HomeMy WebLinkAboutMINUTES - 12131988 - 1.17 CLAIM /ri7
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT December 13 , 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: Unspecified Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: GLENN BARBERA
3527 Remco Street
ATTORNEY: Castro Valley, CA 94546
Date received
ADDRESS: BY DELIVERY TO CLERK ON November 1` '; ' '1'98
BY MAIL POSTMARKED: November 15 , 1988
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim. ?
�� f-
IL gATCHELOR, Clerk
DATED: November 17 , 1988 : Deputy
L. Hall
II. FROM- County Counsel TO: Clerk of the Board of Supervisors
(V ) 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
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
(►' ) This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date. AQ0
Dated: D E C 13 �900 PHIL BATCHELOR, Clerk, By Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant as shown above.
Dated: DEC 16 1988 BY: PHIL BATCHELOR by
puty Clerk
CC: County Counsel County Administrator
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 per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not "later than the 100th day after the accrual of 'the cause of
action. Claims relating to causes of action for death or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months 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. ., (Govt. Code'§911.2.)
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•
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 the end of -this
form. _.. .
RE: Claim By ) Reserved fnr Clarkts Ming c2tamp ,
RECE IVES
NOV 1 61988
Against the County of' Contra Costa )
or ) L 6AT FOR
Cl[RfC .OAR" "S
O°'" O
District)
B ... .. ...i.. ....... .. .. .. ur
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 sy�pprt ,�f�•i,L}
this claim represents as follows:
--------------------------------------------------------------- ---------
1. When did the damage or injury occur? (Give exact date and hour)
--- •�= _- ---------- y- --42t-rL-------------------------------
2. Where did the damage ',or injury occur? (Include city and county)
-- Q .S---- ��rL------------------------------------------------
--------
3. How did the damage or injury occur? (Give full details; use extra paper if
required) w k.
A.S J Pl4i n j
4. What particular act or omission on the part of county or district officers,
servants or employees caused the injury o amage.
No ' s pi-t
(over)
5. WriA are the names of county or district officers, servants or employees causing_
the damage or injury?
----------- -------------------------------------------- --- -__-- -
5. What damage or injuries do you claim resulted? (Give full extent -of injuries or
damages claimed. Attach two estimates for auto damage.
�Q�'KT ,4�� ���z' `,n�tF�R e���-� , �, o� �{.e_ wkv � e :�(-k�Je►Z
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury " damage.) a b _t,4itict- d'S1 iwc� �e5 E'�2cyr�
aha IZ� 7 in�55 ion r�l ✓c�, .
8. Names and addresses of witnesses, doctors and hospitals.
Y=_ ---------------------------------------------------------- r
9. -List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
�C) 6y
oar"br"The
Gov. Code Sec. 910.2 provides:
W) claim must be signed by the claimant
SEND NOTICES TO: ( ) or by some personon his behalf."
Name and Address of Ajt r y
SAA ,
laiman ignature
NAYWARP DMICT OFRCf 3 5 r7 fZe141
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IM CUAbW 6iWRT • Q. O. BOX I3H 42-4 !QU ✓ I L�✓q�Cl�,
MAYWARD. CALIPORWA 94840 Ad re__'
Telephone No. Telephone No.
f
NOTICE
Section 72 of.the Penal Code provides:
"Every person who, with intent to defraud, presents for allowance or for
payment to any state board or officer, or to any county, city or district board or
officer, authorized to allow or pay the same if genuine, any false or fraudulent
claim, bill, account, voucher, or writing, is punishable either by imprisonment in
the county jail for a period of not more than one year, by a fine of not exceeding
one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in
the state prison, by a fine of not exceeding. ten thousand dollars ($10,000, or by
both such imprisonment and fine.
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CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Caim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT December 13 , 1988
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: $240. 00 Section 913 and 915.4. Please note all "Warnings".
C:vi!!Et'y' 4.;ju
CLAIMANT: DAVID WELLS
1432 Mondana Place !i;_?'f
ATTORNEY: Pittsburg, CA 94565
Date received M [ "
ADDRESS: BY DELIVERY TO CLERK ON November 16,
BY MAIL POSTMARKED: November 15 , 1988
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: November 17 , 1988 PpHHIL BATCHELOR, Clerk
BY: Deputy
L. Hall
1I. 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: eputy County Counsel
1II. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
(" ) This Claim is rejected in full.
( } Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date. 3 ��M0
DEC 1 vv
Dated: PHIL BATCHELOR, Clerk, By �Gt 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. 1
Dated: D E G 198'08 BY: PHIL BATCHELOR by (� uty Clerk
CC: County Counsel County Administrator
Clair t 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 per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not ,later than the 100th day after the accrual -of -the cause of---
action. Claims relating to causes of action for death or for injury -to person
or to personal property or growing crops and which accrue on or after _January 1,
1988, must be presented not later than six months 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. (Govt. Code -§911.2.)
