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HomeMy WebLinkAboutMINUTES - 02131990 - 1.12 AMENDED 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 February 13, 1990 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 Gov �a�n3t Ccld,OL UIlS6l Amount: Undetermined Section 913 and 915.4. Please note all Warnings CLAIMANT: DOCIMO, Marlene FED 7 1390 ATTORNEY: Martinez. GA 1'4553 Charles Nicholas Cuda Date received ADDRESS: Attorney at Law BY DELIVERY TO CLERK ON February 6 , 1990 (via Counsel 565 Ygnacio Valley Rd. , Suite 300 BY MAIL POSTMARKED: Walnut mreek, CA 94596- 3828 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ��IL gATCHELOR, Clerk DATED: February 7 , 1990 : Deputy 11. FROM: County Counsel TO: Clerk of the Board of Sup cors �(v ) This^c1 _ 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: 2 � o BY: I-' )14+_S 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). 1V. BOARD ORDER: By unanimous vote of the Superviscrs present (j<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:FE B 11 1999 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.l Dated: FEB ', 3 1990 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Count; Counsel FFS 5 1 0 �S CHARLES NICHOLAS CUDA Martinez. CA 94553 ATTORNEY AND COUNSELOR AT LAW A PROFESSIONAL LAW CORPORATION 565 YGNACIO VALLEY ROAD SUITE 300 WALNUT CREEK, CALIFORNIA 94596-3828 TELEPHONE (415) 942-5100 FAX (415) 933-3801 February 1, 1990 RECEIVED FEB 6 1990 Mr. Philip F. Altoff PHILmycNE10A Deputy County Counsel tIQt EACHOAkD�QOVAC0190ks P.O. BOX 69 8 De Martinez, CA 94553-0116 RE: Docimo vs. County of Contra Costa Dear Mr. Altoff: Enclosed please find the Amended Claim previously filed on January 11, 1990. Thank you very much. Very truly/yours, CHARLES NICHOLAS CUDA CNC: ly Enclosure CLAIM OF MARLENE DOCIMO ) AMENDED CLAIM FOR PERSONAL VS. ) INJURIES SECTION 910 OF THE GOVERNMENT CODE PREVIOUSLY COUNTY OF CONTRA COSTA ) FILED ON JANUARY 11, 1990 TO THE COUNTY OF CONTRA COSTA: YOU ARE HEREBY NOTIFIED that MARLENE DOCIMO, whose address is 300 Victor Court, Mokelleume Hill, California claims damages from the County of Contra Costa in the State of California. This claim is based on injuries claimant suffered on July 17 , 1989 , while riding as a passenger in a vehicle operated by ALISA BRYCE when the vehicle hit a monument located alongside of Highway 4 at Balfour Road in Brentwood, California. The highway was negligently designed and maintained in that the road had an excessive drop off to the shoulder and that the monument causing fatal injuries was placed too close to the side of the road and not adequately isolated. Claimant suffered severe injuries, including but not limited to severe facial cuts which have resulted in extensive scaring. ALISA BRYCE was killed in the accident. The names of the public employees who may have caused claimant' s injuries are unknown at this time. The amount claimed is over the jurisdiction of the Municipal Court and rests in the Superior Court. RECEIVED FE B 6 1990 PHIL BATCHELOR CLERK 80ARD OF SUPERVISORS C RA COSTA CO. -1- All notices or other communications with regard to this claim should be sent to claimant c/o Charles Nicholas Cuda, Esq. , 565 Ygnacio Valley Road, Suite 300, Walnut Creek, California 94596. DATED: January 31, 1990 By: -� CHARLES NICHOLAS CUDA Attorney for Claimant -2- 1 PROOF OF SERVICE BY MAIL 2 (C. C. P. 1013a, 2015. 5) 3 I declare that: 4 I am employed in the County of Contra Costa, California. 5 I am over the age of eighteen years and not a party of the 6 within entitled cause; my business address is 565 Ygnacio 7 Valley Road, Suite 300, Walnut Creek, California 94596. 8 � On February 1, 1990, I served the attached AMENDED CLAIM 9 FOR PERSONAL INJURIES SECTION 910 OF THE GOVERNMENT CODE 10 PREVIOUSLY FILED ON JANUARY 11, 1990 on the interested parties 11 in said cause, by placing it via first class mail, postage 12 prepaid, addressed as follows: 13 Mr. Philip F. Altoff I 14 Deputy County Counsel P.O. Box 69 15 Martinez, CA 94553-0116 16 I declare under penalty of perjury under the laws of the 17 State of California that the foregoing is true and correct, 18 and that this declaration was executed on February 1, 1990, 19 at Walnut Creek, California. 20 21 22 .. 3 Loretta R. Varni w 24 25 26 27 28 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 February 13, 1990 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: $2,000,000.00 Section 913 and 915.4. Please note all "WaOdAt/ Counsel CLAIMANT: DOCIMO, Marlene JAN 12 1990 ATTORNEY: Mr. Charles Nicholas Cuda Martinez. CA n4553 Attorney at Law Date received ADDRESS: 565 Ygnacio Valley Rd. , Ste. 300 BY DELIVERY TO CLERK ON January 12, 1990 Walnut Creek, CA 94596-3828 BY MAIL POSTMARKED: January 11, 1990 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: January 12, 1990 UVIL BAATTCHELOR , Clerk 149;4- II. FROM: County Counsel TO: Clerk of the Board of S&pervisors 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: _!of /96 BY: I _ 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: FEB 13 1990 JR 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 1 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: FEB BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Ma ne Docimo c/o Ch es Nicholas Cuda Attorney a aw 565 Ygnacio Va Rd. , Ste 300 Walnut Creek, CA 6-3828 Re: Claim of MARLENE DOCIMO Please Take Notice As Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code section 910 and 910 . 2, or is otherwise insufficient for the reasons checked below: 1 . The claim fails to state the name and post office address of the claimant. 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. x 3 . The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. 4 . The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000) . If the claim totals less than ten thousand dollars ($10,000) , the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10,000) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. 6 . The claim is not signed by the claimant or by some person on his behalf . 7 . Other: VICTOR J. WESTMAN, County Counsel B Qi� Y: Deputy o my Coun 1 CERTIFICATE OF SERVICE BY MAIL C.C.P. 95 1012, 1013a, 2015 .5; Evid. C. 66 641, 664 ) My business address is the County Counsel's Office of Contra Costa County, Co. Admin. Bldg. , P.O. Box 69, Martinez, California, 94553, and I am a citizen of the United States, over 18 years of age, employed in Contra Costa County, and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non Acceptance of Claim by placing it in an envelope(s) addressed as shown above (which is/are place(s) having delivery service by U.S. Mail) , which envelope(s) was then sealed and postage fully prepaid thereon, and thereafter was, on this day deposited in the U.S. Mail at Martinez/Concord, Contra Costa County, California. I certify under penalty of perjury that the foregoing is true and correct. Dated: — C�— , at Martinez, California. cc: Clerk of the Board of Supervisors ( iginal) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910 . 2, 920 .4, 910. 8) Claim of MARLENE DOCIMO ) CLAIM FOR PERSONAL INJURIES VS. SECTION 910GOVERN CODE EI COUNTY OF CONTRA COSTA = REC JAN 12 1990 PHIL BATCHELOR TO THE COUNTY OF CONTRA COSTA: CLERKSOARDOF -.::.OR, CONTRA CO De ut e .................... YOU ARE HEREBY NOTIFIED that MARLENE DOCIMO, those a d ess is 300 Victor Court, Mokelleume Hill, California claims damages from the County of Contra Costa and the State of California in the amount of $2 , 000, 000. 