Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
MINUTES - 01121988 - 1.5
15 5 CLAIM BOARD OFkSUPERVISORS OF. CONTRA COSTA COUNTY, CALIFORNIA r :. Claim Against the County; or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT January 1 2, 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: 3,871. 00 Section 913 and 915.4. Please note all "WaQp40y Counsel CLAIMANT: W .J. HADNER DEC 111987 350 Menlo Sourt ATTORNEY: Walnut Creek, CA 94598 Martinez, CA 94553 Date received ADDRESS: BY. DELIVERY TO CLERK ON December 11, 1987 Sup . III BY MAIL POSTMARKED: no envelope I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. IL BATCHELOR, Clerk DATED: Decenber 11, 1987 ��: Deputy 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: fe 11 1 Z-1 4 QkBY: 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: J A I °�MS 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 Orderan Notice to Claimant, addressed to the claimant as shown above. Dated: JAN 1 9 1988 BY: PHIL BATCHELOR by eputy Clerk CC: County Counsel County Administrator VecembeA 80 1987 RobeAt 1, Schroder Board ob Supetcvizou _ DistiLi,ct 3 1410 No. Main. Walnut Cnee.h., Ca. 94596 Dean Mn, SchnodeA., Attached is my claim against ContAa. Coma. County in the amount ob $3,871.00 to %ecover damages to my can, ne6utt ng bnom an unsabe access to the Byron Highway. I have been a 21 yeah nesident ob Walnut Creek and .6houtd be able to drive .in a .6a6eh environment than that expehienced on the Byron Highway while my wi6e and 1 were en route to yo.6emdte bon a bew days ob vacation. OU W. J. Haenen 350 Menlo Ct. Walnut Creek, Ca.94598 (415) 939-1529 � Cf/ 0 G / REL;BfVED Y CCai,m against: CONTRA COSTA COUNTY Ctadm amount: . CHP CoUie.ion Report No. 10-428 Date: OctobeA 28, 1987 Location: Byron Highway (J4) at N. Sunt Way I was the victim o6 a cotti,6i,on when a truck suddenty putted across the Byton Highway 6tom a supposed•2y oZd unused toad and broad"ed by car. The driver o 4 the tAr.ck teadie y admitted that he couCd not see oncoming #ra.66.ic to his night and he neverthe e.66 proceeded to cross over the Byron Highway. There was no atop sign, yiee.d sign of bakAiet to kestA.&A or warn. tta6�i.c on this o td toad. The otd toad is paved and gtaveted right up to .the •Levee o6 the Byton H.ighmy. This situation (tack o6 ptopet safety measures by Contta Costa County) ditec t2y tesu?.ted .in the cotk i•s.r on. The dni.ver and owner o6 the truck do not have .i;nzurance and I have been anabte to %ece.ive a response from them tegatdi,n.g any kind o6 se ttement. My insurance cannier (Patmeu Inawtance Pocity No. 96-108222779) does not cover damages to my cat by an un.i n,6uAed motoA i st. Thus, t iz is my cta im against Contra Costa County in the amount of $3,871.00. Attachments: 1. Paid *voice Byer's Auto Repay., Inc. 2. P•a Zd-,ikvoice - H 8 M Dizmanteer's, Inc. 3.•►:.Ma)p ,z*ho tocati.on. 4; Skitch��ng site o6 cok..ei.s.ion. _•5. #4P os `showing site of co.eedz ion. .`.6, os showing cot i.ation. �.7. IFVJALepoAt o f bra A j.ic accident. S. CHP co.2,QL6ion tepont no. 10-428 9. Lettvw to dpiiver and owner 66 ttucck. 10. CoAA apondence with Deeta Count regarding non-appearance o6 dt.iver. W. J. Haener 350 Mento Ct. WaEn.ut Creek, Ca.94598 Tee. (415)939-1529 December 8, 1987 mWMQ u»vwOKV'1)40 HOidON nOCO-L\es. ^ QQQ Wto rt o� it W 1 < JO\< W W J w\< O 5 p r N U Wco VZ > O Er S¢ Q Wr yt(o� J¢ > OOOF OmUZa St.- �-O-D LH ¢ O m 2-1 2 co HzQ n.LU wMxw d ❑ O Q O LL 0 (nLL zT W �♦ (n0Z01 Q r a Z O y } z (o U.1 +% Q l0 w Q O O r. W w 0 Z V +. 2 cn z co i o w y 0 LO W OQ W 2 z m =7 Z c m 3 ` U ¢ D z d > a Y O 0 — ♦ z a a a U x ❑ U Q. c o Em m Q, a U)i C _ E o m .Q E m ¢ t m m a O � E ° Z CO CID (n _� r m d m o ~-� �o c » t H c� _ z W m m —°m m $ c ° po Q M fW O ' Qm G c ¢� mCn Q a (D U. = ��\x + w z E W - j c° n a o Li. QCo >- t V �+ lr`, fN Q m Y v W a A <U W o _ r ` WIM E \O' f r Z z � Z 41 Ir mpr � m O J = Z a° \ , \�^+ U W v c (Oj m E 3 `o f' ^CL W m U � m m Cc C W r m nY U N x p c Q ¢ cr;m f Z w J _d UmU L a c m m Ccc CD ` W W a Z = z m E z ~ to m c°i 2 U d d Q � A10 , a mi z O y a Q C Q W w < cc CL W ►- �V } 2 W O \ MD W :D Z in AN Q (n H IL \ O o � i. c z - - - '�-,�H 8 M AUTO DISMANTLERS, INC.'•J o USED AND TOWING P.IO. BOX 565LING 5 HIWAY 4A TTBROWN TONE RD. v j BRENTWOOD. CALIF. 94513 pAKLEY, CALIF. PHONE(415)625-2753 s :r . . . , ,.i I. NAME DATE I G a ADDRESS P.O. CITY PHONE TERMS MAKE MODEL YEAR COL95 CO �� �� ✓J ��! e LICENSE NO. SERIAL NO. MOTOR NO. v!1 ! S CASH .❑ row CHARGE ❑ ROAD ❑ SERVICE POLICE DEPT TIME/0 WRIT/TEpti�/,BY-DRIVER TRUCK NO. I P.M TOW: FRONT © REAR DOLLY ❑ PULL DRIVE SHAFT LS G✓ WINCH BLOCKS DESCRIPTION: OVER EDSTUCKIN IN FIELD OR❑ "I LEVEE SAND ORCHARD CANAL a ROLL a OVER•. LOCATION: EXTRA EXTRA LABOR: MAN: ADVANCE CHARGES: STORAGE: FROM /G _ ^ TO: (, �. SECOND TOW PAID • • .. " . - -��'�� wO v 3 'gib T TAX TOTAL ;. i Q! H&M Auto Dismantlers I • 1,the undorsrgned.do hweby certify that 1 am legally authorized and ennr:od to take possession of the above described vehicle,and all penonol prope.ry rherem,and 1 hereby release H 8 M AUTO DISMANTLERS.INC,from any and all damage and/or lou due ro handling vandalism,or MeH, -1 =13 \ ,� CYPRESS RD. 1If TRACT a �, .. 1; � Y Ot � �• Y \ \ I� '�, BACON / ..-gP•lnrR no, , wuuAt \ S TOLE U. IL wLUNO r� '.,.'� �`� \ aUND u19 Rack Z eROwNSro.c ro Knightsen Yl. • OELTA RD. 0[LTA ro. VEALE 1.3 �.6 _ ISLAND .5 o +�!�.:s TRACT WAY \ 1 LOWER PALM Y awRr sr wns[r ro. l! \ rDWEs ]s ' TRACT ���, //�., TRACi p, /r 51 AYE �c 1 �� swoa AYE I j I� '7 LL 76 DEMDaa •� ro � —Brentwood \,\ ]' ORWOOD �!ountt AYE SRENTWO00 wD. W000WARD �M6{AIIIIEN ro. /�; AONES a ro. SALFOUR ED. f/h TRACT TRACT \\\ \\ i !BUND I �• Indian l I gr, CORE" AYE Il'nndua7d Canal MTNC 2.5 POINT Or TIMSEE NONO. Victn7lav Canai a v� k-ARS14 CREEK i \ R ] RD. BYRON - 1: VICTORIA of s a \ l 1.5 Nalm cam \ !BUND (� 1 MIMO 's � u TRACT EO SCprYA COSTA CO. SYEE �� nl p,A AAMCr / [a O ° I Bron 3.5 U111.0 v too )n o i CONEY G• _ .. GatoP ISLAND lJIJ UNION I H ISLAND Pr Gmnt Lin, Canal : r,. IRROITN ro / o Fabian and 8,1f Canal // ci pOH' aa G- DELTA PVWPNIQ ILANI.% TRACY NAKP SrArgNv aim ,ID 41 �CouN� 8 EiBethany INTAIN 4.5 1 • '-:.��.>-LLYti'.s ��..--.5�3.c1 8 _..� +Y 2rta.'k� .fY s'` Than, '_.•Na :.�_-� wANY Ln.e _ Mountain House 1 25 V 1, w.� N " F a'- '� T.d 'f �r r � K� � I,R �� �� • C rpt {f l��! I� ,..� Vit ,- r -�t � �, r ''•" � 1�r,,.: �:`s oa Ir 1t i � ��!a.,,s r "F'` `•fir � � a �I-t.ice Y .. ��� _..-.. • �� 07 ` REPORT OF TRAFFIC ACCIDENT _ —7 Every driver of o motor vehicle involved in an occident on a public street or highway resukirlq in jnryry or death of isny person,of property damage to any one person(including the driver)in excess of S30Q DMV File No. •M AI must,.ithin TO days,teparr the ocadem on this form to the Department of Motor Vehicles. DEPARTMENTAL USE ONLY • MAIL THIS REPORT TO •_ ' DEPARTMENT OF MOTOR VEHICLES—FINANCIAL RESPONSIBILITY 'ASE PRINT P.O.BOX 9a2t18A.SACRAMENTO.CALIFORNIA 94284-0OOI ONTH 0.1 YEAR HOuw . iDe�►/T SrdJc T 2 8 '967 8.3 0. QK A.M. ❑ P.M. LOCATION O•ACclost— CT COVNTY PARKWO LOT - a YR Oi•L w r-0'4-C1;A Cos7a I ❑ YES No - MeeR va-64A IN.='CENT FA MYw PERSONS INI —EUR PoesONS Kuno `=' YOUR VEHICLE 11 OTHER VEHICLE-.. . ... _ m Stooped .. Legalty I Stopped Lega(y in Traffic Moving ❑ Parked ❑ Pedestrian ❑ Bicycle ❑ in Traffic 04 M.—V ❑ Parked ❑ Pedestrian ❑ Bkvcle ' ra"NAME IFIRST.MIpOLL LAST ORIVER'I NAME VIR[T.MICI LAST 11 t.LLA-AA Soy£-Pt} R KF-114 PI, KFNnLE-17A 8 EAR V 19w ADDRESS INUMYR AND ITIII a111vaR•Si AOCREUE tNVMSER AMC fTRasm .. 350 MEfLt_ti GT • {�T. 8o1c�{ By{t�oNt Rcrr- SeRtc445 P+P• sTAtt ss►COO[ CT STAT[ aP Coca -' V AL_Tyl u T GHEE-k4,, if 4T%c(>{sq 8 s�(ae[•t, ca q L{s t-t rlw a .NFA WV«eeP ANO trI D•T[OF e11T•• OXIVee LICaNaa wV«vee•Mo ZrATEI OAT[OF SIXTH N�1 08�-1g90 CA t0 Z i? R ('04(j-7;L C-P4 M OF V[MWC x You WERE DenWa OWST.WOOL&L zn OrrNIR OF OTHER VSMICLE IIRZT.MIDOLK.LAZi1 SAME- ` L-�.RP• 'QoFFEtlt�oT Russ wUMYR AND SrR[ET ACCRUES WUMS/R AND STREET) •• STATE V.coo! cT ITATE ZIP COO! 'Ella DRIVER uCENY IMuMaam AND SID•tt OP m.— IIIOWNIR•I Dwrvtw LICENSE WVMSlR AND TATO DATE 10 WITH .o-UY,TUM w0.UT.'s— ICL[YOU WERE ORIVwa MEAN AMO MAKE SOOT rrPa OTHER VaMICLE(YEAR AND MAXIM I IODy Type 4 81 a a.0 X VP, C? 6 S rsM G AX -«y u crC ICu uca" a ENC-[oR Lo.NUMaEw Iva.'.ucENsc lNau+e ow IL""NIDE - - vs��s1 CA 4.4 CA 9�B4 4-7z�Z ..a 714 ESTIMATED COST OF w[PAlws 118—TIO COST OF RaPA.11 _ S 1+ CAi- Pu--i• 1�6 3 3 0 S � � 'e You Drivi a Vehicle Owned by Y~ Employer and With Was he/she Driving a Vehicle Owned by on Employer and NTdh nasion? L�Yes No Permission? Yes ❑ No •_ . aMOLOYIR•I NAM[AND AOORIES1 [MPLOT[RS NAME AMO ACCRUE -as If Yes DF � RQJT SAMA(✓ ASS QOlf� "AMI aP OIdaCTIT Ov-9 2 HAM! NO ADORSa[ MAGE ty[otl£ OTHER NATURE OF DANAGY EITMATED COST TO 0121 OAMAaE OPERTY s - INJURIES AND DEATHS CAUSED BY THE ACCIDENT M.M[ AG( I • . ❑Driver ❑In Your Vehicle ❑ Bicyclist ❑Passenger ❑In Other Vehicle ❑Pedestrian A000923 TYPE OF AI El Fatal - - rLo ae- I NAM[ .. Aaa ❑DriI C3 In Your Vehicle ❑ Bicyclist - ❑Posserger [3Ot lel her Vehicle ❑ Pedestrian - - ADORES) I TM oP IwunT Fatal l I o policy of L1ABIUTY irlwromee or o bond,covering the operotion of your vehicle DEPARTMENT USE ONLY - Ifect at Iims of accident? Yes ❑ No 93 GWS NAME OF WSVRAMCE COMPANY OR SU.97V COMPANY IMOT AaaNCT p"Y ON 00.0 MUMMER - 1 A.FLv1ES�,5 I Use NC..c. 1%6 t O8 2'J— --7 -7 ERTIFY UNDER PENALTY OF PERJURY THAT THE ACODENr INFORMATION ABOVE AND THE INSURANCE DRMAMN BELOW(If ANY) 5 TRUE TO THE BEST OF MY KNOWLEDGL (PERJURY K PUNISHABLE BY RISONMENT. FINE OR BOTH.) - - c[D.T 111 DATE SIGN MOVE - -- --- ----- - --- --- ------ -------------- ------ - - -- - - -----------I INSURANCE OR BOND INFORMATION DO NOT DETACH DMV FILE NUMBER 1LIFORNIA ih.O.vo anew—Ws the Pa.to the ins—enc.--pawy or surety c—speRy iwdREted.B net hAY c.."lcMd.it mill M msM.Md Y••.....not imsered or hondsd for The eccidewt. . NAME OF INSURANCE COMPANY OR SURETY COMPANY w (NOT AGENCY) THAT ISSUED POLICY OF LIABILITY INSURANCE FAf�MfLF4S t NS I OR BOND CQVtRING THE OPERATION Of YOUR VEHICLE j POLICY Ow SONO"VM/q POLICY OR SOMD 0110100 L q 6 10 8 2.— IL'T 7 4 •.o C—1-1 —eq To 3-IS-86 am-..N.....NUMaER 1 DATE OF ACCIOENT 1 w ORNEAR CT OR TOWM �En Yp• a f5`(liofi R1414WA'%( Wfl8g7 qo C-Pt MAKE OF Yauw vWQCLETTM Yat [MOWS M t0.NVMYR VEHICLE LICINiI C A fl �.ptL LP 1�8 l !66Ais�{l q�B 9 i1zzae R"M... Na.T.To . ID?R'i5 GA • ol/Ivan tawnaR . ADDRa" ADDRESS i 350 ME k--1 La GT . + Vv p►l�p1l t T C- r--L-,as x Ck 4 Sclg CITY STATE esI• ' I A wv..IEr r a►I . 1 i 1 - I 7 --� �•-'- - �C� t !717- `G - - 7-7 -r--- �-1 JI �j _ 4eAl TAAFFIC.COL LISION REPORT /MOV �v `,� PACE DF &7[GK CO.