claim as of the date of this notice is in
excess of $25 , 000 . 00 .
8 . The basis of computation of the above amount is as
follows :
Medical expenses Incurred to Date : Total not yet ascertained
Estimated Future Medical Expenses : Total unknown
Loss of Wages : Total unknown
General Damages : In excess of $25 , 000 . 00
Total : In excess of $25 , 000 . 00
Dated : September ,Z. � , 1987
v
r
E EN . HANNON, Attorney at Law,
On Be if of Claimants STEVE and
JANICE CALDERA
-3-
i
. ] PROOF OF SERVICE By KAIL
2 I declare that:
3 I am employed and reside in the County of Contra Costa,
4 California. I am over the age of eighteen years and not a party
5 of the within entitled cause; my business address is 1934 Contra
6 Costa Boulevard, Pleasant Hill, California.
7 On September 28, 1987, I served the attached
8 NOTICE OF CLAIM
9
10
11 on the public entity named below in said cause
the original
12 by placing a-*~-"py thereof enclosed in a sealed envelope
13 with postage thereon fully prepaid, in the United States mail at
14 Pleasant Hill, California, addressed as follows:
15 Board of Supervisors
16 County of Contra Costa
651 Pine St .
17 Martinez, CA 94553
18
19
20
21
22
23 I declare under penalty of perjury under the laws of the
24 State of California that the foregoing is true and correct, and
25 that this declaration was executed on Setember 28, 1987,
26 at Pleasant Hill, California. _
27
28 CAROL ZU I
CLAIM
BOAZD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) N0710E TO CLAIMANT November 3 , 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
Amcunt; 25 ,000 . 00 C0urjy§tCP0L0S%6 915.4. Please note all "Warnings".
CLAIMAr,T: CHERIE L. BUCKINGHAM I 02ISS7
c/o Eugene M. Hannon
ATTORNEY: Attorneat Law Contra Costa Blvd. �`�a�'noa'eC�9� d53
1934
ADDRESS: Pleasant Hill , CA 94523 BY DELIVERY TO CLERK ON
September 30, 1987
BY MAIL POSTMARKED: . September 29, 1987
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim. -
IL BATCHELOR, Clerk
DATED: October 2, 1987 �b: Deputy
L. Hall
11. 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:
Dated: 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 Superviscrs 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. .
NOV 3 1987 � -
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 1 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: N O V 4 1987 BY: PHIL BATCHELOR by Deputy Clerk
CC: County Counsel County Administrator
t
NOTICE OF CLAIM S F P "o 0 19`7
TO: BOARD OF SUPERVISORS , CONTRA COSTA COUNTY
CHERIE L . BUCKINGHAM hereby makes claim against Contra
Costa County for a sum in excess of $25 , 000 . 00 , and makes the
following statements in support of the claim:
1 . Claimant ' s address is 1770 San Miguel Drive , No. 2 ,
Walnut Creek , California 94596. Claimant , CHERIE L. BUCKINGHAM,
is employed by the County of Contra Costa as a security officer
at the Merrithew Memorial .Hospital , located at 2500 Alhambra
Avenue , Martinez , California .
2 . Notices concerning the claim should be sent to
EUGENE M. HANNON, Attorney at Law, 1934 Contra Costa Boulevard ,
Pleasant Hill , California 94523 .
3 . The date and place of the incident giving rise to
this claim is June 25 , 1987 , at , on , and/or near Merrithew
Memorial Hospital .
4 . The circumstances giving rise to this claim are as
follows : Administrators , co-employees , and/or superiors of
Claimant (all being employed by Contra Costa County ) fraudulently
concealed and failed to disclose , among other things , that ' a
"runaway" patient from Merrithew Memorial Hospital , whom Claimant
wasiordered to apprehend , was infected with a life-threatening
contagious and/or communicable disease . During the course of
subduing and apprehending the patient , Claimant CHERIE L.
-
BUCKINGHAM was covered with and exposed to the infected patient ' s
� Y 1
blood and saliva. Since Claimant had not been forewarned, she
did not have the opportunity to take precautionary measures in
the course of fulfilling her employment responsibilities during
this incident .
5. Claimants ' injuries , as presently known , are:
(a) Severe emotional distress ;
(b ) Other damages unknown at this time .