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•
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 the end of this
form.
RE: Claim By ) Reserved for Clerk's filing stamp
RECEIVED
Against the County of Contra Costa ) N O v 6 1988
or )
District) CIE roe
Fill in name ) a sT Ut
The undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $ _'2-1/0• o O and in support of
this claim represents as follows:
---------------------------------------
1. When did the damage or injury occur? (Give exact date and hour)
4�1.CZ<l le/--X
------------------------------------------------------------------------------------
2. Where did thepns,
damage or injury occur? (Include city and county)
K-- ie_-- - --�' ��6_�c _ 04 ------------------------------
3. How did the damage or injury occur? (Give full details; use extra paper/ if
required) J y Rc'C A-10 - Pr d(edvlc %�v c I &Cly e /?yitiJ
�G CSC�/n i/� �S (,:..i �� Y
F,gv, Ole A ✓ (1/ l"c>���1>C� i�/ fir �c�l'(�a�e
� f r�
19 4vee C_ c/%C4 q /,N�e
ZL
4. What particular act or omission on the par of county 'or district officers,
servants or employees, caused the injury or damage?
eC ,('c�.9du�4 j 7' 21-e,21-e,CA" PP,C �'FA�P� �✓�s
,�/ 1
U,✓ /`• F /cl,A /j.✓O� Gcic �K��i w &,- f' AlC! C��P.� ,v;,�lc vn ��L
�R t W
/ �ivr/ i,.,)� ,jvi���E(� G/? :�. ��iv�,` 4 ri � 6;l/n. OG'a ! �.1 CG"� AiC �� �i}r.•j�l•
/i C
5. What are the names of"'county or district officers, servants or employees causing
the damage or injury?
Or zc�:J-/� e/00 'All -J,
--�-- Je
-
5. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or' damage.)
8. Names and addresses of witnesses, doctors and hospitals.
------------------------------------
9. List the expenditureslyou made on account of this accident or injury:
DATE ITEM AMOUNT
y
Gov. Code Sec. 910.2 provides:
"Th im must be signed by the claimant
SEND NOTICES TO: (Attorney) or by some person ori-his behalf."
Name and Address of Attorney
Claimant's Signature
Address
Telephone No. Telephone No. `/ 5� 'q 3
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, city or district board or
officer, authorized to allow or pay the same if genuine, any false or fraudulent
claim, bill, account, voucher, or writing, is punishable either by imprisonment in
the county jail for a period of not more than one year, by a fine of not exceeding
one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in
the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by
both such imprisonment and fine.
Attachment for Claim of Damages
November 14, 1988
The exact dates "of when this damage took place I can not recall .
It was during the summer months around June "88 . This was a
large contract to apply a tar/gravel material to the roadway that
took about two ' weeks to complete . Please check with the
department that ,deals with roadway maintenance or perhaps your
contracting department can provide the exact dates.
The road work on Kirker Pass Road appeared to be done by a
Contractor under. County Supervision, because there were few
County vehicles present. The construction crew was laying a heavy
tar like substance then covering it with a layer of pea sized
gravel . They would roll the gravel into the tar and then let
vehicles travel ' over the thick layer of gravel to help grind the
gravel into the pavement. There was so much gravel on the roadway
that it stayed for months . Even with the attempts to use
commercial sweepers the sides of the roadway still today have
hugh piles of gravel .
Although there were reduced speed signs (35MPH) theworkers were
only controlling traffic in one direction. This left the
opposite lanes to travel at what ever speed they_ wanted .
Needless to say they were traveling near the speed limit of 50MPH
which caused gravel to fly from their tires directly into our
path. Keep in mind this is two lanes at this point, 1 in each
direction. One" lane adjacent the workers traveling at stop and
go speeds with men directing and stopping traffic while the other
on coming lanes were traveling at speeds near legal limit of 50
MPH.
We travel this road at least twice a day \and sometimes more. The
everyday travel over this road caused more than 50 small pits in
our front windshield. We noticed during a car washing that some
of the pits actually penetrate the glass which is evidenced by
inside fogging of the glass around the large pits during a wash.
Additionally one large star shaped pit has turned into a
horizontal crack that keeps getting larger.
I might suggest to the County that whatever the method is called
that puts this tar like substance and gravel onto the roads and
then allows vehicle traffic to grind the gravel into the
vement causes a lot of damage to windshields and auto paint. .'
avid W. ells
1432 Mondana Place
Pittsburg, Ca. 94565
Daytime 974-8395
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<•'FRANK-:-SERGI_
CONTRACTORS ,:L; C: # 374336
<----- — -------- --- -------- --- — -----------
QUOTED-P_R.I.CE_-GOOD
PROPOSAL 'CONTRACT ACCEPTED BY: ----------------- ------------
DATE:------------- ------
--':' MIKE R,OSF'S AUTO BODY INC.IDBA --Y- - - ----
I MAKE j�n. } YEAR
'Al� {B
BODY. STY CO
MIL GE LICENSE
------ B86 1739 --' SERIAL NO.