00, computed as of the date of this claim. This claim is based upon the injuries claimant suffered while riding as a passenger in a vehicle operated by ALISA BRYCE when the vehicle hit a monument located alongside of Highway 4 at Balfour Road in Brentwood, California. The highway was negligently designed and maintained. Claimant suffered severe injuries, including but not limited to severe facial cuts which have resulted in extensive scaring. ALISA BRYCE was killed in the accident. The names of the public employees who may have caused claimant' s injuries are unknown at this time. The accident claimed, as of the date of presentation of this claim are computed as general damages; claimant' s current medical bills are in excess of $12 , 000. 00, future medical undetermined, wage loss, is undetermined, at this time. All notices or other communications with regard to this claim should be sent to claimant c/o Charles Nicholas Cuda, Esq. , 565 Ygnacio Valley Road, Suite 300, Walnut Creek, California 94596. DATED: January 11, 1990 A" F i By: CHARLES NICHOLAS CUDA Attorney for Claimant PROOF OF SERVICE BY MAIL (C.C. P. 1013a, 2015. 5) I declare that: I am employed in the County of Contra Costa, California. I am over the age of eighteen years and not a party of the within entitled cause; my business address is 565 Ygnacio Valley Road, Suite 300, Walnut Creek, California 94596. On January 11, 1990, I served the attached CLAIM FOR PERSONAL INJURIES SECTION 910 OF THE GOVERNMENT CODE on the interested parties in said cause, by sending a true copy thereof via first class mail, postage prepaid, addressed as follows: Board of Supervisors County of Contra Costa 651 Pine Street, Suite 106 Martinez , CA 94553 I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, and that this declaration was executed on January 11, 1990, at Walnut Creek, California. Loretta R. Varni O a .�. n.4•"1�. 1., LL.0 m u 00. as J � (i� £ m '7914 • cn ' cn rA b� 1-\ ,,,,o G (0 00 m <C � A � 7 Y U 0 �O Q i 7i 0 H a a w o o IJ m V 4 ? v CLAIM Z BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT February 13 190 and Board Action. All Section references are to ) The copy of this document mailed to you is your notife o California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant tonnvernment Code Amount: $25,000.00 Section 913 and 915.4. Please note all 1Q aY%Xsgounsei CLAIMANT: FISHER, Odile JAN 12 1990 ATTORNEY: Mr. Carl B. Metoyer Date received Martinez., CA P-4553 6014 Market Street ADDRESS: Oakland, CA 94608 BY DELIVERY TO CLERK ON January 11, 1990 BY MAIL POSTMARKED: January 10, 1990 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: January 12, 1990 JVIL DepputyLOR, Clerk I1. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: ) 13o 1 p 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). 1V. 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: FEB 13 1990 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code sec ion 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: FEB 1 3 1990 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of. action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes. of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553• . C. If claim -is against a district governed by the Board of Supervisors, •rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims. must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By ) ReseryP(L.-for. Mar."LA 911ing stemp ODILE FISHER ) j' RECEIVED Against the County of Contra Costa ) J AN 1 1 1990 or ) PHIL BATCHELOR h CIFRr.BOARD OF SUPERVISORS N COSTA CO. B ... De ut ..... District yJ Fill in name ) The undersigned claimant hereby makes claim .against the County of Contra Costa or the above-named District in the sum of $ 25, 000. 00 and in support of this claim represents as follows: ------------------------------------------------------------------------------------- 1. When did the damage or injury occur? (Give exact date and hour) November 11, 1989 at approximately 11 :15 a.m. 2. Where did the damage or injury occur? (Include city and county) On the sidewalk on the north side of Oberlin Avenue, Kensington, CA, just west of the driveway leading to the property at 663 Oberlin -----aupenue,P Zen L.siugtnn*- ---------------------------------------------------- 3. How did the damage or injury occur? (Give full details; use extra paper if required) I was walking to my automobile which was parked on the north side of Oberlin Avenue; facing west, at a point just west of the driveway leading to the real property at 663 Oberlin Avenue, Kensington, CA. As I was walking west on .the sidewalk located on the northern side -------------------------�SEF-1 AZUMENZ)----------------------------------------- 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Failure to repair the sidewalk on the northerly side of. Oberlin Avenue, in the area where I sustained my fall, or to cause its repair by the adjoining property owner. (over) 5. What are the names of county or district officers, servants or employees causing the damage or injury? Unknown. -------------------------------------------------------------------------=---------- 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Injuries to my right leg,' ankle, left knee and left foot. Medical expenses and lost wages. . ------------------------------------------------------------------------------------- 7. How .was the amount claimed above computed? (Include the estimated amount of any prospective in jury.or damage.) LOST WAGES - $400 -001. - GENERAL DAMAGES - PAIN. AND SUFFERING - $24 , 600 . 00 ------------------------------------------------------------------_---_---------------- 8. Names and addresses of witnesses, doctors and hospitals. ELEANOR PAYTON, 663 Oberlin Avenue, Kensington, CA; RUFUS FISHER, 4017 Sequoyah Road, Oakland, CA; OAK KNOLL NAVAL HOSPITAL, Oakland, CA NAVCARE CLINIC, 8450 Edes Avenue, Oakland, CA 94621 ------------------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES.TO: '_ (Attorney) or by so_W person on his behalf." Name and Address of Attorney CARL B. METOYER By Attorney at Law Claimant tune 6014 Market Street CARL B. METOYER, Claimant' s Attorney Oakland, CA 94608 :.:. : Address 6014 Market Street Oakland,- CA94608 Telephone No. (415) 658-1077 Telephone No. (415) 658-1077 * * * * * * * * * * * * * * * N O T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. ATTACHMENT to 3 . - (Continued) of Oberlin Avenue, my heel caught in a crack in the sidewalk, causing me to fall. to the sidewalk. LAW OFFICES OF CARL B. METOYER leor 6014 Market St. - Oakland, CA 9460 • VED I J A N 1 1 1990 CLERK ECiARD OF PERVISORS _ CONTRA COS Oe u ems.......... . . To Clerk of the Board of Supervisors Date January 10, 1990 County Administration Bldg. , Room 106 651 Pine Street Subject Claim of Odile Fisher Martinez , CA 94553 D/Injury: 11/11/89 Gentlemen: Enclosed herewith is an original and two copies of a Claim relative to the above-noted matter. Please file the Claim and return two (2) endorsed filed copies of same to us in the return addressed stamped envelope. Thank you for your cooperation in this matter. Ver,Vtruly_v ours CARL B. METOYER CBM/cc Encls. FOLD AT(-)TO FIT DRAWING BOARD ENVELOPE#EW 10P Ilam•MM72 Tb Dmw g B ,,L Dallas,Teas 75256-0429 .. G Whn1w Gmw.M.,1962 iR Har ,S man to a �. bx 04 V •�. 0 a b 4, M ro In O -u 4-J �� of Ul 4j �4 IY(y .r,y 4 v N. o >i•H 4J ` UUtLno � i w o JAN 1 11990 U.0 O tt F PHIL BATCHELOR {p N Q CLERK BOARD OF SUPERVISORS LU U) 2 CONTRA COSTA CO. U W I- X 999 BY ............ Deputy LL �^ �! W U ►-a zz U < 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 February 13, 1990 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 ecFe fnment Code Amount: :-.Undetermined Section 913 and 915.4. Please note all "WaWiRgur CLAIMANT: GONSALVES, Susan JAN 1 1990 kesti,,e2. Ca ATTORNEY: Mr. Nick Lymberis `63 Attorney at Law Date received ADDRESS: 111 North Market St. , Suite 1010 BY DELIVERY TO CLERK ON January 12, 1990 (hand delivered) San Jose, CA 95113 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppHH gg DATED: January 12, 1990 BYIL DeputyLOR, Clerk OF 9a 11. FROM: County Counsel TO: Clerk of the Board of Sup visors (� ) 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: i Dated: BY: J Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARD ORDER: By unanimous vote of the Supervisors present (fes ) 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: FEB 1 3 990 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code sec ion 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: FEB 11 1990 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator t Claim of Susan Gonsalves CLAIM FOR PERSONAL INJURIES (WRONGFUL DEATH) V. (Government Code Section 910) County of Contra Costa � MMM RECEIVED /,/)-. /0 a-�47- JAN la 1990 To: CLERK OF THE BOARD OF SUPERVISORS COUNTY OF CONTRA COSTA PHIL WCHEwLOR "651 Pine Street, Room 106] UERK BOARDf Of SW.fMSon ;- Martinez, CA 94553 _`� �'� ce .... owrt� You are hereby notified that Susan Gonsalves, whose address is 1904 E. Chippewa River Rd, Midland, MI 48640, claims damages from the County of Contra Costa and the Contra Costa Sheriff 's Department (hereinafter collectively referred to as the "County") . 1. This claim is based on personal injuries and the resulting wrongful death sustained by claimant's late husband William Gonsalves, on or about July 14, 1989, at or near the end of Avila Road, approximately 1.2 miles East of Willow Pass Road, in the . unincorporated area of the County of Contra Costa, California. On or about that time and place, Mr. Gonsalves was seriously injured and, as a result, thereafter died, in an automobile accident caused in whole or in part by an unreasonably dangerous condition of the roadway and the negligent conduct of the County and its employees, to wit: a. The County and employees of the County had negligently designed, constructed and maintained said portion of Avila Road and the surrounding area so as to pose an unreasonable risk of injury to drivers on said road in that the road ended abruptly, without sufficient or adequate warning, and in such a way that the topography and conditions of land immediately following the dead end was extremely dangerous to persons who could not stop at the end of the road, and further, the roadway, signs and speed limits, as constructed and designed were inherently misleading to drivers with respect to the existence and whereabouts of the dead- end. Because of each of the foregoing attributes, the road was in an unreasonably dangerous condition at the time of the accident, which the County knew to pose an unreasonable risk of injury and death to persons using said road. b. In addition to the foregoing, it is alleged that deputy sheriffs of the Contra Costa County Sheriffs department were negligent in attempting to extract Mr. Gonsalves from the wrecked vehicle in that they did so without due care and in such a way so as to cause further injury to Mr. Gonsalves and death, and further, that they administered cardiopulmonary resuscitation to Mr.Gonsalves even though he plainly had suffered substantial chest CLAIM OF SUSAN GONSALVES 1 r CLAIM OF SUSAN GONSALVES (continued) injuries, and said sheriff deputies knew or should have known that the administration of CPR in such situation poses an unreasonable risk of death and injury to the victim. It was therefore negligent to administer CPR under the circumstances known to the deputies at the time of the accident. C. It is further alleged that the County and employees of the County negligently hired, trained, maintained, employed and supervised its aforementioned employees, all of which directly resulted in the foregoing accident, injuries and death. d. As a direct result of the foregoing negligent design, construction, maintenance, unreasonably dangerous condition and failure to warn, and the negligent conduct of the county and county employees, including but not limited to the deputy sheriffs, Mr. Gonsalves ran off the end of Avila Road at or about the above stated time and place, he was injured, his injuries were exacerbated and Mr. Gonsalves died as a result thereof. 2 . The names of the public employees .causing claimant's injuries under the described circumstances, in so far as they are known, are Does 1 to 30. 3 . The injuries sustained by claimant, as far as known, as to the date of presentation of the claim, consist of the following: Claimant has suffered emotional distress, pain and suffering, medical expenses, funeral expenses, and she has lost the company, consortium and support of her late husband Mr. Gonsalves. 4 . Jurisdiction over this claim would rest in Superior Court. Pursuant to Government Code Section 9101 the amount of damages claimed is not stated. 5. All notices and other communications with regard to this claim should be sent to claimant's attorney as follows: NICK LYMBERIS ATTORNEY AT LAW 111 North Market Street Suite 1010 San Jose, CA 95113 Dated:- . NICK LYMBERIS Attorney for c imant NL14M136 CLAIM OF SUSAN GONSALVES 2 ` CLAIM JAN � `� �g BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Ma ftin e—; G ``45 5 j Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT February 13, 1990 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: $315.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: BROWN, Ricky ATTORNEY: Date received ADDRESS: c/o Tonya Jackson BY DELIVERY TO CLERK ON January 19, 1990 (hand delivered) 160 Corte Maria Pittsburg, CA 94565 BY MAIL POSTMARKED: 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim, JJIL BATCHELOR, Clerk DATED: January 19. 1990 : Deputy 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: / �q I�1(� BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy o.f the Board's Order entered in its minutes for this date. Dated: FEB 1 3 1990 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code sec n 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: F E B 13 l1990 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator BOARD OF SUPERVISORS OF. CONTRA CDFejur-92R,7wappllcatlon to: Instructions to Claimant OerVoll-heBa-ard P.0,Box 911 MATU-neZ.CAMOMil 94553 A Claims relating to causes of action. for death cz XOX :Lm@ury to person or to personal property or gzovi_ng c-ropes W- ast be presented not later than the 100th day after tbe. acn_—aal of the -cause of action. claims relating to any othie�r cause:, of act-ion.. must be presented not later than one year a±tex 'the acc=zzl. of -the cause of action. (Sec. 911. 2, Govt. Codet B. Claims must be- filed with the Clerk of t- be Board =oma Supervisors at its office in Room 106 , County ..:Aa,,m-'Lnis.trati,,o.n Building, 651 Pine Street, Martinez , California 9455K C. If claim is against a district goy-meed by the Bnard of Superviso-rs , rather than the County, the name of -the Di.:s--t=:i=t st­omlld be filled in. D. If the claim is against more than vne p tic emr-tity" Se'paxate claims must be filed against each..public emltlty_ ..- E. Fraud. See penalty for fraudulent c_1-z_Jms, :Pe.