-ploN{ NUMBERI T E RUIN QTY aAIUR[D FELO04T JUDLCI4 ONTTaC'T MLBWatR ♦ ❑ N' /Q _ 8 HUMBER MIT 1 RLb COUNTY RE PORTw;.DKTRICT BEAT � O � V BILLED BOSO. � ❑ COILISON OCCURRED ON _ ___ BBD. pAY TEAR Tm(a" NCC E OFFICER LD. � BBILcrosTR•PDRM•noN ----� ---��-•-- 7 :g O F OAT OF WEER TOM AWAY NOTOORA OV: OG e SMTWTFS ®T[somm V ®AT aVTERfECTLON MR►N ^ ,An HWY REL OIL: RETl IXLES Oi // / [� / /2 []Yu No p(I NOMe PARTY DRIVER'S st wml.m -CTEAVT[ CUSS SAFETY VEIL TIL BBARE/MODEL ICOLOR /�� UCENS[NUMMER STATE EouF, v � 1v /V6 C u V'>2 CA P �S. �.�.� . ? l/1�4f.�. R NAN RST,rOOLt.LJLBf1 ,J av y PEDES. STREET ADDRESS �Q OWNER'S MAPF ❑ SAMt AS DRIVER TTY AN Cl tz el n 7-- PARKED CITY i STAT&I ZIP OWNER'S ADORES SAYE AS DRTV[R T[HIC u , ❑ y 9 OCT. 64E[ 1WR TES MEIOMT WEIGHT •ATHOAn RACE pfroSITION OF YLMG[ONOILDERS Oi. ❑OFFICER ®DRIVER a OTHEA OUST NO. DAY • T(M 1:1IVH OTHER MOPE P••ONE - aUSNESS PHONE M INVOR YECMAWC AL DEFECTS: NONE APPARURy1 REFER TO NANMTIV[ . ❑ �I O ��i , CHI,US&ONLY TYPE DESCRIBE VENCLE DAMAGE IN w OWAG[0 A"A INSURANINSURANCEARRI SNCE CER POUCYMUMBER aLINK. ❑NOM[ aBOBOR • . is MOD ❑MAJOR OTWAL pR.OF ON STREET OR NONWAT S►EEO PCF /.;Z B :3 3 1wAyE� /I CG/L OSS LIW �C IFJ,' S PUC o S g o v _H• ❑ r-> PARTY DRIVER'S UC&NSi NUMBER STATE CUSS SAFETY VEIL TR WKE/YODEL/COLOR LICENSE NUMBER FTAT[ 2 E .. ONVER NAME(NRST,BOODLE.UST) w .g PEDEL STREET ADDRESS OWNER'S NAME SAYE AS DRIVER MAN PARKED CITY I STATE I D► OWNER'S ADDRESS SAYE AS DOVER VENIC Lt MCY. SEE IWq �Ylg,GqfT WEt NT BIRTHDATE RACE DISPOSTION OF VENICL&ON ORDERS OF: a OFFICER �DRIvtIL 0 OTHER CLIST WO. DAY TEAR❑ � y OTHER NONE PNON[ BUSINESS►MON[ PRIOR MECMANCAL DEFECTS: NONE APPARENT' 10 UP[R TO NARRATIVE ❑ ❑ /I,S / • ~/ CHP USE ONLY DESCRIBE VENCLE DAMAGE WRADE N DAMAGED AREA INSURANCE CARIOLR POUCV MUMBtR .Y(NICLE TYPE QMOO..0 MAJOR.O TOTAL Din OFOM STREET OR IWGNWAT S►E[0 PCF CC ❑ TRAVEL LINT PNC ❑ CMP ❑ PARTY DRIVER'S LICENSE HUMSER STATE CUSS I SAFETY VEIL VP- WARE I MODEL I COLOR LICENSE NUMBER STATE 3 &DRIP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DRN ER NAYS(FIRST.POOLE.UST) ❑ PEDEL STREET ADDRESS OWNER S BYMEa TAME AS DOVER THAN PARKED CITY I STAT[I[IP OWNER'S ADDRESS Q BAYt AS DRIVER V[NCLE ❑ "II I am SKB BWGNS WOoMT r0. W MAV Tt: TVR %"a DISPOSITION of V&POCL9 DM ORDERS OF: tSt Qo [R DRIVER El D DTHER i OMR BOY&PHONESO ES►•ION[ ❑ � � M� � POOR Y[CILAgCAL D[FErn: YON[Aww[► a IItFER TD NBRRATW[ ❑ CMP LAS[ONLY D[SGRIa[WINCLE DANA" SMD[IN DAMAGED AREA tl[NCU TY►! POLOLANCE CARRNPOLICY NLra&R R O 1/aL Q mewB27AL I pBB00. OBBAJOR W.OF 1 ON STREET qR IOOMWAV MEEDPCF PRIUC O ' TRAVU WT CHP ❑ PFIEPAR[R B NWA AS MEW&R'S NYJ DATE REYL[W[D /^ 9 -� (8/ ..HP 555-Page t (Rev. 7-87)OPI 042 •OwME WS wNaTE �ODRESE PROPERTY ' DAMAGE � R, �--:'_ —:�.��.,t+.T:,_�'ire,$��-I•y+�-�F:_' _ �' la--.-�11D DEiCwrnON ON DONNAS[ a-.r-c,.- - - - ' - •c+i _:�...ir�-�'3..7!.�.-�-•. ��-.�..,+iia.:.=� ._� - SEATING POSITION _ UPANTS SAFELY.EQugi"rzti=:: �''" -- C.M.EAOY��EA - - I-DOVEROCC A•NONE IN VEHICLE -3%'7UR _ i��' '�•_ ' ~ 2 TO••PASSENGERS B-UNKNOWN T•ETA WGK REAR c-LAP BELT USED _ = :_= -it: ailiTLV -- ... •.RR.OCC.TRK_OR VAN 0-LAP BELT NOT USED y:lNIIt = =.�'W _ =- - 3-Lgduoo IN �-POSITION UNKNOWN E•SHOULDER HARNESS USED 7 1 23 0-OTHER F•SHOULDER HARNESS NOT USED Qi RIESIp�I.rr. PASSENGER 4 56 G-LAP r SHOULDER HARNESS USED 0-IM vBOME USED i-IID - N-LAP/SHOULDER HARNESS NOT USED R:IN VE1 l E NOT USED " V-VES 7 _ J-PASSIVE RESTRAWT USED S•IN VEMGLE USE UNKN0WN K-PASSIVE,RESTRAINT NOT USED T•M VEHICLE IMPROPER USE U•NONE IN VEHICLE ITEMS MARKED BELOW WHICH ARE FOLLOWED BY AN ASTERISK(•)SHOULD BE EXPLAINED IN THE NARRATIVE PRIMARY COLLISION FACTORTRAFFIC CONTROL DEVICES TYPE OF VEHICLE , 3 MOVEMENT PROCEDING 1 LIST NUMBER(/)OF PARTY AT FAULT Z 3 8 A VC SECTION VIOLATED: a yrs A CONTROLS FUNCTIONING A PASSENGER CAR;STA.W COLLISION _ONTROLS NOT FUNCTIONING- B FASSENGEA CAA W, LER A STOPPED B OTHER IMPROPER DRIVING C CONTROLS OBSCURED C MOTORCYCLE/ TEA B PROCEEDING STRAIGHT D ND CONTROLS PRESENT/FACTOR 0 PICKUP ORP L TRUCK C RAN OFF ROAD C OTHER THAN DRIVER- TYPE OF COLLISION E PICKUP/P El TRK W/TI D MAKING RIGHT TURN . p UNKNOWN A HEAD-ON F TRUCK RUCK RACTOR E MAKING LESS TURN e E FELL ASLEEP' B SIDESWIPE I G TRK/ K TRACTOR W/TLR F MAKING U TURN C REAR END I H scmoqL BUS G BACKING WEATHER I MARK I TO 2 ITEMS 1 D BROADSIDE I OTH§4 BUS H SLOWING/STOPPING A CLEAR E HIT OBJECT J EM GENCY VEHCLE 11 PASSING OTHER VEHICLE B CLOUDY F OVERTURNED K Y.CONST.EQUIPMENT j CHANGING LANES C RAINING G VEHICLE/PEDESTRIAN ICYCLE K PARKING MANUEVER Q SNOWING H OTHER% oM OTHER VEHICLE L ENTERING TRAFFIC E FOG/VISIBILITY FT. MOTOR VEHICLE INVOLVED WITH N PEDESTRIAN M OTHER UNSAFE TURNING F OTHER': A NON-COLUSON O MOPED N XNG WTO OPPOSNG LANE G WIND B PEDESTRIAN 10 PARKED UGNTING C OTHER MOTOR VEHCLE P VERGING A DAYLIGHT p MOTOR VEK ON OTHER ROADWAY OTHER ASSOCIATED FACTOR Q TRAVEUNG WRONG WAY B DUSK-DAWN E PARKED MOTOR VEHICLE (MARK I TO 2 REMS) R OTHER' C DARK•STREET LIGHTS F TRAIN A vc SEVIION VIOLATION: cmO D DARK-NO STREET LIGHTS G BICYCLE Qrss ONO E DARK- STREET LIGHT'S NOT H ANIMAL: B vc SEcTION"OLATKTw: c3no FUNCTIONING* MEs ROADWAY SURFACE SOBRIETY-0RUG I FIXED OBJECT: O� PHYSICAL A DRY C vc"cnON VIOLATION, arED Own ( HARK T TO 2(TENS) C SNOWY-ICY K Y OTHER OBJECT: !J 13"O A HAD NOT BEEN DRINKING C 1 N6 G SLIPPERY(MUDDY.OILY,ETC.) /R E VISION OBSCUREME : B D•UNDER INFLUENCE F INATTENTION 0-IAT UNDER WFLU.• pOADWAY CONDITIONS G STOP A GO TRAFFIC HBD-BtPAIRMENi LINK• MARK I TO 2 ITEMS) PEDESTRIANS ACTION E UNDER DRUG INFLU.• A NO PEDESTRIAN INVOLVED H PREVIUS/LEAVING RAW 7ON F IMPAIRMENT-PHYSICAL' A HOLES,DEEP RUTS CROSSING IN CROSSWALK 1 PREVIOUS j UNFAMILIARR WITH OWITM ROAD G IMPAIRMENT NOT KNOWN B B LOOSE MATERIAL ON RDWY- AT INTERSECTION K DEFECTIVE VER,EOUIR: ano H NOT APPLICABLE C OBSTRUCTION ON ROADWAY. CROSSING IN CROSSWALK•NOT 13YES I SLEEPY I FATIGUED CONSTRUCTION•REPAIR ZONE C AT INTERSECTION 13010 SPECIAL INFORMATION E REDUCED ROADWAY WIDTH I p CROSSING•NOT IN CROSSWALK L UNINVOLVED VEHICLE A HAZARDOUS MATERIAL F FLOODED E IN ROAD-INCLUDES SHOULDER M OTHER': G OTHER% F NOT IN ROAD N NONE APPARENT H NO UNUSUAL CONDITIONS G APPROACH/LEAVING SCHOOL BUS O RUNAWAY VEHICLE NctrcN rsN:EurNEous V'� Nwo •rt V N C �rr C , CWP SSS•Pgpe 2 j Rev I-117)OPI 042 87 4�63F s►•TE o'cu/FOR/a'A INJURED Y VRTNESSES / PASSENGERS PACE 3 DATE OP TIME 04m) _74-11A OFFICER I.D. EXTENT OF INJURY ( "X" ONE ) INJURED WAS( "X" ONE ) Ywnlni ►AisENO[R AGE "x PANTY BEAT SAFM EJECTED OMIT OMIT FATAL SEVERE OTHER VMISLE COMPL/UIFT NUMS[R FOR. EOUF. INJURY PULPY KIuRT OI PAIN OW49M PASS FED. OCT UST OTHER ° 1:1 ❑ ❑ ❑ ❑ ❑ ❑ ED ❑ ❑ NAME J D.O.S.,ADDR[i TWPNONE G 1 ^/ 5 ONJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIB[INJURIES ❑ lacm OF VIOLENT a.ME N wwo 1010101 0—Tol I T7 NAPE,O.OJ.,ADOR[SS hIONE 8- ONJURED ONLY)TRANSPORTED BY: TAKEN TO: A DESCRISE INJURIES ❑NC IM OF la"INT CREW NOTIFIED NAME J D.OAL/ADDRESS �, R TELEPHONE OWURED ONLY)TRANSPORTED BY: TAKEN TO: DESCIBSE WURIES ❑IRCTIM OF VmxZHT CJWE MOTMED ❑u 9 F ❑ ❑. ❑ ❑ O ❑ ❑ ❑ 101 ,;031z-. NAME J D.O.I J ADORfSi TELEPHONE OWURLD ONLY)TRANSPORTED by. TAKEN TO: DESCRIBE INJURIES -L ❑W."Im OF VIOLENT Cs"m NOTIRED D� ❑ I t ❑ ❑ ❑ ❑ 1010 ol ❑ 1131 wAME-0.0 S.,ADDRESS TE:EP-ONE ONJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE WURIES ❑ Inc I 1 OF YNOLENT CJBME 007mO ❑" 10 1 1 ❑ ❑ ❑ ❑ 1010101 ❑ I ❑ "ME/OO L/ADORES TILLE"aw ONAMAD ONLY)TRANSMIMU BY: THEW TO: DEICRIBE B•KIRI[i ❑ vcTw OF"Kra ptlt MOTMLm PREPARER'S HMW LD.plum"It MO. DAY YEAR REVIEMs"NAEt ENO. OAY tl CHP 555-Page 3(Rev.7.87) OPI 042 E/ • 3l O.T[ O• tGYI�.�Olil •Iy[ 17 .01 co Yratt� _a_�r = v� ALL MEASUREMENTS ARE APPROXIMATE AND NOT,4' KLL '":-W i T&4iS l {�•_ y,r._i3 "' _=•� - U•�-c*Sb . 1 to v=a �- c Ll a "am"e, wWroaa ro. •.• •o JQ�gg�i l CMP 555—PW 4 Mev 11.851 OPI 042 NARRATiVE;S'J?PLEMENTAL-' PAGE D-9 O/ OwIG INAL IN CID[NT 0 TIIJa (Y001 NCIC MUMaaw D►►IC[w I.D. Muraan O ro♦ DAY Tw. ON[ "11"O.w TYPE su••La.IaNTAL ("A"A►/LICAa La) . IS NARRATIVE COLLISION R[►ORT ❑ RA UPDATE ❑ FATAL ❑ MIT Q RUN UPDATE ❑ SU►FLEIAENTAL ❑ OTMEN: L_I MA2. MATERIALS ❑ •CM00L RUB ❑ OTNER: CITY/COUNTV/JUDICIAL DISTa1CT In".DIaTwIcT/aEAT CITATION Ww"aaw LOCATION/auaJa CT [TATE M10"-AT wa LA TaD YES ❑ No 1. 2. 4. 0 2 .� 5. > So > 7.ZAooP V Z .� `" L_7- 12 L s. C/,� o 10. �v 7 1,. S y O ,00 14. 15. 16. c7 18. V 20. 21. VbWj L 7'i� `--D Ply 12 22.?'- CAI A4 eg 2 12 f L1,4 1 y - r 23. 24. c = T w a v 25. o 27.'7'W 28. .. 2s. V u 30. ge ►wa►ANGR'[NAra I.D,Nuraaw ro. DAT TE. aEVlEraw'a NAra ro. RAV Tw. . & 06 e -.cz 9 2 2 CHP 556(Rev 12$4)OPI 042 Use previous edition&until depleted. m 404" rvr.nnH �,v crJurrL twlclyI NL DATE oO _owIGI-AL 1-CI69NT TIMI l7ASO) -CIC Nv..aN "f•• Nf "R•'oN[ T.�[ SY��Lf rf RSAL�\ x 1 _~'� _=� - _ _T•"�•cti�s_ _ _,r...��-:.::.r ..a,... _ �?_ _ - - - _� •'rte 1 C� NAR RATIVt COLLISION IMPORT RA UR O [ATy � _• ?! l..q ?�" �tD`. 1[YN ylail - SU►►L[M[NTAL � OTHER: O NA2. MATS R7ALl�:'--� ��'f CN_OO L'af-~' '�•L..r�TNtR: CITY/Cow"fT/IYOICIAL RISTwICT _ wwT.wIST-$cT/wfAT CITATION RVrwfw - I LOCATION/SYSJf CT 7 - '- - STATE NIG"WAT wSLATfD n n � L: rt5 NO 1. 2. 3. • i 4. 9. iJ A O 10. .J o c.>T D3'0942,12 12.0& > -e-;,,12 Y v 14. S o Y JA 15. 7 19. 4 ,t7 iJ G 45i9.'J 21. v 22. v o G D0,0V 23. 24. 25_5'.47,o"* ` s' 00 T >'- V& 26. N ...r K� 2� 9 •ov 27. /a P�"02 o �o ��.g c y /two r� - J >>r�sss 28. ka& -A- 29. 30. &V 31. �J IZO 101116►ARf R'S MAr Lo,Nurwfw ro. eAr TR, wavlf�fw'S wArf ro. OAY ... CHP 556(Rev 1284)OPI 042 Use previous editions until depleted. ee MM74 WARRAt1VE!SUPPLEMENTAL PAGE lTa 01 OI.1i1wAL two*) MCIC MW.Saw _IDIIICa11 I.D. MYMaaw 67) o•.�� --DAT' iw. Q. "P"•e«c ^a"ewa TIPS SUP►La-aM/AL )"A•'APILICASLa► NARRATIVE COLLISION REPORT {�! [A UPDATE FATAL MIT RUN UPDATE i DSVIPL[-ENTAL OTHER: HA2. MATERIALS LJ SCHOOL ■US Lam: OTHER: CITT/COYNTT/JUDICIAL DISTRICT Rh.101010ICII09AT CITATION MU-Saw LOCAT/OM/SUaJa CT STAT[ MIOMIPAT MCLATaD t :_I TEs L: No 3. Z2it) 7'iy 0 7. 7;;-,.!:, y/ d 6. 1 9. 10. IS 12. .a G Y d 14. y- w 7- RZ2 O't-J, w.9 Y .m 1 16. 1�. yIIA42 - - OBJ 0 c>.I-�S W S' i9�v D fi✓A .5 19. N ec es Z. 20. u.J 5' - a c// 22.E 24. 25. /1 O 26. 27. T o 28.IZ - S y- lJ y V .•/ i 30. T• V s1- 92 s /ti d ►Ra PARA R'a NA a ,e.Nu-Saw -e. DAT VR, Rtvlt ara w'a NA-a RIC CMP 556 IRev 12-941 ON 042 Use previous editions until dn)*td. �'0"" rrAre o• u�l• N'AFIRATI`O�E"wN/uSUPPLEMENTAL PAGE 8 oA.[ D� ew;o INAL IN GIo[N♦ +Irl (aAN) INCIC ca. I.D. wurR[w 1u. ror DAY Yw. O I I O -L4 2$ ••A•''a.[ ••71••ON[ TT•l SY►►L[r["TAL ("A"A►.LICADLl1 j� NARRATIVE COLLISION REPORT !C ■A UPDATE C FATAL G NIT A RUN UPDATE CSVFwLMM[NTAL O OTNCR: D NAZ. MATERIALS C SCNOOL DUS CI OTHER: CITr/COUNTY/JUDICIAL DISTRICT I*".DISTRICTIOZAT CITATM.RYr•[w I LOCATION/SVIJICT STAT[RNNDAT�w1[LAT[D E: L: VMS NO z. Y 11 ! 