I
INSURANCE COMPANY CLAIM#
2001 FREMONT ST.CONCORD,CALIF.94520 -
A COMPLETE QUALITY PAINTING& REPAIRING SERVICE _._ -. ADJUSTER ` _ PHONE
OWING-FR STRAIGHTENING - EXPERT COLOR MATCHING
NAME ..0 V HOME# WORK# ---
REPAIR REPLACE t_ `ESTIMATE OF REPAIR COSTS PAINT BODY _ ;PARTS SUBLET
I ti(-A
(
71
Jf-i
ulwil
:._.. -
ALIGNMENT
HRS. @a S Per Hr. S
PARTS $ CHARGE AIC
PAINT MATERIALS $ AIM HIL
SUBLET•PARTS S
SUBLET-LABOR S �l V.� STRIPE
STORAGEITOW S COLOR MATCH
TWO TONE
SALES TAX S
TWO STAGE
GRAND TOTAL
ROCK GUARD
THIS ESTIMATE IS BASED ON OUR INSPECTION AND DOES NOT COVER ADDITIONAL PARTS OR LABOR
WHICH MAY BE REQUIRED AFTER THE WORK HAS BEEN STARTED. AFTER THE WORK HAS BEEN
STARTED, WORN OR DAMAGED PARTS WHICH ARE NOT'EVIDENT ON FIRST INSPECTION MAY BE t
DISCOVERED NATURALLY THIS ESTIMATE CANNOT COVER SUCH CONTINGENCIES, PARTS PRICES TOTAL /
SUBJECT TO CHANGE WITHOUT NOTICE.THIS ESTIMATE IS FOR IMMEDIATE ACCEPTANCE. ��J-
CLAIM
, J
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT December 13 , 1988
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: 4 0. 0 0 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: LARRY NELSON JR.
P.O. Box 2000 V-343 J 19
ATTORNEY: Vacaville, CA 95696-2000
Date received November W,r6Tgg8'%DA :S,'�bDJ
ADDRESS: BY DELIVERY TO CLERK ON
BY MAIL POSTMARKED: November 14, 1988
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: November 17 , 1988 ppNNIL DATCHELOR, Clerk
BY: 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: BY: Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( } Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
(This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date.
� ��ea �--
Dated: DEC i 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. ?
DEC 16 199$
Dated: BY: PHIL BATCHELOR by ' 2�dze�e-;,, utylerk
CC: County Counsel County Administrator
^MAIM TO: BOARD OF SUPERVISORS OF CONTRA CO§ ( i yapptlCatlan tp,
�,..,•''f r - "Rei�ur�f�fi�iTllal .
ri -Instructions to Claimant Clerk of the Board
P.t3.Box 911
y Martinez,CallfornIA 94553
A. Claims relating to causes of action for death or tor 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
�.A�Ay
ECHN, 0
)
Against the COUNTY OF CONTRA. COSTA) NQkf 1 5 198$
}
or DISTRICT) C c:;, ;, e o `,;....s _
(Fill in name) ) Q jai, si
De u
. 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 : 7
1. -When_didMthe damage or injury occur?- (Give exact-date and hour) . _
DAX 7-5-S% 61,250 H&)Pb MDF VArItLt►Y BocKI►,16 ND, 8 S- 10438cT -
RF-CC.. No. t�0yt�3
27Where did the damage or injury occur? -(Include-City and county}_---
WAL LE t. AND /L W&b 171-� LOST 1 1 KE t�l�►oc ��y Cao ta�N t�oaNj
3.--How did the_damage or-injury occur? - (Give full-details,-----------------
use extra
if required)
1h/A5 G tvE.N A .PP_aPC-,f,7y a►P At4D 1.i CN1S ,
IN 15_T0RJ4NGL- J3 WHEN 1QAV45FE9RED IHAI t?i�NREZT \/\IA5 WOT
rwtjD aft r9L-E-l0 ►NEa
---------- ___-----------
___________________________
4 . What particular act or omission on the part of county or district
officers , servants or employees caused the injury or damage?
1 H� �MP�.oyY�S NlIS�LA��D 1 t-t�, r��,oPE�i y
(over)
What are -of-of county or district officers, servants .or
__employees:causing the damage or injury?
_ My I��OPE�TY i� tpT: WAl '
NT SIGNED .
ASN 6FEK 66T i.- itkvrz, A C.O�
5. What damage oriinjuries do_you_t c3.aim`resuited?� {Give"full extent!
of injuries or damages claimed. Attach two estimates for auto
damage)
Loss OFA�P�,►2Z1I '•
?,r4liowwas-the amount claimed above computed?- (Include the estimatedii-
amount of any prospective injury or damage.)