6 . The names of the public employees causing the
Claimant ' s injuries are unknown and/or are not fully ascertained
at this time , but Claimant is informed and believes that the
County of Contra Costa owns and operates the !Merrithew Memorial
Hospital property , and , among other things , had the County
properly supervised , managed , and hired its employees , proper
precautionary procedures and measures would have been implemented
and followed , and Claimant CHERIE L. BUCKINGHAM would have been
made aware of the risks inherent in apprehending the runaway
patient and could have taken precautions to prevent exposure to
the subject disease . Claimant , instead , now has to endure the
agony , and severe mental stress of testing and .the passage of
time to learn whether or not she has contracted a deadly disease .
7 . The claim as of the date of this notice is in
excess of $25 , 000 . 00 .
8 . The basis of computation of the above amount is as
follows -
-2-
Medical expenses Incurred to Date : Total not yet ascertained
Estimated Future Medical Expenses : Total unknown
Loss of Wages : Total unknown
General Damages : In excess of $25 , 000 . 00
Tot.al : - In excess of $25 , 000 . 00
Dated : September , 1987
u�
i
GEN M. A NON, Attorney at Law,
On B half of Claimant CHERIE L.
BUCKINGHAM
-3-
I PROOF OF SERVICE BY MAIL
2 I declare that:
3 I am employed and reside in the County of Contra Costa,
4 California. I am over the age of eighteen years and not a party
5 of the within entitled cause; my business address is 1934 Contra
6 Costa Boulevard, Pleasant Hill, California.
7 On September 28, 1987, I served the attached
8 NOTICE OF CLAIM
9
10
11 on the public entity named below in said cause
12 by placing t&et �9py thereof enclosed in a sealed envelope
13 with postage thereon fully prepaid, in the United States mail at
14 Pleasant Hill, California, addressed as follows:
15 Board of Supervisors
16 County of Contra Costa
651 Pine St .
17 Martinez, CA 94553
18
19
20
21
22
23 I declare under penalty of perjury under the laws of the
24 State of California that the foregoing is true and correct, and
25 that this declaration was executed on Setember 28, 1987,
26 at Pleasant Hill, California.
27
2814�tOL ZUG I.-..
CLAIM
' BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Clain Against the County, or District governed by) BOARD ACTION
thp�oard of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT November 3 , 1987
and Bpard 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
Amo-int: $80 . 00 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT; Kenneth Ray Robinsen
County Counsel
A71ORNEY: OCT U 6 1987
Date received MM eZ, CA 94553
ADDR`SS: 126 Seeno West Avenue BY DELIVERY TO CLERK ON October 2 , '"1 I/�
West Pittsburg, CA 94565
BY MAIL POSTMARKED:
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim. -
�dIL BATCHELOR, Clerk o
DATED: October 5 , 1987 : Deputy
Ann Cervelli
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: ; BY: Afd A7,44i JA'----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 Superviscrs present
( (/.This Claim is rejected in full .
( ) Other:
I
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this dater.
Dated: NOV V 3 L98 7 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 Vas shown above.
Dated: AY
�O Y 4 TJX /
BY: PHIL BATCHELOR by r Deputy Clerk
CC: County Counsel County Administrator
• CLAIM TO: BOARD OF SUPERVISORS OF CONTRA CON_;,L8TrFdW app{icationto:
€ Instructions to ClaimantC!erk of the Board
.O.Box 911
Martinez,Calitomia 94553
A. •Claims* relating to causes '6f action for death or for injury to
• person or to personal property or growing crops must be presented
not later than the 100th day after the accrual of the cause of
action. Claims relating to any other cause of action must be
presented not later than one year after the accrual of the cause
of action. (Sec. 911.2, Govt. Code)
B. Claims must be filed with the Clerk of the Board of Supervisors
at its office in Room 106, County Administration Building, 651 Pine
Street, Martinez, California 94553.
C. If claim is against a district governed by the Board of Supervisors,
rather than the County, the name of the District should be filled in.
D. If the claim is against more than one public entity, separate claims
must be filed against each public entity. .
E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at end
of this form.