00 3. a. itJ d YC 12 V / w 5.eV C o C6. H I 1 7. I 8. 9. nJ a o 10. 11. p Mdad I� 12.OfI2 O y �- , A Jr/C iJ_S t3. 14. Y ' 15. AI 6 /✓ �) 16. • 1�. 18. S 7;9d= FLI-Z -y,�.sn s�- SSS► 5 r.�7�� 1s. > I i 20. ' 21. 22. 23. 24. I 25. 26. 127. I 28. 29. 30. _31. •wtwAwl•'S MAUI ll-*1111-090 1-0. *AT Tw, RIV/lw■w'S MAY■ IrO. DAY rw, 1 I :HP 556 IRev 12$41 ON 042 Use previous editions until depleted. November 15, 1987 Bryan Kenneth Beatd Rt. 1, Box 4, Byron Hot SpAi.ngd Rd. Byron, Ca. 94514 Thi6 Zettex pvhta inn to the eo.e .bion on the Byron Highway (J4) , October 28, 1987,--caused by your operation ob the GMC tPu Lck (hegiztened to Lanny Po bb e,vtoth) , which %ezueted .in major damaged to my car. The CHP tnabb.i,c cottizion nepott number 10-428 eonctuded that the eo.P.ti4 on was cauaed by you in "i.ng exth.emety poort judgement in tAy-in.g to cAodd a bu6y highway on which you eouZd not dee approaching tnabb.ir-. W.i tnezzea appxoach.ing a both di tect i.ond have dubdtant.iated that it w u6 totaUy your bauPt and .there wze no way we cou.ed have avoided the eo.P.Zia.i.on. Whiee . there wad no .immediate indication ob .cn jun,i..ed, I have .6ace that event experienced dtibbnu.6 and jo.tnt pain in my neck, upper back and dhoueden. I am euntentZy nece i.v.ing 'medication bnom my doctor. Damaged to the can were majora. It wad. not dn,i.veabZe and had to be towed to the H 8 M Auto DizmantZena, Inc., in OakZey. Bdtunatea 'wete requested bnom Mazzei*Cadittae/Antioch, Cagey Auto Body/Brentwood, and Byen'd. Auto Body, 'Inc./Mentwood. Dney Byet'd. nedponded on a timeey ba.6i6 and zince the cat wa.a dub jest to daily dtoAage changed at H 8 M we went with them. MoneoveA, we agrteed to the aze ob uaed pants .in ondeA to minimize the coat. The nepa u 'ante not expected to be eompQeted until the wezh ob Novembet 233, do you can .tnapect the damaged i6 you do ded.!Ae. So. ba-t the total .t6 a.6 yottowd: (See attached estimate and paid .invo.i.cc.r, H 8 M Di.6ma t?-eAz i- Inc. $ 149.00 Byen'd Auto Body, Inc. 3;722:00 $3,871.00 PZeaze pn.ov.ide me with the name ob your .indunanee eannie)t. IS you ane not coveted by .cndunance I mudt demand dettLement, cm,%ent2y totes t ng $3,871, within 10 'dayd, of px.iox to the time that xepa.uts have &en eompZeted. I b you do not respond within this gime t m.it, I wiU have no at-term t i.ve but to take Zegat action. I*iizLU never tet this mattet just bade away. Quite the contrary, and ib nequixed, I w.itt vigonou Zy puA4ue a.Pt a6pec .6 .through count action. 'you can put this unpteadant matter behind u6 aZt by bonwanding a cv tib.ied bank check .in the amount ob $3,871.00 *and, I w.itt hereby wave any a.ddit i.onae demand, .cnceuding but not Limited to medical, can %ental' and attoAney beea. W. J. Haener 350 Me.neo Ct. WaZnat Cxeek, Ca.94598 cc: Lanny Pobbenxoth ti. . 215-654 •'- MUNICIPAL COURT OF CALIFORNIA, COUNTY OF CONTRA COSTA DELTA JUDICIAL DISTRICT The People of- he State of California vs . BEARD . . . .. . . ... .. .... .. . . .. . . . .. .. . . .. .. .. . .. .. . . . .. .. . .. . . . .. .. . . . . . . . . . . . . .. .. .. . . .. . . . �.Mdent�s� Action No .. 604594-2 To: WILLIAM J . HAENER 350 Menlo Court Walnut Creek, CA 94598 PLEASE BE ADVISED THAT THE ABOVE—MENTIONED DEFENDANT DID NOT APPEAR ON HIS SCHELDULED COURT DATE . THEREFORE, THE ONLY ADDRESS WE HAVE IS THE ONE ON THE CITATION. THE COURT HAS NO FURTHER RECORD OF ANOTHER ADDRESS. IF YOU WISH TO CHECK BACK IN THE FUTURE , PLEASE REFER TO THE ABOVE ACTION NUMBER . NANCY H. RAMPANI, Clerk Dated: 12-147 By: M. RIVERA D"Uty awk 45 Civic Avenue - Room 116 x Pittsburg, California 94565 Phone: 439-4170 NovembeA 15P 1987 LaVLy Poijeww h Rt. 1, Box 4, Byron Hot Spningz Rd. Byton, Ca. 94514 Th,iz tettet petctainz to the eotZizion on the Byron Highway _(J4) , October 28, 1987, caused by the GMAC truck, Ca. License No. 17747M, regiztered to you, wh.,i.c.h ,%e u tied .in ma jot. damages to m y cat. The CHP tnab b.ic eotf;?.i 6 ion report number 10-428 eonceude a that the eott-iz ion was caused by .the driven. (Bryan Kenneth Beard) ob your veh.i,cZe in us.cng extneme.ey pooh judgement in trying to doss a buoy highway on wh.i.ch he eoutd not see approaching trabb.ie. Wi tnuzes approaching in both directions have substantiated that it w-z totatty ki4 bauPtt and there waz no my we cou.ed have avoided .the eott i z ion. W hi Ze there vizz no ..i.mmedia to indication ion ob .i.njun,i.es, I have ,since that event .expehi,enced 6tib6ne,6s and joint pain .in my neck, upper back and ahouP.der. I am eunrentey neceivi.ng medication bnom my doctor. Damages to the eats were major. It waz not dniveabQe and had to be towed to the 'H 8 M Auto DizmantZeAz, Inc., .in Oaktey. >=6t mates were requested btc.om Mazzei Cadi- ac/Antioch, Casey Auto Body/Brentwood, and ByeA's. Auto Body, 'Inc./Brentwood. OnZy Byer'a. responded on a t.imety ba6.iz and e.ince the cat% waz subject to dai-y ztonage ehatges at H 8 M we went with them. Moreover, we agreed to the use ob used pants .in order to minimize the cost. The repairs are not expected to be compe.eted untit the week ob November 23, ao you can .inspect the damages .i6 you .ao dez ire. So ban the total iz az boZZows: ('See attached estimate and paid .invoice) . H 8 M D.i..smanttens, Inc. $ 149.00 ByeA'z Auto Body, Inc. 3:722:00 �3,877.00 Ptease pnov.ide me with the name ob your% in6unanee eaA iet. Ib you ane not coveted by .i.nzuAance I must demand aetttement, cmAentty zotaR- ng ,$3 7871, ituthin 10 days, on prior to the time that repairs have been eompt-eted. I b you do not ,%u pond w.i thin this time t m.it, I wie,2 have no atternative but to take tegat action. Thin content obt igation on your pant as neg.i ate,%ed owner ob GMAC tAcck, CaZ. License No. 17747M, must take pnecedenee oven any other probtemz or Litigation that you'mentioned in ouA tetephone eonvetsation ob November 13. I Witt never .het this matter% Just bade away. Quite the eowtaary, and .ib required, I wilt v.igon.ouzZy puA,6ue aU aspects tht%ough couAt action, you can put this unpbeazant matter' behind us aU by bo& tc.d.i.ng a centib.ied bank check .in the amount ob $3,871.00 and, I w tt hereby wave any addit,i.onat demand, .cnceuding but not t mited to medieaZ, car nentat and attorney bees. W. J. Haener 350 Meneo Count Watnut Creek, Ca. 94598 cc: Bryan Kenneth Beard f F - NovembeA 23, 1987 pF �R1�Z Commibb-i.onet Hootey P.O. Box 431 P.ctt6bung, Ca. 94565 I am uvuting in tegaad to Cabe #604594-2 acheduted jot appeaA nce in your count on Novembers 30, 1987 at 9 a.m. Bryan Kenneth BeoAd =z &i.v.i.ng an unt,i.c.eued truck which hit u6 and cau6ed app&ox.imateey $4,000 damage to ours can on October. 280 1987. We have tied to contact him by %egizteAed tetteA, tegutat maie. and telephone to no avaie. We have been told by dE-MEQ Lanny Po�6ennoth, the owner of the truck, that Bryan Kenneth Beard does not t.ive at the addte,6a t zted on the C.H.P. tepont. . .Route 1, Box 4 Syron Hot6pting.6 Rd. , Byton, Ca. g KNN, ol We request the count to j.cnd out.and .cn6otm u6 ob Bryan Kenneth. Beard's �F A� cottect addtebb and phone number. We would at6o tequebt that he be otdeAed F to pay the damageb he cau6ed to out can by h,i6 teckle6a action, a.6 pant of hi.6 penaety. Thank you jot your heep. Witt.i,a.m J. Haen et 350 Mento Count Waenut C,%e.e(t, Ca.94598 (415)939-1529 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION 988 the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT January , 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: $1, 000, 000. 00 Section 913 and 915.4. Please note all 'Q?kliAV.-Counsel CLAIMANT: JOSEPHINE ZIZZO DEC 18 1987 ATTORNEY: Constance 14. Rutherford Martinez, CA 94553 Attorney at Law Date received ADDRESS: P.O. Box 20753 BY DELIVERY TO CLERK ON December 17 , 1987 Oakland, CA 94620 BY MAIL POSTMARKED: December 16 , 1987 to Auditor' s I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. r December. 17, 1987 PpHHIL BATCHELOR, Clerk �r DATED: BY: Deputy nn Cervelli II. FROM: County Counsel TO: Clerk of the Board of Supervisors (X This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: � �I� BY: Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present 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. JAN 12 1988 Dated: PHIL BATCHELOR, Clerk, By , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and No ice to Claimant, addressed to the claimant as shown above. Dated: JAN 19 1988 BY: PHIL BATCHELOR by 7 eputy Clerk CC: County Counsel County Administrator Y Reorder from a VA*ffGr0phi0Cfxporoliaf //� ` p/� WRITE IT! - DON'T SAY IT! M 103 CONTRA COSTA COUNTY TOClerk of the Board DATE December 17, 1987 FROM Auditor-ControllersuBJECT Claim of Josephine Zizzo The attached claim was received in the Auditor's office today. 1 SIGNED PLEASE REPLY HERE TO DATE F SIGNED I' INSTRUCTIONS -FILL IN TOP PORTION,REMOVE DUPLICATE (YELLOW) AND FORWARD REMAINING PARTS WITH CARBONS.TO REPLY,FILL IN LOWER PORTION AND SNAP OUT CARBONS.RETAIN TRIPLICATE(PINK)AND RETURN ORIGINAL. FORM M 103 Cowstaw A Rutherford AttorNey at,Caw p O. Nor 20759 Oakla#d, eaaloraia 94620 (415) 465-0604 December 14, 1987 Auditor-Controller Contra Costa County 625 Court St. Martinez, CA 94553 Re: Presentation of Claim of Josephine Zizzo Dear Sir or Madam: Enclosed please find a claim on behalf of Josephine Zizzo regarding an incident which took place on September 30, 1987. Thank you for your attention to this matter. Sincerely, o staan ,M. he ord 1 RECE `� !j 0. DEC ►1 1887 F PHK QAT.^ E!OP. B Dt 1 CLAIM AGAINST COUNTY OF CONTRA COSTA 2 3 The following information is provided pursuant to California Government Code section 910: 4 CLAIMANT: Josephine Zizzo 5 275 Park View Terrace #4 6 Oakland, CA 94610 NOTICES TO: Constance M. Rutherford 7 Attorney at Law P. O. Box 20753 8 Oakland, CA 94620 9 DATE & September 30, 1987 PLACE OF Knox Freeway (aka State Highway 580) , 10 ACCIDENT: near Marina Way, Richmond, California 11 CIRCUM- Claimant was driving west on the Knox STANCES Freeway (Highway 580) , then under construction. 12 OF She proceeded west after stopping at the traffic ACCIDENT: signal at Marina Way. The new freeway curves to 13 the right at that point, whereas the old road is straight ahead. The old road had no barricades and 14 there were no markings indicating the curve to the right. Without barricades or the dirt pile which 15 was later put up at the site, drivers traveling west were easily deceived and, as in the case of 16 Ms. Zizzo, could easily attempt to drive straight on the old road, rather than curve to the right on 17 the new road. Ms. Zizzo was triggered to curve right only when she noticed the on-coming traffic. 