8. �hamesrandraddresses�ofiwitnesses, doctors and hospitals. �-'���_______
9. List the expenditures you�made on-account of�this�accident or injury:
DATE ITEM AMOUNT
3
Govt: Code Sec. 910.2 provides :
-- "The claim signed by the claiman
SEND NOTICES TO: (Attorney) or by some person on his behalf. '
Name and Address of Attorney
Cla 'mant` s S nature
AonV-3z/3
Address
VACAu t LLL.CAL if.g5tcft ID-a000
Telephone No. . Telephone No. ,
NOTICE
4
Section 72 of the Penal Code provides:
"Every person who, with intent to defraud, presents for allowance or
for payment to any state board- or officer, or to any county, town, city
district, ward or village board or officer, authorized to allow or pay
the same if genuine, any false or fraudulent claim, bill, account , voucher
or writing, is guilty of a felony. "
._. .. _.. - --... ... __..... -�.•a.. ...«=s1:�....,,.. ...;:.-,.., �:;:uani.a.:.. _> _.... ._,._.,x ......,...i:.:..�,Y.`X.....:.:y;,:r�4++.�,-.baa .Y++i.l{:7ea =''ii.`Sii/i�r —
/- 1T
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT December 13 , 1988
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: X389, 04 Section 913 and 915.4. Please note all "Warn n sr• ti..4
CLAIMANT: RONALD BLASQUEZ N 1V 1Qa8
2550 Davis Street
ATTORNEY: San Leandro, CA 94577 f�a ilne ., CA 0,455.3
Date received
ADDRESS: BY DELIVERY TO CLERK O 988
BY MAIL POSTMARKED:_ November 14 1988
Certified P 850 535 049
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim. YX 19a� gy1L BATCHELOR, Clerk �
DATED: November 17, eputy
L. Hall
II. FROM-
County Counsel TO: Clerk of the Board of Supervisors
{V } 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:
t
Dated: V B Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
( This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date.
V
(4�Dated: OEC 1 3 1988 PHIL BATCHELOR, Clerk, By Deputy Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. if you want to consult
an attorney, you should do so immediately.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant as shown above.
Dated: DEC 1 19v8 BY: PHIL BATCHELOR by "" .puty Clerk
CC: County Counsel County Administrator
ti 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 per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not 'later than'-the 100th- day after -the-"accrual.-of-,the -cause of
action. Claims relating to causes of action for -death or for injury to person
or to personal property or growing crops and which accrue on or -after January 1,
1988, must be presented not later than six months 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. (Govt. Code §911.2.)
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•
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-_the -end-ofathis
form. -.. _.
RE: Claim By ) Reserved for Clerk's filing stamp
P000AQ> C?t_ ASQuE?_ ) - IV
--,
Against the County of Contra Costa ) N O V 1 j 688
or )
District) eou
ty
Fill in name )
a ..... .. .... ... ..
The undersigned claimant hereby makes claim ajainst the County of Contra Costa or
the above-named District in the sum of $ $9 EYL and in support of
this claim represents as ''follows:
-------------------------------------------------------------------------------------
1. When did the damage or injury occur? (Give exact date and hour)
Po v E n BES--��►- `l`8y----C I=3°_ P
H
-----------------------------------
2. Where did the damage or injury occur? (Include city and county)
--------O RR 1 --1��°l N Y-o N -- -i�---�1--- A _R�9 Ko lu f--60T'_R1a COST�- -�----
3. How did the damage or injury occur? (Give full details; use extra paper if
required)
WmILf- 1�121VING ori Noe RIS G9oYou Pb Lifrr fAin.7r F-Koh Fie£S!tCY
PAINrEJ CEroree- lINE (rAS SpieA-►Ep -ON rN-E 41bES ANv IRCAk oF" '7`ME
cI�R.
4. What particular act or omission on the part of county or district officers,
servants or employees caused the injury or damage?
LNr-rL OF RoAt> 54AJS Afiblok CONCS 7-0 SIGivlFY w Er PAiNr,
(over)
Wfiat are-the names of county or district officers, servants or employees causing
' the damage or injury?
CW
_ Ro Al 10 cR -------
6. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for. auto damage.
yCLlOw 'Mitj'r c.9A5 O✓eoe ha3T OF TttE eAR.
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.) _
71 riE Afib i-11q kiA0 VS2b
8. Names and addresses of witnesses,
J040) GLA40V[7- , KENETH M001-z Ro,JALD l046
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
(�c c TTAcM E�
Gov. Code Sec. 910.2 provides:
"The claim must be signed by the claimant
SEND NOTICES TO: (Attorney) or bysome person on his behalf."