=41 Code Sec- 72 at end of this form. RE: Claim by !,�Mp_s-gryed -fror stamps RECPYED JAN 19 1990 Against. the '£OUNTY OF CONTRA COSTA) Z3 fwk"TCWROI D F SUPEAWK01S U-1 R I CT CtftK COAR 'SU"" :�jAA, 10jSA CC (Fill in name) ...... gas, . The undersigned claimant hereby malzzes c1adLm acraimst the coun-ty of Contra Costa or the above-named District in the :snm of t$_-._4:w�Mvr---7- and in support of this claim repre-;ents as Lallkowsz ---I------- ----------------i-- ,.,r? -—nd------ - 1. When did the damage or nDury )cc,, TGi-7. e, exa.c-L dalte, -a- hour) --- _2" -----I - --- - 2. Where did the damage inj-Hry occ=..-? Clmriluude city •end-county)- 3, How did the damage or injury odetall, S,occur? (jG117e ±z3_L_ use extra sheets if ------------ ——--- --------- - cular act or omission om ,be paxt of c(Dmm. ty or district officers , servants or employees cattsi_-d the. im-4mm27 :o-r damage? U-4-N (1 6 (over) 1 '.:5.:.4 iat• ar.e.:the..names of county or district officers, servants or {' i employees causing the damage or injury? Eft 6. What damage or injuries do you claim resulted. (Give full extent - of injuries or damages claimed. Attach two estimates for auto damage) p{y�= �rl%,� ���� C,�fl� ��So , 0 0 oN�� Q ,4� Sc� C`��F�las ;�t�L l�2�Joc,\� '�c NNIS S�1eeS �S .00 ' bnti '��; 7 . How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) 8. - names ana addresses of winesses , doctors and hosaitals 9 . Lict_. ''2e exd�e _ es you made on account of this accident or injury: T 1 TE2d AMOUNT f r .r�aaw:aa Govt. Code Sec. 910 . 2 provides : "The claim signed by the claimant SEND_:. NOTICES TOS:. (Attorney) or by some Gerson on his behalf." Name and Address of "Attorney C imant ' s Signature /a 1 \I AddLets 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 may the same if genuine, any false or fraudulent claim, bill, account , voucher, : or writing , is guilty of a felony. " County Counsel CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA JAN 1 - 19/90 9 y. 9 y •+�nQ . CA .1"%553 Claim Against the County, or District governed b ) B0. ,,. �... the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT February 13, 1990 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: $50,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: VILLANDRE, John E. ATTORNEY: Stanley Pedder Esq. Malott, Pedder, Stover & ?.,. .., .._,.;:.Date received ADDRESS: Hasseltine BY DELIVERY TO CLERK ON January 18, 1990 3445 Golden Gate Way, Lafayette, CA 94549 BY MAIL POSTMARKED: January 17, 1990 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. January 19, 1990 PpHIL BATCHELOR, Clerk DATED: B�: Deputy II. \FROM: County Counsel TO: Clerk of the Board of Supervisors V ) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: y 1-1 196 BY: - S_ � 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 (1/1 Claim is rejected in full . ( ) Other: I certify that this is a true and correct copy o.f the Board's Order entered in its minutes for this date. Dated: FEB 11 1990 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: FEB 13 1990 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator MALOTT, PEDDER, STOVER, HESSELTINE & WESTCOTT ATTORNEYS AT LAW RICHARD A. MALOI l NEVADA CITY OFFICE STANLEY PEDDER 3445 GOLDEN GATE WAY WASHINGTON STAR ROUTE JOHN A. STOVER POST OFFICE BOX 479 NEVADA CITY, CALIFORNIA 95959 W. G. HESSELTINE (916) 265-4835 DAVID V WESTCOTT LAFAYETTE, CALIFORNIA 94549-0479 CAROLE R. HEBERT (415) 283-6816 1 TIMOTHY B. WALKER i j1 ROBERT J. PEDDER, ryYvir 1 !I }� OF COUNSEL January 15 , 1990 h-,�� fi� A� y J AN 18 1990 Clerk of the Board of Supervisors Room 106 , County Administration Building 1 C1Ut, :;OARDl:rS!IlEd\'!cORS 651 Pine Street ` = "CO peU Martinez , CA 94553 5 RE: Villandre v. County of Contra Costa CASE NO. : ENCLOSED HEREWITH ARE THE FOLLOWING: Claim These are furnished for the purpose designated below: . ( X ) Filing and return of conformed copies in the enclosed envelope. ( ) Enclosed is our check in the sum of $ for ( ) Filing Fee ( ) Recording ( ) Certifying ( ) Signature of the Court, filing of original and return of conformed copies to us in the enclosed envelope. ( ) Your signature and return in the enclosed envelope. ( ) Entry of Default, filing and return of conformed conies in the enclosed envelope. ( ) Other Very truly yours , MALOTT, PEDDER, STOVER, HESSELTINE & WESTCOTT /I &A- By: t NE M. KEITH Enclosures Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553• C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. Tf the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's filing stamp JOHN E . VILLANDRE ���$ y��•., �1�+ ) I = Against the County of Contra Costa ) J AIN 18 1990 = or ) _ ';ATCHELOR : "F SUPERVISORS - District) t :osra co. Fill in name The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 50, 000 . 00 and in support of this claim represents as follows: ------------------------------------------------------------------------------------- 1. When did the damage or injury occur? (Give exact date and hour) November 27 , 1989 , at 8 : 30 a.m. ----See attached Traffic Collision Re ort -----------------------------------1--------------------------------------- 2. Where did the damage or injury occur? (Include city and county) I-680 , S/B, Walnut Creek , Contra Costa County. -------- -See attached Traffic Colli.si:on Report ---------- ----------------------------------------------------------------- 3. How did the damage or injury occur? (Give full details; use extra paper if required) See attached—Traffic Collision Report ------------------------------------------------------------------------------------ 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? See attached T.rdffic Collison Report (over) 5. What are the names of county or district officers, servants or employees causing the damage or injury? CHRISTINE LYNN DEAN - Contra Costa County Sheriff 6. What damage or injuries .do you .claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Suffered neck & upper back injur=ies . See attached estimate . ------------------------------------------------------------------------------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Amount not known at this time . Under treatment with Chiropractic Associates. See attached note . ------------------------------------------------------------------------•------------- V. L4G1111%ZJ a.L1U Oulu C.JJC:J Vi Al UVV VVl J 011e alV iJt./1 VOLJ. Chiropractic Associates , 1981 North Broadway, Suite 120 , Walnut Creek, CA 94596 Jerome H. Davis , M.D. , San Ramon Valley Orthopaedic Group, 907 San Ramon Valley Blvd_, Suite 202 , Danville CA 94526 ------ - ----------Z-------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Auto deductible (for repair) $250 . 00 Medical Bills., Unknown at this time. Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf." Name and Address of Attorney STANLEY PEDDER, ESQ. MALOTT , PEDDER , STOVER & Clai is Signature HESSELTINE STANLEY PEDDER , ESQ. P. 0. Box 479 MALOTT ,PEDDER, STOVER & HESSELTINE Lafayette , CA 94549 Address 3445 Golden Gate Way, P.O. Box 479 Lafayette , CA 94549 Telephone No. 415/283-6816 Telephone No. 415/283-6816 N O T I C E Section 72 of the Penal Code provides: . "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. TRA►.F!C COLLISION REPOR ePAM ,. H[ K NUM.[R IT JUDICIAL OMSTR ICT OCAL UrORT NUYBKR -�°"°Iu�Y - -- L� iCs�Z y N .[R HIRUNwrr a ReoDISTRICT .ur w _ 63 3COL LM4 H OCCURRE9 ON//��nn C m DAr rLMt(BIee) NCHC aOF19C[R l 0. Z - r^ MILEPOST INFORMATION 69 DAY Or*1141K TOW AWAY, pH10TOGRA/1A BY: u `� S 7 MTWTFS Ort. ON* �� �nS� joAr LNTIRs[ vm BTAn HLrr REL J//ov - OSI: /WL. Or , rp ^ /7 /CJ ❑YMOla1�' , PARTY DRIVER'S LICiNSE NUMBER STATE CLAM BAFM VEK TSAR MAUI NOMI COLOR ` NUMBER [TATE DRIVER 7JAYa FIR.T.NOOIt.LAST) 0 ��hu-) blnAILLANI PEDIS- ATM [M OVINE"NAYYE[ ®.AAS DRIVER TRIAN 0 O NLmo M6 mla- PARK[0 /.T TE/ o.BI[R.ADOREM �sAYt A.oJSVq p` L u NCT. on HAIR tY[. NOGNT roGNr (BIRTHDATE RACK DIE►OMTIONOFVENICLAONORDERSOP. 