18 An accident resulted. 19 INJURY, Claimant' s automobile ( 1985 Chevrolet Spectrum) DAMAGE, was totalled. Her immediate physical injury was 20 OR LOSS: whiplash. She has been seeing a chiropractor regularly since the accident for pain and stiffness. 21 Most importantly, she was on her way to an audition for the lead singer in the Pirates of Penzance at 22 the Dickens Fair. AS well, for some period of time after the accident, she was unable to overcome 23 depression and unable to carry on with her career. This loss, with respect to her singing career, was 24 severe due to the interference with precisely .calculated timing in the pursuit of her professional 25 career. 26 AMOUNT CLAIMED: $1, 000, 000 27 28 '.1 I PROOF OF SERVICE BY MAIL(C. C.P. 1013a,2015.5) STA TE OF CALIFORNIA COUNTY OF..............ALAMEDA .............................................. I am a citizen of the United States and a resident of the county of.......Alameda I am over the age of eighteen years and not a party to the within above entitled action;myxesminersidimX i ddress is: P.O. Box 20753, Oakland, CA 94620 .......................................................................................................................................................................................... .......................................................................................................................................................................................... on......Te1 . 15, 1987 .. .Iservedthewithin......Claim of Josephine Zizzo .... ............................................................ .......................................................................................................................................................................................... On the.......G.on ,r, .... o.s t.4,,,C,Qt It—V in said action, by placing a true copy thereof enclosed in a sealed envelope with postage thereon fully prepaid, in the United States post office mail box at.... ....CA............................. addressed as follows: Auditor—Controller Contra Costa County 625 Court St. Martinez, CA 94553 Constance M. Rutherford I, ............................... ............................................................................ .certify(or declare),under penalty of perjury,• (name must be typed or printed) that the foregoing is true and correct. Executedon........Dec........5'.....x.98..7................... at................ .......Oakland................................_.. ;- lifornia (date) (place) �--, 4:: .......... Signature •Proof of service by mail forms, being signed under penalty of perjury,do not require notarization. This document is only a general form which may be proper for use in simple IransaOrons and in no way acts.or is intended 10 act.as a substitute for the advice of an attorney. The pubiisne,does not make any warranty.either express or implied as to tho legal validity of any provision or the suitability of these forms in any specific transaction. Cowdery's Form No. 1045—Proof of Service by Mail(California Action) � S CLAIM 4, BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) .T anuBOAR0 TION1 9 8 8 the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT ' 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: $1, 000, 000 .00 Section 913 and 915.4. Please note all "War " `��nty COUf1Se) CLAIMANT: LISA MARIE STARK DEC IS 1987 ATTORNEY: Hinton & Alfert ,� Date received Martinez, CA 94553 ADDRESS: 2940 Camino Diablo BY DELIVERY TO CLERK ON December 15 , 1987 Suite 300 Walnut Creek, CA 94596 BY MAIL POSTMARKED: Hand delivered 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. December 17 1987 PpHHIL BATCHELOR, Clerk DATED: ' BY: Deputy _IAnn Cervel i 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: 114g, / 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 (VI This Claim is rejected in full. ( ) Other: 1 certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. JAN 12 1988 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 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. Dated: JAN 19 1988 BY: PHIL BATCHELOR by eputy Clerk CC: County Counsel County Administrator � Q RECEI"_�ED PETER J. HINTON b ����► HINTON & ALFERT A Professional Corporation 2940 Camino Diablo, Suite 300 �� �� Walnut_ treek, CA 94596 1 Telephone: (415) 932-6006 Attorneys for Claimant CLAIM AGAINST COUNTY OF CONTRA COSTA TO: COUNTY OF CONTRA COSTA YOU ARE HEREBY NOTIFIED that LISA MARIE STARK, residing at 1947 Palo Verde Drive, Concord, California, 94553, claims damages from COUNTY OF CONTRA COSTA in the amount of One Million ($1, 000, 000. 00) Dollars, plus economic losses as proved. This claim is based on severe injuries to her legs, knees arms, shoulders, pelvis, skull and the surrounding muscles, tissues, bones and nerves, as a result of an accident which occurred on or about September 12 , 1987. The facts giving rise to this claim are as follows: On or about September 12 , 1987, claimant was driving her automobile westbound on Willow Pass Road at or near its intersection with Kinne Boulevard when she was struck head on by another vehicle which had crossed over from the eastbound lane into the westbound lane colliding head on with claimant's vehicle and proximately causing claimant's injuries and damages. At the time of the accident, Willow Pass Road was a public roadway consisting of one lane of travel in each opposing direction and was designed, controlled, owned, operated and maintained by the COUNTY OF CONTRA COSTA and subject to heavy amounts of traffic traveling at high rates of speed, with limited visibility of oncoming traffic resulting from the presence of a bridge which created a sight-distance hazard for vehicles approaching from opposite sides of the. bridge under prevailing speed and traffic conditions. The approach to the bridge was marked in a manner not adequate to prevent vehicles from crossing into opposing traffic lanes, and it was reasonably foreseeable that as a result of these and other conditions, vehicles would cross into the opposing lane of travel and that head-on collisions between vehicles would occur at or about the place of said accident unless adequate protective measures were taken. The COUNTY OF CONTRA COSTA negligently designed, constructed, maintained, operated, controlled, inspected and supervised said roadway in such a dangerous and defective condition, without adequate sight distance and without adequate striping, warning signs, speed restrictions, guard rails, divider strips, median dividers or other means to prevent or control vehicles from crossing to the wrong side of the roadway, and without any adequate warning of or means of preventing collisions between vehicles traveling in opposite directions, in violation of recognized standards. The COUNTY OF CONTRA COSTA created and maintained a dangerous and defective condition of said public roadway as aforesaid and created a substantial risk of injury to persons using the said roadway with due care. Said condition was created by the COUNTY OF CONTRA COSTA, its employees and others, and the COUNTY OF CONTRA COSTA had actual or constructive notice of the dangerous and defective condition of said roadway a sufficient time prior to the accident to have corrected the dangerous condition. As a direct and proximate result of the negligence of the COUNTY OF CONTRA COSTA and its employees, and the dangerous condition of said roadway, claimant Lisa Marie Stark sustained severe injuries to her legs, knees arms, shoulders, pelvis, skull and the surrounding muscles, tissues, bones and nerves, and was and still is required to undergo additional x-ray examinations and medical treatments. The names of said employees, agents or servants causing the injuries are unknown to claimant at this time. The amount claimed as of the date of presentation of this claim is computed as follows: Medical bills according to proof; Loss of earnings according to proof; Loss of earning capacity according to proof; Incidental damages according to proof; General damages in the sum of $1, 000, 000. 00. All notices or further communications with regard to this claim should be sent to the claimant in care of HINTON & ALFERT, 2940 Camino Diablo, Suite 300, Walnut Creek, CA 94596 - telephone (415) 932-6006. DATED: December 15, 1987 HINTON & A FERT by _'A R LAI, N /s 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 January 12 , 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: $275 ,000- 00 Section 913 and 915.4. Please note all "Warnings".County Counsel CLAIMANT: JOEL BENITO JUAREZ-C DEC 18 1987 ATTORNEY: Thomas G. McLaughlin Martinez, CA 94553 Date received Sanders , Didson, Rives et al December 11 1987 ADDRESS: 3701 Lone Tree Way BY DELIVERY TO CLERK ON , Suite 8 Antioch, CA 94509 BY MAIL POSTMARKED: December 10, 1987 1. FROM: Clerk of the Joard of Supervisors c,=TO: County Counsel Attached is a copy of the above-noted claim. December 17 1987 PpHHIL ATCHELOR, Clerk DATED: ' BY: Deputy _ CL J_�u, 91 'llin Cervelli II. 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: ���, 9g BY: Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ` (� ) This Claim is rejected in full. /( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JAN 12 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. z 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. JAN 19 1988 ' )ated: BY: PHIL BATCHELOR by puty Clerk :C: County Counsel County Administrator r LAW OFFICES OF SANDERS, DODSON, RIVES, MCLAUGHLIN&PEGNIM STANLEY K.DODSON PLEASE REPLY TO: RONALD P.RIVES ❑PITTSBURG THOMAS G.MC LAUGHLIN T 2211 RAILROAD AVE THOMAS M-PEGNIM PITTSBURG.G 94565 HUGH A-SCOTT (415)432.3511 DEBORAH JO SANDLER7 ANTIOCH RICHARD O.SANDERS 3701 LONE TREE WAY, OF COUNSEL SUITE 8 ANTIOCH.G 94509 (415)754-2811 December 10, 1987 CONCORD (415)676.4464 Contra Costa County CERTIFIED MAIL Board of Supervisors--Clerk 651 Pine Street Martinez , CA 94553 Re: Claim of Joel Benito Juarez-C Gentlemen: Enclosed please find the original and three copies of the Claim for Personal Injuries on behalf of Joel Benito Juarez-C. Please return an endorsed/filed copy to this office in the enclosed envelope. Thank you for your assistance. Very truly yours, SANDERS, DODSON, RIVES, McLAUGHLIN & PEGNIM THOMAS G. McLAUGHLIN TGM:ct Enclosures Claim of Joel Benito Juarez-C, Claimant, CLAIM FOR PERSONAL INJURIES (Government Code Section 910) against The County of Contra Costa, You are hereby notified that JOEL BENITO JUAREZ-C, hereinafter described as claimant, whose address is 426 E. 10th Street, Pittsburg, California, claims damages from the County of Contra Costa in the amount computed as of the date of presentation of this claim of $275 , 000 . 