Name and Address of Attorney
Claimant's Si tore
;Z55-0 b4v,S Sr
Address
SAO I CAA)DP-2 CA. 9 Y57 77
Telephone No. Telephone No. S6 P—6 700
• * * * * * V I * * * * * * * *
NOTICE
Section 72 of the Penal Code provides:
"Every person who, with intent to defraud, presents for allowance or for
payment to any state board or officer, or to any county, city or district board or
officer, authorized to allow or pay the same if genuine, any false or fraudulent
claim, bill, account, voucher, or writing, is punishable either by imprisonment in
the county jail for a period of not more than one year, by a fine of not exceeding
one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in
the state prison, by a fine of not exceeding ten thousand dollars .($10,000, or by
both such imprisonment and fine.
A
U -LASSIC AUTOMOTIVE RESTORATIONS
1706 A TIMOTHY DRIVE (415) 351-4880 -SAN LEANDRO,CA 94577
NAME 20'1'aU qs e L DATE ��5
ADDRESS 2S�t A"' INSURANCE
CITY ��'�L L-e -^s!L't' PHONE .5� ` ���d'D ADJUSTER
MAKE t.c�c, t�'SS MODEL C IZ)( SERIAL MILEAGEZ,2 3 / LICENSE 96 2-3
Symbol FRONT UtLt St Lob.,Mrs. Parts Symbol LEFT etiesiAT Lobo,Mrs. Parts Symbol RIGHT eR lUr1LT laba'Nit. Ports
Bumper(U)Ex-New C Fender,Fn.d Ext. ,3 G
Fender,Fri.d Ext. '3
Bumper(L)Ex-New Fender Shield ,$ Fender Shield j
bumper Brkt. Fender Mldg. Fender Mldg.
Bumper Gd. Headlamp I Heodlomp
Frt.System Headlomp Door Heodlamp Door
Frame Sealed Beam In-Out Sealed Beam In-Out
Cross Member Cowl-Post Cowl-Post
Stabilizer Windshield Midg. Windshield Mldg.
Wheel Door,Front I G Door,Front 3
Hub Cap-Sm.-lge. Door Hinge Door Hinge
Mull d Drum Door Glass Door Glass
Vent Glass Vent Glass
Knuckle Sup. Door Mldg. Door Mldg.
Lr.Cont.Arm Door Handle Door Handle
Lr.Cont.Shaft Center Post Center Post
Up.Cont.A(m Door Raor Door Rear
Up.Cont.Shah Door Glass T-CI. Door Gloss T-Cf.
Shock Door Mldg. Door Mldg.
_Tie Rod-Ends C Rocker Panel ,3 C Rocker Panel ,3
Steering Gear i Rocker Midg. 3 C Rocker Mldg. 3
Steering Wheel Floor Floor
Morn Ring PLOuar.Inner Const. Ouar.Inner Const. .5-
Gravel Shield ,3 Ouar.-Ext. Ouar.-Ext.
Park.Light Ouor.Panel Upper Ouar.Panel Upper
Rod.Grille,Ctr. Ouor.lower ,3 C Ouar.Panel Lower 3
Rod.Grille,Side Ouar.Mld s. Ouor.Panel Mld s.
Grille Mldg. Ouor.-Gloss T-CI. Ouor.-Gloss T-CI.
REAR MISC.
CBumper Ex.-New 3 Inst.Panel
Bumper Brkt. Front Seat
Morn Bumper Gd. Front Seat Tracks
Baffle,Side Grovel Shield Rear Seat
Baffle,lower C Lower Panel 3 Headlining
Baffle,Upper Floor Top
Lock Plate,Lr. C Trunk Lid Cli-fV- j Tire 42100W �.J
Lock Plate.Lift. Trunk lid-Hinges Trim
Hood Top L Trunk Handle Mldgs. Battery
Hood Hinrje B Toil Light A.1 Point 6 Material .2.C 3E C,
Hood Mldg. At 11 Tail Pipe-Muffler
Ornament Back Up Light Antenna
Rod.Sup, Frame•Crossmember
Rad.Core Gas Tank Windshield T-CL
Hub 8 Drum
Rad.Hoses Axle-Housin
Fon Blade Spring
Fan Bell Control-Arms
Water Pum -Pulley C. E. W tceR A-ALIGN N-NEM ON-OVERHAUL EX-EXCHANGE
Motor MIS. RC-RECHROME U-USED S-STRAIGHTEN OR REPAIR
Trans.linkage C
wMbu►ar
Labor - ,e c His. G-9 S
INCLUDES ALL PARTS AND LABOR. IF ON CLOSER ANALYSIS IT IS POUND THAT AD- Pate >j -�c'•L'C
OITIONAL REPAIRS ARE NECESSARY,YOU WILL BE CONTACTED FOR AUTHORIZATION. S
PHONE 6-66-6?C'0 REVISED AMOUNT Tax
swat s
DATE TIME PERSON CONTACTEC
I NAVE READ A O UNDERSTAND THE ABOVE ESTIMATE AND TERMS. �a 1,s C A G,s'fi i
1 AUTHORIZE I TO BE PERFORMED,INCLUDING SUBLET WORK.AND ACKNOW- /{
LEDOE RE 1 T IS ESTIMATE.