0OfNCER UIWM OOTHM cur � rtAR ❑ I — bIRWpil NOM OTHER HOU[PHONE SuSpJSM P`JHONE 71BOR MECHANICAL DEFECTS: NONE APPARENT REFER TO W munvol ❑ W� i LU Io —9 ) 13 CNP WE ONLY O�ABKVtMCLt OAYAOt BNADE W DAMAGED AREA VEHICLE TYPE YdURANCE CARRIER POLICY NUMBER ll ,-L El— KI ❑ OOYAJOR �1/NAL011 DIR OP ON.MRiIFNI HIGHIWAr .PEED PCF LoCQ ' V PueQ CW Q PARTY D1VvtR1 LICUA[NUMBER STATE CLAM SAFETY vm YEAR MAKE IMODI LI COLOR �ICEHSE NUMBER .TATE t r. 2 B� CI. . y� . .�JK E4.�5 o'i'1.� ONVER -NAME(FIRST.SBODI[.LAST) FIDES- ZTRUT ADDRESSOWNERS NAME ❑SAYE AS DRIVER TRIAM ❑ la0 f)0 ky(� H (ZeFk RhAtb C o w`1T`1 OV . Co WIFEA G 4 T; PARKED .TAT[/LP OWNER'S ADORES. ❑SAME A.DRIVER VEHICLE NCP• SES HAIR ETA MERGHR WEIGHT BIRTHDATE RACE DISPOSITION OF v[NCLIONORDERSOF: �ORMCER (QORIVER 0OTN[ll CUNT YO. DAY I YEAR u (� -0 Li OTIf R NOM[PHONE I BUS""PRION[ PIS011 YfCHANICAL DEFECTS: NDN[APPARENTUP[R TO NARRATIVE❑ ❑ (q 1� ) 1^�� � / C 4P US[ONLY DESCRIBE VEMCLE D.MIAOE WADE W DAMAGED AVIA. ��KEEJJJ 1 HHHLLL!!! [[JJ�� 000��� WIHICLEn►t �I INSURANCE CARRIER POLICY NWLB[R Ou1.0 NONE pV,rH .� L F7 �YOa �YAJOR aTDTK OIIL M Oow HIGHWAY .TEED F ICC Q , J J. LIYlT PUC Q . . !L 7/J. CwQ PARTY D1Vv[R-S UCENN NUMBER .TATE CLASS SAFETY VEAL MAKE AKE IMODEL I COLOR J.JCENfI NUMBER STATE Gulp. 3 [ _ i DRIVER NAME(FIRST,YDDLE.LAST) PEDES- -STREET ADDRESS OWNER'S/NMI []SAME AS DRIVER TftAN ❑ PARKED CITY ISTATE/ZIP OWNERS ADDRESS SAYE AS DRIVER VEHICLE . - .. MCT. SEI NAIR EYESNE/GHT WUGNT SIO. O IM DATATIE r[A1H RAC[ DISPOSITION OF VEHICLE ON ORDERS OF: []OFFICER ODPJVER []OTHER CUST % OTHER NOMa PHONE BUSINESS PHONE PROR MECHANICAL DEFECTS: NONE APPARENT ••REFER TO NARRATIVE[] ❑ ` , ( , CHP USE ONLY FFT CL[DAMAGE SHADE W Yf EUOAAD ARmcfa MINOR IMURANCI CARRIER POUCTNUMSR/ . .. V[NCL[1rK YA.gII TOTAL . OIKOP JONST11116TORNOMWAV SPEED ICP ICCQ , TRAVEL OMIT PUCQ CW Q PREPARER7 NAME JV�W DISPATCH NOTIFIED jREvIEwIER-SNAml OAT[^REVIEWEDn cl W O VES 13 NO C3 NU C.r�i.l GrG7G 1P'+► 1`�V �1 CHP 65S PAGE 1 (Row 18B) OPI 042 88 48067 STATt A/CALIR)W"A 'TRAFFIC COLLISION COD(_ oKrr of oLusloN Trt Imo. NC1C MuwtA L o rums"',oAv vtA� i • PpOPERTY 4WNER6 N/Wt/ADO u Nonr+to 11- 0 40 DAMAGE IDIESCourno"oPDAM"Jil SEATING POSITION SAFETY EQUIPMENT EJECTED FROM VEHICLE OCCUPANTS L-AIR SAO DEPLOYED �'C■ICYC c_NCI rICT 0•NOT EJECTED - A•NONE IN VEHICLE M•AIR SAO NOT DEPLOYED DAFM 1•FULLY EJECTED B-UNKNOWN N-OTHER V-1110 2•PARTIALLY EJECTED C-LAP BELT USED P.NOT REGUIRED W-7u 3-UNKNOWN T-DRIVER D•LAP BELT NOT USED 2 3 2 TO 6.PASSENGERS E-SHOULDER HARNESS USED PASSENGER 4 5 6 7-STATION WAGON REAR F-SHOULDER HARNESS NOT USED CHILD RESTRAINT X_110 6•REAR OCC.TRK OR VAN G-LAP/SHOULDER HARNESS USED 0_IN VEHICLE USED Y-YES s•POSITION UNKNOWN H-LAP I SHOULDER HARNESS NOT USED R-IN VEHICLE NOT USED � 0-OTHER J•PASSIVE RESTRAINT USED S-IN VEHICLE USE UNKNOWN � K-PASSIVE RESTRAINT NOT USED T-IN VEHICLE IMPROPER USE U-NONE IN VEHICLE ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK(•)SHOULD BE EXPLAINED IN THE NARRATIVE PRIMARY COLLISION FACTOR CONTROL DEVICES 1 ,� 3 TYPE VEHICLE ' 2 3 MOVEMENT PRECEDING UST NUMBER(s)OF PARTY AT FAULT COLLISION s AVC SECTION VIOLATED: p��MI gCONTROLSFUNCnONNG APASSENGERCAR/STATION WAGON ASTOPPED NO B CONTROLS NOT FUNCTIONING• B PASSENGER CAR W/TRAILER B PROCEEDING STRAIGHT B OTHER IMPROPER DRIVING•: CONTROLS OBSCURED C MOTORCYCLE/SCOOTER IC RAN OFF ROAD D NO CONTROLS PRESENT/FACTOR K D PICKUP OR PANEL TRUCK D MAKING RIGHT TURN C OTHER THAN DRIVER• TYPE OF COLLISION E PICKUP/PANEL TRUCIK W/TRAILER E MAKING LEFT TURN D UNKNOWN• HEAD-ON F TRUCK OR TRUCK TRACTOR F MAKING U TURN s E LLB SIDESWIPE GTRUCK/TRUCK TRACTOR W/TRLR. G BACKING (;REAR END H SCHOOL BUS H SLOWING/STOPPING WEATHER( MARK I TO 21TEMS) D BROADSIDE I OTHER BUS I PASSING OTHER VEHICLE gCLEAR E HIT OBJECT J EMERGENCY VEHICLE J CHANGING LANES B CLOUDY F OVERTURNED KHIGHWAY CONST.EOUPMENT K PARKING MANEUVER C RAINING G VEHICLE/PEDESTRIAN L BICYCLE L ENTERING TRAFFIC D SHOWING R OTHER•: MOTHER VEHICLE MOTHER UNSAFE TURNING E FOG/VISIBILITY FT. MOTOR VEHICLE INVOLVED WITH N PEDESTRIAN N XING INTO OPPOSING LANE POTHER': ANON-COLLISION 0 MOPED OPARKED G VINO PEDESTRIAN P MERGING LIGHTING >QC OTHER MOTOR VEHICLE 0TRAVELING WRONG WAY q DAYUGHT D MOTOR VEHICLE ON OTHER ROADWAY OTHER ASSOCIATED FACTOR(S) IR OTHER•: B DUSK-DAWN E PARKED MOTOR VEHICLE 1 2 3 (MARK 1 TO ITEMS) CDARK-STREET LIGHTS FTRAIN ZE CTWNVIOLAMN: arfo D DARK.NO STREET LIGHTS G BICYCLE OO O DARK.STREET LIGHTS NOT ANIMAL: CT10NWOUTIOM: Ano FUNCTIONING• :H OyQ ROADWAY SURFACE ONO SOBRIETY-DRUG A DRY I FIXED OBJECT: CTTON VI0LAr4N: CrTto 1 2 3 PHYSICAL OTO (MARK 1 TO 2ITEMS) B WET OTHER OBJECT: ONO C SNOWY.ICY HAD NOT BEEN DRI NIU NG J p D SLIPPERY(MUDDY.OILY,ETC.) E VISION OBSCUREMENT: B HBO.UNDER INFLUENCE F INATTENTION': HBD MOT UNDER INFLUENCE ROADWAY CONDITION(S) PEDESTRIANSG STOP 8 GO TRAFFIC HOD-IMPAIRMENT UNKNOWN (MARK 1 TO 2ITEMS.) INVOLVED E UNDER DRUG INFLUENCE q NO PEDESTRIAN INVOLVED H ENTERING/LEAVING RAMP A HOLES.,DEEP RUT• I PREVIOUS COLLISION F IMPAIRMENT NOT KN AL CROSSING IN CROSSWALK IMPAIRMENT NOT KNOWN B LOOSE MATERIAL ON ROADWAY• B AT INTERSECTIONUNFAMILIAR WITH ROAD C OBSTRUCTION ON ROADWAY• K DEFECTIVE VEH.EQUIP.: �D NOT APPLICABLE CROSSING IN CROSSWALK_NOT Glyn I SLEEPY/FATIGUED Q CONSTRUCTION-REPAIR ZONE C AT INTERSECTION ONO SPECIAL INFORMATIQN E REDUCED ROADWAY WIDTH p CROSSING-NOT IN CROSSWALK L UNINVOLVED VEHICLE I 1ANAZARDOUS MATERIAL FLOODED E INROAD.INCLUDES SHOULDER M OTHER G OTHER-: F NOT W ROAD NONE APPARENT H NO UNUSUAL CONDITIONS (i APPROACHING/LEAVING SCHOOL BUS 0RUNAWAY VEHICLE SKETCH MISCELLANEOUS `'_ NOICATI NORTH • •• ter:• .;.��•�. 4^� .. ...a , .••... - .. l •l. ., - 1 - .. .) S'3 SAKE . •- -- e c s KIQD —Soyl 13aumn CHP SSS PAGE 2( Rev 1.68)OPI 042 FAQT-UAL DIAGRAM .wa. •owic o• coun�or. me (.eeo( wc�c wu..wcw 'ccw ..o. ....•an S • ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED (SCALE- 90 �S ou w f3.o(juo L ow6S I Y • V • 1 �r�. �I;5-x1s 3 wow Tw 1AEDfA(1 , I OF • 1 r 0 11h.. `L `. • 1 r U_ • • , L 1 � 2 /1RLXX Q2 ;WAu r i . � 1 . 1 1 . 1 . w• �.o-..u:.wcw +.ll�-A._ rw- CHP 555—Page 4 (Rev II-85)OPI 042 SIA�EO�CALIf NARRAMVE/SUPPLEMENTPAGE MAT E Of; ]— mmA kL%NUMBERF7 n4 I- rL M-3n '7rCO7NE '7C ONE TYPE SUPPUWNIAL rr APPJC^" kAARATM COLLMON REPORT 0 $A UPDATE a FATAL11 WT a RUN UPOATt ❑ SUPPLEMENTAL0 OTHER KVAADOLO MATERIALSSC4400LBUS f--HT OTHER: CITY I COUNT Yj-VD.CAJ;kSTW-T FtEPOAT^G OISTFjr-T I BEAT ICATATIDhkuMBER LOCATON,SuMC' STAEMr, WAYFfLATEV YES No Za�1061 3. h-77- 4. u? v e. • rxr-..a 4 & OA Al)---- 10. -Z, 11. 12. -?611,AIJ) Al _0 u A10 13. 14. YOM ty 15. 16. ' ItI'do R=16 t/ n A/ My V- Z121 19. 20. 21. /C/ 22. =IAIA 24. 25. 26. 27. 28. V11 29. 30. 31. 32. PAREirSMBERDAYIYEAA IREVIEWWSNAME L40NTHIDAYIYEAR NAW oo' ' ('FGO:n �"d*O~ 88 48641 c- ^-HP 556(Rev.7-87)OPI 042 .:�i ��� � • . ice . . �/ rT mI I FAVA ���i�i IOWA OEM Egg r �. e�l��1 ► ♦ mil ��� l � !� ' �s; r1. . Ica; es► !:� _� lel .�T�l AIWA : . 1 i'. . / li .:• A � i I l iHIMigamI � • `/I /IMM O • s a r r WW"! e ��•� AP A j VArAUWJ uME-a►►. fir: ♦_ .11"` c�It :.r//.-�/. . 