RE: Claim by )Reserved for Clerk's filing stamps
RECEIVED
Against the COUNTY OF CONTRA COSTA) O A 1987
or DISTRICT) isArcWEoa
0 of VISM
(Fillin name j cos ,
By
The undersigned claimant hereby makes claim againsta Coun of Contra
Costa or the above-named District in the sum of $ gc �{��Ar
and in support of this claim represents as follows:
�. When did the damage or injury occur? (Give exact date and hour]
o o
�. Wee 1d the dirge o in3ury occur? (Include city and county)
37 How did the damage or ink ry occur? (Give_1u11 details, use extra /
sheets if re uired�
Sf �WA 0 flys ��
Joh} ke. C h c.rti P0,04, �j co I A."v +C G f
�4 1
4. -What articular~a.ct or omissi4,4 .tLf
:� J. on on the T .Y
P part of county or district
officers, servants or employees caused the injury or damage?
i
SC.r I.l�r
ti �,,
5 5 '
qt R! '� qe (over)
r 5 s04
'CLAIM' �� y
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA and as Governing Boarc
of the Contra Costa County Flood Control and Water Conseration District
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT November 3 , 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 .
Am
$270 ,000 Section 913 and 915.4. Please note all "Warnings".
CLA!M.A?J R.N. Stefan, Mark Stefan & Lisa_ Stefan County Counsel
ATTORNEY: Edward E. Rockman T li 1g�r
Golden, Stefan, Ellenberg Date received October 5 , 1987( rte
ADDRESS: & Toby BY DELIVERY TO CLERK ON Oc _ober Va 9%-PA 94553
7677 Oakport St. , Suite 460
Oakland , CA 94621 BY MAIL POSTMARKED:
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim. -
IL BATCHELOR, Clerk o
DATED: October 5 . 1987 �b: eputy
Ann Cery lli
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: P_ /W-;, 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 Superviscrs present
(� ThisClaim 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. Q
Dated: N O V 3 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.
i
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: N O V 4 1987 BY: PHIL BATCHELOR by , vi� De uty Clerk
CC: County Counsel County Administrator
LAW OFFICES OF
GOLDEN, STEFAN, ELLENBERG & TOBY
A PROFESSIONAL CORPORATION
THEODORE GOLDEN 11907-1971; (415) S69-3030
R.N. STEFAN 7677 OAKPORT
MARVIN B.ELLENBERG SUITE 460
BARRY J.TOBY
OAKLAND,CALIFORNIA 94621-1967
HOLLY HELMUTH
EDWARD E.ROCKMAN
GEORGE C.ROGERS
HAND DELIVERED
TO: Contra Costa County Flood Control and Water Conserv ion
RE: Claim for Damages E I D
Brought by
R. N. Stefan,
Mark Stefan and OCT 7
fh
II'0 3 198198
Lisa Stefan,
PHIL BATCHELOR
rj
claimants KBO OF SUPE Op$
CO A COSTA o
Pursuant to Government Code §§905 and 910, the followingi-C8=1111 10
e
on behalf of R. N. Stefan, Mark Stefan and Lisa Stefan for damages caused to their
property by the City of Orinda.
1. Claimants' post office address is 8 La Plaza, Orinda, California.
2. Notices concerning the claim should be sent to Edward E. Rockman, Golden,
Stefan, Ellenberg & Toby, A Professional Corporation, 7677 Oakport Street, Suite 460,
Oakland, California 94621.
3. Claimants R. N. Stefan and Mark Stefan are co-owners of that certain
real property commonly known as 8 La Plaza, Orinda, California consisting of a single
family residence. Claimant Lisa Stefan is the wife of Mark Stefan and she and Mark
Stefan make their home and reside at 8 La Plaza, Orinda, California.
The City of Orinda owns and maintains the street Linda Vista which lies
to the east and up a steep hillside from La Plaza and the street Camino Sobrante
which lies to the west and downslope from La Plaza. The City of Orinda or its
predecessor in interest constructed a catch basin and drain which collects water from
the hillside lying to the east of Linda Vista at a location approximately adjacent to
47 Linda Vista. From there the water flows through a pipe underneath Linda Vista
and discharges into another catch basin on the hillside to the west of Linda Vista and
adjacent to 54 Linda Vista. From there, the water enters another pipe which transports
it down slope to a point on the hillside to the south of 62 Mira Loma. From there
the water travels by a concrete channel for approximately 15 feet before entering
another pipe which again transports it down slope before discharging it into a pipe
which surfaces at the top of the La Plaza cul-de-sac. The La Plaza pipe then travels
underground before surfacing and discharging its water onto .Camino Sobrante.