OWNER DATE The DUpllcating Center-San Leandro,CA.
� ^ CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
v ^
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT December 13 , 1988
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: $400, 000. 00 Section 913 and 915.4, Please note all "Wmt�dWyy
CLAIMANT: }UBERT CHANDLER i�0V n �� 11988
c/o Jaoe'u E. Scott, boq'
ATTORNEY: Law Offices of Scott & BaraOttl Mari!;Dez. C/\ 94553
315 East Leland Road Date received
ADDRESS: Pittsburg,ittCA94565 BY DELIVERY TO CLERK ON November I6 1988 CC
BY MAIL POSTMARKED: November 12 1988
Certified P 754 360 046
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: November 17, 1988 epu y—'
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 AlO and 9I0,2, and we are so notifying
claimant, The Board cannot act for lS 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:
DatedBY: Deputy County Counsel
111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911,3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
� �'
.
�
( This Claim is rejected in full,
( )
Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date.
DEC 13 1988
Dated: PHIL BATCHELOR, Clerk, B , Deputy Clerk
WARNING (Gov' code section 913)
Subject to certain exceptions, you have only six (8) 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 946.6,
'
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 l am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today l 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.
���� � � 1����
DEC 16 .�==
uaceo� BY: PHIL BATCHELOR b y Clerk
CC; County Counsel County Administrator
/
erdthew
emorial County Counsel
o WOU&I
AND CLINICS NOV 151988
Pviartinez, CA 84553
To: Office of County Counsel Date: November 14, 1988
Contra Costa County
From: ` Subject:
Finucane
CLAIM - Hubert Chandler
Health Services Director Re: Christopher Chandler
#345823-9
The attached claim, regarding the above named patient, was received via
U.S. mail by Merrithew Memorial Hospital on November 14, 1988.
SP
Attachment
cc: Ron Harvey., Liability Claims Officer
,..�z Contra Costa County
�o
A-301B (3/87)
LAW OFFICES
1 SCOTT & BARSOTTI
A Professional Corporation - ... ...
2 315 East Leland Road
Pittsburg , CA 94565
3 415/432-2955
4
Attorneys for Claimant ;
5
6
IN THE MATTER OF THE CLAIM OF: y
7 -
8 HUBERT CHANDLER , ) CLAIM FOR WRONGFUL
DEATH OF CHRISTOPHER
9 Claimant , ) MICHAEL CHANDLER n /j
10
VS . )
11 MERRIHEW HOSPITAL , ) UVE
and DOE 1 through DOE 10, ) REC
12 inclusive, ) 1958-
M h
Hoo ; ,3 ) NOV 16
o � aZ Respondent . .)
� a
�
A.
u c g z o ; 14 CLERK B RD O ER
U,
S d 7R Mty
�Qa , w a
By
15
g 0 < 6 '
� W p
16 I
U �
u� a
17 Claimant HUBERT CHANDLER , by and through his attorneys ,
18 the Law Offices of Scott & Barsotti , hereby presents his claim
19 to MERRIHEW ' HOSPITAL , and DOE 1 through DOE 10, inclusive,
20 pursuant to Government Code Section 910, et seq .
21 II .
22 The name and address of Claimant is as follows :
23 Hubert Chandler
833' Deltren Street
24 Pittsburg , California 94565
25
26
27
28
1
• ti
III .
1
2
The address to which Claimant requests as -matters inci-
dent to this claim be sent is as follows :
3
4' James E. Scott , Esq .
Law Offices
SCOTT & BARSOTTI
5 315 East Leland Road
6 Pittsburg , California 94565
IV.
7
8 On or about August 18, 1988, CHRISTOPHER MICHAEL
9 CHANDLER , born July 6, 1979, underwent surgery at MERRIHEW
10 HOSPITAL, City of Martinez , County of Contra Costa, State of
11 California . , The surgery was incident to surgical repair of an
12 umbilical hernia. Because of complications , CHRISTOPHER MICHAEL
13 CHANDLER was transferred from MERRIHEW HOSPITAL to Children ' s
F z
F
O o O 2
Waoo > Hospital , Oakland , California. CHRISTOPHER MICHAEL CHANDLER
udg = o 14
egg ;
'`= W died either in route or shortly thereafter . The cause of death
J
; oboU � a 15
J (yu W q
Dom , is reported as hypoxic encephalopathy due to respiratory depres-
; �+ � 16
U �
V 4 sion and failure following general anesthesia for surgical repair
17
18 of ventral hernia.