1 :ML r ii l_ 1'ems' . r •'�• �'i � /r PI FA ddp ME • I ♦� I il�/// �ia�9lli�///iii � , , � � �� 4 � Jl • i � "� •moi / i �%t i V / j"' s s 4r b a a RETURN TO WORK OR SCHOOL k CHIROPRACTIC ASSOCIATES •` 1981 North Broadway.Suite 120 Walnut Creek,California 94596 i' Telephone:(415)935.8040 i. CIS Date This is to certify that t -v�V1, L-", }� hs been under my care for the following: � Ap _ 0 t. pin +!wk�ai�NK�tiiii�?tiC i�MW�'�` i�isisl>♦�yct�iMtii�tii!t�ttT44ii �� �� � y'f�.-�•-C �V�{N�� •/.• ......... �... M1fV Il .�n,:y�Mwts•a rl:u«.u...u.1N,Y.0.+R4n4.>Y;:SL t ` I 1 'r 1 V'k Q. l t er .............. .. . .. t and is able to return to wsr.o re1 on Remarks: i ( I NAU ) 113107 Medical Arts Press,MpI_MN 114I7 v i 1_ moi;%.if 1'11_};iIG S'I?•t�LAR11 li FL.ii '� � _ LAIPA 54 613 3 545 A t L0(1 N0 j, r �r MC MESSAGE Dc` _" . . C3 01 CALL DEALER FOR EXACT PART # REOUIREF) mm o Ji� / 05 INCLUDED SUB-ASSEMBLY mm D •�- Dz z . + INAL CALCULATIONS & ENTRIES c,= GROSS PARTS 631 65 >00 J.. OTHER PARTS 50. 00 sm PAINT MATERIAL 1911.66) m� ARTS TOTAL 814.65 O mo z TAX ON PARTS & MATERIAL. w 7 .00i;°%, 61. ,("„� ZD O _ m LABOR RATE REPLACE HRS REPAIR HRS 1-SHEET METAL 42.00 19.8 5.0 1.. )--31 .60 mp r 2-MECH/ELEC 42.00 - 3-FRAME 42.00 _ 4-REFINISH 42.00 10.0 4"0.00 5-PAINT MATERIAL 19.x.10 ABOR TOTAL 1.1161 .60 TAX ON LABOR O i SUBLET REPAIRS D TOWING &, STORAGE {r- __ ROSS TOTAL ?`a7.4b' �U � c LESS: DEDUCTIBLE -250.00- Z mm ET TOTAL 2, i47-48 DZ z Fcn KD � C DP#AUDATEX Al U ES LOG 22782-08 DATE 11/30/89 11 : 59:32 039 NN/00/OO;OOi UG c�T r-m 2 >00 NOTICE - REPAIRS' TO THIS VEHICLE MAY REQUIRE SPECIFIC �M N ELDING EQUIPMENT AS RECOMMENDED BY THE MANUFACTURER" m �-----r-- - ------ --- ------- „ mp z x o P L E A S.4;N H 11- R V"I C F E N Tf:i-. CD < Ewlvf P. Q. rlil. 4011 >(h CD z 4 15'! 68 17601) -4m 0 0 'n CONLOPI), (A. 94524 >--1 Al L.9G NO i20, DATE "nm > >z z M L A I Vi 59 61133 545 P 0 L I C Y INSURED VILLANDRE, JOHN CLAIMANT >00 _OSS DATE 11/2-7/89 TYPE OF COL MN mm > m 17 mm 0 mo Z (nm __j [NSP DATE 1li29/89 LOCATION PH' C m -STIMATOR WISE/WRIGH", COMPANY Z> 0 >-0 m > F-9> NAME VILLANDRE, JOHN ADDRESS 1890 ALMOND AVE CITY STATE WALNUT (,PEEK. C-A Z I P. PHONE 9.116 9ALI-6 -j IC# CTIG15A virl JAABL14AYGO1/65114 Co-<r- T > NG/COLOR MILEAGE (142888 (n 1-0 ONDITION ACCT'NG CI'L# MARY CROW >r- --4m 0 m 7- -4 -NEW PART E.C=QU.AL REPL PART EU=LIKE KIND & OUALITY EP -n rn > ,j A L RPI PRT RPT P='-HECK I- >zz M-4 , =REPAIR/ALIGN/SUBLET L=REFINISH N=ADDITIONAL LABOR OPERATION 3:Cf) ;tf E=PART/PARTIAL REPLACE ET=LABOR/PARTiAL REPLA.(_E IT=LABOR/PARTIAL REPAIR cpm —N r-m >00 A-APPEARANCE ALLOWANCE RP=RELATED PRIOR DAMAGE UP=UNRE LATE PR -? !OR DAMAGE... mm > 986: SLIZU PICKUP STANDARD 6' BED 18102A OPTNS C/E M-0 Z- "um 0 m j - mo z cr PTIONS: POWER STEERING Z> C. -j-0 > u PRT A m P GDE MC DESCRIPTION MFG. PART N(t. f(E HOURS R :j <0 389 PANEL.BEDSIDE LT REPAIR/ALIGN 1 .5AI L 2 389 PANEL,BEDSIDE LT REFINISH .8 4 39.0 PANEL,BEDSIDE RT 8944320941- 252.64 9 5; 1 390 PANEL,BEDSIDE RT REFINISH 3•r 4 443 01 DECAL,TAILGAiE 8944006490 't2. 2- .2 1 479 SHELL,TAILGATE 8941042743 111.41 .6 1 479 SHELL.TAILGATE REFINISH 1.8 4 > 488 05 14 1 N G E�TA 1 L G AT E RT 8942176130 1 tic Co r- --q 511 FILLER.LOWER PANEL 8942175662 45. 72 4 . i. I > co i 511 FILLER,LOWEER PANEL REFINISH .8 4 >_u z P A LZ 'd 513 ANEL ,RR BDY SILL 89441032130 64.56 m --j -1rTl > 568 BUMPFR,RErA%P STEP 2900030020 107.60 1 .t7 1 1-17- Z_ x..568 BUMPER.REAR STEP REFINISH 4 ' C-) 980 BED ASSEMBLY R&I ADDTL LABOR I r- Mol CLEAR rOAT REFINISH 25 5*1 >C) 0 STRIPES QUALITY RLEPL PART 25-00- 1 .0*1 m P&I SHELL REPAIR/ALIGN 1 .Uk1 m MATC4 PAINT REFINISH mo Z 16 ITEMS a 0 m G bn C 0 � � U N N w ,, vo � v � o � o � d o � � O s 471 41e The enclosed materials are provided by The Riverview Fire Protection District vt6 R 0 0 (415)757-13W 0 0 JIM HILL _ Assistant Fire Chief ��TBCTION iverview 1500 WEST FOURTH STREET nRB PR CTIOAT ANTIOCH,CA 94509 DI,STRlCT IdJ fill M M C1 e ' $$t J� aN o �4 5t7 N 4�I. ;! ,-- : a U) N o • a •a Zv a T.. z ro by U) .H 4a •a � . O E s4 In I'll >� to 0 -p -p W � N CJ1 � N N O S., r� U -p U 4-) U7 4-1 lL? aJ N O O r !U .x ss. •a r-+ O Lr) ro W _Z F- -1 0)EE E j a o z 'JAN 18 1990 FLAIL BATCHELOR Z w 0 CLERK BOARD OF SUPERVISORS W a 4 CONTRA COSTA CO. Z j LL .................... Deputy Wd oo 0 U t- Q d a rw W V F IL � W 4 O Q J Q CLAIM C°;3i.Inty v0urls l BOARD :OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOAR ,. G,T ON7 "053 the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT February 3 99 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: $25,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: KRAUCYK, Jean ATTORNEY: Mr. Joseph E. Canciami.11a Sanders, Dodson & Rives Date received January 17, 1990 (via Risk Mgmt.) ADDRESS: 2211 Railroad Ave. BY DELIVERY TO CLERK ON Pittsburg, CA 94565 • BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppMMIL BATCHELOR, Clerk 00, DATED: January 19, 1990 BY: Deputy 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: / (�� �C) BY: 0 / Deputy County Counsel i III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Superviscrs present ( Por 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. o Dated: FEB 13 199 0 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code sec 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: F E B 1 1990 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator JAN I n 1990 L�51'FIRE j;I v j' PRO'i ECTION DISTRICT RECEED T � CLAIM AGAINST PUBLIC ENTITY- AN 17 ,1990 - Phn eAX Of ICIJUIOAR i 1E TO: RIVERVIEW FIRE PROTECTION DISTRICT 'Z a 1500 W. 4th Street 006 An= ocn, CA 94509 'Ty, JEAN KRAUCYK, hereby makes claim against the CITY OF caivT illi ly an,' RiVER�,'I E.7 FIRE PROTECTION DISTP.I CT, for the sun of $25,000. 00 and makes the following statments in support of the claim: 1. Claimant's post office address is: Rt 2 , Box 235, Brentwood, CA 94513 . 2 . Notices concerning this claim should be sent to: JOSEPH E. CANCIAMILLA, SANDERS, DODSON & RIVES, 2211 Railroad Avenue, Pittsburg, CA 94565. 3 . The ;date and place of the circumstances giving rise- to this-claim are:: a. Date: September 26, 1989. b. Place: Sidewalk outside of the Riverview Fire Station near 10th Street in Antioch, CA. 4 . The circumstances giving rise to this claim are as follows: The City and Fire District maintained a sidewalk outside the station in a dangerous condition in that it was cracked and uneven and protruded into an area normally traversed by pedestrians, including claimant. Claimant while walking along the street fell after tripping on the sidewalk. 5. Claimant's injuries consisted of multiple contusions, bruises, sprains to the ankle, knee, and wrist. 6 . The names of the public employees causing the claimant's injuries are unknown. 7 . Claimant's claims as of the date of this claim is $25 , 000 . 00 . 8. The basis of the computation . of the above amount is as follows: Medical expenses to date approximately . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,500. 