00 . This claim is based on personal injuries sustained by claimant on or about September 8 , 1987 , on Cummings Skyway at the intersection with I80 off and on ramps, in an unincorporated area of Contra Costa County, State of California. Claimant was injured in a truck accident which occurred at the aforesaid location. At the time of said accident, claimant was a passenger in a vehicle which careened off the roadway and through a barrier constructed alongside the roadway. The injuries were a proximate result of a dangerous design, maintenance, construction and failure to warn of the particular hazards of the roadway and immediate areas adjacent to the roadway. The injuries sustained by claimant, as far as known, as of the date of presentation of this claim are as follows: �e,4 az Loss of earnings and Impairment to Wage Earning Capacity . . . . . . . . . . . . . . . . . . . . . $ Unknown at this time General Damages . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260, 000 . 00 Medical Expenses . . . . . . . . . . . . . . . . . . . . . . . 15, 000. 00 (approx. ) Total Amount Claimed: $ 275, 000 . 00 All notices or other communications with regard to this claim should be sent to Thomas G. McLaughlin of Sanders, Dodson, Rives, McLaughlin & Pegnim, 3701 Lone Tree Way, Suite 8, Antioch, CA 94509. Dated: December 10, 1987 THOMAS G. McLAUGHLIV Attorney for Claim nt -2- CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Clairt Against the County, or District governed by) BOARD ACTION the Bdard of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT January 12 , 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: $120. 00 Section 913 and 915.4. Please note all "WaWings . C�; Counsel CLAIMANT: ROBERT i1ITCHELL DEC 18 1987 ATTORNEY: Date received Martinez, CA 94553 ADDRESS: 312 So. 15th Street BY.DELIVERY TO CLERK ON December 15 , 1987 Richmond, CA 94804 December 11, 1987 BY MAIL POSTMARKED: I. FROM: Clerk of the jloard of Supervisors _—TO: County Counsel Attached is a copy of the above-noted claim. December 17 , 1987 PpHHIL BATCHELOR, Clerk a DATED: BY: Deputy QA�nn Cervelli 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: ,Q 1�. �� BY:_&L&ZA0Deputy County Counsel 11I. 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 (JV 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 dat_g JAN 12 1988 Dated: PHIL BATCHELOR, Clerk, By , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately, AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: `jaN 1. 9 988 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator BOARD OF SUPERVISORS OF CONTRA C Q9WWapplication to: Instructions to ClaimantC!erk of the Board P.O.Box 911 Martinez,Califomia 94553 A. Claims relating to causes •of action for death or for injury to person or to personal property or growing crops must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to any other cause of action must be . presented not later than one year after the accrual of the cause of action. (Sec. 911.2, Govt. Code) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, California 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District%should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. . E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at end his form. RE: Claim by )Reser s ri g stamps RCbur-� r-t i k;id R1FCT\T DEC 1987 Against the COUNTY OF CONTRA COSTA) rr,n aar-veto� igK ;.RD' F F'".�•15�'•F:5 orDISTRICT) - (Filln name The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 120 .00 and in support of this claim represents as follows: ----————--——----——-----—T—T------------—-----------—------------ ---- 1. When did the damage or injury occur? (Give exact date and hour] - 2.- Where Z11a U; damage or in3ury occur? (Include city and county) ---Conk o- C:ms _ a, 1 ---- -------------- 3. How did the damage or in3ury occur? (GiveuII-�etai'Is, use extra sheets if required) bean mOVed �roan CohA-a- Co$:AC.. COca r►k� j a-� 1 �-o HO�.r�n �.Ye Gh�-lon FALL i l i�j ! Q 1\ A.r 4-i c e's o� C,toA- t n5 w ere- 103--. NOLn ls, gni rd-) �en n is shocsl w al l_C t ; al)d CU. �o Yms o to P, 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Room C n(loiccs LJC rc- h e��►� �. (over) r • 5. What are the names of county or district officers, servants or employees causing the damage or injury? "Qroptr�- �oorrt Cm pt ' s a.nd p-crson�s - resPonsi blc Y ,gyp er�-�- '� V m ar �r►s�-►4'c.i� an A-0 anon-ntr-%, --------- ---- -------------- r 'fin � cn _ 6. What 3amag-e�or-njuries do you claim=esulte�? ZGive-dull extent of injuries of damages claimed. - Attach too estimates for auto damagpe,,),�L o�t r��Jc .` cued O-L& ` I''Ck Ch;�- � c ad' Qa11k5 A a ♦�i3 ' W��L�� i7�li��'. 'tT1�L�l{�` t6o-0 P 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) '1Z.Y1k5 S 30 .00Wocu-Le :0 - .shots � `6o�a �-Eo��nc�� �5�• O� 6. Names and addresses of witnesses, doctors and hospitals. List the expenditures you made on account of this accident or Zn�ury: DATE ITEM AMOUNT Govt. Code Sec. 910.2 provides: "The claim signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf. " Name and Address of Attorney Claims t s Sipature 3/2,f0. , 8"d�1 Address Telephone No. Telephone No. �«t::*�t;�t+�#:��w�*fes#*t�:tee**��**•*f���*•*two*�e*t*�*tr•f��:t*trr•*w+�w**www NOTICE Section 72 of the Penal Code provides: "Every! person who, with intent to defraud, presents for allowance or for payment to any state board or officer, * or to any county, town, city district, ward or village board or officer', authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is guilty of a felony." CLAIM F, BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA y7laim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT January 12 , 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: $188. 00 Section 913 and 915.4. Please note all "Warn' �s" �,U6ty Counsel CLAIMANT- Joe Willis DEC 13 1987 ATTORNEY: Date received Martinez, CA 94553 ADDRESS: 171 W. 7th Street BY DELIVERY TO CLERK ON December 11 , 1987 Pittsburg, CA 94565 BY MAIL POSTMARKED: unreadable 1. FROM: Clerk of the Joard of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. December 17 1987 ppHHIL BATCHELOR, Clerk C DATED: ' BY: Deputy irL nn erve 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: 1,, / BY: eputy County Counsel 7 Ill. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (� ) This Claim is rejected in full. /( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JAN 12 1988 PHIL BATCHELOR, Clerk, By r Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date 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 16; 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: JAN 1 9 1988 BY: PHIL BATCHELOR by Clerk, CC: County Counsel County Administrator CLAIM �O; BOARD OF SUPERVISORS OF CONTRA COQ Yapplicationto: Instructions to ClaimantClerk of the Board .O.Box 911 Martinez.Califomla 94583 A. Claims relating to causes 'of action for death or for injury to person or to personal property or growing crops must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to any other cause of action must be • presented not later than one year after the accrual of the cause of action. (Sec. 911.2, Govt. Code) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 1061 County Administration Building, 651 Pine Street, Martinez, California 94553. C. If claim is against Adistrict governed by the Board of Supervisors, rather than the ounty 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 o this form. MMMMTWW******** RE: C aim by )Resery T#c �L'�L stamps k VTJ,S' i CEG 1987 - -J# Against 987 - Against th COUNTY OF CONTRA COS A)' anT a or -F- V DISTRICT) er TF-111 in name ) The undersigned claimant hereby makes claim against County of Contra) Costa or the above-named District in the sum of $ ' and in support of this claim represents as follows: �. When did the damage or injury occur? (Give exact date and hour] Sha e - -- '�. W�ieze did tie damage or in3ury occur? Include city and county) 3. How did the damage or in3ury occur? (Giveu�� �etai�s, use extra sheets if required) r 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? e c A v ►4, S© (over) 5. What exe' the names oft��tggi or district officers, servants or ees causing the or injury? employ g jury .J1 44", 6. What aama a or injuries do you-;!;,m resulted? Give cull extent of injuries of 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. -71 '�� (,� ,S 'c'►�Y'bg- ����f RCC lZ , j�6'(z - Shy pv�s1��- �btE ����` Thr'__--__________________________T___.._�________T_T____ 3. 7st the expenditure$ you made on account of this accident or injury: DATE ITEM AMOUNT bqe++ — eff' Cir j,,Itek 75" Govt. Code Sec. 910.2 provides: "The claim signed by the claimant SEND NOTICES TO: (Attorney) or by some erson on his behalf. " Name and Address of Attorney 0 '' mA, Claimant's Signature ! i3O, 7 ddress Telephone No. Telephone No. wR**:*�r�ttwtr���**��:*�t*���:+t:f�,��trt**#�**t�**��*�*:f**�w*R�r:t��*t►�t*:*�*w** NOTICE Section 72 of the Penal Code provides: "£very person who, with intent to defraud, presents for allowance or for payment to any state board or officer, ' or to any county, town, city district, ward or village board or officer', authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is guilty of a felony." CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT January. 1 2 , 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: $265 . 50 Section 913 and 915.4. Please note all "WarniftInty Counsel CLAIMANT: Steve H. Humphrey DEC 18 1987 ATTORNEY: Martinez, CA 945,53 Date received ADDRESS: 434 Hiliday Hills Drive BY DELIVERY TO CLERK ON December 14, 1987 Martinez, CA 94553 BY MAIL POSTMARKED: no envelope 1. FROM: Clerk of the Joard of Supervisors TO: -County Counsel Attached is a; copy of the above-noted claim. December 17 , 1987 PpHHIL BATCHELOR, Clerk O DATED: BY: Deputy A n Cervelli 11. FROM: County Counsel TO: Clerk of the Board of Supervisors (4-/,This claim complies substantially with Sections 910 and 910.2. ( ) This claim F41LS 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: J914, P BY: Oeputy 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' Order entered in its minutes for this date. Dated:J A N 12 198R- 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. Dated: JAN 19 .1988 BY: PHIL BATCHELOR by eputy Clerk :C: County Counsel County Administrator ''CLAIM TO: BOARD OF SUPERVISORS OF CONTRA CO§�� 'i yappiicationto: Instructions to ClaimantC!erk of the Board .O.Box 911 Martinez.California 94553 A. Claims relating to causes 'of action for death or for injury to person or to personal property or growing crops must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of.,.action. (Sec. 911.2, Govt. Code) B. Claims must be filed with the Clerk of the Board of Sqpery�sprs 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 Distr4ctt-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 Por fraudulent claims, Penal Co3dF'T-&c:72 at end of this form. RE: Claim by )Reserved for Clerk's ;ffiling stamps SizVE H HumPHREV ) ) RECIEEIVEii 741- •711I-1ZJ Against the COUNTY OF CONTRA COSTA) DEC IJ 1987 L or DISTRICT) PHIL GF77CHEL s (Fillin name oP���Y - 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: �. When did the damage or in3ury occur? (Give exact date and hour] :a> 11-),o- 97 TIME /S-/ ' �. WFiere did-tie damage or in3ury occur? (Include city and county) _.