19 V.
20 Claimant HUBERT CHANDLER is the natural father of dece-
21 dent CHRISTOPHER MICHAEL CHANDLER .
22 V I .
23 The proximate cause of the death of decedent was , but not
24 limited to , improper diagnosis of decedent ' s condition , improper
25 surgical procedures including the administration of general
26 anesthesia, and improper post-operative care. The conduct com-
27 plained of was the proximate cause of the death of decedent .
28
2
VII .
1 .
2 As a proximate result of the misconduct claimed .-herein ,
Claimant HUBERT CHANDLER has been deprived of the society ,
3
4 comfort , and protection of decedent and has been damaged far in
5 excess of the statutory limit of damages allowed in this
situation .
6
7 VIII .
8 Because of the statutory limit , damages recoverable, and
9 of the misconduct of the Respondent that proximately caused the
death of CHRISTOPHER MICHAEL CHANDLER , Claimant makes demand in
10
the amount of Two Hundred Fifty Thousand Dollars ( $250,000.00)
11
12 for the wrongful death of CHRISTOPHER MICHAEL CHANDLER .
F• s IX.
H 13
o <
vc, am� S
o Z o ; 14 In addition , Claimant makes demand for funeral and burial
o� Zg < � 15 expenses in the amount of One Thousand Five Hundred Dollars
3 � o � ve
0 Ln
( $1 ,500.00) .
O n n 16
U �
° X.
17
18 Claimant requests further communication or correspon-
19 dence in this matter to be directed to James E. Scott , Esq . , the
20 Law Offices of Scott & Barsotti , 315 East Leland Road , Pittsburg ,
21 California 94565 .
22 DATED: November 11 , 1988
23 Law Offices
S TT & BARSOTT
24
25
26 S E . St
At orney for Claimant
27
28
3
PROOF OF SERVICE BY MAIL - CCP 1013a, 2015a
1
I declare that :
I
3 am a resident of the County of Contra Costa ,
California.
4
I am •over the age of eighteen years and not a party of the
5
within entitled cause; my business address is 315 East Leland
6
Road , Pittsburg , California 94565 .
7
8 On November 11 , 1988 , I served the attached CLAIM FOR
WRONGFUL DEATH OF CHRISTOPHER MICHAEL CHANDLER on the parties in
9
said cause, by placing a true copy thereof enclosed in a sealed
10
11 envelope with postage thereon fully prepaid , by certified mail ,
12 return receipt requested , in the United States Mail at Pittsburg ,
M
13 California , addressed as follows :
F z
F
0 ° oz II
14 Frank Puglasil , Hospital Administrator
4 C 3 5 t ; MERR I HEW HOSPITAL
z �
o� < 1. 2500 Alhambra Avenue
g H N W a ; 15
Martinez , CA 94553
o ° tea 16 I declare under penalty of perjury under the laws of the
U
17 State of California that the foregoing is true andcorrect , and
18 that this declaration was executed on November 11 , 1988, at
19 Pittsburg , California.
20
21
22 n
23 Terri L . Calisesi
24
25
26
27
28
CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
4 t,
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT December 13 , 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: Unspecified Section 913 and 915.4. Please note all "WaUiT `,`.,,;`;�
CLAIMANT: RONALD A. SPEARS
916 View Drive lY�)`J �' 1�
ATTORNEY: Richmond, CA 94804
Date received (`,lctt"t`sI?ec., G'A
ADDRESS: BY DELIVERY TO CLERK ON November 17 , 1988
BY MAIL POSTMARKED: November 15 , 1988
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: November 17, 1988 RYIL ELOR, Clerk
gATCH: Deputy
L. Hall
11. FROM: County Counsel TO: Clerk of the Board of Supervisors
(✓ ) This claim complies substantially with Sections 910 and 910.2.
( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying
claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: BY: Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
( /This Claim is rejected in full.
( )
Other:
—
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date.
Dated: D E C l 3 1988 PHIL BATCHELOR, Clerk, By__z �--"+ 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 Slates 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.
lutea: DEC 16 1988 BY: PHIL BATCHELOR by ` Clerk
CC: County Counsel County Administrator
r �
BOARD OF SUPERVISORS OF CONTRA COWARR application to:
Instructions to Claimant-Cierkofthe Board .