00 Estimated future medical expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Unknown Impairment to earnings capacity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Unknown General damages. . . . . . . . . . . . . . . . . . . . . . . . . . $23 ,500 .00 $25,000.00 Dated: January 8, 1990 SANDERS, DODSON & RIVES BY• H 0. dCANCIAMILLA torney for Claimant RVj�,� RIVERVIEW FIRE 0 C PROTECTION DISTRICT 1500 W.FOURTH ST. ANTIOCH,CALIFORNIA INCIDENT REPORT OCCUPANT NAME RELATIONSHIP Y AR INCIDENT NO. ADORESO INCIDENT1� C:T PHONE: HOME❑WORK❑CONTACT❑ 0 It OWNER NAME ADDRESS CITY PHONE: HOME❑WORKOCONTACTO A. INFORMATION (PAGE 11) FIRE DEPT. I.D. EXP.NO. TIME MONTH DAY YEAR Day CITY STTA.NO. ALARM ALARMS AREA CODE 07005 i � ,� 3v � z6FS t11 0111811 �� � � 0 `2- B. INCIDENT,CONDITION, RESULT & CONTROL (PAGE 13) CODE TYPE OF INCIDENT CONSTR DATE CODE CONDITION ON ARRIVAL 1. o/ Pre 72 Post 71 2 Ill--] 2❑ CODE RESULT OF ALARM CODE HOW FIRE CONTROLLED 3 4 C. PROPERTY CLASS & TYPE (PAGE 18) CODE PROPERTY CLASSIFICATION (INDIVIDUAL) CODE PROPERTY CLASSIFICATION (COMPLEX) 1 1 12 Prop. Prop. I Bldg. lExt.Wall Int.Wall Floor/ rRa ire 3 Mgmt. Type No Stories Roof ted D. ORIGIN, IGNITION & CAUSE (PAGE 37) CODE LEVEL OF ORIGIN CODE AREA OF ORIGIN 1 1 1 2 1 1 CODE TYPE OF MATERIAL FIRST IGNITED CODE FORM OF MATERIAL FIRST IGNITED CODE SOURCE OF HEAT CAUSING IGNITION CODE FORM OF HEAT CAUSING IGNITION 5 1 6 1 1 CODE ACTOR OMMISSION CAUSING IGNITION CODE CAUSE OF FIRE 8 1 1 E. SPREAD (PAGE 61) CODE MAIN AVENUE OF FIRE SPREAD' CODE TYPE OF MATERIAL CAUSING FIRE SPREAD 1 2 3 CODE FORM OF MATERIAL CAUSING FIRE SPREAD 4 CODE ACT OR COMMISSION CAUSING FIRE SPREAD CODE MAIN AVENUE OF SMOKE SPREAD 5 F. PROTECTION FACILITIES (PAGE 74) Sprinklers Standpipes Port.Exting. Priv.Brigade Spec.Protect. Signal/Warning Svstem Watchmn Separations Type Effect Type Effect Type Effect Type Effect Type Effect Type Effect Activ. Detec. Effect Type Effect Cause of failure —41 a b c d e f g h i j k I m I n I o p q G. RESPONSE & HOSE STREAMS (PAGE 81) STATION APPARATUS STATION HOSE STREAMS AT SCENE Engs. Trks. PW/ Boat Personnel B.S. None 2214" 11/2" 211z" Master Fjyd. Foam Chief FPB P.D. tp.t8er T. 2 1 / W. Lines 3 a b I C d e f a b C d e f g a b c d H. LOSS PROPERTY & PERSONS PAGE 82 FirefighterCivilians CODE LOSS PROPERTY CODE LOSS CONTENTS Injured deaths Injured deaths 2 SFM FORM GO-1 SUBMITTED FOR EACH SERIOUS 3 INJURY OR DEATH CHECK BOX IF YES RFP-101 i i __ 44.44...................__. I. VEHICLE (PAGE 83) CODE TYPE OF VEHICLE CODE MAKE FUEL/POWER MODEL YEAR LICENSE NO. STATE ..• J. HAZARDOUS MATERIAL(PAGE 86) CODE CLASS CODE TYPE CODE REASON CODE LOCATION K. RESCUE (PAGE 87) CODE TYPE RESCUE CODE RESCUE LOCATION 1 2 CODE D PROVIDED PRPR TO ARRIVAL BY CODE NUMBER OF VICTIMS 31116 14 6 ( tp,� CODE Fib-PERSONNEL IN AMBULANCE CODE NO.PARDICS AT SCENE 5 6 51 e2j CODE REASON NO SERVICE GIVEN 7 L.VICTIM DATA(PAGE 90) ENG CCIMPANY MEMBERS a b c d e f g h i j k I m n o p q r i=lm,Y--A ✓/-r 2 J > Q it c > W u�) ¢ W IY W n Z O OF u) a 111 J ~ F ¢ 2 LL W a a a MEMBER IN AMBULANCE 0 00 Q D > to a > ¢ O 00D Q Z a F F j 0 W a m y Q LL O F O O ¢ '2 D m > Q U J F- F J N OLL Q F F 0 LL ¢ -� 0 N U 0 Z Z F 0 Q U F s 0 tn E FO v~i J a a 0 W a > rn W W x U _ W ut 0 Q a ut ar F• H ut rn n H Q uW) > a yr a cr v>i D a ul v]i Q a 2 m VIC IM NAME AGE la U C S�6S(3 �z i 2 62 D� O iy Jo iVICTIM NAME 2 AGE I VICTIM NAME AGE ;3 VICTIM NAME AGE 14 M. REMARKS(PCGE 97) C �j�S�► R�y i.\ r� ( l4 K S.j Era Cas a >; t6- . .i\Ltd V LU JAN 17 149(1 ENTRIES CONTAINED IN THIS REPORT ARE INTENDED FOR THE SOLE R PARED BY DATE USE OF THE FIRE DEPARTMENT. ESTIMATIONS AND EVALUATIONS MADE HEREIN REPRESENT "MOST LIKELY" AND "MOST PROBABLE" CAUSE AND EFFECT. ANY REPRESENTATION AS TO THE VALIDITY OR PROVED BY DATE ACCURACY OF REPORTED CONDITIONS, OUTSIDE THE FIRE DEPART. MENT, IS NEITHER INTENDED NOR IMPLIED. 1% - CLAIM CCfl my vGUIIS%) 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 Fe bru � I`) ;" 1A 4553 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 "Warnings". CLAIMANT: HICKS, Robert S. ATTORNEY: - Date received ADDRESS: 2300 Sycamore Drive #56 BY DELIVERY TO CLERK ON January 17, 1990 (hand delivered) Antioch, CA 94509 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PpHHIL BATCHELOR, Clerk DATED: January 19, 1990 BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Sup visors �+ ) 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: i Dated: ig. BY: IA I Deputy County Counsel I1I. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD RDE By unanimous vote of the Superviscrs present ( This Claim is rejected in full . ( ) Other: I certify that this is a ;true and correct copy o.f the Board's Order entered in its minutes for this date. Dated: FEB 13 1990 PHIL BATCHELOR, Clerk, By Deputy Clerk 107 WARNING (Gov. code sect'on 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: FEB 13 1990 BY: PHIL BATCHELOR by Deputy Clerk 17S7 CC: County Counsel County Administrator RECEIVED 1 ROBERT S. HICKS - JAN 17 1990 - In Propria Persona q' ,o a. m 2 2300 Sycamore Drive No. 56 PHI BATCMUOR Antioch, CA. 94509 Offt WAW Telephone: (415) 778-6569 _aNn 3 - 4 5 CLAIM AGAINST COUNTY OF CONTRA COSTA 6 NAME AND ADDRESS OF CLAIMANT: ROBERT S. HICKS 2300 Sycamore Drive No. 56 7 Antioch, CA. 94509 8 SEND ALL NOTICES TO Robert S. Hicks 2300 Sycamore Drive No. 56 9 Antioch, CA. 94509 10 DATE OF OCCURRENCE August 22, 1989 11 PLACE OF OCCURRENCE Bolinger Canyon Road 1. 3 miles North of Deerwood Drive, CCC. 12 CIRCUMSTANCES OF OCCURRENCE : Claimant was proceeding South on Bolinger Canyon Road 1/3 miles North of Deerwood Drive, in the 13 County of Contra Costa, as aforesaid; that at said time and place, claimant was driving a 1977 Landrover on the roadway which 14 was in the processing of construction and roadwork; the road was covered with loose gravel causing claimant' s vehicle to lose 15 control and roll-over off of the roadway, thereby causing personal injuries and damages to claimant. 16 GENERAL DESCRIPTION OF INJURY, DAMAGE, OR LOSS: Serious multiple 17 injuries consisting of a ruptured spleen; enucleation of the gallbladder from the liverbed; multiple liver lacerations; 18 rupture of the right dome of the diaphram; right hemothoral; wideded mediastinum; fractured ribs; numerous lacerations on 19 right forearm. Income loss; Property Damge and General Damages. 20 AMOUNT OF CLAIM AND BASIS OF COMPUTATION: 21 Personal Injuries; Income loss; property damages; General Damages in the amount of $1,000 ,000.00. 22 DATED: January 6 , 1990 23 ROBERT S. HICKS Claimant 24 Receipt of a copy of the within claim is hereby acknowledged this 25 day of 1990. 26 BY COUNTY OF CONTRA COSTA 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 February 13, 1990 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: Undetermined Section 913 and 915.4. Please note all "WaAft9tyr C 0011sef CLAIMANT: SAFEWAY STORES, Inc. . .►,�� .ANI 2 1990 ATTORNEY: Jolie Krakauer ��ej.. C Martin, Ryan & Andrada Date received S4663 ADDRESS: A Professional Corporation BY DELIVERY TO CLERK ON January 10, 1990 (hand delivered) Ordway Bldg. , Suite 2275 One Kaiser Plaza BY MAIL POSTMARKED: Oakland, CA 94612 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: January 12, 1990 PpHkIL BATCHELOR, Clerk 8Y: Deputy JW 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: 1 Z HCl BY:I Deputy County Counsel v 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 o.f the Board's Order entered in its minutes for this date. Dated: FEB 13 1990 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: FEB 13 1990 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator RECEIVED MARTIN, RYAN & ANDRADA A Professional Corporation JAN /0, 1990 Ordway Building, Suite 2275 /:,-10 ,Oq One Kaiser Plaza PHIL BATCHELOR Oakland, CA 94612 CLERK OARD OF SUPERVISORS (415) 763-6510 NTRA ACO. _ B Attorneys for Claimant SAFEWAY STORES, INC. CLAIM AGAINST CONTRA COSTA COUNTY HEALTH DEPARTMENT TO: CLERK OF THE BOARD OF SUPERVISORS, 651 Pine Street, Room 106, Martinez, CA 94553: SAFEWAY STORES, INC. , hereby makes a claim against the CONTRA COSTA COUNTY HEALTH DEPARTMENT and makes the following statement in support thereof: 1. Claimant' s post office address is: SAFEWAY STORES , . INC. , 201 - 4th Street, Oakland, California 94607. 