�...: ::.-. .C.o1V Ti .A C_-0_STiq D6—r'6VT10N AR04-1_TY X01 COURT 5'7- 7_ rZ Chi 3. How did the damage or in3ury occur? (Give iuiiwdetaiis, use extra ` � sheets if required) WW N = WAS C.10ECKED 1,070 TItE rYlAf�';tJE-� P�rcnl7�eN FACILITY MY CL-OYN+NG WAS PLACED 1n! BOX * /;LV_5 (sUpposEDIY) f3� E D�pUTY o�7 RUTti' ON DEc.3,158't lnlHEN Z WAS rZELEASED CN A !�'IEDICAL PA55, my PROPER T V uJAS To SC POL)Na .AND SMILE TNA i T1mE SVBSECtc1agT se:AR1LtIES •• HAVE 'TURNED VP � NO i NTNG, a. What particular act or omission on the part of county or district- officers, servants or employees caused the injury or damage? = (ff15 15,4 CASA O F NEC>L 16FrA/i O N THE PARI OF gilt 8O4C i NG 5-AF i AT TNC MA2T iMez bC- Te,4/-rIOA) 1--Ac 1c.r7'Y, (over) �:K�l�..-r..+;•a.. _- :::,a.<._..= ...._ .. rH,_..,r. _. ....,...r:.isi.a.7�.siii: :....: ;ia' .w..z.....pieh:i�aa.r..:w::o�+Ci�ive.v. 5.� Wh�Tt 'a�e the names of county or district officers, servants or employees causing the damage or 3nj 1 TW BOOK,NG O�IcERs AD&C Iv 6. what damage or �n3uries do you claim resulted? ZGive-full extent of injuries of damages claimed. . Attach two estimates for auto ^_! damage) �1� CI.oTNtNG WAS EITHER MISPLAc( O OR TAKEN1 !N AN CA5CI I-CISU ST /6 A RESULT OF -r'415 INC06"T, AM..• _ --���.- ---��--- - - ---���.----------------------------- � - �-� 7. How was the amount claimed above computed? (Include�--th-e�esrt�ima�� �r� ted amount of any prospective injury or damage.) J-+ (JAS CoN�PuTCD aY.. ADDING T VE kETAiL VALvE dF &rACK.-ART►c4L- Lo5-r. (ALL VERY MoDEtv►Tc ESTiAie4'��,� ------------------------o fwit'------------------------------------------- . 6. Names and addresses of witnesses, doctors and hospitals. QEII�1G 1 N CU5'T ODY AT T C 'TIME • � •4AD MC, ,f`f,�/E c,S�j -.. �FICr-RS JN OUTYr Z- O0 1-IOWE✓�� i�RvF :: WHO C46CIKED MY 13L0IV6 I Nr.5 W., �. List the expenditures you made on account of this accident or 1n�ury: DATE ITEM �AM—OUNT t5ATHER IMC-M36RS ONLY" =AGKET NEw)FRWA M4cgs .�rS—l{.00 (oN SAL'J"- aA)E "ARRow" DR;55 514IRT NEw)r-ROM A'4LYS WJ,,.40 � J O NE SeT OF (SR+EF5 00 PAIR of A►YsoN DRESS SOCKS .50 11 pN( PAIR of DRE5$ PRNTS � ► o,t-� pr+1 R a F �cQY�,e. aRF ss �Y��s (",�cJ) F�^:,�rn�c Ys s •° �6�So �-:� r Govt. Code Sec. 910.2 provides: "The claim signed by the claimant . SEND NOTICES TO: (Attorney) or by some person on his behalf.",' Name and Address of Attorney ,} tt aa%an Jf a F Sffli Ig'"44 t u r e 4134 Abe-1DA9' /.limos_ AeiV4!-;- Address EAddress fY1 r/ go z- ra 94t=1 Telephone No Telephone No. t NOTICE Section 72 of the Penal Code provides: " 'Every-person who, with intent to defraud. .presents for all-owance or for payment to any state board or officer, *or to any county, town, city district, ward or village board or officer', authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is guilty of a felony." CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA j Chaim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT JANUA 8 8 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 GoverrCeb�? e C O Ut15 6! Amount: unspecified Section 913 and 915.4. Please note all "Warnings". CLAIMANT: KEVIN WALLA DEC 18 1987 ATTORNEY: Martinez, CA 94553 Date received ADDRESS: 2405 Lancaster Place #7 BY DELIVERY TO CLERK ON December 14, 1987 Richmond, CA BY MAIL POSTMARKED: no envelope I. FROM: Clerk of the Joard of Supervisors ."TO: County Counsel Attached is a copy of the above-noted claim. DATED: December 17 , 1987 EVIL BATCYELOR, Clerk epuAlm Ann ervelli I1. 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: �t l � BY: &&t&4Deputy County Counsel I11. 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. JAN 12 1988 Dated: PHIL BATCHELOR, Clerk, By r , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date 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: .JA N S 1988 BY: PHIL BATCHELOR by puty Clerk CC: County Counsel County Administrator f CLAIk-; ATO:w BOARD OF SUPERVISORS OF CONTRA C0§;_,t8TrF09WYapp1ication to: Instructions to ClaimantC!erk of the Board P.0.Box 911 Martinez,Califomia 94553 A. Claims relating to causes 'of action for death or for injury to person or to personal property or growing crops must be presented not later than the 100th day after the accrual of the cause of action. 'Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Sec. 911.21 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. ���*•�:f***fry**+r���rrt*�e*�**�*�r�r**��*,r*����*�t****�*�*�**��r*�*,r**�*eft***� RE: Claim by )Reserya for stamps !fie LJ Ill RECEIVED D E C 14 1987 Against the COUNTY OF CONTRA COSTA) PHIL CA.Tr�fEl R :ER.✓.p• or DISTRICT) (Fill in name ) The undersigned claimant hereby makes claim against the ounty of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows: �. When did the damage or injury occur? (Give exact date and hour] �. W�iere did-tfie damage or injury occur? (Include city and county) em2ticr-damage r. Ho3w or inju occur? (Give Zui1 NEalls, use extra sheets if required) 4. what particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? y'cd 1.7 � z� 41.2 / - (over) 5. ZWhat are the names of county or district officers, servants or employees causing the damage or injury? /W ,t C 6. what damage or fn�uries do you cla��n resulted? ZGive full extent of injuries of damages claimed. - Attach two estimates for auto damage) ?. How was the amount claimed above computedclud/- t7 (Inh sted amount of any prospective injury or damage. ) c 8. Names and addresses of witnesses, doctors and hospitals. �S.! List the expenditures you made on account of this accident or in3ury: DATE ITEM AMOUNT Govt. Code Sec. 910.2 provides: "The claim signed by the claimant SEND NOTICES TO: (Attorney) or b me person on his behalf. " Name and Address of Attorney n C a nt s Signa J:.ureG .� Address Telephone No. Telephone No. •�i*�:*��:**�*r**����**���ita�,�*t:��r�*�:**+err*�w*�r:**��*�**t**�����t*���r�r*�*� WOTICE Section 72 of the Penal Code provides: '.Every- person who, with intent to defraud, presents for allowance or for payment to any state board or officer, ' or to any county, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is guilty of a felony. " 1 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Agi ,nst the County, or District governed by) - BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT January 12 , 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 "WWaaarrni f''3��' CLAIMANT:GAYE WOMACK ATTORNEY: Gary L. Randall aCti�eZ, U1 1200 Concord Avenue, Suite 2ftGte received ADDRESS: Concord, CA 94520 BY DELIVERY TO CLERK ON December 16 , 1987 BY MAIL POSTMARKED: December 15 , 1987 1. FROM: Clerk of the Board of Supervisors j'- -TO: `County Counsel Attached is a copy of the above-noted claim. December 17 , 1987 PpHHIL BATCHELOR, Clerk DATED: BY: Deputy AnA erve 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: X, 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: SAN 12 1988 PHIL BATCHELOR, Clerk, By-Zy , 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:—JAN 1.9 7988 BY: PHIL BATCHELOR by uty Clerk CC: County Counsel County Administrator 1 GARY L. RANDALL A Professional Corporation �- 2 1200 Concord Avenue, Suite 260 �TT,E Concord, CA 94520 C `�J 3 ( 415 ) 682-7777 DEC i� 1957 4 PHII PA-4Ft A YY►n l 6 7 8 CLAIM AGAINST PUBLIC ENTITY 9 10 In the Matter of the Claim of ) CLAIM FOR DAMAGES 11 GAYE WOMACK ) (Govt. Code Section 910 et . seq. ) 12 vs . 13 MT. DIABLO HOSPITAL ) Does 1 To 20 ) 14 1 . I , GAYE WOMACK the undersigned, present this claim for 15 damages as a person acting on behalf of the claimant . 16 2 . I desire notice relative to this matter to be sent to 17 my following business address : Gary L. Randall , 1200 Concord 18 Avenue , Suite 260, Concord, CA 94520 , ( 415 ) 682-7777 . 19 3 . The name and address of claimant are: Gaye Womack, 20 3828 Cowell Road, Concord, CA 94518 . 21 4 . The date and place of the occurrence that gave rise 22 to this claim are as follows : September 24, 1987 , Mt . Diablo 23 Hospital , Concord, CA. 24 5 . The circumstances of the occurrence which gave rise to 25 the claim are: Defendant, MT. DIABLO HOSPITAL, did provide 26 medical care and treatment below the standard of care in the 27 28 e 1 medical community, specifically in that their hospital staff 2 failed to promptly or properly diagnosis the nature of the 3 injury; failed to competently take appropriate medical tests; 4 failure to intervene surgically, i .e . laparotomy; all of which 5 proximately caused decedent, WALLACE SMILEY, death. 6 6 . A general description of claimant' s injuries , damages , 7 and losses incurred so far as is now known are as follows : 8 Death of decedent did cause loss of society, love, comfort, 9 companionship, nurture, solace and other damages recoverable 10 by statute . 11 7 . In known, the name(s ) of the public employee(s ) 12 causing said injuries , damages , and losses is/are : 13 Unknown. 14 8 . The amount claimed as of the date of presentation 15 of this claim consists of general damages and special damages 16 relative to claimant' s injuries and property damage and loss 17 of use of same in amounts unknown at this time but in the 18 aggregate not less than $100 , 000 . 00 and exceeding the 19 jurisdiction of the Municipal Court of the State of California. 20 Claimant reserves the right to insert said amounts when same 21 are ascertained. 22 DATED: December 14 , 1987 23 Signature of Claimant or Person 24 Acting on Behalf of Claimant 25 26 27 28 C PROOF OF SERVICE BY MAIL (C.C.P. 1013A, 2015 . 