0=fox 911
t?rtinez,Caillomiia 94533
laims relating to causes of action for death or or injury o
person or to personal property or growing -crops must-bepresented
later than the 100th day jafter the -accrual---6f -the-�*M—*MU6e--of -- -
action. Claims relating to any other cause'•of action'-must be
presented not later than one year after the accrual of *th6' 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 th i c; 'form,
RE: Claim by ) Reserved for Clerk' s fili stamps
f EC I_V
t1 )
Against the COUNT -Y OF CONTRA COSTA)
NOV-1 711988
rr n�
X-7 ) OR
or r
(Fill in name) ) B ....... .f. .. . . . .. De
. 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 aid the damage o injury occur? (G�ve exact date and-hour)
Qe Uk+r,c �-1No�/e u'�. f.j�� Dh a���-U�+�eh �x-'� i�'aj,s c;.�;, f
------------ --------- -- --------- -- -----
2. Where did the damage or injuury .occur. (Include city and county)
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3- How did the damage or injury occur? (Give (fu1 details , }ase ext�ia
Sheets if requir,,ed) I J�J, Lu.� j,. �Ir �'c.U�,f,lt /Lw�
M"T 6' ti� fJa` Ih%•e� J 1 r I �( 1 J ? :lr
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4 What particular act or 'omission on the part of county or district
officers , servants or employees caused the injury or damage?
(over)
�:5.. cers;aate-'him6r; = f county or district offisC
employea-s-:,causing the damage or injury?
-------------------- -----------------------------------------------------
6. What damage or injuries do you claim resulted? (Give full extent
of .injuries-or .dam ges -.claimed Attach two. estimates -for---auto
damage)
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----------------------------------------------------------------==-- -
7. How was the amount claimed above computed? (Include the estimat-ed---
amount of any prospective injury or damage. ) p
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8. Names and addresses of witnesses , doctors and hospitals.
-----------
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
Govt. Code Sec. 910.2 provides :
"The claim signed by the claiman-
SEND NOTICES TO: (Attorney) or by some person on his behalf
Name and Address of, Attorney U
Cla�ma ' ' s Signature
Address f
l�\u f tk 4W., CA fr
Telephone No. Telephone No.
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NOTICE
Section 72 of the penal Code provides:
"Every peison ,;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. "
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ire�
• CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT December 13 , 1988
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: Unspecified Section 913 and 915.4. Please note all "Warnings
..,Ut
CLAIMANT: DAVID R. WIESENFELD
36 Kalan Circle J y, 19
ATTORNEY: Fairfield, CT 06430-4046
Date received 1v c4f-I,: F'z, CA ;94553
ADDRESS: BY DELIVERY TO CLERK ON November 16, 1985
BY MAIL POSTMARKED: November 11, 1988
I. FROM: Clerk of the Board of Supervisors T0: County Counsel
Attached is a cagy of the above-noted claim.
PHIL BATCHELOR, Clerk !C
DATED: November 17 , 1988 BY: Deputy
L Hall
II. FROM: County Counsel TO: Clerk of the Board of Supervisors
( )/This claim complies substantially with Sections 910 and 910.2.
( v 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:
Gated: BY: — `� Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( } Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
( � This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date.
Dated: DEC 3 1988 PHIL BATCHELOR, Clerk, By x- ,-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
Unitee 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.
bck DEC 16 1988 BY: PHIL BATCHELOR by tr y Clerk
CC: County Counsel County Administrator
e��W County Counsel
Vn.f@1%P &L j�1 V 15 1988
AND CLINICS
Martinez, CA 94553
To: Office of County Counsel Date: November 14, 1988
Contra Costa County
From: ' Subject:
Mark Finucane �J` CJ � CLAIM
Health Services 'eirector (� " David R. Wiesenfeld
#463235-7
The attached claim, regarding the above named patient, was received
via Federal Express by Merrithew Memorial Hospital on November 14, 1988.
SP
Attachment
cc: Ron Harvey, Liability Claims Officer
Contra Costa Count
Y
:�O LTJ
ST'4 CUUK'n
A-301B (3/87)
36 Kalan Circle
Fairfield, CT 06430-4046
..November 1 1 , 1958
Tri ty�+r;iir;ictrator
�.
Contra Costa County ,Health Services
IrleCrii�1P-.w r(lr'iaj1 t osnita` ar�r, C! r: cs
Jart'nez, CA
1' h,,)tic.e Of Mellj lc al; f l�lrjr.`,r.ttrts C^?moi
Dear
Cir- ,r' P•j,,r,;Y,�
Notice tc._ rt r r 1'!�Sn ti rr l Ni rCi; rtt ? �f f t ttr"�eCe1t i i�
is hereby giver" � :� � ? ►. �. . .,, to � �� Ute D:. r: in tl�e 'C vil -
P,-C-Ceeu;.,1_ section of Vtl,e Statutes of the State of Ca1,ifc nia, that ! am
Cons derina IDrina,ina a'-i action against this hoSc)ital for order!nu, throuq_h
h t yr ? of r-i , rr { ( Walnut�lr t y r
..: t.? f be in, o!u,! .u, l� com: ,tted to CPC alnut Cr eeK
!-'�Wft�al, aria for the treatrnent I reClerved while involuntarily placed in the
ir!Lprl `'
it-4 k s,+ i C;P!-,faitI
REG t U
0 0�;
tJ putY
ey `