The City of Orinda or its predecessor in interest have been discharging
water into the La Plaza pipe for an unknown period of time but exceeding five (5)
years from the claimants discovery of the use. Neither claimants nor their predecessors
in interest, nor others with a property interest in the La Plaza pipe, ever granted the
City of Orinda or its predecessor in interest permission to use the La Plaza pipe. La
Plaza is a private road in which claimants have a property interest. The City of
Orinda and its predecessor in interest use of the La Plaza pipe has been actual, open,
continuous, uninterupted, adverse, under a claim of right, and notorious for greater
than five (5) years thus constituting a prescriptive use of the La Plaza pipe.
The County of Contra Costa is the predecessor in interest of the City of
Orinda. The County of Contra Costa had jurisdiction over the territory which is now
the City of Orinda until July 1, 1985. From July 1, 1985 until July 1, 1986, the County
of Contra Costa and/or Contra Costa County Flood Control and Water Conservation
District provided services to the City of Orinda including services for the maintainance.
and repair of the drainage system including the La Plaza pipe.
4. Neither claimants' property, nor the properties of the other homeowners
situated on La Plaza discharge water into the La Plaza pipe. The La Plaza pipe has
fallen into such disrepair that it no longer has structural integrity. The water has
broken through the pipe and through the surface of the roadway creating a hole. The
hole has expanded and is undermining the concrete driveway of claimants' property at
8 La Plaza.
The water from the pipe first burst through the surface of the La Plaza
roadway on or about February 15, 1986. Efforts were undertaken by claimants and
others to contain the water by filling in the hole but with each new rainstorm, the
repair efforts failed and the hole continued to grow. On or about October 12, 1986,
the source of the water being discharged into the La Plaza pipe, i.e. the catch basin
and pipes draining the hillside at Linda Vista, were discovered by claimants. On that
same date, a letter was sent to the City of Orinda seeking its assistance. To this
date, the City has failed and refused to undertake maintenance and repair of the La
Plaza pipe causing current damage to claimants.
The failure of the County of Contra Costa and/or Contra Costa County
Flood Control and Water Conservation District to maintain and repair the La Plaza
pipe was a substantial cause of its deterioration creating damages set forth below.
The failure of the County of Contra Costa and/or Contra Costa County Flood Control
and Water Conservation District to maintain and repair the La Plaza pipe has caused
physical injury to the real property of the claimants. The damage caused by the La
Plaza pipe also obstructs the free use of claimants' property, obstructs the free passage
and use of the La Plaza roadway, diminishes the value of claimants' property, interfers
with the comfortable enjoyment of claimants' property, and constitutes a taking for
public use without just compensation all to claimants' special and general damage.
5. The names of the public employees causing claimants' injuries are unknown
at this time.
6. At the time of the presentation of this claim, the amount required by
claimants to repair the La Plaza pipe is not precisely known but will exceed the amount
of $20,000.00. The amount necessary to compensate claimants for the damage to their
real property, including diminution in value of their property at 8 La Plaza, Orinda,
Ww-
California is not precisely known, but estimated to be in the area of $100,000.00. The
amount of damages for claimants' annoyance, discomfort, inconvenience, and mental
suffering is $50,000.00 each. The total amount of damages as of this date is $270,000.00.
DATED: October 2, 1987.
GOLDEN, STEFAN, ELLENBERG dt TOBY
A Professional Corporation
B
Y•
EDWARD E. ROCKMAN
CLAIM /'/D
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 November 3 , 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: $270 , 000 Section 913 and 915.4. Please note all "Warnings".
County Counsel
CLAIMANT: R.N. Stefan, Mark Stefan and Lisa Stefan
Edward E. Rockman
0 C T U u 1961
ATTORNEY: Golden, Stefan, Ellenberg & IMeYreceived Martinez CA 94553
A Professional Corporation a e
ADDRESS: 7677 Oakport St , Suite 460 BY DELIVERY TO CLERK ON October 5 , 1987
Oakland, CA 94621
BY MAIL POSTMARKED:
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
October 5 , 1987 PpHHIL BATCHELOR, Clerk
DATED: BY: Deputy
rlA� 01
Ann C rvel i
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: a U • BY: pu y County Counsel
J . . - _
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. BOARDD 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.
NOV 3 1987
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
1 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.