5) STATE OF CALIFORNIA COUNTY OF CONTRA COSTA I am a citizen of the United States and a resident of the County of Contra Costa. I am over the age of eighteen years and not a party to the within above entitled action. My business address is 1200 Concord Avenue, Suite 260, Concord, California 94520 . On December 15 , 1987 I served the within CLAIM AGAINST PUBLIC ENTITY on the Parties in said action, by placing a true copy thereof enclosed in a sealed envelope with postage there on fully prepaid, in the United States Mail at Concord, California, addressed as follows : Mt. Diablo Hospital Administration 2540 East Street Concord, CA 94520 Clerk Contra Costa County Board of Supervisors 651 Pine Martinez, CA I , Peggy B. Scott, certify (or declare) , under penalty of perjury that the foregoing is true and correct. Executed on December 15 , 1987 at Concord, California. S /- S i CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA r Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT January 12, 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: BILL SMILEY County Counsel ATTORNEY: Gary L. Randall DEC 18 1987 1200 Concord Avenue Date received �ai0ez,1qW945.3 ADDRESS: Suite 260 BY DELIVERY TO CLERK ON December:. , Concord, CA 94520 December 15, 1987 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors ;TO: County Counsel Attached is a copy of the above-noted claim. December 17 , 1987 ppHH1L ATCHELOR, Clerk a DATED: BY: Deputy n tilaCervelli Ji 1I. FROM: County Counsel TO: Clerk of the Board of Supervisors (X This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: BY: 1*10%eZ� Deputy County Counsel 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 Supervisors present () This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Boa;4r4 Order entered in its minutes for this date. JAN 12 1988 Dated: PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the. United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JAN 19 1988 BY: PHIL BATCHELOR by eputy Clerk CC: County Counsel County Administrator i 1 GARY L. RANDALL 2 A Professional Corporation 1200 Concord Avenue , Suite 260 Concord , -7 94520 ECEI EIE., 3 ( 415 ) 682-"r 777 1! _._.J 4 DEC [b 1987 5 _ PHtI RA"HF(.. 6 n+ V NNi 7 8 CLAIM AGAINST PUBLIC ENTITY 9 10 In the Matter of the Claim of ) II ) CLAIM FOR DAMAGES BILL SMILEY ) ( Govt . Code Section 910 12 ) et . sen. ) VS . ) 13 ) MT . DIABLO HOSPITAL ) 14 Does 1 To 20 ) 15 1 . I , BILL SMILEY the undersigned, present this claim for 16 damages as a person acting on behalf of the claimant . 17 2 . 1 desire notice relative to this matter to be sent to 18 my following business address : Gary L. Randall , 1200 Concord 19 Avenue , Suite 260 , Concord , CA 94520 , ( 415 ) 682-7777 . 20 3 . The name and :address of claimant are : Bill Smiley, 21 747 Pronto Drive , San Jose , CA . 22 4 . The date and place of the occurrence that gave rise 23 to this claim are as fol.lot:s : September 241 "1987 , . Mt . Diablo 24 Hospital , Concord , CA . 25 5 . The circumstances of the occurrence which gave rise to 20 the claim are : Defendant , MT . DIABLO HOSPITAL, did provide 27 medical care and treatment beloi: the standard of care in the 28 V . f 1 medical community, specifically in that their hospital staff 2 failed to promptly or properly diagnosis the nature of the 3 injury; failed to competently take appropriate medical tests ; 4 failure to intervene surgically, i . e . laparotomy; all of which 5 proximately caused decedent , WALLACE SMILEY, death. 6 6 . A general description of claimant ' s injuries , damages , 7 and losses incurred so far as is now known are as follows : 8 Death of decedent did cause loss of society, love, comfort , 9 companionship, nurture , solace and other damages recoverable 10 by statute . 11 7 . In known , the name ( s ) of the public employee ( s ) 12 causing said injuries , damages , and losses is/are : 13 Unknown . 14 8 . The amount claimed as of the date of presentation 15 of this claim consists of general damages and special damages 16 relative to claimant ' s injuries and property damage and loss 17 of use of same in amounts unknown at, this time but in the 18 aggregate not less than $100 , 000 . 00 and exceeding the 19 jurisdiction of the Municipal Court of the State of California. 20 Claimant reserves the right to insert said amounts when same 21 are ascertained . 22 DATED: December 14 , 1987 23 24 Signature of Claimant or Person Acting on Behalf of .Claimant 25 26 27 28 PROOF OF SERVICE BY MAIL (C.C.P. 1013A, 2015. 5) STATE OF CALIFORNIA COUNTY OF CONTRA COSTA I am a citizen of the United States and a resident of the County of Contra Costa. I am over the age of eighteen years and not a party to the within above entitled action. My business address is 1200 Concord Avenue, Suite 260, Concord, California 94520. On December 15 , 1987 I served the within CLAIM AGAINST PUBLIC ENTITY on the Parties in said action, by placing a true copy thereof enclosed in a sealed envelope with postage there on fully prepaid, in the United States Mail at Concord, California, addressed as follows : Mt. Diablo Hospital Administration 2540 East Street Concord, CA 94520 Clerk Contra Costa County Board of Supervisors 651 Pine Martinez, CA I , Peggy B. Scott, certify (or declare) , under penalty of perjury that the foregoing is true and correct . Executed on December 15, 1987 at Concord, California. S 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 January 12, 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". Counsel CLAIMANT: KATHI LARET ATTORNEY: Gary L. Randall DEC 18 1987 1200 Concord Avenue Date received Martinez, CA 94553 ADDRESS: Suite 260 BY DELIVERY TO CLERK ON December 16 , 1.987 Concord, CA 94520 BY MAIL POSTMARKED: December 15 , 1987 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. December 17 , 1987 PpHHIL BATCHELOR, Cle k DATED: BY: Deputy Ann Cervelli 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: y� / �Z 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 K 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. JAN 12 1988 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 shoulddo 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. JAN 19 1988 Dated: BY: PHIL BATCHELOR by y Clerk CC: County Counsel County Administrator I GARY L. RANDALL A Professional Corporation 2 1200 Concord Avenue , Suite 260 Concord, CA 94520 3 ( X15 ) 682-7777 A� 4 DEC � 1987 5 PHIL PATCFjplo ERK 8 co ' =. .' �: Is a [RECE 7 tS CLAIM AGAINST PUBLIC ENTITY 9 10 In the Matter of the Claim of ) CLAIM FOR DAMAGES 11 KATHI LARET ) (Govt . Code Section 910 et . seq. ) 12 vs . 13 MT. DIABLO HOSPITAL ) Does 1 To 20 ) 14 15 1 . I , KATHI LARET the undersigned, present this claim for 16 damages as a person acting on behalf of the claimant. 17 2 . I desire notice relative to this matter to be sent to my following business address : Gary L. Randall , 1200 Concord 18 19 Avenue , Suite 260 , Concord , CA 94520 , ( 415 ) 682-7777 . 20 3 . The name and address of claimant are : Kathi Laret , San Jose , CA. 21 22 4 . The date and place of the occurrence that gave rise 23 to this claim are as follows : September 24 , '1987 , Mt . Diablo 24 Hospital , Concord, CA . 25 5 . The circumstances of the occurrence which gave rise to 26 the claim are: Defendant , MT. DIABLO HOSPITAL, did provide medical care and treatment below the standard of care in the 27 28 1 medical community, specifically in that their hospital staff 2 failed to promptly or properly diagnosis the nature of the 3 injury; failed to competently take appropriate medical tests; 4 failure to intervene surgically, i . e . laparotomy; all of which 5 pro3timately caused decedent , WALLACE SMILEY, death . 6 6 . A general description of claimant ' s injuries , damages , 7 and losses incurred so far as is now known are as follows : 8 Death of decedent did cause loss of society, love, comfort, 9 companionship, nurture , solace and other damages recoverable 10 by statute . 11 7 . In known , the name( s ) of the public employee( s ) 12 causing said injuries , damages , and losses is/are : 13 Unknown . 14 g , The amount claimed as of the date of presentation 15 of this claim consists of genera]. damages and special damages 16 relative to claimant ' s injuries and property damage and loss 17 of use of same in amounts unknown at this time but in the 18 aggregate not less than $100 , 000 . 00 and exceeding the 19 jurisdiction of the Municipal Court of the State of California. 20 Claimant reserves the right to insert said amounts when same 21 are ascertained . 22 DATED: December 14 , 1981 23 24 Sig atu e of Claimant or Person Acting on Behalf of Claimant 25 26 27 28 M, PROOF OF SERVICE BY MAIL (C.C.P. 1013A, 2015. 5) STATE OF CALIFORNIA COUNTY OF CONTRA COSTA I am a citizen of the United States and a resident of the County of Contra Costa. I am over the age of eighteen years and not a party to the within above entitled action. My business address is 1200 Concord Avenue, Suite 260 , Concord, California 94520 . On December 15, 1987 I served the within CLAIM AGAINST PUBLIC ENTITY on the Parties in said action, by placing a true copy thereof enclosed in a sealed envelope with postage there on fully prepaid, in the United States Mail at Concord, California, addressed as follows : Mt. Diablo Hospital Administration 2540 East Street Concord, CA 94520 Clerk Contra Costa County Board of Supervisors 651 Pine Martinez , CA I , Peggy B. Scott , certify (or declare) , under penalty of perjury that the foregoing is true and correct . Executed on December 15 , 1987 at Concord, California. J 1 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 January 12 , 988 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 GovernmetcR%k/ Counsel Amount: $117 .40 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: DEANNA FIDDES DEC 18 1987 ATTORNEY: Martinez, CA 94553 5557 Maryland Drive Date received December 17 1987 ADDRESS: Y BY DELIVERY TO CLERK ON � Concord, CA 94521 BY MAIL POSTMARKED: December 11, 1987 to Risk Mgmt 1. FROM: Clerk of the Board of Supervisors `T0: County Counsel Attached is a copy of the above-noted claim. IL gATCHELOR, Clerk 9 DATED: December 17, 1987 �b: Deputy C�4M 4 0 P nn Cervel ' 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: , _f i� _ BY: uty County Counsel on-i0dJ 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 K) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JAN 12 1988 PHIL BATCHELOR, Clerk, By V, >aw Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personalty 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: JAN 19 1988 BY: PHIL BATCHELOR by eputy 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 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 ' g stamps ' REIROVtD. Against the COUNTY OF CONTRA COSTA) DEC 0 1987 PHII EATrHa09 or DISTRICT) :°RK0 0c:+ SUP fdvA-= E CO, ? A C057l. " Fill in name) ) u.,�f� The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $-I/ -j , and in support of this claim represents as follows: --------------------------------------------------------- ----When--d-id-the damage or injury occur? (Give exact date and hour) IC, �-� t . 