2. Notices . concerning the claim should be sent to Gerald P. Martin, Jr. , Martin, Ryan & Andrada, One Kaiser Plaza, Suite 2275, Oakland, CA 94612. 3. The date and place of the occurrence giving rise to this claim are as follows: On or about July 11, 1989 SAFEWAY STORES , INC. was served with a complaint captioned James Myles v. Safeway Stores, Inc. Case No. 096161) . The action was filed in the Municipal Court of California, County of Contra Costa Bay Judicial District. On or about July 10. 1989 SAFEWAY STORES INC. , was served with a complaint captioned Fred Dale Anderson v. Safeway Stores, Inc. (Case No. 095229) . The action was filed in the Municipal Court of California, County of Contra Costa Bay Judicial District. On or about July 10, 1989 SAFEWAY STORES , INC. was -1- served with the complaint captioned Cindy K. Anderson et. al. v. Safeway Stores, Inc. (Case No. 0905121) . The action was filed in the Municipal Court of California, County of Contra Costa Bay Judicial District. On or about July 10 1989 SAFEWAY STORES , INC. was served with the complaint captioned Carl Adams et. al. v. Safeway Stores, Inc. (Case No. 658403-9) . The action was filed in the Superior Court of California, County of Alameda. 4. The circumstances giving rise to liability are as follows: SAFEWAY STORES, INC. , owned and operated a distribution center warehouse at 2900 Hoffman Boulevard, City of Richmond, County of Contra Costa, State of California. On July 11, 1988, there was a fire in the warehouse. The fire burned for a number of days. The above-described lawsuit involves claims by plaintiff for personal injury and property damage as a result of exposure to smoke from the July 11, 1988 fire at the Safeway distribution center warehouse in Richmond, California. Among other allegations, plaintiff contends that the fire should have been extinguished immediately and that plaintiff should have been evacuated. Safeway contends that the Contra Costa County Health Department was responsible for monitoring the air quality in the area of the fire, advising community residents with regard to air quality, evacuating the area if necessary, rendering advice to the Richmond Fire Department regarding the necessity for extinguishing the fire, and for issuing any health advisories necessitated by the fire. The Contra Costa County Health Department was also responsible for monitoring the presence of toxins, if any, and rendering health advisories, if any such advisories were necessary. As a result of the Contra Costa County Health Department ' s failure to properly manage the Safeway fire and its aftermath, claimant contends that it is entitled to indemnity for the damages sought in the above-described complaint. 5. General Description of Injury, Damage or Loss Incurred: Claimant is entitled to equitable or partial indemnity from the Contra Costa County Health Department pursuant to Greyhound Lines, Inc. , v. County of Santa Clara (1986) 187 Cal.App. 3d 480. The indemnity to which claimant is entitled -2- extends not only to the complaints set forth above, but to any subsequent complaints or cross-complaints brought against claimant based on the above-described occurrences. 6. Jurisdiction over this claim would rest in Superior Court. 7 . The names of the public employees causing claimant' s damages are unknown. 8 . The amount of the claim and the basis for its computation have yet to be determined. DATED: 1 /)o/90 NtARTIN, RYAN & ANDRADA A Professional Corporation (=�aL, By JOLIE KRAKAUER -3- r • I -� PROOF OF SERVICE (PERSONAL SERVICE) (C.C.P. §1011) The undersigned declares: I am over the age of 18 years, residing or employed in the County of Alameda, and not a party to the within action; my business address is: Ordway Building, Suite 2275, Oakland, California 94612. On January 10 1990 , I served the within CLAIM AGAINST CONTRA COSTA HEALTH DEPARTMENT by personal delivery to: Clerk of the Board of Supervisors 651 Pine Street, Room 106 Martinez, CA 94553 I declare under penalty of perjury that the foregoing is true and correct. Executed on January 1990 , at Oakland, California. KIRSTEN HILLEN -` ' int ' CLAIM Y Counsel BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA JAN 12 1990 Claim Against the County, or District governed by) BC4c� the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT February 12, 1995`; 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: $3,000,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: BRYCE, E. Eugene and Glenda ATTORNEY: Charles Nicholas Cuda Attorney at Law Date received ADDRESS: 565 Ygnacio Valley Rd. , Ste. 300 BY DELIVERY TO CLERK ON January 12, 1990 Walnut Creek, CA 94596-3828 BY MAIL POSTMARKED: January 11, 1990 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. Januar 12 1990 PpHHIL BATCHELOR, Clerk DATED: y BY: Deputy 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: 2 / 2 BY: Deputy County CounselU_ \rj . T� 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 Superviscrs present yr 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: FEB 1 3 1990 PHIL BATCHELOR, Clerk, By , Deputy Clerk WARNING (Gov. code s ' n 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: FEB 13 1990 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Claim of E. EUGENE AND ) GLENDA BRYCE ) CLAIM FOR PERS VS. ) SECTION 910 OF T rJ!_ry �'$-.� CODE i�, gg ��// ��',, COUNTY OF CONTRA COSTA ) J A N 12 1990 PHIL BATCHELOR k SORS TO THE COUNTY OF CONTRA COSTA: cLERco T ° TOF ACO. 9 ................ .. e u ty YOU ARE HEREBY NOTIFIED that E. EUGENE AND GLENDA BRYCE whose address is 1907 Birch Avenue, Antioch, California 94509 claims damages from the COUNTY OF CONTRA COSTA, in the State of California, in the amount, computed as of the date of presentation of this claim of $3 , 000, 000. 00. This claim is based on the death of claimant' s daughter on or about July 17 , 1989 in the town of Brentwood under the following circumstances: That the claimant's daughter ALISA DAWN BRYCE, date of birth, September 12 , 1972 was wrongfully killed when her automobile struck a roadside monument located on Highway 4 at Balfour Road, Antioch, California, a public highway that was negligently designed and maintained. The names of the public employees causing claimant' s injuries are yet to be determined. The amount claimed, as of the date of presentation of this claim, are computed as general damages. All notices or other communications with regard to this claim should be sent to claimant c/o Charles Nicholas Cuda, Esq. , 565 Ygnacio Valley Road, Suite 300, Walnut Creek, California 94596. DATED: January 11, . 1990 By: CHARLES NICHOLAS CUDA Attorney for Claimant PROOF OF SERVICE BY MAIL (C.C.P. 1013a, 2015. 5) I declare that: I am employed in the County of Contra Costa, California. I am over the age of eighteen years and not a party of the within entitled cause; my business address is 565 Ygnacio Valley Road, Suite 300, Walnut Creek, California 94596. On January 11, 1990, I served the attached CLAIM FOR PERSONAL INJURIES SECTION 910 OF THE GOVERNMENT CODE on the interested parties in said cause, by sending a true copy thereof via first class mail, postage prepaid, addressed as follows: Board of Supervisors County of Contra Costa 651 Pine Street, Suite 106 Martinez , CA 94553 I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, and that this declaration was executed on January 11, 1990, at Walnut Creek, California. Loretta R. Varni t. Z Y`� low P { < q C1 C Z (1 O D o m Fri j Z O 1� v dt? � ry l4 00 Ul tai t--' G n � t t" O ro o � N � � to p ro roc A- N nn 0Ln { , G O W V. fi N rt ro A _ to � � � � t�` r�`• } s ; i