NOV4 1987 /
Dated: BY: PHIL BATCHELOR by ✓ � ----Deputy Clerk
i
CC: County Counsel County Administrator
LAW OFFICES OF
GOLDEN, STEFAN, ELLENBERG & TOBY
A PROFESSIONAL CORPORATION
THEODORE GOLDEN 11907-1971) (415) 569-3030
R.N. STEFAN 7677 OAKPORT
MARVIN B. ELLENBERG SUITE 460
BARRY J.TOBY
HOLLY 14ELMUTH OAKLAND,CALIFORNIA 94621-1967
EDWARD E.ROCKMAN
GEORGE C.ROGERS
HAND DELIVERED
TO: Contra Costa County Storm Drainage District Fn r T 1987
RE: Claim for Damages I1:03c,.t,
PHLL BATCKELOR
-Brought by 9 00F sU VISORS
R. N. Stefan, By CO RAC os D"Ufy
Mark Stefan and
Lisa Stefan,
claimants
Pursuant to Government Code S§905 and 910, the following claim is presented
on behalf of R. N. Stefan, Mark Stefan and Lisa Stefan for damages caused to their
property by the City of Orinda.
1. Claimants' post office address is 8 La Plaza, Orinda, California.
2. Notices concerning the claim should be sent to Edward E. Rockman, Golden,
Stefan, Ellenberg & Toby, A Professional Corporation, 7677 Oakport Street, Suite 460,
Oakland, California 94621.
3. Claimants R. N. Stefan and Mark Stefan are co-owners of that certain
real property commonly known as 8 La Plaza, Orinda, California consisting of a single
family residence. Claimant Lisa Stefan is the wife of Mark Stefan and she and Mark
Stefan make their home and reside at 8 La Plaza, Orinda, California.
The City of Orinda owns and maintains the street Linda Vista which lies
to the east and up a steep hillside from La Plaza and the street Camino Sobrante
which lies to the west and downslope from La Plaza. The City of Orinda or its
predecessor. in interest constructed a catch basin and drain which collects water from
the hillside lying to the east of Linda Vista at a location approximately adjacent to
47 Linda Vista. From there the water flows through a pipe underneath Linda Vista
and discharges into another catch basin on the hillside to the west of Linda Vista and
adjacent to 54 Linda Vista. From there, the water enters another pipe which transports
it down slope to a point on the hillside to the south of 62 Mira Loma. From there
the water travels by a concrete channel for approximately 15 feet before entering
another pipe which again transports it down slope before discharging it into a pipe
which surfaces at the top of the La Plaza cul-de-sac. The La Plaza pipe then travels
underground before surfacing and discharging its water onto Camino Sobrante.
The City of Orinda or its predecessor in interest have been discharging
water into the La Plaza pipe for an unknown period of time but exceeding five (5)
years from the claimants discovery of the use. Neither claimants nor their predecessors
'in interest, nor others with a property interest in the La Plaza pipe, ever granted the
City of Orinda or its predecessor in interest permission to use the La Plaza pipe. La
Plaza is a private road in which claimants have a property interest. The City of
Orinda and its predecessor in interest use of the La Plaza pipe has been actual, open,
continuous, uninterupted, adverse, under a claim of right, and notorious for greater
than five (5) years thus constituting a prescriptive use of the La Plaza pipe.
The County of Contra Costa is the predecessor in interest of the City of
Orinda. The County of Contra Costa had jurisdiction over the territory which is now
the City of Orinda until July 1, 1985. From July 1, 1985 until July 1, 1986, the County
of Contra Costa and/or Contra Costa County Storm Drainage District provided services
to the City of Orinda including services for the maintainance and repair of the drainage
system including the La Plaza pipe.
4. Neither claimants' property, nor the properties of the other homeowners
situated on La Plaza discharge water into the La Plaza pipe. The La Plaza pipe has
fallen into such disrepair that it no longer has structural integrity. The water has
broken through the pipe and through the surface of the roadway creating a hole. The
hole has expanded and is undermining the concrete driveway of claimants' property at
8 La Plaza.
The water from the pipe first burst through the surface of the La Plaza
roadway on or about February 15, 1986. Efforts were undertaken by claimants and
others to contain the water by filling in the hole but with each new rainstorm, the
repair efforts failed and the hole continued to grow. On or about October 12, 1986,
the source of the water being discharged into the La Plaza pipe, i.e. the catch basin
and pipes draining the hillside at Linda Vista, were. discovered by claimants. On that
same date, a letter was sent to the City of Orinda seeking its assistance. To this
date, the City has failed and refused to undertake maintenance and repair of the La
Plaza pipe causing current damage to claimants.