00 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full details, use extra sheets if required) , 04- +-k e S err u_"� \r" r` N' r� - '\-\- .��C'�v�lZQ CQ 1 y -t-�L 2 \ � QQ - 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? o c�c9• v� v..._S � v-S'�' W O R--��'� O r� G v� qQ o wc-c9. _ o-"C"CJ (over) S. What are the names of county or district officers, servants or l empl4oyeee causing the damage or injury? V'`o o-A �r, ------------------------------------------------------------------------- 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage) V a'35hl' �/ b RA�s.�_CL��-?_��?�__���_��v_`��-.�.R�c,�, --1Lo_y�2__7_O_0 /a.�.►o.r.�-e 7. How was the amount claimed above computed? (Include the estimated + 44 amount of any prospective injury or damage. ) S-�', N �� e -Eio �.�. �OOF e�cZ .R ctS `►. c� -�-o b 10�,..c��•(Z`Q- ----- ------ ----- -- - -- :�` t------------ -- --- ------- -------- ------ - ---- ------ 8. Names and addresses of witnesses, doctors and hospitals. la lRob; 9. List the expenditures you made-on account of this accident or injury DATE J�� .R. ITEM AMOUNT ************************************************************************** Govt. Code Sec. 910.2 provides : "The claim signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf. " Name and Address of Attorney oEm F. -0 S,� _ �Q p , ��. Claimant' signature Address $11 c Telephone No. ) Telephone No. ************************************************************************** NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is guilty of a felony. " tS CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA !:laim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT January 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: $1, 000, 000- 00 Section 913 and 915.4. Please note all Q alitYsOOunsel CLAIMANT: YVETTE ESCARANIO DEC 18 1987 ATTORNEY: Frederick E. Beyer Martinez, CA 94553 Beyer & Beyer- Date received ADDRESS: Attorneys at Law BY DELIVERY TO CLERK ON December 16, 1987 2730 Lone Tree 1]ay, Suite 6 Antioch, CA 94509 BY MAIL POSTMARKED: December 15 , 1987 I. FROM: Clerk of the Board of Supervisors �-TO: "County Counsel Attached is a copy of the above-noted claim. December 17 , 1987 pH IL BATCHELOR, Clerk DATED: BY: Deputy Alin Cervelli 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: 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 XThis 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. JAN 12 1988 Dated: PHIL BATCHELOR, Clerk, ByVez-1z"'12 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: JAN 1. 9 1988 BY: PHIL BATCHELOR by puty Clerk CC: County Counsel County Administrator CLAiM ,TC BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY Instructions to Claimant Return original apPlication tc Clerk of the Board 651 Pine St., Room 106 Martinez. CA 94553 A. Claims relating to causes of action for death 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) S. Claims must be- filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, California 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at end of this form. r*srr•r*•s►*:�+►+►:s►**•�►:ri:s*•e::*,e*rr:rr�*+rr+►*rrr:srrr+►r:rrrrrrrrrrrrrrrr RE: Claim by )Reserved for Clerk's filing stamps YVETTE ESCARANIO Against the COUNTY OF CONTRA COSTA) DEr. 16 19$7 or DISTRICT) (Fill in name ) � o . The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 1 ,000,000.00 and in support of this claim represents as follows: lien asd the samage or �nlury occur? Give exact date ana fiourf 9-23-87, About 11 :55 PPI --- r -- -------- -r------------ --- ----:----....r�.e s..i- ---- '�: Wfi-=e-aid-tFie anmage or In3ury occur? Include city and county; Intersection of James Donlon Blvd. & Somersville Rd. , City of Antioch, County of Contra Costa, 3. Now did the damage or in�ury occur? Give �uII aetails, use extra sheets if required) Claimant was driving west on James Donlon Blvd. , and due to unsafe condition of rd. , claimant was unable to ascertain that the road ended, and her auto went through Somersville Rd. and off an embankment, causing her Serio us injuries. 1. fiat partleular act or omsslon on the part o county or �istr�ct officers, servants or employees caused the .injury or damage? Inadequate lighting, safety signs or protection from steep embankment. (over) 5. What are the name's of county or district officers, servants or, ' employees causing the damage or injury? Unknown 6. What damage or �n�uries �o you claim resulted? ZG�ve �uYI extent of inj ries or damages claimed. Attach two estimates for auto damage) Broken ribs, broken collarbone, punctured lung, concussion, and injuries to head, neck, back and other parts of her body, the full extent of which is unknbwn at this time. 7. How was the amount claimed above computed? (Include the estsmate amount of any prospective injury or damage. ) $975,O00.00 General Damages $25,000.00- Special Medical Expenses estimated. -------------------------------------------------- ---- 6, Names and addresses of witnesses, doctors and hospitals. Los Medanos Hospital, Pittsburg, California. �. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Unknov,n at this time. Govt. Code Sec. 910.2 provides : "The claim signed by the claimant SEND NOTICES TO: - (Attorne ) or b 8 person, on his behalf. " Name and Address of Attorney BEYER & BEYER C a ant s igrr ture Attorneys at Lav, Care of Attorney at lwft_ 2730 Lone Tree `:`:gay, Suite 6 Address Antioch, Ca. 94509 Telephone No. (415)-754-5959 Telephone No. NOTICE Section 72 of the Penal Code provides: 'Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher , or writing, is guilty of a felony. " CLAIM 70-: . BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY Instructions to Claimant Return original application tc Clerk of the Board 651 Pine St., Room 106 Martinez. CA 94553 A. Claims relating to causes of action for death: orfor 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 accrimal 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 . oof•tRiis form. lt!!!!!!!!!!!!*R!*R!ltf��C!!1e!!•!!!f�!!t!!1tlt!!!!!!!!!!!!!!!!!!!!!!!!!Q*tom! RE: Claim by )Reserved for Clerk's filing stamps YVETTE ESCARANIO ) ) Against the COUNTY OF CONTRA COSTA) ) Or DISTRICT) (Fillin name)) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 130001000.00 and in support of this claim represents as follows: rrrrrrrr .1. -- � r T - - rrrrrrrrrr�rr rrr � ���.� �. 1�ihen did the damage or in�u`ry occui? Give exact date and fiourj 9-23-87, About 11 :55 PM r� --�- ♦ �- r- ...r�.rrrr .�..r-----r----. -- --Trrrrrrrrorrr�r rr�r` iJ�iere did tFie damage orn3ury occur? iZnc�ud� city and cuntyf Intersection of James Donlon Blvd. & Somersville Rd. , City of Antioch, County of Contra Costa. 37—i the damage or injury occur?" Give` uIS`de`tniis;`use`extzar- sheets if required) Claimant was driving west on James Donlon Blvd. , and due to unsafe condition of rd. , claimant was unable to ascertain that the road ended, and her auto went through Somersville Rd. and off an embankment, causing her serio us injuries. rrrrrrr..rrr r-� �rrrrrr-r�r -.�.rrrr�r-rr r�.rrrrr rrrrrrrrrrr .*r.r �.�rrr Z: 1Phat particular act or omission on the part o county or district officers, servants or employees caused the injury or damage? Inadequate lighting, safety signs or protection from steep embankment. (over) 5. ,•ghat are the names of county or district officers, servants or' employees causing- the damage or injury? Unknown �. WFia"t damage-or in?cries do you claim resu�te�? �G�ve'�uii extent of inj ries or damages claimed. Attach two estimates for auto damage Broken ribs, broken collarbone, punctured lung, concussion, and injuries to head, neck, back and other parts of her body, the full e7tent of which is unknown at this time. --------------------------------------------------------------------- -- 7. Bow was the amount claimed above computed? (Include the estimate amount of any prospective injury or .damage. ) $975,000.00 General Damages $25,000.00- Special Medical Expenses estimated. ---------------------------------------------------- --------------------- 6. Names and addresses of witnesses, doctors and hospitals. Los Medanos Hospital, Pittsburg, California. List the expenditures you made on account of this accident or �n�ury: DATE ITEM AMOUNT Unknown at this time. Govt. Code Sec. 910.2 provides : "The claim signed by the claimant SEND NOTICES TO: - (Attorney) orb s e person,. on his behalf. " i Name and Address of Attorney BEYER & BEYER CZa ant s Pign-iture Attorneys at Law - -- Gare of Attorney 2730 Lone Tree vay, Suite 6Adress ,, Antioch, Ca. 94509 C Telephone No. (415)-754-5959 Telephone No. NOTICE Section 72 of the Penal Code provides: 'Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher , or writing, is guilty of a felony. " PROOF OF SERVICE BY MAIL - CCP 10130, 2015.5 I I I declare that: 2 1 am (a ocioftoxWempioyed in) the county of.............Gian-tra...Co-st-a......................................................... .California. (COUNTY WHERE MAILING OCCURRED) 3 1 am over the age of eighteen years and not a party of the within entitled cause; my(business/09MMMaddress is: 207 37th Street - 4 Richmond, Ca. 94509- & I am an active member of the .St. .: .e Biqr 0 a ...................................................................................................................................................................... ...... . .... . 5 0 n 1-2715787.................... I served the attached ......Claim against COUTI ............against .ty....Q.;r....................... (DATE) Contra Costa 6 7 .............................................................................................. on the ........ .................................................................. 8 in said cause, by placing a true copy thereof enclosed in a sealed envelope with postage thereon fully prepaid,in the 9 United States mail at.........Ri..c.hmPn.d.,'....Q.q ,........................... .............. .............................. addressed as follows 10 i CLERK OF THE BOARD of SUPERVISORS 11 651 Pine Street, Room 106 Martinez, Ca- 94553 12 13 14 15 16 17 18 19 20 21 22 23 1 declare under penalty of perjury that the foregoing is true and correct, and that this declaration was executed on 24 ............ ...2'... 5-$.7.............................................. at........Richmond.....Ga..................................................... California (DATE) tPLACE) 25 26 ........ FREDERICK....C B.E.Y.E.R..................................... t T Y P E OR PRINT NAME) S16-'NATURE