The failure of the County of Contra Costa and/or Contra Costa County
Storm Drainage District to maintain and repair the La Plaza pipe was a substantial
cause of its deterioration creating damages set forth below. The failure of the County
of Contra Costa and/or Contra Costa County Storm Drainage District to maintain and
repair the La Plaza pipe has caused physical injury to the real property of the claimants.
The damage caused by the La Plaza pipe also obstructs the free use of claimants`
property, obstructs the free passage and use of the La Plaza roadway, diminishes the
value of claimants' property, interfers with the comfortable enjoyment of claimants'
property, and constitutes a taking for public use without just compensation all to
claimants' special and general damage.
5. The names of the public employees causing claimants' injuries are unknown
at this time.
6. At the time of the presentation of this claim, the amount required by
claimants to repair the La Plaza pipe is not precisely known but will exceed the amount
of $20,000.00. The amount necessary to compensate claimants for the damage to their
real property, including diminution in value of their property at 8 La Plaza, Orinda,
California is not precisely known, but estimated to be in the area of $100,000.00. The
amount of damages for claimants' annoyance, discomfort, inconvenience, and mental
suffering is $50,000.00 each. The total amount of damages as of this date is $270,000.00.
DATED: October 2, 1987.
GOLDEN, STEFAN, ELLENBERG do TOBY
A Professional Corporation
/ �.
By:
EDWARD E. ROCKMAN
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim 'gainst the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT November 3 , 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 tak +0oarC� Rftithe Board of Supervisors
(Paragraoh IV below?, given pursuant to Government Code
Amount: Unspecified Section 913 and "f-0 71t"7note all "Warnings".
CLAIMANT:- ROY R. AMERINE Martinez, CA 94553
ATTORNEY: Theresa M. Bosworth
Birnherg & Associates Date received
ADDRESS: Attorney at. Law BY DELIVERY TO CLERK ON October 7 , 1987
261 World Trade Center
Ferry Building BY MAIL POSTMARKED: October 3 & 5 , 1987
San Franciscc , CA 94111
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
IL BATCHELOR, Clerk d
DATED: October 7 , 1987 �b: Deputy
_ 01 JLJ
Qnn Cervelli
11. FROM: County Counsel TO: Clerk of the Board of Supervisors
( ) This claim complies substantially with Sections 910 and 910.2.
KThis claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying
claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: — BY: Deputy County Counsel
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. BOARDORDER: By unanimous vote of the Supervisors present
✓
( r ) 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: N O V 3 1 1
987 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: N O V 4 1987 BY: PHIL BATCHELOR by Deputy Clerk -
CC: County Counsel County Administrator
BIRNBERG & ASSOCIATES
ATTORNEYS AT LAW
CORY A. BIRNBERG TELEPHONE
A PROFESSIONAL CORPORATION 261 WORLD TRADE CENTER (415) 398-1040
THERESA M. BOSWORTH TELEX 4944591 ADMIRAL
FER-Y BUILDING
FAX 396-2001
SAN FRANCISCO, CALIFORNIA 94111
October 3, 1987
Contra Costa County Board of Supervisors RECEIV
County of Contra Costa ED
651 Pine Street
Martinez , CA OCT rl 1987
RE: Claim for Damages ar+IL IATCHELOR
K so Ao of sua (Spg3
Claimant: Roy R. Amerine c ncosr
Date of Injury: June 27 , 1987 �anr
Our File No: 405
Dear Sir or Madam:
Please take notice that Roy R. Amerine makes a claim for
damages based on the conduct of Officers Kris Harmon, G. Miraglia,
and J. Harberson, all of the Walnut Creek Police DEpartment, as a
result of the wrongful arrest, wrongful detention and the prosecu-
tion resulting from said arrest on June 27, 1987 at the intersection
of Oakland Blvd. and Almond .Avenue , City of Walnut Creek, County of
Contra Costa, State of California .
Mr. Amerine has sustained physical injuries, emotional
distress, property damage and other damages as a result of the
conduct of these officers. Claimant has been falsely arrested,
falsely detained and has been defamed. Claimant has had to defend
himself against these false charges.
Therefore, claimant, represented by this firm, requests
that this claim for damages be honored. The amount of claimant ' s
damages is as yet undetermined. Claimant will amend this claim
when the full amount of damages has been ascertained.
Respectfully,
Birnberg & Associates
Theresa M. Bosworth